Real-time monitoring of liquid media conditions adjacent to the laser lithotripsy treatment area

Abstract

To monitor conditions of media proximate to an endoscopic treatment or diagnostic site in real time.SOLUTION: Disclosed herein are systems and methods for monitoring a condition associated with a medium proximate to a target region. The system comprises a surgical laser, and a surgical fiber coupled to the surgical laser for delivering laser light to a target region and receiving at least a portion of the laser light reflected from the target region. The system further comprises a processor configured to analyze the collected reflected laser light and determine, based at least in part on the analysis of the reflected laser light, a value of a parameter associated with the medium proximate to the target region.SELECTED DRAWING: Figure 5

Description

[Technical Field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of priority to U.S. Provisional Patent Application No. 63 / 261,316, filed September 17, 2021, the contents of which are incorporated by reference herein in their entirety.

[0002] The present disclosure relates to a system for monitoring liquid media conditions proximate a laser lithotripsy treatment area. [Background technology]

[0003] During medical procedures utilizing a scope (e.g., endoscope or ureteroscope), such as a lithotripsy procedure, there is a space between the tip of the fiber or scope that may contain necrotic tissue debris, blood, or other liquid medium. The properties of the liquid in the treatment area / area of ​​treatment can change very quickly as the procedure progresses. As a result of energy delivery to a target, such as a kidney stone, conditions in the liquid medium, such as temperature, pressure, or amount of vapor bubbles, can change very quickly (e.g., within about 1 ms) as the procedure progresses. Summary of the Invention [Problem to be solved by the invention]

[0004] During endoscopic procedures, such as lithotripsy or other similar procedures employing, using, or utilizing laser light or laser radiation (e.g., tissue ablation procedures, kidney stone ablation or removal, etc.), conditions in the liquid medium in the treatment area can change very quickly. For example, the temperature of the liquid medium can increase when laser radiation is delivered to the treatment area and absorbed by the liquid. This can cause the liquid to reach excessively high temperatures (e.g., above 43°C), which can be dangerous to human or animal tissue. For example, when temperatures in the body reach 43°C, tissue necrosis can occur. Similarly, when irrigation fluid is introduced to remove necrotic tissue debris, a camera at the distal end of the scope allows the surgeon to see the target more clearly, and pressure inside the organ (e.g., inside the kidney) can increase to undesirable or dangerous levels. Furthermore, if fluid return through the scope becomes clogged, the irrigation agent (e.g., saline solution) can still be introduced without a properly functioning exit passage, potentially increasing pressure inside the organ.

[0005] In addition to the damage to tissue or organs that can occur when temperatures or pressures in the treatment area increase to unacceptable or otherwise dangerous levels, the efficiency of ablation can be reduced. For example, necrotic tissue debris and blood can collect or clump at the tip of the scope, especially when combined with high local temperatures, which can cause contamination of the scope tip, which can reduce overall ablation efficiency because less laser light / radiation can reach the intended target. Therefore, there is a need for real-time monitoring of the conditions of the media adjacent to an endoscopic treatment or diagnostic site to address issues such as changes in temperature or pressure adjacent the distal end of the endoscope. [Means for solving the problem]

[0006] One method for monitoring the condition of a liquid medium, such as temperature and pressure, during lithotripsy or other laser procedures is to analyze the modulation of the intensity of reflected laser light. The laser light can be reflected as optical speckles, creating a "speckle field" or "caustic field" that can be used to determine the current and changing conditions / states of the medium filling the region between the scope tip and the target stone or tissue. For example, the changing intensity of the reflected laser speckles or optical caustics can be monitored to infer factors affecting the medium, such as temperature, pressure, and irrigation flow issues. One advantage of being able to infer factors such as temperature, pressure, and irrigation flow is that the system does not need to include temperature or pressure sensors and does not need to use the additional resources (e.g., power) that such sensors require. Additionally, using the speckle field to determine changes in parameters such as temperature and pressure allows the system to more efficiently adapt to and mitigate changing conditions.

[0007] An example system for monitoring the condition of a liquid medium may include a surgical laser, a surgical fiber configured to be coupled to the surgical laser, and a surgical scope (e.g., an endoscope, etc.) configured to be coupled to the surgical fiber, such as at a distal end of the surgical fiber. The surgical fiber may include an optical fiber. The surgical laser may include an ablation laser configured to emit laser radiation, such as laser light, through the optical fiber and the surgical fiber. In addition to the ablation laser used to ablate tissue or organs in the body, the surgical laser may also include a laser configured to emit visible laser light to allow a surgeon to better visualize the surgical or treatment area. The surgical laser system may also include an optical splitter configured to collect at least a portion of the laser light reflected from a target, such as a kidney stone or tissue fragment, and reflected back toward the scope. Additionally or alternatively, the reflected laser light may be collected using a dedicated fiber attached to the surgical laser.

[0008] The surgical laser may also include a processing device capable of analyzing at least a portion of the reflected laser light collected by the optical splitter at a first time and determining a first value for a parameter associated with the liquid medium (e.g., temperature, pressure, amount / number of bubbles, etc.) based on the analysis of the reflected laser light collected at the first time. The processing device may further determine whether the first value is above a first predetermined threshold, below a second predetermined threshold, within a specific range, or above a predetermined range, and may apply mitigation based on that determination. Additionally or alternatively, the processing device may analyze at least a portion of the reflected laser light collected at a second time to determine a second value for the parameter. The second value of the parameter may be compared to a predetermined threshold, range, and / or first value, and mitigation may be applied based on the comparison (e.g., if the comparison reveals that the parameter has changed by an undesirable amount).

