Variation of spectral profile VS. target distance

Abstract

A surgical system can include a light source that can generate therapeutic laser light and controllably vary a spectral profile of the therapeutic laser light. An optical fiber having a distal end can deliver the therapeutic laser light to a target site. A distance sensor can repeatedly measure a. time-varying distance value that corresponds to a time- varying separation between the distal end of the optical fiber and the target site. A controller can cause the light source to temporally vary the spectral profile of the therapeutic laser light in response to the distance value. In some examples, the light source can include a first laser that is activated only when the distance value is less than a specified distance threshold and a. second laser, at a different wavelength, that is activated only when the distance value is greater than the specified distance threshold.

Description

VARIATION OF SPECTRAL PROFILE VS. TARGET DISTANCE CROSS-REFERENCE TO RELATED APPLICATION

[0001] This application claims the benefit of U.S. Provisional Application No. 63 / 581,802, filed September 11, 2023, which is hereby incorporated by reference in its entirety. FIELD OF THE DISCLOSURE

[0002] This document relates generally to surgical systems, such as endoscopic systems. BACKGROUND OF THE DISCLOSURE

[0003] An operator, such as a physician, practitioner, or user, can use an endoscope to provide visual access to an internal location of a patient. The operator can insert an endoscope into a patient’s body. The endoscope can deliver light to a target being examined, such as a target anatomy or object. The endoscope can collect light that is reflected from the object. The reflected light can carry information about the target being examined.

[0004] An endoscope can include a working channel. In some examples, the operator can perform suction through the working channel. In some examples, the operator can pass instruments, such as brushes, biopsy needles or forceps, through the working channel. In some examples, the operator can perform minimally invasive surgery through the working channel, such as to remove unwanted tissue or foreign objects from the body of the patient.

[0005] An endoscope can use a laser or plasma system to perform laser therapy, such as ablation, coagulation, vaporization, fragmentation, lithotripsy, and others. In laser therapy, the operator can use the endoscope to deliver surgical laser energy to various target treatment areas, such as soft or hard tissue. In lithotripsy, the operator can use the endoscope to deliver surgical laser energy to break down calculi structures in the patient’s kidney, gallbladder, ureter, or other stone-forming regions, or to ablate large calculi into smaller fragments. Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1SUMMARY

[0006] In an example, a surgical system can comprise: a light source configured to generate therapeutic laser light and controllably vary a spectral profile of the therapeutic laser light; an optical fiber having a distal end configured to deliver the therapeutic laser light to a target site; a distance sensor configured to repeatedly measure a time-varying distance value that corresponds to a time-varying separation between the distal end of the optical fiber and the target site; and a controller configured to cause the light source to temporally vary the spectral profile of the therapeutic laser light in response to the time-varying distance value.

[0007] In an example, a method for operating a surgical system can comprise: generating therapeutic laser light with a light source having a variable spectral profile; propagating the therapeutic laser light distally along a length of an optical fiber; propagating the therapeutic laser light from a distal end of the optical fiber to a target site; repeatedly measuring a time-varying distance value that corresponds to a time- varying separation between the distal end of the optical fiber and the target site; and causing the light source to temporally vary the spectral profile of the therapeutic laser light in response to the time-varying distance value.

[0008] In an example, a surgical system can comprise: a light source configured to generate therapeutic laser light that includes one of first light or second light, the light source comprising a first laser configured to emit the first light at a first wavelength and a second laser configured to emit the second light at a second wavelength, water having a first absorption coefficient at the first wavelength, water having a second absorption coefficient at the second wavelength, the first absorption coefficient being greater than the second absorption coefficient; an optical fiber having a distal end configured to deliver the therapeutic laser light to a target site; a distance sensor configured to repeatedly measure a time-varying distance value that corresponds to a time-varying separation between the distal end of the optical fiber and the target site; and a controller configured to: compare each measured value of the time-varying distance value to a specified distance threshold; cause the light source to activate the first laser but not the second laser such that the therapeutic laser light has the first wavelength when the time- varying distance value is less than the specified distance threshold; and cause the light Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1source to activate the second laser but not the first laser such that the therapeutic laser light has the second wavelength when the time-varying distance value is greater than the specified distance threshold. BRIEF DESCRIPTION OF THE DRAWINGS

[0009] Various embodiments are illustrated by way of example in the figures of the accompanying drawings. Such embodiments are demonstrative and not intended to be exhaustive or exclusive embodiments of the present subject matter.

[0010] FIG. 1 shows a side-view schematic drawing of an example of a surgical system that includes an endoscope.

[0011] FIG. 2 shows a side-view schematic drawing of an example of a beamsplitter suitable for use with the surgical system of FIG. 1.

[0012] FIG. 3 shows a side-view schematic drawing of an example of a beamsplitter suitable for use with the surgical system of FIG. 1.

[0013] FIG. 4 shows a flow chart of an example of a method for operating a surgical system.

