Surgical laser system and method of operation thereof - Patents.com

Abstract

To prevent endoscope damage and patient surgical delays.SOLUTION: A surgical laser system comprises: an endoscope 20 including a working channel; an optical detector 30 configured to detect an amount of light reflected from a target in response to light directed to the target from a distal end of the endoscope 20; a laser fiber 22 extending through the working channel of the endoscope 20, the laser fiber 22 configured to transmit laser energy and the optically detected light reflected from the target; and a feedback analyzer 50 configured to, based at least in part on the optically detected amount of light, adjust laser emission through the laser fiber 22.SELECTED DRAWING: Figure 1

Description

[Technical field]

[0001] (Priority Claim) This application claims the benefit of priority under 35 U.S.C. § 119(e) to U.S. Provisional Patent Application No. 62 / 882,837, filed August 5, 2019, U.S. Provisional Patent Application No. 62 / 893,913, filed August 30, 2019, and U.S. Provisional Patent Application No. 63 / 027,079, filed May 19, 2020, which are incorporated by reference in their entireties.

[0002] This document relates generally to surgical lasers, and more particularly to a system and method for determining the advancement of a surgical laser fiber within an endoscope and providing coordinated feedback to the surgical laser. [Background technology]

[0003] Laser or plasma systems have been used to deliver surgical laser energy to various target treatment areas, such as soft or hard tissue. Examples of laser treatments include ablation, coagulation, vaporization, fragmentation, etc. In lithotripsy applications, lasers are used to break up stone structures in the kidney, gallbladder, ureter, and other stone-forming areas, or to ablate large stones into smaller fragments.

[0004] Endoscopes are typically used to provide access to internal locations of a subject and provide visual access to a physician. Endoscopes are typically inserted into a patient's body to deliver light to a target (e.g., a target anatomical structure or object) to be inspected and collect light reflected from the object. The reflected light provides information about the object being inspected and can be used to create an image of the object. Some endoscopes include a working channel through which an operator can perform suction, pass instruments such as brushes, biopsy needles, or forceps, or perform minimally invasive surgery to remove unwanted tissue or foreign objects from the patient's body. Summary of the Invention [Means for solving the problem]

[0005] According to one aspect of the present invention, a surgical laser system includes: a laser device emitting a surgical laser; Working Channel and a light source for generating illumination light for illuminating the target. Endoscope and ,before a laser fiber extending into the working channel of the endoscope, The surgical laser emitted from the laser device. Leh The , reflected from the target The above lighting light Transmits reflected light A laser fiber; a photodetector that detects the reflected light that is reflected from the target and returns through the laser fiber; A controller, comparing a reflectance of the reflected light relative to the illumination light directed from the light source to the target with a threshold value indicative of whether the distal end of the laser fiber extends beyond the distal end of the endoscope; and upon determining that the distal end of the laser fiber does not extend beyond the distal end of the endoscope, Through the laser fiber Prevent the surgical laser from being irradiated. Generates control signals and output to the laser device. and a controller configured to:

[0006] According to another aspect of the present invention, The controller executes The method of operation of the surgical laser system includes: The controller includes a working channel. Endoscopy A light source provided in from The generated illumination light target and the controller: reflected from the target, Return through a laser fiber that extends into the working channel of the endoscope. The above illumination Light Using a photodetector detection the controller compares a reflectance of the reflected light with respect to the illumination light directed from the light source to the target with a threshold value indicating whether the distal end of the laser fiber extends beyond the distal end of the endoscope, and when it is determined that the distal end of the laser fiber does not extend beyond the distal end of the endoscope, generates and outputs a control signal to a laser device to prevent irradiation of a surgical laser through the laser fiber; Includes.

[0007] This Summary is a summary of the disclosure of a portion of the application and is not intended to be an exclusive or exhaustive treatment of the subject matter. Further details regarding the subject matter are set forth in the detailed description and appended claims. Other aspects of the present disclosure will be apparent to those skilled in the art upon reading the following detailed description and viewing the drawings that form a part thereof, each of which should not be construed in a limiting sense. The scope of the present disclosure is defined by the appended claims and their legal equivalents.

[0008] Various embodiments are illustrated by way of example in the accompanying drawing figures. Such embodiments are illustrative and are not intended to be exhaustive or exclusive embodiments of the present subject matter. [Brief description of the drawings]

[0009] [Figure 1]1 is a schematic side view of a system using an endoscope and a surgical laser. [Diagram 2] FIG. 2 is a schematic end view of the system of FIG. 1. [Diagram 3] 1 is a graphical representation of the spectra of light sources used in various endoscopes. [Figure 4] 1 is a graphical representation of the optical absorption spectra of water, hemoglobin, oxyhemoglobin, and melanin. [Diagram 5] 1 is a graphical representation of the light source spectrum detected through a surgical laser fiber at different distances from the tip of an endoscope. [Figure 6] FIG. 2 is a schematic side view of a portion of the endoscope of the system of FIG. 1, showing the distance of the surgical laser fiber from the tip of the endoscope. [Figure 7] 2 is a graphical representation of data showing the detected reflectance of a surgical laser fiber of the system of FIG. 1. [Figure 8A] 1 is a test setup showing that light can be deflected into various solutions. [Figure 8B] 1 is a test setup showing that light can be deflected into various solutions. [Figure 9] 1 is a graphical representation of data showing reflectance in a simulation of a potential clinical environment. [Figure 10] FIG. 1 illustrates a transparent liner over the lumen of the working channel of the endoscope. [Figure 11] 1 illustrates an example of an endoscope that includes a reflective coating on a transparent liner of the working channel of the endoscope. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0010] Damage to an endoscope during a surgical procedure can result in costly repairs to the endoscope, delays to the surgical procedure, and / or damage to other equipment. Currently, in laser endoscopy, there is no way to protect the inside workings of the endoscope from accidental laser irradiation while the laser fiber is inside the working channel of the scope. Accidental laser irradiation can cause back reflections that can damage the laser system or physical damage to the endoscope, which can disrupt the equipment's ability to navigate by the user or interfere with visualization of the target area on the patient.

