Method and kit for treatment of tissue

Information

  • Patent Grant
  • 7229436
  • Patent Number
    7,229,436
  • Date Filed
    Tuesday, March 25, 2003
    21 years ago
  • Date Issued
    Tuesday, June 12, 2007
    17 years ago
Abstract
These and other objects of the present invention are achieved in a method for creating a desired tissue effect. An RF electrode is provided that includes a conductive portion. The RF electrode is coupled to a fluid delivery member that delivers a cooling fluidic medium to a back surface of the RF electrode. A dielectric is positioned on a skin surface. The RF electrode is coupled with the dielectric. RF energy is delivered from the RF electrode and the dielectric to the skin surface.
Description
FIELD OF THE INVENTION

This invention relates generally to methods and kits used to deliver energy through a skin surface to create a desired tissue effect, and more particularly to methods and kits to create a desired tissue effect using an RF electrode and a dielectric.


DESCRIPTION OF RELATED ART

The human skin is composed of two elements: the epidermis and the underlying dermis. The epidermis with the stratum corneum serves as a biological barrier to the environment. In the basilar layer of the epidermis, pigment-forming cells called melanocytes are present. They are the main determinants of skin color.


The underlying dermis provides the main structural support of the skin. It is composed mainly of an extra-cellular protein called collagen. Collagen is produced by fibroblasts and synthesized as a triple helix with three polypeptide chains that are connected with heat labile and heat stable chemical bonds. When collagen-containing tissue is heated, alterations in the physical properties of this protein matrix occur at a characteristic temperature. The structural transition of collagen contraction occurs at a specific “shrinkage” temperature. The shrinkage and remodeling of the collagen matrix with heat is the basis for the technology. Although the technology can be deployed to effect other changes to the skin, skin appendages (sweat glands, sebaceous glands, hair follicles, etc.), or subcutaneous tissue structures.


Collagen crosslinks are either intramolecular (covalent or hydrogen bond) or intermolecular (covalent or ionic bonds). The thermal cleavage of intramolecular hydrogen crosslinks is a scalar process that is created by the balance between cleavage events and relaxation events (reforming of hydrogen bonds). No external force is required for this process to occur. As a result, intermolecular stress is created by the thermal cleavage of intramolecular hydrogen bonds. Essentially, the contraction of the tertiary structure of the molecule creates the initial intermolecular vector of contraction.


Collagen fibrils in a matrix exhibit a variety of spatial orientations. The matrix is lengthened if the sum of all vectors acts to lengthen the fibril. Contraction of the matrix is facilitated if the sum of all extrinsic vectors acts to shorten the fibril. Thermal disruption of intramolecular hydrogen bonds and mechanical cleavage of intermolecular crosslinks is also affected by relaxation events that restore preexisting configurations. However, a permanent change of molecular length will occur if crosslinks are reformed after lengthening or contraction of the collagen fibril. The continuous application of an external mechanical force will increase the probability of crosslinks forming after lengthening or contraction of the fibril.


Hydrogen bond cleavage is a quantum mechanical event that requires a threshold of energy. The amount of (intramolecular) hydrogen bond cleavage required corresponds to the combined ionic and covalent intermolecular bond strengths within the collagen fibril. Until this threshold is reached, little or no change in the quaternary structure of the collagen fibril will occur. When the intermolecular stress is adequate, cleavage of the ionic and covalent bonds will occur. Typically, the intermolecular cleavage of ionic and covalent bonds will occur with a ratcheting effect from the realignment of polar and nonpolar regions in the lengthened or contracted fibril.


Cleavage of collagen bonds also occurs at lower temperatures but at a lower rate. Low-level thermal cleavage is frequently associated with relaxation phenomena in which bonds are reformed without a net change in molecular length. An external force that mechanically cleaves the fibril will reduce the probability of relaxation phenomena and provides a means to lengthen or contract the collagen matrix at lower temperatures while reducing the potential of surface ablation.


Soft tissue remodeling is a biophysical phenomenon that occurs at cellular and molecular levels. Molecular contraction or partial denaturization of collagen involves the application of an energy source, which destabilizes the longitudinal axis of the molecule by cleaving the heat labile bonds of the triple helix. As a result, stress is created to break the intermolecular bonds of the matrix. This is essentially an immediate extra-cellular process, whereas cellular contraction requires a lag period for the migration and multiplication of fibroblasts into the wound as provided by the wound healing sequence. In higher developed animal species, the wound healing response to injury involves an initial inflammatory process that subsequently leads to the deposition of scar tissue.


The initial inflammatory response consists of the infiltration by white blood cells or leukocytes that dispose of cellular debris. Seventy-two hours later, proliferation of fibroblasts at the injured site occurs. These cells differentiate into contractile myofibroblasts, which are the source of cellular soft tissue contraction. Following cellular contraction, collagen is laid down as a static supporting matrix in the tightened soft tissue structure. The deposition and subsequent remodeling of this nascent scar matrix provides the means to alter the consistency and geometry of soft tissue for aesthetic purposes.


In light of the preceding discussion, there are a number of dermatological procedures that lend themselves to treatments which deliver thermal energy to the skin and underlying tissue to cause a contraction of collagen, and/or initiate a would healing response. Such procedures include skin remodeling/resurfacing, wrinkle removal, and treatment of the sebaceous glands, hair follicles adipose tissue and spider veins.


Currently available technologies that deliver thermal energy to the skin and underlying tissue include Radio Frequency (RF), optical (laser) and other forms of electromagnetic energy as well as ultrasound and direct heating with a hot surface. However, these technologies have a number of technical limitations and clinical issues which limit the effectiveness of the treatment and/or preclude treatment altogether.


These issues include the following: i) achieving a uniform thermal effect across a large area of tissue, ii) controlling the depth of the thermal effect to target selected tissue and prevent unwanted thermal damage to both target and non-target tissue, iii) reducing adverse tissue effects such as bums, redness blistering, iv) replacing the practice of delivery energy/treatment in a patchwork fashion with a more continuous delivery of treatment (e.g. by a sliding or painting motion), v) improving access to difficult-to-reach areas of the skin surface and vi) reducing procedure time and number of patient visits required to complete treatment. As will be discussed herein the current invention provides an apparatus for solving these and other limitations.


One of the key shortcomings of currently available RF technology for treating the skin is the edge effect phenomenon. In general, when RF energy is being applied or delivered to tissue through an electrode which is in contact with that tissue, the current concentrate around the edges of the electrode, sharp edges in particular. This effect is generally known as the edge effect. In the case of a circular disc electrode, the effect manifests as a higher current density around the perimeter of that circular disc and a relatively low current density in the center. For a square-shaped electrode there is typically a high current density around the entire perimeter, and an even higher current density at the corners.


Edge effects cause problems in treating the skin for several reasons. First, they result in a non-uniform thermal effect over the electrode surface. In various treatments of the skin, it is important to have a uniform thermal effect over a relatively large surface area, particularly for dermatological treatments. Large in this case being on the order of several square millimeters or even several square centimeters. In electrosurgical applications for cutting tissue, there typically is a point type applicator designed with the goal of getting a hot spot at that point for cutting or even coagulating tissue. However, this point design is undesirable for creating a reasonably gentle thermal effect over a large surface area. What is needed is an electrode design to deliver uniform thermal energy to skin and underlying tissue without hot spots.


A uniform thermal effect is particularly important when cooling is combined with heating in skin/tissue treatment procedure. As is discussed below, a non-uniform thermal pattern makes cooling of the skin difficult and hence the resulting treatment process as well. When heating the skin with RF energy, the tissue at the electrode surface tends to be warmest with a decrease in temperature moving deeper into the tissue. One approach to overcome this thermal gradient and create a thermal effect at a set distance away from the electrode is to cool the layers of skin that are in contact with the electrode. However, cooling of the skin is made difficult if there is a non-uniform heating pattern.


