Interchangeable probe tips for lithotripsy

Abstract

A device for acoustic lithotripsy can include an elongated, acoustically transparent probe body extending between a distal portion and a proximal portion, and an acoustically transparent probe tip that is selectively user-replaceable on the probe body. The probe body can have a lumen extending longitudinally therethrough. A method for fragmenting a concretion can include a user replacing the probe tip on the probe body without the need for additional tools, and transmitting acoustic energy through the probe body and the probe tip to at least partially fragment the concretion.

Description

[Technical field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of priority to U.S. Provisional Patent Application No. 63 / 065,845, filed August 14, 2020, the contents of which are incorporated by reference herein in their entirety.

[0002] This document relates to techniques for breaking up obstructions, such as physiological calculi or "stones," using lithotripsy, and more particularly, to techniques for breaking up obstructions, such as using laser lithotripsy. [Background technology]

[0003] Medical endoscopes were first developed in the early 1800s and have been used to examine the inside of the body. A typical endoscope has a distal end with an optical or electrical imaging system and a proximal end with controls for operating the device or viewing images, etc. An elongated shaft connects the proximal and distal ends. Some endoscopes allow the physician to pass tools through one or more working channels, for example to remove tissue or retrieve objects.

[0004] Over the past few decades, several advances have been made in the field of endoscopy, particularly with regard to the destruction of physiological stones in the bile ducts, urinary tract, kidneys, and gallbladder. Physiological stones in these areas can block the ducts and cause a significant amount of pain to the patient, and therefore must be destroyed and / or removed. Different techniques have been developed to destroy stones, including ultrasound or other acoustic lithotripsy, pneumatic lithotripsy, electrohydraulic lithotripsy (EHL), and laser lithotripsy, which can include the destruction of stones using green light, YAG, or holmium lasers. Summary of the Invention [Problem to be solved by the invention]

[0005] In one approach to lithotripsy, a single probe with a non-removable probe end can be used for stone fragmentation and removal. In this approach, a single type of probe end with a particular size and shape is used with a variety of stones that may be of different hardness and size. Such an approach may limit the flexibility of the operator to tailor the treatment of such stones based on their shape and type, etc., with respect to the probe end type. [Means for solving the problem]

[0006] The present disclosure provides, among other things, a system and method for fragmenting or removing stones with a device having an end user replaceable probe end. Having a wide variety of probe end types and shapes can allow for the selection of a probe end that is best suited for a particular procedure and stone being treated. Allowing the end user to select a particular probe end can allow for more efficient fragmentation or removal of such stones. For example, softer stones can be more easily fragmented when treated with a square cut probe end, while harder stones can be more easily fragmented when treated with a sharper chisel cut probe end.

[0007] Interchangeable probe tips can be configured and manufactured based on the needs of an individual patient or based on the needs presented by a particular stone. For example, diagnostic tools can be used to identify the type and size of stone that requires fragmentation and / or removal, and the tip can be suitably shaped and manufactured to fragment and / or remove that particular stone. Such interchangeable probe tips can also help extend the life of a reusable probe body, allowing an operator to continue using the same probe body, thereby reducing processing costs.

[0008] Interchangeable probe tips can allow for adjustment or optimization of the stone fragmentation and / or removal procedure, such as can help reduce procedure time. Additionally, interchangeable probe tips can potentially aid in lower operating costs by extending the operational life of the probe overall, such as by allowing the end user to replace worn or unnecessary probe ends as needed.

[0009] In one example, a device for acoustic lithotripsy can include an elongated, acoustically transparent probe body extending between a distal portion and a proximal portion, the probe body including a lumen extending longitudinally therethrough, and one or more acoustically transparent probe tips selectively user-interchangeable with the probe body.

[0010] In one example, a kit for use with a lithotripsy device may include a number of different acoustically transparent probe tips that are selectively user-interchangeable with the probe body of the lithotripsy device, such as without the need for a separate tool.

[0011] In one example, a method for fragmenting a concretion may include selecting or exchanging a probe body probe end, such as by an end user without requiring additional tools, and transmitting acoustic energy through the probe body and the selected probe end to the concretion to at least partially fragment the concretion.

[0012] The figures are not necessarily to scale, but like numerals in different figures may describe like components. Like numerals with different letter suffixes may represent different instances of the like components. The figures generally illustrate by way of example, but not by way of limitation, various embodiments discussed in the present document. [Brief description of the drawings]

[0013] [Figure 1]FIG. 1 is a schematic diagram illustrating a stone breaking and removal device having an interchangeable probe end in one example. [Figure 2A] FIG. 13 is a perspective view illustrating an example of an interchangeable probe tip. [Figure 2B] FIG. 13 is a perspective view illustrating an example of an interchangeable probe tip. [Figure 3A] FIG. 13 is a schematic diagram illustrating an interchangeable probe tip in one example. [Figure 3B] FIG. 13 is a schematic diagram illustrating an interchangeable probe tip in one example. [Figure 3C] FIG. 13 is a schematic diagram illustrating an interchangeable probe tip in one example. [Figure 4] FIG. 13 is a schematic diagram illustrating an interchangeable probe tip in one example. [Diagram 5] FIG. 13 is a schematic diagram illustrating an interchangeable probe tip in one example. [Figure 6] FIG. 13 is a schematic diagram illustrating an interchangeable probe tip in one example. [Figure 7] 13 is a flow chart illustrating a method of applying interchangeable probe tips in one example. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0014] Stone fragmentation and removal can include end-user replaceable probe ends (or kits of ends) that can be selected or replaced depending on the type or nature (e.g., hardness) of the stone (e.g., kidney stone) being treated. End features can include, for example, fluid inlet holes or one or more axial grooves. Different ends can have different morphologies or can include or be made of different materials, such as ceramics or composites.

