Patent Publication Number: US-2021187315-A1

Title: Photodynamic therapy device and methods of use

Description:
PRIORITY CLAIM 
     This application claims priority to U.S. Ser. No. 62/951,447, filed on Dec. 20, 2019, entitled “PHOTODYNAMIC THERAPY DEVICE AND METHODS OF USE”, the disclosure of which is incorporated by reference in its entirety. 
    
    
     TECHNICAL FIELD 
     This document pertains generally, but not by way of limitation, to surgical instruments and methods that include surgical tooling that can be used to apply photodynamic therapy to treat target tissue. 
     BACKGROUND 
     Many surgical procedures involve the treatment or removal of target tissue, e.g., diseased or unwanted tissue, located inside of a patient. As such, these procedures require access to the internal anatomy of the patient via an open procedure or through a smaller opening in minimally invasive procedures. 
     Women suffer from a variety of uterine abnormalities that can cause various issues. Endometriosis is a condition in which tissue that normally lines the inside of the uterus, the endometrium, grows outside the uterus. Endometriosis can cause severe, ongoing chronic pain. Often, endometriosis occurs in and around the pelvis, such as near the ovaries, fallopian tubes, and other tissue lining the pelvis. In rare cases, endometrial tissue can spread beyond pelvic organs. Endometriosis can include shallow endometrial tissue growth in and around these areas, deeper endometrial tissue growth, or both. 
     Another abnormality is menorrhagia, which refers to menstrual bleeding lasting more than seven days at a time, and can often include heavy bleeding. Menorrhagia affects more than ten million American women every year, meaning about one out of every five women nationally has menorrhagia. Untreated menorrhagia can cause anemia, a common blood problem in which the patient lacks sufficient healthy red blood cells to carry adequate oxygen throughout the body. 
     Menorrhagia can be caused by uterine problems, hormonal problems, or other illnesses. Some particular causes can include, but are not limited to, growths or tumors in the uterus, cancer of the uterus or cervix, pregnancy-related problems such as miscarriage or ectopic pregnancy, bleeding disorders, some types of birth control, kidney, thyroid, or liver diseases, infection of the female reproduction organs such as pelvic inflammatory disease, menopause, child birth, fibroids or polyps in the lining or muscles of the uterus, taking certain drugs such as aspirin, or combinations thereof. 
     OVERVIEW 
     A variety of approaches can be taken for treatment of uterine abnormalities including endometriosis, menorrhagia, polyps, and fibroids. For example, ablation therapy can be provided to treat cases various uterine abnormalities. In an example of treating endometriosis, targeted ablation such as radiofrequency (RF) ablation can be used to provide electromagnetic energy for ablating tissue or can provide a blade-like device for physically excising tissue. In an example of treating menorrhagia, the endometrial tissue in the uterus can be treated by ablation therapy so that the tissue does not continue to heavily bleed during the menstrual cycle. Such treatment of the uterus can be referred to as global endometrial ablation (GEA). GEA approaches can use a variety of ablation technologies to ablate the endometrium and prevent menorrhagia. Some of these approaches can include radiofrequency (RF) energy, microwave energy, cryogenics, thermal energy, steam, and plasma ablation technologies. Devices and methods for delivery of these approaches can be large and can create patient pain or discomfort when used. 
     To help increase efficacy and reduce complications, the present disclosure describes, among other things, an improved treatment modality using photodynamic therapy to treat various uterine abnormalities. 
     Photodynamic Therapy (PDT), is the treatment of diseased, usually hyper proliferative tissue using photosensitizing chemicals and light. For example, PDT involves two non-toxic components that are combined at the treatment site to induce cellular and tissue damage in an oxygen-dependent manner. A non-toxic photosensitizer drug and a non-hazardous light of a matched wavelength are delivered to the treatment site. The photosensitization of the drug elicits the transfer of energy or an electron to molecular oxygen resulting in instant local generation of cytotoxic reactive oxygen species (ROS). Depending on the drug and the treatment protocol, phototoxicity can be directed toward the targeted tissue. The half-life of these radicals in the biological milieu is extremely short, thereby confining the damage to the illuminated area. Compared to surgical resection of tissue and ablations therapy, PDT is a highly controlled, minimally-invasive, local treatment that can effectively treat uterine abnormalities such as endometriosis, menorrhagia, and polyps, among others. 
     An example of previous PDT procedures includes treating tumors. Typically, the photosensitizer is delivered, generally intravenously, then waiting for some period of time for the photosensitizer to be accumulated within the target tissues while most nontarget tissue eliminates the photosensitizer. The therapeutic response of PDT includes both cellular and vascular effects. Current therapy protocols for PDT require the procedural step of allowing a period of time to elapse after injection of a photosensitizer into the blood stream to permit the photosensitizers to sufficiently accumulate in a target tissue, sometimes referred to as “drug-to-light” time. The countdown, the elapsed time required for accumulation prior to administering phototherapeutic light, begins upon introduction of the photodynamically active photosensitizer into the patient&#39;s circulatory system. With time, the photosensitizer is taken up by tissue(s) and tissue components and bound thereto. While utilization of this preferential, differentially selective photosensitizer uptake/retention by hyperproliferating tissue is effective for a variety of photosensitizers and target tissues, due to uptake throughout the body and elimination, the delay time necessary for the accumulation of a therapeutically effective concentration of photosensitizer in the tissue generally requires the use of a relatively high photosensitizer dose. This high level of drug, in turn, can lead to problems such as systemic and local toxicity and prolonged photosensitivity of the skin. In addition, this methodology does not specifically target vasculature but focuses instead on the selective ability of a target tissue (a tissue to be treated by PDT), to take up and retain photosensitizers from the blood. Additionally, by injecting the photosensitizer into the patient&#39;s circulatory system and waiting until a sufficient amount is retained within the target tissue, provides a critical window in which the illumination needs to happen for efficient treatment of the target tissue. 
     The present disclosure describes devices and methods that can deliver selective targeted PDT therapy to treat various conditions and eliminate the requirement of previous approaches needing to wait between the injection of the photosensitizer and illumination. Further, the devices and methods disclosed herein can provide either a targeted PDT treatment for a specific target tissue (e.g., endometriosis or polyp) or can provide a global PDT treatment that can be used to treat, e.g., the intra-uterine wall for menorrhagia. 
     In particular, the devices and methods disclosed herein provide delivery of the photosensitizer and illumination to a surface of a target tissue. In an example, the photosensitizer and the illumination occur substantially simultaneously. In doing so, precise targeted PDT therapy can be delivered to the target tissue. Such an approach can include providing or using a PDT therapy device for producing intra-uterine tissue effects for menorrhagia and targeted tissue effects for endometriosis and uterine polyps. The therapy device can include a portion that can be sized and shaped for at least partial insertion into a patient. The device can have a shaft, including a proximal portion and a distal portion. The device can further include a treatment end that includes a therapy light emitter and an applicator that can deliver the photosensitizer in a desired manner to a particular tissue or area (target tissue). The photosensitizer and therapy light can be delivered to the tissue or area simultaneously or substantially simultaneously so that the tissue or area can be effectively treated. Further, since the photosensitizer is being applied to the surface of the tissue, the amount of the photosensitizer used and absorbed by the body can be reduced and the uncertain waiting in previous approaches to allow a sufficient amount to be concentrated in a particular tissue is eliminated. Moreover, 
     This overview is intended to provide an overview of subject matter of the present patent application. It is not intended to provide an exclusive or exhaustive explanation of the invention. The detailed description is included to provide further information about the present patent application. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a schematic illustration of a therapy device including a surgical device having a treatment end that can provide PDT to a target tissue, according to one example of the present disclosure. 
