Needle biopsy device

Information

  • Patent Grant
  • 9186128
  • Patent Number
    9,186,128
  • Date Filed
    Wednesday, October 1, 2008
    16 years ago
  • Date Issued
    Tuesday, November 17, 2015
    9 years ago
Abstract
A device for needle biopsy is provided. The device includes a handle member having proximal and distal portions. A proximal handle member is disposed to the proximal portion of the handle member and a distal handle member is disposed to the distal portion of the handle member. A sheath lumen is disposed within the handle member and extends from the distal portion of the handle member. A needle housing member is partially disposed to the proximal portion of the handle member and a needle is disposed within the sheath lumen. A plurality of protrusions are disposed upon the needle.
Description
BACKGROUND

1. Technical Field


The present disclosure generally relates to the biopsy devices, and more particularly, needle biopsy devices for collecting tissue, fluid, and cell samples in conjunction with procedures such as endoscopic ultrasound or endoscopic bronchial ultrasound.


2. Background of the Invention


Endoscopic ultrasounds have been used for more than twenty five years within the field of medicine. These procedures allow clinicians to scan, locate and identify individual layers of the gastrointestinal (GI) tract and determine the location of individual mucosal and submucosal layers. As a result, appropriate therapeutic modes of treatment for malignancies and various abnormalities may be determined.


An endoscopic ultrasound procedure consist of several steps. First, a clinician sedates a patient and inserts a probe via esophagogastroduodenoscopy into the patient's stomach and duodenum. Second, an endoscope is passed through the patient's mouth and advanced to the level of the duodenum. Third, from various positions between the esophagus and duodenum, organs or masses outside the gastrointestinal tract are imaged to determine abnormalities. Fourth, organs or masses can be biopsed through the process of “fine needle aspiration” (FNA) if any abnormalities are present.


Endoscopic ultrasounds and endoscopic bronchial ultrasounds through fine needle aspiration are presently the standard modes of treatment in the field of gastrointestinal endoscopy and bronchoscopy. These procedures traditionally result in high yields of sensitivity and specificity in the management of indications of diseases such as esophageal cancer, pancreatic cancer, liver mass, non-small cell lung cancer, pancreatic mass, endobronchial mass, and intra-abdominal lymph nodes.


An endoscopic ultrasound through fine needle aspiration requires a device that is attached to the luer port or working channel of a typical echoendoscope. Prior art devices utilize a series of push and pull handles to control the axial movement of the catheter shaft of the device and the depth of needle penetration. These devices, however, suffer from several drawbacks.


First, the means of attaching a device to an echoendoscope is cumbersome. For example, these devices presently utilize male fitting adapters that must be screwed onto a female luer port of an endoscope. Second, prior art devices provide sub-optimal ergonomics of use. More specifically, a clinician must actuate a number of handles independently and lock respective handles in position via cap screw arrangement to secure the device. The cumulative actions required by a clinician result in significantly drawn out procedures. Third, needles commonly kink or deform during removal from a device causing numerous delays and failures. Fourth, multiple passes per procedure are required, which prolong the procedure and result in a clinician needing to reconfirm the location of a needle relative to a desired aspiration site with each new pass.


Additionally, prior art devices are not designed to individually accommodate needles of various diameters. Specifically, a device must be removed from an endoscope during a procedure if a clinician chooses to utilize multiple needle sizes. For example, a clinician may begin an endoscopic ultrasound procedure with: 1) a device having a needle with a diameter of 19 AWG; 2) aspirate; 3) remove the needle housing member from the device; 4) remove the device from the endoscope; 5) attach a new device to the endoscope and insert a needle having a diameter of 22 AWG; and 6) track the needle through the device's sheath lumen and continue the procedure. In this instance, absent removing the device from an endoscope, the difference in the clearance between the inner diameter of the sheath and the outer diameter of the needle will increase when moving from a large needle to a smaller needle. As a result, instability in the ability of the needle to puncture a desired lesion or cyst can result causing increased manipulation time for the clinician and loss of procedural efficiency.


Therefore, a need exists for an improved device for use in endoscopic ultrasound procedures.


SUMMARY

Accordingly, a device for needle biopsy is provided for collecting tissue, fluid, and cell samples in conjunction with procedures such as an endoscopic ultrasound or endoscopic bronchial ultrasound.


In a first aspect, a device for needle biopsy comprises a handle member having proximal and distal portions, a proximal handle member disposed to the proximal portion of the handle member, and a distal handle member disposed to the distal portion of the handle member. A sheath lumen is disposed within the handle member and extends from the distal portion of the handle member. Additionally, a needle housing member is partially disposed to the proximal portion of the handle member. A needle is also disposed within the sheath lumen and a plurality of protrusions are disposed thereon.


In one embodiment, a plurality of protrusions can be distributed along the length of the needle. Alternatively, the plurality of protrusions may be located at a consistent increment over the length of the needle. Additionally, the protrusions can be distributed on at least a portion of the length of the needle.


In another embodiment, at least a portion of the needle can include a tapered region for increasing the overall dimension of the needle. The tapered region and the sheath lumen may provide interference for creating stability for the needle as it passes through the sheath lumen. The interference can be a drag force creating frictional resistance between an outer diameter of the needle and an inner diameter of the sheath lumen. In another embodiment, at least a portion of the needle may also include materials or design features to enhance echogenicity and ultrasonic visibility. In a further embodiment, a stylet is disposed within the needle.


In a second aspect, a device for needle biopsy comprises a handle member having proximal and distal portions, a proximal handle member disposed to the proximal portion of the handle member, and a distal handle member disposed to the distal portion of the handle member. A sheath lumen is disposed within the handle member and extends from the distal portion of the handle member. Additionally, a needle housing member is partially disposed to the proximal portion of the handle member. Furthermore, a needle is disposed within the sheath lumen and at least a portion of the needle is surrounded by a polymer.


In one embodiment, a polymer may be comprised of lubricous materials. The polymer may also increase the overall dimension of the needle to create stability for the needle as it passes through the sheath lumen. In another embodiment, at least a portion of the needle may also include materials or design features to enhance echogenicity and ultrasonic visibility. In a further embodiment, a stylet is disposed within the needle.


In a third aspect, a device for needle biopsy comprises a handle member having proximal, distal, and stop portions, a proximal handle member disposed to the proximal portion of the handle member, and a distal handle member disposed to the distal portion of the handle member. The proximal handle member is configured for slideable engagement to the proximal portion of the handle member and includes a friction member. The friction member engages at least one indentation of a first series of indentations along the proximal portion of the handle member to limit slideable movement. The distal handle member is configured for slideable engagement to the distal portion of the handle member and includes friction members. The friction members engages at least one indentation of a second series of indentations along the distal portion of the handle member to limit slideable movement. A sheath lumen is disposed within the handle member and extends from the distal portion of the handle member. A needle housing member is partially disposed to the proximal portion of the handle member and includes a needle that is disposed within the sheath lumen.


In one embodiment, at least one indentation of the first series of indentations may represent the length by which the needle extends beyond a distal portion of the sheath member. Additionally, at least one indentation of the second series of indentations may represent the length by which the sheath member extends beyond the distal portion of the distal handle member.


In another embodiment, a stop portion of the handle member is disposed between the proximal and distal handle members. The stop portion can prevent axial movement of the proximal handle member into the distal handle member and axial movement of the distal handle member into the proximal handle member.


In another embodiment, friction members may include a male indentation having a mating end configured to engage to a female indentation. The friction member may also include a female indentation having a mating end configured to engage to a male indentation. In another embodiment, at least a portion of the needle may also include materials or design features to enhance echogenicity and ultrasonic visibility. In a further embodiment, a stylet is disposed within the needle.


In a fourth aspect, a device for needle biopsy comprises a handle member having proximal and distal portions, a proximal handle member disposed to the proximal portion of the handle member, and a distal handle member disposed to the distal portion of the handle member. The distal handle member includes a connector having a release member that connects axially to a medical device and engages and disengages to a channel port of the medical device. Additionally, a sheath lumen is disposed within the handle member and extends from the distal portion of the handle member. Furthermore, a needle housing member is partially disposed to the proximal portion of the handle member and includes a needle that is disposed within the sheath lumen.


In one embodiment, a channel port may be a luer port of the medical device. In another embodiment, a connector may include at least two adaptations to connect to the medical device. The two adaptations may also connect relative to the longitudinal axis of the medical device. In another embodiment, the connector is disposed to the distal portion of the distal handle member. The release member may also be depressible. In another embodiment, at least a portion of the needle may also include materials or design features to enhance echogenicity and ultrasonic visibility. In a further embodiment, a stylet is disposed within the needle.


In a fifth aspect, a device for needle biopsy comprises a handle member having proximal and distal portions, a proximal handle member disposed to the proximal portion of the handle member, and a distal handle member disposed to the distal portion of the handle member. The proximal handle member includes at least one adaptation member. A sheath lumen is disposed within the handle member and extends from the distal portion of the handle member. A needle housing member is partially disposed to the proximal portion of the handle member that is moveable in a substantially transverse direction relative to the longitudinal axis of the handle member. The needle housing member includes a needle that is disposed within the sheath lumen and a strain relief member.


In one embodiment, a needle housing member may include at least one indentation for engaging to at least one adaptation member. In another embodiment, a needle housing member can detach from the proximal handle member by moving the needle housing member in the substantially transverse direction. This movement can cause at least one indentation to disengage from at least one adaptation member.