[0015] For end-user operators acoustically fragmenting and removing stones, it is desirable to reduce fragmentation time. This can be aided by using a larger amplitude acoustic fragmentation signal, however such a large amplitude may result in increased probe wear or premature probe failure. Operators may desire reduced fragmentation time without probe failure, and an overall shorter time to complete the procedure once the lithotripsy device is inserted into the patient before the puncture site is closed. Additionally, it may be desirable for there to be no fragments remaining after such a procedure.

[0016] A probe end that can be removably coupled to the probe body of the lithotripsy device, e.g., the lumen of the probe body, can allow for more efficient fragmentation of the concretion, such as by allowing the end user to select and use a probe end type that can be adapted to the concretion to be treated. This can help to better fragment the target concretion, which in turn can help to reduce the size of the resulting particles that are expelled through the probe. For example, a distal probe end of ceramic or composite type can be fixed and aligned by the end user to the probe body such that the expulsion path is through the end and through the probe. This can allow for efficient breakage of the concretion and expulsion of the stone fragments. A particular probe end can be easily removable and replaceable by the end user with another probe end of a different type or other nature, such as when the end user desires, such as based on the stone type or some other reason.

[0017] 1 illustrates a schematic diagram of an example of portions of an acoustically transparent stone breaking and removal probe assembly 100 having an end user replaceable probe tip 114. The probe assembly 100 can include a proximal portion 102 and a distal portion 104. The probe assembly 100 can include a probe 110 having a probe body 112 and an end user attachable or end user detachable probe tip 114. The probe assembly 100 can also include or be coupled to one or more of an acoustic transducer 120, a hand piece 125, an exhaust path 130, and a pressure source 140. The probe assembly 100 can be in communication with a generator 150.

[0018] The probe assembly 100 may include a lithotripsy device for treatment of stones, such as by fragmentation. The probe assembly 100 may achieve lithotripsy treatment, such as by using ultrasonic or other acoustic energy, using low frequency solenoid-driven ballistic impact, or any combination thereof, to fragment stones or otherwise treat physiological targets. The probe assembly 100 may include a dual frequency or other multi-frequency device, such as may enable both sonic and ultrasonic pulsed operation for stone destruction.

[0019] The probe 110 can be sized and shaped, such as to allow insertion into a patient, such as through an incision, for treating stones. The probe 110 can include an acoustically transparent probe for transmitting acoustic energy from a generator or acoustic transducer to a target stone for fragmentation. The probe 110 can include a proximal portion 102 closer to an operator using the device, and a distal portion 104 closer to the site of treatment. The probe 110 can have a length of about 350 mm to about 600 mm, for example, depending on the particular probe type and end-user attachable or detachable probe distal end used. The probe 110 can have a diameter of about 0.90 mm to about 3.80 mm, for example, depending on the particular probe type and end-user attachable or detachable probe distal end used.

[0020] The probe 110 can include a probe body 112 extending between the proximal portion 102 and the distal portion 104, such as having a lumen 113 also extending between the proximal portion 102 and the distal portion 104. The probe body 112 can be sized and shaped for insertion into a patient, such as to reach a stone for fragmentation. The probe body 112 can include or be made of a metallic or composite metallic material. The probe body 112 can include one or more couplers or other attachment mechanisms for coupling with the probe end 114. The probe body 112 can enable an operator to manipulate to position and operate the probe end 114 on or near a target stone.

[0021] The probe end 114 can be selected and attached to the probe body 112 by an end user. The probe end 114 can be sized, shaped, and positioned to break, fragment, or fragment one or more target stones. The probe end 114 can be attached to the probe body 112. In some cases, the probe end 114 can include a lumen 116. When the probe end 114 is attached to the probe body 112 by an end user, the lumen 116 of the probe end 114 can align with and extend from the lumen 113 of the probe body 112, such as to provide a continuous irrigation and / or drainage passageway. The probe end 114 can have a desired morphology or other properties, such as a chisel end, a rectangular end, an end with a large or small distal or peripheral surface area, various topographies, various morphologies, or of various materials, depending on the particular procedure being performed or the particular goal for which the procedure is being performed.

