Medical device and methods of use

The present disclosure is directed to a medical device. Systems and methods are provided for utilizing a laser to break a kidney stones into smaller fragments and/or dust, and removing particles, stone fragments and/or stone dust from a patient. The medical device may include a delivery device including a tube, and an elongate member having a distal end, a proximal end, and a lumen extending between the proximal end and the distal end, wherein the elongate member is configured to move axially relative to the tube and apply suction through the distal end.

TECHNICAL FIELD

The present disclosure relates generally to medical devices. More particularly, the disclosure relates to medical devices used, for example, in breaking objects into smaller particles, and removing the resulting particles from a patient. The disclosure also relates to methods of using such devices.

BACKGROUND

The incidence of hospitalization for the removal of urinary calculi, commonly referred to as kidney stones, has been estimated at 200,000 cases per year. A vast majority of these patients pass their stones spontaneously; however, in the remainder, the kidney stone(s) become impacted in the ureter, a muscle tube joining the kidney to the bladder. An impacted kidney stone is a source of intense pain and bleeding, a source of infection and, if a stone completely blocks the flow of urine for any extended length of time, can cause the loss of a kidney.

Recently, various methods have been utilized to break the stone into smaller fragments. One such method is stone dusting. Stone dusting is used by some urologists to fragment and evacuate stones from a kidney and is often performed by a ureteroscope. Intense light energy from a laser within the ureteroscope breaks the stone into increasingly smaller pieces. However, in some cases, the stone and/or the stone fragments may be pushed away from the ureteroscope by the laser, thus making it impossible to continue to break the stone or stone fragments into smaller fragments without repositioning the ureteroscope. The disclosure addresses the above-mentioned process and other problems in the art.

Further, rather than breaking up the stone into chunks, which are removed by baskets, dusting generates very small fragments that are capable of being passed naturally. However, in some cases, these small stone fragments may not pass naturally. For example, the stone fragments may collect in an area of the kidney where they are less likely to flow out naturally, such as the lower calyx of the kidney. In theory, any of these small stone fragments that do not evacuate through natural urine flow, could be a seed for new stone growth. Thus, the application of suction may be employed to remove the stone dust. Breaking up a stone and providing suction requires a working channel with a sufficient internal cross-sectional area to receive a laser fiber and a lumen with sufficient internal cross-sectional area to allow stone fragments and/or dust to pass through without clogging. The combined cross-sectional areas of these two elements may make a device too large to reach the target kidney stone. For example, the kidney stone may be within the kidney, or, specifically, within the lower calyx of the kidney. Often, the space within the kidney and/or lower calyx of the kidney is more limited than the space within the ureter and this space may not be large enough to accommodate both a working channel for a laser fiber and a lumen for applying suction. The disclosure addresses the above-mentioned process and other problems in the art.

SUMMARY OF THE DISCLOSURE

Aspects of the present disclosure provide device and methods for breaking an object into smaller particles and removing said particles from portions of the human body.

In one example, a medical device may include a delivery device including a tube, and an elongate member having a distal end, a proximal end, and a lumen extending between the proximal end and the distal end, wherein the elongate member is configured to move axially relative to the tube and apply suction through the distal end.

Examples of the medical device may additionally and/or alternatively include one or more other features. Features of the various examples described in the following may be combined unless explicitly stated to the contrary. For example, the proximal end of the elongate member may be forked. The proximal end of the elongate member may be connected to a control system. The control system may control the vacuum source. The proximal end of the elongate member may be in fluid communication with a vacuum source. The medical device may include a sleeve, wherein the sleeve may be configured to receive the tube and the elongate member simultaneously. The delivery device may be one of ureteroscope, sheath, catheter, or endoscope. The medical device may include a laser fiber connected to the tube. The lumen of the elongate member may be substantially D-shaped. The tube may include an illumination device. The tube may include an imaging device. The tube may have a first engaging surface, and the elongate member may have a second engaging surface, and the first engaging surface may be substantially complementary of the second engaging surface. The elongate member may be in fluid communication with a fluid source. The lumen of the elongate member may have an inner diameter of approximately 1 mm to approximately 3.5 mm. The elongate member may be at least partially controlled by a control system and the tube may be at least partially controlled by a handle.

