Laser systems with irradiation control

Abstract

This system provides a method for controlling target irradiation to identify targets during endoscopic procedures. [Solution] The endoscope system comprises a light source that generates illumination light, a diagnostic energy source configured to generate a diagnostic beam, an imaging sensor, an endoscope, and a controller circuit, wherein the controller circuit is configured to receive from the imaging sensor an image of a target illuminated by the light source operating in a first illumination mode, determine the brightness or intensity of the received image of the target, send a trigger to the diagnostic energy source to emit the diagnostic beam through the optical fiber to the target when the determined brightness or intensity of the received image satisfies certain conditions, receive reflected light from the target generated by the diagnostic beam, and identify the composition of the target, at least in part, based on the analysis of the reflected light.

Description

[Technical Field]

[0001] Claim of priority This application is hereby made available by reference in its entirety pursuant to Section 119(e) of the United States Patent Act. This is incorporated in U.S. Provisional Patent Application No. 62 / 882,837, filed on August 5, 2019. , U.S. Provisional Patent Application No. 62 / 894,226 filed on 30 August 2019, and 202 Claiming priority rights from U.S. Provisional Patent Application No. 63 / 027,090, filed on May 19, 2000. ru.

[0002] This specification generally relates to endoscopic systems, and more specifically, to target identification during endoscopic procedures. This relates to a system and method for controlling the irradiation of a target. [Background technology]

[0003] Typically, this involves providing access to the internal location of an object, such as providing visual access to a physician. Endoscopes are used for this purpose. An endoscope is typically inserted into the patient's body for examination. Light is delivered to a target (for example, the anatomical tissue or object of the target) and reflected from the object. It collects the light it emits. The reflected light carries information about the object being investigated. The endoscope includes a working channel, and the operator can remove unwanted tissue or foreign objects from the patient's body. To remove it, suction is performed through the working channel, or the working channel To pass instruments such as brushes, biopsy needles, or forceps through the flannel, or to perform minimally invasive surgery. It is possible.

[0004] To deliver surgical laser energy to various target treatment areas such as soft tissue or hard tissue. Laser or plasma systems have been used for this purpose. Examples of laser therapy include excision and aspiration. It includes solidification, evaporation, fragmentation, etc. In application examples of lithotripsy, among other stone-forming regions, the kidney , gallbladder, and ureter, lasers have been used to break down the stone structure or to excise large stones into smaller fragments.

Summary of the Invention

Means for Solving the Problems

[0005] This specification describes a system, device, and method for identifying a target during an endoscopic procedure. The endoscopic target identification system includes an endoscope having an endoscopic irradiation source, an optical fiber that can be inserted through the working channel of the endoscope and is coupled to a non-endoscopic irradiation source different from the endoscopic irradiation source, and a controller. The controller can send a control signal to the non-endoscopic irradiation source so as to emit a diagnostic beam through the optical fiber when at least one endoscopic irradiation source changes from a first mode to a second mode. The second mode has a lower irradiation dose than the first mode. The controller can determine the composition of the target based on the light from the diagnostic beam incident on the target and the diagnostic beam reflected from the target. Example 1 is a method for identifying a target during an endoscopic procedure. This method includes the step of changing the irradiation mode of the endoscope from a first mode to a second mode, where the first mode has a first irradiation dose and the second mode has a second irradiation dose smaller than the first dose; the step of emitting a diagnostic beam towards the target near the distal end of the endoscope by a non-endoscopic irradiation source while the irradiation mode of the endoscope is in the second mode; and the step of the diagnostic beam incident on the target and when the diagnostic beam is incident on the target and the diagnostic beam reflected from the target, the controller can determine the composition of the target.

[0006] Example involves changing the irradiation mode of the endoscope from a first mode to a second mode, where the first mode has a first irradiation dose and the second mode has a second irradiation dose smaller than the first dose; emitting a diagnostic beam towards the target near the distal end of the endoscope by a non-endoscopic irradiation source while the irradiation mode of the endoscope is in the second mode; and while the irradiation mode of the endoscope is in the second mode, emitting a diagnostic beam towards the target near the distal end of the endoscope by a non-endoscopic irradiation source; and ​determining the composition of the target based on the diagnostic beam and the light from the diagnostic beam reflected from the target including the step of

[0007] In Example 2, the subject matter of Example 1 optionally includes a step of changing the irradiation mode for the endoscope, including adjusting at least one endoscope irradiation source so as to provide respective irradiation amounts in the first and second modes.

[0008] In Example 3, the subject matter of any one or more of Examples 1 to 2 optionally includes a step of changing the irradiation mode for the endoscope, wherein the step of changing the irradiation mode for the endoscope includes emitting irradiation light by a first endoscope irradiation source while the irradiation mode of the endoscope is in the first mode, and emitting irradiation light by a different second endoscope irradiation source while the irradiation mode of the endoscope is in the second mode, and the irradiation light is emitted near the distal end of the endoscope. including

[0009] In Example 4, the subject matter of any one or more of Examples 1 to 3 optionally includes receiving a trigger signal so as to emit a diagnostic beam by a non-endoscope irradiation source, wherein the step of changing the irradiation mode from the first mode to the second mode is performed in response to the trigger signal.

[0010] In Example 5, the subject matter of any one or more of Examples 1 to 4 optionally includes receiving an image of the target, wherein the step of changing the irradiation mode from the first mode to the second mode is performed in response to a change in the luminance or intensity of the received image of the target.

[0011] In Example 6, the subject matter of any one or more of Examples 1 to 5 optionally includes the diagnostic beam including a laser beam emitted from a laser source. including

[0012] ​​​ In Example 7, one or more of the themes from Examples 1-6 were selected at will, and the diagnosis was made using a non-endoscopic radiation source. After stopping the beam emission, the irradiation mode is changed back from the second mode to the first mode. This includes the act of making something happen.

[0013] In Example 8, one or more subjects from Examples 1-7 are optionally selected to have endoscopic irradiation turned off. Includes a second mode that can be switched to.

[0014] In Example 9, one or more subjects from Examples 1-8 are optionally selected, and the irradiation mode is the second mode. This includes displaying an image of the target on the display while in the code, and the image is of the target prior to Includes an image of the target or a modified image of the target's current image.

[0015] In Example 10, one or more of the themes from Examples 1-9 are of arbitrary choice, and the target includes a calculus target. The step of determining the composition of the target is to determine the first composition of the first part of the stone target. This includes determining the second composition of the second portion of the stone target, and the second composition This includes the fact that it is different from the first composition.

[0016] In Example 11, the subject of Example 10 is optional, and the first part of the stone target is targeted. , to program the first laser setting, or to program the first laser setting To propose to the user, a second laser to target the second part of the gallstone target. To allow the user to program the settings, or to program a second laser setting. The second laser setting differs from the first laser setting, including the considerations mentioned above.

[0017] Example 12 is a system with at least one processor and a minimum number of computer program codes. A device comprising at least one non-temporary memory, and at least one non-temporary memory The computer program code is transmitted to the device by at least one processor. This involves changing the irradiation mode for the endoscope from the first mode to the second mode. Mode 1 has a first irradiation dose, and Mode 2 has a second irradiation dose that is smaller than the first dose. To do so, to change and, while the endoscopic irradiation mode is in the second mode, non-endoscopic irradiation Depending on the source, a diagnostic beam is emitted towards the target near the distal end of the endoscope, and towards the target Based on the light from the incident diagnostic beam and the diagnostic beam reflected from the target, the set of targets It is configured to perform the task of determining the finished product.

[0018] In Example 13, the subject of Example 12 is optionally at least one memory and computer The program code is transmitted to the device by at least one processor for the endoscope. It is configured to change the irradiation mode, and it is possible to change the irradiation mode for the endoscope. , to provide the respective irradiation doses under the first and second modes, at least one of This includes adjusting the endoscopic illumination source.

[0019] In Example 14, one or more of the themes from Examples 12-13 are optional, and at least one of them is The memory and computer program code are stored by at least one processor. The device is configured to change the irradiation mode for the endoscope, and the irradiation for the endoscope Changing the mode allows the endoscope's irradiation mode to be in the first mode while the first endoscopic view is in the first mode. The light is emitted by the mirror irradiation source, and while the endoscope's irradiation mode is in the second mode... This includes emitting illumination light from a different second endoscopic illumination source, and the illumination light is used in the endoscope. This includes being emitted near the distal end of the mirror.

[0020] In Example 15, one or more of the themes from Examples 12-14 are optional, and at least one of them is The memory and computer program code are stored by at least one processor. The device receives a trigger signal and, in response to the trigger signal, performs a diagnosis using a non-endoscopic irradiation source. It is configured to emit a beam and change the irradiation mode from the first mode to the second mode. This includes being

[0021] In Example 16, one or more of the themes from Examples 12-15 are optional, and at least one of them is The memory and computer program code are stored by at least one processor. The device switches the irradiation mode to a first mode in response to changes in the brightness or intensity of the target image. This includes being configured to change to a second mode.

[0022] In Example 17, one or more of the themes from Examples 12-16 are optional, and at least one of them is The memory and computer program code are stored by at least one processor. After the non-endoscopic irradiation source stops emitting the diagnostic beam, the device switches the irradiation mode to the second mode. This includes being configured to change back from mode D to the first mode.

[0023] In Example 18, one or more subjects from Examples 12-17 are optionally selected, and the diagnostic beam is This includes including a laser beam emitted from a laser source.

[0024] In Example 19, one or more of themes from Examples 12-18 are optionally selected for the second mode. This includes switching off the endoscopic irradiation.

[0025] In Example 20, one or more of the themes from Examples 12-19 are optional, and at least one of them is The memory and computer program code are stored by at least one processor. The device displays an image of the target on the display while the irradiation mode is in the second mode. It is configured such that the image is a previous image acquired by the endoscopic imaging system, and This is a corrected image of the current image of the target transmitted by the endoscopic imaging system. This includes doing so.

[0026] In Example 21, one or more of the themes from Examples 12-20 are optional, and at least one of them is The memory and computer program code are stored by at least one processor. The device determines the first composition of the first part of the stone target, and the second composition of the second part of the stone target. It is configured to determine the composition of the second composition, and includes the fact that the second composition is different from the first composition. nothing.

[0027] In Example 22, the subject of Example 21 is optionally at least one memory and computer The program code is transmitted to the device by at least one processor to the first stone target. Program the first laser setting to target the part, or the first laser setting The user is asked to suggest a target, and the target should be the second part of the gallstone target. , to program a second laser setting, or to program a second laser setting It is configured to allow the user to make suggestions, and the second laser setting is different from the first laser setting. This includes.

[0028] Example 23 is an endoscopic target identification system. The system identifies at least one endoscopic irradiation An endoscope including a source, and an insertable device through the working channel of the endoscope, with at least 1 A fiber optic cable coupled to a non-endoscopic irradiation source different from the two endoscopic irradiation sources, and a controller and The controller is equipped with a first mode and controls at least one endoscopic irradiation source from a first mode to a second mode. When it changes to a certain state, it emits a diagnostic beam near the distal end of the endoscope through the optical fiber. The first mode generates a control signal to a non-endoscopic irradiation source, and the first mode is the first irradiation dose. Having a second mode having a second irradiation dose smaller than the first amount, and generating, Based on the light from the diagnostic beam incident on the target and the diagnostic beam reflected from the target, the target It is configured to perform the task of determining the composition of the

[0029] In Example 24, the subject of Example 23 is optionally a diagnostic beam containing a laser beam, using an optical fiber. This includes being coupled to a non-endoscopic irradiation source that includes a laser source configured to emit a flame.

[0030] In Example 25, one or more of the themes from Examples 23-24 were selected, and the endoscope was used for endoscopic vision. While the mirror's illumination mode is in the first mode, the first inner is configured to emit illumination light. The endoscope light source and the emission of light while the endoscope's irradiation mode is in the second mode. The system includes a different second endoscopic light source, wherein the light is emitted near the distal end of the endoscope. Includes.

[0031] In Example 26, one or more of the themes from Examples 23-25 ​​are optional, and the controller... In response to a trigger signal, the irradiation mode is changed from the first mode to the second mode. This includes being configured to generate control signals to the endoscope.

[0032] In Example 27, one or more of the themes from Examples 23-26 were selected, and the endoscope targeted the target. The system includes an imaging system configured to acquire images of the target, and the controller controls the image of the target. In response to changes in brightness or intensity, the illumination mode is changed from the first mode to the second mode. This includes being configured to generate control signals to the endoscope.

[0033] In Example 28, one or more of the themes from Examples 23-27 are optional, and the controller... After the non-endoscopic irradiation source stops emitting the diagnostic beam, the irradiation mode is restarted from the second mode. The system is configured to generate control signals to the endoscope so as to change it to the first mode. This includes.

[0034] In Example 29, one or more of themes from Examples 23-28 are optionally selected for the second mode. This includes switching off the endoscopic irradiation.

[0035] In Example 30, one or more of the themes from Examples 23-29 were selected, and the endoscope targeted the... The system includes an imaging system configured to acquire images, and the controller is configured to set the irradiation mode to While in the second mode, control signals are sent to the display to show the target image. It is configured so that the image is a modified version of the target's previous or current image. This includes a certain thing.

[0036] In Example 31, one or more of the themes from Examples 23-30 are optional, and the controller... , determine the first composition of the first part of the stone target, and determine the second composition of the second part of the stone target. It is configured to determine that the second composition is different from the first composition.

[0037] In Example 32, the subject of Example 31 is optional, and the controller targets the first portion of the stone target. Program the first laser setting to target, or program the first laser setting Generate a recommendation to ram and use a second laser to target the second portion of the stone target. It will generate recommendations for programming the settings or programming a second laser setting. The configuration includes the fact that the second laser setting is different from the first laser setting.

[0038] This summary is an overview of some of the teachings of this application and does not constitute an exclusive or exhaustive approach to the subject matter. This is not intended to be treated as such. Further details regarding this subject can be found in the detailed explanation. and as can be seen in the attached claims. Other aspects of this disclosure can be found by reading the detailed description below. It is clear to those skilled in the art by understanding and looking at the drawings that form part of it, and detailed The descriptions and drawings should not be interpreted restrictively. The scope of this disclosure is limited to the attached patent. Defined by the scope of the claim and its legal equivalents.

