Beam diffraction in surgical lasers

Abstract

The present disclosure teaches the use of endoscopic surgical lasers using beam diffraction. During lithotripsy treatment, an endoscopic probe equipped with a laser fiber is deployed. A diffraction grating within the optical core of the laser fiber distributes the laser energy over a larger area for more effective removal of kidney stones.

Description

[Technical Field]

[0001] (Related Applications) This application claims the benefit of U.S. Provisional Patent Application No. 63 / 448,985, filed February 28, 2023, the disclosure of which is incorporated herein by reference.

[0002] (Technical field) The present disclosure relates generally to surgical laser systems. In particular, but not exclusively, the present disclosure relates to laser fibers used during endoscopic laser treatment. [Background technology]

[0003] Medical lasers are used in a variety of clinical areas. One treatment for addressing kidney stones, also known as nephrolithiasis, is ureteroscopy, also known as ureteroscopy. An endoscopic probe equipped with a camera or other sensors is inserted into the patient's urinary tract to locate and remove the stone. In endoscopic lithotripsy, the probe also contains an optical fiber, which conducts a laser beam to break up any stones found.

[0004] The ideal lithotripsy procedure would be fast, precise, and thorough, requiring the practitioner to minimize the time spent inserting the endoscope, direct all emitted laser energy toward the target stone, and ensure that no large stones or stone fragments remain. However, these three goals are sometimes in tension. For larger stones, relatively low-intensity but high-frequency pulses can be used to remove or ablate layers from the target without fracturing it (known as dusting). While this treatment is thorough, it is somewhat time-consuming due to the maximum intensity that can be applied without risking premature fragmentation or fragmentation. Summary of the Invention [Problem to be solved by the invention]

[0005] Therefore, there is a need for a device that can more quickly, safely and effectively break down target stones. [Means for solving the problem]

[0006] This Summary is provided to introduce some concepts in a simplified form that are further described below in the Detailed Description. This Summary is not intended to necessarily identify key features or essential features of the claimed subject matter, nor is it intended as an aid in determining the scope of the claimed subject matter.

[0007] The present disclosure provides an endoscopic lithotripsy solution that allows for more efficient disintegration of stones.

[0008] Generally, the present disclosure provides beam diffraction of laser energy used in endoscopic surgical treatments. The diffraction pattern within the optical core of a laser fiber distributes the beam over a wider area, dissolving the target more evenly and more quickly.

[0009] In some embodiments, the present disclosure provides an endoscopic surgery device comprising: a laser light source; a laser fiber optically coupled to the laser light source, the laser fiber comprising an optical core and a fiber tip, the optical core including a plurality of grating patterns forming a diffraction grating; and an endoscopic probe housing an imager and the fiber tip.

[0010] In some embodiments, the laser light source is a high-energy pulsed laser. In some embodiments, the grating patterns are evenly spaced along the length of the optical core. In some embodiments, the grating patterns are spaced apart between 1.9 microns and 35 microns along the optical core. In some embodiments, the spacing is between 7.5 microns and 7.9 microns. In some embodiments, the optical core has a diameter between 200 microns and 550 microns. In some embodiments, each of the grating patterns is engraved onto the optical core by mechanical, chemical, or laser etching. In some embodiments, each of the grating patterns is inserted into the optical core by implantation or material compositing. In some embodiments, the diffraction grating is disposed within the fiber tip. In some embodiments, one of the grating patterns is engraved onto the distal end face of the fiber tip.

[0011] The device may further include a display configured to display image data received from the imager while the endoscopic probe is deployed. The device may further include a controller configured to receive image data from the imager while the endoscopic probe is deployed and to activate the laser light source to emit laser energy through the laser fiber, the laser energy being emitted from the fiber tip. In some implementations, the laser energy is distributed over an area greater than 10 times the diameter of the laser tip. In some implementations, the laser energy is distributed over an area including multiple regions of high intensity separated by regions of lower intensity.

[0012] In some embodiments, the present disclosure may be practiced as a method of endoscopic lithotripsy in which any embodiment of the device described herein is deployed, and laser energy is emitted from a laser source through a laser fiber to remove or ablate a portion of the kidney stone.

