Automatic laser setting adjustment

Abstract

To provide a laser system with the ability to receive or determine ranges for settings of a laser and to determine the need for updates or adjustments to the settings based on conditions experienced or encountered during a medical procedure.SOLUTION: The processor may receive a range for at least one setting of the at least one laser at which the at least one laser may operate. The processor can further determine a proposed update value for the at least one setting and determine that the proposed update value is within the range. A display of the proposed update value and an option for the user to accept or reject the proposed update value may be provided on the user interface. In response to the acceptance, at least one setting may be adjusted based on the proposed update value. In response to not being rejected within a predetermined period of time, the processor may adjust the at least one setting or cease adjusting the at least one setting.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] Priority claims This application claims the benefit of priority to U.S. Provisional Patent Application No. 63 / 364,460, filed May 10, 2022, the contents of which are incorporated herein by reference.

[0002] The present disclosure relates to laser settings during medical procedures using laser radiation. [Background technology]

[0003] Laser systems are used during both therapeutic and diagnostic medical procedures, for example, in systems where laser fibers are used as part of an in-vivo endoscopic system. During surgical laser procedures, such as laser lithotripsy, a laser is used to ablate or cut tissue or to reduce stones, such as kidney or gallstones, into small pieces that can be naturally removed from the body or actively removed with a retrieval device or by flushing with a solution such as saline. Summary of the Invention [Problem to be solved by the invention]

[0004] Depending on the type of medical procedure being performed, it may be necessary to change or adjust the intensity of the laser being used for that procedure. The amount of time it takes to shrink a stone or treat tissue can be reduced by using laser settings optimized for the specific type of stone or tissue being targeted. For example, during the ablation of a "concrete" (stone), such as a kidney stone or gallstone, the composition of the stone may change from a hard material to a soft material, or vice versa. For example, a stone may be composed partially of calcium oxalate and calcium phosphate, thus having a hard "shell" and a soft "core." In another example, a patient may have multiple kidney stones, some stones may be formed from calcium oxalate, others from calcium phosphate, and still others from uric acid. Different laser intensities may be required for each stone type to efficiently break down the stones (e.g., reduce their size and / or break them into dust) so that they can pass through the body or be otherwise removed. Other procedures may involve a physician applying laser energy to a portion of tissue, such as bladder tissue, which may require a different laser type and / or laser intensity than that used to destroy or shrink stones. [Means for solving the problem]

[0005] The present inventors have recognized a need for, among other things, a laser system capable of receiving or determining ranges for laser settings and determining the need for updates or adjustments to the settings based on conditions experienced or encountered during a medical procedure, e.g., during the procedure. The laser system can include a processor or processing circuit capable of receiving ranges for at least one setting for a laser included in the laser system on which the laser can operate. The processing circuit can be included as part of the surgical laser system or as a component of a computer or machine to which the laser is coupled or connected. The at least one setting can include the wavelength or intensity of the laser radiation, a power setting, a spot size of the laser, a pulse width of the laser, a duty cycle of the laser pulse, or any available setting or parameter of the laser. The ranges for the settings can be based on the type of procedure being performed and can be determined, input, or obtained prior to the procedure. For example, the ranges for the settings can be entered by a physician or user into a graphical user interface (GUI) included as part of or connected to the laser system, and / or can be obtained from a patient file retrievable by the processing circuit from a database or server connected to the laser system (or the machine to which the laser system is connected).

[0006] The laser system can receive confirmation for the user or otherwise determine that the laser can automatically operate within a range. For example, the laser can automatically tune to a different wavelength within a predetermined range of wavelengths, e.g., set by the user. The system can determine the need for a change or adjustment to the settings and indicate a proposed updated value for the settings. The proposed updated value can be a different value within the range from the current value. For example, the laser wavelength range can be from 700 nanometers (nm) to 900 nm, and the current value of the wavelength can be set to 750 nm. The system can determine that the wavelength should be updated to 900 nm and provide an indication on the GUI, e.g., through a message popping up on the GUI. The system can include an option for the user to accept or reject the proposed updated value as part of the indication or separately from the indication. For example, the message popping up while providing the indication can include an accept or reject button. In response to the proposed updated value being accepted by the user within a predetermined time (e.g., a set period such as 10 seconds) or not rejecting the proposed updated value, the laser system can adjust the laser settings based on the proposed updated value.

[0007] Thus, the system may include one or more of the following features, which are discussed in more detail below. i) "Laser Interlocking" which allows laser emission to be temporarily stopped or disabled while the laser settings are updated and then resumed after receiving a command from the laser system and / or acceptance of the new settings by the user; ii) automatic adjustment of laser settings, which can adjust one or more settings of the laser within a range based on the composition of the target, changes in the composition of the target (e.g., based on spectroscopic analysis of the target), or any other relevant parameters; iii) prompted laser settings adjustment, in which the laser system may suggest or recommend adjustments to one or more laser settings to the user and prompt the user to accept or reject the new, updated settings; and / or iv) A target analysis information display that displays information about the target (or changes to the target) on a GUI and can be updated in real time during treatment.

[0008] In auto-adjust mode, the system can provide the user with a display or notification of the new laser settings, for example, via a pop-up screen on the GUI, allowing the physician to accept or cancel the adjustment. During this time, laser interlocking can be used to lock or disable the laser system, preventing the laser from beating or firing. If the user accepts the changes, the laser can remain locked until an adjustment is made, and then laser emission can resume under the new settings. If the user cancels or rejects the adjustment, laser emission can resume under the current laser settings. However, if the user does not respond to the display (e.g., the user does not affirmatively accept the adjustment but does not reject it within the time period), the system can automatically adjust the settings and resume laser emission without additional user interaction as long as the user continues to engage in laser emission (e.g., a footswitch remains depressed, a button or trigger is pressed, etc.). Thus, auto-adjust mode provides an approach that allows the system to automatically adjust the laser settings if the proposed values ​​are within a predetermined, safe range and the user does not object to the adjustment.

[0009] Conversely, in prompt adjustment mode, if the user does not respond to or ignores the indication but does not affirmatively abort the adjustment, no changes will be made to the current laser settings. In short, in automatic adjustment mode, the laser settings will change when the user either affirmatively accepts the new settings or does not reject the new settings within a period of time (e.g., 2 seconds, or any suitable or desired time frame). In prompt adjustment mode, the laser settings will only change if the user affirmatively accepts the changes. Laser interlocking and / or targeting information can occur in either automatic adjustment mode or prompt adjustment mode.

[0010] The terms "physician" and "user" are used interchangeably herein and are understood to include any person who may be operating a laser system. It is also understood that the terms "laser system" and "system" are used interchangeably.

[0011] In the drawings, which are not necessarily drawn to scale, like numerals may refer to similar components in different figures. Like numerals with different letter suffixes may represent different instances of similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document. [Brief explanation of the drawings]

[0012] [Figure 1] 1 illustrates an example of a system for automatic laser tuning. [Figure 2] 1 illustrates an example method for automatic adjustment of a laser system. [Figure 3] 1 is a flow chart for the operation of the laser tuning system. [Figure 4] 1 is a block diagram illustrating an example of a machine in which one or more embodiments may be implemented. [Figure 5] 1 shows a schematic diagram of an exemplary computer-based clinical decision support system (CDSS). DETAILED DESCRIPTION OF THE INVENTION

[0013] Lasers are used in medical procedures, particularly to reduce stones, such as kidney stones or gallstones, into smaller fragments that can pass naturally through the body or be actively removed. The amount of time required to reduce a stone varies depending on factors such as the stone's material composition, and the amount of time required to reduce or destroy a stone can be reduced by adjusting the laser settings to optimize for the specific type of stone being targeted. For example, lasers emitting high pulse energy and low frequencies may be appropriate for stones primarily structured or composed of calcium phosphate, while lasers emitting low pulse energy and high frequencies may be appropriate for stones primarily structured or composed of calcium oxalate.

[0014] Furthermore, stone compositions can be heterogeneous, such that the exterior (e.g., outer shell) of a stone may have a different material composition or density than the interior or inner volume. In such instances, different laser settings may be optimal when ablating or treating the outer shell than when treating the inner volume to most effectively reduce the stone. Therefore, a system that can identify stone composition and automatically adjust laser settings when the stone composition changes from one material to another or from one density to another, such as changing from calcium oxalate to calcium phosphate, is desired. This would allow a physician to ensure that heterogeneous stones are reduced while consistently delivering optimal laser energy, both in intensity and frequency.

