Method and system for photoselective vaporization of the prostate, and other tissue

1. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on a surface the tissue, the laser radiation being absorbed substantially completely by the tissue within about 1 mm of the surface, and having average irradiance in the treatment area greater than 10 kiloWatts/cm 2 in a spot size at least about 0.05 mm 2 .

2. The method of claim 1 , wherein the spot size is between about 0.1 and 0.8 mm 2 in the treatment area.

3. The method of claim 1 , wherein the irradiance is at least 30 kiloWatts/cm 2 in the treatment area.

4. The method of claim 1 , wherein the laser radiation has a wavelength in a range from about 650 to about 200 nm.

5. The method of claim 1 , wherein the delivered laser radiation has a wavelength in a range of about 200 nm to about 650 nm, and has an average irradiance in the treatment area greater than 20 kiloWatts/cm 2 .

6. The method of claim 1 , wherein the delivered laser radiation has a wavelength in a range of about 200 nm to about 650 nm, and has an average irradiance in the treatment area greater than 30 kiloWatts/cm 2 .

7. The method of claim 1 , including delivering a flow of irrigant to the treatment area.

8. The method of claim 1 , wherein said tissue comprises prostate gland tissue.

9. The method of claim 1 , wherein said tissue comprises prostate gland tissue, and said delivering comprises using a transurethral cystoscope, with an optical fiber adapted to direct laser radiation from the fiber to the treatment area.

10. The method of claim 1 , wherein said delivering comprises using a transurethral cystoscope, with an optical fiber having a side firing optical element directing laser radiation from the fiber to the treatment area, and placing said side firing optical element within about 1 mm, or less, of the treatment area.

11. The method of claim 1 , wherein said tissue comprises prostate gland tissue, and said delivering comprises using a transurethral cystoscope, and further including applying only local anesthetic during said delivering.

12. The method of claim 1 , including generating said laser radiation using a solid state laser with greater than 60 Watts average output power.

13. The method of claim 1 , including generating laser radiation using a macro-pulsed solid state laser with greater than 60 Watts average output power, and having output power greater than about 200 Watts during a macro-pulse.

14. The method of claim 1 , wherein said delivering comprises delivering a macro-pulse consisting of a sequence of micro-pulses of laser radiation, and said irradiance is greater than 50 kiloWatts/cm 2 during the macro-pulse.

15. The method of claim 1 , including generating said laser radiation using Neodymium doped solid state laser medium, and optics to produce an output at a second or higher harmonic frequency with greater than 60 Watts average output power.

16. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation and a flow of a transparent liquid irrigant to a treatment area on a surface the tissue, the laser radiation causing vaporization of a volume of tissue greater than a volume of residual coagulation of tissue, and having irradiance in the treatment area greater than 10 kiloWatts/cm 2 in a spot size at least 0.05 mm 2 .

17. The method of claim 16 , wherein the spot size is less than about 0.8 mm 2 in the treatment area.

18. The method of claim 16 , wherein the irradiance is at least 30 kiloWatts/cm 2 in the treatment area.

19. The method of claim 16 , wherein the laser radiation has a wavelength in a range from about 650 to about 200 nm.

20. The method of claim 16 , wherein the delivered laser radiation has a wavelength in a range of about 200 nm to about 650 nm, and has an average irradiance in the treatment area greater than 20 kiloWatts/cm 2 .

21. The method of claim 16 , wherein the delivered laser radiation has a wavelength in a range of about 200 nm to about 650 nm, and has an average irradiance in the treatment area greater than 30 kiloWatts/cm 2 .

22. The method of claim 16 , wherein the irrigant comprises water.

23. The method of claim 16 , wherein said tissue comprises prostate gland tissue.

24. The method of claim 16 , wherein said tissue comprises prostate gland tissue, and said delivering comprises using a transurethral cystoscope, with an optical fiber adapted to direct laser radiation from the fiber to the treatment area.

25. The method of claim 16 , wherein said delivering comprises using a transurethral cystoscope, with an optical fiber having a side firing optical element directing laser radiation from the fiber to the treatment area, and placing said side firing optical element within about 1 mm, or less, of the treatment area.

