This application relates to trocar assemblies, and more particularly to seal assemblies or valves often used in trocar assemblies.
Surgical procedures often require a surgeon to gain access to a cavity in a patient's body. Generally, when such a procedure is required, an incision is made in an exterior wall of the cavity and an instrument is inserted into the working channel created by the incision. One common instrument used in such a procedure is a trocar assembly. Trocar assemblies include a variety of components, but generally can include a trocar cannula, a trocar obturator, and a trocar housing. In many designs, in order to access the body cavity, the trocar cannula is directed through the skin and the trocar obturator is inserted through an interior lumen defined by the cannula. The trocar obturator is then used to penetrate the skin, which has often already had an incision made in it with a scalpel or similar device, and access the body cavity. More specifically, in some designs, applying pressure against a proximal end of the trocar obturator allows a sharp point at a distal end of the trocar obturator to be forced through the skin until it enters the body cavity. Then, the trocar cannula is inserted through the perforation made by the trocar obturator and the trocar obturator is withdrawn, leaving the inner lumen of the trocar cannula as a path to access the body cavity from outside of the body.
The trocar housing can be joined to a proximal end portion of the trocar cannula, and further, the housing can define a working chamber with an open distal end portion that is in communication with the interior lumen of the cannula. Just as the interior lumen can receive the obturator, it can also receive other elongated surgical instruments such that the instruments can be axially extended into and withdrawn from the cannula through the proximal end portion of the working chamber defined by the trocar housing. For example, in order to allow a surgeon to more easily see during a procedure, an endoscope can be inserted through the cannula and proximal or into the body cavity.
It is common for a sealing assembly or sealing device to be used in the trocar assembly. Sealing assemblies and devices are often generally referred to as valves. Sealing assemblies generally help prevent fluid or gas from escaping during surgical procedures. Such prevention is needed, especially during certain minimally invasive surgical procedures, in which an insufflation gas is used to expand a body cavity. However, it can be difficult to maintain the internal gas pressure because during the course of the procedure instruments are typically passed into and out of the trocar assembly. Accordingly, a sealing assembly, and often two sealing assemblies, are generally provided in the trocar assembly. The sealing assembly can seal against an outer surface of inserted instruments and thus can prevent fluids and insufflation gas from leaving and/or entering the body cavity through the trocar cannula.
In instances where two sealing assemblies are provided, the one that is a top, or proximal, seal is usually designed to seal around a surgical instrument when it is present, and the bottom, or distal, seal is usually designed for sealing the trocar cannula when the instrument is not present. One type of distal seal is a “duckbill” seal, which is sometimes referred to as a zero-closure valve. A duckbill seal assembly generally includes a pair of opposed valve members which open and close a seal face in much the same manner a duck opens and closes its bill. The opening and closing of the duckbill seal assembly can generally result from the insertion and/or removal of an instrument from the duckbill seal assembly. More specifically, the duckbill seal assembly can generally be opened by contacting an inner surface of the seal face with the instrument. Further, the valve members can include a straight wall angle which defines a flex point for the opening and closing of the assembly, or alternatively, they can include multi-angled walls that can serve the same purpose but that can also have improved tear resistance and buckling prevention. Some examples of such valve members can be found in United States Publication No. 2005/0077688 of Voegele et al., filed on Sep. 17, 2004, and entitled “Multi-Angled Duckbill Seal Assembly,” which is hereby incorporated by reference in its entirety. An inner surface of each of the valve members and the seal face is generally in contact with an environment outside of the body cavity while an outer surface of each of the valve members and the seal face is generally in contact with an environment inside of the body cavity.
While such sealing assemblies are effective to prevent fluids and insufflation gas from leaving and/or entering the body cavity through the trocar cannula, fluid from both outside and inside the body cavity often builds up on both the inner and outer surfaces of the seal face, respectively. Thus, as instruments are passed through the sealing assemblies and come into contact with the seal face, fluid that exists on the inner and outer surfaces of the seal face is often wiped directly onto the instruments during the course of a procedure. This is especially problematic for instruments such as endoscopes and laparoscopes because fluid is often wiped directly onto the camera lens and thus obscures the surgeon's view.
Accordingly, there is a need for a seal assembly that reduces the amount of contact between instruments being passed into and out of the seal assembly and a seal face of such seal assembly.
Trocars are generally provided having one or more valves or seal assemblies provided to create a closed system between the outside environment and the environment in which the trocar is being inserted. In one embodiment a valve for use in a trocar assembly is provided and includes a valve having a flange with an aperture extending through the flange, a sealing wall extending distally from the flange and having an inner surface and a distal end that is movable between a sealed closed position and an open position, and an activation extension formed on the sealing wall and configured such that the distal end of the sealing wall is moved to the open position by an instrument contacting the activation extension. In the open position the sealing wall can be configured to receive an instrument therethrough. In an exemplary embodiment the instrument does not come into contact with the distal end of the sealing wall during the procedure. The instrument can also not contact the inner surface of the sealing wall during the procedure. The activation extensions can have a height and a width. In one embodiment a distal-most end of the activation extension can be closer to a longitudinal axis extending through the flange than the inner surface of the sealing wall. The distal-most end of the activation extension can be proximal to the distal end of the sealing wall. Further, the activation extension can come in the form of a protrusion on the inner surface and can have a substantially triangular profile. An angle formed by a contacting side of the substantially triangular profile of the activation extension and a transverse plane substantially perpendicular to a longitudinal axis extending through the flange can be more acute than an angle formed by the inner surface of the sealing wall and the same transverse plane.
