Abstract:
Aspects of this disclosure pertain to a device with an elongated body having a distal end. The distal end may comprise a port that permits discharge of a laser energy towards a tissue from an optical fiber located in the distal end. An exterior surface of the distal end may include a cauterization portion that permits discharge of a cauterization energy towards the tissue. In some aspects, the device includes an insulative portion that attaches the distal end to the elongated body and limits energy transfer therebetween. Related systems and methods are also disclosed.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This patent application claims the benefit of priority under 35 U.S.C. §119 to U.S. Provisional Patent Application No. 62/192,098, filed Jul. 14, 2015, and U.S. Provisional Patent Application No. 62/195,375, filed Jul. 22, 2015, the entireties of which are herein incorporated by reference. 
     
    
     TECHNICAL FIELD 
       [0002]    Aspects of this disclosure relate to laser devices including, for example, laser systems, laser bars and laser modules comprising laser diodes, and methods of using the laser devices. Some aspects relate particularly to cauterization devices, methods, and systems, such as those including laser devices. 
       BACKGROUND 
       [0003]    Lasers have been increasingly adopted as medical surgical tools. Optical fibers have are normally used to deliver laser energy during, for example, a laser surgery. As compared to traditional surgical tools, laser surgery can reduce bleeding, pain and infection. Additionally, patients often have less hospitalization time after laser surgery. 
         [0004]    Laser energy may be less efficient than conventional electrical heating devices at stopping bleeding (coagulation), such as bleeding from incised blood vessels. Therefore, many surgeons will use a laser tool in some procedural steps, and a separate cauterization tool for other steps. Using multiple tools may complicate certain procedures, such as those performed in a relatively confined portion of the body, like an interior portion of a kidney. These complications may increase operating time and, thus, the cost of such procedures. 
       SUMMARY 
       [0005]    Aspects of the present disclosure relate to cauterization devices, methods, and systems. Numerous aspects of the present disclosure are now described. 
         [0006]    One aspect of this disclosure is a device with an elongated body having a distal end. The distal end may comprise: a port that permits discharge of a laser energy towards a tissue from an optical fiber located in the distal end; an exterior surface including a cauterization portion that permits discharge of a cauterization energy towards the tissue; and an insulative portion that attaches the distal end to the elongated body and limits energy transfer therebetween. 
         [0007]    According to this aspect, the port of an exemplary device may be adjacent the cauterization portion. The distal end may have a longitudinal axis, and the port may extend through the cauterization portion along an axis transverse to the longitudinal axis. The cauterization portion may comprise the entire exterior surface of the distal end. In some aspects, the cauterization energy may be an electrical energy, and the cauterization portion may include an electrical conductor extending proximally through, for example, the insulative portion and the elongated body for connection to a source of electrical energy. In other instances, the cauterization energy may be a thermal energy, and, for example, the laser energy may be discharged towards the tissue at a first power level to perform a treatment, and towards the cauterization portion at a second power level to generate the thermal energy. The optical fiber may include a first optical fiber that discharges a first laser energy toward the tissue, and a second optical fiber that discharges a second laser energy towards the cauterization portion to generate the thermal energy. These first and second laser energies may have different power levels and/or wavelengths. 
         [0008]    Another aspect of the present disclosure is a system. An exemplary system may comprise: an elongated body including a distal end and at least one lumen; an optical fiber extending through the at least one lumen for discharge of a laser energy; a port on the distal end for discharge of the laser energy towards a tissue; a cauterization portion on the distal end for discharge of a cauterization energy toward the tissue; and an insulative portion that attaches the distal end to the elongated body and limits energy transfer therebetween. 
         [0009]    According to this aspect, the distal end of the elongated body in an exemplary system may be removably attached to the elongated body. The port may extend through the cauterization portion. In some aspects, the cauterization energy may be an electrical energy, and the cauterization portion may include an electrical conductor, which may extend proximally through the insulative portion and/or the elongated body for connection to a source of electrical energy. In other aspects, the cauterization energy may be a thermal energy, and the laser energy may be dischargeable towards the cauterization portion to generate the thermal energy. For example, the optical fiber may be mounted in the elongated element for movement between a first position, wherein the laser energy is discharged through the port towards the tissue, to a second position, wherein the laser energy is discharged towards an interior surface of cauterization portion. The laser energy may be discharged towards the tissue at a first power level, and towards the interior surface of the cauterization portion at a second power level greater than the first power level. The laser energy also may be discharged towards the tissue at a first wavelength, and towards the interior surface of the cauterization portion at a second wavelength different from the first wavelength. 
         [0010]    Yet another aspect of the present disclosure is a method. For example, this method may comprise: positioning a distal end of a device adjacent a tissue, the distal end including a port and a cauterization portion; aligning the port with a treatment area of the tissue; discharging a laser energy through the port and towards the treatment area; positioning the cauterization portion adjacent the treatment area; and discharging a cauterization energy through the cauterization portion and towards the treatment area. 