In another embodiment, the proximal handle member can include a release member that engages and disengages the needle housing member. Additionally, the release member may also be depressible. In other embodiments, the strain relief member may provide a semi-flexible transition between at least one adaptation member and the needle to reduce deformation of the needle during removal from the proximal handle member. In another embodiment, at least a portion of the needle may also include materials or design features to enhance echogenicity and ultrasonic visibility. In a further embodiment, a stylet is disposed within the needle.


In a sixth aspect, a device for needle biopsy comprises a handle member having proximal and distal portions, a proximal handle member disposed to the proximal portion of the handle member, and a distal handle member disposed to the distal portion of the handle member. A sheath lumen is disposed within the handle member and extends from the distal portion of the handle member. A needle housing member is partially disposed to the proximal portion of the handle member that is moveable in a substantially transverse direction relative to the longitudinal axis of the handle member. A needle having a plurality of protrusions disposed thereon is disposed within the sheath lumen.


In one embodiment, a plurality of protrusions may be distributed along the length of the needle. The plurality of protrusions may also be located at a consistent increment over the length of the needle. Additionally, the protrusions may be distributed on at least a portion of the length of the needle.


In another embodiment, at least a portion of the needle can include a tapered region for increasing the overall dimension of the needle. The tapered region and the sheath lumen can provide interference for creating stability for the needle as it passes through the sheath lumen. This interference may be a drag force creating frictional resistance between an outer diameter of the needle and an inner diameter of the sheath lumen.


In another embodiment, a needle housing member can include at least one indentation for engaging to at least one adaptation member. The needle housing member can detach from the proximal handle member by moving the needle housing member in a substantially transverse direction, thereby causing at least one indentation to disengage from at least one adaptation. The proximal handle member may also include a release member that engages and disengages the needle housing member. Additionally, the release member may be depressible. In another embodiment, a strain relief member reduces a drag force between the needle and sheath lumen as the needle is removed from the sheath lumen. In other embodiments, at least a portion of the needle may also include materials or design features to enhance echogenicity and ultrasonic visibility. In a further embodiment, a stylet is disposed within the needle.


In a seventh aspect, a device for needle biopsy comprises a handle member having proximal and distal portions, a proximal handle member disposed to the proximal portion of the handle member, and a distal handle member disposed to the distal portion of the handle member. The proximal handle member is configured for slideable engagement to the proximal portion of the handle member and includes a friction member. The friction member engages at least one indentation of a first series of indentations along the proximal portion of the handle member to limit slideable movement. The distal handle member is configured for slideable engagement to the distal portion of the handle member and includes a friction member. The friction member engages at least one indentation of a second series of indentations along the distal portion of the handle member to limit slideable movement. A sheath lumen is disposed within the handle member and extends from the distal portion of the handle member. A needle housing member is partially disposed to the proximal portion of the handle member. A needle including a plurality of protrusions disposed thereon is disposed within the sheath lumen. At least a portion of the needle is surrounded by a polymer.





BRIEF DESCRIPTION OF THE DRAWINGS

The objects and features of the present disclosure, which are believed to be novel, are set forth with particularity in the appended claims. The present disclosure, both as to its organization and manner of operation, together with further objectives and advantages, may be best understood by reference to the following description, taken in connection with the accompanying drawings as set forth below:



FIG. 1 is a perspective view of a needle biopsy device;



FIG. 2 is a perspective view of a handle member;



FIG. 3 is a cross-sectional view of a proximal portion of a handle member;



FIG. 4 is a cross-sectional view of a proximal portion of a handle member and a proximal handle member;



FIG. 5 is a cross-sectional view of an assembled proximal portion of a needle biopsy device;



FIG. 6 is a partial cross-sectional view of an assembled distal portion of a needle biopsy device;



FIG. 7 is a perspective view of an assembled distal portion of a needle biopsy device;



FIG. 8 is a cross-sectional view of a connector according to another embodiment of the invention;



FIG. 9 is a perspective view of a connector according to another embodiment of the invention;



FIG. 10 is a cross-sectional view of a connector according to another embodiment of the invention;



FIG. 11 is a partial cross-sectional view of a disassembled distal portion of the invention;



FIG. 12 is a perspective view of a needle housing member;



FIG. 13 is a perspective view of a needle housing member according to another embodiment of the invention;



FIG. 14 is a perspective view of a needle housing member according to another embodiment of the invention;



FIG. 15 is a perspective view of a needle housing member according to another embodiment of the invention;



FIG. 16 is a cross-sectional view of a needle housing member according to another embodiment of the invention;



FIG. 17 is a perspective view of a sheath lumen;



FIG. 18 is a cross-sectional view of a needle according to another embodiment of the invention;



FIG. 19 is a cross-sectional view of a needle according to another embodiment of the invention;



FIG. 20 is a cross-sectional view of a needle according to another embodiment of the invention; and



FIG. 21 is a cross-sectional view of a needle according to another embodiment of the invention.





DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS

The exemplary embodiments of the needle biopsy device and methods of operation disclosed are discussed in terms of needle biopsy devices for collecting tissue, fluid, and cell samples from a body in conjunction with an endoscopic ultrasound or endoscopic bronchial ultrasound. It is envisioned that the present disclosure, however, finds application to a wide variety of biopsy devices for the collection of samples from a subject. It is also envisioned that the present disclosure may be employed for collection of body fluids including those employed during procedures relating to phlebotomy, digestive, intestinal, urinary, veterinary, etc. It is contemplated that the needle biopsy device may be utilized with other needle biopsy applications including, but not limited to, fluid collection, catheters, catheter introducers, spinal and epidural biopsy, aphaeresis, dialysis, etc.


In the discussion that follows, the term “proximal” refers to a portion of a structure that is closer to a clinician, and the term “distal” refers to a portion that is further from the clinician. According to the present disclosure, the term “clinician” refers to an individual performing sample collection, installing or removing a needle from a needle biopsy device, and may include support personnel. Reference will now be made in detail to exemplary embodiments of the disclosure, which are illustrated in the accompanying figures.


Referring to FIG. 1, a needle biopsy device 10 is provided for fine needle aspiration during procedures such as endoscopic ultrasound. The device 10 is generally comprised of a handle 12, a proximal handle member 14, a distal handle member 16, a sheath lumen 18, a needle housing member 20, a stylet 21, a needle 22, and a connector 24.


In one embodiment, a clinician connects the device 10 to another medical device via the connector 24. The clinician subsequently inserts the needle housing member 20, which includes the stylet 21 and the needle 22, into the proximal portion of the proximal handle member 14. The stylet 21 may be, but is not limited to, a removable coaxial thin wire which is passed within the lumen of the needle 22. It is envisioned that the stylet 21 may provide rigidity and stability to the needle 22. Additionally, it is contemplated that the stylet 21 can protect the needle 22 from damage or inadvertent collection of samples.


Upon passing the needle 22 through the sheath lumen 18, the clinician may slideably manipulate the proximal handle member 14 and the distal handle member 16 along the axis of the handle 12. At this juncture, the clinician may lock the proximal handle member 14 and the distal handle member 16 at various depths along the handle 12. Movement of the proximal handle member 14 causes the needle 22 to extend from the distal portion of the sheath 18. Additionally, movement of the distal handle member 16 adjusts the depth of exposure of the sheath 18. A clinician may subsequently withdraw the stylet 21 from the needle housing member 20 and begin needle aspiration.


Referring to FIG. 2, the handle 12 includes a proximal portion 26, a distal portion 30, and a stop portion 28. The handle 12 may be monolithically formed and injection molded from a rigid polymer such as acrylonitrile butadiene styrene, polystyrene, polyetherketone, polyamide, polyethersulfone, polyurethane, ether block amide copolymers, polyacetal, and derivatives thereof. It is contemplated that the handle 12 can be integrally assembled of multiple sections and may be substantially transparent, opaque, etc. The handle 12 may also be variously configured and dimensioned such as, for example, rectangular, spherical, tapered etc.


The handle 12 can be joined by any appropriate process such as, for example, snap fit, adhesive, solvent weld, thermal weld, ultrasonic weld, screw, rivet, etc. In this configuration, the handle 12 is presented wherein the proximal portion 26, the distal portion 30, and the stop portion 28 are joined through a snap fit process. In one embodiment, the handle 12 is assembled by inserting the stop portion 28 into the proximal portion 26, and subsequently inserting the distal portion 30 into the stop portion 28. The stop portion 28 is disposed between the proximal portion 26 and the distal portion 30 to prevent axial movement of the proximal 14 and distal 16 handle members, as shown in FIG. 1, into one another.


The stop portion 28 takes the form of a circular ring with details 34 that are incorporated into the molding. The details 34 facilitate the insertion of the stop portion 28 into proximal portion 26 and the distal portion 30 of the handle 12. It is envisioned that the details 34 may create a permanent binding between the proximal portion 26, the stop portion 28, and the distal portion 30.


Referring to FIG. 3, an alternative embodiment is presented wherein the details 36 consist of a male and female mating configuration. The details 36 consists of a raised circular male ridge that fits into a female type depression 38 in the proximal portion of a handle 40. It is envisioned that an identical configuration can exist between the details 36 and the distal portion (not shown in Figure) of the handle 40. A configuration is further contemplated wherein a stop portion 42 includes details 36 that are female type depressions and the proximal and distal portions of the handle 40 includes a raised circular male ridge.


Turning to FIG. 4, a proximal portion of a handle 46 is presented wherein a proximal handle member 44 is disposed thereon. The handle 46 includes indentations 48 to facilitate slideable engagement along the axis of the handle 46. The indentations 48 may take the form of ribs, ridges, or other forms of detents. In a preferred embodiment, the indentations 48 are located at approximately one centimeter intervals along the handle 46.


