Medical systems and devices

Abstract

A method for removing one or more objects or materials from a body cavity includes delivering a tube and an expandable device to the body cavity to a location proximal to the one or more objects or materials. The expandable device is positioned within the lumen of the tube, and the expandable device includes a lumen extending from a distal portion to a proximal portion. The method further includes proximally retracting the tube such that the expandable device remains in the position proximal to the one or more objects or materials; distally advancing the expandable device such that the distal portion of the expandable device at least partially surrounds the one or more objects or materials; at least partially closing a distal end of the expandable device; and moving the expandable device proximally to remove the expandable device and the one or more objects or materials from the lumen.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit of priority to U.S. Provisional Patent Application No. 63 / 379,927, filed on October 18, 2022, the entire contents of which are incorporated herein by reference. Technical Field

[0002] The present invention generally relates to medical systems, devices, and related methods. More specifically, at least some embodiments of the present invention relate to systems, devices, and related methods for endoscopic medical procedures, such as grasping, moving, extracting, and / or removing one or more objects or materials from a body cavity, organ, or cavity. Background Art

[0003] Technological advances have enabled users of medical systems, devices, and methods to perform increasingly complex surgeries on subjects. One challenge in the field of minimally invasive surgery is associated with extracting objects or materials from a subject, such as, for example, extracting gallstones from a subject's bile duct. Such surgeries may require the use of multiple instruments to remove the gallstones, such as, for example, a device for enlarging the bile duct, a device for trawling the bile duct, and a device for extracting the gallstones. The need to use multiple instruments during surgery can lead to various surgical problems, increased surgical time, and / or an increased risk of injury to the subject. Therefore, there is a need for systems, devices, and methods that address one or more of these difficulties or other related problems. Summary of the Invention

[0004] Examples of the present invention relate, among other things, to systems, devices, and methods for performing one or more medical procedures with medical systems and devices.Each of the examples disclosed herein can include one or more of the features described in conjunction with any of the other disclosed examples.

[0005] According to a method for removing one or more objects or materials from a body cavity, the method includes: delivering a tube and an expandable device to the body cavity to a position proximal to the one or more objects or materials, wherein the expandable device is positioned within the cavity of the tube and wherein the expandable device includes a cavity extending from a distal portion to a proximal portion; retracting the tube proximally so that the expandable device remains in a position proximal to the one or more objects or materials; advancing the expandable device distally so that the distal portion of the expandable device at least partially surrounds the one or more objects or materials; at least partially closing the distal end of the expandable device; and moving the expandable device proximally to remove the expandable device and the one or more objects or materials from the cavity.

[0006] Any of the examples described herein can have any of the following features in any combination. The method can also include expanding a distal portion of the expandable device with a balloon before advancing the expandable device distally. At least the distal portion of the expandable device can be formed from a shape memory material that expands on its own when no longer positioned within the lumen of the tube. At least partially closing the distal end of the expandable device can include proximally retracting one or more pull wires coupled to the distal end of the expandable device. Proximally retracting the one or more pull wires can cause the distal end of the expandable device to taper radially inward to at least partially close the distal end of the expandable device.

[0007] The method may further comprise delivering a medical device or an endoscope through the lumen of the tube and through the lumen of the expandable device, wherein the medical device or the endoscope comprises one or more visualization devices. Advancing the expandable device distally may comprise abutting a distal end of the endoscope with one or more radially inward extensions on an inner surface of the expandable device and advancing the endoscope distally to advance the expandable device distally.

[0008] The method may further include, after at least partially closing the distal end of the expandable device, delivering an energy delivery device through the lumen of the tube and the lumen of the expandable device; and activating the energy delivery device one or more times to direct energy toward one or more objects or materials. In some embodiments, the tube and expandable device may be delivered to the body lumen via an incision.

[0009] The method may further include depositing one or more objects or materials into a basket positioned proximal to the cavity. Depositing the one or more objects or materials into the basket may include passing a fluid through the cavity of the tube and into the expandable device. In some embodiments, the cavity may be a bile duct, and the one or more objects or materials may include one or more gallstones.

[0010] In an additional or alternative method for removing one or more gallstones from a bile duct, the method may include: making an incision in a subject adjacent to the bile duct; delivering a tube and an expandable device to the bile duct through the incision to a position proximal to the one or more gallstones, wherein the expandable device is positioned within the lumen of the tube and wherein the expandable device includes a lumen extending from a distal portion to a proximal portion; retracting the tube proximally such that the expandable device remains in a position proximal to the one or more gallstones; advancing the expandable device distally such that the distal portion of the expandable device at least partially surrounds the one or more gallstones; at least partially closing the distal end of the expandable device; and moving the expandable device proximally to remove the expandable device and the one or more gallstones from the bile duct.

[0011] The method may further include, before distally advancing the expandable device, expanding the distal portion of the expandable device and enlarging a portion of the bile duct by inflating a balloon positioned within the distal portion of the lumen of the expandable device. In some embodiments, at least partially closing the distal end of the expandable device comprises proximally retracting one or more pull wires coupled to the distal end of the expandable device, and wherein proximally retracting the one or more pull wires causes the distal end of the expandable device to taper radially inward to at least partially close the distal end of the expandable device.

[0012] The method may also include delivering a medical device or endoscope through the lumen of the tube and through the lumen of the expandable device, wherein the medical device or endoscope includes one or more visualization devices, and wherein advancing the expandable device distally includes abutting the distal end of the endoscope with one or more radially inward extensions on an inner surface of the expandable device, and advancing the endoscope distally to advance the expandable device distally. The method may also include delivering an energy delivery device through the lumen of the tube and the lumen of the expandable device after at least partially closing the distal end of the expandable device and before moving the expandable device proximally; and activating the energy delivery device one or more times to direct energy toward the one or more gallstones to fragment or break the one or more gallstones. The method may also include depositing the one or more fragmented or broken gallstones into a basket positioned proximal to the lumen.

[0013] In an alternative embodiment, a medical system may include a tube having a lumen; and an expandable device having a proximal portion, a distal portion, and an intermediate portion between the proximal and distal portions. The expandable device may include a lumen extending from the proximal portion to the distal portion. In a first configuration, the expandable device may be positioned within the lumen of the tube, may be in an unexpanded configuration, and the distal end of the distal portion may be open. In a second configuration, the expandable device may at least partially extend from the lumen of the tube, may be in an expanded state, and the distal end of the distal portion may be open and larger than the distal end in the first configuration. In a third configuration, the expandable device may at least partially extend from the lumen of the tube, may be in an expanded state, and the distal end of the distal portion may be at least partially closed. In the third configuration, the expandable device may be configured to retract proximally and retain one or more objects or materials within the expandable device. The medical system may also include an endoscope configured to be conveyed through the lumen of the tube and at least partially through the lumen of the expandable device. The endoscope may include one or more visualization devices. The energy delivery device may be configured to be delivered through the lumen of the tube and at least partially through the lumen of the expandable device.The energy delivery device may be configured to at least partially fragment or disintegrate one or more objects or materials. BRIEF DESCRIPTION OF THE DRAWINGS

[0014] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate various exemplary embodiments and, together with the description, serve to explain the principles of the disclosed embodiments.

[0015] Figures 1A to 1E are side cross-sectional views of an exemplary medical system / device at least partially within a body cavity at various points or steps of an exemplary procedure in accordance with aspects of the present invention.

[0016] Figure 2 is a flow chart of an exemplary method according to aspects of the present invention.

[0017] Figure 3 is a side view of an alternative exemplary medical device according to aspects of the present invention.

[0018] Figure 4 is a perspective view of a section of an alternative exemplary medical device according to aspects of the present invention.

[0019] Figure 5 is a side view of an alternative exemplary medical device according to aspects of the present invention.

[0020] Figure 6A and Figure 6B is in an open configuration ( Figure 6A ) and in closed form ( Figure 6B ) in a stereoscopic view of an exemplary medical device.

[0021] Figure 7A and Figure 7B is a perspective view of an alternative form of an exemplary medical device according to aspects of the present invention.

[0022] Figure 8A is a perspective view of an exemplary medical device according to aspects of the present invention, and Figure 8B is a side view of an exemplary medical device according to aspects of the present invention.

[0023] Figure 9 is a perspective view of another exemplary medical device according to aspects of the present invention. DETAILED DESCRIPTION

[0024] Reference will now be made in detail to various aspects of the present invention, examples of which are illustrated in the accompanying drawings. Wherever possible, the same or similar reference numerals will be used throughout the drawings to refer to the same or similar parts. The term "distal" refers to the portion of the device that is farthest from the user when the device is introduced into a subject (e.g., a patient). Conversely, the term "proximal" refers to the portion that is closest to the user when the device is placed in the subject.

