Patent Grant
11925347
The present invention relates generally to apparatus, systems, and methods for performing medical procedures, and, more particularly, to stapler apparatus for performing laparoscopic or other surgery, e.g., to remove an appendix of a subject, and systems and methods for using such apparatus.
Appendicitis is seen in approximately 5-10% of the population in their life time. Since 1983, laparoscopic appendix surgery is the mainstay for treatment. In an example of conventional surgery to remove an appendix, the following steps may be performed. First, the appendix and its vessel may be initially identified e.g., lying within a fold of tissue called the mesoappendix. A window or surgical field may be created within the subject's body, and a stapler apparatus is then used, e.g., to initially staple and divide the structure closest to the operator, and then to staple and divide the remaining structure.
For example,
To perform laparoscopic or open surgery, a device may be introduced carrying a camera that is independent from the stapler, e.g., to enable visualization of the surgical space and anatomy from the side, e.g., when the stapler is introduced and used to remove the appendix. Existing laparoscopic staplers generally include a cartridge having multiple rows of staples equally distributed on either side of a knife.
One of the most common complications from such surgery is post-operative bleeding. The bleeding is generally sub-clinical in approximately 15%, and clinical in approximately 5% patients, i.e., requiring further intervention. The majority of bleeding occurs from the staple line on individual vessels or vessels within the wall of intestine. For example, “B” shaped clips may create a lumen between the tines that may allow blood or other fluid to escape. Other complication include leaking of intestinal fluid from the intestinal lumen.
Accordingly, apparatus and methods that facilitate laparoscopic surgery, e.g., to remove an appendix would be useful.
The present invention is directed to apparatus, systems, and methods for performing medical procedures, and, more particularly, to stapler apparatus for performing surgery, such as laparoscopic surgery, e.g., to remove an appendix of a subject or to perform other intestinal procedures, vascular surgery, lung surgery, and the like, and to systems and methods for using such apparatus.
In accordance with an exemplary embodiment, an apparatus is provided for performing a medical procedure that includes a shaft including a proximal end and a distal end sized for introduction into a patient's body; first and second jaws on the distal end of the shaft that are movable relative to one another between open and closed positions, thereby directing first and contact surfaces of the first and second jaws away from and towards one another, respectively, the first jaw carrying one or more staples deployable from the first contact surface; a Doppler radar or other sensor on one of the first and second contact surfaces; and a handle on the proximal end of the shaft comprising a first actuator for opening and closing the jaws, e.g., a trigger to close the second jaw adjacent the first jaw to capture tissue between the contact surfaces, a second actuator for deploying one or more staples from the first jaw into tissue between the first and second contact surfaces, e.g., after locking the jaws closed using the trigger or a separate locking mechanism, and a third actuator for activating the Doppler or other sensor to detect blood flow in the tissue.
In an exemplary embodiment, the first and second jaws may be carried on an end effector removably coupled to the distal end of the shaft. The first jaw may carry first and second sets of staples, e.g., each set arranged in rows adjacent one another, optionally arranged within a replaceable cartridge. A cutting element may be disposed on the distal end, e.g., movable between the first and second sets of staples, e.g., using a fourth actuator on the handle to advance the cutting element to sever the stapled tissue. In addition or alternatively, a thermal element or other hemostasis element may also be provided on one of the first and second jaws, e.g., opposite the Doppler sensor, and the handle may include a fifth actuator for activating the hemostasis element to deliver thermal energy to the stapled tissue. Optionally, the handle may include one or more additional actuators, e.g., one or more controls for positioning and/or activating a light and/or camera carried on the distal end of the shaft or the end effector.
In accordance with another embodiment, an end effector is provided for a stapler apparatus including a shaft including a proximal end including a handle and a distal end sized for introduction into a patient's body. The end effector may include one or more connectors for removably connecting the end effector to the distal end of the shaft and, optionally, a cartridge insertable into a recess of one of the jaws. The first and second jaws are movable relative to one another between open and closed positions, thereby directing contact surfaces of the first and second jaws away from and towards one another, respectively. For example, the first jaw may be fixed and the second jaw may be pivotally mounted to open and close relative to the first jaw, e.g., to capture tissue between the contact surfaces. One or more staples are carried by the first jaw, e.g., in a replaceable cartridge, such that actuation of a staple actuator on the handle deploys one or more staples from the first jaw into tissue between the contact surfaces and towards the second jaw to deform the one or more staples. Optionally, a Doppler radar sensor and/or hemostasis element may be provided on one of the contact surfaces to detect blood flow in the tissue.
In accordance with still another embodiment, a method is provided for performing a surgical procedure within a patient's body that includes introducing first and second jaws on a distal end of a shaft into a region within the patient's body; with the jaws in an open position, placing tissue within the region between contact surfaces of the first and second jaws; closing the jaws to engage the tissue; actuating a staple actuator to deploy one or more staples from the first jaw into the tissue towards the second jaw to deform the one or more staples and secure the tissue. For example, the second jaw may be closed to squeeze the tissue between the contact surfaces and, optionally, may be locked in the closed position. The staple(s) may be then be deployed from the first jaw using the staple actuator such that they are directed through the tissue and engage anvils or shaping surfaces on the second jaw to deform tines of the staple(s). A Doppler or other sensor on one of the contact surfaces may be activated to detect blood flow in the stapled tissue; and after confirming that blood flow has discontinued in the stapled tissue, a cutting element may be actuated to sever the stapled tissue from adjacent tissue at the region.
In accordance with yet another embodiment, a method is provided for performing an appendectomy within a patient's body that includes introducing first and second jaws on a distal end of a shaft into an abdominal cavity of the patient's body; placing an appendix and appendicular artery within the abdominal cavity between contact surfaces of the first and second jaws; actuating one or both of the first and second jaws to secure the appendix and artery between the contact surfaces; and deploying one or more staples from the first jaw through the appendix and artery to staple the appendix and artery. Thereafter, a Doppler sensor on one of the contact surfaces may be activated to detect blood flow in the stapled appendix and artery, and, if blood flow is detected, a thermal element may be activated to deliver thermal energy to stop blood flow, e.g., alternately to detect and cauterize the tissue. Once blood flow has stopped, a cutting element may be actuated to simultaneously sever the appendix and artery.