[0015] In one example, the system can notify or prompt the physician to make adjustments to the laser settings, for example, through a graphical user interface (GUI). For example, if the system detects a change in stone composition, the system can notify the physician on a display that the stone composition has changed and that adjustments to the laser settings should be made. The notification can be as a recommendation to the physician to change from the current laser settings to new laser settings, with input from the physician accepting or approving the changed settings required. Additionally, information about the stone or any other target can be displayed on the same monitor or display showing the endoscopic video of the laser procedure, minimizing or eliminating the need to redirect the physician's focus from the endoscopic view to a different monitor.

[0016] Another medical procedure in which a laser system can be used is one in which soft tissue (as opposed to stones) is treated, such as during treatment for benign prostatic hyperplasia (BPH). For example, BPH treatment may involve using a laser to cut into an adenoma while avoiding the prostate capsule so as not to puncture it. The system can automatically measure the type of tissue being targeted by the surgical fiber and disable laser emission while the capsular tissue is being measured. In another example, instead of a stone or enlarged prostate, the target may be a tumor, such as a cancerous tumor on an organ like the bladder. In such an example, the system can automatically disable laser emission when non-cancerous tissue is being detected or treated.

[0017] When using a laser fiber to automatically shut off laser emission and / or change laser settings optimized for a particular tissue, whether treating soft or hard tissue, it is desirable to 1) change the laser settings to settings determined (e.g., by a physician) to be safe for the particular patient being treated, and 2) notify the physician when the system determines that the target or tissue has changed and to what extent. The change in target or tissue can be determined, for example, by receiving information from a spectroscopy system connected or communicatively coupled to the laser system.

[0018] Such a system represents an improvement over existing medical laser systems that do not include an automatic interlocking system and / or an automatic laser adjustment system that responds to changing targets. Laser procedures performed with existing systems suffer from inefficient treatment procedures, long treatment times, and inefficient treatment results. These efficiency issues are exacerbated when dealing with targets or tissues, and the treatment is highly dependent on the physician's skill and experience level. The laser system of the present disclosure provides the physician with the opportunity to override the system's decisions and / or recommendations to make changes to one or more settings of the laser and / or to limit the system to make changes to laser settings within certain ranges determined by the physician to be safe for a particular patient. The physician can request that their confirmation be provided before any changes to laser settings are made. Furthermore, the system can be set or configured to operate in an automatic or semi-automatic mode for a predetermined time or for predetermined limits, such as a time limit, a total energy delivery limit, the duration of a single treatment, or any other duration or limit desired or appropriate.

[0019] In one example, even when operating in an automatic mode, the laser system may provide an alert or notification to the physician that one or more settings will be changed and provide the physician with an opportunity to discontinue laser emission by, for example, releasing a footswitch or foot pedal if the physician disagrees with the new settings or wishes to delay implementation of the new settings. In another example, in a semi-automatic mode, before a setting change, the system may provide a display on the GUI requesting approval for the change to the new settings. In such an example, the change to the new settings may be implemented once approved by the physician or if the system does not receive a rejection of the new settings from the physician within a predetermined time or period.

[0020] Example implementations of the system may include:

[0021] Interlocking the laser emission ("laser interlocking"). This can include temporarily ceasing or stopping the laser emission and then resuming it after receiving a command, for example, from the spectroscopy system. For example, the 1940 nm laser emission can be stopped and then resumed within 50 milliseconds (ms) after receiving a command. In such an example, as long as the physician continues to press the footswitch, the laser emission can resume without requiring any other physician or user interaction with the system. The GUI can indicate to the physician when the laser is interlocked, for example, through a message or graphic on the GUI.

[0022] Automatic laser setting adjustment (“auto-tuning”) mode. This can include automatically adjusting laser settings based on spectral signature information about the target received from the spectroscopy system. Such spectral signature information about the target can be used by the processor to determine updated laser settings or one or more updated ranges for one or more laser settings. In various embodiments, before and / or during a medical procedure, the system processor can be requested by a physician, e.g., via a GUI, to provide ranges of settings to which the laser system may automatically adjust. The system processor can (i) compare the updated settings with values ​​to which the laser system may automatically adjust, and (ii) verify that the laser system is capable of operating in auto-tuning mode within these physician-specified or physician-approved ranges. Once verified, the laser system can automatically adjust based on the determined updated settings. In some embodiments, information about the updated laser settings or ranges can be presented to the physician via the GUI, e.g., on a pop-up or pop-out screen on the GUI. The system processor can also provide the physician with an opportunity to approve or abort the adjustment (e.g., by indicating to the physician that new settings will be implemented and requesting physician approval before performing such updates). For example, the pop-up screen can include one or more buttons, such as an accept or deny button, a yes or no button, or any similar button that allows the physician to approve or abort the adjustment. In an auto-adjust mode, when the physician ignores the pop-up screen and does not cancel or exit the pop-up screen for a predetermined period or time (e.g., 10 seconds), the system can automatically adjust to the new or updated proposed laser settings. The system can then temporarily interlock the laser emission, adjust or change the existing laser settings to the new settings, and then resume laser emission without further interaction as long as the physician continues to press the footswitch.

[0023] On-demand laser setting adjustment, (“on-demand adjustment”) mode. This can include adjusting the laser settings to those received from the processor, for example, based on target spectral signature information from the spectroscopy system. The processor can trigger the adjusted settings to be displayed on the GUI. In such an example, the physician can be requested to provide a range of settings within which the laser system can propose new settings. The physician can confirm that the laser system can operate in on-demand adjustment mode within the range specified by the physician. The system can then propose new settings for the laser, for example, based on updated spectral signature information for the target received from the spectroscopy system. The system can request the physician to affirmatively select the proposed new laser settings to apply and implement the proposed new laser settings. For example, this can involve the physician approving the proposed laser settings on the GUI. The proposed settings can be shown to the physician, for example, through a pop-up screen or box on the GUI. In one example, if the physician ignores or dismisses the pop-up screen (for a predetermined period or time, such as 10 seconds), no changes to the currently emitting laser settings are made in the on-demand adjustment mode. When the physician affirmatively chooses to apply the proposed settings (or not reject them), the system temporarily interlocks the laser emission, adjusts the laser settings to the new settings, and can resume laser emission without additional user interaction as long as the footswitch remains depressed. Thus, the proposed adjustment mode provides an approach that allows the system to adjust the laser settings only if the proposed values ​​are within predetermined, safe ranges and the user affirmatively accepts the proposed adjustments.

[0024] Target analysis information display ("target information"). This can include using the GUI to display information about the target received from the spectroscopy system and / or processor (e.g., on the treatment and emission screens). For example, the GUI can display the estimated or measured composition of the target stone or soft tissue type, which can be updated when changes in the target or tissue type are detected.

[0025] FIG. 1 illustrates an example of portions of a system 100 for automated laser adjustment. The system 100 can include a surgical laser 102. The system can include a graphical user interface (GUI) 104. The GUI 104 can include a touchscreen or other input mechanism (e.g., a button, switch, or other similar actuation member on the handle of an endoscope) configured to operate, control, etc., the surgical laser 102. The surgical laser 102 can include one or more laser sources configured to emit laser radiation. As shown by the dotted box in the example of FIG. 1, the laser sources can include an ablation laser 106 and / or a probe laser 108. The ablation laser 106 can emit infrared radiation, while the probe laser 108 can emit an aiming or illumination beam of visible light (e.g., from a light-emitting diode (LED)) to indicate where the tip of the scope (and thus the ablative energy from the ablation laser 106) should be aimed or can be used to illuminate a target 126. The target 126 can be a piece of tissue, a fragment, or an object, such as a kidney stone, to be ablated, etc. Thus, the light emission 128 can be emitted from the ablation laser 106 or the probe laser 108 independently of each other or in conjunction with each other, meaning that the light emission 128 emitted from the surgical laser can be visible, invisible, or both (e.g., a combination of infrared and visible light).

