Tissue sealer with non-conductive variable stop members and method of sealing tissue

Information

  • Patent Grant
  • 7491201
  • Patent Number
    7,491,201
  • Date Filed
    Friday, May 14, 2004
    20 years ago
  • Date Issued
    Tuesday, February 17, 2009
    15 years ago
Abstract
A bipolar forceps for sealing tissue includes an elongated shaft having opposing jaw members at a distal end thereof, each of the jaw members including an electrically conductive sealing surface. The jaw members are movable relative to one another from a first position wherein the jaw members are disposed in spaced relation relative to one another to a second position wherein the jaw members cooperate to grasp tissue therebetween. The bipolar forceps is connected to a source of electrical energy such that the jaw members are capable of conducting bipolar energy through tissue held therebetween to effect a seal. The forceps also includes a stop member assembly having at least one non-conductive stop member which is selectively extendible to regulate the distance between the jaw members when tissue is held therebetween.
Description
BACKGROUND

The present disclosure relates to an electrosurgical instrument and method for performing electrosurgical procedures. More particularly, the present disclosure relates to an open or endoscopic bipolar electrosurgical forceps and method of using same which includes a selectively-variable, non-conductive stop member associated with one or both of the opposing jaw members. The selectively-variable, non-conductive stop member is designed to control the gap distance between opposing jaw members and enhance the manipulation and gripping of tissue during the sealing process.


TECHNICAL FIELD

Forceps utilize mechanical action to constrict, grasp, dissect and/or clamp tissue. Electrosurgical forceps utilize both mechanical clamping action and electrical energy to effect hemostasis by heating the tissue and blood vessels. By controlling the intensity, frequency and duration of the electrosurgical energy applied through the jaw members to the tissue, the surgeon can coagulate, cauterize and/or seal tissue.


In order to effect a proper seal with larger vessels or thick tissue, two predominant mechanical parameters must be accurately controlled: the pressure applied to the tissue; and the gap distance between the electrodes. As can be appreciated, both of these parameters are affected by the thickness of vessels or tissue. More particularly, accurate application of pressure is important for several reasons: to reduce the tissue impedance to a low enough value that allows enough electrosurgical energy through the tissue; to overcome the forces of expansion during tissue heating; and to contribute to the end tissue thickness which is an indication of a good seal. It has been determined that fused tissue is optimum between about 0.001 inches to about 0.006 inches for small vessels and tissues and about 0.004 inches to about 0.008 inches for large, soft tissue structures. Below these ranges, the seal may shred or tear and above this range the tissue may not be properly or effectively sealed.


It is thought that the process of coagulating or cauterizing small vessels is fundamentally different than electrosurgical vessel or tissue sealing. “Vessel sealing” or “tissue sealing” is defined as the process of liquefying the collagen, elastin and ground substances in the tissue so that it reforms into a fused mass with significantly-reduced demarcation between the opposing tissue structures. In contrast, the term “cauterization” is defined as the use of heat to destroy tissue (also called “diathermy” or “electrodiathermy”) and the term “coagulation” is defined as a process of desiccating tissue wherein the tissue cells are ruptured and dried. Coagulation of small vessels is usually sufficient to permanently close them, however, larger vessels or tissue need to be “sealed” to assure permanent closure.


Numerous electrosurgical instruments have been proposed in the past for various open and endoscopic surgical procedures. However, most of these instruments cauterize or coagulate tissue and are normally not designed to provide uniformly reproducible pressure on the blood vessel or tissue which, if used for sealing purposes, would result in an ineffective or non-uniform seal. For example, U.S. Pat. No. 2,176,479 to Willis, U.S. Pat. Nos. 4,005,714 and 4,031,898 to Hiltebrandt, U.S. Pat. Nos. 5,827,274, 5,290,287 and 5,312,433 to Boebel et al., U.S. Pat. Nos. 4,370,980, 4,552,143, 5,026,370 and 5,116,332 to Lottick, U.S. Pat. No. 5,443,463 to Stern et al., U.S. Pat. No. 5,484,436 to Eggers et al. and U.S. Pat. No. 5,951,549 to Richardson et al., all relate to electrosurgical instruments for coagulating, cauterizing, and cutting vessels or tissue.


Many of these instruments include blade members or shearing members which simply cut tissue in a mechanical and/or electromechanical manner and are relatively ineffective for vessel or tissue sealing purposes. Other instruments generally rely on clamping pressure alone to procure proper sealing thickness and are often not designed to take into account gap tolerances and/or parallelism and flatness requirements which are parameters which, if properly controlled, can assure a consistent and effective tissue seal. For example, it is known that it is difficult to adequately control thickness of the resulting sealed tissue by controlling clamping pressure alone for either of two reasons: 1) if too much force is applied, there is a possibility that the two poles will touch and energy will not be transferred through the tissue resulting in an ineffective seal; or 2) if too low a force is applied, a thicker less reliable seal is created.


Thus, a need exists to develop an electrosurgical instrument which effectively and consistently seals tissue and solves the aforementioned problems. This instrument should be designed to regulate the gap distances between opposing jaws members to procure a consistent and effective seal. Preferably, the instrument should also be designed to reduce the chances of the opposing jaws short circuiting during activation and assist in manipulating, gripping and holding the tissue prior to and during electrosurgical activation.


SUMMARY

The present disclosure relates to a bipolar forceps for sealing tissue which includes an elongated shaft having opposing jaw members at a distal end thereof and electrically conductive sealing surfaces attached to each jaw member. The jaw members are movable relative to one another from a first position wherein the electrically conductive sealing surfaces are disposed in spaced relation relative to one another to a second position wherein the electrically conductive sealing surfaces of the jaw members cooperate to grasp tissue therebetween. The electrically conductive sealing surfaces are connected to a source of electrical energy such that the electrically conductive sealing surfaces are capable of conducting energy through tissue held therebetween to effect a tissue seal. The forceps also includes a stop member assembly having at least one non-conductive stop member which is selectively adjustable to regulate the gap distance between the opposing electrically conductive sealing surfaces when tissue is held therebetween.


Preferably, the stop member assembly includes at least one controller which is engagable with the stop member and which is configured to extend and retract the stop member in response to a signal from a control source, e.g., an electrosurgical generator. In one embodiment, the forceps includes a sensor disposed on one of the jaw members. Preferably, the sensor is configured to sense information relating to tissue impedance, tissue thickness and/or tissue type. The sensor relays the sensed information to the control source which, in turn, sends a signal to the controller for adjusting the stop member.


In one embodiment, the stop member assembly utilizes a set of gears to selectively extend and retract the stop member. In another embodiment, the stop member assembly utilizes a cam (or series of cams) to regulate the distance the stop member extends from the electrically conductive sealing surface. Other mechanisms are also envisioned, e.g., electromechanical actuators, ferroelectric actuators, piezo-electric actuators, piezo-ceramic actuators, hydraulics actuators, pneumatics actuators, magnetostrictors and rotational actuators.


Preferably, the stop member is selectively extendible in the range of about 0.001 inches to about 0.008 inches from the electrically conductive sealing surface of at least one jaw member. The stop member may be extendible from one or both jaw members and may be manufactured from materials selected from parylene, nylon and ceramic. The stop member may be adjusted either prior to or during activation. For example, the stop member may be automatically adjusted based upon a pre-surgical condition or tissue type and/or may be automatically adjustable based upon a surgical condition during activation, e.g., tissue impedance, tissue clarity, tissue moisture content, etc. Automatically adjusting the stop member during activation may create better results for large or thick tissues (e.g., liver) or ridged tissue (e.g., bronchus).


The present disclosure also relates to a method of sealing tissue comprising the steps of: providing a bipolar forceps which includes a shaft having opposing jaw members at a distal end thereof. Each of the jaw members including an electrically conductive sealing surface which cooperate to grasp tissue therebetween. The forceps also includes at least one non-conductive stop member disposed on an electrically conductive surface of at least one of the jaw members. The non-conductive stop member is selectively adjustable to regulate the distance between the electrically conductive sealing surfaces when tissue is held therebetween.


The method also includes the steps of: connecting the electrically conductive sealing surfaces to a source of electrosurgical energy; adjusting the distance that the stop members extend from the electrically conductive sealing surface depending upon a pre-surgical condition; actuating the jaw members to grasp tissue between opposing electrically conductive sealing surfaces; and conducting energy to the electrically conductive sealing surfaces through tissue held therebetween to effect a seal. The method of sealing tissue may further include the step of severing the tissue along the tissue seal. Additional steps may also be included for automatically adjusting the stop members based upon a pre-surgical condition or sensed surgical condition during surgery as described above.


In another method of sealing tissue according to the present disclosure, the adjusting step further includes the steps of: sensing a pre-surgical condition; and signaling the controller to selectively adjust the stop members relative to the electrically conductive sealing surface depending upon the sensed pre-surgical condition.


Another method according to the present disclosure includes the steps of: providing a bipolar forceps which includes a shaft having opposing jaw members at a distal end thereof which cooperate to grasp tissue therebetween, each of the jaw members including an electrically conductive sealing surface; at least one non-conductive stop member operatively associated with at least one electrically conductive surface of at least one of the jaw members, the non-conductive stop member being selectively adjustable to regulate the distance between the electrically conductive surfaces when tissue is held therebetween.


The method also includes the steps of: connecting the jaw members to a source of electrosurgical energy; actuating the jaw members to grasp tissue between opposing jaw members; conducting energy to the jaw members through tissue held therebetween to effect a tissue seal; and adjusting the distance that the stop members extend from the electrically conductive sealing surface depending upon a sensed surgical condition during activation.