In another example, a method operating a medical device may include positioning a distal end of an elongate member of the medical device at a target area, applying suction through a lumen of the elongate member to seal an object to the distal end of the elongate member, and moving the distal end of the elongate member to move the object sealed to the distal end of the elongate member.

Examples of the method of operating the medical device may additionally and/or alternatively include one or more other features. For example, prior to positioning the distal end of the elongate member of the medical device at the target area, the method may include positioning the distal end of the elongate member proximal to the target area, and supplying dye through the lumen of the elongate member to the distal end of the elongate member. The method may include moving the object proximate to a tube, disposing a laser fiber within the tube, and initiating the laser.

In another example, a method operating a medical device may include positioning a distal end of an elongate member of the medical device distal to a distal end of a tube of the medical device, applying suction through a lumen of the elongate member to seal a kidney stone to the distal end of the elongate member, and moving the distal end of the elongate member to move the kidney stone sealed to the distal end of the elongate member proximally toward the distal end of the tube.

Examples of the method of operating the medical device may additionally and/or alternatively include one or more other features. For example, the method may include disposing a laser fiber within the tube, and initiating the laser.

DETAILED DESCRIPTION

Reference is now made in detail to examples of the present disclosure, examples of which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts. The term “distal” refers to a position farther away from a user end of the device. The term “proximal” refers a position closer to the user end of the device. As used herein, the terms “approximately” and “substantially” indicate a range of values within +/−5% of a stated value.

Overview

Aspects of the present disclosure relate to systems and methods for breaking kidney stones into smaller particles and removing those particles from a target area of a patient's body. The medical device described herein may work by securing an elongate member for suction to an outer surface of a tube of a delivery device. A distal end of the tube and a distal end of the elongate member may be positioned within a ureter of a patient. In some examples, radiopaque dye may be injected into the target area, e.g., the kidney, from a lumen of the elongate member. Then, the elongate member may be extended distally to a retrieval position in which the distal end of the elongate member is positioned within the target area, e.g., the lower calyx of the kidney, and/or proximate the target kidney stone. Suction may be applied through the elongate member, pulling the stone toward a distal opening of the elongate member until the stone contacts and forms a seal with the distal opening of the elongate member. The formed seal secures the kidney stone to the distal opening of the elongate member. With the stone secured to the elongate member, the elongate member may be retracted or pulled proximally toward the distal end of the tube until the elongate member is in the operating position, e.g., the secured stone is proximate a distal opening of the tube. At this point, a laser fiber, disposed within the tube, may be used to break up kidney stones into particles. It should be noted that the stone may be broken into particles in any way known in the art, including the application of ultrasound and/or sound waves on the stone. Once the stone is broken into particles that are smaller than the distal opening the elongate member, the seal may be broken and/or particles may be suctioned into the lumen of the elongate member. These particles may be vacuumed through the elongate member and out of the patient's body.

DETAILED EXAMPLES

FIG. 1illustrates medical device100for removing stones from a patient's body. Medical device100may include a retrieval system. The retrieval system may include elongate member202and control system210. Elongate member202may be a hollow, flexible, elongate tube having a distal end204and a proximal end206and at least one lumen (e.g., lumen214ofFIGS. 2A-B) extending therebetween. Proximal end206of elongate member202may be coupled to control system210, vacuum source250, and/or fluid source280. As shown inFIG. 1, medical device100may include a delivery device. The delivery device may be, for example, any traditional delivery device, including a ureteroscope, sheath, catheter, endoscope, etc. The delivery device may include a tube102and a handle portion110. Tube102may be a hollow, flexible, elongate tube having a distal end104and a proximal end106and at least one lumen (e.g., lumen112ofFIGS. 2A-B) extending therebetween. Proximal end106of tube102may be coupled to handle portion110. The handle portion110and/or the proximal end106of tube102may be attached to a laser control130and/or a fluid supply assembly140. In some examples, medical device100may include a sleeve302and fastener136. Sleeve302and fastener136may be any mechanism known in the art for allowing elongate member202(and/or the entirety of the retrieval device) to move axially relative to tube102and prevent radial movement of elongate member202relative to tube102.