If the skin is sufficiently cooled such that there are no burns at the corners of a square or rectangular electrode, or at the perimeter of a circular disc electrode, then there will probably be overcooling in the center and there won't be any significant thermal effect (i.e. tissue heating) under the center of the electrode. Contrarily, if the cooling effect is decreased to the point where there is a good thermal effect in the center of the electrode, then there probably will not be sufficient cooling to protect tissue in contact with the edges of the electrode.


As a result of these limitations, in the typical application of a standard electrode there is usually an area of non-uniform treatment and/or burns on the skin surface. So uniformity of the heating pattern is very important. It is particularly important in applications treating skin where collagen-containing layers are heated to produce a collagen contraction response for tightening of the skin. For this and related applications, if the collagen contraction and resulting skin tightening effect are non-uniform, then a medically undesirable result may occur.


There is a need for improved methods and kits for treating tissue sites. There is a further need for improved methods and kits for treating skin tissue.


SUMMARY OF THE INVENTION

Accordingly, an object of the present invention is to provide an improved method and kit for treating tissue.


Another object of the present invention is to provide an improved method and kit for treating skin tissue.


A further object of the present invention is to provide a method and kit for treating skin tissue that utilizes an RF electrode device with a separate dielectric coupled to the RF electrode.


Yet another object of the present invention is to provide a method and kit for treating skin tissue that utilizes an RF electrode and separate dielectric that are capacativly coupled when at least a portion of the dielectric is in contact with a skin surface.


These and other objects of the present invention are achieved in a method for creating a desired tissue effect. An RF electrode is provided that includes a conductive portion. The RF electrode is coupled to a fluid delivery member that delivers a cooling fluidic medium to a back surface of the RF electrode. A dielectric is positioned on a skin surface. The RF electrode is coupled with the dielectric. RF energy is delivered from the RF electrode and the dielectric to the skin surface.


In another embodiment of the present invention, a method for creating a desired tissue effect provides an RF electrode with a back plate and a plurality of electrical contact pads coupled to the back plate. A dielectric is positioned on a skin surface. The RF electrode is coupled to the dielectric. RF energy is delivered from the RF electrode and the dielectric to the skin surface.


In another embodiment of the present invention, a kit is provided. The kit has an RF electrode that includes a conductive portion. The RF electrode is coupled to a fluid delivery member that delivers a cooling fluidic medium to a back surface of the RF electrode.


In another embodiment of the present invention, a kit is provided. The kit includes an RF electrode with a conductive portion and a flex circuit. A dielectric member is included in the kit.


In another embodiment of the present invention, a kit is provided that includes an RF electrode device. The RF electrode device has a support structure, an RF electrode coupled to the support structure and a first sensor coupled to the RF electrode. A dielectric member is included in the kit.


In another embodiment of the present invention, a kit is provided that has an RF electrode device including a support structure, an RF electrode coupled to the support structure and a first sensor coupled to the RF electrode and a non-volatile memory coupled to the support structure. A dielectric member is included in the kit.





BRIEF DESCRIPTION OF THE DRAWINGS


FIG. 1(
a) is a cross-sectional view of one embodiment of the handpiece of the present invention.



FIG. 1(
b) is a cross-sectional view of another embodiment of the RF device with a thermoelectric cooler.



FIG. 2 is an exploded view of the FIG. 1 RF electrode assembly.



FIG. 3(
a) is a close-up view of one embodiment of an RF electrode of the present invention.



FIG. 3(
b) illustrates one embodiment of an RF electrode, that can be utilized with the present invention, with an outer edge geometry configured to reduce an amount of capacitively coupled area the outer edge.



FIG. 3(
c) illustrates an one embodiment of an RF electrode, that can be utilized with the present invention, that has voids where there is little if any conductive material.



FIG. 4 is a cross-sectional view of the RF electrode assembly from FIG. 1.



FIG. 5 is a side view of one embodiment of an RF handpiece assembly of the present invention.



FIG. 6 is a rear view of the FIG. 5 RF electrode assembly.





DETAILED DESCRIPTION

In various embodiments, the present invention provides methods for treating a tissue site. In one embodiment, an energy delivery surface of an energy delivery device is coupled to a skin surface. The coupling can be a direct, in contact, placement of the energy delivery surface of the energy delivery on the skin surface, or distanced relationship between the two with our without a media to conduct energy to the skin surface from the energy delivery surface of the energy delivery device. The skin surface is cooled sufficiently to create a reverse thermal gradient where a temperature of the skin surface is less than an underlying tissue. Energy is delivered from the energy delivery device to the underlying tissue area, resulting in a tissue effect at the skin surface.


Referring now to FIG. 1(a), the methods of present invention can be achieved with the use of a handpiece 10. Handpiece 10 is coupled with a handpiece assembly 12 that includes a handpiece housing 14 and a cooling fluidic medium valve member 16. Handpiece housing 14 is configured to be coupled to an electrode assembly 18. Electrode assembly 18 has a least one RF electrode 20 that is capacitively coupled to a skin surface when at least a portion of RF electrode 20 is in contact with the skin surface. Without limiting the scope of the present invention, RF electrode 20 can have a thickness in the range of 0.010 to 1.0 mm.


Handpiece 10 provides a more uniform thermal effect in tissue at a selected depth, while preventing or minimizing thermal damage to the skin surface and other non-target tissue. Handpiece 10 is coupled to an RF generator. RF electrode 20 can be operated either in mono-polar or bi-polar modes. Handpiece 10 is configured to reduce, or preferably eliminate edge effects and hot spots. The result is an improved aesthetic result/clinical outcome with an elimination/reduction in adverse effects and healing time.


A fluid delivery member 22 is coupled to cooling fluidic medium valve member 16. Fluid delivery member 22 and cooling fluidic medium valve member 16 collectively form a cooling fluidic medium dispensing assembly. Fluid delivery member 22 is configured to provide an atomizing delivery of a cooling fluidic medium to RF electrode 20. The atomizing delivery is a mist or fine spray. A phase transition, from liquid to gas, of the cooling fluidic medium occurs when it hits the surface of RF electrode 20. The transition from liquid to gas creates the cooling. If the transition before the cooling fluidic medium hits RF electrode 20 the cooling of RF electrode 20 will not be as effective.


In another embodiment, illustrated in FIG. 1(b), a thermoelectric cooler 23 is utilized in place of cooling fluidic medium valve member 16 and fluid delivery member 22.


In one embodiment, the cooling fluidic medium is a cryogenic spray, commercially available from Honeywell, Morristown, N.J. A specific example of a suitable cryogenic spray is R134A2, available from Refron, Inc., 38-18 33rd St,, Long Island City, N.Y. 11101. The use of a cryogenic cooling fluidic medium provides the capability to use a number of different types of algorithms for skin treatment. For example, the cryogenic cooling fluidic medium can be applied milliseconds before and after the delivery of RF energy to the desired tissue. This is achieved with the use of cooling fluidic medium valve member 16 coupled to a cryogen supply, including but not limited to a compressed gas canister. In various embodiments, cooling fluidic medium valve member 16 can be coupled to a computer control system and/or manually controlled by the physician by means of a foot switch or similar device.


Providing a spray, or atomization, of cryogenic cooling fluidic medium is particularly suitable because of it provides an availability to implement rapid on and off control. Cryogenic cooling fluidic medium allows more precise temporal control of the cooling process. This is because cooling only occurs when the refrigerant is sprayed and is in an evaporative state, the latter being a very fast short-lived event. Thus, cooling ceases rapidly after the cryogenic cooling fluidic medium is stopped. The overall effect is to confer very precise time on-off control of cryogenic cooling fluidic medium.