[0025] The foregoing general description and the following detailed description are exemplary and explanatory only and are not limitations on the features, as claimed. As used herein, the terms "comprises," "including," "having," "contains," or other variations thereof are intended to cover a non-exclusive inclusion such that a process, method, article, or apparatus that includes a list of elements includes not only those elements but may include additional elements not expressly listed or inherent to such process, method, article, or apparatus. In this disclosure, relative terms such as, for example, "about," "substantially," "approximately," and "approximately" are used to indicate a possible variation of ±10% of a stated value or characteristic.

[0026] Embodiments of the present invention may address one or more of the limitations in the art. However, the scope of the invention is defined by the appended claims, not by its ability to solve a specific problem. In certain embodiments, the present invention is directed to inserting a medical device into a body cavity, such as a catheter. The catheter may include, for example, the common bile duct, the cystic duct, the hepatic duct, and the like.

[0027] Figures 1A to 1E Side cross-sectional views of an exemplary medical system 100 at various points, stages, or steps during an exemplary procedure are shown in accordance with one embodiment of the present invention. As discussed in detail below, medical system 100 includes a primary device or outer tube 102 (hereinafter referred to as "tube" 102) and a secondary device or expandable device 104 (hereinafter referred to as device 104). In addition, tube 102 and / or device 104 can be at least partially moved relative to the other, for example, to assist in enclosing and / or removing one or more objects or materials from a cavity 150 of a subject. For example, tube 102 can be moved relative to device 104 and / or vice versa. Additionally, Figure 2 An exemplary method or process 200 is shown that one or more users may perform with any of the medical systems, devices, or systems discussed herein, such as, for example, portions of medical system 100 .

[0028] Specifically, Figure 1A The medical system 100 is depicted during insertion into a cavity 150 of a subject. Figure 1A As shown, the tube 102 can be at least partially cylindrical. The tube 102 can be made of a rigid or semi-rigid material (e.g., polypropylene plastic, high-density polyethylene plastic, nitinol, stainless steel, Elgiloy (e.g., non-magnetic cobalt-chromium-nickel-molybdenum alloy), nylon, , etc.), and, at least in some embodiments, is straight, without bends. Although not shown, it should be understood that in some embodiments, the tube 102 may include one or more bends or curvatures along the longitudinal length between the proximal end 106 and the distal end 108. For example, one or more portions of the tube 102 may be S-shaped or U-shaped. Additionally or alternatively, one or more surfaces or portions of the tube 102 may be at least partially coated with any biocompatible material known in the art (i.e., silicone-based lubricants, coatings, gels, fluids, anticoagulants (heparin), polytetrafluoroethylene (PTFE), etc.). For example, coating one or more outer surfaces or portions of the tube 102 may facilitate insertion, positioning, and / or removal of the medical system 100 from the cavity 150. Additionally or alternatively, the tube 102 may also include a pull wire (not shown) extending proximally from the proximal end of the tube 102. For example, a pull wire (not shown) can be used to facilitate insertion, positioning, and / or removal of the tube 102 and / or medical system into the lumen 150, and / or from the lumen 150. Additionally or alternatively, coating one or more interior surfaces or portions of the tube 102 can facilitate insertion, positioning, and / or removal of the device 104 through the lumen 103 of the tube 102, as will be further described herein.

[0029] The longitudinal length of tube 102 can range from about 10 centimeters to about 30 centimeters, for example, about 20 centimeters. However, it should be understood that tube 102 can include various other shapes, sizes and / or lengths except those shown and described herein. For example, tube 102 can be inserted into the subject's body via opening 154, such as through an incision in the subject's body. Therefore, tube 102 can have enough size so that the proximal end 106 of tube 102 remains outside the subject's body, and at least the distal end 108 of tube 102 is within cavity 150.

[0030] As mentioned above, the tube 102 also includes a lumen 103 extending from a proximal end 106 to a distal end 108 of the tube 102. The lumen 103 can be of sufficient size to receive a secondary device (e.g., a stent) 104, as described in further detail below. By way of example only, but in some embodiments, the tube 102 of the medical system 100 can include an outer diameter of about 4 mm to about 10 mm, and the lumen 103 can include an inner diameter of about 3 mm to about 9 mm. Thus, the wall thickness of the tube 102 can range from about 0.5 mm to about 3.5 mm. The outer diameter and / or inner diameter of the tube 102 can be consistent along the entire longitudinal length of the tube 102. In an alternative example (not shown), the outer diameter and / or inner diameter of the tube 102 can vary along the longitudinal length. For example, the outer diameter and / or inner diameter of the tube 102 can decrease along the longitudinal length, such that the inner diameter and / or outer diameter is greater at the proximal portion of the tube 102 than at the distal portion of the tube 102. In an alternative example (not shown), the wall thickness of the tube 102 can vary along its longitudinal length. For example, the wall thickness of the tube 102 can be greater on the proximal portion of the tube 102 than on the distal portion of the tube 102, or vice versa. The increased wall thickness on one or more portions of the tube 102 can help provide additional stability during surgery. In some aspects, the tube 102 can have a transverse cross-sectional shape such as, for example, an oval, a circle, a square, a rectangle, a star, or any shape known in the art.

[0031] The outer surface of the tube 102 may also include one or more various features (not shown), such as indentations, raised surfaces, markings (e.g., radiopaque markings), etc., or any combination thereof. These features may serve various purposes. For example, the indentations and / or raised surfaces may help the tube 102 remain in place during surgery, e.g., by increasing the surface area of the outer surface of the tube 102. Additionally or alternatively, one or more markings may provide a visual cue or indicator to the user to ensure that the medical system 100 is properly placed within the cavity 150, e.g., when using one or more visualization devices, fluoroscopy, etc.

[0032] The medical system 100 also includes a secondary or expandable device 104. The device 104 can include any device having expandable and / or memory shape (or shape memory) properties, such as, for example, a stent. A device including a memory shape material can be configured to "remember" an original or specific shape and return to the same shape when subjected to an external stimulus (e.g., a mechanical force or temperature change) and / or after the stimulus or constraint is removed. Thus, the device 104 can be formed from one or more flexible or semi-flexible materials, such as, for example, plastic, nitinol, stainless steel, Elgiloy (e.g., a non-magnetic cobalt-chromium-nickel-molybdenum alloy), a shape memory polymer, or any material known in the art. In a first configuration, the device 104 can be positioned within the cavity 103 in an unexpanded state such that the distal end 112 of the device 104 is proximal to the distal end 108 of the tube 102. The proximal end 110 of the device 104 can be distal to the proximal end 106 of the tube 102. This arrangement of the device 104 allows the device 104 to be delivered or positioned within the cavity 150 .

[0033] In an alternative configuration, the proximal end 110 of the device 104 can be aligned with the proximal end 106 of the tube 102 or extend proximally beyond the proximal end 106 of the tube 102. Thus, the longitudinal length of the device 104 can range from about 5 centimeters to about 30 centimeters. Similarly, in the first, unexpanded configuration, the outer diameter of the device 104 can range from about 2 millimeters to about 15 millimeters. In the first, unexpanded configuration, the device 104 can be at least partially cylindrical. However, it should be noted that the device 104 can include various other shapes, sizes and / or lengths in addition to those shown and described herein. For example, the device 104 can have a transverse cross-sectional shape that is oval, circular, square, rectangular, star-shaped, or any shape known in the art.

[0034] Furthermore, the device 104 may include one or more features similar to those described above with respect to the tube 102. For example, the outer surface of the device 104 may also include various features (not shown). These features may include, for example, indentations, raised surfaces, markings, etc., or any combination thereof. Additionally, the device 104 need not be the same shape as the tube 102. For example, the device 104 may include a circular cross-section, and the tube 102 may be oval or square in cross-section, or vice versa. Alternative combinations are also possible.

[0035] Device 104 includes a lumen 107 extending from a proximal end 110 to a distal end 112. Similar to tube 102, one or more surfaces of device 104 can be at least partially coated with any material known in the art to facilitate insertion, positioning, and / or removal of device 104 through lumen 103 of tube 102, or insertion, positioning, and / or removal of additional devices (not shown) through lumen 107 of device 104. Additionally or alternatively, one or more surfaces of device 104 can be at least partially coated to facilitate insertion, positioning, and / or removal of device 104 through lumen 150. The walls (e.g., inner walls) forming lumen 107 of device 104 can additionally or alternatively be insulated, coated, or otherwise formed to help prevent damage to surrounding tissue in or around lumen 150 when performing certain procedures, such as, for example, lithotripsy. Additionally or alternatively, the walls forming lumen 107 can be at least partially porous and / or can include a plurality of cavities to facilitate absorption of shock waves through elastic deformation. In some aspects, the material comprising the walls forming cavity 107 can be elastic, for example, formed of silicone.