[0009] In the drawings, which are not necessarily to scale, like reference numerals may represent like components in different views. Like reference numerals with different subscripts may represent different instances of like components. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in this document. [Brief explanation of the drawings]

[0010] [Figure 1] FIG. 1 is a diagram of an example system for monitoring liquid medium conditions proximate a laser treatment area. [Figure 2] 10A-10C show examples of reflected laser light speckles / caustics at the tip of a fiber and a scope. [Figure 3] 1A and 1B show examples of reflected laser light in the medium between the tip of the scope and the target. [Figure 4A] FIG. 10 is a diagram illustrating an example of a detection signal from reflected laser light. [Figure 4B] FIG. 2 is a diagram of the detected signal transformed into the frequency domain. [Figure 4C]FIG. 1 is a diagram of a frequency reference versus time. [Figure 5] 1A-1C are diagrams of example methods for monitoring liquid media conditions proximate a laser lithotripsy treatment area. [Figure 6] 1A-1C are diagrams of example methods for monitoring liquid media conditions proximate a laser lithotripsy treatment area. [Figure 7] 1 is an example block diagram of a machine in which any one or more of the techniques herein may be implemented. [Figure 8] FIG. 1 is a diagram of an example of a Computer-based Decision Support System (CDSS). DETAILED DESCRIPTION OF THE INVENTION

[0011] During endoscopic medical procedures such as lithotripsy or laparoscopy, the properties of the liquid medium in the treatment area can change very quickly. For example, the medium's condition can change in temperature, pressure, or the amount of vapor bubbles resulting from energy delivery to the target (e.g., a kidney stone or tissue fragment being ablated). Such changes in liquid medium condition can inhibit or reduce the effectiveness of the procedure, such as making ablation less effective, and can also be harmful to the patient. For example, if the temperature at the treatment site is too high, the tissue being ablated or tissue near the treatment site can be damaged. Similarly, pressure within the body or within an organ, such as a kidney, can increase during the procedure. For example, introducing irrigation fluid through the scope to remove necrotic tissue fragments can exert excessive pressure on the associated organ. Similarly, the irrigation return passage can become clogged, which can increase pressure in the body and interfere with the procedure, such as clouding or obscuring the endoscopic view. Additionally, necrotic tissue debris and blood can collect near the endoscope tip, especially at elevated temperatures, which can contaminate the tip of the scope and reduce the efficiency of the ablation.

[0012] Therefore, there is a need for real-time monitoring of the condition of a liquid medium proximate to an endoscopic treatment or diagnostic site. The disclosed systems and methods provide a solution for real-time monitoring of the liquid medium proximate to a treatment region (e.g., the region between the endoscope tip and the target) and, based on an analysis of the condition of the liquid medium, automatically applying appropriate mitigation in real time, such as to correct or mitigate characteristics that pose problems or risks to the procedure, the patient, or both.

[0013] FIG. 1 illustrates an example system 100 for monitoring liquid medium conditions proximate a laser treatment area. System 100 may include a surgical laser 102. The system may optionally include a graphical user interface 104, which may include a touchscreen or other input mechanism configured to operate, control, or otherwise operate surgical laser 102. Contained within surgical laser 102 (as indicated by the dotted rectangle) may be one or more laser sources configured to emit laser radiation. The laser sources may include an ablation laser 106 and / or a probe laser 108. Ablation laser 106 may emit infrared radiation, while probe laser 108 may emit visible light to indicate where the tip of the scope (and thus the ablation energy from ablation laser 106) should be aimed, or may be used to illuminate a target 126. Target 126 may be a piece of tissue to be ablated, a piece of necrotic tissue, or an object such as a kidney stone. Thus, the emitted laser radiation / light 128 can be emitted from the ablation laser 106 or the probe laser 108 independently of each other or in conjunction with each other, which means that the emitted laser radiation / light 128 emitted from the surgical laser can be visible, invisible, or both (e.g., a combination of infrared and visible light).

[0014] Emitted laser radiation / light 128 from the laser sources 106, 108 may be emitted through an optical fiber 116 that is coupled to the surgical fiber 118 via an optical coupler 120. In examples, the structure of the surgical fiber 118 may be the same as or different from the structure of the optical fiber 116. The surgical fiber 118 may be located wholly or partially external to the surgical laser 102. Thus, the emitted laser radiation / light 128 may be emitted from the laser sources 106, 108 through the optical fiber 116, the optical coupler 120, and the surgical fiber 118 to a distal end of the surgical fiber 118 to which a scope 124, such as an endoscope or ureteroscope, may be attached. In examples, the laser sources 106, 108 may be single-mode or multi-mode lasers, or the like, and the optical fiber 116 may be single-mode or multi-mode fiber, or the like. Single-mode lasers and fibers can deliver a collimated laser spot, while multi-mode lasers and fibers can produce countless spots or smaller spots similar to "blinking" pixels, creating a speckle field or speckle pattern that typically occurs in diffuse reflection of laser light (as depicted later in FIG. 2). In an example, at least a portion of the emitted laser radiation / light 128 emitted from the distal end of the surgical fiber 118 and scope 124 can be reflected from the target 126 through the medium between the tip of the scope 124 and the target 126, resulting in a speckle pattern.

[0015] Returning to FIG. 1 , the surgical laser 102 can further include a light splitter 110 configured to collect at least a portion of the reflected laser light 130 that passes through the aperture of the surgical fiber 118, where the collected laser light can form a resultant speckle field. In an example, the light splitter 110 can be replaced with a dedicated fiber configured to collect at least a portion of the reflected laser light 130. In an example, the portion of the reflected laser light 130 collected by the light splitter 110 or the dedicated fiber can be sent to a processing device 112 coupled to the surgical laser 102. The processing device 112 can analyze the portion of the reflected laser light 130 collected by the light splitter 110 and can determine a first value for a parameter based on the analysis of the reflected laser light 130. In an example, the parameter can be a temperature value or range, a pressure value or range, an amount / number of bubbles in a liquid medium, or any other similar parameter desired to be observed, monitored, tracked, etc. In examples, multiple parameters can be monitored over time, and which parameters are monitored may vary depending on the procedure being performed.

