Note: Descriptions are shown in the official language in which they were submitted.
This invention relates to an extracting device for remov-
ing kidney stones or other objects from the urinary tract or
other passages of the human body, some of which,such as blood
vessels, may be reached through incisions.
One objec-t of the present invention is to provide a new
and improved extracting device which can easily be inserted
into the ureters or other narrow passages of the human body,
and will be capable of removing kidney stones and other objects
in a highly effective and efficient manner.
A further object is to provide such a new and improved
extracting device which will be capable of removing kidney
stones and other similar objects from narrow passages of the
human body, without scratching or otherwise injuring the walls
of the passages.
To accomplish these objects, the present invention prefer-
- ably provides an extracting device for insertion into a human
body passage for removing foreign ob-jects therefrom~ said
- device comprising an outer flexible tube the distal end of
which is insertable into a body passage, an inner flexible tube
having a greater length than and slideabl~ received within said
outer tube for free longitudinal sliding movement with the
distal end of said inner tube normally projecting beyond the
distal end of said outer tube, said inner and outer tubes
having clearance space threbetween for carrying fluid under
pressure, a thin tubular highly distendable and limp sleeve
having a proximal portion connected at its terminal end to said
distal end of said outer tube, said sleeve having a distal
portion which is inverted and is connected at its terminal end
to the distal end of said inner tube, said sleeve being other-
wise free to expand upon inflation, said tubular sleeve havingfirst and second tubular surfaces on opposite sides of said
sleeve, said first surface facing inwardly at said proximal
~,
. - 1- ~ ,
portion of said sleeve, said inverted distal portion of said
sleeve being turned inside out with said second surface facing
inwardly, said sleeve being insertable with said tubes into the
body passage, said sleeve being inflatable by fluid transmitted
along said ~learance space to dilate the body passage, said
sleeve when inflated having an annular flaring portion bulging
beyond the distal end of said inner tube and curved convexly in
longitudinal section for sealing engagement with a foreiyn
object in the body passage, said annular flaring curved portion
being soft, pliable and capable of conforming to the shape of
the foreign object to effect a seal therewith, said inner tube
being operative to transmit suction for capturing and holding
the foreign object in sealing engagement with said annular
flaring portion of said sleeve, and means for retracting said
inner tube relative to said outer tube while the suction holds ~ ~`
the foreign object in engagement with said sleeve and said
sleeve is progressively turned inside out around the foreign
object to envelop the foreign object for removal with said tubes.
,
A pressure source and a control valve are preferably con~
nected ~o the pro~imal end of the clearance space, ~or select-
ively supplying ~luid pressure thereto so as to inflate the
sleeve. A vacuum source and a vacuum control valve are preferably
connected to the proximal end o~ the inner tube, for select-
ively providing a vacuum or suction within the inner tube to
suck the foreign object against the end of the inflated sleeve,
so as to capture the object. The inner tube is then retracted
relative to the outer tube, so that the object will be pulled
into the confines of the sleeve. Simultaneously, the sleeve
is preferably deflated so that the sleeve will enfold the
object. The outer and inner tubes may then be withdrawn from
the body passage, so as to remove the object. The sleeve sur-
rounds the object and prevents it from scratching or otherwise
- 2 -
injuring the inner walls of the bocly passage.
The flexible inner and outer tubes are preferably made
of a resinous plastic material, such as polyethylene, for
example. An X-ray contrast medium is preferably incorporated
into or coated upon the material of the outer or inner tube,
or a flexible metal wire may be inserted into the inner tube,
so that an X-ray fluoroscope may be used to assist in inserting
the outer tube into the ureter or other body passage. A fiber
optic device can also be used for observing and guiding the
probe during insertion.
;
The inflatable sleeve is preferably made of a thin
elastic latex rubber material or the like.
A manipulator is preferably connected to the free ends
of the outer and inner tubes, 50 that the operator can easily
advance and retract the inner tube, relative to the outer tube,
with the thumb and fingers of one hand.
