OBJECT REMOVAL THROUGH A PERCUTANEOUS SUCTION TUBE

• US 20170119413A1
• Filed: 10/31/2016
• Published: 05/04/2017
• Est. Priority Date: 10/30/2015
• Status: Active Grant

• Current Assignee: Auris Health, Inc. (Johnson & Johnson)
• Original Assignee: Auris Surgical Robotics, Inc. (Johnson & Johnson)
• Inventors: Romo, Enrique
• Granted Patent: US 10,231,793 B2
• Time in Patent Office: Days
• CPC Class Codes: A61B 1/00045 Display arrangement
• CPC Class Codes: A61B 1/00096 Optical elements
• CPC Class Codes: A61B 1/00135 Oversleeves mounted on the endoscope prior to insertion
• CPC Class Codes: A61B 1/00149 using articulated arms
• CPC Class Codes: A61B 1/0016 using motor drive units
• CPC Class Codes: A61B 1/00165 with light-conductive means, e.g. fibre optics A61B1/07 takes precedence
• CPC Class Codes: A61B 1/0051 with controlled bending of insertion part
• CPC Class Codes: A61B 1/015 Control of fluid supply or evacuation
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 1/05 characterised by the image sensor, e.g. camera, being in the distal end portion
• CPC Class Codes: A61B 1/0676 at distal tip of an endoscope
• CPC Class Codes: A61B 1/307 for the urinary organs, e.g. urethroscopes, cystoscopes
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/221 Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions surgical snare instruments A61B17/32056
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 17/32037 for removing obstructions from inner organs or blood vessels, e.g. for atherectomy
• CPC Class Codes: A61B 17/320758 with a rotating cutting instrument, e.g. motor driven A61B17/320725, A61B17/32075 and A61B17/320783 take precedence; for removing intra-ocular material A61F9/00763; endoscopic rotatable cutting instruments A61B17/32002
• CPC Class Codes: A61B 18/26 for producing a shock wave, e.g. laser lithotripsy
• CPC Class Codes: A61B 2017/00296 mounted on an endoscope
• CPC Class Codes: A61B 2017/00867 shape memory effect
• CPC Class Codes: A61B 2017/00991 : Telescopic means
• CPC Class Codes: A61B 2017/2212 : having a closed distal end, e.g. a loop
• CPC Class Codes: A61B 2017/2215 : having an open distal end
• CPC Class Codes: A61B 2017/320008 : Scrapers
• CPC Class Codes: A61B 2018/00511 : Kidney
• CPC Class Codes: A61B 2018/00517 : Urinary bladder or urethra
• CPC Class Codes: A61B 2034/102 : Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/105 : Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/107 : Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2051 : Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2065 : Tracking using image or pattern recognition
• CPC Class Codes: A61B 2034/254 : being adapted depending on the stage of the surgical procedure
• CPC Class Codes: A61B 2034/301 : for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
• CPC Class Codes: A61B 2034/302 : specifically adapted for manipulations within body cavities, e.g. within abdominal or thoracic cavities
• CPC Class Codes: A61B 2034/742 : Joysticks
• CPC Class Codes: A61B 2090/3614 : using optical fibre
• CPC Class Codes: A61B 2090/376 : using X-rays, e.g. fluoroscopy
• CPC Class Codes: A61B 2217/005 : with suction drainage system
• CPC Class Codes: A61B 2217/007 : with irrigation system
• CPC Class Codes: A61B 34/20 : Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 34/25 : User interfaces for surgical systems
• CPC Class Codes: A61B 34/30 : Surgical robots
• CPC Class Codes: A61B 34/71 : Manipulators operated by drive cable mechanisms
• CPC Class Codes: A61B 34/74 : Manipulators with manual electric input means
• CPC Class Codes: A61B 6/12 : Arrangements for detecting or locating foreign bodies
• CPC Class Codes: A61B 90/50 : Supports for surgical instruments, e.g. articulated arms

Abstract

A method is described for using percutaneous access to a patient to remove an object from a cavity within the patient. The method includes inserting a suction tube into a port created by a percutaneous cut. An endoscope is also advanced into the cavity, however the endoscope passes through a patient lumen rather than through the port. Using a working channel within the endoscope, fluid is irrigated through the cavity. Additionally, a negative pressure is applied to the suction tube, such that the combination of fluid irrigation and negative pressure assist in removing the object from the cavity through the suction tube.

Claims

1. A method for removing an object from a patient, comprising:

inserting a suction tube into a port into a cavity created by a percutaneous cut;

advancing an endoscope into the cavity through a patient lumen other than the port, the endoscope comprising a working channel;

irrigating the patient cavity with a fluid, where the fluid passes within the working channel of the endoscope; and

applying negative pressure to the suction tube, the combination of the fluid irrigation and the negative pressure assisting in causing the object to be removed from the cavity through the suction tube.

2. The method of claim 1, further comprising:

directing a surgical tool into the patient cavity through the port; and

manipulating the surgical tool to assist in removing the object through the suction tube.