In one embodiment the activation extension can be integrally formed with the sealing wall, while in another embodiment it can be made from a different material than the sealing wall. In an exemplary embodiment the material used to form the activation extension can be more rigid than the material used to form the sealing wall.
In various embodiments the sealing wall can be made of two or more seal elements, including embodiments with at least three seal elements and four seal elements. The two or more seal elements can include inner and outer surfaces and can meet at a seal face at the distal end of the sealing wall. Further, the activation extension can be a plurality of activation extensions and each activation extension can be separately disposed on the inner surface of a separate seal element of the two or more seal elements. At least one activation extension can be formed on the inner surface of each of the seal elements of the sealing wall. In one embodiment the inner surfaces of the seal elements can be configured to selectively promote movement of fluid away from a central portion of the seal elements toward a peripheral portion of the seal elements at the seal face. For instance, a central portion of each of the inner surfaces of the seal elements can be at a more proximal position than a peripheral portion of the seal elements at the seal face. In another embodiment, the inner surfaces of the seal elements can be configured to quickly evacuate fluid from a peripheral portion of the seal elements toward a central portion of the seal elements at, and subsequently beyond, the seal face. For instance, a peripheral portion of each of the inner surfaces of the seal elements can be at a more proximal position than a central portion of the seal elements at the seal face. The valve can be a duckbill seal assembly or a zero-closure valve.
In another embodiment of a valve for use in a trocar assembly, a sealing wall extends from a flange and is configured for selectively opening and closing to seal an opening of a trocar assembly when an instrument is not passed through the valve. The sealing wall can also include at least one activation extension protruding from an inner surface of the sealing wall. In an exemplary embodiment the sealing wall can be formed of a first material and an instrument contacting surface of the at least one activation extension can be formed of a second material. In a further exemplary embodiment the second material can be more rigid than the first material. The at least one activation extension can have a height and a width. When an instrument is passed through the valve, the assembly can be configured such that the instrument does not contact a distal end of the sealing wall. Alternatively, or additionally, the assembly can be configured such that when an instrument is passed through the valve, the instrument does not come into contact with the inner surface of the sealing wall. In another embodiment a distal-most end of the at least one activation extension can be closer to a longitudinal axis extending through the flange than the inner surface of the sealing wall. The distal-most end of the activation extension can be proximal to the distal end of the sealing wall.
In various embodiments the sealing wall can be made of two or more seal elements, including embodiments with at least three seal elements and four seal elements. The two or more seal elements can include inner and outer surfaces and can meet at a seal face at the distal end of the sealing wall. Further, the activation extension can be a plurality of activation extensions and each activation extension can be separately disposed on the inner surface of a separate seal element of the two or more seal elements. At least one activation extension can be formed on the inner surface of each of the seal elements of the sealing wall. In one embodiment the inner surfaces of the seal elements can be configured to selectively promote movement of fluid away from a central portion of the seal elements toward a peripheral portion of the seal elements at the seal face. For instance, a central portion of each of the inner surfaces of the seal elements can be at a more proximal position than a peripheral portion of the seal elements at the seal face. In another embodiment, the inner surfaces of the seal elements can be configured to quickly evacuate fluid from a peripheral portion of the seal elements toward a central portion of the seal elements at, and subsequently beyond, the seal face. For instance, a peripheral portion of each of the inner surfaces of the seal elements can be at a more proximal position than a central portion of the seal elements at the seal face. The valve can be a duckbill seal assembly or a zero-closure valve.
In one embodiment of a trocar assembly a housing is provided that includes two seals: a proximal instrument seal that is adapted to form a seal around an instrument inserted through the instrument seal and a distal zero-closure valve with an inner surface and a seal face. In an exemplary embodiment as least one ridge can be formed on the inner surface of the zero-closure valve. The at least one ridge can be adapted to prevent contact between an instrument inserted through the zero-closure valve and the seal face. The at least one ridge can also be adapted to prevent contact between an instrument inserted through the zero-closure valve and the inner surface. The at least one ridge can have a height and a width. The zero-closure valve can be configured to open in response to an instrument contacting the at least one ridge as the instrument is passed through the zero-closure valve. In one embodiment a distal-most end of the at least one ridge can be closer to a longitudinal axis extending through the zero-closure valve than the inner surface of the zero-closure valve. In various embodiments the zero-closure valve can include two or more seal elements, including embodiments with at least three seal elements and four seal elements. The two or more seal elements can include inner and outer surfaces and can meet at the seal face at a distal end of the zero-closure valve. Further, the at least one ridge can be a plurality of ridges and each ridge can be separately disposed on the inner surface of a separate seal element of the two or more seal elements. At least one ridge can be formed on the inner surface of each of the seal elements of the zero-closure valve. In one embodiment the inner surfaces of the seal elements can be configured to selectively promote movement of fluid away from a central portion of the seal elements toward a peripheral portion of the seal elements at the seal face. For instance, a central portion of each of the inner surfaces of the seal elements can be at a more proximal position than a peripheral portion of the seal elements at the seal face. In another embodiment, the inner surfaces of the seal elements can be configured to quickly evacuate fluid from a peripheral portion of the seal elements toward a central portion of the seal elements at, and subsequently beyond, the seal face. For instance, a peripheral portion of each of the inner surfaces of the seal elements can be at a more proximal position than a central portion of the seal elements at the seal face.