One or more auxiliary tubes may be inserted through the
inner tube to provide auxiliary communication with the body
~; passage, to supply various medications, or to withdraw mucus
or other fluids. An auxiliary tube having a plurali-ty of tube
elements or bores may be employed if desired. Alternately, one
or more auxiliary tubes may be inserted into the body passage
along with the outer tube.
While the extracting device is particularly well adapted
for removing kidney stones from the urinary tract, the extract-
ing device may also be employed for removing gallstones, by
inserting the extracting device through a drainage tube which
has been installed during gallbladder surgery. The extracting
device may also be employed to remove foreign objects from the
respiratory tract or the esophagus, or to remove blood clots or
foreign materials from blood vessels, by inserting the extract-
ing device through an incision into the blood vessel.
- 3 -
Furthex objects, advantages and features of the present
invention will appear from the following description, taken with
the accompanying drawings, in which:
Fig. 1 i5 ~ n elevational view o~ an extracting device to
~; be described as an illustrative embodiment o~ the present invention,
the view being partly in lcngitudinal section. J
Fig. ~ is a fragmentary longitudinal section o~ the extract-
ing device, showing the in~latable sleeve in a changed position.
Fig. 3 is a fragmentary elevation of the manipulator for
10 the extracting device, the view being taken generally as indicated
by the line 3-3 in Fig. 1.
Fig. 4 is a fragmentary perspective view showing the inflat-
able sleeve on the insertable end o~ the extracting device.
Fig. 5 is a fragmentary perspective view, showing the
manipulator for the extracting device.
Fig. 6(a) is a fragmentary enlarged longitudinal section
of the extracting device, the view being partly diagrammatic.
~. ~
Fig. 6(b) is a ~ragmentary section corresponding to a portion
o~ Fig. 6(a) and showing a modified construction.
20 Fig. 6(c) is a fragmentary section corresponding to a portion
of Fig. 6(a) and showing a modi~ied construction with a sliding seal
used with a snare, wire or one or more auxiliary tubes, to permit full
use o~ the device with the snare, wire or one or more au~iliary tubes
in place.
- Figs. 7(a)-(g) are a series of fragmentary sections showing
successive steps in a procedure whereby the extracting device may be
used to capture and enfold a kidney stone or some other object in a
human body passage.
Figs. 8(a)-(e) are a series of fragmentary sections
showing successive steps in a procedure for advancing the insert-
able portion of the extracting device throuyh a narrow body passage.
Fig. 9(a) i5 a fragmentary section showing the insertable
portion of the extracting device, as employed in conjunction with
an auxiliary tube adapted to be inserted lnto the hody passage
along with the extracting device.
Fig. 9(b) is a view similar to Fig. 9(a), but showing
the extracting device in conjunction with two auxiliary tubes.
Fig. 9(c) is a view similar to E'ig. 9(a), but showing
the extracting device in conjunction with an auxiliary tube having
three tube elements affording three individual passages.
Figs. lO(a)-(f~ are a series of diagramatic sections
showing several alternative constructions o~ the inflatable sleeve~
Figs. ll(a)-(f) are ragmentary longitudinal sections
; showing the insertable portion of the extracting device in con-
junction with a snare to assist in capturing a kidney stone or
other object, the views showing successive steps of a procedure
for capturing and enfolding the obje~t~
Fig. 12 is an enlarged fragmentary section showing the
insertable portion of the extracting device in conjunction with a
stiffening wire or auxiliary tube, inserted through the inner tube
of the extracting device.
Fig. 13 is a fragmentary enlarged longitudinal section
showing the extracting device in conjunction with a plurality of
auxiliary tubes, inserted through the inner tube o~ the extracting
device.
Fig. 14(a) is a fragmentary enlarged section of the
insertable portion of the extracting device in conjunction with
an auxiliary ~uhe havirlg a plurality of tube elements to afford
a plurality of individual ~assages, the tube ~eing inserted through
the inner tube of the extracting device.
