Abstract:
An ultrasonic medical probe comprises an elongate shaft formed integrally with a head portion having a distal end face oriented at least partially transversely to a longitudinal axis of the shaft. The shaft is provided with an internal longitudinal channel or bore extending to the end face. The end face is formed with an indentation communicating with the channel or bore at a distal end thereof, whereby liquid is guided over an extended surface of the end face relative to the channel or bore. The head portion also has a lateral surface extending substantially parallel to the longitudinal axis of the probe. The lateral surface is provided with at least one outwardly or radially extending projection. The projection enables the application of ultrasonic cavitation energy to a tissue surface that is in contact with the lateral or side surface of the probe head.

Description:
BACKGROUND OF THE INVENTION  
       [0001]     This invention relates to ultrasonic surgical instruments and associated methods of use. More particularly, this invention relates to high-efficiency medical treatment probes for ultrasonic surgical aspirators. These probes increase the ability to fragment and emulsify hard and soft tissue in a clinical environment while reducing unwanted heat and collateral tissue damage.  
         [0002]     Over the past 30 years, several ultrasonic tools have been invented which can be used to ablate or cut tissue in surgery. Such devices are disclosed by Wuchinich et al. in U.S. Pat. No. 4,223,676 and Idemoto et al in U.S. Pat. No. 5,188,102.  
         [0003]     In practice, these surgical devices include a blunt tip hollow probe that vibrates at frequencies between 20 kc and 100 kc, with amplitudes up to 300 microns or more. Such devices ablate tissue by either producing cavitation bubbles which implode and disrupt cells, tissue compression and relaxation stresses (sometimes called the jackhammer effect) or by other forces such as micro streaming of bubbles in the tissue matrix. The effect is that the tissue becomes liquefied and separated. It then becomes emulsified with the irrigant solution. The resulting emulsion is then aspirated from the site. Bulk excision of tissue is possible by applying the energy around and under an unwanted tumor to separate it from the surrounding structure. The surgeon can then lift the tissue out using common tools such as forceps.  
         [0004]     The probe or tube is excited by a transducer of either the piezoelectric or magnetostrictive type that transforms an alternating electrical signal within the frequencies indicated into a longitudinal or transverse vibration. When the probe is attached to the transducer, the two become a single element with series and parallel resonances. The designer will try to tailor the mechanical and electrical characteristics of these elements to provide the proper frequency of operation. Most of the time, the elements will have a long axis that is straight and has the tip truncated in a plane perpendicular to the long axis, as shown in  FIG. 1 . This is done for simplicity and economic considerations. In almost all applications, whether medical or industrial, such an embodiment is practical and useful. However, in applications such as the debridement of burns, wounds, diabetic ulcers or ulcers induced by radiation treatments, the blunt straight probe has been shown to be less effective in removing the hard eschar buildup that occurs when the wound is healing. This eschar buildup must be removed so that the healthy tissue is exposed and allowed to close the wound to provide complete healing with minimal scar tissue formation. Also, the small diameter tip, since it is cannulated, has a small annular area with limits energy transmission into the wound. This extends the length of the procedure and causes operator fatigue and patient discomfort.  
         [0005]     Therefore, it is desired to provide a probe that can be mated to an ultrasonic surgical aspirator which increases the efficiency of emulsification, does not heat up the operative site and lowers the time of operation.  
       OBJECTS OF THE INVENTION  
       [0006]     An object of the present invention is to provide an improved ultrasonic surgical instrument for use in debridement of wounds.  
         [0007]     A more particular object of the present invention is to provide such an instrument in the form of a probe that may be used in conjunction with ultrasonic surgical aspirators to debride wounds.  
         [0008]     Another relatively specific object of the present invention is to provide an improved ultrasonic surgical instrument with a form that enhances surgical efficiency and reduces the time required to complete at least some kinds of debridement procedures.  
         [0009]     It is a further object of the present invention to provide such an improved ultrasonic surgical instrument with irrigation or suction capability.  
         [0010]     It is an additional object of the present invention to provide an improved ultrasonic surgical instrument that may be used in debriding deep wounds such as cuts and puncture wounds.  
