The disclosure relates to an apparatus and method for permanently closing body vessels such as the utero-tubal junction, uterine isthmus, and fallopian tubes. In particular, the disclosure is directed to a relatively simple surgical procedure for sterilizing human females which may be performed in the physician's office.
It is often desired or necessary for medical reasons to permanently close the fallopian tubes of women. The procedures currently proposed for occluding the fallopian tubes to effect sterilization include surgical ligation, occlusion by insertion of a foreign body, and occlusion by scarring in response to severe wounding.
One method for sterilization in females is surgical tubal ligation, a procedure in which the fallopian tubes are tied and cut, or clamped or fused with instruments passed into the pelvic cavity through an incision made through the wall of the abdomen. When done endoscopically, the pelvic cavity must be pneumatically inflated using an inert gas. Tubal ligation done with a laparotomy requires a surgical incision in the abdomen between 6 and 12 centimeters long done under general anesthesia. Currently, when the fallopian tubes are clamped or fused from the outside of the tubes, they must be clamped or fused at two or three different points in order to ensure that the tubes remain closed.
Various wounding techniques have been proposed. Cohen, et al, Method for Tubal Electroligation, U.S. Pat. No. 5,556,396 (Sep. 17, 1996) discloses a method for tubal ligation by providing an electrically energizable electrode to a fallopian tube. The electrode is advanced into the fallopian tube and energized to thermally damage the fallopian tube, thereby causing enough scarring of the fallopian tube to permanently occlude it. In another technique, a sclerosing agent (quinacrine) is injected into the uterus and fallopian tubes to create a permanent closure of the fallopian tubes.
Various plugs have been proposed for occlusion of the fallopian tubes or the utero-tubal junction. One technique involves transcervically injecting a curable elastomeric composition such as silicone into the fallopian tubes in an amount sufficient to fill the portion of the oviduct adjacent the uterus. The elastomeric composition is allowed to solidify to thereby nonsurgically block the tube. Erb, Method and Apparatus for No-Surgical, Reversible Sterilization of Females, U.S. Pat. No. 3,805,767 (Apr. 23, 1974). Others have proposed placement of an occlusive wire or coil within the fallopian tubes to occlude them. Ton, Endoluminal Coil Delivery System Having A Mechanical Release Mechanism, U.S. Pat. No. 5,601,600 (Feb. 11, 1997), proposes placement of a Guglielmi detachable coil (typically used for vascular occlusion) deep within the fallopian tube, past the isthmus. The coil must be delivered into the fallopian tubes with a delivery catheter extending from the uterus into the fallopian tubes.
Several references suggest that the fallopian tube should be damaged to the point of scarring to weld the tubes shut or to enhance retention of a plug. For example, Vancaillie, Transuterine Sterilization Apparatus and Method, U.S. Pat. No. 5,095,917 (Mar. 17, 1992) teaches a method of forming scar tissue in the fallopian tube to occlude the fallopian tube, including application of chemical scarring agents (tetracycline hydrochloride) or application of high frequency current to the fallopian tubes. The goal is to cause an immediate inflammatory reaction, including edema, arrival of white blood cells, proliferation of fibroblasts and connective tissue, and arrival of macrophages, and also to cause the subsequent healing process which leads to the formation of scar tissue in the damaged area. Lessen, Surgical Method and Electrode Therefor, U.S. Pat. No. 3,858,586 (Jan. 7, 1975) teaches the scarification of the fallopian tubes with the application of RF energy, without placement of a plug afterward, under the theory that the resulting scarring would be sufficient to seal the fallopian tubes. Both the type of injury used to initiate a lesion in the ostium/isthmus/fallopian tube and the nature of the plug material dictates the type of wound healing response that occurs. If high power is used to create the lesion, the biological response of the body will follow a typical inflammatory response and lead to creation of scar tissue.
