Abstract:
A lithotripter includes a handle with a distal end and a proximal end, a driver resource contained within the handle, the driver resource having a driver resource distal end and a driver resource proximal end, and a probe housed within the handle, the probe having a probe distal end and a probe proximal end, the probe distal end terminating at the distal end of the apparatus at a point distal from the handle distal end, the probe proximal end terminating proximal to the driver resource proximal end. The lithotripter further includes a shielding insert surrounding at least a portion of the probe, the shielding insert having a shielding insert proximal end and a shielding insert distal end, the shielding insert proximal end terminating proximal to the proximal end of the driver resource, and the shielding insert distal end terminating distal to the distal end of the driver resource, the probe proximal end being contained within the handle.

Description:
RELATED APPLICATION 
       [0001]    This application is a continuation-in-part application of U.S. patent application Ser. No. 14/450,363, filed on Aug. 4, 2014. The entire contents of the above application are incorporated herein by reference. 
     
    
     FIELD 
       [0002]    The present invention relates to an improved lithotripter, more particularly to an apparatus and method for protecting an internal lumen of a lithotripter handle from surgical waste and to provide for faster sterilization procedures. 
       BACKGROUND 
       [0003]    Over the past several decades, several advances have been made in the field of endoscopy, and in particular relating to the breaking up of physiologic calculi in the bile ducts, urinary tract, kidneys, and gall bladder. Physiological calculi in these regions may block ducts and cause a patient a substantial amount of pain and therefore must be broken down and/or removed. Different techniques have been developed to break up stones, including ultrasonic lithotripsy, pneumatic lithotripsy, electro-hydraulic lithotripsy (EHL), and dissolution of calculi using YAG or holmium lasers, for example. 
         [0004]    A number of rigid solid or tubular probe-based lithotripsy devices that use ultrasonic or pneumatic energy to break the stone into smaller pieces for easier removal from the patient&#39;s urologic system have been developed. For example, the Olympus LUS-2, the Gyrus ACMI Cyberwand, and the Swiss Lithoclast are such devices. They may function by having ultrasonic or acoustic frequency energy transmitted down a stiff metal probe and delivered by contact to a kidney stone. Ultrasonic lithotripters generally require tuned probes and the effectiveness of these lithotripters depend on their ability to maintain resonance down the length of the probe (i.e. ultrasonic energy does not travel well around bends or turns). It is believed that probe bending can dissipate enough heat to seriously damage adjacent tissue or the endoscopic device itself, in addition to the loss of energy transfer to the tip of the probe. 
         [0005]    For procedures performed with a tubular probe device, suction of liquid and debris during the lithotripsy procedure may be possible via the center of the tubular probe. Some devices may incorporate and deliver a lower frequency energy component to the kidney stone either through the same probe or via a second probe; this second probe is usually coaxial to the ultrasonic energy probe (i.e. the Cyberwand). This secondary, lower frequency energy shows evidence of improving the stone breaking efficiency over a solely ultrasonic energy approach. 
         [0006]    Throughout the procedure, bodily waste including blood, stone debris, fluids and/or tissue have been removed from the patient through active suction and have passed through the lithotripsy probe and a central lumen of the handpiece. Most lithotripters include interchangeable probes that are added and removed from the lithotripter depending on the particular need for a particular procedure. The probe may be removed from sterile packaging, removed from non-sterile packaging and subsequently sterilized, or sterilized and reused from a previous procedure, and connected to the handpiece after the surgical handpiece has been sterilized. After a procedure is performed, the one or more probes are typically removed from connection at a distal end of a handpiece and may be discarded or sterilized for reuse in a subsequent procedure. The handpiece, including the internal lumen which may still contain bodily waste is subsequently processed for sterilization. Sterilization procedures that might occur on a lithotripsy device include wet/steam sterilization, dry heat sterilization, ethylene oxide, or sporicidal chemicals, for example. 
         [0007]    In the case of an ultrasonic lithotripsy device, the evacuation path of the waste liquid is commonly through the center of the driver. If the ultrasonic driver is massive enough and the lumen is small enough, and the preferred sterilization method is autoclaving, it may be difficult to achieve a high enough temperature in the center of the ultrasonic driver to sufficiently sterilize the full length of the central lumen. 
