Detection of an endoscope to a fluid management system

Description

TECHNICAL FIELD

The disclosure is directed to a fluid management system. More particularly, the disclosure is directed to a system and method for verifying connectivity of a device to a fluid management system.

BACKGROUND

Flexible ureteroscopy (fURS), gynecology, and other endoscopic procedures require the circulation of fluid for several reasons. Surgeons today deliver the fluid in various ways such as, for example, by hanging a fluid bag and using gravity to deliver the fluid, filling a syringe and manually injecting the fluid or using a peristaltic pump to deliver fluid from a reservoir at a fixed pressure or flow rate via a fluid management system. Fluid management systems may adjust the flow rate and/or pressure at which fluid is delivered from the reservoir based on data collected from a procedural device, such as, but not limited to, an endoscope. Of the known medical devices, systems, and methods, each has certain advantages and disadvantages. There is an ongoing need to provide alternative medical devices and fluid delivery systems.

SUMMARY

The disclosure is directed to systems and methods for verifying connectivity of a procedural device to a fluid management system.

In a first example, a fluid management and medical device system may comprise a fluid management system and a medical device. The fluid management system may comprise a pump configured to pump fluid from a fluid supply source through the fluid management system at a fluid flow rate and a processing device including a user interface, the processing device configured to control the pump to maintain a target fluid flow rate based on the set of system operating parameters. The medical device may comprise an elongate shaft in fluid communication with the pump of the fluid management system, a pressure sensor disposed at a distal end of the elongate shaft, and a handle coupled to a proximal end of the elongate shaft. The processing device of the fluid management system may be configured to adjust the fluid flow rate based on data received from the pressure sensor of the medical device and the processing device of the fluid management system may be configured to verify the medical device is in a patient's body prior to adjusting the fluid flow rate based on the data received from the pressure sensor of the medical device.

Alternatively or additionally to any of the examples above, in another example, the pulsatile pressure generated at the pump and the data received from the pressure sensor of the medical device may each be filtered, normalized, and converted to a frequency domain.

Alternatively or additionally to any of the examples above, in another example, when a dominant tone extracted from the frequency domain of the pulsatile pressure generated at the pump matches a dominant tone extracted from the frequency domain of the data received from the pressure sensor, the processing device of the fluid management system may determine the medical device is in use within the patient's body.

Alternatively or additionally to any of the examples above, in another example, when a temperature measured at the temperature sensor is greater than a threshold temperature above room temperature, the processing device of the fluid management system may determine the medical device is in use within the patient's body. In some instances, the threshold temperature may be 25° C., 28° C., 30° C., 32° C., or 35° C.

Alternatively or additionally to any of the examples above, in another example, the system may further comprise a stress sensor disposed at the distal end of the elongate shaft of the medical device.

Alternatively or additionally to any of the examples above, in another example, when a stress measured at the stress sensor is above a predetermined threshold, the processing device of the fluid management system may determine the medical device is in use within the patient's body.

Alternatively or additionally to any of the examples above, in another example, the stress sensor may be a Fiber Bragg grating optical fiber.

Alternatively or additionally to any of the examples above, in another example, the system may further comprise a position marker at the distal end of the elongate shaft of the medical device, the position marker configured for use in sensing in a magnetic field of a mapping and navigation system.

Alternatively or additionally to any of the examples above, in another example, a position of the position marker may be determined relative to the patient.

Alternatively or additionally to any of the examples above, in another example, when the position of the position marker is within the patient's body, the processing device of the fluid management system may determine the medical device may be in use within the patient's body.

Alternatively or additionally to any of the examples above, in another example, the processing device of the fluid management system may be configured to compare a pulsatile pressure generated within the body with the data received from the pressure sensor of the medical device, and when the data received from the pressure sensor of the medical device matches the pulsatile pressure the processing device of the fluid management system may determine the medical device is in use within the patient's body.

Alternatively or additionally to any of the examples above, in another example, the processing device of the fluid management system may be configured to compare an atmospheric pressure with the data received from the pressure sensor of the medical device while the pump is active, and when the data received from the pressure sensor of the medical device is greater than the atmospheric pressure the processing device of the fluid management system may determine the medical device is in use within the patient's body.

Alternatively or additionally to any of the examples above, in another example, the medical device may further comprise a workstation in electronic communication with the pressure sensor and the processing device of the fluid management system, the workstation including at least a display and a processor.

In another example, a fluid management and medical device system may comprise a fluid management system and a medical device. The fluid management system may comprise a pump configured to pump fluid from a fluid supply source through the fluid management system at a fluid flow rate and a processing device including a user interface, the processing device configured to control the pump to maintain a target fluid flow rate based on the set of system operating parameters. The medical device may comprise an elongate shaft in fluid communication with the pump of the fluid management system, and a pressure sensor disposed at a distal end of the elongate shaft, a handle coupled to a proximal end of the elongate shaft. The processing device of the fluid management system may be configured to adjust the fluid flow rate based on data received from the pressure sensor of the medical device and the processing device of the fluid management system may be configured to verify the medical device is in a patient's body prior to adjusting the fluid flow rate based on the data received from the pressure sensor of the medical device.

Alternatively or additionally to any of the examples above, in another example, the processing device of the fluid management system may be configured to compare a pulsatile pressure generated at the pump with the data received from the pressure sensor of the medical device and the pulsatile pressure generated at the pump and the data received from the pressure sensor of the medical device may each be filtered, normalized, and converted to a frequency domain.

Alternatively or additionally to any of the examples above, in another example, the system may further comprise a temperature sensor disposed at the distal end of the elongate shaft of the medical device and when a temperature measured at the temperature sensor is above room temperature, the processing device of the fluid management system may determine the medical device is in use within the patient's body.

Alternatively or additionally to any of the examples above, in another example, the system may further comprise a stress sensor disposed at the distal end of the elongate shaft of the medical device and when a stress measured with the stress sensor is above a predetermined threshold, the processing device of the fluid management system may determine the medical device is in use within the patient's body.

Alternatively or additionally to any of the examples above, in another example, the processing device of the fluid management system may be configured to compare a pulsatile pressure generated within the body with the data received from the pressure sensor of the medical device, and when a characteristic extracted from the data received from the pressure sensor of the medical device matches a characteristic extracted the pulsatile pressure, the processing device of the fluid management system may determine the medical device is in use within the patient's body.

Alternatively or additionally to any of the examples above, in another example, the processing device of the fluid management system may be configured to compare an atmospheric pressure with the data received from the pressure sensor of the medical device while the pump is active, and when the data received from the pressure sensor of the medical device is greater than the atmospheric pressure, the processing device of the fluid management system may determine the medical device is in use within the patient's body.

In another example, a fluid management and medical device system may comprise a fluid management system and a medical device. The fluid management system may comprise a pump configured to pump fluid from a fluid supply source through the fluid management system at a fluid flow rate and a processing device including a user interface, the processing device configured to control the pump to maintain a target fluid flow rate based on the set of system operating parameters. The medical device may comprise an elongate shaft in fluid communication with the pump of the fluid management system, a pressure sensor disposed at a distal end of the elongate shaft, and a handle coupled to a proximal end of the elongate shaft. The processing device of the fluid management system may be configured to adjust the fluid flow rate based on data received from the pressure sensor of the medical device and the processing device of the fluid management system may be configured to verify the medical device is in a patient's body using at least a first verification process and a second verification process prior to adjusting the fluid flow rate based on the data received from the pressure sensor of the medical device.

Alternatively or additionally to any of the examples above, in another example, the processing device may be further configured to use a third verification process prior to adjusting the fluid flow rate based on the data received from the pressure sensor of the medical device.

Alternatively or additionally to any of the examples above, in another example, each of the first verification process, the second verification process, and the third verification process may be different.

Alternatively or additionally to any of the examples above, in another example, if a majority of the first, second, and third verification processes indicate the medical device is in a patient's body, the processing device of the fluid management system may determine the medical device is in use within the patient's body.

Alternatively or additionally to any of the examples above, in another example, the processing device of the fluid management system may be configured to use a weighted average of a result from each of the first, second, and third verification processes to determine if the medical device is in use within the patient's body.

In another example, a method for verifying a medical device is in use may comprise receiving a first set of data from a medical device, receiving a second set of data from a fluid management system, the second set of data being a same type of data as the first set of data, comparing the first set of data with the second set of data, and if the first set of data and the second set of data meet a predetermined condition, determining the medical device is within a body of a patient.

Alternatively or additionally to any of the examples above, in another example, the first set of data may be one or more pressure readings obtained at a distal end of the medical device and the second set of data may be one or more pressure readings obtained at the fluid management system and the first set of data and the second set of data may each be filtered, normalized, and converted to a frequency domain.

Alternatively or additionally to any of the examples above, in another example, the first set of data and the second set of data may meet the predetermined condition when a dominant tone extracted from the frequency domain of the first set of data and a dominant tone extracted from the second set of data match.

Alternatively or additionally to any of the examples above, in another example, the first set of data may be one or more temperature readings obtained at a distal end of the medical device and the second set of data may be an ambient temperature and the first set of data and the second set of data may meet the predetermined condition when the one or more temperature readings of the first set of data is greater than the ambient temperature.

Alternatively or additionally to any of the examples above, in another example, the first set of data may be one or more pressure readings obtained at a distal end of the medical device while the fluid management system is active and the second set of data may be an atmospheric pressure and the first set of data and the second set of data may meet the predetermined condition when the one or more pressure readings of the first set of data is greater than the atmospheric pressure.

The above summary of some example embodiments is not intended to describe each disclosed embodiment or every implementation of the invention.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention may be more completely understood in consideration of the following detailed description of various embodiments in connection with the accompanying drawings, in which:

FIG. 1 is a schematic illustration of a fluid management system according to an illustrative embodiment of the present disclosure;

FIG. 2 is a side view of a medical device of the system of FIG. 1 according to an illustrative embodiment;

FIG. 3 is a top view of the medical device of FIG. 2;

FIG. 4 is a schematic illustration of the medical device of FIG. 2 in situ;

FIG. 5 is a partial perspective view of the heater assembly and cassette of the system of FIG. 1 according to an illustrative embodiment;

FIG. 6 is a schematic block diagram of the illustrative fluid management system and medical device of FIG. 1;

FIGS. 7A-7C are a set of illustrative graphs of pressure data from the fluid management system and the medical devices;

FIGS. 8A-8C are another set of illustrative graphs of pressure data from the fluid management system and the medical devices;

FIGS. 9-12 are illustrative flow charts of methods for determining if data from the medical device can be used to control the fluid management system;

FIG. 13 is a schematic perspective view of an illustrative mapping and navigation system; and

FIG. 14 is another illustrative flow chart of a method for determining if data from the medical device can be used to control the fluid management system.

While the invention is amenable to various modifications and alternative forms, specifics thereof have been shown by way of example in the drawings and will be described in detail. It should be understood, however, that the intention is not to limit aspects of the invention to the particular embodiments described. On the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the invention.

DETAILED DESCRIPTION

For the following defined terms, these definitions shall be applied, unless a different definition is given in the claims or elsewhere in this specification.

All numeric values are herein assumed to be modified by the term “about”, whether or not explicitly indicated. The term “about” generally refers to a range of numbers that one of skill in the art would consider equivalent to the recited value (i.e., having the same function or result). In many instances, the term “about” may be indicative as including numbers that are rounded to the nearest significant figure.

The recitation of numerical ranges by endpoints includes all numbers within that range (e.g., 1 to 5 includes 1, 1.5, 2, 2.75, 3, 3.80, 4, and 5).

Although some suitable dimensions ranges and/or values pertaining to various components, features and/or specifications are disclosed, one of skill in the art, incited by the present disclosure, would understand desired dimensions, ranges and/or values may deviate from those expressly disclosed.

As used in this specification and the appended claims, the singular forms “a”, “an”, and “the” include plural referents unless the content clearly dictates otherwise. As used in this specification and the appended claims, the term “or” is generally employed in its sense including “and/or” unless the content clearly dictates otherwise.

The following detailed description should be read with reference to the drawings in which similar elements in different drawings are numbered the same. The detailed description and the drawings, which are not necessarily to scale, depict illustrative embodiments and are not intended to limit the scope of the invention. The illustrative embodiments depicted are intended only as exemplary. Selected features of any illustrative embodiment may be incorporated into an additional embodiment unless clearly stated to the contrary.

The terms “proximal” and “distal” as used herein are intended to refer to a direction toward (proximal) and away from (distal) a user of the device.

Some fluid management systems for use in flexible ureteroscopy (fURS) procedures (e.g., ureteroscopy, percutaneous nephrolithotomy (PCNL), benign prostatic hyperplasia (BPH), etc.), gynecology, and other endoscopic procedures may regulate body cavity pressure when used in conjunction with an endoscope device such as, but not limited to, a LithoVue™ scope device using pressure and/or temperature data from the endoscope or other endoscopic device. Direct regulation of the intracavity pressure during a medical procedure may allow the fluid management system to safely drive system pressures of up to 600 mmHg to ensure no loss of flow during the procedure when tools are inserted into the working channel of the endoscope device. However, the fluid management system may need to determine when it is safe to use the endoscope data for regulating body cavity pressure (e.g., intrarenal pressure). Systems and methods for verifying the endoscope device is connected to the fluid management system and in use within the body are desired.