[0013] To easily identify the discussion of any element or act, the most significant digit(s) of a reference number refers to the figure number in which that element is first introduced. [Brief explanation of the drawings]

[0014] [Figure 1] 1 illustrates an endoscopic surgery system according to embodiment(s) of the present disclosure. [Figure 2] 1 illustrates a laser fiber having a diffraction grating according to embodiment(s) of the present disclosure. [Figure 3] 1 illustrates an undispersed laser intensity pattern according to embodiment(s) of the present disclosure. [Figure 4A] 1 illustrates a dispersed laser intensity pattern according to embodiment(s) of the present disclosure. [Figure 4B] 1 illustrates a dispersed laser intensity pattern according to embodiment(s) of the present disclosure. [Figure 5] 5 illustrates a computer-readable storage medium 500 according to one embodiment. [Figure 6] 6 shows a diagrammatic representation of a machine 600 in the form of a computer system within which a set of instructions can be executed to cause the machine to perform any one or more of the methodologies discussed herein, according to an exemplary embodiment. DETAILED DESCRIPTION OF THE INVENTION

[0015] The foregoing has outlined broadly the features and technical advantages of the present disclosure in order that the following detailed description of the disclosure may be better understood. Those skilled in the art will appreciate that the disclosed embodiments may readily be utilized as a basis for modifying or designing other structures for carrying out the same purposes of the present disclosure. The novel features of the present disclosure, both as to its organization and method of operation, together with further objects and advantages, will be better understood from the following description when considered in connection with the accompanying drawings. It is expressly understood, however, that each of the figures is provided for the purpose of illustration and description only and is not intended as a definition of the limits of the present disclosure.

[0016] 1 illustrates an endoscopic surgery system 100 according to a non-limiting example of the present disclosure. In general, the endoscopic surgery system 100 is a system for deploying and controlling an endoscopic probe for imaging, targeting, and destroying stones. While the present disclosure focuses on lithotripsy, which may involve the use of a ureteroscope, the present disclosure is applicable to other urological or endoscopic modalities and / or applications, which may utilize, for example, a duodenoscope, gastroscope, colonoscope, bronchoscope, etc.

[0017] The endoscopic surgery system 100 includes an endoscopic probe 102 that is positioned during lithotripsy. The probe 102 includes an imager 104 and a laser fiber 106. The imager 104 can return endoscopic images, video, or other data of the patient's urinary tract while the endoscopic probe 102 is deployed. In some embodiments, the imager 104 can be a camera or other sensor that is deployed with the endoscope during the lithotripsy procedure.

[0018] Although this disclosure uses visible spectrum camera images to describe exemplary embodiments, the imager 104 may be any endoscopic imaging device, such as, for example, a fluoroscopic imaging device, an ultrasound imaging device, an infrared or ultraviolet imaging device, a computed tomography (CT) imaging device, a magnetic resonance (MR) imaging device, a positron emission tomography (PET) imaging device, or a single photon emission computed tomography (SPECT) imaging device.

[0019] The imager 104 can generate information elements or data including an indication of a kidney stone. The controller 108 of the surgical system 100 is communicatively coupled to the imager 104 and can receive data including endoscopic images from the imager 104. Generally, the endoscopic images can include indications of shape and / or appearance data of the urinary tract. The shape data can include landmarks, surfaces, and boundaries of the three-dimensional surface of the urinary tract. In some examples, the endoscopic images can consist of two-dimensional (2D) images or three-dimensional (3D) images.

[0020] The laser fiber 106 is optically coupled to a laser source 110. The laser source 110 generates electromagnetic radiation or laser energy in the form of a laser beam according to conventional techniques. The laser energy is emitted or projected through the tip of the laser fiber 106, which is in turn supported by the body of the endoscopic probe 102.

[0021] Generally, the display device 112 may be a digital display device arranged to receive rendered image data and display the data in a graphical user interface. The controller 108 may be part of a variety of computing devices. In some embodiments, the controller 108 may be incorporated into and / or implemented by the console of the display device 112. In some embodiments, the controller 108 may be a workstation or server communicatively coupled to the imager 104 and / or the display device 112. In still other embodiments, the controller 108 may be provided by a cloud-based computing device, such as a computing system as a service accessible over a network (e.g., the Internet, an intranet, a wide area network, etc.). The user input 114 may include dedicated components such as a keyboard or may also be integrated with the display device 112 in the form of a capacitive touch control. In some implementations, remote user input may be received and used by the controller 108.

[0022] It should be noted that endoscopic surgery system 100 includes custom components that are specifically configured, programmed, and / or arranged to execute the logical flows and methods detailed herein. For example, controller 108 may be pre-configured to perform laser control and emission or illumination, as further described.

