Patent Grant
8109873
The present invention relates generally to surgical tissue retractors and specifically to retractors that may be used to enlarge a surgical incision or a natural body opening. Retraction of a surgical incision or body opening is generally accomplished by placing a first, flexible retention member through the incision or body opening and into a body cavity, such as an abdominal cavity, and subsequently tensioning the first retention member against the inner portion of the associated body wall adjacent to the incision or opening by applying tension to a sleeve that is coupled to the first tension member. The sleeve may be tensioned by winding it upon an external, more rigid structure. As the sleeve is wound around the external structure, the incision or opening is reshaped and/or enlarged to a substantially round condition.
The invention relates generally to a surgical retractor for retracting a surgical incision or a natural biological body orifice. A surgical access device has a surgical retractor for retracting an opening in a biological body and a lid. The surgical retractor has a noncompliant outer ring, an inner ring, and a sleeve that couples the outer ring to the inner ring. The outer ring has an annular axis and is adapted for juxtaposition with an outer surface of the biological body wall. The inner ring is adapted for juxtaposition with an inner surface of the biological body wall. The sleeve is adapted to traverse the opening in the body wall. The noncompliant outer ring is adapted to roll over itself around the annular axis to roll the sleeve around the outer ring in order to retract and seal the opening in the body wall. The lid is adapted for being coupled to the noncompliant outer ring of the surgical retractor. The outer ring of the surgical retractor has a cross-sectional shape that prohibits the lid from being partially or incorrectly coupled to the outer ring of the surgical retractor.
In one aspect, the outer ring of the surgical retractor has an oval cross-sectional shape. The outer ring of the surgical retractor has a first, outer portion that has at least one lumen, and a second, inner portion that has a noncompliant hoop. The noncompliant hoop is positioned in the at least one lumen of the first, outer portion. In one aspect, the at least one lumen in the first, outer portion of the outer ring has a first, middle lumen, a second, top lumen, and a third, bottom lumen, with the noncompliant hoop of the second, inner portion of the outer ring being positioned in the first, middle lumen. The first, outer portion of the outer ring may have the oval cross-sectional shape with the first, second, and third lumens of the first, outer portion of the outer ring being positioned along a major axis of the oval cross-section. The first lumen is positioned at a minor axis of the oval cross-section, the second lumen is positioned on a first side of the minor axis and the third lumen is positioned on a second, opposite side of the minor axis. A split hoop may be positioned in each of the second and third lumens of the first, outer portion of the outer ring. In one aspect, the first, outer portion of the outer ring of the surgical retractor has two lumens with a noncompliant split hoop positioned in each of the two lumens of the first, outer portion of the outer ring of the surgical retractor. The first, outer portion of the outer ring is made of materials that allow the outer ring to be turned around its annular axis. The sleeve is made of a material that is flexible and impermeable to fluids and bacteria. The inner ring is made of materials having sufficient hardness to retain the shape of the inner ring after insertion of the inner ring into a body cavity. In one aspect, the lid is a gel cap that has a cap ring and a gel pad. The cap ring is adapted to be coupled to the outer ring of the surgical retractor. The gel pad is made of a gel material and is coupled to the cap ring. The gel pad of the gel cap may have an access portion for providing a passage from external the body to a body cavity. The passage forms an instrument seal in the presence of an instrument inserted therethrough and a zero seal in the absence of an instrument inserted therethrough. A distal portion of the cap ring may be adapted to receive the outer ring of the surgical retractor such that the outer ring of the surgical retractor embeds into the gel pad and displaces the gel, thereby forming a seal between the gel pad and the outer ring and sleeve of the surgical retractor.
These and other features and advantages of the invention will become more apparent with a discussion of embodiments in reference to the associated drawings.
A surgical retractor 100 is placed into a surgical incision or body orifice to enlarge, reshape and isolate the incision or body orifice. Referring to
The second, outer ring 110 includes a first, outer component 112 and a second, inner component 114. The first, outer component 112 includes an overall shape that is substantially circular and may include a substantially oval cross-section. In one aspect, the height of the cross-section of the first, outer component 112 is larger than the width of the cross-section. Alternatively, the width of the cross-section of the first, outer component 112 is larger than the height of the cross-section. The ratio between the height and width of the cross-section relates to the hardness of the first, outer component 112 material and the diameter of the second, outer ring 110. More particularly, with a softer material for the first, outer component 112, the ratio between the height and width of the cross-section of the first, outer component is greater. Similarly, with the first, outer component 112 having a greater diameter, the ratio between the height and width of the cross-section of the first, outer component is greater. The first, outer component 112 may be made of a thermoplastic elastomeric material, such as a HYTREL, a thermoplastic polyester elastomeric material manufactured by E. I. DuPont de Nemours & Co. of Wilmington, Del., and/or PELLETHANE, a thermoplastic polyurethane elastomeric material manufactured by The Dow Chemical Company of Midland, Mich.
In one aspect, the first, outer component 112 of the second, outer ring 110 includes three lumens that extend throughout the outer component. A first, middle lumen 116 may include an oval cross-section and be sized larger than a second, top lumen 118 and a third, bottom lumen 120. The second, top lumen 118 and third, bottom lumen 120 may each include a tear-dropped cross-section having tapered portions away from the first, middle lumen 116. The first 116, second 118, and third 120 lumens are positioned substantially along a major axis of the oval cross-section of the outer component 112. The first lumen 116 is further positioned substantially at a minor axis of the oval cross-section of the outer component 112 of the outer ring 110, the second lumen 118 is positioned on a first side of the minor axis and the third lumen 120 is positioned on a second, opposite side of the minor axis. Alternatively, the cross-sectional shape of the first, outer component 112 may vary greatly from the oval shape. Further, the lumens may include other cross-sectional shapes, such as round. Alternatively, the first, outer component 112 of the outer ring 110 may include only a single lumen 116 extending throughout the first, outer component of the second, outer ring and positioned substantially in the center of the cross-section of the first, outer component of the second, outer ring. Additionally, the single lumen 116 in the first, outer component 112 of the second, outer ring 110 may be positioned off-center of the first, outer component.
The first, outer component 112 of the second, outer ring 110 may be made of a split piece of material, such as a substantially straight piece of material, having a first end 122 and a second end 124. The first 122 and second 124 ends of the material forming the first, outer component 112 may be brought proximate each other and coupled together, as will be discussed in more detail below.
In one aspect, the second, inner component 114 of the outer ring 110 is made of a rigid wire that is bent into a generally circular shape. The second, inner component 114 is inserted into the first, middle lumen 116 of the first, outer component 112. The wire is not compliant or resilient in relation to the body tissue of the surgical incision or natural body orifice. The wire does not flex, yield or deform in relation to the body tissue of the surgical incision or natural body orifice during retraction of the incision or body orifice. The rigid wire dictates the peripheral shape, or footprint, of the second, outer ring of the surgical retractor. The rigid wire marks the center point of rotation for the second, outer ring 110, thereby functioning as an axle about which the first, outer component 112 rotates. The wire may be made of full hard stainless steel, or other material that is significantly harder than the first, outer component 112 of the second, outer ring 110. The wire of which the second, inner component 114 is made may be a split wire having a first 126 end and a second end 128. In one aspect, the first 126 and second 128 ends of the rigid wire are coupled together.
Referring to
The monolithic coupler includes a base portion 132 having a first face 134, a second face 136 opposing the first face, and a periphery that substantially matches the periphery of the cross-section of the first, outer component 112 of the second, outer ring 110. Each of the first 134 and second 136 faces of the base portion 132 of the monolithic coupler 130 has a first pin 138, a second pin 140 and a tube portion 142 protruding therefrom with the pins and tube portion on each face being substantially symmetrical to the pins and tube portion on the opposing face. The first 138 and second 140 pins on the first face 134 of the monolithic coupler base 132 are positioned, aligned and adapted to mate with the second 118 and third 120 lumens, respectively, at the first end 122 of the first, outer component 112 of the second, outer ring 110. Similarly, the first 138 and second 140 pins on the second face 136 of the monolithic coupler base 132 are positioned, aligned and adapted to mate with the second 118 and third lumens 120, respectively, at the second end 124 of the first, outer component 112 of the second, outer ring 110. The tube portion 142 on the first face 134 of the monolithic coupler base 132 is aligned and adapted to mate with the first lumen 116 at the first end 122 of the first, outer component 112 of the second, outer ring 110 and the tube portion 142 on the second face 136 of the monolithic coupler base 132 is aligned and adapted to mate with the first lumen 116 at the second end 124 of the first, outer component 112 of the second, outer ring 110. Each of the tube portions 142 of the monolithic coupler 130 includes an aperture 144 that is open at the end of the tube portion away from the base 132 of the monolithic coupler. Alternatively, the monolithic coupler 130 may include an aperture 144 that extends completely through the tube portion 142 on the first face 134, the base portion 132, and the tube portion 142 on the second face 136. The aperture 144 of each of the tube portions 142 of the monolithic coupler 130 is adapted to receive one of the first 126 and second 128 ends of the rigid ring 115 of the second, inner component 114 of the second, outer ring 110 of the surgical retractor 100.
The first 138 and second 140 pins on each of the first 134 and second 136 faces of the monolithic coupler base 132 tapers away from the base. The taper on the pins facilitates insertion of the pins into the respective lumens 118, 120 of the first, outer component 112 of the second, outer ring 110. The outer surface of the tube portions 142 on each of the first 134 and second 136 faces of the monolithic coupler base 132 also tapers away from the base with the taper facilitating insertion of the tube portions into the first lumen 116 of the first, outer component 112 of the second, outer ring 110. The aperture 144 of each of the tube portions 142 is tapered toward the monolithic coupler base 132 to facilitate the insertion of one of the first 126 and second 128 ends of the second, inner component 114 of the second, outer ring 110 therein.
The length of each of the tube portions 142 of the monolithic coupler 130 is sufficient to maintain the first 126 and second 128 ends of the second, inner component 114 of the second, outer ring 110 therein and to maintain the tube portions within the first, middle lumen 116 of the first, outer component 112 of the second, outer ring. Similarly, the first 138 and second 140 pins protruding from the first 134 and second 136 faces of the monolithic coupler base 132 are of sufficient length to maintain the pins in the second 118 and third 120 lumens, respectively, of the first, outer component 112 of the second, outer ring 110. Being made of Acrylonitrile Butadiene Styrene (ABS), the monolithic coupler 130 is flexible and the pins 138, 140 and tube portions 142 thereof may assume a curved shape as influenced upon by the rigid wire 115 of the second, inner component 114 of the second, outer ring 110 and by the first, outer component 112 of the second, outer ring. Alternatively, the monolithic coupler 130 may be substantially rigid and may be made by methods including die casting, metal injection molding, and/or powdered metallurgy.
The first, inner ring 102 may include a single component having an overall substantially circular shape and a substantially circular cross-section. The first, inner ring 102 may be made of a material that is softer than the material of which the first, outer component 112 of the second, outer ring 110 is made. Alternatively, the first, inner ring 102 may be made of a material having about the same hardness as the material of which the first, outer component 112 of the second, outer ring 110 is made or may be made of a material that is harder than the material of which the first, outer component of the second, outer ring is made. The sleeve 106 may be made of a flexible, semi-transparent plastic film that is coupled to the first, inner ring 102 and the second, outer ring 110.
Referring again to the first, outer component 112 of the second, outer ring 110, the cross-sectional height and width of the first, outer component may be proportionally different or varied to create lock points as the outer component is rotated about the second, inner component 112. As the sleeve 106 is rolled around the second, outer ring 110, while the outer ring is rotated, lock points prevent the outer ring from rotating back, and thus prevent the sleeve from unraveling from the second, outer ring. Different cross-sectional shapes (not shown) of the first, outer component (e.g., triangle, cross, etc.) assist in providing differing lock points. Lock points also provide incremental rotational positions for the second, outer ring, thereby providing incremental retraction of the incision or body opening. Generally symmetrical cross-sectional shapes provide substantially uniform rotational motion and lock points, thereby providing a substantially uniform “snap” feel with each incremental rotation. The lock points also help keep the first, outer component of the second, outer ring from tilting as a result of forces encountered when retracting the surgical incision or body orifice.
The footprint of the second, outer ring 110 can be symmetrical or non-symmetrical and can vary in size and shape, such as a circle, ellipse or other suitable shape, to conform to a body type, position or size and thereby increase the working space or reduce potential interference with other instruments or ports during the laparoscopic procedure. In one aspect, the first, outer component 112 can be formed in a Mobius shape (
As stated above, the first, outer component 112 may be made of a thermoplastic elastomeric material, such as HYTREL or PELLETHANE. Increasing the hardness of the material used for the first, outer component increases resistance to lock the second, outer ring 110 in position with each rotation of the outer ring. The type of material used for the first, outer component can affect the height and width of the first, outer component to provide sufficient lock points for the second, outer ring. For example, the material hardness can be reduced while the height/width cross-section ratio of the first, outer component is increased. Conversely, the material hardness can be increased while the height/width cross-section ratio of the first, outer component is reduced. The first, outer component can be extruded, injection molded, compression molded, or over-molded. Those with ordinary skill in the art will recognize that other means for creating the first, outer component may be utilized. An over-molded first, outer component is substantially neutral, in relation to stress loads, and therefore experiences a difference in forces required to produce successive snaps. The difference in forces produced by an over-molded first, outer component may facilitate the outer component in maintaining a neutral position and in snapping or rotating into the neutral position. However, an over-molded first, outer component may also resist rotation of the outer component away from the neutral position. An extruded first, outer component may have the ends produced thereby heat sealed together.
