Surgical instruments with articulating shafts

Description

BACKGROUND

Various embodiments are directed to surgical devices, including various articulatable shafts and ultrasonic blades for use with surgical devices.

Ultrasonic surgical devices, such as ultrasonic scalpels, are used in many 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 comprises a proximally-positioned ultrasonic transducer and an instrument coupled to the ultrasonic transducer having a distally-mounted end effector comprising an ultrasonic blade to cut and seal tissue. The end effector is typically coupled either to a handle and/or a robotic surgical implement via a shaft. The blade is acoustically coupled to the transducer via a waveguide extending through the shaft. 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. 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 hemostatic 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.

Also used in many surgical applications are electrosurgical devices. Electrosurgical devices apply electrical energy to tissue in order to treat tissue. An electrosurgical device may comprise an instrument having a distally-mounted end effector comprising one or more electrodes. The end effector can be positioned against 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 sometimes also comprises 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. 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.

With respect to both ultrasonic and electrosurgical devices, it is often desirable for clinicians to articulate a distal portion of the instrument shaft in order to direct the application of ultrasonic and/or RF energy. Bringing about and controlling such articulation, however, is often a considerable challenge.

DRAWINGS

The features of the various embodiments are set forth with particularity in the appended claims. The various embodiments, however, both as to organization and methods of operation, together with advantages thereof, may best be understood by reference to the following description, taken in conjunction with the accompanying drawings as follows:

FIG. 1 illustrates one embodiment of a surgical system including a surgical instrument and an ultrasonic generator.

FIG. 2 illustrates one embodiment of the surgical instrument shown in FIG. 1.

FIG. 3 illustrates one embodiment of an ultrasonic end effector.

FIG. 4 illustrates another embodiment of an ultrasonic end effector.

FIG. 5 illustrates an exploded view of one embodiment of the surgical instrument shown in FIG. 1.

FIG. 6 illustrates a cut-away view of one embodiment of the surgical instrument shown in FIG. 1.

FIG. 7 illustrates various internal components of one embodiment of the surgical instrument shown in FIG. 1

FIG. 8 illustrates a top view of one embodiment of a surgical system including a surgical instrument and an ultrasonic generator.

FIG. 9 illustrates one embodiment of a rotation assembly included in one example embodiment of the surgical instrument of FIG. 1.

FIG. 10 illustrates one embodiment of a surgical system including a surgical instrument having a single element end effector.

FIG. 11 is a perspective view of one embodiment of an electrical energy surgical instrument.

FIG. 12 is a side view of a handle of one embodiment of the surgical instrument of FIG. 11 with a half of a handle body removed to illustrate some of the components therein.

FIG. 13 illustrates a perspective view of one embodiment of the end effector of the surgical instrument of FIG. 11 with the jaws open and the distal end of an axially movable member in a retracted position.

FIG. 14 illustrates a perspective view of one embodiment of the end effector of the surgical instrument of FIG. 11 with the jaws closed and the distal end of an axially movable member in a partially advanced position.

FIG. 15 illustrates a perspective view of one embodiment of the axially moveable member of the surgical instrument of FIG. 11.

FIG. 16 illustrates a section view of one embodiment of the end effector of the surgical instrument of FIG. 11.

FIG. 17 illustrates a section a perspective view of one embodiment of a cordless electrical energy surgical instrument.

FIG. 18A illustrates a side view of a handle of one embodiment of the surgical instrument of FIG. 17 with a half handle body removed to illustrate various components therein.

FIG. 18B illustrates an RF drive and control circuit, according to one embodiment.

FIG. 18C illustrates the main components of the controller, according to one embodiment.

FIG. 19 illustrates a block diagram of one embodiment of a robotic surgical system.

FIG. 20 illustrates one embodiment of a robotic arm cart.

FIG. 21 illustrates one embodiment of the robotic manipulator of the robotic arm cart of FIG. 20.

FIG. 22 illustrates one embodiment of a robotic arm cart having an alternative set-up joint structure.

FIG. 23 illustrates one embodiment of a controller that may be used in conjunction with a robotic arm cart, such as the robotic arm carts of FIGS. 19-22.

FIG. 24 illustrates one embodiment of an ultrasonic surgical instrument adapted for use with a robotic system.

FIG. 25 illustrates one embodiment of an electrosurgical instrument adapted for use with a robotic system.

FIG. 26 illustrates one embodiment of an instrument drive assembly that may be coupled to a surgical manipulator to receive and control the surgical instrument shown in FIG. 24.

FIG. 27 illustrates another view of the instrument drive assembly embodiment of FIG. 26 including the surgical instrument of FIG. 24.

FIG. 28 illustrates another view of the instrument drive assembly of FIG. 26 including the electrosurgical instrument of FIG. 25.

FIGS. 29-31 illustrate additional views of the adapter portion of the instrument drive assembly embodiment of FIG. 26.

FIGS. 32-34 illustrate one embodiment of the instrument mounting portion of FIGS. 24-25 showing components for translating motion of the driven elements into motion of the surgical instrument.

FIGS. 35-37 illustrate an alternate embodiment of the instrument mounting portion of FIGS. 24-25 showing an alternate example mechanism for translating rotation of the driven elements into rotational motion about the axis of the shaft and an alternate example mechanism for generating reciprocating translation of one or more members along the axis of the shaft 538.

FIGS. 38-42 illustrate an alternate embodiment of the instrument mounting portion FIGS. 24-25 showing another alternate example mechanism for translating rotation of the driven elements into rotational motion about the axis of the shaft.

FIGS. 43-46A illustrate an alternate embodiment of the instrument mounting portion showing an alternate example mechanism for differential translation of members along the axis of the shaft (e.g., for articulation).

FIGS. 46B-46C illustrate one embodiment of a tool mounting portion comprising internal power and energy sources.

FIG. 47 illustrates a schematic cross-sectional view of a portion of one example embodiment of an ultrasonic medical instrument comprising first, second and third waveguide portions, where the second waveguide portion is substantially % of a resonant-longitudinal-wavelength long.

FIG. 47A illustrates cross sections for two example embodiments of the second waveguide portion of FIG. 47.

FIG. 48 illustrates a schematic cross-sectional view of a portion of one example embodiment of an ultrasonic medical instrument comprising first and second waveguide portions, where the first waveguide portion spans multiple % resonant longitudinal wavelengths.

FIG. 49 illustrates a schematic cross-sectional view of one example embodiment of an ultrasonic waveguide for use with a medical instrument and comprising first and second waveguide portions, where a first waveguide portion is joined to a second waveguide portion by a dowel press fit.

FIG. 50 illustrates a schematic cross-sectional view of one example embodiment of an ultrasonic waveguide for use with a medical instrument and comprising first and second waveguide portions, where the first waveguide portion is joined to the second waveguide portion by a ball-and-socket type attachment.

FIG. 51 illustrates a schematic cross-sectional view of a portion of another embodiment of an ultrasonic medical instrument comprising a medical ultrasonic waveguide having a length and including a proximal waveguide portion and a distal waveguide portion.

FIG. 52 illustrates one embodiment of a shaft that may be utilized with various surgical instruments, including those described herein.

FIG. 53 illustrates one embodiment of the shaft of FIG. 52 with the wedge translated distally and the blade pivoted, as described.

FIG. 54 illustrates an alternative embodiment of the shaft of FIG. 52 comprising several additional features.

FIG. 55 illustrates one embodiment of an example wedge having a curved or rounded shape.

FIG. 56 illustrates the wedge in conjunction with an end effector comprising an ultrasonic blade as well as a flange.

FIG. 57 illustrates a cross-section of one embodiment of the shaft showing a keyed flange.

FIG. 58 illustrates one embodiment of a keyed wedge comprising steps matching the notches of the keyed flange of FIG. 57.

FIG. 59 illustrates a wedge for use with the shaft, the wedge having a stepped profile.

FIG. 60 illustrates one example embodiment of a shaft for use with various surgical instruments having a cammed articulation mechanism, including those described herein.

FIG. 61 illustrates a cross-sectional view of the shaft of FIG. 60 providing a view of the shaft cam feature and waveguide cam feature.

FIG. 62-64 illustrates one embodiment of an articulating shaft that may be utilized with various surgical instruments, including those described herein.

FIGS. 65-67 illustrate one example embodiment of a shaft coupled to an end effector comprising an ultrasonic blade and a pivotable clamp arm.

FIG. 68 illustrates one embodiment of the end effector of FIGS. 65-67 illustrating a first way to utilize the clamp arm member to open and close the clamp arm.

FIGS. 69-70 illustrate another example embodiment of the end effector of FIGS. 65-67 illustrating an additional way to utilize the clamp arm member to open and close the clamp arm.

FIGS. 71-72 illustrate one example embodiment of the shaft of FIGS. 65-67 showing an example mechanism for managing differential translation of the translating members.

FIGS. 73-74 illustrate one embodiment of a hand-held surgical instrument utilizing the shaft of FIGS. 65-67 in the configuration shown in FIGS. 71-72.

FIGS. 75-76 illustrate one embodiment of an articulating shaft that may be utilized with various surgical instruments, including those described herein.

FIG. 77 illustrates one embodiment of a shaft that may be utilized with various surgical instruments, including those described herein.

FIG. 78 illustrates a view showing additional details of one embodiment of an outer shaft shown in FIG. 77.

FIG. 79 illustrates a cut-away view of one embodiment of the shaft shown in FIG. 77.

FIG. 80 illustrates the cut-away view of one embodiment of the shaft of FIG. 79, with the outer shaft extended distally to articulate the blade.

FIG. 81 illustrates one embodiment of the shaft of FIG. 77 having an additional distal flange.

DESCRIPTION

Example embodiments described herein are directed to articulating surgical instruments, shafts thereof, and methods of using the same. The surgical instruments may comprise an end effector configured to treat tissue in any suitable manner. In some example embodiments, the end effector comprises an ultrasonic blade for cutting and/or coagulating tissue. Details of example ultrasonic blades and the operation thereof are provided herein. Also, in some example embodiments, the end effector can comprise one or more electrodes for providing electrical energy to tissue for cutting, coagulating and/or “welding” tissue. Surgical instruments described herein may be utilized in different surgical settings. For example, different embodiments may be optimized for endoscopic, laparoscopic and/or traditional open surgical techniques. Also, different example embodiments of the surgical instruments described herein may be optimized for manual use by a clinician and/or for robotic use by a clinician in conjunction with a surgical robot.

Various example embodiments of surgical instruments described herein comprise an elongated shaft extending proximally from the end effector along a longitudinal axis. In some example embodiments, the end effector comprises an ultrasonic blade that may be articulated and/or directed from within the shaft (e.g., without otherwise articulating the shaft or in addition to otherwise articulating the shaft). For example, in some example embodiments, the ultrasonic blade is acoustically coupled to a waveguide extending proximally from the ultrasonic blade through the shaft. The waveguide may define a distally positioned flange positioned within the hollow shaft proximally from the blade. The waveguide may further be held stationary at a first pivot point positioned within the shaft proximally from the flange. A reciprocating wedge may be positioned to reciprocate distally and proximally within the shaft. Distal translation of the wedge may push the wedge between the flange and an interior wall of the shaft, ending to cause the ultrasonic blade and waveguide to pivot away from a longitudinal axis of the shaft about the first pivot point. Additional wedges may be placed at different angular positions around the interior wall of the shaft so as to articulate the ultrasonic blade in different directions.

In some example embodiments, an interior wall of the shaft defines a longitudinally directed slot and at least a portion of the reciprocating wedge is positioned within the longitudinal slot as the wedge translates distally and proximally. Also, in some example embodiments, the wedge and flange have corresponding keyed surfaces. For example, the flange may define a notch and the wedge may define a corresponding step such that the step rides within the notch as the reciprocating wedge is translated distally. Additional notches and wedges may also be present and, in some example embodiments, form a step pattern. In some example embodiments, the reciprocating wedge may be stepped, where steps are arranged along the longitudinal axis such that successive steps of the wedge cause the ultrasonic blade and waveguide to pivot about the pivot point by differing amounts.

In some example embodiments, the shaft is translatable along the longitudinal axis relative to the waveguide and ultrasonic blade. For example, the shaft may define first and second axially-directed slots, wherein the flange of the waveguide comprises first and second pegs positioned within the first and second slots. The shaft may be translatable relative to the ultrasonic blade to alternately sheathe and unsheathe the blade.

In some example embodiments, an interior portion of the hollow shaft defines a shaft cam feature directed towards the longitudinal axis. The shaft may be rotatable such that the shaft cam alternately contacts and does not contact the flange of the waveguide. In some embodiments, the flange of the waveguide has a corresponding cam feature. When the cam feature contacts the flange, it may cause the waveguide and ultrasonic blade to pivot about the pivot point. In various example embodiments, multiple surface cam features and/or multiple cam features on the flange may be utilized to bring about pivoting of the ultrasonic blade and waveguide in different directions.

In various example embodiments, the interior wall of the shaft defines a groove. Different portions of the groove are positioned at different axial distances from the end effector. The instrument may further comprise first and second interface members coupled to the ultrasonic blade and/or the waveguide at a coupling point. Each interface member extends proximally from the coupling point to a peg member. The peg members are positioned within the groove. The first interface member has a first length from the coupling point to its peg member while the second interface member has a second length from the coupling point to its peg member, where the second length is less than the first length. When the shaft rotates relative to the waveguide and ultrasonic blade, the pegs may ride within the groove and be forced either distally and/or proximally depending on the position of the pegs within the groove. When the distance from the pegs to the coupling point is different than the length of the respective coupling members, the coupling members may bend, deflecting the ultrasonic blade away from the longitudinal axis.

In various example embodiments, a surgical instrument may comprise an end effector with an ultrasonic blade, a hollow shaft and a waveguide. The shaft may comprise a rigid portion and a flexible portion. The end effector may comprises a member from which the ultrasonic blade extends, a clamp arm coupled to the member at a pivot point offset from the longitudinal axis and a flexible control cable coupled to the clamp arm at a point offset from the pivot point. Distal and proximal translation of the control cable may cause the clamp arm to pivot relative to the ultrasonic blade.

Reference will now be made in detail to several embodiments, including embodiments showing example implementations of manual and robotic surgical instruments with end effectors comprising ultrasonic and/or electrosurgical elements. Wherever practicable similar or like reference numbers may be used in the figures and may indicate similar or like functionality. The figures depict example embodiments of the disclosed surgical instruments and/or methods of use for purposes of illustration only. One skilled in the art will readily recognize from the following description that alternative example embodiments of the structures and methods illustrated herein may be employed without departing from the principles described herein.

FIG. 1 is a right side view of one embodiment of an ultrasonic surgical instrument 10. In the illustrated embodiment, the ultrasonic surgical instrument 10 may be employed in various surgical procedures including endoscopic or traditional open surgical procedures. In one example embodiment, the ultrasonic surgical instrument 10 comprises a handle assembly 12, an elongated shaft assembly 14, and an ultrasonic transducer 16. The handle assembly 12 comprises a trigger assembly 24, a distal rotation assembly 13, and a switch assembly 28. The elongated shaft assembly 14 comprises an end effector assembly 26, which comprises elements to dissect tissue or mutually grasp, cut, and coagulate vessels and/or tissue, and actuating elements to actuate the end effector assembly 26. The handle assembly 12 is adapted to receive the ultrasonic transducer 16 at the proximal end. The ultrasonic transducer 16 is mechanically engaged to the elongated shaft assembly 14 and portions of the end effector assembly 26. The ultrasonic transducer 16 is electrically coupled to a generator 20 via a cable 22. Although the majority of the drawings depict a multiple end effector assembly 26 for use in connection with laparoscopic surgical procedures, the ultrasonic surgical instrument 10 may be employed in more traditional open surgical procedures and in other embodiments, may be configured for use in endoscopic procedures and in other embodiments, may be configured for use in endoscopic procedures. For the purposes herein, the ultrasonic surgical instrument 10 is described in terms of an endoscopic instrument; however, it is contemplated that an open and/or laparoscopic version of the ultrasonic surgical instrument 10 also may include the same or similar operating components and features as described herein.

In various embodiments, the generator 20 comprises several functional elements, such as modules and/or blocks. Different functional elements or modules may be configured for driving different kinds of surgical devices. For example, an ultrasonic generator module 21 may drive an ultrasonic device, such as the ultrasonic surgical instrument 10. In some example embodiments, the generator 20 also comprises an electrosurgery/RF generator module 23 for driving an electrosurgical device (or an electrosurgical embodiment of the ultrasonic surgical instrument 10). In various embodiments, the generator 20 may be formed integrally within the handle assembly 12. In such implementations, a battery would be co-located within the handle assembly 12 to act as the energy source. FIG. 18A and accompanying disclosures provide one example of such implementations. As shown in FIG. 1, according to various embodiments, the ultrasonic generator module 21 and/or the electrosurgery/RF generator module 23 may be located external to the generator (shown in phantom as ultrasonic generator module 21′ and electrosurgery/RF generator module 23′). In some embodiments, the electrosurgery/RF generator module 23 may be configured to generate a therapeutic and/or a sub-therapeutic energy level. In the example embodiment illustrated in FIG. 1, the generator 20 includes a control system 25 integral with the generator 20, and a foot switch 29 connected to the generator via a cable 27. The generator 20 may also comprise a triggering mechanism for activating a surgical instrument, such as the instrument 10. The triggering mechanism may include a power switch (not shown) as well as a foot switch 29. When activated by the foot switch 29, the generator 20 may provide energy to drive the acoustic assembly of the surgical instrument 10 and to drive the end effector 18 at a predetermined excursion level. The generator 20 drives or excites the acoustic assembly at any suitable resonant frequency of the acoustic assembly and/or derives the therapeutic/sub-therapeutic electromagnetic/RF energy.

In one embodiment, the electrosurgical/RF generator module 23 may be implemented as an electrosurgery unit (ESU) capable of supplying power sufficient to perform bipolar electrosurgery using radio frequency (RF) energy. In one embodiment, the ESU can be a bipolar ERBE ICC 350 sold by ERBE USA, Inc. of Marietta, Ga. In bipolar electrosurgery applications, as previously discussed, a surgical instrument having an active electrode and a return electrode can be utilized, wherein the active electrode and the return electrode can be positioned against, or adjacent to, the tissue to be treated such that current can flow from the active electrode to the return electrode through the tissue. Accordingly, the electrosurgical/RF module 23 generator may be configured for therapeutic purposes by applying electrical energy to the tissue T sufficient for treating the tissue (e.g., cauterization).

In one embodiment, the electrosurgical/RF generator module 23 may be configured to deliver a sub-therapeutic RF signal to implement a tissue impedance measurement module. In one embodiment, the electrosurgical/RF generator module 23 comprises a bipolar radio frequency generator as described in more detail below. In one embodiment, the electrosurgical/RF generator module 23 may be configured to monitor electrical impedance Z, of tissue T and to control the characteristics of time and power level based on the tissue T by way of a return electrode provided on a clamp member of the end effector assembly 26. Accordingly, the electrosurgical/RF generator module 23 may be configured for sub-therapeutic purposes for measuring the impedance or other electrical characteristics of the tissue T. Techniques and circuit configurations for measuring the impedance or other electrical characteristics of tissue T are discussed in more detail in commonly assigned U.S. Patent Publication No. 2011/0015631, titled “Electrosurgical Generator for Ultrasonic Surgical Instruments,” the disclosure of which is herein incorporated by reference in its entirety.

A suitable ultrasonic generator module 21 may be configured to functionally operate in a manner similar to the GEN300 sold by Ethicon Endo-Surgery, Inc of Cincinnati, Ohio as is disclosed in one or more of the following U.S. patents, all of which are incorporated by reference herein: U.S. Pat. No. 6,480,796 (Method for Improving the Start Up of an Ultrasonic System Under Zero Load Conditions); U.S. Pat. No. 6,537,291 (Method for Detecting Blade Breakage Using Rate and/or Impedance Information); U.S. Pat. No. 6,662,127 (Method for Detecting Presence of a Blade in an Ultrasonic System); U.S. Pat. No. 6,679,899 (Method for Detecting Transverse Vibrations in an Ultrasonic Hand Piece); U.S. Pat. No. 6,977,495 (Detection Circuitry for Surgical Handpiece System); U.S. Pat. No. 7,077,853 (Method for Calculating Transducer Capacitance to Determine Transducer Temperature); U.S. Pat. No. 7,179,271 (Method for Driving an Ultrasonic System to Improve Acquisition of Blade Resonance Frequency at Startup); and U.S. Pat. No. 7,273,483 (Apparatus and Method for Alerting Generator Function in an Ultrasonic Surgical System).

It will be appreciated that in various embodiments, the generator 20 may be configured to operate in several modes. In one mode, the generator 20 may be configured such that the ultrasonic generator module 21 and the electrosurgical/RF generator module 23 may be operated independently.

For example, the ultrasonic generator module 21 may be activated to apply ultrasonic energy to the end effector assembly 26 and subsequently, either therapeutic or sub-therapeutic RF energy may be applied to the end effector assembly 26 by the electrosurgical/RF generator module 23. As previously discussed, the sub-therapeutic electrosurgical/RF energy may be applied to tissue clamped between claim elements of the end effector assembly 26 to measure tissue impedance to control the activation, or modify the activation, of the ultrasonic generator module 21. Tissue impedance feedback from the application of the sub-therapeutic energy also may be employed to activate a therapeutic level of the electrosurgical/RF generator module 23 to seal the tissue (e.g., vessel) clamped between claim elements of the end effector assembly 26.

In another embodiment, the ultrasonic generator module 21 and the electrosurgical/RF generator module 23 may be activated simultaneously. In one example, the ultrasonic generator module 21 is simultaneously activated with a sub-therapeutic RF energy level to measure tissue impedance simultaneously while the ultrasonic blade of the end effector assembly 26 cuts and coagulates the tissue (or vessel) clamped between the clamp elements of the end effector assembly 26. Such feedback may be employed, for example, to modify the drive output of the ultrasonic generator module 21. In another example, the ultrasonic generator module 21 may be driven simultaneously with electrosurgical/RF generator module 23 such that the ultrasonic blade portion of the end effector assembly 26 is employed for cutting the damaged tissue while the electrosurgical/RF energy is applied to electrode portions of the end effector clamp assembly 26 for sealing the tissue (or vessel).

When the generator 20 is activated via the triggering mechanism, electrical energy is continuously applied by the generator 20 to a transducer stack or assembly of the acoustic assembly. In another embodiment, electrical energy is intermittently applied (e.g., pulsed) by the generator 20. A phase-locked loop in the control system of the generator 20 may monitor feedback from the acoustic assembly. The phase lock loop adjusts the frequency of the electrical energy sent by the generator 20 to match the resonant frequency of the selected longitudinal mode of vibration of the acoustic assembly. In addition, a second feedback loop in the control system 25 maintains the electrical current supplied to the acoustic assembly at a pre-selected constant level in order to achieve substantially constant excursion at the end effector 18 of the acoustic assembly. In yet another embodiment, a third feedback loop in the control system 25 monitors impedance between electrodes located in the end effector assembly 26. Although FIGS. 1-9 show a manually operated ultrasonic surgical instrument, it will be appreciated that ultrasonic surgical instruments may also be used in robotic applications, for example, as described herein, as well as combinations of manual and robotic applications.

In ultrasonic operation mode, the electrical signal supplied to the acoustic assembly may cause the distal end of the end effector 18, to vibrate longitudinally in the range of, for example, approximately 20 kHz to 250 kHz. According to various embodiments, the blade 22 may vibrate in the range of about 54 kHz to 56 kHz, for example, at about 55.5 kHz. In other embodiments, the blade 22 may vibrate at other frequencies including, for example, about 31 kHz or about 80 kHz. The excursion of the vibrations at the blade can be controlled by, for example, controlling the amplitude of the electrical signal applied to the transducer assembly of the acoustic assembly by the generator 20. As noted above, the triggering mechanism of the generator 20 allows a user to activate the generator 20 so that electrical energy may be continuously supplied to the acoustic assembly. The generator 20 also has a power line for insertion in an electro-surgical unit or conventional electrical outlet. It is contemplated that the generator 20 can also be powered by a direct current (DC) source, such as a battery. The generator 20 can comprise any suitable generator, such as Model No. GEN04, and/or Model No. GEN11 available from Ethicon Endo-Surgery, Inc.

FIG. 2 is a left perspective view of one example embodiment of the ultrasonic surgical instrument 10 showing the handle assembly 12, the distal rotation assembly 13, the elongated shaft assembly 14, and the end effector assembly 26. In the illustrated embodiment the elongated shaft assembly 14 comprises a distal end 52 dimensioned to mechanically engage the end effector assembly 26 and a proximal end 50 that mechanically engages the handle assembly 12 and the distal rotation assembly 13. The proximal end 50 of the elongated shaft assembly 14 is received within the handle assembly 12 and the distal rotation assembly 13. More details relating to the connections between the elongated shaft assembly 14, the handle assembly 12, and the distal rotation assembly 13 are provided in the description of FIGS. 5 and 7.

In the illustrated embodiment, the trigger assembly 24 comprises a trigger 32 that operates in conjunction with a fixed handle 34. The fixed handle 34 and the trigger 32 are ergonomically formed and adapted to interface comfortably with the user. The fixed handle 34 is integrally associated with the handle assembly 12. The trigger 32 is pivotally movable relative to the fixed handle 34 as explained in more detail below with respect to the operation of the ultrasonic surgical instrument 10. The trigger 32 is pivotally movable in direction 33A toward the fixed handle 34 when the user applies a squeezing force against the trigger 32. A spring element 98 (FIG. 5) causes the trigger 32 to pivotally move in direction 33B when the user releases the squeezing force against the trigger 32.

In one example embodiment, the trigger 32 comprises an elongated trigger hook 36, which defines an aperture 38 between the elongated trigger hook 36 and the trigger 32. The aperture 38 is suitably sized to receive one or multiple fingers of the user therethrough. The trigger 32 also may comprise a resilient portion 32a molded over the trigger 32 substrate. The resilient portion 32a is formed to provide a more comfortable contact surface for control of the trigger 32 in outward direction 33B. In one example embodiment, the resilient portion 32a may also be provided over a portion of the elongated trigger hook 36 as shown, for example, in FIG. 2. The proximal surface of the elongated trigger hook 32 remains uncoated or coated with a non-resilient substrate to enable the user to easily slide their fingers in and out of the aperture 38. In another embodiment, the geometry of the trigger forms a fully closed loop which defines an aperture suitably sized to receive one or multiple fingers of the user therethrough. The fully closed loop trigger also may comprise a resilient portion molded over the trigger substrate.

In one example embodiment, the fixed handle 34 comprises a proximal contact surface 40 and a grip anchor or saddle surface 42. The saddle surface 42 rests on the web where the thumb and the index finger are joined on the hand. The proximal contact surface 40 has a pistol grip contour that receives the palm of the hand in a normal pistol grip with no rings or apertures. The profile curve of the proximal contact surface 40 may be contoured to accommodate or receive the palm of the hand. A stabilization tail 44 is located towards a more proximal portion of the handle assembly 12. The stabilization tail 44 may be in contact with the uppermost web portion of the hand located between the thumb and the index finger to stabilize the handle assembly 12 and make the handle assembly 12 more controllable.

In one example embodiment, the switch assembly 28 may comprise a toggle switch 30. The toggle switch 30 may be implemented as a single component with a central pivot 304 located within inside the handle assembly 12 to eliminate the possibility of simultaneous activation. In one example embodiment, the toggle switch 30 comprises a first projecting knob 30a and a second projecting knob 30b to set the power setting of the ultrasonic transducer 16 between a minimum power level (e.g., MIN) and a maximum power level (e.g., MAX). In another embodiment, the rocker switch may pivot between a standard setting and a special setting. The special setting may allow one or more special programs to be implemented by the device. The toggle switch 30 rotates about the central pivot as the first projecting knob 30a and the second projecting knob 30b are actuated. The one or more projecting knobs 30a, 30b are coupled to one or more arms that move through a small arc and cause electrical contacts to close or open an electric circuit to electrically energize or de-energize the ultrasonic transducer 16 in accordance with the activation of the first or second projecting knobs 30a, 30b. The toggle switch 30 is coupled to the generator 20 to control the activation of the ultrasonic transducer 16. The toggle switch 30 comprises one or more electrical power setting switches to activate the ultrasonic transducer 16 to set one or more power settings for the ultrasonic transducer 16. The forces required to activate the toggle switch 30 are directed substantially toward the saddle point 42, thus avoiding any tendency of the instrument to rotate in the hand when the toggle switch 30 is activated.

In one example embodiment, the first and second projecting knobs 30a, 30b are located on the distal end of the handle assembly 12 such that they can be easily accessible by the user to activate the power with minimal, or substantially no, repositioning of the hand grip, making it suitable to maintain control and keep attention focused on the surgical site (e.g., a monitor in a laparoscopic procedure) while activating the toggle switch 30. The projecting knobs 30a, 30b may be configured to wrap around the side of the handle assembly 12 to some extent to be more easily accessible by variable finger lengths and to allow greater freedom of access to activation in awkward positions or for shorter fingers.

In the illustrated embodiment, the first projecting knob 30a comprises a plurality of tactile elements 30c, e.g., textured projections or “bumps” in the illustrated embodiment, to allow the user to differentiate the first projecting knob 30a from the second projecting knob 30b. It will be appreciated by those skilled in the art that several ergonomic features may be incorporated into the handle assembly 12. Such ergonomic features are described in U.S. Pat. App. Pub. No. 2009/0105750 entitled “Ergonomic Surgical Instruments,” now U.S. Pat. No. 8,623,027, which is incorporated by reference herein in its entirety.

In one example embodiment, the toggle switch 30 may be operated by the hand of the user. The user may easily access the first and second projecting knobs 30a, 30b at any point while also avoiding inadvertent or unintentional activation at any time. The toggle switch 30 may readily operated with a finger to control the power to the ultrasonic assembly 16 and/or to the ultrasonic assembly 16. For example, the index finger may be employed to activate the first contact portion 30a to turn on the ultrasonic assembly 16 to a maximum (MAX) power level. The index finger may be employed to activate the second contact portion 30b to turn on the ultrasonic assembly 16 to a minimum (MIN) power level. In another embodiment, the rocker switch may pivot the instrument 10 between a standard setting and a special setting. The special setting may allow one or more special programs to be implemented by the instrument 10. The toggle switch 30 may be operated without the user having to look at the first or second projecting knob 30a, 30b. For example, the first projecting knob 30a or the second projecting knob 30b may comprise a texture or projections to tactilely differentiate between the first and second projecting knobs 30a, 30b without looking.

In other embodiments, the trigger 32 and/or the toggle switch 30 may be employed to actuate the electrosurgical/RF generator module 23 individually or in combination with activation of the ultrasonic generator module 21.

In one example embodiment, the distal rotation assembly 13 is rotatable without limitation in either direction about a longitudinal axis “T.” The distal rotation assembly 13 is mechanically engaged to the elongated shaft assembly 14. The distal rotation assembly 13 is located on a distal end of the handle assembly 12. The distal rotation assembly 13 comprises a cylindrical hub 46 and a rotation knob 48 formed over the hub 46. The hub 46 mechanically engages the elongated shaft assembly 14. The rotation knob 48 may comprise fluted polymeric features and may be engaged by a finger (e.g., an index finger) to rotate the elongated shaft assembly 14. The hub 46 may comprise a material molded over the primary structure to form the rotation knob 48. The rotation knob 48 may be overmolded over the hub 46. The hub 46 comprises an end cap portion 46a that is exposed at the distal end. The end cap portion 46a of the hub 46 may contact the surface of a trocar during laparoscopic procedures. The hub 46 may be formed of a hard durable plastic such as polycarbonate to alleviate any friction that may occur between the end cap portion 46a and the trocar. The rotation knob 48 may comprise “scallops” or flutes formed of raised ribs 48a and concave portions 48b located between the ribs 48a to provide a more precise rotational grip. In one example embodiment, the rotation knob 48 may comprise a plurality of flutes (e.g., three or more flutes). In other embodiments, any suitable number of flutes may be employed. The rotation knob 48 may be formed of a softer polymeric material overmolded onto the hard plastic material. For example, the rotation knob 48 may be formed of pliable, resilient, flexible polymeric materials including Versaflex® TPE alloys made by GLS Corporation, for example. This softer overmolded material may provide a greater grip and more precise control of the movement of the rotation knob 48. It will be appreciated that any materials that provide adequate resistance to sterilization, are biocompatible, and provide adequate frictional resistance to surgical gloves may be employed to form the rotation knob 48.

In one example embodiment, the handle assembly 12 is formed from two (2) housing portions or shrouds comprising a first portion 12a and a second portion 12b. From the perspective of a user viewing the handle assembly 12 from the distal end towards the proximal end, the first portion 12a is considered the right portion and the second portion 12b is considered the left portion. Each of the first and second portions 12a, 12b includes a plurality of interfaces 69 (FIG. 7) dimensioned to mechanically align and engage each another to form the handle assembly 12 and enclosing the internal working components thereof. The fixed handle 34, which is integrally associated with the handle assembly 12, takes shape upon the assembly of the first and second portions 12a and 12b of the handle assembly 12. A plurality of additional interfaces (not shown) may be disposed at various points around the periphery of the first and second portions 12a and 12b of the handle assembly 12 for ultrasonic welding purposes, e.g., energy direction/deflection points. The first and second portions 12a and 12b (as well as the other components described below) may be assembled together in any fashion known in the art. For example, alignment pins, snap-like interfaces, tongue and groove interfaces, locking tabs, adhesive ports, may all be utilized either alone or in combination for assembly purposes.

In one example embodiment, the elongated shaft assembly 14 comprises a proximal end 50 adapted to mechanically engage the handle assembly 12 and the distal rotation assembly 13; and a distal end 52 adapted to mechanically engage the end effector assembly 26. The elongated shaft assembly 14 comprises an outer tubular sheath 56 and a reciprocating tubular actuating member 58 located within the outer tubular sheath 56. The proximal end of the tubular reciprocating tubular actuating member 58 is mechanically engaged to the trigger 32 of the handle assembly 12 to move in either direction 60A or 60B in response to the actuation and/or release of the trigger 32. The pivotably moveable trigger 32 may generate reciprocating motion along the longitudinal axis “T.” Such motion may be used, for example, to actuate the jaws or clamping mechanism of the end effector assembly 26. A series of linkages translate the pivotal rotation of the trigger 32 to axial movement of a yoke coupled to an actuation mechanism, which controls the opening and closing of the jaws of the clamping mechanism of the end effector assembly 26. The distal end of the tubular reciprocating tubular actuating member 58 is mechanically engaged to the end effector assembly 26. In the illustrated embodiment, the distal end of the tubular reciprocating tubular actuating member 58 is mechanically engaged to a clamp arm assembly 64, which is pivotable about a pivot point 70, to open and close the clamp arm assembly 64 in response to the actuation and/or release of the trigger 32. For example, in the illustrated embodiment, the clamp arm assembly 64 is movable in direction 62A from an open position to a closed position about a pivot point 70 when the trigger 32 is squeezed in direction 33A. The clamp arm assembly 64 is movable in direction 62B from a closed position to an open position about the pivot point 70 when the trigger 32 is released or outwardly contacted in direction 33B.

In one example embodiment, the end effector assembly 26 is attached at the distal end 52 of the elongated shaft assembly 14 and includes a clamp arm assembly 64 and a blade 66. The jaws of the clamping mechanism of the end effector assembly 26 are formed by clamp arm assembly 64 and the blade 66. The blade 66 is ultrasonically actuatable and is acoustically coupled to the ultrasonic transducer 16. The trigger 32 on the handle assembly 12 is ultimately connected to a drive assembly, which together, mechanically cooperate to effect movement of the clamp arm assembly 64. Squeezing the trigger 32 in direction 33A moves the clamp arm assembly 64 in direction 62A from an open position, wherein the clamp arm assembly 64 and the blade 66 are disposed in a spaced relation relative to one another, to a clamped or closed position, wherein the clamp arm assembly 64 and the blade 66 cooperate to grasp tissue therebetween. The clamp arm assembly 64 may comprise a clamp pad (not shown) to engage tissue between the blade 66 and the clamp arm 64. Releasing the trigger 32 in direction 33B moves the clamp arm assembly 64 in direction 62B from a closed relationship, to an open position, wherein the clamp arm assembly 64 and the blade 66 are disposed in a spaced relation relative to one another.

The proximal portion of the handle assembly 12 comprises a proximal opening 68 to receive the distal end of the ultrasonic assembly 16. The ultrasonic assembly 16 is inserted in the proximal opening 68 and is mechanically engaged to the elongated shaft assembly 14.

In one example embodiment, the elongated trigger hook 36 portion of the trigger 32 provides a longer trigger lever with a shorter span and rotation travel. The longer lever of the elongated trigger hook 36 allows the user to employ multiple fingers within the aperture 38 to operate the elongated trigger hook 36 and cause the trigger 32 to pivot in direction 33B to open the jaws of the end effector assembly 26. For example, the user may insert three fingers (e.g., the middle, ring, and little fingers) in the aperture 38. Multiple fingers allows the surgeon to exert higher input forces on the trigger 32 and the elongated trigger hook 36 to activate the end effector assembly 26. The shorter span and rotation travel creates a more comfortable grip when closing or squeezing the trigger 32 in direction 33A or when opening the trigger 32 in the outward opening motion in direction 33B lessening the need to extend the fingers further outward. This substantially lessens hand fatigue and strain associated with the outward opening motion of the trigger 32 in direction 33B. The outward opening motion of the trigger may be spring-assisted by spring element 98 (FIG. 5) to help alleviate fatigue. The opening spring force is sufficient to assist the ease of opening, but not strong enough to adversely impact the tactile feedback of tissue tension during spreading dissection.

For example, during a surgical procedure the index finger may be used to control the rotation of the elongated shaft assembly 14 to locate the jaws of the end effector assembly 26 in a suitable orientation. The middle and/or the other lower fingers may be used to squeeze the trigger 32 and grasp tissue within the jaws. Once the jaws are located in the desired position and the jaws are clamped against the tissue, the index finger can be used to activate the toggle switch 30 to adjust the power level of the ultrasonic transducer 16 to treat the tissue. Once the tissue has been treated, the user may release the trigger 32 by pushing outwardly in the distal direction against the elongated trigger hook 36 with the middle and/or lower fingers to open the jaws of the end effector assembly 26. This basic procedure may be performed without the user having to adjust their grip of the handle assembly 12.

FIGS. 3-4 illustrate the connection of the elongated shaft assembly 14 relative to the end effector assembly 26. As previously described, in the illustrated embodiment, the end effector assembly 26 comprises a clamp arm assembly 64 and a blade 66 to form the jaws of the clamping mechanism. The blade 66 may be an ultrasonically actuatable blade acoustically coupled to the ultrasonic transducer 16. The trigger 32 is mechanically connected to a drive assembly. Together, the trigger 32 and the drive assembly mechanically cooperate to move the clamp arm assembly 64 to an open position in direction 62A wherein the clamp arm assembly 64 and the blade 66 are disposed in spaced relation relative to one another, to a clamped or closed position in direction 62B wherein the clamp arm assembly 64 and the blade 66 cooperate to grasp tissue therebetween. The clamp arm assembly 64 may comprise a clamp pad (not shown) to engage tissue between the blade 66 and the clamp arm 64. The distal end of the tubular reciprocating tubular actuating member 58 is mechanically engaged to the end effector assembly 26. In the illustrated embodiment, the distal end of the tubular reciprocating tubular actuating member 58 is mechanically engaged to the clamp arm assembly 64, which is pivotable about the pivot point 70, to open and close the clamp arm assembly 64 in response to the actuation and/or release of the trigger 32. For example, in the illustrated embodiment, the clamp arm assembly 64 is movable from an open position to a closed position in direction 62B about a pivot point 70 when the trigger 32 is squeezed in direction 33A. The clamp arm assembly 64 is movable from a closed position to an open position in direction 62A about the pivot point 70 when the trigger 32 is released or outwardly contacted in direction 33B.