In accordance with another embodiment, an apparatus is provided for performing a medical procedure that includes a shaft including a proximal end, a distal end sized for introduction into a patient's body, and a longitudinal axis extending between the proximal and distal ends; first and second jaws on the distal end of the shaft that are movable relative to one another between open and closed positions, thereby directing first and contact surfaces of the first and second jaws away from and towards one another, respectively, the first jaw carrying first and second sets of staples positioned on opposite sides of a cutting element, wherein at least some of the staples are a different size than other staples; and a handle on the proximal end of the shaft. For example, each set of staples may include one to five rows of staples aligned along the longitudinal axis, with two to fifty staples in each row. The staples in each set and/or each row may have different sizes depending on the anatomy encountered. For example, the apparatus may include a plurality of available cartridges, each including different arrangements of staples, that may be selected and inserted into a cavity of the first jaw. The handle includes a first actuator for driving the staples from the first jaw into tissue between the first and second contact surfaces and towards the second jaw to deform the staples; and a second actuator for advancing the cutting element from a retracted position to an advanced position aligned with the longitudinal axis to sever the stapled tissue.
In accordance with yet another embodiment, an end effector is provided for a stapler apparatus including a shaft comprising a proximal end including a handle, a distal end sized for introduction into a patient's body, and a longitudinal axis extending between the proximal and distal ends. The end effector may include one or more connectors for removably connecting the end effector to the distal end of the shaft; first and second jaws that are movable relative to one another between open and closed positions using a first actuator on the handle, thereby directing first and contact surfaces of the first and second jaws away from and towards one another, respectively; and a cartridge carried by the first jaw comprising first and second sets of staples arranged in rows on opposite sides of a cutting element such that actuation of a second actuator on the handle deploys the staples into tissue between the first and second contact surfaces and drives the staples against the second jaw to deform the one or more staples, wherein at least some of the staples are a different size than other staples.
In accordance with still another embodiment, a staple is provided for delivery into tissue that includes a substantially straight base element including first and second ends; a first tine extending from the first end substantially perpendicular to the base, the first tine having a first length and including one or more notches adjacent a tip of the first tine; and a second tine extending from the second end substantially perpendicular to the base to a second tip, the second tine having a second length longer than the first length and longer than the length of the straight base such that, when the second tine is bent adjacent the base, the second tip of the second tine is engaged in the one or more notches located on the first tine.
In accordance with another embodiment, a port is provided for introducing one or more instruments into a patient's body that includes an elongate tubular member comprising a proximal end, a distal end sized for introduction into a patient's body, and a lumen extending between the proximal and distal ends, thereby defining a longitudinal axis there between; a display; and one or more deployment arms on the tubular member adjacent the distal end carrying an imaging device, each deployment arm comprising a first end pivotably coupled to the tubular member and a second free end that is movable from a retracted position wherein the second end is aligned with a wall of the tubular member and a deployed position wherein the second end moves outwardly relative to the longitudinal axis for presenting images on the display.
In accordance with still another embodiment, a port is provided for introducing one or more instruments into a patient's body that includes an elongate tubular member comprising a proximal end, a distal end sized for introduction into a patient's body, and a primary lumen extending between the proximal and distal ends for receiving an instrument therethrough, and a plurality of secondary lumens positioned around the primary lumen and extending between the proximal and distal ends; and a video module. The video module may include a hub; a display; and a plurality of elongate imaging elements mounted to the hub and sized for introduction simultaneously into respective secondary lumens of the tubular member such that distal tips of the imaging elements are positioned adjacent the distal end of the tubular member for acquiring images beyond the distal end.
Other aspects and features of the present invention will become apparent from consideration of the following description taken in conjunction with the accompanying drawings.
The drawings illustrate exemplary embodiments of the invention, in which:
Before the exemplary embodiments are described, it is to be understood that the invention is not limited to particular embodiments described, as such may, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting, since the scope of the present invention will be limited only by the appended claims.
Where a range of values is provided, it is understood that each intervening value, to the tenth of the unit of the lower limit unless the context clearly dictates otherwise, between the upper and lower limits of that range is also specifically disclosed. Each smaller range between any stated value or intervening value in a stated range and any other stated or intervening value in that stated range is encompassed within the invention. The upper and lower limits of these smaller ranges may independently be included or excluded in the range, and each range where either, neither or both limits are included in the smaller ranges is also encompassed within the invention, subject to any specifically excluded limit in the stated range. Where the stated range includes one or both of the limits, ranges excluding either or both of those included limits are also included.
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although any methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, some potential and exemplary methods and materials are now described.
It must be noted that as used herein and in the appended claims, the singular forms “a,” “an,” and “the” include plural referents unless the context clearly dictates otherwise. Thus, for example, reference to “a compound” includes a plurality of such compounds and reference to “the polymer” includes reference to one or more polymers and equivalents thereof known to those skilled in the art, and so forth.
Turning to the drawings,
As shown, the shaft 20 is an elongate member, e.g., a substantially rigid tubular body, including a proximal end 22 and a distal end 24, defining a longitudinal axis 26 extending there between. The shaft 20 may include one or more lumens or passages (not shown) extending between the proximal and distal ends 22, 24, e.g., for receiving actuator elements, wires, and/or other components, as described elsewhere herein. At least the distal end 24 of the shaft 20 is sized for introduction into a patient's body, e.g., having a diameter sufficiently small enough to be received through a port or cannula to allow introduction into a laparoscopic surgical space within a patient's body.
Optionally, at least a portion of the shaft 20 may be malleable, e.g., such that at least a distal region of the shaft 20 may be deformed into a desired shape outside the patient's body, which the shaft 20 may maintain during introduction. Alternatively, at least a distal region of the shaft 20 and/or the end effector 40 may be flexible, e.g., for introduction into body passages, such as blood vessels, GI passages, and the like, such that the distal region follows the passages during introduction. Optionally, in this alternative, the shaft 20 may include one or more steering wires or other elements therein (not shown) that may be actuated to change the shape of the shaft 20, e.g., to facilitate introduction into a desired location and/or manipulation within the patient's body.
The handle 30 may include a handgrip 32, e.g., shaped and/or otherwise configured to facilitate holding and/or manipulating the apparatus 8 during use. In addition, the handle 30 may include one or more actuators, e.g., for operating mechanical and/or electrical components on the stapler assembly 40. For example, as shown in
Optionally, as shown in
For example, a CMOS, CCD, or other imaging element (not shown) may be provided on the distal end 24 of the shaft 20 (or alternatively on the end effector 40) that is oriented to acquire images of the region beyond the stapler assembly 40 and/or between jaws 46, 48 of the end effector 40. One or more wires and/or optical fiber may transmit signals to the display 38, which may include a processor to process the signals and present the images on a screen of the display 38. In addition or alternatively, one or more LEDs or other light sources may be provided on the distal end 24 of the shaft 20 (or alternatively on the end effector 40), e.g., adjacent the imaging element to provide illumination for the images. For example, one or more lights may be arranged circumferentially on the distal end 24 of the shaft 20, such as a circular Xenon LED lamp (not shown), e.g., operating at 200-2500 W, that may provide dispersed illumination (due to internal reflections in the lamp) without generating thermal energy that may damage nearby tissue. Alternatively, one or more LEDs or other light sources (not shown) may be provided in the handle 30, and light may be transmitted using light conductive material such as optical fiber or transparent plastic to provide illumination to the distal end 24. The handle 30 and/or display 38 may include one or more controls (not shown), e.g., to turn the illumination source(s) and/or imaging element(s) off and on, as desired. Optionally, the imaging element(s) and/or illumination source(s) may be movable relative to the end effector 40, e.g., rotated about the longitudinal axis 26 and, if so, one or more actuators (not shown) may be provided on the handle 30 to rotate or otherwise adjust their position during a procedure.