         [0008]    A potential result of bodily waste remaining in the central lumen of the handpiece or perhaps being rinsed out quickly before entering the sterilizer is that complete sterilization of the device with a four minute flash cycle, for example, may not be possible. However, in certain situations when fast sterilization is needed, this type of sterilization procedure may be run without fully sterilizing the device. 
         [0009]    It is contemplated that there is a need for a lithotripter that allows for reliably eliminating a bulk of bodily waste to facilitate rapid sterilization cycles. This can result in practitioner and patient confidence that a complete sterilization has been achieved before reusing the device on a subsequent procedure. 
       SUMMARY 
       [0010]    The present disclosure meets one or more of the above needs by providing a protective removable passageway. The protective removable passageway may be the probe itself extended to the proximal end of the lithotripsy handle, a shielding insert surrounding at least a portion of the probe and contained from a proximal end to a distal end of the central lumen of the handpiece or a portion thereof, or an additional removable passageway extending along a portion of the central lumen of the handpiece. 
         [0011]    Accordingly, pursuant to one aspect, a lithotripter includes a handle with a distal end and a proximal end, a driver resource contained within the handle, the driver resource having a driver resource distal end and a driver resource proximal end, and a probe housed within the handle, the probe having a probe distal end and a probe proximal end, the probe distal end terminating at the distal end of the apparatus at a point distal from the handle distal end, the probe proximal end terminating proximal to the driver resource proximal end. The lithotripter further includes a shielding insert surrounding at least a portion of the probe, the shielding insert having a shielding insert proximal end and a shielding insert distal end, the shielding insert proximal end terminating proximal to the proximal end of the driver resource, and the shielding insert distal end terminating distal to the distal end of the driver resource, the probe proximal end being contained within the handle. The driver resource causes the probe to move in a direction parallel with a longitudinal axis of the probe. The handle also includes one or more distal end seals, one or more proximal end seals, or a combination thereof positioned adjacent to the shielding insert and between the shielding insert and the handle to provide a fluid tight sealing directly adjacent to the shielding insert. 
         [0012]    The foregoing aspect may be further characterized by one or any combination of the features described herein, such as, for example: the one or more distal seals are located distal to the distal end of the driver resource and the one or more proximal end seals are located proximal to the proximal end of the driver resource; and the one or more distal end seals, the one or more proximal end seals, or both are o-rings. 
         [0013]    Pursuant to another aspect, a lithotripter includes a handle with a distal end and a proximal end, a driver resource contained within the handle, the driver resource having a driver resource distal end and a driver resource proximal end, and a probe housed within the handle, the probe having a probe distal end and a probe proximal end, the probe distal end terminating at the distal end of the apparatus at a point distal from the handle distal end. The lithotripter further includes a shielding insert surrounding at least a portion of the probe within the handle, the shielding insert having a shielding insert proximal end and a shielding insert distal end, the shielding insert proximal end terminating proximal to the driver resource proximal end and the shielding insert distal end terminating distal to the driver resource distal end, the probe distal end terminating distal to the shielding insert distal end and the probe proximal end terminating proximal to the shielding insert proximal end. The driver resource causes the probe to move in a direction parallel with a longitudinal axis of the probe. 
         [0014]    The foregoing aspect may be further characterized by one or any combination of the features described herein, such as, for example: a removable passageway is contained within a central lumen of the driver resource; the handle further includes one or more distal end seals, one or more proximal end seals, or a combination thereof positioned adjacent to the shielding insert and between the shielding insert and the handle to provide a fluid tight sealing directly adjacent to the shielding insert; the one or more distal seals are located distal to the distal end of the driver resource and the one or more proximal end seals are located proximal to the proximal end of the driver resource; and the one or more distal end seals, the one or more proximal end seals, or both are o-rings. 