26. The method of claim 16 , wherein said tissue comprises prostate gland tissue, and said delivering comprises using a transurethral cystoscope, and further including applying only local anesthetic during said delivering.

27. The method of claim 16 , including generating said laser radiation using a solid state laser with greater than 60 Watts average output power.

28. The method of claim 16 , including generating laser radiation using a macro-pulsed solid state laser with greater than 60 Watts average output power, and having output power greater than about 200 Watts during a macro-pulse.

29. The method of claim 16 , wherein said delivering comprises delivering a macro-pulse consisting of a sequence of micro-pulses of laser radiation, and said irradiance is greater than 50 kiloWatts/cm 2 during the macro-pulse.

30. The method of claim 16 , including generating said laser radiation using Neodymium doped solid state laser medium, and optics to produce an output at a second or higher harmonic frequency with greater than 60 Watts average output power.

31. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the delivered laser radiation has an average irradiance in the treatment area greater than 10 kiloWatts/cm 2 in a spot size at least 0.05 mm 2 .

32. The method of claim 31 , including delivering said laser radiation using an optical fiber, and wherein the delivered laser radiation has a wavelength in a range of about 200 nm to about 650 nm, and the optical fiber is adapted to cause a spot size of at least about 0.05 mm 2 in the treatment area.

33. The method of claim 31 , wherein the delivered laser radiation has a wavelength in a range of about 200 nm to about 650 nm, and has an average irradiance in the treatment area greater than 20 kiloWatts/cm 2 and the optical fiber is adapted to cause a spot size of at least about 0.05 mm 2 in the treatment area.

34. The of claim 31 , wherein the delivered laser radiation has a wavelength in a range of about 200 rim to about 650 nm, and has an average irradiance in the treatment area greater than 30 kiloWatts/cm 2 and the optical fiber is adapted to cause a spot size of at least about 0.05 mm 2 in the treatment area.

35. The method of claim 31 , wherein the spot size is less than about 0.8 mm 2 in the treatment area.

36. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the average irradiance is at least 30 kiloWatts/cm 2 in the treatment area.

37. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the laser radiation has a wavelength in a range from about 650 to about 200 nm.

38. The method of claim 31 , including delivering a flow of irrigant to the treatment area.

39. The method of claim 31 , wherein said tissue comprises prostate gland tissue.

40. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein said tissue comprises prostate gland tissue, and said delivering comprises using a transurethral cystoscope, with an optical fiber adapted to direct laser radiation from the fiber to the treatment area.

41. The method of claim 40 , wherein said optical fiber has a side firing optical element directing laser radiation from the fiber to the treatment area, and placing said side firing optical element within about 1 mm, or less, of the treatment area.

42. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein said tissue comprises prostate gland tissue, and said delivering comprises using a transurethral cystoscope, and further including applying only local anesthetic during said delivering.

43. The method of claim 31 , including generating said laser radiation using a solid state laser with greater than 60 Watts average output power.

44. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, including generating laser radiation using a macro-pulsed solid state laser with greater than 60 Watts average output power, and having output power greater than about 200 Watts during a macro-pulse.

45. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein said delivering comprises delivering a macro-pulse consisting of a sequence of micro-pulses of laser radiation, and said irradiance is greater than 50 kiloWatts/cm 2 during the macro-pulse.

46. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, including generating said laser radiation using Neodyrnium doped solid state laser medium, and optics to produce an output at a second or higher harmonic frequency with greater than 60 Watts average output power.

47. A method for photoselective vaporization of tissue, comprising:

delivering laser radiation to a treatment area on the tissue, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, including generating said laser radiation using a diode-pumped, Neodymium doped solid state laser medium, and optics to produce an output at a second or higher harmonic frequency with greater than 60 Watts average output power.

