Patent Grant
11730476
The present invention is directed toward systems, devices, and methods for providing remote manipulation or traction to tissue using one or more graspers, delivery devices, and magnetic control assemblies.
Many surgical procedures are shifting toward the use of minimally-invasive approaches that are configured to minimize the number and size of incisions that are made in a patient. Minimally-invasive procedures such as endoscopic and laparoscopic procedures may be associated with lower pain, quicker post-surgical recovery, shortened hospitalization, and reduced complications when compared to open surgical procedures. During minimally-invasive procedures it may be desirable to reposition or otherwise manipulate tissue. However, the introduction of additional devices to engage tissue may crowd the access sites provided by incisions, which may require the formation of larger or additional access sites. Accordingly, it may be desirable to provide one or more systems that allow for manipulation of tissue without the need to have a portion of the device present in an access site to the body.
Described here are systems, devices, and methods for providing remote manipulation or traction to tissue. In some variations, the systems may comprise some combination of a grasper configured to be inserted into a patient, a delivery device, and a magnetic control element. The grasper may be configured for insertion into the patient during a minimally-invasive procedure, such as a laparoscopic operation. The graspers described here may be configured to releasably connect to tissue. In some embodiments, the grasper may comprise a clip, a clamp, a suction device, a coil, or the like, and may be configured to connect to any suitable tissue of the body (for example, including but not limited to tissue in the abdominal cavity, such as an appendix, a gallbladder, or the like). Accordingly, the grasper may be sized such that it may fit through a laparoscopic port (e.g., a 10 mm port or the like) or another incision formed in the body. In some instances, the grasper may be introduced into the body via an incision or port using a delivery device. The delivery device may be configured to releasably engage the grasper to deliver the grasper, remove it from the patient, or reposition it. The delivery device may additionally be configured to actuate the grasper to attach it to tissue and/or detach it from tissue. The grasper may be further configured to be manipulated by a magnetic control element positioned externally of the body to move, reposition, and/or hold the grasper.
The grasper may be any suitable device for releasably connecting to tissue, such as those described here. In some variations, the grasper may be a clip, clamp, or the like, which may attach to tissue by pressing or otherwise holding tissue between two surfaces. In other variations, the grasper may be a suction device, which may attach to tissue by creating a vacuum between the grasper and tissue. In yet other variations, the grasper may comprise a wire having a pre-formed shape such as a coil, which may attach to tissue by ensnaring it. The delivery devices may be any suitable device configured to deliver the grasper to the area of the tissue of interest, and the delivery device may be further configured to actuate the grasper to selectively connect the grasper to tissue or to detach the grasper from tissue.
The magnetic control element may be configured to be positioned outside the body and to provide a magnetic force to the grasper when the grasper is positioned inside the body. The magnetic field produced by the magnetic control assembly may provide one or more forces to the grasper to control the position of the grasper and the attached tissue. The magnetic control element may have any suitable configuration, and in some variations may comprise at least one magnet configured to generate a magnetic field and at least one force modulation device. The force modulation device may control the magnitude of the force applied to the magnetic device.
In some variations, the systems described herein comprise a system for manipulating tissue, comprising a grasper configured to be attached to tissue in a body of a patient, a delivery device configured to releasably engage the grasper and to actuate the grasper between a first configuration and a second configuration, and a magnetic control assembly comprising a magnet configured to generate a magnetic field and to apply a magnetic force to the grasper. In some variations, the grasper comprises a magnetic or ferromagnetic material. In some of these variations, the grasper further comprises two members connected by a pivot joint, wherein the two members are configured to attach to tissue by holding the tissue between the two surfaces. In some of these variations the delivery device comprises a cylindrical shaft having a lumen therethrough and a collet having a lumen therethrough and configured to be located at least partially within the lumen of the cylindrical shaft, wherein the grasper is configured to be located at least partially within the lumen of the collet and to be actuated by motion of the cylindrical shaft relative to the collet. In some of these variations, the grasper and delivery device each comprise a central longitudinal axis, and wherein the grasper is configured to be engaged by the delivery device when the central longitudinal axis of the delivery device is offset from the central longitudinal axis of the grasper by up to 90 degrees. In some variations, the grasper is configured to attach to tissue using suction. In some variations, the grasper comprises a wire having a coiled shape in the second configuration, and wherein the coiled shape is configured to ensnare tissue. In some variations, the grasper comprises two arms having an open configuration and a closed configuration, wherein the arms are configured to attach to tissue by holding the tissue between two surfaces in the closed configuration, and wherein the two arms are connected via a linkage assembly having an expanded configuration and a collapsed configuration and comprising a plurality of struts and a plurality of pivot joints. In some of these variations, the two arms can be moved from the open configuration to the closed configuration by moving the linkage assembly from the expanded configuration to the collapsed configuration. In some of these variations, the two arms can be moved from the open configuration to the closed configuration by moving the linkage assembly from the collapsed configuration to the expanded configuration.
In some variations, the methods described herein comprise a method of performing minimally invasive surgery, comprising positioning a grasper within a body of a patient using a delivery device, attaching the grasper to tissue within the body of the patient using the delivery device to actuate the grasper, disengaging the delivery device from the grasper, positioning a magnetic control assembly externally of the body, wherein the magnetic control assembly comprises a magnet configured to generate a magnetic field and apply a magnetic force to the grasper, and applying the magnetic force to the grasper to manipulate the magnetic device. In some variations, the methods further comprise reengaging the grasper with the delivery device. In some of these variations, the method further comprises using the delivery device to actuate the grasper to detach the grasper from the tissue. In some of these variations, the method further comprises repositioning the grasper to a new area of tissue.
Described here are devices, systems, and methods for providing remote manipulation of tissue during minimally-invasive procedures. Generally, the systems described here include a grasper that is configured to be releasably connected to tissue. The grasper may be further configured to be attracted to one or more magnets positioned externally of the body. The systems described here may also comprise a delivery device. The delivery devices described here are generally configured to releasably carry the grasper, and may be further configured to actuate the grasper to selectively connect the grasper to tissue or detach the grasper from tissue. The delivery devices are typically further configured to release the grasper from the delivery device (e.g., after the grasper has been connected to tissue). In some variations, the system may further comprise a magnetic control element comprising one or more magnets, which may be configured to be positioned outside the body and to provide a magnetic force to the grasper when the grasper is positioned in the body. While illustrative examples of the graspers and delivery devices are described together herein, it should be appreciated that any of the graspers may be actuated and delivered using any suitable delivery device, and that that the delivery devices described here may be used to actuate and deliver any suitable grasper.
Generally, the methods described here comprise releasably connecting a grasper (such as one of the graspers described here) to a tissue, and providing a magnetic force to the grasper to move and/or hold the grasper and to provide traction of the tissue engaged by the grasper. The magnetic force may be provided by a magnetic control element configured to magnetically attract the grasper from a position outside the body. In some variations, the grasper may be releasably connected to a tissue inside of the body, and the magnetic control element may be positioned externally of the body to magnetically attract the grasper. To connect the grasper to the tissue, the grasper may be releasably coupled with a delivery device, wherein the delivery device is configured to actuate the grasper. The delivery device may actuate the grasper to releasably connect the grasper to tissue, and may decouple from the grasper after the grasper is connected to tissue. In some instances, the delivery device may be used to repositioned the grasper and reattached it to tissue (either the same tissue or a different tissue), or to remove the grasper and/or tissue from the body.
Devices and Systems
As mentioned above, the systems described here may comprise a grasper configured to be releasably connected to tissue. In some variations, the grasper may comprise a clip, clamp, or the like, which is configured to attach to tissue by pressing or otherwise holding tissue between two surfaces.
In some variations, the delivery device 150 and the clip 100 may be configured for laparoscopic introduction into the body. In these variations, the clip 100 may be sized such that it may be advanced through a laparoscopic port. In some instances, the clip 100 may be sized such that it may fit through a laparoscopic port when the clip 100 is in the open configuration, in the closed configuration, or either the open or closed configuration. In some of these variations, the largest width of the clip 100 in a closed configuration may be less than or equal to about 10 mm, so that the clip 100 may be advanced through a 10 mm laparoscopic port when the clip is in the closed configuration. Similarly, a distal portion of the delivery device 150 may also be sized such that it may fit through a laparoscopic port. In some variations, the delivery device 150 may be configured such that the distal portion of the delivery device 150 (e.g., a cylindrical wall 156, as discussed in more detail herein) may have a diameter less than or equal to about 10 mm. The clip 100 and delivery device 150 may be formed from any suitable materials, such as one or more of medical grade, high-strength plastics or metals, such as stainless steel, cobalt chromium, nickel titanium, PEEK, one or more nylons, polyimide, or the like, and/or may at least partially be formed from magnetic materials, as described herein. Additionally, in some instances a portion of the delivery device (such as a shaft of the delivery device) may have a diameter of about 5 mm or less, such that additional devices may be introduced through a 10 mm port while the delivery device is positioned in the port.
The clip 100 illustrated in
The distal portions 108 and 110 of the first and second lever arms 102 and 104, respectively, may comprise one or more features that may promote engagement with tissue, but need not. In some variations, one or both of inner surfaces 112 and 114 of the distal portions 108 and 110, respectively, may be roughened or texturized, which may help to reduce slipping between the lever arms and tissue. Additionally or alternatively, the inner surfaces 112 and/or 114 may comprise teeth or ridges 124 (such as shown in
The proximal ends 116 and 118 of the first and second lever arms 102 and 104, respectively, may be sized and configured to be engaged by a delivery device to releasably couple the clip 100 to a delivery device (such as delivery device 150, as described in more detail herein). In general, it may be desirable for the graspers described herein to comprise external features on exposed surfaces that may promote the ability of an external instrument (e.g., a delivery device) to remain engaged with the graspers while applying a compressive force to the graspers. For example, the graspers may comprise one or more flat surfaces, recesses, guides (e.g., ridges or channels), or gently curved convex surfaces, such that the instrument is less likely to slip or change positions during grasper actuation. In the variation shown in
Generally, at least a portion of the clip 100 described here may be formed from one or more materials which may be attracted to a magnetic field, as described in more detail herein, but need not be. The materials may include one or more magnetic or ferromagnetic materials, such as, for example, stainless steel, iron, cobalt, nickel, neodymium iron boron, samarium cobalt, alnico, ceramic ferrite, alloys thereof and/or combinations thereof. In variations in which the materials include steel alloys, the steel alloys may be in a martensitic state. In some variations, coldworking may be used to improve the magnetic permeability of the clip 100, for instance during the machining process. Having at least a portion of the clip 100 formed from one or more metallic or magnetic materials that may be attracted to a magnetic field may allow the clip 100 to be manipulated by a magnetic control assembly, as will be discussed in more detail herein. In some variations, the proximal ends and/or protrusions of the clip 100 may comprise magnetic or ferromagnetic materials to facilitate engagement by the delivery device (as described in more detail herein), but need not.
Turning to the variation of the delivery device 150 shown in
The engagement portion 154 may comprise a first elongate member 160 and second elongate member 162. The engagement portion 154 may have an open and a closed configuration. In some variations, the first elongate member 160 and second elongate member 162 may be rotatably connected or otherwise attached at their proximal ends 164 and 166, respectively, but need not be attached. In variations in which the elongate members are attached, the attachment mechanism may allow for the engagement portion 154 to be moved between the open and closed configurations. In some variations, the attachment mechanism may be a pivot joint. In other variations, the first elongate member 160 and second elongate member 162 may be joined, welded or otherwise fused together, and the members may be sufficiently flexible to allow the engagement portion 154 to flex between closed and open configurations.
When the engagement portion 154 is moved to the open configuration, the distal portions 168 and 170 of first elongate member 160 and second elongate member 162, respectively, may be spaced apart to define a space between the distal portions 168 and 170 of first elongate member 160 and second elongate member 162, as shown in
While it may be possible for the distal portion 168 of the first elongate member 160 to be moved into contact with the distal portion 170 of the second elongate member 162, this may not be necessary for the engagement portion 154 to releasably engage a clip. For example, when the engagement portion 154 releasably engages with the clip 100 depicted in
In some variations, the first elongate member 160 and the second elongate member 162 may be configured such that their distal ends 168 and 170 are biased away from each other, which may in turn bias the engagement portion 154 toward an open configuration. For example, in some variations the engagement portion 154 may comprise a spring (not shown), such as a compression spring, which may spring-bias the engagement portion 154 toward an open position, such as shown in
As mentioned above, the engagement portion 154 of the delivery device 150 may be configured to releasably couple to and actuate a clip, such as the clip 100 shown in
In some variations, the distal portions 168 and 170 of the first and second elongate members 160 and 162, respectively, may comprise features that may improve the ability of the delivery device 150 to reliably grip onto a clip (such as clip 100) and to exert a force on the lever arms of a clip, but need not comprise such features. For example, the delivery device 150 may comprise apertures or recesses (e.g., apertures 172 shown in
Additionally or alternatively, features of the proximal ends 116 and 118 of the first and second lever arms 102 and 104, respectively, of the clip 100, and/or features of the distal portions 168 and 170 of the first and second elongate members 160 and 162, respectively, of the delivery device 150 may enable a clip (such as clip 100) to be engaged by a delivery device (such as delivery device 150) from a broad range of angles (e.g. angles of approach wherein the central longitudinal axis of the grasper is offset from the central axis of the delivery device by up to 10°, 20°, 30°, 40°, 50°, 60°, 70°, 80°, 90°, or more), assist in delivery and/or retrieval of the grasper, and/or assist in locating the clip 100 for retrieval. For example, the outwardly facing hemispherical protrusions 120 and 122 on proximal ends 116 and 118 of the first and second lever arms 102 and 104 of clip 100 enable the clip to be accessed from a broad range of angles because the rounded surface creates a partially rotationally symmetric contact area for a delivery device. The outwardly facing hemispherical protrusions 120 and 122 may also enable the clip 100 to be more easily located because of the larger size of the hemispherical protrusions 120 and 122 as compared to the proximal ends 116 and 118 of the first and second lever arms 102 and 104.
In some variations, there may be an attractive force between distal portions 168 and 170 of first and second elongate members 160 and 162 and one or more portions of the clip 100 (e.g., the distal portions 116 and 118 and/or protrusions 120 and 122). In some variations, this attractive force may be magnetic. In variations in which the attractive force is magnetic, the magnetic force may be generated by the distal portions 168 and 170 of the first and second elongate members 160 and 162, and one or more portions of the clip 100, wherein each of these components comprises one or more magnetic or ferromagnetic materials. For example, in variations in which one or more portions of a clip (e.g., the distal portions 116 and 118 and/or protrusions 120 and 122 of the clip 100) comprise magnetic materials, the distal portions 168 and 170 of the elongate members 160 and 162 may comprise magnetic or ferromagnetic materials; in variations in which one or more portions of a clip (e.g., the distal portions 116 and 118 and/or protrusions 120 and 122 of the clip 100) comprise ferromagnetic materials and no magnetic materials, the distal portions 168 and 170 of the elongate members 160 and 162 may comprise magnetic materials.