FIG. 1 is a schematic view of an illustrative fluid management system 10 that may be used in an endoscopic procedure, such as fURS procedures. The fluid management system 10 may be coupled to a surgical device 20 that allows flow of fluid therethrough and includes a pressure sensor. An illustrative surgical device may be a LithoVue′ scope device, or other endoscope. In an illustrative embodiment, the device 20 may include a temperature sensor to provide intracavity temperature feedback to the fluid management system 10, a pressure sensor to provide intracavity pressure feedback to the fluid management system 10, and/or a camera to provide visual feedback to the fluid management system 10.

Briefly, the fluid management system 10 may include a pump system 50 configured to transfer fluid from a fluid bag 34 to the medical device 20. In some cases, the fluid may pass through a heating system 60 prior to entering the medical device 20. The flow of fluid, pressure of the fluid, temperature of the fluid, and other operational parameters may be controlled by or at least partially controlled by a main processing device 48 including a display screen 44. The main processing device 48 may be in electronic communication (e.g., wired or wireless) with the medical device 20, the pump system 50, and/or the heating system 60 to provide control commands and/or to transfer or receive data therebetween. For example, as will be described in more detail herein, the main processing system 48 may receive data from the medical device 20, such as, but not limited to, pressure and temperature data. The main processing system 48 may then use the data received from the medical device 20 to control operational parameters of the pump system 50 and/or the heating system 60.

The fluid management system 10 also includes a fluid management unit 30. An illustrative fluid management unit 30 may include one or more fluid container supports, such as fluid bag hangers 32, each of which supports one or more fluid bags 34. In an embodiment, placement of the fluid bag 34 may be detected using a remote sensor. The fluid bag hangers 32 may receive a variety of sizes of fluid bags 34 such as, for example, 1 liter (L) to 5 L bags. It will be understood that any number of fluid containers may be used. Furthermore, fluid containers of any size may be used depending on the procedure. An illustrative fluid management unit 30 may be mounted to a rolling stand, which may include a pole 36 and/or a base 38. The base 38 may include a plurality of wheels to facilitate easy movement of the fluid management unit 30 when in use. However, it will be understood that the fluid bag 34 may also be hung from the ceiling or other location depending on the clinical preference. The fluid bag hanger 32 extends from the pole 36 and may include one or more hooks 40 from which one or more fluid bags 34 may be suspended. The fluid used in the fluid management unit 30 may be 0.9% saline. However, it will be understood that a variety of other fluids of varying viscosities may be used depending on the procedure.

The fluid management system 10 may also include one or more user interface components such as a touch screen interface 42. The touch screen interface 42 includes a display screen 44 and may include switches or knobs in addition to touch capabilities. The touch screen interface 42 allows the user to input/adjust various functions of the system 10 such as, for example flow rate, pressure or temperature. The user may also configure parameters and alarms (such as, but not limited to, a max pressure alarm), information to be displayed, and the procedure mode. The touch screen interface 42 allows the user to add, change or discontinue the use of various modular systems within the fluid management system 10. The touch screen interface 42 may also be used to change the system 10 between automatic and manual modes for various procedures. It is contemplated that other systems configured to receive user input may be used in place of or in addition to the touch screen interface 42.

The touch screen interface 42 may be configured to include selectable areas like buttons and/or may provide a functionality similar to physical buttons as would be understood by those skilled in the art. The display screen 44 may be configured to show icons related to modular systems and devices included in the fluid management system 10. For example, the display screen 44 may provide the user with a live video feed of the target tissue/vessel/cavity from the scope or medical device 20. The display screen 44 may also include a flow rate display. The flow rate display may be determined based on a desired threshold for flow rate set by the user prior to the procedure or based on known common values, etc. In some embodiments, the operating parameters may be adjusted by touching the corresponding portion of the touch screen interface 42. The touch screen interface 42 may also display visual alerts and/or audio alarms if parameters (e.g., flow rate, temperature, etc.) are above or below predetermined thresholds. The touch screen interface 42 may also be configured to display the system power, the amount of fluid remaining in the fluid bag 34, and any other information the user may find useful during the procedure. In an illustrative embodiment, the fluid management system 10 may also include further user interface components such as a foot pedal 46, a heater user interface, a fluid control interface or other device to manually control various modular systems. For example, the foot pedal 46 may be used to manually control flow rate. Some illustrative display screens 44 and other user interface components are described in described in commonly assigned U.S. Patent Publication Number 2018/0361055, titled AUTOMATED FLUID MANAGEMENT SYSTEM, the disclosure of which is hereby incorporated by reference.

The touch screen interface 42 may be operatively connected to or a part of the main processing device 48. The main processing device 48 may be a computer, tablet computer, or other processing device. The main processing device 48 may be operatively connected to one or more system components such as, for example, the pump system 50, the heating system 60 and a fluid deficit management system. The main processing device 48 is capable of and configured to perform various functions such as calculation, control, computation, display, etc. The main processing device 48 is also capable of tracking and storing data pertaining to the operations of the management system 10 and each component thereof. In an illustrative embodiment, the main processing device 48 includes network communication capabilities, such as Wi-Fi, through which the processing device 48 may be connected to, for example, a local area network. The main processing device 48 may also receive signals from the sensors of the system 10. In an embodiment, the main processing device 48 may communicate with databases for best practice suggestions and the maintenance of patient records which may be displayed to the user on the display screen 44.

The fluid management system 10 may be user selectable between different modes based on the procedure, patient characteristics, etc. For example, different modes may include, but are not limited to, fURS Mode, BPH Mode, Hysteroscopy Mode, Cystoscopy Mode, etc. Once a mode has been selected by the user, mode parameters such as flow rate, pressure, fluid deficit and temperature are provided to the user via the display screen. The exemplary parameters of the specific modes may be previously determined and loaded onto the main processing device 48 using, for example, software. Thus, when a user selects a procedure from an initial display on the touch screen interface display screen 44, these known parameters are loaded from the processor to the various components of the fluid management system 10, such as, but not limited to the pump system 50, the heating system 60, the fluid deficit management system, etc. The fluid management system 10 may also be user selectable between automatic and manual mode. For example, for certain procedures, the user may wish to manually adjust a flow rate, pressure or other parameters. Once the user has selected the manual mode on, for example, the touch screen interface 42, the user may the adjust flow rate or pressure via other manual interfaces such as the foot pedal 46 or the fluid control interface. If the user selects an automatic mode, the user may be prompted to select or input via the touch screen interface 42 which medical device 20 is being used so that the processing device 48 may determine if data obtained from the medical device 20 can be used to facilitate control of the fluid management system 10. As will be described in more detail herein, the fluid management system 10 may be configured to verify the medical device 20 selected is actually being used prior to using the collected data.

The main processing device 48 may be configured to include visual software/image recognition software that can detect visual noise based on variations in brightness (e.g., light monitoring), contrast, or color pixilation. If the image provided to the main processing device 48 is determined to be not sufficiently clear or sharp, the fluid management system 10 increases the flow rate of the fluid to flush out debris to sharpen/clear the image. The flow rate is increased for a temporary time (e.g., a predetermined time period) or until the field of view is deemed to be sufficiently clear. This temporary increase ensures that the time at which a flow rate is increased is limited to ensure that pressure does not exceed safe limits. For example, the system 10 may recognize a red hue in the irrigation (a sign of blood) and signal to one or more peristaltic pumps 52 within the pump assembly 50 to increase the flow rate until the blood is cleared from the field of view. Alternatively, the processing device 48 may provide a visual alert on the display screen 44 or an audible alert to the physician or nurse that a cloudy view has been detected and the user may then adjust the irrigation flow rate manually. In another example, in instances where there is a lot of debris, light reflected from the debris will brighten the image substantially. In this situation, the main processing device 48 detects this inordinate brightness and signals to the pump system 50 to increase a flow rate to remove debris. Once the reflected light has been reduced as the debris is flushed clear of the field of view of the vision system, the pump system 50 is controlled by the main processing device 48 to reduce the flow rate. In some cases, the physician may create a baseline level for visibility at which he or she prefers to initiate a field clearing flow of fluid and input these parameters into the system 10 via the touch screen interface 42 prior to the procedure. Once the baseline has been created, the system 10 monitors the visual feed for variation in the picture and adjusts the flow rate as necessary.

In order to adjust the rate of flow of fluid through the system 10, the fluid management unit 30 may include one or more pressurization devices such as a pump 52. An illustrative pump 52 may be a peristaltic pump. The pump 52 may be electrically driven and may receive power from a line source such as a wall outlet or an external or internal electrical storage device such as a disposable or rechargeable battery. The peristaltic pump 52 may operate at any desired speed sufficient to deliver fluid at a target pressure such as, for example, 5 mmHg to 50 mmHg. As noted previously, the pump 52 may be automatically adjusted based on, for example, pressure and temperature readings within the patient and/or visual feedback from the medical device 20. The pump 52 may also be manually adjusted via, for example, foot pedal 46, the touch screen interface 42, or a separate fluid controller. While not explicitly shown, the fluid controller may be a separate user interface including buttons that allow the user to increase or decrease each individual pump 52. Alternatively, the fluid controller may be incorporated into the main processing device and receive input via the touch screen interface 42. It will be understood that any number of pumps may be used. In an embodiment, the fluid management system 10 may include multiple pumps having different flow capabilities. A flow meter may be located before and/or after the pump(s) 52.

The flow rate of the fluid at any given time is displayed on the display screen 44 to allow the operating room (OR) visibility for any changes. If the OR personnel notice a change in flow rate that is either too high or too low, the user may manually adjust the flow rate back to a preferred level. This may happen, for example, as physicians insert and remove tools into the working channel of the medical device 20. The fluid management system 10 may also monitor and automatically adjust the flow rate based on previously set parameters, as previously discussed. This feature may also be beneficial when flow is provided manually such as an assistant injecting irrigation through a syringe.

As noted above, in an embodiment, the fluid management system 10 may include visual software or image recognition and analysis software. In this embodiment, the fluid management system 10 may detect, via a camera 70 (see, for example, FIGS. 2 and 3) positioned on the medical device 20 within the body, whether a tool has been inserted or not and which tool is being used. The tool may, for example, have an identifiable marker that the visual software may see to inform the system what type of tool is being used. The fluid management system 10 may then automatically adjust the flow rate based on the tool identified by the visual software. When the tool is retracted from the working channel, the fluid management system 10 reduces the pump rate accordingly.

Additionally, or alternatively, the fluid management system 10 may automatically adjust the flow rate based on a pressure and/or a temperature detected within the patient. The pressure and/or the temperature may be measured in line through a tool, such as temperature sensors 72 and/or pressure sensors or transducers 74 mounted on the medical device 20, used in conjunction with the fluid management system 10. The fluid management system 10 may include pressure monitoring software so that the pump 52 may be configured by the user to be automatically started, stopped, and/or speed adjusted by the fluid management system 10 to maintain a fluid pressure delivered to a surgical site at a target pressure and/or within a predetermined pressure band. For example, a scope pressure sensor 74 may detect pressure within the kidney and automatically alter the flow rate within the fluid management system 10 based on a monitored intrarenal pressure. If intrarenal pressure is too high, the fluid management system 10 will decrease the flow rate and vice versa. In an exemplary temperature control mode, the fluid management system 10 may include temperature monitoring software so that the heating system 60 may be controlled (e.g., started, stopped, and temperature adjusted) to maintain a fluid temperature delivered to a surgical site at about a target temperature and/or within a predetermined temperature pressure band, as will be described in further detail below. For example, the temperature may be monitored in vivo or in vitro and the flow of fluid altered based on the temperature feedback provided. In an illustrative embodiment, the fluid management system 10 may compare the temperature and pressure sensed within the kidney to known values and provide a warning when the parameters are outside of a predetermined safe region. The warning may be a visual or audio alert.

In an embodiment, the fluid management system 10 may monitor movement of a target structure such as, for example, a kidney stone. The fluid management system 10 may calculate the rate of movement based on the original position of the stone and its new position. If the movement exceeds a predetermined threshold, the user may be alerted to manually adjust the flow rate of the fluid management system 10. As described above, flow rate may be adjusted manually via a foot pedal 46, the touch screen interface 42 and/or a pump interface. In an embodiment, if the fluid management system 10 is in an auto mode, the fluid management system 10 will automatically adjust the flow of irrigation as necessary automatically. This capability may be extremely beneficial during procedures such as a lithotripsy to control retropulsion of the stone.

FIGS. 2 and 3 are schematic views of an illustrative medical device 20 that may be used in conjunction with the fluid management system 10. In the illustrated embodiments, the medical device 20 may be a ureteroscope such as a LithoVue™ scope. However, other medical devices, such as another endoscope, may be used in addition to or in place of a ureteroscope. The medical device 20 delivers fluid from the fluid management system 10 to the target tissue via an elongate or scope shaft 76. The elongate shaft 76 may include one or more working lumens for receiving a flow of fluid or other medical devices therethrough. The medical device 20 is connected to the fluid management system 10 via one or more supply line(s) 78 (e.g., a tube), as shown in FIG. 4, which is a schematic view of the medical device 20 in fluid communication with the fluid management system 10 and positioned within a patient's body.