[0023] 2 shows a laser fiber 200 for use with the endoscopic surgery system described above. Fiber 200 includes an optical core 202 surrounded by a coating 204. Optical core 202 is transparent to the laser wavelengths transmitted through fiber 200, while coating 204 is reflective to these wavelengths and serves as a waveguide for the laser energy emitted through fiber 200 during lithotripsy.

[0024] The laser fiber 200 includes a series of gratings 206 inscribed within the optical core 200. In some embodiments, the gratings 206 are inscribed into the core 200 by mechanical, chemical, or laser etching processes. Compounding, implantation, or other optical engineering methods can be used instead of or in addition to etching to create the refractive index difference required to affect the dispersive grating. The gratings 206 are spaced at set intervals along the core to form a Bragg grating within the optical fiber.

[0025] For effective endoscopic lithotripsy, the overall size of the endoscopic probe and therefore the diameter of the fiber 200 may be limited. For example, the fiber 200 may be limited to an overall diameter of 300 microns. This further limits the available laser wavelengths and possible dispersion patterns.

[0026] The size and spacing of the grating 206 depend on the laser type and settings. For example, a holmium pulsed laser can project energy at a wavelength of 2100 nm. In this case, a grating size of no more than 0.48 lines per micron is used. Depending on the desired dispersion pattern, any grating size between 0.03 and 0.48 lines per micron can be selected (which corresponds to a line-to-line spacing between 2.1 and 35 microns). A basic dispersion grating is formed from horizontal and vertical lines etched perpendicular to the longitudinal axis of the fiber, although other patterns can be used. As another example, a thulium pulsed laser projecting energy at a wavelength of 1940 nm can have a grating size of no more than 0.51 lines per micron (corresponding to a spacing of 1.96 microns).

[0027] Figure 3 is a position graph showing laser pulses emitted from a fiber without a grating as described above, while Figures 4A and 4B show laser pulses from a grated fiber. In Figure 3, the energy of the laser pulses is highly concentrated near the center of the graph. This limits the maximum energy and pulse frequency that can be used without spalling or fragmenting the target stone in front of the laser fiber.

[0028] In Figure 4A, which shows the energy intensity 1 mm from the tip of a fiber described herein, the grating causes the energy to be dispersed over a larger area. This dispersion allows more laser energy to be directed at the target without the risk of spallation or fragmentation. Figure 4B shows the intensity at 3 mm from the fiber tip, which allows for even greater beam dispersion when a greater distance from the target is selected, such as for larger stones.

[0029] FIG. 5 illustrates a computer-readable storage medium 500. The computer-readable storage medium 500 may include any non-transitory computer-readable or machine-readable storage medium, such as an optical, magnetic, or semiconductor storage medium. In various embodiments, the computer-readable storage medium 500 may include an article of manufacture. In some embodiments, the medium 500 may store computer-executable instructions 502 executable by a circuit (e.g., a processor, etc.). For example, the computer-executable instructions 502 may include instructions to perform the operations described with respect to the method 504, the routine 506, the routine 508, the BIOS (510), the OS (512), and / or the driver 514. Examples of the computer-readable or machine-readable storage medium 500 may include any tangible medium capable of storing electronic data, including volatile or non-volatile memory, removable or non-removable memory, erasable or non-erasable memory, writeable or rewritable memory, etc. Examples of computer-executable instructions 502 may include any suitable type of code, such as source code, compiled code, interpreted code, executable code, static code, dynamic code, object-oriented code, visual code, etc.

[0030] 6 illustrates a diagrammatic representation of a machine 600 in the form of a computer system within which a set of instructions may be executed to cause the machine to perform any one or more of the methodologies discussed herein. More specifically, FIG. 6 illustrates a diagrammatic representation of a machine 600 in the example form of a computer system within which instructions 608 (e.g., software, programs, applications, applets, apps, or other executable code) may be executed to cause the machine 600 to perform any one or more of the methodologies discussed herein. For example, instructions 608 may cause the machine 600 to perform method or technique 504 of FIG. 5, routine 506 of FIG. 5, routine 508 of FIG. 5, etc. More generally, instructions 608 may cause the machine 600 to allocate memory during pre-boot operation and to preserve memory for post-boot operation (or use).