[0026] The light emission 128 from the laser sources 106, 108 can be emitted through an optical fiber 116, which can be connected to the surgical fiber 118 via an optical connector 120. In one example, the structure of the surgical fiber 118 can be the same as or different from that of the optical fiber 116. The surgical fiber 118 can be located completely or partially outside the surgical laser 102. The light emission 128 can thus be emitted from the laser sources 106, 108, through the optical fiber 116, the optical connector 120, and the surgical fiber 118 to a distal end of the surgical fiber 118, which can be inserted into a scope 124, such as an endoscope, ureteroscope, laryngoscope, etc. In one example, at least a portion of the light emission 128 emitted from the distal end of the surgical fiber 118 and the scope 124 can be reflected (reflected light 130) from the target 126 through a medium between the tip of the scope 124 and the target 126.

[0027] The surgical laser 102 can further include or be coupled to an optical component, such as an optical splitter 110 configured to collect at least a portion of the reflected light 130 that passes through an aperture in the surgical fiber 118. In one example, the optical splitter 110 can be replaced with a dedicated fiber configured to collect at least a portion of the reflected light 130. In one example, the portion of the reflected light 130 collected by the optical splitter 110 or the dedicated fiber can be sent to a processor 112 associated with the surgical laser 102. A photodetector 132 (e.g., a spectrometer) can be disposed between the optical splitter 110 and the processor 112 and can perform a spectroscopic analysis of the reflected light 130 to determine one or more characteristics of the target 126, such that a determination can be made (e.g., by the processor 112) whether one or more laser settings should be adjusted. Prior to a medical procedure, ranges for one or more settings for the laser sources 106, 108 can be provided to or received by the processor 112. In one example, the setting can be the intensity or amount of energy of the laser light or laser radiation to be emitted from one of the laser sources 106, 108, and the range can be the intensity values ​​(e.g., an upper threshold or upper limit and a lower threshold or lower limit, and values ​​therebetween) at which the ablation laser 106 and / or the probe laser 108 can operate. In another example, the setting can be the wavelength of the laser, and the range can be an upper wavelength threshold, a lower wavelength threshold, and values ​​therebetween. In such an example, because adjusting the wavelength of a single diode is generally not easily accomplished, changing the wavelength value can include switching to a second laser diode with a higher or lower wavelength than the currently active or in-use laser diode. In yet another example, the setting can be the pulse width or duty cycle of the emitted laser light.

[0028] In one example, the processor 112 can receive confirmation, for example from a physician, that the laser can automatically operate within range. The range or range limits can be determined based on at least one of the type of organ that the scope 124 is proximate to (e.g., whether the scope is on or outside the kidney), characteristics of the organ that the scope 124 and / or surgical fiber 118 are proximate to (e.g., whether the organ contains healthy tissue or a target to be ablated), the type of laser fiber included in the surgical laser 102 or used during the medical procedure, and the type of medical procedure for which the system 100 is being used.

[0029] In one example, the portion of the organ can be determined based on any suitable image recognition technique performed on images from an imaging device connected to the scope 124. For example, a camera can be connected to the scope 124 to capture images (e.g., still or video), and the system 100 can perform the image recognition technique to determine which portion of the patient's organ the scope 124 (or a portion of the scope 124, such as the tip of the scope 124) is currently at or near. The type of medical procedure can be entered by the physician prior to the procedure, for example, on a graphical user interface 104 connected to the surgical laser 102. Alternatively, the processor 112 can be communicatively coupled to a database containing patient information (such as the database discussed below with respect to FIGS. 5 and 6), and the type of medical procedure can be determined from the patient information in the database.

[0030] The processor 112 and / or the photodetector 132 can analyze a portion of the reflected light 130 collected by the optical splitter 110 (or receive analysis by a spectrometer connected to or coupled to the processor 112 and / or the photodetector 132) and determine suggested updates to the laser settings based on the analysis of the reflected light 130. Additionally or alternatively, the determination can be based on an environmental condition measured by a sensor coupled to the processor 112, such as a temperature value or range at the tip of the scope 124 measured by a temperature sensor coupled to or included in the scope 124. Additionally or alternatively, the environmental condition can be a pressure value or range, such as the pressure in a medium in which the scope 124 is disposed. In another example, the determination can be based on a characteristic of the target 126. For example, the processor 112 and / or the photodetector 132 can analyze the reflected light 130 from the target 126 to determine a characteristic of the target 126 at a first time. The characteristic can be the composition (material composition) or size of the target 126 at the first time. The processor 112 can then analyze the reflected light 130 from the target 126 at a second time during the procedure and determine a change in the characteristics of the target 126 at the second time by comparing the characteristics of the target 126 at the first time with the characteristics of the target 126 at the second time. For example, when the target is a stone or other concretion, the composition of the target 126 may change, e.g., from a hard material to a soft material, or the target 126 may be substantially smaller at the second time than at the first time, thereby requiring less laser energy to ablate or destroy the target 126. Based on the determination of the change in the characteristics of the target at the second time, the system can determine a suggested update value. Additionally or alternatively, the suggested update value may be based at least in part on the position of the ablation laser 106 and / or the probe laser 108 and / or one of the laser fibers, such as the distance of the tip of the scope 124 from the target 126.For example, the closer the tip of the laser fiber or scope 124 is to the target 126, the less energy may need to be emitted, and therefore the intensity of the laser emission may be reduced and / or the time of the laser pulse may be adjusted.

[0031] Suggested updated values ​​can be shown on the graphical user interface 104 and an option to accept or reject the proposed updated values ​​can be provided. For example, when the processor 112 determines the need for changes to settings, a display or notification, e.g., in the form of a pop-up box or menu, can be sent to the graphical user interface 104 to inform the physician that updated settings are recommended or will be implemented. The notification can include the values ​​of the updated settings, and laser emission can continue or, in some embodiments, be locked, disabled, terminated, blocked, or otherwise prevented (via the “laser interlocking” discussed above) while the notification is displayed on the graphical user interface 104. In one example, the notification can include a button, link, etc., in a pop-up screen or elsewhere on the graphical user interface 104 for the physician to accept or reject the proposed updated settings. For example, a pop-up screen with the proposed changes can include an “accept” button and / or a “reject” button that the user can click. In another example, acceptance or rejection of the updated values ​​can be initiated via a voice command or actuation of an actuation member. The actuation member may include a button or switch on the scope 124 or a handpiece on (or connected to) the scope 124, or a foot switch or foot pedal connected to the system 100, for example, connected to the surgical laser 102 and / or the scope 124.

[0032] In one example, the system 100 can include a feedback mechanism that provides an additional indication or notification that can accompany or be included with the notification discussed above. The additional indication can notify or alert the physician that a proposed update has been determined. The additional indication can be through a tactile feedback mechanism, such as a vibration of the handpiece of the scope 124, an audible feedback mechanism, such as a beep or chime through a speaker or similar output device, or an illumination feedback mechanism, such as changing the characteristics of a user-visible target illumination beam projected toward the target. For example, when the processor 112 determines the need for an update setting, the processor 112 can issue a chime or beep through a speaker included in the graphical user interface 104, vibrate the handpiece of the scope 124, illuminate or flash a button on the handpiece of the scope 124, and / or cause a visible light projected through the scope 124 to blink, change color, etc.

[0033] The additional notification can also serve as a warning that the setting of one or more settings is within a threshold amount of the upper limit of a range. For example, the additional notification can inform the user when the intensity of the radiation, light, or signal emitted from the laser source 106, 108 is approaching the upper limit of a range established prior to the medical procedure. This additional notification or warning can be particularly useful when the system automatically changes settings within a range without interaction or approval from the user (e.g., in a fully automated system), so that the user is aware when a setting is approaching the upper limit of a range and can make any desired or appropriate adjustments.

[0034] The surgical laser 102 may optionally or additionally include a controller 114 communicatively coupled to the processor 112. In response to accepting the proposed updated values, the controller 114 may adjust the current settings of the laser to the updated settings. In one example, the changed settings may include causing a change (e.g., stopping, reducing, lowering, increasing, raising, etc.) in the intensity of the emitted laser radiation / light 128 based on one or more factors such as distance from the target 126, a change in the composition of the target 126, or any related factor that warrants an adjustment to the intensity of the emitted laser radiation or light 128. In another example, the adjustment of the settings may include changing one or more other parameters (e.g., duty cycle, pulse width, etc.) of the light or radiation emitted from one of the lasers. Additionally or alternatively, the controller 114 may cause a surgical fiber actuator 122 configured to be connected to the surgical fiber 118 to adjust the location of at least a portion of the surgical fiber 118. For example, the surgical fiber actuator 122 can cause the surgical fiber 118, such as the portion of the surgical fiber 118 connected to the scope 124, to change its location (e.g., move closer to or away from the target).

