Retropulsion device for reversing

Abstract

The present invention relates to a reverse retreat lithotripsy device. The reverse retreat device can include a lithotripter, a collection channel, and an energy directing device. The lithotripter can be configured to deliver energy to tissue at a tissue formation site. The collection channel can be positioned at or near a body lumen. The energy directing device can be positioned near the lithotripter and the collection channel. The energy directing device can be configured to propel tissue toward the collection channel.

Description

[0001] Cross-referencing related applications

[0002] Pursuant to Section 119(e) of 35 USC, this patent application claims priority to U.S. Patent Application Serial No. 62 / 964,709 (Attorney’s File No. 5409.023PRV), filed January 23, 2020, entitled “REVERSE RETROPULSION LITHOTRIPSY DEVICE,” which is incorporated herein by reference in its entirety. Technical Field

[0003] This disclosure relates to the field of stone crushing devices, and more specifically, to a reversible backward stone crushing device. Background Technology

[0004] Tissue can form within organs in the human body, such as the kidneys. In some cases, tissue (such as kidney stones) cannot pass through the organ naturally, thus requiring surgical removal. In many cases, tissue must be broken into smaller fragments or pieces to be removed from body cavities such as the kidneys or urethra. Lithotripsy devices are used to break up and remove tissue. Common forms of lithotripsy include laser lithotripsy, ultrasonic lithotripsy, and mechanical lithotripsy. In each of these forms, energy is delivered from the lithotripsy device to the tissue to break it into smaller fragments or pieces for removal. Summary of the Invention

[0005] According to one aspect of this disclosure, a reversing retraction device is provided, the reversing retraction device comprising: a lithotripter configured to deliver energy to tissue located at a tissue-forming region; a collection channel locating in or near a body cavity; and an energy guiding device locating near the lithotripter and the collection channel, the energy guiding device including a reflector having an opening and a cavity, wherein the reflector is positioned to allow tissue to enter the cavity of the reflector through the opening, and wherein the reflector is configured to reverse the retraction of the plurality of portions of the tissue by contacting a plurality of portions of the tissue within the cavity to advance the plurality of portions of the tissue toward the collection channel.

[0006] According to another aspect of this disclosure, a reversing device for performing a lithotripsy process is provided, the reversing device comprising: a lithotripter configured to deliver energy to tissue in a body cavity; a collection channel capable of being positioned near or adjacent to the lithotripter in the body cavity; and a reflector capable of being positioned distal to the lithotripter in or adjacent to the body cavity, the reflector having an opening and a cavity and being configured to direct energy from the lithotripter to the tissue, wherein the reflector is positioned such that the tissue enters the cavity of the reflector through the opening, and wherein the reflector is configured to reverse the retreat of the tissue by contacting the tissue within the cavity to advance the tissue toward the collection channel. Attached Figure Description

[0007] In drawings that are not necessarily drawn to scale, the same reference numerals may describe similar parts in different views. The same reference numerals with different letter suffixes may indicate different embodiments of similar parts. The drawings generally illustrate the various embodiments discussed herein by way of example and not limitation.

[0008] Figure 1 A perspective view and a partial cross-sectional view of a stone crushing device according to at least one embodiment of the present disclosure are shown.

[0009] Figure 2 A perspective view and a partial cross-sectional view of a portion of a stone crushing device according to at least one embodiment of the present disclosure are shown.

[0010] Figure 3A A perspective view of a stone crushing device in a first state according to at least one embodiment of the present disclosure is shown.

[0011] Figure 3B A perspective view of a stone crushing device in a second state according to at least one embodiment of the present disclosure is shown.

[0012] Figure 4A A perspective view of a portion of a stone crushing apparatus according to at least one embodiment of the present disclosure is shown.

[0013] Figure 4B A perspective view of a portion of a stone crushing apparatus according to at least one embodiment of the present disclosure is shown.

[0014] Figure 4C A perspective view of a portion of a stone crushing apparatus according to at least one embodiment of the present disclosure is shown.

[0015] Figure 5A A portion of a stone crushing device in a first state according to at least one embodiment of the present disclosure is shown along... Figure 5BThe cross-sectional view of indicator 5A-5A.

[0016] Figure 5B A portion of a stone crushing device in a first state according to at least one embodiment of the present disclosure is shown along... Figure 5A The cross-sectional view of indicator 5B-5B.

[0017] Figure 5C A portion of a stone crushing device in a second state according to at least one embodiment of the present disclosure is shown along... Figure 5D The cross-sectional view of 5C-5C is indicated.

[0018] Figure 5D A portion of a stone crushing device in a second state according to at least one embodiment of the present disclosure is shown along... Figure 5C The indication is a 5D-5D cross-sectional view.

[0019] Figure 5E A cross-sectional view of a portion of a stone crushing device in a third state according to at least one embodiment of the present disclosure is shown.

[0020] Figure 6 A cross-sectional view of a portion of a stone crushing device according to at least one embodiment of the present disclosure is shown.

[0021] Figure 7 A perspective view and a partial cross-sectional view of a portion of a stone crushing device according to at least one embodiment of the present disclosure are shown.

[0022] Figure 8 A perspective view and a partial cross-sectional view of a portion of a stone crushing device according to at least one embodiment of the present disclosure are shown.

[0023] Figure 9A A portion of a stone crushing device according to at least one embodiment of the present disclosure is shown along... Figure 9B The cross-sectional view of indicator 9A-9A.

[0024] Figure 9B A portion of a stone crushing device according to at least one embodiment of the present disclosure is shown along... Figure 9A The cross-sectional view of indicator 9B-9B.

[0025] Figure 10 A cross-sectional view of a portion of a stone crushing device according to at least one embodiment of the present disclosure is shown.

[0026] Figure 11 A schematic diagram of a stone crushing system according to at least one embodiment of the present disclosure is shown. Detailed Implementation

[0027] In every form of lithotripsy, energy can be delivered from the lithotripsy device to the tissue to break it into smaller fragments or pieces for removal from the patient; however, the act of applying energy from the lithotripsy device to the tissue can cause the tissue to recoil, or move away from the lithotripsy device. Tissue recoil during lithotripsy can complicate further tissue fragmentation and the removal of the tissue and its fragments or pieces.

[0028] This disclosure provides a solution to the problem of tissue regression by using a reverse retraction mechanism. That is, an energy retraction device can be used to guide tissue fragments or debris toward the lithotripsy device, toward the suction device or suction tube. This can help reduce tissue regression and thus help save time during lithotripsy procedures.

[0029] In some embodiments, reversing the retraction can be achieved by redirecting energy provided by the laser to the dorsal side of the tissue (or the distal side relative to the instrument) to guide the tissue toward the aspiration tube. In some embodiments, a cap or reflector can contain the tissue to reflect the retracted tissue and tissue fragments toward the aspiration tube. In another embodiment, flushing fluid can be directed to the tissue to guide it toward the aspiration tube.