[0011] The ability to detect when a laser fiber has advanced outside of an endoscope can help prevent damage to equipment and surgical delays for the patient. This detection can be accomplished with the equipment used to perform endoscopy configured as described herein.

[0012] The embodiments described herein address the problem of accidental firing of a surgical laser system inside an endoscope, using a method to identify when a surgical laser fiber transitions from inside the working channel of the endoscope to outside the endoscope. The method uses a light source(s) associated with an endoscopic instrument and a surgical laser fiber that is used to treat a patient. An optical feedback system is incorporated into the surgical laser system to limit laser illumination through the laser fiber while the laser fiber is still inside the endoscope. This interlocking functionality of the system can work with a wide range of endoscopes and laser fiber sizes.

[0013] The embodiments described herein also protect against the fiber breaking inside the endoscope: the surgical laser fiber exits the endoscope, but even if the fiber breaks inside the endoscope, the system detects the break as a new "tip" of the surgical laser fiber, recognizes that the new tip (now the end) is still inside the endoscope, and prevents further laser firing inside the endoscope.

[0014] The method may be performed by measuring an optically detected reflectance returning through the surgical laser fiber. The reflected light originates from a light source used in endoscopy. The light source may be selected from a wide variety of light sources. A lack of optical detection (or optical detection below a predetermined value) of the reflected signal returning through the surgical laser fiber results in a determination that the surgical laser fiber is within the working channel of the endoscope. Optical detection of a reflected signal above a predetermined value returning through the surgical laser fiber results in a determination that the surgical laser fiber has advanced sufficiently through the working channel and exited the endoscope. In this manner, the location of the distal end of the surgical laser fiber may be confirmed prior to emitting laser energy.

[0015] With reference to FIG. 1, a system using an endoscope and a surgical laser for use in surgical endoscopy is generally indicated at 10, hereafter referred to as "system 10." System 10 includes an endoscope 20 operably coupled to a laser 40 and a feedback analyzer 50. Endoscope 20 includes a surgical laser fiber 22, at least one light source 24, and a light detector 30 (which may include a camera). Surgical laser fiber 22, light source 24, and light detector 30 are disposed within a sheath 34 (shown in FIG. 2). Laser 40 is operably coupled to surgical laser fiber 22 and feedback analyzer 50, both of which may be remote from endoscope 20. Laser 40 may include a laser interlock 42. Feedback analyzer 50 is operably coupled to laser interlock 42 and may include a processor 54 and a memory 56 having program code associated therewith. In some embodiments, system 10 can provide input data to another system, such as image processor 44, so that a monitor or another type of display can display information to a user, the displayed information relating to the illumination capabilities of laser 40.

[0016] 2, the sheath 34 is tubular and has a generally circular cross-section that defines a working channel 36. The surgical laser fiber 22, light sources 24 (two shown), and photodetector 30 are suitably disposed within the working channel 36. Although these components are shown spaced apart from one another, it should be understood that such components may be suitably closely packed within the working channel 36, either in contact with one another or with minimal space between them.

[0017] Regarding the laser 40, such fiber integrated laser systems can be used in endoscopy due to their ability to pass laser energy through a flexible endoscope to effectively treat hard and soft tissues. These laser systems generate laser output beams in a wide wavelength range (200 nanometers (nm) to 10,000 nm) from ultraviolet (UV) to infrared (IR). Some fiber integrated lasers generate output in wavelength ranges that are highly absorbed by soft or hard tissues, such as 1900 nm to 3000 nm for water absorption and 400 nm to 520 nm for oxyhemoglobin and / or deoxyhemoglobin absorption. Table 1 below summarizes a list of IR lasers that emit in the high water absorption range (1900 nm to 3000 nm). [Table 1]

[0018] Some fiber integrated laser systems generate laser light output in wavelength ranges that are minimally absorbed by target soft or hard tissue. This type of laser provides effective tissue coagulation due to a penetration depth similar to the diameter of the capillary tube, e.g., about 5 micrometers (μm) to about 10 μm. Exemplary laser sources for the laser applicable to this embodiment include, but are not limited to, a) UV-VIS emitting InXGa1-XN semiconductor lasers (e.g., GaN with emission from 515 nm to 520 nm, and InXGa1-XN with emission from 370 nm to 493 nm), b) GaXAl1-XAs with emission from 750 nm to 850 nm, and c) InXGa1-XA with emission from 904 nm to 1065 nm.

