System and method for guided removal from an in vivo subject

1. A method for removing an object from a kidney, comprising:

guiding a flexible tube through a passageway of an in vivo subject, wherein the flexible tube comprises at least a first passageway and a second passageway encompassed by the first passageway, wherein the second passageway is positioned concentrically within the first passageway, the first passageway forming an annular lumen surrounding the second passageway;

inserting a distal end of the flexible tube into a target region of the kidney;

infusing liquid through the first passageway substantially continuously into the target region of the kidney during a first period of time;

initiating suction through the second passageway after the liquid has begun to be infused into the target region of the kidney and simultaneously continuing suction and infusion during a second period of time; and

aspirating the object through the second passageway with at least a portion of the liquid while the liquid continues to be infused into the target region of the kidney.

2. The method of claim 1 , wherein the liquid is infused at a flow rate of at least about 5 milliliters per minute.

3. The method of claim 2 , further comprising:

coupling a bag containing liquid to the second passageway; and

increasing pressure on the bag to cause the liquid to be infused.

4. The method of claim 1 , wherein infusing the liquid comprises infusing the liquid through the first passageway for at least five minutes.

5. The method of claim 1 , further comprising:

causing suction to be provided at the distal end of the second passageway by a suction source coupled to the second passageway; and

removing another object through the second passageway with at least a second portion of the liquid while the suction is being provided.

6. The method of claim 1 , further comprising:

inserting a sheath into the passageway of the vivo subject;

inserting a device through the sheath;

positioning the device adjacent to a second object;

using the device to break the second object into a plurality of objects including the object; and

wherein the flexible tube is guided through the sheath.

7. The method of claim 6 , wherein the flexible tube is guided through the sheath subsequent to removal of the device.

8. The method of claim 7 , wherein the second object is a kidney stone that has a diameter greater than about 10 millimeters and cannot be removed through the first passageway, and the object is a fragment of the kidney stone that has a diameter of less than about 4.33 millimeters.

9. The method of claim 7 , wherein the device is a ureteroscope.

10. The method of claim 1 , wherein the flexible tube has an external diameter of at least about 11 French.

11. The method of claim 1 , wherein the first passageway has a dimension less than a diameter of the object and the second passageway has a circular cross-section having a diameter greater than the diameter of the object.

12. A method for removing an object from a kidney, comprising:

inserting a sheath into an in vivo passageway of a subject;

inserting a device through the sheath;

positioning a distal end of the device within the kidney adjacent to the object;

using the device to break the object into a plurality of smaller objects;

removing the device;

guiding, subsequent to removal of the device, a flexible tube having an external diameter of at least about 11 French through the sheath,

wherein the flexible tube comprises at least a first passageway and a second passageway encompassed by the first passageway, wherein the second passageway is positioned concentrically within the first passageway, the first passageway forming an annular lumen surrounding the second passageway;

positioning a distal end of the second passageway adjacent to at least one of the plurality of smaller objects;

infusing saline solution through the first passageway without suction being applied through the second passageway; and

applying suction through the second passageway simultaneously with infusing saline solution through the first passageway; and

aspirating at least one of the plurality of smaller objects through the second passageway with at least a portion of the saline solution.

13. The method of claim 12 , wherein the device is a ureteroscope.

14. The method of claim 12 , wherein the first passageway has a dimension less than a diameter of at least one of the plurality of smaller objects.