[0016] The surgical laser 102 may optionally or additionally include a controller 114 communicatively coupled to the processing unit 112. In response to determining that the first value for the parameter is at least one of above an upper threshold, below a lower threshold, within a range, or above a range, the processing unit may be further operable to apply a relaxation. The relaxation may include causing the controller 114 to cause a surgical fiber actuator 122 configured to be coupled to the surgical fiber 118 to adjust a location of at least a portion of the surgical fiber 118. For example, the surgical fiber actuator 122 may cause the surgical fiber 118, such as a portion of the surgical fiber 118 coupled to the scope 124, to change its location (e.g., move closer to or away from the target). In an example, the mitigation may include causing a change in the intensity of the emitted laser radiation / light 128 (e.g., cessation, reduction, or slowing), or a change in other parameters of the laser light (e.g., duty cycle or pulse width), or the mitigation may be causing an irrigation fluid, such as saline, to be emitted from the scope 124. In an example, the mitigation may be changing the flow rate of the irrigation fluid emitted from the scope 124. It is understood that any of these mitigation techniques, or any other suitable mitigation techniques, may be applied independently or in conjunction with one another, as desired or appropriate. In an example, the processing unit 112 may be configured to automatically select and apply one or more appropriate mitigation techniques. By configuring the processing unit to automatically select and apply appropriate mitigation based on an analysis of the reflected laser light 130 and the determined values ​​of the parameters, the system may increase the efficiency of the ablation because the processing unit may apply mitigation more quickly than a human can react.

[0017] Speckle field When laser radiation / light is emitted from a tip portion of a surgical fiber, such as the distal end to which an endoscope or other similar scope may be attached, and reflected from a target 126, a speckle field of moving optical speckles may be generated in the liquid medium between the tip of the fiber / scope and the target, such as a kidney stone or tissue fragment (because the liquid medium is not homogeneous). A portion of the optical speckles may be reflected back into the opening of the fiber toward the tip of the fiber or scope to be collected by an optical splitter. The surgical fiber can act as a "pinhole" for the reflected speckle of light, so that not all of the light / speckle is reflected back into the fiber. The reflected speckle field can be monitored (e.g., to observe how the optical speckles move or otherwise change conditions) to determine values ​​for parameters associated with the liquid medium, such as temperature or pressure.

[0018] Figure 2 shows an example of reflected laser light speckles / caustics at the tip of a fiber and a scope. In the particular example of Figure 2, after laser radiation / laser is emitted from a distal portion of a surgical fiber, such as through an aperture 200 of the surgical fiber 118 to which the scope 124 is coupled, a speckle field including a plurality of laser speckles 202 can be generated when the emitted laser radiation / light 128 is reflected from a target 126. The speckles 202 can move (as indicated by the arrows), for example, due to changes in the liquid medium, causing the speckles 202 to appear as flashing, blinking, shimmering, flickering, twinkling, flashing, or wavering. At least a portion of the reflected speckles 202 generated by the reflected laser light 130 reflected from the target 126 can be reflected back through the liquid medium between the scope 124 and the target 126 and travel back through the aperture 200 of the surgical fiber 118 where it is captured by the optical splitter 110. In examples, the aperture 200 of the surgical fiber 118 may be between 150 micrometers (μm) and 1 millimeter (mm) in diameter. It is understood that the diameter of the aperture 200 may be of any suitable size depending on the medical or surgical procedure being performed, the scope being used, or any other factor upon which the diameter of the surgical fiber 118 depends.

[0019] The amount of light reflected back into the fiber (and towards the optical splitter 110) may depend on various factors, such as the size of the aperture 200 in the surgical fiber 118, the type of liquid medium, or conditions present in the liquid medium. In various embodiments, a portion of the speckle 202 may be collected by the optical splitter 110 and analyzed by the processing unit 112.

[0020] FIG. 3 shows an example of reflected laser light in a medium between the tip of the scope and the target. In the example of FIG. 3, laser radiation / light 128 can propagate, pass through, propagate, etc., through the surgical fiber 118 and can be emitted through the tip (e.g., distal end / portion) of the surgical fiber 118 or the tip of the scope 124 (as indicated by the downward arrow) and propagate through the liquid medium toward the target 126. The emitted laser radiation / light 128 can reflect from the target 126 in the form of reflected laser light 130, causing speckles 202 to form a speckle field, as previously described. In an example, the surgical fiber 118 can be used as a limited optical aperture. The speckles 202 are constantly moving in the medium, for example, due to changes in the state of the liquid medium as a result of the application of the laser radiation / light, and the size of the speckles 202 and / or the space / distance between the speckles 202 can change, which can further result in a change in the intensity of the reflected laser light 130. This change in the intensity of the reflected laser light 130 can correspond to a modulation of the refractive index of the medium (as indicated by the "wavy" arrow in FIG. 3). The modulation of the refractive index of the medium can correspond to a change in a parameter associated with the liquid medium being monitored, such as temperature, pressure, or number / amount of bubbles. Based on the change in the parameter, relaxation can be applied as discussed above with respect to FIG.

[0021] Speckle field analysis A multimode laser and an optical fiber generate in-phase, spatially modulated laser radiation. The phase modulation can be converted into laser light intensity variations, which are the speckle fields described above. The speckle field / light intensity variations fluctuate, forming a complex curve that varies with time. If this curve is monitored at high speeds (e.g., between 10 kilohenries (KH) and 100 KH), the curve can be recorded / graphed versus time, and in real time, a processing device can apply a form of statistical analysis (e.g., Fourier transform) that allows statistical changes in light intensity to be monitored and analyzed. This allows conditions in a medium (e.g., temperature or pressure) to be inferred without directly measuring them.

[0022] 4A-4C show examples of detected signals from reflected laser light, the detected signal converted to the frequency domain, and a frequency reference versus time. FIG. 4A shows a real-time detected signal 400A of speckle 202 reflected from the target 126 through the medium back to the surgical fiber 118 and collected by the optical splitter 110. The real-time detected signal 400A represents the amplitude of the proportional reflected laser light at the aperture 200 over time. The real-time detected signal 400A can be converted to the frequency domain as shown in FIG. 4B. The frequency amplitude represented signal 400B is a or, ω a , ω b , and ω cThe frequency may be separated into multiple frequencies, such as Δωb, ... When the change in frequency over time 400C rises above an upper threshold, this may indicate an undesirable increase in temperature in the liquid medium (e.g., to a temperature that causes clinical damage to tissue), and mitigation may be applied, such as causing a change (e.g., cessation, reduction, or decrease) in the intensity of the emitted laser radiation / light 128. Additionally or alternatively, mitigation may include emitting a irrigation fluid, such as saline, from the scope 124 to reduce or decrease the temperature of the liquid medium. Similarly, a change in frequency over time 400C rising above an upper threshold may indicate an undesirable increase in pressure in the liquid medium, and appropriate mitigation may be applied.

