Electrical ablation devices

Description

BACKGROUND

Electrical ablation therapy has been employed in medicine for the treatment of undesirable tissue such as diseased tissue, cancer, malignant and benign tumors, masses, lesions, and other abnormal tissue growths. While conventional apparatuses, systems, and methods for the electrical ablation of undesirable tissue are effective, one drawback with conventional electrical ablation treatment is the resulting permanent damage that may occur to the healthy tissue surrounding the abnormal tissue due primarily to the detrimental thermal effects resulting from exposing the tissue to thermal energy generated by the electrical ablation device. This may be particularly true when exposing the tissue to electric potentials sufficient to cause cell necrosis using high temperature thermal therapies including focused ultrasound ablation, radiofrequency (RF) ablation, or interstitial laser coagulation. Other techniques for tissue ablation include chemical ablation, in which chemical agents are injected into the undesirable tissue to cause ablation as well as surgical excision, cryotherapy, radiation, photodynamic therapy, Moh's micrographic surgery, topical treatments with 5-fluorouracil, laser ablation. Other drawbacks of conventional thermal, chemical, and other ablation therapy are cost, length of recovery, and the extraordinary pain inflicted on the patient.

Conventional thermal, chemical, and other ablation techniques have been employed for the treatment of a variety of undesirable tissue. Thermal and chemical ablation techniques have been used for the treatment of varicose veins resulting from reflux disease of the greater saphenous vein (GSV), in which the varicose vein is stripped and then is exposed to either chemical or thermal ablation. Other techniques for the treatment of undesirable tissue are more radical. Prostate cancer, for example, may be removed using a prostatectomy, in which the entire or part of prostate gland and surrounding lymph nodes are surgically removed. Like most other forms of cancer, radiation therapy may be used in conjunction with or as an alternate method for the treatment of prostate cancer. Another thermal ablation technique for the treatment of prostate cancer is RF interstitial tumor ablation (RITA) via trans-rectal ultrasound guidance. While these conventional methods for the treatment of prostate cancer are effective, they are not preferred by many surgeons and may result in detrimental thermal effects to healthy tissue surrounding the prostate. Similar thermal ablation techniques may be used for the treatment of basal cell carcinoma (BCC) tissue, a slowly growing cutaneous malignancy derived from the rapidly proliferating basal layer of the epidermis. BCC tissue in tumors ranging in size from about 5 mm to about 40 mm may be thermally ablated with a pulsed carbon dioxide laser. Nevertheless, carbon dioxide laser ablation is a thermal treatment method and may cause permanent damage to healthy tissue surrounding the BCC tissue. Furthermore, this technique requires costly capital investment in carbon dioxide laser equipment. Undesirable tissue growing inside a body lumen such as the esophagus, large bowel, or in cavities formed in solid tissue such as the breast, for example, can be difficult to destroy using conventional ablation techniques. Surgical removal of undesirable tissue, such as a malignant or benign tumor, from the breast is likely to leave a cavity. Surgical resection of residual intralumenal tissue may remove only a portion of the undesirable tissue cells within a certain margin of healthy tissue. Accordingly, some undesirable tissue is likely to remain within the wall of the cavity due to the limitation of conventional ablation instrument configurations, which may be effective for treating line-of-sight regions of tissue, but may be less effective for treating the residual undesirable tissue.

Accordingly, there remains a need for improved electrical ablation apparatuses, systems, and methods for the treatment of undesirable tissue found in diseased tissue, cancer, malignant and benign tumors, masses, lesions, and other abnormal tissue growths. There remains a need for minimally invasive treatment of undesirable tissue through the use of irreversible electroporation (IRE) ablation techniques without causing the detrimental thermal effects of conventional thermal ablation techniques.

FIGURES

The novel features of the various described embodiments are set forth with particularity in the appended claims. The various embodiments, however, both as to organization and methods of operation, together with advantages thereof, may be understood in accordance with the following description taken in conjunction with the accompanying drawings as follows.

FIG. 1 illustrates one embodiment of an electrical ablation system in accordance with one non-limiting embodiment.

FIGS. 2A-D illustrate one embodiment of the electrical ablation device in various phases of deployment.

FIGS. 3A-C illustrate perspective views of one embodiment of the electrical ablation device shown in FIGS. 2A-2D.

FIGS. 4A-B illustrate perspective views of one embodiment of the electrical ablation device.

FIGS. 5A-C illustrate the operation of electrical ablation device shown in FIGS. 4A-B in accordance with one non-limiting embodiment.

FIG. 6 illustrates an electrical ablation apparatus in accordance with one non-limiting embodiment.

FIG. 7 illustrates an electrical ablation apparatus in accordance with one non-limiting embodiment.

FIG. 8 illustrates an electrical ablation apparatus in accordance with one non-limiting embodiment.

FIG. 9 illustrates an electrical ablation apparatus in accordance with one non-limiting embodiment.

FIG. 10 illustrates an electrical ablation apparatus in accordance with one non-limiting embodiment.

FIGS. 11A-B illustrate the use of an alignment guide with an electrical ablation apparatus in accordance with one non-limiting embodiment.

FIG. 12 illustrates the engagement of the alignment guide shown in FIGS. 11A-B and a handle of the electrical ablation apparatus shown in FIGS. 11A-B.

FIG. 13 illustrates an alignment guide comprising a plurality of visual indicators in accordance with one non-limiting embodiment.

FIG. 14 illustrates an alignment guide comprising a plurality of detents in accordance with one non-limiting embodiment.

DESCRIPTION

Various embodiments are directed to apparatuses, systems, and methods for the electrical ablation treatment of undesirable tissue such as diseased tissue, cancer, malignant and benign tumors, masses, lesions, and other abnormal tissue growths without causing any detrimental thermal effects to surrounding healthy tissue. Numerous specific details are set forth to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments as described in the specification and illustrated in the accompanying drawings. It will be understood by those skilled in the art, however, that the embodiments may be practiced without the specific details described and illustrated herein. In other instances, well-known operations, components, and elements have not been described in detail so as not to obscure the embodiments described in the specification. Those of ordinary skill in the art will understand that the embodiments described and illustrated herein are non-limiting examples, and thus it can be appreciated that the specific structural and functional details disclosed herein may be representative and do not necessarily limit the scope of the embodiments, the scope of which is defined solely by the appended claims.

Reference throughout the specification to “various embodiments,” “some embodiments,” “one embodiment,” or “an embodiment” means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, appearances of the phrases “in various embodiments,” “in some embodiments,” “in one embodiment,” or “in an embodiment” in places throughout the specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, the particular features, structures, or characteristics illustrated or described in connection with one embodiment may be combined, in whole or in part, with the features structures, or characteristics of one or more other embodiments without limitation.

It will be appreciated that the terms “proximal” and “distal” may be used throughout the specification with reference to a clinician manipulating one end of an instrument used to treat a patient. The term “proximal” refers to the portion of the instrument closest to the clinician and the term “distal” refers to the portion located furthest from the clinician. It will be further appreciated that for conciseness and clarity, spatial terms such as “vertical,” “horizontal,” “up,” and “down” may be used herein with respect to the illustrated embodiments. However, surgical instruments may be used in many orientations and positions, and these terms are not intended to be limiting and absolute.

Various embodiments of apparatuses, systems, and methods for the electrical ablation treatment of undesirable tissue such as diseased tissue, cancer, malignant and benign tumors, masses, lesions, and other abnormal tissue growths, are described throughout the specification and illustrated in the accompanying drawings. The electrical ablation devices in accordance with the described embodiments may comprise one or more electrodes configured to be positioned into or proximal to undesirable tissue in a tissue treatment region (e.g., target site, worksite) where there is evidence of abnormal tissue growth, for example. In general, the electrodes comprise an electrically conductive portion (e.g., medical grade stainless steel, gold plated, etc.) and are configured to electrically couple to an energy source. Once the electrodes are positioned into or proximal to the undesirable tissue, an energizing potential is applied to the electrodes to create an electric field to which the undesirable tissue is exposed. The energizing potential (and the resulting electric field) may be characterized by multiple parameters such as frequency, amplitude, pulse width (duration of a pulse or pulse length), and/or polarity. Depending on the diagnostic or therapeutic treatment to be rendered, a particular electrode may be configured either as an anode (+) or a cathode (−) or may comprise a plurality of electrodes with at least one configured as an anode and at least one other configured as a cathode. Regardless of the initial polar configuration, the polarity of the electrodes may be reversed by reversing the polarity of the output of the energy source.

In various embodiments, a suitable energy source may comprise an electrical waveform generator, which may be configured to create an electric field that is suitable to create irreversible electroporation in undesirable tissue at various electric field amplitudes and durations. The energy source may be configured to deliver irreversible electroporation pulses in the form of direct-current (DC) and/or alternating-current (AC) voltage potentials (e.g., time-varying voltage potentials) to the electrodes. The energy source may also be configured to reverse the potential between the electrodes. The irreversible electroporation pulses may be characterized by various parameters such as frequency, amplitude, pulse length, and/or polarity. The undesirable tissue may be ablated by exposure to the electric potential difference across the electrodes.

In one embodiment, the energy source may comprise a wireless transmitter to deliver energy to the electrodes using wireless energy transfer techniques via one or more remotely positioned antennas. Those skilled in the art will appreciate that wireless energy transfer or wireless power transmission is the process of transmitting electrical energy from an energy source to an electrical load without interconnecting wires. An electrical transformer is the simplest instance of wireless energy transfer. The primary and secondary circuits of a transformer are not directly connected and the transfer of energy takes place by electromagnetic coupling through a process known as mutual induction. Power also may be transferred wirelessly using RF energy. Wireless power transfer technology using RF energy is produced by Powercast, Inc. and can achieve an output of about 6 volts for a little over one meter. Other low-power wireless power technology has been proposed such as described in U.S. Pat. No. 6,967,462.

The apparatuses, systems, and methods in accordance with the described embodiments may be configured for minimally invasive ablation treatment of undesirable tissue through the use of irreversible electroporation to be able to ablate undesirable tissue in a controlled and focused manner without inducing thermally damaging effects to the surrounding healthy tissue. The apparatuses, systems, and methods in accordance with the described embodiments may be configured to ablate undesirable tissue through the use of electroporation or electropermeabilization. More specifically, the apparatuses, systems, and methods in accordance with the described embodiments may be configured to ablate undesirable tissue through the use of irreversible electroporation. Electroporation increases the permeabilization of a cell membrane by exposing the cell to electric pulses. The external electric field (electric potential/per unit length) to which the cell membrane is exposed to significantly increases the electrical conductivity and permeability of the plasma in the cell membrane. The primary parameter affecting the transmembrane potential is the potential difference across the cell membrane. Irreversible electroporation is the application of an electric field of a specific magnitude and duration to a cell membrane such that the permeabilization of the cell membrane cannot be reversed, leading to cell death without inducing a significant amount of heat in the cell membrane. The destabilizing potential forms pores in the cell membrane when the potential across the cell membrane exceeds its dielectric strength causing the cell to die under a process known as apoptosis and/or necrosis. The application of irreversible electroporation pulses to cells is an effective way for ablating large volumes of undesirable tissue without deleterious thermal effects to the surrounding healthy tissue associated with thermal-inducing ablation treatments. This is because irreversible electroporation destroys cells without heat and thus does not destroy the cellular support structure or regional vasculature. A destabilizing irreversible electroporation pulse, suitable to cause cell death without inducing a significant amount of thermal damage to the surrounding healthy tissue, may have amplitude in the range of about several hundred to about several thousand volts and is generally applied across biological membranes over a distance of about several millimeters, for example, for a relatively long duration. Thus, the undesirable tissue may be ablated in-vivo through the delivery of destabilizing electric fields by quickly creating cell necrosis.

The apparatuses, systems, and methods for electrical ablation therapy in accordance with the described embodiments may be adapted for use in minimally invasive surgical procedures to access the tissue treatment region in various anatomic locations such as the brain, lungs, breast, liver, gall bladder, pancreas, prostate gland, and various internal body lumen defined by the esophagus, stomach, intestine, colon, arteries, veins, anus, vagina, cervix, fallopian tubes, and the peritoneal cavity, for example, without limitation. Minimally invasive electrical ablation devices may be introduced to the tissue treatment region using a trocar inserted though a small opening formed in the patient's body or through a natural body orifice such as the mouth, anus, or vagina using translumenal access techniques known as Natural Orifice Translumenal Endoscopic Surgery (NOTES)™. Once the electrical ablation devices (e.g., electrodes) are located into or proximal to the undesirable tissue in the treatment region, electric field potentials can be applied to the undesirable tissue by the energy source. The electrical ablation devices comprise portions that may be inserted into the tissue treatment region percutaneously (e.g., where access to inner organs or other tissue is done via needle-puncture of the skin). Other portions of the electrical ablation devices may be introduced into the tissue treatment region endoscopically (e.g., laparoscopically and/or thoracoscopically) through trocars or channels of the endoscope, through small incisions, or transcutaneously (e.g., where electric pulses are delivered to the tissue treatment region through the skin). An electrical ablation device in commonly owned U.S. patent application Ser. No. 12/352,375 titled “ELECTRICAL ABLATION DEVICES,” filed Jan. 12, 2009, the entire disclosure of which is incorporated herein by reference in its entirety.

FIG. 1 illustrates one embodiment of an electrical ablation system 10. The electrical ablation system 10 may be employed to ablate undesirable tissue such as diseased tissues, cancers, tumors, masses, lesions, abnormal tissue growths inside a patient using electrical energy. The electrical ablation system 10 may be used in conjunction with endoscopic, laparoscopic, thoracoscopic, open surgical procedures via small incisions or keyholes, percutaneous techniques, transcutaneous techniques, and/or external non-invasive techniques, or any combinations thereof without limitation. The electrical ablation system 10 may be configured to be positioned within a natural body orifice of the patient such as the mouth, anus, or vagina and advanced through internal body lumen or cavities such as the esophagus, colon, cervix, urethra, for example, to reach the tissue treatment region. The electrical ablation system 10 also may be configured to be positioned and passed through a small incision or keyhole formed through the skin or abdominal wall of the patient to reach the tissue treatment region using a trocar. The tissue treatment region may be located in the brain, lungs, breast, liver, gall bladder, pancreas, prostate gland, various internal body lumen defined by the esophagus, stomach, intestine, colon, arteries, veins, anus, vagina, cervix, fallopian tubes, and the peritoneal cavity, for example, without limitation. The electrical ablation system 10 can be configured to treat a number of lesions and ostepathologies comprising metastatic lesions, tumors, fractures, infected sites, inflamed sites. Once positioned into or proximate the tissue treatment region, the electrical ablation system 10 can be actuated (e.g., energized) to ablate the undesirable tissue. In one embodiment, the electrical ablation system 10 may be configured to treat diseased tissue in the gastrointestinal (GI) tract, esophagus, lung, or stomach that may be accessed orally. In another embodiment, the electrical ablation system 10 may be adapted to treat undesirable tissue in the liver or other organs that may be accessible using translumenal access techniques such as, without limitation, NOTES™ techniques, where the electrical ablation devices may be initially introduced through a natural orifice such as the mouth, anus, or vagina and then advanced to the tissue treatment site by puncturing the walls of internal body lumen such as the stomach, intestines, colon, cervix. In various embodiments, the electrical ablation system 10 may be adapted to treat undesirable tissue in the brain, liver, breast, gall bladder, pancreas, or prostate gland, using one or more electrodes positioned percutaneously, transcutaneously, translumenally, minimally invasively, and/or through open surgical techniques, or any combination thereof.

In one embodiment, the electrical ablation system 10 may be employed in conjunction with a flexible endoscope 12, as well as a rigid endoscope, laparoscope, or thoracoscope, such as the GIF-100 model available from Olympus Corporation. In one embodiment, the endoscope 12 may be introduced to the tissue treatment region trans-anally through the colon, trans-orally through the esophagus and stomach, trans-vaginally through the cervix, transcutaneously, or via an external incision or keyhole formed in the abdomen in conjunction with a trocar. The electrical ablation system 10 may be inserted and guided into or proximate the tissue treatment region using the endoscope 12. In other embodiments, an endoscope 12 is not utilized, and instead other technique, such as ultrasound or a computerized tomography (CT) scan, for example, is used to determine proper instrument placement during the procedure.

In the embodiment illustrated in FIG. 1, the endoscope 12 comprises an endoscope handle 34 and an elongate relatively flexible shaft 32. The distal end of the flexible shaft 32 may comprise a light source and a viewing port. Optionally, the flexible shaft 32 may define one or more channels for receiving various instruments therethrough, such as electrical ablation devices, for example. Images within the field of view of the viewing port are received by an optical device, such as a camera comprising a charge coupled device (CCD) usually located within the endoscope 12, and are transmitted to a display monitor (not shown) outside the patient.

In one embodiment, the electrical ablation system 10 may comprise an electrical ablation device 20, a plurality of electrical conductors 18, 19, a handpiece 16 comprising an activation switch 62, and an energy source 14, such as an electrical waveform generator, electrically coupled to the activation switch 62 and the electrical ablation device 20. The electrical ablation device 20 may comprise a first lumen 26 and a second lumen 27. The first lumen 26 and the second lumen 27 may be introduced to the tissue treatment region using a variety of known techniques such as an open incision and a trocar, through one of more of the channels of the endoscope 12, percutaneously, or transcutaneously. In some embodiments, the first lumen 26 and the second lumen 27 may be relatively rigid or flexible. Additionally, additional lumens may be utilized, such as a larger lumen (not shown) surrounding the first lumen 26 and the second lumen 27. Further, a housing 33, or other suitable structure, may be utilized to maintain the relative position of the first lumen 26 and the second lumen 27.

In one embodiment, one or more electrodes (e.g., needle electrodes, balloon electrodes), such as a first electrodes 24 and a second electrode 25, extend out from the distal end of the electrical ablation device 20. In one embodiment, the first electrode 24 may be configured as the positive electrode and the second electrode 25 may be configured as the negative electrode. The first electrode 24 is electrically connected to a first electrical conductor 18, or similar electrically conductive lead or wire, which is coupled to the positive terminal of the energy source 14 through the activation switch 62. The second electrode 25 is electrically connected to a second electrical conductor 19, or similar electrically conductive lead or wire, which is coupled to the negative terminal of the energy source 14 through the activation switch 62. The electrical conductors 18, 19 are electrically insulated from each other and surrounding structures except for the electrical connections to the respective electrodes 24, 25. In various embodiments, the electrical ablation device 20 may be configured to be introduced into or proximate the tissue treatment region using the endoscope 12 (laparoscope or thoracoscope), open surgical procedures, or external and non-invasive medical procedures. The electrodes 24, 25 may be referred to herein as endoscopic or laparoscopic electrodes, although variations thereof may be inserted transcutaneously or percutaneously. As previously discussed, either one or both electrodes 24, 25 may be adapted and configured to slideably move in and out of lumens 26, 27, respectively. In one embodiment, either one or both of the electrodes 24, 25 may be formed in a radius (i.e., arcuate, curved). Additionally, as discussed in more detail below, either one or both of the electrodes 24, 25 may be rotatable within their respective lumens 26, 27. Various features of one embodiment of the first and second electrodes 24, 25 are described in more detail in FIGS. 2A-D.

Once the electrodes 24, 25 are positioned at the desired location into or proximate the tissue treatment region, the electrodes 24, 25 may be connected to or disconnected from the energy source 14 by actuating or de-actuating the switch 62 on the handpiece 16. The switch 62 may be operated manually or may be mounted on a foot switch (not shown), for example. The electrodes 24, 25 deliver electric field pulses to the undesirable tissue. The electric field pulses may be characterized based on various parameters such as pulse shape, amplitude, frequency, and duration. The electric field pulses may be sufficient to induce irreversible electroporation in the undesirable tissue. The induced potential depends on a variety of conditions such as tissue type, cell size, and electrical pulse parameters. The primary electrical pulse parameter affecting the transmembrane potential for a specific tissue type is the amplitude of the electric field and pulse length that the tissue is exposed to.

In one embodiment, the first and second electrical conductors 18, 19 may be provided through the handle 28. In the illustrated embodiment, the electrode 24 can be slideably moved in and out of the distal end of the first lumen 26 using a slide member 30 to retract and/or advance the first electrode 24. The electrode 25 can be slideably moved in and out of the distal end of the second lumen 27 using a slide member 31 to retract and/or advance the second electrode 25. In various embodiments either or both electrodes 24, 25 may be coupled to a single slide member, or additional slide members, to advance and retract the electrodes 24, 25, e.g., position the electrodes 24, 25. In the illustrated embodiment, the first electrical conductor 18 coupled to the first electrode 24 is coupled to the slide member 30. In this manner, the first electrode 24, which is slidably movable within the cannula, lumen, or channel defined by the first lumen 26, can be advanced and retracted with the slide member 30. In the illustrated embodiment, the second electrical conductor 19 coupled to the second electrode 25 is coupled to the slide member 31. In this manner, the second electrode 25, which is slidably movable within the cannula, lumen, or channel defined by the second lumen 27, can be advanced and retracted with the slide member 31. In one embodiment, various slide members, such as the slide member 31, are rotatable. Thus rotation of the slide member 30, 31 rotates the corresponding electrode 24, 25, respectively, at the distal end of the electrical ablation device 20.

In various other embodiments, transducers or sensors 29 may be located in the handle 28 (or other suitable location) of the electrical ablation device 20 to sense the force with which the electrodes 24, 25 penetrate the tissue in the tissue treatment zone. This feedback information may be useful to determine whether either one or both of the electrodes 24, 25 have been properly inserted in the tissue treatment region. As is particularly well known, cancerous tumor tissue tends to be denser than healthy tissue and thus greater force is required to insert the electrodes 24, 25 therein. The transducers or sensors 29 can provide feedback to the operator, surgeon, or clinician to physically sense when the electrodes 24, 25 are placed within the cancerous tumor. The feedback information provided by the transducers or sensors 29 may be processed and displayed by circuits located either internally or externally to the energy source 14. The sensor 29 readings may be employed to determine whether the electrodes 24, 25 have been properly located within the cancerous tumor thereby assuring that a suitable margin of error has been achieved in locating the electrodes 24, 25.

In one embodiment, the input to the energy source 14 may be connected to a commercial power supply by way of a plug (not shown). The output of the energy source 14 is coupled to the electrodes 24, 25, which may be energized using the activation switch 62 on the handpiece 16, or in one embodiment, an activation switch mounted on a foot activated pedal (not shown). The energy source 14 may be configured to produce electrical energy suitable for electrical ablation, as described in more detail below.

In one embodiment, the electrodes 24, 25 are adapted and configured to electrically couple to the energy source 14 (e.g., generator, waveform generator). Once electrical energy is coupled to the electrodes 24, 25, an electric field is formed at a distal end of the electrodes 24, 25. The energy source 14 may be configured to generate electric pulses at a predetermined frequency, amplitude, pulse length, and/or polarity that are suitable to induce irreversible electroporation to ablate substantial volumes of undesirable tissue in the treatment region. For example, the energy source 14 may be configured to deliver DC electric pulses having a predetermined frequency, amplitude, pulse length, and/or polarity suitable to induce irreversible electroporation to ablate substantial volumes of undesirable tissue in the treatment region. The DC pulses may be positive or negative relative to a particular reference polarity. The polarity of the DC pulses may be reversed or inverted from positive-to-negative or negative-to-positive a predetermined number of times to induce irreversible electroporation to ablate substantial volumes of undesirable tissue in the treatment region.