As previously discussed, the clamp arm assembly 64 may comprise electrodes electrically coupled to the electrosurgical/RF generator module 23 to receive therapeutic and/or sub-therapeutic energy, where the electrosurgical/RF energy may be applied to the electrodes either simultaneously or non-simultaneously with the ultrasonic energy being applied to the blade 66. Such energy activations may be applied in any suitable combinations to achieve a desired tissue effect in cooperation with an algorithm or other control logic.

FIG. 5 is an exploded view of the ultrasonic surgical instrument 10 shown in FIG. 2. In the illustrated embodiment, the exploded view shows the internal elements of the handle assembly 12, the handle assembly 12, the distal rotation assembly 13, the switch assembly 28, and the elongated shaft assembly 14. In the illustrated embodiment, the first and second portions 12a, 12b mate to form the handle assembly 12. The first and second portions 12a, 12b each comprises a plurality of interfaces 69 dimensioned to mechanically align and engage one another to form the handle assembly 12 and enclose the internal working components of the ultrasonic surgical instrument 10. The rotation knob 48 is mechanically engaged to the outer tubular sheath 56 so that it may be rotated in circular direction 54 up to 360°. The outer tubular sheath 56 is located over the reciprocating tubular actuating member 58, which is mechanically engaged to and retained within the handle assembly 12 via a plurality of coupling elements 72. The coupling elements 72 may comprise an O-ring 72a, a tube collar cap 72b, a distal washer 72c, a proximal washer 72d, and a thread tube collar 72e. The reciprocating tubular actuating member 58 is located within a reciprocating yoke 84, which is retained between the first and second portions 12a, 12b of the handle assembly 12. The yoke 84 is part of a reciprocating yoke assembly 88. A series of linkages translate the pivotal rotation of the elongated trigger hook 32 to the axial movement of the reciprocating yoke 84, which controls the opening and closing of the jaws of the clamping mechanism of the end effector assembly 26 at the distal end of the ultrasonic surgical instrument 10. In one example embodiment, a four-link design provides mechanical advantage in a relatively short rotation span, for example.

In one example embodiment, an ultrasonic transmission waveguide 78 is disposed inside the reciprocating tubular actuating member 58. The distal end 52 of the ultrasonic transmission waveguide 78 is acoustically coupled (e.g., directly or indirectly mechanically coupled) to the blade 66 and the proximal end 50 of the ultrasonic transmission waveguide 78 is received within the handle assembly 12. The proximal end 50 of the ultrasonic transmission waveguide 78 is adapted to acoustically couple to the distal end of the ultrasonic transducer 16 as discussed in more detail below. The ultrasonic transmission waveguide 78 is isolated from the other elements of the elongated shaft assembly 14 by a protective sheath 80 and a plurality of isolation elements 82, such as silicone rings. The outer tubular sheath 56, the reciprocating tubular actuating member 58, and the ultrasonic transmission waveguide 78 are mechanically engaged by a pin 74. The switch assembly 28 comprises the toggle switch 30 and electrical elements 86a,b to electrically energize the ultrasonic transducer 16 in accordance with the activation of the first or second projecting knobs 30a, 30b.

In one example embodiment, the outer tubular sheath 56 isolates the user or the patient from the ultrasonic vibrations of the ultrasonic transmission waveguide 78. The outer tubular sheath 56 generally includes a hub 76. The outer tubular sheath 56 is threaded onto the distal end of the handle assembly 12. The ultrasonic transmission waveguide 78 extends through the opening of the outer tubular sheath 56 and the isolation elements 82 isolate the ultrasonic transmission waveguide 78 from the outer tubular sheath 56. The outer tubular sheath 56 may be attached to the waveguide 78 with the pin 74. The hole to receive the pin 74 in the waveguide 78 may occur nominally at a displacement node. The waveguide 78 may screw or snap into the hand piece handle assembly 12 by a stud. Flat portions on the hub 76 may allow the assembly to be torqued to a required level. In one example embodiment, the hub 76 portion of the outer tubular sheath 56 is preferably constructed from plastic and the tubular elongated portion of the outer tubular sheath 56 is fabricated from stainless steel. Alternatively, the ultrasonic transmission waveguide 78 may comprise polymeric material surrounding it to isolate it from outside contact.

In one example embodiment, the distal end of the ultrasonic transmission waveguide 78 may be coupled to the proximal end of the blade 66 by an internal threaded connection, preferably at or near an antinode. It is contemplated that the blade 66 may be attached to the ultrasonic transmission waveguide 78 by any suitable means, such as a welded joint or the like. Although the blade 66 may be detachable from the ultrasonic transmission waveguide 78, it is also contemplated that the single element end effector (e.g., the blade 66) and the ultrasonic transmission waveguide 78 may be formed as a single unitary piece.

In one example embodiment, the trigger 32 is coupled to a linkage mechanism to translate the rotational motion of the trigger 32 in directions 33A and 33B to the linear motion of the reciprocating tubular actuating member 58 in corresponding directions 60A and 60B. The trigger 32 comprises a first set of flanges 97 with openings formed therein to receive a first yoke pin 94a. The first yoke pin 94a is also located through a set of openings formed at the distal end of the yoke 84. The trigger 32 also comprises a second set of flanges 96 to receive a first end 92a of a link 92. A trigger pin 90 is received in openings formed in the link 92 and the second set of flanges 96. The trigger pin 90 is received in the openings formed in the link 92 and the second set of flanges 96 and is adapted to couple to the first and second portions 12a, 12b of the handle assembly 12 to form a trigger pivot point for the trigger 32. A second end 92b of the link 92 is received in a slot 93 formed in a proximal end of the yoke 84 and is retained therein by a second yoke pin 94b. As the trigger 32 is pivotally rotated about the pivot point 190 formed by the trigger pin 90, the yoke translates horizontally along longitudinal axis “T” in a direction indicated by arrows 60A,B.

FIG. 8 illustrates one example embodiment of an ultrasonic surgical instrument 10. In the illustrated embodiment, a cross-sectional view of the ultrasonic transducer 16 is shown within a partial cutaway view of the handle assembly 12. One example embodiment of the ultrasonic surgical instrument 10 comprises the ultrasonic signal generator 20 coupled to the ultrasonic transducer 16, comprising a hand piece housing 99, and an ultrasonically actuatable single or multiple element end effector assembly 26. As previously discussed, the end effector assembly 26 comprises the ultrasonically actuatable blade 66 and the clamp arm 64. The ultrasonic transducer 16, which is known as a “Langevin stack”, generally includes a transduction portion 100, a first resonator portion or end-bell 102, and a second resonator portion or fore-bell 104, and ancillary components. The total construction of these components is a resonator. The ultrasonic transducer 16 is preferably an integral number of one-half system wavelengths (nλ/2; where “n” is any positive integer; e.g., n=1, 2, 3 . . . ) in length as will be described in more detail later. An acoustic assembly 106 includes the ultrasonic transducer 16, a nose cone 108, a velocity transformer 118, and a surface 110.

In one example embodiment, the distal end of the end-bell 102 is connected to the proximal end of the transduction portion 100, and the proximal end of the fore-bell 104 is connected to the distal end of the transduction portion 100. The fore-bell 104 and the end-bell 102 have a length determined by a number of variables, including the thickness of the transduction portion 100, the density and modulus of elasticity of the material used to manufacture the end-bell 102 and the fore-bell 22, and the resonant frequency of the ultrasonic transducer 16. The fore-bell 104 may be tapered inwardly from its proximal end to its distal end to amplify the ultrasonic vibration amplitude as the velocity transformer 118, or alternately may have no amplification. A suitable vibrational frequency range may be about 20 Hz to 32 kHz and a well-suited vibrational frequency range may be about 30-10 kHz. A suitable operational vibrational frequency may be approximately 55.5 kHz, for example.

In one example embodiment, the piezoelectric elements 112 may be fabricated from any suitable material, such as, for example, lead zirconate-titanate, lead meta-niobate, lead titanate, barium titanate, or other piezoelectric ceramic material. Each of positive electrodes 114, negative electrodes 116, and the piezoelectric elements 112 has a bore extending through the center. The positive and negative electrodes 114 and 116 are electrically coupled to wires 120 and 122, respectively. The wires 120 and 122 are encased within the cable 22 and electrically connectable to the ultrasonic signal generator 20.

The ultrasonic transducer 16 of the acoustic assembly 106 converts the electrical signal from the ultrasonic signal generator 20 into mechanical energy that results in primarily a standing acoustic wave of longitudinal vibratory motion of the ultrasonic transducer 16 and the blade 66 portion of the end effector assembly 26 at ultrasonic frequencies. In another embodiment, the vibratory motion of the ultrasonic transducer may act in a different direction. For example, the vibratory motion may comprise a local longitudinal component of a more complicated motion of the tip of the elongated shaft assembly 14. A suitable generator is available as model number GEN11, from Ethicon Endo-Surgery, Inc., Cincinnati, Ohio. When the acoustic assembly 106 is energized, a vibratory motion standing wave is generated through the acoustic assembly 106. The ultrasonic surgical instrument 10 is designed to operate at a resonance such that an acoustic standing wave pattern of predetermined amplitude is produced. The amplitude of the vibratory motion at any point along the acoustic assembly 106 depends upon the location along the acoustic assembly 106 at which the vibratory motion is measured. A minimum or zero crossing in the vibratory motion standing wave is generally referred to as a node (i.e., where motion is minimal), and a local absolute value maximum or peak in the standing wave is generally referred to as an anti-node (e.g., where local motion is maximal). The distance between an anti-node and its nearest node is one-quarter wavelength (λ/4).

The wires 120 and 122 transmit an electrical signal from the ultrasonic signal generator 20 to the positive electrodes 114 and the negative electrodes 116. The piezoelectric elements 112 are energized by the electrical signal supplied from the ultrasonic signal generator 20 in response to an actuator 224, such as a foot switch, for example, to produce an acoustic standing wave in the acoustic assembly 106. The electrical signal causes disturbances in the piezoelectric elements 112 in the form of repeated small displacements resulting in large alternating compression and tension forces within the material. The repeated small displacements cause the piezoelectric elements 112 to expand and contract in a continuous manner along the axis of the voltage gradient, producing longitudinal waves of ultrasonic energy. The ultrasonic energy is transmitted through the acoustic assembly 106 to the blade 66 portion of the end effector assembly 26 via a transmission component or an ultrasonic transmission waveguide portion 78 of the elongated shaft assembly 14.

In one example embodiment, in order for the acoustic assembly 106 to deliver energy to the blade 66 portion of the end effector assembly 26, all components of the acoustic assembly 106 must be acoustically coupled to the blade 66. The distal end of the ultrasonic transducer 16 may be acoustically coupled at the surface 110 to the proximal end of the ultrasonic transmission waveguide 78 by a threaded connection such as a stud 124.

In one example embodiment, the components of the acoustic assembly 106 are preferably acoustically tuned such that the length of any assembly is an integral number of one-half wavelengths (nλ/2), where the wavelength λ is the wavelength of a pre-selected or operating longitudinal vibration drive frequency f_dof the acoustic assembly 106. It is also contemplated that the acoustic assembly 106 may incorporate any suitable arrangement of acoustic elements.

In one example embodiment, the blade 66 may have a length substantially equal to an integral multiple of one-half system wavelengths (nλ/2). A distal end of the blade 66 may be disposed near an antinode in order to provide the maximum longitudinal excursion of the distal end. When the transducer assembly is energized, the distal end of the blade 66 may be configured to move in the range of, for example, approximately 10 to 500 microns peak-to-peak, and preferably in the range of about 30 to 64 microns at a predetermined vibrational frequency of 55 kHz, for example.

In one example embodiment, the blade 66 may be coupled to the ultrasonic transmission waveguide 78. The blade 66 and the ultrasonic transmission waveguide 78 as illustrated are formed as a single unit construction from a material suitable for transmission of ultrasonic energy. Examples of such materials include Ti6Al4V (an alloy of Titanium including Aluminum and Vanadium), Aluminum, Stainless Steel, or other suitable materials. Alternately, the blade 66 may be separable (and of differing composition) from the ultrasonic transmission waveguide 78, and coupled by, for example, a stud, weld, glue, quick connect, or other suitable known methods. The length of the ultrasonic transmission waveguide 78 may be substantially equal to an integral number of one-half wavelengths (nλ/2), for example. The ultrasonic transmission waveguide 78 may be preferably fabricated from a solid core shaft constructed out of material suitable to propagate ultrasonic energy efficiently, such as the titanium alloy discussed above (i.e., Ti6Al4V) or any suitable aluminum alloy, or other alloys, for example.

In one example embodiment, the ultrasonic transmission waveguide 78 comprises a longitudinally projecting attachment post at a proximal end to couple to the surface 110 of the ultrasonic transmission waveguide 78 by a threaded connection such as the stud 124. The ultrasonic transmission waveguide 78 may include a plurality of stabilizing silicone rings or compliant supports 82 (FIG. 5) positioned at a plurality of nodes. The silicone rings 82 dampen undesirable vibration and isolate the ultrasonic energy from an outer protective sheath 80 (FIG. 5) assuring the flow of ultrasonic energy in a longitudinal direction to the distal end of the blade 66 with maximum efficiency.

FIG. 9 illustrates one example embodiment of the proximal rotation assembly 128. In the illustrated embodiment, the proximal rotation assembly 128 comprises the proximal rotation knob 134 inserted over the cylindrical hub 135. The proximal rotation knob 134 comprises a plurality of radial projections 138 that are received in corresponding slots 130 formed on a proximal end of the cylindrical hub 135. The proximal rotation knob 134 defines an opening 142 to receive the distal end of the ultrasonic transducer 16. The radial projections 138 are formed of a soft polymeric material and define a diameter that is undersized relative to the outside diameter of the ultrasonic transducer 16 to create a friction interference fit when the distal end of the ultrasonic transducer 16. The polymeric radial projections 138 protrude radially into the opening 142 to form “gripper” ribs that firmly grip the exterior housing of the ultrasonic transducer 16. Therefore, the proximal rotation knob 134 securely grips the ultrasonic transducer 16.

The distal end of the cylindrical hub 135 comprises a circumferential lip 132 and a circumferential bearing surface 140. The circumferential lip engages a groove formed in the housing 12 and the circumferential bearing surface 140 engages the housing 12. Thus, the cylindrical hub 135 is mechanically retained within the two housing portions (not shown) of the housing 12. The circumferential lip 132 of the cylindrical hub 135 is located or “trapped” between the first and second housing portions 12a, 12b and is free to rotate in place within the groove. The circumferential bearing surface 140 bears against interior portions of the housing to assist proper rotation. Thus, the cylindrical hub 135 is free to rotate in place within the housing. The user engages the flutes 136 formed on the proximal rotation knob 134 with either the finger or the thumb to rotate the cylindrical hub 135 within the housing 12.

In one example embodiment, the cylindrical hub 135 may be formed of a durable plastic such as polycarbonate. In one example embodiment, the cylindrical hub 135 may be formed of a siliconized polycarbonate material. In one example embodiment, the proximal rotation knob 134 may be formed of pliable, resilient, flexible polymeric materials including Versaflex® TPE alloys made by GLS Corporation, for example. The proximal rotation knob 134 may be formed of elastomeric materials, thermoplastic rubber known as Santoprene®, other thermoplastic vulcanizates (TPVs), or elastomers, for example. The embodiments, however, are not limited in this context.

FIG. 10 illustrates one example embodiment of a surgical system 200 including a surgical instrument 210 having single element end effector 278. The system 200 may include a transducer assembly 216 coupled to the end effector 278 and a sheath 256 positioned around the proximal portions of the end effector 278 as shown. The transducer assembly 216 and end effector 278 may operate in a manner similar to that of the transducer assembly 16 and end effector 18 described above to produce ultrasonic energy that may be transmitted to tissue via blade 226.

FIGS. 11-18C illustrate various embodiments of surgical instruments that utilize therapeutic and/or sub-therapeutic electrical energy to treat and/or destroy tissue or provide feedback to the generators (e.g., electrosurgical instruments). The embodiments of FIGS. 11-18C are adapted for use in a manual or hand-operated manner, although electrosurgical instruments may be utilized in robotic applications as well. FIG. 11 is a perspective view of one example embodiment of a surgical instrument system 300 comprising an electrical energy surgical instrument 310. The electrosurgical instrument 310 may comprise a proximal handle 312, a distal working end or end effector 326 and an introducer or elongated shaft 314 disposed in-between.

The electrosurgical system 300 can be configured to supply energy, such as electrical energy, ultrasonic energy, heat energy, or any combination thereof, to the tissue of a patient either independently or simultaneously as described, for example, in connection with FIG. 1, for example. In one example embodiment, the electrosurgical system 300 includes a generator 320 in electrical communication with the electrosurgical instrument 310. The generator 320 is connected to electrosurgical instrument 310 via a suitable transmission medium such as a cable 322. In one example embodiment, the generator 320 is coupled to a controller, such as a control unit 325, for example. In various embodiments, the control unit 325 may be formed integrally with the generator 320 or may be provided as a separate circuit module or device electrically coupled to the generator 320 (shown in phantom as 325′ to illustrate this option). Although in the presently disclosed embodiment, the generator 320 is shown separate from the electrosurgical instrument 310, in one example embodiment, the generator 320 (and/or the control unit 325) may be formed integrally with the electrosurgical instrument 310 to form a unitary electrosurgical system 300, where a battery located within the electrosurgical instrument 310 is the energy source and a circuit coupled to the battery produces the suitable electrical energy, ultrasonic energy, or heat energy. One such example is described herein below in connection with FIGS. 17-18C.

The generator 320 may comprise an input device 335 located on a front panel of the generator 320 console. The input device 335 may comprise any suitable device that generates signals suitable for programming the operation of the generator 320, such as a keyboard, or input port, for example. In one example embodiment, various electrodes in the first jaw 364A and the second jaw 364B may be coupled to the generator 320. The cable 322 may comprise multiple electrical conductors for the application of electrical energy to positive (+) and negative (−) electrodes of the electrosurgical instrument 310. The control unit 325 may be used to activate the generator 320, which may serve as an electrical source. In various embodiments, the generator 320 may comprise an RF source, an ultrasonic source, a direct current source, and/or any other suitable type of electrical energy source, for example, which may be activated independently or simultaneously.

In various embodiments, the electrosurgical system 300 may comprise at least one supply conductor 331 and at least one return conductor 333, wherein current can be supplied to electrosurgical instrument 300 via the supply conductor 331 and wherein the current can flow back to the generator 320 via the return conductor 333. In various embodiments, the supply conductor 331 and the return conductor 333 may comprise insulated wires and/or any other suitable type of conductor. In certain embodiments, as described below, the supply conductor 331 and the return conductor 333 may be contained within and/or may comprise the cable 322 extending between, or at least partially between, the generator 320 and the end effector 326 of the electrosurgical instrument 310. In any event, the generator 320 can be configured to apply a sufficient voltage differential between the supply conductor 331 and the return conductor 333 such that sufficient current can be supplied to the end effector 110.

FIG. 12 is a side view of one example embodiment of the handle 312 of the surgical instrument 310. In FIG. 12, the handle 312 is shown with half of a first handle body 312A (see FIG. 11) removed to illustrate various components within second handle body 312B. The handle 312 may comprise a lever arm 321 (e.g., a trigger) which may be pulled along a path 33. The lever arm 321 may be coupled to an axially moveable member 378 (FIGS. 13-16) disposed within elongated shaft 314 by a shuttle 384 operably engaged to an extension 398 of lever arm 321. The shuttle 384 may further be connected to a biasing device, such as a spring 388, which may also be connected to the second handle body 312B, to bias the shuttle 384 and thus the axially moveable member 378 in a proximal direction, thereby urging the jaws 364A and 364B to an open position as seen in FIG. 11. Also, referring to FIGS. 11-12, a locking member 190 (see FIG. 12) may be moved by a locking switch 328 (see FIG. 11) between a locked position, where the shuttle 384 is substantially prevented from moving distally as illustrated, and an unlocked position, where the shuttle 384 may be allowed to freely move in the distal direction, toward the elongated shaft 314. In some embodiments, the locking switch 328 may be implemented as a button. The handle 312 can be any type of pistol-grip or other type of handle known in the art that is configured to carry actuator levers, triggers or sliders for actuating the first jaw 364A and the second jaw 364B. The elongated shaft 314 may have a cylindrical or rectangular cross-section, for example, and can comprise a thin-wall tubular sleeve that extends from handle 312. The elongated shaft 314 may include a bore extending therethrough for carrying actuator mechanisms, for example, the axially moveable member 378, for actuating the jaws and for carrying electrical leads for delivery of electrical energy to electrosurgical components of the end effector 326.

The end effector 326 may be adapted for capturing and transecting tissue and for the contemporaneously welding the captured tissue with controlled application of energy (e.g., RF energy). The first jaw 364A and the second jaw 364B may close to thereby capture or engage tissue about a longitudinal axis “T” defined by the axially moveable member 378. The first jaw 364A and second jaw 364B may also apply compression to the tissue. In some embodiments, the elongated shaft 314, along with first jaw 364A and second jaw 364B, can be rotated a full 360° degrees, as shown by arrow 196 (see FIG. 11), relative to handle 312. For example, a rotation knob 348 may be rotatable about the longitudinal axis of the shaft 314 and may be coupled to the shaft 314 such that rotation of the knob 348 causes corresponding rotation of the shaft 314. The first jaw 364A and the second jaw 364B can remain openable and/or closeable while rotated.

FIG. 13 shows a perspective view of one example embodiment of the end effector 326 with the jaws 364A, 364B open, while FIG. 14 shows a perspective view of one example embodiment of the end effector 326 with the jaws 364A, 364B closed. As noted above, the end effector 326 may comprise the upper first jaw 364A and the lower second jaw 364B, which may be straight or curved. The first jaw 364A and the second jaw 364B may each comprise an elongated slot or channel 362A and 362B, respectively, disposed outwardly along their respective middle portions. Further, the first jaw 364A and second jaw 364B may each have tissue-gripping elements, such as teeth 363, disposed on the inner portions of first jaw 364A and second jaw 364B. The first jaw 364A may comprise an upper first outward-facing surface 369A and an upper first energy delivery surface 365A. The second jaw 364B may comprise a lower second outward-facing surface 369B and a lower second energy delivery surface 365B. The first energy delivery surface 365A and the second energy delivery surface 365B may both extend in a “U” shape about the distal end of the end effector 326.

The lever arm 321 of the handle 312 (FIG. 12) may be adapted to actuate the axially moveable member 378, which may also function as a jaw-closing mechanism. For example, the axially moveable member 378 may be urged distally as the lever arm 321 is pulled proximally along the path 33 via the shuttle 384, as shown in FIG. 12 and discussed above. FIG. 15 is a perspective view of one example embodiment of the axially moveable member 378 of the surgical instrument 310. The axially moveable member 378 may comprise one or several pieces, but in any event, may be movable or translatable with respect to the elongated shaft 314 and/or the jaws 364A, 364B. Also, in at least one example embodiment, the axially moveable member 378 may be made of 17-4 precipitation hardened stainless steel. The distal end of axially moveable member 378 may comprise a flanged “I”-beam configured to slide within the channels 362A and 362B in jaws 364A and 364B. The axially moveable member 378 may slide within the channels 362A, 362B to open and close the first jaw 364A and the second jaw 364B. The distal end of the axially moveable member 378 may also comprise an upper flange or “c”-shaped portion 378A and a lower flange or “c”-shaped portion 378B. The flanges 378A and 378B respectively define inner cam surfaces 367A and 367B for engaging outward facing surfaces of the first jaw 364A and the second jaw 364B. The opening-closing of jaws 364A and 364B can apply very high compressive forces on tissue using cam mechanisms which may include movable “I-beam” axially moveable member 378 and the outward facing surfaces 369A, 369B of jaws 364A, 364B.

More specifically, referring now to FIGS. 13-15, collectively, the inner cam surfaces 367A and 367B of the distal end of axially moveable member 378 may be adapted to slidably engage the first outward-facing surface 369A and the second outward-facing surface 369B of the first jaw 364A and the second jaw 364B, respectively. The channel 362A within first jaw 364A and the channel 362B within the second jaw 364B may be sized and configured to accommodate the movement of the axially moveable member 378, which may comprise a tissue-cutting element 371, for example, comprising a sharp distal edge. FIG. 14, for example, shows the distal end of the axially moveable member 378 advanced at least partially through channels 362A and 362B (FIG. 13). The advancement of the axially moveable member 378 may close the end effector 326 from the open configuration shown in FIG. 13. In the closed position shown by FIG. 14, the upper first jaw 364A and lower second jaw 364B define a gap or dimension D between the first energy delivery surface 365A and second energy delivery surface 365B of first jaw 364A and second jaw 364B, respectively. In various embodiments, dimension D can equal from about 0.0005″ to about 0.040″, for example, and in some embodiments, between about 0.001″ to about 0.010″, for example. Also, the edges of the first energy delivery surface 365A and the second energy delivery surface 365B may be rounded to prevent the dissection of tissue.

FIG. 16 is a section view of one example embodiment of the end effector 326 of the surgical instrument 310. The engagement, or tissue-contacting, surface 365B of the lower jaw 364B is adapted to deliver energy to tissue, at least in part, through a conductive-resistive matrix, such as a variable resistive positive temperature coefficient (PTC) body, as discussed in more detail below. At least one of the upper and lower jaws 364A, 364B may carry at least one electrode 373 configured to deliver the energy from the generator 320 to the captured tissue. The engagement, or tissue-contacting, surface 365A of upper jaw 364A may carry a similar conductive-resistive matrix (i.e., a PTC material), or in some embodiments the surface may be a conductive electrode or an insulative layer, for example. Alternatively, the engagement surfaces of the jaws can carry any of the energy delivery components disclosed in U.S. Pat. No. 6,773,409, filed Oct. 22, 2001, entitled ELECTROSURGICAL JAW STRUCTURE FOR CONTROLLED ENERGY DELIVERY, the entire disclosure of which is incorporated herein by reference.

The first energy delivery surface 365A and the second energy delivery surface 365B may each be in electrical communication with the generator 320. The first energy delivery surface 365A and the second energy delivery surface 365B may be configured to contact tissue and deliver electrosurgical energy to captured tissue which are adapted to seal or weld the tissue. The control unit 325 regulates the electrical energy delivered by electrical generator 320 which in turn delivers electrosurgical energy to the first energy delivery surface 365A and the second energy delivery surface 365B. The energy delivery may be initiated by an activation button 328 (FIG. 12) operably engaged with the lever arm 321 and in electrical communication with the generator 320 via cable 322. In one example embodiment, the electrosurgical instrument 310 may be energized by the generator 320 by way of a foot switch 329 (FIG. 11). When actuated, the foot switch 329 triggers the generator 320 to deliver electrical energy to the end effector 326, for example. The control unit 325 may regulate the power generated by the generator 320 during activation. Although the foot switch 329 may be suitable in many circumstances, other suitable types of switches can be used.

As mentioned above, the electrosurgical energy delivered by electrical generator 320 and regulated, or otherwise controlled, by the control unit 325 may comprise radio frequency (RF) energy, or other suitable forms of electrical energy. Further, the opposing first and second energy delivery surfaces 365A and 365B may carry variable resistive positive temperature coefficient (PTC) bodies that are in electrical communication with the generator 320 and the control unit 325. Additional details regarding electrosurgical end effectors, jaw closing mechanisms, and electrosurgical energy-delivery surfaces are described in the following U.S. patents and published patent applications: U.S. Pat. Nos. 7,087,054; 7,083,619; 7,070,597; 7,041,102; 7,011,657; 6,929,644; 6,926,716; 6,913,579; 6,905,497; 6,802,843; 6,770,072; 6,656,177; 6,533,784; and 6,500,312; and U.S. Pat. App. Pub. Nos. 2010/0036370 and 2009/0076506, all of which are incorporated herein in their entirety by reference and made a part of this specification.

In one example embodiment, the generator 320 may be implemented as an electrosurgery unit (ESU) capable of supplying power sufficient to perform bipolar electrosurgery using radio frequency (RF) energy. In one example embodiment, the ESU can be a bipolar ERBE ICC 350 sold by ERBE USA, Inc. of Marietta, Georgia. In some embodiments, such as for bipolar electrosurgery applications, a surgical instrument having an active electrode and a return electrode can be utilized, wherein the active electrode and the return electrode can be positioned against, adjacent to and/or in electrical communication with, the tissue to be treated such that current can flow from the active electrode, through the positive temperature coefficient (PTC) bodies and to the return electrode through the tissue. Thus, in various embodiments, the electrosurgical system 300 may comprise a supply path and a return path, wherein the captured tissue being treated completes, or closes, the circuit. In one example embodiment, the generator 320 may be a monopolar RF ESU and the electrosurgical instrument 310 may comprise a monopolar end effector 326 in which one or more active electrodes are integrated. For such a system, the generator 320 may require a return pad in intimate contact with the patient at a location remote from the operative site and/or other suitable return path. The return pad may be connected via a cable to the generator 320. In other embodiments, the operator 20 may provide sub-therapeutic RF energy levels for purposes of evaluating tissue conditions and providing feedback in the electrosurgical system 300. Such feedback may be employed to control the therapeutic RF energy output of the electrosurgical instrument 310.

During operation of electrosurgical instrument 300, the user generally grasps tissue, supplies energy to the captured tissue to form a weld or a seal (e.g., by actuating button 328 and/or pedal 216), and then drives a tissue-cutting element 371 at the distal end of the axially moveable member 378 through the captured tissue. According to various embodiments, the translation of the axial movement of the axially moveable member 378 may be paced, or otherwise controlled, to aid in driving the axially moveable member 378 at a suitable rate of travel. By controlling the rate of the travel, the likelihood that the captured tissue has been properly and functionally sealed prior to transection with the cutting element 371 is increased.

FIG. 17 is a perspective view of one example embodiment of a surgical instrument system comprising a cordless electrical energy surgical instrument 410. The electrosurgical system is similar to the electrosurgical system 300. The electrosurgical system can be configured to supply energy, such as electrical energy, ultrasonic energy, heat energy, or any combination thereof, to the tissue of a patient either independently or simultaneously as described in connection with FIGS. 1 and 11, for example. The electrosurgical instrument may utilize the end effector 326 and elongated shaft 314 described herein in conjunction with a cordless proximal handle 412. In one example embodiment, the handle 412 includes a generator circuit 420 (see FIG. 18). The generator circuit 420 performs a function substantially similar to that of generator 320. In one example embodiment, the generator circuit 420 is coupled to a controller, such as a control circuit. In the illustrated embodiment, the control circuit is integrated into the generator circuit 420. In other embodiments, the control circuit may be separate from the generator circuit 420.

In one example embodiment, various electrodes in the end effector 326 (including jaws 364A, 364B thereof) may be coupled to the generator circuit 420. The control circuit may be used to activate the generator 420, which may serve as an electrical source. In various embodiments, the generator 420 may comprise an RF source, an ultrasonic source, a direct current source, and/or any other suitable type of electrical energy source, for example. In one example embodiment, a button 328 may be provided to activate the generator circuit 420 to provide energy to the end effectors 326, 326.

FIG. 18A is a side view of one example embodiment of the handle 412 of the cordless surgical instrument 410. In FIG. 18, the handle 412 is shown with half of a first handle body removed to illustrate various components within second handle body 434. The handle 412 may comprise a lever arm 424 (e.g., a trigger) which may be pulled along a path 33 around a pivot point. The lever arm 424 may be coupled to an axially moveable member 478 disposed within elongated shaft 314 by a shuttle operably engaged to an extension of lever arm 424. In one example embodiment, the lever arm 424 defines a shepherd's hook shape comprising a distal member 424a and a proximal member 424b.

In one example embodiment, the cordless electrosurgical instrument comprises a battery 437. The battery 437 provides electrical energy to the generator circuit 420. The battery 437 may be any battery suitable for driving the generator circuit 420 at the desired energy levels. In one example embodiment, the battery 437 is a 100 mAh, triple-cell Lithium Ion Polymer battery. The battery may be fully charged prior to use in a surgical procedure, and may hold a voltage of about 12.6V. The battery 437 may have two fuses fitted to the cordless electrosurgical instrument 410, arranged in line with each battery terminal. In one example embodiment, a charging port 439 is provided to connect the battery 437 to a DC current source (not shown).

The generator circuit 420 may be configured in any suitable manner. In some embodiments, the generator circuit comprises an RF drive and control circuit 440. FIG. 18B illustrates an RF drive and control circuit 440, according to one embodiment. FIG. 18B is a part schematic part block diagram illustrating the RF drive and control circuitry 440 used in this embodiment to generate and control the RF electrical energy supplied to the end effector 326. As will be explained in more detail below, in this embodiment, the drive circuitry 440 is a resonant mode RF amplifier comprising a parallel resonant network on the RF amplifier output and the control circuitry operates to control the operating frequency of the drive signal so that it is maintained at the resonant frequency of the drive circuit, which in turn controls the amount of power supplied to the end effector 326. The way that this is achieved will become apparent from the following description.

As shown in FIG. 18B, the RF drive and control circuit 440 comprises the above described battery 437 are arranged to supply, in this example, about 0V and about 12V rails. An input capacitor (C_in) 442 is connected between the 0V and the 12V for providing a low source impedance. A pair of FET switches 443-1 and 443-2 (both of which are N-channel in this embodiment to reduce power losses) is connected in series between the 0V rail and the 12V rail. FET gate drive circuitry 445 is provided that generates two drive signals—one for driving each of the two FETs 443. The FET gate drive circuitry 445 generates drive signals that causes the upper FET (443-1) to be on when the lower FET (443-2) is off and vice versa. This causes the node 447 to be alternately connected to the 12V rail (when the FET 443-1 is switched on) and the 0V rail (when the FET 443-2 is switched on). FIG. 18B also shows the internal parasitic diodes 448-1 and 448-2 of the corresponding FETs 443, which conduct during any periods that the FETs 443 are open.

As shown in FIG. 18B, the node 447 is connected to an inductor-inductor resonant circuit 450 formed by inductor L_s452 and inductor L_m454. The FET gate driving circuitry 445 is arranged to generate drive signals at a drive frequency (f_d) that opens and crosses the FET switches 443 at the resonant frequency of the parallel resonant circuit 450. As a result of the resonant characteristic of the resonant circuit 450, the square wave voltage at node 447 will cause a substantially sinusoidal current at the drive frequency (f_d) to flow within the resonant circuit 450. As illustrated in FIG. 18B, the inductor L_m454 is the primary of a transformer 455, the secondary of which is formed by inductor L_sec456. The inductor L_sec456 of the transformer 455 secondary is connected to an inductor-capacitor-capacitor parallel resonant circuit 457 formed by inductor L₂458, capacitor C₄460, and capacitor C₂462. The transformer 455 up-converts the drive voltage (V_d) across the inductor L_m454 to the voltage that is applied to the output parallel resonant circuit 457. The load voltage (V_L) is output by the parallel resonant circuit 457 and is applied to the load (represented by the load resistance R_load459 in FIG. 18B) corresponding to the impedance of the forceps' jaws and any tissue or vessel gripped by the end effector 326. As shown in FIG. 18B, a pair of DC blocking capacitors Obi 480-1 and 480-2 is provided to prevent any DC signal being applied to the load 459.

In one embodiment, the transformer 455 may be implemented with a Core Diameter (mm), Wire Diameter (mm), and Gap between secondary windings in accordance with the following specifications:

- Core Diameter, D (mm)
- D=19.9×10−3
- Wire diameter, W (mm) for 22 AWG wire
- W=7.366×10−4
- Gap between secondary windings, in gap=0.125
- G=gap/25.4

In this embodiment, the amount of electrical power supplied to the end effector 326 is controlled by varying the frequency of the switching signals used to switch the FETs 443. This works because the resonant circuit 450 acts as a frequency dependent (loss less) attenuator. The closer the drive signal is to the resonant frequency of the resonant circuit 450, the less the drive signal is attenuated. Similarly, as the frequency of the drive signal is moved away from the resonant frequency of the circuit 450, the more the drive signal is attenuated and so the power supplied to the load reduces. In this embodiment, the frequency of the switching signals generated by the FET gate drive circuitry 445 is controlled by a controller 481 based on a desired power to be delivered to the load 459 and measurements of the load voltage (V_L) and of the load current (I_L) obtained by conventional voltage sensing circuitry 483 and current sensing circuitry 485. The way that the controller 481 operates will be described in more detail below.

In one embodiment, the voltage sensing circuitry 483 and the current sensing circuitry 485 may be implemented with high bandwidth, high speed rail-to-rail amplifiers (e.g., LMH6643 by National Semiconductor). Such amplifiers, however, consume a relatively high current when they are operational. Accordingly, a power save circuit may be provided to reduce the supply voltage of the amplifiers when they are not being used in the voltage sensing circuitry 483 and the current sensing circuitry 485. In one-embodiment, a step-down regulator (e.g., LT3502 by Linear Technologies) may be employed by the power save circuit to reduce the supply voltage of the rail-to-rail amplifiers and thus extend the life of the battery 437.

FIG. 18C illustrates the main components of the controller 481, according to one embodiment. In the embodiment illustrated in FIG. 18C, the controller 481 is a microprocessor based controller and so most of the components illustrated in FIG. 16 are software based components. Nevertheless, a hardware based controller 481 may be used instead. As shown, the controller 481 includes synchronous I,Q sampling circuitry 491 that receives the sensed voltage and current signals from the sensing circuitry 483 and 485 and obtains corresponding samples which are passed to a power, V_rmsand I_rmscalculation module 493. The calculation module 493 uses the received samples to calculate the RMS voltage and RMS current applied to the load 459 (FIG. 18B; end effector 326 and tissue/vessel gripped thereby) and from them the power that is presently being supplied to the load 459. The determined values are then passed to a frequency control module 495 and a medical device control module 497. The medical device control module 497 uses the values to determine the present impedance of the load 459 and based on this determined impedance and a pre-defined algorithm, determines what set point power (P_set) should be applied to the frequency control module 495. The medical device control module 497 is in turn controlled by signals received from a user input module 499 that receives inputs from the user (for example pressing buttons or activating the control levers 114, 110 on the handle 104) and also controls output devices (lights, a display, speaker or the like) on the handle 104 via a user output module 461.

The frequency control module 495 uses the values obtained from the calculation module 493 and the power set point (P_set) obtained from the medical device control module 497 and predefined system limits (to be explained below), to determine whether or not to increase or decrease the applied frequency. The result of this decision is then passed to a square wave generation module 463 which, in this embodiment, increments or decrements the frequency of a square wave signal that it generates by 1 kHz, depending on the received decision. As those skilled in the art will appreciate, in an alternative embodiment, the frequency control module 495 may determine not only whether to increase or decrease the frequency, but also the amount of frequency change required. In this case, the square wave generation module 463 would generate the corresponding square wave signal with the desired frequency shift. In this embodiment, the square wave signal generated by the square wave generation module 463 is output to the FET gate drive circuitry 445, which amplifies the signal and then applies it to the FET 443-1. The FET gate drive circuitry 445 also inverts the signal applied to the FET 443-1 and applies the inverted signal to the FET 443-2.

The electrosurgical instrument 410 may comprise additional features as discussed with respect to electrosurgical system 300. Those skilled in the art will recognize that electrosurgical instrument 410 may include a rotation knob 348, an elongated shaft 314, and an end effector 326. These elements function in a substantially similar manner to that discussed above with respect to the electrosurgical system 300. In one example embodiment, the cordless electrosurgical instrument 410 may include visual indicators 435. The visual indicators 435 may provide a visual indication signal to an operator. In one example embodiment, the visual indication signal may alert an operator that the device is on, or that the device is applying energy to the end effector. Those skilled in the art will recognize that the visual indicators 435 may be configured to provide information on multiple states of the device.