[0035] More than one setting can be adjusted, and the adjustments can be applied independently of each other or in conjunction with each other, as desired or appropriate. The processor 112 and / or controller 114 can be configured to automatically select and apply one or more appropriate adjustments to one or more settings based on an analysis of the reflected light 130. By configuring the processor 112 and / or controller 114 to automatically select and apply setting adjustments based on an analysis of the reflected light 130, the system can increase ablation or surgical efficiency because the processor 112 and / or controller 114 can apply adjustments more quickly than a person can react to changing conditions during a medical procedure, resulting in a more efficient and effective laser procedure.

[0036] FIG. 2 illustrates an example method 200 for automatically adjusting a laser system. Method 200 may include or comprise several operations or steps (202-214). These operations are exemplary, and the method performed may omit one or more of the listed operations, repeat operations, include other operations, or perform operations in parallel, substantially simultaneously, or in a different order, as appropriate or desired. These operations may be performed automatically by a processor or controller of a machine or computer, such as described below with respect to FIG. 4.

[0037] In operation 202, artificial intelligence (AI) or machine learning (ML) or other algorithms (collectively, "algorithms") can be used to determine ranges for at least one setting of a laser included in the laser system. The operation of the algorithm is discussed below with respect to FIG. 4. The ranges can be determined by the algorithm prior to a laser procedure, such as a lithotripsy procedure, for example, by a physician entering information about the medical procedure on a user interface, or by retrieving information about the medical procedure (e.g., what procedure is to be performed, what equipment will be used during the procedure, etc.) and / or patient information from a database connected to the computer on which the algorithm is running or operating. For example, the ranges can be tied to or based on a particular type of medical procedure to be performed on the patient (e.g., kidney stone removal), which can be retrieved from a patient file stored in a database. In another example, a physician can indicate the type of medical procedure, for example, on a user interface, and the ranges can be retrieved from a file in a database that has information specific to that particular medical procedure but not any patient-specific information or data. When provided with information about the type of procedure, which may include information such as the composition of the kidney stone, the location of the kidney stone within the patient's urinary system, the type of laser to be used during the procedure, or any additional relevant information, the algorithm can determine appropriate settings for the laser. For example, the algorithm can determine upper and lower limits of a range for the laser intensity that is appropriate for a particular procedure, upper and lower limits for the duty cycle at which the laser is pulsed, etc. The ranges can be ranges of values ​​selected or determined by the physician performing the procedure, or can be set ranges for that procedure that are specific to the hospital or medical facility where the procedure is performed. The ranges can be edited or adjusted by the physician as desired, for example, through prompts or menus on the GUI.

[0038] In operation 204, the system can determine that the laser can automatically operate within a range. In one example, once information about a medical procedure is obtained and an algorithm determines a range for laser settings that are appropriate for the procedure, the algorithm can determine that the laser can operate within the determined range based on the actual laser (e.g., a red light laser, a blue light laser, a green light laser, or a combination of different types of lasers) used during the procedure. This range and the determination that a particular laser can operate within the determined range can also be determined by the physician performing the medical procedure based on that physician's prior experience with the procedure. In this manner, if the laser is only partially capable of automatically operating within the determined range (e.g., if the laser can emit laser radiation at the lower limit of the determined range but not at the upper limit of the determined range), the algorithm can adjust the determined range. Additionally or alternatively, the system can recommend using a different laser during the procedure.

[0039] In operation 206, the algorithm can determine the need to adjust at least one setting. This determination can be based on one or more factors or conditions occurring or encountered during the medical procedure. In one example, the condition can be an environmental condition, such as temperature and / or pressure at a target site proximate the tip of a scope used during the procedure, as measured by a temperature and / or pressure sensor coupled to the laser or the scope. In another example, the need to adjust a setting can be based on a change in a characteristic of the target. For example, when the target is a kidney stone, the algorithm can determine that less laser radiation is needed to continue to destroy the stone based on a change in its size as the stone is ablated (e.g., determined by image analysis of the stone). In another example, the system can determine that the composition of the stone has changed (e.g., based on spectroscopic analysis of signals reflected or emitted from the stone) and adjust the laser intensity or other settings based on the change. For example, the composition of the stone can change from a hard material to a soft material, or vice versa. A stone may be composed in part of calcium oxalate and calcium phosphate, such that it has a hard "shell" and a soft "core," and different levels of laser radiation may be appropriate for ablating different material types. Based on spectroscopic analysis of the stone, for example, by a spectrometer included in or attached to the laser system described above with respect to FIG. 1, the algorithm can determine that the stone's composition has changed and adjust settings based on that change.

[0040] In another example, the need to adjust settings can be based on the distance of the laser fiber or scope tip to the target or the location of the laser fiber or scope tip within the patient. For example, the closer the laser fiber is to a kidney stone, the less energy may be required to ablate the stone. In another example, if the laser fiber is positioned such that it emits laser radiation toward non-target tissue that may be affected by the radiation, the radiation or laser intensity can be reduced or the laser emission can be stopped until the laser fiber and / or scope are repositioned.

[0041] At operation 208, an indication of the updated value of at least one setting can be provided on the user interface. For example, if the algorithm determines the need to adjust a setting at operation 206, the system can notify the physician, for example, on a GUI, that the laser setting needs to be adjusted and what the new setting will be changed to. Additionally, the indication can include displaying the reason for the determined need. At operation 210, laser emission can be disabled, locked, terminated, turned off, or otherwise prevented. This can occur simultaneously with or shortly after the indication is provided at operation 208. In another example, after an indication or notification is provided to the physician and the physician accepts the changed value, the laser can be locked. Or, stated another way, the laser can be pulsed only after the physician accepts the changed setting. At least one setting can be adjusted to the updated value at operation 212. This adjustment can occur while laser emission is disabled at operation 210. Adjusting laser settings while the laser is disabled can provide a measure of safety, as this may allow the scope to be positioned to prevent stray radiant energy from contacting non-target tissue, particularly when the adjustment involves increasing radiant intensity. In operation 214, laser emission can be resumed after adjusting at least one setting.

[0042] In some examples, more than one laser may be available for use during a procedure. The operations listed in method 200, as well as all of the components discussed above with respect to FIG. 1, may apply to a dual-laser system. In an example involving more than one laser, adjustments may include switching from one laser to another, e.g., switching from a first laser to a second laser, based on any of the factors discussed above. Thus, system 100 or an algorithm may selectively switch from a first laser to a second laser based on changes in environmental conditions, a change in the location of the scope (e.g., the portion of the organ in which the scope is located), a change in the characteristics of the target, a change in the medical procedure, or any factor or parameter that warrants or requires a change from one type of laser to another. For example, when a medical procedure calls for the removal of a stone and also for cutting or cauterizing tissue, a first laser may be better suited to ablating the stone, while the other may be better suited to cutting or cauterizing the tissue. In this manner, the laser actively emitting radiation may be changed or switched depending on which portion of the procedure is being performed.

[0043] FIG. 3 is a flowchart for the operation of a laser adjustment system. As shown in FIG. 3, in operation 300, the laser system may prompt a user for input for laser adjustments. After determining, via the methods described above (such as the method illustrated and discussed above with respect to FIG. 2), that one or more settings of the laser system should be adjusted, the laser system may prompt the user for input. When the laser system is operating in an auto-adjust mode, in operation 303, a determination may be made at 302A as to whether to accept, reject, or ignore this prompt for adjusting the laser settings. For example, the laser system may use a pop-up or pop-out screen on the GUI to notify the user that adjustments to one or more settings are recommended or required, and may prompt the user to accept or decline the setting changes, e.g., via buttons on the pop-up screen that allow the user to select to accept the proposed changes and / or buttons that allow the user to select to abort or reject the proposed changes.