If the plug material has an architecture, chemistry and/or pore size (smooth, non-porous materials, for example) that induces a foreign body response to the material, this will encourage the formation of scar tissue and a fibrous capsule which surrounds the plug. The foreign body response consists primarily of fibroblasts attraction to the area (including fibroblast insinuation into the plug material, if possible) and the resultant formation of connective matrix with few vascular structures. The foreign body response has also been described as “scar” formation. The cells that comprise this foreign body response can differentiate into myofibroblasts that are capable of contracting around the material and either cause the material to distort or fracture, or in the fallopian tube, dislodge the implant. The combination of the myofibroblastic contractions, peristalic movement of the tube, tubal contractions, and ciliated epithelium create a combined force capable of expulsing the material from the tube.
If the plug is inserted into a fallopian tube without the concomitant disruption of the epithelial cell lining, expulsion of the plug will usually result. The epithelial lining of the fallopian tube functions to protect the underlying layers from infiltration and infection by foreign substances and infectious agents. In the same way, few cells will traverse the epithelial lining to enter the lumen of the fallopian tube, where the plug resides. Thus, implanting a plug in an intact tube results in little, if any, infiltration unto the plug material. Instead, it is likely that a non-infiltrated large pore plug would become a receptacle for necrotic debris shed within the fallopian tube. This could result in higher contamination and infection of the plug matrix. Additionally, the lack of ingrowth would result in less anchoring of the plug matrix, so the expulsion forces present within the fallopian tube could dislodge and expulse the plug. Thus, retention of an intact epithelial layer is not desired, and the epithelial cell layer must be destroyed or disrupted to eliminate the physical barrier to infiltrating cells. After this has occurred, a porous material can be placed into the denuded area, and a wound healing response can follow. Implanting porous materials into a fallopian tube that has an intact epithelial lining does not allow ingrowth into the material, as part of the epithelial cell lining's function is to act as a physical barrier to infectious agents and cellular infiltrate.
Our prior patent application, Harrington et al, Method And Apparatus For Tubal Occlusion, U.S. application Ser. No. 09/063,119, (filed May 20, 1998) (the disclosure of which is incorporated herein by reference) illustrates a method blocking off the fallopian tubes by placing a plug in the ostium or cornu of the uterus leading into the fallopian tubes. An exemplary embodiment discussed in our prior application was the application of heat to damage the tissue of the ostium and place a plug into the ostium which, was secured into the ostium by the inflammation of the ostium caused by the thermal injury. The proposed plug comprised a foamed material which permitted the ingrowth of tissue into the plug.
In one aspect, a device for occluding the ovarian pathway of a female body is disclosed. The device comprises a catheter body having a distal end and a proximal end, a wounding segment extending distally from the distal end of the catheter body and movable relative to the catheter body between an extended position and a retracted position and a wounding element disposed on the wounding segment. At least one plug is housed within the catheter body and/or wounding segment and is sized and dimensioned to be implanted into a target site within the ovarian pathway leading from the ovaries to the uterus of a female body. The at least one plug defines numerous interconnecting pores. In at least one embodiment the pores are sized to encourage at least one of vascularized tissue ingrowth and vascularized capsule growth. And in at least one embodiment, the at least one plug is a foam plug or a reticulated foam plug. A holding rod is disposed within the catheter body and extends into the wounding segment adjacent to the at least one plug to prevent movement of the at least one plug relative to the target site during proximal movement of the wounding segment from the extended position toward the retracted position. The device is operable so that proximal movement of the wounding segment from the extended position toward the retracted position disposes the at least one plug at the target site without moving, and without requiring movement of, the catheter body relative to the female body.