[0014] FIG. 5 shows a schematic diagram of an example of a computer-based clinical decision support system (CDSS) that is configured to provide a selection of a spectral profile from a plurality of (predefined) spectral profiles based on measured separation between a distal end of an optical fiber and a target site. DETAILED DESCRIPTION

[0015] In a laser therapy treatment, a practitioner can position a distal end of an endoscope close to a target, such as a kidney stone. The endoscope can include an optical fiber that can deliver therapeutic laser light to the target, such as via a distal end of the optical fiber. During the treatment, it can be beneficial to dynamically monitor a separation between the distal end of the optical fiber and the target. For example, if the distal end of the optical fiber is positioned too close to the target, it could lead to a condition known as flashing, which can degrade the distal end of the optical fiber. Likewise, if the distal end of the optical fiber is positioned too far from the target, then a significant fraction of the therapeutic laser light can be absorbed before reaching the Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1target, which can decrease an efficiency of the laser therapy treatment or cause the treatment to take longer.

[0016] To address the issue of absorption during propagation of the therapeutic laser light from the optical fiber to the target, an endoscope can dynamically measure a separation between the distal end of the optical fiber and the target, and dynamically vary a spectral profile of the therapeutic laser light as a function of the measured separation. For example, when the separation is relatively large, absorption during propagation may be significant, and the endoscope may select a spectral profile that has a relatively low amount of absorption in the propagation medium disposed between the optical fiber and the target. Likewise, when the separation is relatively small, absorption during propagation may become less significant, and the endoscope may select a spectral profile that has a relatively high amount of absorption in the propagation medium disposed between the optical fiber and the target. In some examples, the endoscope can include a controller that can cause a light source to temporally vary the spectral profile of the therapeutic laser light in response to the time-varying distance value. In some examples, the light source can include a first laser that is activated only when the time-varying distance value is less than a specified distance threshold and a second laser, at a different wavelength, that is activated only when the time-varying distance value is greater than the specified distance threshold.

[0017] FIG. 1 shows a side-view schematic drawing of an example of a surgical system 100 that includes an endoscope 102. The configuration of FIG. 1 is but one example of a surgical system; other configurations can also be used.

[0018] The endoscope 102 can include an elongated body portion extending between a proximal end 102P and a distal end 102D. The precise shape of the elongated body portion can depend on the medical procedure for which the endoscope 102 was originally designed. For simplicity, the elongated body portion is shown as being a cylinder, and having a circular cross-section, taken orthogonal to the direction of elongation. Other suitable shapes can also be used.

[0019] The surgical system 100 can include a light source 104 that can generate therapeutic laser light (L) and controllably vary a spectral profile of the therapeutic laser light (L). The surgical system 100 can include an optical fiber 106 having a distal end Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1106D that can deliver the therapeutic laser light (L) to a target site 108. The surgical system 100 can include a distance sensor 110 that can repeatedly measure a time-varying distance value (Z) that corresponds to a time-varying separation between the distal end 106D of the optical fiber 106 and the target site 108. The surgical system 100 can include a controller 112 that can cause the light source 104 to temporally vary the spectral profile of the therapeutic laser light (L) in response to the time-varying distance value (Z). The light source 104, the optical fiber 106, the distance sensor 110, and the controller 112 are presently described in more detail.

[0020] The light source 104 can generate therapeutic laser light (L) and controllably vary a spectral profile of the therapeutic laser light (L). For example, the light source 104 can receive an electrical spectral profile control signal 114 from the controller 112 and, in response, can produce therapeutic laser light (L) having one of a specified number of spectral profiles. The spectral profiles can correspond to spectral regions having different absorption coefficients (given in units of inverse length) or absorptivity, for a propagation medium (M) disposed between the distal end 106D of the optical fiber 106 and the target site 108, such as water. The controller 112 can select a spectral region that is suitable for the instantaneous (or nearly instantaneous) physical conditions during a procedure.

[0021] For example, if the distal end 106D of the optical fiber 106 is relatively far from the target site 108, the therapeutic laser light (L) can propagate through a relatively long distance in the propagation medium (M). For these cases, it may be desirable to select a spectral region for which the propagation medium (M) has a relatively low absorption coefficient or absorptivity, to reduce an amount of therapeutic laser light (L) that is lost to absorption before the therapeutic laser light (L) reaches the target site 108.

[0022] Similarly, if the distal end 106D of the optical fiber 106 is relatively close to the target site 108, the therapeutic laser light (L) can propagate through a relatively short distance in the propagation medium (M). For these cases, more absorption (per unit distance of propagation) in the propagation medium (M) can be tolerated, because there is less distance over which therapeutic laser light (L) propagates. For these cases, it may be desirable to select a spectral region for which the propagation medium (M) has a Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1relatively high absorption coefficient. For examples in which the propagation medium (M) is water or is mostly water, the target site 108 may also include a substantial fraction of water, and using a spectral region in which water has a relatively high absorption coefficient may improve an efficiency during ablation of the target site 108.