         FIG. 2  is a schematic illustration of a therapy device providing PDT to a patient having menorrhagia, according to one example of the present disclosure. 
         FIG. 3  is a schematic illustration of a therapy device that can provide PDT including a phototherapeutic light containment device and a distension member, according to one example of the present disclosure. 
         FIG. 4  is a close-up view of the distal portion of the therapy device shown in  FIG. 3  applying PDT to a patient having an intra-uterine polyp. 
         FIG. 5A  is a schematic perspective view of a phototherapeutic light containment device, according to one example of the present disclosure. 
         FIG. 5B  is a schematic end-view of the phototherapeutic light containment device shown in  FIG. 5A . 
         FIG. 6  is a schematic diagram illustrating a laparoscopic surgical procedure to provide PDT to a patient having endometriosis, according to an example of the present disclosure. 
         FIG. 7  is a schematic cross-sectional view of another example of a therapy device that can provide PDT to a target tissue, according to one example of the present disclosure. 
         FIG. 8  is a schematic cross-sectional view of another example of a therapy device that can provide PDT to a target tissue, according to one example of the present disclosure. 
         FIG. 9  is a schematic cross-sectional view of another example of a therapy device that can provide PDT to a target tissue, according to one example of the present disclosure. 
         FIG. 10  is a schematic line diagram illustrating a method for providing PDT to a target tissue, according to one example of the present disclosure. 
         FIG. 11  is a schematic line diagram illustrating methods for providing PDT to a target tissue, according to one example of the present disclosure. 
         FIG. 12  is a schematic line diagram illustrating methods for providing PDT to a target tissue, according to one example of the present disclosure. 
     
    
    
     In the drawings, which are not necessarily drawn to scale, like numerals may describe similar components in different views. Like numerals having different letter suffixes may represent different instances of similar components. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document. 
     DETAILED DESCRIPTION 
     The present disclosure describes, among other things, devices and methods that can be used to treat a patient, such as for locally treating target tissue including, but not limited to, endometriosis, menorrhagia, and intra-uterine growths such as polyps. As defined herein, “target tissue” refers to any biological tissue or a part thereof, including blood and/or vessels, which is the object of focused tissue ablation and includes, e.g., a group of cells, a tissue, a body part or an organ. 
     The device can include an outer shaft that can be inserted into the patient. A surgical instrument having a treatment end can be translatable within the outer shaft to extend from the outer shaft and deliver the PDT therapy to the patient. The treatment end can include a light emitter and an applicator tip in a configuration such that the photosensitizer and illumination provided by the light emitter can be applied to the surface of a target tissue. As discussed more herein, the photosensitizer and illumination can be provided simultaneously, i.e., at the same time, during the procedure for providing PDT. In one example, the photosensitizer can initially be applied alone, but after a certain time limit, the illumination can be delivered with the continued application of the photosensitizer. In some examples, the photosensitizer can be applied to the surface of the target tissue and the illumination can be provided substantially simultaneously or subsequently. In this instance, the illumination can be provided subsequently after the application of the photosensitizer. For example, the illumination can be provided within 10 minutes of the application of the photosensitizer, such as about 9 minutes, 8 minutes, 7 minutes, 6 minutes, 5 minutes, 4 minutes, 3 minutes, 2 minutes, and 1 minute. In one example, the illumination occurs less than 1 minute such as within 40 seconds, 30 seconds, 20 seconds, 10 seconds, 5 seconds, and 3 seconds. Further, a combination of simultaneous application of the illumination and photosensitizer and staggered (or subsequent) application of illumination can be used during the procedure, as discussed more herein. Whether the photosensitizer and illumination are provided simultaneously, substantially simultaneously, or subsequently, can depend on a variety of factors such as the target tissue, the particular, photosensitizer, and desired treatment outcome. 
       FIG. 1  is a schematic illustration of therapy device  10  (also referred to herein as “device  10 ”) that can apply PDT to target tissue. Therapy device  10  can comprise handle or handpiece  20 , outer shaft  12 , and surgical instrument  23 . The surgical instrument  23  can deliver PDT by applying the photosensitizer and illumination to the target tissue such as a surface of the target tissue. The surgical instrument  23  can provide the photosensitizer via an applicator system  29  and can provide the illumination via a lighting system  21 . The applicator system  29  can comprise an application shaft  28  and an applicator tip  26 . The lighting system  21  can comprise a light source  38 , light delivery shaft  33 , light conductor  32 , and light emitter  24 . The application tip  26  and the light emitter  24  can form a treatment end  22  of the surgical instrument  23  that deliver the PDT to the target tissue. 
     The outer shaft  12  can include an elongate member extending from a proximal portion  14  to a distal portion  16 . The outer shaft  12  defines a lumen  19  extending from the proximal portion  14  to the distal portion  16  including a distal opening  18 . The handpiece  20  can be mounted or connected to the proximal portion  14  of the outer shaft  12 . Portions of the applicator system  29  and the lighting system  21  can run within or along the outer shaft  12 , such as from the proximal portion  14  to the distal portion  16 . 
     In examples, the outer shaft  16  can be sized, shaped, or arranged for performing laparoscopic procedures in conjunction with a laparoscope as well as performing transcervical procedures. As such, shaft  16  can be inserted into an incision in the epidermis of a patient, through a body cavity of the patient and into an organ or transcervically into a uterus. Thus, it is desirable for the diameter or cross-sectional shape of shaft  16  to be as small as possible to facilitate minimally invasive surgical procedures and minimal dilation of the cervix. The outer shaft  12  can be rigid and formed from a metal or plastic material. In an example, the outer shaft  12  can have a diameter of less than about 6 mm. The proximal portion  14  can be near an operator when the device  10  is in use. 
     A drug-delivery conduit  30  can be defined by the application shaft  28 . A drug source  46  can be connected to the drug-delivery conduit  30  at the proximal end  14  to deliver the photosensitizer to the applicator tip  26 . The applicator tip  26  is configured to apply the photosensitizer to the target tissue in a manner specific to the type of treatment and anatomy being treated. The therapy device  10  can further comprise a power source or generator  48  that can be coupled to the drug source  46  via linkage  50  and to the therapy device  10  via linkage  44 . The drug source  46  can be removable (or refillable), thereby allowing for attachment or use of different photosensitizers during a treatment. 
     Handpiece  20  can comprise any device suitable for facilitating manipulation and operation of therapy device  10 . Handpiece  20  can be located at the proximal portion  14  or another suitable location along shaft  12 . In examples, handpiece  20  can comprise a pistol grip, a knob, a handlebar grip and the like. Actuation device  42  can be attached to handpiece  20  to operate linkages  44 ,  50 . Actuation device  42  can comprise one or more of buttons, triggers, levers, knobs, dials and the like. Linkages  44 ,  50  can comprise any suitable device for allowing operation of therapy device  10  from handpiece  20 . In examples, linkages  44 ,  50  can be a mechanical linkage, an electronic linkage, an electric linkage, a fluid linkage or an acoustic linkage. 