[0022] The acoustic transducer 120 may be operable to provide acoustic energy to the target stone via the acoustically transparent probe 110. The acoustic transducer 120 may provide ultrasonic energy, sonic energy, or some combination thereof, such as to break up the target stone, such as by fragmentation or pulverization. In some cases, the acoustic transducer 120 may be configured to pulse impact between various energy levels or types. This may include, for example, applying ultrasonic energy with intermittent low frequency acoustic energy pulses or with intermittent ballistic mechanism energy administration. The acoustic transducer 120 may provide acoustic energy of various waveforms or frequencies depending on the particular operation. For example, the acoustic transducer 120 may operate to select, adjust, or optimize waveforms during one or more portions of a procedure. An acoustic transducer 120 can be acoustically coupled to the acoustically transparent probe body 112, such as to provide acoustic energy down the length of the probe body 112 to a probe end 114 that can be positioned near or in contact with a target stone. In one example, the acoustic transducer 120 can have a diameter of about 4 to about 6 cm, a length of about 15 to about 25 cm, and a weight of about 0.4 to about 1.0 kg, depending on the particular transducer used.

[0023] The hand piece 125 can be shaped and sized to allow an end user operator to grasp and manipulate the probe assembly 100. In one example, the hand piece 125 can house all or a portion of the acoustic transducer 120. The hand piece 125 can include one or more buttons or other user interface means, such as to allow an operator to control the probe assembly 100. For example, the hand piece 125 can include a dial for variable suction control in communication with the pressure source 140. In one example, the hand piece can include one or more buttons for applying ultrasonic, sonic, or other energy from the acoustic transducer 120 to apply to the target stone for fragmentation. In some examples, the system can additionally or alternatively include a foot pedal or other auxiliary actuator, such as to control activation of the acoustic transducer 120.

[0024] The exhaust line 130 may be fluidly connected to a lumen of the probe 110 to provide irrigation, suction, or both, etc. to the probe assembly 100. The exhaust line 130 may extend outwardly from the handpiece 125 to a pressure source 140 or other pressure source. The pressure source 140 may provide an exhaust pressure down the length of the exhaust line 130 to draw fragments of the fractured stone down the exhaust line 130 and away from the lumen of the probe 110. The exhaust line 130 may be additionally irrigated as desired.

[0025] The generator 150 may be in electrical communication with the probe assembly 100, such as to provide electrical energy to the probe assembly 100 during use. The generator 150 can provide electrical energy to power the acoustic transducer 120 to generate ultrasonic or other acoustic or ballistic energy, such as for fragmenting a target stone. In one example, the generator 150 can provide AC electrical energy of about 90 to about 264 volts (peak-to-peak). The electrical energy signal provided by the generator 150 can be varied (e.g., amplitude, frequency, pulse width, modulation, etc.), such as depending on the particular process being performed and the desired parameters.

[0026] 2A-2B illustrate an example of a perspective view of a portion of a probe assembly 100 having a user replaceable probe tip 114. The probe assembly 100 may include a proximal portion 102 and a distal portion 104. The probe assembly 100 may include a probe body 112 having a lumen 113. The probe assembly 100 may also include a probe tip 114 having an attachment mechanism 222, a lumen 116, one or more optional side openings 226, and one or more optional axial grooves 228. The probe assembly 100 may be used with an acoustic transducer and generator, such as those discussed above with reference to FIG. 1, for fragmentation of one or more target stones.

[0027] The probe assembly 100 may be delivered to an operator with the probe tip 114 attached to the probe body 112, or the probe tip 114 may not be attached to the probe body 112, but instead may be delivered to an operator with one or more probe tips 114 provided separately (e.g., as an ancillary accessory or in a kit including various probe tips 114), and the operator (as an end user) may then select a desired probe tip 114 and attach it to the probe body 112 as desired. In some cases, multiple different probe tips 114 may be included for use with a single probe body 112. The multiple probe tips 114 may be configured differently, such that an end user operator may be able to switch in and out of a particular probe tip 114, such as depending on the particular procedure being performed, or even dedicated to a particular target or portion of the procedure.

[0028] The probe body 112 can be shaped and sized to be removably connected to and functional at the probe end 114 by an end user. The probe body 112 can extend from the proximal portion 102 to the distal portion 104. At the proximal portion 102, a handpiece and acoustic transducer can be provided for use by an operator. At the distal portion 104, the probe body 112 can be attachable to the probe end 114 by an end user.

[0029] 1 to provide acoustic energy through the probe body to actuate the probe end 114 to acoustically fragment the target stone. The probe body 112 may include a lumen 113 extending longitudinally therethrough, such as to allow stone fragments to be passed through the probe body 112 and discharged for collection or disposal, such as into an aspiration or discharge tube or pathway.

[0030] The probe tip 114 may be user-attachable and detachable from the probe body 112, such that an end-user operator of the probe assembly 100 may select or exchange different probe tips 114 as desired depending on the procedure being performed and the type of target stone. The user-exchangeable probe tip 114 may be acoustically transparent to enable acoustic fragmentation, fragmentation, or pulverization of the target stone. The acoustic impedance of the probe tip 114 may be matched to the acoustic impedance of the probe body 112, such that acoustic energy of a desired frequency is transmitted across a boundary, joint, or junction between the two components without significant attenuation of acoustic energy due to acoustic impedance mismatch between the two components. The probe tip 114 may be user-exchangeable without the need for a separate tool such as those described herein, such that the probe tip 114 may be exchanged before or even during a procedure by an end-user operator rather than during manufacturing of the probe assembly 100.