         [0011]    According to this aspect, the method may further comprise attaching the distal end to an elongated body of device so as to limit energy transfer between the distal end and the elongated body. In some aspects, the cauterization energy may be an electrical energy, and discharging the cauterization energy may comprise activing a source of electrical energy. In other aspects, the cauterization energy may include a thermal energy, and discharging the cauterization energy may comprise discharging the laser energy towards the cauterization portion to generate the thermal energy. The distal end may be attached to the elongated body, and the laser energy may be discharged through an optical fiber mounted in a lumen of the elongated body. In which case, the method may further comprise: moving the optical fiber to a first position in the lumen before discharging the laser energy through the port; and moving the optical fiber to a second position in the lumen before discharging the laser energy towards an interior surface of the cauterization portion. 
         [0012]    It may be understood that both the foregoing summary and the following detailed descriptions are exemplary and explanatory only, neither being restrictive of the inventions claimed below. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0013]    The accompanying drawings are incorporated in and constitute a part of this disclosure. These drawings illustrate aspects that, together with the written descriptions, serve to explain the principles of this disclosure. 
           [0014]      FIG. 1  is a simplified diagram of an exemplary medical laser system with electrical cauterization in accordance with aspects of this disclosure. 
           [0015]      FIGS. 2A and 2B  are simplified side cross-sectional views of a distal end of an exemplary energy delivery device in accordance with aspects of this disclosure respectively performing a laser operation and an electrical cauterization operation. 
           [0016]      FIGS. 3A and 3B  are simplified side cross-sectional views of a distal end of an exemplary energy delivery device in accordance with aspects of this disclosure respectively performing a laser operation and an electrical cauterization operation. 
           [0017]      FIG. 4  is a simplified diagram of an exemplary medical laser system in accordance with aspects of this disclosure. 
           [0018]      FIGS. 5A and 5B  are simplified side cross-sectional views of a distal end of an exemplary energy delivery device in accordance with aspects of this disclosure respectively performing exemplary laser and cauterization operations. 
           [0019]      FIG. 6  is a simplified diagram of an exemplary medical laser system in accordance with aspects of this disclosure. 
           [0020]      FIGS. 7 and 8  are simplified side cross-sectional views of a distal end of an exemplary energy delivery device in accordance with aspects of this disclosure respectively performing a laser operation and an electrical cauterization operation. 
           [0021]      FIG. 9  is a simplified side cross-sectional view of a distal end of an exemplary energy delivery device performing a laser operation in accordance with aspects of this disclosure. 
           [0022]      FIG. 10  is a front cross-sectional view of the exemplary energy delivery device of  FIG. 9  taken generally along line A-A of  FIG. 9 . 
           [0023]      FIG. 11  is a simplified side cross-sectional view of the exemplary energy delivery device of  FIG. 9  during a cauterization operation. 
           [0024]      FIGS. 12 and 13  are simplified side cross-sectional views of exemplary heating tips in accordance with aspects of this disclosure. 
           [0025]      FIGS. 14 and 15  are simplified side cross-sectional views of an exemplary energy delivery device in accordance with aspects of this disclosure respectively performing laser and cauterization operations. 
           [0026]      FIGS. 16 and 17  are simplified side cross-sectional views of exemplary energy delivery devices in accordance with aspects of this disclosure. 
           [0027]      FIG. 18  is a front cross-sectional view of the exemplary energy delivery device of  FIG. 17  taken generally along line B-B of  FIG. 17 . 
       
    
    
     DETAILED DESCRIPTION 
       [0028]    Aspects of this disclosure are described more fully hereinafter with reference to the accompanying drawings. Elements that are identified using the same or similar reference characters refer to the same or similar elements. The various aspects of this disclosure may, however, be embodied in many different forms and should not be construed as limited to the aspects set forth herein. Rather, these aspects are provided so that this disclosure will be thorough and complete, and will convey the scope of this disclosure to those skilled in the art. 
         [0029]    Specific details are given in the following description to provide a thorough understanding of the aspects. However, it is understood by those of ordinary skill in the art that the aspects may be practiced without these specific details. For example, circuits, systems, networks, processes, frames, supports, connectors, motors, processors, and other components may not be shown, or shown in block diagram form in order to not obscure the aspects in unnecessary detail. 
         [0030]    The terminology used herein is for the purpose of describing particular aspects only and is not intended to be limiting of this disclosure. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof. 
         [0031]    It will be understood that when an element is referred to as being “connected” or “coupled” to another element, it can be directly connected or coupled to the other element or intervening elements may be present. In contrast, if an element is referred to as being “directly connected” or “directly coupled” to another element, there are no intervening elements present. 
         [0032]    It will be understood that, although the terms first, second, etc. may be used herein to describe various elements, these elements should not be limited by these terms. These terms are only used to distinguish one element from another. Thus, a first element could be termed a second element without departing from the teachings of the present disclosure. 
         [0033]    Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art. It will be further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of the relevant art and will not be interpreted in an idealized or overly formal sense unless expressly so defined herein. 