In this configuration, the proximal handle member 44 incorporates a detail member 50. The detail member 50 provides a means for the proximal handle member 44 to engage the indentations 48. As previously presented in FIG. 3, the detail member 50 similarly include a male mating configuration to facilitate a snap fit engagement process. The detail member 50 includes a male ridge member 52, which fits into a female depression 54 and can form a permanent bond therebetween.


The detail member 50 includes friction members 56, which facilitate engagement with at least one indentation 48 of a first series of indentations 48 along the proximal portion of the handle 46. A frictional drag force is created between the friction members 56 engaging at least one indentation 48 of a first series of indentations 48. It is contemplated that the proximal handle member 44 and the detail member 50 may be joined via alternative processes such as adhesive, solvent weld, thermal weld, ultrasonic weld, etc.


The friction members 56 may be, but are not limited to, protrusions such as semi-circular barbs. In a preferred embodiment, the friction members 56 engage at least one indentation 48 of a first series of indentations 48 and provide a clinician with a definitive depth measurement of the proximal handle member 44. Additionally, the friction members 56 serves to securely lock the proximal handle member 44 in place to provide a clinician with a consistent point of reference. It is contemplated that multiple friction members 56 may be employed. It is further contemplated that friction members 56 may have flexible portions, which may be of varying flexibility according to the particular requirements of the handle 46.


Referring to FIG. 5, a proximal portion of a fully assembled handle 64 is presented wherein a proximal handle member 60 can slideably advance a needle 66 within a sheath 68. In this configuration, friction members 58 are disposed to a distal portion of the proximal handle member 60 as semi-circular barbs. As presented, the friction member 58 allow the proximal handle member 60 to engage indentations 62 at any of a plurality of positions along the axis of the handle member 64. It is contemplated that each of indentation 62 can represent a specific length by which the needle 66 extends relative to the sheath 68. More specifically, in an engaged position, a clinician can set a maximum length by which the needle 66 can extend beyond the distal end of the sheath 68. A clinician may easily manipulate the position of the needle 66 by applying pressure to the distal portion of the proximal handle member 60. It is envisioned that an excessive level of pressure is not required to move the proximal handle member. However, such pressure must be sufficient to overcome the frictional resistance created between the friction member 58 and at least one indentation 62.


Referring to FIGS. 6-7, a distal handle member 70 is presented that is identical to the proximal handle member as described in FIG. 5. The distal handle member 70 includes friction members 71, which facilitate engagement with at least one indentation 73 of a second series of indentations 73 along the distal portion of a handle 74. A frictional drag force is created between the friction members 71, which engage at least one indentation 73 of a second series of indentations 73 along the handle 74.


The proximal handle member (not shown in Figure) and the distal handle member 70 further include a structural adaptation 72 that facilitates seamless movement along the handle 74. In the present configuration, the structural adaptation 72 has a larger outer diameter than other portions of the distal handle member 70. Additionally, the structural adaptation 72 is ergonomically configured to serve as a resting position for a finger or thumb of a clinician. It is contemplated that the structural adaptation 72 may provide a surface that facilitates movement of the distal handle member 70 along the handle 74. It is envisioned that the surface may be comprised of materials such as a rubber or other polymeric materials. The structural adaptation 72 may also provide a clinician with a tactile feel measurement system for gauging the position of the sheath 76 relative to the handle 74.


The distal handle member 70 also provides a means for engaging the needle biopsy device to another medical device. Referring to FIG. 7, the distal handle member 70 provides a connector 78 to facilitate attachment of the device to another medical device. The connector 78 is structurally capable of interacting with a connector on another medical device such as a channel or luer port. This interaction between the connector 78 and a connector on another medical device (not shown in Figure) can be, but is not limited to, a mating or locking connection.


Referring to FIG. 8, an alternative embodiment of a connector 78 is shown. The connector 78 provides a mechanism for the quick connect and disconnect of a needle biopsy device 80 from a channel port 82 of a medical device 84. The connector 78 includes an adaptation that provides for connection relative to the longitudinal axis of the medical device. It is contemplated that the adaptation may be a female mating configuration and may further provide for a side loading removal motion of the device 80 from the channel port 82. It is further contemplated that the connector 78 is sized such that the device 80 is securely locked onto the channel port 82 in both an axial and perpendicular direction.


Referring to FIG. 9, another embodiment of a quick connect connector 86 is shown. The connector 86 includes two adaptations 88 that provide for connection relative to the longitudinal axis of the medical device. It is envisioned that the two adaptations 88 may represent a male mating configuration engaging a female mating channel port of another medical device. It is further envisioned that the two adaptations provide a secure connection to the medical device.


Referring to FIG. 10, another embodiment of a connector 90 is shown. The connector 90 is a spring loaded mechanism which facilitates connection to other medical devices with different channel ports. In the present configuration, a clinician can quickly load a device 96 axially onto a channel port 98 of another medical device 100. A button 92 is provided to work in concert with a spring 94 to provide a spring loaded tension between the device 96 and another medical device 100. The button 92 may also be depressed to release the spring loading tension and disengage the device 96. It is contemplated that the button 92 may be situated in a position to allow the clinician to utilize their thumb or finger to depress the button 92 without disturbing the desired configuration of the device 96.


Referring to FIG. 11, a distal portion of a handle 102 is presented wherein a connector 104 is joined via a snap fit process. It is contemplated that the connector 104 may utilize a snap fit detail 106, which can be a male mating configuration that engages a female mating configuration 108. In one embodiment, the snap fit detail 106 is permanently locked to the female mating member 108. It is further contemplated that the connector 104 may be adaptations in the form of two protruding male mating adaptations, a female mating adaptation, a spring loading mechanism, etc to satisfy the need for a quick connection mechanism.


Referring to FIGS. 1, 4, and 11, the needle biopsy device may also be assembled by engaging the connector 104 to the distal handle member 110, and subsequently attaching the distal handle member 110 to a stop portion 112. The stop portion 112 may be attached to the handle 46, as shown in FIG. 4, to complete the assembly of the handle 12, as shown in FIG. 1.


Turning to FIGS. 12 and 13, assembly of the needle biopsy device may be completed by inserting a needle housing member 114 into a proximal handle member 122. The needle housing member 114 is designed to allow a clinician to quickly and seamlessly remove the needle 116 after an aspirating sample is taken at a site of lesion or abnormality.


The needle housing member 114 includes a needle 116, a hub 118, and a strain relief 120. Due to the varying requirements of endoscopic ultrasound procedures, the needle 116 may be designed to range in length from fifty centimeters to two-hundred and fifty centimeters. Additionally, the needle 116 may be beveled via a single or double bevel at its distal end to aid a clinician in penetrating tissue in preparation of collecting an aspirated sample. It is contemplated that the needle 116 can be manufactured from several metallic based materials, such as stainless steel or alloys thereof and nitinol or alloys thereof. Alternatively, the needle 116 may be manufactured from polymeric materials including, but not limited to, polyetherketone, polyamide, polyethersulfone, polyurethane, ether block amide copolymers, polyacetal, polytetrafluoroethylene and derivatives thereof. Moreover, a combination of metallic based and polymeric materials may be suitable for this purpose. It is contemplated that one skilled in the art will realized that other materials suitable for manufacture in accordance with the present disclosure will also be appropriate.


The needle 116 requires a secure bond to the needle housing member 114. In one embodiment, the needle is attached to the needle housing member 114 via adhesive bonding. Although adhesive bonding is suitable for this purpose, an alternative and preferred method, such as direct injection over-molding can be utilized.


The method of over-molding consists of a two step molding operation with two constituent components. First, an inner component (not shown in the Figure) consists of a rigid polymer. The purpose of the inner component is to provide the primary bond between the hub 118 and the needle 116. It is contemplated that the inner component has shore hardness in the range of forty to eighty five Shore Durometer D. However, shore hardness in the range of seventy to eighty-five Shore Durometer D is generally preferable. It is contemplated that the shore hardness may include a scale of Shore Durometer A in addition to Shore Durometer D.


Second, the needle housing member 114 includes an outer component which consists of a strain relief 120. A common issue associated with prior art references is the kinking and deformation of needles during insertion and removal from a device. The strain relief 120 is designed to address the issue by providing a smooth transition and bend radius for the needle housing member 114 upon insertion and removal from the proximal handle member 112. The strain relief 120 is comprised of a relatively soft polymer, having shore hardness in the range of ten to fifty-five durometer. It is contemplated, however, that shore hardness in the range of thirty to forty-five durometer is preferable.


Referring to FIG. 14, an alternative embodiment of the needle housing member 124 is shown. In the present configuration, the needle housing member 124 is loaded into an opening at the proximal portion of a proximal handle member 126. To limit the need for a clinician to remove their hand from the device, the needle housing member 124 provides connecting details 128 that are immediately proximal to a strain relief 130 to facilitate insertion and removal of the needle housing member 124. More specifically, the connecting details 128 provides a means for rapid connection and disengagement of the needle housing member 124 relative to the proximal handle member 126. Upon inserting the needle housing member 124 into the proximal handle member 126, female connecting details 130 engage male connecting details 132 housed on the proximal handle member 126. The engagement of the female connecting details 130 and the male connecting details 132 provides the needle housing member 124 with a secure lock in the axial direction. This lock ensures that the needle subassembly can not move or deform while is use.