Depending upon the particular implementation and intended use, the length of tube102, elongate member202, and/or sleeve302may vary. In the example shown inFIG. 1, sleeve302may be shorter in length than tube102and elongate member202. Depending upon the particular implementation and intended use, tube102, elongate member202, and/or sleeve302can be rigid along its entire length, flexible along a portion of its length, or configured for flexure at only certain specified locations. In one example, tube102, elongate member202, and/or sleeve302may be flexible, adapted for flexible steering within bodily lumens, as understood in the art. For example, tube102can include a steering system (not shown) to move at least a portion (e.g., distal end104) up/down and/or side-to-side. Additional degrees of freedom, provided for example via rotation, translational movement of tube102, or additional articulation of bending sections, may also be implemented. Examples of such steering systems may include at least one of or more of pulleys, control wires, gearing, and electrical actuators.

Tube102, elongate member202, and/or sleeve302may be formed of any suitable material having sufficient flexibility to traverse body cavities and tracts. In general, tube102, elongate member202, and/or sleeve302may be made of any suitable material that is compatible with living tissue or a living system. That is, tube102, elongate member202, and/or sleeve302may be non-toxic or non-injurious, and it should not cause immunological reaction or rejection. In some examples, tube102, elongate member202, and/or sleeve302may be made of polymetric elastomers, rubber tubing, and/or medically approved polyvinylchloride tubing. Polymeric elastomers may be, for example, EVA (Ethylene vinyl acetate), silicone, polyurethane, and/or C-Flex.

Further, tube102, elongate member202, and/or sleeve302may include any suitable coating and/or covering. For example, the outer surface may include a layer of lubricous material to facilitate insertion through a body lumen or through sleeve302. Further, tube102, elongate member202, and/or sleeve302may be coated with a biocompatible material such as Teflon. To inhibit bacterial growth in the body cavity, tube102, elongate member202, and/or sleeve302may be coated with an antibacterial coating. Further, an anti-inflammatory substance may also be applied to the outer surface of the tube102, elongate member202, and/or sleeve302, if required.

Tube102, elongate member202, and/or sleeve302may be designed to impose minimum risk to the surrounding tissues while in use. To this end, one or more portions of tube102, elongate member202, and/or sleeve302may include atraumatic geometrical structures, such as rounded or beveled terminal ends or faces (e.g., distal end104of tube102), to reduce trauma and irritation to surrounding tissues.

Sleeve302may be hollow and configured to slidably receive tube102and elongate member202simultaneously. Tube102may be circular, ovoidal, irregular, and/or any shape suitable to enter a body and/or receive tube102and elongate member202. In some examples, a lumen running through sleeve302may be shaped to accommodate the size and shape of tube102and elongate member202. In other examples, the lumen may be substantially circular and sleeve302may be made of elastic material to stretch to accommodate the size and shape of the combination of tube102and elongate member202. A lumen extending through sleeve302may include any suitable coating. For example, the lumen may include a layer of lubricous material, for example, to facilitate insertion of tube102and elongate member202.

II. Delivery Device

As previously described, medical device100may include a delivery device. The delivery device may be, for example, any delivery device known in the art, including ureteroscope, sheath, catheter, endoscope, etc. The delivery device may include a tube102and a handle portion110.