[0030] The foregoing discussion is intended to provide an overview of the subject matter of this patent application. It is not intended to provide an exclusive or exhaustive explanation of the invention. The following description is included to provide further information regarding this patent application.

[0031] Figure 1 A perspective view and a partial cross-sectional view of a rock-crushing device 100 are shown. The rock-crushing device 100 may include a rock crusher 102 and a reflector 104. The rock crusher 102 may include a body 106, a probe 108, and a suction cavity 110 (of the probe 108). The reflector 104 may include a body 112, a reflective surface 114, an opening 116, and a cavity 118. Figure 1 The diagram also shows tissue 50, tissue fragments 52, and orientation indicators “proximal” and “distal”. Tissue 50 may include any mass within the body cavity, such as soft tissue, hard tissue, calcified tissue, etc. Stones (e.g., kidney stones or gallstones) may be a type of sclerotic tissue and / or may include proliferating minerals or tissue, blood, etc. Tissue 50 may be suspended within the body cavity (not attached to any other tissue within the body cavity). Alternatively, tissue 50 may be substantially (e.g., in an area corresponding to more than 50% of its surface area) suspended, with the remainder attached to other parts of the body.

[0032] Lithotripter 102 can be a lithotripter configured to engage or interact with fragments or pieces of tissue within a patient's body cavity, such as laser, ultrasound, electromagnetic, or other lithotripsy devices. Lithotripsy may include tissue ablation, and lithotripter 102 may be configured to ablate tissue. Figure 1 In the illustrated embodiment, lithotripter 102 may be an ultrasonic and electromagnetic lithotripter configured for percutaneous use to deliver energy to tissue 50, thereby breaking tissue 50 into fragments, such as fragment 52, for removal via the aspiration lumen 110 of probe 108.

[0033] The body 106 of the lithotripter may be an elongated member that can be positioned from outside the patient's internal cavity near a tissue target containing tissue 50. The body 106 may support the probe 108 and includes one or more components configured to deliver energy to the probe 108, such as a piezoelectric stack and a waveguide. The body 106 may also include controls for operating the lithotripter 100. In some embodiments, the body 106 may be connected to a controller to receive electrical and / or control signals.

[0034] The lithotripter's probe 108 can be an elongated member that can be positioned within a patient's body cavity near a tissue target containing tissue 50. The body cavity can be any tissue or stone-forming area in the body, such as within the kidneys, urethra (typically, the patient's renal system), bile ducts, etc. The probe 108 can be configured to deliver energy to tissue within a portion of the body cavity. The probe 108 may include a suction lumen 110 (or suction device) that can extend through the probe 108 and can be connected to a suction source at or further upstream of the body 106. The suction lumen 110 can be sized to receive fragments of tissue passing through it, such as fragment 52, for removal from the body cavity.

[0035] Reflector 104 may be a cap configured to reflect tissue toward probe 108. Reflector 104 may be a rigid or semi-rigid member removably or rigidly attached to probe 108 at body 112. In some embodiments, reflector 104 may be movably fixed to probe 108 such that reflector 104 may extend along the longitudinal axis of probe 108 or may rotate relative to probe 108, which may help capture tissue portions of various sizes within cavity 118 of reflector 104.

[0036] The body 112 may define a reflective surface 114, which may be curved, arc-shaped, or other shaped, configured to reflect tissue 50 and its fragments toward the probe 108 (and thus toward the aspiration lumen 110). The body 112 may also define an opening 116 therein, which may connect to a cavity 118 and may be located proximal to the distal end of the probe 108. The cavity 118 may be sized to accommodate a portion of the lithotripter 102 and to receive tissue 50 therein.

[0037] In some embodiments, the lithotripter 102 can be inserted into a patient's body cavity near a target tissue (e.g., near tissue 50 within the patient's body cavity). The body 106 can be used to position the tissue 50 through opening 116 into a cavity 118 of the reflector body 112 adjacent to the distal portion (or tip) of the probe 108. The probe 108 can then be activated to deliver energy to the tissue 50, thereby breaking the tissue into fragments. These fragments, such as fragment 52, can be removed from the patient's body cavity by aspiration of the cavity 110.

[0038] During the interaction between probe 108 and tissue 50, the energy applied to the tissue may cause the tissue to retract or move distally relative to probe 108 and reflector 104. Because reflector 104 is positioned distally to probe 108, fragments or tissue 50 can engage reflective surface 114 and can be redirected proximally for further engagement with probe 108 until tissue 50 is completely (or substantially) removed through aspiration lumen 110. Reflector 104 can thus help reverse the retraction to more quickly break up and remove tissue 50 during lithotripsy.

[0039] Figure 2 A perspective view and a partial cross-sectional view of a portion of a rock-crushing device 200 are shown. The rock-crushing device 200 may include a rock crusher 202 and a reflector 204. The rock crusher 202 may include a body 206, a laser emitter 207, and a suction sleeve 209 (including an inner cavity 210). The reflector 204 may include a body 212, a reflective surface 214, an opening 216, and a cavity 218. Figure 2 The diagram also shows tissue 50, beam B, reflected beam R, and orientation indicators “proximal” and “distal”.

[0040] The lithotripter 202 may be similar to the lithotripter 102 described above, however, the lithotripter 202 may use a laser emitter 207 as a means of delivering energy to tissue 50 to treat (or break up) tissue 50. The body 206 may be a rigid member in some embodiments, and a flexible member in others, such as the flexible axis of an endoscope (e.g., a cholangioscope or ureteroscope). The body 206 may be configured to support the laser emitter 207, the suction cannula 209, and the reflector 204.

[0041] Laser emitter 207 may be part of a laser (e.g., an optical fiber) configured to deliver a laser beam B to tissue 50 to break the tissue 50 into smaller fragments for removal. Suction cannula 209 may be a flexible or semi-rigid suction device, such as a tube that can be positioned within body 206, like the tube of an endoscope. Suction lumen 210 may extend through cannula 209 and may be connected to a suction source at or further upstream of the endoscope. Suction lumen 210 may be sized to receive fragments of tissue, such as fragment 52, passing through it for removal from the body cavity.

[0042] Reflector 204 may be a cap configured to reflect fragments or pieces of tissue toward aspiration cannula 209. Reflector 204 may be a flexible or semi-rigid member removably or rigidly attached to body 206. In some embodiments, reflector 204 may be movably fixed to body 206 such that reflector 204 can extend along the longitudinal axis of body 206 or can rotate relative to body 206, which can help capture tissue of various sizes within cavity 218 of reflector 204. Body 212 may define an opening 216 therein that can connect to cavity 218. Cavity 218 may be sized to accommodate a portion of lithotripter 202 and to receive tissue 50 therein.