Fig. ]4(b) is a fxagmentary cross section of the auxiliary
tube shown in Fig. 14(a).
As ~ust indi~ated, Figs. 1 6 illustrate an extracting
device 20 comprisin~ an outer flexible tu~e or sheath 22 capable
of being inserted into a narrow passage of the human body, suc~ â S
~ one of the ureters. The outer tube 22 is sufficiently long to be
; 10 inserted through the urethra and the bladder in~o one o~ the uretexs~
and along such ureter as far as possible toward the corresponding
kidney. The diameter of the outer tube 22 is such as to fit snug:y
~ but comfsrtably into one of the ureters~ The inflatable sleeve 2
;~ can be made in various sizes to accommodate various size~ objects
~;~ to be removed. The inner tube 24 and the outer tube 22 can be
sized accordingly. ~he outer tube 22 may be made of a resinous
plastic material, such as polyethylene, for example. The tu~e 22
is sufficiently flexible to conform to the shape o~ the body
passage, while being su-fficiently stiff to provide for insertion
20 o~ ~he tube ~ithout causing it to collapse.
The outer tube 22 may be inserted into one o~ the ureters
with the aid of an auxiliary device such a~ a cystoscope and an
X-ray system having a fluoroscope.- Thus, the insertable portion
of the extracting device 20 should preferably incorporate a material
which is sufficiently opaque to X-rays to be visible on the fluoro-
scope. For this purpGse, an X-ray contrast medium may be incorpo-
rated into the plastic material of the outer tube 22 or may be
coated thereon. Alternately, a flexible metal wire may be inserted
within the extracting device 20, as will be discussed below in great~r
30detail. The wire is visible on the X-ray fluoroscope and also may
- serve to stiffen the insertable portion of the extracting device 20,
so that it will be easier to insert. Alternately, a fiber optic
device can be used for observing and guiding the probe during
insertion.
As shown in Fig. 6, an inner flexible ~ube 24 is teles-
- copically received within the outer tube 22, with an annular
clearance space 26 therebetween for transmitting air or some other
fluid under pressure. The inner tube 24 is freely slidable within
the outer tube 22. As in the case of the outer tube 22, the inner
10 tube 24 is preferably made of a resinous plastic material, such as
polyethylene, fo~ example. If desired, an X-ray contrast material
may be incorporated into the material of the inner tube 24, or may
be coated theron so that the inner tube will be visible on an X-ray
fluoroscope. Alternately, a fiber optic device can be used for
observing and guiding the probe during insertion. In addition to
serving as a conduit for air or some other fluid, the inner tube
; may be inserted more easily into the body passage by the operator,
without causing the outer tube 22 to collapse.
An inflatable sleeve or dilator 28 is connected between
20 the insertable end of the outer tube 22 and the corresponding end
of the inner tube 24. The sleeve 28 is thin, highly flexible and
limp, and also is preferably elastic so as to be capable of stretching
when inflated with co~pressed air or some other fluid. The sleeve 28
is preferably made of thin latex rubber or some other similar material.
The thin rubber material may be similar to that employed for surgical
rubber gloves and other thin rubber objects. A thin resinous plastic
film material can also be used.
The thin flexible sleeve 28 has one end portion 28a which
is stretched around and secured to the insertable end of the outer
30 tube 22, as by means of a suitable cement or adhesive. The sleeve 28
has a second end portion 28b which is stretched around the insertable
end of the inner tube 24 and is secured thereto, as by means of a
suitable cement or adhesive. Any other suitable means, such as a
tieing ring or collar, may be employed to secure the ends of the
sleeve 28 to the ends of the tubes 22 and 24.
As shown in Figs. 6(a) and lO(a), the end portion 28b of
the flexible sleeve 28 is preferably re-entrant, in thak end portion
28b extends into the sleeve 28. With this construction, the sleeve 28
projects beyond the end of the inner tube 22, particularly when the
sleeve 28 is inflated, as shown, for example, in Fig~ 7(b).
