|Publication number||US3830240 A|
|Publication date||Aug 20, 1974|
|Filing date||Jul 2, 1972|
|Priority date||Jul 2, 1972|
|Publication number||US 3830240 A, US 3830240A, US-A-3830240, US3830240 A, US3830240A|
|Inventors||Antonevich J, Goodfriend R|
|Original Assignee||Blackstone Corp|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (6), Referenced by (74), Classifications (10), Legal Events (4)|
|External Links: USPTO, USPTO Assignment, Espacenet|
lZ8'2nA United States Patent Antonevich et al.
[ 51 Aug. 20, 1974 METHOD AND APPARATUS FOR 3,517,665 6/1970 Sheldon 128/24 A DISINTEGRATION 0F URINARY CALCULI g regg lnvemorsr if?! aif g s 3.584.327 6/1971 Murry [28/24 A er nen anta Clara, C afiif. FOREIGN PATENTS OR APPLICATIONS Assigneez Backstone Corporation, Jamestown l,2T8,l l2 6/[961 Germany 128/328 N.Y. Primary Examiner-Channing L. Pace  led: July 1972 Attorney, Agent, or Firm-Buell, Blenko & 211 Appl. No.: 273,985 Ziesenheim  US. Cl. 128/328, 128/24 A ABSTRACT  Int. Cl A6lb 17/22 A method and a pparatus are provided for dlsmtegrat- [S8] Fleld of Search 128/24 A, 328 mg urinary calculi by subjecting the urinary calculi to  References Cited 252212221: 'gzfizielt ransmltted transversely of a wave UNITED STATES PATENTS 2,227,727 1/1941 Leggiadro 128/328 x 10 Chums 13 D'awmg F'gures l4 I5 u I x r .m
- D 4 a ms PAIENTEDAUBZOIQM 3.830.240 saw 108- 2 METHOD AND APPARATUS FOR DISINTEGRATION OF URINARY CALCULI This invention relates to methods and apparatus for disintegration of urinary calculi and particularly to an ultrasonic method and apparatus for fragmenting or drilling through urinary calculi.
It is well known that the average number of hospital admissions for removal of urinary calculi or stones is about 1 per 1,000 of population per year. This means that there are in excess of 200,000 cases of urinary calculi requiring hospital care. Stones which are quite small may in some cases be passed without hospitalization. However, all stones and particularly larger stones, especially if associated with obstruction or infection, must be removed from the urinary tract to prevent renal damage. Stones which are lodged low in the ureter may often be removed by manipulation using devices which are passed through the ureter up to the stone where they engage the stone for mechanical extraction. When the stone is high in the ureter or remains in the kidney, then it must be removed with open surgery in present practices.
The present invention eliminates the need for surgical removal of urinary calculi and reduces the hazards of mechanical manipulation in removing stones from the urinary tract.
The idea of vibratory impact machining of urinary calculi is not new. At least as early as 1946 proposals for vibratory impact machining of stones obstructing urinary tracts were made. Thereafter many investigators worked on techniques for ultrasonic disintegration of such urinary calculi. Focused beam techniques on distal stones were difficult to control and results were questionable. Impact machining techniques by transmitting longitudinal vibrations through wire wave guides were found to be effective to some degree but much too slow to be practical. Moreover, such methods were difficult to control and greatly restricted in utility because of excessive heat generation along the wave guide and the very large size of the wire used in order to provide longitudinal vibration.
We have found that urinary calculi can be quickly fragmented or drilled through if a wave guide or coupling member is passed through the lumen of a catheter in the ureter so that both catheter and wave guide touch the calculi to be fragmented and the relative size of the wave guide with respect to the catheter in such that lateral motion of the wave guide within the catheter at the stone is possible. We have found that with such an arrangement large urinary calculi can be quickly fragmented and removed, usually in 2 to 60 seconds.