         [0015]    Accordingly, pursuant to another aspect, a lithotripter includes a handle with a distal end and a proximal end, a driver resource contained within the handle, the driver resource having a driver resource distal end and a driver resource proximal end, and a probe housed within the handle, the probe having a probe distal end and a probe proximal end, the probe distal end terminating at the distal end of the apparatus at a point distal from the handle distal end. The lithotripter further includes a shielding insert surrounding at least a portion of the probe within the handle, the shielding insert having a shielding insert proximal end and a shielding insert distal end, the shielding insert proximal end terminating proximal to the driver resource proximal end and the shielding insert distal end terminating distal to the driver resource distal end, the probe extending through the entire length of the shielding insert with the probe distal end terminating distal to the shielding insert distal end. The driver resource causes the probe to move in a direction parallel with a longitudinal axis of the probe. 
         [0016]    The foregoing aspect may be further characterized by one or any combination of the features described herein, such as, for example: a removable passageway is contained within a central lumen of the driver resource; the handle further includes one or more distal end seals, one or more proximal end seals, or a combination thereof positioned adjacent to the shielding insert and between the shielding insert and the handle to provide a fluid tight sealing directly adjacent to the shielding insert; the one or more distal seals are located distal to the distal end of the driver resource and the one or more proximal end seals are located proximal to the proximal end of the driver resource; and the one or more distal end seals, the one or more proximal end seals, or both are o-rings. 
         [0017]    Further aspects, advantages and areas of applicability will become apparent from the description provided herein. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure. 
     
    
     
       DRAWINGS 
         [0018]    The drawings described herein are for illustration purposes only and are not intended to limit the scope of the present disclosure in any way. 
           [0019]      FIG. 1  is a cross-sectional view of one embodiment of a lithotripter in accordance with the teachings of the present invention. 
           [0020]      FIG. 2  is a cross-sectional view of an alternative embodiment of a lithotripter in accordance with the teachings of the present invention. 
           [0021]      FIG. 3  is a cross-sectional view of an alternative embodiment of a lithotripter in accordance with the teachings of the present invention. 
           [0022]      FIG. 4  is a cross-sectional view of an alternative embodiment of a lithotripter in accordance with the teachings of the present invention. 
           [0023]      FIG. 5  is an exploded cross sectional view of one embodiment of a distal end of a lithotripter handpiece in accordance with the teachings of the present invention. 
       
    
    
     DETAILED DESCRIPTION 
       [0024]    The following description is merely exemplary in nature and is not intended to limit the present disclosure, application, or uses. Those skilled in the art may adapt and apply the teachings in its numerous forms, as may be best suited to the requirements of a particular use. The disclosures of all articles and references, including patent applications and publications, are incorporated by reference for all purposes. Other combinations are also possible as will be gleaned from the following claims, which are also hereby incorporated by reference into this written description. 
         [0025]    As will be seen, the devices and methods taught herein offer an improved surgical instrument, preferably the surgical instrument is a lithotripter, which is capable of achieving complete sterilization in less time than those taught in the prior art. Examples of surgical procedures that the lithotripter of the teachings herein may be used to perform include lithotripsy to cause destruction of kidney stones. The lithotripter as discussed herein includes an interchangeable probe, a handpiece, and a driver resource. In one aspect, the present invention describes a lithotripter in which a probe, shielding insert, or removable passageway may extend from a distal end to a proximal end of a handpiece and which may be provided with one or more seals between the probe, shielding insert, or removable passageway and the handpiece at connection points at a distal end, at a proximal end, or both of a handpiece to prevent liquids or surgical debris from coming into direct contact with the inner surface of the handpiece. The teachings of the present invention may therefore be able to limit, minimize, or eliminate surgical waste products from coming into direct contact with the inner lumen of the lithotripter handle. 
         [0026]    One embodiment of the invention may use a shielding insert as a protective removable passageway extending through the handle of the lithotripter assembly. The shielding insert may house a portion of the lithotripter probe or the lithotripter probe may extend through the entire length of the shielding insert. The proximal end of the probe may terminate proximal to the proximal end of the shielding insert. The shielding insert may be removably secured to the inner passageway of the lithotripter handpiece. Suction at the proximal end of the handpiece may make direct contact with the shielding insert, the lithotripsy probe, or both. 
