Endoscopic laser energy delivery system and methods of use

Abstract

To provide a system, a device, and a method for delivering laser energy to a target in an endoscopic procedure.SOLUTION: An exemplary method comprises providing a first laser pulse train and a different second laser pulse train that are emitted from a distal end of an endoscope and incident on a target. The first laser pulse train has a first laser energy level, and the second laser pulse train has a second laser energy level higher than the first laser energy level. In an example, the first laser pulse train is used to form cracks on a surface of a calculus structure, and the second laser pulse train causes fragmentation of the calculus structure after the cracks are formed.SELECTED DRAWING: Figure 27

Description

[Technical Field]

[0001] Priority claims This application is incorporated herein by reference in its entirety under 35 U.S.C. §119(e). Incorporated U.S. Provisional Patent Application No. 62 / 882,837, filed August 5, 2019 and benefit of priority from U.S. Provisional Patent Application No. 62 / 894,280, filed August 30, 2019. Claim the benefits.

[0002] This specification relates generally to endoscopic laser systems, and more particularly to methods and systems for use in endoscopic procedures. The present invention relates to a system and method for controlling laser energy delivered to a target. [Background technology]

[0003] Typically, the device provides access to an internal location of a subject, such as providing visual access to a physician. To provide this information, an endoscope is used. An endoscope is typically inserted into the patient's body and examined. The method involves delivering light to a target (e.g., a target anatomy or object) and capturing the reflected light from the object. Collects light. The reflected light carries information about the object being studied. The speculum includes a working channel that allows the operator to remove unwanted tissue or foreign matter from within the patient's body. To remove the catheter, apply suction through the working channel or It can be used to pass instruments such as brushes, biopsy needles, or forceps, or to perform minimally invasive surgery. do.

[0004] To deliver surgical laser energy to various target treatment areas, such as soft or hard tissues Laser or plasma systems have been used for ablation, coagulation, Examples of applications of lithotripsy include the kidney, gallbladder, and gallbladder, among other stone-forming areas. To break up stone structures in the bladder, ureter, or to remove large stones into smaller pieces Lasers have been used to achieve this. [Prior art documents] [Patent documents]

[0005] [Patent Document 1] International Publication No. 2013 / 154708 Summary of the Invention [Means for solving the problem]

[0006] The present specification describes a system, device, and method for delivering laser energy to a target in an endoscopic procedure. An exemplary method is to emit a laser beam from the distal end of an endoscope and impinge on a target. generating a first laser pulse train that is different from the first laser pulse train and a second laser pulse train that is different from the first laser pulse train. The laser pulse train has a first laser energy level and the second laser pulse train has a second laser energy level. A second laser energy level is higher than the first laser energy level. The first laser pulse train is used to create cracks on the surface of the stone structure, and the second laser pulse train is used to create cracks on the surface of the stone structure. The laser pulse train causes fragmentation of the stone structure after fissures are formed.

[0007] Example 1 is a method of providing laser treatment to a target, the method including: generating a first laser pulse train according to the first laser energy level and generating a second ... generating a second laser pulse train according to a second laser energy level; directing the first and second laser pulse trains from the distal end of the endoscope toward the target. include.

[0008] In Example 2, the subject matter of Example 1 optionally includes: a first laser pulse train for a specific duration; This includes being produced substantially constantly.

[0009] In Example 3, the subject matter of Example 2 optionally includes generating a second laser pulse train while the first laser pulse train is being generated. It involves two laser pulse trains being generated intermittently over a specific period of time.

[0010] In Example 4, the subject matter of any one or more of Examples 1-3 optionally includes a second laser pulse train. is located in time between two pulses of the first laser pulse train.

[0011] In Example 5, the subject matter of any one or more of Examples 1-4 optionally comprises: generating a third laser pulse train according to the level; , which is located in time between the first and third laser pulse trains.

[0012] In Example 6, the subject matter of any one or more of Examples 1-5 optionally comprises first and second lasers. It involves directing a pulse train at the stone structure.

[0013] In Example 7, the subject matter of Example 6 is optionally configured to form cracks in the surface of the stone structure. The first laser pulse train was designed to cause fragmentation of the stone structure after the cracks were formed. and a second laser pulse train configured as follows:

[0014] In Example 8, the subject matter of any one or more of Examples 1-7 optionally comprises a method for hemostasis or clotting. Directing first and second laser pulse trains to the target tissue.

[0015] Example 9 illustrates a method for implementing a computer program comprising at least one processor and at least one computer program. and one non-transitory memory, The computer program code causes the device to, by at least one processor, causing the laser system to emit a first train of laser pulses according to a first laser energy level. , a second laser energy level higher than the first laser energy level; A laser pulse train is emitted, and the first laser pulse train and the second laser pulse train are incident on the endoscope. It is configured to be directed from the distal end towards a target.

[0016] In Example 10, the subject matter of Example 9 optionally comprises a first substantially constant value over a particular period of time. Includes a laser pulse train.

[0017] In Example 11, the subject matter of Example 10 optionally further comprises: , including a second train of laser pulses that are emitted intermittently over a specific period of time.

[0018] In Example 12, the subject matter of any one or more of Examples 9-11 optionally comprises at least one The non-transitory memory and the computer program code are executed by at least one processor. Thus, the device is provided with a second laser pulse located in time between two pulses of the first laser pulse train. The laser pulse train is configured to generate a laser pulse train.

[0019] In Example 13, the subject matter of any one or more of Examples 9-12 optionally comprises at least one The non-transitory memory and the computer program code are executed by at least one processor. causing the device to generate a third train of laser pulses according to the first laser energy level. a second laser pulse located between the first and third laser pulse trains in time; The pulse train is configured to generate a pulse train.

[0020] In Example 14, the subject matter of any one or more of Examples 9-13 optionally comprises at least one The non-transitory memory and the computer program code are executed by at least one processor. and causing the device to deliver first and second trains of laser pulses to the stone structure; The first laser pulse train is configured to form cracks in the surface of the stone structure, and the second laser pulse train is configured to form cracks in the surface of the stone structure. The pulse train is configured to cause fragmentation of the stone structure after the fissure is formed. Includes:

[0021] In Example 15, the subject matter of any one or more of Examples 9-14 optionally comprises at least one The non-transitory memory and the computer program code are executed by at least one processor. The device is configured to deliver first and second laser pulse trains to target tissue for hemostasis or coagulation. This includes being configured to

[0022] Example 16 is a machine-readable, machine-executable instruction set. A non-transitory program storage device that tangibly embodies the program of the instructions and generates a first laser pulse train according to a first laser energy level; a second laser pulse according to a second laser energy level higher than the first laser energy level; generating a first laser pulse train and a second laser pulse train at a distal end of the endoscope; and directing the beam from the target.

[0023] In Example 17, the subject matter of Example 16 optionally further comprises: The second laser pulse train is generated substantially constantly while the first laser pulse train is being generated. The pulse train is generated intermittently over a specific period of time.

[0024] In Example 18, the subject matter of Examples 16 or 17 optionally further comprises: generating a third laser pulse train according to the energy level of the second laser pulse; The laser pulse train is located between the first and third laser pulse trains in time. include.

[0025] In Example 19, the subject matter of any one or more of Examples 16-18 optionally comprises: delivering first and second laser pulse trains to the stone structure, the first laser pulse The first laser pulse train is configured to form a crack in the surface of the stone structure, and the second laser pulse train is configured to form a crack in the surface of the stone structure. The method includes causing fragmentation of the stone structure after it has been formed.

[0026] In Example 20, the subject matter of any one or more of Examples 16-19 optionally comprises: and delivering first and second laser pulse trains to the target tissue for hemostasis or coagulation. This includes:

[0027] This summary is an overview of some of the teachings of the present application and is not intended to be an exclusive or exhaustive treatment of the present subject matter. Further details regarding this subject matter are provided in the detailed description and the accompanying drawings. Other aspects of the present disclosure can be understood by reading the following detailed description. and the drawings which form a part hereof, and which will be apparent to those skilled in the art. The scope of the present disclosure is limited to the scope of the appended claims. It is defined by its scope and its legal equivalents.

[0028] Various embodiments are illustrated by way of example in the figures of the accompanying drawings. These are illustrative and are not intended to be exhaustive or exclusive embodiments of the present subject matter. [Brief explanation of the drawings]

[0029] [Figure 1] FIG. 1 is a schematic diagram of an exemplary laser therapy system including a laser feedback control system. [Figure 2A] FIG. 1 shows examples of absorption spectra of different types of tissue, including hemoglobin (Hb) and oxyhemoglobin (HbO2). [Figure 2B] FIG. 1 shows examples of absorption spectra of different types of tissue, including hemoglobin (Hb) and oxyhemoglobin (HbO2). [Figure 3A] FIG. 1 shows examples of absorption spectra of different types of tissue, including normal and carbonized tissue, Hb, HbO2, and melanin. [Figure 3B] FIG. 1 shows examples of absorption spectra of different types of tissue, including normal and carbonized tissue, Hb, HbO2, and melanin. [Figure 3C] FIG. 1 shows examples of absorption spectra of different types of tissue, including normal and carbonized tissue, Hb, HbO2, and melanin. [Figure 4] FIG. 10 illustrates the penetration depth of the laser output. [Figure 5] FIG. 1 is a block diagram illustrating a laser feedback control system for providing a laser output. [Figure 6] 1 is a flow diagram illustrating an example of an algorithm for controlling one or more laser systems based on feedback generated by a laser feedback control system. [Figure 7] 1 is a flow diagram illustrating an example of an algorithm for controlling one or more laser systems based on feedback generated by a laser feedback control system. [Figure 8]FIG. 1 is a timing diagram of an exemplary dual laser system that uses two wavelengths of light to provide tissue ablation and coagulation. [Figure 9A] FIG. 1 is a diagram showing an example of an endoscope into which a laser fiber is inserted. [Figure 9B] FIG. 1 is a diagram showing an example of an endoscope into which a laser fiber is inserted. [Figure 10A] FIG. 1 illustrates an example of a feedback-controlled laser treatment system. [Figure 10B] FIG. 1 illustrates an example of a feedback-controlled laser treatment system. [Figure 11A] FIG. 1 illustrates an example of an endoscopic system for identifying a target using a diagnostic beam, such as a laser beam. [Figure 11B] FIG. 1 illustrates an example of an endoscopic system for identifying a target using a diagnostic beam, such as a laser beam. [Figure 12] FIG. 10 shows reflectance spectra for identifying target types, such as for identifying the composition of different types of kidney stones. [Figure 13A] FIG. 10 shows reflectance spectra for identifying target types, such as for identifying the composition of different types of kidney stones. [Figure 13B] FIG. 10 shows reflectance spectra for identifying target types, such as for identifying the composition of different types of kidney stones. [Figure 14] 13A-13B show optical peaks corresponding to different sections of UV wavelengths in the reflectance spectra of several types of stone. [Figure 15] 13A-13B show optical peaks corresponding to different sections of UV wavelengths in the reflectance spectra of several types of stone. [Figure 16A] FIG. 1 shows examples of reflectance spectra captured with a UV-VIS spectrometer from various soft and hard tissue compositions. [Figure 16B] FIG. 1 shows examples of reflectance spectra captured with a UV-VIS spectrometer from various soft and hard tissue compositions. [Figure 16C]FIG. 1 shows examples of FTIR spectra of typical stone compositions. [Figure 16D] FIG. 1 shows examples of FTIR spectra of several soft and hard tissue compositions. [Figure 17] 1 is a schematic diagram of a laser treatment system. [Figure 18] 1 is a schematic diagram of a laser treatment system. [Figure 19A] FIG. 1 illustrates an example of a combined laser pulse train generated using multiple (e.g., N) laser pulse trains. [Figure 19B] FIG. 1 illustrates an example of a combined laser pulse train generated using multiple (e.g., N) laser pulse trains. [Figure 20] FIG. 1 is a schematic diagram of an exemplary spectroscopic system with spectroscopic feedback. [Figure 21A] FIG. 1 illustrates an example of an endoscopic laser system having a multi-fiber configuration. [Figure 21B] FIG. 1 illustrates an example of an endoscopic laser system having a multi-fiber configuration. [Figure 21C] FIG. 1 illustrates an example of an endoscopic laser system having a multi-fiber configuration. [Figure 21D] FIG. 1 illustrates an example of an endoscopic laser system having a multi-fiber configuration. [Figure 22] FIG. 1 is a block diagram illustrating an example of a multi-fiber system used in a fiber optic distribution system. [Figure 23A] FIG. 1 illustrates an example of a multi-fiber accessory having a source optical input and a spectroscopic feedback signal. [Figure 23B] FIG. 1 illustrates an example of a multi-fiber accessory having a source optical input and a spectroscopic feedback signal. [Figure 24A] 1 illustrates an exemplary method for calculating the distance between the distal end of a laser delivery system (e.g., an optical fiber) and a target. [Figure 24B] 1 illustrates an exemplary method for calculating the distance between the distal end of a laser delivery system (e.g., an optical fiber) and a target. [Figure 24C] 1 illustrates an exemplary method for calculating the distance between the distal end of a laser delivery system (e.g., an optical fiber) and a target. [Figure 24D] 1 illustrates an exemplary method for calculating the distance between the distal end of a laser delivery system (e.g., an optical fiber) and a target. [Figure 25A] FIG. 10 illustrates the effect of the distance between the tissue and the distal tip of the spectroscopic probe on the spectrum of reflected light from the target. [Figure 25B] FIG. 10 illustrates the effect of the distance between the tissue and the distal tip of the spectroscopic probe on the spectrum of reflected light from the target. [Figure 26] FIG. 1 illustrates an example of an endoscopic system for identifying a target using a diagnostic beam, such as a laser beam. [Figure 27] 1 is a graph of a sequence of laser pulses having different pulse energies or power levels for use in laser treatment of target tissue or stone structures. [Figure 28] FIG. 1 is a block diagram illustrating an example machine capable of performing any one or more of the techniques (e.g., methods) discussed herein. DETAILED DESCRIPTION OF THE INVENTION

[0030] Systems, devices, and methods for delivering laser energy to a target during an endoscopic procedure An exemplary method is described herein in which a laser beam is emitted from the distal end of an endoscope and incident on a target. providing a first laser pulse train that is different from the first laser pulse train and a second laser pulse train that is different from the first laser pulse train. The laser pulse train has a first laser energy level and the second laser pulse train has The second laser energy level is higher than the first laser energy level. The first laser pulse train is used to create cracks on the surface of the stone structure, and the second The laser pulse train causes fragmentation of the stone structure after which fissures are formed.

[0031] Endoscopic laser therapy involves recognizing different tissues and targeting the therapeutic structure (e.g., cancerous tissue, or This allows the laser energy to be applied only to the specific stone type, and to the non-treated tissue (e.g. It is desirable to avoid or reduce exposure of the target tissue (e.g., normal tissue). Recognition of the target surgical site and its surrounding environment can be achieved by the operator, for example, by visualizing the target surgical site and its surrounding environment through an endoscope. Such manual methods can lack precision and, at a minimum, In some cases, access to the surgical site is limited, limiting the field of view during surgery. Therefore, it may not be possible to determine the composition of the target. Biopsy techniques have been used to extract ) from the body and analyze its composition ex vivo. However, in many clinical applications, there are many options to reduce surgical time and complexity and improve the effectiveness of therapy. It is desirable to determine tissue composition in vivo to improve the quality of life. Laser lithotripsy, in which a laser is applied to break up certain types of stones (e.g., The system automatically recognizes the chemical composition of stones in the kidney, pancreatic bile duct, or gallbladder in vivo and transfers them to the surrounding tissue. By distinguishing between the target stone and the adjacent stone, physicians can more effectively remove the target stone while simultaneously Laser settings (e.g., power, exposure time, or It should be possible to adjust the launch angle.