[0023] In an example, a display may be associated, coupled, etc. with scope 124 to display the speckle pattern. By tracking the movement of the speckle pattern (e.g., based on a displayed animation of the speckle pattern), changes in the state of the liquid medium may be determined. Additionally or alternatively, the movement of the speckle pattern may be combined with information about the intensity of the speckle pattern to determine changes in the state of the medium.

[0024] In an example, both supervised and unsupervised machine learning can be used to determine correlations between the spectral patterns of the detected signals in the frequency domain and the state (or changes in state) of the medium, which can then be determined by applying the learned correlations to the detected real-time intensity of the reflected speckle.

[0025] FIG. 5 illustrates an example method for monitoring liquid medium conditions proximate a laser treatment region. In operation 500, the method may include emitting laser radiation from a surgical laser. The surgical laser may include a probe laser that emits visible radiation / light or an ablation laser that emits non-visible radiation. For example, the laser radiation may be infrared or other non-visible laser radiation used for ablation, heating tissue, or the like. Stated differently, the surgical laser may include at least one ablation laser, at least one probe laser, or one or more of each. In some examples, the surgical laser may include multiple laser sources that can be used independently or in conjunction with each other. In some examples, one or more of the laser sources included in the surgical laser may be a multimode laser configured to generate laser radiation spatially modulated in phase. The surgical laser may further comprise an optical fiber that, when coupled to the multimode laser, can convert phase modulation into light intensity variations to generate multiple small laser spots, which can generate a speckle field when reflected from a target (e.g., kidney stones, gallstones, or tissue fragments). In an example, laser radiation / laser light may be emitted from the surgical laser through an optical fiber and a surgical fiber coupled to the optical fiber by an optical connector. In an example, the surgical fiber may comprise a scope, such as an endoscope, at a distal end of the surgical fiber. The laser radiation may be emitted in a direction to aim at a target, such as a tissue fragment, stone, or any other similar target in a portion of a patient's body, to be ablated.

[0026] Operation 502 may include collecting at least a portion of the reflected laser light at a first time. When the laser radiation / light is reflected from the target, at least a portion of the reflected laser light / laser radiation may be reflected back into the surgical fiber and propagate through the surgical fiber back toward the surgical laser.

[0027] In an example, a portion of the reflected laser light / laser radiation is reflected back into the surgical fiber and can be collected by an optical splitter or by a dedicated fiber included as part of the surgical laser (e.g., in the housing unit of the surgical laser). In an example, the optical splitter can be a fiber optic splitter or any other means for collecting and / or directing the reflected laser light. Operation 504 can include analyzing the portion of the reflected laser light collected at the first time. The analysis can be performed by a processing device, which can be included as part of an on-chip analysis device or system or as part of any other processing unit / CPU attached to or included in the surgical laser. In an example, the analysis can include determining the amount of laser speckle reflected back into the surgical fiber and collected by the optical splitter. In an example, the analysis can be an analysis of a complex curve formed by fluctuations in the speckle field / light intensity, such as applying a Fourier transform to the complex curve and analyzing the signal 400B in which the frequency is represented, as discussed above with respect to FIGS. 4A-4C.

[0028] Operation 506 may include determining a first value for a parameter. In an example, a parameter such as the temperature of the liquid medium, the pressure in the liquid medium, or the number of bubbles in the liquid medium may be determined from the analysis of the reflected laser light performed in operation 504. For example, the temperature of the liquid medium (e.g., 36° C.) or the pressure of the liquid medium may have a specific known frequency or a specific spectral pattern in the frequency domain. Using a signal representing the frequency, the processing device can determine a value for the parameter. In an example, the value may be definite or approximate (e.g., within a range) and may be determined to be safe or acceptable, or unsafe, unacceptable, undesirable, etc., depending on factors such as the type of treatment or the patient's response during the treatment.

[0029] Operation 508 may include applying a mitigation in response to determining that the first value for the parameter is at least one of above an upper threshold, below a lower threshold, or within a range. For example, the processor may apply a mitigation when the frequency value represents a parameter value above an upper threshold, below a lower threshold, or within an undesirable range. For example, the processor may automatically apply an appropriate mitigation when the frequency shifts in an amount that results in an undesirable change in temperature (e.g., a 7°C temperature increase), or an undesirable change in pressure (e.g., a 1000-3000 Pascal pressure increase), or an undesirable collection of material at the tip of the surgical fiber or scope. In examples, the processor may decrease, reduce, interrupt, shut off, or stop ablation energy from the ablation laser, or may change or modify the duty cycle, pulse width, or the like. Alternatively, the processor may use a position actuator, which may optionally be attached to the surgical fiber and / or scope, to reposition, move, change, or the like the location of the tip of the surgical fiber or scope relative to the target. This can allow for more efficient treatment because the processing device can react to changing conditions in the medium more quickly than a human, allowing the actuator to reposition the surgical fiber and / or scope tip and react accordingly as soon as it determines that too much ablation energy is being delivered to the tissue, or that insufficient ablation energy is being delivered to the tissue, etc.

[0030] FIG. 6 illustrates an example method for monitoring a liquid medium condition proximate a laser treatment region. Operation 600 may include emitting laser radiation from a surgical laser. Operation 602 may include collecting at least a portion of reflected laser light at a first time. Operation 604 may include analyzing the portion of reflected laser light collected at the first time. Operation 606 may include determining a first value for a parameter. These operations 600-606 may be performed in the same or similar manner as operations 500-508, as discussed above with respect to FIG. 5. Operation 608 may include collecting at least a portion of reflected laser light at a second time, different from the first time, and analyzing at least a portion of reflected laser light collected at the second time. In an example, the system may monitor the speckle field at different time intervals, such as every 10 milliseconds, or at any other desired or suitable interval. In an example, the reflected light may be continuously collected and continuously analyzed. In examples, the reflected light, as it propagates back through the surgical fiber to the optical splitter, may be collected in the same or similar manner as discussed above.