[0019] An endoscopic light source (such as light source 24), such as those used in endoscopy, may be used in conjunction with a surgical laser system (such as laser 40) and fiber (such as surgical laser fiber 22) to provide the laser interlock 42 to the system 10. The endoscopic light source may be any light source that can provide suitable illumination and be compatible with a suitable endoscope. FIG. 3 shows at 300 the spectra of three different light sources, a UV-VIS light source 310, an endoscopic light source 320, and a VIS light source 330, any of which may be used as the light source 24 and used to collect preliminary data with various endoscopes. Such light sources 24 are typically shown as procedural white light and may also span the UV and IR spectrum. This extended wavelength range of the light source 24 may be particularly useful for the feedback analyzer 50 of the system 10.

[0020] The light sources shown in Table 2 are additional light sources and wavelengths that may be used in an endoscope light source to promote accurate reflectance in the optimal range. [Table 2]

[0021] 1 and 2, in one exemplary embodiment of the system 10, light from the light source 24 can be transmitted through an endoscope 20 (or any applicable endoscope) that can be used to treat a patient so long as the endoscope 20 has the ability to direct the light from the light source 24 to a target area. The endoscope 20 can be rigid, semi-rigid, or flexible. Endoscopes 20 that can be used in laser surgical procedures include ureteroscopes, cystoscopes, nephroscopes, and resectoscopes. The system 10 described herein is intended to be used with any combination of endoscope types and flexibilities, as well as any other endoscopes not mentioned that are designed to accept a surgical laser fiber for patient care.

[0022] Surgical procedures performed with system 10 are carried out via a surgical laser fiber 22. The surgical laser fiber 22 may have a core diameter ranging from about 50 μm to about 1000 μm. The material from which the surgical laser fiber 22 is constructed is compatible with the wavelengths used to deliver the laser energy, but the transmission of the wavelengths of interest incident from the light source 24 and reflected from the target area should also be taken into consideration.

[0023] The photodetector 30 reads the reflected light that travels through the surgical laser fiber 22 to the target area. The light source signal from the light source 24 and reflected from the target area to the photodetector 30 is also collected and transmitted to the feedback analyzer 50 along with the reflected light from the surgical laser fiber 22.

[0024] The photodetector 30 may be a dedicated photodetector tuned to the wavelengths of interest of the system 10 or may be a spectroscopy system integrated into the system 10. Spectroscopy / spectrometry techniques are used in physics and chemistry to identify various materials through the spectra reflected, transmitted, emitted, or absorbed by such materials and may be used in the system 10. Optical spectroscopy is a powerful method used for simple and rapid analysis of organic and inorganic materials, with the following advantages: a) easy integration with fiber laser delivery systems, b) non-destructive method of chemical composition analysis of materials, c) allowing the material composition to be detected in real time, and d) applicability to the analysis of various types of materials (e.g., hard and soft tissues, stones, etc.). Other advantages may also be present.

[0025] The following spectroscopy techniques may be used alone or in combination to analyze the chemical composition of tissue and generate spectroscopy feedback.

[0026] UV-VIS reflectance spectroscopy. This method gathers information from light reflected by an object, similar to that obtained by the eye or from color images created by high resolution cameras, but more quantitative and objective. Reflectance spectroscopy provides information about materials, since the reflection and absorption of light depends on their chemical composition and surface properties. Using this technique, it is also possible to obtain specific information about both the surface and volume properties of a sample. Reflectance spectroscopy is a valuable technique for recognizing the composition of hard or soft tissues.

[0027] Fluorescence spectroscopy. This is a type of electromagnetic spectroscopy that analyzes fluorescence from a sample. It involves using a light beam, usually UV, to excite material compounds, which emit light, usually in the visible or IR range. This method is applicable to the analysis of some organic components, e.g. hard and soft tissues.

[0028] Fourier Transform Infrared Spectroscopy (FTIR). This is a method used for easy and fast material analysis. This technique has relatively good spatial resolution and provides information about the chemical composition of materials.

[0029] Raman spectroscopy. Raman chemical analysis shows good accuracy in identifying hard and soft tissue components. As a high spatial resolution technique, it is also useful to determine the distribution of components within a target.

[0030] In some embodiments, one or more types of spectroscopy may be used within the endoscope 20 to identify the presence of reflected light. The endoscopic light source signal reflected from the target is rapidly detected and transmitted via the surgical laser fiber to a spectrometer. Alternatively, the detector may be a simple optical module dedicated to detecting the endoscopic wavelength of interest.

[0031] Still referring to FIGS. 1 and 2 , the feedback analyzer 50 uses the light returned through the surgical laser fiber 22 as feedback to determine whether the distal end of the surgical laser fiber 22 has advanced beyond the distal end of the working channel 36 of the endoscope 20. In some embodiments, the feedback analyzer 50 may determine that the surgical laser fiber 22 is fully disposed within the working channel 36 and may indicate this to the user, for example, via a red light (or similar signal). Based on the feedback, the feedback analyzer 50 may interface with the laser interlock 42 to prevent the laser 40 from firing, even when in illumination mode and the user intentionally attempts to fire the laser. The laser interlock 42 may also prevent unintentional firing of the laser 40. The laser 40 remains restricted from firing based on the reflectivity of the light source 24 returned through the surgical laser fiber 22 until the surgical laser fiber 22 protrudes from the sheath 34 and leaves the endoscope 20.

