Lithotripsy device for breaking up calculi with an axially movable acceleration tube, and method for accelerating a projectile of a lithotripsy device

Abstract

The invention relates to a lithotripsy device for breaking up calculi, the lithotripsy device comprising: a support unit; a guide tube; an acceleration tube having an axial direction, a cavity, a proximal end, and a distal end; a movable projectile; and a proximal stop element and a distal stop element for the movable projectile. The acceleration tube has at least one proximal opening and at least one distal opening for the inflow and / or outflow of a pressure medium into and / or out of the cavity of said acceleration tube in order to move the projectile back and forth between the proximal stop element and the distal stop element, the acceleration tube being positioned so as to be movable in the axial direction internally at its proximal end portion by means of the proximal stop element and at its distal end portion by means of the distal stop element so that the acceleration tube can be displaced in a distal direction and in a proximal direction relative to the guide tube. The invention also relates to a method for accelerating a projectile of a lithotripsy device.

Description

Lithotripsy device for crushing body stones with an axially movable acceleration tube and method for accelerating a projectile of a lithotripsy device

[0001] The invention relates to a lithotripsy device for fragmenting body stones, wherein the lithotripsy device comprises a carrier unit, a guide tube, an acceleration tube with an axial direction, a cavity, a proximal end and a distal end, a movable projectile, and a proximal-side stop element and a distal-side stop element for the movable projectile, wherein the acceleration tube is at least partially surrounded by the guide tube and the acceleration tube has at least one proximal-side opening and at least one distal-side opening for the inflow and / or outflow of a pressure medium into and / or from its cavity for moving the projectile back and forth between the proximal-side stop element and the distal-side stop element, and wherein a drive device for supplying and / or removing the pressure medium and a probe can be associated with the lithotripsy device.The probe can be connected directly or indirectly to the carrier unit at its proximal end and can be excited by mechanical contact of the projectile with the distal-side stop element. Furthermore, the invention relates to a method for accelerating a projectile of a lithotripsy device.

[0002] Lithotripsy is a well-known procedure for breaking up body stones, which form, for example, through the condensation and / or crystallization of salts and proteins as so-called concretions in body organs, such as the bladder or kidneys. If the body stones are too large to pass naturally and If stones cause discomfort, they must be broken up with a lithotripter so that the fragmented stones can be eliminated through natural excretion and / or using a suction-flushing pump. The body stones to be broken up are often inhomogeneous, with varying compositions and / or densities.

[0003] Pneumatic lithotripters are based on the impact hammer principle, in which a projectile is accelerated within a usually fixed acceleration tube. The kinetic energy of the projectile is transferred via an elastic impact to the proximal end of a probe and / or sonotrode, and further to its distal end to fragment the body stone. The successive impacts of the projectile are typically controlled by timed compressed air pulses. This means that the rate of the shock waves transmitted to the probe and / or sonotrode is directly dependent on the timing of the successive compressed air pulses. Consequently, the impact rate is limited in known lithotripters due to the single-lumen acceleration tube and the reversing compressed air drive of the projectile.Furthermore, a compressed air reservoir must be connected distally to the interior of the acceleration tube via a connection and / or a switching valve in order to move the project back to the proximal stop after it has reached a distal stop. In the simplest case, a passive air spring is used for the repulsion of the project, in which the distally moving project displaces the air from the acceleration tube into a reservoir, where the pressure increases. After the acceleration pressure in the distal direction is switched off, the pressure in the reservoir can be used to move the project back in the proximal direction. A disadvantage of this is that the built-up acceleration pressure in the distal direction reduces the repulsion of the project. The projectile is dampened in the proximal direction, and the energy that can be stored in the reservoir is limited, resulting in a slower re-acceleration of the projectile. Consequently, the air in the connecting tube to the lithotripter must also be forced back with each pulse and released into the atmosphere via a proximal-side reversing valve, for example, in the control unit. In addition to pressure regulation, a complex control unit with a time-controlled reversing valve is therefore required. Furthermore, the projectile does not typically rebound automatically at the proximal stop, i.e., at the reversal point, but must be accelerated again from a standstill with compressed air in the distal direction. These constraints usually limit the maximum pulse rate to well below 15 Hz.

[0004] Furthermore, a known device typically requires a deflection lever to change the direction of movement of the projectile and thus to redirect the impact. Due to a loss of impact impulse caused by a deflection lever, generating a large distal velocity with a simultaneously high amplitude at the sonotrode and / or probe end is only possible to a limited extent.

[0005] Conventional lithotripters have the significant disadvantage of lacking active return and thus repulsion of the projectile. Instead, they rely on slow and inefficient air springs between the projectile and the inside of the acceleration tube. This limits the usable impact frequency and can result in the entire acceleration range no longer being utilized above a certain frequency. Furthermore, if the switching valve is located externally in a drive and / or supply unit, a considerable amount of pressure is typically lost through expansion of the compressed air supply hose. Conversely, using a stiffer hose with lower pressure loss worsens the performance. Handling the lithotripter. Installing the valve and / or the entire drive and supply unit in the handpiece of the lithotripter makes sterilization more difficult and increases the weight.

[0006] The purpose of the invention is to improve the state of the art.

[0007] The problem is solved by a lithotripsy device for fragmenting body stones, wherein the lithotripsy device comprises a carrier unit, a guide tube, an acceleration tube with an axial direction, a cavity, a proximal end and a distal end, a movable projectile, and a proximal-side stop element and a distal-side stop element for the movable projectile, wherein the acceleration tube is at least partially surrounded by the guide tube and the acceleration tube has at least one proximal-side opening and at least one distal-side opening for the inflow and / or outflow of a pressure medium into and / or from its cavity for moving the projectile back and forth between the proximal-side stop element and the distal-side stop element, and wherein a drive device for supplying and / or removing the pressure medium and a probe can be associated with the lithotripsy device.The probe can be connected directly or indirectly to the carrier unit at its proximal end and can be excited to vibration by a mechanical impact of the projectile on the distal-side stop element, wherein the accelerator tube is arranged internally at its proximal end section by means of the proximal-side stop element and at its distal end section by means of the distal-side stop element in the axial direction, so that the accelerator tube is displaceable in a distal direction and in a proximal direction relative to the guide tube.

[0008] Thus, a lithotripsy device with an axially movable acceleration tube is provided, in which friction losses are minimized due to a very short fit of the proximal end section with the proximal-side stop element and the distal end section with the distal-side stop element, making it possible to utilize the entire acceleration path and thus the length of the acceleration tube in its cavity for accelerating the projectile.

[0009] Because the accelerator tube has at least one proximal opening and at least one distal opening for the inflow and / or outflow of a pressure medium into and / or from its cavity, and because the accelerator tube is arranged to be axially movable relative to the surrounding guide tube, the position of the at least one proximal opening and the at least one distal opening relative to the guide tube can be directly adjusted by moving the accelerator tube in the axial direction. Due to the axial mobility of the accelerator tube, and thus its targeted displacement in the axial direction, the at least one proximal opening and the at least one distal opening are shifted accordingly relative to the guide tube and can be used directly to control the supply and / or discharge of the pressure medium and thus to accelerate the projectile in the distal or proximal direction.Consequently, a self-regulating pneumatic drive is provided by means of the axially movable acceleration tube. This enables the projectile to be accelerated over a multiple of its length along the acceleration path, in order to transfer the projectile's momentum upon impact with the distal stop element to the probe for pneumatic stone fragmentation.

