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Publication numberUS3861391 A
Publication typeGrant
Publication dateJan 21, 1975
Filing dateMar 20, 1974
Priority dateJul 2, 1972
Publication numberUS 3861391 A, US 3861391A, US-A-3861391, US3861391 A, US3861391A
InventorsAntonevich John N, Goodfriend Roger
Original AssigneeBlackstone Corp
Export CitationBiBTeX, EndNote, RefMan
External Links: USPTO, USPTO Assignment, Espacenet
Apparatus for disintegration of urinary calculi
US 3861391 A
Abstract
A method and apparatus are provided for disintegrating urinary calculi by subjecting the urinary calculi to ultrasonic forces transmitted transversely of a wave guide in a catheter.
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United States Patent Antonevich et al.

1451 Jan. 21, 1975 APPARATUS FOR DISINTEGRATION OF URINARY CALCULI Inventors: John N. Antonevich, Jamestown,

N.Y.; Roger Goodfriend, San Jose,

Calif.

Assignee: Blackstone Corporation, Jamestown,

Filed: Mar. 20, 1974 Appl. No.: 453,063

Related US. Application Data Division of Ser. No. 273,985, July 2, 1972, Pat. No. 3,830,240.

US. Cl. 128/328, 128/24 A Int. Cl A6111 17/22 Field of Search 128/24 A, 328

[56] References Cited UNITED STATES PATENTS 2,227,727 1/1941 Leggiadro 1211/3211 x 3,413,976 12/1968 ROze 123/3211 3,543,757 12/1970 Balaev et al. Q8/3212 3,584,327 6/1971 Murry 128/24 A X 3,735,764 5/1973 Balaev et :11. .1 128/328 Primary ExaminerCh-anning L. Pace Attorney, Agent, or FirmBuell, Blenko and Ziesenheim [57] ABSTRACT A method and apparatus are provided for disintegrating urinary calculi by subjecting the urinary calculi to ultrasonic forces transmitted transversely of a wave guide in a catheter.

6 Claims, 13 Drawing Figures APPARATUS FOR DISINTEGRATION OF URINARY CALCULI This is a division of application Ser. No. 273,985, filed July 21, 1972, now US. Pat. No. 3,830,240 dated Aug. 20, 1974.

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 1000 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 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 ana 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. I illustrates the apparatus of this invention, partly in section in place in a human urinary system for removing a stone;

FIGS. 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 flush solution into the catheter; and

FIGS. 5 (a) through 5 (d) illustrates in side elevation several embodiments of wave guide cutting and fragmentary ends.

Referring to the drawings we have illustrated a cystoscope I0 inserted through a urethra 11 into a bladder 12. A catheter I3 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 ofwire 16 is inserted through the catheter until its end contacts the stone 15. The wire I6 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 16a of the wire I6 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 slenderness ration of the guide (wire), this coupling will, above a threshold ultrasonic displacement velocity lead to instability resulting in conversion of longitudi nal 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(6), 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(j) 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 gasses 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 15'. 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.

We claim:

I. 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, ultrasonic means acting on the coupling member to cause trans verse vibration of the end thereof adjacent the calculi, and means engaging the end of the catheter remote from the calculi whereby said end is immobilized relatively to the ultrasonic means and the ultrasonic means is mounted on a slide movable at a controlled rate to and from said catheter.

2. An apparatus as claimed in claim I wherein the ultrasonic means is mounted on a slide and micrometer feed means act on the slide to provide a controlled rate of movement of the ultrasonic means toward and away from the end of the catheter.

3. An apparatus as claimed in claim 2 wherein the end of the said end of the catheter is mounted in a clamp on a tilting base carrying the slide and ultrasonic means mounted thereon.

