Lithotripsy device for breaking up calculi with a control sleeve, 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 having a cavity, a movable projectile, and a proximal stop element and a distal stop element for the movable projectile. The guide tube has at least one proximal through-opening and at least one distal through-opening for feeding and / or discharging the pressure medium into and / or out of the cavity of said guide tube, a control sleeve being located in the cavity of the guide tube, the control sleeve having a cavity along its longitudinal central axis, at least one proximal opening, and at least one distal opening for the pressure medium, and the movable projectile with a driver element for driving the control sleeve being located in the cavity of the control sleeve so that, when the control sleeve is moved along by means of the driver element of the projectile, a first valve-opening position and a second valve-opening position for flowing of the pressure medium are provided. The invention also relates to a method for accelerating a projectile of a lithotripsy device.

Description

Lithotripsy device for crushing body stones with a control sleeve 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 with 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 guide tube is at least partially arranged in the carrier unit, and the lithotripsy device is equipped with a drive device for supplying and / or supplying a pressure medium to an interior of the carrier unit and / or the guide tube for moving the projectile back and forth between the proximal-side stop element and the distal-side stop element, and a sonotrode.wherein the guide tube has at least one proximal through-opening and at least one distal through-opening for supplying and / or draining the pressure medium into and / or out of its cavity, and the sonotrode is directly or indirectly connectable to the carrier unit and / or the guide tube at its proximal end and can be set into vibration by mechanical contact of the projectile with the distal 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 kidney stones, which form, for example, through the condensation and / or crystallization of salts and proteins as so-called calculus in body organs such as the bladder or kidneys. If the kidney stones are too large to be passed naturally and cause discomfort, they must be broken up with a lithotripter so that the fragmented stones can be removed through natural excretion and / or with the aid of a suction-irrigation pump. The kidney 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 an acceleration tube, and 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 usually controlled by timed compressed air pulses. Thus, 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 due to the single-lumen acceleration tube and reversing compressed air drive. The projection of the projectile is limited in known lithotripters. Furthermore, a compressed air reservoir must be connected distally to the interior of the accelerator tube via a connection and a switching valve in order to move the projectile back to the proximal stop after a distal stop. Accordingly, the air in the connecting tube to the lithotripter must also be forced back with each pulse and released into the atmosphere via the resistance of a proximal-side changeover valve, for example, in the control unit. In addition to pressure regulation, a complex control unit with a time-controlled changeover valve is therefore required. Furthermore, the projectile does not typically spring back automatically at the proximal stop, and thus 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, known devices typically require 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] The purpose of the invention is to improve the state of the art.

[0006] The problem is solved by a lithotripsy device for fragmenting body stones, wherein the lithotripsy device comprises a carrier unit, a guide tube with 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 guide tube is at least partially arranged in the carrier unit, and the lithotripsy device includes a drive device for supplying and / or supplying a pressure medium to an interior of the carrier unit and / or the guide tube for moving the projectile back and forth between the proximal-side stop element and the distal-side stop element, and a sonotrode.wherein the guide tube has at least one proximal through-opening and at least one distal through-opening for supplying and / or draining the pressure medium into and / or out of its cavity, and the sonotrode is directly or indirectly connectable to the carrier unit and / or the guide tube at its proximal end and can be excited by mechanical contact of the projectile with the distal stop element, wherein a control sleeve is arranged in the cavity of the guide tube, wherein the control sleeve has a cavity along its longitudinal central axis, a proximal end, a distal end, at least one proximal opening and at least one distal opening for the pressure medium, and in the cavity of the control sleeve the movable projectile with a drive element for driving the control sleeve, is arranged so that, when the control sleeve is moved by means of the drive element of the project, a first valve opening position is available for the pressure medium to flow through the at least one proximal-side through-opening of the guide tube and the at least one proximal-side opening of the control sleeve into and / or out of the cavity of the control sleeve to move the project towards the distal-side stop element, and a second valve opening position is available for the pressure medium to flow through the at least one distal-side through-opening of the guide tube and the at least one distal-side opening of the control sleeve into and / or out of the cavity of the control sleeve to move the project back to the proximal-side stop element.

[0007] Thus, a lithotripsy device with a self-stimulating project is provided, with continuous supply and / or discharge of the pressure medium. The project is kept in constant motion by the movement of the control sleeve, which forms a switching valve with the guide tube. This results in a continuous alternation between the first and second valve opening positions, driving the project back and forth between the proximal and distal stop elements. A particular advantage is the continuous supply and / or discharge of the pressure medium, preventing alternating pressure surges on the components. The lithotripsy device consists of a pneumatic system through which the pressure medium is passed. In contrast to conventional pneumatic lithotripters, where components such as hoses and valves are subjected to constant pressure changes due to pulsed pressure surges, resulting in increased wear, the continuous supply and / or discharge of the pressure medium ensures a long service life and low maintenance requirements for the lithotripsy device. Furthermore, the safety risk of leaks is significantly reduced. Additionally, the more consistent movement of the pressure medium and the reduction of pressure surges minimize the tendency of the tubing to oscillate and vibrate, allowing for more comfortable instrument handling and thus enabling better surgical outcomes.

[0008] Furthermore, the lithotripsy device has a smaller installation space and thus a potentially reduced instrument weight, since the distal-side pressure reservoir with switching valve and connection to the acceleration section is omitted compared to known lithotripters.

[0009] By means of the drive element, the project carries the control sleeve a certain switching path along the acceleration path until the control sleeve strikes the proximal stop element with its proximal end or the distal stop element with its distal end, and then the project continues on its own against the proximal When the stop element or the distal stop element moves and is repulsed at the corresponding stop element, and the control sleeve is carried back in the opposite direction, an automatic switching of the direction of movement of the projectile and the exposed passage openings for the inflow and / or outflow of the pressure medium within the lithotripsy device itself takes place. Thus, after the pressure medium supply has been started once, a self-stimulating process occurs in which the projectile is continuously moved back and forth by the constantly applied pressure.The uniform flow of the pressurized medium through the at least one proximal and at least one distal opening of the guide tube, and through the at least one proximal and at least one distal opening of the control sleeve, always in the same directions, combined with the repulsion of the projectile at the proximal and distal stop elements, results in a higher impact rate, particularly with a frequency of > 15 Hz, preferably > 30 Hz, than in known lithotripters. Consequently, a higher impact velocity of the projectile is also achievable, leading to a higher stone removal rate than in known lithotripters. Accordingly, a lower pressure can be used in the lithotripsy device for the same projectile velocity.

[0010] A key aspect of the invention is to implement a valve switching mechanism for moving the projectile back and forth directly within the lithotripsy device itself, using a guide tube and a control sleeve that is partially driven along with the project by means of the drive element. The pressure medium is then continuously supplied and / or discharged through the guide tube and control sleeve. By integrating the valve switching mechanism and thus redirecting the projectile's direction of movement, a complex external supply and discharge system, pressure medium control, time control of external switching valves, and a distal pressure reservoir are no longer required. Overall, this enables a high distal velocity combined with a high amplitude at the distal end of the sonotrode, resulting in optimal and efficient stone removal.Furthermore, the frequency of the mechanical impacts of the project on the sonotrode is not determined by externally timed pressure pulses, but is specifically adjustable via the pressure medium flow, the design of the guide tube, the control sleeve and the drive element of the project.