When the delivery device 150 has engaged a clip (such as clip 100 shown in
The engagement portion 154 may be moved between its open and closed configurations in any suitable manner. In some variations, the engagement portion 154 may be actuated by advancing or retracting the engagement portion 154 through the lumen 158 of cylindrical wall 156 of the delivery device 150. Movement of the cylindrical wall 156 distally relative to the engagement portion 154 may cause the inner surface of cylindrical wall 156 at the distal end 174 to contact the outer surface of the first and second elongate members 160 and 162. Further movement of the cylindrical wall 156 distally relative to the engagement portion 154 may then cause the cylindrical wall 156 to press against the outer surfaces of the first and second elongate members 160 and 162, which may force the distance between the first and second elongate members 160 and 162 to stay substantially constant at the point where the first and second elongate members 160 and 162 contact the cylindrical wall 156. As a result, the movement of the cylindrical wall 156 distally relative to the engagement portion 154 may push the engagement portion 154 toward a closed configuration. When the engagement portion 154 is moved toward a closed configuration, distal ends 168 and 170 of the first and second elongate members 160 and 162 may be moved toward each other, which in turn may press the distal ends 116 and 118 of the lever arms 102 and 104, respectively, of the clip 100 toward each other. This may move the lever arms 102 and 104 of the clip 100 into an open configuration, as shown in
The delivery device 150 may be used to releasably attach a clip (such as clip 100 depicted in
In some variations, a distal portion of the delivery device 200 may be configured for laparoscopic introduction into the body, such as described in more detail herein. In some of these variations, the delivery device 200 may be configured for advancement through a 10 mm laparoscopic port. In some instances, the shaft 200 and the distal engagement portion 206 of the delivery device 200 may be sized such that they may fit through a laparoscopic port when the distal engagement portion 206 is in the open configuration, the closed configuration, or either the open or closed configuration. In some of these variations, the largest width of the shaft 204 and the distal engagement portion 206 in a closed configuration may be less than or equal to about 10 mm, so that at least a portion of the delivery device 200 may be advanced through a 10 mm laparoscopic port when the distal engagement portion 206 is in a closed configuration. In some of these variations, the largest width of the shaft 204 and the distal engagement portion 206 in an open configuration may be less than or equal to about 10 mm, so that at least a portion of the delivery device 200 may be advanced through a 10 mm laparoscopic port when the distal engagement portion 206 is in an open configuration. In some of these variations, the distal engagement portion 206 may have an outer diameter less than or equal to about 4 mm in the open configuration, the closed configuration, or either the open or closed configuration. In these variations, it may be possible to advance the distal engagement portion 206 through a 10 mm laparoscopic port, and to further advance a second device having a diameter of about 5 mm or less through the port while the shaft 204 is positioned in the port. It should be appreciated that the shaft 204 may have any suitable diameter (e.g., between about 1 mm and about 15 mm, between about 5 mm and about 10 mm, or the like). The shaft 204 and distal engagement portion 206 may be formed from any suitable materials, such as one or more medical-grade, high-strength plastics or metals, such as stainless steel, cobalt chromium, PEEK, one or more nylons, polyimide, or the like, and/or may at least partially be formed from materials that may be attracted to a magnetic field, as described herein.
The distal engagement portion 206 may comprise a first arm 208 and a second arm 210 having distal ends 216 and 218, respectively, which may be able to be actuated between an open configuration (as shown in
Generally, the handle 202 may comprise an actuation control mechanism 220 that may be manipulated by a user to controllably actuate the distal engagement portion 206. The actuation control mechanism 220 may comprise any suitable configuration capable of actuating the distal engagement portion 206, such as but not limited to a trigger, slider, knob, or the like. The delivery device 200 may comprise actuation elements within the shaft 204, which may be connected to the actuation control mechanism 220 and/or the distal engagement portion 206. A user may selectively open and close the arms 208 and 210, as described herein, by moving the actuation control mechanism 220 between a first position and a second position. For example, when the actuation control mechanism 220 is in a first position (as shown in
In the variation shown in
In other instances, moving the actuation control mechanism from a first position to a second position may apply tension to the pull wires, which may move the arms from the open position to the closed position. The delivery device 200 may in these instances be further configured such that moving the actuation control mechanism from a second position to a first position may return the device to the open position (e.g., the arms may be biased towards the open position, and moving the actuation control mechanism from a second position to a first position may release the tension in the pull wires, which may allow the arms to return to the to the open position).
Accordingly, to engage the clip 100, a user may place the actuation control mechanism 220 in the second position (or an intermediate position between the first and second positions) to open (or partially open) the first and second arms 208 and 210, and the user may the move the actuation control mechanism 220 toward the first position to close the arms around the clip 100. The distal engagement portion 206 of the delivery device may be sized and configured to engage a clip (such as clip 100). In some variations, the distal portions 216 and 218 of the first and second arms 208 and 210 may comprise one or more features that may improve the ability of the delivery device 200 to reliably grip onto a clip (such as clip 100) and to exert a force on a clip, but need not comprise such features. For example, in variations in which the clip, such as clip 100, comprises protrusions at the proximal ends of the lever arms (such as proximal ends 116 and 118 of lever arms 102 and 104 of clip 100), the distal engagement portion 206 may be configured to engage the protrusions. More specifically, if the protrusions comprise outwardly facing hemispherical protrusions 120 and 122, as in clip 100 of
The actuation control mechanism 220 may be further moved toward the first position to press the clip 100 into an open configuration. The user may then manipulate the clip 100, using the delivery device 200, to position tissue between the first 102 and second 104 lever arms of the clip 100. With the tissue positioned between the arms, the actuation control mechanism may be moved back toward the second position to first allow the clip 100 to close, and then to release the clip 100 from the delivery device 200.
In some variations, the delivery device 340 and the clip 300 may be configured for laparoscopic introduction into the body, such as discussed herein. In these variations, the clip 300 may be sized such that it may be advanced through a laparoscopic port. In some instances, the clip 300 may be sized such that it may fit through a laparoscopic port when the clip 300 is in the open configuration, in the closed configuration, or in either the open or closed configuration. In some of these variations, the largest width of the clip 300 in a closed configuration may be less than or equal to about 10 mm, so that the clip 100 may be advanced through a 10 mm laparoscopic port when the clip is in the closed configuration. Similarly, a distal portion of the delivery device 340 may also be sized such that it may fit through a laparoscopic port. In some variations, the delivery device 340 may be configured such that the distal portion of the delivery device 340 may have a diameter less than or equal to about 10 mm. The clip 300 and delivery device 340 may be formed from any suitable materials, such as one or more of medical grade, high-strength plastics or metals, such as stainless steel, cobalt chromium, PEEK, one or more nylons, polyimide, or the like, and/or may be at least partially formed from materials that may be attracted to a magnetic field, as described herein.
The clip 300 illustrated in
The distal portions 308 and 310 of first and second lever arms 302 and 304, respectively, may comprise one or more features which may promote engagement with tissue, but need not. In some variations, the inner surfaces 312 and/or 314 of the distal portions 308 and 310, respectively, may be roughened or texturized, which may help to reduce slipping between the lever arms and tissue. Additionally or alternatively, the inner surfaces 312 and/or 314 may comprise teeth or ridges 316 (such as shown in
The proximal ends 316 and 318 of lever arms 302 and 304, respectively, may be sized and configured to be engaged by a delivery device (such as delivery device 340, as described in more detail herein) to open the clip in order to engage tissue In some instances, as shown in
Generally, at least a portion of the clip 300 described here may be formed from one or more materials which may be attracted to a magnetic field, as described in more detail herein, but need not be. The materials may include one or more magnetic or ferromagnetic materials, such as, for example, stainless steel, iron, cobalt, nickel, neodymium iron boron, samarium cobalt, alnico, ceramic ferrite, alloys thereof and/or combinations thereof. In variations in which the materials include steel alloys, the steel alloys may be in a martensitic state. In some variations, coldworking may be used to improve the magnetic permeability of the clip 300, for instance during the machining process. Having at least a portion of the clip 300 formed from one or more metallic or magnetic materials that may be attracted to a magnetic field may allow the clip 300 to be manipulated by a magnetic control assembly, as will be discussed in more detail herein. In some variations, the proximal ends of the clip 300 may comprise magnetic or ferromagnetic materials to facilitate engagement by the delivery device (as described in more detail herein), but need not. In some variations, the at least a portion of the clip 300 formed from one or more materials which may be attracted to a magnetic field may be part of the coupling element 380 described below; in other variations, this magnetic portion may be distinct from the coupling element 380.
As mentioned above, the clip 300 may also comprise a coupling element 380. The coupling element 380 may facilitate engagement of the clip 300 to a delivery device (such as the delivery device 340), and may further facilitate actuation of the clip 300 between open and closed configurations, as described in detail herein. As shown in
Turning to the variation of the delivery device 340 shown in
The clip 300 may be moved into and out of the lumen 350 of outer sheath 342 using any suitable mechanism. In the variation of the delivery device 340 shown in
In order for releasable engagement of the actuation rod 346 and linking body 382, delivery device 340 may further comprise a depth stop that may prevent linking body 382 from moving within lumen 350 of outer sheath 342 beyond a certain point. Thus, if actuation rod 346 is moved beyond the depth stop, the force from the depth stop on the linking body 342 may overcome the engagement force connecting the actuation rod 346 and linking body 342 (e.g., magnetic attractive force), and actuation rod 346 may be disengaged from the linking body 382. In some variations, as shown in
Thus, the system of
The clip 300 can then be releasably attached to tissue by moving the actuation rod distally relative to the outer cylinder 342, which may release the constraint on the proximal ends 316 and 318 of lever arms 302 and 304, which in turn may allow the distal ends 316 and 318 of lever arms 302 and 304 to be moved into a closed configuration. In variations in which the first lever arm 302 and the second lever arm 304 are rotationally biased toward each other, this bias may help to return the clip 300 to the closed position. Additionally, the bias of the lever arms toward the closed configuration may act to hold tissue positioned between the first lever arm 302 and the second lever arm 304. Once the clip 300 holds tissue between the first lever arm 302 and the second lever arm 304, the clip 300 may be controlled by the magnetic control assembly to manipulate the attached tissue, as described in more detail herein.
The clip 300 may then be decoupled from the delivery device 340. The clip 300 may be decoupled from the delivery device 340 by withdrawing the actuation rod 346 distally relative to the inner sheath 344 to a retracted position, as shown in
Although
In the variation shown in
As in the other variations discussed herein, the delivery device 450 and the clip 400 may be configured for laparoscopic introduction into the body. In these variations, the clip 400 may be sized such that it may be advanced through a laparoscopic port. In some instances, the clip 400 may be sized such that it may fit through a laparoscopic port when the clip 400 is in the open configuration, the closed configuration, or either the open or closed configuration. In some of these variations, the largest width of the clip 400 in a closed configuration may be less than or equal to about 10 mm, so that the clip 400 may be advanced through a 10 mm laparoscopic port when the clip is in the closed configuration. Similarly, a distal portion of the delivery device 450 may also be sized such that it may fit through a laparoscopic port. In some variations, the delivery device 450 may be configured such that the distal portion of the delivery device 450 (e.g., actuation rod 452, as discussed in more detail herein) may have a diameter less than or equal to about 10 mm. The clip 400 and delivery device 450 may be formed from any suitable materials, such as one or more of medical grade, high-strength plastics or metals, such as stainless steel, cobalt chromium, PEEK, one or more nylons, polyimide, or the like, and/or may at least partially be formed from magnetic materials, as described herein.
The distal portions 412 and 414 of the first and second arms 402 and 404, respectively, may comprise one or more features that may promote engagement with tissue, but need not. In some variations, the inner surfaces 416 and/or 418 of the distal portions 412 and 414, respectively, may be roughened or texturized, which may help to reduce slipping between the arms and tissue. Additionally or alternatively, the inner surfaces 416 and/or 418 may comprise teeth or ridges, or other projections that may facilitate engagement of the first and second arms 402 and 404 with tissue. In some variations of the clip described here, the clip may comprise one or more coatings that may help to smooth discontinuities in the contours of the clip and may act to provide one or more atraumatic surfaces of the clip. The one or more coatings may comprise silicone, urethane, one or more nylon blends, polyethylenes, fluoropolymers, combinations thereof, and the like.
Generally, at least a portion of the clip 400 described here may be formed from one or more materials which may be attracted to a magnetic field, as described in more detail herein, but need not be. The materials may include one or more magnetic or ferromagnetic materials, such as, for example, stainless steel, iron, cobalt, nickel, neodymium iron boron, samarium cobalt, alnico, ceramic ferrite, alloys thereof and/or combinations thereof. In variations in which the materials include steel alloys, the steel alloys may be in a martensitic state. In some variations, coldworking may be used to improve the magnetic permeability of the clip 400, for instance during the machining process. Having at least a portion of the clip 400 formed from one or more metallic or magnetic materials that may be attracted to a magnetic field may allow the clip 400 to be manipulated by a magnetic control assembly, as will be discussed in more detail herein. In some variations, the proximal ends of the clip 400 may comprise magnetic or ferromagnetic materials to facilitate engagement by the delivery device (as described in more detail herein), but need not. In some variations, the at least a portion of the clip 400 formed from one or more materials which may be attracted to a magnetic field may be part of the coupling element 420 described herein; in other variations, this magnetic portion may be distinct from the coupling element 420.
As mentioned above, the clip 400 may further comprise a coupling element 420. The coupling element 420 may facilitate engagement of the clip 400 to a delivery device (such as the delivery device 450), and may further facilitate actuation of the clip 400 between open and closed configurations, as described in detail herein. As shown in
Generally, the bore may be configured to house the proximal ends 408 and 410 of the lever arms 402 and 404 to couple the coupling element 420 to the arms. The bore 424 may be sized to accommodate the proximal ends 408 and 410 of the lever arms 402 and 404, and a distal portion of the bore 424 may be sized such that remainder of the clip (i.e., the first and second lever arms 402 and 404) may be prevented from disengaging the coupling element 420 during use of the clip 400. Additionally, in some variations the bore may comprise a threaded portion 426, which may engage a portion of a delivery device, as will be described in more detail herein. Additionally or alternatively, the bore 424 may comprise a funnel portion 428 at a proximal end of the bore 424, such that the diameter of the bore 424 may increase from a distal end of a funnel portion 428 to a proximal end of the funnel portion 428. The larger diameter at the proximal end of the funnel portion may provide a larger entrance to receive a portion of a delivery device, and the decreasing diameter towards the distal end of the funnel portion may guide the received portion of the delivery device toward the remainder of the bore 424. In some variations, at least a portion of the funnel portion 428 may have a non-circular cross-section, which may facilitate actuation of the clip 400, as will be discussed in more detail herein.
As mentioned above, the coupling element 420 may be configured to facilitate temporary coupling between the clip 400 and a delivery device. For example,
When the threaded portion 456 of the actuation rod 452 reaches the threaded portion 426 of the bore 424, the actuation rod 452 may be rotated relative to the coupling element 420 to screw the threaded portion 456 of the actuation rod into the threaded portion 426 of the bore 424 to engage the actuation rod 452 and the bore 424. When the threaded portions 426 and 456 of the bore 424 and the actuation rod 452, respectively, are engaged, rotation of the actuation rod 452 in a first direction relative to the coupling element 420 may advance the actuation rod 452 along the bore 424. Conversely, rotation of the actuation rod 452 in an opposite direction relative to the coupling element 420 may retract the actuation rod 452 relative to the bore 424.
When the actuation rod 452 engages the coupling element 424 as discussed herein, it may be desirable to hold or otherwise constrain the coupling element 424 such that rotation of the actuation rod 452 does not cause the clip 400 to rotate with the actuation rod 452. If the clip 400 is free to rotate with the actuation rod 452, the actuation rod 452 may not rotate relative to the clip 400, and thus may not be able to advance or withdraw relative to the clip 400. Accordingly, in some variations, the outer sheath 458 may comprise one or more projections 460 extending from a distal end of the outer sheath 458. The one or more projections 460 may be configured to engage a portion of the coupling element 420, such that the engagement between the one or more projections 460 and the coupling element 420 prevents rotation between the outer sheath 458 and the coupling element 420. For example, in variations where a portion of the bore 424 of the coupling element 420 comprises a non-circular cross-sectional shape (e.g., a square-shaped portion of a funnel portion 428), the outer sheath 458 may comprise a projection 460 having a corresponding shape (e.g., a square-shaped projection) that is configured to fit within the bore 424 and prevent rotation between the bore 424 and the projection 460. In these instances, the outer sheath may be advanced such that the projection 460 engages the coupling element 420. Since this engagement may prevent rotation between the outer sheath 458 and the clip 400, rotation of the actuation rod 452 relative to the outer sheath 458 may also result in rotation of the actuation rod 452 relative to the clip 400, which may cause threading between the actuation rod and the bore, as discussed herein.
