CA1322226C - Method and apparatus for ultrasonic surgical fragmentation and removal of tissue - Google Patents
Method and apparatus for ultrasonic surgical fragmentation and removal of tissueInfo
- Publication number
- CA1322226C CA1322226C CA000533538A CA533538A CA1322226C CA 1322226 C CA1322226 C CA 1322226C CA 000533538 A CA000533538 A CA 000533538A CA 533538 A CA533538 A CA 533538A CA 1322226 C CA1322226 C CA 1322226C
- Authority
- CA
- Canada
- Prior art keywords
- amplitude
- tissue
- tool
- ultrasonic
- duty cycle
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related
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Classifications
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- B—PERFORMING OPERATIONS; TRANSPORTING
- B06—GENERATING OR TRANSMITTING MECHANICAL VIBRATIONS IN GENERAL
- B06B—METHODS OR APPARATUS FOR GENERATING OR TRANSMITTING MECHANICAL VIBRATIONS OF INFRASONIC, SONIC, OR ULTRASONIC FREQUENCY, e.g. FOR PERFORMING MECHANICAL WORK IN GENERAL
- B06B1/00—Methods or apparatus for generating mechanical vibrations of infrasonic, sonic, or ultrasonic frequency
- B06B1/02—Methods or apparatus for generating mechanical vibrations of infrasonic, sonic, or ultrasonic frequency making use of electrical energy
- B06B1/0207—Driving circuits
- B06B1/0215—Driving circuits for generating pulses, e.g. bursts of oscillations, envelopes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B17/22004—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves
- A61B17/22012—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/1206—Generators therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00084—Temperature
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00137—Details of operation mode
- A61B2017/00141—Details of operation mode continuous, e.g. wave
- A61B2017/00146—Details of operation mode continuous, e.g. wave with multiple frequencies
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00137—Details of operation mode
- A61B2017/00154—Details of operation mode pulsed
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00973—Surgical instruments, devices or methods, e.g. tourniquets pedal-operated
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/005—Auxiliary appliance with suction drainage system
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/007—Auxiliary appliance with irrigation system
-
- B—PERFORMING OPERATIONS; TRANSPORTING
- B06—GENERATING OR TRANSMITTING MECHANICAL VIBRATIONS IN GENERAL
- B06B—METHODS OR APPARATUS FOR GENERATING OR TRANSMITTING MECHANICAL VIBRATIONS OF INFRASONIC, SONIC, OR ULTRASONIC FREQUENCY, e.g. FOR PERFORMING MECHANICAL WORK IN GENERAL
- B06B2201/00—Indexing scheme associated with B06B1/0207 for details covered by B06B1/0207 but not provided for in any of its subgroups
- B06B2201/70—Specific application
- B06B2201/76—Medical, dental
Abstract
ABSTRACT OF THE INVENTION
A method and apparatus for periodically interrupting ultrasonic power applied to a ultrasonically vibrating tip to control its amplitude between high and low or zero amplitudes with a selectable duty cycle and repetition rate provides enhanced fragmentation and improves surgical control. The duty cycle may also vary as a function of a remotely sensed parameter such as tissue temperature.
A method and apparatus for periodically interrupting ultrasonic power applied to a ultrasonically vibrating tip to control its amplitude between high and low or zero amplitudes with a selectable duty cycle and repetition rate provides enhanced fragmentation and improves surgical control. The duty cycle may also vary as a function of a remotely sensed parameter such as tissue temperature.
Description
~ 3~2~
METHOD AND APPARATUS FOR ULT~ASONIC SURGICAL
FR~GMENTATION AND REMOVAL OF TISSUE
_ Dr~ ROI UD or_-rr ~nv~ o~
This invention relates to ultrasonic apparatus, and especially to ultrasonic surgical apparatus and methods for ultrasonic surgical fragmentation and removal of tissue~ More particularly, this invention relates to a method and apparatus for pulsing or modulating the vibration of an ultrasonically vibrating tip to control its duty cycle for improving its cutting characteristics. Still more particularly, this invention relates to a method and apparatus for continuously controlling the duty cycle of an ultrasonic device, in discrete preset increments, between predetermined high and low amplitudes in variable programmed groups, or continuously in response to a remotely sensed parameter for accurately controlling ultrasonic energy delivered to the operating field.
Devices which effectively utilize ultrasonic energy for a variety of applications are well-known in a number of diverse arts. The application of ultrasonically vibrating surgical devices used to fragment and remove unwanted tissue with signiicant precision an~ safety has thus led to the development of a number of valuable surgical procedures. Accordingly, the use of ultrasonic aspirators for the fragmenta~ion and surgical removal of tissue from a body has become well-known. Initially, the technique of surgical aspiration was applied for the fragmentation and removal of cataract tissue as shown, for example, in U.S. Patents Nos. 3,589,363 and 3,693,613. Later, such techniques were applied with significant success to neurosurgery and other surgical specialties where the application of ultrasonic technology through a small, hand-held device for ~32~2~
selectively removing tissue Oll a layer-by-layer basis with precise control has proven feasible.
Certain devices known in the art characteristically produce continuous vibrations having a substantially constant amplitude at a frequency of about 20 to 30 kHz up to about 40 to 50 kHz. U.S. Patent No. 3,589,363 describes one such device which is especially adapted for use in the removal of cataracts, while U.S. Patent No. 4,063,557 describes a device suitable for the removal of soft tissue which is particularly adapted for removing highly compliant elastic tissue mixed with blood. Such devices are continuously operative when a surgeon wishes to fragment and remove tissue, and generally operate under the control of a foot switch.