[0031] The probe tip 114 can include or be made of ceramic or composite materials such as zirconia, alumina, or compounds, and optionally doped with one or more of diamond, cubic zirconia, carbon nanotubes, tungsten, or combinations thereof. Lightweight materials such as ceramics can help to avoid any significant increase in the weight of the probe assembly 100 when the probe tip 114 is attached. This can provide the transducer or probe body 112 with an overall smaller mass that needs to be tuned or optimized to effectively transmit acoustic energy to the target stone. The material of the probe tip 114 can be acoustically transparent, such as at the ultrasonic or acoustic frequencies used for treatment.

[0032] The probe end 114 may be any number of interchangeable probe ends of various morphologies. For example, the probe end 114 may be selected from a variety of interchangeable probe ends that allow for varying contact pressure depending on the target stone type. For example, a probe end with a wide end may be used for softer stones, and a probe end with a sharp end may be used for harder stones. For example, a rectangular end probe end with a larger surface area to contact the stone may be used for softer stones. In contrast, a chisel, serrated, segmented, or cup-end type probe end with a more targeted, smaller surface area to contact the stone may be used to target and break up harder stones. In some cases, a dual-purpose probe end, such as one with a beveled end or an angled end (such as about 45 degrees), may be used for a probe end that has both a needle-like characteristic to target harder stones and a grinding type characteristic to target softer stones.

[0033] The probe tip 114 can be secured and attached to the probe body 112 by an end-user operator through one or more couplers or attachments, etc., that can provide a mating or other engagement therebetween. For example, the coupler on the probe tip 114 can include one or more tool-less attachments and / or interlocks that are user-operable to the probe body 112 for engaging, attaching, and / or locking thereto and for disengaging or removing therefrom. The attachment mechanism 222 can include threads or other protrusions or grooves or shapes that engage with corresponding complementary mechanisms on the probe body 112, such as to help lock or otherwise mechanically secure the probe tip 114 to the probe body 112. In one example, the attachment mechanism 222 can include threads on an inner diameter of the probe body 112 and a corresponding thread mechanism on the probe tip 114. In another example, the attachment mechanism 222 can include a right-turn slot in the probe body 112 that corresponds to a hub post on the probe tip 114, such as a post that clicks into the slot with a quarter turn. In some cases, the outer diameter of the probe 110 can be crimped to allow for a better diametric fit. In one example, the attachment mechanism 222 can include an inward scroll shape on the distal end of the probe 110. In this case, there may be a relief groove in the device to interact with the scroll shape. Additional relief sections can allow for improved diametric fit. In some cases, an inward spring hook can be used. In another example, the attachment mechanism 222 can include an outward scroll shape and a corresponding inner groove. In some cases, an external spring hook can be used. In some cases, the attachment mechanism 222 can additionally or alternatively include an adhesive.

[0034] For example, the probe body 112 may include a lumen 113 into which an interference fit attachment mechanism 222 of the probe tip 114 with a reduced outer diameter may be inserted. The interference fit attachment mechanism 222 of the probe tip 114 may be inserted such that the probe tip 114 is securely engaged with the probe body 112, such as when a matching outer diameter portion of the probe tip 114 is placed into a mating end at the distal end of the probe body 112 and the interference fit attachment mechanism 222 is inserted into the lumen of the probe body 112. The interference fit may allow for attachment and retention without locking.

[0035] In one example, the attachment mechanism 222 may be a locking mechanism that allows for the attachment, engagement, and locking of the probe tip 114 to the probe body 112. Such a locking engagement may include a quarter-turn interlock or similar retention system in which the probe tip 114 is inserted into the probe body 112 by an end user and then rotated a quarter turn or other specified amount to lock the probe tip 114 into the probe body.

[0036] In one example, the attachment mechanism 222 may be a snap fit. A snap fit may include forcing one or more interlocking components, such as protrusions, grooves, or other geometries on the probe end 114 into corresponding features on the probe body 112. Such snap fits may include cantilever, torsion, annular, or combination snap fits, depending on the shape and size of the probe body 112 and probe end 114. A snap fit may be used to both attach and interlock the probe body 112 and probe end 114.

[0037] In one example, the attachment mechanism 222 may be a threaded mechanism. For example, threads may be on an inner wall of the lumen 113 of the probe body 112 and corresponding threads may be on an outer wall of the probe tip 114. In another example, threads may be on the outside of the probe body 112. The threads may allow the probe tip 114 to be attached and secured to the probe body 112.

[0038] The probe end 114 may include a longitudinal lumen 116 that is aligned with the lumen 113 of the probe body 112 when the probe end 114 is secured to the probe body 112, such as to allow fragmented stone portions to be removed through an aspiration or evacuation path defined by the lumens 113, 116, and an optional separate evacuation path.

[0039] The probe tip 114 can include one or more side openings 226, such as openings from a side region near the exterior of the probe tip 114 into the lumen 113. The side openings 226 can allow fluid inflow into the lumen 116 of the probe tip 114, such as to help flush stone fragments therein. The side openings 226 can help promote, increase, or maximize fluid flow in one or both of the lumens 113, 116, such as can help transport stone fragments when the distal end opening of the probe tip 114 into the lumen 116 is partially or completely blocked. The location of the side openings 226 on the replaceable probe tip 114 can help inhibit or prevent stress risers and fracture points that may occur if the side openings 226 were located in the probe body 112. The probe body 112 is subjected to vibration during operation and may be intended to be more durable and reusable than the probe tip 114, which may be discarded or replaced by the end user as described herein.