In one embodiment, a timing circuit may be coupled to the output of the energy source 14 to generate electric pulses. The timing circuit may comprise one or more suitable switching elements to produce the electric pulses. For example, the energy source 14 may produce a series of n electric pulses (where n is any positive integer) of sufficient amplitude and duration to induce irreversible electroporation suitable for tissue ablation when the n electric pulses are applied to the electrodes 24, 25. In one embodiment, the electric pulses may have a fixed or variable pulse length, amplitude, and/or frequency.

The electrical ablation device 20 may be operated either in bipolar or monopolar mode. In bipolar mode, the first electrode 24 is electrically connected to a first polarity and the second electrode 25 is electrically connected to the opposite polarity. For example, in monopolar mode, the first electrode 24 is coupled to a prescribed voltage and the second electrode 25 is set to ground. In the illustrated embodiment, the energy source 14 may be configured to operate in either the bipolar or monopolar modes with the electrical ablation system 10. In bipolar mode, the first electrode 24 is electrically connected to a prescribed voltage of one polarity and the second electrode 25 is electrically connected to a prescribed voltage of the opposite polarity. When more than two electrodes are used, the polarity of the electrodes may be alternated so that any two adjacent electrodes may have either the same or opposite polarities, for example.

In monopolar mode, it is not necessary that the patient be grounded with a grounding pad. Since a monopolar energy source 14 is typically constructed to operate upon sensing a ground pad connection to the patient, the negative electrode of the energy source 14 may be coupled to an impedance simulation circuit. In this manner, the impedance circuit simulates a connection to the ground pad and thus is able to activate the energy source 14. It will be appreciated that in monopolar mode, the impedance circuit can be electrically connected in series with either one of the electrodes 24, 25 that would otherwise be attached to a grounding pad.

In one embodiment, the energy source 14 may be configured to produce RF waveforms at predetermined frequencies, amplitudes, pulse widths or durations, and/or polarities suitable for electrical ablation of cells in the tissue treatment region. One example of a suitable RF energy source is a commercially available conventional, bipolar/monopolar electrosurgical RF generator such as Model Number ICC 350, available from Erbe, GmbH.

In one embodiment, the energy source 14 may be configured to produce destabilizing electrical potentials (e.g., fields) suitable to induce irreversible electroporation. The destabilizing electrical potentials may be in the form of bipolar/monopolar DC electric pulses suitable for inducing irreversible electroporation to ablate tissue undesirable tissue with the electrical ablation device 20. A commercially available energy source suitable for generating irreversible electroporation electric field pulses in bipolar or monopolar mode is a pulsed DC generator such as Model Number ECM 830, available from BTX Molecular Delivery Systems Boston, Mass. In bipolar mode, the first electrode 24 may be electrically coupled to a first polarity and the second electrode 25 may be electrically coupled to a second (e.g., opposite) polarity of the energy source 14. Bipolar/monopolar DC electric pulses may be produced at a variety of frequencies, amplitudes, pulse lengths, and/or polarities. Unlike RF ablation systems, which require high power and energy levels delivered into the tissue to heat and thermally destroy the tissue, irreversible electroporation requires very little energy applied to the tissue to kill the cells of the undesirable tissue using electric field potentials rather than heat. Accordingly, irreversible electroporation systems avoid the detrimental thermal effects of RF ablation systems.

In one embodiment, the energy source 14 may be coupled to the first and second electrodes 24, 25 by either a wired or a wireless connection. In a wired connection, the energy source 14 is coupled to the electrodes 24, 25 by way of the electrical conductors 18, 19, as shown. In a wireless connection, the electrical conductors 18, 19 may be replaced with a first antenna (not shown) coupled the energy source 14 and a second antenna (not shown) coupled to the electrodes 24, 25, wherein the second antenna is remotely located from the first antenna. In one embodiment, the energy source may comprise a wireless transmitter to deliver energy to the electrodes using wireless energy transfer techniques via one or more remotely positioned antennas. As previously discussed, wireless energy transfer or wireless power transmission is the process of transmitting electrical energy from the energy source 14 to an electrical load, e.g., the abnormal cells in the tissue treatment region, without using the interconnecting electrical conductors 18, 19.

In one embodiment, the energy source 14 may be configured to produce DC electric pulses at frequencies in the range of about 1 Hz to about 10,000 Hz, amplitudes in the range of about ±100 to about ±3,000 VDC, and pulse lengths (e.g., pulse width, pulse duration) in the range of about 1 μs to about 100 ms. The polarity of the electric potentials coupled to the electrodes 24, 25 may be reversed during an electrical ablation therapy procedure. For example, initially, the DC electric pulses may have a positive polarity and an amplitude in the range of about +100 to about +3,000 VDC. Subsequently, the polarity of the DC electric pulses may be reversed such that the amplitude is in the range of about −100 to about −3,000 VDC. In one embodiment, the undesirable cells in the tissue treatment region may be electrically ablated with DC pulses suitable to induce irreversible electroporation at frequencies of about 10 Hz to about 100 Hz, amplitudes in the range of about +700 to about +1,500 VDC, and pulse lengths of about 10 μs to about 50 μs. In another embodiment, the abnormal cells in the tissue treatment region may be electrically ablated with an electrical waveform having an amplitude of about +500 VDC and pulse duration of about 20 ms delivered at a pulse period T or repetition rate, frequency f=1/T, of about 10 Hz. It has been determined that an electric field strength of about 1,000V/cm is suitable for destroying living tissue by inducing irreversible electroporation.

FIGS. 2A-D illustrate one embodiment of the electrical ablation device 20 in various phases of deployment. The electrical ablation device 20 may be used in conjunction with the electrical ablation system 10 shown in FIG. 1. It will be appreciated that other devices and electrode configurations may be employed without limitation. FIG. 2A illustrates an initial phase of deployment in which the first electrode 24 is retracted into the first lumen 26 and the second electrode 25 is retraced into the second lumen 27. The electrodes 24, 25 may have dimensions of about 0.5 mm, about 0.75 mm, about 1 mm, or about 1.5 mm in diameter. It will be appreciated that the dimensions of the electrodes 24, 25 may be anywhere from about 0.5 mm to about 1.5 mm in diameter. In various embodiments, the diameter of the first electrode 24 may by different from the diameter of the second electrode 25. The electrical ablation device 20 may be introduced into the tissue treatment region through a trocar, for example, or inserted to a tissue treatment region transcutaneously, percutaneously, or other suitable techniques. In one embodiment, the distal end 46 of the first lumen 26 may comprise a cutting edge, such as a bevel or other sharp edge, to aid in the puncturing/piercing of tissue. The distal end 47 of the second lumen 27 may have a similar configuration.

FIG. 2B illustrates another phase of deployment in which the first electrode 24 is extended distally from the first lumen 26 and the second electrode 25 is extended distally from the second lumen 27. As illustrated, the electrodes 24, 25 may comprise a cutting edge, such as a bevel, on their distal ends to aid in the puncturing/piercing of tissue. In one embodiment, movement of the slide member 30 in the direction indicated by arrow 35 extends the first electrode 24 distally from the first lumen 26 and movement of the slide member 31 in the direction indicated by arrow 37 extends the second electrode 25 distally from the second lumen 27. In various embodiments, other techniques of extending the electrodes 24, 25 may be utilized, such as a linear drive motor, for example. In this phase of deployment, the first and second electrodes 24, 25 may extend distally through the distal end of the electrical ablation device 20 into or proximate the tissue treatment region. In one embodiment, the second electrode 25 may be formed with a radius, such that it curves or splays when it extends from the second lumen 27, as illustrated in FIG. 2B.

The second electrode 25 may be retracted into the second lumen 27 by pulling proximally on the slide member 31 in the direction indicated by arrow 39 in FIG. 2C. During a medical procedure, the second electrode 25 may remain inserted into the tissue treatment area. In a retracted position, the second electrode 25 may be rotated about its longitudinal axis (shown as “A”) as indicated by arrow 41. In the illustrated embodiment, the slide member 31 may be rotated to rotate the second electrode 25. The second electrode 25 may be rotated in any suitable direction and any suitable number of degrees, such as 45°, 90°, or 135°, for example. FIG. 2D illustrates another phase of deployment in which the second electrode 25 is in a fully extended position after it has been rotated. To achieve this position, the slide member 31 may be moved in the direction indicated by arrow 37.

One or more of the electrodes 24, 25 may be retracted, rotated, and then placed in a new location in the tissue treatment region. FIGS. 3A-C are perspective views of one embodiment of the electrical ablation device 20 in various stages of rotation about axis “A.” Such rotation enables the surgeon or clinician to target and treat a larger tissue treatment region without having to remove the electrical ablation device 20 from the tissue treatment area. Thus, the second electrode 25, for example, may be located in a plurality of positions in and around the tissue treatment region in order to change the distance between the first electrode 24 and the second electrode 25 and treat much larger regions of tissue. As shown in FIG. 3A, in a first position, the distal tip of the first electrode 24 may be separated by a distance “d₁” from the distal tip of the second electrode 25. As shown in FIG. 3B, in a second position, the distal tip of the first electrode 24 may be separated by a distance “d₂” from the distal tip of the second electrode 25. As shown in FIG. 3C, in a third position, the distal tip of the first electrode 24 may be separated by a distance “d₃” from the distal tip of the second electrode 25. Furthermore, increasing the radius “r” (FIG. 3A) of the second electrode 25 and/or the spacing between the electrodes 24, 25 enables the generation of an electric field over much larger tissue treatment regions and thus the ablation of larger volumes of undesirable tissue. In this manner, the operator can treat a larger tissue treatment region comprising cancerous lesions, polyps, or tumors, for example.

It will be appreciated that the electrical ablation device 20 described with reference to FIGS. 1, 2A-D, and 3A-C may be introduced inside a patient transcutaneously, percutaneously, through an open incision, through a trocar, through a natural orifice, or any combination thereof. In one embodiment, the outside diameter of the electrical ablation device 20 may be sized to fit within a channel of an endoscope and in other embodiments the outside diameter of the electrical ablation device 20 may be sized to fit within a hollow outer sleeve, or trocar, for example. The hollow outer sleeve or trocar may be inserted into the upper gastrointestinal tract of a patient and may be sized to also receive a flexible endoscopic portion of an endoscope (e.g., gastroscope), similar to the endoscope 12 described in FIG. 1.

Although the electrical ablation electrodes according to the described embodiments have been described in terms of the particular needle type electrodes 24, 25 as shown and described in FIGS. 1, 2A-D, and 3A-C those skilled in the art will appreciate that other configurations of electrical ablation electrodes may be employed for the ablation of undesirable tissue, without limitation. In another embodiment, the electrical ablation device 20 may comprise three or more retractable electrodes, one embodiment of which is described below with reference to FIGS. 4A and 4B. In another embodiment, the electrical ablation device 20 may comprise at least one slidable electrode disposed within at least one channel of the flexible shaft 32 of the endoscope 12. In another embodiment, the electrical ablation device 20 may comprise at least one electrode configured to be inserted into the tissue treatment region transcutaneously or percutaneously. Still in various other embodiments, the electrical ablation device 20 may comprise at least one electrode configured to be introduced to the tissue treatment region transcutaneously or percutaneously and at least one other electrode may be configured to be introduced to the tissue treatment region through at least one channel of the flexible shaft 32 of the endoscope 12. The embodiments, however, are not limited in this context.

FIGS. 4A-4B illustrate one embodiment of an electrical ablation device 100 comprising multiple needle electrodes. In the illustrated embodiment, the electrical ablation device 100 comprises three electrodes 124, 125, 126. It will be appreciated that in one embodiment, the electrical ablation device 100 also may comprise a greater number of needle electrodes. One or more needle electrodes of the electrical ablation device 100 may be formed with a radius. In the illustrated embodiment the electrode 125 and the electrode 126 are both formed with a radius r₁and r₂(FIG. 4A), respectively, such that they curve when extended distally from the electrical ablation device 100.

The electrical ablation device 100 may be used in conjunction with the electrical ablation system 10 shown in FIG. 1. It will be appreciated that other devices and electrode configurations may be employed without limitation. The electrodes 124, 125, 126 each may have dimensions of about 0.5 mm, about 0.75 mm, about 1 mm, or about 1.5 mm in diameter. It will be appreciated that the dimensions of each of the electrodes 124, 125, 126 may be anywhere from about 0.5 mm to about 1.5 mm in diameter. The electrical ablation device 100 may be introduced into the tissue treatment region through a trocar, transcutaneously, percutaneously, or using other suitable techniques.

The electrical ablation device 100 comprises essentially the same components as the electrical ablation device 20 described with reference to FIGS. 2A-D. The electrical ablation device 100 comprises electrodes 124, 125, 126 that may be individually or simultaneously deployable, retractable, and/or rotatable with respect to the corresponding lumens 129, 127, 128. The electrodes 124, 125, 126 extend distally from the distal end of the electrical ablation device 100. In one embodiment, the electrode 124 may be configured as the positive electrode coupled to the anode of the energy source 14 (FIG. 1) and the electrodes 125, 126 may be configured as the negative electrode coupled to the cathode of the energy source 14 (FIG. 1). Once the electrodes 124, 125, 126 are positioned at the desired location into or proximate the tissue treatment region, the electrodes 124, 125, 126 may be connected/disconnected from the energy source 14 by actuating/de-actuating the switch 62 (FIG. 1).

Similar to the electrical ablation device 20, the various electrodes 124, 125, 126 may be rotatable and the distance between the various electrodes and/or relative positions of the electrodes 124, 125, 126 may be changed. In the illustrated embodiment, two of the electrodes 125, 126 are rotatable whereas the other electrode 124 is non-rotatable. For example, one of the electrodes 125 may be rotatable about its longitudinal axis (illustrated as “B”) and the other electrode 126 may be rotatable about its longitudinal axis (illustrated as “C”). FIG. 4A illustrates the rotatable electrodes 125, 126 in a first position and FIG. 4B illustrates the rotatable electrodes 125, 126 in a second position (i.e., after rotation). The rotatable electrodes 125, 126 may be rotated using any suitable method, such as by slide members similar to slide member 31 (FIGS. 2A-2B). As is to be appreciated, the rotatable electrodes 125, 126 may be retracted into their respective lumens 127, 128 prior to rotation. Once rotated to a desired position, the rotatable electrodes 125, 126 then may be extended distally from the distal end of the ablation device 100. Such rotation of the rotatable electrodes 125, 126 enables the surgeon or clinician to target and treat a larger tissue treatment region without having to remove the electrical ablation device 100 from the tissue treatment area. Additionally, for embodiments with multiple rotating electrodes, each electrode may be retracted, extended, and rotated independently from the other electrodes.

FIGS. 5A-5B illustrate the operation of electrical ablation device 100 in accordance with one non-limiting embodiment. The electrodes 124, 125, 126 may be inserted into a tissue treatment region 144. The tissue treatment region 144 may be representative of a variety of diseased tissues, cancers, tumors, masses, lesions, abnormal tissue growths, for example. In one embodiment, one of the rotatable electrodes 125 may be rotated in the directions indicated by arrow 140 and the other rotatable electrode 126 may be rotated in the directions indicated by arrow 142. One of the rotatable electrodes 125 may be retracted into the lumen 127 prior to rotation and the other rotatable electrode 126 may be retracted into the lumen 128 prior to rotation. As shown in FIG. 5B, to ablate a portion of the tissue treatment region 144, the operator initially may locate one of the rotatable electrodes 125 at a first position and the other rotatable electrode 126 at a second position. Once the rotatable electrodes 125, 126 are located into or proximate the tissue treatment region 144, all of the electrodes 124, 125, 126 are energized with irreversible electroporation pulses to create a first necrotic zone 148 having a first shape substantially similar to that shown in FIG. 5B. For example, once the rotatable electrodes 125, 126 are located in the desired positions, the tissue treatment region 144 may be exposed to an electric field generated by energizing all of the electrodes 124, 125, 126 with the energy source 14 (FIG. 1). The electric field may have a magnitude, frequency, and pulse length suitable to induce irreversible electroporation in the tissue treatment region 144 to create the first necrotic zone 148 having a first shape. The size of the necrotic zone 148 is substantially dependent on the size, separation, and orientation of the rotatable electrodes 125, 126, as previously discussed. The treatment time is defined as the time that the rotatable electrodes 125, 126 are activated or energized to generate the electric pulses suitable for inducing irreversible electroporation in the tissue treatment region 144.

This procedure may be repeated to destroy relatively larger portions of the tissue treatment region 144 through rotation of at least one of the rotatable electrodes 125, 126. As illustrated in FIG. 5C, one of the rotatable electrodes 125 has been rotated to a second position. Prior to rotating, one of the rotatable electrodes 125 is retracted by pulling on an associated slide member (not shown) in a direction toward the proximal end. The rotatable electrode 125 may then be rotated within the corresponding lumen 127 to the second position. Once the rotatable electrode 125 is rotated to the second position, it may be advanced to engage the tissue treatment region 144 by pushing on the slide member (not shown) in a direction towards the distal end of the electrical ablation device 100. A second necrotic zone 148 having a second shape substantially as shown is formed upon energizing all of the electrodes 124, 125, 126. As is to be appreciated, a plurality of necrotic zones having a plurality of shapes may be formed by retracting the at least one of the rotatable electrodes 125, 126, rotating the first electrode(s) to a new location, advancing the first electrode(s) into the tissue treatment region 144 and energizing all of the electrodes 124, 125, 126. This process may be repeated as often as necessary to create any number of necrotic zones. At anytime, the surgeon or clinician can reposition the non-rotatable electrode 124 and begin the process anew. Those skilled in the art will appreciate that similar techniques may be employed to ablate any other undesirable tissues that may be accessible trans-anally through the colon, and/or orally through the esophagus and the stomach using translumenal access techniques. Therefore, the embodiments are not limited in this context.

FIG. 6 illustrates an electrical ablation apparatus 200 in accordance with various embodiments. The electrical ablation apparatus 200 may comprise an elongate sheath 202. The distal end of the elongate sheath 202 may have a cutting edge, such as a bevel 208, to aid in the puncturing or piercing of tissue. A first and second electrode 210, 212 may be deployable from the distal end of the elongate sheath 202. In various embodiments, a greater number of electrodes or lesser number of electrodes may be deployable from the distal end of the elongate sheath 202. In one embodiment, a sleeve 204 at least partially surrounds the elongate sheath 202. The sleeve 204 comprises an additional electrode 206 which may be in addition to one or more electrodes deployable from the distal end of the elongate sheath 202, such as the first electrode 210 or the second electrode 212. An insulator 218 may be utilized to electrically isolate the electrode 206 from the elongate sheath 202. While the sleeve 204 is illustrated as a cylinder, it is to be appreciated that the sleeve 204 may be any suitable size, shape, or configuration. The first and second electrodes 210, 212 may be pre-formed with a radius. Upon deployment from the distal end of the elongate sheath 202, the first and second electrodes 210, 212 may generally bend toward the proximal end of the electrical ablation apparatus 200 due to their pre-formed radius.

In one embodiment, at least one of the first and second electrodes 210, 212 is rotatable within the elongate sheath 202. Similar to previously discussed embodiments, the electrical ablation apparatus 200 may be inserted into a tissue treatment region and a plurality of necrotic zones having a plurality of shapes may be formed by retracting at least one of the electrodes 210, 212, rotating the electrode(s) to a new location, advancing the electrode(s) into the tissue treatment region and energizing the electrodes 206, 210, 212. This process may be repeated as often as necessary to create any number of necrotic zones, each with a varying shape.

FIG. 7 illustrates an electrical ablation apparatus 300 in accordance with various embodiments. The electrical ablation apparatus 300 comprises features similar to the electrical ablation apparatus 200. The electrical ablation apparatus 300 comprises an elongate sheath 302 having a bevel 308 at the distal end to aid in the puncturing or piercing of tissue. The illustrated embodiment also comprises first and second electrodes 310, 312, each with a pre-formed radius, that are deployable from the elongate sheath 302. The sleeve 304 comprises an extension 314 extending distally from the distal end of the electrical ablation apparatus 300. The extension 314 may have a sharp distal end. The sleeve 304 and the extension 314 may comprise an additional electrode 306 which may be in addition to one or more electrodes deployable from the distal end of the elongate sheath 302, such as the first electrode 310 or the second electrode 306. An insulator 318 may be utilized to electrically isolate the electrode 306 from the elongate sheath 302. The extension 314 may be used to pierce tissue and positionally secure the electrical ablation apparatus 300 proximate to a tissue treatment region. At least one of the first and second electrodes 310, 312 may be rotatable within the elongate sheath 302. Similar to the electrical ablation device 200 described with reference to FIG. 6, the electrical ablation apparatus 300 may be inserted into a tissue treatment region to create a plurality of necrotic zones having a plurality of shapes by retracting the at least one of the electrodes 310, 312, rotating the electrode(s) to a new location, advancing the electrode(s) into the tissue treatment region and energizing the electrodes 306, 310, 312. This process may be repeated as often as necessary to create any number of necrotic zones, each with a varying shape. The extension 306 is used to anchor the electrical ablation device 300 during the procedure.

FIG. 8 illustrates another embodiment of an electrical ablation apparatus 400. The electrical ablation apparatus 400 may comprise a first elongate sheath 402 and a second elongate sheath 404. The first elongate sheath 402 may be substantially parallel to the second elongate sheath 404. In some embodiments, the first elongate sheath 402 and the second elongate sheath 404 may be coupled together or otherwise formed together. First, second, and third electrodes 424, 425, 426 are deployable from the first elongate sheath 402. Fourth, fifth, and sixth electrodes 427, 428, 429 are deployable from the second elongate sheath 404. Each electrode 424, 425, 426, 427, 428, 429 may be coupled to an energy source (not shown) at a proximal end and configured to couple to a tissue treatment region at the distal end. As illustrated, in various embodiments, some electrodes, such as the first electrode 424 and the fourth electrode 427 may be electrically isolated from the other electrodes. In one embodiment, the first electrode 424 is at least partially surrounded by an insulative sleeve 432 and the fourth electrode 437 is at least partially surrounded by an insulative sleeve 434. In one embodiment, the first electrode 424 comprises a non-conductive distal end 431 and the second electrode 427 also comprises a non-conductive distal end 433. In various embodiments, the non-conductive distal ends 431, 433 comprise ceramic, or another non-conductive material. The use of the non-conductive distal ends 431, 433 reduces the current density present at the distal end of the electrodes 424, 427 when energized.

Various electrodes of the electrical ablation apparatus 400 may be pre-formed with a radius. In the illustrated embodiment, the second and third electrodes 425, 426 and the fifth and sixth electrodes 428, 429 are formed with a pre-formed radius. Therefore, similar to the previously discussed embodiments, after an initial energization, these electrodes may be retracted into their respective elongate sheaths and rotated in order to change the shape of the necrotic zone when the electrodes are re-introduced into a tissue treatment region and energized.