Certain limitations have emerged in attempts to use such devices in a broad spectrum of surgical procedures. For example, the action of a continuously vibrating device did not have a desired effect in breaking up certain types of body tissue, bone, or concretations~ Because the range of ultrasonic frequency is limited by the physical characteristics of a hand-held device, only the motion available at the tip was a focal point for improving the cutting characteristics of the instrument. This limited focus proved to be ineffective for certain applications because either the motion available at the tip was insufficient to fragment and remove hard tissue at a surgically-acceptable rate, or the available stroke and stroke amplitude was so large as to cause excessive damage to surrounding tissue and the vaporization of fluids at the surgical site so as to obscure the view of the surgeon. Accordingly, there has been a need in the art for a method and ultrasonic appara~us in which the cutting range and efficiency of the
METHOD AND APPARATUS FOR ULT~ASONIC SURGICAL
FR~GMENTATION AND REMOVAL OF TISSUE
_ Dr~ ROI UD or_-rr ~nv~ o~
This invention relates to ultrasonic apparatus, and especially to ultrasonic surgical apparatus and methods for ultrasonic surgical fragmentation and removal of tissue~ More particularly, this invention relates to a method and apparatus for pulsing or modulating the vibration of an ultrasonically vibrating tip to control its duty cycle for improving its cutting characteristics. Still more particularly, this invention relates to a method and apparatus for continuously controlling the duty cycle of an ultrasonic device, in discrete preset increments, between predetermined high and low amplitudes in variable programmed groups, or continuously in response to a remotely sensed parameter for accurately controlling ultrasonic energy delivered to the operating field.
Devices which effectively utilize ultrasonic energy for a variety of applications are well-known in a number of diverse arts. The application of ultrasonically vibrating surgical devices used to fragment and remove unwanted tissue with signiicant precision an~ safety has thus led to the development of a number of valuable surgical procedures. Accordingly, the use of ultrasonic aspirators for the fragmenta~ion and surgical removal of tissue from a body has become well-known. Initially, the technique of surgical aspiration was applied for the fragmentation and removal of cataract tissue as shown, for example, in U.S. Patents Nos. 3,589,363 and 3,693,613. Later, such techniques were applied with significant success to neurosurgery and other surgical specialties where the application of ultrasonic technology through a small, hand-held device for ~32~2~
selectively removing tissue Oll a layer-by-layer basis with precise control has proven feasible.
Certain devices known in the art characteristically produce continuous vibrations having a substantially constant amplitude at a frequency of about 20 to 30 kHz up to about 40 to 50 kHz. U.S. Patent No. 3,589,363 describes one such device which is especially adapted for use in the removal of cataracts, while U.S. Patent No. 4,063,557 describes a device suitable for the removal of soft tissue which is particularly adapted for removing highly compliant elastic tissue mixed with blood. Such devices are continuously operative when a surgeon wishes to fragment and remove tissue, and generally operate under the control of a foot switch.
Certain limitations have emerged in attempts to use such devices in a broad spectrum of surgical procedures. For example, the action of a continuously vibrating device did not have a desired effect in breaking up certain types of body tissue, bone, or concretations~ Because the range of ultrasonic frequency is limited by the physical characteristics of a hand-held device, only the motion available at the tip was a focal point for improving the cutting characteristics of the instrument. This limited focus proved to be ineffective for certain applications because either the motion available at the tip was insufficient to fragment and remove hard tissue at a surgically-acceptable rate, or the available stroke and stroke amplitude was so large as to cause excessive damage to surrounding tissue and the vaporization of fluids at the surgical site so as to obscure the view of the surgeon. Accordingly, there has been a need in the art for a method and ultrasonic appara~us in which the cutting range and efficiency of the
- 2 -~ 3222~
vibrating clevice can be extencled Eor saEe and efficacious tissua removal.
Thus, it is another overall objective to provide a method and ultrasonic apparatus for accurately controlling energy as it is transmitted to tissue so as to enhance its cutting action in both hard and soft tissue, while maintaining the temperature in the surrounding tissue below a preset level. In this context it is desirable to utilize a higher stroke level than can otherwise be surgically tolerated without exceeding the allowable average energy, i.e., to simulate the effect of a high stroke level with a lower stroke levelO It is also an objective to improve the visibility and control o~ the cutting action when fragmenting soft tissue and to utilize higher stroke levels for improved but safe fragmentation without damage to surrounding tissue areas as is characteristic of prior art devices.
; In addition, since it is known that precisely controlled heating of certain types of cancerous and tumorous tissue may have a beneficial effect, it is another overall objective of this invention to provide a method and apparatus for precisely raising the temperature in tissues surrounding the tumorous growth to a preset level.
It is apparent that prior art concepts did not suggest such an invention. For example, U.S. Patent No. 3,812,858 describes a dental electrosurgical device known to the art which regulates the application of RF power through an active electrode to a patient according to the resistance of the tissue, and further incorporates a duty cycle timer to regulate the period of active current flow and interrupt repeatedly active current flow to the patientO However, such relatively lengthy periods of interruption are not practicable in an ultrasonic unit which can cause the surgeon to have to wait for a reapplication o~ power~
132~
perhaps at crucial points in the surgery, and such techniques have not been applied to ultrasonic surgical apparatus of the type with which this invention is concerned.
In an ultrasonic machining method and apparatusl as discussed in U.S. Patent No~ 4,343,111, the vibratory oscillations applied to the machining tool are periodically interrupted so that the oscillations are applied in the form of a series of time-spaced bursts, for ultrasonically machining irregular contours. Such a device does not suggest its appli-cability to ultrasonic surgery or instrumentation and the technique there discussed is hardly directed to the problem solved by this invention.
The objects described above and other purposes of this invention will become apparent from a review of the written description of the invention which follows, taken in conjunction with the accompanying drawings.
SUMMARY OF TEIE INVENTION
Directed to achieving the foregoing objects of the invention and to providing a solution to the problems there noted, the apparatus according to this invention includes an improvement in a surgical device of the type which comprises an ultrasonically actuated handpiece, an ultrasonic generator, a control system, a control panel cooperating with the control systemr and a foot switch for controlling the on/off state of the power as delivered to the handpiece. The improvement comprises a means for periodically pulsing the ultrasonic vibrating tip at a relatively high rate of speed at a repetition rate determined by the system response and the optimum fragmentation rate. In a preferred embodiment, the on/off state of the power continuously supplied to the ultrasonically~vibrating tip is pulsed between an on and off state at a frequency of about 33 Hz at a duty cycle 1322~
within a range of about 1 to 2 (50~) to about 1 to 6 (16.67~).