         [0011]     An additional object of the present invention is to provide an improved ultrasonic surgical instrument that has liquid directing channels for greater heat reduction at the distal face and to prevent liquid jetting or spraying from the tissue probe interface.  
         [0012]     These and other objects of the invention will be apparent from the drawings and descriptions herein. Although every object of the invention is attained in at least one embodiment of the invention, there is not necessarily any embodiment which attains all of the objects of the invention.  
       SUMMARY OF THE INVENTION  
       [0013]     A probe for use as an ultrasonically vibrating tool is disclosed with a central bore coincident with the longitudinal axis. The proximal end of said bore communicates with a bore in the ultrasonic handpiece using methods well known to the art, such as a male/female thread combination. The probe is shaped such as to provide both a resonant frequency of operation in the range for which the electronic generator was designed and an amplitude of vibration at the distal face which is desired for proper tissue ablation. Such amplitudes have generally been shown to be in the range of 30 to 300 microns. Again, the technique needed for calculating said shapes is well known to the art and outside the scope of this disclosure.  
         [0014]     Probe heads or ends in accordance with the present invention incorporate either a substantially symmetrical distal end or a distal end with a pronounced asymmetry. Each end has attributes that increase its effectiveness on varying tissue pathologies.  
         [0015]     Probe ends pursuant to the present invention are further modified to improve the liquid flow to the probe/tissue interface such as to reduce the bulk temperature rise of the tissue and prevent clogging of the liquid passageway. Probe ends are further modified to produce energy directors that impart energy from the sides of the probes instead of only at the distal face of the probe. Such energy directors, when contacting skin or tissue, will increase volume of tissue treated per unit time and thereby reduce the operating time of the procedure.  
         [0016]     In one embodiment of the present invention, an ultrasonic medical probe comprises an elongate shaft formed integrally with a head portion having a distal end face oriented at least partially transversely to a longitudinal axis of the shaft. The shaft is provided with an internal longitudinal channel or bore extending to the end face. The end face is formed with an indentation communicating with the channel or bore at a distal end thereof, whereby liquid is guided over an extended surface of the end face relative to the channel or bore.  
         [0017]     The head portion may be enlarged in a transverse direction relative to the shaft. In that event, the end face has an elongated shape, while the indentation is elongate and forms a groove in the end face of the head portion. This groove may extend parallel to or in a length dimension of the end face.  
         [0018]     When the channel or bore is connected to a suction source, fluid in the indentation flows toward the channel or bore. When the channel or bore is connected to a source of irrigation liquid, liquid in the indentation flows away from the channel or bore.  
         [0019]     Pursuant to a feature of the present invention, the end face is inclined or beveled relative to the longitudinal axis of the probe.  
         [0020]     In another embodiment of the present invention, an ultrasonic medical probe comprises an elongate shaft formed integrally with a head portion having a distal end face oriented at least partially transversely to a longitudinal axis of the shaft. The head portion also has a lateral surface extending substantially parallel to the longitudinal axis of the probe. The lateral surface is provided with at least one outwardly or radially extending projection. The projection enables the application of ultrasonic cavitation energy to a tissue surface that is in contact with the lateral or side surface of the probe head.  
         [0021]     Pursuant to a feature of the present invention, the projection is one of a plurality of projections extending from the lateral surface. The projections may be identical to one another and staggered from one another along the lateral surface of the probe head. The projections may have a shape that is pyramidal, semi-cylindrical, wedge-shaped, or plate-like. The projections may lie down against the lateral surface of the probe head, in the nature of fish scales, flaps, or flattened plates.  
         [0022]     The projections may take the form of ridges. The projections or ridges may extend perimetrally or circumferentially about the probe head. Preferably, however, the projections or ridges are disposed only along one side (or possibly two sides, in some applications) of the probe head. The probe head may take a prismatic form, with the energy-directing projections or ridges formed along one (or two) lateral surfaces thereof. This placement of the energy-directing projections facilitates use of the probe in surgical procedures, inasmuch as it is easier for the surgeon to keep track of the location of the projections to ensure that the projections come into contact only with target debridement tissues.  
         [0023]     It is contemplated that the projections may be finely distributed over a lateral face of the probe head so as to form a knurled surface. Such a knurled surface is similar to that found on a metal filing tool.  