The delivery device 450 may also be configured to actuate the clip 400. As mentioned above, rotation of the actuation rod 452 relative to the clip 400 may advance the actuation rod 452 through the bore 424 of the coupling element 420. As the actuation rod 452 is advanced, the tapered distal end 454 of the actuation rod 452 may be selectively advanced between the distal portions 408 and 410 of the first and second lever arms 402 and 404. Further advancement of the actuation rod 452 may rotate the proximal ends 407 and 409 of the first and second arms 402 and 404 away from each other, which may move the clip 400 into an open configuration, as shown in
As in the other variations discussed herein, the delivery devices 1150, 1250 and the clips 1100, 1200 may be configured for laparoscopic introduction into the body. In these variations, the clips 1100, 1200 may be sized such that they may be advanced through a laparoscopic port. In some instances, the clips 1100, 1200 may be sized such that they may fit through a laparoscopic port when the clips 1100, 1200 are in an open configuration, closed configuration, or either the open or closed configurations. In some of these variations, the largest width of the clips 1100, 1200 in a closed configuration may be less than or equal to about 10 mm, so that the clips 1100, 1200 may be advanced through a 10 mm laparoscopic port when the clips are in a closed configuration. Similarly, distal portions of the delivery devices 1150, 1250 may also be sized such that they may fit through a laparoscopic port. In some variations, the delivery devices 1150, 1250 may be configured such that the distal portions of the delivery devices 1150, 1250 may have diameters less than or equal to about 10 mm. The clips 1100, 1200 and delivery devices 1150, 1250 may be formed from any suitable materials, such as one or more of medical grade, high-strength plastics or metals, such as stainless steel, cobalt chromium. PEEK, one or more nylons, polyimide, or the like, and/or may at least partially be formed from magnetic materials, as described herein.
As shown in
It should be appreciated that force need not be applied to all struts in the linkage assembly in order to move the clip between the open and closed configurations; rather, force applied to a subset of the struts (e.g., one or two struts, such as two opposing struts, or at one or two pivot joints, such as two opposing pivot joints) may cause the clip to move between the open and closed configuration. While the linkage assemblies 1120, 1220 shown in
The clip 1100 may comprise a first arm 1102 and a second arm 1104 attached via struts 1122 and 1124. As shown in
Similarly, the clip 1200 may comprise a first arm 1202 and a second arm 1204 attached via struts 1222 and 1224. As shown in
As mentioned above, it should be appreciated that the clips 1100, 1200 may comprise other configurations than those described above. For example, the linkage assembly may have more or fewer struts and/or pivot joints, other types of joints, other strut shapes, or the like. Similarly, the clip may have other designs, such as the other grasper designs described herein. In some variations, for example, the first arm and second arm may be directly rotatably connected, such as via a pivot joint at their proximal ends, or via a pivot joint located at points on the first and second arms between their ends, so that if distal portions of the first and second arms rotate away from each other, proximal portions of the first and second arms rotate toward each other.
In some variations, clips 1100, 1200 may comprise protective sheaths 1138, 1238 located over at least a portion of the linkage assemblies 1120, 1220 and/or at least a portion of the coupling elements 1112, 1222, described in more detail herein. In these variations, the protective sheaths 1138, 1238 may comprise windows through which portions of the linkage assemblies 1120, 1220 may extend when the linkage assemblies 1120, 1220 are in an expanded configuration.
The clips 1100, 1200 may be actuated between closed and open configurations to releasably connect the clip to tissue or release the clip from tissue, respectively. In the open configuration, the first and second arms 1102 and 1104 of clip 1100, or first and second arms 1202 and 1204 of clip 1200, may be positioned away from each other to define a space between the arms, as shown in
In some variations, the clips 1100, 1200 may be biased toward a closed configuration by one or more biasing elements, which may act on the struts and/or pivot joints to rotationally bias the first and second arms toward each other. In other variations, the clip may be biased toward an open configuration by one or more biasing elements, which may act on the struts and/or pivot joints to rotationally bias the first and second arms away from each other. In some variations, the biasing elements may comprise springs, such as torsional, extension, and/or compression springs. For example, the clip 1100 may comprise a torsional spring at pivot joint 1130 that spring-biases the clip 1100 toward a closed configuration. As another example, the clip 1100 may comprise one or more compression springs proximal to pivot joint 1130 and/or one or more extension springs distal to pivot joint 1130 configured to collapse the linkage assembly, which may spring-bias the clip 1100 toward a closed configuration. When the clip 1100 is biased toward a closed configuration, this bias may act to hold tissue positioned between the distal portions of the arms 1102 and 1104.
In some variations, the one or more springs or other biasing elements, and/or the relative lengths of the struts, may be tailored to the desired force required to move the clip between open and closed configurations and/or the desired force applied by the clip in a closed configuration. For example, the relative lengths of the struts and location of pivot joints may be chosen to provide mechanical advantage to an actuation motion, for example to increase the distance between the arms of the clip for a given actuation force, or to increase the holding force between the arms. Additionally or alternatively, the relative lengths of the struts and/or springs or biasing elements may be tailored such that the amount of forced required to move the clip between open and closed configurations may depend on the strut or struts to which the force is applied.
The distal portions of the first and second arms 1102 and 1104 of clip 1100, or the first and second arms 1202 and 1204 of clip 1200, may comprise one or more features that may promote engagement with tissue, but need not. In some variations, the inner surfaces 1106, 1206 and 1108, 1208 may be roughened or texturized, which may help to reduce slipping between the arms and tissue. Additionally or alternatively, the inner surfaces 1106, 1206 and 1108, 1208 may comprise teeth or ridges, or other projections that may facilitate engagement of the first and second arms 1102, 1202 and 1104, 1204 with tissue. In some variations, the clips 1100, 1200 may comprise one or more coatings that may help to smooth discontinuities in the contours of the clip and may act to provide one or more atraumatic surfaces of the clip. The one or more coatings may comprise silicone, urethane, one or more nylon blends, polyethylenes, fluoropolymers, combinations thereof, and the like.
Generally, at least a portion of the clips 1100, 1200 described here may be formed from one or more materials which may be attracted to a magnetic field, as described in more detail herein, but need not be. The materials may include one or more magnetic or ferromagnetic materials, such as, for example, stainless steel, iron, cobalt, nickel, neodymium iron boron, samarium cobalt, alnico, ceramic ferrite, alloys thereof and/or combinations thereof. In variations in which the materials include steel alloys, the steel alloys may be in a martensitic state. In some variations, coldworking may be used to improve the magnetic permeability of the clips 1100, 1200, for instance during the machining process. Having at least a portion of the clips 1100, 1200 formed from one or more metallic or magnetic materials that may be attracted to a magnetic field may allow the clips 1100, 1200 to be manipulated by a magnetic control assembly, as will be discussed in more detail herein. In some variations, the proximal ends of the clips 1100, 1200 may comprise magnetic or ferromagnetic materials to facilitate engagement by the delivery device (as described in more detail herein), but need not be. In some variations, the at least a portion of the clips 1100, 1200 formed from one or more materials that may be attracted to a magnetic field may be part of the coupling elements 1112, 1212 described herein; in other variations, this magnetic portion may be distinct from the coupling elements 1112, 1212.
As mentioned above, the clips 1100, 1200 may further comprise coupling elements 1112, 1212, respectively. The coupling elements 1112, 1212 may facilitate engagement of the clips 1100, 1200 to a delivery device (such as the delivery devices 1150, 1250), and may further facilitate actuation of the clips between open and closed configurations, as described herein. The coupling elements 1112, 1212 may be configured to facilitate temporary coupling between the clips 1100, 1200 and a delivery device. Generally, the linkage assemblies 1120, 1220 may be rotatably attached to the distal end of the coupling elements 1112, 1212, as shown in
Turning to the variation of delivery device 1150 shown in
As described above, the clip 1100 may be actuated between closed and open configurations by expanding or collapsing the linkage assembly 1120. In some variations, the delivery device 1150 may be used to expand or collapse the linkage assembly 1120. As shown in
For example, in the variation shown in
The clip 1100 may be moved into and out of the lumen 1154 using any suitable mechanism. In the variation of the delivery device 1150 shown in
Additionally or alternatively, the clip 1100 may be moved between open and closed configurations by a tool separate from the delivery device 1150. For example, a grasping tool (not shown) may be used to apply force to the linkage assembly 1120 (e.g., on two or more opposing struts, or one two or more opposing pivot joints) to move them toward a collapsed configuration. In variations in which the clip 1100 comprises a protective sheath 1138 located over at least a portion of the linkage assembly 1120 and/or at least a portion of the coupling element 1112, force may be applied to the portions of the linkage assembly 1120 extending through windows in the protective sheath 1138.
In the variation shown in
As in the other variations discussed herein, in some variations depicted in
The clip illustrated in
In some variations, the distal ends 508 and 510 of the first jaw 502 and the second jaw 504, respectively, may be rotationally biased toward each other. For example, in some variations the clip 500 may comprise a spring, such as a torsional spring, that may spring-bias the distal ends 508 and 510 of the first and second jaws 502 and 504 toward each other, biasing the clip 500 into a closed position. In other variations, the clip 500 may comprise a spring, such as a compression spring, that may spring-bias the proximal ends 512 and 514 of the first and second jaws 502 and 504, respectively, away from each other, biasing the clip 500 into a closed position. The bias toward the closed configuration may act to hold tissue positioned between the distal portions 508 and 510 of the first and second jaws 502 and 504.
In some variations, the jaws 502 and 504 of the clip 500 may be shaped such that when the clip 500 is in the closed configuration, the proximal portions 512 and 514 of the first jaw 502 and second jaw 504, respectively, define a substantially cylindrical shape, having a substantially constant diameter. This may reduce the overall profile of the clip 500. The distal portions 508 and 510 may also form a tapered cylindrical or conical shape in the closed configuration. The substantially cylindrical shape of the proximal end of clip 500, with rounded, convex surface contours, may also help to make the clip 500 less traumatic to surrounding anatomy.
Additionally, the substantially cylindrical shape of the proximal end of clip 500 may also facilitate actuation of the clip 500 by both the delivery devices described here and standard laparoscopic tools, as described in detail herein. The jaws 502 and 504 of the clip 500 may also have a ramped shape, such that in the closed configuration, the distal portions 512 and 514 of the clip 500 define cylindrical shape, while in the open configuration, the distal portions 512 and 514 of the clip 500 define a tapered cylindrical shape due to the ramp angle of the proximal portions (labeled as 530), such that the bottom surface of the first jaw 502 does not extend past the bottom surface of the second jaw 504, and the top surface of the second jaw 504 does not extend past the top surface of the first jaw 502, when in an open configuration, as shown in
The distal ends 508 and 510 of the first and second jaws 502 and 504, respectively, may comprise one or more features that may promote engagement with tissue, but need not. In some variations, the inner surfaces 516 and/or 518 of the distal ends 508 and 510, respectively, may be roughened or texturized, which may help to reduce slipping between the jaws and tissue. Additionally or alternatively, the inner surfaces 516 and/or 518 may comprise teeth or ridges 520 (such as shown in
Generally, at least a portion of the clip 500 described here may be formed from one or more materials which may be attracted to a magnetic field, as described in more detail herein, but need not be. The materials may include one or more magnetic or ferromagnetic materials, such as, for example, stainless steel, iron, cobalt, nickel, neodymium iron boron, samarium cobalt, alnico, ceramic ferrite, alloys thereof and/or combinations thereof. In variations in which the materials include steel alloys, the steel alloys may be in a martensitic state. In some variations, coldworking may be used to improve the magnetic permeability of the clip 500, for instance during the machining process. Having at least a portion of the clip 500 formed from one or more metallic or magnetic materials that may be attracted to a magnetic field may allow the clip 500 to be manipulated by a magnetic control assembly, as will be discussed in more detail herein. In some variations, the proximal ends and/or protrusions of the clip 500 may comprise magnetic or ferromagnetic materials to facilitate engagement by the delivery device (as described in more detail herein), but need not.
As mentioned above, the delivery device 550 may be releasably coupled and actuate the clip 500 shown in
As mentioned above, the collet 554 may be configured to receive a proximal portion of the clip 500 when the collet 554 is in an advanced position, as shown in
Conversely, when the outer sheath 552 is retracted proximally relative to the collet 554, the clip may return to a closed configuration (e.g., by virtue of a spring bias toward the closed configuration), as the constraining force provided by the outer sheath may be removed as the shaft is retracted. When tissue is positioned between the distal portions of the jaws, moving the clip 500 to the closed configuration may cause the clip 500 to releasably connect to the tissue. Once the clip 500 holds tissue between the first jaw 502 and the second jaw 504, the location of the clip 500 may be controlled by a magnetic control assembly to manipulate the attached tissue. The delivery device 550 may then be disengaged from the clip 500 and removed from the anatomical cavity. If desirable, the delivery device 550 may subsequently reengage the clip 500 to disconnect the clip 500 from the tissue and/or to reposition the clip 500.
As in the variations discussed above, in some variations, the delivery device 650 and the clip 600 may be configured for laparoscopic introduction into the body. In these variations, the clamp 600 may be sized such that it may be advanced through a laparoscopic port. In some instances, the clamp 600 may be sized such that it may fit through a laparoscopic port when the clamp 600 is in the open configuration, the closed configuration, or either the open or closed configuration. In some of these variations, the largest width of the clamp 600 in a closed configuration may be less than or equal to about 10 umm, so that the clamp 600 may be advanced through a 10 mm laparoscopic port when the clip is in the closed configuration. Similarly, a distal portion of the delivery device 650 may also be sized such that it may fit through a laparoscopic port. In some variations, the delivery device 650 may be configured such that the distal portion of the delivery device 650 (e.g., an outer sheath 652, as discussed in more detail herein) may have a diameter less than or equal to about 10 mm. The clamp 600 and delivery device 650 may be formed from any suitable materials, such as one or more of medical grade, high-strength plastics or metals, such as stainless steel, cobalt chromium, nickel titanium, PEEK, one or more nylons, polyimide, or the like, and/or may at least partially be formed from magnetic materials, as described herein.
