JP6942831B2 - Equipment and methods for laser lithotripsy - Google Patents

Description

Exemplary and non-limiting embodiments relate generally to laser lithotripsy, and more specifically to devices and methods for laser lithotripsy.

Patent Document 1 describes aiming beam detection for laser lithotripsy. Patent Document 2 describes computer-aided image-based lithotripsy. Patent Document 3 describes a low energy laser pulse and an amplified laser pulse.

U.S. Pat. No. 9,282,985 U.S. Pat. No. 9,259,231 U.S. Patent Publication No. 2006/0217688 (A1)

The following outline is merely intended as an example. This summary is not intended to limit the scope of claims.

According to one embodiment, an exemplary embodiment is provided in a device for fragmenting a stone, the device being an endoscope comprising a working channel, the working channel having a recovery basket inserted therein. A sheath comprising an endoscope, a laser fiber, and at least two lumens, wherein the first lumen of the lumens extends through the first lumen by the shaft of the endoscope. It has a laser fiber that is connected to the endoscope and a second of the lumens is separated from the shaft of the endoscope having a channel close to the outer surface of the shaft and the second lumen is inserted therein. The sheath is configured to deliver a low energy check pulse from the laser fiber and detect a response based on the low energy check pulse, as well as at least partially controlling the delivery of the high energy laser pulse from the laser fiber to cause stone formation. It comprises a detection feedback system configured to fragment the laser.

According to another aspect, an exemplary method is to connect the sheath to the shaft of the endoscope, where the sheath contains at least two lumens, the first of which lumens passes through the first lumen. The second lumen of the lumen is separated from the shaft of the endoscope having a channel close to the outer surface of the shaft, and the laser. Includes inserting the fiber into the second lumen and a low energy pulse from the laser fiber to detect a response based on a low energy check pulse, and a high energy laser pulse from the laser fiber to fragment the stone. Includes controlling the delivery of energy from the laser fiber.

According to another aspect, an exemplary embodiment is provided and operates in a non-transient program storage device that is readable by a device that clearly embodies a program of instructions that can be executed by the device to perform the operation. Delivers a low-energy pulse from the laser fiber, detects a response based on the low-energy check pulse, and delivers a high-energy laser pulse from the laser fiber, at least partially based on the detected response. Includes determining whether to fragment the stone or deliver a different low energy check pulse from the laser fiber.

The above aspects and other features will be adopted and described in the following description in conjunction with the accompanying drawings.

It is a block diagram which shows an exemplary embodiment. It is a partial perspective view which shows the proximal end of the endoscope shown in FIG. It is sectional drawing which shows the sheath attached to the endoscope shown in FIG. FIG. 3 is a cross-sectional view similar to FIG. 3 showing a crushed tube in an expanded form. 2 is a cross-sectional view showing the proximal end of the crushable tube shown in FIGS. 2-4. FIG. 3 is a perspective view of an alternative exemplary embodiment. It is a block diagram which shows a part component of the controller shown in FIG. It is a block diagram which shows a part component of the detection system shown in FIG. 7. It is a figure which shows the feature of the exemplary method. It is a schematic diagram which shows a part of a calculus and a basket arm in the path of a laser pulse. It is a figure which shows the exemplary method. It is a figure which shows the image recognition pattern applied to the basket arm. Schematic examples of endoscopes with features as described herein are shown. Schematic examples of endoscopes with features as described herein are shown.

Referring to FIG. 1, a block diagram of device 10 incorporating features of an exemplary embodiment is shown. Although this feature is described by reference to the exemplary embodiments shown in the drawings, it should be understood that this feature can be embodied in many alternative embodiments of the embodiment. In addition, any suitable size, shape or type of element or material can be used.

