This invention relates to surgical instruments for applying energy to tissue, and more particularly relates to a system for volumetric removal of tissue by means of high velocity ejection of a vapor media from a first vapor port proximate to soft tissue wherein the vapor-to-liquid phase change of the media applies energy to the tissue. Contemporaneously, the system provides a second port coupled to a suction source that cooperates with the first vapor port to suction tissue debris from the targeted site.
Various types of radiofrequency (Rf) and laser surgical instruments have been developed for delivering thermal energy to tissue, for example to ablate tissue, to cause hemostasis, to weld tissue or to cause a thermoplastic remodeling of tissue. While such prior art forms of energy delivery are suitable for some applications. Rf and laser energy typically cannot cause highly “controlled” and “localized” thermal effects that are desirable in microsurgeries or other precision surgeries. In general, the non-linear or nonuniform characteristics of tissue affect, both laser and Rf energy distributions in tissue.
What is needed for many surgical procedures is an instrument and technique that can controllably deliver energy to tissue for volumetric tissue removal or tissue cutting without the possibility of desiccation or charring of adjacent tissues, and without collateral thermal damage.
The present invention is adapted to provide improved methods of controlled energy delivery to localized tissue volumes, for example for volumetric tissue removal or thermoplastic remodeling of tissue.
In general, the thermally-mediated treatment method comprises causing a vapor-to-liquid phase state change in a selected media at a targeted tissue site thereby applying thermal energy substantially equal to the heat of vaporization of the selected media to said tissue site. The thermally-mediated therapy can be delivered to tissue by such vapor-to-liquid phase transitions, or “internal energy” releases, about the working surfaces of several types of instruments for endoluminal treatments or for soft tissue thermotherapies.
It has been found that the controlled application of internal energies in an introduced media-tissue interaction solves many of the vexing problems associated with energy-tissue interactions in Rf, laser and ultrasound modalities. The apparatus of the invention provides a fluid-carrying chamber in the interior of the device or working end. A source provides liquid media to the interior chamber wherein energy is applied to instantly vaporize the media. In the process of the liquid-to-vapor phase transition of a saline media in the interior of the working end, large amounts of energy are added to overcome the cohesive forces between molecules in the liquid, and an additional amount of energy is requires to expand the liquid 1000+ percent (PΔD) into a resulting vapor phase (see
In
In one embodiment, the system is configured for ablation and extraction of soft tissue, for example in treating a disc. The flow of vapor is controlled by a computer controller to cause a selected pressure, a selected volume of vapor to be ejected from a working end port. Contemporaneous with tissue contact, the vapor undergoes a vapor-to-liquid phase transition which delivers large amount of energy to the targeted tissue to obliterate or ablate the tissue. In one embodiment, the system causes volumetric removal of tissue by high velocity ejection of the vapor media from a first vapor port. The system provides a second port coupled to a suction source that cooperates with the first vapor port to suction tissue debris from the targeted site.
In another embodiment, the invention comprises a flexible micro-catheter device or other member for endoluminal introduction that carries a thermal energy emitter, for example first and second electrodes coupled to an electrical source, within at least one interior bore of the device's working end. In one embodiment, electrical discharges between opposing polarity electrodes are adapted to vaporize, cavitate and expand a fluid media that inflows into and though the interior bore. The working end is adapted for related methods of use in Type “C” embodiments. The Type “C” embodiment is designed to deliver energy to endoluminal media in the form of controlled therapeutic heat, without ohmic (resistive) heating of tissue as in practiced in prior art Rf devices.
In a Type “C” system corresponding to the invention, electrical energy is delivered to interior lumen of the working end that interfaces with pressurized fluid media inflows. In this embodiment, the working end is optimized for therapeutically heating the vessel walls to shrink, occlude or seal the lumen. One use of the Type “C” system is for closure of blood vessels to treat varicose veins. The working end causes controlled thermal effects in the vessel walls by means of superheated vapor that is propagated from the working surface. Advantageously, the peak temperatures cannot exceed about 100° C. which will prevent damage to nerves that extend along targeted vessels. Such nerves can easily be damaged if Rf energy and ohmic heating are used to obliterate blood vessels to treat varicose veins.
The Type “C” system and its method of use also can be used to apply therapeutic heat to vessel wails to treat chronic vascular insufficiency (CVI) or to shrink arterial vascular malformations (AVM) and aneurysms. The Type “C” system and method also can be used to apply therapeutic heat to any duct, cavity, lumen, septae or the like in the body to shrink, collapse or damage the anatomic walls or to fuse together and seal endothelial layers thereof.
Additional advantages of the invention will be apparent from the following description, the accompanying drawings and the appended claims.
1. Type “A” Thermotherapy Instrument
Referring to
In
The second moving component or flexible loop 22B is actuatable by a slidable portion 24a of the loop that extends through a slot 25 in the working end to an actuator in the handle portion 14 as is known in the art (see
Now turning to the fluid-to-gas energy delivery means of the invention, referring to
Of particular interest, still referring to
The electrodes 40A and 40B of working end 10 have opposing polarities and are coupled to Rf generator or electrical source 55.
Operation and use of the working end of
Now turning to
The above electrical energy deliver step is continuous or can be repeated at a high repetition rate to cause a pulsed form of thermal energy delivery in the engaged tissue. The fluid media M inflow may be continuous or pulsed to substantially fill chamber 30 before an electrical discharge is caused therein. The repetition rate of electrical discharges may be from about 1 Hz to 1000 Hz. More preferably, the repetition rate is from about 10 Hz to 200 Hz. The selected repetition rate preferably provides an interval between electrical discharges that allows liar thermal relaxation of tissue, that may range from about 10 ms to 500 ms. The electrical source or voltage source 55 may provide a voltage ranging between about 20 volts and 10,000 volts to cause instant vaporization of the volume of fluid media M captured between the electrode elements 40A and 40B. After a selected time interval of such energy application to tissue T, that may range from about 1 second to 30 seconds, and preferably from about 5 to 20 seconds, the engaged tissue will be contain a core region in which the tissue constituents are denatured and intermixed under relatively high compression between surfaces 20A and 20B. Upon disengagement and cooling of the targeted tissue T, the treated tissue will be fused or welded. Over time, the body's wound healing response will reconstitute the treated tissue by means of fibrosis to create a collagenous volume or scar-like tissue.