[0031] Operation 610 may include determining a second value for the parameter. In an example, this determination may be made based on an analysis of the portion of the laser light collected at the second time in operation 608 and may be made in the same or similar manner as operations 506 and 606. Operation 612 may include comparing the first value for the parameter to a second value of the parameter, and operation 614 may include determining a change in the value of the parameter. In an example, the second value of the parameter may be compared to a predetermined threshold value as previously described in FIG. 5. As previously described, a parameter such as the temperature of the liquid medium (e.g., 36° C.) or the pressure of the liquid medium may have a specific known frequency or a specific spectral pattern in the frequency domain that can be determined when a detector signal such as that shown at 400A is converted to the frequency domain as shown at 400B.

[0032] The frequency can shift when the value of the parameter changes, such as a higher temperature or an increase in pressure. Thus, the shift can indicate a change in the parameter. Operation 616 can include applying a relaxation in response to determining that the change in the value of the parameter exceeds a threshold amount. For example, when the frequency shifts by an amount that results in an undesirable change in temperature (e.g., a 7° C. temperature increase), an undesirable change in pressure (e.g., a 1000-3000 Pascal pressure increase), or an undesirable collection of material at the tip of the surgical fiber or scope, the processing unit can automatically apply the appropriate relaxation. The relaxation can include causing a controller, such as controller 114, to adjust the location of at least a portion of the surgical fiber. For example, surgical fiber actuator 122 can cause a portion of the surgical fiber, such as the tip of the surgical fiber, or a portion of the surgical fiber coupled to a scope, such as scope 124, to change its location (e.g., move closer to the target). In an example, the mitigation may include causing a change (e.g., cessation, reduction, slowing, etc.) in the intensity, duty cycle, or pulse width of the emitted laser radiation / light, or the mitigation may be causing an irrigation fluid, such as saline, to be emitted from the scope 124 (or changing the flow rate of the irrigation fluid). It is understood that any of these mitigation techniques, or any other suitable mitigation techniques, may be applied independently or in conjunction with one another, as desired or appropriate. In an example, the processing unit 112 may be configured to select and automatically apply one or more appropriate mitigation techniques based on the values ​​of the parameters determined in steps 606, 610.By configuring the processing device to automatically select and apply appropriate mitigation based on analysis of the reflected laser light and the determined values ​​of the parameters, the system can provide increased ablation efficiency because the processing device can apply mitigation more quickly, promptly, accurately, etc. than could be done by a human.

[0033] FIG. 7 shows an example block diagram of a machine capable of implementing any one or more of the techniques herein. In alternative embodiments, machine 700 may operate as a stand-alone device or may be coupled (networked) to other machines. For example, machine 700 may be part of or a component of a surgical laser, or a component operably coupled to a surgical laser, etc. Machine 700 may be a personal computer (PC), a tablet PC, a control system, a mobile phone, a web appliance, a network router, switch or bridge, or any machine capable of executing instructions (sequential or otherwise) that define actions to be taken by that machine. Furthermore, while only a single machine is shown, the term “machine” is intended to include any collection of machines that individually or collectively execute a set (or sets) of instructions to perform any one or more of the methodologies discussed herein.

[0034] Examples may include or operate on logic circuits or several components, modules, or mechanisms, as described herein. A module is a tangible entity (e.g., hardware) that, when operated, can perform a particular operation. A module comprises hardware. In examples, the hardware may be explicitly configured (e.g., hardwired) to perform a particular operation. In examples, the hardware may include configurable execution units (e.g., transistors, circuits, etc.) and computer-readable media containing instructions, where the instructions configure the execution units to perform a particular operation during operation. The configuration may occur under the direction of an execution unit or a loading mechanism. Thus, the execution unit is communicatively coupled to the computer-readable media when the device is operating. In this example, the execution unit may be a member of two or more modules. For example, during operation, the execution unit may be configured by a first set of instructions to perform a first module at a given time and reconfigured by a second set of instructions to perform a second module.

[0035] The machine (e.g., a computer system) 700 may include a hardware processing unit 702 (e.g., a central processing unit (CPU), a graphics processing unit (GPU), a hardware processing unit core, or any combination thereof), a main memory 704, and a static memory 706, some or all of which may communicate with each other via an interconnect (e.g., a bus) 730. The machine 700 may further include a display device 710, an alphanumeric input device 712, and a user interface (UI) navigation device 714. In an example, the display device 710, the alphanumeric input device 712, and the UI navigation device 714 may be touchscreen displays. The machine 700 may additionally include a storage device (e.g., a drive unit) 708, a signal generating device 718 (e.g., a speaker), a network interface device 720, and one or more sensors 716, such as a global positioning system (GPS) sensor, an accelerometer, or other sensors. The machine 700 may include an output control device 728, such as a serial (e.g., Universal Serial Bus (USB)), parallel, or other wired or wireless (e.g., infrared (IR), near field communication (NFC), etc.) connection, for communicating with or controlling one or more peripheral devices (e.g., printing devices, card readers, etc.).

[0036] Storage device 708 may comprise a non-transitory, machine-readable medium 722 on which is stored one or more sets of data structures or instructions 724 (e.g., software) that embody or are utilized by any one or more of the techniques or functions described herein. The instructions 724 may also reside, completely or at least partially, in main memory 704, in static memory 706, or in hardware processing unit 702 during execution thereof by machine 700. In an example, one or any combination of hardware processing unit 702, main memory 704, static memory 706, or storage device 708 may constitute a machine-readable medium.

[0037] Although machine-readable medium 722 is shown as a single medium, the term "machine-readable medium" may comprise a single medium or multiple media (e.g., a centralized or distributed database, or associated caches and servers) configured to store one or more instructions 724.

[0038] The term "machine-readable medium" may include any non-transitory medium that can store, encode, or carry instructions for execution by machine 700, and that can cause machine 700 to perform any one or more of the techniques of this disclosure or store, encode, or carry data structures used by or associated with such instructions. Non-limiting examples of machine-readable media may include solid-state memory, as well as optical and magnetic media. Specific examples of machine-readable media may include non-volatile memory such as semiconductor memory devices (e.g., electrically programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM)) and flash memory devices, magnetic disks such as internal hard disks and removable disks, magneto-optical disks, and CD-ROM and DVD-ROM disks.