The clamp 600 may comprise a first gripping pad 602, a second gripping pad 604, and a wire 606 connecting the first pad 602 and the second pad 604. The wire 606 may have a scissor-like configuration, manipulation of which may allow the clamp 600 to be actuated between closed and open configurations. This in turn may allow the clamp 600 to releasably connect to tissue. When the clamp 600 is in an open configuration, the first pad 602 and the second pad 604 may be separated to define a space between the first pad 602 and the second pad 604, such as shown in
In the variation shown in
In some variations, the wire 606 may be formed with loops at the junctions between the first distal portion 608 and first proximal portion 612, between second distal portion 610 and second proximal portion 614, and between first and second proximal portions 612 and 614 (these loops are labeled as 620, 622, and 616, respectively). Each loop may comprise one or more coils. Each loop may act as a torsion spring, such that rotation between two portions from a resting position may store energy in the loop connecting them, thereby providing a biasing force toward the resting position. Accordingly, the loops 620, 622, and 616 may bias the wire 606 toward a closed configuration (such as shown in
The wire may have any suitable properties to have a desired torsion coefficient, and in turn a desired clamping force on tissue. For example, the wire diameter, loop diameter, and number of coils in each loop may affect the torsion. Increasing the wire diameter, decreasing the loop diameter, and/or decreasing the number of coils per loop may increase the torsion coefficient, and in turn the clamping force on tissue. Conversely, decreasing the wire diameter, increasing the loop diameter, and/or increasing the number of coils per loop may decrease the torsion coefficient, and in turn the clamping force on tissue. In some variations, the wire diameter may be between about 0.015 inches and about 0.030 inches. In other variations, the wire diameter may be between about 0.01 inches and about 0.02 inches, about 0.02 inches and about 0.04 inches, about 0.04 inches and about 0.05 inches, about 0.05 inches and about 0.06 inches, or greater. It should be appreciated that in some variations the wire may have a constant diameter along its length, while in other variations the wire may have a variable diameter along its length. In some variations, the loop diameters may be between about 1 mm to about 5 mm (e.g., between about 1 mm and about 2 mm, about 2 mm and about 3 mm, about 3 mm and about 4 mm, about 4 mm and about 5 mm). In other variations, the loop diameters may be between about 5 mm and about 6 mm, about 6 mm and about 7 mm, about 7 mm and about 8 mm, about 8 mm and about 9 mm, about 9 mm and about 10 mm, or greater. The loop diameters may be sized such that they are configured to fit within delivery device 650. It should be appreciated that each loop may have a different diameter than the other loops, or two or more loops (including all loops) may have the same diameter. In some variations, the loops may comprise a single coil. In other variations, the loops may comprise multiple coils (e.g., two, three, four, five, six, or more). The number of coils may be such that the loops may be configured to fit within delivery device 650. It should be appreciated that each loop may have a different number of coils, or two or more loops (including all loops) may have the same number of coils.
All or part of the inner surfaces 610 and 612 of the pads 602 and 604, respectively, may comprise one or more features that may promote engagement with tissue, but need not. In some variations, all or part of the inner surfaces 610 and 612 of the pads 602 and 604, respectively, may be roughened or texturized, which may help to reduced slipping between the pads and tissue. Additionally or alternatively, the all or part of the inner surfaces 610 and 612 may comprise teeth or ridges 618 (as shown in
The one or more coatings may comprise silicone, urethane, one or more nylon blends, polyethylenes, fluoropolymers, combinations thereof, and the like.
Generally, at least a portion of the clamp 600 described here may be formed from one or more materials which may be attracted to a magnetic field, as described in more detail herein, but need not be. The materials may include one or more magnetic or ferromagnetic materials, such as, for example, stainless steel, iron, cobalt, nickel, neodymium iron boron, samarium cobalt, alnico, ceramic ferrite, alloys thereof and/or combinations thereof. In variations in which the materials include steel alloys, the steel alloys may be in a martensitic state. In some variations, coldworking may be used to improve the magnetic permeability of the clamp 600, for instance during the machining process. Having at least a portion of the clamp 600 formed from one or more metallic of magnetic materials that may be attracted to a magnetic field may allow the clamp 600 to be manipulated by a magnetic control assembly, as will be discussed in more detail herein.
The clamp 600 may be manipulated, actuated, and or delivered by a delivery device. For example,
To releasably couple the clamp 600 to the delivery device 650, the distal hook 658 may engage a portion of the wire 606, and the distal hook 658 may be withdrawn relative to the outer sheath 652 (e.g., by withdrawing the pull wire 656) to pull the clamp 600 into contact with the outer sheath 652. Holding the clamp 600 in contact with the outer sheath 652 using the distal hook 658 may temporarily keep the clamp 600 engaged with the delivery device 650. In some instances, to engage the wire 606, the distal hook 658 may be placed into the loop 616 between the first and second proximal portions 612 and 614 of the wire 606. The position of the pull wire 656 and the distal hook 658 relative to the outer sheath 652 may be controlled by any suitable mechanism, such as a triggering mechanism that may be manipulated by the user at a proximal portion of the delivery device (e.g., a handle or the like).
The distal hook 658 and pull wire 656 may also be manipulated to actuate the clamp 600. When the distal hook 658 is retracted relative to the outer sheath 652 to pull the clamp 600 into contact with the outer sheath 652, further retraction of distal hook 658 may cause a distal end 660 of the cylinder 652 to contact and press against the first and second proximal portions 612 and 614 of the wire 606. This may cause the first and second proximal portions 612 and 614 to rotate towards each other, which in turn may push the pads 602 and 604 away from each other to move the clamp 600 into an open configuration, as shown in
Conversely, the distal hook 658 may be advanced (or the outer sheath 652 may be moved proximally) to advance the clamp 600 relative to the outer sheath 652. As the clamp 600 is advanced relative to the outer sheath 652, the constraining forces provided by the outer sheath may be removed, and the first and second proximal portions 612 and 614 may rotate away from each other (e.g., via mechanical energy stored in the loop 616), which may move the first and second pads 602 and 604 toward each other, thereby returning the clamp 600 to a closed configuration. When a tissue (such as tissue 690 shown in
In some variations of the systems described here, the system may comprise a grasper configured to attach to tissue using a vacuum between the grasper and the tissue.
As in other variations discussed herein, in some variations, the delivery device 750 and the grasper 700 may be configured for laparoscopic introduction into the body, such as discussed in more detail herein. In these variations, the grasper 700 may be sized such that it may be advanced through a laparoscopic port. In some instances, the grasper 700 may be sized such that it may fit through a laparoscopic port when the grasper 700 is in the open configuration, the closed configuration, or either the open or closed configuration. In some of these variations, the largest width of the grasper 700 in a closed configuration may be less than or equal to about 10 mm, so that the grasper 700 may be advanced through a 10 mm laparoscopic port when the clip is in the closed configuration. Similarly, a distal portion of the delivery device 750 may also be sized such that it may fit through a laparoscopic port. In some variations, the delivery device 750 may be configured such that the distal portion of the delivery device 750 may have a diameter less than or equal to about 10 mm.
In the embodiment of the grasper 700 shown in
To connect the grasper 700 to tissue, the bladder 706 may be compressed to evacuate air from the bladder 706 out of the suction cup 702, and the suction cup 702 may be positioned against tissue. With the suction cup 702 positioned against tissue, the compressive force applied to the bladder 706 may be at least partially released. Due to the tendency of the bladder 706 to return to an uncompressed configuration, the bladder 706 may attempt to draw air into the bladder 706, but the presence of the tissue in the suction cup 702 may prevent air from passing into the bladder 706 through the suction cup 702. Accordingly, the bladder 706 may instead provide a vacuum force to the tissue via the tube 704 and the opening 712 in the suction cup 702. This vacuum force may hold the grasper 700 against the tissue. To release the grasper 700 from tissue, the bladder 706 may again be compressed to remove the vacuum force.
Generally, the suction cup 702 may be configured to promote connection of the grasper 700 to tissue. For example, the suction cup 702 may be formed from a shape that defines a cavity configured to at least partially receive tissue. In some variations, the suction cup 702 may have a hemispherical or a conical shape. Additionally or alternatively, the suction cup 702 may comprise one or more tabs or other protrusions that may be configuration to at least partially wrap around tissue. In these variations, the tabs/protrusions may engage tissue and may help to hold it temporarily in place.
While the bladder 706 is shown in
The grasper 700 and delivery device 750 may be formed from any suitable materials, such as one or more of medical grade, high-strength plastics or metals, such as stainless steel, cobalt chromium. PEEK, one or more nylons, polyimide, or the like, and/or may be at least partially formed from materials that may be attracted to a magnetic field, as described herein. In some variations, the bladder 706 may be formed from one or more resilient materials, such as one or more rubbers (e.g., silicon, one or more thermoset elastomers) or urethanes such that the bladder 706 has a tendency to return to an uncompressed configuration. In these variations, as the bladder 706 returns to an uncompressed configuration, the bladder 706 may draw air into the bladder 706 through the suction cup 702 and the tube 704. Additionally, in some variations, the suction cup 702 may be formed from a deformable or flexible material, which may allow the suction cup 702 to deform to accommodate irregular tissue. For example, in some variations the suction cup 702 may be formed from one or more rubbers (e.g., silicon, one or more thermoset elastomers) or urethanes. It should be appreciated that the suction cup 702 and bladder 706 may be formed from the same material or combination of materials, or may be formed from different materials.
Generally, at least a portion of the grasper 700 described here may be formed from one or more materials which may be attracted to a magnetic field, as described in more detail herein, but need not be. The materials may include one or more magnetic or ferromagnetic materials, such as, for example, stainless steel, iron, cobalt, nickel, neodymium iron boron, samarium cobalt, alnico, ceramic ferrite, alloys thereof and/or combinations thereof. In variations in which the materials include steel alloys, the steel alloys may be in a martensitic state. In some variations, coldworking may be used to improve the magnetic permeability of the grasper 700, for instance during the machining process. Having at least a portion of the grasper 700 formed from one or more metallic or magnetic materials that may be attracted to a magnetic field may allow the grasper 700 to be manipulated by a magnetic control assembly, as will be discussed in more detail herein. In some variations, at least a portion of the bladder may comprise magnetic or ferromagnetic materials to facilitate engagement by the delivery device (as described in more detail herein), but need not.
One or more delivery devices may be configured to compress and/or release the bladder 706 to releasably connect the grasper 700 to tissue. For example,
The engagement portion 754 may comprise a first elongate member 760 and second elongate member 762. The engagement portion 754 may have an open and a closed configuration. In some variations, the first elongate member 760 and second elongate member 762 may be rotatably connected or otherwise attached at their proximal ends 764 and 766, respectively, but need not be attached. In variations in which the elongate members are attached, the attachment mechanism may allow for the engagement portion 754 to be moved between the open and closed configurations. In some variations, the attachment mechanism may be a pivot joint. In other variations, the first elongate member 760 and second elongate member 762 may be welded, fused, or otherwise joined together, and the members may be sufficiently flexible to allow the engagement portion 754 to move between closed and open configurations.
When the engagement portion 754 is moved to the open configuration, the distal portions 768 and 770 of first elongate member 760 and second elongate member 762, respectively, may be spaced apart to define a space between the distal portions 768 and 770 of first elongate member 760 and second elongate member 762, as shown in
While it may be possible for the distal portion 768 of the first elongate member 760 to be moved into contact with the distal portion 770 of the second elongate member 762, this may not be necessary for the engagement portion 754 to releasably engage a grasper. For example, when the engagement portion 754 releasably engages with the grasper 700 depicted in
In some variations, the first elongate member 760 and the second elongate member 762 may be configured such that their distal ends 768 and 770 are biased away from each other, which may in turn bias the engagement portion 754 toward and open configuration. For example, in some variations the engagement portion 754 may comprise a spring (not shown), such as a compression spring, which may spring-bias the engagement portion 204 toward an open position, such as shown in
As mentioned above, the engagement portion 754 of the delivery device 750 may be configured to releasably couple to and actuate a grasper, such as the grasper 700 shown in
In some variations, the distal portions 768 and 770 of the first and second elongate members 760 and 762, respectively, may comprise features that may improve the ability of the delivery device 750 to reliably grip onto a grasper (such as grasper 700), but need not comprise such features. For example, the delivery device 750 may comprise apertures or recesses (e.g., apertures 772 shown in
In some variations, there may be an attractive force between distal portions 768 and 770 of first and second elongate members 760 and 762 and one or more portions of the grasper 700 (e.g., the bladder 706). In some variations, this attractive force may be magnetic. In variations in which the attractive force is magnetic, the magnetic force may be generated by the distal portions 768 and 770 of the first and second elongate members 760 and 762, and one or more portions of the grasper 700, comprising magnetic or ferromagnetic materials. In variations in which one or more portions of a grasper (e.g., the bladder 706 of grasper 700) comprise magnetic materials, the distal portions 768 and 770 of the elongate members 760 and 762 may comprise magnetic or ferromagnetic materials; in variations in which one or more portions of a grasper (e.g., the bladder 706 of grasper 700) comprise ferromagnetic materials and no magnetic materials, the distal portions 768 and 770 of the elongate members 760 and 762 may comprise magnetic materials.
When the delivery device 750 has engaged a grasper (such as grasper 700 shown in
The engagement portion 754 may be moved between its open and closed configurations in any suitable manner. In some variations, the engagement portion 754 may be actuated by advancing or retracting the engagement portion 754 through the lumen 758 of elongate sheath 752 of the delivery device 750. Movement of the elongate sheath 752 distally relative to the engagement portion 754 may cause the inner surface of elongate sheath 752 at the distal end 774 to contact the outer surface of the first and second elongate members 760 and 762. Further movement of the elongate sheath 752 distally relative to the engagement portion 754 may then cause the elongate sheath 752 to press against the outer surfaces of the first and second elongate members 760 and 762, which may force the distance between the first and second elongate members 760 and 762 to stay constant at the point where the first and second elongate members 760 and 762 contact the elongate sheath 752. As a result, the movement of the elongate sheath 752 distally relative to the engagement portion 754 may push the engagement portion 754 toward a closed configuration. When the engagement portion 754 is moved toward a closed configuration, distal ends 768 and 770 of the first and second elongate members 760 and 762 may be moved toward each other, which in turn may compress the bladder 706 of grasper 700. This may move the grasper 700 into a compressed configuration, as shown in
The delivery device 750 may be used to releasably attach a grasper (such as grasper 700 depicted in
In some variations, the delivery device 850 and the grasper 800 may be configured for laparoscopic introduction into the body, such as discussed in more detail herein. In these variations, the grasper 800 may be sized such that it may be advanced through a laparoscopic port. In some of these variations, the largest width of the grasper 800 (e.g., the diameter of the suction cup 802) may be less than or equal to about 10 mm, so that the grasper 800 may be advanced through a 10 mm laparoscopic port. Similarly, a distal portion of the delivery device 850 may also be sized such that it may fit through a laparoscopic port. In some variations, the delivery device 850 may be configured such that the distal portion of the delivery device 850 may have a diameter less than or equal to about 10 mm. The clip 800 and delivery device 850 may be formed from any suitable materials, such as one or more of medical grade, high-strength plastics or metals, such as stainless steel, cobalt chromium, PEEK, one or more nylons, polyimide, or the like, and/or may be at least partially formed from magnetic materials, as described herein. Additionally, in some variations, the suction cup 802 may be formed from a deformable or flexible material, which may allow the suction cup 802 to deform to accommodate irregular tissue. For example, in some variations the suction cup 802 may be formed from one or more rubbers (e.g., silicon, one or more thermoset elastomers) or urethanes.
In the embodiment of the grasper 800 shown in
To connect the grasper 800 to tissue, the piston 806 may be advanced to evacuate air from the tube 804 out of the suction cup 802, and the suction cup 802 may be positioned against tissue. With the suction cup 802 positioned against tissue, the piston 806 may be at least partially retracted. This may create a vacuum, as the presence of the tissue in the suction cup 802 may prevent air from passing into the tube 804 through the suction cup 802. Accordingly, the section cup 802 may instead provide a vacuum force to the tissue. This vacuum force may hold the grasper 800 against the tissue. To release the grasper 800 from tissue, the piston 806 may be advanced to remove the vacuum force.
The proximal end of the piston rod 808 may have an attached linking element 810, which may allow the grasper 800 to be engaged by the delivery device 850, as describe in more detail herein. The linking element 810 may comprise a magnetic or ferromagnetic material, such as, for example, stainless steel, iron, cobalt, nickel, neodymium iron boron, samarium cobalt, alnico, ceramic ferrite, alloys thereof and/or combinations thereof. In addition to allowing for engagement with the delivery device 850, the linking element 810 may allow the grasper 800 to be manipulated by the magnetic control assembly.