Preferably, the adjusting step further includes the step of: communicating with a feedback control system which continually senses surgical conditions during activation to automatically regulate the distance that the stop members extend from the electrically conductive sealing surfaces. The adjusting step may also include the step of: communicating with a feedback control system to automatically regulate the distance that the stop members extend from the electrically conductive sealing surfaces based upon at least one of tissue impedance, tissue temperature, tissue thickness, tissue moisture, tissue compliance or tissue clarity during activation.





BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the present disclosure are described herein with reference to the drawings wherein:



FIG. 1A is a perspective view of an endoscopic bipolar forceps which is configured to support a variable stop member assembly according to the present disclosure;



FIG. 1B is a side, partial internal view of an endoscopic forceps showing a selectively adjustable stop member assembly according to the present disclosure;



FIG. 1C is an enlarged view of the area of detail of FIG. 1B;



FIG. 2 is a side, partial internal view of an end effector assembly shown in closed configuration;



FIG. 3 is a rear, perspective view of the end effector of FIG. 2 shown with tissue grasped therein; and



FIG. 4 is an enlarged, perspective view of an electrically conductive sealing surface of the end effector assembly showing a series of selectively adjustable stop members disposed thereon.





DETAILED DESCRIPTION

Referring now to FIGS. 1A-4, an endoscopic bipolar forceps 10 is shown by way of example for use with various endoscopic surgical procedures. Either an endoscopic instrument or an open instrument may be utilized for supporting the variable stop member assembly according to the present disclosure. Obviously, different electrical and mechanical connections and considerations apply to each particular type of instrument, however, the novel aspects with respect to the stop member assembly and its operating characteristics remain generally consistent with respect to both the open or endoscopic designs. Forceps 10 is shown by way of example and other electrosurgical forceps are also envisioned which may support the stop member assembly of the present disclosure. In the drawings and in the description which follows, the term “proximal”, as is traditional, will refer to the end of the forceps 10 which is closer to the user, while the term “distal” will refer to the end of the forceps which is further from the user.



FIGS. 1A-1C show an endoscopic vessel sealing forceps 10 which is configured to support an electrode sealing assembly 100. More particularly, forceps 10 generally includes a housing 20, a handle assembly 30, a rotating assembly 80, a trigger assembly 70 and the end effector assembly 100 which mutually cooperate to grasp, seal and, if warranted, divide tissue. The forceps 10 includes a shaft 12 which has a distal end 14 dimensioned to mechanically engage the end effector assembly 100 and a proximal end 16 which mechanically engages the housing 20 proximate the rotating assembly 80.


Forceps 10 also includes a plug (not shown) which connects the forceps 10 to a source of electrosurgical energy, e.g., an electrosurgical generator 500, via an electrical cable 310. Handle assembly 30 includes a fixed handle 50 and a movable handle 40. Handle 40 moves relative to fixed handle 50 to actuate the end effector assembly 100 and enable a user to grasp and manipulate tissue 400 (See FIG. 3). The end effector assembly 100 includes a pair of opposing jaw members 110 and 120 which each have an electrically conductive sealing surface 112 and 122, respectively, attached thereto for conducting electrosurgical energy through tissue 400 held therebetween. More particularly, the jaw members 110 and 120 move in response to movement of the handle 40 from an open position wherein the electrically conductive sealing surfaces 112 and 122 are disposed in spaced relation relative to one another, to a clamping or closed position wherein the electrically conductive sealing surfaces 112 and 122 cooperate to grasp tissue therebetween.


The housing 20 encloses a drive assembly (not shown) which cooperates with the movable handle 40 to impart movement of the jaw members 110 and 120 from the open position to the clamping or closed position. One Example of a handle assembly is shown and described in commonly-owned U.S. application Ser. No. 10/389,894 entitled “VESSEL SEALER AND DIVIDER AND METHOD MANUFACTURING SAME” which is hereby incorporated by reference herein in its entirety. The handle assembly of this particular disclosure is generally be characterized as a four-bar mechanical linkage which provides a unique mechanical advantage when sealing tissue between the jaw members 110 and 120. For example, once the desired position for the sealing site is determined and the jaw members 110 and 120 are properly positioned, handle 40 may be compressed fully to lock the electrically conductive sealing surfaces 112 and 122 in a closed position against the tissue. The details relating to the inter-cooperative relationships of the inner-working components of forceps 10 are disclosed in the above-cited commonly-owned U.S. patent application Ser. No. 10/369,894. When the electrically conductive sealing surfaces 112 and 122 of the jaw members 110 and 120 are fully compressed about the tissue 400, the forceps 10 is now ready for selective application of electrosurgical energy (See FIG. 3). Another example of an endoscopic handle assembly is disclosed in U.S. patent application Ser. No. 10/460,926 entitled “VESSEL SEALER AND DIVIDER FOR USE WITH SMALL TROCARS AND CANNULAS”, the entire contents of this application being incorporated by reference herein.


Experimental results suggest that the magnitude of pressure exerted on the tissue 400 by the electrically conductive sealing surfaces 112 and 122 is important in assuring a proper surgical seal. Pressures within a working range of about 3 kg/cm2 to about 16 kg/cm2 and, preferably, within a working range of about 7 kg/cm2 to about 13 kg/cm2 have been shown to be effective for sealing various small tissue types. Pressure within a working range of about 4.5 kg/cm2 to about 8.5kg/cm2 are optimal for large soft tissue structures.


As explained above, movement of the handle assembly 30, e.g., via a four-bar linkage, ultimately causes the opposing jaw members 110 and 120 to move relative to one another. As can be appreciated, the significant mechanical advantage associated with the four-bar linkage permits facile, consistent and uniform compression of the jaw members 110 and 120 about the tissue 400. Other details and advantages of the four-bar mechanical linkage are more fully discussed with respect to the above-mentioned commonly-owned U.S. patent application Ser. No. 10/369,894.


As best seen in FIGS. 1A-1C, forceps 10 also includes a trigger 70 which advances a knife 200 disposed within the end effector assembly 100. Once a tissue seal is formed, the user can activate the trigger 70 to separate the tissue 400 along the tissue seal. Knife 200 preferably includes a sharpened edge 205 for severing the tissue 400 held between the jaw members 110 and 120 at the tissue sealing site.


A rotating, assembly 80 may also be incorporated with forceps 10. Preferably, rotating assembly 80 is mechanically associated with the shaft 12 and the drive assembly (not shown). Movement of the rotating assembly 80 imparts similar rotational movement to the shaft 12 which, in turn, rotates the end effector assembly 100. These features along with the unique electrical configuration for the transference of electrosurgical energy through the handle assembly 20 and the rotating assembly 80 are described in more detail in the above-mentioned commonly-owned U.S. patent application Ser. Nos. 10/369,894 and 10/460,926.


As best seen with respect to FIGS. 1A-2, end effector assembly 100 attaches to the distal end 14 of shaft 12. The jaw members 110 and 120 are preferably pivotable about a pivot 160 from the open to closed positions upon relative reciprocation, i.e., longitudinal movement, of the drive assembly (not shown). Again, mechanical and cooperative relationships with respect to the various moving elements of the end effector assembly 100 are further described by example with respect to the above-mentioned commonly-owned U.S. patent application Ser. Nos. 10/369,894 and 10/460,926.


It is envisioned that the forceps 10 may be designed such that it is fully or partially disposable depending upon a particular purpose or to achieve a particular result. For example, end effector assembly 100 may be selectively and releasably engageable with the distal end 14 of the shaft 12 and/or the proximal end 16 of the shaft 12 may be selectively and releasably engageable with the housing 20 and handle assembly 30. In either of these two instances, the forceps 10 would be considered “partially disposable” or “reposable”, i.e., a new or different end effector assembly 100 (or end effector assembly 100 and shaft 12) selectively replaces the old end effector assembly 100 as needed.


Each of the jaw members 110 and 120 includes an electrically conductive sealing surface 112 and 122, respectively disposed on an inner-facing surface thereof. It is envisioned that the electrically conductive surfaces 112 and 122 cooperate to seal tissue 400 held therebetween upon the application of electrosurgical energy. Insulators 116 and 126 (together with the outer, non-conductive surfaces of the jaw members 110 and 120) may be included to limit and/or reduce many of the known undesirable effects related to tissue sealing, e.g., flashover, thermal spread and stray current dissipation (See FIG. 1C).


Preferably, a least one of the electrically conductive surfaces, e.g., 112, of one of the jaw members, e.g., 110, includes a longitudinally-oriented channel 210 defined therein (See FIG. 4) which extends from the proximal end of the electrically conductive sealing surface 112 to the distal end. The channel 210 facilitates longitudinal reciprocation of the knife 200 along a preferred cutting plane to effectively and accurately separate the tissue 400 along a formed tissue seal.


By controlling the intensity, frequency and duration of the electrosurgical energy applied to the tissue 400, the user can selectively seal tissue 400. As mentioned above, two mechanical factors play an important role in determining the resulting thickness of the sealed tissue and effectiveness of the seal, i.e., the pressure applied between opposing jaw members 110 and 120 and the gap distance “G” between the opposing sealing surfaces 112 and 122 of the jaw members 110 and 120, respectively, during the sealing process.