The device 10 of this exemplary embodiment is adapted for use in laser lithotripsy. The device 10 includes an endoscope 12, a main unit 14, and a user control 16. The user control 16 may be, for example, a foot pedal. The user control 16 may be used by the user, for example, to control the delivery of laser pulses from the laser 20. The main unit 14 may include a plurality of devices, but may be provided as a separate unit. The main unit includes a controller 18 and a laser 20. The laser 20 may include two or more lasers. Also referring to FIG. 2, the endoscope 12 includes a shaft 22 having an optical image fiber or an objective head for the bundle 24, and a working channel 26. The distal end of the shaft 22 can be controlledly deflected by the user at the proximal end of the endoscope.

FIG. 2 shows a tool 28 extending out of the distal end of the working channel 26. The tool 28 can be a surgeon-controlled basket-type device (SCBD). The tool 28 is detachably inserted into the working channel 26 at the proximal end of the endoscope 12 and typically includes a basket device 30 and a sheath 32. The basket device 30 includes an elongated shaft extending through the sheath 32 and a front end basket 34. The basket 34 includes an arm 36. The basket 34 has a first position inside the sheath 32 and a second position extending from the front end of the sheath 32. In the first position, the arms 36 are elastically packed together inside the sheath 32. FIG. 2 shows a second position elastically expanded when the arm 36 is no longer restricted by the sheath 32. In the second position, the basket 34 can be moved over the stone and subsequently folded (by moving the basket device 30 and the sheath 32 to each other) in order for the basket 34 to catch the stone. In an alternative example, a means other than a surgeon-controlled basket-type device (SCBD), such as a gel, can be used to temporarily fix the stone for lithotripsy.

FIG. 2 shows an auxiliary device 38 attached to the shaft 22 of the endoscope 12. The auxiliary device 38 in this example is a sheath configured to support the laser fiber 40 with respect to the endoscope shaft 22. The laser fiber 40 is connected to the laser 20 so that the laser pulse can be delivered via the laser fiber 40 to a site near the distal end of the endoscope. Also referring to FIGS. 3-4, the sheath 38 is generally made of a flexible and elastic material such as a polymer material. The sheath 38 is configured to slide on the shaft 22 and can be removed for disposal after use. The sheath 38 generally includes a first tube 42 and a second tube 44 formed integrally. The second tube 44 is smaller than the first tube 42 and usually extends in parallel along the outer surface of the first tube 42.

FIG. 3 shows a second tube 44 in the form of a natural home position. In this first form, the second pipe 44 has a collapsed state with respect to the outer surface of the first pipe 42. The second tube 44 is elastically expandable from its naturally collapsed state into an expanded form as shown in FIG. The fluid introduced at the proximal end of the second tubing 44 can be used to extend the second tubing 44. Thus, along with the extended second tube 44, the sheath 38 constitutes a first lumen 46 for the endoscope shaft 22 and a second lumen 48 for insertion of the laser fiber 40 to form a laser. The fiber is guided to a portion near the distal end of the shaft 22. Also with reference to FIG. 5, a cross-sectional view of an example of the proximal end of the second tube 44 is shown. In this example, the proximal end of the second tube 44 includes a laser fiber inlet 50 and a separate liquid inlet 52 leading to a second lumen 48. In this example, the laser fiber inlet 50 is substantially rigid and has a generally tapered or funnel shape as an inlet to the second lumen 48. The liquid inlet 52 in this example includes a post 54 configured to be connected to a liquid source such as an irrigation liquid. However, in an alternative example, a different type of structure may be provided at the proximal end of the second tube 44.

Also with reference to FIG. 6, an alternative example of the sheath 38'is shown. In this example, the sheath 38'is shown attached to an endoscope 12 with a deployed basket device 30 and a laser fiber 40 arranged substantially identical to that shown in FIG. However, the sheath 38'includes a clip 42' that attaches the second tube 44 to the endoscope 12. This indicates that two or more methods are provided and the laser fiber sheath can be detachably connected to the endoscope. In another alternative, the laser fiber sheath may have a crushable tube 44 located within the working channel 26. Thus, in the example where the channel 44 is located within the working channel 26, while the tube 44 is collapsed, the portion of the working channel 26 required for the laser fiber 40 is for other purposes (eg, irrigation, etc.). Can be substantially open to use. In this alternative, the first tube 42 may or may not include a second tube 44. If a first tube 42 is provided, it may be used, for example, through a medical tool, or, for example, another irrigation flow path (in / out) may be separated.

