Patent Grant
8704425
The present disclosure generally relates to ultrasonic surgical systems and, more particularly, to an ultrasonic system that allows surgeons to perform cutting and coagulation.
Ultrasonic surgical instruments are finding increasingly widespread applications in surgical procedures by virtue of the unique performance characteristics of such instruments. Depending upon specific instrument configurations and operational parameters, ultrasonic surgical instruments can provide substantially simultaneous cutting of tissue and homeostasis by coagulation, desirably minimizing patient trauma. The cutting action is typically realized by an-end effector, or blade tip, at the distal end of the instrument, which transmits ultrasonic energy to tissue brought into contact with the end effector. Ultrasonic instruments of this nature can be configured for open surgical use, laparoscopic, or endoscopic surgical procedures including robotic-assisted procedures.
Some surgical instruments utilize ultrasonic energy for both precise cutting and controlled coagulation. Ultrasonic energy cuts and coagulates by using lower temperatures than those used by electrosurgery. Vibrating at high frequencies (e.g., 55,500 times per second), the ultrasonic blade denatures protein in the tissue to form a sticky coagulum. Pressure exerted on tissue with the blade surface collapses blood vessels and allows the coagulum to form a hemostatic seal. The precision of cutting and coagulation is controlled by the surgeon's technique and adjusting the power level, blade edge, tissue traction, and blade pressure.
A primary challenge of ultrasonic technology for medical devices, however, continues to be sealing of blood vessels. Work done by the applicant and others has shown that optimum vessel sealing occurs when the inner muscle layer of a vessel is separated and moved away from the adventitia layer prior to the application of standard ultrasonic energy. Current efforts to achieve this separation have involved increasing the clamp force applied to the vessel.
Furthermore, the user does not always have visual feedback of the tissue being cut. Accordingly, it would be desirable to provide some form of feedback to indicate to the user that the cut is complete when visual feedback is unavailable. Moreover, without some form of feedback indicator to indicate that the cut is complete, the user may continue to activate the harmonic instrument even though the cut is complete, which cause possible damage to the harmonic instrument and surrounding tissue by the heat that is generated exponentially when activating a harmonic instrument with nothing between the jaws.
It would be desirable to provide an ultrasonic surgical instrument that overcomes some of the deficiencies of current instruments. The ultrasonic surgical instrument described herein overcomes those deficiencies.
In one general aspect, an ultrasonic surgical instrument assembly embodying the principles of the described embodiments is configured to permit selective dissection, cutting, coagulation, and clamping of tissue during surgical procedures. In one embodiment, an end effector is coupled to an ultrasonic drive system of a surgical instrument. A generator coupled to an ultrasonic drive system generates a first ultrasonic drive signal. The ultrasonic drive system comprises an ultrasonic transducer coupled to a waveguide and an end effector coupled to the waveguide. The ultrasonic drive system is configured to resonate at a resonant frequency. The ultrasonic transducer is actuated with the first ultrasonic drive signal for a first period. The generator generates a second ultrasonic drive signal. The ultrasonic transducer is actuated with the second ultrasonic drive signal for a second period, subsequent to the first period. The first drive signal is different from the second drive signal over the respective first and second periods. The first and second drive signals define a step function waveform over the first and second periods.
The novel features of the described embodiments are set forth with particularity in the appended claims. The described embodiments, however, both as to organization and methods of operation, may be best understood by reference to the following description, taken in conjunction with the accompanying drawings in which:
Before explaining various embodiments of ultrasonic surgical instruments in detail, it should be noted that the illustrative embodiments are not limited in application or use to the details of construction and arrangement of parts illustrated in the accompanying drawings and description. The illustrative embodiments may be implemented or incorporated in other embodiments, variations and modifications, and may be practiced or carried out in various ways. Further, unless otherwise indicated, the terms and expressions employed herein have been chosen for the purpose of describing the illustrative embodiments for the convenience of the reader and are not for the purpose of limitation thereof.
Further, it is understood that any one or more of the following-described embodiments, expressions of embodiments, examples, can be combined with any one or more of the other following-described embodiments, expressions of embodiments, and examples.
Various embodiments are directed to improved ultrasonic surgical instruments configured for effecting tissue dissecting, cutting, and/or coagulation during surgical procedures. In one embodiment, an ultrasonic surgical instrument apparatus is configured for use in open surgical procedures, but has applications in other types of surgery, such as laparoscopic, endoscopic, and robotic-assisted procedures. Versatile use is facilitated by selective use of ultrasonic energy.
The various embodiments will be described in combination with an ultrasonic instrument as described herein. Such description is provided by way of example, and not limitation, and is not intended to limit the scope and applications thereof. For example, any one of the described embodiments is useful in combination with a multitude of ultrasonic instruments including those described in, for example, U.S. Pat. Nos. 5,938,633; 5,935,144; 5,944,737; 5,322,055; 5,630,420; and 5,449,370.
As will become apparent from the following description, it is contemplated that embodiments of the surgical instrument described herein may be used in association with an oscillator unit of a surgical system, whereby ultrasonic energy from the oscillator unit provides the desired ultrasonic actuation for the present surgical instrument. It is also contemplated that embodiments of the surgical instrument described herein may be used in association with a signal generator unit of a surgical system, whereby electrical energy in the form of radio frequencies (RF), for example, is used to provide feedback to the user regarding the surgical instrument. The ultrasonic oscillator and/or the signal generator unit may be non-detachably integrated with the surgical instrument or may be provided as separate components, which can be electrically attachable to the surgical instrument.
One embodiment of the present surgical apparatus is particularly configured for disposable use by virtue of its straightforward construction. However, it is also contemplated that other embodiments of the present surgical instrument can be configured for non-disposable or multiple uses. Detachable connection of the present surgical instrument with an associated oscillator and signal generator unit is presently disclosed for single-patient use for illustrative purposes only. However, non-detachable integrated connection of the present surgical instrument with an associated oscillator and/or signal generator unit is also contemplated. Accordingly, various embodiments of the presently described surgical instruments may be configured for single use and/or multiple use with either detachable and/or non-detachable integral oscillator and/or signal generator unit, without limitation, and all combinations of such configurations are contemplated to be within the scope of the present disclosure.
With reference to
In accordance with the described embodiments, the ultrasonic generator 30 produces an electrical signal of a particular voltage, current, and frequency, e.g. 55,500 cycles per second (Hz). The generator is 30 connected by the cable 22 to the handle assembly 68, which contains piezoceramic elements forming the ultrasonic transducer 50. In response to a switch 312a on the handle assembly 68 or a foot switch 434 connected to the generator 30 by another cable the generator signal is applied to the transducer 50, which causes a longitudinal vibration of its elements. A structure connects the transducer 50 to a surgical blade 79, which is thus vibrated at ultrasonic frequencies when the generator signal is applied to the transducer 50. The structure is designed to resonate at the selected frequency, thus amplifying the motion initiated by the transducer 50. In one embodiment, the generator 30 is configured to produce a particular voltage, current, and/or frequency output signal that can be stepped with high resolution, accuracy, and repeatability.
Referring to
Referring to
With reference now back to
The transmission assembly 71 may include an outer tubular member or an outer sheath 72, an inner tubular actuating member 76, a waveguide 80, and an end effector 81 comprising, for example, the blade 79, a clamp arm 56, and one or more clamp pads 58. As subsequently described, the outer sheath 72, the actuating member 76, and the waveguide 80 or transmission rod may be joined together for rotation as a unit (together with the ultrasonic transducer 50) relative to the handle assembly 68. The waveguide 80, which is adapted to transmit ultrasonic energy from the ultrasonic transducer 50 to the blade 79 may be flexible, semi-flexible, or rigid. The waveguide 80 also may be configured to amplify the mechanical vibrations transmitted through the waveguide 80 to the blade 79 as is well known in the art. The waveguide 80 may further have features to control the gain of the longitudinal vibration along the waveguide 80 and features to tune the waveguide 80 to the resonant frequency of the system. In particular, the waveguide 80 may have any suitable cross-sectional dimension. For example, the waveguide 80 may have a substantially uniform cross-section or the waveguide 80 may be tapered at various sections or may be tapered along its entire length. In one expression of the current embodiment, the waveguide diameter is about 0.113 inches nominal to minimize the amount of deflection at the blade 79 so that gapping in the proximal portion of the end effector 81 is minimized.
The blade 79 may be integral with the waveguide 80 and formed as a single unit. In an alternate expression of the current embodiment, the blade 79 may be connected by a threaded connection, a welded joint, or other coupling mechanisms. The distal end of the blade 79 is disposed near an anti-node in order to tune the acoustic assembly to a preferred resonant frequency fo when the acoustic assembly is not loaded by tissue. When the ultrasonic transducer 50 is energized, the distal end of the blade 79 is configured to move longitudinally in the range of, for example, approximately 10 to 500 microns peak-to-peak, and preferably in the range of about 20 to about 200 microns at a predetermined vibration frequency fo of, for example, 55,500 Hz.
With particular reference to
Due to sinusoidal motion, the greatest displacement or amplitude of motion is located at the most distal portion of the blade 79, while the proximal portion of the tissue treatment region is on the order of 50% of the distal tip amplitude. During operation, the tissue in the proximal region of the end effector 81 will desiccate and thin, and the distal portion of the end effector 81 will transect tissue in that distal region, thereby allowing the desiccated and thinned tissue within the proximal region to slide distally into the more active region of the end effector 81 to complete the tissue transection.
FT=FA(X2/X1) (1)
Where FA equals the spring preload of a proximal spring 94 (less frictional losses), which, in one embodiment, is about 12.5 pounds, and FT equals about 4.5 pounds.
FT is measured in the region of the clamp arm/blade interface where optimal tissue treatment occurs as defined by tissue marks 61a and 61b. The tissue marks 61a, b are etched or raised on the clamp arm 56 to provide a visible mark to the surgeon so the surgeon has a clear indication of the optimal tissue treatment area. The tissue marks 61a, b are about 7 mm apart in distance, and more preferably about 5 mm apart in distance.
In one embodiment, the generator 30 drive system 32 may comprise one or more embedded applications implemented as firmware, software, hardware, or any combination thereof. The generator 30 drive system 32 may comprise various executable modules such as software, programs, data, drivers, application program interfaces (APIs), and so forth. The firmware may be stored in nonvolatile memory (NVM), such as in bit-masked read-only memory (ROM) or flash memory. In various implementations, storing the firmware in ROM may preserve flash memory. The NVM may comprise other types of memory including, for example, programmable ROM (PROM), erasable programmable ROM (EPROM), electrically erasable programmable ROM (EEPROM), or battery backed random-access memory (RAM) such as dynamic RAM (DRAM), Double-Data-Rate DRAM (DDRAM), and/or synchronous DRAM (SDRAM).
In one embodiment, the generator 30 drive system 32 comprises a hardware component implemented as a processor 400 for executing program instructions for monitoring various measurable characteristics of the ultrasonic surgical instrument 100 (
In one embodiment, under control of one or more software program routines, the processor 400 executes the methods in accordance with the described embodiments to generate a step function formed by a stepwise waveform of drive signals comprising current (I), voltage (V), and/or frequency (f) for various time intervals or periods (T). The stepwise waveforms of the drive signals may be generated by forming a piecewise linear combination of constant functions over a plurality of time intervals created by stepping the generator 30 drive signals, e.g., output drive current (I), voltage (V), and/or frequency (f). The time intervals or periods (T) may be predetermined (e.g., fixed and/or programmed by the user) or may be variable. Variable time intervals may be defined by setting the drive signal to a first value and maintaining the drive signal at that value until a change is detected in a monitored characteristic. Examples of monitored characteristics may comprise, for example, transducer impedance, tissue impedance, tissue heating, tissue transection, tissue coagulation, and the like. The ultrasonic drive signals generated by the generator 30 include, without limitation, ultrasonic drive signals capable of exciting the ultrasonic transducer 50 in various vibratory modes such as, for example, the primary longitudinal mode and harmonics thereof as well flexural and torsional vibratory modes.
