Lithotripsy system with drill and lateral emitters

Abstract

This application discloses lithotripsy systems with drills and lateral emitters. A system that delivers energy to treat a moving calculus can include a drill and a lateral energy emitter. The drill can be configured to drill a recess into the moving calculus or a channel through the moving calculus. The lateral energy emitter can be configured to advance into the recess or channel and send energy inside the moving calculus to fragment the moving calculus. In some examples, the system can include a deployable capture portion to constrain the stone relative to the capture portion.

Description

[0001] Cross-references to related applications

[0002] This application claims the benefit of priority to U.S. Provisional Patent Application Serial No. 63 / 047,684, filed July 2, 2020, the entire contents of which are incorporated herein by reference. Technical Field

[0003] This disclosure relates to techniques for breaking up obstacles such as physiological stones or "pebbles" using lithotripsy. Background Technology

[0004] Medical endoscopes were first developed in the early 1800s and have been used to examine the inside of the body. A typical endoscope consists of a distal end including an optical or electronic imaging system and a proximal end with controls for manipulating tools and devices used to view images, with a solid or tubular elongated shaft connecting these ends. Some endoscopes allow physicians to pass tools or treatments along a hollow working channel, such as to remove tissue or retrieve objects.

[0005] Over the past few decades, there has been progress in the field of endoscopy, specifically in the breaking up of physiological stones in the bile ducts, urinary tract, kidneys, and gallbladder. Physiological stones in these areas can obstruct ducts and cause significant pain to patients, and therefore must be broken up and / or removed. Various techniques have been developed to break up stones, including ultrasonic lithotripsy, pneumatic lithotripsy, electro-hydraulic lithotripsy (EHL), and laser lithotripsy, which includes the use of green light, YAG, or holmium lasers to break up stones. Summary of the Invention

[0006] Furthermore, the inventors have recognized that problems to be solved when performing laser lithotripsy in a living organism include the surgeon's ability to easily capture, fragment, and remove stone fragments located within the body. This subject matter can provide solutions to these and other problems.

[0007] In examples, a system for delivering energy to treat stones, such as mobile stones located within a living organism, may include a drill configured to drill into a recess or through a channel in the mobile stone. The system may also include a transducer configured to advance into the recess or channel and deliver energy within the mobile stone to fracture it. In some examples, the drill may be located at the distal portion of a delivery member having an elongated shaft capable of delivery to a treatment site via a working channel, wherein the transducer is located proximal to the drill. In some examples, the system may also include a trapping portion configured to restrict movement of at least a portion of the mobile stone relative to the trapping portion.

[0008] In another example, a method of treating a mobile stone in a patient can include drilling a hole into the mobile stone to create a recess into the mobile stone or a channel through the mobile stone to receive a delivery member having an acoustic transducer. The method can also include advancing the acoustic transducer into the channel and exciting the acoustic transducer to send acoustic energy to the mobile stone to fragment the mobile stone.

[0009] In another example, a method of controlling a lithotripter can include providing a lithotripsy system including a drill at a distal portion, an acoustic transducer proximal to the drill, and a capture portion. The method can also include emitting or receiving a first control signal to actuate the drill, emitting or receiving an input to deploy the capture portion, and emitting or receiving a second control signal to excite the acoustic transducer.

[0010] Benefits of the methods described herein include reduced time to perform percutaneous nephrolithotomy.

[0011] This summary 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 DRAWINGS

[0012] Figure 1 An isometric view of a portion of a lithotripsy system is shown, in accordance with at least one example.

[0013] Figure 2 An isometric view of a portion of a second lithotripsy system is shown, in accordance with at least one example.

[0014] Figure 3 An isometric view of a portion of a third lithotripsy system is shown, in accordance with at least one example.

[0015] Figure 4A A side view of a portion of a fourth lithotripsy system in a stored state is shown, in accordance with at least one example.

[0016] Figure 4B A side view of a portion of the fourth lithotripsy system in a deployed state is shown.

[0017] Figure 5A An isometric view of a portion of a fifth lithotripsy system in a first deployed state for receiving a stone is shown, in accordance with at least one example.

[0018] Figure 5B An isometric view of a portion of the fifth lithotripsy system in a second deployed state for capturing a stone is shown, in accordance with at least one example.

[0019] Figure 6A flowchart showing a method of treating a moving stone in a patient is shown.

[0020] Figure 7 A flowchart showing a method of controlling a lithotripter according to at least one example is shown.

[0021] In the drawings, which are not necessarily to scale, like numerals can describe similar components in different views. Like numerals having different letter suffixes can represent different instances of similar components. The drawings illustrate generally, by way of example, various implementations discussed in the present document. DETAILED DESCRIPTION

[0022] The present disclosure provides examples of systems and methods that can help address the problem of fragmenting and collecting stones during lithotripsy, such as ultrasonic lithotripsy, although aspects described herein can be used with other types of lithotripsy.

[0023] In ultrasonic lithotripsy and other acoustic lithotripsy, a practitioner can break a stone into smaller fragments by applying sonic waves to the stone. For example, a lithotripsy probe can deliver oscillating pulses of ultrasonic energy having variable amplitude and / or frequency to the stone. Once the stone is broken into relatively small fragments, the practitioner can remove the small fragments through an endoscope.

[0024] Fragmenting and collecting stones can be challenging because the stones can be free-floating, moving stones, so they can move during the fragmentation process. Additionally, the physical properties of the stones, such as hardness, can vary throughout different portions of the stone. For example, the exterior of the stone will generally be harder than the interior of the stone. Stones can be present in various organs of the body, including but not limited to the kidneys, bladder, ureters, bile ducts, and gallbladder.

