Systems and methods for navigation and visualization

Description

BACKGROUND

The field of the disclosure relates generally to visualization and navigation, and more specifically, to methods and systems for visualizing sites that do not have direct line of sight to a user.

Generally, clear visualization is important when performing detailed tasks such as driving, operating machinery, or performing surgery. For example, surgical procedures require direct line of site to prepare and conduct the surgical procedure to ensure accuracy. To reduce the complications during the surgical procedure, surgeons attempt to minimize any disturbances to body. Those disturbances can include minimal incisions that reduce the size surgical site, which in turn can limit the field of view for the surgeon. Accordingly, a need exists for visualization and navigation that provides feedback to a user (e.g., a physician/surgeon) while performing tasks (e.g., preoperatively, intraoperatively, and postoperatively) to increase the accuracy and efficiency of the task.

SUMMARY

In a first aspect, a surgical system is provided that comprises a robotic system comprising a moveable arm that is configured to support an end effector relative to a surgical site, wherein the end effector is configured to remove material from a bone; a scanner being configured to scan the surgical site and detect a vessel on the bone; and one or more controllers coupled to the robotic system and the scanner and being configured to: obtain image data of the bone; receive, from the scanner, positional information of the vessel on the bone; input the positional information of the vessel to the image data of the bone; generate a boundary for the vessel; register the boundary to the bone for navigation; control the robotic system to remove material from the bone with the end effector; and control the robotic system based on the boundary to prevent interaction between the end effector and the vessel.

In a second aspect, a method of operating a surgical system is provided, wherein the surgical system comprises a robotic system including a moveable arm that is configured to support an end effector relative to a surgical site for removing material from a bone, a scanner being configured to scan the surgical site and detect a vessel on the bone, and one or more controllers coupled to the robotic system and the scanner, the method comprising the one or more controllers performing the steps of: obtaining image data of the bone; receiving, from the scanner, positional information of the vessel on the bone; inputting the positional information of the vessel to the image data of the bone; generating a boundary for the vessel; registering the boundary to the bone for navigation; controlling the robotic system for removing material from the bone with the end effector; and controlling the robotic system based on the boundary for preventing interaction between the end effector and the vessel.

In a third aspect, a navigation system is provided, wherein the navigation system is configured to be utilized with a robotic system comprising a moveable arm that is configured to support an end effector relative to a surgical site, wherein the end effector is configured to remove material from a bone, the navigation system comprising: a scanner being configured to scan the surgical site and detect a vessel on the bone; and one or more controllers coupled to the scanner and being configured to: obtain image data of the bone; receive, from the scanner, positional information of the vessel on the bone; input the positional information of the vessel to the image data of the bone; generate a boundary for the vessel; and register the boundary to the bone to provide navigated guidance for the robotic system based on the boundary to prevent interaction between the end effector and the vessel.

The features, functions, and advantages that have been discussed can be achieved independently in various embodiments or may be combined in yet other embodiments, further details of which can be seen with reference to the following description and drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a block diagram of a robotic system 100 used in surgical procedures.

FIG. 2 is a perspective of an exemplary procedural component that may be used with the system shown in FIG. 1.

FIG. 3 is a perspective of an alternative procedural component that may be used with the system shown in FIG. 1.

FIG. 4 is a perspective of an alternative procedural component that may be used with the system shown in FIG. 1.

FIG. 5 is a perspective of a patient undergoing a procedure using the system shown in FIG. 1.

FIGS. 6A and 6B are exemplary images produced by the system shown in FIG. 1.

FIG. 7 is a perspective view of a portion of a spine having markers that may be sued with the system shown in FIG. 1.

FIG. 8 is a cut-away perspective view of an exemplary temperature implant for use with the system shown in FIG. 1.

FIG. 9A is an exemplary image produced by the system shown in FIG. 1.

FIG. 9B is a schematic of the exemplary image shown in FIG. 9A.

FIGS. 10-12 are exemplary data flow diagrams of filtering images performed by the system shown in FIG. 1.

DETAILED DESCRIPTION

The systems and methods described herein enable accurate navigation during surgical procedures. The systems and methods described herein provide landmark information inside the body of a patient during a surgical procedure. As used herein, the term “tissue” or “body tissue” refers to a group or layer of similarly specialized cells that together perform certain special functions and can refer to any type of tissue in the body including, but not limed to, bone, organs, cartilage, muscles, skin, fat, nerves, and scars. As used herein the terms “procedure” or “surgery” refers to an operation performed on a patient to investigate and/or treat a pathological condition.

FIG. 1 is a block diagram of a robotic system 100 used in surgical procedures. System 100 includes a computing device 102, user input controls 104, a presentation interface 106, a communications interface 108, an imaging device 110, and a procedural component 112 having at least one end effector 114. In some embodiments, system 100 is communicatively coupled (e.g., through an electrical wire or cable, or wirelessly through Bluetooth or Wi-Fi) to additional operating room systems including, but not limited to, monitoring surgical room controls 120, surgical monitoring systems 122, and additional surgical systems 124 as well as an operating table or bed 220. The robotic system 100 could attach to the floor, be table mounted, and/or mounted to the patient. As further described herein, system 100 may be attached to or moving relative to the patient's body tissue. Moreover, system 100 could be a micro-robot that would be ingested or placed within the patient's body, including sensors that could communicate wirelessly and/or recharge via electromagnetic radiofrequency motion, ultrasound, capacitive coupling, and the like. Non-limiting examples of room controls 120 are HVAC (temperature, humidity), Oxygen, Nitrogen, Carbon Dioxide, and lighting and nonlimiting examples of surgical monitoring systems 122 include cardiac, hemodynamic, respiratory, neurological, blood glucose, blood chemistry, organ function, childbirth, and body temperature monitoring. Additional surgical systems 124 include, but are not limited to, anesthesia (e.g., oxygen, carbon dioxide, nitrogen, nitrous oxide, etc.), endoscopy, arthroscopic, electromagnetic guidance, oncology, navigation, arthroscopy, tissue ablation, ultrasound ablation, cardiac, stent, valve, cardiovascular, ESW, inhalation, urologic, cerebrospinal fluid, synovial fluid, OB/GYN, ENG, neurosurgery, plastic surgery, pulmonary gastroenterology, and IV infusion systems. One having ordinary skill in the art will understand that system 100 may be used in a macroscopic manner and/or a microscopic manner, looking at cellular chemistry.

Computing device 102 includes at least one memory device 120 and one or more processors 122 (e.g., in a multi-core configuration) that is coupled to memory device 120 for executing instructions. In some embodiments, executable instructions are stored in memory device 120. Further, processor 122 may be implemented using one or more heterogeneous processor systems in which a main processor is present with secondary processors on a single chip. As another illustrative example, processor 122 may be a symmetric multiprocessor system containing multiple processors of the same type. Processor 122 may perform partial processing and receive partial processing by a processor and/or computing device communicatively coupled to computing device 102 to enable cloud or remote processing. Further, processor 122 may be implemented using any suitable programmable circuit including one or more systems and microcontrollers, microprocessors, reduced instruction set circuits (RISC), application specific integrated circuits (ASIC), programmable logic circuits, field programmable gate arrays (FPGA), and any other circuit capable of executing the functions described herein. In the exemplary embodiment, processor receives imaging information from device 110 and creates co-registered images for display on interface 106 as well as providing movement limitations to component 112 based the imaging information.

In the exemplary embodiment, memory device 120 is one or more devices that enable information such as executable instructions and/or other data to be stored and retrieved. Memory device 120 may include one or more computer readable media, such as, without limitation, dynamic random access memory (DRAM), static random access memory (SRAM), a solid state disk, and/or a hard disk. Memory device 120 may be configured to store, without limitation, application source code, application object code, source code portions of interest, object code portions of interest, configuration data, execution events and/or any other type of data. In some embodiments, memory device 120 retains or stores limited or no information locally but stores information on a device communicatively coupled to system 100 to enable cloud storage.

In some embodiments, computing device 102 includes a presentation interface 106 that is coupled to processor 122. Presentation interface 106 presents information, such patient information and/or images (e.g. scans), to a user/surgeon. For example, presentation interface 106 may include a display adapter (not shown) that may be coupled to a display device, such as a cathode ray tube (CRT), a liquid crystal display (LCD), an organic LED (OLED) display, and/or an “electronic ink” display. In some embodiments, presentation interface 106 includes one or more display devices. In the exemplary embodiment, presentation interface 106 displays surgical site data that is received from imaging device 110 and created by processor 122. The surgical site data may be displayed on presentation interface 106 and/or in any format that enables user view to surgical site information including but not limited to, glasses, a heads up display positioned within a surgical helmet, a retinal display that projects information onto the user's retina, and a monitor located within the operating room or some other remote location. In some embodiments, presentation interface 106 projects images from system 100 directly into the retina of a surgeon. In some embodiments, surgical site data is provided to the surgeon with audible commands to help direct the surgeon during a procedure.

In the exemplary embodiment, computing device 102 includes a user input interface 104. In the exemplary embodiment, user input interface 104 is coupled to processor 122 and receives input from a user/surgeon. User input interface 104 may include, for example, a keyboard, a pointing device, a mouse, a stylus, a touch sensitive panel (e.g., a touch pad or a touch screen), a gyroscope, an accelerometer, a position detector, and/or an audio user input interface. In some embodiments, user input interface 104 is a haptic feedback system that provides feedback (e.g. pressure, torque) from a procedural component 112. In some embodiments, a single component, such as a touch screen, may function as both a display device of presentation interface 106 and user input interface 104. In one or more embodiments, user input interface is a sensor that senses vibration, heat, thermal properties, and the like.

In one embodiment, user input interface 104 is one or more sensors coupled to a surgeon that are configured to detect muscle movement such that the procedural component 112 and/or end effector(s) 114 will respond to the detected muscle movements. In some embodiments, sensors are positioned on the skin of a surgeon or user so that the sensor can detect either mechanical (e.g., physical movement) or electrical signals of the muscles and/or nerves. Such a system enables a surgeon to perform a procedure remotely without the use of instrumentation directly coupled to the procedural component 112 and/or end effector 114. In some embodiments, a camera (i.e., imaging device 110) is utilized in conjunction with the sensors to determine and/or track surgeon movement patterns to provide a more efficient determination of surgeon movements.

In the exemplary embodiment, computing device 102 includes or is coupled to a communication interface 108 coupled to processor 122. Communication interface 108 communicates with imaging device 110, procedural component 112, and/or remote computing systems (not shown) such as mobile phones and/or tablets. To communicate with imaging device 110, procedural component 112, and/or remote computing systems, communication interface 108 may include, for example, a wired network adapter, a wireless network adapter (e.g. Bluetooth, Wi-Fi), and/or a mobile telecommunications adapter. In the exemplary embodiment, communication interface 108 and presentation interface 106 enable remote conferencing of a procedure with system 100. For example, a surgeon can receive guidance during a procedure from a remote surgeon, assistant, or medical sales representative during a procedure. Additionally, system 100 includes sensors of components 112 that sense movement of components and provide feedback to system 100 enabling system 100 to provide signals to provide tactile feedback and/or alarms to a surgeon through device in which the surgeon is interacting. Imaging device(s) 110 can provide remote users to visualize what is occurring in the procedure in real-time, while allowing the surgeon to interactively communicate with those remotely connected. Imaging device(s) 110 may also provide preoperative and/or postoperative images. Moreover, different types of imaging devices (e.g., fiberoptic, light, acoustic, laser, etc.) may be utilized intraoperatively.

Additionally, the remote conferencing described above can also be utilized to enable remote inventory management. For example, a medical device company or representative can utilize imaging device(s) 110 to view the inventory present in an operating room, or outside the operating room in a secure location (e.g., pharmacy, stock room), to determine what devices and/or objects have been utilized during a procedure. In some embodiments, an imaging device 110 (e.g., camera) scans an inventory system (e.g., cart) to determine, via processor 122, which objects are no longer present and were utilized during a procedure. It should be noted that system 100 can determine inventory levels by utilizing additional sensors. For example, in some embodiments, system 100 is coupled to a scale that weighs the inventory to determine missing items. In one embodiment, sensors are utilized to provide feedback to determine missing inventory based on displacement, an empty space in a known inventory location, and/or a changed shape of a stack or collection of inventory. Alternatively, system 100 is configured to track inventory using Automatic identification and data capture (AIDC) sensors configured to provide device information by receiving information from the inventory that includes, but it not limited to including, bar codes, Radio Frequency Identification (RFID), biometrics, magnetic stripes, Optical Character Recognition (OCR), smart cards, and voice recognition.

The device utilization is processed by system 100 and transmitted, via communication interface 108, to a hospital billing department, medical device supplier, practitioner, clinic, and/or any other entity necessary to track device usage (e.g., insurance, procedure payor, and government reporting entity). It should be noted that system 100 is configured to track inventory systems within the medical and/or hospital including but not limited to, implants, surgical instruments, disposable medical devices, pharmaceuticals, and bracing. Additionally, the inventory control features described herein could be utilized by any system needing inventory control outside of the medical field.

In some embodiments, system 100 utilizes movement patterns for navigation (e.g., surgical navigation, vehicle navigation, etc.). In a surgical context, the actual movement or stimulation of tissue that twitches, moves, or goes in a motion pattern can be tracked by system 100 and used to navigate (i.e., understand where soft tissue is located relative to soft tissue and/or bone). For example, if electrical stimulation is used to stimulate a muscle or nerve to twitch, system 100 can track these movement patterns to determine where the nerve or muscle is located. In another exemplary embodiment, a spasm in the blood vessel can be created to determine where the blood vessel is located to create patterns of navigation. System 100 can also be used at a microscopic level to create navigation at a cellular level where cell membranes and/or cell receptors are stimulated. As movement patterns are tracked, system 100, using methods described herein, could remove pixels and/or enhance or change a visualization. For example, if tissue, cells, and/or membranes are stimulated to move, system 100 could eliminate or remove those pixels.

In some embodiments, aspects of system 100 utilize extensor optical systems. Numerous optical sensors are known to those of ordinary skill in the art. For example, if there are opacities in the way of the optical sensor such as cloudiness, bleeding, or synovial fluid, an optical sensor may inaccurately note properties, such as pH or pressure. By removing opacities, system 100 improves the functioning of the optical sensors. In some embodiments, system 100 changes light to color the frequency or intensity by strobing, flashing on/off, and/or displaying different intensities as it reflects (i.e., albedo). System 100 may also remove tissues that reflect differently based on light color, frequency, intensity, and/or strobe.

FIGS. 2-4 are schematic diagrams of exemplary procedural components 210, 230, and 250 that may be used with system 100, shown in FIG. 1. FIG. 2 is a schematic diagram of an exemplary procedural component 112 in the form of a telemanipulator 210. Telemanipulator 210 receives operational instructions from a user/surgeon operating input interface 104. In such an embodiment, the user/surgeon is capable of performing normal surgical movements while arms 212 carry out those movements using end-effectors and manipulators 214 to perform the actual surgery on the patient 200. It should be noted that utilizing a telemanipulator 210, the surgeon does not have to be present in the operating room, but can be anywhere in the world, leading to the possibility for remote surgery. In some embodiments, telemanipulator 210 includes an imaging device 110 (e.g. endoscope) within an arm 214.

FIG. 3 is a schematic diagram of an alternative procedural component 112 in the form of a user movable robotic arm 220. In the exemplary embodiment, a surgeon manipulates arm 220 by moving an end effector 222 into place by movement of handle portion 224. During a procedure, the surgeon utilizes arm 220 and more specifically end effector 222 with limitations that are imposed by computing device 102 and/or processor 122 with information obtained from imaging device 110.

FIG. 4 is a schematic diagram of an alternative procedural component 112 in the form of a manual surgical tool 230. In such an embodiment, tool 230 is manufactured to be portable (i.e. hand-held) such that the surgeon can manipulate the tool 230 during a procedure. Tool 230 includes an end effector 232 capable of performing surgical functions on a patient. In an embodiment, tool 230 can be at least partially sterilized. In another embodiment, tool 230 includes surgical drains that cover part of tool 230 and sterilize parts in an operating room, such as sleeves, drapes, and the like.