         [0027]    The probe may be any probe that is suitable to perform a lithotripsy procedure. The probe may be rigid, semi-rigid, flexible, include a flexible portion, or a combination thereof. The probe may be one piece. The probe may rotate longitudinally, axially, or both. Preferably, the probe is a single tube that oscillates longitudinally to cause destruction of a bodily calculus. Preferably, the shielding insert remains stationary during use with respect to the handpiece. The position of the probe may be monitored with sensors to determine if the tip is in contact with tissue, contact with a stone, the type of stone, if a user is applying force in excess of a predetermined threshold, or physical characteristics of the stone. Sensors may be provided at the probe tip, in the handpiece, or both. 
         [0028]    The handpiece or handle may be any part of the device that is gripped by the user during use. The handpiece may be a central part of the device that assists in connecting or connects all of the pieces together so that the device functions as a surgical instrument. The handpiece may be a reusable part, a disposable part, or a combination thereof. Preferably, the handpiece is a reusable part that may be subjected to a sterilization process. Preferably, the handpiece may be free of components that may degrade through multiple sterilization cycles (i.e. repeated heating and cooling). More preferably, the handpiece may be free of sealing components that may degrade through multiple sterilizations. The components of the handpiece may withstand about 500 or more, preferably about 1000 or more, and more preferably about 1500 or more sterilization cycles. The handpiece may include a distal region, a central region, and a proximal region. 
         [0029]    The distal region may be the part of the handpiece proximal to the interchangeable probe. The distal region may be in the shape of a horn. The distal region may include one or more attachment ports. Preferably, the distal region includes a probe attachment port. The probe attachment port may be any shape or size so that the probe attachment port accommodates the interchangeable probe. The probe attachment port may partially surround a portion of the interchangeable probe so that the probe is held securely in place by the probe attachment port. For example, the probe attachment port may be a “U” or “C” shape such that the interchangeable probe is securely held by the probe attachment port and the interchangeable probe is substantially restricted so that the interchangeable probe is substantially free of movement. It is contemplated that the probe being substantially restricted or substantially free of movement refers to the probe being free to move longitudinally when being driven by the driver resource but may be limited in axial movement at the point of attachment in the probe attachment port such that the oscillations produced by the driver resource may not be dampened or minimized at the point of connection to the probe attachment port. The probe attachment port may include a collet, a nut, a gripping ferrule, a ferrule, or any combination thereof in the distal region of the handpiece. The probe attachment port may be secured using a friction fit, a screw connection, or any combination thereof. The probe attachment port may be any shape that is complementary to the shape of the interchangeable probe. The probe attachment port may be a circle, square, diamond, a “D” shape, an ellipse, or combination thereof so that the interchangeable probe is properly installed in the probe attachment port and the interchangeable probe is securely connected to the handpiece. The probe attachment portion may include one or more probe locking ports. 
         [0030]    The probe locking ports may be located anywhere in the distal region of the handpiece. Preferably, the probe locking ports may be an aperture, a through hole, a dimple, or a combination thereof in the handpiece for securing the probe in the handpiece. 
         [0031]    The center region may be any part of the handpiece that is gripped during a procedure. The center region may be the largest portion of the handpiece. The center region may be free of any ports where other devices are inserted. 
         [0032]    The proximal region may include a power port to supply energy to the driver resource which drives the probe. The proximal region may include one or more drain ports or fluid supply ports. The drain ports or fluid supply ports may be any feature in the handpiece that allows fluids to exit the handpiece. Preferably, the drain port allows cooling fluids to exit the handpiece after the handpiece is removed from a cooling fluid. Drain ports may be located on each side of the handpiece. 
         [0033]    The handpiece may be provided with one or more seals, at a distal end, a proximal end, or both. The one or more seals may be located at any connection point so that fluid leakage is prevented, loss of suction is prevented, bodily waste is prevented from entering the internal lumen of the handpiece, appropriate spacing is provided to facilitate movement, or a combination thereof. The one or more seals may be located between the shielding insert and the probe, between the shielding insert and the handpiece, between the removable passageway and the shielding insert, between the probe and the internal lumen of the handpiece, or a combination thereof. The one or more seals may be o-ring seals, washers, or the like. The one or more seals may be made of any material that assists in preventing fluid leakage, is resistant to heat, is resistant to breaking down when in contact with bodily fluids, prevents loss of suction, or a combination thereof. The seals may be made of ethylene vinyl acetate (EVA), polyethylene vinyl acetate (PEVA), polyvinyl acetate (PVA), polyvinyl butyral (PVB), plastic, a polyvinyl chloride (PVC), a polytetrafluoroethylene (PTFE), a polyester, a polyvinyl fluoride (PVF), a polycarbonate, acetal, or a combination thereof. Preferably the seals may be made of silicone. 