[0031] The instructions 608 transform a general, unprogrammed machine 600 into a specific machine 600 that is programmed to perform the functions described and illustrated in a particular manner. In alternative embodiments, machine 600 may operate as a stand-alone device or may be coupled to other machines (e.g., coupled to a network). In a networked deployment, machine 600 may operate in the capacity of a server machine or a client machine in a server-client network environment, or as a peer machine in a peer-to-peer (or distributed) network environment. Machine 600 may include, but is not limited to, a server computer, a client computer, a personal computer (PC), a tablet computer, a laptop computer, a netbook, a set-top box (STB), a PDA, an entertainment media system, a mobile phone, a smartphone, a mobile device, a wearable device (e.g., a smart watch), a smart home device (e.g., a smart appliance), another smart device, a web appliance, a network router, a network switch, a network bridge, or any machine capable of sequentially or otherwise executing instructions 608 that specify actions to be performed by machine 600. Furthermore, although only a single machine 600 is shown, the term "machine" is intended to include a collection of machines 600 that individually or jointly execute instructions 608 to perform any one or more of the methodologies discussed herein.

[0032] Machine 600 may include processor 602, memory 604, and I / O components 642, which may be configured to communicate with each other via, for example, bus 644. In an exemplary embodiment, processor 602 (e.g., a central processing unit (CPU), a reduced instruction set computing (RISC) processor, a multiple instruction set computing (CISC) processor, a graphics processing unit (GPU), a digital signal processor (DSP), an ASIC, a radio frequency integrated circuit (RFIC), another processor, or any suitable combination thereof) may include, for example, processor 606 and processor 610, which may execute instructions 608. The term “processor” is intended to include multi-core processors, which may include two or more independent processors (sometimes referred to as “cores”) that can execute instructions simultaneously. While FIG. 6 shows multiple processors 602, machine 600 may include a single processor with a single core, a single processor with multiple cores (e.g., a multi-core processor), multiple processors with a single core, multiple processors with multiple cores, or any combination thereof.

[0033] Memory 604 may include a main memory 612, a static memory 614, and a storage device 616, all of which are accessible to processor 602, for example, via bus 644. Main memory 604, static memory 614, and storage device 616 store instructions 608 that embody any one or more of the methodologies or functions described herein. Additionally, instructions 608 may reside, completely or partially, within main memory 612, static memory 614, a machine-readable medium 618 in storage device 616, within at least one of processors 602 (e.g., within a processor's cache memory), or some suitable combination thereof during their execution by machine 600.

[0034] I / O components 642 can include a wide variety of components for receiving input, providing output, generating output, sending information, exchanging information, capturing measurements, etc. The specific I / O components 642 included in a particular machine will depend on the type of machine. For example, a portable machine such as a cell phone will likely include a touch input device or other input mechanism, while a headless server machine will likely not include such a touch input device. It should be understood that I / O components 642 may include many other components not shown in FIG. 6 . I / O components 642 are grouped according to functionality solely to simplify the following discussion, but this grouping is by no means limiting. In various exemplary embodiments, I / O components 642 may include output components 628 and input components 630. Output components 628 may include visual components (e.g., a display device such as a plasma display panel (PDP), a light-emitting diode (LED) display, a liquid crystal display (LCD), a projector, or a cathode ray tube (CRT)), audio components (e.g., speakers), haptic components (e.g., vibration motors, resistive mechanisms), other signal generators, etc. Input components 630 may include alphanumeric input components (e.g., a keyboard, a touchscreen configured to receive alphanumeric input, a photo-optical keyboard, or other alphanumeric input component), point-based input components (e.g., a mouse, touchpad, trackball, joystick, motion sensor, or other pointing device), tactile input components (e.g., a physical button, a touchscreen that provides the position and / or force of a touch or touch gesture, or other tactile input component), audio input components (e.g., a microphone), etc.

[0035] In further exemplary embodiments, I / O components 642 may include biometric components 632, motion components 634, environmental components 636, or position components 638, among a wide variety of other components. For example, biometric components 632 may include components for detecting facial expressions (e.g., hand expressions, facial expressions, vocal expressions, body gestures, or eye tracking), measuring biosignals (e.g., blood pressure, heart rate, body temperature, sweat, or brain waves), person identification (e.g., voice identification, retinal identification, face identification, fingerprint identification, or brain wave-based identification), etc. Motion components 634 may include acceleration sensor components (e.g., accelerometers), gravity sensor components, rotation sensor components (e.g., gyroscopes), etc. The environmental components 636 may include, for example, an illuminance sensor component (e.g., a photometer), a temperature sensor component (e.g., one or more thermometers that detect ambient temperature), a humidity sensor component, a pressure sensor component (e.g., a barometer), an acoustic sensor component (e.g., one or more microphones that detect background noise), a proximity sensor component (e.g., an infrared sensor that detects nearby objects), a gas sensor (e.g., a gas detection sensor that detects concentrations of hazardous gases for safety purposes or measures pollutants in the air), or other components that can provide indications, measurements, or signals corresponding to the surrounding physical environment. The location components 638 may include a location sensor component (e.g., a GPS receiver component), an altitude sensor component (e.g., an altimeter or barometer that detects air pressure from which altitude can be derived), an orientation sensor component (e.g., a magnetometer), etc.