[0039] The instructions 724 may further be transmitted or received over a communications network 726 using a transmission medium via a network interface device 720 utilizing any one of several transport protocols (e.g., Frame Relay, Internet Protocol (IP), Transmission Control Protocol (TCP), User Datagram Protocol (UDP), Hypertext Transfer Protocol (HTTP), etc.). Example communications networks may include a local area network (LAN), a wide area network (WAN), a packet data network (e.g., the Internet), a mobile telephone network (e.g., a cellular network), a Power On Telephone (POTS) network, a wireless data network (e.g., the Institute of Electrical and Electronics Engineers (IEEE) 802.11 family of standards known as Wi-Fi®, the IEEE 802.16 family of standards known as WiMax®), the IEEE 802.15.4 family of standards, a peer-to-peer (P2P) network, among others. In an example, network interface device 720 may include one or more physical jacks (e.g., Ethernet jacks, coaxial jacks, or telephone jacks) or one or more antennas for coupling to communications network 726. In an example, network interface device 720 may include multiple antennas for wireless communication using at least one of single-input multiple-output (SIMO), multiple-input multiple-output (MIMO), or multiple-input single-output (MISO) technologies. The term “transmission medium” is intended to include any intangible medium, including digital communications signals, analog communications signals, or other intangible media, capable of storing, encoding, or carrying instructions for execution by machine 700 and facilitating communication of such software.

[0040] 8 shows an example of a computer-based decision support system (CDSS). In an example, the CDSS 800 can be configured to determine the state (or change in state) of a liquid medium based on a spectral pattern of a detected signal in the frequency domain. In various embodiments, the CDSS 800 includes an input interface 804 for providing a spectral pattern of the detected signal in the frequency domain that is specific to a patient as an input feature to an artificial intelligence (AI) model 806, a processing unit such as the processing unit 702 capable of performing an inferencing operation in which the detected signal in the frequency domain is applied to the AI ​​model to generate a determined state of the medium, and a user interface (UI) for communicating the determined state of the medium to a user, such as a clinician.

[0041] In one embodiment, the input interface 804 may be a direct data link between the CDSS 800 and one or more medical devices that generate at least some of the input features. For example, the input interface 804 may directly transmit the spectral pattern of the detected signal in the frequency domain to the CDSS during a therapeutic and / or diagnostic medical procedure. Additionally or alternatively, the input interface 804 may be a classic user interface that facilitates interaction between a user and the CDSS 800. Additionally or alternatively, the input interface 804 may provide the CDSS 800 with access to an electronic patient record from which one or more input features may be extracted. In either of these cases, the input interface 804 is configured to collect one or more of the following input features associated with a particular patient at or before the time the CDSS 800 is used to determine the condition of the medium:

[0042] Based on one or more of the above input features, the processing unit 702 performs inference operations using an AI model to generate a determined state of the medium. For example, the input interface 804 can deliver spectral patterns of the detected signal in the frequency domain to an input layer of the AI ​​model, which propagates these input features through the AI ​​model to an output layer. An AI model can provide a computer system with the ability to perform tasks without being explicitly programmed by making inferences based on patterns found in analyzing data. AI models explore the research and construction of algorithms (e.g., machine learning algorithms) that can learn from existing data and make predictions about new data. Such algorithms operate by building an AI model from example training data to make data-driven predictions or decisions, which are represented as outputs or evaluations.

[0043] There are two general modes of machine learning (ML): supervised ML and unsupervised ML. Supervised ML uses prior knowledge (e.g., examples correlating inputs with outputs or outcomes) to learn relationships between inputs and outputs. The goal of supervised ML is to learn a function that best approximates the relationship between training inputs and outputs, given some training data, so that the ML model can implement the same relationship when given an input to generate a corresponding output. Unsupervised ML is the training of an ML algorithm using uncategorized or unclassified information and allowing the algorithm to act on that information without guidance. Unsupervised ML is useful in exploratory analysis because it can automatically identify structure in data.

[0044] Common tasks for supervised ML are classification and regression problems. Classification problems, also called categorization problems, aim to classify an item into one of several categorical values ​​(e.g., is this object an apple or an orange?). Regression algorithms aim to quantify some item (e.g., by providing a score for the value of some input). Some examples of commonly used supervised ML algorithms are logistic regression (LR), naive Bayes, random forest (RF), neural networks (NN), deep neural networks (DNN), matrix decomposition, and support vector machines (SVM).

[0045] Some common tasks for unsupervised ML include clustering, representation learning, and density estimation. Some examples of commonly used unsupervised ML algorithms are K-means clustering, principal component analysis, and autoencoders.

[0046] Another type of ML is federated learning (also known as collaborative learning), which trains algorithms across multiple decentralized devices that hold local data without exchanging data. This approach contrasts with traditional centralized machine learning techniques, where all local datasets are uploaded to a single server, and also with more classical decentralized approaches that often assume local data samples are similarly distributed. Federated learning allows all parties to build a common, robust machine learning model without shared data, thus addressing important concerns such as data privacy, data protection, data access rights, and access to disparate data.

[0047] In one example, the AI ​​model may be continuously or periodically trained prior to the performance of an inference operation by the processing unit 702. Thus, during the inference operation, patient-specific input features provided to the AI ​​model may be propagated from an input layer, through one or more hidden layers, and ultimately to an output layer corresponding to the determined state of the medium. For example, the amplitude of a signal representing frequency may be measured and correlated to different parameters / characteristics present in the liquid medium, such as temperature, pressure, or the amount of bubbles present. Thus, by applying the learned correlation of reflected speckle and detected real-time intensity, the state of the medium may be determined.

[0048] During and / or after the inferential operation, the determined state of the medium may be communicated to a user via a user interface (UI) and / or may cause a surgical fiber or scope coupled to the processing unit 702 to automatically perform a desired action (e.g., apply relaxation). For example, based on the determined state of the medium, the processing unit may cause the surgical fiber actuator 122 to adjust the location of at least a portion of the surgical fiber to change its location (e.g., move it closer to the target). Additionally or alternatively, the determination may cause the processing unit to make a change (e.g., stop, decrease, or lower) in the intensity, duty cycle, or pulse width of the emitted laser radiation / light, or the like, or to emit an irrigation fluid, such as saline, from the scope 124 (or change the flow rate of the irrigation fluid).