In various embodiments, other electrode configurations may be implemented to create necrotic zones of various shapes within a tissue treatment region. Yet another embodiment of an electrical ablation apparatus 500 is illustrated in FIG. 9. The electrical ablation apparatus 500 comprises an elongate shaft 502. The distal end of the elongate shaft 502 may be sharpened, or otherwise contain a cutting edge, such as a bevel 504. A plurality of electrodes may be disposed along the elongate shaft, alternating in polarity when in an energized state. In one embodiment, the first and second electrodes 506, 508 may be at a first polarity and a third electrode 510 may be at a second polarity when energized. Regardless of the initial polar configuration, the polarity of the electrodes may be reversed by reversing the polarity of the output of the energy source. The third electrode 510 may be coupled to an energy source (not shown) via any suitable connection, such as an insulated conductor 512, for example. Similarly, the first and second electrodes 506, 508 may be coupled to an energy source, such as with conductors positioned internal to the elongate shaft 502, for example. A first insulator 514 may be positioned intermediate the first electrode 506 and the third electrode 510 and a second insulator 516 may be positioned intermediate the second electrode 508 and the third electrode 510. In some embodiments, the insulators 514, 516 may be coupled to the third electrode 510. The insulators 514, 516 prohibit an electrically conductive connection between two adjacent electrodes having opposite polarities.

In one embodiment, the third electrode 510 is slidably engaged with the elongate sheath 502. The position along the elongate sheath 502 may be controlled by the user at the proximal end of the electrical ablation apparatus 500, such as with a slide member similar to previously discussed embodiments. During a tissue treatment procedure, the third electrode 510 is placed in a first position and the electrical ablation apparatus 500 is positioned within a tissue treatment region. As is to be appreciated, the electrical ablation apparatus 500 may be introduced inside a patient endoscopically, transcutaneously, percutaneously, through an open incision, through a trocar, through a natural orifice, or any combination thereof. Once positioned by the user, the electrodes 506, 508, 510 may be energized to form a necrotic zone having a first shape in the tissue treatment region. The shape of the necrotic zone will be dependent on the position of the third electrode 510 relative to the first and second electrodes 506, 508. The user may slide the third electrode 510 in the direction indicated by arrow 518 to change the relative position of the third electrode 510. When the electrodes 506, 508, 510 are re-energized, a necrotic zone having a second shape is formed in the tissue treatment region. This process may be repeated as often as necessary to create any number of necrotic zones using the electrical ablation apparatus 500. At any time, the surgeon or clinician can reposition the electrical ablation apparatus 500 within the tissue treatment region and begin the process anew. Further, as is to be appreciated, the electrodes 506, 508, 510 may be formed in any suitable configuration. For example, in one embodiment, the third electrode 510 comprises a cutting edge to assist in the movement of the third electrode 510 through tissue.

FIG. 10 illustrates an electrical ablation apparatus 600 in accordance with one non-limiting embodiment. The electrical ablation apparatus 600 comprises an elongate sheath 602 and an electrode 624 deployable from the distal end of the elongate sheath 602. As illustrated, in various embodiments, the electrode 624 may be at least partially surrounded by an insulative sleeve 632. The electrical ablation apparatus 600 further comprises a fluid nozzle 640 configured to deploy a fluid into a tissue treatment region 644. The fluid nozzle 640 may be coupled to a fluid source 642 via a fluid conduit 648. Upon deployment, the fluid 650 bores a path in the tissue treatment region 644 to create a cavity 656. The fluid 650 may be any suitable conductive solution (e.g., saline solution). After the formation of the cavity 656, the fluid 650 located in the cavity 656 may be electrically connected to a first polarity of an energy source 614 to function as an electrode. The electrode 624 is supplied energy having an opposite polarity through an electrical coupling to the energy source 614. As current flows through the tissue treatment region 644 from the first electrode 624 to the fluid 650 in the cavity 656, a necrotic zone having a first shape is formed in the tissue treatment region 644. The user of the electrical ablation apparatus 600 then can rotate, or otherwise reposition the fluid nozzle 640, and deploy the fluid 650 to create a second cavity 652 and the process may be repeated to form a third necrotic zone having a second shape. As illustrated, a third cavity 654 may be created to form yet a third necrotic zone having a third shape. Various parameters of the fluid and the fluid deployment process, such as a pressure, temperature, duration, may be altered or adjusted according to the type of tissue in the tissue treatment region 644 and the desired size of the cavity created. Furthermore, in various embodiments, a plurality of fluid nozzles 640 and/or a plurality of electrodes 624 may be utilized by the electrical ablation apparatus 600.

FIGS. 11A-B illustrate an alignment guide 700 in accordance with one non-limiting embodiment. The alignment guide 700 assists in the placement and delivery of electrodes to a treatment site inside a patient. As illustrated, the alignment guide 700 is positioned on the surface 702 of the skin 704 of a patient. The center of the alignment guide 700 may be positioned above the center of the targeted tissue (e.g., a tumor). Once placed in the proper position, the alignment guide 700 may be secured to the surface 702 of the skin 704 using any suitable attachment technique, such as surgical tape. In one embodiment, the alignment guide 700 comprises an adhesive on the skin contacting portion to adhere the alignment guide to the patient. The alignment guide 700 may be radio-opaque to allow proper placement through the use of ultrasound, CT guidance, or other techniques, proximate to the target tissue.

The alignment guide 700 defines a passageway 706 configured to receive an electrical ablation apparatus 710. In one embodiment, the electrical ablation apparatus 710 comprises first and second electrodes 712, 714, with each electrode 712, 714 comprising a first end configured to couple to an energy source 720 and a second end configured to couple to a tissue treatment region. In some embodiments, more electrodes, such as a third electrode 716, may be utilized. Furthermore, one or more of the electrodes may be pre-formed with a radius so that they curve or splay upon deployment from the distal end of the electrical ablation apparatus 710. According to one embodiment, the electrical ablation apparatus 710 comprises a first lumen 718 configured to receive the first electrode 712 and a second lumen 722 configured to receive the second electrode 714. If additional electrodes are utilized, the electrical ablation apparatus 710 also may comprise additional lumens, such as a third lumen 724 configured to receive a third electrode 716. The first electrode 712 may movable between a first position and a second position with respect to the second electrode 714 (e.g., through rotation of the electrical ablation apparatus 710). A zone of cell necrosis in a first shape is created in a tissue treatment region when the first electrode 712 is in a first position and a zone of necrosis in a second shape is created when the first electrode 712 is in the second position (e.g., subsequent to rotation).

The electrical ablation apparatus 710 may further comprise a first handle 730, a second handle 732, and a third handle 734. The handles 730, 732, 734 are configured to receive the lumens 718, 722, 724. In the illustrated embodiment, the first handle 730 is configured to be placed against the surface 702 of the skin 704 through the passageway 706 of the alignment guide 700. The electrical ablation apparatus 710 is rotatable about the longitudinal axis (shown as “D”) in the directions indicated by arrow 738. The second and third handles 732, 734 may be moved in the direction indicated by arrow 740 in order to pass the electrodes 712, 714, 716 through the skin 704 and into a tissue treatment region (not shown). Once the electrodes 712, 714, 716 are coupled to the target tissue, the electrodes 712, 714, 716 may be energized with the energy source 720 using previously discussed techniques to create a necrotic zone having a first shape. The user may then move the second and third handles 732, 734 in the direction indicated by arrow 742 (FIG. 11B) to remove at least one electrode from the target treatment region. In one embodiment, the center electrode (i.e., the second electrode 714) remains engaged with the tissue treatment region to serve as a central pivot as the electrical ablation apparatus 710 is rotated about axis D by the user. Once rotated, the user may once again move the second and third handles 732, 734, in the direction indicated by arrow 740 in order to pass the rotated electrodes 712, 716 through the skin 704 and into a tissue treatment region at a different location. Once the electrodes 712, 714, 716 are again coupled to the target tissue, the electrodes may be energized with the energy source 720 to create a necrotic zone having a second shape. This process may be repeated as often as necessary to create any number of necrotic zones using the electrical ablation apparatus 710. The alignment guide 700 serves to ensure proper position of the electrical ablation apparatus 710 during the procedure.

As illustrated in FIG. 12, the handle 730 may be configured to rotate within the passageway 706 of the alignment guide 700. In order to assist the user in the rotation of the handle 730, various alignment aids may be used. For example, the skin contacting portion of the handle 730 may comprise a dye to mark the surface of the skin upon contact. As the user rotates the handle 730 and places it against the skin, a series of marks indicative of previous contacts will be imprinted on the skin. Additionally, as illustrated in FIG. 13, a plurality of visual indicators 750 may be distributed around the periphery of the alignment guide 700. Throughout a procedure, the user lines the handle 730 with the various visual indicators 750 prior to piercing the skin and underlying target tissue with the electrodes. Through the use of the visual indicators 750, the user can create necrotic zones of varying shapes within the target treatment region.

In some embodiments, as illustrated in FIG. 14, a plurality of detents may be used to assist the user in positioning the handle 730 during rotation. For example, the alignment guide 700 may define a plurality of notches 752 distributed around the periphery of the passageway 706. The notches 752 are configured to receive a portion of the handle 730, such as a protrusion 754, during rotation.

The embodiments of the electrical ablation devices described herein may be introduced inside a patient using minimally invasive or open surgical techniques. In some instances it may be advantageous to introduce the electrical ablation devices inside the patient using a combination of minimally invasive and open surgical techniques. Minimally invasive techniques provide more accurate and effective access to the treatment region for diagnostic and treatment procedures. To reach internal treatment regions within the patient, the electrical ablation devices described herein may be inserted through natural openings of the body such as the mouth, anus, and/or vagina, for example. Minimally invasive procedures performed by the introduction of various medical devices into the patient through a natural opening of the patient are known in the art as NOTES™ procedures. Surgical devices, such as an electrical ablation devices, may be introduced to the treatment region through the channels of the endoscope to perform key surgical activities (KSA), including, for example, electrical ablation of tissues using irreversible electroporation energy. Some portions of the electrical ablation devices may be introduced to the tissue treatment region percutaneously or through small—keyhole—incisions.

Endoscopic minimally invasive surgical and diagnostic medical procedures are used to evaluate and treat internal organs by inserting a small tube into the body. The endoscope may have a rigid or a flexible tube. A flexible endoscope may be introduced either through a natural body opening (e.g., mouth, anus, and/or vagina). A rigid endoscope may be introduced via trocar through a relatively small—keyhole—incision incisions (usually 0.5-1.5 cm). The endoscope can be used to observe surface conditions of internal organs, including abnormal or diseased tissue such as lesions and other surface conditions and capture images for visual inspection and photography. The endoscope may be adapted and configured with channels for introducing medical instruments to the treatment region for taking biopsies, retrieving foreign objects, and/or performing surgical procedures.

Once an electrical ablation device is inserted in the human body internal organs may be reached using trans-organ or translumenal surgical procedures. The electrical ablation device may be advanced to the treatment site using endoscopic translumenal access techniques to perforate a lumen, and then, advance the electrical ablation device and the endoscope into the peritoneal cavity. Translumenal access procedures for perforating a lumen wall, inserting, and advancing an endoscope therethrough, and pneumoperitoneum devices for insufflating the peritoneal cavity and closing or suturing the perforated lumen wall are well known. During a translumenal access procedure, a puncture must be formed in the stomach wall or in the gastrointestinal tract to access the peritoneal cavity. One device often used to form such a puncture is a needle knife which is inserted through the channel of the endoscope, and which utilizes energy to penetrate through the tissue. A guidewire is then fed through the endoscope and is passed through the puncture in the stomach wall and into the peritoneal cavity. The needle knife is removed, leaving the guidewire as a placeholder. A balloon catheter is then passed over the guidewire and through the channel of the endoscope to position the balloon within the opening in the stomach wall. The balloon can then be inflated to increase the size of the opening, thereby enabling the endoscope to push against the rear of the balloon and to be fed through the opening and into the peritoneal cavity. Once the endoscope is positioned within the peritoneal cavity, numerous procedures can be performed through the channel of the endoscope.

The endoscope may be connected to a video camera (single chip or multiple chips) and may be attached to a fiber-optic cable system connected to a “cold” light source (halogen or xenon), to illuminate the operative field. The video camera provides a direct line-of-sight view of the treatment region. If working in the abdomen, the abdomen may be insufflated with carbon dioxide (CO₂) gas to create a working and viewing space. The abdomen is essentially blown up like a balloon (insufflated), elevating the abdominal wall above the internal organs like a dome. CO₂gas is used because it is common to the human body and can be removed by the respiratory system if it is absorbed through tissue.

Once the electrical ablation devices are located at the target site, the diseased tissue may be electrically ablated or destroyed using the various embodiments of electrodes discussed herein. The placement and location of the electrodes can be important for effective and efficient electrical ablation therapy. For example, the electrodes may be positioned proximal to a treatment region (e.g., target site or worksite) either endoscopically or transcutaneously (percutaneously). In some implementations, it may be necessary to introduce the electrodes inside the patient using a combination of endoscopic, transcutaneous, and/or open techniques. The electrodes may be introduced to the tissue treatment region through a channel of the endoscope, an overtube, or a trocar and, in some implementations, may be introduced percutaneously or through small—keyhole—incisions.

Preferably, the various embodiments of the devices described herein will be processed before surgery. First, a new or used instrument is obtained and if necessary cleaned. The instrument can then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK® bag. The container and instrument are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in the sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility.

It is preferred that the device is sterilized prior to use. This can be done by any number of ways known to those skilled in the art including beta or gamma radiation, ethylene oxide, steam.

Although the various embodiments of the devices have been described herein in connection with certain disclosed embodiments, many modifications and variations to those embodiments may be implemented. For example, different types of end effectors may be employed. Also, where materials are disclosed for certain components, other materials may be used. The foregoing description and following claims are intended to cover all such modification and variations.

Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.

Claims

1. An electrical ablation apparatus, comprising: a first lumen extending along a first longitudinal axis toward a distal end of the first lumen;a first electrode selectively rotatable within the first lumen, wherein the first electrode comprises a distal portion pre-formed with a radius to splay away from the first longitudinal axis when the distal portion translates outside the distal end of the first lumen;a second lumen extending along a second longitudinal axis toward a distal end of the second lumen;a second electrode selectively rotatable within the second lumen, wherein the second electrode comprises a distal portion pre-formed with a radius to splay away from the second longitudinal axis when the distal portion translates outside the distal end of the second lumen;a third lumen extending along a third longitudinal axis toward a distal end of the third lumen; anda third electrode non-rotatable within the third lumen, wherein the third electrode comprises a distal portion selectively translatable outside the distal end of the third lumen into a tissue treatment region;wherein the distal portion of the first electrode is selectively translatable outside the distal end of the first lumen at a first rotated position into the tissue treatment region and the distal portion of the second electrode is selectively translatable outside the distal end of the second lumen at a second rotated position into the tissue treatment region to create a first necrotic zone having a first shape upon energizing the first electrode, the second electrode, and the third electrode via an energy source; andwherein at least one of: the distal portion of the first electrode is selectively translatable inside the distal end of the first lumen, selectively rotatable within the first lumen about the first longitudinal axis to an adjusted first rotated position, and selectively translatable outside the distal end of the first lumen at the adjusted first rotated position to create a second necrotic zone having a second shape upon energizing the first electrode, the second electrode, and the third electrode via the energy source; orthe distal portion of the second electrode is selectively translatable inside the distal end of the second lumen, selectively rotatable within the second lumen about the second longitudinal axis to an adjusted second rotated position, and selectively translatable outside the distal end of the second lumen at the adjusted second rotated position to create the second necrotic zone having the second shape upon energizing the first electrode, the second electrode, and the third electrode via the energy source.
2. The electrical ablation apparatus of claim 1, wherein at least one of the distal end of the first lumen, the distal end of the second lumen, or the distal end of the third lumen comprises a cutting edge.
3. The electrical ablation apparatus of claim 1, wherein at least one of the first electrode, the second electrode, or the third electrode comprises a needle electrode.
4. The electrical ablation apparatus of claim 1, wherein the pre-formed radius of the first electrode is different than the pre-formed radius of the second electrode.
5. The electrical ablation apparatus of claim 1, wherein each of the first electrode, the second electrode, and the third electrode further comprise a proximal portion, wherein the proximal portion of the first electrode and the proximal portion of the second electrode are configured to be coupled to a cathode of the energy source, and wherein the proximal portion of the third electrode is configured to be coupled to an anode of the energy source.
6. The electrical ablation apparatus of claim 1, further comprising: a first actuator coupled to the first electrode, wherein the first actuator is configured to independently rotate and independently translate the first electrode relative to the second electrode and the third electrode;a second actuator coupled to the second electrode, wherein the second actuator is configured to independently rotate and independently translate the second electrode relative to the first electrode and the third electrode; anda third actuator coupled to the third electrode, wherein the third actuator is configured to independently translate the third electrode relative to the first electrode and the second electrode.
7. The electrical ablation apparatus of claim 1, further comprising: a housing configured to maintain the third lumen in position between the first lumen and the second lumen.
8. The electrical ablation apparatus of claim 1, wherein at least one of the distal portion of the first electrode, the distal portion of the second electrode, or the distal portion of the third electrode comprise a cutting edge.
9. The electrical ablation apparatus of claim 1, wherein the first electrode and the second electrode are independently rotatable and translatable relative to each other and the third electrode.
10. An electrical ablation apparatus, comprising: a first lumen, a second lumen, and a third lumen, wherein each lumen comprises a distal end;a first electrode configured to be selectively extended outside and selectively retracted inside the distal end of the first lumen, wherein the first electrode is configured to diverge from a first longitudinal axis when extended outside the distal end of the first lumen;a second electrode configured to be selectively extended outside and selectively retracted inside the distal end of the second lumen, and wherein the second electrode is configured to diverge from a second longitudinal axis when extended outside the distal end of the second lumen; anda third electrode configured to be selectively extended outside and selectively retracted inside the distal end of the third lumen, wherein the third electrode is non-rotatable within the third lumen;wherein the first electrode, the second electrode, and the third electrode are electrically coupled to an energy source, and wherein the first electrode, the second electrode, and the third electrode are extendable into a tissue treatment region to create a first necrotic zone having a first shape upon being energized via the energy source;wherein at least one of: the first electrode is selectively rotatable within the first lumen about the first longitudinal axis to reposition the first electrode into the tissue treatment region to create a second necrotic zone having a second shape upon being energized via the energy source; orthe second electrode is selectively rotatable within the second lumen about the second longitudinal axis to reposition the second electrode into the tissue treatment region to create the second necrotic zone having the second shape upon being energized via the energy source; andwherein the third electrode is configured to remain extendable into the tissue treatment region to positionally secure the electrical ablation apparatus at the tissue treatment region as the at least one of the first electrode or the second electrode are repositioned.
11. The electrical ablation apparatus of claim 10, wherein at least one of the distal end of the first lumen, the distal end of the second lumen, or the distal end of the third lumen comprises a cutting edge.
12. The electrical ablation apparatus of claim 10, wherein at least one of the first electrode, the second electrode, or the third electrode comprises a needle electrode.
13. The electrical ablation apparatus of claim 10, wherein each of the first electrode and the second electrode are pre-formed with a radius to diverge the first electrode from the first longitudinal axis and the second electrode from the second longitudinal axis, respectively.
14. The electrical ablation apparatus of claim 13, wherein the pre-formed radius of the first electrode is different than the pre-formed radius of the second electrode.
15. The electrical ablation apparatus of claim 10, further comprising: a first actuator coupled to the first electrode, wherein the first actuator is configured to independently rotate, independently extend, and independently retract the first electrode relative to the second electrode and the third electrode;a second actuator coupled to the second electrode, wherein the second actuator is configured to independently rotate, independently extend, and independently retract the second electrode relative to the first electrode and the third electrode; anda third actuator coupled to the third electrode, wherein the third actuator is configured to independently extend and independently retract the third electrode relative to the first electrode and the second electrode.
16. The electrical ablation apparatus of claim 10, further comprising: a housing configured to maintain the third lumen in position between the first lumen and the second lumen.
17. An electrical ablation system, comprising: an energy source; andan electrical ablation apparatus, comprising: a plurality of lumens, wherein each lumen comprises a respective distal end and extends along a respective longitudinal axis;a plurality of electrodes, comprising: at least two electrodes configured to be selectively extended outside and selectively retracted inside the respective distal ends of their respective lumens, wherein the at least two electrodes are configured to diverge from the respective longitudinal axes when extended outside the respective distal ends of their respective lumens; andat least one electrode configured to be selectively extended outside and selectively retracted inside the respective distal end of its respective lumen, wherein the at least one electrode is non-rotatable within its respective lumen;wherein the plurality of electrodes are electrically coupled to the energy source, and wherein the plurality of electrodes are extendable into a tissue treatment region to create a first necrotic zone having a first shape upon being energized via the energy source;wherein one or more than one of the at least two electrodes is selectively rotatable within their respective lumens about the respective longitudinal axes to reposition the one or more than one of the at least two electrodes into the tissue treatment region to create a second necrotic zone having a second shape upon being energized via the energy source; andwherein the at least one electrode is configured to remain extendable into the tissue treatment region to positionally secure the electrical ablation apparatus at the tissue treatment region as the one or more than one of the at least two electrodes are repositioned.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application claiming priority under 35 U.S.C. § 120 to U.S. patent application Ser. No. 12/607,252, filed Oct. 28, 2009, entitled ELECTRICAL ABLATION DEVICES, now U.S. Patent Application Publication No. 2011/0098704, the entire disclosure of which is hereby incorporated by reference herein.