The cross-sectional profile of the second, outer ring 110 of the surgical retractor 100 may be reduced to increase the insertion angle for instruments being inserted therethrough. More particularly, the cross-sectional height and/or width of the second, outer ring may be reduced. This is particularly useful for body orifice retraction, such as rectal or vaginal retraction. The more the profile of the second, outer ring is reduced, the more difficult it becomes to roll the first, outer component of the outer ring about the second, inner component of the outer ring and a tool may be required to facilitate rolling the outer component about the inner component.
Referring again to the lumens 116, 118, 120 of the first, outer component 112 of the second, outer ring 110, the lumens may include other shapes, such as circular, polygonal, or other suitable shapes (not shown). Additionally, the first, middle lumen 116 may have detents, protuberances or other forms to interact with the second, inner component 114 of the second, outer ring 110. The second, inner component of the second, outer ring, such as the rigid wire 115, may also have detents, protrusions or other forms to interact with the first, middle lumen of the first, outer component. Both the middle lumen and rigid wire may have interacting detents, protrusions, notches or other forms. This interaction provides lock points that provide incremental rotation of the second, outer ring and retraction of the incision or body opening.
As indicated above, the first 112 and second 114 components of the second, outer ring 110 of the surgical retractor 100 may be coupled together with a monolithic coupler 130. Alternatively, the first 122 and second 124 ends of the first, outer component 112 of the second, outer ring 110 may be coupled together with at least one coupler (not shown). The at least one coupler may include a substantially longitudinal rod having a barb on each end (not shown). The at least one coupler for coupling the first and second ends of the first, outer component may include a first coupler and a second coupler. The first coupler couples the first and second ends of the second, top lumen 118 together in a snap-fit relationship while the second coupler couples the first and second ends of the third, bottom lumen 120 together in a snap-fit relationship. The couplers may be made of plastic or other suitable material. Similarly, the first and second pins on the first and second sides of the monolithic coupler base 132 may include barbs (not shown) to facilitate retention of the pins 138, 140 in the second and third lumens 118, 120 of the first, outer component 112 of the second, outer ring 110.
Referring to
As indicated above, the second, inner component 114 of the second, outer ring 110 may be made of a rigid wire 115 that is bent into a generally circular shape. The wire thickness for the rigid wire may be between about 0.25-12.70 mm (0.010-0500 inches) in diameter. The wire thickness may vary in correlation to the wound or body opening size and the device size. For example, the larger the wound or body opening size is, the larger the wire size is. The wire diameter can also correlate to the wire material. For example, as the hardness of the material of the wire is increased, the wire diameter may be reduced. One or more wires having differing lengths may be used and form a ring when bundled together. One or more wire segments, such as barrels, can be aligned from end to end within the lumen 116 of the first, outer component 112 to form a ring. The rigid wire may include one wire or more wires that may be bundled or bonded together. The wires may be braided or overlapped together. One or more wires may also be wound one or more times through the first, middle lumen 116 of the first, outer component 112 of the second, outer ring 110.
Referring to
In one aspect, the second 162 and/or third 164 wire includes a space between the first and second ends of the respective wire. When positioned within the second lumen 118 of the first, outer component 112 of the second, outer ring 110, the first end of the second wire is positioned proximate the first pin 138 protruding from the first face 134 of the monolithic coupler 130 and the second end of the second wire is positioned proximate the first pin 134 protruding from the second face 136 of the monolithic coupler. Likewise, when the third wire 164 is present in the third lumen 120, the first end of the third wire is positioned proximate the second pin 140 protruding from the first face 134 of the monolithic coupler 130 and the second end of the third wire is positioned proximate the second pin 140 protruding from the second face 136 of the monolithic coupler. In one aspect, the space between the first and second ends of the second 162 and/or third 164 wire is sufficient to permit the periphery of the second and/or third wire to contract to a smaller size when the respective wire is rolled inside the first wire 160 during rolling of the second, outer ring 110 without at least one of the first and second ends of the respective wire contacting the first 138 and/or second 140 pins of the monolithic coupler 130.
The second 162 and third 164 wires may be substantially identical to each other and have a wire thickness smaller than the wire thickness of the first wire 160 positioned in the first lumen 116 of the first, outer component 112 of the second, outer ring 110. More particularly, each of the second 162 and third 164 wires may have a wire thickness of about 0.25-6.35 mm (0.010-0.250 inches) in diameter Having a wire positioned in at least one of the second 118 and third 120 lumens of the first, outer component 112 of the second, outer ring 110 facilitates “snapping” of the outer ring when turning the outer ring and holds the outer ring substantially in the neutral position against high retraction forces.
The rigid wire 115 for the second, inner component 114 of the second, outer ring 110 may include a straight rigid wire. The straight rigid wire may be inserted into the first, middle lumen 116 of the first, outer component 112. When the ends 122, 124 of the first, outer component 112 of the second, outer ring 110 are joined, the wire 115 is forced to assume a substantially circular shape, placing the wire in a preloaded condition. The preloaded condition of the wire causes the wire to maintain a tendency to straighten out. The tendency of the wire to straighten out helps the second, outer ring 110 maintain a circular shape when the ends 122, 124 of the first, outer component 112 of the outer ring are joined.
The rigid wire 115 of the second, inner component of the second, outer ring may be bent and inserted into the first, middle lumen 116 of the first, outer component 112. As indicated above, the first 126 and second 128 ends of the rigid wire 115 may be coupled together by the monolithic coupler 130 or the ferrule 150. Alternatively, the first 126 and second 128 ends of the rigid wire 115 may be coupled together by other means, such as being welded, soldered, adhered or otherwise bonded together. Windows or cutouts may be provided in the first, outer component of the second, outer ring to facilitate the coupling of the first and second ends of the rigid wire together. Other means for coupling the first and second ends of the rigid wire of the second, inner component 114 of the second, outer ring 110 together include providing interlocks on the ends of the rigid wire. The interlocks may include notches, detents or other similar defects on the wire ends to create or increase the mechanical interlock of the wire ends. Ball and socket, opposing hooks, spring pins, or other interlock configurations may also be provided to lock the first and second ends of the wire together. Alternatively, in one aspect the first and second ends of the rigid wire may be left uncoupled.
The rigid wire 115 of the second, inner component 114 of the second, outer ring 110 may include straight end sections to prevent or reduce movement of the ferrule 150 relative to the ring. Notches, detents or other similar defects may be introduced on the wire ends to create or increase the mechanical interlock between the wire and the monolithic coupler 130 or the ferrule 150.
The second, inner component 114 of the second, outer ring 110 may include a pre-bent, continuous rigid ring 115. The first, outer component 112 of the second, outer ring 110 may include one or more slits extending from an external surface of the outer component to the first, middle lumen 116 of the outer component to facilitate insertion of the continuous rigid ring into the middle lumen. The slit may extend the entire length or periphery of the first, outer component, thereby permitting the continuous rigid ring to be inserted into the first, middle lumen of the outer component. With the second, inner component of the second, outer ring positioned in the first, middle lumen of the first, outer component of the outer ring, the slit may be closed through heat-sealing, adhesive, or by other bonding techniques that are well known in the art.
The rigid wire 115 of the second component 114 of the second, outer ring 110 may be positioned external and substantially adjacent the first component 112 of the outer ring and the first and second components may be stitched together (not shown). In this manner, the rigid wire is positioned off-center of the first component. With the rigid wire positioned off-center of the first, inner component of the second, outer ring, the diameter of the first, outer component of the outer ring may be expandable and/or contractible. The first component may be made of a soft material that allows the first component to stretch in tension and/or reduce in compression while being rotated about the rigid wire of the second component.
As stated above, the second, inner component 114 of the second, outer ring 110 may include a rigid wire 115 having its ends 126, 128 joined together with a ferrule 150. For example, each end of the wire may be inserted into the ferrule and the ferrule may be crimped in the center or on one or both ends of the ferrule. A center crimp, like an end crimp, prevents the ferrule from sliding around the wire and bonds the wire to the ferrule. The ends of the ring may be force fitted into the ferrule. The ferrule diameter corresponds to the diameter of the rigid wire. The ferrule diameter can vary. The generally curved rigid wire being forced into the generally straight ferrule causes the ferrule and wire to resist separation from each other.
The ferrule 150 may be made of 304 CRES and be TIG welded to the ring, however, those with ordinary skill in the art will recognize that other suitable materials and coupling means may be utilized. More particularly, the ferrule may be made of steel or other material that corresponds to the wire material. Welding the ferrule to the wire 115 may produce tighter tolerances for the diameter or perimeter of the wire relative to welding the ends 126, 128 of the wire together. Corresponding notches, detents or other similar defects may be introduced on the wire ends to create or increase the crimping or welding connection between the wire and the ferrule.
The length of the ferrules 150 may vary. For example, the ferrule may be similar in length and shape to the wire 115 with the wire extending through the lumen 156 of the ferrule. Those with ordinary skill in the art will recognize that other lengths and shapes may be used. A split (not shown) may be provided in the ferrule and positioned offset from the split in the wire. For example, the splits in the ferrule and wire can be positioned about 180° apart from each other. Again, those with ordinary skill in the art will recognize that the splits in the ferrule and wire may be offset at other positions.
Referring to
The first 220 and second 230 split hoops may be made of metals, such as stainless steel, piano wire heat treated to a spring temper, or other metals that produce a substantially noncompliant hoop. The first and second split hoops may also be formed of rigid polymeric materials through molding, machining, and other processes that are well known in the art. The substantially noncompliant split hoops may also be formed of other suitable rigid materials that are well known in the art.
The spacing between the first 216 and second 218 lumens of the first, outer component 212 of the second, outer ring 210 and the cross-sectional size of the first 220 and second 230 split hoops of the second, inner component 214 of the outer ring positioned within the first and second lumens dictates the effectiveness of the surgical retractor. During use, the second, outer ring of the surgical retractor 200 is rolled down by forcing one of the split hoops open, thereby causing a space between the first and second ends of the hoop, and around the other split hoop. In this manner, one of the rigid split hoops works as an axle or center of rotation for the other split hoop. By placing the two split hoops further apart or by increasing the strength of the split hoops, greater force is required to rotate the second, outer ring of the surgical retractor. The spacing between the first and second lumens and the cross-sectional size of the first and second split hoops may, therefore, be selected for a desired balance between the force required to rotate the second, outer ring against the tendency of the outer ring to unroll because of the force imparted on the outer ring by a retracted incision or body opening.
The cross-sectional diameter of the first 220 and second 230 split hoops may vary depending on the cross-section of the first outer component 212 of the second, outer ring 210 and on the size of the incision or body opening to be retracted. In one aspect, for incisions 5-9 cm in length, 30 mm diameter wire may be utilized. Each of the first and second hoops may be made of a wire having a thickness of about 0.25-6.35 mm (0.010-0.250 inches) in diameter.
The first 220 and second 230 split hoops of the second, inner component 214 of the second, outer ring 210 of the surgical retractor 200 may be formed of, for example, full-hard temper wire and to a peripheral size that is smaller than that which the first, outer component 212 of the outer ring would force the first and second split hoops into. In this manner, the first, outer component 212 of the second, outer ring 210 is held closed and the first 220 and second 230 split hoops control the orientation of the outer component during use. To attain a peripheral size of the first 220 and second 230 split hoops that is smaller than that which the first, outer component 212 of the second, outer ring 210 would force upon the first and second split hoops, the split hoops may be formed with first and second end portions of each of the split hoops overlapping each other. In one aspect, the materials of which the first, outer component 212 of the second, outer ring 210 is made, combined with the size of the first 216 and second 218 lumens of the outer component, do not permit the first and second end portions of the split hoops to overlap each other within the lumens. When the first 220 and second 230 split hoops are assembled with the first, outer component 212 of the second, outer ring 210, the overlap between the end portions of the first and second split hoops is removed and the first and second ends of each of the split hoops substantially abut each other with a spring force that causes the second, outer ring to remain closed. In this manner, the first 220 and second 230 split hoops facilitate stability of the second, outer ring 210 so that the cross-section of the first, outer component 212 remains vertical at 0° and 180° orientations, thereby facilitating the attachment of a cap 302 (
Since each of the first 220 and second 230 split hoops has substantially abutting first and second ends, each of the split hoops functions as an axle about which the first, outer component 212 may turn for half a rotation, or 180°. More particularly, the second, outer ring 210 may be rolled such that the first split hoop 220 is rolled outside the second split hoop 230 with the periphery of the first split hoop expanding to clear the second split hoop. With continued rolling of the second, outer ring 210, the second split hoop 230 may be rolled outside the first split hoop 220 with the periphery of the second split hoop expanding to clear the first split hoop. These steps may be repeated until the incision or body opening is retracted to the desired degree.
