End effector control and calibration

Description

TECHNICAL FIELD

The technical field may generally relate to controlling surgical instruments, and in particular, controlling and calibrating end effectors of surgical instruments.

BACKGROUND

Various aspects are directed to surgical instruments, and controlling and calibrating end effectors of surgical instruments.

For example, ultrasonic surgical devices are finding increasingly widespread applications in surgical procedures by virtue of their unique performance characteristics. Depending upon specific device configurations and operational parameters, ultrasonic surgical devices can provide substantially simultaneous transection of tissue and homeostasis by coagulation, desirably minimizing patient trauma. An ultrasonic surgical device may comprise a handpiece containing an ultrasonic transducer, and an instrument coupled to the ultrasonic transducer having a distally mounted end effector (e.g., an ultrasonic blade and a clamp arm, where the clamp arm may comprise a non-stick tissue pad) to cut and seal tissue. In some cases, the instrument may be permanently affixed to the handpiece. In other cases, the instrument may be detachable from the handpiece, as in the case of a disposable instrument or an instrument that is interchangeable between different handpieces. The end effector transmits ultrasonic energy to tissue brought into contact with the end effector to realize cutting and sealing action. Ultrasonic surgical devices of this nature can be configured for open surgical use, laparoscopic, or endoscopic surgical procedures including robotic-assisted procedures.

Ultrasonic energy cuts and coagulates tissue using temperatures lower than those used in electro surgical procedures. Vibrating at high frequencies (e.g., 55,500 times per second), the ultrasonic blade denatures protein in the tissue to form a sticky coagulum. Pressure exerted on tissue by the ultrasonic blade surface collapses blood vessels and allows the coagulum to form a hemostatic seal. A surgeon can control the cutting speed and coagulation by the force applied to the tissue by the end effector, the time over which the force is applied and the selected excursion level of the end effector.

SUMMARY

In one aspect, a method for controlling an end effector may include detecting a signal in response to movement of a first tube relative to a second tube, the first tube driving movement of a clamp arm of the end effector. The method may also include determining a clamp arm position of the end effector relative to a ultrasonic blade of the end effector based on the signal. The method may additionally include adjusting a power output to the ultrasonic blade of the end effector based on the clamp arm position.

One or more of the following features may be included. The first tube may be an inner tube and the second tube may be an outer tube, the inner tube being moveable relative to the outer tube, the outer tube being static relative to the inner tube. The method may further include detecting the signal using a Hall-effect sensor and a magnet positioned on the first tube. The method may also include moving a magnet positioned on the first tube relative to a Hall-effect sensor as the first tube drives movement of the clamp arm of the end effector. The method may additionally include adjusting the power output to the ultrasonic blade of the end effector using an ultrasonic transducer based on a voltage change in a Hall-effect sensor. Moreover, the method may include adjusting the power output to the ultrasonic blade of the end effector dynamically, based on a travel ratio that changes as the clamp arm approaches the ultrasonic blade. Further more, the method may include adjusting the power output to the ultrasonic blade of the end effector dynamically, using a proportional-integral controller, based on a travel ratio that changes as the clamp arm approaches the ultrasonic blade.

In one or more implementations, the method may include determining a type of tissue between the clamp arm and the ultrasonic blade based on the signal. The method may also include adjusting the power output to the ultrasonic blade of the end effector based on the type of tissue. The method may additionally include, in response to determining that the type of tissue between the clamp and the ultrasonic blade is a small vessel, reducing the power output to the ultrasonic blade of the end effector by an amount less than for a large vessel. Moreover, the method may include in response to determining that the type of tissue between the clamp and the ultrasonic blade is a large vessel, reducing the power output to the ultrasonic blade of the end effector by an amount more than for a small vessel.

In one aspect, an apparatus for controlling an end effector may include a sensor configured to detect a signal in response to movement of a first tube relative to a second tube, the first tube driving movement of a clamp arm of the end effector. The apparatus may also include a processor configured to determine a clamp arm position of the end effector relative to a ultrasonic blade of the end effector based on the signal. The apparatus may further include a transducer configured to adjust a power output to the ultrasonic blade of the end effector based on the clamp arm position.

One or more of the following features may be included. The first tube may be an inner tube and the second tube may be an outer tube, the inner tube being moveable relative to the outer tube, the outer tube being static relative to the inner tube. The apparatus may further include a magnet positioned on the first tube wherein the sensor is a Hall-effect sensor used to detect the signal based on a position of the magnet. The magnet may be positioned on the first tube moves relative to a Hall-effect sensor as the first tube drives movement of the clamp arm of the end effector. The transducer may be an ultrasonic transducer configured to adjust the power output to the ultrasonic blade of the end effector based on a voltage change in a Hall-effect sensor. The apparatus may also include a proportional-integral controller configured to adjust the power output to the ultrasonic blade of the end effector dynamically, based on a travel ratio that changes as the clamp arm approaches the ultrasonic blade.

In one aspect, a method for calibrating an apparatus for controlling an end effector may include detecting a first signal corresponding to a fully open position of a clamp arm and a ultrasonic blade of the end effector. The method may also include detecting a second signal corresponding to an intermediate position of the clamp arm and the ultrasonic blade of the end effector, the intermediate position resulting from clamping a rigid body between the clamp arm and the ultrasonic blade. The method may additionally include detecting a third signal corresponding to a fully closed position of the clamp arm and the ultrasonic blade of the end effector. The method may further include determining a best fit curve to represent signal strength as a function of sensor displacement based on at least the first, second, and third signals, the fully open, intermediate, and fully closed positions, and a dimension of the rigid body. Moreover, the method may include creating a lookup table based on at least the first, second, and third signals, and the fully open, intermediate, and fully closed positions.

The details of one or more implementations are set forth in the accompanying drawings and the description below. Other features and advantages will become apparent from the description, the drawings, and the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an elevation view of an example surgical instrument in accordance with one aspect of the present disclosure

FIG. 2 is a perspective view of an example surgical instrument in accordance with one aspect of the present disclosure;

FIG. 3 illustrates an example end effector of a surgical instruments in accordance with one aspect of the present disclosure;

FIG. 4 illustrates an example end effector of a surgical instruments in accordance with one aspect of the present disclosure;

FIG. 5 is an exploded view of one aspect of a surgical instrument in accordance with one aspect of the present disclosure;

FIG. 6 illustrates a diagram of a surgical instrument in accordance with one aspect of the present disclosure;

FIG. 7 illustrates a structural view of a generator architecture in accordance with one aspect of the present disclosure;

FIGS. 8A-8C illustrate functional views of a generator architecture in accordance with one aspect of the present disclosure;

FIG. 9 illustrates a controller for monitoring input devices and controlling output devices in accordance with one aspect of the present disclosure;

FIGS. 10A and 10B illustrate structural and functional aspects of one aspect of the generator in accordance with one aspect the present disclosure;

FIG. 11 illustrates an example end effectors and shaft of a surgical instrument in accordance with one aspect of the present disclosure;

FIG. 12 illustrates an example Hall-effect sensor and magnet configuration in accordance with one aspect of the present disclosure where the Hall-effect sensor is fixed and the magnet moves in a line perpendicular to the face of the Hall sensor;

FIG. 13A illustrates an example Hall-effect sensor and magnet configuration in accordance with one aspect of the present disclosure where the Hall-effect sensor is fixed and the magnet moves in a line parallel to the face of the Hall-effect sensor;

FIG. 13B illustrates an example Hall-effect sensor and magnet configuration in accordance with one aspect of the present disclosure where the Hall-effect sensor is fixed and the magnet moves in a line parallel to the face of the Hall-effect sensor;

FIG. 14A is a table of output voltage of a Hall-effect sensor as a function of distance as a clamp arm moves from a fully closed position to a fully open position in accordance with one aspect the present disclosure;

FIG. 14B is a graph of output voltage of a Hall-effect sensor as a function of distance as a clamp arm moves from a fully closed position to a fully open position in accordance with one aspect the present disclosure;

FIG. 15A is a top view of a Hall-effect sensor and magnet configurations in a surgical instrument and corresponding open jaws end effector position in accordance with one aspect of the present disclosure;

FIG. 15B is a top view of a Hall-effect sensor and magnet configurations in a surgical instrument and corresponding closed jaws end effector position in accordance with one aspect of the present disclosure;

FIG. 16 illustrates a plan view of a system comprising a Hall-effect sensor and magnet configuration in a surgical instrument in accordance with one aspect of the present disclosure;

FIG. 17A illustrates a view of an Hall-effect sensor and magnet configurations in the context of a surgical instrument in accordance with one aspect of the present disclosure;

FIG. 17B illustrates a view of an Hall-effect sensor and magnet configurations in the context of a surgical instrument in accordance with one aspect of the present disclosure;

FIG. 18 illustrates a Hall-effect sensor and magnet configuration in a surgical instrument in accordance with one aspect of the present disclosure;

FIG. 19A illustrates a Hall-effect sensor and magnet configuration in accordance with one aspect of the present disclosure;

FIG. 19B illustrates Hall-effect sensor and magnet configurations in a surgical instrument in accordance with one aspect of the present disclosure;

FIG. 20 is a graph of a curve depicting Travel Ratio (TR) along the y-axis, based on Hall-effect sensor output voltage, as a function of Time (Sec) along the x-axis in accordance with one aspect of the present disclosure;

FIG. 21 illustrates a graph of a first curve depicting Travel Ratio (TR) along the left y-axis, based on Hall-effect sensor output voltage, as a function of Time (Sec) along the x-axis in accordance with one aspect of the present disclosure;

FIG. 22 illustrates charts showing Proportional-Integral control of power output to an ultrasonic blade in accordance with one aspect of the present disclosure;

FIG. 23 illustrates several vessels that were sealed using the techniques and features described herein in accordance with one aspect of the present disclosure;

FIG. 24 illustrates a graph of a best fit curve of Hall-effect sensor output voltage as a function of distance for various positions of the clamp arm as the clamp arm moves between fully closed to a fully open positions in accordance with one aspect of the present disclosure;

FIGS. 25-28 illustrate an end effector being calibrated in four different configurations in accordance with various aspects of the present disclosure using gage pins for two of the configurations for recording a Hall-effect sensor response corresponding to various positions of the clamp arm to record four data points (1-4) to create a best fit curve during production, where:

FIG. 25 illustrates an end effector in a fully open configuration to record a first data point (1) in accordance with one aspect of the present disclosure;

FIG. 26 illustrates an end effector in a second intermediate configuration grasping a first gage pin of a known diameter to record a second data point (2) in accordance with one aspect of the present disclosure;

FIG. 27 illustrates an end effector in a third intermediate configuration grasping a second gage pin of a known diameter to record a third data point (3) in accordance with one aspect of the present disclosure; and

FIG. 28 illustrates an end effector in a fully closed configuration to record a fourth data point (4) in accordance with one aspect of the present disclosure;

FIGS. 29A-D illustrate an example surgical instrument in accordance with one aspect of the present disclosure and charts showing example output power level in a hemostasis mode for small and large vessels, where:

FIG. 29A is a schematic diagram of surgical instrument configured to seal small and large vessels in accordance with one aspect of the present disclosure;

FIG. 29B is a diagram of an example range of a small vessel and a large vessel and the relative position of a clamp arm of the end effector in accordance with one aspect of the present disclosure;

FIG. 29C is a graph that depicts a process for sealing small vessels by applying various ultrasonic energy levels for a different periods of time in accordance with one aspect of the present disclosure; and

FIG. 29D is a graph that depicts a process for sealing large vessels by applying various ultrasonic energy levels for different periods of time in accordance with one aspect of the present disclosure;

FIG. 30 is a logic diagram illustrating an example process for determining whether hemostasis mode should be used, in accordance with one aspect of the present disclosure;

FIG. 31 is a logic diagram illustrating an example process for end effector control in accordance with one aspect of the present disclosure;

FIG. 32 is a logic diagram illustrating an example process for calibrating an apparatus for controlling for an end effector in accordance with one aspect of the present disclosure;

FIG. 33 is a logic diagram of a process for tracking wear of the tissue pad portion of the clamp arm and compensating for resulting drift of the Hall-effect sensor and determining tissue coefficient of friction in accordance with one aspect of the present disclosure;

FIG. 34 illustrates a Hall-effect sensor system that can be employed with the process of FIG. 33 in accordance with one aspect of the present disclosure; and

FIG. 35 illustrates one aspect of a ramp type counter analog-to-digital converter (ADC) that may be employed with the Hall-effect sensor system of FIG. 34 in accordance with one aspect of the present disclosure.

DESCRIPTION

Various aspects described herein are directed to surgical instruments comprising distally positioned, articulatable jaw assemblies. The jaw assemblies may be utilized in lieu of or in addition to shaft articulation. For example, the jaw assemblies may be utilized to grasp tissue and move it towards an ultrasonic blade, RF electrodes or other component for treating tissue.

In one aspect, a surgical instrument may comprise an end effector with an ultrasonic blade extending distally therefrom. The jaw assembly may be articulatable and may pivot about at least two axes. A first axis, or wrist pivot axis, may be substantially perpendicular to a longitudinal axis of the instrument shaft. The jaw assembly may pivot about the wrist pivot axis from a first position where the jaw assembly is substantially parallel to the ultrasonic blade to a second position where the jaw assembly is not substantially parallel to the ultrasonic blade. In addition, the jaw assembly may comprise first and second jaw members that are pivotable about a second axis or jaw pivot axis. The jaw pivot axis may be substantially perpendicular to the wrist pivot axis. In some aspects, the jaw pivot axis itself may pivot as the jaw assembly pivots about the wrist pivot axis. The first and second jaw members may be pivotably relative to one another about the jaw pivot axis such that the first and second jaw members may “open” and “close.” Additionally, in some aspects, the first and second jaw members are also pivotable about the jaw pivot axis together such that the direction of the first and second jaw members may change.

Reference will now be made in detail to several aspects, including aspects showing example implementations of manual and robotic surgical instruments with end effectors comprising ultrasonic and/or electro surgical elements. Wherever practicable similar or like reference numbers may be used in the figures and may indicate similar or like functionality. The figures depict example aspects of the disclosed surgical instruments and/or methods of use for purposes of illustration only. One skilled in the art will readily recognize from the following description that alternative example aspects of the structures and methods illustrated herein may be employed without departing from the principles described herein.

FIG. 1 is a right side view of one aspect of an ultrasonic surgical instrument 10. In the illustrated aspect, the ultrasonic surgical instrument 10 may be employed in various surgical procedures including endoscopic or traditional open surgical procedures. In one aspect, the ultrasonic surgical instrument 10 comprises a handle assembly 12, an elongated shaft assembly 14, and an ultrasonic transducer 16. The handle assembly 12 comprises a trigger assembly 24, a distal rotation assembly 13, and a switch assembly 28. The elongated shaft assembly 14 comprises an end effector assembly 26, which comprises elements to dissect tissue or mutually grasp, cut, and coagulate vessels and/or tissue, and actuating elements to actuate the end effector assembly 26. The handle assembly 12 is adapted to receive the ultrasonic transducer 16 at the proximal end. The ultrasonic transducer 16 is mechanically engaged to the elongated shaft assembly 14 and portions of the end effector assembly 26. The ultrasonic transducer 16 is electrically coupled to a generator 20 via a cable 22. Although the majority of the drawings depict a multiple end effector assembly 26 for use in connection with laparoscopic surgical procedures, the ultrasonic surgical instrument 10 may be employed in more traditional open surgical procedures and in other aspects, may be configured for use in endoscopic procedures. For the purposes herein, the ultrasonic surgical instrument 10 is described in terms of an endoscopic instrument; however, it is contemplated that an open and/or laparoscopic version of the ultrasonic surgical instrument 10 also may include the same or similar operating components and features as described herein.

In various aspects, the generator 20 comprises several functional elements, such as modules and/or blocks. Different functional elements or modules may be configured for driving different kinds of surgical devices. For example, an ultrasonic generator module 21 may drive an ultrasonic device, such as the ultrasonic surgical instrument 10. In some example aspects, the generator 20 also comprises an electrosurgery/RF generator module 23 for driving an electrosurgical device (or an electro surgical aspect of the ultrasonic surgical instrument 10). In the example aspect illustrated in FIG. 1, the generator 20 includes a control system 25 integral with the generator 20, and a foot switch 29 connected to the generator via a cable 27. The generator 20 may also comprise a triggering mechanism for activating a surgical instrument, such as the instrument 10. The triggering mechanism may include a power switch (not shown) as well as a foot switch 29. When activated by the foot switch 29, the generator 20 may provide energy to drive the acoustic assembly of the surgical instrument 10 and to drive the end effector 18 at a predetermined excursion level. The generator 20 drives or excites the acoustic assembly at any suitable resonant frequency of the acoustic assembly and/or derives the therapeutic/sub-therapeutic electromagnetic/RF energy. In one aspect, the electrosurgical/RF generator module 23 may be implemented as an electrosurgery unit (ESU) capable of supplying power sufficient to perform bipolar electrosurgery using radio frequency (RF) energy. In one aspect, the ESU can be a bipolar ERBE ICC 350 sold by ERBE USA, Inc. of Marietta, Ga. In bipolar electrosurgery applications, as previously discussed, a surgical instrument having an active electrode and a return electrode can be utilized, wherein the active electrode and the return electrode can be positioned against, or adjacent to, the tissue to be treated such that current can flow from the active electrode to the return electrode through the tissue. Accordingly, the electrosurgical/RF module 23 generator may be configured for therapeutic purposes by applying electrical energy to the tissue T sufficient for treating the tissue (e.g., cauterization). For example, in some aspects, the active and/or return electrode may be positioned on the jaw assembly described herein.

In one aspect, the electrosurgical/RF generator module 23 may be configured to deliver a subtherapeutic RF signal to implement a tissue impedance measurement module. In one aspect, the electrosurgical/RF generator module 23 comprises a bipolar radio frequency generator. In one aspect, the electrosurgical/RF generator module 23 may be configured to monitor electrical impedance Z, of tissue T and to control the characteristics of time and power level based on the tissue T by way of a return electrode provided on a clamp member of the end effector assembly 26. Accordingly, the electrosurgical/RF generator module 23 may be configured for subtherapeutic purposes for measuring the impedance or other electrical characteristics of the tissue T. Techniques and circuit configurations for measuring the impedance or other electrical characteristics of tissue Tare discussed in more detail in commonly assigned U.S. Patent Publication No. 2011/0015631, titled “Electrosurgical Generator for Ultrasonic Surgical Instrument,” the disclosure of which is herein incorporated by reference in its entirety.

A suitable ultrasonic generator module 21 may be configured to functionally operate in a manner similar to the GEN300 sold by Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio as is disclosed in one or more of the following U.S. patents, all of which are incorporated by reference herein: U.S. Pat. No. 6,480,796 (Method for Improving the Start Up of an Ultrasonic System Under Zero Load Conditions); U.S. Pat. No. 6,537,291 (Method for Detecting a Loose Blade in a Hand Piece Connected to an Ultrasonic Surgical System); U.S. Pat. No. 6,662,127 (Method for Detecting Presence of a Blade in an Ultrasonic System); U.S. Pat. No. 6,977,495 (Detection Circuitry for Surgical Handpiece System); U.S. Pat. No. 7,077,853 (Method for Calculating Transducer Capacitance to Determine Transducer Temperature); U.S. Pat. No. 7,179,271 (Method for Driving an Ultrasonic System to Improve Acquisition of Ultrasonic Blade Resonance Frequency at Startup); and U.S. Pat. No. 7,273,483 (Apparatus and Method for Alerting Generator Function in an Ultrasonic Surgical System).

It will be appreciated that in various aspects, the generator 20 may be configured to operate in several modes. In one mode, the generator 20 may be configured such that the ultrasonic generator module 21 and the electrosurgical/RF generator module 23 may be operated independently.

For example, the ultrasonic generator module 21 may be activated to apply ultrasonic energy to the end effector assembly 26 and subsequently, either therapeutic sub-therapeutic RF energy may be applied to the end effector assembly 26 by the electrosurgical/RF generator module 23. As previously discussed, the sub-therapeutic electrosurgical/RF energy may be applied to tissue clamped between claim elements of the end effector assembly 26 to measure tissue impedance to control the activation, or modify the activation, of the ultrasonic generator module 21. Tissue impedance feedback from the application of the sub-therapeutic energy also may be employed to activate a therapeutic level of the electrosurgical/RF generator module 23 to seal the tissue (e.g., vessel) clamped between claim elements of the end effector assembly 26.

In another aspect, the ultrasonic generator module 21 and the electrosurgical/RF generator module 23 may be activated simultaneously. In one example, the ultrasonic generator module 21 is simultaneously activated with a sub-therapeutic RF energy level to measure tissue impedance simultaneously while the ultrasonic blade of the end effector assembly 26 cuts and coagulates the tissue (or vessel) clamped between the clamp elements of the end effector assembly 26. Such feedback may be employed, for example, to modify the drive output of the ultrasonic generator module 21. In another example, the ultrasonic generator module 21 may be driven simultaneously with electrosurgical/RF generator module 23 such that the ultrasonic blade portion of the end effector assembly 26 is employed for cutting the damaged tissue while the electrosurgical/RF energy is applied to electrode portions of the end effector clamp assembly 26 for sealing the tissue (or vessel).

When the generator 20 is activated via the triggering mechanism, electrical energy is continuously applied by the generator 20 to a transducer stack or assembly of the acoustic assembly. In another aspect, electrical energy is intermittently applied (e.g., pulsed) by the generator 20. A phaselocked loop in the control system of the generator 20 may monitor feedback from the acoustic assembly. The phase lock loop adjusts the frequency of the electrical energy sent by the generator 20 to match the resonant frequency of the selected longitudinal mode of vibration of the acoustic assembly. In addition, a second feedback loop in the control system 25 maintains the electrical current supplied to the acoustic assembly at a pre-selected constant level in order to achieve substantially constant excursion at the end effector 18 of the acoustic assembly. In yet another aspect, a third feedback loop in the control system 25 monitors impedance between electrodes located in the end effector assembly 26. Although FIGS. 1-5 show a manually operated ultrasonic surgical instrument, it will be appreciated that ultrasonic surgical instruments may also be used in robotic applications, for example, as described herein as well as combinations of manual and robotic applications.

In ultrasonic operation mode, the electrical signal supplied to the acoustic assembly may cause the distal end of the end effector 18, to vibrate longitudinally in the range of, for example, approximately 20 kHz to 250 kHz. According to various aspects, the ultrasonic blade 22 may vibrate in the range of about 54 kHz to 56 kHz, for example, at about 55.5 kHz. In other aspects, the ultrasonic blade 22 may vibrate at other frequencies including, for example, about 31 kHz or about 80 kHz. The excursion of the vibrations at the ultrasonic blade can be controlled by, for example, controlling the amplitude of the electrical signal applied to the transducer assembly of the acoustic assembly by the generator 20. As noted above, the triggering mechanism of the generator 20 allows a user to activate the generator 20 so that electrical energy may be continuously or intermittently supplied to the acoustic assembly. The generator 20 also has a power line for insertion in an electro-surgical unit or conventional electrical outlet. It is contemplated that the generator 20 can also be powered by a direct current (DC) source, such as a battery. The generator 20 can comprise any suitable generator, such as Model No. GEN04, and/or Model No. GEN11 available from Ethicon Endo-Surgery, Inc.

FIG. 2 is a left perspective view of one example aspect of the ultrasonic surgical instrument 10 showing the handle assembly 12, the distal rotation assembly 13, and the elongated shaft assembly 14. FIG. 3 shows the end effector assembly 26. In the illustrated aspect the elongated shaft assembly 14 comprises a distal end 52 dimensioned to mechanically engage the end effector assembly 26 and a proximal end 50 that mechanically engages the handle assembly 12 and the distal rotation assembly 13. The proximal end 50 of the elongated shaft assembly 14 is received within the handle assembly 12 and the distal rotation assembly 13. More details relating to the connections between the elongated shaft assembly 14, the handle assembly 12, and the distal rotation assembly 13 are provided in the description of FIG. 5. In the illustrated aspect, the trigger assembly 24 comprises a trigger 32 that operates in conjunction with a fixed handle 34. The fixed handle 34 and the trigger 32 are ergonomically formed and adapted to interface comfortably with the user. The fixed handle 34 is integrally associated with the handle assembly 12. The trigger 32 is pivotally movable relative to the fixed handle 34 as explained in more detail below with respect to the operation of the ultrasonic surgical instrument 10. The trigger 32 is pivotally movable in direction 33a toward the fixed handle 34 when the user applies a squeezing force against the trigger 32. A spring element 98 (FIG. 5) causes the trigger 32 to pivotally move in direction 33b when the user releases the squeezing force against the trigger 32.

In one example aspect, the trigger 32 comprises an elongated trigger hook 36, which defines an aperture 38 between the elongated trigger hook 36 and the trigger 32. The aperture 38 is suitably sized to receive one or multiple fingers of the user therethrough. The trigger 32 also may comprise a resilient portion 32 a molded over the trigger 32 substrate. The overmolded resilient portion 32 a is formed to provide a more comfortable contact surface for control of the trigger 32 in outward direction 33 b. In one example aspect, the overmolded resilient portion 32 a may be provided over a portion of the elongated trigger hook 36. The proximal surface of the elongated trigger hook 32 remains uncoated or coated with a non-resilient substrate to enable the user to easily slide their fingers in and out of the aperture 38. In another aspect, the geometry of the trigger forms a fully closed loop which defines an aperture suitably sized to receive one or multiple fingers of the user therethrough. The fully closed loop trigger also may comprise a resilient portion molded over the trigger substrate.

In one example aspect, the fixed handle 34 comprises a proximal contact surface 40 and a grip anchor or saddle surface 42. The saddle surface 42 rests on the web where the thumb and the index finger are joined on the hand. The proximal contact surface 40 has a pistol grip contour that receives the palm of the hand in a normal pistol grip with no rings or apertures. The profile curve of the proximal contact surface 40 may be contoured to accommodate or receive the palm of the hand. A stabilization tail 44 is located towards a more proximal portion of the handle assembly 12. The stabilization tail 44 may be in contact with the uppermost web portion of the hand located between the thumb and the index finger to stabilize the handle assembly 12 and make the handle assembly 12 more controllable.

In one example aspect, the switch assembly 28 may comprise a toggle switch 30. The toggle switch 30 may be implemented as a single component with a central pivot 304 located within inside the handle assembly 12 to eliminate the possibility of simultaneous activation. In one example aspect, the toggle switch 30 comprises a first projecting knob 30a and a second projecting knob 30b to set the power setting of the ultrasonic transducer 16 between a minimum power level (e.g., MIN) and a maximum power level (e.g., MAX). In another aspect, the rocker switch may pivot between a standard setting and a special setting. The special setting may allow one or more special programs, processes, or algorithms and described herein to be implemented by the device. The toggle switch 30 rotates about the central pivot as the first projecting knob 30a and the second projecting knob 30b are actuated The one or more projecting knobs 30a, 30b are coupled to one or more arms that move through a small arc and cause electrical contacts to close or open an electric circuit to electrically energize or de-energize the ultrasonic transducer 16 in accordance with the activation of the first or second projecting knobs 30a, 30b. The toggle switch 30 is coupled to the generator 20 to control the activation of the ultrasonic transducer 16. The toggle switch 30 comprises one or more electrical power setting switches to activate the ultrasonic transducer 16 to set one or more power settings for the ultrasonic transducer 16. The forces required to activate the toggle switch 30 are directed substantially toward the saddle point 42, thus avoiding any tendency of the instrument to rotate in the hand when the toggle switch 30 is activated.

In one example aspect, the first and second projecting knobs 30a, 30b are located on the distal end of the handle assembly 12 such that they can be easily accessible by the user to activate the power with minimal, or substantially no, repositioning of the hand grip, making it suitable to maintain control and keep attention focused on the surgical site (e.g., a monitor in a laparoscopic procedure) while activating the toggle switch 30. The projecting knobs 30a, 30b may be configured to wrap around the side of the handle assembly 12 to some extent to be more easily accessible by variable finger lengths and to allow greater freedom of access to activation in awkward positions or for shorter fingers. In the illustrated aspect, the first projecting knob 30a comprises a plurality of tactile elements 30c, e.g., textured projections or “bumps” in the illustrated aspect, to allow the user to differentiate the first projecting knob 30a from the second projecting knob 30b. It will be appreciated by those skilled in the art that several ergonomic features may be incorporated into the handle assembly 12. Such ergonomic features are described in U.S. Pat. App. Pub. No. 2009/0105750 entitled “Ergonomic Surgical Instruments” which is incorporated by reference herein in its entirety.

In one example aspect, the toggle switch 30 may be operated by the hand of the user. The user may easily access the first and second projecting knobs 30a, 30b at any point while also avoiding inadvertent or unintentional activation at any time. The toggle switch 30 may readily operated with a finger to control the power to the ultrasonic assembly 16 and/or to the ultrasonic assembly 16. For example, the index finger may be employed to activate the first contact portion 30a to tum on the ultrasonic assembly 16 to a maximum (MAX) power level. The index finger may be employed to activate the second contact portion 30b to tum on the ultrasonic assembly 16 to a minimum (MIN) power level. In another aspect, the rocker switch may pivot the instrument 10 between a standard setting and a special setting. The special setting may allow one or more special programs to be implemented by the instrument 10. The toggle switch 30 may be operated without the user having to look at the first or second projecting knob 30a, 30b. For example, the first projecting knob 30a or the second projecting knob 30b may comprise a texture or projections to tactilely differentiate between the first and second projecting knobs 30a, 30b without looking.

In one example aspect, the distal rotation assembly 13 is rotatable without limitation in either direction about a longitudinal axis “T.” The distal rotation assembly 13 is mechanically engaged to the elongated shaft assembly 14. The distal rotation assembly 13 is located on a distal end of the handle assembly 12. The distal rotation assembly 13 comprises a cylindrical hub 46 and a rotation knob 48 formed over the hub 46. The hub 46 mechanically engages the elongated shaft assembly 14. The rotation knob 48 may comprise fluted polymeric features and may be engaged by a finger (e.g., an index finger) to rotate the elongated shaft assembly 14. The hub 46 may comprise a material molded over the primary structure to form the rotation knob 48. The rotation knob 48 may be overmolded over the hub 46. The hub 46 comprises an end cap portion 46a that is exposed at the distal end. The end cap portion 46a of the hub 46 may contact the surface of a trocar during laparoscopic procedures. The hub 46 may be formed of a hard durable plastic such as polycarbonate to alleviate any friction that may occur between the end cap portion 46a and the trocar. The rotation knob 48 may comprise “scallops” or flutes formed of raised ribs 48a and concave portions 48b located between the ribs 48a to provide a more precise rotational grip. In one example aspect, the rotation knob 48 may comprise a plurality of flutes (e.g., three or more flutes). In other aspects, any suitable number of flutes may be employed. The rotation knob 48 may be formed of a softer polymeric material overmolded onto the hard plastic material. For example, the rotation knob 48 may be formed of pliable, resilient, flexible polymeric materials including Versaflex® TPE alloys made by GLS Corporation, for example. This softer overmolded material may provide a greater grip and more precise control of the movement of the rotation knob 48. It will be appreciated that any materials that provide adequate resistance to sterilization, are biocompatible, and provide adequate frictional resistance to surgical gloves may be employed to form the rotation knob 48.

In one example aspect, the handle assembly 12 is formed from two (2) housing portions or shrouds comprising a first portion 12a and a second portion 12b. From the perspective of a user viewing the handle assembly 12 from the distal end towards the proximal end, the first portion 12a is considered the right portion and the second portion 12b is considered the left portion. Each of the first and second portions 12a, 12b includes a plurality of interfaces 69 (FIG. 5) dimensioned to mechanically align and engage each another to form the handle assembly 12 and enclosing the internal working components thereof. The fixed handle 34, which is integrally associated with the handle assembly 12, takes shape upon the assembly of the first and second portions 12a and 12b of the handle assembly 12. A plurality of additional interfaces (not shown) may be disposed at various points around the periphery of the first and second portions 12a and 12b of the handle assembly 12 for ultrasonic welding purposes, e.g., energy direction/deflection points. The first and second portions 12a and 12b (as well as the other components described below) may be assembled together in any fashion known in the art. For example, alignment pins, snap-like interfaces, tongue and groove interfaces, locking tabs, adhesive ports, may all be utilized either alone or in combination for assembly purposes.

In one example aspect, the elongated shaft assembly 14 comprises a proximal end 50 adapted to mechanically engage the handle assembly 12 and the distal rotation assembly 13; and a distal end 52 adapted to mechanically engage the end effector assembly 26. The elongated shaft assembly 14 comprises an outer tubular sheath 56 and a reciprocating tubular actuating member 58 located within the outer tubular sheath 56. The proximal end of the tubular reciprocating tubular actuating member 58 is mechanically engaged to the trigger 32 of the handle assembly 12 to move in either direction 60A or 60B in response to the actuation and/or release of the trigger 32. The pivotably moveable trigger 32 may generate reciprocating motion along the longitudinal axis “T.” Such motion may be used, for example, to actuate the jaws or clamping mechanism of the end effector assembly 26. A series of linkages translate the pivotal rotation of the trigger 32 to axial movement of a yoke coupled to an actuation mechanism, which controls the opening and closing of the jaws of the clamping mechanism of the end effector assembly 26. The distal end of the tubular reciprocating tubular actuating member 58 is mechanically engaged to the end effector assembly 26. In the illustrated aspect, the distal end of the tubular reciprocating tubular actuating member 58 is mechanically engaged to a clamp arm assembly 64, which is pivotable about a pivot point 70 (FIG. 4), to open and close the clamp arm assembly 64 in response to the actuation and/or release of the trigger 32. For example, in the illustrated aspect, the clamp arm assembly 64 is movable in direction 62A from an open position to a closed position about a pivot point 70 when the trigger 32 is squeezed in direction 33 a. The clamp arm assembly 64 is movable in direction 62B from a closed position to an open position about the pivot point 70 when the trigger 32 is released or outwardly contacted in direction 33b.

In one example aspect, the end effector assembly 26 is attached at the distal end 52 of the elongated shaft assembly 14 and includes a clamp arm assembly 64 and a ultrasonic blade 66. The jaws of the clamping mechanism of the end effector assembly 26 are formed by clamp arm assembly 64 and the ultrasonic blade 66. The ultrasonic blade 66 is ultrasonically actuatable and is acoustically coupled to the ultrasonic transducer 16. The trigger 32 on the handle assembly 12 is ultimately connected to a drive assembly, which together, mechanically cooperate to effect movement of the clamp arm assembly 64. Squeezing the trigger 32 in direction 33a moves the clamp arm assembly 64 in direction 62A from an open position, wherein the clamp arm assembly 64 and the ultrasonic blade 66 are disposed in a spaced relation relative to one another, to a clamped or closed position, wherein the clamp arm assembly 64 and the ultrasonic blade 66 cooperate to grasp tissue therebetween. The clamp arm assembly 64 may comprise a clamp pad 69 to engage tissue between the ultrasonic blade 66 and the clamp arm 64. Releasing the trigger 32 in direction 33b moves the clamp arm assembly 64 in direction 62B from a closed relationship, to an open position, wherein the clamp arm assembly 64 and the ultrasonic blade 66 are disposed in a spaced relation relative to one another.

The proximal portion of the handle assembly 12 comprises a proximal opening 68 to receive the distal end of the ultrasonic assembly 16. The ultrasonic assembly 16 is inserted in the proximal opening 68 and is mechanically engaged to the elongated shaft assembly 14.

In one example aspect, the elongated trigger hook 36 portion of the trigger 32 provides a longer trigger lever with a shorter span and rotation travel. The longer lever of the elongated trigger hook 36 allows the user to employ multiple fingers within the aperture 38 to operate the elongated trigger hook 36 and cause the trigger 32 to pivot in direction 33b to open the jaws of the end effector assembly 26. For example, the user may insert three fingers (e.g., the middle, ring, and little fingers) in the aperture 38. Multiple fingers allows the surgeon to exert higher input forces on the trigger 32 and the elongated trigger hook 326 to activate the end effector assembly 26. The shorter span and rotation travel creates a more comfortable grip when closing or squeezing the trigger 32 in direction 33a or when opening the trigger 32 in the outward opening motion in direction 33b lessening the need to extend the fingers further outward. This substantially lessens hand fatigue and strain associated with the outward opening motion of the trigger 32 in direction 33b. The outward opening motion of the trigger may be spring-assisted by spring element 98 (FIG. 5) to help alleviate fatigue. The opening spring force is sufficient to assist the ease of opening, but not strong enough to adversely impact the tactile feedback of tissue tension during spreading dissection.

For example, during a surgical procedure either the index finger may be used to control the rotation of the elongated shaft assembly 14 to locate the jaws of the end effector assembly 26 in a suitable orientation. The middle and/or the other lower fingers may be used to squeeze the trigger 32 and grasp tissue within the jaws. Once the jaws are located in the desired position and the jaws are clamped against the tissue, the index finger can be used to activate the toggle switch 30 to adjust the power level of the ultrasonic transducer 16 to treat the tissue. Once the tissue has been treated, the user the may release the trigger 32 by pushing outwardly in the distal direction against the elongated trigger hook 36 with the middle and/or lower fingers to open the jaws of the end effector assembly 26. This basic procedure may be performed without the user having to adjust their grip of the handle assembly 12.

FIGS. 3-4 illustrate the connection of the elongated shaft assembly 14 relative to the end effector assembly 26. As previously described, in the illustrated aspect, the end effector assembly 26 comprises a clamp arm assembly 64 and a ultrasonic blade 66 to form the jaws of the clamping mechanism. The ultrasonic blade 66 may be an ultrasonically actuatable ultrasonic blade acoustically coupled to the ultrasonic transducer 16. The trigger 32 is mechanically connected to a drive assembly. Together, the trigger 32 and the drive assembly mechanically cooperate to move the clamp arm assembly 64 to an open position in direction 62A wherein the clamp arm assembly 64 and the ultrasonic blade 66 are disposed in spaced relation relative to one another, to a clamped or closed position in direction 62B wherein the clamp arm assembly 64 and the ultrasonic blade 66 cooperate to grasp tissue therebetween. The clamp arm assembly 64 may comprise a clamp pad 69 to engage tissue between the ultrasonic blade 66 and the clamp arm 64. The distal end of the tubular reciprocating tubular actuating member 58 is mechanically engaged to the end effector assembly 26. In the illustrated aspect, the distal end of the tubular reciprocating tubular actuating member 58 is mechanically engaged to the clamp arm assembly 64, which is pivotable about the pivot point 70, to open and close the clamp arm assembly 64 in response to the actuation and/or release of the trigger 32. For example, in the illustrated aspect, the clamp arm assembly 64 is movable from an open position to a closed position in direction 62B about a pivot point 70 when the trigger 32 is squeezed in direction 33a. The clamp arm assembly 64 is movable from a closed position to an open position in direction 62A about the pivot point 70 when the trigger 32 is released or outwardly contacted in direction 33b.

As previously discussed, the clamp arm assembly 64 may comprise electrodes electrically coupled to the electrosurgical/RF generator module 23 to receive therapeutic and/or sub-therapeutic energy, where the electrosurgical/RF energy may be applied to the electrodes either simultaneously or non simultaneously with the ultrasonic energy being applied to the ultrasonic blade 66. Such energy activations may be applied in any suitable combinations to achieve a desired tissue effect in cooperation with an algorithm or other control logic.