Alternatively, an additional channel outside the working channel 26 may be incorporated into the endoscope itself for either the removable path of the laser or the fixed laser fiber. An example of this is shown in FIG. 13A, where an off-center channel 44'' is provided within the endoscope itself as either a removable path within another channel 45 or a fixed laser channel. Has been done. Another example of this is shown in FIG. 13B, where the endoscope has a fixed laser fiber 40 off center, separated from the image and illumination bundles 25, 27.

In one example, holmium: YAG (Ho: YAG) laser lithotripsy can use a laser beam with a wavelength of 2170 nm to crush kidney stones of various compositions into small pieces by photothermal effect. During this process, it is desirable to target the stone in a fixed position and avoid subdividing the stone into a small number of masses (early subdivision) before the stone is reduced to a smaller size. To stabilize kidney stones during the procedure, some doctors hold the stones in a basket and rotate the basket to effectively scrape the edges of the stones. This is a parallel arrangement of the basket and the laser fiber. In the application of such procedures with current flexible endoscopes, the basket and laser fiber are inserted through the same working channel, typically 1.2 mm (3.6 Fr) in diameter. Both of these instruments occupy most of the lumen of the working channel. This makes it difficult for these instruments to operate independently as needed by the procedure. The working channel of a flexible endoscope is generally centered along the endoscope body.

The use of baskets to hold the stones will reduce the backflow and flow effects of the stones and may be expected to increase crushing time efficiency. However, it has been found that trapping stones can reduce crushing time efficiency. The reason that stone trapping does not improve crushing time efficiency may be due to the inability to effectively manipulate the laser fiber through the working channel shared with the trapping device. This would be a constraint similar to that found in laser baskets where the laser can only be emitted through the center of the stone. Features such as those described herein can be used to optimize the coupling between the laser fiber and the trapped stone, which increases time efficiency during the crushing procedure.

Another problem with the traditional placement of basket devices and laser fibers in the same endoscopic working channel is that the working channel is for irrigation fluids (for cleaning the field of view and removing the heat of the laser beam from the ureter or kidney). It is the same as the channel. As a result, the fluid flow in the working channel is reduced and may be inadequate. The dimensions of the working channel of a flexible endoscope are limited by the diameter of the scope shaft and the space occupied by the mechanism inside the endoscope shaft. Also, the shaft diameter is limited by the body cavity in which the scope is used. Particularly from the perspective of a ureteroscope, a general ureteral access sheath (UAS) is 12-14 Fr for ureters that have not been pre-stented. The endoscope is inserted with an access sheath having an inner diameter (ID) of 4 mm. A space must be left between the UAS ID and the scope shaft so that the scope can easily enter the UAS, and the same space is the outflow route for irrigation water. As an example, the GYRUS ACMI DUR-8 Ultra has a shaft outer diameter (OD) of 2.9 mm and the OLYMPUS URF-P5 has a shaft OD of 2.6 mm. By placing a second circular lumen parallel to these endoscopes inside the UAS of 12-14 Fr, the second lumen is 1.1 mm OD for DUR-8 Ultra, or for URF-P5. Can have an OD of 1.4 mm.

In order to solve the above-mentioned problems caused by only one working channel for two instruments, that is, a basket device to be inserted and a laser fiber, the features described herein are used within the flexibility. A crushable, externally flexible tunnel that attaches to the shaft of the endoscope can be designed. Made of a thin flexible polymer material, this tunnel can be completely collapsed over most of its entire length when the endoscope is inserted into the ureter or through the UAS into the ureter. (In some cases, it is not crushed at its proximal end). In the collapsed state, this tunnel adds a minimum thickness to the scope OD on one side, so it is not inconvenient for insertion and does not interfere with insertion. When the endoscope is deployed and the laser is ready to be introduced into the patient's body cavity, such as the ureter, the external tunnel can be inflated by the injection of water. Then, the laser fiber can be inserted into an open tunnel. At the end of insertion, the tip of the laser fiber appears on the side of the scope shaft at the distal end of the endoscope.

