Patent Grant
9623237
Various embodiments are directed to surgical devices, and generators for supplying energy to surgical devices, for use in open or minimally invasive surgical environments.
Ultrasonic surgical devices, such as ultrasonic scalpels, are finding increasingly widespread applications in surgical procedures by virtue of their unique performance characteristics. Depending upon specific device configurations and operational parameters, ultrasonic surgical devices can provide substantially simultaneous transection of tissue and homeostasis by coagulation, desirably minimizing patient trauma. An ultrasonic surgical device may comprise a handpiece containing an ultrasonic transducer, and an instrument coupled to the ultrasonic transducer having a distally-mounted end effector (e.g., a blade tip) to cut and seal tissue. In some cases, the instrument may be permanently affixed to the handpiece. In other cases, the instrument may be detachable from the handpiece, as in the case of a disposable instrument or an instrument that is interchangeable between different handpieces. The end effector transmits ultrasonic energy to tissue brought into contact with the end effector to realize cutting and sealing action. Ultrasonic surgical devices of this nature can be configured for open surgical use, laparoscopic, or endoscopic surgical procedures including robotic-assisted procedures.
Ultrasonic energy cuts and coagulates tissue using temperatures lower than those used in electrosurgical procedures and can be transmitted to the end effector by an ultrasonic generator in communication with the handpiece. Vibrating at high frequencies (e.g., 55,500 times per second), the ultrasonic blade denatures protein in the tissue to form a sticky coagulum. Pressure exerted on tissue by the blade surface collapses blood vessels and allows the coagulum to form a haemostatic seal. A surgeon can control the cutting speed and coagulation by the force applied to the tissue by the end effector, the time over which the force is applied and the selected excursion level of the end effector.
The ultrasonic transducer may be modeled as an equivalent circuit comprising first branch having a static capacitance and a second “motional” branch having a serially connected inductance, resistance and capacitance that define the electromechanical properties of a resonator. Known ultrasonic generators may include a tuning inductor for tuning out the static capacitance at a resonant frequency so that substantially all of generator's drive signal current flows into the motional branch. Accordingly, by using a tuning inductor, the generator's drive signal current represents the motional branch current, and the generator is thus able to control its drive signal to maintain the ultrasonic transducer's resonant frequency. The tuning inductor may also transform the phase impedance plot of the ultrasonic transducer to improve the generator's frequency lock capabilities. However, the tuning inductor must be matched with the specific static capacitance of an ultrasonic transducer at the operational resonance frequency. In other words, a different ultrasonic transducer having a different static capacitance requires a different tuning inductor.
Additionally, in some ultrasonic generator architectures, the generator's drive signal exhibits asymmetrical harmonic distortion that complicates impedance magnitude and phase measurements. For example, the accuracy of impedance phase measurements may be reduced due to harmonic distortion in the current and voltage signals.
Moreover, electromagnetic interference in noisy environments decreases the ability of the generator to maintain lock on the ultrasonic transducer's resonant frequency, increasing the likelihood of invalid control algorithm inputs.
Electrosurgical devices for applying electrical energy to tissue in order to treat and/or destroy the tissue are also finding increasingly widespread applications in surgical procedures. An electrosurgical device may comprise a handpiece and an instrument having a distally-mounted end effector (e.g., one or more electrodes). The end effector can be positioned against the tissue such that electrical current is introduced into the tissue. Electrosurgical devices can be configured for bipolar or monopolar operation. During bipolar operation, current is introduced into and returned from the tissue by active and return electrodes, respectively, of the end effector. During monopolar operation, current is introduced into the tissue by an active electrode of the end effector and returned through a return electrode (e.g., a grounding pad) separately located on a patient's body. Heat generated by the current flow through the tissue may form haemostatic seals within the tissue and/or between tissues and thus may be particularly useful for sealing blood vessels, for example. The end effector of an electrosurgical device may also comprise a cutting member that is movable relative to the tissue and the electrodes to transect the tissue.
Electrical energy applied by an electrosurgical device can be transmitted to the instrument by a generator in communication with the handpiece. The electrical energy may be in the form of radio frequency (“RF”) energy. RF energy is a form of electrical energy that may be in the frequency range of 300 kHz to 1 MHz. During its operation, an electrosurgical device can transmit low frequency RF energy through tissue, which causes ionic agitation, or friction, in effect resistive heating, thereby increasing the temperature of the tissue. Because a sharp boundary may be created between the affected tissue and the surrounding tissue, surgeons can operate with a high level of precision and control, without sacrificing un-targeted adjacent tissue. The low operating temperatures of RF energy may be useful for removing, shrinking, or sculpting soft tissue while simultaneously sealing blood vessels. RF energy may work particularly well on connective tissue, which is primarily comprised of collagen and shrinks when contacted by heat.
Due to their unique drive signal, sensing and feedback needs, ultrasonic and electrosurgical devices have generally required different generators. Additionally, in cases where the instrument is disposable or interchangeable with a handpiece, ultrasonic and electrosurgical generators are limited in their ability to recognize the particular instrument configuration being used and to optimize control and diagnostic processes accordingly. Moreover, capacitive coupling between the non-isolated and patient-isolated circuits of the generator, especially in cases where higher voltages and frequencies are used, may result in exposure of a patient to unacceptable levels of leakage current.
Furthermore, due to their unique drive signal, sensing and feedback needs, ultrasonic and electrosurgical devices have generally required different user interfaces for the different generators. In such conventional ultrasonic and electrosurgical devices, one user interface is configured for use with an ultrasonic instrument whereas a different user interface may be configured for use with an electrosurgical instrument. Such user interfaces include hand and/or foot activated user interfaces such as hand activated switches and/or foot activated switches. As various embodiments of combined generators for use with both ultrasonic and electrosurgical instruments are contemplated in the subsequent disclosure, additional user interfaces that are configured to operate with both ultrasonic and/or electrosurgical instrument generators also are contemplated.
Additional user interfaces for providing feedback, whether to the user or other machine, are contemplated within the subsequent disclosure to provide feedback indicating an operating mode or status of either an ultrasonic and/or electrosurgical instrument. Providing user and/or machine feedback for operating a combination ultrasonic and/or electrosurgical instrument will require providing sensory feedback to a user and electrical/mechanical/electromechanical feedback to a machine. Feedback devices that incorporate visual feedback devices (e.g., an LCD display screen, LED indicators), audio feedback devices (e.g., a speaker, a buzzer) or tactile feedback devices (e.g., haptic actuators) for use in combined ultrasonic and/or electrosurgical instruments are contemplated in the subsequent disclosure.
Various embodiments of a generator to communicate a drive signal to a surgical device are disclosed. In accordance with various embodiments, the generator may comprise a power amplifier to receive a time-varying drive signal waveform. The drive signal waveform may be generated by a digital-to-analog conversion of at least a portion of a plurality of drive signal waveform samples. An output of the power amplifier may be for generating a drive signal. The drive signal may comprise one of: a first drive signal to be communicated to an ultrasonic surgical device, a second drive signal to be communicated to an electrosurgical device. The generator may also comprise a sampling circuit to generate samples of current and voltage of the drive signal when the drive signal is communicated to the surgical device. Generation of the samples may be synchronized with the digital-to-analog conversion of the drive signal waveform samples such that, for each digital-to-analog conversion of a drive signal waveform sample, the sampling circuit generates a corresponding set of current and voltage samples. The generator may also comprise at least one device programmed to, for each drive signal waveform sample and corresponding set of current and voltage samples, store the current and voltage samples in a memory of the at least one device to associate the stored samples with the drive signal waveform sample. The at least one device may also be programmed to, when the drive signal comprises the first drive signal: determine a motional branch current sample of the ultrasonic surgical device based on the stored current and voltage samples, compare the motional branch current sample to a target sample selected from a plurality of target samples that define a target waveform, the target sample selected based on the drive signal waveform sample, determine an amplitude error between the target sample and the motional branch current sample, and modify the drive signal waveform sample such that an amplitude error determined between the target sample and a subsequent motional branch current sample based on current and voltage samples associated with the modified drive signal waveform sample is reduced.
In accordance with various embodiments, the generator may comprise a memory and a device coupled to the memory to receive for each of a plurality of drive signal waveform samples used to synthesize the drive signal, a corresponding set of current and voltage samples of the drive signal. For each drive signal waveform sample and corresponding set of current and voltage samples, the device may store the samples in a memory of the device to associate the stored samples with the drive signal waveform sample. Also, for each drive signal waveform sample and corresponding set of current and voltage samples, the device may, when the drive signal comprises a first drive signal to be communicated to an ultrasonic surgical device, determine a motional branch current sample of the ultrasonic surgical device based on the stored samples, compare the motional branch current sample to a target sample selected from a plurality of target samples that define a target waveform, the target sample selected based on the drive signal waveform sample, determine an amplitude error between the target sample and the motional branch current sample, and modify the drive signal waveform sample such that an amplitude error determined between the target sample and a subsequent motional branch current sample based on current and voltage samples associated with the modified drive signal waveform sample is reduced.
In accordance with various embodiments, methods for determining motional branch current in an ultrasonic transducer of an ultrasonic surgical device over multiple frequencies of a transducer drive signal are also disclosed. In one embodiment, the method may comprise, at each of a plurality of frequencies of the transducer drive signal, oversampling a current and voltage of the transducer drive signal, receiving, by a processor, the current and voltage samples, and determining, by the processor, the motional branch current based on the current and voltage samples, a static capacitance of the ultrasonic transducer and the frequency of the transducer drive signal.
In accordance with various embodiments, methods for controlling a waveform shape of a motional branch current in an ultrasonic transducer of a surgical device are also disclosed. In one embodiment, the method may comprise generating a transducer drive signal by selectively recalling, using a direct digital synthesis (DDS) algorithm, drive signal waveform samples stored in a look-up table (LUT), generating samples of current and voltage of the transducer drive signal when the transducer drive signal is communicated to the surgical device, determining samples of the motional branch current based on the current and voltage samples, a static capacitance of the ultrasonic transducer and a frequency of the transducer drive signal, comparing each sample of the motional branch current to a respective target sample of a target waveform to determine an error amplitude, and modifying the drive signal waveform samples stored in the LUT such that an amplitude error between subsequent samples of the motional branch current and respective target samples is reduced.
In accordance with various embodiments, a surgical generator for providing a drive signal to a surgical device may comprise a first transformer and a second transformer. The first transformer may comprise a first primary winding and a first secondary winding. The second transformer may comprise a second primary winding and a second secondary winding. The surgical generator may further comprise a generator circuit to generate the drive signal. The generator circuit may be electrically coupled to the first primary winding to provide the drive signal across the first primary winding. The surgical generator may also comprise a patient-side circuit electrically isolated from the generator circuit. The patient-side circuit may be electrically coupled to the first secondary winding. Further, the patient-side circuit may comprise first and second output lines to provide the drive signal to the surgical device. In addition, the surgical generator may comprise a capacitor. The capacitor and the second secondary winding may be electrically coupled in series between the first output line and ground.
In accordance with various embodiments, a surgical generator for providing a drive signal to a surgical device may comprise a first transformer, a patient-side circuit, and a capacitor. The first transformer may comprise a primary winding, a first secondary winding, and a second secondary winding. A polarity of the first secondary winding relative to the primary winding may be opposite the polarity of the second secondary winding. The generator circuit may generate the drive signal and may be electrically coupled to the first primary winding to provide the drive signal across the first primary winding. The patient-side circuit may be electrically isolated from the generator circuit and may be electrically coupled to the first secondary winding. Also, the patient-side circuit may comprise first and second output lines to provide the drive signal to the surgical device. The capacitor and second secondary winding may be electrically coupled in series between the first output line and ground.
In accordance with various embodiments, a surgical generator for providing a drive signal to a surgical device may comprise a first transformer, a generator circuit, a patient-side circuit and a capacitor. The first transformer may comprise a primary winding and a secondary winding. The generator circuit may generate the drive signal and may be electrically coupled to the first primary winding to provide the drive signal across the first primary winding. The patient-side circuit may be electrically isolated from the generator circuit and may be electrically coupled to the secondary winding. Further, the patient-side circuit may comprise first and second output lines to provide the drive signal to the surgical device. The capacitor may be electrically coupled to the primary winding and to the first output line.
In accordance with various embodiments, a surgical generator for providing a drive signal to a surgical device may comprise a first transformer, a generator circuit, a patient-side circuit, as well as first, second and third capacitors. The first transformer may comprise a primary winding and a secondary winding. The generator circuit may generate the drive signal and may be electrically coupled to the first primary winding to provide the drive signal across the first primary winding. The patient-side circuit may be electrically isolated from the generator circuit and may be electrically coupled to the secondary winding. Further, the patient-side circuit may comprise first and second output lines to provide the drive signal to the surgical device. A first electrode of the first capacitor may be electrically coupled to the primary winding. A first electrode of the second capacitor may be electrically coupled to the first output line and a second electrode of the second capacitor may be electrically coupled to a second electrode of the first capacitor. A first electrode of the third capacitor may be electrically coupled to the second electrode of the first capacitor and the second electrode of the second capacitor. A second electrode of the third capacitor may be electrically coupled to ground.
In accordance with various embodiments, control circuits for surgical devices are also disclosed. In one embodiment, the control circuit may comprise a first circuit portion comprising at least one first switch. The first circuit portion may communicate with a surgical generator over a conductor pair. The control circuit may also comprise a second circuit portion comprising a data circuit element. The data circuit element may be disposed in an instrument of the surgical device and transmit or receive data. The data circuit element may implement data communications with the surgical generator over at least one conductor of the conductor pair.
In accordance with various embodiments, the control circuit may comprise a first circuit portion comprising at least one first switch. The first circuit portion may communicate with a surgical generator over a conductor pair. The control circuit may also comprise a second circuit portion comprising a data circuit element. The data circuit element may be disposed in an instrument of the surgical device and transmit or receive data. The data circuit element may implement data communications with the surgical generator over at least one conductor of the conductor pair. The first circuit portion may receive a first interrogation signal transmitted from the surgical generator in a first frequency band. The data circuit element may communicate with the surgical generator using an amplitude-modulated communication protocol transmitted in a second frequency band. The second frequency band may be higher than the first frequency band.
In accordance with various embodiments, the control circuit may comprise a first circuit portion comprising at least one first switch. The first circuit portion may receive a first interrogation signal transmitted from a surgical generator over a conductor pair. The control circuit may also comprise a second circuit portion comprising at least one of a resistive element and an inductive element disposed in an instrument of the device. The second circuit portion may receive a second interrogation signal transmitted from the surgical generator over the conductor pair. The second circuit portion may be frequency-band separated from the first circuit portion. A characteristic of the first interrogation signal, when received through the first circuit portion, may be indicative of a state of the at least one first switch. A characteristic of the second interrogation signal, when received through the second circuit portion, may uniquely identify the instrument of the device.
In accordance with various embodiments, the control circuit may comprise a first circuit portion comprising a first switch network and a second switch network. The first switch network may comprise at least one first switch, and the second switch network may comprise at least one second switch. The first circuit portion may communicate with a surgical generator over a conductor pair. The control circuit may also comprise a second circuit portion comprising a data circuit element. The data circuit element may be disposed in an instrument of the surgical device and may transmit or receive data. The data circuit element may be in data communication with the surgical generator over at least one conductor of the conductor pair.
In accordance with various embodiments, a surgical generator for providing a drive signal to a surgical device may comprise a surgical generator body having an aperture. The surgical generator may also comprise a receptacle assembly positioned in the aperture. The receptacle assembly may comprise a receptacle body and a flange having an inner wall and an outer wall. The inner wall may be comprised of at least one curved section and at least one linear section. The inner wall may define a cavity. A central protruding portion may be positioned in the cavity and may comprise a plurality of sockets and a magnet. An outer periphery of the central protruding portion may comprise at least one curved section and at least one linear section.
In accordance with various embodiments, a surgical instrument may comprises an electrical connector assembly. The electrical connector assembly may comprise a flange defining a central cavity and a magnetically compatible pin extending into the central cavity. The electrical connector assembly may comprise a circuit board and a plurality of electrically conductive pins coupled to the circuit board. Each of the plurality of electrically conductive pins may extend into the central cavity. The electrical connector assembly may further comprise a strain relief member and a boot.
In accordance with various embodiments, a surgical instrument system may comprise a surgical generator comprising a receptacle assembly. The receptacle assembly may comprise at least one curved section and at least one linear portion. The surgical instrument system may comprise a surgical instrument comprising a connector assembly and an adapter assembly operatively coupled to the receptacle assembly and the connector assembly. The adapter assembly may comprise a distal portion contacting the receptacle assembly. The distal portion may comprise a flange with the flange having at least one curved section and at least one linear portion. The adapter assembly may comprise a proximal portion contacting the connector assembly. The proximal portion may define a cavity dimensioned to receive at least a portion of the connector assembly. The adapter assembly may further comprise a circuit board.
In accordance with various embodiments, methods may be utilized (e.g., in conjunction with surgical instruments) to accomplish various surgical objectives. For example, methods to control electrical power provided to tissue via first and second electrodes may comprise providing a drive signal to the tissue via the first and second electrodes and modulating a power provided to the tissue via the drive signal based on a sensed tissue impedance according to a first power curve. The first power curve may define, for each of a plurality of potential sensed tissue impedances, a first corresponding power. The methods may also comprise monitoring a total energy provided to the tissue via the first and second electrodes. When the total energy reaches a first energy threshold, the methods may comprise determining whether an impedance of the tissue has reached a first impedance threshold. The methods may further comprise, conditioned upon the impedance of the tissue failing to reach the first impedance threshold, modulating the power provided to the tissue via the drive signal based on the sensed tissue impedance according to a second power curve. The second power curve may define, for each of the plurality of potential sensed tissue impedances, a second corresponding power.
In accordance with various embodiments, methods for controlling electrical power provided to tissue via first and second electrodes may comprise providing a drive signal to the tissue via the first and second electrodes and determining a power to be provided to the tissue. The determining may comprise receiving an indication of a sensed tissue impedance; determining a first corresponding power for the sensed tissue impedance according to a power curve; and multiplying the corresponding power by a multiplier. The power curve may define a corresponding power for each of a plurality of potential sensed tissue impedances. The methods may further comprise modulating the drive signal to provide the determined power to the tissue and, conditioned upon the impedance of the tissue failing to reach a first impedance threshold, increasing the multiplier as a function of the total energy provided to the tissue.
In accordance with various embodiments, methods for controlling electrical power provided to tissue via first and second electrodes may comprise providing a drive signal to the tissue via the first and second electrodes and determining a power to be provided to the tissue. The determining may comprise receiving an indication of a sensed tissue impedance; determining a first corresponding power for the sensed tissue impedance according to a power curve; and multiplying the corresponding power by a first multiplier to find a determined power. The power curve may define a corresponding power for each of a plurality of potential sensed tissue impedances. The methods may further comprise modulating the drive signal to provide the determined power to the tissue and monitoring a total energy provided to the tissue via the first and second electrodes. In addition, the methods may comprise, when the total energy reaches a first energy threshold, determining whether the impedance of the tissue has reached a first impedance threshold; and, conditioned upon the impedance of the tissue not reaching the first impedance threshold, increasing the first multiplier by a first amount.
In accordance with various embodiments, methods for controlling electrical power provided to tissue via a surgical device may comprise providing a drive signal to a surgical device; receiving an indication of an impedance of the tissue; calculating a rate of increase of the impedance of the tissue; and modulating the drive signal to hold the rate of increase of the impedance greater than or equal to a predetermined constant.
In accordance with various embodiments, methods for controlling electrical power provided to tissue via a surgical device may comprise providing a drive signal. A power of the drive signal may be proportional to a power provided to the tissue via the surgical device. The methods may also comprise periodically receiving indications of an impedance of the tissue and applying a first composite power curve to the tissue, wherein applying the first composite power curve to the tissue comprises. Applying the first composite power curve to the tissue may comprise modulating a first predetermined number of first composite power curve pulses on the drive signal; and for each of the first composite power curve pulses, determining a pulse power and a pulse width according to a first function of the impedance of the tissue The methods may also comprise applying a second composite power curve to the tissue. Applying the second composite power curve to the tissue may comprise modulating at least one second composite power curve pulse on the drive signal; and for each of the at least one second composite power curve pulses, determining a pulse power and a pulse width according to a second function of the impedance of the tissue.
In accordance with various embodiments, a generator is provided to generate a drive signal to a surgical device. The generator includes an ultrasonic generator module to generate a first drive signal to drive an ultrasonic device, an electrosurgery/radio frequency (RF) generator module to generate a second drive signal to drive an electrosurgical device, and a foot switch coupled to each of the ultrasonic generator module and the electrosurgery/RF generator module. The foot switch is configured to operate in a first mode when the ultrasonic device is coupled to the ultrasonic generator module and the foot switch is configured to operate in a second mode when the electrosurgical device is coupled to the electrosurgery/RF generator module.
In accordance with various embodiments, a generator is provided that includes a user interface to provide feedback in accordance with the operation of any one of the ultrasonic device and the electrosurgical device in accordance with a predetermined algorithm.
In accordance with various embodiments, a control circuit of a surgical device is provided. The control circuit comprises a first circuit portion coupled to at least one switch operable between an open state and a closed state. The first circuit portion communicates with a surgical generator over a conductor pair to receive a control signal to determine a state of the at least one switch.
In accordance with various embodiments, a control circuit of a surgical device is provided. The control circuit comprises a first circuit portion coupled to at least one switch operable between an open state and a closed state. The first circuit portion communicates with a surgical generator over a conductor pair to receive a control signal from input terminals to determine a state of the at least one switch. The control signal having a positive phase and a negative phase. A first transistor is coupled between the input terminals, a first capacitor, and a first resistor is coupled in series with the first capacitor. During the positive phase of the control signal the first transistor is held in cutoff mode while the first capacitor charges to a predetermined voltage and during an initial portion of the negative phase of the control signal the first transistor transitions from cutoff mode to saturation mode and is held in saturation mode until the first capacitor discharges through the first resistor. During a final portion of the negative phase of the control signal the first transistor transitions from saturation mode to cutoff mode when the first capacitor voltage drops below a predetermined threshold.
In accordance with various embodiments, a method is provided. The method comprises receiving a control signal at a control circuit of a surgical device and determining the state of the at least one switch based on the value of the resistor. The control circuit comprising a first circuit portion coupled to at least one switch operable between an open state and a closed state. The circuit portion to communicate with a surgical generator over a conductor pair to receive the control signal. The first circuit portion comprising at least one resistor coupled to the at least one switch.
The novel features of the various embodiments are set forth with particularity in the appended claims. The described embodiments, however, both as to organization and methods of operation, may be best understood by reference to the following description, taken in conjunction with the accompanying drawings in which:
Before explaining various embodiments of surgical devices and generators in detail, it should be noted that the illustrative embodiments are not limited in application or use to the details of construction and arrangement of parts illustrated in the accompanying drawings and description. The illustrative embodiments may be implemented or incorporated in other embodiments, variations and modifications, and may be practiced or carried out in various ways. Further, unless otherwise indicated, the terms and expressions employed herein have been chosen for the purpose of describing the illustrative embodiments for the convenience of the reader and are not for the purpose of limitation thereof. Also, it will be appreciated that one or more of the following-described embodiments, expressions of embodiments and/or examples, can be combined with any one or more of the other following-described embodiments, expressions of embodiments and/or examples.
Various embodiments are directed to improved ultrasonic surgical devices, electrosurgical devices and generators for use therewith. Embodiments of the ultrasonic surgical devices can be configured for transecting and/or coagulating tissue during surgical procedures, for example. Embodiments of the electrosurgical devices can be configured for transecting, coagulating, scaling, welding and/or desiccating tissue during surgical procedures, for example.
Embodiments of the generator utilize high-speed analog-to-digital sampling (e.g., approximately 200× oversampling, depending on frequency) of the generator drive signal current and voltage, along with digital signal processing, to provide a number of advantages and benefits over known generator architectures. In one embodiment, for example, based on current and voltage feedback data, a value of the ultrasonic transducer static capacitance, and a value of the drive signal frequency, the generator may determine the motional branch current of an ultrasonic transducer. This provides the benefit of a virtually tuned system, and simulates the presence of a system that is tuned or resonant with any value of the static capacitance (e.g., C0 in
High-speed analog-to-digital sampling of the generator drive signal current and voltage, along with digital signal processing, may also enable precise digital filtering of the samples. For example, embodiments of the generator may utilize a low-pass digital filter (e.g., a finite impulse response (FIR) filter) that rolls off between a fundamental drive signal frequency and a second-order harmonic to reduce the asymmetrical harmonic distortion and EMI-induced noise in current and voltage feedback samples. The filtered current and voltage feedback samples represent substantially the fundamental drive signal frequency, thus enabling a more accurate impedance phase measurement with respect to the fundamental drive signal frequency and an improvement in the generator's ability to maintain resonant frequency lock. The accuracy of the impedance phase measurement may be further enhanced by averaging falling edge and rising edge phase measurements, and by regulating the measured impedance phase to 0°.
Various embodiments of the generator may also utilize the high-speed analog-to-digital sampling of the generator drive signal current and voltage, along with digital signal processing, to determine real power consumption and other quantities with a high degree of precision. This may allow the generator to implement a number of useful algorithms, such as, for example, controlling the amount of power delivered to tissue as the impedance of the tissue changes and controlling the power delivery to maintain a constant rate of tissue impedance increase.
Various embodiments of the generator may have a wide frequency range and increased output power necessary to drive both ultrasonic surgical devices and electrosurgical devices. The lower voltage, higher current demand of electrosurgical devices may be met by a dedicated tap on a wideband power transformer, thereby eliminating the need for a separate power amplifier and output transformer. Moreover, sensing and feedback circuits of the generator may support a large dynamic range that addresses the needs of both ultrasonic and electrosurgical applications with minimal distortion.
Various embodiments may provide a simple, economical means for the generator to read from, and optionally write to, data circuit (e.g., a single-wire bus device, such as a one-wire protocol EEPROM known under the trade name “1-Wire”) disposed in an instrument attached to the handpiece using existing multi-conductor generator/handpiece cables. In this way, the generator is able to retrieve and process instrument-specific data from an instrument attached to the handpiece. This may enable the generator to provide better control and improved diagnostics and error detection. Additionally, the ability of the generator to write data to the instrument makes possible new functionality in terms of, for example, tracking instrument usage and capturing operational data. Moreover, the use of frequency band permits the backward compatibility of instruments containing a bus device with existing generators.
Disclosed embodiments of the generator provide active cancellation of leakage current caused by unintended capacitive coupling between non-isolated and patient-isolated circuits of the generator. In addition to reducing patient risk, the reduction of leakage current may also lessen electromagnetic emissions.
These and other benefits of embodiments of the present invention will be apparent from the description to follow.
It will be appreciated that the terms “proximal” and “distal” are used herein with reference to a clinician gripping a handpiece. Thus, an end effector is distal with respect to the more proximal handpiece. It will be further appreciated that, for convenience and clarity, spatial terms such as “top” and “bottom” may also be used herein with respect to the clinician gripping the handpiece. However, surgical devices are used in many orientations and positions, and these terms are not intended to be limiting and absolute.
The generator 102 may be activated to provide the drive signal to the transducer 114 in any suitable manner. For example, the generator 102 may comprise a foot switch 120 coupled to the generator 102 via a footswitch cable 122 (
Additionally or alternatively, the one or more switches may comprises a toggle button 136c that, when depressed, causes the generator 102 to provide a pulsed output. The pulses may be provided at any suitable frequency and grouping, for example. In certain embodiments, the power level of the pulses may be the power levels associated with toggle buttons 136a, b (maximum, less than maximum), for example.
It will be appreciated that a device 104 may comprise any combination of the toggle buttons 136a, b, c. For example, the device 104 could be configured to have only two toggle buttons: a toggle button 136a for producing maximum ultrasonic energy output and a toggle button 136c for producing a pulsed output at either the maximum or less than maximum power level per. In this way, the drive signal output configuration of the generator 102 could be 5 continuous signals and 5 or 4 or 3 or 2 or 1 pulsed signals. In certain embodiments, the specific drive signal configuration may be controlled based upon, for example, EEPROM settings in the generator 102 and/or user power level selection(s).
In certain embodiments, a two-position switch may be provided as an alternative to a toggle button 136c. For example, a device 104 may include a toggle button 136a for producing a continuous output at a maximum power level and a two-position toggle button 136b. In a first detented position, toggle button 136b may produce a continuous output at a less than maximum power level, and in a second detented position the toggle button 136b may produce a pulsed output (e.g., at either a maximum or less than maximum power level, depending upon the EEPROM settings).