[0010] Thus, after the pressure medium supply is initiated once, a self-regulating process takes place in which the projectile is continuously moved back and forth by the constant pressure of the pressure medium. The switching of the direction of movement is determined by the axial position of the accelerator tube and the at least one proximal opening and / or the at least one distal opening. The uniform, constant flow of the pressure medium through the at least one proximal opening or the at least one distal opening of the accelerator tube, and the essentially complete utilization of the acceleration path, enable a higher impact rate, particularly with a frequency of > 15 Hz, preferably > 30 Hz, than is possible with known lithotripters.Furthermore, it is ensured that the entire acceleration section is utilized and that the impact force does not decrease with increasing frequency, thus achieving a higher stone removal rate than in known lithotripters. Accordingly, the lithotripsy device according to the invention can also operate at a lower pressure for the same proctile velocity. In addition, the lithotripsy device has a smaller installation space and therefore a reduced instrument weight, since the distal-side pressure reservoir with and / or without a switching valve and with connection to the acceleration section, as found in known lithotripters, is omitted.

[0011] A key aspect of the invention is based on the principle, contrary to the conventional view that an accelerator tube must be fixedly installed within a lithotripsy device, of designing the accelerator tube to be movable in the axial direction and of achieving a specific effect by moving the accelerator tube in the axial or proximal direction. To implement valve switching for moving the project back and forth, the axially movable accelerator tube allows for direct control of the project's direction of movement. This integration within the lithotripsy device eliminates the need for complex external supply and discharge systems, pressure medium control, external switching valve timing, and a distal pressure reservoir. Furthermore, the frequency of the project's mechanical impacts on the probe is not determined by externally timed pressure pulses, but rather by the pressure medium flow rate. This is controlled by the axial position of the accelerator tube, specifically the position of the at least one proximal and at least one distal opening, and thus whether these openings are operating in an overpressure (or alternatively, underpressure) or ambient pressure range. The project's direction of movement can also be predetermined.

[0012] The following terms will be explained:

[0013] A "lithotripsy device" (also called a "lithotripter") is, in particular, a device for fragmenting body stones by impacts, shock waves, and / or deformation waves. The term "lithotripsy device" encompasses various components, structural elements, and / or functional parts of a lithotripter. The lithotripsy device can constitute a lithotripter completely or partially. A lithotripsy device can be, in particular, intracorporeal or extracorporeal. In the case of an intracorporeal lithotripsy device, it may additionally include a rinsing / suction pump. The lithotripsy device can be designed as a handheld device and / or include an endoscope or be inserted into an endoscope. The lithotripsy device is, in particular, autoclavable and is made, for example, of instrument steel and / or plastic. The lithotripsy device may include further components, such as a control and / or power supply unit, or these may be associated with the lithotripsy device. A lithotripsy device is, in particular, a pneumatic lithotripsy device. In principle, the lithotripsy device can also have a combined excitation with a repetitive percussive excitation by means of the projectile and a constant vibration excitation, for example, by means of an ultrasonic generator. For this purpose, the lithotripsy device has, in particular, a counter bearing, a horn, and at least one piezoelectric element as a vibration exciter between the counter bearing and the horn, wherein the horn is, in particular, connectable to the probe and the at least one piezoelectric element is electrically connectable to an associated ultrasonic generator, so that a substantially constant ultrasonic energy can be supplied to the probe by means of the piezoelectric element.In the case of combined excitation, the probe is preferably designed as a solid rod sonotrode. Furthermore, the lithotripsy device and / or the carrier unit has a control unit for starting, stopping, and / or individually triggering a movement of the projectile. This control unit can be, for example, a lever, a push button, and / or a rotary knob. By operating the switching function on the lithotripsy device itself, the otherwise conventional foot switch for triggering a shock wave of the projectile can be dispensed with, thus reducing the cost of the lithotripsy device and improving clarity in the operating room.

[0014] The term "body stones" (also called "concretion") refers specifically to all stones in a human or animal body that form, for example, from salts and proteins through crystallization and / or condensation. Body stones can include, for example, gallstones, urinary stones, kidney stones and / or salivary stones.

[0015] A "carrier unit" is, in particular, a hand and / or holding part of the lithotripsy device. The carrier unit can be, in particular, a handle for manual and / or automated operation and / or connection of the lithotripsy device. The carrier unit can also be arranged at, connected to, and / or automatically guided at a distal end of a robot arm. The carrier unit, in particular, comprises a housing.

[0016] A "guide tube" is, in particular, an elongated hollow body whose length is greater than its diameter. The guide tube has, in particular, a cavity in which the accelerator tube is at least partially arranged. The guide tube may, in particular, have the same length as the accelerator tube or a shorter length. If the guide tube is shorter, a proximal end cap may be arranged at its proximal end and a distal end cap at its distal end, with the accelerator tube being further arranged axially within a cavity of the proximal and distal end caps.The guide tube, the proximal end cap, and / or the distal end cap can accommodate at least one proximal supply air channel and at least one proximal exhaust air channel, and / or at least one distal supply air channel and one proximal exhaust air channel, through which the pressure medium flows into or out of the at least one proximal opening and the at least one distal opening of the acceleration tube. Supply air and exhaust air channels in the guide tube can be designed as cavities, allowing the pressure medium to flow into and / or out of the acceleration tube from all sides. The cavity of the guide tube itself is preferably located below. Ambient pressure conditions. Instead of a tube, a guide tube can also be a hollow cylinder, with the two fully and / or partially closed end faces directly or indirectly (for example, by means of an intermediate spring) forming a proximal and a distal stop for the axially movable proximal and distal stop elements. The guide tube can also be designed as two axially aligned guide elements, each arranged at least around the proximal and distal ends of the accelerator tube. In principle, the cross-section of the guide tube need not be circular, but can have any shape, such as oval, triangular, square, or polygonal. The guide tube is, in particular, fixedly installed inside the support unit of the lithotripsy device and is therefore not movable.

[0017] A "stop element" is, in particular, an element or component that serves as the intended endpoint of the project's movement along the acceleration path, at which the accelerated project strikes, decelerates, rebounds, and / or is repulsed and / or moved in the opposite direction. Thus, the stop element absorbs at least some of the project's kinetic energy. A distal stop element, in particular, absorbs the impact and / or shock of the project and transmits it directly or indirectly to the probe. A proximal stop element is, in particular, located at and / or in the proximal end of the acceleration tube and / or within the cavity in a region of the proximal section of the acceleration tube. Accordingly, a distal stop element is, in particular, located at and / or in the distal end of the acceleration tube and / or within the cavity in a region of the distal end section of theThe accelerator tube is arranged. The distal end stop is connected, in particular, directly or indirectly to the proximal end of the probe. The proximal end stop and the distal end stop are essentially cylindrical in shape, with their longitudinal axis aligned parallel to the longitudinal axis of the accelerator tube. The proximal end stop and the distal end stop are movable, in particular, in the axial, distal, and / or proximal directions. The proximal end stop and / or the distal end stop are made, in particular, of a hard material, such as stainless steel or hardened steel, and / or a hardening layer, such as a diamond-like carbon layer. Preferably, the proximal end stop and / or the distal end stop are harder than the projectile, or vice versa.Preferably, one of the two impact partners is softer than the other. The proximal and distal impact elements can each form a compressed air spring with the surrounding acceleration tube inside the cavity. Preferably, however, no compressed air spring is formed; instead, the proximal and distal impact elements each impact against a separate spring element. The distal impact element (also called a "billiard ball") has a slightly higher mass than the projectile. The mass ratio of the projectile to the billiard ball is preferably in the range of 0.6 to 1.4, preferably close to 1:1, and optimally at 1:1.2, in order to achieve optimal energy and momentum transfer for an elastic impact in the latter case.The mass ratio of the proximal-side stop element to the projectile should ideally be around 1:1. This mass ratio ensures that the projectile transfers force in the event of an impact. The entire impulse is transferred to a spring-loaded, proximal-side stop element, and a force is further transmitted to the accelerator tube via a first spring element, which shifts it in the proximal direction until a proximal stop of the accelerator tube and a starting position for renewed acceleration of the projectile in the distal direction are reached.