In one embodiment, the executable modules comprise one or more step function algorithm(s) 402 stored in memory that when executed causes the processor 400 to generate a step function formed by a stepwise waveform of drive signals comprising current (I), voltage (V), and/or frequency (f) for various time intervals or periods (T). The stepwise waveforms of the drive signals may be generated by forming a piecewise linear combination of constant functions over two or more time intervals created by stepping the generator's 30 output drive current (I), voltage (V), and/or frequency (f). The drive signals may be generated either for predetermined fixed time intervals or periods (T) of time or variable time intervals or periods of time in accordance with the one or more stepped output algorithm(s) 402. Under control of the processor 400, the generator 30 steps (e.g., increment or decrement) the current (I), voltage (V), and/or frequency (f) up or down at a particular resolution for a predetermined period (T) or until a predetermined condition is detected, such as a change in a monitored characteristic (e.g., transducer impedance, tissue impedance). The steps can change in programmed increments or decrements. If other steps are desired, the generator 30 can increase or decrease the step adaptively based on measured system characteristics.
In operation, the user can program the operation of the generator 30 using the input device 406 located on the front panel of the generator 30 console. The input device 406 may comprise any suitable device that generates signals 408 that can be applied to the processor 400 to control the operation of the generator 30. In various embodiments, the input device 406 includes buttons, switches, thumbwheels, keyboard, keypad, touch screen monitor, pointing device, remote connection to a general purpose or dedicated computer. In other embodiments, the input device 406 may comprise a suitable user interface. Accordingly, by way of the input device 406, the user can set or program the current (I), voltage (V), frequency (f), and/or period (T) for programming the step function output of the generator 30. The processor 400 then displays the selected power level by sending a signal on line 410 to an output indicator 412.
In various embodiments, the output indicator 412 may provide visual, audible, and/or tactile feedback to the surgeon to indicate the status of a surgical procedure, such as, for example, when tissue cutting and coagulating is complete based on a measured characteristic of the ultrasonic surgical instrument 100, e.g., transducer impedance, tissue impedance, or other measurements as subsequently described. By way of example, and not limitation, visual feedback comprises any type of visual indication device including incandescent lamps or light emitting diodes (LEDs), graphical user interface, display, analog indicator, digital indicator, bar graph display, digital alphanumeric display. By way of example, and not limitation, audible feedback comprises any type of buzzer, computer generated tone, computerized speech, voice user interface (VUI) to interact with computers through a voice/speech platform. By way of example, and not limitation, tactile feedback comprises any type of vibratory feedback provided through the instrument housing handle assembly 68.
In one embodiment, the processor 400 may be configured or programmed to generate a digital current signal 414 and a digital frequency signal 418. These signals 414, 418 are applied to a direct digital synthesizer (DDS) circuit 420 to adjust the amplitude and the frequency (f) of the current output signal 416 to the transducer 50. The output of the DDS circuit 420 is applied to an amplifier 422 whose output is applied to a transformer 424. The output of the transformer 424 is the signal 416 applied to the ultrasonic transducer 50, which is coupled to the blade 79 by way of the waveguide 80 (
In one embodiment, the generator 30 comprises one or more measurement modules or components that may be configured to monitor measurable characteristics of the ultrasonic instrument 100 (
To actually cause the surgical blade 79 to vibrate, e.g., actuate the blade 79, the user activates the foot switch 434 (
The programmed operation of the generator 30 can be further illustrated with reference to
It will be appreciated by those skilled in the art that the current 300 step function set points (e.g., I1, I2, I3) and the time intervals or periods (e.g., T1, T2) of duration for each of the step function set points described in
Having described operational details of various embodiments of the surgical system 19, operations for the above surgical system 19 may be further described in terms of a process for cutting and coagulating a blood vessel employing a surgical instrument comprising the input device 406 and the transducer impedance measurement capabilities described with reference to
Accordingly, with reference now to
In one embodiment, a first ultrasonic frequency may be set initially to mechanically separate the muscle tissue layer of a vessel prior to applying a second ultrasonic frequency to cut and seal the vessel. By way of example, and not limitation, in accordance with one implementation of the program, initially, the generator 30 is programmed to output a first drive frequency f1 for a first period T1 of time (for example less than approximately 1 second), wherein the first frequency f1 is significantly off resonance, for example, fo/2, 2fo or other structural resonant frequencies, where fo is the resonant frequency (e.g., 55.5 kHz). The first frequency f1 provides a low level of mechanical vibration action to the blade 79 that, in conjunction with the clamp force, mechanically separates the muscle tissue layer (subtherapeutic) of the vessel without causing significant heating that generally occurs at resonance. After the first period T1, the generator 30 is programmed to automatically switch the drive frequency to the resonant frequency fo for a second period T2 to transect and seal the vessel. The duration of the second period T2 may be programmed or may be determined by the length of time it actually takes to cut and seal the vessel as determined by the user or may be based on measured system characteristics such as the transducer impedance Z as described in more detail below.
In one embodiment, the tissue/vessel transection process (e.g., separating the muscle layer of the vessel from the adventitia layer and transecting/sealing the vessel) may be automated by sensing the impedance Z characteristics of the transducer 50 to detect when the transection of the tissue/vessel occurs. The impedance Z can be correlated to the transection of the muscle layer and to the transection/sealing of the vessel to provide a trigger for the processor 400 to generate the frequency and/or current step function output. As previously discussed with reference to
In one embodiment, the ultrasonic surgical instrument 110 may be operated in accordance with a programmed step function algorithm responsive to the transducer impedance Z. In one embodiment, a frequency step function output may be initiated based on a comparison of the transducer impedance Z and one or more predetermined thresholds that have been correlated with tissue loads against the blade 79. When the transducer impedance Z transitions above or below (e.g., crosses) a threshold, the processor 400 applies a digital frequency signal 418 to the DDS circuit 420 to change the frequency of the drive signal 416 by a predetermined step in accordance with the step function algorithm(s) 402 responsive to the transducer impedance Z. In operation, the blade 79 is first located at the tissue treatment site. The processor 400 applies a first digital frequency signal 418 to set a first drive frequency f1 that is off resonance (e.g., fo/2, 2foor other structural resonant frequencies, where fo is the resonant frequency). The drive signal 416 is applied to the transducer 50 in response to activation of the switch 312a on the handle assembly 68 or the foot switch 434. During this period the ultrasonic transducer 50 mechanically activates the blade 79 at the first drive frequency f1. A force or load may be applied to the clamp member 60 and the blade 79 to facilitate this process. During this period, the processor 400 monitors the transducer impedance Z until the load on the blade 79 changes and the transducer impedance Z crosses a predetermined threshold to indicate that the tissue layer has been transected. The processor 400 then applies a second digital frequency signal 418 to set a second drive frequency f2, e.g., the resonant frequency fo or other suitable frequency for transecting, coagulating, and sealing tissue. Another portion of the tissue (e.g., the vessel) is then grasped between the clamp member 60 and the blade 79. The transducer 50 is now energized by the drive signal 416 at the second drive frequency f2 by actuating either the foot switch 434 or the switch 312a on the handle assembly 68. It will be appreciated by those skilled in the art that the drive current (I) output also may be stepped as described with reference to
According to one step function algorithm 402, the processor 400 initially sets a first drive frequency f1 that is significantly off resonance to separate the inner muscle layer of the vessel from the adventitia layer. During this period of operation the processor 400 monitors the transducer impedance Z to determine when the inner muscle layer is transected or separated from the adventitia layer. Because the transducer impedance Z is correlated to the load applied to the blade 79, for example, cutting more tissue decrease the load on the blade 79 and the transducer impedance Z. The transection of the inner muscle layer is detected when the transducer impedance Z drops below a predetermined threshold. When the change in transducer impedance Z indicates that the vessel has been separated from the inner muscle layer, the processor 400 sets the drive frequency to the resonant frequency fo. The vessel is then grasped between the blade 79 and the clamp member 60 and the transducer 50 is activated by actuating either the foot switch or the switch on the handle assembly 68 to transect and seal the vessel. In one embodiment, the impedance Z change may range between about 1.5 to about 4 times a base impedance measurements from an initial point of contact with the tissue to a point just before the muscle layer is transected and sealed.
In various embodiments, the clamp arm assembly 451 may comprise a non-electrically conductive or insulative material, such as plastic and/or rubber, for example, positioned intermediate the conductive jacket 472 and the base 449. The electrically insulative material can prevent current from flowing, or shorting, between the conductive jacket 472 and the base 449. In various embodiments, the base 449 may comprise at least one aperture 478, which can be configured to receive a pivot pin (not illustrated). The pivot pin can be configured to pivotably mount the base 449 to the sheath 72 (
Having described operational details of various embodiments of the surgical system 190, operations for the above surgical system 190 may be further described with reference to
In one embodiment, the ultrasonic surgical instrument 120 may be operated in accordance with a programmed step function algorithm 402 responsive to the tissue impedance Zt. In one embodiment, a frequency step function output may be initiated based on a comparison of the tissue impedance Zt and predetermined thresholds that have been correlated with various tissue states (e.g., desiccation, transection, sealing). When the tissue impedance Zt transitions above or below (e.g., crosses) a threshold, the processor 400 applies a digital frequency signal 418 to the DDS circuit 420 to change the frequency of an ultrasonic oscillator by a predetermined step in accordance with the step function algorithm 402 responsive to the tissue impedance Zt.
In operation, the blade 79 is located at the tissue treatment site. The tissue 514 is grasped between the blade 79 and the clamp arm assembly 451 such that the blade 79 and the conductive jacket 472 make electrical contact with the tissue 514. The processor 400 applies a first digital frequency signal 418 to set a first drive frequency f1 that is off resonance (e.g., f0/2, 2fo or other structural resonant frequencies, where fo is the resonant frequency). The blade 79 is electrically energized by the low level subtherapeutic RF voltage vrf supplied by the tissue impedance module 502. The drive signal 416 is applied to the transducer 50/blade 79 in response to actuation of the switch 312a on the handle assembly 68 or the foot switch 434 until the tissue impedance Zt changes by a predetermined amount. A force or load is then applied to the clamp arm assembly 451 and the blade 79. During this period the ultrasonic transducer 50 mechanically activates the blade 79 at the first drive frequency f1 and as a result, the tissue 514 begins to desiccate from the ultrasonic action applied between the blade 79 and the one or more clamp pads 58 of the clamp arm assembly 451 causing the tissue impedance Zt to increase. Eventually, as the tissue is transected by the ultrasonic action and applied clamp force, the tissue impedance Zt becomes very high or infinite. It will be appreciated by those skilled in the art that the drive current (I) output also may be stepped as described with reference to
In one embodiment, the tissue impedance Zt may be monitored by the impedance module 502 in accordance with the following process. A measurable RF current i1 is conveyed through the first energizing conductor 504a to the blade 79, through the tissue 514, and back to the impedance module 502 through the conductive jacket 472 and the second conductor 504b. As the tissue 514 is desiccated and cut by the ultrasonic action of the blade 79 acting against the one or more clamp pads 58, the impedance of the tissue 514 increases and thus the current in the return path, i.e., the second conductor 504b, decreases. The impedance module 502 measures the tissue impedance Zt and conveys a representative signal to the ADC 432 whose digital output 433 is provided to the processor 400. The processor 400 calculates the tissue impedance Zt based on these measured values of vrf and irf. The processor 400 steps the frequency by any suitable increment or decrement in response to changes in tissue impedance Zt. The processor 400 controls the drive signals 416 and can make any necessary adjustments in amplitude and frequency in response to the tissue impedance Zt. In one embodiment, the processor 400 can cut off the drive signal 416 when the tissue impedance Zt reaches a predetermined threshold value.