[0049] As used herein, terms such as "substantially" or "generally" refer to the complete or nearly complete extent or degree of an act, characteristic, property, state, structure, item, or result. For example, "substantially" or "generally" surrounding an object means that the object is either completely surrounded or nearly completely surrounded. The precise acceptable degree of deviation from absolute completeness may depend, in some cases, on the specific context. However, broadly speaking, the proximity to completeness will generally achieve the same overall result as would be achieved if absolute total completeness were achieved. The use of "substantially" or "generally" is equally applicable when used in the negative sense to refer to the complete or nearly complete absence of an act, characteristic, property, state, structure, item, or result. For example, an element, combination, embodiment, or composition that is "substantially free" or "generally free" of an element may still actually include such element, so long as there is generally no substantial effect of it.

[0050] The above description is intended to be illustrative, not limiting. For example, the above examples (or one or more aspects thereof) can be used in combination with each other. Other embodiments may be employed by, for example, those skilled in the art who review the preceding description. The Abstract is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims, but will allow the reader to quickly ascertain the nature of the technical disclosure. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be construed as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Accordingly, the following claims are hereby incorporated into the Detailed Description, with each claim standing on its own as a separate embodiment. The scope of the embodiments should be determined with reference to the appended claims, along with the full range of equivalents to which such claims are entitled.

[0051] Various notes and examples Each of these non-limiting examples can stand on its own or can be combined in various permutations or combinations with one or more of the other examples.

[0052] Examples of the methods described herein may be implemented, at least in part, by a machine or computer. Some examples may include a computer-readable medium or machine-readable medium encoded with instructions operable to configure an electronic device to perform the methods as described in the previous examples. An implementation of such methods may include code, such as microcode, assembly language code, or high-level language code. Such code may include computer-readable instructions for performing various methods. The code may form part of a computer program product. Further, in examples, the code may be tangibly stored on one or more volatile, non-transitory, or non-volatile tangible computer-readable media, such as during execution or at other times. Examples of these tangible computer-readable media may include, but are not limited to, hard disks, removable magnetic disks, removable optical disks (e.g., compact disks and digital video disks), magnetic cassettes, memory cards or sticks, random access memory (RAM), and read-only memory (ROM).

[0053] Example 1 is a system comprising a surgical laser, a surgical fiber coupled to the surgical laser for delivering laser light to a target area and receiving at least a portion of the laser light reflected from the target area at a first time, and a processing device configured to analyze the received at least a portion of the reflected laser light and determine a first value of a parameter associated with a medium proximate to the target area based at least in part on the analysis of the reflected laser light.

[0054] In Example 2, the subject matter of Example 1 optionally includes the processing device being further operable to apply mitigation in response to determining that the first value of the parameter is at least one of above an upper threshold, below a lower threshold, within a first range, or above a second range.

[0055] In Example 3, the subject matter of Example 2 optionally includes a surgical fiber actuator coupled to the surgical fiber and configured to adjust a location of at least a portion of the surgical fiber, wherein the relaxing includes causing the surgical fiber actuator to adjust a location of the at least a portion of the surgical fiber relative to the target area.

[0056] In Example 4, the subject matter of any one or more of Examples 2-3 optionally includes wherein the mitigation includes a change in at least one of the intensity, duty cycle, or pulse width of the laser light emitted from the surgical laser.

[0057] In Example 5, the subject matter of any one or more of Examples 2-4 optionally includes that the mitigation is (i) releasing a cleaning fluid from a fluid source to the target area, or (ii) adjusting a flow rate of the cleaning fluid.

[0058] In Example 6, the subject matter of any one or more of Examples 2-5 optionally includes wherein the processing device is further configured to: analyze at least a portion of the reflected laser light collected by the optical splitter at a second time, different from the first time; determine a second value of the parameter based at least in part on the analysis of the reflected laser light collected by the optical splitter at the second time; compare the second value of the parameter to at least one of the first value of the parameter, an upper threshold, a lower threshold, a first range, or a second range; determine a change in the value of the parameter based at least in part on the comparison; and apply mitigation in response to determining that the change in the value of the parameter exceeds a threshold amount.

[0059] In Example 7, the subject matter of any one or more of Examples 1-6 optionally includes where analyzing the received at least a portion of the reflected laser light includes computationally converting the received at least a portion of the reflected laser light from a time domain signal to a frequency domain signal and determining a change in the frequency domain signal over a period of time.

[0060] In Example 8, the subject matter of Example 7 optionally includes wherein the variation is in at least one of an amplitude or a pattern associated with the frequency domain signal.

[0061] In Example 9, the subject matter of any one or more of Examples 7-8 optionally includes the frequency domain signal corresponding to a parameter associated with a medium proximate the target region, and a change in the frequency domain signal representing a change in the value of the parameter.

[0062] In Example 10, the subject matter of any one or more of Examples 7-9 optionally includes where analyzing the collected at least a portion of the reflected laser light further includes using a machine learning model to determine a correlation between a spectral pattern in the frequency domain signal and a condition of a medium proximate to the target area.

[0063] In Example 11, the subject matter of one or more of any of Examples 1-10 optionally includes wherein the parameters include at least one of temperature, pressure, or amount of bubbles in the medium.

[0064] In Example 12, the subject matter of any one or more of Examples 1-11 optionally includes the surgical fiber being configured to couple to a surgical scope for obtaining imaging information about the target area.

[0065] In Example 13, the subject matter of one or more of any of Examples 1-12 optionally includes wherein the target area includes at least one of a kidney stone or bodily tissue.

[0066] In Example 14, the subject matter of any one or more of Examples 1-13 optionally includes wherein the surgical laser comprises a multimode laser and the surgical fiber comprises a multimode optical fiber.

[0067] In Example 15, the subject matter of any one or more of Examples 1-14 optionally includes wherein analyzing the collected at least a portion of the reflected laser light includes detecting an amount of laser light speckle in the reflected laser light passing through at least a portion of the surgical fiber and / or detecting a movement of laser light speckle in the reflected laser light passing through at least a portion of the surgical fiber.