In one aspect, the first split hoop 220 of the second, inner component 214 of the second, outer ring 210 may include a space (not shown) positioned between the first and second ends of the first split hoop, while the first and second ends of the second split hoop 230 may substantially abut each other. When the first split hoop 220 is rolled inside the second split hoop 230 during rolling of the second, outer ring 210, the first split hoop contracts, thereby reducing the space between the first and second ends of the first split hoop and reducing the perimeter of the first split hoop to a size smaller than the second split hoop. With the perimeter of the first split hoop 220 reduced, the first split hoop may roll through the second split hoop 230. In one aspect, each of the first 220 and second 230 split hoops may include a space positioned between the first and second ends of the respective split hoop. The first 220 and second 230 split hoops are positioned within the first 216 and second 218 lumens, respectively, of the first, outer component 212 of the second, outer ring 210 with the space in the first split hoop circumferentially offset from the space in the second split hoop to substantially prevent having a weak or collapsing section of the second, outer ring of the surgical retractor 200. When the first split hoop 220 is rolled inside the second split hoop 230 during rolling of the second, outer ring 210, the first split hoop contracts and the second split hoop expands. Likewise, when the second split hoop 230 is rolled inside the first split hoop 220, the second split hoop contracts and the first split hoop expands. With each of the first 220 and second 230 split hoops having a space between respective first and second ends, during rolling of the second, outer ring 210 the axis of rotation is between the first and second split hoops, or between the first 216 and second 218 lumens.
The second, outer ring 210 of the surgical retractor 200 may be formed by transforming an extruded elastomeric tube into a circular ring by placing the first 220 and second 230 split hoops into the first 216 and second 218 lumens of the first, outer component 212 of the outer ring. This is accomplished by inserting one of the first and second ends of the first split hoop 220 into the first lumen 216 of the first, outer component 212 and inserting one of the first and second ends of the second split hoop 230 into the second lumen 218 of the first, outer component. Each of the first 220 and second 230 split hoops is continually fed into the respective lumen 216, 218 until each of the split hoops is substantially entirely within the respective lumen. The first, outer component 212 takes on the shape of the split hoops 220, 230 positioned in the first 216 and second 218 lumens thereof.
It is appreciated that the first, outer component 212 of the surgical retractor 200 can be designed in various configurations and sizes to achieve various retraction rates and/or to conform to different body surfaces. The first 216 and second 218 lumens may have cross-sections of different geometries, such as circular, oval, triangular, rectangular, any geometric shape with multiple sides, etc. The first 220 and second 230 split hoops may also have cross-sections of different geometries, such as circular, rectangular, oval, triangular, any geometric shape with multiple sides, etc. Advantages of the above embodiments of the invention include improved retraction adjustability and stability.
The footprint of the second, outer ring 210 can be symmetrical or non-symmetrical and can vary in size and shape, such as a circle, ellipse or other suitable shape, to conform to a body type, position or size and thereby increase the working space or reduce potential interference with other instruments or ports during the laparoscopic procedure. In one aspect, the first, outer component 212 can be formed in a Mobius shape by twisting the first end of the first, outer component of the second, outer ring 180° relative to the second end of the first, outer component and joining the first and second ends together. In this manner, the first lumen 216 at the first end of the first, outer component 212 of the second, outer ring 210 couples to the second lumen 218 at the second end of the outer component of the outer ring, and the second lumen at the first end of the first, outer component of the second, outer ring couples to the first lumen at the second end of the outer component of the outer ring.
In one aspect, the second, outer ring 210 of the surgical retractor 200 may include an oval footprint. The first, inner ring 202 of the surgical retractor may also include an oval footprint. During use, the oval outer ring 210 can be set either perpendicular to the incision or parallel to the incision. An oval outer ring may have a substantially circular cross-section, or other substantially neutral cross-section. With the second, outer ring having an oval footprint, the sleeve 206 will not unravel from the outer ring 210 following winding of the sleeve around the outer ring. The straight portions of the oval outer ring can include handlebar-type grips for winding the sleeve.
Referring to
Referring to
Referring to
The gel cap 302 maintains pneumoperitoneum during multiple hand and/or instrument exchanges and is configured to substantially prevent unintentional loss of pneumoperitoneum. The gel cap 302 also provides substantially continuous access and visibility. The gel cap 302 includes a small profile for limited body cavity space.
In one aspect, to combine the gel pad 306 with the cap ring 304, the cap ring may be placed into a mold that includes the shape of the desired gel pad and uncured gel is added to the mold. Referring to
In one aspect, the distal portion 314 of the cap ring 304 may be substantially cylindrical and configured to receive the outer ring 110 of the surgical retractor 100. In one aspect, the distal portion 314 of the cap ring 304 includes a lip 324 at the distal end 326 thereof (see
In one aspect, the distal portion 314 of the cap ring 304 also includes a swinging lever 330 (
In a first, open state (
The gel cap facilitates simple and rapid set-up. In use, the surgical retractor 100 is first used to retract the incision in the body wall of a patient, as described above. With the lever 330 in the first state, the gel cap 302 is brought to the outer ring 110 of the surgical retractor 100 at an angle with the lip portion 324 of the cap ring 304 toward the patient. The lip portion 324 of the cap ring is slid under the first, outer component of the outer ring 110, between the outer ring and the patient, and then the remainder of the gel cap 302 is swung onto the outer ring. The lever 330 is then swung closed into the second state (
The lever 330 includes locking means 354 (
With the gel cap 302 mounted onto the outer ring 110 of the surgical retractor 100 and the lever 330 positioned in the second state, the proximal lip 348 on the lever positioned in the aperture 352 in the cap ring 304 provides support for the lever to counteract cantilever forces induced by the displaced gel of the gel pad 306. Support of the proximal lip 348 also helps the distal lip 344 maintain the position of the outer ring 110 of the surgical retractor 100 against the gel pad 306.
In another aspect, the gel cap 302 may include more than one lever 330 with the levers substantially equally spaced between each other and the lip 324 on the cap ring 304. In a further aspect, the lip 324 on the cap ring 304 may be omitted and at least two levers 330 used to secure the gel cap 302 to the surgical retractor 100. The at least two levers 330 may be substantially equally spaced about the periphery of the distal portion of the cap ring.
The gel cap 302 with the lip 324 and lever 330 on the cap ring is best suited for use with surgical retractors 100 having an outer ring 110 that is substantially rigid and noncompliant. If the outer ring 110 of the surgical retractor 100 were not rigid, the outer ring may tend to pull out of the gel cap 302, thereby compromising the seal between the gel pad 306 and the surgical retractor and potentially resulting in deflation of the insufflated body cavity.
The cap ring 304 in one aspect includes a polymer, e.g., polyethylene (PE). In one aspect, the polyethylene is a low density polyethylene (LDPE) or high density polyethylene (HDPE), or ultra high molecular weight polyethylene (UHMWPE). In one aspect, the cap ring 304 may be made of a polymer, such as polycarbonate and may be fabricated by methods including injection molding.
The gel pad 306 may be coupled to, attached to, formed or integrated with the cap ring 304 so that a gas-tight conduit is formed between the cap ring and the sleeve 106. The gel pad 306 covers and seals the entire opening in the cap ring 304. Additionally, in one aspect the gel pad 306 is adapted to cover substantially the entire wound 400 opening or body opening. As stated above, in one aspect the gel pad includes a plurality of intersecting dead-end slits 360, 362 that form an access portion or passage through the gel pad 306. The gel pad 306 provides a gas tight seal around a variety of shapes and sizes of hands or instruments inserted therethrough.
In one aspect, the gel material from which the gel pad 306 is made is an elastomeric gel. Some such gels have been described in U.S. patent application Ser. No. 10/381,220, filed Mar. 20, 2003, the disclosure of which is hereby incorporated by reference as if set forth in full herein. The gel can be prepared by mixing a triblock copolymer with a solvent for the midblocks. The endblocks are typically thermoplastic materials, such as styrene, and the midblocks are thermoset elastomers such as, ethylene/butylene, isoprene or butadiene; e.g., Styrene-Ethylene/Butylene-Styrene (SEBS), Styrene-Isoprene-Styrene (SIS), Styrene-Butadiene-Styrene (SBS). In one aspect, the solvent used is mineral oil. Upon heating this mixture or slurry, the midblocks are dissolved into the mineral oil and a network of the insoluble endblocks forms. The resulting network has enhanced elastomeric properties over the parent copolymer. In one aspect, the triblock copolymer used is KRATON G1651, which has a styrene to rubber ratio of 33167 Once formed, the gel is substantially permanent and, by the nature of the endblocks, processable as thermoplastic elastomers henceforward. The mixture or slurry has a minimum temperature at which it becomes a gel, i.e., the minimum gelling temperature (MGT). This temperature, in one aspect, corresponds to the glass transition temperature of the thermoplastic endblock plus a few degrees. For example, the MGT for the mixture of KRATON G1651 and mineral oil is about 120° C. When the slurry reaches the MGT and the transformation to a gel state takes place, the gel becomes more transparent, thereby providing means for visually confirming when the transformation of the slurry to the gel state is substantially complete and that the gel may be cooled. In addition to triblocks, there are also diblock versions of the materials that may be used where Styrene is present at only one end of the formula, for example, Styrene-Ethylene/Butylene (SEB).
For a given mass of slurry to form into a complete gel, the entire mass of the slurry is heated to the MGT and remains heated at the MGT for sufficient time for the end blocks to form a matrix of interconnections. The slurry will continue to form into gel at temperatures above the MGT until the slurry/gel reaches temperatures at which the components within the slurry/gel begin to decompose or oxidize. For example, when the slurry/gel is heated at temperatures above 250° C., the mineral oil in the slurry/gel will begin to be volatile and oxidize. Oxidizing may cause the gel to turn brown and become oily.
The speed at which a given volume of slurry forms a gel is dependant on the speed with which the entire mass of slurry reaches the MGT. Also, with the application of temperatures higher than the MGT, this speed is further enhanced as the end block networks distribute and form more rapidly.
The various base formulas may also be alloyed with one another to achieve a variety of intermediate properties. For example, KRATON G1701X is a seventy percent (70%) SEB thirty percent (30%) SEBS mixture with an overall Styrene to rubber ratio of 28/72. It can be appreciated that an almost infinite number of combinations, alloys, and Styrene to rubber ratios can be formulated, each capable of providing advantages to a particular embodiment of the invention. These advantages will typically include low durometer, high elongation, and good tear strength.
It is contemplated that the gel material may also include silicone, soft urethanes and even harder plastics that might provide the desired sealing qualities with the addition of a foaming agent. The silicone material may be of the types currently used for electronic encapsulation. The harder plastics may include PVC, Isoprene, KRATON neat, and other KRATON/oil mixtures. In the KRATON/oil mixture, oils such as vegetable oils, petroleum oils and silicone oils may be substituted for the mineral oil.
Any of the gel materials contemplated could be modified to achieve different properties such as enhanced lubricity, appearance, and wound protection. Additives may be incorporated directly into the gel or applied as a surface treatment. Other compounds may be added to the gel to modify its physical properties or to assist in subsequent modification of the surface by providing bonding sites or a surface charge. Additionally, oil based colorants may be added to the slurry to create gels of different colors.
In one aspect, the mixture/slurry used with the various embodiments of the cap rings that are described herein are composed of about ninety percent (90%) by weight of mineral oil and about ten percent (10%) by weight of KRATON G1651. From a thermodynamic standpoint, this mixture behaves similar to mineral oil. Mineral oil has a considerable heat capacity and, therefore, at about 130° C. it can take three (3) or four (4) hours to heat a pound of the slurry sufficiently to form a homogeneous gel. Once formed, the gel can be cooled as quickly as practicable with no apparent deleterious effects on the gel. This cooling, in one aspect, is accomplished with cold-water immersion. In another aspect, the gel may be air-cooled. Those with ordinary skill in the art will recognize that other cooling techniques that are well known in the art may be employed and are contemplated as within the scope of the present invention.
Many of the properties of the KRATON/oil mixture will vary with adjustments in the weight ratio of the components. In general, the greater the percentage of mineral oil the less firm the mixture; the greater the percentage of KRATON, the more firm the mixture. If the resultant gel is too soft it can lead to excessive tenting or doming of the gel cap during surgery when a patient's abdominal cavity is insufflated. Excessive tenting or doming may cause the slits 360, 362 to open, providing a leak path. Additionally, if the gel is too soft it might not provide an adequate seal. However, the gel should be sufficiently soft to be comfortable for the surgeon while simultaneously providing good sealing both in the presence of an instrument and in the absence of an instrument.
If the slurry is permitted to sit for a prolonged period of time, the copolymer, such as KRATON, and the solvent, such as mineral oil, may separate. The slurry may be mixed, such as with high shear blades, to make the slurry more homogeneous. However, mixing the slurry may introduce or add air to the slurry. To remove air from the slurry, the slurry may be degassed. In one aspect, the slurry may be degassed in a vacuum, such as within a vacuum chamber. In one aspect, the applied vacuum may be 0.76 meters (29.9 inches) of mercury, or about one (1.0) atmosphere. The slurry may be stirred while the slurry is under vacuum to facilitate removal of the air During degassing within a vacuum, the slurry typically expands, then bubbles, and then reduces in volume. The vacuum may be discontinued when the bubbling substantially ceases. Degassing the slurry in a vacuum chamber reduces the volume of the slurry by about ten percent (10%). Degassing the slurry helps reduce the potential of the finished gel to oxidize.
Degassing the slurry tends to make the resultant gel firmer. A degassed slurry composed of about 91.6% by weight of mineral oil and about 8.4% by weight of KRATON G1651, an eleven-to-one ratio, results in a gel having about the same firmness as a gel made from a slurry that is not degassed and that is composed of about ninety percent (90%) by weight of mineral oil and about ten percent (10%) by weight of KRATON G1651, a nine-to-one ratio.
