A medical system may include: a medical device including an elongate shaft configured to access a treatment site within a patient and a handle coupled to a proximal end of the elongate shaft; a laser device including an elongate tubular member configured for insertion through a working lumen of the medical device, the elongate tubular member including a cooling channel and a laser fiber extending distally within the cooling channel; and a fluid management system including an inflow pump configured to pump fluid from a first fluid supply source through the elongate shaft to the treatment site, a cooling pump configured to pump fluid from a second fluid supply source through the cooling channel, and a controller configured to control the inflow pump and the cooling pump.

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.

Apparatus and methods for segmental treatment of hollow anatomical structures using an optical fiber are disclosed. An elongate energy application device can absorb, scatter and/or reflect laser energy over a length of the elongate energy application device to thereby treat the hollow anatomical structure along one or more lengthened treatment segments.

An aspect of the present disclosure may include an apparatus having an optical waveguide. The optical waveguide may have a distal end surface non-normal to a longitudinal centerline of a distal end portion of the optical waveguide, wherein the distal end surface may define a portion of an interface configured to redirect electromagnetic radiation propagated from within the optical waveguide and incident on the portion of the interface to a direction offset from the longitudinal centerline. The apparatus may further include a capillary component which may have a first portion of an inner surface heat-fused to a portion of an outer surface of the optical waveguide. The apparatus may also include a reinforcement component which may have a proximal end surface disposed distal to the distal end surface of the optical waveguide such that the distal end surface of the optical waveguide and the proximal end surface of the reinforcement component may be separated by a non-zero distance, and wherein a portion of an outer surface of the reinforcement component may be heat-fused to a second portion of the inner surface of the capillary component.

A probe tip for communicating and laterally directing electromagnetic radiation comprises a waveguide, a primary capsule, a compressible member and a malleable secondary capsule. The waveguide is configured to communicate electromagnetic radiation and includes a beveled surface at a distal tip for redirecting electromagnetic radiation in a lateral direction. The primary capsule is attached over the distal tip of the waveguide. The compressible member covers a portion of the primary capsule. The malleable secondary capsule is positioned over the primary capsule and the compressible member, and includes a crimp that compresses the compressible member against the primary capsule and secures the secondary capsule to the primary capsule.

An improved optical fiber comprising a waveguide with an input for coupling focused laser energy into the waveguide and communicating electromagnetic radiation in a propagation direction to an internally reflective tip of the waveguide, a tissue contacting surface wherein the light path from the reflecting surface to the transmitting surface in substantially homogenous in refractive index and cooled by fluid flow. In minimizing the variations in refractive index within the lateral light path, while providing active cooling directly below the tissue contact surface, the invention prevents internal reflections and beam distortion and greatly improves the efficiency and durability of the laterally directing probe. Free rotation of the tissue contact surface, about the lateral tip, may be provided and tissue vaporization efficiency may be improved by providing a morcellating tool on the tissue contact surface.

A laser lithotripsy system to deliver laser energy from one or more laser sources to a stone (e.g., mobile calculus), the system including a capture portion, a first laser node and a second laser node. The capture portion configured to be movable from a stored state to a deployed state. In the deployed state, the capture portion is configured to at least partially surround the stone. The first laser node and the second laser node are coupled to the capture portion and are configured to deliver the laser energy to the stone, and the first laser node is spaced apart from the second laser node.

A catheter system (100) for placement within a treatment site (106) at a vessel wall (208A) or a heart valve includes an energy source (124), a balloon (104), an energy guide (122A), and a tissue identification system (142). The energy source (124) generates energy. The balloon (104) is positionable substantially adjacent to the treatment site (106). The balloon (104) has a balloon wall (130) that defines a balloon interior (146). The balloon (104) is configured to retain a balloon fluid (132) within the balloon interior (146). The energy guide (122A) is configured to receive energy from the energy source (124) and guide the energy into the balloon interior (146) so that plasma is formed in the balloon fluid (132) within the balloon interior (146). The tissue identification system (142) is configured to spectroscopically analyze tissue within the treatment site (106). A method for treating a treatment site (106) within or adjacent to a vessel wall (208A) or a heart valve can utilize any of the catheter systems (100) described herein.

A catheter system (100) for treating a treatment site (106) within or adjacent to the vessel wall of a blood vessel (108), or the heart valve, includes an energy source (124), a balloon (104), an energy guide (122A), and a balloon integrity protection system (142). The energy source (124) generates energy. The balloon (104) is positionable substantially adjacent to the treatment site (106). The balloon (104) has a balloon wall (130) that defines a balloon interior (146). The balloon (104) is configured to retain a balloon fluid (132) within the balloon interior (146). The energy guide (122A) is configured to receive energy from the energy source (124) and guide the energy into the balloon interior (146) so that plasma is formed in the balloon fluid (132) within the balloon interior (146). The balloon integrity protection system (142) is operatively coupled to the balloon (104). The balloon integrity protection system (142) is configured to inhibit rupture of the balloon (104) due to the plasma formed in the balloon fluid (132) within the balloon interior (146) during use of the catheter system (100).

A system and method for detecting relative location of a surgical laser fiber tip relative to a surgical laser target during a surgical laser procedure utilizes a spectrophotometer to detect radiation indicative of the relative location. For example, the detected radiation may indicate contact between the fiber tip and a stone being subjected to laser lithotripsy, so as to prompt the surgeon to withdraw the fiber tip from the stone and/or take other action to limit contact-induced erosion of the fiber tip, and to avoid saturation of the endoscope camera resulting from the flash that occurs following contact. In addition, the absence of any detected radiation by the spectrophotometer may be used to indicate that the stone is no longer present, or that the fiber tip is no longer aimed at the stone, prompting the operator to reposition the fiber and/or temporarily cease firing of the laser. The main surgical laser may be a pulsed Holmium laser, which is delivered to the target through the optical fiber together with a pulsed 532 nm aiming beam.