Referring now to FIG. 2, fluid delivery member 22 and thermo-electric cooler 23 can be positioned in handpiece housing 14 or electrode assembly 18. Fluid delivery member 22 is configured to controllably deliver a cooling fluidic medium. Fluid delivery member 22 and thermoelectric cooler 23 cool a back surface 24 of RF electrode 20 and maintain back surface 24 at a desired temperature. The cooling fluidic medium evaporatively cools RF electrode 20 and maintains a substantially uniform temperature of front surface 26 of RF electrode 20. Fluid delivery member 22 evaporatively cools back surface 24. Front surface 26 may or may not be flexible and conformable to the skin, but it will still have sufficient strength and/or structure to provide good thermal coupling when pressed against the skin surface.


RF electrode 20 then conductively cools a skin surface that is adjacent to a front surface 26 of RF electrode 20. Suitable fluidic media include a variety of refrigerants such as R134A and freon.


Fluid delivery member 22 is configured to controllably deliver the cooling fluidic medium to back surface 24 at substantially any orientation of front surface 26 relative to a direction of gravity. A geometry and positioning of fluid delivery member 22 is selected to provide a substantially uniform distribution of cooling fluidic medium on back surface 24. The delivery of the cooling fluidic medium can be by spray of droplets or fine mist, flooding back surface 24, and the like. Cooling occurs at the interface of the cooling fluidic medium with atmosphere, which is where evaporation occurs. If there is a thick layer of fluid on back surface 24 the heat removed from the treated skin will need to pass through the thick layer of cooling, fluidic medium, increasing thermal resistance. To maximize cooling rates, it is desirable to apply a very thin layer of cooling fluidic medium. If RF electrode 20 is not horizontal, and if there is a thick layer of cooling fluidic medium, or if there are large drops of cooling fluidic medium on back surface 24, the cooling fluidic medium can run down the surface of RF electrode 20 and pool at one edge or corner, causing uneven cooling. Therefore, it is desirable to apply a thin layer of cooling fluidic medium with a fine spray. Thermo-electric cooler 23 achieves these same results but without delivering a cooling medium. Thermo-electric cooler 23 is cold on the side that is adjacent to or in contact with surface 24, while its opposing side becomes warmer.


In various embodiments, RF electrode 20, as illustrated in FIG. 3(a), has a conductive portion 28 and a dielectric portion 30. Conductive portion 28 can be a metal including but not limited to copper, gold, silver, aluminum and the like. Dielectric portion 30 can be made of a variety of different materials including but not limited to polyimide, Teflon® and the like, silicon nitride, polysilanes, polysilazanes, polyimides, Kapton and other polymers, antenna dielectrics and other dielectric m materials well known in the art. Other dielectric materials include but are not limited to polymers such as polyester, silicon, sapphire, diamond, zirconium-toughened alumina (ZTA), alumina and the like. Dielectric portion 30 can be positioned around at least a portion, or the entirety of a periphery of conductive portion 28. In another embodiment, RF electrode 20 is made of a composite material, including but not limited to gold-plated copper, copper-polyimide, silicon/silicon-nitride and the like.


Dielectric portion 30 creates an increased impedance to the flow of electrical current through RF electrode 20. This increased impedance causes current to travel a path straight down through conductive portion 28 to the skin surface. Electric field edge effects, caused by a concentration of current flowing out of the edges of RF electrode 20, are reduced.


Dielectric portion 30 produces a more uniform impedance through RF electrode 20 and causes a more uniform current to flow through conductive portion 28. The resulting effect minimizes or even eliminates, edge effects around the edges of RF electrode 20. As shown in FIG. 3(c), RF electrode 20 can have voids 33 where there is little or no conductive material. Creating voids 33 in the conductive material alters the electric field. The specific configuration of voids can be used to minimize edge effect, or alter the depth, uniformity or shape of the electric field. Under a portion 28′ of the RF electrode 20 with solid conductive material the electric field is deeper. Under a portion 28″ of RF electrode 20 with more voids, the electric field is shallower. By combining different densities of conductive material, an RF electrode 20 is provided to match the desired heating profile.


In one embodiment, conductive portion 28 adheres to dielectric portion 30 which can be a substrate with a thickness, by way of example and without limitation, of about 0.001″. This embodiment is similar to a standard flex circuit board material commercially available in the electronics industry. In this embodiment, dielectric portion 30 is in contact with the tissue, the skin, and conductive portion 28 is separated from the skin.


The thickness of the dielectric portion 30 can be decreased by growing conductive portion 28 on dielectric portion 30 using a variety of techniques, including but not limited to, sputtering, electro deposition, chemical vapor deposition, plasma deposition and other deposition techniques known in the art. Additionally, these same processes can be used to deposit dielectric portion 30 onto conductive portion 28. In one embodiment dielectric portion 30 is an oxide layer which can be grown on conductive portion 28. An oxide layer has a low thermal resistance and improves the cooling efficiency of the skin compared with many other dielectrics such as polymers.


In various embodiments, RF electrode 20 is configured to inhibit the capacitive coupling to tissue along its outside edge 31. Referring to FIG. 3(b) RF electrode 20 can have an outer edge 31 with a geometry that is configured to reduce an amount of capacitively coupled area at outer edge 31. Outer edge 31 can have less of the conductive portion 28 material. This can be achieved by different geometries, including but not limited to a scalloped geometry, and the like. The total length of outer edge 31 can be increased, with different geometries, and the total area that is capacitively coupled to tissue is reduced. This produces a reduction in energy generation around outer edge 31.


Alternatively, the dielectric material can be applied in a thicker layer at the edges, reducing the electric field at the edges. A further alternative is to configure the cooling to cool more aggressively at the edges to compensate for any electric field edge effect.


Fluid delivery member 22 has an inlet 32 and an outlet 34. Outlet 34 can have a smaller cross-sectional area than a cross-sectional area of inlet 32. In one embodiment, fluid delivery member 22 is a nozzle 36.


Cooling fluidic medium valve member 16 can be configured to provide a pulsed delivery of the cooling fluidic medium. Pulsing the delivery of cooling fluidic medium is a simple way to control the rate of cooling fluidic medium application. In one embodiment, cooling fluidic medium valve member 16 is a solenoid valve. An example of a suitable solenoid valve is a solenoid pinch valve manufactured by the N-Research Corporation, West Caldwell, N.J. If the fluid is pressurized, then opening of the valve results in fluid flow. If the fluid is maintained at a constant pressure, then the flow rate is constant and a simple open/close solenoid valve can be used, the effective flow rate being determined by the pulse duty cycle. A higher duty cycle, close to 100% increases cooling, while a lower duty cycle, closer to 0%, reduces cooling. The duty cycle can be achieved by turning on the valve for a short duration of time at a set frequency. The duration of the open time can be 1 to 50 milliseconds or longer. The frequency of pulsing can be 1 to 50 Hz or faster.


Alternatively, cooling fluidic medium flow rate can be controlled by a metering valve or controllable-rate pump such as a peristaltic pump. One advantage of pulsing is that it is easy to control using simple electronics and control algorithms.


Electrode assembly 18 is sufficiently sealed so that the cooling fluidic medium does not leak from back surface 24 onto a skin surface in contact with a front surface of RF electrode 20. This helps provide an even energy delivery through the skin surface. In one embodiment, electrode assembly 18, and more specifically RF electrode 20, has a geometry that creates a reservoir at back surface 24 to hold and gather cooling fluidic medium that has collected at back surface 24. Back surface 24 can be formed with “hospital corners” to create this reservoir. Optionally, electrode assembly 18 includes a vent that permits vaporized cooling fluidic medium to escape from electrode assembly 18.