Returning to
As shown, the first jaw 46 may be integrally formed with or otherwise fixed relative to the housing 42, e.g., such that the first jaw 46 remains aligned with the axis 26 of the shaft 20 during use. The second jaw 48 may be movably mounted to the housing 42, e.g., by one or more hinges or other features (not shown) such that the second jaw 48 may be pivotable between an open position, e.g., as shown in
The jaws 46, 48 may be biased to one of the open and closed positions or may be actuatable between the open and closed positions. For example, the jaws 46, 48 may be provided initially in a closed position, e.g., to facilitate introduction into a patient's body, whereupon a lock or other mechanism may be released, whereupon the second jaw 48 may automatically move to the open position, and the actuator 34 on the handle 30 may become active to deploy staples and/or close the second jaw 48, as described further elsewhere herein. Alternatively, the trigger 34 on the handle 30 may be pulled or released to close and open the second jaw 48 without deploying staples to facilitate introduction and/or manipulation of the cartridge 40, e.g., until a switch or other control is actuated to activate deployment of the staples. A locking mechanism, e.g., ratchet 34a, as shown in
With particular reference to
Optionally, the cartridge 50 or first jaw 46 may include a thermal element 56 on the first surface 46a adjacent the rows of staples. For example, the cartridge 50 may include sets of staples disposed on opposite sides of the thermal element 56, e.g., with the sets aligned with the axis 26 of the shaft 20. Alternatively, as shown in
In the example shown in
In the embodiment shown in
For example,
Alternatively, as shown in
Returning to
Optionally, the second jaw 48 may include a Doppler radar or other sensor 58, e.g., located on the second contact surface 48a generally opposite the thermal element 56. For example, the Doppler sensor 58 may be an elongate crystal element mounted on the second contact surface 56 and aligned along the axis 26 (when the second jaw 48 is closed). The Doppler sensor 58 may be configured to transmit radar signals and receive reflections from the tissue captured between the jaws 46, 48 to identify whether blood is flowing within the tissue, e.g., using systems and methods known in the art.
As can be seen in
In an exemplary embodiment, the thermal element may include one or more electrodes, e.g., a single elongate electrode 56, e.g., extending axially along the first contact surface 46a, which may be coupled to a source of electrical energy, e.g., a generator (not shown), in the handle 30a nd/or connected to the handle 30, as described further elsewhere herein. For example, as shown in
Alternatively, the location of the thermal element 56 and Doppler sensor 58 may be reversed, if desired, e.g., with the thermal element on the second contact surface and the Doppler sensor on the first contact surface (not shown). In a further alternative, the thermal sensor may be omitted entirely and only a Doppler sensor 58 may be provided on one of the jaws, e.g., on the second jaw 48, as shown in
In yet another alternative, the Doppler sensor may be provided at other locations on the second contact surface on any of these embodiments. For example, as shown in
In the embodiments shown in
Returning to
Optionally, the cartridge 40 may include one or more additional components for use during a procedure. For example, an illumination source and/or imaging element may be mounted on the housing 42, e.g., to facilitate imaging and/or monitoring use of the apparatus 8 during a procedure. In an exemplary embodiment, a CMOS, CCD, or other imaging element and/or one or more LEDs or other light sources (not shown) may be provided on the end effector 40, e.g., adjacent the proximal end of the first jaw 46 where the second jaw 48 pivots, that may be oriented distally to acquire images of the region beyond the stapler assembly 40. For example, the field of view of the imaging element may include the first contact surface 46a of the first jaw 46 such that an operator may use the images to position and/or orient a desired tissue structure on the contact surface 46a before actuating the second jaw 48 to close.
The apparatus 8 may be used to deliver staples into tissue during a medical procedure, e.g., during a laparoscopic surgical procedure, such as an appendectomy. Initially, a surgical space may be created, e.g., by introducing a trocar and/or cannula device (not shown) through the patient's skin and intervening tissue to a target region, e.g., the patient's abdominal cavity, and insufflating or otherwise opening the space to access a desired tissue structure, such as an appendix indicated for removal.
An end effector 40 and cartridge 50 may be selected and connected to the distal end 24 of the shaft 20 before introduction into the patient's body. For example, based on the anatomy encountered, the operator may select a cartridge 50 including a particular arrangement of staples, e.g., including uniform-size staples or different size staples, such as those described elsewhere herein, insert the cartridge 50 into the cavity 46c of the first jaw 46, e.g., before or after connecting the end effector 40 the shaft 20. Once the apparatus 8 is ready, the distal end 24 of the shaft 20 carrying the end effector 40 may be introduced into the surgical space, e.g., through a cannula or other port (not shown), until the jaws 46, 48 are located the surgical space. For example, the surgical space may be initially accessed using a needle, trocar, and/or dilator device, e.g., punctured through the patient's skin and intervening tissue into the abdominal cavity to approach the appendix, and a cannula may be positioned through the puncture. Gas may be delivered through the cannula or other device to insufflate and create a surgical cavity or space.
The distal end 24 of the shaft 40, carrying the selected end effector 40 and/or cartridge 50, may then be introduced through the cannula into the surgical space. For example, the jaws 46, 48 may be initially locked in the closed position to facilitate introduction through the cannula and then may be released once located within the surgical space, whereupon the second jaw 48 may open. Alternatively, the second jaw 48 may be biased to open but may be manually or otherwise closed to allow insertion through the cannula.
With the jaws 46, 48 in the open position within the surgical space, tissue within the region, e.g., the patient's appendix, may be placed on the contact surface 46a of the first jaw 46 and/or otherwise positioned between the jaws 46, 48. For example, both the appendix and the appendicular artery may be positioned between the jaws 46, 48, e.g., with one distal to the other depending on the orientation of the appendix.
Once the tissue is positioned as desired, the trigger actuator 34 may be manipulated to close the second jaw 48 and lock the tissue in place between the contact surfaces 46a, 48a. For example, the trigger 34 may include a ratchet mechanism that allows the second jaw 48 to close while preventing it from reopening, or a separate locking mechanism (not shown) may activated once the second jaw 48 is closed to engage the tissue. A separate staple actuator (not shown) may then be used to deploy one or more staples from the first jaw 46 into and through the tissue and towards the second jaw 48 to deform the staples(s) and engage the tissue.