[0044] If the user aborts or rejects the changes in operation 302A, for example by selecting an "Abort" or "Reject" option on a pop-up screen, the laser system may resume using the current laser settings, at which point the laser system may return to operation 300 if new adjustments are proposed. If the user accepts the proposed changes in operation 302, the laser system may proceed to operation 304, lock or disable laser emission, adjust one or more laser settings in operation 306, and resume laser operation or emission with the updated settings in operation 308, at which point the laser system may return to operation 300 if another adjustment is requested. However, if the user does not respond to the indication at operation 302A (e.g., the user does not affirmatively accept but also does not reject the adjustment within a period of time, such as within 5 seconds, or any suitable or desired amount of time), the laser system may automatically proceed to operations 304, 306, and 308, disable laser emission, adjust the settings, and resume laser emission without additional user interaction as long as the user continues to engage in laser emission (e.g., the footswitch continues to be pressed, the button or trigger is pressed, or any actuating member that activates the laser remains engaged).

[0045] When the laser system is operating in the prompt adjustment mode, in operation 302B the user can decide whether to accept, reject, or ignore the prompt sent in operation 300. If the user rejects the proposed changes in 302B or does not accept or reject the proposed changes within a period of time (e.g., 5 seconds), the laser system will continue to operate with the current laser settings and will return to operation 300 if another adjustment is required. It is only when the user affirmatively accepts the proposed changes to the laser settings in the prompt adjustment mode that the laser system can continue to operations 304, 306, and 308 to update the settings and continue laser emission with the updated settings.

[0046] 2 and 3 show that laser emission is locked or disabled after a display and prompt to accept or reject proposed changes to settings is provided, the laser system can disable or lock laser emission before or simultaneously with the prompt displayed in operation 300. Further, the laser system can switch from auto-adjust mode to on-demand adjustment mode as desired by the user, for example, during a medical procedure. Additionally, or alternatively, the laser system can automatically switch between on-demand adjustment mode and auto-adjust mode based, for example, on which portion of the medical procedure is being performed. For example, a user may desire to have more control over the laser system during some portions of the procedure, and the laser system can be programmed or configured prior to the procedure to remain in on-demand adjustment mode during those portions of the procedure, and then switch to auto-adjust mode during other portions of the procedure where the user deems the auto-adjust mode acceptable.

[0047] FIG. 4 is a block diagram of an example of a machine 400 capable of performing any one or more of the techniques (e.g., methodologies) discussed herein. The machine 400 can operate as a standalone device or can be connected (e.g., networked) to other machines. For example, the machine 400 can be included in or connected to the surgical laser 102 and / or the scope 124 and can include components such as the graphical user interface 104, processor 112, controller 114, or surgical fiber actuator 122 discussed above. Additionally or alternatively, the machine 400 can operate the algorithm discussed above with respect to FIG. 2 or the computer-based clinical decision support system (CDSS) discussed below with respect to FIG. 4. In a networked deployment, the machine 400 can operate as a server machine, a client machine, or both in a server-client network environment. In one example, the machine 400 can act as a peer machine in a peer-to-peer (P2P) (or other distributed) network environment. Machine 400 may be a personal computer (PC), tablet PC, set-top box (STB), personal digital assistant (PDA), mobile phone, web appliance, network router, switch or bridge, or any machine capable of executing instructions (serial or otherwise) that specify actions to be taken by that machine. Additionally, although only a single machine is shown, the term "machine" should also be taken to include any collection of machines that individually or collectively execute a set (or sets) of instructions to perform any one or more of the methodologies discussed herein, such as cloud computing, software as a service (SaaS), other computer cluster configurations, etc.

[0048] As described herein, some examples may include or operate with logic or several components or mechanisms. A circuit set is a collection of circuits implemented in tangible objects including hardware (e.g., simple circuits, gates, logic, etc.). The constituent elements of a circuit set may be flexible over time and over the variability of the underlying hardware. A circuit set includes elements that, when operating, can perform specified operations, either alone or in combination. In one example, the hardware of a circuit set may be invariably designed (e.g., hardwired) to perform specific operations. In one example, the hardware of a circuit set may include variably connected physical components (e.g., execution units, transistors, simple circuits, etc.) including computer-readable media physically modified (e.g., magnetically, electrically, movable arrangements such as immutable mass particles) to encode instructions for specific operations. In connecting the physical components, the underlying electrical properties of the hardware components may change, for example, from insulator to conductor or vice versa. The instructions enable embedded hardware (e.g., an execution unit or loading mechanism) to create circuit set members in the hardware via variable connections to perform certain portions of operations when the device is operating. Thus, when the device is operating, the computer-readable medium is communicatively coupled to other components of the circuit set members. In one example, any of the physical components can be used for more than one member of more than one circuit set. For example, during operation, an execution unit can be used in a first circuit of a first circuit set at one time and reused by a second circuit in the first circuit set or by a third circuit in a second circuit set at a different time.

[0049] The machine 400 (e.g., a computer system) may include a hardware processor 402 (e.g., a central processing unit (CPU), a graphics processing unit (GPU), a hardware processor core, a field programmable gate array (FPGA), or any combination thereof), a main memory 404, and a static memory 406, some or all of which may communicate with each other via an interlink (e.g., a bus) 430. The machine 400 may further include a display unit 410, an alphanumeric input device 412 (e.g., a keyboard), and a user interface (UI) navigation device 414 (e.g., a mouse). In one example, the display unit 410, the input device 412, and the UI navigation device 414 may be touchscreen displays. The machine 400 may additionally include a storage device 408 (e.g., a drive unit), a signal generating device 418 (e.g., a speaker), a network interface device 420, and one or more sensors 416, such as a global positioning system (GPS) sensor, a compass, an accelerometer, or other sensors. The machine 400 may include an output controller 428, such as a serial (e.g., Universal Serial Bus (USB)), parallel, or other wired or wireless (e.g., infrared (IR), near field communication (NFC), etc.) connection, that communicates with or controls one or more peripheral devices (e.g., printer, card reader, etc.).

[0050] Storage device 408 may include machine-readable medium 422 (e.g., non-transitory medium) on which is stored one or more sets of data structures or instructions 424 (e.g., software) that embody or are used by any one or more of the techniques or functions described herein. The instructions 424 may reside, completely or at least partially, within main memory 404, static memory 406, or even within hardware processor 402 during execution thereof by machine 400. In one example, one or any combination of hardware processor 402, main memory 404, static memory 406, or storage device 408 may constitute a machine-readable medium.

[0051] Although the machine-readable medium 422 is depicted as a single medium, the term “machine-readable medium” can include a single medium or multiple media (e.g., centralized or distributed databases and / or associated caches and servers) configured to store one or more instructions 424. The term “machine-readable medium” can include any non-transitory medium capable of storing, encoding, or carrying instructions for execution by the machine 400, causing the machine 400 to perform any one or more of the techniques of this disclosure, or storing, encoding, or carrying data structures used by or associated with such instructions. Non-limiting examples of machine-readable media include solid-state memory, and optical and magnetic media. In one example, a large-scale machine-readable medium includes a machine-readable medium comprising a plurality of particles having an unchanging (e.g., stationary) mass. Thus, the large-scale machine-readable medium is not a transitory, propagating signal. Specific examples of mass-scale machine-readable media may include non-volatile memory, such as semiconductor memory devices (e.g., electrically programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM)) and flash memory devices, magnetic disks, such as internal hard disks and removable disks, magneto-optical disks, and CD-ROM and DVD-ROM disks.

[0052] 5 shows a schematic diagram of an exemplary computer-based clinical decision support system (CDSS) 500 configured to implement or recommend altered laser settings based on information about the target being treated, the piece or portion of tissue being treated, or conditions encountered during the laser medical procedure. In various embodiments, the CDSS 500 includes an input interface 502 in which one or more patient-specific laser setting ranges are provided as input features to an artificial intelligence (AI) model 504, a processor, such as processor 402, that performs inference operations to apply information about the target or piece or portion of tissue to the AI ​​model to generate one or more altered laser settings, and a user interface (UI) in which the one or more altered laser settings are communicated to a user, e.g., a clinician.