The vent prevents pressure from building up in electrode assembly 18. The vent can be a pressure relief valve that is vented to the atmosphere or a vent line. When the cooling fluidic medium comes into contact with RF electrode 20 and evaporates, the resulting gas pressurizes the inside of electrode assembly 18. This can cause RF electrode 20 to partially inflate and bow out from front surface 26. The inflated RF electrode 20 can enhance the thermal contact with the skin and also result in some degree of conformance of RF electrode 20 to the skin surface. An electronic controller can be provided. The electronic controller sends a signal to open the vent when a programmed pressure has been reached.


Various leads 40 are coupled to RF electrode 20. One or more thermal sensors 42 are coupled to RF electrode. Suitable thermal sensors 42 include but are not limited to thermocouples, thermistors, infrared photo-emitters and a thermally sensitive diode. In one embodiment, a thermal sensor 42 is positioned at each corner of RF electrode 20. A sufficient number of thermal sensors 42 are provided in order to acquire sufficient thermal data of the skin surface or the back surface 24 of the electrode 20. Thermal sensors 42 are electrically isolated from RF electrode 20. In another embodiment, at least one sensor 42 is positioned at back surface 24 of RF electrode and detects the temperature of back surface 24 in response to the delivery of cooling fluidic medium.


Thermal sensors 42 measure temperature and can provide feedback for monitoring temperature of RF electrode 20 and/or the tissue during treatment. Thermal sensors 42 can be thermistors, thermocouples, thermally sensitive diodes, capacitors, inductors or other devices for measuring temperature. Preferably, thermal sensors 42 provide electronic feedback to a microprocessor of the RF generator coupled to RF electrode 20 in order to facilitate control of the treatment.


Measurements from thermal sensors 42 can be used to help control the rate of application of cooling fluidic medium. For example, a cooling control algorithm can be used to apply cooling fluidic medium to RF electrode 20 at a high flow rate until the temperature fell below a target temperature, and then slow down or stop. A PID, or proportional-integral-differential, algorithm can be used to precisely control RF electrode 20 temperature to a predetermined value.


Thermal sensors 42 can be positioned on back surface 24 of RF electrode 20 away from the tissue. This configuration is preferable for controlling the temperature of the RF electrode 20. Alternatively, thermal sensors 42 can be positioned on front surface 26 of RF electrode 10 in direct contact with the tissue. This embodiment can be more suitable for monitoring tissue temperature. Algorithms are utilized with thermal sensors 42 to calculate a temperature profile of the treated tissue. Thermal sensors 42 can be used to develop a temperature profile of the skin which is then used for process control purposes to assure that the proper amounts of heating and cooling are delivered to achieve a desired elevated deep tissue temperature while maintaining skin tissue layers below a threshold temperature and avoid thermal injury.


The physician can use the measured temperature profile to assure that he stays within the boundary of an ideal/average profile for a given type of treatment. Thermal sensors 42 can be used for additional purposes. When the temperature of thermal sensors 42 is monitored it is possible to detect when RF electrode 20 is in contact with the skin surface. This can be achieved by detecting a direct change in temperature when skin contact is made or examining the rate of change of temperature which is affected by contact with the skin. Similarly, if there is more than one thermal sensor 42, the thermal sensors 42 can be used to detect whether a portion of RF electrode 20 is lifted or out of contact with skin. This can be important because the current density (amperes per unit area) delivered to the skin can vary if the contact area changes. In particular, if part of the surface of RF electrode 20 is not in contact with the skin, the resulting current density is higher than expected.


Referring again to FIG. 1(a), a force sensor 44 is also coupled to electrode assembly 18. Force sensor 44 detects an amount of force applied by electrode assembly 18, via the physician, against an applied skin surface. Force sensor 44 zeros out gravity effects of the weight of electrode assembly 18 in any orientation of front surface 26 of RF electrode 20 relative to a direction of gravity. Additionally, force sensor 44 provides an indication when RF electrode 20 is in contact with a skin surface. Force sensor 44 also provides a signal indicating that a force applied by RF electrode 20 to a contacted skin surface is, (i) above a minimum threshold or (ii) below a maximum threshold.


As illustrated in FIG. 4, an activation button 46 is used in conjunction with the force sensor. Just prior to activating RF electrode 20, the physician holds handpiece 10 in position just off the surface of the skin. The orientation of handpiece 10 can be any angle relative to the direction of gravity. To arm handpiece 10, the physician can press activation button 46 which tares force sensor 44, by setting it to read zero. This cancels the force due to gravity in that particular treatment orientation. This method allows consistent force application of RF electrode 20 to the skin surface regardless of the angle of handpiece 10 relative to the direction of gravity.


RF electrode 20 can be a flex circuit, which can include trace components. Additionally, thermal sensor 42 and force sensor 44 can be part of the flex circuit. Further, the flex circuit can include a dielectric that forms a part of RF electrode 20.


Electrode assembly 18 can be moveably positioned within handpiece housing 12. In one embodiment, electrode assembly 18 is slideably moveable along a longitudinal axis of handpiece housing 12.


Electrode assembly 18 can be rotatably mounted in handpiece housing 12. Additionally, RF electrode 20 can be rotatably positioned in electrode assembly 18. Electrode assembly 18 can be removably coupled to handpiece housing 12 as a disposable or non-disposable RF device 52.


For purposes of this disclosure, electrode assembly 18 is the same as RF device 52. Once movably mounted to handpiece housing 12, RF device 52 can be coupled to handpiece housing 12 via force sensor 44. Force sensor 44 can be of the type that is capable of measuring both compressive and tensile forces. In other embodiments, force sensor 44 only measures compressive forces, or only measures tensile forces.


RF device 52 can be spring-loaded with a spring 48. In one embodiment, spring 48 biases RF electrode 20 in a direction toward handpiece housing 12. This, pre-loads force sensor 44 and keeps RF device 52 pressed against force sensor 44. The pre-load force is tared when activation button 46 is pressed just prior to application of RF electrode 20 to the skin surface.


A shroud 50 is optionally coupled to handpiece 10. Shroud 50 serves to keep the user from touching RF device 52 during use which can cause erroneous force readings.


A non-volatile memory 54 can be included with RF device 52. Additionally, non-volatile memory can be included with handpiece housing 12. Non-volatile memory 54 can be an EPROM and the like. Additionally, a second non-volatile memory can be included in handpiece housing 12 for purposes of storing handpiece 10 information such as but not limited to, handpiece model number or version, handpiece software version, number of RF applications that handpiece 10 has delivered, expiration date and manufacture date. Handpiece housing 12 can also contain a microprocessor 58 for purposes of acquiring and analyzing data from various sensors on handpiece housing 12 or RF device 52 including but not limited to thermal sensors 42, force sensors 44, fluid pressure gauges, switches, buttons and the like.


Microprocessor 58 can also control components on handpiece 10 including but not limited to lights, LEDs, valves, pumps or other electronic components. Microprocessor 58 can also communicate data to a microprocessor of the RF generator.