2. Type “B” Thermotherapy Instrument
Now referring to
In
In one embodiment, the introducer sleeve 205 is fabricated of a temperature resistant polymer or a metal in combination with a polymeric coating. The introducer sleeve 205 can be rigid, deformable or articulatable as in known in the art. In one embodiment, the introducer sleeve 205 is a metal coated with a polymer having a low thermal conductivity, for example less than about 1.0 W/m-K, and preferably less than about 0.50 W/m-K. In one example, an unreinforced polyetheretherketone (PEEK) has a thermal conductivity of about 0.25 W/m-K and can be used for inner and/or outer layers of the introducer. Alternatively, the introducer sleeve 205 can be of PEEK. PEEK is high temperature resistant engineered thermoplastic with excellent chemical and fatigue resistance plus thermal stability. PEEK had a maximum continuous working temperature of 480° F. and retains its mechanical properties up to 570° F. in high-pressure environments. Other materials used in the introducer can comprise formulations or blends of polymers that include, but are not limited to PTFE, polyethylene terephthalate (PET), or PEBAX, PTFE (polytetrafluoroethylene) is a fluoropolymer which has high thermal stability (up to 260° C.), is chemically inert, has a very low dielectric constant, a very low surface friction and is inherently flame retardant. A range of homo and co-fluoropolymers are commercialized under such names as Teflon®, Tefzel®, Neoflon®, Polyvflon® and Hyflon®. In another embodiment, the introducer sleeve can carry another layer of a suitable thickness that comprises a low thermal conductivity region such as an air gaps, a layer of an insulative ceramic or glass microspheres or fibers, or at least one lumen that carries a cryofluid in communication with a cryogenic fluid source as in known in the art.
Now turning to
The system also includes a negative pressure source 270 that communicates with an outflow channel 276 and outflow lumen 278 in the introducer sleeve, as can be seen in the cut-away view of
Referring to
Turning back to
An optional pressure sensor 288 located at the distal end of the introducer 205 (
In another embodiment and method of the invention, referring to
In the embodiment of
The schematic view of system 400 in
The scope of the invention includes the use valve system 428 and recirculating channel 430 in other embodiments that utilize Rf, laser microwave or other energy deliver mechanisms. For example, in an Rf energy system as in
In another embodiment similar to that of
The scope of the invention included use of the system to apply energy from a phase-change release to tissue for tissue modification in various procedures. The system can be configured with a needle-like working end to treat tumor tissue in a prostate, liver, kidney, breast, lung, vertebra and the like. The system can be configured with a needle-like working end for ablating fibroids. In another embodiment, a very small gauge needle (e.g., 36 ga.) can be used with fiber optic viewing to treat macular degeneration for shrinking and sealing leaking microvasculature. As very small gauge needle also can be used in a vision correction treatment to treat the cornea. A series of spots around the cornea can be targeted with vapor to shrink collagen to create a steepened cornea for treating presbyopia or to treat hyperopia. In another embodiment, the system can use a phase change energy release in an endometrial ablation procedure. In another embodiment, the system can use a small gauge blunt-tipped vapor delivery device that used pulses of vapor to cut brain tissue without causing any collateral thermal damage. A similar device can be used in orthopedic surgery to cut ligaments, cartilage and the like. The system can use in a cutting loop for TURP procedures. The system also can be used for delivering energy to a body lumen such as a blood vessel. In another embodiment, the system can be used to shrink lung tissue to cause lung volume reduction.
3. Type “C” Embodiment of Working End for Energy Delivery.
Now referring to
The working end 100 of
In the system embodiment of
In
As represented in
As shown in
Another advantage of the invention is that the system propagates a therapeutic vapor media from the working end surface 104 that can be imaged using conventional ultrasound imaging systems. This will provide an advantage over other heat transfer mechanisms, such as ohmic heating, that cannot be directly imaged with ultrasound.
The working end 100 and its method of use as depicted in
In another method of the invention, the working end 100 as depicted in
The above Type “C” system and methods have been described for use in endoluminal environments wherein the propagation of heated matter (vapor) can function optimally (i) within a fluid in the lumen, (ii) by displacing the fluid in the lumen, or (iii) by expanding, a space within a collapsed lumen, duct, septae or the like. It should be appreciated that the systems and methods of the invention also can be used to apply energy directly to the interior of soft tissue volumes, for example to kill tumors. The heat vapor will propagate within extracellular spaces to thereby cause therapeutic heating for any purpose.
The Type “C” system described above has opposing polarity electrodes to deliver energy to the inflowing fluid media. In an alternative embodiment (not shown), a resistive element can be used made out of any suitable material such as tungsten. The system can apply high levels of energy to the resistive element that interfaces with the inflowing fluid media. The superheated resistive element can vaporize the fluid media as describe above. The resistive element can be helical, tubular or a microporous structure that allows fluid flow therethrough.
Although particular embodiments of the present invention have been described above in detail, it will be understood that this description is merely for purposes of illustration and the above description of the invention is not exhaustive. Specific features of the invention are shown in some drawings and not in others, and this is for convenience only and any feature may be combined with another in accordance with the invention. A number of variations and alternatives will be apparent to one having ordinary skills in the art. Such alternatives and variations are intended to be included within the scope of the claims. Particular features that are presented in dependent claims can be combined and fall within the scope of the invention. The invention also encompasses embodiments as if dependent claims were alternatively written in a multiple dependent claim format with reference to other independent claims.