It should be noted that system 100 is configured to complete an entire surgical procedure utilizing only system 100, inclusive of the procedural component 112 which non-limiting examples are represented by telemanipulator 210, arm 220, and tool 230. As noted above, procedural component may include one or more end effectors 214, 222, and 232 to perform to actions needed to perform the surgical procedure. The actions of component 112 can be any surgical action including, but not limited to, sewing, stitching, stapling, cutting, sawing, cauterizing, grasping, pinching, holding, tensioning, moving, implanting, removing, viewing, sensing force, sensing pressure, and tying. The end effectors 214, 222, and 232 can be any end effector needed for performing the surgical actions including, but not limited to, forceps, needles, needle drivers, retractors, clip appliers, probe graspers, cardiac stabilizers, balloons, tissue dissectors, saws, knives, mills, reamers, coagulation devices, lasers, ultrasonic transducers/probes, cautery instruments, scalpels, staplers, scissors, graspers, and sealers.

In the exemplary embodiment, system 100 includes at least one imaging device 110. As shown in FIG. 5, imaging device 110 can substantially surround or be positioned adjacent patient 200 undergoing a procedure (i.e., intraoperative) performed at least in part by procedural component 112 and/or end effector 114. In the exemplary embodiment, imaging device 110 includes a C-arm 300 coupled to a scanner 302. In one embodiment, scanner 302 is a gamma camera configured to detect radioactive tracers inside the body of patient 200. Alternatively, scanner 302 is any device that is capable of scanning and/or detecting environmental information of patient 200, a surgical site, and/or and operating room including, but not limited to, endoscopy, fluoroscopy (e.g. X-ray, CT, CAT scan), laser or ultrasonic Doppler velocimetry, projection radiography, MRI, SPECT, PET, ultrasound, infrared, elastography, tactile imaging, photoacoustic imaging, thermography, tomography, echocardiography, NIRS, and fNIRS. In an embodiment, environmental information scanned and/or detected via a plurality of techniques may be combined (e.g., combining visible light wavelengths and infrared for imaging technologies). In some embodiments, imaging device 110 may have one or more scanners 302 located at, near, adjacent, or in a surgical site to perform imaging In one embodiment, imaging device 110 includes a scanner 302 that is configured to locate procedural component markers 250 positioned on procedural components 112. Marker 250 information is transmitted to computing device 102 to determine component location relative to patient 200, other components of system 100, and/or the operating room. In the exemplary embodiment, system 100 includes an imaging device 110 that provides holistic imaging of a surgical site to provide users with the necessary imaging to complete a procedure. For example, in a knee arthroplasty procedure, the imagine device(s) 110 used in the procedure would provide the surgeon images of the knee as well as relative joints (e.g., hip and ankle) to ensure an effective procedure. In such a procedure, system 100 would produce a three-dimensional model of the hip, knee, and ankle to provide views of the procedure in all angles including anterior-posterior (AP) views and medial-lateral (ML) views. While a non-limiting example of an arthroplasty procedure is provided, it should be noted that the holistic imaging could be utilized with any type of procedure utilizing system 100.

In preparation for use of the robotic system 100, a calibration is required to ensure that accuracy of the end effectors 114. Typically, imaging (e.g. CT) of the patient is done preoperatively and the images are loaded into system 100. In some instances, during the calibration of system 100, while patient 200 is in the operating room and on the operating table, patient markers are placed or pinned into the body to provide landmark information. The system 100 is configured to associate the patient landmark information with the images provided preoperatively to provide a map of a surgical site as shown in FIG. 9.

In some embodiments, calibration is aided by coupling the robotic system to the surgical table and/or the patient. Coupling system 100 to a surgical table or bed provides system 100 relative patient position information as the patient is moved during a procedure. Referring to FIG. 2, procedural component 112 can be configured to couple directly to table 220 at a base 230 of telemanipulator 210 or at or near arm(s) 212 of telemanipulator 210 via coupling mechanism 232. Referring to FIG. 3, movable robotic arm 220 can be configured to have one or more recesses or docks 240 provided within arm 220 to couple directly into table 220. In addition to being coupled to table 220. Components 112 can be coupled directly to the patient. In some embodiments, custom molded or 3-D printed devices 250 can be created for each patient to be worn during a procedure. To create such devices 250, preoperative scans are taken of a surgical site and custom fit devices 250 would be manufactured to be placed on the patient. In one such non-limiting example, as is shown in FIG. 3, for a brain surgery, a helmet 250 is custom manufactured for patient 200 and includes attachment portions 252 that provide a coupling point for components 112 as well as apertures 254 for performing the procedure. Devices 250 can be manufactured to fit any body portion undergoing a procedure including, but not limited to, an abdomen, leg, knee, foot, ankle, neck, back, torso, arm, hand, head, and face.

It should be noted that procedural components can be configured to dock or electrically couple into surgical tables or beds such that communication from each can be transmitted back and forth via a communications interface. In some embodiments, procedural components 112 rigidly couple to the table or bed while other embodiments provide an electrical wire, cable, or wireless (e.g., Bluetooth or Wi-Fi) coupling between the components 112 and the table. In addition, in some embodiments, procedural components 112 rigidly couple directly to a patient or to surgical instrumentations utilized during a procedure (e.g., surgical robot, instrumentation, visualization system, retractor, electrosurgery system, knife, saw, and mill). In some embodiments, procedural components 112 are used in a transmitter/physician office or other locations such as insurance companies and the like.

In the exemplary embodiment, a radioactive tracer is inserted into the body and landmark information of the patient is determined by a radioactive detector (e.g. scanner 302) of system 100 and provided to a surgeon via presentation interface 106 to increase the efficiency and accuracy of the procedure. As is commonly known, radioactive tracers emit gamma rays from within the body. These tracers are generally short-lived isotopes linked to chemical compounds (e.g. radiopharmaceutical) that enable examination of specific physiological processes and/or anatomical landmarks. In some embodiments, the tracers are given through an intravenous injection (e.g. IV), inhalation, or orally. In some embodiments, the tracers are optical and/or biodegradable.

In the exemplary embodiment, Technecium-99m is used as the radioactive tracer. Technetium-99m emits 140 key gamma rays with a half-life of approximately 6 hours that exits in the form of pertechnetiate ion (TcO4). Alternatively, any radioactive tracer could be used with the systems and methods described herein, including but not limited to, Bismuth-213, Calcium-47, Carbon-11, Cesium-137, Chromium-51, Cobalt-57, Cobalt-60, Copper-67, Dysprosium-165, Erbium-169, Fluorine-18, Gallium-67, Holmium-166, Indium-111, Iodine-123, Iodine-125, Iodine-131, Iridium-192, Iron-59, Irridium-192, Krypton-81m, Lutetium-177, Molybdenum-99, Nitrogen-13, Oxygen-15, Palladium-103, Phosphorus-32 & 33, Potassium-42, Rhenium-186, Rhenium-188, Rubidium-82, Samarium-153, Selenium-75, Sodium-24, Strantium-85, Strontium-89, Strontium-92, Sulfur-35, Technecium-99m, Thallium-201, Uranium-235, Xenon-133, Ytterbium-169, and Yttrium-90.

In some embodiments, the tracers are detected by a gamma camera, which recognize photons enabling a view of internal landmarks of a patient from many different angles. In such an embodiment, the camera builds up an image from the points from which radiation is emitted and the image is enhanced by system 100 and viewed by a physician on monitor 106. In an alternative embodiment, a Positron Emission Tomography (PET) is performed in which a PET camera detects emission of two identifiable gamma rays in opposite directions to identify landmarks. In yet another embodiment, myocardial perfusion imaging (MPI) is performed to identify landmarks. In some embodiments, images having landmarks identified with tracers (e g gamma, PET, MPI) are utilized with a computerized tomography (CT) scan and the images are co-registered (e.g. layered) by system 100 to provide complete landmark information. It should be noted that the tracer images can be co-registered with any other type of imaging (e.g. ultrasound, x-ray, and MRI) to produce landmark information. In an embodiment, the tracers are used for ultrasound navigation with or without radiation. The ultrasound navigation may be utilized for surface mapping or registering anatomical data points.

During robot assisted surgery, such as surgery utilizing system 100, it is necessary to have multiple fixed points for recognition by trackers to allow for navigational computation. Currently, in the case of arthroplasty, invasive pins are inserted into the bones to calibrate the robotic system and to create landmarks. In the exemplary embodiment, the landmark information found via tracers is utilized for calibration and navigational computation. In such an embodiment, after the radiopharmaceutical (e.g. technetium) is introduced into the system, the tracer is taken up by osteoblasts and noted on resulting images. Often, the tracer appears dark on an image and can be known as a hot spot. These locations are co-registered with other images, by system 100 and the system 100 performs calculations using known algorithms to determine key distances and/or boundary layers for surgery.

FIGS. 6A and 6B are illustrations of an exemplary image 400 created, displayed, and/or utilized by system 100. In the exemplary image 400, a bone scan created with the use of a gamma camera is shown with multiple hot spots 402, indicative of the location of the radiopharmaceutical. In some embodiments, a (e.g. surgeon, physician's assistant, nurse) creates a cut within tissue (e.g. bone) that would promote osteoblast formation and hot spot formation as the osteoblast will absorb the tracer. In such an embodiment, the tracer can be injected and/or placed directly on the cut such that the tracer remains substantially in place and avoids systemic introduction of the tracer. In an embodiment, different tracers may be absorbed into different tissues such as thyroid, liver, kidney, and the like. The system 100 is also capable of creating, displaying, and/or utilizing three-dimensional images using ultrasound, radialized isometry, and/or three-dimensional views anterior, posterior, and circumferential.

In one embodiment, as shown in FIG. 7, in addition to, and/or in substitution of, creating tissue cuts, a user places one or more tissue markers 420 in discrete locations within the body. The tissue marker 420 can be injected, filled, or formed with a tracer to provide location information (e.g., via a thermogram). In one embodiment, the marker 420 is a scaffold that is formed to adhere to the contours of body tissue. The scaffold 420 may be formed to adhere directly to the tissue and/or be affixed with a fixation substance (e.g. surgical adhesive, bio-adhesive, glue, fasteners, ultrasonic welding, other tissue reconstruction repair approaches). Alternatively, tracers can be compounded with an agent (e.g. PLLA, collagen) and positioned on the tissue with or without the use of a fixation substance. It should be noted that the markers can be biodegradable such that the tissue marker can remain in the body after the surgical procedure. Additionally, the markers can be fabricated from a non-biodegradable material. In some embodiments, the markers include a wireless transmitter (e.g. RFID tag, Bluetooth) that provides, at minimum, location information for inventory and/or complication risk assessment. Additionally, the markers can be sensors in the tissue.

In one embodiment, sensors 422 are positioned within a procedure site. The sensors 422 are configured to detect and transmit non line of sight surgical data to the surgeon, through system 100. Although the sensors are configured to communicate with system 100 in a wireless fashion, the sensors 422 can electrically couple to system 100 to communicate directly over a transmission line (e.g. fiber or metallic cable). In one embodiment, the sensors 422 would act as Geiger counters and detect tracers within a particular location. In an embodiment, sensors 422 are powered by capacitors. In another embodiment, sensors 422 are powered by body flow across cell membranes (i.e., turning tissue into a battery) by utilizing electrical energy through the membranes through thermal application. It should be noted that the body flow could be accomplished through synthetic tissue. In an embodiment, sensors 422 measure microcellular micro-cellular electrical gradients inside the cell. In some embodiments, sensors 422 are configured to detect force to provide feedback as to the forces exerted on and around tissue. In some embodiments, sensors 422 measure electrical pulses emitted by the body (e.g. nerves) during surgery. In such embodiments, sensors 422 can detect pulses by EEG, EMG, micro electrode arrays, or other electrophysiological recording methods. In one embodiment, sensors 422 are provided such that somatosensory evoked potentials are detected during a procedure. It should be noted that sensors 422 can be any sensor that monitors environmental factors including, but not limited to, force, acoustic, vibratory, density, pressure, optical, chemical, and electric. In some embodiments, sensors 422 are optical and/or biodegradable. Sensors 422 may also be positioned on the skin of a patient or implantable in the body of the patient. In some embodiments, sensors 422 partially degrade. For example, sensors 422 could include a biodegradable coating or slowly degrade over a specific time when exposed to water. The degradation may be hastened by heat, pH, and the like. In some embodiments, sensors 422 are rechargeable, such as through electromagnetic, optical, laser, ultrasound, vibratory, and/or thermal techniques.

In one embodiment, sensors 422 are configured to measure distances of particular tools. For example, as shown in FIG. 7, an end effector 114 (e.g. ultrasonic scalpel) may have an emitter 424 positioned at a fixed location. As end effector 114 is inserted in the body, system 100 can monitor the distance of the tool relative to sensor 422. In the exemplary embodiment, the sensor is placed on at least a portion of the spinal cord 430. As the tool would progress internally towards the spinal cord 430, system 100 and/or processor 122 would lock-out (prevent) end effector from functioning and/or progressing to prevent disruption of spinal cord 430. In some embodiments, sensors detect tools directly without the need for an emitter. For example, sensor may detect the vibratory or acoustic energy emitted by tool to determine a location of the tool relative to the sensor.

As noted above, system 100 can be calibrated such that the markers 420 and/or sensors 422 provide boundaries such that disturbances to portions of the body not part of the surgical procedure are minimized Additionally, the markers 420 and/or sensors 422 can provide a secondary layer of protection should a fault occur. In such an embodiment, the markers and/or sensors can require the software of system 100 to perform a first check of calibration and confirm navigation throughout the procedure.

It should be noted that while methods and systems shown herein are depicted for arthroplasty, the methods and systems described herein can be utilized in any part of the body for any surgical procedure. For example, a tracer could be absorbed into organ (e.g. heart, gallbladder, etc.) which enables system 100 to create a boundary for procedural component 112 and/or end effector 114, such that the end effector does not work outside of the boundaries created using information obtained from markers 420, sensors 422, and/or scanners 302. Accordingly, as the soft tissue moves or is moved, system 100 can maintain an accurate location of the surgical site. Moreover, the methods and systems described herein can be utilized for robotics and/or haptics guided with preoperative imaging via CT, MRI, ultrasound techniques, and the like. The method and systems described herein may also be utilized standalone intraoperatively.

In the exemplary embodiment, system 100 receives instructions from software that enables processor 122 to determine boundaries within a surgical site and prevent (e.g., lock-out or disable) components 112 and/or end effectors 114 from operating outside of the determined boundaries. To this, if a components 112 and/or end effectors 114 are prevented from continued operation due to a boundary, system 100 and/or processor 122 is configured to determine whether to move the component 112 and/or end effector 114 or a portion (or all) of table 220 to enable further operation of the component 112 and/or end effector 114. In one embodiment, the determination of what object to move is provided to a surgeon to enable manual intervention.

Alternatively, system 100 provides signals to the appropriate object (e.g., effector 114 or table 220) to enable the procedure to continue. The signals provided to the table 220 can be any signals that effect a table to re-position a patient as needed, including but not limited to, manipulating, rotating, torqueing, twisting, distracting, flexing, extending, elevating, descending, inflating or utilizing a retractor (i.e., internal or external) or bolster that aid in bringing objects into/out of a surgical site. Such a repositioning of objects enables a surgeon to optimize portions of a body relative to a portal or incision. For example, system 100 is configured to provide instructions to manipulate vessel blood flow, organ position, or the position of any other body part. The signals provided to the table 220 can also be any signals that affect a table to move relative to a body part. The body part could also move relative to the table 220 and/or relative to other systems (e.g., 120, 122, 124, and 220) coupled to system 100. Moreover, the table and the body part could both move together synchronously or independently. In addition to providing instructions to manipulate table 220, system 100 can also provide instructions to other systems (e.g., 120, 122, 124, and 220) coupled to system 100. For example, system 100 manipulates a change in table 220, system 100 would also transmit a signal to adjust lighting or visualization to re-position to the new location of the surgical site. The signals described herein may enable control and/or activation of aspects of system 100 through voice commands, remote commands, imaging controls, and/or robotic activation. Aspects of system 100 may also be controlled with a robotic mechanism with or without navigation or visualization.