Over the years a variety of minimally invasive robotic (or “telesurgical”) systems have been developed to increase surgical dexterity as well as to permit a surgeon to operate on a patient in an intuitive manner. Robotic surgical systems can be used with many different types of surgical instruments including, for example, ultrasonic or electrosurgical instruments, as described herein. Example robotic systems include those manufactured by Intuitive Surgical, Inc., of Sunnyvale, California, U.S.A. Such systems, as well as robotic systems from other manufacturers, are disclosed in the following U.S. Patents which are each herein incorporated by reference in their respective entirety: U.S. Pat. No. 5,792,135, entitled “Articulated Surgical Instrument For Performing Minimally Invasive Surgery With Enhanced Dexterity and Sensitivity”, U.S. Pat. No. 6,231,565, entitled “Robotic Arm DLUs For Performing Surgical Tasks”, U.S. Pat. No. 6,783,524, entitled “Robotic Surgical Tool With Ultrasound Cauterizing and Cutting Instrument”, U.S. Pat. No. 6,364,888, entitled “Alignment of Master and Slave In a Minimally Invasive Surgical Apparatus”, U.S. Pat. No. 7,524,320, entitled “Mechanical Actuator Interface System For Robotic Surgical Tools”, U.S. Pat. No. 7,691,098, entitled Platform Link Wrist Mechanism”, U.S. Pat. No. 7,806,891, entitled “Repositioning and Reorientation of Master/Slave Relationship in Minimally Invasive Telesurgery”, and U.S. Pat. No. 7,824,401, entitled “Surgical Tool With Writed Monopolar Electrosurgical End Effectors”. Many of such systems, however, have in the past been unable to generate the magnitude of forces required to effectively cut and fasten tissue.

FIGS. 19-46A illustrate example embodiments of robotic surgical systems. In some embodiments, the disclosed robotic surgical systems may utilize the ultrasonic or electrosurgical instruments described herein. Those skilled in the art will appreciate that the illustrated robotic surgical systems are not limited to only those instruments described herein, and may utilize any compatible surgical instruments. Those skilled in the art will further appreciate that while various embodiments described herein may be used with the described robotic surgical systems, the disclosure is not so limited, and may be used with any compatible robotic surgical system.

FIGS. 19-25 illustrate the structure and operation of several example robotic surgical systems and components thereof. FIG. 19 shows a block diagram of an example robotic surgical system 500. The system 500 comprises at least one controller 508 and at least one arm cart 510. The arm cart 510 may be mechanically coupled to one or more robotic manipulators or arms, indicated by box 512. Each of the robotic arms 512 may comprise one or more surgical instruments 514 for performing various surgical tasks on a patient 504. Operation of the arm cart 510, including the arms 512 and instruments 514 may be directed by a clinician 502 from a controller 508. In some embodiments, a second controller 508′, operated by a second clinician 502′ may also direct operation of the arm cart 510 in conjunction with the first clinician 502′. For example, each of the clinicians 502, 502′ may control different arms 512 of the cart or, in some cases, complete control of the arm cart 510 may be passed between the clinicians 502, 502′. In some embodiments, additional arm carts (not shown) may be utilized on the patient 504. These additional arm carts may be controlled by one or more of the controllers 508, 508′. The arm cart(s) 510 and controllers 508, 508′ may be in communication with one another via a communications link 516, which may be any suitable type of wired or wireless communications link carrying any suitable type of signal (e.g., electrical, optical, infrared, etc.) according to any suitable communications protocol. Example implementations of robotic surgical systems, such as the system 500, are disclosed in U.S. Pat. No. 7,524,320 which has been herein incorporated by reference. Thus, various details of such devices will not be described in detail herein beyond that which may be necessary to understand various embodiments of the claimed device.

FIG. 20 shows one example embodiment of a robotic arm cart 520. The robotic arm cart 520 is configured to actuate a plurality of surgical instruments or instruments, generally designated as 522 within a work envelope 527. Various robotic surgery systems and methods employing master controller and robotic arm cart arrangements are disclosed in U.S. Pat. No. 6,132,368, entitled “Multi-Component Telepresence System and Method”, the full disclosure of which is incorporated herein by reference. In various forms, the robotic arm cart 520 includes a base 524 from which, in the illustrated embodiment, three surgical instruments 522 are supported. In various forms, the surgical instruments 522 are each supported by a series of manually articulatable linkages, generally referred to as set-up joints 526, and a robotic manipulator 528. These structures are herein illustrated with protective covers extending over much of the robotic linkage. These protective covers may be optional, and may be limited in size or entirely eliminated in some embodiments to minimize the inertia that is encountered by the servo mechanisms used to manipulate such devices, to limit the volume of moving components so as to avoid collisions, and to limit the overall weight of the cart 520. Cart 520 will generally have dimensions suitable for transporting the cart 520 between operating rooms. The cart 520 may be configured to typically fit through standard operating room doors and onto standard hospital elevators. In various forms, the cart 520 would preferably have a weight and include a wheel (or other transportation) system that allows the cart 520 to be positioned adjacent an operating table by a single attendant.

FIG. 21 shows one example embodiment of the robotic manipulator 528 of the robotic arm cart 520. In the example shown in FIG. 21, the robotic manipulators 528 may include a linkage 530 that constrains movement of the surgical instrument 522. In various embodiments, linkage 530 includes rigid links coupled together by rotational joints in a parallelogram arrangement so that the surgical instrument 522 rotates around a point in space 532, as more fully described in issued U.S. Pat. No. 5,817,084, the full disclosure of which is herein incorporated by reference. The parallelogram arrangement constrains rotation to pivoting about an axis 534a, sometimes called the pitch axis. The links supporting the parallelogram linkage are pivotally mounted to set-up joints 526 (FIG. 20) so that the surgical instrument 522 further rotates about an axis 534b, sometimes called the yaw axis. The pitch and yaw axes 534a, 534b intersect at the remote center 536, which is aligned along a shaft 538 of the surgical instrument 522. The surgical instrument 522 may have further degrees of driven freedom as supported by manipulator 540, including sliding motion of the surgical instrument 522 along the longitudinal instrument axis “LT-LT”. As the surgical instrument 522 slides along the instrument axis LT-LT relative to manipulator 540 (arrow 534c), remote center 536 remains fixed relative to base 542 of manipulator 540. Hence, the entire manipulator 540 is generally moved to re-position remote center 536. Linkage 530 of manipulator 540 is driven by a series of motors 544. These motors 544 actively move linkage 530 in response to commands from a processor of a control system. As will be discussed in further detail below, motors 544 are also employed to manipulate the surgical instrument 522.

FIG. 22 shows one example embodiment of a robotic arm cart 520′ having an alternative set-up joint structure. In this example embodiment, a surgical instrument 522 is supported by an alternative manipulator structure 528′ between two tissue manipulation instruments. Those of ordinary skill in the art will appreciate that various embodiments of the claimed device may incorporate a wide variety of alternative robotic structures, including those described in U.S. Pat. No. 5,878,193, the full disclosure of which is incorporated herein by reference. Additionally, while the data communication between a robotic component and the processor of the robotic surgical system is primarily described herein with reference to communication between the surgical instrument 522 and the controller, it should be understood that similar communication may take place between circuitry of a manipulator, a set-up joint, an endoscope or other image capture device, or the like, and the processor of the robotic surgical system for component compatibility verification, component-type identification, component calibration (such as off-set or the like) communication, confirmation of coupling of the component to the robotic surgical system, or the like.

FIG. 23 shows one example embodiment of a controller 518 that may be used in conjunction with a robotic arm cart, such as the robotic arm carts 520, 520′ depicted in FIGS. 20-22. The controller 518 generally includes master controllers (generally represented as 519 in FIG. 23) which are grasped by the clinician and manipulated in space while the clinician views the procedure via a stereo display 521. A surgeon feed back meter 515 may be viewed via the display 521 and provide the surgeon with a visual indication of the amount of force being applied to the cutting instrument or dynamic clamping member. The master controllers 519 generally comprise manual input devices which preferably move with multiple degrees of freedom, and which often further have a handle or trigger for actuating instruments (for example, for closing grasping saws, applying an electrical potential to an electrode, or the like).

FIG. 24 shows one example embodiment of an ultrasonic surgical instrument 522 adapted for use with a robotic surgical system. For example, the surgical instrument 522 may be coupled to one of the surgical manipulators 528, 528′ described hereinabove. As can be seen in FIG. 24, the surgical instrument 522 comprises a surgical end effector 548 that comprises an ultrasonic blade 550 and clamp arm 552, which may be coupled to an elongated shaft assembly 554 that, in some embodiments, may comprise an articulation joint 556. FIG. 25 shows another example embodiment having an electrosurgical instrument 523 in place of the ultrasonic surgical instrument 522. The surgical instrument 523 comprises a surgical end effector 548 that comprises closable jaws 551A, 551B having energy delivery surfaces 553A, 553B for engaging and providing electrical energy to tissue between the jaws 551A, 551B. A tissue cutting element or knife 555 may be positioned at the distal end of an axially movable member 557 that may extend through the elongated shaft assembly 554 to the instrument mounting portion 558. FIG. 26 shows one example embodiment of an instrument drive assembly 546 that may be coupled to one of the surgical manipulators 528, 528′ to receive and control the surgical instruments 522, 523. The instrument drive assembly 546 may also be operatively coupled to the controller 518 to receive inputs from the clinician for controlling the instrument 522, 523. For example, actuation (e.g., opening and closing) of the clamp arm 552, actuation (e.g., opening and closing) of the jaws 551A, 551B, actuation of the ultrasonic blade 550, extension of the knife 555 and actuation of the energy delivery surfaces 553A, 553B, etc. may be controlled through the instrument drive assembly 546 based on inputs from the clinician provided through the controller 518. The surgical instrument 522 is operably coupled to the manipulator by an instrument mounting portion, generally designated as 558. The surgical instruments 522 further include an interface 560 which mechanically and electrically couples the instrument mounting portion 558 to the manipulator.

FIG. 27 shows another view of the instrument drive assembly of FIG. 26 including the ultrasonic surgical instrument 522. FIG. 28 shows another view of the instrument drive assembly of FIG. 26 including the electrosurgical instrument 523. The instrument mounting portion 558 includes an instrument mounting plate 562 that operably supports a plurality of (four are shown in FIG. 26) rotatable body portions, driven discs or elements 564, that each include a pair of pins 566 that extend from a surface of the driven element 564. One pin 566 is closer to an axis of rotation of each driven elements 564 than the other pin 566 on the same driven element 564, which helps to ensure positive angular alignment of the driven element 564. The driven elements 564 and pints 566 may be positioned on an adapter side 567 of the instrument mounting plate 562.

Interface 560 also includes an adaptor portion 568 that is configured to mountingly engage the mounting plate 562 as will be further discussed below. The adaptor portion 568 may include an array of electrical connecting pins 570, which may be coupled to a memory structure by a circuit board within the instrument mounting portion 558. While interface 560 is described herein with reference to mechanical, electrical, and magnetic coupling elements, it should be understood that a wide variety of telemetry modalities might be used, including infrared, inductive coupling, or the like.

FIGS. 29-31 show additional views of the adapter portion 568 of the instrument drive assembly 546 of FIG. 26. The adapter portion 568 generally includes an instrument side 572 and a holder side 574 (FIG. 29). In various embodiments, a plurality of rotatable bodies 576 are mounted to a floating plate 578 which has a limited range of movement relative to the surrounding adaptor structure normal to the major surfaces of the adaptor 568. Axial movement of the floating plate 578 helps decouple the rotatable bodies 576 from the instrument mounting portion 558 when the levers 580 along the sides of the instrument mounting portion housing 582 are actuated (See FIGS. 24, 25) Other mechanisms/arrangements may be employed for releasably coupling the instrument mounting portion 558 to the adaptor 568. In at least one form, rotatable bodies 576 are resiliently mounted to floating plate 578 by resilient radial members which extend into a circumferential indentation about the rotatable bodies 576. The rotatable bodies 576 can move axially relative to plate 578 by deflection of these resilient structures. When disposed in a first axial position (toward instrument side 572) the rotatable bodies 576 are free to rotate without angular limitation. However, as the rotatable bodies 576 move axially toward instrument side 572, tabs 584 (extending radially from the rotatable bodies 576) laterally engage detents on the floating plates so as to limit angular rotation of the rotatable bodies 576 about their axes. This limited rotation can be used to help drivingly engage the rotatable bodies 576 with drive pins 586 of a corresponding instrument holder portion 588 of the robotic system, as the drive pins 586 will push the rotatable bodies 576 into the limited rotation position until the pins 586 are aligned with (and slide into) openings 590.

Openings 590 on the instrument side 572 and openings 590 on the holder side 574 of rotatable bodies 576 are configured to accurately align the driven elements 564 (FIGS. 27, 28) of the instrument mounting portion 558 with the drive elements 592 of the instrument holder 588. As described above regarding inner and outer pins 566 of driven elements 564, the openings 590 are at differing distances from the axis of rotation on their respective rotatable bodies 576 so as to ensure that the alignment is not 33 degrees from its intended position. Additionally, each of the openings 590 may be slightly radially elongated so as to fittingly receive the pins 566 in the circumferential orientation. This allows the pins 566 to slide radially within the openings 590 and accommodate some axial misalignment between the instrument 522, 523 and instrument holder 588, while minimizing any angular misalignment and backlash between the drive and driven elements. Openings 590 on the instrument side 572 may be offset by about 90 degrees from the openings 590 (shown in broken lines) on the holder side 574, as can be seen most clearly in FIG. 31.

Various embodiments may further include an array of electrical connector pins 570 located on holder side 574 of adaptor 568, and the instrument side 572 of the adaptor 568 may include slots 594 (FIG. 31) for receiving a pin array (not shown) from the instrument mounting portion 558. In addition to transmitting electrical signals between the surgical instrument 522, 523 and the instrument holder 588, at least some of these electrical connections may be coupled to an adaptor memory device 596 (FIG. 30) by a circuit board of the adaptor 568.

A detachable latch arrangement 598 may be employed to releasably affix the adaptor 568 to the instrument holder 588. As used herein, the term “instrument drive assembly” when used in the context of the robotic system, at least encompasses various embodiments of the adapter 568 and instrument holder 588 and which has been generally designated as 546 in FIG. 26. For example, as can be seen in FIG. 26, the instrument holder 588 may include a first latch pin arrangement 600 that is sized to be received in corresponding clevis slots 602 provided in the adaptor 568. In addition, the instrument holder 588 may further have second latch pins 604 that are sized to be retained in corresponding latch clevises 606 in the adaptor 568. See FIG. 30. In at least one form, a latch assembly 608 is movably supported on the adapter 568 and is biasable between a first latched position wherein the latch pins 600 are retained within their respective latch clevis 602 and an unlatched position wherein the second latch pins 604 may be into or removed from the latch clevises 606. A spring or springs (not shown) are employed to bias the latch assembly into the latched position. A lip on the instrument side 572 of adaptor 568 may slidably receive laterally extending tabs of instrument mounting housing 582.

As described the driven elements 564 may be aligned with the drive elements 592 of the instrument holder 588 such that rotational motion of the drive elements 592 causes corresponding rotational motion of the driven elements 564. The rotation of the drive elements 592 and driven elements 564 may be electronically controlled, for example, via the robotic arm 512, in response to instructions received from the clinician 502 via a controller 508. The instrument mounting portion 558 may translate rotation of the driven elements 564 into motion of the surgical instrument 522, 523.

FIGS. 32-34 show one example embodiment of the instrument mounting portion 558 showing components for translating motion of the driven elements 564 into motion of the surgical instrument 522, 523. FIGS. 32-34 show the instrument mounting portion with a shaft 538 having a surgical end effector 610 at a distal end thereof. The end effector 610 may be any suitable type of end effector for performing a surgical task on a patient. For example, the end effector may be configured to provide RF and/or ultrasonic energy to tissue at a surgical site. The shaft 538 may be rotatably coupled to the instrument mounting portion 558 and secured by a top shaft holder 646 and a bottom shaft holder 648 at a coupler 650 of the shaft 538.

In one example embodiment, the instrument mounting portion 558 comprises a mechanism for translating rotation of the various driven elements 564 into rotation of the shaft 538, differential translation of members along the axis of the shaft (e.g., for articulation), and reciprocating translation of one or more members along the axis of the shaft 538 (e.g., for extending and retracting tissue cutting elements such as 555, overtubes and/or other components). In one example embodiment, the rotatable bodies 612 (e.g., rotatable spools) are coupled to the driven elements 564. The rotatable bodies 612 may be formed integrally with the driven elements 564. In some embodiments, the rotatable bodies 612 may be formed separately from the driven elements 564 provided that the rotatable bodies 612 and the driven elements 564 are fixedly coupled such that driving the driven elements 564 causes rotation of the rotatable bodies 612. Each of the rotatable bodies 612 is coupled to a gear train or gear mechanism to provide shaft articulation and rotation and clamp jaw open/close and knife actuation.

In one example embodiment, the instrument mounting portion 558 comprises a mechanism for causing differential translation of two or more members along the axis of the shaft 538. In the example provided in FIGS. 32-34, this motion is used to manipulate articulation joint 556. In the illustrated embodiment, for example, the instrument mounting portion 558 comprises a rack and pinion gearing mechanism to provide the differential translation and thus the shaft articulation functionality. In one example embodiment, the rack and pinion gearing mechanism comprises a first pinion gear 614 coupled to a rotatable body 612 such that rotation of the corresponding driven element 564 causes the first pinion gear 614 to rotate. A bearing 616 is coupled to the rotatable body 612 and is provided between the driven element 564 and the first pinion gear 614. The first pinion gear 614 is meshed to a first rack gear 618 to convert the rotational motion of the first pinion gear 614 into linear motion of the first rack gear 618 to control the articulation of the articulation section 556 of the shaft assembly 538 in a left direction 620L. The first rack gear 618 is attached to a first articulation band 622 (FIG. 32) such that linear motion of the first rack gear 618 in a distal direction causes the articulation section 556 of the shaft assembly 538 to articulate in the left direction 620L. A second pinion gear 626 is coupled to another rotatable body 612 such that rotation of the corresponding driven element 564 causes the second pinion gear 626 to rotate. A bearing 616 is coupled to the rotatable body 612 and is provided between the driven element 564 and the second pinion gear 626. The second pinion gear 626 is meshed to a second rack gear 628 to convert the rotational motion of the second pinion gear 626 into linear motion of the second rack gear 628 to control the articulation of the articulation section 556 in a right direction 620R. The second rack gear 628 is attached to a second articulation band 624 (FIG. 33) such that linear motion of the second rack gear 628 in a distal direction causes the articulation section 556 of the shaft assembly 538 to articulate in the right direction 620R. Additional bearings may be provided between the rotatable bodies and the corresponding gears. Any suitable bearings may be provided to support and stabilize the mounting and reduce rotary friction of shaft and gears, for example.

In one example embodiment, the instrument mounting portion 558 further comprises a mechanism for translating rotation of the driven elements 564 into rotational motion about the axis of the shaft 538. For example, the rotational motion may be rotation of the shaft 538 itself. In the illustrated embodiment, a first spiral worm gear 630 coupled to a rotatable body 612 and a second spiral worm gear 632 coupled to the shaft assembly 538. A bearing 616 (FIG. 17) is coupled to a rotatable body 612 and is provided between a driven element 564 and the first spiral worm gear 630. The first spiral worm gear 630 is meshed to the second spiral worm gear 632, which may be coupled to the shaft assembly 538 and/or to another component of the instrument 522, 523 for which longitudinal rotation is desired. Rotation may be caused in a clockwise (CW) and counter-clockwise (CCW) direction based on the rotational direction of the first and second spiral worm gears 630, 632. Accordingly, rotation of the first spiral worm gear 630 about a first axis is converted to rotation of the second spiral worm gear 632 about a second axis, which is orthogonal to the first axis. As shown in FIGS. 32-33, for example, a CW rotation of the second spiral worm gear 632 results in a CW rotation of the shaft assembly 538 in the direction indicated by 634CW. A CCW rotation of the second spiral worm gear 632 results in a CCW rotation of the shaft assembly 538 in the direction indicated by 634CCW. Additional bearings may be provided between the rotatable bodies and the corresponding gears. Any suitable bearings may be provided to support and stabilize the mounting and reduce rotary friction of shaft and gears, for example.

In one example embodiment, the instrument mounting portion 558 comprises a mechanism for generating reciprocating translation of one or more members along the axis of the shaft 538. Such translation may be used, for example to drive a tissue cutting element, such as 555, drive an overtube for closure and/or articulation of the end effector 610, etc. In the illustrated embodiment, for example, a rack and pinion gearing mechanism may provide the reciprocating translation. A first gear 636 is coupled to a rotatable body 612 such that rotation of the corresponding driven element 564 causes the first gear 636 to rotate in a first direction. A second gear 638 is free to rotate about a post 640 formed in the instrument mounting plate 562. The first gear 636 is meshed to the second gear 638 such that the second gear 638 rotates in a direction that is opposite of the first gear 636. In one example embodiment, the second gear 638 is a pinion gear meshed to a rack gear 642, which moves in a liner direction. The rack gear 642 is coupled to a translating block 644, which may translate distally and proximally with the rack gear 642. The translation block 644 may be coupled to any suitable component of the shaft assembly 538 and/or the end effector 610 so as to provide reciprocating longitudinal motion. For example, the translation block 644 may be mechanically coupled to the tissue cutting element 555 of the RF surgical device 523. In some embodiments, the translation block 644 may be coupled to an overtube, or other component of the end effector 610 or shaft 538.

FIGS. 35-37 illustrate an alternate embodiment of the instrument mounting portion 558 showing an alternate example mechanism for translating rotation of the driven elements 564 into rotational motion about the axis of the shaft 538 and an alternate example mechanism for generating reciprocating translation of one or more members along the axis of the shaft 538. Referring now to the alternate rotational mechanism, a first spiral worm gear 652 is coupled to a second spiral worm gear 654, which is coupled to a third spiral worm gear 656. Such an arrangement may be provided for various reasons including maintaining compatibility with existing robotic systems 500 and/or where space may be limited. The first spiral worm gear 652 is coupled to a rotatable body 612. The third spiral worm gear 656 is meshed with a fourth spiral worm gear 658 coupled to the shaft assembly 538. A bearing 760 is coupled to a rotatable body 612 and is provided between a driven element 564 and the first spiral worm gear 738. Another bearing 760 is coupled to a rotatable body 612 and is provided between a driven element 564 and the third spiral worm gear 652. The third spiral worm gear 652 is meshed to the fourth spiral worm gear 658, which may be coupled to the shaft assembly 538 and/or to another component of the instrument 522, 523 for which longitudinal rotation is desired. Rotation may be caused in a CW and a CCW direction based on the rotational direction of the spiral worm gears 656, 658. Accordingly, rotation of the third spiral worm gear 656 about a first axis is converted to rotation of the fourth spiral worm gear 658 about a second axis, which is orthogonal to the first axis. As shown in FIGS. 36 and 37, for example, the fourth spiral worm gear 658 is coupled to the shaft 538, and a CW rotation of the fourth spiral worm gear 658 results in a CW rotation of the shaft assembly 538 in the direction indicated by 634CW. A CCW rotation of the fourth spiral worm gear 658 results in a CCW rotation of the shaft assembly 538 in the direction indicated by 634CCW. Additional bearings may be provided between the rotatable bodies and the corresponding gears. Any suitable bearings may be provided to support and stabilize the mounting and reduce rotary friction of shaft and gears, for example.

Referring now to the alternate example mechanism for generating reciprocating translation of one or more members along the axis of the shaft 538, the instrument mounting portion 558 comprises a rack and pinion gearing mechanism to provide reciprocating translation along the axis of the shaft 538 (e.g., translation of a tissue cutting element 555 of the RF surgical device 523). In one example embodiment, a third pinion gear 660 is coupled to a rotatable body 612 such that rotation of the corresponding driven element 564 causes the third pinion gear 660 to rotate in a first direction. The third pinion gear 660 is meshed to a rack gear 662, which moves in a linear direction. The rack gear 662 is coupled to a translating block 664. The translating block 664 may be coupled to a component of the device 522, 523, such as, for example, the tissue cutting element 555 of the RF surgical device and/or an overtube or other component which is desired to be translated longitudinally.

FIGS. 38-42 illustrate an alternate embodiment of the instrument mounting portion 558 showing another alternate example mechanism for translating rotation of the driven elements 564 into rotational motion about the axis of the shaft 538. In FIGS. 38-42, the shaft 538 is coupled to the remainder of the mounting portion 558 via a coupler 676 and a bushing 678. A first gear 666 coupled to a rotatable body 612, a fixed post 668 comprising first and second openings 672, first and second rotatable pins 674 coupled to the shaft assembly, and a cable 670 (or rope). The cable is wrapped around the rotatable body 612. One end of the cable 670 is located through a top opening 672 of the fixed post 668 and fixedly coupled to a top rotatable pin 674. Another end of the cable 670 is located through a bottom opening 672 of the fixed post 668 and fixedly coupled to a bottom rotating pin 674. Such an arrangement is provided for various reasons including maintaining compatibility with existing robotic systems 500 and/or where space may be limited. Accordingly, rotation of the rotatable body 612 causes the rotation about the shaft assembly 538 in a CW and a CCW direction based on the rotational direction of the rotatable body 612 (e.g., rotation of the shaft 538 itself). Accordingly, rotation of the rotatable body 612 about a first axis is converted to rotation of the shaft assembly 538 about a second axis, which is orthogonal to the first axis. As shown in FIGS. 38-39, for example, a CW rotation of the rotatable body 612 results in a CW rotation of the shaft assembly 538 in the direction indicated by 634CW. A CCW rotation of the rotatable body 612 results in a CCW rotation of the shaft assembly 538 in the direction indicated by 634CCW. Additional bearings may be provided between the rotatable bodies and the corresponding gears. Any suitable bearings may be provided to support and stabilize the mounting and reduce rotary friction of shaft and gears, for example.

FIGS. 43-46A illustrate an alternate embodiment of the instrument mounting portion 558 showing an alternate example mechanism for differential translation of members along the axis of the shaft 538 (e.g., for articulation). For example, as illustrated in FIGS. 43-46A, the instrument mounting portion 558 comprises a double cam mechanism 680 to provide the shaft articulation functionality. In one example embodiment, the double cam mechanism 680 comprises first and second cam portions 680A, 680B. First and second follower arms 682, 684 are pivotally coupled to corresponding pivot spools 686. As the rotatable body 612 coupled to the double cam mechanism 680 rotates, the first cam portion 680A acts on the first follower arm 682 and the second cam portion 680B acts on the second follower arm 684. As the cam mechanism 680 rotates the follower arms 682, 684 pivot about the pivot spools 686. The first follower arm 682 may be attached to a first member that is to be differentially translated (e.g., the first articulation band 622). The second follower arm 684 is attached to a second member that is to be differentially translated (e.g., the second articulation band 624). As the top cam portion 680A acts on the first follower arm 682, the first and second members are differentially translated. In the example embodiment where the first and second members are the respective articulation bands 622 and 624, the shaft assembly 538 articulates in a left direction 620L. As the bottom cam portion 680B acts of the second follower arm 684, the shaft assembly 538 articulates in a right direction 620R. In some example embodiments, two separate bushings 688, 690 are mounted beneath the respective first and second follower arms 682, 684 to allow the rotation of the shaft without affecting the articulating positions of the first and second follower arms 682, 684. For articulation motion, these bushings reciprocate with the first and second follower arms 682, 684 without affecting the rotary position of the jaw 902. FIG. 46 shows the bushings 688, 690 and the dual cam assembly 680, including the first and second cam portions 680B, 680B, with the first and second follower arms 682, 684 removed to provide a more detailed and clearer view.

In various embodiments, the instrument mounting portion 558 may additionally comprise internal energy sources for driving electronics and provided desired ultrasonic and/or RF frequency signals to surgical tools. FIGS. 46B-46C illustrate one embodiment of a tool mounting portion 558′ comprising internal power and energy sources. For example, surgical instruments (e.g., instruments 522, 523) mounted utilizing the tool mounting portion 558′ need not be wired to an external generator or other power source. Instead, the functionality of the various generators 20, 320 described herein may be implemented on board the mounting portion 558.

As illustrated in FIGS. 46B-46C, the instrument mounting portion 558′ may comprise a distal portion 702. The distal portion 702 may comprise various mechanisms for coupling rotation of drive elements 592 to end effectors of the various surgical instruments 522, 523, for example, as described herein above. Proximal of the distal portion 702, the instrument mounting portion 558′ comprises an internal direct current (DC) energy source and an internal drive and control circuit 704. In the illustrated embodiment, the energy source comprises a first and second battery 706, 708. In other respects, the tool mounting portion 558′ is similar to the various embodiments of the tool mounting portion 558 described herein above.

The control circuit 704 may operate in a manner similar to that described above with respect to generators 20, 320. For example, when an ultrasonic instrument 522 is utilized, the control circuit 704 may provide an ultrasonic drive signal in a manner similar to that described above with respect to generator 20. Also, for example, when an RF instrument 523 or ultrasonic instrument 522 capable of providing a therapeutic or non-therapeutic RF signal is used, the control circuit 704 may provide an RF drive signal, for example, as described herein above with respect to the module 23 of generator 20 and/or the generator 300. In some embodiments, the control circuit 704 may be configured in a manner similar to that of the control circuit 440 described herein above with respect to FIGS. 18B-18C.

Various embodiments described herein comprise an articulatable shaft. When using an articulatable shaft, components running through the shaft from the end effector must be flexible, so as to flex when the shaft articulates. In various embodiments, this can be accomplished by utilizing waveguides that have flexible portions. For example, FIG. 47 illustrates a schematic cross-sectional view of a portion of one example embodiment of an ultrasonic medical instrument 1500 comprising first, second and third waveguide portions. In FIG. 47, the hand piece and the sheath-articulation control knobs, etc. of the ultrasonic medical instrument 1500 are omitted for clarity. In the example embodiment shown in FIG. 47, the ultrasonic medical instrument 1500 comprises a medical ultrasonic waveguide 1502 for transmitting ultrasonic energy from a transducer (not shown in FIG. 47) to an ultrasonic blade 1544. The medical ultrasonic waveguide 1502 has a length and includes first, second and third waveguide portions 1504, 1506 and 1508. The second waveguide portion 1506 is located lengthwise between the first and third waveguide portions 1504 and 1508; the first waveguide portion 1504 is located proximal the second waveguide portion 1506; and the third waveguide portion 1508 is located distal the second waveguide portion 1506. The first and third waveguide portions 1504 and 1508 each have a larger transverse area and the second waveguide portion 1506 has a smaller transverse area. The second waveguide portion 1506 is more bendable than either of the first and third waveguide portions 1504 and 1508. It is further noted that ultrasonic vibration can be any one, or any combination, of longitudinal, transverse, and torsional vibration. In some embodiments, the section 1506 may have a circular cross-section (e.g., a uniform cross-sectional radius).

In some embodiments the second bendable waveguide portion 1506 may not have a uniform cross-sectional radius. For example, FIG. 47A illustrates cross sections for two example embodiments of the waveguide portion 1506. The waveguide portion 1506′ is illustrated in relation to two axes 1509, 1511, also shown in FIG. 47. In various embodiments, the waveguide portion 1506′ may have a cross sectional length along axis 1511 that is less than its cross sectional dimension along axis 1509. In some embodiments, the cross sectional length along the axis 1509 may be equal to the cross sectional length of the other waveguide portions 1504, 1506. The waveguide portion 1506′ may be bendable along the axis 1509. Referring now to waveguide portion 1506″, its cross sectional lengths along the axis 1509, 1511 may be the same, providing the waveguide portion 1506″ with a greater range of directions for bending.

In some example embodiments, the medical ultrasonic waveguide 1502 is a monolithic (e.g., the blade portion 1544 is integral to the waveguide 1502). Also, in some example embodiments, the medical ultrasonic waveguide 1502 includes first and second longitudinal vibration antinodes 1510 and 1512. The first waveguide portion 1504 may transition to the second waveguide portion 1506 proximate the first longitudinal vibration antinode 1510; and the second waveguide portion 1506 may transition to the third waveguide portion 1508 proximate the second longitudinal vibration antinode 1512. In some example embodiments, as illustrated by FIG. 47, the second waveguide portion 1506 is substantially % of a resonant-longitudinal-wavelength long.

In one example application of the embodiment of FIG. 47, the ultrasonic medical instrument 1500 also includes a user-actuated articulated sheath 1514 which surrounds the medical ultrasonic waveguide 1502. In various example embodiments, the medical ultrasonic waveguide 1502 includes three (meaning at least three) longitudinal vibration nodes 1516 located, one each, on the first, second and third waveguide portions 1504, 1506 and 1508. It is noted that one or more additional longitudinal vibration nodes may, or may not, be present between any one or two of the three longitudinal vibration nodes 1516. In one modification, the sheath 1514 contacts (e.g., directly contacts or indirectly contacts through at least one intervening member 1517 such as a silicone intervening member) the first, second and third waveguide portions 1504, 1506 and 1508 at a corresponding one of the three longitudinal vibration nodes 1516. In one example, the sheath 1514 includes a rigid first sheath portion 1518 contacting the first waveguide portion 1504 at the first longitudinal vibration node (the leftmost node 1516 of FIG. 47), a flexible second sheath portion 1520 contacting the second waveguide portion 1506 at the second longitudinal vibration node (the middle node 1516 of FIG. 47), and a rigid third sheath portion 1522 contacting the third waveguide portion 1508 at the third longitudinal vibration node (the rightmost node 1516 of FIG. 47). In some example embodiments, the sheath 1514 has only two articulation positions (e.g., straight and fully articulated). In other example embodiments, the sheath 1514 has a number of intermediate bent positions between a straight position and a fully articulated position depending on the number of energy efficient curves the waveguide 1502 can be formed to. In some example embodiments, such energy efficient curves minimize vibrational energy going into non-longitudinal vibrational modes.

FIG. 48 illustrates a schematic cross-sectional view of a portion of one example embodiment of an ultrasonic medical instrument 1524 comprising first and second waveguide portions 1530, 1532, where the first waveguide portion 1530 spans multiple % resonant longitudinal wavelengths. In the example embodiment show in FIG. 48, a medical ultrasonic waveguide 1526 includes at least two longitudinal vibration nodes 1528 located on the first waveguide portion 1530. In one variation, a sheath 1534 contacts (e.g., directly contacts or indirectly contacts through at least one intervening member 1536 such as a silicone intervening member) the first waveguide portion 1530 at the at-least-two longitudinal vibration nodes 1528. In some example embodiments, the sheath 1534 includes two rigid sheath portions 1538 and 1542 and one flexible sheath portion 1540, wherein the flexible sheath portion 1540 contacts the first waveguide portion 1530 at least one of the two longitudinal vibration nodes 1528, and wherein the flexible sheath portion 1540 is disposed between the two rigid sheath portions 1538 and 1542. In one example embodiment, the two rigid sheath portions 1538 and 1542 each contact the second waveguide portion 1532 at a corresponding one of the at-least-two longitudinal vibration nodes 1528.

Referring now to FIG. 47, the waveguide 1502 may comprise a blade portion 1544 adapted to contact and ultrasonically treat patient tissue. The blade portion 1544 may be disposed at a distal end of the waveguide 1502 (e.g., distal of the third blade portion 1508 of the blade 1502). In one example embodiment, the surgical instrument 1500 may also comprise a user-actuated clamp arm 1546 pivotally attached to the sheath 1514, 1534 proximate the blade portion 1544, wherein the clamp arm 1546 and the medical ultrasonic waveguide 1502 at least in part define an ultrasonic surgical shears 1548. The tissue pad and clamping arm control mechanism has been omitted from FIG. 47. Referring again to FIG. 48, the medical ultrasonic waveguide 1526 may also comprise a blade portion 1545, similar to the blade portion 1544, and disposed at a distal end of the first waveguide portion 1532. The blade portion 1545 may also be adapted to contact and ultrasonically treat patient tissue. The instrument 1524 of FIG. 48 may also comprise a clamp arm 1546, defining, with the blade portion 1545, an ultrasonic surgical shears 1548.

In various example embodiments, certain portions of the waveguides 1502, 1526 are substantially rigid. For example, first and third portions 1504 and 1508 of the waveguide 1502 may be substantially rigid. The first portion 1532 of the waveguide 1526 may be substantially rigid. Referring again to FIG. 47, the medical ultrasonic waveguide 1502 may include first and second neck portions 1550 and 1552 joining, respectively, the first and second waveguide portions 1504 and 1506 and the second and third waveguide portions 1506 and 1508. (A similar neck portion 1552 may join the first and second waveguide portions 1530, 1532 of the waveguide 1526.)

In one modification, the medical ultrasonic waveguide 1502 is substantially cylindrical from the first waveguide portion 1504 to the third waveguide portion 1508, wherein the first, second and third waveguide portions 1504, 1506 and 1508 each have a substantially constant diameter, and wherein the diameter of the second waveguide portion 1506 is smaller than the diameter of either of the first and third waveguide portions 1504 and 1508. In some example embodiments, the diameter of the second waveguide portion 1506 is between substantially one and two millimeters, and the diameter of the first and third waveguide portions is between substantially three and five millimeters. In one choice of materials, the medical ultrasonic waveguide 1502 consists essentially of a titanium alloy. In one modification, the medical ultrasonic waveguide 1502 includes first and second longitudinal vibration antinodes 1510 and 1512, and the first neck portion 1550 is disposed proximate the first longitudinal vibration antinode 1510 and the second neck portion 1552 is disposed proximate the second longitudinal vibration antinode 1512.

FIG. 49 illustrates a schematic cross-sectional view of one example embodiment of an ultrasonic waveguide 1554 for use with a medical instrument and comprising first and second waveguide portions, where a first waveguide portion 1556 is joined to a second waveguide portion 1558 by a dowel press fit. In the example illustrated in FIG. 49, the second waveguide portion 1558 is also coupled to a third waveguide portion 1560 by a dowel press fit. In various example embodiments, the second waveguide portion 1558 consists essentially of titanium or nitinol. In the same or a different illustration, the length of the second waveguide portion 1558 is less than ½ wavelength (a wavelength being the length of a resonant-longitudinal-wavelength of the medical ultrasonic waveguide which depends essentially on the material of the waveguide and the frequency at which it is run) and in one example is less than ⅛ wave.

FIG. 50 illustrates a schematic cross-sectional view of one example embodiment of an ultrasonic waveguide 1564 for use with a medical instrument. Like the waveguide 1554, the waveguide 1564 is not a monolithic waveguide. The waveguide 1564 may comprise first and second waveguide portions 1564, 1566, where the first waveguide portion 1564 is joined to the second waveguide 1566 portion by a ball-and-socket type attachment. The second waveguide portion 1566 may also be joined to a third waveguide portion 1568 in any suitable manner. In the example of FIG. 50, the second waveguide portion 1566 is joined to the third waveguide portion 1568 via a dowel press fit. Other attachments between waveguide portions are left to those skilled in the art.

FIG. 51 illustrates a schematic cross-sectional view of a portion of another embodiment of an ultrasonic medical instrument 1570 comprising a medical ultrasonic waveguide 1572 having a length and including a proximal waveguide portion 1574 and a distal waveguide portion 1576. The proximal waveguide portion 1574 has a larger transverse area and the distal waveguide portion 1576 has a smaller transverse area. The distal waveguide portion 1576 bends more easily than does the proximal waveguide portion 1574. The distal waveguide portion 1576 includes a distal end portion 1580 adapted to contact and ultrasonically treat patient tissue. In various example embodiments, the additional ½ wave needed to neck up and create the larger diameter end effector of the embodiment of FIG. 47 is eliminated making it possible to place the articulation joint closer to the distal end of the ultrasonic medical instrument 1570. The embodiments, applications, etc. shown in FIGS. 47-50 are equally applicable (without the presence of the third waveguide portion) to the embodiment of FIG. 51.