This application is a continuation of U.S. patent application Ser. No. 12/255,394 filed Oct. 21, 2008, now U.S. Pat. No. 8,313,485 issued Nov. 20, 2012, which is a continuation of U.S. patent application Ser. No. 11/244,329 filed Oct. 5, 2005, now U.S. Pat. No. 8,016,823 issued Sep. 13, 2011, which claims priority to U.S. Provisional Patent Application No. 60/615,900 filed Oct. 5, 2004 and is a continuation-in-part of U.S. patent application Ser. No. 10/346,877 filed Jan. 18, 2003, now U.S. Pat. No. 6,911,028 issued Jun. 28, 2005, and U.S. patent application Ser. No. 11/244,329 filed Oct. 5, 2005, now U.S. Pat. No. 8,016,823 is also a continuation-in-part of U.S. patent application Ser. No. 10/681,628 filed Oct. 7, 2003, now U.S. Pat. No. 7,674,259 issued Mar. 9, 2010, the contents of which are incorporated herein by reference in their entirety.
Number | Name | Date | Kind |
---|---|---|---|
408899 | Bioch et al. | Aug 1889 | A |
697181 | Smith | Apr 1902 | A |
1719750 | Bridge et al. | Sep 1927 | A |
3818913 | Wallach | Jun 1974 | A |
3880168 | Berman | Apr 1975 | A |
3930505 | Wallach | Jan 1976 | A |
4024866 | Wallach | May 1977 | A |
4083077 | Knight et al. | Apr 1978 | A |
4447227 | Kotsanis | May 1984 | A |
4672962 | Hershenson | Jun 1987 | A |
4682596 | Bales et al. | Jul 1987 | A |
4748979 | Hershenson | Jun 1988 | A |
4773410 | Blackmer et al. | Sep 1988 | A |
4793352 | Eichenlaub | Dec 1988 | A |
4872920 | Flynn et al. | Oct 1989 | A |
4898574 | Uchiyama et al. | Feb 1990 | A |
4915113 | Holman | Apr 1990 | A |
4950266 | Sinofsky | Aug 1990 | A |
4985027 | Dressel | Jan 1991 | A |
5006119 | Acker et al. | Apr 1991 | A |
5011566 | Hoffman | Apr 1991 | A |
5078736 | Behl | Jan 1992 | A |
5084043 | Hertzmann et al. | Jan 1992 | A |
5102410 | Dressel | Apr 1992 | A |
5112328 | Taboada et al. | May 1992 | A |
5122138 | Manwaring | Jun 1992 | A |
5158536 | Sekins et al. | Oct 1992 | A |
5162374 | Mulieri et al. | Nov 1992 | A |
5190539 | Fletcher et al. | Mar 1993 | A |
5217459 | Kamerling | Jun 1993 | A |
5217465 | Steppe | Jun 1993 | A |
5263951 | Spears et al. | Nov 1993 | A |
5277696 | Hagen | Jan 1994 | A |
5298298 | Hoffman | Mar 1994 | A |
5306274 | Long | Apr 1994 | A |
5318014 | Carter | Jun 1994 | A |
5331947 | Shturman | Jul 1994 | A |
5334190 | Seiler | Aug 1994 | A |
5344397 | Heaven et al. | Sep 1994 | A |
5348551 | Spears et al. | Sep 1994 | A |
5352512 | Hoffman | Oct 1994 | A |
5417686 | Peterson et al. | May 1995 | A |
5424620 | Cheon et al. | Jun 1995 | A |
5433708 | Nichols et al. | Jul 1995 | A |
5433739 | Sluijter | Jul 1995 | A |
5462521 | Brucker et al. | Oct 1995 | A |
5500012 | Brucker et al. | Mar 1996 | A |
5503638 | Cooper et al. | Apr 1996 | A |
5524620 | Rosenschein | Jun 1996 | A |
5529076 | Schachar | Jun 1996 | A |
5542928 | Evans et al. | Aug 1996 | A |
5549628 | Cooper et al. | Aug 1996 | A |
5554172 | Horner et al. | Sep 1996 | A |
5562608 | Sekins et al. | Oct 1996 | A |
5575803 | Cooper et al. | Nov 1996 | A |
5584872 | LaFontaine et al. | Dec 1996 | A |
5591157 | Hennings et al. | Jan 1997 | A |
5591162 | Fletcher et al. | Jan 1997 | A |
5616120 | Andrew et al. | Apr 1997 | A |
5620440 | Heckele et al. | Apr 1997 | A |
5669907 | Platt, Jr. et al. | Sep 1997 | A |
5681282 | Eggers et al. | Oct 1997 | A |
5683366 | Eggers et al. | Nov 1997 | A |
5695507 | Auth et al. | 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 |
5700262 | Acosta et al. | Dec 1997 | A |
5707352 | Sekins et al. | Jan 1998 | A |
5735811 | Brisken | Apr 1998 | A |
5741247 | Rizoiu et al. | Apr 1998 | A |
5741248 | Stern et al. | Apr 1998 | A |
5752965 | Francis et al. | May 1998 | A |
5755753 | Knowlton | May 1998 | A |
5782914 | Schankereli | Jul 1998 | A |
5785521 | Rizoiu et al. | Jul 1998 | A |
5800482 | Pomeranz et al. | Sep 1998 | A |
5810764 | Eggers et al. | Sep 1998 | A |
5824703 | Clark, Jr. | Oct 1998 | A |
5827268 | Laufer | Oct 1998 | A |
5836896 | Rosenschein | Nov 1998 | A |
5843019 | Eggers et al. | Dec 1998 | A |
5843073 | Sinofsky | Dec 1998 | A |
5871469 | Eggers et al. | Feb 1999 | A |
5879329 | Ginsburg | Mar 1999 | A |