Additionally, if processor 122 determined that a repertory change of the patient would aid in the effectiveness of the procedure, a signal can be generated and transmitted to the anesthesia system and/or anesthetist to alter the anesthetic (e.g., amount or type) given. In an embodiment, processor 122 generates and transmits a signal to dictate anesthesia to, for example, increase or decrease inflation of the lungs, change the blood pressure, heartbeat rate, lung volume, and the like. Moreover, processor 122 is capable of controlling electrical currents for transcutaneous electrical nerve stimulation (TENS) to stimulate muscular activity and/or vascular activity and control position. For example, electrothermal vibrations could be used to stimulate tissue and/or electrical soma.

FIG. 8 is a cut-away perspective view of an exemplary temperature implant 500 for use with system 100 shown in FIG. 1. Implant 500 includes a heating portion 502 that provides heating to tissue in direct contact with implant 500. Implant 500 also includes a cooling portion 504 that surrounds and is adjacent heating portion 502 that prevents heating of tissue that is not in direct contact with heating portion 502. Heating portion includes a surface 506 that is configured to increase temperature as a result of a heating element 510 positioned within implant 500. Heating element 510 can be any element that produces heat to surface 506 including, but not limited to, metal, ceramic, and composite. In one embodiment, heat is produced from the use of vibratory (e.g. ultrasonic) energy. In the exemplary embodiment, surface 506 is fabricated to include a polymer but can include any material that enables heat transfer including, but not limited to, metals and polymer composites. In some embodiments, heating portion 502 includes a magnetic surface. Heating element 510 can also be any element that produces electrical charges to an implant surface, cell membrane, tumor, or infection, for example through microscopic membranes, cell membranes, nerve fibers, mitochondria, and/or intracellular.

To provide cooling to implant 500, cooling portion 504 includes a heat exchanger to reduce heating of tissue that is not in direct contact with surface 506. In one embodiment, implant 500 is fabricated to be modular. In such an embodiment, implant 500 is fabricated to have multiple removable sections such as a base section 520 and first modular section 522. Modular section(s) 522 can be added or removed to increase or reduce the size of the implant 500 thus providing for a variable sized implant.

In the exemplary embodiment, heating element 510 and/or cooling portion 504 is powered by a controller 530 and power source 532. In one embodiment, power source 532 is a battery. Alternatively, power source 532 is a power converter that converts power (e.g. A/C or D/C current) from a power source (e.g. outlet) into electrical signals for use by the heating element 510 and/or heat exchanger 504. Implant 500 also includes sensors 534 configured to monitor environmental factors within the operating site. In one embodiment, a sensor 534 is temperature sensor configured to monitor the temperature of implant 500 and/or the tissue in contact with surface 506 and/or the tissue adjacent to implant 500. Additionally, the sensors 534 can be any sensor that monitors environmental factors including, but not limited to, force, acoustic, vibratory, density, pressure, optical, chemical, and electric. In some embodiments, implant 500 includes a timer (not shown) coupled to controller 530 that enables controller to selectively provide power to heating element 510 at predetermined times or intervals. In an embodiment, sensors 534 are internal sensors.

Sensors 534 are coupled to a communication interface 540 coupled to processor 542 and/or controller 530. Communication interface 540 communicates with system 100, shown in FIG. 1. In addition to providing operating site information, communication interface 540 also receives instructions, remotely, for powering and adjusting parameters (e.g. temperature) of implant 500. To communicate with system 100, communication interface 540 may include, for example, a wired network adapter, a wireless network adapter, and/or a mobile telecommunications adapter. Moreover, communication interface 540 may communicate via nerve transport, cellular membrane transport, and/or cellular signals.

In use, implant 500 is placed on tissue. In some embodiments, implant 500 heats tissue for a predetermined amount of time and then removed. After removal, a thermogram scan can be taken to provide landmark information to system 100. In one embodiment, implant 500 remains positioned within the body to allow for selective heating of tissue throughout the procedure. The resulting thermogram images can be co-registered with other images (e.g. CT, MRI, X-Ray, Gamma) taken of the patient to provide landmark information to system 100 and/or the surgeon. In some embodiments, the thermogram can be utilized as an alternative to the radioisotopes described above. The advantages of the use of implant 500 and the resulting thermogram images is that landmark information can be provided and registered without having direct line of site enabling the implant 500 to be positioned on the side, back, or into the padding behind the arthroplasty as one would not require direct line of site, which would impede the surgical procedure. In some embodiments, implant 500 uses electrical, thermal, and/or magnetic techniques to stimulate muscle, vessels, nerves, and the like to contract over movement patterns. Landmark information can be detected by creating boundary levels as well as navigation. For example, a stimulator would move to detect where the movement is and then create boundary layers or guidance direction to a specific site.

In one embodiment, system 100 includes a scanner 302 in the form of a vessel determination device. The scanner is configured to locate vessels and flow rates in the body. The scanner 302 can include any flow determination technology for locating vessels including, but not limited to ultrasonic flow meters and/or laser Doppler velocimeters. Once the vessels are located, positional information can be transmitted to system 100 to be input into images and navigation calibration. In one embodiment, system 100 determines the type of vessel (e.g. artery, vein, capillary) based on the size and/or flow rates of the located vessels. Vessels that are within a procedure site can be used as boundaries such that procedural component 112 and/or end effector 114 will be disabled when approaching the vessel to maintain patient safety during the procedure.

FIG. 9A is an exemplary image 600 created by processor 122, shown in FIG. 1, using information received from scanners 302 for display on interface 106. FIG. 9B is a schematic representation of image 600. Image 600 is created by co-registering multiple images created from scanners 302. As can be seen in the image, a knee joint having a femur 604 and tibia 606 are created from an MRI. Image 600 also displays a vessel 602 positioned behind the femur 604 and tibia 606 from flow determination technology. Radioactive tracer information is shown by hot spots 608 that were derived from a gamma camera or PET, ands sensors 422 or markers 610 can be located as well. Image 600 also includes thermography information 612 from the patient. In one embodiment, image 600 includes cutting guides 614 that display portions of tissue that will be removed by the surgeon. It should be noted that any and all of the landmarks, sensors, or makers that can be identified by system 100 can serve as boundaries or limitations on procedural components 112 and/or end effectors 114. Additionally, any of the imaging and/or landmark determination techniques described herein can be combined such that processor 122 can co-register the information to produce images and instructions for system 100.

In addition to image 600, processor and/or system 100 can also generate a composite image of the surgical site in the form of an animation or 3-D rendering based on the information shown in FIG. 9. Such an image would provide a reconstruction of the surgical site enabling the surgeon to rotate through the surgical site and visualize the entire site from any desired angle. As noted above, the images produced would also enable a surgeon to receive a holistic view of a site. For example, while a portion of image 600 displays a portion of the knee, a surgeons' view would provide views of the pelvis, hip, foot, and ankle for relative information. Such information is vital to determine how objects in the surgical site (e.g., knee movement) affect remote portions of the body (e.g., hip, spine, and ankle). In addition to optical changes, the images produced may also enable detection of electrical and/or motion patterns.

In the exemplary embodiment, the images produced by system 100 also provide a surgeon the ability to locate anatomical structures (e.g., bones, organs, arteries, vessels, cartilage) in a surgical site and denote those structures by color coding or labeling. Such structures can also be removed or added to a view, via input interface 104, during a procedure based on the surgeons' needs. Images produced by system 100 may also be utilized for external ablation systems that utilize ultrasound, thermal, and like techniques to refine exact tissue location for ablation of tumors, treatment of infection with antibiotics to enhance growth, neurologic tissue, rewire neurons, and/or repair complex neurological bundles.

To decrease the trauma (e.g. pain, swelling, etc.) received or resulting from a surgical procedure, surgical markers and/or sensors can be positioned at points of interest for a surgeon. The surgical markers are substances including a dye that fluoresce when exposed to ultraviolet light (UV). As an alternative to directly placing the surgical markers on tissue, tissue closure devices (e.g. suture, staples) can be impregnated with the dye such that it is absorbed or transferred to the tissue that is in direct contact with the closure device. For example, in a revision arthroplasty procedure in which an infected joint replacement component is being extracted and replaced, the surgeon can position surgical markers on the incision or open tissue after he/she extracts the joint replacement component and before closing the surgical site to allow the body to eliminate/fight the present infection. When patient returns for the secondary procedure (e.g., placing a drug local into the body), ultraviolet light can be used to locate former incision locations. Using the UV indicated locations, a surgeon can utilize the former incision to open the surgical site. Utilizing a former incision can greatly reduce pain, inflammation, and trauma to the patient as scar tissue generally forms at locations of former incisions, which has been found to be less traumatic to a patient than disturbances (i.e. cuts) to muscle tissue.

In addition to the images created in system 100 from imaging devices 110, system 100 can include software filter for filtering out material and/or objects from an image that can restrict line of sight of a user (e.g., physician/surgeon, driver, machine operator, etc.). For example, the filters described herein would enhance the surgeon's ability to visualize a surgical site during a procedure (e.g., arthroscopy) by filtering opaque bleeds or blood flow and allowing the surgeon to determine the location or source of the bleed. In another exemplary embodiment, the filters described herein would enhance the driver's ability to visualize upcoming stretches of roadway by filtering fog, rain, and the like and allowing the driver to determine if hazards exist on the upcoming stretches of roadway. When video is digitized, each frame is represented by a two-dimensional array. Each location in the array represents a pixel and each pixel contains a set of values representing color and other attributes. The filters described herein manipulate these pixel values. For example, the filters described herein may change pixels and/or remove pixels with or without electrical charges or motion changes. It should be noted that these filters could be applied to any video format and coding methods including, but not limited to, PAL, NTSC, MP4, and AVI.

In one embodiment, a first filter is utilized within system 100 and the first filter is configured to determine when blood exists in the saline solution of a surgical site during surgery. This is accomplished by monitoring a sequence of frames for a range of target colors that move in a particular pattern. In one embodiment, the first filter lowers the color values of blood to match the surrounding colors. Alternatively, the first filter lowers the intensity of color of blood (e.g. red) to enable the surgeon to better visualize the intended area. In some embodiments, the first filter lowers the color values and well as lowering the intensity of color. For example, one could see the reflective coefficient (e.g., albedo), albedo with different light sources, and/or different movement creating the changes. In some embodiments, the first filter accomplishes the determination with vibratory changes, acoustic changes, moving cells that change, and/or move or have specific electrical charges. The first filter could remove these pixels in the tissue/bone. In some embodiments, the target (e.g., tissue) may be magnetized. In some embodiments, the filter bounces, changes, and/or reflects light. For example, the filter could enable a user to see around corners with reflective light by using an albedo or reflective coefficient.

In another embodiment, a second filter is utilized by system 100 to provide images to a user. The second filter is configured to adjust particular colors in an image by removing pixels in each frame that meet a predetermined criteria (e.g., blood flow). The pixels in the buffer which would be displayed on a standard image without the use of second filter would then be used in place of the obscured pixels. This would give the second filter hysteresis which would allow it to use previous information to help recreate what is behind an object (e.g., blood, synovium, tissue fats, debris, bone fragments) that could obscure the view other objects of interest (e.g., soft tissue, cartilage, muscle, bone). It should be noted that the first and second filters could be used in combination to provide an accurate rendering of a surgical site enabling a surgeon to selectively eliminate unnecessary objects from their view. For example, multiple filters could be used to change orange pixels to red pixels. In some embodiments, one filter is a software filter, for example a mechanical filter (e.g., film, prism, Fresnel lens, UV lens).

In some embodiments, the second filter is utilized by generating a baseline image and comparing the baseline image to new images taken at predetermined time increments (e.g., 0.1, 0.5, 1, 2, 30 seconds or minutes). In such embodiments, pixels could be compared to determine flow patterns of fluid or other moving objects. Additionally, system 100 is configured to enhance objects in an image by receiving imaging information, comparing to known imaging information (e.g., pre-operative scan), determining the differential and adding necessary data to the received imaging information.

FIG. 9 is an exemplary flowchart 700 of a method of visualization for use with the system 100 shown in FIG. 1. In the exemplary embodiment, system 100 receives an image of a site. In some embodiments, an image is received by computing device 102 from an imaging device 110 and or input interface 104. In some embodiments, images are received by computing device 102 from a remote location through communications interface 108.

FIGS. 10-13 are images utilized with the method shown in FIG. 9.

In some embodiments, system 100 utilizes filters to determine the source of the blood flow. Once system 100 and/or processor 122 determines the location or source of a blood flow, system 100 can indicate, on the image, the source of the blood. Additionally, system 100 can also indicate a particular concentration of blood in the image at certain areas where the blood is has stronger concentration. In some embodiments, system 100 can determine the velocity of the blood flow in one or more locations, which may indicate the source of blood flow. Any of the determinations described above, can be indicated on an image, by system 100 and/or processor 122, with indicia having non-limiting examples of a circle, marker, or color differentiation so that the surgeon can easily locate the area of blood flow to allow for electrocautery, to locate the source of the bleed, and/or to apply pressure for coagulation.

In one embodiment, a diagnostic ultrasound or B-Mode ultrasound head is imbedded into an imaging device 110 (e.g., camera) to enable overlaying the information from the diagnostic ultrasound with the video image in real time. This provides the surgeon a 3-dimensional view of the surgical site as well as the direct camera view. Such a combination is useful in removing blood or other debris from the surgeon's view with filters. In some embodiments, a second portal or external ultrasound is utilized in conjunction with the camera to enable these filters as well. If either internal or external ultrasound is used, it is possible to use Doppler information to better detect blood for filtering. The filters would work as previously mentioned for either removal the color or using information from previous frames. The Doppler information is useful in a more precise determination of the location of the bleed. The filter should also monitor for dramatic increase in the blood flow. If system 100 determines an increase in blood flow has occurred, an alert is transmitted to the users that a bleed is occurring and being filtered out that might require attention. In one embodiment, the alert is provided as an overlay warning the surgeon of the increase in blood flow. Alternatively, system 100 can be configured to turn off filters when an amount of blood in the field of view exceeds a predetermined threshold. In some embodiments, system 100 is configured to filter out objects that produce a reflection at or above a predetermined threshold.

In one embodiment, system 100 creates a charged particle filter used for filtering out particular objects. In such an embodiment, system 100 projects or transmits a number of charged particles (e.g., ions in a gas) at a site that attach to a particular object. The charge is selected by determining an object to be filtered out and charging particles to a predetermined setting that would enable the particles to attach or couple to the object. Once the particles attach to the object, system 100 detects the location of the objects and filters out the information from the images generated.

In some embodiments, physical optical filters are utilized on or with lighting and visualization systems to aid in visualization. For example, physical filters could be applied to the lights to substantially block a predetermined color (e.g., red) from appearing in the imaging. Alternatively, physical filters can be utilized to substantially increase the brightness or coloration of particular color in an image. As such, the physical filters can be applied to block out additional unwanted properties (e.g., UV, sun photons).

In the exemplary embodiment, system 100 is configured to enable a surgeon and/or user to switch between the filters, combine particular filters, remove particular filters, and turn the filters on and off all together. While the software filters discussed above were provided in the application of blood during surgery, these techniques could also be used to eliminate other unwanted elements of an image including, but not limited to, smoke that is released during electrocautery, or moving objects and debris in the view of the camera. The visualization system described herein is valuable because the system 100 enables a surgeon to operate or perform a surgical procedure in a substantially dark room reducing heat from the lights, which can be detrimental during a procedure and affect tissue healing. Additionally, the system described herein eliminates the necessity for water or carbon dioxide air during an endoscopic procedure.

In some embodiments, imaging device 110 is an ingestible-type camera for examination of the internal system of a body (e.g. abdomen). An endoscopic application, colonoscopy, or microsurgery could be used to repair individual nerve fibers or vascular fibers. Aspects of system 100 could be used for cardia ablation to localize exactly where irregular cardiac rhythms are coming from.