The invention will be more fully understood from the following detailed description taken in conjunction with the accompanying drawings, in which:
Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will understand that the devices specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the scope of the present invention is defined solely by the claims. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments. Such modifications and variations are intended to be included within the scope of the present invention.
The trocar described herein includes a seal assembly with a seal face that is configured to open without being contacted by an object, such as a surgical tool, e.g., an endoscope or laparoscope. More specifically, the seal face can be opened by a surgical tool contacting activation extensions that are associated with the seal assembly. Such contact with the activation extensions, as opposed to the seal face, can allow the object to pass through the seal face without ever contacting the seal face. This presents a number of advantages, including reducing the amount of fluid that comes into contact with the object and reducing the amount of drag on the object as it is passed in and out of the seal assembly during a surgical procedure.
Apart from the seal assembly, in accordance with the present disclosure, the general structure of the trocar assembly does not generally form part of the present invention. As such, a person skilled in the art will certainly appreciate that the present seal assembly can be adapted for use with a variety of trocar assemblies without departing from the spirit of the invention disclosed herein. Further, although the seal assembly as disclosed is generally described as being a duckbill seal assembly for a trocar assembly, a person skilled in the art will appreciate that the designs discussed herein can be equally applied to any seal assembly, not just duckbill seal assemblies, and other devices that utilize seal assemblies. A person skilled in the art will also appreciate that while the embodiments disclosed herein generally refer to the present seal assembly as a seal assembly, the seal assembly can also be described as a valve, or in some instances, a zero-closure valve.
Referring to
The proximal seal assembly 108 can be adapted to cooperate with an exterior of any instrument inserted at least partially through the trocar cannula 102 such that the proximal seal assembly 108 can sealingly engage the exterior of the instrument and thus can prevent the passage of fluids through the trocar housing 104 when the instrument is present within the trocar assembly 100. A variety of instruments, although primarily surgical instruments, can be inserted at least partially through the trocar cannula 102. One example of such an instrument is an endoscope or a similar device that enables visualization and/or surgical procedures during minimally invasive surgical procedures. One skilled in the art will recognize that many other instruments are known for insertion into at least a portion of the trocar cannula 102, and accordingly, that the proximal seal assembly 108 can likewise sealingly engage the exterior of those instruments as well.
The seal assembly can also include one or more activation extensions. At least one activation extension can be formed on the inner surface of at least one seal element. In the embodiment illustrated in
The activation extensions 30 can be configured to open and substantially close the seal face 26, either in lieu of or in conjunction with the seal body 12 and/or the seal elements 14, 16. In an exemplary embodiment contact from an object, such as a surgical tool, with the activation extensions 30 can cause the seal face 26 to open. The portion of the activation extensions 30 that an object contacts is sometimes referred to as an instrument contacting surface. Such contact by an object can result in reduced contact between the object and the seal face 26. In fact, in an exemplary embodiment the object does not contact the seal face 26 as it extends toward and through the seal face 26.
Likewise, the contact between the activation extensions 30 and the object can also be reduced and/or minimized. Such reduced contact can be created by configuring the activation extensions 30 in a variety of ways. In an exemplary embodiment a point contact, which can be designated by an instance where the object and each of the activation extensions 30 engages only at a single point, can be created at distal-most ends 30d of the activation extensions 30. In other embodiments the contact can be characterized as a line contact such that only a small portion of the activation extensions, or a limited number of single points, engages the object. In one embodiment the distal-most ends 30d of the activation extensions 30 are closer to the longitudinal axis L than are the inner surfaces 18, 20. Further, the distal-most ends 30d of the activation extensions 30 can be proximal to the seal face 26. In other embodiments the distal-most ends 30d are more proximal to the longitudinal axis L than they are to the respective inner surfaces 18, 20. In still other embodiments a distance between the distal-most ends 30d and the inner surfaces 18, 20 is at least in the range of about 0.07 to 0.17 inches.
Each activation extension 30 can come in a variety of shapes and sizes, and furthermore, can be associated with any portion of the seal body 12 and/or the seal elements 14, 16. In an exemplary embodiment the activation extensions 30 have a substantially triangular profile. More particularly, the distal-most ends each form a first vertex 32 of the substantially triangular profile while second and third vertices 34, 36 are located near the proximal and distal ends 12p, 12d of the seal body 12, respectively, such that a majority of a profile of the inner surfaces 18, 20 are covered by the activation extensions 30. In other embodiments the activation extensions 30 only cover a portion of the profile of the inner surfaces 18, 20, and as such, the second and third vertices 34, 36 are closer together and not necessarily near either the proximal or distal ends 12p, 12d of the seal body 12.
