DIRECTED FLUIDICS

• US 20190175799A1
• Filed: 12/06/2018
• Published: 06/13/2019
• Est. Priority Date: 12/08/2017
• Status: Active Grant

• Current Assignee: Auris Health, Inc. (Johnson & Johnson)
• Original Assignee: Auris Health, Inc. (Johnson & Johnson)
• Inventors: Hsu, Jason Joseph, Wong, Ka Chun, Chok, Rachel Leigh, DeFonzo, Joshua F., Nguyen, Binh T., Nguyen, Vivian Thalia, Purohit, Rishi Nikhil, Urban, JR., Joseph A.
• Granted Patent: US 10,850,013 B2
• Time in Patent Office: Days
• CPC Class Codes: A61B 1/00149 using articulated arms
• CPC Class Codes: A61B 1/015 Control of fluid supply or evacuation
• CPC Class Codes: A61B 1/2676 Bronchoscopes
• CPC Class Codes: A61B 1/307 for the urinary organs, e.g. urethroscopes, cystoscopes
• CPC Class Codes: A61B 10/0283 with vacuum aspiration, e.g. caused by retractable plunger or by connected syringe A61B10/025, A61B10/0266 take precedence
• CPC Class Codes: A61B 17/22012 in direct contact with, or very close to, the obstruction or concrement for removing obstructions in blood vessels by laser A61B18/245
• CPC Class Codes: A61B 17/2202 the ultrasound transducer being inside patient's body at the distal end of the catheter
• CPC Class Codes: A61B 17/22031 Gripping instruments, e.g. forceps, for removing or smashing calculi A61B17/221 takes 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 17/34 Trocars; Puncturing needles pointed biopsy instruments A61B10/0233; devices for piercing the ear-lobes A44C7/001; seals or hemostasis valves A61M39/06
• CPC Class Codes: A61B 18/26 for producing a shock wave, e.g. laser lithotripsy
• CPC Class Codes: A61B 2017/00199 with a console, e.g. a control panel with a display
• CPC Class Codes: A61B 2017/00323 Cables or rods
• CPC Class Codes: A61B 2017/22035 for retrieving or repositioning foreign objects
• CPC Class Codes: A61B 2017/22079 with suction of debris
• CPC Class Codes: A61B 2017/306 holding by means of suction
• 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 2217/005 with suction drainage system
• CPC Class Codes: A61B 2217/007 with irrigation system
• CPC Class Codes: A61B 2218/002 Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61B 46/10 : specially adapted for instruments, e.g. microscopes
• CPC Class Codes: A61B 50/13 : Trolleys, e.g. carts
• CPC Class Codes: A61M 1/74 : Suction control underwater drainage A61M1/61
• CPC Class Codes: A61M 1/77 : Suction-irrigation systems aspiration tips supplying fluids A61M1/85; specific for negative pressure wound therapy A61M1/92; combined with tracheal tubes A61M16/0463
• CPC Class Codes: A61M 1/772 : operating alternately
• CPC Class Codes: A61M 16/0463 : combined with suction tubes, catheters or the like; Outside connections
• CPC Class Codes: A61M 2205/058 : with ultrasound therapy
• CPC Class Codes: A61M 2205/18 : with alarm
• CPC Class Codes: A61M 2205/3317 : Electromagnetic, inductive or dielectric measuring means
• CPC Class Codes: A61M 2205/3331 : Pressure; Flow
• CPC Class Codes: A61M 2205/3334 : Measuring or controlling the flow rate
• CPC Class Codes: A61M 2205/3344 : Measuring or controlling pressure at the body treatment site
• CPC Class Codes: A61M 2205/3553 : remote, e.g. between patient's home and doctor's office
• CPC Class Codes: A61M 2205/3561 : local, e.g. within room or hospital
• CPC Class Codes: A61M 2205/502 : User interfaces, e.g. screens or keyboards
• CPC Class Codes: A61M 2205/52 : with memories providing a history of measured variating parameters of apparatus or patient
• CPC Class Codes: A61M 2205/587 : Lighting arrangements
• CPC Class Codes: A61M 2210/1035 : Bronchi
• CPC Class Codes: A61M 2230/06 : Heartbeat rate only
• CPC Class Codes: A61M 2230/42 : Rate
• CPC Class Codes: A61M 3/0202 : with electronic control means or interfaces
• CPC Class Codes: A61M 3/022 : Volume; Flow rate
• CPC Class Codes: A61M 3/0258 : by means of electric pumps
• CPC Class Codes: A61M 3/0283 : with at least two inner passageways, a first one for irrigating and a second for evacuating suction-irrigation systems A61M1/77; aspiration tips with fluid supply means A61M1/85; for negative pressure wound therapy A61M1/92

Abstract

Methods and systems for administering directed fluidics during a medical procedure for removing an object are disclosed. A method includes inserting first and second medical instruments into a treatment site, providing irrigation and aspiration of the treatment site through the first and second medical instruments, determining a characteristic of one of the irrigation and the aspiration, and selecting a characteristic of the other of the irrigation and aspiration based on the determined characteristic.