[0032] Conventional endoscopic laser therapy involves continuous monitoring of tissue type (e.g., composition) during the procedure. There are many moving parts during endoscopic procedures, and The tissue seen through the endoscope can change throughout the procedure. Traditional biopsy techniques The composition of the tissue must be monitored throughout the procedure, as this requires the removal of tissue samples to identify the target tissue. It is not possible to monitor the structure type (e.g., soft or hard tissue) at the tip of the endoscope. Continuously monitor and recognize the type of tissue, normal vs. cancerous tissue, or composition of stone structure This gives doctors more information to better tailor treatment during the procedure. For example, if a doctor is breaking up a kidney stone that has a hard surface but a soft core, Continuous tissue composition information from the endoscope allows the physician to determine the continuously detected stone surface composition. Based on this, the first setting performs better on the hard surface of the stone, and the second setting performs better on the soft core of the stone. This allows you to adjust the laser settings, such as a second different setting, to suit your needs. Cut.

[0033] Some of the features described herein may be useful for targeting various sets of targets in, for example, medical applications. Compositions (e.g., soft or hard tissue) can be identified in vivo by endoscopy. A method and apparatus can be provided that allows a user to This allows for continuous monitoring of the target composition throughout treatment. This can be used in combination with a laser system, and the method This can provide feedback to the laser system to adjust settings based on the composition. This feature allows you to adjust the laser settings within the range of the original laser settings selected by the user. This allows for instantaneous adjustment of the

[0034] Using some of the features described herein, differences in the chemical composition of a target can be detected in vivo. Measure and suggest laser settings or adjust laser settings to better achieve the desired effect. Examples of targets and applications include: laser lithotripsy of kidney stones, and laser incision or vaporization of soft tissue. Three main components are provided: a laser, a spectroscopic system, and a feedback analyzer. In one example, the controller of the laser system may select an appropriate laser beam based on the target composition. The parameter settings allow the laser therapy to be automatically programmed. ,controlling the laser based on machine learning algorithms trained on spectrometer data. Additionally or alternatively, a user (e.g., a physician) may select a target type during a procedure. can receive continuous instructions and prompt the user to adjust the laser settings. Adjust the laser settings to tailor the laser therapy to the composition of a single stone target. This allows the stone removal or fragmentation procedure to be carried out faster and more energy-efficiently. do.

[0035] Some features described herein include Internet connectivity and measurement capabilities. Data input to the feedback analyzer to include connectivity to other surgical devices Additionally, the laser system may include an image processor. It can provide input data to another system, such as a treatment model processor, The monitor can display information about the medical procedure to the user. Different soft tissues, vasculature, capsular tissues, etc. within the field of view during the procedure, as well as different structures within the same target, such as stones. The goal is to more clearly identify the chemical composition.

[0036] Some of the features described herein may be useful for different tissue types or different stone types, etc. Systems and methods can be provided to distinguish between different target types. , a single stone structure (e.g., kidney, bladder, pancreatic bile duct, or gallbladder stone) is a brushite, Calcium phosphate (CaP), calcium oxalate dihydrate (COD), calcium oxalate Monohydrate (COM), Magnesium Ammonium Phosphate (MAP), or Cholesterol A stone with two or more different compositions throughout its volume, such as a uric acid or uric acid stone structure. For example, the target stone structure may include the first part of the COD and the second part of the COM. According to one aspect, the present disclosure provides a method for continuously analyzing spectroscopic data in vivo. The different components contained in a single target (e.g., a single stone) can be identified based on the collection and analysis of the A system and method for continuously identifying compositions that are suitable for treatment (e.g., laser therapy) is described. ) can be adapted according to the identified target composition. In response to identifying a first composition (e.g., COD) that is Programming the laser system (e.g., power, exposure time, or firing angle) and the laser system controls the laser accordingly to ablate or fragment the first portion. During laser therapy, spectroscopic data can be continuously collected and analyzed. A second composition different from the first composition within the same target stone being treated can be analyzed. In response to identifying the object (e.g., COM), the laser therapy is performed differently than the laser parameter settings. A second laser parameter setting (e.g., a different power, exposure time, or firing angle) ) and program the laser system accordingly to target a second portion of the same target stone. Can be adjusted, such as by delivering a laser beam to ablate or fragment In some examples, multiple different laser sources can be included in the laser system. The stone portions of the composition can be treated with different laser sources. The quality of the laser can be determined by identifying the stone type.

[0037] Some features described herein may be advantageous for incorporating different types of laser sources. It can be used in conjunction with laser systems for a variety of possible applications. For example, the features described herein may be used in industrial or medical applications, such as medical diagnostics, therapeutics, and surgical procedures. The features described herein may be suitable for endoscopy, laser surgery, laser imaging, and other settings. The device can be used in conjunction with lithotripsy, laser settings, and / or spectroscopy.

[0038] FIG. 1 is a block diagram of an exemplary laser feedback control system 100 according to an embodiment of the present disclosure. 1 shows a schematic diagram of a laser treatment system. Possible applications include the detection of soft (e.g., non-calcified) or hard (e.g., calcified) tissues, or for industrial use and / or for the treatment of stone formations such as stones in the kidney, pancreatic bile duct or gallbladder This includes integration into laser systems for many applications, including medical applications. For example, the systems and methods disclosed herein can be used to perform precisely controlled procedures such as ablation, coagulation, and vaporization. It may be useful for delivering therapeutic treatments or for ablating, fragmenting, or breaking up stone structures.

[0039] Referring to FIG. 1, a laser feedback control system 100 is provided for controlling one or more laser systems. 1 illustrates a first laser system 102 and an optional Optionally, a laser feedback is connected to a second laser system 104 (shown in dotted lines). Although a system is shown, additional laser systems are contemplated within the scope of this disclosure.

[0040] The first laser system 102 includes a first laser source 106, a power supply, a display, and cooling. The first laser system 102 may include a laser beam splitter, ... Also including a first optical fiber 108 operably coupled to the first laser source 106. The first optical fiber 108 transmits the laser light from the first laser source 106 to the target tissue 122. The device may be configured to transmit the user output.

[0041] In one example, the first laser source 106 may be configured to provide a first output 110. The first output 110 can extend over a first wavelength range. According to some embodiments, the first wavelength range is a portion of the absorption spectrum of the target tissue 122. The absorption spectrum represents the absorption coefficient for the range of laser wavelengths. FIG. 2A shows, as an example, the absorption spectrum 210 of water. FIG. 2B shows, as an example, the absorption spectrum 210 of oxyhemoglobin. The absorption spectrum of globin 221 and the absorption spectrum of hemoglobin 222 are shown. In such an example, the first output 110 is a signal that corresponds to the absorption spectrum of tissue. The wavelength range provides effective ablation and / or carbonation of the target tissue 122. It is advantageous to be able to

[0042] For example, the first laser source 106 may have a first output 110 emitted in a first wavelength range. , high absorption by tissue of the incident first output 110 (e.g., about 250 cm -1 Exceeds In an exemplary embodiment, the first laser source 10 6 is about 1900 nanometers to about 3000 nanometers (e.g., high absorption by water) ), and / or about 400 nanometers to about 520 nanometers (e.g., The first output corresponds to high absorption of oxyhemoglobin and / or deoxyhemoglobin. 110. The interaction of light with tissue occurs in two ways: absorption and scattering. The main mechanism is known to be high tissue absorption (absorption coefficient 250 cm -1 of When the absorption coefficient exceeds 250 cm, the first absorption mechanism becomes dominant and the absorption is low (absorption coefficient is 250 cm -1 For example, for lasers in the wavelength range of 800-1100 nm, the scattering mechanism is Become dominant.

[0043] A variety of commercially available medical grade laser systems are suitable for the first laser source 106. For example, it can be about 515 nanometers to about 520 nanometers or about 370 nanometers. providing a first output 110 within a first wavelength range of about 493 nanometers to about 493 nanometers; A semiconductor laser such as a Ga1-XN semiconductor laser can be used. Infrared (IR) lasers such as those summarized in Table 1 below can be used. [Table 1]

[0044] Referring to FIG. 1, the laser treatment system of the present disclosure optionally includes a second laser system. The second laser system 104 may include a second laser system 104, as previously described. a second laser source 116 for providing power 120, as well as a power supply, display, and cooling system; The second laser system 104 includes the first laser source 10 6, or alternatively, can be operatively separate from the first laser source 106. In some examples, the second laser system 104 may be coupled to a second output a second optical fiber operably coupled to the second laser source 116 to transmit a power 120; 118 (separate from the first optical fiber 108). Alternatively, the first Optical fiber 108 is configured to transmit both first output 110 and second output 120. It can be achieved.

[0045] In certain embodiments, the second output 120 is over a second wavelength range that is distinct from the first wavelength range. Accordingly, the wavelength range can be extended between the first wavelength range and the second wavelength range. There may be no overlap. Alternatively, the first wavelength range and the second wavelength range may be , may have at least partial overlap with each other. For example, the second wavelength range may be selected from the absorption spectrum of the target tissue 122 that has previously been ablated or carbonized. corresponds to areas where the incident radiation is strongly absorbed by unprotected tissue (e.g., as shown in Figure 2). In some such embodiments, the second output 120 may not include the non-carbonized tissue. Additionally, in another example, the second output 120 may be a previously ablated In a further example, the second output 120 can be used to ablate the charred tissue. For example, the second output 120 may coagulate tissue or blood vessels. This can be more suitable for use in the following cases.

[0046] Laser radiation can be highly absorbed by soft or hard tissue, stones, etc. 3A to 3C show the absorption spectra of different tissue types. The absorption spectrum 311 of the tissue (before excision) and the absorption spectrum 312 of the carbonized tissue (after excision) are shown. FIG. 3B shows the absorption within a specific wavelength range (e.g., 450 to 850 nm). The spectra show an exponential decay with respect to the laser wavelength (Figures 3A and 3B). The data shown is taken from http: / / omlc.org / spectra / hemogl Figure 3C shows the water spectra 331A-331C (75% and 100%, respectively). , and 4% concentration), hemoglobin (Hb) spectrum 332, oxyhemoglobin (H bO2) spectrum 333, and melanin spectra 334A to 334D (2% each) The melanosomes were measured in different media, including 13%, 30%, and 100% melanosome volume fractions. The optical absorption spectrum measured by the method shown in Figure 3C is taken from http: / / www. americanlaserstudyclub.org / laser-surgery -education / ) The wavelength of water absorption is in the range of 1900nm to 3000nm. The wavelength of oxyhemoglobin and / or deoxyhemoglobin is 400nm to 520nm. Many surgical lasers react with water or hemoglobin within a certain range. There are also media that are highly absorbent but have limited ability to absorb water, which is why the inside of the endoscope This can be the reason why it can be damaged by the laser energy.

[0047] FIG. 4 shows the penetration depth of a laser output, such as second output 120 (the data shown in FIG. 4 The reference is http: / / www.americanlaserstudyclub.org / laser-surgery-education / ). As seen in the same source, the second The output 120 of the ion beam has a penetration equivalent to the characteristic dimensions of a small capillary (e.g., about 5 to about 10 μm). The penetration depth may be favorable for effective coagulation. Furthermore, in certain instances, the penetration depth may be favorable for effective coagulation. Referring to B, the second wavelength range corresponds to the lower second output 120 due to uncarbonized tissue. It can accommodate a low absorption rate, but the carbonized tissue (e.g., the ablation of the first output 110) The spectral characteristics of the second output 120 can also be used to deal with high absorption due to the is high (e.g., about 250 cm) due to the carbonized structure of the incident second output 120. -1 twist It is clear that this corresponds to a large absorption. Examples of suitable second laser sources include those with a wavelength of about 750 nm. a second output 120 in a second wavelength range of nanometers to about 850 nanometers; a X Al 1-X A, or a second wavelength range of about 904 nanometers to about 1065 nanometers In having a second output 120 within the X Ga 1-X Contains A.

[0048] have partially overlapping spectra suitable for absorption by tissues (normal and / or carbonized) Although two laser systems are described above, in an alternative embodiment, the second laser system 104 Alternatively, the first laser system 102 may provide the second output 120 . In one example, the first laser system 102 may be configured to remove a high percentage of previously unablated “normal” tissue. A first output spanning a first wavelength range suitable for absorption (e.g., as shown in FIG. 2). 110 and corresponds to low absorption by tissue before carbonization and / or coagulation (e.g., a second output 1 spanning a second wavelength range that is more suitable for a 20. The first laser system 102 can provide a can provide additional output.

[0049] Referring again to Figure 1, by way of example, the laser treatment system may include a laser feedback control Referring now to FIG. 5, as previously mentioned, the laser feedback control system 100 includes The control system 100 analyzes the feedback signal 130 from the target tissue 122 and determines the desired The first laser system 10 is configured to generate a laser output suitable for providing a therapeutic effect. 2 and / or the second laser system 104. For example, The feedback control system 100 controls the flow of the target tissue 122 during a therapeutic procedure (e.g., ablation). The properties are monitored to determine whether the tissue is properly ablated prior to further therapeutic treatment (e.g., coagulation of blood vessels). The laser feedback control system can then be configured to determine whether the laser has reached the target position. 100 may include a feedback analyzer 140 .

[0050] Continuing with reference to FIG. 5, the feedback analyzer 140, according to one example, The spectral characteristics of the light can be monitored. The spectral characteristics may include properties such as reflectance and absorption index. Accordingly, the feedback analyzer 140 includes a spectroscopic sensor 142. The spectroscopic sensor 142 may be a Fourier transform infrared spectrometer (FTIR), a Raman spectrometer, or the like. spectrometer, UV-VIS reflectance spectrometer, fluorescence spectrometer, etc. This technique is used for simple and rapid material analysis. Raman spectroscopy has high resolution and gives information about the chemical composition of materials. It has good accuracy in identifying tissue components. Raman spectroscopy is a technique with high spatial resolution. UV-VIS reflectance spectroscopy is also useful for determining the distribution of components within a target. It is similar to the information provided by the eye or a color image produced by a high-resolution camera, but Reflectance spectroscopy is a method of collecting information from light reflected from an object in a quantitative and objective manner. The method is based on the understanding of materials, since the reflection and absorption of light depends on their chemical composition and surface properties. This technique can be used to obtain information about both the surface and internal properties of a sample. Reflectance spectroscopy can also provide unique information about the composition of hard or soft tissue. Fluorescence spectroscopy is a type of electrochemical method that analyzes the fluorescence from a sample. Fluorescence spectroscopy involves the use of a beam of light, usually ultraviolet, The beam excites the material compound, causing it to emit light, typically in the visible or IR range. This method is applicable to the analysis of several organic components, such as hard and soft tissues. be.

[0051] The feedback analyzer 140 optionally includes, in one example, an imaging sensor 144 (e.g., For example, a CCD or CCD that is sensitive to ultraviolet (UV), visible (VIS), or infrared (IR) wavelengths. In some examples, the spectroscopic sensor 142 may include a spectroscopic sensor (e.g., a MOS camera). To enhance the sensing and detection of features (e.g., carbonized and non-carbonized tissue, vascular structures, etc.) It may include two or more of the spectrometers or imaging cameras listed herein.

