Abstract:
A deflation device for use in deflating an inflatable or implantable balloon device, comprising, in combination: an endoscope tube, having a distal end, a proximal end, and a lumen; a cap disposed at the distal end of the endoscope tube and having walls defining a balloon interface chamber; a coring device disposed within the lumen and configured to travel within the lumen such that a distal end of the coring device is extendable beyond the distal end of the cap; wherein the cap is configured to provide a normal surface of a balloon relative to the orientation of the coring device as the coring device is disposed near the distal end of the cap.

Description:
RELATED APPLICATION 
       [0001]    This application claims the full Paris Convention benefit of and priority to U.S. Provisional Patent Application Ser. No. 61/245,630, filed Sep. 24, 2009; and U.S. Provisional Patent Application Ser. No. 61/330,188, filed Apr. 30, 2010, the contents of which are incorporated by reference herein in their entirety, as if fully set forth herein. 
     
    
     BACKGROUND 
       [0002]    1. Field 
         [0003]    This disclosure relates to devices and methods for operating on an implantable and inflatable balloon device. More particularly, this disclosure relates to a device and method for providing a proper configuration and orientation for puncturing and aspirating an implantable and inflatable balloon device. 
         [0004]    2. Summary 
         [0005]    Briefly stated, a deflation device is disclosed according to embodiments, comprising, in combination: an endoscope tube, having a distal end, a proximal end, and a lumen; a cap disposed at the distal end of the endoscope tube and having walls defining a balloon interface chamber; a coring device disposed within the lumen and configured to travel within the lumen such that a distal end of the coring device is extendable beyond the distal end of the cap; and wherein the cap is configured to cause a portion of a surface of a balloon to be orthogonal to a longitudinal axis of the coring device as the coring device is disposed near the distal end of the cap. 
         [0006]    The cap may further comprise a flexible distal portion and a rigid proximal portion. The cap may further comprise a protrusion extending radially inward from the walls of the cap, the walls defining a coring channel. The protrusion may be configured to guide the coring device to an orientation perpendicular to the balloon. The protrusion may be an annular ring. The protrusion may be tapered and the coring channel may be a frustoconical space having a proximal aperture smaller than a distal aperture. The protrusion may define a guiding channel for the coring device, wherein the guiding channel may be of a diameter substantially equal to the diameter of the coring device. 
         [0007]    The deflation device may further comprise a vacuum device in fluid communication with the balloon interface chamber. The vacuum device may be in fluid communication with the balloon interface chamber via the lumen. 
         [0008]    According to embodiments, disclosed is a method for deflating an inflated balloon device, comprising, in combination: advancing a deflation device to a balloon until a cap at a distal end of the deflation device contacts a surface of the balloon, the cap and the surface of the balloon defining a balloon interface chamber; applying a vacuum to the balloon interface chamber, whereby a portion of the surface enclosing the balloon interface chamber is drawn into a convex shape; advancing the coring device from a lumen of the deflation device through a coring channel defined by a protrusion extending radially inward from walls of the cap, whereby a tip of the coring channel is deflected by the protrusion to be made orthogonal to the surface of the balloon at a site of penetration; penetrating the balloon with the coring device at a site of penetration; and aspirating fluid from within the balloon through the site of penetration. 
         [0009]    The protrusion may be an annular ring. The protrusion may be tapered and the coring channel may be a frustoconical space having a proximal aperture smaller than a distal aperture. The protrusion may define a guiding channel for the coring device, wherein the guiding channel may be of a diameter substantially equal to the diameter of the coring device. Advancing the coring device within the lumen to the balloon further comprises advancing the coring device against a protrusion extending radially inward from the walls of the cap, whereby the coring device is aligned to be at least substantially orthogonal with a portion of the balloon surface. 
         [0010]    According to embodiments, disclosed is a deflation device, comprising, in combination: an endoscope tube, having a distal end, a proximal end, and a lumen; a cap disposed at the distal end of the endoscope tube and having walls defining a balloon interface chamber at a distal end of the cap, the balloon interface chamber being in communication with the lumen; a coring device disposed within the lumen and configured to travel within the lumen such that a distal end of the coring device is extendable beyond the distal end of the cap; a vacuum chamber at the distal end of the cap; and a vacuum line fluidly connected to the vacuum chamber, wherein the vacuum chamber is configured to interface with a surface of a balloon and secure the cap thereto when vacuum pressure is applied. 