As shown in Fig. 6(a), the extracting device 20 pre~erably
includes a system or ~eans 30 for supplying air or some other fluid
under pressure to the clearance space 26 between the outer and inner
tubes 22 and 24, so as to inflate the thin flexible sleeve 28. The
system 30 also preferably includes means for producing suction or a
vacuum in the inner tu~e 24 to assist in capturing the kidney stone
or other object which is to be removed from the body passage.
As shown in Fig. 6, the free end ~f the outer tube 22 is
provided with a connector or itting 32 to which a flexlble hose 32a
~r the like may be connected, the hose being represented diagramatically
20by a solid line. Similarly, the inner tube 24 is provided with a con-
nector or fitting 34 to which a hose 34a or the like may be connected.
As shown, the hoses 32a and 34a extend radially or at right angles to
the outer and inner tubes 22 and 24. The inner tube 24 extends through
af~ annular seal 36 mounted in an opening 38 in the fitting 32, such
opening being coaxial with the outer tube 22.
The illustrated system 30 of Fig. 6 for selectively producing
air pressure incorporates an air compressor 40 which supplies compressed
air to a pressure line 42 to which a pressure gauge 44 may be connected.
A pres~ure xeyulator 46 and a combination flow control valve and meter 46a
are preferably connected between the high pressure line 42 and a
low pressure line 48 to which another pressure gauge S0 may be con-
nected. A storage tank 52 may also be connected to the low pressure
line 48, if desired.
In this embodiment, a filter 54 and a control valve 56 are
connected between the low pressure line 48 and the hose or conduit 32a
which is cGnnected to the end fitting 32 on the outer tube 22~ The
illustrated control valve 56 is of a three~way type, adapted to connect
the interior of the outer tube 22 to either the pressure line 48 or a
10 vent line 58 leading to the atmosphere. In the position of the valve
56 shown in Fig. 6(a), the outer tube 22 is connected to the vent line
58 by an internal passage 60 within the valve 56. It will be apparent
~ that t~e valve 56 may be shifted to a position in which the internal
- passage 60 establishes a connection between the pressure line 48 and
the interior of the tube 22. The pressure regulator 46 and the flow
control valve and meter 46(a) may be ad~ustable so that the air pressure
in the low pressure line 48 may be variedO as desired.
In the system 30a of Fig. 6(a), a ~ombined compxessor and
~- vacuum pump 40a supplies vacuum to an output vacuum line 62, to which
20 a vacuum gauge 64 may be connected. It will be realized that the
compressor and the vacuum pump may be provided a~ two sep~rate units,
if desired. In this embodiment, a vacuum regulator 65 and a combination
flow control valve and meter 66a are connected between the vacuum line
62 and a regulated vacuum line 68 to which another vacuum gauge 70 may
he connected. A storage tank 72 may also he connected to the vacuum
line 68 if desired.
A filter 74 and a vacuum contro] valve 76 are preferably
connected between the regulated vacuum line 68 and the hose 34a which
lead~ to the fitting 34 on the end of the inner tube 24. ~he control
L~ ~ ~
valve 76 may be of the three-way type and is shown in a position in
which the interior of the inner tube 24 i9i connected to a vent line 78
by an interna] passage 80 within the valve 76. It will be evident that
the valve 76 can be shifted into a position in which the regulated
vacuum line 68 is connected to the interior of the inner tube 24. The
vacuum regulator 66 and flow control val~e 66a may be adjustable so
that the vacuum in the line 68 may be ~aried, as desired.