[0052] In some examples, the spectroscopic sensor 142 (also known as a spectrometer) may be any of the sensors listed herein. The imaging capabilities of the endoscope used during the therapeutic procedure can be enhanced by including any of the spectrometers For example, endoscopes can be used to perform therapeutic procedures (e.g., laser ablation of tumors). ) can be used to visualize anatomical features during imaging. The sensor 142 can enhance the imaging capabilities of the endoscope. The mirror is suitable for enhanced visualization of anatomical features (e.g., lesions, tumors, vasculature, etc.) The spectroscopic sensor 142 can be used for endoscopic imaging (white light and / or is narrowband imaging) to precisely control the delivery of therapeutic treatments. The detection of tissue characteristics such as charring level can be enhanced.

[0053] Referring again to FIG. 5, the spectroscopic sensor 142 is operatively connected to a signal detection optical fiber 150. In such an example, the signal detection optical fiber 150 can collect the spectral information from the tissue. It may have optical properties suitable for transmitting a spectroscopic signal to the sensor 142. The spectroscopic sensor 142 is connected to the first optical fiber 108 of the first laser system 102 and / or can be operably coupled to a second optical fiber 118 of the second laser system 104. , thereby distributing the light through the first optical fiber 108 and / or the second optical fiber 118. An optical signal can be detected.

[0054] With continued reference to FIGS. 1 and 5, the laser feedback control system 100 The optical sensor 142, the first laser system 102, and optionally the second laser system 1 1. The laser controller 160 is in operative communication with each of the lasers 104. 160 includes one or more laser systems for providing a desired therapeutic effect to the target tissue 122. One or more control algorithms described herein may be used to control the laser output from the Thus, one or more laser systems (e.g., For example, the first laser system 102, the second laser system 104, and / or any additional laser systems).

[0055] Laser controller 160 performs one or more of the functions attributed to laser controller 160. To perform this, microprocessors, digital signal processors (DSPs), and application-specific Integrated Circuit (ASIC), Field Programmable Gate Array (FPGA), or any processors, such as other equivalent integrated or discrete logic circuits, and such components Optionally, the laser controller 160 may be wired or The spectroscopic sensor 142 and one or more laser systems (e.g., a first the laser system 102, the second laser system 104, and Optional laser system).

[0056] The laser controller 160 communicates with the feedback analyzer 140 (e.g., , via a wired or wireless connection), from the feedback analyzer 140 one or more feedback The laser controller 160 can receive a feedback signal. As will be described, one or more characteristics of the target tissue 122 are determined based on the feedback signal. For example, the laser controller 160 may adjust the amplitude of the feedback signal. The widths are compared to provide minimum and maximum amplitudes and to identify tissue characteristics (e.g., charring, coagulation, etc.). It can be determined.

[0057] In some examples, the feedback analyzer 140 continuously monitors the target tissue 122. and continuously communicates with the laser controller 160 to provide a feedback signal. In response, the laser controller 160 adjusts the amplitude of the feedback signal. The laser system can continue to remain in one or more states until a change is detected. When a change in the amplitude of the spectroscopic signal is detected, the laser controller 160 controls one or more Communicates with the laser system and can change conditions to deliver the desired therapeutic effect Alternatively or additionally, the laser controller 160 may be configured to control the laser beam by an operator (e.g., a medical professional). ) and provides one or more output systems with feedback signals. The power can be displayed and, optionally, the first laser can be adjusted to deliver the desired therapeutic effect. and / or a second laser system to perform one or more therapeutic procedures. It is possible to give instructions to the operator.

[0058] In the example described herein, the laser controller 160 monitors the state of the laser system. By varying the laser power, one or more laser systems can be controlled. According to this, the laser controller 160 can independently control each laser system. For example, the laser controller 160 may send separate control signals to each laser system. Alternatively, each laser system can be controlled independently of the other laser systems. Thus, the laser controller 160 may use a common Can send signals.

[0059] In some examples, each of the laser systems may include a laser system that generates a laser output. and a second state in which the laser system does not produce laser output. For example, the first laser system 102 may be associated with a first output A first state in which a force 110 (e.g., a first wavelength range) is generated and a first output 110 is Similarly, the second laser system 104 may have a second state in which the second laser system 104 is not generated. is a first state in which a second output 120 (e.g., a second wavelength range) is generated, and a second and a second state in which no output 120 is generated. The controller 160 changes the state of the laser system from a first state to a second state or vice versa. one or more laser systems by sending a control signal that causes the laser system to change from a first state to a second state. Additionally, optionally, each laser system can control additional states, For example, it may have a third state in which a laser output of a different wavelength range is produced. In response, the laser controller is adjusted to generate a laser output that provides the desired therapeutic effect. The laser 160 sends additional control signals to the laser system to change one of their current states. to any additional states (e.g., from the first state to the third state, from the second state to the third state, etc.) , from the third state to the first state, and from the third state to the second state) It can be done.

[0060] Exemplary Laser System Control Algorithm 6 and 7 illustrate laser feedback control systems according to some examples described in this disclosure. 1 illustrates an example algorithm for controlling one or more laser systems using the system 100. According to the control algorithm 600 shown in FIG. a feedback analyzer 140 (e.g., a spectroscopic sensor 142 or an imaging sensor 144) In step 604, a first signal (e.g., a spectroscopic signal) can be detected. The user controller 160 receives a first signal from the feedback analyzer 140. The first signal may correspond to a first characteristic. In step 606, The laser controller 160 determines whether the first signal is approximately equal to a first preset value. For example, the laser controller 160 may adjust the amplitude of the first signal to a target value. the target tissue 122 A first characteristic of the tissue (e.g., a tissue fragment) can be determined after the tissue has been subjected to a therapeutic treatment. The laser controller 160 can be configured to Based on the first characteristic (comparison between the first signal and the first preset value), a desired therapeutic effect is achieved. It can be determined that the first control signal has been acquired, and in step 608, a first control signal is transmitted to the first laser system. to the first laser system 102, and to change the first laser system 102 from the first state to the The second state of the system 102 can be changed to a second state. According to one example, this can result in a satisfactory As a result of delivering a therapeutic effect (e.g., ablation), the first laser system 102 Alternatively, in step 606, the first signal does not generate the first event output 110. If it is determined that the value is not approximately equal to the preset value (not sufficiently ablated), the laser control The controller does not send any control signal and the feedback analyzer pulls the first signal. You can continue to monitor.

[0061] Optionally, in step 612, the feedback analyzer 140 determines whether the first signal is A separate second signal can be received. The second signal has a second preset value. For example, the second signal may be indicative of a first characteristic of the target tissue, e.g., a reflection from the tissue. The amplitude of the light may be different from the first signal. A second signal may be received by the controller 160. Optional Step 61 At 6, the laser controller 160 determines whether the second signal is approximately equal to a second preset value. For example, the second signal (e.g., a spectroscopic signal or an image) can be determined as follows: The target tissue 122 is not carbonized by absorption of the first output 110 (e.g., The signal amplitude determined is less than the maximum amplitude of the spectroscopic signal or image of the ablated tissue. In some instances, such a condition may be due to inadequate resection or other Therapeutic effects may be unsatisfactory, and laser treatment is required to remove the tissue. Accordingly, in optional step 618, , the laser controller 160 communicates with the first laser system 102 to generate a second control signal. The second control system can send the first laser system 102 in the first state. (e.g., to continue delivering the first output 110). As an example, when the first laser system is in a second state (e.g., off), In step 620, a second control signal is transmitted, e.g., to subsequently deliver additional ablation to the target tissue. changing the state of the first laser system to a first state (e.g., on) to This can be done.

[0062] In optional step 620, the laser controller 160 determines whether satisfactory delivery of the treatment condition is achieved. After determining the arrival of the laser, the laser controller 160 may provide additional laser power (e.g., a different wavelength). Additional control actions can be performed to deliver additional therapeutic effects by delivering additional therapeutic effects. do.

[0063] Figure 7 shows the control algorithm for controlling the dual laser system. The laser controller 160 is in operative communication with two or more laser systems. In some such instances, as previously mentioned, The laser system 102 is configured to deliver a first output 110 (e.g., a first wavelength range). and the second laser system 104 may be configured to output a second output 120 (e.g., The second wavelength range may be configured to deliver a second wavelength range different from the first wavelength range. The control algorithm 700 controls the first laser system 102, the second laser system 104, and optionally additional laser systems.

[0064] According to the control algorithm 700, at step 702, the feedback analyzer 14 0 can detect a first signal (e.g., a spectroscopic signal or an image). At step 704, the laser controller 160 receives a first In step 706, the laser controller 160 receives a first Is the signal approximately equal to a first preset value (e.g., within a specified tolerance of the first preset value)? For example, the laser controller 160 can determine whether the first signal The amplitude is compared to a target value or a preset extreme value (e.g., maximum or minimum amplitude) and the target A first characteristic of the tissue 122 can be determined. The first characteristic can be a characteristic of the tissue 122 after undergoing a therapeutic treatment. The laser controller 1 can be used to characterize tissue (e.g., ablated or carbonized tissue). 60 determines a desired treatment based on the first characteristic meeting a target value or preset criteria. It can be determined that a therapeutic effect has been achieved, and in step 708, the first control signal is set to a first to the first laser system 102, and outputting the first laser beam from the first state of the first laser system 102. For example, the laser controller 102 may be changed to a second state. The laser 160 determines that the ablation is satisfactory based on the light reflected from the ablated tissue; Send a first control signal to the first laser system to return the first laser system to an OFF state. Alternatively, in an illustrative example, the laser controller 160 may and / or change the state of the first laser system to the "OFF" state Provide an output to an operator (e.g., a medical professional) to indicate that the It is possible.

[0065] In step 708, the laser controller 160 also transmits the fourth signal to the second laser system. and transmitting the second laser system 104 from the second state of the second laser system 104 to the second laser system For example, the second laser system 104 can be changed to a first state. may be more suitable for cutting charred tissue. Upon detecting (e.g., step 708), the laser controller 160 In some examples, a first control signal is sent to turn off the first laser system 102. and a fourth control signal can be sent to switch on the second laser system 104. 1 shows an exemplary timing diagram of the states of the first laser system and the second laser system. Shown in Figure 8.

[0066] In some examples, the first control signal and the fourth control signal may be sent simultaneously. Alternatively, the first control signal and the fourth control signal may be sent consecutively.

[0067] Returning to FIG. 7, in optional step 710, the feedback analyzer 140 A second signal (e.g., a spectroscopic signal or an image) can be detected that is separate from one signal. For example, the second signal may be generated when the target tissue 122 is carbonized due to absorption of the first output 110. (e.g., the measured signal amplitude is not within the predefined range of the spectroscopic signal of the ablated tissue. In some instances, such a condition can be indicated by: Inadequate resection or other unsatisfactory therapeutic effects may occur, and tissue removal may be necessary. It is desirable to continue delivering laser power so that the laser can be At step 712, the laser controller receives a second signal and, at optional step 714, The second signal can be compared to a second preset value. If the second preset value is approximately equal to the second preset value (e.g., within a specified tolerance), then proceed to optional step 7. At 16, the laser controller 160 sends a second control signal to the first laser system; A third control signal can be sent to the second laser system. An exemplary timing diagram of the second laser system state is shown in FIG.

[0068] The second control signal, in some examples, causes the first laser system to enter a second state (e.g., , OFF) to a first state (e.g., ON). When the first laser system is in a first state (e.g., ON), the second control signal is: The first laser system 102 can be maintained in a first state (e.g., a first output Optionally, in step 716, the laser controller The laser 160 outputs a third control signal when the second laser system 104 is in its first state. to the second laser system 104, thereby causing the second laser system 104 to The first state (e.g., ON) of the laser system 104 is changed to the second state (e.g., ON) of the laser system 104. 4 to a second state (e.g., OFF). Alternatively, the third control The control signal is for controlling the second laser system 104 when the second laser system is in the second state. can be maintained in a second state (e.g., OFF).

[0069] According to some examples, the first laser system 102 and the second laser system 104 Each of the first states respectively causes the first laser source 106 to generate a first output 110 and and a second laser source 116 generating a second output 120. In response, the first state of each of the first laser system 102 and the second laser system 104 In some such instances, the first laser beam The second state of each of the stem 102 and the second laser system 104 is an "off" state. We can respond to your requests.

[0070] Referring to FIG. 5, a laser feedback control system 100 includes one or more output systems. One or more output systems 170 may include a user and / or supervisor. Irrigation suction / pumping systems used in medical treatments, or optical display controllers, or other systems, and / or In some examples, the signal can be delivered to an output system 170. The display 172 may include a screen (e.g., For example, a touch screen, or alternatively, a simple visual indicator (e.g., one or more colored LED lights). In a further example, the output system The system 170 includes an audio output system 174 (e.g., a speaker) capable of providing an audio signal. The output system 170 may include a monitor, alarm system, etc. The output system 170 may be configured to output a desired therapeutic effect. One or more outputs (e.g., a first color LED light, a screen The output can be a first message on the screen, a first tone alarm. , may be provided, for example, in step 610 and optionally in step 620. In a further optional example, the output system 170 may be configured to detect if the desired therapeutic effect is not being achieved. When the output system 170 is , one or more outputs (e.g., the first) to indicate that the desired treatment effect has not been achieved. Provides two color LED lights, a second message on the screen, and a second tone alarm Such an output can take more than one step (e.g., one or more The laser system is used to perform additional treatment steps and provide additional laser power. ) can prompt the operator (medical worker).

[0071] FIG. 8 illustrates an example of delivering tissue ablation and coagulation by utilizing two wavelengths of light. The timing of the dual laser system having the laser feedback control system 100 is However, as previously mentioned, the laser feedback control system 100 To optimize delivery of laser therapy or other types of therapeutic effects to tissue 122, a single or can be utilized with multiple light wavelength systems. The therapeutic effect can be achieved by any combination, including simultaneous Alternatively, the therapeutic effects can be delivered at different times. This can be done.

[0072] According to one example, lasers from the first laser system 102 and the second laser system 104 The laser energy can be delivered to a target (e.g., a tissue surface) and, in one example, continuously. The first and second laser systems can be delivered via the same optical fiber. Alternatively, the first and second laser energies can be delivered separately. The laser system transmits each laser energy through a separate optical fiber. Amplitude A max The optical feedback signal 810 having and can be detected and analyzed by the feedback analyzer 140. The first and second laser systems may be in their respective operating states (e.g., ON or OFF). As shown in FIG. 8, the first laser system 102 can be switched to its first state or remain in its first state (e.g., ON) 8 20A, and the second laser system 104 is maintained in a second state (e.g., The first laser can be switched to OFF or maintained in that state. can be used to ablate and carbonize tissue. During operation, the first signal may be received by the laser controller 160, Amplitude is at threshold level A min It can exhibit high tissue absorption until it is reduced to The wavelength of the output from the laser system 102 is preferably a wavelength suitable for effective carbonization of the target tissue. The tissue may be within a first wavelength range in the absorption spectrum of the target, such as In one example, the first laser output is a UV-VIS or deep It is in the infrared wavelength range.

[0073] The laser controller 160 then causes the first laser system 102 to enter a second state (e.g., The second laser system 104 is in the first state (e.g., ON) 8 The state of the laser system can be changed so that the output of the second laser system is 30A. The power output from the stem 104 can be largely absorbed by the carbonized tissue, thus The carbonized tissue is ablated, effectively eliminating the carbonization. The wavelength can be within a second wavelength range in the absorption spectrum of the target. The range can be different from the first wavelength range of the output from the first laser system 102. The wavelength of the output from the second laser system 104 is also suitable for effective coagulation. In one example, the second laser output can be in the infrared wavelength range (e.g., 100-300 The decarburization process causes the amplitude of the signal (e.g., the second signal) to decrease from the initial level. Lu A max The laser controller 160 adjusts the laser state accordingly. can be varied so that the first laser system 102 is in a first state (e.g., , ON), and the second laser system 104 is in a second state (e.g., OFF). This process can be repeated, thus allowing the first laser system 102 and the second laser system The laser system 104 alternately ablates and / or coagulates the desired tissue as shown in FIG. are repeatedly switched to ON states 820B and 830B, respectively, until In some examples, the optical feedback signal 810 discussed herein may be a combination of laser energy and The present invention relates to an electrosurgical system that can controllably adjust and optimize different electrosurgical energies. can be provided to the system.