A. Handle Portion

Handle portion110can be attached to proximal end106of tube102by, for example, welding, a locking configuration, use of an adhesive, or integrally forming with tube102. The handle portion110may include a plurality of ports. For example, a first port may supply to distal end104of tube102a laser fiber (e.g., laser fiber120) coupled to laser control (e.g., laser control130). In some examples, a second port may place lumen112in fluid communication with a fluid supply assembly (e.g., fluid supply assembly140). Additional ports and lumens may be provided for supplying and/or controlling an illumination device and/or an imaging device located at or near distal end104of tube102. The handle portion110may include an actuating mechanism (not shown) to actuate one or more medical devices that may be located at the distal end104of tube102. For example, handle portion110may include an actuating mechanism to power on or off the laser, the illumination device, and/or the imaging device.

B. The Tube

Tube102may be circular, ovoidal, irregular, and/or any shape suitable to enter a body. Further, tube102may have a uniform shape along its length, or may having a varying shape, such as a taper at the distal end to facilitate insertion within the body. In some embodiments of the present disclosure, the distal end104of tube102includes visualization devices such as a camera and/or a light source. These devices may attach to the distal end104using known coupling mechanisms. Alternatively, the visualization devices may be detachably introduced into tube102through lumen112(or a separate lumen, e.g., lumen124or126ofFIGS. 2A-B) when required.

Lumen112may be defined by an elongate hollow lumen that extends between proximal end106and distal end104of tube102. Lumen112may be any size, shape, and/or in any configuration within tube102. Exemplary cross-sections of tube102and lumen112will be described in further detail below with respect toFIGS. 3A and 3B.

III. Retrieval System

As previously described, medical device100may include a retrieval system. The retrieval system may include elongate member202and control system210.

A. The Elongate Member

Elongate member202may be circular, ovoidal, irregular, and/or any shape suitable to enter a body and/or sleeve302. Further, elongate member202may have a uniform shape along its length, or may having a varying shape, such as a taper at the distal end to facilitate insertion within the body. In some embodiments of the present disclosure, the distal end204of elongate member202includes reinforced section226. The walls of reinforced section226may be thicker than the remainder of elongate member202. This may prevent distortion of the reinforced section226when a stone is vacuumed and held against a distal opening/distal end204(as described in further detail below with respect toFIGS. 5A-C).

Lumen214may be defined by an elongate hollow lumen that extends between proximal end206and distal end204of elongate member202. Lumen214may be any size, shape, and/or in any configuration within elongate member202. For example, the inner diameter of lumen214may be approximately 1 mm to approximately 3.5 mm, approximately 1.5 mm to approximately 3 mm, or approximately 2 mm to approximately 3 mm. Exemplary cross-sections of elongate member202and lumen214will be described in further detail below with respect toFIGS. 3A and 3B.

In some examples, elongate member202may act as a guidewire to guide attached tube202. For example, elongate member202may be inserted into the body before the insertion of tube102, and tube102may be tracked along an outer surface (e.g., engaging surface284) of elongate member202in order to position tube102within the body. It should be noted that any of lumens112or214may additionally or alternatively be configured to receive a guidewire. In some embodiments, lumen214may receive a guidewire to facilitate positioning elongate member202in the body.

To effectively maneuver the elongate member202within a body cavity and, for example, position distal end204proximate of a kidney stone within a lower calyx of a kidney, an operator may need to know the exact location of the elongate member202in the body. To this end, one or more portions of elongate member202may be made of radiopaque, such as by inclusion of barium sulfate in plastic material or inclusion of one or more metal portions, which provide sufficient radiopacity. In some examples, elongate member202may have a radiopaque coating. Additionally or alternatively, distal end204of elongate member202may include radiopaque or sonoreflective markers (not shown). These markings facilitate detection of a position and/or orientation of elongate member202within a patient's body, and an operator, with the aid of suitable imaging equipment, may track the path followed by elongate member202. This may help the operator avoid potential damage to sensitive tissues. By using fluoroscopic guidance, elongate member202may be located without the visualization devices within tube102and, therefore, move independently of and/or not within the field of view of these visualization devices. Further, with such guidance, the space within elongate member202that would be needed for direct visualization (e.g., an imaging apparatus) may instead be used to maximize the size of the lumen and/or the flow rate of the suction.

