Kidney stones may be treated in various ways. Small kidney stones may pass through the urinary tract without treatment. Larger kidney stones or kidney stones that block the urinary tract may need to be removed via a medical procedure. Laser lithotripsy is a procedure for removing a calculus (e.g., a kidney stone) from the urinary tract of the patient. Laser lithotripsy includes inserting a laser optical fiber through the urinary tract to the calculus. The laser is then activated to break the calculus into small pieces that can be passed naturally by the patient or removed by a retrieval instrument. A typical procedure includes inserting a ureteroscope through the urethra, bladder, ureter and if necessary, into the kidney so that a distal tip of the scope is positioned adjacent the calculus. The laser optical fiber is inserted through a working channel of the ureteroscope to the calculus. The laser is then activated to break up the calculus into fragments small enough to be retrieved via a retrieval device such as a basket device or to be passed naturally by the patient through the urinary tract.
During laser ablation of the kidney stone, small fragments (e.g., fast moving dust particles) may be separated from the stone and suspended in urinary fluid. The small fragments may be so numerous so as to affect the visibility of objects through the urinary fluid. In some instances, the small fragments may significantly obstruct the view of larger fragments causing difficulty in further performance of the lithotripsy process. Such difficulty may inhibit identification and tracking of larger stone fragments that require further ablation. In some instances, an operator may need to pause the ablation process to reacquire visibility and retarget larger stone fragments.
Accordingly, disclosed herein are ureteroscope systems and methods that enhance the visibility of objects such as kidney stone fragments via a ureteroscope, tracking the fragments, and assessing a size of fragments during a laser lithotripsy procedure.
Briefly summarized, disclosed herein is a ureteroscope system including a ureteroscope configured for insertion into a urinary tract of a patient body. The ureteroscope includes an elongate flexible shaft having a camera disposed at a distal end thereof and an image processing module operatively coupled with the ureteroscope. The module includes a console having one or more processors and a non-transitory computer-readable medium. Logic stored on the medium, when executed by the one or more processors, is configured to perform various operations as summarized below.
The operations include receiving imaging data and defining a first image and a second image from the imaging data. The first image includes a plurality of objects including a first subset of the plurality of objects that obstructs the visibility of one or more objects of a second subset of the plurality of objects in the first image. In the second image, the one or more obstructed objects in the first image are visibly unobstructed. The operations include rendering the first image or the second image on a display of the system.
The imaging data may include video imaging data, and the first and second images may include video images. The objects may include fragments of a kidney stone.
The operations may further include removing the first subset of the plurality of objects from the first image to define the second image. In some embodiments, the second subset includes objects that are persistent within the first image, and the first subset includes objects that are transient within the first image.
The operations may further include: (i) tracking the locations of one or more objects within the first image or the second image; and (ii) defining a tracking image overlay, where the tracking overlay includes tracking indicia associated with the tracked objects. The operations may further include rendering the tracking overlay on top of the first image or the second image on the display.
The operations may further include: (i) identifying circumferential edges of one or more objects within the first image or the second image; (ii) highlighting the circumferential edges in an image overlay; and (iii) rendering the edge-highlighting overlay on top of the first image or the second image on the display.
The operations may further include: (i) defining sizes of one or more objects within the first image or the second image by calculating an area enclosed by the circumferential edge; and (ii) defining a sizing image overlay that includes size indicia associated with the sized objects, where each size indicium provides a visual indication of the respective object's size. The operations may further include rendering the sizing overlay on top of the first image or the second image on the display.
The operations may further include comparing each calculated area with an area limit stored in the non-transitory computer-readable medium and modifying the size indicium if the respective calculated area exceeds the area limit.
The operations may further include defining maximum lengths of one or more objects within the first image or the second image, where each maximum length is defined by a maximum distance between two points of the circumferential edge of the respective object. The operations may further include defining a length image overlay, where the length overlay includes a line indicium visually representing each respective maximum length, and the operations may further include rendering the length overlay on top of the first image or the second image on the display.
Also summarized herein is a method of performing a lithotripsy procedure on a patient. The method includes inserting a ureteroscope within a urinary tract of the patient; receiving imaging data from the ureteroscope; defining a first image of kidney stone fragments from the imaging data; and rendering a second image on a display, where the second image includes one or more persistent fragments of the first image, and omits one or more transient fragments of the first image. The method further includes ablating a fragment of the second image and removing an ablated portion of the fragment from the second image.