[0074] Exemplary Endoscopic System with Target Identification Figures 9-11 show how target composition analysis can be performed entirely within the endoscope. Target composition analysis is performed using the distal end of the laser fiber and possibly the digital endoscope. With a camera on the tip, this can be done via spectroscopy.

[0075] 9A and 9B show an example of an endoscope into which a laser fiber is inserted. The elongated body portion of 910 contains a laser fiber 912, an illumination source 914, and a camera 916. The laser fiber 912 surrounds various components including the laser system 102. 9 is an example of the optical path 108 of the laser system 202. The laser fiber 912 is A working channel 913 can extend through the elongate body of the catheter 910. In some instances, the laser fiber 912 may be separate from the endoscope. For example, the laser fiber 912 may be routed along the working channel of the endoscope prior to use, After use, it can be retrieved from the working channel of the endoscope.

[0076] The illumination source 914 allows the operator to visualize the target structure (e.g., tissue or stone structure). An example of an illumination source is a light source that directs light through a thin endoscope. configured to emit distally away from the distal end of the elongate body to irradiate an area of ​​the target structure. In one example, the illumination source 914 can include one or more LEDs that illuminate the target structure. The white light can be emitted to allow the physician to see the distal end of the body of the endoscope. It may be possible to observe discoloration or other color-based effects of stones or tissue in the vicinity. In one example, the illumination source 914 may emit blue light to illuminate the target structure. Blue light indicates the spread of heat in tissue, thereby detecting damage within the tissue. Other colours and / or colour bands such as red, amber, yellow, green etc. You can also use a region.

[0077] The camera 916 is part of the visualization system. The camera 916 may take a video image or one or more images of the illuminated target structure and the surrounding environment. The video images can be captured in real time or while waiting for processing. The time required for the image acquisition can be relatively short, almost real time, so the doctor can operate the endoscope while The camera 916 is located at the focal plane of the lens and can observe the target structure. The sensor may include a multi-pixel sensor for each pixel in the video image. The color sensor may be a sensor that provides intensity values ​​of red, green, and blue light corresponding to the color of the image. The circuit board can store digital video data representing the captured video image of the irradiated stone. Digital video signals can be generated at 10 Hz, 20 Hz, 24 Hz , 25Hz, 30Hz, 40Hz, 50Hz, 60Hz video refresh rates, or may have another suitable video refresh rate.

[0078] 10A and 10B show an example of a feedback-controlled laser treatment system. At 0A, the laser treatment system 1000A includes a feedback loop that receives camera feedback. The endoscope 910 includes an integrated laser therapy system 1010 controlled by a lock. The treatment system 1000A is an example of the laser treatment system 100, and includes an endoscope 910, a filter 912, and a Feedback-controlled laser treatment system 1010, laser source 1020, and light source 1030 In various examples, a portion of the feedback-controlled laser treatment system 1010 includes Or it can be entirely embedded in the endoscope 910.

[0079] The feedback controlled laser treatment system 1010 is a laser feedback control system. The spectrometer 1011 (an example of the spectroscopic sensor 242) is an example of the system 200. a feedback analyzer 1012 (an example of at least a portion of the feedback analyzer 240); and a laser controller 1013 (an example of the laser controller 260). 1020 is an example of a laser system 202, which is coupled to the laser fiber 912. The fiber-integrated laser system can deliver laser energy to a flexible endoscope. Its ability to effectively treat hard and soft tissue through the These laser systems range from the UV range to the IR range (200nm to 10000nm). They produce laser output beams within a wide wavelength range (nm). The laser is in a wavelength range that is highly absorbed by soft or hard tissue, e.g., water absorption. In the case of 1900 to 3000 nm, or oxyhemoglobin and / or deoxyhemoglobin The Robin absorption produces an output between 400 and 520 nm. This is an overview of an IR laser emitting within the high water absorption range of ~3000 nm.

[0080] Some fiber-integrated lasers are minimally absorbed by the target soft or hard tissue. These types of lasers produce output in the wavelength range of 5-10 μm. The penetration depth is similar to the diameter of umbilical capillaries, providing effective tissue coagulation. Examples of 1020 include GaN lasers emitting at 515-520 nm, 370-493 nm, and In emitted at m X Ga 1-X N laser, Ga emitting at 750-850 nm X Al 1- X A laser, or In emitting at 904-1065 nm X Ga 1-X A laser, UV -VIS-emitting In X Ga 1-XN semiconductor lasers.

[0081] The light source 1030 can generate an electromagnetic radiation signal, which can be transmitted to the endoscope. the first optical path extending along the elongated body of the target structure 122. The first optical path can be located in the working channel 913. The first optical path can be an optical fiber separate from the laser fiber 912. As shown in Figure 10A, an electromagnetic radiation signal is used to transmit a laser beam. The electromagnetic radiation can be transmitted through the same laser fiber 912 as the first optical fiber. The light exits the distal end of the tract and is projected onto the target structure and the surrounding environment. The structure is within the field of view of the endoscopic camera 916 so that the electromagnetic radiation is visible to the target structure and surrounding area. an endoscopic camera 916, such as a CCD or CMOS camera, in response to being projected into the environment; collects the signal reflected from the target structure 122, producing an imaging signal 1050 of the target structure. and delivers the imaging signal to a feedback-controlled laser treatment system 1010. In some cases, a laser scanning sensor, such as a CCD or CCD, can be used to collect the spectral response. Imaging systems other than OS cameras can be used.

[0082] A feedback signal (e.g., a camera signal) generated and transmitted through the camera system 916 In addition to, or instead of, the image signal, in some instances, a signal reflected from the target structure may additionally or alternatively be connected to a separate fiber channel or is collected through a laser fiber into a feedback-controlled laser treatment system 1010. FIG. 10B shows a configuration for receiving spectroscopic sensor feedback. The endoscope 91 is integrated with the feedback-controlled laser treatment system 1010. 1 shows an example of a laser treatment system 1000B including a reflected spectroscopic signal 1070 (FIG. 1 and an example of the feedback signal 130 in FIG. 2) is fed to a laser fiber 912, Through the same optical path used to transmit the electromagnetic radiation from the light source 1030 to the target structure. This can be fed back to the feedback controlled laser treatment system 1010. The reflected spectroscopic signal 1070 is a reflection of the electromagnetic radiation transmitted from the light source 1030 to the target structure. The feedback is transmitted through a second optical path, such as a fiber optic channel, that is separate from the first optical fiber. The patient can then proceed to a computer-controlled laser treatment system 1010.

[0083] The feedback controlled laser treatment system 1010 includes one or more feedback signals. and analyzing the signal (e.g., the imaging signal 1050 of the target structure or the reflected spectroscopic signal 1070). The spectrometer 1011 can be used to determine the operating conditions for the laser source 1020. As discussed above with reference to optical sensor 242, an FTIR spectrometer, a Raman spectrometer, a UV- Use one or more of the following: a VIS spectrometer, a UV-VIS-IR spectrometer, or a fluorescence spectrometer generating one or more spectral signatures from one or more feedback signals, such as by The feedback analyzer 1012 can be used to detect the target 246 or the target classifier 248. 48. The laser can be configured to identify or classify the laser as one of the following structural types: Controller 1013 controls laser system 10 as also discussed above with reference to FIG. The device may be configured to determine 20 modes of operation.

[0084] The light source 1030 is capable of producing electromagnetic radiation in the UV to IR light range. Table 2 below provides examples of light sources 1030 for spectroscopy systems applicable to the examples discussed herein. Show. [Table 2]

[0085] In some examples, the feedback analyzer 1012 may be configured to between the end and the target structure 122, or receive the reflected signal and transmit it back to the spectrometer 1011 Determining the distance 1060 (shown in FIG. 10A) between the distal end of the optical path and the target structure 122 The distance 1060 is the distance between the spectrometer 1011 and the reflectance spectrum. The laser controller 1013 calculates the threshold (d th )un If the distance 1060 meets the condition, such as being within or within a specified laser firing range, the target structure 122 The laser source 1020 can be controlled to deliver laser energy to the In this case, the target structure 122 is determined to be the intended treatment structure type (e.g., a specified soft tissue type or is identified as a specified stone type), but the target structure 122 is not within the range of the laser ( For example, d>d th ), the laser controller 1013 controls the laser source 1020 to The control signal is sent to "lock" the laser source 1020 (i.e., prevent the laser source 1020 from firing). Information about the distance 1060 and whether the target structure is outside the range of the laser ( d>dth ) can be presented to the physician, who then Adjust the endoscope 910, such as by repositioning the distal end of the laser fiber 912 so that it is closer to the target. The distance 1060, as well as the target structure type, can be continuously monitored and determined. The target is recognized as the intended therapeutic structure type and can be presented to the physician. Within the range (d≦d th ), the laser controller 1013 controls the laser source 102 A control signal can be generated to "unlock" 0, and the laser source 1020 , according to the laser operating mode (e.g., power setting), to aim and fire at the target structure 122. For an example of how to calculate the distance 1060 from the spectroscopic data, see FIGS. 24A-24C. This will be discussed below with reference to Figure 24D etc.

[0086] In some examples, the spectrometer 1011 is configured to transmit electromagnetic radiation from a source to a target. The information about the geometry and positioning of the optical path obtained can be further used to determine the spectral characteristics (e.g. , reflection spectrum). For example, a laser fiber 912 or a separate optical fiber that transmits the spectroscopic signal reflected from the target to the spectrometer 1011. The outer diameter of the optical path, or the angle of projection of the fiber or path from the endoscope 910, determines the reflected signal. The outer diameter and / or protrusion angle can be measured and used to measure the intensity of the signal. As discussed above, the target structure can be The distance 1060 between the structure and the distal end of the fiber is used to determine the spectral data, the fiber, or the optical path. The measured outer diameter and its projection angle, and / or an input signal from the endoscope image processor. can be calculated using

[0087] 11A-11B show an example of an endoscopic system that uses a diagnostic beam to identify a target. As shown in FIG. 11A, an endoscope system 1100A includes an endoscope 1110 and An optical fiber 1114 may be insertable through a working channel 1112 of an endoscope 1110. The endoscope 1110 may include at least one endoscope illumination device. The radiation source 1130 may include, or otherwise be accessible through the endoscope port 1114. The at least one endoscope illumination source 1130 can be coupled to one endoscope illumination source 1130. 130 can controllably provide different doses of irradiation. When inserted through the working channel 1112, e.g., via the endoscope port 1114, The non-endoscopic illumination source 1140 may be coupled to a non-endoscopic illumination source 1140. The non-endoscopic illumination source 1140 can be different from at least one endoscopic illumination source 1130. , through optical fiber 1120A and into the vicinity of distal end 1116 of endoscope 1110. The optical fiber 1120A can emit a diagnostic beam 1142 to a target 1142. 001. In one example, the non-endoscopic illumination source 1140 includes a laser beam. The source may be a laser configured to emit a diagnostic beam containing a white light. A colored light lamp, LED light source, or transillumination light source is inserted through the working channel of the endoscope. The catheter may be inserted through a separate port, such as a laparoscopic port.

[0088] The endoscope system 1100A can include a controller 1150. The laser 1150 may be configured to emit a first radiation beam having, for example, a first radiation dose and a second radiation beam having, for example, a first radiation dose and a second radiation beam having, for example, a second radiation dose and a second radiation dose ... and a second mode having a second dose of illumination. The radiation source 1130 can be controllably operated. In one example, the controller 1150 and changing the illumination mode (e.g., from a first mode to a second mode) in response to a trigger signal. In one example, the endoscope may generate such a control signal to an imaging system 1160 capable of acquiring an image of the target 1001; 150 responds to changes in brightness or intensity of the image of the target by changing the illumination mode (e.g., first generating a control signal to the endoscope to change the endoscope mode (from a first mode to a second mode) Hereinafter, the first mode will be referred to as the high illumination mode, and the second mode will be referred to as the low illumination mode. In one example, the high illumination mode and the low illumination mode are configured such that the illumination light is emitted under the high illumination mode. a first endoscope illumination source configured to emit illumination light under a low illumination mode; The radiation can be provided by different endoscopic radiation sources, such as a different second endoscopic radiation source connected to the The illumination light can be emitted near the distal end 1116 of the endoscope 1110. In one example, the illumination light is transmitted through the working channel 1112 via a different optical fiber 1120A. The optical path can pass through a light path that passes the illumination light 1132 through the projection of the diagnostic beam. The target 1001 can be the same as the target 1001 that is used for the

[0089] The controller 1150 may be configured to transition at least one endoscope illumination source 1130 from a high illumination mode to a low illumination mode. When changing to the low exposure mode, the diagnostic beam 1142 (e.g., a lower therapeutic level of energy) A control signal is sent to the non-endoscopic irradiation source 1140 to emit a laser beam having a given energy. In one example, the low illumination mode can be configured to switch off illumination for the endoscope. This includes dimming the target site illumination under low illumination mode to reduce the incidence of the target. This can enhance the return of the diagnostic beam from the target, thereby improving target discrimination. can help.

[0090] In some examples, the controller 1150, while the illumination mode is in the second mode, A control signal can be generated to a display to display an image of the target, the image being , a modified image of a previous or current image of the target. Based on the diagnostic beam incident on the target and the light from the diagnostic beam reflected from the target, In one example, the controller 1150 can determine the composition of the stone target. determining a first composition of one portion of the stone target and a different second composition of a second portion of the stone target. Based on the identified compositions of the different portions of the target, the controller 115 0 programs a first laser setting to target a first portion of the stone target; and The controller may generate recommendations for programming the first laser setting. 1150 may be configured to use a second laser setting different from the first to target a second portion of the stone target. Recommendation for further programming or programming a second laser setting. Recommendations can be generated.

[0091] In one example, the non-endoscopic illumination source 1140 stops emitting the diagnostic beam 1142, and then the The Troller 1150 is designed to change the illumination mode from low illumination mode to high illumination mode again. In addition, a control signal to the endoscope can be generated.

[0092] FIG. 11B is an example of an endoscope system 1100B, which is a variant of the endoscope system 1100A. In this example, diagnostic beam 1142 is transmitted through optical fiber 1120B. The optical fiber 11 inserted into the working channel 1112 of the endoscope 1110 Unlike 20A, optical fiber 1120B is routed separately from working channel 1112. In some examples, as shown in FIG. 11B, the diagnostic beam 1142 , which can be delivered through a secondary port 1115, such as a laparoscopic port in one example. Port 1115 is separate from endoscope port 1114, which is used to deliver endoscopic illumination light. The optical fiber 1120B is connected to the distal end 1116 of the endoscope 1110 and the optical fiber 1120B. Both distal ends of 120B can be positioned to aim at target 1001.