[0018] The terms "distal" and "distal" refer to an arrangement close to the body and thus farther from the user, and / or a corresponding end or section. Similarly, "proximal" or "proximal" refers to an arrangement close to the user and thus farther from the body, or a corresponding end or section. Accordingly, "distal direction" refers to the direction oriented towards the distal end of the accelerator tube and / or the lithotripsy device. The distal direction is, in particular, the direction of the projectile's movement towards the probe. "Proximal direction" refers, in particular, to the direction towards the proximal end of the accelerator tube and / or the lithotripsy device. Thus, the proximal direction is the direction of the projectile's return movement.

[0019] An "acceleration path" is, in particular, a section of a longitudinal dimension of the cavity of the acceleration tube, which is defined by a distal end stop of the proximal end stop and by a proximal end stop of the distal end stop. The maximum acceleration path of the project corresponds, in particular, to the maximum longitudinal dimension of the cavity of the acceleration tube minus the project length, if the proximal end stop is flush with the proximal end of the acceleration tube and the distal end stop They are arranged flush with the distal end of the acceleration tube. The longitudinal dimension of the cavity can, for example, be 150 mm.

[0020] A "projectile" is, in particular, a body that is freely movable along the acceleration path within the cavity of the acceleration tube. Specifically, the projectile is movable back and forth between the proximal and distal end stops within the cavity of the acceleration tube. In principle, the projectile can have any shape. For example, it can be shaped like a bolt or a sphere. The projectile can have a slightly smaller diameter at its proximal end than in its middle section. Thus, the projectile can have a chamfer at its proximal end, which, for example, widens conically from the proximal end to the middle section of the projectile.The project can also have a chamfer at its distal end, thus narrowing from a central region to the distal end. Such a double chamfer of the project particularly improves movement at a starting point and / or reversal point of the project. Furthermore, the project can have surface textures, such as grooves. This minimizes contact with the inner surface of the accelerator tube. The project is made of hard steel and / or has magnetic properties. For free movement, the project has a slightly smaller outer diameter than the diameter of the cavity of the accelerator tube. For example, the project can have an outer diameter of 8 mm, preferably 6 mm.

[0021] The project can be moved back and forth continuously between the proximal and distal stop elements, and thus along the acceleration path, by means of the pressure medium of the drive device. Preferably, the project is moved back and forth continuously, intermittently, and / or oscillatingly between the proximal and distal stop elements.

[0022] The "acceleration tube" is, in particular, an elongated hollow body whose length is greater than its diameter. The acceleration tube has, in particular, an axially continuous cavity within which the project can move. The acceleration tube is, in particular, tubular with an open proximal end and an open distal end, wherein the proximal-side stop element is at least partially located and movable within the open proximal end, and the distal-side stop element is at least partially located and movable within the open distal end. The acceleration tube can also be designed as a hollow cylinder, with at least one opening arranged in each of the end faces. The acceleration tube has, in particular, a smaller diameter than the guide tube.The acceleration tube has at least one proximal opening and at least one distal opening for the passage of the pressure medium. The acceleration tube can be arranged in a rotationally secure manner, in particular within the cavity of the guide tube and / or the end caps on both sides, so that axial movement of the acceleration tube is permitted, but rotation of the acceleration tube is not, thereby connecting the respective proximal opening and / or the distal opening of the acceleration tube with the respective supply air duct or exhaust air duct in the guide tube and / or the two end caps. End caps can be brought into a continuous position for the pressure medium. If the supply and exhaust air channels in the guide tube are designed as cavities, especially as circumferential cavities around the outer surface of the acceleration tube, a rotation lock is not required.

[0023] The acceleration tube and its at least one proximal opening and at least one distal opening are designed such that, for example, in the event of a proximal impact of the proximal stop element and the proximal end of the acceleration tube, the proximal opening of the acceleration tube is continuously connected to the proximal supply air duct, and pressurized medium can flow through the supply air duct and the proximal opening into the cavity to accelerate the project in the distal direction. Likewise, in the event of a distal impact of the distal stop element and the distal end of the acceleration tube, the distal opening is continuously connected to the distal supply air duct, and the inflowing pressurized medium moves the project back in the proximal direction within the cavity. In this case, the project can repulse at the respective stop element.

[0024] A "longitudinal center axis" is, in particular, the axis of the accelerator tube and / or the lithotripsy device that corresponds to the direction of the largest dimension of the accelerator tube and / or the lithotripsy device. Thus, the longitudinal center axis runs along the axial direction.

[0025] The term "radial" is understood to mean, in particular, extending in the direction of a radius. Thus, the radial direction runs outwards from the longitudinal center axis.

[0026] A proximal and a distal opening are each a penetration through a wall of the accelerator tube. The proximal and distal openings are specifically designed to extend through the entire surface of the accelerator tube. Each of the proximal and distal openings of the accelerator tube can be a bore. These openings have a relatively large diameter, so that essentially no pressure loss occurs. For example, the openings of the accelerator tube can have a diameter in the range of 2 to 3 mm, with a diameter of the accelerator tube of The openings of the acceleration tube may have a chamfer on the inside of its cavity to prevent wear and / or chip formation on the projectile.

[0027] In principle, a "drive device" can be any type of device that exerts a force on the project, and thus causes movement of the project, by supplying and / or removing a pressure medium. The drive device, in particular, ensures a continuous and uniform flow of the pressure medium through the proximal or distal openings of the acceleration tube, for example pneumatically using compressed air, and accelerates the project within the cavity of the acceleration tube.

[0028] A "pressure medium" is, in particular, a fluid. A pressure medium can be a gas, such as compressed air. The pressure medium can, for example, be taken from a domestic water supply and / or generated by a compressor. The pressure medium is, in particular, continuously supplied to and / or removed from the lithotripsy device and / or circulated. The pressure medium has, in particular, a pressure of a range of 0 to 10 bar. Due to the continuous supply and discharge of the pressure medium free from alternating loads, a pressure of > 10 bar can also be used.

[0029] A "probe" is, in particular, an elongated component, which may be, for example, rod-, tube-, and / or hose-shaped. A probe may also be a hollow probe, which has a cavity running at least partially or completely through its interior in the longitudinal direction. The hollow probe has, in particular, a distal opening at its distal end, which is connected to the internal cavity. The probe can be set into vibration, resonant vibration, and / or deformation vibration, in particular, by the application and / or introduction of mechanical vibrations. A probe may also be a sonotrode. The probe is, in particular, formed in one piece. The probe has, in particular, a diameter in the range of 0.5 mm to 4.5 mm, especially from 0.8 mm to 3.8 mm. The probe is made, in particular, of steel, titanium, aluminum, and / or carbon.A probe can be, in particular, a reusable probe or a disposable probe.

[0030] In a pneumatic lithotripsy device, an impact energy is used to imprint a precisely shaped deformation wave onto the probe when a projectile strikes a distal stop element. This deformation wave causes a translational movement of the probe, which, due to the deflection, results in improved stone fragmentation. In addition to the mechanical impact, the probe can also be excited into vibration, particularly longitudinal vibration, by means of a vibration excitation device, such as an ultrasonic vibration exciter. The probe is designed in particular as a waveguide for the vibration waves generated by a vibration excitation device and / or for the shock waves and / or deformation waves of the project.