For example, as the stapler actuator 67 is pushed, an actuation shaft 67a within the shaft 20 may advance a wedge or other staple actuation element (not shown) within the cartridge 50 or end effector 40 to begin deploying staples from the receptacles 52 out of the first contact surface 50a/46a of the first jaw 46 upwardly towards the second jaw 48, thereby causing one or more tines of the staples to contact the corresponding recesses 54 in the second contact surface 48a and deform to staple the tissue.
The deployment of the staples may be sequential within each set, e.g., simultaneously delivering first staples from each of the sets 52a-52c at the proximal end of the first jaw 46 and, as the trigger 34 continues to be pulled, additional staples are deployed until the desired length of stapling, whereupon actuation may be discontinued, which may leave one or more staples closest to the distal tip 46a of the first jaw 46 undeployed. In this manner, the operator may control how many staples are deployed based on the extent to which the staple actuator is pulled. Alternatively, the actuator 34 may be binary, i.e., wherein, when the trigger 34 is initially pulled, all of the staples in the first jaw are deployed in rapid succession.
If the apparatus 8 includes a Doppler sensor 58, e.g., on the second jaw 48, the Doppler sensor 58 may be activated, e.g., using a radar actuator (not shown) on the handle 30, to detect blood flow in the stapled tissue. For example, signals from the sensor 58 may be transmitted, e.g., via one or more wires (not shown) in the shaft 20 to a processor in the handle 30, which may analyze the signals to confirm whether blood flow has discontinued in the stapled tissue. The apparatus 8 may include an output device, e.g., an indicator light, speaker, and the like (not shown), e.g., on the handle 30 that may provide a positive indication that blood flow has stopped. The operator may then manipulate another actuator, e.g., a slider, dial, and the like (not shown) on the handle 30 to advance the blade 60 to sever the stapled tissue from adjacent tissue.
If the output device indicates that blood is still flowing in the stapled tissue, additional actions may be taken to cauterize the tissue and/or stop blood flow. For example, if the apparatus 8 includes the thermal element 56, the operator may activate the thermal element to deliver thermal energy to the stapled tissue. For example, a button or switch (not shown) on the handle 30 may be activated to deliver RF energy from a power source coupled to the handle 30 via one or more wires (not shown) in the shaft 20 to the electrode(s) 56a on the first jaw 46 to cauterize the stapled tissue. Energy may be delivered until the output device/Doppler sensor 58 provides a confirmation that blood flow has stopped, whereupon the blade 60 may be advanced to sever the tissue, e.g., to simultaneously sever the appendix and the appendicular artery.
Optionally, before severing the tissue, the second jaw 48 may be released and opened and the jaws 46, 48 repositioned relative to the stapled tissue and then closed and locked at one or more subsequent positions, e.g., to use the Doppler sensor 58 to confirm blood flow has stopped and/or deliver further thermal energy to cauterize the tissue. Once desired, the blade 60 may be used to sever the tissue.
The apparatus 8 may then be removed from the surgical space and the procedure completed using conventional methods. For example, the blade 60 may be retracted, and the Doppler sensor 58 and/or hemostasis element 56 may be deactivated (if not already). The end effector 40 may be removed from the patient's body with the second jaw 48 remaining locked to remove the excised tissue.
Optionally, the procedure may be illuminated and/or monitored using an illumination source and/or imaging element on the end effector 40 and/or shaft 20, as described elsewhere herein. In addition or alternatively, other light sources and/or imaging devices may be provided to monitor the procedure. For example, a separate endoscope may be introduced into the surgical space, e.g., via a different cannula or port (not shown) than the cannula used to introduce the apparatus 8.
In another alternative, a cannula or access port may be provided that includes one or more illumination and/or imaging elements, and the apparatus 8 may be introduced using the access port. For example, turning to
A handle or hub 80 may be provided on the proximal end 74, e.g., to facilitate manipulation of the access port 70 during use. The hub 80 may include one or more valves or seals (not shown), which may seal the primary lumen 78a yet facilitate inserting an instrument into the primary lumen 78a, e.g., providing a substantially fluid-tight seal around the instrument. In this manner, the seal(s) may prevent insufflation gas or other fluid to escape through the primary lumen 78a, e.g., when the access port is introduced into a patient's body, as described elsewhere herein.
In addition, a display or other output device 82 may be provided on the hub 80, e.g., to facilitate observing or otherwise monitoring the procedure using one or more imaging devices on the access port 80. For example, a distal portion of the tubular body 72 may include a pair of deployable arms 84 including first ends 84a pivotally coupled to the tubular body 72 and second or free ends 84b that may carry one or more cameras, light sources, and/or other imaging device, as described further below.
In one embodiment, the display 82 may be removably mountable on the hub 80, which may include one or more connectors or cables (not shown) that may be coupled to corresponding connectors on the hub 80, which are, in turn, coupled to one or more wires extending to the imaging device(s) on the arms 84. Thus, in this alternative, the display 82 may be reusable and the tubular body 72 may be disposable/single-use. Alternatively, the display 82 may be permanently mounted to the hub 80 and one or more wires or other elements may communicate with the imaging device(s). Thus, in this alternative, the entire access port 80 may cleaned and reused or may be single-use. In a further alternative, the access port 80 may include a communications interface that may transmit signals from the imaging device wirelessly, e.g., using Bluetooth or other communications protocols, to allow images to be presented on a remote display.
In an exemplary embodiment, a CMOS, CCD, or other imaging element (not shown) may be provided on the free end 84b of one of the arms 84 and one or more LEDs or other light sources may be provided on the free end 84b of the other arm 84. Alternatively, separate light sources and imaging elements may be provided on both arms, e.g., to provide multiple images simultaneously on the display 82. In a further alternative, only one arm may be provided, if desired, including one or more light sources and/or imaging elements on its free end.
In any of these embodiments, one or more wires may transmit signals from the imaging element(s) to the display 82, which may include a processor to process the signals and present the images on a screen of the display 82. The imaging element(s) may include a field of view oriented distally beyond the distal end 76 of the tubular body 72, e.g., to illuminate and/or image an instrument deployed within a region beyond the distal end 76.