         [0024]     As discussed above, the shaft and the probe head may be provided with an internal longitudinal channel or bore extending to the end face of the probe head, with the end face being formed with an indentation communicating with the channel or bore at a distal end thereof. The indentation extends laterally relative to the channel or bore, whereby liquid is guided over an extended surface of the end face relative to the channel or bore.  
         [0025]     The indentation may be elongate and form a groove in the end face of the head portion. Where the head portion has an elongated shape, the groove may extend parallel to a length dimension of the end face.  
         [0026]     A surgical method in accordance with the present invention utilizes a probe vibratable at at least one ultrasonic frequency, the probe having a distal end face oriented at least partially transversely to a longitudinal axis of the shaft. The method comprises bringing the distal end face into contact with organic tissues of a patient, energizing the probe to vibrate the end face at the ultrasonic frequency during the contacting of the tissues with the distal end face, and channeling liquid between the contacted tissues and a longitudinal bore in the probe, during the contacting of the tissues with the distal end face, via an indentation in the end face communicating with the bore.  
         [0027]     Where the bore is connected to a suction source, the channeling of liquid includes guiding liquid from the contacted tissues to the bore.  
         [0028]     Where the bore is connected to a source of irrigation liquid, the channeling of liquid comprises guiding liquid to the contacted tissues from the bore.  
         [0029]     A surgical method in accordance with another feature of the present invention utilizes a probe vibratable at at least one ultrasonic frequency, where the probe has a distal end face oriented at least partially transversely to a longitudinal axis of the shaft, a lateral surface extending substantially perpendicularly to the end face and substantially parallel to the longitudinal axis, and at least one outwardly or radially extending projection extending out from the lateral surface. The method comprises bringing the lateral surface together with the projection into contact with organic tissues of a patient and, during the contacting of the tissues with the lateral surface and the projection, energizing the probe to vibrate the lateral surface and the projection at the ultrasonic frequency.  
         [0030]     Pursuant to another feature of the present invention, the bringing of the lateral surface together with the projection into contact with organic tissues of a patient includes inserting a distal end portion of the probe into a fissure or recess in an organ of the patient and moving the probe so that the lateral surface and the projection contact a wall of the fissure or recess.  
         [0031]     According to another feature of the present invention, the bringing the lateral surface together with the projection into contact with organic tissues of a patient includes manipulating the probe so that the lateral surface is oriented substantially parallel to the organic tissues and so that the end face is oriented substantially perpendicularly to the organic tissues immediately prior to an engaging of the organic tissues with the lateral surface and the projection. In one embodiment of the present invention, an ultrasonic medical probe comprises an elongate shaft formed integrally with a head portion having a distal end face oriented at least partially transversely to a longitudinal axis of the shaft. The shaft is provided with an internal longitudinal channel or bore extending to the end face. The end face is formed with an indentation communicating with the channel or bore at a distal end thereof, whereby liquid is guided over an extended surface of the end face relative to the channel or bore.  
         [0032]     The head portion may be enlarged in a transverse direction relative to the shaft. In that event, the end face has an elongated shape, while the indentation is elongate and forms a groove in the end face of the head portion. This groove may extend parallel to or in a length dimension of the end face.  
         [0033]     When the channel or bore is connected to a suction source, fluid in the indentation flows toward the channel or bore. When the channel or bore is connected to a source of irrigation liquid, liquid in the indentation flows away from the channel or bore.  
         [0034]     Pursuant to a feature of the present invention, the end face is inclined or beveled relative to the longitudinal axis of the probe.  
         [0035]     In another embodiment of the present invention, an ultrasonic medical probe comprises an elongate shaft formed integrally with a head portion having a distal end face oriented at least partially transversely to a longitudinal axis of the shaft. The head portion also has a lateral surface extending substantially parallel to the longitudinal axis of the probe. The lateral surface is provided with at least one outwardly or radially extending projection. The projection enables the application of ultrasonic cavitation energy to a tissue surface that is in contact with the lateral or side surface of the probe head.  
         [0036]     Pursuant to a feature of the present invention, the projection is one of a plurality of projections extending from the lateral surface. The projections may be identical to one another and staggered from one another along the lateral surface of the probe head. The projections may have a shape that is pyramidal, semi-cylindrical, wedge-shaped, or plate-like. The projections may lie down against the lateral surface of the probe head, in the nature of fish scales, flaps, or flattened plates.  