[0011] The following terms will be explained:

[0012] 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 A lithotripter can be fully or partially constructed. A lithotripsy device can be, in particular, an intracorporeal or extracorporeal lithotripsy device. 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 supply unit, or these may be associated with the lithotripsy device. A lithotripsy device is, in particular, a pneumatic lithotripsy device.

[0013] The term "body stones" (also called "concretions") 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.

[0014] 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 attached to a distal end of a The robot arm is arranged, connected and / or automatically guided. The carrier unit includes, in particular, a housing.

[0015] 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 control sleeve and a project freely movable in the longitudinal direction are arranged. Furthermore, the guide tube has, in particular, a proximal end and a distal end, which spatially define the maximum acceleration distance for the project. For the pneumatic actuation of the project, the guide tube has at least one proximal through-opening and at least one distal through-opening for the passage of a pressurized medium into and / or out of its cavity. The guide tube, in particular, represents a stationary, outer valve sleeve with corresponding through-openings that correspond to the openings of the control sleeve.The guide tube can also be a hollow cylinder instead of a tube, with the two closed end faces directly forming the proximal and distal stop elements. The guide tube can also be connected to the proximal stop element and / or the distal stop element. For this purpose, one end of the guide tube can, for example, be arranged to engage directly in a groove in the stop element.

[0016] A "stop element" is, in particular, a deliberate endpoint of the projectile's movement along the The acceleration section is where the accelerated project strikes the stop element, is decelerated, rebounds, and / or moves in the opposite direction. The stop element thus absorbs the impact and / or shock of the project. A stop element can be, for example, a wall transverse to the longitudinal center axis of the guide tube and / or the control sleeve, a spring element, part of an ultrasonic transducer such as a horn, and / or an air cushion of a compressed air spring. A proximal stop element is located, in particular, at and / or in the proximal end of the guide tube and / or within the cavity in a region of the proximal section of the guide tube. Similarly, a distal stop element is located, in particular, at and / or in the distal end of the guide tube and / or within the cavity in a region of the distal section of the guide tube.The proximal-side stop element can be, for example, a spring element. The distal-side stop element is connected, in particular, directly or indirectly to the proximal end of the sonotrode. The distal-side stop element can be, for example, a spring element, a wall of a holder for the sonotrode and / or the horn, oriented towards the cavity of the guide tube.

[0017] The terms “distal” and “distal” refer to a proximal and therefore distant arrangement and / or a corresponding end or section. Accordingly, the terms "proximal-side" or "proximal" are used. understood as a user-friendly and therefore remote arrangement or a corresponding end or section.

[0018] An "acceleration path" is, in particular, a section of a longitudinal dimension of the cavity of the guide tube, which is defined by a distal end stop of the proximal end stop and 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 minus the project length, if the proximal end stop is flush with the proximal end of the guide tube and the distal end stop is flush with the distal end of the guide tube. The longitudinal dimension of the cavity can, for example, be 150 mm.

[0019] A "projectile" is, in particular, a body that is freely movable within the cavity of the guide tube along the acceleration path. The projectile is, in particular, movable back and forth between the proximal-side stop element and the distal-side stop element within the cavity of the guide tube located between them, with the projectile being surrounded by the control sleeve. In principle, the projectile can have any shape. For example, the projectile can have the shape of a bolt or a sphere. The project is, in particular, made of hard steel and / or has magnetic properties. To allow for free movement, the project has, in particular, a slightly smaller outer diameter than the diameter of the cavity of the guide tube. Control sleeve on. For example, the project can have a have an outer diameter of 8 mm, preferably 6 mm.

[0020] The project can be moved back and forth continuously between the proximal and distal end stops, and thus along the acceleration path, by means of the pressure medium of the drive unit. Preferably, the project is moved back and forth continuously, intermittently, and / or oscillatingly between the proximal and distal end stops. To prevent wear on the project at the distal and / or proximal end stops, the project can have slightly chamfered edges at its distal and / or proximal end.

[0021] A "drive element" is, in particular, an element that is fixedly or loosely connected in and / or on an outer surface of the project and whose side opposite the project rests against the inner surface of the control sleeve. The drive element is designed, in particular, such that, due to frictional and / or adhesive forces, it drives the control sleeve along with the project when the project moves within the control sleeve, thereby causing the control sleeve to move with the project. The drive element can, for example, be arranged in a partially or fully radially circumferential groove in the project. The drive element comprises, in particular, a polymer, such as polyoxymethylene. The drive element can also, for example, be a The drive element can be a Teflon rod or tube bent into a ring. For example, the drive element can also be made of nylon, which has low wear properties. The drive element can also be fibrous or textile in nature, e.g., felt, nonwoven, woven, knitted, and / or crocheted fabrics. Preferably, the drive element only provides the friction and / or adhesion necessary for drive and exhibits low wear. The drive element can seal the projectile and the inside of the control sleeve against each other; however, the drive element does not necessarily have to be airtight.On the contrary, a non-sealing drive element causes the pressure medium, which flows into the cavity of the control sleeve at one end of the guide tube and / or the control sleeve and thus acts on the corresponding end of the project, to also flow laterally past the project to the other end of the project and / or guide tube in the direction of flow and to escape through the corresponding opening of the control sleeve and through-opening of the guide tube, thereby preventing unwanted overpressures, for example in the event of a blockage.

[0022] A "drive device" can, in principle, 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, enables a continuous and uniform flow of the pressure medium through the proximal and distal through-openings of the guide tube and the proximal and distal openings of the control sleeve, for example pneumatically with the aid of compressed air, and an acceleration of the projectile within the cavity of the control sleeve and / or the guide tube.

[0023] 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 drawn from a domestic water supply and / or generated by a compressor. The pressure medium is continuously supplied to and / or removed from the lithotripsy device and / or circulated. The pressure medium has a pressure in the range of 0 to 10 bar. Due to the continuous supply and removal of the pressure medium without alternating loads, a pressure of > 10 bar can be used.