FIG. 10 is a data flow diagram of an exemplary two-input filtering method 700 for use with the system 100 shown in FIG. 1. In the method 700, computing device 102 creates buffered scenes 702 from current scenes captured by a primary camera (e.g., imaging devices 110). The computing device 102 uses scenes captured by a secondary camera (e.g., imaging devices 110) to create a background model 704. The secondary camera may capture images using CT, MRI, infrared, ultrasound, and/or like techniques. The computing device 102 subtracts the background model 704 from the current scene captured by the primary camera utilizing a threshold (T1) to create a foreground mask 706. Moreover, the computing device 102 takes the complement of the foreground mask to generate a foreground mask complement 708 (i.e., a background mask). The computing device 102 subtracts the foreground mask 706 from the current scene captured by the primary camera to generate a background 710. The computing device 102 also generates a foreground 712 by subtracting the foreground mask complement 708 from the current scene captured by the primary camera. And the computing device 102 subtracts the foreground mask complement 708 from one or more buffered scenes 702 to generate a buffered background 714. The computing device 102 generates a weighted average or threshold (T2) of the foreground 712 and the buffered background 714. The computing device 102 then generates an output frame 716 by determining the absolute difference between the background 710 and the weighted average.

FIG. 11 is a data flow diagram of an exemplary two-input filtering method 800 for use with system 100 shown in FIG. 1. In the method 800, the computing device 102 creates buffered primary scenes 802 from current scenes captured by the primary camera and buffered secondary scenes 804 from current scenes captured by the secondary camera. The computing device 102 uses the buffered primary scenes 802 and buffered secondary scenes 804 to find frames where the object in the foreground obstructing the view is not present. In this embodiment, the computing device 102 may create the background model 704 from any combination of the primary input, secondary input, output frame 716, primary buffer 802, and secondary buffer 804. As described above, the computing device 102 utilizes the background model 704 to create a foreground mask 706 from the primary camera. In addition to generating the background 710 as described above, the computing device 102 applies the background mask 708 to the primary camera input to generate a primary foreground image 806. The computing device 102 also applies the background mask 708 to the secondary camera input to generate a secondary foreground image 812. To create a buffered primary foreground image 808, the computing device 102 applies the background mask 708 to images selected from the buffered primary scenes 802. And the computing device 102 generates a buffered secondary foreground image 810 by applying the background mask 708 to images selected from the buffered secondary scenes 804. The computing device 102 takes a weighted average of the primary foreground image 806 over time T2, the buffered primary foreground image over time T3, the buffered secondary foreground image over time T4, and the secondary foreground image 812 over time T5. The final output frame 716 is generated by the computing device 102 taking the absolute difference between the weighted average and the background image 710.

FIG. 12 is a data flow diagram of an exemplary color shift filtering method 900 for use with system 100 shown in FIG. 1. In the method 900, the computing device 102 creates a primary color shift image 902 from the primary camera input and a secondary color shift image 904 from the secondary camera input. In an embodiment, the color shifts are dependent upon one or more wavelengths of interest. The computing device 102 applies the background mask 708 to the color shifted primary image 902 to create a color shift primary foreground image 908 and applies the background mask 708 to the color shifted secondary image 904 to create a color shift secondary foreground image 910. The computing device takes a weighted average (T2) of the primary foreground image 806, the color shift primary foreground image 908 threshold (T3), the color shift secondary foreground image 910 threshold (T4), and the secondary foreground threshold (T5). The final output frame 716 is generated by the computing device 102 taking the absolute difference between the weighted average and the background image 710.

The system and methods described above could be used in tumor, oncology, endoscopic, arthroscopic, and/or tissue ablation procedures such as ultrasound ablation. For example, the system and methods could be used for guidance, direction, and/or location tasks during surgical procedures. In some embodiments the system and methods could be done on a macroscopic level and in some embodiments the system and methods could be done on a microscopic level, looking for specific cells, movement patterns, visualization patterns, and/or electromagnetic patterns. In an embodiment, the system and methods described above could be used to detect cells such as tumor cells or infections, which could be removed with navigation visualization provided by aspects of the system and methods. For example, one could have a patient adjust or intravenously give a marker that would absorb by abnormal cells such as a tumor or infectious cells and then visualization aspects of the system and methods could be utilized to remove pixels or enhance pixels with types of light frequency, vibrations, and the like. The tumor or infectious cells could be removed either by external tissue ablation such as ultrasonic, thermal guided ablation, or internally. Moreover, it could guide surgeons during removal of specific cells both on a macroscopic and microscopic level. For example, cells of amyloid deposits for Alzheimer's disease and/or cells that create hypertrophic tissue or infectious tissue.

While the system and methods described above have been described in a non-limiting medical setting, it should also be noted that the systems and methods described above (e.g., software filters) could also be used in non-medical applications, such as optimizing a heads up display on a car when there is fog or rain. In such an embodiment, a vehicle system can be configured to utilize the filters described above to filter objects (e.g., fog, mist, sun, pollution, smoke, or rain) and provide a clear image to vehicle passengers' either in place of a passengers' view or as an addition to a passengers' view. Such a system is also configured to detect objects in the path of the vehicle and alert passengers of the detected objects.

The embodiments described herein enable non line of sight structures and/or landmarks in the body to be observed before, during, and/or after a surgical procedure. As compared to at least some known navigational systems that require objects to be affixed to the body through invasive measures, the systems and methods described herein are capable of providing information to a robotic system to enable calibration and/or boundary layer configuration to assist in creating a more efficient and safe surgical procedure. The methods and systems described herein provide surgeons the ability to calibrate a robotic system and perform surgical procedures without direct line of site needed in known systems. The method and systems described herein could vibrate the visual fields as particles would have different vibratory frequencies based on their densities, thickness, or movement. The particles with variable movement patterns could then be removed. For example, this could be done through vibratory, acoustic, electromagnetic, external compression, internal compression, magnetic frequency, and the like. Although there may be a slight delay, any delay would not affect visualization for surgery treatment or non-surgical tasks.

The embodiments described herein may utilize executable instructions embodied in a non-transitory computer readable medium, including, without limitation, a storage device or a memory area of a computing device. Such instructions, when executed by one or more processors, cause the processor(s) to perform at least a portion of the methods described herein. As used herein, a “storage device” is a tangible article, such as a hard drive, a solid state memory device, and/or an optical disk that is operable to store data.

Although specific features of various embodiments of the invention may be shown in some drawings and not in others, this is for convenience only. In accordance with the principles of the invention, any feature of a drawing may be referenced and/or claimed in combination with any feature of any other drawing. Accordingly, while many procedures described herein relate to arthroplasty or orthopedic surgery, the methods and systems described herein can be utilized in any surgical procedure including, but not limited to, general surgery, cardiothoracic surgery, tissue ablation, ultrasound ablation, arthroscopic procedures, endoscopic procedures, cardiology and electrophysiology procedures, colon and rectal surgery, plastic surgery, anesthesia, pain management procedures, ENT procedures, gastrointestinal surgery, gynecology procedures, neurosurgery, oncology procedures, pediatric procedures, radiosurgery, reconstructive surgery, spine surgery, transplant surgery, urology procedures, and vascular surgery. Additionally, it should be noted that the systems and methods described herein could be utilized to provide encryption technology by determining known patterns and either accepting or rejecting based on a determination that known patterns have been detected.

While system 100 has been described as including a procedural component 112 and at least one end effector 114, it should be noted that system 100 can operate independently to provide visualization and/or navigation to users. For example, system 100 can be utilized in a manual surgical environment where system 100 provides surgical site information to a surgeon operating manually (i.e., without robotic assistance). Additionally, the system 100 described herein can be utilized to provide visualization and/or navigation with other non-medical and/or non-surgical applications. For example, portions of system 100 and method 700 can be installed in vehicles to provide the visualization and/or navigation needed. Portions of system 100 and method 700 can be utilized to enable a driver/passenger to “see through” objects that would limit sight. In the case of a car, truck, motorcycle, bus, or other land vehicle, system 100 and method 700 is utilized to remove fog, cloud cover, rain, sunlight, hail, mist, pollution, smoke, snow, or any other form of debris obfuscating in air or fluid media from a visual image to provide a substantially clear image of the path of travel of the vehicle. Consequently, the system 100 is configured to provide the same visualization to air vehicles (e.g., plane, spaceship, rocket, balloon, unmanned aerial vehicle (UAV) (e.g., drone)) and water vehicles (e.g., boats, ships, and submarines). Additionally, portions of system 100 and method 700 can be utilized in any application reproducing video or image feeds including, but not limited to including, residential and commercial surveillance systems, television production systems and equipment, telescopes, binoculars, marine applications, and satellite imagery. It should also be noted that the system and method described herein can be utilized with technologies described in U.S. patent application Ser. Nos. 14/451,562, 10/102,413, 13/559,352, and 62/275,436, each of which is hereby incorporated by reference in their entirety.

This written description uses examples to disclose various embodiments, which include the best mode, to enable any person skilled in the art to practice those embodiments, including making and using any devices or systems and performing any incorporated methods. The patentable scope is defined by the claims, and may include other examples that occur to those skilled in the art. Such other examples are intended to be within the scope of the claims if they have structural elements that do not differ from the literal language of the claims, or if they include equivalent structural elements with insubstantial differences from the literal languages of the claims.

A robotic system for navigation of a surgical site is provided. The robotic system includes a computing device coupled to a presentation interface, a procedural component, and a communications interface. The computing device is also coupled to a first imaging device configured to provide imaging data of a surgical site. The computing device is also coupled to a second computing device that is configured to provide a second type of imaging data of the surgical site that is different that the imaging data of the first imaging device. The computing device is configured to co-register the imaging data to create a surgical site image for display to a surgeon on the presentation interface.

Claims

1. A surgical system comprising: a robotic system comprising a moveable arm that is configured to support an end effector relative to a surgical site, wherein the end effector is configured to remove material from a bone;a scanner being configured to scan the surgical site and detect a vessel on the bone; andone or more controllers coupled to the robotic system and the scanner and being configured to: obtain image data of the bone;receive, from the scanner, positional information of the vessel on the bone;input the positional information of the vessel to the image data of the bone;generate a boundary for the vessel;register the boundary to the bone for navigation;control the robotic system to remove material from the bone with the end effector; andcontrol the robotic system based on the boundary to prevent interaction between the end effector and the vessel.
2. The surgical system of claim 1, wherein the one or more controllers control the robotic system based on the boundary by being configured to provide movement limitations to the robotic system.
3. The surgical system of claim 1, wherein the one or more controllers control the robotic system based on the boundary by being configured to disable the end effector in response to the end effector approaching the boundary.
4. The surgical system of claim 1, wherein the scanner is configured to detect the vessel by detecting one or more of: blood flow and flow rate related to the vessel.
5. The surgical system of claim 1, wherein the scanner is configured to detect the vessel by utilizing one or more of: an ultrasonic flow meter and a laser Doppler velocimeter.
6. The surgical system of claim 1, wherein the scanner is configured to detect one or more of: a type and a size of the vessel.
7. The surgical system of claim 1, further comprising a display device and wherein the one or more controllers are configured to control the display device to present the image data of the bone and the vessel positioned relative to the image data of the bone.
8. The surgical system of claim 7, wherein the one or more controllers are configured to control the display device to present the vessel behind the image data of the bone.
9. The surgical system of claim 7, wherein the one or more controllers are configured to control the display device to present the vessel with color coding or labeling.
10. The surgical system of claim 7, wherein the one or more controllers are configured to generate a 3-D rendering of the image data of the bone and the vessel, and control the display device to present the 3-D rendering, wherein the 3-D rendering is configured to be rotated and visualized from any desired angle.
11. A method of operating a surgical system, the surgical system comprising a robotic system including a moveable arm that is configured to support an end effector relative to a surgical site for removing material from a bone, a scanner being configured to scan the surgical site and detect a vessel on the bone, and one or more controllers coupled to the robotic system and the scanner, the method comprising the one or more controllers performing the steps of: obtaining image data of the bone;receiving, from the scanner, positional information of the vessel on the bone;inputting the positional information of the vessel to the image data of the bone;generating a boundary for the vessel;registering the boundary to the bone for navigation;controlling the robotic system for removing material from the bone with the end effector; andcontrolling the robotic system based on the boundary for preventing interaction between the end effector and the vessel.
12. The method of claim 11, wherein controlling the robotic system based on the boundary comprises the one or more controllers limiting movement of the robotic system.
13. The method of claim 11, wherein controlling the robotic system based on the boundary comprises the one or more controllers disabling the end effector in response to the end effector approaching the boundary.
14. The method of claim 11, comprising the one or more controllers receiving, from the scanner, one or more of: blood flow and flow rate related to the vessel.
15. The method of claim 11, comprising the one or more controllers receiving, from the scanner, one or more of: a type and a size of the vessel.
16. The method of claim 11, wherein the surgical system comprises a display device, and comprising the one or more controllers controlling the display device for presenting the image data of the bone and the vessel positioned relative to the image data of the bone.
17. The method of claim 16, comprising the one or more controllers controlling the display device for presenting the vessel behind the image data of the bone.
18. The method of claim 16, comprising the one or more controllers controlling the display device for presenting the vessel with color coding or labeling.
19. The method of claim 16, comprising the one or more controllers generating a 3-D rendering of the image data of the bone and the vessel, and controlling the display device for presenting the 3-D rendering, wherein the 3-D rendering is configured to be rotated and visualized from any desired angle.
20. A navigation system configured to be utilized with a robotic system comprising a moveable arm that is configured to support an end effector relative to a surgical site, wherein the end effector is configured to remove material from a bone, the navigation system comprising: a scanner being configured to scan the surgical site and detect a vessel on the bone; andone or more controllers coupled to the scanner and being configured to: obtain image data of the bone;receive, from the scanner, positional information of the vessel on the bone;input the positional information of the vessel to the image data of the bone;generate a boundary for the vessel; andregister the boundary to the bone to provide navigated guidance for the robotic system based on the boundary to prevent interaction between the end effector and the vessel.

CROSS-REFERENCE TO RELATED APPLICATIONS

The subject application is a continuation of U.S. patent application Ser. No. 16/986,467, filed Aug. 6, 2020, which is a continuation of U.S. patent application Ser. No. 16/113,666, filed Aug. 27, 2018, now U.S. Pat. No. 10,765,484, which is a continuation of U.S. patent application Ser. No. 15/299,981, filed Oct. 21, 2016, now U.S. Pat. No. 10,058,393, which claims the benefit of and priority to U.S. Provisional Patent Application No. 62/369,821, filed Aug. 2, 2016 and U.S. Provisional Patent Application No. 62/244,460, filed Oct. 21, 2015, the disclosures of each of the aforementioned applications being hereby incorporated by reference in their entirety.