         [0011]    The vacuum chamber may be an annular ring concentric with the balloon interface chamber. The vacuum chamber may be separated from the balloon interface chamber by a septum. 
         [0012]    According to embodiments, disclosed is a method for deflating an inflated balloon device, comprising, in combination: advancing a deflation device to a balloon until a cap of the deflation device contacts a surface of the balloon, whereby a balloon interface chamber and a vacuum chamber of the cap are enclosed partly by the surface of the balloon; providing vacuum to the vacuum chamber, whereby the cap is secured relative to balloon and a portion of the surface enclosing the balloon interface chamber is substantially flat and orthogonal to a longitudinal axis of a coring device within the deflation device; advancing the coring device, whereby the balloon is penetrated at a site of penetration; and aspirating fluid from within the balloon through the site of penetration. 
         [0013]    Providing vacuum to the vacuum chamber may be effectuated through a vacuum line in fluid communication with the vacuum chamber. The vacuum chamber may surround the balloon interface chamber. Providing vacuum to the vacuum chamber may cause the portion of the surface enclosing the balloon interface chamber to be stretched flat. Providing vacuum to the vacuum chamber may cause the portion of the surface enclosing the balloon interface chamber to be stretched flat. 
     
    
     
       DRAWINGS 
         [0014]    The above-mentioned features and objects of the present disclosure will become more apparent with reference to the following description taken in conjunction with the accompanying drawings wherein like reference numerals denote like elements and in which: 
           [0015]      FIG. 1A  shows a view of an endoscope with cap, according to embodiments of the present disclosure; 
           [0016]      FIG. 1B  shows a perspective view of an endoscope with cap, according to embodiments of the present disclosure; 
           [0017]      FIG. 1C  shows a front view of an endoscope with cap, according to embodiments of the present disclosure; 
           [0018]      FIG. 1D  shows a sectional view of an endoscope with cap, according to embodiments of the present disclosure; 
           [0019]      FIG. 1E  shows a sectional view of an endoscope with cap, according to embodiments of the present disclosure; 
           [0020]      FIG. 2  shows a perspective view of an endoscope with cap engaged on a balloon, according to embodiments of the present disclosure; 
           [0021]      FIG. 3A  shows a perspective view of an endoscope with cap having a vacuum chamber, according to embodiments of the present disclosure; 
           [0022]      FIG. 3B  shows a front view of an endoscope with cap having a vacuum chamber, according to embodiments of the present disclosure; 
           [0023]      FIG. 3C  shows a side view of an endoscope with cap having a vacuum chamber, according to embodiments of the present disclosure; 
           [0024]      FIG. 3D  shows a sectional view of an endoscope with cap having a vacuum chamber, according to embodiments of the present disclosure; 
           [0025]      FIG. 3E  shows a side view of an endoscope with cap having a vacuum chamber engaged on a balloon, according to embodiments of the present disclosure; 
           [0026]      FIG. 3F  shows a sectional view of an endoscope with cap having a vacuum chamber engaged on a balloon, according to embodiments of the present disclosure; 
           [0027]      FIG. 4A  shows a perspective view of a cap, according to embodiments of the present disclosure; 
           [0028]      FIG. 4B  shows a perspective view of a cap, according to embodiments of the present disclosure; 
           [0029]      FIG. 4C  shows a sectional view of a cap, according to embodiments of the present disclosure; 
           [0030]      FIG. 4D  shows a sectional view of an endoscope with cap engaged on a balloon, according to embodiments of the present disclosure; 
           [0031]      FIG. 5A  shows a perspective view of a cap, according to embodiments of the present disclosure; 
           [0032]      FIG. 5B  shows a perspective view of a cap, according to embodiments of the present disclosure; 
           [0033]      FIG. 5C  shows a sectional view of a cap, according to embodiments of the present disclosure; 
           [0034]      FIG. 5D  shows a sectional view of an endoscope with cap engaged on a balloon, according to embodiments of the present disclosure; 
           [0035]      FIG. 6A  shows a perspective view of a cap, according to embodiments of the present disclosure; 
           [0036]      FIG. 6B  shows a perspective view of a cap, according to embodiments of the present disclosure; 
           [0037]      FIG. 6C  shows a sectional view of a cap, according to embodiments of the present disclosure; and 
           [0038]      FIG. 6D  shows a sectional view of an endoscope with cap engaged on a balloon, according to embodiments of the present disclosure. 