[0032] Laser radiation can be highly absorbed by soft or hard tissues, stones, etc. Referring now to FIG. 4, optical absorption spectra measured in different media over a range of wavelengths are generally indicated at 400. Illustrated therein are spectra of water 410A-410C (at concentrations of 75%, 100%, and 4%, respectively), hemoglobin (Hb) 420, oxyhemoglobin (HbO 2 ) 430, and melanin 440A-440D (volume fractions of melanosomes are 2%, 13%, 30%, and 100%, respectively). The water absorption wavelength is in the range of 1900 nm to 3000 nm. The wavelength of oxyhemoglobin and / or oxyhemoglobin is in the range of 400 nm to 520 nm.

[0033] 1, 4, 5, and 6 show how the endoscope 20 can be used with the system 10. FIG. 4 shows the absorption of laser technology in different media. Many surgical lasers are highly absorbed by water or hemoglobin, but inside the scope, the medium that absorbs water is limited, which can cause the inside of the endoscope to be damaged by the laser energy. FIG. 1 shows the basic setup of the system 10 to detect reflectance from the light source 24. FIG. 5 shows at 500 the spectral output 510 of reflected light from the light source 24 that is detected through the surgical laser fiber 22 as it travels (forward or backward) through the working channel 36 of the endoscope 20. FIG. 6 shows the basic setup as the surgical laser fiber 22 passes through the working channel 36 and leaves the distal end of the endoscope 20.

[0034] Referring now to FIG. 7, feasibility data for identifying when the surgical laser fiber 22 exits the working channel 36 is generally designated 700. Data was collected by advancing a surgical laser fiber 22 having a 200 μm core into a flexible ureteroscope with a compatible light source 24 serving as the optical signal source. This feasibility data 700 shows a significant increase 710 in the detected signal 720 as the surgical laser fiber 22 moves to the end of the working channel 36, making it possible to distinguish between the surgical laser fiber 22 being retracted into the working channel 36 and being advanced beyond the working channel 36. Using this detection technique, data from the optical detector 30 can be processed in the feedback analyzer 50 to prevent accidental laser firing.

[0035] 8A and 8B show a simulation setup 800 showing light from a surgical laser fiber 22 being deflected into a container containing phosphate buffered saline and calcium oxalate hydrate powder, simulating compositions that may be experienced during a clinical procedure. FIG. 8A shows a test setup where light is deflected into a phosphate buffered saline solution 810 (PBS 810), and FIG. 8B shows a test setup where light is deflected into PBS containing calcium oxalate hydrate 820. The setup in FIG. 8B includes a cloudy white calcium oxalate hydrate solution 820 (shown in shading) in contrast to the clear, transparent phosphate buffer solution 810. The calcium oxalate hydrate solution 820 may promote additional reflection and light scattering.

[0036] 9, at 900, the data points shown show the reflectance when light from the endoscope 20 is deflected into PBS (open circles) and PBS calcium oxalate solution (PBS with COM, filled circles). At 910, while this data shows higher detection of the source light signal, the surgical laser fiber 22 is within the working channel 36 of the endoscope 20 and the data trend is the same as when tested in air. An algorithm implemented in the feedback analyzer 50 can account for the trend in the data and determine when the surgical laser fiber 22 protrudes from the distal end of the endoscope 20.

[0037] Damage to the endoscope associated with accidental laser firing from within the working channel 36 can result from the transparent working channel liner of the endoscope 20. FIG. 10 is a diagram 1000 showing a transparent liner 1010 on the lumen of the working channel 36. During a surgical procedure, accidental laser firing while the laser fiber 22 is inside the working channel 36 can cause laser energy 1001 to scatter off the sides of the transparent liner 1010, which can damage internal components of the endoscope 20, such as those adjacent the transparent liner 1010 and those adjacent the distal end of the endoscope 20.

[0038] This document discusses solutions to prevent or reduce damage from accidental laser firing from within the working channel 36, according to various examples. FIG. 11 shows an example of an endoscope 1100 that includes a reflective coating 1020 on a transparent liner 1010 of the working channel 36. The reflective coating 1020 may include a reflective material, such as aluminum, silver, gold, or copper, in the wavelength range of the laser radiation. In some examples, the reflective surface may include a reflective coating, which may be one or more of barium sulfate, magnesium oxide, polytetrafluoroethylene (PTFE), a dielectric highly reflective (HR) coating, a dichroic mirror, or a reflective photonic structure. The reflective coating 1002 may be applied using vacuum metallization / deposition, spray application, vapor deposition, conductive painting, or flame spraying, among other techniques.

[0039] As shown in FIG. 11, laser energy 1002 emitted from the laser fiber 22 may be substantially reflected by the reflective coating 1020 when the laser fiber 22 is inside the working channel 36. The laser energy 1002 bounces off the walls of the liner 1010 and travels to and from the distal end of the working channel 36. In this manner, the amount of damage to various components of the endoscope caused by laser dispersion may be substantially reduced. Endoscopes with reflective coatings on the working channel liner described herein may advantageously minimize accidental damage to the scope during a procedure, reduce procedure and repair costs for reusable scopes, and reduce the amount of time that a reusable scope is out of use. In some instances, a reflective coating may be applied to the liner of a disposable scope, thereby minimizing accidental damage that may occur to multiple scopes in one procedure.