         [0034]    The driver resource may be any driver resource capable of producing longitudinal waves or axial rotation, or both to create an oscillatory stone destructive action at the probe distal tip. The driver resource may be any driver resource that rotates clockwise, rotates counterclockwise, expands, contracts, or a combination thereof. The driver resource may be any driver resource that may be heated in an autoclave and sanitized. The driver resource may be any driver resource that may be rapidly heated and/or cooled without performance being affected. The driver resource may be any driver resource that may be heated and cooled with driver resource parts not prematurely wearing, breaking, misaligning, or a combination thereof. The driver resource may be an enclosed driver resource so that the driver resource may be placed in a cooling fluid. For example, the driver resource may be placed in water and the water may not penetrate the outer surface of the driver resource damaging the internal components. The driver resource may be substantially sealed within the handpiece so that the driver resource power source extends out of the handpiece. By way of example, the driver resource may be a piezoelectric driver, a linear motor, a brushless DC motor, a magnetic driver, an electromagnetic driver, or a combination thereof. 
         [0035]    A driver resource power transfer device may be provided which transfers energy from a power source to the driver resource. The driver resource power transfer device may be any power transfer device that may transfer power from the driver resource to another component so that the other component oscillates or rotates. The driver resource power transfer device may be any power transfer device that directly couples to another power transfer device so that the power transfer device is rotated. The driver resource power transfer device may directly connect to another component so that the other component is directly driven by the driver resource power transfer device. The driver resource power transfer device may transfer power to a second power transfer device that drives a component. The driver resource power transfer device may be a belt and pulley, a cog, a gear, a sprocket, a toothed wheel, a mechanism to transfer power by impact, or a combination thereof. The driver resource power transfer device may be any power transfer device that may be heated or cooled. The driver resource power transfer device may be any power transfer device that may substantially maintain its shape, form, structural attributes, tolerances, or a combination thereof when rapidly heated and cooled. The driver resource power transfer device may be made of a natural material, a synthetic material, a metal, a plastic, a polymer, or a combination thereof. Preferably the driver resource power transfer device is made of metal. The driver resource power transfer device may be located proximate to a power attachment port. 
         [0036]    The power attachment port may be located so that a user may ergonomically grip the lithotripter so that hand strain is minimized. The power attachment port may include an attachment and/or detachment feature so that the power attachment may be connected and disconnected from the handpiece so that the handpiece may be sanitized after use. The power attachment port may be angled so that the power attachment port rests on a user&#39;s hand during use, the handpiece curves to the shape of a user&#39;s hand, the power attachment forms an angle so that the power attachment port is aligned with a user&#39;s hand and/or arm so that the weight of the power attachment is not supported solely by the user&#39;s grip. 
         [0037]    In one embodiment, a heat exchanger may be attached to the lithotripsy device of the present invention during a sterilization procedure in order to facilitate more rapid heat transfer to the internal lumen of the handpiece. A heat exchanger is a piece of equipment built for efficient heat transfer from one medium to another. The heat exchanger may be made of copper, aluminum, carbon steel, stainless steel, nickel alloys, titanium, or a combination thereof. The heat exchanger may be externally affixed to the lithotripter, internally affixed to the lithotripter, or both. Fins may protrude radially outward from a central portion of the heat exchanger in a single plane or multiple planes to pull heat into the central lumen of the lithotripter. It is contemplated that the heat exchanger may operate optimally in temperature ranges including 100° C.-140° C., pressure ranges including 15 psi-30 psi, with pressure drops across the exchanger such as 0.5-2 psi, or with sterilization techniques that use different product mixes (i.e. liquid/liquid, particulates or high-solids liquid), for example. Preferably, the heat exchanger may be free of components that may degrade through multiple sterilization cycles (i.e. repeated heating and cooling). More preferably, the heat exchanger may be free of sealing components that may degrade through multiple sterilizations. The components of the heat exchanger may withstand about 500 or more, preferably about 1000 or more, and more preferably about 1500 or more sterilization cycles. 