4. An apparatus as claimed in claim 3 wherein the ultrasonic means is a transducer.

5. An apparatus as claimed in claim I wherein the coupling member is less than two-thirds the diameter of the lumen.

6. An apparatus as claimed in claim 1 wherein the coupling member is a wire.

k i I =0

Patent Citations
Cited PatentFiling datePublication dateApplicantTitle
US2227727 *Apr 11, 1938Jan 7, 1941Leggiadro VincentLithotrite
US3413976 *Jul 29, 1963Dec 3, 1968G Elektrotekhnichesky Zd VefArrangement for removal of concretions from urinary tract
US3543757 *Apr 6, 1965Dec 1, 1970Ediny Jury GrigorievichInstrument for crushing concretions in the urinary bladder
US3584327 *Apr 4, 1969Jun 15, 1971Fibra SonicsUltrasonic transmission system
US3735764 *Nov 23, 1970May 29, 1973Balev OInstrument for crushing stones in urinary bladder
Referenced by
Citing PatentFiling datePublication dateApplicantTitle
US4192294 *Oct 11, 1977Mar 11, 1980Gekhman Boris SMethod of removing concretions from the ureter
US4474180 *May 13, 1982Oct 2, 1984The United States Of America As Represented By The Administrator Of The National Aeronautics And Space AdministrationApparatus for disintegrating kidney stones
US4589415 *Aug 31, 1984May 20, 1986Haaga John RMethod and system for fragmenting kidney stones
US4684369 *Aug 19, 1985Aug 4, 1987Wildemeersch Dirk A AInstrument for suprapubic drainage of the bladder, inserted through the urethra
US4870953 *Nov 13, 1987Oct 3, 1989Donmicheal T AnthonyIntravascular ultrasonic catheter/probe and method for treating intravascular blockage
US4920954 *Aug 5, 1988May 1, 1990Sonic Needle CorporationFor removing unwanted material from an artery
US4989588 *Feb 27, 1987Feb 5, 1991Olympus Optical Co., Ltd.Medical treatment device utilizing ultrasonic wave
US5047043 *Dec 7, 1989Sep 10, 1991Olympus Optical Co., Ltd.Resecting device for living organism tissue utilizing ultrasonic vibrations
US5103556 *Sep 14, 1990Apr 14, 1992Circon CorporationMethod of manufacturing an electrohydraulic probe
US5154722 *Sep 14, 1990Oct 13, 1992Circon CorporationElectrohydraulic probe having a controlled discharge path
US5163421 *Dec 12, 1989Nov 17, 1992Angiosonics, Inc.In vivo ultrasonic system with angioplasty and ultrasonic contrast imaging
US5248296 *Dec 24, 1990Sep 28, 1993Sonic Needle CorporationUltrasonic device having wire sheath
US5267954 *May 5, 1992Dec 7, 1993Baxter International Inc.Ultra-sound catheter for removing obstructions from tubular anatomical structures such as blood vessels
US5304115 *Jan 11, 1991Apr 19, 1994Baxter International Inc.Ultrasonic angioplasty device incorporating improved transmission member and ablation probe
US5312328 *Jul 9, 1992May 17, 1994Baxter International Inc.Ultra-sound catheter for removing obstructions from tubular anatomical structures such as blood vessels
US5324255 *Jul 10, 1992Jun 28, 1994Baxter International Inc.Angioplasty and ablative devices having onboard ultrasound components and devices and methods for utilizing ultrasound to treat or prevent vasopasm
US5342292 *May 24, 1993Aug 30, 1994Baxter International Inc.Ultrasonic ablation device adapted for guidewire passage
US5344395 *Jan 24, 1992Sep 6, 1994Scimed Life Systems, Inc.Apparatus for intravascular cavitation or delivery of low frequency mechanical energy
US5368557 *May 5, 1993Nov 29, 1994Baxter International Inc.Ultrasonic ablation catheter device having multiple ultrasound transmission members
US5368558 *Jun 3, 1993Nov 29, 1994Baxter International Inc.Ultrasonic ablation catheter device having endoscopic component and method of using same
US5380273 *May 19, 1993Jan 10, 1995Dubrul; Will R.Vibrating catheter
US5380274 *Oct 12, 1993Jan 10, 1995Baxter International Inc.Ultrasound transmission member having improved longitudinal transmission properties