[0031] The proximal end of the probe can, in particular, rest directly or indirectly against the distal stop element. Preferably, the probe is joined proximally in a threaded / retaining nipple that is thicker than its diameter. The corresponding nipple can also be a headpiece. Preferably, the headpiece of the probe is movably mounted. The probe is, in particular, shaped such that it optimally transmits the vibration waves, deformation waves, shock waves, and / or the ultrasound vibrations at its distal end into the body, the body region to be treated, and / or directly onto the body stone to be fragmented.

[0032] In another embodiment of the lithotripsy device, when the axially movable accelerator tube reaches a proximal stop, a first valve opening position allows the pressure medium to flow through the at least one proximal opening into and / or out of the cavity of the accelerator tube to move the projectile towards the distal stop element or to move the project back to the proximal stop element. A second valve opening position is also available when the axially movable accelerator tube reaches a distal stop. The valve opening position allows the pressure medium to flow through the at least one distal opening into and / or out of the cavity of the acceleration tube to move the project back to the proximal stop element or to move the project towards the distal stop element.

[0033] Thus, depending on the position of the movable part Acceleration tube in axial direction a defined first valve opening position or a defined second valve opening position is enabled, whereby by striking the projectile against the distal-side stop element or the proximal-side stop element, the acceleration tube is moved axially further in the direction of movement of the project, thereby switching the flow direction of the pressure medium and thus changing the direction of movement of the project and also of the axially movable acceleration tube.

[0034] In principle, it should be noted that the pressure medium can flow into or out of the cavity of the acceleration tube through either the respective opening on the proximal side or the opening on the distal side. For example, if the proximal end of the acceleration tube is stopped, and the pressure medium flows in through the opening on the proximal side, thus creating an overpressure operation, the project is accelerated towards the distal stop. For a vacuum operation, and thus for the pressure medium to flow out of the cavity, a vacuum must be applied to the opening on the distal side of the acceleration tube so that the project moves from the proximal end of the acceleration tube towards the distal stop.Thus, depending on their axial position, the proximal and distal openings are located in the overpressure (or alternatively, underpressure) or ambient pressure range, which controls the direction of movement of the projectile. The change in direction of movement is induced by the projectile striking the proximal or distal stop element, with a simultaneous impact on the probe on the distal side. This reverses the supply or discharge of compressed air to the accelerator tube, making the project passive and / or active. to move back. It is particularly advantageous that only a single hose is required to supply the pressure medium to the lithotripsy device (for the supply air or for applying a vacuum), and the energy for switching is taken from the projectile in the acceleration direction while it is still being accelerated by the incoming (or outgoing) pressure medium. Depending on the movement of the acceleration tube in the distal or proximal direction, and depending on the axial position, at least one proximal-side opening is open in the first valve opening position and thus allows the pressure medium to flow through it, and closed in the second valve opening position to allow the pressure medium to flow in. The valve opening positions are correspondingly reversed for the distal-side opening.

[0035] In order to achieve a uniform, spatially distributed flow of the pressure medium, the accelerator tube has a second proximal opening and / or further proximal openings and a second distal opening and / or further distal openings.

[0036] Furthermore, the flow resistance can be reduced by having several openings on the proximal and / or distal side.

[0037] The “second proximal opening” or “further proximal openings” and the “second distal opening” or “further distal openings” each refer, in their respective design and function, to a proximal or distal opening as defined above. However, these further proximal or distal openings may be located at a different position within the accelerator tube.

[0038] In another form of implementation of the The lithotripsy device is or are the at least one proximal opening or the proximal openings and the at least one distal opening or the distal openings in a lateral surface of the acceleration tube, axially symmetric to a longitudinal central axis of the acceleration tube and / or circumferentially arranged.

[0039] The respective proximal and distal openings are designed to extend through the outer surface of the accelerator tube, thus orienting them radially perpendicular to the axial direction. This allows the outflowing pressure medium to be discharged laterally from the accelerator tube and / or the lithotripsy device. The venting direction is therefore perpendicular to the distal direction, and the pressure medium exiting the cavity of the accelerator tube is preferably already at ambient pressure before passing through an exhaust duct, from where it is released into the environment surrounding the lithotripsy device. This prevents any overpressure of the pressure medium directed distally towards the probe, thus avoiding a risk to the patient from unwanted overpressure in the event of a malfunction.

[0040] Furthermore, the axially symmetrical arrangement of the respective proximal and / or distal openings, or their circumferential arrangement, ensures a uniform inflow and / or outflow from the cavity of the acceleration tube, thus preserving the axial mobility of the acceleration tube. It should be emphasized that, of course, the multiple proximal and / or distal openings preferably have the same They have cross-sectional openings. However, these can also have cross-sectional openings of different sizes.

[0041] In order to arrange the proximal-side stop element and / or the distal-side stop element at least partially in the cavity of the acceleration tube and to make it movable, the proximal-side stop element has a first cylindrical section and the distal-side stop element has a second cylindrical section, wherein the proximal end section of the acceleration tube is movable in the axial direction around the first cylindrical section and the distal end section of the acceleration tube is movable around the second cylindrical section.

[0042] In another embodiment, the proximal-side stop element has a first termination section as a stop at the proximal end of the acceleration tube, and the distal-side stop element has a second termination section as a stop at the distal end of the acceleration tube.

[0043] In addition to forming a defined stop, the respective end sections of the proximal and distal stop elements also reliably seal the pressurized area of ​​the acceleration tube cavity. This, along with the radial exhaust air discharge, prevents unwanted overpressure distal to the probe and thus to the patient. The end sections also prevent the projectile from exiting the acceleration tube axially.

[0044] A "terminal section" is in particular an area of ​​the proximal and distal stop elements which has a larger cross-section than the cross-section of the outer diameter of the acceleration tube, such that The proximal and distal ends of the accelerator tube each abut the radially outwardly projecting end section in the axial direction, respectively. To dampen the respective impact, a damping element, such as an O-ring, can be arranged between the respective end of the accelerator tube and the end section.

[0045] In order to actively move the projectile struck against the stop element back in the opposite direction, in addition to passive resetting, a first spring element for repulsion of the projectile is arranged proximal to the proximal-side stop element and / or to the first end element.

[0046] Thus, an active proximal reversal mechanism is provided, in which the kinetic energy of the project is transferred to the proximal-side stop element. This stop element compresses the spring element, which exerts a force on the accelerator tube, thereby displacing it in a proximal direction. The remaining force can then be converted back into kinetic energy by the spring element of the proximal-side stop element and transferred from this stop element to the project via a push, thereby recovering some of the energy that was supplied to the project during its movement from the distal end of the accelerator tube to the proximal end.Ideally, the proximal first spring element is used to largely store the kinetic energy of the impacting projectile and utilize it for the axial movement of the accelerator tube and the repulsion of the projectile. Thus, the spring element promotes the projectile's rebound and therefore its reversal motion. In principle, it should be emphasized that in a... Sufficient speed allows the project to be passively repulsed and / or moved back at the proximal or distal stop element without a spring element. However, in the case of this passive return, a short dead time can occur at this reversal point. To reliably overcome this reversal point, a first and / or second spring element of the distal and / or proximal stop element actively initiates and accelerates the reversal of movement, consequently achieving a rapid switch between the valve opening positions.