A typical endoscope has a segment at the tip and the distal end of the shaft that can be deflected in two opposite directions. For purposes of explanation, these two directions are referred to as "up" and "down". When the tip is deflected in this way, the centerlines to the left and right along the shaft are neutral relative to the curvature of the shaft. The neutral line is a line whose length does not change due to the curvature, because the pipe attached in the outer longitudinal direction on the neutral plane will not affect the curvature of the shaft, or the effect will be minimal. Therefore, the left side, the right side, or both sides are ideal positions for mounting the tunnel because they do not interfere with the bending of the shaft. Regular working channels are reserved for basket devices and irrigation fluids as the laser passes through externally mounted tunnels. Therefore, the basket and the laser fiber can be operated without interfering with each other. When the basket passes through the working channel of the scope and through a tunnel fitted with a laser fiber, these two instruments do not interfere with each other as the surgeon operates them independently of each other. The additional tunnel 44 can extend all the way to the proximal end of the endoscope. At the proximal end of the scope, the additional tunnel 44 may be terminated with an additional head block attached to the handle of the scope. In this additional tunnel 44, the laser enters the tunnel through a port in the additional head block.

Also with reference to FIG. 7, the controller 18 typically includes a processor 56 and a memory 58. The controller may be configured to provide a variety of different features, including, for example, controlling the delivery of laser pulses from the laser 20 to the laser fiber 40, at least in part. In this example, the controller includes a detection system 60. The detection system 60 preferably includes the use of at least a portion of the processor 56 and the memory 58 having the software code. The detection system 60 uses the optical information input to the image bundle 24 to detect one or more states or situations in front of the objective head of the endoscope. In the examples described, the controller 18 uses a detection system to determine if and / or how the laser 20 and laser fiber 40 should be used to deliver laser pulses. It is configured as follows. The detection system 60 can also be used as an input to the controller 18 to control at least one other predetermined function or operation.

Also with reference to FIG. 8, the detection system 60 in this example is configured to provide a range determination function 62, a reflectance and / or emissivity determination function 64, and an image processing function 66. However, in alternatives, more or less functionality may be provided by the detection system 60. For example, a system having a reflectance and / or emissivity determination function 64 but not an image processing function 66 may be provided. Alternatively, a system having an image processing function 66 but not a reflectance / emissivity determination function 64 can be provided.

The range determination function 62 determines the range or distance between the proximal end of the laser fiber 40 and an object such as a stone in the laser path in front of the laser fiber 40 or a portion of one of the arms 36 of the basket 34. It is configured as follows. The laser fiber 40 can deliver a low energy laser pulse, based on the response from this low energy laser pulse, eg, perceived as an input to the image bundle 24 or returned through the laser fiber 40. The detection system may be able to determine the range or distance between the proximal end of the laser fiber 40 and an object in the laser path in front of the laser fiber 40. This may be based, for example, on the timing of the response of the laser pulse to ignition and / or with the use of image processing.

The reflectance and / or emissivity determination function 64 can be used by the controller 18 to coordinate or control the delivery of laser pulses from the laser 20 through the laser fiber 40. In one example, the reflectance and / or emissivity determination function 64 can be used to stop the high energy laser pulse being used based on predetermined conditions.

In conventional procedures, laser energy is usually applied as a first step, after crushing the stone, a basket is inserted to capture the debris. However, there is often a backflow of stone debris scattered to other areas of the kidney, such as after a powerful laser energy pulse. In doing so, the surgeon will need to track the stone and apply higher energy or capture and remove the stone debris. By using the features described herein, the advantage of having a low energy check pulse to determine if it is safe to emit laser energy to the stone may be provided. This may be combined with the combination of the side-illuminated laser and the basket described above.

The basket-detection laser function can automatically stop the laser when the basket wire 36 is detected, using a reflectance measurement method for laser equipment. Alternatively, or in addition, this function may also be an image processing detection function that interlocks the laser by image processing. Laser reflectance detection may be preferred because it can be less susceptible to slight changes in the image, such as blood, air bubbles during lithotripsy, and a flash of laser in the image.

