Method for retrieval of retained common bile duct stones

• US 5,374,273 A
• Filed: 10/05/1992
• Issued: 12/20/1994
• Est. Priority Date: 10/05/1992
• Status: Expired due to Term

• Current Assignee: Granit Medical Innovations LLC
• Original Assignee: Naomi L. Nakao, Peter J. Wilk
• Inventors: Wilk, Peter J., Nakao, Naomi L.
• Primary Examiner(s): Graysay, Tamara L.
• Application Number:
  US07/957,416
• Time in Patent Office: 806 Days
• Field of Search: 606/113, 606/114, 606/127, 606/47, 606/41, 128/898, 43/7, 43/11
• US Class Current: 606/127
• 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 2018/00535 Biliary tract

Abstract

A method for the removal of retained common bile duct stones includes the steps of introducing a distal end of a flexible tubular member into the common bile duct and ejecting from the distal end of the tubular member a loop to which a flexible web is attached to form a capture pocket. The loop and the pocket are expanded from a collapsed configuration upon ejection of the loop from the distal end of the tubular member. The loop and the pocket are moved through the common bile duct to capture a retained stone in the pocket. Subsequently, the loop and the pocket are at least partially closed by drawing the loop and the pocket in a proximal direction into the distal end of the tubular member, thereby enclosing the captured stone in the pocket. The tubular member and the contracted loop and pocket are withdrawn from the common bile duct, thereby removing the captured stone from the common bile duct. The loop may be bent to form a right angle in an unstressed opened configuration, while the capture pocket may be formed with a trap door or flap for preventing the loss of stones once they are caught in the capture pocket.

Claims

1. A method for the removal of retained common bile duct stones, comprising the steps of:

introducing a distal end of a flexible tubular member into the common bile duct;

ejecting from said distal end a loop to which a flexible web is attached to form a capture pocket;

upon ejection of said loop from said distal end, expanding said loop and said pocket from a collapsed configuration;

moving said loop and said pocket through said common bile duct to capture a retained stone in said pocket;

at least partially closing said loop and said pocket by drawing said loop and said pocket in a proximal direction into said distal end of said tubular member, thereby enclosing the captured stone in said pocket; and

withdrawing said tubular member and the contracted loop and pocket from the common bile duct, thereby removing the captured stone from the common bile duct,

said step of introducing including the steps of (i) inserting an endoscope through the stomach and into the upper intestinal tract, (ii) ejecting said tubular member from a biopsy channel in said endoscope, and (iii) inserting said distal end of said tubular member through the Ampulla of Vater into the common bile duct.

2. The method defined in claim 1, further comprising the steps of (a) injecting a radio-opaque fluid into the common bile duct through said tubular member upon insertion of said distal end into the common bile duct, and (b) using an X-ray machine to visually inspect the common bile duct for the locations of stones therein prior to and during said step of moving.

3. The method defined in claim 2 wherein said tubular member is provided with a longitudinally extending elongate window at said distal end and a cauterization wire fastened to said distal end, additionally comprising the steps of (c) exerting tension on said wire upon an ejection of said tubular member from said biopsy channel, thereby bending said tubular member at said distal end to expose a section of said wire through said window, (d) manipulating said tubular member to bring the exposed section of said wire into contact with the Ampulla of Vater, and (e) energizing said wire to cauterize organic tissues during said step of manipulating, thereby enlarging an opening into the common bile duct.

4. The method defined in claim 1, further comprising the steps of (a) ejecting a daughter scope from said biopsy channel, (b) inserting a distal end of said daughter scope through the Ampulla of Vater into the common bile duct, and (c) using said daughter scope to inspect the common bile duct for retained stones, said tubular member being ejected from said daughter scope into the common bile duct.

5. A method for the removal of retained stone from a common bile duct of a patient, comprising the steps of:

providing a flexible tubular member, said tubular member being provided at a distal end with a longitudinally extending elongate window and a cauterization wire fastened to said distal end;

introducing said distal end of said flexible tubular member into the patient;

upon introduction of said distal end of said tubular member into the patient, exerting tension on said wire to bend said tubular member at said distal end to expose a section of said wire through said window;

manipulating said tubular member to bring the exposed section of said wire into contact with an Ampulla of Vater of the patient;

energizing said wire to cauterize organic tissues of the Ampulla of Vater during said step of manipulating, thereby enlarging an opening through the Ampulla of Vater into a common bile duct of the patient;

inserting said distal end of said tubular member through the opening and into the common bile duct;

upon introduction of said distal end of said tubular member into the common bile duct, ejecting from said distal end a capture device;

upon ejection of said capture device from said distal end, expanding said capture device from a collapsed configuration;

moving said capture device through the common bile duct to capture a retained stone in said capture device;

at least partially closing said capture device by drawing said capture device in a proximal direction into said distal end of said tubular member, thereby enclosing the captured stone in said capture device; and

withdrawing said tubular member and the contracted capture device from the common bile duct, thereby removing the captured stone from the common bile duct of the patient.