[0047] A "spring element" (also called a spring) is, in particular, any element and / or component that can deform elastically enough to overcome a brief counter-pressure at the reversal point of the projectile's motion at the distal or proximal stop element. A spring element can, for example, be a helical spring, i.e., a wire wound in a helical shape with sufficient energy storage capacity. The respective spring element converts, in particular, the kinetic energy of the projectile, which is initially transferred to the proximal or distal stop element, into potential energy, which is used for axial movement of the accelerator tube and the active return of the projectile. The spring, in particular, has a larger diameter than the projectile and / or a similar or larger diameter than the accelerator tube.For example, the spring element can have a diameter in the range of 5.00 mm to 9.00 mm and / or a wire thickness in the range of 0.50 mm to 1.25 mm. The length of the spring element can, for example, be in the range of 5.00 mm to 10.00 mm in a relaxed state and in the range of 1.00 mm to 2.00 mm in a compressed state.

[0048] In another embodiment, the distal-side stop element has a push pin distal to the second cylindrical section and / or the second end section for transferring a push from the projectile to the probe.

[0049] Thus, the impact pin efficiently transmits the impact to the probe. A particular advantage is that the design of the impact pin, especially its length and diameter, can be realized independently of the design of the other distal-side impact element. This allows the diameter of the impact pin to be individually adapted to the diameter of the probe head against which it strikes. This enables efficient acceleration and active rebound of a projectile over a multiple of its own length, in order to transfer its momentum to a probe for stone fragmentation.

[0050] A "shock pin" is, in particular, a distal section of the distal stop element used to transmit a shock to the probe. The shock pin has, in particular, a conical and / or cylindrical shape. With its distal end face and / or circular surface, the shock pin strikes, in particular, directly or indirectly, the proximal end of the probe. The end face is, in particular, a smooth surface.

[0051] In order to also effect an active axial displacement of the accelerator tube and optionally an active repulsion of the projectile at the distal end of the projectile, a second spring element is arranged distal to the second end section and / or around the push pin of the distal end stop element.

[0052] It is particularly advantageous if the spring element, for example designed as a coil spring, is located on the outside. The impact pin is surrounded by a spring. This allows the impact pin to move distally beyond the distal end of the spring and efficiently transfer an impact to the probe. This design of the distal end stop element simultaneously enables efficient energy and impact transfer. When the projectile strikes the billiard project, which acts as the distal end stop, the momentum and kinetic energy of the projectile are transferred to the billiard project. The billiard project compresses the second spring element, which rests proximally against the second end element of the billiard project, thus transferring a force to the accelerator tube, which is moved distally. The billiard project and the spring element are designed such that the spring element is compressed just enough to move the accelerator tube sufficiently fast.By selecting an appropriate spring constant, the amount of energy transferred to the accelerator tube can be precisely controlled. The billiard projectile still possesses residual velocity in the distal direction and uses this velocity to strike the probe head via its impact pin, thereby transferring all of its remaining energy and momentum to the probe to shatter a body stone. Meanwhile, the accelerator tube continues to move, with the distal opening initially remaining closed and then being moved into the overpressure zone, while the previously open proximal opening is closed and then moved into the ambient pressure zone. This allows compressed air to flow into the cavity of the accelerator tube through the distal opening, accelerating the projectile in the proximal direction.

[0053] This section-by-section design of the billiard project in the axial direction offers the advantage that a variance and Independence of all component dimensions, especially the The spring element is present. Therefore, both the first and second spring elements can be selected and adjusted according to the intended energy flow and do not necessarily have to fit into the accelerator tube of the project. Thus, the required spring stiffness, especially of the distal spring element, can be achieved in a dimension around the shock pin for which there would otherwise be no available installation space.

[0054] While the energy absorbed by the spring on the proximal side is used to further displace the accelerator tube in the proximal direction and to repulse the projectile back in the distal direction, the energy transferred to the second spring element at the distal end is used to displace the accelerator tube distally, to excite the probe with a shock, and optionally to repulse the projectile proximally. Simultaneously, the billiard-shaped projectile, acting as a distal-side stop element, protects the spring and provides redundancy for safety in case the lithotripsy device has not been correctly assembled for an operation. It is particularly advantageous that the impact pin of the billiard-shaped projectile strikes the probe before all of its kinetic energy is absorbed by the spring.Thus, the billiard project with the spring element serves as a shock absorber and transmitter without an air spring forming, and consequently, no venting is necessary in this area during regular operation of the lithotripsy device.

[0055] In another embodiment of the lithotripsy device, the first spring element and at least part of the proximal-side stop element are received in a proximal-side holding unit, and the second spring element and at least part of the distal-side stop element are received in a distal-side holding unit, wherein the proximal-side holding unit and the The distal-side holding unit is each directly or indirectly connected to an outside of the acceleration tube and is movable in the axial direction.

[0056] Thus, a complete assembly with an axially movable accelerator tube is provided, which can be easily manufactured. Because the proximal-side holding unit is attached externally to the outside of the proximal end section of the accelerator tube, and because the first spring element is arranged proximally on the inside, followed distally by the proximal stop element, and because an analogous structure is formed distally, except for a passage opening on the distal wall of the distal holding unit for the insertion of the shock pin, this entire assembly can be easily and movably arranged and mounted within the guide tube and / or the end caps. The respective outer surfaces of the proximal-side holding unit and the distal-side holding unit preferably rest directly against the inside of the respective end caps and / or the guide tube.

[0057] A "retaining unit" is, in particular, a component or components which receive and hold the respective spring element and at least partially the respective stop element. The outer surface of the proximal or distal end section of the accelerator tube is, in particular, directly or indirectly, firmly attached to the respective retaining unit. The retaining unit can be made in one piece or in multiple pieces. For example, the retaining unit can be made in two parts: a cap with an external thread, which is firmly connected to the outer surface of the accelerator tube at each end (e.g., soldered on), and an end piece with an internal thread, which is screwed onto the cap as the second part of the retaining unit. The connection between the respective retaining unit and the accelerator tube is, in particular, a butt joint and / or strong and conclusive. To make this assembly easy to build, the proximal and distal retaining units are made from the thinnest possible material.

[0058] Because the holding unit is firmly connected to the outside of the accelerator tube, the spring presses directly onto the accelerator tube via the holding unit, thereby causing the axial displacement.

[0059] To enable quick switching between the To realize valve opening positions and to provide the pressure medium proximally and distally within the lithotripsy device, a chamber or two or more separate chambers for passing pressure medium to and / or from the at least one proximal opening or openings and / or the at least one distal opening or openings are arranged between an outer surface of the guide tube and an inner surface of the support unit.

[0060] Through at least one chamber, or preferably four separate chambers evenly distributed across the cross-section of the carrier unit, which are arranged along the longitudinal direction of the carrier unit and thus of the acceleration tube, compressed air can preferably be supplied directly to both the proximal and distal supply air channels, so that a pressure medium is present in both supply air channels immediately, regardless of the respective valve opening position. This enables rapid switching between the first The valve opening position and the second valve opening position are realized. In contrast, the exhaust air is preferably not discharged via chambers, but, as described above, vented radially outwards outside the lithotripsy device. Chambers can be designed, in particular, as longitudinal bores in the support unit.

[0061] In another embodiment, the lithotripsy device has a connection port for connecting to the drive unit and for continuously supplying or removing the pressure medium.

[0062] Preferably, the lithotripsy device has only a single connection port, allowing the drive unit to be connected to this port with a single hose. This simplifies the handling of the lithotripsy device.

[0063] A "connection" is any connecting element that ensures a connection for the pressure medium between the drive unit and the lithotripsy device. A connection is typically a short piece of tubing, such as a hose connector, hose barb, or hose coupling. A connection can also simply be an opening in the housing wall and / or the support unit of the lithotripsy device. This opening may, for example, have an internal thread for screwing in a hose barb. Alternatively, such an opening may be unthreaded, allowing the pressure medium to flow directly into the lithotripter.