[0023] In some examples, such as cases in which a first spectral region corresponds to propagating a relatively small distance in the propagation medium (M) and a second spectral region corresponds to propagating a relatively large distance in the propagation medium (M), the first spectral region can have a relatively high absorption coefficient, and the second spectral region can have a relatively low absorption coefficient. In other words, the propagation medium (M) can have a first absorption coefficient in the first spectral region and a second absorption coefficient in the second spectral region, where the first absorption coefficient can be greater than the second absorption coefficient.

[0024] In some examples, the light source 104 can include a first laser 122 that can emit first light at a first wavelength (^^) and a second laser 124 that can emit second light at a second wavelength (^2). In some examples, the first wavelength (^^) can be about 1.9 microns, such as between about 1810 nm and about 2100 nm, between about 1900 nm and about 2000 nm, about 1940 nm, or 1940 nm. In some examples, the first laser 122 can include a thulium fiber laser. In some examples, the second wavelength (^2) can be about 2.1 microns, such as between about 2100 nm and about 2140 nm, about 2100 nm, or 2100 nm. In some examples, the second laser 124 can include a holmium yttrium aluminum garnet (Ho:YAG) laser. Other wavelengths and / or wavelength ranges can also be used. Other laser types can also be used.

[0025] In some examples, the first spectral profile can include only first light. In some examples, the second spectral profile can include only second light. For examples in which the light source 104 includes a first laser 122 that can emit first light at the first wavelength (^^) and a second laser 124 that can emit second light at the second wavelength (^2), the light source 104 may electrically power the first laser 122 but not the second laser 124 to form the therapeutic laser light (L) having the first spectral profile, and electrically power the second laser 124 but not the first laser 122 to form the therapeutic laser light (L) having the second spectral profile. Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1

[0026] In some examples, the surgical system 100 can further include a beamsplitter 126. The beamsplitter 126 can combine more of the first light than the second light to generate the first spectral profile, and combine more of the second light than the first light to generate the second spectral profile.

[0027] FIG. 2 shows a side-view schematic drawing of an example of a beamsplitter 126A suitable for use with the surgical system 100 of FIG. 1. The configuration of FIG. 2 is but one example of a beamsplitter 126A; other configurations can also be used.

[0028] In the example of FIG. 2, the beamsplitter 126A can include a dichroic beamsplitter. For example, for the configuration in which the first wavelength is about 1.9 microns and the second wavelength is about 2.1 microns, the dichroic beamsplitter can reflect most or all light at about 1.9 microns (or about 2.1 microns) and transmit most or all light at about 2.1 microns (or about 1.9 microns). The beamsplitter 126A can define a first optical path 202 that extends from the first laser 122 to the beamsplitter 126A and further to the distal end 106D of the optical fiber 106. The therapeutic laser light (L) can propagate along the first optical path 202. The beamsplitter 126A can further define a second optical path 204 that extends from the second laser 124 to the beamsplitter 126A and further to the distal end 106D of the optical fiber 106. The therapeutic laser light (L) can propagate along the second optical path 204. Other suitable beamsplitter configurations can also be used, including wavelength-insensitive, 50-50, fiber-based beamsplitters, and others.

[0029] FIG. 3 shows a side-view schematic drawing of an example of a beamsplitter 126B suitable for use with the surgical system 100 of FIG. 1. The configuration of FIG. 3 is but one example of a beamsplitter 126B; other configurations can also be used.

[0030] In the example of FIG. 3, the beamsplitter 126B can include at least one movable mirror. For example, the at least one movable mirror can receive a movable mirror signal 128 (FIG.1) from the controller 112 and, in response, move to a position that forms an optical path between one of the lasers 122, 124 and the optical fiber 106. In some examples, the movable mirror signal 128 can be an electrical movable mirror signal. The beamsplitter 126B can define a first optical path 202 that extends from the 7 Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1first laser 122 to the beamsplitter 126B and further to the distal end 106D of the optical fiber 106. The therapeutic laser light (L) can propagate along the first optical path 202. The beamsplitter 126B can further define a second optical path 204 that extends from the second laser 124 to the beamsplitter 126B and further to the distal end 106D of the optical fiber 106. The therapeutic laser light (L) can propagate along the second optical path 204. Other suitable movable mirror configurations can also be used, including mirrors that can rotate, translate, rotate and translate, and others.

[0031] Returning to FIG. 1, in some examples, the surgical system 100 can include a single optical fiber 106 extending along a length of the endoscope 102, and can include the beamsplitter 126 that can direct therapeutic laser light (L) at a suitable wavelength along an optical path that extends along a length of the optical fiber 106 to the distal end 106D of the optical fiber 106. In some examples, the surgical system 100 can include multiple optical fibers 106 extending parallel to one another along the length of the endoscope 102, each optical fiber 106 being configured to deliver therapeutic laser light (L) at a respective wavelength (^) to the target site 108.

[0032] The distance sensor 110 can repeatedly measure the time-varying distance value (Z) that corresponds to the time-varying separation between the distal end 106D of the optical fiber 106 and the target site 108. In some examples, the distance sensor 110 can measure the time-varying distance value (Z) discretely at regular or irregular time intervals. In some examples, the distance sensor 110 can measure the time-varying distance value (Z) continuously. In some examples, the distance sensor 110 can include an optical sensor that can direct electromagnetic energy toward the target site 108, capture reflected electromagnetic energy that is reflected from the target site 108, and determine the time-varying distance value (Z) from the captured reflected electromagnetic energy.