US5382228 *Sep 28, 1993Jan 17, 1995Baxter International Inc.Method and device for connecting ultrasound transmission member (S) to an ultrasound generating device
US5390678 *Oct 12, 1993Feb 21, 1995Baxter International Inc.Method and device for measuring ultrasonic activity in an ultrasound delivery system
US5397301 *Jul 19, 1993Mar 14, 1995Baxter International Inc.Ultrasonic angioplasty device incorporating an ultrasound transmission member made at least partially from a superelastic metal alloy
US5405318 *Sep 28, 1993Apr 11, 1995Baxter International Inc.Ultra-sound catheter for removing obstructions from tubular anatomical structures such as blood vessels
US5417672 *Oct 4, 1993May 23, 1995Baxter International Inc.Connector for coupling an ultrasound transducer to an ultrasound catheter
US5427118 *Oct 4, 1993Jun 27, 1995Baxter International Inc.Ultrasonic guidewire
US5447509 *Oct 4, 1993Sep 5, 1995Baxter International Inc.Ultrasound catheter system having modulated output with feedback control
US5474530 *Jun 8, 1994Dec 12, 1995Baxter International Inc.Angioplasty and ablative devices having onboard ultrasound components and devices and methods for utilizing ultrasound to treat or prevent vasospasm
US5725570 *Feb 29, 1996Mar 10, 1998Boston Scientific CorporationTubular medical endoprostheses
US6277084May 5, 1997Aug 21, 2001Boston Scientific CorporationUltrasonic medical device
US6283981Apr 6, 2000Sep 4, 2001Ethicon Endo-SurgeryMethod of balancing asymmetric ultrasonic surgical blades
US6287271Jan 9, 1998Sep 11, 2001Bacchus Vascular, Inc.Motion catheter
US6287331May 12, 1998Sep 11, 2001Boston Scientific CorporationTubular medical prosthesis
US6290721Oct 21, 1997Sep 18, 2001Boston Scientific CorporationTubular medical endoprostheses
US6309400Jun 29, 1998Oct 30, 2001Ethicon Endo-Surgery, Inc.Curved ultrasonic blade having a trapezoidal cross section
US6328751Feb 8, 2000Dec 11, 2001Ethicon Endo-Surgery, Inc.Balanced ultrasonic blade including a plurality of balance asymmetries
US6436115Sep 12, 2000Aug 20, 2002Jean M. BeaupreBalanced ultrasonic blade including a plurality of balance asymmetries
US6497709May 5, 1997Dec 24, 2002Boston Scientific CorporationMetal medical device
US6508782Aug 16, 2000Jan 21, 2003Bacchus Vascular, Inc.Thrombolysis device
US6527802Sep 23, 1997Mar 4, 2003Scimed Life Systems, Inc.Clad composite stent
US6551337Jul 19, 2000Apr 22, 2003Omnisonics Medical Technologies, Inc.Ultrasonic medical device operating in a transverse mode
US6617760 *Mar 3, 2000Sep 9, 2003Cybersonics, Inc.Ultrasonic resonator
US6660013Oct 5, 2001Dec 9, 2003Omnisonics Medical Technologies, Inc.Apparatus for removing plaque from blood vessels using ultrasonic energy
US6660017May 21, 2001Dec 9, 2003Ethicon Endo-Surgery, Inc.Balanced ultrasonic blade including a singular balance asymmetry
US6689086Jul 29, 1999Feb 10, 2004Advanced Cardiovascular Systems, Inc.Method of using a catheter for delivery of ultrasonic energy and medicament
US6689087Mar 28, 2002Feb 10, 2004Cybersonics, Inc.Floating probe for ultrasonic transducers
US6695782Oct 11, 2001Feb 24, 2004Omnisonics Medical Technologies, Inc.Ultrasonic probe device with rapid attachment and detachment means
US6733451Mar 25, 2003May 11, 2004Omnisonics Medical Technologies, Inc.Apparatus and method for an ultrasonic probe used with a pharmacological agent
US6866670Aug 6, 2003Mar 15, 2005Omnisonics Medical Technologies, Inc.Apparatus for removing plaque from blood vessels using ultrasonic energy
US6929632Jun 27, 2002Aug 16, 2005Advanced Cardiovascular Systems, Inc.Ultrasonic devices and methods for ablating and removing obstructive matter from anatomical passageways and blood vessels
US6936025Nov 1, 2000Aug 30, 2005Bacchus Vascular, Inc.Thrombolysis device