US Referenced Citations (1126)

Number	Name	Date	Kind
319296	Molesworth	Jun 1885	A
668878	Jensen	Feb 1901	A
668879	Miller	Feb 1901	A
702789	Gibson	Jun 1902	A
862712	Collins	Aug 1907	A
2121193	Hanicke	Jun 1938	A
2178840	Lorenian	Nov 1939	A
2187852	Friddle	Jan 1940	A
2199025	Conn	Apr 1940	A
2235419	Callahan	Mar 1941	A
2248054	Becker	Jul 1941	A
2270188	Longfellow	Jan 1942	A
2518276	Braward	Aug 1950	A
2557669	Lloyd	Jun 1951	A
2566499	Richter	Sep 1951	A
2621653	Briggs	Dec 1952	A
2725053	Bambara	Nov 1955	A
2830587	Everett	Apr 1958	A
3204635	Voss	Sep 1965	A
3347234	Voss	Oct 1967	A
3367809	Soloff	Feb 1968	A
3391690	Armao	Jul 1968	A
3477429	Sampson	Nov 1969	A
3513848	Winston	May 1970	A
3518993	Blake	Jul 1970	A
3577991	Wilkinson	May 1971	A
3596292	Erb	Aug 1971	A
3608539	Miller	Sep 1971	A
3625220	Engelsher	Dec 1971	A
3648705	Lary	Mar 1972	A
3653388	Tenckhoff	Apr 1972	A
3656476	Swinney	Apr 1972	A
3657056	Winston	Apr 1972	A
3678980	Gutshall	Jul 1972	A
3709218	Halloran	Jan 1973	A
3711347	Wagner	Jan 1973	A
3739773	Schmitt	Jun 1973	A
3760808	Bleuer	Sep 1973	A
3788318	Kim	Jan 1974	A
3789852	Kim	Feb 1974	A
3802438	Wolvek	Apr 1974	A
3807394	Attenborough	Apr 1974	A
3809075	Matles	May 1974	A
3811449	Gravlee	May 1974	A
3825010	McDonald	Jul 1974	A
3833003	Taricco	Sep 1974	A
3835849	McGuire	Sep 1974	A
3842824	Neufeld	Oct 1974	A
3845772	Smith	Nov 1974	A
3857396	Hardwick	Dec 1974	A
3867932	Huene	Feb 1975	A
3875652	Arnold	Apr 1975	A
3898992	Balamuth	Aug 1975	A
3918442	Nikolaev	Nov 1975	A
3968800	Vilasi	Jul 1976	A
3976079	Samuels	Aug 1976	A
4023559	Gaskell	May 1977	A
4064566	Fletcher	Dec 1977	A
4089071	Kainberz	May 1978	A
4108399	Pilgram	Aug 1978	A
4156574	Boben	May 1979	A
4164794	Spector	Aug 1979	A
4171544	Hench	Oct 1979	A
4183102	Guiset	Jan 1980	A
4199864	Ashman	Apr 1980	A
4200939	Oser	May 1980	A
4210148	Stivala	Jul 1980	A
4213816	Morris	Jul 1980	A
4235233	Mouwen	Nov 1980	A
4235238	Ogiu	Nov 1980	A
4244370	Furlow	Jan 1981	A
4257411	Cho	Mar 1981	A
4265231	Scheller, Jr. et al.	May 1981	A
4281649	Derweduwen	Aug 1981	A
4291698	Fuchs	Sep 1981	A
4309488	Heide	Jan 1982	A
4320762	Bentov	Mar 1982	A
4351069	Ballintyn	Sep 1982	A
4364381	Sher	Dec 1982	A
4365356	Broemer	Dec 1982	A
4388921	Sutter	Jun 1983	A
4395798	McVey	Aug 1983	A
4409974	Freedland	Oct 1983	A
4414166	Carlson	Nov 1983	A
4437362	Hurst	Mar 1984	A
4437941	Marwil	Mar 1984	A
4444180	Schneider	Apr 1984	A
4448194	DiGiovanni et al.	May 1984	A
4456005	Lichty	Jun 1984	A
4461281	Carson	Jul 1984	A
4493317	Klaue	Jan 1985	A
4495664	Bianquaert	Jan 1985	A
4501031	McDaniel	Feb 1985	A
4504268	Herlitze	Mar 1985	A
4506681	Mundell	Mar 1985	A
4514125	Stol	Apr 1985	A
4526173	Sheehan	Jul 1985	A
4532926	O'Holla	Aug 1985	A
4535772	Sheehan	Aug 1985	A
4547327	Bruins	Oct 1985	A
4556059	Adamson	Dec 1985	A
4556350	Bernhardt	Dec 1985	A
4566138	Lewis	Jan 1986	A
4589868	Dretler	May 1986	A
4590928	Hunt	May 1986	A
4597379	Kihn	Jul 1986	A
4599085	Riess	Jul 1986	A
4601893	Cardinal	Jul 1986	A
4606335	Wedeen	Aug 1986	A
4611593	Fogarty	Sep 1986	A
4621640	Mulhollan	Nov 1986	A
4630609	Chin	Dec 1986	A
4632101	Freedland	Dec 1986	A
4645503	Lin	Feb 1987	A
4657460	Bien	Apr 1987	A
4659268	Del Mundo	Apr 1987	A
4662063	Collins	May 1987	A
4662068	Polonsky	May 1987	A
4662887	Turner	May 1987	A
4669473	Richards	Jun 1987	A
4681107	Kees	Jul 1987	A
4685458	Leckrone	Aug 1987	A
4691741	Affa	Sep 1987	A
4705040	Mueller	Nov 1987	A
4706670	Andersen et al.	Nov 1987	A
4708139	Dunbar, IV	Nov 1987	A
4713077	Small	Dec 1987	A
4716901	Jackson	Jan 1988	A
4718909	Brown	Jan 1988	A
4722331	Fox	Feb 1988	A
4722948	Sanderson	Feb 1988	A
4724584	Kasai	Feb 1988	A
4738255	Goble	Apr 1988	A
4739751	Sapega	Apr 1988	A
4741330	Hayhurst	May 1988	A
4749585	Greco	Jun 1988	A
4750492	Jacobs	Jun 1988	A
4768507	Fischell	Sep 1988	A
4772286	Goble	Sep 1988	A
4776328	Frey	Oct 1988	A
4776738	Winston	Oct 1988	A
4776851	Bruchman	Oct 1988	A
4781182	Purnell	Nov 1988	A
4790303	Steflee	Dec 1988	A
4792336	Hiavacek	Dec 1988	A
4817591	Klause	Apr 1989	A
4822224	Carl	Apr 1989	A
4823794	Pierce	Apr 1989	A
4832025	Coates	May 1989	A
4832026	Jones	May 1989	A
4834752	VanKampen	May 1989	A
4841960	Gamer	Jun 1989	A
4843112	Gerhart	Jun 1989	A
4846812	Walker	Jul 1989	A
4862812	Walker	Sep 1989	A
4862882	Venturi	Sep 1989	A
4869242	Galluzo	Sep 1989	A
4870957	Goble	Oct 1989	A
4883048	Purnell	Nov 1989	A
4890612	Kensey	Jan 1990	A
4895148	Bays	Jan 1990	A
4898156	Gattuma	Feb 1990	A
4899729	Gill	Feb 1990	A
4899743	Nicholson et al.	Feb 1990	A
4899744	Fujitsuka et al.	Feb 1990	A
4901721	Hakki	Feb 1990	A
4921479	Grayzel	May 1990	A
4922897	Sapega	May 1990	A
4924865	Bays	May 1990	A
4924866	Yoon	May 1990	A
4932960	Green	Jun 1990	A
4935026	McFadden	Jun 1990	A
4935028	Drews	Jun 1990	A
4945625	Winston	Aug 1990	A
4946468	Li	Aug 1990	A
4954126	Wallsten	Sep 1990	A
4955910	Bolesky	Sep 1990	A
4957498	Caspari	Sep 1990	A
4961741	Hayhurst	Oct 1990	A
4963151	Ducheyne	Oct 1990	A
4964862	Arms	Oct 1990	A
4966583	Debbas	Oct 1990	A
4968315	Gattuma	Nov 1990	A
4969888	Scholten et al.	Nov 1990	A
4969892	Burton	Nov 1990	A
4979949	Matsen, III et al.	Dec 1990	A
4990161	Kampner	Feb 1991	A
4994071	MacGregor	Feb 1991	A
4997445	Hodorek	Mar 1991	A
4998539	Delsanti	Mar 1991	A
5002550	Li	Mar 1991	A
5002563	Pyka	Mar 1991	A
5009652	Morgan	Apr 1991	A
5009663	Broome	Apr 1991	A
5009664	Sievers	Apr 1991	A
5013316	Goble	May 1991	A
5019090	Pinchuk	May 1991	A
5021059	Kensey et al.	Jun 1991	A
5031841	Schafer	Jul 1991	A
5035713	Friis	Jul 1991	A
5037404	Gold	Aug 1991	A
5037422	Hayhurst	Aug 1991	A
5041093	Chu	Aug 1991	A
5041114	Chapman	Aug 1991	A
5041129	Hayhurst	Aug 1991	A
5046513	Gattuma	Sep 1991	A
5047055	Gattuma	Sep 1991	A
5051049	Wills	Sep 1991	A
5053046	Janese	Oct 1991	A
5053047	Yoon	Oct 1991	A
5059193	Kuslich	Oct 1991	A
5059206	Winters	Oct 1991	A
5061274	Kensey	Oct 1991	A
5061286	Lyle	Oct 1991	A
5069674	Farnot	Dec 1991	A
5078140	Kwoh	Jan 1992	A
5078731	Hayhurst	Jan 1992	A
5078744	Chvapil	Jan 1992	A
5078745	Rhenter	Jan 1992	A
5084050	Draenert	Jan 1992	A
5084051	Tormala	Jan 1992	A
5085660	Lin	Feb 1992	A
5085661	Moss	Feb 1992	A
5086401	Glassman et al.	Feb 1992	A
5090072	Kratoska	Feb 1992	A
5098433	Freedland	Mar 1992	A
5098434	Serbousek	Mar 1992	A
5098436	Ferrante	Mar 1992	A
5100405	McLaren	Mar 1992	A
5100417	Cerier	Mar 1992	A
5102417	Palmaz	Apr 1992	A
5102421	Anspach	Apr 1992	A
5120175	Arbegast	Jun 1992	A
5123520	Schmid	Jun 1992	A
5123914	Cope	Jun 1992	A
5123941	Lauren et al.	Jun 1992	A
5133732	Wiktor	Jul 1992	A
RE34021	Mueller	Aug 1992	E
5141520	Goble	Aug 1992	A
5147362	Goble	Sep 1992	A
5152765	Ross	Oct 1992	A
5154720	Trott	Oct 1992	A
5156613	Sawyer	Oct 1992	A
5156616	Meadows	Oct 1992	A
5158566	Pianetti	Oct 1992	A
5158934	Ammann	Oct 1992	A
5163960	Bonutti	Nov 1992	A
5171251	Bregen	Dec 1992	A
5176682	Chow	Jan 1993	A
5179964	Cook	Jan 1993	A
5180388	DiCarlo	Jan 1993	A
5183464	Dubrul	Feb 1993	A
5192287	Fournier et al.	Mar 1993	A
5192326	Bao et al.	Mar 1993	A
5197166	Meier et al.	Mar 1993	A
5197971	Bonutti	Mar 1993	A
5203784	Ross	Apr 1993	A
5203787	Noblitt	Apr 1993	A
5208950	Merritt	May 1993	A
5209776	Bass	May 1993	A
5217486	Rice	Jun 1993	A
5217493	Raad	Jun 1993	A
5219359	McQuilkin	Jun 1993	A
5224946	Hayhurst	Jul 1993	A
5226899	Lee	Jul 1993	A
5230352	Putnam	Jul 1993	A
5234006	Eaton	Aug 1993	A
5234425	Fogarty	Aug 1993	A
5236438	Wilk	Aug 1993	A
5236445	Hayhurst	Aug 1993	A
5242902	Murphy	Sep 1993	A
5246441	Ross	Sep 1993	A
5250026	Ehrlich	Oct 1993	A
5250055	Moore	Oct 1993	A
5254113	Wilk	Oct 1993	A
5258007	Spetzler	Nov 1993	A
5258015	Li	Nov 1993	A
5258016	Di Poto	Nov 1993	A
5261914	Warren	Nov 1993	A
5266325	Kuzma	Nov 1993	A
5269783	Sander	Dec 1993	A
5269785	Bonutti	Dec 1993	A
5269809	Hayhurst	Dec 1993	A
5281235	Haber	Jan 1994	A
5282832	Toso	Feb 1994	A
5290281	Tschakaloff	Mar 1994	A
5304119	Balaban	Apr 1994	A
5306280	Bregen	Apr 1994	A
5306301	Graf	Apr 1994	A
5312438	Johnson	May 1994	A
5315741	Dubberke	May 1994	A
5318588	Horzewski et al.	Jun 1994	A
5320611	Bonutti	Jun 1994	A
5324308	Pierce	Jun 1994	A
5328480	Melker	Jul 1994	A
5329846	Bonutti	Jul 1994	A
5329924	Bonutti	Jul 1994	A
5330468	Burkhart	Jul 1994	A
5330476	Hiot	Jul 1994	A
5330486	Wilkinson	Jul 1994	A
5336231	Adair	Aug 1994	A
5336240	Metzler	Aug 1994	A
5339799	Kami et al.	Aug 1994	A
5343385	Joskowicz	Aug 1994	A
5349956	Bonutti	Sep 1994	A
5352229	Goble	Oct 1994	A
5354298	Lee	Oct 1994	A
5354302	Ko	Oct 1994	A
5366480	Corriveaau	Nov 1994	A
5370646	Reese et al.	Dec 1994	A
5370660	Weinstein et al.	Dec 1994	A
5372146	Branch	Dec 1994	A
5374235	Ahrens	Dec 1994	A
5376126	Lin	Dec 1994	A
5382254	McGarry	Jan 1995	A
5383883	Wilk	Jan 1995	A
5383905	Golds	Jan 1995	A
5391171	Schmieding	Feb 1995	A
5391173	Wilk	Feb 1995	A
5395308	Fox	Mar 1995	A
5397311	Walker	Mar 1995	A
5400805	Warren	Mar 1995	A
5402801	Taylor	Apr 1995	A
5403312	Yates	Apr 1995	A
5403348	Bonutti	Apr 1995	A
5405359	Pierce	Apr 1995	A
5411523	Goble	May 1995	A
5411538	Bonutti	May 1995	A
5413585	Pagedas	May 1995	A
5417691	Hayhurst	May 1995	A
5417701	Holmes	May 1995	A
5417712	Whittaker	May 1995	A
5423796	Shikhman	Jun 1995	A
5423860	Lizardi	Jun 1995	A
5431670	Holmes	Jul 1995	A
5438746	Demarest	Aug 1995	A
5439470	Li	Aug 1995	A
5441502	Bartlett	Aug 1995	A
5441538	Bonutti	Aug 1995	A
5443512	Parr	Aug 1995	A
5447503	Miller	Sep 1995	A
5449372	Schmaltz	Sep 1995	A
5449382	Dayton	Sep 1995	A
5451235	Lock	Sep 1995	A
5453090	Martinez	Sep 1995	A
5456722	McLeod	Oct 1995	A
5458653	Davison	Oct 1995	A
5462561	Voda	Oct 1995	A
5464424	O'Donnell	Nov 1995	A
5464425	Skiba	Nov 1995	A
5464426	Bonutti	Nov 1995	A
5464427	Curtis	Nov 1995	A
5467911	Tsuruta	Nov 1995	A
5470337	Moss	Nov 1995	A
5472444	Huebner	Dec 1995	A
5474554	Ku	Dec 1995	A
5478351	Meade	Dec 1995	A
5478353	Yoon	Dec 1995	A
5480403	Lee	Jan 1996	A
5486197	Le	Jan 1996	A
5487216	Demarest	Jan 1996	A
5487844	Fujita	Jan 1996	A
5488958	Topel	Feb 1996	A
5496292	Burnham	Mar 1996	A
5496335	Thomason	Mar 1996	A
5496348	Bonutti	Mar 1996	A
5500000	Feagin	Mar 1996	A
5501700	Hirata	Mar 1996	A
5504977	Weppner	Apr 1996	A
5505735	Li	Apr 1996	A
5507754	Green	Apr 1996	A
5514153	Bonutti	May 1996	A
5518163	Hooven	May 1996	A
5518164	Hooven	May 1996	A
5520700	Beyar	May 1996	A
5522844	Johnson	Jun 1996	A
5522845	Wenstrom	Jun 1996	A
5522846	Bonutti	Jun 1996	A
5527341	Goglewski	Jun 1996	A
5527342	Pietrzak	Jun 1996	A
5527343	Bonutti	Jun 1996	A
5528844	Johnson	Jun 1996	A
5529075	Clark	Jun 1996	A
5531759	Kensey	Jul 1996	A
5534012	Bonutti	Jul 1996	A
5534028	Bao et al.	Jul 1996	A
5540703	Barker	Jul 1996	A
5540718	Bartlett	Jul 1996	A
5542423	Bonutti	Aug 1996	A
5545178	Kensey	Aug 1996	A
5545180	Le	Aug 1996	A
5545206	Carson	Aug 1996	A
5549630	Bonutti	Aug 1996	A
5549631	Bonutti	Aug 1996	A
5556402	Xu	Sep 1996	A
5562688	Riza	Oct 1996	A
5569252	Justin	Oct 1996	A
5569305	Bonutti	Oct 1996	A
5569306	Thal	Oct 1996	A
5573517	Bonutti	Nov 1996	A
5573538	Laboureau	Nov 1996	A
5573542	Stevens	Nov 1996	A