48. A method for photoselective vaporization of prostate tissue, comprising:

generating laser radiation using a Neodymium doped solid state laser medium, and optics producing a second or higher harmonic output with greater than 60 Watts average output power;

coupling said output to an optical fiber in a transurethral cystoscope, the optical fiber adapted to direct laser radiation from the fiber to a treatment area on a surface of the tissue;

delivering a flow of irrigant to the treatment area; and

delivering laser radiation to a treatment area on the tissue via the optical fiber, the laser radiation having a wavelength and having irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation.

49. The method of claim 48 , wherein the delivered laser radiation has an average irradiative in the treatment area greater than 10 kiloWatts/cm 2 and the optical fiber is adapted to cause a spot size of at least about 0.05 mm 2 in the treatment area.

50. The method of claim 48 , wherein the delivered laser radiation has an average irradiance in the treatment area greater than 20 kiloWatts/cm 2 and the optical fiber is adapted to cause a spot size of at least about 0.05 mm 2 in the treatment area.

51. The method of claim 48 , wherein the delivered laser radiation has an average irradiance in the treatment area greater than 30 kiloWatts/cm 2 and the optical fiber is adapted to cause a spot size of at least about 0.05 mm 2 in the treatment area.

52. The method of claim 48 , wherein the delivered laser radiation has an average irradiance in the treatment area greater than 10 kiloWatts/cm 2 , and the optical fiber is adapted to cause a spot size is less than about 0.8 mm 2 in the treatment area.

53. The method of claim 48 , wherein the average irradiance is at least 30 kiloWatts/cm 2 in the treatment area.

54. The method of claim 48 , wherein the optical fiber includes a side firing tip, and including placing said side firing tip within about 1 mm, or less, of the treatment area.

55. The method of claim 48 , including applying only local anesthetic during said delivering.

56. The method of claim 48 , including Q-switching said laser medium to produce micro-pulses during application of input power to the laser medium, and applying input power to the laser medium in a sequence of pulses to generate macro-pulses of output radiation, and wherein said output power is greater than about 200 Watts during said macro-pulses.

57. The method of claim 48 , including Q-switching said laser medium to produce micro-pulses during application of input power to the laser medium, and applying input power to the laser medium in a sequence of pulses to generate macro-pulses of output radiation, and said irradiance is greater than 50 kiloWatts/cm 2 during the macro-pulse.

58. An apparatus for photoselective vaporization of tissue, comprising:

a laser producing laser radiation;

an endoscope, including an optical fiber coupled to the laser, adapted to direct laser radiation from the fiber, and a flow of irrigant to a treatment area on a surface of the tissue; laser and optical fiber being adapted to deliver the laser radiation at a wavelength and irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the laser comprises a Neodymium doped solid state laser medium, and optics producing a second or higher harmonic output with greater than 60 Watts average output power.

59. An apparatus for photoselective vaporization of tissue, comprising:

a laser producing laser radiation;

an endoscope, including an optical fiber coupled to the laser, adapted to direct laser radiation from the fiber, and a flow of irrigant to a treatment area on a surface of the tissue; laser and optical fiber being adapted to deliver the laser radiation at a wavelength and irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the laser and optical fiber are adapted to deliver laser radiation having a wavelength in a range of about 200 nm to about 650 nm, and said irradiance has an average irradiance in the treatment area greater than 10 kiloWatts/cm 2 and the optical fiber is adapted to cause a spot size of at least about 0.05 mm 2 in the treatment area.

60. The apparatus of claim 59 , wherein said irradiance has an average irradiance in the treatment area greater than 20 kiloWatts.

61. The apparatus of claim 59 , wherein said irradiance has an average irradiance in the treatment area greater than 30 kiloWatts.

62. An apparatus for photoselective vaporization of tissue, comprising:

a laser producing laser radiation;

an endoscope, including an optical fiber coupled to the laser, adapted to direct laser radiation from the fiber, and a flow of irrigant to a treatment area on a surface of the tissue; laser and optical fiber being adapted to deliver the laser radiation at a wavelength and irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the laser and optical fiber are adapted to deliver laser radiation having a wavelength in a range of about 200 nm to about 650 nm, and has an average irradiance in the treatment area greater than 10 kiloWatts/cm 2 , and the optical fiber is adapted to cause a spot size is less than about 0.8 mm 2 in the treatment area.