[0025] Furthermore, benefits of the methods described herein include reducing the time it takes to fragment and remove a stone by: capturing a stone to be treated; delivering energy from the interior of the stone to the stone to target the generally softer interior portions of the stone; and maintaining capture of at least a portion of the fragmented stone to be removed. These methods can result in shorter procedure times because the location of the stone is controlled and known during the lithotripsy process, reducing the stone’s retreat and other unwanted movement that can cause the surgeon to have to “chase” the stone throughout the process. Maintaining capture of the stone fragments can also improve post-operative stone clearance in the patient.

[0026] For purposes of the present disclosure, “proximal” refers to the end of the system that is closer to the device operator during use, and “distal” refers to the end of the system that is at the distal end or further from the device operator during use.

[0027] Figure 1 An isometric view of an example of a lithotripsy system 100 is shown, including a lithotriptor 102 having a housing 104 such as a handle. The lithotriptor 102 can include a delivery member 106 that is deliverable through a working channel WC of a scope E to a treatment site. The scope E can also include a light source LS and a camera C.

[0028] The delivery member 106 can include a flexible or rigid elongate shaft 108 having a tubular structure. Suitable materials for the delivery member include, but are not limited to, polytetrafluoroethylene (“PTFE”), polyethylene (“PE”), and polyamide. The elongate shaft 108 can include an outer surface 110 and at least one lumen 112 extending therethrough suitable for passage of components and materials in communication with the end effector described herein.

[0029] The delivery member 106 can include an end effector at a distal end, such as a probe 114, that is deliverable to a treatment site. The probe 114 can be configured to deliver energy to fragment a mobile calculus such as a stone located in a biliary duct, urinary tract, kidney, or gallbladder. The probe 114 of the lithotriptor 102 can be driven by the delivery member 106 through a working channel WC of a scope E or similar instrument to be introduced into a patient. The probe 114 can be flexible or rigid.

[0030] The lithotriptor can be connected to a generator 116 (e.g., signal generator, energy generator). The generator 116 can include a power source 118 or be couplable to an external power source. The generator 116 can also include an input device 120 for receiving instructions from an operator, and can include a controller 122 having processing circuitry for determining actions based on operator input and for sending control signals to communicate with the lithotriptor 102 via an output device 124. The generator 116 can generate and send signals to the probe 114 of the lithotriptor 102 to cause the probe 114 to emit acoustic energy. The acoustic energy can include sonic waves, sound waves, ultrasonic waves, or shock waves, or any combination of these. The acoustic energy can be delivered to a stone S to cause the stone S to deteriorate, break, and thereby fragment. Examples herein are described with reference to ultrasonic wave applications, but any suitable acoustic energy for fragmenting a stone can be provided. The terms “acoustic” and “ultrasonic” can be used interchangeably herein, and can include suitable acoustic energy for fragmenting a stone.

[0031] The features of probe 114 can provide improved fragmentation of the stone S. For example, probe 114 may include a drill 126 (which does not necessarily include a rotary drill bit) such as an ultrasonic drill that emits acoustic energy in the longitudinal direction A1 to drill a hole in the stone. Probe 114 may also include one or more transverse emitters 128 such as transverse ultrasonic transducers to deliver acoustic energy within the hole, thereby fragmenting the stone from the inside out.

[0032] Drill 126 may be coupled to elongated shaft 108 and may be located at the distal end of probe 114. Drill 126 may include at least a portion extending distal to elongated shaft 108. Figure 1 In the example, drill 126 can be configured to emit ultrasonic energy in the longitudinal direction A1. Drill 126 can cause mechanical alteration or damage to the stone S by generating pulsating shock waves that move generally along the longitudinal direction A1. Drill 126 can be configured to drill holes, such as into recesses in the stone S or through channels P through the stone S. Figure 1 An example of drill 126 is shown, which includes a channel P that has been drilled through the stone S.

[0033] Drill 126 may be an ultrasonic transmitter that receives ultrasonic energy from a remotely positioned ultrasonic transducer 136, which will be referred to as drill transducer 136 for clarity in comparison with other transmitters and transducers in this disclosure. Drill transducer 136 may be located within a housing 104 of, for example, a lithotripter 102. Drill transducer 136 may deliver ultrasonic energy distally out of housing 104 in a generally longitudinal direction A1. Ultrasonic energy may be transmitted from drill transducer 136 to drill 126 via ultrasonic transmission member 138. Ultrasonic transmission member 138 may be coupled to drill transducer 136 at a proximal end and to drill 126 at a distal end. Ultrasonic transmission member 138 may be formed of any material capable of transmitting ultrasonic energy from drill transducer 136 to drill 126, including but not limited to metals, metal alloys, shape memory alloys, polymers, ceramics, fibers, crystals, or composites thereof.

[0034] The drill transducer 136 can be electrically coupled to the generator 116, for example, via connector 140, to receive signals for operating the drill 126. The drill transducer 136 can be actuated, for example, by an operator pressing a foot pedal 132 electrically connected to the generator 116, or by a drill actuator 134 coupled to a housing 104 electrically connected to the generator 116. Any other suitable actuator for controlling the activation of the drill 126 can be provided.