[0024] The "control sleeve" is, in particular, an elongated hollow body whose length is greater than its diameter. The control sleeve has, in particular, a cavity inside in which the project can move longitudinally. The control sleeve is, in particular, tubular with an open proximal end and an open distal end. The control sleeve can also be designed as a hollow cylinder, with at least one opening arranged in each of the end faces. The control sleeve has, in particular, a smaller diameter than the Guide tube. The control sleeve has in particular at least one proximal opening and at least one distal opening for the passage of the pressure medium, wherein the proximal opening and the distal opening can each be formed on the end face and / or in the outer surface of the control sleeve. The control sleeve is arranged in the cavity of the guide sleeve in a manner that prevents rotation, so that the respective proximal through-opening of the guide tube with the proximal through-opening of the control sleeve and the distal through-opening of the guide tube with the proximal through-opening of the control sleeve can be aligned with each other in such a way that the pressure medium can flow continuously through the respective through-opening of the guide tube and the corresponding opening of the control sleeve, and thus a first valve opening position or a second valve opening position can be set.An anti-rotation device for the control sleeve can be implemented, for example, by a guide and / or control wire which is soldered to the control sleeve in a solder groove, exits the carrier unit and / or lithotripsy device through a bore in the proximal direction, and is terminated with an operating element, such as a handle. This prevents the control sleeve from rotating and allows it to be controlled by the user. The control sleeve is arranged concentrically to the guide tube. The control sleeve has a length that is shorter than the length of the guide tube. The control sleeve can have a length that is 2 mm to 30 mm, in particular 3 mm to 20 mm, preferably 4 mm to 10 mm, shorter than the length of the guide tube. The control sleeve, with its proximal and distal openings, is in particular axially symmetrical to its longitudinal and / or transverse axis.

[0025] The control sleeve and its at least one proximal opening and at least one distal opening are designed such that, for example, if the control sleeve strikes the distal stop element, the distal through-opening of the guide tube is closed by the outer wall of the contacting and struck control sleeve. Likewise, if the control sleeve strikes the proximal stop element, the proximal through-opening of the guide tube is closed by the side wall of the control sleeve.By repulsing the project at the respective stop element, consequently moving the project in the opposite direction and by taking the control sleeve along by means of the drive element, the corresponding through-opening of the guide tube at the respective stop is released again, whereby pressure medium flows in through this through-opening and supports the further movement of the project in the opposite direction.

[0026] The "longitudinal center axis" is in particular the axis of the control sleeve which corresponds to the direction of its greatest extension.

[0027] One proximal and one distal side "Through-through openings" are penetrations through the wall of the guide tube. Similarly, a proximal opening and a distal opening are penetrations through a wall of the control sleeve (also called valve bores). The proximal and distal openings can extend through the entire surface of the control sleeve and / or be located on either end face of the control sleeve at the proximal or distal end. Thus, the open end of the control sleeve can form a proximal opening and / or a distal opening. The through-through opening(s) of the guide tube, as well as the distal and proximal openings of the control sleeve, can each be a bore. These through-through openings and / or openings typically have a relatively large diameter, so that essentially no pressure loss occurs.For example, the respective through-opening of the guide tube and / or the opening of the control sleeve can have a diameter in the range of 2 to 3 mm with a guide tube diameter of 6 mm. Thus, the through-openings and valve openings are designed with large cross-sections to minimize flow resistance. The openings of the control sleeve can have an internal chamfer facing the cavity of the control sleeve to prevent wear and / or chip formation on the projectile.

[0028] A sonotrode is, in particular, a component that is set into vibration, resonance, and / or deformation vibration by the application and / or introduction of mechanical vibrations. A sonotrode is, in particular, an elongated component. A sonotrode is, in particular, a probe, which is, for example, rod-, tube-, and / or hose-shaped. The sonotrode can be a hollow probe. The sonotrode can be made of one piece or multiple parts. The sonotrode 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 sonotrode is made, in particular, of steel, titanium, aluminum, and / or carbon. The impact energy from the projectile striking the distal end of the stop imprints a specifically shaped deformation wave onto the sonotrode.The deformation wave causes, in particular, a translational movement of the sonotrode, which, due to the deflection, results in improved stone fragmentation. In addition to the mechanical impact, the sonotrode can also be excited into vibration, particularly longitudinal vibration, by means of a vibration excitation device, for example, an ultrasonic vibration exciter. Thus, the sonotrode 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 projectile. The proximal end of the sonotrode can, in particular, bear directly or indirectly against the distal stop element. Preferably. The sonotrode is joined proximally in a threaded / retaining nipple that is thicker than its diameter. This nipple can also be a headpiece. Preferably, the headpiece of the sonotrode is movably mounted. The sonotrode is shaped in such a way that it optimally directs the vibration waves, deformation waves, shock waves, and / or the ultrasound vibration at its distal end into the body, the body region to be treated, and / or directly onto the body stone to be fragmented.

[0029] In another embodiment of the lithotripsy device, the control sleeve has a second proximal opening, a third proximal opening, a fourth proximal opening and / or further proximal openings and / or a second distal opening, a third distal opening, a fourth distal opening and / or further distal openings.

[0030] Thus, multiple proximal and / or distal openings can be distributed across the cross-section of the control sleeve and / or radially around its outer surface, resulting in a more uniform flow of the pressure medium along the cross-section. Furthermore, the flow resistance can be reduced accordingly by having multiple proximal and / or distal openings.

[0031] For the corresponding training according to the Regarding the number of proximal and distal openings of the control sleeve, the guide tube has a second proximal through-opening, a third proximal through-opening, a fourth proximal through-opening and / or further proximal through-openings and / or a second distal through-opening, a third distal through-opening, a fourth distal through-opening and / or further distal through-openings.

[0032] In addition to a uniform radial arrangement of the respective proximal and / or distal through-openings, the proximal and / or distal through-openings can also be spaced apart longitudinally, i.e., along the longitudinal center axis of the control sleeve. For example, the first proximal through-opening, through which the pressure medium flows into the cavity of the guide tube, can be located closer to the proximal end of the guide tube than a second proximal through-opening, through which the pressure medium flows out of the cavity of the guide tube. This prevents short-circuiting, and depending on the design of the control sleeve, the first proximal through-opening can be connected to the incoming pressure medium, or the second proximal through-opening to the outgoing pressure medium. the movement of the projectile and the intended The valve opening position must be closed. This applies analogously to the distal through-openings.

[0033] The second, third, fourth, and / or subsequent proximal or distal openings are, in their design and function, each defined above as a proximal or distal opening. However, these subsequent proximal or distal openings may be located at a different position on the control sleeve. Similarly, the second, third, fourth, and / or subsequent proximal or distal through-openings are also defined above as proximal or distal through-openings, and each through-opening may be located at a different position on the guide tube.It should be emphasized that, of course, the openings and / or through-holes can have different cross-sections; however, they preferably have the same cross-section to ensure uniform flow. In the guide tube, these additional proximal and / or distal through-holes extend continuously through the outer surface.

[0034] In another embodiment, the distal opening, the respective distal opening and / or the distal openings are arranged at the distal end and / or in a lateral surface of the control sleeve. and / or the proximal opening, the respective proximal opening and / or the proximal openings at the proximal end and / or in the outer surface of the control sleeve.

[0035] When the respective distal and / or proximal openings are arranged in the surface of the cylinder, the opening runs particularly in the direction of the longitudinal center axis of the control sleeve. As a result, the respective distal and proximal openings are oriented transversely to the longitudinal center axis of the control sleeve in longitudinal section.

[0036] To avoid local overpressure on the control sleeve and consequently contact between the outer surface of the control sleeve and the inner surface of the guide tube, friction between the two, and uneven movement of the control sleeve, the proximal-side through-openings, the distal-side through-openings, the proximal-side openings, and / or the distal-side openings are arranged axially symmetrically to the longitudinal center axis of the control sleeve.