Claims

1. A method of administering fluidics during a medical procedure, the method comprising:

inserting a first medical instrument into a treatment site, the first medical instrument comprising a first fluid channel and a second fluid channel;

providing irrigation into the treatment site through the first fluid channel of the first medical instrument;

providing aspiration from the treatment site through the second fluid channel of the first medical instrument;

determining a characteristic of one of the irrigation and the aspiration; and

selecting a characteristic of the other of the irrigation and aspiration based on the determined characteristic.

2. The method of claim 1, wherein inserting the first medical instrument into the treatment site comprises advancing the first medical instrument percutaneously into the treatment site.

3. The method of claim 1, wherein inserting the first medical instrument into the treatment site comprises advancing the first medical instrument through a lumen of a patient into the treatment site.

4. The method of claim 2, further comprising inserting a second medical instrument into the treatment site through a lumen of the patient.

5. The method of claim 1, wherein the determined characteristic comprises at least one of an instantaneous flow rate and an average flow rate over a period of time.

6. The method of claim 1, wherein the selected characteristic comprises at least one of an instantaneous flow rate and an average flow rate over a period of time.

7. The method of claim 1, wherein the selected characteristic substantially matches the determined characteristic.

8. The method of claim 1, further comprising:

determining a characteristic of the treatment site; and

when the determined characteristic of the treatment site exceeds a threshold value, at least one of;

reducing irrigation into the treatment site,

increasing aspiration from the treatment site, and

providing an alert.

9. The method of claim 1, wherein the determined characteristic of the treatment site comprises one of a volume of fluid within the treatment site and an internal pressure of the treatment site.

10. The method of claim 4, wherein at least one of the first medical instrument and the second medical instrument is robotically controlled.

11. The method of claim 1, further comprising:

performing lithotripsy on an object within the treatment site to break the object into fragments; and

aspirating the fragments through the second fluid channel of the first medical instrument.

12. The method of claim 11, wherein lithotripsy is performed with a second medical instrument.

13. The method of claim 1, further comprising:

contacting an articulable distal end of the first medical instrument to an object within the treatment site; and

providing aspiration through the second fluid channel to hold the object to the articulable distal end.

14. The method of claim 13, wherein the articulable distal end comprises a pocket configured to hold the object.

15. The method of claim 14, further comprising performing lithotripsy while the object is held in the pocket.

16. The method of claim 13, further comprising moving the first medical instrument to reposition the object within the treatment site.

17. A system for performing a medical procedure, the system comprising:

a first medical instrument configured to be inserted into a treatment site, the first instrument including a first fluid channel and a second fluid channel;

a vacuum connected to one of the first fluid channel and the second fluid channel and configured to apply a negative pressure to provide aspiration from the treatment site;

a pump coupled to an irrigation source and the other of the first fluid channel and the second fluid channel, the pump configured to provide irrigation to the treatment site; and

a fluidics control system coupled to the vacuum and the pump, the fluidics control system comprising one or more processors configured to;

determine a characteristic of one of the irrigation and the aspiration; and

control a characteristic of at least one of the pump or the vacuum based on the determined characteristic.

18. The system of claim 17, further comprising a second medical instrument that is configured to be inserted percutaneously into the treatment site.

19. The system of claim 17, wherein the first medical instrument further comprises a flow rate sensor positioned in the first fluid channel, and wherein an output of the flow rate sensor is connected to the fluidics control system.

20. The system of claim 17, wherein the first medical instrument further comprises a pressure sensor disposed to measure an internal pressure of the treatment site, an output of the pressure sensor connected to the fluidics control system, and wherein the one or more processors are further configured to control at least one of the pump or the vacuum to adjust at least one of the aspiration and the irrigation based on the measured internal pressure of the treatment site.

21. The system of claim 17, wherein the first medical instrument comprises an articulable distal end.

22. A medical device comprising:

an articulable elongate body extending along an axis to a distal end;

a first fluid channel extending along the axis, the first fluid channel terminating in a first fluid orifice formed in a distal face of the distal end; and

at least one additional fluid channel formed through the elongate body, the at least one additional fluid channel terminating in at least one additional fluid exit orifice formed in a radial surface of the elongate body proximal the distal end.

23. The medical device of claim 22, further comprising a pocket formed in the distal face.

24. The medical device of claim 22, wherein the pocket is configured to at least partially receive an object to be removed during a medical procedure.

25. The medical device of claim 22, wherein the at least one additional channel annularly surrounds the first fluid channel.

26. The medical device of claim 22, wherein the at least one additional fluid orifice comprises additional fluid orifices positioned around the axis.

27. The medical device of claim 22, wherein the at least one additional channel comprises additional channels positioned radially around the first fluid channel.

28. The medical device of claim 22, wherein each of the four additional fluid channels terminates at an additional fluid orifice positioned radially around the axis.

29. The medical device of claim 22, further comprising at least one pull wire for articulating the elongate body.

30. A non-transitory computer readable storage medium having stored thereon instructions that, when executed, cause a processor of a device to at least:

determine a characteristic of at least one of irrigation into a treatment site through a first channel of a first medical instrument and an aspiration from the treatment site through a second channel of the first medical instrument; and

select a characteristic of at least one of the irrigation and the aspiration based on the determined characteristic.