Accordingly, by way of example, and not limitation, in one embodiment, the ultrasonic surgical instrument 120 may be operated in accordance with a programmed stepped output algorithm to separate the inner muscle layer of a vessel from the adventitia layer prior to transecting and sealing the vessel. As previously discussed, according to one step function algorithm, the processor 400 initially sets a first drive frequency f1 that is significantly off resonance. The transducer 50 is activated to separate the inner muscle layer of the vessel from the adventitia layer and the tissue impedance module 502 applies a subtherapeutic RF voltage vrf signal to the blade 79. During this period T1 of operation the processor 400 monitors the tissue impedance Zt to determine when the inner muscle layer is transected or separated from the adventitia layer. The tissue impedance Zt is correlated to the load applied to the blade 79, for example, when the tissue becomes desiccated or when the tissue is transected the tissue impedance Zt becomes extremely high or infinite. The change in tissue impedance Zt indicates that the vessel has been separated or transected from the inner muscle layer and the generator 500 is deactivated for a second period of time T2. The processor 400 then sets the drive frequency to the resonant frequency fo. The vessel is then grasped between the blade 79 and the clamp arm assembly 451 and the transducer 50 is reactivated to transect and seal the vessel. Continuous monitoring of the tissue impedance Zt provides an indication of when the vessel is transected and sealed. Also, the tissue impedance Zt may be monitored to provide an indication of the completeness of the tissue cutting and/or coagulating process or to stop the activation of the ultrasonic generator 500 when the tissue impedance Zt reaches a predetermined threshold value. The threshold for the tissue impedance Zt may be selected, for example, to indicate that the vessel has been transected. In one embodiment, the tissue impedance Zt may range between about 10 Ohms to about 1000 Ohms from an initial point to a point just before the muscle layer is transected and sealed.
The applicants have discovered that experiments that run varying current set points (both increasing and decreasing) and dwell times indicate that the described embodiments can be used to separate the inner muscle layer from the outer adventitia layer prior to completing the transection resulting in improved hemostasis and potentially lower total energy (heat) at the transection site. Furthermore, although the surgical instruments 100, 120 have been described in regards to impedance threshold detection schemes to determine when the muscle layer is separated from the adventitia, other embodiments that do not employ any detection scheme are within the scope of the present disclosure. For example, embodiments of the surgical instruments 100, 120 may be employed in simplified surgical systems wherein non-resonant power is applied to separate the layers for a predetermined time of approximately 1 second or less, prior to applying a resonant power to cut the tissue. The embodiments are not limited in this context.
Having described operational details of various embodiments of the surgical systems 19 (
In one embodiment, the generator 30 generates a third ultrasonic drive signal. The ultrasonic transducer 50 is actuated with the third ultrasonic drive signal for a third period. The third drive signal is different from the first second drive signals over the first, second, and third periods. The first, second, and third drive signals define a step function waveform over the first, second, and third periods. In one embodiment, generating the first, second, and third ultrasonic drive signals comprises generating a corresponding first, second, and third drive current and actuating the ultrasonic transducer 50 with the first drive current for the first period, actuating the ultrasonic transducer 50 with the second drive current for the second period, and actuating the ultrasonic transducer 50 with the third drive current for the third period.
In one embodiment, the generator 30 generates the first ultrasonic drive signal at a first frequency, which is different from the resonant frequency. The ultrasonic transducer 50 is then actuated with the first ultrasonic drive signal at the first frequency for the first period. Actuation at the first frequency provides a first level of mechanical vibration to the end effector 81 suitable for separating a first tissue from a second tissue, for example, to separate the inner muscle layer of a vessel from the adventitia layer. The generator 30 generates the second ultrasonic drive signal at the resonant frequency, e.g., 55.5 kHz, and the actuates the ultrasonic transducer 50 with the second ultrasonic drive signal at the resonant frequency for the second period subsequent to the first period. Actuation at the second, resonant frequency, provides a second level of mechanical vibration to the end effector 81 suitable for transecting and sealing the first tissue, such as the vessel, once it separated from the inner muscle layer. In one embodiment, the second ultrasonic drive signal at the resonant frequency is generated automatically by the generator 30 after the first period. In one embodiment, the first frequency is substantially different from the resonant frequency and the first period is less than about one second. For example, in one embodiment, the first frequency is defined by the following equation: f1=2*fo, wherein f1 is the first frequency and fo is the resonant frequency. In another embodiment, the first frequency is defined by the following equation: f1=fo/2, wherein f1 is the first frequency and fo is the resonant frequency. The first, second, and third ultrasonic drive signals are also envisioned to excite be vibratory modes of the ultrasonic transducer 50 in longitudinal, flexural, and torsional modes and harmonics thereof.
In one embodiment, the generator 30 monitors a measurable characteristic of the ultrasonic drive system and generates any one of the first and second drive signals based on the measured characteristic. For example, the generator 30 monitors the impedance Z of the ultrasonic transducer 50. The generator 30 comprises electronic circuitry suitable for measuring the impedance of the transducer 50. For example, a current sense circuit (e.g., current sense circuit 426) senses the current flowing through the transducer 50 and a voltage sense circuit (e.g., voltage sense circuit 428) senses the output voltage applied to the transducer 50. A multiplexer (e.g., multiplexer 430) routes the appropriate analog signal to an analog-to-digital converter (e.g., ADC 432), whose digital output is provided to a processor (e.g., processor 400). The processor 400 calculates the transducer impedance Z based on the measured values of current and voltage.
In one embodiment, the generator 500 comprises an impedance module (e.g., tissue impedance module 502) to measure the impedance of a tissue portion contacting an end effector (e.g., end effector 810). The impedance module 502 includes an RF oscillator (e.g., RF oscillator 506) to generate a subtherapeutic RF signal. The subtherapeutic RF signal is applied to a blade (e.g., blade 79) portion of the end effector 810, which forms an energizing electrode. The tissue portion is grasped between the end effector 810 and a return electrode of a clamp arm assembly (e.g., clamp arm assembly 451) and the impedance of the tissue (e.g., tissue 514). The tissue impedance is then measured by a voltage sense circuit (e.g., voltage sense circuit 508) and current sense circuit (e.g., current sense circuit 510) and of the impedance module 502. These signals are applied to the ADC 432 via the multiplexer 430. The digital output of the ADC 432 is provided to the processor 400, which calculates the tissue impedance Zt based on the measured values of current through the tissue and the voltage applied to the blade 79 portion of the end effector 810.
In various embodiments, the feedback is provided by the output indicator 412 shown in
In one embodiment, the logic flow diagrams 700, 800, 900 may be implemented as executable modules (e.g., algorithms) comprising computer readable instructions to be executed by the processor 400 (
The frequency inflection point analysis module and the voltage drop point analysis module determine when a change in tissue state has occurred based on correlated empirical data associated with a particular ultrasonic instrument type and the energy level at which the instrument is driven. At 714, the results 710 from the frequency inflection point analysis module and/or the results 712 from the voltage drop point analysis module are read by the processor 400. The processor 400 determines 716 whether the frequency inflection point result 710 and/or the voltage drop point result 712 indicates a change in tissue state. If the results 710, 714 do not indicate a change in tissue state, the processor 400 continues along the “No” branch to 702 and reads an additional voltage and frequency signal sample from the generator 30. In embodiments that utilize the generator current in the analysis, the processor 400 would now also read an additional current signal sample from the generator 30. If the results 710, 714 indicate a sufficient change in tissue state, the processor 400 continues along the “Yes” branch to 718 and activates the output indicator 412.
As previously discussed, the output indicator 412 may provide visual, audible, and/or tactile feedback to alert the user of the ultrasonic surgical instrument 100, 120 that a change in tissue state has occurred. In various embodiments, in response to the feedback from the output indicator 412, the operational mode of the generator 30, 500 and/or the ultrasonic instrument 100, 120 may be controlled manually, automatically, or semi-automatically. The operational modes include, without limitation, disconnecting or shutting down the output power of the generator 30, 500, reducing the output power of the generator 30, 500, cycling the output power of the generator 30, 500, pulsing the output power of the generator 30, 500, and/or outputting a high-power momentary surge from the generator 30, 500. The operational modes of the ultrasonic instrument in response to the change in tissue state can be selected, for example, to minimize heating effects of the end effector 81, 810, e.g., of the clamp pad 58 (
Stf=αYtf+(1−α)Stf−1 (2)
Where:
The α value 808 may vary from about 0 to about 1 in accordance with a desired filtering or smoothing factor, wherein small α values 808 approaching about 0 provide a large amount of filtering or smoothing and large α values 808 approaching about 1 provide a small amount of filtering or smoothing. The α value 808 may be selected based on the ultrasonic instrument type and power level. In one embodiment, blocks 804, 806, and 808 may be implemented as a variable digital low pass filter 810 with the α value 808 determining the cutoff point of the filter 810. Once the frequency samples are filtered, the slope of the frequency samples is calculated at 812 as:
Frequency Slope=Δf/Δt (3)
The calculated Frequency Slope data points are provided to a “slow response” moving average filter 814 to calculate the EWMA moving average for the Frequency Slope to further reduce system noise. In one embodiment, the “slow response” moving average filter 814 may be implemented by calculating the EWMA for the Frequency Slope at 818 in accordance with the frequency slope moving average equation 820 and alpha value (α′) 822:
S′tf=α′Y′tf+(1−α′)S′tf−1 (4)
Where:
The α′ value 822 varies from about 0 to about 1, as previously discussed with respect to digital filter block 810 in accordance with a desired filtering or smoothing factor, wherein small α′ value 822 approaching 0 provide a large amount of filtering or smoothing and large α′ value 822 approaching 1 provide a small amount of filtering or smoothing. The α′ value 822 may be selected based on the ultrasonic instrument type and power level.
The calculated Frequency Slope data points are provided to a “fast response” filter 816 to calculate the moving average for the Frequency Slope. At 824, the “fast response” filter 816 calculates the moving average for the Frequency Slope based on a number of data points 826.