     Light conductor  32  can comprise a medium for transmitting light from light source  38  to light emitter  24 . Light conductor  32  can be located within a light shaft  33  extending from the proximal portion  14  to the light emitter  24  at the distal portion  16 . Light conductor  32  can comprise a material suitable for transmitting waves of electromagnetic radiation at various wavelengths. Light conductor  32  can be coupled to light source  38  via cable  36  and connector  34 . Cable  36  can comprise an extension of light conductor  32  and can be fabricated from the same material as light conductor  32 . In examples, light conductor  32  and cable  36  can comprise fiber optic cables. In examples, the fiber optic cables can comprise glass and plastic fibers jacketed with one or more protective coatings. Light emitter  24  can be located at or near the distal end of light conductor  32 . Light emitter  24  can be coupled to light conductor  32  by any suitable means. In examples, light emitter  24  can comprise a lens for focusing or a diffuser for spreading light waves from light conductor  32 . Light emitter  24  can be unidirectional or omnidirectional. Light emitter  24  can comprise a glass or plastic body of transparent material. However, in additional examples, a separate light emitter is not used and light conductor  32  can comprise an end-emitting fiber such that the distal or terminal end of light emitter  32  can comprise light emitter  32 . 
     In an example, the light emitter  24  and the application tip  26  can be coupled such that they cannot move relative to each other. That is, they can be linearly locked together such that they move relative to the outer shaft  12  together. The light emitter  24  and application tip  26  can be located and the end of a single shaft or located at the end of two respective shafts (light shaft  33  and the applicator shaft  28 ), where the two shafts can be coupled together. In another example, the light emitter  23  and the application tip  26  are not linearly locked and can move relative to one another and to the outer shaft  12 . 
     The light source  38  may be any suitable light source that emits a light beam with a wavelength that matches one of the absorption peaks of the photosensitizer drug. That is, the light source  38  should emit a photosensitizer activating light (referred to herein as “phototherapeutic light” or “therapy light”) and is based on the type of photosensitizer drug used. 
     As mentioned, light source  38  can be coupled to light conductor  32  via cable  36 . Connector  34  can comprise any suitable device for linking light conductor  32  and cable  36  such that fibers disposed therein can be adjoined in an end-to-end manner. As such, light source  38  can be located remotely from therapy device  10 . In examples, light source  38  can comprise a stand-alone module couplable to the therapy device  10  via cable  36 . In additional examples, light source  38  can be attached directly to the exterior of handpiece  20  via connector  34  without using cable  36 . As such, light source  38  can be removable, thereby allowing for attachment of light generators that produce different intensities or wavelengths, which, as discussed below, can allow for activation of different types of photosensitizer drugs. In additional examples, light source  38  can be incorporated into handpiece  20  such that connector  34  is not used. In additional examples, light source  38  can be incorporated into generator  48  and cable  36  and cable  44  can be included in a common cable bundle. In additional examples, the light source  38  can be provided at the distal end of the light shaft  33  such that the light source  38  is coupled to a power source and the light is generated at the distal end of the light shaft  33  instead of generated and transmitted to the light emitter  24  using the light conductor  32 . 
     The light from light source  38  can be transmitted through light shaft  33  using light conductor  32  to provide the photosensitizer activating light (illumination) with or without the aid of a separate light emitter device, such as light emitter  24 . As mentioned, removable light generators can facilitate production of light at different wavelengths such that the activation wavelength can be matched for the particular photosensitizer drug used. This is beneficial as the particular photosensitizer drug used can depend on the type of target tissue, surrounding tissue/anatomy, and strength needed to treat the target tissue. As discussed herein, during a treatment of a target tissue, one or more photosensitizers can be applied to the target tissue to alter the intensity of the PDT. In an example, the drug source  46  and the light source  38  can be changed such that the wavelength of the light from the light source  38  matches the new photosensitizer so that different photosensitizers can be used. For example, depending on the target tissue and treatment intensity needed, different photosensitizers may be used during a single PDT treatment. 
     Actuation device  40  can be attached to handpiece  20  to operate linkage  36 . Actuation device  40  can comprise one or more of buttons, trigger, lever, knobs, dials and the like. Linkage  36  can comprise any suitable device for allowing operation of one or more features of the lighting system  21  from handpiece  20 . In examples, linkage  36  can be a mechanical linkage, an electronic linkage, an electric linkage, a fluid linkage or an acoustic linkage. 
     As discussed herein, the wavelength emitted from the light source  38  is matched with one of the absorption peaks of the selected photosensitizer. The estimated light intensity to be delivered depends on the lighting system  21 , the mode of illumination used, the nature of the target tissue, and the objective of the treatment. 
     The drug source  46  can hold the photosensitizer of choice. As discussed herein, since the photosensitizer is being applied topically to the target tissue, a lower amount of the photosensitizer can be used and less is absorbed into the body as it is not injected intravenously or taken orally. Additionally, because the photosensitizer and illumination are provided substantially simultaneously and to the surface of the target tissue, there is no critical window in which a user needs to provide the illumination in order to provide effective and efficient PDT to a patient. 
     The photosensitizer can be selected from any suitable photosensitizer. An exemplary list of photosensitizers include, but is not limited to porphyrins, 5-Aminolaevulinic acid (ALA), chlorin, pyrrole-derived macrocyclic compounds, porphyrins, chlorins, bacteriochlorins, isobacteriochlorins, phthalocyanines, naphthalocyanines, porphycenes, porphycyanines, pentaphyrin, sapphyrins, texaphyrins, phenoxazine dies, phenothiazines, chaloorganapyrylium dyes, triarylmethanes, rhodamines, fluorescenes, azapophyrins, benzochlorins, purpurins, chlorophylls, verdines, and derivatives thereof. 
     The manner in which the photosensitizer is applied to the target tissue via the applicator tip  26  can depend on the location and type of target tissue. For example, the photosensitizer can be applied in a stream in a high or low pressure low, as a spray, as an atomized spray (a mist or fog), or as a paste. 
     As discussed herein, the photosensitization of the drug elicits the transfer of energy and can ablate the target tissue. Ablation can include, for example, removal or destruction of the target tissue by the application of PDT. In some cases, ablation can cause tissue necrosis. In on example, the target tissue can scar in response to ablation, preventing it from copious bleeding and producing menorrhagia effects. 
     Further, while not shown in  FIG. 1 , a gas-conduit can be provided in the therapy device  10  to provide an oxygen stream to the target tissue. The oxygen concentration at the target tissue can change the results from the PDT. For example, low oxygen content can reduce phototoxicity preventing the PDT from achieving its full therapeutic potential. Thus, any of the therapy devices disclosed herein can be configured to supply oxygen to the target tissue to increase the oxygen at the target tissue and maximize the therapeutic potential of the PDT. 
       FIG. 2  is a schematic illustration of a therapy device  10  providing PDT to a patient having menorrhagia, according to one example of the present disclosure. The outer shaft  12  has been inserted into a body cavity (the uterus  66 ) and the surgical instrument  23  is advanced from the outer shaft  12  such that the treatment end  22  is at a desired position. In this example, since the therapy device  10  is treating for menorrhagia, the photosensitizer  61  can be applied in a mist form from the applicator tip  26  such as to most efficiently come into contact with the surface of the uterine wall  70 . However, any application method of the photosensitizer is contemplated. 