The medical device 20 may be in electronic communication with a workstation 81 via a wired connection 79. The workstation 81 may include a touch panel computer 83, an interface box 85 for receiving the wired connection 79, a cart 87, and a power supply 89, among other features. In some cases, the interface box 85 may be configured to be in wired or wireless communication 91 with the main processing device 48. The touch panel computer 83 may include at least a display screen, an image processor, and a controller. In some cases, the workstation 81 may be a multi-use component (e.g., used for more than one procedure) while the medical device 20 may be a single use device, although this is not required. In some cases, the workstation 81 may be omitted and the medical device 20 may be directly coupled to the main processing device 48 of the fluid management system.

The supply line(s) 78 from the fluid management system 10 to the medical device 20 may be formed of a material the helps dampen the peristaltic motion created by the pump(s) 52. As shown in FIG. 2, the medical device 20 may include a pressure transducer 74 at a distal tip of the scope shaft 76 to measure pressure within, for example, the kidney. The medical device 20 may also include other sensors such as, for example, a temperature sensor 72, a Fiber Bragg grating optical fiber 75 to detect stresses, and/or an antenna or electromagnetic sensor 93. In an illustrative embodiment, the distal end 80 of the medical device 20 may also include at least one camera 70 to provide a visual feed to the user on the display screen 44. In another embodiment, the medical device 20 may include two cameras 70 having different communications requirements or protocols so that different information may be relayed to the user by each camera 70. When so provided, the user may switch back and forth between cameras 70 at will through the touch screen interface 42. While not explicitly shown, the scope shaft 76 may include one or more working lumens for receiving the fluid and/or other medical devices.

The medical device 20 includes a handle 82 coupled to a proximal end of the elongate shaft 76. The handle 82 may have a fluid flow on/off switch 84, which allows the user to control when fluid is flowing through the medical device 20 and into the patient. The handle 82 may further include other buttons 86 that perform other various functions. For example, in one embodiment, the scope handle 82 may include buttons to control the temperature of the scope or fluid. In another embodiment, the scope handle 82 may include a laser so that the user may fire laser energy. In an illustrative embodiment, the laser may be a Lumenis or StarMed Tech Laser. A laser fiber may be connected to the laser system and inserted through the ureteroscope working channel. The user may fire the laser so that energy comes out of the laser fiber tip which hits the debris/stone to break it up. In an exemplary embodiment including a laser button on the scope, a communication line between the laser system and the scope is maintained (e.g., hardwire or wireless). It will be understood that while the exemplary embodiment describes a ureteroscope, the features detailed above may also be directly integrated into a cystoscope, hysteroscope, or virtually any device with an image capability. Medical device 20 may also include a drainage port 88 which may be connected to a drainage system 90. Some illustrative drainage systems 90 are described in described in commonly assigned U.S. Patent Publication Number 2018/0361055, titled AUTOMATED FLUID MANAGEMENT SYSTEM, the disclosure of which is hereby incorporated by reference.

Returning briefly to FIG. 1, the fluid management system 10 may include a fluid deficit monitoring system 92. In an illustrative embodiment, the fluid deficit monitoring system 92 monitors the amount of fluid (e.g., saline) in a fluid bag 34 through weight. For example, a weight sensor 94 such as a scale is hung from the hook 40. The weight sensor 94 may also include a hook 96 from which one or more fluid bags 34 are suspended. The weight sensor 94 determines a weight of the fluid bag 34 attached to the management unit 30 to compare an initial amount of fluid in the fluid bag 34 to a current amount of fluid remaining in the fluid bag 34. The readout of the scale is shown to the user on the display screen 44. As the procedure proceeds, the readout of the scale is updated in real time to alert the physician to how much fluid is left in the fluid bag 34 and this amount may then be used to determine the amount of fluid that has been infused into the patient. In an illustrative embodiment, the fluid management system 10 provides the amount of time remaining before a new bag is needed based on the weight of the bag 34 and the rate at which the bag 34 is emptying (e.g., flow rate). In another embodiment, the amount of fluid remaining may be shown. An alert may be shown on the display screen 44 with an audible signal when, for example, 10% of the saline is left in the bag 34. In an illustrative embodiment, the weight sensor 94 may connect to the display screen 44 via a Wi-Fi signal. In another exemplary embodiment, the weight sensor 94 may be connected to the display screen 44 via a hard wire connection.

In another illustrative embodiment, the fluid deficit monitoring system 92 may include a pressure sensor connected inline between the fluid bag 34 and the device 20. In this embodiment, pressure is determined based on the height of the fluid bag 34. The amount of head pressure decreases as the bag empties. When the pressure falls below a threshold set by the user, an alert is shown on the display screen 44 and an audible signal is emitted. In another exemplary embodiment, the fluid deficit monitoring system 92 may be set to a specific flow rate based on the amount of time that has passed. The physician may enter a bag fluid volume into the fluid management system 10 which then calculates the amount of fluid already used and how much is left based on the known flow rate and the amount of time the fluid management system 10 has been in use.

The fluid management system 10 may utilize small diameter pump tubing 78 to connect various components. Illustrative tubing 78 for irrigation procedures may be less than or equal to 1/16 inches in diameter. However, it will be understood that tubing size may vary based on the application. Tubing may be disposable and provided sterile and ready to use. Different types of tubing may be used for various functions within the fluid management system 10. For example, one type of tubing may be used for fluid heating and fluid flow control to the device 20 while another type of tubing may be used for irrigation within the body.

In an illustrative embodiment, the fluid management system 10 may optionally include a fluid warming system 60 for heating fluid to be delivered to the patient, as shown in FIG. 5. The fluid warming system 60 includes a heater 62 and a heater cassette 64. The cassette 64 may be configured to be a single use cassette 64 while the heater 62 may be reused for multiple procedures. For example, the cassette 64 may isolate fluid flow such that the heater 62 may be reused with minimal maintenance. The cassette 64 may be formed of, for example, polycarbonate or any high heat rated biocompatible plastic and is formed as a single piece or a plurality of pieces permanently bonded to one another. An illustrative cassette 64 may include a fluid inlet port 61 and a fluid outlet port 63 located at a lateral side of the cassette 64. The fluid inlet and outlet ports 61, 63 may each be configured to couple to a tube 78 of the fluid management system 10. For example, the fluid inlet port 61 may couple the fluid source 34 and the fluid warming system 60 (via the pump 52) while the outlet port 63 may couple the fluid warming system 60 with the medical device 20 each via the fluid tubing 78.

In an illustrative embodiment, the cassette 64 includes an internal flow path along a channel through which fluid may flow from the fluid inlet 61 to the fluid outlet 63. The cassette 64 may include one fluid path or multiple fluid paths. In some cases, the channel may pass through a susceptor 66 which may allow the fluid to be heated via induction heating. When the cassette 64 is coupled with the heater 62, the susceptor 66 may be configured to be positioned within an induction coil 68. Other heater configurations and methods may also be used, as desired. For example, the heater 62 may include one or more heat sources such as, for example a platen system or an in line coil in the fluid supply line using electrical energy. Heating may be specifically designed and tailored to the flow rates required in the specific application of the fluid management system 10. Some illustrative heater systems 60 are described in described in commonly assigned U.S. Patent Publication Number 2018/0361055, titled AUTOMATED FLUID MANAGEMENT SYSTEM, the disclosure of which is hereby incorporated by reference.

While not explicitly shown, the fluid warming system 60 may include a heater user interface separate from the touch screen interface 42. The heater user interface may simply be a display screen providing a digital display of the internal temperature of the heater. In another embodiment, the user interface may also include temperature adjustment buttons to increase or decrease the temperature of the heater 62. In this embodiment, the heater display screen) may indicate the current temperature of the heater as well as the target temperature to be reached. It is noted that all information output from the fluid warming system 60 may be transmitted directly to the display screen 44 such that no heater user interface is necessary.

The fluid warming system 60 may include one or more sensors configured to monitor the fluid. For example, temperature sensors 65 may be mounted in the fluid warming system 60 such that they detect the temperature of the fluid flowing through the cassette 64. The temperature sensors 65 may be located at or near the fluid inlet port 61 and the fluid outlet port 63. In an illustrative embodiment, the temperature sensors 65 may be mounted so that they detect the temperature of fluid flowing through the cassette 64 prior to the fluid entering the susceptor 66 and after fluid exits the susceptor 66. In some embodiments, additional sensors may be located at a medial portion of the susceptor 66 so that they detect the progression of the temperature increase of the fluid in the cassette 64. The temperature sensors 65 may remotely send any information to the display screen 44 or they may send information to heater user interface display screen, if so provided. In another embodiment, the temperature sensors 65 may be hardwired with the heater user interface (if provided) which is then able to remotely transmit desired information to the system display screen 44. Alternatively, or additionally, the temperature sensors 65 may be hardwired with the main processing device 48.

The heater assembly 62 may further include a pressure sensor 67 and a bubble sensor 69. The cassette 64 may include a corresponding pressure sensor interface 71 and bubble sensor interface 73 that allow the sensors 67, 69 to monitor the fluid flowing through the cassette 64 when the cassette is coupled with the fluid warming system 60. The pressure sensor 67 and/or bubble sensor 69 may remotely send any information to the display screen 44 or they may send information to heater user interface display screen, if so provided. In another embodiment, the pressure sensor 67 and/or bubble sensor 69 may be hardwired with the heater user interface (if provided) which is then able to remotely transmit desired information to the system display screen 44. Alternatively, or additionally, the pressure sensor 67 and/or bubble sensor 69 may be hardwired with the main processing device 48.

FIG. 6 is a schematic block diagram illustrating the fluid management system 10 and the medical device 20. As described herein, there may be two primary interfaces between the fluid management system 10 and the medical device 20 including one or more mechanical connections (e.g., fluid tubes 78) fluidly coupling the medical device 20 to the cassette 64 and one or more electrical or communications connections 91 (e.g., an Ethernet cord) coupling the workstation 81 of the medical device with the main processing device 48 of the fluid management system 10. The workstation 81 of medical device 20 may transmit intrarenal pressure measurements (e.g., obtained with the medical device 20) with the main processing device 48 of the fluid management system 10. The main processing device 48 of the fluid management system 10 may then use this pressure data to adjust fluid flow rates when a user specified or predetermined pressure limit is reached.

However, during a typical stone procedure, for example, the fluid management system 10 may be connected to multiple endoscopes, or other medical devices. Also, in a procedure where both the medical device 20 with the pressure sensor 74 and the fluid management system 10 are used, it is may be that the main procession device 48 and the workstation may be connected during the staging of the OR, and main remain connected throughout the procedure. This might mean if a medical device 20 is connected to its workstation 81, the workstation 81 will transmit pressure data to the main processing device 48 of the fluid management system 10 whether or not the medical device 20 is in use. Thus, the main processing device 48 of the fluid management system 10 may be configured to determine when it is safe to use the pressure data from the medical device 20 for regulating intrarenal pressure. In some cases, this may be done by asking the user to select on the touch screen interface 42 the type of scope being used. If the physician selects a device other than the medical device 20, the main processing device 48 of the fluid management system 10 may ignore the pressure data being sent from the medical device 20.

However, there can be cases where the physician incorrectly selects the medical device 20 when the physician is not actually using it or the physician may forget to tell the fluid management system 10 that the medical device 20 is no longer in use and a different scope or medical device is now in use. If the fluid management system 10 is unable to detect that a new scope or medical device is being used, the fluid management system 10 may incorrectly use the pressure data sent from the medical device 20 which is not in use (and therefore the pressure data is inaccurate relative to the intrarenal pressure). As a result, this may essentially bypass the fluid management system 10 pressure limit control and allow the fluid management system 10 to drive or deliver potentially hazardous pressures. To prevent such hazards from occurring, it may be necessary for the fluid management system 10 system to determine when it safe to use the pressure data transmitted from the medical device 20 via the workstation 81. Thus, it may be desirable to detect is a sensor enabled medical device 20 is connected to the fluid management system 10 when the only connection between the medical device 20 and the fluid management system 10 may be a physical connection using, for example, a standard Luer connector.

When the medical device 20 is in use with the fluid management system 10, the medical device 20 may be exposed to several unique sources of pulsatile pressures that can be measured by the pressure sensor 74 at the tip of the medical device 20. These sources of pulsation can either be unique to the fluid management system 10 or to the patient. If one or more sources of pulsation can be distinguished, the fluid management system 10 can make the determination that the medical device 20 is in use and thus safe to limit pressure based off the pressure measurements from the medical device 20.

One source of pulsatile pressure may be generated within the fluid management system 10. For example, a peristaltic fluid pump 52 may create a unique fingerprint in its pulsatile flow that can be measured with a pressure sensor, such as the pressure sensor 74 on the medical device 20. The pulsatility may be a function of the pump head rollers and the revolutions per minute (RPM) of the pump head. When the medical device 20 is connected to the fluid management system 10, this fingerprint can be measured by the medical device 20 and matched against the signature created by the pump mechanism of the fluid management system 10. When there is a match between the measured pressure pulsatile flow at the pressure sensor 74 of the medical device 20 and the known signature of the pump 52 of the fluid management system 10, the fluid management system 10 can confirm the medical device 20 is in use and connected to the fluid management system 10.