[0039] Various embodiments are shown as examples in the attached drawings. Such embodiments are described below. This is a general overview and is not intended to represent an exhaustive or exclusive embodiment of the subject matter. [Brief explanation of the drawing]

[0040] [Figure 1] This is a schematic diagram of an exemplary laser therapy system, including a laser feedback control system. [Figure 2A] This figure shows examples of absorption spectra of different types of tissues, including hemoglobin (Hb) and oxyhemoglobin (HbO2). [Figure 2B] This figure shows examples of absorption spectra of different types of tissues, including hemoglobin (Hb) and oxyhemoglobin (HbO2). [Figure 3A] This figure shows examples of absorption spectra of different types of tissue, including normal and carbonized tissue, Hb, HbO2, and melanin. [Figure 3B] This figure shows examples of absorption spectra of different types of tissue, including normal and carbonized tissue, Hb, HbO2, and melanin. [Figure 3C] This figure shows examples of absorption spectra of different types of tissue, including normal and carbonized tissue, Hb, HbO2, and melanin. [Figure 4] This figure shows the penetration depth of the laser power. [Figure 5] This is a block diagram of a laser feedback control system for providing laser output. [Figure 6] This flowchart illustrates an example of an algorithm for controlling one or more laser systems based on feedback generated by a laser feedback control system. [Figure 7] This flowchart illustrates an example of an algorithm for controlling one or more laser systems based on feedback generated by a laser feedback control system. [Figure 8] This is a timing diagram of an exemplary dual laser system that uses two light wavelengths to provide tissue excision and coagulation. [Figure 9A] This figure shows an example of an endoscope with a laser fiber inserted. [Figure 9B] This figure shows an example of an endoscope with a laser fiber inserted. [Figure 10A] This figure shows an example of a feedback-controlled laser treatment system. [Figure 10B] This figure shows an example of a feedback-controlled laser treatment system. [Figure 11A]This figure shows an example of an endoscopic system for identifying targets using a diagnostic beam, such as a laser beam. [Figure 11B] This figure shows an example of an endoscopic system for identifying targets using a diagnostic beam, such as a laser beam. [Figure 12] This figure shows the reflectance spectrum for identifying target types, such as for distinguishing the composition of different types of kidney stones. [Figure 13A] This figure shows the reflectance spectrum for identifying target types, such as for distinguishing the composition of different types of kidney stones. [Figure 13B] This figure shows the reflectance spectrum for identifying target types, such as for distinguishing the composition of different types of kidney stones. [Figure 14] Figures 13A and 13B show the optical peaks corresponding to different segments of the UV wavelength in the reflection spectra of several types of stones. [Figure 15] Figures 13A and 13B show the optical peaks corresponding to different segments of the UV wavelength in the reflection spectra of several types of stones. [Figure 16A] This figure shows examples of reflectance spectra captured by a UV-VIS spectrometer from various soft and hard tissue compositions. [Figure 16B] This figure shows examples of reflectance spectra captured by a UV-VIS spectrometer from various soft and hard tissue compositions. [Figure 16C] This figure shows an example of an FTIR spectrum of a typical stone composition. [Figure 16D] This figure shows examples of FTIR spectra of several soft and hard tissue compositions. [Figure 17] This is a schematic diagram of a laser treatment system. [Figure 18] This is a schematic diagram of a laser treatment system. [Figure 19A] This figure shows an example of a combined laser pulse train generated using multiple (for example, N) laser pulse trains. [Figure 19B]This figure shows an example of a combined laser pulse train generated using multiple (for example, N) laser pulse trains. [Figure 20] This is a schematic diagram of an exemplary spectroscopic system with spectral feedback. [Figure 21A] This figure shows an example of an endoscopic laser system with a multi-fiber configuration. [Figure 21B] This figure shows an example of an endoscopic laser system with a multi-fiber configuration. [Figure 21C] This figure shows an example of an endoscopic laser system with a multi-fiber configuration. [Figure 21D] This figure shows an example of an endoscopic laser system with a multi-fiber configuration. [Figure 22] Block diagram showing an example of a multifiber system used in a fiber optic delivery system. [Figure 23A] This figure shows an example of a multifiber accessory having a source optical input and a spectral feedback signal. [Figure 23B] This figure shows an example of a multifiber accessory having a source optical input and a spectral feedback signal. [Figure 24A] This figure illustrates an exemplary method for calculating the distance between the distal end of a laser delivery system (e.g., an optical fiber) and a target. [Figure 24B] This figure illustrates an exemplary method for calculating the distance between the distal end of a laser delivery system (e.g., an optical fiber) and a target. [Figure 24C] This figure illustrates an exemplary method for calculating the distance between the distal end of a laser delivery system (e.g., an optical fiber) and a target. [Figure 24D] This figure illustrates an exemplary method for calculating the distance between the distal end of a laser delivery system (e.g., an optical fiber) and a target. [Figure 25A] This figure shows the effect of the distance between the tissue and the distal end of the spectroscopic probe on the spectrum of reflected light from the target. [Figure 25B]This figure shows the effect of the distance between the tissue and the distal end of the spectroscopic probe on the spectrum of reflected light from the target. [Figure 26] This figure shows an example of an endoscopic system for identifying targets using a diagnostic beam, such as a laser beam. [Figure 27] This is a graph of laser pulse sequences with different pulse energy or power levels for use in laser treatment of target tissue or calculus structures. [Figure 28] This is a block diagram illustrating an exemplary machine capable of performing one or more of the techniques (e.g., methods) discussed herein. [Modes for carrying out the invention]

[0041] Systems, devices, and methods for identifying targets during endoscopic procedures are described herein. The endoscopic target identification system is used with an endoscope that has an endoscopic irradiation source and the working endoscope. It can be inserted through a channel and is coupled to a non-endoscopic irradiation source different from the endoscopic irradiation source. It includes an optical fiber and a controller. The controller has at least one endoscopic irradiation source. When it changes from the first mode to the second mode, it emits a diagnostic beam through the optical fiber. In this way, control signals can be sent to non-endoscopic irradiation sources. The second mode is the same as the first mode. It has a smaller irradiation dose than the target. The controller controls the diagnostic beam incident on the target and the target Based on the light from the diagnostic beam reflected from the target, the composition of the target can be determined.

[0042] Endoscopic laser therapy recognizes different tissues and targets therapeutic structures (for example, cancerous tissue, etc.) Laser energy is applied only to (or specific types of) stones, and non-treatment tissue ( For example, it is desirable to avoid or reduce the exposure of normal tissue. Conventionally, targeted therapy Structural recognition involves visualizing the target surgical site and its surrounding environment using an endoscope, etc. It is performed manually by individuals. Such manual methods may lack precision, and Even if not, in some cases, access to the surgical site is limited, and the field of view during surgery is restricted. For example, the composition of the target may not be determined due to the target structure (for example) Biopsy techniques are used to extract tissues from the body and analyze their composition outside the body. However, in many clinical applications, it has reduced surgical time and complexity, and improved the effectiveness of the therapy. To improve efficacy, it is desirable to determine the tissue composition in vivo. For example, kidney stones. In laser lithotripsy, which involves applying a laser to crush or break up certain types of stones, For example, automatically recognizing the chemical composition of kidney, pancreatic, bile duct, or gallbladder stones in the body, By distinguishing it from the surrounding tissue, doctors can more effectively remove the target stone while simultaneously To avoid radiation to non-treatment tissue adjacent to the target stone, the laser settings (e.g., power) It should become possible to adjust (exposure time, or firing angle).

[0043] Conventional endoscopic laser therapy involves continuously monitoring the tissue type (e.g., composition) during the procedure. There is also the limitation that it cannot be seen. During endoscopic procedures, there are many moving parts, and internally The tissue observed through the endoscope can change throughout the procedure. Conventional biopsy techniques are compositional To identify the object, the tissue sample must be removed, so the composition of the tissue must be considered throughout the procedure. It is not possible to monitor the structure type (e.g., soft tissue or hard tissue) at the tip of the endoscope. Continuous monitoring and recognition of tissue type, normal tissue vs. cancerous tissue, or composition of calculus structures. This provides doctors with more information to better adapt the treatment during the procedure. It is possible. For example, when a doctor is breaking up a kidney stone that is hard on the surface but soft at the core. Based on continuous tissue composition information obtained through endoscopy, the physician can continuously detect the stone surface composition Based on the material, the first setting performs better on the hard surface of the stone, while the second setting performs better on the flexible core of the stone. This allows for adjustment of laser settings, such as a second, different setting that performs better. It is possible.

[0044] Some of the features described herein are, for example, various target sets in medical applications. The organism (for example, soft tissue or hard tissue) can be identified in vivo using an endoscope. A method and apparatus can be provided that allows the user to observe with an endoscope. This allows for continuous monitoring of the target composition throughout the procedure. This can be used in combination with a laser system, and this method targets It is possible to send feedback to the laser system to adjust the settings based on the composition. Yes, it is possible. This feature allows the laser to operate within the setting range of the original laser settings selected by the user. This allows for instant adjustment of settings.

[0045] Using some of the features described herein, differences such as the target chemical composition can be detected in living organisms. We will measure and propose or set up laser settings to better achieve the desired effect. We can provide a system and method for automatically adjusting the settings. Target and application examples Examples include laser lithotripsy for kidney stones, and laser cutting or evaporation of soft tissue. In this example, the three main components are a laser, a spectroscopic system, and a feedback analyzer. A base is provided. In one example, the controller of the laser system is based on the target composition. By setting appropriate laser parameters, laser therapy can be automatically programmed. For example, based on a machine learning algorithm trained with spectrometer data, The can control the procedure. In addition or alternatively, the user (for example, a doctor) can take action. You can receive continuous target type instructions and adjust the laser settings accordingly. This can facilitate the treatment. Adjust the laser settings and target the compositional portion of a single stone with laser therapy. By adapting the system, stone cutting or crushing can be performed more quickly and energy-efficiently. It can be done.

[0046] Some of the features described herein include internet connectivity and measurement capabilities. Data input to the feedback analyzer, including connectivity to other surgical devices. We can provide systems and methods that provide [this]. In addition, the laser system [this] It can provide input data to other systems such as image processors, thereby processing A monitor can display information about medical procedures to the user. One example is... Different soft tissues, vascular structures, capsular tissues, and the same target within the field of view during treatment, such as litholiths. The goal is to more clearly distinguish between different chemical compositions.

[0047] Some of the characteristics described herein may differ from those of different tissue types or different types of calculi, etc. A system and method can be provided to identify different target types. In some cases, a single stone structure (for example, a stone in the kidney, bladder, pancreaticobiliary duct, or gallbladder) can be detected by brushing. Oxalite, calcium phosphate (CaP), calcium oxalate dihydrate (COD), oxalic acid Calcium monohydrate (COM), magnesium ammonium phosphate (MAP), or co Resterol-based or uric acid-based stone structures, or other structures that encompass two or more different types of gases throughout their entire volume. It may have a composition such as the first part of the COD and It may include a second part of COM. According to one embodiment, this specification uses spectral data to describe biological Based on continuous collection and analysis within a single target (e.g., a single stone), This document describes a system and method for sequentially identifying different compositions contained within. For example, laser therapy can be adapted according to the identified target composition. In response to the identification of a first composition (e.g., COD) in the target stone, the first laser pulse The laser system is controlled by the lamellar settings (e.g., power, exposure time, or firing angle). The laser system can be programmed to remove the first part accordingly. The laser beam can be delivered to cause fragmentation. During laser therapy, spectral data The first composition within the same target stone being treated can be collected and analyzed sequentially. In response to the identification of a second composition (e.g., COM) that is different from the first, the laser therapy is performed. A second laser parameter setting different from the parameter setting (for example, a different power, or The laser system is programmed according to the exposure time or firing angle, etc. For example, delivering a laser beam to excise or fragment a second portion of the same target stone. Therefore, it can be adjusted. It can be included in the treatment. Treating stone portions of different compositions with different laser sources. This is possible. The appropriate laser to use can be determined by identifying the type of stone. .

[0048] Several features described herein are advantageous for incorporating different types of laser sources. It can be used in relation to laser systems for a variety of possible applications. The features described herein are for industrial or medical applications such as medical diagnosis, treatment, and surgical procedures. This may be suitable for setting up medical treatment. The features described herein include endoscopy, laser surgery, It can be used in connection with laser lithography, laser setting, and / or spectroscopy.

[0049] Figure 1 is an example including a laser feedback control system 100 according to an example of the present disclosure. A schematic diagram of the laser treatment system is shown. An exemplary laser feedback control system 100 is also shown. Examples of applications include soft (e.g., non-calcified) tissues or hard (e.g., calcified) tissues, or industrial and / or for the treatment of lithic structures such as kidney, pancreaticobiliary duct, or gallbladder stones. This also includes integration into laser systems for many applications, such as medical applications. For example, the systems and methods disclosed herein are precisely controlled for processes such as excision, coagulation, and evaporation. It may be useful for delivering controlled treatments, or for excising, fragmenting, or crushing stone structures. ru.

[0050] Referring to Figure 1, the laser feedback control system 100 includes one or more lasers It can communicate with the stem in an operable manner. Figure 1 shows the first laser system 102 and A laser feedback is optionally connected to the second laser system 104 (shown by the dotted line). While a basic system is shown, additional laser systems are also envisioned within the scope of this disclosure.

[0051] The first laser system 102 includes a first laser source 106, a power supply, a display, and a cooling system. It may include associated components such as systems. The first laser system 102 is Furthermore, it includes a first optical fiber 108 operably coupled to the first laser source 106. This is possible. The first optical fiber 108 transmits a laser from the first laser source 106 to the target tissue 122. The output can be configured to transmit.

[0052] In one example, the first laser source 106 is configured to provide a first output 110. This is possible. The first output 110 can extend over a first wavelength range. According to some aspects, the first wavelength range is part of the absorption spectrum of the target tissue 122. It can correspond to minutes. The absorption spectrum represents the absorption coefficient in the range of laser wavelengths. Figure Figure 2A shows the absorption spectrum of water 210 as an example. Figure 2B shows the absorption spectrum of oxyhemoglobin as an example. The absorption spectra of globin (221) and hemoglobin (222) are shown. In an example like this, the first output 110 corresponds to the absorption spectrum of the tissue. Because it spans a wavelength range, it effectively excises and / or carbonates the target tissue 122. Being able to provide this is advantageous.

[0053] For example, the first laser source 106 emits a first output 110 in a first wavelength range. , high absorption by the tissue of the incident first output 110 (for example, about 250 cm²) -1 exceeding It can be configured to correspond to (doing). In an exemplary embodiment, the first laser source 10 6 is approximately 1900 nanometers to approximately 3000 nanometers (for example, high absorption by water). (corresponding to), and / or about 400 nanometers to about 520 nanometers (for example) (corresponding to the high absorption of oxyhemoglobin and / or deoxyhemoglobin) It can emit an output of 110. The interaction of light with tissue involves absorption and scattering. It is known that there are two main mechanisms. The tissue has high absorption (absorption coefficient of 250 cm -1 When it exceeds 25, the first absorption mechanism becomes dominant, resulting in low absorption (absorption coefficient is 25). 0cm -1 When it is smaller, for example, in lasers in the wavelength range of 800-1100 nm, The scattering mechanism becomes dominant.

[0054] Various commercially available medical-grade laser systems are suitable for the first laser source 106. It is possible. For example, approximately 515 nanometers to approximately 520 nanometers or approximately 370 nanometers. In provides a first output 110 within a first wavelength range of meters to approximately 493 nanometers. Semiconductor lasers such as XGa1-XN semiconductor lasers can be used. Alternatively, Infrared (IR) lasers, such as those summarized in Table 1 below, can be used.

[0055] [Table 1]

[0056] Referring to Figure 1, the laser treatment system of this disclosure optionally includes a second laser system It may include a second laser system 104, as described above, a second output A second laser source 116 to provide force 120, and a power supply, display, and cooling system. The second laser system 104 includes the first laser source 10 It can be detached from 6 to operate, or alternatively, to the first laser source 106 to operate It can be coupled. In some examples, the second laser system 104 is the second A second optical fiber operably coupled to a second laser source 116 to transmit output 120 It may include fiber 118 (separate from the first optical fiber 108). Alternatively, the first The optical fiber 108 is designed to transmit both the first output 110 and the second output 120. It can be configured as follows.

[0057] In certain embodiments, the second output 120 is in a second wavelength range separate from the first wavelength range. It can extend. Accordingly, between the first wavelength range and the second wavelength range There may be no significant overlap. Alternatively, the first wavelength range and the second wavelength range These may have at least partial overlap with each other. In some aspects of this disclosure If so, the second wavelength range is the absorption spectrum of the target tissue 122 that has been previously excised or carbonized. In areas where the incident radiation is strongly absorbed by untreated tissue (for example, as shown in Figure 2) It may not be compatible. In some such embodiments, the second output 120 is a non-carbonized group. It is advantageous not to cut the tissue. Furthermore, in another example, the second output 120 was previously cut The removed carbonized tissue can be excised. In an additional example, the second output 120 is an additional It can provide therapeutic effects. For example, the second output 120 can constrict tissue or blood vessels. This can be made more suitable for solidification.

[0058] Laser emission can be greatly absorbed by soft or hard tissue, stones, etc. Example Figures 3A to 3C show the absorption spectra of different tissue types. Figure 3A shows normal tissue. Absorption spectrum 311 of tissue (before excision) and absorption spectrum 311 of carbonized tissue (after excision) Figure 3B shows the results for each of the two points. Figure 3B shows the results within a specific wavelength range (for example, 450-850 nm). This shows that the absorption spectrum undergoes exponential decay with respect to the laser wavelength (Figure 3A and The source of the data shown in Figure 3B is http: / / omlc.org / spectra / hem oglobin / ). Figure 3C shows the water spectra 331A-331C (75%, 1%). (At concentrations of 00% and 4%), hemoglobin (Hb) spectrum 332, oxyhemoglobin Bin (HbO2) spectrum 333, and melanin spectrum 334A~334D ( (Containing different volume fractions of melanosomes: 2%, 13%, 30%, and 100%, respectively) The light absorption spectra measured within the medium are shown (the source of the data shown in Figure 3C is http: / / www.americanlaserstudyclub.org / laser-s (Urgry-education / ). The wavelength of water absorption is 1900nm to 3000nm. It is within the range. The wavelength of oxyhemoglobin and / or oxyhemoglobin is 40 The range is 0nm to 520nm. Many surgical lasers are capable of filtering water within a certain range. It is largely absorbed by hemoglobin, but there are also media that are limited in their ability to absorb water, and this This could be a reason why the inside of the endoscope can be damaged by laser energy.