The present configuration is designed to allow a clinician to easily disengage the needle housing member 124 from the proximal handle member 126. For example, once the clinician has acquired the desired tissue or fluid sample through needle aspiration, they may apply force in a substantially traverse direction to the needle housing member 124. The needle housing member 124 may be subsequently retracted for disposing the sample contained upon the needle. As a result, it is envisioned that a clinician can seamlessly acquire and insert another needle housing member 124 without reconfiguring the positions of the proximal handle member 126.


Referring to FIGS. 15 and 16, it is contemplated that a spring loaded mechanism may be provided to facilitate the removal of a needle housing member 134 from a device 136. In the present configuration, a release member 138 is provided which functions in concert with a lever 140. The lever 140 operates under a spring loaded tension 142 to securely fasten the needle housing member 134 to the device 136. The lever 140 is operated by depressing the release member 138. Upon depressing the release member 138, the tension released by a spring 142 causes the lever 140 to release the needle housing member 134 from the device 136.


Turning to FIG. 17, a sheath lumen 144 is provided to house the needle 22 from the proximal handle member 14 through the distal handle member 16, as shown in FIG. 1. The sheath lumen 144 is comprised of, but not limited to, thermoplastic materials. It is contemplated that the thermoplastic materials may be polyurethane, polyamide and derivatives thereof, ether block amide copolymers, polyimide, placental, polyethylene and derivates thereof, polytetrafluoroethylene, and the like. In a preferred embodiment, the sheath lumen 144 is comprised of a helically braided configuration 146 of outer thermoplastic materials with a lubricious inner core 148.


The inner core 148 may be made from polytetrafluoroethylene, fluorinated ethylene propylene, or derivatives thereof, to provide a lubricous surface for the needle 22, as shown in FIG. 1, as it is passed through the sheath lumen 144. It is contemplated that the sheath lumen 144 may have an outer diameter ranging from three French to twelve French. It is further contemplated that the sheath lumen 144 may have an inner diameter ranging from two French to ten French. In a preferred embodiment, the inner and outer diameter of the sheath 144 is between three French and six French.


Referring to FIG. 18, a taper 152 on the distal end of a needle 150 may be provided to provide a level of interference between a sheath 154 and the needle 150 during needle advancement. The taper 152 addresses the issue of needle instability by providing an enlarged portion that provides a frictional resistance in the form of a drag force. It is envisioned that the taper 152 may be incorporated onto the needle 150 through centerless grinding or cold-drawing techniques.


Referring to FIG. 19, an alternative embodiment is presented wherein a needle 156 comprises stabilizing bulbs 158 located at constant increments over the length of the needle 156. These bulbs 158 may be spaced anywhere from two millimeters to one centimeter apart and may be located over the entire length of the needle 156 or over a portion of the needle 156. It is contemplated that the bulbs 158 may be circular or elliptical in geometry and may be incorporated onto the needle 156 via soldering or laser welding or incorporating into the grind profile of the needle 156. It is further contemplated that the stabilizing bulbs 158 will provide sufficient frictional resistance between the needle 156 and a sheath 160.


Referring to FIG. 20, another embodiment is contemplated wherein a series of barbs 162 are located at varying intervals along the length of a needle 164. The purpose of the barbs 162 is to reduce the effective clearance between the outer diameter of the needle 164 and the inner diameter of a sheath 166. It is contemplated that the barbs 162 may be positioned at the distal end of the needle 164 or alternately, may be spaced over the entire length of the needle 164.


It is contemplated that all forms of protrusions, including the “taper”, “bulb” or “barb” details, extend into the sheath 166 when the needle 164 is fully extended relative to the sheath 166. This ensures that at maximum needle insertion depth, the needle 164 is kept stable in the assembly and achieves the desired design intent.


Referring to FIG. 21, a clinician may yield the benefit of improving the echogenicity and ultrasonic visibility of a needle 168 during endoscopic ultrasound, by enhancing the definition of the needle 168 and the ability to discern needle 168 during the procedure. It is contemplated that the needle 168 can be surrounded by echogenic materials such as a polymer impregnated with sonically reflective particles to provide ultrasonic visibility. It is further contemplated that ultrasonic visibility may be, but is not limited to, x-rays, ultrasounds, sonography, etc. It is envisioned that the polymer may be, but is not limited to, a thermoplastic or thermoset coating. It is further contemplated that the echogenic properties of the needle 168 may be enhanced through techniques such as sandblasting, laser etching, surface roughening, the introduction of various patterned geometries onto the surface of the needle, etc.


In the present configuration, an alternative configured is contemplated wherein a polymeric sleeve or jacket 170 covers the proximal portion of the needle 160, which extends distally from a sheath 172 back to a hub on a housing member 174. The purpose of the sheath 172 is to act as a “buffer-layer” between the outer diameter of the needle 168 and the inner diameter of the sheath 172. In this way, the advancement of smaller diameter needles are stabilized as a result of frictional resistance between the needle 168 and the sheath 172. The material used for the needle jacket 170 is preferably extruded from a thermoplastic material such as polyurethane, polyethylene, polypropylene or copolymers thereof, polyamide, polyimide, and polyether block amide or copolymers thereof. Alternately and more preferably, the jacket 170 may be extruded from a highly lubricious material such as polytetrafluoroethylene or fluorinated ethylene-propylene. It is contemplated that by utilizing low co-efficient of friction materials on the outer wall of the needle 168, the frictional drag or insertion force required to insert the needle 168 through the sheath 172 to the desired anatomical location for aspiration is minimized.


In the present configuration, the polymeric jacket or sleeve 170 is located to commence at the needle housing member 174 and run the entire length of the needle 168 to a specified location. This method ensures that the distal portion of the needle 168, which extends from the sheath 172, is bare and the polymeric jacket 170 does not interfere with passage of the needle 168 through the clinical anatomical mass under evaluation. The jacket 170 may be captured at the proximal end during insert molding of the needle housing member 174 or alternately may abut the needle housing member 174.


The incorporation of such a polymeric jacket 170 to encase the proximal portion of the needle 168 also serves to provide the clinician with passive feedback during removal of the needle 168 from the proximal handle housing. During removal of the needle 168 from the device once the sample has been acquired, it is important that the clinician be made aware of when they are approaching the sharp end of the needle 168. With the polymeric jacket 170 being positioned at a constant distance from the sharp bevel of the needle 168, once the clinician observes the end of the polymeric jacket 170 on the needle 168, they are passively made aware that a sharp bevel 176 is located at a specified distance from the end of the polymeric jacket 170. This passive feedback is important as the clinician can now exercise additional caution to ensure that they do not inadvertently pierce themselves with the needle 168 or cause the needle 168 to become entangled, endangering the diagnosing value of the collected sample.


It is contemplated that these concepts pertain to the maintenance of stability during needle advancement, particularly in the case of a needle 168 with 22 or 25 AWG, wherein the gap between outer diameter of the needle 168 and inner diameter of the sheath 172 is more appreciable. It is desirable to also incorporate the jacket type arrangement into the design for the 19 AWG needle portion. With a reduced amount of concentric clearance available between inner diameter of the sheath 172 and the outer diameter of the needle 168 in the case of a 19 AWG needle 168, the polymer jacket 170 may take the form of polytetrafluoroethylene or other thermoplastic material heat shrink which is thermally laminated onto the outer diameter of the needle 168. Alternately, it is further contemplated that a 19 AWG needle 168 may be spray coated with a lubricious material such as teflon. At the distal end of the needle 168, the heat shrink material or coated material may terminate at specific distance from the sharp end of the needle 168. It is envisioned that this method will provide the clinician with feedback as to when they are approaching the sharp bevel at the distal end during extraction of the needle 168.


It will be understood that various modifications may be made to the embodiments disclosed herein. Therefore, the above description should not be construed as limiting, but merely as exemplifications of the various embodiments of the invention. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.