[0053] In some embodiments, the input interface 502 can be a direct data link between the CDSS 500 and one or more medical devices that generate at least some of the input features. For example, the input interface 502 can communicate information about a target, such as the target's composition or density, directly to the CDSS 500 during a therapeutic and / or diagnostic medical procedure. Additionally or alternatively, the input interface 502 can be a classic user interface that facilitates interaction between a user and the CDSS 500. For example, the input interface 502 can facilitate a user interface through which a user can manually input a range of patient-specific laser settings that the laser system can suggest during a procedure. Additionally or alternatively, the input interface 502 can provide the CDSS 500 with access to an electronic patient record from which one or more input features can be extracted. In any of these cases, the input interface 502 is configured to collect one or more of the following input features associated with a particular patient at or before the time of evaluation using the CDSS 500:

[0054] information about the composition of the target, information about the density of the target, or information about the size of the target, i.e., information about the target characteristics 510; information regarding changes in target properties 512 (e.g., changes in the composition or density of the target); environmental conditions, Location of the laser fiber and / or scope, information about medical procedures; Indication of non-target tissue, and / or Laser setting tolerances specific to the patient or procedure being performed may include:

[0055] Based on one or more of the above input features, the processor 402 performs an inference operation using the AI ​​model to generate one or more laser setting changes to be implemented or one or more recommended laser setting changes to be suggested to the user. For example, the input interface 502 can deliver target characteristics, determined changes in the target characteristics, and ranges of allowable laser settings into the input layer of the AI ​​model, which propagates these input features through the AI ​​model to the output layer. AI models can provide a computer system with the ability to perform tasks by making inferences based on patterns found in analyzing data without being explicitly programmed. AI models explore the study and architecture of algorithms (e.g., machine learning algorithms) that can learn from existing data and make predictions about new data. Such algorithms operate by building an AI model from example training data to make data-driven predictions or decisions, which are expressed as outputs or evaluations.

[0056] There are two common modes of machine learning (ML): supervised ML and unsupervised ML. Supervised ML uses prior knowledge (e.g., examples correlating inputs with outputs or outcomes) to learn the relationship between inputs and outputs. The goal of supervised ML is to learn a function that best approximates the relationship between training inputs and outputs, given some training data, so that an ML model can implement that same relationship and generate the corresponding output when given an input. Unsupervised ML is the training of an ML algorithm using unclassified or unlabeled information, allowing the algorithm to act on that information without guidance. Unsupervised ML is useful in exploratory analysis because it can automatically identify structure in data.

[0057] Some tasks for supervised ML are classification and regression problems. Classification problems, also called categorization problems, aim to classify multiple items into one of several categorical values ​​(e.g., is this object an apple or an orange?). Regression algorithms aim to quantify some items (e.g., by providing a score for the value of some input). Some examples of commonly used supervised ML algorithms are logistic regression (LR), naive Bayes, random forest (RF), neural networks (NN), deep neural networks (DNN), matrix factorization, and support vector machines (SVM).

[0058] Some tasks for unsupervised ML include clustering, representation learning, and density estimation. Some examples of algorithms for unsupervised ML are K-means clustering, principal component analysis, and autoencoders.

[0059] Another type of ML is federated learning (also known as collaborative learning), which trains algorithms across multiple distributed devices that hold local data without exchanging data. This approach contrasts with centralized machine learning techniques, where all local datasets are uploaded to a single server, as well as more classical distributed approaches, where local data samples are often assumed to be equally distributed. Federated learning allows multiple actors to build common, robust machine learning models without sharing data, thus addressing important issues such as data privacy, data security, data access rights, and access to heterogeneous data.

[0060] In some examples, the AI ​​model may be trained continuously or periodically prior to execution of an inference operation by processor 402. Then, during the inference operation, patient-specific input features provided to the AI ​​model may be propagated from an input layer, through one or more hidden layers, and finally to an output layer corresponding to changes to one or more of the laser settings. For example, when the target is a kidney stone, changes to laser settings, such as laser intensity and / or frequency, may be propagated to the output layer based on the stone's characteristics and determined changes in the target characteristics (e.g., changes in the stone's composition).

[0061] During and / or after the inference calculation, changes in the laser settings can be communicated to the user via a user interface (UI) and / or can automatically cause the processor 402 to automatically adjust the laser settings and proceed with the laser procedure using the new settings.

[0062] Notes and Examples Example 1 is a laser system including a processor, a user interface coupled to the processor, and a memory coupled to the processor, the memory configured to store instructions that, when executed by the processor, cause the processor to receive ranges for at least one setting of a first laser within which a first laser of the laser system can operate, determine a proposed update value for the at least one setting, determine whether the proposed update value is within the received range, provide, via the user interface, (i) a display of the proposed update value and (ii) an option for a user to accept or reject the proposed update value for the at least one setting, and, in response to the proposed update value being accepted by the user or the proposed update value not being rejected within a predetermined time, adjust the at least one setting based on the proposed update value.

[0063] In Example 2, the subject matter of Example 1 optionally includes the instructions causing the processor to temporarily disable the first laser after receiving acceptance or no rejection of the proposed update value by the user.

[0064] In Example 3, the subject matter of any one or more of Examples 1-2 optionally includes the instructions causing the processor to temporarily disable emission of the first laser while indicating the suggested update value until at least one of adjusting at least one setting based on the suggested update value and a user rejection of the suggested update value.

[0065] In Example 4, the subject matter of any one or more of Examples 1-3 optionally includes the instructions causing the processor to determine a characteristic of the target at a first time, determine a change in the characteristic of the target at a second time, and determine a proposed updated value of the at least one setting based on the change in the characteristic of the target at the second time.

[0066] In Example 5, the subject matter of any one or more of Examples 1-4 optionally includes the instructions causing the processor to determine a proposed update value for the at least one setting based on at least one of a distance of the laser fiber from the target and a position of the laser fiber within a scope connected to the laser system or a portion of an organ in which at least one of the laser fibers is located.

[0067] In Example 6, the subject matter of any one or more of Examples 1-5 optionally includes the instructions causing the processor to determine a suggested updated value for the at least one setting based on an environmental condition measured by a sensor coupled to the processor.

[0068] In Example 7, the subject matter of Example 6 optionally includes wherein the sensor includes one or more of a temperature sensor, a pressure sensor, or an accelerometer.

[0069] In Example 8, the subject matter of any one or more of Examples 1-7 optionally includes, wherein the at least one setting includes an amount of energy emitted by the first laser, and wherein the at least one setting includes one or more of an intensity of the laser light or laser radiation of the first laser, a wavelength of the first laser, a pulse width of the first laser, or a duty cycle of the first laser.

[0070] In Example 9, the subject matter of any one or more of Examples 1-8 optionally includes a feedback mechanism that provides an additional indication, the additional indication providing a warning to the user, and the feedback mechanism includes one or more of a tactile feedback mechanism, an illumination feedback mechanism, or an audible feedback mechanism.

[0071] In Example 10, the subject matter of Example 9 optionally includes alerting the user that at least one of the setting of the first laser is within a threshold amount of an upper limit of a range and that a suggested update value has been determined.

[0072] In Example 11, the subject matter of any one or more of Examples 9-10 optionally includes, wherein the illumination feedback mechanism includes modifying a characteristic of a user-visible target illumination beam emitted toward the target.

[0073] In Example 12, the subject matter of any one or more of Examples 1-11 optionally includes wherein acceptance of the proposed updated value is initiated through a voice command or activation of an actuation member, including a button or switch on a handpiece connected to the laser system, or a footswitch connected to the laser system.

[0074] In Example 13, the subject matter of any one or more of Examples 1-12 optionally includes determining at least one of the range and the range limit based on at least one of a portion of an organ to which at least one of a scope or laser fiber connected to the laser system is attached, a type of laser fiber included in the laser system, and a type of medical procedure for which the laser system is used.

[0075] In Example 14, the subject matter of Example 13 optionally includes determining the portion of the organ based on image recognition techniques performed on images from an imaging device connected to the scope.

[0076] In Example 15, the subject matter of any one or more of Examples 13-14 optionally includes the laser system being communicatively coupled to a database containing patient information, and the type of medical procedure being determined from the patient information in the database.

[0077] In Example 16, the subject matter of any one or more of Examples 1-15 may further comprise instructions for causing a processor to receive a second range for at least one setting of the second laser within which the second laser may operate, determine a second proposed update value for at least one setting of the second laser, determine whether the second proposed update value is within the received second range, and provide, via the user interface, (iii) a display of the second proposed update value, and (iv) an option to accept or reject the second proposed update value for at least one setting of the second laser; and optionally, adjusting at least one setting of the second laser based on the second proposed updated value of the at least one setting of the second laser in response to accepting the second proposed updated value of the at least one setting of the second laser; selecting one of the first laser and the second laser based on at least one of environmental conditions measured by a sensor coupled to the processor, a portion of an organ to which at least one of the laser fiber and the scope connected to the laser system is attached, and a type of medical procedure for which the laser system is to be used; and selectively switching to the other of the first laser and the second laser based on a change in the environmental conditions, a change in the portion of the organ, or a change in the medical procedure.