[0036] refer to Figure 1A and Figure 2 In step 202, the medical system 100 can be inserted into the cavity 150, for example, via the opening 154. The opening 154 can be, for example, an incision or a natural orifice of the subject. In some examples, step 202 can include making an incision, for example, to enter the cavity 150. The incision can be adjacent to the bile duct and / or the target site. The cavity 150 can contain, for example, one or more objects and / or materials 160 (hereinafter referred to as "objects" 160). In some aspects, the objects 160 can be stones, for example, gallstones. The medical system 100 can be inserted into the cavity 150 via the opening 154 and positioned so that the distal end 108 of the tube 102 is proximal or near the object 160. Although not shown, it should be noted that the medical system 100 can also be inserted into the cavity 150 by a trocar, sheath, cannula, or any other device commonly used in the art to create and / or maintain the opening 154. Additionally, as previously described, at least a portion of the proximal end 106 of the tube 102 can remain outside of the opening 154 or extend proximally from the opening 154. In some embodiments, the medical system 100 can be delivered to the target site with the aid of a delivery device (not shown), such as, for example, an endoscope. Once the medical system 100 is in place, the delivery device (not shown) can be removed.

[0037] Once the medical system 100 is in the desired position, step 204 may include removing or at least partially retracting the tube 102 from the lumen 150 and leaving the device 104 within the lumen 150, as shown. Figure 1B106 . The tube 102 can be retracted or removed by grasping the proximal end 106 and pulling the proximal end 106 proximally. In some embodiments, an endoscope 130 (described in more detail below) can be inserted through the lumen 103 of the tube 102 and the lumen 107 of the device 104 before the tube 102 is removed. The inner surface of the device 104 may include one or more radially inwardly extending features 145. For example, the one or more features 145 may include one or more protrusions, flanges, lips, hooks, or any other features known in the art that may extend partially or completely around the inner surface of the device 104 (e.g., radially inwardly). In this regard, the distal end of the endoscope 130 (e.g., the distal end face and / or outer circumference of the endoscope 130) can be used to push against or abut the one or more features 145 to assist in maintaining the position of the device 104 when the tube 102 is retracted.

[0038] Upon removal of the tube 102, the proximal portion 114 of the device 104 (e.g., the cross-sectional area of the proximal portion 114) and the distal portion 116 of the device 104 (e.g., the cross-sectional area of the distal portion 116) can each expand (e.g., radially outward). For example, due to the shape memory properties / materials of the device 104, as previously described, the device 104 can self-expand when released / removed from the lumen 103 of the tube 102 and / or once the device 104 is no longer positioned within the lumen 103 of the tube 102. The device 104 can expand such that one or more exterior surfaces of the device 104 contact, abut, or press against one or more interior surfaces of the lumen 150. The intermediate portion 118 (e.g., the cross-sectional area of the intermediate portion 118) can remain unchanged or can similarly expand.

[0039] In an alternative configuration, tube 102 can be inserted into lumen 150 without preloading device 104 within lumen 103. In such a configuration, device 104 can be loaded or inserted into lumen 103 of tube 102, for example, once tube 102 is in a desired position within lumen 150. Thus, once device 104 is positioned within lumen 103, tube 102 can be retracted and / or removed, as previously described.

[0040] Before, during, or after removal of the tube 102, an endoscope 130 may be inserted through the lumen 107 of the device 104. The endoscope 130 may include one or more visualization devices (e.g., cameras), one or more illumination devices (e.g., light sources), and / or one or more lumens (not shown) to assist in visualization and / or delivery, positioning, and / or removal of auxiliary medical devices during the procedure.

[0041] Still refer to Figure 1BThe proximal portion 114 and / or the distal portion 116 can be expanded by virtue of the shape memory or shape memory material comprising the device 104. For example, the proximal portion 114 and / or the distal portion 116 can be naturally biased to the expanded configuration. However, in some embodiments, the method 200 can include an optional step 206 in which the proximal portion 114 and / or the distal portion 116 can be manually expanded, for example, by means of a balloon radially inserted within one or more portions of the device 104. In the expanded configuration, the outer walls of the proximal portion 114, the intermediate portion 118, and / or the distal portion 116 can be pressed against the inner walls of the opening 154 and / or the lumen 150, respectively. The radially outward force exerted by the outer walls of the proximal portion 114 and the distal portion 116 on the corresponding tissue can help secure the device 104 in place within the opening 154 and / or the lumen 150. The radially outward force of the proximal portion 114 can further help open or maintain the opening 154. The radially outward force of distal portion 116 may also assist in expanding lumen 150 to further facilitate capture and / or removal of object 160, as will be described in further detail below.

[0042] When the tube 102 is removed, the proximal portion 114, the middle portion 118, and the distal portion 116 can have a circular cross-section. The proximal portion 114, the middle portion 118, and / or the distal portion 116 can assist in widening or expanding the opening 154 and / or the cavity 150. The proximal portion 114 and the distal portion 116 can be shaped variably. For example, the size of the inner and / or outer walls of the proximal portion 114 and / or the distal portion 116 can taper (e.g., radially) toward the middle portion 118. The inner and / or outer walls of the proximal portion 114 and / or the distal portion 116 can be alternately shaped to provide additional stability within the cavity 150 when the device 104 is deployed. Additionally or alternatively, the size and shape of the proximal portion 114 and the distal portion 116 can vary relative to each other. For example, the proximal portion 114 may be longer (e.g., longitudinally) than the distal portion 116, or vice versa. Additionally or alternatively, the proximal portion 114 may include a larger and / or deeper taper as compared to the distal portion 116, or vice versa.

[0043] In some embodiments, the proximal portion 114, the distal portion 116, and / or the middle portion 118 can be formed from the same material. Alternatively, one or more of the proximal portion 114, the distal portion 116, and / or the middle portion 118 can be formed from different materials with different properties or from the same material with different properties. For example, if the device 104 is composed of braided nitinol wires or wires, such as a stent, the wires or wires forming the proximal portion 114 can be sized and / or spaced differently than the wires or wires forming the distal portion 116 and / or the middle portion 118. Many other combinations are possible.

[0044] Once the device 104 is deployed (e.g., by removing the tube 102), the longitudinal length of the device 104 may decrease overall. This may be a result of expansion of one or more of the proximal portion 114, the distal portion 116, and / or the intermediate portion 118. For example, as the outer diameter of one or more of the proximal portion 114, the intermediate portion 118, and / or the distal portion 116 increases, the length of the same one or more of the proximal portion 114, the intermediate portion 118, and / or the distal portion 116 may decrease. Thus, upon deployment of the device 104, the overall length of the device 104 may decrease. Thus, the longitudinal length of the device 104 in the expanded, deployed configuration may range from approximately 3 cm to approximately 29 cm, e.g., from approximately 5 cm to approximately 20 cm, e.g., from approximately 10 cm. In the deployed state, the outer diameter of at least a portion of the proximal portion 114, the intermediate portion 118, and the distal portion 116 may range from approximately 2.5 mm to approximately 30 mm, e.g., from approximately 5 mm to approximately 25 mm, e.g., from approximately 15 mm.

[0045] Radial expansion of distal portion 116 may cause radial expansion of lumen 150, which may help allow device 104 to surround object 160. For example, radial expansion may help form an opening between object 160 and the inner wall of lumen 150, and device 104 may then pass through the formed opening to help at least partially surround object 160.

[0046] To assist in positioning object 160 within device 104, additional devices may be used. For example, in some embodiments, a device having screws, piercing members, and / or suction elements may be attached to the proximal side of object 160 to pull or reposition object 160 into lumen 107 of device 104. Additionally or alternatively, a netting device may be deployed around object 160 and deployed distally. The netting mechanism may comprise, for example, a cage, a net, a stent, a balloon, or any combination thereof. Once deployed or deployed, the netting mechanism may be retracted proximally, causing the netting mechanism to pull object 160 toward or into lumen 107 of device 104. Additionally or alternatively, a device having rods, tines, and / or a spline array may be deployed or deployed distally around object 160. The device may also comprise a suture that can be tightened around object 160. Once the suture is tightened around the object 160, the device can be pulled or otherwise pushed proximally, thereby drawing the object 160 into the lumen 107 of the device 104. Additionally or alternatively, a device comprising a spiral or coil can be used to reposition the object 160. For example, the spiral or coil can be rotated around the object 160. Continued rotation will draw the object 160 proximally, similar to a corkscrew motion.