In the practice of our invention a catheter is passed cystoscopically to the side of the stone in the urinary tract, a wave guide is passed through the lumen of the catheter and both are made to contact the stone, the wave guide being of such size as to provide lateral motion of the guide within the catheter. An ultrasonic transducer is attached to the wave guide and energized setting the guide into longitudinal and transverse vibration thereby causing an impaction and scraping action of the free end of the guide on the stone resulting in fragmentation or drilling of the stone. Preferably the wave guide is a wire. The cutting area may be irrigated or cooled by passing flushing fluid through the catheter around the wave guide. Preferably the apparatus consists of hollow catheter means adapted to enter the ureter and contact the stone, wave guide means having a diameter smaller than the hollow portion of the catheter means and adapted to pass through said hollow catheter means to contact the stone, and transducer means engaging the wave guide at the end opposite the stone and imparting both lateral and transverse motion to the wave guide at the end contacting the stone.
In the foregoing general description of our invention we have set out certain objects, purposes and advantages. Other objects, purposes and advantages will be apparent from a consideration of the following description and the accompanying drawings in which:
FIG. 1 illustrates the apparatus of this invention, partly in section in place in a human urinary system for removing a stone;
FIG. 2 (a) through 2 (f) illustrates fragmentarily several embodiments of coupling between transducer and wave guide;
FIG. 3 is a side elevational view of an apparatus for controlled fragmentation of stones;
FIG. 4 is a section through a connector for a catheter and wave guide for introducing flushsolution into the catheter; and
FIG. 5 (a) through 5 (d) illustrates in side elevation several embodiments of wave guide cutting and fragmenting ends.
Referring to the drawings we have illustrated a cystoscope 10 inserted through a urethra 11 into a bladder 12. A catheter 13 is inserted through the cystoscope 10, the bladder 12 and into a ureter 14 until its end contacts stone 15. At this point a wave guide in the form of wire 16 is inserted through the catheter until its end contacts the stone 15. The wire 16 must be of substantially smaller diameter than the lumen diameter of the catheter, preferably less than two-thirds of the lumen diameter. The free end of the wire 16 is attached to a transducer 17 by a set screw 18 or it may simply be abutted against the transducer with the transducer being urged toward the stone to put pressure on the wave guide.
With the catheter and wave guide in fixed position against the stone, the cystoscope is moved to the position which provides the least amount of curvature in the catheter and wave guide. An X-ray picture of the urinary tract is preferably taken at this point to assure contact of the catheter and wave guide with the stone. At this point with contact assured the transducer is energized and the catheter and wave guide are both pushed gently toward the stone until the wave guide has moved a distance equal to the estimated thickness of the stone.
We have found that coupling of the transducer 17 with the wire 16 can take various forms. The transducer can be directly mechanically connected as shown in FIG. 2(a) using a set screw or similar means. This is in general our preferred connection. Due to the high slendemess ratio of the guide (wire), this coupling will, above a threshold ultrasonic displacement velocity lead to instability resulting in conversion of longitudinal motion into transverse motion of the guide, which is desired in the practice of this invention. The same is true of the embodiment of FIG. 2(b) where there is no mechanical attachment between the transducer and wire and coupling is achieved by the force pushing against the wire end to force the wire into contact with the stone. The connections shown in FIGS. 2(c), 2(d) and 2(e) provide indirect conversion of the transducer motion into combined longitudinal and transverse, longitudinal and transverse torsional and longitudinal and transverse ellipsoidal motion respectively at the free end of the wire when it contacts the stone. The connection shown at 2(f) converts the longitudinal motion of the transducer into transverse motion.
In order to better control the position of the catheter and wave guide at the distal point which may be 40 cm. from the transducer we provide a control apparatus shown in the modification of FIG. 3. In this embodiment those elements which are identical with elements of FIG. I bear like reference numerals with the addition of a prime sign. Referring to FIG. 3, the catheter 13' and wave guide 16' are positioned at the stone as described in connection with FIG. 1 above. The exposed ends of the catheter and wire guide are fixed in a T" connector 20 provided with an O-ring 21 to seal around the catheter 13 without collapsing the catheter end. A puncturable rubber diaphragm 22 is placed at the opposite end of the T and the wire 16 is passed therethrough. A viscous grease such as silicon vacuum grease seals the puncture in the diaphragm through which the wire passes so that gases or liquids may be pumped through the side arm of the T to cool or flush the stone area. The T member 20 is fixed in a clamp 24 mounted on a tilting base 25 which carries a slide 26 on which is mounted transducer assembly 17'. The slide 26 is controlled by micrometer feed 27 to apply pressure through the transducer 17, the wire 16' to the stone l5 The micrometer 27 allows a fixed controlled feed of wire against the stone and reduces the chance of the wire going through the stone and accidentally penetrating the ureter.