5575801	Habermeyer	Nov 1996	A
5580344	Hasson	Dec 1996	A
5584835	Greenfield	Dec 1996	A
5584860	Goble	Dec 1996	A
5584862	Bonutti	Dec 1996	A
5591206	Moufarrege	Jan 1997	A
5593422	Muijs Van de Moer	Jan 1997	A
5593425	Bonutti	Jan 1997	A
5593625	Riebel	Jan 1997	A
5601557	Hayhurst	Feb 1997	A
5601558	Torrie	Feb 1997	A
5601595	Schwartz	Feb 1997	A
5607427	Tschakaloff	Mar 1997	A
5609595	Pennig	Mar 1997	A
5618314	Harwin et al.	Apr 1997	A
5620461	Muijs Van De Moer et al.	Apr 1997	A
5626612	Bartlett	May 1997	A
5626614	Hart	May 1997	A
5626718	Phillippe	May 1997	A
5628446	Geiste	May 1997	A
5628751	Sander	May 1997	A
5628756	Barker	May 1997	A
5630824	Hart	May 1997	A
5634926	Jobe	Jun 1997	A
5643272	Haines	Jul 1997	A
5643274	Sander	Jul 1997	A
5643293	Kogasaka	Jul 1997	A
5643295	Yoon	Jul 1997	A
5643320	Lower	Jul 1997	A
5643321	McDevitt	Jul 1997	A
5645553	Kolesa	Jul 1997	A
5645597	Krapiva	Jul 1997	A
5645599	Samani	Jul 1997	A
5649940	Hart	Jul 1997	A
5649955	Hashimoto	Jul 1997	A
5649963	McDevitt	Jul 1997	A
5651377	O'Donnell	Jul 1997	A
5658313	Thal	Aug 1997	A
5660225	Saffran	Aug 1997	A
5662658	Wenstrom	Sep 1997	A
5665089	Dall	Sep 1997	A
5665109	Yoon	Sep 1997	A
5665112	Thal	Sep 1997	A
5667513	Torrie	Sep 1997	A
5669917	Sauer	Sep 1997	A
5674240	Bonutti	Oct 1997	A
5680981	Mililli	Oct 1997	A
5681310	Yuan et al.	Oct 1997	A
5681333	Burkhart	Oct 1997	A
5681351	Jamiolkowski	Oct 1997	A
5681352	Clancy	Oct 1997	A
5682886	Delp et al.	Nov 1997	A
5683401	Schmieding	Nov 1997	A
5683418	Luscombe	Nov 1997	A
5685820	Riek	Nov 1997	A
5688283	Knapp	Nov 1997	A
5690654	Ovil	Nov 1997	A
5690655	Hart	Nov 1997	A
5690674	Diaz	Nov 1997	A
5690676	Dipoto	Nov 1997	A
5693055	Zahiri	Dec 1997	A
5697950	Fucci	Dec 1997	A
5702397	Gonle	Dec 1997	A
5702462	Oberlander	Dec 1997	A
5707395	Li	Jan 1998	A
5713903	Sander	Feb 1998	A
5713921	Bonutti	Feb 1998	A
5718717	Bonutti	Feb 1998	A
5720747	Burke	Feb 1998	A
5720753	Sander	Feb 1998	A
5725529	Nicholson	Mar 1998	A
5725541	Anspach	Mar 1998	A
5725556	Moser	Mar 1998	A
5725582	Bevan	Mar 1998	A
5730747	Ek	Mar 1998	A
5733306	Bonutti	Mar 1998	A
5735875	Bonutti	Apr 1998	A
5735877	Pagedas	Apr 1998	A
5735899	Schwartz	Apr 1998	A
5741268	Schutz	Apr 1998	A
5741282	Anspach	Apr 1998	A
5743915	Bertin	Apr 1998	A
5748767	Raab	May 1998	A
5752952	Adamson	May 1998	A
5752974	Rhee	May 1998	A
5755809	Cohen	May 1998	A
5762458	Wang et al.	Jun 1998	A
5766126	Anderson	Jun 1998	A
5766221	Benderev	Jun 1998	A
5769092	Williamson, Jr.	Jun 1998	A
5769894	Ferragamo	Jun 1998	A
5772672	Toy	Jun 1998	A
5776136	Sahay et al.	Jul 1998	A
5776151	Chan	Jul 1998	A
5779706	Tschakaloff	Jul 1998	A
5779719	Klein	Jul 1998	A
5782862	Bonutti	Jul 1998	A
5785713	Jobe	Jul 1998	A
5792096	Rentmeester	Aug 1998	A
5797931	Bito	Aug 1998	A
5797963	McDevitt	Aug 1998	A
5800537	Bell	Sep 1998	A
5806518	Mittelstadt	Sep 1998	A
5807403	Beyar	Sep 1998	A
5810849	Kontos	Sep 1998	A
5810853	Yoon	Sep 1998	A
5810884	Kim	Sep 1998	A
5814072	Bonutti	Sep 1998	A
5814073	Bonutti	Sep 1998	A
5817107	Schaller	Oct 1998	A
5823994	Sharkey	Oct 1998	A
5824009	Fukuda	Oct 1998	A
5824085	Sahay et al.	Oct 1998	A
5830125	Scribner	Nov 1998	A
5836897	Sakurai	Nov 1998	A
5839899	Robinson	Nov 1998	A
5843178	Vanney	Dec 1998	A
5844142	Blanch et al.	Dec 1998	A
5845645	Bonutti	Dec 1998	A
5847394	Alfano et al.	Dec 1998	A
5851185	Berns	Dec 1998	A
5855583	Wang et al.	Jan 1999	A
5865728	Moll	Feb 1999	A
5865834	McGuire	Feb 1999	A
5866634	Tokushige	Feb 1999	A
5868749	Reed	Feb 1999	A
5873212	Esteves	Feb 1999	A
5873891	Sohn	Feb 1999	A
5874235	Chan	Feb 1999	A
5876325	Mizuno	Mar 1999	A
5879371	Gardiner	Mar 1999	A
5879372	Bartlett	Mar 1999	A
5891166	Schervinsky	Apr 1999	A
5891168	Thal	Apr 1999	A
5893880	Egan	Apr 1999	A
5897574	Bonutti	Apr 1999	A
5899911	Carter	May 1999	A
5899921	Casparai	May 1999	A
5906579	Vander Salm et al.	May 1999	A
5906625	Bito	May 1999	A
5908429	Yoon	Jun 1999	A
5911449	Daniele	Jun 1999	A
5911721	Nicholson	Jun 1999	A
5915751	Esteves	Jun 1999	A
5918604	Whelan	Jul 1999	A
5919193	Slavitt	Jul 1999	A
5919194	Andersen	Jul 1999	A
5919208	Valenti	Jul 1999	A
5919215	Wiklund	Jul 1999	A
5921986	Bonutti	Jul 1999	A
5924976	Stelzer	Jul 1999	A
5925064	Meyers	Jul 1999	A
5928244	Tovey	Jul 1999	A
5928267	Bonutti	Jul 1999	A
5931838	Vito	Aug 1999	A
5931869	Boucher	Aug 1999	A
5937504	Esteves	Aug 1999	A
5940942	Fong	Aug 1999	A
5941900	Bonutti	Aug 1999	A
5941901	Egan	Aug 1999	A
5945002	Bonutti	Aug 1999	A
5947982	Duran	Sep 1999	A
5948000	Larsen	Sep 1999	A
5948001	Larsen	Sep 1999	A
5948002	Bonutti	Sep 1999	A
5951590	Goldfarb	Sep 1999	A
5956927	Daniele	Sep 1999	A
5957953	DiPoto	Sep 1999	A
5961499	Bonutti	Oct 1999	A
5961521	Roger	Oct 1999	A
5961538	Pedlick	Oct 1999	A
5961554	Janson	Oct 1999	A
5964075	Daniele	Oct 1999	A
5964765	Fenton	Oct 1999	A
5964769	Wagner	Oct 1999	A
5967970	Cowan	Oct 1999	A
5968046	Castleman	Oct 1999	A
5968047	Reed	Oct 1999	A
5970686	Demarest	Oct 1999	A
5976156	Taylor et al.	Nov 1999	A
5980520	Vancaillie	Nov 1999	A
5980558	Wiley	Nov 1999	A
5980559	Bonutti	Nov 1999	A
5983601	Blanch	Nov 1999	A
5984929	Bashiri	Nov 1999	A
5987848	Blanch	Nov 1999	A
5989282	Bonutti	Nov 1999	A
5993458	Vaitekunas	Nov 1999	A
5993477	Vaitekunas	Nov 1999	A
6007567	Bonutti	Dec 1999	A
6007580	Lento	Dec 1999	A
6010525	Bonutti	Jan 2000	A
6010526	Sandstrom	Jan 2000	A
6012216	Esteves	Jan 2000	A
6014851	Daniele	Jan 2000	A
6017321	Boone	Jan 2000	A
6032343	Blanch et al.	Mar 2000	A
6033415	Mittelstadt et al.	Mar 2000	A
6033429	Magovern	Mar 2000	A
6033430	Bonutti	Mar 2000	A
6045551	Bonutti	Apr 2000	A
6050998	Fletcher	Apr 2000	A
6056751	Fenton	May 2000	A
6056772	Bonutti	May 2000	A
6056773	Bonutti	May 2000	A
6059797	Mears	May 2000	A
6059817	Bonutti	May 2000	A
6059827	Fenton	May 2000	A
6063095	Wang et al.	May 2000	A
6066151	Miyawaki	May 2000	A
6066160	Colvin	May 2000	A
6066166	Bischoff	May 2000	A
6068637	Popov	May 2000	A
6068648	Cole	May 2000	A
6074409	Goldfarb	Jun 2000	A
6077277	Mollenauer	Jun 2000	A
6077292	Bonutti	Jun 2000	A
6080161	Eaves	Jun 2000	A
6081981	Demarest	Jul 2000	A
6083244	Lubbers	Jul 2000	A
6083522	Chu	Jul 2000	A
6086593	Bonutti	Jul 2000	A
6086608	Ek	Jul 2000	A
6090072	Kratoska	Jul 2000	A
6099531	Bonutti	Aug 2000	A
6099537	Sugai	Aug 2000	A
6099547	Gellman	Aug 2000	A
6099550	Yoon	Aug 2000	A
6099552	Adams	Aug 2000	A
6102850	Wang et al.	Aug 2000	A
6106545	Egan	Aug 2000	A
6117160	Bonutti	Sep 2000	A
6120536	Ding	Sep 2000	A
6125574	Ganaja	Oct 2000	A
6126677	Ganaja	Oct 2000	A
6132368	Cooper	Oct 2000	A
6139320	Hahn	Oct 2000	A
RE36974	Bonutti	Nov 2000	E
6149658	Gardiner	Nov 2000	A
6149669	Li	Nov 2000	A
6152949	Bonutti	Nov 2000	A
6155756	Mericle	Dec 2000	A
6159224	Yoon	Dec 2000	A
6159234	Bonutti	Dec 2000	A
6171307	Orlich	Jan 2001	B1
6174324	Egan	Jan 2001	B1
6179840	Bowman	Jan 2001	B1
6179850	Goradia	Jan 2001	B1
6187008	Hamman	Feb 2001	B1
6190400	Van De Moer	Feb 2001	B1
6190401	Green et al.	Feb 2001	B1
6200322	Branch	Mar 2001	B1
6200329	Fung	Mar 2001	B1
6205411	DiGioia, III et al.	Mar 2001	B1
6205748	Daniele	Mar 2001	B1
6217591	Egan	Apr 2001	B1
6224593	Ryan	May 2001	B1
6224630	Bao	May 2001	B1
6228086	Wahl	May 2001	B1
6231565	Tovey	May 2001	B1
6231592	Bonutti	May 2001	B1
6238395	Bonutti	May 2001	B1
6238396	Bonutti	May 2001	B1
6241749	Rayhanabad	Jun 2001	B1
6246200	Blumenkranz et al.	Jun 2001	B1
6258091	Sevrain	Jul 2001	B1
6263558	Blanch	Jul 2001	B1
6264675	Brotz	Jul 2001	B1
6267761	Ryan	Jul 2001	B1
6273717	Hahn	Aug 2001	B1
6280474	Cassidy et al.	Aug 2001	B1
6286746	Egan et al.	Sep 2001	B1
6287325	Bonutti	Sep 2001	B1
6293961	Schwartz	Sep 2001	B2
6306159	Schwartz	Oct 2001	B1
6309405	Bonutti	Oct 2001	B1
6312448	Bonutti	Nov 2001	B1
6319252	McDevitt	Nov 2001	B1
6319271	Schwartz	Nov 2001	B1
6322567	Mittelstadt et al.	Nov 2001	B1
6327491	Franklin et al.	Dec 2001	B1
6331181	Tierney et al.	Dec 2001	B1
6338730	Bonutti	Jan 2002	B1
6340365	Dittrich	Jan 2002	B2
6348056	Bates	Feb 2002	B1
6358271	Egan	Mar 2002	B1
6364897	Bonutti	Apr 2002	B1
6368325	McKinley	Apr 2002	B1
6368326	Dakin	Apr 2002	B1
6368343	Bonutti	Apr 2002	B1
6371957	Amrein	Apr 2002	B1
6385475	Cinquin et al.	May 2002	B1
6395007	Bhatnagar et al.	May 2002	B1
6409742	Fulton	Jun 2002	B1
6409743	Fenton	Jun 2002	B1
6419704	Ferree	Jul 2002	B1
6423072	Zappala	Jul 2002	B1
6423088	Fenton	Jul 2002	B1
6425919	Lambrect	Jul 2002	B1
6428562	Bonutti	Aug 2002	B2
6430434	Mittelstadt	Aug 2002	B1
6432115	Mollenauer	Aug 2002	B1
6436107	Wang et al.	Aug 2002	B1
6447516	Bonutti	Sep 2002	B1
6447550	Hunter	Sep 2002	B1
6450985	Schoelling	Sep 2002	B1
6451027	Cooper et al.	Sep 2002	B1
6461360	Adam	Oct 2002	B1
6468265	Evans et al.	Oct 2002	B1
6468293	Bonutti	Oct 2002	B2
6471715	Weiss	Oct 2002	B1
6475230	Bonutti	Nov 2002	B1
6488196	Fenton	Dec 2002	B1
6496003	Okumura et al.	Dec 2002	B1
6500195	Bonutti	Dec 2002	B2
6503259	Huxel	Jan 2003	B2
6527774	Lieberman	Mar 2003	B2
6530933	Yeung	Mar 2003	B1
6533157	Whitman	Mar 2003	B1
6533818	Weber	Mar 2003	B1
6535764	Imran	Mar 2003	B2
6544267	Cole	Apr 2003	B1
6545909	Tanaka et al.	Apr 2003	B2
6547792	Tsuji	Apr 2003	B1
6551304	Whalen	Apr 2003	B1
6554852	Oberlander	Apr 2003	B1
6557426	Reinemann, Jr. et al.	May 2003	B2
6558390	Cragg	May 2003	B2
6562043	Chan	May 2003	B1
6565554	Niemeyer	May 2003	B1
6568313	Fukui	May 2003	B2
6569167	Bobechko	May 2003	B1
6569187	Bonutti	May 2003	B1
6572635	Bonutti	Jun 2003	B1
D477776	Pontaoe	Jul 2003	S
6585746	Gildenberg	Jul 2003	B2
6585750	Bonutti	Jul 2003	B2
6585764	Wright	Jul 2003	B2
6592609	Bonutti	Jul 2003	B1
6594517	Nevo	Jul 2003	B1
6605090	Trieu	Aug 2003	B1
6610080	Morgan	Aug 2003	B2
6618910	Pontaoe	Sep 2003	B1
6623486	Weaver	Sep 2003	B1
6623487	Goshert	Sep 2003	B1
6626944	Taylor	Sep 2003	B1
6632245	Kim	Oct 2003	B2
6635073	Bonutti	Oct 2003	B2
6638279	Bonutti	Oct 2003	B2
6641592	Sauer	Nov 2003	B1
6645227	Fallin	Nov 2003	B2
6666877	Morgan	Dec 2003	B2
6669705	Westhaver	Dec 2003	B2
6676669	Charles et al.	Jan 2004	B2
6679888	Green	Jan 2004	B2
6685750	Plos	Feb 2004	B1
6699177	Wang et al.	Mar 2004	B1
6699240	Francischelli	Mar 2004	B2
6702821	Bonutti	Mar 2004	B2
6705179	Mohtasham	Mar 2004	B1
6709457	Otte	Mar 2004	B1
6712828	Schraft et al.	Mar 2004	B2
6714841	Wright	Mar 2004	B1
6719765	Bonutti	Apr 2004	B2
6719797	Ferree	Apr 2004	B1
6722552	Fenton	Apr 2004	B2
6731988	Green	May 2004	B1
6733506	McDevitt et al.	May 2004	B1
6733531	Trieu	May 2004	B1
6764514	Li	Jul 2004	B1
6770078	Bonutti	Aug 2004	B2
6770079	Bhatnagar	Aug 2004	B2
6780198	Gregoire	Aug 2004	B1
6783524	Anderson et al.	Aug 2004	B2
6786989	Torriani et al.	Sep 2004	B2
6796003	Marvel	Sep 2004	B1
6799065	Niemeyer	Sep 2004	B1
6818010	Eichhorn	Nov 2004	B2
6823871	Schmieding	Nov 2004	B2
6827712	Tovey	Dec 2004	B2
6837892	Shoham	Jan 2005	B2
6840938	Morley et al.	Jan 2005	B1
6843403	Whitman	Jan 2005	B2
6860878	Brock	Mar 2005	B2
6860885	Bonutti	Mar 2005	B2
6869437	Hausen	Mar 2005	B1
6878167	Ferree	Apr 2005	B2
6884264	Spiegelberg et al.	Apr 2005	B2