FIG. 52 illustrates one embodiment of a shaft 1000 that may be utilized with various surgical instruments, including those described herein. An end effector 1006 is positioned within a shaft body 1004 and may comprise an ultrasonic blade 1008. The ultrasonic blade 1008 may be acoustically coupled to a waveguide 1020 extending proximally from the blade 1008. The waveguide 1020 may comprise a bendable portion 1012, such as the bendable portions 1506, 1530, 1576, etc., described herein above. Also positioned within the shaft 1000 is a wedge 1016 coupled to a translating cable 1018 that extends proximally from the wedge 1016. The wedge 1016 may reciprocate proximally and distally under the control of the cable 1018. The cable 1018 may be made of any suitable material including, for example, a material that is rigid enough to provide a distally directed force on the wedge 1016 when the cable 1018 is pushed distally (e.g., from a handle, from a robotic instrument mounting portion, etc.). In some embodiments, the cable 1018 may be made from a metal material.

The ultrasonic waveguide 1020 may be coupled to the shaft body 1004 at a pivot point 1014. For example, the pivot point 1014 may represent a pin received through the waveguide 1020 to hold the waveguide stationary relative to the shaft body 1004 at about the pivot point 1014. The pivot point may be located proximally from the bendable portion 1012. Distal of the bendable portion 1012 of the waveguide 1020, the waveguide 1020 and/or ultrasonic blade 1008 defines a flange 1010. As the wedge 1016 is translated distally, it may come into contact with the flange 1010. As the flange 1010 rides up the wedge 1016, the waveguide 1020 may pivot about the pivot point, tending to pivot the blade 1008 and waveguide 1020 away from a longitudinal axis 1002 of the shaft 1000. FIG. 53 illustrates one embodiment of the shaft 1000, with the wedge 1016 translated distally and the blade 1008 pivoted, as described. Proximal translation of the wedge 1016 from the position shown in FIG. 53 may release the force on the flange 1010 tending to cause deflection of the blade 1008. Absent the force, the blade 1008 and waveguide 1020 may return to the resting position illustrated in FIG. 52. For example, the blade 1008 and/or waveguide 1020 may be constructed from a resilient material that regains its original shape after bending. For example, in various embodiments, the wedge 1016 may not push the blade 1008 and/or the waveguide 1020 past their respective points of plasticity. The flange 1010 and pivot point 1014 may both be positioned at nodes of the waveguide 1020 (e.g., portions where there is substantially no movement of the waveguide 1020). In some embodiments, the flange 1010 and pivot point 1014 may be separated by a single wavelength.

The wedge 1016 and cable 1018 may be translated distally and proximally according to any suitable method or mechanism. For example, when the shaft 1000 is used in conjunction with a manual or hand held surgical instrument, the cable 1018 may be translated distally and proximally in a manner similar to that described herein above with respect to the reciprocating tubular actuating member 58 of the instrument 10 and/or the axially moving member 378 of the instrument 300. Also, for example, when the shaft 1000 is used in conjunction with a surgical robot, the cable 1018 may be translated distally and proximally in a manner similar to that described above with respect to the tissue cutting element 555 of the instrument 310.

FIG. 54 illustrates an alternative embodiment of the shaft 1000 comprising several additional features. For example, the shaft 1000, as illustrated in FIG. 54 comprises an optional second wedge 1016′ and cable 1018′. The second wedge 1016′ and cable 1018′ may operate similar to the wedge 1016 and cable 1018 described herein above. The second wedge 1016′ and cable 1018′, however, may be offset from the first wedge 1016 and cable 1018 about the longitudinal axis such that distal translation of the first wedge 1016 causes the end effector 1008 and waveguide 1020 to pivot in a first direction and distal translation of the second wedge 1016′ causes the end effector 1008 and waveguide 1020 to pivot in a second direction. In various example embodiments, the first and second directions may be 180° opposed from one another about the longitudinal axis. In the example embodiment illustrated in FIG. 54, the shaft body 1004 also comprises slots 1022, 1022′ for receiving slot members 1024, 1024′ of the respective wedges 1016, 1016′. The slots 1022, 1022′ and slot members 1024, 1024′ may serve to maintain axially alignment of the respective wedges 1016, 1016′.

FIG. 54 also illustrates one example mechanism for translating the wedges 1016, 1016′ and cables 1018, 1018′ distally and proximally (e.g., in a robotic surgical embodiment). For example, each cable 1018, 1018′ may be wound around respective spools 1026, 1026′. The spools 1026, 1026′, in turn, may be coupled to a robotically controlled component such as, for example, respective rotatable bodies 612 as described herein. Clockwise and counter clockwise rotation of the spools 1026, 1026′ may wind and unwind the cables 1018, 1018′ providing alternating distal and proximally translation to the wedges 1016, 1016′.

The wedges 1016, 1016′ of FIGS. 52-54 are shown in two dimensions. Wedges according to various embodiments, however, can have different three dimensional shapes. FIG. 55 illustrates one embodiment of an example wedge 1028 having a curved or rounded shape. A cross-section 1030 of the wedge 1028 shows a wedge face portion 1032 for contacting the flange 1010. The arrow 1032 indicates a distal direction along the longitudinal axis 1002. FIG. 56 illustrates the wedge 1028 in conjunction with an end effector 1006 comprising an ultrasonic blade 1008 as well as a flange 1010.

FIG. 57 illustrates a cross-section of one embodiment of the shaft 1000 showing a keyed flange 1010′. The flange 1010′ comprises a first keyed surface 1038 for receiving a keyed wedge. The keyed surface 1038 defines first, second and third notches 1036, 1038, 1040 for receiving a steps of a correspondingly keyed wedge. FIG. 58 illustrates one embodiment of a keyed wedge 1044 comprising steps 1046, 1048, 1050 matching the notches 1036, 1038, 1040 of the keyed flange 1010′. In various embodiments, the longitudinal slopes of the various steps 1046, 1048, 1050 are equal. The keyed flange 1010′ is also illustrated with an optional second keyed surface 1042, for example, for interfacing with a second keyed wedge (not shown) in a multi-wedge embodiment such as that shown in FIG. 54. Also, although three notches 1036, 1038, 1040 and three steps 1046, 1048, 1050 are shown, it will be appreciated that keyed surfaces 1038 and wedges 1044 may have more or fewer notches and steps.

FIG. 59 illustrates a wedge 1052 for use with the shaft 1000, the wedge 1052 having a stepped profile. The stepped profile may allow the wedge 1052 to pivot the ultrasonic blade 1008 and waveguide 1020 by discrete amounts. For example, as the wedge 1052 is translated distally, a first wedge portion 1054 pushes the flange 1010, pivoting the blade 1008 and waveguide 1020 by a first amount. As the flange 1010 reaches a first flat portion 1056, it may be held, pivoted by the first amount, until the flange 1010 encounters a second wedge portion 1058. The second wedge portion 1058 may pivot the blade 1008 and waveguide 1020 by a second amount, which is again held as the flange 1010 slides across a second flat portion 1060. A third wedge portion 1062 and third flat portion 1064 may operate in a similar fashion as the wedge 1052 continues to translate distally. When the wedge 1052 is retracted proximally, the flange 1010 (and therefore the blade 1008 and waveguide 1020) may transition back through the discrete pivot amounts associated with each wedge portion and flat portion pair.

FIG. 60 illustrates one example embodiment of a shaft 1066 for use with various surgical instruments, including those described herein having a cammed articulation mechanism. Positioned within the shaft 1066 is a waveguide 1020 coupled to the shaft 1066 at a pivot point 1014. The waveguide 1020 is acoustically coupled to an ultrasonic blade 1008, as described above. The flange 1068 may be a cammed flange defining a waveguide cam feature 1072 configured to contact a shaft cam feature 1070 to deflect the waveguide 1020 and blade 1008 about the pivot point 1012. FIG. 61 illustrates a cross-sectional view of the shaft 1066 providing a view of the shaft cam feature 1070 and waveguide cam feature 1072. In various example embodiments, the shaft body 1004 may be rotatable about the longitudinal axis 1002. As the shaft body 1004 rotates, the shaft cam feature 1070 may come into contact with the waveguide cam feature 1072, causing the waveguide 1020 and blade 1008 to pivot about the pivot point 1014 away from the shaft cam feature 1070.

In some example embodiments, as illustrated in FIG. 61, the flange 1068 may define additional waveguide cam features 1074, 1076, 1078 that may operate in a manner similar to the waveguide cam feature 1072. For example, as the shaft body 1004 rotates, the shaft cam feature 1070 may, in turn, contact each of the additional waveguide cam features 1074, 1076, 1078, causing the waveguide 1020 and blade 1008 to pivot away from the shaft cam feature 1070 about the pivot point 1014. In various embodiments, the shaft body 1004 may define additional shaft cam features (not shown). The shaft body 1004 may be rotated in any suitable manner. For example, in manual or hand-operated surgical instruments, the shaft body 1004 may be rotated in a manner similar to that described above with respect to the distal rotation assembly 13 and shaft assembly 14. In robotic surgical instruments, for example, the shaft body 1004 may be rotated in a manner similar to those described above with respect to FIGS. 32-46C. Also, FIG. 60 illustrates another embodiment for rotating the shaft body 1004, for example, in a robotic setting. For example, a proximal end of the shaft body 1004 may comprise first and second spools 1085, 1087. Additional spools 1081, 1083 are positioned to be rotated by a robot (e.g., the spools 1081, 1083 may be coupled to rotatable bodies 612, as described herein. A cable 1093 may be wound around spools 1085 and 1081. Similarly, a cable 1091 may be wound around spools 1083, 1087. Rotation of spool 1081 may cause the cable 1093 to wind off of the spool 1085 to the spool 1081, thereby rotating the shaft body 1004 in a first direction. The shaft rotation in the first direction may also cause cable 1091 to wind off of spool 1083 and onto spool 1087. In some embodiments, spool 1083 may be separately driven to facilitate this winding. To rotate the shaft body 1004 in a direction opposite the first direction, the spool 1083 may be rotated in an opposite direction, causing cable 1091 to wind from the spool 1087 to the spool 1093. At the same time, spool 1085 may draw cable 1093 from spool 1081. Again, spool 1081 may be separated driven to facilitate this winding.

FIG. 62-64 illustrates one embodiment of an articulating shaft 1080 that may be utilized with various surgical instruments, including those described herein. The shaft body 1004 comprises an interior wall 1092 defining a groove 1082. The groove 1082 may have different portions positioned at different axial distances from the end effector 1006. For example, in some example embodiments, the groove 1082 may be an ovaloid. Also, in some example embodiments, as illustrated by FIGS. 62-64, the groove 1082 may represent a partial or complete cross-section of the shaft body 1004 taken in a plane that intersects the longitudinal axis 1002, but is not perpendicular to the axis 1002.

The flange 1010 of the waveguide 1020 (and/or end effector 1006) may be coupled to a pair of interface members 1084, 1086 at a coupling point (represented in FIGS. 62-64 as the flange 1010). A first interface member 1084 may extend proximally from the flange 1010 and may comprise and/or define a first peg member 1088 positioned to ride within the groove 1082. A second interface member 1084 may extend proximally from the flange 1010 and, similarly, may comprise and/or define a second peg member 1090 also positioned to ride within the groove 1082. As illustrated, the length of the first interface member 1084 between the flange 1010 and the first peg 1088 is longer than the length of the second interface member 1086 between the flange 1010 and the second peg 1090, although this is not necessary.

In the example embodiment shown in FIGS. 62-64, the end effector 1006 is pivoted away from the longitudinal axis 1002 by rotating the shaft body 1004 relative to the waveguide 1020, blade 1008 and interface members 1084, 1086. This relative rotation be brought about by rotation of the shaft body 1004, rotation of the waveguide 1020, or both. As the relative rotation takes place, the peg members 1088, 1090 may ride within the groove 1082. As the peg members 1088, 1090 ride within portions of the groove that are closer to and further from the end effector 1006, the peg members 1088, 1090 may be pushed close to and further from the end effector 1006. Differential axial translation of the peg members 1088, 1090 may cause bending of the interface members 1084, 1086, resulting in pivoting of the end effector 1006. For example, as illustrated in FIG. 64, the peg members 1088, 1090 are placed at a position roughly equidistant from the end effector 1006. As the interface member 1084 is longer than the interface member 1086 in the example of FIG. 64, member 1084 may be pushed distally, while member 1086 is pulled proximally. This may result in the pivoting of the end effector 1006 away from the longitudinal axis 1002 as shown.

The shaft body 1004 and/or waveguide 1020 may be rotated in any suitable manner. For example, in manual or hand-operated surgical instruments, the shaft body 1004 and/or waveguide 1020 may be rotated in a manner similar to that described above with respect to the distal rotation assembly 13 and shaft assembly 14. In robotic surgical instruments, for example, the shaft body 1004 and/or waveguide 1020 may be rotated in a manner similar to those described above with respect to FIGS. 32-46C.

FIGS. 65-67 illustrate one example embodiment of a shaft 1100 coupled to an end effector 1106 comprising an ultrasonic blade 1108 and a pivotable clamp arm 1110. The shaft 11102 comprises a proximal tube 1102 and a flexible portion 1104 with the end effector 1106 coupled to the flexible portion 1104. A clamp arm 1110 is pivotably coupled to the end effector 1106 (e.g., an end effector member 1107) at pivot point 1112. FIGS. 66-67 are cut-away views showing components positioned inside of the shaft 1100. For example, a waveguide 1114 may be acoustically coupled to the ultrasonic blade 1108 and may comprise a bendable portion 1116 at about the position of the flexible portion 1104 of the shaft 1100. Articulation translating members 1113, 1115 may be coupled to the end effector member 1107 at points 1126 and 1124, respectively, to bring about articulation of the end effector 1106, as described below. A clamp arm member 1117 may be coupled to the clamp arm 1110 and may translate distally and proximally to open and close the clamp arm 1110, as described herein below.

FIG. 68 illustrates one embodiment of the end effector 1106 illustrating a first way to utilize the clamp arm member 1117 to open and close the clamp arm 1110. As described above, the clamp arm 1110 may be pivotably coupled to the end effector member 1107 at pivot point 1112. In the example embodiments shown in FIG. 68, the clamp arm member 1117 is a translating member that is coupled to the clamp arm 1110 at 1120. Distal translation of the clamp arm member 1117 may push the point 1120 of the clamp arm 1110 distally, causing the clamp arm 1110 to pivot about the pivot point 1112 to an open position (as illustrated by the dotted lines in FIG. 67). Alternately, pulling the clamp arm member 1117 proximally may pull the point 1120 proximally, causing the clamp arm 1110 to pivot back to the closed position shown in FIGS. 65-66 and 68. The translating clamp arm member 1117 may be translated distally and proximally in any suitable manner. For example, when the shaft 1100 is used in conjunction with a manual or hand held surgical instrument, the translating member 1117 may be translated distally and proximally in a manner similar to that described herein above with respect to the reciprocating tubular actuating member 58 of the instrument 10 and/or the axially moving member 378 of the instrument 300. Also, for example, when the shaft 1100 is used in conjunction with a surgical robot, the translating member 1117 may be translated distally and proximally in a manner similar to that described above with respect to the tissue cutting element 555 of the instrument 310.

FIGS. 69-70 illustrate another example embodiment of the end effector 1106 illustrating an additional way to utilize a clamp arm member 1117′ to open and close the clamp arm 1110. The clamp arm member 1117′ may be a flexible, threaded cable defining a threaded portion 1130 that may extend through a threaded hole 1134 of the end effector member 1107. A distal portion of the clamp arm member 1117′ may be coupled to a mount 1132 positioned distally from the pivot point 1112. As the clamp arm member 1117′ is rotated in a first direction, it may translate distally, pushing distally on the mount 1132 and clamp arm 1110 and tending to close the clamp arm 1110. As the clamp arm member 1117′ is rotated in a second direction opposite the first direction, it may translate proximally, pulling proximally on the mount 1132 and tending to open the clamp arm 1110. The clamp arm member 1117′ may be rotated in any suitable manner. For example, in manual or hand-operated surgical instruments, the clamp arm member 1117′ may be rotated in a manner similar to that described above with respect to the distal rotation assembly 13 and shaft assembly 14. In robotic surgical instruments, for example, the clamp arm member 1117′ may be rotated in a manner similar to those described above with respect to FIGS. 32-46C.

Referring now again to FIGS. 65-67, it will be appreciated that articulation of the end effector 1106 may be brought about in any suitable manner. For example, when the translating member 1113 is pulled proximally, the end effector 1106 may pivot toward the translating member 1113 as shown in FIG. 65. Conversely, when the translating member 1115 is pulled proximally, the end effector 1106 may pivot towards the translating member 1115.

FIGS. 71-72 illustrate one example embodiment of the shaft 1110 showing an example mechanism for managing differential translation of the translating members 1113, 1115. As shown in FIGS. 71-72, the translating members may comprise and/or define respective rack gears 1138, 1136. A pinion gear 1140 may be positioned to engage both of the rack gears 1138, 1136. When one of the translating members 1113 is translated along the longitudinal axis, rack gear 1138 may interface with the pinion gear 1140 causing corresponding and oppositely-directed translation of the opposite translating member 1115, and visa versa. This may facilitate differential translation of the members 1113, 1115. In some embodiments, the pinion gear 1140 may be driven, either manually via a lever and/or automatically (e.g., by a robotic surgical device). When the pinion gear 1140 is driven, it may, in turn, drive rack gears 1138, 1136 causing differential proximal and distal translation of the translating members 1113, 1115 and articulation of the end effector 1106.

Differential translation of the translating members 1113, 1115 may be accomplished in any suitable manner. For example, when the shaft 1100 is utilized in the context of a surgical robot, the members 1170, 1172 may be differentially translated utilizing any of the methods and/or mechanisms described herein above with respect to FIGS. 32-46C. Alternatively, FIGS. 73-74 illustrate one embodiment of a hand-held surgical instrument utilizing the shaft 1100 in the configuration shown in FIGS. 71-72. Pinion gear 1140 is shown in FIG. 73 as coupled to a lever 1142 that may be rotated by a clinician to bring about articulation of the end effector 1106, as described herein above. FIG. 74 shows the instrument 1150 including the lever 1142, demonstrating placement and use of the lever 1142 to bring about articulation.

FIGS. 75-76 illustrate one embodiment of an articulating shaft 1200 that may be utilized with various surgical instruments, including those described herein. The shaft 1200 comprises a distal tube 1202 pivotably coupled to a proximal tube 1204 via a hinge interface 1208. The hinge interface 1208 may be and/or comprise any suitable type of hinge and may, in some example embodiments, comprise a pin. An inner rotatable member 1206 may extend proximally through the proximal tube 1204 and at least a portion of the distal tube 1202. The inner rotatable member 1206 may define a slanted slot 1210. The distal tube 1202 may comprise a peg 1212 positioned to ride within the slanted slot 1210.

The peg 1212, as illustrated, may be positioned opposite the longitudinal axis 1002 from the hinge interface 1208. Due to the slant of the slot 1210, rotation of the inner rotatable member 1206 and slot 1210 in a first direction may tend to push the peg 1212, and thereby the distal tube 1202, distally. Rotation of the inner rotatable member 1206 and slot 1210 in a second direction opposite the first direction may tend to pull the peg 1212 and distal tube 1202 proximally. When the peg 1212 and distal tube 1202 are pushed distally by rotation of the member 1206 and slot 1210, the distal tube 1202 may pivot about the hinge interface 1208 away from the longitudinal axis 1002, as illustrated in FIG. 76. When the peg 1212 and distal tube 1202 are pulled proximally by rotation of the member 1206 and slot 1210, the distal tube 1202 may pivot back towards the longitudinal axis 1002 to the position illustrated in FIG. 75. Rotation of the rotatable member 1206 may be actuated in any suitable manner. For example, in manual or hand-operated surgical instruments, the member 1206 may be rotated in a manner similar to that described above with respect to the distal rotation assembly 13 and shaft assembly 14. In robotic surgical instruments, for example, the member 1206 may be rotated in a manner similar to those described above with respect to FIGS. 32-46C. It will be appreciated that the shaft 1200 may be used with any suitable type of surgical instrument including, for example, an ultrasonic surgical instrument, an electrosurgical instrument, etc. In some embodiments, wire, waveguides and/or other control devices for a surgical instrument may pass through the proximal and distal tubes 1204, 1202. For example, in some embodiments, a waveguide extending through the proximal and distal tubes 1204, 1202 may have a bendable portion 1046, for example, similar to the bendable portions 1506, 1530, 1576, etc., described herein above. The bendable portion may be positioned at about the hinge interface 1208 so as to bend as the distal tube 1202 pivots.

FIG. 77 illustrates one embodiment of a shaft 1300 that may be utilized with various surgical instruments, including those described herein. An end effector 1309 is positioned within an inner shaft 1322 and an outer shaft 1302. The end effector 1309 comprises an ultrasonic blade 1303. Moving proximally, the blade 1303 is acoustically coupled to a flange 1305 that extends through a slot 1312 in the outer shaft 1302. The flange 1305 is coupled to a second flange 1306 via a bendable waveguide portion 1316 (e.g., similar to the bendable portions 1506, 1530, 1576 described herein above). The second flange 1306 may be fixedly coupled to the inner shaft 1322 via supports 1308. The second flange 1306 and supports 1308 may form pivot point 1304. The outer shaft 1302 defines a slot 1312 that receives the flange 1305. When the outer shaft 1302 is translated distally relative to the inner shaft 1322, the flange 1305 may reach a proximal-most portion of the slot 1312, causing the blade 1303 to pivot about the pivot point 1304. The blade 1303 may return to its rest position when the outer shaft 1302 is pulled proximally again. In various embodiments, the respective flanges 1306, 1305 may be positioned at nodes of the waveguide 1308 at the resonant wavelength of the system. In some embodiments, the flanges 1306, 1305 are separated by a single resonant wavelength.

The outer shaft 1302 may be translated distally and proximally in any suitable manner. FIG. 78 illustrates a view showing additional details of one embodiment of the outer shaft 1302. In certain embodiments, the outer shaft 1302 biased distally by a spring 1310. Reciprocating control members 1320 may be utilized to pull the outer shaft 1302 proximally, overcoming the bias of the spring 1310. When tension on the control members 1320 is released, the spring 1310 may bias the outer shaft distally, causing articulation as described above. The control members 1320 may be translated distally and proximally in any suitable manner. For example, when the shaft 1200 is used in conjunction with a manual or hand held surgical instrument, the control members 1320 may be translated distally and proximally in a manner similar to that described herein above with respect to the reciprocating tubular actuating member 58 of the instrument 10 and/or the axially moving member 378 of the instrument 300. Also, for example, when the shaft 1300 is used in conjunction with a surgical robot, the control members 1320 may be translated distally and proximally in a manner similar to that described above with respect to the tissue cutting element 555 of the instrument 310. In certain embodiments, however, the spring 1310 may be omitted. For example, both proximal and distal force may be provided to the outer shaft 1302 by the reciprocating control members.

FIG. 79 illustrates a cut-away view of one embodiment of the shaft 1300. FIG. 79 shows additional features of the inner shaft 1322. For example, the inner shaft 1322 may define a slot 1324 which may also receive the flange 1305. The slot 1324 may have an area larger than that of the slot 1312. For example, the flange 1305 may not contact the edges of the slot 1324 during normal operation. FIG. 80 illustrates the cut-away view of one embodiment of the shaft 1300, with the outer shaft 1302 extended distally to articulate the blade 1303. As illustrated, a distal edge 1313 of the slot 1312 contacts the flange 1305 pushing it distally in the direction of arrow 1311. This, in turn, causes the blade 1303 and flange 1305 to pivot (at bendable waveguide portion 1316) to the position shown.

FIG. 81 illustrates one embodiment of the shaft 1300 having an additional distal flange 1307. The flange 1307 may extend substantially opposite the flange 1305. To prevent interference with articulation, the outer and inner shafts 1302, 1322 may define additional slots 1330, 1332 of a size sufficient such that the flange 1307 does not contact any edges of the slots 1330, 1332 during articulation. Also, although articulation in the described embodiment is provided by distal and proximal translation of the outer shaft 1302, it will be appreciated that similar shafts may be constructed having a reciprocating inner slotted shaft to perform the function provided by the outer shaft 1302 as described herein. For example, the inner shaft may be translatable within an outer shaft and may define a slot for receiving the flange 1305.

As the inner shaft translates distally, its slot may contact the flange 1305, causing the blade 1303 to articulate, as shown in FIG. 80.

NON-LIMITING EXAMPLES

Various embodiments are directed to articulatable surgical instruments comprising an end effector comprising an ultrasonic blade, a hollow shaft extending proximally from the end effector along a longitudinal axis and a waveguide extending through the shaft and acoustically coupled to the ultrasonic blade. In certain embodiments, the waveguide comprises a distally positioned flange positioned within the hollow shaft proximally from the blade. The waveguide may also be held stationary at a first pivot point positioned within the hollow shaft proximally from the flange. A reciprocating wedge may be positioned within the hollow shaft such that distal motion of the wedge pushes the wedge between the flange and the hollow shaft, causing the ultrasonic blade to pivot about the first pivot in a first direction.

In certain embodiments, the hollow shaft may comprise a first shaft defining a slot and a second shaft. The first and second shafts may be translatable relative to one another along the longitudinal axis. The waveguide may comprise a distally positioned first flange positioned within the hollow shaft proximally from the blade, a bendable portion positioned proximally from the first flange, and a second flange positioned proximally from the bendable portion and fixedly coupled to the second shaft. The first flange may extend through the slot. Also, the first shaft may be translatable from a distal position where a proximal edge of the slot pushes the first flange distally, bending the ultrasonic blade away from the longitudinal axis to a proximal position.

In certain embodiments, an interior portion of the hollow shaft defines a shaft cam feature directed towards the longitudinal axis. Further, the waveguide may define a waveguide cam feature directed away from the longitudinal axis. In this way, rotation of the hollow shaft relative to the waveguide causes the shaft cam feature to come into contact with the waveguide cam feature, resulting in bending of the waveguide and ultrasonic blade away from the longitudinal axis about the first pivot point in a first direction. In certain embodiments, the end effector comprises a clamp arm coupled to a member positioned around the ultrasonic blade. The clamp arm may be pivotably coupled to the member at a pivot point. A flexible control cable may be coupled to the clamp arm at a point offset from the pivot point. Distal and proximal translation of the control cable may cause the clamp arm to pivot relative to the ultrasonic blade. In certain embodiments, the member may define a threaded hole through which extends a flexible, threaded cable. The cable may also be coupled to the clamp arm such that rotation of the cable causes it to translate proximally and distally, depending on the direction of rotation. Such proximally and distal translation may cause the clamp arm to open and close.

Also, various embodiments are directed to articulatable surgical instruments comprising an end effector comprising an ultrasonic blade and a hollow shaft extending proximally from the end effector. An interior wall of the hollow shaft may define a groove, where different positions of the groove are positioned at different axial distances from the end effector. A first interface member may be coupled to either a waveguide or the ultrasonic blade at a coupling point and extending proximally. The first interface member may comprise a first peg member positioned within the groove. A second interface member may be coupled to the waveguide or the ultrasonic blade at the coupling point and may extend proximally. The second interface member may also comprise a peg member positioned within the groove. Upon rotation of the hollow shaft relative to the waveguide, the first and second peg members may translate within the groove causing bending of the first and second interface members and deflection of the first and second interface members away from the longitudinal axis.

Various embodiments are directed to articulatable surgical instruments comprising an end effector and a shaft extending proximally from the end effector along a longitudinal axis. The shaft may comprise a proximal tube and a distal tube pivotably coupled to the proximal tube at a hinge interface offset from the longitudinal axis. The distal tube may comprise an axially directed peg member. The surgical instruments may further comprise an inner rotatable member extending proximally through at least a portion of the proximal tube and at least a portion of the distal tube. The inner rotatable member may define a slanted slot such that the axially directed peg member rides at least partially within the slanted slot and such that rotation of the inner rotatable member in a first direction pushes the peg member and distal tube distally and rotation of the inner rotatable member in a second direction opposite the first direction pushes the peg member and distal tube proximally.

Applicant also owns the following patent applications that are each incorporated by reference in their respective entireties:

- U.S. patent application Ser. No. 13/536,271, filed on Jun. 28, 2012 and entitled “Flexible Drive Member,” now U.S. Pat. No. 9,204,879;
- U.S. patent application Ser. No. 13/536,288, filed on Jun. 28, 2012 and entitled “Multi-Functional Powered Surgical Device with External Dissection Features,” now U.S. Patent Application Publication No. 2014-0005718 A1;
- U.S. patent application Ser. No. 13/536,295, filed on Jun. 28, 2012 and entitled “Rotary Actuatable Closure Arrangement for Surgical End Effector,” now U.S. Pat. No. 9,119,657;
- U.S. patent application Ser. No. 13/536,326, filed on Jun. 28, 2012 and entitled “Surgical End Effectors Having Angled Tissue-Contacting Surfaces,” now U.S. Pat. No. 9,289,256;
- U.S. patent application Ser. No. 13/536,303, filed on Jun. 28, 2012 and entitled “Interchangeable End Effector Coupling Arrangement,” now U.S. Pat. No. 9,028,494;
- U.S. patent application Ser. No. 13/536,393, filed on Jun. 28, 2012 and entitled “Surgical End Effector Jaw and Electrode Configurations,” now U.S. Patent Application Publication No. 2014-0005640 A1;
- U.S. patent application Ser. No. 13/536,362, filed on Jun. 28, 2012 and entitled “Multi-Axis Articulating and Rotating Surgical Tools,” now U.S. Pat. No. 9,125,662; and
- U.S. patent application Ser. No. 13/536,417, filed on Jun. 28, 2012 and entitled “Electrode Connections for Rotary Driven Surgical Tools,” now U.S. Pat. No. 9,101,385.

It will be appreciated that the terms “proximal” and “distal” are used throughout the specification with reference to a clinician manipulating one end of an instrument used to treat a patient. The term “proximal” refers to the portion of the instrument closest to the clinician and the term “distal” refers to the portion located furthest from the clinician. It will further be appreciated that for conciseness and clarity, spatial terms such as “vertical,” “horizontal,” “up,” or “down” may be used herein with respect to the illustrated embodiments. However, surgical instruments may be used in many orientations and positions, and these terms are not intended to be limiting or absolute.

Various embodiments of surgical instruments and robotic surgical systems are described herein. It will be understood by those skilled in the art that the various embodiments described herein may be used with the described surgical instruments and robotic surgical systems. The descriptions are provided for example only, and those skilled in the art will understand that the disclosed embodiments are not limited to only the devices disclosed herein, but may be used with any compatible surgical instrument or robotic surgical system.

Reference throughout the specification to “various embodiments,” “some embodiments,” “one example embodiment,” or “an embodiment” means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one example embodiment. Thus, appearances of the phrases “in various embodiments,” “in some embodiments,” “in one example embodiment,” or “in an embodiment” in places throughout the specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics illustrated or described in connection with one example embodiment may be combined, in whole or in part, with features, structures, or characteristics of one or more other embodiments without limitation.

While various embodiments herein have been illustrated by description of several embodiments and while the illustrative embodiments have been described in considerable detail, it is not the intention of the applicant to restrict or in any way limit the scope of the appended claims to such detail. Additional advantages and modifications may readily appear to those skilled in the art. For example, each of the disclosed embodiments may be employed in endoscopic procedures are, laparoscopic procedures, as well as open procedures, without limitations to its intended use.

It is to be understood that at least some of the figures and descriptions herein have been simplified to illustrate elements that are relevant for a clear understanding of the disclosure, while eliminating, for purposes of clarity, other elements. Those of ordinary skill in the art will recognize, however, that these and other elements may be desirable. However, because such elements are well known in the art, and because they do not facilitate a better understanding of the disclosure, a discussion of such elements is not provided herein.

While several embodiments have been described, it should be apparent, however, that various modifications, alterations and adaptations to those embodiments may occur to persons skilled in the art with the attainment of some or all of the advantages of the disclosure. For example, according to various embodiments, a single component may be replaced by multiple components, and multiple components may be replaced by a single component, to perform a given function or functions. This application is therefore intended to cover all such modifications, alterations and adaptations without departing from the scope and spirit of the disclosure as defined by the appended claims.

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.

Claims

1. An articulatable surgical instrument comprising: an end effector comprising an ultrasonic blade, wherein the ultrasonic blade comprises a flange;a hollow shaft extending proximally from the end effector along a longitudinal axis, the hollow shaft comprising a rigid portion and a flexible portion at a first position on the longitudinal axis distal from the rigid portion;a waveguide extending through the hollow shaft and acoustically coupled to the ultrasonic blade, wherein the waveguide comprises a flexible portion at the first position on the longitudinal axis; andan interface portion positioned within the hollow shaft, wherein the interface portion is configured to translate within the hollow shaft between a proximal position and a distal position in response to a user input, wherein the interface portion causes the flange to cause the ultrasonic blade to pivot about the longitudinal axis as the interface portion translates between the proximal position and the distal position, and wherein the interface portion comprises a wedge configured to engage the flange as it translates between the proximal position and the distal position.
2. The articulatable surgical instrument of claim 1, wherein the end effector further comprises: a member, wherein the ultrasonic blade extends through the member;a clamp arm coupled to the member at a pivot point offset from the longitudinal axis, wherein the clamp arm is pivotable relative to the ultrasonic blade about the pivot point; andwherein the interface portion comprises a flexible control cable coupled to the clamp arm at a point offset from the pivot point such that distal and proximal translation of the flexible control cable causes the clamp arm to pivot relative to the ultrasonic blade.
3. A surgical system comprising: an articulatable surgical instrument comprising: an end effector to treat tissue, wherein the end effector comprises an ultrasonic blade, and wherein the ultrasonic blade comprises a flange;a hollow shaft extending proximally from the end effector along a longitudinal axis, the hollow shaft comprising a rigid portion and a flexible portion at a first position on the longitudinal axis distal from the rigid portion;a waveguide extending through the hollow shaft and acoustically coupled to the ultrasonic blade, wherein the waveguide comprises a flexible portion at the first position on the longitudinal axis such that the end effector is pivotable away from the longitudinal axis from the first position; andan interface portion positioned within the hollow shaft, wherein the interface portion is configured to translate within the hollow shaft between a proximal position and a distal position in response to a user input, wherein the interface portion causes the flange to cause the ultrasonic blade to pivot about the longitudinal axis as the interface portion translates between the proximal position and the distal position, and wherein the interface portion comprises a wedge configured to engage the flange as it translates between the proximal position and the distal position; andan instrument mounting portion coupled to the end effector, wherein the instrument mounting portion is configured to pivot the end effector.
4. The surgical system of claim 3, wherein the end effector further comprises: a member, wherein the ultrasonic blade extends through the member;a clamp arm coupled to the member at a pivot point offset from the longitudinal axis, wherein the clamp arm is pivotable relative to the ultrasonic blade about the pivot point; andwherein the interface portion comprises a flexible control cable coupled to the clamp arm at a point offset from the pivot point such that distal and proximal translation of the flexible control cable causes the clamp arm to pivot relative to the ultrasonic blade.
5. An articulatable surgical instrument comprising: an end effector comprising an ultrasonic blade, wherein the ultrasonic blade comprises a flange;a hollow shaft extending from the end effector along a longitudinal axis, the hollow shaft comprising a rigid shaft portion and a flexible shaft portion;a waveguide extending through the hollow shaft and acoustically coupled to the ultrasonic blade, the waveguide comprising a flexible waveguide portion; andan interface portion positioned within the hollow shaft, wherein the interface portion is configured to translate within the hollow shaft between a proximal position and a distal position in response to a user input, wherein the interface portion causes the flange to cause the ultrasonic blade to pivot about the longitudinal axis as the interface portion translates between the proximal position and the distal position, wherein the flexible waveguide portion is positionally aligned with the flexible shaft portion such that the end effector is pivotable away from the longitudinal axis, and wherein the interface portion comprises a wedge configured to engage the flange as it translates between the proximal position and the distal position.
6. The articulatable surgical instrument of claim 5, wherein the end effector further comprises: a member, wherein the ultrasonic blade extends through the member;a clamp arm coupled to the member at a pivot point offset from the longitudinal axis, wherein the clamp arm is pivotable relative to the ultrasonic blade about the pivot point; andwherein the interface portion comprises a flexible control cable coupled to the clamp arm at a point offset from the pivot point such that distal and proximal translation of the flexible control cable causes the clamp arm to pivot relative to the ultrasonic blade.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional application claiming priority under 35 U.S.C. § 121 to U.S. patent application Ser. No. 15/212,742, filed Jul. 18, 2016, which is a divisional application claiming priority under 35 U.S.C. § 121 to U.S. patent application Ser. No. 13/538,700, filed Jun. 29, 2012, entitled “Surgical Instruments with Articulating Shafts,” which issued on Aug. 9, 2016 as U.S. Pat. No. 9,408,622, the entire disclosures of which are hereby incorporated by reference herein. This application is related to the following U.S. Patent Applications, filed Jun. 29, 2012, which are incorporated herein by reference in their entirety: U.S. patent application Ser. No. 13/539,096, entitled “Haptic Feedback Devices for Surgical Robot,” now U.S. Pat. No. 9,198,714;U.S. patent application Ser. No. 13/539,110, entitled “Lockout Mechanism for Use with Robotic Electrosurgical Device,” now U.S. Pat. No. 9,326,788;U.S. patent application Ser. No. 13/539,117, entitled “Closed Feedback Control for Electrosurgical Device,” now U.S. Pat. No. 9,226,767;U.S. patent application Ser. No. 13/538,588, entitled “Surgical Instruments with Articulating Shafts,” now U.S. Patent Application Publication No. 2014/0005701;U.S. patent application Ser. No. 13/538,601, entitled “Ultrasonic Surgical Instruments with Distally Positioned Transducers,” now U.S. Patent Application Publication No. 2014/0005702;U.S. patent application Ser. No. 13/538,711, entitled “Ultrasonic Surgical Instruments with Distally Positioned Jaw Assemblies,” now U.S. Pat. No. 9,351,754;U.S. patent application Ser. No. 13/538,720, entitled “Surgical Instruments with Articulating Shafts,” now U.S. Patent Application Publication No. 2014/0005705;U.S. patent application Ser. No. 13/538,733, entitled “Ultrasonic Surgical Instruments with Control Mechanisms,” now U.S. Pat. No. 9,820,768; andU.S. patent application Ser. No. 13/539,122, entitled “Surgical Instruments With Fluid Management System,” now U.S. Pat. No. 9,283,045.