         [0034]    As will further be appreciated by one of skill in the art, the present disclosure may be embodied as methods, systems, devices, and/or computer program products, for example. Accordingly, the present disclosure may take the form of an entirely hardware aspect, an entirely software aspect or an aspect combining software and hardware aspects. The computer program or software aspect of the present disclosure may comprise computer readable instructions or code stored in a computer readable medium or memory. Execution of the program instructions by one or more processors (e.g., central processing unit) results in the one or more processors performing one or more functions or method steps described herein. Any suitable patent subject matter eligible computer readable media or memory may be utilized including, for example, hard disks, CD-ROMs, optical storage devices, or magnetic storage devices. Such computer readable media or memory do not include transitory waves or signals. 
         [0035]    The computer-usable or computer-readable medium may be, for example but not limited to, an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system, apparatus, device, or propagation medium. More specific examples (a non-exhaustive list) of the computer-readable medium would include the following: an electrical connection having one or more wires, a portable computer diskette, a random access memory (RAM), a read-only memory (ROM), an erasable programmable read-only memory (EPROM or Flash memory), an optical fiber, and a portable compact disc read-only memory (CD-ROM). Note that the computer-usable or computer-readable medium could even be paper or another suitable medium upon which the program is printed, as the program can be electronically captured, via, for instance, optical scanning of the paper or other medium, then compiled, interpreted, or otherwise processed in a suitable manner, if necessary, and then stored in a computer memory. 
         [0036]    Aspects of this disclosure may also be described using flowchart illustrations and block diagrams. Although a flowchart may describe the operations as a sequential process, many of the operations can be performed in parallel or concurrently. In addition, the order of the operations may be re-arranged. A process is terminated when its operations are completed, but could have additional steps not included in a figure or described herein. 
         [0037]      FIG. 1  is a simplified diagram of an exemplary system  100  configured to perform laser operations and electrical cauterization operations in accordance with aspects of this disclosure. The system  100  is generally configured to discharge laser energy  102  from a distal end  103  of an energy delivery device  104  for use in a medical laser operation, such as tissue cutting, ablation, vaporization, or other medical laser operation. Additionally, the system  100  is configured to perform an electrical cauterization operation at the distal end  103  of the energy delivery device  104 . 
         [0038]    The energy delivery device  104  may be supported in an endoscope or other suitable probe. Endoscopes can be used to provide imaging guidance and a flow of cooling liquid, in accordance with conventional practices. 
         [0039]    In some aspects, the system  100  includes a laser source  110  and an electrical cauterization unit  112 . The laser source  110  is configured to generate the laser energy  102  that is optically coupled to the energy delivery device  104  in accordance with conventional techniques. The electrical cauterization unit  112  is configured to generate electrical energy in the form of an electrical current that is coupled to the energy delivery device  104  through one or more electrical conductors. 
         [0040]    In some aspects, the system  100  includes one or more input devices  114  that are used by the operator of the system  100  to control the delivery of the laser energy  102  and the electrical energy through the energy delivery device  104 . In some aspects, the input device  114  includes at least one switch  116  for operating the laser source  110 , and at least one switch  118  for operating the electrical cauterization unit  112 . In some aspects, the switches  116  and  118  may be implemented using foot pedals, buttons, or other suitable input devices. 
         [0041]    In some aspects, the laser source  110  and the electrical cauterization unit  112  are each standalone units. In some aspects, the laser source  110  and the electrical cauterization unit  112  are integrated into a single console, as illustrated in  FIG. 1 . 
         [0042]      FIGS. 2A and 2B  are simplified side cross-sectional views of the distal end  103  of an exemplary energy delivery device  104  in accordance with aspects of this disclosure respectfully performing a laser operation and an electrical cauterization operation on tissue  120 .  FIGS. 3A and 3B  are simplified side cross-sectional views of the distal end  103  of an exemplary energy delivery device  1104  in accordance with aspects of this disclosure respectfully performing a laser operation and an electrical cauterization operation on tissue  120 . In some aspects, the energy delivery device  104  includes an optical or laser fiber  122  that is configured to receive the laser energy  102  generated by the laser source  110  and transmit the laser energy  102  to the distal end  103  where it is discharged for performing the desired laser operation, as shown in  FIGS. 2A and 3A . The optical or laser fiber  122  may take on various conventional forms. For example, the laser fiber  122  may have a side-fire configuration, in which a terminating end  124  has a beveled surface configured to reflect the laser energy  102  laterally relative to a longitudinal axis  126  and discharge the laser energy  102  through a side port  128  of the device  104  to the targeted tissue  120 , as shown in  FIGS. 2A and 3A . Alternatively, the laser fiber  122  may be configured to discharge the laser energy  102  along the longitudinal axis  126  of the laser fiber  122  at the terminating end and through a suitable port of the device  104  (end-fire configuration). 