FIG. 5 is an exploded view of the ultrasonic surgical instrument 10 shown in FIG. 2. In the illustrated aspect, the exploded view shows the internal elements of the handle assembly 12, the handle assembly 12, the distal rotation assembly 13, the switch assembly 28, and the elongated shaft assembly 14. In the illustrated aspect, the first and second portions 12a, 12b mate to form the handle assembly 12. The first and second portions 12a, 12b each comprises a plurality of interfaces 69 dimensioned to mechanically align and engage one another to form the handle assembly 12 and enclose the internal working components of the ultrasonic surgical instrument 10. The rotation knob 48 is mechanically engaged to the outer tubular sheath 56 so that it may be rotated in circular direction 54 up to 360°. The outer tubular sheath 56 is located over the reciprocating tubular actuating member 58, which is mechanically engaged to and retained within the handle assembly 12 via a plurality of coupling elements 72. The coupling elements 72 may comprise an O-ring 72a, a tube collar cap 72b, a distal washer 72c, a proximal washer 72d, and a thread tube collar 72e. The reciprocating tubular actuating member 58 is located within a reciprocating yoke 84, which is retained between the first and second portions 12a, 12b of the handle assembly 12. The yoke 84 is part of a reciprocating yoke assembly 88. A series of linkages translate the pivotal rotation of the elongated trigger hook 32 to the axial movement of the reciprocating yoke 84, which controls the opening and closing of the jaws of the clamping mechanism of the end effector assembly 26 at the distal end of the ultrasonic surgical instrument 10. In one example aspect, a four-link design provides mechanical advantage in a relatively short rotation span, for example.

In one example aspect, an ultrasonic transmission waveguide 78 is disposed inside the reciprocating tubular actuating member 58. The distal end 52 of the ultrasonic transmission waveguide 78 is acoustically coupled (e.g., directly or indirectly mechanically coupled) to the ultrasonic blade 66 and the proximal end 50 of the ultrasonic transmission waveguide 78 is received within the handle assembly 12. The proximal end 50 of the ultrasonic transmission waveguide 78 is adapted to acoustically couple to the distal end of the ultrasonic transducer 16. The ultrasonic transmission waveguide 78 is isolated from the other elements of the elongated shaft assembly 14 by a protective sheath 80 and a plurality of isolation elements 82, such as silicone rings. The outer tubular sheath 56, the reciprocating tubular actuating member 58, and the ultrasonic transmission waveguide 78 are mechanically engaged by a pin 74. The switch assembly 28 comprises the toggle switch 30 and electrical elements 86a,b to electrically energize the ultrasonic transducer 16 in accordance with the activation of the first or second projecting knobs 30a, 30b.

In one example aspect, the outer tubular sheath 56 isolates the user or the patient from the ultrasonic vibrations of the ultrasonic transmission waveguide 78. The outer tubular sheath 56 generally includes a hub 76. The outer tubular sheath 56 is threaded onto the distal end of the handle assembly 12. The ultrasonic transmission waveguide 78 extends through the opening of the outer tubular sheath 56 and the isolation elements 82 isolate the ultrasonic transmission waveguide 24 from the outer tubular sheath 56. The outer tubular sheath 56 may be attached to the waveguide 78 with the pin 74. The hole to receive the pin 74 in the waveguide 78 may occur nominally at a displacement node. The waveguide 78 may screw or snap into the hand piece handle assembly 12 by a stud. Flat portions on the hub 76 may allow the assembly to be torqued to a required level. In one example aspect, the hub 76 portion of the outer tubular sheath 56 is preferably constructed from plastic and the tubular elongated portion of the outer tubular sheath 56 is fabricated from stainless steel. Alternatively, the ultrasonic transmission waveguide 78 may comprise polymeric material surrounding it to isolate it from outside contact.

In one example aspect, the distal end of the ultrasonic transmission waveguide 78 may be coupled to the proximal end of the ultrasonic blade 66 by an internal threaded connection, preferably at or near an antinode. It is contemplated that the ultrasonic blade 66 may be attached to the ultrasonic transmission waveguide 78 by any suitable means, such as a welded joint or the like. Although the ultrasonic blade 66 may be detachable from the ultrasonic transmission waveguide 78, it is also contemplated that the single element end effector (e.g., the ultrasonic blade 66) and the ultrasonic transmission waveguide 78 may be formed as a single unitary piece.

In one example aspect, the trigger 32 is coupled to a linkage mechanism to translate the rotational motion of the trigger 32 in directions 33a and 33b to the linear motion of the reciprocating tubular actuating member 58 in corresponding directions 60a and 60b (FIG. 2). The trigger 32 comprises a first set of flanges 98 with openings formed therein to receive a first yoke pin 94a. The first yoke pin 94a is also located through a set of openings formed at the distal end of the yoke 84. The trigger 32 also comprises a second set of flanges 96 to receive a first end of a link 92. A trigger pin 90 is received in openings formed in the link 92 and the second set of flanges 96. The trigger pin 90 is received in the openings formed in the link 92 and the second set of flanges 96 and is adapted to couple to the first and second portions 12a, 12b of the handle assembly 12 to form a trigger pivot point for the trigger 32. A second end of the link 92 is received in a slot formed in a proximal end of the yoke 84 and is retained therein by a second yoke pin 94b. As the trigger 32 is pivotally rotated about a pivot point formed by the trigger pin 90, the yoke translates horizontally along a longitudinal axis “T” in a direction indicated by arrows 60a,b.

FIG. 6 illustrates a diagram of one aspect of a force feedback surgical device 100 which may include or implement many of the features described herein. For example, in one aspect, surgical device 100 may be similar to or representative of surgical instrument 10. The surgical device 100 may include a generator 102. The surgical device 100 may also include an ultrasonic end effector 106, which may be activated when a clinician operates a trigger 110. When the trigger 110 is actuated, a force sensor 112 may generate a signal indicating the amount of force being applied to the trigger 110. In addition to, or instead of force sensor 112, the device 100 may include a position sensor 113, which may generate a signal indicating the position of the trigger 110 (e.g., how far the trigger has been depressed or otherwise actuated). In one aspect, the position sensor 113 may be a sensor positioned with the outer tubular sheath 56 described above or reciprocating tubular actuating member 58 located within the outer tubular sheath 56 described above In one aspect, the sensor may be a Hall-effect sensor or any suitable transducer that varies its output voltage in response to a magnetic field. The Hall effect sensor may be used for proximity switching, positioning, speed detection, and current sensing applications. In one aspect, the Hall-effect sensor operates as an analog transducer, directly returning a voltage. With a known magnetic field, its distance from the Hall plate can be determined.

A control circuit 108 may receive the signals from the sensors 112 and/or 113. The control circuit 108 may include any suitable analog or digital circuit components. The control circuit 108 also may communicate with the generator 102 and/or the transducer 104 to modulate the power delivered to the end effector 106 and/or the generator level or ultrasonic blade amplitude of the end effector 106 based on the force applied to the trigger 110 and/or the position of the trigger 110 and/or the position of the outer tubular sheath 56 described above relative to the reciprocating tubular actuating member 58 located within the outer tubular sheath 56 described above (e.g., as measured by a Hall-effect sensor and magnet combination). For example, as more force is applied to the trigger 110, more power and/or a higher ultrasonic blade amplitude may be delivered to the end effector 106. According to various aspects, the force sensor 112 may be replaced by a multi-position switch.

According to various aspects, the end effector 106 may include a clamp or clamping mechanism, for example, such as that described above with respect to FIGS. 1-5. When the trigger 110 is initially actuated, the clamping mechanism may close, clamping tissue between a clamp arm and the end effector 106. As the force applied to the trigger increases (e.g., as sensed by force sensor 112) the control circuit 608 may increase the power delivered to the end effector 106 by the transducer 104 and/or the generator level or ultrasonic blade amplitude brought about in the end effector 106. In one aspect, trigger position, as sensed by position sensor 113 or clamp or clamp arm position, as sensed by position sensor 113 (e.g., with a Hall-effect sensor), may be used by the control circuit 108 to set the power and/or amplitude of the end effector 106. For example, as the trigger is moved further towards a fully actuated position, or the clamp or clamp arm moves further towards the ultrasonic blade (or end effector 106), the power and/or amplitude of the end effector 106 may be increased.

According to various aspects, the surgical device 100 also may include one or more feedback devices for indicating the amount of power delivered to the end effector 106. For example, a speaker 114 may emit a signal indicative of the end effector power. According to various aspects, the speaker 114 may emit a series of pulse sounds, where the frequency of the sounds indicates power. In addition to, or instead of the speaker 114, the device may include a visual display 116. The visual display 116 may indicate end effector power according to any suitable method. For example, the visual display 116 may include a series of light emitting diodes (LEDs), where end effector power is indicated by the number of illuminated LEDs. The speaker 114 and/or visual display 116 may be driven by the control circuit 108. According to various aspects, the device 100 may include a ratcheting device (not shown) connected to the trigger 110. The ratcheting device may generate an audible sound as more force is applied to the trigger 110, providing an indirect indication of end effector power. The device 100 may include other features that may enhance safety. For example, the control circuit 108 may be configured to prevent power from being delivered to the end effector 106 in excess of a predetermined threshold. Also, the control circuit 108 may implement a delay between the time when a change in end effector power is indicated (e.g., by speaker 114 or display 116), and the time when the change in end effector power is delivered. In this way, a clinician may have ample warning that the level of ultrasonic power that is to be delivered to the end effector 106 is about to change.

FIG. 7 is a simplified diagram of one aspect of the generator 102 which may provide for inductorless tuning, among other benefits. FIGS. 8A-8C illustrate an architecture of the generator 102 of FIG. 7 according to one aspect of the present disclosure. FIG. 9 illustrates a controller 196 for monitoring input devices and controlling output devices in accordance with one aspect of the present disclosure. With reference now to FIGS. 7-9, the generator 102 may comprise a patient isolated stage 152 in communication with a non-isolated stage 154 via a power transformer 156. A secondary winding 158 of the power transformer 156 is contained in the isolated stage 152 and may comprise a tapped configuration (e.g., a center-tapped or non-center tapped configuration) to define drive signal outputs 160a, 160b, 160c for outputting drive signals to different surgical devices, such as, for example, a surgical device 100, ultrasonic surgical instrument 10, or an electrosurgical device. In particular, drive signal outputs 160a, 160c may output a drive signal (e.g., a 420V RMS drive signal) to an ultrasonic instrument 10, and drive signal outputs 160b, 160c may output a drive signal (e.g., a 100V RMS drive signal) to an electro surgical device, with output 160b corresponding to the center tap of the power transformer 156. The non-isolated stage 154 may comprise a power amplifier 162 having an output connected to a primary winding 164 of the power transformer 156. In certain aspects the power amplifier 162 may comprise a push-pull amplifier, for example. The non-isolated stage 154 may further comprise a programmable logic device 166 for supplying a digital output to a digital-to-analog converter (DAC) 168, which in tum supplies a corresponding analog signal to an input of the power amplifier 162. In certain aspects the programmable logic device 166 may comprise a field-programmable gate array (FPGA), for example. The programmable logic device 166, by virtue of controlling the power amplifier's 162 input via the DAC 168, may therefore control any of a number of parameters (e.g., frequency, waveform shape, waveform amplitude) of drive signals appearing at the drive signal outputs 160a, 160b, 160c. In certain aspects and as discussed below, the programmable logic device 166, in conjunction with a processor (e.g., processor 174 discussed below), may implement a number of digital signal processing (DSP)-based and/or other control algorithms to control parameters of the drive signals output by the generator 102.

Power may be supplied to a power rail of the power amplifier 162 by a switch-mode regulator 170. In certain aspects the switch-mode regulator 170 may comprise an adjustable buck regulator, for example. The non-isolated stage 154 may further comprise a processor 174, which in one aspect may comprise a DSP processor such as an Analog Devices ADSP-21469 SHARC DSP, available from Analog Devices, Norwood, Mass., for example. In certain aspects the processor 174 may control operation of the switch-mode power converter 170 responsive to voltage feedback data received from the power amplifier 162 by the processor 174 via an analog-to-digital converter (ADC) 176. In one aspect, for example, the processor 174 may receive as input, via the ADC 176, the waveform envelope of a signal (e.g., an RF signal) being amplified by the power amplifier 162. The processor 174 may then control the switch-mode regulator 170 (e.g., via a pulse-width modulated (PWM) output) such that the rail voltage supplied to the power amplifier 162 tracks the waveform envelope of the amplified signal. By dynamically modulating the rail voltage of the power amplifier 162 based on the waveform envelope, the efficiency of the power amplifier 162 may be significantly improved relative to a fixed rail voltage amplifier schemes.

In certain aspects and as discussed in further detail in connection with FIGS. 10A and 10B, the programmable logic device 166, in conjunction with the processor 174, may implement a direct digital synthesizer (DDS) control scheme to control the waveform shape, frequency and/or amplitude of drive signals output by the generator 102. In one aspect, for example, the programmable logic device 166 may implement a DDS control algorithm 268 by recalling waveform samples stored in a dynamically-updated lookup table (LUT), such as a RAM LUT which may be emebedded in an FPGA. This control algorithm is particularly useful for ultrasonic applications in which an ultrasonic transducer may be driven by a clean sinusoidal current at its resonant frequency. Because other frequencies may excite parasitic resonances, minimizing or reducing the total distortion of the motional branch current may correspondingly minimize or reduce undesirable resonance effects. Because the waveform shape of a drive signal output by the generator 102 is impacted by various sources of distortion present in the output drive circuit (e.g., the power transformer 156, the power amplifier 162), voltage and current feedback data based on the drive signal may be input into an algorithm, such as an error control algorithm implemented by the processor 174, which compensates for distortion by suitably pre-distorting or modifying the waveform samples stored in the LUT on a dynamic, ongoing basis (e.g., in real-time). In one aspect, the amount or degree of pre-distortion applied to the LUT samples may be based on the error between a computed motional branch current and a desired current waveform shape, with the error being determined on a sample-by sample basis. In this way, the predistorted LUT samples, when processed through the drive circuit, may result in a motional branch drive signal having the desired waveform shape (e.g., sinusoidal) for optimally driving the ultrasonic transducer. In such aspects, the LUT waveform samples will therefore not represent the desired waveform shape of the drive signal, but rather the waveform shape that is required to ultimately produce the desired waveform shape of the motional branch drive signal when distortion effects are taken into account.

The non-isolated stage 154 may further comprise an ADC 178 and an ADC 180 coupled to the output of the power transformer 156 via respective isolation transformers 182, 184 for respectively sampling the voltage and current of drive signals output by the generator 102. In certain aspects, the ADCs 178, 180 may be configured to sample at high speeds (e.g., 80 Msps) to enable oversampling of the drive signals. In one aspect, for example, the sampling speed of the ADCs 178, 180 may enable approximately 200× (depending on drive frequency) oversampling of the drive signals. In certain aspects, the sampling operations of the ADCs 178, 180 may be performed by a singleADC receiving input voltage and current signals via a two-way multiplexer. The use of high-speed sampling in aspects of the generator 102 may enable, among other things, calculation of the complex current flowing through the motional branch (which may be used in certain aspects to implement DDSbased waveform shape control described above), accurate digital filtering of the sampled signals, and calculation of real power consumption with a high degree of precision. Voltage and current feedback data output by the ADCs 178, 180 may be received and processed (e.g., FIFO buffering, multiplexing) by the programmable logic device 166 and stored in data memory for subsequent retrieval by, for example, the processor 174. As noted above, voltage and current feedback data may be used as input to an algorithm for pre-distorting or modifying LUT waveform samples on a dynamic and ongoing basis. In certain aspects, this may require each stored voltage and current feedback data pair to be indexed based on, or otherwise associated with, a corresponding LUT sample that was output by the programmable logic device 166 when the voltage and current feedback data pair was acquired. Synchronization of the LUT samples and the voltage and current feedback data in this manner contributes to the correct timing and stability of the pre-distortion algorithm.

In certain aspects, the voltage and current feedback data may be used to control the frequency and/or amplitude (e.g., current amplitude) of the drive signals. In one aspect, for example, voltage and current feedback data may be used to determine impedance phase. The frequency of the drive signal may then be controlled to minimize or reduce the difference between the determined impedance phase and an impedance phase setpoint (e.g., 0°), thereby minimizing or reducing the effects of ultrasonic distortion and correspondingly enhancing impedance phase measurement accuracy. The determination of phase impedance and a frequency control signal may be implemented in the processor 174, for example, with the frequency control signal being supplied as input to a DDS control algorithm implemented by the programmable logic device 166.

In another aspect, for example, the current feedback data may be monitored in order to maintain the current amplitude of the drive signal at a current amplitude setpoint. The current amplitude setpoint may be specified directly or determined indirectly based on specified voltage amplitude and power setpoints. In certain aspects, control of the current amplitude may be implemented by control algorithm, such as, for example, a proportional-integral-derivative (PID) or a proportional-integral (PI) control algorithm, in the processor 174. Variables controlled by the control algorithm to suitably control the current amplitude of the drive signal may include, for example, the scaling of the LUT waveform samples stored in the programmable logic device 166 and/or the full-scale output voltage of the DAC 168 (which supplies the input to the power amplifier 162) via a DAC 186.

The non-isolated stage 154 may further comprise a processor 190 for providing, among other things user interface (UI) functionality. In one aspect, the processor 190 may comprise an Atmel AT91 SAM9263 processor having an ARM926 EJ-S core, available from Atmel Corporation, San Jose, Calif., for example. Examples of UI functionality supported by the processor 190 may include audible and visual user feedback, communication with peripheral devices (e.g., via a Universal Serial Bus (USB) interface), communication with the footswitch 120, communication with an input device 145 (e.g., a touch screen display) and communication with an output device 146 (e.g., a speaker). The processor 190 may communicate with the processor 174 and the programmable logic device (e.g., via serial peripheral interface (SPI) buses). Although the processor 190 may primarily support UI functionality, it may also coordinate with the processor 174 to implement hazard mitigation in certain aspects. For example, the processor 190 may be programmed to monitor various aspects of user input and/or other inputs (e.g., touch screen inputs, footswitch 120 inputs, temperature sensor inputs) and may disable the drive output of the generator 102 when an erroneous condition is detected.

In certain aspects, both the processor 174 and the processor 190 may determine and monitor the operating state of the generator 102. For the processor 174, the operating state of the generator 102 may dictate, for example, which control and/or diagnostic processes are implemented by the processor 174. For the processor 190, the operating state of the generator 102 may dictate, for example, which elements of a user interface (e.g., display screens, sounds) are presented to a user. The processors 174, 190 may independently maintain the current operating state of the generator 102 and recognize and evaluate possible transitions out of the current operating state. The processor 174 may function as the master in this relationship and determine when transitions between operating states are to occur. The processor 190 may be aware of valid transitions between operating states and may confirm if a particular transition is appropriate. For example, when the processor 174 instructs the processor 190 to transition to a specific state, the processor 190 may verify that requested transition is valid. In the event that a requested transition between states is determined to be invalid by the processor 190, the processor 190 may cause the generator 102 to enter a failure mode.

The non-isolated stage 154 may further comprise a controller 196 for monitoring input devices 145 (e.g., a capacitive touch sensor used for turning the generator 102 on and off, a capacitive touch screen). In certain aspects, the controller 196 may comprise at least one processor and/or other controller device in communication with the processor 190. In one aspect, for example, the controller 196 may comprise a processor (e.g., a Mega168 8-bit controller available from Atmel) configured to monitor user input provided via one or more capacitive touch sensors. In one aspect, the controller 196 may comprise a touch screen controller (e.g., a QT5480 touch screen controller available from Atmel) to control and manage the acquisition of touch data from a capacitive touch screen.

In certain aspects, when the generator 102 is in a “power off” state, the controller 196 may continue to receive operating power (e.g., via a line from a power supply of the generator 102, such as the power supply 211 discussed below). In this way, the controller 196 may continue to monitor an input device 145 (e.g., a capacitive touch sensor located on a front panel of the generator 102) for turning the generator 102 on and off. When the generator 102 is in the power off state, the controller 196 may wake the power supply (e.g., enable operation of one or more DC/DC voltage converters 213 of the power supply 211) if activation of the “on/off” input device 145 by a user is detected. The controller 196 may therefore initiate a sequence for transitioning the generator 102 to a “power on” state. Conversely, the controller 196 may initiate a sequence for transitioning the generator 102 to the power off state if activation of the “on/off” input device 145 is detected when the generator 102 is in the power on state. In certain aspects, for example, the controller 196 may report activation of the “on/off” input device 145 to the processor 190, which in tum implements the necessary process sequence for transitioning the generator 102 to the power off state. In such aspects, the controller 196 may have no independent ability for causing the removal of power from the generator 102 after its power on state has been established.

In certain aspects, the controller 196 may cause the generator 102 to provide audible or other sensory feedback for alerting the user that a power on or power off sequence has been initiated. Such an alert may be provided at the beginning of a power on or power off sequence and prior to the commencement of other processes associated with the sequence.

In certain aspects, the isolated stage 152 may comprise an instrument interface circuit 198 to, for example, provide a communication interface between a control circuit of a surgical device (e.g., a control circuit comprising handpiece switches) and components of the non-isolated stage 154, such as, for example, the programmable logic device 166, the processor 174 and/or the processor 190. The instrument interface circuit 198 may exchange information with components of the non-isolated stage 154 via a communication link that maintains a suitable degree of electrical isolation between the stages 152, 154, such as, for example, an infrared (IR)-based communication link. Power may be supplied to the instrument interface circuit 198 using, for example, a low-dropout voltage regulator powered by an isolation transformer driven from the non-isolated stage 154.

In one aspect, the instrument interface circuit 198 may comprise a programmable logic device 200 (e.g., an FPGA) in communication with a signal conditioning circuit 202. The signal conditioning circuit 202 may be configured to receive a periodic signal from the programmable logic device 200 (e.g., a 2 kHz square wave) to generate a bipolar interrogation signal having an identical frequency. The interrogation signal may be generated, for example, using a bipolar current source fed by a differential amplifier. The interrogation signal may be communicated to a surgical device control circuit (e.g., by using a conductive pair in a cable that connects the generator 102 to the surgical device) and monitored to determine a state or configuration of the control circuit. The control circuit may comprise a number of switches, resistors and/or diodes to modify one or more characteristics (e.g., amplitude, rectification) of the interrogation signal such that a state or configuration of the control circuit is uniquely discernable based on the one or more characteristics. In one aspect, for example, the signal conditioning circuit 202 may comprise an ADC for generating samples of a voltage signal appearing across inputs of the control circuit resulting from passage of interrogation signal therethrough. The programmable logic device 200 (or a component of the nonisolated stage 154) may then determine the state or configuration of the control circuit based on the ADC samples.

In one aspect, the instrument interface circuit 198 may comprise a first data circuit interface 204 to enable information exchange between the programmable logic device 200 (or other element of the instrument interface circuit 198) and a first data circuit disposed in or otherwise associated with a surgical device. In certain aspects, a first data circuit 206 may be disposed in a cable integrally attached to a surgical device handpiece, or in an adaptor for interfacing a specific surgical device type or model with the generator 102. In certain aspects, the first data circuit may comprise a non-volatile storage device, such as an electrically erasable programmable read-only memory (EEPROM) device. In certain aspects and referring again to FIG. 7, the first data circuit interface 204 may be implemented separately from the programmable logic device 200 and comprise suitable circuitry (e.g., discrete logic devices, a processor) to enable communication between the programmable logic device 200 and the first data circuit. In other aspects, the first data circuit interface 204 may be integral with the programmable logic device 200.

In certain aspects, the first data circuit 206 may store information pertaining to the particular surgical device with which it is associated. Such information may include, for example, a model number, a serial number, a number of operations in which the surgical device has been used, and/or any other type of information. This information may be read by the instrument interface circuit 198 (e.g., by the programmable logic device 200), transferred to a component of the non-isolated stage 154 (e.g., to programmable logic device 166, processor 174 and/or processor 190) for presentation to a user via an output device 146 and/or for controlling a function or operation of the generator 102. Additionally, any type of information may be communicated to first data circuit 206 for storage therein via the first data circuit interface 204 (e.g., using the programmable logic device 200). Such information may comprise, for example, an updated number of operations in which the surgical device has been used and/or dates and/or times of its usage.

A surgical instrument may be detachable from a handpiece to promote instrument interchangeability and/or disposability. In such cases, known generators may be limited in their ability to recognize particular instrument configurations being used and to optimize control and diagnostic processes accordingly. The addition of readable data circuits to surgical device instruments to address this issue is problematic from a compatibility standpoint, however. For example, designing a surgical device to remain backwardly compatible with generators that lack the requisite data reading functionality may be impractical due to, for example, differing signal schemes, design complexity and cost. Aspects of instruments may use data circuits that may be implemented in existing surgical instruments economically and with minimal design changes to preserve compatibility of the surgical devices with current generator platforms.

Additionally, aspects of the generator 102 may enable communication with instrument-based data circuits. For example, the generator 102 may be configured to communicate with a second data circuit contained in an instrument of a surgical device. The instrument interface circuit 198 may comprise a second data circuit interface 210 to enable this communication. In one aspect, the second data circuit interface 210 may comprise a tri-state digital interface, although other interfaces may also be used. In certain aspects, the second data circuit may generally be any circuit for transmitting and/or receiving data. In one aspect, for example, the second data circuit may store information pertaining to the particular surgical instrument with which it is associated. Such information may include, for example, a model number, a serial number, a number of operations in which the surgical instrument has been used, and/or any other type of information. Additionally or alternatively, any type of information may be communicated to second data circuit for storage therein via the second data circuit interface 210 (e.g., using the programmable logic device 200). Such information may comprise, for example, an updated number of operations in which the instrument has been used and/or dates and/or times of its usage. In certain aspects, the second data circuit may transmit data acquired by one or more sensors (e.g., an instrument-based temperature sensor). In certain aspects, the second data circuit may receive data from the generator 102 and provide an indication to a user (e.g., an LED indication or other visible indication) based on the received data.

In certain aspects, the second data circuit and the second data circuit interface 210 may be configured such that communication between the programmable logic device 200 and the second data circuit can be effected without the need to provide additional conductors for this purpose (e.g., dedicated conductors of a cable connecting a handpiece to the generator 102). In one aspect, for example, information may be communicated to and from the second data circuit using a 1-wire bus communication scheme implemented on existing cabling, such as one of the conductors used transmit interrogation signals from the signal conditioning circuit 202 to a control circuit in a handpiece. In this way, design changes or modifications to the surgical device that might otherwise be necessary are minimized or reduced. Moreover, because different types of communications can be implemented over a common physical channel (either with or without frequency-band separation), the presence of a second data circuit may be “invisible” to generators that do not have the requisite data reading functionality, thus enabling backward compatibility of the surgical device instrument. In certain aspects, the isolated stage 152 may comprise at least one blocking capacitor 296-1 connected to the drive signal output 160 b to prevent passage of DC current to a patient. A single blocking capacitor may be required to comply with medical regulations or standards, for example. While failure in single-capacitor designs is relatively uncommon, such failure may nonetheless have negative consequences. In one aspect, a second blocking capacitor 296-2 may be provided in series with the blocking capacitor 296-1, with current leakage from a point between the blocking capacitors 296-1, 296-2 being monitored by, for example, an ADC 298 for sampling a voltage induced by leakage current. The samples may be received by the programmable logic device 200, for example. Based on changes in the leakage current (as indicated by the voltage samples in the aspect of FIG. 7), the generator 102 may determine when at least one of the blocking capacitors 296-1, 296-2 has failed. Accordingly, the aspect of FIG. 7 may provide a benefit over single-capacitor designs having a single point of failure.

In certain aspects, the non-isolated stage 154 may comprise a power supply 211 for outputting DC power at a suitable voltage and current. The power supply may comprise, for example, a 400 W power supply for outputting a 48 VDC system voltage. The power supply 211 may further comprise one or more DC/DC voltage converters 213 for receiving the output of the power supply to generate DC outputs at the voltages and currents required by the various components of the generator 102. As discussed above in connection with the controller 196, one or more of the DC/DC voltage converters 213 may receive an input from the controller 196 when activation of the “on/off” input device 145 by a user is detected by the controller 196 to enable operation of, or wake, the DC/DC voltage converters 213.

FIGS. 10A and 10B illustrate certain functional and structural aspects of one aspect of the generator 102. Feedback indicating current and voltage output from the secondary winding 158 of the power transformer 156 is received by the ADCs 178, 180, respectively. As shown, the ADCs 178, 180 may be implemented as a 2-channel ADC and may sample the feedback signals at a high speed (e.g., 80 Msps) to enable oversampling (e.g., approximately 200× oversampling) of the drive signals. The current and voltage feedback signals may be suitably conditioned in the analog domain (e.g., amplified, filtered) prior to processing by the ADCs 178, 180. Current and voltage feedback samples from the ADCs 178, 180 may be individually buffered and subsequently multiplexed or interleaved into a single data stream within block 212 of the programmable logic device 166. In the aspect of FIGS. 10A and 10B, the programmable logic device 166 comprises an FPGA.

The multiplexed current and voltage feedback samples may be received by a parallel data acquisition port (PDAP) implemented within block 214 of the processor 174. The PDAP may comprise a packing unit for implementing any of a number of methodologies for correlating the multiplexed feedback samples with a memory address. In one aspect, for example, feedback samples corresponding to a particular LUT sample output by the programmable logic device 166 may be stored at one or more memory addresses that are correlated or indexed with the LUT address of the LUT sample. In another aspect, feedback samples corresponding to a particular LUT sample output by the programmable logic device 166 may be stored, along with the LUT address of the LUT sample, at a common memory location. In any event, the feedback samples may be stored such that the address of an LUT sample from which a particular set of feedback samples originated may be subsequently ascertained. As discussed above, synchronization of the LUT sample addresses and the feedback samples in this way contributes to the correct timing and stability of the pre-distortion algorithm. A direct memory access (DMA) controller implemented at block 216 of the processor 174 may store the feedback samples (and any LUT sample address data, where applicable) at a designated memory location 218 of the processor 174 (e.g., internal RAM).

Block 220 of the processor 174 may implement a pre-distortion algorithm for pre-distorting or modifying the LUT samples stored in the programmable logic device 166 on a dynamic, ongoing basis. As discussed above, pre-distortion of the LUT samples may compensate for various sources of distortion present in the output drive circuit of the generator 102. The pre-distorted LUT samples, when processed through the drive circuit, will therefore result in a drive signal having the desired waveform shape (e.g., sinusoidal) for optimally driving the ultrasonic transducer.

At block 222 of the pre-distortion algorithm, the current through the motional branch of the ultrasonic transducer is determined. The motional branch current may be determined using Kirchoffs Current Law based on, for example, the current and voltage feedback samples stored at memory location 218, a value of the ultrasonic transducer static capacitance Co (measured or known a priori) and a known value of the drive frequency. A motional branch current sample for each set of stored current and voltage feedback samples associated with a LUT sample may be determined.

At block 224 of the pre-distortion algorithm, each motional branch current sample determined at block 222 is compared to a sample of a desired current waveform shape to determine a difference, or sample amplitude error, between the compared samples. For this determination, the sample of the desired current waveform shape may be supplied, for example, from a waveform shape LUT 226 containing amplitude samples for one cycle of a desired current waveform shape. The particular sample of the desired current waveform shape from the LUT 226 used for the comparison may be dictated by the LUT sample address associated with the motional branch current sample used in the comparison. Accordingly, the input of the motional branch current to block 224 may be synchronized with the input of its associated LUT sample address to block 224. The LUT samples stored in the programmable logic device 166 and the LUT samples stored in the waveform shape LUT 226 may therefore be equal in number. In certain aspects, the desired current waveform shape represented by the LUT samples stored in the waveform shape LUT 226 may be a fundamental sine wave. Other waveform shapes may be desirable. For example, it is contemplated that a fundamental sine wave for driving main longitudinal motion of an ultrasonic transducer superimposed with one or more other drive signals at other frequencies, such as a third order ultrasonic for driving at least two mechanical resonances for beneficial vibrations of transverse or other modes, could be used.

Each value of the sample amplitude error determined at block 224 may be transmitted to the LUT of the programmable logic device 166 (shown at block 228 in FIG. 10A) along with an indication of its associated LUT address. Based on the value of the sample amplitude error and its associated address (and, optionally, values of sample amplitude error for the same LUT address previously received), the LUT 228 (or other control block of the programmable logic device 166) may pre-distort or modify the value of the LUT sample stored at the LUT address such that the sample amplitude error is reduced or minimized. It will be appreciated that such pre-distortion or modification of each LUT sample in an iterative manner across the entire range of LUT addresses will cause the waveform shape of the generator's output current to match or conform to the desired current waveform shape represented by the samples of the waveform shape LUT 226.

Current and voltage amplitude measurements, power measurements and impedance measurements may be determined at block 230 of the processor 174 based on the current and voltage feedback samples stored at memory location 218. Prior to the determination of these quantities, the feedback samples may be suitably scaled and, in certain aspects, processed through a suitable filter 232 to remove noise resulting from, for example, the data acquisition process and induced ultrasonic components. The filtered voltage and current samples may therefore substantially represent the fundamental frequency of the generator's drive output signal. In certain aspects, the filter 232 may be a finite impulse response (FIR) filter applied in the frequency domain. Such aspects may use the fast Fourier transform (FFT) of the output drive signal current and voltage signals. In certain aspects, the resulting frequency spectrum may be used to provide additional generator functionality. In one aspect, for example, the ratio of the second and/or third order ultrasonic component relative to the fundamental frequency component may be used as a diagnostic indicator. At block 234, a root mean square (RMS) calculation may be applied to a sample size of the current feedback samples representing an integral number of cycles of the drive signal to generate a measurement Irms representing the drive signal output current.

At block 236, a root mean square (RMS) calculation may be applied to a sample size of the voltage feedback samples representing an integral number of cycles of the drive signal to determine a measurement Vrms representing the drive signal output voltage. At block 238, the current and voltage feedback samples may be multiplied point by point, and a mean calculation is applied to samples representing an integral number of cycles of the drive signal to determine a measurement Pr of the generator's real output power.

At block 240, measurement Pa of the generator's apparent output power may be determined as the product Vrms. Irms.

At block 242, measurement Zm of the load impedance magnitude may be determined as the quotient Vrms/Irms.

In certain aspects, the quantities Irms, Vrms, Pr, Pa, and Zm determined at blocks 234, 236, 238, 240 and 242 may be used by the generator 102 to implement any of number of control and/or diagnostic processes. In certain aspects, any of these quantities may be communicated to a user via, for example, an output device 146 integral with the generator 102 or an output device 146 connected to the generator 102 through a suitable communication interface (e.g., a USB interface). Various diagnostic processes may include, without limitation, handpiece integrity, instrument integrity, instrument attachment integrity, instrument overload, approaching instrument overload, frequency lock failure, over-voltage, over-current, over-power, voltage sense failure, current sense failure, audio indication failure, visual indication failure, short circuit, power delivery failure, blocking capacitor failure, for example.

Block 244 of the processor 174 may implement a phase control algorithm for determining and controlling the impedance phase of an electrical load (e.g., the ultrasonic transducer) driven by the generator 102. As discussed above, by controlling the frequency of the drive signal to minimize or reduce the difference between the determined impedance phase and an impedance phase setpoint (e.g., 0°, the effects of ultrasonic distortion may be minimized or reduced, and the accuracy of the phase measurement increased.

The phase control algorithm receives as input the current and voltage feedback samples stored in the memory location 218. Prior to their use in the phase control algorithm, the feedback samples may be suitably scaled and, in certain aspects, processed through a suitable filter 246 (which may be identical to filter 232) to remove noise resulting from the data acquisition process and induced ultrasonic components, for example. The filtered voltage and current samples may therefore substantially represent the fundamental frequency of the generator's drive output signal.

At block 248 of the phase control algorithm, the current through the motional branch of the ultrasonic transducer is determined. This determination may be identical to that described above in connection with block 222 of the pre-distortion algorithm. The output of block 248 may thus be, for each set of stored current and voltage feedback samples associated with a LUT sample, a motional branch current sample.

At block 250 of the phase control algorithm, impedance phase is determined based on the synchronized input of motional branch current samples determined at block 248 and corresponding voltage feedback samples. In certain aspects, the impedance phase is determined as the average of the impedance phase measured at the rising edge of the waveforms and the impedance phase measured at the falling edge of the waveforms.

At block 252 of the of the phase control algorithm, the value of the impedance phase determined at block 222 is compared to phase setpoint 254 to determine a difference, or phase error, between the compared values.

At block 256 of the phase control algorithm, based on a value of phase error determined at block 252 and the impedance magnitude determined at block 242, a frequency output for controlling the frequency of the drive signal is determined. The value of the frequency output may be continuously adjusted by the block 256 and transferred to a DDS control block 268 (discussed below) in order to maintain the impedance phase determined at block 250 at the phase setpoint (e.g., zero phase error). In certain aspects, the impedance phase may be regulated to a oo phase setpoint. In this way, any ultrasonic distortion will be centered about the crest of the voltage waveform, enhancing the accuracy of phase impedance determination.

Block 258 of the processor 174 may implement an algorithm for modulating the current amplitude of the drive signal in order to control the drive signal current, voltage and power in accordance with user specified setpoints, or in accordance with requirements specified by other processes or algorithms implemented by the generator 102. Control of these quantities may be realized, for example, by scaling the LUT samples in the LUT 228 and/or by adjusting the full-scale output voltage of the DAC 168 (which supplies the input to the power amplifier 162) via a DAC 186. Block 260 (which may be implemented as a PID controller in certain aspects) may receive as input current feedback samples (which may be suitably scaled and filtered) from the memory location 218. The current feedback samples may be compared to a “current demand” Id value dictated by the controlled variable (e.g., current, voltage or power) to determine if the drive signal is supplying the necessary current. In aspects in which drive signal current is the control variable, the current demand Id may be specified directly by a current setpoint 262A (Isp). For example, an RMS value of the current feedback data (determined as in block 234) may be compared to user-specified RMS current setpoint Isp to determine the appropriate controller action. If, for example, the current feedback data indicates an RMS value less than the current setpoint Isp, LUT scaling and/or the full-scale output voltage of the DAC 168 may be adjusted by the block 260 such that the drive signal current is increased. Conversely, block 260 may adjust LUT scaling and/or the full-scale output voltage of the DAC 168 to decrease the drive signal current when the current feedback data indicates an RMS value greater than the current setpoint Isp.

In aspects in which the drive signal voltage is the control variable, the current demand Id may be specified indirectly, for example, based on the current required to maintain a desired voltage setpoint 262B (Vsp) given the load impedance magnitude Zm measured at block 242 (e.g. Id=Vsp/Zm). Similarly, in aspects in which drive signal power is the control variable, the current demand Id may be specified indirectly, for example, based on the current required to maintain a desired power setpoint 262C (Psp) given the voltage Vrms measured at blocks 236 (e.g. Id=Psp/Vrms).

Block 268 may implement a DDS control algorithm for controlling the drive signal by recalling LUT samples stored in the LUT 228. In certain aspects, the DDS control algorithm be a numerically-controlled oscillator (NCO) algorithm for generating samples of a waveform at a fixed clock rate using a point (memory location)-skipping technique. The NCO algorithm may implement a phase accumulator, or frequency-to-phase converter, that functions as an address pointer for recalling LUT samples from the LUT 228. In one aspect, the phase accumulator may be a D step size, modulo N phase accumulator, where D is a positive integer representing a frequency control value, and N is the number of LUT samples in the LUT 228. A frequency control value of D=1, for example, may cause the phase accumulator to sequentially point to every address of the LUT 228, resulting in a waveform output replicating the waveform stored in the LUT 228. When D>1, the phase accumulator may skip addresses in the LUT 228, resulting in a waveform output having a higher frequency. Accordingly, the frequency of the waveform generated by the DDS control algorithm may therefore be controlled by suitably varying the frequency control value. In certain aspects, the frequency control value may be determined based on the output of the phase control algorithm implemented at block 244. The output of block 268 may supply the input of (DAC) 168, which in tum supplies a corresponding analog signal to an input of the power amplifier 162.