[0035] Although Drill 126 is described as an ultrasonic drill, in some examples, other types of drills may be provided, including but not limited to motor-operated rotary drills. Like... Figure 1Like the drill transducer in the example of FIG. 1, the motor can be positioned away from the probe 114, such as positioned in the housing 104, and the motor can be coupled to the drill 126 via a rotational transmission member. In other words, in variations of the example of FIG. 1, the drill transducer 136 can be replaced with a rotational motor, and the ultrasonic transmission member 138 can be replaced with a rotational transmission member. Figure 1

[0036] In addition to using an ultrasonic emitter for drilling, the probe 114 can include at least one radial or lateral emitter 128, such as a lateral ultrasonic emitter, configured to direct ultrasonic energy outward and away from the longitudinal direction Al, such as toward the inner surface of the stone S (the passageway P) in a radial or lateral direction A2. In the example of FIG. 1, the at least one lateral emitter 128 includes a plurality of lateral emitters 128 or an array of lateral emitters 128. Figure 1

[0037] Each of the lateral emitters 128 can direct ultrasonic energy in the lateral direction A2, with each of the lateral emitters 128 positioned along a different longitudinal position on the probe 114. In some examples, the lateral emitters 128 can be spaced apart along the longitudinal direction Al. The lateral emitters 128 can extend laterally or radially around the probe 114. In some examples, the lateral emitters 128 can extend around the entire 360-degree circumference of the probe 114, or when the probe has a non-circular cross-section in a direction A1 that is transverse or perpendicular to the longitudinal direction Al, the lateral emitters 128 can extend around the perimeter of the probe 114. In other examples, the lateral emitters 128 can only partially encircle the probe 114.

[0038] The lateral emitters 128 can be located proximally of the drill 126. A benefit of this arrangement is that the lateral emitters 128 can follow the drill 126, such that after the drill 126 has prepared the passageway P in the stone S, the lateral acoustic wave emitters 128 can be advanced through the passageway P. When the lateral emitters 128 are activated, such as by a lateral emitter actuator 142 in electrical communication with the lateral emitters 128 via electrical elements 144, such as electrical wires, the lateral emitters 128 can be configured to emit ultrasonic energy into the passageway P and inside the stone S to fracture the stone S from the inside.

[0039] ​​Similar to the drill transducer 136, the lateral emitter 128 can comprise an ultrasonic transducer or other acoustic transducer. An electroacoustic transducer is a variant of a component that can convert an electrical signal into a physical quantity such as a sound wave or pressure. An ultrasonic transducer can comprise a linear piezoelectric stack having a piezoelectric element located between two metal plates. Such a piezoelectric element can convert electrical energy (e.g., electrical current) into mechanical energy (e.g., sound waves, acoustic waves, ultrasonic waves, shock waves). The piezoelectric element can comprise a crystal such as quartz having physical properties that cause the crystal to experience mechanical stress when subjected to an electric field that causes the crystal to change in size or shape. The piezoelectric element alternately expands and contracts in response to an alternating electric field, which can be provided by the generator 116, for example. This expansion and contraction can generate sound waves that can be delivered to the stone S to fragment the stone S. In some examples, a photoacoustic transducer or a magnetoresistive stack can be provided to convert light energy received from a generator (e.g., a light energy generator in place of the generator 116) into acoustic energy.

[0040] To help position the stone S to be relatively stationary with respect to the working channel WC of the endoscope E, and with respect to the probe 114 (except for the longitudinal Al movement of the probe through the stone), suction can be applied through the working channel WC, as indicated by the suction arrow 130. The suction 130 can cause the stone S to be“captured” by pulling the stone S toward the working channel WC and thus the drill 126 of the probe 114 that is used for drilling.

[0041] Some lithotripsy systems described herein can include a fluid input device 166 for receiving fluid from a fluid reservoir FS and delivering the fluid to the treatment site, as described in the illustrative example of Figure 3 .

[0042] While the illustrative examples of this disclosure are generally described with reference to lithotripsy apparatuses including acoustic emitters, ultrasonic emitters, and fluid emitters (e.g., jets that emit kinetic energy via moving fluid), other forms of energy, such as lasers, can be provided as the drill 126 and / or the lateral emitter 128 described herein. For example, the drill 126 or at least one lateral emitter 128 can emit laser energy instead of acoustic or ultrasonic energy, or emit laser energy in addition to acoustic or ultrasonic energy. In such illustrative examples, the lithotripsy system can receive laser energy from a laser generator (e.g., instead of signal generator 116). In such examples, at least one of the drill 126 and the lateral emitter 128 can be a laser emitter that receives laser energy via at least one laser fiber (e.g., instead of ultrasonic transmission member 138). In other words, the drill can be configured to emit laser energy to drill a channel through the stone S, and at least one lateral emitter can be configured to emit laser energy into the channel P to break the stone S. Laser energy is received from the laser generator via the laser fiber and transmitted to the drill and the lateral emitter. In some examples, such a lateral emitter may include an external coupler or a side-emitting laser to laterally direct laser energy.

[0043] Figure 2 An isometric view of a portion of a second lithotripsy system 200, including a lithotripter 202, is shown. The lithotripsy system 200 may include... Figure 1 Features of the lithotripsy system 100. The same reference numerals may denote the same elements; therefore, for the sake of brevity, not all aspects of the lithotripsy system 200 may be described in further detail.

[0044] The Stonecrushing System 200 can include Figure 1 All features of the lithotripsy system 100. For example, the lithotripter 202 and probe 214 may be the same as or similar to the lithotripter 102 and probe 114. The lithotripsy system 200 may also include a capturing portion 246 (e.g., a capturing structure). The capturing portion 246 can capture the stone S and drill holes in the probe 214, such as recesses or channels into the stone. Figure 1 The stone is held in place by the channel shown. The capturing portion 246 can restrain the movement of at least a portion of the stone S relative to the capturing portion 246. The capturing portion 246 provides a suction-like effect. Figure 1 The suction arrow 130) or other benefits besides suction, said suction can be achieved via, for example... Figure 1 The working channel shown and described in the lithotripsy system 100 is applied to the stone S. The stone-capturing portion 246 makes it easier for the probe 214 to drill through the stone S and prevents the surgeon from having to "chase" the moving stone S. More efficient capture of stone fragments can reduce surgical time.