[0040] Below, further description of various non-limiting exemplary embodiments is provided. The exemplary embodiments described below may be implemented in conjunction with one or more other aspects or exemplary embodiments. That is, the exemplary embodiments of the present invention, such as those described below, may be implemented, performed, or utilized in any combination (e.g., any combination that is suitable, operable, and / or practicable), and are not limited to only those combinations described herein and / or included in the appended claims.

[0041] Example 1 is a method for feedback control of a surgical laser system, the method including directing light from a distal end of an endoscope toward a target, optically detecting an amount of light reflected from the target, transmitting the optically detected amount of light through a laser fiber extending through a working channel of the endoscope, determining a position of a distal end of the laser fiber relative to the distal end of the endoscope based on the amount of light optically detected, and generating a control signal to a surgical laser system to adjust laser illumination through the laser fiber.

[0042] In Example 2, the subject matter of Example 1 optionally includes where determining a position of the distal end of the laser fiber relative to the distal end of the endoscope includes determining that the distal end of the laser fiber extends beyond the distal end of the endoscope if the amount of optically detected light is greater than a predetermined value, and determining that the distal end of the laser fiber does not extend beyond the distal end of the endoscope if the amount of optically detected light is less than a predetermined value, and generating a control signal to prevent the laser from emitting laser energy through the laser fiber.

[0043] In Example 3, the subject matter of Example 2 optionally includes providing a user with a first indicator of a distal end of the laser fiber that extends beyond the distal end of the endoscope and a second indicator of a distal end of the laser fiber that does not extend beyond the distal end of the endoscope.

[0044] In Example 4, the subject matter of any one or more of Examples 1-3 optionally includes, where determining the position of the distal end of the laser fiber relative to the distal end of the endoscope is based on an increase or rate of increase in the amount of light detected over time.

[0045] In Example 5, the subject matter of any one or more of Examples 1-4 optionally includes, where generating a control signal to the surgical laser system includes generating a control signal to enable the surgical laser system to emit laser energy through the laser fiber when the amount of optically detected light is greater than a predetermined value, and generating a control signal to prevent the surgical laser system from emitting laser energy through the laser fiber when the amount of optically detected light is less than a predetermined value.

[0046] In Example 6, the subject matter of Example 5 optionally includes detecting a wavelength of the directional light using a photodetector, where generating a control signal to the surgical laser system to emit laser energy is further based on the detected wavelength of the directional light.

[0047] In Example 7, the subject matter of Example 6 optionally includes identifying the target as one of a plurality of target types using a feedback analyzer based on light reflected from the target, and wherein generating a control signal to the surgical laser system to adjust the laser illumination is further based on the identification of the target.

[0048] In example 8, the subject matter of example 7 optionally includes determining one or more spectral characteristics of light reflected from the target using a spectroscopic system, and identifying the target based on the one or more spectral characteristics.

[0049] In Example 9, the subject matter of Example 8 optionally includes, wherein determining the one or more spectroscopic properties includes using at least one of UV-VIS reflectance spectroscopy, fluorescence spectroscopy, Fourier transform infrared spectroscopy, or Raman spectroscopy.

[0050] Example 10 is a laser feedback control system that includes an endoscope including an optical detector configured to detect an amount of light reflected from a target in response to illumination of the target from a distal end of the endoscope, a laser fiber extending through a working channel of the endoscope and configured to transmit the detected amount of light reflected from the target, and a controller configured to determine a position of a distal end of the laser fiber relative to the distal end of the endoscope based on the amount of optically detected light and generate a control signal to a surgical laser system to adjust laser illumination through the laser fiber.

[0051] In Example 11, the subject matter of Example 10 optionally includes, wherein the controller being configured to determine a position of the distal end of the laser fiber includes determining that the distal end of the laser fiber extends beyond the distal end of the endoscope if the amount of optically detected light is greater than a predetermined value, and determining that the distal end of the laser fiber does not extend beyond the distal end of the endoscope if the amount of optically detected light is less than the predetermined value.

[0052] In Example 12, the subject matter of any one or more of Examples 10-11 optionally includes a laser interlock coupled to the surgical laser system, the laser interlock configured to, in accordance with the control signal, enable the surgical laser system to emit laser energy through the laser fiber when the amount of optically detected light is greater than a predetermined value, and to prevent the surgical laser system from emitting laser energy through the laser fiber when the amount of optically detected light is less than the predetermined value.

[0053] In Example 13, the subject matter of any one or more of Examples 10-12 optionally includes a spectroscopic system configured to determine one or more spectroscopic characteristics from light reflected from the target, and a feedback analyzer configured to identify the target as one of a plurality of target types based on the one or more spectroscopic characteristics, wherein the controller generates a control signal to the surgical laser system to adjust the laser illumination further based on the identification of the target.

[0054] In Example 14, the subject matter of Example 13 optionally includes, wherein the controller is configured to determine a position of the distal end of the laser fiber relative to the distal end of the endoscope based on an increase or rate of increase in the amount of light detected over time.