US Referenced Citations (2037)

Number	Name	Date	Kind
112794	Felton	Mar 1871	A
645576	Tesla	Mar 1900	A
649621	Tesla	May 1900	A
787412	Tesla	Apr 1905	A
1039354	Bonadio	Sep 1912	A
1127948	Wappler	Feb 1915	A
1330147	Stitzer	Feb 1920	A
1330205	McKeehan	Feb 1920	A
1335331	Gunderson	Mar 1920	A
1440116	Telfer	Dec 1922	A
1482653	Lilly	Feb 1924	A
1581706	White	Apr 1926	A
1581707	White	Apr 1926	A
1581708	White	Apr 1926	A
1581709	White	Apr 1926	A
1581710	White	Apr 1926	A
1625602	Gould	Apr 1927	A
1892018	Stanton	Dec 1932	A
1916722	Ende	Jul 1933	A
2028635	Wappler	Jan 1936	A
2031682	Wappler	Feb 1936	A
2113246	Wappler	Apr 1938	A
2137710	Anderson	Nov 1938	A
2155365	Rankin	Apr 1939	A
2191858	Moore	Feb 1940	A
2196620	Attarian	Apr 1940	A
2303961	Sprague	Dec 1942	A
2330120	Hagelstein	Sep 1943	A
2388137	Graumlich	Oct 1945	A
2409379	Mosaly	Oct 1946	A
2451077	Emsig	Oct 1948	A
2493108	Casey	Jan 1950	A
2504152	Riker	Apr 1950	A
2514698	Herrero	Jul 1950	A
2514951	Herndon	Jul 1950	A
2644210	McNamee	Jul 1953	A
2938382	De Graaf	May 1960	A
2952206	Becksted	Sep 1960	A
3044461	Murdock	Jul 1962	A
3069195	Buck	Dec 1962	A
3070088	Brahos	Dec 1962	A
3110956	Fischer, Jr.	Nov 1963	A
3170471	Schnitzer	Feb 1965	A
3435824	Gamponia	Apr 1969	A
3470876	Barchilon	Oct 1969	A
3481325	Glassman	Dec 1969	A
3543760	Bolduc	Dec 1970	A
3595239	Petersen	Jul 1971	A
3669487	Roberts et al.	Jun 1972	A
3746881	Fitch et al.	Jul 1973	A
3799672	Vurek	Mar 1974	A
3854473	Matsuo	Dec 1974	A
3854743	Hansen	Dec 1974	A
3929123	Jamshidi	Dec 1975	A
3946740	Bassett	Mar 1976	A
3948251	Hosono	Apr 1976	A
3961632	Moossun	Jun 1976	A
3965890	Gauthier	Jun 1976	A
3994301	Agris	Nov 1976	A
4011872	Komiya	Mar 1977	A
4012812	Black	Mar 1977	A
4043342	Morrison, Jr.	Aug 1977	A
4071028	Perkins	Jan 1978	A
4085743	Yoon	Apr 1978	A
4164225	Johnson et al.	Aug 1979	A
4170997	Pinnow et al.	Oct 1979	A
4174715	Hasson	Nov 1979	A
4178920	Cawood, Jr. et al.	Dec 1979	A
4207873	Kruy	Jun 1980	A
4235238	Ogiu et al.	Nov 1980	A
4258716	Sutherland	Mar 1981	A
4269174	Adair	May 1981	A
4278077	Mizumoto	Jul 1981	A
4281646	Kinoshita	Aug 1981	A
4285344	Marshall	Aug 1981	A
4311143	Komiya	Jan 1982	A
4329980	Terada	May 1982	A
4393872	Reznik et al.	Jul 1983	A
4394791	Groth	Jul 1983	A
4396021	Baumgartner	Aug 1983	A
4396139	Hall et al.	Aug 1983	A
4406656	Hattler et al.	Sep 1983	A
4452246	Bader et al.	Jun 1984	A
4461281	Carson	Jul 1984	A
4491132	Aikins	Jan 1985	A
4491135	Klein	Jan 1985	A
4492232	Green	Jan 1985	A
4527331	Lasner et al.	Jul 1985	A
4527564	Eguchi et al.	Jul 1985	A
4538594	Boebel et al.	Sep 1985	A
D281104	Davison	Oct 1985	S
4569347	Frisbie	Feb 1986	A
4580551	Siegmund et al.	Apr 1986	A
4646722	Silverstein et al.	Mar 1987	A
4649904	Krauter et al.	Mar 1987	A
4653476	Bonnet	Mar 1987	A
4655219	Petruzzi	Apr 1987	A
4657016	Garito et al.	Apr 1987	A
4657018	Hakky	Apr 1987	A
4669470	Brandfield	Jun 1987	A
4671477	Cullen	Jun 1987	A
4677982	Llinas et al.	Jul 1987	A
4685447	Iversen et al.	Aug 1987	A
4711239	Sorochenko et al.	Dec 1987	A
4711240	Goldwasser et al.	Dec 1987	A
4712545	Honkanen	Dec 1987	A
4721116	Schintgen et al.	Jan 1988	A
4727600	Avakian	Feb 1988	A
4733662	DeSatnick et al.	Mar 1988	A
D295894	Sharkany et al.	May 1988	S
4742817	Kawashima et al.	May 1988	A
4753223	Bremer	Jun 1988	A
4763669	Jaeger	Aug 1988	A
4770188	Chikama	Sep 1988	A
4790624	Van Hoye et al.	Dec 1988	A
4791707	Tucker	Dec 1988	A
4796627	Tucker	Jan 1989	A
4807593	Ito	Feb 1989	A
4815450	Patel	Mar 1989	A
4819620	Okutsu	Apr 1989	A
4823794	Pierce	Apr 1989	A
4829999	Auth	May 1989	A
4836188	Berry	Jun 1989	A
4846573	Taylor et al.	Jul 1989	A
4867140	Hovis et al.	Sep 1989	A
4869238	Opie et al.	Sep 1989	A
4869459	Bourne	Sep 1989	A
4873979	Hanna	Oct 1989	A
4880015	Nierman	Nov 1989	A
4904048	Sogawa et al.	Feb 1990	A
4911148	Sosnowski et al.	Mar 1990	A
4926860	Stice et al.	May 1990	A
4934364	Green	Jun 1990	A
4938214	Specht et al.	Jul 1990	A
4950273	Briggs	Aug 1990	A
4950285	Wilk	Aug 1990	A
4953539	Nakamura et al.	Sep 1990	A
4960133	Hewson	Oct 1990	A
4977887	Gouda	Dec 1990	A
4979496	Komi	Dec 1990	A
4979950	Transue et al.	Dec 1990	A
4984581	Stice	Jan 1991	A
4990152	Yoon	Feb 1991	A
4991565	Takahashi et al.	Feb 1991	A
4994079	Genese et al.	Feb 1991	A
5007917	Evans	Apr 1991	A
5010876	Henley et al.	Apr 1991	A
5015249	Nakao et al.	May 1991	A
5020514	Heckele	Jun 1991	A
5020535	Parker et al.	Jun 1991	A
5025778	Silverstein et al.	Jun 1991	A
5026379	Yoon	Jun 1991	A
5033169	Bindon	Jul 1991	A
5037433	Wilk et al.	Aug 1991	A
5041129	Hayhurst et al.	Aug 1991	A
5046513	Gatturna et al.	Sep 1991	A
5049153	Nakao et al.	Sep 1991	A
5050585	Takahashi	Sep 1991	A
5052372	Shapiro	Oct 1991	A
5065516	Dulebohn	Nov 1991	A
5066295	Kozak et al.	Nov 1991	A
5098378	Piontek et al.	Mar 1992	A
5099827	Melzer et al.	Mar 1992	A
5108421	Fowler	Apr 1992	A
5123913	Wilk et al.	Jun 1992	A
5123914	Cope	Jun 1992	A
5133727	Bales et al.	Jul 1992	A
5147374	Fernandez	Sep 1992	A
5156151	Imran	Oct 1992	A
5156609	Nakao et al.	Oct 1992	A
5174300	Bales et al.	Dec 1992	A
5176126	Chikama	Jan 1993	A
5190050	Nitzsche	Mar 1993	A
5190555	Wetter et al.	Mar 1993	A
5192284	Pleatman	Mar 1993	A
5192300	Fowler	Mar 1993	A
5197963	Parins	Mar 1993	A
5201752	Brown et al.	Apr 1993	A
5201908	Jones	Apr 1993	A
5203785	Slater	Apr 1993	A
5203787	Noblitt et al.	Apr 1993	A
5209747	Knoepfler	May 1993	A
5217003	Wilk	Jun 1993	A
5217453	Wilk	Jun 1993	A
5219357	Honkanen et al.	Jun 1993	A
5219358	Bendel et al.	Jun 1993	A
5222362	Maus et al.	Jun 1993	A
5222961	Nakao et al.	Jun 1993	A
5222965	Haughton	Jun 1993	A
5224946	Hayhurst et al.	Jul 1993	A
5234437	Sepetka	Aug 1993	A
5234453	Smith et al.	Aug 1993	A
5235964	Abenaim	Aug 1993	A
5242456	Nash et al.	Sep 1993	A
5245460	Allen et al.	Sep 1993	A
5246424	Wilk	Sep 1993	A
5254130	Poncet et al.	Oct 1993	A
5257999	Slanetz, Jr.	Nov 1993	A
5259366	Reydel et al.	Nov 1993	A
5263958	deGuillebon et al.	Nov 1993	A
5273524	Fox et al.	Dec 1993	A
5275607	Lo et al.	Jan 1994	A
5275614	Haber et al.	Jan 1994	A
5275616	Fowler	Jan 1994	A
5284128	Hart	Feb 1994	A
5284162	Wilk	Feb 1994	A
5287845	Faul et al.	Feb 1994	A
5287852	Arkinstall	Feb 1994	A
5290299	Fain et al.	Mar 1994	A
5290302	Pericic	Mar 1994	A
5295977	Cohen et al.	Mar 1994	A
5297536	Wilk	Mar 1994	A
5297687	Freed	Mar 1994	A
5301061	Nakada et al.	Apr 1994	A
5308327	Heaven et al.	May 1994	A
5312023	Green et al.	May 1994	A
5312333	Churinetz et al.	May 1994	A
5312351	Gerrone	May 1994	A
5312416	Spaeth et al.	May 1994	A
5312423	Rosenbluth et al.	May 1994	A
5318589	Lichtman	Jun 1994	A
5320636	Slater	Jun 1994	A
5324261	Amundson et al.	Jun 1994	A
5325845	Adair	Jul 1994	A
5330471	Eggers	Jul 1994	A
5330486	Wilk	Jul 1994	A
5330488	Goldrath	Jul 1994	A
5330496	Alferness	Jul 1994	A
5330502	Hassler et al.	Jul 1994	A
5331971	Bales et al.	Jul 1994	A
5334168	Hemmer	Aug 1994	A
5334198	Hart et al.	Aug 1994	A
5336192	Palestrant	Aug 1994	A
5336222	Durgin, Jr. et al.	Aug 1994	A
5339805	Parker	Aug 1994	A
5341815	Cofone et al.	Aug 1994	A
5342396	Cook	Aug 1994	A
5344428	Griffiths	Sep 1994	A
5345927	Bonutti	Sep 1994	A
5348259	Blanco et al.	Sep 1994	A
5350391	Iacovelli	Sep 1994	A
5352184	Goldberg et al.	Oct 1994	A
5352222	Rydell	Oct 1994	A
5354302	Ko	Oct 1994	A
5354311	Kambin et al.	Oct 1994	A
5356381	Ensminger et al.	Oct 1994	A
5356408	Rydell	Oct 1994	A
5360428	Hutchinson, Jr.	Nov 1994	A
5364408	Gordon	Nov 1994	A
5364410	Failla et al.	Nov 1994	A
5366466	Christian et al.	Nov 1994	A
5366467	Lynch et al.	Nov 1994	A
5368605	Miller, Jr.	Nov 1994	A
5368606	Marlow et al.	Nov 1994	A
5370647	Graber et al.	Dec 1994	A
5370679	Atlee, III	Dec 1994	A
5374273	Nakao et al.	Dec 1994	A
5374275	Bradley et al.	Dec 1994	A
5374277	Hassler	Dec 1994	A
5374953	Sasaki et al.	Dec 1994	A
5376077	Gomringer	Dec 1994	A
5377695	An Haack	Jan 1995	A
5378234	Hammerslag et al.	Jan 1995	A
5383877	Clarke	Jan 1995	A
5383888	Zvenyatsky et al.	Jan 1995	A
5386817	Jones	Feb 1995	A
5387259	Davidson	Feb 1995	A
5391174	Weston	Feb 1995	A
5392789	Slater et al.	Feb 1995	A
5395367	Wilk	Mar 1995	A
5395381	Green et al.	Mar 1995	A
5395386	Slater	Mar 1995	A
5397332	Kammerer et al.	Mar 1995	A
5401248	Bencini	Mar 1995	A
5403311	Abele et al.	Apr 1995	A
5403326	Harrison et al.	Apr 1995	A
5403328	Shallman	Apr 1995	A
5403342	Tovey et al.	Apr 1995	A
5403348	Bonutti	Apr 1995	A
5405073	Porter	Apr 1995	A
5405359	Pierce	Apr 1995	A
5409478	Gerry et al.	Apr 1995	A
5417699	Klein et al.	May 1995	A
5423821	Pasque	Jun 1995	A
5431635	Yoon	Jul 1995	A
5433721	Hooven et al.	Jul 1995	A
5433735	Zanakis et al.	Jul 1995	A
5439471	Kerr	Aug 1995	A
5439478	Palmer	Aug 1995	A
5441059	Dannan	Aug 1995	A
5441494	Ortiz	Aug 1995	A
5441498	Perkins	Aug 1995	A
5441499	Fritzsch	Aug 1995	A
5443463	Stern et al.	Aug 1995	A
5445638	Rydell et al.	Aug 1995	A
5445648	Cook	Aug 1995	A
5449021	Chikama	Sep 1995	A
5454827	Aust et al.	Oct 1995	A
5456667	Ham et al.	Oct 1995	A
5456684	Schmidt et al.	Oct 1995	A
5458131	Wilk	Oct 1995	A
5458583	McNeely et al.	Oct 1995	A
5460168	Masubuchi et al.	Oct 1995	A
5460629	Shlain et al.	Oct 1995	A
5462561	Voda	Oct 1995	A
5465731	Bell et al.	Nov 1995	A
5467763	McMahon et al.	Nov 1995	A
5468250	Paraschac et al.	Nov 1995	A
5470308	Edwards et al.	Nov 1995	A
5470320	Tiefenbrun et al.	Nov 1995	A
5472441	Edwards et al.	Dec 1995	A
5478347	Aranyi	Dec 1995	A
5478352	Fowler	Dec 1995	A
5480404	Kammerer et al.	Jan 1996	A
5482029	Sekiguchi et al.	Jan 1996	A
5482054	Slater et al.	Jan 1996	A
5484451	Akopov et al.	Jan 1996	A
5489256	Adair	Feb 1996	A
5496347	Hashiguchi et al.	Mar 1996	A
5499990	Schulken et al.	Mar 1996	A
5499992	Meade et al.	Mar 1996	A
5499997	Sharpe et al.	Mar 1996	A
5500012	Brucker et al.	Mar 1996	A
5501692	Riza	Mar 1996	A
5503616	Jones	Apr 1996	A
5505686	Willis et al.	Apr 1996	A
5507755	Gresl et al.	Apr 1996	A
5511564	Wilk	Apr 1996	A
5514157	Nicholas et al.	May 1996	A
5518501	Oneda et al.	May 1996	A
5522829	Michalos	Jun 1996	A
5522830	Aranyi	Jun 1996	A
5524633	Heaven et al.	Jun 1996	A
5527321	Hinchliffe	Jun 1996	A
5533418	Wu et al.	Jul 1996	A
5536234	Newman	Jul 1996	A
5536248	Weaver et al.	Jul 1996	A
5538509	Dunlap et al.	Jul 1996	A
5540648	Yoon	Jul 1996	A
5549637	Crainich	Aug 1996	A
5554151	Hinchliffe	Sep 1996	A
5555883	Avitall	Sep 1996	A
5558133	Bortoli et al.	Sep 1996	A
5562693	Devlin et al.	Oct 1996	A
5569243	Kortenbach et al.	Oct 1996	A
5569298	Schnell	Oct 1996	A
5571090	Sherts	Nov 1996	A
5573540	Yoon	Nov 1996	A
5578030	Levin	Nov 1996	A
5582611	Tsuruta et al.	Dec 1996	A
5582617	Klieman et al.	Dec 1996	A
5584845	Hart	Dec 1996	A
5590660	MacAulay et al.	Jan 1997	A
5591179	Edelstein	Jan 1997	A
5591205	Fowler	Jan 1997	A
5593420	Eubanks, Jr. et al.	Jan 1997	A
5595562	Grier	Jan 1997	A
5597378	Jervis	Jan 1997	A
5601573	Fogelberg et al.	Feb 1997	A
5601574	Stefanchik et al.	Feb 1997	A
5601588	Tonomura et al.	Feb 1997	A
5601602	Fowler	Feb 1997	A
5604531	Iddan et al.	Feb 1997	A
5607386	Flam	Mar 1997	A
5607389	Edwards et al.	Mar 1997	A
5607406	Hernandez et al.	Mar 1997	A
5607450	Zvenyatsky et al.	Mar 1997	A
5609601	Kolesa et al.	Mar 1997	A
5613975	Christy	Mar 1997	A
5613977	Weber et al.	Mar 1997	A
5614943	Nakamura et al.	Mar 1997	A
5616117	Dinkler et al.	Apr 1997	A
5618303	Marlow et al.	Apr 1997	A
5620415	Lucey et al.	Apr 1997	A
5624399	Ackerman	Apr 1997	A
5624431	Gerry et al.	Apr 1997	A
5626578	Tihon	May 1997	A
5626587	Bishop et al.	May 1997	A
5628732	Antoon, Jr. et al.	May 1997	A
5630782	Adair	May 1997	A
5630795	Kuramoto et al.	May 1997	A
5643283	Younker	Jul 1997	A
5643292	Hart	Jul 1997	A
5643294	Tovey et al.	Jul 1997	A
5644798	Shah	Jul 1997	A
5645083	Essig et al.	Jul 1997	A
5645519	Lee et al.	Jul 1997	A
5645565	Rudd et al.	Jul 1997	A
5649372	Souza	Jul 1997	A
5653677	Okada et al.	Aug 1997	A
5653690	Booth et al.	Aug 1997	A
5653722	Kieturakis	Aug 1997	A
5657755	Desai	Aug 1997	A
5662621	Lafontaine	Sep 1997	A
5662663	Shallman	Sep 1997	A
5665096	Yoon	Sep 1997	A
5665100	Yoon	Sep 1997	A
5667527	Cook	Sep 1997	A
5669875	van Eerdenburg	Sep 1997	A
5681276	Lundquist	Oct 1997	A
5681279	Roper et al.	Oct 1997	A
5681324	Kammerer et al.	Oct 1997	A
5681330	Hughett et al.	Oct 1997	A
5685820	Riek et al.	Nov 1997	A
5688269	Newton et al.	Nov 1997	A
5690606	Slotman	Nov 1997	A
5690656	Cope et al.	Nov 1997	A
5690660	Kauker et al.	Nov 1997	A
5695448	Kimura et al.	Dec 1997	A
5695505	Yoon	Dec 1997	A
5695511	Cano et al.	Dec 1997	A
5700275	Bell et al.	Dec 1997	A
5702438	Avitall	Dec 1997	A
5704892	Adair	Jan 1998	A
5709708	Thal	Jan 1998	A
5711921	Langford	Jan 1998	A
5716326	Dannan	Feb 1998	A
5716375	Fowler	Feb 1998	A
5725542	Yoon	Mar 1998	A
5728094	Edwards	Mar 1998	A
5730740	Wales et al.	Mar 1998	A
5735849	Baden et al.	Apr 1998	A
5741234	Aboul-Hosn	Apr 1998	A
5741278	Stevens	Apr 1998	A
5741285	McBrayer et al.	Apr 1998	A
5741429	Donadio, III et al.	Apr 1998	A
5743456	Jones et al.	Apr 1998	A
5746759	Meade et al.	May 1998	A
5749826	Faulkner	May 1998	A
5749881	Sackier et al.	May 1998	A
5749889	Bacich et al.	May 1998	A
5752951	Yanik	May 1998	A
5755731	Grinberg	May 1998	A
5759150	Konou et al.	Jun 1998	A
5759151	Sturges	Jun 1998	A
5762604	Kieturakis	Jun 1998	A
5766167	Eggers et al.	Jun 1998	A
5766170	Eggers	Jun 1998	A
5766205	Zvenyatsky et al.	Jun 1998	A
5769849	Eggers	Jun 1998	A
5776188	Shepherd et al.	Jul 1998	A
5779701	McBrayer et al.	Jul 1998	A
5779716	Cano et al.	Jul 1998	A
5779720	Walder-Utz et al.	Jul 1998	A
5779727	Orejola	Jul 1998	A
5782748	Palmer et al.	Jul 1998	A
5782859	Nicholas et al.	Jul 1998	A
5782861	Cragg et al.	Jul 1998	A
5782866	Wenstrom, Jr.	Jul 1998	A
5791022	Bohman	Aug 1998	A
5792113	Kramer et al.	Aug 1998	A
5792153	Swain et al.	Aug 1998	A
5792165	Klieman et al.	Aug 1998	A
5797835	Green	Aug 1998	A
5797928	Kogasaka	Aug 1998	A
5797939	Yoon	Aug 1998	A
5797941	Schulze et al.	Aug 1998	A
5797959	Castro et al.	Aug 1998	A
5797960	Stevens et al.	Aug 1998	A
5800449	Wales	Sep 1998	A
5800451	Buess et al.	Sep 1998	A
5803903	Athas et al.	Sep 1998	A
5807395	Mulier et al.	Sep 1998	A
5808665	Green	Sep 1998	A
5810805	Sutcu et al.	Sep 1998	A
5810806	Ritchart et al.	Sep 1998	A
5810849	Kontos	Sep 1998	A
5810865	Koscher et al.	Sep 1998	A
5810876	Kelleher	Sep 1998	A
5810877	Roth et al.	Sep 1998	A
5813976	Filipi et al.	Sep 1998	A
5814026	Yoon	Sep 1998	A
5814058	Carlson et al.	Sep 1998	A
5817061	Goodwin et al.	Oct 1998	A
5817107	Schaller	Oct 1998	A
5817108	Poncet	Oct 1998	A
5817119	Klieman et al.	Oct 1998	A
5818527	Yamaguchi et al.	Oct 1998	A
5819736	Avny et al.	Oct 1998	A
5823947	Yoon et al.	Oct 1998	A
5824071	Nelson et al.	Oct 1998	A
5827190	Palcic et al.	Oct 1998	A
5827276	LeVeen et al.	Oct 1998	A
5827281	Levin	Oct 1998	A
5827299	Thomason et al.	Oct 1998	A
5827323	Klieman et al.	Oct 1998	A
5830221	Stein et al.	Nov 1998	A
5830231	Geiges, Jr.	Nov 1998	A
5833603	Kovacs et al.	Nov 1998	A
5833700	Fogelberg et al.	Nov 1998	A
5833703	Manushakian	Nov 1998	A
5833715	Vachon et al.	Nov 1998	A
5836960	Kolesa et al.	Nov 1998	A
5843017	Yoon	Dec 1998	A
5843097	Mayenberger et al.	Dec 1998	A
5843121	Yoon	Dec 1998	A
5843156	Slepian et al.	Dec 1998	A
5848986	Lundquist et al.	Dec 1998	A
5849022	Sakashita et al.	Dec 1998	A
5853374	Hart et al.	Dec 1998	A
5855569	Komi	Jan 1999	A
5855585	Kontos	Jan 1999	A
5860913	Yamaya et al.	Jan 1999	A
5860995	Berkelaar	Jan 1999	A
5868762	Cragg et al.	Feb 1999	A
5873849	Bernard	Feb 1999	A
5876411	Kontos	Mar 1999	A
5882331	Sasaki	Mar 1999	A
5882344	Stouder, Jr.	Mar 1999	A
5885280	Nettekoven et al.	Mar 1999	A
5893846	Bales et al.	Apr 1999	A
5893874	Bourque et al.	Apr 1999	A
5893875	O'Connor et al.	Apr 1999	A
5897487	Ouchi	Apr 1999	A
5899919	Eubanks, Jr. et al.	May 1999	A
5902238	Golden et al.	May 1999	A
5902254	Magram	May 1999	A
5904702	Ek et al.	May 1999	A
5906625	Bito et al.	May 1999	A
5908420	Parins et al.	Jun 1999	A
5908429	Yoon	Jun 1999	A
5911737	Lee et al.	Jun 1999	A
5916146	Allotta et al.	Jun 1999	A
5916147	Boury	Jun 1999	A
5919207	Taheri	Jul 1999	A
5921892	Easton	Jul 1999	A
5921993	Yoon	Jul 1999	A
5921997	Fogelberg et al.	Jul 1999	A
5922008	Gimpelson	Jul 1999	A
5925052	Simmons	Jul 1999	A
5928255	Meade et al.	Jul 1999	A
5928266	Kontos	Jul 1999	A
5936536	Morris	Aug 1999	A
5938661	Hahnen	Aug 1999	A
5938668	Scirica et al.	Aug 1999	A
5941815	Chang	Aug 1999	A
5944718	Austin et al.	Aug 1999	A
5951547	Gough et al.	Sep 1999	A
5951549	Richardson et al.	Sep 1999	A
5954720	Wilson et al.	Sep 1999	A
5954731	Yoon	Sep 1999	A
5957936	Yoon et al.	Sep 1999	A
5957943	Vaitekunas	Sep 1999	A
5957953	DiPoto et al.	Sep 1999	A
5964782	Lafontaine et al.	Oct 1999	A
5970581	Chadwick et al.	Oct 1999	A
5971995	Rousseau	Oct 1999	A
5972002	Bark et al.	Oct 1999	A
5976074	Moriyama	Nov 1999	A
5976075	Beane et al.	Nov 1999	A
5976130	McBrayer et al.	Nov 1999	A
5976131	Guglielmi et al.	Nov 1999	A
5980539	Kontos	Nov 1999	A
5980556	Giordano et al.	Nov 1999	A
5984933	Yoon	Nov 1999	A
5984938	Yoon	Nov 1999	A
5984939	Yoon	Nov 1999	A
5984950	Cragg et al.	Nov 1999	A
5989182	Hori et al.	Nov 1999	A
5993447	Blewett et al.	Nov 1999	A
5993474	Ouchi	Nov 1999	A
5995875	Blewett et al.	Nov 1999	A
5997555	Kontos	Dec 1999	A
6001120	Levin	Dec 1999	A
6004269	Crowley et al.	Dec 1999	A
6004330	Middleman et al.	Dec 1999	A
6007566	Wenstrom, Jr.	Dec 1999	A
6010515	Swain et al.	Jan 2000	A
6012494	Balazs	Jan 2000	A
6016452	Kasevich	Jan 2000	A
6017356	Frederick et al.	Jan 2000	A
6019770	Christoudias	Feb 2000	A
6024708	Bales et al.	Feb 2000	A
6024747	Kontos	Feb 2000	A
6027522	Palmer	Feb 2000	A
6030365	Laufer	Feb 2000	A
6030384	Nezhat	Feb 2000	A
6030634	Wu et al.	Feb 2000	A
6033399	Gines	Mar 2000	A
6033401	Edwards et al.	Mar 2000	A
6036640	Corace et al.	Mar 2000	A
6036685	Mueller	Mar 2000	A
6050992	Nichols	Apr 2000	A
6053927	Hamas	Apr 2000	A
6053937	Edwards et al.	Apr 2000	A
6059719	Yamamoto et al.	May 2000	A
6066090	Yoon	May 2000	A
6066160	Colvin et al.	May 2000	A
6068603	Suzuki	May 2000	A
6068629	Haissaguerre et al.	May 2000	A
6071233	Ishikawa et al.	Jun 2000	A
6074408	Freeman	Jun 2000	A
6086530	Mack	Jul 2000	A
6086600	Kortenbach	Jul 2000	A
6090105	Zepeda et al.	Jul 2000	A
6090107	Borgmeier et al.	Jul 2000	A
6090108	McBrayer et al.	Jul 2000	A
6090129	Ouchi	Jul 2000	A
6096046	Weiss	Aug 2000	A
6102909	Chen et al.	Aug 2000	A
6102926	Tartaglia et al.	Aug 2000	A
6106473	Violante et al.	Aug 2000	A
6106521	Blewett et al.	Aug 2000	A
6109852	Shahinpoor et al.	Aug 2000	A
6110154	Shimomura et al.	Aug 2000	A
6110183	Cope	Aug 2000	A
6113593	Tu et al.	Sep 2000	A
6117144	Nobles et al.	Sep 2000	A
6117158	Measamer et al.	Sep 2000	A
6123718	Tu et al.	Sep 2000	A
6131790	Piraka	Oct 2000	A
6139555	Hart et al.	Oct 2000	A
6139562	Mauze et al.	Oct 2000	A
6141037	Upton et al.	Oct 2000	A
6146391	Cigaina	Nov 2000	A
6148222	Ramsey, III	Nov 2000	A
6149653	Deslauriers	Nov 2000	A
6149662	Pugliesi et al.	Nov 2000	A
6152871	Foley et al.	Nov 2000	A
6152920	Thompson et al.	Nov 2000	A
6156006	Brosens et al.	Dec 2000	A
6159200	Verdura et al.	Dec 2000	A
6165175	Wampler et al.	Dec 2000	A
6165184	Verdura et al.	Dec 2000	A
6167297	Benaron	Dec 2000	A
6168570	Ferrera	Jan 2001	B1
6168605	Measamer et al.	Jan 2001	B1
6169269	Maynard	Jan 2001	B1
6170130	Hamilton et al.	Jan 2001	B1
6173872	Cohen	Jan 2001	B1
6179776	Adams et al.	Jan 2001	B1
6179832	Jones et al.	Jan 2001	B1
6179837	Hooven	Jan 2001	B1
6183420	Douk et al.	Feb 2001	B1
6183469	Thapliyal et al.	Feb 2001	B1
6190353	Makower et al.	Feb 2001	B1
6190383	Schmaltz et al.	Feb 2001	B1
6190384	Ouchi	Feb 2001	B1
6190399	Palmer et al.	Feb 2001	B1
6203533	Ouchi	Mar 2001	B1
6206872	Lafond et al.	Mar 2001	B1
6206877	Kese et al.	Mar 2001	B1
6206904	Ouchi	Mar 2001	B1
6210409	Ellman et al.	Apr 2001	B1
6214007	Anderson	Apr 2001	B1
6214028	Yoon et al.	Apr 2001	B1
6216043	Swanson et al.	Apr 2001	B1
6228096	Marchand	May 2001	B1
6231506	Hu et al.	May 2001	B1
6234958	Snoke et al.	May 2001	B1
6240312	Alfano et al.	May 2001	B1
6245079	Nobles et al.	Jun 2001	B1
6246914	de la Rama et al.	Jun 2001	B1
6248124	Pedros et al.	Jun 2001	B1
6258064	Smith et al.	Jul 2001	B1
6261242	Roberts et al.	Jul 2001	B1
6264664	Avellanet	Jul 2001	B1
6270497	Sekino et al.	Aug 2001	B1
6270505	Yoshida et al.	Aug 2001	B1
6277136	Bonutti	Aug 2001	B1
6280379	Resnick	Aug 2001	B1
6283963	Regula	Sep 2001	B1
6287304	Eggers et al.	Sep 2001	B1
6293909	Chu et al.	Sep 2001	B1
6293952	Brosens et al.	Sep 2001	B1
6296630	Altman et al.	Oct 2001	B1
6306131	Hareyama et al.	Oct 2001	B1
6306159	Schwartz et al.	Oct 2001	B1
6314963	Vaska et al.	Nov 2001	B1
6322578	Houle et al.	Nov 2001	B1
6325534	Hawley et al.	Dec 2001	B1
6326177	Schoenbach et al.	Dec 2001	B1
6328730	Harkrider, Jr.	Dec 2001	B1
6346092	Leschinsky	Feb 2002	B1
6350267	Stefanchik	Feb 2002	B1
6350269	Shipp et al.	Feb 2002	B1
6350278	Lenker et al.	Feb 2002	B1
6352503	Matsui et al.	Mar 2002	B1
6352541	Kienzle et al.	Mar 2002	B1
6352543	Cole	Mar 2002	B1
6355013	van Muiden	Mar 2002	B1
6355035	Manushakian	Mar 2002	B1
6361534	Chen et al.	Mar 2002	B1
6364879	Chen et al.	Apr 2002	B1
6368340	Malecki et al.	Apr 2002	B2
6371956	Wilson et al.	Apr 2002	B1
6379366	Fleischman et al.	Apr 2002	B1
6383195	Richard	May 2002	B1
6383197	Conlon et al.	May 2002	B1
6387671	Rubinsky et al.	May 2002	B1
6391029	Hooven et al.	May 2002	B1
6398708	Hastings et al.	Jun 2002	B1
6402735	Langevin	Jun 2002	B1
6402746	Whayne et al.	Jun 2002	B1
6406440	Stefanchik	Jun 2002	B1
6409727	Bales et al.	Jun 2002	B1
6409733	Conlon et al.	Jun 2002	B1
6419639	Walther et al.	Jul 2002	B2
6419641	Mark et al.	Jul 2002	B1
6427089	Knowlton	Jul 2002	B1
6431500	Jacobs et al.	Aug 2002	B1
6436107	Wang et al.	Aug 2002	B1
6443970	Schulze et al.	Sep 2002	B1
6443988	Felt et al.	Sep 2002	B2
6447444	Avni et al.	Sep 2002	B1
6447511	Slater	Sep 2002	B1
6447523	Middleman et al.	Sep 2002	B1
6454783	Piskun	Sep 2002	B1
6454785	De Hoyos Garza	Sep 2002	B2
6458074	Matsui et al.	Oct 2002	B1
6458076	Pruitt	Oct 2002	B1
6464701	Hooven et al.	Oct 2002	B1
6464702	Schulze et al.	Oct 2002	B2
6470218	Behl	Oct 2002	B1
6475104	Lutz et al.	Nov 2002	B1
6485411	Konstorum et al.	Nov 2002	B1
6489745	Koreis	Dec 2002	B1
6491626	Stone et al.	Dec 2002	B1
6491627	Komi	Dec 2002	B1
6491691	Morley et al.	Dec 2002	B1
6493590	Wessman et al.	Dec 2002	B1
6494893	Dubrul et al.	Dec 2002	B2
6500176	Truckai et al.	Dec 2002	B1
6503192	Ouchi	Jan 2003	B1
6506190	Walshe	Jan 2003	B1
6508827	Manhes	Jan 2003	B1
6514239	Shimmura et al.	Feb 2003	B2