Non-volatile memory 54 can store a variety of data that can facilitate control and operation of handpiece 10 and its associated system including but not limited to, (i) controlling the amount of current delivered by RF electrode 20, (ii) controlling the duty cycle of the fluid delivery member 22 and thermo-electric cooler 23, (iii) controlling the energy delivery duration time of the RF electrode 20, (iv) controlling the temperature of RF electrode 20 relative to a target temperature, (v) providing a maximum number of firings of RF electrode 20, (vi) providing a maximum allowed voltage that is deliverable by RF electrode 20, (vii) providing a history of RF electrode 20 use, (viii) providing a controllable duty cycle to fluid delivery member 22 and thermoelectric cooler 23 for the delivery of the cooling fluidic medium to back surface 24 of RF electrode 20, (ix) providing a controllable delivery rate of cooling fluidic medium delivered from fluid delivery member 22 to back surface 24, (x) providing a control of thermoelectric cooler 23 and the like.


Referring now to FIGS. 5 and 6, RF device 52 includes a support structure, including but not limited to a housing 60 that defines the body of RF device 52. RF device 52 can include a back plate 62 that is positioned at a proximal portion of support structure 60. A plurality of electrical contact pads 64 can be positioned at back plate 62. At least a portion of fluid delivery member 22 and thermo-electric cooler 23 can extend through back plate 62. Fluid delivery member 22 can be a channel with a proximal end that is raised above the back surface of back plate 62.


First and second engagement members 64 can also be formed in the body of support structure 60. Engagement members 64 provide engagement and disengagement with handpiece housing 14. Suitable engagement members 64 include but are not limited to snap members, apertures to engage with snap members of substrate support 60, and the like.


Handpiece 10 can be used to deliver thermal energy to modify tissue including, but not limited to, collagen containing tissue, in the epidermal, dermal and subcutaneous tissue layers, including adipose tissue. The modification of the tissue includes modifying a physical feature of the tissue, a structure of the tissue or a physical property of the tissue. The modification can be achieved by delivering sufficient energy to modify collagen containing tissue, cause collagen shrinkage, and/or a wound healing response including the deposition of new or nascent collagen, and the like.


Handpiece 10 can be utilized for performing a number of treatments of the skin and underlying tissue including but not limited to, (i) dermal remodeling and tightening, (ii) wrinkle reduction, (iii) elastosis reduction, (iv) scar reduction, (v) sebaceous gland removal/deactivation and reduction of activity of sebaceous gland, (vi) hair follicle removal, (vii) adipose tissue remodeling/removal, (viii) spider vein removal, (ix) modify contour irregularities of a skin surface, (x) create scar or nascent collagen, (xi) reduction of bacteria activity of skin, (xii) reduction of skin pore size, (xiii) unclog skin pores and the like.


In various embodiments, handpiece 10 can be utilized in a variety of treatment processes, including but not limited to, (i) pre-cooling, before the delivery of energy to the tissue has begun, (ii) an on phase or energy delivery phase in conjunction with cooling and (iii) post cooling after the delivery of energy to tissue has stopped.


Handpiece 10 can be used to pre-cool the surface layers of the target tissue so that when RF electrode 20 is in contact with the tissue, or prior to turning on the RF energy source, the superficial layers of the target tissue are already cooled. When RF energy source is turned on or delivery of RF to the tissue otherwise begins, resulting in heating of the tissues, the tissue that has been cooled is protected from thermal effects including thermal damage. The tissue that has not been cooled will warm up to therapeutic temperatures resulting in the desired therapeutic effect.


Pre-cooling gives time for the thermal effects of cooling to propagate down into the tissue. More specifically, pre-cooling allows the achievement of a desired tissue depth thermal profile, with a minimum desired temperature being achieved at a selectable depth. The amount or duration of pre-cooling can be used to select the depth of the protected zone of untreated tissue. Longer durations of pre-cooling produce a deeper protected zone and hence a deeper level in tissue for the start of the treatment zone. The opposite is true for shorter periods of pre-cooling. The temperature of front surface 26 of RF electrode 20 also affects the temperature profile. The colder the temperature of front surface 26, the faster and deeper the cooling, and vice verse.


Post-cooling can be important because it prevents and/or reduces heat delivered to the deeper layers from conducting upward and heating the more superficial layers possibly to therapeutic or damaging temperature range even though external energy delivery to the tissue has ceased. In order to prevent this and related thermal phenomena, it can be desirable to maintain cooling of the treatment surface for a period of time after application of the RF energy has ceased. In various embodiments, varying amounts of post cooling can be combined with real-time cooling and/or pre-cooling.


In various embodiments, handpiece 10 can be used in a varied number of pulse on-off type cooling sequences and algorithms may be employed. In one embodiment, the treatment algorithm provides for pre-cooling of the tissue by starting a spray of cryogenic cooling fluidic medium, followed by a short pulse of RF energy into the tissue. In this embodiment, the spray of cryogenic cooling fluidic medium continues while the RF energy is delivered, and is stopping shortly thereafter, e.g. on the order of milliseconds. This or another treatment sequence can be repeated again. Thus in various embodiments, the treatment sequence can include a pulsed sequence of cooling on, heat, cooling off, cooling on, heat, cool off, and with cooling and heating durations on orders of tens of milliseconds. In these embodiments, every time the surface of the tissue of the skin is cooled, heat is removed from the skin surface. Cryogenic cooling fluidic medium spray duration, and intervals between sprays, can be in the tens of milliseconds ranges, which allows surface cooling while still delivering the desired thermal effect into the deeper target tissue.


In various embodiments, the target tissue zone for therapy, also called therapeutic zone or thermal effect zone, can be at a tissue depth from approximately 100 μm beneath the surface of the skin down to as deep as 10 millimeters, depending upon the type of treatment. For treatments involving collagen contraction, it can be desirable to cool both the epidermis and the superficial layers of the dermis of the skin that lies beneath the epidermis, to a cooled depth range between 100 μm two millimeters. Different treatment algorithms can incorporate different amounts of pre-cooling, heating and post cooling phases in order to produce a desired tissue effect at a desired depth.


Various duty cycles, on and off times, of cooling and heating are utilized depending on the type of treatment. The cooling and heating duty cycles can be controlled and dynamically varied by an electronic control system known in the art. Specifically the control system can be used to control cooling fluidic medium valve member 16 and the RF power source.


The foregoing description of a preferred embodiment of the invention has been presented for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise forms disclosed. Obviously, many modifications and variations will be apparent to practitioners skilled in this art. It is intended that the scope of the invention be defined by the following claims and their equivalents.