The method may further include defining a circumferential edge of the fragment and overlaying the second image with an edge indicium associated with the fragment, where the edge indicium visually highlights the circumferential edge of the fragment in the second image.
The method may further include overlaying the second image with a size indicium associated with the fragment, where the size indicium visually indicates a size of the fragment in the second image.
The method may further include overlaying the second image with a location indicium associated with the fragment, where the location indicium tracts displacement of the fragment in the second image.
The method may further include overlaying the second image with a length indicium associated with the fragment, where the length indicium depicts a maximum length of the fragment in the second image.
The method may further include the step of rendering a third image on the display, where the third image is a high-contrast black-and-white view of the second image.
The method may further include providing an image processing module operatively coupled with the ureteroscope that includes a console having one or more processors and a non-transitory computer-readable medium. Logic stored on the medium is configured such that, when executed by the one or more processors, performs operations including one or more of the steps summarized above.
These and other features of the concepts provided herein will become more apparent to those of skill in the art in view of the accompanying drawings and following description, which describe particular embodiments of such concepts in greater detail.
A more particular description of the present disclosure will be rendered by reference to specific embodiments thereof that are illustrated in the appended drawings. It is appreciated that these drawings depict only typical embodiments of the invention and are therefore not to be considered limiting of its scope. Example embodiments of the invention will be described and explained with additional specificity and detail through the use of the accompanying drawings in which:
Before some particular embodiments are disclosed in greater detail, it should be understood that the particular embodiments disclosed herein do not limit the scope of the concepts provided herein. It should also be understood that a particular embodiment disclosed herein can have features that can be readily separated from the particular embodiment and optionally combined with or substituted for features of any of a number of other embodiments disclosed herein.
Regarding terms used herein, it should also be understood the terms are for the purpose of describing some particular embodiments, and the terms do not limit the scope of the concepts provided herein. Ordinal numbers (e.g., first, second, third, etc.) are generally used to distinguish or identify different features or steps in a group of features or steps, and do not supply a serial or numerical limitation. For example, “first,” “second,” and “third” features or steps need not necessarily appear in that order, and the particular embodiments including such features or steps need not necessarily be limited to the three features or steps. Labels such as “left,” “right,” “top,” “bottom,” “front,” “back,” “upward,” “downward,” and the like are used for convenience and are not intended to imply, for example, any particular fixed location, orientation, or direction. Instead, such labels are used to reflect, for example, relative location, orientation, or directions. Singular forms of “a,” “an,” and “the” include plural references unless the context clearly dictates otherwise. Also, the words “including,” “has,” and “having,” as used herein, including the claims, shall have the same meaning as the word “comprising.”
Lastly, in the following description, the terms “or” and “and/or” as used herein are to be interpreted as inclusive or meaning any one or any combination. As an example, “A, B or C” or “A, B and/or C” mean “any of the following: A; B; C; A and B; A and C; B and C; A, B and C.” An exception to this definition will occur only when a combination of elements, components, functions, steps, or acts are in some way inherently mutually exclusive.
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by those of ordinary skill in the art.
Any methods disclosed herein include one or more steps or actions for performing the described method. The method steps and/or actions may be interchanged with one another. In other words, unless a specific order of steps or actions is required for proper operation of the embodiment, the order and/or use of specific steps and/or actions may be modified. Moreover, sub-routines or only a portion of a method described herein may be a separate method within the scope of this disclosure. Stated otherwise, some methods may include only a portion of the steps described in a more detailed method.
In certain situations, the term “logic” is representative of hardware, firmware, and/or software that is configured to perform one or more functions. As hardware, the logic may include circuitry having data processing or storage functionality. Examples of such circuitry may include, but are not limited or restricted to a microprocessor, one or more processor cores, a programmable gate array, a microcontroller, an application specific integrated circuit, wireless receiver, transmitter and/or transceiver circuitry, semiconductor memory, or combinatorial logic.
During the treatment, the flexible shaft 115 of the ureteroscope 110 is inserted into the urinary tract of the patient 50 to a treatment location. The imaging module 120 renders images on the display 105 as acquired via the camera at the distal end of the shaft 115. The images show tissue and other objects (e.g., a kidney stone) at the treatment location. The operator 30 performs the treatment via operation of the laser instrument 70 while viewing the images acquired by the ureteroscope 110 and rendered on the display 105.