5885243 | Capetan et al. | Mar 1999 | A |
5888198 | Eggers et al. | Mar 1999 | A |
5891095 | Eggers et al. | Apr 1999 | A |
5891134 | Goble et al. | Apr 1999 | A |
5913856 | Chia et al. | Jun 1999 | A |
5938660 | Swartz et al. | Aug 1999 | A |
5944686 | Patterson et al. | Aug 1999 | A |
5944715 | Goble et al. | Aug 1999 | A |
5957919 | Laufer | Sep 1999 | A |
5964752 | Stone | Oct 1999 | A |
5968037 | Rizoiu | Oct 1999 | A |
5980504 | Sharkey et al. | Nov 1999 | A |
5986662 | Argiro et al. | Nov 1999 | A |
5989212 | Sussman et al. | Nov 1999 | A |
5989238 | Ginsburg | Nov 1999 | A |
5989249 | Kirwan | Nov 1999 | A |
5989445 | Wise et al. | Nov 1999 | A |
5997499 | Sussman et al. | Dec 1999 | A |
6024095 | Stanley, III | Feb 2000 | A |
6024733 | Eggers et al. | Feb 2000 | A |
6027501 | Goble et al. | Feb 2000 | A |
6032077 | Pomeranz | Feb 2000 | A |
6032674 | Eggers et al. | Mar 2000 | A |
6047700 | Eggers et al. | Apr 2000 | A |
6053909 | Shadduck | Apr 2000 | A |
6056746 | Goble et al. | May 2000 | A |
6059011 | Giolo | May 2000 | A |
6063079 | Hovda et al. | May 2000 | A |
6063081 | Mulier et al. | May 2000 | A |
6066134 | Eggers et al. | May 2000 | A |
6066139 | Ryan et al. | May 2000 | A |
6074358 | Andrew et al. | Jun 2000 | A |
6080128 | Sussman et al. | Jun 2000 | A |
6080151 | Swartz et al. | Jun 2000 | A |
6083255 | Laufer et al. | Jul 2000 | A |
6095149 | Sharkey et al. | Aug 2000 | A |
6099251 | LaFleur | Aug 2000 | A |
6102046 | Weinstein et al. | Aug 2000 | A |
6102885 | Bass | Aug 2000 | A |
6106516 | Bmassengill | Aug 2000 | A |
6110162 | Sussman et al. | Aug 2000 | A |
6113722 | Hoffman et al. | Sep 2000 | A |
6126682 | Sharkey et al. | Oct 2000 | A |
6130671 | Argiro | Oct 2000 | A |
6139571 | Fuller et al. | Oct 2000 | A |
6149620 | Baker et al. | Nov 2000 | A |
6156036 | Sussman et al. | Dec 2000 | A |
6159194 | Eggers et al. | Dec 2000 | A |
6162232 | Shadduck | Dec 2000 | A |
6168594 | LaFontaine et al. | Jan 2001 | B1 |
6174308 | Goble et al. | Jan 2001 | B1 |
6179805 | Sussman et al. | Jan 2001 | B1 |
6190381 | Olsen et al. | Feb 2001 | B1 |
6194066 | Hoffman | Feb 2001 | B1 |
6196989 | Padget et al. | Mar 2001 | B1 |
6200333 | Laufer | Mar 2001 | B1 |
6206848 | Sussman et al. | Mar 2001 | B1 |
6210404 | Shadduck | Apr 2001 | B1 |
6210405 | Goble et al. | Apr 2001 | B1 |
6219059 | Argiro | Apr 2001 | B1 |
6224592 | Eggers et al. | May 2001 | B1 |
6231567 | Rizoiu et al. | May 2001 | B1 |
6235020 | Cheng et al. | May 2001 | B1 |
6238391 | Olsen et al. | May 2001 | B1 |
6254597 | Rizoiu et al. | Jul 2001 | B1 |
6261286 | Goble et al. | Jul 2001 | B1 |
6261311 | Sharkey et al. | Jul 2001 | B1 |
6264650 | Hovda et al. | Jul 2001 | B1 |
6264651 | Underwood et al. | Jul 2001 | B1 |
6264654 | Swartz et al. | Jul 2001 | B1 |
6277112 | Underwood et al. | Aug 2001 | B1 |
6283910 | Bradshaw et al. | Sep 2001 | B1 |
6283961 | Underwood et al. | Sep 2001 | B1 |
6283989 | Laufer et al. | Sep 2001 | B1 |
6287274 | Sussman et al. | Sep 2001 | B1 |
6290715 | Sharkey et al. | Sep 2001 | B1 |
6296636 | Cheng et al. | Oct 2001 | B1 |
6296638 | Davidson et al. | Oct 2001 | B1 |
6299633 | Laufer | Oct 2001 | B1 |
6300150 | Venkatasubramanian | Oct 2001 | B1 |
6312408 | Eggers et al. | Nov 2001 | B1 |
6312474 | Francis et al. | Nov 2001 | B1 |
6315755 | Sussman | Nov 2001 | B1 |
6319222 | Andrew et al. | Nov 2001 | B1 |
6327505 | Medhkour et al. | Dec 2001 | B1 |
6331171 | Cohen | Dec 2001 | B1 |
6355032 | Hovda et al. | Mar 2002 | B1 |
6375635 | Moutafis et al. | Apr 2002 | B1 |
6379350 | Sharkey et al. | Apr 2002 | B1 |
6391025 | Weinstein et al. | May 2002 | B1 |
6394949 | Crowley et al. | May 2002 | B1 |
6394996 | Lawrence et al. | May 2002 | B1 |
6398759 | Sussman et al. | Jun 2002 | B1 |
6398775 | Perkins et al. | Jun 2002 | B1 |
6409723 | Edwards | Jun 2002 | B1 |
6416508 | Eggers et al. | Jul 2002 | B1 |
6458231 | Wapner et al. | Oct 2002 | B1 |
6461350 | Underwood et al. | Oct 2002 | B1 |
6464694 | Massengil | Oct 2002 | B1 |
6464695 | Hovda et al. | Oct 2002 | B2 |
6468270 | Hovda et al. | Oct 2002 | B1 |
6468274 | Alleyne et al. | Oct 2002 | B1 |
6468313 | Claeson et al. | Oct 2002 | B1 |