[0033] In some examples, such as the configuration shown in FIG. 1, the distance sensor 110 can be separate from the optical fiber 106 and the target site 108. In some examples, the distance sensor 110 can direct the electromagnetic energy toward the target site 108 via the optical fiber 106, such as by producing distance-sensor light at the light source 104 and using a beamsplitter such as beamsplitter 126 to direct the distance- sensor light distally along the optical fiber 106 toward the target site 108. Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1

[0034] In some examples, such as the configuration shown in FIG. 1, the distance sensor 110 can capture the reflected electromagnetic energy using a detector that is separate from the optical fiber 106. In some examples, the distance sensor 110 can capture the reflected electromagnetic energy via the optical fiber 106, such as by including one or more sensors in a housing that includes the light source 104 and using a beamsplitter such as beamsplitter 126 to direct the reflected electromagnetic energy to the one or more sensors.

[0035] In some examples, the optical sensor can include a time-of-flight sensor that can determine the time-varying distance value (Z) from an arrival time of the reflected electromagnetic energy. For example, the flight-of-flight sensor can be a light detection and ranging (LIDAR) system, using light or electromagnetic radiation at a suitable wavelength. Another suitable time-of-flight sensor can utilize frequency modulated continuous wave (FMCW) radiation, which may use continuous (e.g., non- pulsed) light, and in which the distance is proportional to a measured frequency difference. Another suitable time-of-flight sensor can utilize dual comb radiation, which may use two light sources with regularly spaced frequency components, with the frequency spacing being slightly different for the two light sources. In some examples, the distance sensor 110 can include a camera that can capture images of the target site 108 and determine the time-varying distance value (Z) from the captured images. In some examples, the distance sensor 110 can include an acoustic device that can direct acoustic energy toward the target site 108, capture reflected acoustic energy that is reflected from the target site 108, and determine the time-varying distance value (Z) from the captured reflected acoustic energy. For example, the acoustic device can be an acoustic imager. These are but mere examples; other suitable distance sensors can also be used.

[0036] The controller 112 can cause the light source 104 to temporally vary the spectral profile of the therapeutic laser light (L) in response to the time-varying distance value (Z). For example, the controller 112 can apply one or more criteria to the time- varying distance value (Z) to decide whether the distal end 106D of the optical fiber 106 is relatively close to, or relative far from, the target site 108 and, in response, cause the light source 104 to generate the therapeutic laser light (L) to have the first spectral profile Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1or the second spectral profile. In some examples, the controller 112 can compare each measured value of the time-varying distance value (Z) to a specified distance threshold (Z0). The controller 112 can cause the light source 104 to generate the therapeutic laser light (L) to have a first spectral profile when the time-varying distance value (Z) is less than the specified distance threshold (Z0). The controller 112 can cause the light source 104 to generate the therapeutic laser light (L) to have a second spectral profile, different from the first spectral profile, when the time-varying distance value (Z) is greater than the specified distance threshold (Z0).

[0037] In some examples, the specified distance threshold (Z0) can be user- selectable. For example, the specified distance threshold (Z0) can user-selectable based on stone type and / or tissue type. The stone type and / or tissue type can be identified automatically by the surgical system 100, such as by performing spectral analysis of one or more images captured by a camera at the distal end 102D of the endoscope 102. Alternatively or in addition, the stone type and / or tissue type can be identified manually by a user, such as by the user inputting information to the controller 112. As another example, the specified distance threshold (Z0) can be user-selectable based on which technique is used for removing the stone. For example, two such removal techniques are dusting and fragmenting. The user can automatically or manually select the specified distance threshold (Z0) based on the removal technique. Other criteria can also be applied to selecting the specified distance threshold (Z0).

[0038] In some examples, the controller 112 can automatically activate the first laser 122 but not the second laser 124 when the time-varying distance value (Z) is less than the specified distance threshold (Z0). In some examples, the controller 112 can automatically activate the second laser 124 but not the first laser 122 when the time- varying distance value (Z) is greater than the specified distance threshold (Z0). In some examples, the controller 112 can automatically select which laser is activated, based on spectral analysis of the image or images captured by the camera at the distal end 102D of the endoscope 102. In some examples, the controller 112 can automatically adjust the specified distance threshold (Z0), based on spectral analysis of the image or images captured by the camera at the distal end 102D of the endoscope 102. Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1

[0039] In some examples, the controller 112 can trigger an alarm 130, via an electrical alert activation signal 132, to a user when one of the first laser 122 or the second laser 124 becomes one of activated or deactivated. In some examples, the alarm 130 can include a visual alarm such as series of LEDs or colored LEDs. In some examples, the alarm 130 can include a speaker configured to produce an audible alarm, such as a beep. In some examples, the alarm 130 can include both a visible alarm and an audible alarm. Other suitable alarms can also be used.