US Referenced Citations (3279)

Number	Name	Date	Kind
969528	Disbrow	Sep 1910	A
1570025	Young	Jan 1926	A
1813902	Bovie	Jul 1931	A
2188497	Calva	Jan 1940	A
2366274	Luth et al.	Jan 1945	A
2425245	Johnson	Aug 1947	A
2442966	Wallace	Jun 1948	A
2458152	Eakins	Jan 1949	A
2510693	Green	Jun 1950	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
2867039	Zach	Jan 1959	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
3166971	Stoecker	Jan 1965	A
3322403	Murphy	May 1967	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
3525912	Wallin	Aug 1970	A
3526219	Balamuth	Sep 1970	A
3554198	Tatoian et al.	Jan 1971	A
3580841	Cadotte et al.	May 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
3703651	Blowers	Nov 1972	A
3776238	Peyman et al.	Dec 1973	A
3777760	Essner	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
3989952	Hohmann	Nov 1976	A
4005714	Hiltebrandt	Feb 1977	A
4012647	Balamuth et al.	Mar 1977	A
4034762	Cosens et al.	Jul 1977	A
4058126	Leveen	Nov 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
4203430	Takahashi	May 1980	A
4203444	Bonnell et al.	May 1980	A
4220154	Semm	Sep 1980	A
4237441	van Konynenburg et al.	Dec 1980	A
4244371	Farin	Jan 1981	A
4281785	Brooks	Aug 1981	A
4300083	Heiges	Nov 1981	A
4302728	Nakamura	Nov 1981	A
4304987	van Konynenburg	Dec 1981	A
4306570	Matthews	Dec 1981	A
4314559	Allen	Feb 1982	A
4353371	Cosman	Oct 1982	A
4409981	Lundberg	Oct 1983	A
4445063	Smith	Apr 1984	A
4461304	Kuperstein	Jul 1984	A
4463759	Garito et al.	Aug 1984	A
4491132	Aikins	Jan 1985	A
4492231	Auth	Jan 1985	A
4494759	Kieffer	Jan 1985	A
4504264	Kelman	Mar 1985	A
4512344	Barber	Apr 1985	A
4526571	Wuchinich	Jul 1985	A
4535773	Yoon	Aug 1985	A
4541638	Ogawa et al.	Sep 1985	A
4545374	Jacobson	Oct 1985	A
4545926	Fouts, Jr. et al.	Oct 1985	A
4549147	Kondo	Oct 1985	A
4550870	Krumme et al.	Nov 1985	A
4553544	Nomoto et al.	Nov 1985	A
4562838	Walker	Jan 1986	A
4574615	Bower et al.	Mar 1986	A
4582236	Hirose	Apr 1986	A
4593691	Lindstrom et al.	Jun 1986	A
4608981	Rothfuss et al.	Sep 1986	A
4617927	Manes	Oct 1986	A
4633119	Thompson	Dec 1986	A
4633874	Chow et al.	Jan 1987	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
4694835	Strand	Sep 1987	A
4708127	Abdelghani	Nov 1987	A
4712722	Hood et al.	Dec 1987	A
4735603	Goodson et al.	Apr 1988	A
4739759	Rexroth et al.	Apr 1988	A
4761871	O'Connor et al.	Aug 1988	A
4808154	Freeman	Feb 1989	A
4819635	Shapiro	Apr 1989	A
4827911	Broadwin et al.	May 1989	A
4830462	Karny 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
4849133	Yoshida et al.	Jul 1989	A
4850354	McGurk-Burleson et al.	Jul 1989	A
4852578	Companion et al.	Aug 1989	A
4860745	Farin et al.	Aug 1989	A
4862890	Stasz et al.	Sep 1989	A
4865159	Jamison	Sep 1989	A
4867157	McGurk-Burleson et al.	Sep 1989	A
4878493	Pasternak et al.	Nov 1989	A
4880015	Nierman	Nov 1989	A
4881550	Kothe	Nov 1989	A
4896009	Pawlowski	Jan 1990	A
4903696	Stasz et al.	Feb 1990	A
4910389	Sherman et al.	Mar 1990	A
4915643	Samejima et al.	Apr 1990	A
4920978	Colvin	May 1990	A
4922902	Wuchinich et al.	May 1990	A
4926860	Stice et al.	May 1990	A
4936842	D'Amelio et al.	Jun 1990	A
4954960	Lo et al.	Sep 1990	A
4965532	Sakurai	Oct 1990	A
4979952	Kubota et al.	Dec 1990	A
4981756	Rhandhawa	Jan 1991	A
5001649	Lo et al.	Mar 1991	A
5003693	Atkinson et al.	Apr 1991	A
5009661	Michelson	Apr 1991	A
5013956	Kurozumi et al.	May 1991	A
5015227	Broadwin et al.	May 1991	A
5020514	Heckele	Jun 1991	A
5026370	Lottick	Jun 1991	A
5026387	Thomas	Jun 1991	A
5035695	Weber, Jr. et al.	Jul 1991	A
5042461	Inoue et al.	Aug 1991	A
5042707	Taheri	Aug 1991	A
5052145	Wang	Oct 1991	A
5061269	Muller	Oct 1991	A
5075839	Fisher et al.	Dec 1991	A
5084052	Jacobs	Jan 1992	A
5099840	Goble et al.	Mar 1992	A
5104025	Main et al.	Apr 1992	A
5105117	Yamaguchi	Apr 1992	A
5106538	Barma et al.	Apr 1992	A
5108383	White	Apr 1992	A
5109819	Custer et al.	May 1992	A
5112300	Ureche	May 1992	A
5113139	Furukawa	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
5156633	Smith	Oct 1992	A
5160334	Billings et al.	Nov 1992	A
5162044	Gahn et al.	Nov 1992	A
5163421	Bernstein et al.	Nov 1992	A
5163537	Radev	Nov 1992	A
5163945	Ortiz et al.	Nov 1992	A
5167619	Wuchinich	Dec 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	Grzeszykowski	Feb 1993	A
5188102	Idemoto et al.	Feb 1993	A
D334173	Liu et al.	Mar 1993	S
5190517	Zieve et al.	Mar 1993	A
5190518	Takasu	Mar 1993	A
5190541	Abele et al.	Mar 1993	A
5196007	Ellman et al.	Mar 1993	A
5203380	Chikama	Apr 1993	A
5205459	Brinkerhoff et al.	Apr 1993	A
5205817	Idemoto et al.	Apr 1993	A
5209719	Baruch et al.	May 1993	A
5213569	Davis	May 1993	A
5214339	Naito	May 1993	A
5217460	Knoepfler	Jun 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
5231989	Middleman et al.	Aug 1993	A
5234428	Kaufman	Aug 1993	A
5241236	Sasaki et al.	Aug 1993	A
5241968	Slater	Sep 1993	A
5242339	Thornton	Sep 1993	A
5242460	Klein et al.	Sep 1993	A
5246003	DeLonzor	Sep 1993	A
5254129	Alexander	Oct 1993	A
5257988	L'Esperance, Jr.	Nov 1993	A
5258004	Bales et al.	Nov 1993	A
5258006	Rydell et al.	Nov 1993	A
5261922	Hood	Nov 1993	A
5263957	Davison	Nov 1993	A
5264925	Shipp et al.	Nov 1993	A
5269297	Weng et al.	Dec 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
5285945	Brinkerhoff et al.	Feb 1994	A
5290286	Parins	Mar 1994	A
5293863	Zhu et al.	Mar 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
5309927	Welch	May 1994	A
5312023	Green et al.	May 1994	A
5312425	Evans et al.	May 1994	A
5318525	West et al.	Jun 1994	A
5318563	Malis et al.	Jun 1994	A
5318564	Eggers	Jun 1994	A
5318570	Hood et al.	Jun 1994	A
5318589	Lichtman	Jun 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
5330471	Eggers	Jul 1994	A
5330502	Hassler et al.	Jul 1994	A
5334183	Wuchinich	Aug 1994	A
5339723	Huitema	Aug 1994	A
5342356	Ellman et al.	Aug 1994	A
5342359	Rydell	Aug 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
5361583	Huitema	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
5383874	Jackson et al.	Jan 1995	A
5383917	Desai et al.	Jan 1995	A
5387207	Dyer et al.	Feb 1995	A
5387215	Fisher	Feb 1995	A
5389098	Tsuruta et al.	Feb 1995	A
5394187	Shipp	Feb 1995	A
5395033	Byrne et al.	Mar 1995	A
5395312	Desa	Mar 1995	A
5395363	Billings et al.	Mar 1995	A
5395364	Anderhub et al.	Mar 1995	A
5396266	Brimhall	Mar 1995	A
5396900	Slater et al.	Mar 1995	A
5400267	Denen et al.	Mar 1995	A
5403312	Yates et al.	Apr 1995	A
5403334	Evans et al.	Apr 1995	A
5406503	Williams, Jr. et al.	Apr 1995	A
5408268	Shipp	Apr 1995	A
D358887	Feinberg	May 1995	S
5411481	Allen et al.	May 1995	A
5417709	Slater	May 1995	A
5419761	Narayanan et al.	May 1995	A
5421829	Olichney et al.	Jun 1995	A
5423844	Miller	Jun 1995	A
5428504	Bhatla	Jun 1995	A
5429131	Scheinman et al.	Jul 1995	A
5438997	Sieben et al.	Aug 1995	A
5441499	Fritzsch	Aug 1995	A
5443463	Stern et al.	Aug 1995	A
5445638	Rydell et al.	Aug 1995	A
5445639	Kuslich et al.	Aug 1995	A
5447509	Mills et al.	Sep 1995	A
5449370	Vaitekunas	Sep 1995	A
5451053	Garrido	Sep 1995	A
5451161	Sharp	Sep 1995	A
5451220	Ciervo	Sep 1995	A
5451227	Michaelson	Sep 1995	A
5456684	Schmidt et al.	Oct 1995	A
5458598	Feinberg et al.	Oct 1995	A
5462604	Shibano et al.	Oct 1995	A
5465895	Knodel et al.	Nov 1995	A
5471988	Fujio et al.	Dec 1995	A
5472443	Cordis et al.	Dec 1995	A
5476479	Green et al.	Dec 1995	A
5478003	Green et al.	Dec 1995	A
5480409	Riza	Jan 1996	A
5483501	Park et al.	Jan 1996	A
5484436	Eggers et al.	Jan 1996	A
5486162	Brumbach	Jan 1996	A
5486189	Mudry et al.	Jan 1996	A
5490860	Middle et al.	Feb 1996	A
5496317	Goble et al.	Mar 1996	A
5499992	Meade et al.	Mar 1996	A
5500216	Julian et al.	Mar 1996	A
5501654	Failla et al.	Mar 1996	A
5504650	Katsui et al.	Apr 1996	A
5505693	Mackool	Apr 1996	A
5507297	Slater et al.	Apr 1996	A
5507738	Ciervo	Apr 1996	A
5509922	Aranyi et al.	Apr 1996	A
5511556	DeSantis	Apr 1996	A
5520704	Castro et al.	May 1996	A
5522832	Kugo et al.	Jun 1996	A
5522839	Pilling	Jun 1996	A
5527331	Kresch et al.	Jun 1996	A
5531744	Nardella et al.	Jul 1996	A
5536267	Edwards et al.	Jul 1996	A
5540681	Strul et al.	Jul 1996	A
5540684	Hassler, Jr.	Jul 1996	A
5540693	Fisher	Jul 1996	A
5542916	Hirsch et al.	Aug 1996	A
5548286	Craven	Aug 1996	A
5549637	Crainich	Aug 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
5562703	Desai	Oct 1996	A
5563179	Stone et al.	Oct 1996	A
5569164	Lurz	Oct 1996	A
5571121	Heifetz	Nov 1996	A
5573424	Poppe	Nov 1996	A
5573533	Strul	Nov 1996	A
5573534	Stone	Nov 1996	A
5577654	Bishop	Nov 1996	A
5584830	Ladd et al.	Dec 1996	A
5591187	Dekel	Jan 1997	A
5593414	Shipp et al.	Jan 1997	A
5599350	Schulze et al.	Feb 1997	A
5600526	Russell et al.	Feb 1997	A
5601601	Tal et al.	Feb 1997	A
5603773	Campbell	Feb 1997	A
5607436	Pratt et al.	Mar 1997	A
5607450	Zvenyatsky et al.	Mar 1997	A
5609573	Sandock	Mar 1997	A
5611813	Lichtman	Mar 1997	A
5618304	Hart et al.	Apr 1997	A
5618307	Donlon et al.	Apr 1997	A
5618492	Auten et al.	Apr 1997	A
5620447	Smith et al.	Apr 1997	A
5624452	Yates	Apr 1997	A
5626587	Bishop et al.	May 1997	A
5626595	Sklar et al.	May 1997	A
5626608	Cuny et al.	May 1997	A
5628760	Knoepfler	May 1997	A
5630420	Vaitekunas	May 1997	A
5632432	Schulze et al.	May 1997	A
5632717	Yoon	May 1997	A
5638827	Palmer et al.	Jun 1997	A
5640741	Yano	Jun 1997	A
D381077	Hunt	Jul 1997	S
5647871	Levine et al.	Jul 1997	A
5649937	Bito et al.	Jul 1997	A
5649955	Hashimoto et al.	Jul 1997	A
5651780	Jackson et al.	Jul 1997	A
5653713	Michelson	Aug 1997	A
5655100	Ebrahim et al.	Aug 1997	A
5658281	Heard	Aug 1997	A
5662662	Bishop et al.	Sep 1997	A
5662667	Knodel	Sep 1997	A
5665085	Nardella	Sep 1997	A
5665100	Yoon	Sep 1997	A
5669922	Hood	Sep 1997	A
5674219	Monson et al.	Oct 1997	A
5674220	Fox et al.	Oct 1997	A
5674235	Parisi	Oct 1997	A
5678568	Uchikubo et al.	Oct 1997	A
5688270	Yates et al.	Nov 1997	A
5690269	Bolanos et al.	Nov 1997	A
5693042	Boiarski et al.	Dec 1997	A
5693051	Schulze et al.	Dec 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
5704791	Gillio	Jan 1998	A
5707369	Vaitekunas 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
5716366	Yates	Feb 1998	A
5717306	Shipp	Feb 1998	A
5720742	Zacharias	Feb 1998	A
5720744	Eggleston et al.	Feb 1998	A
5722980	Schulz et al.	Mar 1998	A
5723970	Bell	Mar 1998	A
5728130	Ishikawa et al.	Mar 1998	A
5730752	Alden et al.	Mar 1998	A
5733074	Stock et al.	Mar 1998	A
5735848	Yates et al.	Apr 1998	A
5741226	Strukel et al.	Apr 1998	A
5743906	Parins et al.	Apr 1998	A
5752973	Kieturakis	May 1998	A
5755717	Yates et al.	May 1998	A
5759183	VanDusseldorp	Jun 1998	A
5762255	Chrisman et al.	Jun 1998	A
5766164	Mueller et al.	Jun 1998	A
5772659	Becker et al.	Jun 1998	A
5776130	Buysse et al.	Jul 1998	A
5776155	Beaupre et al.	Jul 1998	A
5779130	Alesi et al.	Jul 1998	A
5779701	McBrayer et al.	Jul 1998	A
5782834	Lucey et al.	Jul 1998	A
5792135	Madhani et al.	Aug 1998	A
5792138	Shipp	Aug 1998	A
5792165	Klieman et al.	Aug 1998	A
5796188	Bays	Aug 1998	A
5797941	Schulze et al.	Aug 1998	A
5797958	Yoon	Aug 1998	A
5797959	Castro et al.	Aug 1998	A
5800432	Swanson	Sep 1998	A
5800448	Banko	Sep 1998	A
5800449	Wales	Sep 1998	A
5805140	Rosenberg et al.	Sep 1998	A
5807393	Williamson, IV et al.	Sep 1998	A
5808396	Boukhny	Sep 1998	A
5810811	Yates et al.	Sep 1998	A
5810828	Lightman et al.	Sep 1998	A
5810859	DiMatteo et al.	Sep 1998	A
5817033	DeSantis et al.	Oct 1998	A
5817084	Jensen	Oct 1998	A
5817093	Williamson, IV et al.	Oct 1998	A
5817119	Klieman et al.	Oct 1998	A
5823197	Edwards	Oct 1998	A
5827271	Buysse et al.	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
5836909	Cosmescu	Nov 1998	A
5836943	Miller, III	Nov 1998	A
5836957	Schulz et al.	Nov 1998	A
5836990	Li	Nov 1998	A
5843109	Mehta et al.	Dec 1998	A
5851212	Zirps et al.	Dec 1998	A
5853412	Mayenberger	Dec 1998	A
5854590	Dalstein	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
5876401	Schulze et al.	Mar 1999	A
5878193	Wang et al.	Mar 1999	A
5879364	Bromfield et al.	Mar 1999	A
5880668	Hall	Mar 1999	A
5883615	Fago et al.	Mar 1999	A
5891142	Eggers et al.	Apr 1999	A
5893835	Witt et al.	Apr 1999	A
5897523	Wright	Apr 1999	A
5897569	Kellogg et al.	Apr 1999	A
5903607	Tailliet	May 1999	A
5904681	West, Jr.	May 1999	A
5906625	Bito et al.	May 1999	A
5906627	Spaulding	May 1999	A
5906628	Miyawaki et al.	May 1999	A
5910129	Koblish et al.	Jun 1999	A
5911699	Anis et al.	Jun 1999	A
5913823	Hedberg et al.	Jun 1999	A
5916229	Evans	Jun 1999	A
5921956	Grinberg et al.	Jul 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
5954717	Behl et al.	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
5984938	Yoon	Nov 1999	A
5987344	West	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
6003517	Sheffield et al.	Dec 1999	A
6004335	Vaitekunas et al.	Dec 1999	A
6013052	Durman et al.	Jan 2000	A
6024741	Williamson, IV et al.	Feb 2000	A
6024744	Kese 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
6039734	Goble	Mar 2000	A
6048224	Kay	Apr 2000	A
6050943	Slayton et al.	Apr 2000	A
6050996	Schmaltz 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
6068629	Haissaguerre et al.	May 2000	A
6068647	Witt et al.	May 2000	A
6074389	Levine et al.	Jun 2000	A
6077285	Boukhny	Jun 2000	A
6080149	Huang et al.	Jun 2000	A
6083191	Rose	Jul 2000	A
6086584	Miller	Jul 2000	A
6090120	Wright et al.	Jul 2000	A
6091995	Ingle et al.	Jul 2000	A
6096033	Tu et al.	Aug 2000	A
6099483	Palmer et al.	Aug 2000	A
6099542	Cohn et al.	Aug 2000	A
6099550	Yoon	Aug 2000	A
6109500	Alli et al.	Aug 2000	A
6110127	Suzuki	Aug 2000	A
6113594	Savage	Sep 2000	A
6113598	Baker	Sep 2000	A
6117152	Huitema	Sep 2000	A
H1904	Yates et al.	Oct 2000	H
6126629	Perkins	Oct 2000	A
6126658	Baker	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
6132429	Baker	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
6144402	Norsworthy et al.	Nov 2000	A
6147560	Erhage et al.	Nov 2000	A
6152902	Christian et al.	Nov 2000	A
6152923	Ryan	Nov 2000	A
6154198	Rosenberg	Nov 2000	A
6156029	Mueller	Dec 2000	A
6159160	Hsei et al.	Dec 2000	A
6159175	Strukel et al.	Dec 2000	A
6162194	Shipp	Dec 2000	A
6162208	Hipps	Dec 2000	A
6165150	Banko	Dec 2000	A
6174309	Wrublewski et al.	Jan 2001	B1
6174310	Kirwan, Jr.	Jan 2001	B1
6176857	Ashley	Jan 2001	B1
6179853	Sachse et al.	Jan 2001	B1
6183426	Akisada et al.	Feb 2001	B1
6187003	Buysse et al.	Feb 2001	B1
6190386	Rydell	Feb 2001	B1
6193709	Miyawaki et al.	Feb 2001	B1
6204592	Hur	Mar 2001	B1
6205383	Hermann	Mar 2001	B1
6205855	Pfeiffer	Mar 2001	B1
6206844	Reichel et al.	Mar 2001	B1
6206876	Levine 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
6232899	Craven	May 2001	B1
6233476	Strommer et al.	May 2001	B1
6238366	Savage et al.	May 2001	B1
6238384	Peer	May 2001	B1
6241724	Fleischman et al.	Jun 2001	B1
6245065	Panescu et al.	Jun 2001	B1
6251110	Wampler	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
6259230	Chou	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
6277117	Tetzlaff et al.	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
6292700	Morrison et al.	Sep 2001	B1
6299591	Banko	Oct 2001	B1
6306131	Hareyama et al.	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
6340878	Oglesbee	Jan 2002	B1
6350269	Shipp et al.	Feb 2002	B1
6352532	Kramer et al.	Mar 2002	B1
6356224	Wohlfarth	Mar 2002	B1
6358246	Behl 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
6387094	Eitenmuller	May 2002	B1
6387109	Davison et al.	May 2002	B1
6388657	Natol	May 2002	B1
6390973	Ouchi	May 2002	B1
6391026	Hung et al.	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
6405184	Bohme et al.	Jun 2002	B1
6405733	Fogarty et al.	Jun 2002	B1
6409722	Hoey et al.	Jun 2002	B1
H2037	Yates et al.	Jul 2002	H
6416469	Phung et al.	Jul 2002	B1
6416486	Wampler	Jul 2002	B1
6417969	DeLuca et al.	Jul 2002	B1
6419675	Gallo, Sr.	Jul 2002	B1
6423073	Bowman	Jul 2002	B2
6423082	Houser et al.	Jul 2002	B1
6425906	Young et al.	Jul 2002	B1
6428538	Blewett et al.	Aug 2002	B1
6428539	Baxter et al.	Aug 2002	B1
6430446	Knowlton	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
6458128	Schulze	Oct 2002	B1
6458130	Frazier et al.	Oct 2002	B1
6458142	Faller et al.	Oct 2002	B1
6459363	Walker et al.	Oct 2002	B1
6461363	Gadberry et al.	Oct 2002	B1
6464689	Qin et al.	Oct 2002	B1
6464702	Schulze et al.	Oct 2002	B2
6468270	Hovda et al.	Oct 2002	B1
6475211	Chess et al.	Nov 2002	B2
6475215	Tanrisever	Nov 2002	B1
6480796	Wiener	Nov 2002	B2
6485490	Wampler et al.	Nov 2002	B2
6491690	Goble et al.	Dec 2002	B1
6491701	Tierney et al.	Dec 2002	B2
6491708	Madan et al.	Dec 2002	B2
6497715	Satou	Dec 2002	B2
6500112	Khouri	Dec 2002	B1
6500176	Truckai et al.	Dec 2002	B1
6500188	Harper et al.	Dec 2002	B2
6500312	Wedekamp	Dec 2002	B2
6503248	Levine	Jan 2003	B1
6506208	Hunt et al.	Jan 2003	B2
6511478	Burnside et al.	Jan 2003	B1
6511480	Tetzlaff et al.	Jan 2003	B1
6511493	Moutafis et al.	Jan 2003	B1
6514252	Nezhat et al.	Feb 2003	B2
6514267	Jewett	Feb 2003	B2
6517565	Whitman et al.	Feb 2003	B1
6524251	Rabiner et al.	Feb 2003	B2
6524316	Nicholson et al.	Feb 2003	B1
6527736	Attinger et al.	Mar 2003	B1
6531846	Smith	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
6551309	LePivert	Apr 2003	B1
6554829	Schulze et al.	Apr 2003	B2
6558376	Bishop	May 2003	B2
6558380	Lingenfelder et al.	May 2003	B2
6561983	Cronin et al.	May 2003	B2
6562035	Levin	May 2003	B1
6562037	Paton et al.	May 2003	B2
6565558	Lindenmeier et al.	May 2003	B1
6572563	Ouchi	Jun 2003	B2
6572632	Zisterer et al.	Jun 2003	B2
6572639	Ingle et al.	Jun 2003	B1
6575969	Rittman, III et al.	Jun 2003	B1
6582427	Goble et al.	Jun 2003	B1
6582451	Marucci et al.	Jun 2003	B1
6584360	Francischelli et al.	Jun 2003	B2
D477408	Bromley	Jul 2003	S
6585735	Frazier et al.	Jul 2003	B1
6588277	Giordano et al.	Jul 2003	B2
6589200	Schwemberger et al.	Jul 2003	B1
6589239	Khandkar et al.	Jul 2003	B2
6590733	Wilson et al.	Jul 2003	B1
6599288	Maguire et al.	Jul 2003	B2
6602252	Mollenauer	Aug 2003	B2
6602262	Griego et al.	Aug 2003	B2
6607540	Shipp	Aug 2003	B1
6610059	West, Jr.	Aug 2003	B1
6610060	Mulier et al.	Aug 2003	B2
6611793	Burnside et al.	Aug 2003	B1
6616450	Mossle et al.	Sep 2003	B2
6619529	Green et al.	Sep 2003	B2
6620161	Schulze et al.	Sep 2003	B2
6622731	Daniel et al.	Sep 2003	B2
6623482	Pendekanti 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
6632221	Edwards et al.	Oct 2003	B1
6633234	Wiener et al.	Oct 2003	B2
6635057	Harano 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
6656198	Tsonton 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
6673248	Chowdhury	Jan 2004	B2
6676660	Wampler et al.	Jan 2004	B2
6678621	Wiener et al.	Jan 2004	B2
6679875	Honda et al.	Jan 2004	B2
6679882	Kornerup	Jan 2004	B1
6679899	Wiener et al.	Jan 2004	B2
6682501	Nelson et al.	Jan 2004	B1
6682544	Mastri et al.	Jan 2004	B2
6685700	Behl et al.	Feb 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
6690960	Chen et al.	Feb 2004	B2
6695840	Schulze	Feb 2004	B2
6702821	Bonutti	Mar 2004	B2
6716215	David et al.	Apr 2004	B1
6719692	Kleffner et al.	Apr 2004	B2
6719765	Bonutti	Apr 2004	B2
6719776	Baxter et al.	Apr 2004	B2
6722552	Fenton, Jr.	Apr 2004	B2
6723091	Goble et al.	Apr 2004	B2
D490059	Conway et al.	May 2004	S
6730080	Harano et al.	May 2004	B2
6731047	Kauf et al.	May 2004	B2
6733498	Paton et al.	May 2004	B2
6733506	McDevitt et al.	May 2004	B1
6736813	Yamauchi et al.	May 2004	B2
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
6766202	Underwood et al.	Jul 2004	B2
6770072	Truckai et al.	Aug 2004	B1
6773409	Truckai et al.	Aug 2004	B2
6773434	Ciarrocca	Aug 2004	B2
6773435	Schulze et al.	Aug 2004	B2
6773443	Truwit et al.	Aug 2004	B2
6773444	Messerly	Aug 2004	B2
6775575	Bommannan et al.	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
6789939	Schrodinger et al.	Sep 2004	B2
6790173	Saadat et al.	Sep 2004	B2
6790216	Ishikawa	Sep 2004	B1
6794027	Araki et al.	Sep 2004	B1
6796981	Wham et al.	Sep 2004	B2
D496997	Dycus et al.	Oct 2004	S
6800085	Selmon et al.	Oct 2004	B2
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
6811842	Ehrnsperger et al.	Nov 2004	B1
6814731	Swanson	Nov 2004	B2
6819027	Saraf	Nov 2004	B2
6821273	Mollenauer	Nov 2004	B2
6827712	Tovey et al.	Dec 2004	B2
6828712	Battaglin et al.	Dec 2004	B2
6835082	Gonnering	Dec 2004	B2
6835199	McGuckin, Jr. et al.	Dec 2004	B2
6840938	Morley et al.	Jan 2005	B1
6843789	Goble	Jan 2005	B2
6849073	Hoey et al.	Feb 2005	B2
6860878	Brock	Mar 2005	B2
6860880	Treat et al.	Mar 2005	B2
6863676	Lee et al.	Mar 2005	B2
6866671	Tierney 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
6893435	Goble	May 2005	B2
6898536	Wiener et al.	May 2005	B2
6899685	Kermode et al.	May 2005	B2
6905497	Truckai et al.	Jun 2005	B2
6908463	Treat 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
6923806	Hooven et al.	Aug 2005	B2
6926712	Phan	Aug 2005	B2
6926716	Baker et al.	Aug 2005	B2
6926717	Garito et al.	Aug 2005	B1
6929602	Hirakui et al.	Aug 2005	B2
6929622	Chian	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	Birge	Sep 2005	B2
6948503	Refior et al.	Sep 2005	B2
6953461	McClurken et al.	Oct 2005	B2
6958070	Witt et al.	Oct 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
6984231	Goble et al.	Jan 2006	B2
6988295	Tillim	Jan 2006	B2
6988649	Shelton, IV et al.	Jan 2006	B2
6994708	Manzo	Feb 2006	B2
6994709	Iida	Feb 2006	B2
7000818	Shelton, IV et al.	Feb 2006	B2
7001335	Adachi et al.	Feb 2006	B2
7001379	Behl et al.	Feb 2006	B2
7001382	Gallo, Sr.	Feb 2006	B2
7004951	Gibbens, III	Feb 2006	B2
7011657	Truckai et al.	Mar 2006	B2
7014638	Michelson	Mar 2006	B2
7018389	Camerlengo	Mar 2006	B2
7025732	Thompson et al.	Apr 2006	B2
7033356	Latterell et al.	Apr 2006	B2
7033357	Baxter et al.	Apr 2006	B2
7037306	Podany et al.	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
7052494	Goble et al.	May 2006	B2
7052496	Yamauchi	May 2006	B2
7055731	Shelton, IV et al.	Jun 2006	B2
7063699	Hess et al.	Jun 2006	B2
7066893	Hibner et al.	Jun 2006	B2
7066895	Podany	Jun 2006	B2
7066936	Ryan	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
7083075	Swayze et al.	Aug 2006	B2
7083613	Treat	Aug 2006	B2
7083618	Couture et al.	Aug 2006	B2
7083619	Truckai et al.	Aug 2006	B2
7087054	Truckai et al.	Aug 2006	B2
7090637	Danitz et al.	Aug 2006	B2
7090672	Underwood et al.	Aug 2006	B2
7094235	Francischelli	Aug 2006	B2
7101371	Dycus et al.	Sep 2006	B2
7101372	Dycus et al.	Sep 2006	B2
7101373	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
7113831	Hooven	Sep 2006	B2
D531311	Guerra et al.	Oct 2006	S
7117034	Kronberg	Oct 2006	B2
7118564	Ritchie et al.	Oct 2006	B2
7118570	Tetzlaff et al.	Oct 2006	B2
7118587	Dycus et al.	Oct 2006	B2
7119516	Denning	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
7131970	Moses 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
7143925	Shelton, IV et al.	Dec 2006	B2
7144403	Booth	Dec 2006	B2
7147138	Shelton, IV	Dec 2006	B2
7153315	Miller	Dec 2006	B2
D536093	Nakajima et al.	Jan 2007	S
7156189	Bar-Cohen et al.	Jan 2007	B1
7156846	Dycus et al.	Jan 2007	B2
7156853	Muratsu	Jan 2007	B2
7157058	Marhasin et al.	Jan 2007	B2
7159750	Racenet et al.	Jan 2007	B2
7160259	Tardy et al.	Jan 2007	B2
7160296	Pearson et al.	Jan 2007	B2
7160298	Lawes et al.	Jan 2007	B2
7160299	Baily	Jan 2007	B2
7163548	Stulen et al.	Jan 2007	B2
7166103	Carmel et al.	Jan 2007	B2
7169144	Hoey et al.	Jan 2007	B2
7169146	Truckai et al.	Jan 2007	B2
7169156	Hart	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
7195631	Dumbauld	Mar 2007	B2
D541418	Schechter et al.	Apr 2007	S
7198635	Danek et al.	Apr 2007	B2
7204820	Akahoshi	Apr 2007	B2
7207471	Heinrich et al.	Apr 2007	B2
7207997	Shipp et al.	Apr 2007	B2
7208005	Frecker 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
7225964	Mastri et al.	Jun 2007	B2
7226447	Uchida et al.	Jun 2007	B2
7226448	Bertolero et al.	Jun 2007	B2
7229455	Sakurai et al.	Jun 2007	B2
7232440	Dumbauld et al.	Jun 2007	B2
7235071	Gonnering	Jun 2007	B2
7235073	Levine et al.	Jun 2007	B2
7241294	Reschke	Jul 2007	B2
7244262	Wiener et al.	Jul 2007	B2
7251531	Mosher et al.	Jul 2007	B2
7252641	Thompson et al.	Aug 2007	B2
7252667	Moses et al.	Aug 2007	B2
7258688	Shah et al.	Aug 2007	B1
7264618	Murakami et al.	Sep 2007	B2
7267677	Johnson et al.	Sep 2007	B2
7267685	Butaric et al.	Sep 2007	B2
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	Beaupre	Oct 2007	B2
7287682	Ezzat et al.	Oct 2007	B1
7297149	Vitali et al.	Nov 2007	B2
7300431	Dubrovsky	Nov 2007	B2
7300435	Wham et al.	Nov 2007	B2
7300446	Beaupre	Nov 2007	B2
7300450	Vleugels et al.	Nov 2007	B2
7303531	Lee et al.	Dec 2007	B2
7303557	Wham et al.	Dec 2007	B2
7306597	Manzo	Dec 2007	B2
7307313	Ohyanagi et al.	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
7318832	Young et al.	Jan 2008	B2
7326236	Andreas et al.	Feb 2008	B2
7329257	Kanehira 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	Truckal et al.	Apr 2008	B2
7357287	Shelton, IV et al.	Apr 2008	B2
7357802	Palanker et al.	Apr 2008	B2
7361172	Cimino	Apr 2008	B2
7364577	Wham et al.	Apr 2008	B2
7367976	Lawes et al.	May 2008	B2
7371227	Zeiner	May 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
7384420	Dycus et al.	Jun 2008	B2
7390317	Taylor et al.	Jun 2008	B2
7396356	Mollenauer	Jul 2008	B2
7403224	Fuller et al.	Jul 2008	B2
7404508	Smith et al.	Jul 2008	B2
7407077	Ortiz et al.	Aug 2008	B2
7408288	Hara	Aug 2008	B2
7412008	Lliev	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
7422582	Malackowski et al.	Sep 2008	B2
D578643	Shumer et al.	Oct 2008	S
D578644	Shumer et al.	Oct 2008	S
D578645	Shumer et al.	Oct 2008	S
7431694	Stefanchik et al.	Oct 2008	B2
7431704	Babaev	Oct 2008	B2
7431720	Pendekanti et al.	Oct 2008	B2
7435582	Zimmermann et al.	Oct 2008	B2
7441684	Shelton, IV et al.	Oct 2008	B2
7442193	Shields et al.	Oct 2008	B2
7445621	Dumbauld et al.	Nov 2008	B2
7449004	Yamada et al.	Nov 2008	B2
7451904	Shelton, IV	Nov 2008	B2
7455208	Wales et al.	Nov 2008	B2
7455641	Yamada et al.	Nov 2008	B2
7462181	Kraft et al.	Dec 2008	B2
7464846	Shelton, IV et al.	Dec 2008	B2
7464849	Shelton, IV et al.	Dec 2008	B2
7472815	Shelton, IV et al.	Jan 2009	B2
7473145	Ehr et al.	Jan 2009	B2
7473253	Dycus 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
7488319	Yates	Feb 2009	B2
7491201	Shields et al.	Feb 2009	B2
7491202	Odom et al.	Feb 2009	B2
7494468	Rabiner et al.	Feb 2009	B2
7494501	Ahlberg et al.	Feb 2009	B2
7498080	Tung et al.	Mar 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
7507239	Shadduck	Mar 2009	B2
7510107	Timm et al.	Mar 2009	B2
7510556	Nguyen et al.	Mar 2009	B2
7513025	Fischer	Apr 2009	B2
7517349	Truckai et al.	Apr 2009	B2
7520865	Radley Young et al.	Apr 2009	B2
7524320	Tierney et al.	Apr 2009	B2
7525309	Sherman et al.	Apr 2009	B2
7530986	Beaupre et al.	May 2009	B2
7534243	Chin et al.	May 2009	B1
7535233	Kojovic et al.	May 2009	B2
D594983	Price et al.	Jun 2009	S
7540871	Gonnering	Jun 2009	B2
7540872	Schechter et al.	Jun 2009	B2
7543730	Marczyk	Jun 2009	B1
7544200	Houser	Jun 2009	B2
7549564	Boudreaux	Jun 2009	B2
7550216	Ofer et al.	Jun 2009	B2
7553309	Buysse et al.	Jun 2009	B2
7554343	Bromfield	Jun 2009	B2
7559450	Wales et al.	Jul 2009	B2
7559452	Wales et al.	Jul 2009	B2
7563259	Takahashi	Jul 2009	B2
7566318	Haefner	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
7582086	Privitera et al.	Sep 2009	B2
7582087	Tetzlaff et al.	Sep 2009	B2
7582095	Shipp et al.	Sep 2009	B2
7585181	Olsen	Sep 2009	B2
7586289	Andruk et al.	Sep 2009	B2
7587536	McLeod	Sep 2009	B2
7588176	Timm et al.	Sep 2009	B2
7588177	Racenet	Sep 2009	B2
7594925	Danek et al.	Sep 2009	B2
7597693	Garrison	Oct 2009	B2
7601119	Shahinian	Oct 2009	B2
7601136	Akahoshi	Oct 2009	B2
7604150	Boudreaux	Oct 2009	B2
7607557	Shelton, IV et al.	Oct 2009	B2
7617961	Viola	Nov 2009	B2
7621930	Houser	Nov 2009	B2
7625370	Hart et al.	Dec 2009	B2
7628791	Garrison et al.	Dec 2009	B2
7628792	Guerra	Dec 2009	B2
7632267	Dahla	Dec 2009	B2
7632269	Truckai et al.	Dec 2009	B2
7637410	Marczyk	Dec 2009	B2
7641653	Dalla Betta et al.	Jan 2010	B2
7641671	Crainich	Jan 2010	B2
7644848	Swayze et al.	Jan 2010	B2
7645240	Thompson et al.	Jan 2010	B2
7645277	McClurken et al.	Jan 2010	B2
7645278	Ichihashi et al.	Jan 2010	B2
7648499	Orszulak et al.	Jan 2010	B2
7649410	Andersen et al.	Jan 2010	B2
7654431	Hueil et al.	Feb 2010	B2
7655003	Lorang et al.	Feb 2010	B2
7658311	Boudreaux	Feb 2010	B2
7659833	Warner et al.	Feb 2010	B2
7662151	Crompton, Jr. et al.	Feb 2010	B2
7665647	Shelton, IV et al.	Feb 2010	B2
7666206	Taniguchi et al.	Feb 2010	B2
7667592	Ohyama 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
7678105	McGreevy et al.	Mar 2010	B2
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
7691095	Bednarek et al.	Apr 2010	B2
7691098	Wallace et al.	Apr 2010	B2
7696441	Kataoka	Apr 2010	B2
7699846	Ryan	Apr 2010	B2
7703459	Saadat et al.	Apr 2010	B2
7703653	Shah et al.	Apr 2010	B2
7708735	Chapman et al.	May 2010	B2
7708751	Hughes et al.	May 2010	B2
7708758	Lee et al.	May 2010	B2
7708768	Danek et al.	May 2010	B2
7713202	Boukhny et al.	May 2010	B2
7713267	Pozzato	May 2010	B2
7714481	Sakai	May 2010	B2
7717312	Beetel	May 2010	B2
7717914	Kimura	May 2010	B2
7717915	Miyazawa	May 2010	B2
7721935	Racenet et al.	May 2010	B2
7722527	Bouchier et al.	May 2010	B2
7722607	Dumbauld et al.	May 2010	B2
D618797	Price et al.	Jun 2010	S
7726537	Olson et al.	Jun 2010	B2
7727177	Bayat	Jun 2010	B2
7731717	Odom et al.	Jun 2010	B2
7738969	Bleich	Jun 2010	B2
7740594	Hibner	Jun 2010	B2
7744615	Couture	Jun 2010	B2
7749240	Takahashi et al.	Jul 2010	B2
7751115	Song	Jul 2010	B2
7753245	Boudreaux et al.	Jul 2010	B2
7753904	Shelton, IV et al.	Jul 2010	B2
7753908	Swanson	Jul 2010	B2
7762445	Heinrich et al.	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
7766910	Hixson et al.	Aug 2010	B2
7768510	Tsai 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
7776037	Odom	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
7780663	Yates et al.	Aug 2010	B2
7784662	Wales et al.	Aug 2010	B2
7784663	Shelton, IV	Aug 2010	B2
7789883	Takashino et al.	Sep 2010	B2
7793814	Racenet et al.	Sep 2010	B2
7794475	Hess et al.	Sep 2010	B2
7796969	Kelly et al.	Sep 2010	B2
7798386	Schall et al.	Sep 2010	B2
7799020	Shores et al.	Sep 2010	B2
7799027	Hafner	Sep 2010	B2
7799045	Masuda	Sep 2010	B2
7803151	Whitman	Sep 2010	B2
7803152	Honda et al.	Sep 2010	B2
7803156	Eder et al.	Sep 2010	B2
7803168	Gifford 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
7815238	Cao	Oct 2010	B2
7815641	Dodde et al.	Oct 2010	B2
7819298	Hall et al.	Oct 2010	B2
7819299	Shelton, IV et al.	Oct 2010	B2
7819819	Quick et al.	Oct 2010	B2
7819872	Johnson et al.	Oct 2010	B2
7821143	Wiener	Oct 2010	B2
D627066	Romero	Nov 2010	S
7824401	Manzo et al.	Nov 2010	B2
7832408	Shelton, IV et al.	Nov 2010	B2
7832611	Boyden et al.	Nov 2010	B2
7832612	Baxter, III 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
7846159	Morrison et al.	Dec 2010	B2
7846160	Payne 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
7862561	Swanson et al.	Jan 2011	B2
7867228	Nobis et al.	Jan 2011	B2
7871392	Sartor	Jan 2011	B2
7871423	Livneh	Jan 2011	B2
7876030	Taki et al.	Jan 2011	B2
D631965	Price et al.	Feb 2011	S
7877852	Unger et al.	Feb 2011	B2
7878991	Babaev	Feb 2011	B2
7879029	Jimenez	Feb 2011	B2
7879033	Sartor et al.	Feb 2011	B2
7879035	Garrison et al.	Feb 2011	B2
7879070	Ortiz et al.	Feb 2011	B2
7883475	Dupont et al.	Feb 2011	B2
7892606	Thies et al.	Feb 2011	B2
7896875	Heim et al.	Mar 2011	B2
7897792	Iikura et al.	Mar 2011	B2
7901400	Wham et al.	Mar 2011	B2
7901423	Stulen et al.	Mar 2011	B2
7905881	Masuda et al.	Mar 2011	B2
7909220	Viola	Mar 2011	B2
7909820	Lipson et al.	Mar 2011	B2
7909824	Masuda et al.	Mar 2011	B2
7918848	Lau et al.	Apr 2011	B2
7919184	Mohapatra et al.	Apr 2011	B2
7922061	Shelton, IV et al.	Apr 2011	B2
7922651	Yamada et al.	Apr 2011	B2
7931611	Novak et al.	Apr 2011	B2
7931649	Couture et al.	Apr 2011	B2
D637288	Houghton	May 2011	S
D638540	Ijiri et al.	May 2011	S
7935114	Takashino et al.	May 2011	B2
7936203	Zimlich	May 2011	B2
7951095	Makin et al.	May 2011	B2
7951165	Golden et al.	May 2011	B2
7954682	Giordano et al.	Jun 2011	B2
7955331	Truckai et al.	Jun 2011	B2
7956620	Gilbert	Jun 2011	B2
7959050	Smith et al.	Jun 2011	B2
7959626	Hong et al.	Jun 2011	B2
7963963	Francischelli et al.	Jun 2011	B2
7967602	Lindquist	Jun 2011	B2
7972328	Wham et al.	Jul 2011	B2
7972329	Refior et al.	Jul 2011	B2
7975895	Milliman	Jul 2011	B2
7976544	McClurken et al.	Jul 2011	B2
7980443	Scheib et al.	Jul 2011	B2
7981050	Ritchart et al.	Jul 2011	B2
7981113	Truckai et al.	Jul 2011	B2
7997278	Utley et al.	Aug 2011	B2
7998157	Culp et al.	Aug 2011	B2
8002732	Visconti	Aug 2011	B2
8002770	Swanson et al.	Aug 2011	B2
8020743	Shelton, IV	Sep 2011	B2
8025672	Novak et al.	Sep 2011	B2
8028885	Smith et al.	Oct 2011	B2
8033173	Ehlert et al.	Oct 2011	B2
8034049	Odom et al.	Oct 2011	B2
8038693	Allen	Oct 2011	B2
8048070	O'Brien et al.	Nov 2011	B2
8048074	Masuda	Nov 2011	B2
8052672	Laufer et al.	Nov 2011	B2
8055208	Lilla et al.	Nov 2011	B2
8056720	Hawkes	Nov 2011	B2
8056787	Boudreaux et al.	Nov 2011	B2
8057468	Konesky	Nov 2011	B2
8057498	Robertson	Nov 2011	B2
8058771	Giordano et al.	Nov 2011	B2
8061014	Smith et al.	Nov 2011	B2
8066167	Measamer et al.	Nov 2011	B2
8070036	Knodel	Dec 2011	B1
8070711	Bassinger et al.	Dec 2011	B2
8070762	Escudero et al.	Dec 2011	B2
8075555	Truckai et al.	Dec 2011	B2
8075558	Truckai et al.	Dec 2011	B2
8089197	Rinner et al.	Jan 2012	B2
8092475	Cotter et al.	Jan 2012	B2
8096459	Ortiz et al.	Jan 2012	B2
8097012	Kagarise	Jan 2012	B2
8100894	Mucko et al.	Jan 2012	B2
8105230	Honda et al.	Jan 2012	B2
8105323	Buysse et al.	Jan 2012	B2
8105324	Palanker et al.	Jan 2012	B2
8114104	Young et al.	Feb 2012	B2