[0059] Figure 4 shows the penetration depth for the second laser output, such as 120 (data shown in Figure 4). The source is http: / / www.americanlaserstudyclub.org / (laser-surgery-education / ). As can be seen in the same source, the second Output 120 is equivalent to the characteristic dimensions of small capillaries (e.g., approximately 5 to 10 μm). Depending on the depth of insertion, it may be suitable for effective coagulation. Furthermore, in certain examples, Figure 3A and Figure Referring to 3B, the second wavelength range is the second output 120 due to the non-carbonized tissue. It can handle low absorption, but carbonized tissue (for example, the first output 110 cut It can also handle high absorption due to (division). Spectral characteristics of the second output 120 The properties are high due to the carbide structure of the second incoming output 120 (for example, about 250 cm²). -1 Yo It is clear that it can handle absorption of a large amount. A suitable example of a second laser source is approximately 75 It has a second output 120 in a second wavelength range of 0 nanometers to approximately 850 nanometers. Ga X Al 1-X A, or the second wave, approximately 904 nanometers to approximately 1065 nanometers. In having a second output 120 within a long range X Ga 1-X A is included.

[0060] It has partially overlapping spectra suitable for absorption by tissue (normal and / or carbonized). Two laser systems were described above, but as an alternative example, the second laser system 10 Instead of 4, the first laser system 102 can provide the second output 120. For example, the first laser system 102 uses a laser on previously unexcised "normal" tissue. A first wavelength range suitable for high absorption (for example, as shown in Figure 2) Output 110, and low absorption by the tissue before carbonization, and / or coagulation (even A second wavelength range is preferable (as shown in Figures 3A and 3B). The first laser system 102 can provide an output of 120. It can provide additional output across a wider range.

[0061] Refer to Figure 1 again. For example, the laser treatment system is laser feedback control This includes system 100. Referring next to Figure 5, as mentioned above, laser feedback control Your system 100 analyzes the feedback signal 130 from the target tissue 122 and determines the desired The first laser system 10 generates a laser output suitable for providing a therapeutic effect. It is possible to control two and / or a second laser system 104. For example, The feedback control system 100 controls the target tissue 12 during a therapeutic procedure (e.g., excision). By monitoring the properties of 2, the tissue is preferably excised before another treatment procedure (e.g., vascular coagulation). It is possible to determine whether or not this has been done. Accordingly, the laser feedback control system The TEM 100 can include a feedback analyzer 140.

[0062] Continuing to refer to Figure 5, the feedback analyzer 140, for example, is an organization The spectral characteristics can be monitored. Spectral characteristics include properties such as reflectance and absorption index. This is possible. Accordingly, the feedback analyzer 140 includes a spectroscopic sensor 142. It is possible to do so. The spectroscopic sensor 142 is a Fourier transform infrared spectrometer (FTIR), Raman spectroscopy. This may include light meters, UV-VIS reflectance spectrometers, fluorescence spectrometers, etc. FTIR is determined by... This is a simple and rapid method used for material analysis. This technique is relatively good in terms of space. It has resolution and provides information about the chemical composition of the material. Raman spectroscopy is used for hard tissues and It has good accuracy in identifying the components of soft tissue. Raman spectroscopy is a technique with high spatial resolution. As a method, it is also useful for determining the distribution of components within a target. UV-VIS reflectance spectroscopy is This is similar to information received from the eyes or color images created by a high-resolution camera. Reflection is a method of collecting information from light reflected from an object in a more quantitative and objective way. Spectroscopy is a method of analyzing materials because the reflection and absorption of light depend on their chemical composition and surface properties. This provides information about the material. This technique is used to determine the surface and internal properties of the sample. It is also possible to obtain unique information about both. Reflectance spectroscopy can be used to obtain information about hard or soft tissue. This can be a useful technique for recognizing compositions. Fluorescence spectroscopy analyzes the fluorescence from a sample. It is a type of electromagnetic spectroscopy. Fluorescence spectroscopy typically involves the use of an ultraviolet light beam. This light beam excites the material compound, and this material compound is typically illuminated or ionized. This method emits light from the R region. This method is used for several organic components such as hard and soft tissues. It is applicable to the analysis.

[0063] The feedback analyzer 140 is optional; for example, the imaging sensor 144 (for example) For example, a CCD capable of sensing ultraviolet (UV), visible (VIS), or infrared (IR) wavelengths. This may include a CMOS camera. In some examples, the spectroscopic sensor 142 is various Enhances the sensing and detection of distinctive features (e.g., carbonized and non-carbonized tissues, vascular structures, etc.). For this purpose, it may include two or more types of spectrometers or imaging cameras as described herein.

[0064] In some examples, the spectroscopic sensor 142 (also known as a spectrometer) is described herein. It may include any of the following spectrometers, further enhancing the imaging capabilities of the endoscope used during the treatment procedure. It can be relied upon. For example, endoscopy can be used for therapeutic procedures (e.g., laser resection of tumors). ) can be used to visualize anatomical features. In such cases, spectral spectroscopy can be used. The imaging capability of the endoscope can be increased by the 142. For example, conventional endoscopy Mirrors are suitable for enhanced visualization of anatomical features (e.g., lesions, tumors, vascular structures, etc.). It can provide narrowband imaging. The spectroscopic sensor 142 is used for endoscopic imaging (white light and / By combining it with (or narrowband imaging), it allows for precise control of the delivery of therapeutic agents. This allows for increased detection of tissue characteristics such as carbonization levels.

[0065] Referring again to Figure 5, the spectroscopic sensor 142 is operable to the signal detection optical fiber 150. They can be coupled. In such an example, the signal detection optical fiber 150 spectrally analyzes the tissue. It can have optical characteristics suitable for transmitting spectral signals to sensor 142. Alternatively, The spectroscopic sensor 142 is connected to the first optical fiber 108 and / of the first laser system 102. Alternatively, operably coupled to the second optical fiber 118 of the second laser system 104. This makes it possible to connect the first optical fiber 108 and / or the second optical fiber 118. The spectral signal can be detected through this.

[0066] Referring again to Figures 1 and 5, the laser feedback control system 100 is: Spectroscopic sensor 142, first laser system 102, and optionally second laser system Includes a laser controller 160 that communicates operably with each of the M104. -Laser 160 delivers one or more laser pulses to the target tissue 122 to produce the desired therapeutic effect. To control the laser output from the system, one or more control algorithms described herein According to the instructions, one or more laser systems are operably connected to the laser controller 160. (For example, the first laser system 102, the second laser system 104, and / or It can control any additional laser systems.

[0067] The laser controller 160 performs one or more of the functions attributable to the laser controller 160. To do this, microprocessors, digital signal processors (DSPs), and application-specific processors are used. Integrated circuits (ASICs), field-programmable gate arrays (FPGAs), or other similar technologies. Other equivalent integrated or individual logic circuits, such processors, and such configurations It can include any combination of elements. Optionally, the laser controller 160 has By wire or wireless connection, the spectral sensor 142 and one or more laser systems (even For example, the first laser system 102, the second laser system 104, and as shown herein It can be coupled to any selected laser system that is not currently configured.

[0068] The laser controller 160 communicates with the feedback analyzer 140 (for example) (via wired or wireless connection), one or more feedback analyzers 140 It can receive a back-back signal. The laser controller 160 is further described herein. As explained below, based on the feedback signal, one or more characteristics of the target tissue 122 are selected. It can make a determination. For example, the laser controller 160 can determine the feedback signal The amplitudes are compared to show the minimum and maximum amplitudes, and the characteristics of the tissue (e.g., carbonization, coagulation, etc.) are presented. ) can be determined.

[0069] In some cases, the feedback analyzer 140 continuously monitors the target tissue 122. It observes and communicates continuously with the laser controller 160 to provide a feedback signal. This can be done. Accordingly, the laser controller 160 adjusts the amplitude of the feedback signal. The laser system can continue to be maintained in one or more states until a change is detected. When a change in the amplitude of the spectral signal is detected, the laser controller 160 will perform one or more It can communicate with the laser system and change its state to deliver the desired therapeutic effect. Alternatively or additionally, the laser controller 160 may be controlled by an operator (for example, a medical professional). It communicates with the user and, via one or more output systems, indicates a feedback signal to one or more The output can be displayed, and optionally, to deliver the desired therapeutic effect, the first laser One or more treatment procedures are performed by the system and / or a second laser system. The operator can be instructed to do so.

[0070] In the examples described herein, the laser controller 160 determines the status of the laser system. By changing it, one or more laser systems can be controlled. In one embodiment Therefore, the laser controller 160 can control each laser system independently. For example, the laser controller 160 sends separate control signals to each laser system. Each laser system can be controlled independently of other laser systems. Alternatively, The laser controller 160 controls one or more laser systems using a common method. It can send signals.

[0071] In some examples, each of the laser systems generates a laser output. There are two distinct states: the first state, and the second state in which the laser system does not generate laser output. It can be associated with individual states. For example, the first laser system 102 is the first A first state in which an output 110 (for example, a first wavelength range) is generated, and the first output 110 It can have a second state in which no is generated. Similarly, the second laser system 10 4 is a first state in which a second output 120 (for example, a second wavelength range) is generated, and the second It can have a second state in which output 120 is not generated. In such an example, The controller 160 changes the state of the laser system from the first state to the second state or By sending a control signal that changes from the second state to the first state, one or more lasers The system can be controlled. Furthermore, each laser system can optionally have additional status It can have a third state in which, for example, laser output in different wavelength ranges is generated. Accordingly, in order to generate the laser output that provides the desired therapeutic effect, the laser controller Roller 160 sends additional control signals to the laser system, and from their current state To one or more additional states (for example, from the first state to the third state, from the second state to the third state) (The state, from the third state to the first state, and from the third state to the second state) those states It can be changed.

[0072] [Embodimentary laser system control algorithm] Figures 6 and 7 show laser feedback control systems according to some examples described in this disclosure. This shows an example algorithm for controlling one or more laser systems using TEM100. This is a flowchart. According to the control algorithm 600 shown in Figure 6, in step 602, The back analyzer 140 (for example, the spectral sensor 142 or the imaging sensor 144) Therefore, the first signal (for example, the spectral signal) can be detected in step 604. The laser controller 160 receives a first signal from the feedback analyzer 140. It can be obtained. The first signal can correspond to the first characteristic. Step 606 The laser controller 160 then checks whether the first signal is approximately equal to the first preset value. It is possible to determine the amplitude of the first signal. For example, the laser controller 160 determines the amplitude of the first signal. Compare to a target value or a preset extreme value (e.g., maximum or minimum amplitude), and the target set The first characteristic of fabric 122 can be determined. The first characteristic is the set after treatment. It can show the characteristics of the tissue (e.g., excised or carbonized tissue). Laser controller 1 60 determines the desired based on the first characteristic (comparison between the first signal and the first preset value). If it can be determined that a therapeutic effect has been achieved, in step 608, the first control signal is given The laser is sent to the laser system 102, and the first laser system 102 is changed from the first state to the first laser - The system 102 can be changed to a second state. For example, this can be done As a result of delivering satisfactory therapeutic effects (e.g., excision), the first laser system 1 02 will no longer generate the first output 110. Alternatively, in step 606, the first signal If it is determined that it is not approximately equal to the first preset value (not sufficiently removed), then - The controller does not send any control signals, and the feedback analyzer is the first The signal can continue to be monitored.

[0073] Optionally, in step 612, the feedback analyzer 140 is configured to receive the first signal. A separate second signal can be received. The second signal is a signal with a second preset value. The first characteristic of the target tissue can be shown. For example, reflection from the tissue in the second signal. The amplitude of the light may differ from that of the first signal. In the optional step 614, the laser co The second signal can be received by the controller 160. Optional step 61 In step 6, the laser controller 160 checks whether the second signal is approximately equal to the second preset value. It is possible to determine whether a second signal (e.g., a spectral signal or an image) is , the target tissue 122 is not carbonized by the absorption of the first output 110 (for example, The measured signal amplitude is smaller than the preset maximum amplitude of the spectral signal or image of the excised tissue. It can be shown that (this is the case). In some cases, such a condition is due to insufficient excision. Alternatively, it may show other unsatisfactory treatment effects, and it may be possible to excise the tissue. Therefore, it is desirable to continue delivering laser power. Accordingly, optional step 6 At 18, the laser controller 160 communicates with the first laser system 102 to control the second laser system It can send signals. The second control system controls the first laser system 102 This state can be maintained (for example, to continue delivering the first output 110). Alternatively, if the first laser system is in the second state (e.g., off), In selection step 620, a second control signal is issued, for example, to continue with additional excision of the target tissue. To deliver, change the state of the first laser system to the first state (for example, ON). It can be done.

[0074] In the optional step 620, the laser controller 160 delivers a satisfactory treatment result. After determining the signal, the laser controller 160 will add additional laser power (for example, different waves). To deliver (longer) and deliver additional therapeutic effects, additional control actions can be performed. ru.

[0075] Figure 7 shows the control algorithm for controlling the dual laser system. The Zum 700 enables the laser controller 160 to communicate with and operate with two or more laser systems. This may be preferable in the case of the first re - The system 102 delivers a first output 110 (for example, a first wavelength range) The second laser system 104 can be configured to have a second output 120 (for example, It can be configured to deliver a second wavelength range (different from the first wavelength range). Your algorithm 700 is a first laser system 102, a second laser system 104, Additionally, an optional additional laser system can be controlled.

[0076] According to the control algorithm 700, in step 702, the feedback analyzer 14 A value of 0 allows the detection of a first signal (e.g., a spectral signal or image). In the 704, the laser controller 160 receives the first feedback from the feedback analyzer 140. It can receive the signal. In step 706, the laser controller 160 first The signal is approximately equal to the first preset value (within the tolerance range of the specified first preset value). It is possible to determine whether or not. For example, the laser controller 160 can determine whether or not the first signal The amplitude is compared to a target value or a preset extreme value (e.g., maximum or minimum amplitude). This allows for the determination of the first characteristic of the target tissue 122. The first characteristic is that the treatment procedure was performed. The characteristics of the tissue after treatment (e.g., excised or carbonized tissue) can be shown. The Roller 160 is based on the first characteristic meeting a target value or a pre-set criterion. It can be determined that the desired therapeutic effect has been achieved, and in step 708, the first control signal The signal is sent to the first laser system 102, and from the first state of the first laser system 102 The first laser system 102 can be changed to a second state. For example, the laser The controller 160 determines whether the excision is satisfactory based on the reflected light from the excised tissue. The system determines this and sends a first control signal to the first laser system, and then turns the first laser system OF It can be returned to state F. Alternatively, in a practical example, the laser controller 160 can be used as desired. To indicate that the therapeutic effect has been achieved and / or the state of the first laser system is " To indicate to the operator (for example, a healthcare professional) that the state will be changed to "OFF", It can provide output to [the specified location].

[0077] In step 708, the laser controller 160 also sends a fourth signal to the second laser system. Send to Tem 104, and from the second state of the second laser system 104 to the second laser system It can be changed to the first state of 104. For example, the second laser system 104 This may be more suitable for excising charred tissue. Accordingly, when the tissue is sufficiently charred When it detects that this is happening (for example, step 708), the laser controller 160 In some cases, a first control signal is sent to turn off the first laser system 102. Alternatively, a fourth control signal can be sent to switch on the second laser system 104. Exemplary timing diagrams of the states of the first and second laser systems. This is shown in Figure 8.

[0078] In some cases, the first and fourth control signals can be sent simultaneously. Alternatively, the first and fourth control signals can be sent consecutively.

[0079] Returning to Figure 7, in the optional step 710, the feedback analyzer 140 is It is possible to detect a second signal (for example, a spectral signal or an image) that is separate from the first signal. For example, the second signal indicates that the target tissue 122 is carbonized by the absorption of the first output 110. Not being set (for example, the measured signal amplitude is not set to a preset spectral signal of the excised tissue) It can be shown that it is greater than the maximum amplitude. In some examples, such a state is This may result in insufficient excision or other unsatisfactory treatment outcomes, and tissue excision may be necessary. It is desirable to continue delivering laser power so that this can be achieved. Optional step In step 712, the laser controller receives the second signal and, in the optional step 714, The second signal can be compared to the second preset value. If the value is approximately equal to (for example, within the tolerance range of the second preset value), then select the optional step. In step 716, the laser controller 160 sends a second control signal to the first laser system. The third control signal can then be sent to the second laser system. An exemplary timing diagram of the state of the second laser system is shown in FIG. 8.

[0080] In some examples, the second control signal can change the first laser system from a second state (e.g., , OFF) to a first state (e.g., ON). Alternatively, when the first laser system is in the first state (e.g., ON), the second control signal can maintain the first laser system 102 in the first state (e.g., to continue delivering the first output 110). Optionally, at step 716, the laser controller 160 can send a third control signal to the second laser system 104 when the second laser system 104 is in its first state, thereby changing the second laser system 104 from the first state (e.g., ON) of the second laser system 104 to the second state (e.g., OFF) of the second laser system 10 4. Alternatively, the third control signal can maintain the second laser system 104 in the second state (e.g., OFF) when the second laser system is in the second state.