[0093] 12 and 13A to 13B are obtained by UV-VIS spectroscopy or UV-VIS-IR spectroscopy. Through the different types of kidney stones, you can identify the composition of several different types. 1 shows reflectance spectrum data for identifying targets of , Calcium oxalate stone (monohydrate), Calcium oxalate stone (dihydrate), Calcium phosphate Images of each of the five primary types of kidney stones, including sodium stones, struvite stones, and uric acid stones. , collected by directing a UV-VIS spectrometer or a UV-VIS-IR spectrometer. In one example, the electromagnetic radiation can include one or more ultraviolet wavelengths between 10 nm and 400 nm. In another example, a countermeasure used to distinguish between different types of targets is shown in Figure 12. The radiation spectrum can be recoded from the spectrometer in the wavelength range of 200-1100 nm. In Figure 12, ammonium magnesium phosphate (AM MAG) hydrate, oxalate Calcium oxalate (CA) monohydrate, calcium oxalate (CA) hydrate, calcium phosphate Reflectance spectra of kidney stone compositions containing uric acid (CA) and uric acid are shown. The reflectance spectrum of the composition is lower than that of the higher wavelength range (e.g., above 400). The wavelength range (e.g., less than 400 nm) is more discernible. Magnesium oxalate hydrate spectrum 1310, calcium oxalate monohydrate spectrum Spectrum 1320, Calcium Oxalate Hydrate Spectrum 1330, Calcium Phosphate Spectrum Figure 1340 and uric acid spectrum 1350 in the wavelength range of 200-400 nm 12 shows a portion of the reflectance spectrum. This UV wavelength range is the same as the spectrum of the stone image. Figure 13B shows the cystine spectrum. 60, uric acid spectrum 1370, and calcium oxalate monohydrate spectrum 1380 Figure 1 shows the reflectance spectra of various kidney stone compositions within the wavelength range of 400-700 nm, including: UV-VIS spectroscopy or UV-VIS-IR spectroscopy can be used to identify different types of kidney stones. , it is possible to distinguish between different types of targets.

[0094] Therefore, the UV wavelength range can distinguish between different target compositions, such as kidney stones. Therefore, a light source that allows for analysis of this region is required in the system. are in the UV wavelength range of approximately 250 nm, 280 nm, 310 nm, and 340 nm, respectively. The light peaks 1410, 1420, 1430, and 1440 cover respective segments of the Figure 15 shows the normalized reflectance spectra of several types of stones from Figures 13A-13B. These light peaks 1410 to 1440 are superimposed on the toru. ~1440 is a potential spectrometer that should allow the spectrometer to analyze target compositions within UV wavelengths. Demonstrates potential light sources.

[0095] FIG. 16A shows a cartilage spectrum 1610, a bone spectrum 1620, and a muscle spectrum 1630. 0, fat spectrum 1640, and liver tissue spectrum 1650. Figure 16B shows an example of a normalized reflectance spectrum captured by a UV-VIS spectrometer from a sample. , Cartilage Spectrum 1610, Bone Spectrum 1620, Muscle Spectrum 1630, Fat Spectrum various spectra, including 1640, liver tissue spectrum 1650, and vascular spectrum 1660. Separate normalized reflectance spectra captured with a UV-VIS spectrometer from various soft and hard tissues. The reflection spectrum data shown in FIGS. 16A and 16B is obtained by measuring the working channel of an endoscope. This demonstrates the feasibility of analyzing target compositions from methods available within the panel. The UV-VIS region is used to measure the spectra captured from stone images, as well as the different types of Figure 16C shows the FTIR spectrum of a typical stone composition. FIG. 16D shows an example of the composition of some soft and hard tissues. Regarding spectra.

[0096] Exemplary Laser Treatment System The features described herein may be advantageously adapted to incorporate different types of laser sources. It can be used in connection with laser systems for a variety of applications. The features described in this document may be used in industrial or medical settings, such as medical diagnostics, therapeutics, and surgical procedures. This may be suitable for

[0097] The features described herein may be combined with fiber-integrated laser systems and endoscopes. It can be used with a spectroscopic system that can be used in conjunction with a microscope.

[0098] 17-18 show schematic diagrams of laser treatment systems according to various examples described in this disclosure. The laser treatment system is configured to deliver laser energy toward a target. a laser system having a laser feedback loop configured to be coupled to the laser system; The laser system may include a laser control system and a laser beam control system. One or more laser modules 1710A-1710N capable of emitting from the V to the IR (e.g., a solid-state laser module). The number of modules, output power, emission range, pulse shape, and pulse train affect the cost of the system and It is selected to balance the desired effect with the performance required to deliver the desired effect to the target.

[0099] One or more laser modules 1710A-1710N may be integrated with a fiber. The fiber-integrated laser system can be It delivers laser energy through a flexible endoscope to effectively treat hard and soft tissue. These capabilities allow them to be used in endoscopic procedures. Lasers in a wide wavelength range from the V range to the IR range (e.g., 200 nm to 10,000 nm) Some fiber-integrated lasers can be used to target soft or hard tissue. Within the wavelength range where absorption is significant, for example, 1900-3000 nm for water m, or 400 for absorption of oxyhemoglobin and / or deoxyhemoglobin Produces an output of ∼520 nm. A variety of IR lasers can be used as the laser source.

[0100] Each of the laser modules 1710A-1710N increases the output power and directs the emission toward the target. The laser beam is delivered by a laser diode integrated into an optical fiber. Some fiber-integrated lasers can achieve minimal damage depending on the target soft or hard tissue. These types of lasers produce output in the wavelength range where light is absorbed to the maximum extent. Provides effective tissue coagulation due to a penetration depth similar to the diameter of small capillaries (m) The fiber-integrated laser modules 1710A-1 described in accordance with various examples of the present disclosure The 710N has several advantages. For one, the light emitted by the laser module is symmetrical. The beam quality is excellent and has a round and smooth (homogenized) intensity profile. The cooling arrangement is integrated into the laser module, making the whole system compact. Laser modules 1710A-1710N can be easily combined with other fiber optic components. In addition, the fiber-integrated laser modules 1710A to 1710N The module accepts standard fiber optic connectors, allowing it to be used with most This allows for smooth operation with optical modules without alignment. The driver-integrated laser modules 1710A to 1710N are suitable for aligning the laser coupling system. It can be easily replaced without changing the combination.

[0101] In some instances, the laser module may be used to illuminate soft or hard tissue, stones, or other tissues, as shown in FIG. 3C. , in wavelength ranges that are significantly absorbed by some materials such as bone and teeth, e.g., the absorption of water In the case of hemoglobin, 1900 to 3000 nm, or oxyhemoglobin and / or deoxyhemoglobin In the case of globin absorption, a laser output of 400 to 520 nm can be generated. In some instances, the laser module is used to target soft or hard tissue, stones, bones, teeth, etc. This type of laser can produce laser output in a wavelength range where absorption is lower. The laser is focused on small capillary diameters (e.g., 5–10 μm), as shown in Figure 3C. They offer similar penetration depths and therefore more effective tissue coagulation. Commercially available solid-state lasers: It is a potential emission source for the laser module. Examples are GaN (emitting at 515-520 nm) or In X Ga 1-X N(370~49 3 nm), GaXAl1-XA laser (emitting at 750-850 nm), or InX In lasers that emit UV-VIS, such as Ga1-XA lasers (emitting at 904-1065 nm) X Ga 1-X Such laser sources can also be used for tissue coagulation. may be applicable to the following applications:

[0102] The laser feedback control system may include, for example, a spectroscopic system 1720, a feedback One or more subsystems including a clock analyzer 1730, and a laser controller 1740. It can be equipped with a system.

[0103] Spectroscopic System 1720 The spectroscopic system 1720 may be used to detect, but is not limited to, stones, soft tissue, or hard tissue. A light source transmits a control light signal to a target, such as tissue, bone, or teeth, or an industrial target, and the target The reflected spectral response data from the target can be collected. This response is then It can be delivered to the spectrometer through a fiber optic, laser fiber, or endoscope system. The spectrometer sends the digital spectral data to the System Feedback Analyzer 1730. Examples of light sources for spectroscopy systems covering the UV to IR range are , including those described above with reference to Table 2. FIG. 20 shows an example feedback algorithm. 17 shows a schematic diagram of a spectroscopic system 1720 having a analyzer 1730.

[0104] Optical spectroscopy is a powerful method that can be used for the easy and rapid analysis of organic and inorganic materials. According to various examples described in this disclosure, the spectral light sources can be separated into separate fiber channels, lasers, and the like. The light source reflected from the target can be integrated into the laser fiber or endoscope system. The signal may be transmitted to a digital endoscope using a sensor such as a CCD or CMOS sensor. The imaging system, including the detector, allows rapid collection and delivery to the spectrometer. Other imaging systems, such as laser scanning, can also be used to collect the photoresponse. Optical spectroscopy has several advantages: it is compatible with fiber laser delivery systems; Optical spectroscopy can detect and measure the chemical composition of materials. Optical spectroscopy is a non-destructive technique for analyzing the structure of a sample, and the analysis can be performed in real time. Optical methods analyze different types of materials, including, for example, hard and soft tissue, stone structures, etc. can be used for

[0105] Various spectroscopic techniques can be used to analyze target chemical compositions and generate spectroscopic feedback. They can be used alone or in combination. Examples of such spectroscopic techniques are, inter alia, UV -VIS reflectance spectroscopy, fluorescence spectroscopy, Fourier transform infrared spectroscopy (FTIR), or Raman spectroscopy Table 2 above covers the applicable UV to IR light range as an example. Examples of light sources for spectroscopic systems are presented. Generally, in the visible and near IR range, When performing spectroscopic measurements, a tungsten halogen light source is used. Known for its stable output, it is used for UV absorption or reflectance measurements. Mixing with deuterium light provides a smooth spectrum from 200 to 2500 nm A wide spectral range light source is available for fluorescence measurements and other applications. Xenon light sources are used in applications where LED and laser diode light are required. The source provides high power at precise wavelengths, has a long lifetime, a short warm-up time, and high The spectroscopic light source can be a separate fiber channel, a laser fiber, or an endoscope system. The light source signal reflected from the target can be fed to a separate fiber optic channel. It can be rapidly detected and delivered to a spectrometer through a fiber optic or laser.

[0106] Feedback Analyzer 1730 The feedback analyzer 1730 may suggest or directly adjust laser system operating parameters. Accepts input from a variety of sources, including spectral response data from a spectrometer to adjust In one example, the feedback analyzer 1730 may analyze the target composition data. Spectroscopic response data can be compared with available database libraries. Based on the system feedback, the signal analyzer detects and identifies the target material composition. To achieve effective tissue treatment for the tissue composition, at least one laser module Laser operating mode (also called laser setup), including operating parameters for the module Examples of operating parameters include at least one laser wavelength, pulsed or continuous wave ( CW) Emission mode, peak pulse power, pulse energy, pulse rate, pulse shape and simultaneous or sequential pulse emission from at least one laser module. Although not explicitly stated, the successive pulses may be coordinated to deliver a selected pulse energy. Pulses as used herein generally include bursts of laser modulated pulses. This refers to the time between the start and stop of laser emission from the module. As long as this is maintained, the intensity of the laser energy during each pulse will fluctuate, increasing or decreasing. The shape of the ramp or sinusoidal profile, or any other shape, may be used alone or in pulses. For example, if there is only one pulse, In this case, an average power setting of 2 W with a pulse energy of 1 J occurs at a frequency of 2 Hz. However, the energy is delivered as two 0.5 J pulses at a rate of 2 Hz. Each of these pulses may have a similar or different pulse shape. The feedback analyzer 1730 can analyze the algorithm and input data. directly adjust or suggest laser operating parameters such as those described in the examples above. .

[0107] In some examples, the feedback analyzer 1730 utilizes the input data to Based on a separately developed algorithm, the distance of the laser delivery system 1701 (fiber) The distance between the target and the target can be calculated and controlled. In the case of a target exceeding a predetermined threshold, the feedback analyzer 1730 detects the target by fiber optics. A laser-operated power plant uses vapor bubbles in water to create a suction effect, drawing the vapor bubbles to the distal end of the power plant. This feature allows the user to adjust or suggest parameters for the effect of the moving target. The effort required to maintain the desired therapeutic distance is minimized. The distance between the distal end of the endoscope and the spectral data, the known outer diameter of each fiber, and / or calculates the projection angle from the endoscope image processor. 24A-24D show an example of a laser delivery system 1701 (F This figure shows how to calculate the distance between the distal end of the target and the laser delivery system. The dependency of the spectral reflection signal on the distance between the sensor 1701 and the object 1702 is shown in FIGS. 24A and 24B. 24A is the 730 nm measured at different distances between the tissue and the distal tip of the spectroscopic probe. Figure 24B shows an example of the reflected signal intensity at different distances between the tissue and the distal end of the spectroscopic probe. The following shows an example of the reflected signal intensity at 450 nm measured at different distances. Determining using spectral data and information about the geometry of the laser delivery system Analysis of the spectroscopic signal allows for rapid estimation of distance and delivery of this information to the user. do.

[0108] FIG. 24C is an exemplary algorithm for calculating the distance between the fiber and the tissue target. In the example, the spectroscopic system transmits a control light signal from a light source to a target and receives a spectral response data from the target. The spectrometer collects the data, transmits the response signal to the spectrometer, and filters the digital spectral data from the spectrometer. The calibration curve 1000 shown in FIG. 24C is the same as that shown in FIGS. Using a feedback signal reflected from a target structure such as a spider, the spectral reflected signal intensity (e.g., a spectroscopic signal reflected from a target structure in response to electromagnetic radiation) and a distal end of the fiber. The calibration curve 1000 represents the relationship between the distance 1060 between the edge of the target structure and the target structure. is projected by electromagnetic radiation of a specific wavelength (for example, 450 nm or 730 nm) and measuring the reflected signal intensity at different distances between the tissue and the distal end of the spectroscopic probe. By reference to the calibration curve, the analysis of the spectroscopic signal can be performed by Allows for quick estimation of distance.

[0109] An exemplary process for generating a calibration curve is as follows: First, a base value for each distance is calculated. The light reflection intensity depends on the reflection of the test piece, so it is difficult to distinguish the distance. The calibration curve itself cannot be used to distinguish between the two. An example of a standard value for this purpose is as follows: Reference value = dI / dx*1 / I (1)

[0110] During the in vivo surgical process, the operator can detect the reflectance spectrum of the target tissue composition. Move the fiber or endoscope while continuously recording the spectroscopic feedback until It is possible.

[0111] Referring to FIG. 24C, the first spectrum is measured at a distance x1 where the reflected signal intensity is I1. At this time, the actual value of x1 and the curve of the reflected signal strength are unknown. Then, the fiber or the distal end of the endoscope (reflected light detector) can be moved continuously. Then, the next reflected light intensity I2 corresponding to the distance x2 can be measured. x2 is close to x1. Therefore, the curve between x1 and x2 can be approximated linearly. The timing, x1, x2, and reflected signal strength curves are unknown. I1, I2, and Δ Using (x2-x1), the comparison value can be calculated as follows: Comparison value = Δ(I2-I1) / Δ(x2-x1)*1 / I1(2)

[0112] The reference value is then searched for a value identical to the comparison value. r )only If is found to be identical to the comparison value given in equation (2), then x r x1 distance It can be determined that the distance is large. r1 , x r2 ) exists, The fiber or the distal end of the endoscope (reflected light detector) can be moved continuously, corresponding to a distance of x3 The next reflected light intensity I3 can be measured. x3 can be close to x2, but Therefore, the curve between x2 and x3 can be approximated linearly. , x2, x3, and the curve of the reflected signal intensity are unknown. I1, I2, I3, Δ(x2-x 1), and Δ(x3-x2), the new comparison value can be calculated as follows: do. Comparison value = Δ(I3-I2) / Δ(x3-x2)*1 / I2(3)

[0113] Then, x r1 +Δ(x2-x1) and x r2 +Δ(x2-x1) for the same value , a reference value is retrieved. The reference value can be compared with the comparison value given in equation (3). The distance with the reference value that is most similar to the comparison value is presumed to be the actual distance.