6482201 | Olsen et al. | Nov 2002 | B1 |
6482202 | Goble et al. | Nov 2002 | B1 |
6488673 | Laufer et al. | Dec 2002 | B1 |
6493589 | Medhkour et al. | Dec 2002 | B1 |
6500173 | Underwood et al. | Dec 2002 | B2 |
6508816 | Shadduck | Jan 2003 | B2 |
6517568 | Sharkey et al. | Feb 2003 | B1 |
6522930 | Schaer et al. | Feb 2003 | B1 |
6527761 | Soltesz et al. | Mar 2003 | B1 |
6527766 | Bair | Mar 2003 | B1 |
6540741 | Underwood et al. | Apr 2003 | B1 |
6544211 | Andrew et al. | Apr 2003 | B1 |
6544248 | Bass | Apr 2003 | B1 |
6547810 | Sharkey et al. | Apr 2003 | B1 |
6558379 | Batchelor et al. | May 2003 | B1 |
6575929 | Sussman et al. | Jun 2003 | B2 |
6575968 | Eggers et al. | Jun 2003 | B1 |
6579270 | Sussman et al. | Jun 2003 | B2 |
6582423 | Thapliyal et al. | Jun 2003 | B1 |
6585639 | Kotmel et al. | Jul 2003 | B1 |
6588613 | Pechenik et al. | Jul 2003 | B1 |
6589201 | Sussman et al. | Jul 2003 | B1 |
6589204 | Sussman et al. | Jul 2003 | B1 |
6592594 | Rimbaugh et al. | Jul 2003 | B2 |
6595990 | Weinstein et al. | Jul 2003 | B1 |
6599311 | Biggs et al. | Jul 2003 | B1 |
6602248 | Sharps et al. | Aug 2003 | B1 |
6605087 | Swartz et al. | Aug 2003 | B2 |
6610043 | Ingenito | Aug 2003 | B1 |
6620130 | Ginsburg | Sep 2003 | B1 |
6620155 | Underwood et al. | Sep 2003 | B2 |
6623444 | Babaev | Sep 2003 | B2 |
6632193 | Davison et al. | Oct 2003 | B1 |
6632220 | Eggers et al. | Oct 2003 | B1 |
6634363 | Danek et al. | Oct 2003 | B1 |
6648847 | Sussman et al. | Nov 2003 | B2 |
6652594 | Francis et al. | Nov 2003 | B2 |
6653525 | Ingenito et al. | Nov 2003 | B2 |
6659106 | Hovda et al. | Dec 2003 | B1 |
6669685 | Rizoiu et al. | Dec 2003 | B1 |
6669694 | Shadduck | Dec 2003 | B2 |
6676628 | Sussman et al. | Jan 2004 | B2 |
6676629 | Andrew et al. | Jan 2004 | B2 |
6679264 | Deem et al. | Jan 2004 | B1 |
6679879 | Shadduck | Jan 2004 | B2 |
6682520 | Ingenito | Jan 2004 | B2 |
6682543 | Barbut et al. | Jan 2004 | B2 |
6692494 | Cooper et al. | Feb 2004 | B1 |
6695839 | Sharkey et al. | Feb 2004 | B2 |
6699212 | Kadziauskas et al. | Mar 2004 | B1 |
6699244 | Carranza et al. | Mar 2004 | B2 |
6712811 | Underwood et al. | Mar 2004 | B2 |
6712812 | Roschak et al. | Mar 2004 | B2 |
6719738 | Mehier | Apr 2004 | B2 |
6719754 | Underwood et al. | Apr 2004 | B2 |
6723064 | Babaev | Apr 2004 | B2 |
6726684 | Woloszko et al. | Apr 2004 | B1 |
6726708 | Lasheras | Apr 2004 | B2 |
6746447 | Davison et al. | Jun 2004 | B2 |
6755794 | Soukup | Jun 2004 | B2 |
6758846 | Goble et al. | Jul 2004 | B2 |
6763836 | Tasto et al. | Jul 2004 | B2 |
6764487 | Mulier et al. | Jul 2004 | B2 |
6766202 | Underwood et al. | Jul 2004 | B2 |
6770070 | Balbierz | Aug 2004 | B1 |
6772012 | Woloszko et al. | Aug 2004 | B2 |
6776765 | Soukup et al. | Aug 2004 | B2 |
6780180 | Goble et al. | Aug 2004 | B1 |
6805130 | Tasto et al. | Oct 2004 | B2 |
6813520 | Truckai et al. | Nov 2004 | B2 |
6832996 | Woloszko et al. | Dec 2004 | B2 |
6837884 | Woloszko | Jan 2005 | B2 |
6837888 | Ciarrocca et al. | Jan 2005 | B2 |
6852108 | Barry et al. | Feb 2005 | B2 |
6860847 | Alferness et al. | Mar 2005 | B2 |
6860868 | Sussman et al. | Mar 2005 | B1 |
6875194 | MacKool | Apr 2005 | B2 |
6896674 | Woloszko et al. | May 2005 | B1 |
6896675 | Leung et al. | May 2005 | B2 |
6901927 | Deem et al. | Jun 2005 | B2 |
6904909 | Andreas et al. | Jun 2005 | B2 |
6907881 | Suki et al. | Jun 2005 | B2 |
6911028 | Shadduck | Jun 2005 | B2 |
6918903 | Bass | Jul 2005 | B2 |
6921385 | Clements et al. | Jul 2005 | B2 |
6929640 | Underwood et al. | Aug 2005 | B1 |
6949096 | Davison et al. | Sep 2005 | B2 |
6955675 | Jain | Oct 2005 | B2 |
6960182 | Moutafis et al. | Nov 2005 | B2 |
6962584 | Stone et al. | Nov 2005 | B1 |
6972014 | Eum et al. | Dec 2005 | B2 |
6978174 | Gelfand et al. | Dec 2005 | B2 |
6986769 | Nelson et al. | Jan 2006 | B2 |
6991028 | Comeaux et al. | Jan 2006 | B2 |
6991631 | Woloszko et al. | Jan 2006 | B2 |
7022088 | Keast et al. | Apr 2006 | B2 |
7031504 | Argiro et al. | Apr 2006 | B1 |
7083612 | Littrup et al. | Aug 2006 | B2 |
7094249 | Broome et al. | Aug 2006 | B1 |
7128748 | Mooradian et al. | Oct 2006 | B2 |
