Patent Application
20230397966
This disclosure relates to sterile drape systems used to provide a sterile barrier during a medical procedure and, more particularly, to sterile drape systems for use with position recognition devices during robot-assisted surgery.
Medical drapes, also referred to as surgical drapes, can be used during surgical procedures to help protect patients and equipment from contamination. For example, a patient drape may be used to cover portions of a patient's body not involved in a surgical procedure, providing a window or segregated space for accessing a region of the patient's body on which the surgical procedure is being performed. Such patient drapes may be used during a traditional surgical procedure performed under the direction of one or more clinicians or during a robot-assisted surgery. In the case of a robot-assisted surgical procedure, the surgeon may control a surgical robot that include one or more robotic arms manipulable by the surgeon during the surgical procedure. The surgical robot can include various medical instruments insertable into the patient for performing the surgical procedure and may also include visualization aids, such as endoscopes, cameras, etc. to observe what is happening in and/or around the patient at the site of the surgical procedure.
In robot-assisted surgeries, the location of the patient and objects, such as surgical instruments, typically need to be tracked with a high degree of precision as an instrument is being positioned and moved by a robot or by a physician. To do so, a position recognition systems can be used to determine the position of and track a particular object in 3-dimensions (3D). The position recognition system can use passive and/or active sensors or markers that are attached to an object, such as a patient, to be tracked. Objects to be tracked may include passive sensors, such as reflective spherical balls, which are positioned at strategic locations on the object to be tracked. When using active sensors or markers, the objects to be tracked include active infrared transmitters, such as light emitting diodes (LEDs), that generate their own signals for 3D detection. In either case, the system can geometrically resolve the 3-dimensional position of the active and/or passive sensors based on information from or with respect to one or more of the infrared cameras, digital signals, known locations of the active or passive sensors, distance, the time it took to receive the responsive signals, other known variables, or a combination thereof.
In practice, one or more tracking devices can be attached to a patient to track one or more anatomical locations of the patient during the surgical procedure. A tracking device may be desirably attached to the patient at a location covered by a surgical drape. If the tracking device is positioned under the surgical drape, the drape material can hinder accurate detection and tracking of the tracking device through the drape. However, if the tracking device is positioned outside of the surgical drape, the clinician may need to puncture the drape to provide an access hole for attaching the tracking device to the patient through the drape. Puncturing the drape can breach the sterility of the drape and undermine the effectiveness of the sterile draping.
In general, this disclosure is directed to connectors for connecting a patient tracking device to a patient through a drape in a medical procedure, including associated methods and systems involve such connectors and/or drapes. In some examples, a medical drape (also referred to as a surgical drape) defines a sheet of drape material configured (e.g., sized and/or shaped) to be positioned over at least a portion of a patient undergoing a medical procedure. The drape can include a region that defines a continuous sheet of material devoid of openings, which can define the entire extent of the drape or may be a part of the drape that also includes one or more openings (e.g., cutouts, windows) through which a surgeon can access the patient through the drape. In either case, a clinician may attach one or more patient tracking devices to the patient at a location on the patient to be covered by the drape. To connect the patient tracking device to the patient through the drape while helping to maintain the sterile barrier provided by the drape, a connector may be provided.
In some examples, a connector according to disclosure is configured to connect a patient tracking device across the thickness of the drape without creating a hole or otherwise breaching the drape. To do so in some implementations, the patient tracking device may be configured as a multipiece device that includes one component positionable under the drape and another component positionable over the drape. For example, the patient tracking device may include a base configured to be attached to the patient under the drape and a head configured to be positioned on an opposite side of the drape. The head of the patient tracking device can carry one or more tracking markers that can be tracked by a surgical position recognition system in the surgical environment.
The connector can also include multiple pieces positionable on opposite sides of the drape. For example, the connector can include a first connector body coupled to the base of the patient tracking device and a second connector body coupled to the head of the patient tracking device. The first connector body can connect to the second connector body with the drape material positioned between the two connector bodies. For instance, in some implementations, the first connector body and the second connector body may each magnets of opposite polarity from each other that are configured to magnetically attached to each other through the thickness of the drape material.