In an alternative, the power supply is pulsed at a rate which causes the amplitude of the ultrasonically-vibrating tip to vary between a high amplitude and a relatively low amplitude according to the pulse frequency. Thus, the wave form provlded to the ultrasonic tip is, in efEect, an ultrasonic carrier wave of about 23 kHz modulated by the periodically~applied pulse modulating wave. Circuit means are representatively illustrated for achieving this result in cooperation with a system known to the art.
In accordance with another aspect of the invention, a method is provided for pulsing an ultrasonically vibrating tip on and ofE at a relatively high rate of speed to achieve an improved and faster cutting action on bone, cartilage and other hard tissue. Such a me-thod eliminates or reduces the burning or adverse heating of surrounding bone and cartilage, while appar-ently reducing the force necessary to advance the tip through such hard tissue. It also precludes vaporization of the irrigation fluid, tissue, and other fluids which might otherwise obscure the vision of the attending surgeon. The method is characterized (a~ in the step of controlling the duty cycle, i.e., the time on versus the time off or at a lesser stroke, so that the instrument can achieve a higher stroke level for improved but safe fragmentation without corresponding tissue damage to surroundlng areas, and (b) setting the duty cycle so as to impart a predetermined level of energy or heat to the tissues surrounding a morbid or malignant growth to reduce or destroy the unwanted cells therein. According to the method of the invention, the duty cycle of the device is controlled continuously, in discrete preset increments, in vaxiable preprogrammed groups, or continuously based upon a remote sensed parameter, such as ~ 3 2 2 2 2 ~ 70557-~7 temperature, in the operative field to yield a closed loop system. Circllit means are disclosed for achievincl the method according to the invention There is ~hus disclosed an ultrasonic surgical apparatus comprisinga a surgical handpiece, an ultrasonic ~issue frag~enting tool adapted for ultrasonically fragm~nti~g tissue at a surgical site of a patient, said tool being supported by said handpiece, saicl tool havinq an ultrasonically-vibratable tool tip, a supplying means for supplying ultrasonic vibrations to said tool tip, a switchi.ng means for automatically and repeatedly switching the amplitude of the ultrasonic vibrations of said tool, during a tissue fragmenting procedure at the surgical site, back and forth between a working high ampli~ude and a standby low ampli~ucle which is a lower amplitude than said high amplitucle, an aspirating means connected to said handpiece for aspirating, from the surgical site, rluid and tissue fragmented by said ultrasonically-vibrating tool tip, and an irrigating means connected to said handpiece for supplying an irrigating solution to the area of the surgical site for suspending the tissue particles fragmented by said tool tip.
There is further disclosed an ultrasonic surgical apparatus for removing tumorous tissue from a patient with minimal resul.ting damage to the healthy tissue ad~acent to the tumorous tissue comprising: an ultrasonic tissue fragmenting tool, a pulsing means for pulsing said tool with ultrasonic vibrations during the ultrasonic tumorous tissue fragmenting procedures at a xapid pulse rate between a working high amplitude for a first period of time and a standby low 30 amplitude which is lower t.han said high amplitude ior a second period of time, a cycle time defined by said first period of 5a 132'2226 70557 47 time plus said seconcl period of time, a dut~y cycle defined by said first per~od of time d:Lviclecl by said cycle time, a senslng n~eans for sen~ing the temperature of ~he adjacent healthy tissue while the tumorous t.tssue is being fragmented during a fra~menting procedure, ancl an adjusting means for automatically varying, as a ~unct:ion of the temperature sensed by said sensing means, saicl duty cycle.
There is fllrther disclosed an ultrasonic surgica:L
apparatus comprising: an ultrasonic tissue fragmenting tool adaptecl for ultrasonically fragmenting tissue at a sur~ical si~e of patient, a supplyiny means for supplying ultrasonic vibrations ~o said tool, a switching means for switching the amplitude of the ultrasonic vibrations of said tool, during a tissue fragmenting procedure at the surgical site, baclc and forth between a working high amplitude and a standby low amplitucle which is a lower amplitude than said high amplitude, said switching means including a duty cycle control means for providing a variable preselected duty cycle for said high and said low amplitude vibrations, said duty cycle control means being responsive to a remotely-sensed parameter, and said remotely-sensed parameter being temperature.
5b .
13~222~ 70557-b~7 BRIEF DESCRIPTION OF THE DE?AWING
Other features, aspects, and characteristics of the invention will be apparent from the following descriptions.
In the drawings:
Fig. 1 is a functional block diagram of an ultrasonic surgical system known in the art;
Fig~ 2 i5 a functional block diagram of a portion of FigO 1 to which the invention is applicable;
Figs. 3A-3E is a diagram showing a continuous delivery of ultrasonic energy to an ultrasonically-vibrating handpiece in the prior art, and as modified under the invention illustrating manually-adjusted variations and modulated variations in stroke amplitude;
Fig. 4 is a block diagram of the fragmentation rate control circuit for controlling the apparatus of Fig. 1 and further including a temperature responsive input;
Fig. 5 is a circuit block diagram similar to Fig. 4 showing a system of temperature control by using pulse wave modification with a particular controller circuit;
Fig. 6 is a block diagram of an input control circuit for an ultrasonic surgical aspirator in acc~rdance with a preferred embodiment with variable pulse control for continuously adjusting on-time;
Fig. 7 is a schematic diagram of another input control circ~it for an ultrasonic surgical aspirator in accordance with another embodiment of the invention to control temperature of the operating field;
, . . .