7136064 | Zuiderveld | Nov 2006 | B2 |
7144402 | Kuester, III | Dec 2006 | B2 |
7144588 | Oray et al. | Dec 2006 | B2 |
7162303 | Levin et al. | Jan 2007 | B2 |
7192400 | Campbell et al. | Mar 2007 | B2 |
7233820 | Gilboa | Jun 2007 | B2 |
7235070 | Vanney | Jun 2007 | B2 |
7311708 | McClurken | Dec 2007 | B2 |
7335195 | Mehier | Feb 2008 | B2 |
7347859 | Garabedian et al. | Mar 2008 | B2 |
7524315 | Blott et al. | Apr 2009 | B2 |
7549987 | Shadduck | Jun 2009 | B2 |
7585295 | Ben-Nun | Sep 2009 | B2 |
7617005 | Demarais et al. | Nov 2009 | B2 |
7620451 | Demarais et al. | Nov 2009 | B2 |
7647115 | Levin et al. | Jan 2010 | B2 |
7653438 | Deem et al. | Jan 2010 | B2 |
7674259 | Shadduck | Mar 2010 | B2 |
7717948 | Demarais et al. | May 2010 | B2 |
7756583 | Demarais et al. | Jul 2010 | B2 |
7815616 | Boehringer et al. | Oct 2010 | B2 |
7815646 | Hart | Oct 2010 | B2 |
7853333 | Demarais | Dec 2010 | B2 |
7873417 | Demarais et al. | Jan 2011 | B2 |
7892229 | Shadduck et al. | Feb 2011 | B2 |
7937143 | Demarais et al. | May 2011 | B2 |
7993323 | Barry et al. | Aug 2011 | B2 |
8016823 | Shadduck | Sep 2011 | B2 |
8131371 | Demarals et al. | Mar 2012 | B2 |
8131372 | Levin et al. | Mar 2012 | B2 |
8145316 | Deem et al. | Mar 2012 | B2 |
8145317 | Demarais et al. | Mar 2012 | B2 |
8150518 | Levin et al. | Apr 2012 | B2 |
8150519 | Demarais et al. | Apr 2012 | B2 |
8150520 | Demarais et al. | Apr 2012 | B2 |
8175711 | Demarais et al. | May 2012 | B2 |
8187269 | Shadduck et al. | May 2012 | B2 |
8192424 | Woloszko | Jun 2012 | B2 |
8313485 | Shadduck | Nov 2012 | B2 |
8444636 | Shadduck et al. | May 2013 | B2 |
8574226 | Shadduck | Nov 2013 | B2 |
8579888 | Hoey et al. | Nov 2013 | B2 |
8579892 | Hoey et al. | Nov 2013 | B2 |
8579893 | Hoey | Nov 2013 | B2 |
20010020167 | Woloszko et al. | Sep 2001 | A1 |
20010029370 | Hodva et al. | Oct 2001 | A1 |
20010037106 | Shadduck | Nov 2001 | A1 |
20020049438 | Sharkey et al. | Apr 2002 | A1 |
20020077516 | Flanigan | Jun 2002 | A1 |
20020078956 | Sharpe et al. | Jun 2002 | A1 |
20020082667 | Shadduck | Jun 2002 | A1 |
20020095152 | Ciarrocca et al. | Jul 2002 | A1 |
20020111386 | Sekins et al. | Aug 2002 | A1 |
20020128638 | Chauvet et al. | Sep 2002 | A1 |
20020133147 | Marchitto et al. | Sep 2002 | A1 |
20020161326 | Sussman et al. | Oct 2002 | A1 |
20020177846 | Mulier et al. | Nov 2002 | A1 |
20020193789 | Underwood et al. | Dec 2002 | A1 |
20030028189 | Woloszko et al. | Feb 2003 | A1 |
20030040742 | Underwood et al. | Feb 2003 | A1 |
20030097126 | Woloszko et al. | May 2003 | A1 |
20030097129 | Davison et al. | May 2003 | A1 |
20030099279 | Venkatasubramanian et al. | May 2003 | A1 |
20030109869 | Shadduck | Jun 2003 | A1 |
20030130655 | Woloszko et al. | Jul 2003 | A1 |
20030130738 | Hovda et al. | Jul 2003 | A1 |
20030144654 | Hilal | Jul 2003 | A1 |
20030158545 | Hovda et al. | Aug 2003 | A1 |
20030163178 | Davison et al. | Aug 2003 | A1 |
20030181922 | Alferness | Sep 2003 | A1 |
20030212394 | Pearson et al. | Nov 2003 | A1 |
20030212395 | Woloszko et al. | Nov 2003 | A1 |
20030225364 | Kraft et al. | Dec 2003 | A1 |
20040024398 | Hovda et al. | Feb 2004 | A1 |
20040024399 | Sharps et al. | Feb 2004 | A1 |
20040031494 | Danek et al. | Feb 2004 | A1 |
20040038868 | Ingenito | Feb 2004 | A1 |
20040047855 | Ingenito | Mar 2004 | A1 |
20040049180 | Sharps et al. | Mar 2004 | A1 |
20040054366 | Davison et al. | Mar 2004 | A1 |
20040055606 | Hendricksen et al. | Mar 2004 | A1 |
20040068256 | Rizoiu et al. | Apr 2004 | A1 |
20040068306 | Shadduck | Apr 2004 | A1 |
20040087937 | Eggers et al. | May 2004 | A1 |
20040116922 | Hovda et al. | Jun 2004 | A1 |
20040193150 | Sharkey et al. | Sep 2004 | A1 |
20040199226 | Shadduck | Oct 2004 | A1 |
20040230190 | Dahla et al. | Nov 2004 | A1 |
20040254532 | Mehier | Dec 2004 | A1 |
20050004634 | Ricart et al. | Jan 2005 | A1 |
20050010205 | Hovda et al. | Jan 2005 | A1 |
20050070894 | McClurken | Mar 2005 | A1 |
20050119650 | Sanders et al. | Jun 2005 | A1 |
20050166925 | Wilson et al. | Aug 2005 | A1 |
20050171582 | Matlock | Aug 2005 | A1 |
20050187543 | Underwood et al. | Aug 2005 | A1 |