In the system 30a of Fig. 6(a), the combined compressor and
vacuum pump 40a supplies pressure to an auxiliary pressure supply
system 81, illustrated as comprising a compressor output pressure line
81a to which a control valve 81b may be connected. It will be realized
that the compressor and the vacuum pump may be provided as two separate
units if desired. The illustrated control valve 81b is of a three-way
; type, adapted to connect the compressor output pressure line 81a to
either a high pressure input line 81c or a vent line 81d, leading to
the atmosphere. In the position of the valve 81b shown in Fig. 6(a),
the compressor output pressure line 8Ia is connected ~o the high pres-
sure input line 81c. It will be apparent that the valve 81b may be
shifted to a position in which the compressor output pressure line 81a
20 is connected to the vent 81d. A gauge 81e may be connected to the high
pressure input line 81c. A pressure regulator 81f and a combination
flow control valve and meter 81g are preferably connected between the
high pressure input line 81c and a low pressure line 81h to which
another pressure gauge 81i may be connected. A storage tank 81j may
also be connected to the low pressure line 81h if desired. In this
embodimant, a filter 81k is comlected between the low pressure line
81h and a hoie or conduit 81m which is connected to the auxiliary tube
or tubes 130 and 132, to ~ie described in connaction with Figs~ 9(a)-(a~
and Figs. 12 to 14.
- 10 -
Fig. 6(b) shows a modi~ied construction o~ the fi-ktiny 34
having an axial openin~ 8~ throuyh w~ich an auxiliary tube, a snare
or a stiffening wire may be inserted into the inner tube 24. A
plug 8~ ma~ be provided to close the opening 82 when not in use.
Fig~ 6(c) shows another modi~ied construction in which the
plug 84 of Fig. 6(b) is replaced by a sliding seal or bushiny 85
through whicn the auxiliary tube, snare or stiffening wire 130 may
be inserted into the inner tube 24. The seal is inserted into the
opening 82 in the ~itting 32. The plug 84 may be used to close the
opening 82 w~en the seal 85 is not in us~.
As shown in Figs~ 1 to 5, a manipulator 90 is preferably
connected to the free ends of the outer and inner tubes Z2 and 24,
to make it easy to advance and retract the inner tube 24 relative
to the outer tube 22. By using the manipulator 90, the opera-tor
can advance and retract the inner tube 24 with the thumb and
fingers of one hand, so that the other hand can be used to operate
the pressure and vacuum control valves 56 and 76 of Fig. 6.
As illustrated in Figs. 1 to 5, the manipulator 90 com-
prises a first me~ber 92 which is telescopically slidable within a
second member 94. The members 92 and 94 are connected to the outer
., ,
- lOa -
~ .
and inner tubes 22 and 24, respectively. ~ore specifically, the
fitting or connector 3~ on the ~ree end of the outer tuhe ~2 is
mounted in the member 92, while the end fitting or connector
34 on the free end of the inner tube ~4 is mounted in -the mernber
9~ .
Finger and thumb rings are preferably provided on the
telescopically slideable members 92 and 94. As shown, a
thumb ring 96 is connected to the member 92 by means of a
.~ plunger rod 98. A swivel joint 100 is provided between the
thumb ring 96 and the plunger rod 98, so that the thumb ring
can be turned to an angle which is comfortable and convenient.
The illustrated thumb ring 96 is made from a strip o~ sheet
. metal and can be bent to adjust the size of the thumb ring, as
- desired by the operator.
h~
.: As shown, the member 94 is fitted with a pair o-f ~inger
rings 102 which are also bent from a strip o~ sheet metal, so
~hat the size of the rings 10~ can easily be adjusted to suit
the needs o~ the operator. The finyer rings 102 are swingably
mounted on the body member 94. For this purpose, the finger
rings 102 are provided with a mounting member 104 having a
pair o~ arms 106 which are swingably connected to the body
member 94 by diametrically opposlte pivo-ts 108.
In the illustrated manipulator 90, two stop nuts 110
are mounted on the plunger rod 98, which is threaded to receive
the stop nuts. It will be seen that the stop nuts 110 may be
adjusted to limit the extent to which the plunger rod 98 may be
depressed through the moun-ting member 104, which is apertured
L~
to provide a passage for the rod 98. In effect, the stop nuts 110
thereby provide an a~]ustment of the extent to which the inner
tube 24 may be retracted relative to the outer tube 22.
The operation o the extracting device 10 i5 illustrated
in Figs. 7 and 8, which should be taken in conjunction with Figs. 1-6.
