Laser pumping signal triggered spectroscopic data collection

Abstract

Systems and methods for identifying an anatomical target during a surgical laser procedure and adjusting laser treatment are disclosed. An exemplary surgical laser system includes a laser system to emit laser energy via a laser fiber to an anatomical target, at least one optical sensor to sense data indicative of optical properties of the target, a pumping signal detector to detect a presence or absence of a laser pumping signal that provides the laser energy in the laser system, and a control system to coordinate triggered sensor data collection with laser emission based on the detection of laser pumping signal. The control system can identify a type or composition of the anatomical target using the coordinated collection of sensor data, and adjust a laser output setting based on the result of target identification.

Description

LASER PUMPING SIGNAL TRIGGERED SPECTROSCOPIC DATA COLLECTIONPRIORITY CLAIM

[0001] This application claims the benefit of priority to U.S. Provisional Patent Application Serial No. 63 / 655,206, filed lune 3, 2024, the contents of which are incorporated herein by reference.TECHNICAL FIELD

[0002] This document relates generally to surgical laser systems, and more specifically relates to a laser endoscopy system for coordinated spectroscopic data collection and target identification during an endoscopy procedure.BACKGROUND

[0003] Endoscopes are typically used to provide access to an internal location of a patiem so that a doctor is provided with visual access. Some endoscopes are used in minimally invasive surgery to remove unwanted tissue or foreign objects from the body of the patient. For example, a nephroscope is used by a clinician to inspect the renal system, and to perform various procedures under direct visual control. In a percutaneous nephrolithotomy (PCNL) procedure, a nephroscope is placed through the patient’s flank into the renal pelvis. Calculi or mass from various regions of a body including, for example, urinary system, gallbladder, nasal passages, gastrointestinal tract, stomach, or tonsils, can be visualized and extracted.

[0004] Laser or plasma systems have been used for delivering surgical laser energy to various target treatment areas such as soft or hard tissue. Laser emission is typically produced through a laser pumping process. Excitation energy is introduced into a laser system to produce a population inversion, where more atoms or molecules in a gain medium are in an excited state than in the ground state. Laser pumping can be achieved through optical, electrical, or chemical means. In optical pumping, an incoming photon excites atoms or molecules in the gain medium, which emits a second photon of the samewavelength and phase. Such amplification process increases the probability of stimulated emission of coherent light that is in phase and has a single wavelength and direction, thus enables lasing to occur.

[0005] Examples of the laser therapy include ablation, coagulation, vaporization, fragmentation, etc. In lithotripsy applications, laser has been used to break down calculi structures in kidney, gallbladder, ureter, among other stone-forming regions, or to ablate large calculi into smaller fragments. In endoscopic laser therapy, it is desirable that lasers be applied only to target treatment structures (e.g., calculi or cancerous tissue), and spare non-treatment tissue from unintended laser irradiation.SUMMARY

[0006] The present document describes systems, devices, and methods for identifying an anatomical target such as a calculi structure or tissue during a medical procedure such as a surgical laser procedure using sensor data collected from an anatomical target, and automatically adjusting therapy in accordance with the result of target identification. To improve target identification accuracy, sensor data are collected at selected times or in response to certain trigger events, such as events indicating laser energy being delivered to the anatomical target. In certain cases where continuous target identification and laser adjustment are desired, sensor data collection and analysis may be coordinated or synchronized with laser emission, such that the collected sensor data are not substantially interfered by laser emission.

[0007] In accordance with an embodiment described herein, a surgical laser system includes a laser system to emit laser energy via a laser fiber to an anatomical target, at least one optical sensor to sense data indicative of optical properties of the anatomical target, a pumping signal detector to detect a presence or absence of a laser pumping signal that provides the laser energy over a laser gain medium in the laser system, and a control system to coordinate collection of sensor data sensed by the at least one optical sensor with laser emission from the laser system based on the detection of laser pumping signal. The control system can identify a type or composition of the anatomical targetusing the coordinated collection of sensor data, and determine or adjust a laser output setting of the laser system based on the result of target identification.

[0008] Example 1 is a surgical laser system. The system includes: a laser system configured to emit laser energy via a laser fiber to an anatomical target, the laser energy provided by a laser pumping signal having a pumping wavelength or wavelength range over a laser gain medium; at least one optical sensor configured to sense data indicative of optical properties of the anatomical target; a pumping signal detector configured to detect a presence or absence of the laser pumping signal produced by the laser system; and a control system configured to: based on the detection of the laser pumping signal, coordinate collection of sensor data sensed by the at least one optical sensor with laser emission from the laser system; and identify a type or composition of the anatomical target using the coordinated collection of sensor data.

[0009] In Example 2, the subject matter of Example 1 optionally includes wherein to coordinate the collection of sensor data with the laser emission includes to initiate the collection of sensor data at specific durations determined based on the detected laser pumping signal.

[0010] In Example 3, the subject matter of Example 2 optionally includes the laser pumping signal that can include a pumping pulse train with pulse ON periods and pulse OFF periods, and wherein to coordinate collection of sensor data with the laser emission, the control system is configured to: enable sensor data collection between consecutive pulses in the pumping pulse train during the pulse OFF periods, and disable sensor data collection during the pulse ON periods; and identify the type or composition of the anatomical target using the collected sensor data between the consecutive pulses during the pulse OFF periods.

[0011] In Example 4, the subject matter of Example 3 optionally includes the pumping signal detector that can be configured to continuously or periodically detect the presence or absence of the laser pumping signal during the laser emission; and the control system that can be configured to detect the pulse ON periods based on the detected presence of the laser pumping signal, and to detect the pulse OFF periods based on the detected absence of the laser pumping signal.

[0012] In Example 5, the subject matter of Example 4 optionally includes the control system that can be configured to detect one or more of the pulse ON periods or the pulse OFF periods further based on one or more pulse train parameters including a pulse width or a pulse rate.

[0013] In Example 6, the subject matter of any one or more of Examples 1-5 optionally includes a memory circuit configured to continuously record and buffer the sensor data sensed by the at least one optical sensor, wherein the control system is configured to, in response to the detected presence of the laser pumping signal: set a flag or timestamp of the laser pumping signal on the continuously recorded and buffered sensor data; coordinate collection of a portion of the continuously recorded and buffered sensor data relative in time to the set flag or timestamp; and identify the type or composition of the anatomical target using the collected portion of the continuously recorded and buffered sensor data.

[0014] In Example 7, the subject matter of any one or more of Examples 1-6 optionally includes the laser system that can include infrared (IR) emitting diodes configured to generate a near-IR laser pumping signal.

[0015] In Example 8, the subject matter of any one or more of Examples 1-7 optionally includes the control system that can include a spectrometer configured to perform a spectral analysis of the sensed spectroscopic data.

[0016] In Example 9, the subject matter of Examples 8 optionally includes the sensor data being collected in response to the laser emission to the anatomical target, wherein the pumping signal detector is configured to detect the presence or absence of the laser pumping signal based on a spectral content at or within the pumping wavelength or wavelength range determined from the spectral analysis of the sensed sensor data.

[0017] In Example 10, the subject matter of Example 9 optionally includes the spectral analysis that can be performed on an integration of multiple measurements of the sensor data at distinct times during a specific data collection period.

[0018] In Example 11, the subject matter of any one or more of Examples 1-10 optionally includes the sensor data being collected in response to an electromagnetic radiation from a light source to the anatomical target, theelectromagnetic radiation having a wavelength or wavelength range different than the pumping wavelength or wavelength range.

[0019] In Example 12, the subject matter of Example 11 optionally incudes the control system that can identify the type or composition of the anatomical target based on a spectral content of the coordinatedly collected sensor data.

[0020] In Example 13, the subject matter of any one or more of Examples 1-12 optionally includes the control system that can be electrically coupled to the laser system, and electronically triggered to initiate the coordinated collection of the sensor data in response to the detection of the laser pumping signal.

[0021] In Example 14, the subject matter of any one or more of Examples 1-13 optionally includes the control system that can be optically coupled to the laser system, and optically triggered to initiate the coordinated collection of the sensor data in response to the detection of the laser pumping signal.

[0022] In Example 15, the subject matter of any one or more of Examples 1-13 optionally includes the control system that can be configured to adjust a laser output setting of the laser system based at least in part on the identified type or composition of the anatomical target.

[0023] In Example 16, the subject matter of Example 15 optionally includes the pumping signal detector that can be configured to redetect the presence or absence of the laser pumping signal produced by the laser system in accordance with the adjusted laser output setting, wherein the feedback analyzer is configured to, based on the redetection of the laser pumping signal, coordinate the collection of sensor data with the laser emission generated in accordance with the adjusted laser output setting.

[0024] In Example 17, the subject matter of any one or more of Examples 1-16 optionally includes, wherein the anatomical target includes a calculi target, wherein the control system is configured to adjust a laser output setting based at least in part on the identification of the calculi target, and to control the laser system to emit the laser energy to the calculi target inaccordance with the adjusted laser output setting to ablate or fragment the calculi target.

[0025] In Example 18, the subject matter of any one or more of Examples 1-17 optionally includes, wherein to identify the type or composition of the anatomical target includes to identify the anatomical target as a treatment target or a non-treatment target, wherein the control system is configured to control the laser system to enable emission of laser energy to the treatment target, and to disable emission of laser energy to the non-treatment target.

[0026] Example 19 is a method of identifying an anatomical target and providing laser treatment thereof via a laser system, the method comprising: directing laser energy provided by a laser pumping signal in the laser system, and electromagnetic radiation produced by a light source, to the anatomical target, the laser pumping signal and the electromagnetic radiation having distinct wavelengths or wavelength ranges; sensing data indicative of optical properties of the anatomical target using at least one optical sensor; detecting a presence or absence of the laser pumping signal from the sensed data; based on the detection of the laser pumping signal, coordinating collection of sensor data sensed by the at least one optical sensor with laser emission from the laser system; and identifying a type or composition of the anatomical target using the coordinated collection of sensor data.