     Phototherapeutic light  63  (the photosensitizer activating light) is delivered to illuminate the intrauterine wall  70 . The phototherapeutic light  63  can be administered at the same time, or substantially the same time, as the photosensitizer  61 . The therapy device  10  allows the selective destruction of the intrauterine wall  70  because the light is delivered during the time of maximum photosensitizer concentration at the surface of the target tissue. That is, the light is delivered as the photosensitizer is continuously being applied to the surface of the target tissue. The dose, amount, and type of the photosensitizer, as well as the length of the illumination, can depend on the particular patient and desired tissue outcome. Thus, in one example, the protocol for PDT can include applying the photosensitizer/illumination at the same time for a time period. 
     As discussed herein, the type of abnormality being treated can determine the protocol used during the PDT. For example, in other examples, the protocol can include switching between applying the PDT (photosensitizer/illumination) and not applying the PDT. For example, a duty cycle of applying the PDT can be applied when treating the patient. The type of photosensitizer can also determine the type of protocol used. In an example, some photosensitizers can work immediately, and their therapeutic affect is done whereas other photosensitizers can have a longer effective duration. Thus, an operator can apply PDT such as applying the photosensitizer/illumination and then diagnosis the target tissue after a time period to determine if additional sessions of PDT is necessary. 
     In one example a coaxial optical fiber can be used and includes a visual light that can connect to a camera and a treatment light to apply the wavelength that matches the photosensitizer being used. The operator can then switch between applying PDT and diagnosing until the target tissue is sufficiently treated. In one example, the diagnosing can occur while the PDT is being applied. However, in other examples, the diagnosing can occur after the PDT (photosensitizer/illumination) has stopped and the effective duration of the photosensitizer is over. An optical system and/or imaging system can be used to identify target tissues, immediately measure the treatment of the target tissue to determine if more treatment is needed, and determine if the procedure is complete. One example of such an optical system is disclosed in U.S. Provisional Patent Application 62/940,328, filed Nov. 26, 2019, titled “Surgical devices with Integrated Lighting Systems,” which is incorporated by reference in its entirety. 
     In another example, the same effect can be realized by applying the photosensitizer  61 , stopping the application of the photosensitizer  61 , and illuminating the target tissue within a certain time limit after the application of the photosensitizer  61  has stopped. This sequence can be repeated numerous times until the desired tissue outcome is realized. Thus, in one example, the protocol for delivering the PDT can be: apply photosensitizer-illuminate-apply photosensitizer-illuminate-apply photosensitizer-illuminate, etc. The time limit can vary and be less than 5 minutes, such as but not limited to less than 1 minutes, and less than 10 seconds. 
     Optionally, the therapy device  10  can include fallopian blockers  60 A,  60 B that can extend from the outer shaft  12 . The fallopian blockers  60 A,  60 B include elongate member  62 A,  62 B with block portions  64 A,  64 B that are configured to block the fallopian tubes  71  to minimize the photosensitizer  61  and phototherapeutic light  63  from entering the fallopian tubes  71  and ablating unintended target tissue. 
     As shown in  FIG. 2 , the therapy device  10  is applying a global application of PDT for treating menorrhagia where the fallopian tubes are tissue that is meant to not receive treatment. However, there may be other instances where a large area of tissue is the target tissue but there may be areas that are not mean to receive treatment other than the fallopian tubes. Optionally, a pretreatment can be performed on the area around the target tissue that is not meant to receive the treatment. The pretreatment can include applying a blocking coating to tissue that is not meant to receive the PDT. The blocking coating can prevent the photosensitizer from contacting/absorbing into the tissue and/or block the wavelengths from the light source  38 . In an example, the therapy device  10  or a separate device can be used to apply the blocking coating to a surface of tissue not meant to receive the PDT treatment. Examples of the blocker coating can include, but are not limited to, hydrophobic coatings, beeswax, and mucosal adhesive, among others, that have the properties to prevent attachment/contact of the photosensitizer to the tissue or to block the wavelength generated from the light source  38 . 
     As discussed herein, the light emitter  24  and application tip  26  can be linearly locked together. In an example, during the treatment of the intrauterine wall  70 , while the PDT is being delivered, the light emitter  24  and the application tip  26  can be moved along a longitudinal axis (together) within the uterus  66  to treat the target tissue. Alternatively, the light emitter  24  and the application tip  26  can move independently of each other such that one may remain in a stationary position while the other one moves linearly. Moreover, they both can move at the same time in different directions or at different speeds relative to one another. In one example, the applicator tip  26  position is maintained constant while applying the photosensitizer  61  and the light emitter  24  is moved back and forth along a longitudinal axis to effectively apply and thoroughly illuminate the intrauterine wall  70 . Further, the surgical device  23  can be rotated about a longitudinal axis to increase the efficiency of the PDT. 
       FIG. 3  is a schematic illustration of the therapy device  10  including a distension member  74  and a phototherapeutic light containment device  72 .  FIG. 4  is a close-up view of the distal portion of the therapy device shown in  FIG. 3  applying PDT to a patient having an intra-uterine polyp. The distension member  74  and a phototherapeutic light containment device  72  are optional and can be utilized to increase the efficiency of the application of PDT in certain instances.  FIGS. 3 and 4  will be discussed together. 
     The distention member  74  can be translatable within the outer shaft  12  and configured to distend a patient&#39;s uterus. Distension member  74  could also be utilized in the example illustrated in  FIG. 2  for treating menorrhagia. The distention member  72  can have a non-expanded position and an expanded position. For example, while positioned within the outer shaft  12 , the distension member  72  can be in the non-expanded positioned (compressed state) and as the distension member  72  advances from the outer shaft  12 , the distension member  72  transitions from the non-expanded positioned to the expanded position (uncompressed state) to distend a body cavity such as a uterus. While any distension structures are contemplated, in one example, the distension member  72  includes two or more elongated legs. The distension member  72  can be formed from, but not limited to, silicone, PET, polyurethane, rubber, or the like. 
     That phototherapeutic light containment device  72  can be used to contain the illumination to a particular area. For targeted PDT such as applying PDT to a polyp (as shown in  FIG. 4 ) or endometriosis (as shown in  FIG. 6 ), it may be easier to contain the light than it would be to contain the application of the photosensitizer to a particular location. In certain instances, the photosensitizer characteristics such as viscosity can be changed to allow the photosensitizer to stay in a particular location for an extended period of time. For example, the photosensitizer can be applied in a liquid, gel, or paste form depending on the location and features of the therapy device  10 . 
     Similar to the distension member  74 , the phototherapeutic light containment device  72  can have a non-expanded position and an expanded position. For example, while positioned within the outer shaft  12 , the phototherapeutic light containment device  72  can be in the non-expanded positioned (compressed state) and as the phototherapeutic light containment device  72  advances from the outer shaft  12 , the phototherapeutic light containment device  72  transitions from the non-expanded positioned to the expanded position (uncompressed state) and can be advanced such that a distal end of the phototherapeutic light containment device  72  contacts an area around the target tissue  76  (uterine polyp). The phototherapeutic light containment device  72  surrounds the treatment end  22  of the surgical instrument  23  to contain the phototherapeutic light  63  to a desired location while the photosensitizer  61  is being delivered. In order to contain the phototherapeutic light  63 , the phototherapeutic light containment device  72  is formed from a material that does not transmit the phototherapeutic light. 
     Therapy device  10  can also include a gas-conduit  78  located, e.g., in the wall of the outer shaft  12  to deliver a gas. The gas can assist in distending the body cavity but can also be used for increasing the reactivity of the photosensitizer when the gas is oxygen. While shown in the wall of the outer shaft  12 , the oxygen gas flow can be supplied in a variety of ways. In one example, a flow of oxygen can be supplied through the phototherapeutic light containment device  72 . However, other configurations are contemplated. 