         [0038]    It is contemplated that different output accessories can be used with the device of the present invention. In one embodiment, a lithotripsy probe may be used in combination with a stone retrieval device (i.e. stone basket or stone grasper). Another embodiment might include a laser fiber used in combination with a stone retrieval device. Various other alternatives and configurations are possible to remove a calculus of interest, as discussed for example in US Patent Publication 20140121458 and are herein incorporated by reference. 
         [0039]    It is contemplated that the device of the present invention is able to support a four minute flash cycle validation. A flash cycle may refer to heating an instrument with steam at 132 degrees Celsius for 3-4 minutes at 27-28 lbs. of pressure in a gravity displacement sterilizer. The time required for flash sterilization depends on the type of sterilizer and the item being sterilized. A device being able to support a 4 minute flash cycle validation involves challenging the device with microorganisms, performing a flash sterilization for two minutes, testing that the safety assurance level for a half cycle has a safety assurance level (SAL) of at least 10 −10 . If this SAL can be verified, then it may be inferred that a SAL of 10 −12  may be achieved through a full sterilization (four minute cycle). 
         [0040]    Turning now to the drawings to illustrate examples of embodiments of the present teachings,  FIG. 1  details an example embodiment of a lithotripter of the present invention. Lithotripter  10  is provided with a lithotripsy probe  20  which extends through handle  28  from a handle proximal end  30  to a handle distal end  29  and, as illustrated, is secured with O-rings  25  at handle proximal end  30 . Driver resource  32  is illustrated as a piezoelectric stack and provides energy to probe  20  to produce oscillatory stone destructive motion at probe distal end  22 . Horn  31  extends from handle distal end  29 . Probe attachment port  34  is provided at the distal end of horn  31  for securing probe  20  within handle  28 . Probe distal end  22  extends beyond the distal most end of handpiece  28  and may make contact with a kidney stone during active use. Probe proximal end  23 , in this embodiment, terminates proximate to the proximal end  30  of handpiece  28 . Suction connector  27  is provided at the handle proximal end  30  and enables connection of a fluid source, suction source, or both. Lithotripsy probe  20  has an internal lumen  24  through which an accessory instrument, suction, or fluid may pass. In some embodiments, a removable passageway at location  33  may be provided surrounding probe  20 . If probe  20  is removed after use and prior to a sterilization procedure, removable passageway at location  33  may provide extra protection against bodily waste coming into contact with the internal lumen of handle  20 . A plug may optionally be provided in one end of the probe or the removable passageway prior to removal from handle  20  to further limit any bodily debris from entering the internal lumen of the device handle prior to sterilization. 
         [0041]      FIG. 2  illustrates another example embodiment of a lithotripter of the present invention. Lithotripter  110  is provided with a lithotripsy probe  120  which may extend through a portion of handle  128  or may terminate at a distal end of handle  128 . Shielding insert  121  includes shielding insert proximal end  119  and shielding insert distal end  117  and may extend from a handle proximal end  130  to a handle distal end  129  and, as illustrated, is secured with O-rings  125  at handle proximal end  130  and handle distal end  129 . One or more distal end seals, one or more proximal end seals, or a combination thereof may be provided at junction points of shielding insert  121 , lithotripsy probe  120 , or handle  128 . Driver resource  132  is illustrated as a piezoelectric stack and provides energy to probe  120  to produce oscillatory stone destructive motion at probe distal end  122 . Horn  131  extends within handle distal end  129 . Probe attachment port  134  is provided at the distal end of horn  131  for securing probe  120  within handle  128 . Probe distal end  122  extends beyond the distal most end of handpiece  128  and may make contact with a kidney stone during active use. Probe proximal end  123 , in this embodiment, terminates within shielding insert  121 . In other variations, however, the probe proximal end  123  terminates proximal to the proximal end  119  of the shielding insert  121 . Suction connector  127  is provided at the handle proximal end  130  and enables connection of a fluid source, suction source, or both. Lithotripsy probe  120  has an internal lumen  124  through which an accessory instrument, suction, or fluid may pass. In some embodiments, removable passageway  133  may be provided surrounding probe  120 . If probe  120  is removed after use and prior to a sterilization procedure, removable passageway  133  may provide extra protection against bodily waste coming into contact with the internal lumen of handle  120 . A plug may optionally be provided in one end of the probe  120  or the removable passageway  133  prior to removal from handle  128  to further limit any bodily debris from entering the internal lumen of the device handle prior to sterilization. 