In the illustrated embodiment, the output of the “slow response” moving average filter 814 “Slope EWMA” is applied to a (+) input of an adder 828 and the output of the “fast response” filter 816 “Slope Avg” is applied to (−) input of the adder 828. The adder 828 computes the difference between the outputs of the “slow response” moving average filter 814 and the “fast response” filter 816. The difference between these outputs is compared at 830 to a predetermined limit 832. The limit 832 is determined based on the type of ultrasonic instrument and the power level at which the particular type of ultrasonic instrument is energized at. The limit 832 value may be predetermined and stored in memory in the form of a look-up table or the like. If the difference between the “Slope EWMA” and the “Slope Avg” is not greater than the limit 832, the processor 400 continues along the “No” branch and returns a value 834 to the results 710 block that indicates that no inflection point was found in the sampled frequency signal and, therefore, no change in tissue state was detected. However, if the difference between the “Slope EWMA” and the “Slope Avg” is greater than the limit 832, the processor 400 continues along the “Yes” branch and determines that a frequency inflection point 836 was found and returns point index 838 to the results 710 block indicating that an inflection point was found in the sampled frequency data and, therefore, a change in tissue state was detected. As previously discussed with reference to
Stv=αYtv+(1−α)Stv−1 (5)
Where:
As previously discussed, the α value 908 may vary from 0 to 1 in accordance with a desired filtering or smoothing factor and may be selected based on the ultrasonic instrument type and power level. In one embodiment, blocks 904, 906, and 908 may be implemented as a variable digital low pass filter 910 with the α value 908 determining the cutoff point of the filter 910. Once the voltage samples are filtered, the slope of the voltage samples is calculated at 912 as:
Voltage Slope=Δv/Δt (6)
The calculated Voltage Slope data points are provided to a “slow response” moving average filter 914 to calculate the EWMA moving average for the Voltage Slope to further reduce system noise. In one embodiment, the “slow response” moving average filter 914 may be implemented by calculating the EWMA for the Voltage Slope at 918 in accordance with the voltage slope moving average equation 920 and alpha value (α′) 822:
S′tv=α′Y′tv+(1−α′)S′tv−1 (7)
Where:
The α′ value 922 varies from about 0 to about 1, as previously discussed with respect to digital filter block 910 in accordance with a desired filtering or smoothing factor, wherein small α′ value 922 approaching about 0 provide a large amount of filtering or smoothing and large α′ value 922 approaching about 1 provide a small amount of filtering or smoothing. The α′ value 922 may be selected based on the ultrasonic instrument type and power level.
The calculated Voltage Slope data points are provided to a “fast response” filter 916 to calculate the moving average for the Voltage Slope. At 924, the “fast response” filter 916 calculates the moving average for the Voltage Slope based on a number of data points 926.
In the illustrated embodiment, the output of the “slow response” moving average filter 914 “Slope EWMA” is applied to a (+) input of an adder 928 and the output of the “fast response” filter 916 “Slope Avg” is applied to (−) input of the adder 928. The adder 928 computes the difference between the outputs of the “slow response” moving average filter 914 and the “fast response” filter 916. The difference between these outputs is compared at 930 to a predetermined limit 932. The limit 932 is determined based on the type of ultrasonic instrument and the power level at which the particular type of ultrasonic instrument is energized at. The limit 932 value may be predetermined and stored in memory in the form of a look-up table or the like. If the difference between the “Slope EWMA” and the “Slope Avg” is not greater than the limit 932, the processor 400 continues along the “No” branch and resets a counter to zero at 940, then returns a value 934 to the results 710 block that indicates that no voltage drop point was found in the sampled voltage signals and, therefore, no change in tissue state was detected. However, if the difference between the “Slope EWMA” and the “Slope Avg” is greater than the limit 932, the processor 400 continues along the “Yes” branch and increments a counter at 942. At 944, the processor 400 decides whether the counter is greater than 1, or some other predetermined threshold value for example. In other words, the processor 400 takes at least two data points in regards to the voltage drop point. If the counter is not greater than the threshold (e.g., 1 in the illustrated embodiment) the processor 400 continues along the “No” branch and returns a value 934 to the results 710 block that indicates that no voltage drop point was found in the sampled voltage signals and, therefore, no change in tissue state was detected. If the counter is greater than the threshold (e.g., 1 in the illustrated embodiment) the processor 400 continues along the “Yes” branch and determines that a voltage drop point 936 was found and returns a point index 938 to the results 712 block indicating that a voltage drop point was found in the sampled voltage signals and, therefore, a change in tissue state was detected. As previously discussed with reference to
While several embodiments have been illustrated and described, it is not the intention of the applicant to restrict or limit the scope of the appended claims to such detail. Numerous variations, changes, and substitutions will occur to those skilled in the art without departing from the scope of the invention. Moreover, the structure of each element associated with the described embodiments can be alternatively described as a means for providing the function performed by the element. Accordingly, it is intended that the described embodiments be limited only by the scope of the appended claims.
Reference throughout the specification to “various embodiments,” “some embodiments,” “one embodiment,” or “an embodiment” means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, appearances of the phrases “in various embodiments,” “in some embodiments,” “in one embodiment,” or “in an embodiment” in places throughout the specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, the particular features, structures, or characteristics illustrated or described in connection with one embodiment may be combined, in whole or in part, with the features structures, or characteristics of one or more other embodiments without limitation.
This application is a divisional application, under 35 U.S.C. §121, of U.S. patent application Ser. No. 13/294,576, filed on Nov. 11, 2011, entitled “Ultrasonic Device For Cutting and Coagulating With Stepped Output,” now U.S. Publication No. 2012/0123458, which is a divisional application, under 35 U.S.C. §121, of U.S patent application Ser. No. 12/503,775, filed on Jul. 15, 2009, entitled “Ultrasonic Device for Cutting and Coagulating with Stepped Output,” now U.S. Pat. No. 8,058,771, which claimed the benefit under Title 35, United States Code §119(e), of (1) U.S. Provisional Patent Application Ser. No. 61/086,619, filed Aug. 6, 2008 and entitled “Ultrasonic Device for Cutting and Coagulating with Stepped Output” and (2) U.S. Provisional Patent Application Ser. No. 61/188,790, filed Aug. 13, 2008 and entitled “Ultrasonic Device for Cutting and Coagulating with Stepped Output,” all of which are hereby incorporated by reference in their entirety.
| Number | Name | Date | Kind |
|---|---|---|---|
| 969528 | Disbrow | Sep 1910 | A |
| 1570025 | Young | Jan 1926 | A |
| 2704333 | Calosi et al. | Mar 1955 | A |
| 2736960 | Armstrong | Mar 1956 | A |
| 2849788 | Creek | Sep 1958 | A |
| RE25033 | Balamuth et al. | Aug 1961 | E |
| 3015961 | Roney | Jan 1962 | A |
| 3513848 | Winston et al. | May 1970 | A |
| 3526219 | Balamuth | Sep 1970 | A |
| 3614484 | Shoh | Oct 1971 | A |
| 3636943 | Balamuth | Jan 1972 | A |
| 3776238 | Peyman et al. | Dec 1973 | A |
| 3805787 | Banko | Apr 1974 | A |
| 3830098 | Antonevich | Aug 1974 | A |
| 3854737 | Gilliam, Sr. | Dec 1974 | A |
| 3862630 | Balamuth | Jan 1975 | A |
| 3900823 | Sokal et al. | Aug 1975 | A |