FIGS. 2A-Billustrate exemplary distal ends of medical device100with elongate member202in a retrieval position and an operating position, respectively. As shown inFIG. 2A, in a retrieval position, distal end204of elongate member202may be distal of the distal end104of tube102. In an operating position, as shown inFIG. 2B, distal end204of elongate member202may be closer to and/or flush with the distal end104of tube102.

FIG. 3Aillustrates a cross-sectional view of an exemplary medical device100. This view may, for example, be at line3-3ofFIG. 1. As shown, tube102may include a lumen112, illumination device126, imaging apparatus124, and/or engaging surface184. Lumen112may be semi-circular in shape. Lumen112, however, may have any cross-sectional size and/or shape. In the example shown inFIG. 3A, engaging surface184may be substantially planar. Engaging surface184is not limited thereto and may have shape, including any shape that is substantially complementary with an engaging surface of an elongate member (e.g., engaging surface284of tube202). For example, as shown inFIG. 3A, elongate member202has a substantially planar engaging surface284. Lumen214of elongate member202may be substantially D-shaped, however, lumen214is not limited thereto and may have any cross-sectional size and/or shape.FIG. 3Ashows a space between engaging surface284of elongate member202and engaging surface184of tube102. In some examples, however, gravity may pull and/or sleeve302may push engaging surface284of elongate member202to contact engaging surface184of tube102. Sleeve302should be configured to avoid so much friction as to restrict axial movement of elongate member202relative to tube102. Spaces304are spaces between an interior wall of sleeve302and the outer surfaces of elongate member202and/or tube102. In some examples, these spaces may be minimized, for example, if sleeve302is made of an elastic material configured to “hug” on the outer surfaces of elongate member202and/or tube102.

FIG. 3Billustrates a cross-sectional view of an alternative exemplary medical device100. This view may, for example, be at line3-3ofFIG. 1. As shown, the cross-sectional area of elongate member202′ and lumen214′ of elongate member202′ are substantially circular. Tube102includes a lumen112, illumination device126, imaging apparatus124, and/or engaging surface184′. Engaging surface184′ is substantially concave and may be substantially complementary to an outer surface of elongate member202′.

It should be noted that in some examples, elongate member202and/or elongate member202′ may be configured to engage (and/or slide across) an outer surface of a conventional or substantially circular delivery device. In such examples, engaging surface284and/or284′ may be concave and/or be complementary with the outer surface of a substantially circular delivery device.

B. Control System

FIG. 4is an enlarged exemplary view of proximal end206of elongate member202and control system210. Distal of proximal end206, elongate member202may fork, for example, into first end214and second end244. First end244of elongate member202may be open and configured to attach to, for example any fluid source known in the art, e.g., a fluid source280ofFIG. 1. For example, dye or, more specifically, radiopaque dye may be within fluid source280.

Second end214of elongate member202may attach to control system210by, for example, a locking configuration, use of an adhesive, or integrally forming with elongate member202. Control system210may allow an operator to control operation of the retrieval system. For example, as described in further detail below, control system210may include the ability to control steering of elongate member202, introduce dye into elongate member202, and/or apply suction through elongate member202. In some examples, control system210may include or be in fluid communication with a vacuum source, e.g., vacuum source250ofFIG. 1. A vacuum source may include a house vacuum, vacuum pump, compressor unit, etc. Control system210may include any input devices known in the art, including buttons, switches, keyboards, dials, touchscreens, etc. Input device230may, for example, be an on-off button to turn on or off the vacuum source and either apply or cease application of suction from distal end204of elongate member202. Input device230may be a dial for adjusting the flow rate of this suction.