[0045] In the lithotripsy system 200, the capture portion 246 can be deployed distally from a working channel WC or other channel of the endoscope E Figure 1 ). The capture portion 246 can hold and constrain the stone S relative to the capture portion 246, thereby constraining the stone S relative to the probe 214 (in addition to longitudinal movement of the probe through the stone S) while drilling.

[0046] In some examples, the capture portion 246 can be at least partially retracted into the sheath 248 of the lithotripter 202 or into the working channel WC to draw the stone S toward the working channel WC and the probe 214. Although the capture portion 246 can not eliminate all movement of the stone S, it reduces movement of the stone S, particularly movement of the stone S away from the probe 214.

[0047] The sheath 248 can guide the probe 214 and the capture portion 246 through the working channel. The capture portion 246 can function as a stone S holding member configured to move from a stored state contained within the lumen 250 of the sheath 248 to a deployed state capturing the stone S. The sheath 248 can have any suitable cross-section, including but not limited to: circular, oval, elliptical, polygonal, or irregular.

[0048] In Figure 2 , the capture portion 246 is shown in the deployed state, and the direction of movement from the stored state to the deployed state and the direction of movement from the deployed state to the stored state are shown by the movement arrows P-D. The deployed state can refer to a state (e.g., expanded) in which the capture portion 246 is advanced distally of the sheath 248, for example, by a capture actuator 262 located on the housing (e.g., 104). The movement from the stored state to the deployed state can include movement of the capture portion 246 distally in the longitudinal direction Al and expansion in the lateral direction A2 such as but not limited to lateral directions LI, L2, L3, L4. In other words, the deployment can include movement of the capture portion 246 in a direction having a longitudinal component along the proximal-distal direction and a lateral component relative to the elongated shaft when actuated by the operator. Figure 1

[0049] The capture portion 246 can include at least one receiving opening 252 to receive the stone S into a receiving cavity 260. The capture portion 246 can include at least one strut 254 to capture the stone S. Figure 2 Four deformable struts 254 are included that separate four receiving openings 252, but any suitable number of struts 254 and receiving openings 252 can be provided to allow the stone S to enter the capture portion 246 and be captured by the struts.

[0050] ​In some examples, the struts 254 can form a basket or cage. The struts 254 can converge at a distal end. The struts 254 can be formed as four separate struts 254 that join together at a distal coupling such as the hub 256, or the struts 254 can be integrally formed with one another or overlap one another. Suitable materials for the struts 254 can include elastic materials and biocompatible materials such as nitinol, spring stainless steel, shape memory polymers, any other suitable shape memory material, and alloys and combinations including such materials.

[0051] In some examples, proximally retracting the capture portion 246 can cause the struts 254 to move proximally and at least partially into the lumen 250 of the sheath 248. This proximal movement can cause the proximal portions of the struts 254 to be compressed and at least partially deflect inward (as shown by the deflection arrows 258), thereby narrowing or reducing the volume of the receiving cavity 260 so that the capture portion 246 can be brought close to and in some cases press against the stone S to limit movement of the stone S. The capture portion 246 can be used with any of the lithotripsy systems 100, 200, 300, 400, and 500 described herein.

[0052] Figure 3 An isometric view of a portion of a third lithotripsy system is shown in accordance with at least one example. Figure 3 The lithotripsy system 300 can include Figure 1 and Figure 2 features of the lithotripsy systems 100, 200. Like reference numbers can refer to like elements, and therefore all aspects of the lithotripsy system 300 can not be further described in detail for the sake of brevity.

[0053] The lithotripsy system 300 can include Figure 1 all features of the lithotripsy system 100. For example, the lithotriptor 302 can include features of the probe 114 of the lithotriptor 102 including the transverse wave emitter 128 as the probe 314 and the transverse emitter 328. The lithotriptor 302 can also include a delivery member 306 having an elongated shaft 308 including a tubular structure having an outer surface 310. As Figure 1 described in the lithotripsy system 100, the transverse emitter 328 can deliver ultrasonic energy to the stone S to fragment the stone S. The delivery member 306 can be delivered to the treatment site via the working channel WC of the endoscope E.

[0054] In addition to the features of the lithotripsy system 100, Figure 1 the delivery member 306 can include a fluid delivery channel 364 extending therethrough. The fluid delivery channel 364 can be configured to receive fluid from a fluid reservoir (FS; Figure 1 ) via a fluid input device (166; Figure 1) receive fluid.

[0055] The fluid delivery channel 364 can be in fluid communication with the at least one fluid port 270, 272 through the outer surface 310 of the elongated shaft 308. The fluid delivery channel 364 can deliver fluid F to the at least one fluid port 370, 372, such as a jet or nozzle configured to dispense fluid F outward from the surface 310 of the probe 314. The fluid port 370, 372 can be configured to cause fluid F to exit the probe under pressure.

[0056] As shown in FIG. 3, Figure 3 The drill 326 can be provided in the form of a distal fluid port 370 located at the distal end of the probe 314 instead of an ultrasonic drill, as shown in FIG. 3. The distal fluid port 370 (e.g., drill, fluid drill) can be in fluid communication with the fluid delivery channel 364 to receive fluid and dispense the fluid under pressure to the treatment site. Fluid exiting the distal fluid port 370 can be configured to cause the stone S to deteriorate to drill a hole, channel, or recess in the stone S.

[0057] The fluid delivery channel 364 (or second fluid delivery channel) can also deliver fluid to the at least one lateral fluid port 372. Fluid exiting the lateral fluid port 372 can help to cause the stone S to deteriorate and provide a cooling fluid to an area proximate to the stone S. The lateral fluid port 372 can include a jet or nozzle configured to deliver fluid laterally outward from the probe 314 under pressure to cause a split or micro-split in the stone S. The lateral fluid port 372 can be spaced apart longitudinally and / or laterally (e.g., can be radial or another lateral direction) along the probe 314. Benefits of delivering fluid to the stone S as described include a shorter procedure time and a reduction in local fluid temperature. Suitable fluids for delivery to the stone S to cause the stone S to split can include, but are not limited to, an aqueous solution such as saline.