         [0043]    The electrical cauterization function of the energy delivery devices  104  and  1104  can be realized in a monopolar form or a bipolar form. In general, the energy delivery devices  104  and  1104  respectively include at least a first electrical conductor  132 ,  1132 , which can be in the form of a metal wire, that receives electrical energy from the electrical cauterization unit  112  and delivers the electrical energy in the form of an electrical current to a cauterization portion  130  at the distal end  103  of the energy delivery devices  104  and  1104 . In some aspects, the cauterization portion  130  includes an electrically conductive portion or element  134  ( FIGS. 2A and 2B ) or  1134  ( FIGS. 3A and 3B ) that is supported at the distal end  103 . In some aspects, the portions  134  and  1134  are in the form of a metal cap, as shown in  FIGS. 2A and 3A . In some aspects, the electrically conductive portion  134  or  1134  includes the port  128 , through which the laser energy  102  may be discharged, as shown in  FIGS. 2A and 3A . In some aspects, the cauterization portion  130  includes an electrically insulative portion  136  ( FIG. 2A ) or  1136  ( FIG. 3A ) located toward the proximal end of the device  104  from the electrically conductive portion  134  or  1134 , respectively. The electrically insulative portion  136  or  1136  operates to insulate the electrically conductive portion  134  or  1134  from components of the energy delivery device  104  or  1104 , other than the conductor  132 . In some aspects, the electrically insulative portion  136  or  1136  is formed of a polymer or ceramic material. 
         [0044]    Depicted in  FIGS. 2A and 2B  is a monopolar aspect of this disclosure. In this aspect, the energy delivery device  104  includes a laser fiber  122  having a longitudinal axis  126 , a cauterization portion  130  included on a distal portion of the laser fiber  122  and having an electrically conductive portion  134  and a side port  128 , an electrical conductor  132  and an electrically insulative portion  136 . As can be seen in  FIGS. 2A and 2B , the electrical conductor  132  connects to the cauterization portion  130  through the electrically insulative portion  136 . In this monopolar aspect, a return pad  137  may be necessary to complete the electric circuit allowing current  139  to flow from the cauterization portion  130 , through the tissue  120  and into the return pad  137  thereby cauterizing the tissue  120 , as depicted in  FIG. 2B . 
         [0045]    In some aspects, as depicted in  FIGS. 3A and 3B , the delivery device  1104  has a bipolar configuration, and includes a first electrically conductive element  1134  that is electrically coupled to a first electrical conductor  1132 . In addition, the delivery device  1104  includes a second electrically conductive element  1138  that is electrically coupled to a second electrical conductor  1140 . The first and second electrical conductors can be, for example, metal wire. In order to isolate the first electrically conductive element  1134  from the second electrically conductive element  1138 , an electrically insulative, non-conductive material  1136  is included between the first electrically conductive element  1134  from the second electrically conductive element  1138 . The non-conductive material  1136  can be, for example, a polymeric or ceramic material. 
         [0046]    In use, electrical current  1141  delivered to the tissue  1120  through the first electrical conductor  1132 , to the first electrically conductive element  1134 , through the tissue  120 , into the second electrically conductive element  1138 , to the second electrical conductor  1140  and then back to the electrical cauterization unit  112 . In some aspects, the first electrically conductive element  1134  is in the form of a cap that is glued or crimped to the electrically insulative portion  1136  or other component of the energy delivery device  1104 . 
         [0047]    During a laser operation, laser energy  102  is generated by the laser source  110  and delivered to a proximal end of the optical fiber  122 . The laser energy is delivered through the optical fiber  122  to the distal end  103  of the energy delivery device  104  where it is discharged toward the targeted tissue  120  of the patient. The laser energy  102  may be discharged laterally (side-fire configuration) through a port  128  to the tissue  120 , as shown in  FIGS. 2A, 2B, 3A and 3B . Alternatively, the terminating distal end of the fiber  122  may be configured to discharge the laser energy  102  along the axis  126  of the fiber to the targeted tissue, as indicated in phantom lines in  FIG. 1 . The generation of the laser energy  102  by the laser source  110  may be controlled through a suitable input device  114  by the user of the system  100 . 
         [0048]    An electrical cauterization operation can be performed by enabling the electrical cauterization unit  112  to produce electrical energy, which is delivered to the distal end  103  of the energy delivery device  104 ,  1104  through the first electrical conductor  132 ,  1132 . The generation of the electrical energy may be triggered using a suitable input device  114  by the user. The electrical energy in the form of an electrical current is conducted to the targeted tissue  120  through the electrically conductive portion  134  or first electrically conductive element  1134 . In the monopolar aspect of  FIGS. 2A and 2B , a return path for the electrical current  139  to the electrical cauterization unit  112  may be provided through the return pad  137  that is attached to the patient. In the bipolar aspect of  FIGS. 3A and 3B , the electrical current  1141  may be returned to the electrical cauterization unit  112  through the second electrically conductive element  1138  and the second electrical conductor  1140 . The delivery of the electrical current to the tissue  120  of the patient generates heat that cauterizes the tissue  120  to stop bleeding. 
         [0049]    In general, such an electrical cauterization operation is performed after a laser operation in order to control bleeding in the patient. The input device  114  allows the user to quickly switch between the laser operation and the electrical cauterization operation as needed. 
         [0050]      FIG. 4  is a simplified diagram of an exemplary system  150  that is configured to perform laser and cauterization operations according to another aspect of this disclosure. In some aspects, the cauterization operations are performed by conducting laser-generated heat to the targeted tissue. 