In some embodiments, the end effector 126 may also comprise a pair of electrodes 159, 157. The electrodes 159, 157 may be in communication with the generator 102, for example, via the cable 122. The electrodes 159, 157 may be used, for example, to measure an impedance of a tissue bite present between the clamp arm 155 and the blade 151. The generator 102 may provide a signal (e.g., a non-therapeutic signal) to the electrodes 159, 157. The impedance of the tissue bite may be found, for example, by monitoring the current, voltage, etc. of the signal.
The jaw members 167, 169 of the end effector 132 may comprise respective electrodes 177, 179. The electrodes 177, 179 may be connected to the generator 102 via electrical leads 187a, 187b (
In use, a clinician may place the end effector 132 and close the jaws 144 around a tissue bite to be acted upon, for example, by pivoting the jaw closure trigger 142 along arrow 183 as described. Once the tissue bite is secure between the jaws 144, the clinician may initiate the provision of RF or other electro-surgical energy by the generator 102 and through the electrodes 177, 179. The provision of RF energy may be accomplished in any suitable way. For example, the clinician may activate the foot switch 120 (
In accordance with the described embodiments, the ultrasonic generator module 108 may produce a drive signal or signals of particular voltages, currents, and frequencies, e.g. 55,500 cycles per second (Hz). The drive signal or signals may be provided to the ultrasonic device 104, and specifically to the transducer 114, which may operate, for example, as described above. In one embodiment, the generator 102 may be configured to produce a drive signal of a particular voltage, current, and/or frequency output signal that can be stepped with high resolution, accuracy, and repeatability.
In accordance with the described embodiments, the electrosurgery/RF generator module 110 may generate a drive signal or signals with output power sufficient to perform bipolar electrosurgery using radio frequency (RF) energy. In bipolar electrosurgery applications. The drive signal may be provided, for example, to the electrodes 177, 179 of the electrosurgical device 106, for example, as described above. Accordingly, the generator 102 may be configured for therapeutic purposes by applying electrical energy to the tissue sufficient for treating the tissue (e.g., coagulation, cauterization, tissue welding, etc.).
The generator 102 may comprise an input device 145 (
The generator 102 may also comprise an output device 147 (
Although certain modules and/or blocks of the generator 102 may be described by way of example, it can be appreciated that a greater or lesser number of modules and/or blocks may be used and still fall within the scope of the embodiments. Further, although various embodiments may be described in terms of modules and/or blocks to facilitate description, such modules and/or blocks may be implemented by one or more hardware components, e.g., processors, Digital Signal Processors (DSPs), Programmable Logic Devices (PLDs), Application Specific Integrated Circuits (ASICs), circuits, registers and/or software components, e.g., programs, subroutines, logic and/or combinations of hardware and software components.
In one embodiment, the ultrasonic generator drive module 108 and electrosurgery/RF drive module 110 may comprise one or more embedded applications implemented as firmware, software, hardware, or any combination thereof. The modules 108, 110 may comprise various executable modules such as software, programs, data, drivers, application program interfaces (APIs), and so forth. The firmware may be stored in nonvolatile memory (NVM), such as in bit-masked read-only memory (ROM) or flash memory. In various implementations, storing the firmware in ROM may preserve flash memory. The NVM may comprise other types of memory including, for example, programmable ROM (PROM), erasable programmable ROM (EPROM), electrically erasable programmable ROM (EEPROM), or battery backed random-access memory (RAM) such as dynamic RAM (DRAM), Double-Data-Rate DRAM (DDRAM), and/or synchronous DRAM (SDRAM).
In one embodiment, the modules 108, 110 comprise a hardware component implemented as a processor for executing program instructions for monitoring various measurable characteristics of the devices 104, 106 and generating a corresponding output drive signal or signals for operating the devices 104, 106. In embodiments in which the generator 102 is used in conjunction with the device 104, the drive signal may drive the ultrasonic transducer 114 in cutting and/or coagulation operating modes. Electrical characteristics of the device 104 and/or tissue may be measured and used to control operational aspects of the generator 102 and/or provided as feedback to the user. In embodiments in which the generator 102 is used in conjunction with the device 106, the drive signal may supply electrical energy (e.g., RF energy) to the end effector 132 in cutting, coagulation and/or desiccation modes. Electrical characteristics of the device 106 and/or tissue may be measured and used to control operational aspects of the generator 102 and/or provided as feedback to the user. In various embodiments, as previously discussed, the hardware components may be implemented as DSP, PLD, ASIC, circuits, and/or registers. In one embodiment, the processor may be configured to store and execute computer software program instructions to generate the step function output signals for driving various components of the devices 104, 106, such as the ultrasonic transducer 114 and the end effectors 126, 132.
Various embodiments of the generator 102 may not rely on a tuning inductor Lt to monitor the motional branch current Im. Instead, the generator 102 may use the measured value of the static capacitance C0 in between applications of power for a specific ultrasonic surgical device 104 (along with drive signal voltage and current feedback data) to determine values of the motional branch current Im on a dynamic and ongoing basis (e.g., in real-time). Such embodiments of the generator 102 are therefore able to provide virtual tuning to simulate a system that is tuned or resonant with any value of static capacitance C0 at any frequency, and not just at a single resonant frequency dictated by a nominal value of the static capacitance C0.
Power may be supplied to a power rail of the power amplifier 162 by a switch-mode regulator 170. In certain embodiments the switch-mode regulator 170 may comprise an adjustable buck regulator, for example. The non-isolated stage 154 may further comprise a processor 174, which in one embodiment may comprise a DSP processor such as an Analog Devices ADSP-21469 SHARC DSP, available from Analog Devices, Norwood, Mass., for example. In certain embodiments the processor 174 may control operation of the switch-mode power converter 170 responsive to voltage feedback data received from the power amplifier 162 by the processor 174 via an analog-to-digital converter (ADC) 176. In one embodiment, for example, the processor 174 may receive as input, via the ADC 176, the waveform envelope of a signal (e.g., an RF signal) being amplified by the power amplifier 162. The processor 174 may then control the switch-mode regulator 170 (e.g., via a pulse-width modulated (PWM) output) such that the rail voltage supplied to the power amplifier 162 tracks the waveform envelope of the amplified signal. By dynamically modulating the rail voltage of the power amplifier 162 based on the waveform envelope, the efficiency of the power amplifier 162 may be significantly improved relative to a fixed rail voltage amplifier schemes.
In certain embodiments and as discussed in further detail in connection with
The non-isolated stage 154 may further comprise an ADC 178 and an ADC 180 coupled to the output of the power transformer 156 via respective isolation transformers 182, 184 for respectively sampling the voltage and current of drive signals output by the generator 102. In certain embodiments, the ADCs 178, 180 may be configured to sample at high speeds (e.g., 80 Msps) to enable oversampling of the drive signals. In one embodiment, for example, the sampling speed of the ADCs 178, 180 may enable approximately 200× (depending on drive frequency) oversampling of the drive signals. In certain embodiments, the sampling operations of the ADCs 178, 180 may be performed by a single ADC receiving input voltage and current signals via a two-way multiplexer. The use of high-speed sampling in embodiments of the generator 102 may enable, among other things, calculation of the complex current flowing through the motional branch (which may be used in certain embodiments to implement DDS-based waveform shape control described above), accurate digital filtering of the sampled signals, and calculation of real power consumption with a high degree of precision. Voltage and current feedback data output by the ADCs 178, 180 may be received and processed (e.g., FIFO buffering, multiplexing) by the programmable logic device 166 and stored in data memory for subsequent retrieval by, for example, the processor 174. As noted above, voltage and current feedback data may be used as input to an algorithm for pre-distorting or modifying LUT waveform samples on a dynamic and ongoing basis. In certain embodiments, this may require each stored voltage and current feedback data pair to be indexed based on, or otherwise associated with, a corresponding LUT sample that was output by the programmable logic device 166 when the voltage and current feedback data pair was acquired. Synchronization of the LUT samples and the voltage and current feedback data in this manner contributes to the correct timing and stability of the pre-distortion algorithm.
In certain embodiments, the voltage and current feedback data may be used to control the frequency and/or amplitude (e.g., current amplitude) of the drive signals. In one embodiment, for example, voltage and current feedback data may be used to determine impedance phase. The frequency of the drive signal may then be controlled to minimize or reduce the difference between the determined impedance phase and an impedance phase setpoint (e.g., 0°, thereby minimizing or reducing the effects of harmonic distortion and correspondingly enhancing impedance phase measurement accuracy. The determination of phase impedance and a frequency control signal may be implemented in the processor 174, for example, with the frequency control signal being supplied as input to a DDS control algorithm implemented by the programmable logic device 166.
In another embodiment, for example, the current feedback data may be monitored in order to maintain the current amplitude of the drive signal at a current amplitude setpoint. The current amplitude setpoint may be specified directly or determined indirectly based on specified voltage amplitude and power setpoints. In certain embodiments, control of the current amplitude may be implemented by control algorithm, such as, for example, a proportional-integral-derivative (PID) control algorithm, in the processor 174. Variables controlled by the control algorithm to suitably control the current amplitude of the drive signal may include, for example, the scaling of the LUT waveform samples stored in the programmable logic device 166 and/or the full-scale output voltage of the DAC 168 (which supplies the input to the power amplifier 162) via a DAC 186.
The non-isolated stage 154 may further comprise a processor 190 for providing, among other things user interface (UI) functionality. In one embodiment, the processor 190 may comprise an Atmel AT91 SAM9263 processor having an ARM 926EJ-S core, available from Atmel Corporation, San Jose, Calif., for example. Examples of UI functionality supported by the processor 190 may include audible and visual user feedback, communication with peripheral devices (e.g., via a Universal Serial Bus (USB) interface), communication with the footswitch 120, communication with an input device 112 (e.g., a touch screen display) and communication with an output device 147 (e.g., a speaker). The processor 190 may communicate with the processor 174 and the programmable logic device (e.g., via serial peripheral interface (SPI) buses). Although the processor 190 may primarily support UI functionality, it may also coordinate with the processor 174 to implement hazard mitigation in certain embodiments. For example, the processor 190 may be programmed to monitor various aspects of user input and/or other inputs (e.g., touch screen inputs, footswitch 120 inputs, temperature sensor inputs) and may disable the drive output of the generator 102 when an erroneous condition is detected.
In certain embodiments, both the processor 174 and the processor 190 may determine and monitor the operating state of the generator 102. For the processor 174, the operating state of the generator 102 may dictate, for example, which control and/or diagnostic processes are implemented by the processor 174. For the processor 190, the operating state of the generator 102 may dictate, for example, which elements of a user interface (e.g., display screens, sounds) are presented to a user. The processors 174, 190 may independently maintain the current operating state of the generator 102 and recognize and evaluate possible transitions out of the current operating state. The processor 174 may function as the master in this relationship and determine when transitions between operating states are to occur. The processor 190 may be aware of valid transitions between operating states and may confirm if a particular transition is appropriate. For example, when the processor 174 instructs the processor 190 to transition to a specific state, the processor 190 may verify that requested transition is valid. In the event that a requested transition between states is determined to be invalid by the processor 190, the processor 190 may cause the generator 102 to enter a failure mode.
The non-isolated stage 154 may further comprise a controller 196 for monitoring input devices 145 (e.g., a capacitive touch sensor used for turning the generator 102 on and off, a capacitive touch screen). In certain embodiments, the controller 196 may comprise at least one processor and/or other controller device in communication with the processor 190. In one embodiment, for example, the controller 196 may comprise a processor (e.g., a Mega168 8-bit controller available from Atmel) configured to monitor user input provided via one or more capacitive touch sensors. In one embodiment, the controller 196 may comprise a touch screen controller (e.g., a QT5480 touch screen controller available from Atmel) to control and manage the acquisition of touch data from a capacitive touch screen.
In certain embodiments, when the generator 102 is in a “power off” state, the controller 196 may continue to receive operating power (e.g., via a line from a power supply of the generator 102, such as the power supply 211 discussed below). In this way, the controller 196 may continue to monitor an input device 145 (e.g., a capacitive touch sensor located on a front panel of the generator 102) for turning the generator 102 on and off. When the generator 102 is in the power off state, the controller 196 may wake the power supply (e.g., enable operation of one or more DC/DC voltage converters 213 of the power supply 211) if activation of the “on/off” input device 145 by a user is detected. The controller 196 may therefore initiate a sequence for transitioning the generator 102 to a “power on” state. Conversely, the controller 196 may initiate a sequence for transitioning the generator 102 to the power off state if activation of the “on/off” input device 145 is detected when the generator 102 is in the power on state. In certain embodiments, for example, the controller 196 may report activation of the “on/off” input device 145 to the processor 190, which in turn implements the necessary process sequence for transitioning the generator 102 to the power off state. In such embodiments, the controller 196 may have no independent ability for causing the removal of power from the generator 102 after its power on state has been established.
In certain embodiments, the controller 196 may cause the generator 102 to provide audible or other sensory feedback for alerting the user that a power on or power off sequence has been initiated. Such an alert may be provided at the beginning of a power on or power off sequence and prior to the commencement of other processes associated with the sequence.
In certain embodiments, the isolated stage 152 may comprise an instrument interface circuit 198 to, for example, provide a communication interface between a control circuit of a surgical device (e.g., a control circuit comprising handpiece switches) and components of the non-isolated stage 154, such as, for example, the programmable logic device 166, the processor 174 and/or the processor 190. The instrument interface circuit 198 may exchange information with components of the non-isolated stage 154 via a communication link that maintains a suitable degree of electrical isolation between the stages 152, 154, such as, for example, an infrared (IR)-based communication link. Power may be supplied to the instrument interface circuit 198 using, for example, a low-dropout voltage regulator powered by an isolation transformer driven from the non-isolated stage 154.
In one embodiment, the instrument interface circuit 198 may comprise a programmable logic device 200 (e.g., an FPGA) in communication with a signal conditioning circuit 202. The signal conditioning circuit 202 may be configured to receive a periodic signal from the programmable logic device 200 (e.g., a 2 kHz square wave) to generate a bipolar interrogation signal having an identical frequency. The interrogation signal may be generated, for example, using a bipolar current source fed by a differential amplifier. The interrogation signal may be communicated to a surgical device control circuit (e.g., by using a conductive pair in a cable that connects the generator 102 to the surgical device) and monitored to determine a state or configuration of the control circuit. As discussed below in connection with
In one embodiment, the instrument interface circuit 198 may comprise a first data circuit interface 204 to enable information exchange between the programmable logic device 200 (or other element of the instrument interface circuit 198) and a first data circuit disposed in or otherwise associated with a surgical device. In certain embodiments and with reference to
In certain embodiments, the first data circuit 206 may store information pertaining to the particular surgical device with which it is associated. Such information may include, for example, a model number, a serial number, a number of operations in which the surgical device has been used, and/or any other type of information. This information may be read by the instrument interface circuit 198 (e.g., by the programmable logic device 200), transferred to a component of the non-isolated stage 154 (e.g., to programmable logic device 166, processor 174 and/or processor 190) for presentation to a user via an output device 147 and/or for controlling a function or operation of the generator 102. Additionally, any type of information may be communicated to first data circuit 206 for storage therein via the first data circuit interface 204 (e.g., using the programmable logic device 200). Such information may comprise, for example, an updated number of operations in which the surgical device has been used and/or dates and/or times of its usage.
As discussed previously, a surgical instrument may be detachable from a handpiece (e.g., instrument 124 may be detachable from handpiece 116) to promote instrument interchangeability and/or disposability. In such cases, known generators may be limited in their ability to recognize particular instrument configurations being used and to optimize control and diagnostic processes accordingly. The addition of readable data circuits to surgical device instruments to address this issue is problematic from a compatibility standpoint, however. For example, designing a surgical device to remain backwardly compatible with generators that lack the requisite data reading functionality may be impractical due to, for example, differing signal schemes, design complexity and cost. Embodiments of instruments discussed below in connection with
Additionally, embodiments of the generator 102 may enable communication with instrument-based data circuits, such as those described below in connection with
In certain embodiments, the second data circuit and the second data circuit interface 210 may be configured such that communication between the programmable logic device 200 and the second data circuit can be effected without the need to provide additional conductors for this purpose (e.g., dedicated conductors of a cable connecting a handpiece to the generator 102). In one embodiment, for example, information may be communicated to and from the second data circuit using a one-wire bus communication scheme implemented on existing cabling, such as one of the conductors used transmit interrogation signals from the signal conditioning circuit 202 to a control circuit in a handpiece. In this way, design changes or modifications to the surgical device that might otherwise be necessary are minimized or reduced. Moreover, as discussed in further detail below in connection with
In certain embodiments, the isolated stage 152 may comprise at least one blocking capacitor 296-1 connected to the drive signal output 160b to prevent passage of DC current to a patient. A single blocking capacitor may be required to comply with medical regulations or standards, for example. While failure in single-capacitor designs is relatively uncommon, such failure may nonetheless have negative consequences. In one embodiment, a second blocking capacitor 296-2 may be provided in series with the blocking capacitor 296-1, with current leakage from a point between the blocking capacitors 296-1, 296-2 being monitored by, for example, an ADC 298 for sampling a voltage induced by leakage current. The samples may be received by the programmable logic device 200, for example. Based on changes in the leakage current (as indicated by the voltage samples in the embodiment of
In certain embodiments, the non-isolated stage 154 may comprise a power supply 211 for outputting DC power at a suitable voltage and current. The power supply may comprise, for example, a 400 W power supply for outputting a 48 VDC system voltage. The power supply 211 may further comprise one or more DC/DC voltage converters 213 for receiving the output of the power supply to generate DC outputs at the voltages and currents required by the various components of the generator 102. As discussed above in connection with the controller 196, one or more of the DC/DC voltage converters 213 may receive an input from the controller 196 when activation of the “on/off” input device 145 by a user is detected by the controller 196 to enable operation of, or wake, the DC/DC voltage converters 213.
The multiplexed current and voltage feedback samples may be received by a parallel data acquisition port (PDAP) implemented within block 214 of the processor 174. The PDAP may comprise a packing unit for implementing any of a number of methodologies for correlating the multiplexed feedback samples with a memory address. In one embodiment, for example, feedback samples corresponding to a particular LUT sample output by the programmable logic device 166 may be stored at one or more memory addresses that are correlated or indexed with the LUT address of the LUT sample. In another embodiment, feedback samples corresponding to a particular LUT sample output by the programmable logic device 166 may be stored, along with the LUT address of the LUT sample, at a common memory location. In any event, the feedback samples may be stored such that the address of an LUT sample from which a particular set of feedback samples originated may be subsequently ascertained. As discussed above, synchronization of the LUT sample addresses and the feedback samples in this way contributes to the correct timing and stability of the pre-distortion algorithm. A direct memory access (DMA) controller implemented at block 216 of the processor 174 may store the feedback samples (and any LUT sample address data, where applicable) at a designated memory location 218 of the processor 174 (e.g., internal RAM).
Block 220 of the processor 174 may implement a pre-distortion algorithm for pre-distorting or modifying the LUT samples stored in the programmable logic device 166 on a dynamic, ongoing basis. As discussed above, pre-distortion of the LUT samples may compensate for various sources of distortion present in the output drive circuit of the generator 102. The pre-distorted LUT samples, when processed through the drive circuit, will therefore result in a drive signal having the desired waveform shape (e.g., sinusoidal) for optimally driving the ultrasonic transducer.
At block 222 of the pre-distortion algorithm, the current through the motional branch of the ultrasonic transducer is determined. The motional branch current may be determined using Kirchoff's Current Law based on, for example, the current and voltage feedback samples stored at memory location 218 (which, when suitably scaled, may be representative of Ig and Vg in the model of
At block 224 of the pre-distortion algorithm, each motional branch current sample determined at block 222 is compared to a sample of a desired current waveform shape to determine a difference, or sample amplitude error, between the compared samples. For this determination, the sample of the desired current waveform shape may be supplied, for example, from a waveform shape LUT 226 containing amplitude samples for one cycle of a desired current waveform shape. The particular sample of the desired current waveform shape from the LUT 226 used for the comparison may be dictated by the LUT sample address associated with the motional branch current sample used in the comparison. Accordingly, the input of the motional branch current to block 224 may be synchronized with the input of its associated LUT sample address to block 224. The LUT samples stored in the programmable logic device 166 and the LUT samples stored in the waveform shape LUT 226 may therefore be equal in number. In certain embodiments, the desired current waveform shape represented by the LUT samples stored in the waveform shape LUT 226 may be a fundamental sine wave. Other waveform shapes may be desirable. For example, it is contemplated that a fundamental sine wave for driving main longitudinal motion of an ultrasonic transducer superimposed with one or more other drive signals at other frequencies, such as a third order harmonic for driving at least two mechanical resonances for beneficial vibrations of transverse or other modes, could be used.
Each value of the sample amplitude error determined at block 224 may be transmitted to the LUT of the programmable logic device 166 (shown at block 228 in
Current and voltage amplitude measurements, power measurements and impedance measurements may be determined at block 230 of the processor 174 based on the current and voltage feedback samples stored at memory location 218. Prior to the determination of these quantities, the feedback samples may be suitably scaled and, in certain embodiments, processed through a suitable filter 232 to remove noise resulting from, for example, the data acquisition process and induced harmonic components. The filtered voltage and current samples may therefore substantially represent the fundamental frequency of the generator's drive output signal. In certain embodiments, the filter 232 may be a finite impulse response (FIR) filter applied in the frequency domain. Such embodiments may use the fast Fourier transform (FFT) of the output drive signal current and voltage signals. In certain embodiments, the resulting frequency spectrum may be used to provide additional generator functionality. In one embodiment, for example, the ratio of the second and/or third order harmonic component relative to the fundamental frequency component may be used as a diagnostic indicator.
At block 234, a root mean square (RMS) calculation may be applied to a sample size of the current feedback samples representing an integral number of cycles of the drive signal to generate a measurement Irms representing the drive signal output current.
At block 236, a root mean square (RMS) calculation may be applied to a sample size of the voltage feedback samples representing an integral number of cycles of the drive signal to determine a measurement Vrms representing the drive signal output voltage.
At block 238, the current and voltage feedback samples may be multiplied point by point, and a mean calculation is applied to samples representing an integral number of cycles of the drive signal to determine a measurement Pr of the generator's real output power.
At block 240, measurement Pa of the generator's apparent output power may be determined as the product Vrms·Irms.
At block 242, measurement Zm of the load impedance magnitude may be determined as the quotient Vrms/Irms.
In certain embodiments, the quantities Irms, Vrms, Pr, Pa and Zm determined at blocks 234, 236, 238, 240 and 242 may be used by the generator 102 to implement any of number of control and/or diagnostic processes. In certain embodiments, any of these quantities may be communicated to a user via, for example, an output device 147 integral with the generator 102 or an output device 147 connected to the generator 102 through a suitable communication interface (e.g., a USB interface). Various diagnostic processes may include, without limitation, handpiece integrity, instrument integrity, instrument attachment integrity, instrument overload, approaching instrument overload, frequency lock failure, over-voltage, over-current, over-power, voltage sense failure, current sense failure, audio indication failure, visual indication failure, short circuit, power delivery failure, blocking capacitor failure, for example.
Block 244 of the processor 174 may implement a phase control algorithm for determining and controlling the impedance phase of an electrical load (e.g., the ultrasonic transducer) driven by the generator 102. As discussed above, by controlling the frequency of the drive signal to minimize or reduce the difference between the determined impedance phase and an impedance phase setpoint (e.g., 0°), the effects of harmonic distortion may be minimized or reduced, and the accuracy of the phase measurement increased.
The phase control algorithm receives as input the current and voltage feedback samples stored in the memory location 218. Prior to their use in the phase control algorithm, the feedback samples may be suitably scaled and, in certain embodiments, processed through a suitable filter 246 (which may be identical to filter 232) to remove noise resulting from the data acquisition process and induced harmonic components, for example. The filtered voltage and current samples may therefore substantially represent the fundamental frequency of the generator's drive output signal.
At block 248 of the phase control algorithm, the current through the motional branch of the ultrasonic transducer is determined. This determination may be identical to that described above in connection with block 222 of the pre-distortion algorithm. The output of block 248 may thus be, for each set of stored current and voltage feedback samples associated with a LUT sample, a motional branch current sample.
At block 250 of the phase control algorithm, impedance phase is determined based on the synchronized input of motional branch current samples determined at block 248 and corresponding voltage feedback samples. In certain embodiments, the impedance phase is determined as the average of the impedance phase measured at the rising edge of the waveforms and the impedance phase measured at the falling edge of the waveforms.
At block 252 of the of the phase control algorithm, the value of the impedance phase determined at block 222 is compared to phase setpoint 254 to determine a difference, or phase error, between the compared values.
At block 256 of the phase control algorithm, based on a value of phase error determined at block 252 and the impedance magnitude determined at block 242, a frequency output for controlling the frequency of the drive signal is determined. The value of the frequency output may be continuously adjusted by the block 256 and transferred to a DDS control block 268 (discussed below) in order to maintain the impedance phase determined at block 250 at the phase setpoint (e.g., zero phase error). In certain embodiments, the impedance phase may be regulated to a 0° phase setpoint. In this way, any harmonic distortion will be centered about the crest of the voltage waveform, enhancing the accuracy of phase impedance determination.
Block 258 of the processor 174 may implement an algorithm for modulating the current amplitude of the drive signal in order to control the drive signal current, voltage and power in accordance with user specified setpoints, or in accordance with requirements specified by other processes or algorithms implemented by the generator 102. Control of these quantities may be realized, for example, by scaling the LUT samples in the LUT 228 and/or by adjusting the full-scale output voltage of the DAC 168 (which supplies the input to the power amplifier 162) via a DAC 186. Block 260 (which may be implemented as a PID controller in certain embodiments) may receive as input current feedback samples (which may be suitably scaled and filtered) from the memory location 218. The current feedback samples may be compared to a “current demand” Id value dictated by the controlled variable (e.g., current, voltage or power) to determine if the drive signal is supplying the necessary current. In embodiments in which drive signal current is the control variable, the current demand Id may be specified directly by a current setpoint 262A (Isp). For example, an RMS value of the current feedback data (determined as in block 234) may be compared to user-specified RMS current setpoint Isp to determine the appropriate controller action. If, for example, the current feedback data indicates an RMS value less than the current setpoint Isp, LUT scaling and/or the full-scale output voltage of the DAC 168 may be adjusted by the block 260 such that the drive signal current is increased. Conversely, block 260 may adjust LUT scaling and/or the full-scale output voltage of the DAC 168 to decrease the drive signal current when the current feedback data indicates an RMS value greater than the current setpoint Isp.
In embodiments in which the drive signal voltage is the control variable, the current demand Id may be specified indirectly, for example, based on the current required maintain a desired voltage setpoint 262B (Vsp) given the load impedance magnitude Zm measured at block 242 (e.g. Id=Vsp/Zm). Similarly, in embodiments in which drive signal power is the control variable, the current demand Id may be specified indirectly, for example, based on the current required to maintain a desired power setpoint 262C (Psp) given the voltage Vrms measured at blocks 236 (e.g. Id=Psp/Vrms).
Block 268 may implement a DDS control algorithm for controlling the drive signal by recalling LUT samples stored in the LUT 228. In certain embodiments, the DDS control algorithm be a numerically-controlled oscillator (NCO) algorithm for generating samples of a waveform at a fixed clock rate using a point (memory location)-skipping technique. The NCO algorithm may implement a phase accumulator, or frequency-to-phase converter, that functions as an address pointer for recalling LUT samples from the LUT 228. In one embodiment, the phase accumulator may be a D step size, modulo N phase accumulator, where D is a positive integer representing a frequency control value, and N is the number of LUT samples in the LUT 228. A frequency control value of D=1, for example, may cause the phase accumulator to sequentially point to every address of the LUT 228, resulting in a waveform output replicating the waveform stored in the LUT 228. When D>1, the phase accumulator may skip addresses in the LUT 228, resulting in a waveform output having a higher frequency. Accordingly, the frequency of the waveform generated by the DDS control algorithm may therefore be controlled by suitably varying the frequency control value. In certain embodiments, the frequency control value may be determined based on the output of the phase control algorithm implemented at block 244. The output of block 268 may supply the input of DAC 168, which in turn supplies a corresponding analog signal to an input of the power amplifier 162.