Generally, the suction cup 802 may be configured to promote connection of the grasper 800 to tissue. For example, the suction cup 802 may be formed from a shape that defines a cavity configured to at least partially receive tissue. In some variations, the suction cup 802 may have a hemispherical or a conical shape. Additionally or alternatively, the suction cup 802 may comprise one or more tabs or other protrusions that may be configuration to at least partially wrap around tissue. In these variations, the tabs/protrusions may engage tissue and may help to hold it temporarily in place. The volume of the tube 804 and size of the suction cup 802 may be chosen based on the desired suction strength; a larger tube and/or suction cup may allow the grasper 800 to have greater negative pressure adhering the grasper 800 to the tissue.
The grasper 800 may be delivered and actuated by any delivery device that is configured to reversibly withdraw the piston 806 of the grasper 800 to create suction to hold the grasper 800 to tissue. In one variation shown in
The delivery linking element 858 may be configured to releasably couple the delivery device 850 to the grasper 800 via magnetic attraction between the delivery linking element 858 and the linking element 810 of the grasper 800 described herein. At least a portion of the delivery linking element 858 may comprise one or more materials which may be attracted to a magnetic field. These materials may include one or more magnetic or ferromagnetic materials, such as, for example, stainless steel, iron, cobalt, nickel, neodymium iron boron, samarium cobalt, alnico, ceramic ferrite, alloys thereof and/or combinations thereof. The delivery linking element 858 may be movable between an advanced position (as shown in
In order for releasable engagement of the delivery linking element 858 of the delivery device 850 and the linking element 810 of the grasper 800, delivery device 850 may further comprise a depth stop that may prevent linking element 810 from moving proximal to a certain point within lumen 856 of elongate sheath 854. Thus, if actuation rod 852 is moved proximally beyond the depth stop, the force from the depth stop on the linking element 810 may overcome the engagement force connecting the delivery linking element 858 and the linking element 810 (e.g., a magnetic attractive force), and the delivery linking element 858 and the linking element 810 may disengage. In some variations (not shown), the depth top may comprise an inner sheath. The inner sheath may be sized such that the delivery linking element 858 can fit within the inner sheath, but the linking element 810 cannot. Thus, if the actuation rod 852, and thus the delivery linking element 858, are withdrawn proximally relative to and within the inner sheath, the linking element 810 of clip 100 may not be able to move proximally beyond the distal end of the inner sheath, and thus the distance between the delivery linking element 858 and the linking element 810 may increase. Because force applied by a magnet decreases as the function of the distance from the magnet, increasing this distance may decrease the magnetic attractive force felt between the delivery linking element 858 and linking element 810. Eventually, the attractive force may be sufficiently diminished such that the delivery linking element 858 may decouple from the linking element 810. If desirable, the delivery device 850 may subsequently reengage the clip 800 to disconnect the clip 800 from tissue and/or reposition the clip 800.
In some variations, instead of a depth stop for releasable engagement of the delivery linking element 858 of the delivery device 850 and the linking element 810 of the grasper 800, delivery device 850, either the delivery linking element 858 or the delivery device 850 may comprise an electromagnet. The electromagnet may comprise an active configuration and an inactive configuration. The electromagnet may be activated in order to allow the delivery linking element 858 and delivery device 850 to releasably engage. Conversely, the electromagnet may be inactivated to allow the delivery linking element 858 and delivery device 850 to disengage. Additionally, although the system of
In addition to clip- or clamp-like grasping devices and suction-based devices, a system may include a wire having a pre-formed shape that may be configured to ensnare or otherwise engage tissue.
The delivery device 950 may comprise a shaft 952 configured to hold the wire 900 in a straightened configuration. The wire 900 may be inserted into the patient, for example through a laparoscopic port, while housed in the shaft 952. After the wire 900 is located near the target tissue, the wire 900 may be advanced distally out of the shaft 952, as shown in
Magnetic Control Assembly
Once attached to tissue within the patient's body, the grasper may be manipulated by a magnetic control assembly. Generally, the magnetic control assembly may be configured to be placed outside a patient's body and to produce a magnetic field. The magnetic field produced by the magnetic control assembly may provide one or more forces to the magnetic device to control the position of the magnetic device. The magnetic control assembly may comprise at least one magnet configured to generate a magnetic field and at least one force modulation device. The force modulation device may control the magnitude of the force applied to the magnetic device.
In some embodiments, the force modulation device may comprise an adjustable shielding device, which may be configured to alter the magnetic field produced by the magnetic control assembly. Additionally or alternatively, the force modulation device may be configured to control a distance between the magnetic device and at least one magnet of the magnetic control assembly, which in turn may modulate the force applied to the magnetic device by the magnetic control assembly. In yet other embodiments, the force modulation device may be configured to both alter the magnetic field produced by the magnetic control assembly and control the distance between the magnetic control assembly and the magnetic device. In some variations, the magnetic control assemblies may comprise all or a portion of those described in U.S. application Ser. No. 14/200,302, filed on Mar. 7, 2014, and titled “Magnetic Control Assemblies and Systems Therefor.” the contents of which are hereby incorporated by reference in their entirety.
The magnet 1004 may be configured to generate a magnetic field, such that when the magnetic control assembly 1000 is positioned near a patient 1008, the magnetic field may be generated inside the patient 1008. This magnetic field may apply a force to and manipulate a grasper 1010 positioned in the body. In some variations, the magnet 1004 may comprise one or more permanent magnets and/or one or more electromagnets. The magnet 1004 may comprise any number of individual magnets, which in some instances may be formed in an array. The magnet 1004 may have any suitable size and shape, such as cylindrical shape having a circular, oval, or semi-circle cross-section, a bar magnet having a rectangular or triangular cross section, a spherical magnet, or the like.
Generally, the mounting device 1002 may be configured to mount the magnetic control assembly 1000 to one or more structures (e.g., a wall, ceiling, an operating table, or the like). In some instances, the mounting device 1002 may be further configured to counterbalance the weight of the magnet 1004 and the force modulation device 1006, such that the magnet 1004 and the force modulation device 1006 may be moveably suspended by the mounting device 1006. With the magnetic control assembly 1000 suspended by the mounting device 1002, an operator may move the magnet 1004 and/or force modulation device 1006. Additionally or alternatively, the force modulation device 1006 may alter the positioning of the magnet 1004. In some variations, the position of the mounting device 1002 may be temporarily locked to fix the positions of the magnet 1004 and/or force modulation device 1006.
The force modulation device 1006 may be configured to modulate the strength of the magnetic field applied to a grasper 1010 positioned in the body. For example, in some instances it may be desirable to suspend the grasper 1010 against a tissue wall (e.g., the abdominal wall) while limiting the force that the grasper 1010 applies to the tissue wall. Accordingly, by modulating the strength of the magnetic field applied to the grasper 1010, the magnetic control assembly 1000 may control the force applied to the grasper 1010, which in turn may control the pressure applied by the grasper 1010 to the tissue wall. In some variations, the magnetic control assembly 1000 may comprise force modulation device 1006 that comprises an adjustable shielding device, which may alter the magnetic field produced by the magnet 1004 of the assembly. In other variations, the force modulation device 1006 may comprise a distance adjustment device, which may alter the distance between the magnet 1004 of the assembly and a grasper 1010 positioned in the body. In still other variations, the force modulation device 1006 may comprise an adjustable shielding device that is also configured to alter the distance between the magnet 1004 of the assembly 1000 and a grasper 1010 positioned in the body.
In some embodiments, the force modulation device 1006 may be controlled by an automated feedback loop based on a sensor located in the grasper 1010. This sensor may provide feedback, which is may be used by the magnetic control assembly to modulate the force applied to the grasper. In some variations of the graspers described here, the grasper may comprise at least one sensor. In some variations, the grasper may comprise a magnetometer configured to measure the strength of the magnetic fields applied to grasper. In these variations, the magnetometer may comprise a scalar magnetometer configured to measure a total strength of the magnetic field applied thereto or may comprise a vector magnetometer configured to measure the strength of a magnetic field in a particular direction. In some instances, a grasper may comprise a plurality of vector magnetometers configured to measure the strength of a magnetic field in multiple directions (e.g., along two axes, along three axes, or the like).
Additionally or alternatively, in some variations, the graspers described here may comprise a pressure sensor configured to measure pressure applied to one or more surfaces of the grasper. For example, when the grasper is pulled against an abdominal wall of a patient, the pressure sensor may be configured to measure the pressure between the grasper and the abdominal wall. It may be desirable to limit this pressure, as too much pressure applied to the abdominal wall may block blood flow thereto and possibly cause tissue necrosis. The grasper may comprise any combination of pressure sensors and magnetometers. When a grasper comprises at least one sensor, the grasper may be configured to communicate data from the sensor or sensors to the magnetic control assembly. In some variations, the grasper may be configured to communicate this data wirelessly. Additionally or alternatively, the grasper may be configured to produce one or more signals which may be used by the magnetic control assembly to determine a relative positioning between the grasper and the magnetic control assembly.
Methods
As mentioned above, the graspers described here may be used to provide remote suspension of tissue during a minimally-invasive procedure. Generally, to provide suspension of a tissue, a grasper as described herein may be advanced into the body, may be releasably connected to a tissue in the body, and may be suspended using one or more magnets positioned externally to the body to move and suspend the tissue. In some variations, the grasper may be detached from the tissue, and the grasper may be repositioned and reconnected to tissue (either the same tissue or different tissue).
The grasper, such as any of the graspers described herein, may be advanced into the body in any suitable manner. In some variations, the grasper may be advanced into the body through a laparoscopic port as part of a laparoscopic procedure. In some instances, the laparoscopic procedure may be a single-incision laparoscopic procedure. In some variations, the grasper may be advanced into the body using a delivery device, such as any of the delivery devices described herein. In these variations, the grasper may be releasably coupled to a distal engagement portion of the delivery device, and the distal engagement portion of the delivery device may be advanced into the body to advance and position the grasper within the body.
Once the grasper is positioned in the body, it may be releasably connected to tissue. To connect the grasper to tissue, the grasper may first be placed in an open configuration. In some variations, the grasper may be placed in an open configuration using the delivery device carrying the grasper, as described with respect to each system herein. With the grasper in the open configuration, the grasper may be manipulated to position the tissue between the first jaw and the second jaw. The grasper may be returned to a closed configuration. The grasper may then be released from the delivery device, which may be removed from the body in some variations. With the grasper releasably connected to the tissue, a magnetic control element comprising one or more magnets may be positioned externally of the body and may magnetically attract the grasper to reposition and/or hold the grasper.
In some instances it may be desirable to detach the grasper from the tissue. For example, in some instances it may be desirable to attach the grasper to a different portion of the tissue. In these instances, the grasper may be detached from the tissue using a delivery device to return the grasper to an open configuration. The grasper may be repositioned to again place tissue between the jaws of the grasper, and the grasper may then be placed in the closed configuration to reattach the grasper to tissue. In other instances, the grasper may be detached from the tissue, and removed from the body.
This application is a divisional application of U.S. patent application Ser. No. 15/195,898, filed on Jun. 28, 2016, which is a continuation application of International Patent Application No. PCT/US2015/012319, filed on Jan. 21, 2015, which claims priority to U.S. Provisional Application Ser. No. 61/929,918, filed on Jan. 21, 2014, and titled “Laparoscopic Graspers and Systems Therefor,” the contents of each of which are hereby incorporated in their entirety.