6890334	Brace	May 2005	B2
6893434	Fenton	May 2005	B2
6899722	Bonutti	May 2005	B2
6913666	Aeschlimann	Jul 2005	B1
6916321	TenHuisen	Jul 2005	B2
6921264	Mayer	Jul 2005	B2
6923824	Morgan	Aug 2005	B2
6932835	Bonutti	Aug 2005	B2
6942684	Bonutti	Sep 2005	B2
6944111	Nakamura	Sep 2005	B2
6951535	Ghodoussi et al.	Oct 2005	B2
6955540	Mayer	Oct 2005	B2
6955683	Bonutti	Oct 2005	B2
6958077	Suddaby	Oct 2005	B2
6987983	Rosenblatt	Jan 2006	B2
6997940	Bonutti	Feb 2006	B2
7001411	Dean	Feb 2006	B1
7004959	Bonutti	Feb 2006	B2
7008226	Mayer	Mar 2006	B2
7013191	Rubber	Mar 2006	B2
7018380	Cole	Mar 2006	B2
7033379	Peterson	Apr 2006	B2
7048755	Bonutti	May 2006	B2
7066960	Dickman	Jun 2006	B1
7087073	Bonutti	Aug 2006	B2
7090111	Egan	Aug 2006	B2
7090683	Brock et al.	Aug 2006	B2
7094251	Bonutti	Aug 2006	B2
7104996	Bonutti	Sep 2006	B2
7128763	Blatt	Oct 2006	B1
7147652	Bonutti	Dec 2006	B2
7153312	Torrie	Dec 2006	B1
7160405	Aeschlimann	Jan 2007	B2
7179259	Gibbs	Feb 2007	B1
7192448	Ferree	Mar 2007	B2
7209776	Leitner	Apr 2007	B2
7217279	Reese	May 2007	B2
7217290	Bonutti	May 2007	B2
7241297	Shaolian et al.	Jul 2007	B2
7250051	Francischelli	Jul 2007	B2
7252685	Bindseil	Aug 2007	B2
7273497	Ferree	Sep 2007	B2
7297142	Brock	Nov 2007	B2
7329263	Bonutti	Feb 2008	B2
7331932	Leitner	Feb 2008	B2
7335205	Aeschlimann	Feb 2008	B2
7445634	Trieu	Nov 2008	B2
7477926	McCombs	Jan 2009	B2
7481825	Bonutti	Jan 2009	B2
7481831	Bonutti	Jan 2009	B2
7510895	Rateman	Mar 2009	B2
7641660	Lakin et al.	Jan 2010	B2
7708741	Bonutti	May 2010	B1
7794467	McGinley et al.	Sep 2010	B2
7831295	Friedrich	Nov 2010	B2
7854750	Bonutti	Dec 2010	B2
7879072	Bonutti	Feb 2011	B2
7891691	Bearey	Feb 2011	B2
7959635	Bonutti	Jun 2011	B1
7967820	Bonutti	Jun 2011	B2
8046052	Verard et al.	Oct 2011	B2
8073528	Zhao	Dec 2011	B2
8109942	Carson	Feb 2012	B2
8128669	Bonutti	Mar 2012	B2
8140982	Hamilton	Mar 2012	B2
8147514	Bonutti	Apr 2012	B2
8162977	Bonutti	Apr 2012	B2
8214016	Lavallee et al.	Jul 2012	B2
8221402	Francischelli et al.	Jul 2012	B2
8382765	Axelson et al.	Feb 2013	B2
8429266	Vanheuverzwyn	Apr 2013	B2
8480679	Park	Jul 2013	B2
8483469	Pavlovskaia	Jul 2013	B2
8500816	Dees	Aug 2013	B2
8532361	Pavlovskaia	Sep 2013	B2
8560047	Haider et al.	Oct 2013	B2
8617171	Park et al.	Dec 2013	B2
8702732	Woodard	Apr 2014	B2
8715291	Park	May 2014	B2
8737700	Park	May 2014	B2
8740798	Hamada	Jun 2014	B2
8777875	Park	Jul 2014	B2
8781193	Steinberg et al.	Jul 2014	B2
8781556	Kienzle	Jul 2014	B2
8894634	Devengenzo et al.	Nov 2014	B2
8968320	Park	Mar 2015	B2
9008757	Wu	Apr 2015	B2
9014851	Wong et al.	Apr 2015	B2
9060797	Bonutti	Jun 2015	B2
9119655	Bowling et al.	Sep 2015	B2
9186046	Ramamurthy et al.	Nov 2015	B2
9195926	Spodak	Nov 2015	B2
9456765	Odermatt	Oct 2016	B2
9844414	Fischer et al.	Dec 2017	B2
9922410	Shimada	Mar 2018	B2
10058393	Bonutti et al.	Aug 2018	B2
10194801	Elhawary et al.	Feb 2019	B2
10350390	Moll et al.	Jul 2019	B2
10368951	Moll et al.	Aug 2019	B2
10433763	Piron et al.	Oct 2019	B2
10499996	de Almeida Barreto	Dec 2019	B2
10594931	Piponi	Mar 2020	B2
10672134	Suzuki	Jun 2020	B2
10687784	Shoham	Jun 2020	B2
10765484	Bonutti et al.	Sep 2020	B2
10828786	Shoham	Nov 2020	B2
10974069	Maguire et al.	Apr 2021	B2
11197651	Cohen et al.	Dec 2021	B2
11229362	Ben-Haim	Jan 2022	B2
20010002440	Bonutti	May 2001	A1
20010005975	Golightly	Jul 2001	A1
20010009250	Herman	Jul 2001	A1
20010041916	Bonutti	Nov 2001	A1
20010049497	Kalloo	Dec 2001	A1
20020016593	Hearn	Feb 2002	A1
20020016633	Lin	Feb 2002	A1
20020019649	Sikora	Feb 2002	A1
20020026244	Trieu	Feb 2002	A1
20020029083	Zucherman	Mar 2002	A1
20020029084	Paul	Mar 2002	A1
20020038118	Shoham	Mar 2002	A1
20020045888	Ramans	Apr 2002	A1
20020045902	Bonutti	Apr 2002	A1
20020049449	Bhatnagar	Apr 2002	A1
20020062136	Hillstead	May 2002	A1
20020062153	Paul	May 2002	A1
20020082612	Moll	Jun 2002	A1
20020087048	Brock	Jul 2002	A1
20020087049	Brock	Jul 2002	A1
20020087148	Brock	Jul 2002	A1
20020087166	Brock	Jul 2002	A1
20020087169	Brock	Jul 2002	A1
20020095175	Brock	Jul 2002	A1
20020103495	Cole	Aug 2002	A1
20020115934	Tuke	Aug 2002	A1
20020120252	Brock	Aug 2002	A1
20020123750	Eisermann	Sep 2002	A1
20020128633	Brock	Sep 2002	A1
20020128661	Brock	Sep 2002	A1
20020128662	Brock	Sep 2002	A1
20020133173	Brock	Sep 2002	A1
20020133174	Charles et al.	Sep 2002	A1
20020133175	Carson	Sep 2002	A1
20020138082	Brock	Sep 2002	A1
20020138109	Keogh	Sep 2002	A1
20020143319	Brock	Oct 2002	A1
20020183762	Anderson	Dec 2002	A1
20020183851	Spiegelberg	Dec 2002	A1
20020188301	Dallara	Dec 2002	A1
20030014064	Blatter	Jan 2003	A1
20030028196	Bonutti	Feb 2003	A1
20030039196	Nakamura	Feb 2003	A1
20030040758	Wang	Feb 2003	A1
20030045900	Hahnen	Mar 2003	A1
20030055409	Brock	Mar 2003	A1
20030060927	Gerbi et al.	Mar 2003	A1
20030065361	Dreyfuss	Apr 2003	A1
20030069591	Carson et al.	Apr 2003	A1
20030105474	Bonutti	Jun 2003	A1
20030118518	Hahn	Jun 2003	A1
20030125808	Hunter	Jul 2003	A1
20030135204	Lee	Jul 2003	A1
20030153978	Whiteside	Aug 2003	A1
20030158582	Bonutti	Aug 2003	A1
20030167072	Oberlander	Sep 2003	A1
20030176783	Hu	Sep 2003	A1
20030181800	Bonutti	Sep 2003	A1
20030195530	Thill	Oct 2003	A1
20030195565	Bonutti	Oct 2003	A1
20030204204	Bonutti	Oct 2003	A1
20030212403	Swanson	Nov 2003	A1
20030216669	Lang	Nov 2003	A1
20030216742	Wetzler	Nov 2003	A1
20030225438	Bonutti	Dec 2003	A1
20030229361	Jackson	Dec 2003	A1
20040010287	Bonutti	Jan 2004	A1
20040030341	Aeschlimann	Feb 2004	A1
20040034282	Quaid	Feb 2004	A1
20040034357	Beane	Feb 2004	A1
20040097939	Bonutti	May 2004	A1
20040097948	Heldreth	May 2004	A1
20040098050	Foerster	May 2004	A1
20040102804	Chin	May 2004	A1
20040106916	Quaid et al.	Jun 2004	A1
20040138703	Alleyne	Jul 2004	A1
20040143334	Ferree	Jul 2004	A1
20040152970	Hunter et al.	Aug 2004	A1
20040157188	Luth et al.	Aug 2004	A1
20040167548	Bonutti	Aug 2004	A1
20040199072	Sprouse et al.	Oct 2004	A1
20040220616	Bonutti	Nov 2004	A1
20040225325	Bonutit	Nov 2004	A1
20040230223	Bonutti	Nov 2004	A1
20040236374	Bonutti	Nov 2004	A1
20040236424	Berez	Nov 2004	A1
20040243109	Tovey	Dec 2004	A1
20040267242	Grimm	Dec 2004	A1
20050033366	Cole	Feb 2005	A1
20050038514	Helm	Feb 2005	A1
20050043796	Grant	Feb 2005	A1
20050071012	Serhan	Mar 2005	A1
20050090827	Gedebou	Apr 2005	A1
20050090840	Gerbino	Apr 2005	A1
20050096699	Wixey et al.	May 2005	A1
20050113846	Carson	May 2005	A1
20050113928	Cragg et al.	May 2005	A1
20050126680	Aeschlimann et al.	Jun 2005	A1
20050143826	Zucherman et al.	Jun 2005	A1
20050149024	Ferrante et al.	Jul 2005	A1
20050149029	Bonutti	Jul 2005	A1
20050177169	Fisher et al.	Aug 2005	A1
20050192673	Saltzman et al.	Sep 2005	A1
20050203521	Bonutti	Sep 2005	A1
20050216059	Bonutti	Sep 2005	A1
20050216087	Zucherman	Sep 2005	A1
20050222620	Bonutti	Oct 2005	A1
20050234332	Murphy	Oct 2005	A1
20050234461	Burdulis	Oct 2005	A1
20050234465	McCombs et al.	Oct 2005	A1
20050240190	Gall	Oct 2005	A1
20050240227	Bonutti	Oct 2005	A1
20050246021	Ringelsen	Nov 2005	A1
20050261684	Shaolian	Nov 2005	A1
20050267481	Carl	Dec 2005	A1
20050267534	Bonutti	Dec 2005	A1
20060009855	Goble	Jan 2006	A1
20060015101	Warburton	Jan 2006	A1
20060015108	Bonutti	Jan 2006	A1
20060024357	Carpenter	Feb 2006	A1
20060026244	Watson	Feb 2006	A1
20060064095	Senn	Mar 2006	A1
20060089646	Bonutti	Apr 2006	A1
20060122600	Cole	Jun 2006	A1
20060122704	Vresilovic	Jun 2006	A1
20060142657	Quaid et al.	Jun 2006	A1
20060142799	Bonutti	Jun 2006	A1
20060161051	Terrill-Grisoni	Jul 2006	A1
20060161136	Anderson	Jul 2006	A1
20060167495	Bonutti	Jul 2006	A1
20060200199	Bonutti	Sep 2006	A1
20060207978	Rizun et al.	Sep 2006	A1
20060212073	Bonutti	Sep 2006	A1
20060217765	Bonutti	Sep 2006	A1
20060229623	Bonutti	Oct 2006	A1
20060235470	Bonutti	Oct 2006	A1
20060241695	Bonutti	Oct 2006	A1
20060258938	Hoffman et al.	Nov 2006	A1
20060265009	Bonutti	Nov 2006	A1
20060265011	Bonutti	Nov 2006	A1
20060271056	Terrill-Grisoni	Nov 2006	A1
20070032825	Bonutti	Feb 2007	A1
20070088340	Brock	Apr 2007	A1
20070088362	Bonutti	Apr 2007	A1
20070100258	Shoham	May 2007	A1
20070118055	McCombs	May 2007	A1
20070118129	Fraser	May 2007	A1
20070173946	Bonutti	Jul 2007	A1
20070185498	Lavallee	Aug 2007	A2
20070198555	Friedman	Aug 2007	A1
20070219561	Lavallee	Sep 2007	A1
20070239153	Hodorek et al.	Oct 2007	A1
20070265561	Yeung	Nov 2007	A1
20070270833	Bonutti et al.	Nov 2007	A1
20070287889	Mohr	Dec 2007	A1
20080021474	Bonutti et al.	Jan 2008	A1
20080039845	Bonutti et al.	Feb 2008	A1
20080039873	Bonutti et al.	Feb 2008	A1
20080046090	Paul et al.	Feb 2008	A1
20080097448	Binder	Apr 2008	A1
20080108897	Bonutti	May 2008	A1
20080108916	Bonutti	May 2008	A1
20080114399	Bonutti	May 2008	A1
20080132950	Lange	Jun 2008	A1
20080140088	Orban	Jun 2008	A1
20080140116	Bonutti	Jun 2008	A1
20080140117	Bonutti	Jun 2008	A1
20080195145	Bonutti	Aug 2008	A1
20080243127	Lang	Oct 2008	A1
20080249394	Giori	Oct 2008	A1
20080262812	Arata	Oct 2008	A1
20080269753	Cannestra	Oct 2008	A1
20080269808	Gall	Oct 2008	A1
20090024161	Bonutti	Jan 2009	A1
20090088634	Zhao et al.	Apr 2009	A1
20090093684	Schorer	Apr 2009	A1
20090131941	Park et al.	May 2009	A1
20090138014	Bonutti	May 2009	A1
20090194969	Bearey	Aug 2009	A1
20090197217	Butscher	Aug 2009	A1
20090287222	Lee et al.	Nov 2009	A1
20100211120	Bonutti	Aug 2010	A1
20100217400	Nortman et al.	Aug 2010	A1
20100256504	Moreau-Gaudry	Oct 2010	A1
20110029093	Bojarski	Feb 2011	A1
20110060375	Bonutti	Mar 2011	A1
20110082462	Suarez et al.	Apr 2011	A1
20110087332	Bojarski	Apr 2011	A1
20110130761	Plaskos et al.	Jun 2011	A1
20110144661	Houser	Jun 2011	A1
20110295253	Bonutti	Dec 2011	A1
20120053591	Haines	Mar 2012	A1
20120123937	Spodak	May 2012	A1
20120165841	Bonutti	Jun 2012	A1
20120184961	Johannaber	Jul 2012	A1
20120191140	Bonutti	Jul 2012	A1
20120215233	Bonutti	Aug 2012	A1
20120323244	Cheal et al.	Dec 2012	A1
20120330429	Axelson, Jr. et al.	Dec 2012	A1
20130006267	Odermatt et al.	Jan 2013	A1
20130035696	Qutub	Feb 2013	A1
20130072821	Odermatt	Mar 2013	A1
20130211531	Steines et al.	Aug 2013	A1
20130331730	Fenech	Dec 2013	A1
20140257293	Axelson, Jr. et al.	Sep 2014	A1
20140343573	Bonutti	Nov 2014	A1
20150106024	Lightcap	Apr 2015	A1
20150141759	Charles et al.	May 2015	A1
20150145953	Fujie et al.	May 2015	A1
20150157416	Andersson	Jun 2015	A1
20150257768	Bonutti	Sep 2015	A1
20150320514	Ahn et al.	Nov 2015	A1
20160012306	Huang	Jan 2016	A1
20160030115	Shen	Feb 2016	A1
20160081758	Bonutti	Mar 2016	A1
20160199548	Cheng	Jul 2016	A1
20160202053	Walker et al.	Jul 2016	A1
20160206375	Abbasi et al.	Jul 2016	A1
20170148213	Thomas et al.	May 2017	A1
20170252114	Crawford et al.	Sep 2017	A1
20180296283	Crawford et al.	Oct 2018	A1
20190000049	Bonutti et al.	Jan 2019	A1
20190220976	Holsing et al.	Jul 2019	A1
20190274765	Crawford et al.	Sep 2019	A1
20190388160	Wood et al.	Dec 2019	A1
20210106389	Bonutti et al.	Apr 2021	A1
20220015727	Averbuch	Jan 2022	A1