       FIG. 5A  is a schematic perspective view of the phototherapeutic light containment device  72  and  FIG. 5B  is a schematic end-view of the phototherapeutic light containment device  72 .  FIG. 5A  illustrates the phototherapeutic light containment device  72  in an expanded state. The phototherapeutic light containment device  72  can include an elongate body  80  and a plurality of flexible members  82  connected by a flexible material  84 . The area defined by the distal end of the phototherapeutic light containment device  72  can vary and be dependent on how far the phototherapeutic light containment device  72  is extended out of the outer shaft  12 . The phototherapeutic light containment device  72  can define a lumen  86  that can receive the surgical instrument  23  and or provide an oxygen gas flow. 
       FIG. 6  is a schematic diagram illustrating a laparoscopic surgical procedure to provide PDT to a patient having endometriosis. The surgical procedure can comprise an open procedure or a laparoscopic procedure.  FIG. 6  illustrates a laparoscopic procedure being performed with the therapy device  10  shown in  FIG. 4  without the distention member  74 . The surgical procedure can be performed to remove or otherwise ablate target tissue that is diseased or invasive.  FIG. 6  illustrates a surgical procedure being performed to remove endometrium tissue from the cavity of abdomen A that has grown outside of uterus U.  FIG. 9  illustrates an operating room environment where laparoscope  90  is coupled to camera  92  and display  94 . 
     The therapy device  10  can be inserted into passage  96  of the laparoscope  90 . As shown, the distal portion  16  of the outer shaft  12  protrudes from passage  96  and is located inside the abdomen A. The treatment end  22  of the surgical instrument  23  can be advanced from the outer shaft  12  and positioned to deliver the PDT. As seen in  FIG. 6 , the phototherapeutic light containment device  72  is deployed and surrounds the treatment end  22  as well as confines the phototherapeutic light to the target tissue  90  (endometriosis). 
       FIGS. 7 and 8  illustrate portions of other examples of therapy devices  100 ,  200  such as for one or more intra-uterine tissue effects.  FIG. 7  illustrates therapy device  100  including a treatment end  22 . The treatment end  22  includes the lighting system  21  as disclosed herein and an applicator system  103 . The applicator system  103  includes an expandable medium  102  including a layer  104  of the photosensitizer on the outer surface  109  of the expandable medium  102 . The expansion of the expandable medium  120  is configured to apply the photosensitizer to the target tissue. The lighting system  21  can include the light emitter  24 , the light shaft  33 , and the light conductor  32 . However, light shaft  33  as shown in  FIG. 7  can includes a medium-delivery conduit  106  in fluid communication with an interior  105  of the expandable medium  102 . The medium-delivery conduit  130  can run within or along the light shaft  33 . A medium source such as gas or liquid can be connected to the medium-delivery conduit  106  at the proximal end of the light shaft  12 . The expandable medium  102  can be, for example, elastic and inflatable, such as using a balloon-type material and is transparent to the wavelength generated by the light source. 
     The applicator system  103  includes a layer  104  of the photosensitizer on an outer surface  109  of the expandable medium  103 . In one example, the layer  104  can be a composite material that includes the photosensitizer. 
     The expandable medium  102  can have both a lower profile state and a relatively higher profile state. In the lower profile state, the expandable medium  102  can be, for example, collapsed on light shaft  33 . In the lower profile state, the expandable medium  102  can be, for example, narrower in profile, such as for easier insertion into a patient. In the lower profile state, the expandable medium  102  can have a lateral profile outer dimension, such as a diameter, of less than about 6 mm, such as for easier transcervical insertion into the patient. 
     In the higher profile state, the expandable medium  102  can be expanded to a larger size, such as a larger diameter, cross-section, or volume, such as while within the uterus. When in the relatively higher profile state, the expandable medium  102  can have a lateral profile outer dimension, such as a diameter, of about 3 cm to about 4 cm. 
     The expandable medium  102  can include, for example, a urethane material. In some cases, the expandable medium  102  can include more than one layer of material, such as discussed below with reference to  FIG. 8 . 
     The medium-delivery conduit  106  can deliver a medium to the expandable medium  102  at or via an outlet  107 . When deployed, the expandable medium  102  can cover or encase the outlet  107  so that the fluid can be delivered directly into the expandable medium  102 . The fluid can include, for example, water, saline, oxygen, carbon dioxide or other suitable liquid or gas. 
     In some cases, the outlet  107  can include a valve in fluid communication with the medium-delivery conduit  106 . The valve can be configured to be user-triggered to allow or prevent or otherwise control delivery of the medium towards expandable medium  102  via the valve. The operator can trigger the valve, for example, by a button or trigger on the hand piece. In some cases, the operator can trigger the valve by a foot pedal or other actuator coupled to the device  100 . 
     The medium can be provided to the expandable medium  102  via the fluid-delivery conduit  106  from a medium source. In an example, the medium source can include a pre-filled syringe such as can be integrated with or attached to the hand piece. The syringe can have, for example, a plunger, such as can be actuated by a coiled spring, or can be manually actuated by the operator. The fluid source can include a tube, hose, pump, or combination thereof, such as for connecting the device to a larger canister, container, faucet, or other reservoir holding the fluid. 
     In some cases, the operator can use the device  100 , for example, by inserting the distal portion  16  with the expandable medium  102  in a lower profile state (e.g., compacted) into the uterus of the patient, through the cervix. The operator can determine the correct placement of the device  100  in the patient, in some cases, by visual confirmation, through a scope (such as an endoscope) or camera integrated into the device. In some cases, the operator can use other imaging technology such as ultrasound. In other examples, where the operator intends to have the expandable medium  103  touch, extend, or distend the uterine wall, the operator can physically detect when the device  100  touches the uterine wall. The applicator system  103  includes a layer  104  of the photosensitizer on an outer surface  109  of the expandable medium  103 . 
     After insertion, the operator can actuate the medium source so that the medium can be delivered down the medium-delivery conduit  106  and dripped, sprayed, or poured into the expandable medium  102 , causing the expandable medium  102  to swell with the medium from a lower profile state (e.g., compacted) to a higher profile state (e.g., expanded), and partially or wholly filled with fluid. At the higher profile state, the layer  104  of the photosensitizer can contact the interior wall of the uterus. Subsequently or simultaneously, the user can activate the light so that the light emitter  24  can emit phototherapeutic light to illuminate the uterus and cause the activation of the photosensitizer. 
     The produced energy can ablate the endometrium. Ablation can include, for example, removal or destruction of the target tissue. In some cases, ablation can cause tissue necrosis. The target tissue can scar in response to ablation, preventing it from copious bleeding and producing menorrhagia effects. 
       FIG. 8  illustrates therapy device  200  for providing PDT. The device  200  can include the outer shaft  12 , a surgical device  23  including the lighting system  21 , and an applicator system  111 . The applicator system  111  includes an expandable medium  110  including a first layer  112  and a second layer  114 . As discussed herein, the expansion of the expandable medium  110  is to distend the uterus as well as apply the photosensitizer to the surface of the target tissue. The lighting system  21  can have the light emitter  24 , the light shaft  33 , and the light conductor  32 . However, light shaft  33  as shown in  FIG. 8  includes a medium-delivery conduit  106  in fluid communication with an interior  113  of the expandable medium  110 . The medium-delivery conduit  106  can transition the expandable medium  110  from the low-profile state to the higher profile state as described in  FIG. 7 . 