[0081] According to some examples, each first state of the first laser system 102 and the second laser system 10 4 can correspond to the generation of the first output 110 by the first laser source 106 and the generation of the second output 120 by the second laser source 116, respectively. Accordingly, each first state of the first laser system 102 and the second laser system 104 can represent an "on" state. In some such examples, each second state of the first laser system 102 and the second laser system 104 can correspond to an "off"

[0082] state.

[0082] Referring to FIG. 5, the laser feedback control system 100 can include one or more output systems 170. The one or more output systems 170 can communicate with, and / or deliver signals to, a user and / or a perfusion aspiration / pumping system, or a light display controller, or other systems such as other systems that are used for therapeutic treatment. In some examples, the output system 170 can include a display 172. The display 172 can be a screen (e.g., a touch screen), or alternatively, can be a simple visual indicator (e.g., LED light of one or more colors). In additional examples, the output system 170 can include an auditory output system 174 (e.g., a speaker, an alarm system, etc.) that can provide an auditory signal. The output system 170 can provide one or more outputs (e.g., LED light of a first color, a first message on the screen, an alarm sound of a first tone) to indicate that a desired therapeutic effect has been achieved. The output can be provided, for example, at step 610, and optionally at step 620. In a further optional example, the output system 170 can provide one or more different outputs when a desired therapeutic effect has not been achieved. For example, the output system 170 can provide one or more outputs (e.g., LED light of a second color, a second message on the screen, an alarm sound of a second tone) to indicate that a desired therapeutic effect has not been achieved. Such an output can take one or more steps (e.g., at For example, the output system 170 can provide one or more outputs (e.g., LED light of a second color, a second message on the screen, an alarm sound of a second tone) to indicate that a desired , using one or more laser systems, perform additional treatment steps and prompt the operator (medical staff) to provide additional laser output power).

[0083] FIG. 8 shows a timing diagram of a dual laser system having a laser feedback control system 100 for delivering tissue ablation and coagulation by utilizing two light wavelengths. However, as described above, the laser feedback control system 100 can be utilized with a single or multiple light wavelength systems to optimize the delivery of laser therapy or other types of treatment effects to the target tissue 122. The treatment effects can be delivered in any sequence including simultaneously. Alternatively, the treatment effects can be delivered at different times. According to one example, the laser energy from the first laser system 102 and the second laser system 104 can be delivered to a target (e.g., tissue surface), and in one example, it can be delivered continuously. The first and second laser systems can deliver their respective laser energies through the same optical fiber. Alternatively, the first and second laser systems can deliver their respective laser energies through separate optical fibers. An optical feedback signal 810 having an amplitude A is reflected from the tissue surface and can be detected and analyzed by the feedback analyzer 140. The first and second laser systems can alternately change their respective operating states (e.g., ON state or OFF state). As shown in FIG. 8, the first laser system ... ...

[0084] In one example, the laser energy from the first laser system 102 and the second laser system 104 can be delivered to a target (e.g., the tissue surface), and in one example, it can be delivered continuously, such as continuously delivering. The first and second laser systems can deliver their respective laser energies through the same optical fiber. Alternatively, the first and second laser systems can deliver their respective laser energies through separate optical fibers. The first and second laser systems can alternately change their respective operating states (e.g., ON state or OFF state). As shown in FIG. 8, the first laser system ... ... second laser systems can deliver their respective laser energies through separate optical fibers. The amplitude A ... max of the optical feedback signal 810 is reflected from the tissue surface and can be detected and analyzed by the feedback analyzer 140. The first and second laser systems can alternately change their respective operating states (e.g., ON state or OFF state). As shown in FIG. 8, the first laser system ... ... ... Stem 102 can be switched to its first state, or to its first state (for example For example, it can be maintained at ON)820A, and the second laser system 104 is in the second state It can be switched to a state (for example, OFF) or maintained in that state. The first laser can be used to excise and carbonize tissue. During the operation of the laser system 102, the first signal is received by the laser controller 160. It is possible for its amplitude to reach threshold level A min The tissue shows high absorption until it is reduced to [a certain level]. It is possible. The wavelength of the output from the first laser system 102 is effective for targeting the target tissue. The wavelength suitable for carbonization can be set to a first wavelength range in the target's absorption spectrum. The tissue has high absorption of laser energy. In one example, the first laser output is It is within the UV-VIS or deep infrared wavelength range.

[0085] The laser controller 160 then causes the first laser system 102 to enter a second state (for example) For example, it turns OFF, and the second laser system 104 returns to the first state (for example, ON) 8 The state of the laser system can be changed to 30A. The output from stem 104 can be largely absorbed by the carbonized tissue, and therefore carbon The charred tissue is excised, effectively removing the carbonization. The output wave from the second laser system 104 The length can be within the second wavelength range in the absorption spectrum of the target. The range can be different from the first wavelength range of the output from the first laser system 102. The wavelength of the output from the second laser system 104 is also suitable for effective coagulation. It is possible. In one example, the second laser output is within the infrared wavelength range (e.g., 100 - 300 μm). By the decarburization process, the amplitude of the signal (e.g., the second signal) returns to near the initial level A max . Accordingly, the laser controller 160 can change the state of the laser, so that the first laser system 102 is in the first state (e.g., , ON), and the second laser system 104 is in the second state (e.g., OFF). This process can be repeated, so that the first laser system 102 and the second laser system 104 are alternately switched to the ON states 820B and 830B as shown in FIG. 8, respectively, until the resection and / or coagulation of the desired tissue is achieved. In some examples, the optical feedback signal 810 discussed herein can be provided to an electrosurgical system that can controllably adjust and optimize an electrosurgical energy different from laser energy.

[0086] [Exemplary Endoscopic System with Target Identification] FIGS. 9 - 11 demonstrate how target composition analysis can be fully performed within an endoscope. Target composition analysis can be performed via spectroscopy by a laser fiber and optionally a camera on the distal tip of a digital endoscope.

[0087] FIGS. 9A - 9B show an example of an endoscope with a laser fiber inserted. The elongated body portion of the exemplary endoscope 910 surrounds various components including a laser fiber 912, an illumination source 914, and a camera 916. The laser fiber 912 is connected to the laser system 10 ​​​​​​​​​2 or an example of the optical path 108 of laser system 202. The laser fiber 912 is inside The working channel 913 can extend along the elongated body of the telescope 910. In some cases, the laser fiber 912 can be separate from the endoscope. For example, the laser fiber 912 is supplied along the working channel of the endoscope before use. Furthermore, it can be retrieved from the working channel of the endoscope after use.

[0088] The irradiation source 914 allows the operator to visualize the target structure (e.g., tissue or calculus structure). It can be part of a visualization system that enables this. An example of an illumination source is to use light on the endoscope. The system is configured to emit light distally, away from the distal end of the elongated body, to irradiate a region of the target structure. It may include one or more LEDs. In one example, the illumination source 914 illuminates the target structure. To emit light, it can emit white light. The white light is directed at the distal end of the endoscope body. This allows for the observation of gallstones or tissue discoloration or other color-based effects in the vicinity. This is possible. For example, the irradiation source 914 emits blue light in order to irradiate the target structure. This allows for the detection of damage within the tissue by observing the thermal spread of blue light. It is often well-suited for displaying. Other colors such as red, amber, yellow, green and / Alternatively, you can use a color bandwidth.

[0089] Camera 916 is part of the visualization system. Camera 916 is an image sensor 244. This is just one example. Camera 916 captures video images of the illuminated target structure and the surrounding environment or 1 Multiple still images can be captured. Video images can be processed in real time or for processing purposes. The waiting time can be relatively short, almost real time, and therefore the doctor can operate the endoscope. While doing so, the target structure can be observed. Camera 916 has a lens and the focal plane of the lens. It may include a multi-pixel sensor located at each pixel in the video image. Color sensors such as sensors that provide intensity values ​​for red, green, and blue light relative to a given element. This can be done. The circuit board displays a digital video image of the irradiated stone. It can generate digital video signals. Digital video signals are 10Hz, 20Hz, Video refresh rates of 24Hz, 25Hz, 30Hz, 40Hz, 50Hz, and 60Hz. It may have a video refresh rate of , or another suitable video refresh rate.

[0090] Figures 10A and 10B show examples of feedback-controlled laser treatment systems. Figure 1 At 0A, the laser treatment system 1000A receives camera feedback. Includes an endoscope 910 integrated with a control-controlled laser treatment system 1010. Therapy system 1000A is an example of laser therapy system 100, and includes an endoscope 910 and a phi Back-controlled laser treatment system 1010, laser source 1020, and light source 103 It includes 0. In various examples, it is part of a feedback-controlled laser treatment system 1010. The entire or partial portion can be implanted into the endoscope 910.

[0091] The feedback-controlled laser treatment system 1010 is a laser feedback control system This is an example of stem 200, spectrometer 1011 (an example of spectroscopic sensor 242), feedback A quer analyzer 1012 (an example of at least a part of the feedback analyzer 240), and includes a laser controller 1013 (an example of a laser controller 260). Source 1020 is an example of a laser system 202, coupled to a laser fiber 912. This is possible. The fiber-integrated laser system allows for laser energy delivery to flexible endoscopes. - Due to its ability to effectively treat hard and soft tissues, it is used in endoscopic procedures. These laser systems can operate in the UV range to the IR range (200nm~100nm). It generates a laser output beam within a wide wavelength range of 00 nm. Several fibers are integrated. The laser in this formula is within a wavelength range that is strongly absorbed by soft or hard tissue, for example, water. For absorption, 1900-3000 nm, or oxyhemoglobin and / or deodorant In the case of xyhemoglobin absorption, an output of 400-520 nm is produced. Table 1 above This is an overview of an IR laser that emits light within a wide water absorption range of 1900-3000 nm.

[0092] Some fiber-integrated lasers are absorbed minimally by target soft or hard tissue. These lasers produce output within a specific wavelength range of 5-10 μm. Due to its penetration depth, which is similar to the diameter of small capillaries, it provides effective tissue coagulation. An example of source 1020 is a GaN laser that emits light at 515-520 nm, specifically 370-493 nm. In emitted at nm X Ga 1-X N laser, emitting Ga at 750-850 nm X Al1 -X A laser, or In that emits at 904-1065 nm X Ga 1-X A lasers, etc. In X Ga 1-X It can include an N semiconductor laser.

[0093] The light source 1030 can generate an electromagnetic radiation signal, and this electromagnetic radiation signal is used in endoscopes. The signal can be transmitted to the target structure 122 via a first optical path that extends along the elongated body. The first optical path can be located within the working channel 913. In one example, The optical path 1 can be a separate optical fiber from the laser fiber 912. In another example... As shown in Figure 10A, electromagnetic radiation signals are used to transmit the laser beam. It can be transmitted through the same laser fiber 912 as the object. Electromagnetic radiation is the first light The projected signal exits the distal end of the path and is projected onto the target structure and surrounding environment. As shown in Figure 10A, the target The structure is within the field of view of the endoscope camera 916, and therefore electromagnetic radiation is directed at the target structure and In response to being projected onto the surrounding environment, an endoscope camera such as a CCD or CMOS camera... 916 collects the signal reflected from the target structure 122 and the imaging signal 1050 of the target structure. The system generates an image signal, which is then transmitted to a feedback-controlled laser treatment system 1010. This is possible. In some cases, to collect the spectral response, a CCD such as a laser scan can be used. Alternatively, imaging systems other than CMOS cameras can be used.

[0094] Feedback signals generated and transmitted through the camera system 916 (for example, In addition to the imaging signal, or instead, in some examples, reflected from the target structure The signal is transmitted as an additional or alternative method, such as from a separate fiber optic cable, including one attached to the endoscope 910. A feedback-controlled laser treatment system 101, via Nell or laser fiber. It can be collected and transmitted to 0. Figure 10B shows the spectral sensor receiving feedback. Integrated with a feedback-controlled laser treatment system 1010 configured to do so. An example of a laser treatment system 1000B including an endoscope 910 is shown. Reflected spectral signal 1 070 (an example of feedback signal 130 in Figures 1 and 2) is a laser fiber Similar to those used to transmit electromagnetic radiation from light source 1030 to the target structure, such as 912. It can return to the feedback-controlled laser treatment system 1010 via the light path. In another example, the reflected spectral signal 1070 is transmitted from the light source 1030 to the target structure via electromagnetic radiation. Through a second optical path, such as a separate optical fiber channel, from the first optical fiber that transmits the signal, This allows us to proceed to the feedback-controlled laser treatment system 1010.

[0095] The feedback-controlled laser treatment system 1010 uses one or more feedback signals Analyze the signal (for example, the imaging signal 1050 of the target structure or the reflected spectral signal 1070). This allows us to determine the operating state of the laser source 1020. The spectrometer 1011 is As discussed above with reference to spectroscopic sensor 242, FTIR spectrometer, Raman spectrometer, UV - Use one or more of the following: VIS spectrometer, UV-VIS-IR spectrometer, or fluorescence spectrometer. By doing so, one or more spectral characteristics can be generated from one or more feedback signals. The feedback analyzer 1012 can use the target detector 246 or target segment. By using one or more of the 248 type instruments, the target structure can be divided into multiple structural categories. It can be configured to identify or classify as one of the following structural types. The laser controller 1013, as discussed similarly above with reference to Figure 2, controls the laser... It can be configured to determine the operating mode of the stem 1020.

[0096] Light source 1030 can generate electromagnetic radiation within the UV to IR light range. Table 2 provides examples of light sources 1030 for spectroscopic systems applicable to the examples discussed herein. To show.

[0097] [Table 2]

[0098] In some examples, the feedback analyzer 1012 is located at the far end of the laser fiber 912. Between the terminal end and the target structure 122, or after receiving the reflected signal, it is transmitted again to the spectrometer 1011. The distance 1060 (shown in Figure 10A) between the distal end of the optical path and the target structure 122 is determined. This can be done. The distance 1060 is the spectral distance, such as the reflection spectrum produced by the spectrometer 1011. The characteristics can be used to calculate the threshold (d th ) If the distance 1060 is less than or within the specified laser emission range, the target structure 1 The laser source 1020 can be controlled to deliver laser energy to 22. In one example, the target structure 122 is of the intended therapeutic structure type (e.g., a specified soft tissue type). Identified as a type of calculus (or a specified calculus type), but the target structure 122 is within the range of the laser. No (for example, d > d th ) In this case, the laser controller 1013 controls the laser source 1020 Control to "lock" it (i.e., prevent the laser source 1020 from firing). A signal can be generated. Information about the distance 1060 and the target structure of the laser Out of range (d>d) thThe instruction that ) can be presented to the doctor, and the doctor will then, The position of the distal end of the laser fiber 912 is changed to get closer to the target, etc. 0 can be adjusted. Distance 1060, and target structure type are continuously monitored. The results can be identified and presented to the physician. The target is recognized as the intended therapeutic structure type. It is recognized, and within the range of the laser (d≦d th When this is the case, the laser controller 1013 will A control signal can be generated to "unlock" the laser source 1020. The source 1020 targets the target structure 122 according to the laser operating mode (e.g., power setting). It can be launched like this. Here is an example of how to calculate a distance of 1060 from spectral data. This will be discussed below, with reference to Figures 24A to 24D, etc.

[0099] In some examples, the spectrometer 1011 is configured to transmit electromagnetic radiation from a light source to a target. Further information regarding the geometry and positioning of the optical path is used to determine the spectral characteristics (even if For example, it can be configured to generate a reflection spectrum. The outer diameter of the 912, or a separate unit that transmits the spectral signal reflected from the target to the spectrometer 1011. The outer diameter of the optical path, or the projection angle of the fiber or path from the endoscope 910, is reflected. This may affect the intensity of the signal. Measuring the outer diameter and / or projection angle allows for spectral analysis. It can be provided to a total of 1011 devices, and reflectance spectral data can be obtained. As discussed above... The distance between the target structure and the distal end of the fiber is 1060, and the spectral data is obtained from the fiber. Or the measured outer diameter of the optical path, its projection angle, and / or the endoscopic image process The calculation can be performed using the input signal from the source.

[0100] Figures 11A and 11B show an example of an endoscopic system that uses a diagnostic beam to identify a target. This is a diagram. As shown in Figure 11A, the endoscope system 1100A consists of an endoscope 1110 and Optical fiber can be inserted through the working channel 1112 of the endoscope 1110. The endoscope 1110 may include a fiber 1120A. It may include the injection source 1130, or in other forms via the endoscope port 1114. It can also be coupled to another endoscopic irradiation source 1130. 1130 can provide different irradiation doses in a controllable manner. Optical fiber 1120A is When inserted through the working channel 1112, via the endoscope port 1114, etc. It can then be coupled to the non-endoscopic irradiation source 1140. The non-endoscopic irradiation source 1140 is small Even if not present, it can be different from one endoscopic irradiation source 1130. Non-endoscopic irradiation source 1140 The diagnostic beam passes through the optical fiber 1120A near the distal end 1116 of the endoscope 1110. It can emit 1142. The optical fiber 1120A targets the diagnostic beam 1142. It can be directed towards 1001. In one example, the non-endoscopic irradiation source 1140 directs the laser beam It can be a laser source configured to emit a diagnostic beam including Insert a white light lamp, LED light source, or fluoroscopy light source through the working channel of the endoscope. It can be inserted, or through another port such as a laparoscopic port. .