6516500	Ogino et al.	Feb 2003	B2
6517534	McGovern et al.	Feb 2003	B1
6520954	Ouchi	Feb 2003	B2
6526320	Mitchell	Feb 2003	B2
6527753	Sekine et al.	Mar 2003	B2
6527782	Hogg et al.	Mar 2003	B2
6530880	Pagliuca	Mar 2003	B2
6530922	Cosman et al.	Mar 2003	B2
6535764	Imran et al.	Mar 2003	B2
6537200	Leysieffer et al.	Mar 2003	B2
6543456	Freeman	Apr 2003	B1
6551270	Bimbo et al.	Apr 2003	B1
6551356	Rousseau	Apr 2003	B2
6554766	Maeda et al.	Apr 2003	B2
6554823	Palmer et al.	Apr 2003	B2
6554829	Schulze et al.	Apr 2003	B2
6558384	Mayenberger	May 2003	B2
6562034	Edwards et al.	May 2003	B2
6562035	Levin	May 2003	B1
6562052	Nobles et al.	May 2003	B2
6569085	Kortenbach et al.	May 2003	B2
6569091	Diokno et al.	May 2003	B2
6569120	Green et al.	May 2003	B1
6569159	Edwards et al.	May 2003	B1
6572629	Kalloo et al.	Jun 2003	B2
6572635	Bonutti	Jun 2003	B1
6575988	Rousseau	Jun 2003	B2
6579311	Makower	Jun 2003	B1
6581889	Carpenter et al.	Jun 2003	B2
6585642	Christopher	Jul 2003	B2
6585717	Wittenberger et al.	Jul 2003	B1
6587750	Gerbi et al.	Jul 2003	B2
6592559	Pakter et al.	Jul 2003	B1
6592603	Lasner	Jul 2003	B2
6594971	Addy et al.	Jul 2003	B1
6602262	Griego et al.	Aug 2003	B2
6605105	Cuschieri et al.	Aug 2003	B1
6607529	Jones et al.	Aug 2003	B1
6610072	Christy et al.	Aug 2003	B1
6610074	Santilli	Aug 2003	B2
6613038	Bonutti et al.	Sep 2003	B2
6613068	Ouchi	Sep 2003	B2
6616632	Sharp et al.	Sep 2003	B2
6620193	Lau et al.	Sep 2003	B1
6623448	Slater	Sep 2003	B2
6626919	Swanstrom	Sep 2003	B1
6632171	Iddan et al.	Oct 2003	B2
6632229	Yamanouchi	Oct 2003	B1
6632234	Kieturakis et al.	Oct 2003	B2
6638275	McGaffigan et al.	Oct 2003	B1
6638286	Burbank et al.	Oct 2003	B1
6645225	Atkinson	Nov 2003	B1
6652518	Wellman et al.	Nov 2003	B2
6652521	Schulze	Nov 2003	B2
6652545	Shipp et al.	Nov 2003	B2
6652551	Heiss	Nov 2003	B1
6656194	Gannoe et al.	Dec 2003	B1
6662035	Sochor	Dec 2003	B2
6663641	Kovac et al.	Dec 2003	B1
6663655	Ginn et al.	Dec 2003	B2
6666854	Lange	Dec 2003	B1
6672338	Esashi et al.	Jan 2004	B1
6673058	Snow	Jan 2004	B2
6673070	Edwards et al.	Jan 2004	B2
6673087	Chang et al.	Jan 2004	B1
6673092	Bacher	Jan 2004	B1
6676685	Pedros et al.	Jan 2004	B2
6679882	Kornerup	Jan 2004	B1
6684938	Tsujita et al.	Feb 2004	B2
6685628	Vu	Feb 2004	B2
6685724	Haluck	Feb 2004	B1
6692445	Roberts et al.	Feb 2004	B2
6692462	Mackenzie et al.	Feb 2004	B2
6692493	McGovern et al.	Feb 2004	B2
6695867	Ginn et al.	Feb 2004	B2
6699180	Kobayashi	Mar 2004	B2
6699256	Logan et al.	Mar 2004	B1
6699263	Cope	Mar 2004	B2
6706018	Westlund et al.	Mar 2004	B2
6708066	Herbst et al.	Mar 2004	B2
6709188	Ushimaru	Mar 2004	B2
6709445	Boebel et al.	Mar 2004	B2
6716226	Sixto, Jr. et al.	Apr 2004	B2
6731875	Kartalopoulos	May 2004	B1
6736822	McClellan et al.	May 2004	B2
6740030	Martone et al.	May 2004	B2
6740082	Shadduck	May 2004	B2
6743166	Berci et al.	Jun 2004	B2
6743226	Cosman et al.	Jun 2004	B2
6743239	Kuehn et al.	Jun 2004	B1
6743240	Smith et al.	Jun 2004	B2
6749560	Konstorum et al.	Jun 2004	B1
6749609	Lunsford et al.	Jun 2004	B1
6752768	Burdorff et al.	Jun 2004	B2
6752811	Chu et al.	Jun 2004	B2
6752822	Jespersen	Jun 2004	B2
6758857	Cioanta et al.	Jul 2004	B2
6761685	Adams et al.	Jul 2004	B2
6761718	Madsen	Jul 2004	B2
6761722	Cole et al.	Jul 2004	B2
6767352	Field et al.	Jul 2004	B2
6767356	Kanner et al.	Jul 2004	B2
6773434	Ciarrocca	Aug 2004	B2
6776165	Jin	Aug 2004	B2
6776787	Phung et al.	Aug 2004	B2
6780151	Grabover et al.	Aug 2004	B2
6780352	Jacobson	Aug 2004	B2
6783491	Saadat et al.	Aug 2004	B2
6786382	Hoffman	Sep 2004	B1
6786864	Matsuura et al.	Sep 2004	B2
6786905	Swanson et al.	Sep 2004	B2
6788977	Fenn et al.	Sep 2004	B2
6790173	Saadat et al.	Sep 2004	B2
6790217	Schulze et al.	Sep 2004	B2
6795728	Chornenky et al.	Sep 2004	B2
6800056	Tartaglia et al.	Oct 2004	B2
6808491	Kortenbach et al.	Oct 2004	B2
6814697	Ouchi	Nov 2004	B2
6814739	Secrest et al.	Nov 2004	B2
6817974	Cooper et al.	Nov 2004	B2
6818007	Dampney et al.	Nov 2004	B1
6821285	Laufer et al.	Nov 2004	B2
6824548	Smith et al.	Nov 2004	B2
6830545	Bendall	Dec 2004	B2
6830578	O'Heeron et al.	Dec 2004	B2
6835200	Laufer et al.	Dec 2004	B2
6836688	Ingle et al.	Dec 2004	B2
6837847	Ewers et al.	Jan 2005	B2
6840246	Downing	Jan 2005	B2
6840938	Morley et al.	Jan 2005	B1
6843794	Sixto, Jr. et al.	Jan 2005	B2
6852078	Ouchi	Feb 2005	B2
6861250	Cole et al.	Mar 2005	B1
6866627	Nozue	Mar 2005	B2
6866628	Goodman et al.	Mar 2005	B2
6869394	Ishibiki	Mar 2005	B2
6869395	Page et al.	Mar 2005	B2
6869398	Obenchain et al.	Mar 2005	B2
6878106	Herrmann	Apr 2005	B1
6878110	Yang et al.	Apr 2005	B2
6881213	Ryan et al.	Apr 2005	B2
6881216	Di Caprio et al.	Apr 2005	B2
6884213	Raz et al.	Apr 2005	B2
6887255	Shimm	May 2005	B2
6889089	Behl et al.	May 2005	B2
6890295	Michels et al.	May 2005	B2
6896683	Gadberry et al.	May 2005	B1
6896692	Ginn et al.	May 2005	B2
6899710	Hooven	May 2005	B2
6908427	Fleener et al.	Jun 2005	B2
6908476	Jud et al.	Jun 2005	B2
6911019	Mulier et al.	Jun 2005	B2
6913613	Schwarz et al.	Jul 2005	B2
6916284	Moriyama	Jul 2005	B2
6918871	Schulze	Jul 2005	B2
6918906	Long	Jul 2005	B2
6918908	Bonner et al.	Jul 2005	B2
6921408	Sauer	Jul 2005	B2
6926723	Mulhauser et al.	Aug 2005	B1
6926725	Cooke et al.	Aug 2005	B2
6932810	Ryan	Aug 2005	B2
6932824	Roop et al.	Aug 2005	B1
6932827	Cole	Aug 2005	B2
6932834	Lizardi et al.	Aug 2005	B2
6936003	Iddan	Aug 2005	B2
6939290	Iddan	Sep 2005	B2
6939292	Mizuno	Sep 2005	B2
6939327	Hall et al.	Sep 2005	B2
6939347	Thompson	Sep 2005	B2
6942613	Ewers et al.	Sep 2005	B2
6944490	Chow	Sep 2005	B1
6945472	Wuttke et al.	Sep 2005	B2
6945979	Kortenbach et al.	Sep 2005	B2
6949096	Davison et al.	Sep 2005	B2
6949105	Bryan et al.	Sep 2005	B2
6955641	Lubock	Oct 2005	B2
6955683	Bonutti	Oct 2005	B2
6958035	Friedman et al.	Oct 2005	B2
6960162	Saadat et al.	Nov 2005	B2
6960163	Ewers et al.	Nov 2005	B2
6960183	Nicolette	Nov 2005	B2
6962587	Johnson et al.	Nov 2005	B2
6964662	Kidooka	Nov 2005	B2
6966909	Marshall et al.	Nov 2005	B2
6966919	Sixto, Jr. et al.	Nov 2005	B2
6967462	Landis	Nov 2005	B1
6971988	Orban, III	Dec 2005	B2
6972017	Smith et al.	Dec 2005	B2
6974411	Belson	Dec 2005	B2
6976992	Sachatello et al.	Dec 2005	B2
6980854	Bernabei	Dec 2005	B2
6980858	Fuimaono et al.	Dec 2005	B2
6984203	Tartaglia et al.	Jan 2006	B2
6984205	Gazdzinski	Jan 2006	B2
6986738	Glukhovsky et al.	Jan 2006	B2
6986774	Middleman et al.	Jan 2006	B2
6988987	Ishikawa et al.	Jan 2006	B2
6989028	Lashinski et al.	Jan 2006	B2
6991602	Nakazawa et al.	Jan 2006	B2
6991627	Madhani et al.	Jan 2006	B2
6991631	Woloszko et al.	Jan 2006	B2
6994705	Nobis et al.	Feb 2006	B2
6994706	Chornenky et al.	Feb 2006	B2
6994708	Manzo	Feb 2006	B2
6997870	Couvillon, Jr.	Feb 2006	B2
6997931	Sauer et al.	Feb 2006	B2
7000818	Shelton, IV et al.	Feb 2006	B2
7001329	Kobayashi et al.	Feb 2006	B2
7001341	Gellman et al.	Feb 2006	B2
7004957	Dampney et al.	Feb 2006	B1
7008375	Weisel	Mar 2006	B2
7008419	Shadduck	Mar 2006	B2
7009634	Iddan et al.	Mar 2006	B2
7010340	Scarantino et al.	Mar 2006	B2
7011669	Kimblad	Mar 2006	B2
7018373	Suzuki	Mar 2006	B2
7020531	Colliou et al.	Mar 2006	B1
7025580	Heagy et al.	Apr 2006	B2
7025721	Cohen et al.	Apr 2006	B2
7029435	Nakao	Apr 2006	B2
7029438	Morin et al.	Apr 2006	B2
7029450	Gellman	Apr 2006	B2
7032600	Fukuda et al.	Apr 2006	B2
7035680	Partridge et al.	Apr 2006	B2
7037290	Gardeski et al.	May 2006	B2
7041052	Saadat et al.	May 2006	B2
7052454	Taylor	May 2006	B2
7052489	Griego et al.	May 2006	B2
7056330	Gayton	Jun 2006	B2
7060024	Long et al.	Jun 2006	B2
7060025	Long et al.	Jun 2006	B2
7063697	Slater	Jun 2006	B2
7063715	Onuki et al.	Jun 2006	B2
7066879	Fowler et al.	Jun 2006	B2
7066936	Ryan	Jun 2006	B2
7070559	Adams et al.	Jul 2006	B2
7070602	Smith et al.	Jul 2006	B2
7076305	Imran et al.	Jul 2006	B2
7083618	Couture et al.	Aug 2006	B2
7083620	Jahns et al.	Aug 2006	B2
7083629	Weller et al.	Aug 2006	B2
7083635	Ginn	Aug 2006	B2
7087010	Ootawara et al.	Aug 2006	B2
7087071	Nicholas et al.	Aug 2006	B2
7088923	Haruyama	Aug 2006	B2
7090673	Dycus et al.	Aug 2006	B2
7090683	Brock et al.	Aug 2006	B2
7090685	Kortenbach et al.	Aug 2006	B2
7093518	Gmeilbauer	Aug 2006	B2
7101371	Dycus et al.	Sep 2006	B2
7101372	Dycus et al.	Sep 2006	B2
7101373	Dycus et al.	Sep 2006	B2
7105000	McBrayer	Sep 2006	B2
7105005	Blake	Sep 2006	B2
7108696	Daniel et al.	Sep 2006	B2
7108703	Danitz et al.	Sep 2006	B2
7112208	Morris et al.	Sep 2006	B2
7115092	Park et al.	Oct 2006	B2
7115124	Xiao	Oct 2006	B1
7115785	Guggenheim et al.	Oct 2006	B2
7117703	Kato et al.	Oct 2006	B2
7118531	Krill	Oct 2006	B2
7118578	West, Jr. et al.	Oct 2006	B2
7118587	Dycus et al.	Oct 2006	B2
7122605	Ohrbom et al.	Oct 2006	B2
7128708	Saadat et al.	Oct 2006	B2
7130697	Chornenky et al.	Oct 2006	B2
RE39415	Bales et al.	Nov 2006	E
7131978	Sancoff et al.	Nov 2006	B2
7131979	DiCarlo et al.	Nov 2006	B2
7131980	Field et al.	Nov 2006	B1
7137980	Buysse et al.	Nov 2006	B2
7137981	Long	Nov 2006	B2
7146984	Stack et al.	Dec 2006	B2
7147650	Lee	Dec 2006	B2
7150097	Sremcich et al.	Dec 2006	B2
7150655	Mastrototaro et al.	Dec 2006	B2
7150713	Shener et al.	Dec 2006	B2
7150750	Damarati	Dec 2006	B2
7152488	Hedrich et al.	Dec 2006	B2
7153321	Andrews	Dec 2006	B2
7156845	Mulier et al.	Jan 2007	B2
7160296	Pearson et al.	Jan 2007	B2
7163525	Franer	Jan 2007	B2
7169104	Ueda et al.	Jan 2007	B2
7169115	Nobis et al.	Jan 2007	B2
7172714	Jacobson	Feb 2007	B2
7175591	Kaladelfos	Feb 2007	B2
7179254	Pendekanti et al.	Feb 2007	B2
7179262	Bryan et al.	Feb 2007	B2
7186265	Sharkawy et al.	Mar 2007	B2
7188627	Nelson et al.	Mar 2007	B2
7189231	Clague et al.	Mar 2007	B2
7195612	van Sloten et al.	Mar 2007	B2
7195631	Dumbauld	Mar 2007	B2
7204804	Zirps et al.	Apr 2007	B2
7204820	Akahoshi	Apr 2007	B2
7204840	Skakoon et al.	Apr 2007	B2
7207997	Shipp et al.	Apr 2007	B2
7208005	Frecker et al.	Apr 2007	B2
7211089	Kear et al.	May 2007	B2
7211092	Hughett	May 2007	B2
7220227	Sasaki et al.	May 2007	B2
7223271	Muramatsu et al.	May 2007	B2
7223272	Francese et al.	May 2007	B2
7226458	Kaplan et al.	Jun 2007	B2
7229438	Young	Jun 2007	B2
7232414	Gonzalez	Jun 2007	B2
7232445	Kortenbach et al.	Jun 2007	B2
7235084	Skakoon et al.	Jun 2007	B2
7235089	McGuckin, Jr.	Jun 2007	B1
7241290	Doyle et al.	Jul 2007	B2
7241295	Maguire	Jul 2007	B2
7244228	Lubowski	Jul 2007	B2
7250027	Barry	Jul 2007	B2
7252660	Kunz	Aug 2007	B2
7255675	Gertner et al.	Aug 2007	B2
7261725	Binmoeller	Aug 2007	B2
7261728	Long et al.	Aug 2007	B2
7270663	Nakao	Sep 2007	B2
7278179	Schneider	Oct 2007	B2
7288075	Parihar et al.	Oct 2007	B2
7290615	Christanti et al.	Nov 2007	B2
7291127	Eidenschink	Nov 2007	B2
7294139	Gengler	Nov 2007	B1
7301250	Cassel	Nov 2007	B2
7306597	Manzo	Dec 2007	B2
7308828	Hashimoto	Dec 2007	B2
7311107	Harel et al.	Dec 2007	B2
7318802	Suzuki et al.	Jan 2008	B2
7320695	Carroll	Jan 2008	B2
7322934	Miyake et al.	Jan 2008	B2
7323006	Andreas et al.	Jan 2008	B2
7329256	Johnson et al.	Feb 2008	B2
7329257	Kanehira et al.	Feb 2008	B2
7329383	Stinson	Feb 2008	B2
7331968	Arp et al.	Feb 2008	B2
7335220	Khosravi et al.	Feb 2008	B2
7338513	Lee et al.	Mar 2008	B2
7341554	Sekine et al.	Mar 2008	B2
7344536	Lunsford et al.	Mar 2008	B1
7349223	Haemer et al.	Mar 2008	B2
7352387	Yamamoto	Apr 2008	B2
7357802	Palanker et al.	Apr 2008	B2
7357806	Rivera et al.	Apr 2008	B2
7364582	Lee	Apr 2008	B2
7367939	Smith et al.	May 2008	B2
7371215	Colliou et al.	May 2008	B2
7381216	Buzzard et al.	Jun 2008	B2
7390324	Whalen et al.	Jun 2008	B2
7393322	Wenchell	Jul 2008	B2
7402162	Ouchi	Jul 2008	B2
7404791	Linares et al.	Jul 2008	B2
7410483	Danitz et al.	Aug 2008	B2
7413563	Corcoran et al.	Aug 2008	B2
7416554	Lam et al.	Aug 2008	B2
7422590	Kupferschmid et al.	Sep 2008	B2
7431694	Stefanchik et al.	Oct 2008	B2
7435229	Wolf	Oct 2008	B2
7435257	Lashinski et al.	Oct 2008	B2
7441507	Teraura et al.	Oct 2008	B2
7442166	Huang et al.	Oct 2008	B2
7452327	Durgin et al.	Nov 2008	B2
7455208	Wales et al.	Nov 2008	B2
7455675	Schur et al.	Nov 2008	B2
7468066	Vargas et al.	Dec 2008	B2
7476237	Taniguchi et al.	Jan 2009	B2
7479104	Lau et al.	Jan 2009	B2
7485093	Glukhovsky	Feb 2009	B2
7488295	Burbank et al.	Feb 2009	B2
7494499	Nagase et al.	Feb 2009	B2
7497867	Lasner et al.	Mar 2009	B2
7498950	Ertas et al.	Mar 2009	B1
7507200	Okada	Mar 2009	B2
7507239	Shadduck	Mar 2009	B2
7510107	Timm et al.	Mar 2009	B2
7511733	Takizawa et al.	Mar 2009	B2
7514568	Freeman	Apr 2009	B2
7515953	Madar et al.	Apr 2009	B2
7520876	Ressemann et al.	Apr 2009	B2
7520950	Saadat et al.	Apr 2009	B2
7524281	Chu et al.	Apr 2009	B2
7524302	Tower	Apr 2009	B2
7534228	Williams	May 2009	B2
7535570	Muraishi	May 2009	B2
7536217	Minai et al.	May 2009	B2
7540872	Schechter et al.	Jun 2009	B2
7542807	Bertolero et al.	Jun 2009	B2
7544195	Lunsford et al.	Jun 2009	B2
7544203	Chin et al.	Jun 2009	B2
7547310	Whitfield	Jun 2009	B2
7548040	Lee et al.	Jun 2009	B2
7549564	Boudreaux	Jun 2009	B2
7549990	Canady	Jun 2009	B2
7549991	Lu et al.	Jun 2009	B2
7549998	Braun	Jun 2009	B2
7553278	Kucklick	Jun 2009	B2
7553298	Hunt et al.	Jun 2009	B2
7559452	Wales et al.	Jul 2009	B2
7559887	Dannan	Jul 2009	B2
7559916	Smith et al.	Jul 2009	B2
7560006	Rakos et al.	Jul 2009	B2
7561907	Fuimaono et al.	Jul 2009	B2
7561916	Hunt et al.	Jul 2009	B2
7565201	Blackmore et al.	Jul 2009	B2
7566300	Devierre et al.	Jul 2009	B2
7566334	Christian et al.	Jul 2009	B2
7575144	Ortiz et al.	Aug 2009	B2
7575548	Takemoto et al.	Aug 2009	B2
7578832	Johnson et al.	Aug 2009	B2
7579005	Keeler et al.	Aug 2009	B2
7579550	Dayton et al.	Aug 2009	B2
7582096	Gellman et al.	Sep 2009	B2
7588177	Racenet	Sep 2009	B2
7588557	Nakao	Sep 2009	B2
7588585	Gold et al.	Sep 2009	B2
7591781	Hirata	Sep 2009	B2
7591783	Boulais et al.	Sep 2009	B2
7597229	Boudreaux et al.	Oct 2009	B2
7604150	Boudreaux	Oct 2009	B2
7608083	Lee et al.	Oct 2009	B2
7611479	Cragg et al.	Nov 2009	B2
7612084	James et al.	Nov 2009	B2
7615002	Rothweiler et al.	Nov 2009	B2
7615003	Stefanchik et al.	Nov 2009	B2
7615005	Stefanchik et al.	Nov 2009	B2
7615058	Sixto, Jr. et al.	Nov 2009	B2
7615067	Lee et al.	Nov 2009	B2
7618398	Holman et al.	Nov 2009	B2
7618437	Nakao	Nov 2009	B2
7621910	Sugi	Nov 2009	B2
7621927	Messerly et al.	Nov 2009	B2
7621936	Cragg et al.	Nov 2009	B2
7628792	Guerra	Dec 2009	B2
7628797	Tieu et al.	Dec 2009	B2
7632250	Smith et al.	Dec 2009	B2
7635373	Ortiz	Dec 2009	B2
7637903	Lentz et al.	Dec 2009	B2
7637905	Saadat et al.	Dec 2009	B2
7645288	McKenna et al.	Jan 2010	B2
7648457	Stefanchik et al.	Jan 2010	B2
7648519	Lee et al.	Jan 2010	B2
7650742	Ushijima	Jan 2010	B2
7651483	Byrum et al.	Jan 2010	B2
7651509	Bojarski et al.	Jan 2010	B2
7653438	Deem et al.	Jan 2010	B2
7654431	Hueil et al.	Feb 2010	B2
7655004	Long	Feb 2010	B2
7658738	Nobis et al.	Feb 2010	B2
7662089	Okada et al.	Feb 2010	B2
7666180	Holsten et al.	Feb 2010	B2
7666203	Chanduszko et al.	Feb 2010	B2
7670282	Mathis	Mar 2010	B2
7670336	Young et al.	Mar 2010	B2
7670346	Whitfield	Mar 2010	B2
7674259	Shadduck	Mar 2010	B2
7674275	Martin et al.	Mar 2010	B2
7678043	Gilad	Mar 2010	B2
7680543	Azure	Mar 2010	B2
7684599	Horn et al.	Mar 2010	B2
7684851	Miyake et al.	Mar 2010	B2
7686826	Lee et al.	Mar 2010	B2
7691103	Fernandez et al.	Apr 2010	B2
7697970	Uchiyama et al.	Apr 2010	B2
7699835	Lee et al.	Apr 2010	B2
7699864	Kick et al.	Apr 2010	B2
7708756	Nobis et al.	May 2010	B2
7710563	Betzig et al.	May 2010	B2
7713189	Hanke	May 2010	B2
7713270	Suzuki	May 2010	B2
7717847	Smith	May 2010	B2
7721742	Kalloo et al.	May 2010	B2
7722631	Mikkaichi et al.	May 2010	B2
7727242	Sepetka et al.	Jun 2010	B2
7727246	Sixto, Jr. et al.	Jun 2010	B2
7727248	Smith et al.	Jun 2010	B2
7727249	Rahmani	Jun 2010	B2
7731697	Porter et al.	Jun 2010	B2
7731725	Gadberry et al.	Jun 2010	B2
7736191	Sochor	Jun 2010	B1
7736360	Mody et al.	Jun 2010	B2
7736374	Vaughan et al.	Jun 2010	B2
7744591	Rioux et al.	Jun 2010	B2
7744613	Ewers et al.	Jun 2010	B2
7744615	Couture	Jun 2010	B2
7749161	Beckman et al.	Jul 2010	B2
7749163	Mulac et al.	Jul 2010	B2
7751866	Aoki et al.	Jul 2010	B2
7751869	Rioux et al.	Jul 2010	B2
7753901	Piskun et al.	Jul 2010	B2
7753933	Ginn et al.	Jul 2010	B2
7758577	Nobis et al.	Jul 2010	B2
7758598	Conlon et al.	Jul 2010	B2
7762949	Nakao	Jul 2010	B2
7762959	Bilsbury	Jul 2010	B2
7762960	Timberlake et al.	Jul 2010	B2
7762998	Birk et al.	Jul 2010	B2
7763012	Petrick et al.	Jul 2010	B2
7765010	Chornenky et al.	Jul 2010	B2
7766819	Matsumoto	Aug 2010	B2
7766896	Kornkven Volk et al.	Aug 2010	B2
7770584	Danek et al.	Aug 2010	B2
7771396	Stefanchik et al.	Aug 2010	B2
7771416	Spivey et al.	Aug 2010	B2
7771437	Hogg et al.	Aug 2010	B2
7776035	Rick et al.	Aug 2010	B2
7780639	Van Lue	Aug 2010	B2
7780683	Roue et al.	Aug 2010	B2
7780691	Stefanchik	Aug 2010	B2
7784663	Shelton, IV	Aug 2010	B2
7785348	Kuhns et al.	Aug 2010	B2
7789825	Nobis et al.	Sep 2010	B2
7789827	Landry	Sep 2010	B2
7794409	Damarati	Sep 2010	B2
7794447	Dann et al.	Sep 2010	B2
7794458	McIntyre et al.	Sep 2010	B2
7794475	Hess et al.	Sep 2010	B2
7798386	Schall et al.	Sep 2010	B2
7798750	Clark	Sep 2010	B2
7798960	Jaeger	Sep 2010	B2
7803163	Skakoon	Sep 2010	B2
7803195	Levy et al.	Sep 2010	B2
7813590	Horn et al.	Oct 2010	B2
7813789	Glukhovsky	Oct 2010	B2
7815565	Stefanchik et al.	Oct 2010	B2
7815566	Stefanchik et al.	Oct 2010	B2
7815651	Skakoon et al.	Oct 2010	B2
7815652	Messerly et al.	Oct 2010	B2
7815659	Conlon et al.	Oct 2010	B2
7815662	Spivey et al.	Oct 2010	B2
7819836	Levine et al.	Oct 2010	B2
7819872	Johnson et al.	Oct 2010	B2
7828186	Wales	Nov 2010	B2
7828793	Thompson et al.	Nov 2010	B2
7828808	Hinman et al.	Nov 2010	B2
7828809	Skakoon et al.	Nov 2010	B2
7833156	Williams et al.	Nov 2010	B2
7833231	Skakoon et al.	Nov 2010	B2
7833238	Nakao	Nov 2010	B2
7837615	Le et al.	Nov 2010	B2
7842028	Lee	Nov 2010	B2
7842050	Diduch et al.	Nov 2010	B2
7842068	Ginn	Nov 2010	B2
7846087	Stefanchik et al.	Dec 2010	B2
7846107	Hoffman et al.	Dec 2010	B2
7846171	Kullas et al.	Dec 2010	B2
7850660	Uth et al.	Dec 2010	B2
7850686	Nobis et al.	Dec 2010	B2
7850712	Conlon et al.	Dec 2010	B2
7857183	Shelton, IV	Dec 2010	B2
7857820	Skakoon et al.	Dec 2010	B2
7862546	Conlon et al.	Jan 2011	B2
7862553	Ewaschuk	Jan 2011	B2
7862572	Meade et al.	Jan 2011	B2
7862582	Ortiz et al.	Jan 2011	B2
7867216	Wahr et al.	Jan 2011	B2
7871371	Komiya et al.	Jan 2011	B2
7875042	Martin et al.	Jan 2011	B2
7879004	Seibel et al.	Feb 2011	B2
7883458	Hamel	Feb 2011	B2
7887530	Zemlok et al.	Feb 2011	B2
7887550	Daglow et al.	Feb 2011	B2
7887558	Lin et al.	Feb 2011	B2
7892200	Birk et al.	Feb 2011	B2
7892220	Faller et al.	Feb 2011	B2
7896804	Uchimura et al.	Mar 2011	B2
7896887	Rimbaugh et al.	Mar 2011	B2
7905828	Brock et al.	Mar 2011	B2
7905830	Stefanchik et al.	Mar 2011	B2
7909809	Scopton et al.	Mar 2011	B2
7914513	Voorhees, Jr.	Mar 2011	B2
7916809	Tsushima	Mar 2011	B2
7918783	Maseda et al.	Apr 2011	B2
7918785	Okada et al.	Apr 2011	B2
7918844	Byrum et al.	Apr 2011	B2
7918845	Saadat et al.	Apr 2011	B2
7918848	Lau et al.	Apr 2011	B2
7918869	Saadat et al.	Apr 2011	B2
7922650	McWeeney et al.	Apr 2011	B2
7922717	Sugita	Apr 2011	B2
7922739	Downey	Apr 2011	B2
7922743	Heinrich et al.	Apr 2011	B2
7927271	Dimitriou et al.	Apr 2011	B2
7931624	Smith et al.	Apr 2011	B2
7931661	Saadat et al.	Apr 2011	B2
7935130	Williams	May 2011	B2
7937143	Demarais et al.	May 2011	B2
7945332	Schechter	May 2011	B2
7947000	Vargas et al.	May 2011	B2
7951073	Freed	May 2011	B2
7953326	Farr et al.	May 2011	B2
7955298	Carroll et al.	Jun 2011	B2
7955340	Michlitsch et al.	Jun 2011	B2
7955355	Chin	Jun 2011	B2
7959627	Utley et al.	Jun 2011	B2
7959629	Young et al.	Jun 2011	B2
7959642	Nobis et al.	Jun 2011	B2
7963192	Mayenberger et al.	Jun 2011	B2
7963912	Zwolinski et al.	Jun 2011	B2
7963975	Criscuolo	Jun 2011	B2
7965180	Koyama	Jun 2011	B2
7967808	Fitzgerald et al.	Jun 2011	B2
7967842	Bakos	Jun 2011	B2
7969473	Kotoda	Jun 2011	B2
7972330	Alejandro et al.	Jul 2011	B2
7972333	Nishimura	Jul 2011	B2
7976458	Stefanchik et al.	Jul 2011	B2
7976552	Suzuki	Jul 2011	B2
7985239	Suzuki	Jul 2011	B2
7985830	Mance et al.	Jul 2011	B2
7988618	Mikkaichi et al.	Aug 2011	B2
7988685	Ziaie et al.	Aug 2011	B2
7988690	Chanduszko et al.	Aug 2011	B2
7998132	Gregorich et al.	Aug 2011	B2
8007474	Uth et al.	Aug 2011	B2
8007495	McDaniel et al.	Aug 2011	B2
8021340	Porter et al.	Sep 2011	B2
8021358	Doyle et al.	Sep 2011	B2
8021362	Deem et al.	Sep 2011	B2
8021378	Sixto, Jr. et al.	Sep 2011	B2
8029504	Long	Oct 2011	B2
8034046	Eidenschink	Oct 2011	B2
8037591	Spivey et al.	Oct 2011	B2
8038596	Miyake et al.	Oct 2011	B2
8038612	Paz	Oct 2011	B2
8043289	Behl et al.	Oct 2011	B2
8048060	Griffin et al.	Nov 2011	B2
8048067	Davalos et al.	Nov 2011	B2
8048108	Sibbitt, Jr. et al.	Nov 2011	B2
8052597	Boulais	Nov 2011	B2
8052699	Sherwinter	Nov 2011	B1
8057462	Weitzner et al.	Nov 2011	B2
8057510	Ginn et al.	Nov 2011	B2
8062306	Nobis et al.	Nov 2011	B2
8062311	Litscher et al.	Nov 2011	B2
8066632	Dario et al.	Nov 2011	B2
8066702	Rittman, III et al.	Nov 2011	B2
8070743	Kagan et al.	Dec 2011	B2
8070759	Stefanchik et al.	Dec 2011	B2
8070804	Hyde et al.	Dec 2011	B2
8075478	Campos	Dec 2011	B2
8075567	Taylor et al.	Dec 2011	B2
8075572	Stefanchik et al.	Dec 2011	B2
8075573	Gambale et al.	Dec 2011	B2
8075587	Ginn	Dec 2011	B2
8083787	Korb et al.	Dec 2011	B2
8088062	Zwolinski	Jan 2012	B2
8092374	Smith et al.	Jan 2012	B2
8092549	Hillis et al.	Jan 2012	B2
8096459	Ortiz et al.	Jan 2012	B2
8096941	Fowler et al.	Jan 2012	B2
8096998	Cresina	Jan 2012	B2
8097001	Nakao	Jan 2012	B2
8100922	Griffith	Jan 2012	B2
8105342	Onuki et al.	Jan 2012	B2
8109872	Kennedy, II et al.	Feb 2012	B2
8109919	Kraft et al.	Feb 2012	B2
8109926	Azure	Feb 2012	B2
8114072	Long et al.	Feb 2012	B2
8114113	Becker	Feb 2012	B2
8114119	Spivey et al.	Feb 2012	B2
8115447	Toya et al.	Feb 2012	B2
8118738	Larkin	Feb 2012	B2
8118821	Mouw	Feb 2012	B2
8118834	Goraltchouk et al.	Feb 2012	B1
8118835	Weisel et al.	Feb 2012	B2
8123677	Fujimori	Feb 2012	B2
8131371	Demarals et al.	Mar 2012	B2
8147424	Kassab et al.	Apr 2012	B2
8157813	Ko et al.	Apr 2012	B2
8157817	Bonadio et al.	Apr 2012	B2
8157834	Conlon	Apr 2012	B2
8159549	Glukhovsky et al.	Apr 2012	B2
8166615	Coldiron	May 2012	B2
8167894	Miles et al.	May 2012	B2
8172772	Zwolinski et al.	May 2012	B2
8172839	Kato	May 2012	B2
8182414	Handa et al.	May 2012	B2