         [0051]    In some aspects, the system  150  includes a laser source  152  and an energy delivery device  154 . In some aspects, the laser source  152  includes a discharge laser source  156  and a cauterization laser source  158 . The discharge laser source  156  is configured to generate laser energy  160  that is optically coupled to a discharge laser fiber  162 . The discharge laser fiber  162  transmits the laser energy  160  to a discharge tip  164 , which discharges the laser energy  160  toward targeted tissue  182  during a laser operation in order to perform a laser treatment such as, for example, vaporization, etc. 
         [0052]    The cauterization laser source  158  is configured to generate laser energy  166  that is optically coupled to a cauterization laser fiber  168 . The cauterization laser fiber  168  is configured to discharge the laser energy  166  to a cauterization tip  170  to heat the cauterization tip  170  and perform a cauterization operation (see  FIG. 5B ). In general, the cauterization tip  170 , heated in response to exposure to the laser energy  166 , is placed in contact with targeted tissue  182  to heat and cauterize the tissue to stop bleeding. 
         [0053]    In some aspects, the system  150  includes at least one input device  172  to control the discharge laser source  156  and the cauterization laser source  158 . In some aspects, the input device  172  includes a switch  174  for activating and deactivating the discharge laser source  156 , and a switch  176  for activating and deactivating the cauterization laser source  158 . In some aspects, the switches  174  and  176  are in the form of foot pedals or other suitable input devices. 
         [0054]      FIGS. 5A and 5B  are simplified side cross-sectional views of a distal end  180  of an exemplary energy delivery device  154  in accordance with aspects of this disclosure performing an exemplary laser operation ( FIG. 5A ) and cauterization operation ( FIG. 5B ). In some aspects, the discharge laser fiber  162  has a proximal end that receives the laser energy  160  generated by the discharge laser source  156 . The laser energy  160  is transmitted through the fiber  162  to the discharge tip  164  where it is discharged toward targeted tissue  182 , as shown in  FIG. 5A . The discharge laser fiber  162  may be formed in accordance with the aspects of the laser fiber  122  described above with regard to  FIGS. 2 and 3 . For example, the discharge laser fiber  162  may be configured to discharge the laser energy  160  laterally relative to a longitudinal axis  126  of the discharge laser fiber  162  (side-fire configuration), or the discharge laser fiber  162  may be configured to discharge the laser energy  160  along the longitudinal axis  126  (end-fire configuration). The discharge laser fiber  162  may also be configured to discharge the laser energy  160  in accordance with other conventional techniques. If necessary, the discharge laser energy  160  may be discharged through a port of the energy delivery device  154 , such as port  128  shown in  FIGS. 5A and 5B . 
         [0055]    In some aspects, the energy delivery device  154  includes the cauterization laser fiber  168  that receives the laser energy  166  generated by the cauterization laser source  158  and delivers the cauterization laser energy  166  to the cauterization tip  170 . In some aspects, the cauterization tip  170  includes a thermally conductive element formed of a material that absorbs the cauterization laser energy  166  and is positioned to receive the cauterization laser energy  166  discharged from the cauterization laser fiber  168 , as shown in  FIG. 5B . In some aspects, the cauterization tip  170  is in the form of a metal cap that is secured (e.g., crimped, glued, etc.) to the discharge laser fiber  162 , the cauterization laser fiber  168 , and/or other components of the energy delivery device  154 , as shown in  FIGS. 5A and 5B . 
         [0056]    In some aspects, the distal end of the cauterization laser fiber  168  through which the cauterization laser energy  166  is discharged is sufficiently spaced from the cauterization tip  170  to avoid damage due to the discharge of the laser energy  166  and the associated heating of the cauterization tip  170  responsive to the exposure to the cauterization laser energy  166 . In some aspects, the energy delivery device  154  includes an insulative element  184  located on the proximal side of the cauterization tip  170  that is configured to insulate elements of the energy delivery device  154  from the heat generated at the distal end  180  due to the discharge of the cauterization laser energy  166 . In some aspects, the insulative element  184  extends distally as illustrated in  FIG. 5A  to thermally insulate the cauterization laser fiber  168  and the discharge tip  164  from heat generated responsive to the discharge of the cauterization laser energy  166  from the cauterization laser fiber  168 . In some aspects, the cauterization tip  170  is attached directly to the insulative element  182 . 
         [0057]    During a laser operation/treatment, a user triggers activation of the discharge laser source  156 , such as by using the input device  172 , to generate the discharge laser energy  160 . The laser energy  160  is optically coupled to the discharge laser fiber  162 , which delivers the laser energy  160  to the discharge tip  164  where it is discharged to targeted tissue  182  to perform the desired laser operation on the tissue  182 . When the user wishes to cauterize tissue of the patient, such as due to bleeding after the performance of the laser operation, the discharge laser source  156  is deactivated, and the cauterization laser source  158  is activated by the user, such as through the input device  172 . The cauterization laser energy  166  generated by the cauterization laser source  158  is delivered to the cauterization tip  170  through the cauterization laser fiber  168 . Exposure of the cauterization tip  170  to the cauterization laser energy  166  quickly heats the cauterization tip  170 . The tip  170  can then be brought into contact with the targeted tissue  182  to cauterize the tissue  182 , as shown in  FIG. 5B . 