[0068] Example 16 is a method for monitoring a condition associated with a medium proximate a target area, the method including emitting laser light at the target area; collecting at least a portion of the laser light reflected from the target area at a first time; analyzing the collected at least a portion of the reflected laser light; and determining a first value of a parameter associated with the medium proximate the target area based at least in part on the analysis of the collected laser light.

[0069] In Example 17, the subject matter of Example 16 optionally includes applying a relaxation in response to a determination that the first value of the parameter is at least one of above an upper threshold, below a lower threshold, within a first range, or above a second range.

[0070] In Example 18, the subject matter of Example 17 optionally includes, wherein the mitigation includes a change in at least one of an intensity, a duty cycle, or a pulse width of the laser light emitted to the target area.

[0071] In Example 19, the subject matter of any one or more of Examples 17-18 optionally includes that the mitigation is (i) releasing a cleaning fluid from a fluid source to the target area, or (ii) adjusting a flow rate of the cleaning fluid.

[0072] In Example 20, the subject matter of any one or more of Examples 17-19 optionally includes analyzing at least a portion of the reflected laser light collected at a second time different from the first time; determining a second value of the parameter based at least in part on the analysis of the reflected laser light at the second time; comparing the second value of the parameter to at least one of the first value of the parameter, an upper threshold, a lower threshold, a first range, or a second range; determining a change in the value of the parameter based at least in part on the comparison; and applying mitigation in response to determining that the change in the value of the parameter exceeds a threshold amount.

[0073] In Example 21, the subject matter of any one or more of Examples 16-20 optionally includes wherein the collected at least a portion of the laser light reflected from the target area is in the time domain, and the method includes converting the collected time domain signal into a frequency domain signal, the frequency domain signal corresponding to a parameter associated with a medium proximate the target area, and determining a change in the frequency domain signal over a period of time, the change in the frequency domain signal representing a change in the value of the parameter.

[0074] In Example 22, the subject matter of Example 21 optionally includes wherein the variation is in at least one of an amplitude or a pattern associated with the frequency domain signal.

[0075] In Example 23, the subject matter of any one or more of Examples 21-22 optionally includes using a machine learning model to determine a correlation between a spectral pattern in the frequency domain signal and a state of the medium or a change in the state of the medium.

[0076] In Example 24, the subject matter of any one or more of Examples 16-23 optionally includes, wherein the parameters include at least one of temperature, pressure, or amount of bubbles in the medium, and the target area includes at least one of a kidney stone or body tissue.

[0077] In Example 25, the subject matter of any one or more of Examples 16-24 optionally includes wherein analyzing the collected at least a portion of the reflected laser light includes detecting an amount of laser light speckle in the reflected laser light and / or detecting movement of the laser light speckle in the reflected laser light. [Explanation of symbols]

[0078] 100 systems 102 Surgical Lasers 104 Graphical User Interface 106 Ablation laser, laser source 108 Probe laser, laser source 110 Optical Splitter 112 Processing equipment 114 Control device 116 Optical Fiber 118 Surgical Fiber 120 Optical coupler 122 Surgical Fiber Actuator 124 Scope 126 Target 128 Emitting Laser Radiation / Light 130 Reflected laser light 200 aperture 202 Laser speckle, reflection speckle 400A real-time detected signal 400B Signal with frequency amplitude 400C Change in frequency with time 700 machines 702 Hardware Processing Unit 704 Main Memory 706 Static Memory 708 Storage Devices 710 Display device 712 Alphanumeric Input Device 714 User Interface (UI) Guidance Device 716 Sensors 718 Signal Generating Device 720 Network Interface Device 724 Command 728 Output Control Device 730 Interconnection 800 CDSS 804 input interface 806 Artificial Intelligence (AI) Models

Claims

1. 1. A system for real-time monitoring and management of a condition of a liquid medium during a medical procedure, comprising: a processing device; a memory containing instructions stored therein; the instructions, when executed by the processing unit, cause the processing unit to: receiving a signal from the target region; analyzing the signals received from the target region; and determining a real-time condition of a liquid medium adjacent the target area based at least in part on the analysis of the received target signals; converting the signals received from the target region from time domain signals to frequency domain signals; A system for determining a real-time state of the liquid medium based on the frequency domain signal using a correlation between a spectral pattern of the frequency domain signal and a state of the liquid medium.

2. The instructions direct the processing unit to:

10. The system of claim 1, wherein one or more operating parameters of a surgical laser are adjusted based on the determined real-time condition, the correlation being determined using a trained learning model.

3. the surgical laser is a multimode surgical laser capable of emitting both visible and invisible light, and the system comprises: a dual mode surgical fiber attached to the surgical laser configured to emit laser light and collect the signal received from the target area, wherein the instructions further include: analyzing one or more patterns in the signals received from the target region using the trained learning model; using the trained learning model to predict changes in the liquid medium by comparing the real-time conditions against a training dataset; and The system of claim 2 , wherein if the predicted change in the liquid medium exceeds a safety threshold, one or more corrective actions are initiated.

4. The system of claim 3 , wherein the one or more corrective actions include adjusting an irrigation fluid flow or adjusting the one or more operating parameters of the surgical laser.

5. The system of claim 4 , wherein the corrective action comprises changing a wavelength of laser light emitted by the surgical laser to accommodate changes in one or more optical properties of the liquid medium.

6. The system of claim 3 , wherein the multimode surgical fiber is further configured to automatically adjust its position in response to analysis of the received signal.

7. The system of claim 2 , wherein the trained learning mode is configured to continuously update based on real-time data resulting from the medical procedure.

8. The system of claim 2 , wherein adjusting the one or more operating parameters of the surgical laser comprises adjusting an intensity of radiation of the surgical laser.

9. 10. The system of claim 8, wherein adjustments to the intensity of the surgical laser are controlled through a feedback loop, the feedback loop incorporating real-time temperature measurements of the liquid medium adjacent the target area.

10. The system of claim 2 , wherein the trained learning model comprises an artificial intelligence or machine learning algorithm.

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