~ ~2~
Fiy. 8 is a typical input control circuit for producing a continuous7 discrete on-time adjustment; and Fig. 9 sllows an input control circuit for producing bursting modulating pulses according to a predetermined sequence;
DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS
In order to better understand the method and apparatus according to the invention relative to a conventional prior art system, such a conventional system, commercially available from the assignee of this application, will be discussed in connection with Fig. 1. The block diagram of Fig. 1 is representative of a commercially available device curren~ly on the market under the mark CUSA NS-100. The system, designated by the reference numeral 10, incorporates several major functional systems available at a handpiece 12 for effectively removing tissue from a body. Those ~ystems include a vibration system, designated generally by the reference numeral 14; an irrigation system 15; a suction system 16; and a handpiece cooling system 17; which cooperate with a control system 18 as is thus well-known. An ultrasonically-vibrating surgical tip 11 forms part of the handpiece 12 and is caused to vibrate longitudinally thereby fragmenting tissue in contact with its end. In such an embodiment, the level of vibration is manually and continuously adjustable to vary the amplitude of the tip. The irrigation system is controlling a flow o~ sterile irrigating solution from an IV source to a coagulant space between an outer surface of the surgical tip 11 and an inner surface to cause the fluid to exit near the tip 11 where it enters the operating field and suspends fragmented particles. The aspiration system 16 includes a pump for applying suction to the hollow surgical tip 11 to aspirate fluid through an end of the tip 11 for deposit in a disposabl~
containerO
1~22226 70557_47 An ultrasonlc generator 20 provlde~ electrlcal energy at ultrasonlc frequencles to the handpiece 12, and ln partlcu-lar to drlve coils wl~hln the handplece 12 ~o control the vlbratlonal strolce of the tlp 11. Each of the foregoln~
systems and the ultrasonic generator is controlled by a control and interlock system 18 ln cooperatlon with a control panel 21.
In operatlon, after the system 10 ls itself turned on with an appropriate push button at the control panel 21, the vlbratlon of the handplece 12 and delivery of ultrasonlc energy from the ultrasonic generator 20 to the handpiece 12 ls under the con-trol o~ a ~oot swltch 22 operated by the surgeon. In this sy~tem, whlle the foot switch 22 ls depressed and the system 19 ls on, ultrasonic energy ~rom the generator 20 is contlnuously and unlnterruptedly provlded to the tip 11 or the handplece 12.
The ultrasonic yenerator 20 provides power to drive the tip 11 of the handplece 12, pre~erably at a frequency of 23 kH~, and, by way of a signal derived from a handplece feed-back coll, which monltors and controls the amplitude of the stroke of the tlp. A prlor art feedback control system ls shown ln U.S. Patent 4,063,557 whlch may be utlllzed to achleve these Eunctlons. In lts physlcal embodlment, the control system 18 lncludes a control lnput cooperatlng wlth the foot switch 22 for adju~ting the vlbration in circuit wlth an lnput relay on a control circuit module. The foot swltch ls connec-ted to the control lnput for controlllng the continuous on/off state. While the control system 18 includes, ln a pr~ctlcal embodlment, a number of other control subsystems, such are not relevant or modlfied by the applicatlon of the lnventlon here dlsclosed.
The control panel 21 lncludes a potentlometer 24 for ad~ustlng the maximum stroke amplitude for the vlbr~ting tlp 11 ~ 3 2 ~ rJ I~J 6 Oll the handpiece, whic~l is usually set by the surgeon. Thus, with the power to the sy.stem 10 on, and the footswitch 22 depressed, ultrasonic power is con-tinuously, and selectively adjustably, del.ivered from the ultrasonic generator 20 to the handpiece 12 and hence to the vibrating tip 11. Fig. 3A shows the continuous application of such energy in the curve 21 at a typical frequency of 23 kHz. As illustrated by the curve 21a, the amplitude of -the stroke may be adjusted (by adjustment of the potentiometer 24) while the footswitch is off, thereby to establish a differing stroke amplitude for the tip.
Fig. 2 illustrates the basic concept of the invention in a simplified block diagram of a portion of the block diagram of Fig. 1~ A switching circuit 26 is connected to the con-trol system 18 and cooperates therewith for periodically interrupting the ultrasonic vibra-tions from the ultrasonic generator 20 to the vibrating tip 21. The connection between the switching control 26 and the contro.l system 18 is depicted by the solid line 27.
However, the circuit 26 could alternatively be connected to or cooperate with other systems, as shown by the dotted lines 27a, 27b, 27c, and 27d. In effect, the ultrasonic carrier wave form normally applied to the handpiece 11 (Fig. 3A) while the foot-switch 22 is depressed is modulated by a modulating wave form, as shown in Figs. 3B and 3C, to rapidly interrupt the ultrasonic power seen by the tip 11 Eor reasons to be discussed~ thus -to produce the applied wave form shown for a generalized case in Fig. 3E~
The apparatus shown in Fig. 2 is arranged and constructed so that the switching or modulating control circuit 26 causes the ultrasonic power for the ultrasonic generator to be delivered to the tip 11 of the handp.iece 12 in a precisely controlled fashion~ In one aspect of the invention, the :1~2~22~
ultrasonic power, preferably delivered at 23 k~lz is periodically i~terrupted by the modulating output from the switching control circuit 26 to vary the amplitude of the delivered wave form to the handpiece 12 continuously between a high amplitude, governed by the amplitude of the control setting on the potentiometer 24 on the control panel, and a low amplitude dete.rmined e:Lectronically at a suitable low level. Another aspect of the invention according to ~he method is to vary the amplitude between a predetermined high amplitude and an off state on a modulated periodic basis, as shown in Fig. 3D. The repetition rate is determined to be sufficiently rapid so that while the foot switch is depressed, the surgeon does not distractedly sense that he is wait.ing for the machine to operate while the periodic interruption of the delivered ultrasonic signal is providing a beneficial effect to his cutting. Thus, the repetition rate must be sufficiently high that the surgeon is not aware that the handpiece has shut off. Thuc., for example, a suitable repetition rate is believed to be at least 30 Hz or higher, and the exact frequency is determined by the system response and the optimum fragmentation rate for particular hard tissue.
The repeti-tion rate of the modulating frequency establishes the wave form of the delivered modulated ultrasonic carrier wave form as is shown in Fig. 3E. Thusf Fig. 3E shows a modulated 23 kHz carrier wave~ shown unmodulated in Fig. 3B and delivered while the footswitch 22 is depressed representing ultrasonic energy as normally applied in the embodiment in Fig.
1, modulated according to the high/low (or on/off) modulating influence established by the switching control circuit 26.