     In the device  200 , the expandable medium  110  can include a second layer  114  for delivering the photosensitizer. The device  200  includes a drug-delivery conduit  108  located, e.g., within the light shaft  33 . The drug-delivery conduit  108  can run along the length of the light shaft  33  to an outlet  115 . In an example, the outlet  115  is fully encompassed by the first layer  112  and the second layer  114 . 
     The second layer  114  is porous and includes pores  116  that are in fluid communication with the drug-deliver conduit  108 . The second layer  114  can be made of a material that interacts well with the target tissue, without causing damage to the target tissue. In some cases, when the expandable medium  110  is in a higher profile state, the second layer  114  can touch or directly interact with the target tissue. In some cases, where the second layer  114  touches the target tissue, the expandable medium can extend or distend the uterine wall. 
     The medium-delivery conduit  106  can deliver the medium to the expandable medium  110 . For example, the medium can be provided to the interior  114  of the first layer  112  of the expandable medium  110  to transition the expandable medium  110  to the higher profile state. Once in the higher profile state, the drug-delivery conduit  108  can deliver the photosensitizer to the expandable medium  110  at or via an outlet  115 . The photosensitizer can flow from the drug-delivery conduit  108 , into a space  121  between the first layer  112  and the second layer  114  of the expandable medium  110 , and out the pores  116  of the second layer  114  and contact the inner wall of the uterus. 
     In some cases, the outlet  115  can include a valve in fluid communication with the drug-delivery conduit  108 . The valve can be configured to be user-triggered to allow or prevent or otherwise control delivery of the photosensitizer towards the expandable medium  110  via the valve. The operator can trigger the valve, for example, by a button or trigger on the hand piece. In some cases, the operator can trigger the valve by a foot pedal or other actuator coupled to the device  100 . The photosensitizer can be provided to the expandable medium  110  via the drug-delivery conduit  108  from a photosensitizer source. 
     In some cases, the operator can use the device  200 , for example, by inserting the distal portion  16  with the expandable medium  110  in a lower profile state (e.g., compacted) into the uterus of the patient, through the cervix. The operator can determine the correct placement of the device  100  in the patient, in some cases, by visual confirmation, through a scope (such as an endoscope) or camera integrated into the device. In some cases, the operator can use other imaging technology such as ultrasound. In other examples, where the operator intends to have the expandable medium  110  touch, extend, or distend the uterine wall, the operator can physically detect when the device  200  touches the uterine wall. The applicator system  111  includes the expandable medium  110  including the first layer  112  and the second layer  114  (porous layer). 
     After insertion, the operator can actuate the medium source so that the medium can be delivered down the medium-delivery conduit  106  and dripped, sprayed, or poured into the expandable medium  110 , causing the expandable medium  110  to swell with the medium from a lower profile state (e.g., compacted) to a higher profile state (e.g., expanded), and partially or wholly filled with fluid. At the higher profile state, the second layer  114  can contact the interior wall of the uterus. Once in the higher profile state, the operator can actuate the photosensitizer source so that the photosensitizer can be delivered down the drug-delivery conduit  108  and dripped, sprayed, or poured into the space  121  between the first layer  112  and the second layer  114  such that the photosensitizer flows through the pores  116  and contacts the target tissue. Subsequently or simultaneously, the user can activate the light so that the light emitter  24  can emit phototherapeutic light to illuminate the uterus and cause the activation of the photosensitizer. While shown with one drug-delivery conduit  108 , one or more drug-delivery conduits can be utilized. 
     The embodiment shown in  FIG. 8  includes a two-layer balloon configuration. However, the second porous layer could also be a sponge that can receive the photosensitizer from the drug-delivery conduit  108  and deliver the photosensitizer to the target tissue. 
     The produced energy can ablate the endometrium. Ablation can include, for example, removal or destruction of the target tissue. In some cases, ablation can cause tissue necrosis. The target tissue can scar in response to ablation, preventing it from copious bleeding and producing menorrhagia effects. 
       FIG. 9  illustrates therapy device  300  for providing targeted PDT. The device  300  can include the outer shaft  12 , a surgical device  23  including the lighting system  21 , and an applicator system  130 . The lighting system  21  can have the light emitter  24 , the light shaft  33 , and the light conductor  32 . The applicator system  130  includes an applicator shaft  132  defining a lumen  134  that can receive a portion of the lighting system  21 . For example, the light emitter  24 , the light shaft  33 , and the light conductor  32  can extend within the lumen  124 . The applicator shaft  132  includes a cover  136  such as a lens located at the distal end. The cover  136  is a phototherapeutic light transparent lens such that the phototherapeutic light generated from a light source can transmit through the cover  136 . The cover  136  includes a layer  138  of the photosensitizer. 
     In some cases, the operator can use the device  300 , for example, by inserting the distal portion  16  into the patient, through the cervix or through an incision during a laparoscopic procedure. The operator can determine the location of the target tissue by visual confirmation, through a scope (such as an endoscope) or camera integrated into the device. In some cases, the operator can use other imaging technology such as ultrasound. The operator can guide the surgical instrument  23  such that the layer  138  of photosensitizer material contacts a surface of the target tissue. Simultaneously, or shortly thereafter contact is made with the target tissue, the operator can activate the light source such that the phototherapeutic light generated can be delivered to the target tissue via the light emitter  24 . 
     The produced energy can ablate the target tissue. Ablation can include, for example, removal or destruction of the target tissue. In some cases, ablation can cause tissue necrosis. The target tissue can scar in response to ablation, preventing it from copious bleeding and producing menorrhagia effects. 
       FIG. 10  is a line diagram illustrating method  1000  for performing a surgical procedure according the present disclosure. Method  100  can include providing PDT to a target tissue in a patient. The method  1000  can include inserting the device, at step  1002 . That is, the distal portion  16  of the outer shaft  12  can be inserted into the patient. At step  1004 , the method  100  can include applying a photosensitizer and phototherapeutic light to a surface of the target tissue. As discussed herein, the photosensitizer and the phototherapeutic light can be applied simultaneously, substantially simultaneously (within seconds/minutes), of a combination of both depending on the target tissue, treatment purpose, therapy device used, and type of photosensitizer. Additionally, the treatment can include applying one or more photosensitizers to the target tissue. Further, the protocol for the PDT therapy can include applying a duty cycle of the PDT. That is, the photosensitizer/illumination can be applied intermittently until the operator is satisfied with the tissue effects produced by the PDT. After applying the PDT treatment, the therapeutic device can be removed from the patient at step  1006 . 
       FIG. 11  is a line diagram illustrating a more detailed method  1100  for performing PDT according the present disclosure. Method  1100  can include providing PDT to a target tissue in a patient. The method  1100  can include inserting the device, at step  1102 . That is, the distal portion  16  of the outer shaft  12  can be inserted into the patient. At optional step  1104 , the method  1100  includes distending the body cavity. For example, as shown in  FIG. 4 , a distension member  74  can be deployed to distend the uterus. Distending the uterus may or may not be needed and can be determined by the operator. 