[0036] Communication can be performed using a wide variety of technologies. I / O component 642 can include a communication component 640 operable to couple machine 600 to network 620 or device 622 via coupling 624 and coupling 626, respectively. For example, communication component 640 can include a network interface component or other suitable device for interfacing with network 620. In further examples, communication component 640 can include a wired communication component, a wireless communication component, a cellular communication component, a near field communication (NFC) component, a Bluetooth® component (e.g., Bluetooth® Low Energy), a Wi-Fi® component, and other communication components for providing communication via other modalities. Device 622 can be another machine or a wide variety of peripheral devices (e.g., a peripheral device coupled via USB).

[0037] Further, the communications component 640 can include a component that detects an identifier or is operable to detect an identifier. For example, the communications component 640 can include a radio frequency identification (RFID) tag reading component, an NFC smart tag detection component, an optical reading component (e.g., an optical sensor that detects one-dimensional barcodes such as Universal Product Code (UPC) barcodes, multidimensional barcodes such as Quick Response (QR) Codes, Aztec Codes, Data Matrix, DataGlyph, MaxiCode, PDF417, Ultra Code, UCC RSS-2D barcodes, and other optical codes), or an acoustic detection component (e.g., a microphone for identifying tagged audio signals). Additionally, various information can be derived using the communications component 640, such as location information using Internet Protocol (IP) geolocation, location information using Wi-Fi signal triangulation, and location information using detection of NFC beacon signals that may indicate a particular location.

[0038] Various memories (i.e., memory 604, main memory 612, static memory 614, and / or memory of processor 602) and / or storage device 616 can store one or more sets of instructions and data structures (e.g., software) embodied in or utilized by any one or more of the methodologies or functions described herein. These instructions (e.g., instructions 608), when executed by processor 602, cause various operations to implement the disclosed embodiments.

[0039] As used herein, the terms “machine storage medium,” “device storage medium,” and “computer storage medium” mean the same thing and may be used interchangeably in this disclosure. These terms refer to single or multiple storage devices and / or media (e.g., centralized or distributed databases and / or associated caches and servers) that store executable instructions and / or data. Accordingly, the terms are intended to include, but are not limited to, solid-state memory, optical, and magnetic media, including memory internal or external to a processor. Specific examples of machine storage media, computer storage media, and / or device storage media include, for example, semiconductor memory devices such as erasable programmable read-only memories (EPROMs), electrically erasable programmable read-only memories (EEPROMs), FPGAs, flash memory devices, and the like; magnetic disks such as internal hard disks and removable disks; magneto-optical disks; and CD-ROM and DVD-ROM disks. The terms “machine storage medium,” “computer storage medium,” and “device storage medium” specifically exclude carrier waves, modulated data signals, and other such media, at least some of which are covered by the term “signal media” below.

[0040] In various exemplary embodiments, one or more portions of network 620 may be an ad-hoc network, an intranet, an extranet, a VPN, a LAN, a WLAN, a WAN, a WWAN, a MAN, the Internet, a portion of the Internet, a portion of the PSTN, a plain old telephone service (POTS) network, a cellular network, a wireless network, a Wi-Fi network, another type of network, or a combination of two or more such networks. For example, network 620 or portions of network 620 may include a wireless or cellular network, and coupling 624 may be a code division multiple access (CDMA) connection, a Global System for Mobile Communications (GSM) connection, or another type of cellular or wireless coupling. In this example, coupling 624 may implement any of a variety of types of data transfer technologies, such as single-carrier radio transmission technology (1xRTT), evolutionary data optimization (EVDO) technology, general packet radio service (GPRS) technology, enhanced data rates for GSM evolution (EDGE) technology, 3rd Generation Partnership Project (3GPP) including 3G, fourth generation wireless (4G) networks, universal mobile telecommunications system (UMTS), high speed packet access (HSPA), worldwide interoperable microwave access (WiMAX), long term evolution (LTE) standards, others defined by various standards setting organizations, other long-range protocols, or other data transfer technologies.