Block 270 of the processor 174 may implement a switch-mode converter control algorithm for dynamically modulating the rail voltage of the power amplifier 162 based on the waveform envelope of the signal being amplified, thereby improving the efficiency of the power amplifier 162. In certain embodiments, characteristics of the waveform envelope may be determined by monitoring one or more signals contained in the power amplifier 162. In one embodiment, for example, characteristics of the waveform envelope may be determined by monitoring the minima of a drain voltage (e.g., a MOSFET drain voltage) that is modulated in accordance with the envelope of the amplified signal. A minima voltage signal may be generated, for example, by a voltage minima detector coupled to the drain voltage. The minima voltage signal may be sampled by ADC 176, with the output minima voltage samples being received at block 272 of the switch-mode converter control algorithm. Based on the values of the minima voltage samples, block 274 may control a PWM signal output by a PWM generator 276, which, in turn, controls the rail voltage supplied to the power amplifier 162 by the switch-mode regulator 170. In certain embodiments, as long as the values of the minima voltage samples are less than a minima target 278 input into block 262, the rail voltage may be modulated in accordance with the waveform envelope as characterized by the minima voltage samples. When the minima voltage samples indicate low envelope power levels, for example, block 274 may cause a low rail voltage to be supplied to the power amplifier 162, with the full rail voltage being supplied only when the minima voltage samples indicate maximum envelope power levels. When the minima voltage samples fall below the minima target 278, block 274 may cause the rail voltage to be maintained at a minimum value suitable for ensuring proper operation of the power amplifier 162.
Referring to the embodiment of
During operation, an interrogation signal (e.g., a bipolar interrogation signal at 2 kHz) from the signal conditioning circuit 202 may be applied across both branches of the control circuit 300-1. In this way, the voltage appearing across the branches may be uniquely determined by the states of SW1 and SW2. For example, when SW1 is open, the voltage drop across the control circuit 300-1 for negative values of the interrogation signal will be sum of the forward voltage drops across D1 and D2. When SW1 is closed, the voltage drop for negative values of the interrogation signal will be determined by the forward voltage drop of D1 only. Thus, for example, with a forward voltage drop of 0.7 volts for each of D1 and D2, open and closed states of SW1 may correspond to voltage drops of 1.4 volts and 0.7 volts, respectively. In the same way, the voltage drop across the control circuit 300-1 for positive values of the interrogation signal may be uniquely determined by the state of SW2. For example, when SW2 is open, the voltage drop across the control circuit 300-1 will be the sum of the forward voltage drops across D3 and D4 (e.g., 1.4 volts) and the breakdown voltage of D5 (e.g., 3.3 volts). When SW2 is closed, the voltage drop across the control circuit 300-1 will be the sum of the forward voltage drop across D3 and the breakdown voltage of D5. Accordingly, the state or configuration of SW1 and SW2 may be discerned by the generator 102 based on the interrogation signal voltage appearing across the inputs of the control circuit 300-1 (e.g., as measured by an ADC of the signal conditioning circuit 202).
In certain embodiments, the generator 102 may be configured to communicate with the data circuit 304, and, in particular, with the data storage element 302, via the second data circuit interface 210 (
As explained above in connection with
As noted above, the data circuit 304 may additionally or alternatively comprise components or elements other than the data storage element 302 for transmitting or receiving data. Such components or elements may be configured to, for example, transmit data acquired by one or more sensors (e.g., an instrument-based temperature sensor) and/or receive data from the generator 102 and provide an indication to a user (e.g., an LED indication or other visible indication) based on the received data.
Embodiments of the control circuit may comprise additional switches. With reference to the embodiment of
Referring to
In certain embodiments and as shown in
Referring to
In certain embodiments, the generator 102 may be configured to communicate with the data circuit 284, and, in particular, with the data storage element 286, via the second data circuit interface 210 (
As explained above in connection with
In certain embodiments and as shown in
In certain embodiments, a data circuit may comprise one or more switches to modify one or more characteristics (e.g., amplitude, rectification) of an interrogation signal received by the data circuit such that a state or configuration of the one or more switches is uniquely discernable based on the one or more characteristics.
Additionally, it will be appreciated that switches in addition to SW3 may be added to a data circuit. As shown in
In certain cases, the switches (e.g., SW1-SW4) may impede the ability of the generator 102 to communicate with the data storage element 286. In one embodiment, this issue may be addressed by declaring an error if the states of the switches are such that they will interfere with communication between the generator 102 and the data storage element 286. In another embodiment, the generator 102 may only permit communication with the data storage element 286 when determined by the generator 102 that the states of the switches will not interfere with the communication. Because the states of the switches may be unpredictable to an extent, the generator 102 may make this determination on a recurring basis. The addition of L1 in certain embodiments may prevent interference caused by switches external to the data circuit (e.g., SW1 and SW2). For switches contained within the data circuit (e.g., SW3 and SW4), isolation of the switches by frequency band separation may be realized by the addition of a capacitor C2 having a capacitance value significantly smaller than C1 (e.g., C2<<C1). Embodiments of data circuits 284-5, 284-6, 284-7 comprising C2 are shown in
In any of the embodiments of
With the addition of an inductor L1 to prevent interference with data storage element 286 communications caused by switches external to the data circuit 288 (e.g., SW1 and SW2), the data circuit 288 may be used in control circuits of electrosurgical instruments, as shown in the embodiment of the data circuit 288-1 of
With the exception of C2 and R3, and the more likely need for D7, the embodiments of
In the embodiment of
In certain embodiments, the data circuit may not comprise a data storage element 286 (e.g., an EEPROM device) to store information.
In
In certain embodiments, multiple capacitors C1 for allowing interrogation at multiple frequencies could be used to differentiate between a larger number of distinct R1 values for a given signal-to-noise ratio, or for a given set of component tolerances. In one such embodiment, inductors may be placed in series with all but the lowest value of C1 to create specific pass bands for different interrogation frequencies, as shown in the embodiment of the data circuit 290-3 in
In embodiments of control circuits based on the control circuit 280 of
In various embodiments, the generator 102 may be electrically isolated from the surgical devices 104, 106 in order to prevent undesired and potentially harmful currents in the patient. For example, if the generator 102 and the surgical devices 104, 106 were not electrically isolated, voltage provided to the devices 104, 106 via the drive signal could potentially change the electrical potential of patent tissue being acted upon by the device or devices 104, 106 and, thereby, result in undesired currents in the patient. It will be appreciated that such concerns may be more acute when using an ultrasonic surgical device 104 that is not intended to pass any current though tissue. Accordingly, the remainder of the description of active cancellation of leakage current is described in terms of an ultrasonic surgical device 104. It will be appreciated, however, that the systems and methods described herein may be applicable to electrosurgical devices 106 as well.
According to various embodiments, an isolation transformer, such as the isolation transformer 156, may be used to provide electrical isolation between the generator 102 and the surgical device 104. For example, the transformer 156 may provide isolation between the non-isolated stage 154 and the isolated stage 152 described above. The isolated stage 154 may be in communication with the surgical device 104. The drive signal may be provided by the generator 102 (e.g., the generator module 108) to the primary winding 164 of the isolation transformer 156 and provided to the surgical device 104 from the secondary winding 158 of the isolation transformer. Considering the non-idealities of real transformers, however, this arrangement may not provide complete electrical isolation. For example, a real transformer may have stray capacitance between the primary and secondary windings. The stray capacitance may prevent complete electrical isolation and allow electrical potential present on the primary winding to affect the potential of the secondary winding. This may result in leakage currents within the patient.
Contemporary industry standards, such as the International Electrotechnical Commission (IEC) 60601-1 standard limit allowable patient leakage current to 10 μA or less. Leakage current may be passively reduced by providing a leakage capacitor between the secondary winding of the isolation transformer and ground (e.g., earth ground). The leakage capacitor may operate to smooth changes in patient-side potential coupled from the non-isolated side via the stray capacitance of the isolation transformer and thereby reduce leakage current. As the voltage, current, power and/or frequency of the drive signal provided by the generator 102 increase, however, the leakage current may also increase. In various embodiments, induced leakage current may increase beyond the capability of a passive leakage capacitor to keep it below 10 μA and/or other leakage current standards.
Accordingly, various embodiments are directed to systems and methods for actively cancelling leakage current.
A leakage capacitor 810 and active cancellation circuit 812 may be provided, as shown, connected between the secondary winding 806 and ground 818. The active cancellation circuit 812 may generate an inverse drive signal 814 that may be about 180° out of phase with the drive signal 816. The active cancellation circuit 812 may be electrically coupled to the leakage capacitor 810 to drive the leakage capacitor to a potential that, relative to ground 818, is about 180° out of phase with the drive signal 816. Accordingly, electrical charge on the patient-side secondary winding 806 may reach ground 818 via the leakage capacitor 810 instead of through the patient, reducing leakage current. According to various embodiments, the leakage capacitor 810 may be designed to meet adequate, industry, government and/or design standards for robustness. For example, the leakage capacitor 810 may be a Y-type capacitor complying with the IEC 60384-14 standard and/or may comprise multiple physical capacitors in series.
Electrical isolation between the generator circuit 824 and the patient-side circuit 822 may be provided by an isolation transformer 826. The primary winding 828 of the isolation transformer 826 may be coupled to the generator circuit 824. For example, the generator circuit 824 may generate the drive signal across the primary winding 828. The drive signal may be generated across the primary winding 828 according to any suitable method. For example, according to various embodiments, the primary winding 828 may comprise a center tap 829 that may be held to a DC voltage (e.g., 48 volts). The generator circuit 824 may comprise output stages 825, 827 that are, respectively, coupled to the other ends of the primary winding 828. Output stages 825, 827 may cause currents corresponding to the drive signal to flow in the primary winding 828. For example, positive portions of the drive signal may be realized when the output stage 827 pulls its output voltage lower than the center tap voltage, causing the output stage 827 to sink current from across the primary winding 828. A corresponding current may be induced in the secondary winding 830. Likewise, negative portions of the drive signal may be implemented when the output state 827 pulls its output voltage lower than the center tap voltage, causing the output stage 825 to sink an opposite current across the primary winding 828. This may induce a corresponding, opposite current in the secondary winding 830. The patient-side circuit 822 may perform various signal conditioning and/or other processing to the isolated drive signal, which may be provided to a device 104 via output lines 821, 823.
An active cancellation transformer 832 may have a primary winding 834 and a secondary winding 836. The primary winding 834 may be electrically coupled to the primary winding 828 of the isolation transformer 826 such that the drive signal is provided across the winding 834. For example, the primary winding 834 may comprise two windings 843, 845. A first end 835 of the first winding 845 and a first end 839 of the second winding 843 may be electrically coupled to the center tap 829 of the winding 828. A second end 841 of the first winding 845 may be electrically coupled to the output stage 827, while a second end 837 of the second winding 843 may be electrically coupled to the output state 825. The secondary winding 836 of the cancellation transformer 832 may be coupled to ground 818 and to a first electrode of a cancellation capacitor 840. The other electrode of the cancellation capacitor 840 may be coupled to the output line 823. An optional load resistor 838 may also be electrically coupled in parallel across the secondary winding 836.
According to various embodiments, the secondary winding 836 of the active cancellation transformer may be wound and/or wired to the other components 840, 838, 818, such that its polarity is opposite the polarity of the primary winding 834. For example, an inverse drive signal may be induced across the secondary winding 836. Relative to ground 818, the inverse drive signal may be 180° out of phase with the drive signal provided across the primary winding 834 of the active cancellation transform 832. In conjunction with the load resistor 838, the secondary winding 836 may provide the inverse drive signal at the cancellation capacitor 840. Accordingly, charge causing leakage potential appearing at the patient-side circuit 822 due to the drive signal may be drawn to the cancellation capacitor 840. In this way, the capacitor 840, secondary winding 836 and load resistor 838 may sink potential leakage current to ground 818, minimizing patient leakage current.
According to various embodiments, the parameters of the components 832, 838, 840 may be selected to maximize leakage current cancellation and, in various embodiments, to lessen electromagnetic emissions. For example, the active cancellation transformer 832 may be made from materials and according to a construction that allows it to match the frequency, temperature, humidity and other characteristics of the isolation transformer 826. Other parameters of the active transformer 832 (e.g., number of turns, turn ratios, etc.) may be selected to achieve a balance between minimizing output-induced current, electromagnetic (EM) emissions and leakage current due to applied external voltage. For example, the circuit 820 may be configured to meet the IEC 60601 or other suitable industry or government standards. The value of the load resistor 838 may be similarly chosen. In addition, the parameters of the cancellation capacitor 840 (e.g., capacitance, etc.) may be selected to match, as well as possible, the characteristics of the stray capacitances responsible for the inducing leakage current.
The circuit 848 is shown with the active cancellation transformer 832 omitted and the capacitor 840 and second secondary winding 846 in the configuration of the circuit 844. It will be appreciated, however, that the correction control circuit 851 may be utilized in any of the configurations described herein (e.g., 820, 842, 844, etc.). For example, the correction control circuit 851 may be substituted for ground 818 in any of the circuits 820, 842, 844.
A surgical generator, such as the generator 102 schematically illustrated in
Referring again to
The adapter assemblies 1002 and 1004 may comprise substantially the similar components that are contained by the connector body 922 (
Referring to
As shown in
In a surgical procedure utilizing an ultrasonic surgical device, such as the ultrasonic surgical device 104, the end effector 126 transmits ultrasonic energy to tissue brought into contact with the end effector 126 to realize cutting and sealing action. The application of ultrasonic energy in this manner may cause localized heating of the tissue. Monitoring and controlling such heating may be desirable to minimize unintended tissue damage and/or to optimize the effectiveness of the cutting and sealing action. Direct measurement of ultrasonic heating requires temperature sensing devices in or near the end effector 126. Although sensor-based measurements of ultrasonic heating is technically feasible, design complexity and other considerations may make direct measurement impractical. Various embodiments of the generator 102 may address this problem by generating an estimate of temperature or heating resulting from an application of ultrasonic energy.
In particular, one embodiment of the generator 102 may implement an artificial neural network to estimate ultrasonic heating based on a number of input variables 1218. Artificial neural networks are mathematical models that learn complex, nonlinear relationships between inputs and outputs based on exposure to known input and output patterns, a process commonly referred to as “training.” An artificial neural network may comprise a network of simple processing units, or nodes, connected together to perform data processing tasks. The structure of an artificial neural network may be somewhat analogous to the structure of biological neural networks in the brain. When an artificial neural network is presented with an input data pattern, it produces an output pattern. An artificial neural network may be trained for a specific processing task by presentation of large amounts of training data. In this way, the artificial neural network may modify its structure by changing the “strength” of communication between nodes to improve its performance on the training data.
Each node 1204, 1208 in the layers 1202, 1210 may include one or more weight values w 1212, a bias value b 1214, and a transform function f 1216. In
A particular node 1208 of the output layer 1210 may receive an output from one or more of the nodes 1204 of the hidden layer 1206 (e.g., each node 1208 receives outputs f1(•), f2(•), . . . , fi(•) from respective nodes 1204-1, 1204-2, . . . , 1204-i in
In certain embodiments, the transform function f 1216 of a node 1204, 1208 may be a nonlinear transfer function. In one embodiment, for example, one or more of the transform functions f 1216 may be a sigmoid function. In other embodiments, the transform functions f 1216 may include a tangent sigmoid, a hyperbolic tangent sigmoid, a logarithmic sigmoid, a linear transfer function, a saturated linear transfer function, a radial basis transfer function, or some other type of transfer function. The transform function f 1216 of a particular node 1204, 1208 may be the same as, or different from, a transform function f 1216 in another node 1204, 1208.
In certain embodiments, the input variables p 1218 received by the nodes 1204 of the hidden layer 1206 may represent, for example, signals and/or other quantities or conditions known or believed to have an effect on the temperature or heating resulting from an application of ultrasonic energy. Such variables may comprise, for example, one or more of: drive voltage output by the generator 102, drive current output by the generator 102, drive frequency of the generator output 102, drive power output by the generator 102, drive energy output by the generator 102, impedance of the ultrasonic transducer 114, and time duration over which ultrasonic energy is applied. Additionally, one or more of the input variables p 1218 may be unrelated to outputs of the generator 102 and may comprise, for example, characteristics of the end effector 126 (e.g., blade tip size, geometry, and/or material) and a particular type of tissue targeted by the ultrasonic energy.
The neural network 1200 may be trained (e.g., by changing or varying the weight values w 1212, the bias values b 1214, and the transform functions f 1216) such that its output (e.g., estimated temperature Test in the embodiment of
In certain embodiments, when the estimated temperature exceeds a user-defined temperature threshold Tth, the generator 102 may be configured to control the application of ultrasonic energy such that the estimated temperature Test is maintained at or below the temperature threshold Tth. For example, in embodiments in which the drive current is an input variable p 1218 to the neural network 1200, the drive current may be treated as a control variable and modulated to minimize or reduce the difference between Test and Tth. Such embodiments may be implemented using a feedback control algorithm (e.g., a PID control algorithm), with Tth being input to the control algorithm as a setpoint, Test being input to the algorithm as process variable feedback, and drive current corresponding to the controlled output of the algorithm. In cases where the drive current serves as the control variable, suitable variations in drive current value should be represented in the sets of input variables p 1218 used to train the neural network 1200. In particular, the effectiveness of drive current as a control variable may be reduced if the training data reflects constant drive current values, as the neural network 1200 may reduce the weight values w 1212 associated with drive current due to its apparent lack of effect on temperature. It will be appreciated that input variables p 1218 other than drive current (e.g., drive voltage) may be used to minimize or reduce the difference between Test and Tth.
According to various embodiments, the generator 102 may provide power to a tissue bite according to one or more power curves. A power curve may define a relationship between power delivered to the tissue and the impedance of the tissue. For example as the impedance of the tissue changes (e.g., increases) during coagulation, the power provided by the generator 102 may also change (e.g., decrease) according to the applied power curve.
Different power curves may be particularly suited, or ill-suited, to different types and/or sizes of tissue bites. Aggressive power curves (e.g., power curves calling for high power levels) may be suited for large tissue bites. When applied to smaller tissue bites, such as small vessels, more aggressive power curves may lead to exterior searing. Exterior searing may reduce the coagulation/weld quality at the exterior and can also prevent complete coagulation of interior portions of the tissue. Similarly, less aggressive power curves may fail to achieve hemostasis when applied to larger tissue bites (e.g., larger bundles).
The aggressiveness of two power curves may be compared according to any suitable method. For example, a first power curve may be considered more aggressive than a second power curve over a given range of potential tissue impedances if the first power curve has a higher delivered power corresponding to at least half of the range of potential tissue impedances. Also, for example, a first power curve may be considered more aggressive than a second power curve over a given range of potential tissue impedances if the area under the first curve over the range is larger than the area under the second curve over the range. Equivalently, when power curves are expressed discretely, a first power curve may be considered more aggressive than a second power curve over a given set of potential tissue impedances if the sum of the power values for the first power curve over the set of potential tissue impedances is greater than the sum of the power values for the second power curve over the set of potential tissue impedances.
According to various embodiments, the power curve shifting algorithms described herein may be used with any kind of surgical device (e.g., ultrasonic device 104, electrosurgical device 106). In embodiments utilizing a ultrasonic device 104, tissue impedance readings may be taken utilizing electrodes 157, 159. With an electrosurgical device, such as 106, tissue impedance readings may be taken utilizing first and second electrodes 177, 179.
In some embodiments, an electrosurgical device 104 may comprise a positive temperature coefficient (PTC) material positioned between one or both of the electrodes 177, 179 and the tissue bite. The PTC material may have an impedance profile that remains relatively low and relatively constant until it reaches a threshold or trigger temperature, at which point the impedance of the PTC material may increase. In use, the PTC material may be placed in contact with the tissue while power is applied. The trigger temperature of the PTC material may be selected such that it corresponds to a tissue temperature indicating the completion of welding or coagulation. Accordingly, as a welding or coagulation process is completed, the impedance of the PTC material may increase, bringing about a corresponding decrease in power actually provided to the tissue.
It will be appreciated that during the coagulation or welding process, tissue impedance may generally increase. In some embodiments, tissue impedance may display a sudden impedance increase indicating successful coagulation. The increase may be due to physiological changes in the tissue, a PTC material reaching its trigger threshold, etc., and may occur at any point in the coagulation process. The amount of energy that may be required to bring about the sudden impedance increase may be related to the thermal mass of the tissue being acted upon. The thermal mass of any given tissue bite, in turn, may be related to the type and amount of tissue in the bite.
Various embodiments may utilize this sudden increase in tissue impedance to select an appropriate power curve for a given tissue bite. For example, the generator 102 may select and apply successively more aggressive power curves until the tissue impedance reaches an impedance threshold indicating that the sudden increase has occurred. For example, reaching the impedance threshold may indicate that coagulation is progressing appropriately with the currently applied power curve. The impedance threshold may be a tissue impedance value, a rate of change of tissue impedance, and/or a combination of impedance and rate of change. For example, the impedance threshold may be met when a certain impedance value and/or rate of change are observed. According to various embodiments, different power curves may have different impedance thresholds, as described herein.
The first power curve may be applied to the tissue in any suitable manner. For example, the generator 102 may generate a drive signal implementing the first power curve. The power curve may be implemented by modulating the power of the drive signal. The power of the drive signal may be modulated in any suitable manner. For example, the voltage and/or current of the signal may be modulated. Also, in various embodiments, the drive signal may be pulsed. For example, the generator 102 may modulate the average power by changing the pulse width, duty cycle, etc. of the drive signal. The drive signal may be provided to the first and second electrodes 177, 179 of the electrosurgical device 106. Also, in some embodiments the drive signal implementing the first power curve may be provided to an ultrasonic generator 114 of the ultrasonic device 104 described above.
While applying the first power curve, the generator 102 may monitor the total energy provided to the tissue. The impedance of the tissue may be compared to the impedance threshold at one or more energy thresholds. There may be any suitable number of energy thresholds, which may be selected according to any suitable methodology. For example, the energy thresholds may be selected to correspond to known points where different tissue types achieve the impedance threshold. At 1334, the generator 102 may determine whether the total energy delivered to the tissue has met or exceeded a first energy threshold. If the total energy has not yet reached the first energy threshold, the generator 102 may continue to apply the first power curve at 1332.
If the total energy has reached the first energy threshold, the generator 102 may determine whether the impedance threshold has been reached (1336). As described above, the impedance threshold may be a predetermined rate of impedance change (e.g., increase) a predetermined impedance, or combination of the two. If the impedance threshold is reached, the generator 102 may continue to apply the first power curve at 1332. For example, reaching the impedance threshold in the first power curve may indicate that the aggressiveness of the first power curve is sufficient to bring about suitable coagulation or welding.
In the event that the impedance threshold is not reached at 1336, the generator 102 may increment to the next most aggressive power curve at 1338 and apply the power curve as the current power curve at 1332. When the next energy threshold is reached at 1334, the generator 102 again may determine whether the impedance threshold is reached at 1336. If it is not reached, the generator 102 may again increment to the next most aggressive power curve at 1338 and deliver that power curve at 1332.
The process flow 1330 may continue until terminated. For example, the process flow 1330 may be terminated when the impedance threshold is reached at 1336. Upon reaching the impedance threshold, the generator 102 may apply the then-current power curve until coagulation or welding is complete. Also, for example, the process flow 1330 may terminate upon the exhaustion of all available power curves. Any suitable number of power curves may be used. If the most aggressive power curve fails to drive the tissue to the impedance threshold, the generator 102 may continue to apply the most aggressive power curve until the process is otherwise terminated (e.g., by a clinician or upon reaching a final energy threshold).
According to various embodiments, the process flow 1330 may continue until the occurrence of a termination threshold. The termination threshold may indicate that coagulation and/or welding is complete. For example, the termination threshold may be based on one or more of tissue impedance, tissue temperature, tissue capacitance, tissue inductance, elapsed time, etc. These may be a single termination threshold or, in various embodiments, different power curves may have different termination thresholds. According to various embodiments, different power curves may utilize different impedance thresholds. For example, the process flow 1330 may transition from a first to a second power curve if the first power curve has failed to drive the tissue to a first tissue impedance threshold and may, subsequently, shift from the second to a third power curve if the second power curve has failed to drive the tissue to a second impedance threshold.
As illustrated in
According to various embodiments, the process flow 1330 may be implemented by a digital device (e.g., a processor, digital signal processor, field programmable gate array (FPGA), etc.) of the generator 102. Examples of such digital devices include, for example, processor 174, programmable logic device 166, processor 190, etc.).
At 1346, the digital device may reset an impedance threshold flag. As described below, setting the impedance threshold flag may indicate that the impedance threshold has been met. Accordingly, resetting the flag may indicate that the impedance threshold has not been met, as may be appropriate at the outset of the process flow 1330. At 1348, the digital device may continue to the next routine 1350.
At 1366, the digital device may calculate the total accumulated energy delivered to the tissue. For example, the digital device may monitor the total time of power curve delivery and the power delivered at each time. Total energy may be calculated from these values. At 1368, the digital device may determine whether the total energy is greater than or equal to a next energy threshold, for example, similar to the manner described above with respect to 1334 of
If the next energy threshold is met at 1368, then at 1370, the digital device may determine whether the impedance threshold flag is set. The state of the impedance threshold flag may indicate whether the impedance threshold has been met. For example, the impedance threshold flag may have been set by the routine 1350 if the impedance threshold has been met. If the impedance flag is not set (e.g., the impedance threshold is not met), then the digital device may determine, at 1372, whether any more aggressive power curves remain to be implemented. If so, the digital device may point the routine 1362 to the next, more aggressive power curve at 1374. The routine 1362 may continue (1378) to deliver power according to the new power curve at 1364. If all available power curves have been applied, then the digital device may disable calculating and checking of accumulated energy for the remainder of the tissue operation at 1376.
If the impedance flag is set at 1370 (e.g., the impedance threshold has been met), then the digital device may disable calculating and checking of accumulated energy for the remainder of the tissue operation at 1376. It will be appreciated that, in some embodiments, accumulated energy calculation may be continued, while 1370, 1372, 1374, and 1376 may be discontinued. For example, the generator 102 and/or digital device may implement an automated shut-off when accumulated energy reaches a predetermined value.
In some embodiments utilizing a pulsed drive signal, the generator 102 may apply one or more composite load curves to the drive signal, and ultimately to the tissue. Composite load curves, like other power curves described herein, may define a level of power to be delivered to the tissue as a function of a measured tissue property or properties (e.g., impedance). Composite load curves may, additionally, define pulse characteristics, such as pulse width, in terms of the measured tissue properties.
Referring back to
The algorithm 1452 may apply a selected composite load curve in any suitable manner. For example, the algorithm 1452 may use the selected composite load curve to calculate a power level and one or more pulse characteristics based on tissue impedance (e.g., currently measured tissue impedance may be a part of, or may be derived from, the loop input) or resonant frequency characteristics of a ultrasonic device 104. Examples of pulse characteristics that may be determined based on tissue impedance according to a composite load curve may include pulse width, ramp time, and off time.
At set point 1464, the derived power and pulse characteristics may be applied to the drive signal. In various embodiments, a feedback loop 1474 may be implemented to allow for more accurate modulation of the drive signal. At the output of the set point 1464, the drive signal may be provided to an amplifier 1466, which may provide suitable amplification. The amplified drive signal may be provided to a load 1470 (e.g., via sensors 1468). The load 1470 may comprise the tissue, the surgical device 104, 106, and/or any cable electrically coupling the generator 102 with the surgical device 104, 106 (e.g., cables 112, 128).
According to various embodiments, the algorithm 1452 may comprise a plurality of regions 1478, 1480, 1482, 1484. Each region may represent a different stage of the cutting and coagulation of a tissue bite. For example, in the first region 1478, the generator 102 may perform an analysis of initial tissue conditions (e.g., impedance). In the second region 1480, the generator 102 may apply energy to the tissue in order to prepare the tissue for cutting. In the third or cut region 1482, the generator 102 may continue to apply energy while the surgical device 104, 106 cuts the tissue (e.g., with the electrosurgical device 106, cutting may be performed by advancing the blade A18). In the fourth or completion region 1484, the generator 102 may apply energy post-cut to complete coagulation.
Referring now to the first region 1478, the generator 102 may measure any suitable tissue condition or conditions including, for example, current, voltage, temperature, reflectivity, force applied to the tissue, etc. In various embodiments, an initial impedance of the tissue may be measured according to any suitable manner. For example, the generator 102 may modulate the drive signal to provide a known voltage or currency to the tissue. Impedance may be derived from the known voltage and the measured current or vice versa. It will be appreciated that tissue impedance may alternately or additionally be measured in any other suitable manner. According to the algorithm 1452, the generator 102 may proceed from the first region 1478 to the second region 1480. In various embodiments, the clinician may end the algorithm 1452 in the first region 1478, for example, by deactivating the generator 102 and/or the surgical device 104, 106. If the clinician terminates the algorithm 1542, RF (and/or ultrasonic) delivery may also be terminated at 1486.