8118276	Sanders et al.	Feb 2012	B2
8128624	Couture et al.	Mar 2012	B2
8133218	Daw et al.	Mar 2012	B2
8136712	Zingman	Mar 2012	B2
8141762	Bedi et al.	Mar 2012	B2
8142421	Cooper et al.	Mar 2012	B2
8142461	Houser et al.	Mar 2012	B2
8147485	Wham et al.	Apr 2012	B2
8147488	Masuda	Apr 2012	B2
8147508	Madan et al.	Apr 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
8170717	Sutherland et al.	May 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
8186560	Hess et al.	May 2012	B2
8186877	Klimovitch et al.	May 2012	B2
8187267	Pappone 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
8197479	Olson et al.	Jun 2012	B2
8197502	Smith et al.	Jun 2012	B2
8207651	Gilbert	Jun 2012	B2
8210411	Yates et al.	Jul 2012	B2
8211100	Podhajsky et al.	Jul 2012	B2
8220688	Laurent et al.	Jul 2012	B2
8221306	Okada et al.	Jul 2012	B2
8221415	Francischelli	Jul 2012	B2
8221418	Prakash et al.	Jul 2012	B2
8226580	Govari et al.	Jul 2012	B2
8226665	Cohen	Jul 2012	B2
8226675	Houser et al.	Jul 2012	B2
8231607	Takuma	Jul 2012	B2
8235917	Joseph et al.	Aug 2012	B2
8236018	Yoshimine et al.	Aug 2012	B2
8236019	Houser	Aug 2012	B2
8236020	Smith et al.	Aug 2012	B2
8241235	Kahler et al.	Aug 2012	B2
8241271	Millman et al.	Aug 2012	B2
8241282	Unger et al.	Aug 2012	B2
8241283	Guerra et al.	Aug 2012	B2
8241284	Dycus et al.	Aug 2012	B2
8241312	Messerly	Aug 2012	B2
8246575	Viola	Aug 2012	B2
8246615	Behnke	Aug 2012	B2
8246616	Amoah et al.	Aug 2012	B2
8246618	Bucciaglia et al.	Aug 2012	B2
8246642	Houser et al.	Aug 2012	B2
8251994	McKenna et al.	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
8262563	Bakos et al.	Sep 2012	B2
8267300	Boudreaux	Sep 2012	B2
8267935	Couture et al.	Sep 2012	B2
8273087	Kimura et al.	Sep 2012	B2
D669992	Schafer et al.	Oct 2012	S
D669993	Merchant et al.	Oct 2012	S
8277446	Heard	Oct 2012	B2
8277447	Garrison et al.	Oct 2012	B2
8277471	Wiener et al.	Oct 2012	B2
8282581	Zhao et al.	Oct 2012	B2
8282669	Gerber et al.	Oct 2012	B2
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
8292886	Kerr et al.	Oct 2012	B2
8292888	Whitman	Oct 2012	B2
8292905	Taylor et al.	Oct 2012	B2
8295902	Salahieh et al.	Oct 2012	B2
8298223	Wham et al.	Oct 2012	B2
8298225	Gilbert	Oct 2012	B2
8298232	Unger	Oct 2012	B2
8298233	Mueller	Oct 2012	B2
8303576	Brock	Nov 2012	B2
8303579	Shibata	Nov 2012	B2
8303580	Wham et al.	Nov 2012	B2
8303583	Hosier et al.	Nov 2012	B2
8303613	Crandall et al.	Nov 2012	B2
8306629	Mioduski et al.	Nov 2012	B2
8308040	Huang et al.	Nov 2012	B2
8319400	Houser et al.	Nov 2012	B2
8323302	Robertson et al.	Dec 2012	B2
8323310	Kingsley	Dec 2012	B2
8328061	Kasvikis	Dec 2012	B2
8328761	Widenhouse et al.	Dec 2012	B2
8328802	Deville et al.	Dec 2012	B2
8328833	Cuny	Dec 2012	B2
8328834	Isaacs et al.	Dec 2012	B2
8333764	Francischelli 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
8343146	Godara et al.	Jan 2013	B2
8344596	Nield et al.	Jan 2013	B2
8348880	Messerly et al.	Jan 2013	B2
8348947	Takashino et al.	Jan 2013	B2
8348967	Stulen	Jan 2013	B2
8353297	Dacquay et al.	Jan 2013	B2
8357103	Mark et al.	Jan 2013	B2
8357144	Whitman et al.	Jan 2013	B2
8357149	Govari et al.	Jan 2013	B2
8357158	McKenna et al.	Jan 2013	B2
8360299	Zemlok et al.	Jan 2013	B2
8361066	Long et al.	Jan 2013	B2
8361072	Dumbauld et al.	Jan 2013	B2
8361569	Saito et al.	Jan 2013	B2
8366727	Witt et al.	Feb 2013	B2
8372064	Douglass 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
8377044	Coe et al.	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
8382792	Chojin	Feb 2013	B2
8388646	Chojin	Mar 2013	B2
8388647	Nau, Jr. et al.	Mar 2013	B2
8393514	Shelton, IV et al.	Mar 2013	B2
8394115	Houser et al.	Mar 2013	B2
8397971	Yates et al.	Mar 2013	B2
8398394	Sauter et al.	Mar 2013	B2
8398674	Prestel	Mar 2013	B2
8403926	Nobis et al.	Mar 2013	B2
8403945	Whitfield et al.	Mar 2013	B2
8403948	Deville et al.	Mar 2013	B2
8403949	Palmer et al.	Mar 2013	B2
8403950	Palmer et al.	Mar 2013	B2
8409234	Stahler et al.	Apr 2013	B2
8414577	Boudreaux et al.	Apr 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
8423182	Robinson et al.	Apr 2013	B2
8425410	Murray et al.	Apr 2013	B2
8425545	Smith et al.	Apr 2013	B2
8430811	Hess et al.	Apr 2013	B2
8430874	Newton et al.	Apr 2013	B2
8430876	Kappus et al.	Apr 2013	B2
8430897	Novak et al.	Apr 2013	B2
8430898	Wiener et al.	Apr 2013	B2
8435257	Smith et al.	May 2013	B2
8437832	Govari et al.	May 2013	B2
8439912	Cunningham et al.	May 2013	B2
8439939	Deville et al.	May 2013	B2
8444036	Shelton, IV	May 2013	B2
8444637	Podmore et al.	May 2013	B2
8444662	Palmer et al.	May 2013	B2
8444663	Houser et al.	May 2013	B2
8444664	Balanev et al.	May 2013	B2
8453906	Huang et al.	Jun 2013	B2
8454599	Inagaki et al.	Jun 2013	B2
8454639	Du et al.	Jun 2013	B2
8459525	Yates et al.	Jun 2013	B2
8460284	Aronow et al.	Jun 2013	B2
8460288	Tamai et al.	Jun 2013	B2
8460292	Truckai et al.	Jun 2013	B2
8461744	Wiener et al.	Jun 2013	B2
8469981	Robertson et al.	Jun 2013	B2
8471685	Shingai	Jun 2013	B2
8479969	Shelton, IV	Jul 2013	B2
8480703	Nicholas et al.	Jul 2013	B2
8484833	Cunningham et al.	Jul 2013	B2
8485413	Scheib et al.	Jul 2013	B2
8485970	Widenhouse 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
8491625	Horner	Jul 2013	B2
8496682	Guerra et al.	Jul 2013	B2
D687549	Johnson et al.	Aug 2013	S
8506555	Ruiz Morales	Aug 2013	B2
8509318	Tailliet	Aug 2013	B2
8512336	Couture	Aug 2013	B2
8512337	Francischelli et al.	Aug 2013	B2
8512359	Whitman et al.	Aug 2013	B2
8512364	Kowalski et al.	Aug 2013	B2
8512365	Wiener et al.	Aug 2013	B2
8517239	Scheib et al.	Aug 2013	B2
8518067	Masuda et al.	Aug 2013	B2
8521331	Itkowitz	Aug 2013	B2
8523043	Ullrich et al.	Sep 2013	B2
8523882	Huitema et al.	Sep 2013	B2
8523889	Stulen et al.	Sep 2013	B2
8528563	Gruber	Sep 2013	B2
8529437	Taylor et al.	Sep 2013	B2
8529565	Masuda et al.	Sep 2013	B2
8531064	Robertson et al.	Sep 2013	B2
8535308	Govari et al.	Sep 2013	B2
8535311	Schall	Sep 2013	B2
8535340	Allen	Sep 2013	B2
8535341	Allen	Sep 2013	B2
8540128	Shelton, IV et al.	Sep 2013	B2
8546996	Messerly et al.	Oct 2013	B2
8546999	Houser et al.	Oct 2013	B2
8551077	Main et al.	Oct 2013	B2
8551086	Kimura et al.	Oct 2013	B2
8556929	Harper et al.	Oct 2013	B2
8561870	Baxter, III et al.	Oct 2013	B2
8562592	Conlon et al.	Oct 2013	B2
8562598	Falkenstein et al.	Oct 2013	B2
8562600	Kirkpatrick et al.	Oct 2013	B2
8562604	Nishimura	Oct 2013	B2
8568390	Mueller	Oct 2013	B2
8568397	Horner et al.	Oct 2013	B2
8568400	Gilbert	Oct 2013	B2
8568412	Brandt et al.	Oct 2013	B2
8569997	Lee	Oct 2013	B2
8573461	Shelton, IV et al.	Nov 2013	B2
8573465	Shelton, IV	Nov 2013	B2
8574231	Boudreaux et al.	Nov 2013	B2
8574253	Gruber et al.	Nov 2013	B2
8579176	Smith et al.	Nov 2013	B2
8579897	Vakharia et al.	Nov 2013	B2
8579928	Robertson et al.	Nov 2013	B2
8579937	Gresham	Nov 2013	B2
8585727	Polo	Nov 2013	B2
8588371	Ogawa 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
8596513	Olson et al.	Dec 2013	B2
8597193	Grunwald et al.	Dec 2013	B2
8597287	Benamou et al.	Dec 2013	B2
8602031	Reis et al.	Dec 2013	B2
8602288	Shelton, IV et al.	Dec 2013	B2
8603085	Jimenez	Dec 2013	B2
8603089	Viola	Dec 2013	B2
8608044	Hueil et al.	Dec 2013	B2
8608045	Smith et al.	Dec 2013	B2
8608745	Guzman et al.	Dec 2013	B2
8613383	Beckman et al.	Dec 2013	B2
8616431	Timm et al.	Dec 2013	B2
8617152	Werneth et al.	Dec 2013	B2
8617194	Beaupre	Dec 2013	B2
8622274	Yates et al.	Jan 2014	B2
8623011	Spivey	Jan 2014	B2
8623016	Fischer	Jan 2014	B2
8623027	Price et al.	Jan 2014	B2
8623040	Artsyukhovich et al.	Jan 2014	B2
8623044	Timm et al.	Jan 2014	B2
8628529	Aldridge et al.	Jan 2014	B2
8628534	Jones et al.	Jan 2014	B2
8632461	Glossop	Jan 2014	B2
8636736	Yates et al.	Jan 2014	B2
8638428	Brown	Jan 2014	B2
8640788	Dachs, II et al.	Feb 2014	B2
8641663	Kirschenman et al.	Feb 2014	B2
8647350	Mohan et al.	Feb 2014	B2
8650728	Wan et al.	Feb 2014	B2
8652120	Giordano et al.	Feb 2014	B2
8652132	Tsuchiya et al.	Feb 2014	B2
8652155	Houser et al.	Feb 2014	B2
8657489	Ladurner et al.	Feb 2014	B2
8659208	Rose et al.	Feb 2014	B1
8663214	Weinberg et al.	Mar 2014	B2
8663220	Wiener et al.	Mar 2014	B2
8663222	Anderson et al.	Mar 2014	B2
8663223	Masuda et al.	Mar 2014	B2
8663262	Smith et al.	Mar 2014	B2
8668691	Heard	Mar 2014	B2
8668710	Slipszenko et al.	Mar 2014	B2
8684253	Giordano et al.	Apr 2014	B2
8685016	Wham et al.	Apr 2014	B2
8685020	Weizman et al.	Apr 2014	B2
8690582	Rohrbach et al.	Apr 2014	B2
8695866	Leimbach et al.	Apr 2014	B2
8696366	Chen et al.	Apr 2014	B2
8696665	Hunt et al.	Apr 2014	B2
8696666	Sanai et al.	Apr 2014	B2
8696917	Petisce et al.	Apr 2014	B2
8702609	Hadjicostis	Apr 2014	B2
8702702	Edwards et al.	Apr 2014	B1
8702704	Shelton, IV et al.	Apr 2014	B2
8704425	Giordano et al.	Apr 2014	B2
8708213	Shelton, IV et al.	Apr 2014	B2
8709008	Willis et al.	Apr 2014	B2
8709031	Stulen	Apr 2014	B2
8709035	Johnson et al.	Apr 2014	B2
8715270	Weitzner et al.	May 2014	B2
8715277	Weizman	May 2014	B2
8721640	Taylor et al.	May 2014	B2
8721657	Kondoh et al.	May 2014	B2
8733613	Huitema et al.	May 2014	B2
8733614	Ross et al.	May 2014	B2
8734443	Hixson et al.	May 2014	B2
8738110	Tabada et al.	May 2014	B2
8747238	Shelton, IV et al.	Jun 2014	B2
8747351	Schultz	Jun 2014	B2
8747404	Boudreaux et al.	Jun 2014	B2
8749116	Messerly et al.	Jun 2014	B2
8752264	Ackley 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
8758342	Bales et al.	Jun 2014	B2
8758352	Cooper et al.	Jun 2014	B2
8758391	Swayze et al.	Jun 2014	B2
8764735	Coe et al.	Jul 2014	B2
8764747	Cummings et al.	Jul 2014	B2
8767970	Eppolito	Jul 2014	B2
8770459	Racenet et al.	Jul 2014	B2
8771269	Sherman et al.	Jul 2014	B2
8771270	Burbank	Jul 2014	B2
8771293	Surti et al.	Jul 2014	B2
8773001	Wiener et al.	Jul 2014	B2
8777944	Frankhouser et al.	Jul 2014	B2
8777945	Floume et al.	Jul 2014	B2
8779648	Giordano et al.	Jul 2014	B2
8783541	Shelton, IV et al.	Jul 2014	B2
8784415	Malackowski et al.	Jul 2014	B2
8784418	Romero	Jul 2014	B2
8790342	Stulen et al.	Jul 2014	B2
8795274	Hanna	Aug 2014	B2
8795275	Hafner	Aug 2014	B2
8795276	Dietz et al.	Aug 2014	B2
8795327	Dietz et al.	Aug 2014	B2
8800838	Shelton, IV	Aug 2014	B2
8801710	Ullrich et al.	Aug 2014	B2
8801752	Fortier et al.	Aug 2014	B2
8807414	Ross et al.	Aug 2014	B2
8808204	Irisawa et al.	Aug 2014	B2
8808319	Houser et al.	Aug 2014	B2
8814856	Elmouelhi et al.	Aug 2014	B2
8814870	Paraschiv et al.	Aug 2014	B2
8820605	Shelton, IV	Sep 2014	B2
8821388	Naito et al.	Sep 2014	B2
8827992	Koss et al.	Sep 2014	B2
8827995	Schaller et al.	Sep 2014	B2
8834466	Cummings et al.	Sep 2014	B2
8834518	Faller et al.	Sep 2014	B2
8844789	Shelton, IV et al.	Sep 2014	B2
8845537	Tanaka et al.	Sep 2014	B2
8845630	Mehta et al.	Sep 2014	B2
8848808	Dress	Sep 2014	B2
8851354	Swensgard et al.	Oct 2014	B2
8852184	Kucklick	Oct 2014	B2
8858547	Brogna	Oct 2014	B2
8862955	Cesari	Oct 2014	B2
8864749	Okada	Oct 2014	B2
8864757	Klimovitch et al.	Oct 2014	B2
8864761	Johnson et al.	Oct 2014	B2
8870865	Frankhouser et al.	Oct 2014	B2
8874220	Draghici et al.	Oct 2014	B2
8876726	Amit et al.	Nov 2014	B2
8876858	Braun	Nov 2014	B2
8882766	Couture et al.	Nov 2014	B2
8882791	Stulen	Nov 2014	B2
8888776	Dietz et al.	Nov 2014	B2
8888783	Young	Nov 2014	B2
8888809	Davison et al.	Nov 2014	B2
8899462	Kostrzewski et al.	Dec 2014	B2
8900259	Houser et al.	Dec 2014	B2
8906016	Boudreaux et al.	Dec 2014	B2
8906017	Rioux et al.	Dec 2014	B2
8911438	Swoyer et al.	Dec 2014	B2
8911460	Neurohr et al.	Dec 2014	B2
8920412	Fritz et al.	Dec 2014	B2
8920414	Stone et al.	Dec 2014	B2
8920421	Rupp	Dec 2014	B2
8926607	Norvell et al.	Jan 2015	B2
8926608	Bacher et al.	Jan 2015	B2
8926620	Chasmawala et al.	Jan 2015	B2
8931682	Timm et al.	Jan 2015	B2
8932282	Gilbert	Jan 2015	B2
8932299	Bono et al.	Jan 2015	B2
8936614	Allen, IV	Jan 2015	B2
8939974	Boudreaux et al.	Jan 2015	B2
8945126	Garrison et al.	Feb 2015	B2
8951248	Messerly et al.	Feb 2015	B2
8951272	Robertson et al.	Feb 2015	B2
8956349	Aldridge et al.	Feb 2015	B2
8960520	McCuen	Feb 2015	B2
8961515	Twomey et al.	Feb 2015	B2
8961547	Dietz et al.	Feb 2015	B2
8967443	McCuen	Mar 2015	B2
8968283	Kharin	Mar 2015	B2
8968294	Maass et al.	Mar 2015	B2
8968296	McPherson	Mar 2015	B2
8968355	Malkowski et al.	Mar 2015	B2
8974447	Kimball et al.	Mar 2015	B2
8974477	Yamada	Mar 2015	B2
8974479	Ross et al.	Mar 2015	B2
8974932	McGahan et al.	Mar 2015	B2
8979843	Timm et al.	Mar 2015	B2
8979844	White et al.	Mar 2015	B2
8979890	Boudreaux	Mar 2015	B2
8986287	Park et al.	Mar 2015	B2
8986297	Daniel et al.	Mar 2015	B2
8986302	Aldridge et al.	Mar 2015	B2
8989855	Murphy et al.	Mar 2015	B2
8989903	Weir et al.	Mar 2015	B2
8991678	Wellman et al.	Mar 2015	B2
8992422	Spivey et al.	Mar 2015	B2
8992526	Brodbeck et al.	Mar 2015	B2
8998891	Garito et al.	Apr 2015	B2
9005199	Beckman et al.	Apr 2015	B2
9011437	Woodruff et al.	Apr 2015	B2
9011471	Timm et al.	Apr 2015	B2
9017326	DiNardo et al.	Apr 2015	B2
9017355	Smith et al.	Apr 2015	B2
9017370	Reschke et al.	Apr 2015	B2
9017372	Artale et al.	Apr 2015	B2
9023035	Allen, IV et al.	May 2015	B2
9023070	Levine et al.	May 2015	B2
9023071	Miller et al.	May 2015	B2
9028397	Naito	May 2015	B2
9028476	Bonn	May 2015	B2
9028478	Mueller	May 2015	B2
9028481	Behnke, II	May 2015	B2
9028494	Shelton, IV et al.	May 2015	B2
9028519	Yates et al.	May 2015	B2
9031667	Williams	May 2015	B2
9033973	Krapohl et al.	May 2015	B2
9035741	Hamel et al.	May 2015	B2
9037259	Mathur	May 2015	B2
9039690	Kersten et al.	May 2015	B2
9039691	Moua et al.	May 2015	B2
9039692	Behnke, II et al.	May 2015	B2
9039695	Giordano et al.	May 2015	B2
9039696	Assmus et al.	May 2015	B2
9039705	Takashino	May 2015	B2
9039731	Joseph	May 2015	B2
9043018	Mohr	May 2015	B2
9044227	Shelton, IV et al.	Jun 2015	B2
9044230	Morgan et al.	Jun 2015	B2
9044238	Orszulak	Jun 2015	B2
9044243	Johnson et al.	Jun 2015	B2
9044245	Condie et al.	Jun 2015	B2
9044256	Cadeddu et al.	Jun 2015	B2
9044261	Houser	Jun 2015	B2
9050083	Yates et al.	Jun 2015	B2
9050093	Aldridge et al.	Jun 2015	B2
9050098	Deville et al.	Jun 2015	B2
9050123	Krause et al.	Jun 2015	B2
9050124	Houser	Jun 2015	B2
9055961	Manzo et al.	Jun 2015	B2
9059547	McLawhorn	Jun 2015	B2
9060770	Shelton, IV et al.	Jun 2015	B2
9060775	Wiener et al.	Jun 2015	B2
9060776	Yates et al.	Jun 2015	B2
9060778	Condie et al.	Jun 2015	B2
9066720	Ballakur et al.	Jun 2015	B2
9066723	Beller et al.	Jun 2015	B2
9066747	Robertson	Jun 2015	B2
9072523	Houser et al.	Jul 2015	B2
9072535	Shelton, IV et al.	Jul 2015	B2
9072536	Shelton, IV et al.	Jul 2015	B2
9072538	Suzuki et al.	Jul 2015	B2
9072539	Messerly et al.	Jul 2015	B2
9084624	Larkin et al.	Jul 2015	B2
9089327	Worrell et al.	Jul 2015	B2
9089360	Messerly et al.	Jul 2015	B2
9095333	Konesky et al.	Aug 2015	B2
9095362	Dachs, II et al.	Aug 2015	B2
9095367	Olson et al.	Aug 2015	B2
9099863	Smith et al.	Aug 2015	B2
9101358	Kerr et al.	Aug 2015	B2
9101385	Shelton, IV et al.	Aug 2015	B2
9107684	Ma	Aug 2015	B2
9107689	Robertson et al.	Aug 2015	B2
9107690	Bales, Jr. et al.	Aug 2015	B2
9113900	Buysse et al.	Aug 2015	B2
9113907	Allen, IV et al.	Aug 2015	B2
9113940	Twomey	Aug 2015	B2
9119657	Shelton, IV et al.	Sep 2015	B2
9119957	Gantz et al.	Sep 2015	B2
9125662	Shelton, IV	Sep 2015	B2
9125667	Stone et al.	Sep 2015	B2
9144453	Rencher et al.	Sep 2015	B2
9147965	Lee	Sep 2015	B2
9149324	Huang et al.	Oct 2015	B2
9149325	Worrell et al.	Oct 2015	B2
9161803	Yates et al.	Oct 2015	B2
9165114	Jain et al.	Oct 2015	B2
9168054	Turner et al.	Oct 2015	B2
9168085	Juzkiw et al.	Oct 2015	B2
9168089	Buysse et al.	Oct 2015	B2
9173656	Schurr et al.	Nov 2015	B2
9179912	Yates et al.	Nov 2015	B2
9186199	Strauss et al.	Nov 2015	B2
9186204	Nishimura et al.	Nov 2015	B2
9186796	Ogawa	Nov 2015	B2
9192380	(Tarinelli) Racenet et al.	Nov 2015	B2
9192421	Garrison	Nov 2015	B2
9192428	Houser et al.	Nov 2015	B2
9192431	Woodruff et al.	Nov 2015	B2
9198714	Worrell et al.	Dec 2015	B2
9198715	Livneh	Dec 2015	B2
9198718	Marczyk et al.	Dec 2015	B2
9198776	Young	Dec 2015	B2
9204879	Shelton, IV	Dec 2015	B2
9204891	Weitzman	Dec 2015	B2
9204918	Germain et al.	Dec 2015	B2
9204923	Manzo et al.	Dec 2015	B2
9216050	Condie et al.	Dec 2015	B2
9216051	Fischer et al.	Dec 2015	B2
9216062	Duque et al.	Dec 2015	B2
9220483	Frankhouser et al.	Dec 2015	B2
9220527	Houser et al.	Dec 2015	B2
9220559	Worrell et al.	Dec 2015	B2
9226750	Weir et al.	Jan 2016	B2
9226751	Shelton, IV et al.	Jan 2016	B2
9226766	Aldridge et al.	Jan 2016	B2
9226767	Stulen et al.	Jan 2016	B2
9232979	Parihar et al.	Jan 2016	B2
9237891	Shelton, IV	Jan 2016	B2
9237921	Messerly et al.	Jan 2016	B2
9241060	Fujisaki	Jan 2016	B1
9241692	Gunday et al.	Jan 2016	B2
9241728	Price et al.	Jan 2016	B2
9241730	Babaev	Jan 2016	B2
9241731	Boudreaux et al.	Jan 2016	B2
9241768	Sandhu et al.	Jan 2016	B2
9247953	Palmer et al.	Feb 2016	B2
9254165	Aronow et al.	Feb 2016	B2
9259234	Robertson et al.	Feb 2016	B2
9259265	Harris et al.	Feb 2016	B2
9265567	Orban, III et al.	Feb 2016	B2
9265926	Strobl et al.	Feb 2016	B2
9265973	Akagane	Feb 2016	B2
9266310	Krogdahl et al.	Feb 2016	B2
9277962	Koss et al.	Mar 2016	B2
9282974	Shelton, IV	Mar 2016	B2
9283027	Monson et al.	Mar 2016	B2
9283045	Rhee et al.	Mar 2016	B2
9283054	Morgan et al.	Mar 2016	B2
9289256	Shelton, IV et al.	Mar 2016	B2
9295514	Shelton, IV et al.	Mar 2016	B2
9301759	Spivey et al.	Apr 2016	B2
9305497	Seo et al.	Apr 2016	B2
9307388	Liang et al.	Apr 2016	B2
9307986	Hall et al.	Apr 2016	B2
9308009	Madan et al.	Apr 2016	B2
9308014	Fischer	Apr 2016	B2
9314261	Bales, Jr. et al.	Apr 2016	B2
9314292	Trees et al.	Apr 2016	B2
9314301	Ben-Haim et al.	Apr 2016	B2
9326754	Polster	May 2016	B2
9326767	Koch et al.	May 2016	B2
9326787	Sanai et al.	May 2016	B2
9326788	Batross et al.	May 2016	B2
9332987	Leimbach et al.	May 2016	B2
9333025	Monson et al.	May 2016	B2
9333034	Hancock	May 2016	B2
9339289	Robertson	May 2016	B2
9339323	Eder et al.	May 2016	B2
9339326	McCullagh et al.	May 2016	B2
9345481	Hall et al.	May 2016	B2
9345534	Artale et al.	May 2016	B2
9345900	Wu et al.	May 2016	B2
9351642	Nadkarni et al.	May 2016	B2
9351726	Leimbach et al.	May 2016	B2
9351727	Leimbach et al.	May 2016	B2
9351754	Vakharia et al.	May 2016	B2
9352173	Yamada et al.	May 2016	B2
9358003	Hall et al.	Jun 2016	B2
9358065	Ladtkow et al.	Jun 2016	B2
9364171	Harris et al.	Jun 2016	B2
9364230	Shelton, IV et al.	Jun 2016	B2
9364279	Houser et al.	Jun 2016	B2
9370364	Smith et al.	Jun 2016	B2
9370400	Parihar	Jun 2016	B2
9370611	Ross et al.	Jun 2016	B2
9375206	Vidal et al.	Jun 2016	B2
9375230	Ross et al.	Jun 2016	B2
9375232	Hunt et al.	Jun 2016	B2
9375256	Cunningham et al.	Jun 2016	B2
9375264	Horner et al.	Jun 2016	B2
9375267	Kerr et al.	Jun 2016	B2
9385831	Marr et al.	Jul 2016	B2
9386983	Swensgard et al.	Jul 2016	B2
9393037	Olson et al.	Jul 2016	B2
9393070	Gelfand et al.	Jul 2016	B2
9398911	Auld	Jul 2016	B2
9402680	Ginnebaugh et al.	Aug 2016	B2
9402682	Worrell et al.	Aug 2016	B2
9408606	Shelton, IV	Aug 2016	B2
9408622	Stulen et al.	Aug 2016	B2
9408660	Strobl et al.	Aug 2016	B2
9414853	Stulen et al.	Aug 2016	B2
9414880	Monson et al.	Aug 2016	B2
9421014	Ingmanson et al.	Aug 2016	B2
9421060	Monson et al.	Aug 2016	B2
9427249	Robertson et al.	Aug 2016	B2
9427279	Muniz-Medina et al.	Aug 2016	B2
9439668	Timm et al.	Sep 2016	B2
9439669	Wiener et al.	Sep 2016	B2
9439671	Akagane	Sep 2016	B2
9442288	Tanimura	Sep 2016	B2
9445784	O'Keeffe	Sep 2016	B2
9445832	Wiener et al.	Sep 2016	B2
9451967	Jordan et al.	Sep 2016	B2
9456863	Moua	Oct 2016	B2
9456864	Witt et al.	Oct 2016	B2
9468438	Baber et al.	Oct 2016	B2
9468498	Sigmon, Jr.	Oct 2016	B2
9474542	Slipszenko et al.	Oct 2016	B2
9474568	Akagane	Oct 2016	B2
9486236	Price et al.	Nov 2016	B2
9492146	Kostrzewski et al.	Nov 2016	B2
9492224	Boudreaux et al.	Nov 2016	B2
9498245	Voegele et al.	Nov 2016	B2
9498275	Wham et al.	Nov 2016	B2
9504483	Houser et al.	Nov 2016	B2
9504520	Worrell et al.	Nov 2016	B2
9504524	Behnke, II	Nov 2016	B2
9504855	Messerly et al.	Nov 2016	B2
9510850	Robertson et al.	Dec 2016	B2
9510906	Boudreaux et al.	Dec 2016	B2
9522029	Yates et al.	Dec 2016	B2
9522032	Behnke	Dec 2016	B2
9526564	Rusin	Dec 2016	B2
9526565	Strobl	Dec 2016	B2
9545253	Worrell et al.	Jan 2017	B2
9545497	Wenderow et al.	Jan 2017	B2
9554465	Liu et al.	Jan 2017	B1
9554794	Baber et al.	Jan 2017	B2
9554846	Boudreaux	Jan 2017	B2
9554854	Yates et al.	Jan 2017	B2
9560995	Addison et al.	Feb 2017	B2
9561038	Shelton, IV et al.	Feb 2017	B2
9572592	Price et al.	Feb 2017	B2
9574644	Parihar	Feb 2017	B2
9585714	Livneh	Mar 2017	B2
9592056	Mozdzierz et al.	Mar 2017	B2
9592072	Akagane	Mar 2017	B2
9597143	Madan et al.	Mar 2017	B2
9603669	Govari et al.	Mar 2017	B2
9610091	Johnson et al.	Apr 2017	B2
9610114	Baxter, III et al.	Apr 2017	B2
9615877	Tyrrell et al.	Apr 2017	B2
9623237	Turner et al.	Apr 2017	B2
9629623	Lytle, IV et al.	Apr 2017	B2
9629629	Leimbach et al.	Apr 2017	B2
9632573	Ogawa et al.	Apr 2017	B2
9636135	Stulen	May 2017	B2
9636165	Larson et al.	May 2017	B2
9636167	Gregg	May 2017	B2
9638770	Dietz et al.	May 2017	B2
9642644	Houser et al.	May 2017	B2
9642669	Takashino et al.	May 2017	B2
9643052	Tchao et al.	May 2017	B2
9649110	Parihar et al.	May 2017	B2
9649111	Shelton, IV et al.	May 2017	B2
9649126	Robertson et al.	May 2017	B2
9649173	Choi et al.	May 2017	B2
9655670	Larson et al.	May 2017	B2
9662131	Omori et al.	May 2017	B2
9668806	Unger et al.	Jun 2017	B2
9671860	Ogawa et al.	Jun 2017	B2
9674949	Liu et al.	Jun 2017	B1
9675374	Stulen et al.	Jun 2017	B2
9675375	Houser et al.	Jun 2017	B2
9681884	Clem et al.	Jun 2017	B2
9687230	Leimbach et al.	Jun 2017	B2
9687290	Keller	Jun 2017	B2
9690362	Leimbach et al.	Jun 2017	B2
9693817	Mehta et al.	Jul 2017	B2
9700309	Jaworek et al.	Jul 2017	B2
9700339	Nield	Jul 2017	B2
9700343	Messerly et al.	Jul 2017	B2
9705456	Gilbert	Jul 2017	B2
9707004	Houser et al.	Jul 2017	B2
9707027	Ruddenklau et al.	Jul 2017	B2
9707030	Davison et al.	Jul 2017	B2
9713507	Stulen et al.	Jul 2017	B2
9717548	Couture	Aug 2017	B2
9717552	Cosman et al.	Aug 2017	B2
9724094	Baber et al.	Aug 2017	B2
9724118	Schulte et al.	Aug 2017	B2
9724120	Faller et al.	Aug 2017	B2
9724152	Horlle et al.	Aug 2017	B2
9730695	Leimbach et al.	Aug 2017	B2
9733663	Leimbach et al.	Aug 2017	B2
9737301	Baber et al.	Aug 2017	B2
9737326	Worrell et al.	Aug 2017	B2
9737355	Yates et al.	Aug 2017	B2
9737358	Beckman et al.	Aug 2017	B2
9743929	Leimbach et al.	Aug 2017	B2
9743946	Faller et al.	Aug 2017	B2
9743947	Price et al.	Aug 2017	B2
9750499	Leimbach et al.	Sep 2017	B2
9757128	Baber et al.	Sep 2017	B2
9757142	Shimizu	Sep 2017	B2
9757150	Alexander et al.	Sep 2017	B2
9757186	Boudreaux et al.	Sep 2017	B2
9764164	Wiener et al.	Sep 2017	B2
9770285	Zoran et al.	Sep 2017	B2
9782169	Kimsey et al.	Oct 2017	B2
9782214	Houser et al.	Oct 2017	B2
9788836	Overmyer et al.	Oct 2017	B2
9788851	Dannaher et al.	Oct 2017	B2
9795405	Price et al.	Oct 2017	B2
9795436	Yates et al.	Oct 2017	B2
9795808	Messerly et al.	Oct 2017	B2
9801626	Parihar et al.	Oct 2017	B2
9801648	Houser et al.	Oct 2017	B2
9802033	Hibner et al.	Oct 2017	B2
9804618	Leimbach et al.	Oct 2017	B2
9808244	Leimbach et al.	Nov 2017	B2
9808246	Shelton, IV et al.	Nov 2017	B2
9808308	Faller et al.	Nov 2017	B2
9814460	Kimsey et al.	Nov 2017	B2
9814514	Shelton, IV et al.	Nov 2017	B2
9815211	Cao et al.	Nov 2017	B2
9820738	Lytle, IV et al.	Nov 2017	B2
9820768	Gee et al.	Nov 2017	B2
9820771	Norton et al.	Nov 2017	B2
9820806	Lee et al.	Nov 2017	B2
9826976	Parihar et al.	Nov 2017	B2
9839443	Brockman et al.	Dec 2017	B2
9844368	Boudreaux et al.	Dec 2017	B2
9844374	Lytle, IV et al.	Dec 2017	B2
9844375	Overmyer et al.	Dec 2017	B2
9848901	Robertson et al.	Dec 2017	B2
9848902	Price et al.	Dec 2017	B2
9848937	Trees et al.	Dec 2017	B2
9861381	Johnson	Jan 2018	B2
9861428	Trees et al.	Jan 2018	B2
9867612	Parihar et al.	Jan 2018	B2
9867651	Wham	Jan 2018	B2
9867670	Brannan et al.	Jan 2018	B2
9872722	Lech	Jan 2018	B2
9872725	Worrell et al.	Jan 2018	B2
9872726	Morisaki	Jan 2018	B2
9877720	Worrell et al.	Jan 2018	B2
9877776	Boudreaux	Jan 2018	B2
9877782	Voegele et al.	Jan 2018	B2
9878184	Beaupre	Jan 2018	B2
9883860	Leimbach	Feb 2018	B2
9883884	Neurohr et al.	Feb 2018	B2
9888919	Leimbach et al.	Feb 2018	B2
9888958	Evans et al.	Feb 2018	B2
9895148	Shelton, IV et al.	Feb 2018	B2
9895160	Fan et al.	Feb 2018	B2
9901321	Harks et al.	Feb 2018	B2
9901342	Shelton, IV et al.	Feb 2018	B2
9901383	Hassler, Jr.	Feb 2018	B2
9901754	Yamada	Feb 2018	B2
9907563	Germain et al.	Mar 2018	B2
9913642	Leimbach et al.	Mar 2018	B2
9913656	Stulen	Mar 2018	B2
9913680	Voegele et al.	Mar 2018	B2
9918730	Trees et al.	Mar 2018	B2
9924961	Shelton, IV et al.	Mar 2018	B2
9925003	Parihar et al.	Mar 2018	B2
9931118	Shelton, IV et al.	Apr 2018	B2
9937001	Nakamura	Apr 2018	B2
9943309	Shelton, IV et al.	Apr 2018	B2
9949785	Price et al.	Apr 2018	B2
9949788	Boudreaux	Apr 2018	B2
9962182	Dietz et al.	May 2018	B2
9968355	Shelton, IV et al.	May 2018	B2
9974539	Yates et al.	May 2018	B2
9987000	Shelton, IV et al.	Jun 2018	B2
9987033	Neurohr et al.	Jun 2018	B2
9993248	Shelton, IV et al.	Jun 2018	B2
9993258	Shelton, IV et al.	Jun 2018	B2
9993289	Sobajima et al.	Jun 2018	B2
10004497	Overmyer et al.	Jun 2018	B2
10004501	Shelton, IV et al.	Jun 2018	B2
10004526	Dycus et al.	Jun 2018	B2
10004527	Gee et al.	Jun 2018	B2
D822206	Shelton, IV et al.	Jul 2018	S
10010339	Witt et al.	Jul 2018	B2
10010341	Houser et al.	Jul 2018	B2
10013049	Leimbach et al.	Jul 2018	B2
10016199	Baber et al.	Jul 2018	B2
10016207	Suzuki et al.	Jul 2018	B2
10022142	Aranyi et al.	Jul 2018	B2
10022567	Messerly et al.	Jul 2018	B2
10022568	Messerly et al.	Jul 2018	B2
10028761	Leimbach et al.	Jul 2018	B2
10028786	Mucilli et al.	Jul 2018	B2
10034684	Weisenburgh, II et al.	Jul 2018	B2
10034704	Asher et al.	Jul 2018	B2
D826405	Shelton, IV et al.	Aug 2018	S
10039588	Harper et al.	Aug 2018	B2
10041822	Zemlok	Aug 2018	B2
10045776	Shelton, IV et al.	Aug 2018	B2
10045779	Savage et al.	Aug 2018	B2
10045794	Witt et al.	Aug 2018	B2
10045810	Schall et al.	Aug 2018	B2
10045819	Jensen et al.	Aug 2018	B2
10052044	Shelton, IV et al.	Aug 2018	B2
10052102	Baxter, III et al.	Aug 2018	B2
10070916	Artale	Sep 2018	B2
10080609	Hancock et al.	Sep 2018	B2
10085748	Morgan et al.	Oct 2018	B2
10085762	Timm et al.	Oct 2018	B2
10085792	Johnson et al.	Oct 2018	B2
10092310	Boudreaux et al.	Oct 2018	B2
10092344	Mohr et al.	Oct 2018	B2
10092347	Weisshaupt et al.	Oct 2018	B2
10092348	Boudreaux	Oct 2018	B2
10092350	Rothweiler et al.	Oct 2018	B2
10105140	Malinouskas et al.	Oct 2018	B2
10111679	Baber et al.	Oct 2018	B2
10111699	Boudreaux	Oct 2018	B2
10111703	Cosman, Jr. et al.	Oct 2018	B2
10117649	Baxter et al.	Nov 2018	B2
10117667	Robertson et al.	Nov 2018	B2
10117702	Danziger et al.	Nov 2018	B2
10123835	Keller et al.	Nov 2018	B2
10130367	Cappola et al.	Nov 2018	B2
10130410	Strobl et al.	Nov 2018	B2
10130412	Wham	Nov 2018	B2
10135242	Baber et al.	Nov 2018	B2
10136887	Shelton, IV et al.	Nov 2018	B2
10149680	Parihar et al.	Dec 2018	B2
10154848	Chernov et al.	Dec 2018	B2
10154852	Conlon et al.	Dec 2018	B2
10159483	Beckman et al.	Dec 2018	B2
10159524	Yates et al.	Dec 2018	B2
10166060	Johnson et al.	Jan 2019	B2
10172665	Heckel et al.	Jan 2019	B2
10172669	Felder et al.	Jan 2019	B2
10178992	Wise et al.	Jan 2019	B2
10179022	Yates et al.	Jan 2019	B2
10180463	Beckman et al.	Jan 2019	B2
10182816	Shelton, IV et al.	Jan 2019	B2
10182818	Hensel et al.	Jan 2019	B2
10188385	Kerr et al.	Jan 2019	B2
10188455	Hancock et al.	Jan 2019	B2
10194907	Marczyk et al.	Feb 2019	B2
10194972	Yates et al.	Feb 2019	B2
10194973	Wiener et al.	Feb 2019	B2
10194976	Boudreaux	Feb 2019	B2
10194977	Yang	Feb 2019	B2
10194999	Bacher et al.	Feb 2019	B2
10201364	Leimbach et al.	Feb 2019	B2
10201365	Boudreaux et al.	Feb 2019	B2
10201382	Wiener et al.	Feb 2019	B2
10226250	Beckman et al.	Mar 2019	B2
10226273	Messerly et al.	Mar 2019	B2
10231747	Stulen et al.	Mar 2019	B2
10238385	Yates et al.	Mar 2019	B2
10238391	Leimbach et al.	Mar 2019	B2
10245027	Shelton, IV et al.	Apr 2019	B2
10245028	Shelton, IV et al.	Apr 2019	B2
10245029	Hunter et al.	Apr 2019	B2
10245030	Hunter et al.	Apr 2019	B2
10245033	Overmyer et al.	Apr 2019	B2
10245095	Boudreaux	Apr 2019	B2
10245104	McKenna et al.	Apr 2019	B2
10251664	Shelton, IV et al.	Apr 2019	B2
10258331	Shelton, IV et al.	Apr 2019	B2
10258505	Ovchinnikov	Apr 2019	B2
10263171	Wiener et al.	Apr 2019	B2
10265068	Harris et al.	Apr 2019	B2
10265117	Wiener et al.	Apr 2019	B2
10265118	Gerhardt	Apr 2019	B2
10271840	Sapre	Apr 2019	B2
10271851	Shelton, IV et al.	Apr 2019	B2
D847989	Shelton, IV et al.	May 2019	S
10278721	Dietz et al.	May 2019	B2
10285705	Shelton, IV et al.	May 2019	B2
10285724	Faller et al.	May 2019	B2
10285750	Coulson et al.	May 2019	B2
10292704	Harris et al.	May 2019	B2
10299810	Robertson et al.	May 2019	B2
10299821	Shelton, IV et al.	May 2019	B2
D850617	Shelton, IV et al.	Jun 2019	S
D851762	Shelton, IV et al.	Jun 2019	S
10307159	Harris et al.	Jun 2019	B2
10314579	Chowaniec et al.	Jun 2019	B2
10314582	Shelton, IV et al.	Jun 2019	B2
10314638	Gee et al.	Jun 2019	B2
10321907	Shelton, IV et al.	Jun 2019	B2
10321950	Yates et al.	Jun 2019	B2
D854151	Shelton, IV et al.	Jul 2019	S
10335149	Baxter, III et al.	Jul 2019	B2
10335182	Stulen et al.	Jul 2019	B2
10335183	Worrell et al.	Jul 2019	B2
10335614	Messerly et al.	Jul 2019	B2
10342543	Shelton, IV et al.	Jul 2019	B2
10342602	Strobl et al.	Jul 2019	B2
10342606	Cosman et al.	Jul 2019	B2
10342623	Huelman et al.	Jul 2019	B2
10348941	Elliot, Jr. et al.	Jul 2019	B2
10349999	Yates et al.	Jul 2019	B2
10350016	Burbank et al.	Jul 2019	B2
10350025	Loyd et al.	Jul 2019	B1
10357246	Shelton, IV et al.	Jul 2019	B2
10357247	Shelton, IV et al.	Jul 2019	B2
10357303	Conlon et al.	Jul 2019	B2
10363084	Friedrichs	Jul 2019	B2
10368861	Baxter, III et al.	Aug 2019	B2
10368865	Harris et al.	Aug 2019	B2
10376263	Morgan et al.	Aug 2019	B2
10376305	Yates et al.	Aug 2019	B2
10390841	Shelton, IV et al.	Aug 2019	B2
10398439	Cabrera et al.	Sep 2019	B2
10398466	Stulen et al.	Sep 2019	B2
10398497	Batross et al.	Sep 2019	B2
10405857	Shelton, IV et al.	Sep 2019	B2
10405863	Wise et al.	Sep 2019	B2
10413291	Worthington et al.	Sep 2019	B2
10413293	Shelton, IV et al.	Sep 2019	B2
10413297	Harris et al.	Sep 2019	B2
10413352	Thomas et al.	Sep 2019	B2
10413353	Kerr et al.	Sep 2019	B2
10420552	Shelton, IV et al.	Sep 2019	B2
10420579	Wiener et al.	Sep 2019	B2
10420607	Woloszko et al.	Sep 2019	B2
D865175	Widenhouse et al.	Oct 2019	S
10426471	Shelton, IV et al.	Oct 2019	B2
10426507	Wiener et al.	Oct 2019	B2
10426546	Graham et al.	Oct 2019	B2
10426978	Akagane	Oct 2019	B2
10433837	Worthington et al.	Oct 2019	B2
10433849	Shelton, IV et al.	Oct 2019	B2
10433865	Witt et al.	Oct 2019	B2
10433866	Witt et al.	Oct 2019	B2
10433900	Harris et al.	Oct 2019	B2
10441279	Shelton, IV et al.	Oct 2019	B2
10441308	Robertson	Oct 2019	B2
10441310	Olson et al.	Oct 2019	B2
10441345	Aldridge et al.	Oct 2019	B2
10448948	Shelton, IV et al.	Oct 2019	B2
10448950	Shelton, IV et al.	Oct 2019	B2
10448986	Zikorus et al.	Oct 2019	B2
10456140	Shelton, IV et al.	Oct 2019	B2
10456193	Yates et al.	Oct 2019	B2
10463421	Boudreaux et al.	Nov 2019	B2
10463887	Witt et al.	Nov 2019	B2
10470762	Leimbach et al.	Nov 2019	B2
10470764	Baxter, III et al.	Nov 2019	B2
10478182	Taylor	Nov 2019	B2
10478190	Miller et al.	Nov 2019	B2
10485542	Shelton, IV et al.	Nov 2019	B2
10485543	Shelton, IV et al.	Nov 2019	B2
10485607	Strobl et al.	Nov 2019	B2
D869655	Shelton, IV et al.	Dec 2019	S
10492785	Overmyer et al.	Dec 2019	B2
10492849	Juergens et al.	Dec 2019	B2
10499914	Huang et al.	Dec 2019	B2
10507033	Dickerson et al.	Dec 2019	B2
10512795	Voegele et al.	Dec 2019	B2
10517595	Hunter et al.	Dec 2019	B2
10517596	Hunter et al.	Dec 2019	B2
10517627	Timm et al.	Dec 2019	B2
10524787	Shelton, IV et al.	Jan 2020	B2
10524789	Swayze et al.	Jan 2020	B2
10524854	Woodruff et al.	Jan 2020	B2
10524872	Stewart et al.	Jan 2020	B2
10531874	Morgan et al.	Jan 2020	B2
10537324	Shelton, IV et al.	Jan 2020	B2
10537325	Bakos et al.	Jan 2020	B2
10537351	Shelton, IV et al.	Jan 2020	B2
10542979	Shelton, IV et al.	Jan 2020	B2
10542982	Beckman et al.	Jan 2020	B2
10542991	Shelton, IV et al.	Jan 2020	B2
10543008	Vakharia et al.	Jan 2020	B2
10548504	Shelton, IV et al.	Feb 2020	B2
10548655	Scheib et al.	Feb 2020	B2
10555769	Worrell et al.	Feb 2020	B2
10561560	Boutoussov et al.	Feb 2020	B2
10568624	Shelton, IV et al.	Feb 2020	B2
10568625	Harris et al.	Feb 2020	B2
10568626	Shelton, IV et al.	Feb 2020	B2
10568632	Miller et al.	Feb 2020	B2
10575892	Danziger et al.	Mar 2020	B2
10582928	Hunter et al.	Mar 2020	B2
10588625	Weaner et al.	Mar 2020	B2
10588630	Shelton, IV et al.	Mar 2020	B2
10588631	Shelton, IV et al.	Mar 2020	B2
10588632	Shelton, IV et al.	Mar 2020	B2
10588633	Shelton, IV et al.	Mar 2020	B2
10595929	Boudreaux et al.	Mar 2020	B2
10595930	Scheib et al.	Mar 2020	B2
10603036	Hunter et al.	Mar 2020	B2
10610224	Shelton, IV et al.	Apr 2020	B2
10610286	Wiener et al.	Apr 2020	B2
10610313	Bailey et al.	Apr 2020	B2
10617412	Shelton, IV et al.	Apr 2020	B2
10617420	Shelton, IV et al.	Apr 2020	B2
10617464	Duppuis	Apr 2020	B2
10624635	Harris et al.	Apr 2020	B2
10624691	Wiener et al.	Apr 2020	B2
10631858	Burbank	Apr 2020	B2
10631859	Shelton, IV et al.	Apr 2020	B2
10632630	Cao et al.	Apr 2020	B2
RE47996	Turner et al.	May 2020	E
10639034	Harris et al.	May 2020	B2
10639035	Shelton, IV et al.	May 2020	B2
10639037	Shelton, IV et al.	May 2020	B2
10639092	Corbett et al.	May 2020	B2
10639098	Cosman et al.	May 2020	B2
10646269	Worrell et al.	May 2020	B2
10646292	Solomon et al.	May 2020	B2