         [0058]    In some aspects, the laser energy  160  generated by the discharge laser source  156  includes relatively high power laser energy that is useful for tissue cutting, ablation, vaporization, or other medical laser operations/treatments. In some aspects, the laser energy  166  generated by the cauterization laser source  158  has a relatively low power compared to the laser energy  160 , such as less than 10 watts. In some aspects, the cauterization tip  170  is heated to around 60-80° C. to perform the cauterization operation. 
         [0059]    In some aspects, the wavelengths of the discharge laser energy  160  and the cauterization laser energy  166  are the same. In some aspects, the wavelengths of the discharge laser energy  160  and the cauterization laser energy  166  are different. For example, the wavelengths of the laser energy  160  and  166  may be the same but at different power levels. Furthermore, while the discharge laser energy  160  is selected to efficiently perform the desired laser operation, the cauterization laser energy  166  may be selected to efficiently heat the cauterization tip  170 . Thus, in some aspects, the cauterization laser energy  166  has a wavelength that is adapted to efficiently heat the cauterization tip  170 . Other factors for determining the wavelength and power levels of the laser energies  160  and  166  include the diameter of the discharge laser fiber  162  and the cauterization laser fiber  168 , and the laser beam output quality from the laser sources  156  and  158 , for example. 
         [0060]    In some aspects, a single laser source is used to produce both the discharge laser energy  160  and the cauterization laser energy  166 . In accordance with this aspect, suitable optics are used to selectively couple the laser energy outputs from the single laser source to either the discharge laser fiber  162  or the cauterization laser fiber  168 . The settings of the single laser source may be adjusted to provide the desired energy/power levels and/or wavelengths of the laser energies  160  and  166 . 
         [0061]      FIG. 6  is a simplified diagram of an exemplary medical laser system  190  in accordance with aspects of this disclosure. In some aspects, the system  190  includes a laser source  192  and an energy delivery device  194 . In some aspects, the laser source  192  is configured to produce laser energy  196  for use in performing a medical laser operation, such as those described above. The laser source  192  may be configured to output the laser energy  196  at different wavelengths and power levels. In some aspects, the system  190  includes one or more input devices  198 , through which a user controls the activation of the laser source  192  to generate the laser energy  196 , adjust settings of the laser source  192  to control the wavelength and/or power level of the laser energy  196 , and/or perform other functions. The input devices can be any of those previously disclosed and described. 
         [0062]    In some aspects, the energy delivery device  194  includes a laser fiber  200  that is optically coupled to the laser energy  196  generated by the laser source  192 . The laser fiber  200  is configured to discharge the laser energy  196  in a desired direction, such as laterally with respect to a longitudinal axis of the laser fiber  200  (side-fire configuration), or along the longitudinal axis of the laser fiber (end-fire configuration). In some aspects, the energy delivery device  194  is configured to perform a laser operation by directing the laser energy  196  toward targeted tissue of a patient. In some aspects, the energy delivery device  194  is configured to direct the laser energy  196  discharged from the laser fiber  200  to a cauterization tip  202 . The exposure of the cauterization tip  202  to the laser energy  196  heats the cauterization tip  202 , which can be used to perform a cauterization operation on the patient. In some aspects, the laser fiber  200  is moved relative to the cauterization tip  202  to expose the cauterization tip  202  to the laser energy  196 . The laser fiber  200  may then be moved again relative to the cauterization tip  202  to discharge the laser energy  196  toward the targeted tissue to perform a laser operation on the tissue. In other aspects, the cauterization tip  202  is moved relative to the laser fiber  200  to switch between discharging laser energy  196  to targeted tissue and discharging laser energy  196  to the cauterization tip  202  to perform cauterization on targeted tissue. 
         [0063]      FIGS. 7 and 8  are simplified side cross-sectional views of a distal end  206  of an energy delivery device  194 A in accordance with the aspects of this disclosure, respectively performing laser and cauterization operations. In some aspects, the energy delivery device  194 A includes an endoscope  208 , a distal end of which is shown in  FIGS. 7 and 8 . In some aspects, the endoscope  208  is used to deliver the laser fiber  200  and cauterization tip  202  to a desired treatment location to perform laser and cauterization operations on the patient. 
         [0064]    As mentioned above, aspects of the laser fiber  200  include an end-fire configuration in which the laser energy  196  is discharged from the terminating end of the laser fiber  200  along the longitudinal axis  210  of the laser fiber  200 . In some aspects, the laser fiber  200  is configured as a side-fire laser fiber, in which the laser energy  196  is discharged laterally with respect to the longitudinal axis  210 , as shown in  FIGS. 7 and 8 . In some aspects, in order to discharge the laser energy  196  laterally, as depicted in  FIGS. 7 and 8 , the laser fiber  200  includes an optical fiber  212  having a terminating end  214  that includes a beveled surface  216 . A fiber cap  218  covers the terminating end  214  and seals an air cavity  220  adjacent the beveled surface  216 . This configuration causes the laser energy  196  transmitted through the optical fiber  212  to reflect off the beveled surface  216  laterally relative to the longitudinal axis  210  toward targeted tissue  222  to perform a laser operation on the tissue  222 , as shown in  FIG. 7 . Such a laser fiber may also be used with other aspects described herein. 