In the second region 1480, the generator 102 may begin to apply energy to the tissue via the drive signal to prepare the tissue for cutting. Energy may be applied according to the composite load curves 1456, 1458, 1460, 1462, as described below. Applying energy according to the second region 1480 may comprise modulating pulses onto the drive signal according to some or all of the composite load curves 1456, 1458, 1460, 1462. In various embodiments, the composite load curves 1456, 1458, 1460, 1462 may be successively applied in order of aggressiveness (e.g., to accommodate various types of tissue-volume clamped in the instrument jaws).
The first composite load curve 1456 may be applied first. The generator 102 may apply the first composite load curve 1456 by modulating one or more first composite load curve pulses onto the drive signal. Each first composite load curve pulse may have a power and pulse characteristics determined according to the first composite load curve and considering measured tissue impedance. Measured tissue impedance for the first pulse may be the impedance measured at the first region 1478. In various embodiments, the generator 102 may utilize all or a portion of the first composite load curve pulses to take additional measurements of tissue impedance or resonant frequency. The additional measurements may be used to determine the power and other pulse characteristics of a subsequent pulse or pulses.
At 1492, the generator 102 may ramp the power of the drive signal up to a pulse power (PLimit) over a ramp time (tramp), thereby applying the pulse to the tissue. The pulse power may be determined, again, considering the most recent measured tissue impedance (Z) and according to the first composite load curve 1456. The ramp time may be determined according to the composite load curve considering tissue impedance or may be constant (e.g., constant for all first composite load curve pulses, constant for all pulses, etc.). The generator 102 may apply the pulse power to the drive signal in any suitable manner including, for example, modulating a current and/or voltage provided by the drive signal. According to various embodiments, the drive signal may be an alternating current (A/C) signal, and therefore the pulse itself may comprise multiple cycles of the drive signal.
The drive signal may be held at the pulse power for the pulse width at 1494. At the conclusion of the pulse, the drive signal may be ramped down, at 1496, over a fall time (Tfall). The fall time may be determined according to the first composite load curve considering tissue impedance, or may be constant (e.g., constant for all first composite load curve pulses, constant for all pulses, etc.). It will be appreciated that, depending on the embodiment, the ramp time and fall time may or may not be considered part of the pulse width. At 1498, the generator 102 may pause for an off time (Toff). Like the ramp time and fall time, the off time may be determined according to the first composite load curve considering tissue impedance, or may be constant (e.g., constant for all first composite load curve pulses, constant for all pulses, etc.).
At the completion of the off time, the generator 102 may repeat the process flow 1488 as long as the first composite load curve 1456 is applied. According to various embodiments, the generator 102 may apply the first composite load curve 1456 for a predetermined amount of time. Accordingly, the process flow 1488 may be repeated until the predetermined amount of time has elapsed (e.g., as determined based on the time input received from the clock 1454). Also, in various embodiments, the first composite load curve may be applied for a predetermined number of pulses. Because the applied pulse width varies according to measured tissue impedance, the total time that the first composite load curve is applied may also vary with measured tissue impedance. According to various embodiments, the first composite load curve 1456 (as well as the other composite load curves 1458, 1460, 1462) may specify decreasing pulse widths as tissue impedance increases. Therefore, a higher initial tissue impedance may lead to less time spent in the first composite load curve.
Upon completion of the first composite load curve 1456, the generator 102 may successively apply the remaining consolidated load curves 1458, 1460, 1462 throughout the application of the second region 1480. Each load curve 1458, 1460, 1462 may be applied in a manner similar to that of the load curve 1456 described above. For example, pulses according to a current load curve may be generated until the completion of that load curve (e.g., the expiration of a predetermined amount of time or a predetermined number of pulses). The predetermined number of pulses may be the same for each composite load curve 1456, 1458, 1460, 1462 or may be different. According to various embodiments, pulses according to the load curves 1458, 1460, 1462 may be generated in a manner similar to process flow 1488, except that pulse power, pulse width and, in some embodiments, ramp time, fall time, and off time, may be derived according to the current composite load curve.
The second region 1480 may be terminated upon the occurrence of various events. For example, if the total RF application time has exceeded a timeout time, then the generator 102 may end the tissue operation by terminating RF (and/or ultrasonic) delivery at 1486. Also, various events may cause the generator 102 to transition from the second region 1480 to the third region 1482. For example, the generator 102 may transition to the third region 1482 when the tissue impedance (Z) exceeds a threshold tissue impedance (Zterm) and RF energy has been delivered for at least more than a minimum time (Tstart). The threshold tissue impedance may be an impedance and/or an impedance rate of change indicating that the tissue bite is adequately prepared for cutting by the blade 175.
According to various embodiments, if the final load curve 1462 is completed in the second region 1480 before completion of the second region 1480, then the final power curve 1462 may be continuously applied, for example, until the tissue impedance threshold is met, the maximum second region time is reached and/or the timeout time is reached. Also, it will be appreciated that, with some tissue cuts, the second region 1480 may be completed before all available consolidated load curves 1456, 1458, 1460, 1462 are executed.
At the third region 1482, the generator 102 may continue to modulate pulses onto the drive signal. Generally, third region pulses may be modulated onto the drive signal according to any suitable manner including, for example, that described above with reference to the process flow 1488. The power and pulse characteristics of the third region pulses may be determined according to any suitable method and, in various embodiments, may be determined based on the composite load curve that was being executed at the completion of the second region 1480 (the current load curve). According to various embodiments, the current load curve may be utilized to determine the pulse power of third region pulses, while the pulse characteristics (e.g., pulse width, ramp time, fall time, off time, etc.) may be constant regardless of composite load curve. In some embodiments, the third region 1482 may utilize a third-region-specific composite load curve that may be one of the load curves 1456, 1458, 1460, 1462 utilized in the second region 1480, or may be a different composite load curve (not shown).
The generator 102 may continue to execute the third region 1482 until receiving an indication that the tissue cut is complete. In embodiments utilizing surgical implements having a blade, such as 175, the indication may be received when the blade 175 reaches its distal-most position, as shown in
In the fourth region 1484, the generator 102 may provide an energy profile designed to complete coagulation of the now-cut tissue. For example, according to various embodiments, the generator 102 may provide a predetermined number of pulses. The pulses may be provided in a manner similar to that described above with respect to the process flow 1488. The power and pulse characteristics of the pulses may be determined according to any suitable manner. For example, power and pulse characteristics of the fourth region pulses may be determined based on the current composite load curve, the third-region-specific load curve, or a fourth-region-specific composite load curve. In some embodiments, power may be determined based on the current composite load curve, while pulse characteristics may be fourth region-specific. Also, according to various embodiments, the power and pulse characteristics of fourth region pulses may be determined independent of the current composite load curve.
According to various embodiments, the generator 102 may implement a user interface in conjunction with the algorithm 1452. For example, the user interface may indicate the current region of the algorithm. The user interface may be implemented visually and/or audibly. For example, the generator 102 may comprise a speaker for generating audible tones or other audible indication. At least one audible indication may correspond to the second region 1480. The third and fourth regions 1482, 1484 may also have region-specific audible indications. According to various embodiments, the first region 1478 may have a region-specific audible indication as well. According to various embodiments, the audible indications may comprise pulsed tones generated by the generator 102. The frequency of the tones and/or the pitch of the tones themselves may indicate the current region. In addition to, or instead of, the audible indications, the generator 102 may also provide a visual indication of the current region (e.g., on output device 147). It will be appreciated that the clinician may utilize the described user interface to properly use the generator 102 and associated surgical devices 104, 106. For example, the indication of the second region 1480 may let the clinician know that tissue treatment has begun. The indication of the third region 1482 may let the clinician know that the tissue is ready for the cutting operation. The indication of the fourth region 1484 may let the clinician know that the cutting operation is complete. The cessation of the indication and/or a final indication may indicate that the total cutting/coagulation operation is complete.
In various embodiments, the composite load curve 1530 may be suited to smaller surgical devices and/or smaller tissue bites.
The composite load curve 1532 may be targeted at small, single vessel tissue bites and, according to various embodiments, may be a first composite power curve applied in region two 1480.
The composite load curve 1534 may be more aggressive than the prior curve 1532 by virtue of its generally higher power. The composite load curve 1534 may also, initially, have higher pulse widths than the prior curve 1532, although the pulse widths of the composite load curve 1534 may begin to drop at just 150Ω. According to various embodiments, the composite load curve 1536 may be utilized in the algorithm 1542 as a load curve implemented sequentially after the composite load curve 1532.
The composite load curve 1536 may, again, be more aggressive than the prior curve 1534 and, therefore, may be implemented sequentially after the curve 1534 in the algorithm 1452. Also, according to various embodiments, the composite load curve 1536 maybe suited to larger tissue bundles.
The composite load curve 1538 may be used sequentially after the prior curve 1536 in the algorithm 1452.
The composite power curve 1540 is less aggressive than the prior power curve 1538. According to various embodiments, the composite power curve 1540 may be implemented in the algorithm 1452 sequentially after the curve 1538. Also, in some embodiments, the composite power curve 1540 may be implemented in the algorithm 1452 as a third or fourth region-specific composite power curve.
As described above, the various composite power curves used in the algorithm 1452 may each be implemented for a predetermined number of pulses. Table 7 below illustrates the number of pulses per composite power curve for an example embodiment utilizing the power curves 1532, 1534, 1536, 1540 sequentially in the algorithm 1452.
The last composite power curve 1540 is shown without a corresponding number of pulses. For example, the composite power curve 1540 may be implemented until the clinician terminates the operation, until the timeout time is reached, until the threshold tissue impedance is reached, etc.
According to various embodiments, the generator 102 may provide power to a tissue bite in a manner that brings about a desired value of other tissue parameters.
The generator 102, by implementing the algorithm 1572, may monitor the impedance of the tissue or load including, for example, the rate of change of impedance. The generator 102 may modulate one or more of the voltage, current and/or power provided via the drive signal to maintain the rate of change of tissue impedance at a predetermined constant value. Also, according to various embodiments, the generator 102 may maintain the rate of change of the tissue impedance at above a minimum impedance rate of change.
It will be appreciated that the algorithm 1572 may be implemented in conjunction with various other algorithms described herein. For example, according to various embodiments, the generator 102 may sequentially modulate the tissue impedance to different, increasingly aggressive rates similar to the method 1330 described herein with reference to
As previously discussed, in one embodiment, the generator 102 may comprise an ultrasonic generator module 108 to drive an ultrasonic device, such as the ultrasonic device 104 be by providing a drive signal to the transducer 114 in any suitable manner. For example, the generator 102 may comprise a foot switch 120 coupled to the generator 102 via a footswitch cable 122 (
As previously discussed, the drive mode of the generator 102 may be determined by the device identification. The characteristics of the interrogation signal may uniquely indicate the state or configuration of a control circuit, which can be discerned by the generator 102 and used to control aspects of its operation. Any of the control circuits 280, 280-1 to 280-9, 282, and 282-1 to 282-8 previously descried in connection with
In one embodiment, the generator 102 may be configured to operate in ultrasonic mode using the ultrasonic generator module 108. Accordingly, the first pedal of the foot switch 120 enables and/or controls the operation of the ultrasonic generator module 108. During ultrasonic mode operation, the first pedal (e.g., the left pedal) may be configured to activate the ultrasonic output of the ultrasonic generator module 108 to generate a drive signal that corresponds to a minimum (PMin) ultrasonic power level (e.g., minimum energy setting) and the second pedal (e.g., the right pedal) may be configured to activate the ultrasonic generator module 108 to generate a drive signal that corresponds to a the maximum (PMax) ultrasonic power level (e.g., maximum energy setting). It will be appreciated that either the first or second pedal may be configured to activate the ultrasonic generator module 108 to generate a drive signal that corresponds to the minimum (PMin) or maximum (PMax) ultrasonic power levels, without limitation. Therefore, either the left or right pedal may be assigned as the first pedal, and the other pedal may be assigned as the second pedal. In embodiments where the foot switch 120 comprises more than two pedals, each of the pedals may be assigned a predetermined function. In some embodiments, one or more of the foot pedals may be deactivated or ignored by the generator 102 DSP software or logic (e.g., executable instructions, hardware devices, or combinations thereof).
In one embodiment, the generator 102 is configured in ultrasonic mode and the foot switch 120 comprises two pedals, e.g., first and second or left and right. During ultrasonic foot switch 120 activation mode, when a valid activation of the first pedal (e.g., left pedal) of the foot switch 120 is detected and an ultrasonic surgical device 104 (
In one embodiment, during ultrasonic foot switch 120 activation mode, when a valid activation of the second pedal (e.g., right pedal) of the foot switch 120 is detected and an ultrasonic surgical device 104 (
In another embodiment, the generator 102 may comprise an electrosurgery/RF generator module 110 to drive the electrosurgical device 106 in any suitable manner. Control circuits may be employed to detect the presence of the foot switch 120 and the electrosurgery/RF generator module 110 such that the operation of the foot switch 120 is corresponds with the activation of the electrosurgery/RF generator module 110. Accordingly, the generator 102 may be configured to operate in electrosurgical mode (e.g., bi-polar RF mode) using the electrosurgery/RF generator module 110 and the foot switch 120 may comprise two pedals, e.g., first and second or left and right. The first pedal of the foot switch 120 enables and/or controls the operation of the electrosurgery/RF generator module 110. During electrosurgical mode operation, the first pedal (e.g., the left pedal) may be configured to activate the bi-polar RF output of the electrosurgery/RF generator module 110 and the second pedal (e.g., the right pedal) switch may be ignored and may be referred to as an inactive switch. It will be appreciated that the inactive switch (e.g., the right pedal) may be used by the user for input to the generator 102 other than power level. For example, tapping the inactive switch pedal may be a way for the user to acknowledge or clear a fault, among other functions, as well as other inputs from the user to the generator by way of the inactive switch pedal. In embodiments where the foot switch 120 comprises more than two pedals, any two of the multiple pedals may be configured in accordance with the above functionality.
In one embodiment, during electrosurgical foot switch 120 activation mode when an electrosurgical or RF surgical device 106 (
In one embodiment, during electrosurgical foot switch 120 activation mode when an electrosurgical or RF surgical device 106 (
As previously discussed, according to various embodiments, the generator 102 may implement a user interface in conjunction with the algorithm 1452 described in connection with
Accordingly, in one embodiment, the algorithm 1452 may be implemented to control the operation of the electrosurgery/RF generator module 110 to control the electrosurgical or RF surgical device 106 (
Accordingly, turning now to
A second audio tone (Audio Tone-II) is emitted when the tissue impedance threshold is reached. In one embodiment, the second tone is emitted, for example, upon the electrosurgery/RF generator module 110 of the generator 102 entering the third region 1482. In one aspect, the second tone may be latched such that if a transition occurs from the third region 1482 to the second region 1480, the second tone is continued to be emitted.
A third audio tone (Audio Tone-III) is emitted when the electrosurgical (RF) power delivery cycle is complete. In one embodiment, when the generator 102 DSP software and/or logic determines that a “cycle complete” status has been reached, the third tone is emitted upon completion of a fourth energy pulse in the fourth region 1484.
Still with reference to
It will be appreciated that the previously described sequence of tones, first, second, and third audio tones, may be applied to indicate energy delivery to tissue when the generator 102 is configured to operate in ultrasonic mode using the ultrasonic generator module 108. For example, the first audio tone (Audio Tone-I) is emitted when the ultrasonic energy delivery cycle begins, the second audio tone (Audio Tone-II) is emitted when the tissue impedance threshold is reached, and the third audio tone (Audio Tone-III) is emitted when the ultrasonic energy delivery cycle is complete.
In various embodiments, a control circuit of a surgical device is provided. In one embodiment, the control circuit comprises a first circuit portion is coupled to at least one switch operable between an open state and a closed state. The first circuit portion communicates with a surgical generator over a conductor pair to receive a control signal from input terminals to determine a state of the at least one switch. The control signal having a first phase and a second phase. A first transistor coupled between the input terminals, a first capacitor, and a first resistor coupled in series with the first capacitor. During the first phase of the control signal the first transistor is held in cutoff mode while the first capacitor charges to a predetermined voltage and during at initial portion of the second phase of the control signal the first transistor transitions from cutoff mode to saturation mode and is held in saturation mode until the first capacitor discharges through the first resistor. During a final portion of the second phase of the control signal the first transistor transitions from saturation mode to cutoff mode when the first capacitor voltage drops below a predetermined threshold. In one embodiment, during the initial portion of the second phase of the control signal while the first transistor is in saturation mode, a first impedance is presented between the input terminals and during the final portion of the second phase of the control signal while the first transistor is in cutoff mode, a second impedance is presented between the input terminals, where the state of the at least one switch is determinable based on the first and second impedance values. In one embodiment, the control circuit comprises at least one second resistor coupled to the at least one switch, where the second impedance is based at least in part on the at least one second resistor when the at least one switch is in the open state. In one embodiment, the control circuit comprises at least one second resistor coupled to the at least one switch, where the second impedance is based at least in part on the at least one second resistor when the at least one switch is in the closed state. In one embodiment, the control circuit comprises a second transistor coupled to the first capacitor to charge the first capacitor during the first phase of the control signal. In one embodiment, the control circuit comprises a second circuit portion comprising a data circuit element coupled to the first circuit portion, wherein the first capacitor voltage is sufficient to supply voltage to the data element. In one embodiment, the control circuit comprises a voltage reference coupled in parallel to the at least one switch. In one embodiment, the control circuit comprises a second capacitor coupled to the voltage reference, where the state of the at least one switch is determinable based on a slope of the voltage on the second capacitor. In one embodiment, the first phase of the control signal is a positive transition of a current pulse and the second phase of the control signal is a negative transition of a current pulse.
In various embodiments, a method is provided. In one embodiment, the method comprises receiving a control signal at a control circuit of a surgical device and determining the state of the at least one switch based on the value of the resistor. The control circuit comprises a first circuit portion coupled to at least one switch operable between an open state and a closed state, the first circuit portion to communicate with a surgical generator over a conductor pair to receive the control signal, the first circuit portion comprising at least one resistor coupled to the at least one switch. In one embodiment, the method comprises presenting a first impedance during a first phase of the control signal and presenting a second impedance during a second phase of the control signal based on the state of the at least one switch, where determining the state of the at least one switch comprises comparing the first impedance to the second impedance. In one embodiment, the method comprises generating a first voltage slope during a first phase of the control signal and generating a second voltage slope during a second phase of the control signal, where determining the state of the at least one switch comprises comparing the first voltage slope to the second voltage slope. In one embodiment, the method comprises generating a first frequency during a first phase of the control signal and generating a second frequency during a second phase of the control signal, where determining the state of the at least one switch comprises comparing the first frequency to the second frequency. In one embodiment, the method comprises reading a value of the least one resistor by a one-wire multi-switch input device coupled to the at least one switch and communicating the value of the at least one resistor to the generator over a one-wire communication protocol.
The control circuits disclosed in connection with
The configuration and detection methodology of each of the control circuits described in connection with
The various embodiments of the control circuits described in connection with
Depending on the open or closed state of each of the switches SW1, SW2, SWn, for example, the signal conditioning circuit 202 (e.g., from generator terminals HS and SR shown in
The interrogation signal may be coupled across the inputs HS/SR of the control circuit 1602 and applied across both branches of switches SW1, SW2. When both SW1 and SW2 are open, the control circuit 280 may define an open circuit corresponding to a first state. When SW1 is open and SW2 is closed, the interrogation signal may define a second state. When SW1 is closed and SW2 is open, the interrogation signal may define a third state. When both SW1 and SW2 are closed, the interrogation signal may define a fourth state. Accordingly, based on the different characteristics of the interrogation signal corresponding to the different states of SW1 and SW2, the state or configuration of the control circuit 280 may be discerned by the generator 102 based on a voltage signal appearing across the inputs of the control circuit 280 (e.g., as measured by an ADC of the signal conditioning circuit 202).
Still referring to
Diode D2 is provided for unidirectional routing of negative current pulses to the resistor network R1, R2, R3, and Rn+1 configured by the switches SW1, SW2, SWn. In the illustrated embodiment, diode D2 is a single Schottky diode to provide a low voltage drop and minimize impact to the usable voltage range to the ADC of the generator 102. Diode D2 may be provided in discrete form, as part of a multi-diode package, or may be formed as part of a custom integrated circuit (e.g., and ASIC). In other embodiments, other suitable diodes may be employed without limitation. During the positive phase (rising edge) of the current pulse, diode D2 is reverse biased and current flows through transistor M1, which charges gate capacitor C2 through diode D3. During the negative phase (falling edge) of the current pulse, diode D2 is forward biased and the ADC of the generator 102 sees the impedance of the resistor network R1, R2, R3, and Rn+1 configured by the switches SW1, SW2, SWn. In other embodiments, a pair of diodes may be employed for bidirectional power as shown in connection with
Transistor M1 is provided to route a positive current pulse from the generator 102 to gate capacitor C2. In the illustrated embodiment, transistor M1 is a p-channel MOSFET, although in other embodiments, any suitable transistor may be employed, without limitation. In the illustrated embodiment, the drain terminal of transistor M1 is connected to the HS input terminal and to the cathodes of diodes D1, D2 and the gate terminal is connected to the SR input terminal of the surgical device 1600. The source of transistor M1 is connected to the SR input terminal through resistor R5. A positive current pulse, as described in more detail with reference to
In one embodiment, the at least one memory device 1604 may comprise, for example, one or more one-wire EEPROM(s), known under the trade name “1-Wire.” As previously discussed, the one-wire EEPROM is a one-wire memory device 1604. Generally, multiple EEPROMs may be employed in the control circuit 1602. In the illustrated embodiment, up to two EEPROMs may be used in the surgical device 1600. The EEPROM(s) are powered during the positive phase of the current pulse. Transistor M1 also provides low forward voltage drop and minimizes impact to the EEPROM high speed communications. Transistor M1 provides reverse blocking capabilities, which cannot be realized with a simple diode.
A second transistor M2 provides a substantial low impedance path to short out the resistor network R1, R2, R3, Rn+1 in order for the ADC to make an initial reference measurement. The drain terminal of transistor M2 is connected to the anode of diode D2 and one end of resistors R1, R2, R3, and Rn+1. The source terminal of transistor M2 is connected to the SR terminal of the surgical device 1600. In the illustrated embodiment, transistor M2 is also a p-channel MOSFET transistor, although in other embodiments, any suitable transistor can be employed. During a positive phase of the current pulse, transistor M2 turns on and applies a substantial low impedance path across the HS/RS terminals of the surgical device 1600 for a relatively short duration of time as defined by an RC time constant on the gate terminal of transistor M2, where the RC time constant is determined by resistor R4 and gate capacitor C2, each of which is coupled to the gate to transistor M2. Resistor R4 provides a discharge path and timing for the voltage decay of gate capacitor C2. Gate capacitor C2 charges during the positive phase of the current pulse, when transistor M2 is cut off or open circuit. Eventually, the voltage on gate capacitor C2 is sufficient to negatively bias the gate-source and turns on the transistor M2 during the negative phase of the current pulse. A first measurement is then obtained by the ADC of the signal conditioning circuit 202 in the generator 102, which is referred to herein as the “ADC_NEG1” measurement, as shown in
Diode D3 provides a current path during the positive phase of the current pulse and enables gate capacitor C2 to charge quickly while bypassing resistor R4, which provides the discharge path for gate capacitor C2. In one embodiment, transistor M2 may be selected due to a well defined minimum and maximum gate threshold to provide better characterization of ON/OFF timing for the differential measurement. In one embodiment, transistor M2 component may be provided as a stand alone discrete component or in the same package as transistor M1. Resistor R4 may be selected based on the 1% tolerance, 100 ppm temperature coefficient, and small package size. The identified component selection criterion is provided merely as a non-limiting example. Any suitable component may be substituted to perform the desired functionality.
As previously discussed, resistor network R1, R2, R3, and Rn+1 is configured by the switches SW1, SW2, SWn to present a different resistance (e.g., impedance) to the ADC of the generator 102. Resistor R1 sets the maximum resistance used for switch detection, e.g., when all switches SW1, SW2, SWn are open (“off”). When SW1 is closed (“on”), resistor R2 is located in parallel with the other switch detection resistors, as shown in Table 8, for example. When SW2 is closed (“on”), resistor R3 is located in parallel with other switch detection resistors, as shown in Table 8, for example. Each of the resistors R1, R2, R3, Rn+1 can be selected based on a 1% tolerance, 100 ppm temperature coefficient, and small package size, without limitation. Capacitor C1 may be located in parallel with the resistors R1, R2, R3, and Rn+1 to provide high frequency filtering from conducted and/or radiated noise, for example. In one embodiment, capacitor C1 may be a ceramic capacitor, without excluding other capacitor types.
Resistor R5 provides a relatively low impedance path to rapidly turn on transistor M2 during the start of the negative phase of the current pulse. Gate capacitor C2 charges in conjunction with resistor R4 to increases the gate voltage above the turn on threshold of transistor M2 for a short duration. The value of resistor R5 also may be selected to provide a sufficient supply voltage to the one or more EEPROM(s) during the positive phase of the current pulse.
It will be appreciated that although the current pulse is characterized as having a first phase that is a positive transition and a second phase is a negative transition, the scope of the present disclosure includes embodiments where the current pulse is characterized as having the opposite polarity. For example, the current pulse can be characterized as having a first phase that is a negative transition and a second phase is a positive transition. It will also be appreciated that the selection of the components of any of the control circuits disclosed herein can be suitably adapted and configured to operate using a current pulse characterized as having a first phase that is a negative transition and a second phase is a positive transition. Also, although the present disclosure describes the control signal as a differential current pulse, the scope of the present disclosure includes embodiments where the control signal is characterized as a voltage pulse. Accordingly, the disclosed embodiments of the control circuits are not limited in the context of the differential current pulse described in connection with
With reference now to both
With reference back to
In one embodiment, the control circuit 1702 may be connected to the generator 102 to receive an interrogation signal (e.g., a bipolar interrogation signal at a predetermined frequency, such as 2 kHz, for example) from the signal conditioning circuit 202 (e.g., from generator terminals HS and SR shown in
As shown in
In one embodiment, the control circuit 1802 may be connected to the generator 102 to receive an interrogation signal (e.g., a bipolar interrogation signal at a predetermined frequency, such as 2 kHz, for example) from the signal conditioning circuit 202 (e.g., from generator terminals HS and SR shown in
In one embodiment, the control circuit 1802 employs a series variable resistance configurable by up to n pushbutton switches SW1, SW2, SWn. Both positive and negative current pulses can be used to derive a measurement that will allow for compensation of an unknown series cable and contamination resistance within a given range. Initially a positive phase of a current pulse reverse biases diode D2 and forward biases diode D4 to charge gate capacitor C2 through diode D3. During a subsequent negative phase of the current pulse, diode D2 is forward biased and diode D4 is reversed biased. Accordingly, diode D2 now couples series resistors R1, R2, R3, Rn+1, in a configuration determined by the state of pushbutton switches SW1, SW2, SWn, to the external ADC in the generator 102. During the first portion of the negative phase of the current pulse, transistor M2 is in saturation mode due to the voltage on charged gate capacitor C2, thus creating a very low impedance path through the surgical device 1800. After a time period defined by the time constant set by resistor R4 and C2, gate capacitor C2 discharges and the FET channel of transistor M2 opens to steer the total current through the series resistors path defined by resistors R1, R2, R3, Rn+1, in a configuration determined by the state of pushbutton switches SW1, SW2, SWn. The initial shorted state of transistor M2 and the subsequent impedance state of the series resistor path are the only two impedance states in the time domain that are used for detecting the state of pushbutton switches SW1, SW2, SWn. This provides the ability to compensate for an external path resistance (handpiece contacts, cabling, connector resistance) by comparing the difference between these two states. The detection region is similar to that shown in
Depending on the open or closed state of switches SW1, SW2, SWn for example, the signal conditioning circuit 202 (e.g., from generator terminals HS and SR shown in
The dual protection diodes D1 and D5 placed across the HS/RS terminals of the control circuit 1802 are used to clamp ESD and/or transients coming from the surgical device 1800 and the generator 102 when the surgical device 1800 is connected and disconnected to the generator 102.