Mineral oil is of a lighter density than KRATON and the two components will separate after mixing, with the lighter mineral oil rising to the top of the container. This separation may occur when attempting to form static slurry into gel over a period of several hours. The separation can cause the resulting gel to have a higher concentration of mineral oil at the top and a lower concentration at the bottom, e.g., a non-homogeneous gel. The speed of separation is a function of the depth or head height of the slurry being heated. The mass of slurry combined with the head height, the temperature at which the gel sets and the speed with which the energy can be transferred to the gel, factor into the determination or result of homogeneous gel versus a non-homogeneous gel.
The gel pad or gel cap in various aspects of the present invention may be gamma sterilized. The relative or comparative simplicity of qualifying the sterilization process, for example of gamma versus ethylene oxide, of the gel pad and the device with the gel pad is desirable. However, under gamma sterilization large bubbles can form in the gel pad causing potential cosmetic or aesthetic issues in the sterilized devices. The bubbles are more than ninety-nine percent (99%) room air, so removal of the dissolved air in the slurry is performed prior to forming the slurry into gel. For example, the slurry may be degassed via vacuum, as described above, and turned into gel by heat. Bubbles may still form in the gel during gamma sterilization but disappear in a period of about twenty-four (24) to seventy-two (72) hours. In one aspect, the percentage of dissolved gas in the mineral oil at room temperature is about ten percent (10%). The removal of the air in the gel has an additional effect of making the gel firmer. This however is counterbalanced by the softening effect on the gel caused by gamma radiation during gamma sterilization.
If the gel pad is to be gamma sterilized, the gel may include about ninety percent (90%) mineral oil by weight and about ten percent (10%) KRATON by weight. As stated above, degassing the slurry has the effect of making the gel firmer. However, the gamma radiation softens the gel to substantially the same firmness as a gel having about ninety percent (90%) mineral oil by weight and about ten percent (10%) KRATON by weight that is not degassed and gamma sterilized.
In one aspect, cyanoacrylate, e.g., SUPERGLUE or KRAZY GLUE, may be used to bond or otherwise couple or attach the gel pad 306 to the cap ring 304. The adhesive may attach to either the rubber or styrene component of the tri-block and the bond is frequently stronger than the gel material itself. In another aspect, a solvent may be used to dissolve the plastics in the cap ring and the polystyrene in the gel pad. The solution of solvent is applied to the gel pad and cap ring in either a spray or dip form. In effect, the solution melts both the plastic of the cap ring as well as the polystyrene in the gel pad to allow a chemical bond to form between the two, which remains when the solvent evaporates.
Polyethylene can be dissolved in mineral oil and then applied to the gel pad. The mineral oil will not evaporate but will over time absorb into the gel pad and impart a polyethylene layer on the gel pad that may have some beneficial properties.
In one aspect, the gel pad 306 is cast into a DYNAFLEX or KRATON polymer support structure, e.g., the cap ring 304. By using KRATON polymer or a similar material in the cap ring, ring adhesion between the gel pad 306 and the cap ring 304 can be achieved. The polystyrene in the gel pad 306 is identified as achieving adhesion with polyphenylene oxide (PPO), polystyrene and other polymers.
In the casting process, the gel pad 306 and the cap ring 304 are heated to a temperature above about 130° C. and held at that temperature for several hours, e.g., about three (3) to four (4) hours. The temperature used is not sufficient to deform the cap ring 304.
As stated above, in one aspect the cap ring 304 includes a polymer, e.g., polyethylene (PE). The gel includes mineral oil PE has a higher molecular weight than mineral oil PE is dissolved by mineral oil at high temperatures. As such, as the PE in the cap ring 304 and the mineral oil in the gel pad 306 intermix as both are heated to and held at temperatures above about 130° C., a bond between the PE and gel pad is formed.
In one aspect, the cap ring 304 includes polycarbonate. The polycarbonate of the cap ring 304 does not form bonds with the gel pad 306 at 130° C. However, by raising the temperature to about 150° C. for a few minutes during casting, bonding occurs between the gel pad 306 and the cap ring 304. As such, heating the gel pad 306 and cap ring 304 to temperatures at which both the polystyrene of the gel and the polycarbonate are simultaneously beyond their melt points allows bonds to form between the gel pad and the cap ring. Alternatively, the gel pad 306 and cap ring 304 may be heated to near or at the glass transition temperature of the polycarbonate cap ring to form the bond between the gel pad and the cap ring.
In one aspect, casting the gel pad 306 into the cap ring 304 to form a gel cap 302 includes placing the cap ring into a mold cavity of a casting mold. The mold cavity may include support for the annular walls of the cap ring 304. The mold may be made of aluminum, copper, brass, or other mold material having good heat dissipation properties. However, those with ordinary skill in the art will recognize that other mold materials having lower heat dissipation properties will produce acceptable parts and these are contemplated as within the scope of the present invention as well.
The mold cavity having the cap ring 304 is filled with the slurry such that the slurry is in contact with the cap ring. To facilitate filling voids in the mold cavity with the slurry, the slurry may be preheated, for example, to about 52° C. (125° F.) Preheating the slurry to a temperature below the MGT reduces the viscosity of the slurry and allows the slurry to flow more easily. As stated above, the slurry may have been degassed in a vacuum. The slurry may be degassed again within the mold after the mold cavity is filled to remove air that may have been introduced during the filling of the mold cavity and to facilitate flow of the slurry into voids in the mold. Heat is applied to the mold having the cap ring 304 and the slurry, such as in an oven, until the slurry attains a temperature of about 150° C. As stated above, the slurry turns into gel at about 120° C., however, at about 150° C., the gel can bond to a polycarbonate cap ring 304. Depending on the material used to fabricate the cap ring 304, bonding may take place at temperatures other than about 150° C. If the cap ring 304 is fabricated of a material having a lower melting point than 120° C., then the gel pad 306, such as a gel slug 306, may be molded separately and then bonded to the cap ring. The slits 360, 362 may be molded into the gel pad 306 through the use of an insert in the form of the slit in the mold.
Once the temperature of the gel pad 306 reaches about 150° C., the gel cap 302 may be cooled, such as by air-cooling, cold-water immersion, or other cooling means that are well known in the art. At 150° C. the gel pad is soft and if it were distorted during cooling it would set with the distortion included. To reduce the likelihood of distorting the gel pad 306, the gel cap 302 may be cooled within the mold. Cooling times may vary based on parameters including size and configuration of the mold, quantity of gel, temperature and quantity of cooling medium, cooling medium properties and the mold material. As an example, the cooling time may be about two (2) hours if cooling in air and about fifteen (15) minutes if cooling in water. Whether cooling with air or water, the final properties of the gel are substantially the same. The gel cap 302 is typically cooled to about ambient room temperature, but may be cooled to lower temperatures. If the gel cap 302 is cooled to about 0° C., then the gel will harden. This may be beneficial for other means of coupling the gel pad 306 to the cap ring 304, such as with a secondary operation. The gel cap 302 may be removed from the mold at any time after the gel has set.
When removed from the mold, the gel pad 306 typically has a tacky surface. The gel cap 302 may be coated with a powder, such as cornstarch, to substantially reduce or eliminate the tackiness of the cured gel pad 306.
As stated above, in another aspect, the gel pad 306 may be molded separately from the cap ring 304 and coupled to the cap ring by a secondary operation, such as by bonding. In one aspect, the gel pad 306 may be molded into a gel slug 306 having an outer perimeter smaller than the inner cylindrical wall of the cap ring 304 and to a height higher than the height of the cap ring. Since the gel pad 306 is being molded separate from the cap ring 304, the slurry only needs to be heated until it reaches about 120° C. and completes the transformation from slurry into gel and the gel becomes substantially transparent. The gel slug 306 may then be placed within the inner cylindrical wall of the cap ring 304. The gel slug 306 may be cooled, such as to about 0° C., prior to placing it within the inner cylindrical wall of the cap ring 304. The gel slug 306 may be coupled to the cap ring 304 through compression molding with the gel slug being compressed longitudinally so that the outer perimeter of the gel slug expands and compresses against the inner cylindrical wall of the cap ring. The gel slug 306 and cap ring 304 are heated to a sufficient temperature for the polystyrene of the gel and the polymer of the cap ring to form bonds between the gel and the cap ring. Molding the gel slug 306 separately from the cap ring 304 and heat bonding the gel slug to the cap ring at a later time is especially useful when the cap ring is made of a material that has a lower melting temperature than the MGT. In such situations, the gel slug 306 can be molded first and heat bonded to the cap ring 304 without melting the cap ring.