Claims
  • 1. A device for needle biopsy, comprising: a handle member having proximal and distal portions;a proximal handle member disposed at the proximal portion of the handle member the proximal handle member being configured for slideable engagement with the proximal portion of the handle member, the proximal handle member includes a friction member that engages at least one indentation of a first series of indentations along the proximal portion of the handle member to limit slideable movement of the proximal handle member relative to the proximal portion of the handle member;a distal handle member disposed at the distal portion of the handle member and configured to mate with another medical device including a channel, the distal handle member being configured for slideable engagement with the distal portion of the handle member, the distal handle member includes a friction member that engages at least one indentation of a second series of indentations along the distal portion of the handle member to limit slideable movement of the distal handle member relative to the distal portion of the handle member;a sheath, having a lumen, the sheath being disposed within the handle member and extending from the distal portion of the handle member;an exchangeable needle housing member, coupled to a flexible needle disposed within the sheath, the exchangeable needle housing member being releasably coupled to the proximal portion of the handle member and adapted to allow the needle housing member and needle to be removed from the device and exchanged with a different needle housing member and a different needle while the sheath remains disposed in the channel of the another medical device to which the distal handle member is mated, wherein the needle includes a plurality of protrusions disposed thereon, the protrusions centering the needle in the lumen of the sheath as the needle moves axially within the lumen, and at least a portion of the needle is surrounded by a polymer.
  • 2. The device of claim 1, wherein the plurality of protrusions are distributed along the length of the needle.
  • 3. The device of claim 1, wherein the plurality of protrusions are located at a consistent increment over the length of the needle.
  • 4. The device of claim 1, wherein at least a portion of the needle includes a tapered region for increasing the overall dimension of the needle, wherein the tapered region and the sheath lumen provide an interference therebetween for creating stability for the needle as the needle passes through the sheath lumen and is removed from the sheath lumen.
  • 5. The device of claim 4, wherein the interference is a drag force creating frictional resistance between an outer diameter of the needle and an inner diameter of the sheath lumen.
  • 6. The device of claim 1, wherein at least a portion of the needle includes materials or design features to enhance echogenicity and ultrasonic visibility.
  • 7. The device of claim 1, wherein the flexible needle additionally includes a stylet disposed therein.
  • 8. The device of claim 1, wherein the polymer is comprised of lubricous materials.
  • 9. The device of claim 1, wherein the polymer increases the overall dimension of the needle to create stability for the needle as the needle passes through the sheath lumen and is removed from the sheath lumen.
US Referenced Citations (662)
Number Name Date Kind
3612050 Sheridan Oct 1971 A
3666808 Meek May 1972 A
4096860 McLaughlin Jun 1978 A
4249541 Pratt Feb 1981 A
4655226 Lee Apr 1987 A
4838280 Haaga Jun 1989 A
4861341 Woodburn Aug 1989 A
4903523 Flynn Feb 1990 A
4995866 Amplatz et al. Feb 1991 A
5054310 Flynn Oct 1991 A
5057085 Kopans Oct 1991 A
5111829 Alvarez de Toledo et al. May 1992 A
5257628 Ishiguro et al. Nov 1993 A
5266359 Spielvogel Nov 1993 A
5277199 DuBois et al. Jan 1994 A
5320627 Sorensen et al. Jun 1994 A
5333613 Tickner et al. Aug 1994 A
5380292 Wilson Jan 1995 A
5419310 Frassica et al. May 1995 A
5458112 Weaver Oct 1995 A
5470308 Edwards et al. Nov 1995 A
5471988 Fujio et al. Dec 1995 A
5480389 McWha et al. Jan 1996 A
5490521 Davis et al. Feb 1996 A
5526822 Burbank et al. Jun 1996 A
5595724 Deutsch et al. Jan 1997 A
5601588 Tonomura et al. Feb 1997 A
5607389 Edwards et al. Mar 1997 A
5609850 Deutsch et al. Mar 1997 A
5681348 Sato Oct 1997 A
5688490 Tournier et al. Nov 1997 A
5695491 Silverstein Dec 1997 A
5775333 Burbank et al. Jul 1998 A
5800445 Ratcliff et al. Sep 1998 A
5810806 Ritchart et al. Sep 1998 A
5848978 Cecchi Dec 1998 A
5919172 Golba, Jr. Jul 1999 A
5921933 Sarkis et al. Jul 1999 A
5928164 Burbank et al. Jul 1999 A
5938635 Kuhle Aug 1999 A
5941890 Voegele et al. Aug 1999 A
5944673 Gregoire et al. Aug 1999 A
5947964 Eggers et al. Sep 1999 A
5967988 Briscoe et al. Oct 1999 A
5980469 Burbank et al. Nov 1999 A
6019733 Farascioni Feb 2000 A
6045497 Schweich, Jr. et al. Apr 2000 A
6106473 Violante et al. Aug 2000 A
6106524 Eggers et al. Aug 2000 A
6117108 Woehr et al. Sep 2000 A
6133316 Østensen et al. Oct 2000 A
6149598 Tanaka Nov 2000 A
6168779 Barsky et al. Jan 2001 B1
6171249 Chin et al. Jan 2001 B1
6174291 McMahon et al. Jan 2001 B1
6179809 Khairkhahan et al. Jan 2001 B1
6193692 Harris et al. Feb 2001 B1
6221622 Love Apr 2001 B1
6228049 Schroeder et al. May 2001 B1
6231515 Moore et al. May 2001 B1
6261302 Voegele et al. Jul 2001 B1
6273861 Bates et al. Aug 2001 B1
6280399 Rossin et al. Aug 2001 B1
6287304 Eggers et al. Sep 2001 B1
6312428 Eggers et al. Nov 2001 B1
6323335 Huang Nov 2001 B1
6328701 Terwilliger Dec 2001 B1
6333155 Lockhart et al. Dec 2001 B1
6334067 Brabrand Dec 2001 B1
6336812 Cooper et al. Jan 2002 B1
6337994 Stoianovici et al. Jan 2002 B1
6338968 Hefti Jan 2002 B1
6340563 Finkelstein et al. Jan 2002 B1
6340565 Oliner et al. Jan 2002 B1
6340568 Hefti Jan 2002 B2
6344316 Lockhart et al. Feb 2002 B1
6344317 Urnovitz Feb 2002 B2
6347240 Foley et al. Feb 2002 B1
6347241 Burbank et al. Feb 2002 B2
6350244 Fisher Feb 2002 B1
6350274 Li Feb 2002 B1
6350583 Cohen et al. Feb 2002 B1
6351660 Burke et al. Feb 2002 B1
6355033 Moorman et al. Mar 2002 B1
6355275 Klein Mar 2002 B1
6355424 Lorincz et al. Mar 2002 B1
6356782 Sirimanne et al. Mar 2002 B1
6361499 Bates et al. Mar 2002 B1
6361948 Tricoli et al. Mar 2002 B1
6364526 Ivan et al. Apr 2002 B2
6365362 Terstappen et al. Apr 2002 B1
6365712 Kelly Apr 2002 B1
6368280 Cermak et al. Apr 2002 B1
6368292 Ogden et al. Apr 2002 B1
6368792 Billing-Medel et al. Apr 2002 B1
6368795 Hefti Apr 2002 B1
6368799 Chee Apr 2002 B1
6369195 An et al. Apr 2002 B1
6371904 Sirimanne et al. Apr 2002 B1
6371917 Ferrara et al. Apr 2002 B1
6372431 Cunningham et al. Apr 2002 B1
6372444 Powers et al. Apr 2002 B1
6374135 Bucholz Apr 2002 B1
6375634 Carroll Apr 2002 B1
6375953 Srivastava et al. Apr 2002 B1
6376258 Hefti Apr 2002 B2
6379671 Colpitts Apr 2002 B1
6379672 Srivastava et al. Apr 2002 B1
6383484 Achen et al. May 2002 B1
6383491 Srivastava et al. May 2002 B1
6383492 Srivastava et al. May 2002 B1
6383493 Srivastava et al. May 2002 B1
6387056 Kieturakis May 2002 B1
6387374 Srivastava et al. May 2002 B1
6387629 Schneider et al. May 2002 B1
6391306 Srivastava et al. May 2002 B1
6391542 Anderson et al. May 2002 B1