         [0042]      FIG. 3  illustrates another example embodiment of a lithotripter of the present invention prepared for a sterilization procedure. A lithotripsy probe, shielding insert, removable passageway, or a combination thereof, may have been removed from central lumen  238  of lithotripter  210 . Alternatively, heat exchangers may be added to the device without removing any internal lumens. Driver resource  232  is illustrated as a piezoelectric stack maintains enclosed within handle  228  during a sterilization procedure. Horn  231  extends within handle distal end  229 . Heat exchanger  235  may be attached to the lithotripter prior to performing a sterilization procedure and may consist of a distinct heat exchanger proximal portion  237  and heat exchanger distal portion  236 . Suction connector  227  is provided at the handle proximal end  230  and enables connection of a heat exchanger  237  at handle proximal end  230 . Seals  225  may be provided to help secure heat exchanger into suction connector  227 . An additional heat exchanger  236  is provided at handle distal end  229  and surrounds the outside of horn  231 . 
         [0043]      FIG. 4  illustrates another example embodiment of a lithotripter of the present invention. Lithotripter  310  is provided with a lithotripsy probe  320  which extends through a portion of handle  328  from a handle proximal end  330  to a handle distal end  329 . Driver resource  332  is illustrated as a piezoelectric stack and provides energy to probe  320  to produce oscillatory stone destructive motion at probe distal end  322 . Horn  331  extends within handle distal end  329 . The probe attachment port is illustrated as split collet  333  provided with a screw connection for securing probe  320  into handle  328 . Probe distal end  322  extends beyond the distal most end of handpiece  328  and may make contact with a kidney stone during active use. Probe proximal end  323 , in this embodiment, terminates at the proximal end of handle  328 . Suction connector  327  is provided at the handle proximal end  330  and enables connection of a fluid source, suction source, or both. Lithotripsy probe  320  has an internal lumen  324  through which an accessory instrument, suction, or fluid may pass. In some embodiments, removable passageway  333  (not shown) may be provided surrounding probe  320 . If probe  320  is removed after use and prior to a sterilization procedure, removable passageway  333  may provide extra protection against bodily waste coming into contact with the internal lumen of handle  328 . A plug may optionally be provided in one end of the probe  320  or the removable passageway  333  prior to removal from handle  328  to further limit any bodily debris from entering the internal lumen of the device handle prior to sterilization. 
         [0044]      FIG. 5  illustrates another example embodiment of a probe attachment port of a lithotripter of the present invention. Lithotripter  410  is provided with a lithotripsy probe  420  which extends through a portion of distal portion  429  of handle  428 . The probe attachment port is illustrated as collet  433  provided with a screw connection  434  for securing probe  420  into handle  428 . Ferrule  440  is provided to create a friction fit seal securing probe  420  in place and creating a seal to prevent liquid or bodily waste from entering a central lumen of lithotripter  410 . 
         [0045]    It is contemplated embodiments or examples described above may not be mutually exclusive and may be used in combination with each other. 
         [0046]    Unless stated otherwise, dimensions and geometries of various structures depicted herein are not intended to be restrictive of the invention, and other dimensions or geometries are possible. Plural structural components can be provided by a single integrated structure. Alternatively, a single integrated structure might be divided into separate plural components. In addition, while a feature of the present invention may have been described in the context of only one of the illustrated embodiments, such feature may be combined with one or more other features of other embodiments, for any given application. It will also be appreciated from the above that the fabrication of the unique structures herein and the operation thereof also constitute methods in accordance with the present invention. 