In another aspect, a system for occluding the ovarian pathway of a female body is disclosed. The system comprises an occlusion device comprising a catheter body having a distal end and a proximal end, a wounding segment extending distally from the distal end of the catheter body and movable relative to the catheter body between an extended position and a retracted position and a wounding element disposed on the wounding segment and including an RF electrode array. At least one plug is housed within the catheter body and/or wounding segment and is sized and dimensioned to be implanted into a target site within the ovarian pathway leading from the ovaries to the uterus of a female body. The at least one plug defines numerous interconnecting pores sized to encourage at least one of vascularized tissue ingrowth and vascularized capsule growth. In at least one embodiment, the at least one plug is a foam plug or a reticulated foam plug. A holding rod is disposed within the catheter body and extending into the wounding segment adjacent to the at least one plug to prevent movement of the at least one plug relative to the target site during proximal movement of the wounding segment from the extended position toward the retracted position. The occlusion device is operable so that proximal movement of the wounding segment from the extended position toward the retracted position disposes the at least one plug at the target site without moving, and without requiring movement of, the catheter body relative to the female body. The system further comprises a power supply for supplying power to the RF electrode array. In some embodiments, the system further comprises an endoscope or hysteroscope including a working channel for receiving the occlusion device and operable for viewing the precise placement of the occlusion device within the ovarian pathway.
These and other features, aspects, and advantages of the disclosed embodiments will become better understood with regard to the following description, appended claims, and accompanying drawings.
a illustrate the prior art method of occluding the fallopian tubes using an occluding plug.
a are cross sections of the utero-tubal junction of the female reproductive system with an organoid plug in place.
b and 4c illustrate the boundary response of wounded tissue with organoid plugs in place.
a and 5b show the cross sections of the device illustrated in
a are microscopic views of the plug material used in the sterilization procedure.
a illustrate the plug composition after placement and partial healing.
a illustrates the damage in each layer of the fallopian tube which occurs when using methods of the prior art which suggest ablation of the fallopian tubes followed by placement of a plug (the prior art methods do not suggest ablation at the utero-tubal junction). Where RF power has been used, the power is applied in amounts sufficient to damage the entire thickness of the fallopian tube, including the circular muscle layer 24 and longitudinal muscle layer 25. This leads to a “standard foreign body response,” which is a term understood among scientists to include inflammation, encapsulation and eventual scar formation. The scar tissue 32 will form in the wounded tissue (resulting in a fundamental change in the tubal architecture), and may also form within the plug if ingrowth is possible. Where a plug is left in the fallopian tube, an avascular fibrotic capsule 33 may form around the plug to protect the host from the plug. Thus, the plug is eventually surrounded by scar tissue and a fibrotic capsule as indicated in
The wound healing response may continue to completion in the surrounding intact pathway, and will further entail reorganization of the granulation tissue into specialized and functional tissue corresponding to the original injured tissue (matching the architecture of the original tissue), and the formation of scar tissue (different from the tissue's original architecture). The tissue response immediately surrounding the plug depends on the composition, pore size and architecture of the plug. For smooth plugs, the response will occur as discussed above in relation to
Where the plug pore size is small compared to cell size, in the range of 1-20 microns, vascularized granulation tissue will not form in the plug interstices. Subsequent healing includes formation of a highly vascularized foreign body capsule and intrusion of some macrophages into the plug pores, without intrusion of other cells or tissue associated with the later stages of healing (such as extracellular matrix, granulation tissue and blood vessels). Instead, the body will form a vascularized capsule with blood vessels closely approaching the plug, lying adjacent and within about 10 um of the foam. This may be referred to as an altered foreign body response.
a illustrates the condition of the plug and ovarian pathway after the wound healing process has proceeded to the extent permitted by the continued presence of the plug. The several layers of the target site of the pathway have healed to form healing granulation tissue around the plug and throughout the wounded pathway. Placement of the plug directly against the wounded inner surface of the pathway has encouraged this tissue to surround the plug, and prevented epithelium from forming around the longitudinal surfaces of the plug. Epithelium 26 has grown to cover the distal and proximal faces of the plug to form distal and proximal layers of tissue over the plug. The unwounded longitudinal muscle layer and remaining circular muscle layer remain in the pre-wound condition. After a period of time, a network of new blood vessels organizes within the granulation tissue, and a matrix of connective tissue forms within the granulation tissue.
Thus, depending on the pore size of the plug foam, the plug may be infiltrated with vascularized granulation tissue (for plugs with large pore sizes in the range of 40-200 microns) or infiltrated with scattered macrophages and surrounded with a vascularized capsule of connective tissue (for plugs with small pore sizes in the range of 1-20 microns). In either case, the growth of epithelium between the plug and the wounded portion of the ovarian pathway is inhibited, and the formation of a foreign body avascular fibrous capsule is inhibited by displacement of that structure in favor of other wound healing structures.