3. The method of claim 2, wherein the surgical tool is inserted within the suction tube.

4. The method of claim 2, wherein the surgical tool is a laser or optical fiber, and manipulating the surgical tool to assist in removing the object through the suction tube comprises:

performing lithotripsy on the object to break it apart.

5. The method of claim 2, wherein the surgical tool is a chisel or drill, and manipulating the surgical tool to assist in removing the object through the suction tube comprises:

respectively, chiseling or drilling the object to break it apart.

6. The method of claim 2, wherein the surgical tool is an ultrasound device, and manipulating the surgical tool to assist in removing the object through the suction tube comprises:

activating the ultrasound device to break apart the object with sound waves.

7. The method of claim 2,

wherein a surgical tool configured to assist in removing the object through the suction tube is integrated into the suction tube.

8. The method of claim 7, wherein the surgical tool is a laser or optical fiber, and manipulating the surgical tool to assist in removing the object through the suction tube comprises:

performing lithotripsy on the object to break it apart.

9. The method of claim 7, wherein the surgical tool is a chisel or drill, and manipulating the surgical tool to assist in removing the object through the suction tube comprises:

respectively, chiseling or drilling the object to break it apart.

10. The method of claim 7, wherein the surgical tool is an ultrasound device, and manipulating the surgical tool to assist in removing the object through the suction tube comprises:

activating the ultrasound device to break apart the object with sound waves.

11. The method of claim 1, further comprising:

inserting a surgical tool through the working channel of the endoscope into the patient cavity; and

manipulating the surgical tool to assist in removing the object through the suction tube.

12. The method of claim 11, further comprising:

wherein the fluid passes on the outside of the surgical tool within the working channel of the endoscope.

13. The method of claim 11, further comprising:

wherein the surgical tool is a basket apparatus comprising an outer support shaft and a plurality of peripheral channels threaded with pull wires.

14. The method of claim 11, wherein the surgical tool is at least one from the group consisting of a laser or optical fiber, an ultrasound device, a chisel, a drill, and a grasper.

15. The method of claim 11, further comprising:

wherein the surgical tool comprises a tool working channel; and

wherein the fluid passes within the tool working channel of the surgical tool.

16. The method of claim 11, further comprising:

wherein the surgical tool is a basket apparatus comprising a working channel;

the method further comprising inserting a second surgical tool within the working channel of the basket apparatus to assist in removing the object from the cavity through the suction tube.

17. The method of claim 16, wherein the second surgical tool is at least one from the group consisting of a laser or optical fiber, an ultrasound device, a chisel, and a drill.

18. The method of claim 11, wherein the surgical tool is a basket apparatus, and manipulating the surgical tool to assist in removing the object through the suction tube comprises:

capturing the object within a basket of the basket apparatus and positioning the stone proximate to the suction tube.

19. The method of claim 11, wherein the surgical tool is a laser or optical fiber, and manipulating the surgical tool to assist in removing the object through the suction tube comprises:

performing lithotripsy on the object to break it apart.

20. The method of claim 11, wherein the surgical tool is a chisel or drill, and manipulating the surgical tool to assist in removing the object through the suction tube comprises:

respectively, chiseling or drilling the object to break it apart.

21. The method of claim 11, wherein the surgical tool is an ultrasound device, and manipulating the surgical tool to assist in removing the object through the suction tube comprises:

activating the ultrasound device to break apart the object with sound waves.

22. The method of claim 1, the method further comprising:

extending a leaderscope disposed within the working channel of the endoscope beyond the distal tip of the endoscope;

inserting a surgical tool down a working channel within the leaderscope into the patient cavity; and

manipulating the surgical tool to assist in removing the object through the suction tube.

23. The method of claim 22, wherein the surgical tool is at least one of a laser or optical fiber, an ultrasound device, a chisel, a drill, and a grasper.

24. The method of claim 22, further comprising:

wherein the fluid passes on the outside of the leaderscope within the working channel of the endoscope.

25. The method of claim 22, wherein the surgical tool is a laser or optical fiber, and manipulating the surgical tool to assist in removing the object through the suction tube comprises:

performing lithotripsy on the object to break it apart.

26. The method of claim 22, wherein the surgical tool is a chisel or drill, and manipulating the surgical tool to assist in removing the object through the suction tube comprises:

respectively, chiseling or drilling the object to break it apart.

27. The method of claim 22, wherein the surgical tool is an ultrasound device, and manipulating the surgical tool to assist in removing the object through the suction tube comprises:

activating the ultrasound device to break apart the object with sound waves.

28. The method of claim 1

wherein the step of inserting the suction tube into the port is performed by a first robotic arm;

and

wherein the step of advancing the endoscope through cavity is performed by a second robotic arm.

29. The method of claim 1

wherein the endoscope comprises of a sheath and leaderscope, and

wherein the step of advancing the endoscope through cavity is performed by a first robotic arm advancing the sheath and a second robotic arm advancing the leaderscope.

30. The method of claim 1 wherein the object is at least one from the group consisting of:

a kidney stone or a bladder stone, a stone formed from at least one of calcium, magnesium, ammonia, uric acid, and cysteine.