[0043] The reflective surface 214 may be a curved, arcuate, or other shaped surface configured to reflect tissue 50 and its fragments toward the laser emitter 207 (and thus toward the suction cavity 210). The reflective surface 214 may also be curved (or otherwise shaped) to help guide the beam B toward the distal side of the tissue. In some embodiments, the reflective surface (and / or other portions of the body 212) may include a liner with a reflective coating comprising one or more of barium sulfate, magnesium oxide, polytetrafluoroethylene (PTFE, such as Spectralon), a dielectric high-reflectivity coating, a dichroic mirror, or a reflective photonic structure. Such a liner or coating may help improve the energy efficiency delivered to the tissue 50 via the reflected beam R.

[0044] In some embodiments, the body 206 and reflector 204 may be inserted into the patient's body cavity at a tissue-forming region, such as near tissue 50 within the patient's body cavity. In some embodiments, the endoscope 206 may be used to insert the laser emitter 207 and reflector 204 into the body cavity. The body 206 may be used to position the tissue 50 into the cavity 218 of the reflector body 212 near the aspiration cannula 209 through an opening 216. The laser emitter 207 may then be activated to deliver a beam B, which may be reflected from the reflective surface 214 of the reflector to generate a reflected beam R, which may be guided by the reflective surface 214 to a posterior or distal portion of the tissue 50. The reflected beam may deliver energy to the tissue 50 to break it up, thereby producing fragments (e.g., fragment 52) ​​small enough to be removed from the patient's body through the aspiration lumen 210.

[0045] Because the reflected beam R is delivered from the distal direction, tissue 50 can be pushed or advanced toward the suction sleeve 209 and the emitter 207, rather than being advanced distally away from the emitter 207 and the sleeve 209, thus helping to limit (or reverse) the retreat of tissue 50. Furthermore, if tissue 50 does retreat, it can be limited by contact between tissue 50 and the body 212 of reflector 204.

[0046] In some embodiments, the reflective surface 214 may be configured (e.g., shaped and sized) to guide the beam B toward the center of the cavity 218. In another embodiment, the reflective surface 214 may be configured to guide the beam B toward another (or more) portions of the cavity 218, such as over the suction cannula 209. In some embodiments, the beam B may be delivered to the tissue 50 from a proximal direction.

[0047] Figure 3A A perspective view of the crushing device 300 in the open position is shown. Figure 3B A perspective view of the crushing device 300 in its closed position is shown. The following discussion will also cover this topic. Figure 3A and Figure 3B .

[0048] The lithotripter 300 may include a lithotripter 302 and a reflector 304. The lithotripter 302 may include a body 306, a laser emitter 307, and a suction sleeve 309 (including an inner cavity 310). The reflector 304 may include a body 312, a reflective surface 314, an opening 316, a cavity 318, and a neck 320. Figure 3A and Figure 3B It also shows tissue 50, beam B, reflected beam R, and orientation indicators “proximal” and “distal”.

[0049] Stone crusher 302 can be similar to Figure 2The lithotripter 202, however, may have the laser emitter 307 extending distally beyond the suction sleeve 309. The reflector 304 may be a reflector configured to reflect the beam B emitted by the emitter 307. The shape of the reflector 304 may differ from that of the reflector 204, and the reflector 304 may be configured to capture and retain tissue 50. Any of the lithotripsy devices discussed above or below may be modified to include such a reflector.

[0050] The neck 320 may be a portion of the reflector 304 with a relatively small diameter to connect the body 312 to the lithotripter 302 (e.g., the body 306 connected to the lithotripter 302). As the body 312 extends distally from the neck 320, it may extend laterally from the neck 320 to form a bulb shape. In some embodiments, the body 312 may have other shapes, such as a spherical or substantially spherical shape. The body 312 may be operable to open and close the opening 316, for example, to capture tissue within the cavity 318. In some embodiments, the body 312 may be made of more than one part to allow the body 312 to... Figure 3A Opening position and Figure 3B The body 312 can move between closed positions. The reflective surface 314 of the body 312 may be polished and / or may include a coating to increase the reflectivity of the reflective surface 314.

[0051] In some embodiments, the body 306 can be used to position tissue 50 into cavity 318 of reflector body 312 through opening 316. Once tissue 50 is located within cavity 318, body 306 (or another control) can be operated to close opening 316 of body 312 to capture tissue 50 within cavity 318 of reflector 304. Laser emitter 307 is then activated to deliver beam B, which can be delivered to tissue 50. Retraction of tissue 50 can be prevented by contact between tissue 50 and reflector 204.

[0052] Furthermore, beam B can be reflected from the reflective surface 314 of reflector 304 to generate a reflected beam R, which can be guided by the reflective surface 314 to the posterior or distal portion of tissue 50. The reflected beam R can deliver energy to tissue 50 to break it up, producing fragments small enough to be removed from the patient through aspiration lumen 310. Delivering the reflected beam R distal to tissue 50 can also reverse the retraction, facilitating the guidance of tissue 50 into aspiration cannula 309. In some embodiments, the laser can be activated when body 312 is in the open position, for example if tissue 50 is too large for cavity 318 and obstructs closure of opening 316. The reflector can then capture single or multiple fragments to complete lithotripsy and remove tissue 50.

[0053] Figure 4AA perspective view of a portion of a lithotripsy apparatus 400A according to at least one embodiment of the present disclosure is shown. The lithotripsy apparatus 400A may include an endoscope or body 406, a suction cannula 410, a body 412, an opening 416, a cavity 418, a flushing supply device 422, actuators 424a and 424b, and crushing features 426 and 428. Figure 4A It also shows orientation indicators “near side” and “far side”, as well as directional arrow D.

[0054] The endoscope or body 406 may be a portion of an endoscope (e.g., a ureteroscope, cholangioscopy, etc.) configured for insertion into a portion of a body cavity to support and guide the aspiration cannula 410 and the flushing supply device 422. In some embodiments, the body 406 may be an integral portion of a lithotripsy device configured to support the aspiration cannula 410 and the flushing supply device 422. The flushing supply device 422 may be a tube configured to deliver and discharge fluid into a cavity 418 to flush tissue fragments out of the cavity 418 through the cannula 410.

[0055] The body 412 may be a rigid or semi-rigid member optionally connected to the body 406. The body 412 may form an opening 416 therein, which may connect to a cavity 418, wherein the size and shape of the cavity 418 may be configured to support tissue located therein. Actuators 424a and 424b may be connected to the body 412 and configured to move the body 412 in a direction D (proximal and distal). In some embodiments, actuators 424a and 424b may be a piezoelectric stack or other actuators configured to oscillate (translate) the body 412 relative to the body 406.