[0058] Combining the application of ultrasonic energy and pressurized fluid to cause the stone S to split can speed up the splitting of the stone S and keep the treatment site cooler. Figure 3 The lithotripsy system 300 can be combined with the capture portion 246 of the lithotripsy system 300 of Figure 2 to capture stone fragments and further speed up the removal of stone fragments.

[0059] Figure 4A A side view of a portion of a fourth lithotripsy system 400 in a stored state is shown. Figure 4B A side view of a portion of the fourth lithotripsy system 400 in a deployed state is shown. Figure 4A and Figure 4B The lithotripsy system 400 can include Figure 1 , Figure 2 and Figure 3Features of lithotripsy systems 100, 200, and 300. The same reference numerals may denote the same elements; therefore, for the sake of brevity, not all aspects of lithotripsy system 400 may be described in further detail.

[0060] The lithotripsy system 400 may include a transport member 408 and a probe 414, the transport member 408 including aspects of any one of transport members 106, 206, and 306, and the probe 414 including aspects of any one of probes 114, 214, and 314 described herein, said aspects relating to Figure 1 , Figure 2 or Figure 3 The lithotripsy system 400 may also include a capture portion 446 capable of unfolding from the cavity 450 of the sheath 448, and may include... Figure 2 Some aspects of the capture part 246.

[0061] The capturing portion 446 may include aspects of the capturing portion 246. The capturing portion 446 may include a layer 476 defining a receiving cavity 460. The receiving cavity 460 may be accessible to receive the stone S through a receiving opening 452. A closing member 474 may be actuated by a capturing actuator 462 to reduce the opening 452. The layer 476 may be made of a compliant material such as a mesh. The layer 476 may be, but is not limited to, the type of mesh used in hernia and other tissue repair procedures. In some examples, the layer 476 may be at least partially transparent, thereby improving visibility during the procedure. In some examples, the layer 476 may be formed from a sheet of a flexible polymeric material such as a membrane. To improve visibility, the membrane may be a transparent membrane.

[0062] like Figure 4A and Figure 4B As shown, the capturing portion 446 can be deployed from a compressed state when positioned within the sheath 448 to a receiving state when deployed distally from the sheath 448. In the receiving state ( Figure 4A Under these conditions, the capturing portion 446 can be configured to receive the stone S into the opening (e.g., the receiving opening). When the closing member 474 is actuated, the receiving opening 452 can deform and reduce so that the capturing portion 446 can restrain the stone S in the capturing state. Figure 4B ).

[0063] In some examples, the stone S can be captured by being scooped into the receiving opening 452. For example, when an operator manipulates the closure actuator 478, the closure member 474 can move the capture portion 446 in one or more of a scooping, pivoting, or closing motion. The operator can actuate, such as by sliding the closure actuator 278, to cause movement of the closure member 474 when a stone S to be captured passes through the receiving opening 452 and into the receiving cavity 460, which causes the scooping, pivoting, or closing action of the capture portion 446 to occur. In addition to scooping, the opening can be reduced in size from an open size to a less open size or a closed size. The closure actuator 478 is a sliding actuator or a pivoting actuator on the housing of the lithotripsy machine, but the closure actuator 478 can be any other suitable actuator capable of causing the closure member 474 to perform the scooping, pivoting, and / or closing motion of the capture portion 446.

[0064] Figure 5A An isometric view of a portion of a fifth lithotripsy system 500 in a first deployed state for receiving a stone S is shown. Figure 5B An isometric view of a portion of the fifth lithotripsy system 500 in a second deployed state for capturing a stone S is shown.

[0065] Figure 5A The lithotripsy system 500 of Figure 5B may include features of the lithotripsy systems 100, 200, 300, and 400 of FIGS. 1-4. Figure 1 , Figure 2 , Figure 3 The same reference numbers can represent the same elements, and therefore all aspects of the lithotripsy system 500 can not be further described in detail for the sake of brevity. Figure 5A The lithotripsy system 500 of Figure 5B is described together.

[0066] The lithotripsy system 500 can include a delivery member 508 including aspects of any of the delivery members 106, 206, 306, 406 and a probe 514 including aspects of any of the probes 114, 214, 314, 414 described herein with respect to Figure 1 , Figure 2 , Figure 3 and described with respect to FIG. 4. The lithotripsy system 500 can also include a capture portion 546 deployable from an inner lumen 550 of a sheath 548 and can include Figure 2 some aspects of the capture portions 246 and 446 of FIG. 4.

[0067] The lithotripsy system 500 can include a capture portion 546 that can be deployed through a working channel (WC, Figure 1) remain in an unexpanded state (e.g., a compressed state) during delivery to a stone treatment site such as a kidney. For example, the stone S can be drawn toward the working channel during drilling by suction (e.g., suction arrows 130) described with respect to Figure 1 . Figure 1 Suction can be applied to the stone S via an opening at a distal end of the working channel (WC; .

[0068] The capture portion 546 can remain in an unexpanded state while the probe 514 drills through the stone S. The capture portion 546 can be configured to advance through the channel and expand distal of the stone S. The capture portion 546 can be automatically expanded when the probe exits the distal side of the stone S, for example, by a spring-loaded connection between the probe 514 and the capture portion 546 or by an operator actuating a capture actuator 562 that is operatively coupled to the capture portion 546. The capture actuator 562 can be a sliding actuator or a pivoting lever actuator on the housing (e.g., 104; Figure 1 .