FIG. 7A is an illustrative graph 100 of unfiltered raw pressure data 102 from the fluid management system 10 and unfiltered raw pressure data 104 from the medical device 20. In some cases, the raw pressure data 102 from the fluid managements system 10 may be received from the pressure sensor 67 in the heater system 60. In other embodiments, the pressure data 102 may be retrieved from a database of expected pressures according to fluid flow rate. In the illustrative embodiment, the data 102, 104 is collected at a medium flow rate of about 100 milliliters per minute (mL/min). However, it should be understood that the data processing steps described herein may be used for flow rates less than 100 mL/min and greater than 100 mL/min. In order to compare the pressure data 102 from the fluid management system 10 and pressure data 104 from the medical device, the data 102, 104 may be filtered using math averaging. To begin, the DC component of each measured waveform 102, 104 may be filtered. In some cases, the data 102, 104 may be filtered with a low pass filter with a filter cutoff frequency. The filter cutoff frequency may be set based off of the pump flow rate. The data 102, 104 may then be normalized. FIG. 7B is a graph 110 of the filtered and normalized pressure data 112 from the fluid management system 10 and the filtered and normalized pressure data 114 from the medical device 20. Next, a fast Fourier transform (FFT) algorithm may be performed on the filtered and normalized data 112, 114 to extract the dominant tone created by the pump 52. The FFT algorithm may convert the filtered and normalized data 112, 114 from the time domain to the frequency domain. FIG. 7C is a graph 120 of the filtered and normalized pressure data of the fluid management system 10 and the filtered and normalized pressure data of the medical device 20 in the frequency domain. When the filtered and normalized pressure data 112, 114 is converted to the frequency domain, the dominant tone 122 (e.g., the frequency having the greatest magnitude) of the fluid management system 10 and the dominant tone 124 of medical device 20 can be identified. As can be seen in FIG. 7C, in the illustrative embodiment, the dominant tone 122 of the fluid management system 10 and the dominant tone 124 of the medical device 20 are similar or the same at about 2.3 Hertz (Hz). In the illustrated example, the fluid management system 10 may determine that the dominant tones 12, 124 match. The dominant tones 122, 124 may be considered to match if they are equal, approximately equal, or within a predetermined range of one another. When the dominant tone 122 of the fluid management system 10 and the dominant tone 124 of the medical device 20 match, the fluid management system 10 can determine that the medical device 20 is in use and connected to the fluid management system 10 and the data from the medical device 20 can be used to control fluid management system 10.

It is contemplated that the data processing may occur at the main processing device 48, the workstation 81, or combinations thereof. In some embodiments, all of the raw pressure data 102, 104 may be processed and analyzed at a single processing device. In other embodiments, the raw pressure data 102, 104 may be processed at separate processing devices. For example, in some cases, the main processing device 48 may process (e.g., filter, normalized, and/or FFT) the raw pressure data 102 obtained from the fluid management system 10 while the workstation 81 may process (e.g., filter, normalize, and/or FFT) the raw pressure data 104 obtained from the medical device 20. In some cases, the processed medical device data may be transferred from the workstation 81 to the main processing device 48 for comparison. In other embodiments, the processed fluid management system data may be transferred from the main processing device 48 to the workstation 81 for analysis.

FIGS. 8A-8C illustrate the processing of another pressure data set. FIG. 8A is an illustrative graph 150 of unfiltered raw pressure data 152 from the fluid management system 10 and unfiltered raw pressure data 154 from the medical device 20. In the illustrative embodiment, the data 152, 154 is collected at a higher flow rate of about 400 milliliters per minute (mL/min). However, it should be understood that the data processing steps described herein may be used for flow rates less than 400 mL/min and greater than 400 mL/min. In order to compare the pressure data 152 from the fluid management system 10 and pressure data 154 from the medical device, the data 152, 154 may be filtered using math averaging. To begin, the DC component of each measured waveform 152, 154 may be filtered. In some cases, the data 152, 154 may be filtered with a low pass filter with a filter cutoff frequency. The filter cutoff frequency may be set based off of the pump flow rate. The data 152, 154 may then be normalized. FIG. 8B is a graph 160 of the filtered and normalized pressure data 162 from the fluid management system 10 and the filtered and normalized pressure data 164 from the medical device 20. Next, a fast Fourier transform (FFT) algorithm may be performed on the filtered and normalized data 162, 164 to extract the dominant tone created by the pump 52. The FFT algorithm may convert the filtered and normalized data 162, 164 from the time domain to the frequency domain. FIG. 8C is a graph 170 of the filtered and normalized pressure data of the fluid management system 10 and the filtered and normalized pressure data of the medical device 20 in the frequency domain. When the filtered and normalized pressure data 162, 164 is converted to the frequency domain, the dominant tone 172 (e.g., the frequency having the greatest magnitude) of the fluid management system 10 and the dominant tone 174 of medical device 20 can be identified. As can be seen in FIG. 8C, in the illustrative embodiment, the dominant tone 172 of the fluid management system 10 and the dominant tone 174 of the medical device 20 are not similar or the same. For example, the dominant tone 172 of the fluid management system 10 is about 9.5 Hz while the dominant tone 174 of the medical device is about 4 Hz. In this example, the fluid management system 10 may determine that the dominant tones 172, 174 do not match and the thus the data from the medical device 20 should not be used to control the fluid management system 10.

Another source of pulsatile pressure may be the patient's heartbeat. For example, pulsatile waves, which are synchronous with the heartbeat, may be transmitted to within the renal pelvis. These pulsatile waves may create a unique pressure signature related to the cardiac rhythm that can be detected by the medical device 20. The fluid management system 10 may be configured to compare a characteristic extracted from the pressure signature of the heartbeat with a characteristic extracted from data received from the pressure sensor 74 on the medical device 20. The characteristic may be a frequency, amplitude, dominant tone, etc. In one example, the fluid management system 10 may compare heartbeat data that has been filtered, normalized and converted to the frequency domain to pressure data from the medical device 20 that has also been filtered, normalized and converted to the frequency domain in a manner similar to that described with respect to FIGS. 7A-7C and FIGS. 8A-8C. It is contemplated that the heartbeat data may be obtained from a medical device other than the fluid management system 10 or the medical device 20. If the cardiac rhythm is detected in the medical device 20 pressure measurements, the fluid management system 10 can make the determination that medical device 20 is in use and thus the fluid management system 10 can use data obtained from the medical device 20 to control the fluid management system 10. If the cardiac rhythm cannot be detected in the medical device 20 pressure measurements, the fluid management system 10 can make the determination that medical device 20 is not in use and the fluid management system 10 should not use pressure measurements from the medical device 20.

Another source of pulsatile pressure may be the ureteral renal pelvic activity of the patient. For example, the contraction and relaxation of the patient's ureter or renal pelvis may create a unique and measurable pressure wave. The periodic from these contractions may be detected with the pressure sensor 74 in the medical device 20. The fluid management system 10 may be configured to compare a characteristic extracted from the pressure signature of the ureteral renal pelvic activity with a characteristic extracted from data received from the pressure sensor 74 on the medical device 20. The characteristic may be a frequency, amplitude, dominant tone, etc. In some cases, the contractions may be detected with a sensor other than the medical device 20 or the fluid management system 10 for comparison to pressure data from the medical device 20. In other embodiments, the fluid management system 10 may be configured to compare an expected or preprogrammed contraction pattern with the pressure data from the medical device 20. It is contemplated that the contraction data (if obtained during the medical procedure) may be filtered, normalized and converted to the frequency domain prior to comparison with the pressure data from the medical device which has also been filtered, normalized and converted to the frequency domain in a manner similar to that described with respect to FIGS. 7A-7C and FIGS. 8A-8C. If the ureteral renal pelvic activity is detected in the medical device 20 pressure measurements, the fluid management system 10 can make the determination that medical device 20 is in use and thus the fluid management system 10 can use data obtained from the medical device 20 to control the fluid management system 10. If the ureteral renal pelvic activity cannot be detected in the medical device 20 pressure measurements, the fluid management system 10 can make the determination that medical device 20 is not in use and the fluid management system 10 should not use pressure measurements from the medical device 20.

Yet another source of pulsatile pressure may be the patient's respiration. For example, the normal respiratory rhythm of the patient may create slow, time varying changes in intrarenal pressure. These slow changes in pressure may be measured by the pressure sensor 74 on the medical device 20 (when the medical device 20 is in use) and matched to the patient's respiratory rhythm. The fluid management system 10 may be configured to compare a characteristic extracted from the pressure signature of the respiratory rhythm with a characteristic extracted from data received from the pressure sensor 74 on the medical device 20. The characteristic may be a frequency, amplitude, dominant tone, etc. In an example, the fluid management system 10 may compare respiration data that has been filtered, normalized and converted to the frequency domain to pressure data from the medical device 20 that has also been filtered, normalized and converted to the frequency domain in a manner similar to that described with respect to FIGS. 7A-7C and FIGS. 8A-8C. It is contemplated that the respiration data may be obtained from a medical device other than the fluid management system 10 or the medical device 20. If the respiration rhythm is detected in the medical device 20 pressure measurements, the fluid management system 10 can make the determination that medical device 20 is in use and thus the fluid management system 10 can use data obtained from the medical device 20 to control the fluid management system 10. If the respiration rhythm cannot be detected in the medical device 20 pressure measurements, the fluid management system 10 can make the determination that medical device 20 is not in use and the fluid management system 10 should not use pressure measurements from the medical device 20.

FIG. 9 is an illustrative flow chart 200 of a method for using pulsatile pressures to determine if the medical device 20 is in use within the body of the patient. To begin, the main processing device 48 of the fluid management system 10 may initiate a device verification process, as shown at block 202. It is contemplated that the main processing device 48 may be configured to perform the check at predetermined intervals during the procedure (e.g., every minute, every five minutes, etc.). In other embodiments, the main processing device 48 may be configured to perform the device verification each time the fluid processing system attempts to use pressure data from the medical device 20 to control fluid flow from the fluid management system. Additionally, or alternatively, the device verification may be manually initiated. For example, the physician may initiate device verification using the touch screen interface 42. The fluid management system 10 may then obtain pressure data from the medical device 20, as shown at block 204. In some cases, the main processing device 48 of the fluid management system 10 may poll the workstation 81 of the medical device 20 for raw data over a predetermined time period, although this is not required. In some cases, the main processing device 48 may command the workstation 81 to obtain the pressure data from the medical device 20. The pressure data from the medical device 20 may then be filtered, normalized, and converted to the frequency domain, as shown at block 206. It is contemplated that the pressure data from the medical device 20 may be processed at the main procession device 48 of the fluid management system 10 or at the workstation 81 of the medical device 20, as desired.

The fluid management system 10 may also obtain pulsatile pressure data from the fluid management system 10 and/or the patient, as shown at block 208. Sources of pulsatile pressure data may include, but are not limited to, the pressure pulses generated by a peristaltic pump 52, the patient's heartbeat, the patient's ureteral renal pelvic activity, the patient's respiratory rhythm, etc. It is contemplated that the fluid management system 10 may be configured to obtain the pulsatile pressure data over the same predetermined time period as (e.g., substantially simultaneously with) the pressure data from the medical device 20. However, in some instances, the fluid management system 10 may not obtain new data related to the pulsatile pressure data, but rather reference a predetermined baseline or expected data. The pressure data from the fluid management system 10 and/or the patient may then be filtered, normalized, and converted to the frequency domain, as shown at block 210. It is contemplated that the pressure data from the fluid management system 10 and/or the patient may be processed at the main processing device 48 of the fluid management system 10 or at the workstation 81 of the medical device 20, as desired.

The main processing device 48 of the fluid management system 10 or the workstation 81 may then compare the frequency domain data of the medical device 20 with the frequency domain data of the pulsatile pressure source, as shown at block 212. The main processing device 48 of the fluid management system 10 or the workstation 81 may then determine if the frequency domain data of the medical device 20 and the frequency domain data of the pulsatile pressure source match, as shown at block 214. If the frequency domain data of the medical device 20 and the frequency domain data of the pulsatile pressure source match, the fluid management system 10 determines the pressure data from the medical device 20 can be used to control the fluid flow from the fluid management system 10, as shown at block 216. If the frequency domain data of the medical device 20 and the frequency domain data of the pulsatile pressure source do not match, the fluid management system 10 determines the pressure data from the medical device 20 cannot or should not be used to control the fluid flow from the fluid management system 10, as shown at block 218.

Alternatively, or additionally, the data obtained from the temperature sensor 72 of the medical device 20 may be used to determine if the data from the pressure sensor 74 can be used to help control the fluid management system 10. FIG. 10 is an illustrative flow chart 300 of a method for using temperature measurements from the medical device 20 to determine if the medical device 20 is in use within the body of the patient. To begin, the main processing device 48 of the fluid management system 10 may initiate a device verification process, as shown at block 302. It is contemplated that the main processing device 48 may be configured to perform the check at predetermined intervals during the procedure (e.g., every minute, every five minutes, etc.). In other embodiments, the main processing device 48 may be configured to perform the device verification each time the fluid processing system attempts to use pressure data from the medical device 20 to control fluid flow from the fluid management system 10. Additionally, or alternatively, the device verification (block 302) may be manually initiated. For example, the physician may initiate device verification using the touch screen interface 42. The fluid management system 10 may then obtain temperature data from the medical device 20, as shown at block 304. In some cases, the main processing device 48 of the fluid management system 10 may poll the workstation 81 of the medical device 20 for raw data over a predetermined time period, although this is not required. In some cases, the main processing device 48 may command the workstation 81 to obtain the temperature data from the medical device 20.