[0040] In some examples, more than two wavelengths or wavelength ranges can also be used. In some examples, more than one specified distance threshold can also be used.

[0041] In a specific example, a surgical system 100 can include a light source 104 that can generate therapeutic laser light (L) that includes one of first light or second light. The light source 104 can include a first laser 122 that can emit the first light at a first wavelength (^^) and a second laser 124 that can emit the second light at a second wavelength (^2). Water can have a first absorption coefficient at the first wavelength (^^). Water can have a second absorption coefficient at the second wavelength (^2). The first absorption coefficient can be greater than the second absorption coefficient. The surgical system 100 can include an optical fiber 106 having a distal end 106D that can deliver the therapeutic laser light (L) to a target site 108. The surgical system 100 can include a distance sensor 110 that can repeatedly measure a time-varying distance value (Z) that corresponds to a time-varying separation between the distal end 106D of the optical fiber 106 and the target site 108. The surgical system 100 can include a controller 112. The controller 112 can compare each measured value of the time-varying distance value (Z) to a specified distance threshold (Z0). The controller 112 can cause the light source 104 to activate the first laser 122 but not the second laser 124 such that the therapeutic laser light (L) has the first wavelength (^^) when the time-varying distance value (Z) is less than the specified distance threshold (Z0). The controller 112 can cause the light source 104 to activate the second laser 124 but not the first laser 122 such that the therapeutic laser light (L) has the second wavelength (^2) when the time- varying distance value (Z) is greater than the specified distance threshold (Z0). 11 Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1

[0042] FIG. 4 shows a flow chart of an example of a method 400 for operating an endoscope, such as the endoscope 102 of FIG. 1 or other suitable endoscopes. The method 400 of FIG. 4 is but one example of a method for operating an endoscope. Other suitable methods can also be used.

[0043] At operation 402, the method 400 can include generating therapeutic laser light, such as the therapeutic laser light (L), with a light source, such as the light source 104, having a variable spectral profile.

[0044] At operation 404, the method 400 can include propagating the therapeutic laser light distally along a length of an optical fiber, such as the optical fiber 106.

[0045] At operation 406, the method 400 can include propagating the therapeutic laser light from a distal end of the optical fiber to a target site, such as the target site 108.

[0046] At operation 408, the method 400 can include repeatedly measuring a time-varying distance value, such as the time-varying distance value (Z), that corresponds to a time-varying separation between the distal end of the optical fiber and the target site. The time-varying distance value can be measured with the distance sensor 110, or another suitable distance sensor.

[0047] At operation 410, the method 400 can include causing the light source to temporally vary the spectral profile of the therapeutic laser light in response to the time- varying distance value. Operation 410 can optionally include comparing each measured value of the time-varying distance value to a specified distance threshold. Operation 410 can optionally include causing the light source to generate the therapeutic laser light to have a first spectral profile when the time-varying distance value is less than the specified distance threshold. Operation 410 can optionally include causing the light source to generate the therapeutic laser light to have a second spectral profile, different from the first spectral profile, when the time-varying distance value is greater than the specified distance threshold.

[0048] FIG. 5 shows a schematic diagram of an example of a computer-based clinical decision support system (CDSS) 500 that is configured to provide a selection of a spectral profile from a plurality of (predefined) spectral profiles based on measured separation between a distal end of an optical fiber, such as optical fiber 106, and a target site, such as target site 108. In various embodiments, the CDSS 500 includes an input Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1interface 502 through which the optical property which is specific to a patient is provided as input features to an artificial intelligence (AI) model 504, a processor, such as controller 112, which performs an inference operation in which the measured separation is applied to the AI model to generate the spectral profile, and a user interface (UI) through which the spectral profile is communicated to a user, e.g., a clinician.

[0049] In some embodiments, the input interface 502 may be a direct data link between the CDSS 500 and one or more medical devices, such as surgical system 100 or endoscope 102, which generate at least some of the input features. For example, the input interface 502 may transmit the optical property directly to the CDSS during a therapeutic and / or diagnostic medical procedure. Additionally, or alternatively, the input interface 502 may be a classical user interface that facilitates interaction between a user and the CDSS 500. For example, the input interface 502 may facilitate a user interface through which the user may manually enter the measured separation. Additionally, or alternatively, the input interface 502 may provide the CDSS 500 with access to an electronic patient record from which one or more input features may be extracted. In any of these cases, the input interface 502 is configured to collect the optical property in association with a specific patient on or before a time at which the CDSS 500 is used to assess the medical condition addressed by the surgical system 100 or endoscope 102, such as a kidney stone.