6. A method for the removal of a retained stone from a common bile duct of a patient, comprising the steps of:

providing a first endoscope with a biopsy channel;

inserting a second endoscope into said biopsy channel;

introducing a distal end of said first endoscope into a patient;

using said first endoscope to visually inspect internal tissues of the patient;

upon visually detecting an opening through an Ampulla of Vater into a common bile duct of the patient, ejecting said second endoscope from said biopsy channel;

upon ejecting of said second endoscope from said biopsy channel, moving said second endoscope in a distal direction and through said opening into the common bile duct;

using said second endoscope to internally inspect the the common bile duct;

upon detecting a retained stone inside the common bile duct with said second endoscope, ejecting, from said second endoscope, a loop to which a flexible web is attached to form a capture pocket;

upon ejection of said loop from said distal end, expanding said loop and said pocket from a collapsed configuration;

moving said loop and said pocket through the common bile duct to capture the retained stone in said pocket;

at least partially closing said loop and said pocket by drawing said loop and said pocket in a proximal direction towards said second endoscope, thereby enclosing the captured stone in said pocket; and

withdrawing said second endocope and the contracted loop and pocket from the common bile duct, thereby removing the captured stone from the common bile duct of the patient.

7. A method for the removal of a retained stone from a common bile duct of a patient, comprising the steps of:

connecting a tubular prosthesis to a common bile duct of the patient so that said tubular prosthesis communicates with the the common bile duct, said tubular prosthesis including a tubular T-bar at an inner end, said step of connecting including the step of disposing said T-bar inside the common bile duct;

introducing a distal end of a flexible tubular member into the common bile duct through said tubular prosthesis and into said common bile duct;

upon introduction of said distal end of said tubular member into the common bile duct, ejecting from said distal end a capture device;

upon ejection of said capture device from said distal end, expanding said capture device from a collapsed configuration;

moving said capture device through common bile duct to capture a retained stone in said capture device;

at least partially closing said capture device by drawing said capture device in a proximal direction into said distal end of said tubular member, thereby enclosing the captured stone in said capture device; and

withdrawing said tubular member and the contracted capture device from the common bile duct through said tubular prosthesis, thereby removing the captured stone from the common bile duct.

8. A method for the removal of retained common bile duct stones, comprising the steps of:

introducing a distal end of a flexible tubular member into the common bile duct;

ejecting from said distal end a loop to which a flexible web is attached to form a capture pocket;

upon ejection of said loop from said distal end, expanding said loop and said pocket from a collapsed configuration;

moving said loop and said pocket through said common bile duct to capture a retained stone in said pocket;

at least partially closing said loop and said pocket by drawing said loop and said pocket in a proximal direction into said distal end of said tubular member, thereby enclosing the captured stone in said pocket; and

withdrawing said tubular member and the contracted loop and pocket from the common bile duct, thereby removing the captured stone from the common bile duct,

said step of introducing including the steps of (i) connecting a tubular prosthesis to said common bile duct so that said tubular prosthesis communicates with the common bile duct and (ii) inserting said distal end of said tubular member through said tubular prosthesis and into said common bile duct.

9. The method defined in claim 8 wherein said tubular prosthesis includes a tubular T-bar at an inner end, said step of connecting including the step of disposing said T-bar inside the common bile duct.

10. A method for the removal of retained common bile duct stones, comprising the steps of:

introducing a distal end of a flexible tubular member into the common bile duct;

ejecting from said distal end a loop to which a flexible web is attached to form a capture pocket;

upon ejection of said loop from said distal end, expanding said loop and said pocket from a collapsed configuration;

moving said loop and said pocket through said common bile duct to capture a retained stone in said pocket;

at least partially closing said loop and said pocket by drawing said loop and said pocket in a proximal direction into said distal end of said tubular member, thereby enclosing the captured stone in said pocket; and

withdrawing said tubular member and the contracted loop and pocket from the common bile duct, thereby removing the captured stone from the common bile duct,

said step of expanding including the step of opening said loop to a configuration having a bend so that the expanded loop lies in two planes oriented at an angle with respect to one another.

11. The method defined in claim 10 wherein said step of moving includes the step of pushing the expanded loop in a direction away from said distal end and towards the retained common bile duct stone.

12. A method for the removal of retained common bile duct stones, comprising the steps of:

introducing a distal end of a flexible tubular member into the common bile duct;

ejecting from said distal end a loop to which a flexible web is attached to form a capture pocket;

upon ejection of said loop from said distal end, expanding said loop and said pocket from a collapsed configuration;

moving said loop and said pocket through said common bile duct to capture a retained stone in said pocket;

at least partially closing said loop and said pocket by drawing said loop and said pocket in a proximal direction into said distal end of said tubular member, thereby enclosing the captured stone in said pocket; and

withdrawing said tubular member and the contracted loop and pocket from the common bile duct, thereby removing the captured stone from the common bile duct,

said pocket being formed with a trap door, further comprising the steps of closing said trap door upon capture of the stone in said pocket and moving said loop to capture another retained common bile duct stone in said pocket.