| Number | Name | Date | Kind |
|---|---|---|---|
| 2678228 | Gerhardt | May 1954 | A |
| 2863444 | Winsten | Dec 1958 | A |
| 3146381 | Louis | Aug 1964 | A |
| 3674014 | Tillander | Jul 1972 | A |
| 3789285 | Nishizawa | Jan 1974 | A |
| 3794091 | Ersek et al. | Feb 1974 | A |
| 4364377 | Smith | Dec 1982 | A |
| 4380999 | Healy | Apr 1983 | A |
| 4706668 | Backer | Nov 1987 | A |
| 4756312 | Epley | Jul 1988 | A |
| 4901405 | Grover et al. | Feb 1990 | A |
| 4915435 | Levine | Apr 1990 | A |
| 4968136 | Lim et al. | Nov 1990 | A |
| 4971067 | Bolduc et al. | Nov 1990 | A |
| 4976723 | Schad | Dec 1990 | A |
| 4997436 | Oberlander | Mar 1991 | A |
| 5002557 | Hasson | Mar 1991 | A |
| 5154189 | Oberlander | Oct 1992 | A |
| 5156608 | Troidl et al. | Oct 1992 | A |
| 5156609 | Nakao et al. | Oct 1992 | A |
| 5282806 | Haber et al. | Feb 1994 | A |
| 5300081 | Young et al. | Apr 1994 | A |
| 5304183 | Gourlay et al. | Apr 1994 | A |
| 5304185 | Taylor | Apr 1994 | A |
| 5307805 | Byrne | May 1994 | A |
| 5340360 | Stefanchik | Aug 1994 | A |
| 5397325 | Della Badia | Mar 1995 | A |
| 5411535 | Fujii et al. | May 1995 | A |
| 5415160 | Ortiz et al. | May 1995 | A |
| 5417701 | Holmes | May 1995 | A |
| 5449361 | Preissman | Sep 1995 | A |
| 5449365 | Green et al. | Sep 1995 | A |
| 5450842 | Tovey et al. | Sep 1995 | A |
| 5458603 | Futch, Sr. | Oct 1995 | A |
| 5458693 | Codorniu | Oct 1995 | A |
| 5465711 | Moll et al. | Nov 1995 | A |
| 5496317 | Goble et al. | Mar 1996 | A |
| 5499986 | Dimarco | Mar 1996 | A |
| 5529568 | Rayman | Jun 1996 | A |
| 5538098 | Sparhawk | Jul 1996 | A |
| 5569274 | Rapacki | Oct 1996 | A |
| 5593379 | Rayman | Jan 1997 | A |
| 5595562 | Grier | Jan 1997 | A |
| 5654864 | Ritter et al. | Aug 1997 | A |
| 5665100 | Yoon | Sep 1997 | A |
| 5681260 | Ueda et al. | Oct 1997 | A |
| 5728121 | Bimbo et al. | Mar 1998 | A |
| 5733292 | Gustilo et al. | Mar 1998 | A |
| 5749881 | Sackier et al. | May 1998 | A |
| 5766189 | Matsuno | Jun 1998 | A |
| 5782748 | Palmer et al. | Jul 1998 | A |
| 5797911 | Sherman et al. | Aug 1998 | A |
| 5797939 | Yoon | Aug 1998 | A |
| 5824041 | Lenker | Oct 1998 | A |
| 5848969 | Panescu et al. | Dec 1998 | A |
| 5849015 | Haywood et al. | Dec 1998 | A |
| 5888196 | Bonutti | Mar 1999 | A |
| 5893873 | Rader et al. | Apr 1999 | A |
| 5933926 | Reiter | Aug 1999 | A |
| 6015414 | Werp et al. | Jan 2000 | A |
| 6017358 | Yoon et al. | Jan 2000 | A |
| 6096038 | Michelson | Aug 2000 | A |
| 6099537 | Sugai et al. | Aug 2000 | A |
| 6099550 | Yoon | Aug 2000 | A |
| 6123657 | Ishikawa et al. | Sep 2000 | A |
| 6126647 | Posey et al. | Oct 2000 | A |
| 6127757 | Banks | Oct 2000 | A |
| 6165180 | Cigaina et al. | Dec 2000 | A |
| 6173715 | Sinanan et al. | Jan 2001 | B1 |
| 6212419 | Blume et al. | Apr 2001 | B1 |
| 6216028 | Haynor et al. | Apr 2001 | B1 |
| 6241671 | Ritter et al. | Jun 2001 | B1 |
| 6311082 | Creighton, IV et al. | Oct 2001 | B1 |
| 6315709 | Garibaldi et al. | Nov 2001 | B1 |
| 6330467 | Creighton, IV et al. | Dec 2001 | B1 |
| 6340365 | Dittrich et al. | Jan 2002 | B2 |
| 6358196 | Rayman | Mar 2002 | B1 |
| 6371973 | Tepper | Apr 2002 | B1 |
| 6398791 | Que et al. | Jun 2002 | B1 |
| 6399146 | Harris et al. | Jun 2002 | B1 |
| 6401723 | Garibaldi et al. | Jun 2002 | B1 |
| 6440133 | Beale et al. | Aug 2002 | B1 |
| 6458146 | Kramer | Oct 2002 | B1 |
| 6459924 | Creighton, IV et al. | Oct 2002 | B1 |
| 6464710 | Foster | Oct 2002 | B1 |
| 6488615 | Mitchiner et al. | Dec 2002 | B1 |
| 6523919 | Israelsen et al. | Feb 2003 | B1 |
| 6537196 | Creighton, IV et al. | Mar 2003 | B1 |
| 6551304 | Whalen et al. | Apr 2003 | B1 |
| 6594517 | Nevo | Jul 2003 | B1 |
| 6630879 | Creighton, IV et al. | Oct 2003 | B1 |
| 6632229 | Yamanouchi | Oct 2003 | B1 |
| 6641595 | Moran et al. | Nov 2003 | B1 |
| 6656199 | Lafontaine | Dec 2003 | B1 |
| 6677752 | Creighton, IV et al. | Jan 2004 | B1 |
| 6689119 | Di Caprio et al. | Feb 2004 | B1 |
| 6702804 | Ritter et al. | Mar 2004 | B1 |
| 6705989 | Cuschieri et al. | Mar 2004 | B2 |
| 6719765 | Bonutti | Apr 2004 | B2 |
| 6761681 | Schmid et al. | Jul 2004 | B2 |
| 6786219 | Garibaldi et al. | Sep 2004 | B2 |
| 6817364 | Garibaldi et al. | Nov 2004 | B2 |
| 6824511 | Bell et al. | Nov 2004 | B1 |
| 6916314 | Schneider et al. | Jul 2005 | B2 |
| 7017584 | Garibaldi et al. | Mar 2006 | B2 |
| 7094245 | Adams et al. | Aug 2006 | B2 |
| 7169104 | Ueda et al. | Jan 2007 | B2 |
| 7182089 | Ries | Feb 2007 | B2 |
| 7182775 | De Guillebon et al. | Feb 2007 | B2 |
| 7189198 | Harburn et al. | Mar 2007 | B2 |
| 7264584 | Ritter et al. | Sep 2007 | B2 |
| 7300400 | Brown | Nov 2007 | B2 |
| 7311107 | Harel et al. | Dec 2007 | B2 |
| 7313429 | Creighton, IV et al. | Dec 2007 | B2 |
| 7314063 | Egli | Jan 2008 | B2 |
| 7341063 | Garbibaldi et al. | Mar 2008 | B2 |
| 7344553 | Opolski et al. | Mar 2008 | B2 |
| 7390298 | Chu | Jun 2008 | B2 |
| 7416335 | Munger | Aug 2008 | B2 |
| 7429259 | Cadeddu et al. | Sep 2008 | B2 |
| 7431726 | Spence et al. | Oct 2008 | B2 |
| 7566038 | Scott et al. | Jul 2009 | B2 |
| 7618435 | Opolski | Nov 2009 | B2 |
| 7686827 | Hushka | Mar 2010 | B2 |
| 7691103 | Fernandez et al. | Apr 2010 | B2 |
| 7691731 | Bet et al. | Apr 2010 | B2 |
| 7708756 | Nobis et al. | May 2010 | B2 |
| 7736356 | Cooper et al. | Jun 2010 | B2 |
| 7766810 | Ohdaira | Aug 2010 | B2 |
| 7769427 | Shachar | Aug 2010 | B2 |
| 7772950 | Tunay | Aug 2010 | B2 |
| 7774046 | Werp et al. | Aug 2010 | B2 |
| 7780054 | Wales | Aug 2010 | B2 |
| 7799050 | Hensley et al. | Sep 2010 | B2 |
| 7837612 | Gill et al. | Nov 2010 | B2 |
| 7850591 | Spector | Dec 2010 | B2 |
| 7942885 | Sixto, Jr. et al. | May 2011 | B2 |
| 7963903 | Ghiron et al. | Jun 2011 | B2 |
| 7966059 | Creighton, IV et al. | Jun 2011 | B2 |
| 7967830 | Ayala et al. | Jun 2011 | B2 |
| 8038612 | Paz | Oct 2011 | B2 |
| 8043290 | Harrison et al. | Oct 2011 | B2 |
| 8057472 | Walker et al. | Nov 2011 | B2 |
| 8060184 | Hastings et al. | Nov 2011 | B2 |
| 8066715 | Ducharme | Nov 2011 | B2 |
| 8074657 | Scott et al. | Dec 2011 | B2 |
| 8082035 | Glukhovsky | Dec 2011 | B2 |
| 8133254 | Dumbauld et al. | Mar 2012 | B2 |
| 8136888 | Suzuki et al. | Mar 2012 | B2 |
| 8137268 | Van Lue | Mar 2012 | B2 |
| 8157149 | Olson et al. | Apr 2012 | B2 |
| 8187286 | Jugenheimer et al. | May 2012 | B2 |
| 8197494 | Jaggi et al. | Jun 2012 | B2 |
| 8226690 | Altarac et al. | Jul 2012 | B2 |
| 8235272 | Nicholas et al. | Aug 2012 | B2 |
| 8241322 | Whitman et al. | Aug 2012 | B2 |
| 8246529 | Riehl et al. | Aug 2012 | B2 |
| 8252021 | Boulnois et al. | Aug 2012 | B2 |
| 8267854 | Asada et al. | Sep 2012 | B2 |
| 8301226 | Csavoy et al. | Oct 2012 | B2 |
| 8303495 | Ducharme | Nov 2012 | B2 |
| 8313497 | Walberg et al. | Nov 2012 | B2 |
| 8316861 | Brewer et al. | Nov 2012 | B2 |
| 8316862 | Shapiro et al. | Nov 2012 | B2 |
| 8333695 | Cuschieri | Dec 2012 | B2 |
| 8343171 | Farritor et al. | Jan 2013 | B2 |
| 8360972 | Paz | Jan 2013 | B2 |
| 8364277 | Glukhovsky | Jan 2013 | B2 |
| 8377044 | Coe et al. | Feb 2013 | B2 |
| 8382754 | Odom et al. | Feb 2013 | B2 |
| 8403916 | Prescott | Mar 2013 | B2 |
| 8409076 | Pang et al. | Apr 2013 | B2 |
| 8480668 | Fernandez et al. | Jul 2013 | B2 |
| 8491626 | Roy et al. | Jul 2013 | B2 |
| 8517931 | Minnelli et al. | Aug 2013 | B2 |
| 8518057 | Walberg et al. | Aug 2013 | B2 |
| 8556919 | Aguirre et al. | Oct 2013 | B2 |
| 8579787 | Shapiro et al. | Nov 2013 | B2 |
| 8585685 | Hagg | Nov 2013 | B2 |
| 8602981 | Deutch | Dec 2013 | B2 |
| 8608773 | Tierney et al. | Dec 2013 | B2 |
| 8623011 | Spivey | Jan 2014 | B2 |
| 8628529 | Aldridge et al. | Jan 2014 | B2 |
| 8636762 | Whitman et al. | Jan 2014 | B2 |
| 8637818 | Balakin | Jan 2014 | B2 |
| 8685043 | Jugenheimer et al. | Apr 2014 | B2 |
| 8758394 | Zimmerling et al. | Jun 2014 | B2 |
| 8764769 | Rodriguez-Navarro et al. | Jul 2014 | B1 |
| 8790245 | Rodriguez Fernandez et al. | Jul 2014 | B2 |
| 8820602 | Walberg et al. | Sep 2014 | B2 |
| 8827891 | Roberts | Sep 2014 | B2 |
| 8828024 | Farritor et al. | Sep 2014 | B2 |
| 8894574 | Ellman | Nov 2014 | B2 |
| 8926656 | Palermo et al. | Jan 2015 | B2 |
| 8944997 | Fernandez et al. | Feb 2015 | B2 |
| 8968332 | Farritor et al. | Mar 2015 | B2 |
| 8968356 | Mueller | Mar 2015 | B2 |
| 9011468 | Ketai et al. | Apr 2015 | B2 |
| 9033957 | Cadeddu et al. | May 2015 | B2 |
| 9044256 | Cadeddu et al. | Jun 2015 | B2 |
| 9339285 | Rodriguez-Navarro et al. | May 2016 | B2 |
| 9386973 | Deutch | Jul 2016 | B2 |
| 9561031 | Heinrich et al. | Feb 2017 | B2 |
| 9627120 | Scott et al. | Apr 2017 | B2 |
| 9844391 | Rodriguez Fernandez et al. | Dec 2017 | B2 |
| 9962148 | Deutch | May 2018 | B2 |
| 9974546 | Rodriguez Fernandez et al. | May 2018 | B2 |
| 10010370 | Rodriguez-Navarro et al. | Jul 2018 | B2 |
| 10130381 | Rodriguez-Navarro et al. | Nov 2018 | B2 |
| 10143459 | Heftman | Dec 2018 | B2 |
| 10335134 | Deutch | Jul 2019 | B2 |
| 10537348 | Rodriguez-Navarro et al. | Jan 2020 | B2 |
| 10905511 | Rodriguez-Navarro et al. | Feb 2021 | B2 |
| 11020137 | Rodriguez-Navarro | Jun 2021 | B2 |
| 11357525 | Rodriguez-Navarro et al. | Jun 2022 | B2 |
| 11413025 | Deutch | Aug 2022 | B2 |
| 11413026 | Deutch | Aug 2022 | B2 |
| 11583354 | Rodriguez-Navarro et al. | Feb 2023 | B2 |
| 20010038683 | Ritter et al. | Nov 2001 | A1 |
| 20020100486 | Creighton, IV et al. | Aug 2002 | A1 |
| 20020107533 | Solingen | Aug 2002 | A1 |
| 20020116043 | Garibaldi et al. | Aug 2002 | A1 |
| 20020173805 | Matsuno et al. | Nov 2002 | A1 |
| 20030114731 | Cadeddu et al. | Jun 2003 | A1 |
| 20030125752 | Werp et al. | Jul 2003 | A1 |
| 20030181945 | Opolski et al. | Sep 2003 | A1 |
| 20030208185 | Sheffer et al. | Nov 2003 | A1 |
| 20040044295 | Reinert et al. | Mar 2004 | A1 |
| 20040050395 | Ueda et al. | Mar 2004 | A1 |
| 20040064153 | Creighton, IV et al. | Apr 2004 | A1 |
| 20040068173 | Viswanathan | Apr 2004 | A1 |
| 20040158972 | Creighton, IV et al. | Aug 2004 | A1 |
| 20040172057 | Guillebon et al. | Sep 2004 | A1 |
| 20040186347 | Shose et al. | Sep 2004 | A1 |
| 20040199074 | Ritter et al. | Oct 2004 | A1 |
| 20040230100 | Shluzas | Nov 2004 | A1 |
| 20040249262 | Werp et al. | Dec 2004 | A1 |
| 20050080440 | Durgin et al. | Apr 2005 | A1 |
| 20050085696 | Uchiyama et al. | Apr 2005 | A1 |
| 20050113628 | Creighton, IV et al. | May 2005 | A1 |
| 20050131390 | Heinrich et al. | Jun 2005 | A1 |
| 20050165449 | Cadeddu et al. | Jul 2005 | A1 |
| 20050220583 | Lutz | Oct 2005 | A1 |
| 20050250988 | Ewers et al. | Nov 2005 | A1 |
| 20050251183 | Buckman | Nov 2005 | A1 |
| 20050277975 | Saadat et al. | Dec 2005 | A1 |
| 20060015178 | Moaddeb et al. | Jan 2006 | A1 |
| 20060074448 | Harrison et al. | Apr 2006 | A1 |
| 20060079897 | Harrison et al. | Apr 2006 | A1 |
| 20060089633 | Bleich et al. | Apr 2006 | A1 |
| 20060116714 | Sepetka et al. | Jun 2006 | A1 |
| 20060149135 | Paz | Jul 2006 | A1 |
| 20060152309 | Mintchev et al. | Jul 2006 | A1 |
| 20060228421 | Seeney et al. | Oct 2006 | A1 |
| 20060241691 | Wilk | Oct 2006 | A1 |
| 20060247522 | Mcgee | Nov 2006 | A1 |
| 20060276738 | Becker | Dec 2006 | A1 |
| 20060293566 | Brown | Dec 2006 | A1 |
| 20070004958 | Ohdaira | Jan 2007 | A1 |
| 20070016010 | Creighton, IV et al. | Jan 2007 | A1 |
| 20070027458 | Sixto, Jr. et al. | Feb 2007 | A1 |
| 20070043359 | Altarac et al. | Feb 2007 | A1 |
| 20070073102 | Matsuno et al. | Mar 2007 | A1 |
| 20070135678 | Suzuki | Jun 2007 | A1 |
| 20070135685 | Cuschieri | Jun 2007 | A1 |
| 20070135802 | Suzuki | Jun 2007 | A1 |
| 20070135803 | Belson | Jun 2007 | A1 |
| 20070156028 | Van Lue et al. | Jul 2007 | A1 |
| 20070191670 | Spector | Aug 2007 | A1 |
| 20070221233 | Kawano et al. | Sep 2007 | A1 |
| 20070255273 | Fernandez et al. | Nov 2007 | A1 |
| 20070270629 | Charles | Nov 2007 | A1 |
| 20070282311 | Scott et al. | Dec 2007 | A1 |
| 20080081883 | King, II et al. | Apr 2008 | A1 |
| 20080097496 | Chang et al. | Apr 2008 | A1 |
| 20080108860 | Bell et al. | May 2008 | A1 |
| 20080134474 | Uryasov | Jun 2008 | A1 |
| 20080171907 | Long et al. | Jul 2008 | A1 |
| 20080243106 | Coe et al. | Oct 2008 | A1 |