[0027] In Example 20, the subject matter of Example 19 optionally includes the laser pumping signal that can include a pumping pulse train with pulse ON periods and pulse OFF periods, wherein coordinating the collection of sensor data with the laser emission includes enabling sensor data collection between consecutive pulses in the pumping pulse train during the pulse OFF periods, and disabling sensor data collection during the pulse ON periods.

[0028] In Example 21, the subject matter of Example 20 optionally includes detecting one or more of the pulse ON periods or the pulse OFF periods further based on one or more pulse train parameters including a pulse width or a pulse rate.

[0029] In Example 22, the subject matter of any one or more of Examples 19-21 optionally include continuously recording and buffering the sensor data sensed by the at least one optical sensor in a memory circuit; and inresponse to the detected presence of the laser pumping signal, setting a flag or timestamp of the laser pumping signal on the continuously recorded and buffered sensor data, wherein coordinating the collection of sensor data includes a portion of the continuously recorded and buffered sensor data relative in time to the set flag or timestamp, wherein identifying the type or composition of the anatomical target includes using the collected portion of the continuously recorded and buffered sensor data.

[0030] In Example 23, the subject matter of any one or more of Examples 19-22 optionally includes performing a spectral analysis of the sensed sensor data.

[0031] In Example 24, the subject matter of Example 23 optionally includes detecting the presence or absence of the laser pumping signal based on a spectral content at or within the pumping wavelength or wavelength range determined from the spectral analysis of the sensed sensor data.

[0032] In Example 25, the subject matter of any one or more of Examples 23-24 optionally includes identifying the type or composition of the anatomical target based on a spectral content at or within the wavelength or wavelength range of the electromagnetic radiation determined from the spectral analysis of the coordinated collection of the sensor data.

[0033] In Example 26, the subject matter of any one or more of Examples 19-25 optionally includes adjusting a laser output setting of the laser system based at least in part on the identified type or composition of the anatomical target.

[0034] In Example 27, the subject matter of any one or more of Examples 19-26 optionally includes adjusting a laser output setting of the laser system based at least in part on the identified type or composition of the anatomical target; and providing laser energy to the anatomical target via the laser system in accordance with the adjusted laser output setting.

[0035] In Example 28, the subject matter of Example 27 optionally includes identifying the type or composition of the anatomical target that can include identifying one or more compositions of a calculi target, wherein adjusting the laser output setting is based at least in part on the identified calculitarget, wherein the laser energy is provided in accordance with the adjusted laser output setting to ablate or fragment the calculi target.

[0036] In Example 29, the subject matter of any one or more of Examples 27-28 optionally includes identifying the type or composition of the anatomical target that can include identifying the anatomical target as a treatment target or a non-treatment target, wherein adjusting the laser output setting includes enabling emission of laser energy to the treatment target and disabling emission of the laser energy to the non-treatment target.

[0037] This summary is an overview of some of the teachings of the present application and not intended to be an exclusive or exhaustive treatment of the present subject matter. Further details about the present subject matter are found in the detailed description and appended claims. Other aspects of the disclosure will be apparent to persons skilled in the art upon reading and understanding the following detailed description and viewing the drawings that form a part thereof, each of which are not to be taken in a limiting sense. The scope of the present disclosure is defined by the appended claims and their legal equivalents.BRIEF DESCRIPTION OF THE DRAWINGS

[0038] 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.

[0039] FIG. l is a block diagram illustrating an example of a laser treatment system configured to provide laser therapy to a target structure in a body, such as an anatomical structure or a calculus structure.

[0040] FIG. 2 is a block diagram illustrating a surgical laser system and a part of the environment in which said system may be used.

[0041] FIG. 3 illustrates an example of an endoscopic laser lithotripsy system with a feedback control using coordinated collection of sensor data.

[0042] FIGS. 4A-4B illustrate examples of reflectance spectra over a wavelength range when lasers are incident on a target structure.

[0043] FIG. 5 illustrates an optical pumping signal comprising a pulse train with alternating pulse ON periods and pulse OFF periods, and coordinated sensor data collection during the pulse OFF periods for in vivo target identification.

[0044] FIG. 6 illustrates an exemplary computer-based clinical decision support system (CDSS) that is configured to determine a proper laser output setting based on coordinated collection of sensor data with respect to a laser pumping signal or features extracted therefrom.

[0045] FIG. 7 a flowchart illustrating an example method for identifying an anatomical target using coordinated collection of sensor data, and providing a laser treatment based on the identification result.

[0046] FIG. 8 is a block diagram illustrating an example machine upon which any one or more of the techniques (e.g., methodologies) discussed herein may perform.DETAILED DESCRIPTION

[0047] Laser endoscopy is a medical procedure of viewing and operating on an internal organ, and delivering surgical laser to a target body region to achieve a particular diagnostic or therapeutic effect. Laser endoscopy have been used for treatment of soft and hard tissue (e.g., damaging or destroying cancer cells), or in lithotripsy applications. For example, in PCNL, a practitioner can insert a rigid scope through an incision in a patient’s back and into the patient’s kidney. Through the scope, the practitioner can locate certain stones in the kidney or upper ureter, break the stones into smaller fragments by illuminating the stone, through the scope, with relatively high-powered infrared laser beam. The laser beam can ablate a stone into smaller fragments. The stone fragments can then be withdrawn from the kidney. The scope can include an endoscope, a nephroscope, and / or a cystoscope.

[0048] In endoscopic laser therapy, it is desirable to recognize different tissue, apply laser energy only to target treatment structures (e.g., cancerous tissue, or a particular calculus type), and avoid or reduce exposing non-treatment tissue (e.g., normal tissue) to laser irradiation. Conventionally, the recognition of a target treatment structure of interest is performed manually by an operator,such as by visualizing the target surgical site and its surrounding environment through an endoscope. At least due to a tight access to an operation site that offers a limited surgical view, manual approach may lack accuracy in some cases, and do not offer in vivo near real-time recognition of target type and / or composition. In vivo near real-time target identification (e.g., target type and composition) may be desired to reduce surgery time and complexity, and to improve therapy efficacy. For example, in laser lithotripsy that uses laser energy to break apart or dust a calculi structure, in vivo identification of a calculi structure (e.g., chemical composition of a kidney or pancreobiliary or gallbladder stone) and distinguishing it from surrounding tissue allows more timely adjustment of a laser irradiation setting (e.g., power, exposure time, or firing angle) to ablate the calculi structure more effectively while avoiding inadvertent irradiation of non-treatment tissue.

[0049] In some endoscopic laser procedures, continuous analysis and identification of target type or composition may be desired. There are many moving parts during an endoscopic procedure, and the tissue viewed at from the endoscope may change during the procedure. Continuous identification of a structure type or composition (e.g., soft or hard tissue type, normal tissue versus cancerous tissue, or composition of calculi structures) at the tip of the endoscope may provide physicians with more information to adapt the treatment during the procedure. For example, in a procedure to dust a renal calculi having a hard surface but a soft core, continuous identification of target composition through the endoscope may help a physician properly adjust laser setting based on target surface structure and composition, such as changing from a first setting optimized for treating the hard surface of the stone to a different second setting optimized for treating the soft core of the target.

[0050] One technical challenge for in vivo target identification is collecting sensor data proper times or under proper conditions to ensure high- quality data be collected and used for target identification. The clinical environment during a procedure is usually dynamic, which may affect sensor data quality and reduce target identification accuracy. For example, a clear field of view (FOV) of the target structure, and a positioning of the laser fiber tip (where one or more sensors are typically located) proximate to the target areimportant considerations for acquiring high-quality sensor data. If the FOV is not clear or if the laser fiber is in a sub-optimal position, then the target identification result may not be accurate. Another source of interference to the sensor data, particularly optical sensor data, is glares reflected from the target surface in response to laser emission. The interference may introduce errors and reduce the accuracy of target identification. Coordinating or synchronizing sensor data collection and analysis with laser emission would be desired to minimize or reduce such interferences on the sensor data.

[0051] Described herein are systems, devices, and methods for coordinating sensor data collection, or flagging on continuously collected and buffered sensor data a reference timing of the data portion, for in vivo target identification during a laser procedure. The in vivo target identification includes, for example, recognizing a type or composition of a calculi target, discriminating between a calculi target and anatomical tissue, or any other decisions. In accordance with an embodiment, an exemplary surgical laser system includes a laser system to emit laser energy via a laser fiber to an anatomical target, at least one optical sensor to sense data indicative of optical properties of the anatomical target, a pumping signal detector to detect a presence or absence of a laser pumping signal that provides the laser energy over a laser gain medium in the laser system, and a control system to coordinate triggered sensor data collection with laser emission based on the detection of laser pumping signal. The control system can identify a type or composition of the anatomical target using the coordinated collection of sensor data, and determine or adjust a laser output setting of the laser system based on the result of target identification.