With specific reference to
Although the illustrated embodiment shows the profile of the activation extensions 30 being substantially triangular, in other embodiments the profile of the activation extensions 30 can be substantially quadrilateral, substantially pentagonal, or in any other shape known to those of skill in the art. Furthermore, the sizes, distances, and other numerical values discussed herein are easily adaptable depending on the size and shape of the seal assembly 10 in which the activation extensions 30 are being used. Accordingly, it is contemplated that even though a particular size and shape may not be discussed herein, it is easily ascertainable given the disclosure provided herein.
The activation extensions 30 can be formed in a variety of ways. In one embodiment the activation extensions 30 can be integrally formed with the seal body 12 and/or the seal elements 14, 16 from a single material. For example, the seal body 12 can be made of an elastomer, such as polyisoprene, and the activation extensions 30 can likewise be formed directly from the same elastomer such that the seal body 12 and the activation extension 30 form one unitary seal assembly 10. When the seal body 12 also includes seal elements 14, 16, the seal elements 14, 16 can be made of an elastomer, and again the activation extensions 30 can be formed from the same elastomer such that the seal body 12, the seal elements 14, 16, and the activation extensions 30 form one unitary seal assembly 10.
Alternatively, as illustrated in
Just as the activation extensions 30, 30′ can be formed in a variety of ways, they can also be formed from a variety of materials. While in one embodiment the activation extensions 30, 30′ can be made from the same material as the seal body 12, 12′ and/or the seal elements 14, 14′, 16, 16′, in another embodiment a hybrid seal assembly can be formed. In the hybrid seal assembly at least two different materials are used to form the seal assembly 10, 10′. More particularly, the seal body 12, 12′ and/or the seal elements 14, 14′, 16, 16′ can be made of one material and the activation extensions 30, 30′ can be made from a different material. In one embodiment, only the instrument contacting surfaces of the activation extensions 30, 30′ are made from a different material than the seal body 12, 12′ and/or the seal elements 14, 14′, 16, 16′. Alternatively, three or more materials can also be used to form different components of the hybrid seal assembly. In an exemplary embodiment the material(s) used for the activation extensions 30, 30′, or at least the instrument contacting surfaces, is more rigid than the material(s) used to form the seal body 12, 12′ and/or the seal elements 14, 14′, 16, 16′. In some embodiments the activation extensions 30, 30′ are configured such that any deformation of the activation extensions 30, 30′ is limited and thus can be described as being rigid or semi-rigid. In one embodiment the activation extensions 30, 30′ are made of polycarbonate. Regardless of the material used to make the activation extension 30, 30′, the various techniques discussed above, as well as others known to those skilled in the art, can be used to form the hybrid seal assembly.
The quick removal of fluid that can build-up in the seal assembly 210 can be further achieved by configuring the inner surfaces 218, 219, 220 of the seal elements 214, 215, 216 such that they can quickly evacuate fluid from the peripheral portion 213 of the seal body 212 and toward the central portion 213 of the seal body 212. While a variety of configurations can be used to achieve this design goal, in one embodiment the peripheral portion 213 can be positioned such that it is more proximal than the central portion 211. In other words, as illustrated in
Similar to the seal assemblies 10, 10′, the seal assembly 210 can also include one or more activation extensions. In the embodiment illustrated in
The use of three seal elements 214, 215, 216 as opposed to two seal elements can allow the seal face 226 to open more quickly, which in turn can provide a larger and longer lasting opening for fluid caught in the seal assembly 210 to exit the seal assembly 210 before an object closes the opening. The removal of fluid from the seal assembly 210 can be beneficial because it reduces the amount of fluid that comes into contact with an object being inserted into the seal assembly 210. This is particularly important when using devices such as endoscopes and laparoscopes because the lens used by the surgeon to view the surgical site should be clear and smudge-free.
An alternative design of a seal assembly that can be effective to prevent smudging on instruments inserted into and through the seal assembly is illustrated in
Prevention of smudging by fluids on instruments inserted into and/or through the seal assembly 210′ can be further achieved by configuring the inner surfaces 218′, 219′, 220′ of the seal elements 214′, 215′, 216′ such that they can selectively promote movement of fluid away from the central portion 211′ of the seal body 212′ and toward the peripheral portion 213′ of the seal body 212′. While a variety of configurations can be used to achieve this design goal, in one embodiment the central portion 211′ can be positioned such that it is more proximal than the peripheral portion 213′. In other words, as illustrated in
Similar to the seal assembly 210, the seal assembly 210′ can also include one or more activation extensions. In the embodiment illustrated in
Still another embodiment of a seal assembly is illustrated in
Similar to the seal assembly 210′, prevention of smudging by fluids on instruments inserted into and/or through the seal assembly 310 can be further achieved by configuring the inner surfaces 318, 319, 320, 321 of the seal elements 314, 315, 316, 317 such that they can selectively promote movement of fluid away from the central portion 311 of the seal body 312 and toward the peripheral portion 313 of the seal body 312. While any of the configurations discussed or incorporated by reference with respect to seal assembly 210′ can be incorporated into the design of seal assembly 310, as illustrated the central portion 311 is raised proximally relative to the peripheral portion 313.