In one embodiment, the control circuit 1902 may be connected to the generator 102 to receive an interrogation signal (e.g., a bipolar interrogation signal at a predetermined frequency, such as 2 kHz, for example) from the signal conditioning circuit 202 (e.g., from generator terminals HS and SR shown in
In one embodiment, the control circuit 1902 employs a series variable resistance configurable by up to n pushbutton switches SW1, SW2, SWn. The control circuit 1902 in
Depending on the open or closed state of switches SW1, SW2, SWn for example, the signal conditioning circuit 202 (e.g., from generator terminals HS and SR shown in
In one embodiment, the control circuit 2002 may be connected to the generator 102 to receive an interrogation signal (e.g., a bipolar interrogation signal at a predetermined frequency, such as 2 kHz, for example) from the signal conditioning circuit 202 (e.g., from generator terminals HS and SR shown in
The switched resistance configuration control circuit 2002 employs variable pulse frequency to determine the states of pushbutton switches SW1, SW2, SWn. The control circuit 2002 utilizes both pulse polarities to detect up to 2n unique switch combinations and also supports communication to one or more memory devices 2004, 2006, such as, for example, two one-wire EEPROM(s). The use of variable frequency allows the detection method employed by the control circuit 2002 to be independent of external variable series resistance. A Schmitt trigger circuit 2008 is configured as an RC oscillator, where the frequency of oscillation is determined by the RC time constant set by the pushbutton switch configured resistors R1, R2, R3, Rn+1 and capacitor C3. An initial negative current pulse charges bulk capacitor C4 to be used as a power supply in order to freewheel between current source pulses. Then the current source generator is configured for zero current during frequency measurement. The output pulses are capacitive coupled by C5 back to the generator comparator. From here the oscillator frequency can be processed to determine the states of the switches SW1, SW2, SWn.
Depending on the open or closed state of switches SW1, SW2, SWn for example, the signal conditioning circuit 202 (e.g., from generator terminals HS and SR shown in
In one embodiment, the control circuit 2102 may be connected to the generator 102 to receive an interrogation signal (e.g., a bipolar interrogation signal at a predetermined frequency, such as 2 kHz, for example) from the signal conditioning circuit 202 (e.g., from generator terminals HS and SR shown in
The control circuit 2102 employs a variable slope waveform to determine the states of pushbutton switches SW1, SW2, SWn. A constant current pulse source drives a current into a capacitive load, e.g., capacitor C6 to generate a slope dependent on the capacitance value of capacitor C6. Using a shunt regulator D6 and charged capacitor combination creates an active circuit that varies the slope by varying the switch configurable resistance R1, R2, R3, Rn+1 rather than varying the capacitance C6. Each pushbutton switch SW1, SW2, SWn state creates a unique ramp slope as shown in
Depending on the open or closed state of switches SW1, SW2, SWn for example, the signal conditioning circuit 202 (e.g., from generator terminals HS and SR shown in
In one embodiment, the control circuit 2202 may be connected to the generator 102 to receive an interrogation signal (e.g., a bipolar interrogation signal at a predetermined frequency, such as 2 kHz, for example) from the signal conditioning circuit 202 (e.g., from generator terminals HS and SR shown in
In one embodiment, the one-wire multi-switch input device of the control circuit 2202 employs a one-wire port expansion device 2204 such as a Maxim DS2408 8-channel, programmable I/O one-wire integrated circuit available from Maxim Integrated Products, Inc., Sunnyvale, Calif., or equivalents thereof, known under the trade name “1-Wire.” The port expansion device 2204 may be powered from the negative current pulse of the generator 102. The port expansion device 2204 complies with the one-wire communication protocol to accommodate up to eight switch inputs 2208. The port expansion device 2204 outputs are configured as open-drain and provide an on resistance of 100Ω max. A robust channel-access communication protocol ensures that the output-setting changes occur error-free. A data-valid strobe output can be used to latch port expansion device 2204 logic states into external circuitry such as a D/A converter (DAC) or microcontroller data bus. The port expansion device 2204 selects one of eight switches SW1-SW8 to select one of eight corresponding resistors 1-8 in resistor bank 2210. In one embodiment, for example, a detection method comprises reading any one of switches SW1-SW8 state using the one-wire communication protocol of the control circuit 2202 utilizing the same software functionality used to read the surgical device 2200 EEPROMs. In other embodiments, the control circuit 2202 can be expanded to read additional switch inputs. In one embodiment, cyclic redundancy code (CRC) error checking may be employed to eliminate or minimize uncertainty of switch states. It may be possible that one-wire communications may be susceptible to activation noise from other electrosurgical instruments, accordingly, compensation circuits and techniques to minimize interference from such electrosurgical instruments are contemplated within this disclosure.
Although the various embodiments of the devices have been described herein in connection with certain disclosed embodiments, many modifications and variations to those embodiments may be implemented. For example, different types of end effectors may be employed. Also, where materials are disclosed for certain components, other materials may be used. The foregoing description and following claims are intended to cover all such modification and variations.
Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.
This application is a divisional of U.S. patent application Ser. No. 13/448,175 entitled SURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, filed Apr. 16, 2012, which issued on Oct. 27, 2015 as U.S. Pat. No. 9,168,154, which is a continuation-in-part of U.S. patent application Ser. No. 13/251,766 entitled SURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, filed Oct. 3, 2011, now U.S. Patent Application Publication No. 2012-0078139, which is a continuation-in-part of U.S. patent application Ser. No. 12/896,360 entitled SURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, filed Oct. 1, 2010, now U.S. Pat. No. 9,060,775, and which claims the benefit under Title 35, United States Code §119(e), of U.S. Provisional Patent Application Ser. No. 61/250,217 entitled A DUAL BIPOLAR AND ULTRASONIC GENERATOR FOR ELECTRO-SURGICAL INSTRUMENTS, filed Oct. 9, 2009. Each of the applications is hereby incorporated by reference in its entirety. The present application also is related to the following U.S. patent applications, concurrently-filed on Oct. 3, 2011, each of which is incorporated herein by reference in its entirety: (1) U.S. patent application Ser. No. 12/896,351, entitled DEVICES AND TECHNIQUES FOR CUTTING AND COAGULATING TISSUE, now U.S. Patent Application Publication No. 2011/0082486 A1; (2) U.S. patent application Ser. No. 12/896,479, entitled SURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, now U.S. Patent Application Publication No. 2011/0087216 A1; (3) U.S. patent application Ser. No. 12/896,345, entitled SURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, now U.S. Patent Application Publication No. 2011/0087212 A1; (4) U.S. patent application Ser. No. 12/896,384, entitled SURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, now U.S. Patent Application Publication No. 2011/0087213 A1; (5) U.S. patent application Ser. No. 12/896,467, entitled SURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, now U.S. Patent Application Publication No. 2011/0087215 A1; (6) U.S. patent application Ser. No. 12/896,451, entitled SURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, now U.S. Patent Application Publication No. 2011/0087214 A1; and (7) U.S. patent application Ser. No. 12/896,470, entitled SURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, now U.S. Patent Application Publication No. 2011/0087217 A1.
| Number | Name | Date | Kind |
|---|---|---|---|
| 969528 | Disbrow | Sep 1910 | A |
| 1570025 | Young | Jan 1926 | A |
| 1813902 | Bovie | Jul 1931 | A |
| 2188497 | Calva | Jan 1940 | A |
| 2425245 | Johnson | Aug 1947 | A |
| 2442966 | Wallace | Jun 1948 | A |
| 2597564 | Bugg | May 1952 | A |
| 2704333 | Calosi et al. | Mar 1955 | A |
| 2736960 | Armstrong | Mar 1956 | A |
| 2748967 | Roach | Jun 1956 | A |
| 2845072 | Shafer | Jul 1958 | A |
| 2849788 | Creek | Sep 1958 | A |
| 2874470 | Richards | Feb 1959 | A |
| 2990616 | Balamuth et al. | Jul 1961 | A |
| RE25033 | Balamuth et al. | Aug 1961 | E |
| 3015961 | Roney | Jan 1962 | A |
| 3033407 | Alfons | May 1962 | A |
| 3053124 | Balamuth et al. | Sep 1962 | A |
| 3082805 | Royce | Mar 1963 | A |
| 3432691 | Shoh | Mar 1969 | A |
| 3433226 | Boyd | Mar 1969 | A |
| 3489930 | Shoh | Jan 1970 | A |
| 3513848 | Winston et al. | May 1970 | A |
| 3514856 | Camp et al. | Jun 1970 | A |
| 3526219 | Balamuth | Sep 1970 | A |
| 3554198 | Tatoian et al. | Jan 1971 | A |
| 3606682 | Camp et al. | Sep 1971 | A |
| 3614484 | Shoh | Oct 1971 | A |
| 3616375 | Inoue | Oct 1971 | A |
| 3629726 | Popescu | Dec 1971 | A |
| 3636943 | Balamuth | Jan 1972 | A |
| 3668486 | Silver | Jun 1972 | A |
| 3702948 | Balamuth | Nov 1972 | A |
| 3776238 | Peyman et al. | Dec 1973 | A |
| 3805787 | Banko | Apr 1974 | A |
| 3809977 | Balamuth et al. | May 1974 | A |
| 3830098 | Antonevich | Aug 1974 | A |
| 3854737 | Gilliam, Sr. | Dec 1974 | A |
| 3862630 | Balamuth | Jan 1975 | A |
| 3875945 | Friedman | Apr 1975 | A |
| 3885438 | Harris, Sr. et al. | May 1975 | A |
| 3900823 | Sokal et al. | Aug 1975 | A |
| 3918442 | Nikolaev et al. | Nov 1975 | A |
| 3924335 | Balamuth et al. | Dec 1975 | A |
| 3946738 | Newton et al. | Mar 1976 | A |
| 3955859 | Stella et al. | May 1976 | A |
| 3956826 | Perdreaux, Jr. | May 1976 | A |
| 4012647 | Balamuth et al. | Mar 1977 | A |
| 4074719 | Semm | Feb 1978 | A |
| 4156187 | Murry et al. | May 1979 | A |
| 4167944 | Banko | Sep 1979 | A |
| 4188927 | Harris | Feb 1980 | A |
| 4200106 | Douvas et al. | Apr 1980 | A |
| 4203444 | Bonnell et al. | May 1980 | A |
| 4300083 | Heiges | Nov 1981 | A |
| 4302728 | Nakamura | Nov 1981 | A |
| 4306570 | Matthews | Dec 1981 | A |
| 4445063 | Smith | Apr 1984 | A |
| 4491132 | Aikins | Jan 1985 | A |
| 4494759 | Kieffer | Jan 1985 | A |
| 4504264 | Kelman | Mar 1985 | A |
| 4512344 | Barber | Apr 1985 | A |
| 4526571 | Wuchinich | Jul 1985 | A |
| 4545374 | Jacobson | Oct 1985 | A |
| 4574615 | Bower et al. | Mar 1986 | A |
| 4617927 | Manes | Oct 1986 | A |
| 4633119 | Thompson | Dec 1986 | A |
| 4634420 | Spinosa et al. | Jan 1987 | A |
| 4640279 | Beard | Feb 1987 | A |
| 4641053 | Takeda | Feb 1987 | A |
| 4646738 | Trott | Mar 1987 | A |
| 4646756 | Watmough et al. | Mar 1987 | A |
| 4649919 | Thimsen et al. | Mar 1987 | A |
| 4662068 | Polonsky | May 1987 | A |
| 4674502 | Imonti | Jun 1987 | A |
| 4708127 | Abdelghani | Nov 1987 | A |
| 4712722 | Hood et al. | Dec 1987 | A |
| 4808154 | Freeman | Feb 1989 | A |
| 4819635 | Shapiro | Apr 1989 | A |
| 4827911 | Broadwin et al. | May 1989 | A |
| 4832683 | Idemoto et al. | May 1989 | A |
| 4836186 | Scholz | Jun 1989 | A |
| 4838853 | Parisi | Jun 1989 | A |
| 4844064 | Thimsen et al. | Jul 1989 | A |
| 4850354 | McGurk-Burleson et al. | Jul 1989 | A |
| 4852578 | Companion et al. | Aug 1989 | A |
| 4865159 | Jamison | Sep 1989 | A |
| 4867157 | McGurk-Burleson et al. | Sep 1989 | A |
| 4878493 | Pasternak et al. | Nov 1989 | A |
| 4881550 | Kothe | Nov 1989 | A |
| 4896009 | Pawlowski | Jan 1990 | A |
| 4903696 | Stasz et al. | Feb 1990 | A |
| 4915643 | Samejima et al. | Apr 1990 | A |
| 4922902 | Wuchinich et al. | May 1990 | A |
| 4965532 | Sakurai | Oct 1990 | A |
| 4979952 | Kubota et al. | Dec 1990 | A |
| 4981756 | Rhandhawa | Jan 1991 | A |
| 5013956 | Kurozumi et al. | May 1991 | A |
| 5015227 | Broadwin et al. | May 1991 | A |
| 5026370 | Lottick | Jun 1991 | A |
| 5026387 | Thomas | Jun 1991 | A |
| 5035695 | Weber, Jr. et al. | Jul 1991 | A |
| 5042707 | Taheri | Aug 1991 | A |
| 5084052 | Jacobs | Jan 1992 | A |
| 5105117 | Yamaguchi | Apr 1992 | A |
| 5109819 | Custer et al. | May 1992 | A |
| 5112300 | Ureche | May 1992 | A |
| 5123903 | Quaid et al. | Jun 1992 | A |
| 5126618 | Takahashi et al. | Jun 1992 | A |
| D327872 | McMills et al. | Jul 1992 | S |
| 5152762 | McElhenney | Oct 1992 | A |
| 5162044 | Gahn et al. | Nov 1992 | A |
| 5163421 | Bernstein et al. | Nov 1992 | A |
| 5163537 | Radev | Nov 1992 | A |
| 5167725 | Clark et al. | Dec 1992 | A |
| 5172344 | Ehrlich | Dec 1992 | A |
| 5174276 | Crockard | Dec 1992 | A |
| D332660 | Rawson et al. | Jan 1993 | S |
| 5176677 | Wuchinich | Jan 1993 | A |
| 5176695 | Dulebohn | Jan 1993 | A |
| 5184605 | Grezeszykowski | Feb 1993 | A |
| 5188102 | Idemoto et al. | Feb 1993 | A |
| D334173 | Liu et al. | Mar 1993 | S |
| 5209719 | Baruch et al. | May 1993 | A |
| 5213569 | Davis | May 1993 | A |
| 5214339 | Naito | May 1993 | A |
| 5218529 | Meyer et al. | Jun 1993 | A |
| 5221282 | Wuchinich | Jun 1993 | A |
| 5222937 | Kagawa | Jun 1993 | A |
| 5226909 | Evans et al. | Jul 1993 | A |
| 5226910 | Kajiyama et al. | Jul 1993 | A |
| 5241236 | Sasaki et al. | Aug 1993 | A |
| 5241968 | Slater | Sep 1993 | A |
| 5242460 | Klein et al. | Sep 1993 | A |
| 5254129 | Alexander | Oct 1993 | A |
| 5257988 | L'Esperance, Jr. | Nov 1993 | A |
| 5261922 | Hood | Nov 1993 | A |
| 5263957 | Davison | Nov 1993 | A |
| 5264925 | Shipp et al. | Nov 1993 | A |
| 5275166 | Vaitekunas et al. | Jan 1994 | A |
| 5275607 | Lo et al. | Jan 1994 | A |
| 5275609 | Pingleton et al. | Jan 1994 | A |
| 5282800 | Foshee et al. | Feb 1994 | A |
| 5282817 | Hoogeboom et al. | Feb 1994 | A |
| 5285795 | Ryan et al. | Feb 1994 | A |
| 5300068 | Rosar et al. | Apr 1994 | A |
| 5304115 | Pflueger et al. | Apr 1994 | A |
| D347474 | Olson | May 1994 | S |
| 5307976 | Olson et al. | May 1994 | A |
| 5312023 | Green et al. | May 1994 | A |
| 5312425 | Evans et al. | May 1994 | A |
| 5322055 | Davison et al. | Jun 1994 | A |
| 5324299 | Davison et al. | Jun 1994 | A |
| 5326013 | Green et al. | Jul 1994 | A |
| 5326342 | Pflueger et al. | Jul 1994 | A |
| 5344420 | Hilal et al. | Sep 1994 | A |
| 5345937 | Middleman et al. | Sep 1994 | A |
| 5346502 | Estabrook et al. | Sep 1994 | A |
| 5353474 | Good et al. | Oct 1994 | A |
| 5357164 | Imabayashi et al. | Oct 1994 | A |
| 5357423 | Weaver et al. | Oct 1994 | A |
| 5359994 | Krauter et al. | Nov 1994 | A |
| 5366466 | Christian et al. | Nov 1994 | A |
| 5368557 | Nita et al. | Nov 1994 | A |
| 5370645 | Klicek et al. | Dec 1994 | A |
| 5371429 | Manna | Dec 1994 | A |
| 5374813 | Shipp | Dec 1994 | A |
| D354564 | Medema | Jan 1995 | S |
| 5381067 | Greenstein et al. | Jan 1995 | A |
| 5387215 | Fisher | Feb 1995 | A |
| 5389098 | Tsuruta et al. | Feb 1995 | A |
| 5394187 | Shipp | Feb 1995 | A |
| 5396266 | Brimhall | Mar 1995 | A |
| 5403312 | Yates et al. | Apr 1995 | A |
| 5403334 | Evans et al. | Apr 1995 | A |
| 5408268 | Shipp | Apr 1995 | A |
| D358887 | Feinberg | May 1995 | S |
| 5411481 | Allen et al. | May 1995 | A |
| 5419761 | Narayanan et al. | May 1995 | A |
| 5421829 | Olichney et al. | Jun 1995 | A |
| 5423844 | Miller | Jun 1995 | A |
| 5438997 | Sieben et al. | Aug 1995 | A |
| 5445639 | Kuslich et al. | Aug 1995 | A |
| 5449370 | Vaitekunas | Sep 1995 | A |
| 5451220 | Ciervo | Sep 1995 | A |
| 5456684 | Schmidt et al. | Oct 1995 | A |
| 5471988 | Fujio et al. | Dec 1995 | A |
| 5472443 | Cordis et al. | Dec 1995 | A |
| 5478003 | Green et al. | Dec 1995 | A |
| 5483501 | Park et al. | Jan 1996 | A |
| 5486162 | Brumbach | Jan 1996 | A |
| 5490860 | Middle et al. | Feb 1996 | A |
| 5500216 | Julian et al. | Mar 1996 | A |
| 5501654 | Failla et al. | Mar 1996 | A |
| 5505693 | Mackool | Apr 1996 | A |
| 5507738 | Ciervo | Apr 1996 | A |
| 5527331 | Kresch et al. | Jun 1996 | A |
| 5540693 | Fisher | Jul 1996 | A |
| 5553675 | Pitzen et al. | Sep 1996 | A |
| 5558671 | Yates | Sep 1996 | A |
| 5562609 | Brumbach | Oct 1996 | A |
| 5562610 | Brumbach | Oct 1996 | A |
| 5562659 | Morris | Oct 1996 | A |
| 5573424 | Poppe | Nov 1996 | A |
| 5577654 | Bishop | Nov 1996 | A |
| 5591187 | Dekel | Jan 1997 | A |
| 5593414 | Shipp et al. | Jan 1997 | A |
| 5601601 | Tal et al. | Feb 1997 | A |
| 5603773 | Campbell | Feb 1997 | A |
| 5607436 | Pratt et al. | Mar 1997 | A |
| 5609573 | Sandock | Mar 1997 | A |
| 5618304 | Hart et al. | Apr 1997 | A |
| 5618492 | Auten et al. | Apr 1997 | A |
| 5620447 | Smith et al. | Apr 1997 | A |
| 5626587 | Bishop et al. | May 1997 | A |
| 5626595 | Sklar et al. | May 1997 | A |
| 5628760 | Knoepfler | May 1997 | A |
| 5630420 | Vaitekunas | May 1997 | A |
| 5632717 | Yoon | May 1997 | A |
| 5640741 | Yano | Jun 1997 | A |
| D381077 | Hunt | Jul 1997 | S |
| 5649937 | Bito | Jul 1997 | A |
| 5651780 | Jackson et al. | Jul 1997 | A |
| 5653713 | Michelson | Aug 1997 | A |
| 5662662 | Bishop et al. | Sep 1997 | A |
| 5669922 | Hood | Sep 1997 | A |
| 5674235 | Parisi | Oct 1997 | A |
| 5678568 | Uchikubo et al. | Oct 1997 | A |
| 5690269 | Bolanos et al. | Nov 1997 | A |
| 5694936 | Fujimoto et al. | Dec 1997 | A |
| 5695510 | Hood | Dec 1997 | A |
| 5700261 | Brinkerhoff | Dec 1997 | A |
| 5704534 | Huitema et al. | Jan 1998 | A |
| 5709680 | Yates et al. | Jan 1998 | A |
| 5711472 | Bryan | Jan 1998 | A |
| 5713896 | Nardella | Feb 1998 | A |
| 5715817 | Stevens-Wright et al. | Feb 1998 | A |
| 5717306 | Shipp | Feb 1998 | A |
| 5728130 | Ishikawa et al. | Mar 1998 | A |
| 5730752 | Alden et al. | Mar 1998 | A |
| 5733074 | Stöck et al. | Mar 1998 | A |
| 5741226 | Strukel et al. | Apr 1998 | A |
| 5766164 | Mueller et al. | Jun 1998 | A |
| 5772659 | Becker et al. | Jun 1998 | A |
| 5792135 | Madhani et al. | Aug 1998 | A |
| 5792138 | Shipp | Aug 1998 | A |
| 5792165 | Klieman et al. | Aug 1998 | A |
| 5797959 | Castro et al. | Aug 1998 | A |
| 5805140 | Rosenberg et al. | Sep 1998 | A |
| 5808396 | Boukhny | Sep 1998 | A |
| 5810859 | DiMatteo et al. | Sep 1998 | A |
| 5817084 | Jensen | Oct 1998 | A |
| 5817119 | Klieman et al. | Oct 1998 | A |
| 5823197 | Edwards | Oct 1998 | A |
| 5827323 | Klieman et al. | Oct 1998 | A |
| 5828160 | Sugishita | Oct 1998 | A |
| 5833696 | Whitfield et al. | Nov 1998 | A |
| 5836897 | Sakurai et al. | Nov 1998 | A |
| 5836957 | Schulz et al. | Nov 1998 | A |
| 5843109 | Mehta et al. | Dec 1998 | A |
| 5851212 | Zirps et al. | Dec 1998 | A |
| 5858018 | Shipp et al. | Jan 1999 | A |
| 5865361 | Milliman et al. | Feb 1999 | A |
| 5873873 | Smith et al. | Feb 1999 | A |
| 5873882 | Straub et al. | Feb 1999 | A |
| 5878193 | Wang et al. | Mar 1999 | A |
| 5879364 | Bromfield et al. | Mar 1999 | A |
| 5883615 | Fago et al. | Mar 1999 | A |
| 5893835 | Witt et al. | Apr 1999 | A |
| 5897523 | Wright et al. | Apr 1999 | A |
| 5897569 | Kellogg et al. | Apr 1999 | A |
| 5903607 | Tailliet | May 1999 | A |
| 5904681 | West, Jr. | May 1999 | A |
| 5906627 | Spaulding | May 1999 | A |
| 5906628 | Miyawaki et al. | May 1999 | A |
| 5911699 | Anis et al. | Jun 1999 | A |
| 5916229 | Evans | Jun 1999 | A |
| 5929846 | Rosenberg et al. | Jul 1999 | A |
| 5935143 | Hood | Aug 1999 | A |
| 5935144 | Estabrook | Aug 1999 | A |
| 5938633 | Beaupre | Aug 1999 | A |
| 5944718 | Austin et al. | Aug 1999 | A |
| 5944737 | Tsonton et al. | Aug 1999 | A |
| 5947984 | Whipple | Sep 1999 | A |
| 5954736 | Bishop et al. | Sep 1999 | A |
| 5954746 | Holthaus et al. | Sep 1999 | A |
| 5957882 | Nita et al. | Sep 1999 | A |
| 5957943 | Vaitekunas | Sep 1999 | A |
| 5968007 | Simon et al. | Oct 1999 | A |
