System and method for guided removal from an in vivo subject

Abstract

In accordance with some configurations, systems and methods for guided removal from an in vivo subject are provided. In some configurations, a method for removing an object is provided. The method comprising, guiding a flexible tube through a passageway of an in vivo subject, wherein the flexible tube comprises at least a first passageway and a second passageway. Positioning a distal end of the first passageway in proximity to the object. Infusing liquid through the second passageway substantially continuously. Removing the object through the first passageway with at least a portion of the liquid while suction is not being provided.

What is claimed is: 
     
         1 . A method for removing an object from a kidney, comprising:
 guiding a flexible tube through a passageway of an in vivo subject, wherein the flexible tube comprises at least a first passageway and a second passageway encompassed by the first passageway, wherein the second passageway is positioned concentrically within the first passageway, the first passageway forming an annular lumen surrounding the second passageway;   inserting a distal end of the flexible tube into a target region of the kidney;   infusing liquid through the first passageway substantially continuously into the target region of the kidney during a first period of time;   ceasing infusion of the liquid;   initiating suction through the second passageway and continuing suction during a second period of time; and   aspirating the object through the second passageway with at least a portion of the liquid.   
     
     
         2 . The method of  claim 1 , wherein the liquid is infused at a flow rate of at least about 5 milliliters per minute. 
     
     
         3 . The method of  claim 2 , further comprising:
 coupling a bag containing liquid to the second passageway; and   increasing pressure on the bag to cause the liquid to be infused.   
     
     
         4 . The method of  claim 1 , wherein infusing the liquid comprises infusing the liquid through the first passageway for at least five minutes. 
     
     
         5 . The method of  claim 1 , further comprising:
 causing suction to be provided at the distal end of the second passageway by a suction source coupled to the second passageway; and   removing another object through the second passageway with at least a second portion of the liquid while the suction is being provided.   
     
     
         6 . The method of  claim 1 , further comprising:
 inserting a sheath into the passageway of the vivo subject;   inserting a device through the sheath;   positioning the device adjacent to a second object;   using the device to break the second object into a plurality of objects including the object; and   wherein the flexible tube is guided through the sheath.   
     
     
         7 . The method of  claim 6 , wherein the flexible tube is guided through the sheath subsequent to removal of the device. 
     
     
         8 . The method of  claim 7 , wherein the second object is a kidney stone that has a diameter greater than about 10 millimeters and cannot be removed through the first passageway, and the object is a fragment of the kidney stone that has a diameter of less than about 4.33 millimeters. 
     
     
         9 . The method of  claim 7 , wherein the device is a ureteroscope. 
     
     
         10 . The method of  claim 1 , wherein the flexible tube is guided through the passageway without the use of an insertion sheath. 
     
     
         11 . The method of  claim 1 , further comprising prior to guiding the flexible tube through the passageway:
 inserting a device through the passageway;   positioning the device adjacent to a second object;   using the device to break the second object into a plurality of objects including the object; and   removing the device from the passageway.   
     
     
         12 . The method of  claim 1 , wherein the flexible tube has an external diameter of at least about 11 French. 
     
     
         13 . The method of  claim 1 , comprising:
 ceasing suction though the second passageway;   resuming infusion of liquid through the first passageway for a third period of time;   ceasing infusion of liquid through the first passageway after conclusion of the third period of time;   reinitiating suction through the second passageway and continuing suction during a fourth period of time; and   aspirating a second object through the second passageway with at least a portion of the liquid.   
     
     
         14 . The method of  claim 1 , comprising using a fluoroscope as a visual guide while guiding the flexible tube. 
     
     
         15 . The method of  claim 1 , wherein an irrigation fluid source is coupled to the first passageway. 
     
     
         16 . The method of  claim 15 , wherein the irrigation fluid source is a syringe containing the liquid. 
     
     
         17 . The method of  claim 1 , wherein the liquid is infused at a rate of 5 ml per minute to 100 ml per minute. 
     
     
         18 . The method of  claim 1 , wherein a handle is coupled to the flexible tube, the handle comprising a lateral irrigation port and an axial aspiration port, the axial aspiration port in line with a portion of the second passageway proximal to the handle, wherein infusing liquid through the first passageway comprises providing the liquid to the irrigation port, and aspiration through the second passageway comprises providing suction to the aspiration port. 
     
     
         19 . The method of  claim 1 , wherein the first passageway has a dimension less than a diameter of the object and the second passageway has a circular cross-section having a diameter greater than the diameter of the object. 
     
     
         20 . A method for removing an object from a kidney, comprising:
 inserting a sheath into an in vivo passageway of a subject;   inserting a device through the sheath;   positioning a distal end of the device within the kidney adjacent to the object;   using the device to break the object into a plurality of smaller objects;   removing the device;   guiding, subsequent to removal of the device, a flexible tube having an external diameter of at least about 11 French through the sheath,
 wherein the flexible tube comprises at least a first passageway and a second passageway encompassed by the first passageway, wherein the second passageway is positioned concentrically within the first passageway, the first passageway forming an annular lumen surrounding the second passageway; 
   positioning a distal end of the second passageway adjacent to at least one of the plurality of smaller objects;   infusing saline solution through the first passageway without suction being applied through the second passageway;   ceasing infusion of the saline solution;   applying suction through the second passageway; and   aspirating at least one of the plurality of smaller objects through the second passageway with at least a portion of the saline solution.   
     
     
         21 . The method of  claim 20 , wherein the device is a ureteroscope. 
     
     
         22 . The method of  claim 20 , comprising after aspirating at least one of the plurality of smaller objects:
 removing the flexible tube from the sheath;   re-inserting the device through the sheath; and   using the device to visualize whether all of the plurality of smaller objects have been removed from the kidney.