         [0065]    In some aspects, the energy delivery device  194 A supports the laser fiber  200  within a lumen  224  of a member  226  that supports the cauterization tip  202 . In some aspects, the cauterization tip  202  is formed of a thermally conductive material, such as metal, that is attached to the member  226 . In some aspects, a thermally insulative portion  228  is positioned between the member  226  and the cauterization tip  202  to reduce the conduction of heat from the cauterization tip  202  to the member  226 . 
         [0066]    As can be seen in  FIGS. 7 and 8 , the cauterization tip  202  includes an opening or side port  227  therein to allow laser energy  196  to be discharged through the cauterization tip  202 . During a laser treatment operation such as, for example, vaporization, the cauterization tip  202  is positioned over the laser fiber  200  such that the side port  227  aligns with the discharge path of the laser energy  196  as depicted in  FIG. 7 . 
         [0067]    In some aspects, when cauterization is desired, a cauterization operation may be performed by moving the laser fiber  200  relative to the member  226  and the supported cauterization tip  202  to position the laser fiber  200  adjacent the cauterization tip  202 , as shown in  FIG. 8 . That is, the laser fiber  200  is positioned within the member  226  and cauterization tip  202  such that the side port  227  no longer aligns with the discharge path of the laser energy  196  ( FIG. 8 ). The laser source  192  is then activated to discharge the laser energy  196  to the cauterization tip  202 . The cauterization tip  202  is heated in response to this exposure to the laser energy  196 . The user of the energy delivery device  194  may then place the heated cauterization tip  202  in contact with the targeted tissue  222  to cauterize the tissue  222 , as shown in  FIG. 8 . 
         [0068]      FIGS. 9-11  illustrate an energy delivery device  194 B in accordance with additional exemplary aspects of this disclosure, which can be used with the system depicted in  FIG. 6 . For example,  FIG. 9  is a simplified side cross-sectional view of the distal end  306  of an exemplary energy delivery device  194 B performing a laser operation in accordance with aspects of this disclosure. As a further example,  FIG. 10  is a front cross-sectional view of the exemplary energy delivery device  194 B of  FIG. 9  taken generally along the line A-A of  FIG. 9 . As yet another example,  FIG. 11  is simplified side cross-sectional view of the exemplary energy delivery device  194 B during a cauterization operation. 
         [0069]    In some aspects, the energy delivery device  194 B utilizes an endoscope  308  to support the laser fiber  200  and the cauterization member  302 . The cauterization member  302  includes a thermally conductive portion  327  at its distal end. In some aspects, both the laser fiber  200  and cauterization member  302  are configured to move relative to each other and the endoscope  308 , such as sliding by hand or other conventional techniques. 
         [0070]    During a laser operation, the laser fiber  200  is extended through the distal end of the endoscope  308 , as shown in  FIG. 9 . The laser source  192  ( FIG. 6 ) is activated to deliver laser energy  196  through the laser fiber  200  and discharge the laser energy  196  to the targeted tissue  322 . The laser operation (such as vaporization) is performed on the tissue  322  in response to the exposure to the laser energy  196 . In some aspects, the cauterization member  302  is recessed within the endoscope  308  during the laser operation, as shown in  FIG. 9 . 
         [0071]    In some aspects, the cauterization operation is performed by advancing the cauterization member  302  through the distal end of the endoscope  308 , as shown in  FIG. 11 . In some aspects, the thermally conductive portion  327  of the cauterization member  302  is positioned adjacent the emission surface of the laser fiber  200  or discharge path of the laser energy  196 . Thus, when the user activates the laser source  192 , the laser energy  196  is transmitted through the laser fiber  200  and discharged into the thermally conductive portion  327  of the cauterization member  302 . The thermally conductive portion  327  is heated in response to exposure to the laser energy  196 . Cauterization is performed by placing the now heated conductive portion  327  in contact with the targeted tissue  322 , as shown in  FIG. 11 . In some aspects, the cauterization member  302  includes a thermally insulative portion  328  that protects the endoscope  308  and/or portions of the laser fiber  200  from excessive heat generated during the cauterization operation. 
         [0072]      FIGS. 12 and 13  are simplified side cross-sectional views of exemplary cauterization members  402  in accordance with aspects of this disclosure. In some aspects, the thermally conductive portion  427  of the cauterization member  402  has a blunt shape, as shown in  FIG. 12 . In some aspects, the thermally conductive portion  427  has a concave shape, such as a half loop, in order to capture the laser energy  196 , as shown in  FIG. 13 . The shape of the thermally conductive portion  427  can be any shape and can be selected based on the type of cauterization operation anticipated to be performed. The shape may affect the efficiency of the cauterization operation. 
         [0073]      FIGS. 14 and 15  are simplified cross-sectional views of an exemplary energy delivery device  194 C in accordance with aspects of this disclosure respectfully performing a laser operation and a cauterization operation. In some aspects, the cauterization member  502  is mounted to the distal end of the endoscope  508 . In some aspects, the endoscope  508  is protected from the heat generated during the cauterization operation by insulating the endoscope  508  from the thermally conductive portion  527  with a thermally insulative portion  528 . 