The wave form of Fig. 3E is presently preferred rather than an on/off wave form, such as shown in Fig. 3D, because one of the problems of an electro-acoust.ic system is that it is ~322~2~
difficult and relatively slow in a mechanical sense to start and to sh~t off. That relative slowness is not determined by the electronic portion of the system limi~ing the s~ar~up or repetition rate, but rather by the mechanical parts in the vibrator itself. It has been learned that it takes significan~
amounts of times, measured in tens of milliseconds, to initiate vibration of the vibrati~g tip on the handpiece 12. During this startup or translent period, the conditions for the driving circuit Eor the tip 11 are relatively adverse in that the load is very low and is changing Erom inductive to capacitive~ These adverse conditions must therefore be accommodated in the physical characteris~ics of the vibra~or on the handpiece 12 and by the tip 11 to handle additional stresses. In addition, when the vibrating tip 11 is subjected to such significant additional stresses, a shorter and possibly a significant shorter life will result.
Thus, in order to shorten the start up time and reduce the related stresses on both the electronic and mechanical compo-nents, it is advantageous not to turn off the vibrations completely, as in one embodiment of this invention as shown in Fig. 3D, but rather to switch between two amplitudes, i.e., a working amplitude Ahi selected by the surgeon by manipulation of the potientiometer 24 on the control panel 21, and a standby amplitude Alow which will be a low amplitude as shown in FigO
3E. The low amplitude can either be preset electronically, as in another embodiment of this invention, or may be as low as practical so that its only function is to keep the system vibra-ting~ On the other hand, the low amplitude can also be made adjustable by the surgeon.
The modulating frequency of Fig. 3C determines the periodicity of the modulating wave and the rel.ative periods ~222~
between the application of thle high amplitude and the application of the low amplitude de-termines the duty cycle. Thus, referring to Fig. 3-E, for a period T, the duty Gycle is determined by the ratio of Tl/Tl ~ T2, where the period T is determined by the sum o Tl + T2; Tl is the periGd in which the amplitude is high, and T2 is the period in which the amplitude is low. Stated ~nother way, the duty cycle is the ratio of the perio~ of application of high power to the total period of application of power in each cycle. Thus, it is another aspect of the method and apparatus of this invention to ~ontrol the duty cycle Eor the applied ultrasonic energy from the ultrasonic generator 20 to the handpiece 12.
Such a method and apparatus according to the invention control ~he fragmenta-tion rate of the ultrasonic surgical system 10 wherein a surgeon may select the duty cycle or, the duty cyc].e may be set electronically or even automatically in response to a derived control signal to vary the duty cycle. Moreover, the use of a variable duty cycle by varying the relative amplitudes and periods of the application of the high and low strokes of the vibrating tip 11 act to control the temperature of the tissues surrounding the operating areas. Such control of the duty cycle will thus permit hard tissue to be fragmented by increasing the stroke to a hiyh amplitude for some limited period within the period of the modulating wave while permitting the heat trans~erred to the tissue to be con-trolled. It is known that when tissue i~ being fragmented, ultrasonic energy is transferred from the tip oE the handpiece to the tissueO Some portion of the energy transferred is used to fragment the tissue, while a subportion is absorbed by the ~issue and results in heating it.
In an extreme case, tissue may be burned or vaporized creating an undesirable effect. Thus, a control of the type utilized in this - 12 ~
:~3~2~
invention prevents overheating of healthy tissues to the point of destruction.
On the other hand, such control is of value in -therapeutically ~reating tumor cells. It is known ~hat certain fast growing tumor cells are sensitive to elevated temperatures and are damaged by such higher temperaturesO In accordance with another aspect of the invention, by sensing the temperature of the healthy tissue adjacent to the tumorous tissue being removed, such temperature as sensed can be utilized to vary automatically the duty cycle of high and low strokes to individually elevate the temperature of the tumor signals to a maximum without destroying the adjacent healthy tissues. In accordance wit'n the method for this applicationl the low amplitude should be set as low as possible, for example 1 mil or less and the duty cycle may be variable frcm about 10% to about 95% to nearly 100~ as a function of temperature.
A convenient way for providing ~unctional circuitry to perform the method according to the invention is to utilize a standard PWM controller as used in switching power supplies modified in one aspect of the invention to utilize a signal for controlling the switch as a function of temperature and noting that the switching frequency is low, such as in the 30 to 100 Hz range.
Fig. 2 thus shows a functional block diagram for modifying the conventional control system 18 of the surgical aspirator 10 as shown in Fig. 1. In the main, the existing equipment is modified to add a low amplitude adjustment potentiometer and utilizing the high adjustment potentiometer in the switching sircuit in combination with a controlled switch to achieve the desired results of the invention~
~..
~ ~22~2~
Thus, as more specifically shown in Fig. 4, the switching circuit for the CUSA lOO as shown to the right of the broken line 40 is modified by the inclusion of a duty cycle modulator designated generally by the reference numeral 41. The duty cycle ~odulator 41 is responsive, in one embodiment, to a thermal probe or other rernote sensor of a selected parameter designated generally by the reference number 42. The high ampli-tude adjustment potentiome~ee 24 on the control panel is shown as comprising a potentiometer 43, a bias source i5 shown at 44 and a vibration adjustment control at 45 as are known in the existing system. The bias source 44 is also connected to a low ampli~ude adjustment potentiometer 46 which provides an input for a low amplitude control switch 47. A high amplitude control switch 48 has its input control connected to a wiper 49 on the high amplitude adjustment potentiometer 43.
An oscillator 50 is set to operate at the desired frequency, such as 30 Hz or more, and generates a ramp voltage for a comparator 51. The oscillator is connected to a source of reEerence potential, such as ground 52, through a resistor 53;
while the input to the comparator 51 is connected to a source of reference potential 52 through a capacitor 54. A reference signal, or the output signal from the remote sensor 42, is applied through an error amplifier 56 to the other input of the comparator 51. The output of the comparator 51 controls the bilateral switch 47, while the complementary output of the comparator 51 through the an inverter 58 controls the output of the second bilateral switch 48.
The switches 47 and 48 thus form a multiplexer which alternately and for varying time durations switches the voltage from the surgeon-cont.rolled high vibration adjustment potentiometer 24 and from the preset low amplitude potentiometer ~3~2~P6 46 to the vibration adjustment control on the system on Fig. 1.
In the alternative, the low amplitude adjustment potentiometer could be a preset source of reference voltage to predetermine the low amplitude or, in a limiting case, could be ground~ wherein the switch 47 could be eliminated, in order to switch the circuit between an on/off position subject to the limitations discussed above.