         [0037]     The projections may take the form of ridges or knurls. Preferably, the projections are disposed along only a portion of the lateral surface area of the probe head. For example, where the probe head is prismatic with three or more planar lateral faces, the energy-direting projections are disposed along less than all of the lateral faces of the probe head. More preferably, the projections are disposed along only one or two lateral faces of the probe head.  
         [0038]     As discussed above, the shaft and the probe head may be provided with an internal longitudinal channel or bore extending to the end face of the probe head, with the end face being formed with an indentation communicating with the channel or bore at a distal end thereof. The indentation extends laterally relative to the channel or bore, whereby liquid is guided over an extended surface of the end face relative to the channel or bore.  
         [0039]     The indentation may be elongate and form a groove in the end face of the head portion. Where the head portion has an elongated shape, the groove may extend parallel to a length dimension of the end face.  
         [0040]     A surgical method in accordance with the present invention utilizes a probe vibratable at at least one ultrasonic frequency, the probe having a distal end face oriented at least partially transversely to a longitudinal axis of the shaft. The method comprises bringing the distal end face into contact with organic tissues of a patient, energizing the probe to vibrate the end face at the ultrasonic frequency during the contacting of the tissues with the distal end face, and channeling liquid between the contacted tissues and a longitudinal bore in the probe, during the contacting of the tissues with the distal end face, via an indentation in the end face communicating with the bore.  
         [0041]     Where the bore is connected to a suction source, the channeling of liquid includes guiding liquid from the contacted tissues to the bore.  
         [0042]     Where the bore is connected to a source of irrigation liquid, the channeling of liquid comprises guiding liquid to the contacted tissues from the bore.  
         [0043]     A surgical method in accordance with another feature of the present invention utilizes a probe vibratable at at least one ultrasonic frequency, where the probe has a distal end face oriented at least partially transversely to a longitudinal axis of the shaft, a lateral surface extending substantially perpendicularly to the end face and substantially parallel to the longitudinal axis, and at least one outwardly or radially extending projection extending out from the lateral surface. The method comprises bringing the lateral surface together with the projection into contact with organic tissues of a patient and, during the contacting of the tissues with the lateral surface and the projection, energizing the probe to vibrate the lateral surface and the projection at the ultrasonic frequency.  
         [0044]     Pursuant to another feature of the present invention, the bringing of the lateral surface together with the projection into contact with organic tissues of a patient includes inserting a distal end portion of the probe into a fissure or recess in an organ of the patient and moving the probe so that the lateral surface and the projection contact a wall of the fissure or recess. According to another feature of the present invention, the bringing the lateral surface together with the projection into contact with organic tissues of a patient includes manipulating the probe so that the lateral surface is oriented substantially parallel to the organic tissues and so that the end face is oriented substantially perpendicularly to the organic tissues immediately prior to an engaging of the organic tissues with the lateral surface and the projection. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0045]      FIG. 1  is a cross sectional view of a prior art ultrasonic probe for use with an ultrasonic aspirator.  
         [0046]      FIG. 2A  is partially a side elevational view and partially a cross-sectional view of an ultrasonic probe in accordance with the present invention.  
         [0047]      FIG. 2B  is a distal end elevational view of the probe of  FIG. 2A .  
         [0048]      FIG. 2C  is partially a top elevational view and partially a cross-sectional view of the probe of  FIG. 2A .  
         [0049]      FIG. 3A  is partially a side elevational view and partially a cross-sectional view of another ultrasonic probe in accordance with the present invention.  
         [0050]      FIG. 3B  is a distal end elevational view of the probe of  FIG. 3A , showing a modification in the form of an elongate groove in a distal end face of the probe head.  
         [0051]      FIG. 3C  is a view similar to  FIG. 3A  showing the groove of  FIG. 3B .  
         [0052]      FIG. 3D  is a partial cross-sectional view taken along line III-III in  FIG. 3C .  
         [0053]      FIG. 4  is partially a side elevational view and partially a cross-sectional view of a further ultrasonic probe in accordance with the present invention.  