         [0074]    During a laser operation, the laser fiber  200  is extended through the distal end  506  of the endoscope  508  and past the cauterization member  502  such that the laser energy  196  discharged from the laser fiber  200  is directed at the targeted tissue  522 , as shown in  FIG. 14 . 
         [0075]    To perform a cauterization operation, the laser fiber  200  is retracted into the endoscope  508  such that the laser energy  196  discharged from the laser fiber  200  is directed into the thermally conductive portion  527  of the cauterization member  502 . The exposure of the thermally conductive portion  527  to the laser energy  196  heats the thermally conductive portion  527 . The user can then place the heated thermally conductive portion  527  into contact with the targeted tissue  522  to perform cauterization on the tissue  522 , as shown in  FIG. 15 . In some aspects, the cauterization member  502  is cylindrically shaped and surrounds the laser fiber  200 . This simplifies the cauterization operation by ensuring that the thermally conductive portion  527  is exposed to the laser energy  196  when the laser fiber  200  is at a known position relative to the endoscope  508  regardless of the angular position of the laser fiber  202  about its longitudinal axis  210 , as shown in  FIG. 15 . 
         [0076]    In some aspects, the cauterization member  602  is in the form of an add-on device that can be removably attached to the distal end  506  of the endoscope  508 . The attachment of the cauterization member  502  can be accomplished using any suitable technique. Thus, following a laser operation, the user can attach the cauterization member  502  to the endoscope  508  to perform a cauterization operation. 
         [0077]    In some aspects, the cauterization member  502  includes a sleeve portion  540  that attaches to the distal end  506  of the endoscope  508 , as shown in the simplified side cross-sectional views of exemplary energy delivery devices  194 D and  194 E shown in  FIGS. 16 and 17 . In some aspects, the sleeve portion  540  includes a thermally insulative portion  528  to prevent overheating of the endoscope  508 . The sleeve portion  540  may be attached to the distal end of the endoscope  508  in many different ways. In some aspects, the sleeve portion  540  forms a socket that receives the distal end of the endoscope  508 , as shown in  FIGS. 16 and 17 . 
         [0078]    In some aspects, the thermally conductive portion  527  of the cauterization member  502  covers the distal end of the laser fiber  200  and is configured to be exposed to laser energy  196  discharged along the longitudinal axis  210  of the laser fiber  200 , as indicated by the phantom arrow  196  shown in  FIG. 16 . In some aspects, the distal end of the laser fiber  200  is configured to discharge laser energy  196  laterally with respect the longitudinal axis  210  of the laser fiber  200 , as indicated in  FIG. 17 . In some aspects, the detachable cauterization member  502  has an open distal end, which allows laser operations to be performed by the laser fiber  200  by extending the laser fiber  200  beyond the open distal end of the cauterization member  502 , as discussed above with respect to  FIG. 14 . In some aspects, the thermally conductive portion  527  surrounds the laser fiber  200 , as shown in  FIG. 18 , which is a simplified front cross-sectional view of the energy delivery device  194 E of  FIG. 17  taken generally along line B-B. 
         [0079]    In some aspects disclosed herein, it is important to monitor and control the temperature of the cauterization portion/tip/member of the energy delivery device in order to (1) prevent overheating of tissue, which can result in carbonization and (2) prevent damage to the cauterization portion/tip/member. Monitoring and measuring of the cauterization portion/tip/member can be achieved by detecting, collecting and/or analyzing the black body radiation or electromagnetic energy feedback produced at the cauterization portion/tip/member. This black body radiation or electromagnetic energy feedback can be used to control the laser power/energy to ensure that the cauterization portion/tip/member temperature remains at a safe level, for example, between 60-100 degrees Celsius. Methods and devices for detecting, collecting and/or analyzing the black body radiation or electromagnetic energy feedback produced at the cauterization portion/tip/member are described and disclosed in commonly-assigned International Patent Application No. PCT/US2014/61319, filed on Oct. 20, 2014, the entire contents of which are incorporated herein by reference in their entirety for all purposes. 
         [0080]    In alternative aspects of the present disclosure, the cauterization portion/tip/member temperature can be controlled by a flowing irrigant. Irrigation flow can be achieved and controlled using the devices described and disclosed in commonly assigned U.S. Pat. Nos. 7,869,016 and 8,858,542, and commonly assigned U.S. patent application Ser. No. 14/471,945, filed on Aug. 28, 2014. The entire contents of U.S. Pat. Nos. 7,869,016 and 8,858,542, and U.S. patent application Ser. No. 14/471,945 are incorporated herein by reference in their entirety for all purposes. Additionally, irrigation can be provided to the cauterization portion/tip/member with an endoscope, cystoscope or other similar device. 
         [0081]    Although the present disclosure has been described with reference to illustrative aspects for particular applications, the disclosure is not limited thereto. Those have ordinary skilled in the art and access to the teachings provided herein will recognize that additional modifications, applications, aspects, changes, and substitution of equivalents all fall in the scope of this disclosure, and may be made in form and detail without departing from the spirit and scope of this disclosure. Accordingly, the present disclosure is not to be considered as limited by the foregoing description.