The arms 84 are movable between a retracted configuration, e.g., as shown in
For example, with particular reference to
Turning to
In the example shown, the staple 90 has a cross section that is substantially uniform along the length of the staple 90, e.g., along a length of the first tine 94, along the base 92, and along the second tine 96. For example, the staple may have a substantially rectangular (with or without sharp corners), oblong, or other generally flattened cross-section, e.g., having a width “w” that is thicker than a thickness “t,” as indicted in
In addition, the first tine 94 includes a notch 98 adjacent its tip 95 configured to receive the tip 97 of the second tine 96 when it is deformed. For example, as shown, the tip 97 of the second tine 97 may be beveled such that the tip 97 tapers towards the first tine 94, which may enhance the tip 97 being locked into the notch 98. Alternatively, as shown in
Optionally, as shown in
In another option, shown in
With additional reference to
Turning to
The video module 180 generally includes an annular hub 182 from which a plurality of elongate sleeves, tubes, or other imaging elements 184 extend, e.g., provided in an arrangement corresponding to the secondary lumens 178b in the tubular body 172. The imaging sleeves 184 may be sized to be inserted into the secondary lumens 178b simultaneously from the proximal end 174 of the tubular body 172 such that distal tips 184b thereof are disposed adjacent the distal end 176 of the tubular body 172, e.g., extending slightly from the outlets 184b for acquiring images beyond the distal end 176.
Optionally, the proximal end 174 of the tubular body 172 and the hub 182 may include cooperating connectors (not shown) to removably couple the hub 182 to the tubular body 172, e.g., such that the access port 170 may be manipulated as a unitary device.
In addition, one or both of the proximal end 174 of the tubular body 172 and the hub 182 may include one or more valves or seals (not shown), e.g., to seal the primary lumen 178a yet facilitate inserting an instrument into the primary lumen 178a, e.g., providing a substantially fluid-tight seal around the instrument. In this manner, the seal(s) may prevent insufflation gas or other fluid to escape through the primary lumen 178a, e.g., when the access port 170 is introduced into a patient's body, as described elsewhere herein.
In addition, a display or other output device 186 may be provided on the hub 182, e.g., to facilitate observing or otherwise monitoring the procedure using one or more imaging devices on the access port 170. In one embodiment, the display 186 may be removably mountable on the hub 182, which may include one or more connectors or cables (not shown) that may be coupled to corresponding connectors on the hub 182. Alternatively, the display 186 may be permanently mounted to the hub 182. In a further alternative, a display may be provided separate from the access port 170 and images may be transmitted wirelessly or via wired connection from the access port 170, similar to other embodiments herein.
Each sleeve 184 may include an elongate tubular body, e.g., formed from stainless steel or other metal, plastic, and/or composite material including a lumen for carrying one or more imaging components. The sleeves 184 may be substantially rigid or, alternatively, may be sufficiently flexible to follow the shape of the lumens 178b, e.g., if the tubular body 172 is malleable or flexible and directed to a nonlinear shape.
In an exemplary embodiment, at least one of the imaging sleeves 184 may carry a CMOS, CCD, or other camera (not shown) on its distal tip 184b to acquire the images.
Alternatively, a lens may be provided on the distal tip 184b and a fiberoptic cable or other optical conductor (also not shown) may extend through the imaging sleeve 184 to the proximal end 184a, where the conductor may be coupled to a camera to acquire the images.
Similarly, at least one of the imaging sleeves 184 may carry an illumination source, e.g., an LED or other light source, on its distal tip 184b for transmitting light beyond the distal end 176 of the tubular body 172. Alternatively, the LED or other light source may be provided within the hub 180, and an optical conductor may extend from the proximal end 184a of the imaging sleeve 184 to its display tip 184b. In the example shown, the video module 180 includes a pair of sleeves 184 on opposite sides of the primary lumen 178a carrying cameras on distal tips 184(1), and a pair of sleeves 184 on opposite sides of one of the camera sleeves carrying an LED or other illumination source on the distal tips 184(2) (or may carry lenses coupled to cameras or LEDs), e.g., providing a field of view as shown in
During use, the imaging elements 184 may be inserted into inlets 175b from the proximal end 174 of the tubular body 172 into the corresponding secondary lumens 178b until the distal tips 184b are positioned adjacent the distal end 176 of the tubular body 172, e.g., extending a desired distance from the outlets 179b to allow acquisition of images. Optionally, when the imaging elements 184 are fully inserted, connectors on the hub 182 and/or proximal end 174 may engage to secure the video module 180 relative to the tubular body 172. The assembled access port 170 may then be introduced into a patient's body to allow introduction of one or more instruments to be introduced to perform a surgical procedure while acquiring images of the procedure, similar to other embodiments herein. For example, as shown in
Upon completing the procedure, any instruments may be removed from the primary lumen 178a, and the port 170 may be removed from the patient's body using conventional methods. The video module 180 may be removed from the tubular body 172 and then cleaned, sterilized, and/or otherwise prepared for use again in a subsequent procedure. The tubular body 172 may be single-use, and may be discarded after the procedure. Alternatively, the tubular body 172 may also be cleaned, sterilized, and/or otherwise prepared for reuse.
Turning to
Unlike the previous embodiments, a plurality of elongate imaging sleeves 284 also extend from the handle portion 210, e.g., from a hub 282 from which the shaft 220 also extends. As shown, the imaging sleeves 284 may be positioned radially around the shaft 220 and may have a length longer than the shaft 220 such that distal tips 284b of the imaging sleeves 284 extend distally beyond the distal end 224 of the shaft 220. The video module 280 may also include a display 286 mounted on the hub 282 (or elsewhere on the handle portion 210 and/or remote from the apparatus 280, as desired) coupled to one or more cameras and/or illumination sources (not shown) that may be used to acquire images beyond the distal tips 184b.
An end effector (not shown) may be coupled to the distal end 224 of the shaft 220 generally similar to other embodiments, e.g., to staple, cauterize, and/or remove tissue. In addition, the housing of the end effector may include a plurality of secondary lumens (also not shown) that may receive the imaging sleeves 284 such that the distal tips 284b are disposed adjacent jaws of the end effector, e.g., similar to the configuration shown in
During use, a desired end effector may be received over the imaging sleeves 284 and coupled to the distal end 224 of the shaft. Optionally, a cartridge (not shown) may be loaded into one of the jaws of the end effector and then the end effector may be introduced into a patient's body to perform a surgical or other medical procedure, similar to other embodiments herein. IN this manner, the video module 280 may be used to acquire images during the procedure. Upon completing the procedure, the apparatus 208 may be removed, the end effector may be removed and, optionally discarded, and the handle portion 210 may be cleaned and/or otherwise prepared for use in another procedure, also similar to other embodiments herein.
Alternatively, it will be appreciated that other staples or clips may be delivered using any of the stapler apparatus herein, such as those described in the provisional application incorporated by reference herein.