[0047] In alternative embodiments, the helix or coil may further include ribs 492 extending radially outward from the wire 490 forming the helix or coil, as shown in FIG. Figure 4 As shown. The ribs 492 can assist, for example, in placing the object 160 ( Figures 1A to 1C shown) and / or object fragments 160'( Figures 1D to 1E ) is maintained within the spiral or coil. The ribs 492 can be formed from one or more flexible or semi-flexible materials such as, for example, polypropylene plastic, high-density polyethylene plastic, nitinol, stainless steel, Elgiloy (e.g., a non-magnetic cobalt-chromium-nickel-molybdenum alloy), silicone, or any material known in the art. The ribs 492 can extend from the wire 490 so as to reduce or close the gap or spacing between each of the spirals or coils (e.g., between adjacent wires). In some aspects, the wire 490 can be at least partially transverse or perpendicular to the longitudinal axis ( Figures 1A to 1E ) arrangement, and ribs 492 can extend at least partially from wire 490 proximally. Similarly, in alternative configurations, ribs 492 can extend distally to reduce or close the gap between each of the spirals or coils. Additionally or alternatively, ribs 492 can extend radially outward from wire 490 at different lengths. For example, for a first length of wire 490, ribs 492 can be longer or extend farther (e.g., radially outward) from wire 490, and for a second length of wire 490, ribs 492 can be shorter or extend less far (e.g., a shorter radially outward distance) from wire 490. Ribs 492 can extend from the entire length of wire 490, or can extend from one or more portions of wire 490.

[0048] Return Reference Figure 1B In some embodiments, the distal end 112 of the distal portion 116 can include one or more features or components to facilitate capturing and / or enclosing the object 160. Although not shown, the distal end 112 can include, for example, one or more radially inwardly extending gripping features, such as one or more protrusions, barbs, extensions, etc. In some embodiments, the protrusions can extend radially inward and in a proximal direction. The protrusions (not shown) can assist, for example, in preventing distal movement of the object 160 once the object 160 is within the cavity 107 of the device 104.

[0049] However, in some cases, object 160 may be too large or the user may be unable to at least partially surround or enclose object 160 within device 104. In such instances, object 160 may remain distal to distal end 112. Method 200 may include optional step 208, in which object 160 may be fragmented or shattered outside of device 104, thereby forming object fragments 160'. For further details below with respect to optional step 214, optional step 208 may include, for example, delivering and activating energy delivery device 140 within lumen 150. Activating energy delivery device 140 may cause object 160 to fragment or shatter, thereby forming object fragments 160'. In this manner, energy delivery device 140 may be activated one or more times, for example, to direct energy toward object 160 and / or object fragments 160'. Once object 160 is fragmented or shattered, for example, to fit within lumen 107 of device 104, object fragments 160' may be pulled or otherwise urged proximally using any of the previously described devices or by applying suction. Alternatively or additionally, optional step 210 may be repeated so that the device 104 may be repositioned or advanced distally to surround the object fragment 160'. The user may then proceed as described below.

[0050] Additionally, method 200 may include another optional step 210, in which device 104 may be repositioned within lumen 150. For example, during or after removal of tube 102 and / or before, during, or after insertion of endoscope 130, device 104 may be repositioned such that object 160 is partially or completely within lumen 107 (e.g., radially surrounded thereby). In some aspects, one or more illumination devices on endoscope 130 may help a user visualize the position of device 104 and object 160, thereby assisting the user in positioning or repositioning device 104 and / or object 160 such that object 160 is at least partially within lumen 107 of device 104. Device 104 may be repositioned by pushing it in a distal direction. For example, a user may push proximal end 110 to move device 104 in a distal direction. Additionally or alternatively, the inner surface of device 104 may include radially inwardly extending features 145, as previously described. In this regard, the distal end of the endoscope 130 can be used to push against or abut feature 145 to move the device 104 in a distal direction. Additionally or alternatively, another medical device (not shown) can be delivered through the lumen of the endoscope 130. The other medical device (not shown) can be used to grasp the device 104 and advance one or more portions of the device 104 distally.

[0051] like Figure 1C and Figure 2As shown, when the object 160 is partially or completely located within the cavity 107, the method 200 includes step 212, in which the distal-most portion 120 of the distal portion 116 is closed. For example, closing the distal-most portion 120 can be similar to tightening a pouch or bag. In the closed configuration, the distal end 112 of the distal portion 116 can form a tip or point 112'. For example, in the closed configuration, a distal segment of the wall forming the distal-most portion 120 of the distal portion 116 can taper radially inward toward the point 112'. As discussed above, a proximal segment of the wall forming the distal portion 116 can taper radially inward toward the intermediate portion 118.

[0052] The distal-most portion 120 can be closed by pulling one or more pull wires 144, for example, by pulling the pull wires 144 in a proximal direction. The pull wires 144 can be coupled to the distal end 112 and, for example, surround at least a portion of the circumference of the distal-most portion 120. The pull wires 144 can extend proximally through the lumen 107 or can extend around the radially outer portion of the device 104. In another aspect, the device 104 can include an additional lumen (not shown), for example, in the wall of the device 104 extending from the proximal end 110 to the distal end 112, through which the pull wires 144 can extend. The pull wires 144 can have a loose proximal end that extends proximally beyond the proximal end 110. The loose proximal end can enable a user to grasp and pull the pull wires 144 proximally, thereby closing the distal-most portion 120. For example, pulling the pull wires 144 proximally results in closing the distal-most portion 120.

[0053] Before, during, or after closing the distal-most portion 120, the method 200 may include an optional step 214 in which an energy delivery device (e.g., an electrohydraulic lithotripsy (EHL) probe or a laser) 140 is inserted through the endoscope 130, such as Figure 1D As shown. The energy delivery device 140 can be inserted such that the distal end 142 of the probe is located distal to the distal end 132 of the endoscope 130 and proximal to the object 160. In some examples, the energy delivery device 140 can be inserted into the device 104 without the use of the endoscope 130. For example, the energy delivery device 140 can be used to deliver energy, for example, to at least partially fragment or break up the object 160. Closing the distal-most portion 120 around the object 160 before the object 160 fragments or breaks into fragments 160' can help prevent, for example, one or more of the fragments 160' from being lost within the distal portion of the lumen 150. Thus, closing the distal-most portion 120 around the object 160 before the object 160 fragments helps retain or contain the object fragments 160' within the device 104 once the object 160 fragments.

[0054] After object 160 is broken into object fragments 160 ′, endoscope 130 and / or energy delivery device 140 may be proximally retracted or removed. Device 104 and object fragments 160 ′ contained or retained within device 104 may then be removed from lumen 150 .

[0055] To remove the device 104 from the cavity 150, for example in step 220 of the method 200, the user can grasp the proximal end 110 with their fingers or a medical device (i.e., forceps, snare, etc.) and pull the device 104 proximally. In doing so, the device 104 can be elongated and the diameter of the device 104 can be reduced, similar to Figure 1E . For example, the proximal portion 114, the middle portion 118, and the distal portion 116 can be compressed to form a single portion 121. Thus, the outer wall of the single portion 121 can exert less force on the inner wall of the cavity 150, and thus enable the user to more easily remove the device 104 from the subject. The inner wall of the device 104 can also assist in retaining the object fragment 160'. Additionally or alternatively, a pull wire (not shown) can extend proximally from the proximal end of the device 104. The pull wire (not shown) can be used to facilitate retraction or removal of the device 104 from the cavity 150. Upon removal, the device 104 can be appropriately discarded and / or the object fragment 160' can be removed for further investigation.

[0056] Figure 3 An alternative embodiment of a medical system 300 is shown. This embodiment of the medical system 300 includes an apparatus 304, which may have any of the characteristics of the apparatus 104, except as described below. The medical system 300 may be used to perform one or more steps of the method 200, except as described below.

[0057] The medical system 300 can be inserted through the opening 354 and can be positioned within the lumen 350, similar to the medical system 100. For example, a tube (not shown) similar to the tube 102 described above can be used to transport the device 304 and position the device 304 within the lumen 350. The device 304 can also include a basket 375 that extends radially from an outer surface of the proximal portion 314 of the device 304. For example, the basket 375 can be positioned proximal to or near the lumen 350 of the device 304. In an alternative embodiment (not shown), the basket 375 can extend radially from an outer surface on the intermediate portion 318 or the distal portion 316.