[0037] In another embodiment of the lithotripsy device, the guide tube has on its inner surface at least a partially radially circumferential recess or several at least partially radially circumferential recesses for guiding the pressure medium around the control sleeve.

[0038] Due to the at least partially radially circumferential The recess can reduce the pressure of the printing medium all around the area. The control sleeve is distributed, thus avoiding local overpressure and / or unwanted friction between the outer surface of the control sleeve and the inner surface of the guide tube.

[0039] A "recess" refers in particular to a cut and / or a depression in the inner surface of the guide tube. The recess can be designed, in particular, as an annular or semi-annular groove running radially in the inner surface of the guide tube.

[0040] In order to selectively supply and / or discharge the pressure medium to the through-openings in the guide tube and to avoid different pressure losses, two or more separate chambers for conveying pressure medium to and / or from the at least one proximal through-opening or the proximal through-openings and / or the at least one distal through-opening or the distal through-openings are arranged between an outer surface of the guide tube and an inner surface of the carrier unit.

[0041] Thus, for example, a gap between the inner housing wall of the lithotripsy device and the outer surface of the guide tube can be used to divide the resulting volume into two inlet and two outlet chambers by means of four septa or partitions. The chambers are separated from each other, particularly in the longitudinal direction, by septa or partitions. The chambers are separated and run along the outside of the guide tube. A rod, for example, can be used as a separating element between the chambers. The intake air chambers and the exhaust air chambers can be arranged alternately around the guide tube, so that two intake air chambers and two exhaust air chambers are always opposite each other.

[0042] In another embodiment of the lithotripsy device, the distal-side stop element and / or the proximal-side stop element has a spring element for repulsing the projectile.

[0043] Because the projectile strikes a spring element on both its proximal and / or distal sides, the projectile's rebound and thus its reversal movement is promoted. It should be noted that, in principle, at sufficient speed, the projectile will be repulsed and / or moved even without a spring element at the proximal or distal stop element. However, a short dead time can occur at these reversal points, during which, with a corresponding force, the projectile will rebound and / or move. Due to the switching of the flow openings for the supply of the pressure medium, the valve opening position means that the project is not accelerated by the flowing pressure medium for a moment. To reliably overcome this reversal point, a spring element in the distal and / or proximal stop element actively initiates and accelerates the reversal of movement. This is achieved by driving the control sleeve along with the drive element of the The moving project opens the corresponding passage opening of the guide tube and, by the flow of the pressure medium through this passage opening of the guide tube and the corresponding opening of the control sleeve, further accelerates the project.

[0044] A "spring element" 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 project'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 spring element can also be arranged distally and / or proximally on the project. For example, the spring of the spring element can be arranged in a tube, the tube preferably having the same inner diameter as the control sleeve, so that when the project compresses the spring, it can enter the cavity of the spring element's tube.Slightly chamfered edges at the incoming end of the project can prevent the formation of chips during the transition into the tube of the spring element.

[0045] In order to easily ensure repulsion of the projectile at the distal end stop and / or the proximal end stop, and thus a repeated, constant back-and-forth movement of the projectile along the acceleration path, the following are formed the projectile and the control sleeve distally and / or proximally comprise a spring element, in particular a compressed gas spring.

[0046] This prevents the spring element, as an independent component, from being destroyed by excessive speeds and / or forces upon impact of the project. Instead, the spring element is directly utilized by the project and the control sleeve, taking advantage of the compression chamber created by the accelerating approaching project. This preferably involves adiabatic compression of the air and / or gas space, resulting in essentially no energy loss. Thus, the project and the control sleeve each form a compressed gas spring on their distal and / or proximal sides, with the control sleeve corresponding to the pressure tube and the project to the piston of a conventional gas spring as a hydropneumatic actuating element. Consequently, the piston action of the project is utilized.

[0047] In another embodiment, the lithotripsy device has at least one connection port for connecting to the drive unit and for continuously supplying or removing the pressure medium.

[0048] Thus, the drive unit can, for example, be connected to the connection port of the lithotripsy device using a hose.

[0049] To avoid noise during the flow in or out of the lithotripter and to prevent contamination, the The lithotripsy device may also have a second connection port or additional connection ports. This allows the supply and exhaust air to be directed into and / or out of the lithotripsy device via a separate connection port. Preferably, the connection port(s) are located on the proximal side of the lithotripsy device so that the hose connections to the drive unit do not interfere with the handling of the lithotripsy device.

[0050] A "connection" is any connecting element that ensures a connection 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 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 or freely into the surrounding environment.

[0051] To provide a comprehensive and / or self-contained lithotripsy device, it includes the sonotrode and / or the drive unit.

[0052] In another form of implementation of the The lithotripsy device is or are capable of imposing a negative pressure and / or a positive pressure on the cavity or part of the cavity of the guide tube and / or the cavity or part of the cavity of the control sleeve by means of the drive device.

[0053] While operating a lithotripsy device under positive pressure requires a compressor or a house 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 unnecessary. Therefore, when operating under negative pressure, the lithotripsy device can, for example, be connected directly to an existing house vacuum system in a hospital.

[0054] In a vacuum operation, for example, instead of supplying compressed air via a proximal through-opening of the guide tube and a proximal opening of the control sleeve, a vacuum is applied at a distal through-opening with the corresponding opening of the control sleeve to move the project to the distal stop element. This draws the air out of the cavity of the control sleeve, thereby moving the project to the distal stop element. Accordingly, the provisions in this application regarding The processes of inflow and supply as well as outflow and discharge of the pressure medium are described analogously for overpressure operation, and vice versa for underpressure operation.

[0055] In order to achieve optimal engagement of the control sleeve in the direction of movement of the project, the drive element has at least a partially annular friction element on and / or in a surface of the project and / or a medium for viscous friction.

[0056] Thus, the engagement of the control sleeve by the engagement element can be based on friction, adhesion, and / or viscosity. Besides a ring-shaped design of the engagement element, for example as an O-ring, it can also be partially ring-shaped and / or C-shaped, such as a clamping ring or piston ring.

[0057] For viscous friction, the driving element can itself be formed by a medium, such as oil. Thus, for example, an oil film on the outer surface of the control sleeve can suffice as a driving element. Likewise, an adhesive or a gel can be used as the driving element.

[0058] In another embodiment of the lithotripsy device, the drive element has a magnetic element and the control sleeve has a counter-magnetic element.

[0059] Thus, the control sleeve can be driven by an eddy current and / or induction current, wherein the drive element has at least one magnetic element or Alternatively, a magnet is built into the project, or the project itself is designed as a permanent magnet. The movement induces eddy currents and / or induced currents in the control sleeve, which then move the control sleeve and the project along with it.

[0060] In order to start or stop the lithotripsy device and to trigger a single movement of the projectile, the lithotripsy device and / or the carrier unit has an operating unit for starting, stopping and / or triggering a single movement of the projectile.