       
    
    
     DETAILED DESCRIPTION 
       [0039]    Devices for deflation and removal of implantable or inflatable devices are intended to be applied and maintained in a stable and normal fashion to the surface of a balloon wall under stain. By doing so, a full thickness and/or a partial thickness circular cut through the balloon wall is accomplished, reducing the chance for tearing at the coring site, as compared to piercing with a conical, beveled, or facetted needle. 
         [0040]    Establishing and maintaining a normal orientation of a coring needle relative to the surface of a balloon to be operated upon may be difficult, as the endoscope catheter used may be flexible and only loosely supported by surrounding anatomy. The balloon may be free to move about and slippery. Both catheter and balloon are subjected to subtle and gross anatomical movement. If the coring needle is not maintained at least substantially orthogonal to the balloon surface, the full thickness and/or a partial thickness cut through the balloon wall may not form the desired complete circle, thereby forming only an incomplete circle. This is not an optimal application of coring for deflation of a balloon under strain, because the terminations or start and ending of the incomplete circle serve as stress risers and can result in small or large tears, corresponding to small or large amounts of undesired fluid leakage from the balloon and an inability to form a seal around the deflation catheter for deflation of the balloon via vacuum. 
         [0041]    The inventors of the present disclosure have developed improvements upon devices for deflation of implantable and inflatable devices, such as inflatable intragastric balloons and other medical devices, addressing longstanding needs and avoiding ostensive issues with migration which have plagued clinically relevant devices and methods. 
         [0042]    This application incorporates by reference U.S. Pat. Pub. No. 2007/0100368, published May 3, 2007; U.S. Pat. Pub. No. 2007/0100369, published May 3, 2007; U.S. Pat. Pub. No. 2007/0149994, published Jun. 28, 2007; WIPO Pub. No. WO 2007/053556, published Oct. 5, 2007; WIPO Pub. No. WO 2007/053707, published Oct. 5, 2007; WIPO Pub. No. WO 2007/053706, published Oct. 5, 2007; WIPO Pub. No. WO 2007/075810, published May 7, 2007; U.S. patent application Ser. No. 12/723,545, filed on Mar. 12, 2010; PCT App. Ser. No. PCT/US2010/043134, filed on Jul. 23, 2010; each as if fully set forth herein in its entirety. 
         [0043]    According to embodiments, the use of endoscopic cap  40  enables the user to normalize a coring needle to balloon surface  110  of balloon  100  and establish a large and stable footprint for puncture at a pre-determined beneficial focal distance, thereby providing the optimal conditions for puncturing the intragastric balloon  100  with a coring needle catheter. The coring needle or other instruments may be delivered to cap  40  via one or more lumens  22  of endoscope  20 . Endoscope cap  40  may be attached to the distal tip of endoscope  20 , as shown in  FIGS. 1A ,  1 B,  1 C,  1 D, and  1 E. The cap  40  may be permanently (fixedly) attached or temporarily (removably) attached by user. It may be constructed of a rigid or semi-rigid material. 
         [0044]    As shown in  FIG. 2 , by pushing cap  40  onto balloon surface  110 , endoscope  20  is indexed at an orthogonal orientation and a large stable contact area, preferably between about 13 mm and about 18 mm in diameter, is created. The device and its dimensions may be scaled to accommodate any purpose. As such, other ranges of dimensions are within the scope of this disclosure. According to embodiments, cap  40  defines and encloses balloon interface chamber  60 , connecting the distal end of endoscope  20  with surface  110  of balloon  100 . 
         [0045]    According to embodiments, contact stability between cap  40  and balloon  100  may be improved by various methods. For example, a user may deflect or retroflex endoscope  20  such that it braces against the nearby gastric wall. By further example, one may provide a high traction engagement surface on cap  40  with a high coefficient of friction material or with surface features such as bumps, indentations, annular rings, or woven fabric to improve contact stability. Further, providing distally extending fingers or projections around the annulus of a distal face of cap  40  may improve contact stability. 