[0101] The endoscopic system 1100A may include a controller 1150. Ra1150 is, for example, a first mode having a first dose, and a smaller dose than the first dose. At least one endoscope in different operating modes, including a second mode having a second dose The irradiation source 1130 can be operated in a controllable manner. For example, the controller 1150 It changes the irradiation mode in response to the trigger signal (for example, from the first mode to the second mode). Such control signals can be generated to cause changes. For example, an endoscope can be used. Includes an imaging system 1160 capable of acquiring an image of target 1001, and a controller 1150 responds to changes in the brightness or intensity of the target image by changing the illumination mode (for example, The control signal to the endoscope is generated to change the mode from the first mode to the second mode. This is possible. Hereafter, the first mode will be called the high-irradiation mode, and the second mode will be called the low-irradiation mode. For example, the high-irradiation mode and low-irradiation mode emit irradiation light under the high-irradiation mode. A first endoscopic irradiation source configured to emit irradiation light under low irradiation mode Each different endoscopic irradiation source provides a different endoscopic irradiation source, such as a second endoscopic irradiation source configured in a different way. It can be provided. The irradiated light is emitted near the distal end 1116 of the endoscope 1110. This is possible. For example, the irradiated light is within the working channel 1112 and the optical fiber 1120 It can travel through a different optical path than A. The optical path allows the irradiated light 1132 to travel through the diagnostic beam. It can be aimed at the same target 1001 as the projected object.

[0102] The controller 1150 indicates that at least one endoscopic irradiation source 1130 is in high irradiation mode. When switching to low-irradiation mode, the diagnostic beam 1142 (for example, a lower treatment level) A control signal is sent to the non-endoscopic irradiation source 1140 to emit an energy-containing laser beam. It is possible to generate a number. For example, the low-irradiation mode switches off the irradiation of the endoscope. This includes darkening the irradiation to the target area under low-irradiation mode, thereby reducing the incidence of radiation on the target. This can enhance the reflection of the diagnostic beam from the target, thereby improving target identification. It can help with that.

[0103] In some cases, the controller 1150, while the irradiation mode is in the second mode, Control signals can be generated to the display to show the target image, and the image will be displayed. , a modified image of the target's previous or current image. Controller 1150 Based on the light from the diagnostic beam incident on the target and the diagnostic beam reflected from the target. The composition of the target can be determined. In one example, the controller 1150 determines the composition of the stone target. Determine the first composition of the first part and determine the different second composition of the second part of the gallstone target. It can be determined. Based on the identified composition of different parts of the target, Controller 1 The 150 is programmed to target the first portion of the gallstone target. , or it can generate recommendations for programming the first laser setting. The Roller 1150 is configured differently from the first laser setting to target a second portion of the gallstone target. To further program a second laser setting, or to program a second laser setting It can generate recommendations for this.

[0104] In one example, after the non-endoscopic irradiation source 1140 stops emitting the diagnostic beam 1142, The Trolla 1150 changes the irradiation mode from low irradiation mode back to high irradiation mode. This allows for the generation of control signals to the endoscope.

[0105] Figure 11B shows an example of the endoscopic system 1100B, a variant of the endoscopic system 1100A. This shows that in this example, the diagnostic beam 1142 is transmitted through the optical fiber 1120B. This can be done. The optical fiber 11 is inserted into the working channel 1112 of the endoscope 1110. Unlike 20A, optical fiber 1120B is distributed separately from working channel 1112. It can be placed. In some examples, as shown in Figure 11B, the diagnostic beam 1142 is In one example, it can be delivered through a secondary port 1115 such as a laparoscopic port. Port 1115 is separate from the endoscope port 1114, which is used to deliver endoscopic irradiation light. There is one. Optical fiber 1120B is connected to the distal end 1116 of the endoscope 1110 and the optical fiber Both distal ends of the 1120B can be positioned to target the target 1001.

[0106] Figures 12 and 13A-13B show UV-VIS spectroscopy or UV-VIS-IR spectroscopy. To identify several different types of kidney stone compositions through optical methods, etc. This figure shows the reflectance spectral data used to identify the target of the ipu. Ta is calcium oxalate (monohydrate), calcium oxalate (dihydrate), phosphate Images of five primary types of kidney stones, including calcium stones, struvite stones, and uric acid stones. Each is collected by pointing a UV-VIS spectrometer or UV-VIS-IR spectrometer at it. For example, electromagnetic radiation includes one or more ultraviolet wavelengths between 10 nm and 400 nm. This can be done. In another example, it can be used to identify different types of targets, as shown in Figure 12. The resulting reflectance spectrum is re-encoded from the spectrometer within the wavelength range of 200-1100 nm. This is possible. Figure 12 shows magnesium ammonium phosphate (AM MAG) hydrate. Calcium oxalate (CA) monohydrate, calcium oxalate (CA) hydrate, calcium phosphate The reflectance spectra of kidney stone compositions containing calcium (CA) and uric acid are shown. The reflection spectra of these stone compositions are compared to the higher wavelength range (e.g., above 400) , it is more discernible in a lower wavelength range (e.g., less than 400 nm). Figure 13A shows, Magnesium ammonium phosphate hydrate spectrum 1310, calcium oxalate monohydrate Physical spectrum 1320, calcium oxalate hydrate spectrum 1330, calcium phosphate Waveforms from 200 to 400 nm, including the uric acid spectrum 1340 and the uric acid spectrum 1350. A portion of the reflection spectrum shown in Figure 12 within the long range is displayed. This UV wavelength range corresponds to the image of the stone. This is one range in the spectrum where a difference can be identified. Figure 13B shows cystine Pectol 1360, Uric Acid Spectrum 1370, and Calcium Oxalate Monohydrate Spectrum Reflectance spectrum of various kidney stone compositions in the wavelength range of 400-700 nm, including Tor 1380. The spectroscopy is shown. Different spectroscopy methods are used by UV-VIS spectroscopy or UV-VIS-IR spectroscopy. It is possible to distinguish between different types of targets, such as ipu kidney stones.

[0107] Therefore, the UV wavelength range can distinguish between different target compositions, such as kidney stones. Because this region is promising, a light source is needed within the system to enable analysis in this area. (Figure 14) These correspond to UV wavelengths of approximately 250nm, 280nm, 310nm, and 340nm, respectively. Light peaks 1410, 1420, 1430, and 14 cover each segment of the range. Figure 15 shows the normalized reflectance of several types of stones from Figures 13A and 13B. These light peaks 1410-1440 are superimposed on the vector. 10-1440 should allow the spectrometer to analyze the target composition within the UV wavelength range. This demonstrates the potential light source.

[0108] Figure 16A shows cartilage spectrum 1610, bone spectrum 1620, and muscle spectrum 163 Various tissue spectra, including fat spectrum 1640 and liver tissue spectrum 1650. An example of a normalized reflectance spectrum captured by a UV-VIS spectrometer from the Ip is shown in Figure 16B. This includes cartilage spectrum 1610, bone spectrum 1620, muscle spectrum 1630, and adipose spectrum. Includes spectrum 1640, liver tissue spectrum 1650, and vascular spectrum 1660. , Normalized reflectance spectra captured by a UV-VIS spectrometer from various soft and hard tissues Here is another example. The reflection spectral data shown in Figures 16A and 16B are from the endoscope work Demonstrates the feasibility of analyzing target compositions using methods available within a channel. To do so, using the UV-VIS region, similar to the spectrum captured from the stone image, different It is possible to identify the type of target. Figure 16C shows the FTIR spectrum of a typical stone composition. Figure 16D shows an example of F, a composition of several soft and hard tissues. Regarding TIR spectra.

[0109] Exemplary laser treatment system The features described herein may be advantageous for incorporating different types of laser sources. It can be used in connection with laser systems for various applications. For example, this specification The features described in this document are industrial or medical settings such as medical diagnosis, treatment, and surgical procedures. This may be preferable in the following context.

[0110] The features described herein are fiber-integrated laser systems and are combined with endoscopes. It can be used in conjunction with a spectroscopic system that can be used in combination with this system.

[0111] Figures 17 and 18 show schematic diagrams of laser treatment systems according to various examples described in this disclosure. The laser treatment system is configured to deliver laser energy towards the target. A laser system and a laser feedback system configured to be coupled to the laser system. It may include a control system. The laser system may use similar or different wavelengths. One or more laser modules 1710A~1710 capable of emitting from UV to IR. N (for example, a solid-state laser module) may be included. The number of joules, output power, emission range, pulse shape, and pulse train affect the system cost. And selected to balance with the performance required to deliver the desired effect to the target. ru.

[0112] One or more laser modules 1710A~1710N can be integrated with a fiber. It is possible and can be included in a laser coupling system. Fiber-integrated laser systems are By passing laser energy through a flexible endoscope, hard and soft tissues can be effectively treated. Because of these capabilities, they can be used in endoscopic procedures. These laser systems A wide wavelength range from the UV range to the IR range (for example, 200 nm to 10000 nm) It generates a laser output beam. Some fiber-integrated lasers can be used on soft tissue or hard tissue. Within the wavelength range where absorption is strongly concentrated by tissues, for example, in the case of water absorption, it is 1900-300. 0 nm, or in the case of absorption of oxyhemoglobin and / or deoxyhemoglobin. This produces an output of 400-520 nm. Refer to Table 1 for the above-mentioned endoscopic procedures. Various IR lasers can be used as the laser source within the device.

[0113] Laser modules 1710A to 1710N each increase their output power and direct the emission towards the target. To deliver, it consists of multiple solid-state laser diodes integrated into an optical fiber. This is possible. Some fiber-integrated lasers can be used to target soft or hard tissue. These lasers produce output within a wavelength range where absorption is minimal. Due to its penetration depth, which is similar to the diameter of tiny capillaries (μm), it provides effective tissue coagulation. The fiber-integrated laser modules 1710A~ described by various examples in this disclosure The 1710N has several advantages. For example, the light emitted by the laser module is It has a beam quality of the same magnitude and a circular, smooth (homogenized) intensity profile. The cooling system is integrated into the laser module, resulting in a smaller overall system size. Fiber optic integrated. The laser modules 1710A~1710N can be easily combined with other optical fiber components. It can be combined. In addition, fiber-integrated laser modules 1710A~1710 N is compatible with standard fiber optic connectors, which means the module is mostly It will be possible to operate smoothly with the optical module without alignment. Furthermore, The fiber-integrated laser modules 1710A~1710N are located in the laser coupling system. It can be easily replaced without changing the alignment.

[0114] In some cases, the laser module can be used to work with soft or hard tissue, as shown in Figure 3C. Within the wavelength range that is largely absorbed by certain materials such as stone, bone, and teeth, for example, the absorption of water For harvesting, use 1900-3000nm, or oxyhemoglobin and / or deoxy In the case of absorption of cyhemoglobin, it is possible to generate a laser output of 400-520 nm. In some cases, the laser module is used to target soft or hard tissue, stones, bones, teeth, and other materials. This allows for the generation of laser power within a wavelength range that is absorbed less by the target. As shown in Figure 3C, this type of laser can penetrate small capillary diameters (e.g., 5-10). Due to its penetration depth similar to μm, it provides more effective tissue coagulation. A laser is a potential emission source for a laser module. Examples of light sources include GaN (emitted at 515-520 nm) or In X Ga 1-X N(37 (Emits light at 0-493nm), GaXAl1-XA laser (emits light at 750-850nm), Alternatively, lasers such as InXGa1-XA lasers (emitting at 904-1065nm) emit UV-VIS. Put out In X Ga 1-X Such laser sources may include N semiconductor lasers. This may be applicable to applications of tissue coagulation.

[0115] A laser feedback control system is, for example, a spectroscopic system 1720, a feedback system. One or more subsystems including a laser analyzer 1730 and a laser controller 1740 It can be equipped with a system.

[0116] Spectroscopic system 1720 The spectroscopy system 1720 is not limited to, but can also be used for gallstones, soft tissue, or A control light signal is sent from the light source to a target such as hard tissue, bone, or teeth, or an industrial target. This allows for the collection of spectral response data reflected from the target. This response is separate. It can be delivered to the spectrometer via a fiber, laser fiber, or endoscope system. Yes, it is possible. The spectrometer uses digital spectral data to generate a system feedback analyzer 17. It can be sent to 30. Light source for a spectroscopic system covering the UV to IR light range. Examples may include those mentioned above, as shown in Table 2. Figure 20 shows an example of a feedback A schematic diagram of the spectroscopic system 1720, which includes a scalar analyzer 1730, is shown.

[0117] Optical spectroscopy is a powerful technique that can be used for the easy and rapid analysis of organic and inorganic materials. This is a method. According to various examples described herein, the spectral light source is connected to a separate fiber channel. It can be integrated into a laser fiber or endoscope system. The light source signal can be contained within a digital endoscope, for example, a CCD or CMOS sensor. Imaging systems including detectors such as these can rapidly collect and deliver data to a spectrometer. To collect the spectral response, use other imaging systems such as laser scanning. It can also be done. Optical spectroscopy has several advantages. Optical spectroscopy is used for fiber laser delivery It can be easily integrated with System 1701. Optical spectroscopy can determine the chemical composition of the material. It is a non-destructive technique for detection and analysis, and the analysis can be performed in real time. Optical spectroscopy can be used to analyze different types of materials, such as hard and soft tissues, and calculus structures. It can be used to analyze the material.

[0118] To analyze the target chemical composition and create spectroscopic feedback, various spectroscopic techniques are used. It can be used alone or in combination. An example of such spectroscopic techniques is, in particular, U V-VIS reflection spectroscopy, fluorescence spectroscopy, Fourier transform infrared spectroscopy (FTIR), or LAMA This may include spectroscopy. Table 2 above shows the UV to IR light range applicable to one example. Examples of light sources for the spectral systems to cover are presented. Generally, the visible and near-IR ranges are covered. When performing spectroscopic measurements within the enclosure, a tungsten halogen light source is used. Deuterium light The source is known for its stable output and is used in UV absorption or reflectance measurements. By mixing logen light with deuterium light, a smooth spectrum from 200 to 2500 nm is obtained. A light source with a wide spectral range that provides a wide range of performance is obtained. Long lifespan and high performance are required for applications such as fluorescence measurements. Xenon light sources are used in applications requiring high output power. LEDs and lasers are also used. Diode light sources provide high power at precise wavelengths, with long lifespan and short warm-up time. It has intervals and high stability. The spectroscopic light source is a separate fiber channel, laser fiber , or it can be integrated into an endoscope system. The light source signal reflected from the target is separate Rapid detection and transmission to a spectrometer via individual fiber channels or laser fibers. It is possible.

[0119] Feedback analyzer 1730 The feedback analyzer 1730 suggests or directly provides laser system operating parameters. It receives input from various sources, including spectral response data from a spectrometer for contact adjustment. It can be obtained. For example, the feedback analyzer 1730 can obtain target composition data. The available database libraries and spectral response data can be compared. Based on stem feedback, the signal analyzer detects and identifies the target material composition. To achieve effective tissue therapy for the tissue composition, at least one laser motor is required. Laser operating modes, including operating parameters in joules (also called laser setup). We propose the following: Examples of operating parameters include at least one laser wavelength, pulse or continuous. Wave (CW) emission mode, peak pulse power, pulse energy, pulse rate, pulse The shape and simultaneous or continuous pulse emission from at least one laser module include It is possible. Although not explicitly stated, continuous pulses deliver the selected pulse energy. Includes bursts of pulses that cooperate in such a way. The pulses described herein, as a whole, This refers to the time between the start and stop of laser emission from the laser module. Selected average laser As long as the power is maintained, the intensity of the laser energy in each pulse will fluctuate and increase or decrease. This can be a decreasing slope or sinusoidal profile shape, or any other shape, on its own. Or it may be combined with a pulse sequence. For example, only one pulse. If present, an average power setting of 2W with a pulse energy of 1J is given at a frequency of 2Hz. It occurs in numbers. However, the energy is generated by two 0.5J pulses occurring at a rate of 2Hz and And it can also be delivered without interruption. Each of those pulses is similar or different It can have a pulse shape. The feedback analyzer 1730 is an algorithm And using the input data, the laser operating parameters, such as those described in the example above, can be directly accessed. To adjust or propose.