6391543 Billing-Medel et al. May 2002 B2
6394965 Klein May 2002 B1
6395480 Hefti May 2002 B1
6398737 Moore et al. Jun 2002 B2
6399069 Srivastava et al. Jun 2002 B1
6399070 Srivastava et al. Jun 2002 B1
6399371 Falduto et al. Jun 2002 B1
6402701 Kaplan et al. Jun 2002 B1
6403095 Srivastava et al. Jun 2002 B1
6405733 Fogarty et al. Jun 2002 B1
6407125 Fernandez-Pol Jun 2002 B1
6409664 Kattan et al. Jun 2002 B1
6410028 Srivastava Jun 2002 B1
6410229 Lockhart et al. Jun 2002 B1
6413751 Benkovic et al. Jul 2002 B1
6416484 Miller et al. Jul 2002 B1
6421559 Pearlman Jul 2002 B1
6423081 Lee et al. Jul 2002 B1
6423313 Esmon et al. Jul 2002 B1
6423489 Anderson et al. Jul 2002 B1
6423494 Jin et al. Jul 2002 B1
6423503 Mikolajczyk et al. Jul 2002 B1
6426195 Zhong et al. Jul 2002 B1
6426367 Das Jul 2002 B1
6427081 Burbank et al. Jul 2002 B1
6427089 Knowlton Jul 2002 B1
6428463 Ravins et al. Aug 2002 B1
6428479 Aksnes et al. Aug 2002 B1
6428487 Burdorff et al. Aug 2002 B1
6432035 Ravins et al. Aug 2002 B1
6432053 Fecht et al. Aug 2002 B1
6432065 Burdorff et al. Aug 2002 B1
6432700 Henderson et al. Aug 2002 B1
6434415 Foley et al. Aug 2002 B1
6436054 Viola et al. Aug 2002 B1
6436120 Meglin Aug 2002 B1
6436394 Henderson et al. Aug 2002 B1
6436404 Srivastava et al. Aug 2002 B1
6436411 Riordan et al. Aug 2002 B1
6440086 Hohenberg Aug 2002 B1
6440147 Lee et al. Aug 2002 B1
6440151 Cragg et al. Aug 2002 B1
6440153 Cragg et al. Aug 2002 B2
6443960 Brabrand et al. Sep 2002 B1
6445767 Karellas Sep 2002 B1
6447477 Burney et al. Sep 2002 B2
6447534 Cragg et al. Sep 2002 B2
6447780 Srivastava et al. Sep 2002 B1
6447781 Srivastava Sep 2002 B1
6447997 Los et al. Sep 2002 B1
6448020 Toftgard et al. Sep 2002 B1
6450973 Murphy Sep 2002 B1
6455027 Barsky et al. Sep 2002 B1
6455048 Srivastava et al. Sep 2002 B1
6455251 Waldman Sep 2002 B1
6459925 Nields et al. Oct 2002 B1
6461615 Srivastava Oct 2002 B1
6463319 Bucholz Oct 2002 B1
6464648 Nakamura Oct 2002 B1
6465181 Billing-Medel et al. Oct 2002 B2
6465183 Wolber Oct 2002 B2
6468985 Huang Oct 2002 B1
6470217 Fenn et al. Oct 2002 B1
6471659 Eggers et al. Oct 2002 B2
6471700 Burbank et al. Oct 2002 B1
6471709 Fawzi et al. Oct 2002 B1
6472518 Ribot et al. Oct 2002 B1
6475732 Shayesteh et al. Nov 2002 B1
6475789 Cech et al. Nov 2002 B1
6477426 Fenn et al. Nov 2002 B1
6482182 Carroll et al. Nov 2002 B1
6482599 Mikolajczyk et al. Nov 2002 B1
6485308 Goldstein Nov 2002 B1
6485436 Truckai et al. Nov 2002 B1
6485905 Hefti Nov 2002 B2
6488636 Bryan et al. Dec 2002 B2
6489097 Hirose et al. Dec 2002 B2
6489113 Traish Dec 2002 B1
6490467 Bucholz et al. Dec 2002 B1
6491699 Henderson et al. Dec 2002 B1
6491702 Heilbrun et al. Dec 2002 B2
6492115 Guida et al. Dec 2002 B1
6494844 Van Bladel et al. Dec 2002 B1
6494859 Love et al. Dec 2002 B2
6494879 Lennox et al. Dec 2002 B2
6495130 Henderson et al. Dec 2002 B1
6496717 Cox et al. Dec 2002 B2
6497706 Burbank et al. Dec 2002 B1
6500622 Bruchez, Jr. et al. Dec 2002 B2
6500938 Au-Young et al. Dec 2002 B1
6505125 Ho Jan 2003 B1
6506156 Jones et al. Jan 2003 B1
6506607 Shyjan Jan 2003 B1
6507748 Selland Jan 2003 B2
6508755 Ravins et al. Jan 2003 B1
6509458 Afar et al. Jan 2003 B1
6509514 Kneteman et al. Jan 2003 B1
6514248 Eggers et al. Feb 2003 B1
6514251 Ni et al. Feb 2003 B1
6514685 Moro Feb 2003 B1
6514695 Barsky et al. Feb 2003 B1
6517498 Burbank et al. Feb 2003 B1
6521211 Unger et al. Feb 2003 B1
6524800 Lockhart et al. Feb 2003 B2
6527731 Weiss et al. Mar 2003 B2
6530888 Smith et al. Mar 2003 B2
6535756 Simon et al. Mar 2003 B1
6537761 Shayesteh et al. Mar 2003 B1
6538119 Billing-Medel et al. Mar 2003 B2
6540694 Van Bladel et al. Apr 2003 B1
6540695 Burbank et al. Apr 2003 B1
6544236 Cragg et al. Apr 2003 B1
6546787 Schiller et al. Apr 2003 B1
6548257 Lockhart et al. Apr 2003 B2
6551255 Van Bladel et al. Apr 2003 B2
6551784 Fodor et al. Apr 2003 B2
6552164 Colpitts et al. Apr 2003 B1
6552181 Dean et al. Apr 2003 B1
6554779 Viola et al. Apr 2003 B2
6558407 Ivanko et al. May 2003 B1
6558916 Veerapandian et al. May 2003 B2
6562562 Casu′ et al. May 2003 B2
6564087 Pitris et al. May 2003 B1
6564806 Fogarty et al. May 2003 B1
6566078 Raitano et al. May 2003 B1
6566079 Hefti May 2003 B2
6567214 Lorincz May 2003 B2
6567689 Burbank et al. May 2003 B2
6568941 Goldstein May 2003 B1
6572551 Smith et al. Jun 2003 B1
6572578 Blanchard Jun 2003 B1
6577904 Zhang et al. Jun 2003 B1
6579891 Fernandez-Pol Jun 2003 B1
6580938 Acker Jun 2003 B1
6582368 Holdaway et al. Jun 2003 B2
6582426 Moorman et al. Jun 2003 B2
6585968 Little et al. Jul 2003 B2
6586713 Essenfeld et al. Jul 2003 B2
6587578 Godik et al. Jul 2003 B2
6589240 Hinchliffe Jul 2003 B2
6592508 Ravins et al. Jul 2003 B1
6592530 Farhadi Jul 2003 B1
6599247 Stetten Jul 2003 B1
6602659 Waldman et al. Aug 2003 B1
6604404 Paltieli et al. Aug 2003 B2
6605294 Sawhney Aug 2003 B2
6607561 Brannon Aug 2003 B2
6608191 Anderson et al. Aug 2003 B1
6608310 Soluri et al. Aug 2003 B2
6610016 Violante et al. Aug 2003 B1
6610499 Fulwyler et al. Aug 2003 B1
6610839 Morin et al. Aug 2003 B1
6612991 Sauer et al. Sep 2003 B2
6613740 Gozes et al. Sep 2003 B1
6614921 Chung et al. Sep 2003 B1
6617110 Cech et al. Sep 2003 B1
6617137 Dean et al. Sep 2003 B2
6623437 Hinchliffe et al. Sep 2003 B2
6626832 Paltieli et al. Sep 2003 B1
6626848 Neuenfeldt Sep 2003 B2
6626850 Kupec et al. Sep 2003 B1
6626903 McGuckin, Jr. et al. Sep 2003 B2
6626930 Allen et al. Sep 2003 B1
6627414 Billing-Medel et al. Sep 2003 B2
6627461 Chapman et al. Sep 2003 B2
6629959 Kuracina et al. Oct 2003 B2
6631204 Smith Oct 2003 B1
6632183 Bowman et al. Oct 2003 B2
6638234 Burbank et al. Oct 2003 B2
6638719 Gunderson et al. Oct 2003 B1
6638727 Hung et al. Oct 2003 B1
6645731 Terstappen et al. Nov 2003 B2
6647285 Da Silva et al. Nov 2003 B2
6649420 Cantor Nov 2003 B1
6652520 Moorman et al. Nov 2003 B2
6652859 Afar et al. Nov 2003 B1
6653080 Bruchez et al. Nov 2003 B2
6653129 Bander et al. Nov 2003 B1
6654120 Ban Nov 2003 B2
6659105 Burbank et al. Dec 2003 B2
6660834 Billing-Medel et al. Dec 2003 B2
6662041 Burbank et al. Dec 2003 B2
6663560 MacAulay et al. Dec 2003 B2
6666811 Good Dec 2003 B1
6670122 Rosenow et al. Dec 2003 B2
6673023 Pflueger Jan 2004 B2
6673914 Hoon Jan 2004 B1
6675037 Tsekos Jan 2004 B1
6676610 Morton et al. Jan 2004 B2
6676658 Burbank et al. Jan 2004 B2
6676935 Henderson et al. Jan 2004 B2
6676984 Sharp et al. Jan 2004 B1
6677157 Cohen Jan 2004 B1
6678545 Bucholz Jan 2004 B2
6678552 Pearlman Jan 2004 B2
6679851 Burbank et al. Jan 2004 B2
6680178 Harris et al. Jan 2004 B2
6689062 Mesallum Feb 2004 B1
6689065 Aksnes et al. Feb 2004 B2
6689067 Sauer et al. Feb 2004 B2
6689071 Burbank et al. Feb 2004 B2
6689072 Kaplan et al. Feb 2004 B2
6689073 Quay Feb 2004 B2
6689744 Gao et al. Feb 2004 B2
6689787 McKearn et al. Feb 2004 B1
6690371 Okerlund et al. Feb 2004 B1
6690966 Rava et al. Feb 2004 B1
6690976 Fenn et al. Feb 2004 B2
6692467 McFarlane Feb 2004 B2
6692724 Yang et al. Feb 2004 B1
6692736 Yu et al. Feb 2004 B2
6695779 Sauer et al. Feb 2004 B2
6697665 Rava et al. Feb 2004 B1
6699205 Fulton, III et al. Mar 2004 B2
6702749 Paladini et al. Mar 2004 B2
6702761 Damadian et al. Mar 2004 B1
6702831 Lee et al. Mar 2004 B2