The plug is preferably made of a material with a pore size, chemistry and architecture that actually facilitates cellular ingrowth into the material (large pore plugs) or that allow macrophage infiltration but inhibit cellular ingrowth (small pore plugs). Regarding the large pore plugs, the nature of the desired ingrowth is vastly different from the standard foreign body reaction. The primary difference is a type of ingrowth that consists of a variety of blood vessels, connective matrix and cells, macrophages, and other cells. Regarding the small pore plugs, the nature of the foreign body capsule is altered to include numerous blood vessels. These structures can be described as “organoid,” as they exist as an integral part of the organ. Two types of materials that we are investigating have displayed this organoid appearance after healing, those materials with a specified architecture and pore size of between 40-200 microns, and those materials that have specific architectures and are microporous (1-20 microns). The wound healing growth would be classified histologically for the small pore materials as resembling the tissue of an “altered foreign body response”, and for the larger pore materials, as approaching the look and content of the “dermis”.
The plug may be made of ePTFE (also referred to as expanded Teflon or expanded polytetraflouroethylene), porous silicone, acrylic copolymer, cellulose acetate, polyethylene and high density polyethylene (HDPE), PE, polyester, and sintered, micro-knurled, or molded titanium and platinum. Textured polyamides or polyimides, hydroxyapitite, and hydrogels are also potential suitable materials. Preferably, these materials are formed into a plug (a sphere, cylinder or other occluding mass) of foamed material. The preferable pore sizes of the foam fall into the two distinct ranges mentioned above, namely 1-20 micron pore size and 40-200 micron pore size (40-120 microns is even better). The foam is preferably formed as a reticulated foam, meaning that the pores communicate with other pores, rather than existing as discrete and isolated voids within the material. The plug may have a solid core surrounded by foam or a porous material having a reticulated network of pores.
Silicone foam is readily formed into foam plugs with the procedure set forth in Seare, Method of Making A Porous Device, U.S. Pat. No. 5,605,693 (Feb. 25, 1997). Uncured silicone (MED 4860 grade supplied by Nusil Technology Corp is suitable) is injected into a form packed with granules, and slowly fills the voids between all the granules. The silicone is cured and the particles are dissolved in a suitable solvent (water, where sugar or salt is used) to form the reticulated foam plug. The foam plug has a durometer value between 20-100 Shore A, preferably about 60 Shore A.
a illustrate the two examples of the large pore foam plug. The foam is a matrix of interlocking angular blocks of silicone 45 (only a few are called out with the item number) which are formed together to create a network of communicating pores 46 with sizes corresponding to the size of the granules that were used to make the negative. The pores communicate with surrounding pores to form a reticulated or networked foam. The pore size of the large foam pore illustrated in
The plug may be fabricated from expanded polytetraflouroethylene, commonly referred to as ePTFE, with the processes used for forming ePTFE generally. Starting with a PTFE rod, the rod is stretched to expand the PTFE to form the system of nodes and fibrils characteristic of ePTFE. Pore size (commonly referring to the distance between the nodes) and the number and size of fibrils connecting the nodes is controlled by stretching the PTFE rods at controlled rates and temperatures. (The plugs may also be fabricated from sheets of PTFE which are stretched to the degree necessary to create the desired porosity, then cut to shape. The plugs may also be formed of very thin sheets of ePTFE which are used to coat or wrap a solid rod of PTFE.) The process results in a material illustrated in
The plug may also be formed of acrylic copolymer (such as tetrafluoroethylene and hexafluoropropylene), as illustrated in
The delivery catheter developed for delivery of the plugs and to apply the desired wounding system is illustrated in
The plugs may be compressed to fit into the lumen 59 in the wounding segment of the catheter. A holding rod 60 is disposed within the catheter body 51, fixed longitudinally within the catheter body at any point distal to the wounding segment (it may be secured by gluing or heat sealing a proximal segment of the holding rod to the inner wall of the catheter body) which permits adequate pullback of the wounding segment to release the plug. A pullwire 61 is secured to the proximal end of the wounding segment by attachment of the boss 62 on the distal end of the pullwire. The pullwire extends distally from the wounding segment to the proximal end of the catheter body.
