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.

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.

A catheter system (100) includes a light guide (122A) and a light source (124). The light guide (122A) is configured to selectively receive light energy. The light source (124) generates the light energy. The light source (124) is in optical communication with the light guide (122A). The light source can include (i) a seed source (260) that outputs the light energy, (ii) a pre-amplifier (262) that receives the light energy from the seed source (260), the pre-amplifier (262) being in optical communication with the seed source (260), and (iii) an amplifier (264) that receives the light energy from the pre-amplifier (262), the amplifier (264) being in optical communication with the pre-amplifier (262) and the light guide (122A).

Multi-fiber laser probes utilize relative motion of fibers and other laser probe elements to preserve small-gauge compatibility while providing for multi-spot beam deliver, or to provide for the selectively delivery of single-spot or multi-spot beam patterns. An example probe includes fibers having distal ends that are movable as a group onto a distal ramp element affixed to a distal end of a cannula, so that the distal ends of the fibers can be moved between a retracted position, in which the distal ends of the fibers are within the cannula or ramp element, and an extended position, in which distal ends of the fibers are guided by grooves or channels of the ramp so as to extend at least partially through external openings in the distal end of the laser probe and so as to be pointed angularly away from a longitudinal axis of the cannula.

A catheter system (100) for treating a treatment site (106) within or adjacent to a vessel wall (108A) of a blood vessel (108) within a body (107) of a patient (109) includes an energy source (124), a catheter fluid (132), and an emitter assembly (129). The energy source (124) generates energy. The emitter assembly (129) includes (i) at least a portion of an energy guide (122A) having a guide distal end (122D) that is selectively positioned near the treatment site (106), (ii) a plasma generator (133), and (iii) an emitter housing (260) that is secured to each of the energy guide (122A) and the plasma generator (133) to maintain a relative position between the guide distal end (122D) of the energy guide (122A) and the plasma generator (133). The energy guide (122A) is configured to receive energy from the energy source (124) and direct the energy toward the plasma generator (133) to generate a plasma bubble (134) in the catheter fluid (132). The plasma generator (133) directs energy from the plasma bubble (134) toward the treatment site (106).

A variable length interstitial probe apparatus includes: a probe for effecting thermal therapy and/or cryotherapy to a tissue; a flexible umbilical sheath permanently affixed to the probe, including at least one interface for supplying energy, cooling fluid, cooling gas, heating fluid, and/or heating gas to the probe; and an adjustable depth stop configured to slide along a length of a shaft region of the probe, and lock to the shaft region at a selected position. The adjustable depth stop is configured to engage a probe driver and/or a skull mount apparatus to stabilize positioning of the probe and to control a depth of entry of the probe into a patient. The probe may be configured to effect temperature modulation therapy, where processing circuitry activates a modulation pattern of thermal therapy emission and cryogenic therapy emission for applying a thermal dose to the tissue.

A catheter system and method for treating a treatment site within or adjacent to a vessel wall or a heart valve within a body of a patient includes an energy source, an inflatable balloon, an energy guide, and an acoustic sensor. The inflatable balloon is positionable substantially adjacent to the treatment site. The inflatable balloon has a balloon wall that defines a balloon interior that receives a balloon fluid. The energy guide receives energy from the energy source and guides the energy into the balloon interior. The acoustic sensor is positioned outside the body of the patient. The acoustic sensor senses acoustic sound waves generated in the balloon fluid within the balloon interior. The acoustic sensor generates a sensor signal based at least in part on the sensed acoustic sound waves.

In certain embodiments, a neural probe comprises a substrate comprising elongated shanks for penetrating neural tissue, each comprising a proximal end and a distal end; at least one optical source integral to the neural probe for illuminating the neural tissue; and microelectrodes located proximate the distal end of the elongated shanks for monitoring neuronal activity. In certain embodiments, a method of monitoring neuronal activity comprises implanting the neural probe into a test subject such that the elongated shanks protrude into neural tissue of the test subject; illuminating the neural tissue with the at least one optical source; and measuring neuronal activity in response to illuminating the neural tissue. In certain embodiments, a device comprises a semiconductor chip; at least one optical source integral to the semiconductor chip; and sensor elements integral to the semiconductor chip for collecting data responsive to light emitted from the at least one optical source.

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.

A laser operation device includes an elongated catheter, a light irradiator configured to irradiate a laser in front of a tip of the catheter, a lens disposed at a front of the light irradiator and allowing the laser to pass therethrough, a wire configured to steering the lens by pulling one side of the lens, and an elastic body configured to give an elastic force to restore the lens against a tension of the wire, wherein when the lens is steered, the laser passes through the lens and is refracted.