10653413	Worthington et al.	May 2020	B2
10667809	Bakos et al.	Jun 2020	B2
10667810	Shelton, IV et al.	Jun 2020	B2
10667811	Harris et al.	Jun 2020	B2
10675021	Harris et al.	Jun 2020	B2
10675024	Shelton, IV et al.	Jun 2020	B2
10675025	Swayze et al.	Jun 2020	B2
10675026	Harris et al.	Jun 2020	B2
10677764	Ross et al.	Jun 2020	B2
10682136	Harris et al.	Jun 2020	B2
10682138	Shelton, IV et al.	Jun 2020	B2
10687806	Shelton, IV et al.	Jun 2020	B2
10687809	Shelton, IV et al.	Jun 2020	B2
10687810	Shelton, IV et al.	Jun 2020	B2
10687884	Wiener et al.	Jun 2020	B2
10688321	Wiener et al.	Jun 2020	B2
10695055	Shelton, IV et al.	Jun 2020	B2
10695057	Shelton, IV et al.	Jun 2020	B2
10695058	Lytle, IV et al.	Jun 2020	B2
10695119	Smith	Jun 2020	B2
10702270	Shelton, IV et al.	Jul 2020	B2
10702329	Strobl et al.	Jul 2020	B2
10709446	Harris et al.	Jul 2020	B2
10709469	Shelton, IV et al.	Jul 2020	B2
10709906	Nield	Jul 2020	B2
10716615	Shelton, IV et al.	Jul 2020	B2
10722233	Wellman	Jul 2020	B2
D893717	Messerly et al.	Aug 2020	S
10729458	Stoddard et al.	Aug 2020	B2
10729494	Parihar et al.	Aug 2020	B2
10736629	Shelton, IV et al.	Aug 2020	B2
10736685	Wiener et al.	Aug 2020	B2
10751108	Yates et al.	Aug 2020	B2
10758229	Shelton, IV et al.	Sep 2020	B2
10758230	Shelton, IV et al.	Sep 2020	B2
10758232	Shelton, IV et al.	Sep 2020	B2
10758294	Jones	Sep 2020	B2
10765427	Shelton, IV et al.	Sep 2020	B2
10765470	Yates et al.	Sep 2020	B2
10772629	Shelton, IV et al.	Sep 2020	B2
10772630	Wixey	Sep 2020	B2
10779821	Harris et al.	Sep 2020	B2
10779823	Shelton, IV et al.	Sep 2020	B2
10779824	Shelton, IV et al.	Sep 2020	B2
10779825	Shelton, IV et al.	Sep 2020	B2
10779845	Timm et al.	Sep 2020	B2
10779849	Shelton, IV et al.	Sep 2020	B2
10779879	Yates et al.	Sep 2020	B2
10786253	Shelton, IV et al.	Sep 2020	B2
10786276	Hirai et al.	Sep 2020	B2
10806454	Kopp	Oct 2020	B2
10813638	Shelton, IV et al.	Oct 2020	B2
10820938	Fischer et al.	Nov 2020	B2
10828058	Shelton, IV et al.	Nov 2020	B2
10835245	Swayze et al.	Nov 2020	B2
10835246	Shelton, IV et al.	Nov 2020	B2
10835247	Shelton, IV et al.	Nov 2020	B2
10835307	Shelton, IV et al.	Nov 2020	B2
10842492	Shelton, IV et al.	Nov 2020	B2
10842523	Shelton, IV et al.	Nov 2020	B2
10842563	Gilbert et al.	Nov 2020	B2
D906355	Messerly et al.	Dec 2020	S
10856867	Shelton, IV et al.	Dec 2020	B2
10856868	Shelton, IV et al.	Dec 2020	B2
10856869	Shelton, IV et al.	Dec 2020	B2
10856870	Harris et al.	Dec 2020	B2
10856896	Eichmann et al.	Dec 2020	B2
10856929	Yates et al.	Dec 2020	B2
10856934	Trees et al.	Dec 2020	B2
10874465	Weir et al.	Dec 2020	B2
D908216	Messerly et al.	Jan 2021	S
10881399	Shelton, IV et al.	Jan 2021	B2
10881401	Baber et al.	Jan 2021	B2
10881409	Cabrera	Jan 2021	B2
10881449	Boudreaux et al.	Jan 2021	B2
10888322	Morgan et al.	Jan 2021	B2
10888347	Witt et al.	Jan 2021	B2
10893863	Shelton, IV et al.	Jan 2021	B2
10893864	Harris et al.	Jan 2021	B2
10893883	Dannaher	Jan 2021	B2
10898186	Bakos et al.	Jan 2021	B2
10898256	Yates et al.	Jan 2021	B2
10912559	Harris et al.	Feb 2021	B2
10912580	Green et al.	Feb 2021	B2
10912603	Boudreaux et al.	Feb 2021	B2
10918385	Overmyer et al.	Feb 2021	B2
10925659	Shelton, IV et al.	Feb 2021	B2
D914878	Shelton, IV et al.	Mar 2021	S
10932766	Tesar et al.	Mar 2021	B2
10932847	Yates et al.	Mar 2021	B2
10945727	Shelton, IV et al.	Mar 2021	B2
10952788	Asher et al.	Mar 2021	B2
10959727	Hunter et al.	Mar 2021	B2
10966741	Illizaliturri-Sanchez et al.	Apr 2021	B2
10966747	Worrell et al.	Apr 2021	B2
10973516	Shelton, IV et al.	Apr 2021	B2
10973517	Wixey	Apr 2021	B2
10973520	Shelton, IV et al.	Apr 2021	B2
10980536	Weaner et al.	Apr 2021	B2
10987123	Weir et al.	Apr 2021	B2
10987156	Trees et al.	Apr 2021	B2
10993715	Shelton, IV et al.	May 2021	B2
10993716	Shelton, IV et al.	May 2021	B2
10993763	Batross et al.	May 2021	B2
11000278	Shelton, IV et al.	May 2021	B2
11000279	Shelton, IV et al.	May 2021	B2
11020114	Shelton, IV et al.	Jun 2021	B2
11039834	Harris et al.	Jun 2021	B2
11045191	Shelton, IV et al.	Jun 2021	B2
11045192	Harris et al.	Jun 2021	B2
11045275	Boudreaux et al.	Jun 2021	B2
11058424	Shelton, IV et al.	Jul 2021	B2
11064997	Shelton, IV et al.	Jul 2021	B2
11065048	Messerly et al.	Jul 2021	B2
11083455	Shelton, IV et al.	Aug 2021	B2
11083458	Harris et al.	Aug 2021	B2
11090048	Fanelli et al.	Aug 2021	B2
11090049	Bakos et al.	Aug 2021	B2
11096688	Shelton, IV et al.	Aug 2021	B2
11109866	Shelton, IV et al.	Sep 2021	B2
11129611	Shelton, IV et al.	Sep 2021	B2
11129666	Messerly et al.	Sep 2021	B2
11134942	Harris et al.	Oct 2021	B2
11141154	Shelton, IV et al.	Oct 2021	B2
11147551	Shelton, IV	Oct 2021	B2
11147553	Shelton, IV	Oct 2021	B2
11160551	Shelton, IV et al.	Nov 2021	B2
11166716	Shelton, IV et al.	Nov 2021	B2
11172929	Shelton, IV	Nov 2021	B2
11179155	Shelton, IV et al.	Nov 2021	B2
11191539	Overmyer et al.	Dec 2021	B2
11191540	Aronhalt et al.	Dec 2021	B2
11197668	Shelton, IV et al.	Dec 2021	B2
11207065	Harris et al.	Dec 2021	B2
11207067	Shelton, IV et al.	Dec 2021	B2
11213293	Worthington et al.	Jan 2022	B2
11213294	Shelton, IV et al.	Jan 2022	B2
11219453	Shelton, IV et al.	Jan 2022	B2
11224426	Shelton, IV et al.	Jan 2022	B2
11224497	Shelton, IV et al.	Jan 2022	B2
11229437	Shelton, IV et al.	Jan 2022	B2
11234698	Shelton, IV et al.	Feb 2022	B2
11241235	Shelton, IV et al.	Feb 2022	B2
11246592	Shelton, IV et al.	Feb 2022	B2
11246625	Kane et al.	Feb 2022	B2
11246678	Shelton, IV et al.	Feb 2022	B2
11253256	Harris et al.	Feb 2022	B2
11259803	Shelton, IV et al.	Mar 2022	B2
11259805	Shelton, IV et al.	Mar 2022	B2
11259806	Shelton, IV et al.	Mar 2022	B2
11259807	Shelton, IV et al.	Mar 2022	B2
11266405	Shelton, IV et al.	Mar 2022	B2
11272931	Boudreaux et al.	Mar 2022	B2
11278280	Shelton, IV et al.	Mar 2022	B2
11284890	Nalagatla et al.	Mar 2022	B2
11291440	Harris et al.	Apr 2022	B2
11291444	Boudreaux et al.	Apr 2022	B2
11291445	Shelton, IV et al.	Apr 2022	B2
11291447	Shelton, IV et al.	Apr 2022	B2
11291451	Shelton, IV	Apr 2022	B2
11298127	Shelton, IV	Apr 2022	B2
11298129	Bakos et al.	Apr 2022	B2
11298130	Bakos et al.	Apr 2022	B2
11304695	Shelton, IV et al.	Apr 2022	B2
11304696	Shelton, IV et al.	Apr 2022	B2
11304699	Shelton, IV et al.	Apr 2022	B2
11311306	Shelton, IV et al.	Apr 2022	B2
11311342	Parihar et al.	Apr 2022	B2
D950728	Bakos et al.	May 2022	S
D952144	Boudreaux	May 2022	S
11317915	Boudreaux et al.	May 2022	B2
11324503	Shelton, IV et al.	May 2022	B2
11324557	Shelton, IV et al.	May 2022	B2
11331100	Boudreaux et al.	May 2022	B2
11331101	Harris et al.	May 2022	B2
11350938	Shelton, IV et al.	Jun 2022	B2
11357503	Bakos et al.	Jun 2022	B2
11361176	Shelton, IV et al.	Jun 2022	B2
11369377	Boudreaux et al.	Jun 2022	B2
11376098	Shelton, IV et al.	Jul 2022	B2
11389161	Shelton, IV et al.	Jul 2022	B2
11389164	Yates et al.	Jul 2022	B2
11399837	Shelton, IV et al.	Aug 2022	B2
11406382	Shelton, IV et al.	Aug 2022	B2
11419606	Overmyer et al.	Aug 2022	B2
11424027	Shelton, IV	Aug 2022	B2
11426167	Shelton, IV et al.	Aug 2022	B2
D964564	Boudreaux	Sep 2022	S
11446029	Shelton, IV et al.	Sep 2022	B2
11653920	Shelton, IV et al.	May 2023	B2
20010025173	Ritchie et al.	Sep 2001	A1
20010025183	Shahidi	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
20020002380	Bishop	Jan 2002	A1
20020019649	Sikora et al.	Feb 2002	A1
20020022836	Goble et al.	Feb 2002	A1
20020029036	Goble et al.	Mar 2002	A1
20020029055	Bonutti	Mar 2002	A1
20020032452	Tierney	Mar 2002	A1
20020049551	Friedman et al.	Apr 2002	A1
20020052617	Anis et al.	May 2002	A1
20020077550	Rabiner et al.	Jun 2002	A1
20020107517	Witt et al.	Aug 2002	A1
20020133152	Strul	Sep 2002	A1
20020156466	Sakurai et al.	Oct 2002	A1
20020156493	Houser et al.	Oct 2002	A1
20020165577	Witt et al.	Nov 2002	A1
20020177862	Aranyi et al.	Nov 2002	A1
20030009164	Woloszko et al.	Jan 2003	A1
20030014053	Nguyen et al.	Jan 2003	A1
20030014087	Fang et al.	Jan 2003	A1
20030036705	Hare et al.	Feb 2003	A1
20030040758	Wang et al.	Feb 2003	A1
20030050572	Brautigam et al.	Mar 2003	A1
20030055443	Spotnitz	Mar 2003	A1
20030073981	Whitman et al.	Apr 2003	A1
20030109778	Rashidi	Jun 2003	A1
20030109875	Tetzlaff et al.	Jun 2003	A1
20030114851	Truckai et al.	Jun 2003	A1
20030130693	Levin et al.	Jul 2003	A1
20030139741	Goble et al.	Jul 2003	A1
20030144680	Kellogg et al.	Jul 2003	A1
20030158548	Phan et al.	Aug 2003	A1
20030171747	Kanehira et al.	Sep 2003	A1
20030176778	Messing et al.	Sep 2003	A1
20030181898	Bowers	Sep 2003	A1
20030199794	Sakurai et al.	Oct 2003	A1
20030204199	Novak et al.	Oct 2003	A1
20030208186	Moreyra	Nov 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
20030225332	Okada et al.	Dec 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
20040087943	Dycus et al.	May 2004	A1
20040092921	Kadziauskas et al.	May 2004	A1
20040092992	Adams et al.	May 2004	A1
20040094597	Whitman 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
20040122423	Dycus et al.	Jun 2004	A1
20040132383	Langford et al.	Jul 2004	A1
20040138621	Jahns et al.	Jul 2004	A1
20040142667	Lochhead et al.	Jul 2004	A1
20040143263	Schechter et al.	Jul 2004	A1
20040147934	Kiester	Jul 2004	A1
20040147945	Fritzsch	Jul 2004	A1
20040158237	Abboud et al.	Aug 2004	A1
20040167508	Wham et al.	Aug 2004	A1
20040176686	Hare et al.	Sep 2004	A1
20040176751	Weitzner et al.	Sep 2004	A1
20040181242	Stack et al.	Sep 2004	A1
20040193150	Sharkey et al.	Sep 2004	A1
20040193153	Sartor et al.	Sep 2004	A1
20040193212	Taniguchi et al.	Sep 2004	A1
20040199193	Hayashi et al.	Oct 2004	A1
20040215132	Yoon	Oct 2004	A1
20040243147	Lipow	Dec 2004	A1
20040249374	Tetzlaff et al.	Dec 2004	A1
20040260273	Wan	Dec 2004	A1
20040260300	Gorensek et al.	Dec 2004	A1
20040267311	Viola et al.	Dec 2004	A1
20050015125	Mioduski et al.	Jan 2005	A1
20050020967	Ono	Jan 2005	A1
20050021018	Anderson et al.	Jan 2005	A1
20050021065	Yamada et al.	Jan 2005	A1
20050021078	Vleugels et al.	Jan 2005	A1
20050033278	McClurken et al.	Feb 2005	A1
20050033337	Muir et al.	Feb 2005	A1
20050070800	Takahashi	Mar 2005	A1
20050080427	Govari et al.	Apr 2005	A1
20050088285	Jei	Apr 2005	A1
20050090817	Phan	Apr 2005	A1
20050096683	Ellins et al.	May 2005	A1
20050099824	Dowling et al.	May 2005	A1
20050107777	West et al.	May 2005	A1
20050131390	Heinrich et al.	Jun 2005	A1
20050143769	White et al.	Jun 2005	A1
20050149108	Cox	Jul 2005	A1
20050165429	Douglas et al.	Jul 2005	A1
20050171522	Christopherson	Aug 2005	A1
20050171533	Latterell et al.	Aug 2005	A1
20050177184	Easley	Aug 2005	A1
20050182339	Lee et al.	Aug 2005	A1
20050187576	Whitman et al.	Aug 2005	A1
20050188743	Land	Sep 2005	A1
20050192610	Houser et al.	Sep 2005	A1
20050192611	Houser	Sep 2005	A1
20050206583	Lemelson 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
20050261588	Makin et al.	Nov 2005	A1
20050262175	Iino et al.	Nov 2005	A1
20050267464	Truckai et al.	Dec 2005	A1
20050271807	Iljima et al.	Dec 2005	A1
20050273090	Nieman et al.	Dec 2005	A1
20050288659	Kimura et al.	Dec 2005	A1
20060025757	Heim	Feb 2006	A1
20060030797	Zhou et al.	Feb 2006	A1
20060030848	Craig et al.	Feb 2006	A1
20060058825	Ogura et al.	Mar 2006	A1
20060063130	Hayman et al.	Mar 2006	A1
20060064086	Odom	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
20060095046	Trieu et al.	May 2006	A1
20060109061	Dobson et al.	May 2006	A1
20060142656	Malackowski et al.	Jun 2006	A1
20060159731	Shoshan	Jul 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
20060217700	Garito et al.	Sep 2006	A1
20060217729	Eskridge et al.	Sep 2006	A1
20060224160	Trieu et al.	Oct 2006	A1
20060247558	Yamada	Nov 2006	A1
20060253050	Yoshimine et al.	Nov 2006	A1
20060259026	Godara et al.	Nov 2006	A1
20060264809	Hansmann et al.	Nov 2006	A1
20060264995	Fanton et al.	Nov 2006	A1
20060265035	Yachi et al.	Nov 2006	A1
20060270916	Skwarek et al.	Nov 2006	A1
20060271030	Francis et al.	Nov 2006	A1
20060293656	Shadduck et al.	Dec 2006	A1
20070016235	Tanaka et al.	Jan 2007	A1
20070016236	Beaupre	Jan 2007	A1
20070021738	Hasser et al.	Jan 2007	A1
20070027468	Wales et al.	Feb 2007	A1
20070032704	Gandini et al.	Feb 2007	A1
20070055228	Berg et al.	Mar 2007	A1
20070056596	Fanney et al.	Mar 2007	A1
20070060935	Schwardt et al.	Mar 2007	A1
20070063618	Bromfield	Mar 2007	A1
20070066971	Podhajsky	Mar 2007	A1
20070067123	Jungerman	Mar 2007	A1
20070073185	Nakao	Mar 2007	A1
20070073341	Smith et al.	Mar 2007	A1
20070074584	Talarico et al.	Apr 2007	A1
20070106317	Shelton et al.	May 2007	A1
20070118115	Artale et al.	May 2007	A1
20070130771	Ehlert et al.	Jun 2007	A1
20070135803	Belson	Jun 2007	A1
20070149881	Rabin	Jun 2007	A1
20070156163	Davison et al.	Jul 2007	A1
20070166663	Telles et al.	Jul 2007	A1
20070173803	Wham et al.	Jul 2007	A1
20070173813	Odom	Jul 2007	A1
20070173871	Houser	Jul 2007	A1
20070173872	Neuenfeldt	Jul 2007	A1
20070175955	Shelton et al.	Aug 2007	A1
20070185474	Nahen	Aug 2007	A1
20070191712	Messerly et al.	Aug 2007	A1
20070191713	Eichmann et al.	Aug 2007	A1
20070203483	Kim et al.	Aug 2007	A1
20070208336	Kim et al.	Sep 2007	A1
20070208340	Ganz et al.	Sep 2007	A1
20070219481	Babaev	Sep 2007	A1
20070232926	Stulen et al.	Oct 2007	A1
20070232928	Wiener et al.	Oct 2007	A1
20070236213	Paden et al.	Oct 2007	A1
20070239101	Kellogg	Oct 2007	A1
20070249941	Salehi et al.	Oct 2007	A1
20070260242	Dycus et al.	Nov 2007	A1
20070265560	Soltani et al.	Nov 2007	A1
20070265613	Edelstein et al.	Nov 2007	A1
20070265616	Couture et al.	Nov 2007	A1
20070265620	Kraas et al.	Nov 2007	A1
20070275348	Lemon	Nov 2007	A1
20070287933	Phan et al.	Dec 2007	A1
20070288055	Lee	Dec 2007	A1
20070299895	Johnson et al.	Dec 2007	A1
20080005213	Holtzman	Jan 2008	A1
20080013809	Zhu et al.	Jan 2008	A1
20080015473	Shimizu	Jan 2008	A1
20080015575	Odom et al.	Jan 2008	A1
20080033465	Schmitz et al.	Feb 2008	A1
20080039746	Hissong et al.	Feb 2008	A1
20080046122	Manzo et al.	Feb 2008	A1
20080051812	Schmitz et al.	Feb 2008	A1
20080058775	Darian et al.	Mar 2008	A1
20080058845	Shimizu et al.	Mar 2008	A1
20080071269	Hilario 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
20080114355	Whayne et al.	May 2008	A1
20080114364	Goldin et al.	May 2008	A1
20080122496	Wagner	May 2008	A1
20080125768	Tahara et al.	May 2008	A1
20080147058	Horrell et al.	Jun 2008	A1
20080147062	Truckai et al.	Jun 2008	A1
20080147092	Rogge et al.	Jun 2008	A1
20080167670	Shelton et al.	Jul 2008	A1
20080171938	Masuda et al.	Jul 2008	A1
20080177268	Daum et al.	Jul 2008	A1
20080188755	Hart	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
20080243162	Shibata et al.	Oct 2008	A1
20080255413	Zemlok et al.	Oct 2008	A1
20080275440	Kratoska et al.	Nov 2008	A1
20080281200	Voic et al.	Nov 2008	A1
20080281315	Gines	Nov 2008	A1
20080287944	Pearson et al.	Nov 2008	A1
20080287948	Newton et al.	Nov 2008	A1
20080296346	Shelton, IV et al.	Dec 2008	A1
20080300588	Groth et al.	Dec 2008	A1
20090012516	Curtis et al.	Jan 2009	A1
20090023985	Ewers	Jan 2009	A1
20090036913	Wiener et al.	Feb 2009	A1
20090043293	Pankratov et al.	Feb 2009	A1
20090048537	Lydon et al.	Feb 2009	A1
20090048589	Takashino et al.	Feb 2009	A1
20090054886	Yachi et al.	Feb 2009	A1
20090054889	Newton et al.	Feb 2009	A1
20090054894	Yachi	Feb 2009	A1
20090065565	Cao	Mar 2009	A1
20090076506	Baker	Mar 2009	A1
20090082716	Akahoshi	Mar 2009	A1
20090082766	Unger et al.	Mar 2009	A1
20090088745	Hushka et al.	Apr 2009	A1
20090088785	Masuda	Apr 2009	A1
20090090763	Zemlok et al.	Apr 2009	A1
20090101692	Whitman et al.	Apr 2009	A1
20090105750	Price et al.	Apr 2009	A1
20090112206	Dumbauld et al.	Apr 2009	A1
20090118751	Wiener et al.	May 2009	A1
20090131885	Akahoshi	May 2009	A1
20090131934	Odom et al.	May 2009	A1
20090138025	Stahler et al.	May 2009	A1
20090143678	Keast et al.	Jun 2009	A1
20090143799	Smith et al.	Jun 2009	A1
20090143800	Deville et al.	Jun 2009	A1
20090157064	Hodel	Jun 2009	A1
20090163807	Sliwa	Jun 2009	A1
20090177119	Heidner et al.	Jul 2009	A1
20090179923	Amundson et al.	Jul 2009	A1
20090182322	D'Amelio et al.	Jul 2009	A1
20090182331	D'Amelio et al.	Jul 2009	A1
20090182332	Long et al.	Jul 2009	A1
20090182333	Eder et al.	Jul 2009	A1
20090192441	Gelbart et al.	Jul 2009	A1
20090198272	Kerver et al.	Aug 2009	A1
20090204114	Odom	Aug 2009	A1
20090216157	Yamada	Aug 2009	A1
20090223033	Houser	Sep 2009	A1
20090240244	Malis et al.	Sep 2009	A1
20090248021	McKenna	Oct 2009	A1
20090248022	Falkenstein et al.	Oct 2009	A1
20090254077	Craig	Oct 2009	A1
20090254080	Honda	Oct 2009	A1
20090259149	Tahara et al.	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
20090270891	Beaupre	Oct 2009	A1
20090270899	Carusillo et al.	Oct 2009	A1
20090287205	Ingle	Nov 2009	A1
20090292283	Odom	Nov 2009	A1
20090299141	Downey et al.	Dec 2009	A1
20090306639	Nevo et al.	Dec 2009	A1
20090327715	Smith et al.	Dec 2009	A1
20100004508	Naito et al.	Jan 2010	A1
20100022825	Yoshie	Jan 2010	A1
20100030233	Whitman et al.	Feb 2010	A1
20100034605	Huckins et al.	Feb 2010	A1
20100036370	Mirel et al.	Feb 2010	A1
20100036373	Ward	Feb 2010	A1
20100042093	Wham et al.	Feb 2010	A9
20100049180	Wells et al.	Feb 2010	A1
20100057081	Hanna	Mar 2010	A1
20100057118	Dietz et al.	Mar 2010	A1
20100063437	Nelson et al.	Mar 2010	A1
20100063525	Beaupre et al.	Mar 2010	A1
20100063528	Beaupre	Mar 2010	A1
20100081863	Hess et al.	Apr 2010	A1
20100081864	Hess et al.	Apr 2010	A1
20100081883	Murray et al.	Apr 2010	A1
20100094323	Isaacs et al.	Apr 2010	A1
20100106173	Yoshimine	Apr 2010	A1
20100109480	Forslund et al.	May 2010	A1
20100158307	Kubota et al.	Jun 2010	A1
20100168741	Sanai et al.	Jul 2010	A1
20100181966	Sakakibara	Jul 2010	A1
20100187283	Crainich et al.	Jul 2010	A1
20100193566	Scheib et al.	Aug 2010	A1
20100204721	Young et al.	Aug 2010	A1
20100222714	Muir et al.	Sep 2010	A1
20100222752	Collins, Jr. et al.	Sep 2010	A1
20100225209	Goldberg et al.	Sep 2010	A1
20100228249	Mohr et al.	Sep 2010	A1
20100228250	Brogna	Sep 2010	A1
20100234906	Koh	Sep 2010	A1
20100256635	McKenna et al.	Oct 2010	A1
20100274160	Yachi et al.	Oct 2010	A1
20100274278	Fleenor et al.	Oct 2010	A1
20100280368	Can et al.	Nov 2010	A1
20100298743	Nield et al.	Nov 2010	A1
20100305564	Livneh	Dec 2010	A1
20100331742	Masuda	Dec 2010	A1
20100331871	Nield et al.	Dec 2010	A1
20110004233	Muir et al.	Jan 2011	A1
20110015650	Choi et al.	Jan 2011	A1
20110022032	Zemlok et al.	Jan 2011	A1
20110028964	Edwards	Feb 2011	A1
20110071523	Dickhans	Mar 2011	A1
20110082494	Kerr et al.	Apr 2011	A1
20110106141	Nakamura	May 2011	A1
20110112400	Emery et al.	May 2011	A1
20110125149	El-Galley et al.	May 2011	A1
20110125151	Strauss et al.	May 2011	A1
20110144640	Heinrich et al.	Jun 2011	A1
20110160725	Kabaya et al.	Jun 2011	A1
20110238010	Kirschenman et al.	Sep 2011	A1
20110238079	Hannaford et al.	Sep 2011	A1
20110273465	Konishi et al.	Nov 2011	A1
20110278343	Knodel et al.	Nov 2011	A1
20110279268	Konishi et al.	Nov 2011	A1
20110284014	Cadeddu et al.	Nov 2011	A1
20110290856	Shelton, IV et al.	Dec 2011	A1
20110295295	Shelton, IV et al.	Dec 2011	A1
20110306967	Payne et al.	Dec 2011	A1
20110313415	Fernandez et al.	Dec 2011	A1
20120004655	Kim et al.	Jan 2012	A1
20120016413	Timm et al.	Jan 2012	A1
20120022519	Huang et al.	Jan 2012	A1
20120022526	Aldridge et al.	Jan 2012	A1
20120022583	Sugalski et al.	Jan 2012	A1
20120041358	Mann et al.	Feb 2012	A1
20120053597	Anvari et al.	Mar 2012	A1
20120059286	Hastings et al.	Mar 2012	A1
20120059289	Nield et al.	Mar 2012	A1
20120071863	Lee et al.	Mar 2012	A1
20120078244	Worrell et al.	Mar 2012	A1
20120080344	Shelton, IV	Apr 2012	A1
20120101493	Masuda et al.	Apr 2012	A1
20120101495	Young et al.	Apr 2012	A1
20120109186	Parrott et al.	May 2012	A1
20120116222	Sawada et al.	May 2012	A1
20120116265	Houser et al.	May 2012	A1
20120116266	Houser et al.	May 2012	A1
20120116381	Houser et al.	May 2012	A1
20120136279	Tanaka et al.	May 2012	A1
20120136347	Brustad et al.	May 2012	A1
20120136386	Kishida et al.	May 2012	A1
20120143182	Ullrich et al.	Jun 2012	A1
20120143211	Kishi	Jun 2012	A1
20120150049	Zielinski et al.	Jun 2012	A1
20120150169	Zielinksi et al.	Jun 2012	A1
20120172904	Muir et al.	Jul 2012	A1
20120191091	Allen	Jul 2012	A1
20120193396	Zemlok et al.	Aug 2012	A1
20120211542	Racenet	Aug 2012	A1
20120226266	Ghosal et al.	Sep 2012	A1
20120234893	Schuckmann et al.	Sep 2012	A1
20120253328	Cunningham et al.	Oct 2012	A1
20120253329	Zemlok et al.	Oct 2012	A1
20120265241	Hart et al.	Oct 2012	A1
20120296239	Chernov et al.	Nov 2012	A1
20120296325	Takashino	Nov 2012	A1
20120296371	Kappus et al.	Nov 2012	A1
20130023925	Mueller	Jan 2013	A1
20130085510	Stefanchik et al.	Apr 2013	A1
20130103031	Garrison	Apr 2013	A1
20130123776	Monson et al.	May 2013	A1
20130158659	Bergs et al.	Jun 2013	A1
20130158660	Bergs et al.	Jun 2013	A1
20130165929	Muir et al.	Jun 2013	A1
20130190760	Allen, IV et al.	Jul 2013	A1
20130214025	Zemlok et al.	Aug 2013	A1
20130253256	Griffith et al.	Sep 2013	A1
20130253480	Kimball et al.	Sep 2013	A1
20130267874	Marcotte et al.	Oct 2013	A1
20130277410	Fernandez et al.	Oct 2013	A1
20130296843	Boudreaux et al.	Nov 2013	A1
20130321425	Greene et al.	Dec 2013	A1
20130334989	Kataoka	Dec 2013	A1
20130345701	Allen, IV et al.	Dec 2013	A1
20140001231	Shelton, IV et al.	Jan 2014	A1
20140001234	Shelton, IV et al.	Jan 2014	A1
20140005640	Shelton, IV et al.	Jan 2014	A1
20140005663	Heard et al.	Jan 2014	A1
20140005678	Shelton, IV et al.	Jan 2014	A1
20140005702	Timm et al.	Jan 2014	A1
20140005705	Weir et al.	Jan 2014	A1
20140005718	Shelton, IV et al.	Jan 2014	A1
20140014544	Bugnard et al.	Jan 2014	A1
20140077426	Park	Mar 2014	A1
20140121569	Schafer et al.	May 2014	A1
20140135804	Weisenburgh, II et al.	May 2014	A1
20140163541	Shelton, IV et al.	Jun 2014	A1
20140163549	Yates et al.	Jun 2014	A1
20140180274	Kabaya et al.	Jun 2014	A1
20140194868	Sanai et al.	Jul 2014	A1
20140194874	Dietz et al.	Jul 2014	A1
20140194875	Reschke et al.	Jul 2014	A1
20140207124	Aldridge et al.	Jul 2014	A1
20140207135	Winter	Jul 2014	A1
20140221994	Reschke	Aug 2014	A1
20140236152	Walberg et al.	Aug 2014	A1
20140246475	Hall et al.	Sep 2014	A1
20140249557	Koch et al.	Sep 2014	A1
20140263541	Leimbach et al.	Sep 2014	A1
20140263552	Hall et al.	Sep 2014	A1
20140276794	Batchelor et al.	Sep 2014	A1
20140276797	Batchelor et al.	Sep 2014	A1
20140276798	Batchelor et al.	Sep 2014	A1
20140303612	Williams	Oct 2014	A1
20140357984	Wallace et al.	Dec 2014	A1
20140373003	Grez et al.	Dec 2014	A1
20150014392	Williams et al.	Jan 2015	A1
20150025528	Arts	Jan 2015	A1
20150032150	Ishida et al.	Jan 2015	A1
20150048140	Penna et al.	Feb 2015	A1
20150066027	Garrison et al.	Mar 2015	A1
20150080876	Worrell et al.	Mar 2015	A1
20150080887	Sobajima et al.	Mar 2015	A1
20150088122	Jensen	Mar 2015	A1
20150100056	Nakamura	Apr 2015	A1
20150112335	Boudreaux et al.	Apr 2015	A1
20150119901	Steege	Apr 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
20150230796	Calderoni	Aug 2015	A1
20150238260	Nau, Jr.	Aug 2015	A1
20150257780	Houser	Sep 2015	A1
20150272557	Overmyer et al.	Oct 2015	A1
20150272571	Leimbach et al.	Oct 2015	A1
20150272580	Leimbach et al.	Oct 2015	A1
20150272581	Leimbach et al.	Oct 2015	A1
20150272582	Leimbach et al.	Oct 2015	A1
20150272657	Yates et al.	Oct 2015	A1
20150272659	Boudreaux et al.	Oct 2015	A1
20150282879	Ruelas	Oct 2015	A1
20150289364	Ilkko et al.	Oct 2015	A1
20150313667	Allen, IV	Nov 2015	A1
20150317899	Dumbauld et al.	Nov 2015	A1
20150351765	Valentine et al.	Dec 2015	A1
20150351857	Vander Poorten et al.	Dec 2015	A1
20150374430	Weiler et al.	Dec 2015	A1
20150374457	Colby	Dec 2015	A1
20160000437	Giordano et al.	Jan 2016	A1
20160038228	Daniel et al.	Feb 2016	A1
20160044841	Chamberlain	Feb 2016	A1
20160045248	Unger et al.	Feb 2016	A1
20160051314	Batchelor et al.	Feb 2016	A1
20160051316	Boudreaux	Feb 2016	A1
20160066913	Swayze et al.	Mar 2016	A1
20160120601	Boudreaux et al.	May 2016	A1
20160175025	Strobl	Jun 2016	A1
20160175029	Witt et al.	Jun 2016	A1
20160206342	Robertson et al.	Jul 2016	A1
20160228171	Boudreaux	Aug 2016	A1
20160249910	Shelton, IV et al.	Sep 2016	A1
20160262786	Madan et al.	Sep 2016	A1
20160270842	Strobl et al.	Sep 2016	A1
20160296251	Olson et al.	Oct 2016	A1
20160296252	Olson et al.	Oct 2016	A1
20160296270	Strobl et al.	Oct 2016	A1
20160331455	Hancock et al.	Nov 2016	A1
20160358849	Jur et al.	Dec 2016	A1
20160367281	Gee et al.	Dec 2016	A1
20170000516	Stulen et al.	Jan 2017	A1
20170000541	Yates et al.	Jan 2017	A1
20170000553	Wiener et al.	Jan 2017	A1
20170020614	Jackson et al.	Jan 2017	A1
20170065331	Mayer et al.	Mar 2017	A1
20170086876	Wiener et al.	Mar 2017	A1
20170086908	Wiener et al.	Mar 2017	A1
20170086909	Yates et al.	Mar 2017	A1
20170119426	Akagane	May 2017	A1
20170135751	Rothweiler et al.	May 2017	A1
20170164972	Johnson et al.	Jun 2017	A1
20170164997	Johnson et al.	Jun 2017	A1
20170189095	Danziger et al.	Jul 2017	A1
20170202571	Shelton, IV et al.	Jul 2017	A1
20170202572	Shelton, IV et al.	Jul 2017	A1
20170202591	Shelton, IV et al.	Jul 2017	A1
20170202595	Shelton, IV	Jul 2017	A1
20170202597	Shelton, IV et al.	Jul 2017	A1
20170202598	Shelton, IV et al.	Jul 2017	A1
20170202599	Shelton, IV et al.	Jul 2017	A1
20170202607	Shelton, IV et al.	Jul 2017	A1
20170224332	Hunter et al.	Aug 2017	A1
20170224405	Takashino et al.	Aug 2017	A1
20170231628	Shelton, IV et al.	Aug 2017	A1
20170281186	Shelton, IV et al.	Oct 2017	A1
20170296169	Yates et al.	Oct 2017	A1
20170296177	Harris et al.	Oct 2017	A1
20170296180	Harris et al.	Oct 2017	A1
20170303954	Ishii	Oct 2017	A1
20170312018	Trees et al.	Nov 2017	A1
20170325874	Noack et al.	Nov 2017	A1
20170333073	Faller et al.	Nov 2017	A1
20170348043	Wang et al.	Dec 2017	A1
20170348044	Wang et al.	Dec 2017	A1
20170367772	Gunn et al.	Dec 2017	A1
20180014872	Dickerson	Jan 2018	A1
20180085157	Batchelor et al.	Mar 2018	A1
20180098785	Price et al.	Apr 2018	A1
20180132850	Leimbach et al.	May 2018	A1
20180146976	Clauda et al.	May 2018	A1
20180168575	Simms et al.	Jun 2018	A1
20180168577	Aronhalt et al.	Jun 2018	A1
20180168579	Aronhalt et al.	Jun 2018	A1
20180168598	Shelton, IV et al.	Jun 2018	A1
20180168608	Shelton, IV et al.	Jun 2018	A1
20180168609	Fanelli et al.	Jun 2018	A1
20180168610	Shelton, IV et al.	Jun 2018	A1
20180168615	Shelton, IV et al.	Jun 2018	A1
20180168618	Scott et al.	Jun 2018	A1
20180168619	Scott et al.	Jun 2018	A1
20180168623	Simms et al.	Jun 2018	A1
20180168625	Posada et al.	Jun 2018	A1
20180168633	Shelton, IV et al.	Jun 2018	A1
20180168647	Shelton, IV et al.	Jun 2018	A1
20180168648	Shelton, IV et al.	Jun 2018	A1
20180168650	Shelton, IV et al.	Jun 2018	A1
20180188125	Park et al.	Jul 2018	A1
20180206904	Felder et al.	Jul 2018	A1
20180221045	Zimmerman et al.	Aug 2018	A1
20180235691	Voegele et al.	Aug 2018	A1
20180250066	Ding et al.	Sep 2018	A1
20180289432	Kostrzewski et al.	Oct 2018	A1
20180303493	Chapolini	Oct 2018	A1
20180325517	Wingardner et al.	Nov 2018	A1
20180333179	Weisenburgh, II et al.	Nov 2018	A1
20180353245	Mccloud et al.	Dec 2018	A1
20180368844	Bakos et al.	Dec 2018	A1
20190000459	Shelton, IV et al.	Jan 2019	A1
20190000461	Shelton, IV et al.	Jan 2019	A1
20190000462	Shelton, IV et al.	Jan 2019	A1
20190000475	Shelton, IV et al.	Jan 2019	A1
20190000476	Shelton, IV et al.	Jan 2019	A1
20190000477	Shelton, IV et al.	Jan 2019	A1
20190029746	Dudhedia et al.	Jan 2019	A1
20190038282	Shelton, IV et al.	Feb 2019	A1
20190038283	Shelton, IV et al.	Feb 2019	A1
20190053818	Nelson et al.	Feb 2019	A1
20190104919	Shelton, IV et al.	Apr 2019	A1
20190105067	Boudreaux et al.	Apr 2019	A1
20190117293	Kano et al.	Apr 2019	A1
20190125384	Scheib et al.	May 2019	A1
20190125390	Shelton, IV et al.	May 2019	A1
20190175258	Tsuruta	Jun 2019	A1
20190183504	Shelton, IV et al.	Jun 2019	A1
20190200844	Shelton, IV et al.	Jul 2019	A1
20190200977	Shelton, IV et al.	Jul 2019	A1
20190200981	Harris et al.	Jul 2019	A1
20190200987	Shelton, IV et al.	Jul 2019	A1
20190201030	Shelton, IV et al.	Jul 2019	A1
20190201045	Yates et al.	Jul 2019	A1
20190201046	Shelton, IV et al.	Jul 2019	A1
20190201047	Yates et al.	Jul 2019	A1
20190201104	Shelton, IV et al.	Jul 2019	A1
20190201136	Shelton, IV et al.	Jul 2019	A1
20190201137	Shelton, IV et al.	Jul 2019	A1
20190201594	Shelton, IV et al.	Jul 2019	A1
20190206562	Shelton, IV et al.	Jul 2019	A1
20190206564	Shelton, IV et al.	Jul 2019	A1
20190206569	Shelton, IV et al.	Jul 2019	A1
20190209201	Boudreaux et al.	Jul 2019	A1
20190223941	Kitamura et al.	Jul 2019	A1
20190262030	Faller et al.	Aug 2019	A1
20190269455	Mensch et al.	Sep 2019	A1
20190274700	Robertson et al.	Sep 2019	A1
20190282288	Boudreaux	Sep 2019	A1
20190282292	Wiener et al.	Sep 2019	A1
20190290265	Shelton, IV et al.	Sep 2019	A1
20190298350	Shelton, IV et al.	Oct 2019	A1
20190298352	Shelton, IV et al.	Oct 2019	A1
20190298353	Shelton, IV et al.	Oct 2019	A1
20190366562	Zhang et al.	Dec 2019	A1
20190388091	Eschbach et al.	Dec 2019	A1
20200030021	Yates et al.	Jan 2020	A1
20200054321	Harris et al.	Feb 2020	A1
20200054382	Yates et al.	Feb 2020	A1
20200078076	Henderson et al.	Mar 2020	A1
20200078085	Yates et al.	Mar 2020	A1
20200078106	Henderson et al.	Mar 2020	A1
20200078609	Messerly et al.	Mar 2020	A1
20200085465	Timm et al.	Mar 2020	A1
20200100825	Henderson et al.	Apr 2020	A1
20200100830	Henderson et al.	Apr 2020	A1
20200113624	Worrell et al.	Apr 2020	A1
20200129261	Eschbach	Apr 2020	A1
20200138473	Shelton, IV et al.	May 2020	A1
20200188047	Itkowitz et al.	Jun 2020	A1
20200222111	Yates et al.	Jul 2020	A1
20200222112	Hancock et al.	Jul 2020	A1
20200222135	Stulen et al.	Jul 2020	A1
20200229833	Vakharia et al.	Jul 2020	A1
20200229834	Olson et al.	Jul 2020	A1
20200237434	Scheib et al.	Jul 2020	A1
20200261078	Bakos et al.	Aug 2020	A1
20200261086	Zeiner et al.	Aug 2020	A1
20200261087	Timm et al.	Aug 2020	A1
20200261141	Wiener et al.	Aug 2020	A1
20200268433	Wiener et al.	Aug 2020	A1
20200305870	Shelton, IV	Oct 2020	A1
20200315623	Eisinger et al.	Oct 2020	A1
20200315712	Jasperson et al.	Oct 2020	A1
20200338370	Wiener et al.	Oct 2020	A1
20200405296	Shelton, IV et al.	Dec 2020	A1
20200405302	Shelton, IV et al.	Dec 2020	A1
20200405316	Shelton, IV et al.	Dec 2020	A1
20200405409	Shelton, IV et al.	Dec 2020	A1
20200405410	Shelton, IV	Dec 2020	A1
20200405437	Shelton, IV et al.	Dec 2020	A1
20200405439	Shelton, IV et al.	Dec 2020	A1
20200410177	Shelton, IV	Dec 2020	A1
20210052313	Shelton, IV et al.	Feb 2021	A1
20210100578	Weir et al.	Apr 2021	A1
20210100579	Shelton, IV et al.	Apr 2021	A1
20210153927	Ross et al.	May 2021	A1
20210177481	Shelton, IV et al.	Jun 2021	A1
20210177494	Houser et al.	Jun 2021	A1
20210177496	Shelton, IV et al.	Jun 2021	A1
20210186492	Shelton, IV et al.	Jun 2021	A1
20210186493	Shelton, IV et al.	Jun 2021	A1
20210186494	Shelton, IV et al.	Jun 2021	A1
20210186495	Shelton, IV et al.	Jun 2021	A1
20210186497	Shelton, IV et al.	Jun 2021	A1
20210186498	Boudreaux et al.	Jun 2021	A1
20210186499	Shelton, IV et al.	Jun 2021	A1
20210186500	Shelton, IV et al.	Jun 2021	A1
20210186501	Shelton, IV et al.	Jun 2021	A1
20210186502	Shelton, IV et al.	Jun 2021	A1
20210186504	Shelton, IV et al.	Jun 2021	A1
20210186507	Shelton, IV et al.	Jun 2021	A1
20210186553	Green et al.	Jun 2021	A1
20210186554	Green et al.	Jun 2021	A1
20210196263	Shelton, IV et al.	Jul 2021	A1
20210196265	Shelton, IV et al.	Jul 2021	A1
20210196266	Shelton, IV et al.	Jul 2021	A1
20210196267	Shelton, IV et al.	Jul 2021	A1
20210196268	Shelton, IV et al.	Jul 2021	A1
20210196269	Shelton, IV et al.	Jul 2021	A1
20210196270	Shelton, IV et al.	Jul 2021	A1
20210196271	Shelton, IV et al.	Jul 2021	A1
20210196301	Shelton, IV et al.	Jul 2021	A1
20210196302	Shelton, IV et al.	Jul 2021	A1
20210196305	Strobl	Jul 2021	A1
20210196306	Estera et al.	Jul 2021	A1
20210196307	Shelton, IV	Jul 2021	A1
20210196334	Sarley et al.	Jul 2021	A1
20210196335	Messerly et al.	Jul 2021	A1
20210196336	Faller et al.	Jul 2021	A1
20210196343	Shelton, IV et al.	Jul 2021	A1
20210196344	Shelton, IV et al.	Jul 2021	A1
20210196345	Messerly et al.	Jul 2021	A1
20210196346	Leuck et al.	Jul 2021	A1
20210196349	Fiebig et al.	Jul 2021	A1
20210196350	Fiebig et al.	Jul 2021	A1
20210196351	Sarley et al.	Jul 2021	A1
20210196352	Messerly et al.	Jul 2021	A1
20210196353	Gee et al.	Jul 2021	A1
20210196354	Shelton, IV et al.	Jul 2021	A1
20210196355	Shelton, IV et al.	Jul 2021	A1
20210196356	Shelton, IV et al.	Jul 2021	A1
20210196357	Shelton, IV et al.	Jul 2021	A1
20210196358	Shelton, IV et al.	Jul 2021	A1
20210196359	Shelton, IV et al.	Jul 2021	A1
20210196360	Shelton, IV et al.	Jul 2021	A1
20210196361	Shelton, IV et al.	Jul 2021	A1
20210196362	Shelton, IV et al.	Jul 2021	A1
20210196363	Shelton, IV et al.	Jul 2021	A1
20210196364	Shelton, IV et al.	Jul 2021	A1
20210196365	Shelton, IV et al.	Jul 2021	A1
20210196366	Shelton, IV et al.	Jul 2021	A1
20210196367	Salguero et al.	Jul 2021	A1
20210212744	Shelton, IV et al.	Jul 2021	A1
20210220036	Shelton, IV et al.	Jul 2021	A1
20210236195	Asher et al.	Aug 2021	A1
20210282804	Worrell et al.	Sep 2021	A1
20210393288	Shelton, IV et al.	Dec 2021	A1
20210393314	Wiener et al.	Dec 2021	A1
20210393319	Shelton, IV et al.	Dec 2021	A1
20220039891	Stulen et al.	Feb 2022	A1
20220071655	Price et al.	Mar 2022	A1
20220167982	Shelton, IV et al.	Jun 2022	A1
20220168005	Aldridge et al.	Jun 2022	A1
20220168039	Worrell et al.	Jun 2022	A1
20220226014	Clauda, IV et al.	Jul 2022	A1
20220304736	Boudreaux	Sep 2022	A1
20220313297	Aldridge et al.	Oct 2022	A1
20220346863	Yates et al.	Nov 2022	A1
20220387067	Faller et al.	Dec 2022	A1
20230038162	Timm et al.	Feb 2023	A1
20230048996	Vakharia et al.	Feb 2023	A1