Claims
  • 1. A method for creating a desired tissue effect with an RF electrode having a back surface and coupled on a dielectric material, comprising: cooling the back surface of the RF electrode;positioning the dielectric material on an external skin surface of a body; anddelivering RF energy from the RF electrode by capacitive coupling through the dielectric material and into the skin surface, the cooling and delivering being controlled so as to create a reverse thermal gradient whereby a temperature of the external skin surface is lower than a temperature of underlying tissue.
  • 2. The method of claim 1, wherein cooling the back surface of the RF electrode is accomplished using a thermo-electric cooler.
  • 3. The method of claim 1, further comprising: introducing a conductive media between the RF electrode and the dielectric.
  • 4. The method of claim 1, wherein the RF electrode is coupled to a support structure, the support structure including a back plane coupled to a plurality of electrical contact pads.
  • 5. The method of claim 1, wherein the RF energy is delivered to tissue underlying the external skin surface without creating substantial necrosis at the skin surface.
  • 6. The method of claim 1, wherein cooling the back surface of the RF electrode further comprises: delivering a controllable amount of a cooling fluidic medium to the back surface of the RF electrode.
  • 7. The method of claim 1, wherein cooling the back surface of the RF electrode further comprises: providing an atomizing delivery of a cooling fluidic medium to the back surface of the RF electrode.
  • 8. The method of claim 1, wherein cooling the back surface of the RF electrode further comprises: evaporatively cooling the back surface of the RF electrode and conductively cooling the external skin surface in contact with the dielectric material.
  • 9. The method of claim 1, wherein cooling the back surface of the RF electrode further comprises: delivering a cooling fluidic medium to the back surface of the RF electrode at substantially any orientation of a front surface of the RF electrode relative to a direction of gravity.
  • 10. The method of claim 1, wherein the desired tissue effect is selected from dermal remodeling and tightening, wrinkle reduction, elastosis reduction, scar reduction, sebaceous gland removal, sebaceous deactivation, hair follicle removal, adipose tissue remodeling or removal, spider vein removal, modification of contour irregularities of a skin surface, creation scar or nascent collagen, reduction of bacteria activity of skin, reduction of skin pore size, and unclogging skin pores.
  • 11. The method of claim 1, wherein a temperature of the external skin surface is lower than an underlying collagen containing tissue site.
  • 12. The method of claim 1, wherein RF energy is delivered through the external skin surface to underlying tissue for a sufficient time to induce a change in collagen tissue in the underlying tissue while minimizing cellular necrosis of the external skin surface to create the desired tissue effect.
  • 13. The method of claim 1, wherein the RF electrode includes a metal conductive portion.
  • 14. The method of claim 1, further comprising: a first sensor coupled to the RF electrode.
  • 15. The method of claim 14, further comprising: sensing at least one of a temperature of the back surface of the RF electrode or a temperature of the external skin surface.
  • 16. The method of claim 1, wherein the RF electrode is coupled to a non-volatile memory.
  • 17. A method for creating a desired tissue effect with an RF electrode having a back surface and coupled on a dielectric material, comprising: cooling the back surface of the RF electrode;positioning the dielectric material on an external skin surface of a body;delivering RF energy from the RF electrode by capacitive coupling through the dielectric material and into the skin surface; andcreating a reverse thermal gradient on at least a portion of the skin surface, the reverse thermal gradient cooling the skin surface while heating underlying tissue, wherein a temperature of the skin surface is lower than a temperature of the underlying tissue.
  • 18. The method of claim 17, wherein cooling the back surface of the RF electrode is accomplished using a thermo-electric cooler.
  • 19. The method of claim 17, wherein the RF electrode is coupled to a support structure, the support structure including a back plane coupled to a plurality of electrical contact pads.
  • 20. The method of claim 17, wherein the RF energy is delivered to tissue underlying the skin surface without creating substantial necrosis at the skin surface.
  • 21. The method of claim 17, wherein cooling the back surface of the RF electrode further comprises: delivering a controllable amount of a cooling fluidic medium to the back surface of the RF electrode.
  • 22. The method of claim 17, wherein cooling the back surface of the RF electrode further comprises: providing an atomizing delivery of a cooling fluidic medium to the back surface of the RF electrode.
  • 23. The method of claim 17, wherein cooling the back surface of the RF electrode further comprises: evaporatively cooling the back surface of the RF electrode and conductively cooling the skin surface in contact with the dielectric material.
  • 24. The method of claim 17, wherein cooling the back surface of the RF electrode further comprises: delivering a cooling fluidic medium to the back surface of the RF electrode at substantially any orientation of a front surface of the RF electrode relative to a direction of gravity.
  • 25. The method of claim 17, wherein the desired tissue effect is selected from dermal remodeling and tightening, wrinkle reduction, elastosis reduction, scar reduction, sebaceous gland removal, sebaceous deactivation, hair follicle removal, adipose tissue remodeling or removal, spider vein removal, modification of contour iffegularities of a skin surface, creation scar or nascent collagen, reduction of bacteria activity of skin, reduction of skin pore size, and unclogging skin pores.
  • 26. The method of claim 17, wherein a temperature of the skin surface is lower than an underlying collagen containing tissue site.
  • 27. The method of claim 17, wherein RF energy is delivered through the skin surface to underlying tissue for a sufficient time to induce a change in collagen tissue in the underlying tissue while minimizing cellular necrosis of the skin surface to create the desired tissue effect.
  • 28. The method of claim 17, wherein the RF electrode includes a metal conductive portion.
  • 29. The method of claim 17, further comprising: a first sensor coupled to the RF electrode.
  • 30. The method of claim 29, further comprising: sensing at least one of a temperature of the back surface of the RF electrode or a temperature of the skin surface.
CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. Ser. No. 10/072,475 filed Feb. 6, 2002 now U.S. Pat. No. 7,022,121, and a continuation-in-part of U.S. Ser. No. 10/072,610, filed Feb. 6, 2002, now U.S. Pat. No. 7,141,049, both of which are continuations-in-part of U.S. Ser. No. 09/522,275, filed Mar. 9, 2000, now U.S. Pat. No. 6,413,255, which claims the benefit of U.S. Ser. No. 60/123,440, filed Mar. 9, 1999. This application is also a continuation-in-part of U.S. Ser. No. 10/026,870, filed Dec. 20, 2001, now U.S. Pat. No. 6,749,624, which is a continuation of U.S. Ser. No. 09/337,015, filed Jun. 30, 1999, now U.S. Pat. No. 6,350,276, which is a continuation-in-part of U.S. Ser. No. 08/583,815, filed Jan. 5, 1996, now U.S. Pat. No. 6,241,753, U.S. Ser. No. 08/827,237, filed Mar. 28, 1997, now U.S. Pat. No. 6,430,446, U.S. Ser. No. 08/914,681, filed Aug. 19, 1997, now U.S. Pat. No. 5,919,219, and U.S. Ser. No. 08/942,274, filed Sep. 30, 1997, now U.S. Pat. No. 6,425,912, which are all fully incorporated herein by reference.