[0120] In some examples, the feedback analyzer 1730 uses the input data to perform a specific task. Based on a separately developed algorithm, the laser delivery system 1701 (fiber) The distance between the terminal and the target can be calculated and controlled. (For example, the target is moving.) In the case of kidney stones, the feedback analyzer 1730 detects targets that exceed a predetermined threshold. Laser operation that uses steam bubbles in water to create a suction effect, drawing the laser towards the distal end of the bar. Parameters can be adjusted or suggested. This feature allows the user to interact with a moving target. The effort required to act to maintain an effective therapeutic distance is minimized. The distance between the distal end of the fiber and the spectral data, the known outer diameter of each fiber and The angle of protrusion from the endoscope, and / or the input signal from the endoscope image processor, It can be calculated using the following. Figures 24A to 24D show, as an example, a laser delivery system 1 This document describes how to calculate the distance between the distal end of a 701 (fiber) and the target. The dependence of the spectral reflection signal on the distance between the system 1701 and the system is shown in Figures 24A and 24B. Figure 24A shows measurements taken at different distances between the tissue and the distal end of the spectroscopic probe. An example of the reflected signal intensity at 730 nm is shown. Figure 24B shows the distance between the tissue and the distal end of the spectroscopic probe. An example of the reflected signal intensity at 450 nm measured at different distances is shown. Existence is determined using spectral data and information about the geometry of the laser delivery system. It is possible to make a determination. Analysis of the spectral signal allows for rapid estimation of distance and provides this information to the user. Enables delivery.

[0121] Figure 24C shows an exemplary algorithm for calculating the distance between a fiber and a tissue target. In this example, the spectroscopic system sends a control light signal from the light source to the target, and the spectral response data from the target is transmitted. The system collects data, sends the response signal to the spectrometer, and filters the digital spectral data from the spectrometer. Send to the back analyzer. The calibration curve 1000 shown in Figure 24C is shown in Figures 10 and 11. Using the feedback signal reflected from the target structure such as a nut, the spectral reflectance signal intensity is measured. (For example, the spectral signal reflected from the target structure in response to electromagnetic radiation) and the distal end of the fiber This represents the relationship between the edge and the distance 1060 between the edge and the target structure. The calibration curve 1000 represents the target structure It is projected by electromagnetic radiation of a specific wavelength (for example, 450 nm or 730 nm). When measuring the reflected signal intensity, different distances are placed between the tissue and the distal end of the spectroscopic probe. It can be generated by and. By referring to the calibration curve, the analysis of the spectral signal is This enables rapid estimation of distance.

[0122] An example process for generating a calibration curve is as follows: First, the basis for each distance The standard value can be calculated. Since the light reflectance depends on the reflection of the test piece, the distance must be known. The calibration curve itself cannot be used for separation. To cancel out the effect of the test specimen's reflection... An example of a reference value is as follows: Reference value = dI / dx*1 / I (1)

[0123] During the in vivo surgical process, the operator can detect the reflectance spectrum of the target tissue composition. Move the fiber or endoscope while continuously recording the spectral feedback until it is done. It is possible.

[0124] Referring to Figure 24C, the first spectrum is measured at a distance x1 where the reflected signal intensity becomes I1. It can be determined. At this timing, the actual value of x1 and the curve of the reflected signal intensity are not yet determined. It is knowledge. Next, the fiber or the distal end of the endoscope (reflected light detector) is moved continuously. This allows us to measure the next reflected light intensity I2 corresponding to the distance x2. x2 is equal to x1. They are close, and therefore the curve between x1 and x2 can be approximated linearly. At this point, the curves for x1, x2, and reflected signal intensity are unknown. I1, I2, Using Δ(x2-x1), the comparison value can be calculated as follows: Comparison value = Δ(I2-I1) / Δ(x2-x1)*1 / I1(2)

[0125] Next, a reference value is searched for for values ​​that are identical to the comparison value. One reference value (x r )only However, if it is found that the comparison values ​​given in equation (2) are identical, x r distance x1 It can be determined that it is a separation. Two reference values ​​(x r1 , x r2 If ) exists, The fiber or the distal end of the endoscope (reflected light detector) can continue to move, and the distance x3 The corresponding reflected light intensity I3 can be measured. x3 may be close to x2. Therefore, the curve between x2 and x3 can be approximated linearly. At this point, x The curves for x1, x2, x3, and reflected signal intensity are unknown. I1, I2, I3, Δ(x2 Using -x1) and Δ(x3-x2), calculate the new comparison value as follows: It is possible. Comparison value = Δ(I3-I2) / Δ(x3-x2)*1 / I2(3)

[0126] Next, x r1 +Δ(x2-x1) and x r2 With respect to the same value as +Δ(x2-x1) Then, the reference value is searched. The reference value can be compared with the comparison value given in equation (3). The distance with a similar reference value, based on the comparison value, is estimated to be the actual distance. .

[0127] Referring to Figure 24D, during the in vivo surgical process, the exemplary method involves the reflection of the target composition. While continuously recording the spectral feedback until a vector is detected, the fiber or This may include moving the endoscope. The distal end of the spectrometer is moving towards the target. In this case, the intensity of the detected reflected light is initially weak, and the distance between the target and the fiber end decreases. It increases as the distance increases. For example, the first spectrum is the distance at which the reflected signal intensity is I1. Measured at d1. Continue moving the fiber or distal end of the endoscope slightly toward the target. By continuously collecting reflection data, this method determines the next reflected light intensity corresponding to the distance d2. I2 can be measured. This method then gives the value of the gradient of change in reflected signal intensity = Δ(I2) This may include calculating -I1) / Δ(d2-d1). To make it independent of the reflected signal intensity, the calculated gradient can be normalized. The final formula for calculating the gradient of change in reflected signal intensity at the measured distance is as follows: It is. Gradient (normalized) = [Δ(I2-I1) / Δ(d2-d1)] / I o (4) In the above equation, I o=AVERAGE(I1,I2).

[0128] This method then uses the calculated gradient to enable the estimation of the required distance. It can be compared with the slope of the calibration curve within Ibrali. All calculations are performed by the software. It can be done quickly using this method.

[0129] Figures 25A and 25B show the distance between the tissue and the distal end of the spectroscopic probe, and the reflected light from the target. The effect on the spectrum is shown. Figure 25A shows the bladder endothelial spectrum 2511 and the gastric endothelial spectrum. Cthol 2512, gastric smooth muscle spectrum 2513, subureteral spectrum 2514, ureteral endothelial spectrum Pectol 2515, renal calycere spectrum 2516, bladder muscle spectrum 2517, and medulla Exemplary normalized UV-VIS reflectance spectra of various soft tissue types, including spectrum 2518. Figure 25B shows the distance between the tissue and the distal end of the spectrometer probe, such as 0 to 0.25 inches. The images show exemplary UV-VIS reflectance spectra of specific tissues recorded at different distances. Figure 25A shows some examples of animal soft tissue spectra. Figure 25B shows tissue and segment Exemplary UV-VIS refraction of tissue recorded at different distances from the distal end of the optical probe. The emission spectrum is presented. In this example, refer to Figures 24A and 24B as discussed above. The reflected signal intensity at two spectral maximums, 450nm and 730nm, indicates the target tissue. The results were measured and presented at different distances between the distal end of the spectroscopic probe and the probe itself.

[0130] [Laser Controller 1740] The laser controller 1740 can be integrated with a laser coupling system. The coupled system consists of one or more laser modules (for example, solid-state laser modules). ) is coupled into a single fiber. The laser controller 1740 is a feedback analyzer. It can be coupled to the Iza 1730, and the feedback analyzer 1730 is optimized. The signal can be sent directly to the laser controller 1740 along with the proposed settings. (Automatic mode), or operator approval may be required to adjust laser settings. (Semi-automatic mode). Figure 17 is a schematic diagram of a fully automated laser system. Figure 1 Figure 8 is a schematic diagram of a semi-automated laser system, where the system has inputs 1850 and User authorization is required via the user interface, including the Display 1860. For example, the laser settings can be adjusted within the setting range, and the setting range is, for example, This can be predetermined by the user at the start of the procedure.

[0131] In some examples, the laser controller 1740 combines two or more laser pulse trains. In addition, a combined laser pulse train can be created. Figure 19A shows the laser control Laser 1740 generates multiple (e.g., N) laser pulse trains 1910A to 1910N. Then, the laser pulse trains 1910A~1910N are combined to form the combined pulse train 1920. Figure 19B shows an example where the target can be exposed to a combined pulse train at 1930. Three different laser arrays 1941A, 1941B, emitted from different laser modules. This figure shows an example of the output laser pulse train 1942 combined from 1941C. As shown in Figure 19B, laser arrays 1941A, 1941B, and 1941C are FI According to the back-up analyzer signal, turn on at different times and / or at different times It can be turned off. In the example shown in Figure 19B, the output combination laser pulse train 19 42 indicates that two or more laser sequences 1941A, 1941B, and 1941C overlap in time. It can include parts that do so.

[0132] Laser modules 1910A~1910N, spectroscopy system 1720, and feedbar The combination with the 1730 laser analyzer allows for the laser feedback system described herein. Stem 1740 continuously identifies the target composition through the endoscope and throughout the procedure. The laser settings can be updated.

[0133] The main components of the laser system can be easily customized according to the target medical procedure. It is possible. For example, the laser controller 1740 can handle different laser types and It supports those combinations. This allows for power, wavelength, pulse rate, pulse shape, etc. A wider range of laser pulses, including profiles, single laser pulse trains, and combined laser pulse trains. A wide range of output signal options becomes available. The operating mode of the laser system allows for each desired optical It can automatically adjust or suggest effects in response to the target. The spectroscopic system is the diagnostic tool. Regarding target materials, which is useful for confirming that the laser parameters are optimal for the target. Gather information. The feedback analyzer 1730 determines the operating mode of the laser system. It can automatically optimize and reduce the risk of human error.

[0134] [Internet of Things (IoT) System 1750] In some examples, the laser system may include an optional IoT system 1750. The IoT system 1750 can access the spectral database library in the cloud 17 Supports storing in 52, spectrum and optimal setup database library Supports rapid access to the cloud 1752 and feedback analyzer 1730. It enables communication between them. Cloud storage of data is handled by the feedback analyzer 173. Supports the use of artificial intelligence (AI) techniques that provide input to 0, algorithms and data Provides instant access to base improvements.

[0135] According to various examples described herein, the IoT system 1750 is a laser system Components can communicate and interact with other components via the internet. It can include a network. IoT is stored in Cloud 1752. Supports rapid access to the Toll database library, Cloud 1752 and feed It performs communication with the back analyzer 1730. In addition, it is a component of the laser system. All of these can be remotely monitored and controlled via the network if necessary. One example of such a successful connection is the Internet of Medical Technology. This is called ngs (also known as the Internet of Health Things). This is an example of an available application of IoT for medical and health-related purposes, research and This includes collecting and analyzing data for monitoring purposes.

[0136] In various examples, the IoT system 1750 targets structures (e.g., calculus structures or anatomy). Cloud-based detection, recognition, or classification of various cloud resources (including those used by academic organizations). It can handle access. In some examples, it can handle cloud-based target detection and recognition. To provide separate or classification services, machine learning (ML) is used within Cloud 1752. The engine can run. The ML engine uses a trained ML model (for example, one It can include machine-readable instructions that can be executed by the above microprocessors. The system receives target spectral data from the laser system or stores it in Cloud 1752. The target spectrometer data is retrieved, and the target is detected, identified, or classified, and the tissue is identified. ipu (for example, normal tissue or cancerous lesion, or tissue in a specific anatomical area), or gallstone type (for example, kidney, bladder, pancreaticobiliary duct, or gallbladder having a specific composition) It can generate outputs such as labels representing stones. Target spectroscopy data can be obtained before treatment or Among other clinical data collected from the patient during the procedure, at the end of the procedure or other scheduled times At that time, it can be automatically uploaded to cloud 1752. Alternatively, System users (for example, clinicians) should upload data to Loud 1752. This can facilitate the identification of the target as tissue or calculus. In some cases, the output identifies the target as tissue or calculus. The probability of being, or the probability of the target being classified as a specific tissue type or stone type. It can also include: System users (for example, clinicians) can access such cloud services. The service is used to target tissue or stones during endoscopic laser procedures, for example, while performing endoscopic laser treatment. Near real-time information can be obtained within the body.

[0137] In some cases, the ML engine stores things like Cloud 1752. This includes a training module configured to train an ML model using training data. This is possible. The training data recognizes the target type (for example, stone type or tissue type). It may include spectral data associated with target information such as separate tags. Training data This includes laboratory data based on spectroscopic analysis of various tissue types and / or calculus types. It is possible. In addition or by alternative means, training data can be obtained from multiple patients in vitro or in vivo. This may include clinical data acquired within the organization. In some cases, such data Remove patient identification information from patient clinical data (e.g., spectral data) before use. This allows you to train an ML model, or use a pre-trained ML model to target an object. To perform detection, identification, or classification, you can upload to Cloud 1752. Yes, it is possible. The system uses anonymized patient clinical data as a data tag identification source (even if This can be associated with the hospital, laser system identification, and treatment time. Clinicians can then perform the procedure. During or after the procedure, analyze and confirm the target type (e.g., calculus or tissue type). By associating target types with anonymized patient clinical data, training data can be formed. It is possible. By using anonymized patient clinical data, large Because it can include additional data from the patient population, cloud-based ML modeling It is advantageous that the robustness of the stone can be increased. Spectroscopic analysis from rare stone types Because it is difficult to obtain data clinically or from the laboratory, this makes rare kidney stones difficult to identify. It is also possible to enhance the performance of ML models for type recognition.

[0138] Decision trees, neural networks, deep learning networks, support vector machines, etc. Various ML model architectures and algorithms can be used. In some cases, additional spectral data is available, allowing for continuous training of the ML model. Training can be performed periodically or in near real time. Training is performed on the trained ML. The algorithm adjusts one or more ML model parameters until the model meets the specified training convergence criteria. This involves adjustments using Zoom. The resulting trained ML model is cloud-based. It can be used for target detection, recognition, or classification. Stored in Cloud 1752. The large amount of data being stored and additional data being added to Cloud 1752 continuously or periodically ML models trained with data have the cloud connectivity described herein. ML-based target recognition offers accuracy and robustness in detecting, recognizing, and classifying targets within living organisms. It can improve sexual performance.

[0139] [Embodimentary Endoscopic Laser System] Figures 21A to 21D show an integrated multifiber accessor, as shown in Figure 10A. An endoscope 2110 with a ri and a feedback-controlled laser treatment system 1010 Endoscopic laser system 21, equipped with a surgical laser system and a laser source 1020. Examples of 00A and 2100B are shown. Alternatively, detection using a CCD or CMOS sensor is also possible. The imaging system, including the output device, can collect and transmit spectral responses to the spectrometer. The target composition is determined through one or more of the cores of the multifiber accessory via spectroscopy. While performing physical analysis, through one or more of the other cores of the multifiber accessory The transmitted light source can illuminate the target.

[0140] As shown in Figure 21A, the endoscopic laser system 2100A transmits the spectral signal back to the spectrometer 1 The laser energy is transmitted to 011, and the surgical laser energy is also delivered from the laser source 1020 to the target structure. Includes a multifiber accessory, including an optical path 2116 used to reach the destination. The optical path 2116 is embedded in the elongated body of the endoscope 2110. It includes an optical fiber extending along the main body. In another example, the optical path 2116 is of the endoscope 2110 It includes two or more optical fibers extending along a long, slender body. The laser controller 1013 is The transmission of spectral signals and the delivery of laser energy occur at different times or simultaneously. This allows for control over the timing of laser emission.

[0141] The multifiber accessory is embedded in the elongated body of the endoscope 2110. It may include two or more light source fibers 2114 extending along the 10 elongated bodies. As an example, not an exhaustive one, Figure 21C shows a radial cross-section of the elongated body of the endoscope 2110. Multiple light source fibers 2114 and optical paths 2116 are routed longitudinally within the elongated body of the endoscope. The light source fiber 2114 is positioned on the radial cross-section of the elongated body of the endoscope. The light is dispersed radially around the optical path 2116, along the circumference or other directions relative to the optical path 2116. (See Figure) In the example shown in 21C, the optical path 2116 is substantially along the central longitudinal axis of the elongated body of the endoscope 2110. It can be located on the directional axis. As an example, not limited to, as shown in Figure 21C, optical path 2 Six light source fibers can be positioned around 116. , and / or light source fibers at other positions relative to optical path 2116 can also be used. For example, Figure 21D shows two light sources positioned radially on either side of the optical path 2116. This shows fiber 2114. The light source fiber 2114 can be coupled to the light source 1030. Alternatively, the light source fiber 2114 is connected to the irradiation source 914 as shown in Figures 9A and 9B. It can be combined. Irradiation source 914 (for example, one or more LEDs) or external endoscope Regardless of the remote light source 1030, the light from the endoscope light source illuminates the target and the target surface. It can perform the function of generating a spectral signal reflected from the source, and this spectral signal is used for spectroscopic analysis. It can be collected for this purpose. The feedback analyzer 1012 is shown in Figures 10-11. Similarly, as shown, the distance 1060 between the distal end of the endoscope 2110 and the target structure 122 is determined. It can be determined.