Block 270 of the processor 174 may implement a switch-mode converter control algorithm for dynamically modulating the rail voltage of the power amplifier 162 based on the waveform envelope of the signal being amplified, thereby improving the efficiency of the power amplifier 162. In certain aspects, characteristics of the waveform envelope may be determined by monitoring one or more signals contained in the power amplifier 162. In one aspect, for example, characteristics of the waveform envelope may be determined by monitoring the minima of a drain voltage (e.g., a MOSFET drain voltage) that is modulated in accordance with the envelope of the amplified signal. A minima voltage signal may be generated, for example, by a voltage minima detector coupled to the drain voltage. The minima voltage signal may be sampled by ADC 176, with the output minima voltage samples being received at block 272 of the switch-mode converter control algorithm. Based on the values of the minima voltage samples, block 274 may control a PWM signal output by a PWM generator 276, which, in turn, controls the rail voltage supplied to the power amplifier 162 by the switch-mode regulator 170. In certain aspects, as long as the values of the minima voltage samples are less than a minima target 278 input into block 262, the rail voltage may be modulated in accordance with the waveform envelope as characterized by the minima voltage samples. When the minima voltage samples indicate low envelope power levels, for example, block 274 may cause a low rail voltage to be supplied to the power amplifier 162, with the full rail voltage being supplied only when the minima voltage samples indicate maximum envelope power levels. When the minima voltage samples fall below the minima target 278, block 274 may cause the rail voltage to be maintained at a minimum value suitable for ensuring proper operation of the power amplifier 162.

In one aspect, a method and/or apparatus may provide functionality for sensing a clamp arm position relative to a ultrasonic blade of an end effector, and a generator such as generator 102 and a controller such as control circuit 108 and/or controller 196 may be used to adjust a power output to the ultrasonic blade based on the clamp arm position. Referring now to FIG. 32, a process 3200 for controlling an end effector is shown. The process 3200 may be executed at least in part by a processor which may be in communication with or may be part of one or more of generator 102, control circuit 108, and/or controller 196. Referring now to FIG. 32, a process 3300 for calibrating a controller for an end effector is shown. The process 3200 may be executed at least in part by a processor which may be in communication with or may be part of one or more of generator 102, control circuit 108, and/or controller 196.

Referring now to FIG. 11, an example end effector 300 and shaft 302 are shown. The clamp arm 304 may have a position (e.g., represented by the “angle” arrow or a displacement) relative to the ultrasonic blade 306, which may be measured using one or more sensors such as Hall-effect sensor. Sensing the position of the clamp arm relative to the ultrasonic blade may provide relevant device information enabling new capabilities such as the ability to sense thickness, quantity, or types of tissues clamped inside the jaws. In one aspect, the process 3200 of FIG. 32 may determine 3220 a type of tissue between the clamp arm and the ultrasonic blade based on a signal (from, e.g., a Hall-effect sensor). Further, using a processor and/or memory, one or more algorithms (e.g., for sealing a vessel without transection) may be chosen based on the thickness, quantity, or type of tissue determined to be clamped inside the jaws.

Ultrasonic blade 306 may deliver a tissue effect through mechanical vibration to tissues and/or blood vessels. Clamp arm 304 may pivot about point 314, which may represent a connection between the clamp arm and an outer tube 310. An inner tube 308 may move back and forth and may drive closure of the clamp arm 304 on ultrasonic blade 306. In various aspects, it may be desirable to measure the angle between the clamp arm 304 and the ultrasonic blade 306.

In one aspect, the position of clamp arm 304 relative to ultrasonic blade 306 (e.g., during activation) may be approximated through a coupling with the inner tube 308. The inner tube 308 may be linked to the clamp arm 304 and may be similar to the reciprocating tubular actuating member 58 located within the outer tubular sheath 56. The outer tube 310, which may be similar to the outer tubular sheath 56, and/or ultrasonic blade 306, may be used to determine a position and/or angle of the clamp arm 304 relative to ultrasonic blade 306. The outer tube 310 may be static and in one aspect may be linked to clamp arm 304. As result, using the techniques and features described herein, the movement (e.g., represented with the bidirectional arrow 312) of the inner tube 308 relative to the outer tube 310 may be measured and used to approximate the claim arm position.

Referring briefly to FIG. 32, process 3200 may detect 3202 a signal (e.g., at a Hall-effect sensor) in response to movement of a first tube relative to a second tube, the first tube driving movement of a clamp arm of the end effector. The first tube may be, for example, similar to reciprocating tubular actuating member 58 and the second tube may be, for example, similar to outer tubular sheath 56. In other words, as described in FIG. 32, the first tube may be an inner tube and the second tube is an outer tube. The inner tube may be moveable 3208 relative to the outer tube. The outer tube may be static relative to the inner tube. The process 3200 may detect 3210 the signal using a Hall-effect sensor and a magnet positioned on the first tube.

Use of Hall-effect sensors will be described herein with respect to various aspects of the present disclosure, however other types of sensors may be used to measure the movement 312. For example, linear variable differential transformers (LVDT), rotary variable differential transformer, piezoelectric transducers, potentiometers, photo electric sensors may be used to measure the movement 312. Furthermore, Hall-effect sensors and suitable equivalents may be used to measure the position of two bodies relative to one another through the use of a small electronic board and magnets.

Referring now to FIG. 12, a representation of an example Hall-effect sensor is shown. A magnet 402 may have north and south poles which move in a line perpendicular to the face of the Hall sensor 404, which may be in a fixed position. Referring now to FIG. 13A, another representation of an example Hall-effect sensor is shown. A magnet 408 may have north and south poles moving in a line parallel to the face of the Hall-effect sensor 410, which may be in a fixed position. Referring now to FIG. 13B, another representation of an example Hall-effect sensor is shown. A magnet 414 may have north and south poles moving in a line (418) parallel to the face of the Hall-effect sensor 416, which may be in a fixed position. The magnet may have diameter D and the magnet and Hall-effect sensor 416 may have total effective air gap (TEAG) 420. This configuration may allow for a very sensitive measurement of movement over small distances with the appropriate magnet-sensor combination.

The Hall-effect sensor may include a small electronic chip which may sense magnetic fields and change its electrical output based on the relative proximity of the magnet or the strength of the magnetic fields to the Hall-effect sensor. As the magnet moves across the face of the Hall-effect sensor (e.g., marked “X”) and gets closer to being directly in front of the face, an output signal of the Hall-effect sensor may change and be used to determine a position of the magnet relative to the Hall-effect sensor. In one aspect, the magnet may not cause much of a change in the output signal of the Hall-effect sensor. For example, using a magnet and Hall-effect sensor having particular characteristics, the magnet being more than 1.5 inches or further distances from the Hall-effect sensor may produce very little in terms of the output signal, but as the magnet moves closer and closer to the Hall-effect sensor, the electrical output changes more rapidly such that a very discernable signal change occurs in response to small motions of the magnet as it is moved closer to a critical position. The electrical response of the Hall-effect sensor at various positions of the magnet may be used to create a best fit curve. For example, the voltage output of the Hall-effect sensor as a function of the displacement of the magnet may be determined.

FIG. 14A is a table 1400 of output voltage of a Hall-effect sensor as a function of distance as a clamp arm moves from a fully closed position to a fully open position in accordance with the present disclosure. Relative distance (mm) is listed in the first column 1402. Absolute distance (mm) is listed in the second column 1404 and absolute distance in inches is listed in the third column 1406. Output voltage of the Hall-effect sensor is listed in the fourth column 1408 and clamp arm position is listed in the fifth column 1410, where the uppermost cell indicates the clamp arm in the fully closed position and the lowermost cell indicates the clamp arm in the fully open position.

Referring now to FIGS. 14A and 14B, a table 1400 and a graph 1450 of the output voltage of a Hall-effect sensor (y-axis) as a function of the displacement (x-axis) and related data are shown. In this example, the sensitivity of a prototyped Hall-effect sensor/magnet combination is shown as a relatively small linear movement (e.g., 0.100″) may result in a 1.5 volts signal change. This signal change may be read by a generator (e.g., generator 102) and used to make determinations about ultrasonic blade displacement, or provide auditory, tactile and/or other feedback to a user (e.g., via speaker 114 and/or visual display 116). A best fit curve 1452 may be determined from the plotted data points 145a-h (e.g., one or more of relative displacement, absolute displacement, voltage output, and position) and a polynomial equation for output voltage of the Hall-effect sensor (y-axis) as a function of the displacement (x-axis) of the magnet may result. The best fit curve may be of the 2nd, 3rd, 4th . . . nth order. The data points 1454a-h and/or the best fit curve 1452 may be used to create a lookup table stored in a memory and/or the resulting equation may be executed in a processor in order to determine, for example, a displacement for the magnet (and a corresponding clamp arm position) given a specific output voltage of the Hall-effect sensor. In this way, turning briefly to FIG. 32, the process 3200 may determine 3204 a clamp arm position of the end effector relative to a ultrasonic blade of the end effector based on the signal (from, e.g., Hall-effect sensor voltage output).

Turning now to FIG. 15A there is shown a top view of a Hall-effect sensor 510 and magnet 508 configurations in a surgical instrument and corresponding open jaws end effector 500 position in accordance with one aspect of the present disclosure and FIG. 15B is a top view of the Hall-effect sensor 510 and magnet 508 configurations in a surgical instrument and corresponding closed jaws end effector 500 position in accordance with one aspect of the present disclosure. In one aspect, as shown in FIGS. 15A and 15B, the voltage output of the Hall-effect sensor 50 is 1.6 VDC when the jaws of the end effector 500 are open and 3.1 VDC when the jaws of the end effector 500 are closed.

Referring now to FIGS. 15A and 15B, one aspect of a Hall-effect sensor 510 and magnet 508 combination are shown as implemented in a surgical device such as one or more of those discussed herein. FIGS. 15A and 15B show two images of top-down views of the example. An inner threaded collar 502 may be attached to a magnet 508. As a trigger of the surgical device is closed, a clamp arm 504 of the end effector 500 comes into closer contact with a ultrasonic blade 504, and the magnet 508 moves further proximal as shown in the top-down views. As the magnet 508 moves (in a direction indicated by arrow 506), the voltage potential of the Hall-effect sensor 510 changes. The magnet 508 positioned on the first tube relative to the Hall-effect sensor 510 may move as the first tube drives movement of the clamp arm 503 of the end effector 500.

It should be noted that while various aspects discussed herein are described to include an outer tube that is static and an inner tube that drives motion of the clamp arm, other configurations are possible and within the scope of the present disclosure. For example, in various aspects, an outer tube may drive the motion of the clamp arm and the inner tube may be static. Additionally, while various aspects discussed herein are described to include a Hall-effect sensor 510 and/or integrated circuit (e.g., chip) that is static and a magnet 508 that moves as the clamp arm 500 moves, other configurations are possible and within the scope of the present disclosure. For example, in various aspects, the Hall-effect sensor 510 may move as the clamp arm 503 moves and the magnet may be static. Many combinations are possible, including a fixed outer tube and a moveable inner, a moving magnet 508 and a stationery Hall-effect sensor 510 or other sensing circuit, a moving Hall-effect sensor 510 or other sensing circuit and a stationary magnet 508, a moveable outer tube and a fixed inner tube, a fixed magnet in one of the inner and outer tubes, and/or a moving magnet in one of the inner and outer tubes. The Hall-effect sensor 510 or other circuit may be mounted to the moving part (e.g., inner or outer tube) or mounted to the stationary part (e.g., inner or outer tube), as long as flexible electrical connections are considered and motion can be achieved.

As shown in FIG. 15A, the inner threaded collar 502 with attached magnet 508 is positioned further left than in FIG. 15B, and the corresponding end effector 500 has an open jaw, e.g., open clamp arm 503. As the user pulls the trigger and closes the end effector 500, multiple springs and the inner threaded collar 502 move (in the direction indicated by arrow 506) the clamp arm 503 is driven closed or is driven to grafting tissue captured in between the clamp arm 503 and the ultrasonic blade 504. A Hall-effect sensor 510 and a magnet 508 is shown, which may be cylindrical, moves over the Hall-effect sensor 510, as the clamp arm 503 closes towards the ultrasonic blade 504.

Referring now to FIG. 16, there is shown a plan view of a system 600 comprising a Hall-effect sensor 602 and magnet 606 arrangement. The Hall-effect sensor 602 includes a circuit board 604 and an integrated circuit 606. The magnet 608 moves back and forth along line 610 as the clamp arm is closed and opened. As the magnet 608 moves towards the center of the Hall effect integrated circuit 606 the sensitivity of the Hall-effect sensor 602 changes and the output signal increases. A carrier 612 for the magnet 608 may be coupled to the inner tube that drives the clamp arm. In one aspect, as the inner tube is pulled towards the handle of the surgical instrument (e.g., by the trigger), the jaw closes (e.g., clamp arm) closes. The magnet 608 is connected to an extended leg of the threaded inner collar of the outer tube.

FIGS. 17A and 17B illustrates different views of the system 600 comprising a Hall-effect sensor 602 and magnet 608 configurations in the context of a surgical instrument in accordance with one aspect of the present disclosure. With reference to FIGS. 17A and 17B, the Hall-effect sensor 602 is shown positioned within a surgical instrument. The Hall-effect sensor 602 is positioned on the threaded inner collar 620 of the outer tube 622. A slot 624 is defined in a rotation knob of the outer tube 622 to allow the magnet 608 to travel. The magnet 608 is positioned within the carrier 612, which is slidably movable within the slot 624. For example, the Hall-effect sensor 602 as described herein may be static and is attached to a rotation knob such that it can rotate around the centerline of the ultrasonic blade. A pin 626 may be positioned within an aperture 628 through both the rotation knob and the Hall-effect sensor 602 and through a center ultrasonic blade portion. As a result, the ultrasonic blade does not move axially, but the inner tube is able to move axially right and left of the pin 626. A threaded connection 630 is made of nylon or any other suitable material with minimum magnetic flux.

FIG. 18 illustrates a Hall-effect sensor 602 and magnet 608 configuration in the context of a surgical instrument in accordance with the present disclosure. Referring now to FIG. 18, a shaft of a surgical instrument is shown and the magnet 608 is positioned within the carrier 612. A magnet movement 632 is coupled to the inner tube 634. The magnet 608 may be coupled with snap fits to a threaded collar 638 of the inner tube 634. The Hall-effect sensor 602 as described herein is static and is attached to a rotation knob such that it can rotate around the centerline of the ultrasonic blade.

FIG. 19A illustrates a Hall-effect sensor 602 and magnet 608 configuration in accordance with one aspect of the present disclosure. FIG. 19B is a detailed view of the Hall-effect sensor 602 and magnet 608 configuration in the context of a surgical instrument in accordance with the present disclosure. Referring now to FIGS. 19A and 19B, in one aspect the Hall-effect sensor 602 and magnet 608 configuration is located on a shaft of a surgical instrument. In one aspect, the pole faces of the magnet 608 and the Hall-effect sensor 602 move in line with one another. In FIGS. 17A, 17B, 19A, and 19B, the Hall-effect sensor 602 is stationary while the magnet 608 moves in connection with the clamp arm. In one aspect, the inner threaded collar is configure to carry the magnet 608 and may be directly connected to the inner tube. In this way, the Hall-effect sensor 602 may be positioned in a different way on the rotation knob such that the faces of the magnet 608 and the Hall-effect sensor 602 come together in a perpendicular manner as shown by the motion arrow 640.

In one aspect, an ultrasonic algorithm or process may be used to enable a surgical device to seal tissue without transection. The implementation of this algorithm or process may require measuring clamp arm position relative to the ultrasonic blade of an end effector. A method can be used to sense the clamp arm position relative to the ultrasonic blade as described herein and that positioning can be consistently calibrated during manufacturing, as will be described below, such that estimates of thickness of tissue can be made. For example, an algorithm or process that is fed information about quantity of tissue can react as that quantity changes. This may allow the surgical device to treat the tissue without completely transecting a vessel.

Turning now briefly to FIG. 32, once the clamp arm position relative to ultrasonic blade is known, how the ultrasonic blade vibrates can be adjusted to get different tissue effects. In this way, process 3200 may adjust 3206 a power output to the ultrasonic blade of the end effector based on the clamp arm position. For example, process 3200 may adjust 3214 the power output to the ultrasonic blade of the end effector using an ultrasonic transducer based on a voltage change in a Hall-effect sensor.

Typically, end effectors may be used to coagulate and cuts vessels at the same time. However, using the techniques and features described herein, an end effector may be used to seal a carotid or vessel without actually transecting it, as may be desired by a surgeon. With information on the clamp arm position, a Travel Ratio (TR) can be calculated, whereby if the clamp arm is in the completely closed position with nothing captured in the end effector, the sensor (e.g., Hall-effect sensor) may indicate a TR of 1. For example, for illustrative purposes only, let XT represent a relative clamp arm position at any given time in activation, X1 be a claim arm position when the surgical device is fully clamped with no tissue, and X2 be a clamp arm position at a beginning of activation, with tissue grasped in the end effector, where:

$TR = \frac{X 1 - XT}{X 1 - X 2}$

Continuing with the example above, X1 may be a value programmed into the surgical device for the clamp arm position when the jaws are fully closed and nothing is captured in the end effector. X2 may be the clamp arm position at the start of an activation such that if a vessel is attached in the end effector and the clamp arm is closed all the way, the clamp arm may be squeezing the vessel down but with some distance to travel before the vessel is transected and the clamp arm is directly opposite the ultrasonic blade with full contact. XT may change dynamically as it is the clamp arm position at any given time.

For example, at the very beginning of activation TR may be zero, as X1 may be set to represent the clamp arm position being fully closed with nothing captured. X2, at the very beginning of the activation, when the clamp arm is touching a vessel, may provide a relative thickness before firing the ultrasonic blade. XT may be the value in the equation that is updating continuously with time as the clamp arm travels further and compresses and starts to cut the tissue. In one aspect, it may be desirable to deactivate (e.g., stop firing) the ultrasonic blade when the clamp arm has traveled 70% or 0.7. Thus, it may be empirically determined beforehand that a desired TR is 0.7 of the way between the clamp arm being closed with a full bite of tissue and being fully closed with nothing in between the clamp arm and ultrasonic blade.

The TR of 0.7 has been described for illustrative purposes only and may depend on many parameters. For example, the desired TR for the point at which the ultrasonic blade will be shut-off may be based on vessel size. The TR may be any value observed to work for treating a given tissue or vessel without transection. Once the desired position is known, the vibrating of the ultrasonic blade may be adjusted based on the desired position. FIG. 20 is a graph 2000 of a curve 2002 depicting Travel Ratio (TR) along the y-axis, based on Hall-effect sensor output voltage, as a function of Time (Sec) along the x-axis. As shown in FIG. 20, the desired TR is 0.7, meaning that the ultrasonic blade is deactivated (e.g., stop firing) when the clamp arm has traveled 70% or 0.7. This is relative to a clamp arm on a vessel with a ultrasonic blade firing where the desired end TR was 0.7. In the particular example of FIG. 20, the ultrasonic blade was activated (e.g., firing) on a carotid and shut off at the TR of 0.7 after about 16 seconds.

In one aspect, it may be desirable to use a proportional-integral controller. FIG. 21 is a graph 2100 of a first curve 2102 depicting Travel Ratio (TR) along the left y-axis, based on Hall-effect sensor output voltage, as a function of Time (Sec) along the x-axis. A second curve 2104 depicts Power (Watts) along the right y-axis as a function of Time (Sec) along the x-axis. The graph 2100 provides an example of what can be accomplished with a proportional-integral (PI) controller. The Travel Ratio (TR)curve 2102 is represented on the graph 2100 by the line marked “TRAVEL RATIO.” The goal or Desired Value for the Travel Ratio may be 0.7, as shown by the line marked “DESIRED VALUE,” although various other values may be used. The Power output curve 2104 represents power through the ultrasonic blade and is shown and marked “POWER (WATTS).”

Turning now briefly to FIG. 32, there is shown the process 3200 may adjust 3216 the power output to the ultrasonic blade of the end effector dynamically, based on the travel ratio that changes as the clamp arm approaches the ultrasonic blade. For example, as the clamp arm moves towards the ultrasonic blade and the Desired Value is approached, the amount of power output to the ultrasonic blade and into the tissue may be reduced. This is because the ultrasonic blade will cut the tissue with enough power. However, if the power being output is reduced over time as the Desired Value is approached (where a full transection may be represented by a Travel Ratio of 1), the chance that the tissue is transected may be drastically reduced. In this way, effective sealing may be achieved without cutting the tissue as may be desired by the surgeon.

Turning back to FIG. 21, there is shown the Power output curve 2104 shown in FIG. 21 may represent the power applied with a drive signal to a transducer stack to activate (e.g., fire) the ultrasonic blade. The Power value may be proportional to the movement of the clamp arm portion of the end effector and delivered to the tissue and the Power curve may represent voltage and current applied to the ultrasonic transducer. In one aspect, the ultrasonic generator (e.g., generator 102) may read the voltage output data from the Hall-effect sensor and, in response, send commands for how much voltage and current to provide to the transducer to drive the ultrasonic blade as desired. As the clamp arm portion of the end effector is moved and the desired value is approached, the ultrasonic blade may be forced to deliver less energy to the tissue and reduce the likelihood of cutting the tissue.

As the ultrasonic blade is powered, the ultrasonic blade will effect the tissue or the vessel such that friction at the interface of the ultrasonic blade and the tissue causes heat to drive the moisture from and dry out the tissue. During this process, the clamp arm portion is able to increasingly compress the tissue as the seal develops. As the TR increases over time the tissue flattens by applying more pressure with the clamp arm as the tissue dries out. In this way, a PI controller may be used to cook the tissue from a beginning point (where TR=0) to a certain second position by controlling power output to effectively seal large vessels. With the PI controller, as the TR approaches the Desired Value, the ultrasonic device drops the power delivery (to the ultrasonic blade) to smoothly control the compression and coagulation of the tissue. This process has shown an ability to effectively seal vessels without transection. In this way, process 3200 may adjust 3218 the power output to the ultrasonic blade of the end effector dynamically, using a proportional-integral (PI) controller, based on a travel ratio that changes as the clamp arm approaches the ultrasonic blade. It will be appreciated that PI control is not the only logic system through which power could be controlled. Many mathematical mappings exist to appropriately reduce power as a function of the Hall-effect sensor. Examples of other logic systems include PID controllers, proportional controllers, fuzzy logic, neural networks, polynomials, Bayesian networks, among others.

FIG. 22 is a graph 2200 depicting how the PI controller works. The Proportional term may be an indication of the absolute difference between TR and the Desired Value for TR. TR approaches the Desired Value, the effect of the proportional term may shrink and as a result the ultrasonic power (e.g., delivered by the ultrasonic blade) may be reduced. The Integral term, shown as the area 2202 under the curve, may be an accumulation of error over a give section of time. For example, as shown above, the Integral term may not begin to accumulate until after 5 seconds. After 5 seconds, the Integral term may begin to take effect and the power to the ultrasonic blade may be increased. After about 9 seconds, the reduction of the effect in the Proportional term may outweigh the effect of the increase in the Integral term causing the power delivery to the ultrasonic blade to become reduced. In this example, a Desired Value of 0.7 for the TR was used, however, as discussed above, the TR value may be optimized for a specific device along with the Proportional and Integral terms of the controller.

In effect, the PI controller may indicate what the power output should be based on the distance at any given time between the Travel Ratio and the Desired Value. From that distance, the PI controller may output a certain value (e.g., 0.4). In the example of FIG. 22, at a moment in time (e.g., 1 second) the distance is based on the values assigned to the P and I. This distance may be multiplied it by a constant that represents P and result in 0.78. The generator may instruct the system to send out 0.78 or send out, for example, 7.8 watts of power when the distance between these two is a certain amount. As a result, the TR curve approaches the Desired Value curve, and the distance reduces. Over time, the amount of power the generator tells the system to send decreases, which may be the desired outcome. However, this could also mean that if only P and not I is used, when time approaches 15 seconds, there may not be enough power output to the tissue to complete the goal. This is where the I portion (integral portion) is calculated at a set period of time, which may be about five seconds. By calculating the area 2202 under the curve (shown in FIG. 22 by hashed lines, captured between the Desired Value and Travel Ratio over time) and in addition to the 0.78, shown between 0 and 5 seconds, the I portion starts to add its own amount of power to help the progression of the Travel Ratio to the Desired Value and make sure that it gets there in a somewhat timely manner. For example, at five seconds, the I portion is not active, but as time progresses the I portion starts to calculate the area captured between the two curves and adds that value (e.g., additional four watts) which is the area under the curve, in addition to the power coming from the Proportional value. Using these two calculations together may provide the Power curve (i.e., the power output) as shown in FIG. 22. The PI controller is configured to drive towards the seal effect in a somewhat timely manner.

In one aspect the techniques described herein may be employed to seal different sizes of vessels (e.g., 5 mm, 6 mm, and 7 mm round vessels). The strength of the seals may be tested until the seal bursts and recording the burst pressure. A higher burst pressure indicates a stronger seal. In the case of an actual surgery, if a surgical instrument or device as described herein is used to seal a vessel the seal will not leak if it has a high associated burst pressure. In one aspect, the burst pressures can be measured across different sizes of vessels, e.g., 5 mm, 6 mm, and 7 mm round vessels, respectively. Typically, smaller vessels have higher burst pressure with larger vessels, the burst pressure is decreased.

Turning now to FIG. 23, there is shown several vessels 2400 that were sealed using the techniques and features described herein (e.g., using an ultrasonic blade and a Hall-effect sensor). Using the PI controller as described above, 60 vessels were sealed. 58 vessels were sealed without transection.

In one aspect, it has been observed that activating a ultrasonic blade with the clamp arm open may help to release tissue that may have stuck to the ultrasonic blade while being coagulated. Detecting a change in signal from a Hall-effect sensor may indicate when the user is opening the clamp arm after device activation. This information may trigger the system to send a low level ultrasonic signal for a short period of time, in order to release any tissue stuck to the ultrasonic blade. This short, sub-therapeutic signal may reduce the level of sticking experienced by the user. This feature may be useful if a ultrasonic shear device were designed for multiple uses and the ultrasonic blade coating began to wear off. In this way, the techniques and features described herein may be used to reduce the amount of tissue sticking to the ultrasonic blade.

A method for calibrating an end effector and Hall-effect sensor may include calibrating the end effector and Hall-effect sensor during manufacturing of thereafter. As discussed above, process 3300 shown in FIG. 32, may be used to calibrate a controller for the end effector. For example, a clamp arm position of a ultrasonic device may be calibrated during assembly. As discussed herein, sensing the position of the clamp arm relative to the ultrasonic blade may provide relevant surgical device information that may enable new capabilities, including but not limited to the ability to sense a quantity or type of tissues which may be clamped inside the jaws. Further, determinations about various algorithms to execute (e.g., such sealing a vessel without transection) may be made based on sensing the position of the clamp arm. However, in various aspects, in order for this information to be useful and reliable, the surgical device must be calibrated in relation to a baseline such as when the clamp arm is fully open or when the clamp arm fully closed with zero material in the end effector.

As described above, determining a Travel Ratio (TR) may help in various processes to control an end effector. In determining TR, X1 is the clamp arm position when the device is fully closed with no tissue. Determining the value (e.g., Hall effect signal) corresponding to X1 may be done during manufacturing and may be part of the calibration process.

Turning now to FIG. 24, there is shown a graph 2500 of a best fit curve 2502 of Hall-effect sensor output voltage along the y-axis as a function of absolute distance (in) along the x-axis for various positions of the clamp arm. The best fit curve 2502 is plotted based on the absolute distance (in) of the clamp arm from the ultrasonic blade as listed in the third column 1406 of the table 1400 shown in FIG. 14A and the corresponding Hall-effect sensor output voltage listed in the fourth column 1408 of the table 1400 shown in FIG. 14A as the clamp arm moves from a fully open position to a fully closed position in accordance with the present disclosure.

Still with reference to FIG. 24, there is shown an example electrical output of a Hall-effect sensor configured to sense clamp arm position is shown. The Hall-effect sensor signal strength plotted against displacement of the sensor (e.g., a magnet) may follow a parabolic shape as shown by the best fit curve 2502. To calibrate the Hall-effect sensor, several readings of the sensor are taken at known baseline locations. During calibration, the best fit curve 2502 as shown in FIG. 24 may be analyzed to confirm that the Hall-effect sensor is reading effectively based on readings made in a production setting. In this way, a Hall-effect sensor response corresponding to various positions of the clamp arm (e.g., fully open, fully closed, and discrete positions therebetween) may be recorded to create a best fit curve during production. Various data points may be recorded (e.g., four data points 1-4 as shown in FIG. 24 or more as may be necessary) to create the best fit curve 2502. For example, in a first position, a Hall-effect sensor response may be measured when the clamp arm is fully opened. In this way, turning briefly to FIG. 32, the process 3300 shown in FIG. 32 may detect 3302 a first measurement signal (e.g., a Hall-effect sensor response) corresponding to a fully open position of a clamp arm and a ultrasonic blade of the end effector.

Turning back now to FIG. 24 in conjunction with FIG. 25, the four data points 1-4 represent voltage measured with a Hall-effect sensor as a function of the gap between the clamp arm 2606 and the ultrasonic blade 2608, as shown in FIG. 24. These data points 1-4 may be recorded as described in connection with FIGS. 25-28. The first data point (1) is recorded when the end effector 2600 is in the configuration shown in FIG. 25. The first data point (1) corresponds to the Hall-effect sensor output voltage recorded when the clamp arm 2606 is in the fully opened positon relative to the ultrasonic blade 2608.

The second data point (2) is recorded when the end effector 2600 is in the configuration shown in FIG. 26. To obtain an accurate gap between the clamp arm 2606 and the ultrasonic blade 2808, a first gage pin 2602 of known diameter is placed at a predetermined location within the jaws of the end effector 2600, e.g., between the clamp arm 2606 and the ultrasonic blade 2608. As shown in FIG. 26, the first gage pin 2602 is positioned between the distal end and the proximal end of the ultrasonic blade 2608 and is grasped between the clamp arm 2606 and the ultrasonic blade 2608 to set an accurate gap between the clamp arm 2606 and the ultrasonic blade 2808. Once the clamp arm 2606 is closed to grasp the first gage pin 2602, the output voltage of the Hall-effect sensor is measured and recorded. The second data point (2) is correlated to the gap set between the clamp arm 2606 and the ultrasonic blade 2608 by the first gage pin 2602. In this way, the output voltage of the Hall-effect sensor is equated to the gap distance between the clamp arm 2606 and the ultrasonic blade 2608. The second data point (2) is one of several data points to develop the polynomial to generate the best fit curve 2502 shown in FIG. 24. The process 3300 described in FIG. 32 detects 3304 an actual Hall-effect sensor voltage and determines the gap between the clamp arm 2606 and the ultrasonic blade 2608 based on the best first curve 2502 (e.g., computing the polynomial).

The third data point (3) is recorded when the end effector 2600 is in the configuration shown in FIG. 27. To obtain another accurate gap between the clamp arm 2606 and the ultrasonic blade 2808, the first gage pin 2602 is removed and a second gage pin 2604 of known diameter is placed at a predetermined location within the jaws of the end effector 2600, e.g., between the clamp arm 2606 and the ultrasonic blade 2608, that is different form the location of the first gage pin 2602. As shown in FIG. 27, the second gage pin 2604 is positioned between the distal end and the proximal end of the ultrasonic blade 2608 and is grasped between the clamp arm 2606 and the ultrasonic blade 2608 to set an accurate gap between the clamp arm 2606 and the ultrasonic blade 2808. Once the clamp arm 2606 is closed to grasp the second gage pin 2602, the output voltage of the Hall-effect sensor is measured and recorded. The third data point (3) is correlated to the gap set between the clamp arm 2606 and the ultrasonic blade 2608 by the second gage pin 2604. In this way, the output voltage of the Hall-effect sensor is equated to the gap distance between the clamp arm 2606 and the ultrasonic blade 2608. The third data point (3) is one of several data points to develop the polynomial to generate the best fit curve 2502 shown in FIG. 24. The process 3300 described in FIG. 32 detects 3304 an actual Hall-effect sensor voltage and determines the gap between the clamp arm 2606 and the ultrasonic blade 2608 based on the best first curve 2502 (e.g., computing the polynomial).

The fourth data point (4) is recorded when the end effector 2600 is in the configuration shown in FIG. 28. To obtain the fourth data point (4), there are no gage pins 2602, 2604 placed between the clamp arm 2606 and the ultrasonic blade 2608, but rather, the clamp arm 2606 is place in the fully closed position relative to the ultrasonic blade 2608. Once the clamp arm 2606 is placed in the fully closed position, the output voltage of the Hall-effect sensor is measured and recorded. The fourth data point (4) is correlated to the fully closed clamp arm 2606 position. In this way, the output voltage of the Hall-effect sensor is equated to the fully closed clamp arm 2606 position relative to the ultrasonic blade 2608. The fourth data point (4) is one of several data points to develop the polynomial to generate the best fit curve 2502 shown in FIG. 24. The process 3300 described in FIG. 32 detects 3304 an actual Hall-effect sensor voltage and determines the gap between the clamp arm 2606 and the ultrasonic blade 2608 based on the best first curve 2502 (e.g., computing the polynomial).

Various configurations of gage pins may create known displacements and/or angles between the clamp arm 2606 and the ultrasonic blade 2608 of the end effector 2600. Using kinematics of a given clamp arm/ultrasonic blade/shaft design and gage pins of known diameter, a theoretical displacement of the shaft assembly can be known at each of the, e.g., four or more positions. This information may be input, along with the voltage readings of the Hall-effect sensor, to fit a parabolic curve (e.g., best fit curve 2502 as shown in FIG. 24), which may becomes a characteristic of each individual surgical device. This information may be loaded onto the surgical device via an EEPROM or other programmable electronics configured to communicate with the generator (e.g., the generator 102 shown in FIG. 6) during use of the surgical device.

The Hall-effect sensor signal response at, for example, the four positions of the clamp arm described above may be graphed and the responses may be fit and entered into to a lookup table or developed into a polynomial which may be used to set/calibrate the Hall-effect sensor such that when used by a surgeon, the end effector delivers the tissue effect desired. In this way, process 3300 may determine 3308 a best fit curve to represent signal strength (e.g., from Hall-effect sensor) as a function of sensor displacement (e.g., magnet displacement) based on at least the first, second, and third signals, the fully open, intermediate, and fully closed positions, and a dimension of the rigid body. Process 3300 may also create 3310 a lookup table based on at least the first, second, and third signals, and the fully open, intermediate, and fully closed positions.

The positioning of the Hall-effect sensor/magnet arrangement in the configurations described above may be used to calibrate the surgical device such that the most sensitive movements of the clamp arm 2606 exist when the clamp arm 2606 is closest to the ultrasonic blade 2608. Four positions, corresponding to four data points (1-4), were chosen in the example described above, but any number of positions could be used at the discretion of design and development teams to ensure proper calibration.

In one aspect, the techniques and features described herein may be used to provide feedback to a surgeon to indicate when the surgeon should use hemostasis mode for the vessel sealing procedure prior to engaging the cutting procedure. For example, hemostasis mode algorithm may be dynamically changed based on the size of a vessel grasped by the end effector 2600 in order to save time. This may require feedback based on the position of the clamp arm 2606.

FIG. 29A is a schematic diagram 3000 of surgical instrument 3002 configured to seal small and large vessels in accordance with one aspect of the present disclosure. The surgical instrument 3002 comprises an end effector 3004, where the end effector comprises a clamp arm 3006 and an ultrasonic blade 3008 for treating tissue including vessels of various sizes. The surgical instrument 3002 comprises a Hall-effect sensor 3010 to measure the position of the end effector 3004. A closure switch 3012 is provided to provide a feedback signal indicating whether the trigger handle 3013 of the surgical instrument is in a fully closed position.

Turning now to FIG. 29B there is shown a diagram of an example range of a small vessel 3014 and a large vessel 3016 and the relative position of a clamp arm of the end effector in accordance with one aspect of the present disclosure. With reference to FIGS. 29A-B, The surgical instrument 3002 shown in FIG. 29A is configured to seal small vessels 3014 having a diameter <4 mm and large vessels 3016 having a diameter >4 mm and the relative position of the clamp arm 3006 when grasping small and large vessels 3014, 3016 and the different voltage readings provided by the end effector 3010 depending on the size of the vessel.

FIGS. 29C and 29D are two graphs 3020, 3030 that depicts two processes for sealing small and large vessels by applying various ultrasonic energy levels for a different periods of time in accordance with one aspect of the present disclosure. Ultrasonic energy level is shown along the y-axis and time (Sec) is shown along the x-axis. With reference now to FIGS. 29A-C, the first graph 3020 shown in FIG. 29C shows a process for adjusting the ultrasonic energy drive level of a ultrasonic blade to seal a small vessel 3014. In accordance with the process illustrated by the first graph 3020 for sealing and transecting a small vessel 3014, a high ultrasonic energy (5) is applied for a first period 3022. The energy level is then lowered to (3.5) for a second period 3024. Finally, the energy level is raised back to (5) for a third period 3026 to complete sealing the small vessel 3014 and achieve transection and then the energy level is turned off. The entire cycle lasting about 5 seconds.

With reference now to FIGS. 29A-D, the second graph 3030 shown in FIG. 29D shows a process for adjusting the ultrasonic energy drive level of a ultrasonic blade to seal a large vessel 3016. In accordance with the process illustrated by the second graph 3030 for sealing and transecting a large vessel 3016, a high ultrasonic energy (5) is applied for a first period 3032. The energy level is then lowered to (1) for a second period 3034. Finally, the energy level is raised back to (5) for a third period 3036 to complete sealing the large vessel 3016 and achieve transection and then the energy level is turned off. The entire cycle lasting about 10 seconds.

Smaller vessels 3014 may be easier to seal at high burst pressure levels. Thus, it may be desirable to sense and determine whether a smaller vessel 3014 (e.g., less than 4 mm) is clamped by the clamp arm 3006, and if so, the ultrasonic energy level may not need to be dropped to 1. Instead, the energy level could be dropped less, to about 3.5 for example, as shown by the first graph 3020 shown in FIG. 29C. This may allow the surgeon to get through the vessel, coagulate it, and cut the vessel more quickly with knowledge that the process can go faster because the vessel 3014 is slightly smaller. If the vessel 3016 is larger, (e.g., 4 mm or greater) a process that heats the vessel slower and over a longer period of time may be more desirable, as shown by the second graph 3030 in FIG. 29D.

FIG. 30 is a logic diagram illustrating an example process 3100 for determining whether hemostasis mode should be used, in accordance with one aspect of the present disclosure. At the outset, the process 3100 reads 3102 the signal from a Hall-effect sensor determine 3102 the position of an end effector. The process 3100 then determines 3104 if a full closure switch of the surgical device is depressed, or if the handle of the surgical device is fully closed. If the full closure switch of the surgical device is not depressed and/or if the handle of the surgical device is not fully closed, the process 3100 may continue to read 3102 the Hall-effect sensor to determine the position of the end effector. If the full closure switch of the surgical device is depressed, or if the handle of the surgical device is fully closed, the process 3100 determines 3106 if the end effector position indicates a vessel larger than 5 mm. If the end effector position does not indicate a vessel larger than 5 mm, and no system indicators are found 3108, the process 3100 may continue to read 3102 the Hall-effect sensor and determine the position of the end effector.

If the end effector position indicates a vessel larger than 5 mm, the process 3100 determines 3110 if the end effector position indicates a vessel larger than 7 mm. If the end effector position does not indicate a vessel larger than 7 mm, the process 3100 indicates 3112 that hemostasis mode should be used. This condition may be indicated using a variety of auditory, vibratory, or visual feedback techniques including, for example, a green LED located on the surgical device (e.g., on top of the handle) may be enabled. If the end effector position does indicate a vessel larger than 7 mm, the process 3100 indicates 3114 that the tissue should not be taken (i.e., hemostasis mode should not be used) because too much tissue has been captured by the end effector. This condition may be indicated using a variety of auditory, vibratory, or visual feedback techniques including, for example, a red LED on the surgical device (e.g., on top of the handle) may be enabled.