During use, the clinician can position the base of the patient tracking device at a target location on the patient. With the first connector body attached to the base of the patient tracking device, the clinician can position the drape over the patient, including over the first connector body. The clinician can then attach the second connector body to the first connector body with the drape sandwiched between the two connector bodies. The head of the patient tracking device can be coupled to the second connector body, e.g., before or after attaching the second connector body to the first connector body. The resulting set up can provide a patient that has a drape covering at least a portion of their body with a patient tracking device positioned external to the drape and connected to the patient at a location under the drape.
While a connector according to the disclosure can have a variety of different configurations as described herein, in some examples, the connector includes two connector bodies that attached to each other in a rotationally restricted position. For example, the two connector bodies may have corresponding geometric features that restrict rotational movement of the two connector bodies relative to each other when coupled together and/or sets of corresponding magnetic features that restrict rotational movement of the two connector bodies relative to each other when coupled together. In some implementations, the two connector bodies are configured to connect with each other in only a single rotational position. In other implementations, the two connector bodies are configured to connect with each other in multiple different rotational positions, although further rotational movement is inhibited once the two connector bodies are coupled together. Inhibiting rotational movement of the connector bodies relative to each other once coupled together may be useful to prevent inadvertent movement of one tracking body relative to the other tracking body during a surgical procedure, which may cause misalignment of one or more tracking markers relative to the intended location to be tracked.
In one example, a drape system is described that includes a drape and a connector. The drape is configured to be placed over at least a portion of a patient undergoing a medical procedure. The drape has a first side configured to face the patient and a second side opposite the first surface. The connector is configured to connect to a patient tracking device across the drape. The connector includes a first connector body configured to couple to a base of the patient tracking device and a second connector body configured to couple to a head of the patient tracking device. The base of the patient tracking device is configured to be attached to a patient and the head of the patient tracking device carries at least one tracking marker configured to be tracked by a surgical position recognition system. The example specifies that the first connector body is configured to connect to the second connector body with the drape positioned between the first connector body and the second connector body.
In another example, a drape system is described that includes a drape, a patient tracking device, and a connector. The drape is configured to be placed over at least a portion of a patient undergoing a medical procedure. The drape has a first side configured to face the patient and a second side opposite the first surface. The patient tracking device includes a base configured to be attached to a patient and a head carrying at least one tracking marker configured to be tracked by a surgical position recognition system. The base of the patient tracking device has a proximal end and the head of the patient tracking device has a distal end. The connector is configured to connect the patient tracking device across the drape. The connector includes a first connector body configured to couple to the proximal end of the base of the patient tracking device and a second connector body configured to couple to the distal end of the head of the patient tracking device. The example specifies that the first connector body is configured to connect to the second connector body with the drape positioned between the first connector body and the second connector body.
In another example, a connector for connecting a tracking device across a drape is described. The connector includes a first connector body and a second connector body. The first connector body is configured to couple to a base of a patient tracking device, the base of the patient tracking device being configured to be attached to a patient, and the first connector body defining a face configured to contact a first side of a drape for covering the patient. The second connector body is configured to couple to a head of the patient tracking device, the head of the patient tracking device carrying at least one tracking marker, the second connector body defining a face configured to contact a second side of a drape. The example specifies that the face of the first connector body is configured to connect to the face of the second connector body with the drape positioned between the first connector body and the second connector body.
In another example, a method of attaching a tracking device across a drape is described. The method includes positioning a first connector body attached to and/or attachable to a base of a tracking device on a first side of a drape. The method includes positioning a second connector body attached to and/or attachable to a head of the tracking device on a second side of the drape, the head carrying at least one tracking marker configured to be tracked by a surgical position recognition system. The method further includes connecting the first connector body to the second connector body with the drape positioned between the first connector body to the second connector body.
The details of one or more examples are set forth in the accompanying drawings and the description below. Other features, objects, and advantages will be apparent from the description and drawings, and from the claims.
This disclosure is generally directed to surgical drapes utilizing a connector system to attach a patient tracking device to a patient through the thickness of the drape while helping to maintain the structural integrity and sterile barrier provided by the drape. The connector system can include two bodies positionable on opposite sides of the drape with the thickness of the material forming the drape positioned between the two bodies. For example, the connector system can include a first body connected to and/or connectable to a first portion of the patient tracking device attachable to the patient. The connector system can also include a second body connected to and/or connectable to a second portion of the patient tracking device intended to be positioned external to the drape. The second portion of the patient tracking device can be or include one or more features detectable by a surgical position recognition system implemented in the operating environment where the patient is being draped. The two connector bodies can connect to each other physically and/or magnetically, thereby forming a joined connector with the drape extending through the cross-section of the connector.