It will be appreciated that elements or components shown with any embodiment herein are exemplary for the specific embodiment and may be used on or in combination with other embodiments disclosed herein. In addition, although the apparatus herein have been described for particular use during an appendectomy procedure. It will be appreciated that the apparatus and methods herein may be used in a variety of surgical procedures, e.g., including open, minimally invasive, laparoscopic, and other procedures, where it is desired to staple and remove target tissues, e.g., within a patient's intestine, lungs, vasculature, and other locations.
While the invention is susceptible to various modifications, and alternative forms, specific examples thereof have been shown in the drawings and are herein described in detail. It should be understood, however, that the invention is not to be limited to the particular forms or methods disclosed, but to the contrary, the invention is to cover all modifications, equivalents and alternatives falling within the scope of the appended claims.
The present application claims benefit of co-pending U.S. provisional application Ser. No. 62/947,903, filed Dec. 13, 2019, the entire disclosure of which is expressly incorporated by reference herein.
| Number | Name | Date | Kind |
|---|---|---|---|
| 3612107 | Grise | Oct 1971 | A |
| 3940844 | Colby | Mar 1976 | A |
| 4423787 | Steinberg | Jan 1984 | A |
| 4487394 | Rothfuss | Dec 1984 | A |
| 4526174 | Froehlich | Jul 1985 | A |
| 4655222 | Florez | Apr 1987 | A |
| 4676245 | Fukuda | Jun 1987 | A |
| 4706864 | Jacobsen | Nov 1987 | A |
| 4773420 | Green | Sep 1988 | A |
| 4787387 | Burbank, III | Nov 1988 | A |
| 4802478 | Powell | Feb 1989 | A |
| 4848637 | Pruitt | Jul 1989 | A |
| 4887601 | Richards | Dec 1989 | A |
| 4919021 | Franks | Apr 1990 | A |
| 4924864 | Danzig | May 1990 | A |
| 4998981 | Miyanaga | Mar 1991 | A |
| 5095590 | Schick | Mar 1992 | A |
| 5163598 | Peters | Nov 1992 | A |
| 5166787 | Irion | Nov 1992 | A |
| 5192288 | Thompson | Mar 1993 | A |
| 5250058 | Miller | Oct 1993 | A |
| 5258016 | DiPoto | Nov 1993 | A |
| 5282829 | Hermes | Feb 1994 | A |
| 5389098 | Tsuruta | Feb 1995 | A |
| 5395030 | Kuramoto | Mar 1995 | A |
| 5403326 | Harrison | Apr 1995 | A |
| 5423857 | Rosenman | Jun 1995 | A |
| 5489058 | Plyley | Feb 1996 | A |
| 5497933 | DeFonzo | Mar 1996 | A |
| 5535935 | Vidal | Jul 1996 | A |
| 5573543 | Akopov | Nov 1996 | A |
| 5624452 | Yates | Apr 1997 | A |
| 5643291 | Pier | Jul 1997 | A |
| 5658312 | Green | Aug 1997 | A |
| 5709680 | Yates et al. | Jan 1998 | A |
| 5755732 | Green | May 1998 | A |
| 5810846 | Vimich | Sep 1998 | A |
| 5893855 | Jacobs | Apr 1999 | A |
| 5893863 | Yoon | Apr 1999 | A |
| 5928137 | Green | Jul 1999 | A |
| 5972002 | Bark | Oct 1999 | A |
| 5984692 | Kumagai | Nov 1999 | A |
| 6003517 | Sheffield et al. | Dec 1999 | A |
| 6059787 | Allen | May 2000 | A |
| 6083241 | Longo | Jul 2000 | A |
| 6165204 | Levinson | Dec 2000 | A |
| 6178346 | Amundson | Jan 2001 | B1 |
| 6221007 | Green | Apr 2001 | B1 |
| 6254615 | Bolduc | Jul 2001 | B1 |
| 6309345 | Stelzer | Oct 2001 | B1 |
| 6419682 | Appleby | Jul 2002 | B1 |
| 6530933 | Yeung | Mar 2003 | B1 |
| 6671581 | Niemeyer | Dec 2003 | B2 |
| 6718196 | Mah | Apr 2004 | B1 |
| 6739374 | Mouzakis | May 2004 | B1 |
| 6981983 | Rosenblatt | Jan 2006 | B1 |
| 7048255 | Buch | May 2006 | B2 |
| 7213736 | Wales | May 2007 | B2 |
| 7267682 | Bender | Sep 2007 | B1 |
| 7381183 | Hale | Jun 2008 | B2 |
| 7431730 | Viola | Oct 2008 | B2 |
| 7438209 | Hess | Oct 2008 | B1 |
| 7621925 | Saadat | Nov 2009 | B2 |
| 7699860 | Huitema | Apr 2010 | B2 |
| 7744613 | Ewers | Jun 2010 | B2 |
| 7776057 | Aufer | Aug 2010 | B2 |
| 7780663 | Yates et al. | Aug 2010 | B2 |
| 7871416 | Phillips | Jan 2011 | B2 |
| 7875063 | Sander | Jan 2011 | B1 |
| 7918873 | Cummins | Apr 2011 | B2 |
| 7946981 | Cubb | May 2011 | B1 |
| 7997468 | Farascioni | Aug 2011 | B2 |
| 7997469 | Olson | Aug 2011 | B2 |
| 8123795 | Knodel | Feb 2012 | B1 |
| 8186555 | Shelton, IV | May 2012 | B2 |
| 8216236 | Heinrich et al. | Jul 2012 | B2 |
| 8303585 | Mollenauer | Nov 2012 | B2 |
| 8348131 | Omaits | Jan 2013 | B2 |
| 8403826 | Zobel | Mar 2013 | B1 |
| 8496154 | Marczyk | Jul 2013 | B2 |
| 8523043 | Ullrich et al. | Sep 2013 | B2 |
| 8579178 | Holsten | Nov 2013 | B2 |
| 8662369 | Manoux | Mar 2014 | B1 |
| 8763878 | Euteneuer | Jul 2014 | B2 |
| 9254131 | Soltz | Feb 2016 | B2 |
| 9414841 | Euteneuer | Aug 2016 | B2 |