An advantage associated with the surgical access device is it enables a surgeon to quickly retract and protectively line an abdominal wall incision while being able to easily accommodate variations in abdominal wall thickness between patients. In addition, the device effectively seals around the interior and exterior of the incision, and allows a sealing cap to be coupled to the device to seal the abdominal cavity and to enable a laparoscopic procedure to be performed.
Many alterations and modifications may be made by those having ordinary skill in the art without departing from the spirit and scope of the invention. For these reasons, the above description should not be construed as limiting the invention, but should be interpreted as merely exemplary of the embodiments.
This application claims the benefits of and priority to U.S. Provisional Patent Application No. 60/917,580, filed on May 11, 2007, the disclosure of which is hereby incorporated by reference as if set forth in full herein.
| Number | Name | Date | Kind |
|---|---|---|---|
| 558364 | Doolittle | Apr 1896 | A |
| 1157202 | Bates et al. | Oct 1915 | A |
| 1598284 | Kinney | Aug 1926 | A |
| 1690995 | Pratt | Nov 1928 | A |
| 1180466 | Deutsch | Jun 1931 | A |
| 1810466 | Deutsch | Jun 1931 | A |
| 2219564 | Reyniers | Oct 1940 | A |
| 2305289 | Coburg | Dec 1942 | A |
| 2478586 | Krapp | Aug 1949 | A |
| 2669991 | Curutchet | Feb 1954 | A |
| 2695608 | Gibbon | Nov 1954 | A |
| 2812758 | Blumenschein | Nov 1957 | A |
| 2835253 | Borgeson | May 1958 | A |
| 2853075 | Hoffman et al. | Sep 1958 | A |
| 3039468 | Price | Jun 1962 | A |
| 3057350 | Cowley | Oct 1962 | A |
| 3111943 | Orndorff | Nov 1963 | A |
| 3195934 | Parrish | Jul 1965 | A |
| 3244169 | Baxter | Apr 1966 | A |
| 3253594 | Matthews et al. | May 1966 | A |
| 3313299 | Spademan | Apr 1967 | A |
| 3329390 | Hulsey | Jul 1967 | A |
| 3332417 | Blanford et al. | Jul 1967 | A |
| 3347226 | Harrower | Oct 1967 | A |
| 3347227 | Harrower | Oct 1967 | A |
| 3397692 | Creager, Jr. et al. | Aug 1968 | A |
| 3402710 | Paleschuck | Sep 1968 | A |
| 3416520 | Creager, Jr. | Dec 1968 | A |
| 3447533 | Spicer | Jun 1969 | A |
| 3522800 | Lesser | Aug 1970 | A |
| 3523534 | Nolan | Aug 1970 | A |
| 3570475 | Weinstein | Mar 1971 | A |
| 3656485 | Robertson | Apr 1972 | A |
| 3685786 | Woodson | Aug 1972 | A |
| 3717151 | Collett | Feb 1973 | A |
| 3717883 | Mosher | Feb 1973 | A |
| 3729006 | Wilder et al. | Apr 1973 | A |
| 3782370 | McDonald | Jan 1974 | A |
| 3797478 | Walsh et al. | Mar 1974 | A |
| 3799166 | Marsan | Mar 1974 | A |
| 3807393 | McDonald | Apr 1974 | A |
| 3828764 | Jones | Aug 1974 | A |
| 3831583 | Edmunds, Jr. et al. | Aug 1974 | A |
| 3841332 | Treacle | Oct 1974 | A |
| 3850172 | Cazalis | Nov 1974 | A |
| 3853126 | Schulte | Dec 1974 | A |
| 3853127 | Spademan | Dec 1974 | A |
| 3856021 | McIntosh | Dec 1974 | A |
| 3860274 | Ledstrom et al. | Jan 1975 | A |
| 3861416 | Wichterle | Jan 1975 | A |
| 3907389 | Cox et al. | Sep 1975 | A |
| 3915171 | Shermeta | Oct 1975 | A |
| 3965890 | Gauthier | Jun 1976 | A |
| 3970089 | Saice | Jul 1976 | A |
| 3996623 | Kaster | Dec 1976 | A |
| 4000739 | Stevens | Jan 1977 | A |
| 4016884 | Kwan-Gett | Apr 1977 | A |
| 4024872 | Muldoon | May 1977 | A |
| 4030500 | Ronnquist | Jun 1977 | A |
| 4043328 | Cawood, Jr. et al. | Aug 1977 | A |
| 4069913 | Harrigan | Jan 1978 | A |
| 4082005 | Erdley | Apr 1978 | A |
| 4083370 | Taylor | Apr 1978 | A |
| 4096853 | Weigand | Jun 1978 | A |
| 4112932 | Chiulli | Sep 1978 | A |
| 4130113 | Graham | Dec 1978 | A |
| 4177814 | Knepshield et al. | Dec 1979 | A |
| 4183357 | Bentley et al. | Jan 1980 | A |
| 4187849 | Stim | Feb 1980 | A |
| 4188945 | Wenander | Feb 1980 | A |
| 4217664 | Faso | Aug 1980 | A |
| 4222126 | Boretos et al. | Sep 1980 | A |
| 4228792 | Rhys-Davies | Oct 1980 | A |
| 4239036 | Krieger | Dec 1980 | A |
| 4240411 | Hosono | Dec 1980 | A |
| 4253201 | Ross et al. | Mar 1981 | A |
| 4254973 | Benjamin | Mar 1981 | A |
| 4306562 | Osborne | Dec 1981 | A |
| 4321915 | Leighton et al. | Mar 1982 | A |
| 4331138 | Jessen | May 1982 | A |
| 4338934 | Spademan | Jul 1982 | A |
| 4338937 | Lerman | Jul 1982 | A |
| 4367728 | Mutke | Jan 1983 | A |
| 4369284 | Chen | Jan 1983 | A |
| 4399816 | Spangler | Aug 1983 | A |
| 4402683 | Kopman | Sep 1983 | A |
| 4411659 | Jensen et al. | Oct 1983 | A |
| 4421296 | Stephens | Dec 1983 | A |
| 4424833 | Spector et al. | Jan 1984 | A |
| 4428364 | Bartolo | Jan 1984 | A |
| 4430081 | Timmermans | Feb 1984 | A |
| 4434791 | Darnell | Mar 1984 | A |
| 4436519 | O'Neill | Mar 1984 | A |
| 4454873 | Laufenberg et al. | Jun 1984 | A |
| 4473067 | Schiff | Sep 1984 | A |
| 4475548 | Muto | Oct 1984 | A |
| 4485490 | Akers et al. | Dec 1984 | A |
| 4488877 | Klein et al. | Dec 1984 | A |
| 4543088 | Bootman et al. | Sep 1985 | A |
| 4550713 | Hyman | Nov 1985 | A |
| 4553537 | Rosenberg | Nov 1985 | A |
| 4555242 | Saudagar | Nov 1985 | A |
| 4556996 | Wallace | Dec 1985 | A |
| 4601710 | Moll | Jul 1986 | A |
| 4610665 | Matsumoto et al. | Sep 1986 | A |
| 4626245 | Weinstein | Dec 1986 | A |
| 4634424 | O'Boyle | Jan 1987 | A |
| 4634432 | Kocak | Jan 1987 | A |
| 4644951 | Bays | Feb 1987 | A |
| 4649904 | Krauter et al. | Mar 1987 | A |
| 4653476 | Bonnet | Mar 1987 | A |
| 4654030 | Moll et al. | Mar 1987 | A |
| 4655752 | Honkanen et al. | Apr 1987 | A |
| 4673393 | Suzuki et al. | Jun 1987 | A |
| 4673394 | Fenton, Jr. et al. | Jun 1987 | A |
| 4691942 | Ford | Sep 1987 | A |
| 4714749 | Hughes et al. | Dec 1987 | A |
| 4738666 | Fuqua | Apr 1988 | A |
| 4755170 | Golden | Jul 1988 | A |
| 4760933 | Christner et al. | Aug 1988 | A |
| 4776843 | Martinez et al. | Oct 1988 | A |
| 4777943 | Chvapil | Oct 1988 | A |
| 4784646 | Feingold | Nov 1988 | A |
| 4796629 | Grayzel | Jan 1989 | A |
| 4798594 | Hillstead | Jan 1989 | A |
| 4802694 | Vargo | Feb 1989 | A |
| 4808168 | Warring | Feb 1989 | A |
| 4809679 | Shimonaka et al. | Mar 1989 | A |
| 4828554 | Griffin | May 1989 | A |
| 4842931 | Zook | Jun 1989 | A |
| 4848575 | Nakamura et al. | Jul 1989 | A |
| 4856502 | Ersfeld et al. | Aug 1989 | A |
| 4863430 | Klyce et al. | Sep 1989 | A |
| 4863438 | Gauderer et al. | Sep 1989 | A |
| 4889107 | Kaufman | Dec 1989 | A |
| 4895565 | Hillstead | Jan 1990 | A |
| 4897081 | Poirier et al. | Jan 1990 | A |
| 4903710 | Jessamine et al. | Feb 1990 | A |
| 4911974 | Shimizu et al. | Mar 1990 | A |
| 4915132 | Hodge et al. | Apr 1990 | A |
| 4926882 | Lawrence | May 1990 | A |
| 4929235 | Merry et al. | May 1990 | A |
| 4944732 | Russo | Jul 1990 | A |
| 4950222 | Scott et al. | Aug 1990 | A |
| 4950223 | Silvanov | Aug 1990 | A |
| 4984564 | Yuen | Jan 1991 | A |
| 4991593 | LeVahn | Feb 1991 | A |
| 4998538 | Charowsky et al. | Mar 1991 | A |
| 5000745 | Guest et al. | Mar 1991 | A |
| 5009224 | Cole | Apr 1991 | A |
| 5015228 | Columbus et al. | May 1991 | A |
| 5019101 | Purkait et al. | May 1991 | A |
| 5026366 | Leckrone | Jun 1991 | A |
| 5037379 | Clayman et al. | Aug 1991 | A |
| 5041095 | Littrell | Aug 1991 | A |
| 5045070 | Grodecki et al. | Sep 1991 | A |
| D320658 | Quigley et al. | Oct 1991 | S |
| 5071411 | Hillstead | Dec 1991 | A |
| 5073169 | Raiken | Dec 1991 | A |
| 5074878 | Bark et al. | Dec 1991 | A |
| 5082005 | Kaldany | Jan 1992 | A |
| 5086763 | Hathman | Feb 1992 | A |
| 5092846 | Nishijima et al. | Mar 1992 | A |
| 5104389 | Deem et al. | Apr 1992 | A |
| 5125396 | Ray | Jun 1992 | A |
| 5125897 | Quinn et al. | Jun 1992 | A |
| 5127626 | Hilal et al. | Jul 1992 | A |
| 5129885 | Green et al. | Jul 1992 | A |
| 5141498 | Christian | Aug 1992 | A |
| 5149327 | Oshiyama | Sep 1992 | A |
| 5156617 | Reid | Oct 1992 | A |
| 5158553 | Berry et al. | Oct 1992 | A |
| 5159921 | Hoover | Nov 1992 | A |
| 5161773 | Tower | Nov 1992 | A |
| 5167636 | Clement | Dec 1992 | A |
| 5167637 | Okada et al. | Dec 1992 | A |
| 5176648 | Holmes et al. | Jan 1993 | A |
| 5176662 | Bartholomew et al. | Jan 1993 | A |
| 5176697 | Hasson et al. | Jan 1993 | A |
| 5178162 | Bose | Jan 1993 | A |
| 5180365 | Ensminger et al. | Jan 1993 | A |
| 5183471 | Wilk | Feb 1993 | A |
| 5188595 | Jacobi | Feb 1993 | A |
| 5188607 | Wu | Feb 1993 | A |
| 5192301 | Kamiya et al. | Mar 1993 | A |
| 5197955 | Stephens et al. | Mar 1993 | A |
| 5207656 | Kranys | May 1993 | A |
| 5209737 | Rirchart et al. | May 1993 | A |
| 5211370 | Powers | May 1993 | A |
| 5211633 | Stouder, Jr. | May 1993 | A |
| 5213114 | Bailey, Jr. | May 1993 | A |
| 5226890 | Ianniruberto et al. | Jul 1993 | A |
| 5234455 | Mulhollan | Aug 1993 | A |
| 5241968 | Slater | Sep 1993 | A |
| 5242409 | Buelna | Sep 1993 | A |
| 5242412 | Blake, III | Sep 1993 | A |
| 5242415 | Kantrowitz et al. | Sep 1993 | A |
| 5248304 | Vigdorchik et al. | Sep 1993 | A |
| 5256150 | Quiachon et al. | Oct 1993 | A |
| 5257973 | Villasuso | Nov 1993 | A |
| 5257975 | Foshee | Nov 1993 | A |
| 5259366 | Reydel et al. | Nov 1993 | A |
| 5261883 | Hood et al. | Nov 1993 | A |
| 5262468 | Chen | Nov 1993 | A |
| 5263922 | Sova et al. | Nov 1993 | A |
| 5269763 | Boehmer et al. | Dec 1993 | A |
| 5269772 | Wilk | Dec 1993 | A |
| 5273449 | Mattis et al. | Dec 1993 | A |
| 5273545 | Hunt et al. | Dec 1993 | A |
| D343236 | Quigley et al. | Jan 1994 | S |
| 5279575 | Sugarbaker | Jan 1994 | A |