[0040] The probe tip 114 may additionally include one or more grooves or channels, such as one or more axial grooves 228. The axial grooves 228 in the lumen 116 of the probe tip 114 may help facilitate fluid flow within the lumen 116, such as when the opening of the probe tip 114 is partially blocked. The axial grooves 228 may additionally allow fluid flow when the lumen 113 of the probe body 112 and the lumen 116 of the probe tip 114 are closed. The axial grooves 228 may extend along the probe tip 114 or may extend further into and along the probe body 112, as desired.

[0041] An end user operator, such as a surgeon, can select a particular probe tip 114 (e.g., from a kit of available probe tips 114) that is best suited for a particular procedure or a particular stone or group of stones to be treated. For example, a particular probe tip 114 can be selected based on the material of one or both of the probe tip or probe body, based on the morphology of the probe tip, based on the acoustic impedance of the probe tip, based on the desired acoustic energy range for the procedure, the surface area of ​​the probe tip itself, other dimensions of the probe tip, or a combination of one or more of those parameters.

[0042] These types of probe end selection parameters can be correlated to the procedure being performed and / or the type or other characteristics of the stone to be fragmented. For example, harder stones can be more effectively fragmented with a cutting end profile that can allow for more specific directionality or area of ​​cutting or fragmentation. Softer stones can be more effectively fragmented with a rectangular end profile or an end profile with a larger surface area. The probe end 114 can help achieve an acoustic impedance match, for example, to the probe body 112 and acoustic transducer, to the target stone, or both. This can help achieve a more effective transfer of acoustic energy from the probe body 112 to the target stone, and such additional flexibility can help deliver acoustic energy to the target stone in a desired manner, such as by appropriately selecting a particular probe end 114 from a kit or set of available probe ends 114, such as at or near the characteristic resonant frequency of the target stone.

[0043] 3A-3C illustrate schematic diagrams of a probe assembly 100 comprising a replaceable probe tip 114 having one or more tongs 326. The probe assembly 100 can have a proximal portion 102 and a distal portion 104. The probe assembly 100 can include a probe body 112 and a probe tip 114. The probe body 112 can include a lumen 113. The probe tip 114 can have an inner diameter 324 defining a lumen 116 along which the tongs 326 can be positioned. The probe tip 114 can additionally include one or more side openings 226. The probe tip 114 can be detached from the probe body 112 and attached such that the lumen 113 and the lumen 116 are aligned.

[0044] In one approach, the probe tip can have an inner diameter or similar dimension across the lumen wall, where both the inner diameter and the lumen wall shape remain constant throughout the length of the probe tip. In another approach, as shown for probe tip 114, the lumen inner diameter 324 can gradually increase, such as from the distal open probe tip 114 towards the probe body 112, such as by defining lumen 116 to have a longitudinally tapered inner diameter. In this approach, the longitudinally tapered inner diameter 324 can help to enable better movement of stone fragments through lumen 116 from the probe tip 114 towards the lumen 113 of the probe body.

[0045] The probe end 114 can have a smaller end hole laterally at the distal portion 104 compared to other probe ends, including compared to one or more other probe ends that may be included together in a kit or set. The smaller hole at the probe end 114 can be drawn from a larger size at a more proximal location at various angles and geometries.

[0046] One or more tongs 326 can extend outward from the probe end 114. The tongs 326 can allow for drawing, such as lowering and capturing and moving stone fragments into the probe 110 during operation, so that the stone fragments move toward the lumen 113 of the probe body 112 toward the drainage or drainage path. The tongs 326 can include multiple tongs at various angles as desired, depending on the type of stone to be treated and the size and type of fragments expected. The tongs 326 can extend outward distally from the probe end 114 to create a larger space to allow for the movement of the stone or stone fragments into the tongs 326. The tongs 326 can be straight or point inward at various angles. A side opening 226 drilled into the probe end 114 can allow for the aspirating and removal of stone fragments.

[0047] 4 illustrates a schematic diagram of an end-user replaceable probe tip in a probe assembly 100. The probe assembly 100 can have a proximal portion 102 and a distal portion 104. The probe assembly 100 can include a probe body 112 and a probe tip 114 having portions 422, 424, 426. In the probe assembly 100, the distal portion 104 can accommodate the probe tip 114, which can be adjustable in length at the end of the probe body 112.

[0048] For example, the probe end 114 may include three or more ring-shaped portions 422, 424, 426. The operator may adjust the number of portions 422, 424, 426 extending distally relative to the probe body 112 for use. The probe end 114 may be slidable relative to the probe body 112 in a longitudinal direction between the proximal portion 102 and the distal portion 104. The probe end portions 422, 424, 426 may be slidable relative to one another depending on the desired probe end shape, size, and length for treatment of the target stone. The probe end portions 422, 424, 426 may be nested within one another. They may be connected to one another by, for example, an interference fit, a snap fit, a thread, a quarter-turn interlock, or other mechanism that allows the ends 422, 424, 426 to move laterally outwardly relative to one another.