However, thickness of the resulting tissue seal cannot be adequately controlled by force alone. In other words, too much force and the two jaw members 110 and 120 would touch and possibly short resulting in little energy traveling through the tissue 400 thus resulting in a bad tissue seal. Too little force and the seal would be too thick. Applying the correct force is also important for other reasons: to reduce the tissue impedance to a low enough value that allows enough current through the tissue 400; and to overcome the forces of expansion during tissue heating in addition to contributing towards creating the required end tissue thickness which is an indication of a good seal.


In order to achieve a desired spacing between the electrically conductive surfaces 112 and 122 of the respective jaw members 110 and 120, (i.e., gap distance “G”) and apply a desired force to seal the tissue 400, at least one jaw member 110 and/or 120 includes at least one stop member, e.g., 150, to limit the movement of the two opposing jaw members 110 and 120 relative to one another. Preferably, the stop member, e.g., 150, extends from at least one of the sealing surfaces 112, 122 a predetermined distance according to the specific material properties of the stop member 150 (e.g., compressive strength, thermal expansion, etc.) to yield a consistent and accurate gap distance “G” during sealing. Preferably, the gap distance “G” between opposing sealing surfaces 112 and 122 during sealing ranges from about 0.001 inches to about 0.008 inches. Preferably for smaller tissue types the gap distance is optimal between about 0.002 inches to about 0.003 inches and for larger tissue types the gap distance is optimal between about 0.004 inches to about 0.007 inches.


Preferably, stop members 150 are made from an insulative material, e.g., parylene, nylon and/or ceramic and are dimensioned to limit opposing movement of the electrically conductive sealing surfaces 112 and 122 to within the above mentioned gap range “G”. It is envisioned that the stop members 150 may be disposed on one or both of the electrically conductive sealing surfaces 112 and 122 depending upon a particular purpose or to achieve a particular result.


As best shown in FIGS. 1B and 1C, at least of the jaw members includes a selectively adjustable stop member assembly 140 which allows a surgeon to regulate the gap distance “G” depending upon a particular tissue type and/or tissue thickness. More particularly, at least one of the jaw members, e.g., jaw member 110, includes a cavity 130 disposed therein which is dimensioned to house the stop member assembly 140. Stop member assembly 140 includes a plurality of selectively adjustable stop member control units 145 which includes a stop member 150 and a controller 155. More particularly, the controller 155 is designed to receive signals from a control source 300 (FIG. 2) which may be attached to an electrosurgical generator 500 or incorporated into the housing of the forceps 10. The control source 300 signals the controller 155 to electrically, mechanically or electro-mechanically adjust the distance the stop member(s) 150 projects or extends from the electrically conductive sealing surface 112 (and/or 122). The distance that the stop member(s) 150 projects from the electrically conductive sealing surface 112 (and/or 122) determines the ultimate gap distance “G” (See FIG. 2).


It is envisioned that the controller 155 may adjust the distance that each stop member 150 extends from the sealing surface 112 is any known fashion. For example, each stop member 150 and its corresponding controller 155 may be threadably connected such that the controller 155 “unscrews” the stop member 150 to adjust the distance that the stop member 150 extends from the sealing surface 112. Thus, by controlling the amount that the stop member 150 unscrews from the controller 155, a surgeon can selectively regulate (or a control source 300 may automatically regulate) the gap distance “G”. Other mechanical systems (not shown) are also envisioned to allow selective regulation of the gap distance “G”, e.g., gearing mechanisms, camming mechanisms, pneumatic mechanisms, hydraulic mechanisms, etc. Electromechanical systems are also contemplated, e.g., electro-mechanical actuators, ferroelectric actuators, piezo-electric actuators, piezo-ceramic actuators, magnetostrictors and rotational actuators, etc.


It is envisioned that the controller 155 may cooperate with a sensor assembly 170a and 170b (or a plurality of sensors) which determines or measures tissue thickness, tissue moisture, tissue type, tissue impedance, etc. and automatically signals the control source 300 to signal the controller 155 to adjust the stop members 150 to extend a specific distance (i.e., a “preferred” or “recommended” gap distance “G”) from the electrically conductive sealing surface 112 prior to activation. The preferred gap distance “G” (which directly corresponds to the specified distance that the stop members 150 extend from the electrically conductive sealing surface 112) may be selected from a look-up table or determined by a computer algorithm stored within the control source 300. It is envisioned that the stop members are selectively adjustable to protrude about 0.001 inches to about 0.008 inches from the electrically conductive sealing surfaces 112 (and/or 122) of the jaw members 110 (and/or 120).


It is also contemplated that one or more stop members 150 may be individually controllable (via controller 155 or manually) to vary the gap distance along or across the sealing surfaces depending upon a particular purpose or to achieve a particular tissue seal. Moreover, it is envisioned that varying the distance that stop member(s) project from the sealing surface(s) may produce different results for different tissue types and may prove desirable for one or more particular tissue types or one or more different surgical procedures.


The sensors 170a and 170b are connected to the control source 300 (or electrosurgical generator) via cables 171a and 171b, respectively. The sensors 170a and 170b may form a part of a closed-loop control system which automatically adjusts the forceps 10 prior to and/or during activation based on pre-surgical parameters and continually-sensed parameters. For example, the stop members 150 may be adjusted based upon a pre-surgical parameter such as tissue thickness, tissue type, tissue compliance, tissue impedance, etc. One example of a closed-loop control system is described in commonly-owned U.S. patent application Ser. No. 10/427,832 filed on May 1, 2003 entitled “METHOD AND SYSTEM FOR CONTROLLING OUTPUT OF RF MEDICAL GENERATOR” the entire contents of which are hereby incorporated by reference herein. For example, the stop member(s) 150 may be set according to a pre-surgical condition (either automatically based upon a sensed condition (e.g., tissue impedance, tissue type, tissue clarity, tissue compliance, etc.)) or manually by the surgeon.


It is also envisioned that the stop member(s) 150 may be adjusted during activation based upon a continually-sensed surgical condition (e.g., tissue impedance, tissue type, tissue clarity, tissue compliance, etc.) utilizing a feed back control loop. It is envisioned that this may allow the control system to achieve a “slow close” condition. More particularly, one preferred technique for sealing larger tissue structures (e.g., lung, liver, bronchus, etc.) is a so-called “slow-close” surgical technique which involves activating the surgical instrument prior to obtaining a fully ratcheted position. As can be appreciated, this type of procedure is very difficult to master manually due to the many variables involved with the sealing process and, as a result, the instrument may short or the sealing cycle may complete prior to obtaining the fully closed ratcheted position. It is envisioned that the automatic stop member adjustment system described above may enable slow close activation which may lead to more effective sealing of large tissue structures. For example, the surgeon can grasp the tissue in a customary manner and fully ratchet the forceps about the tissue within the preferred pressure ranges. The stop member(s) 150 can be programmed to activate in a “slow close” manner and automatically adjust from a large gap distance e.g., about 0.10 inches to within a preferred gap range of about 0.001 inches to about 0.008 inches during activation. The stop member control assembly 140 may also be coupled to a feedback control system which automatically regulates the “slow close” technique based upon tissue thickness, tissue temperature, tissue impedance, tissue moisture, tissue clarity, tissue compliance during activation. As can be appreciated, this enables any surgeon to perform a slow close technique for sealing lager tissue structures.


A control knob 350 (See FIG. 2) may also be included to permit a surgeon to manually adjust the distance that the stop members 150 protrude from the electrically conductive sealing surface 112 (and/or 122) depending upon a particular purpose.



FIG. 4 shows one contemplated configuration of the stop members 150 disposed on or protruding from the electrically conductive sealing surface 112. It is envisioned that the stop members 150 can be positioned on either or both jaw members 110 and 120 depending upon a particular purpose or to achieve a desired result. More particularly and as illustrated in FIG. 4, a series of longitudinally-oriented tab-like stop members 150 are disposed along either side of the knife channel 210 of jaw member 110. Preferably, the stop members 150 may be configured in any known geometric or polynomial configuration, e.g., triangular, rectilinear, circular, ovoid, scalloped, etc., depending upon a particular purpose. Moreover, it is contemplated that any combination of different stop members 150 may be assembled along the sealing surfaces 112 (and/or 122) to achieve a desired gap distance “G”. A ceramic or insulative coating may be deposited or sprayed onto the tissue engaging surface of the stop members 150. Thermal spraying techniques are contemplated which involve depositing a broad range of heat resistant and insulative materials on the tissue engaging surfaces of the stop members 150, high velocity Oxy-fuel deposition, plasma deposition, etc.


Further, although it is preferable that the stop members 150 are selectively adjustable to protrude about 0.001 inches to about 0.008 inches from the electrically conductive sealing surfaces 112, in some cases it may be preferable to have the stop members 150 protrude more or less depending upon a particular purpose. For example, it is contemplated that the type of material used for the stop members 150 and that material's ability to absorb the preferred range of compressive closure forces between jaw members 110 and 120 will vary and, therefore, the overall distance that the stop members 150 may have to extend from the electrically conducive sealing surfaces 112 may have to adjusted to compensate for the particular stop member 150 material being utilized to produce the desired gap distance “G”.


In other words, the compressive strength of the stop member material along with the desired or ultimate gap distance “G” required for effective sealing are parameters which should be considered during activation since one material may have to be adjusted differently from another material to achieve the same gap distance “G”. For example, the compressive strength of nylon is different from ceramic and, therefore, the nylon material may have to extend a greater distance from the electrically conductive sealing surface 112 to counteract the closing force of the opposing jaw members 110 and 120 and to achieve the same desired gap distance “G”. As can be appreciated, these considerations may be automatically regulated or controlled at the control source 300 via a computer algorithm or look up table.