8187166	Kuth et al.	May 2012	B2
8200334	Min et al.	Jun 2012	B1
8202265	Boulais	Jun 2012	B2
8202295	Kaplan	Jun 2012	B2
8206295	Kaul	Jun 2012	B2
8211119	Palmer et al.	Jul 2012	B2
8211125	Spivey	Jul 2012	B2
8216224	Morris et al.	Jul 2012	B2
8216252	Vaughan et al.	Jul 2012	B2
8216255	Smith et al.	Jul 2012	B2
8221310	Saadat et al.	Jul 2012	B2
8221411	Francischelli et al.	Jul 2012	B2
8222385	Yoshizaki et al.	Jul 2012	B2
8241204	Spivey	Aug 2012	B2
8241309	Miles et al.	Aug 2012	B2
8246633	Omori	Aug 2012	B2
8251068	Schnell	Aug 2012	B2
8252057	Fox	Aug 2012	B2
8262563	Bakos et al.	Sep 2012	B2
8262655	Ghabrial et al.	Sep 2012	B2
8262674	Daglow et al.	Sep 2012	B2
8262680	Swain et al.	Sep 2012	B2
8267854	Asada et al.	Sep 2012	B2
8269823	Hirakawa et al.	Sep 2012	B2
8277373	Maahs et al.	Oct 2012	B2
8282665	Kieturakis et al.	Oct 2012	B2
8298161	Vargas	Oct 2012	B2
8303485	Segawa et al.	Nov 2012	B2
8303581	Arts et al.	Nov 2012	B2
8308682	Kramer et al.	Nov 2012	B2
8308738	Nobis et al.	Nov 2012	B2
8308743	Matsuno et al.	Nov 2012	B2
8313496	Sauer et al.	Nov 2012	B2
8315714	Daglow et al.	Nov 2012	B2
8317806	Coe et al.	Nov 2012	B2
8317814	Karasawa et al.	Nov 2012	B2
8328836	Conlon et al.	Dec 2012	B2
8333691	Schaaf	Dec 2012	B2
8333777	Schaller et al.	Dec 2012	B2
8337394	Vakharia	Dec 2012	B2
8337492	Kunis et al.	Dec 2012	B2
8337510	Rieber et al.	Dec 2012	B2
8343041	Byers et al.	Jan 2013	B2
8348827	Zwolinski	Jan 2013	B2
8353487	Trusty et al.	Jan 2013	B2
8357170	Stefanchik	Jan 2013	B2
8359093	Wariar	Jan 2013	B2
8361066	Long et al.	Jan 2013	B2
8361112	Carroll, II et al.	Jan 2013	B2
8366606	Watanabe et al.	Feb 2013	B2
8366733	Gabel et al.	Feb 2013	B2
8377044	Coe et al.	Feb 2013	B2
8377057	Rick et al.	Feb 2013	B2
8382790	Uenohara et al.	Feb 2013	B2
8388653	Nobis et al.	Mar 2013	B2
8394090	Ootsubo	Mar 2013	B2
8397335	Gordin et al.	Mar 2013	B2
8403926	Nobis et al.	Mar 2013	B2
8409076	Pang et al.	Apr 2013	B2
8409197	Slater	Apr 2013	B2
8409200	Holcomb et al.	Apr 2013	B2
8425505	Long	Apr 2013	B2
8430811	Hess et al.	Apr 2013	B2
8449452	Iddan et al.	May 2013	B2
8449538	Long	May 2013	B2
8454594	Demarais et al.	Jun 2013	B2
8460275	Taylor et al.	Jun 2013	B2
8465419	Moriyama	Jun 2013	B2
8465484	Davalos et al.	Jun 2013	B2
8469993	Rothberg et al.	Jun 2013	B2
8475359	Asada et al.	Jul 2013	B2
8475361	Barlow et al.	Jul 2013	B2
8475452	Van Wyk et al.	Jul 2013	B2
8480657	Bakos	Jul 2013	B2
8480689	Spivey et al.	Jul 2013	B2
8485968	Weimer et al.	Jul 2013	B2
8496574	Trusty et al.	Jul 2013	B2
8500697	Kurth et al.	Aug 2013	B2
8506564	Long et al.	Aug 2013	B2
8512335	Cheng et al.	Aug 2013	B2
8517921	Tremaglio et al.	Aug 2013	B2
8518024	Williams et al.	Aug 2013	B2
8518052	Burgermeister et al.	Aug 2013	B2
8518062	Cole et al.	Aug 2013	B2
8523884	Stam et al.	Sep 2013	B2
8523939	Hausen	Sep 2013	B1
8529563	Long et al.	Sep 2013	B2
8540744	Spivey et al.	Sep 2013	B2
8545396	Cover et al.	Oct 2013	B2
8545450	Voegele et al.	Oct 2013	B2
8551058	Measamer et al.	Oct 2013	B2
8562513	Yamatani	Oct 2013	B2
8562602	Azure	Oct 2013	B2
8568410	Vakharia et al.	Oct 2013	B2
8579176	Smith et al.	Nov 2013	B2
8579897	Vakharia et al.	Nov 2013	B2
8585644	Rodriguez Lelis et al.	Nov 2013	B2
8602970	Muyari et al.	Dec 2013	B2
8603138	Faller et al.	Dec 2013	B2
8608652	Voegele et al.	Dec 2013	B2
8617156	Werneth et al.	Dec 2013	B2
8623011	Spivey	Jan 2014	B2
8632534	Pearson et al.	Jan 2014	B2
8632563	Nagase et al.	Jan 2014	B2
8636648	Gazdzinski	Jan 2014	B2
8636650	Lee	Jan 2014	B2
8636730	Keppel	Jan 2014	B2
8640940	Ohdaira	Feb 2014	B2
8641728	Stokes et al.	Feb 2014	B2
8652150	Swain et al.	Feb 2014	B2
8657174	Yates et al.	Feb 2014	B2
8663236	Chen et al.	Mar 2014	B2
8668686	Govari et al.	Mar 2014	B2
8678999	Isaacson	Mar 2014	B2
8679003	Spivey	Mar 2014	B2
8684967	Engel et al.	Apr 2014	B2
8685058	Wilk	Apr 2014	B2
8702753	Mikkaichi et al.	Apr 2014	B2
8704923	Ogasawara et al.	Apr 2014	B2
8715281	Barlow et al.	May 2014	B2
8721658	Kahle et al.	May 2014	B2
8723936	Amling et al.	May 2014	B2
8727967	Weitzner	May 2014	B2
8738141	Smith et al.	May 2014	B2
8747401	Gonzalez et al.	Jun 2014	B2
8753262	Sugiyama et al.	Jun 2014	B2
8753335	Moshe et al.	Jun 2014	B2
8764735	Coe et al.	Jul 2014	B2
8771173	Fonger et al.	Jul 2014	B2
8771260	Conlon et al.	Jul 2014	B2
8774913	Demarais et al.	Jul 2014	B2
8784403	Cefai et al.	Jul 2014	B2
8784436	Ho et al.	Jul 2014	B2
8795161	Carter	Aug 2014	B2
8821520	Schwemberger et al.	Sep 2014	B2
8821532	Schaeffer	Sep 2014	B2
8828031	Fox et al.	Sep 2014	B2
8834461	Werneth et al.	Sep 2014	B2
8845656	Skakoon et al.	Sep 2014	B2
8858590	Shelton, IV et al.	Oct 2014	B2
8876701	Surti et al.	Nov 2014	B2
8876772	Weber et al.	Nov 2014	B2
8880185	Hastings et al.	Nov 2014	B2
8882786	Bearinger et al.	Nov 2014	B2
8888792	Harris et al.	Nov 2014	B2
8906035	Zwolinski et al.	Dec 2014	B2
8911452	Skakoon et al.	Dec 2014	B2
8920442	Sibbitt, Jr. et al.	Dec 2014	B2
8926606	Davalos et al.	Jan 2015	B2
8932208	Kendale et al.	Jan 2015	B2
8939897	Nobis	Jan 2015	B2
8939969	Temelli et al.	Jan 2015	B2
8956352	Mauch et al.	Feb 2015	B2
8974374	Schostek et al.	Mar 2015	B2
8979751	George	Mar 2015	B2
8986199	Weisenburgh, II et al.	Mar 2015	B2
8986343	Bourque et al.	Mar 2015	B2
8992517	Davalos et al.	Mar 2015	B2
9005198	Long et al.	Apr 2015	B2
9011431	Long et al.	Apr 2015	B2
9028483	Long et al.	May 2015	B2
9036015	Verburgh et al.	May 2015	B2
9044247	Kato	Jun 2015	B2
9049987	Conlon et al.	Jun 2015	B2
9060782	Daniel et al.	Jun 2015	B2
9066655	Stefanchik et al.	Jun 2015	B2
9078662	Bakos et al.	Jul 2015	B2
9084621	Weitzner et al.	Jul 2015	B2
9089323	Bonutti et al.	Jul 2015	B2
9125557	Lien et al.	Sep 2015	B2
9125631	Smith et al.	Sep 2015	B2
9125639	Mathis et al.	Sep 2015	B2
9138586	Eiger	Sep 2015	B2
9149172	Iddan et al.	Oct 2015	B2
9155587	Willis et al.	Oct 2015	B2
9162050	Boling	Oct 2015	B2
9186203	Spivey et al.	Nov 2015	B2
9198733	Neal, II et al.	Dec 2015	B2
9220526	Conlon	Dec 2015	B2
9226772	Fox	Jan 2016	B2
9233241	Long	Jan 2016	B2
9248278	Crosby et al.	Feb 2016	B2
9254169	Long et al.	Feb 2016	B2
9265407	Goldfarb et al.	Feb 2016	B2
9271796	Buysse et al.	Mar 2016	B2
9277957	Long et al.	Mar 2016	B2
9295485	Conlon et al.	Mar 2016	B2
9308049	Dejima	Apr 2016	B2
9314620	Long et al.	Apr 2016	B2
9339328	Ortiz et al.	May 2016	B2
9345462	Weitzner et al.	May 2016	B2
9352152	Lindenthaler et al.	May 2016	B2
9364278	DeCarlo et al.	Jun 2016	B2
9370341	Ceniccola et al.	Jun 2016	B2
9375268	Long	Jun 2016	B2
9427255	Griffith et al.	Aug 2016	B2
9486241	Zeiner et al.	Nov 2016	B2
9492148	Ginn et al.	Nov 2016	B2
9545290	Tellio et al.	Jan 2017	B2
9549719	Shohat et al.	Jan 2017	B2
9566126	Weitzner et al.	Feb 2017	B2
9572623	Long	Feb 2017	B2
9596980	Marescaux et al.	Mar 2017	B2
9596994	Futrell et al.	Mar 2017	B2
9598691	Davalos	Mar 2017	B2
9627120	Scott et al.	Apr 2017	B2
9668725	Beaven	Jun 2017	B2
9694175	Tyson, Jr.	Jul 2017	B2
9700334	Hinman et al.	Jul 2017	B2
9788885	Long et al.	Oct 2017	B2
9788888	Bakos et al.	Oct 2017	B2
9788890	Toth et al.	Oct 2017	B2
9808597	Vargas et al.	Nov 2017	B2
9833282	Jun	Dec 2017	B2
9833595	Gonzalez	Dec 2017	B2
9861272	Pell et al.	Jan 2018	B2
9861350	Serina et al.	Jan 2018	B2
9867652	Sano et al.	Jan 2018	B2
9877781	Grasse et al.	Jan 2018	B2
9883910	Conlon et al.	Feb 2018	B2
9974944	Sudam et al.	May 2018	B2
10004558	Long et al.	Jun 2018	B2
10010666	Rubinsky et al.	Jul 2018	B2
10071012	Larson et al.	Sep 2018	B2
10092291	Voegele et al.	Oct 2018	B2
10098527	Weisenburgh, II et al.	Oct 2018	B2
10098691	Long et al.	Oct 2018	B2
10105141	Harris et al.	Oct 2018	B2
10206709	Griffith et al.	Feb 2019	B2
10208158	Banister et al.	Feb 2019	B2
10258406	Long	Apr 2019	B2
10278761	Long et al.	May 2019	B2
10300268	Skakoon et al.	May 2019	B2
10314603	Conlon	Jun 2019	B2
10314649	Bakos et al.	Jun 2019	B2
10321927	Hinman	Jun 2019	B2
10342598	Long et al.	Jul 2019	B2
10376314	van der Weide et al.	Aug 2019	B2
20010023333	Wise et al.	Sep 2001	A1
20020019641	Truwit	Feb 2002	A1
20020022857	Goldsteen et al.	Feb 2002	A1
20020023353	Ting-Kung	Feb 2002	A1
20020029055	Bonutti	Mar 2002	A1
20020042562	Meron et al.	Apr 2002	A1
20020068945	Sixto et al.	Jun 2002	A1
20020082551	Yachia et al.	Jun 2002	A1
20020095164	Andreas et al.	Jul 2002	A1
20020133115	Gordon et al.	Sep 2002	A1
20020138086	Sixto et al.	Sep 2002	A1
20020165592	Glukhovsky et al.	Nov 2002	A1
20030014090	Abrahamson	Jan 2003	A1
20030018373	Eckhardt et al.	Jan 2003	A1
20030069602	Jacobs et al.	Apr 2003	A1
20030078471	Foley et al.	Apr 2003	A1
20030083681	Moutafis et al.	May 2003	A1
20030093104	Bonner et al.	May 2003	A1
20030114731	Cadeddu et al.	Jun 2003	A1
20030114732	Webler et al.	Jun 2003	A1
20030120257	Houston et al.	Jun 2003	A1
20030124009	Ravi et al.	Jul 2003	A1
20030130656	Levin	Jul 2003	A1
20030139646	Sharrow et al.	Jul 2003	A1
20030158521	Ameri	Aug 2003	A1
20030167062	Gambale et al.	Sep 2003	A1
20030170898	Gundersen et al.	Sep 2003	A1
20030181900	Long	Sep 2003	A1
20030187351	Franck et al.	Oct 2003	A1
20030225312	Suzuki et al.	Dec 2003	A1
20030225332	Okada et al.	Dec 2003	A1
20030229269	Humphrey	Dec 2003	A1
20030229371	Whitworth	Dec 2003	A1
20040002683	Nicholson et al.	Jan 2004	A1
20040024414	Downing	Feb 2004	A1
20040045133	Buettell	Mar 2004	A1
20040054377	Foster et al.	Mar 2004	A1
20040092970	Xavier	May 2004	A1
20040098007	Heiss	May 2004	A1
20040101456	Kuroshima et al.	May 2004	A1
20040104999	Okada	Jun 2004	A1
20040133089	Kilcoyne et al.	Jul 2004	A1
20040136779	Bhaskar	Jul 2004	A1
20040138529	Wiltshire et al.	Jul 2004	A1
20040138587	Lyons	Jul 2004	A1
20040138747	Kaladelfos	Jul 2004	A1
20040161451	Pierce et al.	Aug 2004	A1
20040167545	Sadler et al.	Aug 2004	A1
20040176699	Walker et al.	Sep 2004	A1
20040186350	Brenneman et al.	Sep 2004	A1
20040193009	Jaffe et al.	Sep 2004	A1
20040193186	Kortenbach et al.	Sep 2004	A1
20040193188	Francese	Sep 2004	A1
20040193189	Kortenbach et al.	Sep 2004	A1
20040193200	Dworschak et al.	Sep 2004	A1
20040199052	Banik et al.	Oct 2004	A1
20040199159	Lee et al.	Oct 2004	A1
20040206859	Chong et al.	Oct 2004	A1
20040210245	Erickson et al.	Oct 2004	A1
20040225186	Horne et al.	Nov 2004	A1
20040243108	Suzuki	Dec 2004	A1
20040249367	Saadat et al.	Dec 2004	A1
20040249394	Morris et al.	Dec 2004	A1
20040249443	Shanley et al.	Dec 2004	A1
20040254572	McIntyre et al.	Dec 2004	A1
20040260315	Dell et al.	Dec 2004	A1
20040260337	Freed	Dec 2004	A1
20050000553	Noguchi et al.	Jan 2005	A1
20050004515	Hart et al.	Jan 2005	A1
20050010211	Suzuki	Jan 2005	A1
20050015103	Popov	Jan 2005	A1
20050043690	Todd	Feb 2005	A1
20050059963	Phan et al.	Mar 2005	A1
20050059964	Fitz	Mar 2005	A1
20050065509	Coldwell et al.	Mar 2005	A1
20050070947	Franer et al.	Mar 2005	A1
20050080435	Smith et al.	Apr 2005	A1
20050085693	Belson et al.	Apr 2005	A1
20050085832	Sancoff et al.	Apr 2005	A1
20050090837	Sixto et al.	Apr 2005	A1
20050096502	Khalili	May 2005	A1
20050101837	Kalloo et al.	May 2005	A1
20050101838	Camillocci et al.	May 2005	A1
20050107663	Saadat et al.	May 2005	A1
20050107664	Kalloo et al.	May 2005	A1
20050119613	Moenning et al.	Jun 2005	A1
20050124855	Jaffe et al.	Jun 2005	A1
20050125010	Smith et al.	Jun 2005	A1
20050131457	Douglas et al.	Jun 2005	A1
20050137454	Saadat et al.	Jun 2005	A1
20050143690	High	Jun 2005	A1
20050143774	Polo	Jun 2005	A1
20050143803	Watson et al.	Jun 2005	A1
20050149087	Ahlberg et al.	Jul 2005	A1
20050149096	Hilal et al.	Jul 2005	A1
20050165272	Okada et al.	Jul 2005	A1
20050165378	Heinrich et al.	Jul 2005	A1
20050165411	Orban	Jul 2005	A1
20050165429	Douglas et al.	Jul 2005	A1
20050182429	Yamanouchi	Aug 2005	A1
20050192478	Williams et al.	Sep 2005	A1
20050192602	Manzo	Sep 2005	A1
20050209624	Vijay	Sep 2005	A1
20050215858	Vail	Sep 2005	A1
20050216036	Nakao	Sep 2005	A1
20050222495	Okada et al.	Oct 2005	A1
20050228224	Okada et al.	Oct 2005	A1
20050228406	Bose	Oct 2005	A1
20050240249	Tu et al.	Oct 2005	A1
20050250987	Ewers et al.	Nov 2005	A1
20050251176	Swanstrom et al.	Nov 2005	A1
20050256524	Long et al.	Nov 2005	A1
20050261711	Okada et al.	Nov 2005	A1
20050267492	Poncet et al.	Dec 2005	A1
20050272977	Saadat et al.	Dec 2005	A1
20050274935	Nelson	Dec 2005	A1
20050277956	Francese et al.	Dec 2005	A1
20050288555	Binmoeller	Dec 2005	A1
20060004406	Wehrstein et al.	Jan 2006	A1
20060004409	Nobis et al.	Jan 2006	A1
20060004410	Nobis et al.	Jan 2006	A1
20060015009	Jaffe et al.	Jan 2006	A1
20060015131	Kierce et al.	Jan 2006	A1
20060020167	Sitzmann	Jan 2006	A1
20060025654	Suzuki et al.	Feb 2006	A1
20060025781	Young et al.	Feb 2006	A1
20060025812	Shelton	Feb 2006	A1
20060036267	Saadat et al.	Feb 2006	A1
20060041188	Dirusso et al.	Feb 2006	A1
20060058582	Maahs et al.	Mar 2006	A1
20060064083	Khalaj et al.	Mar 2006	A1
20060069424	Acosta et al.	Mar 2006	A1
20060069429	Spence et al.	Mar 2006	A1
20060074413	Behzadian	Apr 2006	A1
20060089528	Tartaglia et al.	Apr 2006	A1
20060095031	Ormsby	May 2006	A1
20060100687	Fahey et al.	May 2006	A1
20060111703	Kunis et al.	May 2006	A1
20060111704	Brenneman et al.	May 2006	A1
20060129166	Lavelle	Jun 2006	A1
20060135962	Kick et al.	Jun 2006	A1
20060135971	Swanstrom et al.	Jun 2006	A1
20060142652	Keenan	Jun 2006	A1
20060142790	Gertner	Jun 2006	A1
20060142798	Holman et al.	Jun 2006	A1
20060149129	Watts et al.	Jul 2006	A1
20060149131	Or	Jul 2006	A1
20060149132	Iddan	Jul 2006	A1
20060161190	Gadberry et al.	Jul 2006	A1
20060167482	Swain et al.	Jul 2006	A1
20060173452	Buysse et al.	Aug 2006	A1
20060178560	Saadat et al.	Aug 2006	A1
20060183975	Saadat et al.	Aug 2006	A1
20060184161	Maahs et al.	Aug 2006	A1
20060189844	Tien	Aug 2006	A1
20060200005	Bjork et al.	Sep 2006	A1
20060200121	Mowery	Sep 2006	A1
20060200169	Sniffin	Sep 2006	A1
20060200170	Aranyi	Sep 2006	A1
20060217665	Prosek	Sep 2006	A1
20060217742	Messerly et al.	Sep 2006	A1
20060237023	Cox et al.	Oct 2006	A1
20060241570	Wilk	Oct 2006	A1
20060241691	Wilk	Oct 2006	A1
20060247500	Voegele et al.	Nov 2006	A1
20060247576	Poncet	Nov 2006	A1
20060247663	Schwartz et al.	Nov 2006	A1
20060253004	Frisch et al.	Nov 2006	A1
20060259010	Stefanchik et al.	Nov 2006	A1
20060259073	Miyamoto et al.	Nov 2006	A1
20060264752	Rubinsky et al.	Nov 2006	A1
20060264904	Kerby et al.	Nov 2006	A1
20060270902	Igarashi et al.	Nov 2006	A1
20060271042	Latterell et al.	Nov 2006	A1
20060271102	Bosshard et al.	Nov 2006	A1
20060276835	Uchida	Dec 2006	A1
20060287644	Inganas et al.	Dec 2006	A1
20060287666	Saadat et al.	Dec 2006	A1
20070000550	Osinski	Jan 2007	A1
20070005019	Okishige	Jan 2007	A1
20070015965	Cox et al.	Jan 2007	A1
20070032701	Fowler et al.	Feb 2007	A1
20070051375	Milliman	Mar 2007	A1
20070066869	Hoffman	Mar 2007	A1
20070067017	Trapp	Mar 2007	A1
20070073102	Matsuno et al.	Mar 2007	A1
20070078439	Grandt et al.	Apr 2007	A1
20070083192	Welch	Apr 2007	A1
20070100375	Mikkaichi et al.	May 2007	A1
20070100376	Mikkaichi et al.	May 2007	A1
20070106113	Ravo	May 2007	A1
20070106317	Shelton et al.	May 2007	A1
20070112251	Nakhuda	May 2007	A1
20070112342	Pearson et al.	May 2007	A1
20070112385	Conlon	May 2007	A1
20070112417	Shanley et al.	May 2007	A1
20070118115	Artale et al.	May 2007	A1
20070123840	Cox	May 2007	A1
20070135803	Belson	Jun 2007	A1
20070142706	Matsui et al.	Jun 2007	A1
20070142710	Yokoi et al.	Jun 2007	A1
20070142779	Duane et al.	Jun 2007	A1
20070156028	Van Lue et al.	Jul 2007	A1
20070161855	Mikkaichi et al.	Jul 2007	A1
20070167901	Herrig et al.	Jul 2007	A1
20070173686	Lin et al.	Jul 2007	A1
20070173691	Yokoi et al.	Jul 2007	A1
20070173869	Gannoe et al.	Jul 2007	A1
20070173870	Zacharias	Jul 2007	A2
20070173872	Neuenfeldt	Jul 2007	A1
20070179525	Frecker et al.	Aug 2007	A1
20070191904	Libbus et al.	Aug 2007	A1
20070198057	Gelbart et al.	Aug 2007	A1
20070203398	Bonadio et al.	Aug 2007	A1
20070208336	Kim et al.	Sep 2007	A1
20070208407	Gerdts et al.	Sep 2007	A1
20070213754	Mikkaichi et al.	Sep 2007	A1
20070225552	Segawa et al.	Sep 2007	A1
20070233040	Macnamara et al.	Oct 2007	A1
20070244356	Carrillo et al.	Oct 2007	A1
20070244358	Lee	Oct 2007	A1
20070255303	Bakos et al.	Nov 2007	A1
20070260121	Bakos et al.	Nov 2007	A1
20070260242	Dycus et al.	Nov 2007	A1
20070260273	Cropper et al.	Nov 2007	A1
20070260302	Igaki	Nov 2007	A1
20070265494	Leanna et al.	Nov 2007	A1
20070270629	Charles	Nov 2007	A1
20070270907	Stokes et al.	Nov 2007	A1
20070282165	Hopkins et al.	Dec 2007	A1
20080004650	George	Jan 2008	A1
20080004656	Livneh	Jan 2008	A1
20080015413	Barlow et al.	Jan 2008	A1
20080021416	Arai et al.	Jan 2008	A1
20080022927	Zhang et al.	Jan 2008	A1
20080027387	Grabinsky	Jan 2008	A1
20080033244	Matsui et al.	Feb 2008	A1
20080058586	Karpiel	Mar 2008	A1
20080065169	Colliou et al.	Mar 2008	A1
20080082108	Skakoon et al.	Apr 2008	A1
20080091068	Terliuc	Apr 2008	A1
20080097159	Ishiguro	Apr 2008	A1
20080097472	Agmon et al.	Apr 2008	A1
20080103527	Martin et al.	May 2008	A1
20080114384	Chang et al.	May 2008	A1
20080125765	Berenshteyn et al.	May 2008	A1
20080125774	Palanker et al.	May 2008	A1
20080125796	Graham	May 2008	A1
20080140069	Filloux et al.	Jun 2008	A1
20080140071	Vegesna	Jun 2008	A1
20080150754	Quendt	Jun 2008	A1
20080171907	Long et al.	Jul 2008	A1
20080188710	Segawa et al.	Aug 2008	A1
20080200755	Bakos	Aug 2008	A1
20080200762	Stokes et al.	Aug 2008	A1
20080200911	Long	Aug 2008	A1
20080200933	Bakos et al.	Aug 2008	A1
20080200934	Fox	Aug 2008	A1
20080208213	Benjamin et al.	Aug 2008	A1
20080214890	Motai et al.	Sep 2008	A1
20080215070	Gildenberg	Sep 2008	A1
20080221587	Schwartz	Sep 2008	A1
20080228213	Blakeney et al.	Sep 2008	A1
20080230972	Ganley	Sep 2008	A1
20080243148	Mikkaichi et al.	Oct 2008	A1
20080255647	Jensen et al.	Oct 2008	A1
20080262513	Stahler et al.	Oct 2008	A1
20080262524	Bangera et al.	Oct 2008	A1
20080262540	Bangera et al.	Oct 2008	A1
20080275474	Martin et al.	Nov 2008	A1
20080287801	Magnin et al.	Nov 2008	A1
20080294159	Akahoshi et al.	Nov 2008	A1
20080300458	Kim et al.	Dec 2008	A1
20080300461	Shaw et al.	Dec 2008	A1
20080300571	LePivert	Dec 2008	A1
20080306493	Shibata et al.	Dec 2008	A1
20080309758	Karasawa et al.	Dec 2008	A1
20080312502	Swain et al.	Dec 2008	A1
20090018396	Takizawa et al.	Jan 2009	A1
20090030278	Minakuchi	Jan 2009	A1
20090048486	Surti	Feb 2009	A1
20090054728	Trusty	Feb 2009	A1
20090062788	Long et al.	Mar 2009	A1
20090062795	Vakharia et al.	Mar 2009	A1
20090069786	Vesely et al.	Mar 2009	A1
20090076499	Azure	Mar 2009	A1
20090078736	Van Lue	Mar 2009	A1
20090082627	Karasawa et al.	Mar 2009	A1
20090093690	Yoshizawa	Apr 2009	A1
20090099414	Goto et al.	Apr 2009	A1
20090112059	Nobis	Apr 2009	A1
20090112063	Bakos et al.	Apr 2009	A1
20090131751	Spivey et al.	May 2009	A1
20090143639	Stark	Jun 2009	A1
20090143649	Rossi	Jun 2009	A1
20090143794	Conlon et al.	Jun 2009	A1
20090163770	Torrie et al.	Jun 2009	A1
20090177219	Conlon	Jul 2009	A1
20090182332	Long et al.	Jul 2009	A1
20090192344	Bakos et al.	Jul 2009	A1
20090192534	Ortiz et al.	Jul 2009	A1
20090198212	Timberlake et al.	Aug 2009	A1
20090198231	Esser et al.	Aug 2009	A1
20090198251	Ransbury et al.	Aug 2009	A1
20090209804	Seiler et al.	Aug 2009	A1
20090210000	Sullivan et al.	Aug 2009	A1
20090221873	McGrath	Sep 2009	A1
20090228001	Pacey	Sep 2009	A1
20090234278	Eck	Sep 2009	A1
20090254019	Gehl et al.	Oct 2009	A1
20090259105	Miyano et al.	Oct 2009	A1
20090281559	Swain et al.	Nov 2009	A1
20090287045	Mitelberg et al.	Nov 2009	A1
20090287236	Bakos et al.	Nov 2009	A1
20090292167	Kimoto	Nov 2009	A1
20090306470	Karasawa et al.	Dec 2009	A1
20090322864	Karasawa et al.	Dec 2009	A1
20100010294	Conlon et al.	Jan 2010	A1
20100010298	Bakos et al.	Jan 2010	A1
20100010303	Bakos	Jan 2010	A1
20100016878	Smith	Jan 2010	A1
20100023032	Granja Filho	Jan 2010	A1
20100036198	Tacchino et al.	Feb 2010	A1
20100048990	Bakos	Feb 2010	A1
20100049223	Granja Filho	Feb 2010	A1
20100056862	Bakos	Mar 2010	A1
20100076451	Zwolinski et al.	Mar 2010	A1
20100081875	Fowler et al.	Apr 2010	A1
20100113872	Asada et al.	May 2010	A1
20100121362	Clague et al.	May 2010	A1
20100130817	Conlon	May 2010	A1
20100152539	Ghabrial et al.	Jun 2010	A1
20100152725	Pearson et al.	Jun 2010	A1
20100160906	Jarrard	Jun 2010	A1
20100191050	Zwolinski	Jul 2010	A1
20100191267	Fox	Jul 2010	A1
20100198248	Vakharia	Aug 2010	A1
20100210906	Wendlandt	Aug 2010	A1
20100217367	Belson	Aug 2010	A1
20100229610	Garrigan et al.	Sep 2010	A1
20100249700	Spivey	Sep 2010	A1
20100268025	Belson	Oct 2010	A1
20100280368	Can et al.	Nov 2010	A1
20100286791	Goldsmith	Nov 2010	A1
20100298642	Trusty et al.	Nov 2010	A1
20100312056	Galperin et al.	Dec 2010	A1
20100331622	Conlon	Dec 2010	A2
20110077476	Rofougaran et al.	Mar 2011	A1
20110087224	Cadeddu et al.	Apr 2011	A1
20110093009	Fox	Apr 2011	A1
20110098694	Long	Apr 2011	A1
20110098704	Long et al.	Apr 2011	A1
20110112434	Ghabrial et al.	May 2011	A1
20110112527	Hamilton, Jr. et al.	May 2011	A1
20110115891	Trusty	May 2011	A1
20110152610	Trusty et al.	Jun 2011	A1
20110152878	Trusty et al.	Jun 2011	A1
20110152923	Fox	Jun 2011	A1
20110160514	Long et al.	Jun 2011	A1
20110190764	Long et al.	Aug 2011	A1
20110224663	Heim et al.	Sep 2011	A1
20110245619	Holcomb	Oct 2011	A1
20110284014	Cadeddu et al.	Nov 2011	A1
20110306840	Allen et al.	Dec 2011	A1
20110313415	Fernandez et al.	Dec 2011	A1
20120005939	Vandewalle	Jan 2012	A1
20120088965	Stokes et al.	Apr 2012	A1
20120089089	Swain et al.	Apr 2012	A1
20120089093	Trusty	Apr 2012	A1
20120101331	Gilad et al.	Apr 2012	A1
20120101413	Beetel et al.	Apr 2012	A1
20120109122	Arena et al.	May 2012	A1
20120116155	Trusty	May 2012	A1
20120116266	Houser et al.	May 2012	A1
20120149981	Khait et al.	Jun 2012	A1
20120191075	Trusty	Jul 2012	A1
20120197246	Mauch	Aug 2012	A1
20130030430	Stewart et al.	Jan 2013	A1
20130090666	Hess et al.	Apr 2013	A1
20130158348	Nobis et al.	Jun 2013	A1
20130245356	Fernandez et al.	Sep 2013	A1
20130267834	McGee	Oct 2013	A1
20130331649	Khait et al.	Dec 2013	A1
20140005557	Rich et al.	Jan 2014	A1
20140014024	Schroeder	Jan 2014	A1
20140052216	Long et al.	Feb 2014	A1
20140121678	Trusty et al.	May 2014	A1
20160296280	Long	Oct 2016	A1
20170086937	Tellio et al.	Mar 2017	A1
20170119465	Long et al.	May 2017	A1
20180303541	Long et al.	Oct 2018	A1
20180360535	Long et al.	Dec 2018	A1
20190053805	Harris et al.	Feb 2019	A1
20190117054	Weisenburgh, II et al.	Apr 2019	A1