Example connector configurations will be described in greater detail with respect to
One or more patient tracking devices 22 may be attached to patient 14 to monitor the position/orientation of one or more locations of the patient of during the surgical procedure utilizing robotic surgical system 12. Each patient tracking device 22 may carry one or more tracking markers 24. A surgical position recognition system 26 can track the one or more tracking markers 24 carried by each tracking device 22. Addition tracking markers 24 may be attached to track the movement of a robot arm, an end-effector, and/or a surgical instrument in three dimensions in the surgical environment.
In some examples, surgical position recognition system 26 may be implemented using one or more cameras (e.g., mounted on a wall or ceiling surface of the surgical room and/or a movable camera stand). When so implemented, the camera may include any suitable camera or cameras, such as one or more infrared cameras (e.g., bifocal or stereophotogrammetric cameras), able to identify, for example, active and/or passive tracking markers 24 in a given measurement volume viewable from the perspective of the camera. The camera may scan the given measurement volume and detect the light that comes from the markers 24 in order to identify and determine the position of the markers 24 in three-dimensions. For example, active markers 24 may include infrared-emitting markers that are activated by an electrical signal (e.g., infrared light emitting diodes (LEDs)), and passive markers 24 may include retro-reflective markers that reflect infrared light (e.g., reflect incoming IR radiation into the direction of the incoming light), for example, emitted by illuminators on the camera or other suitable device.
In some examples, a plurality of tracking markers 24 can be mounted (or otherwise secured) thereon to an outer surface of the robot, such as, for example, on the base of robot, on the robot arm 104, or on the end-effector of the robot. One or more tracking markers 24 can further be mounted (or otherwise secured) to patient 14 as described herein. In some examples, the plurality of tracking markers 24 can be positioned on the patient 14 spaced apart from the surgical field to reduce the likelihood of being obscured by the surgeon, surgical tools, or other parts of the robot. Further, one or more tracking markers 24 can be further mounted (or otherwise secured) to the surgical tools (e.g., a screw driver, dilator, implant inserter, or the like). Thus, the tracking markers can enable each of the marked objects to be tracked by the robot. In examples, the system can use tracking information collected from each of the marked objects to calculate the orientation and location of the tracked object relative to the relative position of patient 14.
Tracking markers 24 may include radiopaque or optical markers. Tracking markers 24 may be suitably shaped include spherical, spheroid, cylindrical, cube, cuboid, or the like. In some examples, one or more of tracking markers 24 may be optical markers. For example, tracking markers 24 may be infrared light-emitting diodes (LEDs) capable of being tracked using an infrared optical tracking system. Additionally or alternatively, tracking markers 24 can comprise conventional reflective spheres capable of being tracked using an optical tracking system. In some implementations, tracking markers 24 attached to patient 16 are passive reflective markers, such as passive reflective spheres. In either case, light emitted from and/or reflected by tracking markers 24 can be detected by surgical position recognition system 26 (which may be implemented using one or more cameras), and can be used to monitor the location and movement of the marked objects. Tracking markers 24 may be sight devices. Additionally or alternatively, tracking markers 24 can comprise a radio-frequency and/or electromagnetic reflector or transceiver and surgical position recognition system 26 can include or be replaced by a radio-frequency and/or electromagnetic transceiver.
One or more computing devices associated with surgical position recognition system 26 may receive and process information from other components in order to display information to the user. For example, one or more computing devices associated with surgical position recognition system 26 may track the location of certain markers that are located on the different components of system and/or instruments used by a clinician during a surgical procedure relative to the location of the patient also tracked by the system. The location, orientation, and/or position of structures having tracking markers may be provided to the one or more computing devices, which may be displayed to a clinician on display 20 or another display device. For example, a surgical instrument may be shown to a user in relation to a three dimensional image of a patient's anatomical structure.