[0114] Referring to FIG. 24D, during an in vivo surgical process, an exemplary method involves the use of a reflective scan of a target composition. While continuously recording the spectroscopic feedback, the fiber or The distal end of the endoscope may be moved toward the target. In this case, the intensity of the detected reflected light is initially weak and increases as the distance between the target and the fiber end decreases. For example, the first spectrum is obtained at a distance d where the reflected signal intensity is I1. The fiber or endoscope distal tip was then moved slightly toward the target, and the reflected light was measured. By continuously collecting data, the method calculates the next reflected light intensity I2 corresponding to the distance d2. This method then calculates the value of the gradient of the reflected signal intensity change = Δ(I - I 1) / Δ(d2-d1). The calculated gradient value can be calculated by The calculated gradient can be normalized to make it independent of the projection signal intensity. The final formula for calculating the gradient of the reflected signal strength change at the measured distance is: be. Gradient (normalized) = [Δ(I2-I1) / Δ(d2-d1)] / I0(4) In the above formula, I0=AVERAGE(I1,I2).

[0115] The method then applies the calculated gradient to the lane to allow for an estimation of the required distance. The slope of the calibration curve in the library can be compared. All calculations are performed by the software. It can be used to perform at high speed.

[0116] 25A-25B show that the distance between the tissue and the distal end of the spectroscopic probe influences the reflected light from the target. Figure 25A shows the effect on the bladder endothelial spectrum 2511 and the gastric endothelial spectrum 2512. Spectrum 2512, Gastric smooth muscle spectrum 2513, Ureteral spectrum 2514, Ureteral endothelial spectrum Spectrum 2515, renal calyx spectrum 2516, bladder muscle spectrum 2517, and medulla spectrum Exemplary normalized UV-VIS reflectance spectra of various soft tissue types, including spectrum 2518. Figure 25B shows the distance between the tissue and the distal tip of the spectroscopic probe, such as 0 to 0.25 inches. Shows exemplary UV-VIS reflectance spectra of specific tissues recorded at different distances. Figure 25A shows some examples of animal soft tissue spectra. Figure 25B shows tissue and spectroscopy. Exemplary UV-VIS reflectance of tissue recorded at different distances from the distal tip of the probe. In this example, the spectrum is presented as discussed above with reference to FIGS. The reflected signal intensity at the two spectral maxima at 450 nm and 730 nm was determined to be the same as that of the target tissue. Measurements were presented at different distances from the distal end of the optical probe.

[0117] Laser Controller 1740 The laser controller 1740 can be integrated with the laser coupling system. The coupling system may include one or more laser modules (e.g., solid-state laser modules). ) into one fiber. The laser controller 1740 The feedback analyzer 1730 can be coupled to the optimized The signal can be sent directly to the laser controller 1740 along with the suggested settings. (automatic mode), or can require operator approval to adjust laser settings ( (Semi-automatic mode). Figure 17 is a schematic diagram of a fully automated laser system. Figure 18 FIG. 1 is a schematic diagram of a semi-automated laser system. The system includes an input 1850 and a Require user approval via a user interface, including a display 1860 In one example, the laser settings can be adjusted within a setting range, which in one example can be This can be predetermined by the user at the start of the procedure.

[0118] In some examples, the laser controller 1740 may combine two or more laser pulse trains. In combination, a combined laser pulse train can be created. Laser 1740 generates a plurality (e.g., N) of laser pulse trains 1910A-1910N. The laser pulse trains 1910A to 1910N are then combined to form a combined pulse train 1920. , 1930 shows an example in which a target can be exposed to a combination pulse train. Three different laser trains 1941A, 1941B emitted from different laser modules, 19 shows an example of an output laser pulse train 1942 combined from 1941A and 1941B. As shown in FIG. 19B, laser arrays 1941A, 1941B, and 1941C are Turn on at different times and / or turn off at different times according to the back analyzer signal In the example shown in FIG. 19B, the output combined laser pulse train 1942 is , the portion where two or more of the laser arrays 1941A, 1941B, and 1941C overlap in time. may include:

[0119] Laser modules 1910A to 1910N, a spectroscopic system 1720, and a feedback The combination of the analyzer 1730 and the laser feedback system described herein The system 1740 continuously identifies the target composition through the endoscope and tracks it throughout the procedure. You can update the user settings.

[0120] The main components of the laser system are easily customizable depending on the targeted medical procedure. For example, the laser controller 1740 can control different laser types and their These combinations are supported, allowing for a wide range of settings, including power, wavelength, pulse rate, pulse shape, and A wider range of profiles, including single laser pulse trains, and combined laser pulse trains The operating mode of the laser system can be varied to achieve each desired optical effect. The spectroscopic system can automatically adjust or suggest for diagnostic purposes. Gather information about the target material that is useful for ensuring that the laser parameters are optimal for the target. The Feedback Analyzer 1730 automatically determines the operating mode of the laser system. This can be optimized and reduces the risk of human error.

[0121] Internet of Things (IoT) System 1750 In some examples, the laser system may include an optional IoT system 1750. The IoT system 1750 can then upload the spectral database library to the cloud 17 52, corresponding to storing spectra and optimal setup database library Supports quick access to Cloud 1752 and Feedback Analyzer 1730 Cloud storage of data allows communication between the Feedback Analyzer 1730 Addresses the use of artificial intelligence (AI) techniques to provide input to algorithms and databases Provides instant access to service improvements.

[0122] According to various examples described herein, the IoT system 1750 may include a laser system A network that allows components to communicate and interact with other components over the Internet. IoT can include a network of sensors stored in the cloud 1752. Supports quick access to cloud database libraries and feedback In addition, the laser system components communicate with the clock analyzer 1730. All can be monitored and controlled remotely over a network if desired. One example of such a successful connection is the Internet of Medical Things. s (also known as Internet of Health Things). are possible applications of IoT for medical and health-related purposes, including research and monitoring. This includes the collection and analysis of data for the purpose of:

[0123] In various examples, the IoT system 1750 may detect a target structure (e.g., a stone structure or anatomy) access to various cloud resources, including cloud-based detection, recognition, or classification of In some instances, cloud-based target detection, identification, or a machine learning (ML) engine in the cloud 1752 to provide classification services. The ML engine can implement a trained ML model (e.g., one or more The ML engine may include: Receives target spectroscopic data from the laser system or stored in the cloud 1752. collects targeted spectroscopic data and performs target detection, identification, or classification, and identifies tissue type (e.g., For example, normal tissue or cancerous lesions, or tissue in specific anatomical locations), or stone types a label representing a group (e.g., kidney, bladder, pancreatic bile duct, or gallbladder stone with a particular composition) Targeted spectroscopic data can be collected from the patient before or during treatment. Among other collected clinical data, at the end of the procedure or at other scheduled times, Alternatively, you can upload the data to the cloud 1752 automatically. System users (e.g., clinicians) can be prompted to upload data. In some examples, the output may be a probability that the target is identified as tissue or stone, or a probability that the target is identified as stone. may further include the probability that the value is classified as a particular tissue type or stone type. System users (e.g., clinicians) can use such cloud services to near real-time information about the target tissue or stone, such as while performing an endoscopic laser procedure. It can be obtained in vivo.

[0124] In some examples, the ML engine may use the data stored in the cloud 1752, such as a training module configured to train the ML model using the training data. The training data can be used to identify target types (e.g., stone types or tissue types). The training data may include spectroscopic data associated with target information such as tags. , which may include laboratory data based on spectroscopic analysis of various tissue types and / or stone types. Additionally or alternatively, training data may be obtained in vitro or in vivo from multiple patients. In some instances, such data may be used Patient identifying information may be removed from patient clinical data (e.g., spectroscopic data) prior to the ,to train an ML model or use a trained ML model to detect,identify targets, Or it can be uploaded to the cloud 1752 for classification. The system collects anonymized patient clinical data by tagging the data with the identifying source (e.g., hospital, The clinician can then use the system to: Target type (e.g., stone or tissue type) was analyzed and confirmed, and de-identified patient clinical data was used. Data can be associated with target types to form training data. Using patient clinical data from a large patient population to train ML models It increases the robustness of cloud-based ML models by allowing for the inclusion of additional data. It would be advantageous to be able to analyze spectroscopic data from rare stone types clinically or in research settings. This allows for the recognition of rare stone types, as these are difficult to obtain from laboratories. It can also enhance the performance of ML models.

[0125] Decision trees, neural networks, deep learning networks, support vector machines, etc. Various ML model architectures and algorithms can be used, such as In some instances, the training of ML models can be successively accelerated as additional spectroscopic data become available. Training can be performed periodically or in near real-time. The algorithm adjusts one or more ML model parameters until the model meets a specified training convergence criterion. The resulting trained ML model is then used to The data stored in the cloud 1752 can be used in detecting, recognizing, or classifying objects. The large amount of data stored in the cloud 1752 and additional data being added to the cloud 1752 on a continuous or periodic basis The cloud-connected ML-based approach described herein is based on ML models trained on the cloud. Target recognition based on this method can improve the accuracy and robustness of in vivo target detection, recognition, and classification. This can be done.

[0126] Exemplary Endoscopic Laser System 21A to 21D show the integrated multi-fiber accessor shown in FIG. 10A. an endoscope 2110 having a feedback-controlled laser treatment system 1010; a surgical laser system including a laser source 1020; and an endoscopic laser system 210 including the laser source 1020. Examples of 2100A and 2100B are shown. Alternatively, a detector such as a CCD or CMOS sensor can be used. The spectral response can be collected and delivered to a spectrometer by an imaging system including: and performing target composition analysis through one or more of the cores of the multi-fiber accessory via While the signal is being transmitted through one or more of the other cores of the multi-fiber accessory, The target can be illuminated by a light source.

[0127] As shown in FIG. 21A, the endoscopic laser system 2100A transmits the spectroscopic signal back to the spectrometer 1. 011, as well as delivering surgical laser energy from laser source 1020 to the target structure. In one example, a multi-fiber accessory includes an optical path 2116 used to The optical path 2116 is embedded in the elongated body of the endoscope 2110. In another example, the optical path 2116 may include an optical fiber extending along the body. The laser controller 1013 includes two or more optical fibers extending along the elongated body. The laser may be configured such that the transmission of the spectroscopic signal and the delivery of the laser energy occur at different times or simultaneously. The timing of the launch can be controlled.

[0128] The multi-fiber accessory is embedded in the elongated body of the endoscope 2110. The optical fiber 2110 may include two or more light source fibers 2114 extending along the elongate body. By way of example and not limitation, FIG. 21C illustrates a radial cross section of the elongate body of endoscope 2110. , a plurality of light source fibers 2114 and light paths 2116 are arranged longitudinally within the elongated body of the endoscope. The light source fiber 2114 is positioned such that the light source fiber 2114 is oriented along a radial cross section of the elongated body of the endoscope. The light is dispersed radially around the periphery of the optical path 2116, such as circumferentially around the path 2116. In the example shown in FIG. 1C, the optical path 2116 extends substantially longitudinally along the center of the elongated body of the endoscope 2110. By way of example and not limitation, as shown in FIG. Six light source fibers can be positioned around 16. Other numbers of light source fibers, And / or other locations of the source fiber relative to the optical path 2116 may be used. For example, FIG. 21D shows two light source fibers 2116 positioned radially on either side of the optical path 2116. 114 is shown. The light source fiber 2114 can be coupled to the light source 1030. Alternatively, The light source fiber 2114 is then coupled to the illumination source 914 as shown in FIGS. 9A-9B. The illumination source 914 (e.g., one or more LEDs) or a remote source, such as the exterior of the endoscope, can be used. Regardless of the remote light source 1030, light from the endoscope light source illuminates the target and reflects off the target surface. The spectroscopic signal can be collected for spectroscopic analysis. The feedback analyzer 1012 can be similarly shown in FIGS. As shown, determining the distance 1060 between the distal end of the endoscope 2110 and the target structure 122 This can be done.

[0129] FIG. 21B shows an endoscopic laser system 2100B that includes a multi-fiber accessory. Instead of delivering laser energy through optical path 2116, a separate laser fiber 2 120 to deliver surgical laser energy from laser source 1020 to the target structure. The optical path 2116 is a dedicated optical path for transmitting the spectroscopic signal back to the spectrometer 1011. Used as a spectroscopic signal fiber.

[0130] 22 and 23A-23B are similar to those discussed above with reference to FIGS. 21A-21D. Examples of multi-fiber systems that can be used in any fiber optic delivery system are given below. In the example shown in FIG. 22, a multi-fiber system 2200 is coupled to a light source and transmits illumination light. a first fiber 2210 configured to direct the light toward the target; and a spectrometer coupled to the first fiber 2210 configured to direct the light toward the target. and transmitting a reflected signal indicative of the spectral characteristics (e.g., light reflected from a target) to a spectrometer. and a separate second fiber 2220 configured therewith.

[0131] 23A-23B show an exemplary master with a source light input and a spectral feedback signal. 23A is a diagram of a multi-fiber accessory. 2300A includes a distal portion 2310, a transition section 2320A, and a proximal portion 2330A. The distal portion 2310 can include the first fiber 2210 and the second fiber 222. 23. The distal portion 2310 of the shaft may be sized and shaped to seal the distal portion 2310. and a proximally located transition section 2320A. The spring 2220 can be embedded in the longitudinal shaft of the distal portion 2310. 310. The shaft may extend along the longitudinal shaft of the endoscope. The tubing may be sized and shaped to extend through the tubing channel. The first fiber 2210 may include two or more optical fibers each coupled to a light source. and / or the second fiber 2220 can include one or more optical fibers. In some examples, as shown in FIGS. 21C-21D, the second fiber 2220 In one example, the second optical fiber 2210 may be radially dispersed around the first optical fiber 2210. At least one of the fibers 2220 extends substantially along the central longitudinal axis of the shaft. The two or more first optical fibers 2210 can extend in the central longitudinal direction of the shaft. The second optical fiber 2220 may be positioned radially on either side of the second optical fiber 2220 extending along the adaxial direction. do.

[0132] The proximal portion 2330A includes a first connector 2332 configured to connect to a light source. and a second connector 2334 configured to be connected to a spectrometer. 320A interconnects the distal portion 2310 and the proximal portion 2330A and is connected to the first connector 2 332 to the first fiber 2210 and a second connector 2334 to the second fiber 2210. 220. Thus, the transition section 2320A can be configured to couple to the The optical fibers are respectively fed from the first connector 2332 and the second connector 2334 to a single shaft. It provides a transition between fibers 2210 and 2220.

[0133] The shaft includes an insertable distal end 2312 extending distally from a distal portion 2310. The insertable distal end 2312 can be configured to be inserted into a patient. The proximal portion 2300A allows the user to operate the multi-fiber accessory 2300A. The handle may be associated with (e.g., contained within) a At least a portion of the fiber accessory 2300A (e.g., distal portion 2310, transition portion 2311) The endoscope may be configured to include one or more of the following components: a working section 2320A, a proximal section 2330A, and a distal section 2330B; The endoscope may be inserted into a working channel or may be insertable into a working channel of the endoscope. Cut.