     At optional step  1104 , the method  1100  can include blocking non-treatment area(s). In on example, step  1104  can include blocking the fallopian tubes. For example, as shown in  FIG. 2 , fallopian blockers  60 A, B can be deployed from the outer shaft  12  to block the fallopian tubes  71  to prevent the photosensitizer and/or light from entering into the fallopian tubes, which may be considered non-target tissues in certain instances. In another example, a pre-treatment can be done such as applying the blocking coating to non-treatment areas that will either prevent the photosensitizer from contacting and/or absorbing into the tissue and/or prevent the wavelengths from the light source from penetrating the blocking coating. 
     At step  1106 , the treatment end is advanced to a desired location relative to the target tissue. At optional step  1110 , the phototherapeutic light containment device can be advanced around the treatment end. For example, as shown in  FIGS. 3 and 4 , the phototherapeutic light containment device  72  can be deployed from the outer shaft  12  to contain the exposure of the generated phototherapeutic light to target the PDT to specific target tissue that may be adjacent to non-target tissue. At step  1112 , the method  1100  can include applying a photosensitizer and phototherapeutic light to a surface of the target tissue, as discussed herein. 
     At step  1114 , the method  1110  can include inspecting the patient for additional target tissue. That is, the operator can inspect the patient to determine if more PDT needs to be applied to a previously treated tissue or if there are additional areas of untreated target tissue that required PDT. If there is identified additional target tissue or there is part of a previously treated tissue that is in of additional treatment, at step  1116 , the operator can go back to step  1112 , and apply the PDT again until the user is satisfied that the target tissue is sufficiently treated or that all of the target tissue has been identified and sufficiently treated. At step  1118 , the method  1100  includes removing the device from the patient. 
       FIG. 9  is a schematic diagram of a laparoscopic surgical procedure being performed according to method  1200  of  FIG. 6 . Elements of  FIG. 6  are not drawn to scale for illustrative purposes.  FIGS. 6 and 9  are discussed concurrently. 
     The surgical procedure can comprise an open procedure or a laparoscopic procedure.  FIG. 6  illustrates a laparoscopic procedure being performed therapy device  10  shown in  FIGS. 3  and  4 , but without the distension member  74 . The surgical procedure can be performed to remove or otherwise abate target tissue that is diseased or invasive.  FIG. 6  illustrates a surgical procedure being performed to remove endometrium tissue from the cavity of abdomen A that has grown outside of uterus U. However, the instruments and methods of the present application can be used to perform other procedures. The surgical procedure can be performed in an operating room in a hospital or out-patient facility.  FIG. 6  illustrates an operating room environment where laparoscope  90  is coupled to camera  92  and display  94 . The patient can be appropriately anesthetized. 
     At step  1202 , incision  91  can be made in abdomen A of the patient. Incision  91  can be an incision having a sufficient length to form a portal for performing an open procedure. Incision  91  can also be a minimally invasive incision, such as one configured to receive laparoscope  90  as shown in  FIG. 6 . 
     At step  1204 , laparoscope  90  can be inserted into incision  91 . Laparoscope  90  can be coupled to camera  92  for viewing tissue within abdomen A of the patient internal to incision  91 . Laparoscope  90  can include passage  96  that extends through incision  91  to allow access to internal tissue of the patient from outside the patient. 
     At step  1206 , a therapy device, such as therapy device  10  having surgical instrument  23  of  FIG. 4 , can be inserted into incision  91 . For example, the surgical instrument  23  can be inserted into passage  96  of laparoscope  90 . Specifically, shaft  12  of therapy device  10  can be inserted through passage  96  such that the distal end  16  protrudes from passage  67  and is located inside abdomen A. At step  1208 , the treatment end  22  including the light emitter  24  and the applicator  26  can be advanced from the outer shaft  12  and be positioned within the abdomen A. 
     At step  1210 , optionally, the phototherapeutic light containment device can be advanced around the treatment end  22 . For example, phototherapeutic light containment device  72  can be advanced until a distal end of the phototherapeutic light containment device contacts, e.g., a surface of the uterus surrounding the target tissue  93  (such as endometriosis). 
     At step  1212 , the PDT can be delivered by applying the photosensitizer and the phototherapeutic light to a surface of the target tissue  93 . For example, the phototherapeutic light can be generated by a light source to be emitted toward the target tissue  93  and contained by the phototherapeutic light. The light source can be attached to the surgical instrument. The light can additionally be light of a wavelength sufficient to activate the photosensitizer. The light from the light source can be passed through the therapy device including the surgical instrument. For example, the light can be emitted from light source  38  ( FIG. 1 ), pass through light conductor  72  ( FIG. 1 ) and into light emitter  24  ( FIG. 1 ) of the treatment end  22 . 
     At step  1214 , the target tissue can be inspected to determine if more PDT needs to be applied to the target tissue or the patient can be inspected for additional target tissue that requires treatment. In particular, the therapy device  10  can be moved around within abdomen A to view different tissue. Steps  1212  and  1214  can be repeated  1216  as necessary to ensure that all target tissue has been removed from the patient. After it is determined that no additional tissue is to be removed, the patient can be prepared to end the procedure and close incision  91 . 
     At step  1218 , all instrumentation can be removed from the patient. For example, therapy device  10  can be removed from laparoscope  90  and laparoscope  90  can be removed from incision  91 . 
     At step  1220 , the incision can be closed. For example, incision  91  can be sutured or closed using any suitable means. 
     The benefits of the systems and methods of the present disclosure can be in the form of, for example, 1) combining photosensitizer and phototherapeutic light together at the tool-end of a surgical instrument to provide PDT capabilities at the tool-end of a surgical instrument, 2) eliminating the need to wait between the administration of a photosensitizer and when the phototherapeutic light is applied, 3) illuminating the need of guessing when there is a sufficient concentration of the photosensitizer at a desired target tissue, 3) providing targeted surface PDT therapy, 4) reducing times to perform surgical procedures, and 5) reducing the need for post-surgery pathology testing. 
     VARIOUS NOTES &amp; EXAMPLES 
     Each of these non-limiting examples can stand on its own, or can be combined in various permutations or combinations with one or more of the other examples. 
     Example 1 provides a therapy device for providing photodynamic therapy to a target tissue, the therapy device comprising: an outer shaft extending from a proximal portion to a distal portion; a surgical instrument translatable within the outer shaft, the surgical instrument including: a treatment end located at the distal portion configured to apply a photosensitizer and deliver phototherapeutic light to the target tissue. 
     In Example 2, the subject matter of Example 1 optionally includes where the photosensitizer and the phototherapeutic light are simultaneously applied to a surface of the target tissue. 
     In Example 3, the subject matter of Examples 1-2 optionally includes where the surgical instrument includes a lighting system to provide the phototherapeutic light and an applicator system to deliver the photosensitizer. 
     In Example 4, the subject matter of Example 3 optionally includes where the lighting system includes a light source sufficient to generate a wavelength that matches an absorption peak of the photosensitizer. 
     In Example 5, the subject matter of Example 4 optionally includes where the lighting system further includes a light conductor coupled to the light source, the light conductor extending from the proximal portion to a light emitter located at the distal portion. 
     In Example 6, the subject matter of Example 5 optionally includes where the light emitter is connected to the light conductor to emit light from the light conductor toward the target tissue. 
     In Example 7, the subject matter of Example 6 optionally includes where the light source includes an optical fiber and the light emitter comprises an end surface of the optical fiber. 
     In Example 8, the subject matter of Example 3 optionally includes where the applicator system includes: an application shaft extending from the proximal portion to an applicator tip located at the distal portion, the application shaft defining a media conduit configured to deliver the photosensitizer from a media source to the application tip. 