By using two different energy laser pulses, the laser pulse is used inside the laser equipment for detection / determination of objects using one type of pulse, and for stone crushing using another different type of pulse. Can be multiplexed for laser irradiation. The basket-detection laser function can also work with an electric basket rotation to automatically collect stones. The laser settings can be adjusted based on the effectiveness of utilizing a laser rangefinder to assess how each laser pulse has an effect on stones. As one exemplary method, the stone may be moved in the xy plane with respect to the laser path, the basket wire may be rotated to reposition the stone-basket combination, and repositioned by a pulsed laser. You may check.

Referring to FIG. 9, an example is first shown in which a low energy pulse is delivered, as shown in block 68. Also with reference to FIG. 10, the detection system 60 can then be used to determine if a portion of the basket, such as the arm 36, is within the laser pulse path 70 located in front of the calculus 72. If the basket is not detected, as shown in block 74, the system may allow high energy pulses to be delivered as shown in block 76. However, if a basket is detected, the system can stop the high energy pulse being delivered. This allows the low energy check pulse to be used to determine if it is safe to fire a high energy laser pulse. At 74, an interlock signal can be generated to control whether a high energy pulse is emitted. This prevents damage to the basket arm 36 due to the high energy pulse.

Since the basket 34 can be rotated relative to the laser fiber 40, there is a risk that the basket arm 36 can enter the path of the laser pulse 70. If the basket arm 36 is damaged by the laser pulse, the damaged basket can be difficult to remove from the patient or cause other problems. Therefore, by preventing the basket arm 36 from being damaged by the laser pulse, potential problems due to basket damage are reduced. By using the features described herein, an automatic stop can be provided to prevent damage to the basket if the basket is detected in path 70.

Also with reference to FIG. 11, the features described herein can be used as inputs from an image bundle as shown by block 78 as inputs that are parsed as shown in block 80. Based on the analysis of this input, the system controls the laser as shown in 82, controls the delivery of the laser pulse as shown in 84, and automatically using the automatic basket controller 86. The basket arm 36 may be configured to disengage the laser pulse path 70 and / or perform one or more movements, including some other movements as shown in 88. The basket controller can rotate the basket 34, thereby rotating the stone (located in the basket) with respect to the path 70 of the laser pulse. Reflectance / emissivity can be measured by multiplexing low and high energy pulses at any desired ratio, eg 1: 1 or 10: 1. The laser control 82 may include, for example, changing the use of various power settings, frequencies, or wavelengths.

In one type of example, image processing 66 can identify the basket arm 36 by color. For example, the basket arm 36 may have metallic gray or dark green, or bright yellow or reddish brown, while the stones may have white or pale yellow. The color of the basket arm can be, for example, multicolored with a pattern. In another example, the basket arm 36 may be provided with a mark or an optical pattern 90 as shown by the example in FIG. 12 for faster or more accurate image recognition. Image processing may in addition to or instead use shape recognition, boundary recognition, or color distinction between the stone 72 and the basket arm 36, for example, as shown in FIG. good. The range detection function can be used to assist in shape calculation and / or determination of power used for laser pulses. The detection system 60 may also be configured to detect the movement of the stones 72 (and debris) and / or the basket 34 individually or, for example, to each other.

The position of the side-illuminated laser fiber can be used to strike the stone off-center and scrape the ends of the stone into smaller pieces. However, if desired, the laser fiber 40 (or additional laser fiber) may be inserted into the working channel 26 for firing in the central region of the stone. Thus, the features described herein allow for a plurality of different laser fiber installation positions with respect to the endoscope. This provides the flexibility of endoscopic / laser fiber configurations that was not previously available. Also, the feature allows two or more laser fibers to be deployed at the same time as the endoscope, and in some cases, for example, at the same time.