[0134] FIG. 23B shows a multi-fiber accessory that is a variant of multi-fiber accessory 2300A. In the example shown in FIG. 23B, the proximal portion 2330B is an optical fiber. a third connector configured to couple a laser source to one of the drivers 2210 or 2220; 23A, the transition section 2320B may further include a connector 2336. The distal portion 2310 and the proximal portion 2330B are interconnected. The energy is transmitted through one of the optical fibers 2210 or 2220 to the proximal portion 233. 0B to the distal portion 2310 and inserted into the target via the insertable distal end 2312. In some instances, the multi-fiber accessory 23 can be delivered to the treatment site. 00B may further include a laser fiber different from the optical fiber 2210 or 2220. The laser fiber can be positioned within the working channel of the endoscope, such as within the shaft. The laser energy generated from the laser source passes through the laser fiber. 2310.

[0135] Exemplary Applications of Laser Systems The laser systems described in accordance with various examples herein may be used to ablate, coagulate, vaporize, or otherwise To improve the effectiveness of laser action, many applications, such as endoscopic hard or soft tissue surgery, It can be used in the example.

[0136] One application of laser systems for tissue surgery applications is laser and plasma devices. Rather than using two different foot pedals, as is often the case with commercially available devices such as The present invention relates to providing effective tissue ablation and coagulation using a laser system. The system emits light at two different wavelengths coupled through fiber into a laser controller. Two or more solid-state laser modules emit light and suggest alternative settings to the user before adjustment UV-VIS reflectance spectroscopy system delivering spectral signals to a feedback analyzer Use the system.

[0137] In one example, emitting at a high tissue absorption wavelength for a more efficient ablation / carbonation process. The first laser module is capable of achieving a penetration depth similar to the diameter of a small capillary. Therefore, the second one can be emitted at a lower tissue absorption wavelength for more efficient coagulation. Two laser modules may be provided, including a first laser module and a second laser module. An example of a laser module is an InXGa1-XN semiconductor emitting in the UV-VIS region, as summarized in Table 1. GaN laser emitting at 515-520nm, InX emitting at 370-493nm Ga1-XN, or IR lasers emitting in the high water absorption range of 1900-3000 nm. An example of a second laser module is a GaX laser emitting at 750-850 nm. It can contain Al1-XA or InXGa1-XA, which emits at 904-1065 nm. Both the first and second laser modules are coupled by a laser coupling system. It can be coupled to a controller.

[0138] The spectroscopic light source can be integrated into a separate fiber channel, a laser fiber, or into the endoscope system. The spectroscopic light source signal reflected from the target can be transmitted to a separate fiber channel or laser. It can be rapidly detected and delivered through a laser fiber to a spectrometer. The system captures spectroscopic signals from an imaging system that includes a detector such as a CCD or CMOS sensor. Based on the spectroscopic system feedback, the signal analyzer can a first or second laser module for detecting target material composition and achieving effective tissue treatment; Used to suggest a system setup and provide suggested setup information to the user. The resulting signal can be delivered to an output system.

[0139] This example shows two optical wavelengths controlled by a feedback analyzer system. By utilizing these laser pulses, tissue ablation and coagulation are possible. Single or multiple light wavelength systems to optimize simultaneous delivery of specific actions to the target. These actions are from the user's point of view. The features described herein allow for wavelengths to be delivered at exactly the same time. The present invention is not limited to the above.

[0140] An exemplary time operation diagram of this laser with spectroscopic feedback is presented in Figure 8. As shown in Figure 8, the amplitude A max The optical feedback signal having The light is then transmitted and reflected from the target surface, where it is detected and analyzed by a signal analyzer. The user then selects to ablate the soft tissue and then turns the second laser off. The first laser can be turned on or the first laser is kept on. During laser operation, the optical feedback signal is generated such that its amplitude exceeds a threshold level A min until it drops to The signal analyzer then changes the laser state to The first laser is turned off and the second laser is turned on. is largely absorbed by the charred tissue, thus ablating the charred tissue and virtually eliminating the charring. The wavelength of the second laser also provides effective coagulation. The amplitude of the feedback pulse is initially at level A. max When this happens, the signal The analyzer changes the laser state again, so that the first laser is turned on and the second laser is turned on. The above process continues until the required amount of tissue ablation and coagulation is achieved. can be repeated with

[0141] Another application of the laser system is to efficiently fragment kidney or bladder stones within a patient. This application concerns a laser lithotripsy process. Multi-wavelength laser energy with wavelengths that are not absorbed is used to heat the target and then It involves a process that uses wavelengths of strong absorption to fragment targets, such as kidney stones. During laser lithotripsy, photothermal action can result in fragmentation of kidney or bladder stones. Capable of absorbing high laser energy and therefore above the threshold for chemical decomposition A rapid temperature rise is induced, resulting in its decomposition and fragmentation. The technique can include a two-stage process. The first stage is a preheating stage. The stone is heated using laser energy of a wavelength of The second step then involves applying laser energy having a second wavelength to the stone. The laser energy absorption by the second wavelength is stronger than that of the first wavelength. This allows for better control of the vapor bubble size and the strength of the shock waves generated compared to the fragmentation process. This makes it possible to reduce the degree of backward movement of the stone.

[0142] In one example, the laser system includes two lasers coupled through a fiber into a laser controller. Two or more solid-state laser modules emitting at different wavelengths and alternate before being aligned A spectroscopy system that delivers spectral signals to a feedback analyzer that suggests settings to the user. The first laser module utilizes a lower temperature for efficient preheating. The second laser module can emit at the wavelength absorbed by water, allowing for more efficient stone cutting. For fragmentation, light can be emitted at wavelengths with high stone / water absorption. The module can produce output at wavelengths with lower mineral or water absorption. The first laser module provides effective and uniform preheating of the stone. Examples of laser sources are GaXAl1-XA, which emit at 750-850 nm, or 904-10 Examples of second laser sources include InXGa1-XA emitting at 65 nm. GaN lasers emitting at 515-520 nm as summarized in 1, or 370-493 nm InXGa1 emitting UV-VIS lasers such as InXGa1-XN lasers emitting at -XN semiconductor laser, emitting in the high water and stone absorption range of 1900-3000 nm It may include an IR laser.

[0143] Both the first and second laser modules are laser-coupled by a laser coupling system. The spectroscopic light source can be connected to a separate fiber channel, laser fiber The spectral light source signal reflected from the target can be , rapidly detected and delivered to a spectrometer through a separate fiber channel or laser fiber. Alternatively, the spectroscopic system may use a detector such as a CCD or CMOS sensor. The spectroscopic signal can also be collected from an imaging system including:

[0144] Based on the spectroscopic system feedback, the signal analyzer detects the target material composition. , the first or second laser module to achieve an effective multi-step stone treatment process Used to suggest a system setup and provide suggested setup information to the user. The laser system can deliver a feedback signal to the output system. Two or more laser modules with optical wavelengths controlled by the analyzer system By utilizing laser pulses of 10000 times, effective stone preheating and fragmentation are simultaneously delivered. However, to optimize simultaneous delivery of specific actions to the target stone composition, Feedback control may also be utilized by one or more optical wavelength systems.

[0145] Yet another application of the laser system is in the treatment of hard tissues, where high laser output power is required. It relates to a process for performing ablation, for example of teeth, bones, etc. Soft tissue laser The effectiveness of the surgery is based on low-temperature water evaporation at 100°C, while the hard tissue cutting process is performed at 5 It requires very high ablation temperatures of around 2,000°C. Therefore, the laser system can combine more laser modules to treat the target. The integrated output power can be increased to a sufficient level. InXGa1-XN semiconductor laser emitting in the V-VIS region, emitting at 515-520 nm GaN, InXGa1-XN emitting at 370-493nm, or 1900-3000nm A laser, such as a 1000 MHz IR laser, can be used as the emission source. The laser source for such a laser module is, for example, a GaAs laser emitting at 750-850 nm. XAl1-XA laser or InXGa1-XA laser emitting at 904-1065 nm may include:

[0146] The laser module can be integrated into the laser controller by a laser coupling system. To achieve the required high power, multiple laser modules are used in the system. The spectroscopic light source can be connected to a separate fiber channel, a laser fiber, The spectral light source signal reflected from the target can be analyzed separately. Rapid detection and delivery through a fiber channel or laser fiber to a spectrometer Alternatively, the spectroscopic system may include a detector such as a CCD or CMOS sensor. Spectroscopic signals can also be collected from an imaging system.

[0147] Based on the spectroscopic system feedback, the signal analyzer detects the target material composition. , laser to achieve an effective multi-step treatment process with the required output power. The module setup and number of laser modules are proposed. A signal can be delivered to an output system that is used to present information to a user. The laser system has an optical wavelength controlled by a feedback analyzer system. Increasing the number of laser modules involved in a treatment process that utilizes two or more laser pulses By increasing the Single or multiple wavelengths of light may be used to optimize simultaneous delivery of specific effects to the target stone composition. Feedback control can also be used by the system. These actions are controlled by the user. can only be simultaneous in terms of wavelengths delivered at exactly the same time. It is not something that can be done.

[0148] The features described herein can be used to provide a method for identifying target compositions. The target can, in some instances, be soft tissue in vivo through the use of surgical accessories. and hard tissues. The accessory can be used to connect a single device containing multiple optical fibers to a at least one fiber providing source radiation and at least one fiber The fiber is intended to guide the reflected light to a spectrometer, allowing the user to monitor the and the composition of the tissue or target, with or without direct endoscopic visualization. This allows for continuous monitoring of the temperature and humidity. The accessory can adjust settings based on the composition of the tissue or target. This feature allows the user to provide feedback to the laser system. This allows instantaneous adjustment of the laser settings within the range of the original laser setting selected. The features described herein can be used in conjunction with a spectroscopic system, the spectroscopic system comprising: It can be used with an optical fiber integrated laser system. capable of transmission through at least one of the fibers in the fiber accessory The light source signal reflected from the target is transmitted to the spectrometer via an additional fiber in the multi-fiber system. It can be rapidly collected and delivered.

[0149] An exemplary method utilizes spectroscopic input data to algorithmically determine the laser delivery system. Calculating and controlling the distance between the distal end of the stem 1701 (e.g., fiber) and the tissue or target. This method can be used to treat soft and hard tissue types in an in vivo surgical process. The distance between the target and the distal end of the fiber is The outer diameter of each fiber and its protrusion from the endoscope can be calculated based on the analysis of the data. The angle affects the intensity of the reflected light that is measured to obtain the spectral data. The features described in the specification allow sequential illumination by lights with different numerical apertures. The distance can be calculated without

[0150] In the case of moving stones, this method allows for distance control and targets that exceed a predetermined threshold. Using steam bubbles in the water to create a suction effect that draws the target to the distal end of the fiber This feature allows the user to adjust or suggest laser operating parameters. Minimal effort is required to maintain an effective therapeutic distance from the target.

[0151] UV-VIS-IR reflectance spectroscopy according to various examples discussed herein can be used to characterize the chemical composition of materials. Generates spectroscopic feedback including analysis and measures reflected light intensity during in vivo diagnostic or therapeutic procedures. It can be used alone or in combination with other spectroscopic techniques to determine the can provide the same information as a color image produced by the eye or a high-resolution camera, Reflectance spectroscopy is a method of measuring the chemical composition and absorption of light. This technique provides information about the material, depending on its surface properties. It is also possible to obtain specific information about both the surface and internal properties of the pull.

[0152] Yet another application of the laser system is to determine the composition of a stone target during laser lithotripsy. According to some examples discussed herein, The endoscope system includes a light source, which projects light to a target within the human body through a light guide of the endoscope. The physician uses a laser to break up the stone under the light from the endoscope system. This situation occurs when a laser system is used to detect stone composition. This can be a bit problematic when using a stone. The light reflected from the stone is weak, and on the other hand, the endoscope system Therefore, analyzing the stone composition under illumination by the endoscope system is difficult. It can be difficult to

[0153] FIG. 26 illustrates the use of a diagnostic beam, such as a laser beam, to identify a target (e.g., a stone). 26 shows an example of an endoscopic system 2600 configured to identify a target composition. System 2600 controls both endoscope light source 2630 and laser generator module 2640. The controller 2650 may include a controller 2650 that can: Entering a command to activate the stone composition detection mode by the physician through the laser system The controller 2650 can then detect the presence of a high Send a command to the endoscope light source 2630 to switch from a high-intensity mode to a low-intensity mode In low-irradiance mode, a reduced dose of radiation is projected onto the target over a specific period of time. During such periods of low or no illumination, the laser system 2640 directs the laser beam toward the target. The detector 2660 can emit a beam and receive the reflected light from the stone. Target discrimination can be performed using the low illumination mode to dim the illumination of the target area. (or turning off the irradiation) to prevent the reflection from the target of the laser beam incident on the target. can be enhanced, which can help improve target discrimination.

[0154] After determining that target identification is complete, detector 2660 sends a termination command to controller 2660. 650. The controller 2650 can then send the can send a command to switch from low illumination to high illumination mode again. indicates that the endoscope light source 2630 is to be turned off or switched from a high illumination mode to a low illumination mode. When a command to switch is received, the image processor in the endoscope system 2600 2670 captures a still image of the target and displays the still image on the monitor of the endoscope system during that period. 11A-11B. Variations of the endoscopic system 2600 for identifying targets are also contemplated.

[0155] FIG. 27 may include a first pulse train 2710 and a second pulse train 2720. Graphs of laser pulse sequences with different pulse energies or power levels, such as 2700. The pulses in the second pulse train 2720 are pulses that are the same as the pulses in the first pulse train 2710. The first pulse train 2710 and the second pulse train 2711 have a higher energy or power level than the first pulse train 2712. The laser train 2720 may be generated by a respective laser source, each of which may be located at the distal end of the endoscope. The first pulse train 2710 can be emitted from the end in the form of a laser beam. is substantially constant over a specific period of time (e.g., controlled by the user), etc. The second pulse train 2720 can be generated after the first pulse train 2710 is delivered. For example, the second pulse The train 2720 is between two pulses in the first pulse train 2710 or between two pulses in the first pulse train 2710. 27, the first pulse can be delivered between two rows of 710. The pulses in train 2710 have a constant energy or power level, and the second pulse train 2 720 is a pulse train having a higher energy or power level than the first pulse train 2710. In some examples, the second pulse train 2720 includes only pulses. 2710 may contain two or more pulses with higher energy or power levels. Cut.

[0156] The sequence of laser pulses shown in Figure 27 is used to crack and fracture stone structures, e.g., in kidneys. It can be used with a laser lithotripsy system to provide fragmentation. As shown, the sequence represents time in the X direction of the graph, but not the location on the stone or other target. The laser pulse sequence is annotated by "A" and "B". is the spatial and temporal pattern of laser pulses with different pulse energies or power levels. In this example, location "A" is at or near the center of a stone or other target, and location "B" is at or near the perimeter of a stone or other target. Between location "A" and location "B" The laser pulses delivered to the actuator may include using an actuator, e.g. When the laser fiber 140 is translated from location "A" to location "B", or Pulses transmitted as fiber 140 is translated from location "B" to location "A" The first pulse train 2710 creates a crack in the target stone without fragmenting it. Thus, in FIG. 27, the first such pulse train 2710, starting from location "A" and moving towards the center of the stone, Proceed towards the periphery of the stone to location "B", then return to location "A" in the center of the stone, at which point , deliver a higher energy pulse 2720 in the first attempt to fragment the target stone. If such fragmentation by a higher energy pulse 2720 is not successful, If so, a further first pulse train 2710 can be delivered, possibly towards the center of the stone. From there, proceed to the periphery of the stone to location "B", then return to location "A" in the center of the stone, and At this point, another higher energy pulse 272 was fired in a second attempt to fragment the target stone. 0 can be delivered. Further repetitions are possible. The "B" can be used for various iterations, and different iterations Location "B" is a location that has such a route from location "A" to such a different surrounding location "B". The effect of the second pulse train 2720 on the adjacent tissue is maximized. Higher energy pulses only when directed towards the center of the stone for minimizing It may be preferable to use 20.