[0064] To provide a comprehensive and / or self-contained lithotripsy device, it includes the probe and / or the drive unit.

[0065] In order to selectively accelerate the project by means of an overpressure or a underpressure, the cavity is or are opened by means of the drive device. or a negative pressure and / or a positive pressure can be imposed on a part of the cavity of the acceleration tube.

[0066] While operating a lithotripsy device under positive pressure requires a compressor or a mains pressure line with a maximum predefined pressure, operating the device under negative pressure, and thus by applying a vacuum, further reduces patient risk, simplifies the design of the operating unit, and therefore reduces costs, as complex compression, pressure regulation, and / or pressure relief valves in the operating unit are no longer necessary. Furthermore, when operating under negative pressure, the lithotripsy device can, for example, be connected directly to an existing home vacuum system in a hospital.

[0067] In a vacuum operation, for example, instead of supplying compressed air through the proximal opening of the accelerator tube, a vacuum is applied at the distal opening to move the project towards the distal stop element. This draws the air out of the cavity of the control sleeve, thereby moving the project towards the distal stop element. Accordingly, the processes described in this application regarding the inflow and supply as well as the outflow and discharge of the pressure medium apply analogously to a positive pressure operation, and conversely to a vacuum operation.

[0068] In a further aspect of the invention, the problem is solved by a method for accelerating a projectile of a lithotripsy device, wherein the lithotripsy device has a guide tube and an acceleration tube with a cavity and the acceleration tube is at least partially surrounded by the guide tube, wherein in the cavity of the acceleration tube a stop element is located between a spring-loaded proximal-side stop element. and a projectile movable by means of a spring-loaded distal stop element, and the accelerator tube has at least one proximal opening and at least one distal opening for the inflow and / or outflow of a pressure medium into and / or from its cavity for moving the projectile back and forth between the spring-loaded proximal stop element and the spring-loaded distal stop element, and the lithotripsy device is associated with a drive device for supplying and / or removing the pressure medium and a probe, and the accelerator tube is arranged internally at its proximal end section by means of the spring-loaded proximal stop element and at its distal end section by means of the spring-loaded distal stop element in the axial direction, with the following steps: Supply and / or discharge of the pressure medium by means of the drive device and flow of the pressure medium through the at least one proximal opening into the cavity of the acceleration tube and movement of the projectile by means of the pressure medium towards the spring-loaded distal stop element, Accelerating the projectile using the pressure medium, Impact of the projectile on the spring-loaded distal stop element and displacement of the accelerator tube by means of the spring-loaded distal stop element in a distal direction to switch the flow of the pressure medium, optionally repulsion of the projectile at the spring-loaded distal stop element, Transfer of a shock from the projectile upon impact to a probe by means of the spring-loaded distal-side stop element and / or Supply and / or discharge of the pressure medium by means of the drive device and flow of the pressure medium through the at least one distal opening into the cavity of the acceleration tube and retraction of the projectile by means of the pressure medium to the spring-loaded proximal stop element, Accelerating the projectile using the pressure medium, Impact of the projectile on the spring-loaded proximal-side stop element and displacement of the accelerator tube by means of the spring-loaded proximal-side stop element in a proximal direction to switch the flow of the pressure medium, and Repulsion of the projectile at the spring-loaded proximal-side stop element.

[0069] Thus, after starting the lithotripsy device, the user can very easily and quickly achieve a repeated back-and-forth movement of the projectile along the acceleration path via the self-regulating, axially movable acceleration tube, based on defined valve positions and switching the direction of movement, without having to pay attention to pressures and valve switching of an external pressure medium supply. The procedure described above refers to overpressure operation and applies analogously to underpressure operation, in which, correspondingly, a suction pressure is applied to the distal opening of the acceleration tube when moving the projectile towards the distal stop element. Conversely, in underpressure operation, the suction pressure is applied to the proximal opening of the acceleration tube when moving the project back towards the proximal stop element.

[0070] In this process, during the distal switching operation, the kinetic energy of the projectile upon impact with the spring-loaded distal stop element is used to shift the accelerator tube further axially in the distal direction by means of force transmission, thereby causing an automatic valve switching for the pressure medium and simultaneously transferring part of the momentum and the remaining energy to the probe by striking the distal stop element against the proximal end of the probe.

[0071] In a further embodiment of the process, the supply and / or removal of the printing medium is carried out continuously.

[0072] This allows the user to continuously utilize a self-regulating process for accelerating a project, without having to constantly monitor the timing of the pressure pulse, as is necessary with conventional pneumatic lithotripters.

[0073] The invention will now be explained in more detail using exemplary embodiments. These will show... Figure 1 is a schematic, partially three-dimensional representation. Illustration of a lithotripsy device with an axially movable acceleration tube in a starting position for accelerating a projectile in a distal direction, Figure 2 is a schematic sectional view of the Lithotripsy device in a state at the moment the projectile hits a distal billiard projectile, Figure 3 is a schematic sectional view of the Lithotripsy device during a distal switching process, Figure 4 is a schematic sectional view of the Lithotripsy device at the start of acceleration of the projectile in the proximal direction, Figure 5 is a schematic sectional view of the Lithotripsy device upon impact of the projectile on the proximal-side stop element, and Figure 6 is a schematic sectional view of the Lithotripsy device during a proximal switching operation.

[0074] A lithotripsy device 101 comprises a carrier unit 103 with a central housing tube 105. A proximal end of the housing tube 105 is connected to a proximal housing cap 107, and a distal end of the housing tube 105 is connected to a distal housing end cap 111 (see Figure 1). Inside the housing tube 105 of the carrier unit 103, a guide tube 121 is arranged, which is connected at its proximal end by means of a proximal end cap 137 and at its distal end by means of a distal end cap 139. The proximal end cap 137 is firmly held in the proximal housing cap 107, and the distal end cap 139 is firmly held in the distal housing cap 111 and is sealed on both the proximal and distal sides by an O-ring 217. Between an inner wall of the housing tube 105 and an outer wall of the guide tube 121, four air intake chambers with symmetrical cross-sections are arranged.These supply air chambers each connect a proximal supply air duct 152 and a distal supply air duct 156, which are radially aligned in the respective end caps 137, 139. The supply air chambers are not visible in Figure 1. are fluidically connected via a compressed air connection 151 on the proximal housing cap 107, whereby compressed air is continuously supplied via the compressed air connection 151 from an external drive device not shown.

[0075] The guide tube 121 has a cavity 122 in which an acceleration tube 131 is arranged with a longitudinal central axis 149 that runs parallel to a distal direction 115. The acceleration tube 131 has, in a proximal end section before its proximal end 133, a proximal opening 123 and a proximal opening 124, as well as two further proximal openings not visible in the figures. Likewise, the acceleration tube 131 has, before its distal end 135, a distal opening 127 and a distal opening 129, as well as two further distal openings not visible in the figures. Inside the accelerator tube 131 has a cavity 141 which forms an acceleration section for a project ectile 143 between a proximal stop element 165 and a billiard project ectile 167 as a distal stop element.The proximal stop element 165 has a proximal cylindrical section 169, which is movably mounted within the cavity 141 of the accelerator tube 131. Proximal to the proximal cylindrical section 169, the proximal stop element 165 has a proximal end section 173, which has a larger diameter than the proximal cylindrical section 169. A proximal cap 183 is soldered externally onto the proximal end section 187 of the accelerator tube 131 and has an external thread 191, onto which a proximal end piece 187 is screwed. A proximal spring 146 is arranged between the proximal inner surface of the proximal cap 183 and the proximal end face of the proximal end section 173. The proximal assembly thus connected, surrounded by the proximal cap 183, is movable within the. cavity of the proximal end cap 137 arranged. The proximal Cap 183 has a proximal through-hole 193.