| 5290310 | Makower et al. | Mar 1994 | A |
| D346022 | Quigley et al. | Apr 1994 | S |
| 5299582 | Potts | Apr 1994 | A |
| 5300034 | Behnke | Apr 1994 | A |
| 5300035 | Clement | Apr 1994 | A |
| 5300036 | Mueller et al. | Apr 1994 | A |
| 5308336 | Hart et al. | May 1994 | A |
| 5309896 | Moll et al. | May 1994 | A |
| 5312391 | Wilk | May 1994 | A |
| 5314417 | Stephens et al. | May 1994 | A |
| 5316541 | Fischer | May 1994 | A |
| 5320611 | Bonutti et al. | Jun 1994 | A |
| 5330437 | Durman | Jul 1994 | A |
| 5330486 | Wilk | Jul 1994 | A |
| 5330497 | Freitas et al. | Jul 1994 | A |
| 5331975 | Bonutti | Jul 1994 | A |
| 5334143 | Carroll | Aug 1994 | A |
| 5336192 | Palestrant | Aug 1994 | A |
| 5336708 | Chen | Aug 1994 | A |
| 5338313 | Mollenauer et al. | Aug 1994 | A |
| 5342315 | Rowe et al. | Aug 1994 | A |
| 5342385 | Norelli et al. | Aug 1994 | A |
| 5350364 | Stephens et al. | Sep 1994 | A |
| 5353786 | Wilk | Oct 1994 | A |
| 5354280 | Haber et al. | Oct 1994 | A |
| 5360417 | Gravener et al. | Nov 1994 | A |
| 5364345 | Lowery et al. | Nov 1994 | A |
| 5364372 | Danks et al. | Nov 1994 | A |
| 5366446 | Tal et al. | Nov 1994 | A |
| 5366478 | Brinkerhoff et al. | Nov 1994 | A |
| 5368545 | Schaller et al. | Nov 1994 | A |
| 5375588 | Yoon | Dec 1994 | A |
| 5380288 | Hart et al. | Jan 1995 | A |
| 5383861 | Hempel et al. | Jan 1995 | A |
| 5385552 | Haber et al. | Jan 1995 | A |
| 5385553 | Hart et al. | Jan 1995 | A |
| 5385560 | Wulf | Jan 1995 | A |
| 5389080 | Yoon | Feb 1995 | A |
| 5389081 | Castro | Feb 1995 | A |
| 5391153 | Haber et al. | Feb 1995 | A |
| 5391156 | Hildwein et al. | Feb 1995 | A |
| 5395367 | Wilk | Mar 1995 | A |
| 5403264 | Wohlers et al. | Apr 1995 | A |
| 5403336 | Kieturakis et al. | Apr 1995 | A |
| 5407433 | Loomas | Apr 1995 | A |
| 5411483 | Loomas | May 1995 | A |
| 5413571 | Katsaros et al. | May 1995 | A |
| 5423848 | Washizuka et al. | Jun 1995 | A |
| 5429609 | Yoon | Jul 1995 | A |
| 5431676 | Durdal et al. | Jul 1995 | A |
| 5437683 | Neumann et al. | Aug 1995 | A |
| 5439455 | Kieturakis et al. | Aug 1995 | A |
| 5441486 | Yoon | Aug 1995 | A |
| 5443452 | Hart et al. | Aug 1995 | A |
| 5456284 | Ryan et al. | Oct 1995 | A |
| 5460170 | Hammerslag | Oct 1995 | A |
| 5460616 | Weinstein et al. | Oct 1995 | A |
| 5468248 | Chin et al. | Nov 1995 | A |
| 5476475 | Gadberry | Dec 1995 | A |
| 5480410 | Cuschieri et al. | Jan 1996 | A |
| 5486426 | McGee et al. | Jan 1996 | A |
| 5490843 | Hildwein et al. | Feb 1996 | A |
| 5492304 | Smith et al. | Feb 1996 | A |
| 5496280 | Vandenbroek et al. | Mar 1996 | A |
| 5503112 | Luhman et al. | Apr 1996 | A |
| 5507758 | Thomason et al. | Apr 1996 | A |
| 5508334 | Chen | Apr 1996 | A |
| 5511564 | Wilk | Apr 1996 | A |
| 5514109 | Mollenauer et al. | May 1996 | A |
| 5514133 | Golub et al. | May 1996 | A |
| 5514153 | Bonutti | May 1996 | A |
| 5518278 | Sampson | May 1996 | A |
| 5520632 | Leveen | May 1996 | A |
| 5522791 | Leyva | Jun 1996 | A |
| 5522824 | Ashby | Jun 1996 | A |
| 5524644 | Crook | Jun 1996 | A |
| 5526536 | Cartmill | Jun 1996 | A |
| 5531758 | Uschold et al. | Jul 1996 | A |
| 5538509 | Dunlap et al. | Jul 1996 | A |
| 5540648 | Yoon | Jul 1996 | A |
| 5540711 | Kieturakis et al. | Jul 1996 | A |
| 5545150 | Danks et al. | Aug 1996 | A |
| 5545179 | Williamson, IV | Aug 1996 | A |
| 5549563 | Kronner | Aug 1996 | A |
| 5549637 | Crainich | Aug 1996 | A |
| 5554124 | Alvarado | Sep 1996 | A |
| 5562632 | Davila et al. | Oct 1996 | A |
| 5562677 | Hildwein et al. | Oct 1996 | A |
| 5562688 | Riza | Oct 1996 | A |
| 5571115 | Nicholas | Nov 1996 | A |
| 5571137 | Marlow et al. | Nov 1996 | A |
| 5575799 | Bolanos et al. | Nov 1996 | A |
| 5577993 | Zhu et al. | Nov 1996 | A |
| 5578048 | Pasqualucci et al. | Nov 1996 | A |
| 5580344 | Hasson | Dec 1996 | A |
| 5584850 | Hart et al. | Dec 1996 | A |
| 5601579 | Semertzides | Feb 1997 | A |
| 5601581 | Fogarty et al. | Feb 1997 | A |
| 5603702 | Smith et al. | Feb 1997 | A |
| 5607443 | Kieturakis et al. | Mar 1997 | A |
| 5620415 | Lucey et al. | Apr 1997 | A |
| 5620420 | Kriesel | Apr 1997 | A |
| 5628732 | Antoon, Jr. et al. | May 1997 | A |
| 5632284 | Graether | May 1997 | A |
| 5632979 | Goldberg et al. | May 1997 | A |
| 5634911 | Hermann et al. | Jun 1997 | A |
| 5634936 | Linden et al. | Jun 1997 | A |
| 5634937 | Mollenauer et al. | Jun 1997 | A |
| 5636645 | Ou | Jun 1997 | A |
| 5640977 | Leahy et al. | Jun 1997 | A |
| 5643301 | Mollenauer | Jul 1997 | A |
| 5649550 | Crook | Jul 1997 | A |
| 5651771 | Tangherlini et al. | Jul 1997 | A |
| 5653705 | de la Torre et al. | Aug 1997 | A |
| 5657963 | Hinchliffe et al. | Aug 1997 | A |
| 5658272 | Hasson | Aug 1997 | A |
| 5658306 | Kieturakis | Aug 1997 | A |
| 5662615 | Blake, III | Sep 1997 | A |
| 5672168 | de la Torre et al. | Sep 1997 | A |
| 5681341 | Lunsford et al. | Oct 1997 | A |
| 5683378 | Christy | Nov 1997 | A |
| 5685854 | Green et al. | Nov 1997 | A |
| 5685857 | Negus et al. | Nov 1997 | A |
| 5697914 | Brimhall | Dec 1997 | A |
| 5707703 | Rothrum et al. | Jan 1998 | A |
| 5709664 | Vandenbroek et al. | Jan 1998 | A |
| 5713858 | Heruth et al. | Feb 1998 | A |
| 5713869 | Morejon | Feb 1998 | A |
| 5720730 | Blake, III | Feb 1998 | A |
| 5725536 | Oberlin et al. | Mar 1998 | A |
| 5728103 | Picha et al. | Mar 1998 | A |
| 5730748 | Fogarty et al. | Mar 1998 | A |
| 5735791 | Alexander et al. | Apr 1998 | A |
| 5738628 | Sierocuk et al. | Apr 1998 | A |
| 5741234 | Aboul-Hosn | Apr 1998 | A |
| 5741298 | MacLeod | Apr 1998 | A |
| 5743884 | Hasson et al. | Apr 1998 | A |
| 5749882 | Hart et al. | May 1998 | A |
| 5755660 | Tyagi | May 1998 | A |
| 5760117 | Chen | Jun 1998 | A |
| 5769783 | Fowler | Jun 1998 | A |
| 5782812 | Hart et al. | Jul 1998 | A |
| 5782817 | Franzel et al. | Jul 1998 | A |
| 5782859 | Nicholas et al. | Jul 1998 | A |
| 5788676 | Yoon | Aug 1998 | A |
| 5792119 | Marx | Aug 1998 | A |
| 5795290 | Bridges | Aug 1998 | A |
| 5803919 | Hart et al. | Sep 1998 | A |
| 5803921 | Bonadio | Sep 1998 | A |
| 5803923 | Singh-Derewa et al. | Sep 1998 | A |
| 5807350 | Diaz | Sep 1998 | A |
| 5810712 | Dunn | Sep 1998 | A |
| 5810721 | Mueller et al. | Sep 1998 | A |
| 5813409 | Leahy et al. | Sep 1998 | A |
| 5814026 | Yoon | Sep 1998 | A |
| 5817062 | Flom et al. | Oct 1998 | A |
| 5819375 | Kastner | Oct 1998 | A |
| 5820555 | Watkins, III et al. | Oct 1998 | A |
| 5820600 | Carlson et al. | Oct 1998 | A |
| 5830191 | Hildwein et al. | Nov 1998 | A |
| 5832925 | Rothrum | Nov 1998 | A |
| 5836871 | Wallace et al. | Nov 1998 | A |
| 5841298 | Huang | Nov 1998 | A |
| 5842971 | Yoon | Dec 1998 | A |
| 5848992 | Hart et al. | Dec 1998 | A |
| 5853395 | Crook et al. | Dec 1998 | A |
| 5853417 | Fogarty et al. | Dec 1998 | A |
| 5857461 | Levitsky et al. | Jan 1999 | A |
| 5860995 | Berkelaar | Jan 1999 | A |
| 5865728 | Moll et al. | Feb 1999 | A |
| 5865729 | Meehan et al. | Feb 1999 | A |
| 5865807 | Blake, III | Feb 1999 | A |
| 5865817 | Moenning et al. | Feb 1999 | A |
| 5871474 | Hermann et al. | Feb 1999 | A |
| 5876413 | Fogarty et al. | Mar 1999 | A |
| 5879368 | Hoskin et al. | Mar 1999 | A |
| 5882344 | Strouder, Jr. | Mar 1999 | A |
| 5884639 | Chen | Mar 1999 | A |
| 5894843 | Benetti et al. | Apr 1999 | A |
| 5895377 | Smith et al. | Apr 1999 | A |
| 5899208 | Bonadio | May 1999 | A |
| 5899913 | Fogarty et al. | May 1999 | A |
| 5904703 | Gilson | May 1999 | A |
| 5906577 | Beane et al. | May 1999 | A |
| 5913847 | Yoon | Jun 1999 | A |
| 5916198 | Dillow | Jun 1999 | A |
| 5916232 | Hart | Jun 1999 | A |
| 5919476 | Fischer et al. | Jul 1999 | A |
| 5931832 | Jensen | Aug 1999 | A |
| 5947922 | MacLeod | Sep 1999 | A |
| 5951467 | Picha et al. | Sep 1999 | A |
| 5951588 | Moenning | Sep 1999 | A |
| 5957888 | Hinchiffe et al. | Sep 1999 | A |
| 5957913 | de la Torre et al. | Sep 1999 | A |
| 5962572 | Chen | Oct 1999 | A |
| 5964781 | Mollenauer et al. | Oct 1999 | A |
| 5976174 | Ruiz | Nov 1999 | A |
| 5989232 | Yoon | Nov 1999 | A |
| 5989233 | Yoon | Nov 1999 | A |
| 5989266 | Foster | Nov 1999 | A |
| 5993471 | Riza et al. | Nov 1999 | A |
| 5993485 | Beckers | Nov 1999 | A |
| 5994450 | Pearce | Nov 1999 | A |
| 5997515 | de la Torre et al. | Dec 1999 | A |
| 6004303 | Peterson | Dec 1999 | A |
| 6010494 | Schafer et al. | Jan 2000 | A |
| 6017355 | Hessel et al. | Jan 2000 | A |
| 6018094 | Fox | Jan 2000 | A |
| 6024736 | de la Torre et al. | Feb 2000 | A |
| 6025067 | Fay | Feb 2000 | A |
| 6033426 | Kaji | Mar 2000 | A |
| 6033428 | Sardella | Mar 2000 | A |
| 6035559 | Freed et al. | Mar 2000 | A |
| 6042573 | Lucey | Mar 2000 | A |
| 6045535 | Ben Nun | Apr 2000 | A |
| 6048309 | Flom et al. | Apr 2000 | A |
| 6050871 | Chen | Apr 2000 | A |
| 6053934 | Andrews et al. | Apr 2000 | A |
| 6059816 | Moenning | May 2000 | A |
| 6066117 | Fox et al. | May 2000 | A |
| 6068639 | Fogarty et al. | May 2000 | A |
| 6077288 | Shimomura | Jun 2000 | A |
| 6086603 | Termin et al. | Jul 2000 | A |
| 6090043 | Austin et al. | Jul 2000 | A |
| 6099506 | Macoviak et al. | Aug 2000 | A |
| 6110154 | Shimomura et al. | Aug 2000 | A |
| 6123689 | To | Sep 2000 | A |
| 6142935 | Flom et al. | Nov 2000 | A |
| 6142936 | Beane et al. | Nov 2000 | A |
| 6149642 | Gerhart et al. | Nov 2000 | A |
| 6150608 | Wambeke et al. | Nov 2000 | A |
| 6159182 | Davis | Dec 2000 | A |
| 6162172 | Cosgrove et al. | Dec 2000 | A |
| 6162196 | Hart et al. | Dec 2000 | A |
| 6162206 | Bindokas | Dec 2000 | A |
| 6163949 | Neuenschwander | Dec 2000 | A |
| 6164279 | Tweedle | Dec 2000 | A |
| 6171282 | Ragsdale | Jan 2001 | B1 |
| 6183486 | Snow et al. | Feb 2001 | B1 |
| 6197002 | Peterson | Mar 2001 | B1 |
| 6217555 | Hart et al. | Apr 2001 | B1 |