         [0054]      FIG. 4A  is partial view, on a larger scale, of a lateral surface of a head of the probe of  FIG. 4 , taken in region IV-IV of  FIG. 4 .  
         [0055]      FIGS. 4B-4D  are side elevational views of the probe head of  FIG. 4 , showing respective modifications of formations along the lateral surface thereof.  
         [0056]      FIG. 4E  is a perspective view of the probe head depicted in  FIG. 4D .  
         [0057]      FIG. 5  is partially a side elevational view and partially a cross-sectional view of yet another ultrasonic probe in accordance with the present invention. 
     
    
     DETAILED DESCRIPTION  
       [0058]     Several probes are disclosed which embody the improvements described herein.  FIG. 1  shows a probe  10  which is known to the art and is currently manufactured for use with an ultrasonic aspirator. This probe  10  is basically shaped with an exponential or Gaussian taper. Probe  10  is cannulated and has an integral male thread (not shown) at the proximal end (proximate the operator). This thread communicates with a female threaded bore (not illustrated) in the transducer  12 . By tightening the probe  10  onto the transducer  12  and using standard wrenches for final torquing, the transducer and probe essentially become one resonant body. Bores of the probe  10  and transducer  12  communicate with one another. The probe  10  is generally constructed of an acoustically efficient metal or ceramic. Titanium is the most commonly used material, but other material has been employed with success. Material choice does not have a significant impact upon the embodiments of this disclosure.  
         [0059]     The distal end of the prior art probe  10  is truncated in a plane P 1  perpendicular to the longitudinal axis  14  of the resonant body (probe and transducer). Since the probe  10  is cannulated, a distal end face  16  takes the form of an annular surface with a small cross sectional area. The shape of the probe  10  allows the probe to become a velocity transformer, i.e., the probe will amplify the input vibrations from the transducer  12  by a fixed value, called a gain factor, determined by the geometry of the probe. For example, if the probe  10  had a gain factor of 10, the probe would multiply the input vibration of the transducer, for example 30 microns, to a final amplitude at the distal end of the probe of 300 microns. This phenomenon is well known to the art. By placing the distal end face  16  of probe  10  against organic tissue of a patient, the tissue will be disrupted through cavitation and mechanical effects. By adding saline or water to the tissue-probe interface, cooling of the tissue is achieved and the tissue is emulsified into the liquid and is more easily aspirated either through the center of the probe  10 , if the center bore is connected to the aspirator or by separate suction cannulae if the center bore is connected to the irrigant source.  
         [0060]     However, the distal end of probe  10  in its conventional configuration is not conducive to ablating large volumes of tissue in short periods of time. By increasing the surface area of distal end face  16 , a probe can be constructed which will ablate tissue faster and allow for a shorter operation. This is especially advantageous when debriding wounds such as bedsores, diabetic ulcers, burn wounds, etc.  
         [0061]      FIGS. 2A-2C  show a probe  18  with a shaft  19  and an enlarged distal head  20 . More particularly, probe head  20  may be asymmetrical such that the cross sectional shape is rectangular or oval (see  FIG. 2B ). This asymmetry allows the probe  18  to maintain a higher gain factor and be more able to be inserted into smaller wounds. The surface area of a distal end face  22  of probe head  20  is greatly increased over the prior art probe ( FIG. 1 ) and will naturally ablate tissue at a higher rate. The shape of the probe head  20  allows access to irregularly shaped wound beds, such as cuts or fissures with slit openings.  
         [0062]     Although the probe of  FIGS. 2A-2C  has been shown to have higher performance over prior art, further improvements may be made.  FIG. 3A  depicts a probe  24  having a shaft  25  and an asymmetrically enlarged head  26  with a truncated or beveled distal end face  28  located in a plane P 2  that is not perpendicular to a longitudinal axis  30  of the probe. This probe  24  has been shown to improve performance in removing the hard eschar buildup of burn wounds, which must be removed in order to expose healthy tissue.  