The present disclosure also relates to a method of sealing tissue utilizing a selectively adjustable stop member 150 and includes the steps of: providing a bipolar forceps 10 having a shaft 12 and opposing jaw members 110 and 120 which cooperate to grasp tissue 400 therebetween; at least one selectively extendible and non-conductive stop member 150 disposed on an electrically conductive surface 112 of at least one of the jaw members, e.g., 110, which regulates the distance between the jaw members 110 and 120 when tissue 400 is held therebetween. The method further includes the steps of: connecting the electrically conductive sealing surfaces 112 and 122 of the jaw members 110 and 120 to a source of electrosurgical energy; adjusting the distance that the stop members 150 extend from the electrically conductive sealing surface 112 depending upon a pre-surgical condition or parameter; actuating the jaw members 110 and 120 to grasp tissue 400 between opposing electrically conductive sealing surfaces 112 and 122; conducting energy to the electrically conductive sealing surfaces 112 and 122 through tissue 400 held therebetween to effect a seal.


The adjusting step of the method may further include the steps of: sensing a pre-surgical condition or parameter such as tissue type, tissue thickness, tissue compliance, tissue impedance, etc. and signaling the controller 155 (via the control source 300 or directly) to selectively extend or retract the stop members 150 relative to the electrically conductive sealing surface 112 depending upon the sensed pre-surgical condition or parameter.


At least one of the jaw members, e.g., 110, of the providing step includes may include an electrically conductive sealing surface 112 having a longitudinally-oriented channel 210 defined therein which facilitates actuation of a knife 200 in a longitudinally reciprocating fashion within the channel 210 for severing the tissue 400 proximate the tissue sealing site. As can be appreciated, the method may also include the step of severing the tissue 400 along the tissue seal.


From the foregoing and with reference to the various figure drawings, those skilled in the art will appreciate that certain modifications can also be made to the present disclosure without departing from the scope of the same. For example, it may be preferable to add other features to the forceps 10, e.g., an articulating assembly to axially displace the end effector assembly 100 relative to the elongated shaft 12.


Moreover, it is contemplated that the presently disclosed forceps may include a disposable end effector assembly 100 which is selectively engageable with at least one portion of the electrosurgical instrument, e.g., shaft 12 and/or handle assembly 80. Preferably, the electrically conductive sealing surfaces 112 and 122 of the jaw members 110 and 120 are relatively flat to avoid current concentrations at sharp edges and to avoid arcing between high points. In addition and due to the reaction force of the tissue 400 when engaged, jaw members 110 and 120 are preferably manufactured to resist bending. For example, the jaw members 110 and 120 may be tapered along their respective widths which is advantageous for two reasons: 1) the taper will apply constant pressure for a constant tissue thickness at parallel; 2) the thicker proximal portion of the jaw members 110 and 120 will resist bending due to the reaction force of the tissue 400.


It is also contemplated that one or more stop members may be disposed adjacent to one or both electrically conductive sealing surfaces to regulate the gap distance between conductive surfaces. Alternatively, one or more selectively extendible stop members may be disposed on one or both electrically conductive sealing surface(s) and one or more stop members may be disposed adjacent to at least one of the electrically conductive surfaces. As can be appreciated, both sets of selectively adjustable stop members would cooperate with the controller (or manually) to adjust and regulate the gap distance.


The stop member(s) may be dimensioned in any known geometric configuration and may be disposed on or adjacent to one or both of the electrically conductive tissue sealing surfaces or operatively associated with one or both jaw members. Moreover, the controller and stop member may be integrally associated with one another or may be formed from two or more components so long as the stop member is selectively adjustable to regulate the distance between the jaw members prior to and/or during electrical activation.


While several embodiments of the disclosure have been shown in the drawings and/or discussed herein, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.

Claims
  • 1. A bipolar forceps for sealing tissue, comprising: an elongated shaft having opposing jaw members at a distal end thereof, each of the jaw members including an electrically conductive sealing surface affixed thereto, the jaw members being movable relative to one another from a first position wherein the electrically conductive sealing surfaces are disposed in spaced relation relative to one another to a second position wherein the electrically conductive sealing surfaces cooperate to grasp tissue therebetween;each electrically conductive sealing surface adapted to be connected to a source of electrical energy such that the electrically conductive sealing surfaces are capable of conducting energy through tissue held therebetween to effect a tissue seal; anda stop member assembly operatively associated with at least one jaw member, the stop member assembly including at least one non-conductive stop member, the at least one non-conductive stop member being selectively adjustable to regulate the distance between the electrically conductive sealing surfaces when tissue is held therebetween based upon a sensed pre-surgical condition during activation.
  • 2. A bipolar forceps for sealing tissue according to claim 1 wherein the stop member assembly includes at least one controller which is engagable wit the at least one stop member, the controller being configured to extend and retract the stop member in response to a signal from a control source.
  • 3. A bipolar forceps for sealing tissue according to claim 2 wherein the forceps includes at least one sensor disposed on at least one of the jaw members, the at least one sensor being configured to sense the sensed pre-surgical condition selected from the group consisting of tissue impedance, tissue thickness, tissue compliance and tissue type and relaying the sensed information to a control source which, in turn, sends a signal to the controller.
  • 4. A bipolar forceps for sealing tissue according to claim 2 wherein the stop member assembly utilizes at least one gear to selectively extend and retract the stop member from the at least one electrically conductive sealing surface.
  • 5. A bipolar forceps for sealing tissue according to claim 2 wherein the stop member assembly utilizes at least one cam to selectively extend and retract the stop member from the at least one electrically conductive sealing surface.
  • 6. A bipolar forceps for sealing tissue according to claim 2 wherein the stop member assembly utilizes at least one actuator to selectively extend and retract the stop member from the at least one electrically conductive sealing surface, the actuator being selected from the group consisting of electro-mechanical actuators, ferroelectric actuators, piezo-electric actuators, piezo-ceramic actuators, hydraulics actuators, pneumatics actuators, magnetostrictors and rotational actuators.
  • 7. A bipolar forceps for sealing tissue according to claim 1 wherein the stop member is manufactured from the group consisting of parylene, nylon and ceramic.
  • 8. A bipolar forceps for sealing tissue according to claim 1 wherein the forceps includes a selectively extendible knife for severing tissue along the tissue seal.
  • 9. A bipolar forceps for sealing tissue according to claim 1 wherein the at least one stop member is selectively extendible in the range of about 0.001 inches to about 0.008 inches from the electrically conductive sealing surface of at least one jaw member.
  • 10. A bipolar forceps for sealing tissue according to claim 1 wherein a first selectively extendible stop member is operatively associated with the electrically conductive sealing surface of one of the jaw members and at least one second selectively extendible stop member is operatively associated with the electrically conductive sealing surface of the other jaw member.
  • 11. A method of sealing tissue comprising the steps of: providing a bipolar forceps which includes:a shaft having opposing jaw members at a distal end thereof which cooperate to grasp tissue therebetween, each of the jaw members including an electrically conductive sealing surface;at least one non-conductive stop member operatively associated with at least one of the jaw members, the non-conductive stop member being selectively adjustable to regulate the distance between the electrically conductive surfaces when tissue is held therebetween;connecting the jaw members to a source of electrosurgical energy;adjusting the distance that the stop members extend from the electrically conductive sealing surface based upon a sensed pre-surgical condition during activation;actuating the jaw members to grasp tissue between opposing jaw members; andconducting energy to the jaw members through tissue held therebetween to effect a tissue seal.
  • 12. A method of sealing tissue according to claim 11 wherein the adjusting step further includes the steps of: sensing the sensed pre-surgical condition; andsignaling the controller to selectively adjust the stop members relative to the electrically conductive sealing surface depending upon the sensed pre-surgical condition.
  • 13. A method of sealing tissue according to claim 11 further comprising the step of: severing the tissue along the tissue seal.
  • 14. A method of sealing tissue according to claim 11 wherein after the conducting step, the method further includes the steps of: sensing the sensed pre-surgical condition during electrosurgical activation; andsignaling the controller to selectively adjust the stop members relative to the electrically conductive sealing surface depending upon the sensed pre-surgical condition.
  • 15. A method of sealing tissue according to claim 14 wherein after the signally step, the method further includes the step of: repeating the sensing and signally steps until a desired seal is effected.
  • 16. A method of sealing tissue comprising the steps of: providing a bipolar forceps which includes:a shaft having opposing jaw members at a distal end thereof which cooperate to grasp tissue therebetween, each of the jaw members including an electrically conductive sealing surface;at least one non-conductive stop member operatively associated with at least one of the jaw members, the non-conductive stop member being selectively adjustable to regulate the distance between the electrically conductive surfaces when tissue is held therebetween;connecting the jaw members to a source of electrosurgical energy;actuating the jaw members to grasp tissue between opposing jaw members;conducting energy to the jaw members through tissue held therebetween to effect a tissue seal; andadjusting the distance that the stop members extend from the electrically conductive sealing surface depending upon a sensed surgical condition during activation.
  • 17. A method of sealing tissue according to claim 16 wherein the adjusting step further includes the step of: communicating with a feedback control system which continually senses surgical conditions during activation to automatically regulate the distance that the stop members extend from the electrically conductive sealing surfaces.
  • 18. A method of sealing tissue according to claim 16 wherein the adjusting step, further includes the step of: communicating with a feedback control system to automatically regulate the distance that the stop members extend from the electrically conductive sealing surfaces based upon at least one of tissue impedance, tissue temperature, tissue thickness, tissue moisture, tissue compliance or tissue clarity during activation.
  • 19. A method of sealing tissue comprising the steps of: providing a bipolar forceps which includes a shaft having opposing jaw members at a distal end thereof each of the jaw members including an electrically conductive sealing surface, at least one of the electrically conductive sealing surfaces including at least one stop member operatively associated therewith;connecting the jaw members to a source of electrosurgical energy;actuating the jaw members to grasp tissue between opposing jaw members;conducting energy to the jaw members through tissue held; andadjusting the at least one stop member to regulate the distance between the jaw members during the conducting step depending upon a sensed surgical condition during activation.
  • 20. A method of sealing tissue according to claim 19 wherein the bipolar forceps includes a stop member and wherein the step of adjusting comprises adjusting the stop member.
  • 21. A method of sealing tissue according to claim 20 wherein the adjusting step further includes the step of: communicating with a feedback control system which continually senses the surgical condition during activation to automatically regulate the distance between the jaw members.
  • 22. A method of sealing tissue according to claim 19 wherein the step of adjusting comprises adjusting the distance between the jaw members so that the distance between the jaw members becomes increasingly smaller.
  • 23. A method of sealing tissue according to claim 19, wherein the sensed surgical condition is selected from the group consisting of at least one of tissue impedance, tissue temperature, tissue thickness, tissue moisture, tissue compliance and tissue clarity.
  • 24. A bipolar forceps for sealing tissue, comprising: an elongated shaft having opposing jaw members at a distal end thereof, each of the jaw members including an electrically conductive sealing surface affixed thereto, the jaw members movable relative to one another from a first position wherein the electrically conductive sealing surfaces are disposed in spaced relation relative to one another to a second position wherein the electrically conductive sealing surfaces cooperate to grasp tissue therebetween;each electrically conductive sealing surface adapted to connect to a source of electrical energy such that the electrically conductive sealing surfaces are capable of conducting energy through tissue held therebetween to effect a tissue seal; anda stop member assembly operatively associated with at least one jaw member, the stop member assembly including at least one non-conductive stop member extending from at least one of the electrically conductive sealing surfaces, the at least one non-conductive stop member selectively adjustable to regulate the distance between the electrically conductive sealing surfaces when tissue is held therebetween.
  • 25. A bipolar forceps for sealing tissue according to claim 24, further comprising: at least one sensor operatively associated with at least one of the jaw members, the at least one sensor configured to sense at least one pre-surgical condition; andat least one controller that is engagable with the at least one stop member, the controller configured to extend and retract the stop member in response to the at least one sensed pre-surgical condition.
CROSS REFERENCE TO RELATED APPLICATION

