Systems, devices, and methods for delivering laser energy to a target in an endoscopic procedure are disclosed. An exemplary method comprises providing a first laser pulse train and a different second laser pulse train emitting from a distal end of an endoscope and incident on a target. The first laser pulse train has a first laser energy level, and the second laser pulse train has a second laser energy level higher than the first laser energy level. In an example, the first laser pulse train is used to form cracks on a surface of a calculi structure, and the second laser pulse train causes fragmentation of the calculi structure after the cracks are formed.

There is provided a process for treatment of rhinitis by diode laser ablation of the posterior nasal nerves. The laser diode delivery device with elongated optic tip is inserted through a patient's nostril and has the length, flexibility and a curvature to reach both above and under the patient's middle turbinate for treatment to both posterior nasal nerves. Skin and tissue temperature is raised to approximately 60-65° C. with the process. Optimal treatment wavelength was found to be approximately 380-450 nanometers with blue lasers.

A method of endodontic therapy with improved disinfection and ablation characteristics may feature the use of an alcohol or polyol-based indocyanine green (ICG) solution with a laser system that emits a wavelength within the maximal absorption range of ICG. By matching the dye and laser output, radiant energy use is maximized for efficient ablation and disinfection of treated tissues. Also, the use of an alcohol or polyol as a solvent for the ICG solution increases the inherent disinfection qualities of the solution itself. In one embodiment, the prepared canal is flooded with the ICG solution and the laser activates with the laser fiber inserted into the solution. In an alternate embodiment, the solution is mostly removed prior to activation of the laser, but only after necrotic tissue has been stained.

A method of endodontic therapy with improved disinfection and ablation characteristics may feature the use of an alcohol or polyol-based indocyanine green (ICG) solution with a laser system that emits a wavelength within the maximal absorption range of ICG. By matching the dye and laser output, radiant energy use is maximized for efficient ablation and disinfection of treated tissues. Also, the use of an alcohol or polyol as a solvent for the ICG solution increases the inherent disinfection qualities of the solution itself. In one embodiment, the prepared canal is flooded with the ICG solution and the laser activates with the laser fiber inserted into the solution. In an alternate embodiment, the solution is mostly removed prior to activation of the laser, but only after necrotic tissue has been stained.

The systems and methods of the present disclosure are used for guiding a medical instrument towards a target, the method positioning a medical instrument at a first location within a patient anatomy, wherein the medical instrument comprises at least one sensor, determining a first biomarker measurement using the at least one sensor, determining a second biomarker measurement using the at least one sensor, comparing the first biomarker measurement with the second biomarker measurement to determine a proximity to the target to provide a first comparison, and providing guidance for moving the medical instrument based on results of the first comparison.

A medical endodevice for an intervention inside a human or animal body includes an elongated liaising structure having a distal end arrangeable inside a body of the human or animal being and a proximal end arrangeable outside the body while the distal end is inside the body. The endodevice has an intervention tool arranged to manipulate a target tissue inside the human or animal body. The intervention tool is arranged at the distal end of the liaising structure. The endodevice further includes a positioning unit having a moving formation arranged to dislocate the intervention tool relative to the target tissue, and an anchoring formation arranged to fix the moving formation to a fixing tissue inside the human or animal body such that the target tissue is positioned in a workspace of the intervention tool.

Apparatus and methods for tissue excision. In certain aspects, the apparatus and methods include an annular converging laser beam. The annular converging laser beam can be directed to a surface of a tissue and displace a portion of the tissue in a single or multiple laser pulses. In particular aspects, the dosimetry of the laser beam (e.g. the beam shape, pulse energy and pulse duration) can be controlled to eject the portion of the tissue in a manner to reduce damage to the displaced tissue and the surrounding tissue.

Apparatus and methods for tissue excision. In certain aspects, the apparatus and methods include an annular converging laser beam. The annular converging laser beam can be directed to a surface of a tissue and displace a portion of the tissue in a single or multiple laser pulses. In particular aspects, the dosimetry of the laser beam (e.g. the beam shape, pulse energy and pulse duration) can be controlled to eject the portion of the tissue in a manner to reduce damage to the displaced tissue and the surrounding tissue.

An instrument according to the invention for medical or surgical treatment of a human or animal patient comprises at least one tool suitable for influencing a patient, e.g. an electrode, which is or are located in the field of view of an optical element. The optical element is arranged inside a channel in which a fluid flow can be maintained or can be caused in distal direction. The light passage window of optical element is offset relative to the distal opening of channel in proximal direction. A closure device is arranged between light passage window and opening of channel, which blocks passage of substances, particularly passage of liquid droplets and particles, from the opening to the light passage window as long as it is in closed position. If the closure device is open, it unblocks the fluid path and the light path between the light passage window to the opening. Preferably the closure device is controlled pneumatically by means of the liquid or gaseous fluid flowing inside channel. With this measure a contamination of the light passage window during operation of the instrument can be reliably avoided or at least reduced to a minor degree.

A tool has a handle and an elongate shaft that extends distally from the handle. A distal portion of the shaft is inserted into a subject during a surgical procedure. An optical fiber delivers laser energy to a tip at the distal portion of the shaft. The tip includes a mechanical cutting mechanism including a moving part that absorbs the laser energy, thermally conducts the absorbed energy to tissue that is disposed between the moving part and another part, and moves with respect to the other part in order to cut tissue that is disposed between the parts using a mechanical force that is lower than a mechanical force that would be required to cut the tissue in the absence of the laser energy. Other embodiments are also described.