| 6217590 | Levinson | Apr 2001 | B1 |
| 6224612 | Bates et al. | May 2001 | B1 |
| 6228063 | Aboul-Hosn | May 2001 | B1 |
| 6238373 | de la Torre et al. | May 2001 | B1 |
| 6241768 | Agarwal et al. | Jun 2001 | B1 |
| 6254533 | Fadem et al. | Jul 2001 | B1 |
| 6254534 | Butler et al. | Jul 2001 | B1 |
| 6258065 | Dennis et al. | Jul 2001 | B1 |
| 6264604 | Kieturakis et al. | Jul 2001 | B1 |
| 6267751 | Mangosong | Jul 2001 | B1 |
| 6276661 | Laird | Aug 2001 | B1 |
| 6287280 | Lampropoulos et al. | Sep 2001 | B1 |
| 6315770 | de la Torre et al. | Nov 2001 | B1 |
| 6319246 | de la Torre et al. | Nov 2001 | B1 |
| 6322541 | West | Nov 2001 | B2 |
| 6325384 | Berry, Sr. et al. | Dec 2001 | B1 |
| 6346074 | Roth | Feb 2002 | B1 |
| 6371968 | Kogasaka et al. | Apr 2002 | B1 |
| 6382211 | Crook | May 2002 | B1 |
| 6383162 | Sugarbaker | May 2002 | B1 |
| 6391043 | Moll et al. | May 2002 | B1 |
| 6413244 | Bestetti et al. | Jul 2002 | B1 |
| 6413458 | Pearce | Jul 2002 | B1 |
| 6420475 | Chen | Jul 2002 | B1 |
| 6423036 | Van Huizen | Jul 2002 | B1 |
| 6440061 | Wenner et al. | Aug 2002 | B1 |
| 6440063 | Beane et al. | Aug 2002 | B1 |
| 6443957 | Addis | Sep 2002 | B1 |
| 6447489 | Peterson | Sep 2002 | B1 |
| 6450983 | Rambo | Sep 2002 | B1 |
| 6454783 | Piskun | Sep 2002 | B1 |
| 6464686 | O'Hara et al. | Oct 2002 | B1 |
| 6468292 | Mollenauer et al. | Oct 2002 | B1 |
| 6482181 | Racenet et al. | Nov 2002 | B1 |
| 6485435 | Bakal | Nov 2002 | B1 |
| 6485467 | Crook et al. | Nov 2002 | B1 |
| 6488620 | Segermark et al. | Dec 2002 | B1 |
| 6488692 | Spence et al. | Dec 2002 | B1 |
| 6494893 | Dubrul et al. | Dec 2002 | B2 |
| 6527787 | Fogarty et al. | Mar 2003 | B1 |
| 6533734 | Corley, III et al. | Mar 2003 | B1 |
| 6551270 | Bimbo et al. | Apr 2003 | B1 |
| 6551276 | Mann et al. | Apr 2003 | B1 |
| 6551344 | Thill | Apr 2003 | B2 |
| 6552109 | Chen | Apr 2003 | B1 |
| 6554793 | Pauker et al. | Apr 2003 | B1 |
| 6558371 | Dorn | May 2003 | B2 |
| 6569120 | Green | May 2003 | B1 |
| 6578577 | Bonadio et al. | Jun 2003 | B2 |
| 6579281 | Palmer et al. | Jun 2003 | B2 |
| 6582364 | Butler et al. | Jun 2003 | B2 |
| 6589167 | Shimomura et al. | Jul 2003 | B1 |
| 6589211 | MacLeod | Jul 2003 | B1 |
| 6607504 | Haarala et al. | Aug 2003 | B2 |
| 6613952 | Rambo | Sep 2003 | B2 |
| 6623426 | Bonadio et al. | Sep 2003 | B2 |
| 6627275 | Chen | Sep 2003 | B1 |
| 6663598 | Carrillo et al. | Dec 2003 | B1 |
| 6669674 | Macoviak et al. | Dec 2003 | B1 |
| 6676639 | Ternström | Jan 2004 | B1 |
| 6702787 | Racenet et al. | Mar 2004 | B2 |
| 6705989 | Cuschieri et al. | Mar 2004 | B2 |
| 6706050 | Giannadakis | Mar 2004 | B1 |
| 6714298 | Ryer | Mar 2004 | B2 |
| 6716201 | Blanco | Apr 2004 | B2 |
| 6723044 | Pulford et al. | Apr 2004 | B2 |
| 6723088 | Gaskill, III et al. | Apr 2004 | B2 |
| 6725080 | Melkent et al. | Apr 2004 | B2 |
| 6793621 | Butler et al. | Sep 2004 | B2 |
| 6794440 | Chen | Sep 2004 | B2 |
| 6796940 | Bonadio et al. | Sep 2004 | B2 |
| 6797765 | Pearce | Sep 2004 | B2 |
| 6800084 | Davison et al. | Oct 2004 | B2 |
| 6811546 | Callas et al. | Nov 2004 | B1 |
| 6814078 | Crook | Nov 2004 | B2 |
| 6814700 | Mueller et al. | Nov 2004 | B1 |
| 6817974 | Cooper et al. | Nov 2004 | B2 |
| 6830578 | O'Heeron et al. | Dec 2004 | B2 |
| 6837893 | Miller | Jan 2005 | B2 |
| 6840946 | Fogarty et al. | Jan 2005 | B2 |
| 6840951 | de la Torre et al. | Jan 2005 | B2 |
| 6846287 | Bonadio et al. | Jan 2005 | B2 |
| 6860463 | Hartley | Mar 2005 | B2 |
| 6863674 | Kasahara et al. | Mar 2005 | B2 |
| 6866861 | Luhman | Mar 2005 | B1 |
| 6867253 | Chen | Mar 2005 | B1 |
| 6869393 | Butler | Mar 2005 | B2 |
| 6878110 | Yang et al. | Apr 2005 | B2 |
| 6884253 | McFarlane | Apr 2005 | B1 |
| 6890295 | Michels et al. | May 2005 | B2 |
| 6895965 | Scarberry et al. | May 2005 | B2 |
| 6902541 | McNally et al. | Jun 2005 | B2 |
| 6902569 | Parmer et al. | Jun 2005 | B2 |
| 6908430 | Caldwell et al. | Jun 2005 | B2 |
| 6909220 | Chen | Jun 2005 | B2 |
| 6913609 | Yencho et al. | Jul 2005 | B2 |
| 6916310 | Sommerich | Jul 2005 | B2 |
| 6916331 | Mollenauer et al. | Jul 2005 | B2 |
| 6929637 | Gonzalez et al. | Aug 2005 | B2 |
| 6936037 | Bubb et al. | Aug 2005 | B2 |
| 6939296 | Ewers et al. | Sep 2005 | B2 |
| 6945932 | Caldwell et al. | Sep 2005 | B1 |
| 6958037 | Ewers et al. | Oct 2005 | B2 |
| 6972026 | Caldwell et al. | Dec 2005 | B1 |
| 6979324 | Bybordi et al. | Dec 2005 | B2 |
| 6991602 | Nakazawa et al. | Jan 2006 | B2 |
| 6997909 | Goldberg | Feb 2006 | B2 |
| 7001397 | Davison et al. | Feb 2006 | B2 |
| 7008377 | Beane et al. | Mar 2006 | B2 |
| 7014628 | Bousquet | Mar 2006 | B2 |
| 7033319 | Pulford et al. | Apr 2006 | B2 |
| 7052454 | Taylor | May 2006 | B2 |
| 7056304 | Bacher et al. | Jun 2006 | B2 |
| 7056321 | Pagliuca et al. | Jun 2006 | B2 |
| 7067583 | Chen | Jun 2006 | B2 |
| 7077852 | Fogarty et al. | Jul 2006 | B2 |
| 7081089 | Bonadio et al. | Jul 2006 | B2 |
| 7083626 | Hart et al. | Aug 2006 | B2 |
| 7093599 | Chen | Aug 2006 | B2 |
| 7100614 | Stevens et al. | Sep 2006 | B2 |
| 7101353 | Liu et al. | Sep 2006 | B2 |
| 7105009 | Johnson | Sep 2006 | B2 |
| 7105607 | Chen | Sep 2006 | B2 |
| 7112185 | Hart et al. | Sep 2006 | B2 |
| 7118528 | Piskun | Oct 2006 | B1 |
| 7134929 | Chen | Nov 2006 | B2 |
| 7153261 | Wenchell | Dec 2006 | B2 |
| 7163510 | Kahle et al. | Jan 2007 | B2 |
| 7192436 | Sing et al. | Mar 2007 | B2 |
| 7193002 | Chen | Mar 2007 | B2 |
| 7195590 | Butler et al. | Mar 2007 | B2 |
| 7214185 | Rosney et al. | May 2007 | B1 |
| 7217277 | Parihar et al. | May 2007 | B2 |
| 7222380 | Chen | May 2007 | B2 |
| 7223257 | Shubayev et al. | May 2007 | B2 |
| 7223278 | Davison et al. | May 2007 | B2 |
| 7226484 | Chen | Jun 2007 | B2 |
| 7235062 | Brustad | Jun 2007 | B2 |
| 7235084 | Skakoon et al. | Jun 2007 | B2 |
| 7238154 | Ewers et al. | Jul 2007 | B2 |
| 7244244 | Racenet et al. | Jul 2007 | B2 |
| 7276075 | Callas et al. | Oct 2007 | B1 |
| 7290367 | Chen | Nov 2007 | B2 |
| 7294103 | Bertolero et al. | Nov 2007 | B2 |
| 7297106 | Yamada et al. | Nov 2007 | B2 |
| 7300399 | Bonadio et al. | Nov 2007 | B2 |
| 7316699 | McFarlane | Jan 2008 | B2 |
| 7331940 | Sommerich | Feb 2008 | B2 |
| 7338473 | Campbell et al. | Mar 2008 | B2 |
| 7344547 | Piskun | Mar 2008 | B2 |
| 7344568 | Chen | Mar 2008 | B2 |
| 7377898 | Ewers et al. | May 2008 | B2 |
| 7390317 | Taylor et al. | Jun 2008 | B2 |
| 7393322 | Wenchell | Jul 2008 | B2 |
| 7412977 | Fields et al. | Aug 2008 | B2 |
| 7445597 | Butler et al. | Nov 2008 | B2 |
| 7473221 | Ewers et al. | Jan 2009 | B2 |
| 7481765 | Ewers et al. | Jan 2009 | B2 |
| 7537564 | Bonadio et al. | May 2009 | B2 |
| 7540839 | Butler et al. | Jun 2009 | B2 |
| 7559893 | Bonadio et al. | Jul 2009 | B2 |
| 7578832 | Johnson | Aug 2009 | B2 |
| 7645232 | Shluzas | Jan 2010 | B2 |
| 7650887 | Nguyen et al. | Jan 2010 | B2 |
| 7661164 | Chen | Feb 2010 | B2 |
| 7704207 | Albrecht et al. | Apr 2010 | B2 |
| 7717847 | Smith | May 2010 | B2 |
| 7727146 | Albrecht et al. | Jun 2010 | B2 |
| 7727255 | Taylor et al. | Jun 2010 | B2 |
| 7736306 | Brustad et al. | Jun 2010 | B2 |
| 7749415 | Brustad et al. | Jul 2010 | B2 |
| 7753901 | Piskun et al. | Jul 2010 | B2 |
| 7758500 | Boyd et al. | Jul 2010 | B2 |
| 7766824 | Jensen et al. | Aug 2010 | B2 |
| 7811251 | Wenchell et al. | Oct 2010 | B2 |
| 7815567 | Albrecht et al. | Oct 2010 | B2 |
| 7837612 | Gill et al. | Nov 2010 | B2 |
| 7850667 | Gresham | Dec 2010 | B2 |
| 7867164 | Butler et al. | Jan 2011 | B2 |
| 7878974 | Brustad et al. | Feb 2011 | B2 |
| 7883461 | Albrecht et al. | Feb 2011 | B2 |
| 7892172 | Albrecht et al. | Feb 2011 | B2 |
| 7896889 | Mazzocchi et al. | Mar 2011 | B2 |
| 7909760 | Albrecht et al. | Mar 2011 | B2 |
| 7913697 | Nguyen et al. | Mar 2011 | B2 |
| 7930782 | Chen | Apr 2011 | B2 |
| 20010037053 | Bonadio et al. | Nov 2001 | A1 |
| 20010047188 | Bonadio et al. | Nov 2001 | A1 |
| 20020002324 | McManus | Jan 2002 | A1 |
| 20020010389 | Butler et al. | Jan 2002 | A1 |
| 20020013542 | Bonadio et al. | Jan 2002 | A1 |
| 20020016607 | Bonadio et al. | Feb 2002 | A1 |
| 20020026230 | Moll et al. | Feb 2002 | A1 |
| 20020038077 | de la Torre et al. | Mar 2002 | A1 |
| 20020072762 | Bonadio et al. | Jun 2002 | A1 |
| 20020111536 | Cuschieri et al. | Aug 2002 | A1 |
| 20030004253 | Chen | Jan 2003 | A1 |
| 20030028179 | Piskun | Feb 2003 | A1 |
| 20030040711 | Racenet et al. | Feb 2003 | A1 |
| 20030078478 | Bonadio et al. | Apr 2003 | A1 |
| 20030139756 | Brustad | Jul 2003 | A1 |
| 20030167040 | Bacher et al. | Sep 2003 | A1 |
| 20030187376 | Rambo | Oct 2003 | A1 |
| 20030192553 | Rambo | Oct 2003 | A1 |
| 20030225392 | McMichael et al. | Dec 2003 | A1 |
| 20030236505 | Bonadio et al. | Dec 2003 | A1 |
| 20030236549 | Bonadio et al. | Dec 2003 | A1 |
| 20040015185 | Ewers et al. | Jan 2004 | A1 |
| 20040024363 | Goldberg | Feb 2004 | A1 |
| 20040049099 | Ewers et al. | Mar 2004 | A1 |
| 20040049100 | Butler | Mar 2004 | A1 |
| 20040054353 | Taylor | Mar 2004 | A1 |
| 20040063833 | Chen | Apr 2004 | A1 |
| 20040068232 | Hart et al. | Apr 2004 | A1 |
| 20040070187 | Chen | Apr 2004 | A1 |
| 20040072942 | Chen | Apr 2004 | A1 |
| 20040073090 | Butler | Apr 2004 | A1 |
| 20040092795 | Bonadio et al. | May 2004 | A1 |
| 20040092796 | Butler et al. | May 2004 | A1 |
| 20040093018 | Johnson | May 2004 | A1 |
| 20040097793 | Butler et al. | May 2004 | A1 |
| 20040106942 | Taylor | Jun 2004 | A1 |
| 20040111061 | Curran | Jun 2004 | A1 |
| 20040127772 | Ewers et al. | Jul 2004 | A1 |
| 20040138529 | Wiltshire et al. | Jul 2004 | A1 |
| 20040143158 | Hart et al. | Jul 2004 | A1 |
| 20040154624 | Bonadio et al. | Aug 2004 | A1 |
| 20040167559 | Taylor et al. | Aug 2004 | A1 |
| 20040173218 | Yamada et al. | Sep 2004 | A1 |