FIG. 31 is a logic diagram illustrating an example process 3200 for end effector control in accordance with one aspect of the present disclosure. In one aspect Referring to FIG. 31, process 3200 detects 3202 a signal (e.g., at a Hall-effect sensor) in response to movement of a first tube relative to a second tube, the first tube driving movement of a clamp arm of the end effector. The first tube may be, for example, similar to reciprocating tubular actuating member 58 (FIGS. 3 and 4) and the second tube may be, for example, similar to outer tubular sheath 56 (FIGS. 3 and 4). In other words, as described in FIG. 31, the first tube may be an inner tube and the second tube is an outer tube. The inner tube may be moveable 3208 relative to the outer tube. The outer tube may be static relative to the inner tube. The process 3200 detects 3210 the signal using a Hall-effect sensor and a magnet positioned on the first tube.

The process 3200 continues and determines 3204 a clamp arm position of the end effector relative to a ultrasonic blade of the end effector based on the signal (from, e.g., Hall-effect sensor voltage output). Once clamp arm position relative to ultrasonic blade is known, the vibrational mode of the ultrasonic blade can be adjusted to obtain different tissue effects. In this way, the process 3200 adjusts 3206 a power output to the ultrasonic blade of the end effector based on the clamp arm position. For example, the process 3200 may adjust 3214 the power output to the ultrasonic blade of the end effector using an ultrasonic transducer based on a voltage change in a Hall-effect sensor. Alternatively, the process can effectively seal vessels without transection. In this way, the process 3200 may adjust 3218 the power output to the ultrasonic blade of the end effector dynamically, using a proportional-integral controller, based on a travel ratio that changes as the clamp arm approaches the ultrasonic blade.

In another aspect, the process 3200 may adjust 3216 the power output to the ultrasonic blade of the end effector dynamically, based on the travel ratio that changes as the clamp arm approaches the ultrasonic blade. For example, as the clamp arm moves towards the ultrasonic blade and a Desired Value (FIGS. 21 and 22) is approached, the amount of power output to the ultrasonic blade and into the tissue may be reduced. This is because the ultrasonic blade will cut the tissue with enough power. However, if the power being output is reduced over time as the Desired Value is approached (where a full transection may be represented by a Travel Ratio of 1), the chance that the tissue is transected may be drastically reduced. In this way, effective sealing may be achieved without cutting the tissue as may be desired by the surgeon.

In one aspect, the process 3200 of FIG. 31 moves 3212a magnet positioned on the first tube relative to a Hall-effect sensor as the first tube drives movement of the clamp arm of the end effector. The process 3200 then determines 3220 a type of tissue between the clamp arm and the ultrasonic blade based on a signal (from, e.g., a Hall-effect sensor). Further, using a processor and/or memory, one or more algorithms (e.g., for sealing a vessel without transection) may be chosen based on the thickness, quantity, or type of tissue determined to be clamped inside the jaws. In response to determining that the type of tissue between the clamp and the ultrasonic blade is a large vessel, the process 3200 may reduce 3226 the power output to the ultrasonic blade of the end effector by an amount more than for a small vessel. Further, in response to determining that the type of tissue between the clamp and the ultrasonic blade is a small vessel, the process 3200 may reduce 3224 the power output to the ultrasonic blade of the end effector by an amount less than for a large vessel. In one aspect, instead of changing algorithms for small vessels as described above, an indicator may be provided to the surgeon to indicate the thickness of the tissue captured in the end effector. In one aspect, the process 3200 adjusts 3222 the power output to the ultrasonic blade of the end effector based on the type of tissue.

FIG. 32 is a logic diagram illustrating an example process 3300 for calibrating an apparatus for controlling for an end effector in accordance with one aspect of the present disclosure. In one aspect, the process 3300 detects 3302 a first signal corresponding to a fully open position of a clamp arm and a blade of the end effector. The process 3300 then detects 3304 a second signal corresponding to an intermediate position of the clamp arm and the blade of the end effector, the intermediate position resulting from clamping a rigid body between the clamp arm and the blade. The process detects 3306 a third signal corresponding to a fully closed position of the clamp arm and the blade of the end effector. Once the three signals are detected, the process 3300 determines 3308 a best fit curve to represent signal strength as a function of sensor displacement based on at least the first, second, and third signals corresponding to the fully open, intermediate, and fully closed positions, respectively, and a dimension of the rigid body. An example of a best fit curve in this context is shown in FIGS. 14B and 24. Finally, the process 3300 creates 3310 a lookup table based on at least the first, second, and third signals corresponding to the fully open, intermediate, and fully closed positions, respectively.

As described hereinabove, the position of the clamp arm portion of the end effector can be measured with a Hall-effect sensor/magnet arrangement. A tissue pad, usually made of TEFLON, may be positioned on the clamp arm to prevent tissue from sticking to the clamp arm. As the end effector is used and the tissue pad is worn, it will be necessary to track the drift of the Hall-effect sensor output signal and establish changing thresholds to maintain the integrity of the tissue treatment algorithm selection and the end of cut trigger points feedback to the tissue treatment algorithms.

Accordingly, a control system is provided. The output of the Hall-effect sensor in the form of counts can be used to track the aperture of the end effector clamp arm. The reader may refer to FIGS. 34 and 35 for ADC systems 3500, 3600 that can employ the counter output of an ADC. The clamp arm position, with or without a tissue pad, can be calibrated using the techniques described herein. Once the clamp arm position is calibrated, the position of the clamp arm and wear of the tissue pad can be monitored. In one aspect, the control system determines that the clamp arm is in a closed position by monitoring for a rise in acoustic impedance that occurs when the ultrasonic blade contacts either tissue or the tissue pad. Thus, a specific number of ADC counter will accumulate a specific number of counts from the time the clamp arm goes from a fully open position to a fully closed position. In one implementation, based on the configuration of the Hall-effect sensor, the Hall-effect sensor ADC counts increase as the clamp arm closes towards the ultrasonic blade. As the tissue pad wears, the counter will accumulate an incremental additional number of counts due to the additional rotational travel experienced by the clamp arm due to tissue pad wear. By tracking the new count value for a closed clamp arm position, the control system can adjust the trigger threshold for an end of cut and better predict the total range of aperture of the clamp arm that has occurred.

Furthermore, the Hall-effect sensor ADC counts may be employed to determine the tissue coefficient of friction (μ) of the tissue under treatment based on the aperture of the clamp arm by employing predetermined μ values stored in a look-up table. For example, the specific tissue treatment algorithm can be dynamically adjusted or changed during an ultrasonic treatment cycle (e.g., firing sequence or activation of ultrasonic energy) to optimize the tissue cut based on the tissue type (e.g., fatty tissue, mesentery, vessel) or the tissue quantity or thickness.

FIG. 33 is a logic diagram of a process 3400 for tracking wear of the tissue pad portion of the clamp arm and compensating for resulting drift of the Hall-effect sensor and determining tissue coefficient of friction, according to one aspect of the present disclosure. The process 3400 may be implemented in software, hardware, firmware, or a combination thereof, employing the generator circuit environment illustrated in connection with FIGS. 6-10.

In one aspect, the process 3400 may be implemented by a circuit may comprising a controller comprising one or more processors (e.g., microprocessor, microcontroller) coupled to at least one memory circuit. The at least one memory circuit stores machine executable instructions that when executed by the processor, cause the processor to execute the process 3400.

The processor may be any one of a number of single or multi-core processors known in the art. The memory circuit may comprise volatile and non-volatile storage media. In one aspect, the processor may include an instruction processing unit and an arithmetic unit. The instruction processing unit may be configured to receive instructions from the one memory circuit.

In one aspect, a circuit may comprise a finite state machine comprising a combinational logic circuit configured to implement the process 3400 described herein. In one aspect, a circuit may comprise a finite state machine comprising a sequential logic circuit comprising a combinational logic circuit and at least one memory circuit, for example. The at least one memory circuit can store a current state of the finite state machine. The sequential logic circuit or the combinational logic circuit can be configured to implement the process 3400 described herein. In certain instances, the sequential logic circuit may be synchronous or asynchronous.

In other aspects, the circuit may comprise a combination of the processor and the finite state machine to implement the compression and decompression techniques described herein. In other embodiments, the finite state machine may comprise a combination of the combinational logic circuit and the sequential logic circuit.

As described herein, the position of the clamp arm is sensed by a Hall-effect sensor relative to a magnet located in a closure tube of a surgical instrument. Turning now to the process 3400, the initial home position of the clamp arm, e.g., the position of the Hall-effect sensor located on the closure tube, is stored 3402 in memory. As the closure tube is displaced in a distal direction, the clamp arm is closed towards the ultrasonic blade and the instantaneous position of the clamp arm is stored 3404 in memory. The difference, delta (x), between the instantaneous position and the home position of the clamp arm is calculated 3406. The difference, delta (x), may be used to determine a change in displacement of the tube, which can be used to calculate the angle and the force applied by the clamp arm to the tissue located between the clamp arm and the ultrasonic blade. The instantaneous position of the clamp arm is compared 3408 to the closed position of the clamp arm determine whether the clamp arm is in a closed position. While the clamp arm is not yet in a closed position, the process 3400 proceeds along the no path (N) and compares the instantaneous position of the clamp arm with the home position of the clamp arm until the clamp reaches a closed position.

When the clamp arm reaches a closed position, the process 3400 continues along the yes path (Y) and the closed position of the clamp arm is applied to one input of a logic AND function 3410. The logic AND function 3410 is a high level representation of a logic operation, which may comprise boolean AND, OR, XOR, and NAND operations implemented either in software, hardware, or a combination thereof. When a tissue pad abuse or wear condition is determined based on acoustic impedance measurements, the current clamp arm closed position is set 3414 as the new home position of the clamp arm to compensate for the abuse or wear condition. If no tissue pad abuse or wear is determined, the home position of the clamp arm remains the same. Abuse or wear of the clamp arm tissue pad is determined by monitoring 3420 the impedance 3422 of the ultrasonic blade. The tissue pad/ultrasonic blade interface impedance id s determined 3422 and compared 3412 to a tissue pad abuse or wear condition. When the impedance corresponds to a tissue pad abuse or wear condition, the process 3400 proceeds along the yes path (Y) and the current closed position of the clamp arm is set 3414 as the new home position of the clamp arm to compensate for the abuse or wear condition of the tissue pad. When the impedance does not correspond to a tissue pad abuse or wear condition, the process 3400 proceeds along the no path (N) and the home position of the clamp arm remains the same.

The stored 3404 instantaneous position of the clamp arm is also provided to the input of another logic AND function 3416 to determine the quantity and thickness of the tissue clamped between the clamp arm and the ultrasonic blade. The tissue/ultrasonic blade interface impedance is determined 3422 and is compared 3424, 34267, 3428 to multiple tissue coefficients of friction μ=x, μ=y, or μ=z. Thus, when the tissue/ultrasonic blade interface impedance corresponds to one of the tissue coefficients of friction μ=x, μ=y, or μ=z based on the tissue quantity or thickness, e.g., the aperture of the clamp arm, the current tissue algorithm is maintained 3430 and the current algorithm is used for monitoring 3420 the impedance 3422 of the ultrasonic blade. If the tissue coefficient of friction μ=x, μ=y, or μ=z based on the tissue quantity or thickness, e.g., the aperture of the clamp arm, changes, the current tissue algorithm is changed 3418 based on the new tissue coefficient of friction μ and the tissue quantity or thickness, e.g., the aperture of the clamp arm and the new algorithm is used for monitoring 3420 the impedance 3422 of the ultrasonic blade.

Accordingly, the current clamp arm aperture is used to determine the current tissue coefficient of friction μ based on the quantity and thickness of tissue as measured by the aperture of the clamp arm. Thus, an initial algorithm may be based on an initial aperture of the clamp arm. The impedance of the ultrasonic blade is compared 3424, 3426, 3428 to several tissue coefficients of friction μ=x, μ=y, or μ=z, which are stored in a look-up table, and correspond to fatty tissue, mesentery tissue, or vessel tissue, for example. If no match occurs between the impedance of the ultrasonic blade and the tissue coefficient of friction, the process 3400 proceeds along the no paths (N) of any of the tissue impedance comparisons 3424, 3426, 3428 and the current tissue algorithm is maintained. If any one of the outputs of the comparison 3424, 3426, 3428 functions is true, the processor switches to a different tissue treatment algorithm based on the new tissue impedance and clamp arm aperture. Accordingly, a new tissue treatment algorithm is loaded in the ultrasonic instrument. The process 3400 continues by monitoring 3420 the impedance of the ultrasonic blade, clamp arm aperture, and tissue pad abuse or wear.

FIG. 34 illustrates a Hall-effect sensor system 3500 that can be employed with the process 3400 of FIG. 33, according to one aspect of the present disclosure. In connection with the process 3400 described in FIG. 33, the Hall-effect sensor system 3500 of FIG. 34 includes a Hall-effect sensor 3502 powered by a voltage regulator 3504. The output of the Hall-effect sensor 3502 is an analog voltage proportional to the position of the clamp arm, which is applied to an analog-to-digital converter 3506 (ADC). The n-bit digital output of the ADC 3506 is applied to a microprocessor 3508 coupled to a memory 3510. The microprocessor 3508 is configured to process and determine the position of the clamp arm based on the n-bit digital input from the ADC 3505. It will be appreciated that the digital output of the ADC 3506 may be referred to as a count.

As described herein, the analog output of the Hall-effect sensor is provided to an internal or an external analog-to-digital converter such as the ADC 3506 shown in FIG. 34 or any of the analog-to-digital converter circuits located in the generator. The transducer 104 shown in FIG. 6 may comprise an Hall-effect sensor comprising and analog-to-digital converter circuit whose output is applied to the control circuit 108. In one aspect, the generator 102 shown in FIG. 7 comprises several analog-to-digital converter circuits such as ADCs 176, 178, 180, which can be adapted and configured to receive the analog voltage output of the Hall-effect sensor and convert it into digital forms to obtain counts and to interface the Hall-effect sensor with a DSP processor 174, microprocessor 190, a logic device 166, and/or a controller 196.

FIG. 35 illustrates one aspect of a ramp type counter analog-to-digital converter 3600 (ADC) that may be employed with the Hall-effect sensor system 3500 of FIG. 34, according to one aspect of the present disclosure. The digital ramp ADC 3600 receives an analog input voltage from a Hall-effect sensor at the Vin positive input terminal of a comparator 3602 and Dn through D0 (Dn-D0) are the digital outputs (n-bits). The control line found on a counter 3606 turns on the counter 3606 when it is low and stops the counter 3606 when it is high. In operation, the counter 3606 is increased until the value found on the counter 3606 matches the value of the analog input signal at Vin. The digital output Dn-D0 is applied to a digital-to-analog converter 3604 (DAC) and the analog output is applied to the negative terminal of the comparator 3602 and it is compared to the analog input voltage at Vin. When this condition is met, the value on the counter 3606 is the digital equivalent of the analog input signal at Vin.

A START pulse is provided for each analog input voltage Vin to be converted into a digital signal. The END signal represents the end of the conversion for each individual analog input voltage found at Vin (each sample), and not for the entire analog input signal. Each clock pulse increments the counter 3606. Supposing an 8-bit ADC, for converting the analog value for “128” into digital, for example, it would take 128 clock cycles. The ADC 3600 counts from 0 to the maximum possible value (2n−1) until the correct digital output Dn-D0 value is identified for the analog input voltage present at Vin. When this is true, the END signal is given and the digital value for Vin is for at Dn-D0.

While various aspects have been described herein, it should be apparent, however, that various modifications, alterations and adaptations to those aspects may occur to persons skilled in the art with the attainment of some or all of the advantages of the invention. The disclosed aspects are therefore intended to include all such modifications, alterations and adaptations without departing from the scope and spirit of the invention. Accordingly, other aspects and implementations are within the scope of the following claims. For example, the actions recited in the claims can be performed in a different order and still achieve desirable results.

While various details have been set forth in the foregoing description, it will be appreciated that the various aspects of the techniques for operating a generator for digitally generating electrical signal waveforms and surgical instruments may be practiced without these specific details. One skilled in the art will recognize that the herein described components (e.g., operations), devices, objects, and the discussion accompanying them are used as examples for the sake of conceptual clarity and that various configuration modifications are contemplated. Consequently, as used herein, the specific exemplars set forth and the accompanying discussion are intended to be representative of their more general classes. In general, use of any specific exemplar is intended to be representative of its class, and the non-inclusion of specific components (e.g., operations), devices, and objects should not be taken limiting.

Further, while several forms have been illustrated and described, it is not the intention of the applicant to restrict or limit the scope of the appended claims to such detail. Numerous modifications, variations, changes, substitutions, combinations, and equivalents to those forms may be implemented and will occur to those skilled in the art without departing from the scope of the present disclosure. Moreover, the structure of each element associated with the described forms can be alternatively described as a means for providing the function performed by the element. Also, where materials are disclosed for certain components, other materials may be used. It is therefore to be understood that the foregoing description and the appended claims are intended to cover all such modifications, combinations, and variations as falling within the scope of the disclosed forms. The appended claims are intended to cover all such modifications, variations, changes, substitutions, modifications, and equivalents.

For conciseness and clarity of disclosure, selected aspects of the foregoing disclosure have been shown in block diagram form rather than in detail. Some portions of the detailed descriptions provided herein may be presented in terms of instructions that operate on data that is stored in one or more computer memories or one or more data storage devices (e.g. floppy disk, hard disk drive, Compact Disc (CD), Digital Video Disk (DVD), or digital tape). Such descriptions and representations are used by those skilled in the art to describe and convey the substance of their work to others skilled in the art. In general, an algorithm refers to a self-consistent sequence of steps leading to a desired result, where a “step” refers to a manipulation of physical quantities and/or logic states which may, though need not necessarily, take the form of electrical or magnetic signals capable of being stored, transferred, combined, compared, and otherwise manipulated. It is common usage to refer to these signals as bits, values, elements, symbols, characters, terms, numbers, or the like. These and similar terms may be associated with the appropriate physical quantities and are merely convenient labels applied to these quantities and/or states.

Unless specifically stated otherwise as apparent from the foregoing disclosure, it is appreciated that, throughout the foregoing disclosure, discussions using terms such as “processing” or “computing” or “calculating” or “determining” or “displaying” or the like, refer to the action and processes of a computer system, or similar electronic computing device, that manipulates and transforms data represented as physical (electronic) quantities within the computer system's registers and memories into other data similarly represented as physical quantities within the computer system memories or registers or other such information storage, transmission or display devices.

In a general sense, those skilled in the art will recognize that the various aspects described herein which can be implemented, individually and/or collectively, by a wide range of hardware, software, firmware, or any combination thereof can be viewed as being composed of various types of “electrical circuitry.” Consequently, as used herein “electrical circuitry” includes, but is not limited to, electrical circuitry having at least one discrete electrical circuit, electrical circuitry having at least one integrated circuit, electrical circuitry having at least one application specific integrated circuit, electrical circuitry forming a general purpose computing device configured by a computer program (e.g., a general purpose computer configured by a computer program which at least partially carries out processes and/or devices described herein, or a microprocessor configured by a computer program which at least partially carries out processes and/or devices described herein), electrical circuitry forming a memory device (e.g., forms of random access memory), and/or electrical circuitry forming a communications device (e.g., a modem, communications switch, or optical-electrical equipment). Those having skill in the art will recognize that the subject matter described herein may be implemented in an analog or digital fashion or some combination thereof.

The foregoing detailed description has set forth various forms of the devices and/or processes via the use of block diagrams, flowcharts, and/or examples. Insofar as such block diagrams, flowcharts, and/or examples contain one or more functions and/or operations, it will be understood by those within the art that each function and/or operation within such block diagrams, flowcharts, and/or examples can be implemented, individually and/or collectively, by a wide range of hardware, software, firmware, or virtually any combination thereof. In one form, several portions of the subject matter described herein may be implemented via an application specific integrated circuits (ASIC), a field programmable gate array (FPGA), a digital signal processor (DSP), or other integrated formats. However, those skilled in the art will recognize that some aspects of the forms disclosed herein, in whole or in part, can be equivalently implemented in integrated circuits, as one or more computer programs running on one or more computers (e.g., as one or more programs running on one or more computer systems), as one or more programs running on one or more processors (e.g., as one or more programs running on one or more microprocessors), as firmware, or as virtually any combination thereof, and that designing the circuitry and/or writing the code for the software and or firmware would be well within the skill of one of skill in the art in light of this disclosure. In addition, those skilled in the art will appreciate that the mechanisms of the subject matter described herein are capable of being distributed as one or more program products in a variety of forms, and that an illustrative form of the subject matter described herein applies regardless of the particular type of signal bearing medium used to actually carry out the distribution. Examples of a signal bearing medium include, but are not limited to, the following: a recordable type medium such as a floppy disk, a hard disk drive, a Compact Disc (CD), a Digital Video Disk (DVD), a digital tape, a computer memory, etc.; and a transmission type medium such as a digital and/or an analog communication medium (e.g., a fiber optic cable, a waveguide, a wired communications link, a wireless communication link (e.g., transmitter, receiver, transmission logic, reception logic, etc.), etc.).

In some instances, one or more elements may be described using the expression “coupled” and “connected” along with their derivatives. It should be understood that these terms are not intended as synonyms for each other. For example, some aspects may be described using the term “connected” to indicate that two or more elements are in direct physical or electrical contact with each other. In another example, some aspects may be described using the term “coupled” to indicate that two or more elements are in direct physical or electrical contact. The term “coupled,” however, also may mean that two or more elements are not in direct contact with each other, but yet still co-operate or interact with each other. It is to be understood that depicted architectures of different components contained within, or connected with, different other components are merely examples, and that in fact many other architectures may be implemented which achieve the same functionality. In a conceptual sense, any arrangement of components to achieve the same functionality is effectively “associated” such that the desired functionality is achieved. Hence, any two components herein combined to achieve a particular functionality can be seen as “associated with” each other such that the desired functionality is achieved, irrespective of architectures or intermedial components. Likewise, any two components so associated also can be viewed as being “operably connected,” or “operably coupled,” to each other to achieve the desired functionality, and any two components capable of being so associated also can be viewed as being “operably couplable,” to each other to achieve the desired functionality. Specific examples of operably couplable include but are not limited to physically mateable and/or physically interacting components, and/or wirelessly interactable, and/or wirelessly interacting components, and/or logically interacting, and/or logically interactable components, and/or electrically interacting components, and/or electrically interactable components, and/or optically interacting components, and/or optically interactable components.

In other instances, one or more components may be referred to herein as “configured to,” “configurable to,” “operable/operative to,” “adapted/adaptable,” “able to,” “conformable/conformed to,” etc. Those skilled in the art will recognize that “configured to” can generally encompass active-state components and/or inactive-state components and/or standby-state components, unless context requires otherwise.

While particular aspects of the present disclosure have been shown and described, it will be apparent to those skilled in the art that, based upon the teachings herein, changes and modifications may be made without departing from the subject matter described herein and its broader aspects and, therefore, the appended claims are to encompass within their scope all such changes and modifications as are within the true scope of the subject matter described herein. It will be understood by those within the art that, in general, terms used herein, and especially in the appended claims (e.g., bodies of the appended claims) are generally intended as “open” terms (e.g., the term “including” should be interpreted as “including but not limited to,” the term “having” should be interpreted as “having at least,” the term “includes” should be interpreted as “includes but is not limited to,” etc.). It will be further understood by those within the art that if a specific number of an introduced claim recitation is intended, such an intent will be explicitly recited in the claim, and in the absence of such recitation no such intent is present. For example, as an aid to understanding, the following appended claims may contain usage of the introductory phrases “at least one” and “one or more” to introduce claim recitations. However, the use of such phrases should not be construed to imply that the introduction of a claim recitation by the indefinite articles “a” or “an” limits any particular claim containing such introduced claim recitation to claims containing only one such recitation, even when the same claim includes the introductory phrases “one or more” or “at least one” and indefinite articles such as “a” or “an” (e.g., “a” and/or “an” should typically be interpreted to mean “at least one” or “one or more”); the same holds true for the use of definite articles used to introduce claim recitations.

In addition, even if a specific number of an introduced claim recitation is explicitly recited, those skilled in the art will recognize that such recitation should typically be interpreted to mean at least the recited number (e.g., the bare recitation of “two recitations,” without other modifiers, typically means at least two recitations, or two or more recitations). Furthermore, in those instances where a convention analogous to “at least one of A, B, and C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, and C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). In those instances where a convention analogous to “at least one of A, B, or C, etc.” is used, in general such a construction is intended in the sense one having skill in the art would understand the convention (e.g., “a system having at least one of A, B, or C” would include but not be limited to systems that have A alone, B alone, C alone, A and B together, A and C together, B and C together, and/or A, B, and C together, etc.). It will be further understood by those within the art that typically a disjunctive word and/or phrase presenting two or more alternative terms, whether in the description, claims, or drawings, should be understood to contemplate the possibilities of including one of the terms, either of the terms, or both terms unless context dictates otherwise. For example, the phrase “A or B” will be typically understood to include the possibilities of “A” or “B” or “A and B.”

With respect to the appended claims, those skilled in the art will appreciate that recited operations therein may generally be performed in any order. Also, although various operational flows are presented in a sequence(s), it should be understood that the various operations may be performed in other orders than those which are illustrated, or may be performed concurrently. Examples of such alternate orderings may include overlapping, interleaved, interrupted, reordered, incremental, preparatory, supplemental, simultaneous, reverse, or other variant orderings, unless context dictates otherwise. Furthermore, terms like “responsive to,” “related to,” or other past-tense adjectives are generally not intended to exclude such variants, unless context dictates otherwise.

It is worthy to note that any reference to “one aspect,” “an aspect,” “one form,” or “a form” means that a particular feature, structure, or characteristic described in connection with the aspect is included in at least one aspect. Thus, appearances of the phrases “in one aspect,” “in an aspect,” “in one form,” or “in an form” in various places throughout the specification are not necessarily all referring to the same aspect. Furthermore, the particular features, structures or characteristics may be combined in any suitable manner in one or more aspects.

With respect to the use of substantially any plural and/or singular terms herein, those having skill in the art can translate from the plural to the singular and/or from the singular to the plural as is appropriate to the context and/or application. The various singular/plural permutations are not expressly set forth herein for sake of clarity.

In certain cases, use of a system or method may occur in a territory even if components are located outside the territory. For example, in a distributed computing context, use of a distributed computing system may occur in a territory even though parts of the system may be located outside of the territory (e.g., relay, server, processor, signal-bearing medium, transmitting computer, receiving computer, etc. located outside the territory).

A sale of a system or method may likewise occur in a territory even if components of the system or method are located and/or used outside the territory. Further, implementation of at least part of a system for performing a method in one territory does not preclude use of the system in another territory.

All of the above-mentioned U.S. patents, U.S. patent application publications, U.S. patent applications, foreign patents, foreign patent applications, non-patent publications referred to in this specification and/or listed in any Application Data Sheet, or any other disclosure material are incorporated herein by reference, to the extent not inconsistent herewith. 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.

In summary, numerous benefits have been described which result from employing the concepts described herein. The foregoing description of the one or more forms has been presented for purposes of illustration and description. It is not intended to be exhaustive or limiting to the precise form disclosed. Modifications or variations are possible in light of the above teachings. The one or more forms were chosen and described in order to illustrate principles and practical application to thereby enable one of ordinary skill in the art to utilize the various forms and with various modifications as are suited to the particular use contemplated. It is intended that the claims submitted herewith define the overall scope.

Various aspects of the subject matter described herein are set out in the following numbered clauses:

1. A method for controlling an end effector, the method comprising: detecting a signal in response to movement of a first tube relative to a second tube, the first tube driving movement of a clamp arm of the end effector; determining a clamp arm position of the end effector relative to a ultrasonic blade of the end effector based on the signal; and adjusting a power output to the ultrasonic blade of the end effector based on the clamp arm position.

2. The method of clause 1, wherein adjusting the power output to the ultrasonic blade is achieved by manipulating the electrical current sent to the handpiece.

3. The method of clause 1 or 2, wherein the first tube is an inner tube and the second tube is an outer tube, the inner tube being moveable relative to the outer tube, the outer tube being static relative to the inner tube.

4. The method of any one of clause 1 or 2, wherein the first tube is an inner tube and the second tube is an outer tube, the outer tube being moveable relative to the inner tube, the inner tube being static relative to the inner tube.

5. The method of any one of clauses 1-4 further comprising detecting the signal using a Hall-effect sensor and a magnet positioned on the first tube.

6. The method of any one of clauses 1-5, further comprising moving a magnet positioned on the first tube relative to a Hall-effect sensor as the first tube drives movement of the clamp arm of the end effector.

7. The method of any one of clauses 1-6, further comprising adjusting the power output to the ultrasonic blade of the end effector using an ultrasonic transducer based on a voltage change in a Hall-effect sensor.

8. The method of any one of clauses 1-7, further comprising adjusting the power output to the ultrasonic blade of the end effector dynamically, based on a travel ratio that changes as the clamp arm approaches the ultrasonic blade.

9. The method of any one of clauses 1-8, further comprising adjusting the power output to the ultrasonic blade of the end effector dynamically, using a proportional-integral controller, based on a travel ratio that changes as the clamp arm approaches the ultrasonic blade.

10. The method of any one of clauses 1-9, further comprising switching off completely the power output to the ultrasonic blade of the end effector once a travel ratio threshold has been met.

11. The method of any one of clauses 1-10, further comprising: determining a quantity or thickness of tissue between the clamp arm and the ultrasonic blade based on the signal; and adjusting the power output to the ultrasonic blade of the end effector based on the quantity or thickness of tissue.

12. The method of clause 11, further comprising in response to determining that the quantity or thickness of tissue between the clamp arm and the ultrasonic blade is less than a predetermined threshold, reducing the power output to the ultrasonic blade of the end effector by an amount less than for a larger quantity or thickness of tissue.

13. The method of clause 11 or 12, further comprising in response to determining that the quantity or thickness of tissue between the clamp arm and the ultrasonic blade is above a predetermined threshold, reducing the power output to the ultrasonic blade of the end effector by an amount more than for a smaller quantity or thickness of tissue.

14. An apparatus for controlling an end effector, the apparatus comprising: a sensor configured to detect a signal in response to movement of a first tube relative to a second tube, the first tube driving movement of a clamp arm of the end effector; a processor configured to determine a clamp arm position of the end effector relative to a ultrasonic blade of the end effector based on the signal; and a transducer configured to adjust a power output to the ultrasonic blade of the end effector based on the clamp arm position.

15. The apparatus of clause 14, wherein the first tube is an inner tube and the second tube is an outer tube, the outer tube being moveable relative to the inner tube, the inner tube being static relative to the outer tube.

16. The apparatus of clause 14, wherein the first tube is an inner tube and the second tube is an outer tube, the inner tube being moveable relative to the outer tube, the outer tube being static relative to the inner tube.

17. The apparatus of any one of clauses 14-16, further comprising: a magnet positioned on the first tube; and wherein the sensor is a Hall-effect sensor used to detect the signal based on a position of the magnet.

18. The apparatus of any one of clauses 14-17, wherein the magnet positioned on the first tube moves relative to a Hall-effect sensor as the first tube drives movement of the clamp arm of the end effector.

19. The apparatus of any one of clauses 14-18, wherein the transducer is an ultrasonic transducer configured to adjust the power output to the ultrasonic blade of the end effector based on a voltage change in a Hall-effect sensor.

20. The apparatus of any one of clauses 14-19, wherein the transducer is configured to adjust the power output to the ultrasonic blade of the end effector dynamically, based on a travel ratio that changes as the clamp arm approaches the ultrasonic blade.

21. The apparatus of any one of clauses 14-20, further comprising: a proportional-integral controller configured to adjust the power output to the ultrasonic blade of the end effector dynamically, based on a travel ratio that changes as the clamp arm approaches the ultrasonic blade.

22. A method for calibrating an apparatus for controlling an end effector, the method comprising: detecting a first signal corresponding to a fully open position of a clamp arm and a ultrasonic blade of the end effector; detecting a second signal corresponding to an intermediate position of the clamp arm and the ultrasonic blade of the end effector, the intermediate position resulting from clamping a rigid body between the clamp arm and the ultrasonic blade; and detecting a third signal corresponding to a fully closed position of the clamp arm and the ultrasonic blade of the end effector.

23. The method of clause 22, further comprising: determining a best fit curve to represent signal strength as a function of sensor displacement based on at least the first, second, and third signals, the fully open, intermediate, and fully closed positions, and a dimension of the rigid body.

24. The method of clause 22 or 23, further comprising: creating a lookup table based on at least the first, second, and third signals, and the fully open, intermediate, and fully closed positions.

Claims

1. An apparatus for controlling an end effector, the apparatus comprising: a sensor configured to detect a signal in response to movement of a first tube relative to a second tube, the first tube driving movement of a clamp arm of the end effector;a processor configured to: determine a clamp arm position of the end effector relative to an ultrasonic blade of the end effector based on the signal;determine a thickness of a tissue based on the clamp arm position;determine an impedance of the ultrasonic blade in contact with the tissue; anddetermine a type of the tissue based on the impedance; anda transducer configured to dynamically adjust a power output to the ultrasonic blade of the end effector during an ultrasonic treatment, to adjust a tissue cut based on the thickness and the type of the tissue.
2. The apparatus of claim 1, wherein the first tube is an inner tube and the second tube is an outer tube, the outer tube being moveable relative to the inner tube, the inner tube being static relative to the outer tube.
3. The apparatus of claim 1, wherein the first tube is an inner tube and the second tube is an outer tube, the inner tube being moveable relative to the outer tube, the outer tube being static relative to the inner tube.
4. The apparatus of claim 1, further comprising: a magnet positioned on the first tube; andwherein the sensor is a Hall-effect sensor used to detect the signal based on a position of the magnet.
5. The apparatus of claim 4, wherein the magnet positioned on the first tube moves relative to the Hall-effect sensor as the first tube drives movement of the clamp arm of the end effector.
6. The apparatus of claim 1, wherein the transducer is an ultrasonic transducer configured to adjust the power output to the ultrasonic blade of the end effector based on a voltage change in a Hall-effect sensor.
7. The apparatus of claim 1, wherein the transducer is configured to adjust the power output to the ultrasonic blade of the end effector based on a travel ratio that changes as the clamp arm approaches the ultrasonic blade.
8. The apparatus of claim 1, further comprising: a proportional-integral controller configured to adjust the power output to the ultrasonic blade of the end effector based on a travel ratio that changes as the clamp arm approaches the ultrasonic blade.
9. The apparatus of claim 1, wherein the type of the tissue comprises at least one of a fatty tissue, a mesentery tissue, and a vessel tissue.
10. The apparatus of claim 1, wherein the transducer is configured to dynamically adjust the power output during the ultrasonic treatment based on a tissue treatment algorithm.
11. The apparatus of claim 10, wherein the processor is further configured to: determine a second impedance of the ultrasonic blade;determine a second clamp arm position of the end effector relative to the ultrasonic blade; andadjust the tissue treatment algorithm based on the second impedance and the second clamp arm position.
12. A control system for an ultrasonic surgical instrument, the ultrasonic surgical instrument comprising an ultrasonic blade, a clamp arm, a first tube movable relative to a second tube to cause the clamp arm to pivot towards the ultrasonic blade, and a transducer coupled to the ultrasonic blade and configured to ultrasonically oscillate the ultrasonic blade, the control system comprising: a sensor configured to detect a position of the first tube relative to the second tube; anda control circuit coupled to the sensor, the control circuit configured to: monitor the sensor to sense the position of the first tube;determine a clamp arm position of an end effector relative to an ultrasonic blade of the end effector based on the position of the first tube;determine a thickness of a tissue between the clamp arm and the ultrasonic blade according to the clamp arm position;determine an impedance of the ultrasonic blade in contact with the tissue;determine a type of the tissue based on the impedance; anddynamically adjust a power output via the transducer during an ultrasonic treatment, to adjust a tissue cut according to the thickness and the type of the tissue.
13. The control system of claim 12, wherein the sensor comprises a Hall-effect sensor configured to detect a magnet positioned on the first tube.
14. The control system of claim 12, wherein the control circuit is configured to adjust the power output via the transducer based on a travel ratio that changes as the clamp arm approaches the ultrasonic blade.
15. The control system of claim 12, wherein the type of the tissue comprises at least one of a fatty tissue, a mesentery tissue, and a vessel tissue.
16. The control system of claim 12, wherein the control circuit is configured to dynamically adjust the power output via the transducer during the ultrasonic treatment based on a tissue treatment algorithm.
17. The control system of claim 16, wherein the control circuit is further configured to: determine a second impedance of the ultrasonic blade;determine a second clamp arm position of the end effector relative to the ultrasonic blade; anddynamically adjust the tissue treatment algorithm based on the second impedance and the second clamp arm position.