[0058] Basket 375 can be positioned externally or internally to the subject. Basket 375 can be used to collect objects and / or object fragments 360' as they are trawled or otherwise removed from cavity 350. For example, object fragments 360' can be deposited into basket 375 during surgery. Basket 375 can be made of any material commonly used in the art to produce medical baskets. For example, basket 375 can be made of cloth, mesh, plastic, or any combination thereof. Basket 375 can also or alternatively be made of an at least partially porous film. Alternatively or additionally, basket 375 can include an additional outer layer of material, such as, for example, a sealing bag 377. Sealing bag 377 can be made of, for example, a non-porous material, which can help prevent leaks. A sealing grommet (not shown) can be positioned proximally to basket 375. The sealing grommet (not shown) can be used to help facilitate fluid flow through basket 375 and / or assist in flushing, for example, objects and / or object fragments 360' into basket 375.

[0059] The basket 375 may also include one or more pull wires 345 that can be used to close or tighten the basket 375 from the device 304. For example, when the pull wire 345 is pulled proximally or otherwise pushed, a portion of the basket can be closed or tightened. One or more tubes (not shown) can extend from the sealing bag 377 and be fluidly connected thereto. One or more tubes (not shown) can be used for suction and / or saline flushing. Suction and / or saline flushing can assist the user in flushing object debris 360' from the cavity 350. For example, when flushing object debris 360' from the cavity 350, the object debris 360' can be captured by the basket 375. Excess fluid can flow through the basket 375 and be captured by the sealing bag 377.

[0060] Figure 5 An alternative embodiment of a distal portion 516 of the device 504 is shown. The device 504 of this embodiment can have any of the characteristics of the device 104, except as described below. Additionally, the device 504 can be used to perform one or more steps of the method 200, except as described below.

[0061] In this embodiment, the distal portion 516 may include one or more features or components to facilitate capturing and / or enclosing the object 560. The distal portion 516 may include, for example, one or more gripping features 517. The gripping features 517 may include one or more wires or hooks extending distally from the distal end 512 of the intermediate portion 518 of the device 504. In some embodiments, the distal end of the gripping features may also include loops or, for example, eyelets 519a, 519b, 519c. Although Figure 5519c, but alternative configurations may include two, four, five, etc. eyelets. One or more of the eyelets 519a, 519b, 519c may be curled or bent radially inward or radially outward. The pull wire 544 may, for example, extend sequentially through each of the eyelets 519a, 519b, 519c. For example, the pull wire 544 may begin in the eyelet 519a and then extend through the eyelet 519b, then the eyelet 519c, and so on. The proximal end of the pull wire 544 may extend proximally through the lumen 507 of the device 504 such that in the second configuration, for example, when the object 560 is partially or completely within the lumen 507, the pull wire 544 may be pulled or otherwise pushed proximally to close or constrict the distal-most end of the device 504. In an alternative configuration (not shown), the pull wire 544 may extend around the radially outer portion of the device 504.

[0062] In a further alternative configuration, a covering 523 can extend between one or more gripping features 517. The covering 523 can include one or more materials such as, for example, a mesh material, a silicone material, a mesh material, or any combination thereof. In some embodiments, the covering 523 can help allow fluid to escape or otherwise flow out of the device 504 while helping to maintain the object 560 within the cavity 507.

[0063] Figure 6A and Figure 6B The exemplary medical device 600 is shown deployed in an open configuration ( Figure 6A ) and closed forms ( Figure 6B ). The device 600 may include a proximal basket 604 and a distal basket 608.

[0064] The proximal basket 604 and the distal basket 608 can be formed from one or more flexible or semi-flexible materials, such as, for example, plastic, nitinol, stainless steel, Elgiloy (e.g., a non-magnetic cobalt-chromium-nickel-molybdenum alloy), one or more shape-memory polymers, or any other material known in the art. Additionally or alternatively, the proximal basket 604 and the distal basket 608 can be formed similar to a stent and comprise, for example, braided wires or wires, mesh, fabric, silicone, or any combination thereof. The proximal basket 604 and the distal basket 608 can be formed from the same material. Alternatively, the proximal basket 604 and the distal basket 608 can be formed from different materials with different properties or from the same material with different properties. For example, if the proximal basket 604 is comprised of braided nitinol wires or wires similar to a stent, the wires or wires forming the proximal basket 604 can be sized and / or spaced differently than the wires or wires forming the distal basket 608. Many other combinations are also possible.

[0065] The proximal portion 604A of the proximal basket 604 can be coupled to the outer surface of the inner sheath 606. The proximal basket 604 can be coupled to the inner sheath 606, for example, by one or more fasteners or adhesives. For example, the proximal basket 604 can be coupled to the inner sheath 606 by one or more glues, heat shrinks, crimps, etc.

[0066] The inner sheath 606 can extend, for example, along the longitudinal axis 601 through the center of the proximal basket 604. The proximal basket 604 can extend partially or completely around or around the inner sheath 606. The distal portion 604B of the proximal basket 604 can be loose or unfixed relative to the inner sheath 606 so that Figure 6A and Figure 6B In the deployed configuration shown, the distal portion 604B of the proximal basket 604 is radially expanded outward. Thus, when the proximal basket 604 is in the deployed configuration, the distal opening of the proximal basket 604 is oriented in the distal direction.

[0067] The distal portion of the inner sheath 606 can extend through the proximal portion 608A of the distal basket 608. The distal portion 608B of the distal basket 608 can be coupled to the outer surface of the control wire 610. The distal basket 608 can be coupled to the control wire 610, for example, via one or more fasteners or adhesives. For example, the distal basket 608 can be coupled to the control wire 610 via one or more glues, heat shrinks, crimps, etc. In some embodiments, the distal sheath 614 can extend partially or completely around or around the distal portion 608B of the distal basket 608. For example, the distal sheath 614 can resemble a cap. In an alternative configuration, although not shown, the control wire 610 can extend through the center of the distal sheath 614, such that the distal portion of the control wire 610 can extend beyond the distal end of the distal sheath 614.

[0068] The control wire 610 can extend, for example, along the longitudinal axis 601 through the center of the distal basket 608. For example, the distal basket 608 can extend partially or completely around or around the control wire 610. The proximal portion 608A of the distal basket 608 can be loose or unfixed relative to the control wire 610 so that Figure 6A and Figure 6B In the deployed configuration shown, the proximal portion 608A of the distal basket 608 is radially expanded outward. Thus, when the distal basket 608 is in the deployed state, the proximal opening of the distal basket 608 is oriented in a proximal direction.

[0069] The control wire 610 can extend from the proximal end of the device 600 to the distal end of the device 600. For example, the control wire 610 can extend from the proximal end of the device 600 to the distal end through the lumen of the inner sheath 606. The control wire 610 can move independently relative to the inner sheath 606. For example, when the control wire 610 is extended distally relative to the inner sheath 606, the inner sheath 606 can remain in place. Although not shown, the proximal portion of the control wire 610 can be coupled to an actuator on the handle so that, for example, when the actuator in the handle is actuated, the control wire 610 and the distal basket 608 can be retracted proximally or extended distally relative to the inner sheath 606.

[0070] Similarly, the inner sheath 606 can extend through the lumen of the outer sheath 602 from the proximal end of the device 600 to the distal end of the device 600. The inner sheath 606 can move independently of the outer sheath 602. For example, the outer sheath 602 can remain in position when the inner sheath 606 is proximally retracted or distally advanced relative to the outer sheath 602. In some embodiments, the inner sheath 606 can be extended or moved distally relative to the outer sheath 602 to deploy one or more proximal baskets 604 and distal baskets 608. Although not shown, the proximal portion of the inner sheath 606 can be coupled to a second actuator on the handle such that, for example, when the second actuator in the handle is actuated, the inner sheath 606 and proximal baskets 604 can be proximally retracted or distally advanced. Additionally or alternatively, in such a configuration, the proximal portion of the outer sheath 602 can be coupled to the handle.

[0071] Alternatively, the outer sheath 602 can move independently relative to the inner sheath 606. For example, the inner sheath 606 can remain in position when the outer sheath 602 is retracted proximally or advanced distally relative to the inner sheath 606. For example, retracting or moving the outer sheath 602 proximally relative to the inner sheath 606 can deploy one or more proximal baskets 604 and distal baskets 608. In such a configuration, the proximal portion of the outer sheath 602 can instead be coupled to a second actuator in the handle such that, for example, when the second actuator in the handle is actuated, the outer sheath 602 can move proximally or distally relative to the inner sheath 606.

[0072] One or more of the outer sheath 602 , the inner sheath 606 , and the distal sheath 614 can each be formed from one or more flexible or semi-flexible materials, such as, for example, plastic, polyvinyl chloride (PVC), polyethylene, thermoplastic elastomer (TPE), nylon, silicone, etc. In some configurations, the outer sheath 602 can be transparent or translucent to help a user visualize the position of the proximal basket 604 and / or the distal basket 608 .