In order to obtain the maximum efficiency while reducing the likelihood of accidental penetration of the ureter, the wire end illustrated in FIG. 5 have been used by us with success. These ends are designed to center the wire end in the catheter to prevent by-passing the stone. In addition, some of these ends by rotation after drilling through the stone can be used to reverse drill and thus create a better chance of breaking the stone or they may be used to pull the stone out of the ureter.
We have also found that an expandable catheter aids in centering the wire and in preventing accidental penetration of the ureter. Such a catheter can be provided with a double wall construction, the outer wall being relatively thin and elastic and enlarged by introducing air or gas between the two walls after the catheter is placed in contact with the stone.
in the foregoing specification we have set out certain preferred practices and embodiments of our invention, however the invention may be otherwise practiced within the scope of the following claims.
1. An apparatus for fragmenting and drilling urinary calculi comprising a catheter adapted to be inserted into a ureter to abut the calculi to be removed, a coupling member extending lengthwise of the lumen of said catheter and having a diameter less than the diameter of said lumen whereby said coupling member may vibrate transversely within the catheter and ultrasonic means acting on the coupling member to cause transverse vibration of the end thereof adjacent the calculi.
2. An apparatus as claimed in claim 1 wherein the diameter of the coupling member is less than two-thirds the diameter of the lumen.
3. An apparatus as claimed in claim 1 wherein the coupling member is a wire.
4. A method for fragmenting and drilling urinary calculi comprising th steps of:
a. placing a catheter in a ureter containing a calculi to be removed with one end abutting the calculi and the other end free,
b. inserting a coupling member through the lumen of said catheter until one end abuts the calculi while the other end extends out of the free end of the catheter, said coupling member having a smaller diameter than the lumen diameter,
c. subjecting the coupling member to ultrasonic vibrations such that transverse vibrations are produced at the end abutting the calculi, and
d. moving the coupling member into the catheter to cause it to fragment and drill the calculi.
S. A method as claimed in claim 4 wherein the coupling member is a wire whose diameter is less than twothirds of the diameter of the lumen of the catheter.
6. A method as claimed in claim 4 wherein a cystoscope is inserted in the urinary tract to at least the bladder and the catheter is inserted through the cystoscope into the bladder and from thence into the ureter.
7. A method as claimed in claim 4 wherein flushing fluid is introduced into the catheter whereby the catheter is irrigated with fluid during fragmenting and drilling.
8. An apparatus as claimed in claim 1 wherein the coupling member has a wave form adjacent the point when the ultrasonic means acts upon it.
9. An apparatus as claimed in claim 1 wherein the coupling member has a spiral fonn adjacent the end where the ultrasonic means acts upon it.
10. An apparatus as claimed in claim 1 wherein the ultrasonic means acts on the coupling member transversely to its length.