In some embodiments, the ureteroscope 110 may include a remote interface 118. The remote interface 118 is communicatively coupled with the imaging module 120 and may facilitate operation of the imaging system 100 via the handle 117.
A treatment procedure may typically include positioning the working distal end of the laser shaft 71 at a desired location as verified by the acquired images. The operator 30, via manipulation of the handle 117 of the ureteroscope 110, may position the distal end of the ureteroscope 110 at the desired location and aim the distal end of the fiber optic laser 71 at objects to be ablated such as a kidney stone or fragments thereof. During ablation of the kidney stone, the operator 30 may reposition the ureteroscope 110 several times to view different fragments of the kidney stone and re-aim the fiber optic laser 71 at the different fragments.
During ablation of the kidney stone, fragments of different sizes are broken off and separated from stone. Some fragments may be small enough to exit the patient via the urinary tract without further fragmentation. Other fragments may require further ablation or removal from the patient via a retrieval device. As such visibility of the fragments helps facilitate further ablation or retrieval. In some instances, the quantity of separated fragments may so numerous so as to obstruct visibility of other objects via the ureteroscope 110.
The logic modules include imaging logic 141 and image processing logic 142. The imaging logic 141 is configured to retrieve unprocessed imaging data from the ureteroscope 110 and deliver processed imaging data to the display 105. The imaging logic 141 may communicate with the remote interface 118 so as to render images on the display as defined by the operator 30.
The image processing logic 142 includes image augmenting logic 143, object tracking logic 144, and object sizing logic 145. The image augmenting logic 143 is described below in relation to
The console 125 may include other hardware or electrical components to facilitate operation of the imaging module 120 and the ureteroscope 110 such as power supplies, I/O ports, power management modules, signal conditioners, processing electronics, GUI signal processing units, computational electronics, graphical processing units, field-programmable gate arrays and the like.
In some embodiments, the object tracking logic 144 may assign identification indicia 321-324 to the stone fragments 211-214, respectively. By assigning identification indicia, the operator may more easily re-identify and track the location of the identified stone fragments 211-214. In some, embodiments, the object tracking logic 144 may automatically assign the identification indicia to defined fragments within the video image. In other embodiments, the object tracking logic 144 may be configured to facilitate manual selection (e.g., via a mouse pointer) of stone fragments to be identified and tracked. In some embodiments, other tracking indicia may also be shown in the tracking overlay 301 such as the arrow 321A showing a displacement path, for example. In the illustrated embodiment, the tracking overlay 301 may be displayed on top of the augmented image 202 or the raw image 201.
In some embodiments, the object sizing logic 144 may include size criteria associated with the urinary tract such as a flow path area of a ureter, for example. The object sizing logic 144 may further determine if a fragment size exceeds a defined size criterion, and if so, the object sizing logic 144 may include a secondary indicum such as the indicium 441A, change the shape of the size indicium, change a color of the size indicium, or provide visual indication in any suitable differentiating fashion. By way of summary, the object sizing logic 144 may automatically indicate to the operator which fragments need further fragmentation and which fragments may naturally pass through the urinary tract out of the patient.
With further reference to
Again, with reference to
The image processing logic 142 may facilitate rendering of any combination of the images 201, 202, and 501 with the overlays 301, 401, 402, and 403. The image processing logic 142 may also facilitate switching between any of the combinations at will by the operator via the GUI 151 or the remote interface 118.
Embodiments of the invention may be embodied in other specific forms without departing from the spirit of the present disclosure. The described embodiments are to be considered in all respects only as illustrative, not restrictive. The scope of the embodiments is, therefore, indicated by the appended claims rather than by the foregoing description. All changes that come within the meaning and range of equivalency of the claims are to be embraced within their scope.
This application claims the benefit of priority to U.S. Provisional Application No. 63/197,142, filed Jun. 4, 2021, which is incorporated by reference in its entirety into this application.
Filing Document | Filing Date | Country | Kind |
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PCT/US2022/032131 | 6/3/2022 | WO |
Number | Date | Country | |
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63197142 | Jun 2021 | US |