[0073] One or more components of the device 600, e.g., one or more outer sheaths 602, the proximal basket 604, the inner sheath 606, the distal basket 608, and / or the control wire 610, can include or be composed of a material that enables a user to visualize the position of each of the one or more components of the device 600 during medical imaging, e.g., fluoroscopy, x-ray imaging, magnetic resonance imaging (MRI), ultrasound, computed tomography (CT), etc. Additionally or alternatively, in a similar manner, one or more components of the device 600 can include one or more radiopaque markers to enable a user to visualize the position of the one or more components of the device 600. For example, the material or marker can be used to position one or more components of the device 600 relative to the object 660. For example, the user may wish to position the distal basket 608 distal to the object 660.

[0074] In an undeployed configuration (not shown) of the device 600, the outer sheath 602 can extend around or around the proximal basket 604, the inner sheath 606, the distal basket 608, and the control wire 610. For example, the proximal basket 604, the inner sheath 606, the distal basket 608, and the control wire 610 can be constrained within the lumen of the outer sheath 602. For example, the outer sheath 602 can extend distally beyond the distal-most portions of the distal basket 608 and / or the control wire 610, e.g., to constrain other components of the device 600. The device 600 can be in an undeployed state, for example, during insertion and / or positioning of the device 600 into a cavity or lumen.

[0075] In some configurations, the outer sheath 602 can be retracted or pulled proximally to deploy or release the proximal basket 604 and the distal basket 608. In an alternative configuration, the distal basket 608 can be constrained within the lumen of the inner sheath 606 such that when the outer sheath 602 is retracted or pulled proximally, only the proximal basket 604 is deployed or released. In such a configuration, the distal basket 608 can be deployed or released by extending or pushing the control wire 610 distally relative to the inner sheath 606.

[0076] like Figure 6AAs shown, once the proximal basket 604 and the distal basket 608 are deployed or released, an opening or gap 612 can separate the proximal basket 604 from the distal basket 608. For example, the gap 612 separating the proximal basket 604 from the distal basket 608 can be large or wide enough so that the distal portion 604B of the proximal basket 604 is proximal to or near the proximal-most portion of the object 660, and the proximal portion 608A of the distal basket 608 is distal to or near the distal-most portion of the object 660. In some cases, the user can manipulate the control wire 610 to position the distal basket 608 and / or the proximal basket 604 relative to the object 660. For example, the user can position the object 660 within or near the gap 612. Additionally or alternatively, the inner sheath 606 and the control wire 610 can each be composed of one or more flexible materials such that the inner sheath 606 and / or the control wire 610 can be axially deflected from the longitudinal axis 601. For example, the inner sheath 606 and / or the control wire 610 can be positioned against the wall of the cavity. For example, offsetting the inner sheath 606 and / or the control wire 610 can facilitate the ability of the device 600 to maneuver around and / or capture the object 660. For example, offsetting the inner sheath 606 and / or the control wire 610 can enable a user to maneuver around and / or capture a larger object 660.

[0077] Additionally or alternatively, the distal portion 604B of the proximal basket 604 and / or the proximal portion 608A of the distal basket 608 can be axially offset from the inner sheath 606, the control wire 610, and / or the longitudinal axis 601. Axially offsetting the distal portion 604B of the proximal basket 604 and / or the proximal portion 608A of the distal basket 608 can also facilitate the ability of the device 600 to maneuver around and / or capture an object 660. For example, offsetting the distal portion 604B of the proximal basket 604 and / or the proximal portion 608A of the distal basket 608 can enable a user to maneuver around and / or capture a larger object 660.

[0078] like Figure 6BAs shown, the proximal basket 604 can be moved or advanced distally by extending the inner sheath 606, and / or the distal basket 608 can be retracted or pulled proximally by retracting or pulling the control wire 610 proximally. Thus, the gap 612 can be reduced or eliminated. For example, the distal-most portion of the proximal basket 604 can abut or contact the proximal-most portion of the distal basket 608. Thus, the object 660 can be captured within each of the proximal basket 604 and the distal basket 608. The device 600 and the object 660 can then be removed from the subject. In some configurations, the distal portion 604B of the proximal basket 604 and / or the proximal portion 608A of the distal basket 608 can at least partially overlap, for example, to assist in enclosing the object 660. For example, the overlap of the distal portion 604B of the proximal basket 604 and / or the proximal portion 608A of the distal basket 608 can enable the distal basket 608 to reduce in diameter when the sheath 602 extends over the proximal basket 604. This configuration can facilitate reducing the outer diameter of the device 600 for removal from a subject. Similarly, the object 660 can be fragmented before being captured within each of the proximal basket 604 and the distal basket 608. Fragmenting the object 660 can assist in further reducing the outer diameter of the device 600 for removal from a subject.

[0079] Figure 7A An alternative embodiment of an exemplary medical device 700 is shown deployed. The device 700 may include a flexible or semi-flexible wire 710. The wire 710 may extend through the ring 702 and the basket 708. Figure 7A and Figure 7B , the wire 710 can extend through the entire basket 708, for example, through the distal portion 708A of the basket 708. Alternatively, the wire 710 can be coupled to an inner wall (not shown) comprising the distal portion 708A of the basket 708. The wire 710 can be coupled to the inner wall of the basket 708 by one or more adhesives and / or mechanical fasteners. Additionally or alternatively, the wire 710 can be coupled to the ring 702 and / or a portion of the basket 708 such that the wire 710 is oriented off-axis relative to the body cavity. In this configuration, for example, the proximal opening of the basket 708 can be larger to facilitate capturing or maneuvering around an object (not shown).

[0080] The ring 702 can form the proximal opening of the basket 708. The ring 702 can be formed from one or more flexible or semi-flexible materials, such as, for example, plastic, nitinol, stainless steel, Elgiloy (e.g., a non-magnetic cobalt-chromium-nickel-molybdenum alloy), a shape memory polymer, or any material known in the art. The ring 702 can be circular, oval, elliptical, square, rectangular, pentagonal, etc. In some configurations, the ring 702 can be configured to fill the diameter of the lumen when deployed. In some aspects, the ring 702 can have an irregular shape.

[0081] The basket 708 can be coupled to the ring 702. For example, the proximal portion of the basket 708 can be coupled to the outer diameter or inner diameter of the ring 702. The basket 708 can be formed similar to a stent and / or composed of, for example, braided wire or wire, mesh, fabric, silicone, or any combination thereof. Additionally or alternatively, the basket 708 (or one or more portions of the basket 708) can include a flexible porous membrane and / or can include a shape memory material. The material forming the basket 708 can help maintain the shape of the basket 708 and / or help prevent one or more portions of the basket 708 from collapsing. In some configurations, the basket 708 can be formed around the ring 702. For example, the ring 702 can be woven into the basket 708.

[0082] In some configurations, the medical device 700 can include more than one ring 702. For example, two, three, four, or more rings 702 can be oriented or spaced along the length of the basket 708. The additional rings 702 can be of similar size or can include a variety of shapes and sizes. For example, the rings 702 in the proximal portion of the basket 708 can be larger (e.g., have a larger diameter) than the rings 702 in the distal portion of the basket 708, or vice versa, to form a tapered configuration for the basket 708.

[0083] In some configurations, the device 700 can include a control wire 712. The control wire 712 can extend through the lumen of the outer sheath 704 (e.g., from the proximal end to the distal end). In an alternative configuration, the control wire 712 can extend outwardly to the outer sheath 704 (e.g., Figure 7A 704 ). The proximal end of the control wire 712 may include a free end (not shown) or may be coupled to a handle (not shown) to assist in pulling the control wire 712 proximally or pushing the control wire 712 distally. The distal end of the control wire 712 may be coupled to the distal-most portion of the wire 710 such that, for example, at least a portion of each of the ring 702 and the basket 708 is located between the wire 710 and the control wire 712. Thus, when the control wire 712 is pulled or otherwise pushed proximally, the ring 702 and the basket 708 may collapse against the wire 710. This may enable a user to more easily extend and / or retract the outer sheath 704 around the ring 702 and / or the basket 708, and / or assist in removing the device 700 from a subject. Additionally or alternatively, distal movement of the control wire 712 may cause the ring 702 and the basket 708 to expand.

[0084] Although one control wire 712 is shown, alternative configurations may include two, three, four, or more control wires 712. Additional control wires 712 may be positioned around the ring 702 and basket 708 so that when the control wire 712 is pulled or otherwise pushed proximally, the ring 702 and basket 708 collapse more evenly against the wire 710. Similarly, the additional control wires 712 may assist in the expansion of the ring 702 and basket 708.