|Cited Patent||Filing date||Publication date||Applicant||Title|
|US2227727 *||Apr 11, 1938||Jan 7, 1941||Leggiadro Vincent||Lithotrite|
|US3517665 *||Jun 28, 1967||Jun 30, 1970||Sheldon Edward E||Negative pressure treatment device|
|US3543757 *||Apr 6, 1965||Dec 1, 1970||Ediny Jury Grigorievich||Instrument for crushing concretions in the urinary bladder|
|US3570476 *||Nov 18, 1968||Mar 16, 1971||David Paul Gregg||Magnetostrictive medical instrument|
|US3584327 *||Apr 4, 1969||Jun 15, 1971||Fibra Sonics||Ultrasonic transmission system|
|*||DE1218112A||Title not available|
|Citing Patent||Filing date||Publication date||Applicant||Title|
|US4046150 *||Jul 17, 1975||Sep 6, 1977||American Hospital Supply Corporation||Medical instrument for locating and removing occlusive objects|
|US4203429 *||Oct 11, 1977||May 20, 1980||Ediny Jury G||Method of removing concretions from the ureter|
|US4474180 *||May 13, 1982||Oct 2, 1984||The United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration||Apparatus for disintegrating kidney stones|
|US4509947 *||Aug 2, 1982||Apr 9, 1985||Medtronic, Inc.||Self-cleaning drug delivery catheter and storage bladder|
|US4608979 *||Feb 22, 1984||Sep 2, 1986||Washington Research Foundation||Apparatus for the noninvasive shock fragmentation of renal calculi|
|US4660573 *||May 8, 1985||Apr 28, 1987||Fibra-Sonics, Inc.||Ultrasonic lithotriptor probe|
|US4698058 *||Oct 15, 1985||Oct 6, 1987||Albert R. Greenfeld||Ultrasonic self-cleaning catheter system for indwelling drains and medication supply|
|US4823793 *||Oct 30, 1985||Apr 25, 1989||The United States Of America As Represented By The Administrator Of The National Aeronuautics & Space Administration||Cutting head for ultrasonic lithotripsy|
|US4836211 *||Sep 11, 1987||Jun 6, 1989||Naomi Sekino||Ultrasonic treatment apparatus for performing medical treatment by use of ultrasonic vibrations|
|US4867141 *||Jun 12, 1987||Sep 19, 1989||Olympus Optical Co., Ltd.||Medical treatment apparatus utilizing ultrasonic wave|
|US4870953 *||Nov 13, 1987||Oct 3, 1989||Donmicheal T Anthony||Intravascular ultrasonic catheter/probe and method for treating intravascular blockage|
|US4899733 *||Dec 19, 1988||Feb 13, 1990||Blackstone Ultrasonic, Inc.||Device and technique for transurethral ultrasonic lithotripsy using a flexible ureteroscope|
|US4907572 *||Apr 18, 1989||Mar 13, 1990||Urological Instruments Research, Inc.||Vibrational method for accelerating passage of stones from ureter|
|US5058570 *||Nov 27, 1986||Oct 22, 1991||Sumitomo Bakelite Company Limited||Ultrasonic surgical apparatus|
|US5103556 *||Sep 14, 1990||Apr 14, 1992||Circon Corporation||Method of manufacturing an electrohydraulic probe|
|US5116343 *||Aug 28, 1990||May 26, 1992||Richard Wolf Gmbh||Device for disintegrating concretions disposed in body cavities|
|US5154722 *||Sep 14, 1990||Oct 13, 1992||Circon Corporation||Electrohydraulic probe having a controlled discharge path|
|US5344395 *||Jan 24, 1992||Sep 6, 1994||Scimed Life Systems, Inc.||Apparatus for intravascular cavitation or delivery of low frequency mechanical energy|
|US5725570 *||Feb 29, 1996||Mar 10, 1998||Boston Scientific Corporation||Tubular medical endoprostheses|
|US5830127 *||Aug 5, 1996||Nov 3, 1998||Cybersonics, Inc.||Method and apparatus for cleaning endoscopes and the like|
|US6277084||May 5, 1997||Aug 21, 2001||Boston Scientific Corporation||Ultrasonic medical device|
|US6283981||Apr 6, 2000||Sep 4, 2001||Ethicon Endo-Surgery||Method of balancing asymmetric ultrasonic surgical blades|
|US6287331||May 12, 1998||Sep 11, 2001||Boston Scientific Corporation||Tubular medical prosthesis|