IV. Insertion and Operation of the Medical Device

FIG. 5A-Cillustrate an exemplary method of operation of medical device100, including an enlarged view of upper ureter406and lower calyx410of kidney408. Kidney stones470and472are located in lower calyx410. As previously mentioned, the space within calyx410of kidney408is often more limited than the space within the ureter406.

An operator (e.g., a doctor or other medical professional) may connect elongate member202and tube102by sliding their respective distal ends through a proximal opening of sleeve302. In some examples, medical device100may be pre-assembled and this step may omitted. In some examples, one or both of tube102and elongate member202may be separately or simultaneously inserted into patient's urethra, through the urinary bladder, and into ureter406. In examples in which elongate member202is used as a guidewire, distal end204of elongate member202may be inserted into a patient's urethra, through the urinary bladder, and into ureter406. In some examples, once distal end204of elongate member202is positioned within the upper ureter, an operator may initiate the introduction of fluid into kidney408through lumen214of elongate member202. For example, a fluid source (e.g., fluid source280ofFIG. 1) may be fluidly connected to first end244of elongate member202and fluid may be transmitted through first end244, through lumen214of elongate member202, to distal end204of elongate member202, and into the kidney408. In some examples, the fluid may be radiopaque dye. As shown inFIG. 5A, dye550may enter the ureter406and/or kidney408(depending on the location of distal end204of elongate member202) and may disperse throughout kidney408and/or lower calyx410. This may allow the operator to determine the location of any kidney stones within the kidney. The introduction of any fluid (e.g., not limited to radiopaque) into the kidney may at least partially inflate the kidney, thus providing additional space to perform the desired procedure. Further, the introduction of fluid as an initial step may ensure that the pressure within the kidney remains at a sufficient level, e.g., the kidney will not collapse, once suction is applied to the kidney through lumen214of elongate member202(as described in further detail below). It should be noted that in some examples, fluid is not introduced through lumen214of elongate member202, and once disposed with the patient's body, an operator may proceed to the next step, e.g., locating and securing a kidney stone.

Elongate member202may be extended distally into kidney408, so that the distal opening of lumen214is proximate to kidney stone470. At this point, elongate member202is in a retrieval position, e.g., distal end204of the elongate member202is positioned distal of distal end104of tube102. An operator may initiate a vacuum source, e.g., by selecting input device230ofFIG. 4, to apply suction through lumen214to distal end204of elongate member202. Suction into lumen214of elongate member202may pull the stone toward a distal opening of elongate member202until the stone contacts and forms a seal with the distal opening of elongate member202. The formed seal may secure the kidney stone to the distal opening of the elongate member202. As shown inFIG. 5B, with the stone secured to elongate member202, elongate member202may be retracted or pulled proximally toward ureter406and/or distal end104of tube102until the elongate member is in the operating position, e.g., secured stone470is proximate a distal opening of tube102. At any time between the insertion of elongate member202into the patient and the above step of securing the stone proximate the distal opening of tube102, tube102may track elongate member202like a guidewire, so that distal end104is positioned within ureter406.FIG. 5Cillustrates an operating position of elongate member202in which distal end204of elongate member202is closer to distal end104of tube102than in the retrieval position.

As shown inFIG. 5C, once the laser fiber120is in a sufficient position to aim for secured kidney stone470, the operator may initiate the laser to break up kidney stone470. Laser fiber120may be introduced into a patient through lumen112of tube102. Laser fiber120may be connected to and/or controlled by laser control130. (It should be noted that the stone may be broken into particles in any way known in the art, including the application of ultrasound and/or sound waves on the stone.) Once stone470is broken into particles that are smaller than the cross-sectional area of the distal opening of elongate member202, the seal may be broken and/or particles may be suctioned into lumen214of elongate member202. These particles may be vacuumed through elongate member202and out of the patient's body. The stone particles are suctioned out from lumen214of elongate member202along with the used saline fluid and collect in the chamber outside the patient body through the saline outlet pathway.