[0056] Fragmentation features 426 and 428 may be attached to the proximal surface of the distal portion of the body and may be directed proximally toward the suction cannula 410. Each of fragmentation features 426 and 428 may be configured to engage a piece of tissue to fragment or break it. In some embodiments, fragmentation features 426 and 428 may have different shapes and / or be oriented in different directions to engage tissues of various shapes and sizes from various directions to help to effectively fragment tissues of various shapes and sizes.

[0057] Figure 4B A perspective view of a portion of the rock-crushing device 400B is shown. The rock-crushing device 400B may be similar to the rock-crushing device 400A described above, however, the rock-crushing device 400B may include a probe 408.

[0058] Probe 408 may be attached to the distal external portion of body 412. Probe 408 may be similar to probe 108, as probe 400 may be attached to one or more components, such as piezoelectric stacks and waveguides, configured to deliver energy to probe 408. Probe 408 may be positioned within a patient's body cavity (e.g., within the renal system) near a tissue-forming target containing tissue and may be configured to deliver energy to tissue within a portion of the body cavity.

[0059] The probe 408 can be used, for example, to break up or fracture tissue that is too large to be located within the cavity 418 through the opening 416. Once the tissue is small enough, it can be located within the cavity 418, and the breaking features 426 and 428 can be used to break up the tissue in a more controlled environment, thereby using reverse retraction to guide the tissue and tissue fragments toward the suction cannula 410 for removal from the body cavity.

[0060] Figure 4C A perspective view of a portion of a stone crushing device 400C according to at least one embodiment of the present disclosure is shown. The stone crushing device 400C may be similar to the stone crushing device 400A described above, however, the stone crushing device 400C may include externally mounted crushing features 426 and 428.

[0061] Fragmentation features 426 and 428 can, for example, be used to fragment or break tissue that is too large to be located within cavity 418 through opening 416, and tissue fragments can be removed through aspiration cannula 410. Once the tissue is small enough, it can be located within cavity 418, and the tissue can be fragmented in a more controlled environment using other methods (e.g., laser, internal fragmentation features, and / or internal probes), thereby using reverse retraction to guide the tissue and tissue fragments toward aspiration cannula 410 for extraction from the body cavity.

[0062] Figure 5A A portion of the crushing device 500 in the open position is shown along the edge. Figure 5B The cross-sectional view of indicator 5A-5A. Figure 5B A portion of the crushing device 500 in the open position is shown along the edge. Figure 5A The cross-sectional view of indicator 5B-5B. Figure 5C A portion of the crushing device 500 in the closed position is shown along the edge. Figure 5D The cross-sectional view of 5C-5C is indicated. Figure 5D A portion of the crushing device 500 in the closed position is shown along the edge. Figure 5C The indication is a 5D-5D cross-sectional view. Figure 5E A cross-sectional view of a portion of the crushing device 500 in the closed position while simultaneously discharging flushing fluid is shown. This will be discussed further below. Figures 5A to 5E .

[0063] The crushing device 500 may include an inner sleeve 502 and an outer sleeve 504. The inner sleeve 502 may define an opening 506 therein. The outer sleeve 504 may define an opening 508 therein. The crushing device 500 may also include a flushing system 510, which includes a manifold 512 and a nozzle 514. Figures 5A to 5E It also shows tissue 50, axis A, fluid f, directional arrows D and R, and orientation indicators “proximal” and “distal”.

[0064] The lithotripsy device 500 may be similar to those discussed above and may include a lithotripsy probe for delivering ultrasound energy to tissue and / or may include a laser emitter for emitting a laser beam toward tissue. In some embodiments, the lithotripsy device 500 may be connected to any type of lithotripter, and in some embodiments, the lithotripsy device 500 may be connected to an endoscope.

[0065] The inner sleeve 502 may be a semi-rigid or flexible member extending along the longitudinal axis A. The inner sleeve 502 may be connected to the outer sleeve 504 and configured to rotate relative to the outer sleeve 504. The inner sleeve 502 may define an opening 506 therein, which may extend through the inner sleeve 502 near its distal end. Similarly, the outer sleeve 504 may be a semi-rigid or flexible member extending along the longitudinal axis A. The outer sleeve 504 may be connected to the inner sleeve 502 and configured to rotate relative to the outer sleeve 504. In some embodiments, the inner sleeve 502 and the outer sleeve 504 may be configured to flex together, such as flexing within a cavity in the patient during surgery.

[0066] The outer sleeve 504 may define an opening 508 therein, which may extend through the outer sleeve 540 near the distal end of the outer sleeve 504. The inner sleeve 502 may be connected to a suction device to remove debris (e.g., tissue fragments) and fluid (e.g., fluid f) from the inner sleeve 502 and the outer sleeve 504. In some embodiments, the manifold 512 of the flushing system 510 may connect the inner sleeve 502 to the outer sleeve 504 such that the outer sleeve 504 can rotate relative to the inner sleeve 502.

[0067] The flushing system 510 may be a flushing system connected to a fluid supply device to deliver flushing fluid to the inner sleeve 502 and the outer sleeve 504. In some embodiments, the nozzle 514 may be connected to (or formed in) the manifold 512 and may be configured to discharge flushing fluid or solution into the cavity and into the inner sleeve 502 (and the outer sleeve 504).

[0068] In some embodiments, the lithotripsy device 500 can be inserted into a body cavity near or at the tissue target. Before or after insertion into the cavity, the outer sleeve 504 can be rotated relative to the inner sleeve 502 such that opening 506 aligns with opening 508, as... Figure 5A and Figure 5B As shown. When openings 506 and 508 are in the open position, device 500 can be used to allow tissue 50 to enter the cavity 518 of inner sleeve 502 through openings 506 and 508. Once inside cavity 518, outer sleeve 504 (or inner sleeve 502) can rotate about axis A in direction R, as shown. Figure 5D As shown, this causes openings 506 and 508 to no longer align, as... Figure 5C and Figure 5D As shown. In some embodiments, the outer sleeve 504 (or inner sleeve 502) can be rotated about axis A in either direction to open and close openings 506 and 508.

[0069] When tissue 50 is captured by outer sleeve 504, lithotripsy can be performed on tissue 50, and inner sleeve 502 and outer sleeve 504 can accommodate tissue 50 and its fragments to help limit tissue retraction during lithotripsy. Furthermore, when tissue 50 is captured by outer sleeve 504, a flushing system can be activated, causing nozzle 514 to discharge fluid f in direction D to help guide tissue 50 and tissue fragments toward a suction device (such as any of the suction devices described above, which can be incorporated into lithotripsy device 500), thereby further helping to reverse the retraction of tissue 50 and its fragments during lithotripsy and helping to facilitate relatively rapid removal of fragments. Lithotripsy can be performed on tissue 50 until its fragments are extracted from cavity 518 by the suction device. Lithotripsy device 500 can then be removed from cavity 518.