         [0046]    According to embodiments, indexing and stability benefits are also achieved by providing endoscopic cap  40  that can apply a vacuum under the whole cap  40  cross-sectional profile or a portion of the profile. As used herein, “vacuum” means a pressure less than at least one of the pressure within balloon  100  and the pressure outside balloon  100 , endoscope  20 , and cap  40 . “Vacuum” refers to providing a pressure that is relatively lower than the pressure of an immediately adjacent space. As used herein, vacuum may not necessarily mean a volume of space that is entirely empty of matter. 
         [0047]    According to embodiments, vacuum chamber  50  is provided to interact with surface  110  of balloon  100 . As shown in  FIGS. 3A ,  3 B,  3 C,  3 D,  3 E, and  3 F, vacuum chamber  50  may be a space defined by an annular ring surrounding balloon interface chamber  60  (i.e., the coring needle site). Such an annular ring provides selectable securement to balloon  100  entirely around balloon interface chamber  60 . Other configurations may be provided for vacuum chamber  50 . For example, vacuum chamber  50  may be one or more spaces providing various engagement sites. Vacuum chamber  50  may be of any geometry to optimize engagement onto balloon  100 . 
         [0048]    There are multiple ways in which vacuum may be achieved for improved stability and to hold onto balloon  100 . For example, vacuum line  52  may be provided in communication with vacuum chamber  50  of cap  40 . Vacuum may be created under all or a portion of cap  40  footprint through independent vacuum line  52  communicating with the cap  40 , as shown in  FIG. 3D . Vacuum chamber  50  may be independent of and separate from balloon interface chamber  60 . 
         [0049]    According to embodiments, vacuum may be created under all or a portion of the cap  40  footprint via communication with vacuum applied through the lumen  22  of the endoscope  20 . According to embodiments, vacuum may be created under all or a portion of the cap  40  footprint via communication with vacuum applied through a catheter. 
         [0050]    When vacuum is applied to an area surrounding the coring needle site, such as around an annular ring, the vacuum may stabilize and hold the balloon surface  110  without deforming or making surface  110  more convex. This leaves the balloon surface  110  substantially flat (or otherwise conforming to portions of cap  40 ) and generally orthogonal to lumen  22  of endoscope  20  and does not introduce additional stress or strain to the site of penetration. 
         [0051]    According to embodiments, vacuum may be applied to balloon interface chamber  60 . For example, vacuum may be applied through one or more lumens  22  or through devices therein. 
         [0052]    According to embodiments, balloon interface chamber  60  may be configured to cause surface  110  of balloon  100  to conform to the boundaries thereof. For example, as surface  110  of balloon  100  is drawn into balloon interface chamber  60  due to relatively low pressure therein, portions of surface  110  of balloon  100  may conform to the boundaries of balloon interface chamber  60  such as walls  62  or a distal portion of protrusion  46 . This may cause surface  110  of balloon  100  to achieve an orthogonal orientation relative to at least one of coring device  30 , lumen  22 , and endoscope  20 . 
         [0053]    According to embodiments, when vacuum is applied to an area including the area to be cored, such as balloon interface chamber  60  or the entire area under cap  40 , the surface to be cored may be stabilized by the vacuum hold. At the same time, surface  110  may also deform or be made more convex by the applied vacuum. As a result, balloon surface  110  under cap  40  and aligned with the scope working channel may no longer be orthogonal to lumen  22  (i.e., working channel) of endoscope  20  or coring device  30 . 
         [0054]    A surface having a tendency to deform at the puncture site for the above reasons or others may still be provided with a normal alignment relative to coring device  30  for puncture. For example, endoscopic cap  40  may have one or more protrusions  46  that deflect tip  32  of coring device  30  as it is extended from lumen  22  of endoscope  20  such that it engages the convex portion of surface  110  of balloon  100  at a normal angle of approach. For example, coring device  30  may naturally extend from lumen  22  of endoscope  20  in a manner that does not naturally provide orthogonal alignment any nearby portion of surface  110 . This may be the case where coring device  30  and lumen  22  are not aligned on a central axis of the balloon interface chamber  60 . 
         [0055]    According to embodiments, coring channel  64  may be provided to align coring device  30  as it extends from lumen  22 . As shown in  FIGS. 4D ,  5 D, and  6 D, coring channel  64  spans, is a portion of, or includes the space between the distal end of endoscope  20  and balloon interface chamber  60 . 