[0142] Figure 21B shows the endoscopic laser system 2100B including multifiber accessories. Instead of delivering laser energy through optical path 2116, a separate laser fiber 2 Using 120, surgical laser energy is delivered from laser source 1020 to the target structure. This is possible. The optical path 2116 is dedicated to transmitting the spectral signal back to the spectrometer 1011. It is used as a spectral signal fiber.

[0143] Figures 22 and 23A to 23B refer to the discussion above with reference to Figures 21A to 21D. Examples of multifiber systems that can be used in optical fiber delivery systems such as As shown in Figure 22, in the example shown, the multifiber system 2200 is coupled to the light source, and irradiation A first fiber 2210 configured to direct light towards the target, coupled to a spectrometer, and the target The reflected signal (for example, light reflected from the target) that shows the spectral characteristics is transmitted to the spectrometer. This includes a separate second fiber 2220 configured as follows.

[0144] Figures 23A and 23B show exemplary sources of light input and spectral feedback signals. This is a diagram of a multifiber accessory. As shown in Figure 23A, the multifiber accessory Ri 2300A consists of a distal portion 2310, a transition section 2320A, and a proximal portion 2330A. It may include the distal portion 2310, the first fiber 2210 and the second fiber A shaft that can be sized and shaped to seal 2220, and distal portion 2 Includes transition section 2320A located proximal to 310. First fiber 2210 and Fiber 2220 can be embedded in the longitudinal shaft of the distal portion 2310. The distal portion 2310 can extend along the longitudinal shaft. The shaft is an endoscope. It can be sized and shaped to extend through the working channel. In one example, the first fiber 2210 is connected to two or more optical fibers, each coupled to a light source. It may include and / or the second fiber 2220 may include one or more optical fibers. It is possible to do so. In some examples, as shown in Figures 21C to 21D, the second fiber 2220 can be radially dispersed around the first optical fiber 2210. (Example) Then, at least one of the second optical fibers 2220 has a substantially central length of the shaft. It can extend along the direction axis. Two or more first optical fibers 2210 are shafts The second optical fiber 2220 extends along the central longitudinal axis of the torto, and is radially positioned on both sides of it. It is possible.

[0145] The proximal portion 2330A is connected to a first connector 2332 configured to connect to a light source. It also includes a second connector 2334 configured to be connected to a spectrometer. Transition Section 2 320A interconnects the distal portion 2310 and the proximal portion 2330A, and the first connector Connect 2332 to the first fiber 2210, and connect the second connector 2334 to the second fiber It can be configured to connect to 2220. Therefore, transition section 2320A is From the first connector 2332 and the second connector 2334 to a single shaft, respectively This provides transitions for optical fibers 2210 and 2220.

[0146] The shaft includes an insertable distal end 2312 extending distally from the distal portion 2310. The insertable distal end 2312 can be configured to be inserted into the patient. The proximal portion 2300A allows the user to operate the multifiber accessory 2300A. It can be associated with a handle for (for example, included in) a . For example, At least a portion of the fiber accessory 2300A (for example, the distal portion 2310, transverse portion) Transposition 2320A or one or more of the proximal portion 2330A) is used in the endoscopic working To be able to be included in a working channel or to be insertable into the working channel of an endoscope. It is possible.

[0147] Figure 23B shows a variant of the multifiber accessory 2300A, the multifiber accessory. Another example of Sari 2300B is shown. In the example shown in Figure 23B, the proximal portion 2330B is optical fiber A third laser source configured to be coupled to one of the IBA 2210 or 2220 Connector 2336 may be further included. Similar to Figure 23A, transition section 2320B is The distal portion 2310 and the proximal portion 2330B are interconnected. The laser energy passes through one of the optical fibers 2210 or 2220 to the proximal portion Transmission can occur from 2330B to the distal portion 2310 via the insertable distal end 2312. This allows delivery to the target therapeutic site. In some cases, multifiber accessors The RI2300B is a laser fiber that is different from optical fiber 2210 or 2220. It can include: laser fibers within the working channel of the endoscope, such as within the shaft. It can be positioned. The laser energy generated from the laser source is used by the laser fan. It can be transmitted through the rib to the distal portion 2310.

[0148] Exemplary applications of laser systems The laser systems described in accordance with various examples herein are for excision, coagulation, evaporation, or other purposes. To improve the effectiveness of laser action, many procedures such as endoscopic hard or soft tissue surgery are performed. It can be used in application examples.

[0149] One application of laser systems to tissue surgery is the use of laser and plasma devices. Instead of using two different foot pedals, which is often done with commercially available devices such as S This relates to providing effective tissue excision and coagulation using a laser system. The system uses two different wavelengths coupled through a fiber into the laser controller. It uses two or more solid-state laser modules that emit light, and allows the user to set alternative settings before adjustment. A UV-VIS reflection spectrometer that delivers spectral signals to the proposed feedback analyzer. Use the stem.

[0150] For example, it emits light at high tissue absorption wavelengths for a more efficient excision / carbonation process. A first laser module capable of, for example, penetrating to a depth similar to the diameter of a small capillary. Therefore, for more efficient coagulation, a second type of light can be emitted at lower tissue absorption wavelengths. We can provide two laser modules, including the first laser module. An example of the module is the UV-VIS emitting InXGa1-XN semiconductor summarized in Table 1. Body laser, GaN emitting at 515-520nm, InX emitting at 370-493nm Ga1-XN, or an IR laser that emits in a high water absorption range of 1900-3000 nm It can include. An example of a second laser module is Ga, which emits at 750-850 nm. Contains XAl1-XA or InXGa1-XA that emits at 904-1065 nm. This is possible. Both the first and second laser modules are connected by a laser coupling system. It can be coupled to a laser controller.

[0151] The spectroscopic light source is either a separate fiber channel, laser fiber, or integrated into the endoscope system. It can be converted. The spectral light source signal reflected from the target is sent to a separate fiber channel or It can be rapidly detected and delivered to the spectrometer via a laser fiber. Alternatively, The spectroscopic system separates the data from the imaging system, which includes a detector such as a CCD or CMOS sensor. It can also collect optical signals. Based on the spectral system feedback, signal analysis is performed. The first or second radar for detecting target material compositions and achieving effective tissue therapy - Proposes a module setup and provides the user with the proposed setup information. The signals used can be delivered to the output system.

[0152] This example shows two optical wavelengths controlled by a feedback analyzer system. By utilizing the above laser pulses, tissue excision and coagulation become possible. However, To optimize the simultaneous delivery of specific effects to the target, a single or multiple optical wavelength system Feedback control can also be utilized. These effects are from the user's perspective. These can only be done simultaneously, and the features described herein are that the wavelengths are transmitted at exactly the same time. It is not limited to reaching a certain point.

[0153] An exemplary time-operation diagram of this laser with spectral feedback is shown in Figure 8. As shown in Figure 8, amplitude A max The optical feedback signal having this characteristic is transmitted to the target surface. It is subsequently delivered, reflected from the target surface, and detected and analyzed by a signal analyzer. Next, the user chose to excise the soft tissue and then turned off the second laser. The first laser can be turned ON, or kept ON. During the operation of laser 1, the optical feedback signal has an amplitude that reaches threshold level A. min It decreases Until then, it is largely absorbed by the carbonized tissue. Next, the signal analyzer checks the state of the laser. The settings are changed so that the first laser is turned OFF and the second laser is turned ON. The second laser is The carbonized tissue largely absorbs the carbonized tissue, and therefore the carbonized tissue is excised, effectively removing the carbonization. The wavelength of the second laser also provides effective coagulation. By the decarburization process, light The amplitude of the feedback pulse is at the initial level A max Return to the vicinity. When this happens, believe The analyzer changes the laser state again, turning on the first laser and the second laser The process is turned OFF. The above process ensures that the required amount of tissue is excised and coagulated. It can be repeated until it succeeds.

[0154] Another application of laser systems is the efficient fragmentation of kidney or bladder stones within a patient. This concerns a typical laser lithotripsy process. This application example is firstly based on the target, which is not very Using multi-wavelength laser energy with wavelengths that are not absorbed, the target is heated, and then Using wavelengths with strong absorption, for example, in relation to the process of fragmenting targets such as kidney stones. During laser lithotripsy, the photothermal effect can be used to fragment kidney or bladder stones. The stone can absorb high laser energy, thus raising the threshold for chemical decomposition. A rapid temperature increase occurs, leading to its decomposition and fragmentation. For example, The quarrying process can consist of two stages. The first stage is the preheating stage. The stone is heated using laser energy of the first wavelength, and the laser energy is absorbed by the stone. The yield becomes lower. The next second step involves applying a laser energy with a second wavelength. The laser energy absorption by the stone becomes stronger than the first wavelength. Seth allows for better control of the vapor bubble criteria compared to the fragmentation process, and the resulting impact This makes it possible to reduce the intensity of the waves (reduce the backward movement of the rocks).

[0155] In one example, the laser system is coupled to the laser controller via a fiber. Two or more solid-state laser modules emitting at different wavelengths, and alternatives before adjustment. A spectroscopic system that delivers spectral signals to a feedback analyzer that suggests settings to the user. The system utilizes a lower stone for efficient preheating. The first laser module uses a lower stone. The second laser module can emit light at water absorption wavelengths, allowing for more efficient stone cutting. For fragmentation, it can be emitted at high stone / water absorption wavelengths. The first example of this application is The module can produce output at lower stone or water absorption wavelengths. The laser provides effective and uniform preheating of the stone. First laser module for the first Examples of laser sources include GaXAl1-XA, which emits at 750-850 nm, or 904- It can include InXGa1-XA that emits at 1065 nm. An example of a second laser source is GaN lasers emitting at 515-520 nm, as summarized in Table 1, or 370-493 nm InXG emits UV-VIS lasers such as InXGa1-XN lasers that emit light at nm. a1-XN semiconductor laser, or in the high water and stone absorption range of 1900-3000 nm It may include an IR laser that emits light.

[0156] Both the first and second laser modules are connected by a laser coupling system. It can be coupled to a controller. The spectral light source is a separate fiber channel, laser fiber It can be integrated into an IBA or endoscope system. Spectroscopic light source signals reflected from the target The signal is rapidly detected and transmitted to the spectrometer via a separate fiber channel or laser fiber. It can be delivered. Alternatively, the spectroscopic system can use a CCD or CMOS sensor, etc. Spectroscopic signals can also be collected from imaging systems that include detectors.

[0157] Based on the spectroscopic system feedback, the signal analyzer detects the target material composition. ...to achieve an effective multi-step stone treatment process, the first or second laser modulus It is used to propose a route setup and provide the user with the proposed setup information. The signal to be used can be delivered to the output system. The laser system provides feedback Two or more laser modules with optical wavelengths controlled by the analyzer system By utilizing the laser pulses shown above, effective preheating and fragmentation of the stone can be delivered simultaneously. This is possible. However, in order to optimize the simultaneous delivery of the specific action to the target stone composition, Feedback control can also be utilized by a single or multiple optical wavelength system. .

[0158] Another application of laser systems is in hard tissues where high laser power output is required. For example, this relates to the process of performing the removal of teeth, bones, etc. (Soft tissue laser) The effectiveness of the surgery is based on low-temperature water evaporation at 100°C, but the hard tissue cutting process is 5 It requires a very high cutting temperature of around 1,000°C. To deliver enhanced output power Therefore, laser systems combine more laser modules to treat targets. The integrated output power can be increased to a sufficient level. Table 1 summarizes U InXGa1-XN semiconductor laser that emits light using V-VIS, emitting light at 515-520nm. GaN, InXGa1-XN emitting at 370-493nm, or 1900-3000 A nm IR laser can be used as the emission source. This is applicable to this example. A laser source for a capable laser module is, for example, a G-emitting laser at 750-850 nm. aXAl1-XA laser, or InXGa1-XA laser emitting at 904-1065nm - It can include -za.

[0159] The laser module is integrated into the laser controller by a laser coupling system. This is possible. To achieve the required high power, a large number of laser modules are used in the system. It can be coupled to the system. The spectroscopic light source is a separate fiber channel, laser fiber, Alternatively, it can be integrated into an endoscope system. The spectral light source signal reflected from the target is Rapid detection and transmission to the spectrometer via a separate fiber channel or laser fiber. Alternatively, a spectroscopic system can detect a CCD or CMOS sensor. It is also possible to collect spectral signals from imaging systems that include the instrument.

[0160] Based on the spectroscopic system feedback, the signal analyzer detects the target material composition. To achieve an effective multi-step treatment process with the required output power, The module setup and the number of laser modules are proposed, and the proposed setup The system can deliver signals used to provide user information to the output system. The laser system has a light wavelength controlled by a feedback analyzer system. The number of laser modules included in a treatment process that utilizes two or more laser pulses By increasing the power output, it becomes possible to simultaneously deliver the required high laser power. To optimize the simultaneous delivery of specific effects to the target stone composition, one or more lights Feedback control can also be utilized through wavelength systems. These effects are From a strobe perspective, this can only be considered simultaneous, and is limited to delivering wavelengths at exactly the same time. It is not something that can be determined.

[0161] The features described herein are used to provide a method for identifying a target composition. This can be done. The target is, in some cases, soft tissue in the body through the use of surgical accessories. It can also be used as a medical target for hard tissues, etc. This accessory can be used endoscopically or abdominally. It can be used under a dental endoscopic examination. The accessory is a single device containing multiple optical fibers. It can consist of, with at least one fiber supplying source irradiation, and at least one The fiber is intended to guide the reflected light to the spectrometer. This allows the user during the procedure. Throughout, whether or not direct visualization with endoscopy is used, the tissue or target This makes it possible to continuously monitor the composition. Furthermore, this can be combined with a laser system. It can be used in this way, and the accessory is configured based on the composition of the tissue or target. Feedback can be sent to the laser system for adjustment. This feature is useful. Allows for instant adjustment of laser settings within the setting range of the original laser setting selected by the system. The features described herein can be used in conjunction with a spectroscopic system, and the spectroscopic system The TEM can be used with an optical fiber integrated laser system. The spectroscopic light source is to transmit through at least one of the fibers in a multifiber accessory. This is possible. The light source signal reflected from the target is transmitted through additional fibers within the multifiber. It can be rapidly collected and delivered to a spectrometer.

[0162] An exemplary method uses spectral input data to perform laser delivery based on an algorithm. The distance between the distal end of stem 1701 (such as a fiber) and the tissue or target is calculated and controlled. This method allows for control of soft and hard tissues during in vivo surgical processes. It can be applied to both types. The distance between the target and the distal end of the fiber is the spectral distance. It can be calculated based on the analysis of the data. The outer diameter of each fiber and the distance from the endoscope. The angle of protrusion affects the intensity of the reflected light measured to acquire spectral data. The features described herein allow for sequential illumination by lights having different aperture values. It is possible to calculate the distance without shooting.

[0163] In the case of moving stones, this method allows for distance control and detection of stones exceeding a predetermined threshold. A suction effect is created using steam bubbles in water to draw the target towards the distal end of the fiber. The laser operating parameters can be adjusted or suggested. This feature allows the user to move The effort required to maintain an effective therapeutic distance from the dynamic target is minimized.

[0164] UV-VIS-IR reflectance spectroscopy, as demonstrated by various examples discussed herein, is used to analyze the chemical composition of materials. This generates spectral feedback, including analysis, and controls the reflected light intensity during in vivo diagnostic or therapeutic procedures. It can be used alone or in combination with other spectroscopic techniques for measurement. The incoming light can provide the same information as a color image created by the eye or a high-resolution camera. However, it can be done more quantitatively and objectively. Reflectance spectroscopy is a method that analyzes the chemical composition of light reflection and absorption. This technique provides information about the material, as it depends on the finished product and surface properties. This also makes it possible to obtain unique information regarding both the surface and internal properties of the sample. be.

[0165] Another application of laser systems is determining the composition of a target stone during laser lithotripsy. This relates to the process of identifying target types, as shown in some examples discussed herein. The endoscope system has a light source, which guides the endoscope's light to target areas inside the human body. The laser provides light to break up the stones under the light emitted from the endoscopic system. The system is used. In this situation, the laser system is used to detect the stone composition. In some cases, this can be somewhat problematic. The light reflected from the stone is weak, while the endoscopic system... The light emitted from the endoscopic system is strong. Therefore, analyzing the composition of the stone under irradiation by the endoscopic system is difficult. It can be difficult to do.