In use, the catheter is inserted into the uterus transcervally, and the distal tip of the catheter is navigated into the fallopian tubes, until the wounding segment is stationed at the desired point along the ovarian pathway (the utero-tubal junction is our preferred location for the wound and the plug placement). Surgeons may view the placement with an endoscope or hysteroscope, and/or placement within the pathway can be confirmed with fluoroscopy. (Of course, placement of the catheter may be accomplished blindly, using tactile feedback only.) Once the wounding element is in place, the appropriate wound may be created by application of power limited so as destroy the epithelial layer/endosalpinx in the area of plug placement, yet avoid unwanted physiological reactions. The goal is to completely necrose the epithelium/endosalpinx, and to accomplish this goal, the surgeon applies sufficient wounding power to necrose the epithelium/endosalpinx, and the lamina propria, while limiting the wounding power to prevent damage to the longitudinal muscle layer. Damage to the circular muscle layer should be insubstantial, but may be tolerated. After wounding the ovarian pathway, the wounding segment is withdrawn by pulling the pullwire proximally while holding the catheter in place. This ejects the plug without need for relative motion between the plug and the wound after the operator has positioned the catheter for use.
When using RF energy as the wounding mechanism, we have determined that power of 0.1 to 5 watts for about 5 to 60 seconds causes thermal necrosis of the epithelial layer, without damaging the longitudinal muscle layer and without inducing an acute inflammatory response. Preferably, temperature in the tissue is monitored with temperature sensors mounted on the delivery catheter wounding segment, and power is applied to maintain tissue temperature in the range of 40-80.degree. C. for a period of 5 to 60 seconds. Experimentally, we have determined that maintaining temperature of about 70.degree. C. for 7 seconds works well. Also, maintaining temperature in the range of 52-58.degree. C. for 40-60 seconds works well. The heating may also be accomplished in two stages, heating briefly to 70-80.degree. C. (5 to 10 seconds) followed by heating to 40-60.degree. C. for an additional 30 to 60 seconds.
a are photographs of an actual implant with the large pore foam.
Formation of the vascularized fibrotic capsule is illustrated in
While the preferred embodiments of the devices and methods have been described in reference to the environment in which they were developed, they are merely illustrative of the principles of the inventions. It is contemplated that additional materials may be developed for use in the inventions described, and that additional means for wounding the ovarian pathway may be developed for use with inventions described. Other embodiments and configurations may be devised without departing from the spirit of the inventions and the scope of the appended claims.
This application is a continuation of U.S. application Ser. No. 10/812,476, filed Mar. 29, 2004, now U.S. Pat. No. 7,842,035, which is continuation of U.S. application Ser. No. 09/810,761, filed Mar. 16, 2001, now U.S. Pat. No. 6,712,810, which is a continuation of U.S. application Ser. No. 09/241,790, filed Feb. 1, 1999, now U.S. Pat. No. 6,309,384, all of which are incorporated by reference herein in their entireties as part of the present disclosure.