US Referenced Citations (2619)

Number	Name	Date	Kind
969528	Disbrow	Sep 1910	A
1570025	Young	Jan 1926	A
1813902	Bovie	Jul 1931	A
2188497	Calva	Jan 1940	A
2366274	Luth et al.	Jan 1945	A
2425245	Johnson	Aug 1947	A
2442966	Wallace	Jun 1948	A
2458152	Eakins	Jan 1949	A
2510693	Green	Jun 1950	A
2597564	Bugg	May 1952	A
2704333	Calosi et al.	Mar 1955	A
2736960	Armstrong	Mar 1956	A
2748967	Roach	Jun 1956	A
2845072	Shafer	Jul 1958	A
2849788	Creek	Sep 1958	A
2867039	Zach	Jan 1959	A
2874470	Richards	Feb 1959	A
2990616	Balamuth et al.	Jul 1961	A
RE25033	Balamuth et al.	Aug 1961	E
3015961	Roney	Jan 1962	A
3033407	Alfons	May 1962	A
3053124	Balamuth et al.	Sep 1962	A
3082805	Royce	Mar 1963	A
3166971	Stoecker	Jan 1965	A
3322403	Murphy	May 1967	A
3432691	Shoh	Mar 1969	A
3433226	Boyd	Mar 1969	A
3489930	Shoh	Jan 1970	A
3513848	Winston et al.	May 1970	A
3514856	Camp et al.	Jun 1970	A
3525912	Wallin	Aug 1970	A
3526219	Balamuth	Sep 1970	A
3554198	Tatoian et al.	Jan 1971	A
3580841	Cadotte et al.	May 1971	A
3606682	Camp et al.	Sep 1971	A
3614484	Shoh	Oct 1971	A
3616375	Inoue	Oct 1971	A
3629726	Popescu	Dec 1971	A
3636943	Balamuth	Jan 1972	A
3668486	Silver	Jun 1972	A
3702948	Balamuth	Nov 1972	A
3703651	Blowers	Nov 1972	A
3776238	Peyman et al.	Dec 1973	A
3777760	Essner	Dec 1973	A
3805787	Banko	Apr 1974	A
3809977	Balamuth et al.	May 1974	A
3830098	Antonevich	Aug 1974	A
3854737	Gilliam, Sr.	Dec 1974	A
3862630	Balamuth	Jan 1975	A
3875945	Friedman	Apr 1975	A
3885438	Harris, Sr. et al.	May 1975	A
3900823	Sokal et al.	Aug 1975	A
3918442	Nikolaev et al.	Nov 1975	A
3924335	Balamuth et al.	Dec 1975	A
3946738	Newton et al.	Mar 1976	A
3955859	Stella et al.	May 1976	A
3956826	Perdreaux, Jr.	May 1976	A
3989952	Hohmann	Nov 1976	A
4005714	Hiltebrandt	Feb 1977	A
4012647	Balamuth et al.	Mar 1977	A
4034762	Cosens et al.	Jul 1977	A
4058126	Leveen	Nov 1977	A
4074719	Semm	Feb 1978	A
4156187	Murry et al.	May 1979	A
4167944	Banko	Sep 1979	A
4188927	Harris	Feb 1980	A
4200106	Douvas et al.	Apr 1980	A
4203430	Takahashi	May 1980	A
4203444	Bonnell et al.	May 1980	A
4220154	Semm	Sep 1980	A
4237441	van Konynenburg et al.	Dec 1980	A
4244371	Farin	Jan 1981	A
4281785	Brooks	Aug 1981	A
4300083	Helges	Nov 1981	A
4302728	Nakamura	Nov 1981	A
4304987	van Konynenburg	Dec 1981	A
4306570	Matthews	Dec 1981	A
4314559	Allen	Feb 1982	A
4353371	Cosman	Oct 1982	A
4409981	Lundberg	Oct 1983	A
4445063	Smith	Apr 1984	A
4463759	Garito et al.	Aug 1984	A
4491132	Aikins	Jan 1985	A
4492231	Auth	Jan 1985	A
4494759	Kieffer	Jan 1985	A
4504264	Kelman	Mar 1985	A
4512344	Barber	Apr 1985	A
4526571	Wuchinich	Jul 1985	A
4535773	Yoon	Aug 1985	A
4541638	Ogawa et al.	Sep 1985	A
4545374	Jacobson	Oct 1985	A
4545926	Fouts, Jr. et al.	Oct 1985	A
4549147	Kondo	Oct 1985	A
4550870	Krumme et al.	Nov 1985	A
4553544	Nomoto et al.	Nov 1985	A
4562838	Walker	Jan 1986	A
4574615	Bower et al.	Mar 1986	A
4582236	Hirose	Apr 1986	A
4593691	Lindstrom et al.	Jun 1986	A
4608981	Rothfuss et al.	Sep 1986	A
4617927	Manes	Oct 1986	A
4633119	Thompson	Dec 1986	A
4633874	Chow et al.	Jan 1987	A
4634420	Spinosa et al.	Jan 1987	A
4640279	Beard	Feb 1987	A
4641053	Takeda	Feb 1987	A
4646738	Trott	Mar 1987	A
4646756	Watmough et al.	Mar 1987	A
4649919	Thimsen et al.	Mar 1987	A
4662068	Polonsky	May 1987	A
4674502	Imonti	Jun 1987	A
4694835	Strand	Sep 1987	A
4708127	Abdelghani	Nov 1987	A
4712722	Hood et al.	Dec 1987	A
4735603	Goodson et al.	Apr 1988	A
4761871	O'Connor et al.	Aug 1988	A
4808154	Freeman	Feb 1989	A
4819635	Shapiro	Apr 1989	A
4827911	Broadwin et al.	May 1989	A
4830462	Karny et al.	May 1989	A
4832683	Idemoto et al.	May 1989	A
4836186	Scholz	Jun 1989	A
4838853	Parisi	Jun 1989	A
4844064	Thimsen et al.	Jul 1989	A
4849133	Yoshida et al.	Jul 1989	A
4850354	McGurk-Burleson et al.	Jul 1989	A
4852578	Companion et al.	Aug 1989	A
4860745	Farin et al.	Aug 1989	A
4862890	Stasz et al.	Sep 1989	A
4865159	Jamison	Sep 1989	A
4867157	McGurk-Burleson et al.	Sep 1989	A
4878493	Pasternak et al.	Nov 1989	A
4880015	Nierman	Nov 1989	A
4881550	Kothe	Nov 1989	A
4896009	Pawlowski	Jan 1990	A
4903696	Stasz et al.	Feb 1990	A
4910389	Sherman et al.	Mar 1990	A
4915643	Samejima et al.	Apr 1990	A
4920978	Colvin	May 1990	A
4922902	Wuchinich et al.	May 1990	A
4936842	D'Amelio et al.	Jun 1990	A
4954960	Lo et al.	Sep 1990	A
4965532	Sakurai	Oct 1990	A
4979952	Kubota et al.	Dec 1990	A
4981756	Rhandhawa	Jan 1991	A
5001649	Lo et al.	Mar 1991	A
5009661	Michelson	Apr 1991	A
5013956	Kurozumi et al.	May 1991	A
5015227	Broadwin et al.	May 1991	A
5020514	Heckele	Jun 1991	A
5026370	Lottick	Jun 1991	A
5026387	Thomas	Jun 1991	A
5035695	Weber, Jr. et al.	Jul 1991	A
5042461	Inoue et al.	Aug 1991	A
5042707	Taheri	Aug 1991	A
5061269	Muller	Oct 1991	A
5075839	Fisher et al.	Dec 1991	A
5084052	Jacobs	Jan 1992	A
5099840	Goble et al.	Mar 1992	A
5104025	Main et al.	Apr 1992	A
5105117	Yamaguchi	Apr 1992	A
5106538	Barma et al.	Apr 1992	A
5108383	White	Apr 1992	A
5109819	Custer et al.	May 1992	A
5112300	Ureche	May 1992	A
5113139	Furukawa	May 1992	A
5123903	Quaid et al.	Jun 1992	A
5126618	Takahashi et al.	Jun 1992	A
D327872	McMills et al.	Jul 1992	S
5152762	McElhenney	Oct 1992	A
5156633	Smith	Oct 1992	A
5160334	Billings et al.	Nov 1992	A
5162044	Gahn et al.	Nov 1992	A
5163421	Bernstein et al.	Nov 1992	A
5163537	Radev	Nov 1992	A
5163945	Ortiz et al.	Nov 1992	A
5167619	Wuchinich	Dec 1992	A
5167725	Clark et al.	Dec 1992	A
5172344	Ehrlich	Dec 1992	A
5174276	Crockard	Dec 1992	A
D332660	Rawson et al.	Jan 1993	S
5176677	Wuchinich	Jan 1993	A
5176695	Dulebohn	Jan 1993	A
5184605	Grzeszykowski	Feb 1993	A
5188102	Idemoto et al.	Feb 1993	A
D334173	Liu et al.	Mar 1993	S
5190517	Zieve et al.	Mar 1993	A
5190518	Takasu	Mar 1993	A
5190541	Abele et al.	Mar 1993	A
5196007	Ellman et al.	Mar 1993	A
5205459	Brinkerhoff et al.	Apr 1993	A
5205817	Idemoto et al.	Apr 1993	A
5209719	Baruch et al.	May 1993	A
5213569	Davis	May 1993	A
5214339	Naito	May 1993	A
5217460	Knoepfler	Jun 1993	A
5218529	Meyer et al.	Jun 1993	A
5221282	Wuchinich	Jun 1993	A
5222937	Kagawa	Jun 1993	A
5226909	Evans et al.	Jul 1993	A
5226910	Kajiyama et al.	Jul 1993	A
5231989	Middleman et al.	Aug 1993	A
5234428	Kaufman	Aug 1993	A
5241236	Sasaki et al.	Aug 1993	A
5241968	Slater	Sep 1993	A
5242339	Thornton	Sep 1993	A
5242460	Klein et al.	Sep 1993	A
5246003	DeLonzor	Sep 1993	A
5254129	Alexander	Oct 1993	A
5257988	L'Esperance, Jr.	Nov 1993	A
5258004	Bales et al.	Nov 1993	A
5258006	Rydell et al.	Nov 1993	A
5261922	Hood	Nov 1993	A
5263957	Davison	Nov 1993	A
5264925	Shipp et al.	Nov 1993	A
5269297	Weng et al.	Dec 1993	A
5275166	Vaitekunas et al.	Jan 1994	A
5275607	Lo et al.	Jan 1994	A
5275609	Pingleton et al.	Jan 1994	A
5282800	Foshee et al.	Feb 1994	A
5282817	Hoogeboom et al.	Feb 1994	A
5285795	Ryan et al.	Feb 1994	A
5285945	Brinkerhoff et al.	Feb 1994	A
5290286	Parins	Mar 1994	A
5293863	Zhu et al.	Mar 1994	A
5300068	Rosar et al.	Apr 1994	A
5304115	Pflueger et al.	Apr 1994	A
D347474	Olson	May 1994	S
5307976	Olson et al.	May 1994	A
5309927	Welch	May 1994	A
5312023	Green et al.	May 1994	A
5312425	Evans et al.	May 1994	A
5318525	West et al.	Jun 1994	A
5318563	Malis et al.	Jun 1994	A
5318564	Eggers	Jun 1994	A
5318570	Hood et al.	Jun 1994	A
5318589	Lichtman	Jun 1994	A
5322055	Davison et al.	Jun 1994	A
5324299	Davison et al.	Jun 1994	A
5326013	Green et al.	Jul 1994	A
5326342	Pflueger et al.	Jul 1994	A
5330471	Eggers	Jul 1994	A
5330502	Hassler et al.	Jul 1994	A
5334183	Wuchinich	Aug 1994	A
5339723	Huitema	Aug 1994	A
5342356	Ellman et al.	Aug 1994	A
5342359	Rydell	Aug 1994	A
5344420	Hilal et al.	Sep 1994	A
5345937	Middleman et al.	Sep 1994	A
5346502	Estabrook et al.	Sep 1994	A
5353474	Good et al.	Oct 1994	A
5357164	Imabayashi et al.	Oct 1994	A
5357423	Weaver et al.	Oct 1994	A
5359994	Krauter et al.	Nov 1994	A
5361583	Huitema	Nov 1994	A
5366466	Christian et al.	Nov 1994	A
5368557	Nita et al.	Nov 1994	A
5370645	Klicek et al.	Dec 1994	A
5371429	Manna	Dec 1994	A
5374813	Shipp	Dec 1994	A
D354564	Medema	Jan 1995	S
5381067	Greenstein et al.	Jan 1995	A
5383874	Jackson et al.	Jan 1995	A
5383917	Desai et al.	Jan 1995	A
5387207	Dyer et al.	Feb 1995	A
5387215	Fisher	Feb 1995	A
5389098	Tsuruta et al.	Feb 1995	A
5394187	Shipp	Feb 1995	A
5395033	Byrne et al.	Mar 1995	A
5395312	Desai	Mar 1995	A
5395363	Billings et al.	Mar 1995	A
5395364	Anderhub et al.	Mar 1995	A
5396266	Brimhall	Mar 1995	A
5396900	Slater et al.	Mar 1995	A
5400267	Denen et al.	Mar 1995	A
5403312	Yates et al.	Apr 1995	A
5403334	Evans et al.	Apr 1995	A
5406503	Williams, Jr. et al.	Apr 1995	A
5408268	Shipp	Apr 1995	A
D358887	Feinberg	May 1995	S
5411481	Allen et al.	May 1995	A
5417709	Slater	May 1995	A
5419761	Narayanan et al.	May 1995	A
5421829	Olichney et al.	Jun 1995	A
5423844	Miller	Jun 1995	A
5428504	Bhatia	Jun 1995	A
5429131	Scheinman et al.	Jul 1995	A
5438997	Sieben et al.	Aug 1995	A
5441499	Fritzsch	Aug 1995	A
5443463	Stern et al.	Aug 1995	A
5445638	Rydell et al.	Aug 1995	A
5445639	Kuslich et al.	Aug 1995	A
5447509	Mills et al.	Sep 1995	A
5449370	Vaitekunas	Sep 1995	A
5451053	Garrido	Sep 1995	A
5451161	Sharp	Sep 1995	A
5451220	Ciervo	Sep 1995	A
5451227	Michaelson	Sep 1995	A
5456684	Schmidt et al.	Oct 1995	A
5458598	Feinberg et al.	Oct 1995	A
5462604	Shibano et al.	Oct 1995	A
5465895	Knodel et al.	Nov 1995	A
5471988	Fujio et al.	Dec 1995	A
5472443	Cordis et al.	Dec 1995	A
5476479	Green et al.	Dec 1995	A
5478003	Green et al.	Dec 1995	A
5480409	Riza	Jan 1996	A
5483501	Park et al.	Jan 1996	A
5484436	Eggers et al.	Jan 1996	A
5486162	Brumbach	Jan 1996	A
5486189	Mudry et al.	Jan 1996	A
5490860	Middle et al.	Feb 1996	A
5496317	Goble et al.	Mar 1996	A
5499992	Meade et al.	Mar 1996	A
5500216	Julian et al.	Mar 1996	A
5501654	Failla et al.	Mar 1996	A
5504650	Katsui et al.	Apr 1996	A
5505693	Mackool	Apr 1996	A
5507297	Slater et al.	Apr 1996	A
5507738	Ciervo	Apr 1996	A
5509922	Aranyi et al.	Apr 1996	A
5511556	DeSantis	Apr 1996	A
5520704	Castro et al.	May 1996	A
5522832	Kugo et al.	Jun 1996	A
5522839	Pilling	Jun 1996	A
5527331	Kresch et al.	Jun 1996	A
5531744	Nardella et al.	Jul 1996	A
5540681	Strul et al.	Jul 1996	A
5540693	Fisher	Jul 1996	A
5542916	Hirsch et al.	Aug 1996	A
5548286	Craven	Aug 1996	A
5549637	Crainich	Aug 1996	A
5553675	Pitzen et al.	Sep 1996	A
5558671	Yates	Sep 1996	A
5562609	Brumbach	Oct 1996	A
5562610	Brumbach	Oct 1996	A
5562659	Morris	Oct 1996	A
5562703	Desai	Oct 1996	A
5563179	Stone et al.	Oct 1996	A
5569164	Lurz	Oct 1996	A
5571121	Heifetz	Nov 1996	A
5573424	Poppe	Nov 1996	A
5573533	Strul	Nov 1996	A
5573534	Stone	Nov 1996	A
5577654	Bishop	Nov 1996	A
5584830	Ladd et al.	Dec 1996	A
5591187	Dekel	Jan 1997	A
5593414	Shipp et al.	Jan 1997	A
5599350	Schulze et al.	Feb 1997	A
5600526	Russell et al.	Feb 1997	A
5601601	Tal et al.	Feb 1997	A
5603773	Campbell	Feb 1997	A
5607436	Pratt et al.	Mar 1997	A
5607450	Zvenyatsky et al.	Mar 1997	A
5609573	Sandock	Mar 1997	A
5611813	Lichtman	Mar 1997	A
5618304	Hart et al.	Apr 1997	A
5618307	Donlon et al.	Apr 1997	A
5618492	Auten et al.	Apr 1997	A
5620447	Smith et al.	Apr 1997	A
5624452	Yates	Apr 1997	A
5626587	Bishop et al.	May 1997	A
5626595	Sklar et al.	May 1997	A
5626608	Cuny et al.	May 1997	A
5628760	Knoepfler	May 1997	A
5630420	Vaitekunas	May 1997	A
5632432	Schulze et al.	May 1997	A
5632717	Yoon	May 1997	A
5640741	Yano	Jun 1997	A
D381077	Hunt	Jul 1997	S
5647871	Levine et al.	Jul 1997	A
5649937	Bito et al.	Jul 1997	A
5649955	Hashimoto et al.	Jul 1997	A
5651780	Jackson et al.	Jul 1997	A
5653713	Michelson	Aug 1997	A
5655100	Ebrahim et al.	Aug 1997	A
5658281	Heard	Aug 1997	A
5662662	Bishop et al.	Sep 1997	A
5662667	Knodel	Sep 1997	A
5665085	Nardella	Sep 1997	A
5665100	Yoon	Sep 1997	A
5669922	Hood	Sep 1997	A
5674219	Monson et al.	Oct 1997	A
5674220	Fox et al.	Oct 1997	A
5674235	Parisi	Oct 1997	A
5678568	Uchikubo et al.	Oct 1997	A
5688270	Yates et al.	Nov 1997	A
5690269	Bolanos et al.	Nov 1997	A
5693051	Schulze et al.	Dec 1997	A
5694936	Fujimoto et al.	Dec 1997	A
5695510	Hood	Dec 1997	A
5700261	Brinkerhoff	Dec 1997	A
5704534	Huitema et al.	Jan 1998	A
5704791	Gillio	Jan 1998	A
5707369	Vaitekunas et al.	Jan 1998	A
5709680	Yates et al.	Jan 1998	A
5711472	Bryan	Jan 1998	A
5713896	Nardella	Feb 1998	A
5715817	Stevens-Wright et al.	Feb 1998	A
5716366	Yates	Feb 1998	A
5717306	Shipp	Feb 1998	A
5720742	Zacharias	Feb 1998	A
5720744	Eggleston et al.	Feb 1998	A
5722980	Schulz et al.	Mar 1998	A
5723970	Bell	Mar 1998	A
5728130	Ishikawa et al.	Mar 1998	A
5730752	Alden et al.	Mar 1998	A
5733074	Stock et al.	Mar 1998	A
5735848	Yates et al.	Apr 1998	A
5741226	Strukel et al.	Apr 1998	A
5743906	Parins et al.	Apr 1998	A
5752973	Kieturakis	May 1998	A
5755717	Yates et al.	May 1998	A
5762255	Chrisman et al.	Jun 1998	A
5766164	Mueller et al.	Jun 1998	A
5772659	Becker et al.	Jun 1998	A
5776130	Buysse et al.	Jul 1998	A
5776155	Beaupre et al.	Jul 1998	A
5779130	Alesi et al.	Jul 1998	A
5779701	McBrayer et al.	Jul 1998	A
5782834	Lucey et al.	Jul 1998	A
5792135	Madhani et al.	Aug 1998	A
5792138	Shipp	Aug 1998	A
5792165	Klieman et al.	Aug 1998	A
5796188	Bays	Aug 1998	A
5797941	Schulze et al.	Aug 1998	A
5797958	Yoon	Aug 1998	A
5797959	Castro et al.	Aug 1998	A
5800432	Swanson	Sep 1998	A
5800448	Banko	Sep 1998	A
5800449	Wales	Sep 1998	A
5805140	Rosenberg et al.	Sep 1998	A
5807393	Williamson, IV et al.	Sep 1998	A
5808396	Boukhny	Sep 1998	A
5810811	Yates et al.	Sep 1998	A
5810828	Lightman et al.	Sep 1998	A
5810859	DiMatteo et al.	Sep 1998	A
5817033	DeSantis et al.	Oct 1998	A
5817084	Jensen	Oct 1998	A
5817093	Williamson, IV et al.	Oct 1998	A
5817119	Klieman et al.	Oct 1998	A
5823197	Edwards	Oct 1998	A
5827271	Buysse et al.	Oct 1998	A
5827323	Klieman et al.	Oct 1998	A
5828160	Sugishita	Oct 1998	A
5833696	Whitfield et al.	Nov 1998	A
5836897	Sakurai et al.	Nov 1998	A
5836909	Cosmescu	Nov 1998	A
5836943	Miller, III	Nov 1998	A
5836957	Schulz et al.	Nov 1998	A
5836990	Li	Nov 1998	A
5843109	Mehta et al.	Dec 1998	A
5851212	Zirps et al.	Dec 1998	A
5853412	Mayenberger	Dec 1998	A
5854590	Dalstein	Dec 1998	A
5858018	Shipp et al.	Jan 1999	A
5865361	Milliman et al.	Feb 1999	A
5873873	Smith et al.	Feb 1999	A
5873882	Straub et al.	Feb 1999	A
5876401	Schulze et al.	Mar 1999	A
5878193	Wang et al.	Mar 1999	A
5879364	Bromfield et al.	Mar 1999	A
5880668	Hall	Mar 1999	A
5883615	Fago et al.	Mar 1999	A
5891142	Eggers et al.	Apr 1999	A
5893835	Witt et al.	Apr 1999	A
5897523	Wright et al.	Apr 1999	A
5897569	Kellogg et al.	Apr 1999	A
5903607	Tailliet	May 1999	A
5904681	West, Jr.	May 1999	A
5906625	Bito et al.	May 1999	A
5906627	Spaulding	May 1999	A
5906628	Miyawaki et al.	May 1999	A
5910129	Koblish et al.	Jun 1999	A
5911699	Anis et al.	Jun 1999	A
5913823	Hedberg et al.	Jun 1999	A
5916229	Evans	Jun 1999	A
5921956	Grinberg et al.	Jul 1999	A
5929846	Rosenberg et al.	Jul 1999	A
5935143	Hood	Aug 1999	A
5935144	Estabrook	Aug 1999	A
5938633	Beaupre	Aug 1999	A
5944718	Austin et al.	Aug 1999	A
5944737	Tsonton et al.	Aug 1999	A
5947984	Whipple	Sep 1999	A
5954717	Behl et al.	Sep 1999	A
5954736	Bishop et al.	Sep 1999	A
5954746	Holthaus et al.	Sep 1999	A
5957882	Nita et al.	Sep 1999	A
5957943	Vaitekunas	Sep 1999	A
5968007	Simon et al.	Oct 1999	A
5968060	Kellogg	Oct 1999	A
5974342	Petrofsky	Oct 1999	A
D416089	Barton et al.	Nov 1999	S
5980510	Tsonton et al.	Nov 1999	A
5980546	Hood	Nov 1999	A
5984938	Yoon	Nov 1999	A
5987344	West	Nov 1999	A
5989274	Davison et al.	Nov 1999	A
5989275	Estabrook et al.	Nov 1999	A
5993465	Shipp et al.	Nov 1999	A
5993972	Reich et al.	Nov 1999	A
5994855	Lundell et al.	Nov 1999	A
6003517	Sheffield et al.	Dec 1999	A
6004335	Vaitekunas et al.	Dec 1999	A
6013052	Durman et al.	Jan 2000	A
6024741	Williamson, IV et al.	Feb 2000	A
6024744	Kese et al.	Feb 2000	A
6024750	Mastri et al.	Feb 2000	A
6027515	Cimino	Feb 2000	A
6031526	Shipp	Feb 2000	A
6033375	Brumbach	Mar 2000	A
6033399	Gines	Mar 2000	A
6036667	Manna et al.	Mar 2000	A
6036707	Spaulding	Mar 2000	A
6039734	Goble	Mar 2000	A
6048224	Kay	Apr 2000	A
6050943	Slayton et al.	Apr 2000	A
6050996	Schmaltz et al.	Apr 2000	A
6051010	DiMatteo et al.	Apr 2000	A
6056735	Okada et al.	May 2000	A
6063098	Houser et al.	May 2000	A
6066132	Chen et al.	May 2000	A
6066151	Miyawaki et al.	May 2000	A
6068627	Orszulak et al.	May 2000	A
6068629	Haissaguerre et al.	May 2000	A
6068647	Witt et al.	May 2000	A
6074389	Levine et al.	Jun 2000	A
6077285	Boukhny	Jun 2000	A
6080149	Huang et al.	Jun 2000	A
6083191	Rose	Jul 2000	A
6086584	Miller	Jul 2000	A
6090120	Wright et al.	Jul 2000	A
6091995	Ingle et al.	Jul 2000	A
6096033	Tu et al.	Aug 2000	A
6099483	Palmer et al.	Aug 2000	A
6099542	Cohn et al.	Aug 2000	A
6099550	Yoon	Aug 2000	A
6109500	Alli et al.	Aug 2000	A
6110127	Suzuki	Aug 2000	A
6113594	Savage	Sep 2000	A
6113598	Baker	Sep 2000	A
6117152	Huitema	Sep 2000	A
H1904	Yates et al.	Oct 2000	H
6126629	Perkins	Oct 2000	A
6126658	Baker	Oct 2000	A
6129735	Okada et al.	Oct 2000	A
6129740	Michelson	Oct 2000	A
6132368	Cooper	Oct 2000	A
6132427	Jones et al.	Oct 2000	A
6132429	Baker	Oct 2000	A
6132448	Perez et al.	Oct 2000	A
6139320	Hahn	Oct 2000	A
6139561	Shibata et al.	Oct 2000	A
6142615	Qiu et al.	Nov 2000	A
6142994	Swanson et al.	Nov 2000	A
6144402	Norsworthy et al.	Nov 2000	A
6147560	Erhage et al.	Nov 2000	A
6152902	Christian et al.	Nov 2000	A
6152923	Ryan	Nov 2000	A
6154198	Rosenberg	Nov 2000	A
6156029	Mueller	Dec 2000	A
6159160	Hsei et al.	Dec 2000	A
6159175	Strukel et al.	Dec 2000	A
6162194	Shipp	Dec 2000	A
6162208	Hipps	Dec 2000	A
6165150	Banko	Dec 2000	A
6174309	Wrublewski et al.	Jan 2001	B1
6174310	Kirwan, Jr.	Jan 2001	B1
6176857	Ashley	Jan 2001	B1
6179853	Sachse et al.	Jan 2001	B1
6183426	Akisada et al.	Feb 2001	B1
6187003	Buysse et al.	Feb 2001	B1
6190386	Rydell	Feb 2001	B1
6193709	Miyawaki et al.	Feb 2001	B1
6204592	Hur	Mar 2001	B1
6205383	Hermann	Mar 2001	B1
6205855	Pfeiffer	Mar 2001	B1
6206844	Reichel et al.	Mar 2001	B1
6206876	Levine et al.	Mar 2001	B1
6210337	Dunham et al.	Apr 2001	B1
6210402	Olsen et al.	Apr 2001	B1
6210403	Klicek	Apr 2001	B1
6214023	Whipple et al.	Apr 2001	B1
6228080	Gines	May 2001	B1
6231565	Tovey et al.	May 2001	B1
6232899	Craven	May 2001	B1
6233476	Strommer et al.	May 2001	B1
6238366	Savage et al.	May 2001	B1
6241724	Fleischman et al.	Jun 2001	B1
6245065	Panescu et al.	Jun 2001	B1
6251110	Wampler	Jun 2001	B1
6252110	Uemura et al.	Jun 2001	B1
D444365	Bass et al.	Jul 2001	S
D445092	Lee	Jul 2001	S
D445764	Lee	Jul 2001	S
6254623	Haibel, Jr. et al.	Jul 2001	B1
6257241	Wampler	Jul 2001	B1
6258034	Hanafy	Jul 2001	B1
6259230	Chou	Jul 2001	B1
6267761	Ryan	Jul 2001	B1
6270831	Kumar et al.	Aug 2001	B2
6273852	Lehe et al.	Aug 2001	B1
6274963	Estabrook et al.	Aug 2001	B1
6277115	Saadat	Aug 2001	B1
6277117	Tetzlaff et al.	Aug 2001	B1
6278218	Madan et al.	Aug 2001	B1
6280407	Manna et al.	Aug 2001	B1
6283981	Beaupre	Sep 2001	B1
6287344	Wampler et al.	Sep 2001	B1
6290575	Shipp	Sep 2001	B1
6292700	Morrison et al.	Sep 2001	B1
6299591	Banko	Oct 2001	B1
6306131	Hareyama et al.	Oct 2001	B1
6306157	Shchervinsky	Oct 2001	B1
6309400	Beaupre	Oct 2001	B2
6311783	Harpell	Nov 2001	B1
6319221	Savage et al.	Nov 2001	B1
6325795	Lindemann et al.	Dec 2001	B1
6325799	Goble	Dec 2001	B1
6325811	Messerly	Dec 2001	B1
6328751	Beaupre	Dec 2001	B1
6332891	Himes	Dec 2001	B1
6338657	Harper et al.	Jan 2002	B1
6340352	Okada et al.	Jan 2002	B1
6340878	Oglesbee	Jan 2002	B1
6350269	Shipp et al.	Feb 2002	B1
6352532	Kramer et al.	Mar 2002	B1
6356224	Wohlfarth	Mar 2002	B1
6358246	Behl et al.	Mar 2002	B1
6358264	Banko	Mar 2002	B2
6364888	Niemeyer et al.	Apr 2002	B1
6379320	Lafon et al.	Apr 2002	B1
D457958	Dycus et al.	May 2002	S
6383194	Pothula	May 2002	B1
6384690	Wilhelmsson et al.	May 2002	B1
6387094	Eitenmuller	May 2002	B1
6387109	Davison et al.	May 2002	B1
6388657	Natoli	May 2002	B1
6390973	Ouchi	May 2002	B1
6391026	Hung et al.	May 2002	B1
6391042	Cimino	May 2002	B1
6398779	Buysse et al.	Jun 2002	B1
6402743	Orszulak et al.	Jun 2002	B1
6402748	Schoenman et al.	Jun 2002	B1
6405184	Bohme et al.	Jun 2002	B1
6405733	Fogarty et al.	Jun 2002	B1
6409722	Hoey et al.	Jun 2002	B1
H2037	Yates et al.	Jul 2002	H
6416469	Phung et al.	Jul 2002	B1
6416486	Wampler	Jul 2002	B1
6419675	Gallo, Sr.	Jul 2002	B1
6423073	Bowman	Jul 2002	B2
6423082	Houser et al.	Jul 2002	B1
6425906	Young et al.	Jul 2002	B1
6428538	Blewett et al.	Aug 2002	B1
6428539	Baxter et al.	Aug 2002	B1
6430446	Knowlton	Aug 2002	B1
6432118	Messerly	Aug 2002	B1
6436114	Novak et al.	Aug 2002	B1
6436115	Beaupre	Aug 2002	B1
6440062	Ouchi	Aug 2002	B1
6443968	Holthaus et al.	Sep 2002	B1
6443969	Novak et al.	Sep 2002	B1
6449006	Shipp	Sep 2002	B1
6454781	Witt et al.	Sep 2002	B1
6454782	Schwemberger	Sep 2002	B1
6458128	Schulze	Oct 2002	B1
6458130	Frazier et al.	Oct 2002	B1
6458142	Faller et al.	Oct 2002	B1
6459363	Walker et al.	Oct 2002	B1
6461363	Gadberry et al.	Oct 2002	B1
6464689	Qin et al.	Oct 2002	B1
6464702	Schulze et al.	Oct 2002	B2
6468270	Hovda et al.	Oct 2002	B1
6475211	Chess et al.	Nov 2002	B2
6475215	Tanrisever	Nov 2002	B1
6480796	Wiener	Nov 2002	B2
6485490	Wampler et al.	Nov 2002	B2
6491690	Goble et al.	Dec 2002	B1
6491701	Tierney et al.	Dec 2002	B2
6491708	Madan et al.	Dec 2002	B2
6497715	Satou	Dec 2002	B2
6500112	Khouri	Dec 2002	B1
6500176	Truckai et al.	Dec 2002	B1
6500188	Harper et al.	Dec 2002	B2
6500312	Wedekamp	Dec 2002	B2
6503248	Levine	Jan 2003	B1
6506208	Hunt et al.	Jan 2003	B2
6511478	Burnside et al.	Jan 2003	B1
6511480	Tetzlaff et al.	Jan 2003	B1
6511493	Moutafis et al.	Jan 2003	B1
6514252	Nezhat et al.	Feb 2003	B2
6514267	Jewett	Feb 2003	B2
6517565	Whitman et al.	Feb 2003	B1
6524251	Rabiner et al.	Feb 2003	B2
6524316	Nicholson et al.	Feb 2003	B1
6527736	Attinger et al.	Mar 2003	B1
6531846	Smith	Mar 2003	B1
6533784	Truckai et al.	Mar 2003	B2
6537272	Christopherson et al.	Mar 2003	B2
6537291	Friedman et al.	Mar 2003	B2
6543452	Lavigne	Apr 2003	B1
6543456	Freeman	Apr 2003	B1
6544260	Markel et al.	Apr 2003	B1
6551309	LePivert	Apr 2003	B1
6554829	Schulze et al.	Apr 2003	B2
6558376	Bishop	May 2003	B2
6561983	Cronin et al.	May 2003	B2
6562035	Levin	May 2003	B1
6562037	Paton et al.	May 2003	B2
6565558	Lindenmeier et al.	May 2003	B1
6572563	Ouchi	Jun 2003	B2
6572632	Zisterer et al.	Jun 2003	B2
6572639	Ingle et al.	Jun 2003	B1
6575969	Rittman, III et al.	Jun 2003	B1
6582427	Goble et al.	Jun 2003	B1
6582451	Marucci et al.	Jun 2003	B1
6584360	Francischelli et al.	Jun 2003	B2
D477408	Bromley	Jul 2003	S
6585735	Frazier et al.	Jul 2003	B1
6588277	Giordano et al.	Jul 2003	B2
6589200	Schwemberger et al.	Jul 2003	B1
6589239	Khandkar et al.	Jul 2003	B2
6590733	Wilson et al.	Jul 2003	B1
6599288	Maguire et al.	Jul 2003	B2
6602252	Mollenauer	Aug 2003	B2
6602262	Griego et al.	Aug 2003	B2
6607540	Shipp	Aug 2003	B1
6610059	West, Jr.	Aug 2003	B1
6610060	Mulier et al.	Aug 2003	B2
6611793	Burnside et al.	Aug 2003	B1
6616450	Mossle et al.	Sep 2003	B2
6619529	Green et al.	Sep 2003	B2
6620161	Schulze et al.	Sep 2003	B2
6622731	Daniel et al.	Sep 2003	B2
6623482	Pendekanti et al.	Sep 2003	B2
6623500	Cook et al.	Sep 2003	B1
6623501	Heller et al.	Sep 2003	B2
6626848	Neuenfeldt	Sep 2003	B2
6626926	Friedman et al.	Sep 2003	B2
6629974	Penny et al.	Oct 2003	B2
6632221	Edwards et al.	Oct 2003	B1
6633234	Wiener et al.	Oct 2003	B2
6635057	Harano et al.	Oct 2003	B2
6644532	Green et al.	Nov 2003	B2
6651669	Burnside	Nov 2003	B1
6652513	Panescu et al.	Nov 2003	B2
6652539	Shipp et al.	Nov 2003	B2
6652545	Shipp et al.	Nov 2003	B2
6656132	Ouchi	Dec 2003	B1
6656177	Truckai et al.	Dec 2003	B2
6656198	Tsonton et al.	Dec 2003	B2
6660017	Beaupre	Dec 2003	B2
6662127	Wiener et al.	Dec 2003	B2
6663941	Brown et al.	Dec 2003	B2
6666860	Takahashi	Dec 2003	B1
6666875	Sakurai et al.	Dec 2003	B1
6669690	Okada et al.	Dec 2003	B1
6669710	Moutafis et al.	Dec 2003	B2
6673248	Chowdhury	Jan 2004	B2
6676660	Wampler et al.	Jan 2004	B2
6678621	Wiener et al.	Jan 2004	B2
6679875	Honda et al.	Jan 2004	B2
6679882	Kornerup	Jan 2004	B1
6679899	Wiener et al.	Jan 2004	B2
6682501	Nelson et al.	Jan 2004	B1
6682544	Mastri et al.	Jan 2004	B2
6685700	Behl et al.	Feb 2004	B2
6685701	Orszulak et al.	Feb 2004	B2
6685703	Pearson et al.	Feb 2004	B2
6689145	Lee et al.	Feb 2004	B2
6689146	Himes	Feb 2004	B1
6690960	Chen et al.	Feb 2004	B2
6695840	Schulze	Feb 2004	B2
6702821	Bonutti	Mar 2004	B2
6716215	David et al.	Apr 2004	B1
6719692	Kleffner et al.	Apr 2004	B2
6719765	Bonutti	Apr 2004	B2
6719776	Baxter et al.	Apr 2004	B2
6722552	Fenton, Jr.	Apr 2004	B2
6723091	Goble et al.	Apr 2004	B2
D490059	Conway et al.	May 2004	S
6730080	Harano et al.	May 2004	B2
6731047	Kauf et al.	May 2004	B2
6733498	Paton et al.	May 2004	B2
6733506	McDevitt et al.	May 2004	B1
6736813	Yamauchi et al.	May 2004	B2
6739872	Turri	May 2004	B1
6740079	Eggers et al.	May 2004	B1
D491666	Kimmell et al.	Jun 2004	S
6743245	Lobdell	Jun 2004	B2
6746284	Spink, Jr.	Jun 2004	B1
6746443	Morley et al.	Jun 2004	B1
6752815	Beaupre	Jun 2004	B2
6755825	Shoenman et al.	Jun 2004	B2
6761698	Shibata et al.	Jul 2004	B2
6762535	Take et al.	Jul 2004	B2
6766202	Underwood et al.	Jul 2004	B2
6770072	Truckai et al.	Aug 2004	B1
6773409	Truckai et al.	Aug 2004	B2
6773434	Ciarrocca	Aug 2004	B2
6773435	Schulze et al.	Aug 2004	B2
6773443	Truwit et al.	Aug 2004	B2
6773444	Messerly	Aug 2004	B2
6775575	Bommannan et al.	Aug 2004	B2
6778023	Christensen	Aug 2004	B2
6783524	Anderson et al.	Aug 2004	B2
6786382	Hoffman	Sep 2004	B1
6786383	Stegelmann	Sep 2004	B2
6789939	Schrodinger et al.	Sep 2004	B2
6790173	Saadat et al.	Sep 2004	B2
6790216	Ishikawa	Sep 2004	B1
6794027	Araki et al.	Sep 2004	B1
6796981	Wham et al.	Sep 2004	B2
D496997	Dycus et al.	Oct 2004	S
6800085	Selmon et al.	Oct 2004	B2
6802843	Truckai et al.	Oct 2004	B2
6808525	Latterell et al.	Oct 2004	B2
6809508	Donofrio	Oct 2004	B2
6810281	Brock et al.	Oct 2004	B2
6811842	Ehrnsperger et al.	Nov 2004	B1
6814731	Swanson	Nov 2004	B2
6819027	Saraf	Nov 2004	B2
6821273	Mollenauer	Nov 2004	B2
6827712	Tovey et al.	Dec 2004	B2
6828712	Battaglin et al.	Dec 2004	B2
6835082	Gonnering	Dec 2004	B2
6835199	McGuckin, Jr. et al.	Dec 2004	B2
6840938	Morley et al.	Jan 2005	B1
6843789	Goble	Jan 2005	B2
6849073	Hoey et al.	Feb 2005	B2
6860878	Brock	Mar 2005	B2
6860880	Treat et al.	Mar 2005	B2
6863676	Lee et al.	Mar 2005	B2
6866671	Tierney et al.	Mar 2005	B2
6869439	White et al.	Mar 2005	B2
6875220	Du et al.	Apr 2005	B2
6877647	Green et al.	Apr 2005	B2
6882439	Ishijima	Apr 2005	B2
6887209	Kadziauskas et al.	May 2005	B2
6887252	Okada et al.	May 2005	B1
6893435	Goble	May 2005	B2
6898536	Wiener et al.	May 2005	B2
6899685	Kermode et al.	May 2005	B2
6905497	Truckai et al.	Jun 2005	B2
6908463	Treat et al.	Jun 2005	B2
6908472	Wiener et al.	Jun 2005	B2
6913579	Truckai et al.	Jul 2005	B2
6915623	Dey et al.	Jul 2005	B2
6923804	Eggers et al.	Aug 2005	B2
6923806	Hooven et al.	Aug 2005	B2
6926712	Phan	Aug 2005	B2
6926716	Baker et al.	Aug 2005	B2
6926717	Garito et al.	Aug 2005	B1
6929602	Hirakui et al.	Aug 2005	B2
6929622	Chian	Aug 2005	B2
6929632	Nita et al.	Aug 2005	B2
6929644	Truckai et al.	Aug 2005	B2
6933656	Matsushita et al.	Aug 2005	B2
D509589	Wells	Sep 2005	S
6942660	Pantera et al.	Sep 2005	B2
6942677	Nita et al.	Sep 2005	B2
6945981	Donofrio et al.	Sep 2005	B2
6946779	Birgel	Sep 2005	B2
6948503	Refior et al.	Sep 2005	B2
6953461	McClurken et al.	Oct 2005	B2
6958070	Witt et al.	Oct 2005	B2
D511145	Donofrio et al.	Nov 2005	S
6974450	Weber et al.	Dec 2005	B2
6976844	Hickok et al.	Dec 2005	B2
6976969	Messerly	Dec 2005	B2
6977495	Donofrio	Dec 2005	B2
6979332	Adams	Dec 2005	B2
6981628	Wales	Jan 2006	B2
6984220	Wuchinich	Jan 2006	B2
6988295	Tillim	Jan 2006	B2
6994708	Manzo	Feb 2006	B2
6994709	Iida	Feb 2006	B2
7000818	Shelton, IV et al.	Feb 2006	B2
7001335	Adachi et al.	Feb 2006	B2
7001379	Behl et al.	Feb 2006	B2
7001382	Gallo, Sr.	Feb 2006	B2
7004951	Gibbens, III	Feb 2006	B2
7011657	Truckai et al.	Mar 2006	B2
7014638	Michelson	Mar 2006	B2
7018389	Camerlengo	Mar 2006	B2
7025732	Thompson et al.	Apr 2006	B2
7033356	Latterell et al.	Apr 2006	B2
7033357	Baxter et al.	Apr 2006	B2
7037306	Podany et al.	May 2006	B2
7041083	Chu et al.	May 2006	B2
7041088	Nawrocki et al.	May 2006	B2
7041102	Truckai et al.	May 2006	B2
7044949	Orszulak et al.	May 2006	B2
7052494	Goble et al.	May 2006	B2
7052496	Yamauchi	May 2006	B2
7055731	Shelton, IV et al.	Jun 2006	B2
7063699	Hess et al.	Jun 2006	B2
7066893	Hibner et al.	Jun 2006	B2
7066895	Podany	Jun 2006	B2
7066936	Ryan	Jun 2006	B2
7070597	Truckai et al.	Jul 2006	B2
7074218	Washington et al.	Jul 2006	B2
7074219	Levine et al.	Jul 2006	B2
7077039	Gass et al.	Jul 2006	B2
7077845	Hacker et al.	Jul 2006	B2
7077853	Kramer et al.	Jul 2006	B2
7083075	Swayze et al.	Aug 2006	B2
7083613	Treat	Aug 2006	B2
7083618	Couture et al.	Aug 2006	B2
7083619	Truckai et al.	Aug 2006	B2
7087054	Truckai et al.	Aug 2006	B2
7090637	Danitz et al.	Aug 2006	B2
7090672	Underwood et al.	Aug 2006	B2
7094235	Francischelli	Aug 2006	B2
7101371	Dycus et al.	Sep 2006	B2
7101372	Dycus et al.	Sep 2006	B2
7101373	Dycus et al.	Sep 2006	B2
7101378	Salameh et al.	Sep 2006	B2
7104834	Robinson et al.	Sep 2006	B2
7108695	Witt et al.	Sep 2006	B2
7111769	Wales et al.	Sep 2006	B2
7112201	Truckai et al.	Sep 2006	B2
7113831	Hooven	Sep 2006	B2
D531311	Guerra et al.	Oct 2006	S
7117034	Kronberg	Oct 2006	B2
7118564	Ritchie et al.	Oct 2006	B2
7118570	Tetzlaff et al.	Oct 2006	B2
7118587	Dycus et al.	Oct 2006	B2
7119516	Denning	Oct 2006	B2