Whether in the initial position, the contacting position, the opening position, or the final position, in an exemplary embodiment a system including the seal assembly 10 and the instrument 50 generally creates a closed cavity between an environment below the distal end 12d of the seal body 12 and an environment above the proximal end 12p of the seal body 12. For instance, as shown in
It is understood that even though the use of seal assemblies was only discussed with respect to seal assembly 10, other embodiments of seal assemblies, for example embodiments of seal assemblies 10′, 210, 210′, 310 can also be used in a similar manner. Likewise, even though the trocar assembly 100 was only discussed with respect to seal assembly 10, other embodiments of seal assemblies, for example embodiments of seal assemblies 10′, 210, 210′, 310 can also be used in the trocar assembly 100.
A person skilled in the art will appreciate that the seal and trocar assemblies disclosed herein have application in conventional endoscopic and open surgical instrumentation as well application in robotic-assisted surgery.
The seal and trocar assemblies disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, the assemblies can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of any or all portions of the assemblies, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, the assemblies can be disassembled, and any number of the particular pieces or parts of the assemblies can be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, the assemblies can be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of a seal or trocar assembly can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.
Preferably, the seal and trocar assemblies described herein will be processed before surgery. First, a new or used seal or trocar assembly is obtained and if necessary cleaned. The assembly can then be sterilized. In one sterilization technique, the assembly is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and device are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation kills bacteria on the assembly and in the container. The sterilized assembly can then be stored in the sterile container. The sealed container keeps the assembly sterile until it is opened in the medical facility.
It is preferred that the assembly is sterilized. This can be done by any number of ways known to those skilled in the art including beta or gamma radiation, ethylene oxide, steam.
One skilled in the art will appreciate further features and advantages of the invention based on the above-described embodiments. Accordingly, the invention is not to be limited by what has been particularly shown and described, except as indicated by the appended claims. All publications and references cited herein are expressly incorporated herein by reference in their entirety.
This application is a continuation of U.S. patent application Ser. No. 11/952,464 filed on Dec. 7, 2007 and entitled “Trocar Seal with Reduced Contact Area,” which is hereby incorporated by reference in its entirety.
Number | Name | Date | Kind |
---|---|---|---|
3900022 | Widran | Aug 1975 | A |
3903877 | Terada | Sep 1975 | A |
3924608 | Mitsui | Dec 1975 | A |
3980078 | Tominaga | Sep 1976 | A |
3981276 | Ernest | Sep 1976 | A |
4204563 | Pyle | May 1980 | A |
4279246 | Chikama | Jul 1981 | A |
4687033 | Furrow et al. | Aug 1987 | A |
4690140 | Mecca | Sep 1987 | A |
4722000 | Chatenever | Jan 1988 | A |
4836187 | Iwakoshi et al. | Jun 1989 | A |
4877016 | Kantor et al. | Oct 1989 | A |
4909798 | Fleischhacker et al. | Mar 1990 | A |
4919305 | Podgers | Apr 1990 | A |
4943280 | Lander | Jul 1990 | A |
5084057 | Green et al. | Jan 1992 | A |
5104383 | Shichman | Apr 1992 | A |
5127909 | Shichman | Jul 1992 | A |
5141498 | Christian | Aug 1992 | A |
5167220 | Brown | Dec 1992 | A |
5180373 | Green et al. | Jan 1993 | A |