The present application claims the benefit of priority to U.S. Provisional Application Ser. No. 60/470,632 filed on May 15, 2003 by Shields et al., the entire contents of which being incorporated by reference herein.

US Referenced Citations (603)
Number Name Date Kind
371664 Brannan et al. Oct 1887 A
702472 Pignolet Jun 1902 A
728883 Downes May 1903 A
1586645 Bierman Jun 1926 A
1813902 Bovie Jul 1931 A
2002594 Wappler et al. May 1935 A
2011169 Wappler Aug 1935 A
2031682 Wappler et al. Feb 1936 A
2176479 Willis Oct 1939 A
2279753 Knopp Apr 1942 A
2305156 Grubel Dec 1942 A
2632661 Cristofv Mar 1953 A
2668538 Baker Feb 1954 A
2796065 Kapp Jun 1957 A
3459187 Pallotta Aug 1969 A
3643663 Sutter Feb 1972 A
3651811 Hildebrandt et al. Mar 1972 A
3720896 Beierlein Mar 1973 A
3862630 Balamuth Jan 1975 A
3863339 Reaney et al. Feb 1975 A
3866610 Kletschka Feb 1975 A
3911766 Fridolph et al. Oct 1975 A
3920021 Hiltebrandt Nov 1975 A
3921641 Hulka Nov 1975 A
3938527 Rioux et al. Feb 1976 A
3952749 Fridolph et al. Apr 1976 A
3970088 Morrison Jul 1976 A
3987795 Morrison Oct 1976 A
4005714 Hiltebrandt Feb 1977 A
4041952 Morrison, Jr. et al. Aug 1977 A
4043342 Morrison, Jr. Aug 1977 A
4074718 Morrison, Jr. Feb 1978 A
4088134 Mazzariello May 1978 A
4112950 Pike Sep 1978 A
4127222 Adams Nov 1978 A
4128099 Bauer Dec 1978 A
4165746 Burgin Aug 1979 A
4233734 Bies Nov 1980 A
4300564 Furihata Nov 1981 A
D263020 Rau, III Feb 1982 S
4370980 Lottick Feb 1983 A
4375218 DiGeronimo Mar 1983 A
4416276 Newton et al. Nov 1983 A
4418692 Guay Dec 1983 A
4452246 Bader et al. Jun 1984 A
4492231 Auth Jan 1985 A
4552143 Lottick Nov 1985 A
4574804 Kurwa Mar 1986 A
4597379 Kihn et al. Jul 1986 A
4600007 Lahodny et al. Jul 1986 A
4655215 Pike Apr 1987 A
4655216 Tischer Apr 1987 A
4657016 Garito et al. Apr 1987 A
4662372 Sharkany et al. May 1987 A
4671274 Sorochenko Jun 1987 A
4685459 Koch et al. Aug 1987 A
D295893 Sharkany et al. May 1988 S
D295894 Sharkany et al. May 1988 S
4754892 Retief Jul 1988 A
4763669 Jaeger Aug 1988 A
4827929 Hodge May 1989 A
4846171 Kauphusman et al. Jul 1989 A
4887612 Esser et al. Dec 1989 A
4938761 Ensslin Jul 1990 A
4985030 Melzer et al. Jan 1991 A
5007908 Rydell Apr 1991 A
5026370 Lottick Jun 1991 A
5035695 Weber, Jr. et al. Jul 1991 A
5084057 Green et al. Jan 1992 A
5099840 Goble et al. Mar 1992 A
5116332 Lottick May 1992 A
5147357 Rose et al. Sep 1992 A
5151102 Kamiyama et al. Sep 1992 A
5176695 Dulebohn Jan 1993 A
5190541 Abele et al. Mar 1993 A
5196009 Kirwan, Jr. Mar 1993 A
5197964 Parins Mar 1993 A
5215101 Jacobs et al. Jun 1993 A
5217457 Delahuerga et al. Jun 1993 A
5217458 Parins Jun 1993 A
5217460 Knoepfler Jun 1993 A
5219354 Choudhury et al. Jun 1993 A
5244462 Delahuerga et al. Sep 1993 A
5250047 Rydell Oct 1993 A
5250063 Abidin et al. Oct 1993 A
5258001 Corman Nov 1993 A
5258006 Rydell et al. Nov 1993 A
5261918 Phillips et al. Nov 1993 A
5275615 Rose Jan 1994 A
5277201 Stern Jan 1994 A
5282799 Rydell Feb 1994 A
5290286 Parins Mar 1994 A
5304203 El-Mallawany et al. Apr 1994 A
5308357 Lichtman May 1994 A
5314445 Degwitz et al. May 1994 A
5318589 Lichtman Jun 1994 A
5324289 Eggers Jun 1994 A
5326806 Yokoshima et al. Jul 1994 A
5330471 Eggers Jul 1994 A
5334183 Wuchinich Aug 1994 A
5334215 Chen Aug 1994 A
5336220 Ryan et al. Aug 1994 A
5336221 Anderson Aug 1994 A
5342359 Rydell Aug 1994 A
5342381 Tidemand Aug 1994 A
5342393 Stack Aug 1994 A
5344424 Roberts et al. Sep 1994 A
5352222 Rydell Oct 1994 A
5354271 Voda Oct 1994 A
5356408 Rydell Oct 1994 A
5366477 LeMarie, III et al. Nov 1994 A
5368600 Failla et al. Nov 1994 A
5376089 Smith Dec 1994 A
5383897 Wholey Jan 1995 A
5389098 Tsuruta et al. Feb 1995 A
5389104 Hahnen et al. Feb 1995 A
5391166 Eggers Feb 1995 A
5391183 Janzen et al. Feb 1995 A
5396900 Slater et al. Mar 1995 A
5403312 Yates et al. Apr 1995 A
5411519 Tovey et al. May 1995 A
5411520 Nash et al. May 1995 A
5413571 Katsaros et al. May 1995 A
5415657 Taymor-Luria May 1995 A
5422567 Matsunaga Jun 1995 A
5423810 Goble et al. Jun 1995 A
5425690 Chang Jun 1995 A
5425739 Jessen Jun 1995 A
5429616 Schaffer Jul 1995 A
5431672 Cote et al. Jul 1995 A
5431674 Basile et al. Jul 1995 A
5437292 Kipshidze et al. Aug 1995 A
5438302 Goble Aug 1995 A
5441517 Kensey et al. Aug 1995 A
5443463 Stern et al. Aug 1995 A
5443464 Russell et al. Aug 1995 A
5443480 Jacobs et al. Aug 1995 A
5445638 Rydell et al. Aug 1995 A
5445658 Durrfeld et al. Aug 1995 A
5451224 Goble et al. Sep 1995 A
5456684 Schmidt et al. Oct 1995 A
5458598 Feinberg et al. Oct 1995 A
5460629 Shlain et al. Oct 1995 A
5462546 Rydell Oct 1995 A
5472443 Cordis et al. Dec 1995 A
5478351 Meade et al. Dec 1995 A
5480409 Riza Jan 1996 A
5484436 Eggers et al. Jan 1996 A
5496312 Klicek Mar 1996 A
5496317 Goble et al. Mar 1996 A
5496347 Hashiguchi et al. Mar 1996 A
5499997 Sharpe et al. Mar 1996 A
5509922 Aranyi et al. Apr 1996 A
5512721 Young et al. Apr 1996 A
5514134 Rydell et al. May 1996 A
5527313 Scott et al. Jun 1996 A
5531744 Nardella et al. Jul 1996 A
5536251 Evard et al. Jul 1996 A
5540684 Hassler, Jr. Jul 1996 A
5540685 Parins et al. Jul 1996 A
5540715 Katsaros et al. Jul 1996 A
5542945 Fritzsch Aug 1996 A
5558671 Yates Sep 1996 A
5558672 Edwards et al. Sep 1996 A
5562699 Heimberger et al. Oct 1996 A
5569241 Edwardds Oct 1996 A
5569243 Kortenbach et al. Oct 1996 A
5571100 Goble et al. Nov 1996 A
5573424 Poppe Nov 1996 A
5573534 Stone Nov 1996 A
5573535 Viklund Nov 1996 A
5575805 Li Nov 1996 A
5578052 Koros et al. Nov 1996 A
5582611 Tsukagoshi et al. Dec 1996 A
5585896 Yamazaki et al. Dec 1996 A
5590570 LeMaire, III et al. Jan 1997 A
5601601 Tal et al. Feb 1997 A
5603711 Parins et al. Feb 1997 A
5603723 Aranyi et al. Feb 1997 A
5611798 Eggers Mar 1997 A
5620453 Nallakrishnan Apr 1997 A
5624452 Yates Apr 1997 A
5626578 Tihon May 1997 A
5626609 Zvenyatsky et al. May 1997 A