[0070] Figure 6 A cross-sectional view of a portion of a lithotripsy apparatus 600 is shown. The lithotripsy apparatus 600 may include a lithotripter 602, a reflector 604, and an endoscope 606. The lithotripter 602 may include laser emitters 607a and 607b (collectively referred to as laser emitter 607). The lithotripsy apparatus 600 may also include a suction cannula 609 (including an inner cavity 610). The reflector 604 may include a body 612, a reflective surface 614, an opening 616, and a cavity 618. Figure 6 The diagram also shows tissue 50, beams Ba and Bb, reflected beams Ra and Rb, and orientation indicators “proximal” and “distal”.

[0071] The lithotripsy device 600 may be similar to the lithotripsy device 200 described above; however, the lithotripsy device 600 may include an endoscope (e.g., a ureteroscope or cholangioscope) 606, which may support a laser emitter 607 and a suction cannula 609. Furthermore, a reflector 604 may be attached (e.g., removably attached) to the endoscope 606. The lithotripsy device 600 also differs in that it includes two laser emitters 607a and 607b positioned on opposite sides of the cannula 609. Although two laser emitters 607a and 607b are shown, the lithotripsy device may include more laser emitters, such as 3, 4, 5, 6, 7, 8, 9, 10, etc.

[0072] In some embodiments, the reflective surface 614 may be shaped such that beams Ba and Bb emitted by emitters 607a and 607b, respectively, are reflected toward the central portion of cavity 618 (shown as reflected beams Ra and Rb, respectively), to guide the beams toward tissue 50. Using reflected beams Ra and Rb for lithotripsy can help reverse regression and can help reduce the time required to break up tissue 50 for removal through aspiration cavity 610. Any lithotripsy apparatus previously discussed and / or discussed later may be modified to include multiple laser emitters.

[0073] Figure 7 A perspective view and a partial cross-sectional view of a portion of a rock-crushing device 700 are shown. The rock-crushing device 700 may include a rock crusher 702 and a reflector 704. The rock crusher 702 may include a body 706 and a probe 708 (including a suction cavity 710). The reflector 704 may include a body 712 defining a reflective surface 714 and an opening 716. The reflector 704 may also include a flushing system 740, which may include a nozzle 742. Figure 7 The fluid f and orientation indicators “proximal” and “distal” are also shown.

[0074] The 700 stone crushing device can be similar to Figure 1 The crushing device 100, however, may include a flushing system 740, which may include a passage 744 extending through the body 712 of the reflector 704, wherein the passage 744 is configured to support fluid flow through the passage. The passage 744 may be connected to a nozzle 742, which may be configured to discharge fluid f from or near the reflective surface 714.

[0075] In operation, reflector 704 can be positioned at or near a body cavity, such as adjacent to tissue 50. Reflector 704 can be positioned such that tissue 50 passes through opening 716 of body 712, thereby allowing tissue to enter cavity 718 of reflector 704. Lithotripter 702 can then be used to break up tissue 50, for example, by engaging tissue 50 with probe 708 to transfer energy to tissue 50.

[0076] During lithotripsy, the flushing system 740 can be activated to supply fluid f through passage 744 to nozzle 742 for discharge toward the suction lumen 710, thereby aiding in the reversal of tissue 50 retraction and in guiding fragments or pieces of tissue 50 toward the lumen 710 for removal from reflector 704 and thus from the patient's cavity. Furthermore, when probe 708 causes tissue 50 retraction during lithotripsy, the flushing system 740 can assist in advancing or pushing tissue 50 proximally toward probe 708, which can help reduce the time required for tissue fragmentation and removal. Any lithotripsy device discussed above and / or below can be modified to include such a flushing system.

[0077] Figure 8 A perspective view and a partial cross-sectional view of a portion of a lithotripsy apparatus 800 are shown. The lithotripsy apparatus 800 may include a lithotripter 802, a reflector 804, and an endoscope 806. The lithotripter 802 may include a laser emitter 807. The lithotripsy apparatus 800 may also include a suction cannula 809 (including an inner cavity 810). The reflector 804 may include a body 812, a reflective surface 814, an opening 816, and a cavity 818. The reflector 804 may also include a flushing system 840, which may include a nozzle 842 and a passage 844. Figure 8 The fluid f and orientation indicators “proximal” and “distal” are also shown.

[0078] The stone crushing device 800 can be similar to Figure 2 The illustrated crushing device 200, however, may include a flushing system 840, which may include a passage 844 extending through the reflector 804, and the passage 844 may be configured to support fluid flow through the passage. The passage 844 may be connected to a nozzle 842, such that the nozzle 842 may discharge fluid f from or near the reflective surface 814.

[0079] In operation, reflector 804 can be positioned at or near the tissue formation area, such as adjacent to tissue 50, and reflector 804 can be positioned such that tissue 50 passes through opening 816 of body 812, thereby allowing tissue to enter cavity 818 of reflector 804. Lithotripter 802 can then be used to break up tissue 50, for example, by firing a beam from emitter 807 at tissue 50 (which can be reflected by reflective surface 814).

[0080] During lithotripsy, the flushing system 840 can be activated, thereby supplying fluid f through passage 844 to nozzle 842 for discharge toward suction cannula 809, which helps to reverse the retraction of tissue 50 and helps to guide fragments or pieces of tissue 50 toward lumen 810 for removal from reflector 804 and thus from the patient's cavity. Any lithotripsy device previously discussed or discussed hereafter can be modified to include such a flushing system.

[0081] Figure 9A A portion of the crushing device 900 is shown along the edge. Figure 9B The cross-sectional view of indicator 9A-9A. Figure 9B A portion of the crushing device 900 is shown along the edge. Figure 9A The cross-sectional view of indicator 9B-9B is shown in the figure. This will be discussed simultaneously below. Figure 9A and Figure 9B .

[0082] The rock-crushing device 900 may include a rock crusher 902 and a reflector 904. The rock crusher 902 may be similar to any of the rock crushers discussed above. The reflector 904 may include a body 912 defining an opening 916 and a cavity 918. The reflector 904 may also include a flushing system 940, which may include nozzles 942a to 942n (collectively referred to as nozzles 942), passages 944a to 944c (collectively referred to as passages 944), and a manifold 946. Figure 9A and Figure 9B The fluid f and orientation indicators “proximal” and “distal” are also shown.