[0052] The systems, devices, and methods according to various embodiments discussed herein provide improved in vivo target identification during the laser procedure. Features described herein may be used in regard to an endoscope, laser surgery, laser lithotripsy, laser settings, and / or spectroscopy. Examples of targets and applications may include laser lithotripsy of renal calculi and laser incision or vaporization of soft tissue. In an example of endoscopic system that incorporates the features as described herein, tissue or calculi types or composition may be identified in vivo and continuously during the procedure. The results of target identification may be used to feedback-control laser emission, such as adjusting a laser output setting. The capability of continuous monitoring and identification of tissue types or calculi types allow for instant adjustment of laser settings during the laser procedure. In accordance with various embodiments, sensor data collection (or flagging on continuously collected and buffered sensor data) for in vivo target identification may be automatically triggered by a detection of a pumping signal produced by a laser system. The laser pumping signal, such as a near-IR pumping signal, can be detected using a spectral detector (e.g., spectrometer) that is also used for spectroscopic analysis of reflectance data from the anatomical target in response to electromagnetic radiation (e.g., visible or UV light). The detection of the pumping signal may be used to coordinate sensor data collection with laser emission. In an example, in response to the detection of laser pumping signal, an electronic trigger may be provided from the laser system to the spectrometer to trigger sensor data collection at proper times. In another example, an optical trigger may be provided from the laser system to a spectrometer that is used for detecting the pumping signal and for identifying target type and composition from the coordinated collection of sensor data. In some examples, the laser emission from the laser system, laser pumping signal detection at the pumping signal detector, and triggered spectroscopic data collection and analysis at the spectrometer can all be optically connected without electric wiring for electronic trigger. This may help reduce system complexity and cost without compromising sensor data quality or target identification accuracy. As a result, therapy efficacy and procedure success rate can be increased, incidents of accidental laser firing or misplaced laser firing can be reduced, and the tissue safety can be enhanced.

[0053] FIG. l is a block diagram illustrating an example of a laser treatment system 100 configured to provide laser treatment to a target structure 122 in a body of a subject, such as anatomical structure (e.g., soft tissue, hard tissue, or abnormal such as cancerous tissue) or calculus structure (e.g., kidney or pancreobiliary or gallbladder stone). The laser treatment system 100 may include a laser feedback control system 101 and at least one laser system 102. The laser feedback control system 101 may be configured to receive a signal from the target in response to electromagnetic radiation produced by a light source, generate one or more spectroscopic properties using the reflected signalfrom the target, identify the target as one of a plurality of structure types with respective distinct compositions (e.g., a calculus type or an tissue type), and determine an operating mode of the laser system based on the identified structure type. The laser feedback control system 101 may be used in various applications, such as industrial and / or medical applications for treatment of soft (e.g., noncalcified) or hard (e.g., calcified) tissue, or calculi structures such as kidney or pancreobiliary or gallbladder stones. In some examples, the laser treatment system 100 may deliver precisely controlled therapeutic treatment of tissue or other anatomical structures (e.g., tissue ablation, coagulation, vaporization, or the like) or treatment of non-anatomical structures (e.g., ablation or dusting of calculi structures).

[0054] The laser feedback control system 101 may be in operative communication with one or more laser systems. FIG. 1 shows the laser feedback system connected to a first laser system 102 and optionally (shown in dotted lines) to a second laser system 104. Additional laser systems are contemplated within the scope of the present disclosure. The first laser system 102 may include a first laser source 106, and associated components such as power supply, display, cooling systems and the like. The first laser system 102 may also include a first optical pathway 108 operatively coupled with the first laser source 106. In an example, the first optical pathway 108 includes an optical fiber. The first optical pathway 108 may be configured to transmit laser beams from the first laser source 106 to the target structure 122.

[0055] The laser feedback control system 101 may analyze feedback signals 130 from the target structure 122, and control the first laser system 102 and / or the second laser system 104 to generate suitable laser outputs for providing a desired therapeutic effect. For instance, the laser feedback control system 101 may monitor properties of the target structure 122 during a therapeutic procedure (e.g., ablating calculi such as kidney stones into smaller fragments) to determine if the tissue was suitably ablated prior to another therapeutic procedure (e.g., coagulation of blood vessels).

[0056] In an example, the first laser source 106 may be configured to provide a first output 110. The first output 110 may extend over a first wavelength range, such as one that corresponds to a portion of the absorptionspectrum of the target structure 122. The first output 110 may provide effective ablation and / or carbonation of the target structure 122 since the first output 110 is over a wavelength range that corresponds to the absorption spectrum of the tissue.

[0057] In an example, the first laser source 106 may be configured such that the first output 110 emitted at the first wavelength range corresponds to high absorption (e.g., exceeding about 250 cm’1) of the incident first output 110 by the tissue. In example aspects, the first laser source 106 may emit first output 110 between about 1900 nanometers (nm) and about 3000 nm (e.g., corresponding to high absorption by water) and / or between about 400 nm and about 520 nm (e.g., corresponding to high absorption by oxy- hemoglobin and / or deoxy-hemoglobin). Appreciably, there are two main mechanisms of light interaction with a tissue: absorption and scattering. When the absorption of a tissue is high (absorption coefficient exceeding 250 cm’1) the first absorption mechanism dominates, and when the absorption is low (absorption coefficient less than 250 cm’1), for example lasers at 800-1100 nm wavelength range, the scattering mechanism dominates.

[0058] Various commercially available medical-grade laser systems may be suitable for the first laser source 106. For instance, semiconductor lasers such as InXGal-XN semiconductor lasers providing the first output 110 in the first wavelength range of about 515 nm and about 520 nm or between about 370 nm and about 493 nm may be used. Alternatively, infrared (IR) lasers such as those summarized in Table 1 below may be used.Table 1 Example List of suitable IR lasersLaser Wavelength Absorption Coefficient Optical Penettation DepthX. (imi) pa / cm’’) 8 (pm)Thdhmi fiber laser: 1908 88 / 150 114 / 67Thulium fiber laser 1940 120 / 135 S3 / 75Thulium: YAG: 2010 62 / 60 161 / 167Holmium: YAG : 2120 24 / 24 417 / 417Erbium:YAG: 2940 12,000 / 1,000 1 / 10

[0059] The optional second laser system 104 may include a second laser source 116 for providing a second output 120, and associated components, such as power supply, display, cooling systems and the like. The second laser system 104 may either be operatively separated from or, in the alternative, operatively coupled to the first laser source 106. In some embodiments, the second lasersystem 104 may include a second optical pathway 118 (separate from the first optical pathway 108) operatively coupled to the second laser source 116 for transmitting the second output 120. Alternatively, the first optical pathway 108 may be configured to transmit both the first output 110 and the second output 120.

[0060] In certain aspects, the second output 120 may extend over a second wavelength range, distinct from the first wavelength range. Accordingly, there may not be any overlap between the first wavelength range and the second wavelength range. Alternatively, the first wavelength range and the second wavelength range may have at least a partial overlap with each other. In advantageous aspects of the present disclosure, the second wavelength range may not correspond to portions of the absorption spectrum of the target structure 122 where incident radiation is strongly absorbed by tissue that has not been previously ablated or carbonized. In some such aspects, the second output 120 may advantageously not ablate uncarbonized tissue. Further, in another embodiment, the second output 120 may ablate carbonized tissue that has been previously ablated. In additional embodiments, the second output 120 may provide additional therapeutic effects. For instance, the second output 120 may be more suitable for coagulating tissue or blood vessels.

[0061] FIG. 2 is a block diagram illustrating a surgical laser system 200, and at least a portion of the environment in which the system 200 may operate. The system 200 can be an embodiment of the laser energy delivery system 100, or a lithotripsy system that may be used for destructing hardened masses like renal stones, bezoars, gallstone, among other calculi structures.

[0062] The surgical laser system 200 may include a feedback control system 210, sensor circuitry 220, a laser system 240, a memory circuit 260, and a user interface device 250. The feedback control system 210, which is an embodiment of the feedback control system 101 of the laser energy delivery system 100, may include a data collection / analysis trigger circuit 211, a feedback analyzer 212, and a controller circuit 214. According to example embodiments, the feedback control system 210 may include processors, such as microprocessors, digital signal processors (DSPs), application specific integrated circuits (ASICs), field programmable gate arrays (FPGAs), or any otherequivalent integrated or discrete logic circuitry, as well as any combinations of such components for performing one or more of the functions attributed to the feedback control system 210.

[0063] The feedback analyzer 212 may be communicatively coupled to the sensor circuitry 220, receive therefrom feedback signals, and analyze the feedback signals to generate one or more signal metrics that may be used for target detection, localization, and / or identification, which may further be used for determining or adjusting laser output. The sensor circuitry 220 may include at least one optical sensor configured to sense data indicative of optical properties of the target structure 122. In an example, the optical sensor can be a spectroscopic sensor configured to sense a spectroscopic signal from the target structure 122, and generate one or more spectroscopic properties, such as reflectivity, reflectance spectrum, absorption index, among others. Examples of the spectroscopic sensor may include a Fourier Transform Infrared (FTIR) spectrometer, a Raman spectrometer, a UV-VIS spectrometer, a UV-VIS-IR spectrometer, or a fluorescent spectrometer, among others. Each spectroscopic sensor may correspond to a spectroscopy technique. For example, UV-VIS reflection spectroscopy may be used to gather information from the light reflected off an object similar to the information yielded from the eye or a color image made by a high resolution camera, but more quantitatively and objectively. The reflection spectroscopy may offer information about the material since light reflection and absorption depends on its chemical composition and surface properties. Information about both surface and bulk properties of the sample may be obtained using this technique. The reflection spectroscopy may be used to recognize composition of hard or soft tissue.Fluorescent spectroscopy is a type of electromagnetic spectroscopy that analyzes fluorescence from a sample. It involves using a beam of light, usually ultraviolet, that excites a material compound and causes the material compound to emit light, typically in visible or IR area. The method may be applied for analysis of some organic components such as hard and soft tissue. FTIR spectroscopy may be used for rapid materials analysis, and has relatively good spatial resolution and gives information about the chemical composition of the material. Raman spectroscopy may be used for identifying hard and soft tissue components. As ahigh spatial resolution technique, it is also useful for determining distribution of components within a target. The spectroscopy techniques as described above may be used alone or in combination to analyze the spectroscopic signal by the spectroscopic sensor 322 to generate one or more spectroscopic properties indicative of structure types with respective distinct compositions.