Number | Name | Date | Kind |
---|---|---|---|
2102270 | Hyams | Dec 1937 | A |
3680542 | Cimber | Aug 1972 | A |
3805767 | Erb | Apr 1974 | A |
3840016 | Lindemann | Oct 1974 | A |
3858571 | Rudolph | Jan 1975 | A |
3858586 | Lessen | Jan 1975 | A |
3918431 | Sinnreich | Nov 1975 | A |
3938527 | Rioux et al. | Feb 1976 | A |
3949736 | Vrana et al. | Apr 1976 | A |
3953566 | Gore | Apr 1976 | A |
RE29345 | Erb | Aug 1977 | E |
4052754 | Homsy | Oct 1977 | A |
4057063 | Grieles et al. | Nov 1977 | A |
4060088 | Morrison, Jr. et al. | Nov 1977 | A |
4185618 | Corey | Jan 1980 | A |
4245643 | Benzing, III et al. | Jan 1981 | A |
4258721 | Parent et al. | Mar 1981 | A |
4311145 | Esty et al. | Jan 1982 | A |
4345602 | Yoshimura et al. | Aug 1982 | A |
4416660 | Dafoe | Nov 1983 | A |
4474179 | Koch | Oct 1984 | A |
4509504 | Brundin | Apr 1985 | A |
4512342 | Zaneveld et al. | Apr 1985 | A |
4523590 | Roth et al. | Jun 1985 | A |
4537186 | Verschoof et al. | Aug 1985 | A |
4606336 | Zeluff | Aug 1986 | A |
4641634 | Storz | Feb 1987 | A |
4700701 | Montaldi | Oct 1987 | A |
4779611 | Grooters et al. | Oct 1988 | A |
4781175 | McGreevy et al. | Nov 1988 | A |
4788966 | Yoon | Dec 1988 | A |
4793326 | Shishido | Dec 1988 | A |
4834091 | Ott | May 1989 | A |
4900303 | Lemelson | Feb 1990 | A |
4907158 | Kettler et al. | Mar 1990 | A |
4966597 | Cosman | Oct 1990 | A |
4994069 | Ritchart et al. | Feb 1991 | A |
5009655 | Daignault, Jr. et al. | Apr 1991 | A |
5095917 | Vancaillie | Mar 1992 | A |
5098430 | Fleenor | Mar 1992 | A |
5122137 | Lennox | Jun 1992 | A |
5147353 | Everett | Sep 1992 | A |
5152784 | Tsilibary | Oct 1992 | A |
5167658 | Ensslin | Dec 1992 | A |
5203344 | Scheltinga et al. | Apr 1993 | A |
5256138 | Burek et al. | Oct 1993 | A |
5303719 | Wilk et al. | Apr 1994 | A |
5304194 | Chee et al. | Apr 1994 | A |
5320091 | Grossi et al. | Jun 1994 | A |
5341804 | Fogt et al. | Aug 1994 | A |
5341807 | Nardella | Aug 1994 | A |
5366476 | Noda | Nov 1994 | A |
5383922 | Zipes et al. | Jan 1995 | A |
5391010 | Gorbunov | Feb 1995 | A |
5391146 | That et al. | Feb 1995 | A |
5395342 | Yoon | Mar 1995 | A |
5458585 | Salmon et al. | Oct 1995 | A |
5458640 | Gerrone | Oct 1995 | A |
5460628 | Neuwirth et al. | Oct 1995 | A |
5469857 | Laurent et al. | Nov 1995 | A |
5490845 | Racz | Feb 1996 | A |
5505686 | Willis et al. | Apr 1996 | A |
5531741 | Barbacci | Jul 1996 | A |
5536267 | Edwards et al. | Jul 1996 | A |
RE35330 | Malone et al. | Sep 1996 | E |
5556396 | Cohen et al. | Sep 1996 | A |
5569242 | Lax et al. | Oct 1996 | A |
5569245 | Guglielmi et al. | Oct 1996 | A |
5569462 | Martinson et al. | Oct 1996 | A |
5581487 | Kelly et al. | Dec 1996 | A |
5589176 | Seare, Jr. | Dec 1996 | A |
5598848 | Swanson et al. | Feb 1997 | A |
5601600 | Ton | Feb 1997 | A |
5605693 | Seare, Jr. | Feb 1997 | A |
