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.

In an embodiment, a method for effecting thermal therapy using an in vivo probe includes positioning the probe in a volume in a patient, identifying an irregularly shaped three-dimensional region of interest and automatically applying thermal therapy to the region using the probe. Applying thermal therapy may include identifying a first emission level at a first rotational angle based in part on a depth of a radial portion of the region in the direction of probe emission, activating emission of the probe, causing rotation of the probe to a next rotational angle, identifying a next emission level at the next rotational angle based in part on a depth of a radial portion of the region in the direction of probe emission, activating emission to deliver therapeutic energy, and repeating rotation and emission until therapeutic energy has been delivered to the volume.

In an embodiment, a method for effecting thermal therapy using an in vivo probe includes positioning the probe in a volume in a patient, identifying an irregularly shaped three-dimensional region of interest and automatically applying thermal therapy to the region using the probe. Applying thermal therapy may include identifying a first emission level at a first rotational angle based in part on a depth of a radial portion of the region in the direction of probe emission, activating emission of the probe, causing rotation of the probe to a next rotational angle, identifying a next emission level at the next rotational angle based in part on a depth of a radial portion of the region in the direction of probe emission, activating emission to deliver therapeutic energy, and repeating rotation and emission until therapeutic energy has been delivered to the volume.

An apparatus may include an optical fiber having an angled grating aligned along a plane non-normal to a longitudinal axis of a distal end portion of the optical fiber. The angled grating may be configured to redirect a first laser energy propagated within the optical fiber and incident on the angled grating to a direction offset from the longitudinal axis. The apparatus may also include a metallic cap coupled to the optical fiber. The metallic cap may have an inner surface configured to redirect a second laser energy incident on the inner surface along the direction offset from the longitudinal axis. The second laser energy being different than the first laser energy.

An apparatus may include an optical fiber having an angled grating aligned along a plane non-normal to a longitudinal axis of a distal end portion of the optical fiber. The angled grating may be configured to redirect a first laser energy propagated within the optical fiber and incident on the angled grating to a direction offset from the longitudinal axis. The apparatus may also include a metallic cap coupled to the optical fiber. The metallic cap may have an inner surface configured to redirect a second laser energy incident on the inner surface along the direction offset from the longitudinal axis. The second laser energy being different than the first laser energy.

The device for carrying out underskin radiation treatment consists of a handpiece that allows easy manipulation by physicians, with a part that can be inserted below the skin and a part that can be held and manipulated outside the body. The part inserted below the skin can be vibrated or oscillated by means of suitable transducers to aid in distributing the radiation. Simultaneously or immediately afterwards, liquefied tissue is aspirated. If convenient, fluid irrigation of the area to be treated can be done. In a preferred embodiment, handpiece consists in a hollow cannula incorporating at least one channel for suction and/or irrigation and a light guiding means in its body/wall section for the purpose of the treatment and liquefaction of adipose tissue. The device further comprises at least one radiation source, included in device part affixed to the handpiece either in a permanent or detachable manner.

The device for carrying out underskin radiation treatment consists of a handpiece that allows easy manipulation by physicians, with a part that can be inserted below the skin and a part that can be held and manipulated outside the body. The part inserted below the skin can be vibrated or oscillated by means of suitable transducers to aid in distributing the radiation. Simultaneously or immediately afterwards, liquefied tissue is aspirated. If convenient, fluid irrigation of the area to be treated can be done. In a preferred embodiment, handpiece consists in a hollow cannula incorporating at least one channel for suction and/or irrigation and a light guiding means in its body/wall section for the purpose of the treatment and liquefaction of adipose tissue. The device further comprises at least one radiation source, included in device part affixed to the handpiece either in a permanent or detachable manner.

A laser can produce pulses of light energy for tissue-type selective ejection of a volume of the target tissue, and the energy can be delivered to a treatment site through a waveguide, such as a fiber optic waveguide. The incident laser energy can be absorbed within a volume of the target tissue with a tissue penetration depth and pulse direction such that the propagation of the energy from the tissue volume is inhibited and such that the target tissue within the volume reaches the spinodal threshold of decomposition and ejects the volume, for example without substantial damage to tissue adjacent the ejected volume. The pulses are set to be tissue selective.

A laser can produce pulses of light energy for tissue-type selective ejection of a volume of the target tissue, and the energy can be delivered to a treatment site through a waveguide, such as a fiber optic waveguide. The incident laser energy can be absorbed within a volume of the target tissue with a tissue penetration depth and pulse direction such that the propagation of the energy from the tissue volume is inhibited and such that the target tissue within the volume reaches the spinodal threshold of decomposition and ejects the volume, for example without substantial damage to tissue adjacent the ejected volume. The pulses are set to be tissue selective.

Embodiments of the invention include a method of initiating an optical fiber of a tip assembly to form a finished tip assembly. In some embodiments, at least a portion of a distal portion of the optical fiber is coated with an energy absorbing initiating material. In some embodiments, the initiating material is an enamel material including a mixture of brass (copper and zinc) flakes or aluminum flakes in a solution of organic solvents. After the initiating material dries, a diode laser is fired through the optical fiber. The laser energy is at least partially absorbed in the initiating material and ignites the organic solvents. This combustion melts the material of the optical fiber, and impregnates the optical fiber with the metal flakes of the initiating material. The resulting initiated optical fiber is thus permanently modified so that the energy applied through the fiber is partially absorbed and converted to heat.