[0041] The instructions 608 may be transmitted or received over the network 620 via a network interface device (e.g., a network interface component included in the communications component 640) and using a transmission medium utilizing any of several well-known transfer protocols (e.g., Hypertext Transfer Protocol (HTTP)). Similarly, the instructions 608 may be transmitted or received using a transmission medium via a coupling 626 (e.g., a peer-to-peer coupling) to the device 622. The terms “transmission medium” and “signal medium” mean the same thing and may be used interchangeably in this disclosure. The terms “transmission medium” and “signal medium” are intended to include any intangible medium capable of storing, encoding, or carrying the instructions 608 for execution by the machine 600, including digital or analog communications signals or other intangible media for facilitating the communication of such software. Accordingly, the terms “transmission medium” and “signal medium” are intended to include all forms of modulated data signals, carrier waves, and the like. The term “modulated data signal” means a signal that has one or more characteristics set or changed in such a manner as to encode information in the signal.

[0042] Terms used in this specification should be governed by their ordinary meaning in the relevant art or by their usage in context, unless an explicit definition is provided, in which case that meaning will control.

[0043] References herein to "one embodiment" or "an embodiment" may, but do not necessarily, refer to the same embodiment. Unless the context clearly requires otherwise, words such as "comprise" and "comprising" throughout this specification and claims shall be construed in an inclusive sense, i.e., "including but not limited to," as opposed to an exclusive or exhaustive sense. The use of the singular or plural also includes the plural or singular, respectively, unless expressly limited to the singular or plural. In addition, the words "herein," "above," "below," and words of similar import, when used in this application, refer to this application as a whole and not to any particular portion of this application. When the word "or" is used in the claims in connection with a list of two or more items, the word encompasses all interpretations of the word as any of the items in the list, all of the items in the list, and any combination of the items in the list, unless expressly limited to one or the other. Any terms not expressly defined herein have their conventional meanings as commonly understood by those of ordinary skill in the relevant art. [Explanation of symbols]

[0044] 102 Endoscopic probe 104 Imager 106 Laser Fiber 108 Controller 110 Laser Light Source 112 Display device 114 User Input

Claims

1. An endoscopic surgery device, A laser light source; a laser fiber optically coupled to the laser light source, the laser fiber comprising an optical core and a fiber tip, the optical core including a plurality of grating patterns forming a diffraction grating; an endoscopic probe containing an imager and the fiber tip; An apparatus comprising:

2. The apparatus of claim 1 , wherein the laser light source is a high-energy pulsed laser.

3. The device of claim 1 or 2, wherein the plurality of grating patterns are equally spaced along the length of the optical core.

4. 4. The device of claim 3, wherein the grating patterns are spaced apart along the optical core at intervals of between 1.9 microns and 35 microns.

5. 5. The apparatus of claim 4, wherein the spacing is between 7.5 microns and 7.9 microns.

6. The device of any preceding claim, wherein the optical core has a diameter between 200 microns and 550 microns.

7. The device of any one of claims 1 to 6, wherein each of the plurality of grating patterns is inscribed on the optical core by mechanical, chemical, or laser etching.

8. The device of any one of claims 1 to 6, wherein each of the plurality of grating patterns is inserted into the optical core by implantation or material compositing.

9. The device according to any one of claims 1 to 8, wherein the diffraction grating is disposed within the fiber tip.

10. The device according to any one of claims 1 to 9, wherein the distal end face of the fiber tip is engraved with one of the plurality of grating patterns.

11. The apparatus of any preceding claim, further comprising a display configured to display image data received from the imager while the endoscopic probe is deployed.

12. While the endoscopic probe is deployed, receiving image data from the imager; activating the laser light source to emit laser energy through the laser fiber; 12. The apparatus of claim 1, further comprising a controller configured to:

13. 13. The apparatus of claim 12, wherein the laser energy is distributed over an area greater than 10 times the diameter of the laser tip.

14. 13. The apparatus of claim 12, wherein the laser energy is distributed over a region comprising multiple regions of high intensity separated by regions of lower intensity.

15. 1. A method of endoscopic lithotripsy, comprising: Deploying an endoscopic surgery device according to any one of claims 1 to 14 into a patient's urinary tract; While the endoscopic surgery device is deployed, emitting laser energy from the laser source through the laser fiber to ablate a portion of the kidney stone; A method comprising:

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