7124932	Isaacson et al.	Oct 2006	B2
7125409	Truckai et al.	Oct 2006	B2
7128720	Podany	Oct 2006	B2
7131860	Sartor et al.	Nov 2006	B2
7131970	Moses et al.	Nov 2006	B2
7135018	Ryan et al.	Nov 2006	B2
7135030	Schwemberger et al.	Nov 2006	B2
7137980	Buysse et al.	Nov 2006	B2
7143925	Shelton, IV et al.	Dec 2006	B2
7144403	Booth	Dec 2006	B2
7147138	Shelton, IV	Dec 2006	B2
7153315	Miller	Dec 2006	B2
D536093	Nakajima et al.	Jan 2007	S
7156189	Bar-Cohen et al.	Jan 2007	B1
7156846	Dycus et al.	Jan 2007	B2
7156853	Muratsu	Jan 2007	B2
7157058	Marhasin et al.	Jan 2007	B2
7159750	Racenet et al.	Jan 2007	B2
7160259	Tardy et al.	Jan 2007	B2
7160296	Pearson et al.	Jan 2007	B2
7160298	Lawes et al.	Jan 2007	B2
7160299	Baily	Jan 2007	B2
7163548	Stulen et al.	Jan 2007	B2
7166103	Carmel et al.	Jan 2007	B2
7169144	Hoey et al.	Jan 2007	B2
7169146	Truckai et al.	Jan 2007	B2
7169156	Hart	Jan 2007	B2
7179254	Pendekanti et al.	Feb 2007	B2
7179271	Friedman et al.	Feb 2007	B2
7186253	Truckai et al.	Mar 2007	B2
7189233	Truckai et al.	Mar 2007	B2
7195631	Dumbauld	Mar 2007	B2
D541418	Schechter et al.	Apr 2007	S
7198635	Danek et al.	Apr 2007	B2
7204820	Akahoshi	Apr 2007	B2
7207471	Heinrich et al.	Apr 2007	B2
7207997	Shipp et al.	Apr 2007	B2
7208005	Frecker et al.	Apr 2007	B2
7210881	Greenberg	May 2007	B2
7211079	Treat	May 2007	B2
7217128	Atkin et al.	May 2007	B2
7217269	El-Galley et al.	May 2007	B2
7220951	Truckai et al.	May 2007	B2
7223229	Inman et al.	May 2007	B2
7225964	Mastri et al.	Jun 2007	B2
7226447	Uchida et al.	Jun 2007	B2
7226448	Bertolero et al.	Jun 2007	B2
7229455	Sakurai et al.	Jun 2007	B2
7232440	Dumbauld et al.	Jun 2007	B2
7235071	Gonnering	Jun 2007	B2
7235073	Levine et al.	Jun 2007	B2
7241294	Ke	Jul 2007	B2
7244262	Wiener et al.	Jul 2007	B2
7251531	Mosher et al.	Jul 2007	B2
7252641	Thompson et al.	Aug 2007	B2
7252667	Moses et al.	Aug 2007	B2
7258688	Shah et al.	Aug 2007	B1
7264618	Murakami et al.	Sep 2007	B2
7267677	Johnson et al.	Sep 2007	B2
7267685	Butaric et al.	Sep 2007	B2
7269873	Brewer et al.	Sep 2007	B2
7273483	Wiener et al.	Sep 2007	B2
D552241	Bromley et al.	Oct 2007	S
7282048	Goble et al.	Oct 2007	B2
7285895	Beaupre	Oct 2007	B2
7287682	Ezzat et al.	Oct 2007	B1
7297149	Vitali et al.	Nov 2007	B2
7300431	Dubrovsky	Nov 2007	B2
7300435	Wham et al.	Nov 2007	B2
7300446	Beaupre	Nov 2007	B2
7300450	Vleugels et al.	Nov 2007	B2
7303531	Lee et al.	Dec 2007	B2
7303557	Wham et al.	Dec 2007	B2
7306597	Manzo	Dec 2007	B2
7307313	Ohyanagi et al.	Dec 2007	B2
7309849	Truckai et al.	Dec 2007	B2
7311706	Schoenman et al.	Dec 2007	B2
7311709	Truckai et al.	Dec 2007	B2
7317955	McGreevy	Jan 2008	B2
7318831	Alvarez et al.	Jan 2008	B2
7318832	Young et al.	Jan 2008	B2
7326236	Andreas et al.	Feb 2008	B2
7329257	Kanehira et al.	Feb 2008	B2
7331410	Yong et al.	Feb 2008	B2
7335165	Truwit et al.	Feb 2008	B2
7335997	Wiener	Feb 2008	B2
7337010	Howard et al.	Feb 2008	B2
7353068	Tanaka et al.	Apr 2008	B2
7354440	Truckal et al.	Apr 2008	B2
7357287	Shelton, IV et al.	Apr 2008	B2
7357802	Palanker et al.	Apr 2008	B2
7361172	Cimino	Apr 2008	B2
7364577	Wham et al.	Apr 2008	B2
7367976	Lawes et al.	May 2008	B2
7371227	Zeiner	May 2008	B2
RE40388	Gines	Jun 2008	E
7380695	Doll et al.	Jun 2008	B2
7380696	Shelton, IV et al.	Jun 2008	B2
7381209	Truckal et al.	Jun 2008	B2
7384420	Dycus et al.	Jun 2008	B2
7390317	Taylor et al.	Jun 2008	B2
7396356	Mollenauer	Jul 2008	B2
7403224	Fuller et al.	Jul 2008	B2
7404508	Smith et al.	Jul 2008	B2
7407077	Ortiz et al.	Aug 2008	B2
7408288	Hara	Aug 2008	B2
7412008	Lliev	Aug 2008	B2
7416101	Shelton, IV et al.	Aug 2008	B2
7416437	Sartor et al.	Aug 2008	B2
D576725	Shumer et al.	Sep 2008	S
7419490	Falkenstein et al.	Sep 2008	B2
7422139	Shelton, IV et al.	Sep 2008	B2
7422463	Kuo	Sep 2008	B2
7422582	Malackowski et al.	Sep 2008	B2
D578643	Shumer et al.	Oct 2008	S
D578644	Shumer et al.	Oct 2008	S
D578645	Shumer et al.	Oct 2008	S
7431694	Stefanchik et al.	Oct 2008	B2
7431704	Babaev	Oct 2008	B2
7431720	Pendekanti et al.	Oct 2008	B2
7435582	Zimmermann et al.	Oct 2008	B2
7441684	Shelton, IV et al.	Oct 2008	B2
7442193	Shields et al.	Oct 2008	B2
7445621	Dumbauld et al.	Nov 2008	B2
7449004	Yamada et al.	Nov 2008	B2
7451904	Shelton, IV	Nov 2008	B2
7455208	Wales et al.	Nov 2008	B2
7455641	Yamada et al.	Nov 2008	B2
7462181	Kraft et al.	Dec 2008	B2
7464846	Shelton, IV et al.	Dec 2008	B2
7464849	Shelton, IV et al.	Dec 2008	B2
7472815	Shelton, IV et al.	Jan 2009	B2
7473145	Ehr et al.	Jan 2009	B2
7473253	Dycus et al.	Jan 2009	B2
7473263	Johnston et al.	Jan 2009	B2
7479148	Beaupre	Jan 2009	B2
7479160	Branch et al.	Jan 2009	B2
7481775	Weikel, Jr. et al.	Jan 2009	B2
7488285	Honda et al.	Feb 2009	B2
7488319	Yates	Feb 2009	B2
7491201	Shields et al.	Feb 2009	B2
7491202	Odom et al.	Feb 2009	B2
7494468	Rabiner et al.	Feb 2009	B2
7494501	Ahlberg et al.	Feb 2009	B2
7498080	Tung et al.	Mar 2009	B2
7502234	Goliszek et al.	Mar 2009	B2
7503893	Kucklick	Mar 2009	B2
7503895	Rabiner et al.	Mar 2009	B2
7506790	Shelton, IV	Mar 2009	B2
7506791	Omaits et al.	Mar 2009	B2
7507239	Shadduck	Mar 2009	B2
7510107	Timm et al.	Mar 2009	B2
7510556	Nguyen et al.	Mar 2009	B2
7513025	Fischer	Apr 2009	B2
7517349	Truckai et al.	Apr 2009	B2
7520865	Radley Young et al.	Apr 2009	B2
7524320	Tierney et al.	Apr 2009	B2
7530986	Beaupre et al.	May 2009	B2
7534243	Chin et al.	May 2009	B1
7535233	Kojovic et al.	May 2009	B2
D594983	Price et al.	Jun 2009	S
7540871	Gonnering	Jun 2009	B2
7540872	Schechter et al.	Jun 2009	B2
7543730	Marczyk	Jun 2009	B1
7544200	Houser	Jun 2009	B2
7549564	Boudreaux	Jun 2009	B2
7550216	Ofer et al.	Jun 2009	B2
7553309	Buysse et al.	Jun 2009	B2
7554343	Bromfield	Jun 2009	B2
7559450	Wales et al.	Jul 2009	B2
7559452	Wales et al.	Jul 2009	B2
7563259	Takahashi	Jul 2009	B2
7566318	Haefner	Jul 2009	B2
7567012	Namikawa	Jul 2009	B2
7568603	Shelton, IV et al.	Aug 2009	B2
7569057	Liu et al.	Aug 2009	B2
7572266	Young et al.	Aug 2009	B2
7572268	Babaev	Aug 2009	B2
7578820	Moore et al.	Aug 2009	B2
7582084	Swanson et al.	Sep 2009	B2
7582086	Privitera et al.	Sep 2009	B2
7582087	Tetzlaff et al.	Sep 2009	B2
7582095	Shipp et al.	Sep 2009	B2
7585181	Olsen	Sep 2009	B2
7586289	Andruk et al.	Sep 2009	B2
7587536	McLeod	Sep 2009	B2
7588176	Timm et al.	Sep 2009	B2
7588177	Racenet	Sep 2009	B2
7594925	Danek et al.	Sep 2009	B2
7597693	Garrison	Oct 2009	B2
7601119	Shahinian	Oct 2009	B2
7601136	Akahoshi	Oct 2009	B2
7604150	Boudreaux	Oct 2009	B2
7607557	Shelton, IV et al.	Oct 2009	B2
7617961	Viola	Nov 2009	B2
7621930	Houser	Nov 2009	B2
7625370	Hart et al.	Dec 2009	B2
7628791	Garrison et al.	Dec 2009	B2
7628792	Guerra	Dec 2009	B2
7632267	Dahla	Dec 2009	B2
7632269	Truckai et al.	Dec 2009	B2
7637410	Marczyk	Dec 2009	B2
7641653	Dalla Betta et al.	Jan 2010	B2
7641671	Crainich	Jan 2010	B2
7644848	Swayze et al.	Jan 2010	B2
7645240	Thompson et al.	Jan 2010	B2
7645277	McClurken et al.	Jan 2010	B2
7645278	Ichihashi et al.	Jan 2010	B2
7648499	Orszulak et al.	Jan 2010	B2
7649410	Andersen et al.	Jan 2010	B2
7654431	Hueil et al.	Feb 2010	B2
7655003	Lorang et al.	Feb 2010	B2
7658311	Boudreaux	Feb 2010	B2
7659833	Warner et al.	Feb 2010	B2
7662151	Crompton, Jr. et al.	Feb 2010	B2
7665647	Shelton, IV et al.	Feb 2010	B2
7666206	Taniguchi et al.	Feb 2010	B2
7667592	Ohyama et al.	Feb 2010	B2
7670334	Hueil et al.	Mar 2010	B2
7670338	Albrecht et al.	Mar 2010	B2
7674263	Ryan	Mar 2010	B2
7678069	Baker et al.	Mar 2010	B1
7678105	McGreevy et al.	Mar 2010	B2
7678125	Shipp	Mar 2010	B2
7682366	Sakurai et al.	Mar 2010	B2
7686770	Cohen	Mar 2010	B2
7686826	Lee et al.	Mar 2010	B2
7688028	Phillips et al.	Mar 2010	B2
7691095	Bednarek et al.	Apr 2010	B2
7691098	Wallace et al.	Apr 2010	B2
7699846	Ryan	Apr 2010	B2
7703459	Saadat et al.	Apr 2010	B2
7703653	Shah et al.	Apr 2010	B2
7708735	Chapman et al.	May 2010	B2
7708751	Hughes et al.	May 2010	B2
7708758	Lee et al.	May 2010	B2
7708768	Danek et al.	May 2010	B2
7713202	Boukhny et al.	May 2010	B2
7713267	Pozzato	May 2010	B2
7714481	Sakai	May 2010	B2
7717312	Beetel	May 2010	B2
7717914	Kimura	May 2010	B2
7717915	Miyazawa	May 2010	B2
7721935	Racenet et al.	May 2010	B2
7722527	Bouchier et al.	May 2010	B2
7722607	Dumbauld et al.	May 2010	B2
D618797	Price et al.	Jun 2010	S
7726537	Olson et al.	Jun 2010	B2
7727177	Bayat	Jun 2010	B2
7731717	Odom et al.	Jun 2010	B2
7738969	Bleich	Jun 2010	B2
7740594	Hibner	Jun 2010	B2
7744615	Couture	Jun 2010	B2
7749240	Takahashi et al.	Jul 2010	B2
7751115	Song	Jul 2010	B2
7753245	Boudreaux et al.	Jul 2010	B2
7753904	Shelton, IV et al.	Jul 2010	B2
7753908	Swanson	Jul 2010	B2
7762445	Heinrich et al.	Jul 2010	B2
D621503	Otten et al.	Aug 2010	S
7766210	Shelton, IV et al.	Aug 2010	B2
7766693	Sartor et al.	Aug 2010	B2
7766910	Hixson et al.	Aug 2010	B2
7768510	Tsai et al.	Aug 2010	B2
7770774	Mastri et al.	Aug 2010	B2
7770775	Shelton, IV et al.	Aug 2010	B2
7771425	Dycus et al.	Aug 2010	B2
7771444	Patel et al.	Aug 2010	B2
7775972	Brock et al.	Aug 2010	B2
7776036	Schechter et al.	Aug 2010	B2
7776037	Odom	Aug 2010	B2
7778733	Nowlin et al.	Aug 2010	B2
7780054	Wales	Aug 2010	B2
7780593	Ueno et al.	Aug 2010	B2
7780651	Madhani et al.	Aug 2010	B2
7780659	Okada et al.	Aug 2010	B2
7780663	Yates et al.	Aug 2010	B2
7784662	Wales et al.	Aug 2010	B2
7784663	Shelton, IV	Aug 2010	B2
7789883	Takashino et al.	Sep 2010	B2
7793814	Racenet et al.	Sep 2010	B2
7794475	Hess et al.	Sep 2010	B2
7796969	Kelly et al.	Sep 2010	B2
7798386	Schall et al.	Sep 2010	B2
7799020	Shores et al.	Sep 2010	B2
7799027	Hafner	Sep 2010	B2
7799045	Masuda	Sep 2010	B2
7803152	Honda et al.	Sep 2010	B2
7803156	Eder et al.	Sep 2010	B2
7803168	Gifford et al.	Sep 2010	B2
7806891	Nowlin et al.	Oct 2010	B2
7810693	Broehl et al.	Oct 2010	B2
7811283	Moses et al.	Oct 2010	B2
7815238	Cao	Oct 2010	B2
7815641	Dodde et al.	Oct 2010	B2
7819298	Hall et al.	Oct 2010	B2
7819299	Shelton, IV et al.	Oct 2010	B2
7819819	Quick et al.	Oct 2010	B2
7819872	Johnson et al.	Oct 2010	B2
7821143	Wiener	Oct 2010	B2
D627066	Romero	Nov 2010	S
7824401	Manzo et al.	Nov 2010	B2
7832408	Shelton, IV et al.	Nov 2010	B2
7832611	Boyden et al.	Nov 2010	B2
7832612	Baxter, III et al.	Nov 2010	B2
7834484	Sartor	Nov 2010	B2
7837699	Yamada et al.	Nov 2010	B2
7845537	Shelton, IV et al.	Dec 2010	B2
7846155	Houser et al.	Dec 2010	B2
7846159	Morrison et al.	Dec 2010	B2
7846160	Payne et al.	Dec 2010	B2
7846161	Dumbauld et al.	Dec 2010	B2
7854735	Houser et al.	Dec 2010	B2
D631155	Peine et al.	Jan 2011	S
7861906	Doll et al.	Jan 2011	B2
7862560	Marion	Jan 2011	B2
7862561	Swanson et al.	Jan 2011	B2
7867228	Nobis et al.	Jan 2011	B2
7871392	Sartor	Jan 2011	B2
7871423	Livneh	Jan 2011	B2
7876030	Taki et al.	Jan 2011	B2
D631965	Price et al.	Feb 2011	S
7877852	Unger et al.	Feb 2011	B2
7878991	Babaev	Feb 2011	B2
7879033	Sartor et al.	Feb 2011	B2
7879035	Garrison et al.	Feb 2011	B2
7879070	Ortiz et al.	Feb 2011	B2
7883475	Dupont et al.	Feb 2011	B2
7892606	Thies et al.	Feb 2011	B2
7896875	Heim et al.	Mar 2011	B2
7897792	Iikura et al.	Mar 2011	B2
7901400	Wham et al.	Mar 2011	B2
7901423	Stulen et al.	Mar 2011	B2
7905881	Masuda et al.	Mar 2011	B2
7909220	Viola	Mar 2011	B2
7909820	Lipson et al.	Mar 2011	B2
7909824	Masuda et al.	Mar 2011	B2
7918848	Lau et al.	Apr 2011	B2
7919184	Mohapatra et al.	Apr 2011	B2
7922061	Shelton, IV et al.	Apr 2011	B2
7922651	Yamada et al.	Apr 2011	B2
7931611	Novak et al.	Apr 2011	B2
7931649	Couture et al.	Apr 2011	B2
D637288	Houghton	May 2011	S
D638540	Ijiri et al.	May 2011	S
7935114	Takashino et al.	May 2011	B2
7936203	Zimlich	May 2011	B2
7951095	Makin et al.	May 2011	B2
7951165	Golden et al.	May 2011	B2
7955331	Truckai et al.	Jun 2011	B2
7956620	Gilbert	Jun 2011	B2
7959050	Smith et al.	Jun 2011	B2
7959626	Hong et al.	Jun 2011	B2
7963963	Francischelli et al.	Jun 2011	B2
7967602	Lindquist	Jun 2011	B2
7972328	Wham et al.	Jul 2011	B2
7972329	Refior et al.	Jul 2011	B2
7976544	McClurken et al.	Jul 2011	B2
7980443	Scheib et al.	Jul 2011	B2
7981050	Ritchart et al.	Jul 2011	B2
7981113	Truckai et al.	Jul 2011	B2
7997278	Utley et al.	Aug 2011	B2
7998157	Culp et al.	Aug 2011	B2
8002732	Visconti	Aug 2011	B2
8002770	Swanson et al.	Aug 2011	B2
8020743	Shelton, IV	Sep 2011	B2
8028885	Smith et al.	Oct 2011	B2
8033173	Ehlert et al.	Oct 2011	B2
8034049	Odom et al.	Oct 2011	B2
8038693	Allen	Oct 2011	B2
8048070	O'Brien et al.	Nov 2011	B2
8052672	Laufer et al.	Nov 2011	B2
8055208	Lilia et al.	Nov 2011	B2
8056720	Hawkes	Nov 2011	B2
8056787	Boudreaux et al.	Nov 2011	B2
8057468	Esky	Nov 2011	B2
8057498	Robertson	Nov 2011	B2
8058771	Giordano et al.	Nov 2011	B2
8061014	Smith et al.	Nov 2011	B2
8066167	Measamer et al.	Nov 2011	B2
8070036	Knodel	Dec 2011	B1
8070711	Bassinger et al.	Dec 2011	B2
8070762	Escudero et al.	Dec 2011	B2
8075555	Truckai et al.	Dec 2011	B2
8075558	Truckai et al.	Dec 2011	B2
8089197	Rinner et al.	Jan 2012	B2
8092475	Cotter et al.	Jan 2012	B2
8096459	Ortiz et al.	Jan 2012	B2
8097012	Kagarise	Jan 2012	B2
8100894	Mucko et al.	Jan 2012	B2
8105230	Honda et al.	Jan 2012	B2
8105323	Buysse et al.	Jan 2012	B2
8105324	Palanker et al.	Jan 2012	B2
8114104	Young et al.	Feb 2012	B2
8118276	Sanders et al.	Feb 2012	B2
8128624	Couture et al.	Mar 2012	B2
8133218	Daw et al.	Mar 2012	B2
8136712	Zingman	Mar 2012	B2
8141762	Bedi et al.	Mar 2012	B2
8142421	Cooper et al.	Mar 2012	B2
8142461	Houser et al.	Mar 2012	B2
8147485	Wham et al.	Apr 2012	B2
8147488	Masuda	Apr 2012	B2
8147508	Madan et al.	Apr 2012	B2
8152801	Goldberg et al.	Apr 2012	B2
8152825	Madan et al.	Apr 2012	B2
8157145	Shelton, IV et al.	Apr 2012	B2
8161977	Shelton, IV et al.	Apr 2012	B2
8162966	Connor et al.	Apr 2012	B2
8170717	Sutherland et al.	May 2012	B2
8172846	Brunnett et al.	May 2012	B2
8172870	Shipp	May 2012	B2
8177800	Spitz et al.	May 2012	B2
8182502	Stulen et al.	May 2012	B2
8186560	Hess et al.	May 2012	B2
8186877	Klimovitch et al.	May 2012	B2
8187267	Pappone et al.	May 2012	B2
D661801	Price et al.	Jun 2012	S
D661802	Price et al.	Jun 2012	S
D661803	Price et al.	Jun 2012	S
D661804	Price et al.	Jun 2012	S
8197472	Lau et al.	Jun 2012	B2
8197479	Olson et al.	Jun 2012	B2
8197502	Smith et al.	Jun 2012	B2
8207651	Gilbert	Jun 2012	B2
8210411	Yates et al.	Jul 2012	B2
8211100	Podhajsky et al.	Jul 2012	B2
8220688	Laurent et al.	Jul 2012	B2
8221306	Okada et al.	Jul 2012	B2
8221415	Francischelli	Jul 2012	B2
8226580	Govari et al.	Jul 2012	B2
8226665	Cohen	Jul 2012	B2
8226675	Houser et al.	Jul 2012	B2
8231607	Takuma	Jul 2012	B2
8235917	Joseph et al.	Aug 2012	B2
8236018	Yoshimine et al.	Aug 2012	B2
8236019	Houser	Aug 2012	B2
8236020	Smith et al.	Aug 2012	B2
8241235	Kahler et al.	Aug 2012	B2
8241271	Millman et al.	Aug 2012	B2
8241282	Unger et al.	Aug 2012	B2
8241283	Guerra et al.	Aug 2012	B2
8241284	Dycus et al.	Aug 2012	B2
8241312	Messerly	Aug 2012	B2
8246575	Viola	Aug 2012	B2
8246615	Behnke	Aug 2012	B2
8246616	Amoah et al.	Aug 2012	B2
8246618	Bucciaglia et al.	Aug 2012	B2
8246642	Houser et al.	Aug 2012	B2
8251994	McKenna et al.	Aug 2012	B2
8252012	Stulen	Aug 2012	B2
8253303	Giordano et al.	Aug 2012	B2
8257377	Wiener et al.	Sep 2012	B2
8257387	Cunningham	Sep 2012	B2
8262563	Bakos et al.	Sep 2012	B2
8267300	Boudreaux	Sep 2012	B2
8267935	Couture et al.	Sep 2012	B2
8273087	Kimura et al.	Sep 2012	B2
D669992	Schafer et al.	Oct 2012	S
D669993	Merchant et al.	Oct 2012	S
8277446	Heard	Oct 2012	B2
8277447	Garrison et al.	Oct 2012	B2
8277471	Wiener et al.	Oct 2012	B2
8282581	Zhao et al.	Oct 2012	B2
8282669	Gerber et al.	Oct 2012	B2
8286846	Smith et al.	Oct 2012	B2
8287485	Kimura et al.	Oct 2012	B2
8287528	Wham et al.	Oct 2012	B2
8287532	Carroll et al.	Oct 2012	B2
8292886	Kerr et al.	Oct 2012	B2
8292888	Whitman	Oct 2012	B2
8292905	Taylor et al.	Oct 2012	B2
8295902	Salahieh et al.	Oct 2012	B2
8298223	Wham et al.	Oct 2012	B2
8298225	Gilbert	Oct 2012	B2
8298232	Unger	Oct 2012	B2
8298233	Mueller	Oct 2012	B2
8303576	Brock	Nov 2012	B2
8303579	Shibata	Nov 2012	B2
8303580	Wham et al.	Nov 2012	B2
8303583	Hosier et al.	Nov 2012	B2
8303613	Crandall et al.	Nov 2012	B2
8306629	Mioduski et al.	Nov 2012	B2
8308040	Huang et al.	Nov 2012	B2
8319400	Houser et al.	Nov 2012	B2
8323302	Robertson et al.	Dec 2012	B2
8323310	Kingsley	Dec 2012	B2
8328061	Kasvikis	Dec 2012	B2
8328761	Widenhouse et al.	Dec 2012	B2
8328802	Deville et al.	Dec 2012	B2
8328833	Cuny	Dec 2012	B2
8328834	Isaacs et al.	Dec 2012	B2
8333764	Francischelli et al.	Dec 2012	B2
8333778	Smith et al.	Dec 2012	B2
8333779	Smith et al.	Dec 2012	B2
8334468	Palmer et al.	Dec 2012	B2
8334635	Voegele et al.	Dec 2012	B2
8337407	Quistgaard et al.	Dec 2012	B2
8338726	Palmer et al.	Dec 2012	B2
8343146	Godara et al.	Jan 2013	B2
8344596	Nield et al.	Jan 2013	B2
8348880	Messerly et al.	Jan 2013	B2
8348947	Takashino et al.	Jan 2013	B2
8348967	Stulen	Jan 2013	B2
8353297	Dacquay et al.	Jan 2013	B2
8357103	Mark et al.	Jan 2013	B2
8357144	Whitman et al.	Jan 2013	B2
8357149	Govari et al.	Jan 2013	B2
8357158	McKenna et al.	Jan 2013	B2
8361066	Long et al.	Jan 2013	B2
8361072	Dumbauld et al.	Jan 2013	B2
8361569	Saito et al.	Jan 2013	B2
8366727	Witt et al.	Feb 2013	B2
8372064	Douglass et al.	Feb 2013	B2
8372099	Deville et al.	Feb 2013	B2
8372101	Smith et al.	Feb 2013	B2
8372102	Stulen et al.	Feb 2013	B2
8374670	Selkee	Feb 2013	B2
8377044	Coe et al.	Feb 2013	B2
8377059	Deville et al.	Feb 2013	B2
8377085	Smith et al.	Feb 2013	B2
8382748	Geisel	Feb 2013	B2
8382775	Bender et al.	Feb 2013	B1
8382782	Robertson et al.	Feb 2013	B2
8382792	Chojin	Feb 2013	B2
8388646	Chojin	Mar 2013	B2
8388647	Nau, Jr. et al.	Mar 2013	B2
8393514	Shelton, IV et al.	Mar 2013	B2
8394115	Houser et al.	Mar 2013	B2
8397971	Yates et al.	Mar 2013	B2
8398394	Sauter et al.	Mar 2013	B2
8403926	Nobis et al.	Mar 2013	B2
8403945	Whitfield et al.	Mar 2013	B2
8403948	Deville et al.	Mar 2013	B2
8403949	Palmer et al.	Mar 2013	B2
8403950	Palmer et al.	Mar 2013	B2
8409234	Stahler et al.	Apr 2013	B2
8414577	Boudreaux et al.	Apr 2013	B2
8418073	Mohr et al.	Apr 2013	B2
8418349	Smith et al.	Apr 2013	B2
8419757	Smith et al.	Apr 2013	B2
8419758	Smith et al.	Apr 2013	B2
8419759	Dietz	Apr 2013	B2
8423182	Robinson et al.	Apr 2013	B2
8425410	Murray et al.	Apr 2013	B2
8425545	Smith et al.	Apr 2013	B2
8430811	Hess et al.	Apr 2013	B2
8430874	Newton et al.	Apr 2013	B2
8430876	Kappus et al.	Apr 2013	B2
8430897	Novak et al.	Apr 2013	B2
8430898	Wiener et al.	Apr 2013	B2
8435257	Smith et al.	May 2013	B2
8437832	Govari et al.	May 2013	B2
8439912	Cunningham et al.	May 2013	B2
8439939	Deville et al.	May 2013	B2
8444637	Podmore et al.	May 2013	B2
8444662	Palmer et al.	May 2013	B2
8444663	Houser et al.	May 2013	B2
8444664	Balanev et al.	May 2013	B2
8453906	Huang et al.	Jun 2013	B2
8454599	Inagaki et al.	Jun 2013	B2
8454639	Du et al.	Jun 2013	B2
8459525	Yates et al.	Jun 2013	B2
8460284	Aronow et al.	Jun 2013	B2
8460288	Tamai et al.	Jun 2013	B2
8460292	Truckai et al.	Jun 2013	B2
8461744	Wiener et al.	Jun 2013	B2
8469981	Robertson et al.	Jun 2013	B2
8471685	Shingai	Jun 2013	B2
8479969	Shelton, IV	Jul 2013	B2
8480703	Nicholas et al.	Jul 2013	B2
8484833	Cunningham et al.	Jul 2013	B2
8485413	Scheib et al.	Jul 2013	B2
8485970	Widenhouse et al.	Jul 2013	B2
8486057	Behnke, II	Jul 2013	B2
8486096	Robertson et al.	Jul 2013	B2
8491578	Manwaring et al.	Jul 2013	B2
8491625	Horner	Jul 2013	B2
8496682	Guerra et al.	Jul 2013	B2
D687549	Johnson et al.	Aug 2013	S
8506555	Ruiz Morales	Aug 2013	B2
8509318	Tailliet	Aug 2013	B2
8512336	Couture	Aug 2013	B2
8512337	Francischelli et al.	Aug 2013	B2
8512359	Whitman et al.	Aug 2013	B2
8512364	Kowalski et al.	Aug 2013	B2
8512365	Wiener et al.	Aug 2013	B2
8518067	Masuda et al.	Aug 2013	B2
8521331	Itkowitz	Aug 2013	B2
8523882	Huitema et al.	Sep 2013	B2
8523889	Stulen et al.	Sep 2013	B2
8528563	Gruber	Sep 2013	B2
8529437	Taylor et al.	Sep 2013	B2
8529565	Masuda et al.	Sep 2013	B2
8531064	Robertson et al.	Sep 2013	B2
8535308	Govari et al.	Sep 2013	B2
8535311	Schall	Sep 2013	B2
8535340	Allen	Sep 2013	B2
8535341	Allen	Sep 2013	B2
8540128	Shelton, IV et al.	Sep 2013	B2
8546996	Messerly et al.	Oct 2013	B2
8546999	Houser et al.	Oct 2013	B2
8551077	Main et al.	Oct 2013	B2
8551086	Kimura et al.	Oct 2013	B2
8556929	Harper et al.	Oct 2013	B2
8561870	Baxter, III et al.	Oct 2013	B2
8562592	Conlon et al.	Oct 2013	B2
8562598	Falkenstein et al.	Oct 2013	B2
8562600	Kirkpatrick et al.	Oct 2013	B2
8562604	Nishimura	Oct 2013	B2
8568390	Mueller	Oct 2013	B2
8568397	Horner et al.	Oct 2013	B2
8568400	Gilbert	Oct 2013	B2
8568412	Brandt et al.	Oct 2013	B2
8569997	Lee	Oct 2013	B2
8573461	Shelton, IV et al.	Nov 2013	B2
8573465	Shelton, IV	Nov 2013	B2
8574231	Boudreaux et al.	Nov 2013	B2
8574253	Gruber et al.	Nov 2013	B2
8579176	Smith et al.	Nov 2013	B2
8579897	Vakharia et al.	Nov 2013	B2
8579928	Robertson et al.	Nov 2013	B2
8579937	Gresham	Nov 2013	B2
8585727	Polo	Nov 2013	B2
8588371	Ogawa et al.	Nov 2013	B2
8591459	Clymer et al.	Nov 2013	B2
8591506	Wham et al.	Nov 2013	B2
8591536	Robertson	Nov 2013	B2
D695407	Price et al.	Dec 2013	S
D696631	Price et al.	Dec 2013	S
8596513	Olson et al.	Dec 2013	B2
8597193	Grunwald et al.	Dec 2013	B2
8597287	Benamou et al.	Dec 2013	B2
8602031	Reis et al.	Dec 2013	B2
8602288	Shelton, IV et al.	Dec 2013	B2
8603089	Viola	Dec 2013	B2
8608044	Hueil et al.	Dec 2013	B2
8608045	Smith et al.	Dec 2013	B2
8608745	Guzman et al.	Dec 2013	B2
8613383	Beckman et al.	Dec 2013	B2
8616431	Timm et al.	Dec 2013	B2
8617152	Werneth et al.	Dec 2013	B2
8617194	Beaupre	Dec 2013	B2
8622274	Yates et al.	Jan 2014	B2
8623011	Spivey	Jan 2014	B2
8623016	Fischer	Jan 2014	B2
8623027	Price et al.	Jan 2014	B2
8623044	Timm et al.	Jan 2014	B2
8628529	Aldridge et al.	Jan 2014	B2
8628534	Jones et al.	Jan 2014	B2
8632461	Glossop	Jan 2014	B2
8636736	Yates et al.	Jan 2014	B2
8638428	Brown	Jan 2014	B2
8640788	Dachs, II et al.	Feb 2014	B2
8641663	Kirschenman et al.	Feb 2014	B2
8647350	Mohan et al.	Feb 2014	B2
8650728	Wan et al.	Feb 2014	B2
8652120	Giordano et al.	Feb 2014	B2
8652132	Tsuchiya et al.	Feb 2014	B2
8652155	Houser et al.	Feb 2014	B2
8657489	Ladurner et al.	Feb 2014	B2
8659208	Rose et al.	Feb 2014	B1
8663214	Weinberg et al.	Mar 2014	B2
8663220	Wiener et al.	Mar 2014	B2
8663222	Anderson et al.	Mar 2014	B2
8663223	Masuda et al.	Mar 2014	B2
8663262	Smith et al.	Mar 2014	B2
8668691	Heard	Mar 2014	B2
8668710	Slipszenko et al.	Mar 2014	B2
8684253	Giordano et al.	Apr 2014	B2
8685016	Wham et al.	Apr 2014	B2
8685020	Weizman et al.	Apr 2014	B2
8690582	Rohrbach et al.	Apr 2014	B2
8695866	Leimbach et al.	Apr 2014	B2
8696366	Chen et al.	Apr 2014	B2
8696665	Hunt et al.	Apr 2014	B2
8696666	Sanai et al.	Apr 2014	B2
8702609	Hadjicostis	Apr 2014	B2
8702704	Shelton, IV et al.	Apr 2014	B2
8704425	Giordano et al.	Apr 2014	B2
8708213	Shelton, IV et al.	Apr 2014	B2
8709031	Stulen	Apr 2014	B2
8709035	Johnson et al.	Apr 2014	B2
8715270	Weitzner et al.	May 2014	B2
8715277	Weizman	May 2014	B2
8721640	Taylor et al.	May 2014	B2
8721657	Kondoh et al.	May 2014	B2
8733613	Huitema et al.	May 2014	B2
8734443	Hixson et al.	May 2014	B2
8747238	Shelton, IV et al.	Jun 2014	B2
8747351	Schultz	Jun 2014	B2
8747404	Boudreaux et al.	Jun 2014	B2
8749116	Messerly et al.	Jun 2014	B2
8752264	Ackley et al.	Jun 2014	B2
8752749	Moore et al.	Jun 2014	B2
8753338	Widenhouse et al.	Jun 2014	B2
8754570	Voegele et al.	Jun 2014	B2
8758342	Bales et al.	Jun 2014	B2
8758352	Cooper et al.	Jun 2014	B2
8758391	Swayze et al.	Jun 2014	B2
8764735	Coe et al.	Jul 2014	B2
8764747	Cummings et al.	Jul 2014	B2
8767970	Eppolito	Jul 2014	B2
8770459	Racenet et al.	Jul 2014	B2
8771269	Sherman et al.	Jul 2014	B2
8771270	Burbank	Jul 2014	B2
8771293	Surti et al.	Jul 2014	B2
8773001	Wiener et al.	Jul 2014	B2
8777944	Frankhouser et al.	Jul 2014	B2
8777945	Floume et al.	Jul 2014	B2
8779648	Giordano et al.	Jul 2014	B2
8783541	Shelton, IV et al.	Jul 2014	B2
8784415	Malackowski et al.	Jul 2014	B2
8784418	Romero	Jul 2014	B2
8790342	Stulen et al.	Jul 2014	B2
8795274	Hanna	Aug 2014	B2
8795276	Dietz et al.	Aug 2014	B2
8795327	Dietz et al.	Aug 2014	B2
8800838	Shelton, IV	Aug 2014	B2
8801710	Ullrich et al.	Aug 2014	B2
8801752	Fortier et al.	Aug 2014	B2
8808204	Irisawa et al.	Aug 2014	B2
8808319	Houser et al.	Aug 2014	B2
8814856	Elmouelhi et al.	Aug 2014	B2
8814870	Paraschiv et al.	Aug 2014	B2
8820605	Shelton, IV	Sep 2014	B2
8821388	Naito et al.	Sep 2014	B2
8827992	Koss et al.	Sep 2014	B2
8827995	Schaller et al.	Sep 2014	B2
8834466	Cummings et al.	Sep 2014	B2
8834518	Faller et al.	Sep 2014	B2
8844789	Shelton, IV et al.	Sep 2014	B2
8845537	Tanaka et al.	Sep 2014	B2
8845630	Mehta et al.	Sep 2014	B2
8848808	Dress	Sep 2014	B2
8851354	Swensgard et al.	Oct 2014	B2
8852184	Kucklick	Oct 2014	B2
8858547	Brogna	Oct 2014	B2
8862955	Cesari	Oct 2014	B2
8864749	Okada	Oct 2014	B2
8864757	Klimovitch et al.	Oct 2014	B2
8864761	Johnson et al.	Oct 2014	B2
8870865	Frankhouser et al.	Oct 2014	B2
8874220	Draghici et al.	Oct 2014	B2
8876726	Amit et al.	Nov 2014	B2
8876858	Braun	Nov 2014	B2
8882766	Couture et al.	Nov 2014	B2
8882791	Stulen	Nov 2014	B2
8888776	Dietz et al.	Nov 2014	B2
8888783	Young	Nov 2014	B2
8888809	Davison et al.	Nov 2014	B2
8899462	Kostrzewski et al.	Dec 2014	B2
8900259	Houser et al.	Dec 2014	B2
8906016	Boudreaux et al.	Dec 2014	B2
8906017	Rioux et al.	Dec 2014	B2
8911438	Swoyer et al.	Dec 2014	B2
8911460	Neurohr et al.	Dec 2014	B2
8920412	Fritz et al.	Dec 2014	B2
8920414	Stone et al.	Dec 2014	B2
8920421	Rupp	Dec 2014	B2
8926607	Norvell et al.	Jan 2015	B2
8926608	Bacher et al.	Jan 2015	B2
8926620	Chasmawala et al.	Jan 2015	B2
8931682	Timm et al.	Jan 2015	B2
8932282	Gilbert	Jan 2015	B2
8932299	Bono et al.	Jan 2015	B2
8936614	Allen, IV	Jan 2015	B2
8939974	Boudreaux et al.	Jan 2015	B2
8945126	Garrison et al.	Feb 2015	B2
8951248	Messerly et al.	Feb 2015	B2
8951272	Robertson et al.	Feb 2015	B2
8956349	Aldridge et al.	Feb 2015	B2
8960520	McCuen	Feb 2015	B2
8961515	Twomey et al.	Feb 2015	B2
8961547	Dietz et al.	Feb 2015	B2
8967443	McCuen	Mar 2015	B2
8968283	Kharin	Mar 2015	B2
8968294	Maass et al.	Mar 2015	B2
8968296	McPherson	Mar 2015	B2
8968355	Malkowski et al.	Mar 2015	B2
8974447	Kimball et al.	Mar 2015	B2
8974477	Yamada	Mar 2015	B2
8974479	Ross et al.	Mar 2015	B2
8974932	McGahan et al.	Mar 2015	B2
8979843	Timm et al.	Mar 2015	B2
8979844	White et al.	Mar 2015	B2
8979890	Boudreaux	Mar 2015	B2
8986287	Park et al.	Mar 2015	B2
8986297	Daniel et al.	Mar 2015	B2
8986302	Aldridge et al.	Mar 2015	B2
8989855	Murphy et al.	Mar 2015	B2
8989903	Weir et al.	Mar 2015	B2
8991678	Wellman et al.	Mar 2015	B2
8992422	Spivey et al.	Mar 2015	B2
8992526	Brodbeck et al.	Mar 2015	B2
8998891	Garito et al.	Apr 2015	B2
9005199	Beckman et al.	Apr 2015	B2
9011437	Woodruff et al.	Apr 2015	B2
9011471	Timm et al.	Apr 2015	B2
9017326	DiNardo et al.	Apr 2015	B2
9017355	Smith et al.	Apr 2015	B2
9017372	Artale et al.	Apr 2015	B2
9023071	Miller et al.	May 2015	B2
9028397	Naito	May 2015	B2
9028476	Bonn	May 2015	B2
9028478	Mueller	May 2015	B2
9028494	Shelton, IV et al.	May 2015	B2
9028519	Yates et al.	May 2015	B2
9031667	Williams	May 2015	B2
9033973	Krapohl et al.	May 2015	B2
9035741	Hamel et al.	May 2015	B2
9037259	Mathur	May 2015	B2
9039690	Kersten et al.	May 2015	B2
9039695	Giordano et al.	May 2015	B2
9039696	Assmus et al.	May 2015	B2
9039705	Takashino	May 2015	B2
9039731	Joseph	May 2015	B2
9043018	Mohr	May 2015	B2
9044227	Shelton, IV et al.	Jun 2015	B2
9044238	Orszulak	Jun 2015	B2
9044243	Johnson et al.	Jun 2015	B2
9044245	Condie et al.	Jun 2015	B2
9044256	Cadeddu et al.	Jun 2015	B2
9044261	Houser	Jun 2015	B2
9050093	Aldridge et al.	Jun 2015	B2
9050098	Deville et al.	Jun 2015	B2
9050123	Krause et al.	Jun 2015	B2
9050124	Houser	Jun 2015	B2
9055961	Manzo et al.	Jun 2015	B2
9059547	McLawhorn	Jun 2015	B2
9060770	Shelton, IV et al.	Jun 2015	B2
9060775	Wiener et al.	Jun 2015	B2
9060776	Yates et al.	Jun 2015	B2
9060778	Condie et al.	Jun 2015	B2
9066720	Ballakur et al.	Jun 2015	B2
9066723	Beller et al.	Jun 2015	B2
9066747	Robertson	Jun 2015	B2
9072523	Houser et al.	Jul 2015	B2
9072535	Shelton, IV et al.	Jul 2015	B2
9072536	Shelton, IV et al.	Jul 2015	B2
9072538	Suzuki et al.	Jul 2015	B2
9072539	Messerly et al.	Jul 2015	B2
9084624	Larkin et al.	Jul 2015	B2
9089327	Worrell et al.	Jul 2015	B2
9089360	Messerly et al.	Jul 2015	B2
9095362	Dachs, II et al.	Aug 2015	B2
9095367	Olson et al.	Aug 2015	B2
9099863	Smith et al.	Aug 2015	B2
9101358	Kerr et al.	Aug 2015	B2
9101385	Shelton, IV et al.	Aug 2015	B2
9107684	Ma	Aug 2015	B2
9107689	Robertson et al.	Aug 2015	B2
9107690	Bales, Jr. et al.	Aug 2015	B2
9113900	Buysse et al.	Aug 2015	B2
9113907	Allen, IV et al.	Aug 2015	B2
9113940	Twomey	Aug 2015	B2
9119657	Shelton, IV et al.	Sep 2015	B2
9119957	Gantz et al.	Sep 2015	B2
9125662	Shelton, IV	Sep 2015	B2
9125667	Stone et al.	Sep 2015	B2
9144453	Rencher et al.	Sep 2015	B2
9147965	Lee	Sep 2015	B2
9149324	Huang et al.	Oct 2015	B2
9149325	Worrell et al.	Oct 2015	B2
9161803	Yates et al.	Oct 2015	B2
9165114	Jain et al.	Oct 2015	B2
9168054	Turner et al.	Oct 2015	B2
9168085	Juzkiw et al.	Oct 2015	B2
9168089	Buysse et al.	Oct 2015	B2
9173656	Schurr et al.	Nov 2015	B2
9179912	Yates et al.	Nov 2015	B2
9186199	Strauss et al.	Nov 2015	B2
9186204	Nishimura et al.	Nov 2015	B2
9186796	Ogawa	Nov 2015	B2
9192380	(Tarinelli) Racenet et al.	Nov 2015	B2
9192421	Garrison	Nov 2015	B2
9192428	Houser et al.	Nov 2015	B2
9192431	Woodruff et al.	Nov 2015	B2