[0049] In use, the first portion 422 can be used for breaking up the target stone. The first portion 422 can extend laterally distally from the probe body 112. The second portion 424 and the third portion 426 can be nested within the first portion 422 at the beginning of the operation. If the first portion 422 is damaged during the operation or if the operator wishes to reach further with the assembly 100, the second portion 424 can be pushed out from within the first portion 422 for use. When the second portion 424 extends, it can still be attached to the first portion 422, effectively lengthening the probe assembly 100. Similarly, if the operator no longer wishes to use the second portion 424, the third portion 426 can be pushed out from within the second portion 424. Throughout this process, the portions 422, 424, and 426 can still be attached to the assembly 100. Parts 422, 424, and 426 are not removed during operation.

[0050] The portions 422, 424, 426 may be actuable by one or more triggers on the assembly's handpiece, such as one or more buttons, levers, or roller wheels. In the case of roller wheels, such wheels may be coupled to the portions 422, 424, 426, and actuation with a finger or thumb may slidably move the portions 422, 424, 426 along the assembly 100, such as in a distal direction toward the distal portion 104 where a new portion is desired. In some cases, the portions 422, 424, 426 may be actuated through a mechanical mechanism, such as one or more springs integrated into the probe body 112. In this case, the springs may be compressed or released to push or pull the portions 422, 424, and 426 along the axis of the probe 110. In some cases, the mechanism may be a hydraulic, electromagnetic, or pneumatic piston actuator for moving the portions 422, 424, 426 in and out of the probe body 112.

[0051] FIG. 5 illustrates a schematic diagram of an example of an interchangeable probe tip portion in a probe assembly 100. The probe assembly 100 can have a proximal portion 102 and a distal portion 104. The probe assembly 100 can include a probe tip 114 having a sheath portion 516 and an end portion 518, where the sheath portion 516 can act as a sheath surrounding the end portion 518. The end portion 518 of the probe tip 114 can be laterally movable along the sheath portion 516, such that an end user can adjust the distal position of the end portion 518 of the probe tip 114 into or out of the sheath portion 516. In the probe assembly 100, the distal portion 104 can receive the sheath portion 516, which allows an adjustable length at the end portion of the sheath portion 516. The sheath portion 516 can be positioned within one or more additional portions of the probe, such as the probe body 112, and can be attached to the one or more additional portions by an end user. The probe tip 114 can be coupled to the probe body 112 and can allow slidable movement of the tip 518 along the sheath 516, such that an operator can move the tip 518 distally along the sheath 516 while the probe body 112 remains constant. The operator can adjust the position of the tip 518 relative to the sheath 516 as required for a particular operation. The tip 518 of the probe tip 114 can contact a target stone. An end user can move the tip 518 of the probe tip 114 relative to the sheath 516 with a switch, dial, or other trigger that is mechanically coupled to the probe tip 114. The mechanical trigger can be easily integrated into the handpiece 125 for easy access, allowing for articulation and lateral movement of the probe tip 114.

[0052] FIG. 6 illustrates a schematic diagram of an interchangeable probe end in a probe assembly 100, similar to the probe assembly discussed above with reference to FIG. 5. The probe assembly 100 can have a proximal portion 102 and a distal portion 104. The probe assembly 100 can include a probe end 114 having a probe delivery sheath 610, an internal rotating tube 615, a probe ring 620 having a threaded portion 622. In the probe assembly 100, the distal portion 104 can house the internal rotating tube 615, the probe ring 620, and the threaded portion 622. In the probe end 114, the internal rotating tube 615, the probe ring 620, and the threaded portion 622 are laterally movable relative to the probe delivery sheath 610.

[0053] The probe ring 620 may be slidable within the probe delivery sheath 610. The probe ring 620 may include a threaded portion 622 connected by an internal rotating tube 615, distal to the probe delivery sheath 610, which may allow for attachment of the probe tip 114 to the probe body 112. In this manner, the probe tip 114 may be interchangeable in an assembly that may allow for distal and proximal joining and positioning of the probe tip 114.

[0054] FIG. 7 illustrates a flow chart showing a method 700 for treating stones. Method 700 may include steps 710 and 720. The process may optionally include selecting a probe end from a set of available probe ends or from a kit including a variety of probe ends. In this case, the kit may include, for example, probe ends with different surface morphologies or materials or other variations as discussed above. The kit may include, for example, probe ends that are labeled for operator use, such as labeling for hard stones, soft stones, large stones, small stones, and other parameters that correlate with the type of stone mass being treated.

[0055] Step 710 may include exchanging a probe body with a probe tip. The probe tip may be exchanged with the probe body by a user, such as a surgeon or other operator, during or before a procedure. The probe tip may be exchanged without the need for additional tools or manufacturing techniques.

[0056] Step 720 may include transmitting acoustic energy through the probe body and the probe tip to the concretion to at least partially fragment the concretion. The energy provided to the concretion through the probe tip may fragment, pulverize, or otherwise fragment the targeted concretion.

[0057] Method 700 can allow for customization of the probe tip, such as custom manufacturing the probe tip based on the specific patient needs and procedure being performed. For example, diagnostic tools can be used to identify the size and type of stone that needs to be removed, and 3D printing or rapid machining can manufacture the corresponding desired probe.