5191878 | Iida et al. | Mar 1993 | A |
5197955 | Stephens et al. | Mar 1993 | A |
5201714 | Gentelia et al. | Apr 1993 | A |
5207213 | Auhll et al. | May 1993 | A |
5209737 | Ritchart et al. | May 1993 | A |
5226891 | Bushatz et al. | Jul 1993 | A |
5237984 | Williams, III et al. | Aug 1993 | A |
5279542 | Wilk | Jan 1994 | A |
5312363 | Ryan et al. | May 1994 | A |
5312397 | Cosmescu | May 1994 | A |
5313934 | Wiita et al. | May 1994 | A |
5320610 | Yoon | Jun 1994 | A |
5326013 | Green et al. | Jul 1994 | A |
5330437 | Durman | Jul 1994 | A |
5334164 | Guy et al. | Aug 1994 | A |
5337730 | Maguire | Aug 1994 | A |
5339800 | Wiita et al. | Aug 1994 | A |
5342315 | Rowe et al. | Aug 1994 | A |
5347988 | Hori | Sep 1994 | A |
5354302 | Ko | Oct 1994 | A |
5364002 | Green et al. | Nov 1994 | A |
5369525 | Bala et al. | Nov 1994 | A |
5382297 | Valentine et al. | Jan 1995 | A |
5389081 | Castro | Feb 1995 | A |
5391154 | Young | Feb 1995 | A |
5392766 | Masterson et al. | Feb 1995 | A |
5395342 | Yoon | Mar 1995 | A |
5400767 | Murdoch | Mar 1995 | A |
5419309 | Biehl | May 1995 | A |
5441513 | Roth | Aug 1995 | A |
5443452 | Hart et al. | Aug 1995 | A |
5448990 | De Faria-Correa | Sep 1995 | A |
5449370 | Vaitekunas | Sep 1995 | A |
5458633 | Bailey | Oct 1995 | A |
5460616 | Weinstein et al. | Oct 1995 | A |
5462100 | Covert et al. | Oct 1995 | A |
5464008 | Kim | Nov 1995 | A |
5476475 | Gadberry | Dec 1995 | A |
5486154 | Kelleher | Jan 1996 | A |
5492304 | Smith et al. | Feb 1996 | A |
5496280 | Vandenbroek et al. | Mar 1996 | A |
5496345 | Kieturakis et al. | Mar 1996 | A |
5496411 | Candy | Mar 1996 | A |
5514084 | Fisher | May 1996 | A |
5514153 | Bonutti | May 1996 | A |
5518026 | Benjey | May 1996 | A |
5518502 | Kaplan et al. | May 1996 | A |
5533496 | De Faria-Correa et al. | Jul 1996 | A |
5535759 | Wilk | Jul 1996 | A |
5536234 | Newman | Jul 1996 | A |
5542931 | Gravener et al. | Aug 1996 | A |
5545142 | Stephens et al. | Aug 1996 | A |
5545179 | Williamson, IV | Aug 1996 | A |
5549543 | Kim | Aug 1996 | A |
5551448 | Matula et al. | Sep 1996 | A |
5554151 | Hinchliffe | Sep 1996 | A |
5568828 | Harris | Oct 1996 | A |
5569183 | Kieturakis | Oct 1996 | A |
5569205 | Hart et al. | Oct 1996 | A |
5575756 | Karasawa et al. | Nov 1996 | A |
5584850 | Hart et al. | Dec 1996 | A |
5590697 | Benjey et al. | Jan 1997 | A |
5603702 | Smith et al. | Feb 1997 | A |
5605175 | Bergsma et al. | Feb 1997 | A |
5628732 | Antoon, Jr. et al. | May 1997 | A |
5630795 | Kuramoto et al. | May 1997 | A |
5634911 | Hermann et al. | Jun 1997 | A |
5643301 | Mollenauer | Jul 1997 | A |
5647372 | Tovey et al. | Jul 1997 | A |
5647840 | D'Amelio et al. | Jul 1997 | A |
5651757 | Meckstroth | Jul 1997 | A |
5657963 | Hinchliffe et al. | Aug 1997 | A |
5658273 | Long | Aug 1997 | A |
5685823 | Ito et al. | Nov 1997 | A |
5688222 | Hluchy et al. | Nov 1997 | A |
5709664 | Vandenbroek et al. | Jan 1998 | A |
5720756 | Green et al. | Feb 1998 | A |
5720759 | Green et al. | Feb 1998 | A |
5725477 | Yasui et al. | Mar 1998 | A |
5725478 | Saad | Mar 1998 | A |
5743884 | Hasson et al. | Apr 1998 | A |
5752938 | Flatland et al. | May 1998 | A |
5755252 | Bergsma et al. | May 1998 | A |
5755732 | Green et al. | May 1998 | A |
5782859 | Nicholas et al. | Jul 1998 | A |
5788676 | Yoon | Aug 1998 | A |
5792044 | Foley et al. | Aug 1998 | A |
5792113 | Kramer et al. | Aug 1998 | A |
5797434 | Benjey et al. | Aug 1998 | A |
5807338 | Smith et al. | Sep 1998 | A |
5814026 | Yoon | Sep 1998 | A |
5817061 | Goodwin et al. | Oct 1998 | A |
5848992 | Hart et al. | Dec 1998 | A |
5860458 | Benjey et al. | Jan 1999 | A |
5871440 | Okada | Feb 1999 | A |
5882345 | Yoon | Mar 1999 | A |
5902231 | Foley et al. | May 1999 | A |
5902264 | Toso et al. | May 1999 | A |
5906595 | Powell et al. | May 1999 | A |
5954635 | Foley et al. | Sep 1999 | A |
