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The development of endoscopic ureteroscopy has allowed for the treatment of ureteral and renal pelvis diseases.
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Technology The development of endoscopic ureteroscopy has allowed for the treatment of ureteral and renal pelvis diseases such as nephrolithiasis, ureteral stricture, uretero-pelvic junction obstruction and upper tract transitional cell carcinoma, through a minimally invasive approach. Due to the size restraints of accessing the upper urinary tract, ureteroscope size has been limited to 8 French or approximately 3mm in outside diameter. Within the ureteroscope, it consists of three channels: 1. An optical channel for endoscope imaging (~1mm diameter) 2. A fiber light source (~0.5 mm diameter) 3. A working channel for laser fiber insertion and irrigation Current challenges: After accounting for the required optics and light source, a flexible ureteroscope allows for only single working channel of approximately 1mm. Unfortunately, this single working channel must accommodate irrigation to allow for visibility and the passage of a laser fiber in order to either destroy kidney stone or ablate tissue. Given the confines of the upper urinary tract system and limitations to current technologies, there exists a clinical need for a novel system to access the entire upper urinary tract system that allows improved irrigation flow, a larger working channel, and unimpeded tip deflection to access difficult areas of renal pelvis. In this invention, the ureteroscope-based laser surgery is transformed using an adaptive optical endoscope approach. The approach is detailed as follows: 1. Using an adaptive optical element, the surgical laser source is sent through the optical channel used for endoscope imaging. This scheme completely opens the working channel for irrigation. 2. By sculpting the wave front of the surgical laser source adaptively using the spatial light modulator, the on-target focal point, divergence, and on-target shape of the ablation laser spot can be actively controlled through the endoscope. 3. The laser beam can be steered within the entire field-of-view of the endoscope without ever moving the tip of the endoscope.