[0050] Based on one or more of the above input features, the processor, such as controller 112, performs an inference operation using the AI model to generate the spectral profile. For example, input interface 502 may deliver the measured separation into an input layer of the AI model which propagates this input feature through the AI model to an output layer. The AI model can provide a computer system the ability to perform tasks, without explicitly being programmed, by making inferences based on patterns found in the analysis of data. AI model explores the study and construction of algorithms (e.g., machine-learning algorithms) that may learn from existing data and make predictions about new data. Such algorithms operate by building an AI model from example training data in order to make data-driven predictions or decisions expressed as outputs or assessments. Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1

[0051] There are two common modes for machine learning (ML): supervised ML and unsupervised ML. Supervised ML uses prior knowledge (e.g., examples that correlate inputs to outputs or outcomes) to learn the relationships between the inputs and the outputs. The goal of supervised ML is to learn a function that, given some training data, best approximates the relationship between the training inputs and outputs so that the ML model can implement the same relationships when given inputs to generate the corresponding outputs. Unsupervised ML is the training of an ML algorithm using information that is neither classified nor labeled 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.

[0052] Common tasks for supervised ML are classification problems and regression problems. Classification problems, also referred to as categorization problems, aim at classifying items into one of several category values (for example, is this object an apple or an orange?). Regression algorithms aim at quantifying some items (for example, by providing a score to the value of some input). Some examples of commonly used supervised-ML algorithms are Logistic Regression (LR), Naive-Bayes, Random Forest (RF), neural networks (NN), deep neural networks (DNN), matrix factorization, and Support Vector Machines (SVM).

[0053] 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.

[0054] Another type of ML is federated learning (also known as collaborative learning) that trains an algorithm across multiple decentralized devices holding local data, without exchanging the data. This approach stands in contrast to traditional centralized machine-learning techniques where all the local datasets are uploaded to one server, as well as to more classical decentralized approaches which often assume that local data samples are identically distributed. Federated learning enables multiple actors to build a common, robust machine learning model without sharing data, thus allowing to address critical issues such as data privacy, data security, data access rights and access to heterogeneous data. Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1

[0055] In some examples, the AI model may be trained continuously or periodically prior to performance of the inference operation by the processor such as controller 112. Then, during the inference operation, the 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 that corresponds to the spectral profile.

[0056] In some examples, the AI model can include a database, which can include data corresponding to a patient. The database can provide a patient record to the CDSS 500. IN some examples, the AI model can receive a measured separation from a distance sensor, such as distance sensor 110.

[0057] During and / or subsequent to the inference operation, the spectral profile may be communicated to the user via the user interface (UI) and / or automatically cause the processor or an alarm connected to the processor to perform a desired action. For example, the processor can cause the light source to produce light having the selected spectral profile. Alternatively, the processor can cause the alarm to alert the practitioner.

[0058] In some examples, the CDSS 500 can optionally be used to determine the action taken in response to a value of measured separation.

[0059] In the foregoing detailed description, the method and apparatus of the present disclosure have been described with reference to specific embodiments thereof. It will, however, be evident that various modifications and changes may be made thereto without departing from the broader spirit and scope of the present disclosure. The present specification and figures are accordingly to be regarded as illustrative rather than restrictive.

[0060] To further illustrate the device and related method disclosed herein, a non-limiting list of examples is provided below. Each of the following non limiting examples can stand on its own or can be combined in any permutation or combination with any one or more of the other examples.

[0061] In Example 1, an endoscope can include: a light source configured to generate therapeutic laser light and controllably vary a spectral profile of the therapeutic laser light; an optical fiber having a distal end configured to deliver the therapeutic laser light to a target site; a distance sensor configured to repeatedly measure a time-varying distance value that corresponds to a time-varying separation between the distal end of the Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1optical fiber and the target site; and a controller configured to cause the light source to temporally vary the spectral profile of the therapeutic laser light in response to the time- varying distance value.

[0062] In Example 2, the endoscope of Example 1 can optionally be configured such that the controller is further configured to: compare each measured value of the time-varying distance value to a specified distance threshold; and cause the light source to generate the therapeutic laser light to have a first spectral profile when the time- varying distance value is less than the specified distance threshold.

[0063] In Example 3, the endoscope of any one of Examples 1-2 can optionally be configured such that the controller is further configured to cause the light source to generate the therapeutic laser light to have a second spectral profile, different from the first spectral profile, when the time-varying distance value is greater than the specified distance threshold.

[0064] In Example 4, the endoscope of any one of Examples 1-3 can optionally be configured such that the specified distance threshold is user-selectable.

[0065] In Example 5, the endoscope of any one of Examples 1-4 can optionally be configured such that the first spectral profile and the second spectral profile result in different amounts of absorption of the therapeutic laser light in a medium located between the distal end of the optical fiber and the target site.

[0066] In Example 6, the endoscope of any one of Examples 1-5 can optionally be configured such that the light source comprises a first laser configured to emit first light at a first wavelength and a second laser configured to emit second light at a second wavelength.

[0067] In Example 7, the endoscope of any one of Examples 1-6 can optionally be configured such that: the first laser comprises a thulium fiber laser; and the second laser comprises a holmium yttrium aluminum garnet (Ho:YAG) laser.

[0068] In Example 8, the endoscope of any one of Examples 1-7 can optionally be configured such that: the first wavelength is about 1.9 microns; and the second wavelength is about 2.1 microns. Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1

[0069] In Example 9, the endoscope of any one of Examples 1-8 can optionally be configured such that: the first spectral profile includes only first light; and the second spectral profile includes only second light.