5964781 | Mollenauer et al. | Oct 1999 | A |
5983958 | Bergsma et al. | Nov 1999 | A |
6004326 | Castro et al. | Dec 1999 | A |
6007487 | Foley et al. | Dec 1999 | A |
6017333 | Bailey | Jan 2000 | A |
6062276 | Benjey et al. | May 2000 | A |
6063050 | Manna et al. | May 2000 | A |
6093176 | Dennis | Jul 2000 | A |
6110103 | Donofrio | Aug 2000 | A |
6126592 | Proch et al. | Oct 2000 | A |
6152871 | Foley et al. | Nov 2000 | A |
6159182 | Davis et al. | Dec 2000 | A |
6162170 | Foley et al. | Dec 2000 | A |
6167920 | Enge | Jan 2001 | B1 |
6176823 | Foley et al. | Jan 2001 | B1 |
6176825 | Chin et al. | Jan 2001 | B1 |
6206057 | Benjey et al. | Mar 2001 | B1 |
6206822 | Foley et al. | Mar 2001 | B1 |
6216661 | Pickens et al. | Apr 2001 | B1 |
6217509 | Foley et al. | Apr 2001 | B1 |
6253802 | Enge | Jul 2001 | B1 |
6264604 | Kieturakis et al. | Jul 2001 | B1 |
6287313 | Sasso | Sep 2001 | B1 |
6354992 | Kato | Mar 2002 | B1 |
6371909 | Hoeg et al. | Apr 2002 | B1 |
6409657 | Kawano | Jun 2002 | B1 |
6423266 | Choperena et al. | Jul 2002 | B1 |
6425535 | Akiba | Jul 2002 | B1 |
6425859 | Foley et al. | Jul 2002 | B1 |
6443190 | Enge | Sep 2002 | B1 |
6447446 | Smith et al. | Sep 2002 | B1 |
6482181 | Racenet et al. | Nov 2002 | B1 |
6494893 | Dubrul et al. | Dec 2002 | B2 |
6497687 | Blanco | Dec 2002 | B1 |
6516835 | Enge | Feb 2003 | B2 |
6520907 | Foley et al. | Feb 2003 | B1 |
6534002 | Lin et al. | Mar 2003 | B1 |
6551282 | Exline et al. | Apr 2003 | B1 |
6562046 | Sasso | May 2003 | B2 |
6569120 | Green et al. | May 2003 | B1 |
6595915 | Akiba | Jul 2003 | B2 |
6595946 | Pasqualucci | Jul 2003 | B1 |
6601617 | Enge | Aug 2003 | B2 |
6605098 | Nobis et al. | Aug 2003 | B2 |
6638214 | Akiba | Oct 2003 | B2 |
6648906 | Lasheras et al. | Nov 2003 | B2 |
6679833 | Smith et al. | Jan 2004 | B2 |
6679834 | Stahl et al. | Jan 2004 | B2 |
6679837 | Daikuzono | Jan 2004 | B2 |
6699185 | Gminder et al. | Mar 2004 | B2 |
6702787 | Racenet et al. | Mar 2004 | B2 |
6712757 | Becker et al. | Mar 2004 | B2 |
6726663 | Dennis | Apr 2004 | B1 |
6755782 | Ogawa | Jun 2004 | B2 |
6860892 | Tanaka et al. | Mar 2005 | B1 |
6918924 | Lasheras et al. | Jul 2005 | B2 |
6923759 | Kasahara et al. | Aug 2005 | B2 |
6942671 | Smith | Sep 2005 | B1 |
6981966 | Green et al. | Jan 2006 | B2 |
6989003 | Wing et al. | Jan 2006 | B2 |
7008416 | Sakaguchi et al. | Mar 2006 | B2 |
7025747 | Smith | Apr 2006 | B2 |
7052454 | Taylor | May 2006 | B2 |
7056321 | Pagliuca et al. | Jun 2006 | B2 |
7077803 | Kasahara et al. | Jul 2006 | B2 |
7083626 | Hart et al. | Aug 2006 | B2 |
7104657 | Sherwin | Sep 2006 | B2 |
7105009 | Johnson et al. | Sep 2006 | B2 |
7112185 | Hart et al. | Sep 2006 | B2 |
7163525 | Franer | Jan 2007 | B2 |
7198598 | Smith et al. | Apr 2007 | B2 |
7207347 | Olshanetsky et al. | Apr 2007 | B2 |
7976501 | Franer et al. | Jul 2011 | B2 |
20020022762 | Beane et al. | Feb 2002 | A1 |
20020065450 | Ogawa | May 2002 | A1 |
20020068923 | Caldwell et al. | Jun 2002 | A1 |
20020103420 | Coleman et al. | Aug 2002 | A1 |
20020161387 | Blanco | Oct 2002 | A1 |
20030004529 | Tsonton et al. | Jan 2003 | A1 |
20030130674 | Kasahara et al. | Jul 2003 | A1 |
20030139756 | Brustad | Jul 2003 | A1 |
20030195472 | Green et al. | Oct 2003 | A1 |
20040034339 | Stoller et al. | Feb 2004 | A1 |
20040106942 | Taylor et al. | Jun 2004 | A1 |
20040167559 | Taylor et al. | Aug 2004 | A1 |
20040220452 | Shalman | Nov 2004 | A1 |
20040230161 | Zeiner | Nov 2004 | A1 |
20040256004 | Kessell et al. | Dec 2004 | A1 |
20050033342 | Hart et al. | Feb 2005 | A1 |
20050043683 | Ravo | Feb 2005 | A1 |
20050059865 | Kahle et al. | Mar 2005 | A1 |
20050059934 | Wenchell et al. | Mar 2005 | A1 |
20050070946 | Franer et al. | Mar 2005 | A1 |
20050077688 | Voegele et al. | Apr 2005 | A1 |
20050077689 | Hueil | Apr 2005 | A1 |
20050096605 | Green et al. | May 2005 | A1 |