| 20080249534 | Gruber et al. | Oct 2008 | A1 |
| 20080269779 | Cadeddu et al. | Oct 2008 | A1 |
| 20080300458 | Kim et al. | Dec 2008 | A1 |
| 20090004324 | Viel et al. | Jan 2009 | A1 |
| 20090005636 | Pang et al. | Jan 2009 | A1 |
| 20090043246 | Dominguez | Feb 2009 | A1 |
| 20090054909 | Farritor et al. | Feb 2009 | A1 |
| 20090062772 | Wakeford et al. | Mar 2009 | A1 |
| 20090076536 | Rentschler et al. | Mar 2009 | A1 |
| 20090137984 | Minnelli | May 2009 | A1 |
| 20090187074 | Saadat et al. | Jul 2009 | A1 |
| 20090192344 | Bakos et al. | Jul 2009 | A1 |
| 20090222029 | Gordin | Sep 2009 | A1 |
| 20090026771 | Baskett | Oct 2009 | A1 |
| 20090267717 | Baskett | Oct 2009 | A1 |
| 20090318762 | Segawa et al. | Dec 2009 | A1 |
| 20100010306 | Kawano et al. | Jan 2010 | A1 |
| 20100030026 | Uchiyama et al. | Feb 2010 | A1 |
| 20100036394 | Mintz et al. | Feb 2010 | A1 |
| 20100036399 | Viola | Feb 2010 | A1 |
| 20100081876 | Linenkugel et al. | Apr 2010 | A1 |
| 20100105984 | Brewer et al. | Apr 2010 | A1 |
| 20100113872 | Asada et al. | May 2010 | A1 |
| 20100114126 | Neff | May 2010 | A1 |
| 20100137845 | Ramstein et al. | Jun 2010 | A1 |
| 20100145147 | Pinsky et al. | Jun 2010 | A1 |
| 20100152539 | Ghabrial et al. | Jun 2010 | A1 |
| 20100160739 | Van Lue | Jun 2010 | A1 |
| 20100168523 | Ducharme | Jul 2010 | A1 |
| 20100174234 | Werp et al. | Jul 2010 | A1 |
| 20100193566 | Scheib et al. | Aug 2010 | A1 |
| 20100204727 | Dominguez | Aug 2010 | A1 |
| 20100217245 | Prescott | Aug 2010 | A1 |
| 20100237206 | Barker | Sep 2010 | A1 |
| 20100256636 | Fernandez et al. | Oct 2010 | A1 |
| 20100268254 | Golden et al. | Oct 2010 | A1 |
| 20100298645 | Deutch | Nov 2010 | A1 |
| 20110040152 | Kim et al. | Feb 2011 | A1 |
| 20110054306 | Del Nido et al. | Mar 2011 | A1 |
| 20110087223 | Spivey | Apr 2011 | A1 |
| 20110087224 | Cadeddu et al. | Apr 2011 | A1 |
| 20110087249 | Rodrigues et al. | Apr 2011 | A1 |
| 20110105848 | Sadovsky et al. | May 2011 | A1 |
| 20110121050 | Nicholas et al. | May 2011 | A1 |
| 20110130787 | Cinguin et al. | Jun 2011 | A1 |
| 20110184440 | Saldinger | Jul 2011 | A1 |
| 20110230726 | Viola | Sep 2011 | A1 |
| 20110230869 | Altamirano | Sep 2011 | A1 |
| 20110276941 | Oi | Nov 2011 | A1 |
| 20110283822 | Cadeddu et al. | Nov 2011 | A1 |
| 20110284014 | Cadeddu et al. | Nov 2011 | A1 |
| 20110285488 | Scott et al. | Nov 2011 | A1 |
| 20110295067 | Rodriguez Fernandez et al. | Dec 2011 | A1 |
| 20110306840 | Allen et al. | Dec 2011 | A1 |
| 20110313415 | Fernandez et al. | Dec 2011 | A1 |
| 20120016362 | Heinrich et al. | Jan 2012 | A1 |
| 20120035416 | Fernandez et al. | Feb 2012 | A1 |
| 20120053402 | Conlon et al. | Mar 2012 | A1 |
| 20120053406 | Conlon et al. | Mar 2012 | A1 |
| 20120065627 | Ghabrial et al. | Mar 2012 | A1 |
| 20120078292 | Banju | Mar 2012 | A1 |
| 20120008535 | Cadeddu et al. | Apr 2012 | A1 |
| 20120085358 | Cadeddu et al. | Apr 2012 | A1 |
| 20120101488 | Aldridge et al. | Apr 2012 | A1 |
| 20120116148 | Weinberg et al. | May 2012 | A1 |
| 20120227748 | Sanders | Sep 2012 | A1 |
| 20120238796 | Conlon | Sep 2012 | A1 |
| 20120330089 | Ritter et al. | Dec 2012 | A1 |
| 20130030462 | Keating et al. | Jan 2013 | A1 |
| 20130066304 | Belson et al. | Mar 2013 | A1 |
| 20130085341 | Nobis et al. | Apr 2013 | A1 |
| 20130090666 | Hess et al. | Apr 2013 | A1 |
| 20130109267 | Schweikardt et al. | May 2013 | A1 |
| 20130110128 | Schostek et al. | May 2013 | A1 |
| 20130123828 | Culmer et al. | May 2013 | A1 |
| 20130158348 | Nobis et al. | Jun 2013 | A1 |
| 20130158523 | Bergs et al. | Jun 2013 | A1 |
| 20130158659 | Bergs et al. | Jun 2013 | A1 |
| 20130158660 | Bergs et al. | Jun 2013 | A1 |
| 20130172672 | Iddan et al. | Jul 2013 | A1 |
| 20130172906 | Olson et al. | Jul 2013 | A1 |
| 20130226226 | Garrison et al. | Aug 2013 | A1 |
| 20130245356 | Fernandez et al. | Sep 2013 | A1 |
| 20130253256 | Griffith et al. | Sep 2013 | A1 |
| 20130253275 | Ransden et al. | Sep 2013 | A1 |
| 20130253550 | Beisel et al. | Sep 2013 | A1 |
| 20130267788 | Duan et al. | Oct 2013 | A1 |
| 20130289579 | Yeung et al. | Oct 2013 | A1 |
| 20130289768 | Yeung et al. | Oct 2013 | A1 |
| 20130303851 | Griffith et al. | Nov 2013 | A1 |
| 20140066695 | Deutch | Mar 2014 | A1 |
| 20140084761 | Scott et al. | Mar 2014 | A1 |
| 20140135616 | Stein et al. | May 2014 | A1 |
| 20140176797 | Silva et al. | Jun 2014 | A1 |
| 20140187857 | Wilson et al. | Jul 2014 | A1 |
| 20140243586 | Rohaninejad | Aug 2014 | A1 |
| 20140243597 | Weisenburgh, II et al. | Aug 2014 | A1 |
| 20140257370 | Taylor et al. | Sep 2014 | A1 |
| 20140276335 | Pate | Sep 2014 | A1 |
| 20140277104 | Rodriguez-Navarro et al. | Sep 2014 | A1 |
| 20140350574 | Farritor et al. | Nov 2014 | A1 |
| 20140358229 | Bergs et al. | Dec 2014 | A1 |
| 20150012010 | Adler et al. | Jan 2015 | A1 |
| 20150141750 | Iddan et al. | May 2015 | A1 |
| 20160038135 | Deutch | Feb 2016 | A1 |
| 20160120613 | Cadeddu et al. | May 2016 | A1 |
| 20180092703 | Rodriguez-Navarro et al. | Apr 2018 | A1 |
| 20180153633 | Rodriguez-Navarro et al. | Jun 2018 | A1 |
| 20180271550 | Rodriguez-Navarro | Sep 2018 | A1 |
| 20180271603 | Nir et al. | Sep 2018 | A1 |
| 20180296289 | Rodriguez-Navarro et al. | Oct 2018 | A1 |
| 20180325604 | Atarot et al. | Nov 2018 | A1 |
| 20190133631 | Rodriguez-Navarro et al. | May 2019 | A1 |
| 20190269394 | Deutch | Sep 2019 | A1 |
| 20190350575 | Deutch | Nov 2019 | A1 |
| 20200289140 | Rodriguez-Navarro et al. | Sep 2020 | A1 |
| 20210290330 | Rodriguez-Navarro et al. | Sep 2021 | A1 |
| 20220015789 | Rodriguez-Navarro | Jan 2022 | A1 |
| 20230021246 | Rodriguez-Navarro et al. | Jan 2023 | A1 |
| Number | Date | Country |
|---|---|---|
| 2 748 471 | Jul 2010 | CA |
| 2733465 | Sep 2011 | CA |
| 2244381 | Jan 1997 | CN |
| 101090672 | Dec 2007 | CN |
| 201079412 | Jul 2008 | CN |
| 201091596 | Jul 2008 | CN |
| 101534725 | Sep 2009 | CN |
| 102068288 | May 2011 | CN |
| 102355865 | Feb 2012 | CN |
| 203953720 | Nov 2014 | CN |
| 42 12 430 | Oct 1993 | DE |
| 19534618 | Mar 1997 | DE |
| 10 2005 006 705 | Aug 2006 | DE |
| 10-2010-010417 | Sep 2011 | DE |
| 1 797 823 | Jun 2007 | EP |
| 1 972 284 | Sep 2008 | EP |
| 2 012 697 | Jan 2009 | EP |
| 2 355 699 | Aug 2011 | EP |
| 2 366 357 | Sep 2011 | EP |
| 2 381 873 | Nov 2011 | EP |
| 2 391 277 | Dec 2011 | EP |
| 1 942 810 | Aug 2012 | EP |
| 2 571 443 | Mar 2013 | EP |
| 2 595 548 | May 2013 | EP |
| 2 842 511 | Mar 2015 | EP |
| 09-192137 | Jul 1997 | JP |
| 2004-357816 | Dec 2004 | JP |
| 2005-021576 | Jan 2005 | JP |
| 4320214 | Aug 2009 | JP |
| 2009-538699 | Nov 2009 | JP |
| WO-0051500 | Sep 2000 | WO |
| WO-2005004734 | Jan 2005 | WO |
| WO-2005032370 | Apr 2005 | WO |
| WO-2006071120 | Jul 2006 | WO |
| WO-2007067231 | Jun 2007 | WO |
| WO-2007130382 | Nov 2007 | WO |
| WO-2007130382 | Nov 2007 | WO |
| WO-2007142977 | Dec 2007 | WO |
| WO-2007142977 | Dec 2007 | WO |
| WO-2007143162 | Dec 2007 | WO |
| WO-2007143162 | Dec 2007 | WO |
| WO-2007143170 | Dec 2007 | WO |
| WO-2007143170 | Dec 2007 | WO |
| WO-2008039237 | Apr 2008 | WO |
| WO-2008085919 | Jul 2008 | WO |
| WO-2008085919 | Jul 2008 | WO |
| WO-2008131128 | Oct 2008 | WO |
| WO-2009008865 | Jan 2009 | WO |
| WO-2009019288 | Feb 2009 | WO |
| WO-2009019288 | Feb 2009 | WO |
| WO-2009070743 | Jun 2009 | WO |
| WO-2010056716 | May 2010 | WO |
| WO-2010056716 | May 2010 | WO |
| WO-2010077561 | Jul 2010 | WO |
| WO-2010083480 | Jul 2010 | WO |
| WO-2010083480 | Jul 2010 | WO |
| WO-2010089635 | Aug 2010 | WO |
| WO-2011044468 | Apr 2011 | WO |
| WO-2011044468 | Apr 2011 | WO |
| WO-2011044471 | Apr 2011 | WO |
| WO-2011044471 | Apr 2011 | WO |
| WO-2011091483 | Aug 2011 | WO |
| WO-2011146691 | Nov 2011 | WO |
| WO-2011146691 | Nov 2011 | WO |
| WO2011146698 | Nov 2011 | WO |
| WO2011146698 | Nov 2011 | WO |
| WO-2011146709 | Nov 2011 | WO |
| WO-2011146709 | Nov 2011 | WO |
| WO-2012010910 | Jan 2012 | WO |
| WO-2012031114 | Mar 2012 | WO |
| WO-2012031114 | Mar 2012 | WO |
| WO-2012033925 | Mar 2012 | WO |
| WO-2012048102 | Apr 2012 | WO |
| WO-2012048102 | Apr 2012 | WO |
| WO-2013096470 | Jun 2013 | WO |
| WO-2014133751 | Sep 2014 | WO |
| WO-2014159023 | Oct 2014 | WO |
| WO-2014163872 | Oct 2014 | WO |
| WO-2015112645 | Jul 2015 | WO |
| WO-2015142953 | Sep 2015 | WO |
| WO-2016168380 | Oct 2016 | WO |
| Entry |
|---|
| Aesculap, “Endoscopic Vascular surgery in the pelvic region,” B/Braun, Aesculap AG & Co.KG, Catalog, 48 pages, 2006, Copy Unavailable, document can be accessed at https://docplayer.net/22042174-Aesculap-endoscopic-technology-endoscopic-vascular-surgery-in-the-pelvic-region.html. |
| Extended European Search Report dated Jul. 22, 2019, for EP Application No. 19 151 941.2, filed on Feb. 25, 2014, 6 pages. |
| Extended European Search Report dated May 31, 2013, for EP Application No. 08 853 840.0, filed on Nov. 26, 2008, 11 pages. |
| Extended European Search Report dated Jan. 4, 2022, for EP Application No. 21 189 505.7, filed on Apr. 13, 2016, 10 pages. |
| Extended European Search Report dated Jan. 18, 2022, for EP Application No. 21 187 437.5, filed on Apr. 13, 2016, 6 pages. |
| Extended European Search Report dated Feb. 17, 2022, for EP Application No. 21 189 492.8, filed on Feb. 25, 2014, 6 pages. |
| Final Office Action dated Nov. 25, 2020, for U.S. Appl. No. 15/728,297, filed Oct. 9, 2017, 11 pages. |
| Final Office Action dated Sep. 3, 2021, for U.S. Appl. No. 16/149,576, filed Oct. 2, 2018, 14 pages. |
| Final Office Action dated Oct. 26, 2021, for U.S. Appl. No. 16/419,363, filed May 22, 2019, 7 pages. |
| Final Office Action dated Oct. 28, 2021, for U.S. Appl. No. 16/528,878, filed Aug. 1, 2019, 8 pages. |
| Final Office Action dated Feb. 7, 2022, for U.S. Appl. No. 16/008,976, filed Jun. 14, 2018, 20 pages. |
| Final Office Action dated May 2, 2022, for U.S. Appl. No. 15/728,297, filed Oct. 9, 2017, 13 pages. |
| International Search Report dated Apr. 9, 2009, for PCT Application No. PCT/US2008/084991, filed on Nov. 26, 2008, 3 pages. |
| Milki et al. (1998). Vaginal ultrasound probe coverage leakage implications for patient care, fertility and sterility, American Society for Reproductive Medicine, vol. 69, No. 3. |
| Non-Final Office Action dated Dec. 22, 2020, for U.S. Appl. No. 16/149,576, filed Oct. 2, 2018, 10 pages. |
| Non-Final Office Action dated May 12, 2021, for U.S. Appl. No. 16/008,976, filed Jun. 14, 2018, 15 pages. |
| Non-Final Office Action dated Apr. 29, 2021, for U.S. Appl. No. 16/419,363, filed May 22, 2019, 9 pages. |
| Non-Final Office Action dated Apr. 15, 2021, for U.S. Appl. No. 16/528,878, filed Aug. 1, 2019, 6 pages. |
| Non-Final Office Action dated Sep. 15, 2021, for U.S. Appl. No. 15/728,297, filed Oct. 9, 2017, 11 pages. |
| Non-Final Office Action dated Aug. 5, 2022, for U.S. Appl. No. 16/008,976, filed Jun. 14, 2018, 18 pages. |
| Notice of Allowance dated Sep. 29, 2020, for U.S. Appl. No. 15/728,302, filed Oct. 9, 2017, 8 pages. |
| Notice of Allowance dated Feb. 5, 2021, for U.S. Appl. No. 15/926,578, filed Mar. 20, 2018, 9 pages. |
| Notice of Allowance dated Feb. 14, 2022, for U.S. Appl. No. 16/149,576, filed Oct. 2, 2018, 9 pages. |
| Notice of Allowance dated Apr. 7, 2022, for U.S. Appl. No. 16/528,878, filed Aug. 1, 2019, 6 pages. |
| Notice of Allowance dated Apr. 20, 2022, for U.S. Appl. No. 16/419,363, filed May 2, 2019, 6 pages. |
| Odwin et al. (1990), Prove covers and disinfectants for transvaginal transducers, JDMS, 6:130-135. |
| Supplemental Notice of Allowability dated Dec. 18, 2020, for U.S. Appl. No. 15/728,302, filed Oct. 9, 2017, 3 pages. |
| Written Opinion of the International Searching Authority dated Apr. 9, 2009, for PCT Application No. PCT/US2008/084991, filed on Nov. 26, 2008, 12 pages. |
| Best, S.L. et al. (2010). “Development of magnetic anchoring and guidance systems for minimally invasive surgery,” Indian J. of Urology 26:418-422. |
| Best, S.L. et al. (2010). “Solo Surgeon LESS Nephrectomy Facilitated by New Generation Magnetically Anchored and Guided (MAGS) Camera,” World Congress of Endourology, PS38-14, Chicago IL, Sep. 2010. |