US6958070Oct 18, 2001Oct 25, 2005Witt David ACurved clamp arm tissue pad attachment for use with ultrasonic surgical instruments
US6976969Jan 14, 2002Dec 20, 2005Ethicon Endo-Surgery, Inc.Blades with functional balance asymmetries for use with ultrasonic surgical instruments
US7101392Aug 8, 2001Sep 5, 2006Boston Scientific CorporationTubular medical endoprostheses
US7300446Jul 20, 2001Nov 27, 2007Ethicon Endo-Surgery, Inc.Curved ultrasonic end effector
US7387612Dec 4, 2003Jun 17, 2008Cybersonics, Inc.Floating probe for ultrasonic transducers
US7479148Oct 28, 2005Jan 20, 2009Crescendo Technologies, LlcUltrasonic shear with asymmetrical motion
US7494468Feb 21, 2003Feb 24, 2009Omnisonics Medical Technologies, Inc.Ultrasonic medical device operating in a transverse mode
US7503895Feb 24, 2003Mar 17, 2009Omnisonics Medical Technologies, Inc.Ultrasonic device for tissue ablation and sheath for use therewith
US7758600Sep 18, 2007Jul 20, 2010Ethicon Endo-Surgery, Inc.Balanced ultrasonic end effector
US7794414Feb 9, 2004Sep 14, 2010Emigrant Bank, N.A.Apparatus and method for an ultrasonic medical device operating in torsional and transverse modes
US7803168Dec 9, 2005Sep 28, 2010The Foundry, LlcAortic valve repair
US8002782Sep 23, 2005Aug 23, 2011Ethicon Endo-Surgery, Inc.Curved clamp arm tissue pad attachment for use with ultrasonic surgical instruments
US8021381Jun 23, 2010Sep 20, 2011Ethicon Endo-Surgery, Inc.Balanced ultrasonic end effector
US8241312Aug 17, 2005Aug 14, 2012Ethicon Endo-Surgery, Inc.Blades with functional balance asymmetries for use with ultrasonic surgical instruments
US8242398Jun 11, 2008Aug 14, 2012Sra Developments LimitedSwitch for ultrasonic surgical tool
US8469982Apr 7, 2011Jun 25, 2013Ethicon Endo-Surgery, Inc.Curved clamp arm for use with ultrasonic surgical instruments
US8617194Sep 1, 2011Dec 31, 2013Ethicon Endo-Surgery, Inc.Balanced ultrasonic end effector
US8623040Jul 1, 2009Jan 7, 2014Alcon Research, Ltd.Phacoemulsification hook tip
US8672959Jun 21, 2013Mar 18, 2014Ethicon Endo-Surgery, Inc.Curved clamp arm for use with ultrasonic surgical instruments
US8790359May 18, 2007Jul 29, 2014Cybersonics, Inc.Medical systems and related methods
US8814895Jun 28, 2012Aug 26, 2014Ethicon Endo-Surgery, Inc.Blades with functional balance asymmetries for use with ultrasonic surgical instruments
EP0243458A1 *Oct 14, 1986Nov 4, 1987Greenfeld Albert RUltrasonic self-cleaning catheter system.
EP1219249A1Mar 31, 1994Jul 3, 2002Ethicon Endo-Surgery, Inc.Ultrasonic surgical instrument
WO1990001300A1 *Jul 27, 1989Feb 22, 1990Sonic Needle CorpUltrasonic device for applying cavitation forces
WO1994014382A1 *Dec 22, 1992Jul 7, 1994Medsonic IncUltrasonic device having wire sheath
WO1996039955A1 *Oct 11, 1995Dec 19, 1996Will R DubrulVibrating catheter
WO1999035982A1 *Jan 19, 1999Jul 22, 1999Michael John Radley YoungUltrasonic cutting tool
WO1999044515A1 *Mar 2, 1999Sep 10, 1999Mentor CorpUltrasonic liposuction probe
Classifications
U.S. Classification606/128, 601/4
International ClassificationA61B17/32, A61B18/00, A61B17/22
Cooperative ClassificationA61B2018/00982, A61B17/22012, A61B2017/320072
European ClassificationA61B17/22B2
Legal Events
DateCodeEventDescription
Dec 23, 1996ASAssignment
Owner name: CYBERSONICS, INC., NEW YORK
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:SONICSTAR INTERNATIONAL, LTD.;REEL/FRAME:008274/0453
Effective date: 19961216
Dec 23, 1996AS02Assignment of assignor's interest
Owner name: CYBERSONICS, INC. 9 NORTH MAIN STREET JAMESTOWN, N
Effective date: 19961216
Owner name: SONICSTAR INTERNATIONAL, LTD.
Sep 5, 1989ASAssignment
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, 1989AS06Security interest
Owner name: BLACKSTONE CORPORATION
Owner name: BOND ACQUISITION CORPORATION
Effective date: 19890828