         [0056]    According to embodiments, as shown in  FIGS. 4A ,  4 B,  4 C, and  4 D, protrusion  46  forms a tapered ring that extends radially inward from walls  62  such that coring device  30  is guided to a preferred orthogonal engagement with the puncture target of surface  110 . For example, protrusion  46  may define coring channel  64  as a generally frustoconical space, with a more narrow aperture at its distal end than at its proximal end. The tapered element may provide a gradual transition from lumen  22  to the puncture target while beneficially modifying the angle of incidence of tip  32  relative to surface  110 . 
         [0057]    According to embodiments, as shown in  FIGS. 5A ,  5 B,  5 C, and  5 D, protrusion  46  forms a tapered ring that extends radially inward from walls  62  such that coring device  30  is deflected to a preferred orthogonal engagement with the puncture target of surface  110 . For example, protrusion  46  may define coring channel  64  as a set of stepped cylindrical spaces, with a more narrow aperture at its distal end than at its proximal end. The more narrow distal aperture provided at protrusion  46  may beneficially modify the angle of incidence of tip  32  relative to surface  110 . Tapered ring protrusion  46  may also be viewed as a septum dividing coring channel  64  from balloon interface chamber  60 , with a through hole to allow passage of coring device  30 . 
         [0058]    According to embodiments, as shown in  FIGS. 6A ,  6 B,  6 C, and  6 D, protrusion  46  forms a tapered ring that extends radially inward from walls  62  such that coring device  30  is deflected to a preferred orthogonal engagement with the puncture target of surface  110 . For example, protrusion  46  may define coring channel  64  as a curved, linear, segmented, or other geometric pathway. A broader, more narrow, or equal-sized aperture may be provided at its distal end relative to its proximal end. The more narrow distal aperture provided at protrusion  46  may beneficially modify the angle of incidence of tip  32  relative to surface  110 . 
         [0059]    According to embodiments, endoscopic cap  40  may have one or more internal features that partially or completely spans the cross-sectional area of cap  40  and engages balloon surface  110  to ensure that the surface is perpendicular to lumen  22  of endoscope  20 . Such features may include a rigid or semi-rigid floor or a flexible septum (preferably clear) with a through hole. Alternatively, there may be provided a lumen within cap  40 , struts that extend radially inward, or a mesh extending partially or entirely across cap  40 . 
         [0060]    According to embodiments, indexing and stability benefits may be achieved by providing endoscopic cap  40  with adhesive on an engagement surface of cap  40 . The engagement surface may be the most distal portion of cap  40  or any portion that engages surface  110  of balloon  100 . The engagement surface may be the entire cross-sectional area of cap  40  or a portion of the cross-sectional area, such as protrusion  46  as an annular ring. For example, cap  40  may be manufactured with adhesive on the engagement surface (e.g. a pressure sensitive adhesive or an adhesive activated by heat, moisture, chemical, etc.). The user may apply an adhesive to the engagement surface before the balloon puncture procedure. The user may deliver the adhesive, such as a liquid adhesive, to the engagement surface during the balloon puncture procedure. The user may activate the adhesive during the balloon puncture procedure by delivering heat, light, energy, liquid, gas, inter alia. 
         [0061]    According to embodiments, endoscope  20  with cap  40  according to features of the present disclosure is shown in the figures. A deflation device may include cap  40  of two or more primary components. For example, cap  40  may include a distal portion manufactured from a rigid polymer (such as polycarbonate), and a proximal portion manufactured from a flexible polymer (such as silicone). The soft section allows for various sizes of endoscopes (8.5 mm to 11 mm, for example) to easily fit within cap  40 . Endoscope  20  may be fitted by friction, fixed by adhesive, or otherwise attached to cap  40  (e.g., by threading, notches, snaps, etc.). For example, the soft section may provide a friction fit for holding cap  40  to the distal end of endoscope  20  without damaging the scope. The distal section may be clear to not obstruct the view of the target balloon  100 . The distal section includes vacuum chamber  50  as depicted in the figures, according to some embodiments. By utilizing an annular vacuum chamber as vacuum chamber  50 , balloon  100  is held relative to the scope and stretched substantially flat without deforming balloon  100  into a convex shape in balloon interface chamber  60 . 