20050215991 | Altman et al. | Sep 2005 | A1 |
20050222485 | Shaw et al. | Oct 2005 | A1 |
20050228423 | Khashayar et al. | Oct 2005 | A1 |
20050228424 | Khashayar et al. | Oct 2005 | A1 |
20050240171 | Forrest | Oct 2005 | A1 |
20050267467 | Paul et al. | Dec 2005 | A1 |
20050283143 | Rizoiu | Dec 2005 | A1 |
20060004400 | McGurk et al. | Jan 2006 | A1 |
20060047291 | Barry | Mar 2006 | A1 |
20060085054 | Zikorus et al. | Apr 2006 | A1 |
20060100619 | McClurken et al. | May 2006 | A1 |
20060130830 | Barry | Jun 2006 | A1 |
20060135955 | Shadduck | Jun 2006 | A1 |
20060142783 | Lewis et al. | Jun 2006 | A1 |
20060161233 | Barry et al. | Jul 2006 | A1 |
20060200076 | Gonzalez et al. | Sep 2006 | A1 |
20060206150 | Demarais et al. | Sep 2006 | A1 |
20060224154 | Shadduck et al. | Oct 2006 | A1 |
20060271111 | Demarais et al. | Nov 2006 | A1 |
20070032785 | Diederich et al. | Feb 2007 | A1 |
20070036417 | Argiro et al. | Feb 2007 | A1 |
20070091087 | Zuiderveld | Apr 2007 | A1 |
20070129720 | Demarais et al. | Jun 2007 | A1 |
20070129760 | Demarais et al. | Jun 2007 | A1 |
20070129761 | Demarais et al. | Jun 2007 | A1 |
20070135875 | Demarais et al. | Jun 2007 | A1 |
20070265687 | Deem et al. | Nov 2007 | A1 |
20080033493 | Deckman et al. | Feb 2008 | A1 |
20080097429 | McClurken | Apr 2008 | A1 |
20080103566 | Mehier | May 2008 | A1 |
20080110457 | Barry et al. | May 2008 | A1 |
20080114297 | Barry et al. | May 2008 | A1 |
20080125747 | Prokop | May 2008 | A1 |
20080132826 | Shadduck et al. | Jun 2008 | A1 |
20080213331 | Gelfand et al. | Sep 2008 | A1 |
20080255642 | Zarins et al. | Oct 2008 | A1 |
20090036948 | Levin et al. | Feb 2009 | A1 |
20090054871 | Sharkey et al. | Feb 2009 | A1 |
20090062873 | Wu et al. | Mar 2009 | A1 |
20090076409 | Wu et al. | Mar 2009 | A1 |
20090105702 | Shadduck | Apr 2009 | A1 |
20090105703 | Shadduck | Apr 2009 | A1 |
20090125009 | Zikorus et al. | May 2009 | A1 |
20090149846 | Hoey et al. | Jun 2009 | A1 |
20090216220 | Hoey et al. | Aug 2009 | A1 |
20090306640 | Glaze et al. | Dec 2009 | A1 |
20090312753 | Shadduck | Dec 2009 | A1 |
20100076416 | Hoey et al. | Mar 2010 | A1 |
20100094270 | Sharma | Apr 2010 | A1 |
20100114083 | Sharma | May 2010 | A1 |
20100137860 | Demarais et al. | Jun 2010 | A1 |
20100137952 | Demarais et al. | Jun 2010 | A1 |
20100160905 | Shadduck | Jun 2010 | A1 |
20100168731 | Wu et al. | Jul 2010 | A1 |
20100168739 | Wu et al. | Jul 2010 | A1 |
20100174282 | Demarais et al. | Jul 2010 | A1 |
20100179528 | Shadduck et al. | Jul 2010 | A1 |
20100185189 | Hoey | Jul 2010 | A1 |
20100191112 | Demarais et al. | Jul 2010 | A1 |
20100204688 | Hoey et al. | Aug 2010 | A1 |
20100222851 | Deem et al. | Sep 2010 | A1 |
20100222854 | Demarais et al. | Sep 2010 | A1 |
20100249773 | Clark et al. | Sep 2010 | A1 |
20100262133 | Hoey et al. | Oct 2010 | A1 |
20100268307 | Demarais et al. | Oct 2010 | A1 |
20110060324 | Wu et al. | Mar 2011 | A1 |
20110077628 | Hoey et al. | Mar 2011 | A1 |
20110112400 | Emery et al. | May 2011 | A1 |
20110118717 | Shadduck | May 2011 | A1 |
20110160648 | Hoey | Jun 2011 | A1 |
20110166499 | Demarais et al. | Jul 2011 | A1 |
20110178570 | Demarais | Jul 2011 | A1 |
20110200171 | Beetel et al. | Aug 2011 | A1 |
20110202098 | Demarais et al. | Aug 2011 | A1 |
20110208096 | Demarais et al. | Aug 2011 | A1 |
20110257564 | Demarais et al. | Oct 2011 | A1 |
20110264011 | Wu et al. | Oct 2011 | A1 |
20110264075 | Leung et al. | Oct 2011 | A1 |
20110264090 | Shadduck et al. | Oct 2011 | A1 |
20120065632 | Shadduck | Mar 2012 | A1 |
20120101413 | Beetel et al. | Apr 2012 | A1 |
20120101538 | Ballakur et al. | Apr 2012 | A1 |
20120116382 | Ku et al. | May 2012 | A1 |
20120116383 | Mauch et al. | May 2012 | A1 |
20120116486 | Naga et al. | May 2012 | A1 |
20120130289 | Demarais et al. | May 2012 | A1 |
20120130345 | Levin et al. | May 2012 | A1 |
20120130359 | Turovskiy | May 2012 | A1 |
20120130360 | Buckley et al. | May 2012 | A1 |
20120130458 | Ryba et al. | May 2012 | A1 |
20120136344 | Buckley et al. | May 2012 | A1 |
20120136350 | Goshgarian et al. | May 2012 | A1 |
20120136417 | Buckley et al. | May 2012 | A1 |