[0069] Figure 6 is a flowchart illustrating a method 600 of treating a mobile calculus such as a stone in a kidney, bladder, ureter, or gallbladder. The method 600 can be performed using any of the lithotripsy systems 100, 200, 300, 400, and 500 of Figures 1 to 3 , Figure 4A , Figure 4B , Figure 5A and Figure 5B may be used with the method 600, although the method 600 can also be used with other lithotripsy systems. Likewise, Figures 1 to 3 , Figure 4A , Figure 4B , Figure 5A and Figure 5B the lithotripsy systems 100, 200, 300, 400, and 500 can be used with other methods. In some examples, steps of the method 600 can be omitted or added.

[0070] Step 610 can include drilling a hole in the stone to create a recess into the stone or a channel through the stone to receive a delivery member having an acoustic transducer such as a transverse acoustic wave emitter.

[0071] Step 620 can include advancing the acoustic transducer into the recess or channel.

[0072] Step 630 can include energizing the acoustic transducer to send acoustic energy to the stone to fragment the stone.

[0073] In some examples, prior to performing step 610, the method 600 can further include aspirating the stone to draw the stone toward a working channel of the endoscope and / or deploying a capture portion configured to receive and constrain at least a portion of the stone; receiving the stone into the opening to capture the stone; and constraining movement of the stone relative to the acoustic transducer while the acoustic transducer is energized.

[0074] In some examples, step 630 can further include providing the fluid through a delivery member having a tubular structure including an outer surface and a fluid delivery channel extending through the delivery member in fluid communication with a fluid port in the outer surface, wherein providing the fluid causes the fluid to be dispensed from the fluid port into the recess or channel to cause deterioration of the stone.

[0075] In some examples, after performing step 630, the method can further include capturing at least a portion of the fragmented stone and removing the stone from the patient and / or aspirating an area surrounding at least a portion of the fragmented stone to move at least a portion of the fragmented stone into a working channel of the endoscope.

[0076] Figure 7 is a flowchart illustrating a method 700 of treating a mobile calculus, such as a stone in a kidney, bladder, ureter, or gallbladder. The method 700 can be performed using any of the lithotripsy systems 100, 200, 300, 400, and 500 of Figures 1 to 3 , Figure 4A , Figure 4B , Figure 5A and Figure 5B may be used with the method 700, but the method 700 can also be used with other lithotripsy systems. Likewise, Figures 1 to 3 , Figure 4A , Figure 4B , Figure 5A and Figure 5B the lithotripsy systems 100, 200, 300, 400, and 500 can be used with other methods. The method 700 can be used alone or with the method 600. In some examples, steps of the method 700 can be omitted or added.

[0077] Step 710 can include providing a lithotripsy system including a drill at a distal portion, an acoustic transducer proximal of the drill, and a capture portion. In some examples, the drill and acoustic transducer can be coupled to a probe. In other examples, the drill and acoustic transducer can be disposed on different probes, such as at the distal ends of different delivery members that are delivered through a working channel (WC; Figure 1 ) that are separated.

[0078] In some examples, step 710 can include providing a delivery member having a tubular structure including an outer surface and a fluid delivery channel extending through the delivery member. The fluid delivery channel can be in fluid communication with a fluid port in the surface. The fluid port can be configured to deliver fluid to the stone to cause the stone to deteriorate or fragment.

[0079] Step 720 can include issuing or receiving a first control signal for actuating the drill. In some examples, the first control signal actuates a longitudinal emitter such as a longitudinal acoustic transducer. In other examples, the first control signal actuates delivery of fluid to a distal fluid port located at a distal end of the probe.

[0080] Step 730 can include issuing or receiving an input for deploying a capture portion. However, some example systems described herein do not include a capture portion.

[0081] Step 740 can include issuing or receiving a second control signal for energizing an acoustic transducer.

[0082] In some examples, an additional step can include issuing or receiving a control signal for dispensing fluid from a fluid opening to cause the stone to fragment. Further, method 700 can include issuing or receiving a control signal for actuating an aspiration system that causes aspiration to occur in a region near a distal end of a working channel, wherein the working channel is configured to allow the drill, the acoustic transducer, and the capture portion to be delivered through the working channel. Method 700 can also include issuing or receiving a control signal for actuating an aspiration system that causes aspiration to occur in a region near a distal end of a working channel (WC; Figure 1 ) of an endoscope. The working channel can be configured to allow the drill, the acoustic transducer, and the capture portion to be delivered through the working channel.

[0083] In some non-limiting examples, the control signals can be received from any suitable source such as the signal generator described in Figure 1 The inputs can be issued by or received from an operator of the system such as by Figure 2 、 Figure 4A and Figure 4B actuators and actuation motions described in

[0084] Benefits of the systems and methods of the present disclosure can include improving the speed at which lithotripsy procedures are performed, reducing the temperature proximate to a treatment site of a stone being treated, improving capture of the stone, and improving collection of fragmented stones to be removed, which reduces the frequency at which a surgeon must “chase” a stone to retrieve the stone.

[0085] In the drawings, which are not necessarily drawn to scale, like numerals can describe similar components in different views. Like numerals having different letter suffixes can represent different instances of the like components. The drawings illustrate generally, by way of example, but not by way of limitation, various embodiments discussed in the present document.

[0086] 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, various embodiments discussed in the document. These embodiments are also referred to herein as “examples.” Such examples can include elements in addition to those illustrated or described. However, the present inventors also contemplate examples in which only those elements shown or described are provided. Moreover, the present inventors also contemplate 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.

[0087] In the document, as is common in patent documents, any use of the terms “a” or “an” are intended to include one or more than one, independent of any other instances or usages of “at least one” or “one or more.” In the 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 the 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.