[0083] Passage 944 may (e.g., separately) be arranged through body 912 and may connect to manifold 946, which may connect to nozzle 942. During the lithotripsy process, fluid f may be supplied to passage 944 and manifold 946 for distribution to nozzle 942. Nozzle 942 may be shaped, positioned, and / or configured to discharge fluid f proximally to advance tissue proximally or toward the suction device of lithotripter 902. Any lithotripsy apparatus previously discussed or discussed hereafter may be modified to include such a flushing system.

[0084] Figure 10A cross-sectional view of a portion of a lithotripsy device 1000 is shown. The lithotripsy device 1000 may include a lithotripter 1002, a reflector 1004, an endoscope 1006, a distal camera 1050, a reflector camera 1052, and an endoscope camera 1054. The lithotripter 1002 may include a laser emitter 1007. The lithotripsy device 1000 may also include a suction cannula 1009 (including an inner cavity 1010). The reflector 1004 may include a body 1012, a reflective surface 1014, an opening 1016, and a cavity 1018. Figure 10 It also shows the orientation indicators “proximal” and “distal”.

[0085] The lithotripsy device 1000 may be similar to those discussed above, but the lithotripsy device 1000 may include a remote camera 1050, a reflector camera 1052 and an endoscope camera 1054.

[0086] Each of the distal camera 1050, reflector camera 1052, and endoscope camera 1054 can be a digital camera device (or imaging device) configured to generate optical or image signals based on images surrounding the lithotripsy device. The distal camera 1050 can be attached to the distal portion of the reflector 1004 and positioned and configured to have a field of view located in front of or distal to the reflector 1004. The reflector camera 1052 can be attached to the internal portion of the reflector 1004 and positioned and configured to have a field of view with opening 1016. The endoscope camera 1054 can be attached to the distal portion of the endoscope (e.g., near opening 1016) and positioned and configured to have a field of view with opening 1016 and reflective surface 1014.

[0087] In some embodiments, the lithotripsy device may be inserted into the cavity 1018. A distal camera 1050 on the reflector 1004 may be used to position the reflector near tissue within a target tissue, such as near the opening 1016 of the body. Each of the reflector camera 1052 and the endoscopic camera 1054 may then be used to guide the tissue through the opening 1016 into the cavity 1018, and may also be used to position the tissue within the cavity before and during lithotripsy.

[0088] Although the rock-breaking device 1000 is shown as including three cameras, it may include fewer or more cameras, such as 1, 2, 4, 5, 6, 7, 8, 9, 10 cameras, etc.

[0089] Figure 11A block diagram of a lithotripsy system 1100 is shown, by which any one or more of the aforementioned techniques can be performed or facilitated. The computer system 1100 can be particularly used to facilitate the operation of the lithotripsy apparatuses 100 to 1000 described or related herein. For example, the computer system 1100 can be connected to a remote camera 1050, a reflector camera 1052, an endoscope camera 1054, and a transmitter 1007.

[0090] In alternative implementations, system 1100 may operate as a standalone device or may be connected (e.g., networked) to other machines. In a networked deployment, the machine may operate as a server or client machine in a server-client network environment, or it may function as a peer machine in a peer-to-peer (or distributed) network environment. The machine may be a personal computer (PC), tablet PC, smartphone, network device, or any machine capable of executing instructions (sequentially or otherwise) specifying actions to be taken by that machine. Furthermore, although only a single machine is shown, the term "machine" should also be understood to include any collection of machines that individually or jointly execute a set (or more) of instructions to perform any one or more methods discussed herein.

[0091] Computer system 1100 may include a processor 1102 (e.g., a central processing unit (CPU), a graphics processing unit (GPU), or both), main memory 1104, and static memory 1106, which communicate with each other via link 1108 (e.g., an interconnect link, a bus, etc.). Computer system 1100 may also include a video display unit 1110, an alphanumeric input device 1112 (e.g., a keyboard), and a user interface (UI) navigation device 1114 (e.g., a mouse). In an embodiment, the video display unit 1110, the input device 1112, and the UI navigation device 1114 are touchscreen displays. Computer system 1100 may additionally include a storage device 1116 (e.g., a drive unit), a signal generation device 1118 (e.g., a speaker), and a network interface device 1120 that can operatively communicate with a communication network 1126 using wired or wireless communication hardware. Computer system 1100 may also include one or more human input sensors 1128 configured to acquire input (including non-contact human input) based on input recognition and detection techniques. Human input sensor 1128 may include a camera, microphone, barcode reader, RFID reader, near-field communication reader, or other sensors that generate data for input purposes. Computer system 1100 may also include output controller 1130, for example, via serial (e.g., Universal Serial Bus (USB), parallel, or other wired or wireless (e.g., infrared (IR)) connections, to communicate with or control one or more peripheral devices (e.g., printers, card readers, etc.).

[0092] Storage device 1116 may include machine-readable medium 1122 on which one or more sets of data structures or instructions 1124 (e.g., software) are stored, which embody any one or more of the methods or functions described herein. Instructions 1124 may also reside wholly or at least partially within main memory 1104, static memory 1106, and / or processor 1102 during execution by computer system 1100, wherein main memory 1104, static memory 1106, and processor 1102 also constitute machine-readable medium.

[0093] Although machine-readable medium 1122 is shown as a single medium in the example embodiment, the term "machine-readable medium" can include a single medium or multiple media (e.g., a centralized or distributed database and / or associated caches and servers) storing one or more instructions 1124. The term "machine-readable medium" should also be understood to include any tangible medium (e.g., a non-transitory medium) capable of storing, encoding, or carrying instructions for execution by computer system 1100 and causing computer system 1100 to perform any one or more methods of the methods of this disclosure, or capable of storing, encoding, or carrying data structures utilized by or associated with such instructions. The term "machine-readable medium" should therefore be understood to include, but is not limited to, solid-state memory and optical and magnetic media. Specific embodiments of machine-readable media include non-volatile memory, including, for example, semiconductor memory devices (e.g., electrically programmable read-only memory (EPROM), electrically erasable programmable read-only memory (EEPROM)) and flash memory devices; magnetic disks, such as internal hard disks and removable disks; magneto-optical disks; and CD-ROM and DVD-ROM disks.

[0094] Instruction 1124 can also be sent or received over communication network 1126 via network interface device 1120 using a transmission medium, utilizing any of a number of well-known transport protocols (e.g., Frame Relay, Internet Protocol (IP), Transmission Control Protocol (TCP), User Datagram Protocol (UDP), Hypertext Transfer Protocol (HTTP)). Embodiments of the communication network include local area networks (LANs), wide area networks (WANs), the Internet, mobile phone networks, conventional telephone (POTS) networks, and wireless data networks (e.g., Wi-Fi, 3G and 4G LTE / LTE-A, or 5G networks). The term "transmission medium" should be considered to include any intangible medium capable of storing, encoding, or carrying instructions for execution by computing system 1100, and includes digital or analog communication signals or other intangible media to facilitate communication by such software.