The application of suction through lumen214of elongate member202may improve the ability to break kidney stones by creating an anti-retropulsion effect. By applying suction through lumen214, a kidney stone may be pulled toward laser fiber120, thus countering the effect of the laser energy pushing the kidney stone away. This configuration thus assists in generating the smaller stone fragments by pulling the stones into the reach of laser fiber120.

Once the operator determines a sufficient amount of the resulting particles of stone470have been removed from the patient's body or does not want to continue for other reasons, the laser process and/or application of suction may be stopped. At any point, an operator may additionally choose to move the device within the patient. For example, an operator may choose repeat the process. InFIG. 5C, elongate member202has secured a first kidney stone470, but a second kidney stone472remains within lower calyx410. Once kidney stone470has been removed from the patient's body, the operator may move distal end204of elongate member202to a retrieval position and position its distal opening proximate to kidney stone472. The above process may then be repeated for securing, moving, and breaking up stone472. An operator may reposition any element of the medical device and/or repeat any of the above described steps any number of times. Once an operator determines no more kidney stones can and/or should be broken apart and/or no more stone fragments/dust can and/or should be removed, medical device100may be removed from the patient's body.

FIG. 6illustrates an exemplary method of use of a medical device for removal of stone fragments/dust. For purposes of discussion, method600will be described using medical device100ofFIG. 1and the urinary system ofFIGS. 5A-C, as described above, but method600is not intended to be limited thereto. As shown inFIG. 6, method600includes steps602,604,606,608,610,612, and614. However, it should be noted that method600may include more or fewer steps as desired for a particular implementation and the order of the steps may be varied.

Method600may commence after elongate member202and/or tube102of medical device100have been inserted into a patient's body. In step602, distal end204of elongate member202may be positioned proximal of a target area (e.g., kidney408and/or lower calyx410). In step604, as illustrated inFIG. 5A, dye (e.g., dye550) may be supplied through a lumen (e.g., lumen214) of the elongate member (e.g., elongate member202) to the distal end (e.g., distal end204) of the elongate member. In step606, distal end204of elongate member202may be positioned at the target area (e.g., kidney408and/or lower calyx410) and/or distal of distal end104of tube102. Once distal end204of elongate member202is proximate an object (e.g., kidney stone470), method600may proceed to step608and suction may be applied through lumen214of elongate member202. An operator may apply suction to lumen214of elongate member202by, for example, initiating vacuum source250ofFIG. 1. The application of suction may move the object to the distal opening of lumen214and the object (e.g., kidney stone470) may form a seal with distal end204of elongate member202. In some examples, distal end204of elongate member202may be repositioned in order to capture the object with the applied suction. Once a seal is formed, method600may proceed to step610. In step610, distal end204of elongate member202may be moved distally and/or proximate to distal end104of tube102, as shown inFIG. 5B. Moving distal end204of elongate member202may also move the object (e.g., kidney stone470) distally and/or proximate to distal end104of tube102. In step612, once the object is proximate to distal end104of tube102, a laser fiber may be disposed within the tube. For example, laser fiber120may extend through lumen112to distal end104of tube102and may aim at kidney stone470. In step614, the laser may be initiated. For example, an operator may initiate the laser through laser control130and/or handle portion110ofFIG. 1.

The many features of the disclosure are apparent from the detailed specification, and thus, it is intended by the appended claims to cover all such features of the disclosure which fall within the true spirit and scope of the disclosure. Further, since numerous modifications and variations will readily occur to those skilled in the art, it is not desired to limit the disclosure to the exact construction and operation illustrated and described, and accordingly, all suitable modifications and equivalents may be resorted to, falling within the scope of the disclosure.