[0088] The above description is intended to be illustrative, and not restrictive. For example, the above-described examples (or one or more aspects thereof) can be used in combination with each other. Other embodiments can be used in addition, or alternatively, examples of which can become apparent to those of ordinary skill in the art upon reading 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. In addition, in the above Detailed Description, various features can be grouped together or described in a single embodiment for the purposes of streamlining the disclosure. This should not be interpreted as intending that the claimed subject matter requires more features than are expressly identified in the description. Rather, the inventive subject matter can be practiced with less than all of the features of a particular disclosed embodiment. Accordingly, the appended claims are hereby expressly incorporated into this Detailed Description, with each claim acting as a separate embodiment of the inventive subject matter, and the inventive subject matter being capable of additional embodiments in various combinations or permutations of the structures, components, and methods described in the detailed description. The scope of the claims should not be limited by the claims themselves but should be given the full scope of equivalents, and alternate aspects, as they will be understood by those skilled in the art once informed by the record.

[0089] Various notes and examples

[0090] Example 1 is a system to deliver energy to treat a mobile stone, the system comprising: a drill configured to drill a recess into the mobile stone or a passageway through the mobile stone; and a transducer configured to advance into the recess or the passageway and transmit energy inside the mobile stone to fragment the mobile stone.

[0091] In Example 2, the subject matter of Example 1 includes: wherein the transducer comprises an acoustic transducer.

[0092] In Example 3, the subject matter of Examples 1-2 includes: wherein at least a portion of the drill is at a distal portion of a delivery member having an elongate shaft that is deliverable to a treatment site through a working channel, and wherein the transducer and the drill are coupled to the elongate shaft with the transducer being proximal to the drill.

[0093] In Example 4, the subject matter of Examples 1-3 includes: a capture portion configured to constrain movement of at least a portion of the mobile stone relative to the capture portion.

[0094] In Example 5, the subject matter of Example 4 includes: wherein the capture portion is configured to capture at least a portion of a fragmented mobile stone to be removed.

[0095] In Example 6, the subject matter of Examples 4-5 includes, wherein the capture portion is located at a distal end portion of a delivery member having an elongate shaft, and wherein the capture portion is configured to be advanced through the channel and to deploy distal of the mobile calculus.

[0096] In Example 7, the subject matter of Examples 4-6 includes, wherein the capture portion includes a deformable strut configured to expand to a deployed position.

[0097] In Example 8, the subject matter of Examples 4-7 includes, wherein the capture portion includes a receiving opening configured to receive the mobile calculus.

[0098] In Example 9, the subject matter of Examples 4-8 includes, wherein the capture portion includes a receiving opening and a closure member, and wherein the capture portion is deployable from a compressed state when positioned in a working channel to a receiving state when deployed distally from the working channel, and wherein, in the receiving state, the capture portion is configured to receive the mobile calculus through the receiving opening, and wherein, when the closure member is actuated, the receiving opening is deformed to enable the capture portion to constrain the mobile calculus in a captured state.

[0099] In Example 10, the subject matter of Examples 1-9 includes a delivery member having an elongate shaft and a fluid delivery channel, the elongate shaft including a tubular structure, the tubular structure including a surface, the fluid delivery channel extending through the delivery member, the fluid delivery channel being in fluid communication with a fluid port in the surface, wherein the fluid port is configured to provide fluid into the recess or the channel to deteriorate the mobile calculus, and wherein the drill and the transducer are coupled to the elongate shaft.

[0100] In Example 11, the subject matter of Example 10 includes, wherein the fluid port includes a plurality of fluid ports longitudinally spaced apart along a length of the elongate shaft.

[0101] In Example 12, the subject matter of Examples 10-11 includes, wherein the fluid port includes a plurality of fluid ports radially spaced apart around the elongate shaft.

[0102] In Example 13, the subject matter of Examples 1-12 includes a delivery member having an elongate shaft including a tubular structure and a fluid delivery channel extending through the delivery member, wherein the drill is located at a distal end of the elongate shaft, and wherein the drill includes a fluid port in fluid communication with the fluid delivery channel, the fluid port configured to supply fluid to drill the recess or the channel in the mobile calculus.

[0103] Implementation 14 is a method of treating a mobile calculus in a patient, the method comprising: drilling a hole in the mobile calculus to create a recess into the mobile calculus or a passageway through the mobile calculus; advancing an acoustic transducer into the recess or the passageway; and energizing the acoustic transducer to transmit acoustic energy to the mobile calculus to fragment the mobile calculus.

[0104] In Example 15, the subject matter of Example 14 includes: deploying a capture portion configured to receive and constrain at least a portion of the mobile calculus.

[0105] In Example 16, the subject matter of Examples 14-15 includes: deploying a capture portion comprising a receiving opening; receiving the mobile calculus into the receiving opening to capture the mobile calculus; constraining movement of the mobile calculus relative to the acoustic transducer; and energizing the acoustic transducer.

[0106] In Example 17, the subject matter of Examples 14-16 includes: capturing at least a portion of the fragmented mobile calculus and removing the mobile calculus from the patient.

[0107] In Example 18, the subject matter of Examples 14-17 includes: suctioning an area surrounding at least a portion of the fragmented mobile calculus to move at least a portion of the fragmented mobile calculus into a working channel.

[0108] In Example 19, the subject matter of Examples 14-18 includes: providing fluid through a delivery member having a tubular structure comprising a surface and a fluid delivery channel extending through the delivery member, the fluid delivery channel being in fluid communication with a fluid port in the surface, wherein providing fluid causes the fluid to be dispensed from the fluid port into the recess or the passageway to cause deterioration of the mobile calculus.