[0064] In another example, the optical sensor included in the sensor circuitry 220 can be an imaging sensor configured to generate images or video frames of at least a portion of the target structure 122 during the endoscopic procedure. The imaging sensor may be included in an imaging system that further includes a lens system. The imaging sensor may take the form of an imaging camera, such as a CCD or CMOS camera sensitive in ultraviolet (UV), visible (VIS) or infrared (IR) wavelengths in an embodiment. The imaging sensor may be located a distal portion of an endoscope for use during the procedure, an example of which is illustrated in FIG. 3. The imaging sensor may generate images or video frames at different times. In some embodiments, the sensor circuitry 220 may include more than a single type of spectrometer or imaging camera listed herein to enhance sensing and detection of various features (e.g., carbonized and non-carbonized tissue, vasculature, and the like).

[0065] The feedback analyzer 212 may detect, localize, and identify the target structure 122 using sensor data, such as optical sensor data, produced by the sensor circuitry 220. Because of the dynamic clinical environment during the surgical procedure, it is desirable to initiate sensor data collection at proper times (or under certain conditions) to ensure high-quality sensor data to be used for in vivo target identification. The data collection and analysis trigger circuit 211, communicatively coupled to the feedback analyzer 212, may determine a specific time to initiate sensor data collection for in vivo target identification. In some examples, the sensor data sensed by the sensor circuitry 220 may be continuously recorded and buffered in the memory circuit 260. In the presence of a trigger event indicative of the laser energy being delivered to the target structure 122 (such as a detection of a laser pumping signal as will be discussed further below), the data collection and analysis trigger circuit 211 may set a flag or timestamp on the continuously collected and buffered sensor data. A portion of the recorded sensor data with a specific duration relative in time to the set flagor timestamp may be used for in vivo target identification. The portion of the continuously recorded and buffered sensor data used for in vivo target identification may begin at the set flag or timestamp in one example, or at a specific time prior to the set flag or timestamp in another example. In an example, the portion of the continuously recorded and buffered sensor data used for target identification may occur during a time period right before the set flag or timestamp.

[0066] In an example, the time to initiate triggered sensor data collection or to set a flag or timestamp on the continuously collected and buffered sensor data for in vivo target identification may be automatically determined based on detection of a pumping signal that provides laser emission from the laser system 240. A laser pumping signal can be an optical or electrical signal that, when interacting with a laser gain medium, induces population inversion which enables lasing to occur. The laser energy may be pulsed laser in one example, or continuous wave (CW) laser in another. Pulsed laser is characterized by a pulsed output power, resulting in relatively high peak powers at a relatively low average power. CW laser is a steady stream of laser light characterized by a substantially constant output power. By way of example and not limitation, the laser system 240 includes a series of infrared (IR) emitting diodes that can generate a near-IR laser pumping signal (an example of optical pumping signal) within a particular pumping wavelength or wavelength range, such as approximately 800-1100 nanometers (nm). The near-IR optical pumping signal excites atoms or molecules in the laser gain medium, which emits additional photons of the same wavelength and phase through an amplification process, which results in stimulated emission of coherent light that is in phase and has a single wavelength and direction. In the case of CW laser, for example, a CW diode pumped solid state laser (DPSS laser) can be created through the optical pumping of a laser gain medium with a semiconductor diode laser or diode laser array. The gain medium being pumped can be a solid crystal, or a doped optical fiber cable. Examples of solid crystals used in DPSS lasers include ND: YAG, Neodymium Doped Yttrium Aluminum Garnet, and TI: Sapphire.

[0067] The pumping signal detector 230 can detect a presence or absence of the laser pumping signal using sensor data (such as optical sensor data)measured by the sensor circuitry 220. In an example, the sensor circuitry 220 includes a spectroscopic sensor configured to collect spectroscopic data in response to laser energy incident on the anatomical target. When laser energy is emitted and incident on the anatomical target, at least a portion of the laser pumping signal can be reflected from the anatomical target, and sensed by the optical sensor (e.g., the spectroscopic sensor) of the sensor circuitry 220 as spectroscopic data. The feedback analyzer 212 may include a spectrometer that can perform a spectral analysis of the spectroscopic data and produce reflectance spectra. The pumping signal detector 230 may detect from the reflectance spectra a presence or absence of the pumping signal at the pumping wavelength or wavelength range. FIGS. 4A-4B illustrate examples of reflectance spectra 400 A and 400B produced by a spectrometer over a wavelength range when lasers are incident on a target structure. The laser emission is induced or provided by a pumping signal at a pumping wavelength of approximately 830 nm. To generate the reflectance spectra 400A or 400B, multiple spectroscopic scans (measurements of the spectroscopic data) may be collected at distinct times during a specific data collection period. The multiple spectroscopic scans may be integrated and averaged to improve signal-to-noise ratio (SNR). The number of spectroscopic scans taken for integration and averaging may depend on the duration of the data collection period and the scan rate. For example, more spectroscopic scan may be produced at a high scan rate, the integration and average of which would lead to a higher SNR. In one example, at least ten scans may be integrated and averaged. The integrated and averaged spectroscopic scans may be processed by the spectrometer to produce the reflectance spectra.

[0068] In the illustrated examples, spectroscopic data were collected under different laser settings (e.g., energy, frequency, or combinations thereof), and the reflectance spectra 400A and 400B were each calculated with different spectrometer integration times. The reflectance spectra 400A in FIG. 4A were obtained when only laser emission, but no other electromagnetic radiation (e.g., VIS, UV, or UV-VIS), is present. The reflectance spectra 400B in FIG. 4B were obtained when laser emission and white light (at a wavelength range of approximately 400-660 nm) are both present. Both spectra 400A and 400B show a spectral peak (peak 410A of the spectra 400 A, and peak 410B of the spectra400B) at the pumping wavelength 830 nm or pumping wavelength range of approximately 780-900 nm, indicating the presence of reflected laser pumping signal. The reflectance spectra 400B also shows another spectral peak 420B in a lower wavelength range of approximately 400-660 nm which corresponds to the reflected white light. No such spectral peak at this wavelength range is detectable in the reflectance spectra 400A, indicating the absence of reflected visible light. The pumping signal detector 230 may detect the presence of a pumping signal based on a comparison of the spectral content at the pumping wavelength 830 nm or the wavelength range 780-900 nm to a threshold 401. For example, the pumping signal is deemed to be present if said spectral content exceeds the threshold 401, or deemed to be absent if said spectral content is below the threshold 401.

[0069] Laser energy incident on the anatomical target may introduce interferences (e.g., glares) in the optical sensor data, which may reduce target identification accuracy. A better coordination or synchronization between sensor data collection and laser emission is desired to minimize or reduce such interferences, and to improve continuous in vivo target identification and instant laser therapy adjustment. In some examples, the data collection and analysis trigger circuit 211 may coordinate sensor data collection and analysis for in vivo target identification with laser emission based on a laser pumping signal in the laser system 240, which can be detected by the pumping signal detector 230. An example of such coordinated sensor collection is illustrated in FIG. 5. An optical pumping signal 500 (e.g., a near-IR pumping signal produced by IR emitting diodes in the laser system 240) can be represented by a pumping pulse train with alternating pulse ON periods (510A, 510B, 510C, 510D, ...) and pulse OFF periods (520A, 520B, 520C, 520D, ...). The pumping signal detector 230 detects the pumping signal at time T, such as based on the reflectance spectra specific pumping wavelength or wavelength range as described above with respect to FIGS. 4A-4B. From time T, the data collection and analysis trigger circuit 211 may initiate coordinated sensor data (e.g., spectroscopic data) collection for in vivo target identification with respect to laser emission, such as by enabling sensor data collection between consecutive pulses in the laser pumping pulse train during the pulse OFF periods (520A, 520B, 520C, 520D, . . .), and disablingsensor data collection during the pulse ON periods (510A, 510B, 5 IOC, 510D, . . .). Because laser pumping signal is generally present during the pulse ON periods and absent during the pulse OFF periods, the pulse ON and OFF periods may be continuously detected based on the spectral content of the reflectance spectra at the pumping wavelength or wavelength range, as described above with respect to FIGS. 4A-4B. In some examples, detection of the pulse ON periods or the pulse OFF periods may be further based on one or more pulse train parameters, such as pulse width or a pulse rate. In an example, reflectance spectra-based pumping signal detection is used only once to detect the first ON period or the first OFF period after time T. The subsequent ON and OFF periods may be estimated as periodic delays from the first ON period or the first OFF period, where the period delays can be determined using the pulse width or pulse rate of the pumping pulse train. In some examples, reflectance spectra-based pumping signal detection may be performed intermittently or periodically (but not continuously) to calibrate the estimated pulse ON and OFF periods based on pulse width or pulse rate.

[0070] In one example, the feedback analyzer 212 (e.g., a spectrometer therein to perform spectral analysis) can be electrically coupled to the laser system 240, and an electronic trigger signal may be provided by the feedback control system 210 to the data collection and analysis trigger circuit 211 to initiate the coordinated collection of sensor data based on the detection of the laser pumping signal. Alternatively, the feedback analyzer 212 (e.g., the spectrometer therein) can be optically coupled to the laser system 240, and an optical trigger signal may be provided by the feedback control system 210 to the data collection and analysis trigger circuit 211 to initiate the coordinated collection of sensor data based on the detection of the laser pumping signal. In such optical trigger configuration, laser emission from the laser system 240, laser pumping signal detection at the pumping signal detector 230, and sensor data collection and analysis at the feedback control system 210 (e.g., the spectrometer in the feedback analyzer 212) can all be optically connected and communicated without the requirement of other means of communication (e.g., electric wiring for electronic trigger). This may help reduce system complexityand cost without compromising sensor data quality or target identification accuracy.