| 9549667 | Manohara | Jan 2017 | B2 |
| 9655618 | Knodel et al. | May 2017 | B2 |
| 9724096 | Thompson | Aug 2017 | B2 |
| 9750502 | Scirica | Sep 2017 | B2 |
| 9775623 | Zammataro | Oct 2017 | B2 |
| 9848874 | Kostrzewski | Dec 2017 | B2 |
| 9872683 | Hopkins et al. | Jan 2018 | B2 |
| 9888832 | Schwartz | Feb 2018 | B2 |
| 10028650 | Yoon | Jul 2018 | B2 |
| 10070861 | Spivey | Sep 2018 | B2 |
| 10098642 | Baxter, III | Oct 2018 | B2 |
| 10130363 | Huitema | Nov 2018 | B2 |
| 10188275 | Sonnenschein et al. | Jan 2019 | B2 |
| 10245038 | Hopkins et al. | Apr 2019 | B2 |
| 10278778 | State | May 2019 | B2 |
| 10426467 | Miller et al. | Oct 2019 | B2 |
| 10426481 | Aronhalt | Oct 2019 | B2 |
| 10542979 | Shelton, IV | Jan 2020 | B2 |
| 10555775 | Hoffman | Feb 2020 | B2 |
| 10595887 | Shelton, IV et al. | Mar 2020 | B2 |
| 10595930 | Scheib et al. | Mar 2020 | B2 |
| 10624616 | Mukherjee et al. | Apr 2020 | B2 |
| 10980539 | Harris | Apr 2021 | B2 |
| 11020111 | Euteneuer | Jun 2021 | B2 |
| 11045267 | Hussain | Jun 2021 | B2 |
| 11090045 | Shelton, IV | Aug 2021 | B2 |
| 11100631 | Yates | Aug 2021 | B2 |
| 11291510 | Shelton, IV | Apr 2022 | B2 |
| 20010044656 | Williamson, IV | Nov 2001 | A1 |
| 20010056282 | Sonnenschein | Dec 2001 | A1 |
| 20020049367 | Irion et al. | Apr 2002 | A1 |
| 20020049472 | Coleman | Apr 2002 | A1 |
| 20020183771 | Burbank | Dec 2002 | A1 |
| 20030144660 | Mollenauer | Jul 2003 | A1 |
| 20030163029 | Sonnenschein | Aug 2003 | A1 |
| 20040006372 | Racenet | Jan 2004 | A1 |
| 20040138525 | Saadat | Jul 2004 | A1 |
| 20050038317 | Ratnakar | Feb 2005 | A1 |
| 20050080434 | Chung | Apr 2005 | A1 |
| 20050090709 | Okada | Apr 2005 | A1 |
| 20050101974 | Burbank | May 2005 | A1 |
| 20050119527 | Banik | Jun 2005 | A1 |
| 20050182298 | Ikeda | Aug 2005 | A1 |
| 20050288707 | De Canniere | Dec 2005 | A1 |
| 20060111210 | Hinman | May 2006 | A1 |
| 20060180633 | Emmons | Aug 2006 | A1 |
| 20060191975 | Adams | Aug 2006 | A1 |
| 20060229594 | Francischelli | Oct 2006 | A1 |
| 20060235469 | Viola | Oct 2006 | A1 |
| 20070005061 | Eder | Jan 2007 | A1 |
| 20070073109 | Irion | Mar 2007 | A1 |
| 20070175947 | Ortiz | Aug 2007 | A1 |
| 20070194082 | Morgan | Aug 2007 | A1 |
| 20070225562 | Spvey | Sep 2007 | A1 |
| 20070244351 | Wazer | Oct 2007 | A1 |
| 20070250102 | Makower | Oct 2007 | A1 |
| 20070262116 | Hueil | Nov 2007 | A1 |
| 20070282356 | Sonnenschein | Dec 2007 | A1 |
| 20080000941 | Sonnenschein | Jan 2008 | A1 |
| 20080015618 | Sonnenschein | Jan 2008 | A1 |
| 20080064921 | Larkin | Mar 2008 | A1 |
| 20080065110 | Duval | Mar 2008 | A1 |
| 20080065153 | Allard | Mar 2008 | A1 |
| 20080082124 | Hess | Apr 2008 | A1 |
| 20080151041 | Shafer | Jun 2008 | A1 |
| 20080249565 | Michler | Oct 2008 | A1 |
| 20080262302 | Azarbarzin | Oct 2008 | A1 |
| 20080269562 | Marescaux | Oct 2008 | A1 |
| 20090054908 | Zand | Feb 2009 | A1 |
| 20090062799 | Holsten | Mar 2009 | A1 |
| 20090065552 | Knodel | Mar 2009 | A1 |
| 20090069806 | De La Mora Levy | Mar 2009 | A1 |
| 20090105815 | Krever | Apr 2009 | A1 |
| 20090134194 | Maksimoski | May 2009 | A1 |
| 20090250501 | Sonnenschein | Oct 2009 | A1 |
| 20090255976 | Marczyk | Oct 2009 | A1 |
| 20090255978 | Viola | Oct 2009 | A1 |
| 20090259097 | Thompson | Oct 2009 | A1 |
| 20090272783 | Crainich | Nov 2009 | A1 |
| 20090277946 | Marczyk | Nov 2009 | A1 |
| 20090277948 | Beardsley | Nov 2009 | A1 |
| 20090281554 | Viola | Nov 2009 | A1 |
| 20090318936 | Harris | Dec 2009 | A1 |
| 20100072258 | Farascioni | Mar 2010 | A1 |
| 20100100138 | Reynolds | Apr 2010 | A1 |
| 20100114124 | Kelleher | May 2010 | A1 |
| 20100127042 | Shelton, IV | May 2010 | A1 |
| 20100191262 | Harris | Jul 2010 | A1 |
| 20100234687 | Azarbarzin | Sep 2010 | A1 |
| 20100237128 | Miller | Sep 2010 | A1 |
| 20100249496 | Cardenas et al. | Sep 2010 | A1 |
| 20100249499 | Whitman | Sep 2010 | A1 |
| 20100249512 | McKinley | Sep 2010 | A1 |
| 20100261961 | Scott | Oct 2010 | A1 |
| 20100264192 | Marczyk | Oct 2010 | A1 |
| 20100274087 | Diolaiti | Oct 2010 | A1 |
| 20100327042 | Amid | Dec 2010 | A1 |
| 20110006104 | Felix | Jan 2011 | A1 |
| 20110046666 | Sorrentino | Feb 2011 | A1 |
| 20110063428 | Sonnenschein et al. | Mar 2011 | A1 |
| 20110066231 | Cartledge | Mar 2011 | A1 |
| 20110071508 | Duval | Mar 2011 | A1 |
| 20110101069 | Bombard | May 2011 | A1 |
| 20110112434 | Ghabrial | May 2011 | A1 |
| 20110245578 | Wazer | Oct 2011 | A1 |
| 20110288573 | Yates | Nov 2011 | A1 |
| 20110295242 | Spivey | Dec 2011 | A1 |