The remote sensor 42 comprises a thermal probe 60 for sensing the temperature at a predetermined site in the vicinity of the surgery, such as at adjacent tissue. In the alternative, other parameters, such as fragmentation rate, vapor generation, or the like, may be used as a control parameter for the input to the duty cycle modulator 41. The output of -the probe 60 is amplified by an amplifier 59 prior to providing the input to the error amplifier 56.
In operation, when the sensed temperature input is low, the duty cycle is high, permitting a relatively longer period of high amplitude vibration, caused by a relatively longer on period for the switch 48. When the temperature is increasing, or higher than desired, the duty cycle modulator acts to increase the period of low amplitude stroke of the tip of the ultrasonic vibrator 11, thus reducing the energy applied to the overheatlng or overheated tissue.
Fig. 5 shows a block diagram in slightly greater detail for implementing the features of Fig. 5 using a CD3524 controller 41~ to achieve the same resul~s and functions. Thusl detailed discussion is not believed to be necessary.
The circuit of FigO 5 further includes a modification for interrupting its operation in the event of excessively high temperature at the operating site. Thus, a signal is applied via a lead 61 to a shutdown signal amplifier 62, having an output :~22~2~
connected to an input o~ the comparator on the PWM controller41A.
The circuit of Fig. 6 is a convenient one for providing a continuous on time adjustment to the input of the system of Fig. l, and in particular to its input control relay. In FigO 6, a trigger circuit 62 provides a timed output signal as shown in the figure. A resistor 63 in series with a variable resistor 64 determines the on time for the output of the trigger circuit, so that the minimum on time is established by the value of the resistor 63. The variable resistor 64 adjusts the on time in cooperation with the resistor 65 and the capacitor 66, whereas the off time is determined only by the resistor 65 and the capacitor 66~ as is well known in the art. During the on time for the trigger circuit 62, the output signal is high to trigger the ultrasonic generator 20 through the control system 18 of Fig.
1.
Fig. 7 shows a suitable schematic, incorporatin~
circuit elements like those shown in Fig. 6, for controlling the temperature of the operating field to less than a predetermined valve by limiting the on time of the ultrasonic vibrations. The impedance of a negative temperature coefficient thermosensor 70 will change with the sensed temperature. The sensor 70 is located at the site where temperature is to be monitored. Since the thermosensor 70 is part of the feedback of a comparator 71, the desired temperature is set by the value of a potentiometer 72 connected between the output and input of the comparator 71, when the temperature rises, the output of the comparator 71 rises and the value of the impedance of the thermosensor 70 rises. This cumulative effect results in decreasing the on period because a second thermosensor 74 having its input in circuit with the out-put of the comparator 71 is in parallel with a resistor 75 in 'he ~3222~6 feedback circuit oE a logic switching circuit 62~ Since the impedance of sensor 74 is in parallel with the resistor 75, the on period from the switching circuit 62 decreases, and in response to increasing sensed temperature~ On the other hand when the temperature decreases, the on ~ime increases. The output, as in Fig. S~ is connected to a relay in the control circuit of the existing system shown in Fig. 1.
As can thus be understood, during the on timel the output of the trigger circuit 62 is hlyh so that the vibrating tip of the handpiece 10 is actuated. When the signal becomes low, ultrasonic power is momentarily deaccuated before again being actuated when the signal again goes high. The trigger circuit shown in Fig. 8 operates the same way as the circuit shown in Fig. 5 except that the on time may be discretely varied by selectively connecting any one of the plurality of resistors 64A, 64B, 64C, or 64D, or some combination thereof, into the RC
network of the trigger circuit 62. Thus, the off time is determined by the resistor 65 and capacitor 66 as it was in connection with the trigger circuit shown in Fig. 5.
Each of the resistors 64A, 64B, 64C, and 64D is respectively in a series circuit with an associated switch 64A', 64B', 64C', and 64D', respectively controlled by the logic control circuit, designated generally by the reference numeral 78.
The trigger circuit 62 shown in Fig. 9 provides, similarly to FigO 81 a fixed off time determined by the resistor 65 and capacitor 66, but the on time provided by the RC network varies se~uentially. Resistors 64A-64D are sequentially connected into the RC network by a counter switch 82 which is actuated each time the output of the trigger circuit 62 becomes low~ Thus, when resistors 64A - 64D are set to respective ~3222~
suita~le values, a first on time, a second on time, a third on time, and a fourth on time are predetermined values, such as 50, 100, lS0, and 200 m sec.~ which can be produced in a repeated sequence, thereby providing a sequentially varied repetition rate.
The control circuit according ko the invention may be used to provlde a number of different modes of operation for khe circuit of Fig. 1. For example, mode 1 may be a continuously operating mode which operates the handpiece in a normal manner as described in connection with Fig. 1. A second mode is a rapid on-off interruption of ultrasonic power typically at a frequency rate of 33 Hz with an on-off duty cycle of 1 to 2. A third mode is a rapid medium speed mode and operates at a frequency of 18 Hz and an on-oEf duty cycle of 1 to 4, as representatively illustrated by the right hand portion of Fig. 3E. Mode 4 is a slow mode which operates at a frequency of 7 Hz and an on off duty cycle of 1 to 4. Finally, mode 5 is a slow mode which operates at a frequency of 5 Hz with an on-off duty cycle of 1 to 6. In each of the modes, the vibration setting is adjusted by the external vibration adjusting potentiometer 45 in Fig. 4, while the frequency and duty cycle are adjusted electronically.
Preferably, the amplitude is set while the system 10 is in the continuous mode, and an automatic interruption mode selected from among exemplary modes 1 to 4. The selected mode is thereafter locked in when the footswitch 22 is depressed and cannot be changed until the footswitch 22 is released. Further modifica-tion of the prior art circuitry to implement the teachings of this invention is within the skill in this art.
The ultrasonic fragmentation produced according to methGd and by the described apparatus in accordance with the present invention provides enhanced cutting action in both hard - 18 ~
1 322.'~ ~
and soft tissue, particularly in bone and cartilage ~here ultrasonic f~agmentation at a constant stroke amplitude provided by a known aspirator apparatus had little effect. In addition, since the present invention permits an average stroke amplitude to be used that is smaller than the stroke needed by constant amplitude aspirators for effective fragmentation, heating o tissue adjacent to the fragmentation sight can be reduced without sacrificing surgical efEectiveness.