US Referenced Citations (314)
Number Name Date Kind
3831604 Ncefe Aug 1974 A
4074718 Morrison Feb 1978 A
4140130 Storm, III Feb 1979 A
4164226 Tapper Aug 1979 A
4290435 Waggott Sep 1981 A
4343301 Indech Aug 1982 A
4346715 Gammell Aug 1982 A
4375220 Matvias Mar 1983 A
4381007 Doss Apr 1983 A
4441486 Pounds Apr 1984 A
4545368 Rand et al. Oct 1985 A
4556070 Vaguine et al. Dec 1985 A
4585237 Koop Apr 1986 A
4633875 Turner Jan 1987 A
4646737 Hussein et al. Mar 1987 A
4676258 Inokuchi et al. Jun 1987 A
4709372 Rando et al. Nov 1987 A
4709701 Weber Dec 1987 A
4756310 Bitterly Jul 1988 A
RE32849 Wei et al. Jan 1989 E
4864098 Basanese et al. Sep 1989 A
4881543 Trembly et al. Nov 1989 A
4887614 Shirakami et al. Dec 1989 A
4889122 Watmough et al. Dec 1989 A
4891820 Rando et al. Jan 1990 A
4944302 Hernandez et al. Jul 1990 A
4957480 Morenings Sep 1990 A
4962761 Golden Oct 1990 A
4976709 Sand Dec 1990 A
5003991 Takayama et al. Apr 1991 A
5011483 Sleister Apr 1991 A
5057104 Chess Oct 1991 A
5100402 Fan Mar 1992 A
5107832 Guibert et al. Apr 1992 A
5131904 Markoll Jul 1992 A
5133351 Masaki Jul 1992 A
5136676 Arnett et al. Aug 1992 A
5143063 Fellner Sep 1992 A
5186181 Franconi et al. Feb 1993 A
5190031 Guibert et al. Mar 1993 A
5190517 Zieve et al. Mar 1993 A
5217455 Tan Jun 1993 A
5230334 Klopotek Jul 1993 A
5231997 Kikuchi et al. Aug 1993 A
5249192 Kuizenga et al. Sep 1993 A
5249575 DiMino et al. Oct 1993 A
5282797 Chess Feb 1994 A
5290273 Tan Mar 1994 A
5300097 Lerner et al. Apr 1994 A
5304169 Sand Apr 1994 A
5304171 Gregory et al. Apr 1994 A
5312395 Tan et al. May 1994 A
5315994 Guibert et al. May 1994 A
5334193 Nardella Aug 1994 A
5342357 Nardella Aug 1994 A
5344418 Ghaffari Sep 1994 A
5348554 Imran et al. Sep 1994 A
5360447 Koop Nov 1994 A
5364394 Mehl Nov 1994 A
5366443 Eggers et al. Nov 1994 A
5370642 Keller Dec 1994 A
5374265 Sand Dec 1994 A
5387176 Markoll Feb 1995 A
5397327 Koop et al. Mar 1995 A
5401272 Perkins Mar 1995 A
5405368 Eckhouse et al. Apr 1995 A
5423807 Milder Jun 1995 A
5423811 Imran et al. Jun 1995 A
5437662 Nardella Aug 1995 A
5454808 Koop et al. Oct 1995 A
5456260 Kollias et al. Oct 1995 A
5458596 Lax et al. Oct 1995 A
5462521 Brucker et al. Oct 1995 A
5464436 Smith Nov 1995 A
5486172 Chess Jan 1996 A
5496312 Klicek Mar 1996 A
5496314 Eggers Mar 1996 A
5500012 Brucker et al. Mar 1996 A
5507790 Weiss Apr 1996 A
5509916 Taylor Apr 1996 A
5522813 Trelles Jun 1996 A
5522814 Bernaz Jun 1996 A
5527308 Anderson et al. Jun 1996 A
5527350 Grove et al. Jun 1996 A
5531739 Trelles Jul 1996 A
5549604 Sutcu et al. Aug 1996 A
5556377 Rosen et al. Sep 1996 A
5556612 Anderson et al. Sep 1996 A
5558667 Yarborough et al. Sep 1996 A
5569242 Lax et al. Oct 1996 A
5571216 Anderson Nov 1996 A
5578029 Trelles et al. Nov 1996 A
5595568 Anderson et al. Jan 1997 A
5599342 Hsia et al. Feb 1997 A
5620478 Eckhouse Apr 1997 A
5626631 Eckhouse May 1997 A
5628744 Coleman et al. May 1997 A
5643334 Eckhouse et al. Jul 1997 A
5649923 Gregory et al. Jul 1997 A
5655547 Karni Aug 1997 A
5660836 Knowlton Aug 1997 A
5669868 Markoll Sep 1997 A
5681282 Eggers et al. Oct 1997 A
5683366 Eggers et al. Nov 1997 A
5683380 Eckhouse et al. Nov 1997 A
5692058 Eggers et al. Nov 1997 A
5693045 Eggers Dec 1997 A
5697281 Eggers et al. Dec 1997 A
5697536 Eggers et al. Dec 1997 A
5697882 Eggers et al. Dec 1997 A
5697909 Eggers et al. Dec 1997 A
5697926 Weaver Dec 1997 A
5720772 Eckhouse Feb 1998 A
5730719 Edwards Mar 1998 A
5735844 Anderson et al. Apr 1998 A
5743901 Grove et al. Apr 1998 A
5746735 Furumoto et al. May 1998 A
5749868 Furumoto May 1998 A
5754573 Yarborough et al. May 1998 A
5755751 Eckhouse May 1998 A
5755753 Knowlton May 1998 A
5769879 Richards et al. Jun 1998 A
5775338 Hastings Jul 1998 A
5776092 Farin et al. Jul 1998 A
5776175 Eckhouse et al. Jul 1998 A
5810801 Anderson et al. Sep 1998 A
5814008 Chen et al. Sep 1998 A
5814040 Nelson et al. Sep 1998 A
5814041 Anderson et al. Sep 1998 A
5820626 Baumgardner Oct 1998 A
5833612 Eckhouse et al. Nov 1998 A
5836999 Eckhouse et al. Nov 1998 A
5843072 Furumoto et al. Dec 1998 A
5843078 Sharkey Dec 1998 A
5849029 Eckhouse et al. Dec 1998 A
5851181 Talmor Dec 1998 A
5871479 Furumoto et al. Feb 1999 A
5879326 Godshall et al. Mar 1999 A
5879346 Waldman et al. Mar 1999 A
5880880 Anderson et al. Mar 1999 A
5885273 Eckhouse et al. Mar 1999 A
5885274 Fullmer et al. Mar 1999 A
5906609 Assa et al. May 1999 A
5911718 Yarborough et al. Jun 1999 A
5919219 Knowlton Jul 1999 A
5925078 Anderson Jul 1999 A
5938657 Assa et al. Aug 1999 A
5948009 Tu Sep 1999 A
5948011 Knowlton Sep 1999 A
5964749 Eckhouse et al. Oct 1999 A
5968034 Fullmer et al. Oct 1999 A
5970983 Karni et al. Oct 1999 A
5979454 Anvari et al. Nov 1999 A
5983900 Clement et al. Nov 1999 A
5995283 Anderson et al. Nov 1999 A
5997530 Nelson et al. Dec 1999 A
6014579 Pomeranz et al. Jan 2000 A
6015404 Altshuler et al. Jan 2000 A
6027495 Miller Feb 2000 A
RE36634 Ghaffari Mar 2000 E
6045548 Furumoto et al. Apr 2000 A
6047215 McClure et al. Apr 2000 A
6050990 Tankovich et al. Apr 2000 A
6053909 Shadduck Apr 2000 A
6066130 Gregory et al. May 2000 A
6077294 Cho et al. Jun 2000 A
6081749 Ingle et al. Jun 2000 A
6090101 Quon et al. Jul 2000 A
6104959 Spertell Aug 2000 A
6120497 Anderson et al. Sep 2000 A
6126655 Domankevitz et al. Oct 2000 A
6129723 Anderson et al. Oct 2000 A
6139569 Ingle et al. Oct 2000 A
6139653 Fernandes et al. Oct 2000 A
6147503 Nelson et al. Nov 2000 A
6159194 Eggers et al. Dec 2000 A
6162212 Kreindel et al. Dec 2000 A
6168590 Neev Jan 2001 B1
6169926 Baker Jan 2001 B1
6171301 Nelson et al. Jan 2001 B1
6183773 Anderson Feb 2001 B1
6187001 Azar et al. Feb 2001 B1
6200308 Pope et al. Mar 2001 B1
6210402 Olsen et al. Apr 2001 B1
6214034 Azar Apr 2001 B1
6228075 Furumoto May 2001 B1
6228078 Eggers et al. May 2001 B1