Foreign Referenced Citations (41)

Number	Date	Country
2641580	Aug 2007	CA
2660827	Feb 2008	CA
2698057	Mar 2009	CA
1903016	Oct 1964	DE
1903316	Jul 1970	DE
3517204	Nov 1986	DE
3722538	Jan 1989	DE
9002844	Dec 1990	DE
0773004	May 1997	EP
0784454	Jul 1997	EP
1614525	Jan 2006	EP
1988837	Nov 2008	EP
2134294	Dec 2009	EP
2696338	Apr 1994	FR
2717368	Sep 1995	FR
2728779	Jul 1996	FR
2736257	Jan 1997	FR
2750031	Dec 1997	FR
2771621	Jun 1999	FR
2785171	May 2000	FR
2093701	Sep 1982	GB
2306110	Apr 1997	GB
H08140982	Jun 1996	JP
184396	Oct 2018	RU
1991012779	Sep 1991	WO
199323094	Nov 1993	WO
1994008642	Apr 1994	WO
1995016398	Jun 1995	WO
1995031941	Nov 1995	WO
1996014802	May 1996	WO
1997012779	Apr 1997	WO
1997049347	Dec 1997	WO
1998011838	Mar 1998	WO
1998026720	Jun 1998	WO
2002053011	Jul 2002	WO
2007092869	Aug 2007	WO
2008116203	Sep 2008	WO
2009029908	Mar 2009	WO
2010099222	Sep 2010	WO
2014163164	Oct 2014	WO
2015020093	Feb 2015	WO

Non-Patent Literature Citations (74)

Entry
English language abstract for WO 2014/163164 A1 extracted from espacenet.com database on Apr. 6, 2022, 2 pages.
510k, Arthrex Pushlock, Jun. 29, 2005, K051219.
510k, Mitek Micro anchor, Nov. 6, 1996, K962511.
510k, Modified Mitek 3.5mm Absorbable Suture Anchor System, Jun. 9, 1997, K970896.
510k, Multitak Suture System, Jan. 10, 1997, K964324.
510K, Summary for Arthrex Inc.'s Bio-Interference Screw, Jul. 9, 1997, K971358.
510k, Surgicraft Bone Tie, Sep. 25, 1998, K982719.
510k—Linvatec Biomaterials modification of Duet and impact Suture Anchor, Nov. 19, 2004, k042966.
510k—TranSet Fracture Fixation System, Feb. 24, 2004, k033711.
Arthrex, Protect your graft, Am J Sports Med, vol. 22, No. 4, Jul.-Aug. 1994.
Ask Oxford, compact Oxford English dictionary: projection, Mar. 30, 2009.
Ask Oxford, compact Oxford English dictionary: slit, Mar. 30, 2009.
Barrett et al, T-Fix endoscopic meniscal repair: technique and approach to different types of tears, Apr. 1995, Arthroscopy vol. 11 No. 2 p. 245-51.
Biomet, Stanmore Modular Hip, J. Bone Joint Surg., vol. 76-B : No. Two, Mar. 1994.
Branson, Polymers: Characteristics and Compatibility for Ultrasonic Assembly, Applied Technologies Group, Publication unknown.
Cobb et al, Late Correction of Malunited Intercondylar Humeral Fractures Intra-Articular Osteotomy and Tricortical Bone Grafting, J BoneJointSurg [Br] 1994; 76-B:622-6.
Cope, Suture Anchor for Visceral Drainage, AJR, vol. 148 p. 160-162, Jan. 1986.
Corrected Petition for Inter Partes Review of U.S. Pat. No. 5,921,986, IPR 2013-00631, filed Sep. 27, 2013.
Corrected Petition for Inter Partes Review of U.S. Pat. No. 8,147,514, IPR 2013-00632, filed Sep. 27, 2013.
Corrected Petition for Inter Partes Review of U.S. Pat. No. 8,147,514, IPR 2013-00633, filed Sep. 27, 2013.
Declaration of David Kaplan. Ph.D. Regarding U.S. Pat. No. 5,980,559, IPR 2013-00603, Sep. 24, 2013.
Declaration of Dr. Philip Hardy in Support of Petition for Inter Partes Review of U.S. Pat. No. 5,527,343, IPR 2013-00628, Sep. 25, 2013.
Declaration of Dr. Philip Hardy in Support of Petition for Inter Partes Review of U.S. Pat. No. 6,500,195, IPR 2013-00624, Sep. 25, 2013.
Declaration of Dr. Steve E. Jordan for U.S. Pat. No. 8,147,514, from IPR 2013-00631, dated Sep. 23, 2013.
Declaration of Steve Jordan for U.S. Pat. No. 5,921,986, from IPR 2013-00632, dated Sep. 24, 2013 (exhibit 1010).
Declaration of Steve Jordan for U.S. Pat. No. 5,921,986, from IPR 2013-00633, dated Sep. 24, 2013 (exhibit 1007).
Declaration of Steve Jordan for U.S. Pat. No. 8,147,514, from IPR 2013-00632, dated Sep. 23, 2013 (exhibit 1009).
Declaration of Steve Jordan for U.S. Pat. No. 8,147,514, from IPR 2013-00633, dated Sep. 23, 2013 (exhibit 1006).
Declaration of Wayne J. Sebastianelli, MD Regarding U.S. Pat. No. 7,087,073, Sep. 24, 2013, IPR 2013-00604.
Enabling Local Drug Delivery-Implant Device Combination Therapies, Surmodics, Inc., (c) 2003.
Expert Declaration of Steve E. Jordan, MD, for Inter Partes Review of U.S. Pat. No. 5,921,986, IPR 2013-00631, Sep. 24, 2013.
Extended Search Report for 17183788.3, dated Oct. 5, 2017, 8 pages.
Fellinger. et al, Radial avulsion of the triangular fibrocartilage complex in acute wrist trauma: a new technique for arthroscopic repair, Jun. 1997, Arthroscopy vol. 13 No. 3 p. 370-4.
Femoral Bone Plug Recession in Endoscope Anterior Cruciate Ligament Reconstruction, David E. Taylor, Arthroscopy: The Journal of Arthroscopic and Related Surgery, Aug. 1996.
Flory, Principles of Polymer Chemistry, 1953, selected pages (cited in IPR 2013-00603, exhibit 1012).
Gabriel, Arthroscopic Fixation Devices, Wiley Enc. of Biomed Eng., 2006.
Gao et el, Swelling of Hydroxypropyl Methylcellulose Matrix Tablets . . . , J. of Pharmaceutical Sciences, vol. 85, No. 7, Jul. 1996, p. 732-740 (cited in IPR 2013-00603, exhibit 1014).
Gopferich, Mechanisms of polymer degradation and erosion, Biomaterials, 1996, vol. 17, No. 2, p. 103-114 (cited in IPR 2013-00603, exhibit 1013).
Grizzi, Hydrolytic degradation of devices based on poly(DL-lactic acid) size-dependence, Biomaterials, 1995, vol. 16, No. 4, p. 305-11 (cited in IPR 2013-00603, exhibit 1006).
Guide to Ultrasound Plastic Assembly, Ultrasonic Division Publication, (c) 1995.
Gupta. “Dynamic illumination based system to remove the glare and improve the quality of medical images.” Engineering in Medicine and Biology Society (EMBC), 2013 35th Annual International Conference of IEEE, pp. 3020-3023, Jul. 3, 2013.
Hecker et al , Pull-out strength of suture anchors for rotator cuff and Bankart lesion repairs, Nov.-Dec. 1993 , The American Journal of Sports Medicine, vol. 21 No. 6 p. 874-9.
Hernigou et al, Proximal Tibial Osteotomy for Osteoarthritis with Varus Deformity a Ten to Thirteen-Year Follow-Up Study, J Bone Joint Surg, vol. 69-A, No. 3. Mar. 1987, p. 332-354.
Ibarra et al, Glenoid Replacement in Total Shoulder Arthroplasty, The Orthopedic Clinics of North America: Total Shoulder Arthroplasty, vol. 29 No. 3, Jul. 1998 p. 403-413.
Innovasive, We've got you covered, Am J Sports Med, vol. 26, No. 1, Jan.-Feb. 1998.
Karlsson et al, Repair of Bankart lesions with a suture anchor in recurrent dislocation of the shoulder, Scand. j. of Med & Science in Sports, 1995, 5:170-174.
Linvatec, Impact Suture Anchor brochure, 2004 (cited in IPR 2013-00628, exhibit 1010).
Madjar et al, Minimally Invasive Pervaginam Procedures, for the Treatment of Female Stress Incontinence . . . , Artificial Organs, 22 (10) 879-885, 1998.
Meniscus Replacement with Bone Anchors: A Surgical Technique, Arthroscopy: The Journal of Arthroscopic and Related Surgery, 1994.
Mosca et al, Calcaneal Lengthening for Valgus Deformity of the Hindfoot: Results in Children Who Had Severe, Symptomatic Flatfoot and Skewfoot, J Bone Joint Surg,, 1195—p. 499-512.
Murphy et al , Radial Opening Wedge Osteotomy in Madelung's Deformity, J. Hand Surg, vol. 21 A No. 6 Nov. 1996, p. 1035-44.
Nowak et al, Comparative Study of Fixation Techniques in the Open Bankart Operation Using Either a Cannulated Screw or Suture-Anchors, Acta Orthopcedica Belgica, vol. 64—Feb. 1998.
Packer et al, Repair of Acute Scapho-Lunate Dissociation Facilitated by the “Tag” Suture Anchor, Journal of Hand Surgery (British and European Volume, 1994) 19B: 5: 563-564.
Petition for Inter Partes Review of U.S. Pat. No. 5,527,343, IPR 2013-00628, filed Sep. 25-26, 2013.
Petition for Inter Partes Review of U.S. Pat. No. 5,980,559, IPR 2013-00603, filed Sep. 24, 2013.
Petition for Inter Partes Review of U.S. Pat. No. 6,500,195, IPR 2013-00624, filed Oct. 2, 2013.
Petition for Inter Partes Review of U.S. Pat. No. 7,087,073, IPR 2013-00604, filed Sep. 4, 2013.
Problem Solving Report Question No. 1014984.066, Ultrasonic Welding, (c) 1999.
Richmond, Modification of the Bankart reconstruction with a suture anchor, Am J Sports Med, vol. 19, No. 4, p. 343-346, 1991.
Seitz et al, Repair of the Tibiofibular Syndesmosis with a Flexible Implant, J. of Orthopaedic Trauma, vol. 5, No. 1, p. 78-82, 1991 (cited in IPR 201300631, exhibit 1007) (cited in 2013-00632).
Shea et al, Technical Note: Arthroscopic Rotator Cuff Repair Using a Transhumeral Approach to Fixation, Arthroscopy: The Journal of Arthroscopic and Related Surgery, vol. 14, No. 1 Jan.-Feb. 1998: pp. 118-122.
Stent Based Delivery of Sirolimus Reduces Neointimal Formation in a Porcine Coronary Model, Takeshi Suzuki, American Heart Association, Inc. (c) 2001.
Textured Surface Technology, Branson Technology, Branson Ultrasonics Copr., (c) 1992.
Tfix, Acufexjust tied the knot . . . , Am. J. Sports Med., vol. 22, No. 3, May-Jun. 1994.
The Search for the Holy Grail: A Century of Anterior Cruciate Ligament Reconstruction, R. John Naranja, American Journal of Orthopedics, Nov. 1997.
Translation of DE9002844.9 with translator's certificate dated Sep. 26, 2013 (cited in IPR 2013-00631, 2013-00632).
Translation of FR2696338 with translator's certificate dated Sep. 17, 2013 (cited in IPR 2013-00631, 2013-00632).
Why Tie a Knot When You Can Use Y-Knot?, Innovasive Devices Inc., (c) 1998.
WO2015020093 English Translation Sep. 4, 2017.
Wong et al, Case Report: Proper Insertion Angle is Essential to Prevent Intra-Articular Protrusion of a Knotless Suture Anchor in Shoulder Rotator Cuff Repair, Arthroscopy: The Journal of Arthroscopic and Related Surgery, vol. 26, No. 2 Feb. 2010:pp. 286-290.
Cobb et al, Late Correction of Malunited Intercondylar Humeral Fractures Intra-Articular Osteotomy and Tricortical Jone Grafling, J BoneJointSurg [Br] 1994; 76-B:629-6.
Murphy et al , Radial Opening Wedge Osteotomy in Madelung's Deformity, J. Hand Surg, vol. 21 A No. Nov. 6, 1996, p. 1035-44.
Packer et al, Repair of Acute Scapho-Lunate Dissociation Facilitated by the “TAG” Suture Anchor, Journal of Hand Surgery (British and European vol. 1994) 19B: 5: 563-564.
Wong et al, Case Report: Proper Insertion Angle is Essential to Prevent Intra-Articular Protrusion of a Knotless Suture Anchor in Shoulder Rotator Cuff Repair, Arthroscopy: The Journal of Arthroscopic and Related Surgery, vol. 26, No. Feb. 2, 2010:pp. 286-290.

Related Publications (1)

	Number	Date	Country
	20220296311 A1	Sep 2022	US

Provisional Applications (2)

	Number	Date	Country
	62369821	Aug 2016	US
	62244460	Oct 2015	US

Continuations (3)

	Number	Date	Country
Parent	16986467	Aug 2020	US
Child	17714191		US
Parent	16113666	Aug 2018	US
Child	16986467		US
Parent	15299981	Oct 2016	US
Child	16113666		US

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