6703216 Parsons et al. Mar 2004 B2
6705994 Vortman et al. Mar 2004 B2
6709408 Fisher Mar 2004 B2
6709816 Huang et al. Mar 2004 B1
6712773 Viola Mar 2004 B1
6712785 Morton et al. Mar 2004 B2
6714808 Klimberg et al. Mar 2004 B2
6716179 Burbank et al. Apr 2004 B2
6722371 Bush et al. Apr 2004 B1
6723052 Mills Apr 2004 B2
6723106 Charles et al. Apr 2004 B1
6723498 Shyjan et al. Apr 2004 B1
6725080 Melkent et al. Apr 2004 B2
6725083 Burbank et al. Apr 2004 B1
6725095 Fenn et al. Apr 2004 B2
6726651 Robinson et al. Apr 2004 B1
6728334 Zhao Apr 2004 B1
6730042 Fulton et al. May 2004 B2
6730045 Finer May 2004 B2
6731966 Spigelman et al. May 2004 B1
6733969 Mack May 2004 B2
6738663 Schroeppel et al. May 2004 B2
6746844 Oliner et al. Jun 2004 B2
6750015 Horwitz et al. Jun 2004 B2
6752154 Fogarty et al. Jun 2004 B2
6752767 Turovskiy et al. Jun 2004 B2
6752768 Burdorff et al. Jun 2004 B2
6753138 Schneider et al. Jun 2004 B1
6758848 Burbank et al. Jul 2004 B2
6764449 Lee et al. Jul 2004 B2
6764495 Lee et al. Jul 2004 B2
6766186 Hoyns et al. Jul 2004 B1
6767704 Waldman et al. Jul 2004 B2
6768925 Fenn et al. Jul 2004 B2
6770066 Leighton et al. Aug 2004 B1
6770070 Balbierz Aug 2004 B1
6770435 Billing-Medel et al. Aug 2004 B1
6770770 Baumann et al. Aug 2004 B1
6773903 Bova Aug 2004 B2
6776757 Larson et al. Aug 2004 B2
6780984 Wang et al. Aug 2004 B2
6785410 Vining et al. Aug 2004 B2
6786870 Miyaki et al. Sep 2004 B2
6788977 Fenn et al. Sep 2004 B2
6790185 Fisher et al. Sep 2004 B1
6797477 Guida et al. Sep 2004 B2
6805669 Swanbom Oct 2004 B2
6805869 Guo Oct 2004 B2
6806712 Akgun Oct 2004 B2
6807444 Tu et al. Oct 2004 B2
6808878 Gray et al. Oct 2004 B1
6818184 Fulwyler et al. Nov 2004 B2
6818750 Reed Nov 2004 B2
6819785 Vining et al. Nov 2004 B1
6821725 Carrasco et al. Nov 2004 B1
6824780 Devaux et al. Nov 2004 B1
6824974 Pisharody et al. Nov 2004 B2
6824995 Wu Nov 2004 B1
6827692 Castellacci Dec 2004 B2
6831059 Donovan Dec 2004 B2
6832111 Tu et al. Dec 2004 B2
6833373 McKearn et al. Dec 2004 B1
6833438 Afar et al. Dec 2004 B1
6835183 Lennox et al. Dec 2004 B2
6835572 Mountford et al. Dec 2004 B1
6838243 Lai et al. Jan 2005 B2
6840952 Saker et al. Jan 2005 B2
6841350 Ogden et al. Jan 2005 B2
6843980 Green Jan 2005 B2
6844153 Waldman et al. Jan 2005 B2
6846320 Ashby et al. Jan 2005 B2
6846650 Recipon et al. Jan 2005 B2
6846911 Kelly Jan 2005 B2
6847841 El Hatw Jan 2005 B1
6849080 Lee et al. Feb 2005 B2
6850588 Arenson et al. Feb 2005 B2
6852528 Yu et al. Feb 2005 B2
6855517 Salceda et al. Feb 2005 B2
6855554 Fritsche et al. Feb 2005 B2
6858412 Willis et al. Feb 2005 B2
6858598 McKearn et al. Feb 2005 B1
6858711 McGall et al. Feb 2005 B2
6859049 Aruntyunyan et al. Feb 2005 B2
6860855 Shelby et al. Mar 2005 B2
6860860 Viola Mar 2005 B2
6863676 Lee et al. Mar 2005 B2
6864224 Sedivy et al. Mar 2005 B1
6866630 Larson et al. Mar 2005 B2
6866993 Williamson Mar 2005 B1
6866994 Morton Mar 2005 B2
6867016 Billing-Medel et al. Mar 2005 B1
6867753 Chinthammit et al. Mar 2005 B2
6871086 Nevo et al. Mar 2005 B2
6872184 Brannon Mar 2005 B2
6872185 Fisher Mar 2005 B2
6872389 Faris Mar 2005 B1
6875182 Wardle et al. Apr 2005 B2
6875184 Morton et al. Apr 2005 B2
6883194 Corbeil et al. Apr 2005 B2
6883958 Mayer Apr 2005 B2
6884578 Warrington et al. Apr 2005 B2
6884605 Hermonat et al. Apr 2005 B2
6887210 Quay May 2005 B2
6888919 Graf May 2005 B2
6890308 Islam May 2005 B2
6890309 Fisher May 2005 B2
6890311 Love et al. May 2005 B2
6890749 Billing-Medel et al. May 2005 B2
6893818 Afar et al. May 2005 B1
6893868 Packard et al. May 2005 B2
6894026 Quay May 2005 B1
6899696 Morton et al. May 2005 B2
6900015 Avihingsanon et al. May 2005 B2
6900049 Yu et al. May 2005 B2
6901278 Notelovitz May 2005 B1
6904305 Tsekos Jun 2005 B2
6904309 Derendorf et al. Jun 2005 B2
6905475 Hauschild et al. Jun 2005 B2
6908440 Fisher Jun 2005 B2
6913882 Glynne et al. Jul 2005 B2
6914130 Gao et al. Jul 2005 B2
6916800 McKearn et al. Jul 2005 B2
6916918 Yu et al. Jul 2005 B2
6918881 Miller et al. Jul 2005 B2
6919176 Yang et al. Jul 2005 B2
6920347 Simon et al. Jul 2005 B2
6923809 Eggers et al. Aug 2005 B2
6924094 Gingeras et al. Aug 2005 B1
6925389 Hitt et al. Aug 2005 B2
6926893 Hansen Aug 2005 B1
6927032 Lockhart et al. Aug 2005 B2
6933105 Jin Aug 2005 B2
6936014 Vetter et al. Aug 2005 B2
6936416 Zhu et al. Aug 2005 B2
6936687 Komoriya et al. Aug 2005 B1
6942985 Waldman Sep 2005 B2
6943236 Xu et al. Sep 2005 B2
6944505 Zhang et al. Sep 2005 B2
6945942 Van Bladel et al. Sep 2005 B2
6947584 Avila et al. Sep 2005 B1
6949357 Billing-Medel et al. Sep 2005 B2
6953691 Reed et al. Oct 2005 B2
6954667 Treado et al. Oct 2005 B2
6955653 Eggers Oct 2005 B2
6965793 Treado et al. Nov 2005 B2
6994712 Fisher et al. Feb 2006 B1
D518175 Hardin, Jr. et al. Mar 2006 S
7014610 Koulik Mar 2006 B2
7025765 Balbierz et al. Apr 2006 B2
7067111 Yang et al. Jun 2006 B1
7067274 Fairbrother et al. Jun 2006 B2
7070816 Newmark et al. Jul 2006 B2
7072704 Bucholz Jul 2006 B2
7074600 Dean et al. Jul 2006 B2
7077842 Cosman Jul 2006 B1
7079132 Sauer et al. Jul 2006 B2
7081340 Baker et al. Jul 2006 B2
7083547 LaStayo et al. Aug 2006 B2
7083985 Hefti et al. Aug 2006 B2
7087393 Billing-Medel et al. Aug 2006 B2
7089121 Wang Aug 2006 B1
7090845 Fong et al. Aug 2006 B2
7090862 Barrett-Reis et al. Aug 2006 B2
7091047 Serrero Aug 2006 B2
7094233 Desinger Aug 2006 B2
7101663 Godfrey et al. Sep 2006 B2
7101862 Cochrum et al. Sep 2006 B2
7108969 Warrington et al. Sep 2006 B1
7115368 Powers et al. Oct 2006 B2
7118876 Tyner et al. Oct 2006 B2
7118910 Unger et al. Oct 2006 B2
7122011 Clifford et al. Oct 2006 B2
7122653 Cohen et al. Oct 2006 B2
7125836 Woodward Oct 2006 B2
7125969 Benz et al. Oct 2006 B1
7128877 Quay et al. Oct 2006 B2
7128893 Leamon et al. Oct 2006 B2
7129048 Bruchez et al. Oct 2006 B2
7131951 Angel Nov 2006 B2
7135333 Waldman et al. Nov 2006 B1
7139601 Bucholz et al. Nov 2006 B2
7141019 Pearlman Nov 2006 B2
7144950 Bazan et al. Dec 2006 B2
7153700 Pardee et al. Dec 2006 B1
7156814 Williamson, IV et al. Jan 2007 B1
7156815 Leigh et al. Jan 2007 B2
7160292 Moorman et al. Jan 2007 B2
7161057 Kneteman et al. Jan 2007 B2
7169114 Krause Jan 2007 B2
7172558 Olson, Jr. Feb 2007 B2
7172739 Maughan Feb 2007 B2
7175839 Hiserodt Feb 2007 B1
7183251 Russo et al. Feb 2007 B1
D538933 Andrade Mar 2007 S
7186522 Lapen et al. Mar 2007 B2
7189206 Quick et al. Mar 2007 B2
7189207 Viola Mar 2007 B2
7190378 Sauer et al. Mar 2007 B2
7192570 Maecke et al. Mar 2007 B2
7195774 Carvalho et al. Mar 2007 B2
7195868 Iartchouk et al. Mar 2007 B2
7195911 Cech et al. Mar 2007 B2
7196182 Reed et al. Mar 2007 B2
7198896 Rush et al. Apr 2007 B2
7199234 Morin et al. Apr 2007 B2
7204988 Cheung Apr 2007 B2
7207985 Duong et al. Apr 2007 B2
7208146 Denney, Jr. Apr 2007 B2
7208267 Salceda et al. Apr 2007 B2
7211398 Astle et al. May 2007 B2
7214489 Bazan et al. May 2007 B2
7217276 Henderson et al. May 2007 B2
7217394 Studer May 2007 B2
7218959 Alfano et al. May 2007 B2
7220258 Myhr May 2007 B2
7220891 Barsky et al. May 2007 B2
7223238 Swanbom May 2007 B2
7223380 Yang et al. May 2007 B2
7223540 Pourmand et al. May 2007 B2
7223542 Raitano et al. May 2007 B2
7226731 Chuaqui et al. Jun 2007 B1
7227009 Craik et al. Jun 2007 B2