The increased ragmentation effectiveness provided by the present invention both increases the speed o~ operation and reduces the force needed to push through hard tissue such as bone, thereby reducing operator fatigue and improving the operator 7 S control of the aspirators. The use of a variable stroke amplitude in an ultrasonic surgical aspirator in accordance with the present invention also provides improved visual control of incisions made in soft tissue by providing improved fragmentation, thereby enhancing debri~ removal by the aspirator.
The improved control provided by varying the duty cycle of the high arnplitude stroke of the vibrator, when used in cooperation with means for sensing the temperature of tissue adjacent to or near the incision made by an ultrasonic surgical aspirator is also well suited for use in providing hypothermic treatment to surrounding tissue while removing a cancerous or tumorous growth. The improved thermal control provided by apparatus in accordance with the present invention permits adjacent tissue to be raised to a precisely controlled temperature that would not destroy healthy tissue but, at the same time would reduce the viability of any fast growing tumor cells that may have invaded adjacent tissue.
?. fi The invention has been described with particular reerence to its presently preferred embodiments, but numerous modiications and variations ~ithin the spirit and scope of the invention as described herein and is deined by the claims will be apparent to one skilled in the art. For example, a feedback signal indicating fragmentation rate could be used to control the ampli-tude or duty cycle of the high amplitude stroke.
vibrating clevice can be extencled Eor saEe and efficacious tissua removal.
Thus, it is another overall objective to provide a method and ultrasonic apparatus for accurately controlling energy as it is transmitted to tissue so as to enhance its cutting action in both hard and soft tissue, while maintaining the temperature in the surrounding tissue below a preset level. In this context it is desirable to utilize a higher stroke level than can otherwise be surgically tolerated without exceeding the allowable average energy, i.e., to simulate the effect of a high stroke level with a lower stroke levelO It is also an objective to improve the visibility and control o~ the cutting action when fragmenting soft tissue and to utilize higher stroke levels for improved but safe fragmentation without damage to surrounding tissue areas as is characteristic of prior art devices.
; In addition, since it is known that precisely controlled heating of certain types of cancerous and tumorous tissue may have a beneficial effect, it is another overall objective of this invention to provide a method and apparatus for precisely raising the temperature in tissues surrounding the tumorous growth to a preset level.
It is apparent that prior art concepts did not suggest such an invention. For example, U.S. Patent No. 3,812,858 describes a dental electrosurgical device known to the art which regulates the application of RF power through an active electrode to a patient according to the resistance of the tissue, and further incorporates a duty cycle timer to regulate the period of active current flow and interrupt repeatedly active current flow to the patientO However, such relatively lengthy periods of interruption are not practicable in an ultrasonic unit which can cause the surgeon to have to wait for a reapplication o~ power~
132~
perhaps at crucial points in the surgery, and such techniques have not been applied to ultrasonic surgical apparatus of the type with which this invention is concerned.
In an ultrasonic machining method and apparatusl as discussed in U.S. Patent No~ 4,343,111, the vibratory oscillations applied to the machining tool are periodically interrupted so that the oscillations are applied in the form of a series of time-spaced bursts, for ultrasonically machining irregular contours. Such a device does not suggest its appli-cability to ultrasonic surgery or instrumentation and the technique there discussed is hardly directed to the problem solved by this invention.
The objects described above and other purposes of this invention will become apparent from a review of the written description of the invention which follows, taken in conjunction with the accompanying drawings.
SUMMARY OF TEIE INVENTION
Directed to achieving the foregoing objects of the invention and to providing a solution to the problems there noted, the apparatus according to this invention includes an improvement in a surgical device of the type which comprises an ultrasonically actuated handpiece, an ultrasonic generator, a control system, a control panel cooperating with the control systemr and a foot switch for controlling the on/off state of the power as delivered to the handpiece. The improvement comprises a means for periodically pulsing the ultrasonic vibrating tip at a relatively high rate of speed at a repetition rate determined by the system response and the optimum fragmentation rate. In a preferred embodiment, the on/off state of the power continuously supplied to the ultrasonically~vibrating tip is pulsed between an on and off state at a frequency of about 33 Hz at a duty cycle 1322~
within a range of about 1 to 2 (50~) to about 1 to 6 (16.67~).
In an alternative, the power supply is pulsed at a rate which causes the amplitude of the ultrasonically-vibrating tip to vary between a high amplitude and a relatively low amplitude according to the pulse frequency. Thus, the wave form provlded to the ultrasonic tip is, in efEect, an ultrasonic carrier wave of about 23 kHz modulated by the periodically~applied pulse modulating wave. Circuit means are representatively illustrated for achieving this result in cooperation with a system known to the art.
In accordance with another aspect of the invention, a method is provided for pulsing an ultrasonically vibrating tip on and ofE at a relatively high rate of speed to achieve an improved and faster cutting action on bone, cartilage and other hard tissue. Such a me-thod eliminates or reduces the burning or adverse heating of surrounding bone and cartilage, while appar-ently reducing the force necessary to advance the tip through such hard tissue. It also precludes vaporization of the irrigation fluid, tissue, and other fluids which might otherwise obscure the vision of the attending surgeon. The method is characterized (a~ in the step of controlling the duty cycle, i.e., the time on versus the time off or at a lesser stroke, so that the instrument can achieve a higher stroke level for improved but safe fragmentation without corresponding tissue damage to surroundlng areas, and (b) setting the duty cycle so as to impart a predetermined level of energy or heat to the tissues surrounding a morbid or malignant growth to reduce or destroy the unwanted cells therein. According to the method of the invention, the duty cycle of the device is controlled continuously, in discrete preset increments, in vaxiable preprogrammed groups, or continuously based upon a remote sensed parameter, such as ~ 3 2 2 2 2 ~ 70557-~7 temperature, in the operative field to yield a closed loop system. Circllit means are disclosed for achievincl the method according to the invention There is ~hus disclosed an ultrasonic surgical apparatus comprisinga a surgical handpiece, an ultrasonic ~issue frag~enting tool adapted for ultrasonically fragm~nti~g tissue at a surgical site of a patient, said tool being supported by said handpiece, saicl tool havinq an ultrasonically-vibratable tool tip, a supplying means for supplying ultrasonic vibrations to said tool tip, a switchi.ng means for automatically and repeatedly switching the amplitude of the ultrasonic vibrations of said tool, during a tissue fragmenting procedure at the surgical site, back and forth between a working high ampli~ude and a standby low ampli~ucle which is a lower amplitude than said high amplitucle, an aspirating means connected to said handpiece for aspirating, from the surgical site, rluid and tissue fragmented by said ultrasonically-vibrating tool tip, and an irrigating means connected to said handpiece for supplying an irrigating solution to the area of the surgical site for suspending the tissue particles fragmented by said tool tip.