Foreign Referenced Citations (174)

Number	Date	Country
2535467	Apr 1993	CA
2460047	Nov 2001	CN
1634601	Jul 2005	CN
1775323	May 2006	CN
1922563	Feb 2007	CN
2868227	Feb 2007	CN
201029899	Mar 2008	CN
101474081	Jul 2009	CN
101516285	Aug 2009	CN
101522112	Sep 2009	CN
102100582	Jun 2011	CN
102149312	Aug 2011	CN
202027624	Nov 2011	CN
102792181	Nov 2012	CN
103281982	Sep 2013	CN
103379853	Oct 2013	CN
203468630	Mar 2014	CN
104001276	Aug 2014	CN
104013444	Sep 2014	CN
104434298	Mar 2015	CN
107374752	Nov 2017	CN
3904558	Aug 1990	DE
9210327	Nov 1992	DE
4300307	Jul 1994	DE
29623113	Oct 1997	DE
20004812	Sep 2000	DE
20021619	Mar 2001	DE
10042606	Aug 2001	DE
10201569	Jul 2003	DE
102012109037	Apr 2014	DE
0171967	Feb 1986	EP
0336742	Oct 1989	EP
0136855	Nov 1989	EP
0705571	Apr 1996	EP
1698289	Sep 2006	EP
1862133	Dec 2007	EP
1972264	Sep 2008	EP
2060238	May 2009	EP
1747761	Oct 2009	EP
2131760	Dec 2009	EP
1214913	Jul 2010	EP
1946708	Jun 2011	EP
1767164	Jan 2013	EP
2578172	Apr 2013	EP
2668922	Dec 2013	EP
2076195	Dec 2015	EP
2510891	Jun 2016	EP
3476302	May 2019	EP
3476331	May 2019	EP
3694298	Aug 2020	EP
2032221	Apr 1980	GB
2317566	Apr 1998	GB
S50100891	Aug 1975	JP
S5968513	May 1984	JP
S59141938	Aug 1984	JP
S62221343	Sep 1987	JP
S62227343	Oct 1987	JP
S62292153	Dec 1987	JP
S62292154	Dec 1987	JP
S63109386	May 1988	JP
S63315049	Dec 1988	JP
H01151452	Jun 1989	JP
H01198540	Aug 1989	JP
H0271510	May 1990	JP
H02286149	Nov 1990	JP
H02292193	Dec 1990	JP
H0337061	Feb 1991	JP
H0425707	Feb 1992	JP
H0464351	Feb 1992	JP
H0430508	Mar 1992	JP
H04152942	May 1992	JP
H 0541716	Feb 1993	JP
H0576482	Mar 1993	JP
H0595955	Apr 1993	JP
H05115490	May 1993	JP
H0670938	Mar 1994	JP
H06104503	Apr 1994	JP
H0824266	Jan 1996	JP
H08229050	Sep 1996	JP
H08275951	Oct 1996	JP
H08299351	Nov 1996	JP
H08336545	Dec 1996	JP
H09130655	May 1997	JP
H09135553	May 1997	JP
H09140722	Jun 1997	JP
H105237	Jan 1998	JP
10127654	May 1998	JP
H10295700	Nov 1998	JP
H11128238	May 1999	JP
H11169381	Jun 1999	JP
2000210299	Aug 2000	JP
2000271142	Oct 2000	JP
2000271145	Oct 2000	JP
2000287987	Oct 2000	JP
2001029353	Feb 2001	JP
2002059380	Feb 2002	JP
2002186901	Jul 2002	JP
2002263579	Sep 2002	JP
2002330977	Nov 2002	JP
2003000612	Jan 2003	JP
2003010201	Jan 2003	JP
2003116870	Apr 2003	JP
2003126104	May 2003	JP
2003126110	May 2003	JP
2003153919	May 2003	JP
2003339730	Dec 2003	JP
2004129871	Apr 2004	JP
2004147701	May 2004	JP
2005003496	Jan 2005	JP
2005027026	Jan 2005	JP
2005074088	Mar 2005	JP
2005337119	Dec 2005	JP
2006068396	Mar 2006	JP
2006081664	Mar 2006	JP
2006114072	Apr 2006	JP
2006217716	Aug 2006	JP
2006288431	Oct 2006	JP
2007037568	Feb 2007	JP
200801876	Jan 2008	JP
200833644	Feb 2008	JP
2008188160	Aug 2008	JP
D1339835	Aug 2008	JP
2010009686	Jan 2010	JP
2010121865	Jun 2010	JP
2012071186	Apr 2012	JP
2012235658	Nov 2012	JP
2013126430	Jun 2013	JP
100789356	Dec 2007	KR
101298237	Aug 2013	KR
2154437	Aug 2000	RU
22035	Mar 2002	RU
2201169	Mar 2003	RU
2405603	Dec 2010	RU
2013119977	Nov 2014	RU
850068	Jul 1981	SU
WO-8103272	Nov 1981	WO
WO-9308757	May 1993	WO
WO-9314708	Aug 1993	WO
WO-9421183	Sep 1994	WO
WO-9424949	Nov 1994	WO
WO-9639086	Dec 1996	WO
WO-9712557	Apr 1997	WO
WO-9800069	Jan 1998	WO
WO-9840015	Sep 1998	WO
WO-9920213	Apr 1999	WO
WO-9923960	May 1999	WO
WO-0024330	May 2000	WO
WO-0064358	Nov 2000	WO
WO-0128444	Apr 2001	WO
WO-0167970	Sep 2001	WO
WO-0172251	Oct 2001	WO
WO-0195810	Dec 2001	WO
WO-02080793	Oct 2002	WO
WO-03095028	Nov 2003	WO
WO-2004037095	May 2004	WO
WO-2004078051	Sep 2004	WO
WO-2004098426	Nov 2004	WO
WO-2006091494	Aug 2006	WO
WO-2007008710	Jan 2007	WO
WO-2008118709	Oct 2008	WO
WO-2008130793	Oct 2008	WO
WO-2010027109	Mar 2010	WO
WO-2010104755	Sep 2010	WO
WO-2011008672	Jan 2011	WO
WO-2011044343	Apr 2011	WO
WO-2011052939	May 2011	WO
WO-2011060031	May 2011	WO
WO-2012044606	Apr 2012	WO
WO-2012061722	May 2012	WO
WO-2012088535	Jun 2012	WO
WO-2012150567	Nov 2012	WO
WO-2016130844	Aug 2016	WO
WO-2019130090	Jul 2019	WO
WO-2019130113	Jul 2019	WO

Non-Patent Literature Citations (63)

Entry
Arnoczky et al., “Thermal Modification of Conective Tissues: Basic Science Considerations and Clinical Implications,” J. Am Acad Orthop Surg, vol. 8, No. 5, pp. 305-313 (Sep./Oct. 2000).
AST Products, Inc., “Principles of Video Contact Angle Analysis,” 20 pages, (2006).
Campbell et al, “Thermal Imaging in Surgery,” p. 19-3, in Medical Infrared Imaging, N. A. Diakides and J. D. Bronzino, Eds. (2008).
Chen et al., “Heat-Induced Changes in the Mechanics of a Collagenous Tissue: Isothermal Free Shrinkage,” Transactions of the ASME, vol. 119, pp. 372-378 (Nov. 1997).
Chen et al., “Heat-Induced Changes in the Mechanics of a Collagenous Tissue: Isothermal, Isotonic Shrinkage,” Transactions of the ASME, vol. 120, pp. 382-388 (Jun. 1998).
Chen et al., “Heat-induced changes in the mechanics of a collagenous tissue: pseudoelastic behavior at 37° C.,” Journal of Biomechanics, 31, pp. 211-216 (1998).
Chen et al., “Phenomenological Evolution Equations for Heat-Induced Shrinkage of a Collagenous Tissue,” IEEE Transactions on Biomedical Engineering, vol. 45, No. 10, pp. 1234-1240 (Oct. 1998).
Covidien 501(k) Summary Sonicision, dated Feb. 24, 2011 (7 pages).
Covidien Brochure, [Value Analysis Brief], LigaSure Advance™ Pistol Grip, dated Rev. Apr. 2010 (7 pages).
Covidien Brochure, LigaSure Atlas™ Hand Switching Instruments, dated Dec. 2008 (2 pages).
Covidien Brochure, LigaSure Impact™ Instrument LF4318, dated Feb. 2013 (3 pages).
Covidien Brochure, The LigaSure Precise™ Instrument, dated Mar. 2011 (2 pages).
Covidien Brochure, The LigaSure™ 5 mm Blunt Tip Sealer/Divider Family, dated Apr. 2013 (2 pages).
Dean, D.A., “Electrical Impedance Spectroscopy Study of Biological Tissues,” J. Electrostat, 66(3-4), Mar. 2008, pp. 165-177. Accessed Apr. 10, 2018: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597841/.
Douglas, S.C. “Introduction to Adaptive Filter”. Digital Signal Processing Handbook. Ed. Vijay K. Madisetti and Douglas B. Williams. Boca Raton: CRC Press LLC, 1999.
Erbe Electrosurgery VIO® 200 S, (2012), p. 7, 12 pages, accessed Mar. 31, 2014 at http://www.erbe-med. com/erbe/media/Marketing materialien/85140170 Erbe En VIO 200 S D027541.
F. A. Duck, “Optical Properties of Tissue Including Ultraviolet and Infrared Radiation,” pp. 43-71 in Physical Properties of Tissue (1990).
Fowler, K.R., “A Programmable, Arbitrary Waveform Electrosurgical Device,” IEEE Engineering in Medicine and Biology Society 10th Annual International Conference, pp. 1324, 1325 (1988).
Gerhard, Glen C., “Surgical Electrotechnology: Quo Vadis?,” IEEE Transactions on Biomedical Engineering, vol. BME-31, No. 12, pp. 787-792, Dec. 1984.
Gibson, “Magnetic Refrigerator Successfully Tested,” U.S. Department of Energy Research News, accessed online on Aug. 6, 2010 at http://www.eurekalert.org/features/doe/2001-11/dl-mrs062802.php (Nov. 1, 2001).
Glaser and Subak-Sharpe,Integrated Circuit Engineering, Addison-Wesley Publishing, Reading, MA (1979). (book—not attached).
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).
Graff, K.F., “Elastic Wave Propagation in a Curved Sonic Transmission Line,” IEEE Transactions on Sonics and Ultrasonics, SU-17(1), 1-6 (1970).
Harris et al., “Altered Mechanical Behavior of Epicardium Due to Isothermal Heating Under Biaxial Isotonic Loads,” Journal of Biomechanical Engineering, vol. 125, pp. 381-388 (Jun. 2003).
Harris et al., “Kinetics of Thermal Damage to a Collagenous Membrane Under Biaxial Isotonic Loading,” IEEE Transactions on Biomedical Engineering, vol. 51, No. 2, pp. 371-379 (Feb. 2004).
Hayashi et al., “The Effect of Thermal Heating on the Length and Histologic Properties of the Glenohumeral Joint Capsule,” American Journal of Sports Medicine, vol. 25, Issue 1, 11 pages (Jan. 1997), URL: http://www.mdconsult.com/das/article/body/156183648-2/jorg=journal&source=MI&sp=1 . . . , accessed Aug. 25, 2009.
Henriques. F.C., “Studies in thermal injury V. The predictability and the significance of thermally induced rate processes leading to irreversible epidermal injury.” Archives of Pathology, 434, pp. 489-502 (1947).
http://www.4-traders.com/JOHNSON-JOHNSON-4832/news/Johnson-Johnson-Ethicon-E . . . .
http://www.apicalinstr.com/generators.htm.
http://www.dotmed.com/listing/electrosurical-unit/ethicon/ultracision-g110-/1466724.
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.
http:/www.ethicon.com/gb-en/healthcare-professionals/products/energy-devices/capital//ge . . . .
https://www.kjmagnetics.com/fieldcalculator.asp, retrieved Jul. 11, 2016, backdated to Nov. 11, 2011 via https://web.archive.org/web/20111116164447/http://www.kjmagnetics.com/fieldcalculator.asp.
Humphrey, J.D., “Continuum Thermomechanics and the Clinical Treatment of Disease and Injury,” Appl. Mech. Rev., vol. 56, No. 2 pp. 231-260 (Mar. 2003).
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).
Hörmann et al., “Reversible and irreversible denaturation of collagen fibers.” Biochemistry, 10, pp. 932-937 (1971).
Incropera et al., Fundamentals of Heat and Mass Transfer, Wiley, New York (1990). (Book—not attached).
Jang, J. et al. “Neuro-fuzzy and Soft Computing.” Prentice Hall, 1997, pp. 13-89, 199-293, 335-393, 453-496, 535-549.
Kurt Gieck & Reiner Gieck, Engineering Formulas § Z.7 (7th ed. 1997).
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.
Lee et al., “A multi-sample denaturation temperature tester for collagenous biomaterials,” Med. Eng. Phy., vol. 17, No. 2, pp. 115-121 (Mar. 1995).
Leonard I. Malis, M.D., “The Value of Irrigation During Bipolar Coagulation,” 1989.
Lim et al., “A Review of Mechanism Used in Laparoscopic Surgical Instruments,” Mechanism and Machine Theory, vol. 38, pp. 1133-1147, (2003).
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).
Moran et al., “Thermally Induced Shrinkage of Joint Capsule,” Clinical Orthopaedics and Related Research, No. 281, pp. 248-255 (Dec. 2000).
Morley, L. S. D., “Elastic Waves in a Naturally Curved Rod,” Quarterly Journal of Mechanics and Applied Mathematics, 14: 155-172 (1961).
National Semiconductors Temperature Sensor Handbook—http://www.national.com/appinfo/tempsensors/files/temphb.pdf; accessed online: Apr. 1, 2011.
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).
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.
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.
Technology Overview, printed from www.harmonicscalpel.com, Internet site, website accessed on Jun. 13, 2007, (3 pages).
Wall et al., “Thermal modification of collagen,” J Shoulder Elbow Surg, No. 8, pp. 339-344 (Jul./Aug. 1999).
Walsh, S. J., White, R. G., “Vibrational Power Transmission in Curved Beams,” Journal of Sound and Vibration, 233(3), 455-488 (2000).
Weir, C.E., “Rate of shrinkage of tendon collagen—heat, entropy and free energy of activation of the shrinkage of untreated tendon. Effect of acid salt, pickle, and tannage on the activation of tendon collagen.” Journal of the American Leather Chemists Association, 44, pp. 108-140 (1949).
Wells et al., “Altered Mechanical Behavior of Epicardium Under Isothermal Biaxial Loading,” Transactions of the ASME, Journal of Biomedical Engineering, vol. 126, pp. 492-497 (Aug. 2004).
Wright, et al., “Time-Temperature Equivalence of Heat-Induced Changes in Cells and Proteins,” Feb. 1998. ASME Journal of Biomechanical Engineering, vol. 120, pp. 22-26.
Moraleda et al., A Temperature Sensor Based on a Polymer Optical Fiber Macro-Bend, Sensors 2013, 13, 13076-13089, doi: 10.3390/s131013076, ISSN 1424-8220.
IEEE Std 802.03-2012 (Revision of IEEE Std 802.3-2008, published Dec. 28, 2012.
“ATM-MPLS Network Interworking Version 2.0, af-aic-0178.001” ATM Standard, The ATM Forum Technical Committee, published Aug. 2003.
Missinne, et al. “Stretchable Optical Waveguides,” vol. 22, No. 4, Feb. 18, 2014, pp. 4168-4179 (12 pages).

Related Publications (1)

	Number	Date	Country
	20190201048 A1	Jul 2019	US

Divisions (2)

	Number	Date	Country
Parent	15212742	Jul 2016	US
Child	16233911		US
Parent	13538700	Jun 2012	US
Child	15212742		US

Surgical instruments with articulating shafts

Information

Patent Number

Date Filed

Date Issued

Inventors

Original Assignees

Examiners

CPC

Field of Search

CPC

International Classifications

Term Extension

Abstract