[0058] For example, a probe tip may be selected in step 710 based on one or more parameters of the target stone, such as stone size, stone density, stone type, or one or more combinations thereof. In some cases, more than one probe may be used during the procedure, such that replacing the probe tip may include replacing an alternate probe tip during the medical procedure based on the stone parameters.

[0059] Various notes and examples Each of these non-limiting examples can stand alone or can be combined with one or more of the other examples in various orders or combinations.

[0060] Example 1 can include a device for acoustic lithotripsy that can include an acoustically transparent elongated probe body extending between a distal portion and a proximal portion having a lumen extending longitudinally therethrough, and an acoustically transparent probe tip that is selectively user replaceable on the probe body.

[0061] Example 2 can include example 1, wherein the acoustically transparent probe tip is selectively user replaceable on the probe body without the need for a separate tool.

[0062] Example 3 can include any of Examples 1-2, further comprising an acoustic energy source operable to provide acoustic energy via the probe body such that the probe end is actuated for acoustic fragmentation of one or more stones via the probe end.

[0063] Example 4 can include any of examples 1-3, wherein the probe tip includes a user-operable tool-less interlock with the probe body for replacing the probe tip with the probe body.

[0064] Example 5 can include any of Examples 1-4, wherein the probe tip comprises a ceramic or composite ceramic material.

[0065] Example 6 can include any of examples 1-5, wherein the probe end includes a longitudinal lumen configured to align with the lumen of the probe body.

[0066] Example 7 can include any of Examples 1-6, wherein the probe end comprises a lateral opening from the longitudinal lumen to an outer peripheral lateral region of the probe end.

[0067] Example 8 can include any of Examples 1-7, wherein the side opening is configured to allow fluid flow into the lumen of the probe body through at least a portion of the longitudinal lumen of the probe end.

[0068] Example 9 can include any of Examples 1-8, wherein the probe end further comprises one or more axial grooves.

[0069] Example 10 can include any of examples 1-9, wherein a distance between a distal end of the probe tip and a distal end of the probe body is at least one of user adjustable or user selectable by user replacement of the probe tip.

[0070] Example 11 can include any of Examples 1-10, wherein a distance between a distal end of the probe tip and a distal end of the probe body is user adjustable, and the probe body is slidable relative to the probe body along a longitudinal axis of the probe body.

[0071] Example 12 may include a kit for a lithotripsy device comprising a plurality of different acoustically transparent probe tips that are selectively user replaceable on the probe body of the lithotripsy device without the need for a separate tool.

[0072] Example 13 can include example 12, wherein at least one of the probe ends further comprises a locking mechanism for securing the probe end to the probe body.

[0073] Example 14 can include any of Examples 12-13, further comprising an acoustic energy source attached to the probe body for providing acoustic energy via the probe body.

[0074] Example 15 can include any of Examples 12-14, wherein the various probe tips differ in at least one of the following characteristics: material, tip morphology, acoustic impedance, tip surface area, or tip dimension, or a combination of one or more thereof.

[0075] Example 16 can include any of Examples 12-15, wherein the probe tip is attachable to the probe body with one or more attachment mechanisms.

[0076] Example 17 can include a method of fragmenting a concretion, comprising: a user replacing a probe tip with a probe body; and transmitting acoustic energy through the probe body and the probe tip to the concretion to at least partially fragment the concretion.

[0077] Example 18 may include example 17, further including selecting a probe tip based on one or more parameters of the stone.

[0078] Example 19 can include any of Examples 17-18, wherein the one or more parameters include stone size, stone density, stone type, or one or more combinations thereof.

[0079] Example 20 can include any of examples 17-19, further including replacing the probe end with an alternative probe end during the medical procedure based on a parameter of the stone.

[0080] Example 21 can include any of Examples 17-20, wherein the step of a user replacing the probe tip on the probe body includes replacing the probe tip without requiring an additional tool.

[0081] Each of these non-limiting examples can stand alone or can be combined with one or more of the other examples in various orders or combinations.

[0082] The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, for illustration purposes, specific embodiments in which the invention may be practiced. These embodiments are also referred to herein as "examples." Such examples may include elements in addition to those shown or described. However, the inventors also contemplate examples in which only those elements shown or described are provided. Furthermore, the inventors also contemplate examples that use combinations or permutations of those elements (or one or more aspects thereof) shown or described with respect to a particular example (or one or more aspects thereof) or with respect to other examples (or one or more aspects thereof).

[0083] In the event of a conflict in usage between this document and any document incorporated by reference, the usage in this document takes precedence.

[0084] In this document, the terms "a" or "an" are used to include one or more than one, as is common in patent documents, independently of any other instance or use of the terms "at least one" or "one or more." In this document, the term "or" is used to refer to a non-exclusive logical or, so that "A or B" includes "A but not B," "B but not A," "A and B," unless otherwise specified. In this document, the terms "including" and "in which" are used as the plain English equivalents of the respective terms "comprising" and "wherein." Also, in the following claims, the terms "including" and "comprising" are open-ended, i.e., systems, devices, articles, compositions, formulations, or processes that include elements in addition to those listed after such terms in a claim are still considered to be within the scope of that claim. Moreover, in the following claims, the terms "first," "second," and "third," etc. are used merely as labels and are not intended to impose numerical requirements on their objects.