Foreign Referenced Citations (53)

Number	Date	Country
666310	Feb 1996	AU
19713797	Oct 1997	DE
19757056	Aug 2008	DE
102006027873	Oct 2009	DE
0086338	Aug 1983	EP
0286415	Oct 1988	EP
0589454	Mar 1994	EP
1281356	Feb 2003	EP
0941128	Oct 2004	EP
0848598	Feb 2005	EP
1281360	Mar 2005	EP
1153578	Mar 2007	EP
1493397	Sep 2011	EP
2731610	Sep 1996	FR
330629	Jun 1930	GB
S63309252	Dec 1988	JP
H0438960	Feb 1992	JP
H0829699	Feb 1996	JP
H0975365	Mar 1997	JP
H1024049	Jan 1998	JP
3007713	Feb 2000	JP
2000245683	Sep 2000	JP
2001526072	Dec 2001	JP
2002369791	Dec 2002	JP
2003088494	Mar 2003	JP
2003235852	Aug 2003	JP
2004033525	Feb 2004	JP
2004065745	Mar 2004	JP
2005121947	May 2005	JP
2005261514	Sep 2005	JP
2005296063	Oct 2005	JP
2006297005	Nov 2006	JP
2006343510	Dec 2006	JP
2007125264	May 2007	JP
5646674	Dec 2014	JP
1021295	Feb 2004	NL
194230	May 1967	SU
980703	Dec 1982	SU
WO-8607543	Dec 1986	WO
WO-9320765	Oct 1993	WO
WO-9712557	Apr 1997	WO
WO-9900060	Jan 1999	WO
WO-9917661	Apr 1999	WO
WO-9930622	Jun 1999	WO
WO-0126708	Apr 2001	WO
WO-0158360	Aug 2001	WO
WO-03081761	Oct 2003	WO
WO-2005018467	Mar 2005	WO
WO-2007013059	Feb 2007	WO
WO-2008102154	Aug 2008	WO
WO-2008151237	Dec 2008	WO
WO-2009029065	Mar 2009	WO
WO-2009032623	Mar 2009	WO