[0055] Example 15 is an apparatus including at least one processor and at least one non-transitory memory including computer program code, the at least one non-transitory memory and the computer program code configured, using the at least one processor, to cause the apparatus to at least: direct light from a distal end of an endoscope to a target; optically detect an amount of directional light reflected from the target; transmit the optically detected amount of light through a laser fiber extending through a working channel of the endoscope; determine a position of the distal end of the laser fiber relative to the distal end of the endoscope based on the amount of optically detected light; and generate control signals to a surgical laser system to adjust laser illumination through the laser fiber.

[0056] In Example 16, the subject matter of Example 15 optionally includes at least one non-transitory memory and computer program code configured, using at least one processor, to cause the device to at least determine that the distal end of the laser fiber extends beyond the distal end of the endoscope when the amount of optically detected light is greater than a predetermined value, and to determine that the distal end of the laser fiber does not extend beyond the distal end of the endoscope when the amount of optically detected light is less than a predetermined value, and to generate a control signal to prevent the surgical laser system from emitting laser energy through the laser fiber.

[0057] In Example 17, the subject matter of any one or more of Examples 15 to 16 optionally includes that the at least one non-transitory memory and computer program code are configured to cause the device, using the at least one processor, to determine a position of the distal end of the laser fiber relative to the distal end of the endoscope based on an increase or rate of increase in the amount of light detected over time.

[0058] In Example 18, the subject matter of any one or more of Examples 15 to 17 optionally includes that the at least one non-transitory memory and computer program code are configured, using the at least one processor, to cause the device to at least generate a control signal to enable the surgical laser system to emit laser energy through the laser fiber when the amount of optically detected light is greater than a predetermined value, and to generate a control signal to prevent the surgical laser system from emitting laser energy through the laser fiber when the amount of optically detected light is less than the predetermined value.

[0059] In Example 19, the subject matter of Example 18 optionally includes at least one non-transitory memory and computer program code configured, using at least one processor, to cause the device to at least identify the target as one of a plurality of target types based on light reflected from the target, and generate control signals to the surgical laser system to adjust laser illumination based on the identification of the target.

[0060] In Example 20, the subject matter of Example 19 optionally includes at least one non-transitory memory and computer program code configured, using the at least one processor, to cause the device to at least determine one or more spectral characteristics of light reflected from the target and identify the target as one of a plurality of target types based on the one or more spectral characteristics.

[0061] Additional Notes The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of example, specific embodiments in which the invention may be practiced. These embodiments are also referred to herein as "examples." Such examples may include elements in addition to those shown or described. However, the inventor also contemplates examples in which only those elements shown or described are provided. Furthermore, the inventor also contemplates examples in which any combination or permutation of those elements (or one or more aspects thereof) shown or described is used either in conjunction with a particular example (or one or more aspects thereof) or with another example (or one or more aspects thereof) shown or described herein.

[0062] In this document, the terms "a" or "an" are used to include one or more, as is common in patent documents, regardless of any other examples or the use of "at least one" or "one or more." In this document, the term "or" is used to refer to an inclusive or, unless otherwise indicated, such that "A or B" includes "A but not B," "B but not A," and "A and B." In this document, the terms "including" and "in which" are used as the plain English equivalents of the respective terms "comprising" and "wherein." Also, in the claims that follow, the terms "including" and "comprising" are open-ended, i.e., systems, devices, articles, compositions, formulations, or processes that include elements in addition to those recited after such terms within the scope of the claims are still considered to be within the scope of the claims. Moreover, in the claims that follow, the terms "first," "second," and "third," etc. are used merely as labels and are not intended to impose numerical requirements on their objects.

[0063] The above description is intended to be illustrative, and not limiting. For example, the foregoing examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments may be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to comply with 37 C.FR 1.72(b) to enable the reader to quickly ascertain the nature of the technical disclosure. The Abstract is presented with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be construed as intending that any unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description as an example or embodiment, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations and permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.