5630833 Katsaros et al. May 1997 A
5637110 Pennybacker et al. Jun 1997 A
5638003 Hall Jun 1997 A
5643294 Tovey et al. Jul 1997 A
5647869 Goble et al. Jul 1997 A
5647871 Levine et al. Jul 1997 A
5649959 Hannam et al. Jul 1997 A
5658281 Heard Aug 1997 A
5662667 Knodel Sep 1997 A
5665100 Yoon Sep 1997 A
5667526 Levin Sep 1997 A
5674220 Fox et al. Oct 1997 A
5681282 Eggers et al. Oct 1997 A
5688270 Yates et al. Nov 1997 A
5693051 Schulze et al. Dec 1997 A
5695522 LeMaire, III et al. Dec 1997 A
5700261 Brinkerhoff Dec 1997 A
5702390 Austin et al. Dec 1997 A
5707369 Vaitekunas et al. Jan 1998 A
5709680 Yates et al. Jan 1998 A
5716366 Yates Feb 1998 A
5720744 Eggleston et al. Feb 1998 A
5722421 Francese et al. Mar 1998 A
5725536 Oberlin et al. Mar 1998 A
5727428 LeMaire, III et al. Mar 1998 A
5735848 Yates et al. Apr 1998 A
5743906 Parins et al. Apr 1998 A
5755717 Yates et al. May 1998 A
5766130 Selmonosky Jun 1998 A
5766166 Hooven Jun 1998 A
5766170 Eggers Jun 1998 A
5769849 Eggers Jun 1998 A
5772655 Bauer et al. Jun 1998 A
5772670 Brosa Jun 1998 A
5776128 Eggers Jul 1998 A
5776130 Buysse et al. Jul 1998 A
5779701 McBrayer et al. Jul 1998 A
H1745 Paraschac Aug 1998 H
5792137 Carr et al. Aug 1998 A
5792177 Kaseda Aug 1998 A
5797927 Yoon Aug 1998 A
5797938 Paraschac et al. Aug 1998 A
5797941 Schulze et al. Aug 1998 A
5797958 Yoon Aug 1998 A
5800449 Wales Sep 1998 A
5807393 Williamson, IV et al. Sep 1998 A
5810808 Eggers Sep 1998 A
5810811 Yates et al. Sep 1998 A
5810877 Roth et al. Sep 1998 A
5814043 Shapeton Sep 1998 A
5817083 Shemesh et al. Oct 1998 A
5820630 Lind Oct 1998 A
5827271 Buysse et al. Oct 1998 A
5827279 Hughett et al. Oct 1998 A
5827281 Levin Oct 1998 A
5827323 Klieman et al. Oct 1998 A
5827548 Lavallee et al. Oct 1998 A
5833690 Yates et al. Nov 1998 A
5843080 Fleenor et al. Dec 1998 A
5849022 Sakashita et al. Dec 1998 A
5853412 Mayenberger Dec 1998 A
5860976 Billings et al. Jan 1999 A
5876401 Schulze et al. Mar 1999 A
5882567 Cavallaro et al. Mar 1999 A
5891141 Rydell Apr 1999 A
5891142 Eggers et al. Apr 1999 A
5893863 Yoon Apr 1999 A
5893875 O'Connor et al. Apr 1999 A
5893877 Gampp, Jr. et al. Apr 1999 A
5902301 Olig May 1999 A
5906630 Anderhub et al. May 1999 A
5908420 Parins et al. Jun 1999 A
5908432 Pan Jun 1999 A
5911719 Eggers Jun 1999 A
5913874 Berns et al. Jun 1999 A
5921984 Sutcu et al. Jul 1999 A
5925043 Kumar et al. Jul 1999 A
5935126 Riza Aug 1999 A
5944718 Dafforn et al. Aug 1999 A
5951549 Richardson et al. Sep 1999 A
5954720 Wilson et al. Sep 1999 A
5957923 Hahnen et al. Sep 1999 A
5960544 Beyers Oct 1999 A
5961514 Long et al. Oct 1999 A
5964758 Dresden Oct 1999 A
5976132 Morris Nov 1999 A
5984939 Yoon Nov 1999 A
5989277 LeMaire, III et al. Nov 1999 A
5997565 Inoue Dec 1999 A
6004335 Vaitekunas et al. Dec 1999 A
6010516 Hulka et al. Jan 2000 A
6024741 Willaimson et al. Feb 2000 A
6024744 Kese et al. Feb 2000 A
6030384 Nezhat Feb 2000 A
6033399 Gines Mar 2000 A
6039733 Buysse et al. Mar 2000 A
6041679 Slater et al. Mar 2000 A
6050996 Schmaltz et al. Apr 2000 A
6053914 Eggers et al. Apr 2000 A
6053933 Balazs et al. Apr 2000 A
D424694 Tetzlaff et al. May 2000 S
D425201 Tetzlaff et al. May 2000 S
6059782 Novak et al. May 2000 A
6074386 Goble et al. Jun 2000 A
RE36795 Rydell Jul 2000 E
6083223 Baker Jul 2000 A
6086586 Hooven Jul 2000 A
6090107 Borgmeier et al. Jul 2000 A
6096031 Mitchell et al. Aug 2000 A
6096037 Mulier et al. Aug 2000 A
6099550 Yoon Aug 2000 A
6102909 Chen et al. Aug 2000 A
6110171 Rydell Aug 2000 A
6113596 Hooven et al. Sep 2000 A
6113598 Baker Sep 2000 A
6117158 Measamer et al. Sep 2000 A
6123701 Nezhat Sep 2000 A
H1904 Yates et al. Oct 2000 H
6126658 Baker Oct 2000 A
6152923 Ryan Nov 2000 A
6162220 Nezhat Dec 2000 A
6174309 Wrublewski et al. Jan 2001 B1
6179834 Buysse et al. Jan 2001 B1
6179837 Hooven Jan 2001 B1
6183467 Shapeton et al. Feb 2001 B1
6187003 Buysse et al. Feb 2001 B1
6190386 Rydell Feb 2001 B1
6193718 Kortenbach et al. Feb 2001 B1
6206876 Levine et al. Mar 2001 B1
6206877 Kese et al. Mar 2001 B1
6217602 Redmon Apr 2001 B1
6221039 Durgin et al. Apr 2001 B1
6224593 Ryan et al. May 2001 B1
6228080 Gines May 2001 B1
6228083 Lands et al. May 2001 B1
6267761 Ryan Jul 2001 B1
6270497 Sekino et al. Aug 2001 B1
6270508 Klieman et al. Aug 2001 B1
6273887 Yamauchi et al. Aug 2001 B1
6277117 Tetzlaff et al. Aug 2001 B1
6280458 Boche et al. Aug 2001 B1
6283961 Underwood et al. Sep 2001 B1
D449886 Tetzlaff et al. Oct 2001 S
6302424 Gisinger et al. Oct 2001 B1
6319451 Brune Nov 2001 B1
6322561 Eggers et al. Nov 2001 B1
6334860 Dorn Jan 2002 B1
6334861 Chandler et al. Jan 2002 B1
6345532 Coudray et al. Feb 2002 B1
6350264 Hooven Feb 2002 B1
6352536 Buysse et al. Mar 2002 B1
6358249 Chen et al. Mar 2002 B1
6358268 Hunt et al. Mar 2002 B1
D457958 Dycus et al. May 2002 S
D457959 Tetzlaff et al. May 2002 S
6387094 Eitenmuller May 2002 B1
6391035 Appleby et al. May 2002 B1
6398779 Buysse et al. Jun 2002 B1
6402747 Lindemann et al. Jun 2002 B1
6409728 Ehr et al. Jun 2002 B1
H2037 Yates et al. Jul 2002 H
6419675 Gallo, Sr. Jul 2002 B1
6425896 Baltschun et al. Jul 2002 B1
6443952 Mulier et al. Sep 2002 B1
6443970 Schulze et al. Sep 2002 B1
6451018 Lands et al. Sep 2002 B1
6458125 Cosmescu Oct 2002 B1
6458128 Schulze Oct 2002 B1
6458130 Frazier et al. Oct 2002 B1
6464701 Hooven et al. Oct 2002 B1
6464704 Schmaltz et al. Oct 2002 B2
6500176 Truckai et al. Dec 2002 B1
6503248 Levine Jan 2003 B1
6506189 Rittman, III et al. Jan 2003 B1
6508815 Strul et al. Jan 2003 B1
6511480 Tetzlaff et al. Jan 2003 B1
6514251 Ni et al. Feb 2003 B1
6514252 Nezhat et al. Feb 2003 B2
6527771 Weadock et al. Mar 2003 B1
6544264 Levine et al. Apr 2003 B2
6558385 McClurken et al. May 2003 B1
6562037 Paton et al. May 2003 B2
6569162 He May 2003 B2
6585735 Frazier et al. Jul 2003 B1
6616658 Ineson Sep 2003 B2