63. An apparatus for photoselective vaporization of tissue, comprising:

a laser producing laser radiation;

an endoscope, including an optical fiber coupled to the laser, adapted to direct laser radiation from the fiber, and a flow of irrigant to a treatment area on a surface of the tissue; laser and optical fiber being adapted to deliver the laser radiation at a wavelength and irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the laser and optical fiber are adapted to deliver average irradiance of at least 30 kiloWatts/cm 2 in the treatment area.

64. The apparatus of claim 63 , wherein the optical fiber includes a side firing tip, and is further adapted for placement of said side firing tip within about 1 mm, or less, of the treatment area.

65. An apparatus for photoselective vaporization of tissue, comprising:

a laser producing laser radiation;

an endoscope, including an optical fiber coupled to the laser, adapted to direct laser radiation from the fiber, and a flow of irrigant to a treatment area on a surface of the tissue; laser and optical fiber being adapted to deliver the laser radiation at a wavelength and irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the laser includes a Q-switch to produce micro-pulses during application of input power to the laser medium, and a power source applying input power to the laser medium in a sequence of pulses to generate macro-pulses of output radiation, and wherein said output power is greater than about 200 Watts during said macro-pulses.

66. An apparatus for photoselective vaporization of tissue, comprising:

a laser producing laser radiation;

an endoscope, including an optical fiber coupled to the laser, adapted to direct laser radiation from the fiber, and a flow of irrigant to a treatment area on a surface of the tissue; laser and optical fiber being adapted to deliver the laser radiation at a wavelength and irradiance in the treatment area sufficient to cause vaporization of a substantially greater volume of tissue than a volume of residual coagulated tissue caused by the laser radiation, wherein the laser includes a Q-switch to produce micro-pulses during application of input power to the laser medium, and a power source applying input power to the laser medium a sequence of pulses to generate macro-pulses of output radiation, and said irradiance is greater than 50 kiloWatts/cm 2 during the macro-pulse.

67. An apparatus for photoselective vaporization of prostate tissue, comprising:

a laser producing laser radiation having a wavelength in a range from about 200 nm to about 650 nm;

a transurethral cystoscope, including an optical fiber coupled to the laser, adapted to direct laser radiation from the fiber, and a flow of irrigant to a treatment area on a surface of the prostate tissue;

said laser and optical fiber being adapted to deliver the laser radiation with an average irradiance in the treatment area greater than 10 kiloWatts/cm 2 and the optical fiber is adapted to cause a spot size of at least about 0.05 mm 2 in the treatment area.

68. The apparatus of claim 67 , wherein the laser comprises a Neodymium doped solid state laser medium, and optics producing a second or higher harmonic output with greater than 60 Watts average output power.

69. The apparatus of claim 67 , wherein the laser and optical fiber are adapted to deliver laser radiation having an average irradiance in the treatment area greater than 20 kiloWatts/cm 2 .

70. The apparatus of claim 67 , wherein the laser and optical fiber are adapted to deliver laser radiation having an average irradiance in the treatment area greater than 30 kiloWatts/cm 2 .

71. The apparatus of claim 67 , wherein the laser and optical fiber are adapted to deliver laser radiation having a spot size is less than about 0.8 mm 2 in the treatment area.

72. The apparatus of claim 67 , wherein the optical fiber includes a side firing tip, and is further adapted for placement of said side firing tip within about 1 mm, or less, of the treatment area.

73. The apparatus of claim 67 , wherein the laser includes a Q-switch to produce micro-pulses during application of input power to the laser medium, and a power source applying input power to the laser medium in a sequence of pulses to generate macro-pulses of output radiation, and wherein said output power is greater than about 200 Watts during said macro-pulses.

74. The apparatus of claim 67 , wherein the laser includes a Q-switch to produce micro-pulses during application of input power to the laser medium, and a power source applying input power to the laser medium a sequence of pulses to generate macro-pulses of output radiation, and said irradiance is greater than 50 kiloWatts/cm 2 during the macro-pulse.