| 3918442 | Nikolaev et al. | Nov 1975 | A |
| 3946738 | Newton et al. | Mar 1976 | A |
| 3955859 | Stella et al. | May 1976 | A |
| 3956826 | Perdreaux, Jr. | May 1976 | A |
| 4156187 | Murry et al. | May 1979 | A |
| 4188927 | Harris | Feb 1980 | A |
| 4200106 | Douvas et al. | Apr 1980 | A |
| 4306570 | Matthews | Dec 1981 | A |
| 4445063 | Smith | Apr 1984 | A |
| 4491132 | Aikins | Jan 1985 | A |
| 4504264 | Kelman | Mar 1985 | A |
| 4574615 | Bower et al. | Mar 1986 | A |
| 4617927 | Manes | Oct 1986 | A |
| 4633119 | Thompson | Dec 1986 | A |
| 4634420 | Spinosa et al. | Jan 1987 | A |
| 4640279 | Beard | Feb 1987 | A |
| 4649919 | Thimsen et al. | Mar 1987 | A |
| 4708127 | Abdelghani | Nov 1987 | A |
| 4712722 | Hood et al. | Dec 1987 | A |
| 4827911 | Broadwin et al. | May 1989 | A |
| 4832683 | Idemoto et al. | May 1989 | A |
| 4838853 | Parisi | Jun 1989 | A |
| 4850354 | McGurk-Burleson et al. | Jul 1989 | A |
| 4865159 | Jamison | Sep 1989 | A |
| 4896009 | Pawlowski | Jan 1990 | A |
| 4903696 | Stasz et al. | Feb 1990 | A |
| 4922902 | Wuchinich et al. | May 1990 | A |
| 4965532 | Sakurai | Oct 1990 | A |
| 4979952 | Kubota et al. | Dec 1990 | A |
| 4981756 | Rhandhawa | Jan 1991 | A |
| 5026387 | Thomas | Jun 1991 | A |
| 5109819 | Custer et al. | May 1992 | A |
| 5112300 | Ureche | May 1992 | A |
| 5123903 | Quaid et al. | Jun 1992 | A |
| 5126618 | Takahashi et al. | Jun 1992 | A |
| 5162044 | Gahn et al. | Nov 1992 | A |
| 5163537 | Radev | Nov 1992 | A |
| 5167725 | Clark et al. | Dec 1992 | A |
| D332660 | Rawson et al. | Jan 1993 | S |
| 5176677 | Wuchinich | Jan 1993 | A |
| 5176695 | Dulebohn | Jan 1993 | A |
| 5184605 | Grzeszykowski | Feb 1993 | A |
| 5188102 | Idemoto et al. | Feb 1993 | A |
| 5213569 | Davis | May 1993 | A |
| 5221282 | Wuchinich | Jun 1993 | A |
| 5226909 | Evans et al. | Jul 1993 | A |
| 5226910 | Kajiyama et al. | Jul 1993 | A |
| 5241236 | Sasaki et al. | Aug 1993 | A |
| 5257988 | L'Esperance, Jr. | Nov 1993 | A |
| 5261922 | Hood | Nov 1993 | A |
| 5263957 | Davison | Nov 1993 | A |
| 5275609 | Pingleton et al. | Jan 1994 | A |
| 5282800 | Foshee et al. | Feb 1994 | A |
| 5304115 | Pflueger et al. | Apr 1994 | A |
| D347474 | Olson | May 1994 | S |
| 5322055 | Davison et al. | Jun 1994 | A |
| 5324299 | Davison et al. | Jun 1994 | A |
| 5326342 | Pflueger et al. | Jul 1994 | A |
| 5344420 | Hilal et al. | Sep 1994 | A |
| 5346502 | Estabrook et al. | Sep 1994 | A |
| 5353474 | Good et al. | Oct 1994 | A |
| 5357164 | Imabayashi et al. | Oct 1994 | A |
| 5357423 | Weaver et al. | Oct 1994 | A |
| 5366466 | Christian et al. | Nov 1994 | A |
| 5371429 | Manna | Dec 1994 | A |
| D354564 | Medema | Jan 1995 | S |
| 5381067 | Greenstein et al. | Jan 1995 | A |
| 5403312 | Yates et al. | Apr 1995 | A |
| D358887 | Feinberg | May 1995 | S |
| 5411481 | Allen et al. | May 1995 | A |
| 5419761 | Narayanan et al. | May 1995 | A |
| 5421829 | Olichney et al. | Jun 1995 | A |
| 5438997 | Sieben et al. | Aug 1995 | A |
| 5449370 | Vaitekunas | Sep 1995 | A |
| 5471988 | Fujio et al. | Dec 1995 | A |
| 5483501 | Park et al. | Jan 1996 | A |
| 5486162 | Brumbach | Jan 1996 | A |
| 5500216 | Julian et al. | Mar 1996 | A |
| 5501654 | Failla et al. | Mar 1996 | A |
| 5505693 | Mackool | Apr 1996 | A |
| 5507738 | Ciervo | Apr 1996 | A |
| 5527331 | Kresch et al. | Jun 1996 | A |
| 5562609 | Brumbach | Oct 1996 | A |
| 5562610 | Brumbach | Oct 1996 | A |
| 5577654 | Bishop | Nov 1996 | A |
| 5601601 | Tal et al. | Feb 1997 | A |
| 5603773 | Campbell | Feb 1997 | A |
| 5607436 | Pratt et al. | Mar 1997 | A |
| 5618492 | Auten et al. | Apr 1997 | A |
| 5628760 | Knoepfler | May 1997 | A |
| 5630420 | Vaitekunas | May 1997 | A |
| D381077 | Hunt | Jul 1997 | S |
| 5651780 | Jackson et al. | Jul 1997 | A |
| 5653713 | Michelson | Aug 1997 | A |
| 5669922 | Hood | Sep 1997 | A |
| 5674235 | Parisi | Oct 1997 | A |
| 5690269 | Bolanos et al. | Nov 1997 | A |
| 5694936 | Fujimoto et al. | Dec 1997 | A |
| 5713896 | Nardella | Feb 1998 | A |
| 5730752 | Alden et al. | Mar 1998 | A |
| 5733074 | Stöck et al. | Mar 1998 | A |
| 5741226 | Strukel et al. | Apr 1998 | A |
| 5792135 | Madhani et al. | Aug 1998 | A |
| 5792165 | Klieman et al. | Aug 1998 | A |
| 5808396 | Boukhny | Sep 1998 | A |
| 5810859 | DiMatteo et al. | Sep 1998 | A |
| 5817084 | Jensen | Oct 1998 | A |
| 5817119 | Klieman et al. | Oct 1998 | A |
| 5827323 | Klieman et al. | Oct 1998 | A |
| 5828160 | Sugishita | Oct 1998 | A |
| 5833696 | Whitfield et al. | Nov 1998 | A |
| 5836897 | Sakurai et al. | Nov 1998 | A |
| 5843109 | Mehta et al. | Dec 1998 | A |
| 5878193 | Wang et al. | Mar 1999 | A |
| 5879364 | Bromfield et al. | Mar 1999 | A |
| 5883615 | Fago et al. | Mar 1999 | A |
| 5893835 | Witt et al. | Apr 1999 | A |
| 5897523 | Wright et al. | Apr 1999 | A |
| 5897569 | Kellogg et al. | Apr 1999 | A |
| 5906628 | Miyawaki et al. | May 1999 | A |
| 5911699 | Anis et al. | Jun 1999 | A |
| 5935143 | Hood | Aug 1999 | A |
| 5935144 | Estabrook | Aug 1999 | A |
| 5938633 | Beaupre | Aug 1999 | A |
| 5944718 | Austin et al. | Aug 1999 | A |
| 5944737 | Tsonton et al. | Aug 1999 | A |
| 5954736 | Bishop et al. | Sep 1999 | A |
| 5954746 | Holthaus et al. | Sep 1999 | A |
| 5957882 | Nita et al. | Sep 1999 | A |
| 5957943 | Vaitekunas | Sep 1999 | A |
| 5968007 | Simon et al. | Oct 1999 | A |
| 5968060 | Kellogg | Oct 1999 | A |
| D416089 | Barton et al. | Nov 1999 | S |
| 5980510 | Tsonton et al. | Nov 1999 | A |
| 5989274 | Davison et al. | Nov 1999 | A |
| 5989275 | Estabrook et al. | Nov 1999 | A |
| 5993972 | Reich et al. | Nov 1999 | A |
| 6024741 | Williamson, IV et al. | Feb 2000 | A |
| 6024750 | Mastri et al. | Feb 2000 | A |
| 6027515 | Cimino | Feb 2000 | A |
| 6033375 | Brumbach | Mar 2000 | A |
| 6036667 | Manna et al. | Mar 2000 | A |
| 6050943 | Slayton et al. | Apr 2000 | A |
| 6051010 | DiMatteo et al. | Apr 2000 | A |
| 6056735 | Okada et al. | May 2000 | A |
| 6063098 | Houser et al. | May 2000 | A |
| 6066132 | Chen et al. | May 2000 | A |
| 6066151 | Miyawaki et al. | May 2000 | A |
| 6068647 | Witt et al. | May 2000 | A |
| 6077285 | Boukhny | Jun 2000 | A |
| 6083191 | Rose | Jul 2000 | A |
| 6086584 | Miller | Jul 2000 | A |
| 6090120 | Wright et al. | Jul 2000 | A |
| 6109500 | Alli et al. | Aug 2000 | A |
| 6110127 | Suzuki | Aug 2000 | A |
| 6113594 | Savage | Sep 2000 | A |
| 6117152 | Huitema | Sep 2000 | A |
| 6126629 | Perkins | Oct 2000 | A |
| 6129735 | Okada et al. | Oct 2000 | A |
| 6132368 | Cooper | Oct 2000 | A |
| 6139320 | Hahn | Oct 2000 | A |
| 6139561 | Shibata et al. | Oct 2000 | A |
| 6142615 | Qiu et al. | Nov 2000 | A |
| 6147560 | Erhage et al. | Nov 2000 | A |
| 6152902 | Christian et al. | Nov 2000 | A |
| 6159160 | Hsei et al. | Dec 2000 | A |
| 6159175 | Strukel et al. | Dec 2000 | A |
| 6165150 | Banko | Dec 2000 | A |
| 6204592 | Hur | Mar 2001 | B1 |
| 6206844 | Reichel et al. | Mar 2001 | B1 |
| 6210403 | Klicek | Apr 2001 | B1 |
| 6214023 | Whipple et al. | Apr 2001 | B1 |
| 6231565 | Tovey et al. | May 2001 | B1 |
| 6233476 | Strommer et al. | May 2001 | B1 |
| 6238366 | Savage et al. | May 2001 | B1 |
| 6252110 | Uemura et al. | Jun 2001 | B1 |
| D444365 | Bass et al. | Jul 2001 | S |
| 6254623 | Haibel, Jr. et al. | Jul 2001 | B1 |
| 6258034 | Hanafy | Jul 2001 | B1 |
| 6267761 | Ryan | Jul 2001 | B1 |
| 6270831 | Kumar et al. | Aug 2001 | B2 |
| 6273852 | Lehe et al. | Aug 2001 | B1 |
| 6274963 | Estabrook et al. | Aug 2001 | B1 |
| 6277115 | Saadat | Aug 2001 | B1 |
| 6278218 | Madan et al. | Aug 2001 | B1 |
| 6283981 | Beaupre | Sep 2001 | B1 |
| 6309400 | Beaupre | Oct 2001 | B2 |
| 6319221 | Savage et al. | Nov 2001 | B1 |
| 6325799 | Goble | Dec 2001 | B1 |
| 6325811 | Messerly | Dec 2001 | B1 |
| 6328751 | Beaupre | Dec 2001 | B1 |
| 6340352 | Okada et al. | Jan 2002 | B1 |
| 6352532 | Kramer et al. | Mar 2002 | B1 |
| 6364888 | Niemeyer et al. | Apr 2002 | B1 |
| 6379320 | Lafon et al. | Apr 2002 | B1 |
| D457958 | Dycus et al. | May 2002 | S |
| 6383194 | Pothula | May 2002 | B1 |
| 6387109 | Davison et al. | May 2002 | B1 |
| 6388657 | Natoli | May 2002 | B1 |
| 6391042 | Cimino | May 2002 | B1 |
| 6405733 | Fogarty et al. | Jun 2002 | B1 |
| 6416486 | Wampler | Jul 2002 | B1 |
| 6423073 | Bowman | Jul 2002 | B2 |
| 6423082 | Houser et al. | Jul 2002 | B1 |
| 6428539 | Baxter et al. | Aug 2002 | B1 |
| 6432118 | Messerly | Aug 2002 | B1 |