         [0062]    According to embodiments, coring device  30  may facilitate aspiration by providing a channel therein through which fluid at coring tip  32  may be drawn. Accordingly, coring device  30  may be used to penetrate and subsequently aspirate balloon  100  without the need to withdraw coring device  30 . According to embodiments, coring device  30  may include one or more aspiration holes  36  that provide fluid communication between an interior channel of coring device  30  with lumen  22  of endoscope  20 . According to embodiments, coring device  30  may be withdrawn from within balloon  100  followed by aspiration of fluid through a site of penetration of coring device  30 . Engagement of cap  40  onto balloon  100  may be maintained after withdrawal of coring device  30  and during aspiration of balloon  100 . 
         [0063]    According to embodiments, a balloon deflation procedure is disclosed for execution with use of cap  40  as disclosed herein. The steps disclosed herein may be performed in any variety of sequences adjustable to the circumstances. The steps may be performed partially or in full, or at different times. 
         [0064]    According to embodiments, a patient may be provided with an implanted inflatable balloon  100  ready for deflation or removal. Cap  40  may be provided over a distal tip of endoscope  20 . At the doctor&#39;s discretion, tape, adhesive, or other interface features may be used to secure cap  40  or vacuum line  52  to the body of endoscope  20 . 
         [0065]    Endoscope  20  may be delivered to the stomach or other cavity with cap  40  attached. At the doctor&#39;s discretion, lubricant may be applied to cap  40  to facilitate delivery. With endoscope  20  straight and in the stomach, coring device  30  may be delivered through lumen  22  of endoscope  20 . At the doctor&#39;s discretion, lubricant may be applied to coring device  30  beforehand. At this point, the advancement of coring device  30  may be limited to the distal end of endoscope  20  or cap  40 , limiting interference as balloon  100  is subsequently engaged by cap  40 . Endoscope  20  and cap  40  may be delivered to surface  110  of balloon  100  such that balloon surface  110  is generally perpendicular to endoscope  20  or cap  40 . Cap  40  may be pressed onto balloon surface  110 . 
         [0066]    In some embodiments, suction may be applied through vacuum line  52 , lumen  22 , or another element, as disclosed herein. Vacuum may be provided to balloon interface chamber  60  or vacuum chamber  50 . Devices for providing vacuum suction are known in the field and may be located at a proximal end of endoscope  20  to communicate with the distal end through lumen  22 , vacuum line  52 , or other channels. The user can confirm that cap  40  has a suction hold of balloon surface  110  by verifying on a suction pump gauge that the vacuum is building. Endoscope  20  position may be adjusted as necessary to achieve a suction hold on balloon surface  110 . Endoscope  20  may be secured to maintain the scope&#39;s position and stability. 
         [0067]    Where vacuum suction is provided to balloon interface chamber  60 , a portion of surface  110  defining a portion of balloon interface chamber  60  may be made convex, such that it is drawn into cap  40  and toward endoscope  20 . Where vacuum suction is provided to vacuum chamber  50 , a portion of surface  110  defining a portion of balloon interface chamber  60  may be secured and stretched flat and substantially orthogonal to coring device  30 . 
         [0068]    With cap  40  suctioned onto balloon surface  110 , coring device  30  may be advanced until its catheter tubing tip  32  lightly touches balloon surface  110 . The coring device  30  may be rotated, advanced, or operated in some other fashion to achieve penetration of balloon surface  110  and advancement of coring needle  32 . Advancement may be performed to the extent desired. Markings may indicate the amount of advancement achieved for comparison with the amount desired. Retraction of coring needle  32  of coring device  30  may then be effectuated. 
         [0069]    Fluid from within balloon  100  may be aspirated through lumen  22  of endoscope  20 , a lumen of coring device  30 , or some other channel, mechanism, or device. Deflation may be effectuated to any desirable degree. Deflation may occur while coring device  30  is extended or after it is retracted. After balloon  100  is partially or completely deflated, suction through the catheter to secure cap  40  to balloon  100  may be discontinued and the device may be removed from balloon  100 . 
         [0070]    According to embodiments, a patch may be applied to the penetration site using cap  40 . A patch such as a woven material, fabric, rubber, polymer, or elastomer may be carried by cap  40  and placed against balloon surface  110 . The patch may have adhesive on the surface facing balloon  100 . The adhesive may be applied to the patch as explained above. The patch may be attached to balloon surface  110 , creating a reinforced puncture target more resistant to tearing or bursting than a non-reinforced balloon  100 . 