5617319 | Arakawa et al. | Apr 1997 | A |
5632767 | Sinofsky | May 1997 | A |
5635482 | Bhatnagar | Jun 1997 | A |
5643253 | Baxter et al. | Jul 1997 | A |
5643257 | Cohen et al. | Jul 1997 | A |
5649924 | Everett et al. | Jul 1997 | A |
5658282 | Daw et al. | Aug 1997 | A |
5673704 | Marchlinski et al. | Oct 1997 | A |
5681572 | Seare, Jr. | Oct 1997 | A |
5743905 | Eder et al. | Apr 1998 | A |
5746769 | Ton et al. | May 1998 | A |
5785705 | Baker | Jul 1998 | A |
5785706 | Bednarek | Jul 1998 | A |
5800529 | Brauker et al. | Sep 1998 | A |
5810810 | Tay et al. | Sep 1998 | A |
5827269 | Saadat | Oct 1998 | A |
5830222 | Makower | Nov 1998 | A |
5836875 | Webster, Jr. | Nov 1998 | A |
5836990 | Li | Nov 1998 | A |
5891457 | Neuwirth et al. | Apr 1999 | A |
5935137 | Saadat et al. | Aug 1999 | A |
5954715 | Harrington et al. | Sep 1999 | A |
5979446 | Loy | Nov 1999 | A |
6013075 | Avramenko et al. | Jan 2000 | A |
6042590 | Sporri et al. | Mar 2000 | A |
6059779 | Mills | May 2000 | A |
6066139 | Ryan et al. | May 2000 | A |
6068626 | Harrington et al. | May 2000 | A |
6071283 | Nardella et al. | Jun 2000 | A |
6080152 | Nardella et al. | Jun 2000 | A |
6091995 | Ingle et al. | Jul 2000 | A |
6096052 | Callister et al. | Aug 2000 | A |
6117070 | Akiba | Sep 2000 | A |
6145505 | Nikolchev et al. | Nov 2000 | A |
6176240 | Nikolchev et al. | Jan 2001 | B1 |
6178354 | Gibson | Jan 2001 | B1 |
6255593 | Reede | Jul 2001 | B1 |
6264653 | Falwell | Jul 2001 | B1 |
6309384 | Harrington et al. | Oct 2001 | B1 |
6346102 | Harrington et al. | Feb 2002 | B1 |
6391024 | Sun et al. | May 2002 | B1 |
6401719 | Farley et al. | Jun 2002 | B1 |
6432116 | Callister et al. | Aug 2002 | B1 |
6526979 | Nikolchev et al. | Mar 2003 | B1 |
6544236 | Cragg et al. | Apr 2003 | B1 |
6565557 | Sporri et al. | May 2003 | B1 |
6569160 | Goldin et al. | May 2003 | B1 |
6595989 | Schaer | Jul 2003 | B1 |
6634361 | Nikolchev et al. | Oct 2003 | B1 |
6637962 | Roche et al. | Oct 2003 | B1 |
6679266 | Nikolchev et al. | Jan 2004 | B2 |
6682477 | Boebel et al. | Jan 2004 | B2 |
6684884 | Nikolchev et al. | Feb 2004 | B2 |
6705323 | Nikolchev et al. | Mar 2004 | B1 |
6709667 | Lowe et al. | Mar 2004 | B1 |
6712810 | Harrington et al. | Mar 2004 | B2 |
6726682 | Harrington et al. | Apr 2004 | B2 |
6763833 | Khera et al. | Jul 2004 | B1 |
6780182 | Bowman et al. | Aug 2004 | B2 |
6871085 | Sommer | Mar 2005 | B2 |
6871650 | Nikolchev et al. | Mar 2005 | B1 |
6964274 | Ryan et al. | Nov 2005 | B1 |
6972018 | Ryan et al. | Dec 2005 | B2 |
7073504 | Callister et al. | Jul 2006 | B2 |
7195630 | Ciarrocca | Mar 2007 | B2 |
7220259 | Harrington et al. | May 2007 | B2 |
7237552 | Khera et al. | Jul 2007 | B2 |
7398780 | Callister et al. | Jul 2008 | B2 |
7428904 | Nikolchev et al. | Sep 2008 | B2 |
7500974 | Sartor | Mar 2009 | B2 |
7506650 | Lowe et al. | Mar 2009 | B2 |