9198714	Worrell et al.	Dec 2015	B2
9198715	Livneh	Dec 2015	B2
9198718	Marczyk et al.	Dec 2015	B2
9198776	Young	Dec 2015	B2
9204879	Shelton, IV	Dec 2015	B2
9204891	Weitzman	Dec 2015	B2
9204918	Germain et al.	Dec 2015	B2
9204923	Manzo et al.	Dec 2015	B2
9216050	Condie et al.	Dec 2015	B2
9216051	Fischer et al.	Dec 2015	B2
9216062	Duque et al.	Dec 2015	B2
9220483	Frankhouser et al.	Dec 2015	B2
9220527	Houser et al.	Dec 2015	B2
9220559	Worrell et al.	Dec 2015	B2
9226750	Weir et al.	Jan 2016	B2
9226751	Shelton, IV et al.	Jan 2016	B2
9226766	Aldridge et al.	Jan 2016	B2
9226767	Stulen et al.	Jan 2016	B2
9232979	Parihar et al.	Jan 2016	B2
9237891	Shelton, IV	Jan 2016	B2
9237921	Messerly et al.	Jan 2016	B2
9241060	Fujisaki	Jan 2016	B1
9241692	Gunday et al.	Jan 2016	B2
9241728	Price et al.	Jan 2016	B2
9241730	Babaev	Jan 2016	B2
9241731	Boudreaux et al.	Jan 2016	B2
9241768	Sandhu et al.	Jan 2016	B2
9247953	Palmer et al.	Feb 2016	B2
9254165	Aronow et al.	Feb 2016	B2
9259234	Robertson et al.	Feb 2016	B2
9259265	Harris et al.	Feb 2016	B2
9265567	Orban, III et al.	Feb 2016	B2
9265926	Strobl et al.	Feb 2016	B2
9265973	Akagane	Feb 2016	B2
9277962	Koss et al.	Mar 2016	B2
9282974	Shelton, IV	Mar 2016	B2
9283027	Monson et al.	Mar 2016	B2
9283045	Rhee et al.	Mar 2016	B2
9289256	Shelton, IV et al.	Mar 2016	B2
9295514	Shelton, IV et al.	Mar 2016	B2
9301759	Spivey et al.	Apr 2016	B2
9305497	Seo et al.	Apr 2016	B2
9307388	Liang et al.	Apr 2016	B2
9307986	Hall et al.	Apr 2016	B2
9308009	Madan et al.	Apr 2016	B2
9308014	Fischer	Apr 2016	B2
9314261	Bales, Jr. et al.	Apr 2016	B2
9314292	Trees et al.	Apr 2016	B2
9314301	Ben-Haim et al.	Apr 2016	B2
9326754	Polster	May 2016	B2
9326787	Sanai et al.	May 2016	B2
9326788	Batross et al.	May 2016	B2
9333025	Monson et al.	May 2016	B2
9333034	Hancock	May 2016	B2
9339289	Robertson	May 2016	B2
9339323	Eder et al.	May 2016	B2
9339326	McCullagh et al.	May 2016	B2
9345481	Hall et al.	May 2016	B2
9345534	Artale et al.	May 2016	B2
9345900	Wu et al.	May 2016	B2
9351642	Nadkarni et al.	May 2016	B2
9351726	Leimbach et al.	May 2016	B2
9351754	Vakharia et al.	May 2016	B2
9352173	Yamada et al.	May 2016	B2
9358065	Ladtkow et al.	Jun 2016	B2
9364171	Harris et al.	Jun 2016	B2
9364230	Shelton, IV et al.	Jun 2016	B2
9364279	Houser et al.	Jun 2016	B2
9370364	Smith et al.	Jun 2016	B2
9370400	Parihar	Jun 2016	B2
9370611	Ross et al.	Jun 2016	B2
9375230	Ross et al.	Jun 2016	B2
9375232	Hunt et al.	Jun 2016	B2
9375256	Cunningham et al.	Jun 2016	B2
9375267	Kerr et al.	Jun 2016	B2
9385831	Marr et al.	Jul 2016	B2
9386983	Swensgard et al.	Jul 2016	B2
9393037	Olson et al.	Jul 2016	B2
9393070	Gelfand et al.	Jul 2016	B2
9398911	Auld	Jul 2016	B2
9402680	Ginnebaugh et al.	Aug 2016	B2
9402682	Worrell et al.	Aug 2016	B2
9408606	Shelton, IV	Aug 2016	B2
9408622	Stulen et al.	Aug 2016	B2
9408660	Strobl et al.	Aug 2016	B2
9414853	Stulen et al.	Aug 2016	B2
9414880	Monson et al.	Aug 2016	B2
9421060	Monson et al.	Aug 2016	B2
9427249	Robertson et al.	Aug 2016	B2
9427279	Muniz-Medina et al.	Aug 2016	B2
9439668	Timm et al.	Sep 2016	B2
9439669	Wiener et al.	Sep 2016	B2
9439671	Akagane	Sep 2016	B2
9442288	Tanimura	Sep 2016	B2
9445784	O'Keeffe	Sep 2016	B2
9445832	Wiener et al.	Sep 2016	B2
9451967	Jordan et al.	Sep 2016	B2
9456863	Moua	Oct 2016	B2
9456864	Witt et al.	Oct 2016	B2
9468498	Sigmon, Jr.	Oct 2016	B2
9474542	Slipszenko et al.	Oct 2016	B2
9474568	Akagane	Oct 2016	B2
9486236	Price et al.	Nov 2016	B2
9492146	Kostrzewski et al.	Nov 2016	B2
9492224	Boudreaux et al.	Nov 2016	B2
9498245	Voegele et al.	Nov 2016	B2
9498275	Wham et al.	Nov 2016	B2
9504483	Houser et al.	Nov 2016	B2
9504520	Worrell et al.	Nov 2016	B2
9504524	Behnke, II	Nov 2016	B2
9504855	Messerly et al.	Nov 2016	B2
9510850	Robertson et al.	Dec 2016	B2
9510906	Boudreaux et al.	Dec 2016	B2
9522029	Yates et al.	Dec 2016	B2
9522032	Behnke	Dec 2016	B2
9526564	Rusin	Dec 2016	B2
9526565	Strobl	Dec 2016	B2
9545253	Worrell et al.	Jan 2017	B2
9545497	Wenderow et al.	Jan 2017	B2
9554846	Boudreaux	Jan 2017	B2
9554854	Yates et al.	Jan 2017	B2
9560995	Addison et al.	Feb 2017	B2
9561038	Shelton, IV et al.	Feb 2017	B2
9572592	Price et al.	Feb 2017	B2
9574644	Parihar	Feb 2017	B2
9592072	Akagane	Mar 2017	B2
9597143	Madan et al.	Mar 2017	B2
9603669	Govari et al.	Mar 2017	B2
9610091	Johnson et al.	Apr 2017	B2
9610114	Baxter, III et al.	Apr 2017	B2
9615877	Tyrrell et al.	Apr 2017	B2
9623237	Turner et al.	Apr 2017	B2
9636135	Stulen	May 2017	B2
9636165	Larson et al.	May 2017	B2
9636167	Gregg	May 2017	B2
9638770	Dietz et al.	May 2017	B2
9642644	Houser et al.	May 2017	B2
9642669	Takashino et al.	May 2017	B2
9643052	Tchao et al.	May 2017	B2
9649111	Shelton, IV et al.	May 2017	B2
9649126	Robertson et al.	May 2017	B2
9649173	Choi et al.	May 2017	B2
9655670	Larson et al.	May 2017	B2
9662131	Omori et al.	May 2017	B2
9668806	Unger et al.	Jun 2017	B2
9671860	Ogawa et al.	Jun 2017	B2
9675374	Stulen et al.	Jun 2017	B2
9675375	Houser et al.	Jun 2017	B2
9687290	Keller	Jun 2017	B2
9690362	Leimbach et al.	Jun 2017	B2
9700309	Jaworek et al.	Jul 2017	B2
9700339	Nield	Jul 2017	B2
9700343	Messerly et al.	Jul 2017	B2
9705456	Gilbert	Jul 2017	B2
9707004	Houser et al.	Jul 2017	B2
9707027	Ruddenklau et al.	Jul 2017	B2
9707030	Davison et al.	Jul 2017	B2
9713507	Stulen et al.	Jul 2017	B2
9717548	Couture	Aug 2017	B2
9717552	Cosman et al.	Aug 2017	B2
9724118	Schulte et al.	Aug 2017	B2
9724120	Faller et al.	Aug 2017	B2
9724152	Horiie et al.	Aug 2017	B2
9730695	Leimbach et al.	Aug 2017	B2
9737326	Worrell et al.	Aug 2017	B2
9737355	Yates et al.	Aug 2017	B2
9737358	Beckman et al.	Aug 2017	B2
9743929	Leimbach et al.	Aug 2017	B2
9743946	Faller et al.	Aug 2017	B2
9743947	Price et al.	Aug 2017	B2
9757142	Shimizu	Sep 2017	B2
9757186	Boudreaux et al.	Sep 2017	B2
9764164	Wiener et al.	Sep 2017	B2
9770285	Zoran et al.	Sep 2017	B2
9782214	Houser et al.	Oct 2017	B2
9788851	Dannaher et al.	Oct 2017	B2
9795405	Price et al.	Oct 2017	B2
9795436	Yates et al.	Oct 2017	B2
9795808	Messerly et al.	Oct 2017	B2
9801648	Houser et al.	Oct 2017	B2
9802033	Hibner et al.	Oct 2017	B2
9808246	Shelton, IV et al.	Nov 2017	B2
9808308	Faller et al.	Nov 2017	B2
9814514	Shelton, IV et al.	Nov 2017	B2
9820768	Gee et al.	Nov 2017	B2
9820771	Norton et al.	Nov 2017	B2
9820806	Lee et al.	Nov 2017	B2
9839443	Brockman et al.	Dec 2017	B2
9848901	Robertson et al.	Dec 2017	B2
9848902	Price et al.	Dec 2017	B2
9848937	Trees et al.	Dec 2017	B2
9861381	Johnson	Jan 2018	B2
9861428	Trees et al.	Jan 2018	B2
9867651	Wham	Jan 2018	B2
9867670	Brannan et al.	Jan 2018	B2
9872722	Lech	Jan 2018	B2
9872725	Worrell et al.	Jan 2018	B2
9872726	Morisaki	Jan 2018	B2
9877720	Worrell et al.	Jan 2018	B2
9877776	Boudreaux	Jan 2018	B2
9878184	Beaupre	Jan 2018	B2
9883884	Neurohr et al.	Feb 2018	B2
9888919	Leimbach et al.	Feb 2018	B2
9888958	Evans et al.	Feb 2018	B2
9901383	Hassler, Jr.	Feb 2018	B2
9901754	Yamada	Feb 2018	B2
9907563	Germain et al.	Mar 2018	B2
9913656	Stulen	Mar 2018	B2
9913680	Voegele et al.	Mar 2018	B2
9918730	Trees et al.	Mar 2018	B2
9925003	Parihar et al.	Mar 2018	B2
9949785	Price et al.	Apr 2018	B2
9949788	Boudreaux	Apr 2018	B2
9962182	Dietz et al.	May 2018	B2
9974539	Yates et al.	May 2018	B2
9987033	Neurohr et al.	Jun 2018	B2
10004526	Dycus et al.	Jun 2018	B2
10004527	Gee et al.	Jun 2018	B2
10010339	Witt et al.	Jul 2018	B2
10010341	Houser et al.	Jul 2018	B2
10016207	Suzuki et al.	Jul 2018	B2
10022142	Aranyi et al.	Jul 2018	B2
10022567	Messerly et al.	Jul 2018	B2
10022568	Messerly et al.	Jul 2018	B2
10028761	Leimbach et al.	Jul 2018	B2
10028786	Mucilli et al.	Jul 2018	B2
10034684	Weisenburgh, II et al.	Jul 2018	B2
10034704	Asher et al.	Jul 2018	B2
10039588	Harper et al.	Aug 2018	B2
10045794	Witt et al.	Aug 2018	B2
10045810	Schall et al.	Aug 2018	B2
10045819	Jensen et al.	Aug 2018	B2
10070916	Artale	Sep 2018	B2
10080609	Hancock et al.	Sep 2018	B2
10085762	Timm et al.	Oct 2018	B2
10085792	Johnson et al.	Oct 2018	B2
10092310	Boudreaux et al.	Oct 2018	B2
10092344	Mohr et al.	Oct 2018	B2
10092348	Boudreaux	Oct 2018	B2
10092350	Rothweiler et al.	Oct 2018	B2
10105140	Malinouskas et al.	Oct 2018	B2
10111699	Boudreaux	Oct 2018	B2
10111703	Cosman, Jr. et al.	Oct 2018	B2
10117667	Robertson et al.	Nov 2018	B2
10117702	Danziger et al.	Nov 2018	B2
10123835	Keller et al.	Nov 2018	B2
10130410	Strobl et al.	Nov 2018	B2
10130412	Wham	Nov 2018	B2
10154848	Chernov et al.	Dec 2018	B2
10154852	Conlon et al.	Dec 2018	B2
10159524	Yates et al.	Dec 2018	B2
10166060	Johnson et al.	Jan 2019	B2
10172665	Heckel et al.	Jan 2019	B2
10172669	Felder et al.	Jan 2019	B2
10179022	Yates et al.	Jan 2019	B2
10188455	Hancock et al.	Jan 2019	B2
10194972	Yates et al.	Feb 2019	B2
10194973	Wiener et al.	Feb 2019	B2
10194976	Boudreaux	Feb 2019	B2
10194977	Yang	Feb 2019	B2
10194999	Bacher et al.	Feb 2019	B2
10201364	Leimbach et al.	Feb 2019	B2
10201382	Wiener et al.	Feb 2019	B2
10226273	Messerly et al.	Mar 2019	B2
10231747	Stulen et al.	Mar 2019	B2
10238391	Leimbach et al.	Mar 2019	B2
10245095	Boudreaux	Apr 2019	B2
10245104	McKenna et al.	Apr 2019	B2
10251664	Shelton, IV et al.	Apr 2019	B2
10263171	Wiener et al.	Apr 2019	B2
10265117	Wiener et al.	Apr 2019	B2
10265118	Gerhardt	Apr 2019	B2
10271840	Sapre	Apr 2019	B2
10507033	Dickerson et al.	Dec 2019	B2
10561560	Boutoussov et al.	Feb 2020	B2
10617420	Shelton, IV et al.	Apr 2020	B2
RE47996	Turner et al.	May 2020	E
10677764	Ross et al.	Jun 2020	B2
10856896	Eichmann et al.	Dec 2020	B2
10874465	Weir et al.	Dec 2020	B2
20010025173	Ritchie et al.	Sep 2001	A1
20010025183	Shahidi	Sep 2001	A1
20010025184	Messerly	Sep 2001	A1
20010031950	Ryan	Oct 2001	A1
20010039419	Francischelli et al.	Nov 2001	A1
20020002377	Cimino	Jan 2002	A1
20020002380	Bishop	Jan 2002	A1
20020019649	Sikora et al.	Feb 2002	A1
20020022836	Goble et al.	Feb 2002	A1
20020029036	Goble et al.	Mar 2002	A1
20020029055	Bonutti	Mar 2002	A1
20020049551	Friedman et al.	Apr 2002	A1
20020052617	Anis et al.	May 2002	A1
20020077550	Rabiner et al.	Jun 2002	A1
20020107517	Witt et al.	Aug 2002	A1
20020156466	Sakurai et al.	Oct 2002	A1
20020156493	Houser et al.	Oct 2002	A1
20020165577	Witt et al.	Nov 2002	A1
20020177862	Aranyi et al.	Nov 2002	A1
20030014053	Nguyen et al.	Jan 2003	A1
20030014087	Fang et al.	Jan 2003	A1
20030036705	Hare et al.	Feb 2003	A1
20030040758	Wang et al.	Feb 2003	A1
20030050572	Brautigam et al.	Mar 2003	A1
20030055443	Spotnitz	Mar 2003	A1
20030109778	Rashidi	Jun 2003	A1
20030109875	Tetzlaff et al.	Jun 2003	A1
20030114851	Truckai et al.	Jun 2003	A1
20030130693	Levin et al.	Jul 2003	A1
20030139741	Goble et al.	Jul 2003	A1
20030144680	Kellogg et al.	Jul 2003	A1
20030158548	Phan et al.	Aug 2003	A1
20030171747	Kanehira et al.	Sep 2003	A1
20030181898	Bowers	Sep 2003	A1
20030199794	Sakurai et al.	Oct 2003	A1
20030204199	Novak et al.	Oct 2003	A1
20030212332	Fenton et al.	Nov 2003	A1
20030212363	Shipp	Nov 2003	A1
20030212392	Fenton et al.	Nov 2003	A1
20030212422	Fenton et al.	Nov 2003	A1
20030225332	Okada et al.	Dec 2003	A1
20030229344	Dycus et al.	Dec 2003	A1
20040030254	Babaev	Feb 2004	A1
20040030330	Brassell et al.	Feb 2004	A1
20040047485	Sherrit et al.	Mar 2004	A1
20040054364	Aranyi et al.	Mar 2004	A1
20040064151	Mollenauer	Apr 2004	A1
20040087943	Dycus et al.	May 2004	A1
20040092921	Kadziauskas et al.	May 2004	A1
20040092992	Adams et al.	May 2004	A1
20040097911	Murakami et al.	May 2004	A1
20040097912	Gonnering	May 2004	A1
20040097919	Wellman et al.	May 2004	A1
20040097996	Rabiner et al.	May 2004	A1
20040116952	Sakurai et al.	Jun 2004	A1
20040122423	Dycus et al.	Jun 2004	A1
20040132383	Langford et al.	Jul 2004	A1
20040138621	Jahns et al.	Jul 2004	A1
20040142667	Lochhead et al.	Jul 2004	A1
20040147934	Kiester	Jul 2004	A1
20040147945	Fritzsch	Jul 2004	A1
20040158237	Abboud et al.	Aug 2004	A1
20040167508	Wham et al.	Aug 2004	A1
20040176686	Hare et al.	Sep 2004	A1
20040176751	Weitzner et al.	Sep 2004	A1
20040193150	Sharkey et al.	Sep 2004	A1
20040193153	Sartor et al.	Sep 2004	A1
20040199193	Hayashi et al.	Oct 2004	A1
20040215132	Yoon	Oct 2004	A1
20040243147	Lipow	Dec 2004	A1
20040249374	Tetzlaff et al.	Dec 2004	A1
20040260273	Wan	Dec 2004	A1
20040260300	Gorensek et al.	Dec 2004	A1
20040267311	Viola et al.	Dec 2004	A1
20050015125	Mioduski et al.	Jan 2005	A1
20050020967	Ono	Jan 2005	A1
20050021018	Anderson et al.	Jan 2005	A1
20050021065	Yamada et al.	Jan 2005	A1
20050021078	Vleugels et al.	Jan 2005	A1
20050033278	McClurken et al.	Feb 2005	A1
20050033337	Muir et al.	Feb 2005	A1
20050070800	Takahashi	Mar 2005	A1
20050080427	Govari et al.	Apr 2005	A1
20050088285	Jei	Apr 2005	A1
20050090817	Phan	Apr 2005	A1
20050096683	Ellins et al.	May 2005	A1
20050099824	Dowling et al.	May 2005	A1
20050107777	West et al.	May 2005	A1
20050131390	Heinrich et al.	Jun 2005	A1
20050143769	White et al.	Jun 2005	A1
20050149108	Cox	Jul 2005	A1
20050165429	Douglas et al.	Jul 2005	A1
20050171522	Christopherson	Aug 2005	A1
20050177184	Easley	Aug 2005	A1
20050182339	Lee et al.	Aug 2005	A1
20050188743	Land	Sep 2005	A1
20050192610	Houser et al.	Sep 2005	A1
20050192611	Houser	Sep 2005	A1
20050222598	Ho et al.	Oct 2005	A1
20050234484	Houser et al.	Oct 2005	A1
20050249667	Tuszynski et al.	Nov 2005	A1
20050256405	Makin et al.	Nov 2005	A1
20050261588	Makin et al.	Nov 2005	A1
20050262175	Iino et al.	Nov 2005	A1
20050267464	Truckai et al.	Dec 2005	A1
20050271807	Iijima et al.	Dec 2005	A1
20050273090	Nieman et al.	Dec 2005	A1
20050288659	Kimura et al.	Dec 2005	A1
20060025757	Heim	Feb 2006	A1
20060030797	Zhou et al.	Feb 2006	A1
20060030848	Craig et al.	Feb 2006	A1
20060058825	Ogura et al.	Mar 2006	A1
20060063130	Hayman et al.	Mar 2006	A1
20060064086	Odom	Mar 2006	A1
20060066181	Bromfield et al.	Mar 2006	A1
20060074442	Noriega et al.	Apr 2006	A1
20060079874	Faller et al.	Apr 2006	A1
20060079879	Faller et al.	Apr 2006	A1
20060095046	Trieu et al.	May 2006	A1
20060109061	Dobson et al.	May 2006	A1
20060159731	Shoshan	Jul 2006	A1
20060190034	Nishizawa et al.	Aug 2006	A1
20060206100	Eskridge et al.	Sep 2006	A1
20060206115	Schomer et al.	Sep 2006	A1
20060211943	Beaupre	Sep 2006	A1
20060217729	Eskridge et al.	Sep 2006	A1
20060224160	Trieu et al.	Oct 2006	A1
20060247558	Yamada	Nov 2006	A1
20060253050	Yoshimine et al.	Nov 2006	A1
20060259026	Godara et al.	Nov 2006	A1
20060264809	Hansmann et al.	Nov 2006	A1
20060264995	Fanton et al.	Nov 2006	A1
20060265035	Yachi et al.	Nov 2006	A1
20060270916	Skwarek et al.	Nov 2006	A1
20060271030	Francis et al.	Nov 2006	A1
20060293656	Shadduck et al.	Dec 2006	A1
20070016235	Tanaka et al.	Jan 2007	A1
20070016236	Beaupre	Jan 2007	A1
20070021738	Hasser et al.	Jan 2007	A1
20070027468	Wales et al.	Feb 2007	A1
20070032704	Gandini et al.	Feb 2007	A1
20070055228	Berg et al.	Mar 2007	A1
20070056596	Fanney et al.	Mar 2007	A1
20070060935	Schwardt et al.	Mar 2007	A1
20070063618	Bromfield	Mar 2007	A1
20070066971	Podhajsky	Mar 2007	A1
20070067123	Jungerman	Mar 2007	A1
20070073185	Nakao	Mar 2007	A1
20070073341	Smith et al.	Mar 2007	A1
20070074584	Talarico et al.	Apr 2007	A1
20070106317	Shelton et al.	May 2007	A1
20070118115	Artale et al.	May 2007	A1
20070130771	Ehlert et al.	Jun 2007	A1
20070135803	Belson	Jun 2007	A1
20070149881	Rabin	Jun 2007	A1
20070156163	Davison et al.	Jul 2007	A1
20070166663	Telles et al.	Jul 2007	A1
20070173803	Wham et al.	Jul 2007	A1
20070173813	Odom	Jul 2007	A1
20070173872	Neuenfeldt	Jul 2007	A1
20070175955	Shelton et al.	Aug 2007	A1
20070185474	Nahen	Aug 2007	A1
20070191712	Messerly et al.	Aug 2007	A1
20070191713	Eichmann et al.	Aug 2007	A1
20070203483	Kim et al.	Aug 2007	A1
20070208336	Kim et al.	Sep 2007	A1
20070208340	Ganz et al.	Sep 2007	A1
20070219481	Babaev	Sep 2007	A1
20070232926	Stulen et al.	Oct 2007	A1
20070232928	Wiener et al.	Oct 2007	A1
20070236213	Paden et al.	Oct 2007	A1
20070239101	Kellogg	Oct 2007	A1
20070249941	Salehi et al.	Oct 2007	A1
20070260242	Dycus et al.	Nov 2007	A1
20070265560	Soltani et al.	Nov 2007	A1
20070265613	Edelstein et al.	Nov 2007	A1
20070265616	Couture et al.	Nov 2007	A1
20070265620	Kraas et al.	Nov 2007	A1
20070275348	Lemon	Nov 2007	A1
20070287933	Phan et al.	Dec 2007	A1
20070288055	Lee	Dec 2007	A1
20070299895	Johnson et al.	Dec 2007	A1
20080005213	Holtzman	Jan 2008	A1
20080013809	Zhu et al.	Jan 2008	A1
20080015575	Odom et al.	Jan 2008	A1
20080033465	Schmitz et al.	Feb 2008	A1
20080039746	Hissong et al.	Feb 2008	A1
20080051812	Schmitz et al.	Feb 2008	A1
20080058775	Darian et al.	Mar 2008	A1
20080058845	Shimizu et al.	Mar 2008	A1
20080071269	Hilario et al.	Mar 2008	A1
20080077145	Boyden et al.	Mar 2008	A1
20080082039	Babaev	Apr 2008	A1
20080082098	Tanaka et al.	Apr 2008	A1
20080097501	Blier	Apr 2008	A1
20080114355	Whayne et al.	May 2008	A1
20080114364	Goldin et al.	May 2008	A1
20080122496	Wagner	May 2008	A1
20080125768	Tahara et al.	May 2008	A1
20080147058	Horrell et al.	Jun 2008	A1
20080147062	Truckai et al.	Jun 2008	A1
20080147092	Rogge et al.	Jun 2008	A1
20080171938	Masuda et al.	Jul 2008	A1
20080177268	Daum et al.	Jul 2008	A1
20080188755	Hart	Aug 2008	A1
20080200940	Eichmann et al.	Aug 2008	A1
20080208108	Kimura	Aug 2008	A1
20080208231	Ota et al.	Aug 2008	A1
20080214967	Aranyi et al.	Sep 2008	A1
20080234709	Houser	Sep 2008	A1
20080243162	Shibata et al.	Oct 2008	A1
20080255413	Zemlok et al.	Oct 2008	A1
20080275440	Kratoska et al.	Nov 2008	A1
20080281200	Voic et al.	Nov 2008	A1
20080281315	Gines	Nov 2008	A1
20080287944	Pearson et al.	Nov 2008	A1
20080287948	Newton et al.	Nov 2008	A1
20080296346	Shelton, IV et al.	Dec 2008	A1
20080300588	Groth et al.	Dec 2008	A1
20090012516	Curtis et al.	Jan 2009	A1
20090023985	Ewers	Jan 2009	A1
20090030412	Willis	Jan 2009	A1
20090043293	Pankratov et al.	Feb 2009	A1
20090048537	Lydon et al.	Feb 2009	A1
20090048589	Takashino et al.	Feb 2009	A1
20090054886	Yachi et al.	Feb 2009	A1
20090054889	Newton et al.	Feb 2009	A1
20090054894	Yachi	Feb 2009	A1
20090065565	Cao	Mar 2009	A1
20090076506	Baker	Mar 2009	A1
20090082716	Akahoshi	Mar 2009	A1
20090082766	Unger et al.	Mar 2009	A1
20090088785	Masuda	Apr 2009	A1
20090090763	Zemlok et al.	Apr 2009	A1
20090118751	Wiener et al.	May 2009	A1
20090143678	Keast et al.	Jun 2009	A1
20090143799	Smith et al.	Jun 2009	A1
20090143800	Deville et al.	Jun 2009	A1
20090163807	Sliwa	Jun 2009	A1
20090182322	D'Amelio et al.	Jul 2009	A1
20090182331	D'Amelio et al.	Jul 2009	A1
20090182332	Long et al.	Jul 2009	A1
20090198272	Kerver et al.	Aug 2009	A1
20090204114	Odom	Aug 2009	A1
20090216157	Yamada	Aug 2009	A1
20090223033	Houser	Sep 2009	A1
20090240244	Malis et al.	Sep 2009	A1
20090248021	McKenna	Oct 2009	A1
20090254077	Craig	Oct 2009	A1
20090254080	Honda	Oct 2009	A1
20090259149	Tahara et al.	Oct 2009	A1
20090264909	Beaupre	Oct 2009	A1
20090270771	Takahashi	Oct 2009	A1
20090270812	Litscher et al.	Oct 2009	A1
20090270853	Yachi et al.	Oct 2009	A1
20090270891	Beaupre	Oct 2009	A1
20090270899	Carusillo et al.	Oct 2009	A1
20090287205	Ingle	Nov 2009	A1
20090292283	Odom	Nov 2009	A1
20090299141	Downey et al.	Dec 2009	A1
20090327715	Smith et al.	Dec 2009	A1
20100004508	Naito et al.	Jan 2010	A1
20100022825	Yoshie	Jan 2010	A1
20100030233	Whitman et al.	Feb 2010	A1
20100034605	Huckins et al.	Feb 2010	A1
20100036370	Mirel et al.	Feb 2010	A1
20100036379	Prakash	Feb 2010	A1
20100042093	Wham et al.	Feb 2010	A9
20100049180	Wells et al.	Feb 2010	A1
20100057118	Dietz et al.	Mar 2010	A1
20100063525	Beaupre et al.	Mar 2010	A1
20100063528	Beaupre	Mar 2010	A1
20100081863	Hess et al.	Apr 2010	A1
20100081864	Hess et al.	Apr 2010	A1
20100081883	Murray et al.	Apr 2010	A1
20100094323	Isaacs et al.	Apr 2010	A1
20100106173	Yoshimine	Apr 2010	A1
20100109480	Forslund et al.	May 2010	A1
20100158307	Kubota et al.	Jun 2010	A1
20100168741	Sanai et al.	Jul 2010	A1
20100181966	Sakakibara	Jul 2010	A1
20100187283	Crainich et al.	Jul 2010	A1
20100204721	Young et al.	Aug 2010	A1
20100222714	Muir et al.	Sep 2010	A1
20100222752	Collins, Jr. et al.	Sep 2010	A1
20100228250	Brogna	Sep 2010	A1
20100234906	Koh	Sep 2010	A1
20100274160	Yachi et al.	Oct 2010	A1
20100274278	Fleenor et al.	Oct 2010	A1
20100280368	Can et al.	Nov 2010	A1
20100298743	Nield et al.	Nov 2010	A1
20100331742	Masuda	Dec 2010	A1
20110004233	Muir et al.	Jan 2011	A1
20110015650	Choi et al.	Jan 2011	A1
20110028964	Edwards	Feb 2011	A1
20110071523	Dickhans	Mar 2011	A1
20110106141	Nakamura	May 2011	A1
20110112400	Emery et al.	May 2011	A1
20110125149	El-Galley et al.	May 2011	A1
20110125151	Strauss et al.	May 2011	A1
20110160725	Kabaya et al.	Jun 2011	A1
20110238010	Kirschenman et al.	Sep 2011	A1
20110273465	Konishi et al.	Nov 2011	A1
20110278343	Knodel et al.	Nov 2011	A1
20110279268	Konishi et al.	Nov 2011	A1
20110284014	Cadeddu et al.	Nov 2011	A1
20110290856	Shelton, IV et al.	Dec 2011	A1
20110295295	Shelton, IV et al.	Dec 2011	A1
20110306967	Payne et al.	Dec 2011	A1
20110313415	Fernandez et al.	Dec 2011	A1
20120004655	Kim et al.	Jan 2012	A1
20120016413	Timm et al.	Jan 2012	A1
20120022519	Huang et al.	Jan 2012	A1
20120022526	Aldridge et al.	Jan 2012	A1
20120022583	Sugalski et al.	Jan 2012	A1
20120041358	Mann et al.	Feb 2012	A1
20120053597	Anvari et al.	Mar 2012	A1
20120059286	Hastings et al.	Mar 2012	A1
20120059289	Nield et al.	Mar 2012	A1
20120071863	Lee et al.	Mar 2012	A1
20120078139	Aldridge et al.	Mar 2012	A1
20120078244	Worrell et al.	Mar 2012	A1
20120080344	Shelton, IV	Apr 2012	A1
20120101495	Young et al.	Apr 2012	A1
20120109186	Parrott et al.	May 2012	A1
20120116222	Sawada et al.	May 2012	A1
20120116265	Houser et al.	May 2012	A1
20120116266	Houser et al.	May 2012	A1
20120116381	Houser et al.	May 2012	A1
20120136279	Tanaka et al.	May 2012	A1
20120136386	Kishida et al.	May 2012	A1
20120143182	Ullrich	Jun 2012	A1
20120143211	Kishi	Jun 2012	A1
20120150049	Zielinski et al.	Jun 2012	A1
20120150169	Zielinksi et al.	Jun 2012	A1
20120172904	Muir et al.	Jul 2012	A1
20120191091	Allen	Jul 2012	A1
20120211542	Racenet	Aug 2012	A1
20120239066	Levine et al.	Sep 2012	A1
20120253328	Cunningham et al.	Oct 2012	A1
20120265241	Hart et al.	Oct 2012	A1
20120296325	Takashino	Nov 2012	A1
20120296371	Kappus et al.	Nov 2012	A1
20130023925	Mueller	Jan 2013	A1
20130035685	Fischer et al.	Feb 2013	A1
20130085510	Stefanchik et al.	Apr 2013	A1
20130123776	Monson et al.	May 2013	A1
20130158659	Bergs et al.	Jun 2013	A1
20130158660	Bergs et al.	Jun 2013	A1
20130165929	Muir et al.	Jun 2013	A1
20130214025	Zemlok et al.	Aug 2013	A1
20130253256	Griffith et al.	Sep 2013	A1
20130253480	Kimball et al.	Sep 2013	A1
20130277410	Fernandez et al.	Oct 2013	A1
20130296843	Boudreaux et al.	Nov 2013	A1
20140001231	Shelton, IV et al.	Jan 2014	A1
20140001234	Shelton, IV et al.	Jan 2014	A1
20140005640	Shelton, IV et al.	Jan 2014	A1
20140005678	Shelton, IV et al.	Jan 2014	A1
20140005702	Timm et al.	Jan 2014	A1
20140005705	Weir et al.	Jan 2014	A1
20140005718	Shelton, IV et al.	Jan 2014	A1
20140012299	Stoddard et al.	Jan 2014	A1
20140014544	Bugnard et al.	Jan 2014	A1
20140114327	Boudreaux	Apr 2014	A1
20140121569	Schafer et al.	May 2014	A1
20140135804	Weisenburgh, II et al.	May 2014	A1
20140180274	Kabaya et al.	Jun 2014	A1
20140194868	Sanai et al.	Jul 2014	A1
20140194874	Dietz et al.	Jul 2014	A1
20140194875	Reschke et al.	Jul 2014	A1
20140207135	Winter	Jul 2014	A1
20140246475	Hall et al.	Sep 2014	A1
20140263541	Leimbach et al.	Sep 2014	A1
20140263552	Hall et al.	Sep 2014	A1
20140276659	Juergens et al.	Sep 2014	A1
20140276754	Gilbert et al.	Sep 2014	A1
20140276797	Batchelor et al.	Sep 2014	A1
20140276806	Heim	Sep 2014	A1
20140330271	Dietz et al.	Nov 2014	A1
20150032100	Coulson et al.	Jan 2015	A1
20150032150	Ishida et al.	Jan 2015	A1
20150080876	Worrell et al.	Mar 2015	A1
20150080887	Sobajima et al.	Mar 2015	A1
20150094703	Zikorus et al.	Apr 2015	A1
20150112335	Boudreaux et al.	Apr 2015	A1
20150157356	Gee	Jun 2015	A1
20150164533	Felder et al.	Jun 2015	A1
20150164534	Felder et al.	Jun 2015	A1
20150164535	Felder et al.	Jun 2015	A1
20150164536	Czarnecki et al.	Jun 2015	A1
20150164537	Cagle et al.	Jun 2015	A1
20150164538	Aldridge et al.	Jun 2015	A1
20150230861	Woloszko et al.	Aug 2015	A1
20150238260	Nau, Jr.	Aug 2015	A1
20150257780	Houser	Sep 2015	A1
20150272659	Boudreaux et al.	Oct 2015	A1
20150272660	Boudreaux et al.	Oct 2015	A1
20150282879	Ruelas	Oct 2015	A1
20150313667	Allen, IV	Nov 2015	A1
20150320480	Cosman, Jr. et al.	Nov 2015	A1
20150320481	Cosman, Jr. et al.	Nov 2015	A1
20160030076	Faller et al.	Feb 2016	A1
20160045248	Unger et al.	Feb 2016	A1
20160051316	Boudreaux	Feb 2016	A1
20160074108	Woodruff et al.	Mar 2016	A1
20160128762	Harris et al.	May 2016	A1
20160144204	Akagane	May 2016	A1
20160157927	Corbett et al.	Jun 2016	A1
20160175029	Witt et al.	Jun 2016	A1
20160199123	Thomas et al.	Jul 2016	A1
20160199125	Jones	Jul 2016	A1
20160206342	Robertson et al.	Jul 2016	A1
20160262786	Madan et al.	Sep 2016	A1
20160270840	Yates et al.	Sep 2016	A1
20160270841	Strobl	Sep 2016	A1
20160270842	Strobl et al.	Sep 2016	A1
20160270843	Boudreaux et al.	Sep 2016	A1
20160278848	Boudreaux et al.	Sep 2016	A1
20160287311	Friedrichs	Oct 2016	A1
20160296249	Robertson	Oct 2016	A1
20160296250	Olson et al.	Oct 2016	A1
20160296251	Olson et al.	Oct 2016	A1
20160296252	Olson et al.	Oct 2016	A1
20160296268	Gee et al.	Oct 2016	A1
20160296270	Strobl et al.	Oct 2016	A1
20160317217	Batross et al.	Nov 2016	A1
20160324537	Green et al.	Nov 2016	A1
20160338726	Stulen et al.	Nov 2016	A1
20160346001	Vakharia et al.	Dec 2016	A1
20160367273	Robertson et al.	Dec 2016	A1
20160367281	Gee et al.	Dec 2016	A1
20160374708	Wiener et al.	Dec 2016	A1
20160374709	Timm et al.	Dec 2016	A1
20160374712	Stulen et al.	Dec 2016	A1
20170000512	Conlon et al.	Jan 2017	A1
20170000516	Stulen et al.	Jan 2017	A1
20170000541	Yates et al.	Jan 2017	A1
20170000542	Yates et al.	Jan 2017	A1
20170000553	Wiener et al.	Jan 2017	A1
20170000554	Yates et al.	Jan 2017	A1
20170056056	Wiener et al.	Mar 2017	A1
20170056058	Voegele et al.	Mar 2017	A1
20170086876	Wiener et al.	Mar 2017	A1
20170086908	Wiener et al.	Mar 2017	A1
20170086909	Yates et al.	Mar 2017	A1
20170086910	Wiener et al.	Mar 2017	A1
20170086911	Wiener et al.	Mar 2017	A1
20170086912	Wiener et al.	Mar 2017	A1
20170086913	Yates et al.	Mar 2017	A1
20170086914	Wiener et al.	Mar 2017	A1
20170095267	Messerly et al.	Apr 2017	A1
20170105757	Weir et al.	Apr 2017	A1
20170105782	Scheib et al.	Apr 2017	A1
20170105786	Scheib et al.	Apr 2017	A1
20170105791	Yates et al.	Apr 2017	A1
20170119426	Akagane	May 2017	A1
20170135751	Rothweiler et al.	May 2017	A1
20170143371	Witt et al.	May 2017	A1
20170143877	Witt et al.	May 2017	A1
20170164994	Smith	Jun 2017	A1
20170164997	Johnson et al.	Jun 2017	A1
20170189095	Danziger et al.	Jul 2017	A1
20170189096	Danziger et al.	Jul 2017	A1
20170196586	Witt et al.	Jul 2017	A1
20170196587	Witt et al.	Jul 2017	A1
20170202571	Shelton, IV et al.	Jul 2017	A1
20170202572	Shelton, IV et al.	Jul 2017	A1
20170202591	Shelton, IV et al.	Jul 2017	A1
20170202592	Shelton, IV et al.	Jul 2017	A1
20170202593	Shelton, IV et al.	Jul 2017	A1
20170202594	Shelton, IV et al.	Jul 2017	A1
20170202595	Shelton, IV	Jul 2017	A1
20170202596	Shelton, IV et al.	Jul 2017	A1
20170202597	Shelton, IV et al.	Jul 2017	A1
20170202598	Shelton, IV et al.	Jul 2017	A1
20170202599	Shelton, IV et al.	Jul 2017	A1
20170202605	Shelton, IV et al.	Jul 2017	A1
20170202607	Shelton, IV et al.	Jul 2017	A1
20170202608	Shelton, IV et al.	Jul 2017	A1
20170202609	Shelton, IV et al.	Jul 2017	A1
20170207467	Shelton, IV et al.	Jul 2017	A1
20170209167	Nield	Jul 2017	A1
20170238991	Worrell et al.	Aug 2017	A1
20170245875	Timm et al.	Aug 2017	A1
20170312014	Strobl et al.	Nov 2017	A1
20170312015	Worrell et al.	Nov 2017	A1
20170312016	Strobl et al.	Nov 2017	A1
20170312017	Trees et al.	Nov 2017	A1
20170312018	Trees et al.	Nov 2017	A1
20170312019	Trees et al.	Nov 2017	A1
20170319228	Worrell et al.	Nov 2017	A1
20170319265	Yates et al.	Nov 2017	A1
20170325874	Noack et al.	Nov 2017	A1
20170348064	Stewart et al.	Dec 2017	A1
20180014872	Dickerson	Jan 2018	A1
20180028257	Yates et al.	Feb 2018	A1
20180036061	Yates et al.	Feb 2018	A1
20180036065	Yates et al.	Feb 2018	A1
20180042658	Shelton, IV et al.	Feb 2018	A1
20180064961	Wiener et al.	Mar 2018	A1
20180078277	Illizaliturri-Sanchez et al.	Mar 2018	A1
20180098785	Price et al.	Apr 2018	A1
20180098808	Yates et al.	Apr 2018	A1
20180177545	Boudreaux et al.	Jun 2018	A1
20180235691	Voegele et al.	Aug 2018	A1
20180280083	Parihar et al.	Oct 2018	A1
20190021783	Asher et al.	Jan 2019	A1
20190105067	Boudreaux et al.	Apr 2019	A1
20190201048	Stulen et al.	Jul 2019	A1
20190209201	Boudreaux et al.	Jul 2019	A1
20190262030	Faller et al.	Aug 2019	A1
20190274700	Robertson et al.	Sep 2019	A1
20190282288	Boudreaux	Sep 2019	A1
20190282292	Wiener et al.	Sep 2019	A1
20200015883	Batross et al.	Jan 2020	A1
20200022724	Worrell et al.	Jan 2020	A1
20200030021	Yates et al.	Jan 2020	A1
20200054382	Yates et al.	Feb 2020	A1
20200078085	Yates et al.	Mar 2020	A1
20200078609	Messerly et al.	Mar 2020	A1
20200085465	Timm et al.	Mar 2020	A1
20200113624	Worrell et al.	Apr 2020	A1
20200138473	Shelton, IV et al.	May 2020	A1
20200222135	Stulen et al.	Jul 2020	A1
20200229833	Vakharia et al.	Jul 2020	A1
20200229834	Olson et al.	Jul 2020	A1
20200237434	Scheib et al.	Jul 2020	A1
20200261141	Wiener et al.	Aug 2020	A1
20200268433	Wiener et al.	Aug 2020	A1