In the illustrated arrangement of
Connector 54 can connect patient tracking device 22 across drape 52. Connector 54 may include at least two separable pieces that her joinable together to define the connector: one piece positionable on the first side 52A of drape 52 and a second piece positionable on the second side 52B of the drape. In the illustrated arrangement, connector 54 is shown implemented using a first connector body 60 and a second connector body 62 First connector body 60 can be coupled to base 56 of patient tracking device 22. Second connector body 62 can be coupled to head 58 of patient tracking device 22. First connector body 60 is configured to mate with and/or connect to second connector body 62 with drape 52 position between the two connector bodies. When connected together, first connector body 60 and second connector body 62 may be temporarily interlocked such that the two connector bodies are configured to not detach in the absence of a deliberate detaching action by the clinician.
First connector body 60 and second connector body 62 can be configured a variety of different ways to allow the two components to form a connection across the thickness of drape 52. In some implementations, each connector body includes one or more magnets allowing the two connector bodies to magnetically connect to each other across the thickness of drape 52. Additionally or alternatively, each connector body may be configured to physically engage with and/or mechanically interlock with the other connector body to form a connection between the two connector bodies. For example, one connector body may include one or lips, recesses, barbs, tangs, projections, cavities that are configured to engage with (e.g., interlock with) one or complementary and/or corresponding structures on the other connector body with drape 52 interposed between the two connector bodies. Drape 52 may bend, fold, and/or otherwise deform around and/or conform to the size and shape of the interconnection features between the two connector bodies.
Independent of the specific means by which first connector body 60 and second connector body 62 are configured to connect to each other, the two connector bodies may connect to each other with drape 52 positioned between the two connector bodies without piercing the drape. For example, the section of drape 52 positioned between first connector body 60 and second connector body 62 may be a region of continuous drape material devoid of openings extending through the thickness of the drape. First connector body 60 and second connector body 62 can be connected together with drape 52 position between the two connector bodies while maintaining the structural integrity of the drape and the barrier properties provided by the drape. After detaching the two connector bodies from each other after use, the section of drape material previously positioned between the two connector bodies may remain devoid of openings (e.g., punctures, piercings). This can help maintain the sterile barrier provided by the drape when using connector 54.
That being said, in other examples, one connector body may include one or more features configured to puncture through the thickness of drape 52, e.g., and interconnect with one or more complementary features on the other connector body. The connection between the two connector bodies may be sufficiently tight after puncturing drape 52 during interconnection of the two connector bodies that connector 54 occludes the puncture(s) in the resulting assembly provides a sterile barrier for the remainder of the surgical procedure.
Base 56 of patient tracking device 22 may be implemented using any structure configured to directly or indirectly attached to patient 14. Base 56 may be attached to a rigid anatomy of patient 14 and may remain attached throughout the surgical procedure. For example, base 56 may attach to a bone of the patient, such as a bone that is located away from the targeted anatomical structure subject to the surgical procedure. Base 56 may define a shaft configured to be inserted into patient 14. For example, base 56 may define a shaft configured to be inserted percutaneously through the skin of patient 14 into an underlying bone. In other examples, base 56 may attach external to the skin of patient 14.
Head 58 of patient tracking device 22 may be implemented using any structure configured to directly or indirectly attached tracking markers 24. In some examples, head 58 defines a shaft extending outwardly (e.g., orthogonally) from the underlying body of patient 14. The one or more tracking markers 24 can be positioned at any desired location along the length of head 58, including a top surface and/or a side surface of the head.
In some implementations, head 58 defines a tracking array 64 carrying a plurality of tracking markers 24. For example, an array of two, three, four or more tracking markers 24 may be provided on head 58 of patient tracking device 22. Tracking array 64 may include a linear section, a cross piece, and may be asymmetric such that the different tracking markers are at different relative positions and locations with respect to one another on the tracking array.
Base 56 may define a fixed orientation relative to first connector body 60 or may define an adjustable orientation relative to the connector body. Similarly, head 58 may define a fixed orientation relative to second connector body 62 or may define an adjustable orientation relative the connector body. When base 56 and/or head 58 are configured with an adjustable orientation, the clinician may adjust the orientation of the feature relative to the corresponding connector body and then lock the adjusted orientation to hold the position. This can provide flexibility for the clinician to adjust the location of one or more tracking markers 24 after connecting first connector body 60 to second connector body 62.
Patient tracking device 22, including base 56 and head 58, may be sterilizable and reusable multiple times across different patients. When so configured, base 56 may or may not be detachably couplable to first connector body 60 and/or head 58 may or may not be detachably couplable two second connector body 62. Connector 54 may be a single use component intended to be disposed after a single use or, instead, may be a sterilizable connector intended to be reused multiple times with a patient tracking device.