[0095] As an additional embodiment, the computational implementation described herein can be implemented in one or a combination of hardware, firmware, and software. The implementation can also be implemented as instructions stored on a computer-readable storage device, which can be read and executed by at least one processor to perform the operations described herein. The computer-readable storage device can include any non-transitory mechanism for storing information in a machine-readable (e.g., computer) form. For example, a computer-readable storage device can include read-only memory (ROM), random access memory (RAM), disk storage media, optical storage media, flash memory devices, and other storage devices and media.

[0096] It should be understood that the functional units or capabilities described in this specification may have been referred to or labeled as components or modules to more specifically emphasize their implementation independence. These components or modules can be implemented as any combination of hardware circuits, programmable hardware devices, or other discrete components. These components or modules can also be implemented in software executed by various types of processors. The identified components or modules of executable code may, for example, comprise one or more physical or logical blocks of computer instructions, which may be organized, for example, as objects, programs, or functions. However, the executable code of the identified components or modules does not need to be physically located together, but may comprise different instructions stored in different locations that, when logically combined, constitute the component or module and achieve the stated purpose of the component or module. In practice, the executable code components or modules may be a single instruction or many instructions, and may even be distributed across several different code segments, between different programs, and across several memory devices.

[0097] Similarly, operational data can be identified and represented within components or modules, and can be embodied in any suitable form and organized within any suitable type of data structure. Operational data can be collected as a single dataset or distributed across different locations (including across different storage devices), and can exist at least partially as electronic signals within a system or network. Components or modules can be passive or active, including agents operable to perform desired functions.

[0098] Notes and Examples

[0099] The following non-limiting embodiments detail certain aspects of the subject matter to address challenges and provide the benefits discussed herein.

[0100] Example 1 is a reversing device comprising: a lithotripter configured to deliver energy to tissue located in a tissue-forming region; a collection channel capable of being positioned in or near a body cavity; and an energy guiding device capable of being positioned near the lithotripter and the collection channel, the energy guiding device being configured to propel the tissue toward the collection channel.

[0101] In Example 2, the subject matter of Example 1 may optionally include: wherein the lithotripter includes a laser emitter that is operable to deliver light energy to the tissue.

[0102] In Example 3, the subject matter of Example 2 may optionally include: wherein the energy guiding device includes a reflector connected to the lithotripter and capable of being positioned to reflect the light energy to propel the tissue toward the collection channel.

[0103] In Embodiment 4, the subject matter of Embodiment 3 may optionally include: wherein the lithotripter includes a second laser emitter operable to deliver light energy to the reflector.

[0104] In Example 5, the subject matter of any one or more of Examples 2 to 4 may optionally include: wherein the reflector includes a reflective coating composed of one or more of barium sulfate, magnesium oxide, dielectric high reflective coating, polytetrafluoroethylene, dichroic mirror, and reflective photonic structure.

[0105] In Example 6, the subject matter of any one or more of Examples 1 to 5 may optionally include: wherein the lithotripter is an ultrasonic lithotripter.

[0106] In Example 7, the subject matter of any one or more of Examples 1 to 6 may optionally include: wherein the energy guiding device includes a reflector connected to the lithotripter, the reflector being configured to reflect multiple portions of the tissue toward the collection channel.

[0107] In Example 8, the subject matter of any one or more of Examples 1 to 7 may optionally include: wherein the energy guiding device includes a reflector connected to the endoscope, the reflector being configured to reflect multiple portions of the tissue toward the collection channel.

[0108] In Example 9, the subject matter of any one or more of Examples 1 to 8 may optionally include a capture device connected to the lithotripter and capable of being positioned in or near the body cavity, the capture device being operable to move between an open position capturing the tissue and a closed position holding the tissue therein.

[0109] In Example 10, the subject matter of Example 9 may optionally include: wherein the energy guiding device includes the capturing device.

[0110] In Example 11, the subject matter of Example 10 may optionally include: wherein the capturing device includes a reflective inner surface to reflect light delivered by the laser of the lithotripter into tissue within the capturing device.

[0111] In Embodiment 12, the subject matter of any one or more of Embodiments 9 to 11 optionally includes a capture device comprising: an inner sleeve defining an opening to receive the tissue into the inner sleeve near the collection channel and the lithotripter; and an outer sleeve connected to the inner sleeve, the outer sleeve being movable to open and close the opening.

[0112] In embodiment 13, the subject matter of embodiment 12 may optionally include: wherein the outer sleeve is rotatable relative to the inner sleeve about an axis common to the outer sleeve and the inner sleeve to open and close the opening of the inner sleeve.

[0113] In Example 14, the subject matter of any one or more of Examples 1 to 13 may optionally include: wherein the energy guiding device includes an outer sleeve capable of translating relative to the lithotripter to apply force to the tissue and advance the tissue toward the collection channel.

[0114] In Example 15, the subject matter of Example 14 may optionally include: wherein the energy guiding device includes a plurality of protrusions extending from the distal portion of the outer sleeve toward the proximal side, the protrusions being configured to apply force to the tissue to break the tissue.

[0115] In Example 16, the subject matter of any one or more of Examples 1 to 15 may optionally include: wherein the energy guiding device is configured to discharge flushing fluid toward the collection channel.

[0116] In embodiment 17, the subject matter of embodiment 16 may optionally include: wherein the energy guiding device includes a flushing device connected to a distal portion of the energy guiding device, the flushing device being configured to discharge fluid toward the collection channel.

[0117] In Example 18, the subject matter of Example 17 may optionally include: wherein the flushing device includes a plurality of nozzles for discharging fluid to propel the tissue toward the collection channel.

[0118] In Embodiment 19, the subject matter of any one or more of Embodiments 1 to 18 may optionally include an imaging device connected to an external portion of the energy guiding device.

[0119] In Example 20, the subject matter of any one or more of Examples 1 to 19 may optionally include: wherein the body cavity is a kidney target and the tissue is a stone.

[0120] Example 21 is a reversing device for performing a lithotripsy process, the reversing device comprising: a lithotripter configured to deliver energy to tissue in a body cavity; a collection channel positioned near the energy delivery device in or near the body cavity; and a reflector positioned distal to the lithotripter in or near the body cavity, the reflector being configured to direct energy from the lithotripter to the tissue to propel the tissue toward the collection channel.

[0121] In Example 22, the subject matter of Example 21 may optionally include: wherein the lithotripter includes a laser emitter operable to deliver light energy to the tissue.

[0122] In embodiment 23, the subject matter of embodiment 22 may optionally include: wherein the reflector is connected to the stone crusher.

[0123] In embodiment 24, the subject matter of embodiment 23 may optionally include: wherein the rock crusher includes a second laser emitter operable to deliver light energy to the reflector.