| 5968060 | Kellogg | Oct 1999 | A |
| 5974342 | Petrofsky | Oct 1999 | A |
| D416089 | Barton et al. | Nov 1999 | S |
| 5980510 | Tsonton et al. | Nov 1999 | A |
| 5980546 | Hood | Nov 1999 | A |
| 5989274 | Davison et al. | Nov 1999 | A |
| 5989275 | Estabrook et al. | Nov 1999 | A |
| 5993465 | Shipp et al. | Nov 1999 | A |
| 5993972 | Reich et al. | Nov 1999 | A |
| 5994855 | Lundell et al. | Nov 1999 | A |
| 6024741 | Williamson, IV et al. | Feb 2000 | A |
| 6024750 | Mastri et al. | Feb 2000 | A |
| 6027515 | Cimino | Feb 2000 | A |
| 6031526 | Shipp | Feb 2000 | A |
| 6033375 | Brumbach | Mar 2000 | A |
| 6033399 | Gines | Mar 2000 | A |
| 6036667 | Manna et al. | Mar 2000 | A |
| 6036707 | Spaulding | Mar 2000 | A |
| 6048224 | Kay | Apr 2000 | A |
| 6050943 | Slayton et al. | Apr 2000 | A |
| 6051010 | DiMatteo et al. | Apr 2000 | A |
| 6056735 | Okada et al. | May 2000 | A |
| 6063098 | Houser et al. | May 2000 | A |
| 6066132 | Chen et al. | May 2000 | A |
| 6066151 | Miyawaki et al. | May 2000 | A |
| 6068627 | Orszulak et al. | May 2000 | A |
| 6068647 | Witt et al. | May 2000 | A |
| 6077285 | Boukhny | Jun 2000 | A |
| 6083191 | Rose | Jul 2000 | A |
| 6086584 | Miller | Jul 2000 | A |
| 6090120 | Wright et al. | Jul 2000 | A |
| 6096033 | Tu et al. | Aug 2000 | A |
| 6099542 | Cohn et al. | Aug 2000 | A |
| 6109500 | Alli et al. | Aug 2000 | A |
| 6110127 | Suzuki | Aug 2000 | A |
| 6113594 | Savage | Sep 2000 | A |
| 6117152 | Huitema | Sep 2000 | A |
| 6126629 | Perkins | Oct 2000 | A |
| 6129735 | Okada et al. | Oct 2000 | A |
| 6129740 | Michelson | Oct 2000 | A |
| 6132368 | Cooper | Oct 2000 | A |
| 6132427 | Jones et al. | Oct 2000 | A |
| 6132448 | Perez et al. | Oct 2000 | A |
| 6139320 | Hahn | Oct 2000 | A |
| 6139561 | Shibata et al. | Oct 2000 | A |
| 6142615 | Qiu et al. | Nov 2000 | A |
| 6142994 | Swanson et al. | Nov 2000 | A |
| 6147560 | Erhage et al. | Nov 2000 | A |
| 6152902 | Christian et al. | Nov 2000 | A |
| 6154198 | Rosenberg | Nov 2000 | A |
| 6159160 | Hsei et al. | Dec 2000 | A |
| 6159175 | Strukel et al. | Dec 2000 | A |
| 6162194 | Shipp | Dec 2000 | A |
| 6165150 | Banko | Dec 2000 | A |
| 6174310 | Kirwan, Jr. | Jan 2001 | B1 |
| 6179853 | Sachse et al. | Jan 2001 | B1 |
| 6183426 | Akisada et al. | Feb 2001 | B1 |
| 6193709 | Miyawaki et al. | Feb 2001 | B1 |
| 6204592 | Hur | Mar 2001 | B1 |
| 6205855 | Pfeiffer | Mar 2001 | B1 |
| 6206844 | Reichel et al. | Mar 2001 | B1 |
| 6210337 | Dunham et al. | Apr 2001 | B1 |
| 6210402 | Olsen et al. | Apr 2001 | B1 |
| 6210403 | Klicek | Apr 2001 | B1 |
| 6214023 | Whipple et al. | Apr 2001 | B1 |
| 6228080 | Gines | May 2001 | B1 |
| 6231565 | Tovey et al. | May 2001 | B1 |
| 6233476 | Strommer et al. | May 2001 | B1 |
| 6238366 | Savage et al. | May 2001 | B1 |
| 6245065 | Panescu et al. | Jun 2001 | B1 |
| 6252110 | Uemura et al. | Jun 2001 | B1 |
| D444365 | Bass et al. | Jul 2001 | S |
| D445092 | Lee | Jul 2001 | S |
| D445764 | Lee | Jul 2001 | S |
| 6254623 | Haibel, Jr. et al. | Jul 2001 | B1 |
| 6257241 | Wampler | Jul 2001 | B1 |
| 6258034 | Hanafy | Jul 2001 | B1 |
| 6267761 | Ryan | Jul 2001 | B1 |
| 6270831 | Kumar et al. | Aug 2001 | B2 |
| 6273852 | Lehe et al. | Aug 2001 | B1 |
| 6274963 | Estabrook et al. | Aug 2001 | B1 |
| 6277115 | Saadat | Aug 2001 | B1 |
| 6278218 | Madan et al. | Aug 2001 | B1 |
| 6280407 | Manna et al. | Aug 2001 | B1 |
| 6283981 | Beaupre | Sep 2001 | B1 |
| 6287344 | Wampler et al. | Sep 2001 | B1 |
| 6290575 | Shipp | Sep 2001 | B1 |
| 6299591 | Banko | Oct 2001 | B1 |
| 6306131 | Hareyama | Oct 2001 | B1 |
| 6306157 | Shchervinsky | Oct 2001 | B1 |
| 6309400 | Beaupre | Oct 2001 | B2 |
| 6311783 | Harpell | Nov 2001 | B1 |
| 6319221 | Savage et al. | Nov 2001 | B1 |
| 6325795 | Lindemann et al. | Dec 2001 | B1 |
| 6325799 | Goble | Dec 2001 | B1 |
| 6325811 | Messerly | Dec 2001 | B1 |
| 6328751 | Beaupre | Dec 2001 | B1 |
| 6332891 | Himes | Dec 2001 | B1 |
| 6338657 | Harper et al. | Jan 2002 | B1 |
| 6340352 | Okada et al. | Jan 2002 | B1 |
| 6350269 | Shipp et al. | Feb 2002 | B1 |
| 6352532 | Kramer et al. | Mar 2002 | B1 |
| 6358264 | Banko | Mar 2002 | B2 |
| 6364888 | Niemeyer et al. | Apr 2002 | B1 |
| 6379320 | Lafon et al. | Apr 2002 | B1 |
| D457958 | Dycus et al. | May 2002 | S |
| 6383194 | Pothula | May 2002 | B1 |
| 6384690 | Wilhelmsson et al. | May 2002 | B1 |
| 6387109 | Davison et al. | May 2002 | B1 |
| 6388657 | Natoli | May 2002 | B1 |
| 6391042 | Cimino | May 2002 | B1 |
| 6398779 | Buysse et al. | Jun 2002 | B1 |
| 6402743 | Orszulak et al. | Jun 2002 | B1 |
| 6402748 | Schoenman et al. | Jun 2002 | B1 |
| 6405733 | Fogarty et al. | Jun 2002 | B1 |
| 6416486 | Wampler | Jul 2002 | B1 |
| 6423073 | Bowman | Jul 2002 | B2 |
| 6423082 | Houser et al. | Jul 2002 | B1 |
| 6428538 | Blewett et al. | Aug 2002 | B1 |
| 6428539 | Baxter et al. | Aug 2002 | B1 |
| 6432118 | Messerly | Aug 2002 | B1 |
| 6436114 | Novak et al. | Aug 2002 | B1 |
| 6436115 | Beaupre | Aug 2002 | B1 |
| 6440062 | Ouchi | Aug 2002 | B1 |
| 6443968 | Holthaus et al. | Sep 2002 | B1 |
| 6443969 | Novak et al. | Sep 2002 | B1 |
| 6449006 | Shipp | Sep 2002 | B1 |
| 6454781 | Witt et al. | Sep 2002 | B1 |
| 6454782 | Schwemberger | Sep 2002 | B1 |
| 6458142 | Faller et al. | Oct 2002 | B1 |
| 6475215 | Tanrisever | Nov 2002 | B1 |
| 6480796 | Wiener | Nov 2002 | B2 |
| 6485490 | Wampler et al. | Nov 2002 | B2 |
| 6491708 | Madan et al. | Dec 2002 | B2 |
| 6497715 | Satou | Dec 2002 | B2 |
| 6500176 | Truckai et al. | Dec 2002 | B1 |
| 6500188 | Harper et al. | Dec 2002 | B2 |
| 6500312 | Wedekamp | Dec 2002 | B2 |
| 6506208 | Hunt et al. | Jan 2003 | B2 |
| 6511478 | Burnside et al. | Jan 2003 | B1 |
| 6511493 | Moutafis et al. | Jan 2003 | B1 |
| 6514267 | Jewett | Feb 2003 | B2 |
| 6524251 | Rabiner et al. | Feb 2003 | B2 |
| 6524316 | Nicholson et al. | Feb 2003 | B1 |
| 6527736 | Attinger et al. | Mar 2003 | B1 |
| 6533784 | Truckai et al. | Mar 2003 | B2 |
| 6537272 | Christopherson et al. | Mar 2003 | B2 |
| 6537291 | Friedman et al. | Mar 2003 | B2 |
| 6543452 | Lavigne | Apr 2003 | B1 |
| 6543456 | Freeman | Apr 2003 | B1 |
| 6544260 | Markel et al. | Apr 2003 | B1 |
| 6558376 | Bishop | May 2003 | B2 |
| 6561983 | Cronin et al. | May 2003 | B2 |
| 6562035 | Levin | May 2003 | B1 |
| 6565558 | Lindenmeier et al. | May 2003 | B1 |
| 6572563 | Ouchi | Jun 2003 | B2 |
| 6572632 | Zisterer et al. | Jun 2003 | B2 |
| 6575969 | Rittman, III et al. | Jun 2003 | B1 |
| 6582427 | Goble et al. | Jun 2003 | B1 |
| 6582451 | Marucci et al. | Jun 2003 | B1 |
| D477408 | Bromley | Jul 2003 | S |
| 6588277 | Giordano et al. | Jul 2003 | B2 |
| 6589200 | Schwemberger et al. | Jul 2003 | B1 |
| 6589239 | Khandkar et al. | Jul 2003 | B2 |
| 6607540 | Shipp | Aug 2003 | B1 |
| 6610059 | West, Jr. | Aug 2003 | B1 |
| 6616450 | Mossle et al. | Sep 2003 | B2 |
| 6619529 | Green et al. | Sep 2003 | B2 |
| 6623500 | Cook et al. | Sep 2003 | B1 |
| 6623501 | Heller et al. | Sep 2003 | B2 |
| 6626848 | Neuenfeldt | Sep 2003 | B2 |
| 6626926 | Friedman et al. | Sep 2003 | B2 |
| 6629974 | Penny et al. | Oct 2003 | B2 |
| 6633234 | Wiener et al. | Oct 2003 | B2 |
| 6644532 | Green et al. | Nov 2003 | B2 |
| 6651669 | Burnside | Nov 2003 | B1 |
| 6652513 | Panescu et al. | Nov 2003 | B2 |
| 6652539 | Shipp et al. | Nov 2003 | B2 |
| 6652545 | Shipp et al. | Nov 2003 | B2 |
| 6656132 | Ouchi | Dec 2003 | B1 |
| 6656177 | Truckai et al. | Dec 2003 | B2 |
| 6660017 | Beaupre | Dec 2003 | B2 |
| 6662127 | Wiener et al. | Dec 2003 | B2 |
| 6663941 | Brown et al. | Dec 2003 | B2 |
| 6666860 | Takahashi | Dec 2003 | B1 |
| 6666875 | Sakurai et al. | Dec 2003 | B1 |
| 6669690 | Okada et al. | Dec 2003 | B1 |
| 6669710 | Moutafis et al. | Dec 2003 | B2 |
| 6676660 | Wampler et al. | Jan 2004 | B2 |
| 6678621 | Wiener et al. | Jan 2004 | B2 |
| 6679875 | Honda et al. | Jan 2004 | B2 |
| 6679899 | Wiener et al. | Jan 2004 | B2 |
| 6682544 | Mastri et al. | Jan 2004 | B2 |
| 6685701 | Orszulak et al. | Feb 2004 | B2 |
| 6685703 | Pearson et al. | Feb 2004 | B2 |
| 6689145 | Lee et al. | Feb 2004 | B2 |
| 6689146 | Himes | Feb 2004 | B1 |
| 6702821 | Bonutti | Mar 2004 | B2 |
| 6716215 | David et al. | Apr 2004 | B1 |
| 6719692 | Kleffner et al. | Apr 2004 | B2 |
| 6719776 | Baxter et al. | Apr 2004 | B2 |
| 6723091 | Goble et al. | Apr 2004 | B2 |
| D490059 | Conway et al. | May 2004 | S |
| 6731047 | Kauf et al. | May 2004 | B2 |
| 6733506 | McDevitt et al. | May 2004 | B1 |
| 6739872 | Turri | May 2004 | B1 |
| 6740079 | Eggers et al. | May 2004 | B1 |
| D491666 | Kimmell et al. | Jun 2004 | S |
| 6743245 | Lobdell | Jun 2004 | B2 |
| 6746284 | Spink, Jr. | Jun 2004 | B1 |
| 6746443 | Morley et al. | Jun 2004 | B1 |
| 6752815 | Beaupre | Jun 2004 | B2 |
| 6755825 | Shoenman et al. | Jun 2004 | B2 |
| 6761698 | Shibata et al. | Jul 2004 | B2 |
| 6762535 | Take et al. | Jul 2004 | B2 |
| 6770072 | Truckai et al. | Aug 2004 | B1 |
| 6773409 | Truckai et al. | Aug 2004 | B2 |
| 6773443 | Truwit et al. | Aug 2004 | B2 |
| 6773444 | Messerly | Aug 2004 | B2 |
| 6778023 | Christensen | Aug 2004 | B2 |
| 6783524 | Anderson et al. | Aug 2004 | B2 |
| 6786382 | Hoffman | Sep 2004 | B1 |
| 6786383 | Stegelmann | Sep 2004 | B2 |
| 6790173 | Saadat et al. | Sep 2004 | B2 |
| 6790216 | Ishikawa | Sep 2004 | B1 |
| 6796981 | Wham et al. | Sep 2004 | B2 |
| D496997 | Dycus et al. | Oct 2004 | S |
| 6802843 | Truckai et al. | Oct 2004 | B2 |
| 6808525 | Latterell et al. | Oct 2004 | B2 |
| 6809508 | Donofrio | Oct 2004 | B2 |
| 6810281 | Brock et al. | Oct 2004 | B2 |
| 6827712 | Tovey et al. | Dec 2004 | B2 |
| 6828712 | Battaglin et al. | Dec 2004 | B2 |
| 6835082 | Gonnering | Dec 2004 | B2 |
| 6849073 | Hoey et al. | Feb 2005 | B2 |
| 6860878 | Brock | Mar 2005 | B2 |
| 6863676 | Lee et al. | Mar 2005 | B2 |
| 6869439 | White et al. | Mar 2005 | B2 |
| 6875220 | Du et al. | Apr 2005 | B2 |
| 6877647 | Green et al. | Apr 2005 | B2 |
| 6882439 | Ishijima | Apr 2005 | B2 |
| 6887209 | Kadziauskas et al. | May 2005 | B2 |
| 6887252 | Okada et al. | May 2005 | B1 |
| 6899685 | Kermode et al. | May 2005 | B2 |
| 6905497 | Truckai et al. | Jun 2005 | B2 |
| 6908472 | Wiener et al. | Jun 2005 | B2 |
| 6913579 | Truckai et al. | Jul 2005 | B2 |
| 6915623 | Dey et al. | Jul 2005 | B2 |
| 6923804 | Eggers et al. | Aug 2005 | B2 |
| 6926712 | Phan | Aug 2005 | B2 |
| 6926716 | Baker et al. | Aug 2005 | B2 |
| 6929602 | Hirakui et al. | Aug 2005 | B2 |
| 6929632 | Nita et al. | Aug 2005 | B2 |
| 6929644 | Truckai et al. | Aug 2005 | B2 |
| 6933656 | Matsushita et al. | Aug 2005 | B2 |
| D509589 | Wells | Sep 2005 | S |
| 6942660 | Pantera et al. | Sep 2005 | B2 |
| 6942677 | Nita et al. | Sep 2005 | B2 |
| 6945981 | Donofrio et al. | Sep 2005 | B2 |
| 6946779 | Birgel | Sep 2005 | B2 |
| 6948503 | Refior et al. | Sep 2005 | B2 |
| D511145 | Donofrio et al. | Nov 2005 | S |
| 6974450 | Weber et al. | Dec 2005 | B2 |
| 6976844 | Hickok et al. | Dec 2005 | B2 |
| 6976969 | Messerly | Dec 2005 | B2 |
| 6977495 | Donofrio | Dec 2005 | B2 |
| 6979332 | Adams | Dec 2005 | B2 |
| 6981628 | Wales | Jan 2006 | B2 |
| 6984220 | Wuchinich | Jan 2006 | B2 |
| 6988295 | Tillim | Jan 2006 | B2 |
| 6994708 | Manzo | Feb 2006 | B2 |
| 7001335 | Adachi et al. | Feb 2006 | B2 |
| 7011657 | Truckai et al. | Mar 2006 | B2 |
| 7014638 | Michelson | Mar 2006 | B2 |
| 7033357 | Baxter et al. | Apr 2006 | B2 |
| 7037306 | Podany | May 2006 | B2 |
| 7041083 | Chu et al. | May 2006 | B2 |
| 7041088 | Nawrocki et al. | May 2006 | B2 |
| 7041102 | Truckai et al. | May 2006 | B2 |
| 7044949 | Orszulak et al. | May 2006 | B2 |
| 7066893 | Hibner et al. | Jun 2006 | B2 |
| 7066895 | Podany | Jun 2006 | B2 |
| 7070597 | Truckai et al. | Jul 2006 | B2 |
| 7074218 | Washington et al. | Jul 2006 | B2 |
| 7074219 | Levine et al. | Jul 2006 | B2 |
| 7077039 | Gass et al. | Jul 2006 | B2 |
| 7077845 | Hacker et al. | Jul 2006 | B2 |
| 7077853 | Kramer et al. | Jul 2006 | B2 |
| 7083618 | Couture | Aug 2006 | B2 |
| 7083619 | Truckai et al. | Aug 2006 | B2 |
| 7087054 | Truckai et al. | Aug 2006 | B2 |
| 7090672 | Underwood et al. | Aug 2006 | B2 |
| 7101371 | Dycus et al. | Sep 2006 | B2 |
| 7101378 | Salameh et al. | Sep 2006 | B2 |
| 7104834 | Robinson et al. | Sep 2006 | B2 |
| 7108695 | Witt et al. | Sep 2006 | B2 |
| 7111769 | Wales et al. | Sep 2006 | B2 |
| 7112201 | Truckai et al. | Sep 2006 | B2 |
| D531311 | Guerra et al. | Oct 2006 | S |
| 7117034 | Kronberg | Oct 2006 | B2 |
| 7118564 | Ritchie et al. | Oct 2006 | B2 |
| 7124932 | Isaacson et al. | Oct 2006 | B2 |
| 7125409 | Truckai et al. | Oct 2006 | B2 |
| 7128720 | Podany | Oct 2006 | B2 |
| 7131860 | Sartor et al. | Nov 2006 | B2 |
| 7135018 | Ryan et al. | Nov 2006 | B2 |
| 7135030 | Schwemberger et al. | Nov 2006 | B2 |
| 7137980 | Buysse et al. | Nov 2006 | B2 |
| 7144403 | Booth | Dec 2006 | B2 |
| 7153315 | Miller | Dec 2006 | B2 |
| D536093 | Nakajima et al. | Jan 2007 | S |
| 7156189 | Bar-Cohen et al. | Jan 2007 | B1 |
| 7156853 | Muratsu | Jan 2007 | B2 |
| 7157058 | Marhasin et al. | Jan 2007 | B2 |
| 7159750 | Racenet et al. | Jan 2007 | B2 |
| 7160296 | Pearson et al. | Jan 2007 | B2 |
| 7160299 | Baily | Jan 2007 | B2 |
| 7163548 | Stulen et al. | Jan 2007 | B2 |
| 7169144 | Hoey et al. | Jan 2007 | B2 |
| 7169146 | Truckai et al. | Jan 2007 | B2 |
| 7179254 | Pendekanti et al. | Feb 2007 | B2 |
| 7179271 | Friedman et al. | Feb 2007 | B2 |
| 7186253 | Truckai et al. | Mar 2007 | B2 |
| 7189233 | Truckai et al. | Mar 2007 | B2 |
| D541418 | Schechter et al. | Apr 2007 | S |
| 7198635 | Danek et al. | Apr 2007 | B2 |
| 7204820 | Akahoshi | Apr 2007 | B2 |
| 7207997 | Shipp et al. | Apr 2007 | B2 |
| 7210881 | Greenberg | May 2007 | B2 |
| 7211079 | Treat | May 2007 | B2 |
| 7217128 | Atkin et al. | May 2007 | B2 |
| 7217269 | El-Galley et al. | May 2007 | B2 |
| 7220951 | Truckai et al. | May 2007 | B2 |
| 7223229 | Inman et al. | May 2007 | B2 |
| 7229455 | Sakurai et al. | Jun 2007 | B2 |
| 7235071 | Gonnering | Jun 2007 | B2 |
| 7244262 | Wiener et al. | Jul 2007 | B2 |
| 7258688 | Shah et al. | Aug 2007 | B1 |
| 7269873 | Brewer et al. | Sep 2007 | B2 |
| 7273483 | Wiener et al. | Sep 2007 | B2 |
| D552241 | Bromley et al. | Oct 2007 | S |
| 7282048 | Goble et al. | Oct 2007 | B2 |
| 7285895 | Beaupré | Oct 2007 | B2 |
| 7300431 | Dubrovsky | Nov 2007 | B2 |
| 7300435 | Wham et al. | Nov 2007 | B2 |
| 7300446 | Beaupre | Nov 2007 | B2 |
| 7303531 | Lee et al. | Dec 2007 | B2 |
| 7303557 | Wham et al. | Dec 2007 | B2 |
| 7306597 | Manzo | Dec 2007 | B2 |
| 7309849 | Truckai et al. | Dec 2007 | B2 |
| 7311706 | Schoenman et al. | Dec 2007 | B2 |
| 7311709 | Truckai et al. | Dec 2007 | B2 |
| 7317955 | McGreevy | Jan 2008 | B2 |
| 7318831 | Alvarez et al. | Jan 2008 | B2 |
| 7326236 | Andreas et al. | Feb 2008 | B2 |
| 7331410 | Yong et al. | Feb 2008 | B2 |
| 7335165 | Truwit et al. | Feb 2008 | B2 |
| 7335997 | Wiener | Feb 2008 | B2 |
| 7337010 | Howard et al. | Feb 2008 | B2 |
| 7353068 | Tanaka et al. | Apr 2008 | B2 |
| 7354440 | Truckai et al. | Apr 2008 | B2 |
| 7364577 | Wham et al. | Apr 2008 | B2 |
| RE40388 | Gines | Jun 2008 | E |
| 7380695 | Doll et al. | Jun 2008 | B2 |
| 7380696 | Shelton, IV et al. | Jun 2008 | B2 |
| 7381209 | Truckai et al. | Jun 2008 | B2 |
| 7390317 | Taylor et al. | Jun 2008 | B2 |
| 7404508 | Smith et al. | Jul 2008 | B2 |
| 7408288 | Hara | Aug 2008 | B2 |
| 7416101 | Shelton, IV et al. | Aug 2008 | B2 |
| 7416437 | Sartor et al. | Aug 2008 | B2 |
| D576725 | Shumer et al. | Sep 2008 | S |
| 7419490 | Falkenstein et al. | Sep 2008 | B2 |
| 7422139 | Shelton, IV et al. | Sep 2008 | B2 |
| 7422463 | Kuo | Sep 2008 | B2 |
| D578643 | Shumer et al. | Oct 2008 | S |
| D578644 | Shumer et al. | Oct 2008 | S |
| D578645 | Shumer et al. | Oct 2008 | S |
| 7431704 | Babaev | Oct 2008 | B2 |
| 7441684 | Shelton, IV et al. | Oct 2008 | B2 |
| 7455208 | Wales et al. | Nov 2008 | B2 |
| 7462181 | Kraft et al. | Dec 2008 | B2 |
| 7464846 | Sheltion, IV et al. | Dec 2008 | B2 |
| 7472815 | Shelton, IV et al. | Jan 2009 | B2 |
| 7473263 | Johnston et al. | Jan 2009 | B2 |
| 7479148 | Beaupre | Jan 2009 | B2 |
| 7479160 | Branch et al. | Jan 2009 | B2 |
| 7481775 | Weikel, Jr. et al. | Jan 2009 | B2 |
| 7488285 | Honda et al. | Feb 2009 | B2 |
| 7494468 | Rabiner et al. | Feb 2009 | B2 |
| 7502234 | Goliszek et al. | Mar 2009 | B2 |
| 7503893 | Kucklick | Mar 2009 | B2 |
| 7503895 | Rabiner et al. | Mar 2009 | B2 |
| 7506790 | Shelton, IV | Mar 2009 | B2 |
| 7506791 | Omaits et al. | Mar 2009 | B2 |
| 7524320 | Tierney et al. | Apr 2009 | B2 |
| 7530986 | Beaupre et al. | May 2009 | B2 |
| 7534243 | Chin et al. | May 2009 | B1 |
| D594983 | Price et al. | Jun 2009 | S |
| 7540871 | Gonnering | Jun 2009 | B2 |
| 7544200 | Houser | Jun 2009 | B2 |
| 7549564 | Boudreaux | Jun 2009 | B2 |
| 7559450 | Wales et al. | Jul 2009 | B2 |
| 7567012 | Namikawa | Jul 2009 | B2 |
| 7568603 | Shelton, IV et al. | Aug 2009 | B2 |
| 7569057 | Liu et al. | Aug 2009 | B2 |
| 7572266 | Young et al. | Aug 2009 | B2 |
| 7572268 | Babaev | Aug 2009 | B2 |
| 7578820 | Moore et al. | Aug 2009 | B2 |
| 7582084 | Swanson et al. | Sep 2009 | B2 |
| 7582095 | Shipp et al. | Sep 2009 | B2 |
| 7585181 | Olsen | Sep 2009 | B2 |
| 7588176 | Timm et al. | Sep 2009 | B2 |
| 7601119 | Shahinian | Oct 2009 | B2 |
| 7607557 | Shelton, IV et al. | Oct 2009 | B2 |
| 7621930 | Houser | Nov 2009 | B2 |
| 7641653 | Dalla Betta et al. | Jan 2010 | B2 |
| 7645278 | Ichihashi et al. | Jan 2010 | B2 |
| 7654431 | Hueil et al. | Feb 2010 | B2 |
| 7659833 | Warner et al. | Feb 2010 | B2 |
| 7665647 | Shelton, IV et al. | Feb 2010 | B2 |
| 7670334 | Hueil et al. | Mar 2010 | B2 |
| 7670338 | Albrecht et al. | Mar 2010 | B2 |
| 7674263 | Ryan | Mar 2010 | B2 |
| 7678069 | Baker et al. | Mar 2010 | B1 |
| 7678125 | Shipp | Mar 2010 | B2 |
| 7682366 | Sakurai et al. | Mar 2010 | B2 |
| 7686770 | Cohen | Mar 2010 | B2 |
| 7686826 | Lee et al. | Mar 2010 | B2 |
| 7688028 | Phillips et al. | Mar 2010 | B2 |
| 7691098 | Wallace et al. | Apr 2010 | B2 |
| 7699846 | Ryan | Apr 2010 | B2 |
| 7713202 | Boukhny et al. | May 2010 | B2 |
| 7714481 | Sakai | May 2010 | B2 |
| 7717312 | Beetel | May 2010 | B2 |
| 7717915 | Miyazawa | May 2010 | B2 |
| 7721935 | Racenet et al. | May 2010 | B2 |
| D618797 | Price et al. | Jun 2010 | S |
| 7726537 | Olson et al. | Jun 2010 | B2 |
| 7727177 | Bayat | Jun 2010 | B2 |
| 7738969 | Bleich | Jun 2010 | B2 |
| 7740594 | Hibner | Jun 2010 | B2 |
| 7751115 | Song | Jul 2010 | B2 |
| D621503 | Otten et al. | Aug 2010 | S |
| 7766210 | Shelton, IV et al. | Aug 2010 | B2 |
| 7766693 | Sartor et al. | Aug 2010 | B2 |
| 7770774 | Mastri et al. | Aug 2010 | B2 |
| 7770775 | Shelton, IV et al. | Aug 2010 | B2 |
| 7771425 | Dycus et al. | Aug 2010 | B2 |
| 7771444 | Patel et al. | Aug 2010 | B2 |
| 7775972 | Brock et al. | Aug 2010 | B2 |
| 7776036 | Schechter et al. | Aug 2010 | B2 |
| 7778733 | Nowlin et al. | Aug 2010 | B2 |
| 7780054 | Wales | Aug 2010 | B2 |
| 7780593 | Ueno et al. | Aug 2010 | B2 |
| 7780651 | Madhani et al. | Aug 2010 | B2 |
| 7780659 | Okada et al. | Aug 2010 | B2 |
| 7784662 | Wales et al. | Aug 2010 | B2 |
| 7796969 | Kelly et al. | Sep 2010 | B2 |
| 7798386 | Schall et al. | Sep 2010 | B2 |
| 7799020 | Shores et al. | Sep 2010 | B2 |
| 7799045 | Masuda | Sep 2010 | B2 |
| 7803152 | Honda et al. | Sep 2010 | B2 |
| 7806891 | Nowlin et al. | Oct 2010 | B2 |
| 7810693 | Broehl et al. | Oct 2010 | B2 |
| 7811283 | Moses et al. | Oct 2010 | B2 |
| 7819819 | Quick et al. | Oct 2010 | B2 |
| 7821143 | Wiener | Oct 2010 | B2 |
| D627066 | Romero | Nov 2010 | S |
| 7824401 | Manzo et al. | Nov 2010 | B2 |
| 7832611 | Boyden et al. | Nov 2010 | B2 |
| 7834484 | Sartor | Nov 2010 | B2 |
| 7837699 | Yamada et al. | Nov 2010 | B2 |
| 7845537 | Shelton, IV et al. | Dec 2010 | B2 |
| 7846155 | Houser et al. | Dec 2010 | B2 |
| 7846161 | Dumbauld et al. | Dec 2010 | B2 |