[0071] The feedback analyzer 212 may identify a type or composition of the target structure 122 as one of a plurality of structure categories, such as a category of calculi structure, or a category of anatomical structure, using the coordinated collection of sensor data, such as triggered by the detection of pumping signal as described above. Data features may be extracted from the collected sensor data, including intensity, power, frequency or spectral content, a graphical feature or shape, or one or more statistical features of the received sensor data. For a tissue target or a calculi target, its ability to absorb laser energy depends on its composition and liquid content. Different target types, such as different calculi structures or soft or hard tissue, may have different composition and / or liquid content. When these targets absorb different amount of laser energy, they may produce respective different spectroscopic properties and / or acoustic properties. Examples of calculi structure may include stones or stone fragments in various stone-forming regions such as urinary system, gallbladder, nasal passages, gastrointestinal tract, stomach, or tonsils. Examples of the anatomical structure may include soft tissue (e.g., muscles, tendons, ligaments, blood vessels, fascia, skin, fat, and fibrous tissues), hard tissue such as bone, connective tissue such as cartilage, among others.

[0072] In an example, the feedback analyzer 212 may identify the target structure 122 as one of a plurality of structure types of the same category, such as a particular tissue type within an identified category of anatomical structure, or as a particular calculi type within an identified category of calculi structure. In an example, the feedback analyzer 212 may identify a calculi structure as one of stone types with distinct chemical compositions, such as one of a CaP stone, a MAP stone, a COM stone, a COD stone, a cholesterol-based stone, a cystine stone, or a uric acid (UA) stone. The target identification may be made based on one or more of spectroscopic properties or acoustic properties, such as intensity, power, frequency or spectral content, or a graphical feature or shape of the received spectroscopic or acoustic signal, or one or more statistical features generated from the received signal. In some example, the feedback analyzer 212 may identify an identified anatomical structure as one of plurality of tissue types.The tissue types may include tissue at distinct anatomical locations, such as calyx tissue, cortex tissue, medulla tissue, ureter tissue, or bladder tissue. In another example, the feedback analyzer 212 may identify an anatomical structure as normal tissue or abnormal tissue (e.g., cancerous tissue). In another example, the feedback analyzer 212 may identify an anatomical structure as a treatment area (e.g., tumor or polyp intended for removal) or a non-treatment area (e.g., blood vessels, muscle, etc.).

[0073] The controller circuit 214 may be coupled by wired or wireless connections to the feedback analyzer 212. The controller circuit 214 may adjust a laser output setting of the laser system 240 based at least in part on the identified type or composition of the target structure 122. The laser system 240, which is an example of the laser system 102 or the laser system 104 as shown in FIG. 1, can include a laser source (such as the first laser source 106) and an optical pathway (such as the first optical pathway 108) for directing the laser energy to the surgical site. The laser source can generate laser energy in accordance with a laser output intensity or one or more laser irradiation parameters (e.g., laser pulse power, duration, frequency, or pulse shape, exposure time, or firing angle). At least some of such laser parameters are programmable or adjustable either automatically such as by the controller circuit 214, or manually by a user via the user interface device 250.

[0074] In various examples, the controller circuit 214 may adjust the operation of the system (such as a laser output setting) using artificial intelligence (Al) or machine learning (ML) based techniques. For example, information about the identified type or composition of the target structure may be applied to a trained ML model to automatically determine a proper laser setting to be used during the procedure. In some examples, coordinated collection of sensor data from the sensor circuitry 220 with respect to the laser pumping signal, or a selected portion of continuously recorded and buffered sensor data relative in time to a set flag or timestamp of the laser pumping signal, may be applied directly to a trained ML model that outputs a proper laser setting. Examples of using a trained ML model to determine a laser output setting are discussed below with respect to FIG. 6.

[0075] The laser system 240 may be coupled to a laser actuator 242 operable by a user to manually activate (or confirm an automated activation of) the laser system 240 to emit laser energy to the target structure. An example of the laser actuator is a foot pedal that, when pressed by the operator, activates laser emission to the target structure.

[0076] In some examples, the laser system 240 may be associated with one of two distinct operating modes or states: a first state wherein the laser system 240 generates a laser output, and a second state where a laser system 240 does not generate a laser output. For instance, the first laser system 102 may have a first state where a first output 110 (e.g., over the first wavelength range) is generated, and a second state where the first output 110 is not generated. Similarly, the second laser system 104 may have a first state where a second output 120 (e.g., over the second wavelength range) is generated, and a second state where the second output 120 is not generated. In such embodiments, the controller circuit 214 may control the laser system 240 by sending control signals that change the operating state the laser system from the first state to the second state, or from the second state to the first state. In some examples, the laser system 240 may have additional states, for instance, a third state where a laser output in accordance with a different laser irradiation parameter setting is generated. Accordingly, additional control signals may be sent by the controller circuit 214 to the laser system(s) to change their states from their current state to one or more additional states (e.g., first state to third state, second state to third state, third state to first state, and third state to second state) to generate laser outputs that provide a desired therapeutic effect.

[0077] In an example, the controller circuit 214 may generate a control signal to operate the laser system 240 in a first operating mode if the target is identified as a calculi structure, or a second operating mode if the target is identified as an anatomical structure, or a third operating mode if the target is identified as neither an anatomical structure nor a calculi structure. In an example, the first operating mode may include activating the laser system 240 to deliver a laser beam programmed with a first irradiation parameter setting to ablate or dust the identified calculi, such as renal stones. In an example, the second operating mode may include withholding laser delivery, or delivering alaser beam programmed with a second irradiation parameter setting different from the first irradiation parameter setting to an identified tissue. In an example, the third operating mode may include deactivating the laser system 240 from delivery of laser energy. The laser irradiation parameters may include wavelength, power, power density, pulse parameters (e.g., pulse width, pulse rate, amplitude, duty cycle), exposure time, total dose or energy, among others.

[0078] In some examples, the controller circuit 214 may determine the operating mode of the laser system 240 based on an identification of the target structure 122 as one of a plurality of calculi types, such as CaP stone, a MAP stone, a COM stone, a COD stone, a cholesterol-based stone, a cystine stone, or a uric acid (UA) stone, as determined by the feedback analyzer 212. The controller circuit 214 may adjust the irradiation parameter setting based on the identification of calculi type, and generate a control signal to control the laser system 240 to deliver laser energy to the target structure 122 in accordance with the adjusted irradiation parameter setting.

[0079] In some examples, the controller circuit 214 may determine the operating mode of the laser system 240 based on the identification of the target structure 122 as one of a plurality of tissue types, such as renal tissue at different anatomical locations (e.g., calyx tissue, cortex tissue, medulla tissue, ureter tissue, or bladder tissue), normal or abnormal tissue (e.g., cancerous tissue), treatment area (e.g., tumor or polyp intended for removal) or a non-treatment area (e.g., blood vessels, muscle, etc.). The controller circuit 214 may adjust the irradiation parameter setting based on the identification of tissue type, and generate a control signal to the laser system 240 that delivers laser energy to the identified anatomical structure in accordance with the adjusted irradiation parameter setting.

[0080] In some examples, the controller circuit 214 may adjust the irradiation parameter setting directly based on one or more of the spectroscopic properties or acoustic properties produced by the feedback analyzer 240 without using information about target type or target composition such as generated by the feedback analyzer 212. For example, the intensity of the feedback signal produced in response to laser firing at a target calculi structure is correlated to laser power density. The controller circuit 214 may automatically adjust anirradiation parameter setting (e.g., laser power) and laser fiber position to achieve a desired feedback signal amplitude.

[0081] In various examples, the feedback analyzer 212 may continuously monitor the target structure 122, collect and analyze feedback signals, and continuously communicate with the controller circuit 214. Accordingly, the controller circuit 214 may continue maintaining the laser systems in one or more states until a change in the feedback is detected (e.g., a different category of the target structure 122, a different tissue type, or a different calculi type). When a change in feedback is detected, the controller circuit 214 may communicate with the one or more laser systems and change their state(s) to deliver a desired therapeutic effect. Alternatively or additionally, the controller circuit 214 may communicate with an operator (e.g., healthcare professional), and display one or more output(s) via one or more output system(s) indicative of the feedback signal, and may, optionally, instruct the operator to perform one or more treatment procedures with the first laser system and / or the second laser system to deliver a desired therapeutic effect.

[0082] In illustrative examples described herein, the controller circuit 214 may control more than one laser system by changing the operating state of each laser system. According to an aspect, the controller circuit 214 may independently control each laser system. For instance, the controller circuit 214 may send a distinct control signal to each laser system to control each laser system independently of the other laser systems. Alternatively, the controller circuit 214 may send a common signal to control one or more laser systems.

[0083] The user interface device 250 may be operatively in communication with the feedback control system 210. The user interface device 250 may include an output / display unit 252 to display information including, for example, feedback signals sensed by the sensor circuitry 220, target detection, localization, and identification results generated by the feedback analyzer 212, or current device settings such as laser irradiation parameters. The output / di splay unit 252 may display UI elements including visual elements, alerts, tactile feedback, or any combination thereof. The output / di splay unit 252 may generate an alert or notification to the user about detection of a trigger event that triggers sensor data collection, or sets a flag or timestamp on the continuously recordedand buffered sensor data. The alert may be presented in an audible, visible, tactile, or otherwise human-perceptible format.

[0084] The user interface device 250 may include one or more input units 254 to receive user programming of the device, such as parameter values used for analyzing sensor signals and detecting target location and identifying target types. The user input may include adjustment of laser irradiation parameters or other device parameters.

[0085] FIG. 3 illustrates an example of an endoscopic laser lithotripsy system 300 with a feedback control using coordinated collection of sensor data, which can be an example of the surgical laser system 200. The endoscopic laser lithotripsy system 300 may include an endoscope 301, a feedback control system 310, a pumping signal detector 330, and an actuator 338. The endoscope 301 has a proximal portion and an elongate distal portion that may be configured to be inserted into a surgical site of a patient during an endoscopic laser lithotripsy procedure. The endoscope 301 may provide visual inspection or treatment of soft (e.g., non-calcified) or hard (e.g., calcified) tissue as well as for visualizing or breaking up or otherwise treating renal stones or other calculi structures or targets.