20120136418 | Buckley et al. | May 2012 | A1 |
20120143181 | Demarais et al. | Jun 2012 | A1 |
20120143293 | Mauch et al. | Jun 2012 | A1 |
20120150267 | Buckley et al. | Jun 2012 | A1 |
20120158104 | Huynh et al. | Jun 2012 | A1 |
20120172837 | Demarais et al. | Jul 2012 | A1 |
20120197198 | Demarais et al. | Aug 2012 | A1 |
20120197252 | Deem et al. | Aug 2012 | A1 |
20120259271 | Shadduck et al. | Oct 2012 | A1 |
20130116683 | Shadduck et al. | May 2013 | A1 |
20130237978 | Shadduck et al. | Sep 2013 | A1 |
20140018890 | Hoey et al. | Jan 2014 | A1 |
20140025057 | Hoey et al. | Jan 2014 | A1 |
20140031805 | Shadduck | Jan 2014 | A1 |
Number | Date | Country |
---|---|---|
WO 0011927 | Mar 2000 | WO |
WO 0029055 | May 2000 | WO |
WO 02069821 | Sep 2002 | WO |
WO 03070302 | Aug 2003 | WO |
WO 03086498 | Oct 2003 | WO |
WO 2005025635 | Mar 2005 | WO |
WO 2005102175 | Nov 2005 | WO |
WO 2006003665 | Jan 2006 | WO |
WO 2006055695 | May 2006 | WO |
WO 2009009398 | Jan 2009 | WO |
Entry |
---|
Coda, et al., “Effects of pulmonary reventilation on gas exchange after cryolytic disobstruction of endobronchial tumors,” Minerva Medical, vol. 72, pp. 1627-1631, Jun. 1981 (with English translation). |
Fishman et al,, “A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema,” N Engl J Med, vol. 348, No. 21, pp. 2059-2073, May 22, 2003. |
Homasson, et al., “Bronchoscopic cryotherapy for airway strictures caused by tumors,” Chest, vol. 90, No. 2, pp. 159-164, Aug. 1986. |
Li, K., “Efficient optimal net surface detection for image segmentation—from theory to practice,” M.Sc. Thesis, The University of Iowa, 2003. |
Marasso, et al., “Cryosurgery in bronchoscopic treatment of tracheobronchial stenosis,” Chest, vol. 103, No. 2, pp. 472-474, Feb. 1993. |
Marasso, et al., “Radiefrequency resection of bronchial tumours in combination with cryotherapy: evaluation of a new technique,” Thorax, vol. 53, pp. 106-109, 1998. |
Mathur et al., “Fiberoptic bronchoscopic cryotherapy in the management of tracheobronchial obstruction,” Chest, vol. 110, No. 3, pp. 718-723, Sep. 1996. |
Morice et al. “Endobtinchial argon plasma coagulation for treatment of hemotysis and neoplastic airway obstruction,” Chest, vol. 119, No. 3, pp. 781-787, Mar. 2001. |
Moulding et al., “Preliminary studies for achieving transcervical oviduct occlusion by hot water or low-pressure steam,” Advancesin Planned Parenthood, vol. 12, No. 2; pp. 79-85, 1977. |
Quin, J., “Use of neodymium yttrium aluminum garnet laser in long-term palliation of airway obstruction,” Connecticut Medicine, vol. 59, No. 7, pp. 407-412, Jul. 1995. |
Sutedja, et al., “Bronchoscopic treatment of lung tumors,” Elsevier, Lung Cancer, 11, pp. 1-17, 1994. |
Tschirren et al.; “Intrathoracic airway trees: segmentation and airway morphology analysis from low-dose CT scans;” IEEE Trans. Med. Imaging, vol. 24, No. 12; pp. 1529-1539, Dec. 2005. |
Tschirren, J., “Segmentation, anatomical labeling, branchpoint matching, and quantitative analysis of human airway trees in volumetric CT images,” Ph.D. Thesis, The University of Iowa, 231 pages, Aug. 2003. |
Tschirren, J., “Segmentation, anatomical labeling, branchpoint matching, and quantitative analysis of human airway trees in volumetric CT images,” Slides from Ph.D. defense, University of Iowa, 130 pages, Aug. 2003. |
Unger, M. et al. “Monolithic Microfabncated Valves and Pumps by Multilayer Soft Lithography,” Science, vol. 288, pp. 113-116, Apr. 7, 2000, accessed at http://web.mit.edu/thorsen/www/113.pdf. |
Xia, Y. et al. “Soft Lithography,” Annu. Rev. Mater. Sci., vol. 28, pp. 153-184, 1998, accessed at http://www.bwfoundry.com.xia.pdf. |
Number | Date | Country | |
---|---|---|---|
20130079772 A1 | Mar 2013 | US |
Number | Date | Country | |
---|---|---|---|
60615900 | Oct 2004 | US |
Number | Date | Country | |
---|---|---|---|
Parent | 12255394 | Oct 2008 | US |
Child | 13681193 | US | |
Parent | 11244329 | Oct 2005 | US |
Child | 12255394 | US |
Number | Date | Country | |
---|---|---|---|
Parent | 10681628 | Oct 2003 | US |
Child | 11244329 | US | |
Parent | 10346877 | Jan 2003 | US |
Child | 10681628 | US |