[0166] Figure 26 shows how to identify targets using diagnostic beams such as laser beams (for example, kidney stones). An example of an endoscopic system 2600 configured to identify the target composition is shown. The TEM2600 controls both the endoscopic light source 2630 and the laser generator module 2640. It can include a controller 2650 that can be controlled. , input of a command to activate the physician-assisted stone composition detection mode via the laser system The force can be detected. The controller 2650 then stops the irradiation, To switch from high-irradiation mode to low-irradiation mode, a command is sent to the endoscope light source 2630. It can be delivered, and in low-irradiation mode, the reduced dose is delivered to the target over a specific period of time. It is projected. During such low-irradiation or non-irradiation periods, the laser system 2640 projects onto the target. It can emit a laser beam and receive reflected light from the stone. Detector 2660 is a reflector. Light can be used to perform target identification. Under low-irradiation mode, irradiation of the target area is reduced. By turning it off (or switching the irradiation off), the laser beam incident on the target can be directed towards the target. This can enhance their reflexes, which in turn can help improve target identification. .

[0167] After determining that target identification is complete, the detector 2660 sends a termination command to the controller 2 It can be sent to 650. Then the controller 2650 re-irradiates the target, Alternatively, a command can be sent to switch back from low-irradiation to high-irradiation mode. For example... Then, the endoscope light source 2630 stops irradiation, or switches from high irradiation mode to low irradiation mode. When a command is received to switch to the image processor within the endoscopic system 2600, The SSA2670 captures a still image of the target and, during that period, displays that still image in the endoscopic system. It can be displayed on the monitor. Refer to Figures 11A and 11B for the information discussed above. Furthermore, variations of the endoscopic system 2600 for target identification are also being considered.

[0168] Figure 27 can include a first pulse train 2710 and a second pulse train 2720. For example, a laser pulse sequence with different pulse energies or power levels. Rough 2700 is shown. The pulses in the second pulse train 2720 are from the first pulse train 2710. The pulse has a higher energy or power level. The first pulse train 2710 and The second pulse train 2720 can be generated by each laser source, each endoscopically The first pulse train can be emitted from the distal end of the mirror in the form of a laser beam. 2710 is effective over a specific period (for example, controlled by the user). It can always be generated. The second pulse train 2720 is generated when the first pulse train 2710 It can be generated intermittently over a specific period of delivery, for example, the second The pulse train 2720 is between two pulses of the first pulse train 2710, or the first It can be delivered between two pulse trains 2710. In the example shown in Figure 27, One pulse in pulse train 2710 has a constant energy or power level, and the second The pulse train 2720 has a higher energy or power level than the first pulse train 2710. It contains only one pulse having . In some examples, the second pulse train 2720 is each Two or more pulses having a higher energy or power level than the first pulse train 2710 It can include S.

[0169] The laser pulse sequence shown in Figure 27 is used to break down cracks in stone structures, such as those in the kidneys. It can be used by a laser lithography system to provide fragmentation. Figure 27 As shown, the sequence represents time in the X direction of the graph, but the location of the stone or other target Annotated by "A" and "B". Therefore, the laser pulse Kens describes the spatial time of laser pulses with different pulse energies or power levels. This represents a target pattern. In this example, location "A" is the center of a stone or other target, or its vicinity. Location "B" is located in or near a stone or other target. The laser pulse transmitted between location "B" includes the use of an actuator. This allows the laser fiber 140 to move in parallel from location "A" to location "B". When, or when the laser fiber 140 is moving in parallel from location "B" to location "A" This shows the pulses sent out. The first pulse train 2710 does not fragment the target stone, It is possible to select a method to cause a crack in the target stone. Therefore, in Figure 27, The first pulse train 2710 can be sent out, starting from location "A" and reaching the center of the stone. First, proceed towards the area around the stone to location "B", then proceed to location "A" in the center of the stone. Returning to the previous step, at that point, in the first attempt at fragmenting the target stone, a higher energy pulse was used. 2720 ​​can be delivered. Such as by higher energy pulses of 2720. If fragmentation is unsuccessful, a further first pulse train 2710 can be delivered. Starting from the point towards the center of the stone, proceed towards the periphery of the stone to point "B", and then to the point at the center of the stone. Returning to location "A", at that point, in the second attempt at fragmenting the target stone, another higher energy Energy pulse 2720 can be delivered. Further repetition is possible. Peripheral area of ​​the stone The same or different location "B" can be used for various repetitions, and different In the repetition, different locations "B" are different surrounding locations "B" from location "A". Along such a path to, multiple cracks are created. A second pulse to neighboring tissue. To minimize the influence of row 2720, etc., only when heading towards the center of the stone, higher It may be preferable to use energy pulse 2720.

[0170] In some examples, different pulse energies or power levels are shown in Figure 27. The sequence of laser pulses is used in endoscopic systems to provide hemostasis or coagulation at the target site. It can be used in this way. For example, the first pulse train 2710 and the second pulse train 2 720 is designed to facilitate efficient hemostasis or coagulation processes, for example, by alternating between timed intervals. It can be delivered to the target site in spatial and temporal patterns such as these.

[0171] The first pulse train 2710 and the second pulse train 2720, for example, have different energies or A pulse with a power level can be operated by the user, such as by a button or foot pedal. It can be controlled and activated via a capable actuator. For example, the user can, Using the first activation pattern (for example, a single press of a button or foot pedal), The delivery of the first pulse train 2710 can be initiated, and the second initiation pattern (for example, Use a button or foot pedal (press twice) to deliver a second pulse train 2720 It can be started. For example, the first pulse train 2710 and the second pulse train 272 Each of the 0s can be controlled via a separate actuator. Additional or alternative methods Then, the first pulse train 2710 and the second pulse train 2720 receive feedback from the target. It can be automatically activated based on a signal such as a clock signal. For example, a spectrometer However, the spectral data of the target can be collected, and the feedback analyzer can collect the spectral data. By analyzing it, it is possible to identify the composition of different parts of the stone structure. Based on the identification, the first pulse is applied to different parts of the target having the respective identified compositions. This delivers different energy pulses, such as pulse train 2710 or a second pulse train 2720. It is possible.

[0172] Figure 28 shows how to perform one or more of the techniques (e.g., methods) discussed herein. A block diagram of the exemplary machine 2800, which can perform this operation, is shown in its entirety. This descriptive section is from this book. Computing frameworks for various parts of a laser treatment system as discussed in the specification. It can be applied to the workpiece.

[0173] In an alternative embodiment, machine 2800 can operate as a standalone device, Alternatively, it can be connected to other machines (for example, networked). In this configuration, machine 2800 is a server in a server-client network environment. It can operate within the capacity of the machine, the client machine, or both. For example, the machine 2800 is a peer-to-peer (P2P) (or other decentralized) network environment. It can function as a machine. Machine 2800 is a personal computer (PC). Tablet PCs, set-top boxes (STBs), personal digital assistants (PDA), mobile phone, web appliance, network router, switch or The bridge, or the machine, executes instructions (sequentially or otherwise) that specify the actions it should take. It can be any machine capable of doing so. Furthermore, only a single machine is shown. However, the term "machine" also refers to cloud computing, software as a service. Any of the methods discussed herein, such as SaaS, other computer cluster configurations, One or more instruction sets to execute one or more of the following individually or jointly This shall be interpreted as including any one group of machines performing the operation.

[0174] The examples described herein may include logic or multiple components or mechanisms. , or it can operate by logic or multiple components or mechanisms. A net is a tangible entity that includes hardware (for example, simple circuits, gates, logic, etc.). This is a group of circuits that will be implemented. The membership of the circuit set is flexible over time. This underlies hardware variability. The circuit set, when operating, performs a specified operation independently or This includes components that can be combined. For example, the hardware of a circuit set is: It can be designed invariantly to perform specific actions (e.g., hardwired). For example, the hardware of a circuit set may be physically encoded to encode instructions for specific actions. Computer-readable media that has been modified accordingly (for example, magnetic and electrical of invariant densely packed particles) Variable-connected physical components (e.g., execution units, including movable arrangements) It may include transistors, simple circuits, etc. When connecting physical components, The fundamental electrical properties of the hardware components are changed, for example, from an insulator to a conductor, or The reverse is also true. These instructions, in their operation, rely on embedded hardware (e.g., execution unit). A variable connection is used to allow a specific part of the operation (either a reel or loading mechanism) to be performed. This makes it possible to create the components of the circuit set in hardware. Accordingly, The reader-readable medium communicates with other components of the circuit set when the device is operating. They can be coupled. For example, in two or more components from two or more circuit sets, Any of the control components can be used. For example, under operation, the execution unit is At one point in time, it can be used in the first circuit of the first set of circuits, and at different times In this case, by the second circuit of the first circuit set, or by the third circuit in the second circuit set It can be reused through the circuit.

[0175] The machine (for example, a computer system) 2800 has a hardware processor 280 2 (For example, a central processing unit (CPU), a graphics processing unit (GPU), and a hardware processor. A 2804 main memory and a static processor core (or any combination thereof), a static processor core, or any combination thereof. It can include memory 2806, some or all of which are interlinked. (For example, bus) 2808 can communicate with each other. Machine 2800 is Display unit 2810 (for example, raster display, vector display) , holographic displays etc.), alphanumeric input devices 2812 (for example, keys Board), and user interface (UI) navigation device 2814 ( For example, it could further include a mouse. The input device 2812 and the UI navigation device 2814 are touchscreens. It can be a screen display. Machine 2800 is a memory device (for example, drive Unit 2816, signal generating device 2818 (e.g., speaker), network Interface device 2820, and global positioning system (GPS ) One or more sensors 2821 such as a sensor, compass, accelerometer, or other sensors It can also include: Machine 2800 has one or more peripheral devices (for example, a printer). To communicate with or control such devices (e.g., card readers), serial ( For example, Universal Serial Bus (USB), parallel, or other wired or wireless connections. Output controllers such as wired connections (e.g., infrared (IR), near-field communication (NFC), etc.) It can contain 2828.

[0176] The storage device 2816 may include a machine-readable medium 2822, and the machine-readable medium 28 22. This involves performing one or more of the techniques or functions described herein, or One or more of the techniques or functions described herein are used. The data structure or instruction set 2824 (for example, software) is stored. 2824 also contains static memory 2804 in main memory 2804 while it is running by machine 2800. Resident fully or at least partially within 06, or within hardware processor 2802. It is possible. For example, hardware processor 2802, main memory 2804, static One or any combination of the memory 2806 or the storage device 2816 is A machine-readable medium can be constructed.

[0177] Although machine-readable medium 2822 is shown as a single medium, the term "machine-readable medium" is used. The term refers to a single medium or multiple media configured to store one or more instructions 2824. A system (for example, a centralized or distributed database, and / or associated cache) It can include (and servers).

[0178] The term “machine-readable medium” means that one or more of the techniques of this disclosure are implemented on the machine 2800. It is possible to store, encode, or carry instructions for execution by the machine 2800. It is capable of, or is used by or associated with such an order. Including any medium capable of storing, encoding, or transporting data structures. This is possible. Examples of machine-readable media, not limited to these, include solid-state memory, as well as optical and magnetic media. It can include a body. For example, densely packed machine-readable media can be immutable (for example, stationary) (t) Includes a machine-readable medium containing multiple particles having mass. Accordingly, densely packed machine-readable A reading medium is not a transient propagating signal. A specific example of a densely packed machine-readable medium is semiconductor memo. Redevices (for example, electrically programmable read-only memory (EPROM), Erasable programmable read-only memory (EPSOM) and flash memory Non-volatile memory such as Moly devices, internal hard disks and removable disks Any magnetic disk, magneto-optical disk, and CD-ROM and DVD-ROM disk It can include a 'k'.

[0179] Instruction 2824 is a communication protocol that handles multiple transmission protocols (e.g., Frame Relay, Internet). Protocol (IP), Transmission Control Protocol (TCP), User Datagram Protocol ( Use one of the following protocols: UDP, Hypertext Transmission Protocol (HTTP, etc.) Communication using a transmission medium via the network interface device 2820 It can be further transmitted or received by network 2826. Exemplary communication network Networks, in particular, include local area networks (LANs) and wide area networks. WAN (Wide Area Network), Packet Data Network (e.g., the Internet), Mobile Phone Network Networks (for example, cellular networks), Plain Old Telephone ne(POTS) networks, and wireless data networks (for example, WiFi) The Institute of Electrical and d Electronics Engineers (IEEE) 802.11 Family Standard (The IEEE 802.16 family standard, also known as WiMAX (registered trademark)), The IEEE 802.15.4 family of standards includes peer-to-peer (P2P) networks. This is possible. For example, the network interface device 2820 is a communication network To connect to the Work 2826, one or more physical jacks (for example, Ethernet, It may include a coaxial cable or telephone jack, or one or more antennas. The network interface device 2820 is a single-input multiple-output (SIMO) device, and is a multi-input multiple-output (SIMO) device. At least one of the following techniques: Multiple Input Multiple Output (MIMO) or Multiple Input Single Output (MISO) It can include multiple antennas that use one to communicate wirelessly. The term refers to storing, encoding, or carrying instructions for execution by machine 2800. This shall be interpreted as including any possible intangible medium, and the communication of such software Includes digital or analog communication signals or other intangible media for facilitating communication.

[0180] [Additional Notes] The above detailed description includes references to attached drawings, which form part of the detailed description. For illustrative purposes, specific embodiments in which the present invention can be carried out are shown herein. These embodiments are also referred to as “examples.” Such examples include elements other than those shown or described. Elements may be included. However, the inventors only provide the elements shown or described. We also intend to include examples of this. Furthermore, the inventors intend to include a specific example (or one or more embodiments thereof) or in relation to other examples (or one or more embodiments thereof) illustrated or described herein. , an example using any combination or rearrangement of the elements shown or described (or one of them) The above configuration is also intended.

[0181] In this specification, the terms "a" or "an" are used as commonly found in patent documents. It depends on any other instance or use of "at least one" or "one or more". Used to include one or more without any exception. In this specification, "or (or The term ")" is used to refer to a non-exclusive "or," and therefore "A or B Unless otherwise specified, "A instead of B", "B instead of A", and "A and Includes "B". In this specification, the terms "including" and "in which" mean "equipped with". The terms "ru" and "wherein" are used as simple English equivalents. Furthermore, in the following claims, the terms “including” and “equipped” are open. It is an end, that is, an element other than the elements listed after such term in a claim. A system, device, article, composition, configuration, or process containing an element is also within the scope of the claim. It is considered to be within the enclosure. Furthermore, in the following claims, "first", "second", Terms such as "third" are used solely as labels and do not impose numerical requirements on those entities. That was not the intention.

[0182] The above explanation is intended as an example, not a restriction. For example, the above example (and One or more of these embodiments can be used in combination with each other. Therefore, by considering the above description, other embodiments can also be used. The abstract is, In accordance with the Patent Act Enforcement Rules §1.72(b), the reader can quickly ascertain the essence of the technical disclosure. The abstract is provided to enable this. The abstract interprets the scope or meaning of the claims. It is submitted with the understanding that it is not intended to be used to limit or restrict. In the detailed description below, various features have been grouped together to simplify this disclosure. This is because the features of the disclosure not claimed are essential to any of the claims. It should not be interpreted as being intended to be so. On the contrary, the subject matter of the present invention is not a specific disclosure. It may also be within a smaller range than all the features of the embodiment. Therefore, the following patent requests The scope of the claims is incorporated in the detailed description herein as examples or embodiments. Each claim stands on its own as a separate embodiment, and such embodiments are diverse. The intention is that the elements can be combined with each other in any combination or rearrangement. The scope is equivalent to the attached claims, which are given by the attached claims. It should be determined along with the complete scope of the item.

Claims

[Claim 1] It is an endoscopic system, A light source configured to irradiate an anatomical target, having selectable irradiation modes including a first mode having a first irradiation dose and a second mode having a second irradiation dose lower than the first irradiation dose, A diagnostic energy source configured to generate a diagnostic beam, Image sensor and An endoscope comprising an optical fiber insertable through the working channel of the endoscope, wherein the optical fiber is operably coupled to the diagnostic energy source, Controller circuit and Equipped with, The controller circuit, The diagnostic energy source emits the diagnostic beam through the optical fiber toward the anatomical target, While the diagnostic beam is being emitted toward the anatomical target, the light source is operated in the second irradiation mode, Receiving the reflected light of the diagnostic beam from the anatomical target, The characteristics of the anatomical target are determined based at least partially on the reflected light of the diagnostic beam, An endoscope system configured to perform the following actions.

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