[0085] In an undeployed configuration (not shown) of the device 700, the outer sheath 704 can extend around or around the ring 702 and the basket 708. For example, the ring 702 and the basket 708 can be positioned within a lumen of the outer sheath 704. The outer sheath 704 can be retracted or pulled proximally, and / or the wire 710 can be extended or advanced distally, to deploy the ring 702 and the basket 708 from the outer sheath 704.

[0086] Figure 7B An alternative embodiment of an exemplary medical device 700' is shown deployed. For example, Figure 7B An alternative configuration for ring 702 of device 700' is shown. Similar to device 700, ring 702' can form a proximal opening of basket 708. In this configuration, ring 702' can be adjustable. For example, ring 702' can be composed of at least two segments 702'A and 702'B. One or more joints 703 can couple segment 702'A to segment 702'B. For example, joints 703 can include hinges, swivel joints, pivots, bends, etc. to allow segment 702'B to move relative to segment 702'A, or vice versa. Joints 703 can be spring-loaded. A portion of segment 702'A can be configured to receive a segment of 702'B, for example, at the end of segment 702'A. Thus, the diameter of ring 702' can be adjustable. For example, segment 702'A can include a cavity (not shown) and have a larger cross-sectional diameter than that of segment 702'B. The cavity (not shown) can be sized to receive segment 702'B, for example, at end 705 of segment 702'A. Thus, when segment 702'B is received by segment 702'A, the diameter of ring 702' can decrease. When segment 702'B is released from segment 702'A, the diameter of ring 702' can increase.

[0087] Basket 708 can be coupled to ring 702'. For example, a proximal portion of basket 708 can be coupled to segments 702'A and / or 702'B. In some configurations, basket 708 can be formed around ring 702'. For example, segments 702'A and / or 702'B can be woven into basket 708.

[0088] Similar to device 700, in an undeployed configuration (not shown) of device 700', outer sheath 704 can extend around or around ring 702' and basket 708. For example, ring 702' and basket 708 can be positioned within a lumen of outer sheath 704. Outer sheath 704 can be retracted or pulled proximally, and / or wire 710 can be extended or advanced distally to deploy ring 702' and basket 708 from outer sheath 704.

[0089] The movement of segment 702'B to segment 702'A, or vice versa, can be controlled by, for example, the natural movement of the lumen. For example, as the diameter of the lumen increases, the diameter of ring 702' can increase, as described above. Similarly, as the diameter of the lumen decreases, the diameter of ring 702' can decrease, as described above. Although not shown, device 700' can include one or more control wires having the same characteristics as control wire 712 of device 700, such as Figure 7A For example, a control wire (not shown) can be coupled to segments 702 ′A and / or 702 ′B and can facilitate expansion and / or collapse of ring 702 ′ and basket 708 .

[0090] exist Figure 7A and Figure 7B In the illustrated embodiment, devices 700 and 700' can be used to capture an object (not shown) within a cavity, for example, within basket 708. For example, rings 702 and 702' can be positioned distally relative to the object. Once rings 702, 702' and basket 708 are released or deployed from outer sheath 704, devices 700 and 700' can be retracted or pulled proximally to capture the object within basket 708. Once the object is captured, devices 700 and 700' can be removed from the subject.

[0091] Figure 8A and Figure 8B An alternative embodiment of an exemplary medical device 800 is shown deployed. The device 800 may include a basket 808 and a ring 802, which may have any of the characteristics of the basket 708 and ring 702 or 702' of the device 700 and / or 700', except as described below. Alternatively, the device 800 may include a flexible or semi-flexible wire 810, which may have any of the characteristics of the device 700 and / or 700'. For example, Figure 8A and Figure 8B As shown, wire 810 can extend through the entire basket 808. Alternatively, wire 810 can be coupled to an inner wall (not shown) comprising basket 808. Wire 810 can be coupled to the inner wall of basket 808 by one or more adhesives and / or mechanical fasteners.

[0092] The distal end of the control wire 812 can be coupled to the ring 802. The control wire 812 can extend through the lumen of the outer sheath 804 (e.g., from the proximal end to the distal end). In an alternative configuration, the control wire 812 can extend outwardly to the outer sheath 804. The proximal end of the control wire 812 can include a free end (not shown) or can be coupled to a handle (not shown) to assist in pulling the control wire 812 proximally or pushing the control wire 812 distally.

[0093] like Figure 8AAs shown, the distal end of the control wire 812 can be coupled to a portion of the ring 802. For example, the control wire 812 can be coupled to a portion of the ring 802 that is opposite the location of the wire 810 relative to the ring 802. Alternatively, the control wire 812 can be coupled to the ring 802 at one or more other locations. For example, the control wire 812 can be coupled to one or more sides of the ring 802. In some configurations, the control wire 812 can enable a user to manipulate, open, and / or close the proximal opening of the basket 808.

[0094] like Figure 8B As shown, the proximal opening 809 of the basket 808 can be angled relative to the control wire 810. For example, a portion of the proximal opening 809 opposite the wire 810 can be located more distally than the upward portion of the proximal opening 809. When the control wire 812 is pulled or otherwise pushed proximally, the portion of the proximal opening 809 opposite the wire 810 can also be pulled or otherwise pushed proximally, such that the portion of the proximal opening 809 opposite the wire 810 is located more proximal to the portion of the proximal opening 809 adjacent to the wire 810. In this movement, the basket 808 can be used to "scoop" an object (not shown) into the basket 808. Additionally, because the wire 810 is offset from the center of the basket 808 and / or because the proximal opening 809 is angled relative to the control wire 810, the proximal opening 809 can be larger to facilitate capturing larger objects (not shown).

[0095] Figure 9 An alternative embodiment of an exemplary medical device 900 is shown deployed in an open configuration. The device 900 may include a proximal basket 908A and a distal basket 908B. The proximal basket 908A and the distal basket 908B may be oriented in a similar manner to the proximal basket 604 and the distal basket 608 of the device 600, as shown in FIG. Figure 6A and Figure 6B As shown. The proximal basket 908A and the distal basket 908B may have Figure 7A and 7B Basket 708 and / or Figure 8A and Figure 8B Additionally, the device 900 may include a proximal ring 902A and a distal ring 902B, which may have Figure 7A Ring 702 and / or Figure 8A and Figure 8B Any of the characteristics of one or more of the rings 802 in .

[0096] The proximal basket 908A and the distal basket 908B can be formed from the same material. Alternatively, the proximal basket 908A and the distal basket 908B can be formed from different materials with different properties or from the same material with different properties. For example, if the proximal basket 908A is composed of braided nitinol wires or wires in a manner similar to a stent, the wires or wires forming the proximal basket 908A can be sized and / or spaced differently than the wires or wires forming the distal basket 908B. Many other combinations are possible.

[0097] The inner sheath 906 can extend through a portion of the basket 908A. For example, the inner sheath 906 can extend through an aperture 911 on an outer surface of the proximal basket 908A. A portion of the proximal basket 908A can be coupled to the outer surface of the inner sheath 906 such that the proximal basket 908A moves (e.g., proximally and / or distally) with movement of the inner sheath 906. The proximal basket 908A can be coupled to the inner sheath 906, for example, via one or more fasteners or adhesives. For example, the proximal basket 908A can be coupled to the sheath 906 via one or more glues, heat shrinks, crimps, etc. The proximal basket 908A can extend partially or completely around or around the inner sheath 906. The proximal portion of the proximal basket 908A can be loose or unsecured relative to the inner sheath 906. Thus, when the proximal basket 908A is in the deployed configuration, the ring 902A can expand and the distal opening of the proximal basket 908A is oriented in a distal direction.

[0098] A portion of the distal basket 908B can be coupled to an outer surface of the control wire 910. The distal basket 908B can be coupled to the control wire 910, for example, via one or more fasteners or adhesives. For example, the distal basket 908B can be coupled to the control wire 910 via one or more glues, heat shrinks, crimps, etc. In some configurations, although not shown, the control wire 910 can extend through the distal basket 908B such that the distal portion of the control wire 910 can extend beyond the distal portion of the distal basket 908B. For example, the distal basket 908B can extend partially or completely around or around the control wire 910. Thus, when the distal basket 908B is in a deployed state, the ring 902B can expand and the proximal opening of the distal basket 908B can be oriented in a proximal direction.

[0099] The control wire 910 can extend from the proximal end of the device 900 to the distal end of the device 900. For example, the control wire 910 can extend from the proximal end of the device 900 to the distal end through the lumen of the inner sheath 906. The control wire 910 can move independently relative to the inner sheath 906. For example, when the control wire 910 is extended distally relative to the inner sheath 906, the inner sheath 906 can remain in place. Although not shown, the proximal portion of the control wire 910 can be coupled to an actuator on the handle so that, for example, when the actuator in the handle is actuated, the control wire 910 and the distal basket 908B can be retracted proximally or extended distally relative to the inner sheath 906.