7582085 | Bowman et al. | Sep 2009 | B2 |
7635382 | Pryor | Dec 2009 | B2 |
7699056 | Tran et al. | Apr 2010 | B2 |
7842035 | Harrington et al. | Nov 2010 | B2 |
7905880 | Harrington et al. | Mar 2011 | B2 |
8100129 | Swann | Jan 2012 | B2 |
20020177855 | Greene et al. | Nov 2002 | A1 |
20020188195 | Mills | Dec 2002 | A1 |
20020188247 | Peery | Dec 2002 | A1 |
20030032936 | Lederman | Feb 2003 | A1 |
20040186423 | Cafferata | Sep 2004 | A1 |
20040225187 | Kamrava et al. | Nov 2004 | A1 |
20040255958 | Harrington et al. | Dec 2004 | A1 |
20040267308 | Bagaoisan et al. | Dec 2004 | A1 |
20050045184 | Khera et al. | Mar 2005 | A1 |
20050143817 | Hunter et al. | Jun 2005 | A1 |
20050171402 | Cohen et al. | Aug 2005 | A1 |
20060116635 | Van Heugten et al. | Jun 2006 | A1 |
20060293560 | Nguyen et al. | Dec 2006 | A1 |
20070123781 | Callahan et al. | May 2007 | A1 |
20070135830 | Schaeffer | Jun 2007 | A1 |
20070161957 | Guenther et al. | Jul 2007 | A1 |
20070173883 | Keegan et al. | Jul 2007 | A1 |
20070196158 | Roche et al. | Aug 2007 | A1 |
20070215163 | Harrington et al. | Sep 2007 | A1 |
20080135053 | Gruber et al. | Jun 2008 | A1 |
20080167664 | Payne et al. | Jul 2008 | A1 |
20080249362 | Jiang et al. | Oct 2008 | A1 |
20090036840 | Viray et al. | Feb 2009 | A1 |
20090056722 | Swann | Mar 2009 | A1 |
20090062611 | Toyama | Mar 2009 | A1 |
20090125023 | Stephen et al. | May 2009 | A1 |
20090132141 | Hrovat et al. | May 2009 | A1 |
20090209951 | Marrouche et al. | Aug 2009 | A1 |
20090266366 | Swann et al. | Oct 2009 | A1 |
20090281558 | Li | Nov 2009 | A1 |
20100063360 | Harrington et al. | Mar 2010 | A1 |
20100198214 | Layton, Jr. et al. | Aug 2010 | A1 |
20110040146 | Harrington et al. | Feb 2011 | A1 |
20110087109 | Swann | Apr 2011 | A1 |
20110146692 | Callaghan et al. | Jun 2011 | A1 |
20110180073 | Callaghan et al. | Jul 2011 | A1 |
20110202077 | Chin et al. | Aug 2011 | A1 |
20110276070 | Viray et al. | Nov 2011 | A1 |
20110308527 | Harrington et al. | Dec 2011 | A1 |
Number | Date | Country |
---|---|---|
5940396 | Feb 1997 | AU |
2182738 | Oct 2000 | CA |
1692872 | Nov 2005 | CN |
3917179 | Dec 1989 | DE |
0 105 669 | Apr 1984 | EP |
0 153 190 | Aug 1985 | EP |
0 541 258 | May 1993 | EP |
0 752 236 | Jan 1997 | EP |
1 554 999 | Jul 2005 | EP |
1 169 974 | Dec 2005 | EP |
2359492 | Aug 2001 | GB |
9640023 | Dec 1996 | WO |
9640024 | Dec 1996 | WO |
9717030 | May 1997 | WO |
9749345 | Dec 1997 | WO |
9855046 | Dec 1998 | WO |
0191834 | Dec 2001 | WO |
0228311 | Apr 2002 | WO |
2009132141 | Oct 2009 | WO |
Number | Date | Country | |
---|---|---|---|
20110040146 A1 | Feb 2011 | US |
Number | Date | Country | |
---|---|---|---|
Parent | 10812476 | Mar 2004 | US |
Child | 12912087 | US | |
Parent | 09810761 | Mar 2001 | US |
Child | 10812476 | US | |
Parent | 09241790 | Feb 1999 | US |
Child | 09810761 | US |