         [0071]    The steps disclosed herein may be repeated for each balloon where multiple-balloon devices are the object of the procedure. After deflating all or a sufficient number of balloons  100 , the deflation device may be removed and the balloon device may be retrieved and removed. At the doctor&#39;s discretion, cap  40  may be removed prior to ventilating and/or capturing the balloon device. 
         [0072]    According to embodiments, a kit of parts is disclosed. One or more kits of parts can be envisioned by the person skilled in the art, the kits of parts to perform at least one of the methods herein disclosed. Likewise, directions for use (“DFU”) are included and the device may be part of a surgical tray or other packaged accessory set for surgeries. The kit may be a sub-component of a surgical tray. 
         [0073]    While the method and agent have been described in terms of what are presently considered to be the most practical and preferred embodiments, it is to be understood that the disclosure need not be limited to the disclosed embodiments. It is intended to cover various modifications and similar arrangements included within the spirit and scope of the claims, the scope of which should be accorded the broadest interpretation so as to encompass all such modifications and similar structures. The present disclosure includes any and all embodiments of the following claims. 
         [0074]    It should also be understood that a variety of changes may be made without departing from the essence of the invention. Such changes are also implicitly included in the description. They still fall within the scope of this invention. It should be understood that this disclosure is intended to yield a patent covering numerous aspects of the invention both independently and as an overall system and in both method and apparatus modes. 
         [0075]    Further, each of the various elements of the invention and claims may also be achieved in a variety of manners. This disclosure should be understood to encompass each such variation, be it a variation of an embodiment of any apparatus embodiment, a method or process embodiment, or even merely a variation of any element of these. 
         [0076]    Particularly, it should be understood that as the disclosure relates to elements of the invention, the words for each element may be expressed by equivalent apparatus terms or method terms—even if only the function or result is the same. 
         [0077]    Such equivalent, broader, or even more generic terms should be considered to be encompassed in the description of each element or action. Such terms can be substituted where desired to make explicit the implicitly broad coverage to which this invention is entitled. 
         [0078]    It should be understood that all actions may be expressed as a means for taking that action or as an element which causes that action. 
         [0079]    Similarly, each physical element disclosed should be understood to encompass a disclosure of the action which that physical element facilitates. 
         [0080]    Any patents, publications, or other references mentioned in this application for patent are hereby incorporated by reference. In addition, as to each term used it should be understood that unless its utilization in this application is inconsistent with such interpretation, common dictionary definitions should be understood as incorporated for each term and all definitions, alternative terms, and synonyms such as contained in at least one of a standard technical dictionary recognized by artisans and the Random House Webster&#39;s Unabridged Dictionary, latest edition are hereby incorporated by reference. 
         [0081]    Finally, all referenced listed in the Information Disclosure Statement or other information statement filed with the application are hereby appended and hereby incorporated by reference; however, as to each of the above, to the extent that such information or statements incorporated by reference might be considered inconsistent with the patenting of this/these invention(s), such statements are expressly not to be considered as made by the applicant(s). 
         [0082]    In this regard it should be understood that for practical reasons and so as to avoid adding potentially hundreds of claims, the applicant has presented claims with initial dependencies only. 
         [0083]    Support should be understood to exist to the degree required under new matter laws—including but not limited to United States Patent Law 35 USC 132 or other such laws—to permit the addition of any of the various dependencies or other elements presented under one independent claim or concept as dependencies or elements under any other independent claim or concept. 
         [0084]    To the extent that insubstantial substitutes are made, to the extent that the applicant did not in fact draft any claim so as to literally encompass any particular embodiment, and to the extent otherwise applicable, the applicant should not be understood to have in any way intended to or actually relinquished such coverage as the applicant simply may not have been able to anticipate all eventualities; one skilled in the art, should not be reasonably expected to have drafted a claim that would have literally encompassed such alternative embodiments. 
         [0085]    Further, the use of the transitional phrase “comprising” is used to maintain the “open-end” claims herein, according to traditional claim interpretation. Thus, unless the context requires otherwise, it should be understood that the term “compromise” or variations such as “comprises” or “comprising”, are intended to imply the inclusion of a stated element or step or group of elements or steps but not the exclusion of any other element or step or group of elements or steps. 
         [0086]    Such terms should be interpreted in their most expansive forms so as to afford the applicant the broadest coverage legally permissible.