[0085] Examples of the methods described herein may be machine or at least partially computer-implemented. Some examples may include computer-readable or machine-readable media encoded with instructions operable to configure an electronic device to perform the methods as described in the examples above. Implementations of such methods may include code such as microcode, assembly language code, high-level language code, and the like. Such code may include computer-readable instructions for performing various methods. The code may form part of a computer program product. Furthermore, in one example, the code may be tangibly stored on one or more volatile, non-transient, or non-volatile, tangible computer-readable media, such as during execution or at other times. Examples of these tangible computer-readable media include, but are not limited to, hard disks, removable magnetic disks, removable optical disks (e.g., compact disks and digital video disks), magnetic cassettes, memory cards or sticks, random access memory (RAM), read-only memory (ROM), and the like.

[0086] The above description is intended to be illustrative, not limiting. For example, the above examples (or one or more aspects thereof) can be used in combination with each other. Other embodiments can be used by those skilled in the art upon review of the above description. The Abstract is provided to enable the reader to quickly ascertain the nature of the present technical disclosure. The Abstract has been submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to simplify the disclosure. This should not be construed as intending that unclaimed disclosed features are essential to any claim. Rather, the subject matter of the present invention may lie in less than all features of a particular disclosed embodiment. Thus, the following claims are herein incorporated into the Detailed Description as an example or embodiment, with each claim standing on its own as a separate embodiment, and it is intended that such embodiments can be combined with each other in various combinations or permutations. The scope of the present invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. [Explanation of symbols]

[0087] 100 Probe assembly 102 Proximal 104 Distal 110 Probe 112 Probe body 113 Lumen 114 Probe tip 116 Lumen 120 Acoustic Transducer 125 Handpiece 130 Emission Path 140 Pressure Source 150 Generator 222 Attachment mechanism 226 Side Opening 228 Axial groove 324 Inner diameter 326 Tongs 422 First Part 424 Second Part 426 Third Part 516 Scabbard part 518 End 610 Probe Delivery Sheath 615 Internal Rotating Tube 620 Probe Ring 622 Threaded part

Claims

1. an acoustically transparent, elongated probe body extending between a distal portion and a proximal portion, the probe body having a lumen extending longitudinally therethrough; a selectively user replaceable acoustically transparent probe tip in the probe body; a source of acoustic energy attached to the probe body for providing acoustic energy through the probe body; Equipped with the probe tip is slidable relative to the probe body along a longitudinal axis of the probe body; the acoustic energy source is a multi-frequency device capable of both sonic and ultrasonic pulsed operation; 1. A device for acoustic lithotripsy, wherein the probe end includes a lateral opening configured to permit the entry of fluid into the lumen of the probe body.

2. The device of claim 1 , wherein the acoustically transparent probe tip is selectively user-replaceable on the probe body without the need for a separate tool.

3. 10. The device of claim 1, wherein the acoustic energy source is operable to provide acoustic energy through the probe body such that the probe end is actuated for acoustic fragmentation of one or more stones through the probe end.

4. The device of claim 1 , wherein the probe tip includes a user-operable, tool-less interlock with the probe body for replacing the probe tip on the probe body.

5. The device of claim 1 , wherein the probe tip comprises a ceramic or composite ceramic material.

6. The device of claim 1 , wherein the probe end includes a longitudinal lumen configured to align with the lumen of the probe body.

7. The device of claim 6 , wherein the lateral openings are formed in lateral regions from the longitudinal lumen to an exterior periphery of the probe end.

8. The device of claim 7 , wherein the side opening is configured to allow fluid entry into the lumen of the probe body through at least a portion of the longitudinal lumen of the probe end.

9. The device of claim 1 , wherein the probe end further comprises one or more axial grooves.

10. The device of claim 1 , wherein a distance between a distal end of the probe tip and a distal end of the probe body is at least one of user adjustable and user selectable by user exchange of the probe tip.

11. The device of claim 10 , wherein the distance between the distal end of the probe tip and the distal end of the probe body is user adjustable.

12. A probe comprising: an acoustically transparent, elongated probe body extending between a distal portion and a proximal portion, the probe body having a lumen extending longitudinally therethrough; a plurality of different acoustically transparent probe tips that are selectively user-interchangeable on a probe body of the lithotripsy device without the need for a separate tool; a source of acoustic energy attached to the probe body for providing acoustic energy through the probe body; Equipped with the probe tip is slidable relative to the probe body along a longitudinal axis of the probe body; the acoustic energy source is a multi-frequency device capable of both sonic and ultrasonic pulsed operation; 11. A kit for a lithotripsy device, wherein the probe end includes a lateral opening configured to allow fluid to enter the lumen of the probe body.

13. The kit of claim 12 , wherein at least one of the probe ends further comprises a locking mechanism for securing the probe end to the probe body.

14. The various probe ends have the following characteristics: material, Edge morphology, Acoustic impedance, Edge surface area, or End dimensions, Or a combination of one or more of these The kit of claim 12, wherein the at least one of the following is different:

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