[0061] Thus, the movement of the control sleeve and / or the projectile can be operated externally by an operator using a control mechanism on the control unit. Preferably, the control unit and / or individual control elements are ergonomically arranged on the outside of the carrier unit and / or the housing of the lithotripsy device. 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, thereby reducing the cost of the lithotripsy device and improving clarity in the operating room.

[0062] In another embodiment, the lithotripsy device has a counter-bearing and a horn, and at least one piezoelectric element is arranged and mechanically coupled between the counter-bearing and the horn as a vibration exciter, with the horn being the distal side has a stop element and / or the horn can be connected to the distal stop element and / or the sonotrode and the at least one piezo element can be electrically connected to an assignable ultrasound generator, so that a combined vibration excitation of the sonotrode by means of the drive device and the at least one piezo element is possible.

[0063] Consequently, the sonotrode can be simultaneously excited by both constant vibration and repeated impact excitation via the imprinting of deformation waves. This dual fragmentation and / or action mechanism achieves a further increase in the efficiency of body stone fragmentation. It is particularly advantageous that a substantially constant ultrasonic energy can be supplied to the sonotrode by means of the vibration exciter, for example, an ultrasonic generator, and the at least one piezoelectric element, while a repetitive, intermittent, yet very uniform ballistic deformation wave energy can be transmitted to the sonotrode by means of the drive unit. The latter allows for the imprinting of a high distal velocity with a high amplitude and a frequency of > 13 Hz.

[0064] A "horn" is, in particular, a component positioned between the vibration exciter and the sonotrode. The horn serves primarily to transmit and / or direct the ultrasonic waves generated by the vibration exciter to the sonotrode. The horn can also be used for mounting. The sonotrode is used. At the same time, the horn, especially in conjunction with a counter bearing, serves for the mechanical mounting of the vibration exciter on both sides.

[0065] A "vibration exciter" is, in particular, a component of an ultrasonic transducer and / or a lithotripsy device that converts the applied alternating voltage at a specific frequency into a mechanical vibration frequency. The vibration exciter is, in particular, an electromechanical transducer utilizing the piezoelectric effect. Applying the alternating electrical voltage generated by an ultrasonic generator produces a mechanical vibration due to deformation of the vibration exciter. The vibration exciter comprises, in particular, one or more piezoelectric elements. Preferably, the vibration exciter comprises at least two piezoelectric elements, with an electrical conductor, for example, a copper disk, arranged between the piezoelectric elements. In the case of ultrasonic excitation, the sonotrode operates, in particular, in the ultrasonic range with a frequency range of 20 kHz to 90 kHz, preferably from 20 kHz to 34 kHz.

[0066] 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 with a cavity and a control sleeve in the cavity of the guide tube, wherein in a cavity of the control sleeve the between a proximal-side stop element and a a movable project is arranged distally on the stop element, and the movable project has a drive element for moving the control sleeve; the lithotripsy device is associated with a drive unit for supplying and / or removing a pressure medium; the guide tube has at least one proximal through-opening and at least one distal through-opening for supplying and / or removing the pressure medium into and / or from its cavity; and the control sleeve has at least one proximal opening and at least one distal opening for the pressure medium, with the following steps: Supplying and / or discharging the pressure medium into the cavity of the guide tube by means of the drive device, Flow of the pressure medium through the at least one proximal-side through-opening of the guide tube and the at least one proximal-side opening of the control sleeve into the cavity of the control sleeve and movement of the projectile towards the distal-side stop element, and Moving the control sleeve by means of the projectile's drive element, and / or Repulsion of the projectile at the distal end stop element, and / or Flow of the pressure medium through the at least one distal through-opening of the guide tube and the at least one distal opening of the control sleeve into the cavity of the control sleeve and retraction of the projectile to the proximal-side stop element and Moving the control sleeve by means of the projectile's drive element, and / or Repulsion of the projectile at the proximal-side stop element.

[0067] 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 using the self-stimulating projectile and the switching control sleeve, without having to pay attention to pressures and valve switching of an external pressure medium supply. The procedure described above refers to overpressure operation. In underpressure operation, suction pressure is applied to the distal through-opening of the guide tube and thus to the corresponding distal opening of the control sleeve when moving the project toward the distal stop element. Similarly, when moving the project back toward the proximal stop element, suction pressure is applied to the proximal through-opening of the guide tube and the distal opening of the control sleeve.

[0068] In a further embodiment of the process, the supply and / or removal of the printing medium is carried out continuously.

[0069] 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 the case with conventional pneumatic lithotripters.

[0070] The invention will now be explained in more detail using exemplary embodiments. These will show... Figure 1 is a highly schematic three-dimensional representation Illustration of a lithium therotripsy device, Figure 2 is a schematic representation of the Lithotripsy device with a guide tube and a control sleeve in longitudinal section during movement of a projectile in a distal direction, Figure 3 is a highly schematic representation of the Operating principle of a guide tube and a control sleeve of a lithotripsy device during movement of a projectile in a distal direction, and Figure 4 is a highly schematic representation of the Operating principle of the guide tube and the control sleeve from Figure 3 during a movement of the projectile in a proximal direction .

[0071] A lithotripsy device 101 comprises a carrier unit 103 with a central housing tube 105. A proximal end cap 107 is screwed onto the housing tube 105 at a proximal end by means of a proximal locknut 109. Likewise, a distal end cap 111 is screwed onto the housing tube 105 at a distal end by means of a distal locknut 113 (see Figure 1 and Figure 2). A first exhaust air connection 151 and a second exhaust air connection 153 (not visible in Figure 1) are arranged at the proximal end of the proximal end cap 107. Furthermore, a first supply air connection 155 and a second supply air connection 156 (not visible in Figure 1) are arranged proximally to the proximal end cap 107. From the distal end section of the distal end cap 111, a suction line 119 for suctioning body stone fragments is led in the opposite direction 115 to the proximal end of the lithotripsy device 101.The extraction line 119 is shown symbolically in Figure 1 and has impractical, tight bending radii. Likewise, a control element 117 at the proximal end of the carrier unit 103 is shown symbolically in Figure 1, whereas in an alternative embodiment, the control element 117 is arranged ergonomically on the housing tube 105. The control element 117 is connected to a control sleeve 131 located inside the housing tube 105 for starting and switching off, as well as for... Designed for single and / or continuous bombardment using the ballistic lithotripsy device 101. At the distal end of the carrier unit 103, an elongated sonotrode 211, designed as a hollow probe, with a sonotrode tip 213 is arranged.

[0072] Inside the housing tube 105 of the carrier unit 103, a guide tube 121 is arranged at a distance from the housing tube 105, wherein between an inner wall of the housing tube 105 and an outer wall of the guide tube 121, two supply air chambers 157 and exhaust air chambers 159 are arranged symmetrically across the cross-section, which are connected via bores in the proximal end cap 107 to the first exhaust air connection 151 and the second exhaust air connection 153 as well as to the first supply air connection 155 and the second supply air connection 156 arranged in a crosswise arrangement (in Figure 2, one supply air chamber 157 is located behind a fifth through-bore 127 and is only visible through this, while the second supply air chamber is located in front of the plane of view). The intake chambers 157 and the exhaust chambers 159 extend over the entire length of the guide tube 121.The two exhaust air connections 151, 153 and the two supply air connections 155, 156 are each connected to a Y-connector (not shown) via a Y-connector. The exhaust hose and an intake hose are connected to a drive device not shown.