| Best, S.L. et al. (2010). “MAGS Instrumentation for LESS/NOTES: Lack of Histologic Damage After Prolonged Magnetic Coupling Across the Abdominal Wall,” World Congress of Endourology, PS2-4, Chicago IL, Sep. 2010. |
| Best, S.L. et al. (2008). “Maximizing Coupling Strength of Magnetically Anchored NOTES Instruments: How Thick Can We Go?” Surgical Endoscopy, vol. 22: S241. |
| Cadeddu, J.A. et al. (2002). “Transabdominal magnetic anchoring system for trocar-less laparoscopic surgery,” J. of Urology, vol. 167, No. 4, Supplement, Abstract No. 16, 1 total page. |
| Cadeddu, J. et al. (2009). “Novel Magnetically Guided Intraabdominal Camera to Facilitate Laparoendoscopic Single Site Surgery: Initial Human Experience,” Surgical Endoscopy 23:1894-1899. |
| Dominguez (2007). “Colecistectomia con un trocar asistida por imanes de neodimio. Reporte de un caso.” Asociacion Mexicana de Cirugia Endo. vol. 8. No. 4, pp. 172-176 (with English Abstract). |
| Dominguez, G. et al. (2009). “Retraction and triangulation with neodymium magnetic forceps for single-port laparoscopic cholecystectomy,” Surg. Endosc. 23:1660-1666. |
| Duchene, D.A. et al. (2004). “Magnetic positioning system for trocarless laparoscopic instruments,” J. of Endourology 18:693. |
| Extended European Search Report dated Jul. 20, 2016, for EP Application No. 14 778 895.4, filed on Feb. 25, 2014, 7 pages. |
| Extended European Search Report dated Dec. 20, 2016, for EP Application No. 09 839 564.3, filed on Oct. 1, 2009, 11 pages. |
| Extended European Search Report dated Sep. 27, 2017, for EP Application No. 15 741 055.6, filed on Jan. 21, 2015, 9 pages. |
| Extended European Search Report dated Oct. 30, 2018, for EP Application No. 16 780 691.8, filed on Apr. 13, 2016, 6 pages. |
| Extended European Search Report dated Nov. 26, 2018, for EP Application No. 16 780 688.4, filed on Sep. 26, 2017, 9 pages. |
| Extended European Search Report dated Aug. 22, 2019, for EP Application No. 17 736 483.3, filed on Jan. 6, 2017, 8 pages. |
| Fernandez, R. et al. (2012). “Determining a Performance Envelope for Capture of Kidney Stones Functionalized with Superparamagnetic Particles,” Journal of Endourology, 26(9):1227-30. |
| Fernandez, R. et al. (2003). “Development of a Transabdominal Anchoring System for Trocar-Less Laparoscopic Surgery,” Advances in Bioengineering—ASME International Mechanical Engineering Congress & Exposition, Washington DC, Nov. 2003, BED vol. 55, pp. 157-158. |
| Final Office Action dated Sep. 16, 2016, for U.S. Appl. No. 14/704,828, filed May 5, 2015, 10 pages. |
| Final Office Action dated Jan. 25, 2016, for U.S. Appl. No. 14/337,082, filed Jul. 21, 2014, 9 pages. |
| Final Office Action dated Dec. 28, 2016, for U.S. Appl. No. 14/200,302, filed Mar. 7, 2014, 15 pages. |
| Final Office Action dated Sep. 6, 2017, for U.S. Appl. No. 14/200,302, filed Mar. 7, 2014, 9 pages. |
| Final Office Action dated Mar. 7, 2018, for U.S. Appl. No. 15/098,262, filed Apr. 13, 2016, 10 pages. |
| Final Office Action dated Feb. 26, 2019, for U.S. Appl. No. 15/195,898, filed Jun. 28, 2016, 9 pages. |
| International Search Report dated Jul. 30, 2014, for PCT Application No. PCT/US2014/021537, filed on Mar. 7, 2014, 2 pages. |
| International Search Report for International Application No. PCT/IB2009/054307 dated Feb. 8, 2010, 4 pages. |
| International Search Report dated May 4, 2015, for PCT Application No. PCT/US2015/012319, filed on Jan. 21, 2015, 2 pages. |
| International Search Report dated Jul. 18, 2014, for PCT Application No. PCT/US2014/018307, filed on Feb. 25, 2014, 4 pages. |
| International Search Report dated Jul. 15, 2016, for PCT Application No. PCT/US2016/027385, filed on Apr. 13, 2016, 2 pages. |
| International Search Report dated Aug. 22, 2016, for PCT Application No. PCT/US2016/027390, filed on Apr. 13, 2016, 4 pages. |
| International Search Report dated Apr. 3, 2017, for PCT Application No. PCT/US2017/012628, filed on Jan. 6, 2017, 2 pages. |
| Leong, F. et al. (2016). “Magnetic surgical instruments for robotic abdominal surgery,” IEEE Reviews in Biomedical Engineering 9:66-78. |
| Mashaud, L. et al. (2011). “Tissue Compression Analysis for Magnetically Anchored Cautery Dissector During Single Site Laparoscopic Cholecystectomy,” Journal of Gastrointestinal Surgery 15:902-907. |
| Mashaud, L. et al. (2010). “Tissue Compression Analysis for Magnetically Anchored Cautery Dissector During Single Site Laparoscopic Cholecystectomy,” Gastroenterology, 138:5 (Supplement 1):S-882. |
| Mashaud, L. et al. (2010). “Magnetic Cautery Dissector Suitability for Traditional or Single Site Laparoscopic Cholecystectomy in Human Cadaver Models,” 12th World Congress of Endoscopic Surgery, P246, National Harbor, MD, Apr. 2010. |
| Non-Final Office Action dated May 25, 2016, for U.S. Appl. No. 14/200,302, filed Mar. 7, 2014, 12 pages. |
| Non-Final Office Action dated May 21, 2013 for U.S. Appl. No. 13/132,185, filed Aug. 17, 2011, 18 pages. |
| Non-Final Office Action dated Jul. 21, 2016, for U.S. Appl. No. 14/337,082, filed Jul. 21, 2014, 9 pages. |
| Non-Final Office Action dated Jul. 13, 2015, for U.S. Appl. No. 14/337,082, filed Jul. 21, 2014, 10 pages. |
| Non-Final Office Action dated Jan. 25, 2016, for U.S. Appl. No. 14/704,828, filed May 5, 2015, 9 pages. |
| Non-Final Office Action dated Jul. 14, 2015, for U.S. Appl. No. 14/704,828, filed May 5, 2015, 10 pages. |
| Non-Final Office Action dated Oct. 24, 2013, for U.S. Appl. No. 14/019,370, filed on Sep. 5, 2013, 7 pages. |
| Non-Final Office Action dated Oct. 22, 2015, for U.S. Appl. No. 14/019,404, filed Sep. 5, 2013, 6 pages. |
| Non-Final Office Action dated May 22, 2017, for U.S. Appl. No. 14/200,302, filed Mar. 7, 2014, 14 pages. |
| Non-Final Office Action dated May 3, 2017, for U.S. Appl. No. 14/704,828, filed May 5, 2015, 8 pages. |
| Non-Final Office Action dated Jul. 24, 2017, for U.S. Appl. No. 15/098,262, filed Apr. 13, 2016, 9 pages. |
| Non-Final Office Action dated Jun. 29, 2018, for U.S. Appl. No. 15/195,898, filed Jun. 28, 2016, 9 pages. |
| Non-Final Office Action dated Sep. 17, 2019, for U.S. Appl. No. 15/728,297, filed Oct. 9, 2017, 8 pages. |
| Non-Final Office Action dated Mar. 3, 2020, for U.S. Appl. No. 15/728,302, filed Oct. 9, 2017, 14 pages. |
| Non-Final Office Action dated Mar. 6, 2020, for U.S. Appl. No. 15/926,578, filed Mar. 20, 2018, 9 pages. |
| Notice of Allowance dated Feb. 14, 2014, for U.S. Appl. No. 14/019,370, filed on Sep. 5, 2013, 7 pages. |
| Notice of Allowance dated Mar. 14, 2014, for U.S. Appl. No. 13/132,185, filed Aug. 17, 2011, 7 pages. |
| Notice of Allowance dated Mar. 14, 2016, for U.S. Appl. No. 14/019,404, filed on Sep. 5, 2013, 7 pages. |
| Notice of Allowance dated May 3, 2017, for U.S. Appl. No. 14/337,082, filed Jul. 21, 2014, 7 pages. |
| Notice of Allowance dated Aug. 25, 2017, for U.S. Appl. No. 14/337,082, filed Jul. 21, 2014, 7 pages. |
| Notice of Allowance dated Nov. 22, 2017, for U.S. Appl. No. 14/200,302, filed Mar. 7, 2014, 5 pages. |
| Notice of Allowance dated Jan. 19, 2018, for U.S. Appl. No. 14/704,828, filed May 5, 2015, 7 pages. |
| Notice of Allowance dated Aug. 24, 2018, for U.S. Appl. No. 15/098,262, filed Apr. 13, 2016, 9 pages. |
| Notice of Allowance dated Sep. 11, 2019, for U.S. Appl. No. 15/195,898, filed Jun. 28, 2016, 9 pages. |
| Notice of Allowance dated Nov. 26, 2019, for U.S. Appl. No. 15/195,898, filed Jun. 28, 2016, 6 pages. |
| Park, S. et al. (2007). “Trocar-less instrumentation for laparoscopy magnetic positioning of intraabdominal camera and retractor,” Surgical Technique 245:379-384. |
| Raman, J. (2009). “Complete Transvaginal NOTES Nephrectomy Using Magnetically Anchored Instrumentation,” Journal of Endourology 23:367-371. |
| Rivas, H. et al. (2005). “A Magnetic Positioning System to Drive Trocarless Laparoscopic Instruments,” First International Minimally Invasive Robotic Association (MIRA) Conference on Robotic Surgery, Innsbruck, Austria, Dec. 2005. |
| Scott, D.J. et al. (2007). “Completely transvaginal NOTES cholecystectomy using magnetically anchored instruments,” Surg. Endosc. 21:2308-2316. |
| Scott, D. et al. (2008). “Optimizing Magnetically Anchored Camera, Light Source, Graspers, and Cautery Dissector for Transvaginal NOTES Cholecystectomy,” Surgical Endoscopy 22:S244. |
| Scott, D. et al. (2008). “Randomized Comparison of Laparoscopic, Flexible Endoscopic, and Wired and Wireless Magnetic NOTES Cameras on Ex-Vivo and In-Vivo Surgical Performance,” Gastrointestinal Endoscopy, vol. 67: AB115. |
| Scott, D. et al. (2008). “Transvaginal Single Access ”Pure“ NOTES Sleeve Gastrectomy Using a Deployable Magnetically Anchored Video Camera,” Gastrointestinal Endoscopy, vol. 67: AB116. |
| Scott, D. et al. (2007). “Transgastric, Transcolonic, and Transvaginal Cholecystectomy Using Magnetically Anchored Instruments,” Surgical Endoscopy, vol. 21: S474. |
| Scott, D. et al. (2007). “Completely Transvaginal Cholecystectomy Using Magnetically Anchored Instruments,” Surgical Endoscopy, vol. 21: S335. |
| Scott, D. et al. (2007). “Short-Term Survival Outcomes Following Transvaginal NOTES Cholecystectomy Using Magnetically Anchored Instruments,” Gastrointestinal Endoscopy, vol. 65: AB109. |
| Swain, C. et al. (2008). “Linear Stapler Formation of Ileo-Rectal, Entero-Enteral and Gastrojejunal Anastomoses During Dual and Single Access “Pure” NOTES Procedures: Methods, Magnets and Stapler Modifications,” Gastrointestinal Endoscopy, vol. 67: AB119. |
| Swain, P. et al. (2008). “Wireless Endosurgery for NOTES,” Gastrointestinal Endoscopy, vol. 67: AB104. |
| Tan, Y. (2011). “Modeling of Magnetic Tools for Use with Superparamagnetic Particles for Magnetic Stone Extraction,” 26th Engineering & Urology Society Annual Meeting, p. 29, Washington DC, May 14, 2011. |
| Tan, Y. (2012). “In Vitro Comparison of Prototype Magnetic Tool with Conventional Nitinol Basket for Ureteroscopic Retrieval of Stone Fragments Rendered Paramagnetic with Iron-Oxide Microparticles,” The Journal of Urology, vol. 187, Issue 4, pp. e857-858. |
| Tang, S. (2008). “Live Video Manipulator for Endoscopy and NOTES,” Gastrointestinal Endoscopy 68:559-564. |
| Tillander, H. (1951). “Magnetic guidance of a catheter with articulated steel tip,” Acta Radiologica pp. 62-64. |
| Wikipedia (2015). “Stainless Steel,” retrieved from https://en.wikipedia.org/wiki/Stainless_steel, 13 pages. |
| Written Opinion of the International Searching Authority dated Jul. 30, 2014, for PCT Application No. PCT/US2014/021537, filed on Mar. 7, 2014, 5 pages. |
| Written Opinion of the International Searching Authority for International Application No. PCT/IB2009/054307 dated Feb. 8, 2010. |
| Written Opinion of the International Searching Authority dated Jul. 18, 2014, for PCT Application No. PCT/US2014/018307, filed on Feb. 25, 2014, 5 pages. |
| Written Opinion of the International Searching Authority dated May 4, 2015, for PCT Application No. PCT/US2015/012319, filed on Jan. 21, 2015, 5 pages. |
| Written Opinion of the International Searching Authority dated Jul. 15, 2016, for PCT Application No. PCT/US2016/027385, filed on Apr. 13, 2016, 11 pages. |
| Written Opinion of the International Searching Authority dated Aug. 22, 2016, for PCT Application No. PCT/US2016/027390, filed on Apr. 13, 2016, 9 pages. |
| Written Opinion of the International Searching Authority dated Apr. 3, 2017, for PCT Application No. PCT/US2017/012628, filed on Jan. 6, 2017, 7 pages. |
| Zeltser, I.S. et al. (2007). “Single trocar laparoscopic nephrectomy using magnetic anchoring and guidance system in the porcine model,” J. of Urology 178:1-4. |
| U.S. Appl. No. 61/113,495, filed Nov. 25, 2008, by Fernandez et al. |
| Notice of Allowance dated Oct. 19, 2022, for U.S. Appl. No. 15/728,297, filed Oct. 9, 2017, 8 pages. |
| Number | Date | Country | |
|---|---|---|---|
| 20200289140 A1 | Sep 2020 | US |
| Number | Date | Country | |
|---|---|---|---|
| 61929918 | Jan 2014 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 15195898 | Jun 2016 | US |
| Child | 16746448 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/US2015/012319 | Jan 2015 | US |
| Child | 15195898 | US |