         [0047]    Preferred embodiments of the present invention have been disclosed. A person of ordinary skill in the art would realize, however, that certain modifications would come with the teachings of the invention. Therefore, the following claims should be studied to determine the true scope and content of the invention. 
         [0048]    Any numerical values recited in the above application include all values from the lower value to the upper value in increments of one unit provided that there is a separation of at least two units between any lower value and any higher value. As an example if it is stated that the amount of a component or a value of a process variable such as, for example, temperature, pressure, time and the like is, for example, from 1 to 90, preferably from 20 to 80, more preferably from 30 to 70, it is intended that values such as 15 to 85, 22 to 68, 43 to 51, 30 to 32 etc. are expressly enumerated in this specification. For values which are less than one, one unit is considered to be 0.0001, 0.001, 0.01, or 0.1 as appropriate. These are only examples of what is specifically intended and all possible combinations of numerical values between the lowest value and the highest value enumerated are to be considered to be expressly stated in this application in a similar manner. 
         [0049]    Unless otherwise stated, all ranges include both endpoints and all numbers between the endpoints. The use of “about” and “approximately” in connection with a range applies to both ends of the range. Thus, “about 20 to about 30” is intended to cover “about 20 to about 30.” Inclusive of at least the specified endpoints. 
         [0050]    The disclosures of all articles and references, including patent applications and publications, are incorporated by reference for all purposes. 
         [0051]    The term “consisting essentially of to describe a combination shall include the elements, ingredients, components or steps identified, and such other elements, ingredients, components or steps that do not materially affect the basic and novel characteristics of the combination. 
         [0052]    The use of the terms “comprising” or “including” describing combinations of elements, ingredients, components or steps herein also contemplates embodiments that consist essentially of the elements, ingredients, components or steps. 
         [0053]    Plural elements, ingredients, components or steps can be provided by a single integrated element, ingredient, component or step might be divided into separate plural elements, ingredients, components or steps. The disclosure of “a” or “one” to describe an element, ingredient, component or step is not intended to foreclose additional elements, ingredients, components, or steps. 
       LIST OF ELEMENTS 
       [0000]    
       
           10  Lithotripter 
           20  Lithotripsy shaft 
           22  Lithotripsy shaft distal end 
           23  Lithotripsy shaft proximal end 
           24  Lithotripsy shaft lumen 
           25  O ring 
           27  Suction connector 
           28  Handle 
           29  Handle distal end 
           30  Handle proximal end 
           31  Horn of driver resource 
           32  Driver Resource 
           33  Removable passageway 
           34  Shaft attachment port (at distal end of horn) 
           110  Lithotripter 
           117  Shielding insert distal end 
           118  Shielding insert lumen 
           119  Shielding insert proximal end 
           120  Lithotripsy shaft 
           121  Shielding insert 
           122  Lithotripsy shaft distal end 
           124  Lithotripsy shaft lumen 
           125  O ring 
           127  suction connector 
           128  Handle 
           129  Handle distal end 
           130  Handle proximal end 
           131  ultrasonic horn 
           132  Driver resource 
           133  Removable passageway 
           134  Connector (at distal end of horn) 
           210  Lithotripter 
           225  O ring 
           227  Suction connector 
           228  Handle 
           229  Handle distal end 
           230  Handle proximal end 
           231  Driver resource horn 
           232  Driver resource 
           234  Heat exchanger lumen 
           235  Heat exchanger 
           236  Heat exchanger distal portion 
           237  Heat exchanger proximal portion 
           238  Lumen 
           239  Lithotripter distal end 
           310  Lithotripter 
           320  Lithotripsy Shaft 
           322  Lithotripsy shaft distal end 
           323  Lithotripsy shaft proximal end 
           324  internal lumen of shaft 
           327  Suction connector 
           328  Handle 
           329  Handle distal end 
           330  Handle proximal end 
           331  Horn of driver resource 
           332  Driver Resource 
           333  Split Collet 
           334  Screw connection 
           410  Lithotripter 
           420  Lithotripsy Shaft 
           428  Handle 
           433  Collet 
           434  Screw connection 
           440  Ferrule