[0109] Example 20 is a method of controlling a lithotripter, the method comprising: providing a lithotripsy system comprising a drill at a distal portion, an acoustic transducer proximal of the drill, and a capture portion; issuing or receiving a first control signal for actuating the drill; issuing or receiving an input for deploying the capture portion; and issuing or receiving a second control signal for energizing the acoustic transducer.

[0110] In Example 21, the subject matter of Example 20 includes: wherein providing the lithotripsy system comprises providing a delivery member having a tubular structure comprising a surface and a fluid delivery channel extending through the delivery member, the fluid delivery channel being in fluid communication with a fluid port in the surface, and the method further comprises: issuing or receiving a control signal for dispensing fluid from the fluid port.

[0111] In Example 22, the subject matter of Examples 20-21 includes issuing or receiving a control signal to actuate an aspiration system that causes aspiration to occur in a region near a distal end of a working channel, wherein the working channel is configured to allow the drill, the acoustic transducer, and the capture portion to be delivered through the working channel.

[0112] Example 23 is a system that delivers energy to treat a mobile calculus, the system comprising: a drill configured to drill a recess into the mobile calculus or a channel through the mobile calculus; and an energy emitter configured to advance into the recess or the channel and send energy inside the mobile calculus to fragment the mobile calculus.

[0113] In Example 24, the subject matter of Example 23 includes wherein the energy emitter comprises at least one of an acoustic transducer, an opto-acoustic transducer, a laser node, or a fluid jet.

[0114] In Example 25, the subject matter of Examples 23-24 includes wherein the energy emitter emits energy in a lateral direction.

[0115] Example 26 is at least one machine readable medium comprising instructions that, when executed by processing circuitry, cause the processing circuitry to perform operations to implement any of Examples 1-25.

[0116] Example 27 is an apparatus comprising means to implement any of Examples 1-25.

[0117] Example 28 is a system to implement any of Examples 1-25.

[0118] Example 29 is a method to implement any of Examples 1-25.

Claims

1. A system to deliver energy to treat a mobile calculus, the system comprising: a drill configured to drill a recess into the mobile calculus or a passageway through the mobile calculus; and a transducer configured to advance into the recess or the passageway and to deliver energy inside the mobile calculus to fragment the mobile calculus, wherein at least a portion of the drill is at a distal end portion of a delivery member having an elongated shaft deliverable through a working channel to a treatment site, and wherein the transducer and the drill are coupled to the elongated shaft with the transducer proximal to the drill.

2. The system of claim 1, wherein, The transducer comprises an acoustic transducer.

3. The system of claim 1, comprising a capture portion configured to constrain movement of at least a portion of the mobile calculus relative to the capture portion.

4. The system of claim 3, wherein, The capture portion is configured to capture at least a portion of a fragmented mobile calculus to be removed.

5. The system of claim 3, wherein, The capture portion is at the distal end portion of the delivery member having the elongated shaft, and wherein the capture portion is configured to advance through the passageway and to deploy distal to the mobile calculus.

6. The system of claim 3, wherein, The capture portion comprises a deformable strut configured to expand to a deployed position.

7. The system of claim 3, wherein, The capture portion comprises a receiving opening configured to receive the mobile calculus.

8. The system of claim 3, wherein, The capture portion comprises a receiving opening and a closure member, and wherein the capture portion is deployable from a compressed state when positioned in a working channel to a receiving state when deployed distally from the working channel, and wherein in the receiving state the capture portion is configured to receive the mobile calculus through the receiving opening, and wherein when the closure member is actuated the receiving opening deforms so that the capture portion is able to constrain the mobile calculus in a captured state.

9. The system of claim 1, wherein, The delivery member has the elongated shaft and a fluid delivery channel, the elongated shaft comprising a tubular structure, the tubular structure comprising a surface, the fluid delivery channel extending through the delivery member, the fluid delivery channel in fluid communication with a fluid port in the surface, wherein the fluid port is configured to provide fluid into the recess or the passageway to deteriorate the mobile calculus, and wherein the drill and the transducer are coupled to the elongated shaft.

10. The system of claim 9, wherein, The fluid port comprises a plurality of fluid ports longitudinally spaced along a length of the elongated shaft.

11. The system of claim 9, wherein, The fluid port comprises a plurality of fluid ports radially spaced around the elongated shaft.

12. The system of claim 1, wherein, The delivery member has the elongated shaft comprising a tubular structure and a fluid delivery channel extending through the delivery member, wherein the drill is at a distal end of the elongated shaft, and wherein the drill comprises a fluid port in fluid communication with the fluid delivery channel, the fluid port configured to supply fluid to drill the recess into the mobile calculus or the passageway through the mobile calculus.

13. A system to deliver energy to treat a mobile calculus, the system comprising: a drill configured to drill a recess into the mobile calculus or a passageway through the mobile calculus; and a transducer configured to advance into the recess or the passageway and to deliver energy inside the mobile calculus to fragment the mobile calculus, wherein at least a portion of the drill is at a distal end portion of a delivery member having an elongated shaft deliverable through a working channel to a treatment site, and wherein the transducer and the drill are coupled to the elongated shaft with the transducer proximal to the drill. an energy emitter configured to advance into the recess or the channel and to send energy inside the mobile calculus to fragment the mobile calculus, wherein at least a portion of the drill is at a distal portion of a delivery member having an elongated shaft deliverable to a treatment site through a working channel, and wherein the energy emitter and the drill are coupled to the elongated shaft, with the energy emitter being proximal to the drill.

14. The system of claim 13, wherein, The energy emitter includes at least one of an acoustic transducer, an opto-acoustic transducer, a laser node, or a fluid jet.

15. The system of claim 13, wherein, The energy emitter emits energy in a transverse direction. The energy emitter emits energy in a transverse direction.

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