| 6436114 | Novak et al. | Aug 2002 | B1 |
| 6436115 | Beaupre | Aug 2002 | B1 |
| 6443969 | Novak et al. | Sep 2002 | B1 |
| 6454781 | Witt et al. | Sep 2002 | B1 |
| 6454782 | Schwemberger | Sep 2002 | B1 |
| 6458142 | Faller et al. | Oct 2002 | B1 |
| 6480796 | Wiener | Nov 2002 | B2 |
| 6485490 | Wampler et al. | Nov 2002 | B2 |
| 6491708 | Madan et al. | Dec 2002 | B2 |
| 6497715 | Satou | Dec 2002 | B2 |
| 6500176 | Truckai et al. | Dec 2002 | B1 |
| 6500188 | Harper et al. | Dec 2002 | B2 |
| 6524251 | Rabiner et al. | Feb 2003 | B2 |
| 6524316 | Nicholson et al. | Feb 2003 | B1 |
| 6527736 | Attinger et al. | Mar 2003 | B1 |
| 6533784 | Truckai et al. | Mar 2003 | B2 |
| 6537291 | Friedman et al. | Mar 2003 | B2 |
| 6543452 | Lavigne | Apr 2003 | B1 |
| 6543456 | Freeman | Apr 2003 | B1 |
| 6544260 | Markel et al. | Apr 2003 | B1 |
| 6561983 | Cronin et al. | May 2003 | B2 |
| 6572632 | Zisterer et al. | Jun 2003 | B2 |
| 6575969 | Rittman, III et al. | Jun 2003 | B1 |
| 6582451 | Marucci et al. | Jun 2003 | B1 |
| 6589200 | Schwemberger et al. | Jul 2003 | B1 |
| 6589239 | Khandkar et al. | Jul 2003 | B2 |
| 6610059 | West, Jr. | Aug 2003 | B1 |
| 6616450 | Mossle et al. | Sep 2003 | B2 |
| 6623501 | Heller et al. | Sep 2003 | B2 |
| 6626926 | Friedman et al. | Sep 2003 | B2 |
| 6633234 | Wiener et al. | Oct 2003 | B2 |
| 6656177 | Truckai et al. | Dec 2003 | B2 |
| 6662127 | Wiener et al. | Dec 2003 | B2 |
| 6663941 | Brown et al. | Dec 2003 | B2 |
| 6669690 | Okada et al. | Dec 2003 | B1 |
| 6676660 | Wampler et al. | Jan 2004 | B2 |
| 6678621 | Wiener et al. | Jan 2004 | B2 |
| 6679875 | Honda et al. | Jan 2004 | B2 |
| 6679899 | Wiener et al. | Jan 2004 | B2 |
| 6682544 | Mastri et al. | Jan 2004 | B2 |
| 6689146 | Himes | Feb 2004 | B1 |
| 6716215 | David et al. | Apr 2004 | B1 |
| 6731047 | Kauf et al. | May 2004 | B2 |
| 6733506 | McDevitt et al. | May 2004 | B1 |
| 6762535 | Take et al. | Jul 2004 | B2 |
| 6770072 | Truckai et al. | Aug 2004 | B1 |
| 6773443 | Truwit et al. | Aug 2004 | B2 |
| 6773444 | Messerly | Aug 2004 | B2 |
| 6783524 | Anderson et al. | Aug 2004 | B2 |
| 6786382 | Hoffman | Sep 2004 | B1 |
| 6786383 | Stegelmann | Sep 2004 | B2 |
| 6790216 | Ishikawa | Sep 2004 | B1 |
| D496997 | Dycus et al. | Oct 2004 | S |
| 6802843 | Truckai et al. | Oct 2004 | B2 |
| 6827712 | Tovey et al. | Dec 2004 | B2 |
| 6828712 | Battaglin et al. | Dec 2004 | B2 |
| 6869439 | White et al. | Mar 2005 | B2 |
| 6875220 | Du et al. | Apr 2005 | B2 |
| 6905497 | Truckai et al. | Jun 2005 | B2 |
| 6908472 | Wiener et al. | Jun 2005 | B2 |
| 6913579 | Truckai et al. | Jul 2005 | B2 |
| 6923804 | Eggers et al. | Aug 2005 | B2 |
| 6926716 | Baker et al. | Aug 2005 | B2 |
| 6929632 | Nita et al. | Aug 2005 | B2 |
| 6929644 | Truckai et al. | Aug 2005 | B2 |
| 6933656 | Matsushita et al. | Aug 2005 | B2 |
| D509589 | Wells | Sep 2005 | S |
| 6942677 | Nita et al. | Sep 2005 | B2 |
| 6945981 | Donofrio et al. | Sep 2005 | B2 |
| D511145 | Donofrio et al. | Nov 2005 | S |
| 6974450 | Weber et al. | Dec 2005 | B2 |
| 6976844 | Hickok et al. | Dec 2005 | B2 |
| 6976969 | Messerly | Dec 2005 | B2 |
| 6977495 | Donofrio | Dec 2005 | B2 |
| 6984220 | Wuchinich | Jan 2006 | B2 |
| 7001335 | Adachi et al. | Feb 2006 | B2 |
| 7011657 | Truckai et al. | Mar 2006 | B2 |
| 7033357 | Baxter et al. | Apr 2006 | B2 |
| 7041083 | Chu et al. | May 2006 | B2 |
| 7041088 | Nawrocki et al. | May 2006 | B2 |
| 7041102 | Truckai et al. | May 2006 | B2 |
| 7070597 | Truckai et al. | Jul 2006 | B2 |
| 7074219 | Levine et al. | Jul 2006 | B2 |
| 7077039 | Gass et al. | Jul 2006 | B2 |
| 7077853 | Kramer et al. | Jul 2006 | B2 |
| 7083619 | Truckai et al. | Aug 2006 | B2 |
| 7087054 | Truckai et al. | Aug 2006 | B2 |
| 7090672 | Underwood et al. | Aug 2006 | B2 |
| 7101371 | Dycus et al. | Sep 2006 | B2 |
| 7101378 | Salameh et al. | Sep 2006 | B2 |
| 7108695 | Witt et al. | Sep 2006 | B2 |
| 7112201 | Truckai et al. | Sep 2006 | B2 |
| D531311 | Guerra et al. | Oct 2006 | S |
| 7118564 | Ritchie et al. | Oct 2006 | B2 |
| 7124932 | Isaacson et al. | Oct 2006 | B2 |
| 7125409 | Truckai et al. | Oct 2006 | B2 |
| 7135018 | Ryan et al. | Nov 2006 | B2 |
| 7135030 | Schwemberger et al. | Nov 2006 | B2 |
| 7144403 | Booth | Dec 2006 | B2 |
| 7153315 | Miller | Dec 2006 | B2 |
| D536093 | Nakajima et al. | Jan 2007 | S |
| 7156189 | Bar-Cohen et al. | Jan 2007 | B1 |
| 7156853 | Muratsu | Jan 2007 | B2 |
| 7157058 | Marhasin et al. | Jan 2007 | B2 |
| 7159750 | Racenet et al. | Jan 2007 | B2 |
| 7160299 | Baily | Jan 2007 | B2 |
| 7163548 | Stulen et al. | Jan 2007 | B2 |
| 7169146 | Truckai et al. | Jan 2007 | B2 |
| 7179271 | Friedman et al. | Feb 2007 | B2 |
| 7186253 | Truckai et al. | Mar 2007 | B2 |
| 7189233 | Truckai et al. | Mar 2007 | B2 |
| D541418 | Schechter et al. | Apr 2007 | S |
| 7204820 | Akahoshi | Apr 2007 | B2 |
| 7217269 | El-Galley et al. | May 2007 | B2 |
| 7220951 | Truckai et al. | May 2007 | B2 |
| 7223229 | Inman et al. | May 2007 | B2 |
| 7229455 | Sakurai et al. | Jun 2007 | B2 |
| 7273483 | Wiener et al. | Sep 2007 | B2 |
| 7285895 | Beaupré | Oct 2007 | B2 |
| 7309849 | Truckai et al. | Dec 2007 | B2 |
| 7311709 | Truckai et al. | Dec 2007 | B2 |
| 7317955 | McGreevy | Jan 2008 | B2 |
| 7326236 | Andreas et al. | Feb 2008 | B2 |
| 7331410 | Yong et al. | Feb 2008 | B2 |
| 7353068 | Tanaka et al. | Apr 2008 | B2 |
| 7354440 | Truckal et al. | Apr 2008 | B2 |
| 7380695 | Doll et al. | Jun 2008 | B2 |
| 7380696 | Shelton, IV et al. | Jun 2008 | B2 |
| 7381209 | Truckai et al. | Jun 2008 | B2 |
| 7390317 | Taylor et al. | Jun 2008 | B2 |
| 7404508 | Smith et al. | Jul 2008 | B2 |
| 7408288 | Hara | Aug 2008 | B2 |
| D576725 | Shumer et al. | Sep 2008 | S |
| D578643 | Shumer et al. | Oct 2008 | S |
| D578644 | Shumer et al. | Oct 2008 | S |
| D578645 | Shumer et al. | Oct 2008 | S |
| 7431704 | Babaev | Oct 2008 | B2 |
| 7441684 | Shelton, IV et al. | Oct 2008 | B2 |
| 7455208 | Wales et al. | Nov 2008 | B2 |
| 7472815 | Shelton, IV et al. | Jan 2009 | B2 |
| 7473263 | Johnston et al. | Jan 2009 | B2 |
| 7479148 | Beaupré | Jan 2009 | B2 |
| 7479160 | Branch et al. | Jan 2009 | B2 |
| 7488285 | Honda et al. | Feb 2009 | B2 |
| 7494468 | Rabiner et al. | Feb 2009 | B2 |
| 7503893 | Kucklick | Mar 2009 | B2 |
| 7503895 | Rabiner et al. | Mar 2009 | B2 |
| 7506790 | Shelton, IV | Mar 2009 | B2 |
| 7506791 | Omaits et al. | Mar 2009 | B2 |
| 7524320 | Tierney et al. | Apr 2009 | B2 |
| 7530986 | Beaupre et al. | May 2009 | B2 |
| 7534243 | Chin et al. | May 2009 | B1 |
| D594983 | Price et al. | Jun 2009 | S |
| 7549564 | Boudreaux | Jun 2009 | B2 |
| 7559450 | Wales et al. | Jul 2009 | B2 |
| 7567012 | Namikawa | Jul 2009 | B2 |
| 7578820 | Moore et al. | Aug 2009 | B2 |
| 7654431 | Hueil et al. | Feb 2010 | B2 |
| 7665647 | Shelton, IV et al. | Feb 2010 | B2 |
| 7670334 | Hueil et al. | Mar 2010 | B2 |
| 7674263 | Ryan | Mar 2010 | B2 |
| 7691098 | Wallace et al. | Apr 2010 | B2 |
| 7713202 | Boukhny et al. | May 2010 | B2 |
| 7714481 | Sakai | May 2010 | B2 |
| D618797 | Price et al. | Jun 2010 | S |
| 7751115 | Song | Jul 2010 | B2 |
| D621503 | Otten et al. | Aug 2010 | S |
| 7770774 | Mastri et al. | Aug 2010 | B2 |
| 7770775 | Shelton, IV et al. | Aug 2010 | B2 |
| 7780054 | Wales | Aug 2010 | B2 |
| 7780659 | Okada et al. | Aug 2010 | B2 |
| 7784662 | Wales et al. | Aug 2010 | B2 |
| 7798386 | Schall et al. | Sep 2010 | B2 |
| 7803152 | Honda et al. | Sep 2010 | B2 |
| 7806891 | Nowlin et al. | Oct 2010 | B2 |
| 7810693 | Broehl et al. | Oct 2010 | B2 |
| D627066 | Romero | Nov 2010 | S |
| 7824401 | Manzo et al. | Nov 2010 | B2 |
| 7837699 | Yamada et al. | Nov 2010 | B2 |
| 7846155 | Houser et al. | Dec 2010 | B2 |
| 7854735 | Houser et al. | Dec 2010 | B2 |
| D631155 | Peine et al. | Jan 2011 | S |
| 7861906 | Doll et al. | Jan 2011 | B2 |
| 7876030 | Taki et al. | Jan 2011 | B2 |
| D631965 | Price et al. | Feb 2011 | S |
| 7892606 | Thies et al. | Feb 2011 | B2 |
| 7901423 | Stulen et al. | Mar 2011 | B2 |
| 7905881 | Masuda et al. | Mar 2011 | B2 |
| 7922651 | Yamada et al. | Apr 2011 | B2 |
| D637288 | Houghton | May 2011 | S |
| D638540 | Ijiri et al. | May 2011 | S |
| 7959050 | Smith et al. | Jun 2011 | B2 |
| 7959626 | Hong et al. | Jun 2011 | B2 |
| 7976544 | McClurken et al. | Jul 2011 | B2 |
| 7998157 | Culp et al. | Aug 2011 | B2 |
| 8038693 | Allen | Oct 2011 | B2 |