[0073] The guide tube 121 has a first through-bore 123 and a fourth through-bore 126 on its proximal side, each of which is connected to one of the two exhaust chambers 159. On its distal side, the guide tube 121 has The guide tube 121 has a second through-bore 124 and a third through-bore 125, each connected to one of the two exhaust chambers 159. Furthermore, the guide tube 121 has a fifth through-bore 127 on its proximal side and another through-bore opposite it, which is not visible in Figure 2. These two through-bores are each connected to one of the two intake chambers 157 (the two corresponding distal through-bores connected to the intake chambers 157 are not shown in Figure 2). All through-bores 123, 124, 125, 126, and 127 extend transversely through the outer surface of the guide tube 121 and each have a diameter of 3 mm.

[0074] The control sleeve 131 is arranged inside the guide tube 121. On its proximal side, corresponding to the proximal through-bores 123 and 126 of the guide tube 121, it has a first valve bore 133 and a fourth valve bore 136. Accordingly, a second valve bore 134 and a third valve bore 135 are provided distally in the control sleeve 131. The control sleeve 131 is arranged within the guide tube 121 in a rotationally secure manner, so that the corresponding through-bores of the guide tube 121 and the valve bores of the control sleeve 131 are freely passable in each valve opening position. The control sleeve 131 has an internal cavity 141, which simultaneously forms an acceleration path for a projectile 143. Project 143 has a [feature / component] on its outer surface. The drive ring 145 rests on an inner surface of the control sleeve 131. The control sleeve 131 is 4 mm shorter than the guide tube 121.

[0075] Proximal to the control sleeve 131, a return spring 171 is arranged in a sheath tube, which is held in the proximal end cap 107 by means of a bracket 173.

[0076] At the distal end of the control sleeve 131, a temperature control spring 181 is arranged for imprinting a defined deformation wave onto the sonotrode 211 due to the mechanical impact of the projectile 143. The temperature control spring 181 has a plurality of stacked polymer discs 191 in the distal direction 115, which are surrounded externally by a sheathing tube 185. The sheathing tube 185 is held in the distal end cap 111 by means of a holder 183. At the proximal end of the sheathing tube 185, a proximal end cap 187 is arranged, which has an internal O-ring 193 and is movably captured and held by means of a weld ring 195, which is welded to the sheathing tube 185. On the distal side, a distal end cap 189 is arranged, which is also movably held by means of a crimping of the sheath tube 185 and also has an O-ring 193 inside.

[0077] Thus, the distal end of the return spring 171 represents a proximal stop element and the proximal end cap 187 of the temperature control spring 181 represents a distal stop element for the project 143. Figure 2 Figure 1 shows the state in which the control sleeve 131 is abutted in a distal direction 115 against the distal-side stop element formed by the proximal end cap 187 of the temperature control spring 181. Since the control sleeve 131 is 4 mm shorter than the guide tube 121, the cavity of the guide tube 121 in the region of the proximal-side fifth through-opening 127 is free of the control sleeve 131. After repulsion of the projectile 143 at the end cap 187 of the temperature control spring 181, the projectile 143 moves back in the opposite direction 115 and takes the control sleeve 131 with it by means of the drive ring 145. This return movement makes the opposite distal through-openings of the guide tube 121 and the associated valve openings for the entry of supply air into the cavity 141 of the control sleeve 131 freely passable, and the incoming supply air pushes the projectile 143 further in the proximal direction.Due to this retraction of the project 143 and the accompanying movement of the control sleeve 131, over a distance of 4 mm, the first valve bore 133 of the control sleeve 131 is pushed onto the first through bore 123 of the guide tube 121, and the fourth valve bore 136 of the control sleeve 131 is pushed onto the fourth through bore 126 of the guide tube 121, upon a defined stop of the proximal end of the control sleeve 131 against the distal end wall of the casing of the return spring 171, thereby making the respective through bore and valve bore continuous for the exit of exhaust air into the exhaust chambers 159. Simultaneously, the fifth through bore 127 and the opposite one are closed. The visible additional through-hole for the passage of supply air is closed. After repulsion of the project 143 at the proximal stop by means of the return spring 171 and followed by renewed movement in the distal direction 115, the control sleeve 131 is again carried along by the project 143 by means of the drive ring 145, thereby opening the fifth through-hole 127 and the opposite, non-visible additional through-hole. Supply air enters the cavity 141 of the control sleeve 131 through these and moves the project 143 further in the distal direction 115 until the state shown in Figure 2 is reached again.

[0078] A headpiece 215 of the sonotrode 211 is arranged distal to the temperature control spring 181. The headpiece 215 is movably mounted at both its proximal and distal ends in a guide element 216 by means of O-rings 217. The headpiece 215 has a transverse bore 221 in which a plunger 223, acting as an anti-rotation device and for removing fragments of body stones, engages loosely with an actuating handle 225. The plunger 223 is held in position by a spring (not shown in Figure 2). By pressing the plunger 223 into the transverse bore 221 using the actuating handle 225, fragments of body stones can be removed from the headpiece 215. A damping element 219 is arranged on the distal side of the headpiece 215 to limit the amplitude of the sonotrode 211.

[0079] The distal end cap 111 has relief holes. 203 to the headpiece 215 of the sonotrode 211 and to the holder 183 the temperature control spring 181, which together with a respective elastomer ring 205 each form a pressure relief valve 201 to the holder 183 of the temperature control spring 181 and to the headpiece 215 of the sonotrode 211, in order to prevent an effect of overpressure in the patient when using the lithotripsy device 101 in the event of a fault.

[0080] To illustrate the operating principle and the drive mechanism, the lithotripsy device 101 with the guide tube 121 and the internal control sleeve 131 is shown in a highly simplified form in Figures 3 and 4, in which only one through-opening for supply air and exhaust air is shown on the distal and proximal sides, respectively, and for illustrative purposes, these are also shown in the same plane. The guide tube 121 has a fifth through-bore 127 for supply air and a fourth through-bore 126 for exhaust air on its proximal side, which pass through a surface of the guide tube 121 and are slightly offset along a longitudinal central axis 149 of the guide tube 121 and the control sleeve 131, which are arranged concentrically to each other. On the distal side, the guide tube 121 has a sixth through-bore 128 for supply air and a third through-bore 125 for exhaust air, which are also arranged offset along the longitudinal central axis 149.Opposite the fifth through-hole 127, the sixth through-hole 128, the third through-hole 125 and the fourth through-hole 126, there is a recess 148 in the inner surface of the. Guide tube 121 formed, wherein the radially circumferential groove has a greater width than the diameter of the respective through bore 125, 126, 127, 128.