In one implementation, connector 54 is a single use component included with each new drape 52. The clinician can obtain a reusable patient tracking device 22, connect the constituent components of the patient tracking device to connector 54, and use the resulting assembly during a surgical procedure with drape 52. After the surgical procedure, the clinician can detach the constituent components of patient tracking device 22 from connector 54, dispose drape 52 and connector 54, and patient tracking device 22 can be sterilized.
In another implementation, connector 54 may be reusable with patient tracking device 22. When so configured, the constituent components of patient tracking device 22 may or may not be detachable from the constituent components of connector 54. For example, base 56 may be permanently attached to first connector body 60 (e.g., to form a unitary structure not intended to be detached from each other) or the base may be detachably attached to the first connector body (e.g., to form a unitary structure that is intended to be separated into two or more individual components from each other). Likewise, head 58 may be permanently attached to second connector body 62 (e.g., to form a unitary structure not intended to be detached from each other) or the base may be detachably attached to the second connector body (e.g., to form a unitary structure that is intended to be separated into two or more individual components from each other).
Independent of whether base 56 and head 58 are permanently or detachably coupled to first connector body 60 and second connector body 62, respectively, the base and head may be joined to the connector bodies in such a way as to configure the connector bodies to engage with each other. For example, base 56 may define a proximal end 66 to which first connector body 60 is coupled. Head 58 may define a distal end 68 two which second connector body 62 is coupled. A variety of mechanical connection features can be utilized to couple base 56 and head 58 to first connector body 60 and second connector body 62, respectively. For example, screws, pins, adhesive, friction fit, and/or another feature may be used to connect one component of patient tracking device 22 to a corresponding component of connector 54. Alternatively, the component of patient tracking device 22 may be formed with the corresponding component of connector 54 (e.g., by casting, molding, milling, or the like).
In use, first connector body 60 and second connector body 62 can be engaged with each other with drape 52 sandwich between the two connector bodies. For example, first connector body 60 can define a face 70 configured to contact the first side 52A of drape 52. Second connector body 62 can define a face 72 configured to contact the second side 52B of drape 52. Face 70 of first connector body 60 may have a complementary shape to face 72 of second connector body 62. For example, the profile of face 70 of first connector body 60 (e.g., surface features, depth change across the face) may conform to the profile of face 72 of second connector body 62. In one example, face 70 of first connector body 60 has a profile that is a mirror image (e.g., substantially equal and opposite of) the profile of face 72 of second connector body 62. In other examples, face 70 of first connector body 60 has a different profile than the profile of face 72 of second connector body 62, but the two profiles are sufficiently similar and/or indexed relative to each other to allow the two connector bodies to interconnect with each other.
In the illustrated arrangement of
As shown in the example of
With further reference to
In other configurations, first connector body 60 and second connector body 62 may be rotationally fixed relative to each other in only a single rotational position. When so configured, face 70 of first connector body 60 and face 72 of second connector body 62 may need to be rotated relative to each other until the two faces are in one particular relative orientation with respect to each other, with the two faces not indexing with each other in other relative orientations. Such an arrangement can be useful to provide a fixed orientation of head 58, including the one or more tracking markers 24 carried by the head, relative to base 56 attach the patient. For example, if the clinician wants or needs to remove head 58 by detaching second connector body 62 from first connector body 60, the clinician do so and can subsequently reattach the two connector bodies together and position head 58 in the same relative orientation as when the head was removed.
A variety of different features can be implemented to configure first connector body 60 to connect a second connector body 62 in a single rotational orientation position. With further reference to
In addition to or in lieu of configuring the face of first connector body 60 in the face of second connector body 62 to align in one or more specific rotational positions, the connector bodies may be configured with one or more magnetics that are arranged to control the rotational positioning of the two components relative to each other. For example, when first connector body 60 and second connector body 62 each include a magnet radially offset from the geometric center of the connector bodies, the corresponding magnets may align with each other to form a magnetic connection only when the connector bodies are in a specific rotational position.
In some examples, first connector body 60 and/or second connector body 62 include a set of magnets that are positioned to control the relative rotational alignment between the two connector bodies.