[0100] Similarly, the inner sheath 906 can extend through the lumen of the outer sheath 904 from the proximal end of the device 900 to the distal end of the device 900. The inner sheath 906 can move independently of the outer sheath 904. For example, the outer sheath 904 can remain in position when the inner sheath 906 is proximally retracted or distally advanced relative to the outer sheath 904. In some embodiments, the inner sheath 906 can be extended or moved distally relative to the outer sheath 904 to deploy one or more proximal baskets 908A and distal baskets 908B. Although not shown, the proximal portion of the inner sheath 906 can be coupled to a second actuator on the handle such that, for example, when the second actuator in the handle is actuated, the inner sheath 906 and the proximal baskets 908A can be proximally retracted or distally advanced. Additionally or alternatively, in such a configuration, the proximal portion of the outer sheath 904 can be coupled to the handle.

[0101] Alternatively, the outer sheath 904 can move independently relative to the inner sheath 906. For example, the inner sheath 906 can remain in position when the outer sheath 904 is retracted proximally or advanced distally relative to the inner sheath 906. For example, retracting or moving the outer sheath 904 proximally relative to the inner sheath 906 can deploy one or more proximal baskets 908A and distal baskets 908B. In such a configuration, the proximal portion of the outer sheath 904 can instead be coupled to a second actuator in the handle such that, for example, when the second actuator in the handle is actuated, the outer sheath 904 can move proximally or distally relative to the inner sheath 906.

[0102] One or more of the outer sheath 904 and the inner sheath 906 can each be formed from one or more flexible or semi-flexible materials, such as, for example, plastic, polyvinyl chloride (PVC), polyethylene, thermoplastic elastomer (TPE), nylon, silicone, etc. In some configurations, the outer sheath 904 can be transparent or translucent to help a user visualize the position of the proximal basket 908A and / or the distal basket 908B.

[0103] One or more components of the device 900, e.g., one or more outer sheaths 904, the proximal basket 908A, the inner sheath 906, the distal basket 908B, and / or the control wire 910, can include or be composed of a material that enables a user to visualize the position of each of the one or more components of the device 900 during medical imaging, e.g., fluoroscopy, x-ray imaging, magnetic resonance imaging (MRI), ultrasound, computed tomography (CT), etc. Additionally or alternatively, in a similar manner, one or more components of the device 900 can include one or more radiopaque markers to enable a user to visualize the position of the one or more components of the device 900. For example, the material or marker can be used to position one or more components of the device 900 relative to an object (not shown). For example, a user may wish to position the distal basket 908B distal to the object.

[0104] In an undeployed configuration (not shown) of the device 900, the outer sheath 904 can extend around or about the proximal basket 908A, the inner sheath 906, the distal basket 908B, and the control wire 910. For example, the proximal basket 908A, the inner sheath 906, the distal basket 908B, and the control wire 910 can be constrained within the lumen of the outer sheath 904. For example, the outer sheath 904 can extend distally beyond the distal-most portion of the distal basket 908B and / or the control wire 910, e.g., to constrain other components of the device 900. The device 900 can be in an undeployed state, for example, during insertion and / or positioning of the device 900 into a cavity or lumen.

[0105] In some configurations, the outer sheath 904 can be retracted or pulled proximally to deploy or release the proximal basket 908A and the distal basket 908B. Alternatively or additionally, the inner sheath 906 and / or the control wire 910 can be extended distally to deploy or release the proximal basket 908A and the distal basket 908B. In an alternative configuration, the distal basket 908B can be constrained within the lumen of the inner sheath 906 such that only the proximal basket 908A is deployed or released when the outer sheath 904 is retracted or pulled proximally. In such a configuration, the distal basket 908B can be deployed or released by extending or pushing the control wire 910 distally relative to the inner sheath 906.

[0106] like Figure 9As shown, once proximal basket 908A and distal basket 908B are deployed or released, an opening or gap 912 can separate proximal basket 908A from distal basket 908B. For example, gap 912 separating proximal basket 908A from distal basket 908B can be large or wide enough so that the distal portion of proximal basket 908A is proximal to or adjacent to an object (not shown) and the proximal portion of distal basket 908B is distal to or adjacent to the object. In some cases, a user can manipulate control wire 910 and / or inner sheath 906 to position distal basket 908B and / or proximal basket 908A relative to the object. For example, a user can position the object within or adjacent to gap 912.

[0107] Although not shown, in the closed configuration, the proximal basket 908A can be moved or advanced distally by extending the inner sheath 906, and / or the distal basket 908B can be retracted or pulled proximally by retracting or pulling the control wire 910 proximally. Thus, the gap 912 can be reduced or eliminated. For example, the distal-most portion of the proximal basket 908A can abut or contact the proximal-most portion of the distal basket 908B. Thus, the object or one or more portions of the object (not shown) can be captured within one or more of the proximal and distal baskets 908A, 908B. Additionally or alternatively, the object can be sandwiched between the proximal and distal baskets 908A, 908B. The device 900 and the object can then be removed from the subject.

[0108] In some configurations, the distal portion of the proximal basket 908A and the proximal portion of the distal basket 908B can at least partially overlap, for example, to facilitate enclosing an object within the proximal basket 908A and the distal basket 908B. For example, the overlap of the distal portion of the proximal basket 908A and the proximal portion of the distal basket 908B can enable the distal basket 908B to reduce in diameter when the outer sheath 904 extends over the proximal basket 908A. This configuration can facilitate reducing the outer diameter of the device 900 for removal from a subject.

[0109] It will be apparent to those skilled in the art that various modifications and variations can be made to the disclosed apparatus without departing from the scope of the invention. Other embodiments of the invention will be apparent to those skilled in the art from consideration of this specification and practice of the disclosed invention. It is intended that the description and examples be considered exemplary only, with the true scope and spirit of the invention being indicated by the following claims.

Claims

1. A medical system comprising: a tube having a lumen; as well as an expandable device having a proximal portion, a distal portion, and an intermediate portion between the proximal portion and the distal portion, wherein the expandable device includes a lumen extending from the proximal portion to the distal portion; wherein in a first configuration, the expandable device is positioned within the lumen of the tube in an unexpanded state, and the distal end of the distal portion is open, wherein in a second configuration, the expandable device at least partially extends from the lumen of the tube in an expanded state, and a distal end of the distal portion is open and larger than the distal end in the first configuration, wherein in a third configuration, the expandable device at least partially extends from the lumen of the tube in the expanded state, and the distal end of the distal portion is at least partially closed, and Wherein in the third configuration, the expandable device is configured to retract proximally and retain one or more objects or materials within the expandable device.

2. The medical system of claim 1, further comprising an endoscope configured to be delivered through the lumen and at least partially through the lumen of the expandable device.

3. The medical system of claim 2, wherein the endoscope comprises one or more visualization devices.

4. The medical system of any preceding claim, further comprising an energy delivery device configured to be delivered through the lumen and at least partially through the lumen of the expandable device.

5. The medical system of claim 4, wherein the energy delivery device is an electrohydraulic lithotripsy (EHL) probe configured to at least partially fragment or break up gallstones.

6. The medical system of any preceding claim, wherein the expandable device is formed from braided nitinol wire.

7. The medical system of any preceding claim, wherein in the second configuration, the distal end of the distal portion is configured to enlarge a lumen or duct. The medical system of claim 7 , wherein the conduit is a bile duct.

9. A medical system according to any preceding claim, further comprising one or more pull wires, wherein the one or more pull wires are connected to the distal end of the expandable device and extend proximally, wherein retracting the one or more pull wires proximally causes the distal end of the expandable device to transition from being open in the second form to being at least partially closed in the third form.

10. The medical system of any preceding claim, wherein the distal portion tapers towards the intermediate portion in the third configuration.

11. The medical system of claim 9 or 10, wherein the one or more puller wires extend proximally outside of the expandable device.

12. The medical system of claim 9 or 10, wherein the one or more puller wires extend proximally through the lumen of the expandable device.

13. The medical system of any preceding claim, wherein the expandable device is configured to transform to a fourth configuration when proximally retracted, wherein in the fourth configuration the proximal portion, the intermediate portion, and the distal portion form a single portion.

14. A medical system according to any preceding claim, wherein the inner surface of the expandable device includes a radial extension that is configured to dock with the distal end of the medical device or endoscope so that distal movement of the medical device or endoscope advances the expandable device distally.

15. The medical system of any preceding claim, further comprising a basket configured to retain the one or more objects or materials removed with the expandable device.

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