[0078] In Example 17, the subject matter of Example 16 optionally includes, in response to the second proposed updated value of the at least one setting of the second laser not being rejected within a predetermined time, adjusting at least one setting of the second laser based on the second proposed updated value of the at least one setting of the second laser.

[0079] In Example 18, the subject matter of any one or more of Examples 16-17 optionally includes ceasing adjustment to at least one setting of the second laser in response to the second proposed updated value of the at least one setting of the second laser not being rejected within a predetermined time.

[0080] Example 19 is a computer-implemented method for automatic adjustment of a laser system, the method including: determining, using a computer-implemented processor, a range for at least one setting of a laser included in the laser system; determining, using the computer-implemented processor, a need to adjust the at least one setting; providing on a user interface a display of an updated value of the at least one setting; verifying, using the computer-implemented processor, whether the updated value is within range; disabling, via control circuitry of the computer, emission of the laser; adjusting, via the control circuitry while the laser is disabled, at least one setting of the laser to the updated value of the at least one setting; and resuming emission of the laser after adjusting the at least one setting of the laser.

[0081] In Example 20, the subject matter of Example 19 optionally includes determining the need to adjust the at least one setting based on at least one of a characteristic of the target, a change in the characteristic of the target, a distance of the laser fiber from the target, a position of the laser fiber, and an environmental condition measured by a sensor coupled to the laser system, and wherein an upper limit of the range is determined based on at least one of a portion of an organ to which a scope connected to the laser system is attached, a type of laser fiber included in the laser system, and a medical procedure in which the laser system is used.

[0082] Example 21 is a laser system including a processor, a user interface coupled to the processor, and a memory coupled to the processor, wherein the memory, when executed by the processor, causes the processor to receive a first range for at least one setting of a first laser to which a first laser of the laser system can be automatically adjusted, receive a second range for at least one setting of a second laser to which a second laser of the laser system can be automatically adjusted, determine at least one of a proposed update value for the at least one setting of the first laser or a second proposed update value for the at least one setting of the second laser, determine whether the proposed update value for the at least one setting of the first laser is within the first range, and determine whether the proposed update value for the at least one setting of the second laser is within the first range. determining whether a second proposed update value for at least one setting of the first laser is within a second range; providing, via the user interface, (i) a display of at least one of the proposed update value for at least one setting of the first laser and the second proposed update value for at least one setting of the second laser, and (ii) an option to accept or reject the proposed update value for at least one setting of the first laser and the second proposed update value for at least one setting of the second laser; and adjusting at least one of the at least one setting of the first laser and the at least one setting of the second laser in response to acceptance of the proposed update value and the second proposed update value.

[0083] In Example 22, the subject matter of Example 21 optionally includes the instructions causing the processor to adjust at least one of the at least one setting of the first laser and the at least one setting of the second laser in response to at least one of the user suggested update value and the second suggested update value not being rejected within a predetermined time period.

[0084] In Example 23, the subject matter of any one or more of Examples 21-22 optionally includes, in response to at least one of the user proposed update value and the second proposed update value not being rejected within a predetermined time period, the instructions cause the processor to discontinue adjusting at least one of the at least one setting of the first laser and the at least one setting of the second laser.

[0085] In Example 24, the subject matter of any one or more of Examples 21-23 optionally includes: a suggested update value for at least one setting of the first laser is within a first range; a second suggested update value for at least one setting of the second laser is within a second range; and the instructions cause the processor to select one of the first laser and the second laser based on at least one of an environmental condition measured by a sensor coupled to the processor, a portion of an organ with a scope connected to the laser system, or a medical procedure for which the laser system is used, and selectively switch to the other of the first laser and the second laser based on a change in the environmental condition, a change in the portion of the organ, or a change in the medical procedure.

[0086] As used herein, the terms "a" or "an" are used to include one or more than one, as is common in patent documents, independently of any other instance or usage of "at least one" or "one or more." As used herein, the term "or" refers to non-exclusion unless otherwise indicated, or "A or B" is used to include "A but not B," "B but not A," and "A and B." In the appended claims, the terms "including" and "in which" are used as the plain-English equivalents of the respective terms "comprising" and "wherein." Also, in the following claims, the terms "including" and "comprising" are open-ended, i.e., a system, device, article, or process that includes elements in addition to those listed after such terms in a claim is still deemed to fall within the scope of that claim. Also, in the following claims, the terms "first," "second," "third," etc. are used merely as labels and are not intended to impose numerical requirements on these items.

[0087] The above description is intended to be illustrative, not limiting. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. For example, other embodiments may be employed by those of ordinary skill in the art upon review of the above description. The Abstract is submitted with the understanding that it will allow the reader to quickly ascertain the nature of the technical disclosure, and will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be construed as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter lies in less than all features of a particular disclosed embodiment. Thus, the following claims are now incorporated into the Detailed Description, with each claim standing on its own as a separate embodiment. The scope of the embodiments should be determined with reference to the appended claims, along with the full range of equivalents to which such claims are entitled.