6616661 Wellman et al. Sep 2003 B2
6620161 Schulze et al. Sep 2003 B2
6641595 Moran et al. Nov 2003 B1
6652514 Ellman et al. Nov 2003 B2
6652521 Schulze Nov 2003 B2
6656177 Truckai et al. Dec 2003 B2
6669696 Bacher et al. Dec 2003 B2
6676660 Wampler et al. Jan 2004 B2
6679882 Kornerup Jan 2004 B1
6682528 Frazier et al. Jan 2004 B2
6685724 Haluck Feb 2004 B1
6689131 McClurken Feb 2004 B2
6692445 Roberts et al. Feb 2004 B2
6702810 McClurken et al. Mar 2004 B2
6726068 Miller Apr 2004 B2
6733498 Paton et al. May 2004 B2
6736813 Yamauchi et al. May 2004 B2
6743229 Buysse et al. Jun 2004 B2
6743230 Lutze et al. Jun 2004 B2
6757977 Dambal et al. Jul 2004 B2
6770072 Truckai et al. Aug 2004 B1
6773409 Truckai et al. Aug 2004 B2
6773434 Ciarrocca Aug 2004 B2
6775575 Bommannan et al. Aug 2004 B2
6776780 Mulier et al. Aug 2004 B2
6790217 Schulze et al. Sep 2004 B2
6796981 Wham et al. Sep 2004 B2
D496997 Dycus et al. Oct 2004 S
6802843 Truckai et al. Oct 2004 B2
6808525 Latterell et al. Oct 2004 B2
D499181 Dycus et al. Nov 2004 S
6818000 Muller et al. Nov 2004 B2
6887240 Lands et al. May 2005 B1
6926716 Baker et al. Aug 2005 B2
6929644 Truckai et al. Aug 2005 B2
6932810 Ryan Aug 2005 B2
6932816 Phan Aug 2005 B2
6934134 Mori et al. Aug 2005 B2
6936061 Sasaki Aug 2005 B2
6942662 Goble et al. Sep 2005 B2
6953461 McClurken et al. Oct 2005 B2
6958070 Witt et al. Oct 2005 B2
6960210 Lands et al. Nov 2005 B2
6964662 Kidooka Nov 2005 B2
6966907 Goble Nov 2005 B2
6977495 Donofrio Dec 2005 B2
6979786 Aukland et al. Dec 2005 B2
6994707 Ellman et al. Feb 2006 B2
6994709 Iida Feb 2006 B2
7011657 Truckai et al. Mar 2006 B2
7033354 Keppel Apr 2006 B2
7033356 Latterell et al. Apr 2006 B2
7041102 Truckai et al. May 2006 B2
7044948 Keppel May 2006 B2
7052496 Yamauchi May 2006 B2
D525361 Hushka Jul 2006 S
7070597 Truckai et al. Jul 2006 B2
7083618 Couture et al. Aug 2006 B2
7083619 Truckai et al. Aug 2006 B2
7087054 Truckai et al. Aug 2006 B2
7090673 Dycus et al. Aug 2006 B2
7090689 Nagase et al. Aug 2006 B2
7101371 Dycus et al. Sep 2006 B2
7101372 Dycus et al. Sep 2006 B2
7101373 Dycus et al. Sep 2006 B2
7103947 Sartor et al. Sep 2006 B2
7112199 Cosmescu Sep 2006 B2
D531311 Guerra et al. Oct 2006 S
7115123 Knowlton et al. Oct 2006 B2
7118570 Tetzlaff et al. Oct 2006 B2
7118587 Dycus et al. Oct 2006 B2
7131860 Sartor et al. Nov 2006 B2
7131970 Moses et al. Nov 2006 B2
7131971 Dycus et al. Nov 2006 B2
7135020 Lawes et al. Nov 2006 B2
D533942 Kerr et al. Dec 2006 S
7145757 Shea et al. Dec 2006 B2
7147638 Chapman et al. Dec 2006 B2
7150097 Sremcich et al. Dec 2006 B2
7150749 Dycus et al. Dec 2006 B2
D535027 James et al. Jan 2007 S
7156842 Sartor et al. Jan 2007 B2
7156846 Dycus et al. Jan 2007 B2
7160298 Lawes et al. Jan 2007 B2
7160299 Baily Jan 2007 B2
7169146 Truckai et al. Jan 2007 B2
7179258 Buysse et al. Feb 2007 B2
7195631 Dumbauld Mar 2007 B2
D541418 Schechter et al. Apr 2007 S
7207990 Lands et al. Apr 2007 B2
D541938 Kerr et al. May 2007 S
7223265 Keppel May 2007 B2
7232440 Dumbauld et al. Jun 2007 B2
7241288 Braun Jul 2007 B2
7241296 Buysse et al. Jul 2007 B2
7252667 Moses et al. Aug 2007 B2
7255697 Dycus et al. Aug 2007 B2
7267677 Johnson et al. Sep 2007 B2
7270660 Ryan Sep 2007 B2
7270664 Johnson et al. Sep 2007 B2
7276068 Johnson et al. Oct 2007 B2
7300435 Wham et al. Nov 2007 B2
7303557 Wham et al. Dec 2007 B2
7314471 Holman Jan 2008 B2
7329256 Johnson et al. Feb 2008 B2
7329257 Kanehira et al. Feb 2008 B2
D564662 Moses et al. Mar 2008 S
7342754 Fitzgerald et al. Mar 2008 B2
7344268 Jigamian Mar 2008 B2
7367976 Lawes et al. May 2008 B2
20020013583 Camran et al. Jan 2002 A1
20020049442 Roberts et al. Apr 2002 A1
20020099372 Schulze et al. Jul 2002 A1
20020107517 Witt et al. Aug 2002 A1
20020111624 Witt et al. Aug 2002 A1
20020188294 Couture et al. Dec 2002 A1
20030018331 Dycus et al. Jan 2003 A1
20030069571 Treat et al. Apr 2003 A1
20030078578 Truckai et al. Apr 2003 A1
20030114851 Truckai et al. Jun 2003 A1
20030139741 Goble et al. Jul 2003 A1
20030139742 Wampler et al. Jul 2003 A1
20030158549 Swanson Aug 2003 A1
20030199869 Johnson et al. Oct 2003 A1
20030216732 Truckai et al. Nov 2003 A1
20030220637 Truckai et al. Nov 2003 A1
20030236325 Bonora Dec 2003 A1
20040030330 Brassell et al. Feb 2004 A1
20040030332 Knowlton et al. Feb 2004 A1
20040049185 Latterell et al. Mar 2004 A1
20040064151 Mollenauer Apr 2004 A1
20040078035 Kanehira et al. Apr 2004 A1
20040116979 Truckai et al. Jun 2004 A1
20040147925 Buysse et al. Jul 2004 A1
20040225288 Buysse et al. Nov 2004 A1
20040230189 Keppel Nov 2004 A1
20040236325 Tetzlaff et al. Nov 2004 A1
20040236326 Schulze et al. Nov 2004 A1
20040243125 Dycus et al. Dec 2004 A1
20040249371 Dycus et al. Dec 2004 A1
20040249374 Tetzlaff et al. Dec 2004 A1
20040250419 Sremcich et al. Dec 2004 A1
20040254573 Dycus et al. Dec 2004 A1
20040260281 Baxter, III et al. Dec 2004 A1
20050004564 Wham et al. Jan 2005 A1
20050004568 Lawes et al. Jan 2005 A1
20050004570 Chapman et al. Jan 2005 A1
20050021025 Buysse et al. Jan 2005 A1
20050021026 Baily Jan 2005 A1
20050021027 Shields et al. Jan 2005 A1
20050033278 McClurken et al. Feb 2005 A1
20050096645 Wellman et al. May 2005 A1
20050101951 Wham et al. May 2005 A1
20050101952 Lands et al. May 2005 A1
20050107784 Moses et al. May 2005 A1
20050107785 Dycus et al. May 2005 A1
20050113818 Sartor et al. May 2005 A1
20050113819 Wham et al. May 2005 A1
20050113826 Johnson et al. May 2005 A1
20050113827 Dumbauld et al. May 2005 A1
20050113828 Shields et al. May 2005 A1
20050119655 Moses et al. Jun 2005 A1
20050137590 Lawes et al. Jun 2005 A1
20050149017 Dycus Jul 2005 A1
20050149151 Orszulak et al. Jul 2005 A1
20050187547 Sugi Aug 2005 A1
20050197659 Bahney Sep 2005 A1
20050203504 Wham et al. Sep 2005 A1
20050240179 Buysse et al. Oct 2005 A1
20060052778 Chapman et al. Mar 2006 A1
