A system for monitoring temperature when carrying out laser light-based lithotripsy in which includes an endoscopic assembly comprising a working channel for a fiber optic cable which is optically coupled to a laser on a proximal side and include a light exit aperture on a distal side, and an irrigation fluid channel opening into a region of the light exit aperture on the distal side which is in fluid communication with an irrigation fluid reservoir on the proximal side. The system includes a modular unit including a flow sensor, which determines the irrigation flow rate without coming into contact with the irrigation fluid; input, via which operating parameters of the laser can be determined, can be transmitted to a processor connected to the input; a temperature sensor which determines the temperature of the irrigation fluid without coming into contact with the irrigation fluid; an analyzer, which numerically determines the temperature of the irrigation fluid and the determined applied laser power, and the temperature generated intracorporeally during the laser lithotripsy at the location of the light exit aperture, and a comparator, which produces a signal in the event that a threshold value is exceeded.

Apparatus for the treatment of a target tissue with a laser beam in which the target tissue is immersed in a liquid medium within a body lumen. The laser device is configured to provide one or more laser pulses which are configured by a controller to have an energy sufficient to form one or more vapor bubbles in the liquid medium at the distal delivery end of the fiber. The one or more pulses are configured by the controller to: first, cause a vapor bubble to be formed distally of the distal end portion of the endoscope and around the distal delivery end of the optical fiber; second, cause a second bubble to be formed distally of the first bubble; and, third, inflate the second bubble as the first bubble has begun to collapse to expand an amount sufficient to displace a substantial portion of the liquid medium from the space between the distal delivery end of the fiber and the target tissue.

Provided is an output adjustment device for a laser lithotripsy apparatus including: a processor including hardware, the processor being configured to: pulse a laser beam; adjust an output of the pulsed laser beam; monotonically increase the output of the laser beam as a first period to generate a bubble binding body containing a plurality of bubbles from a laser emission end; monotonically decrease the output of the laser beam with a gradient larger than a predetermined gradient as a second period following the first period to cause the bubble binding body to disappear so that a crushing target is attracted to the laser emission end; and before the bubble binding body is generated, raise a liquid temperature in a region where the bubble binding body is generated by generating the bubbles and causing the bubbles to disappear.

Provided is a waveform control device for a laser lithotripsy apparatus including: a processor including hardware, the processor being configured to: pulse a laser beam; change an output of the pulsed laser beam; continuously emit the laser beam until a bubble generated from a laser emission end by an irradiation of the laser beam reaches a crushing target; and after the bubble generated from the laser emission end reaches the crushing target, reduce the output of the laser beam or turn off the irradiation of the laser beam during a period in which there is the bubble between the laser emission end and the crushing target, and the bubble does not couple the laser emission end and the crushing target.

A method of reducing retro-repulsion of a stone during a laser lithotripsy procedure involves the use of a spacer tip or standoff sleeve to create a passage between the tip of a fiber and a stone, and to prevent collapse of a bubble formed by vaporization of and/or gas pressure on liquid present in the passage. The laser radiation may consist of continuous or quasi-continuous wave radiation that is relatively low in power compared to the therapeutic pulses, or may consist of the therapeutic pulses if the pulse frequency is high enough to prevent collapse of the bubble between pulses. The spacer tip or standoff sleeve further prevents collapse of the bubble and ingress of liquid into the laser path. The spacer tip or standoff sleeve may be a generally-cylindrical protective cap that is fitted to an end of the optical fiber and that extends beyond the fiber tip to provide a predetermined spacing or standoff between the fiber tip and the stone when the protective cap is in contact with the stone. Alternatively, the spacer tip or standoff sleeve may be a catheter sleeve that permits axial adjustment of fiber position within the sleeve.

Exemplary embodiments of the present disclosure apparatus and methods that provide for subtractive material processing, including efficient and precise ablation of tissues. Certain embodiments include a first laser configured to direct a first pulse of energy at a first wavelength to a region of tissue; a second laser configured to direct a second pulse of energy at a second wavelength to the region of tissue; and a control system configured to control operation of the first laser and the second laser.

A catheter system (100) used for treating a treatment site (106) within or adjacent to the heart valve (108) includes an energy source (124), an energy guide (122A), and a balloon assembly (104). The energy source (124) generates energy. The energy guide (122A) is configured to receive energy from the energy source (124). The balloon assembly (104) is positionable substantially adjacent to the treatment site (106). The balloon assembly (104) includes an outer balloon (104B) and an inner balloon (104A) that is positioned substantially within the outer balloon (104B). Each of the balloons (104A, 104B) has a balloon wall (130) that defines a balloon interior (146). Each of the balloons (104A, 104B) is configured to retain a balloon fluid (132) within the balloon interior (146). The balloon wall (130) of the inner balloon (104A) is positioned spaced apart from the balloon wall (130) of the outer balloon (104B) to define an interstitial space (146A) therebetween. A portion of the energy guide (122A) that receives the energy from the energy source (124) is positioned within the interstitial space (146A) between the balloons (104A, 104B) so that a plasma-induced bubble (134) is formed in the balloon fluid (132) within the interstitial space (146A).

A catheter system (100) for treating a treatment site (106) within or adjacent to a vessel wall (108) or a heart valve includes an inflatable balloon (104), an optical fiber (122), and an energy source (124). The optical fiber (122) has a fiber proximal end (122P), and a fiber distal end (122D) positioned within the inflatable balloon (104). The optical fiber (122) is configured to receive an energy pulse so that the optical fiber (122) emits light energy in a direction away from the optical fiber (122) to generate a plasma pulse within the inflatable balloon (104). The optical fiber (122) can be tapered from the fiber proximal end (122P) toward the fiber distal end (122D). The energy source (124) in optical communication with the fiber proximal end (122P) of the optical fiber (122), and can include a laser. The optical fiber (122) includes a first fiber member (250) and a second fiber member (258) that is coupled to the first fiber member (250). The first fiber member (250) can be fused to the second fiber member (258) in a fused region (256). The first fiber member (250) and the second fiber member (258) can be formed as a unitary structure. The catheter system (100) can also include a ferrule (248) that encircles the fused region (256).

A method for treating a treatment site (106) within or adjacent to a vessel wall (108) or heart valve includes tapering an optical fiber (122) from a fiber proximal end (122P) to a fiber distal end (122D); positioning the optical fiber (122) such that the fiber distal end (122D) is positioned within an inflatable balloon (104); coupling an energy source (124) in optical communication with the fiber proximal end (122P); and receiving an energy pulse from the energy source (124) into the fiber proximal end (122P) so that the optical fiber (122) emits light energy in a direction away from the optical fiber (122) to generate a plasma pulse within the inflatable balloon (104). The method can further include coupling a first fiber member (250) to a second fiber member (258), which can include fusing the first fiber member (250) to the second fiber member (258) at a fused region (256); and encircling the fused region (256) with a ferrule (248).

A catheter system for treating a treatment site within or adjacent to the heart valve within a body of a patient includes an energy source, an energy guide and an energy director. The energy source generates energy. The energy guide includes a guide proximal end and a guide distal end. The energy guide is configured to receive energy from the energy source and guide the energy from the guide proximal end toward the guide distal end. The energy director includes a director wall that defines a director interior, and a director distal end that is selectively positioned substantially adjacent to the treatment site. The guide distal end of the energy guide is positioned within the director interior. The director distal end is at least partially open toward the treatment site.