7229413 Violante et al. Jun 2007 B2
7229417 Foerster et al. Jun 2007 B2
7229439 Burbank et al. Jun 2007 B2
7229604 Yang et al. Jun 2007 B2
7229774 Chinnaiyan et al. Jun 2007 B2
7231015 Kumakhov Jun 2007 B2
7235047 MacAulay et al. Jun 2007 B2
7236816 Kumar et al. Jun 2007 B2
7241736 Hunter et al. Jul 2007 B2
7244619 Contreras et al. Jul 2007 B2
7245748 Degani et al. Jul 2007 B2
7245958 Navab et al. Jul 2007 B1
7247426 Yakhini et al. Jul 2007 B2
7250180 Arellano Jul 2007 B2
7250264 Fong et al. Jul 2007 B2
7250551 Tsai et al. Jul 2007 B2
7251352 Sauer et al. Jul 2007 B2
7251568 Pittman et al. Jul 2007 B2
7252935 Sidransky Aug 2007 B2
7252946 Szasz Aug 2007 B2
7252948 Gingeras et al. Aug 2007 B2
7258973 Astle et al. Aug 2007 B2
7261712 Burbank et al. Aug 2007 B2
7261875 Li et al. Aug 2007 B2
7262288 Cech et al. Aug 2007 B1
7264947 Gozes et al. Sep 2007 B2
7270956 Bazan et al. Sep 2007 B2
7271187 Neuberger et al. Sep 2007 B2
7274810 Reeves et al. Sep 2007 B2
20010007925 Ritchart et al. Jul 2001 A1
20010023322 Espositio et al. Sep 2001 A1
20010047183 Privitera et al. Nov 2001 A1
20020035324 Sirimanne et al. Mar 2002 A1
20020082519 Miller et al. Jun 2002 A1
20020156395 Stephens et al. Oct 2002 A1
20020169418 Menzi et al. Nov 2002 A1
20030078502 Miyaki et al. Apr 2003 A1
20030093007 Wood May 2003 A1
20030105488 Chu Jun 2003 A1
20030163142 Paltieli et al. Aug 2003 A1
20030181823 Gatto Sep 2003 A1
20030195436 Van Bladel et al. Oct 2003 A1
20030204137 Chesbrough et al. Oct 2003 A1
20030208134 Secrest et al. Nov 2003 A1
20030212394 Pearson et al. Nov 2003 A1
20030233101 Lubock et al. Dec 2003 A1
20040073219 Skiba et al. Apr 2004 A1
20040077948 Violante et al. Apr 2004 A1
20040153005 Krueger Aug 2004 A1
20040167429 Roshdieh et al. Aug 2004 A1
20040167432 Burbank et al. Aug 2004 A1
20040236212 Jones et al. Nov 2004 A1
20040260199 Hardia et al. Dec 2004 A1
20050021003 Caso et al. Jan 2005 A1
20050022493 Olinger et al. Feb 2005 A1
20050061697 Moberg Mar 2005 A1
20050113715 Schwindt et al. May 2005 A1
20050143753 Whitmore et al. Jun 2005 A1
20050159676 Taylor et al. Jul 2005 A1
20050192535 Takagi et al. Sep 2005 A1
20050228311 Beckman et al. Oct 2005 A1
20050228312 Surti Oct 2005 A1
20050228413 Binmoeller et al. Oct 2005 A1
20050251111 Saito et al. Nov 2005 A1
20050256426 Brugge Nov 2005 A1
20060052750 Lenker et al. Mar 2006 A1
20060100654 Fukuda et al. May 2006 A1
20060116605 Nakao Jun 2006 A1
20060142789 Lehman et al. Jun 2006 A1
20060155210 Beckman et al. Jul 2006 A1
20060167416 Mathis et al. Jul 2006 A1
20060189891 Waxman et al. Aug 2006 A1
20060235298 Kotmel et al. Oct 2006 A1
20060247530 Hardin et al. Nov 2006 A1
20060258955 Hoffman et al. Nov 2006 A1
20070023304 Joyce et al. Feb 2007 A1
20070032741 Hibner et al. Feb 2007 A1
20070038089 Hatano et al. Feb 2007 A1
20070055173 DeLonzor et al. Mar 2007 A1
20070060837 Cho et al. Mar 2007 A1
20070118049 Viola May 2007 A1
20070123799 Meireles May 2007 A1
20070123800 Nishtala et al. May 2007 A1
20070149893 Heske et al. Jun 2007 A1
20070177009 Bayer et al. Aug 2007 A1
20070185411 Hibner Aug 2007 A1
20070213633 McClellan Sep 2007 A1
20070213634 Teague Sep 2007 A1
20070299306 Parasher et al. Dec 2007 A1
20080058637 Fischell et al. Mar 2008 A1
20080097344 McKinnon et al. Apr 2008 A1
20080097572 Sheldon et al. Apr 2008 A1
20080146962 Ritchie et al. Jun 2008 A1
20080147010 Nakajima et al. Jun 2008 A1
20080200912 Long Aug 2008 A1
20080300462 Intoccia et al. Dec 2008 A1
20080319341 Taylor et al. Dec 2008 A1
20090054773 Shizuka Feb 2009 A1
20090069679 Hibi Mar 2009 A1
20090099414 Goto et al. Apr 2009 A1
20090177114 Chin et al. Jul 2009 A1
20090182200 Golden et al. Jul 2009 A1
20100081965 Mugan et al. Apr 2010 A1
20100121218 Mugan et al. May 2010 A1
20100274085 Mugan et al. Oct 2010 A1
20120116248 Mcweeney et al. May 2012 A1
Foreign Referenced Citations (43)
Number Date Country
0704189 Apr 1996 EP
0738501 Oct 1996 EP
1870051 Dec 2007 EP
2030574 Mar 2009 EP
09818508 Apr 2010 EP
09829751 Jun 2010 EP
6-189965 Jul 1994 JP
7-116169 May 1995 JP
8-38482 Feb 1996 JP
9-135836 May 1997 JP
2007-513692 May 2007 JP
WO-8605324 Dec 1986 WO
WO-9200039 Jan 1992 WO
9204062 Mar 1992 WO
WO-0009178 Feb 2000 WO
0033909 Jun 2000 WO
WO-0046626 Oct 2000 WO
WO-2004066828 Aug 2004 WO
WO-2004066829 Aug 2004 WO
WO-2004073509 Sep 2004 WO
WO-2005020905 Mar 2005 WO
WO-2005081032 Sep 2005 WO
WO-2005081033 Sep 2005 WO
2005096953 Oct 2005 WO
2005096963 Oct 2005 WO
WO-2005112797 Dec 2005 WO
WO-2005120345 Dec 2005 WO
WO-2006014011 Feb 2006 WO
WO-2006028281 Mar 2006 WO
WO-2006057443 Jun 2006 WO
WO-2006064972 Jun 2006 WO
WO-2007021904 Feb 2007 WO
WO-2007021904 Feb 2007 WO
WO-2007081039 Jul 2007 WO
WO-2007081041 Jul 2007 WO
WO-2007081050 Jul 2007 WO
WO-2007081056 Jul 2007 WO
WO-2008020157 Feb 2008 WO
WO-2008020439 Feb 2008 WO
WO-2008024684 Feb 2008 WO
WO-2008044013 Apr 2008 WO
2012112202 Aug 2012 WO
2013074653 May 2013 WO
Non-Patent Literature Citations (18)
Entry
International Search Report for PCT/US2009/059226 mailed Apr. 28, 2010.
International Search Report for PCT/US2008/088431 mailed Jul. 27, 2009.
International Search Report for PCT/US2009/065705 mailed Jul. 7, 2010.
International Search Report and Written Opinion mailed Jul. 7, 2010 as issued in PCT/US2009/065705, 13 pages.
International Search Report and Written Opinion dated May 2, 2013 issued in PCT/US2012/065049, 17 pages.
Iglesias-Garcia, 2011, Feasibility and yield of a new EUS histology needle: results from a multicenter, pooled, cohort study, Gastrointestinal Endoscopy 73(6); 1189-1196.
International Search Report for PCT/US2004/040221 maled Jun. 13, 2005.
International Search Report for PCT/US2012/065049 mailed Feb. 22, 2013.
Iwashita, 2013, High single-pass diagnostic yield of a new 25-gauge core biopsy needle for EUS-guided FNA biopsy in solid pancreatic lesions, Gastrointestinal Endoscopy 77(6); 909-915.
Kahaleh, 2013, Endoscopic ultrasonography guided biliary drainage: Summary of consortium meeting, May 7, 2011 Chicago, World Journal of Gastroenterology, 19(9); 1372-1379.
Khashab, 2013, EUS-guided biliary drainage by using a standardized approach for malignant biliary obstruction: rendezvous versus direct transluminal techniques, Gastrointestinal Endoscopy; 1-8.
Park, 2011, EUS-guided biliary drainage with transluminal stenting after failed ERCP: predictors of adverse events and long-term results, Gastrointestinal Endoscopy 74(6); 1276-1284.
Park, 2013, Prospective evaluation of a treatment algorithm with enhanced guidewire manipulation protocol for EUS-guided biliary drainage after failed ERCP, Gastrointestinal Endoscopy 78(1); 92-101.
Pelaez-Luna, 2008, Interventional EUS guided cholangiography. First description in Mexico of a novel, secure and feasible technique. A case report, Caso clinico.
International Search Report for PCT/JP2007/053498 mailed Mar. 20, 2007.
Creganna Needle Brochure dated Jan. 16, 2008.
International Search Report and Written Opinion issued in PCT/US2011/060981, having a mailing date of Jun. 11, 2012.
International Search Report and Written Opinion issued in PCT/JP2007/053498, having a mailing date of Mar. 20, 2007.
Related Publications (1)
Number Date Country
20100081965 A1 Apr 2010 US