6235024 Tu May 2001 B1
6240925 McMillan et al. Jun 2001 B1
6241753 Knowlton Jun 2001 B1
6248103 Tannenbaum et al. Jun 2001 B1
6254594 Berry Jul 2001 B1
6267758 Daw et al. Jul 2001 B1
6273883 Furumoto Aug 2001 B1
6273884 Altshuler et al. Aug 2001 B1
6273885 Koop et al. Aug 2001 B1
6275962 Fuller et al. Aug 2001 B1
6277116 Utely et al. Aug 2001 B1
6280438 Eckhouse et al. Aug 2001 B1
6283956 McDaniel Sep 2001 B1
6287305 Heim et al. Sep 2001 B1
6299620 Shadduck et al. Oct 2001 B1
6311090 Knowlton Oct 2001 B1
6334074 Spertell Dec 2001 B1
6336926 Goble Jan 2002 B1
6337998 Behl et al. Jan 2002 B1
6350261 Domankivitz et al. Feb 2002 B1
6350276 Knowlton Feb 2002 B1
6377854 Knowlton Apr 2002 B1
6377855 Knowlton Apr 2002 B1
6381497 Knowlton Apr 2002 B1
6381498 Knowlton Apr 2002 B1
6383176 Connors et al. May 2002 B1
6387089 Kreindel et al. May 2002 B1
6387103 Shadduck May 2002 B2
6387380 Knowlton May 2002 B1
6402739 Neev Jun 2002 B1
6405090 Knowlton Jun 2002 B1
6408212 Neev Jun 2002 B1
6413253 Koop et al. Jul 2002 B1
6413255 Stern Jul 2002 B1
6425912 Knowlton Jul 2002 B1
6430446 Knowlton Aug 2002 B1
6436094 Reuter Aug 2002 B1
6451007 Koop et al. Sep 2002 B1
6453202 Knowlton Sep 2002 B1
6463336 Mawhinney Oct 2002 B1
6485484 Connors et al. Nov 2002 B1
6488696 Cho et al. Dec 2002 B1
6500141 Irion et al. Dec 2002 B1
6508813 Altshuler Jan 2003 B1
6511475 Altshuler et al. Jan 2003 B1
6514243 Eckhouse et al. Feb 2003 B1
6514244 Pope et al. Feb 2003 B2
6527763 Esch et al. Mar 2003 B2
6529543 Anderson et al. Mar 2003 B1
6533775 Rizoiu Mar 2003 B1
6569155 Connors et al. May 2003 B1
6600951 Anderson Jul 2003 B1
6605079 Shanks et al. Aug 2003 B2
6605080 Altshuler et al. Aug 2003 B1
6623454 Eggers et al. Sep 2003 B1
6629974 Penny et al. Oct 2003 B2
6632218 Furumoto et al. Oct 2003 B1
6649904 Hayashi et al. Nov 2003 B2
6653618 Zenzie Nov 2003 B2
6659999 Anderson et al. Dec 2003 B1
6662054 Kreindel et al. Dec 2003 B2
6666856 Connors et al. Dec 2003 B2
6702808 Kreindel Mar 2004 B1
6702838 Andersen et al. Mar 2004 B1
6706032 Weaver et al. Mar 2004 B2
6723090 Altshuler et al. Apr 2004 B2
6743222 Durkin et al. Jun 2004 B2
6749602 Sierra et al. Jun 2004 B2
6749624 Knowlton Jun 2004 B2
6758845 Weckwerth et al. Jul 2004 B1
20010037118 Shadduck Nov 2001 A1
20020016587 Furumoto Feb 2002 A1
20020016601 Shadduck Feb 2002 A1
20020019625 Azar Feb 2002 A1
20020022827 Esch et al. Feb 2002 A1
20020035360 Conners et al. Mar 2002 A1
20020049433 Furumoto et al. Apr 2002 A1
20020065533 Weaver et al. May 2002 A1
20020091377 Anderson et al. Jul 2002 A1
20020111605 Furumoto et al. Aug 2002 A1
20020123743 Shanks et al. Sep 2002 A1
20020123745 Svaasand et al. Sep 2002 A1
20020151887 Stern et al. Oct 2002 A1
20020156471 Stern et al. Oct 2002 A1
20020161357 Anderson et al. Oct 2002 A1
20020161362 Penny et al. Oct 2002 A1
20020183724 Neev Dec 2002 A1
20020183789 Neev Dec 2002 A1
20030023283 McDaniel Jan 2003 A1
20030028186 Kreindel Feb 2003 A1
20030032950 Altshuler et al. Feb 2003 A1
20030036751 Anderson et al. Feb 2003 A1
20030040739 Koop Feb 2003 A1
20030055414 Altshuler et al. Mar 2003 A1
20030059386 Sumain et al. Mar 2003 A1
20030065313 Koop et al. Apr 2003 A1
20030065314 Altshuler et al. Apr 2003 A1
20030069567 Eckhouse et al. Apr 2003 A1
20030097162 Kreindel May 2003 A1
20030129154 McDaniel Jul 2003 A1
20030130710 Baker et al. Jul 2003 A1
20030139740 Kreindel Jul 2003 A1
20030163178 Davison et al. Aug 2003 A1
20030187488 Kreindel et al. Oct 2003 A1
20030199859 Altshuler et al. Oct 2003 A1
20030208326 Chen et al. Nov 2003 A1
20030212393 Knowlton et al. Nov 2003 A1
20030216728 Stem et al. Nov 2003 A1
20030218756 Chen et al. Nov 2003 A1
20030220635 Knowlton et al. Nov 2003 A1
20030220749 Chen et al. Nov 2003 A1
20030233138 Spooner Dec 2003 A1
20030236487 Knowlton Dec 2003 A1
20040000316 Knowlton et al. Jan 2004 A1
20040002704 Knowlton et al. Jan 2004 A1
20040002705 Knowlton et al. Jan 2004 A1
20040015157 Connors et al. Jan 2004 A1
20040030332 Knowlton et al. Feb 2004 A1
20040034319 Anderson et al. Feb 2004 A1
20040034341 Altshuler et al. Feb 2004 A1
20040034346 Stern et al. Feb 2004 A1
20040039379 Viator et al. Feb 2004 A1
20040093042 Altshuler et al. May 2004 A1
20040133251 Altshuler et al. Jul 2004 A1
20040147984 Altshuler et al. Jul 2004 A1
20040162549 Altshuler Aug 2004 A1
20040199226 Shadduck Oct 2004 A1
Foreign Referenced Citations (34)
Number Date Country
1 949 534 Apr 1970 DE
31 21 683 Dec 1982 DE
10082526 Jul 1999 DE
0 395 307 Oct 1990 EP
0 519 415 Dec 1992 EP
1 430 850 Dec 2003 EP
2 609 245 Jul 1988 FR
266678 Dec 1997 NZ
9219414 Nov 1992 WO
9313816 Jul 1993 WO
9426228 Nov 1994 WO
9627240 Sep 1996 WO
9627327 Sep 1996 WO
9632051 Oct 1996 WO
9634568 Nov 1996 WO
WO 9634568 Nov 1996 WO
9639914 Dec 1996 WO
9718765 May 1997 WO
9718768 May 1997 WO
WO 9737602 Oct 1997 WO
6803117 Jan 1998 WO
9803220 Jan 1998 WO
98 05286 Feb 1998 WO
WO 9833558 Aug 1998 WO
99 08614 Feb 1999 WO
WO 9908614 Feb 1999 WO
WO 0044297 Aug 2000 WO
WO 0048644 Aug 2000 WO
WO 0054685 Sep 2000 WO
WO 0054686 Sep 2000 WO
WO 0108545 Feb 2001 WO
WO 0226147 Apr 2002 WO
WO 02064209 Aug 2002 WO
WO 02076318 Oct 2002 WO
Related Publications (1)
Number Date Country
20030199866 A1 Oct 2003 US
Provisional Applications (1)
Number Date Country
60123440 Mar 1999 US
Continuations (1)
Number Date Country
Parent 09337015 Jun 1999 US
Child 09522275 US
Continuation in Parts (8)
Number Date Country
Parent 10072475 Feb 2002 US
Child 10400187 US
Parent 10072610 Feb 2002 US
Child 10072475 US
Parent 10026870 Dec 2001 US
Child 10072610 US
Parent 09522275 Mar 2000 US
Child 10026870 US
Parent 08942274 Sep 1997 US
Child 09337015 US
Parent 08914681 Aug 1997 US
Child 08942274 US
Parent 08827237 Mar 1997 US
Child 08914681 US
Parent 08583815 Jan 1996 US
Child 08827237 US