The unit comprising the outer flexible tube 2Z, the inner flexible
tube 24 and the inflatable sleeve 28 constitutes a probe 120 which
can readily be inserted into the urinary tract of the human body
for removing kidney stones. ~he diameter of the outer tube 22 is
10 such as to fit snugly but easily into the urethra and either oE the
ureters. Specifically, the probe 120 is properly lubri~ated and is
inserted through the urethra into the bladder, ~nd then through the
bladder into one of the ureters. An X~ray fluoroscope and a cysto-
scope may be employed advantageously to assist in inserting the
probe 120 into either urethra. In order that the probe 120 may
be clearly visible on the X-ray fluoroscope, the probe preferably
incorporates an X-ray contrast ma~erial which i5 relatively opaque
~ to X-rays. Such ma~erial may be incorporated into the plastic
- material of either the outer tube 22 or the inner tube 24, or both.
20 Alternatively, the X-ray contrast material may comprise a thin
coating of a metal, such as gold, silver or aluminum. Another
alternative is to insert a thin flexible metal wire into the inner
tube 24, while the probe 120 is being inserted~ The wire has the
additional advantage of stiffening the probe 120. After the
probe has been inserted, the wire can be removed. Alternately,
a fiber optic device can be used for observing and guiding the
probe during insertion.
~ 12 -
Figs. 7 (a)-(g) show steps 1-7 of a procedure for
capturing and removing a kidne~ stone 122 or some other similar
object, which may be lodged in one oi the ureters. As shown in
Fig. 7 (a), the probe 120 is inserted un-til it is close to the
kidney stone 122. The sleeve 28 is then infla-ted, as shown in
Fig. 7 (b), by supplying compressed air through the clearance
space 26 between the tubes 22 and 24. The compressed air is
supplied by operating the compressed air control valve 56 to
the position in which it transmits compressed air from the
pressure line 48 to the fitting 32 on the free end of the
outer tube Z2.
The inflation of the sleeve 28 dilates the ureter
to some extent, so as to dislodge or loosen the kidnay stone
122. Suction is then applied to the inner tube 24, so as to
suck the kidney stone 122 toward the end o~ the inner tube 2
i~ :
and into engagement with the projecting end of the inflated
sleeve 28, as shown in Fig. 7 (c). The end of the thin rubber
sleeve 28 ~orms a seal with the kidney stone 122, so that it
is securely held against the end of the probe by the suction.
The inner tube 24 is then gradually retracted, while
the sleeve 28 is simultaneously and gradually deflated, as shown
in Figs. 7 (c)-(g), so that the kidney stone 122 is pulled within
the con~ines o~ the sleeve 28. It will be seen that the deflated
sleeve 28 enfolds the kidney stone 122, as shown to best
advantage in Fig. 7 (y), so that the sleeve 28 is interposed
between the kidney stone 122 and the inner walls oE the ureter.
The suction is applied to the inner tube 24 by
operating the suction control valve 76 of Fig. 6, so that it
- 13 -
dlZpL~
establishes communication between the vacuum line 68 and the
end fitting 34 on the inner tube 24. The suc-tion is maintained
while the probe 120 is withdrawn from the urinary trac-tv The
kidney stone 122 remains a captive within the confines of the
sleeve 28, so that the kidney stone is removed from the urinary
tract. During the removal of the probe 120,the sleeve 28 prevents
the kidney stone 122 from scratching or otherwise injuring the
inner walls of the urinary tract.
Fig. 8 illustrates a procedure for using the inflatable
sleeve 28 to assist in the insertion o~ -the probe 120 into a
narrow passage such as a ureter. In Fig. 8 (a), the probe 120
has been inserted as far as possible with the sleeve 28 deflated.
The sleeve 28 i9 then inflated, as shown in Fig. 8(b), so as to
dilate the passage. Next, the sleeve 28 is again deflated, as
shown in Fig. 8(c), and the outer tube 22 is immediately advanced,
as shown in Fig. 8(d), while some of the dilation persists. The
advancing movement of the outer tube 22 causes -the sleeve 28 to
collapse.