[0076] The billiard project 167 is arranged at the distal end section of the acceleration tube 131. The billiard project 167 has a distal cylindrical section 171, which is movably arranged in the cavity 141 of the acceleration tube 131. Distal to the distal cylindrical section 171, the billiard project 167 has a distal end section 175, which is designed as a shoulder. Distal to the distal end section 175, the billiard project 167 transitions into a butt plug 181, the butt plug 181 having a smaller diameter than the distal cylindrical section 171. The distal end section of the acceleration tube 131 is connected analogously to the above by means of a soldered distal cap 185, which has an external thread 191 onto which a distal end piece 189 is screwed. The distal cap 185 has a distal through-hole 195.An O-ring 217 is arranged between the distal end 135 of the acceleration tube 131 and the proximal side of the distal end section 175. Likewise, an O-ring 217 is arranged between the distal side of the proximal end section 173 and the proximal end 133 of the acceleration tube 131 (see Figure 2). It should be noted that all figures show the same lithotripsy device 101 in different states; however, for the sake of clarity, not all identical components are labelled with their corresponding reference symbols in each figure.

[0077] The butt plug 181 formed distally to the distal end section 175 is surrounded on its outer surface by a distal spring 147. The proximal spring 146 and the distal spring 147 are designed as coil springs. Distal to the distal end cap 139, a headpiece 215 is arranged, to which a probe head 213 is connected. with an elongated probe 211. The front part of the probe head 213 and the proximal end of the probe 211 are surrounded by a silicone tube as a damping element 219, which is supported in the distal direction 115 on the inside of the distal housing cap 111. The space around the probe head 213 is connected to the external environment of the lithotripsy device 101 via a relief bore 203 through the head piece 215. The probe 211 is designed as a hollow probe for fragmenting body stones.

[0078] Project 143 is movably arranged within the cavity 141 of the acceleration tube 131. Project 143 has a chamfer 142 at both its proximal and distal ends for improved movement initiation and circumferential grooves 145 for contact minimization.

[0079] The following work steps are carried out using the lithotripsy device 101 and the axially movable acceleration tube 131:

[0080] The lithotripsy device 101 is started by means of an operating element not shown on the carrier unit 103 and compressed air is continuously supplied through the compressed air connection 151 in an air supply direction 161 to the four longitudinally guided air supply chambers not shown. Starting from an initial position shown in Figure 1 for accelerating the project 143 in the distal direction 115, in which the proximal end piece 187 rests against the inner wall of the proximal housing cap 107 on its proximal side, and thus the proximal air supply channel 152, connected to the air chamber (not shown), is open via the proximal through-bore 193 of the proximal cap 183 and the proximal opening 123 of the acceleration tube 131, compressed air enters the cavity 141 of the acceleration tube 131 and pushes against the project 143 in a project movement direction 144, which corresponds to the distal direction 115. At the distal end, the distal The distal air supply duct 156 is closed by end piece 189, with the proximal end of the distal end piece 189 abutting a stop 199 of the distal end cap 139. The compressed air exits in the distal direction 115 from the cavity 141 through the distal openings 127, 129 into the cavity 122 of the guide tube 121 and further through the distal exhaust duct 158. The distal exhaust duct 158, like a proximal exhaust duct 154, terminates in a venting mixing chamber 157, from which the exiting air is discharged proximally and distally into the environment around the lithotripsy device 101 via venting channels 159. Thus, the distal openings 123, 124 are located in a pressurized area, while the cavity 122 of the guide tube 121 and the venting mixing chamber 157 as well as the exhaust ducts 154, 158 are under ambient pressure.

[0081] Project 143 is accelerated further in the same direction of project motion 144 by the compressed air flowing distally 115 until it collides with the billiard project 167 and thereby transfers its momentum and kinetic energy to the billiard project 167 (Figure 2). The collided billiard project 167 now compresses the distal spring 147, which, due to its spring force, displaces the acceleration tube 131 further distally 115 via the connected distal cap 185 and the distal end piece 189. Thus, energy is transferred from the distal spring 147 to the acceleration tube 131. The residual velocity of the billiard project 167 causes the billiard project 167 to move further in distal direction 115 and the impact pin 181 to strike the probe head 213, thereby transferring the remaining residual energy and momentum to the probe 211 to excite the vibration of the probe 211.This transferred deformation energy can be used to shatter a body stone. Thus, the distal end piece 189 rests against the proximal side of the distal housing cap 111 in an achieved distal starting position (Figure 4).

[0082] Simultaneously, the accelerator tube 131 continues to move distally 115, causing the proximal end piece 187 to increasingly close off the proximal supply air duct 152 until the distal end of the proximal end piece 187 abuts a stop 197 on the proximal end cap 137. At the same time, the proximal openings 123, 124 are moved distally 115, closed by the externally positioned proximal end cap 137 (see Figure 3), and then moved further into the surrounding area. Meanwhile, the closed distal openings 127, 129 continue to move distally 115 until they, together with the distal through-bore 195, are completely open to the distal supply air duct 156 and are now located in the overpressure area.Project 143, which is actively repulsed by the billiard project 167, now moves in the direction of project movement 144 in a proximal direction opposite to the distal direction 115, so that an automatic reversal of the direction of movement has taken place. The project is further accelerated in a proximal direction by the compressed air flowing in through the distal air supply channel 156, the distal through-bore 195 and the distal openings 127, 129 via the chambers not shown, until it strikes the proximal stop element 165 on the proximal side and transfers its entire momentum to the proximal stop element 165 due to the equal mass ratios between the project 143 and the proximal stop element 165.A force is transmitted via the proximal spring 146 to the accelerator tube 131, as described for the distal spring 147, thereby moving the accelerator tube 131 further in the proximal direction until the proximal end piece 187 is again in contact with the distal side of the proximal housing cap 107 (Figure 1).

[0083] These processes described above, namely the acceleration of project 143 and the axial displacement of the The acceleration tube 131 repeats itself automatically in the distal direction 115 and in the opposite direction in the proximal direction without any further user intervention. Thus, a lithotripsy device 101 is provided in which an automatic valve changeover is implemented for moving a projectile 143 back and forth by means of the axially movable acceleration tube 131, the proximal stop element 165, and the billiard projectile 167. With a continuous flow through the acceleration tube 131, the processes repeat themselves automatically in a self-timed manner. This eliminates the need for a complex control and valve switching system for an external, pulsed compressed air supply. Reference character list 101 Li tho tripps the device 103 carrier unit 105 Housing tube 107 Proximal housing cap 111 Distal housing cap 115 Distal direction 121 Guide tube 122 Cavity of the guide tube 123 proximal opening 124 proximal opening 127 distal opening 129 distal opening 131 Acceleration tube 133 proximal end of the accelerator tube 135 distal end of the accelerator tube 137 proximal end cap 139 distal end cap 141 Cavity / Acceleration track 142 Bevel 143 Per j ectil 144 Pro j ectile motion direction 145 grooves 146 Proximal spring 147 Distal spring 149 Longitudinal center axis 151 Compressed air connection 152 proximal supply air duct 154 proximal exhaust duct 156 distal air supply duct 157 Ventilation mixing room 158 distal exhaust duct 159 Venting channel 161 Supply air direction 165 Proximal stop element Billiard projectile (distal stop element) proximal cylinder section distal cylinder section proximal end section distal end section butt plug proximal cap distal cap proximal end distal end external thread proximal through hole distal through hole proximal end cap stop Stop of the distal end cap Relief borehole probe Probe head Headpiece O-ring Steam fungs element