[0070] In Example 10, the endoscope of any one of Examples 1-9 can optionally be configured such that the controller is further configured to: automatically activate the first laser but not the second laser when the time-varying distance value is less than the specified distance threshold; and automatically activate the second laser but not the first laser when the time-varying distance value is greater than the specified distance threshold.

[0071] In Example 11, the endoscope of any one of Examples 1-10 can optionally be configured such that the controller is further configured to provide an alert to a user when one of the first laser or the second laser becomes one of activated or deactivated.

[0072] In Example 12, the endoscope of any one of Examples 1-11 can optionally further include a beamsplitter configured to: combine more of the first light than the second light to generate the first spectral profile; and combine more of the second light than the first light to generate the second spectral profile.

[0073] In Example 13, the endoscope of any one of Examples 1-12 can optionally further include a beamsplitter defining a first optical path that extends from the first laser to the beamsplitter and further to the distal end of the optical fiber, the therapeutic laser light configured to propagate along the first optical path, the beamsplitter further defining a second optical path that extends from the second laser to the beamsplitter and further to the distal end of the optical fiber, the therapeutic laser light configured to propagate along the second optical path.

[0074] In Example 14, the endoscope of any one of Examples 1-13 can optionally be configured such that the beamsplitter comprises a dichroic beamsplitter.

[0075] In Example 15, the endoscope of any one of Examples 1-14 can optionally be configured such that the beamsplitter comprises at least one movable mirror.

[0076] In Example 16, the endoscope of any one of Examples 1-15 can optionally be configured such that the distance sensor comprises an optical sensor Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1configured to direct electromagnetic energy toward the target site, capture reflected electromagnetic energy that is reflected from the target site, and determine the time- varying distance value from the captured reflected electromagnetic energy.

[0077] In Example 17, the endoscope of any one of Examples 1-16 can optionally be configured such that the optical sensor comprises a time-of-flight sensor configured to determine the time-varying distance value from an arrival time of the reflected electromagnetic energy.

[0078] In Example 18, the endoscope of any one of Examples 1-17 can optionally be configured such that the distance sensor comprises a camera configured to capture images of the target site and determine the time-varying distance value from the captured images.

[0079] In Example 19, the endoscope of any one of Examples 1-18 can optionally be configured such that the distance sensor comprises an acoustic device configured to direct acoustic energy toward the target site, capture reflected acoustic energy that is reflected from the target site, and determine the time-varying distance value from the captured reflected acoustic energy.

[0080] In Example 20, a method for operating an endoscope can include: generating therapeutic laser light with a light source having a variable spectral profile; propagating the therapeutic laser light distally along a length of an optical fiber; propagating the therapeutic laser light from a distal end of the optical fiber to a target site; repeatedly measuring a time-varying distance value that corresponds to a time- varying separation between the distal end of the optical fiber and the target site; and causing the light source to temporally vary the spectral profile of the therapeutic laser light in response to the time-varying distance value.

[0081] In Example 21, the method of Example 20 can optionally be configured such that causing the light source to temporally vary the spectral profile of the therapeutic laser light in response to the time-varying distance value comprises: comparing each measured value of the time-varying distance value to a specified distance threshold; causing the light source to generate the therapeutic laser light to have a first spectral profile when the time-varying distance value is less than the specified distance threshold; and causing the light source to generate the therapeutic laser light to Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1have a second spectral profile, different from the first spectral profile, when the time- varying distance value is greater than the specified distance threshold.

[0082] In Example 22, an endoscope can include: a light source configured to generate therapeutic laser light that includes one of first light or second light, the light source comprising a first laser configured to emit the first light at a first wavelength and a second laser configured to emit the second light at a second wavelength, water having a first absorption coefficient at the first wavelength, water having a second absorption coefficient at the second wavelength, the first absorption coefficient being greater than the second absorption coefficient; an optical fiber having a distal end configured to deliver the therapeutic laser light to a target site; a distance sensor configured to repeatedly measure a time-varying distance value that corresponds to a time-varying separation between the distal end of the optical fiber and the target site; and a controller configured to: compare each measured value of the time-varying distance value to a specified distance threshold; cause the light source to activate the first laser but not the second laser such that the therapeutic laser light has the first wavelength when the time- varying distance value is less than the specified distance threshold; and cause the light source to activate the second laser but not the first laser such that the therapeutic laser light has the second wavelength when the time-varying distance value is greater than the specified distance threshold. Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1

Claims

WHAT IS CLAIMED IS:

1. A surgical system, comprising: a light source configured to generate therapeutic laser light and controllably vary a spectral profile of the therapeutic laser light; an optical fiber having a distal end configured to deliver the therapeutic laser light to a target site; a distance sensor configured to repeatedly measure a time-varying distance value that corresponds to a time-varying separation between the distal end of the optical fiber and the target site; and a controller configured to cause the light source to temporally vary the spectral profile of the therapeutic laser light in response to the time-varying distance value.