The inner tube 2~ is then advanced within the outer
tube 22, as shown irl Fig. 8(e), so that the sleeve 28 is no
longer collapsed. It will be seen that Fig. 8(e) is the same
as Fig. 8(a), except that the probe 120 has be~n advanced. If
further advancin~ movement is needed, the successive steps of
Figs. 8~a)-(e) are repeated. This may be done several times
until the probe 120 has been fully inserted to the desired
position in the ureter or o-ther body passage.
In some cases, it may be desirable to insert an
auxiliary tube 130, along with the probe 120, as shown in Fig. 9(a)
The auxiliary tube 130 provides auxiliary communication with the
ure-ter or other body passage an~ may be employed to convey various
fluids to or from the body passage. For example, the auxiliary
tube may be emplyed to carry air into the body passage, beyond the
probe 120, so as to obviate or lessen the tendency of the suction,
applied hy the probe 120, to cause partial collapse o~ the walls of
the body passage. When the auxiliary tube 130 is supplied with
compressed air from the com~ination vacuum pump-compressor 40a of
Fig. 6(a), the throughput of the closed system will provide the
same amount of compressed air (volum~ measured as free air at
atmospheric pressure) as the amount of air evacuated by the vacuum
side of the pump (volume measured as free air at atmospheric pres-
sure). The auxiliary tube 130 may also be employed to introduce a
lubricating fluid into the body passage. A fluid medication can
also be introduced into the body passage through the auxiliary
tube 130. It is also possible to use the auxiliary tube 130 to
withdraw mucus or other body fluids from the body passage.
As shown in Fig~ 9(b), two or more auxiliary tubes 130
may be inserted into the body passage along with the probe 120,
20two such auxiliary tubes being shown in this view.
Fig. 9(c) shows a modiied auxiliary tube 132 ha~ing a
plurality of tube elements forming a plurality of individual auxiliary
passages, As shown to best advantage in the cross section of Fig. 9(d3,
the auxiliary tube 132 has three tube elements 13~a, b and c, which
may be emp~oyed for simultaneously handliny different fluids.
The auxiliary tubes 130 and 132 are preferably made of a
flexible resinous plastic material, such as polyethylene, for example.
I~le triple tube 132 may be ormed by extrusion of the plastic material.
Fig. 12 shows a modified arrangement in which the auxiliary
~ 15 -
~l 3 ~
tube 130 is inser ed through the inner tube 24 of the pro~e 120~
The auxiliary tube 130 may be inserted into the tube 24 through the
sliding seal 85 of Fig. 6(c). As shown in Fig. 13, two or more o~
the auxiliary tubes 130 may be inserted through the inner tube 24,
after being inserted into the tube through a suitable sliding seal.
Figs. 14(a) and (b) show that the triple auxiliary tube
132 may be inserted through the inner tube 24 after being inserted
through a suitable sliding seal. In all cases, the auxiLiary tubes
130 and 132 may be inserted along the inner tube 124 either before
lO or after the probe 120 is inserted into the body passage. The
auxiliary tubes 130 and 132 may be removed rom the inner tube 24
without removing the probe 120 from the body passage. The plug 84
may then be inserted in the connector.
~l It may also be considered that Fig. 12 illustrates inser-
tion of a flexible metal wire within the inner tube 24. The element
130 may be regarded as the wire. As previously indicated/ the
~ flexible wire may be employed to stiffen the tubes 22 and 24 of
- the probe 120, or to absorb X-rays so that the probe 120 will be
clearly visible on an X-ray fluoroscope. Alternately, a fiber optic
20 device can be used for observing and guiding the probe during
insertion.
Fig. 10 illustrates various alternative shapes for the
inflatable sleeve 28. In Fig. lO(a)/ the sleeve 28 has a cylindrical
sid~wall 138 and radial endwalls 140 and 142. In Fig. lO(b) the
sleeve has a tapered or frus~o-conical sidewall 138(a).