| 7854735 | Houser et al. | Dec 2010 | B2 |
| D631155 | Peine et al. | Jan 2011 | S |
| 7861906 | Doll et al. | Jan 2011 | B2 |
| 7862560 | Marion | Jan 2011 | B2 |
| 7876030 | Taki et al. | Jan 2011 | B2 |
| D631965 | Price et al. | Feb 2011 | S |
| 7878991 | Babaev | Feb 2011 | B2 |
| 7879033 | Sartor et al. | Feb 2011 | B2 |
| 7892606 | Thies et al. | Feb 2011 | B2 |
| 7901400 | Wham et al. | Mar 2011 | B2 |
| 7901423 | Stulen et al. | Mar 2011 | B2 |
| 7905881 | Masuda et al. | Mar 2011 | B2 |
| 7909824 | Masuda et al. | Mar 2011 | B2 |
| 7922061 | Shelton, IV et al. | Apr 2011 | B2 |
| 7922651 | Yamada et al. | Apr 2011 | B2 |
| D637288 | Houghton | May 2011 | S |
| D638540 | Ijiri et al. | May 2011 | S |
| 7936203 | Zimlich | May 2011 | B2 |
| 7951095 | Makin et al. | May 2011 | B2 |
| 7951165 | Golden et al. | May 2011 | B2 |
| 7959050 | Smith et al. | Jun 2011 | B2 |
| 7959626 | Hong et al. | Jun 2011 | B2 |
| 7972329 | Refior et al. | Jul 2011 | B2 |
| 7976544 | McClurken et al. | Jul 2011 | B2 |
| 7981050 | Ritchart et al. | Jul 2011 | B2 |
| 7998157 | Culp et al. | Aug 2011 | B2 |
| 8038693 | Allen | Oct 2011 | B2 |
| 8057498 | Robertson | Nov 2011 | B2 |
| 8058771 | Giordano et al. | Nov 2011 | B2 |
| 8061014 | Smith et al. | Nov 2011 | B2 |
| 8070711 | Bassinger et al. | Dec 2011 | B2 |
| 8070762 | Escudero et al. | Dec 2011 | B2 |
| 8075558 | Truckai et al. | Dec 2011 | B2 |
| 8089197 | Rinner et al. | Jan 2012 | B2 |
| 8097012 | Kagarise | Jan 2012 | B2 |
| 8105323 | Buysse et al. | Jan 2012 | B2 |
| 8142461 | Houser et al. | Mar 2012 | B2 |
| 8152801 | Goldberg et al. | Apr 2012 | B2 |
| 8152825 | Madan et al. | Apr 2012 | B2 |
| 8157145 | Shelton, IV et al. | Apr 2012 | B2 |
| 8161977 | Shelton, IV et al. | Apr 2012 | B2 |
| 8162966 | Connor et al. | Apr 2012 | B2 |
| 8172846 | Brunnett et al. | May 2012 | B2 |
| 8172870 | Shipp | May 2012 | B2 |
| 8177800 | Spitz et al. | May 2012 | B2 |
| 8182502 | Stulen et al. | May 2012 | B2 |
| 8186877 | Klimovitch et al. | May 2012 | B2 |
| D661801 | Price et al. | Jun 2012 | S |
| D661802 | Price et al. | Jun 2012 | S |
| D661803 | Price et al. | Jun 2012 | S |
| D661804 | Price et al. | Jun 2012 | S |
| 8197472 | Lau et al. | Jun 2012 | B2 |
| 8197502 | Smith et al. | Jun 2012 | B2 |
| 8207651 | Gilbert | Jun 2012 | B2 |
| 8210411 | Yates et al. | Jul 2012 | B2 |
| 8226675 | Houser et al. | Jul 2012 | B2 |
| 8235917 | Joseph et al. | Aug 2012 | B2 |
| 8236019 | Houser | Aug 2012 | B2 |
| 8236020 | Smith et al. | Aug 2012 | B2 |
| 8241271 | Millman et al. | Aug 2012 | B2 |
| 8246575 | Viola | Aug 2012 | B2 |
| 8246615 | Behnke | Aug 2012 | B2 |
| 8252012 | Stulen | Aug 2012 | B2 |
| 8253303 | Giordano et al. | Aug 2012 | B2 |
| 8257377 | Wiener et al. | Sep 2012 | B2 |
| 8257387 | Cunningham | Sep 2012 | B2 |
| 8273087 | Kimura et al. | Sep 2012 | B2 |
| D669992 | Schafer et al. | Oct 2012 | S |
| D669993 | Merchant et al. | Oct 2012 | S |
| 8286846 | Smith et al. | Oct 2012 | B2 |
| 8287485 | Kimura et al. | Oct 2012 | B2 |
| 8287528 | Wham et al. | Oct 2012 | B2 |
| 8287532 | Carroll et al. | Oct 2012 | B2 |
| 8292888 | Whitman | Oct 2012 | B2 |
| 8298223 | Wham et al. | Oct 2012 | B2 |
| 8298225 | Gilbert | Oct 2012 | B2 |
| 8303576 | Brock | Nov 2012 | B2 |
| 8303580 | Wham et al. | Nov 2012 | B2 |
| 8303583 | Hosier et al. | Nov 2012 | B2 |
| 8319400 | Houser et al. | Nov 2012 | B2 |
| 8323302 | Robertson et al. | Dec 2012 | B2 |
| 8333778 | Smith et al. | Dec 2012 | B2 |
| 8333779 | Smith et al. | Dec 2012 | B2 |
| 8334468 | Palmer et al. | Dec 2012 | B2 |
| 8334635 | Voegele et al. | Dec 2012 | B2 |
| 8337407 | Quistgaard et al. | Dec 2012 | B2 |
| 8338726 | Palmer et al. | Dec 2012 | B2 |
| 8344596 | Nield et al. | Jan 2013 | B2 |
| 8348967 | Stulen | Jan 2013 | B2 |
| 8357103 | Mark et al. | Jan 2013 | B2 |
| 8366727 | Witt et al. | Feb 2013 | B2 |
| 8372099 | Deville et al. | Feb 2013 | B2 |
| 8372101 | Smith et al. | Feb 2013 | B2 |
| 8372102 | Stulen et al. | Feb 2013 | B2 |
| 8374670 | Selkee | Feb 2013 | B2 |
| 8377059 | Deville et al. | Feb 2013 | B2 |
| 8377085 | Smith et al. | Feb 2013 | B2 |
| 8382748 | Geisel | Feb 2013 | B2 |
| 8382775 | Bender et al. | Feb 2013 | B1 |
| 8382782 | Robertson et al. | Feb 2013 | B2 |
| 8403948 | Deville et al. | Mar 2013 | B2 |
| 8403949 | Palmer et al. | Mar 2013 | B2 |
| 8403950 | Palmer et al. | Mar 2013 | B2 |
| 8418073 | Mohr et al. | Apr 2013 | B2 |
| 8418349 | Smith et al. | Apr 2013 | B2 |
| 8419757 | Smith et al. | Apr 2013 | B2 |
| 8419758 | Smith et al. | Apr 2013 | B2 |
| 8419759 | Dietz | Apr 2013 | B2 |
| 8425545 | Smith et al. | Apr 2013 | B2 |
| 8430898 | Wiener et al. | Apr 2013 | B2 |
| 8435257 | Smith et al. | May 2013 | B2 |
| 8439912 | Cunningham et al. | May 2013 | B2 |
| 8439939 | Deville et al. | May 2013 | B2 |
| 8444637 | Podmore et al. | May 2013 | B2 |
| 8444662 | Palmer et al. | May 2013 | B2 |
| 8444664 | Balanev et al. | May 2013 | B2 |
| 8460288 | Tamai et al. | Jun 2013 | B2 |
| 8461744 | Wiener et al. | Jun 2013 | B2 |
| 8469981 | Robertson et al. | Jun 2013 | B2 |
| 8479969 | Shelton, IV | Jul 2013 | B2 |
| 8480703 | Nicholas et al. | Jul 2013 | B2 |
| 8485413 | Scheib et al. | Jul 2013 | B2 |
| 8486057 | Behnke, II | Jul 2013 | B2 |
| 8486096 | Robertson et al. | Jul 2013 | B2 |
| 8491578 | Manwaring et al. | Jul 2013 | B2 |
| D687549 | Johnson et al. | Aug 2013 | S |
| 8506555 | Ruiz Morales | Aug 2013 | B2 |
| 8509318 | Tailliet | Aug 2013 | B2 |
| 8512359 | Whitman et al. | Aug 2013 | B2 |
| 8512365 | Wiener et al. | Aug 2013 | B2 |
| 8523889 | Stulen et al. | Sep 2013 | B2 |
| 8531064 | Robertson et al. | Sep 2013 | B2 |
| 8535340 | Allen | Sep 2013 | B2 |
| 8535341 | Allen | Sep 2013 | B2 |
| 8546996 | Messerly et al. | Oct 2013 | B2 |
| 8546999 | Houser et al. | Oct 2013 | B2 |
| 8568400 | Gilbert | Oct 2013 | B2 |
| 8573461 | Shelton, IV et al. | Nov 2013 | B2 |
| 8573465 | Shelton, IV | Nov 2013 | B2 |
| 8579928 | Robertson et al. | Nov 2013 | B2 |
| 8591459 | Clymer et al. | Nov 2013 | B2 |
| 8591506 | Wham et al. | Nov 2013 | B2 |
| 8591536 | Robertson | Nov 2013 | B2 |
| D695407 | Price et al. | Dec 2013 | S |
| D696631 | Price et al. | Dec 2013 | S |
| 8602031 | Reis et al. | Dec 2013 | B2 |
| 8602288 | Shelton, IV et al. | Dec 2013 | B2 |
| 8608745 | Guzman et al. | Dec 2013 | B2 |
| 8616431 | Timm et al. | Dec 2013 | B2 |
| 8623027 | Price et al. | Jan 2014 | B2 |
| 8650728 | Wan et al. | Feb 2014 | B2 |
| 8652155 | Houser et al. | Feb 2014 | B2 |
| 8659208 | Rose et al. | Feb 2014 | B1 |
| 8663220 | Wiener et al. | Mar 2014 | B2 |
| 8690582 | Rohrbach et al. | Apr 2014 | B2 |
| 8696366 | Chen et al. | Apr 2014 | B2 |
| 8704425 | Giordano et al. | Apr 2014 | B2 |
| 8709031 | Stulen | Apr 2014 | B2 |
| 8747351 | Schultz | Jun 2014 | B2 |
| 8749116 | Messerly et al. | Jun 2014 | B2 |
| 8752749 | Moore et al. | Jun 2014 | B2 |
| 8753338 | Widenhouse et al. | Jun 2014 | B2 |
| 8754570 | Voegele et al. | Jun 2014 | B2 |
| 8764735 | Coe et al. | Jul 2014 | B2 |
| 8771270 | Burbank | Jul 2014 | B2 |
| 8773001 | Wiener et al. | Jul 2014 | B2 |
| 8779648 | Giordano et al. | Jul 2014 | B2 |
| 8784418 | Romero | Jul 2014 | B2 |
| 8808319 | Houser et al. | Aug 2014 | B2 |
| 8827992 | Koss et al. | Sep 2014 | B2 |
| 8845537 | Tanaka et al. | Sep 2014 | B2 |
| 8882791 | Stulen | Nov 2014 | B2 |
| 8888776 | Dietz et al. | Nov 2014 | B2 |
| 8888809 | Davison et al. | Nov 2014 | B2 |
| 8899462 | Kostrzewski et al. | Dec 2014 | B2 |
| 8900259 | Houser et al. | Dec 2014 | B2 |
| 8911460 | Neurohr et al. | Dec 2014 | B2 |
| 8951248 | Messerly et al. | Feb 2015 | B2 |
| 8951272 | Robertson et al. | Feb 2015 | B2 |
| 8956349 | Aldridge et al. | Feb 2015 | B2 |
| 8961547 | Dietz et al. | Feb 2015 | B2 |
| 8968283 | Kharin | Mar 2015 | B2 |
| 8968355 | Malkowski et al. | Mar 2015 | B2 |
| 8974477 | Yamada | Mar 2015 | B2 |
| 8979890 | Boudreaux | Mar 2015 | B2 |
| 8986287 | Park et al. | Mar 2015 | B2 |
| 8986302 | Aldridge et al. | Mar 2015 | B2 |
| 8989903 | Weir et al. | Mar 2015 | B2 |
| 9017326 | DiNardo et al. | Apr 2015 | B2 |
| 9039695 | Giordano et al. | May 2015 | B2 |
| 9044261 | Houser | Jun 2015 | B2 |
| 9050093 | Aldridge et al. | Jun 2015 | B2 |
| 9050124 | Houser | Jun 2015 | B2 |
| 9060775 | Wiener et al. | Jun 2015 | B2 |
| 9060776 | Yates et al. | Jun 2015 | B2 |
| 9066747 | Robertson | Jun 2015 | B2 |
| 9072539 | Messerly et al. | Jul 2015 | B2 |
| 9089360 | Messerly et al. | Jul 2015 | B2 |
| 9095367 | Olson et al. | Aug 2015 | B2 |
| 9107689 | Robertson et al. | Aug 2015 | B2 |
| 9113940 | Twomey | Aug 2015 | B2 |
| 9168054 | Turner et al. | Oct 2015 | B2 |
| 9198714 | Worrell et al. | Dec 2015 | B2 |
| 9220527 | Houser et al. | Dec 2015 | B2 |
| 9226766 | Aldridge et al. | Jan 2016 | B2 |
| 9226767 | Stulen et al. | Jan 2016 | B2 |
| 9232979 | Parihar et al. | Jan 2016 | B2 |
| 9237921 | Messerly et al. | Jan 2016 | B2 |
| 9241728 | Price et al. | Jan 2016 | B2 |
| 9241731 | Boudreaux et al. | Jan 2016 | B2 |
| 9259234 | Robertson et al. | Feb 2016 | B2 |
| 9283045 | Rhee et al. | Mar 2016 | B2 |
| 9326788 | Batross et al. | May 2016 | B2 |
| 9339289 | Robertson | May 2016 | B2 |
| 9351754 | Vakharia et al. | May 2016 | B2 |
| 9393037 | Olson et al. | Jul 2016 | B2 |
| 9408622 | Stulen et al. | Aug 2016 | B2 |
| 9414853 | Stulen et al. | Aug 2016 | B2 |
| 9421060 | Monson et al. | Aug 2016 | B2 |
| 9427249 | Robertson et al. | Aug 2016 | B2 |
| 9439668 | Timm et al. | Sep 2016 | B2 |
| 9439669 | Wiener et al. | Sep 2016 | B2 |
| 9445832 | Wiener et al. | Sep 2016 | B2 |
| 20010025173 | Ritchie et al. | Sep 2001 | A1 |
| 20010025183 | Shahidi et al. | Sep 2001 | A1 |
| 20010025184 | Messerly | Sep 2001 | A1 |
| 20010031950 | Ryan | Oct 2001 | A1 |
| 20010039419 | Francischelli et al. | Nov 2001 | A1 |
| 20020002377 | Cimino | Jan 2002 | A1 |
| 20020019649 | Sikora et al. | Feb 2002 | A1 |
| 20020022836 | Goble et al. | Feb 2002 | A1 |
| 20020029055 | Bonutti | Mar 2002 | A1 |
| 20020049551 | Friedman et al. | Apr 2002 | A1 |
| 20020052617 | Anis et al. | May 2002 | A1 |
| 20020077550 | Rabiner et al. | Jun 2002 | A1 |
| 20020156466 | Sakurai et al. | Oct 2002 | A1 |
| 20020156493 | Houser et al. | Oct 2002 | A1 |
| 20030014087 | Fang | Jan 2003 | A1 |
| 20030036705 | Hare et al. | Feb 2003 | A1 |
| 20030050572 | Brautigam et al. | Mar 2003 | A1 |
| 20030055443 | Spotnitz | Mar 2003 | A1 |
| 20030114851 | Truckai et al. | Jun 2003 | A1 |
| 20030144680 | Kellogg et al. | Jul 2003 | A1 |
| 20030199794 | Sakurai et al. | Oct 2003 | A1 |
| 20030204199 | Novak et al. | Oct 2003 | A1 |
| 20030212332 | Fenton et al. | Nov 2003 | A1 |
| 20030212363 | Shipp | Nov 2003 | A1 |
| 20030212392 | Fenton et al. | Nov 2003 | A1 |
| 20030212422 | Fenton et al. | Nov 2003 | A1 |
| 20030229344 | Dycus et al. | Dec 2003 | A1 |
| 20040030254 | Babaev | Feb 2004 | A1 |
| 20040030330 | Brassell et al. | Feb 2004 | A1 |
| 20040047485 | Sherrit et al. | Mar 2004 | A1 |
| 20040054364 | Aranyi et al. | Mar 2004 | A1 |
| 20040064151 | Mollenauer | Apr 2004 | A1 |
| 20040092921 | Kadziauskas et al. | May 2004 | A1 |
| 20040092992 | Adams et al. | May 2004 | A1 |
| 20040097911 | Murakami et al. | May 2004 | A1 |
| 20040097912 | Gonnering | May 2004 | A1 |
| 20040097919 | Wellman et al. | May 2004 | A1 |
| 20040097996 | Rabiner et al. | May 2004 | A1 |
| 20040116952 | Sakurai et al. | Jun 2004 | A1 |
| 20040132383 | Langford et al. | Jul 2004 | A1 |
| 20040147934 | Kiester | Jul 2004 | A1 |
| 20040167508 | Wham et al. | Aug 2004 | A1 |
| 20040176686 | Hare et al. | Sep 2004 | A1 |
| 20040176751 | Weitzner et al. | Sep 2004 | A1 |
| 20040199193 | Hayashi et al. | Oct 2004 | A1 |
| 20040204728 | Haefner | Oct 2004 | A1 |
| 20040215132 | Yoon | Oct 2004 | A1 |
| 20040243147 | Lipow | Dec 2004 | A1 |
| 20040260300 | Gorensek et al. | Dec 2004 | A1 |
| 20050020967 | Ono | Jan 2005 | A1 |
| 20050021018 | Anderson et al. | Jan 2005 | A1 |
| 20050021065 | Yamada et al. | Jan 2005 | A1 |
| 20050033337 | Muir et al. | Feb 2005 | A1 |
| 20050049546 | Messerly et al. | Mar 2005 | A1 |
| 20050070800 | Takahashi | Mar 2005 | A1 |
| 20050096683 | Ellins et al. | May 2005 | A1 |
| 20050099824 | Dowling et al. | May 2005 | A1 |
| 20050103819 | Racenet et al. | May 2005 | A1 |
| 20050143769 | White et al. | Jun 2005 | A1 |
| 20050149108 | Cox | Jul 2005 | A1 |
| 20050165345 | Laufer et al. | Jul 2005 | A1 |
| 20050177184 | Easley | Aug 2005 | A1 |
| 20050182339 | Lee et al. | Aug 2005 | A1 |
| 20050188743 | Land | Sep 2005 | A1 |
| 20050192610 | Houser et al. | Sep 2005 | A1 |
| 20050209620 | Du et al. | Sep 2005 | A1 |
| 20050222598 | Ho et al. | Oct 2005 | A1 |
| 20050234484 | Houser et al. | Oct 2005 | A1 |
| 20050249667 | Tuszynski et al. | Nov 2005 | A1 |
| 20050256405 | Makin et al. | Nov 2005 | A1 |
| 20050261581 | Hughes et al. | Nov 2005 | A1 |
| 20050261588 | Makin et al. | Nov 2005 | A1 |
| 20050273090 | Nieman et al. | Dec 2005 | A1 |
| 20050288659 | Kimura et al. | Dec 2005 | A1 |
| 20060030797 | Zhou et al. | Feb 2006 | A1 |
| 20060058825 | Ogura et al. | Mar 2006 | A1 |
| 20060063130 | Hayman et al. | Mar 2006 | A1 |
| 20060066181 | Bromfield et al. | Mar 2006 | A1 |
| 20060074442 | Noriega et al. | Apr 2006 | A1 |
| 20060079874 | Faller et al. | Apr 2006 | A1 |
| 20060079879 | Faller et al. | Apr 2006 | A1 |
| 20060084963 | Messerly | Apr 2006 | A1 |
| 20060095046 | Trieu et al. | May 2006 | A1 |
| 20060190034 | Nishizawa et al. | Aug 2006 | A1 |
| 20060206100 | Eskridge et al. | Sep 2006 | A1 |
| 20060206115 | Schomer et al. | Sep 2006 | A1 |
| 20060211943 | Beaupre | Sep 2006 | A1 |
| 20060217729 | Eskridge et al. | Sep 2006 | A1 |
| 20060224160 | Trieu et al. | Oct 2006 | A1 |
| 20060235306 | Cotter et al. | Oct 2006 | A1 |
| 20060247558 | Yamada | Nov 2006 | A1 |
| 20060253050 | Yoshimine et al. | Nov 2006 | A1 |
| 20060264809 | Hansmann et al. | Nov 2006 | A1 |
| 20060271030 | Francis et al. | Nov 2006 | A1 |
| 20070016235 | Tanaka et al. | Jan 2007 | A1 |
| 20070016236 | Beaupre | Jan 2007 | A1 |
| 20070055228 | Berg et al. | Mar 2007 | A1 |
| 20070056596 | Fanney et al. | Mar 2007 | A1 |
| 20070060915 | Kucklick | Mar 2007 | A1 |
| 20070060935 | Schwardt et al. | Mar 2007 | A1 |
| 20070063618 | Bromfield | Mar 2007 | A1 |
| 20070074584 | Talarico et al. | Apr 2007 | A1 |
| 20070078458 | Dumbauld et al. | Apr 2007 | A1 |
| 20070106317 | Shelton, IV et al. | May 2007 | A1 |
| 20070129716 | Daw et al. | Jun 2007 | A1 |
| 20070130771 | Ehlert et al. | Jun 2007 | A1 |
| 20070131034 | Ehlert et al. | Jun 2007 | A1 |
| 20070149881 | Rabin | Jun 2007 | A1 |
| 20070162050 | Sartor | Jul 2007 | A1 |
| 20070166663 | Telles et al. | Jul 2007 | A1 |
| 20070173803 | Wham et al. | Jul 2007 | A1 |
| 20070173813 | Odom | Jul 2007 | A1 |
| 20070173872 | Neuenfeldt | Jul 2007 | A1 |
| 20070175949 | Shelton, IV et al. | Aug 2007 | A1 |
| 20070185380 | Kucklick | Aug 2007 | A1 |
| 20070191712 | Messerly et al. | Aug 2007 | A1 |
| 20070219481 | Babaev | Sep 2007 | A1 |
| 20070239028 | Houser et al. | Oct 2007 | A1 |
| 20070239101 | Kellogg | Oct 2007 | A1 |
| 20070249941 | Salehi et al. | Oct 2007 | A1 |
| 20070260234 | McCullagh et al. | Nov 2007 | A1 |
| 20070265560 | Soltani et al. | Nov 2007 | A1 |
| 20070275348 | Lemon | Nov 2007 | A1 |
| 20070282335 | Young et al. | Dec 2007 | A1 |
| 20070287933 | Phan et al. | Dec 2007 | A1 |
| 20070288055 | Lee | Dec 2007 | A1 |
| 20080009848 | Paraschiv et al. | Jan 2008 | A1 |
| 20080013809 | Zhu et al. | Jan 2008 | A1 |
| 20080051812 | Schmitz et al. | Feb 2008 | A1 |
| 20080058585 | Novak et al. | Mar 2008 | A1 |
| 20080058775 | Darian et al. | Mar 2008 | A1 |
| 20080058845 | Shimizu et al. | Mar 2008 | A1 |
| 20080077145 | Boyden et al. | Mar 2008 | A1 |
| 20080082039 | Babaev | Apr 2008 | A1 |
| 20080082098 | Tanaka et al. | Apr 2008 | A1 |
| 20080097501 | Blier | Apr 2008 | A1 |
| 20080114364 | Goldin et al. | May 2008 | A1 |
| 20080125768 | Tahara et al. | May 2008 | A1 |
| 20080140158 | Hamel et al. | Jun 2008 | A1 |
| 20080147092 | Rogge et al. | Jun 2008 | A1 |
| 20080171938 | Masuda et al. | Jul 2008 | A1 |
| 20080172051 | Masuda et al. | Jul 2008 | A1 |
| 20080177268 | Daum et al. | Jul 2008 | A1 |
| 20080188878 | Young | Aug 2008 | A1 |
| 20080200940 | Eichmann et al. | Aug 2008 | A1 |
| 20080208108 | Kimura | Aug 2008 | A1 |
| 20080208231 | Ota et al. | Aug 2008 | A1 |
| 20080214967 | Aranyi et al. | Sep 2008 | A1 |
| 20080234709 | Houser | Sep 2008 | A1 |
| 20080243106 | Coe et al. | Oct 2008 | A1 |
| 20080243162 | Shibata et al. | Oct 2008 | A1 |
| 20080245371 | Gruber | Oct 2008 | A1 |
| 20080249553 | Gruber et al. | Oct 2008 | A1 |
| 20080255423 | Kondo et al. | Oct 2008 | A1 |
| 20080262490 | Williams | Oct 2008 | A1 |
| 20080281200 | Voic et al. | Nov 2008 | A1 |
| 20080281315 | Gines | Nov 2008 | A1 |
| 20080281322 | Sherman et al. | Nov 2008 | A1 |
| 20080287948 | Newton et al. | Nov 2008 | A1 |
| 20090023985 | Ewers | Jan 2009 | A1 |
| 20090024141 | Stahler et al. | Jan 2009 | A1 |
| 20090048537 | Lydon et al. | Feb 2009 | A1 |
| 20090054886 | Yachi et al. | Feb 2009 | A1 |
| 20090054894 | Yachi | Feb 2009 | A1 |
| 20090076506 | Baker | Mar 2009 | A1 |
| 20090082716 | Akahoshi | Mar 2009 | A1 |
| 20090088738 | Guerra et al. | Apr 2009 | A1 |
| 20090088785 | Masuda | Apr 2009 | A1 |
| 20090112229 | Omori et al. | Apr 2009 | A1 |
| 20090118751 | Wiener et al. | May 2009 | A1 |
| 20090118802 | Mioduski et al. | May 2009 | A1 |
| 20090138006 | Bales et al. | May 2009 | A1 |
| 20090143799 | Smith et al. | Jun 2009 | A1 |
| 20090143800 | Deville et al. | Jun 2009 | A1 |
| 20090143806 | Witt et al. | Jun 2009 | A1 |
| 20090149801 | Crandall et al. | Jun 2009 | A1 |
| 20090163807 | Sliwa | Jun 2009 | A1 |
| 20090207923 | Dress | Aug 2009 | A1 |
| 20090216157 | Yamada | Aug 2009 | A1 |
| 20090223033 | Houser | Sep 2009 | A1 |
| 20090254077 | Craig | Oct 2009 | A1 |
| 20090254080 | Honda | Oct 2009 | A1 |
| 20090264909 | Beaupre | Oct 2009 | A1 |
| 20090270771 | Takahashi | Oct 2009 | A1 |
| 20090270812 | Litscher et al. | Oct 2009 | A1 |
| 20090270853 | Yachi et al. | Oct 2009 | A1 |
| 20090270899 | Carusillo et al. | Oct 2009 | A1 |
| 20090275940 | Malackowski et al. | Nov 2009 | A1 |
| 20090299141 | Downey et al. | Dec 2009 | A1 |
| 20090318945 | Yoshimine et al. | Dec 2009 | A1 |
| 20090327715 | Smith et al. | Dec 2009 | A1 |
| 20100004508 | Naito et al. | Jan 2010 | A1 |
| 20100016785 | Takuma | Jan 2010 | A1 |
| 20100016852 | Manzo et al. | Jan 2010 | A1 |
| 20100022825 | Yoshie | Jan 2010 | A1 |
| 20100030233 | Whitman et al. | Feb 2010 | A1 |
| 20100030248 | Palmer et al. | Feb 2010 | A1 |
| 20100036370 | Mirel et al. | Feb 2010 | A1 |
| 20100042077 | Okada | Feb 2010 | A1 |
| 20100049180 | Wells et al. | Feb 2010 | A1 |
| 20100057118 | Dietz et al. | Mar 2010 | A1 |
| 20100063525 | Beaupre et al. | Mar 2010 | A1 |
| 20100063528 | Beaupré | Mar 2010 | A1 |
| 20100069940 | Miller et al. | Mar 2010 | A1 |
| 20100158307 | Kubota et al. | Jun 2010 | A1 |
| 20100187283 | Crainich et al. | Jul 2010 | A1 |
| 20100222714 | Muir et al. | Sep 2010 | A1 |
| 20100228264 | Robinson et al. | Sep 2010 | A1 |
| 20100234906 | Koh | Sep 2010 | A1 |
| 20100262134 | Jensen et al. | Oct 2010 | A1 |
| 20100274160 | Yachi et al. | Oct 2010 | A1 |
| 20100280407 | Polster | Nov 2010 | A1 |
| 20100292691 | Brogna | Nov 2010 | A1 |
| 20100298743 | Nield et al. | Nov 2010 | A1 |
| 20100298851 | Nield | Nov 2010 | A1 |
| 20100331742 | Masuda | Dec 2010 | A1 |
| 20110004233 | Muir et al. | Jan 2011 | A1 |
| 20110009850 | Main et al. | Jan 2011 | A1 |
| 20110077648 | Lee et al. | Mar 2011 | A1 |
| 20110087218 | Boudreaux et al. | Apr 2011 | A1 |
| 20110112526 | Fritz et al. | May 2011 | A1 |
| 20110125151 | Strauss et al. | May 2011 | A1 |
| 20110125174 | Babaev | May 2011 | A1 |
| 20110144806 | Sandhu et al. | Jun 2011 | A1 |
| 20110224689 | Larkin et al. | Sep 2011 | A1 |
| 20110238065 | Hunt et al. | Sep 2011 | A1 |
| 20110257650 | Deville et al. | Oct 2011 | A1 |
| 20110270126 | Gunday et al. | Nov 2011 | A1 |