The main processing device 48 of the fluid management system 10 or the workstation 81 may then determine if the temperature measurement from the medical device 20 is greater than room temperature (e.g., greater than about 20° C.-23° C.), as shown at block 306. In some cases, the main processing device 48 of the fluid management system 10 or the workstation 81 may then determine if the temperature measurement from the medical device 20 is around body temperature (e.g., about 37° C.). If the temperature measurement obtained from the temperature sensor 72 on the medical device 20 is greater than 20° C.-23° C. (e.g., room temperature) or about 37° C. (e.g., body temperature), the fluid management system 10 determines the pressure data from the medical device 20 can be used to control the fluid flow from the fluid management system 10, as shown at block 308. If the temperature measurement obtained from the temperature sensor 72 on the medical device 20 is about 20° C.-23° C. (e.g., room temperature) or less 37° C. (e.g., body temperature), the fluid management system 10 determines the pressure data from the medical device 20 cannot or should not be used to control the fluid flow from the fluid management system 10, as shown at block 310. In some cases, the fluid management system 10 may be configured to determine the medical device 20 is in use any time the temperature measurement obtained at the temperature sensor 72 is greater than room temperature (e.g., greater than about 20° C.-23° C.). The fluid management system 10 may compare the temperature measurement obtained at the temperature sensor 72 to an ambient temperature measurement of the room (an accurately measured room temperature). In other cases, the fluid management system 10 may be configured such that any temperature measurement greater than 25° C., greater than 28° C., or greater than 30° C. obtained at the temperature sensor is above room temperature and thus the data from the medical device 20 is safe to use.

It is contemplated that the fluid management system 10 may be programmed with a first temperature range that may be considered about room temperature (e.g., 20° C.+/−5° C. or 23° C.+/−3° C.) or an accurate room temperature measurement may be inputted into the fluid management system 10 from a ambient temperature sensor provided with or otherwise communicating with the fluid management system, and a second temperature range that may be considered about body temperature (e.g., 37° C.+/−1° C. or 37° C.+/−2° C.). These are just examples. Other temperature ranges may be used as desired or appropriate for the environmental conditions. In some cases, a body temperature range may be selected that accounts for procedures in which the fluid management system 10 delivers fluid at temperatures greater than body temperature (e.g., for example when a laser is in use). In other cases, a body temperature range may be selected that accounts for procedures in which the fluid management system 10 delivers fluid at temperatures less than body temperature.

Alternatively, or additionally, the data obtained from the pressure sensor 74 of the medical device 20 may be compared to atmospheric pressure to determine if the data from the pressure sensor 74 of the medical device can be used to help control the fluid management system 10. FIG. 11 is an illustrative flow chart 400 of another method for using pressure measurements from the medical device 20 to determine if the medical device 20 is in use within the body of the patient. To begin, the main processing device 48 of the fluid management system 10 may initiate a device verification process, as shown at block 402. It is contemplated that the main processing device 48 may be configured to perform the check at predetermined intervals during the procedure (e.g., every minute, every five minutes, etc.). In other embodiments, the main processing device 48 may be configured to perform the device verification each time the fluid processing system attempts to use pressure data from the medical device 20 to control fluid flow from the fluid management system 10. Additionally, or alternatively, the device verification (block 402) may be manually initiated. For example, the physician may initiate device verification using the touch screen interface 42. The fluid management system 10 may then obtain pressure data from the medical device 20 while the fluid management system 10 is actively delivering fluid, as shown at block 404. In some cases, the main processing device 48 of the fluid management system 10 may poll the workstation 81 of the medical device 20 for raw data over a predetermined time period, although this is not required. In some cases, the main processing device 48 may command the workstation 81 to obtain the pressure data from the medical device 20.

It is contemplated that if the medical device 20 is in the body while the fluid management system 10 is delivering fluid, the pressure measured at the pressure sensor 74 of the medical device 20 will be greater than atmospheric pressure. The main processing device 48 of the fluid management system 10 or the workstation 81 may then determine if the pressure measurement from the medical device 20 is greater than atmospheric pressure, as shown at block 406. If the pressure measurement obtained from the pressure sensor 74 on the medical device 20 is above atmospheric pressure, the fluid management system 10 determines the pressure data from the medical device 20 can be used to control the fluid flow from the fluid management system 10, as shown at block 408. If the pressure measurement obtained from the pressure sensor 74 on the medical device 20 is at or about atmospheric pressure, the fluid management system 10 determines the pressure data from the medical device 20 cannot or should not be used to control the fluid flow from the fluid management system 10, as shown at block 410. It is contemplated that an average pressure measurement and/or a root mean square (RMS) DC pressure from the pressure sensor 74 may be used to compare against atmospheric pressure.

Alternatively, or additionally, data obtained from the Fiber Bragg grating optical fiber 75 at a distal end 80 of the medical device 20 may be used to determine if the data from the pressure sensor 74 of the medical device 20 can be used to help control the fluid management system 10. For example, the Fiber Bragg grating optical fiber 75 may detect stress along the shaft 76 of the medical device 20 that occurs during normal use of the medical device 20. FIG. 12 is an illustrative flow chart 500 of a method for using stress measurements from the medical device 20 to determine if the medical device 20 is in use within the body of the patient. To begin, the main processing device 48 of the fluid management system 10 may initiate a device verification process, as shown at block 502. It is contemplated that the main processing device 48 may be configured to perform the check at predetermined intervals during the procedure (e.g., every minute, every five minutes, etc.). In other embodiments, the main processing device 48 may be configured to perform the device verification each time the fluid processing system attempts to use pressure data from the medical device 20 to control fluid flow from the fluid management system 10. Additionally, or alternatively, the device verification (block 502) may be manually initiated. For example, the physician may initiate device verification using the touch screen interface 42. The fluid management system 10 may then obtain stress data from the Fiber Bragg grating optical fiber 75, or other stress measurement device, at a distal end 80 of the medical device 20, as shown at block 504. In some cases, the main processing device 48 of the fluid management system 10 may poll the workstation 81 of the medical device 20 for raw data over a predetermined time period, although this is not required. In some cases, the main processing device 48 may command the workstation 81 to obtain the stress data from the medical device 20.

It is contemplated that if the medical device 20 is in the body, the Fiber Bragg grating optical fiber 75 may detect stresses in the elongate shaft 76 caused by normal use of the medical device. The main processing device 48 of the fluid management system 10 or the workstation 81 may then determine if the stress measurements from the medical device 20 are detected, as shown at block 506. If stresses are detected, the fluid management system 10 determines the pressure data from the medical device 20 can be used to control the fluid flow from the fluid management system 10, as shown at block 508. If stresses are not detected, the fluid management system 10 determines the pressure data from the medical device 20 cannot or should not be used to control the fluid flow from the fluid management system 10, as shown at block 510. In some cases, the stress measurements may be compared to a predetermined threshold. For example, if the stresses are above a certain level the medical device 20 is in use while if the stresses are at or below the certain level, the medical device 20 is not in use.

Alternatively, or additionally, the location of the distal end 80 of the medical device 20 may be tracked to determine if the medical device 20 is in use. FIG. 13 is schematic view of an illustrative anatomical mapping and navigation system 600. The mapping and navigation system 600 may include an operating table 602 (or other procedural or examination table or chair, etc.). The operating table 602 may be configured to act or function as an electromagnetic generator to generate a magnetic field of a known geometry. Alternatively or additionally, an electromagnetic generator 606 separate from the operating table 602 may be provided. The operating table 602 and/or the electromagnetic generator 606 may be coupled to a control unit 604 which may include among other features, a processor, a memory, a display, and an input means.

A position sensor 93, such as, but not limited to an electromagnetic sensor 93, or other antenna, may be incorporated into the distal end 80 of the elongate shaft 76 of the medical device 20. The position sensor 93 may be configured for use in sensing a location of the position sensor in a magnetic field of a mapping and navigation system 600. The electromagnetic sensor 93 may be coupled to the workstation 81 of the medical device 20. When the electromagnetic sensor 93 is in the magnetic field, the position of the electromagnetic sensor 93 can be mathematically determined relative to the electromagnetic field source (e.g., the operating table 602 and/or the electromagnetic generator 606). The workstation 81 and the control unit 604 may communicate to determine the position of the electromagnetic sensor 93 relative to the patient. When the electromagnetic sensor 93 is positioned within the patient, the fluid management system 10 determines the pressure data from the medical device 20 can be used to control the fluid flow from the fluid management system 10. When the electromagnetic sensor is not positioned within the patient, the fluid management system 10 determines the pressure data from the medical device 20 cannot or should not be used to control the fluid flow from the fluid management system 10

It may be desirable to reduce the likelihood of falsely determining the medical device 20 is in the body when in actuality, the medical device is not in the body. For example, if the medical device 20 is not in the body but a user touches the temperature sensor 72, the medical device 20 may report to the fluid management system 10 the temperature is near body temperature, thus creating a false detection. It is contemplated that it may be desirable to use more than one sensor or technique to determine if the medical device 20 is in the body. FIG. 14 is an illustrative flow chart of a method 700 for using multiple techniques to determine if the medical device 20 is in the body.

To begin, the main processing device 48 of the fluid management system 10 may initiate a device verification process, as shown at block 702. It is contemplated that the main processing device 48 may be configured to perform the check at predetermined intervals during the procedure (e.g., every minute, every five minutes, etc.). In other embodiments, the main processing device 48 may be configured to perform the device verification each time the fluid processing system attempts to use pressure data from the medical device 20 to control fluid flow from the fluid management system. Additionally, or alternatively, the device verification may be manually initiated. For example, the physician may initiate device verification using the touch screen interface 42. The fluid management system 10 may then obtain a result (the result indicating whether or not the medical device 20 is in the body) from a first verification process or technique, as shown at block 704. The verification process may include, but are not limited to, the use of pulsatile pressures from the pump 52 of the fluid management system, pulsatile pressures from the cardiac cycle, pulsatile pressures from the ureteral renal pelvic activity, pulsatile pressures from the respiratory rhythm, temperature data, atmospheric pressure data, stress detection, location sensing, etc. The fluid management system 10 may also obtain results (the result indicating whether or not the medical device 20 is in the body) from one or more additional verification processes or techniques (different from the first verification process), as shown at block 706. It is contemplated that the results from the two or more verification processes may be obtained substantially simultaneously (e.g., in parallel) or sequentially (e.g., one after the other), as desired. The fluid management system 10 may use any number of verification processes and in any combination, as desired.

The main processing device 48 of the fluid management system 10 may compare the results to determine the number of verification processes that confirm the medical device 20 is in use with the number of verification processes that indicate the medical device 20 is not in use, as shown at block 708. The main processing device 48 of the fluid management system 10 may then determine if a majority of the verification processes confirm the medical device 20 is in use, as shown at block 710. If the majority of the verification processes confirm the medical device 20 is in use, the fluid management system 10 determines the pressure data from the medical device 20 can be used to control the fluid flow from the fluid management system 10, as shown at block 712. If the majority of the verification processes do not or fails to confirm the medical device 20 is in use, the fluid management system 10 determines the pressure data from the medical device 20 cannot or should not be used to control the fluid flow from the fluid management system 10, as shown at block 714. In some cases, all of the verification processes may confirm the medical device 20 is in use while in other cases, all of the verification processes may be in agreement that the medical device is not in use 20.

Alternatively, or additionally to determining if a majority of the verification processes confirm or do not confirm the medical device 20 is in user, when at least one verification process returns a result that is different from the one or more additional verification processes, the main processing device 48 of the fluid management system 10 may be configured to apply a weighted average to the results. For example, if a verification process is deemed to be more accurate than other verification processes, the more accurate verification process may be weighted more heavily during the comparison step (block 708) than the other processes. Other techniques for comparing and analyzing the results from the verification processes may be used as desired.

Those skilled in the art will recognize that the present invention may be manifested in a variety of forms other than the specific embodiments described and contemplated herein. Accordingly, departure in form and detail may be made without departing from the scope and spirit of the present invention as described in the appended claims.