|US6290721||Oct 21, 1997||Sep 18, 2001||Boston Scientific Corporation||Tubular medical endoprostheses|
|US6309400||Jun 29, 1998||Oct 30, 2001||Ethicon Endo-Surgery, Inc.||Curved ultrasonic blade having a trapezoidal cross section|
|US6328751||Feb 8, 2000||Dec 11, 2001||Ethicon Endo-Surgery, Inc.||Balanced ultrasonic blade including a plurality of balance asymmetries|
|US6436115||Sep 12, 2000||Aug 20, 2002||Jean M. Beaupre||Balanced ultrasonic blade including a plurality of balance asymmetries|
|US6497709||May 5, 1997||Dec 24, 2002||Boston Scientific Corporation||Metal medical device|
|US6527802||Sep 23, 1997||Mar 4, 2003||Scimed Life Systems, Inc.||Clad composite stent|
|US6617760||Mar 3, 2000||Sep 9, 2003||Cybersonics, Inc.||Ultrasonic resonator|
|US6660017||May 21, 2001||Dec 9, 2003||Ethicon Endo-Surgery, Inc.||Balanced ultrasonic blade including a singular balance asymmetry|
|US6689087||Mar 28, 2002||Feb 10, 2004||Cybersonics, Inc.||Floating probe for ultrasonic transducers|
|US6958070||Oct 18, 2001||Oct 25, 2005||Witt David A||Curved clamp arm tissue pad attachment for use with ultrasonic surgical instruments|
|US6976969||Jan 14, 2002||Dec 20, 2005||Ethicon Endo-Surgery, Inc.||Blades with functional balance asymmetries for use with ultrasonic surgical instruments|
|US7101392||Aug 8, 2001||Sep 5, 2006||Boston Scientific Corporation||Tubular medical endoprostheses|
|US7300446||Jul 20, 2001||Nov 27, 2007||Ethicon Endo-Surgery, Inc.||Curved ultrasonic end effector|
|US7387612||Dec 4, 2003||Jun 17, 2008||Cybersonics, Inc.||Floating probe for ultrasonic transducers|
|US7479148||Oct 28, 2005||Jan 20, 2009||Crescendo Technologies, Llc||Ultrasonic shear with asymmetrical motion|
|US7758600||Sep 18, 2007||Jul 20, 2010||Ethicon Endo-Surgery, Inc.||Balanced ultrasonic end effector|
|US8002782||Sep 23, 2005||Aug 23, 2011||Ethicon Endo-Surgery, Inc.||Curved clamp arm tissue pad attachment for use with ultrasonic surgical instruments|
|US8021381||Jun 23, 2010||Sep 20, 2011||Ethicon Endo-Surgery, Inc.||Balanced ultrasonic end effector|
|US8241312||Aug 17, 2005||Aug 14, 2012||Ethicon Endo-Surgery, Inc.||Blades with functional balance asymmetries for use with ultrasonic surgical instruments|
|US8469982||Apr 7, 2011||Jun 25, 2013||Ethicon Endo-Surgery, Inc.||Curved clamp arm for use with ultrasonic surgical instruments|
|US8617194||Sep 1, 2011||Dec 31, 2013||Ethicon Endo-Surgery, Inc.||Balanced ultrasonic end effector|
|US8623040||Jul 1, 2009||Jan 7, 2014||Alcon Research, Ltd.||Phacoemulsification hook tip|
|US8672959||Jun 21, 2013||Mar 18, 2014||Ethicon Endo-Surgery, Inc.||Curved clamp arm for use with ultrasonic surgical instruments|
|US8814895||Jun 28, 2012||Aug 26, 2014||Ethicon Endo-Surgery, Inc.||Blades with functional balance asymmetries for use with ultrasonic surgical instruments|
|US8986291||Dec 1, 2009||Mar 24, 2015||Percutaneous Systems, Inc.||Methods and systems for capturing and removing urinary stones from body cavities|
|US9233021||Oct 24, 2013||Jan 12, 2016||Alcon Research, Ltd.||Phacoemulsification hook tip|
|US9427250||Aug 25, 2014||Aug 30, 2016||Ethicon Endo-Surgery, Inc.||Blades with functional balance asymmetries for use with ultrasonic surgical instruments|
|US9439670||Mar 17, 2014||Sep 13, 2016||Ethicon Endo-Surgery, Inc.||Curved clamp arm for use with ultrasonic surgical instruments|
|US9474542 *||May 24, 2013||Oct 25, 2016||Sra Developments Ltd.||Ultrasonic transducer system|
|US20010025184 *||Apr 4, 2001||Sep 27, 2001||Messerly Jeffrey D.||Blades with functional balance asymmetries for use with ultrasonic surgical instruments|