An exemplary device for fragmenting a stone may be provided, the device being an endoscope containing a working channel, within which the working channel is configured to have a collection basket inserted therein. A sheath containing an endoscope, a laser fiber, and at least two lumens, the first of which is connected to the endoscope by an endoscope shaft extending through the first lumen. The second lumen of the lumen is separated from the shaft of the endoscope having a channel close to the outer surface of the shaft, and the second lumen is inserted into the sheath having a laser fiber and the laser fiber. It is configured to deliver a low energy check pulse and detect a response based on the low energy check pulse, and to at least partially control the delivery of the high energy laser pulse from the laser fiber to fragment the stone. It comprises a detection feedback system that is configured.

The first lumen can be formed, at least in part, by the first tube, and the second lumen is flexible, at least in part, configured to collapse relative to the first tube. It can be formed by a tube. The second lumen may have a substantially rigid inlet at the proximal end of the second lumen. The proximal end of the second lumen may include both a laser fiber inlet and a separate liquid inlet leading to the second lumen. The detection feedback system may include a range detection system configured to detect the range between the end of the laser fiber and the object to which the low energy check pulse hits. The detection feedback system may be configured to measure reflectance and / or emissivity. The detection feedback system can be configured to use image processing. The detection feedback system may be configured to recognize at least one of the shape of at least a portion of the collection basket, the color of at least a portion of the collection basket, and the pattern of at least a portion of the collection basket. The detection feedback system may be configured to stop the delivery of the high energy laser pulse based on the detection feedback system that determines that the high energy laser pulse will hit the recovery basket. The detection feedback system may include means for detecting whether a portion of the recovery basket is located in the path in front of the laser fiber.

An exemplary method is to connect the sheath to the shaft of the endoscope, where the sheath contains at least two lumens, the first of which lumens extends through the first lumen. The second lumen of the lumen, which is connected to the endoscope by the shaft of the mirror, is separated from the shaft of the endoscope having a channel close to the outer surface of the shaft, and the laser fiber is the second lumen. Of energy from a laser fiber, including a low energy pulse from the laser fiber to detect a response based on a low energy check pulse, and a high energy laser pulse from the laser fiber to fragment the stone. Includes controlling delivery.

The method may further include injecting fluid into the second lumen to extend the second lumen from a collapsed form to an expanded form before inserting the laser fiber into the second lumen. This method may further include using a range detection system that detects the range between the end of the laser fiber and the object to which the low energy check pulse hits. This method measures a reflectance and / or emissivity based on a low energy check pulse and / or a detection feedback system configured to identify an object ahead of the path of the low energy check pulse by image processing. It may further include use.

An exemplary embodiment may be provided in a non-transient program storage device, such as memory 58, which is readable by a device that clearly embodies a program of instructions that can be executed by the device to perform the operation. The operation is to deliver a low energy pulse from the laser fiber, to detect a response based on the low energy check pulse, and to deliver a high energy laser pulse from the laser fiber based at least in part on the detected response. To determine whether to fragment the stone or deliver a different low energy check pulse from the laser fiber.

An exemplary embodiment may be provided in a sheath configured to be detachably connected to the shaft of the endoscope. The sheath may include a first tube forming a first lumen and a second tube formed integrally forming a second lumen along the outer surface of the first tube. The second tube may have a natural home position, including a first collapsed form relative to the first tube. The second tube can be elastically expandable from the first collapsed form to the second expanded form by the liquid, where the laser when the second tube is in its second expanded form. The fiber can be inserted into the second lumen. The sheath may have a substantially rigid inlet at the proximal end of the second lumen. The inlet can have a common funnel shape. The proximal end of the second lumen may include a separate liquid inlet leading to the second lumen.

In an alternative exemplary embodiment, the sheath may be insertable through the working channel of the endoscope or may be removable for disposal. In such an alternative, the sheath may contain less than two lumens. The laser fiber may include a clad on its front surface that prevents the laser fiber from damaging the sheath. Another alternative exemplary embodiment may include at least one clip for attaching the sheath to the shaft of the endoscope in addition to or as an alternative to the first tube.