Claims

1. A fluid management and medical device system comprising: a fluid management system comprising: a pump configured to pump fluid from a fluid supply source through the fluid management system at a fluid flow rate; anda processing device including a user interface, the processing device configured to control the pump to maintain a target fluid flow rate based on a set of system operating parameters;a medical device comprising: an elongate shaft in fluid communication with the pump of the fluid management system;a pressure sensor disposed at a distal end of the elongate shaft;a handle coupled to a proximal end of the elongate shaft; andwherein the processing device of the fluid management system is configured to adjust the fluid flow rate based on data received from the pressure sensor of the medical device;wherein the processing device of the fluid management system is configured to verify the medical device is in a patient's body and connected to the fluid management system prior to adjusting the fluid flow rate based on the data received from the pressure sensor of the medical device; andwherein the processing device is configured to perform the medical device verification each time the fluid management system attempts to use pressure data from the medical device to control fluid flow from the fluid management system.
2. The fluid management and medical device system of claim 1, wherein the processing device of the fluid management system is configured to compare a pulsatile pressure generated at the pump with the data received from the pressure sensor of the medical device; and wherein the pulsatile pressure generated at the pump and the data received from the pressure sensor of the medical device are each filtered, normalized, and converted to a frequency domain.
3. The fluid management and medical device system of claim 2, wherein when a dominant tone extracted from the frequency domain of the pulsatile pressure generated at the pump matches a dominant tone extracted from the frequency domain of the data received from the pressure sensor, the processing device of the fluid management system determines the medical device is in use within the patient's body.
4. The fluid management and medical device system of claim 1, further comprising a temperature sensor disposed at the distal end of the elongate shaft of the medical device; and wherein when a temperature measured at the temperature sensor is greater than a threshold temperature above room temperature, the processing device of the fluid management system determines the medical device is in use within the patient's body.
5. The fluid management and medical device system of claim 1, further comprising a stress sensor disposed at the distal end of the elongate shaft of the medical device; and wherein when a stress measured with the stress sensor is above a predetermined threshold, the processing device of the fluid management system determines the medical device is in use within the patient's body.
6. The fluid management and medical device system of claim 1, wherein the medical device further comprises a workstation in electronic communication with the pressure sensor and the processing device of the fluid management system, the workstation including at least a display and a processor.
7. The fluid management and medical device system of claim 1, further comprising: a position marker at the distal end of the elongate shaft of the medical device, the position marker configured for use in sensing in a magnetic field of a mapping and navigation system; andwherein a position of the position marker is determined relative to the patient.
8. The fluid management and medical device system of claim 7, wherein when the position of the position marker is within the patient's body, the processing device of the fluid management system determines the medical device is in use within the patient's body.
9. The fluid management and medical device system of claim 1, wherein the processing device of the fluid management system is configured to compare a pulsatile pressure generated within the patient's body with the data received from the pressure sensor of the medical device, and when a characteristic extracted from the data received from the pressure sensor of the medical device matches a characteristic extracted from the pulsatile pressure, the processing device of the fluid management system determines the medical device is in use within the patient's body.
10. The fluid management and medical device system of claim 1, wherein the processing device of the fluid management system is configured to compare an atmospheric pressure with the data received from the pressure sensor of the medical device while the pump is active, and when the data received from the pressure sensor of the medical device is greater than the atmospheric pressure, the processing device of the fluid management system determines the medical device is in use within the patient's body.
11. A fluid management and medical device system comprising: a fluid management system comprising:a pump configured to pump fluid from a fluid supply source through the fluid management system at a fluid flow rate; and a processing device including a user interface, the processing device configured to control the pump to maintain a target fluid flow rate based on a set of system operating parameters;a medical device comprising: an elongate shaft in fluid communication with the pump of the fluid management system;a pressure sensor disposed at a distal end of the elongate shaft;a handle coupled to a proximal end of the elongate shaft; andwherein the processing device of the fluid management system is configured to adjust the fluid flow rate based on data received from the pressure sensor of the medical device;wherein the processing device of the fluid management system is configured to verify the medical device is in a patient's body and connected to the fluid management system using at least a first verification process and a second verification process prior to adjusting the fluid flow rate based on the data received from the pressure sensor of the medical device; andwherein the first verification process comprises: comparing an atmospheric pressure with the data received from the pressure sensor of the medical device while the pump is active, and when the data received from the pressure sensor of the medical device is greater than the atmospheric pressure, the processing device of the fluid management system determines the medical device is in use within the patient's body.
12. The fluid management and medical device system of claim 11, wherein the processing device is further configured to use a third verification process prior to adjusting the fluid flow rate based on the data received from the pressure sensor of the medical device.
13. The fluid management and medical device system of claim 12, wherein each of the first verification process, the second verification process, and the third verification process are different.
14. The fluid management and medical device system of claim 12, wherein if a majority of the first verification process, the second verification process, and the third verification process indicate the medical device is in the patient's body, the processing device of the fluid management system determines the medical device is in use within the patient's body.
15. The fluid management and medical device system of claim 12, wherein the processing device of the fluid management system is configured to use a weighted average of a result from each of the first verification process, the second verification process, and the third verification process to determine if the medical device is in use within the patient's body.
16. A fluid management and medical device system comprising: a fluid management system comprising: a pump configured to pump fluid from a fluid supply source through the fluid management system at a fluid flow rate; anda processing device including a user interface, the processing device configured to control the pump to maintain a target fluid flow rate based on a set of system operating parameters;a medical device comprising: an elongate shaft in fluid communication with the pump of the fluid management system;a pressure sensor disposed at a distal end of the elongate shaft;a handle coupled to a proximal end of the elongate shaft; andwherein the processing device of the fluid management system is configured to adjust the fluid flow rate based on data received from the pressure sensor of the medical device; andwherein the processing device of the fluid management system is configured to verify the medical device is in use within a patient's body based on one or more of pressure data, temperature measurement, stress measurement and position measurement obtained at the distal end of the elongate shaft of the medical device, prior to adjusting the fluid flow rate based on the data received from the pressure sensor of the medical device.
17. The fluid management and medical device system of claim 16, wherein the processing device of the fluid management system is configured to compare a pulsatile pressure generated at the pump with the data received from the pressure sensor of the medical device; and wherein the pulsatile pressure generated at the pump and the data received from the pressure sensor of the medical device are each filtered, normalized, and converted to a frequency domain.
18. The fluid management and medical device system of claim 16, further comprising a temperature sensor disposed at the distal end of the elongate shaft of the medical device; and wherein when a temperature measured at the temperature sensor is greater than a threshold temperature above room temperature, the processing device of the fluid management system determines the medical device is in use within the patient's body.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of priority of U.S. Provisional Application No. 62/867,557 filed Jun. 27, 2019, the entire disclosure of which is hereby incorporated by reference.

US Referenced Citations (563)