| 20040215063 | Bonadio et al. | Oct 2004 | A1 |
| 20040230161 | Zeiner | Nov 2004 | A1 |
| 20040243144 | Bonadio et al. | Dec 2004 | A1 |
| 20040249248 | Bonadio et al. | Dec 2004 | A1 |
| 20040254426 | Wenchell | Dec 2004 | A1 |
| 20040260244 | Piechowicz et al. | Dec 2004 | A1 |
| 20040267096 | Caldwell et al. | Dec 2004 | A1 |
| 20050020884 | Hart et al. | Jan 2005 | A1 |
| 20050033246 | Ahlbert et al. | Feb 2005 | A1 |
| 20050059865 | Kahle et al. | Mar 2005 | A1 |
| 20050065475 | Hart et al. | Mar 2005 | A1 |
| 20050065543 | Kahle et al. | Mar 2005 | A1 |
| 20050090713 | Gozales et al. | Apr 2005 | A1 |
| 20050090716 | Bonadio et al. | Apr 2005 | A1 |
| 20050090717 | Bonadio et al. | Apr 2005 | A1 |
| 20050096695 | Olich | May 2005 | A1 |
| 20050131349 | Albrecht et al. | Jun 2005 | A1 |
| 20050148823 | Vaugh et al. | Jul 2005 | A1 |
| 20050155611 | Vaugh et al. | Jul 2005 | A1 |
| 20050159647 | Hart et al. | Jul 2005 | A1 |
| 20050192483 | Bonadio et al. | Sep 2005 | A1 |
| 20050192598 | Johnson et al. | Sep 2005 | A1 |
| 20050197537 | Bonadio et al. | Sep 2005 | A1 |
| 20050203346 | Bonadio et al. | Sep 2005 | A1 |
| 20050209510 | Bonadio et al. | Sep 2005 | A1 |
| 20050222582 | Wenchell | Oct 2005 | A1 |
| 20050240082 | Bonadio et al. | Oct 2005 | A1 |
| 20050241647 | Nguyen | Nov 2005 | A1 |
| 20050251124 | Zvuloni et al. | Nov 2005 | A1 |
| 20050261720 | Caldwell et al. | Nov 2005 | A1 |
| 20050267419 | Smith | Dec 2005 | A1 |
| 20050277946 | Greenhalgh | Dec 2005 | A1 |
| 20050283050 | Gundlapalli et al. | Dec 2005 | A1 |
| 20050288558 | Ewers et al. | Dec 2005 | A1 |
| 20050288634 | O'Heeron et al. | Dec 2005 | A1 |
| 20060020164 | Butler et al. | Jan 2006 | A1 |
| 20060020241 | Piskun et al. | Jan 2006 | A1 |
| 20060030755 | Ewers et al. | Feb 2006 | A1 |
| 20060041270 | Lenker | Feb 2006 | A1 |
| 20060047284 | Gresham | Mar 2006 | A1 |
| 20060047293 | Haberland et al. | Mar 2006 | A1 |
| 20060052669 | Hart | Mar 2006 | A1 |
| 20060084842 | Hart et al. | Apr 2006 | A1 |
| 20060106402 | McLucas | May 2006 | A1 |
| 20060129165 | Edoga et al. | Jun 2006 | A1 |
| 20060149137 | Pingleton et al. | Jul 2006 | A1 |
| 20060149306 | Hart et al. | Jul 2006 | A1 |
| 20060161049 | Beane et al. | Jul 2006 | A1 |
| 20060161050 | Butler et al. | Jul 2006 | A1 |
| 20060241651 | Wilk | Oct 2006 | A1 |
| 20060247498 | Bonadio et al. | Nov 2006 | A1 |
| 20060247499 | Butler et al. | Nov 2006 | A1 |
| 20060247500 | Voegele et al. | Nov 2006 | A1 |
| 20060247516 | Hess et al. | Nov 2006 | A1 |
| 20060247586 | Voegele et al. | Nov 2006 | A1 |
| 20060247673 | Voegele et al. | Nov 2006 | A1 |
| 20060247678 | Weisenburgh, II et al. | Nov 2006 | A1 |
| 20060258899 | Gill et al. | Nov 2006 | A1 |
| 20060264706 | Piskun | Nov 2006 | A1 |
| 20060270911 | Voegele et al. | Nov 2006 | A1 |
| 20070004968 | Bonadio et al. | Jan 2007 | A1 |
| 20070049966 | Bonadio et al. | Mar 2007 | A1 |
| 20070088202 | Albrecht et al. | Apr 2007 | A1 |
| 20070088204 | Albrecht et al. | Apr 2007 | A1 |
| 20070093695 | Bonadio et al. | Apr 2007 | A1 |
| 20070118175 | Butler et al. | May 2007 | A1 |
| 20070149859 | Albrecht et al. | Jun 2007 | A1 |
| 20070151566 | Kahle et al. | Jul 2007 | A1 |
| 20070156023 | Frasier et al. | Jul 2007 | A1 |
| 20070185387 | Albrecht et al. | Aug 2007 | A1 |
| 20070203398 | Bonadio et al. | Aug 2007 | A1 |
| 20070208312 | Norton et al. | Sep 2007 | A1 |
| 20070255219 | Vaugh et al. | Nov 2007 | A1 |
| 20070299387 | Williams et al. | Dec 2007 | A1 |
| 20080027476 | Piskun | Jan 2008 | A1 |
| 20080048011 | Weller | Feb 2008 | A1 |
| 20080097162 | Bonadio et al. | Apr 2008 | A1 |
| 20080097163 | Butler et al. | Apr 2008 | A1 |
| 20080200767 | Ewers et al. | Aug 2008 | A1 |
| 20080255519 | Piskun et al. | Oct 2008 | A1 |
| 20080281161 | Albrecht et al. | Nov 2008 | A1 |
| 20080281162 | Albrecht et al. | Nov 2008 | A1 |
| 20090012477 | Norton et al. | Jan 2009 | A1 |
| 20090036745 | Bonadio et al. | Feb 2009 | A1 |
| 20090069837 | Bonadio et al. | Mar 2009 | A1 |
| 20090093683 | Richard et al. | Apr 2009 | A1 |
| 20090093752 | Richard et al. | Apr 2009 | A1 |
| 20090131754 | Ewers et al. | May 2009 | A1 |
| 20090137879 | Ewers et al. | May 2009 | A1 |
| 20090149714 | Bonadio | Jun 2009 | A1 |
| 20090182279 | Wenchell et al. | Jul 2009 | A1 |
| 20090187079 | Albrecht et al. | Jul 2009 | A1 |
| 20090227843 | Smith et al. | Sep 2009 | A1 |
| 20090292176 | Bonadio et al. | Nov 2009 | A1 |
| 20090326330 | Bonadio et al. | Dec 2009 | A1 |
| 20100063362 | Bonadio et al. | Mar 2010 | A1 |
| 20100063364 | Bonadio et al. | Mar 2010 | A1 |
| 20100081880 | Widenhouse et al. | Apr 2010 | A1 |
| 20100081881 | Murray et al. | Apr 2010 | A1 |
| 20100081995 | Widenhouse et al. | Apr 2010 | A1 |
| 20100100043 | Racenet | Apr 2010 | A1 |
| 20100113882 | Widenhouse et al. | May 2010 | A1 |
| 20100217087 | Bonadio et al. | Aug 2010 | A1 |
| 20100228091 | Widenhouse et al. | Sep 2010 | A1 |
| 20100228092 | Ortiz et al. | Sep 2010 | A1 |
| 20100228094 | Ortiz et al. | Sep 2010 | A1 |
| 20100240960 | Richard | Sep 2010 | A1 |
| 20100249523 | Spiegel et al. | Sep 2010 | A1 |
| 20100249524 | Ransden et al. | Sep 2010 | A1 |
| 20100249525 | Shelton, IV et al. | Sep 2010 | A1 |
| 20100249694 | Choi et al. | Sep 2010 | A1 |
| 20100261972 | Widenhouse et al. | Oct 2010 | A1 |
| 20100261975 | Huey et al. | Oct 2010 | A1 |
| 20100286484 | Stellon et al. | Nov 2010 | A1 |
| 20100298646 | Stellon et al. | Nov 2010 | A1 |
| 20110021877 | Fortier et al. | Jan 2011 | A1 |
| 20110028891 | Okoniewski | Feb 2011 | A1 |
| 20110034935 | Kleyman | Feb 2011 | A1 |
| 20110034946 | Kleyman | Feb 2011 | A1 |
| 20110034947 | Kleyman | Feb 2011 | A1 |
| 20110071462 | Ewers et al. | Mar 2011 | A1 |
| 20110071463 | Ewers et al. | Mar 2011 | A1 |
| Number | Date | Country |
|---|---|---|
| 26 05 148 | Aug 1977 | DE |
| 33 36 279 | Jan 1986 | DE |
| 37 39 532 | Dec 1988 | DE |
| 37 37 121 | May 1989 | DE |
| 296 00 939 | Jun 1996 | DE |
| 19828009 | Dec 1999 | DE |
| 0113520 | Jul 1984 | EP |
| 0142262 | May 1985 | EP |
| 0 517 248 | Dec 1992 | EP |
| 0537768 | Apr 1993 | EP |
| 0 807 416 | Nov 1997 | EP |
| 0 849 517 | Jun 1998 | EP |
| 0950376 | Oct 1999 | EP |
| 1118657 | Jul 2001 | EP |
| 1 125 552 | Aug 2001 | EP |
| 1312318 | May 2003 | EP |
| 1 407 715 | Apr 2004 | EP |
| 2044889 | Apr 2009 | EP |
| 1456623 | Sep 1966 | FR |
| 1151993 | May 1969 | GB |
| 1355611 | Jun 1974 | GB |
| 1372491 | Oct 1974 | GB |
| 1379772 | Jan 1975 | GB |
| 1400808 | Jul 1975 | GB |
| 1407023 | Sep 1975 | GB |
| 1482857 | Aug 1977 | GB |
| 1496696 | Dec 1977 | GB |
| 2071502 | Sep 1981 | GB |
| 2255019 | Oct 1992 | GB |
| 2275420 | Aug 1994 | GB |
| 2298906 | Sep 1996 | GB |
| 930649 | Sep 1993 | IE |
| 930650 | Sep 1993 | IE |
| S940150 | Feb 1994 | IE |
| S940613 | Aug 1994 | IE |
| S940960 | Dec 1994 | IE |
| S950055 | Jan 1995 | IE |
| S950266 | Apr 1995 | IE |
| S75368 | Aug 1997 | IE |
| S960196 | Aug 1997 | IE |
| S970810 | Nov 1997 | IE |
| 991010 | Jul 2000 | IE |
| 990218 | Nov 2000 | IE |
| 990219 | Nov 2000 | IE |
| 990220 | Nov 2000 | IE |
| 990660 | Feb 2001 | IE |
| 990795 | Mar 2001 | IE |
| 10-108868 | Apr 1998 | JP |
| 11-290327 | Oct 1999 | JP |
| 2001-61850 | Mar 2001 | JP |
| 2002-28163 | Jan 2002 | JP |
| 02003 235879 | Aug 2003 | JP |
| 2004-195037 | Jul 2004 | JP |
| 1342485 | Jan 1997 | RU |
| WO 8606272 | Nov 1986 | WO |
| WO 8606316 | Nov 1986 | WO |
| WO 9211880 | Jul 1992 | WO |
| WO 9221292 | Dec 1992 | WO |
| WO 9305740 | Apr 1993 | WO |
| WO 9314801 | Aug 1993 | WO |
| WO 9404067 | Mar 1994 | WO |
| WO 9422357 | Oct 1994 | WO |
| WO 9505207 | Feb 1995 | WO |
| WO 9507056 | Mar 1995 | WO |
| WO 9522289 | Aug 1995 | WO |
| WO 9524864 | Sep 1995 | WO |
| WO 9527445 | Oct 1995 | WO |
| WO 9527468 | Oct 1995 | WO |
| WO 9636283 | Nov 1996 | WO |
| WO 9711642 | Apr 1997 | WO |
| WO 9732514 | Sep 1997 | WO |
| WO 9732515 | Sep 1997 | WO |
| WO 9742889 | Nov 1997 | WO |
| WO 9819853 | May 1998 | WO |
| WO 9835614 | Aug 1998 | WO |
| WO 9848724 | Nov 1998 | WO |
| WO 9903416 | Jan 1999 | WO |
| WO 9915068 | Apr 1999 | WO |
| WO 9916368 | Apr 1999 | WO |
| WO 9922804 | May 1999 | WO |
| WO 9925268 | May 1999 | WO |
| WO 9929250 | Jun 1999 | WO |
| WO 0032116 | Jun 2000 | WO |
| WO 0032117 | Jun 2000 | WO |
| WO 0032119 | Jun 2000 | WO |
| WO 0032120 | Jun 2000 | WO |
| WO 0035356 | Jun 2000 | WO |
| WO 0054675 | Sep 2000 | WO |
| WO 0054676 | Sep 2000 | WO |
| WO 0054677 | Sep 2000 | WO |
| WO 0108563 | Feb 2001 | WO |
| WO 0108581 | Feb 2001 | WO |
| WO 0126558 | Apr 2001 | WO |
| WO 0126559 | Apr 2001 | WO |
| WO 0145568 | Jun 2001 | WO |
| WO 0149363 | Jul 2001 | WO |
| WO 0191652 | Dec 2001 | WO |
| WO 0207611 | Jan 2002 | WO |
| WO 0217800 | Mar 2002 | WO |
| WO 0234108 | May 2002 | WO |
| WO 03011153 | Feb 2003 | WO |
| WO 03011551 | Feb 2003 | WO |
| WO 03026512 | Apr 2003 | WO |
| WO 03032819 | Apr 2003 | WO |
| WO 03034908 | May 2003 | WO |
| WO 03061480 | Jul 2003 | WO |
| WO 03077726 | Sep 2003 | WO |
| WO 03103548 | Dec 2003 | WO |
| WO 2004026153 | Apr 2004 | WO |
| WO 2004030547 | Apr 2004 | WO |
| WO 2004075730 | Sep 2004 | WO |
| WO 2004075741 | Sep 2004 | WO |
| WO 2004075930 | Sep 2004 | WO |
| WO 2005009257 | Feb 2005 | WO |
| WO 2005034766 | Apr 2005 | WO |
| WO 2005089661 | Sep 2005 | WO |
| WO 2006040748 | Apr 2006 | WO |
| WO 2006059318 | Jun 2006 | WO |
| WO 2006100658 | Sep 2006 | WO |
| WO 2008015566 | Feb 2008 | WO |
| WO 2008093313 | Aug 2008 | WO |
| WO 2008121294 | Oct 2008 | WO |
| WO 2010082722 | Jul 2010 | WO |
| WO 2010104259 | Sep 2010 | WO |
| Number | Date | Country | |
|---|---|---|---|
| 20080281161 A1 | Nov 2008 | US |
| Number | Date | Country | |
|---|---|---|---|
| 60917580 | May 2007 | US |