Foreign Referenced Citations (453)

Number	Date	Country
2003241752	Sep 2003	AU
2535467	Apr 1993	CA
1233944	Nov 1999	CN
1253485	May 2000	CN
2460047	Nov 2001	CN
1634601	Jul 2005	CN
1640365	Jul 2005	CN
1694649	Nov 2005	CN
1775323	May 2006	CN
1922563	Feb 2007	CN
2868227	Feb 2007	CN
1951333	Apr 2007	CN
101035482	Sep 2007	CN
101040799	Sep 2007	CN
101396300	Apr 2009	CN
101467917	Jul 2009	CN
101474081	Jul 2009	CN
101516285	Aug 2009	CN
101674782	Mar 2010	CN
101883531	Nov 2010	CN
102100582	Jun 2011	CN
102149312	Aug 2011	CN
102160045	Aug 2011	CN
202027624	Nov 2011	CN
102834069	Dec 2012	CN
101313865	Jan 2013	CN
103281982	Sep 2013	CN
103379853	Oct 2013	CN
3904558	Aug 1990	DE
9210327	Nov 1992	DE
4300307	Jul 1994	DE
4323585	Jan 1995	DE
19608716	Apr 1997	DE
29623113	Oct 1997	DE
20004812	Sep 2000	DE
20021619	Mar 2001	DE
10042606	Aug 2001	DE
10201569	Jul 2003	DE
102012109037	Apr 2014	DE
0171967	Feb 1986	EP
0336742	Oct 1989	EP
0136855	Nov 1989	EP
0342448	Nov 1989	EP
0443256	Aug 1991	EP
0456470	Nov 1991	EP
0238667	Feb 1993	EP
0340803	Aug 1993	EP
0598976	Jun 1994	EP
0630612	Dec 1994	EP
0424685	May 1995	EP
0677275	Oct 1995	EP
0482195	Jan 1996	EP
0695535	Feb 1996	EP
0705571	Apr 1996	EP
0741996	Nov 1996	EP
0612570	Jun 1997	EP
0557806	May 1998	EP
0640317	Sep 1999	EP
1108394	Jun 2001	EP
1138264	Oct 2001	EP
0908148	Jan 2002	EP
1229515	Aug 2002	EP
0722696	Dec 2002	EP
1285634	Feb 2003	EP
0908155	Jun 2003	EP
0705570	Apr 2004	EP
0765637	Jul 2004	EP
0870473	Sep 2005	EP
0624346	Nov 2005	EP
1594209	Nov 2005	EP
1199044	Dec 2005	EP
1609428	Dec 2005	EP
1199043	Mar 2006	EP
1293172	Apr 2006	EP
0875209	May 2006	EP
1433425	Jun 2006	EP
1256323	Aug 2006	EP
1698289	Sep 2006	EP
1704824	Sep 2006	EP
1749479	Feb 2007	EP
1767157	Mar 2007	EP
1254637	Aug 2007	EP
1815950	Aug 2007	EP
1839599	Oct 2007	EP
1844720	Oct 2007	EP
1862133	Dec 2007	EP
1875875	Jan 2008	EP
1878399	Jan 2008	EP
1915953	Apr 2008	EP
1532933	May 2008	EP
1199045	Jun 2008	EP
1707143	Jun 2008	EP
1943957	Jul 2008	EP
1964530	Sep 2008	EP
1972264	Sep 2008	EP
1974771	Oct 2008	EP
1435852	Dec 2008	EP
1498082	Dec 2008	EP
1707131	Dec 2008	EP
1477104	Jan 2009	EP
2014218	Jan 2009	EP
1849424	Apr 2009	EP
2042112	Apr 2009	EP
2042117	Apr 2009	EP
2060238	May 2009	EP
1832259	Jun 2009	EP
2074959	Jul 2009	EP
1810625	Aug 2009	EP
2090256	Aug 2009	EP
2092905	Aug 2009	EP
2105104	Sep 2009	EP
1747761	Oct 2009	EP
2106758	Oct 2009	EP
2111813	Oct 2009	EP
2131760	Dec 2009	EP
1769766	Feb 2010	EP
2151204	Feb 2010	EP
2153791	Feb 2010	EP
2200145	Jun 2010	EP
1214913	Jul 2010	EP
2238938	Oct 2010	EP
2243439	Oct 2010	EP
2298154	Mar 2011	EP
2305144	Apr 2011	EP
1510178	Jun 2011	EP
1946708	Jun 2011	EP
2335630	Jun 2011	EP
1502551	Jul 2011	EP
1728475	Aug 2011	EP
2353518	Aug 2011	EP
2361562	Aug 2011	EP
2365608	Sep 2011	EP
2420197	Feb 2012	EP
2422721	Feb 2012	EP
1927321	Apr 2012	EP
2436327	Apr 2012	EP
2529681	Dec 2012	EP
1767164	Jan 2013	EP
2316359	Mar 2013	EP
2090238	Apr 2013	EP
2578172	Apr 2013	EP
1586275	May 2013	EP
1616529	Sep 2013	EP
1997438	Nov 2013	EP
2668922	Dec 2013	EP
2508143	Feb 2014	EP
2583633	Oct 2014	EP
2076195	Dec 2015	EP
2113210	Mar 2016	EP
2510891	Jun 2016	EP
2227155	Jul 2016	EP
2859858	Dec 2016	EP
2115068	Jun 1998	ES
1482943	Aug 1977	GB
2032221	Apr 1980	GB
2317566	Apr 1998	GB
2379878	Nov 2004	GB
2472216	Feb 2011	GB
2447767	Aug 2011	GB
S50100891	Aug 1975	JP
S5968513	May 1984	JP
S59141938	Aug 1984	JP
S62221343	Sep 1987	JP
S62227343	Oct 1987	JP
S62292153	Dec 1987	JP
S62292154	Dec 1987	JP
S63109386	May 1988	JP
S63315049	Dec 1988	JP
H01151452	Jun 1989	JP
H01198540	Aug 1989	JP
H0271510	May 1990	JP
H02286149	Nov 1990	JP
H02292193	Dec 1990	JP
H0337061	Feb 1991	JP
H0425707	Feb 1992	JP
H0464351	Feb 1992	JP
H0430508	Mar 1992	JP
H04150847	May 1992	JP
H04152942	May 1992	JP
H 0541716	Feb 1993	JP
H0595955	Apr 1993	JP
H05115490	May 1993	JP
H0670938	Mar 1994	JP
H06104503	Apr 1994	JP
H06217988	Aug 1994	JP
H06507081	Aug 1994	JP
H 07500514	Jan 1995	JP
H07508910	Oct 1995	JP
H07308323	Nov 1995	JP
H0824266	Jan 1996	JP
H08229050	Sep 1996	JP
H08275951	Oct 1996	JP
H08299351	Nov 1996	JP
H08336544	Dec 1996	JP
H08336545	Dec 1996	JP
H09503146	Mar 1997	JP
H09130655	May 1997	JP
H09135553	May 1997	JP
H09140722	Jun 1997	JP
H105237	Jan 1998	JP
10127654	May 1998	JP
H10295700	Nov 1998	JP
H11501543	Feb 1999	JP
H11128238	May 1999	JP
H11192235	Jul 1999	JP
H11253451	Sep 1999	JP
H11318918	Nov 1999	JP
2000041991	Feb 2000	JP
2000070279	Mar 2000	JP
2000210299	Aug 2000	JP
2000271145	Oct 2000	JP
2000287987	Oct 2000	JP
2001029353	Feb 2001	JP
2001502216	Feb 2001	JP
2001309925	Nov 2001	JP
2002059380	Feb 2002	JP
2002177295	Jun 2002	JP
2002186901	Jul 2002	JP
2002204808	Jul 2002	JP
2002238919	Aug 2002	JP
2002263579	Sep 2002	JP
2002301086	Oct 2002	JP
2002306504	Oct 2002	JP
2002330977	Nov 2002	JP
2002542690	Dec 2002	JP
2003000612	Jan 2003	JP
2003010201	Jan 2003	JP
2003510158	Mar 2003	JP
2003116870	Apr 2003	JP
2003126104	May 2003	JP
2003126110	May 2003	JP
2003153919	May 2003	JP
2003530921	Oct 2003	JP
2003310627	Nov 2003	JP
2003339730	Dec 2003	JP
2004129871	Apr 2004	JP
2004147701	May 2004	JP
2005003496	Jan 2005	JP
2005027026	Jan 2005	JP
2005040222	Feb 2005	JP
2005066316	Mar 2005	JP
2005074088	Mar 2005	JP
2005507679	Mar 2005	JP
2005534451	Nov 2005	JP
2005337119	Dec 2005	JP
2006006410	Jan 2006	JP
2006068396	Mar 2006	JP
2006075376	Mar 2006	JP
2006081664	Mar 2006	JP
2006114072	Apr 2006	JP
2006512149	Apr 2006	JP
2006116194	May 2006	JP
2006158525	Jun 2006	JP
2006217716	Aug 2006	JP
2006218296	Aug 2006	JP
2006288431	Oct 2006	JP
2007037568	Feb 2007	JP
2007050181	Mar 2007	JP
2007-524459	Aug 2007	JP
2007229454	Sep 2007	JP
2007527747	Oct 2007	JP
2007296369	Nov 2007	JP
200801876	Jan 2008	JP
2008018226	Jan 2008	JP
200833644	Feb 2008	JP
2008036390	Feb 2008	JP
2008508065	Mar 2008	JP
2008119250	May 2008	JP
2008515562	May 2008	JP
2008521503	Jun 2008	JP
2008188160	Aug 2008	JP
D1339835	Aug 2008	JP
2008212679	Sep 2008	JP
2008536562	Sep 2008	JP
2008284374	Nov 2008	JP
2009511206	Mar 2009	JP
2009082711	Apr 2009	JP
2009517181	Apr 2009	JP
4262923	May 2009	JP
2009523567	Jun 2009	JP
2009148557	Jul 2009	JP
2009236177	Oct 2009	JP
2009254819	Nov 2009	JP
2010000336	Jan 2010	JP
2010009686	Jan 2010	JP
2010514923	May 2010	JP
2010121865	Jun 2010	JP
2010534522	Nov 2010	JP
2010540186	Dec 2010	JP
2011505198	Feb 2011	JP
2012075899	Apr 2012	JP
2012071186	Apr 2012	JP
2012235658	Nov 2012	JP
5208761	Jun 2013	JP
5714508	May 2015	JP
2015515339	May 2015	JP
5836543	Dec 2015	JP
100789356	Dec 2007	KR
2154437	Aug 2000	RU
22035	Mar 2002	RU
2201169	Mar 2003	RU
2304934	Aug 2007	RU
2405603	Dec 2010	RU
2013119977	Nov 2014	RU
850068	Jul 1981	SU
WO-8103272	Nov 1981	WO
WO-9222259	Dec 1992	WO
WO-9307817	Apr 1993	WO
WO-9308757	May 1993	WO
WO-9314708	Aug 1993	WO
WO-9316646	Sep 1993	WO
WO-9320877	Oct 1993	WO
WO-9322973	Nov 1993	WO
WO-9400059	Jan 1994	WO
WO-9421183	Sep 1994	WO
WO-9424949	Nov 1994	WO
WO-9509572	Apr 1995	WO
WO-9510978	Apr 1995	WO
WO-9534259	Dec 1995	WO
WO-9630885	Oct 1996	WO
WO-9635382	Nov 1996	WO
WO-9639086	Dec 1996	WO
WO-9710764	Mar 1997	WO
WO-9800069	Jan 1998	WO
WO-9816156	Apr 1998	WO
WO-9826739	Jun 1998	WO
WO-9835621	Aug 1998	WO
WO-9837815	Sep 1998	WO
WO-9840020	Sep 1998	WO
WO-9847436	Oct 1998	WO
WO-9857588	Dec 1998	WO
WO-9920213	Apr 1999	WO
WO-9923960	May 1999	WO
WO-9940857	Aug 1999	WO
WO-9940861	Aug 1999	WO
WO-9952489	Oct 1999	WO
WO-0024330	May 2000	WO
WO-0024331	May 2000	WO
WO-0025691	May 2000	WO
WO-0064358	Nov 2000	WO
WO-0074585	Dec 2000	WO
WO-0124713	Apr 2001	WO
WO-0128444	Apr 2001	WO
WO-0154590	Aug 2001	WO
WO-0167970	Sep 2001	WO
WO-0172251	Oct 2001	WO
WO-0195810	Dec 2001	WO
WO-0224080	Mar 2002	WO
WO-0238057	May 2002	WO
WO-02062241	Aug 2002	WO
WO-02080797	Oct 2002	WO
WO-03001986	Jan 2003	WO
WO-03013374	Feb 2003	WO
WO-03020339	Mar 2003	WO
WO-03028541	Apr 2003	WO
WO-03030708	Apr 2003	WO
WO-03068046	Aug 2003	WO
WO-03082133	Oct 2003	WO
WO-03095028	Nov 2003	WO
WO-2004011037	Feb 2004	WO
WO-2004012615	Feb 2004	WO
WO-2004026104	Apr 2004	WO
WO-2004032754	Apr 2004	WO
WO-2004032762	Apr 2004	WO
WO-2004032763	Apr 2004	WO
WO-2004037095	May 2004	WO
WO-2004060141	Jul 2004	WO
WO-2004078051	Sep 2004	WO
WO-2004098426	Nov 2004	WO
WO-2004112618	Dec 2004	WO
WO-2005052959	Jun 2005	WO
WO-2005117735	Dec 2005	WO
WO-2005122917	Dec 2005	WO
WO-2006012797	Feb 2006	WO
WO-2006021269	Mar 2006	WO
WO-2006036706	Apr 2006	WO
WO-2006042210	Apr 2006	WO
WO-2006055166	May 2006	WO
WO-2006058223	Jun 2006	WO
WO-2006063199	Jun 2006	WO
WO-2006083988	Aug 2006	WO
WO-2006101661	Sep 2006	WO
WO-2006119139	Nov 2006	WO
WO-2006119376	Nov 2006	WO
WO-2006129465	Dec 2006	WO
WO-2007008703	Jan 2007	WO
WO-2007008710	Jan 2007	WO
WO-2007038538	Apr 2007	WO
WO-2007040818	Apr 2007	WO
WO-2007047380	Apr 2007	WO
WO-2007047531	Apr 2007	WO
WO-2007056590	May 2007	WO
WO-2007087272	Aug 2007	WO
WO-2007089724	Aug 2007	WO
WO-2007143665	Dec 2007	WO
WO-2008016886	Feb 2008	WO
WO-2008020964	Feb 2008	WO
WO-2008042021	Apr 2008	WO
WO-2008045348	Apr 2008	WO
WO-2008049084	Apr 2008	WO
WO-2008051764	May 2008	WO
WO-2008089174	Jul 2008	WO
WO-2008099529	Aug 2008	WO
WO-2008101356	Aug 2008	WO
WO-2008118709	Oct 2008	WO
WO-2008130793	Oct 2008	WO
WO-2009010565	Jan 2009	WO
WO-2009018067	Feb 2009	WO
WO-2009018406	Feb 2009	WO
WO-2009022614	Feb 2009	WO
WO-2009027065	Mar 2009	WO
WO-2009036818	Mar 2009	WO
WO-2009039179	Mar 2009	WO
WO-2009046234	Apr 2009	WO
WO-2009059741	May 2009	WO
WO-2009073402	Jun 2009	WO
WO-2009082477	Jul 2009	WO
WO-2009088550	Jul 2009	WO
WO-2009120992	Oct 2009	WO
WO-2009141616	Nov 2009	WO
WO-2009149234	Dec 2009	WO
WO-2010017149	Feb 2010	WO
WO-2010017266	Feb 2010	WO
WO-2010027109	Mar 2010	WO
WO-2010068783	Jun 2010	WO
WO-2010104755	Sep 2010	WO
WO-2011008672	Jan 2011	WO
WO-2011044338	Apr 2011	WO
WO-2011044343	Apr 2011	WO
WO-2011052939	May 2011	WO
WO-2011060031	May 2011	WO
WO-2011084768	Jul 2011	WO
WO-2011089717	Jul 2011	WO
WO-2011100321	Aug 2011	WO
WO-2011144911	Nov 2011	WO
WO-2012044597	Apr 2012	WO
WO-2012044606	Apr 2012	WO
WO-2012061638	May 2012	WO
WO-2012061722	May 2012	WO
WO-2012088535	Jun 2012	WO
WO-2012128362	Sep 2012	WO
WO-2012135705	Oct 2012	WO
WO-2012135721	Oct 2012	WO
WO-2012150567	Nov 2012	WO
WO-2012166510	Dec 2012	WO
WO-2013018934	Feb 2013	WO
WO-2013034629	Mar 2013	WO
WO-2013062978	May 2013	WO
WO-2013102602	Jul 2013	WO
WO-2013154157	Oct 2013	WO
WO-2014092108	Jun 2014	WO
WO-2015197395	Dec 2015	WO
WO-2016009921	Jan 2016	WO

Non-Patent Literature Citations (60)

Entry
Technology Overview, printed from www.harmonicscalpel.com, Internet site, website accessed on Jun. 13, 2007, (3 pages).
Sherrit et al., “Novel Horn Designs for Ultrasonic/Sonic Cleaning Welding, Soldering, Cutting and Drilling,” Proc. SPIE Smart Structures Conference, vol. 4701, Paper No. 34, San Diego, CA, pp. 353-360, Mar. 2002.
AST Products, Inc., “Principles of Video Contact Angle Analysis,” 20 pages, (2006).
Lim et al., “A Review of Mechanism Used in Laparoscopic Surgical Instruments,” Mechanism and Machine Theory, vol. 38, pp. 1133-1147, (2003).
Gooch et al., “Recommended Infection-Control Practices for Dentistry, 1993,” Published: May 28, 1993; [retrieved on Aug. 23, 2008], Retrieved from the internet: URL: http//wonder.cdc.gov/wonder/prevguid/p0000191/p0000191.asp (15 pages).
Huston et al., “Magnetic and Magnetostrictive Properties of Cube Textured Nickel for Magnetostrictive Transducer Applications,” IEEE Transactions on Magnetics, vol. 9(4), pp. 636-640 (Dec. 1973).
Incropera et al., Fundamentals of Heat and Mass Transfer, Wiley, New York (1990).
F. A. Duck, “Optical Properties of Tissue Including Ultraviolet and Infrared Radiation,” pp. 43-71 in Physical Properties of Tissue (1990).
Orr et al., “Overview of Bioheat Transfer,” pp. 367-384 in Optical-Thermal Response of Laser-Irradiated Tissue, A. J. Welch and M. J. C. van Gemert, eds., Plenum, New York (1995).
Campbell et al, “Thermal Imaging in Surgery,” p. 19-3, in Medical Infrared Imaging, N. A. Diakides and J. D. Bronzino, Eds. (2008).
Makarov, S. N., Ochmann, M., Desinger, K., “The longitudinal vibration response of a curved fiber used for laser ultrasound surgical therapy,” Journal of the Acoustical Society of America 102, 1191-1199 (1997).
Morley, L. S. D., “Elastic Waves in a Naturally Curved Rod,” Quarterly Journal of Mechanics and Applied Mathematics, 14: 155-172 (1961).
Walsh, S. J., White, R. G., “Vibrational Power Transmission in Curved Beams,” Journal of Sound and Vibration, 233(3), 455-488 (2000).
http://www.apicalinstr.com/generators.htm.
http://www.4-traders.com/JOHNSON-JOHNSON-4832/news/Johnson-Johnson-Ethicon-E . . . .
http://www.medicalexpo.com/medical-manufacturer/electrosurgical-generator-6951.html.
http://www.valleylab.com/product/es/generators/index.html.
Gerhard, Glen C., “Surgical Electrotechnology: Quo Vadis?,” IEEE Transactions on Biomedical Engineering, vol. BME-31, No. 12, pp. 787-792, Dec. 1984.
Fowler, K.R., “A Programmable, Arbitrary Waveform Electrosurgical Device,” IEEE Engineering in Medicine and Biology Society 10th Annual International Conference, pp. 1324, 1325 (1988).
LaCourse, J.R.; Vogt, M.C.; Miller, W.T., III; Selikowitz, S.M., “Spectral Analysis Interpretation of Electrosurgical Generator Nerve and Muscle Stimulation,” IEEE Transactions on Biomedical Engineering, vol. 35, No. 7, pp. 505-509, Jul. 1988.
http://www.megadyne.com/es_generator.php.
Graff, K.F., “Elastic Wave Propagation in a Curved Sonic Transmission Line,” IEEE Transactions on Sonics and Ultrasonics, SU-17(1), 1-6 (1970).
Sullivan, “Optimal Choice for Number of Strands in a Litz-Wire Transformer Winding,” IEEE Transactions on Power Electronics, vol. 14, No. 2, Mar. 1999, pp. 283-291.
Covidien 501(k) Summary Sonicision, dated Feb. 24, 2011 (7 pages).
http://www.dotmed.eom/listing/electrosurical-unit/ethicon/ultracision-g110-/1466724.
http:/www.ethicon.com/GB-en/healthcare-professionals/products/energy-devices/capital//ge . . . .
Weir, C.E., “Rate of shrinkage of tendon collagen—heat, entropy and free energy of activation of the shrinkage of untreated tendon. Effect of acid salt, pickle, and tannage on the activation of tendon collagen.” Journal of the American Leather Chemists Association, 44, pp. 108-140 (1949).
Henriques. F.C., “Studies in thermal injury V. The predictability and the significance of thermally induced rate processes leading to irreversible epidermal injury.” Archives of Pathology, 434, pp. 489-502 (1947).
Arnoczky et al., “Thermal Modification of Conective Tissues: Basic Science Considerations and Clinical Implications,” J. Am Acad Orthop Surg, vol. 8, No. 5, pp. 305-313 (Sep./Oct. 2000).
Chen et al., “Heat-Induced Changes in the Mechanics of a Collagenous Tissue: Isothermal Free Shrinkage,” Transactions of the ASME, vol. 119, pp. 372-378 (Nov. 1997).
Chen et al., “Heat-Induced Changes in the Mechanics of a Collagenous Tissue: Isothermal, Isotonic Shrinkage,” Transactions of the ASME, vol. 120, pp. 382-388 (Jun. 1998).
Chen et al., “Phenomenological Evolution Equations for Heat-Induced Shrinkage of a Collagenous Tissue,” IEEE Transactions on Biomedical Engineering, vol. 45, No. 10, pp. 1234-1240 (Oct. 1998).
Harris et al., “Kinetics of Thermal Damage to a Collagenous Membrane Under Biaxial Isotonic Loading,” IEEE Transactions on Biomedical Engineering, vol. 51, No. 2, pp. 371-379 (Feb. 2004).
Harris et al., “Altered Mechanical Behavior of Epicardium Due to Isothermal Heating Under Biaxial Isotonic Loads,” Journal of Biomechanical Engineering, vol. 125, pp. 381-388 (Jun. 2003).
Lee et al., “A multi-sample denaturation temperature tester for collagenous biomaterials,” Med. Eng. Phy., vol. 17, No. 2, pp. 115-121 (Mar. 1995).
Moran et al., “Thermally Induced Shrinkage of Joint Capsule,” Clinical Orthopaedics and Related Research, No. 281, pp. 248-255 (Dec. 2000).
Wall et al., “Thermal modification of collagen,” J Shoulder Elbow Surg, No. 8, pp. 339-344 (Jul./Aug. 1999).
Wells et al., “Altered Mechanical Behavior of Epicardium Under Isothermal Biaxial Loading,” Transactions of the ASME, Journal of Biomedical Engineering, vol. 126, pp. 492-497 (Aug. 2004).
Gibson, “Magnetic Refrigerator Successfully Tested,” U.S. Department of Energy Research News, accessed online on Aug. 6, 2010 at http://www.eurekalert.org/features/doe/2001-11/dl-mrs062802.php (Nov. 1, 2001).
Humphrey, J.D., “Continuum Thermomechanics and the Clinical Treatment of Disease and Injury,” Appl. Mech. Rev., vol. 56, No. 2 pp. 231-260 (Mar. 2003).
National Semiconductors Temperature Sensor Handbook—http://www.national.com/appinfo/tempsensors/files/temphb.pdf; accessed online: Apr. 1, 2011.
Chen et al., “Heat-induced changes in the mechanics of a collagenous tissue: pseudoelastic behavior at 37° C.,” Journal of Biomechanics, 31, pp. 211-216 (1998).
Kurt Gieck & Reiner Gieck, Engineering Formulas § Z.7 (7th ed. 1997).
Hayashi et al., “The Effect of Thermal Heating on the Length and Histologic Properties of the Glenohumeral Joint Capsule,” American Journal of Sports Medicine, vol. 25, Issue 1, 11 pages (Jan. 1997), URL: http://www.mdconsult.com/das/article/body/156183648-2/jorg=journal&source=MI&sp=1 . . . , accessed Aug. 25, 2009.
Wright, et al., “Time-Temperature Equivalence of Heat-Induced Changes in Cells and Proteins,” Feb. 1998. ASME Journal of Biomechanical Engineering, vol. 120, pp. 22-26.
Covidien Brochure, [Value Analysis Brief], LigaSure Advance™ Pistol Grip, dated Rev. Apr. 2010 (7 pages).
Covidien Brochure, LigaSure Impact™ Instrument LF4318, dated Feb. 2013 (3 pages).
Covidien Brochure, LigaSure Atlas™ Hand Switching Instruments, dated Dec. 2008 (2 pages).
Covidien Brochure, The LigaSure™ 5 mm Blunt Tip Sealer/Divider Family, dated Apr. 2013 (2 pages).
https://www.kjmagnetics.com/fieldcalculator.asp, retrieved Jul. 11, 2016, backdated to Nov. 11, 2011 via https://web.archive.org/web/20111116164447/http://www.kjmagnetics.com/fieldcalculator.asp.
Douglas, S.C. “Introduction to Adaptive Filter”. Digital Signal Processing Handbook. Ed. Vijay K. Madisetti and Douglas B. Williams. Boca Raton: CRC Press LLC, 1999.
Leonard I. Malis, M.D., “The Value of Irrigation During Bipolar Coagulation,” 1989.
Covidien Brochure, The LigaSure Precise™ Instrument, dated Mar. 2011 (2 pages).
Glaser and Subak-Sharpe,Integrated Circuit Engineering, Addison-Wesley Publishing, Reading, MA (1979).
Jang, J. et al. “Neuro-fuzzy and Soft Computing.” Prentice Hall, 1997, pp. 13-89, 199-293, 335-393, 453-496, 535-549.
Erbe Electrosurgery VIO® 200 S, (2012), p. 7, 12 pages, accessed Mar. 31, 2014 at http://www.erbe-med. com/erbe/media/Marketing materialien/85140170 Erbe En VIO 200 S D027541.
Sullivan, “Cost-Constrained Selection of Strand Diameter and Number in a Litz-Wire Transformer Winding,” IEEE Transactions on Power Electronics, vol. 16, No. 2, Mar. 2001, pp. 281-288.
Hörmann et al., “Reversible and irreversible denaturation of collagen fibers.” Biochemistry, 10, pp. 932-937 (1971).
Dean, D.A., “Electrical Impedance Spectroscopy Study of Biological Tissues,” J. Electrostat, 66(3-4), Mar. 2008, pp. 165-177. Accessed Apr. 10, 2018: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597841/.
Moraleda et al., A Temperature Sensor Based on a Polymer Optical Fiber Macro-Bend, Sensors 2013, 13, 13076-13089, doi: 10.3390/s131013076, ISSN 1424-8220.

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