| 20120059394 | Brenner et al. | Mar 2012 | A1 |
| 20120065494 | Gertner | Mar 2012 | A1 |
| 20120078050 | Schwartz | Mar 2012 | A1 |
| 20120080492 | Scirica | Apr 2012 | A1 |
| 20120080503 | Woodard, Jr. | Apr 2012 | A1 |
| 20120130403 | Brenner | May 2012 | A1 |
| 20120160893 | Harris | Jun 2012 | A1 |
| 20120175401 | Bachnan | Jul 2012 | A1 |
| 20120193398 | Williams | Aug 2012 | A1 |
| 20120193399 | Holcomb | Aug 2012 | A1 |
| 20120199628 | Scirica | Aug 2012 | A1 |
| 20120209318 | Qadeer | Aug 2012 | A1 |
| 20120289781 | Pandey | Nov 2012 | A1 |
| 20120296238 | Chernov | Nov 2012 | A1 |
| 20130023868 | Worrell | Jan 2013 | A1 |
| 20130030438 | Fox | Jan 2013 | A1 |
| 20130153628 | Euteneuer | Jun 2013 | A1 |
| 20130233908 | Knodel | Sep 2013 | A1 |
| 20130240595 | Penna | Sep 2013 | A1 |
| 20130274712 | Schecter | Oct 2013 | A1 |
| 20130306704 | Balbierz | Nov 2013 | A1 |
| 20130345519 | Piskun | Dec 2013 | A1 |
| 20140018613 | Scott | Jan 2014 | A1 |
| 20140021240 | Miyamoto | Jan 2014 | A1 |
| 20140066911 | Nau, Jr. | Mar 2014 | A1 |
| 20140107417 | McKinley | Apr 2014 | A1 |
| 20140114327 | Boudreaux | Apr 2014 | A1 |
| 20140142379 | Faehndrich | May 2014 | A1 |
| 20140144968 | Shelton, IV | May 2014 | A1 |
| 20140213848 | Moskowitz et al. | Jul 2014 | A1 |
| 20140239037 | Boudreaux | Aug 2014 | A1 |
| 20140263570 | Hopkins | Sep 2014 | A1 |
| 20140318687 | Boettcher | Oct 2014 | A1 |
| 20150066000 | An | Mar 2015 | A1 |
| 20150122870 | Zemlok | May 2015 | A1 |
| 20150238187 | Schellin | Aug 2015 | A1 |
| 20150282749 | Zand | Oct 2015 | A1 |
| 20150297227 | Huitema | Oct 2015 | A1 |
| 20150351758 | Shelton, IV | Dec 2015 | A1 |
| 20150351765 | Valentine | Dec 2015 | A1 |
| 20160051259 | Hopkins | Feb 2016 | A1 |
| 20160066916 | Overmyer | Mar 2016 | A1 |
| 20160073855 | Farr | Mar 2016 | A1 |
| 20160089142 | Harris | Mar 2016 | A1 |
| 20160100837 | Huang | Apr 2016 | A1 |
| 20160135806 | Euteneuer | May 2016 | A1 |
| 20160302791 | Schmitt | Oct 2016 | A1 |
| 20160317157 | Bachar | Nov 2016 | A1 |
| 20160345973 | Marczyk | Dec 2016 | A1 |
| 20160345974 | Marczyk | Dec 2016 | A1 |
| 20160367300 | Caldarella | Dec 2016 | A1 |
| 20160374658 | Piskun | Dec 2016 | A1 |
| 20160374685 | Abbott | Dec 2016 | A1 |
| 20170055819 | Hansen | Mar 2017 | A1 |
| 20170056015 | Harris | Mar 2017 | A1 |
| 20170065276 | Weiner | Mar 2017 | A1 |
| 20170112561 | Motai | Apr 2017 | A1 |
| 20170172550 | Mukherjee | Jun 2017 | A1 |
| 20170231477 | Del Nido | Aug 2017 | A1 |
| 20170238991 | Worrell | Aug 2017 | A1 |
| 20170245854 | Zemlok | Aug 2017 | A1 |
| 20170296178 | Miller | Oct 2017 | A1 |
| 20170354408 | Kostrzewski | Dec 2017 | A1 |
| 20170367697 | Shelton, IV | Dec 2017 | A1 |
| 20180028181 | Alzaga | Feb 2018 | A1 |
| 20180042522 | Subramanian | Feb 2018 | A1 |
| 20180059258 | MacLaughlin | Mar 2018 | A1 |
| 20180125570 | Rioux | May 2018 | A1 |
| 20180235484 | Mozdzierz | Aug 2018 | A1 |
| 20180235636 | Culbert | Aug 2018 | A1 |
| 20180256161 | Eschbach | Sep 2018 | A1 |
| 20180256163 | Evans | Sep 2018 | A1 |
| 20180303314 | Noyes | Oct 2018 | A1 |
| 20190046220 | Chaturvedi | Feb 2019 | A1 |
| 20190059894 | Kumada et al. | Feb 2019 | A1 |
| 20190082932 | Schoonbaert | Mar 2019 | A1 |
| 20190082944 | Fujimori | Mar 2019 | A1 |
| 20190104919 | Shelton, IV | Apr 2019 | A1 |
| 20190125458 | Shelton, IV | May 2019 | A1 |
| 20190142589 | Basude | May 2019 | A1 |
| 20190200863 | Shelton, IV | Jul 2019 | A1 |
| 20190201141 | Shelton, IV | Jul 2019 | A1 |
| 20190201146 | Shelton, IV | Jul 2019 | A1 |
| 20190206551 | Yates | Jul 2019 | A1 |
| 20190274531 | Maiorano | Sep 2019 | A1 |
| 20190321042 | Marczyk | Oct 2019 | A1 |
| 20190321044 | Franklin, Sr. | Oct 2019 | A1 |
| 20190328390 | Harris | Oct 2019 | A1 |
| 20200015847 | Pedreira de Cerqueira Filho | Jan 2020 | A1 |
| 20200015897 | Scheib | Jan 2020 | A1 |
| 20200029948 | Wong | Jan 2020 | A1 |
| 20200037858 | Pedreira de Cerqueira Filho | Feb 2020 | A1 |
| 20200100776 | Blumenkranz | Apr 2020 | A1 |
| 20200214703 | Thompson et al. | Jul 2020 | A1 |
| 20210177402 | Vyas | Jun 2021 | A1 |
| 20210177404 | Vyas | Jun 2021 | A1 |
| 20210177405 | Vyas | Jun 2021 | A1 |
| 20210186511 | Shellenberger | Jun 2021 | A1 |
| Number | Date | Country |
|---|---|---|
| 1157666 | Nov 2001 | EP |
| 3409217 | Dec 2018 | EP |
| WO 9717014 | May 1997 | WO |
| 2013134411 | Sep 2013 | WO |
| Number | Date | Country | |
|---|---|---|---|
| 20210177403 A1 | Jun 2021 | US |
| Number | Date | Country | |
|---|---|---|---|
| 62947903 | Dec 2019 | US |