2. The surgical system of claim 1, wherein the controller is further configured to: compare each measured value of the time-varying distance value to a specified distance threshold; and cause the light source to generate the therapeutic laser light to have a first spectral profile when the time-varying distance value is less than the specified distance threshold.

3. The surgical system of claim 2, wherein the controller is further configured to cause the light source to generate the therapeutic laser light to have a second spectral profile, different from the first spectral profile, when the time-varying distance value is greater than the specified distance threshold.

4. The surgical system of claim 2, wherein the specified distance threshold is user- selectable.

5. The surgical system of claim 2, wherein the first spectral profile and the second spectral profile result in different amounts of absorption of the therapeutic laser light in a medium located between the distal end of the optical fiber and the target site. Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO16. The surgical system of claim 5, wherein the light source comprises a first laser configured to emit first light at a first wavelength and a second laser configured to emit second light at a second wavelength.

7. The surgical system of claim 6, wherein: the first laser comprises a thulium fiber laser; and the second laser comprises a holmium yttrium aluminum garnet (Ho:YAG) laser; the first wavelength is about 1.9 microns; and the second wavelength is about 2.1 microns.

8. The surgical system of claim 6, wherein: the first spectral profile includes only first light; and the second spectral profile includes only second light.

9. The surgical system of claim 6, wherein the controller is further configured to: automatically activate the first laser but not the second laser when the time- varying distance value is less than the specified distance threshold; and automatically activate the second laser but not the first laser when the time- varying distance value is greater than the specified distance threshold.

10. The surgical system of claim 9, wherein the controller is further configured to provide an alert to a user when one of the first laser or the second laser becomes one of activated or deactivated.

11. The surgical system of claim 6, further comprising a beamsplitter configured to: combine more of the first light than the second light to generate the first spectral profile; and combine more of the second light than the first light to generate the second spectral profile. Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO112. The surgical system of claim 6, further comprising a beamsplitter defining a first optical path that extends from the first laser to the beamsplitter and further to the distal end of the optical fiber, the therapeutic laser light configured to propagate along the first optical path, the beamsplitter further defining a second optical path that extends from the second laser to the beamsplitter and further to the distal end of the optical fiber, the therapeutic laser light configured to propagate along the second optical path.

13. The surgical system of claim 12, wherein the beamsplitter comprises a dichroic beamsplitter or at least one movable mirror.

14. The surgical system of claim 1, wherein the distance sensor comprises an optical sensor configured to direct electromagnetic energy toward the target site, capture reflected electromagnetic energy that is reflected from the target site, and determine the time-varying distance value from the captured reflected electromagnetic energy.

15. The surgical system of claim 14, wherein the optical sensor comprises a time-of- flight sensor configured to determine the time-varying distance value from an arrival time of the reflected electromagnetic energy.

16. The surgical system of claim 1, wherein the distance sensor comprises a camera configured to capture images of the target site and determine the time-varying distance value from the captured images.

17. The surgical system of claim 1, wherein the distance sensor comprises an acoustic device configured to direct acoustic energy toward the target site, capture reflected acoustic energy that is reflected from the target site, and determine the time- varying distance value from the captured reflected acoustic energy.

18. A method for operating a surgical system, the method comprising: generating therapeutic laser light with a light source having a variable spectral profile; Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1propagating the therapeutic laser light distally along a length of an optical fiber; propagating the therapeutic laser light from a distal end of the optical fiber to a target site; repeatedly measuring a time-varying distance value that corresponds to a time- varying separation between the distal end of the optical fiber and the target site; and causing the light source to temporally vary the spectral profile of the therapeutic laser light in response to the time-varying distance value.

19. The method of claim 18, wherein causing the light source to temporally vary the spectral profile of the therapeutic laser light in response to the time-varying distance value comprises: comparing each measured value of the time-varying distance value to a specified distance threshold; causing the light source to generate the therapeutic laser light to have a first spectral profile when the time-varying distance value is less than the specified distance threshold; and causing the light source to generate the therapeutic laser light to have a second spectral profile, different from the first spectral profile, when the time-varying distance value is greater than the specified distance threshold.

20. A surgical system, comprising: a light source configured to generate therapeutic laser light that includes one of first light or second light, the light source comprising a first laser configured to emit the first light at a first wavelength and a second laser configured to emit the second light at a second wavelength, water having a first absorption coefficient at the first wavelength, water having a second absorption coefficient at the second wavelength, the first absorption coefficient being greater than the second absorption coefficient; an optical fiber having a distal end configured to deliver the therapeutic laser light to a target site; Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1a distance sensor configured to repeatedly measure a time-varying distance value that corresponds to a time-varying separation between the distal end of the optical fiber and the target site; and a controller configured to: compare each measured value of the time-varying distance value to a specified distance threshold; cause the light source to activate the first laser but not the second laser such that the therapeutic laser light has the first wavelength when the time-varying distance value is less than the specified distance threshold; and cause the light source to activate the second laser but not the first laser such that the therapeutic laser light has the second wavelength when the time-varying distance value is greater than the specified distance threshold. Attorney Docket No.: 5409.823WO1 Client Ref. No.: GAP23025-URJD-WO1

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