[0086] As illustrated in FIG. 3, the endoscope 301 may include or provide visualization and illumination optics, such as a visualization optical pathway 360 and an illumination optical pathway 350, each of which may extend longitudinally along the elongate body of the endoscope 301. An eyepiece or camera or imaging display may be provided at or coupled to the visualization optical pathway 360 to permit user or machine visualization of a target region at or near a distal end of the endoscope 301. The target region may be illuminated by light 370, such as provided by a light source 324 at a proximal end of the illumination optical pathway 350 and emitted from a distal end of the illumination optical pathway 350. The light source 324 can include, for example, a Xenon lamp, a light-emitting diode (LED), a laser diode (LD), or any combination thereof. In an example, the light source 324 may include two or more light sources that emit light having different illumination characteristics, referred to as illumination modes. In an example, the illumination modes may include a white light illumination mode, or a special light illumination modesuch as a narrow band imaging mode, an auto fluorescence imaging mode or an infrared imaging mode. A special light illumination can concentrate and intensify specific wavelengths of light, for example, resulting in a better visualization of tissue or other structures at the surgical site.

[0087] The lithotripsy system 300 may include or be coupled to a laser source 332, which may be an example of the first laser source 106, the second laser source 116, or the laser system 240. The laser source 332, which may be included in the laser system 240, may be mechanically and optically connected to an optical pathway 334, which may include a single optical fiber or a bundle of optical fibers. The optical pathway 334, which is an embodiment of the first optical pathway 108 or the second optical pathway 118, or the optical pathway included in the laser system 240, may be introduced via a proximal access port to extend within a working channel or other longitudinal passage or lumen of the endoscope 301 or similar instrument.

[0088] In some examples, the laser source 332 may include a first laser source to generate a treatment beam 383 A and a second different laser source to generate an aiming beam 383B. The treatment beam and the aiming beam can be directed to the target through the same or a different optical pathways. In some examples, the aiming beam may be generated using a light source different than the second laser source. The aiming beam may have a distinct color (e.g., green or red) to distinguish from the illumined background of the surgical site.

[0089] The lithotripsy system 300 may include one or more sensors to sense information from the anatomical target or the surgical site, including a spectroscopic sensor 322, which can be an embodiment of, or included as part of the sensor circuitry 220 in FIG. 2. As described above with reference to FIG. 2, the spectroscopic sensor 322 may sense a spectroscopic signal from the target structure 122. The spectroscopic sensor 322 may be located at a distal end 336 of the optical pathway 334. The feedback control system 310 is an embodiment of the feedback control system 210, and similarly includes the data collection / analysis trigger circuit 211, the feedback analyzer 212, and the controller circuit 214. As described above with respect to FIG. 2, the data collection and analysis trigger circuit 211 may determine an optimal time to initiate triggered sensor data collection for in vivo target identification, or set a flag or timestamp on thecontinuously collected and buffered sensor data. In some examples, the data collection and analysis trigger circuit 211 may coordinate sensor data collection and analysis for in vivo target identification with laser emission during the laser procedure based on the detection of a laser pumping signal. The pumping signal detector 330, which is an embodiment of the pumping signal detector 230, may detect a presence or absence of the pumping signal from reflectance spectra generated by a spectrometer included in the feedback analyzer 212 at the pumping wavelength or wavelength range, such as approximately 800-1100 nm for near-IR laser pumping signal generated by a series of IR emitting diodes. In an example, the coordinated collection of sensor data (e.g., spectroscopic data) with respect to laser emission may include, during a laser procedure, enabling sensor data collection between consecutive pulses in the laser pumping pulse train during the pulse OFF periods, and disabling sensor data collection during the pulse ON periods, as described above with respect to FIG. 2.

[0090] The lithotripsy system 300 may include a camera or imaging device 325, which can be part of the sensor circuitry 220 in FIG. 2. The camera or imaging device 325 can include an imaging sensor that can generate an imaging signal 365 of the target in response to electromagnetic radiation (e.g., illumination light 370) of the target at or near the surgical site. The imaging signal 365 may be transmitted through the optical pathway 360, or alternatively through the optical pathway 334, to the feedback control system 310 (an embodiment of the feedback control system 210). In an example, the imaging signal 365 may pass through an optical splitter before reaching the feedback analyzer 212. The feedback analyzer 212 may use the imaging signal 365 to determine target location.

[0091] The feedback analyzer 212 may detect, localize, and identify the target structure 122 using the coordinated collection of sensor data (e.g., spectroscopic data). In an example, the feedback analyzer 212 may recognize the target as a calculi target or anatomical target at or near the surgical site, or classify the target as one type of tissue or one type of calculi of distinct composition. In some examples, the feedback analyzer 212 may calculate or estimate the fiber-target distance using the spectroscopic data. The controllercircuit 214 may generate a control signal to the laser source 332 to adjust a laser output setting (e.g., one or more laser irradiation parameters).

[0092] In addition or alternative to adjusting laser output settings, in some examples, the controller circuit 214 may generate a control signal to an actuator 338 to adjust the position of the laser fiber distal end 336 relative to the target structure 122. The actuator 338 may be a laser emitting end coupled to a portion of the optical pathway 334, and can be in electrical communication with the controller circuit 214. In an example, the actuator 338 may be located at or near the distal end of the endoscope 301. The actuator 338 may include one or more of an electromagnetic element, an electrostatic element, a piezoelectric element, or other actuating element such as to actuate or otherwise permit longitudinal or rotational positioning of the laser fiber distal end 336 with respect to the working channel or other longitudinal passage of the endoscope 301, or with respect to another reference location for which the endoscope 301 may serve as a frame of reference.

[0093] FIG. 6 is a schematic diagram of an exemplary computer-based clinical decision support system (CDSS) 610 that can be configured to determine a proper laser output setting based on coordinated collection of sensor data from the sensor circuitry 220 with respect to the laser pumping signal, or a selected portion of continuously recorded and buffered sensor data relative in time to a set flag or timestamp of the laser pumping signal, or information about the identified type or composition of the target structure, hereinafter referred to as the “input features”. In various embodiments, the CDSS 610 includes an input interface 612 through which the input features which are specific to a patient are provided to a trained ML model 614 (also referred to as an Al model) . The controller circuit 214 (shown in FIG. 2) performs an inference operation in which the input features are applied to the ML model 614 to generate a laser output setting as an inference output at the output interface 616. The inference output may be output to an output device 640, which may include a user interface (UI) through which the laser output setting can be communicated to a user, e.g., a clinician, or to a controller device such as the controller circuit 214 for performing a desired action.

[0094] In some embodiments, the input interface 612 may be a direct data link between the CDSS 610 and one or more feature generating devices 630 that generate at least some of the input features. For example, the input interface 612 may transmit the input features directly to the CDSS 610 during a therapeutic and / or diagnostic medical procedure. Additionally, or alternatively, the input interface 612 may be a classical user interface that facilitates interaction between a user and the CDSS 610. For example, the input interface 612 may facilitate a user interface through which the user may manually enter at least some of the input features. Additionally, or alternatively, the input interface 612 may provide the CDSS 610 with access to a database of electronic patient record 620 from which one or more input features may be extracted. In any of these cases, the input interface 612 is configured to collect sensor data with respect to the laser pumping signal or features in association with a specific patient on or before a time at which the CDSS 610 is used to determine a proper laser output setting.

[0095] The controller circuit 214 may perform an inference operation using the ML model 614 to generate a proper laser output setting. For example, input interface 612 may deliver the one or more input features into an input layer of the ML model 614 which propagates these input features through the ML model 614 to an output layer. The ML model 614 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. The ML model 614 explores the study and construction of algorithms (e.g., machinelearning algorithms) that may learn from existing data and make predictions about new data. Such algorithms operate by building an ML model from example training data in order to make data-driven predictions or decisions expressed as outputs or assessments, such as determining or adjusting the laser output setting 216, as stated above.

[0096] The ML model may be trained using supervised learning or unsupervised learning. Supervised learning 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 learning is to learn a function that, given some training data, best approximates the relationship between thetraining inputs and outputs so that the ML model can implement the same relationships when given inputs to generate the corresponding outputs. Unsupervised learning 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 learning is useful in exploratory analysis because it can automatically identify structure in data.

[0097] Common tasks for supervised learning are classification problems and regression problems. Classification problems, also referred to as categorization problems, aim at classifying items into one of several category values. 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). Examples of DNN include a convolutional neural network (CNN), a recurrent neural network (RNN), a deep belief network (DBN), or a hybrid neural network comprising two or more neural network models of different types or different model configurations.Some common tasks for unsupervised learning include clustering, representation learning, and density estimation. Some examples of commonly used unsupervised learning algorithms are K-means clustering, principal component analysis, and autoencoders.

[0098] 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.

[0099] The training of the ML model may be performed continuously or periodically, or in near real time as additional procedure data are made available.The training process involves algorithmically adjusting one or more ML model parameters (e.g., weights or bias at any particular layer of a neural network model), until the ML model being trained satisfies a specified training convergence criterion. By way of example and not limitation, the ML model may be trained with weighted square loss (for explicit feedback) or with binary cross-entropy loss (for implicit feedback). Other training techniques, such as deep factorization machine, wide and deep learning, deep structured semantic models, or autoencoder based recommender systems, may be used. Then, during the inference operation, the patient specific input features provided to the ML model may be propagated from an input layer, through one or more hidden layers, and ultimately to an output layer that corresponds to the laser output setting. During and / or subsequent to the inference operation, the laser output setting may be communicated to the user via the user interface (UI) and / or automatically cause the controller circuit 214 for performing a desired action.