First connector body 60 and/or second connector body 62 may have any arcuate (e.g., circular, oval, elliptical) or polygonal (e.g., triangle, square, pentagon, hexagon, octagon) shape, or combinations of arcuate and polygonal shapes. While first connector body 60 may typically be configured to have the same shape as second connector body 62, the two components may have different shapes provided an interlocking connection can be made between the two components. Each connector body may be formed of a polymeric material (e.g., plastic), metal, ceramic, and/or other suitable material.
In general, drape 52 can be made of a sterile (and/or sterilizable) material that can be disposed of after a single use. Drape 52 can be fabricated from any suitable material or combinations of materials. For example, drape 52 may be fabricated from a polymeric material, a fiber cloth (e.g., woven or nonwoven cloth, such as cotton cloth), and/or paper. Example types of polymeric materials that may be used to fabricate drape 52 include, but are not limited to, polyvinyl chloride, polyethylene, polypropylene, polyurethane, polystyrene, and/or polycarbonate. After manufacture but before use, drape 52 may or may not be sterilized to ensure that the drape provides a sterile barrier over patient 14. For example, drape 52 may be subject to a sterilization process, such as steam sterilization, dry heat sterilization, ethylene oxide gas sterilization, or radiation sterilization. Connector 54 may also be sterilized using any of the mentioned sterilization processes.
In some applications, drape 52 and connector 54 are provided as a kit. For example, drape 52 and connector 54 may be provided in a bag or other sterile container. In use, the clinician can open the sterile container, remove connector 54 for use as described herein, and also remove drape 52 to be placed over a patient undergoing a medical procedure. While the preceding discussion has focused on a single patient tracking device 22 and single connector 54, in practice, it should be appreciated that multiple patient tracking devices and multiple connectors 54 may be provided and/or used with drape 52 without departing from the scope of disclosure. Accordingly, any suitable number of connectors (e.g., one, two, three, four, or more) may optionally be provided as part of a kit including drape 52.
In addition, although tracking device 22 has generally been described as a patient tracking device and drape 52 has generally been described as a patient drape, it should be appreciated that the concepts of the disclosure may also be used for nonpatient applications. For example, tracking device 22 may be attached to medical equipment (e.g., a portion of robotic surgical system 12, such as an arm of the robotic surgical system) that is desirably covered by an equipment drape. In these configurations, base 56 of tracking device 22 can be configured to attach, directly or indirectly, to any desired piece of equipment, and drape 52 may be configured to drape any such desired piece of equipment. Accordingly, reference to a patient in the preceding description may be replaced with a corresponding reference to the one or more pieces of surgical equipment or other hardware to be draped and tracked utilizing the concepts described herein.
In use, a clinician can use connector 54 to attach a tracking device 22 across drape 52. The clinician can position first connector body 60 on a first side of drape 52. First connector body 60 can be attached to and/or attachable to base 56 of tracking device 22 (e.g., permanently attached to the base or attached to the base before or after assembly of the connector to the drape). Before or after, the clinician can position second connector body 62 on a second side of drape 52. Second connector body 62 can be attached to and/or attachable to head 58 (e.g., permanently attached to the head or attached to the head before or after assembly of the connector to the drape). The clinician can then interconnect first connector body 60 with second connector body 62.
In some examples, the clinician moves the two connector bodies toward each other (e.g., moves second connector body 62 axially toward first connector body). When configured with magnetic coupling, the two connector bodies may interconnect with each other when the corresponding magnets carried by the two bodies are sufficiently close to each other and/or in appropriate rotational alignment. The clinician may rotate one connector body relative to the other connector body to find an appropriate relative location of the two bodies where physical and/or magnetic alignment exists. In some examples, the clinician presses and/or squeezes the two bodies together. For example, when forming a mechanical interconnection between the two bodies without magnetic coupling, the clinician may press the two connector bodies together to form a mechanical coupling between the two bodies.
Independent of the specific configuration, a connector system according to the disclosure can provide an efficient and effective mechanism for connecting a tracking device across a drape while helping to maintain the sterility and integrity of the drape.
Various examples have been described. These and other examples are within the scope of the following claims.
This application claims the benefit of U.S. Provisional Application No. 63/351,341, filed Jun. 11, 2022, the entire contents of which are incorporated herein by reference.
| Number | Date | Country | |
|---|---|---|---|
| 63351341 | Jun 2022 | US |