|US20020004665 *||Jul 20, 2001||Jan 10, 2002||Beaupre Jean M.||Curved ultrasonic blade having a trapezoidal cross section|
|US20020026184 *||Oct 18, 2001||Feb 28, 2002||Witt David A.||Curved clamp arm tissue pad attachment for use with ultrasonic surgical instruments|
|US20020143355 *||Jan 14, 2002||Oct 3, 2002||Messerly Jeffrey D.||Blades with functional balance asymmetries for use with ultrasonic surgical instruments|
|US20020165523 *||Mar 2, 2001||Nov 7, 2002||Chin Albert C. C.||Multilayer medical device|
|US20040082884 *||Dec 4, 2003||Apr 29, 2004||Dharmendra Pal||Floating probe for ultrasonic transducers|
|US20040097963 *||Nov 19, 2002||May 20, 2004||Seddon J. Michael||Method and apparatus for disintegrating urinary tract stones|
|US20050267421 *||May 28, 2004||Dec 1, 2005||Wing Thomas W||Catheter cleaner|
|US20060020262 *||Sep 23, 2005||Jan 26, 2006||Witt David A||Curved clamp arm tissue pad attachment for use with ultrasonic surgical instruments|
|US20060084963 *||Aug 17, 2005||Apr 20, 2006||Messerly Jeffrey D||Blades with functional balance asymmetries for use with ultrasonic surgical instruments|
|US20060100652 *||Oct 28, 2005||May 11, 2006||Crescendo Technologies, Llc||Ultrasonic shear with asymmetrical motion|
|US20060116693 *||Nov 30, 2005||Jun 1, 2006||Weisenburgh William B Ii||Apparatus and method for stone capture and removal|
|US20080051814 *||Sep 18, 2007||Feb 28, 2008||Beaupre Jean M||Balanced ultrasonic end effector|
|US20100137846 *||Dec 1, 2009||Jun 3, 2010||Percutaneous Systems, Inc.||Methods and systems for capturing and removing urinary stones from body cavities|
|US20100262173 *||Jun 23, 2010||Oct 14, 2010||Beaupre Jean M||Balanced ultrasonic end effector|
|US20110112466 *||Nov 11, 2009||May 12, 2011||Ramon Carsola Dimalanta||Extended Point Phacoemulsification Tip|
|US20110184446 *||Apr 7, 2011||Jul 28, 2011||Witt David A||Curved clamp arm for use with ultrasonic surgical instruments|
|US20120065553 *||Feb 1, 2010||Mar 15, 2012||Lma Urology Limited||Medical device|
|US20130253559 *||May 24, 2013||Sep 26, 2013||Sra Developments Limited||Ultrasonic transducer system|
|US20170065752 *||Nov 17, 2016||Mar 9, 2017||The General Hospital Corporation||System and method for guided removal from an in vivo subject|
|DE3932966C1 *||Oct 3, 1989||Apr 4, 1991||Richard Wolf Gmbh, 7134 Knittlingen, De||Title not available|
|EP0947171B1 *||Mar 23, 1999||Jul 23, 2003||Ferton Holding S.A.||Flexible metal probe for use in intracorporal shock wave lithotripsy|
|U.S. Classification||606/128, 601/4|
|International Classification||A61B17/225, A61B17/22, A61B18/00, A61B17/32|
|Cooperative Classification||A61B2018/00982, A61B2017/320072, A61B17/22012|
|Dec 23, 1996||AS||Assignment|
Owner name: CYBERSONICS, INC., NEW YORK
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:SONICSTAR INTERNATIONAL, INC.;REEL/FRAME:008274/0485
Effective date: 19961216
|Dec 23, 1996||AS02||Assignment of assignor's interest|
Owner name: CYBERSONICS, INC. 9 NORTH MAIN STREET JAMESTOWN, N
Owner name: SONICSTAR INTERNATIONAL, INC.
Effective date: 19961216
|Sep 5, 1989||AS||Assignment|
Owner name: BLACKSTONE CORPORATION
Free format text: SECURITY INTEREST;ASSIGNOR:BOND ACQUISITION CORPORATION;REEL/FRAME:005240/0605
Effective date: 19890828
Owner name: ULTRASONICS, INC., NEW YORK
Free format text: SECURITY INTEREST;ASSIGNOR:BLACKSTONE CORPORATION;REEL/FRAME:005240/0600
|Sep 5, 1989||AS06||Security interest|
Owner name: BLACKSTONE CORPORATION
Owner name: BOND ACQUISITION CORPORATION
Effective date: 19890828