[0088] [Additional note 1] a processor; a user interface coupled to the processor; a memory coupled to the processor; 1. A laser system comprising: The memory, when executed by the processor, causes the processor to: receiving a range for at least one setting of a first laser of the laser system at which the first laser can operate; determining a proposed update value for at least one of said settings; determining whether the proposed update value is within the received range; providing, via the user interface, (i) a display of the proposed update values, and (ii) an option for a user to accept or reject the proposed update values ​​for at least one of the settings; adjusting at least one of the settings based on the proposed update value in response to the proposed update value being accepted by the user or not being rejected within a predetermined time period; Stores instructions, The laser system is configured as follows. [Additional note 2] The instructions direct the processor to: The laser system of claim 1, wherein the first laser is temporarily disabled after receiving acceptance of the proposed update value from the user or after not receiving a rejection. [Additional note 3] The instructions direct the processor to: 10. The laser system of claim 1, wherein while the suggested update value is displayed, emission of the first laser is temporarily disabled until at least one of adjustment of at least one of the settings based on the suggested update value and user rejection of the suggested update value. [Additional note 4] The instructions direct the processor to: determining a characteristic of the target at a first time; determining a change in the property of the target at a second time; 2. The laser system of claim 1, wherein the proposed update value for at least one of the settings is determined based on the change in the characteristic of the target at the second time. [Additional note 5] The instructions direct the processor to: 10. The laser system of claim 1, wherein the proposed update value for at least one of the settings is determined based on at least one of the distance of the laser fiber from the target and the position of the laser fiber within a portion of an organ in which at least one of the scopes or laser fibers connected to the laser system is located. [Additional note 6] The instructions direct the processor to: 2. The laser system of claim 1, wherein the proposed update value for at least one of the settings is determined based on an environmental condition measured by a sensor coupled to the processor. [Additional note 7] The laser system of claim 6, wherein the sensor includes one or more of a temperature sensor, a pressure sensor, and an accelerometer. [Additional note 8] 10. The laser system of claim 1, wherein at least one of the settings includes an amount of energy emitted by the first laser, and wherein at least one of the settings includes one or more of an intensity of the laser light or laser radiation of the first laser, a wavelength of the first laser, a pulse width of the first laser, and a duty cycle of the first laser. [Additional note 9] further comprising a feedback mechanism for providing an additional indication; The laser system of claim 1, wherein the additional display provides a warning to the user and the feedback mechanism includes one or more of a tactile feedback mechanism, an illumination feedback mechanism, and an audible feedback mechanism. [Additional Note 10] The laser system of claim 9, wherein the warning to the user alerts the user to at least one of the following: that at least one of the settings of the first laser is within a threshold amount at the upper limit of the range; and that the proposed update value has been determined. [Additional Note 11] 10. The laser system of claim 9, wherein the illumination feedback mechanism includes modifying a characteristic of a user-visible target illumination beam emitted toward the target. [Additional Note 12] The laser system of claim 1, wherein the acceptance of the proposed update value is initiated through a voice command or activation of an actuation member, including a button or switch on a handpiece connected to the laser system, or a foot switch connected to the laser system. [Additional Note 13] 10. The laser system of claim 1, wherein at least one of the range and the limits of the range are determined based on at least one of a portion of an organ to which at least one of a scope or laser fiber connected to the laser system is attached, a type of laser fiber included in the laser system, and a type of medical procedure for which the laser system is used. [Additional Note 14] The laser system of claim 13, wherein the part of the organ is determined based on image recognition techniques performed on images from an imaging device connected to the scope. [Additional Note 15] 14. The laser system of claim 13, wherein the laser system is communicatively coupled to a database containing patient information, and the type of medical procedure is determined from the patient information in the database. [Additional Note 16] the laser system includes a second laser of a different type than the first laser; The instructions direct the processor to: receiving a second range for at least one setting of the second laser within which the second laser may operate; determining a second proposed update value for at least one of the settings of the second laser; determining whether the second proposed update value is within the received second range; providing, via the user interface, (iii) a display of the second proposed update value, and (iv) an option to accept or reject the second proposed update value for at least one of the settings of the second laser; adjusting the at least one setting of the second laser based on the second proposed updated value of the at least one setting of the second laser in response to accepting the second proposed updated value of the at least one setting of the second laser; selecting one of the first laser and the second laser based on at least one of an environmental condition measured by a sensor coupled to the processor, a portion of an organ to which at least one of a laser fiber or a scope connected to the laser system is attached, and a type of medical procedure for which the laser system is being used; 10. The laser system of claim 1, wherein the laser system selectively switches between the first laser and the second laser based on a change in the environmental conditions, a change in the part of the organ, or a change in the medical procedure. [Additional Note 17] The system of claim 16, wherein, in response to the second proposed update value of at least one of the settings of the second laser not being rejected within a predetermined time, the system adjusts the at least one setting of the second laser based on the second proposed update value of at least one of the settings of the second laser. [Additional Note 18] The system of claim 16, wherein the system discontinues adjustments to at least one of the settings of the second laser in response to the second proposed update value of at least one of the settings of the second laser not being rejected within a predetermined time. [Additional Note 19] 1. A computer-implemented method for automatic adjustment of a laser system, comprising: determining, with a computer-implemented processor, a range for at least one setting of a laser included in the laser system; determining, with said computer-implemented processor, a need to adjust at least one of said settings; providing on a user interface an indication of the updated value of at least one of said settings; using the computer-implemented processor to determine whether the updated value is within the range; disabling said laser emission via computer control circuitry; adjusting, via the control circuitry, at least one of the settings of the laser to the updated value of at least one of the settings while the laser is disabled; resuming emission of the laser after adjusting at least one of the settings of the laser; A method comprising: [Additional Note 20] 20. The method of claim 19, wherein determining the need to adjust at least one of the settings is based on at least one of a characteristic of a target, a change in the characteristic of the target, a distance of a laser fiber from the target, a position of the laser fiber, and an environmental condition measured by a sensor coupled to the laser system, and wherein an upper limit of the range is determined based on at least one of a portion of an organ to which a scope connected to the laser system is attached, a type of laser fiber included in the laser system, and a medical procedure in which the laser system is used. [Additional Note 21] a processor; a user interface coupled to the processor; a memory coupled to the processor; 1. A laser system comprising: The memory, when executed by the processor, causes the processor to: receiving a first range for at least one setting of a first laser of the laser system to which the first laser can be automatically adjusted; receiving a second range for at least one setting of a second laser of the laser system to which the second laser can be automatically adjusted; determining at least one of a proposed update value for at least one of the settings of the first laser or a second proposed update value for at least one of the settings of the second laser; determining whether the proposed update value for at least one of the settings of the first laser is within the first range; determining whether the second proposed update value for at least one of the settings of the second laser is within the second range; providing, via the user interface, (i) a display of at least one of the proposed update value for at least one of the settings of the first laser and the second proposed update value for at least one of the settings of the second laser, and (ii) an option to accept or reject at least one of the proposed update value for at least one of the settings of the first laser or the second proposed update value for at least one of the settings of the second laser; adjusting at least one of the at least one setting of the first laser or the at least one setting of the second laser in response to accepting at least one of the proposed update value and the second proposed update value. A laser system configured to store instructions. [Additional note 22] in response to at least one of the proposed update value and the second proposed update value not being rejected by a user within a predetermined time period; The instructions direct the processor to: 22. The laser system of claim 21, wherein at least one of the settings of the first laser and the settings of the second laser is adjusted. [Additional Note 23] In response to at least one of the proposed update value and the second proposed update value not being rejected by a user within a predetermined time period, the instructions cause the processor to: ceasing the adjustment of at least one of the at least one setting of the first laser and the at least one setting of the second laser; Item 21. A laser system according to claim 21. [Additional note 24] the proposed update value for at least one of the settings of the first laser is within the first range, and the second proposed update value for at least one of the settings of the second laser is within the second range; The instructions direct the processor to: selecting one of the first laser and the second laser based on at least one of an environmental condition measured by a sensor coupled to the processor, a portion of an organ to which a scope connected to the laser system belongs, and a medical procedure for which the laser system is to be used; 22. The laser system of claim 21, wherein the laser system selectively switches between the first laser and the second laser based on a change in the environmental conditions, a change in the part of the organ, or a change in the medical procedure. [Explanation of symbols]

[0089] 100 system, 102 surgical laser, 104 graphical user interface, 106 ablation laser, 108 probe laser, 110 optical splitter, 112 processor, 114 controller, 116 optical fiber, 118 surgical fiber, 120 optical connector, 122 surgical fiber actuator, 124 scope, 126 target, 128 emitted light, 130 reflected light, 132 photodetector, 400 machine, 402 hardware processor, 404 main memory, 406 static memory, 408 storage device, 410 display unit, 412 alphanumeric input device, 414 user interface (UI) navigation device, 416 sensor, 418 signal generating device, 420 network interface device, 422 machine readable medium, 424 instructions, 428 output controller, 430 interlink, 500 clinical decision support system, 502 Input interface, 504 Artificial Intelligence (AI) model, 510 Target characteristics, 512 Changes in target characteristics

Claims

1. a processor; Memory and 1. A laser system comprising: The memory has stored therein instructions that, when executed by the processor, cause the processor to: receiving a range for at least one setting of a laser of the laser system, the range within which the laser is configured to operate; determining a current value for at least one of said settings; determining a proposed update value within said range for at least one of said settings; providing, via a user interface, a display of the proposed update value and an option for the user to accept or reject the proposed update value; adjusting at least one of the settings in response to accepting the proposed update value; maintaining a current value for at least one of said settings in response to no acceptance of said proposed update value within a predetermined time; To make them do so. Laser system.

2. 10. The laser system of claim 1, wherein providing the indication comprises causing the user interface to display a pop-up including the indication of the suggested update value.

3. 3. The laser system of claim 2, wherein the pop-up includes a selectable accept option and a selectable reject option.

4. 10. The laser system of claim 1, wherein determining the proposed update value comprises analyzing spectral signature information about the target.

5. 10. The laser system of claim 1, wherein determining the proposed update value comprises providing input data related to a medical procedure to a trained learning model.

6. 10. The laser system of claim 1, wherein said instructions cause said processor to temporarily interlock said laser emission while providing said indication.

7. a feedback mechanism configured to provide an additional indication of the determination of the proposed update value; 10. The laser system of claim 1 or 6, wherein the feedback mechanism includes at least one of a tactile feedback mechanism, an audible feedback mechanism, and an illumination feedback mechanism.

8. 4. The laser system of claim 2 or 3, wherein acceptance of the proposed update value is initiated through a voice command or actuation of an actuation member.

9. The instructions cause the processor to: Determining a characteristic of the target at a first time; determining a change in the characteristic of the target at a second time; determining the proposed update value based on the change in the characteristic of the target at the second time; 6. The laser system according to claim 4 or 5,

10. the laser system includes a second laser; The instructions cause the processor to: receiving a second range for at least one setting of the second laser; determining a second proposed update value for at least one of the settings of the second laser; and providing, via the user interface, a display of the second proposed update value and an option for the user to accept or reject the second proposed update value; adjusting at least one setting of the second laser in response to accepting the second proposed update value; maintaining a current value for at least one of the settings of the second laser in response to no acceptance of the second proposed update value within a predetermined time; and 6. The laser system of claim 1, 4 or 5, wherein the laser system is adapted to:

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