In Figs. lO(c)/ (d) and (e), the cylindrical sidewall 138
is employed, but the endwall 142 is modified. Thus, the sleeve of
Fig. lO(c) has a re-entrant, tapered, frusto-conical endwal] 142(a)
which may be advantageous in some instances to assist in the enfolding
30 of the ~idney stone by the sleeve. In Fig. lO(d), the sleeve has a
stepped endwall 142(b). In Fig. lO(e), the sleeve has a xe-entrant
- 16 ~
endwall 142(c) which is concavely curved. This construction may be
advantageous in some cases for capturing and en~olding kidney stones.
In Fig. lO~f), the inflatable seal or sleeve 28 has one or
more holes 143 which ~ay be either molded in or pierced. Air or fluid
from the inflator supply will pass through the holes 143 so as to
obviate or lessen the tendency of the suction applied by the probe
120 to cause partial collapse of the walls of the body passage. The
various alternative shapes shown in Figs. lO(b)~ (c), (d) and (e) may
also be provided with one or more holes 143.
Figs. ll(a)-(f) illustrate the successive steps o~ a
procedure for using the probe 120 in conjunction with a snare 150
to assist in capturing and removing a foreign ob~ect, such as the
illustrated kidney stone 122. The illustrated snaxe 150 comprises
a capturing head or portion 154 and an operating portion or member 156,
here shown as a flexible wire which is inserted through the inner tube
24, so as to be accessible to the operator at the free end of the
probe 120. me wire 156 is freely slidable within the inner tube 24.
The capturing head 154 of the snare 150 may comprise a
multituae of strands or filaments 158, made of a material suc~ as
20 tinsel, capable of entwining the kidney stone 122. The ~ilaments 1S8
are in a form resembling a ball and are secured to the front end o~
the operating wire 156. The filaments 158 may be made of metal, a
resinous plastic material, or any other suitable material.
In the procedure of Figs. ll(a)~(f), the probe 120 is
inserted i~to the ureter, or some other body passage, until the
capturing head 154 of the snare 150 is as close as possible to the
kidney stone 122, as shown in Fig. ll(a). The sleeve 28 is then
inflated, as shown in Fig. ll(b), by supplying air or some other
fluid under pressure to the interior of the outer tube 22. The
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inElation of the sleeve ~8 tends to dislodge or loosen the kidney
stone 12~ from -the walls of the ureter.
As shown in Fig. ll(c), the snare 150 is then advanced
by moviny the operating wire 156 throuyh the inner tube 24. As
the capturing head 154 is advanced, -the filaments 158 become en-
twined around the kidney stone 122, as will be evident ~rom Fig. ll(c)
As the snare 150 is advanced, suction is preferably applied to the
interior of the inner tube, so that the suction assists in the
capture of the kidney stone 122.
The snare 150 i5 then retracted by moving the operating
wire 156 within the inner tube 24, so as to bring the capturing
head 154 and the kidney stone 122 as close as possible to the end
of the inner tube. Meanwhile, suction within the inner tube 22 is
maintained. Then~ the inner tube 22 is gradually retracted, as
~L shown in Figs. ll~d) (~), to draw the kidney stone 122 and the
capturing head 154 of the snare 150 into khe confines of the
sleeve 28. Simultaneously, the sleeve 28 is gradually deflated,
so that it will enfold the kidney stone 122 and the capturing
head 154. The thin rubber sleeve ~8 ~orms a seal with the kidney
20 stone 122 and the capturing head 154, so that the suction effectively
retains the kidney stone within the folds of the sleeve 28.
With the suction still maintained, the probe 120 may then
be withdrawn ~rom the body passage, to remove the kidney stone 122
or other object. The sleeve 28 is interposed between the kidney
stone 122 and the walls o~ the body passage, so that neither the
kidney stone nor the head 15~ o~ the snare 150 will scratch or
otherwise injure the walls o~ the body passage.
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