[0081] The control sleeve 131, arranged in the cavity of the guide tube 121, has a fifth valve bore 137 on its proximal side and a fourth valve bore 136 opposite it. On its distal side, the control sleeve 131 has a sixth valve bore 138 and a third valve bore 135 opposite it. A projectile 143 is arranged in the cavity 141, which has a drive ring 145 on its outer surface that is in external contact with the inner surface of the control sleeve 131. The projectile 143 is movable within the cavity 141 along an acceleration path between a proximal stop element 165 and a distal stop element 167. The projectile 143 has a proximal spring element at its proximal end. 146 for repulsion at the proximal stop element 165 and at its distal end a distal spring element 147 for repulsion at the distal stop element 167. Alternatively, the two spring elements 146, 147 are each arranged at the proximal stop element 165 and the distal stop element 167 (as described above for Figure 2).

[0082] The lithotripsy device 101 is started by means of a control element and compressed air is continuously supplied by a drive device (not shown in Figures 3 and 4) in an air supply direction 161 through the fifth through-bore 127 and / or the sixth The compressed air is conveyed through the through-bore 128 of the guide tube 121. Likewise, the compressed air from the cavity 141 continuously exits the guide tube 121 in an exhaust direction 163 through the third through-bore 125 and / or the fourth through-bore 126.

[0083] Figure 3 shows a state in which the driven control sleeve 131, with its distal end, is abutted against the distal stop element 167 during movement of the projectile 143 due to the drive ring 145 in a projectile movement direction 144 in a distal direction 115. This blocks the sixth through-bore 128 of the guide tube 121 through the control sleeve 131, while the offset opposite third through-bore 125 of the guide tube 121 is open, so that compressed air is forced out of the third through-bore 125 as exhaust air due to the projectile movement direction 144 in a distal direction 115.At the proximal end of the tubular control sleeve 131, the fifth through-bore 127 of the guide tube 121 is exposed, so that compressed air as supply air through this fifth through-bore 127 and the open proximal opening of the control sleeve 131 presses directly onto the proximal end of the projectile 143 and moves it further in the direction of projectile movement 144 until it abuts the distal stop 167. Accordingly, the fourth through-bore 126, which is offset opposite the fifth through-bore 127, passes through the control sleeve 131 abutting the distal stop element 167. sealed, so that the incoming compressed air is only used to move the projectile 143 in the direction of movement 144 and cannot escape (see Figure 3).

[0084] After the project 143 strikes the distal stop element 167, it is repulsed by the distal spring element 147 and moved in the opposite direction to the distal direction 115. During this movement, the project 143, due to the drive ring 145, carries the control sleeve 131 along in a proximal direction until the proximal end of the control sleeve 131 strikes the proximal stop element 165 (see the state as shown in Figure 4). The project 143 then continues to move independently in the project movement direction 144, opposite to the distal direction 115.Due to the control sleeve 131 striking the proximal stop element 165, the sixth through-bore 128 at the distal end of the guide tube 121 is now exposed, and compressed air flows continuously through this sixth through-bore 128 and directly through the distal opening of the control sleeve 131 towards the distal end of the project 143, thereby moving it further in the direction of project movement 144 against the proximal stop element 165. To effectively effect this movement, the third through-bore 125 of the guide tube 121 at the distal end of the guide tube 121 is closed by the proximally struck control sleeve 131. Likewise, the fifth through-bore 127 for supplying compressed air through the attached control sleeve 131 is closed on the proximal side, while the offset opposite fourth one is closed. The through-bore 126 is open for venting the compressed air compressed by the movement of the project 143 in the direction of project movement 144. The grooves machined circumferentially into the inner surface of the guide tube 121 at the level of the through-bores 125, 126, 127, and 128, which are visible in Figures 3 and 4 as opposing recesses 148, ensure that the compressed air is optimally and uniformly distributed radially around the control sleeve 131. This prevents local lateral overpressure and friction and / or jamming of the control sleeve 131 on the guide tube 121 when the control sleeve 131 is moved by the project 143 via the drive ring 145. Furthermore, due to the circumferential grooves, an anti-rotation device for the control sleeve 131 can be dispensed with in this case.

[0085] As described above for the distal stop element 167, the project 143 is repulsed by the proximal spring element 146 when it encounters the proximal stop element 165, and is thus moved again in the distal direction 115. During this reversal of movement, the control sleeve 131 is again carried along in the distal direction 115, and the processes described above are continuously repeated.

[0086] Thus, a lithotripsy device 101 is provided in which an automatic valve changeover for moving a self-stimulating projectile back and forth along an acceleration path is realized internally by the design of the guide tube 121, the control sleeve 131 and the projectile 143, wherein the process during a continuous flow through the guide tube The 121 and the control sleeve 131 themselves are clocked and repeat automatically. This eliminates the need for complex control and valve switching of an external, pulsed compressed air supply. Reference character list 101 Lithotripsy device 103 carrier unit 105 Housing tube 107 Proximal end cap 109 Proximal counternut 111 Distal end cap 113 Distal antimother 115 Distal direction 117 Control element 119 Suction line 121 Guide tube 123 First through-hole for exhaust air 124 Second through-hole for exhaust air 125 Third through-hole for exhaust air 126 Fourth through-hole for exhaust air 127 Fifth through-hole for supply air 128 Sixth through-hole for supply air 131 Control sleeve 133 First valve bore 134 Second valve bore 135 Third valve bore 136 Fourth valve bore 137 Fifth valve bore 138 Sixth valve bore 141 Cavity / Acceleration track 143 Project 144 Per ectile movement direction 145 Drive ring 146 Proximal-side spring element Distal-side spring element recess Longitudinal axis first exhaust air connection second exhaust air connection first supply air connection second supply air connection Zulu ft kämme r Ab lu ft kämme r Air supply direction Exhaust air direction Proximal stop element Distal stop element Return spring bracket tempering spring holder sheathing tube Proximal end cap Distal end cap Polymer discs O-ring welding ring Overpressure valve Relief borehole Elastomer ring Sonotrode Sonotrod tip head piece Guide part 217 O-ring 219 Damping element 221 Cross bore 223 plunger 225 operating handle

Claims

Patent claims:

1. Lithotripsy device (101) for fragmenting body stones, the lithotripsy device (101) comprising a carrier unit (103), a guide tube (121) with a cavity, a proximal end and a distal end, 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 guide tube (121) is at least partially arranged in the carrier unit (103), and the lithotripsy device (101) comprising a drive device for supplying and / or removing a pressure medium into an interior of the carrier unit (103) and / or the guide tube (121) for moving the projectile (143) back and forth between the proximal-side stop element (165) and the distal-side stop element. (167) and a sonotrode (211) can be assigned, wherein the guide tube (121) has at least one proximal through-opening (123, 126,127) and has at least one distal through-opening (124, 125, 128) for supplying and / or draining the pressure medium into and / or out of its cavity, and the sonotrode (211) is directly or indirectly connectable at its proximal end to the carrier unit (103) and / or the guide tube (121) and can be excited to vibration by a mechanical impact of the projectile (143) on the distal stop element (167), characterized in that a control sleeve (131) is arranged in the cavity of the guide tube (121), wherein the control sleeve (131) has a cavity (141) along its longitudinal central axis (149), a proximal end, a distal end, at least one proximal opening (133, 136) and at least one distal opening (134, 135) for the pressure medium, and in the cavity (141) the, Control sleeve (131) the movable projectile (143) with a drive element (145) for taking the control sleeve along (131) is arranged so that when the control sleeve (131) is moved by means of the drive element (145) of the projectile (143), a first valve opening position is formed for the flow of the pressure medium through the at least one proximal through-opening (123, 126, 127) of the guide tube (121) and the at least one proximal opening (133, 136, 137) of the control sleeve. (131) in and / or out of the cavity (141) of the control sleeve (131) for moving the projectile (143) towards the distal stop element (167) and a second valve opening position for the pressure medium to flow through the at least one distal through-opening (124, 125, 128) of the guide tube (121) and the at least one distal opening (134, 135, 138) of the control sleeve (131) in and / or out of the cavity (141) of the control sleeve (131) for moving the projectile (143) back to the proximal stop element (165). Lithotripsy device (101) according to claim 1, characterized in that the control sleeve (131) has a second proximal opening, a third proximal opening, a fourth proximal opening and / or further proximal openings (133, 136, 137) and / or a second distal opening, a third distal opening, a fourth distal opening and / or further distal openings (134, 135, 138).Lithotripsy device (101) according to claim 1 or 2, characterized in that the guide tube (121) has a second proximal-side through-opening, a third proximal-side through-opening, a fourth proximal-side through-opening and / or further proximal-side through-openings (123, 126, 127). and / or a second distal through-opening, a third distal through-opening, a fourth distal through-opening and / or further distal through-openings (124, 125, 128). Lithotripsy device (101) according to one of the preceding claims, characterized in that the distal opening, the respective distal opening and / or the distal openings (134, 135, 138) is or are arranged at the distal end and / or in a lateral surface of the control sleeve (131) and / or the proximal opening, the respective proximal opening and / or the proximal openings (133, 136, 137) is or are arranged at the proximal end and / or in the lateral surface of the control sleeve.Lithotripsy device (101) according to any one of claims 2 to 4, characterized in that the proximal through-openings (123, 126, 127), the distal through-openings (124, 125, 128), the proximal openings (133, 136, 137) and / or the distal openings (134, 135, 138) are arranged axially symmetrically to the longitudinal center axis (149) of the control sleeve (131). Lithotripsy device (101) according to any one of the preceding claims, characterized in that the guide tube (121) has in its inner surface at least a partially radially circumferential recess (148) or several at least partially radially circumferential recesses (148) for guiding the pressure medium around the control sleeve (131). Lithotripsy device (101) according to any one of the preceding claims. Claims characterized in that between a outer surface of the guide tube (121) and a Inner surface of the carrier unit (103) two or more Separate chambers (157, 159) for conveying pressure medium to and / or from the at least one proximal through-opening or through-openings (123, 126, 127) and / or the at least one distal through-opening or through-openings (124, 125, 128) are arranged. Lithotripsy device (101) according to one of the preceding claims, characterized in that the distal stop element (167) and / or the proximal stop element (165) has a spring element (171, 181) for repulsing the projectile (143). Lithotripsy device (101) according to one of the preceding claims, characterized in that the projectile (143) and the control sleeve (131) form a spring element, in particular a compressed gas spring, distally and / or proximally. Lithotripsy device (101) according to one of the preceding claims, characterized in that the lithotripsy device (101) has at least one connecting port (151, 153, 155) for connecting to the drive unit and for continuously supplying or discharging the pressure medium. Lithotripsy device (101) according to one of the preceding claims, characterized in that the lithotripsy device (101) comprises the sonotrode (211) and / or the drive unit. Lithotripsy device (101) according to one of the preceding claims, characterized in that the drive unit supplies pressure to the cavity or a part of the cavity of the guide tube (121) and / or to the cavity (141) or a part of the cavity (141) of the control sleeve. (131) a negative pressure and / or a positive pressure can be imposed. Lithotripsy device (101) according to one of the preceding claims, characterized in that the drive element (145) has at least a partially annular friction element on and / or in a surface of the projectile and / or a medium for viscous friction. Lithotripsy device (101) according to one of the preceding claims, characterized in that the drive element (145) has a magnetic element and the control sleeve (131) has a counter-magnetic element. Lithotripsy device (101) according to one of the preceding claims, characterized in that the lithotripsy device (101) and / or the carrier unit (103) has an operating unit (117) for starting, stopping and / or individually triggering a movement of the projectile (143).Lithotripsy device (101) according to one of the preceding claims, characterized in that the lithotripsy device (101) has a counter bearing and a horn, and at least one piezoelectric element is arranged and mechanically coupled between the counter bearing and the horn as a vibration exciter, wherein the horn has the distal-side stop element (167) and / or the horn is connectable to the distal-side stop element (167) and / or the sonotrode (211), and the at least one piezoelectric element is electrically connectable to an associated ultrasound generator, so that a combined vibration excitation of the sonotrode (211) by means of the drive device and the at least one piezoelectric element is possible. Method for accelerating a projectile (143) of a lithotripsy device (101), wherein the lithotripsy device (101) has a guide tube (121) with a cavity and a control sleeve (131) in the cavity of the guide tube (121), wherein the projectile (143) movable between a proximal-side stop element (165) and a distal-side stop element (167) is arranged in a cavity (141) of the control sleeve (131), and the movable projectile (143) has a drive element (145) for moving the control sleeve (131), the lithotripsy device (101) is associated with a drive device for supplying and / or discharging a pressure medium, and the guide tube (121) has at least one proximal-side through-opening (123, 126, 127) and at least one distal-side through-opening. (124, 125, 128) for supplying and / or discharging the pressure medium into and / or out of its cavity (141) and the control sleeve (131) has at least one proximal opening (133, 136,137) and has at least one distal opening (134, 135, 138) for the pressure medium, with the following steps:, - Supplying and / or discharging the pressure medium into the cavity of the guide tube (121) by means of the drive device, - Flow of the pressure medium through the at least one proximal through-opening (127) of the guide tube (121) and the at least one proximal opening (137) of the control sleeve (131) into the cavity (141) of the control sleeve (131) and movement of the projectile towards the distal stop element (167) , and Moving the control sleeve (131) by means of the drive element (145) of the projectile (143) , and / or - Repulsion of the projectile (143) at the distal-side stop element (167), and / or - Flow of the pressure medium through the at least one distal through-opening (128) of the guide tube (121) and the at least one distal opening (138) of the control sleeve (131) into the cavity (141) of the control sleeve (131) and retraction of the projectile (143) to the proximal-side stop element (165) and - Moving the control sleeve (131) by means of the drive element (145) of the projectile (143), and / or - Repulsion of the projectile (143) at the proximal-side stop element (165). Method according to claim 16, characterized in that the supply and / or discharge of the pressure medium is carried out continuously.

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