     In Example 9, the subject matter of Example 8 optionally includes where the applicator system provides the photosensitizer to the target tissue in a predetermined form selected from one of: a stream, a spray, a paste, and a mist. 
     In Example 10, the subject matter of Example 9 optionally includes a generator coupled to the media source and the media conduit to deliver the photosensitizer from the media source, through the media conduit, and out the application tip in a desired form. 
     In Example 11, the subject matter of Example 10 optionally includes where the generator is an atomizer. 
     In Example 12, the subject matter of Examples 1-11 optionally includes a distension device configured to extend from the outer shaft and distend a body cavity. 
     In Example 13, the subject matter of Examples 1-12 optionally includes a phototherapeutic light containment device translatable within the outer shaft, the phototherapeutic light containment device configured to contain the phototherapeutic light to a specific location defined by the phototherapeutic light containment device. 
     In Example 14, the subject matter of Example 13 optionally includes where the phototherapeutic light containment device is formed from a material that does not transmit the phototherapeutic light. 
     In Example 15, the subject matter of Example 14 optionally includes where the phototherapeutic light containment device, when deployed from the outer shaft, is configured to surround the treatment end of the surgical device. 
     Example 16 provide a therapy device for providing photodynamic therapy to a target tissue, the therapy device comprising: a handle; a shaft extending from the handle at a proximal end to a distal end; a lighting system configured to apply a phototherapeutic light to a target tissue; and an application system configured to apply a photosensitizer to the target tissue. 
     In Example 17, the subject matter of Example 16 optionally includes where the lighting system includes: a light conductor extending from the handle and into the shaft; and a light emitter connected to the light conductor and configured to protrude from the distal end to illuminate the target tissue. 
     In Example 18, the subject matter of Examples 16-17 optionally includes where the application system includes: an application shaft extending from the handle and into the shaft, the application shaft defining a conduit; and an application tip defining an outlet configured to deliver the photosensitizer to the target tissue. 
     In Example 19, the subject matter of Examples 16-18 optionally includes where the shaft comprises: a tubular body having a wall defining a working lumen, the wall defining a gas-conduit configured to deliver oxygen to the target site. 
     In Example 20, the subject matter of Examples 16-19 optionally includes a distension device configured to extend from the outer shaft and distend a body cavity. 
     In Example 21, the subject matter of Examples 16-20 optionally includes a phototherapeutic light containment device translatable within the outer shaft, the phototherapeutic light containment device configured to contain the phototherapeutic light to a specific location defined by the phototherapeutic light containment device. 
     In Example 22, the subject matter of Examples 16-21 optionally includes a fallopian tube blocker configured to extend from the outer shaft and block an opening in fallopian tubes. 
     Example 23 provides a method for providing photodynamic therapy to a target tissue, the method comprising: delivering a photosensitizer and a phototherapeutic light to a surface of the target tissue to provide the photodynamic therapy to treat the target tissue. 
     In Example 24, the subject matter of Example 23 optionally includes where delivering a photosensitizer and a phototherapeutic light includes: simultaneously applying the photosensitizer and the phototherapeutic light to the surface of the target tissue. 
     In Example 25, the subject matter of Examples 23-24 optionally includes where delivering a photosensitizer and a phototherapeutic light includes: applying the photosensitizer to the surface of the target tissue; and applying, after a time period, applying the phototherapeutic light to the target tissue. 
     In Example 26, the subject matter of Example 25 optionally includes where the time period is less than 5 minutes. 
     In Example 27, the subject matter of Examples 25 optionally includes where the time period is less than 1 minutes. 
     In Example 28, the subject matter of Examples 25 optionally includes where the time period is less than 5 seconds. 
     In Example 29, the subject matter of Examples 23-28 optionally includes inserting a therapy device into the patient, the therapy device including an outer shaft extending from a proximal portion to a distal portion and surgical instrument translatable within the outer shaft and configured to provide the PDT. 
     In Example 30, the subject matter of Example 29 optionally includes where the surgical instrument includes: a lighting system to provide the phototherapeutic light; and an applicator system to deliver the photosensitizer. 
     In Example 31, the subject matter of Example 30 optionally includes where the applicator includes: an application shaft extending from the proximal portion to an applicator tip located at the distal portion, the application shaft defining a media conduit configured to deliver the photosensitizer from a media source to the application tip. 
     Example 32 provides a therapy device for providing photodynamic therapy to a target tissue, the therapy device comprising: a shaft including a proximal portion and a distal portion; a surgical instrument translatable within the outer shaft, the surgical instrument including a lighting system configured to apply phototherapeutic light to the target tissue and an applicator system configured to apply the photosensitizer to the target tissue. 
     In Example 33, the subject matter of Example 32 optionally includes where the applicator system includes: an expandable medium, near the distal portion of the shaft; a medium-delivery conduit, extending between the proximal portion and the distal portion of the shaft, the medium-delivery conduit comprising an outlet, near the distal portion of the shaft, for delivery of the medium toward the expandable medium; and a layer of the photosensitizer deposited onto an outer surface of the expandable medium. 
     In Example 34, the subject matter of Example 32 optionally includes where the applicator system includes: an expandable medium, near the distal portion of the shaft, the expandable medium including a first layer and a second layer, the second layer including pores; a medium-delivery conduit, extending between the proximal portion and the distal portion of the shaft, the medium-delivery conduit comprising a first outlet, near the distal portion of the shaft, for delivery of the medium toward the expandable medium; and a drug-delivery conduit, extending between the proximal portion and the distal portion of the shaft, the drug-delivery conduit comprising a second outlet, near the distal portion of the shaft, for delivery of the photosensitizer between the first layer and the second porous layer to deliver the photosensitizer to the target tissue. 
     In Example 35, the subject matter of Examples 32 optionally includes wherein the applicator system includes: an applicator shaft extending from the proximal portion and the distal portion of the shaft, wherein a light emitter, a light shaft, and a light conductor of the lighting system are positioned within the applicator shaft; a cover positioned at the distal end of the application shaft, the cover being transparent to the phototherapeutic light emitted by the light emitter; and a coating of the photosensitizer on an external surface of the cover. 
     In Example 36, includes the combination of any one of the Examples 1-35. 
     The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those shown or described. However, the present inventor also contemplates examples in which only those elements shown or described are provided. Moreover, the present inventor also contemplates examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein. 
     In this document, the terms “a” or “an” are used, as is common in patent documents, to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In this document, the term “or” is used to refer to a nonexclusive or, such that “A or B” includes “A but not B,” “B but not A,” and “A and B,” unless otherwise indicated. In this document, the terms “including” and “in which” are used as the plain-English equivalents of the respective terms “comprising” and “wherein.” Also, in the following claims, the terms “including” and “comprising” are open-ended, that is, a system, device, article, composition, formulation, or process that includes elements in addition to those listed after such a term in a claim are still deemed to fall within the scope of that claim. Moreover, in the following claims, the terms “first,” “second,” and “third,” etc. are used merely as labels, and are not intended to impose numerical requirements on their objects. 
     The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments can be used, such as by one of ordinary skill in the art upon reviewing the above description. The Abstract is provided to comply with 37 C.F.R. § 1.72(b), to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be interpreted as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are hereby incorporated into the Detailed Description as examples or embodiments, with each claim standing on its own as a separate embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.