Claims

Patent claims:

1. Lithotripsy device (101) for fragmenting body stones, wherein the lithotripsy device (101) comprises a carrier unit (103), a guide tube (121), an acceleration tube (131) with an axial direction, a cavity (141), a proximal end (133) and a distal end (135), a movable projectile (143), and a proximal-side stop element (165) and a distal-side stop element (167) for the movable projectile (143), wherein the acceleration tube (131) is at least partially surrounded by the guide tube (121) and the acceleration tube (131) has at least one proximal-side opening (123, 124) and at least one distal-side opening (127, 129) for the inflow and / or outflow of a pressure medium. and / or from its cavity (141) for moving the projectile (143) back and forth between the proximal-side stop element (165) and the distal-side stop element (167),and the lithotripsy device (101) is associated with a drive unit for supplying and / or discharging the pressure medium and a probe (211), the probe (211) being directly or indirectly connectable to the carrier unit (103) at its proximal end and being capable of being set into vibration by a mechanical impact of the projectile (143) on the distal-side stop element (167), characterized in that the accelerator tube (131) is arranged internally at its proximal end section by means of the proximal-side stop element (165) and at its distal end section by means of the distal-side stop element (167) so as to be movable in the axial direction, such that the accelerator tube (131) can be moved in a distal direction (115) and in a The proximal direction is displaceable relative to the guide tube. Lithotripsy device (101) according to claim 1, characterized in that, in the event of a proximal stop of the axially movable acceleration tube (131), a first valve opening position allows the pressure medium to flow through the at least one proximal opening (123, 124) into and / or out of the cavity (141) of the acceleration tube (131) to move the projectile (143) towards the distal stop element (167) or to move the projectile (143) back to the proximal stop element (165), and in the event of a distal stop of the axially movable acceleration tube (131) a second valve opening position for the flow of the pressure medium through the at least one distal opening (127, 129) into and / or out of the cavity (141) of the acceleration tube (131) for moving the projectile (143) back to the proximal stop element (165) or for moving the projectile (143) towards the distal stop element (167). Lithotripsy device (101) according to claim 1 or 2, characterized in that the acceleration tube (131) has a second proximal opening and / or further proximal openings (123, 124) and a second distal opening and / or further distal through-openings (127, 129).Lithotripsy device (101) according to one of the preceding claims, characterized in that the at least one proximal opening or the proximal openings (123, 124) and the distal opening or the distal openings (127, 129) are located in a lateral surface of the acceleration tube (131) , axially symmetric to a longitudinal central axis of the. Acceleration tube (131) and / or is arranged circumferentially. Lithotripsy device (101) according to one of the preceding claims, characterized in that the proximal-side stop element (165) has a first cylindrical section (169) and the distal-side stop element (167) has a second cylindrical section (171), wherein the proximal end section of the acceleration tube (131) is movably arranged about the first cylindrical section (169) and the distal end section of the acceleration tube (131) is movably arranged about the second cylindrical section (171) in the axial direction.Lithotripsy device (101) according to one of the preceding claims, characterized in that the proximal-side stop element (165) has a first end section (173) as a stop against the proximal end of the acceleration tube (131) and the distal-side stop element (167) has a second end section (175) as a stop against the distal end of the acceleration tube (131). Lithotripsy device (101) according to one of the preceding claims, characterized in that a first spring element (146) for repulsing the projectile (143) is arranged proximal to the proximal-side stop element (165) and / or to the first end section (173). Lithotripsy device (101) according to one of claims 5 to 7, characterized in that the distal-side stop element (167) has a push pin (181) distal to the second cylindrical section (171) and / or to the second end section (175). The lithotripsy device (101) according to one of claims 5 to 8 is characterized in that a second spring element (147) is arranged distal to the second end section (175) and / or around the impact pin (181) of the distal stop element (167). Lithotripsy device (101) according to one of claims 7 to 9, characterized in that the first spring element (146) and at least partially the proximal-side stop element (165) are received in a proximal-side holding unit (183, 187) and the second spring element (147) and at least partially the distal-side stop element (167) are received in a distal-side holding unit (185, 189), wherein the proximal-side holding unit (183, 187) and the distal-side holding unit (185, 189) are each directly or indirectly connected to an outside of the acceleration tube (131) and are movable in the axial direction.Lithotripsy device (101) according to one of the preceding claims, characterized in that a chamber or two or more separate chambers for conveying pressure medium to and / or from the at least one proximal opening or openings (123, 124) and / or the at least one distal opening or openings (127, 129) are arranged between an outer surface of the guide tube (121) and an inner surface of the support unit (103). Lithotripsy device (101) according to one of the preceding claims, characterized in that the lithotripsy device (101) has a connecting port (151) for connecting to the drive unit and for... a lithotripsy device (101) according to one of the preceding claims, characterized in that a negative pressure and / or a positive pressure can be imposed on the cavity (141) or a part of the cavity (141) of the acceleration tube (131) by means of the drive device. Method for accelerating a projectile (143) of a lithotripsy device (101), wherein the lithotripsy device (101) has a guide tube (121) and an acceleration tube (131) with a cavity (141), and the acceleration tube (131) is at least partially surrounded by the guide tube (121), wherein a projectile (143) movable between a resilient proximal-side stop element (165, 146) and a resilient distal-side stop element (167, 147) is arranged in the cavity (141) of the acceleration tube (131), and the acceleration tube (131) has at least one proximal-side opening (123,124) and has at least one distal opening (127, 129) for the inflow and / or outflow of a pressure medium into and / or from its cavity (141) for moving the projectile (143) back and forth between the resilient proximal stop element (165, 146) and the resilient distal stop element (167, 147), and the lithotripsy device (101) is associated with a drive device for supplying and / or removing the pressure medium and a probe (211), and the accelerator tube (131) is internally connected at its proximal end section by means of the resilient proximal stop element (165, 146) and at its distal end section by means of the resilient distal stop element (167, 147) in the axial, The direction is arranged to move, with the following Steps: - Supplying and / or discharging the pressure medium by means of the drive device and flowing the pressure medium through the at least one proximal opening (123, 124) into the cavity (141) of the acceleration tube (131) and moving the projectile (143) by means of the pressure medium to the spring-loaded distal stop element (167, 147) , - Accelerating the projectile (143) by means of the pressure medium , - Impact of the projectile (143) on the spring-loaded distal stop element (167, 147) and displacement of the acceleration tube (131) by means of the spring-loaded distal stop element (167, 147) in a distal direction to switch the flow of the pressure medium , - Transfer of an impact of the projectile (143) upon impact by means of the spring-loaded distal-side stop element (167, 147) onto a probe (211) and / or - Supplying and / or discharging the pressure medium by means of the drive device and flowing the pressure medium through the at least one distal opening (127, 129) into the cavity (141) of the acceleration tube (131) and moving the projectile (143) back by means of the pressure medium to the spring-loaded proximal stop element (165, 146) , - Accelerating the projectile (143) by means of the pressure medium , - Impact of the projectile (143) on the spring-loaded proximal-side stop element (165, 146) and displacement of the acceleration tube (131) by means of the spring-loaded proximal-side stop element (165, 146) in a proximal direction to switch the flow of the pressure medium, and - Repulsion of the projectile (143) at the spring-loaded proximal-side stop element (165, 146). Method according to claim 14, characterized in that the supply and / or discharge of the pressure medium is carried out continuously.

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