[0100] FIG. 7 is a flowchart illustrating an example method 700 for identifying an anatomical target in a surgical site using coordinated collection of sensor data, and providing a laser treatment based on the identification result. The anatomical target may include an anatomical structure (e.g., soft tissue, hard tissue, or abnormal such as cancerous tissue) or a calculus structure (e.g., kidney or pancreobiliary or gallbladder stone). The method 700 may be implemented in and executed by a laser treatment system, such as the laser treatment system 100 or a variant thereof, such as the surgical laser system 200 or the endoscopic laser lithotripsy system 300. Although the processes of the method 700 are drawn in one flowchart, they are not required to be performed in a particular order. In various examples, some of the processes can be performed in a different order than that illustrated herein.

[0101] At step 710, laser energy produced by a laser system and electromagnetic radiation produced by a light source may be directed to the anatomical target. The laser energy may be induced or provided by a laser pumping signal. The laser pumping signal, such as a near-IR pumping signal produced by a series of infrared (IR) emitting diodes, has a known wavelength or wavelength range. The electromagnetic radiation, such as VIS, UV, or UV-VISlight, has a different wavelength or wavelength range than the pumping wavelength or wavelength ranges.

[0102] At step 720, sensor data indicative of optical properties of the anatomical target may be sensed using at least one optical sensor, such as a spectroscopic sensor. At step 730, a presence or absence of the laser pumping signal may be detected from the sensed data, such as by using the pumping signal detector 230. To detect the presence or absence of the pumping signal, reflectance spectra may be generated using a spectrometer such as included in the feedback analyzer 212, and a spectral content at or within the pumping wavelength or wavelength range may be determined from the reflectance spectra. A pumping signal is detected when the spectral content satisfies a specific condition, such as the spectral peak magnitude exceeding a threshold, as described above with respect to FIGS. 4A-4B. To improve SNR of the spectroscopic data and thus the accuracy of pumping signal detection, multiple spectroscopic scans may be integrated and averaged. The number of spectroscopic scans taken for integration and averaging may depend on the duration of the data collection period and the scan rate.

[0103] At step 740, based on the detection of the laser pumping signal, coordinated collection of the sensor data used for in vivo target identification may be initiated. The detection of the laser pumping signal may trigger collection of sensor data for in vivo target identification. In some examples, the sensor data may be continuously recorded and buffered in a memory circuit. In response to a detected presence of laser pumping signal, a flag or timestamp may be set on the continuously collected and buffered sensor data. A portion of the recorded sensor data relative in time to the set flag or timestamp may be used for in vivo target identification. The portion of the continuously recorded and buffered sensor data used for in vivo target identification may begin at the set flag or timestamp in one example, or at a specific time prior to the set flag or timestamp in another example. In an example, the portion of the continuously recorded and buffered sensor data used for target identification may occur during a time period right before the set flag or timestamp.

[0104] The sensor data collection may be coordinated or synchronized in time with laser emission. In an example, the coordinated collection includesenabling sensor data collection between consecutive pulses in the pumping pulse train during the pulse OFF periods, and disabling sensor data collection during the pulse ON periods, as described above with respect to FIG. 5. In some example, the presence or absence of the laser pumping signal may be continuously or periodically detected (such as using the pumping signal detector 230) during laser emission, and the pulse ON periods may correspond to the detected presence of the laser pumping signal, and pulse OFF periods may correspond to the detected absence of the laser pumping signal. In some examples, the pulse ON periods or the pulse OFF periods may be detected further based on one or more pulse train parameters, such as a pulse width or a pulse rate.

[0105] At step 750, the anatomical target may be identified using the coordinated collection of sensor data from step 740. The target identification includes identify a type or composition of the anatomical target. In an example, a spectral analysis of the coordinated collection of the spectroscopic data may be performed (such as using the spectrometer included in the feedback analyzer 212), and a spectral content at or within the wavelength or wavelength range of the electromagnetic radiation may be determined from the spectral analysis. One or more spectroscopic properties derived from the determined spectral content may be used to identify the target anatomy as one of a plurality of structure categories, such as a category of calculi structure, or a category of anatomical structure. In another example, the anatomical target may be identified as one of a plurality of structure types of the same category, such as a particular tissue type within an identified category of anatomical structure, or as a particular calculi type within an identified category of calculi structure.

[0106] At step 760, laser therapy may be adjusted based at least in part on the identified type or composition of the anatomical target, such as by adjusting a laser output setting. In an example, the laser system may be set to operate in a first operating mode if the target is identified as a calculi structure, or a second operating mode if the target is identified as an anatomical structure, or a third operating mode if the target is identified as neither an anatomical structure nor a calculi structure. In an example, one or more irradiation parameters may be adjusted based on the identification of a calculi type, or basedon the identification of a tissue type. In various examples, the laser output setting may be determined or adjusted using Al or ML based techniques. For example, information about the identified type or composition of the target structure may be applied to a trained ML model to automatically determine a proper laser setting to be used during the procedure. In some examples, coordinated collection of sensor data with respect to the laser pumping signal, or a selected portion of continuously recorded and buffered sensor data relative in time to a set flag or timestamp of the laser pumping signal, may be applied directly to a trained ML model that outputs a proper laser setting. Laser energy may be delivered to the anatomical target in accordance with the adjusted laser output setting.

[0107] FIG. 8 illustrates generally a block diagram of an example machine 800 upon which any one or more of the techniques (e.g., methodologies) discussed herein may perform. Portions of this description may apply to the computing framework of various portions of the laser treatment system 100 (e.g., the laser feedback control system 101), the surgical laser system 200, or the endoscopic laser lithotripsy system 300.

[0108] In alternative embodiments, the machine 800 may operate as a standalone device or may be connected (e.g., networked) to other machines. In a networked deployment, the machine 800 may operate in the capacity of a server machine, a client machine, or both in server-client network environments. In an example, the machine 800 may act as a peer machine in peer-to-peer (P2P) (or other distributed) network environment. The machine 800 may be a personal computer (PC), a tablet PC, a set-top box (STB), a personal digital assistant (PDA), a mobile telephone, a web appliance, a network router, switch or bridge, or any machine capable of executing instructions (sequential or otherwise) that specify actions to be taken by that machine. Further, while only a single machine is illustrated, the term “machine” shall also be taken to include any collection of machines that individually or jointly execute a set (or multiple sets) of instructions to perform any one or more of the methodologies discussed herein, such as cloud computing, software as a service (SaaS), other computer cluster configurations.

[0109] Examples, as described herein, may include, or may operate by, logic or a number of components, or mechanisms. Circuit sets are a collection of circuits implemented in tangible entities that include hardware (e.g., simple circuits, gates, logic, etc.). Circuit set membership may be flexible over time and underlying hardware variability. Circuit sets include members that may, alone or in combination, perform specified operations when operating. In an example, hardware of the circuit set may be immutably designed to carry out a specific operation (e.g., hardwired). In an example, the hardware of the circuit set may include variably connected physical components (e.g., execution units, transistors, simple circuits, etc.) including a computer readable medium physically modified (e.g., magnetically, electrically, moveable placement of invariant massed particles, etc.) to encode instructions of the specific operation. In connecting the physical components, the underlying electrical properties of a hardware constituent are changed, for example, from an insulator to a conductor or vice versa. The instructions enable embedded hardware (e.g., the execution units or a loading mechanism) to create members of the circuit set in hardware via the variable connections to carry out portions of the specific operation when in operation. Accordingly, the computer readable medium is communicatively coupled to the other components of the circuit set member when the device is operating. In an example, any of the physical components may be used in more than one member of more than one circuit set. For example, under operation, execution units may be used in a first circuit of a first circuit set at one point in time and reused by a second circuit in the first circuit set, or by a third circuit in a second circuit set at a different time.

[0110] Machine (e.g., computer system) 800 may include a hardware processor 802 (e.g., a central processing unit (CPU), a graphics processing unit (GPU), a hardware processor core, or any combination thereof), a main memory 804 and a static memory 806, some or all of which may communicate with each other via an interlink (e.g., bus) 808. The machine 800 may further include a display unit 810 (e.g., a raster display, vector display, holographic display, etc.), an alphanumeric input device 812 (e.g., a keyboard), and a user interface (UI) navigation device 814 (e.g., a mouse). In an example, the display unit 810, input device 812 and UI navigation device 814 may be a touch screen display. Themachine 800 may additionally include a storage device (e.g., drive unit) 816, a signal generation device 818 (e.g., a speaker), a network interface device 820, and one or more sensors 821, such as a global positioning system (GPS) sensor, compass, accelerometer, or other sensors. The machine 800 may include an output controller 828, 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 to communicate or control one or more peripheral devices (e.g., a printer, card reader, etc.).

[0111] The storage device 816 may include a machine readable medium 822 on which is stored one or more sets of data structures or instructions 824 (e.g., software) embodying or utilized by any one or more of the techniques or functions described herein. The instructions 824 may also reside, completely or at least partially, within the main memory 804, within static memory 806, or within the hardware processor 802 during execution thereof by the machine 800. In an example, one or any combination of the hardware processor 802, the main memory 804, the static memory 806, or the storage device 816 may constitute machine readable media.

[0112] While the machine readable medium 822 is illustrated as a single medium, the term "machine readable medium" may include a single medium or multiple media (e.g., a centralized or distributed database, and / or associated caches and servers) configured to store the one or more instructions 824.

[0113] The term “machine readable medium” may include any medium that is capable of storing, encoding, or carrying instructions for execution by the machine 800 and that cause the machine 800 to perform any one or more of the techniques of the present disclosure, or that is capable of storing, encoding or carrying data structures used by or associated with such instructions. Nonlimiting machine-readable medium examples may include solid-state memories, and optical and magnetic media. In an example, a massed machine-readable medium comprises a machine readable medium with a plurality of particles having invariant (e.g., rest) mass. Accordingly, massed machine-readable media are not transitory propagating signals. Specific examples of massed 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 (EPSOM)) and flash memory devices; magnetic disks, such as internal hard disks and removable disks; magneto-optical disks; and CD-ROM and DVD-ROM disks.