[0064] [Note] The following embodiment may be adopted. [1] 1. A method of operating a laser feedback control system executed by a controller, comprising: the controller illuminates a target with light generated from a light source of the endoscope; the controller transmits the reflected light from the target through a laser fiber passing through a working channel of the endoscope; the controller determines a position of the distal end of the laser fiber relative to the distal end of the endoscope based on the reflectance of the light; the controller determines that a distal end of the laser fiber extends beyond the distal end of the endoscope when the reflectance of the light is greater than a predetermined value and generates a control signal to enable the surgical laser system to emit laser energy through the laser fiber; the controller determining that a distal end of the laser fiber does not extend beyond the distal end of the endoscope when the reflectance of the light is less than a predetermined value and generating a control signal that prevents the surgical laser system from emitting laser energy through the laser fiber; A method of operating a laser feedback control system comprising: [2] The method of operating a laser feedback control system described in [1], wherein the controller provides a first indicator of a distal end of the laser fiber that extends beyond the distal end of the endoscope, and a second indicator of a distal end of the laser fiber that does not extend beyond the distal end of the endoscope. [3] A method of operating a laser feedback control system described in [1] or [2], wherein the controller determines the position of the distal end of the laser fiber relative to the distal end of the endoscope based on an increase or rate of increase in the reflectivity of the light detected over time. [4] the controller identifies the target as one of a plurality of target types using one or more spectral characteristics based on the reflected light reflected from the target; generating the control signal to the surgical laser system to adjust laser illumination based on the identification of the target; A method for operating the laser feedback control system described in [1]. [5] The method of operating a laser feedback control system described in [4], wherein the controller uses a spectroscopic system to determine one or more spectral characteristics of the reflected light from the target, and identifies the target based on the one or more spectral characteristics. [6] The controller: UV-VIS reflectance spectroscopy, Fluorescence spectroscopy, Fourier transform infrared spectroscopy, or Raman spectroscopy, A method of operating a laser feedback control system as described in [5], further comprising determining one or more spectroscopic characteristics using at least one of the above. [7] 1. A laser feedback control system comprising: an endoscope including a light source that generates light to illuminate a target; a laser fiber extending through a working channel of the endoscope, the laser fiber configured to transmit a reflection of the light reflected from the target; A controller, a feedback analyzer that determines a position of the distal end of the laser fiber relative to the distal end of the endoscope based on the reflectance of the light; a laser interlock coupled to the feedback analyzer to prevent the surgical laser system from emitting laser energy through the laser fiber; The feedback analyzer if the reflectance of the light is greater than a predetermined value, determining that the distal end of the laser fiber extends beyond the distal end of the endoscope, generating and outputting a control signal to the laser interlock to enable the surgical laser system to emit laser energy through the laser fiber; if the reflectance of the reflected light is less than a predetermined value, determining that the distal end of the laser fiber does not extend beyond the distal end of the endoscope, generating and outputting a control signal to the laser interlock to prevent the surgical laser system from emitting laser energy through the laser fiber; The laser interlock includes: if the control signal from the feedback analyzer is a control signal to enable laser energy to be emitted, then the surgical laser system enables laser energy through the laser fiber; preventing the surgical laser system from emitting laser energy through the laser fiber if the control signal enabling emission of laser energy is a control signal preventing emission of laser energy; 13. The laser feedback control system according to claim 12, [8] the feedback analyzer comprises a spectroscopic system configured to determine one or more spectroscopic characteristics from the reflected light reflected from the target, and configured to identify the target as one of a plurality of target types based on the one or more spectroscopic characteristics; and generate a laser illumination control signal to adjust laser illumination of the surgical laser system based on the identification of the target. adjusting the laser illumination based on the laser illumination control signal; The laser feedback control system according to [7], [9] The laser feedback control system of [7], wherein the feedback analyzer is configured to determine a position of the distal end of the laser fiber relative to the distal end of the endoscope based on an increase or rate of increase in the reflectivity of the light detected over time.

[10] An apparatus comprising: At least one processor; at least one non-transitory memory including computer program code, the at least one non-transitory memory and the computer program code being transmitted to the device using the at least one processor, The target is illuminated with light generated from the endoscope's light source. transmitting the reflected light from the target through a laser fiber extending through a working channel of the endoscope; determining a position of the distal end of the laser fiber relative to the distal end of the endoscope based on the reflectance of the light; determining that a distal end of the laser fiber extends beyond the distal end of the endoscope when the reflectance of the light is greater than a predetermined value and generating a control signal that enables the surgical laser system to emit laser energy through the laser fiber; the device is configured to: prevent the surgical laser system from emitting laser energy through the laser fiber by determining that a distal end of the laser fiber does not extend beyond the distal end of the endoscope if the reflectivity of the light is less than a predetermined value, and to generate a control signal that prevents the surgical laser system from emitting laser energy through the laser fiber.

[11] The apparatus of

[10] , wherein the at least one non-transitory memory and the computer program code are configured to cause the apparatus, using the at least one processor, to determine the position of the distal end of the laser fiber relative to the distal end of the endoscope based on an increase or rate of increase in the reflectivity of the light detected over time.

[12] The at least one non-transitory memory and the computer program code are used by the at least one processor to cause the device to at least: identifying the target as one of a plurality of target types based on the reflected light reflected from the target; The apparatus of claim 10, further comprising: a surgical laser system configured to generate a control signal to the surgical laser system to adjust laser illumination based on the identification of the target.

[13] The at least one non-transitory memory and the computer program code are used by the at least one processor to cause the device to at least: determining one or more spectral characteristics of the light reflected from the target; and identifying the target as one of the plurality of target types based on the one or more spectral characteristics.

Claims

1. 1. A surgical laser system comprising: a laser device emitting a surgical laser; an endoscope including a working channel and including a light source that generates illumination light for illuminating a target; a laser fiber extending into the working channel of the endoscope, the laser fiber transmitting the surgical laser emitted from the laser device and the reflected illumination light reflected from the target; a photodetector that detects the reflected light that is reflected from the target and returns through the laser fiber; a controller configured to compare a reflectance of the reflected light with respect to the illumination light directed from the light source to the target with a threshold value indicating whether a distal end of the laser fiber extends beyond the distal end of the endoscope, and to generate and output to the laser device a control signal that prevents irradiation of the surgical laser through the laser fiber when it is determined that the distal end of the laser fiber does not extend beyond the distal end of the endoscope; A surgical laser system comprising:

2. The surgical laser system of claim 1, the controller comparing the reflectance to the threshold indicating whether the distal end of the laser fiber extends beyond the distal end of the endoscope, and if the controller determines that the distal end of the laser fiber extends beyond the distal end of the endoscope, generating and outputting a control signal to the laser device to enable irradiating the target with the surgical laser via the laser fiber; A surgical laser system comprising:

3. The surgical laser system of claim 1, if the controller determines that the distal end of the laser fiber does not extend beyond the distal end of the endoscope, providing an indicator to a user that the distal end of the laser fiber does not extend beyond the distal end of the endoscope; A surgical laser system comprising:

4. The surgical laser system of claim 1, the laser device includes a laser interlock to which a control signal from the controller is input; the laser interlock is configured to prohibit irradiation of the surgical laser when a control signal that prevents irradiation of the surgical laser through the laser fiber is input; A surgical laser system comprising:

5. The surgical laser system of claim 1, the controller is configured to generate the control signal to adjust illumination of the surgical laser based on an increase or rate of increase in the reflectivity over time; A surgical laser system comprising:

6. The surgical laser system of claim 1, the optical detector is configured to detect a wavelength of the reflected light reflected from the target; the controller is configured to generate the control signal to adjust illumination of the surgical laser based on the detected wavelength of the reflected light; A surgical laser system comprising:

7. The surgical laser system of claim 1. The controller: a feedback analyzer configured to identify the target as one of a plurality of target types using one or more spectral characteristics based on the reflected light reflected from the target; generating the control signal to adjust illumination of the surgical laser based on the identification of the target by the feedback analyzer; A surgical laser system comprising:

8. The surgical laser system of claim 1, a spectroscopic system configured to determine one or more spectral characteristics from the reflected light reflected from the target; a feedback analyzer configured to identify the target as one of a plurality of target types based on the one or more spectroscopic characteristics; the controller is configured to generate the control signal to adjust illumination of the surgical laser based on the identification of the target by the feedback analyzer; A surgical laser system comprising:

9. The surgical laser system of claim 1, the working channel of the endoscope includes an exterior surface portion at least partially covered by a reflective coating; the reflective coating comprises a reflective material that reflects radiation of the surgical laser within a working channel of the endoscope when the distal end of the laser fiber is within the working channel; A surgical laser system comprising:

10. The surgical laser system of claim 9, the working channel including a transparent liner between the exterior surface portion and the reflective coating; A surgical laser system comprising:

11. The surgical laser system of claim 9, the reflective coating is made of aluminum, silver, gold, or copper; A surgical laser system comprising:

12. The surgical laser system of claim 9, the reflective material comprises at least one of barium sulfate, magnesium oxide, polytetrafluoroethylene (PTFE), a dielectric highly reflective coating, a dichroic material, or a reflective photonic material; A surgical laser system comprising:

13. A method of operating a surgical laser system executed by a controller, comprising: the controller illuminating the target with illumination light generated from a light source disposed in an endoscope including a working channel; the controller detecting, using a photodetector, a reflection of the illumination light reflected from the target and back through a laser fiber extending into the working channel of the endoscope; The controller: comparing a reflectance of the reflected light with respect to the illumination light directed from the light source to the target with a threshold value indicating whether the distal end of the laser fiber extends beyond the distal end of the endoscope, and when it is determined that the distal end of the laser fiber does not extend beyond the distal end of the endoscope, generating and outputting a control signal to a laser device that prevents irradiation of a surgical laser through the laser fiber; A method of operating a surgical laser system comprising:

14. A method of operating the surgical laser system of claim 13, comprising: the controller comparing the reflectance to the threshold indicating whether the distal end of the laser fiber extends beyond the distal end of the endoscope, and if the controller determines that the distal end of the laser fiber extends beyond the distal end of the endoscope, generating and outputting a control signal to the laser device to enable irradiating the target with the surgical laser via the laser fiber; A method of operating a surgical laser system comprising:

15. A method of operating the surgical laser system of claim 13, comprising: providing an indicator to a user that the distal end of the laser fiber does not extend beyond the distal end of the endoscope when the controller determines that the distal end of the laser fiber does not extend beyond the distal end of the endoscope; A method of operating a surgical laser system comprising:

16. A method of operating the surgical laser system of claim 13, comprising: the laser device includes a laser interlock that inhibits irradiation of the surgical laser; The controller prevents firing of the surgical laser with the laser interlock if the controller determines that the distal end of the laser fiber does not extend beyond the distal end of the endoscope. A method of operating a surgical laser system comprising:

17. A method of operating the surgical laser system of claim 13, comprising: the controller adjusting irradiation of the surgical laser based on the increase or rate of increase of the reflectivity over time; A method of operating a surgical laser system comprising:

18. A method of operating the surgical laser system of claim 13, comprising: The controller detects a wavelength of the reflected light reflected from the target using the light detector; adjusting illumination of the surgical laser based on the detected wavelength of the reflected light; A method of operating a surgical laser system comprising:

19. A method of operating the surgical laser system of claim 13, comprising: the controller using a feedback analyzer to identify the target as one of a plurality of target types based on the reflected light reflected from the target and adjust illumination of the surgical laser based on the identification of the target; A method of operating a surgical laser system comprising:

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