| 20110290853 | Shelton, IV et al. | Dec 2011 | A1 |
| 20110290856 | Shelton, IV et al. | Dec 2011 | A1 |
| 20110295242 | Spivey et al. | Dec 2011 | A1 |
| 20120004655 | Kim et al. | Jan 2012 | A1 |
| 20120022525 | Dietz et al. | Jan 2012 | A1 |
| 20120022530 | Woodruff et al. | Jan 2012 | A1 |
| 20120022583 | Sugalski et al. | Jan 2012 | A1 |
| 20120059289 | Nield et al. | Mar 2012 | A1 |
| 20120065628 | Naito | Mar 2012 | A1 |
| 20120071863 | Lee et al. | Mar 2012 | A1 |
| 20120078139 | Aldridge et al. | Mar 2012 | A1 |
| 20120078243 | Worrell et al. | Mar 2012 | A1 |
| 20120078244 | Worrell et al. | Mar 2012 | A1 |
| 20120078247 | Worrell et al. | Mar 2012 | A1 |
| 20120078278 | Bales, Jr. et al. | Mar 2012 | A1 |
| 20120080332 | Shelton, IV et al. | Apr 2012 | A1 |
| 20120101495 | Young et al. | Apr 2012 | A1 |
| 20120101501 | Nishimura et al. | Apr 2012 | A1 |
| 20120109159 | Jordan et al. | May 2012 | A1 |
| 20120116379 | Yates et al. | May 2012 | A1 |
| 20120116391 | Houser et al. | May 2012 | A1 |
| 20120116394 | Timm et al. | May 2012 | A1 |
| 20120116395 | Madan et al. | May 2012 | A1 |
| 20120130256 | Buysse et al. | May 2012 | A1 |
| 20120130365 | McLawhorn | May 2012 | A1 |
| 20120136354 | Rupp | May 2012 | A1 |
| 20120138660 | Shelton, IV | Jun 2012 | A1 |
| 20120143211 | Kishi | Jun 2012 | A1 |
| 20120150170 | Buysse et al. | Jun 2012 | A1 |
| 20120165816 | Kersten et al. | Jun 2012 | A1 |
| 20120172873 | Artale et al. | Jul 2012 | A1 |
| 20120172904 | Muir et al. | Jul 2012 | A1 |
| 20120177005 | Liang et al. | Jul 2012 | A1 |
| 20120184946 | Price et al. | Jul 2012 | A1 |
| 20120199630 | Shelton, IV | Aug 2012 | A1 |
| 20120199632 | Spivey et al. | Aug 2012 | A1 |
| 20120203143 | Sanai et al. | Aug 2012 | A1 |
| 20120203247 | Shelton, IV et al. | Aug 2012 | A1 |
| 20120209289 | Duque et al. | Aug 2012 | A1 |
| 20120209303 | Frankhouser et al. | Aug 2012 | A1 |
| 20120210223 | Eppolito | Aug 2012 | A1 |
| 20120215220 | Manzo et al. | Aug 2012 | A1 |
| 20120245582 | Kimball et al. | Sep 2012 | A1 |
| 20120253370 | Ross et al. | Oct 2012 | A1 |
| 20120269676 | Houser et al. | Oct 2012 | A1 |
| 20120330307 | Ladtkow et al. | Dec 2012 | A1 |
| 20130012957 | Shelton, IV et al. | Jan 2013 | A1 |
| 20130030433 | Heard | Jan 2013 | A1 |
| 20130035680 | Ben-Haim et al. | Feb 2013 | A1 |
| 20130053840 | Krapohl et al. | Feb 2013 | A1 |
| 20130072856 | Frankhouser et al. | Mar 2013 | A1 |
| 20130072857 | Frankhouser et al. | Mar 2013 | A1 |
| 20130079762 | Twomey et al. | Mar 2013 | A1 |
| 20130103023 | Monson et al. | Apr 2013 | A1 |
| 20130103024 | Monson et al. | Apr 2013 | A1 |
| 20130110145 | Weitzman | May 2013 | A1 |
| 20130123776 | Monson et al. | May 2013 | A1 |
| 20130123777 | Monson et al. | May 2013 | A1 |
| 20130123782 | Trees et al. | May 2013 | A1 |
| 20130123822 | Wellman et al. | May 2013 | A1 |
| 20130131660 | Monson et al. | May 2013 | A1 |
| 20130165929 | Muir et al. | Jun 2013 | A1 |
| 20130217967 | Mohr et al. | Aug 2013 | A1 |
| 20130253498 | Germain et al. | Sep 2013 | A1 |
| 20130274734 | Maass et al. | Oct 2013 | A1 |
| 20130282038 | Dannaher et al. | Oct 2013 | A1 |
| 20130296908 | Schulte et al. | Nov 2013 | A1 |
| 20130338661 | Behnke, II | Dec 2013 | A1 |
| 20130345689 | Ruddenklau et al. | Dec 2013 | A1 |
| 20140005640 | Shelton, IV et al. | Jan 2014 | A1 |
| 20140005653 | Shelton, IV et al. | Jan 2014 | A1 |
| 20140005656 | Mucilli et al. | Jan 2014 | A1 |
| 20140005661 | Shelton, IV et al. | Jan 2014 | A1 |
| 20140005662 | Shelton, IV et al. | Jan 2014 | A1 |
| 20140005676 | Shelton, IV et al. | Jan 2014 | A1 |
| 20140005680 | Shelton, IV et al. | Jan 2014 | A1 |
| 20140005681 | Gee et al. | Jan 2014 | A1 |
| 20140005702 | Timm et al. | Jan 2014 | A1 |
| 20140005705 | Weir et al. | Jan 2014 | A1 |
| 20140005708 | Shelton, IV et al. | Jan 2014 | A1 |
| 20140005718 | Shelton, IV et al. | Jan 2014 | A1 |
| 20140012299 | Stoddard et al. | Jan 2014 | A1 |
| 20140066962 | Robertson et al. | Mar 2014 | A1 |
| 20140087569 | Lee | Mar 2014 | A1 |
| 20140107538 | Wiener et al. | Apr 2014 | A1 |
| 20140114327 | Boudreaux et al. | Apr 2014 | A1 |
| 20140135804 | Weisenburgh, II et al. | May 2014 | A1 |
| 20140155921 | Price et al. | Jun 2014 | A1 |
| 20140180280 | Sigmon, Jr. | Jun 2014 | A1 |
| 20140243864 | Voegele et al. | Aug 2014 | A1 |
| 20140276970 | Messerly et al. | Sep 2014 | A1 |
| 20150045819 | Houser et al. | Feb 2015 | A1 |
| 20150066067 | Stulen | Mar 2015 | A1 |
| 20150073460 | Stulen | Mar 2015 | A1 |
| 20150112335 | Boudreaux et al. | Apr 2015 | A1 |
| 20150119914 | Neurohr et al. | Apr 2015 | A1 |
| 20150119915 | Neurohr et al. | Apr 2015 | A1 |
| 20150119916 | Dietz et al. | Apr 2015 | A1 |
| 20150123348 | Robertson et al. | May 2015 | A1 |
| 20150157355 | Price et al. | Jun 2015 | A1 |
| 20150157356 | Gee | Jun 2015 | A1 |
| 20150164533 | Felder et al. | Jun 2015 | A1 |
| 20150164534 | Felder et al. | Jun 2015 | A1 |
| 20150164535 | Felder et al. | Jun 2015 | A1 |
| 20150164536 | Czarnecki et al. | Jun 2015 | A1 |
| 20150164537 | Cagle et al. | Jun 2015 | A1 |
| 20150164538 | Aldridge et al. | Jun 2015 | A1 |
| 20150182251 | Messerly et al. | Jul 2015 | A1 |
| 20150182276 | Wiener et al. | Jul 2015 | A1 |
| 20150182277 | Wiener et al. | Jul 2015 | A1 |
| 20150196318 | Messerly et al. | Jul 2015 | A1 |
| 20150250495 | Robertson et al. | Sep 2015 | A1 |
| 20150257780 | Houser | Sep 2015 | A1 |
| 20150257781 | Houser et al. | Sep 2015 | A1 |
| 20150265308 | Houser et al. | Sep 2015 | A1 |
| 20150327883 | Messerly et al. | Nov 2015 | A1 |
| 20150328484 | Messerly et al. | Nov 2015 | A1 |
| 20150340586 | Wiener et al. | Nov 2015 | A1 |
| 20150351789 | Robertson et al. | Dec 2015 | A1 |
| 20160030076 | Faller et al. | Feb 2016 | A1 |
| 20160089209 | Parihar et al. | Mar 2016 | A1 |
| 20160095617 | Price et al. | Apr 2016 | A1 |
| 20160106509 | Worrell et al. | Apr 2016 | A1 |
| 20160120563 | Messerly et al. | May 2016 | A1 |
| 20160192999 | Stulen et al. | Jul 2016 | A1 |
| 20160206342 | Robertson et al. | Jul 2016 | A1 |
| 20160262786 | Madan et al. | Sep 2016 | A1 |
| 20160296249 | Robertson | Oct 2016 | A1 |
| 20160296250 | Olson et al. | Oct 2016 | A1 |
| 20160296251 | Olson et al. | Oct 2016 | A1 |
| 20160296252 | Olson et al. | Oct 2016 | A1 |
| Number | Date | Country |
|---|---|---|
| 2003241752 | Sep 2003 | AU |
| 2535467 | Apr 1993 | CA |
| 1233944 | Nov 1999 | CN |
| 1253485 | May 2000 | CN |
| 1634601 | Jul 2005 | CN |
| 1640365 | Jul 2005 | CN |
| 1694649 | Nov 2005 | CN |
| 1922563 | Feb 2007 | CN |
| 1951333 | Apr 2007 | CN |
| 101040799 | Sep 2007 | CN |
| 101467917 | Jan 2009 | CN |
| 3904558 | Aug 1990 | DE |
| 9210327 | Nov 1992 | DE |
| 4323585 | Jan 1995 | DE |
| 19608716 | Apr 1997 | DE |
| 20021619 | Mar 2001 | DE |
| 10042606 | Aug 2001 | DE |
| 0136855 | Sep 1984 | EP |
| 0171967 | Feb 1986 | EP |
| 1839599 | Oct 1987 | EP |
| 0336742 | Apr 1989 | EP |
| 0342448 | Nov 1989 | EP |
| 0424685 | May 1991 | EP |
| 0443256 | Aug 1991 | EP |
| 0456470 | Nov 1991 | EP |
| 0598976 | Jan 1994 | EP |
| 0677275 | Mar 1995 | EP |
| 0482195 | Jan 1996 | EP |
| 0695535 | Feb 1996 | EP |
| 0741996 | Nov 1996 | EP |
| 0612570 | Jun 1997 | EP |
| 1108394 | Jun 2001 | EP |
| 1138264 | Oct 2001 | EP |
| 0908148 | Jan 2002 | EP |
| 1229515 | Aug 2002 | EP |
| 1285634 | Feb 2003 | EP |
| 0908155 | Jun 2003 | EP |
| 0705570 | Apr 2004 | EP |
| 0765637 | Jul 2004 | EP |
| 0870473 | Sep 2005 | EP |
| 0624346 | Nov 2005 | EP |
| 1594209 | Nov 2005 | EP |
| 1199044 | Dec 2005 | EP |
| 1609428 | Dec 2005 | EP |
| 1199043 | Mar 2006 | EP |
| 1433425 | Jun 2006 | EP |
| 1256323 | Sep 2006 | EP |
| 1698289 | Sep 2006 | EP |
| 1704824 | Sep 2006 | EP |
| 1749479 | Feb 2007 | EP |
| 1815950 | Aug 2007 | EP |
| 1844720 | Oct 2007 | EP |
| 1862133 | Dec 2007 | EP |
| 1875875 | Jan 2008 | EP |
| 1199045 | Jun 2008 | EP |
| 1964530 | Sep 2008 | EP |
| 1972264 | Sep 2008 | EP |
| 1974771 | Oct 2008 | EP |
| 1435852 | Dec 2008 | EP |
| 1498082 | Dec 2008 | EP |
| 1707131 | Dec 2008 | EP |
| 1997438 | Dec 2008 | EP |
| 1477104 | Jan 2009 | EP |
| 2014218 | Jan 2009 | EP |
| 2042112 | Apr 2009 | EP |
| 1832259 | Jun 2009 | EP |
| 2074959 | Jul 2009 | EP |
| 2106758 | Oct 2009 | EP |
| 2111813 | Oct 2009 | EP |
| 2200145 | Jun 2010 | EP |
| 1214913 | Jul 2010 | EP |
| 2238938 | Oct 2010 | EP |
| 2298154 | Mar 2011 | EP |
| 1510178 | Jun 2011 | EP |
| 1946708 | Jun 2011 | EP |
| 2305144 | Jun 2011 | EP |
| 2335630 | Jun 2011 | EP |
| 1502551 | Jul 2011 | EP |
| 2361562 | Aug 2011 | EP |
| 2365608 | Sep 2011 | EP |
| 2420197 | Feb 2012 | EP |
| 2422721 | Feb 2012 | EP |
| 1927321 | Apr 2012 | EP |
| 2510891 | Oct 2012 | EP |
| 2316359 | Mar 2013 | EP |
| 1586275 | May 2013 | EP |
| 1616529 | Sep 2013 | EP |
| 2583633 | Oct 2014 | EP |
| 2113210 | Mar 2016 | EP |
| 1482943 | Aug 1977 | GB |
| 2032221 | Apr 1980 | GB |
| 2317566 | Apr 1998 | GB |
| 2379878 | Nov 2004 | GB |
| 2447767 | Aug 2011 | GB |
| S 50-100891 | Aug 1975 | JP |
| S 59-68513 | May 1984 | JP |
| S 59141938 | Aug 1984 | JP |
| 62-221343 | Sep 1987 | JP |
| S 62-227343 | Oct 1987 | JP |
| 62-292153 | Dec 1987 | JP |
| S 62-292154 | Dec 1987 | JP |
| 63-109386 | May 1988 | JP |
| 63-315049 | Dec 1988 | JP |
| H 01-151452 | Jun 1989 | JP |
| H 01-198540 | Aug 1989 | JP |
| 02-71510 | May 1990 | JP |
| 2-286149 | Nov 1990 | JP |
| H 02-292193 | Dec 1990 | JP |
| H 03-37061 | Feb 1991 | JP |
| 04-25707 | Feb 1992 | JP |
| H 04-64351 | Feb 1992 | JP |
| 4-30508 | Mar 1992 | JP |
| H 04-150847 | May 1992 | JP |
| H 04-152942 | May 1992 | JP |
| 05-095955 | Apr 1993 | JP |
| H 05-115490 | May 1993 | JP |
| H 06-070938 | Mar 1994 | JP |
| 6-104503 | Apr 1994 | JP |
| 6-507081 | Aug 1994 | JP |
| H 06-217988 | Aug 1994 | JP |
| H 7-508910 | Oct 1995 | JP |
| 7-308323 | Nov 1995 | JP |
| 8-24266 | Jan 1996 | JP |
| 8-275951 | Oct 1996 | JP |
| H 08-299351 | Nov 1996 | JP |
| H 08-336545 | Dec 1996 | JP |
| H 09-503146 | Mar 1997 | JP |
| H 09-135553 | May 1997 | JP |
| H 09-140722 | Jun 1997 | JP |
| H 10-005237 | Jan 1998 | JP |
| 10-295700 | Nov 1998 | JP |
| H 11-501543 | Feb 1999 | JP |
| H 11-128238 | May 1999 | JP |
| H 11-192235 | Jul 1999 | JP |
| 11-253451 | Sep 1999 | JP |
| H 11-318918 | Nov 1999 | JP |
| 2000-041991 | Feb 2000 | JP |
| 2000-070279 | Mar 2000 | JP |
| 2000-210299 | Aug 2000 | JP |
| 2000-287987 | Oct 2000 | JP |
| 2001-029353 | Feb 2001 | JP |
| 2001-502216 | Feb 2001 | JP |
| 2003612 | Jun 2001 | JP |
| 2001-309925 | Nov 2001 | JP |
| 2002-186901 | Jul 2002 | JP |
| 2002-204808 | Jul 2002 | JP |
| 2002-263579 | Sep 2002 | JP |
| 2002-301086 | Oct 2002 | JP |
| 2002-330977 | Nov 2002 | JP |
| 2002-542690 | Dec 2002 | JP |
| 2003-000612 | Jan 2003 | JP |
| 2003-010201 | Jan 2003 | JP |
| 2003-510158 | Mar 2003 | JP |
| 2003-116870 | Apr 2003 | JP |
| 2003-126104 | May 2003 | JP |
| 2003-126110 | May 2003 | JP |
| 2003-310627 | May 2003 | JP |
| 2003-530921 | Oct 2003 | JP |
| 2003-339730 | Dec 2003 | JP |
| 2004-129871 | Apr 2004 | JP |
| 2004-147701 | May 2004 | JP |
| 2005027026 | Jan 2005 | JP |
| 2005-040222 | Feb 2005 | JP |
| 2005-066316 | Mar 2005 | JP |
| 2005-074088 | Mar 2005 | JP |
| 2005-534451 | Nov 2005 | JP |
| 2006-6410 | Jan 2006 | JP |
| 2006-512149 | Apr 2006 | JP |
| 2006-116194 | May 2006 | JP |
| 2006-158525 | Jun 2006 | JP |
| 2006-218296 | Aug 2006 | JP |
| 2006217716 | Aug 2006 | JP |
| 2006-288431 | Oct 2006 | JP |
| 2007-050181 | Mar 2007 | JP |
| 2007-229454 | Sep 2007 | JP |
| 2007-527747 | Oct 2007 | JP |
| 2008-508065 | Mar 2008 | JP |
| 2008-119250 | May 2008 | JP |
| 2008-521503 | Jun 2008 | JP |
| D1339835 | Aug 2008 | JP |
| 2008-212679 | Sep 2008 | JP |
| 2008-536562 | Sep 2008 | JP |
| 2008-284374 | Nov 2008 | JP |
| 2009-511206 | Mar 2009 | JP |
| 2009-517181 | Apr 2009 | JP |
| 4262923 | May 2009 | JP |
| 2009-523567 | Jun 2009 | JP |
| 2009-236177 | Oct 2009 | JP |
| 2009-254819 | Nov 2009 | JP |
| 2010-000336 | Jan 2010 | JP |
| 2010-514923 | May 2010 | JP |
| 2010-534522 | Nov 2010 | JP |
| 2010-540186 | Dec 2010 | JP |
| 2011-505198 | Feb 2011 | JP |
| 2012-235658 | Nov 2012 | JP |
| 5208761 | Jun 2013 | JP |
| 5714508 | May 2015 | JP |
| 2154437 | Aug 2000 | RU |
| 22035 | Mar 2002 | RU |
| WO 9222259 | Dec 1992 | WO |
| WO 9308757 | May 1993 | WO |
| WO 9314708 | Aug 1993 | WO |
| WO 9316646 | Sep 1993 | WO |
| WO 9320877 | Oct 1993 | WO |
| WO 9421183 | Sep 1994 | WO |
| WO 9424949 | Nov 1994 | WO |
| WO 9509572 | Apr 1995 | WO |
| WO 9534259 | Dec 1995 | WO |
| WO 9630885 | Oct 1996 | WO |
| WO 9639086 | Dec 1996 | WO |
| WO 9816156 | Apr 1998 | WO |
| WO 9826739 | Jun 1998 | WO |
| WO 9835621 | Aug 1998 | WO |
| WO 9837815 | Sep 1998 | WO |
| WO 9847436 | Oct 1998 | WO |
| WO 9920213 | Apr 1999 | WO |
| WO 9952489 | Oct 1999 | WO |
| WO 0064358 | Nov 2000 | WO |
| WO 0074585 | Dec 2000 | WO |
| WO 0124713 | Apr 2001 | WO |
| WO 0154590 | Aug 2001 | WO |
| WO 0167970 | Sep 2001 | WO |
| WO 0195810 | Dec 2001 | WO |
| WO 0224080 | Mar 2002 | WO |
| WO 0238057 | May 2002 | WO |
| WO 02062241 | Aug 2002 | WO |
| WO 03082133 | Oct 2003 | WO |
| WO 2004012615 | Feb 2004 | WO |
| WO 2004026104 | Apr 2004 | WO |
| WO 2004032754 | Apr 2004 | WO |
| WO 2004032762 | Apr 2004 | WO |
| WO 2004032763 | Apr 2004 | WO |
| WO 2004037095 | May 2004 | WO |
| WO 2004060141 | Jul 2004 | WO |
| WO 2004098426 | Nov 2004 | WO |
| WO 2004112618 | Dec 2004 | WO |
| WO 2005117735 | Dec 2005 | WO |
| WO 2005122917 | Dec 2005 | WO |
| WO 2006012797 | Feb 2006 | WO |
| WO 2006042210 | Apr 2006 | WO |
| WO 2006058223 | Jun 2006 | WO |
| WO 2006063199 | Jun 2006 | WO |
| WO 2006083988 | Aug 2006 | WO |
| WO 2006101661 | Sep 2006 | WO |
| WO 2006119139 | Nov 2006 | WO |
| WO 2006119376 | Nov 2006 | WO |
| WO 2006129465 | Dec 2006 | WO |
| WO 2007008703 | Jan 2007 | WO |
| WO 2007008710 | Jan 2007 | WO |
| WO 2007038538 | Apr 2007 | WO |
| WO 2007040818 | Apr 2007 | WO |
| WO 2007047380 | Apr 2007 | WO |
| WO 2007047531 | Apr 2007 | WO |
| WO 2007056590 | May 2007 | WO |
| WO 2007087272 | Aug 2007 | WO |
| WO 2007143665 | Dec 2007 | WO |
| WO 2008016886 | Feb 2008 | WO |
| WO 2008042021 | Apr 2008 | WO |
| WO 2008049084 | Apr 2008 | WO |
| WO 2008051764 | May 2008 | WO |
| WO 2008089174 | Jul 2008 | WO |
| WO 2008118709 | Oct 2008 | WO |
| WO 2008130793 | Oct 2008 | WO |
| WO 2009010565 | Jan 2009 | WO |
| WO 2009018067 | Feb 2009 | WO |
| WO 2009018406 | Feb 2009 | WO |
| WO 2009027065 | Mar 2009 | WO |
| WO 2009046234 | Apr 2009 | WO |
| WO 2009073402 | Jun 2009 | WO |
| WO 2009120992 | Oct 2009 | WO |
| WO 2010017149 | Feb 2010 | WO |
| WO 2010068783 | Jun 2010 | WO |
| WO 2011008672 | Jan 2011 | WO |
| WO 2011052939 | May 2011 | WO |
| WO 2011100321 | Aug 2011 | WO |
| WO 2011144911 | Nov 2011 | WO |
| WO 2012061722 | May 2012 | WO |
| WO 2012128362 | Sep 2012 | WO |
| WO 2012135705 | Oct 2012 | WO |
| WO 2012135721 | Oct 2012 | WO |
| WO 2013018934 | Feb 2013 | WO |
| WO 2013062978 | May 2013 | WO |
| WO 2014092108 | Jun 2014 | WO |
| Entry |
|---|
| Partial European Search Report for 12187105.7, dated Jan. 31, 2013 (7 pages). |
| European Search Report for 12187105.7, dated May 23, 2013 (10 pages). |
| Partial European Search Report for 14194795.2, dated May 26, 2015 (7 pages). |
| Extended European Search Report for 14194795.2, dated Sep. 30, 2015 (10 pages). |
| International Preliminary Report on Patentability for PCT/US2010/051787, Apr. 11, 2012 (27 pages). |
| International Preliminary Report on Patentability for PCT/US2013/036568, Oct. 21, 2014 (10 pages). |
| Partial International Search Report for PCT/US2010/051787, Feb. 17, 2011 (3 pages). |
| International Search Report for PCT/US2010/051787, Aug. 26, 2011 (11 pages). |
| International Search Report for PCT/US2013/036568, dated Nov. 11, 2013 (7 pages). |
| Gerhard, Glen C., “Surgical Electrotechnology: Quo Vadis?,” IEEE Transactions on Biomedical Engineering, vol. BME-31, No. 12, pp. 787-792, Dec. 1984. |
| Fowler, K.R., “A Programmable, Arbitrary Waveform Electrosurgical Device,” IEEE Engineering in Medicine and Biology Society 10th Annual International Conference, pp. 1324, 1325 (1988). |
| LaCourse, J.R.; Vogt, M.C.; Miller, W.T., III; Selikowitz, S.M., “Spectral Analysis Interpretation of Electrosurgical Generator Nerve and Muscle Stimulation,” IEEE Transactions on Biomedical Engineering, vol. 35, No. 7, pp. 505-509, Jul. 1988. |
| Incropera et al., “Fundamentals of Heat and Mass Transfer”, Wiley, New York (1990). (Book—not attached). |
| F. A. Duck, “Optical Properties of Tissue Including Ultraviolet and Infrared Radiation,” pp. 43-71 in Physical Properties of Tissue (1990). |
| Orr et al., “Overview of Bioheat Transfer,” pp. 367-384 in Optical-Thermal Response of Laser-Irradiated Tissue, A. J. Welch and M. J. C. van Gemert, eds., Plenum, New York (1995). |
| Campbell et al, “Thermal Imaging in Surgery,” p. 19-3, in Medical Infrared Imaging, N. A. Diakides and J. D. Bronzino, Eds. (2008). |
| http://www.apicalinstr.com/generators.htm. |
| http://www.dotmed.com/listing/electrosurical-unit/ethicon/ultracision-g110-/1466724. |
| http:/www.ethicon.com/gb-en/healthcare-professionals/products/energy-devices/capital//ge . . . . |
| http://www.4-traders.com/JOHNSON-JOHNSON-4832/news/Johnson-Johnson-Ethicon-E . . . . |
| http://www.medicalexpo.com/medical-manufacturer/electrosurgical-generator-6951.html. |
| http://www.megadyne.com/es—generator.php. |
| http://www.valleylab.com/product/es/generators/index.html. |
| Technology Overview, printed from www.harmonicscalpel.com, internet site, website accessed on Jun. 13, 2007, (3 pages). |
| Sherrit et al., “Novel Horn Designs for Ultrasonic/Sonic Cleaning Welding, Soldering, Cutting and Drilling,” Proc. SPIE Smart Structures Conference, vol. 4701, Paper No. 34, San Diego, CA, pp. 353-360, Mar. 2002. |
| AST Products, Inc., “Principles of Video Contact Angle Analysis,” 20 pages, (2006). |
| Lim et al., “A Review of Mechanism Used in Laparoscopic Surgical Instruments,” Mechanism and Machine Theory, vol. 38, pp. 1133-1147, (2003). |
| Gooch et al., “Recommended Infection-Control Practices for Dentistry, 1993,” Published: May 28, 1993; [retrieved on Aug. 23, 2008]. Retrieved from the internet: URL: http//wonder.cdc.gov/wonder/prevguid/p0000191/p0000191.asp (15 pages). |
| Huston et al., “Magnetic and Magnetostrictive Properties of Cube Textured Nickel for Magnetostrictive Transducer Applications,” IEEE Transactions on Magnetics, vol. 9(4), pp. 636-640 (Dec. 1973). |
| Sullivan, “Cost-Constrained Selection of Strand Diameter and Number in a Litz-Wire Transformer Winding,” IEEE Transactions on Power Electronics, vol. 16, No. 2, Mar. 2001, pp. 281-288. |
| Sullivan, “Optimal Choice for Number of Strands in a Litz-Wire Transformer Winding,” IEEE Transactions on Power Electronics, vol. 14, No. 2, Mar. 1999, pp. 283-291. |
| Graff, K.F., “Elastic Wave Propagation in a Curved Sonic Transmission Line,” IEEE Transactions on Sonics and Ultrasonics, SU-17(1), 1-6 (1970). |
| Makarov, S. N., Ochmann, M., Desinger, K., “The longitudinal vibration response of a curved fiber used for laser ultrasound surgical therapy,” Journal of the Acoustical Society of America 102, 1191-1199 (1997). |
| Morley, L. S. D., “Elastic Waves in a Naturally Curved Rod,” Quarterly Journal of Mechanics and Applied Mathematics, 14: 155-172 (1961). |
| Walsh, S. J., White, R. G., “Vibrational Power Transmission in Curved Beams,” Journal of Sound and Vibration, 233(3), 455-488 (2000). |
| Covidien 501(k) Summary Sonicision, dated Feb. 24, 2011 (7 pages). |
| U.S. Appl. No. 13/751,680, filed Jan. 28, 2013. |
| Number | Date | Country | |
|---|---|---|---|
| 20160089533 A1 | Mar 2016 | US |
| Number | Date | Country | |
|---|---|---|---|
| 61250217 | Oct 2009 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 13448175 | Apr 2012 | US |
| Child | 14867966 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 13251766 | Oct 2011 | US |
| Child | 13448175 | US | |
| Parent | 12896360 | Oct 2010 | US |
| Child | 13251766 | US |