[0114] The instructions 824 may further be transmitted or received over a communication network 826 using a transmission medium via the network interface device 820 utilizing any one of a number of transfer protocols (e.g., frame relay, internet protocol (IP), transmission control protocol (TCP), user datagram protocol (UDP), hypertext transfer protocol (HTTP), etc.). Example communication networks may include a local area network (LAN), a wide area network (WAN), a packet data network (e.g., the Internet), mobile telephone networks (e.g., cellular networks), Plain Old Telephone (POTS) networks, and wireless data networks (e.g., Institute of Electrical and Electronics Engineers (IEEE) 802.11 family of standards known as WiFi®, IEEE 802.16 family of standards known as WiMax®), IEEE 802.15.4 family of standards, peer-to-peer (P2P) networks, among others. In an example, the network interface device 820 may include one or more physical jacks (e.g., Ethernet, coaxial, or phonejacks) or one or more antennas to connect to the communication network 826. In an example, the network interface device 820 may include a plurality of antennas to wirelessly communicate using at least one of single-input multiple-output (SIMO), multiple-input multiple-output (MIMO), or multiple-input single-output (MISO) techniques. The term “transmission medium” shall be taken to include any intangible medium that is capable of storing, encoding or carrying instructions for execution by the machine 800, and includes digital or analog communications signals or other intangible medium to facilitate communication of such software.Additional Notes

[0115] The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventors also contemplate examples in whichonly those elements shown or described are provided. Moreover, the present inventors also contemplate examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein.

[0116] In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, composition, formulation, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects.

[0117] The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted 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. Thus, the following claims are hereby incorporated into the Detailed Description as examples or embodiments, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of theinvention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.

Claims

What is claimed is:

1. A surgical laser system, comprising: a laser system configured to emit laser energy via a laser fiber to an anatomical target, the laser energy provided by a laser pumping signal having a pumping wavelength or wavelength range over a laser gain medium; at least one optical sensor configured to sense data indicative of optical properties of the anatomical target; a pumping signal detector configured to detect a presence or absence of the laser pumping signal produced by the laser system; and a control system, configured to: based on the detection of the laser pumping signal, coordinate collection of sensor data sensed by the at least one optical sensor with laser emission from the laser system; and identify a type or composition of the anatomical target using the coordinated collection of sensor data.

2. The surgical laser system of claim 1, wherein to coordinate the collection of sensor data with the laser emission includes to initiate the collection of sensor data at specific durations determined based on the detected laser pumping signal.

3. The surgical laser system of claim 2, wherein the laser pumping signal includes a pumping pulse train with pulse ON periods and pulse OFF periods, and wherein to coordinate collection of sensor data with the laser emission, the control system is configured to: enable sensor data collection between consecutive pulses in the pumping pulse train during the pulse OFF periods, and disable sensor data collection during the pulse ON periods; and identify the type or composition of the anatomical target using the collected sensor data between the consecutive pulses during the pulse OFF periods.

4. The surgical laser system of claim 3, wherein:the pumping signal detector is configured to continuously or periodically detect the presence or absence of the laser pumping signal during the laser emission; and the control system is configured to detect the pulse ON periods based on the detected presence of the laser pumping signal, and to detect the pulse OFF periods based on the detected absence of the laser pumping signal.

5. The surgical laser system of claim 4, wherein the control system is configured to detect one or more of the pulse ON periods or the pulse OFF periods further based on one or more pulse train parameters including a pulse width or a pulse rate.

6. The surgical laser system of any of claims 1-5, comprising a memory circuit configured to continuously record and buffer the sensor data sensed by the at least one optical sensor, wherein the control system is configured to, in response to the detected presence of the laser pumping signal: set a flag or timestamp of the laser pumping signal on the continuously recorded and buffered sensor data; coordinate collection of a portion of the continuously recorded and buffered sensor data relative in time to the set flag or timestamp; and identify the type or composition of the anatomical target using the collected portion of the continuously recorded and buffered sensor data.

7. The surgical laser system of any of claims 1-6, wherein the laser system includes infrared (IR) emitting diodes configured to generate a near-IR laser pumping signal.

8. The surgical laser system of any of claims 1-7, wherein the control system includes a spectrometer configured to perform a spectral analysis of the sensed sensor data.

9. The surgical laser system of claim 8, wherein the collection of the sensor data is in response to the laser emission to the anatomical target, wherein the pumping signal detector is configured to detect the presence or absence of the laser pumping signal based on a spectral content at or within the pumping wavelength or wavelength range determined from the spectral analysis of the sensed sensor data.

10. The surgical laser system of claim 9, wherein the spectral analysis is performed on an integration of multiple measurements of the sensor data at distinct times during a specific data collection period.

11. The surgical laser system of any of claims 1-10, wherein the collection of the sensor data is in response to an electromagnetic radiation from a light source to the anatomical target, the electromagnetic radiation having a wavelength or wavelength range different than the pumping wavelength or wavelength range.

12. The surgical laser system of claim 11, wherein the control system is configured to identify the type or composition of the anatomical target based on a spectral content of the coordinatedly collected sensor data.

13. The surgical laser system of any of claims 1-12, wherein the control system is electrically coupled to the laser system, and electronically triggered to initiate the coordinated collection of the sensor data in response to the detection of the laser pumping signal.

14. The surgical laser system of any of claims 1-13, wherein the control system is optically coupled to the laser system, and optically triggered to initiate the coordinated collection of the sensor data in response to the detection of the laser pumping signal.

15. The surgical laser system of any of claims 1-14, wherein the control system is configured to adjust a laser output setting of the laser system based at least in part on the identified type or composition of the anatomical target.

16. The surgical laser system of claim 15, wherein the pumping signal detector is configured to redetect the presence or absence of the laser pumping signal produced by the laser system in accordance with the adjusted laser output setting, wherein the control system is configured to, based on the redetection of the laser pumping signal, coordinate the collection of sensor data with the laser emission generated in accordance with the adjusted laser output setting.

17. The surgical laser system of any of claims 1-16, wherein the anatomical target includes a calculi target, wherein the controller system is configured to adjust a laser output setting based at least in part on an identification of the calculi target, and to control the laser system to emit the laser energy to the calculi target in accordance with the adjusted laser output setting to ablate or fragment the calculi target.

18. The surgical laser system of any of claims 1-17, wherein to identify the type or composition of the anatomical target includes to identify the anatomical target as a treatment target or a non-treatment target, wherein the control system is configured to control the laser system to enable emission of laser energy to the treatment target, and to disable emission of laser energy to the non-treatment target.

19. A method of identifying an anatomical target, the method comprising: directing laser energy provided by a laser pumping signal in a laser system, and electromagnetic radiation produced by a light source, to the anatomical target, the laser pumping signal and the electromagnetic radiation having distinct wavelengths or wavelength ranges; sensing data indicative of optical properties of the anatomical target using at least one optical sensor; detecting a presence or absence of the laser pumping signal from the sensed data;based on the detection of the laser pumping signal, coordinating collection of sensor data sensed by the at least one optical sensor with laser emission from the laser system; and identifying a type or composition of the anatomical target using the coordinated collection of sensor data.

20. The method of claim 19, wherein the laser pumping signal includes a pumping pulse train with pulse ON periods and pulse OFF periods, wherein coordinating the collection of sensor data with the laser emission includes enabling sensor data collection between consecutive pulses in the pumping pulse train during the pulse OFF periods, and disabling sensor data collection during the pulse ON periods.

21. The method of claim 20, wherein detecting one or more of the pulse ON periods or the pulse OFF periods is further based on one or more pulse train parameters including a pulse width or a pulse rate.

22. The method of any of claims 19-21, comprising: continuously recording and buffering the sensor data sensed by the at least one optical sensor in a memory circuit; and in response to the detected presence of the laser pumping signal, setting a flag or timestamp of the laser pumping signal on the continuously recorded and buffered sensor data, wherein coordinating the collection of sensor data includes a portion of the continuously recorded and buffered sensor data relative in time to the set flag or timestamp, wherein identifying the type or composition of the anatomical target includes using the collected portion of the continuously recorded and buffered sensor data.

23. The method of any of claims 19-22, further comprising performing a spectral analysis of the sensed sensor data.

24. The method of claim 23, wherein detecting the presence or absence of the laser pumping signal is based on a spectral content at or within the pumping wavelength or wavelength range determined from the spectral analysis of the sensed sensor data.

25. The method of any of claims 23-24, wherein identifying the type or composition of the anatomical target is based on a spectral content at or within the wavelength or wavelength range of the electromagnetic radiation determined from the spectral analysis of the coordinated collection of the sensor data.

26. The method of any of claims 19-25, further comprising adjusting a laser output setting of the laser system based at least in part on the identified type or composition of the anatomical target.

27. The method of any of claims 19-26, further comprising: adjusting a laser output setting of the laser system based at least in part on the identified type or composition of the anatomical target; and directing laser energy to the anatomical target via the laser system in accordance with the adjusted laser output setting.

28. The method of claim 27, wherein identifying the type or composition of the anatomical target includes identifying one or more compositions of a calculi target, wherein adjusting the laser output setting is based at least in part on the identified calculi target, wherein the laser energy is provided in accordance with the adjusted laser output setting to ablate or fragment the calculi target.

29. The method of any of claims 27-28, wherein identifying the type or composition of the anatomical target includes identifying the anatomical target as a treatment target or a non-treatment target,wherein adjusting the laser output setting includes enabling emission of laser energy to the treatment target and disabling emission of the laser energy to the non-treatment target.

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