         [0063]     One problem that is encountered in such probe designs, whether the probe head is truncated in a perpendicular plane P 1  such as head  20  or in a plane P 2  inclined relative to the instrument axis  30  such as probe head  26 , is the bore opening  32  or  34  may become blocked with tissue. This blockage prevents aspiration of the emulsified tissue, if the respective bore  36  or  38  is connected to a vacuum source (not shown) or blocks the flow of cooling fluid out of the probe, if the bore is attached to a pressurized liquid source (not shown). Because of the pressure buildup, the liquid has a tendency to jet or stream from the probe tissue interface, causing the irrigant to be sprayed around the room instead of onto the wound bed. Also, if the distal end face of the probe is very large, the liquid may not cover the entire face, even if the opening  32 ,  34  at the end of the probe is not blocked.  
         [0064]     In order to improve the performance of the probe  24  in this regard, a channel, groove, indentation, or notch  40  is provided in the face  28  of the probe, as shown in  FIGS. 3B, 3C  and  3 D. This channel  40  reduces the likelihood of blockage of an output opening  42  of the probe bore  38  by locating this opening or outlet proximally from the distal end face  28  of the probe head  26 , while allowing the liquid to fill the channel  40  and cover the remaining distal surface area more fully. Many alternative shapes of channels may be employed in the distal end faces of ultrasonic probes without changing the concepts outlined herein. In the illustrated example, channel or groove  40  extend parallel to or in a length dimension of the end face  28 .  
         [0065]     When bore  38  is connected to a suction source (not shown), fluid in the channel  40  flows toward the bore  38 . When the channel or bore  38  is connected to a source of irrigation liquid (not shown), liquid in the channel  40  flows away from the bore  38 .  
         [0066]     Regardless of the shape of the distal surface or end faces of the probes as discussed hereinabove, the probes are limited in their ability to ablate tissue by the fact the only area where this ablation can occur is at the distal end face. The sides or lateral surfaces of the probes are generally disposed parallel to the longitudinal axes and parallel to the direction of ultrasonic compression wave transmission. When tissue touches these lateral surfaces, no ablation occurs since the motion is a sliding or rubbing action, which does not transmit sufficient energy into the tissue to cause emulsion or ablation. It is therefore desired to improve ultrasonic tissue ablation probes so that energy may be transmitted from one or more lateral faces or side surfaces of the probe heads so that more tissue may be ablated per unit time.  
         [0067]      FIGS. 4 and 4 A show a probe  44  which is identical to probe  24  of  FIGS. 3B-3D  with the addition of outwardly or radially extending projections  46  serving as energy guides or directors disposed along at least one lateral or side surface  48  of a probe head  50 . Preferably, probe head  50  has a prismatic shape with four planar lateral surfaces or faces  48 , projections  46  being disposed only along one or two of the lateral surfaces. As depicted in  FIG. 4 , energy-directing projections  46  are disposed only along two opposing lateral surfaces  48 . Where projections occur along only one or at most two lateral surfaces  48 , it is easier for the user to avoid contact with non-target tissues.  
         [0068]     Probe head  50  may be integrally formed with a shaft portion  49  of probe  44 . Alternatively, probe head  50  may be formed as a separate piece that is firmly attached to shaft  49 , e.g., via mating screw threads (not shown) or a force or friction fit. These same alternatives also apply to probe heads  20 ,  26 ,  66 .  
         [0069]     Projections  46  may have a fine geometrical configuration and distribution so as to form the respective lateral surface  48  into a knurled surface as one would find, for example, on a metal file. Or projections  46  may be a series of ridges or knurls on probe head  50 . Alternatively, as shown in  FIG. 4B , projections or energy directors  46  may be pyramidal sections fashioned from the base metal of the probe  44  that project out in a substantially perpendicular direction from a longitudinal axis  51  of the probe. More specifically, projections or energy directors  46  are a series of parallel ridges or knurls each of triangular cross-section extending transversely to a direction of ultrasonic wave propagation. Projections or energy directors  46  may include a first set of parallel ridges  46   a  and a second set of ridges  46   b  that is staggered relative to the first set. Each set of wedge- or triangle-shaped projections or ridges  46   a ,  46   b  defines a corresponding set of grooves (not separately designated) each of triangular cross-section extending transversely to a direction of ultrasonic wave propagation. The resulting faceted surfaces of projections or ridges  46   a ,  46   b  impart a vector force on the target tissue when the probe  44  vibrates, which will cause cavitation and emulsification of the tissue when it contacts the faceted surfaces.  