| 8057498 | Robertson | Nov 2011 | B2 |
| 8058771 | Giordano et al. | Nov 2011 | B2 |
| 8061014 | Smith et al. | Nov 2011 | B2 |
| 8089197 | Rinner et al. | Jan 2012 | B2 |
| 8142461 | Houser et al. | Mar 2012 | B2 |
| 8152825 | Madan et al. | Apr 2012 | B2 |
| 8157145 | Shelton, IV et al. | Apr 2012 | B2 |
| 8162966 | Connor et al. | Apr 2012 | B2 |
| 8177800 | Spitz et al. | May 2012 | B2 |
| 8182502 | Stulen et al. | May 2012 | B2 |
| D661801 | Price et al. | Jun 2012 | S |
| D661802 | Price et al. | Jun 2012 | S |
| D661803 | Price et al. | Jun 2012 | S |
| D661804 | Price et al. | Jun 2012 | S |
| 8226675 | Houser et al. | Jul 2012 | B2 |
| 8236019 | Houser | Aug 2012 | B2 |
| 8252012 | Stulen | Aug 2012 | B2 |
| 8253303 | Giordano et al. | Aug 2012 | B2 |
| 8257377 | Wiener et al. | Sep 2012 | B2 |
| 8287485 | Kimura et al. | Oct 2012 | B2 |
| 8319400 | Houser et al. | Nov 2012 | B2 |
| 8323302 | Robertson et al. | Dec 2012 | B2 |
| 8334635 | Voegele et al. | Dec 2012 | B2 |
| 8344596 | Nield et al. | Jan 2013 | B2 |
| 8348967 | Stulen | Jan 2013 | B2 |
| 8372102 | Stulen et al. | Feb 2013 | B2 |
| 8382782 | Robertson et al. | Feb 2013 | B2 |
| 8419759 | Dietz | Apr 2013 | B2 |
| 8430898 | Wiener et al. | Apr 2013 | B2 |
| 8461744 | Wiener et al. | Jun 2013 | B2 |
| 8469981 | Robertson et al. | Jun 2013 | B2 |
| 8486096 | Robertson et al. | Jul 2013 | B2 |
| 20010025183 | Shahidi | Sep 2001 | A1 |
| 20010025184 | Messerly | Sep 2001 | A1 |
| 20010031950 | Ryan | Oct 2001 | A1 |
| 20010039419 | Francischelli et al. | Nov 2001 | A1 |
| 20020002377 | Cimino | Jan 2002 | A1 |
| 20020019649 | Sikora et al. | Feb 2002 | A1 |
| 20020022836 | Goble et al. | Feb 2002 | A1 |
| 20020049551 | Friedman et al. | Apr 2002 | A1 |
| 20020052617 | Anis et al. | May 2002 | A1 |
| 20020077550 | Rabiner et al. | Jun 2002 | A1 |
| 20020156466 | Sakurai et al. | Oct 2002 | A1 |
| 20020156493 | Houser et al. | Oct 2002 | A1 |
| 20030036705 | Hare et al. | Feb 2003 | A1 |
| 20030055443 | Spotnitz | Mar 2003 | A1 |
| 20030204199 | Novak et al. | Oct 2003 | A1 |
| 20030212332 | Fenton et al. | Nov 2003 | A1 |
| 20030212422 | Fenton et al. | Nov 2003 | A1 |
| 20030229344 | Dycus et al. | Dec 2003 | A1 |
| 20040030254 | Babaev | Feb 2004 | A1 |
| 20040047485 | Sherrit et al. | Mar 2004 | A1 |
| 20040054364 | Aranyi et al. | Mar 2004 | A1 |
| 20040092921 | Kadziauskas et al. | May 2004 | A1 |
| 20040097919 | Wellman et al. | May 2004 | A1 |
| 20040097996 | Rabiner et al. | May 2004 | A1 |
| 20040176686 | Hare et al. | Sep 2004 | A1 |
| 20040199193 | Hayashi et al. | Oct 2004 | A1 |
| 20040204728 | Haefner | Oct 2004 | A1 |
| 20040260300 | Gorensek et al. | Dec 2004 | A1 |
| 20050021065 | Yamada et al. | Jan 2005 | A1 |
| 20050033337 | Muir et al. | Feb 2005 | A1 |
| 20050049546 | Messerly et al. | Mar 2005 | A1 |
| 20050070800 | Takahashi | Mar 2005 | A1 |
| 20050096683 | Ellins et al. | May 2005 | A1 |
| 20050143769 | White et al. | Jun 2005 | A1 |
| 20050149108 | Cox | Jul 2005 | A1 |
| 20050165345 | Laufer et al. | Jul 2005 | A1 |
| 20050177184 | Easley | Aug 2005 | A1 |
| 20050192610 | Houser et al. | Sep 2005 | A1 |
| 20050209620 | Du et al. | Sep 2005 | A1 |
| 20050249667 | Tuszynski et al. | Nov 2005 | A1 |
| 20050261581 | Hughes et al. | Nov 2005 | A1 |
| 20050261588 | Makin et al. | Nov 2005 | A1 |
| 20050273090 | Nieman et al. | Dec 2005 | A1 |
| 20050288659 | Kimura et al. | Dec 2005 | A1 |
| 20060030797 | Zhou et al. | Feb 2006 | A1 |
| 20060063130 | Hayman et al. | Mar 2006 | A1 |
| 20060066181 | Bromfield et al. | Mar 2006 | A1 |
| 20060079876 | Houser et al. | Apr 2006 | A1 |
| 20060079878 | Houser | Apr 2006 | A1 |
| 20060084963 | Messerly | Apr 2006 | A1 |
| 20060095046 | Trieu et al. | May 2006 | A1 |
| 20060190034 | Nishizawa et al. | Aug 2006 | A1 |
| 20060206115 | Schomer et al. | Sep 2006 | A1 |
| 20060211943 | Beaupre | Sep 2006 | A1 |
| 20060235306 | Cotter et al. | Oct 2006 | A1 |
| 20060253050 | Yoshimine et al. | Nov 2006 | A1 |
| 20060264809 | Hansmann et al. | Nov 2006 | A1 |
| 20070016235 | Tanaka et al. | Jan 2007 | A1 |
| 20070016236 | Beaupre | Jan 2007 | A1 |
| 20070055228 | Berg et al. | Mar 2007 | A1 |
| 20070056596 | Fanney et al. | Mar 2007 | A1 |
| 20070060915 | Kucklick | Mar 2007 | A1 |
| 20070060935 | Schwardt et al. | Mar 2007 | A1 |
| 20070063618 | Bromfield | Mar 2007 | A1 |
| 20070106317 | Shelton, IV et al. | May 2007 | A1 |
| 20070129716 | Daw et al. | Jun 2007 | A1 |
| 20070130771 | Ehlert et al. | Jun 2007 | A1 |
| 20070131034 | Ehlert et al. | Jun 2007 | A1 |
| 20070149881 | Rabin | Jun 2007 | A1 |
| 20070162050 | Sartor | Jul 2007 | A1 |
| 20070173872 | Neuenfeldt | Jul 2007 | A1 |
| 20070185380 | Kucklick | Aug 2007 | A1 |
| 20070219481 | Babaev | Sep 2007 | A1 |
| 20070239028 | Houser et al. | Oct 2007 | A1 |
| 20070249941 | Salehi et al. | Oct 2007 | A1 |
| 20070260234 | McCullagh et al. | Nov 2007 | A1 |
| 20070265560 | Soltani et al. | Nov 2007 | A1 |
| 20070275348 | Lemon | Nov 2007 | A1 |
| 20070282335 | Young et al. | Dec 2007 | A1 |
| 20070287933 | Phan et al. | Dec 2007 | A1 |
| 20080009848 | Paraschiv et al. | Jan 2008 | A1 |
| 20080051812 | Schmitz et al. | Feb 2008 | A1 |
| 20080058585 | Novak et al. | Mar 2008 | A1 |
| 20080058775 | Darian et al. | Mar 2008 | A1 |
| 20080058845 | Shimizu et al. | Mar 2008 | A1 |
| 20080082039 | Babaev | Apr 2008 | A1 |
| 20080082098 | Tanaka et al. | Apr 2008 | A1 |
| 20080125768 | Tahara et al. | May 2008 | A1 |
| 20080171938 | Masuda et al. | Jul 2008 | A1 |
| 20080172051 | Masuda et al. | Jul 2008 | A1 |
| 20080177268 | Daum et al. | Jul 2008 | A1 |
| 20080188878 | Young | Aug 2008 | A1 |
| 20080200940 | Eichmann et al. | Aug 2008 | A1 |
| 20080208231 | Ota et al. | Aug 2008 | A1 |
| 20080234709 | Houser | Sep 2008 | A1 |
| 20080234710 | Neurohr et al. | Sep 2008 | A1 |
| 20080243106 | Coe et al. | Oct 2008 | A1 |
| 20080245371 | Gruber | Oct 2008 | A1 |
| 20080249553 | Gruber et al. | Oct 2008 | A1 |
| 20080262490 | Williams | Oct 2008 | A1 |
| 20080281200 | Voic et al. | Nov 2008 | A1 |
| 20080287948 | Newton et al. | Nov 2008 | A1 |
| 20090030311 | Stulen et al. | Jan 2009 | A1 |
| 20090030437 | Houser et al. | Jan 2009 | A1 |
| 20090030439 | Stulen | Jan 2009 | A1 |
| 20090036913 | Wiener et al. | Feb 2009 | A1 |
| 20090036914 | Houser | Feb 2009 | A1 |
| 20090048537 | Lydon et al. | Feb 2009 | A1 |
| 20090054886 | Yachi et al. | Feb 2009 | A1 |
| 20090054894 | Yachi | Feb 2009 | A1 |
| 20090076506 | Baker | Mar 2009 | A1 |
| 20090082716 | Akahoshi | Mar 2009 | A1 |
| 20090105750 | Price et al. | Apr 2009 | A1 |
| 20090118802 | Mioduski et al. | May 2009 | A1 |
| 20090138006 | Bales et al. | May 2009 | A1 |
| 20090143797 | Smith et al. | Jun 2009 | A1 |
| 20090143798 | Smith et al. | Jun 2009 | A1 |
| 20090143799 | Smith et al. | Jun 2009 | A1 |
| 20090143800 | Deville et al. | Jun 2009 | A1 |
| 20090143801 | Deville et al. | Jun 2009 | A1 |
| 20090143802 | Deville et al. | Jun 2009 | A1 |
| 20090143803 | Palmer et al. | Jun 2009 | A1 |
| 20090143804 | Palmer et al. | Jun 2009 | A1 |
| 20090143805 | Palmer et al. | Jun 2009 | A1 |
| 20090143806 | Witt et al. | Jun 2009 | A1 |
| 20090149801 | Crandall et al. | Jun 2009 | A1 |
| 20090270853 | Yachi et al. | Oct 2009 | A1 |
| 20090270899 | Carusillo et al. | Oct 2009 | A1 |
| 20090318945 | Yoshimine et al. | Dec 2009 | A1 |
| 20090327715 | Smith et al. | Dec 2009 | A1 |
| 20100004668 | Smith et al. | Jan 2010 | A1 |
| 20100004669 | Smith et al. | Jan 2010 | A1 |
| 20100016785 | Takuma | Jan 2010 | A1 |
| 20100030248 | Palmer et al. | Feb 2010 | A1 |
| 20100036370 | Mirel et al. | Feb 2010 | A1 |
| 20100069940 | Miller et al. | Mar 2010 | A1 |
| 20100158307 | Kubota et al. | Jun 2010 | A1 |
| 20100187283 | Crainich et al. | Jul 2010 | A1 |
| 20100193567 | Scheib et al. | Aug 2010 | A1 |
| 20100228264 | Robinson et al. | Sep 2010 | A1 |
| 20100234906 | Koh | Sep 2010 | A1 |
| 20100268211 | Manwaring et al. | Oct 2010 | A1 |
| 20100298743 | Nield et al. | Nov 2010 | A1 |
| 20100298851 | Nield | Nov 2010 | A1 |
| 20100331870 | Wan et al. | Dec 2010 | A1 |
| 20110009850 | Main et al. | Jan 2011 | A1 |
| 20110015627 | DiNardo et al. | Jan 2011 | A1 |
| 20110015631 | Wiener et al. | Jan 2011 | A1 |
| 20110082486 | Messerly et al. | Apr 2011 | A1 |
| 20110087212 | Aldridge et al. | Apr 2011 | A1 |
| 20110087213 | Messerly et al. | Apr 2011 | A1 |