Number	Name	Date	Kind
3064649	Lee	Nov 1962	A
3770129	Brumfield et al.	Nov 1973	A
3835842	Iglesias	Sep 1974	A
3850162	Iglesias	Nov 1974	A
3877433	Librach	Apr 1975	A
3900022	Widran	Aug 1975	A
3945375	Banko	Mar 1976	A
4092246	Kummer	May 1978	A
4180074	Murry et al.	Dec 1979	A
4203444	Bonnell et al.	May 1980	A
4261360	Perez	Apr 1981	A
4278078	Smith	Jul 1981	A
4369768	Vukovic	Jan 1983	A
4384580	Leviton	May 1983	A
4388922	Telang	Jun 1983	A
4395258	Wang et al.	Jul 1983	A
4400168	Buechel et al.	Aug 1983	A
4449538	Corbitt et al.	May 1984	A
4475901	Kraegen et al.	Oct 1984	A
4606330	Bonnett	Aug 1986	A
4650461	Woods	Mar 1987	A
4650462	DeSatnick et al.	Mar 1987	A
4650464	Ruiz et al.	Mar 1987	A
4655197	Atkinson	Apr 1987	A
4671792	Borsanyi	Jun 1987	A
4678459	Onik et al.	Jul 1987	A
4700694	Shishido	Oct 1987	A
4712567	Gille et al.	Dec 1987	A
4735603	Goodson et al.	Apr 1988	A
4838856	Mulreany	Jun 1989	A
4844074	Kurucz	Jul 1989	A
4902276	Zakko	Feb 1990	A
4902277	Mathies et al.	Feb 1990	A
4921477	Davis	May 1990	A
4930997	Bennett	Jun 1990	A
4933843	Scheller et al.	Jun 1990	A
RE33258	Onik et al.	Jul 1990	E
4955882	Hakky	Sep 1990	A
4971034	Doi et al.	Nov 1990	A
4994026	Fecondini	Feb 1991	A
4998527	Meyer	Mar 1991	A
4998914	Wiest et al.	Mar 1991	A
5009656	Reimels	Apr 1991	A
5041096	Beuchat et al.	Aug 1991	A
5053002	Barlow	Oct 1991	A
5080660	Buelna	Jan 1992	A
5085658	Meyer	Feb 1992	A
5098375	Baier	Mar 1992	A
5106364	Hayafuji et al.	Apr 1992	A
5152745	Steiner et al.	Oct 1992	A
5152746	Atkinson et al.	Oct 1992	A
5169397	Sakashita et al.	Dec 1992	A
5178606	Ognier et al.	Jan 1993	A
5180896	Gibby et al.	Jan 1993	A
5195541	Obenchain	Mar 1993	A
5213571	Fujio et al.	May 1993	A
5217466	Hasson	Jun 1993	A
5217479	Shuler	Jun 1993	A
5277696	Hagen	Jan 1994	A
5312399	Hakky et al.	May 1994	A
5320091	Grossi et al.	Jun 1994	A
5322506	Kullas	Jun 1994	A
5360396	Chan	Nov 1994	A
5381510	Ford et al.	Jan 1995	A
5382229	Grabenkort et al.	Jan 1995	A
5403276	Schechter et al.	Apr 1995	A
5403277	Dodge et al.	Apr 1995	A
5403311	Abele et al.	Apr 1995	A
5437629	Goldrath	Aug 1995	A
5439441	Grimsley et al.	Aug 1995	A
5445610	Evert	Aug 1995	A
5456689	Kresch et al.	Oct 1995	A
5456835	Castino et al.	Oct 1995	A
5460490	Carr et al.	Oct 1995	A
5464391	Devale	Nov 1995	A
5470324	Cook et al.	Nov 1995	A
5476368	Rabenau et al.	Dec 1995	A
5476447	Noda et al.	Dec 1995	A
5483951	Frassica et al.	Jan 1996	A
5492537	Vancaillie	Feb 1996	A
5503626	Goldrath	Apr 1996	A
5514091	Yoon	May 1996	A
5520638	O'Quinn et al.	May 1996	A
5522805	Vancaille et al.	Jun 1996	A
5527331	Kresch et al.	Jun 1996	A
5536234	Newman	Jul 1996	A
5556378	Storz et al.	Sep 1996	A
5563481	Krause	Oct 1996	A
5569188	Mackool	Oct 1996	A
5571389	Kerampran	Nov 1996	A
5578012	Kamen et al.	Nov 1996	A
5586973	Lemaire et al.	Dec 1996	A
5599301	Jacobs et al.	Feb 1997	A
5602449	Krause et al.	Feb 1997	A
5605545	Nowosielski et al.	Feb 1997	A
5626563	Dodge et al.	May 1997	A
5630798	Beiser et al.	May 1997	A
5630799	Beiser et al.	May 1997	A
5643203	Beiser et al.	Jul 1997	A
5643302	Beiser et al.	Jul 1997	A
5656027	Ellingboe	Aug 1997	A
5662611	Beiser et al.	Sep 1997	A
5669921	Berman et al.	Sep 1997	A
5697281	Eggers et al.	Dec 1997	A
5709670	Vancaillie	Jan 1998	A
5730752	Alden et al.	Mar 1998	A
5733263	Wheatman	Mar 1998	A
5749889	Bacich et al.	May 1998	A
5759185	Grinberg	Jun 1998	A
5776104	Guignard et al.	Jul 1998	A
5800381	Ognier	Sep 1998	A
5800383	Chandler et al.	Sep 1998	A
5807313	Delk et al.	Sep 1998	A
5810770	Chin et al.	Sep 1998	A
5810809	Rydell	Sep 1998	A
5810858	Berman et al.	Sep 1998	A
5810876	Kelleher	Sep 1998	A
5814009	Wheatman	Sep 1998	A
5823971	Robinson et al.	Oct 1998	A
5823990	Henley	Oct 1998	A
5830176	Mackool	Nov 1998	A
5830180	Chandler et al.	Nov 1998	A
5836909	Cosmescu	Nov 1998	A
5840060	Beiser et al.	Nov 1998	A
5843951	Inoue	Dec 1998	A
5853392	Dennis	Dec 1998	A
5873886	Larsen et al.	Feb 1999	A
5875282	Jordan et al.	Feb 1999	A
5882339	Beiser et al.	Mar 1999	A
5885277	Korth	Mar 1999	A
5902264	Toso et al.	May 1999	A
5906615	Thompson	May 1999	A
5919218	Carr	Jul 1999	A
5921953	Novak et al.	Jul 1999	A
5925050	Howard	Jul 1999	A
5941876	Nardella et al.	Aug 1999	A
5944668	Vancaillie et al.	Aug 1999	A
5947983	Solar et al.	Sep 1999	A
5956130	Vancaillie et al.	Sep 1999	A
5960160	Clark et al.	Sep 1999	A
5997534	Tu et al.	Dec 1999	A
6004319	Goble et al.	Dec 1999	A
6010454	Arieff et al.	Jan 2000	A
6024720	Chandler et al.	Feb 2000	A
6024751	Lovato et al.	Feb 2000	A
6030359	Nowosielski	Feb 2000	A
6032673	Savage et al.	Mar 2000	A
6036681	Hooven	Mar 2000	A
6039748	Savage et al.	Mar 2000	A
6046442	Kawamura et al.	Apr 2000	A
6052060	Butler et al.	Apr 2000	A
6056746	Goble et al.	May 2000	A
6077246	Kullas et al.	Jun 2000	A
6090106	Goble et al.	Jul 2000	A
6106494	Saravia et al.	Aug 2000	A
6109268	Thapliyal et al.	Aug 2000	A
6113594	Savage	Sep 2000	A
RE36914	Carlsen et al.	Oct 2000	E
6142974	Kistner et al.	Nov 2000	A
6146359	Carr et al.	Nov 2000	A
6149620	Baker et al.	Nov 2000	A
6149621	Makihara	Nov 2000	A
6159160	Hsei et al.	Dec 2000	A
6176847	Humphreys et al.	Jan 2001	B1
6183437	Walker	Feb 2001	B1
6186752	Deniega et al.	Feb 2001	B1
6193715	Wrublewski et al.	Feb 2001	B1
6203493	Ben-Haim	Mar 2001	B1
6206014	Cameron et al.	Mar 2001	B1
6213970	Nelson et al.	Apr 2001	B1
6238366	Savage et al.	May 2001	B1
6245084	Mark et al.	Jun 2001	B1
6257265	Brunner et al.	Jul 2001	B1
6259074	Brunner et al.	Jul 2001	B1
6261261	Gordon	Jul 2001	B1
6261283	Morgan et al.	Jul 2001	B1
6273862	Privitera et al.	Aug 2001	B1
6283937	Takamatsu et al.	Sep 2001	B1
6293926	Sorensen et al.	Sep 2001	B1
6293942	Goble et al.	Sep 2001	B1
6302864	Nowosielski	Oct 2001	B1
6319221	Savage et al.	Nov 2001	B1
6358224	Tims et al.	Mar 2002	B1
6358263	Mark et al.	Mar 2002	B2
6396583	Clare	May 2002	B1
6428316	Rodriquez	Aug 2002	B1
6432113	Parkin et al.	Aug 2002	B1
6478805	Marino et al.	Nov 2002	B1
6494881	Bales et al.	Dec 2002	B1
6512212	Leverne Harris	Jan 2003	B1
6527743	Fowler et al.	Mar 2003	B1
6527745	Kanda et al.	Mar 2003	B1
6554780	Sampson et al.	Apr 2003	B1
6554791	Cartledge et al.	Apr 2003	B1
6569147	Evans et al.	May 2003	B1
6572641	Brugger et al.	Jun 2003	B2
6585708	Maaskamp	Jul 2003	B1
6595957	Griffiths et al.	Jul 2003	B1
6599277	Neubert	Jul 2003	B2
6602221	Saravia et al.	Aug 2003	B1
6626827	Felix et al.	Sep 2003	B1
6629986	Ross et al.	Oct 2003	B1
6632214	Morgan et al.	Oct 2003	B2
6635031	Fowler et al.	Oct 2003	B2
6635034	Cosmescu	Oct 2003	B1
6685667	Delk et al.	Feb 2004	B1
6699184	Felix et al.	Mar 2004	B2
6712759	Muller	Mar 2004	B2
6740074	Morgan et al.	May 2004	B2
6743184	Sampson et al.	Jun 2004	B2
6746439	Lenker	Jun 2004	B2
6775473	Augustine et al.	Aug 2004	B2
6780166	Kanda et al.	Aug 2004	B2
6824528	Faries et al.	Nov 2004	B1
6832996	Woloszko et al.	Dec 2004	B2
6843099	Derek et al.	Jan 2005	B2
6872183	Sampson et al.	Mar 2005	B2
6875194	MacKool	Apr 2005	B2
6896664	Novak	May 2005	B2
6899697	Fowler et al.	May 2005	B2
6901216	Jusiak et al.	May 2005	B2
6908451	Brody et al.	Jun 2005	B2
6958058	Hunter, Sr. et al.	Oct 2005	B1
6972009	Stromberg et al.	Dec 2005	B1
6979332	Adams	Dec 2005	B2
6997896	Novak	Feb 2006	B2
7029451	Anderson et al.	Apr 2006	B2
7031602	Faries, Jr. et al.	Apr 2006	B2
7063670	Sampson et al.	Jun 2006	B2
7070604	Garito et al.	Jul 2006	B1
7083601	Cosmescu	Aug 2006	B1
7150713	Shener et al.	Dec 2006	B2
7153285	Lauman et al.	Dec 2006	B2
7164852	Cazzini et al.	Jan 2007	B2
7204821	Clare et al.	Apr 2007	B1
7207966	Savare et al.	Apr 2007	B2
7226459	Cesarini et al.	Jun 2007	B2
7232457	Schmidt et al.	Jun 2007	B2
7244256	DeCesare et al.	Jul 2007	B2
7249602	Emanuel	Jul 2007	B1
7273359	Blight et al.	Sep 2007	B2
7297133	Nelson et al.	Nov 2007	B2
7334718	McAlister et al.	Feb 2008	B2
7384417	Cucin	Jun 2008	B2
7394976	Entenman et al.	Jul 2008	B2
7458951	Lauman et al.	Dec 2008	B2
7481936	Gorsuch et al.	Jan 2009	B2
7510535	Hibner et al.	Mar 2009	B2
7549987	Shadduck	Jun 2009	B2
7591794	Lacoste et al.	Sep 2009	B2
7597662	Litscher et al.	Oct 2009	B2
7604610	Shener et al.	Oct 2009	B2
7621898	Lalomia et al.	Nov 2009	B2
7632248	Delk et al.	Dec 2009	B2
7674259	Shadduck	Mar 2010	B2
7678070	Kumar et al.	Mar 2010	B2
7695447	Khashayar et al.	Apr 2010	B2
7731689	Prisco et al.	Jun 2010	B2
7753880	Malackowski	Jul 2010	B2
7811282	McClurken	Oct 2010	B2
7815634	McClurken et al.	Oct 2010	B2
7865072	Cassidy	Jan 2011	B2
7867188	Frey	Jan 2011	B2
7867191	Suzuki	Jan 2011	B2
7892229	Shadduck et al.	Feb 2011	B2
7896834	Smisson, III et al.	Mar 2011	B2
7901403	Woloszko et al.	Mar 2011	B2
7918822	Kumar et al.	Apr 2011	B2
7930575	Suginaka et al.	Apr 2011	B2
7975491	Smisson, III et al.	Jul 2011	B2
7981073	Möllstam et al.	Jul 2011	B2
8052644	Radgowski et al.	Nov 2011	B2
8061359	Emanuel	Nov 2011	B2
8109906	Smisson, III et al.	Feb 2012	B2
8123750	Norton et al.	Feb 2012	B2
8142718	Tak et al.	Mar 2012	B2
8178040	Brauer	May 2012	B2
8206342	Hacker et al.	Jun 2012	B2
8206345	Abboud et al.	Jun 2012	B2
8219982	Harkanyi et al.	Jul 2012	B2
8225643	Abboud et al.	Jul 2012	B2
8226549	Kumar et al.	Jul 2012	B2
8262603	Shener et al.	Sep 2012	B2
8267934	Earley et al.	Sep 2012	B2
8287485	Kimura et al.	Oct 2012	B2
8308726	Kumar et al.	Nov 2012	B2
8313460	Cassidy	Nov 2012	B2
8313485	Shadduck	Nov 2012	B2
8343078	Toth	Jan 2013	B2
8360737	Smisson, III et al.	Jan 2013	B2
8361068	McClurken	Jan 2013	B2
8366667	Chan et al.	Feb 2013	B2
8372067	Woloszko et al.	Feb 2013	B2
8388515	Shener	Mar 2013	B2
8388570	Kumar et al.	Mar 2013	B2
8388582	Eubanks et al.	Mar 2013	B2
8394037	Toth	Mar 2013	B2
8430898	Wiener et al.	Apr 2013	B2
8444592	Williams et al.	May 2013	B2
8447404	Sharma et al.	May 2013	B2
8449500	DelCastillo et al.	May 2013	B2
8460178	Kumar et al.	Jun 2013	B2
8465421	Finkman et al.	Jun 2013	B2
8491285	Haser et al.	Jul 2013	B2
8512283	Kumar et al.	Aug 2013	B2
8512326	Shadduck et al.	Aug 2013	B2
8535237	Nishtala	Sep 2013	B2
8562577	Michaels et al.	Oct 2013	B2
8568424	Shugrue et al.	Oct 2013	B2
8574253	Gruber et al.	Nov 2013	B2
8591453	Stubkjaer et al.	Nov 2013	B2
8591464	Kumar et al.	Nov 2013	B2
8597228	Pyles et al.	Dec 2013	B2
8620149	Entenman et al.	Dec 2013	B2
8652089	Kumar et al.	Feb 2014	B2
8663157	Hacker et al.	Mar 2014	B2
8663216	Davison et al.	Mar 2014	B2
8728066	Shadduck et al.	May 2014	B2
8740866	Reasoner et al.	Jun 2014	B2
8764408	Smisson, III et al.	Jul 2014	B2
8790303	Williams et al.	Jul 2014	B2
8795232	Visconti et al.	Aug 2014	B2
8840625	Adams et al.	Sep 2014	B2
8840626	Adams et al.	Sep 2014	B2
8870756	Maurice	Oct 2014	B2
8870866	Woloszko	Oct 2014	B2
8893722	Emanuel	Nov 2014	B2
8911363	Kumar et al.	Dec 2014	B2
8920372	Faries, Jr. et al.	Dec 2014	B2
8951274	Adams et al.	Feb 2015	B2
8974448	Germain et al.	Mar 2015	B2
8979798	Shener et al.	Mar 2015	B2
9005157	Gerg et al.	Apr 2015	B2
9027389	Abboud et al.	May 2015	B2
9028398	Kumar et al.	May 2015	B2
9060800	Cesarini et al.	Jun 2015	B1
9072431	Adams et al.	Jul 2015	B2
9078562	Poll et al.	Jul 2015	B2
9084847	Klein et al.	Jul 2015	B2
9089358	Emanuel	Jul 2015	B2
9095358	Woloszko et al.	Aug 2015	B2
9095366	Sullivan et al.	Aug 2015	B2
9101701	Kumar et al.	Aug 2015	B2
9125550	Shener-Irmakoglu et al.	Sep 2015	B2
9144374	Maurice, Jr.	Sep 2015	B2
9173987	Meyer et al.	Nov 2015	B2
9179821	Shener	Nov 2015	B2
9226650	Emanuel	Jan 2016	B2
9226765	Emanuel	Jan 2016	B2
9233193	Truckai et al.	Jan 2016	B2
9248221	Look et al.	Feb 2016	B2
9254142	Germain et al.	Feb 2016	B2
9254164	Woloszko	Feb 2016	B2
9272086	Williams et al.	Mar 2016	B2
9283045	Rhee et al.	Mar 2016	B2
9289110	Woolford et al.	Mar 2016	B2
9289541	Norman et al.	Mar 2016	B2
9427247	Emanuel	Aug 2016	B2
9439677	Germain et al.	Sep 2016	B2
9439720	Germain et al.	Sep 2016	B2
9474848	Williams et al.	Oct 2016	B2
9486233	Bek et al.	Nov 2016	B2
9492071	Woolford et al.	Nov 2016	B2
9498586	Smisson, III et al.	Nov 2016	B2
9511184	Woolford et al.	Dec 2016	B2
9549754	Shadduck et al.	Jan 2017	B2
9561335	Barish et al.	Feb 2017	B2
9595104	Satish et al.	Mar 2017	B2
9597149	Germain et al.	Mar 2017	B2
9597445	Ha et al.	Mar 2017	B2
9603990	Woolford	Mar 2017	B2
9636170	Germain et al.	May 2017	B2
9655557	Toth et al.	May 2017	B2
9662060	Peliks et al.	May 2017	B2
9664547	Koltz, Jr. et al.	May 2017	B1
9730575	Shener	Aug 2017	B2
9737362	Germain et al.	Aug 2017	B2
9743979	Germain et al.	Aug 2017	B2
9750520	Emanuel	Sep 2017	B2
9770541	Carr et al.	Sep 2017	B2
9773320	Satish et al.	Sep 2017	B2
9775542	Toth	Oct 2017	B2
9795433	Abboud et al.	Oct 2017	B2
9801678	Cox	Oct 2017	B2
9827037	Germain et al.	Nov 2017	B2
9839473	Germain et al.	Dec 2017	B2
9901665	Klein et al.	Feb 2018	B2
9907563	Germain et al.	Mar 2018	B2
9962472	Woolford et al.	May 2018	B2
10077767	Macari et al.	Sep 2018	B2
20010007925	Ritchart et al.	Jul 2001	A1
20010018550	Boebel et al.	Aug 2001	A1
20010031976	Lobdell	Oct 2001	A1
20020010463	Mulier et al.	Jan 2002	A1
20020038122	Peters	Mar 2002	A1
20020072745	Truckai et al.	Jun 2002	A1
20020085952	Ellingboe et al.	Jul 2002	A1
20020087151	Mody et al.	Jul 2002	A1
20030004470	Hickerson et al.	Jan 2003	A1
20030009164	Woloszko et al.	Jan 2003	A1
20030060862	Goble et al.	Mar 2003	A1
20030097082	Purdy et al.	May 2003	A1
20030176833	Libermann	Sep 2003	A1
20030208200	Palanker et al.	Nov 2003	A1
20030212363	Shipp	Nov 2003	A1
20030216689	Bouhuijs et al.	Nov 2003	A1
20040049217	Ross et al.	Mar 2004	A1
20040059363	Alvarez et al.	Mar 2004	A1
20040073175	Jacobson et al.	Apr 2004	A1
20040087888	DiGianfilippo et al.	May 2004	A1
20040092980	Cesarini et al.	May 2004	A1
20040102770	Goble	May 2004	A1
20040167427	Quick et al.	Aug 2004	A1
20040167428	Quick et al.	Aug 2004	A1
20040170409	Faries, Jr. et al.	Sep 2004	A1
20040199226	Shadduck	Oct 2004	A1
20040230190	Dahla et al.	Nov 2004	A1
20040260232	Cimino	Dec 2004	A1
20040267255	Auge, II et al.	Dec 2004	A1
20050096649	Adams	May 2005	A1
20050119628	Sant et al.	Jun 2005	A1
20050209507	Suzuki et al.	Sep 2005	A1
20050236329	Brotherton et al.	Oct 2005	A1
20050272975	McWeeney et al.	Dec 2005	A1
20060041186	Vancaillie	Feb 2006	A1
20060047185	Shener et al.	Mar 2006	A1
20060047240	Kumar et al.	Mar 2006	A1
20060100579	Maahs et al.	May 2006	A1
20060122556	Kumar et al.	Jun 2006	A1
20060122557	Kumar et al.	Jun 2006	A1
20060129091	Bonnette et al.	Jun 2006	A1
20060135955	Shadduck	Jun 2006	A1
20060178670	Woloszko et al.	Aug 2006	A1
20060200064	Gross et al.	Sep 2006	A1
20060224154	Shadduck et al.	Oct 2006	A1
20060253062	Liao et al.	Nov 2006	A1
20060253128	Sekine et al.	Nov 2006	A1
20070016182	Lipson et al.	Jan 2007	A1
20070021713	Kumar et al.	Jan 2007	A1
20070036768	Fraser et al.	Feb 2007	A1
20070045272	French et al.	Mar 2007	A1
20070073098	Lenker et al.	Mar 2007	A1
20070088275	Stearns et al.	Apr 2007	A1
20070123838	Bernard et al.	May 2007	A1
20070161978	Fedenia et al.	Jul 2007	A1
20070181499	Roberts et al.	Aug 2007	A1
20070219549	Marshall et al.	Sep 2007	A1
20070244353	Larsen	Oct 2007	A1
20070249990	Cosmescu	Oct 2007	A1
20070265689	Frey	Nov 2007	A1
20080021447	Davison et al.	Jan 2008	A1
20080027368	Kollar et al.	Jan 2008	A1
20080039832	Palanker et al.	Feb 2008	A1
20080051708	Kumar et al.	Feb 2008	A1
20080058588	Emanuel	Mar 2008	A1
20080058842	Emanuel	Mar 2008	A1
20080065060	Ein-Gal	Mar 2008	A1
20080071269	Hilario et al.	Mar 2008	A1
20080091061	Kumar et al.	Apr 2008	A1
20080091071	Kumar et al.	Apr 2008	A1
20080091074	Kumar et al.	Apr 2008	A1
20080095625	Honegger et al.	Apr 2008	A1
20080097468	Adams et al.	Apr 2008	A1
20080097471	Adams et al.	Apr 2008	A1
20080097563	Petrie et al.	Apr 2008	A1
20080103504	Schmitz et al.	May 2008	A1
20080154182	Martin et al.	Jun 2008	A1
20080216827	Seydel et al.	Sep 2008	A1
20080232977	Pan et al.	Sep 2008	A1
20080249366	Gruber et al.	Oct 2008	A1
20080249553	Gruber et al.	Oct 2008	A1
20080287893	Ineson	Nov 2008	A1
20090030402	Adahan	Jan 2009	A1
20090043238	Lane et al.	Feb 2009	A1
20090069796	Oskin	Mar 2009	A1
20090082715	Charles	Mar 2009	A1
20090088784	DeBoer et al.	Apr 2009	A1
20090137943	Stearns et al.	May 2009	A1
20090157111	Goh et al.	Jun 2009	A1
20090163863	Lutwyche	Jun 2009	A1
20090173943	Yu et al.	Jul 2009	A1
20090270812	Litscher et al.	Oct 2009	A1
20090270895	Churchill et al.	Oct 2009	A1
20090270896	Sullivan et al.	Oct 2009	A1
20090270897	Adams et al.	Oct 2009	A1
20090270898	Chin et al.	Oct 2009	A1
20090312753	Shadduck	Dec 2009	A1
20100100091	Truckai	Apr 2010	A1
20100121321	Ryan	May 2010	A1
20100145325	Hoey et al.	Jun 2010	A1
20100152533	Mark	Jun 2010	A1
20100152656	Music	Jun 2010	A1
20100152724	Marion et al.	Jun 2010	A1
20100152758	Mark et al.	Jun 2010	A1
20100228222	Williams et al.	Sep 2010	A1
20100234797	Gelfand et al.	Sep 2010	A1
20100312054	Beyar et al.	Dec 2010	A1
20110015961	Chan	Jan 2011	A1
20110031191	Fukuda et al.	Feb 2011	A1
20110060273	Ofsthun et al.	Mar 2011	A1
20110150961	Perry et al.	Jun 2011	A1
20110177415	Harrington et al.	Jul 2011	A1
20110213300	McWeeney et al.	Sep 2011	A1
20110224486	Nguyen et al.	Sep 2011	A1
20110264090	Shadduck et al.	Oct 2011	A1
20110270256	Nelson et al.	Nov 2011	A1
20110306968	Beckman et al.	Dec 2011	A1
20120010464	Adams et al.	Jan 2012	A1
20120053583	Palanker et al.	Mar 2012	A1
20120116168	Möllstam et al.	May 2012	A1
20120157879	Mark et al.	Jun 2012	A1
20120165725	Chomas et al.	Jun 2012	A1
20120172888	Shugrue et al.	Jul 2012	A1
20120172889	Chin et al.	Jul 2012	A1
20120197280	Emanuel	Aug 2012	A1
20120271110	Kumar et al.	Oct 2012	A1
20120271300	Shadduck et al.	Oct 2012	A9
20120289894	Douglas et al.	Nov 2012	A1
20120330292	Shadduck et al.	Dec 2012	A1
20130046304	Germain et al.	Feb 2013	A1
20130046316	Sullivan et al.	Feb 2013	A1
20130079702	Klein et al.	Mar 2013	A1
20130090642	Shadduck et al.	Apr 2013	A1
20130103021	Germain et al.	Apr 2013	A1
20130172805	Truckai et al.	Jul 2013	A1
20130172870	Germain et al.	Jul 2013	A1
20130211321	Dubois et al.	Aug 2013	A1
20130231652	Germain et al.	Sep 2013	A1
20130245637	Norred et al.	Sep 2013	A1
20130267779	Woolford et al.	Oct 2013	A1
20130296847	Germain et al.	Nov 2013	A1
20130310647	Milton et al.	Nov 2013	A1
20140012097	McCrea et al.	Jan 2014	A1
20140031834	Germain et al.	Jan 2014	A1
20140074136	Emanuel	Mar 2014	A1
20140114238	Lee et al.	Apr 2014	A1
20140114300	Orczy-Timko et al.	Apr 2014	A1
20140303551	Germain et al.	Oct 2014	A1
20140324065	Bek et al.	Oct 2014	A1
20150012023	Emanuel	Jan 2015	A1
20150119795	Germain et al.	Apr 2015	A1
20150157396	Germain et al.	Jun 2015	A1
20150314048	Klein et al.	Nov 2015	A1
20150327752	Shener-Irmakoglu et al.	Nov 2015	A1
20150328379	Carr et al.	Nov 2015	A1
20160022346	Shadduck	Jan 2016	A1
20160081530	Imaizumi	Mar 2016	A1
20160089184	Truckai et al.	Mar 2016	A1
20160166758	Norman et al.	Jun 2016	A1
20160220102	Shener-Irmakoglu et al.	Aug 2016	A1
20160242844	Orczy-Timko	Aug 2016	A1
20160287779	Orczy-Timko et al.	Oct 2016	A1
20160310666	Grim et al.	Oct 2016	A1
20170000957	Carr et al.	Jan 2017	A1
20170027637	Germain et al.	Feb 2017	A1
20170049952	Jezierski et al.	Feb 2017	A1
20170055810	Germain et al.	Mar 2017	A1
20170120039	Childs et al.	May 2017	A1
20170184088	Macari et al.	Jun 2017	A1
20170203028	Carr et al.	Jul 2017	A1
20170296727	Burbank et al.	Oct 2017	A1
20180361055	Pereira	Dec 2018	A1
20190282073	Truckai	Sep 2019	A1