[0157] In some examples, the lasers shown in FIG. 27 have different pulse energies or power levels. A sequence of laser pulses is delivered by the endoscopic system to provide hemostasis or coagulation at the target site. In one example, a first pulse train 2710 and a second pulse train 2720 may be arranged, for example, in a time alternating fashion, to facilitate an efficient hemostasis or clotting process. It can be delivered to a target site in a spatiotemporal pattern.

[0158] A first pulse train 2710 and a second pulse train 2720 may be used to stimulate the brain with different energies or powers. The pulse having a low level is generated by a user-operable action such as a button or foot pedal. For example, a user can controllably activate a first A first pattern is generated using an activation pattern (e.g., a single press of a button or foot pedal). The delivery of the pulse train 2710 can be activated by a second activation pattern (e.g., a button or A second pulse train 2720 can be initiated using a second depress of the foot pedal. In one example, the first pulse train 2710 and the second pulse train 2720 can each be Additionally or alternatively, the first power supply may be controlled via a separate actuator. The first pulse train 2710 and the second pulse train 2720 are generated based on a feedback signal from the target or the like. For example, a spectrometer can automatically and controllably activate a target spectrometer. The spectroscopic data can be collected and a feedback analyzer can analyze the spectroscopic data to determine the stone structure. The composition of different parts of the structure can be distinguished at least based on such distinction. , to different portions of the target each having a distinct composition, A different energy pulse can be delivered, such as a second pulse train 2720.

[0159] FIG. 28 illustrates a system for implementing any one or more of the techniques (e.g., methods) discussed herein. 28 generally illustrates a block diagram of an exemplary machine 2800 capable of performing the Computing framework for various parts of the laser treatment system according to the examples discussed herein It can be applied to the workpiece.

[0160] In alternative embodiments, machine 2800 may operate as a stand-alone device, or can be connected (e.g., networked) to other machines. In this configuration, machine 2800 acts as a server machine in a server-client network environment. It may operate in the capacity of a client machine, a client machine, or both. 00 is a peer machine in a peer-to-peer (P2P) (or other distributed) network environment. The machine 2800 can be implemented as a personal computer (PC), a tablet, Lat PC, Set-Top Box (STB), Personal Digital Assistant (PD A) Mobile phones, web appliances, network routers, switches or bridges The machine is capable of executing instructions (sequential or otherwise) that specify the actions that the machine should take. Furthermore, although only a single machine is shown, the term "machine" is used interchangeably with "machine." The term "machine" also applies to cloud computing, software as a service (S any one or more of the methods discussed herein, such as aaS, other computer cluster configurations, etc. Any one of the above may individually or jointly execute one or more sets of instructions to perform the above. shall be construed to include group machines.

[0161] The examples described herein may include logic or multiple components or mechanisms, or logic or a set of components or mechanisms. embodied in tangible entities, including hardware (e.g., simple circuits, gates, logic, etc.) The membership of the circuit set is flexible over time and The set of circuits, when in operation, performs specified operations, either singly or in combination. In one example, the hardware of the circuit set includes components that can perform specific operations. It can be immutably designed to perform certain operations (e.g., hardwired). In a computer, the hardware of a set of circuits is physically modified to encode specific operational instructions. computer-readable media (e.g., magnetically, electrically, or magnetically movable, of immutable dense particles) variably connected physical components (e.g., execution units, transistors, etc.) When connecting physical components, hardware The underlying electrical properties of the component are changed, for example from an insulator to a conductor, or vice versa. These instructions, when executed, are executed by embedded hardware (e.g., execution units or logic units). The loading mechanism (or the like) controls the circuit settings via variable connections to perform specific parts of the operation. It is possible to create components of the set in hardware. The body is communicatively coupled to other components of the circuit set member when the device is operating. In one example, two or more members from two or more circuit sets may have different physical components. For example, under operation, an execution unit may be In this case, the first circuit of the first circuit set may be used, and at different times, the second circuit may be used. by a second circuit of one circuit set, or by a third circuit within the second circuit set; Can be used again.

[0162] The machine (e.g., computer system) 2800 includes a hardware processor 280 2 (e.g., Central Processing Unit (CPU), Graphics Processing Unit (GPU), Hardware hardware processor core, or any combination thereof), main memory 2804, and static memory memory 2806, some or all of which may be interlinked (e.g. For example, the machines 2800 can communicate with each other via a bus 2808. Ray unit 2810 (e.g., raster display, vector display, holographic graphic display, etc.), alphanumeric input device 2812 (e.g., keyboard ), and a user interface (UI) navigation device 2814 (e.g., In one example, the display unit 2810, the input device The UI navigation device 2812 and the UI navigation device 2814 are touch screen displays. The machine 2800 may include a storage device (e.g., a drive unit) 2816, a signal generating device 2818 (e.g., a speaker), a network interface interface device 2820, and a global positioning system (GPS) sensor, The device may further include one or more sensors 2821, such as a rectifier, an accelerometer, or other sensor. The machine 2800 can be connected to one or more peripheral devices (e.g., a printer, a card reader, Serial (e.g., universal serial bus) interfaces are used to communicate with or control such devices. USB, parallel, or other wired or wireless (e.g., infrared) Including an output controller 2828 for infrared (IR), near field communication (NFC), etc. can be done.

[0163] The storage device 2816 may include machine-readable media 2822, 22 includes a computer system that implements any one or more of the techniques or functions described herein or that One or more of the techniques or functions described in the specification A data structure or instruction set 2824 (e.g., software) is stored. 24 also stores, during its execution by the machine 2800, in main memory 2804, static memory 2806, resident entirely or at least partially within the hardware processor 2802 In one example, a hardware processor 2802, a main memory 2804, a static memory 2806, or storage device 2816, or any combination thereof, may include a machine-readable medium. It can be configured.

[0164] Although the machine-readable medium 2822 is shown as a single medium, it is also referred to as a "machine-readable medium." The term refers to a single medium or multiple media configured to store one or more instructions 2824. (e.g., centralized or distributed databases and / or associated caches and The server may include:

[0165] The term "machine-readable medium" refers to a medium that implements any one or more of the techniques of this disclosure on a machine 2800. capable of storing, encoding, or carrying instructions for execution by the executing machine 2800. or data used by or accompanying such instructions The present invention may include any medium capable of storing, encoding, or transporting data structures. Non-limiting examples of machine-readable media include solid-state memories, and optical and magnetic media. In one example, the dense machine-readable medium may have a constant (e.g., stationary) mass. Accordingly, the dense machine-readable medium may be , not a transitory propagating signal. A particular example of a dense machine-readable medium is a semiconductor memory device. Electronically programmable read-only memory (EPROM), electrically Removable Programmable Read-Only Memory (EPSOM) and Flash memory devices non-volatile memory such as hard disks, magnetic disks such as internal hard disks and removable disks may include magnetic optical disks, and CD-ROM and DVD-ROM disks. Cut.

[0166] Instructions 2824 may be used to communicate over multiple transmission protocols (e.g., frame relay, internet Protocol (IP), Transmission Control Protocol (TCP), User Datagram Protocol ( UDP (User Datagram Protocol), Hypertext Transfer Protocol (HTTP), etc.) A communication network using a transmission medium is connected via a network interface device 2820. The data may be further transmitted or received by a network 2826. Networks are particularly known as local area networks (LANs), wide area networks (WLANs), and (WAN), packet data networks (e.g., the Internet), mobile phone networks Networks (e.g., cellular networks), Plain Old Telephony e (POTS) networks, and wireless data networks (e.g., WiFi (registered) (trademark) of the Institute of Electrical and Institute of Electronics Engineers (IEEE) 802.11 family of standards, IEEE802.16 family of standards, known as WiMax (registered trademark), IE EE802.15.4 family of standards, including peer-to-peer (P2P) networks In one example, the network interface device 2820 may One or more physical jacks (for example, Ethernet, coaxial) to connect to the 2826 or phone jack) or one or more antennas. The network interface device 2820 can be a single-input multiple-output (SIMO), multiple-input multiple-output (MIMO), or Multiple Input, Single Output (MIMO), or Multiple Input, Single Output (MISO) techniques. The term "transmission medium" refers to a medium that transmits radio waves over a network. Any device capable of storing, encoding, or carrying instructions for execution by machine 2800 shall be construed to include any intangible medium, including any software, software, or other media used to facilitate communication of such software. This includes digital or analogue communications signals or other intangible media for the purpose of

[0167] Additional notes The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. For purposes of illustration, specific embodiments are shown in which the invention may be practiced. These embodiments may also be referred to as "examples." Such examples may include elements other than those shown or described. However, the inventors have recognized that examples in which only the elements shown or described are provided. Furthermore, the inventors have not specifically contemplated the use of the invention for a particular example (or one or more aspects thereof) or may be used with respect to other examples (or one or more aspects thereof) shown or described herein. Examples (or one or more aspects thereof) using any combination or permutation of the described elements are also contemplated. do.

[0168] As used herein, the terms "a" or "an" are used interchangeably, as is common in patent documents. without relying on any other instance or use of "at least one" or "one or more." It is used herein to include one or more than one. The term "or" is used to refer to a non-exclusive "or," so "A or B" is used to refer to alternatives. Unless otherwise indicated, this includes "A but not B," "B but not A," and "A and B." In the Specification, the terms "including" and "in which" are interchangeable with "comprises" and "where "ein" is used as the plain English equivalent of each term. In the claims, the terms "including" and "comprising" are open-ended, i.e., i.e., a system, device, or the like that includes elements other than those recited after such term in a claim. Any device, article, composition, structure, or process is also considered to be within the scope of the claims. Furthermore, in the following claims, terms such as "first," "second," and "third" shall mean They are used only as labels and are not intended to impose numerical requirements on their subjects. .

[0169] The above description is intended to be illustrative rather than limiting. For example, the above examples (or One or more aspects thereof may be used in combination with each other. For example, other embodiments may be utilized in light of the above description. 37 CFR § 1.72(b) to enable the reader to quickly ascertain the nature of the technical disclosure. The Abstract is provided to enable the reader to interpret or clarify the scope or meaning of the claims. It is submitted with the understanding that it is not intended to be limiting. In the detailed description, various features may be grouped together to streamline the disclosure. This is because an unclaimed feature of the disclosure is essential to any claim. To the contrary, the present subject matter is not intended to be limited to the specific disclosed implementations. It is possible to include in the scope less than all features of the embodiments. The ranges are hereby incorporated into the detailed description as examples or embodiments and are incorporated into each claim. The clauses may stand alone as separate embodiments and such embodiments may be combined in various ways. It is contemplated that the invention may be combined with other methods in any combination, permutation, or combination. Reference is made to the appended claims for full consideration of the full range of equivalents to which such claims are entitled. This should be determined along with the scope.

Claims

1. 1. A method of providing laser treatment to a target, comprising: generating a first laser pulse train according to a first laser energy level; a second laser pulse according to a second laser energy level higher than the first laser energy level; generating a sequence of The first laser pulse train and the second laser pulse train are directed from the distal end of the endoscope to the target. Steps for aiming at the target; A method comprising:

2. 10. The method of claim 1, the first train of laser pulses is generated substantially constantly over a specific time period; A method characterized by:

3. 3. The method of claim 2, While the first laser pulse train is being generated, the second laser pulse train generated intermittently over a period of time, A method characterized by:

4. The method according to any one of claims 1 to 3, The second laser pulse train is timed to be two pulses of the first laser pulse train. Located between A method characterized by:

5. The method according to any one of claims 1 to 4, generating a third train of laser pulses according to the first laser energy level; Including, The second laser pulse train is timed to be different from the first laser pulse train and the third laser pulse train. Located between the pulse train, A method characterized by:

6. The method according to any one of claims 1 to 5, directing the first and second trains of laser pulses at a stone structure; Including, A method characterized by:

7. 7. The method of claim 6, the first train of laser pulses is configured to form cracks in a surface of the stone structure; The second laser pulse train induces fragmentation of the stone structure after the fissure is formed. configured to cause A method characterized by:

8. The method according to any one of claims 1 to 7, Targeting the first and second laser pulse trains for hemostasis or coagulation including the step of directing the A method characterized by:

9. at least one processor; at least one non-transitory memory containing computer program code; An apparatus comprising: The at least one non-transitory memory and the computer program code and causing the device, by at least one processor, to: The laser system emits a first train of laser pulses according to a first laser energy level. and subjecting the laser beam to a second laser energy level higher than the first laser energy level. causing a second train of laser pulses to be emitted; The first and second laser pulse trains are directed from the distal end of the endoscope to a target. configured to direct An apparatus characterized in that

10. 10. The apparatus of claim 9, the first laser pulse train is substantially constant over a particular time period; An apparatus characterized in that

11. 11. The apparatus of claim 10, While the first laser pulse train is being generated, the second laser pulse train released intermittently over a period of time, An apparatus characterized in that

12. The device according to any one of claims 9 to 11, The at least one non-transitory memory and the computer program code and controlling the device by at least one processor to time the first laser pulse train. and generating the second laser pulse train positioned between two of the pulses. can be, An apparatus characterized in that

13. 10. The apparatus of claim 9, The at least one non-transitory memory and the computer program code and at least one processor causing the device to perform a first laser energy level. a third laser pulse train is generated by the first laser pulse train and the third laser pulse train is generated by the second laser pulse train. and generating the second laser pulse train positioned between the first and second laser pulse trains. Ru, An apparatus characterized in that

14. The device according to any one of claims 9 to 13, The at least one non-transitory memory and the computer program code and at least one processor for controlling the device to generate the first laser pulse train and the configured to deliver a second train of laser pulses to the stone structure; the first train of laser pulses is configured to form cracks in a surface of the stone structure; The second laser pulse train induces fragmentation of the stone structure after the fissure is formed. configured to cause An apparatus characterized in that

15. The device according to any one of claims 9 to 14, The at least one non-transitory memory and the computer program code and at least one processor for controlling the device to administer the first level of hemostasis or coagulation. and configured to deliver the first and second laser pulse trains to the target tissue. An apparatus characterized in that

16. A program of instructions that is machine-readable and executable by the machine to perform operations. a non-transitory program storage device tangibly embodying a program, the operation comprising: generating a first laser pulse train according to a first laser energy level; a second laser pulse according to a second laser energy level higher than the first laser energy level; generating a sequence of The first and second laser pulse trains are directed from the distal end of the endoscope to a target. Steps to direct 1. A non-transitory program storage device comprising:

17. 17. The non-transitory program storage device of claim 16, the first train of laser pulses is generated substantially constantly over a specific period of time; While the first laser pulse train is being generated, the second laser pulse train generated intermittently over a period of time, A non-transitory program storage device comprising:

18. 18. A non-transitory program storage device according to claim 16 or 17, comprising: said operating to generate a third laser pulse train according to said first laser energy level; This includes: The second laser pulse train is timed to be different from the first laser pulse train and the third laser pulse train. Located between the pulse train, A non-transitory program storage device comprising:

19. A non-transitory program storage device according to any one of claims 16 to 18, comprising: The operation includes transmitting the first and second laser pulse trains to a stone structure. including reaching the first train of laser pulses is configured to form cracks in a surface of the stone structure; The second laser pulse train induces fragmentation of the stone structure after the fissure is formed. configured to cause A non-transitory program storage device comprising:

20. A non-transitory program storage device according to any one of claims 16 to 19, comprising: The operation comprises combining the first and second laser pulse trains for hemostasis or coagulation. delivering the nucleotide sequence to the target tissue; A non-transitory program storage device comprising:

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