[0124] In embodiment 25, the subject matter of embodiment 24 may optionally include: wherein the reflector includes a curved reflective surface to focus reflected light toward the collection channel.

[0125] In Example 26, the subject matter of any one or more of Examples 22 to 25 may optionally include: wherein the reflector includes a reflective coating composed of one or more of barium sulfate, magnesium oxide, dielectric HR coating, dichroic mirror, and reflective photonic structure.

[0126] Example 27 is a reversing device for performing a lithotripsy process, the reversing device comprising: a lithotripter configured to deliver energy to tissue within a cavity in a body cavity; a collection channel positioned near or adjacent to the energy delivery device in or near the body cavity; and a flushing device positioned distal to or adjacent to the lithotripter in or near the body cavity, the flushing device being configured to guide fluid toward the collection channel to advance the tissue.

[0127] In Embodiment 28, any one or any combination of the devices or methods of Embodiments 1 to 27 may optionally be configured such that all of the elements or options described herein are available for use or selection from.

[0128] The above detailed description includes reference to the accompanying drawings, which form part of the detailed description. The drawings illustrate, by way of illustration, specific embodiments in which the invention can be carried out. These embodiments are also referred to herein as “embodiments.” Such embodiments may include elements other than those shown or described. However, the inventors also contemplate embodiments in which only those elements shown or described are provided. Furthermore, the inventors also contemplate embodiments using any combination or arrangement of those elements (or one or more aspects thereof) shown or described with respect to a particular embodiment (or one or more aspects thereof) or with respect to other embodiments shown or described herein (or one or more aspects thereof).

[0129] In the event of any inconsistency between the use of this document and any other document incorporated herein by reference, the use in this document shall prevail. In this document, the terms “comprising” and “wherein” are used as their simple English equivalents. Furthermore, in the claims, the terms “comprising” and “including” are open-ended, meaning that a system, apparatus, article, composition, formulation, or process that includes elements other than those listed following this term in a claim is still considered to fall within the scope of that claim.

[0130] The above description is intended to illustrate and not limit. For example, the above embodiments (or one or more aspects thereof) can be used in combination with each other. For example, other embodiments can be used by those skilled in the art after reading the above description. The abstract is provided to comply with 37 CFR §1.72(b) to allow the reader to quickly determine the nature of the technical disclosure. It should be understood that the abstract is provided under the understanding that it is not intended to interpret or limit the scope or meaning of the claims. Furthermore, in the above detailed description, various features may be grouped together to streamline this disclosure. This should not be construed as an intention that unclaimed features are necessary for any claim. Rather, the subject matter of the invention may lie in fewer than all features of a particular disclosed embodiment. Therefore, the claims are incorporated herein as embodiments or implementations, wherein each claim is an independent, separate implementation, and such implementations are contemplated to be combined with each other in various combinations or arrangements. The scope of the invention should be determined by reference to the appended claims and the full scope of the equivalents granted by those claims.

Claims

1. A reverse retreatment device, comprising: a lithotripter configured to deliver energy to tissue at a tissue formation region; a collection channel positionable at or near a body lumen; and an energy directing device positionable near the lithotripter and the collection channel, the energy directing device comprising a reflector having an opening and a cavity, wherein the reflector is positioned such that tissue enters the cavity of the reflector through the opening, and wherein the reflector is configured to reverse the retreat of portions of the tissue by contacting the portions of the tissue within the cavity to advance the portions of the tissue toward the collection channel. the lithotripter comprises a laser emitter operable to deliver light energy to the tissue.

2. The reverse fall back apparatus of claim 1, wherein, the reflector is configured to reflect the light energy to advance the tissue toward the collection channel.

3. The reverse fall back apparatus of claim 2, wherein, the lithotripter comprises a second laser emitter operable to deliver light energy to the reflector.

4. The reverse fall back apparatus of claim 3, wherein, the reflector comprises a reflective coating comprised of one or more of barium sulfate, magnesium oxide, a dielectric high-reflective coating, polytetrafluoroethylene, a dichroic mirror, a reflective photonic structure.

5. The reverse fall back apparatus of claim 2, wherein, the lithotripter is an ultrasonic lithotripter.

6. The reverse fall back apparatus of claim 1, wherein, 7. The reverse retreatment device of claim 1, wherein: the reflector is a capture device connected to the lithotripter and positionable at or near the body lumen, the capture device being operable to move between an open position that captures the tissue and a closed position that retains the tissue in the capture device. the capture device comprises a reflective inner surface to reflect light energy delivered by a laser emitter of the lithotripter to tissue within the capture device.

8. The reverse fall back apparatus of claim 7, wherein, 9. The reverse retreatment device of claim 7, the capture device comprising: an inner sleeve defining the opening to receive the tissue into the inner sleeve proximate the collection channel and the lithotripter; and an outer sleeve connected to the inner sleeve, the outer sleeve being movable to open and close the opening. the outer sleeve is rotatable relative to the inner sleeve about an axis common to the outer sleeve and the inner sleeve to open and close the opening of the inner sleeve. the reflector comprises an outer sleeve translatable relative to the lithotripter to apply a force to the tissue and advance the tissue toward the collection channel.

10. The reverse fall back apparatus of claim 9, wherein, the outer sleeve comprises a plurality of protrusions extending proximally from a distal portion of the outer sleeve, the plurality of protrusions being configured to apply a force to the tissue to fragment the tissue.

11. The reverse-astride device of claim 1, wherein, the energy directing device is configured to discharge irrigation fluid toward the collection channel.

12. The reverse fall back apparatus of claim 11, wherein, the energy directing device comprises an irrigation device connected to a distal portion of the energy directing device, the irrigation device being configured to discharge fluid toward the collection channel.

13. The reverse-astride device of claim 1, wherein, the irrigation device comprises a plurality of spouts to discharge fluid to advance the tissue toward the collection channel.

14. The reverse fall back apparatus of claim 13, wherein, ​ 15. The reverse fall back apparatus of claim 14, wherein, ​ 16. A reverse retreat device for performing a lithotripsy procedure, the reverse retreat device comprising: a lithotripter configured to deliver energy to tissue at a body lumen; a collection channel positionable at or near the body lumen in the vicinity of the lithotripter; and a reflector positionable at or near the body lumen distal of the lithotripter, the reflector having an opening and a cavity and being configured to direct energy from the lithotripter to the tissue, wherein the reflector is positioned such that the tissue enters the cavity of the reflector through the opening, and wherein the reflector is configured to reverse a retreat of the tissue by contacting the tissue within the cavity to advance the tissue toward the collection channel. the lithotripter includes a laser emitter operable to deliver optical energy to the tissue.

17. The reverse fall back apparatus of claim 16, wherein, ​

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