Foreign Referenced Citations (49)

Number	Date	Country
0153190	Aug 1985	EP
0331505	Sep 1989	EP
0812574	Dec 1997	EP
0812574	Nov 1998	EP
1911391	Apr 2008	EP
2100567	Sep 2009	EP
2296869	Jul 1996	GB
2327351	Jan 1999	GB
2337000	Nov 1999	GB
55000199	Jan 1980	JP
61185240	Aug 1986	JP
1986185240	Aug 1986	JP
H01213981	Aug 1989	JP
H04312456	Nov 1992	JP
06225851	Aug 1994	JP
09084756	Mar 1997	JP
2000217908	Aug 2000	JP
2002513614	May 2002	JP
2002529185	Sep 2002	JP
2004073833	Mar 2004	JP
2004290520	Oct 2004	JP
2005529674	Oct 2005	JP
2007014854	Jan 2007	JP
2008511397	Apr 2008	JP
2011212450	Oct 2011	JP
2012525915	Oct 2012	JP
2014226471	Dec 2014	JP
8700759	Feb 1987	WO
9217040	Oct 1992	WO
9322979	Nov 1993	WO
9640331	Dec 1996	WO
9716220	May 1997	WO
9746271	Dec 1997	WO
0028890	May 2000	WO
03105697	Dec 2003	WO
2004043313	May 2004	WO
2005037088	Apr 2005	WO
2009128435	Oct 2009	WO
2010096139	Aug 2010	WO
2010127174	Nov 2010	WO
2010128994	Nov 2010	WO
2011060189	May 2011	WO
2010096139	Dec 2011	WO
2012017959	Feb 2012	WO
2013003570	Jan 2013	WO
2013006633	Jan 2013	WO
2013044243	Mar 2013	WO
2014168985	Oct 2014	WO
2018236513	Dec 2018	WO

Non-Patent Literature Citations (16)

Entry
“AAGL Practice Report: Practice Guidelines for the Management of Hysteroscopic Distending Media,” (Replaces Hysteroscopic Fluid Monitoring Guidelines. J Am Assoc Gynecol Laparosc. 2000; 167-168) J Minim Invasive Gynecol. vol. 20:137-48, Mar.-Apr. 2013; doi: 10,1016/j.jmig.2012.12.002.
Liu et al., “Clinical Application of Hysteriscopic Electroresection in 775 Cases,” Di YHi Jun Yi Da Xue Xue Bao. vol. 24(4):467-9, Apr. 2004; (in Chinese with English Abstract).
Phillips et al., “The Effect of Dilute Vasopressin Solution on Blood Loss During Operative Hysteroscopy,” J Am Assoc Gynecol Laparosc. vol. 3(4, Supplement):S38, Aug. 1996.
International Search Report and Written Opinion dated Sep. 24, 2012 for PCT/US2012/043892.
International Search Report and Written Opinion dated Oct. 2, 2012 for PCT/US2012/045428.
International search report and written opinion dated Oct. 16, 2012 for PCT/US2012/044609.
International search report and written opinion dated Dec. 4, 2012 for PCT/US2012/056936.
International Search Report and Written Opinion dated May 15, 2013, for PCT/US2013/022559.
International Search Report and Written Opinion dated Feb. 1, 2013 for PCT/US2012/043891.
International Search Report and Written Opinion dated Mar. 13, 2013 for PCT/US2012/063406.
Office Action for U.S. Appl. No. 13/277,913 dated Jan. 29, 2013.
Edmond et al; “Human Ureteral Peristalsis”, The Journal of Urology, vol. 104, Nov. 1970.
Miles et al; “Intrarenal Pressure”; Journal of Physiology, vol. 123, pp. 131-142, 1954.
Ross et al; “Observations on the Physiology of the Human Renal Pelvis and Ureter”, The Journal of Urology, vol. 97, Mar. 1967.
Weaver et al; “The Relationship of Intrarenal Artery and Renal Intrapelvic Pressure”, The Journal of Urology, vol. 101, Jun. 1969.
International Search Report and Written Opinion dated Sep. 7, 2020 for International Application No. PCT/US2020/039504.

Related Publications (1)

	Number	Date	Country
	20200405955 A1	Dec 2020	US

Provisional Applications (1)

	Number	Date	Country
	62867557	Jun 2019	US

Detection of an endoscope to a fluid management system

Information

Patent Number

Date Filed

Date Issued

Inventors

Original Assignees

Examiners

Agents

CPC

Field of Search

CPC

International Classifications

Term Extension

Abstract