         [0070]     As illustrated in  FIGS. 4B-4E , lateral surface  48  may be provided with energy-directing projections or ridges  52 ,  54 ,  56  of different geometrical shapes. Projections or ridges  52  are convex, for instance, semi-cylindrical. Projections or ridges  54  define concave grooves or recesses  58 . Projections  56  are flattened plates or flaps that lie against lateral surface  48  in the natural of fish scales. These energy directors or projections  52 ,  54 ,  56  allow faster tissue ablation by creating a much larger active surface area at the distal end of the probe  44 .  
         [0071]     In cases where a probe tip must be smaller than that allowed by the described embodiment, such as when small and/or deep bedsores or wounds must be debrided, the probe tip may be improved to allow faster ablation as well.  FIG. 5  shows a probe  60  in the configuration of a tubular end or head  62 . Probe  60  is provided circumferentially along a cylindrical lateral or side surface  64  or probe head  62  with a plurality of pyramidal energy-directing projections  66 . Projections  66  may be small such as that which occurs in a knurled surface, for example, on a metal file. The energy directors  66  will impart vector forces on the tissue when in contact with the wound bed such that emulsion and ablation will occur around the probe as well as in front of it. Such probes have been shown to increase the speed of ablation and thereby significantly reduce the time of operation. Again, such energy directors may be purely pyramidal, or have concave or convex faces.  
         [0072]     All said probes in this embodiment might be designed by those skilled in the art using known tools and techniques.  
         [0073]     In a method of using the above-described probes for debriding and cleaning wounds, sores and ulcers with ultrasound energy, an operator assembles the ultrasonic surgical aspirator with the probes, connects the central bore to a pressurized liquid source which can be adjusted to provide a controlled flow at the probe tip, turn on the system to provide between 30 and 350 microns of probe tip displacement, and touches the tip and the energy directors to the tissue to be ablated, causing cavitational and mechanical forces to be imparted to said tissue which ablates the tissue, thereby debriding and cleansing the wound bed. Aspiration may be accomplished simultaneously or separately from ultrasonic ablation by connecting a flue or sheath around said probe, as in  FIG. 6 , that is in turn connected to a vacuum source and then the emulsified tissue is aspirated through this annular space. Conversely, the flue or sheath may be eliminated and the aspirate removed via separate suction cannulae.  
         [0074]     A surgical method utilizing probe  24  or  44  or another probe provided in an end face with a channel, groove, indentation, or notch such as channel  40  is operated to vibrate at an ultrasonic frequency. The distal end face  22 ,  28  of the probe is brought into contact with organic tissues of a patient. The probe is energized to ultrasonically vibrate the end face  22 ,  28  during the contacting of the tissues with the distal end face, and liquid is channeled between the contacted tissues and longitudinal bore  36 ,  38 , during the contacting of the tissues with the distal end face, via indentation or channel  40 .  
         [0075]     A surgical method utilizing probe  44  or  60  comprises bringing the lateral surface  48  or  64  together with projections, ridges, or knurls  46 ,  66  into contact with organic tissues of a patient and, during the contacting of the tissues with the lateral surface and the projections, energizing the probe to vibrate the lateral surface  48 ,  64  and the projections  46 ,  66  at a predetermined ultrasonic frequency. This method may include inserting a distal end portion of the probe into a cut, fissure or recess in an organ of the patient and moving the probe so that the lateral surface  48 ,  64  and the projections  46 ,  66  contact a wall of the fissure or recess.  
         [0076]     Altneratively or additionally, the probe is manipulating so that the lateral surface  48 ,  64  is oriented substantially parallel to the organic tissues and so that the distal end face is oriented substantially perpendicularly to the organic tissues immediately prior to an engaging of the organic tissues with the lateral surface  48 ,  64  and the projections  46 ,  66 .  
         [0077]     Although the invention has been described in terms of particular embodiments and applications, one of ordinary skill in the art, in light of this teaching, can generate additional embodiments and modifications without departing from the spirit of or exceeding the scope of the claimed invention. Accordingly, it is to be understood that the drawings and descriptions herein are proffered by way of example to facilitate comprehension of the invention and should not be construed to limit the scope thereof.