An exemplary embodiment may be provided in a device comprising an image fiber, a laser fiber connected to an endoscope, and an endoscope comprising a controller configured to control the delivery of laser energy from the laser fiber. .. The controller is configured to control the delivery of laser energy from the laser fiber, at least in part, based on the input to the image fiber at the distal end of the endoscope. The controller allows the delivery of low energy check pulses from the laser fiber and controls the delivery of high energy laser pulses from the laser fiber based at least in part on the input to the image fiber at the distal end of the endoscope. Can be configured to fragment the stone. The controller may also be configured to determine the range between the end of the laser fiber and the target to which the low energy check pulse hits. The controller may be configured to use the reflectance and / or emissivity from the low energy check pulse to control whether the high energy laser pulse is emitted from the laser fiber. The controller may be configured to use image processing to control whether high energy laser pulses are emitted from the laser fiber. The image processing may be configured to recognize at least one of the shape of at least a portion of the collection basket, the color of at least a portion of the collection basket, and the pattern of at least a portion of the collection basket. The controller is configured to stop the high energy laser pulse delivered by the laser fiber based on the determination that the high energy laser pulse will hit a recovery basket extending out of the distal end of the endoscope. Can be done. Image processing can be configured to detect at least a portion of the basket device and / or at least a portion of the stone. The controller may be configured to change the laser energy emitted by the laser fiber, such as frequency and wavelength, based on the determined stone dynamics, such as the direction and velocity of the stone relative to the laser fiber. The device may be configured to automatically rotate or move the basket based on the input to the image fiber. The controller may be configured to coordinate the delivery of laser energy and / or move the basket device based on the dynamics / position of the stone and / or the position of the basket device with respect to the distal end of the laser fiber. Laser fibers may include two or more laser fibers that are optionally configured to deliver different energy pulses.

It should be understood that the above explanation is merely an example. Various alternatives and modifications can be devised by those skilled in the art. For example, the features listed in the various dependent claims can be combined with each other in any suitable combination. Moreover, features derived from the various embodiments described above can be selectively combined with the novel embodiments. Accordingly, this description is intended to include all such alternatives, modifications and modifications that fall within the appended claims.

10 Equipment 12 Endoscope 14 Main unit 16 User control 18 Controller 20 Laser 22 Shaft 24 Image bundle 25 Lighting bundle 26 Working channel 27 Lighting bundle 28 Tool 30 Basket device 32 Sheath 34 Basket 36 Basket arm 38 Auxiliary device, sheath 40 Laser fiber 42 1st tube 44 2nd tube 45 Channel 46 1st lumen 48 2nd lumen 50 Laser fiber inlet 52 Liquid inlet 54 Post 56 Processor 58 Memory 60 Detection system 62 Range determination function 64 Radiation rate determination Function 66 Image processing function 68 Block 70 Path 72 Stone 86 Automatic basket controller 90 Optical pattern

Claims (6)

It ’s a device,
With at least one processor
With at least one non-transient memory containing computer program code,
The at least one memory and the computer program code are brought into the device by the at least one processor.
Controlling the delivery of low energy check pulses from the device
It is configured to detect a response based on the low energy check pulse and control the delivery of a high energy laser pulse from the device.
Control of the delivery of the high energy laser pulse from the device
Based on the determination that the high-energy laser pulse will hit the first predetermined object, the high-energy laser pulse can be delivered from the device, and the high-energy laser pulse is the second. based of the determination that would strike the given subject, at least 1 Tsuo備example of possible to prevent the said energetic laser pulse is delivered from the device,
The device is configured to recognize at least a part of the second predetermined object as a tool . The at least one memory and the computer program code are configured by the at least one processor to cause the device to detect a range between the end of the laser fiber of the device and the first predetermined object. The device according to claim 1. The device of claim 1, wherein the at least one memory and the computer program code are configured by the at least one processor to cause the device to measure reflectance and / or emissivity. The device according to claim 1, wherein the device is configured to use image processing to determine the first predetermined object and / or the second predetermined object. The tool is a retrieval basket, according to claim 1. The device according to claim 1, wherein the device is configured to recognize the first predetermined object as a calculus.

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