Non-Patent Literature Citations (66)

Entry
Zadno et al., “Linear Superelasticity in Cold-Worked Ni—Ti,” Engineering Aspects of Shape Memory Alloys, pp. 414-419 (1990).
Michael S. Kavic, M.D., “Natural Orifice Translumenal Endoscopic Surgery: “NOTES””, JSLS, vol. 10, pp. 133-134 (2006).
Guido M. Sclabas, M.D., et al., “Endoluminal Methods for Gastrotomy Closure in Natural Orifice TransEnteric Surgery (NOTES),” Surgical Innovation, vol. 13, No. 1, pp. 23-30, Mar. 2006.
Fritscher-Ravens, et al., “Transgastric Gastropexy and Hiatal Hernia Repair for GERD Under EUS Control: a Porcine Model,” Gastrointestinal Endoscopy, vol. 59, No. 1, pp. 89-95, 2004.
Kennedy, et al., “High-Burst-Strength, Feedback-Controlled Bipolar Vessel Sealing,” Surgical Endoscopy, vol. 12, pp. 876-878 (1998).
Collins et al., “Local Gene Therapy of Solid Tumors with GM-CSF and B7-1 Eradicates Both Treated and Distal Tumors,” Cancer Gene Therapy, vol. 13, pp. 1061-1071 (2006).
K. Sumiyama et al., “Transesophageal Mediastinoscopy by Submucosal Endoscopy With Mucosal Flap Safety Value Technique,” Gastrointest Endosc., Apr. 2007, vol. 65(4), pp. 679-683 (Abstract).
K. Sumiyama et al., “Submucosal Endoscopy with Mucosal Flap Safety Valve,” Gastrointest Endosc. Apr. 2007, vol. 65(4) pp. 694-695 (Abstract).
K. Sumiyama et al., “Endoscopic Caps,” Tech. Gastrointest. Endosc., vol. 8, pp. 28-32, 2006.
Z-Offset Technique Used in the Introduction of Trocar During Laparoscopic Surgery, M.S. Hershey NOTES Presentation to EES NOTES Development Team, Sep. 27, 2007.
I. Fraser, “An Historical Perspective on Mechanical Aids in Intestinal Anastamosis,” Surg. Gynecol. Obstet. (Oct. 1982), vol. 155, pp. 566-574.
N. Chopita et al., “Endoscopic Gastroenteric Anastamosis Using Magnets,” Endoscopy, (2005), vol. 37(4), pp. 313-317.
H. Okajima et al., “Magnet Compression Anastamosis for Bile Duct Stenosis After Duct to Duct Biliary Reconstruction in Living Donor Liver Transplantation,” Liver Transplantation (2005), pp. 473-475.
P. O'Neill, M.D. et al., “Nonsuture Intestinal Anastomosis,” Am J. Surg, (1962), vol. 104, pp. 761-767.
J.B. Murphy, M.D., “Cholecysto-Intestinal, Gastro-Intestinal, Entero-Intestinal Anastomosis, and Approximation Without Sutures (original research),” Med Rec, (Dec. 10, 1892), vol. 42(24), pp. 665-676.
B. Rubinsky, Ph.D., “Irreversible Electroporation in Medicine,” Technology in Cancer Research and Treatment, vol. 6, No. 4, Aug. 2007, pp. 255-259.
D.B. Nelson, MD et al., “Endoscopic Hemostatic Devices,” Gastrointestinal Endoscopy, vol. 54, No. 6, 2001, pp. 833-840.
J.D. Paulson, M.D., et al., “Development of Flexible Culdoscopy,” The Journal of the American Association of Gynecologic Laparoscopists, Nov. 1999, vol. 6, No. 4, pp. 487-490.
H. Seifert, et al., “Retroperitoneal Endoscopic Debridement for Infected Peripancreatic Necrosis,” The Lancet, Research Letters, vol. 356, Aug. 19, 2000, pp. 653-655.
D. Wilhelm et al., “An Innovative, Safe and Sterile Sigmoid Access (ISSA) for NOTES,” Endoscopy 2007, vol. 39, pp. 401-406.
Wong et al., “Combined Percutaneous Radiofrequency Ablation and Ethanol Injection for Hepatocellular Carcinoma in High-Risk Locations,” AJR, 190, pp. W187-W195 (2008).
Heller et al., “Electrically mediated plasmid DNA delivery to hepatocellular carcinomas in vivo,” Gene Therapy, 7, pp. 826-829 (2000).
Widera et al., “Increased DNA Vaccine Delivery and Immunogenicity by Electroporation In Vivo,” The Journal of Immunology, 164, pp. 4635-4640 (2000).
Weaver et al., “Theory of electroporation: A review,” Bioelectrochemistry and Bioenergetics, 41, pp. 135-160 (1996).
Guyton et al., “Membrane Potentials and Action Potentials,” W.B. Sanders, ed. Textbook of Medical Physiology, p. 56 (2000).
Guyton et al., “Contraction of Skeletal Muscle,” Textbook of Medical Physiology, pp. 82-84 (2000).
“Ethicon Endo-Surgery Novel Investigational Notes and SSL Devices Featured in 15 Presentations at Sages,” Apr. 22, 2009 Press Release; URL http://www.jnj.com/connect/news/all/20090422_152000; accessed Aug. 28, 2009 (3 pages).
Edd, et al., “In Vivo Results of a New Focal Tissue Ablation Technique: Irreversible Electroporation,” IEEE Trans Biomed Eng, vol. 53, pp. 1409-1415, 2006.
Ogando, “Prototype Tools That Go With the Flow,” Design News, 2 pages, Jul. 17, 2006.
K. Sumiyama et al., “Transgastric Cholecystectomy: Transgastric Accessibility to the Gallbladder Improved with the SEMF Method and a Novel Multibending Therapeutic Endoscope,” Gastrointest Endosc., Jun. 2007, vol. 65(7), pp. 1028-1034 (Abstract).
M.E. Ryan et al., “Endoscopic Intervention for Biliary Leaks After Laparoscopic Cholecystectomy: A Multicenter Review,” Gastrointest. Endosc., vol. 47(3), 1998, pp. 261-266.
J.W. Hazey et al., “Natural Orifice Transgastric Endoscopic Peritoneoscopy in Humans: Initial Clinical Trial,” Surg Endosc, (Jan. 2008), vol. 22(1), pp. 16-20.
C. Cope et al., “Long Term Patency of Experimental Magnetic Compression Gastroenteric Anastomoses Achieved with Covered Stents,” Gastrointest Endosc, (2001), vol. 53, pp. 780-784.
A. Fritscher-Ravens et al., “Transluminal Endosurgery: Single Lumen Access Anastamotic Device for Flexible Endoscopy,” Gastrointestinal Endosc, (2003), vol. 58(4), pp. 585-591.
C.P. Swain, M.D. et al., “Anastomosis at Flexible Endoscopy: An Experimental Study of Compression Button Gastrojejunostomy,” Gastrointest Endosc, (1991), vol. 37, pp. 628-632.
Endoscopic Retrograde Cholangiopancreatogram (ERCP); [online] URL: http://www.webmd.com/digestive-disorders/endoscopic-retrograde-cholangiopancreatogram-ercp.htm; last updated: Apr. 30, 2007; accessed: Feb. 21, 2008 (6 pages).
ERCP; Jackson Siegelbaum Gastroenterology; [online] URL: http://www.gicare.com/pated/epdgs20.htm; accessed Feb. 21, 2008 (3 pages).
D.G. Fong et al., “Transcolonic Ventral Wall Hernia Mesh Fixation in a Porcine Model,” Endoscopy 2007; 39: 865-869.
CRE™ Pulmonary Balloon Dilator; [online] URL: http://www.bostonscientific.com/Device.bsci?page=HCP_Overview&navRe1Id=1000.1003&method=D . . . , accessed Jul. 18, 2008 (4 pages).
Ethicon, Inc., “Wound Closure Manual: Chapter 3 (The Surgical Needle),” 15 pages, (1994).
USGI® EndoSurgical Operating System—g-Prox® Tissue Grasper/Approximation Device; [online] URL: http://www.usgimedical.com/eos/components-gprox.htm—accessed May 30, 2008 (2 pages).
Printout of web page—http://www.vacumed.com/zcom/product/Product.do?compid=27&prodid=852, #51XX Low-Cost Permanent Tubes 2MM ID, Smooth Interior Walls, VacuMed, Ventura, California, Accessed Jul. 24, 2007.
Nakazawa et al., “Radiofrequency Ablation of Hepatocellular Carcinoma: Correlation Between Local Tumor Progression After Ablation and Ablative Margin,” AJR, 188, pp. 480-488 (Feb. 2007).
Miklavcic et al., “A validated model of in vivo electric field distribution in tissues for electrochemotherapy and for DNA electrotransfer for gene therapy,” Biochimica et Biophysica Acta, 1523, pp. 73-83 (2000).
Evans, “Ablative and cathether-delivered therapies for colorectal liver metastases (CRLM),” EJSO, 33, pp. S64-S75 (2007).
Mulier et al., “Radiofrequency Ablation Versus Resection for Resectable Colorectal Liver Metastases: Time for a Randomized Trial?” Annals of Surgical Oncology, 15(1), pp. 144-157 (2008).
Link et al., “Regional Chemotherapy of Nonresectable Colorectal Liver Metastases with Mitoxanthrone, 5-Fluorouracil, Folinic Acid, and Mitomycin C May Prolong Survival,” Cancer, 92, pp. 2746-2753 (2001).
“Ethicon Endo-Surgery Studies Presented At DDW Demonstrate Potential of Pure NOTES Surgery With Company's Toolbox,” Jun. 3, 2009 Press Release; URL http://www.jnj.com/connect/news/product/20090603_120000; accessed Aug. 28, 2009 (3 pages).
Castellvi et al., “Hybrid Transvaginal NOTES Sleeve Gastrectomy in a Porcine Model Using a Magnetically Anchored Camera and Novel Instrumentation,” Abstract submitted along with Poster at SAGES Annual Meeting in Phoenix, AZ, Apr. 22, 2009 (1 page).
OCTO Port Modular Laparoscopy System for Single Incision Access, Jan. 4, 2010; URL http://www.medgadget.com/archives/2010/01/octo_port_modular_laparo . . . ; accessed Jan. 5, 2010 (4 pages).
Hakko Retractors, obtained Aug. 25, 2009 (5 pages).
Castellvi et al., “Hybrid Transvaginal NOTES Sleeve Gastrectomy in a Porcine Model Using a Magnetically Anchored Camera and Novel Instrumentation,” Poster submitted along with Abstract at SAGES Annual Meeting in Phoenix, AZ, Apr. 22, 2009 (1 page).
How Stuff Works “How Smart Structures Will Work,” http://science.howstuffworks.com/engineering/structural/smart-structure1.htm; accessed online Nov. 1, 2011 (3 pages).
Stanway, Smart Fluids: Current and Future Developments. Material Science and Technology, 20, pp. 931-939, 2004; accessed online Nov. 1, 2011 at http://www.dynamics.group.shef.ac.uk/smart/smart.html (7 pages).
Rutala et al. “Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008” (available at http://www.cdc.gov/hicpac/Disinfection_Sterilization/13_11sterilizingPractices.html).
Davalos, et al., “Tissue Ablation with Irreversible Electroporation,” Annals of Biomedical Engineering, 33.2 (2005): 223-231.
C. Cope, “Creation of Compression Gastroenterostomy by Means of the Oral, Percutaneous, or Surgical Introduction of Magnets: Feasibility Study in Swine,” J. Vasc Interv Radiol, (1995), vol. 6(4), pp. 539-545.
Schoenbach et al. “Bacterial Decontamination of Liquids with Pulsed Electric Fields” IEEE Transactions on Dielectrics and Electrical Insulation. vol. 7 No. 5. Oct. 2000, pp. 637-645.
Instant Armor: Science Videos—Science News—ScienCentral; http://www.sciencentral.com/articles./view.php3?article_id=218392121; accessed online Nov. 1, 2011 (2 pages).
Bewlay et al., “Spinning” in ASM Handbook, vol. 14B, Metalworking: Sheet Forming (2006).
G.A. Hallenbeck, M.D. et al., “An Instrument for Colorectal Anastomosis Without Sutrues,” Dis Col Rectum, (1963), vol. 5, pp. 98-101.
Maxim Integrated Application Note 3977: Class D Amplifiers: Fundamentals of Operation and Recent Developments, Jan. 31, 2007.
T. Hardy, Jr., M.D. et al., “A Biofragmentable Ring for Sutureless Bowel Anastomosis. An Experimental Study,” Dis Col Rectum, (1985), vol. 28, pp. 484-490.
Jolly et al., Properties and Applications of Commercial Magneto rheological Fluids. SPIE 5th Annual Int. Symposium on Smart Structures and Materials, 1998 (18 pages).
F.N. Denans, Nouveau Procede Pour La Guerison Des Plaies Des Intestines. Extrait Des Seances De La Societe Royale De Medecine De Marseille, Pendant Le Mois De Decembre 1825, et le Premier Tremestre De 1826, Séance Du 24 Fevrier 1826. Recueil De La Societe Royale De Medecin De Marseille. Marseille: Impr. D'Achard, 1826; 1:127-31. (with English translation).
K.E. Mönkemüller, M.D., et al., “Transmural Drainage of Pancreatic Fluid Collections Without Electrocautery Using the Seldinger Technique,” Gastrointestinal Endoscopy, vol. 48, No. 2, 1998, pp. 195-200, (Received Oct. 3, 1997; Accepted Mar. 31, 1998).

Related Publications (1)

	Number	Date	Country
	20170049508 A1	Feb 2017	US

Continuations (1)

	Number	Date	Country
Parent	12607252	Oct 2009	US
Child	15250507		US

Electrical ablation devices

Information

Patent Number

Date Filed

Date Issued

Inventors

Original Assignees

Examiners

CPC

Field of Search

CPC

International Classifications

Term Extension

Abstract