20060064085 Schechter et al. Mar 2006 A1
20060074417 Cunningham et al. Apr 2006 A1
20060079888 Mulier et al. Apr 2006 A1
20060079890 Guerra Apr 2006 A1
20060079891 Arts et al. Apr 2006 A1
20060116675 McClurken et al. Jun 2006 A1
20060129146 Dycus et al. Jun 2006 A1
20060161150 Keppel Jul 2006 A1
20060167450 Johnson et al. Jul 2006 A1
20060167452 Moses et al. Jul 2006 A1
20060173452 Buysse et al. Aug 2006 A1
20060189980 Johnson et al. Aug 2006 A1
20060189981 Dycus et al. Aug 2006 A1
20060190035 Hushka et al. Aug 2006 A1
20060217709 Couture et al. Sep 2006 A1
20060224158 Odom et al. Oct 2006 A1
20060259036 Tetzlaf et al. Nov 2006 A1
20060264922 Sartor et al. Nov 2006 A1
20060264931 Chapman et al. Nov 2006 A1
20060271038 Johnson et al. Nov 2006 A1
20060287641 Perlin Dec 2006 A1
20070016182 Lipson et al. Jan 2007 A1
20070016187 Weinberg et al. Jan 2007 A1
20070043352 Garrison et al. Feb 2007 A1
20070043353 Dycus et al. Feb 2007 A1
20070055231 Dycus et al. Mar 2007 A1
20070060919 Isaacson et al. Mar 2007 A1
20070062017 Dycus et al. Mar 2007 A1
20070074807 Guerra Apr 2007 A1
20070078456 Dumbauld et al. Apr 2007 A1
20070078458 Dumbauld et al. Apr 2007 A1
20070078459 Johnson et al. Apr 2007 A1
20070088356 Moses et al. Apr 2007 A1
20070106295 Garrison et al. May 2007 A1
20070106297 Dumbauld et al. May 2007 A1
20070118111 Weinberg May 2007 A1
20070118115 Artale et al. May 2007 A1
20070142833 Dycus et al. Jun 2007 A1
20070142834 Dumbauld Jun 2007 A1
20070156139 Schechter et al. Jul 2007 A1
20070156140 Baily Jul 2007 A1
20070173811 Couture et al. Jul 2007 A1
20070173814 Hixson et al. Jul 2007 A1
20070179499 Garrison Aug 2007 A1
20070203485 Keppel Aug 2007 A1
20070213706 Dumbauld et al. Sep 2007 A1
20070213707 Dumbauld et al. Sep 2007 A1
20070213708 Dumbauld et al. Sep 2007 A1
20070213712 Buysse et al. Sep 2007 A1
20070255279 Buysse et al. Nov 2007 A1
20070260235 Podhajsky Nov 2007 A1
20070260238 Guerra Nov 2007 A1
20070260241 Dalla Betta et al. Nov 2007 A1
20070260242 Dycus et al. Nov 2007 A1
20070265616 Couture et al. Nov 2007 A1
20080004616 Patrick Jan 2008 A1
20080009860 Odom Jan 2008 A1
20080015575 Odom et al. Jan 2008 A1
20080021450 Couture Jan 2008 A1
20080033428 Artale et al. Feb 2008 A1
20080039835 Johnson et al. Feb 2008 A1
20080045947 Johnson et al. Feb 2008 A1
20080058802 Couture et al. Mar 2008 A1
20080082100 Orton et al. Apr 2008 A1
Foreign Referenced Citations (148)
Number Date Country
2104423 Feb 1994 CA
2415263 Oct 1975 DE
2627679 Jan 1977 DE
8712328 Mar 1988 DE
4303882 Aug 1994 DE
29616210 Jan 1997 DE
19608716 Apr 1997 DE
19751106 May 1998 DE
19751108 May 1999 DE
0364216 Apr 1990 EP
518230 Dec 1992 EP
0 541 930 May 1993 EP
0572131 Dec 1993 EP
584787 Mar 1994 EP
0589453 Mar 1994 EP
0623316 Nov 1994 EP
0624348 Nov 1994 EP
0650701 May 1995 EP
0694290 Mar 1996 EP
0717966 Jun 1996 EP
0754437 Mar 1997 EP
853922 Jul 1998 EP
0875209 Nov 1998 EP
0878169 Nov 1998 EP
0887046 Jan 1999 EP
0923907 Jun 1999 EP
0986990 Mar 2000 EP
1034747 Sep 2000 EP
1034748 Sep 2000 EP
1025807 Oct 2000 EP
1034746 Oct 2000 EP
1050278 Nov 2000 EP
1053719 Nov 2000 EP
1053720 Nov 2000 EP
1055399 Nov 2000 EP
1055400 Nov 2000 EP
1080694 Mar 2001 EP
1082944 Mar 2001 EP
1159926 Dec 2001 EP
1301135 Apr 2003 EP
1330991 Jul 2003 EP
1486177 Jun 2004 EP
1472984 Nov 2004 EP
1527747 May 2005 EP
1530952 May 2005 EP
1532932 May 2005 EP
1535581 Jun 2005 EP
1609430 Dec 2005 EP
1632192 Mar 2006 EP
1645238 Apr 2006 EP
1645240 Apr 2006 EP
1707143 Oct 2006 EP
2214430 Jun 1989 GB
2213416 Aug 1989 GB
501068 Sep 1984 JP
502328 Mar 1992 JP
5-5106 Jan 1993 JP
5-40112 Feb 1993 JP
06343644 Dec 1994 JP
07265328 Oct 1995 JP
08056955 Mar 1996 JP
08252263 Oct 1996 JP
09010223 Jan 1997 JP
11244298 Sep 1999 JP
2000342599 Dec 2000 JP
2000350732 Dec 2000 JP
2001008944 Jan 2001 JP
2001029356 Feb 2001 JP
20011029356 Feb 2001 JP
2001128990 May 2001 JP
401367 Nov 1974 SU
WO8900757 Jan 1989 WO
WO 9204873 Apr 1992 WO
WO 9206642 Apr 1992 WO
WO 9408524 Apr 1994 WO
WO9420025 Sep 1994 WO
WO 9502369 Jan 1995 WO
WO 9507662 Mar 1995 WO
WO9507662 Mar 1995 WO
WO9515124 Jun 1995 WO
WO9605776 Feb 1996 WO
WO 9622056 Jul 1996 WO
WO 9613218 Sep 1996 WO
WO 9700646 Jan 1997 WO
WO 9700647 Jan 1997 WO
WO 9710764 Mar 1997 WO
WO9710764 Mar 1997 WO
WO 9724073 Jul 1997 WO
WO 9724993 Jul 1997 WO
WO 9827880 Jul 1998 WO
WO 9903407 Jan 1999 WO
WO 9903408 Jan 1999 WO
WO 9903409 Jan 1999 WO
WO 9912488 Mar 1999 WO
WO 9940857 Aug 1999 WO
WO 9940861 Aug 1999 WO
WO 9951158 Oct 1999 WO
WO 9966850 Dec 1999 WO
WO 9966850 Dec 1999 WO
WO 0024330 May 2000 WO
WO0024331 May 2000 WO
WO 0024331 May 2000 WO
WO 0041638 Jul 2000 WO
WO0047124 Aug 2000 WO
WO 0053112 Sep 2000 WO
WO 0117448 Mar 2001 WO
WO 0154604 Aug 2001 WO
WO 0207627 Jan 2002 WO
WO0207627 Jan 2002 WO
WO 02067798 Sep 2002 WO
WO02080783 Oct 2002 WO
WO 02080783 Oct 2002 WO
WO02080784 Oct 2002 WO
WO 02080784 Oct 2002 WO
WO02080785 Oct 2002 WO
WO 02080785 Oct 2002 WO
WO02080786 Oct 2002 WO
WO 02080786 Oct 2002 WO
WO02080793 Oct 2002 WO
WO 02080793 Oct 2002 WO
WO02080794 Oct 2002 WO
WO 02080794 Oct 2002 WO
WO 02080795 Oct 2002 WO
WO 02080796 Oct 2002 WO
WO 02080796 Oct 2002 WO
WO02080797 Oct 2002 WO
WO 02080797 Oct 2002 WO
WO 02080798 Oct 2002 WO
WO 02080799 Oct 2002 WO
WO 02081170 Oct 2002 WO
WO02081170 Oct 2002 WO
WO 03090630 Nov 2003 WO
WO 03101311 Dec 2003 WO
WO 2004032776 Apr 2004 WO
WO2004032777 Apr 2004 WO
WO 2004032777 Apr 2004 WO
WO 2004052221 Jun 2004 WO
WO 2004073488 Sep 2004 WO
WO 2004073490 Sep 2004 WO
WO2004073490 Sep 2004 WO
WO2004073753 Sep 2004 WO
WO 2004082495 Sep 2004 WO
WO 2004082495 Sep 2004 WO
WO 2004098383 Nov 2004 WO
WO 2004103156 Dec 2004 WO
WO 2005004734 Jan 2005 WO
WO2005004735 Jan 2005 WO
WO 2005110264 Nov 2005 WO
Related Publications (1)
Number Date Country
20050021027 A1 Jan 2005 US
Provisional Applications (1)
Number Date Country
60470632 May 2003 US