| 20110087214 | Giordano et al. | Apr 2011 | A1 |
| 20110087215 | Aldridge et al. | Apr 2011 | A1 |
| 20110087216 | Aldridge et al. | Apr 2011 | A1 |
| 20110087217 | Yates et al. | Apr 2011 | A1 |
| 20110087218 | Boudreaux et al. | Apr 2011 | A1 |
| 20110087256 | Wiener et al. | Apr 2011 | A1 |
| 20110196286 | Robertson et al. | Aug 2011 | A1 |
| 20110196398 | Robertson et al. | Aug 2011 | A1 |
| 20110196399 | Robertson et al. | Aug 2011 | A1 |
| 20110196403 | Robertson et al. | Aug 2011 | A1 |
| 20110196404 | Dietz et al. | Aug 2011 | A1 |
| 20110288452 | Houser et al. | Nov 2011 | A1 |
| 20120029546 | Robertson | Feb 2012 | A1 |
| 20120059289 | Nield et al. | Mar 2012 | A1 |
| 20120078139 | Aldridge et al. | Mar 2012 | A1 |
| 20120078243 | Worrell et al. | Mar 2012 | A1 |
| 20120078244 | Worrell et al. | Mar 2012 | A1 |
| 20120078247 | Worrell et al. | Mar 2012 | A1 |
| 20120083783 | Davison et al. | Apr 2012 | A1 |
| 20120083784 | Davison et al. | Apr 2012 | A1 |
| 20120123458 | Giordano et al. | May 2012 | A1 |
| 20120132450 | Timm et al. | May 2012 | A1 |
| 20120138660 | Shelton, IV | Jun 2012 | A1 |
| 20120177005 | Liang et al. | Jul 2012 | A1 |
| 20120184946 | Price et al. | Jul 2012 | A1 |
| 20120199630 | Shelton, IV | Aug 2012 | A1 |
| 20120199631 | Shelton, IV et al. | Aug 2012 | A1 |
| 20120199632 | Spivey et al. | Aug 2012 | A1 |
| 20120199633 | Shelton, IV et al. | Aug 2012 | A1 |
| 20120203247 | Shelton, IV et al. | Aug 2012 | A1 |
| 20120205421 | Shelton, IV | Aug 2012 | A1 |
| 20120210223 | Eppolito | Aug 2012 | A1 |
| 20120211546 | Shelton, IV | Aug 2012 | A1 |
| 20120259353 | Houser et al. | Oct 2012 | A1 |
| 20120265196 | Turner et al. | Oct 2012 | A1 |
| 20120269676 | Houser et al. | Oct 2012 | A1 |
| 20120289984 | Houser et al. | Nov 2012 | A1 |
| 20120310262 | Messerly et al. | Dec 2012 | A1 |
| 20120310263 | Messerly et al. | Dec 2012 | A1 |
| 20120310264 | Messerly et al. | Dec 2012 | A1 |
| 20120323265 | Stulen | Dec 2012 | A1 |
| 20130012970 | Houser | Jan 2013 | A1 |
| 20130035706 | Giordano et al. | Feb 2013 | A1 |
| 20130103023 | Monson et al. | Apr 2013 | A1 |
| 20130103024 | Monson et al. | Apr 2013 | A1 |
| 20130123776 | Monson et al. | May 2013 | A1 |
| 20130123777 | Monson et al. | May 2013 | A1 |
| 20130123782 | Trees et al. | May 2013 | A1 |
| 20130131660 | Monson et al. | May 2013 | A1 |
| 20130178882 | Voegele et al. | Jul 2013 | A1 |
| 20130274732 | Wiener et al. | Oct 2013 | A1 |
| Number | Date | Country |
|---|---|---|
| 1634601 | Jul 2005 | CN |
| 1640365 | Jul 2005 | CN |
| 1694649 | Nov 2005 | CN |
| 1922563 | Feb 2007 | CN |
| 1951333 | Apr 2007 | CN |
| 101040799 | Sep 2007 | CN |
| 0171967 | Feb 1986 | EP |
| 0443256 | Aug 1991 | EP |
| 0456470 | Nov 1991 | EP |
| 0482195 | Jan 1996 | EP |
| 0612570 | Jun 1997 | EP |
| 0908148 | Jan 2002 | EP |
| 0908155 | Jun 2003 | EP |
| 1199044 | Dec 2005 | EP |
| 1199043 | Mar 2006 | EP |
| 1433425 | Jun 2006 | EP |
| 1844720 | Oct 2007 | EP |
| 1862133 | Dec 2007 | EP |
| 1199045 | Jun 2008 | EP |
| 1974771 | Oct 2008 | EP |
| 1498082 | Dec 2008 | EP |
| 1832259 | Jun 2009 | EP |
| 2074959 | Jul 2009 | EP |
| 2298154 | Mar 2011 | EP |
| 2032221 | Apr 1980 | GB |
| 2379878 | Nov 2004 | GB |
| 2447767 | Aug 2011 | GB |
| 62-292153 | Dec 1987 | JP |
| 63-315049 | Dec 1988 | JP |
| 02-71510 | May 1990 | JP |
| 04-25707 | Feb 1992 | JP |
| 4-30508 | Mar 1992 | JP |
| 6-104503 | Apr 1994 | JP |
| 6-507081 | Aug 1994 | JP |
| H 7-508910 | Oct 1995 | JP |
| 7-308323 | Nov 1995 | JP |
| 8-24266 | Jan 1996 | JP |
| 8-275951 | Oct 1996 | JP |
| H 09-503146 | Mar 1997 | JP |
| 10-295700 | Nov 1998 | JP |
| 11-253451 | Sep 1999 | JP |
| 2000-041991 | Feb 2000 | JP |
| 2000-070279 | Mar 2000 | JP |
| 2001-309925 | Nov 2001 | JP |
| 2002-186901 | Jul 2002 | JP |
| 2002-263579 | Sep 2002 | JP |
| 2003-510158 | Mar 2003 | JP |
| 2003-126110 | May 2003 | JP |
| 2003-310627 | May 2003 | JP |
| 2003-339730 | Dec 2003 | JP |
| 2005027026 | Jan 2005 | JP |
| 2005-066316 | Mar 2005 | JP |
| 2005-074088 | Mar 2005 | JP |
| 2005-534451 | Nov 2005 | JP |
| 2006-158525 | Jun 2006 | JP |
| 2006217716 | Aug 2006 | JP |
| 2006-288431 | Oct 2006 | JP |
| 2008-508065 | Mar 2008 | JP |
| 2008-119250 | May 2008 | JP |
| 2009-511206 | Mar 2009 | JP |
| WO 9222259 | Dec 1992 | WO |
| WO 9314708 | Aug 1993 | WO |
| WO 9421183 | Sep 1994 | WO |
| WO 9509572 | Apr 1995 | WO |
| WO 9826739 | Jun 1998 | WO |
| WO 9837815 | Sep 1998 | WO |
| WO 0154590 | Aug 2001 | WO |
| WO 0195810 | Dec 2001 | WO |
| WO 2004037095 | May 2004 | WO |
| WO 2005122917 | Dec 2005 | WO |
| WO 2006012797 | Feb 2006 | WO |
| WO 2006042210 | Apr 2006 | WO |
| WO 2006058223 | Jun 2006 | WO |
| WO 2006063199 | Jun 2006 | WO |
| WO 2006083988 | Aug 2006 | WO |
| WO 2006129465 | Dec 2006 | WO |
| WO 2007008710 | Jan 2007 | WO |
| WO 2007047531 | Apr 2007 | WO |
| WO 2007143665 | Dec 2007 | WO |
| WO 2008016886 | Feb 2008 | WO |
| WO 2008042021 | Apr 2008 | WO |
| WO 2008130793 | Oct 2008 | WO |
| WO 2009018406 | Feb 2009 | WO |
| WO 2009027065 | Mar 2009 | WO |
| WO 2011144911 | Nov 2011 | WO |
| WO 2013062978 | May 2013 | WO |
| Entry |
|---|
| Partial International Search Report for PCT/US2009/052616, Nov. 10, 2009 (3 pages). |
| International Preliminary Report on Patentability for PCT/US2009/052616, Feb. 8, 2011 (8 pages). |
| International Search Report for PCT/US2009/052616, Jan. 19, 2010 (6 pages). |
| International Search Report for PCT/US2011/053404, Nov. 27, 2012 (8 pages). |
| International Preliminary Report on Patentability for PCT/US2011/053404, Apr. 2, 2013 (12 pages). |
| Technology Overview, printed from www.harmonicscalpel.com, Internet site, website accessed on Jun. 13, 2007, (3 pages). |
| Sherrit et al., “Novel Horn Designs for Ultrasonic/Sonic Cleaning Welding, Soldering, Cutting and Drilling,” Proc. SPIE Smart Structures Conference, vol. 4701, Paper No. 34, San Diego, CA, pp. 353-360, Mar. 2002. |
| AST Products, Inc., “Principles of Video Contact Angle Analysis,” 20 pages, (2006). |
| Lim et al., “A Review of Mechanism Used in Laparoscopic Surgical Instruments,” Mechanism and Machine Theory, vol. 38, pp. 1133-1147, (2003). |
| Gooch et al., “Recommended Infection-Control Practices for Dentistry, 1993,” Published: May 28, 1993; [retrieved on Aug. 23, 2008]. Retrieved from the Internet: URL: http//wonder.cdc.gov/wonder/prevguid/p0000191/p0000191.asp (15 pages). |
| Huston et al., “Magnetic and Magnetostrictive Properties of Cube Textured Nickel for Magnetostrictive Transducer Applications,” IEEE Transactions on Magnetics, vol. 9(4), pp. 636-640 (Dec. 1973). |
| F. A. Duck, “Optical Properties of Tissue Including Ultraviolet and Infrared Radiation,” pp. 43-71 in Physical Properties of Tissue (1990). |
| Orr et al., “Overview of Bioheat Transfer,” pp. 367-384 in Optical-Thermal Response of Laser-Irradiated Tissue, A. J. Welch and M. J. C. van Gernert, eds., Plenum, New York (1995). |
| Campbell et al, “Thermal Imaging in Surgery,” p. 19-3, in Medical Infrared Imaging, N. A. Diakides and J. D. Bronzino, Eds. (2008). |
| Sullivan, “Cost-Constrained Selection of Strand Diameter and Number In a Litz-Wire Transformer Winding,” IEEE Transactions on Power Electronics, vol. 16, No. 2, Mar. 2001, pp. 281-288. |
| Sullivan, “Optimal Choice for Number of Strands in a Litz-Wire Transformer Winding,” IEEE Transactions on Power Electronics, vol. 14, No. 2, Mar. 1999, pp. 283-291. |
| U.S. Appl. No. 29/404,676, filed Oct. 24, 2011. |
| U.S. Appl. No. 13/151,181, filed Jun. 2, 2011. |
| U.S. Appl. No. 13/369,561, filed Feb. 9, 2012. |
| U.S. Appl. No. 13/369,569, filed Feb. 9, 2012. |
| U.S. Appl. No. 13/369,578, filed Feb. 9, 2012. |
| U.S. Appl. No. 13/369,584, filed Feb. 9, 2012. |
| U.S. Appl. No. 13/369,588, filed Feb. 9, 2012. |
| U.S. Appl. No. 13/369,594, filed Feb. 9, 2012. |
| U.S. Appl. No. 13/369,601, filed Feb. 9, 2012. |
| U.S. Appl. No. 13/369,609, filed Feb. 9, 2012. |
| U.S. Appl. No. 13/369,629, filed Feb. 9, 2012. |
| U.S. Appl. No. 13/369,666, filed Feb. 9, 2012. |
| U.S. Appl. No. 13/849,627, filed Mar. 25, 2013. |
| Number | Date | Country | |
|---|---|---|---|
| 20130035707 A1 | Feb 2013 | US |
| Number | Date | Country | |
|---|---|---|---|
| 61086619 | Aug 2008 | US | |
| 61188790 | Aug 2008 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 13294576 | Nov 2011 | US |
| Child | 13584445 | US | |
| Parent | 12503775 | Jul 2009 | US |
| Child | 13294576 | US |