20050131349 | Albrecht et al. | Jun 2005 | A1 |
20050165277 | Carrillo et al. | Jul 2005 | A1 |
20050203543 | Hilal et al. | Sep 2005 | A1 |
20050216028 | Hart et al. | Sep 2005 | A1 |
20050241647 | Nguyen et al. | Nov 2005 | A1 |
20050288622 | Albrecht et al. | Dec 2005 | A1 |
20060020165 | Adams | Jan 2006 | A1 |
20060047240 | Kumar et al. | Mar 2006 | A1 |
20060052666 | Kumar et al. | Mar 2006 | A1 |
20060068360 | Boulais | Mar 2006 | A1 |
20060069312 | O'Connor | Mar 2006 | A1 |
20060100485 | Arai et al. | May 2006 | A1 |
20060122556 | Kumar et al. | Jun 2006 | A1 |
20060122557 | Kumar et al. | Jun 2006 | A1 |
20060135972 | Zeiner | Jun 2006 | A1 |
20060135977 | Thompson et al. | Jun 2006 | A1 |
20060135978 | Franer | Jun 2006 | A1 |
20060149137 | Pingleton et al. | Jul 2006 | A1 |
20060199998 | Akui et al. | Sep 2006 | A1 |
20060211916 | Kasahara et al. | Sep 2006 | A1 |
20060235455 | Oshida | Oct 2006 | A1 |
20060276688 | Surti | Dec 2006 | A1 |
20060293559 | Grice et al. | Dec 2006 | A1 |
20070021713 | Kumar et al. | Jan 2007 | A1 |
20070129719 | Kendale et al. | Jun 2007 | A1 |
20070142709 | Martone et al. | Jun 2007 | A1 |
20070149931 | Cannon et al. | Jun 2007 | A1 |
20070149993 | Kasahara et al. | Jun 2007 | A1 |
20070185453 | Michael et al. | Aug 2007 | A1 |
20070191759 | Stoller et al. | Aug 2007 | A1 |
20070204890 | Torii | Sep 2007 | A1 |
20070225566 | Kawanishi | Sep 2007 | A1 |
20070244361 | Ikeda et al. | Oct 2007 | A1 |
20090005799 | Franer et al. | Jan 2009 | A1 |
20090149813 | Franer et al. | Jun 2009 | A1 |
Number | Date | Country |
---|---|---|
2060930 | Oct 1992 | CA |
10330518 | Feb 2005 | DE |
0344907 | Dec 1989 | EP |
0517248 | Dec 1992 | EP |
0567142 | Oct 1993 | EP |
568383 | Nov 1993 | EP |
570802 | Nov 1993 | EP |
664101 | Jul 1995 | EP |
0696459 | Feb 1996 | EP |
731718 | Sep 1996 | EP |
845960 | Jun 1998 | EP |
0873721 | Oct 1998 | EP |
875256 | Nov 1998 | EP |
890342 | Jan 1999 | EP |
898971 | Mar 1999 | EP |
0972493 | Jan 2000 | EP |
1210904 | Jun 2002 | EP |
1284664 | Feb 2003 | EP |
1312318 | May 2003 | EP |
1323373 | Jul 2003 | EP |
1348386 | Oct 2003 | EP |
1350477 | Oct 2003 | EP |
1459688 | Sep 2004 | EP |
1629787 | Jul 2006 | EP |
1679043 | Jul 2006 | EP |
1698291 | Sep 2006 | EP |
1707133 | Oct 2006 | EP |
1707135 | Oct 2006 | EP |
1709918 | Oct 2006 | EP |
1834571 | Sep 2007 | EP |
1834573 | Sep 2007 | EP |
1997446 | Dec 2008 | EP |
61036718 | Feb 1986 | JP |
3106329 | May 1991 | JP |
4020324 | Jan 1992 | JP |
4158825 | Jun 1992 | JP |
4170929 | Jun 1992 | JP |
4329510 | Nov 1992 | JP |
5192294 | Aug 1993 | JP |
5199979 | Aug 1993 | JP |
5207962 | Aug 1993 | JP |
6133927 | May 1994 | JP |
6169879 | Jun 1994 | JP |
6304121 | Nov 1994 | JP |
7178039 | Jul 1995 | JP |
7246187 | Sep 1995 | JP |
7289501 | Nov 1995 | JP |
7313442 | Dec 1995 | JP |
8154888 | Jun 1996 | JP |
8173372 | Jul 1996 | JP |
10043128 | Feb 1998 | JP |
11146882 | Jun 1999 | JP |
2002224014 | Aug 2002 | JP |
2002238906 | Aug 2002 | JP |
2003284686 | Oct 2003 | JP |
2004016455 | Jan 2004 | JP |
2004267583 | Sep 2004 | JP |
2005253543 | Sep 2005 | JP |
2005319101 | Nov 2005 | JP |
WO-9407552 | Apr 1994 | WO |
WO-9532019 | Nov 1995 | WO |
WO-9604946 | Feb 1996 | WO |
WO-9740759 | Nov 1997 | WO |
WO-0189371 | Nov 2001 | WO |
WO-0230305 | Apr 2002 | WO |
WO-02078527 | Oct 2002 | WO |
WO-02096307 | Dec 2002 | WO |
WO-03011154 | Feb 2003 | WO |
WO-2004043275 | May 2004 | WO |
WO-2005016133 | Feb 2005 | WO |
WO-2005097019 | Oct 2005 | WO |
WO-2005097234 | Oct 2005 | WO |
WO-2009005986 | Jan 2009 | WO |
Entry |
---|
International Search Report, dated Sep. 12, 2008. |
PCT International Search Report dated Mar. 24, 2009. |
Number | Date | Country | |
---|---|---|---|
20110257598 A1 | Oct 2011 | US |
Number | Date | Country | |
---|---|---|---|
Parent | 11952464 | Dec 2007 | US |
Child | 13168040 | US |