There is further disclosed an ultrasonic surgical apparatus for removing tumorous tissue from a patient with minimal resul.ting damage to the healthy tissue ad~acent to the tumorous tissue comprising: an ultrasonic tissue fragmenting tool, a pulsing means for pulsing said tool with ultrasonic vibrations during the ultrasonic tumorous tissue fragmenting procedures at a xapid pulse rate between a working high amplitude for a first period of time and a standby low 30 amplitude which is lower t.han said high amplitude ior a second period of time, a cycle time defined by said first period of 5a 132'2226 70557 47 time plus said seconcl period of time, a dut~y cycle defined by said first per~od of time d:Lviclecl by said cycle time, a senslng n~eans for sen~ing the temperature of ~he adjacent healthy tissue while the tumorous t.tssue is being fragmented during a fra~menting procedure, ancl an adjusting means for automatically varying, as a ~unct:ion of the temperature sensed by said sensing means, saicl duty cycle.
There is fllrther disclosed an ultrasonic surgica:L
apparatus comprising: an ultrasonic tissue fragmenting tool adaptecl for ultrasonically fragmenting tissue at a sur~ical si~e of patient, a supplyiny means for supplying ultrasonic vibrations ~o said tool, a switching means for switching the amplitude of the ultrasonic vibrations of said tool, during a tissue fragmenting procedure at the surgical site, baclc and forth between a working high amplitude and a standby low amplitucle which is a lower amplitude than said high amplitude, said switching means including a duty cycle control means for providing a variable preselected duty cycle for said high and said low amplitude vibrations, said duty cycle control means being responsive to a remotely-sensed parameter, and said remotely-sensed parameter being temperature.
5b .
13~222~ 70557-b~7 BRIEF DESCRIPTION OF THE DE?AWING
Other features, aspects, and characteristics of the invention will be apparent from the following descriptions.
In the drawings:
Fig. 1 is a functional block diagram of an ultrasonic surgical system known in the art;
Fig~ 2 i5 a functional block diagram of a portion of FigO 1 to which the invention is applicable;
Figs. 3A-3E is a diagram showing a continuous delivery of ultrasonic energy to an ultrasonically-vibrating handpiece in the prior art, and as modified under the invention illustrating manually-adjusted variations and modulated variations in stroke amplitude;
Fig. 4 is a block diagram of the fragmentation rate control circuit for controlling the apparatus of Fig. 1 and further including a temperature responsive input;
Fig. 5 is a circuit block diagram similar to Fig. 4 showing a system of temperature control by using pulse wave modification with a particular controller circuit;
Fig. 6 is a block diagram of an input control circuit for an ultrasonic surgical aspirator in acc~rdance with a preferred embodiment with variable pulse control for continuously adjusting on-time;
Fig. 7 is a schematic diagram of another input control circ~it for an ultrasonic surgical aspirator in accordance with another embodiment of the invention to control temperature of the operating field;
, . . .
~ ~2~
Fiy. 8 is a typical input control circuit for producing a continuous7 discrete on-time adjustment; and Fig. 9 sllows an input control circuit for producing bursting modulating pulses according to a predetermined sequence;
DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS
In order to better understand the method and apparatus according to the invention relative to a conventional prior art system, such a conventional system, commercially available from the assignee of this application, will be discussed in connection with Fig. 1. The block diagram of Fig. 1 is representative of a commercially available device curren~ly on the market under the mark CUSA NS-100. The system, designated by the reference numeral 10, incorporates several major functional systems available at a handpiece 12 for effectively removing tissue from a body. Those ~ystems include a vibration system, designated generally by the reference numeral 14; an irrigation system 15; a suction system 16; and a handpiece cooling system 17; which cooperate with a control system 18 as is thus well-known. An ultrasonically-vibrating surgical tip 11 forms part of the handpiece 12 and is caused to vibrate longitudinally thereby fragmenting tissue in contact with its end. In such an embodiment, the level of vibration is manually and continuously adjustable to vary the amplitude of the tip. The irrigation system is controlling a flow o~ sterile irrigating solution from an IV source to a coagulant space between an outer surface of the surgical tip 11 and an inner surface to cause the fluid to exit near the tip 11 where it enters the operating field and suspends fragmented particles. The aspiration system 16 includes a pump for applying suction to the hollow surgical tip 11 to aspirate fluid through an end of the tip 11 for deposit in a disposabl~
containerO
1~22226 70557_47 An ultrasonlc generator 20 provlde~ electrlcal energy at ultrasonlc frequencles to the handpiece 12, and ln partlcu-lar to drlve coils wl~hln the handplece 12 ~o control the vlbratlonal strolce of the tlp 11. Each of the foregoln~
systems and the ultrasonic generator is controlled by a control and interlock system 18 ln cooperatlon with a control panel 21.
In operatlon, after the system 10 ls itself turned on with an appropriate push button at the control panel 21, the vlbratlon of the handplece 12 and delivery of ultrasonlc energy from the ultrasonic generator 20 to the handpiece 12 ls under the con-trol o~ a ~oot swltch 22 operated by the surgeon. In this sy~tem, whlle the foot switch 22 ls depressed and the system 19 ls on, ultrasonic energy ~rom the generator 20 is contlnuously and unlnterruptedly provlded to the tip 11 or the handplece 12.
The ultrasonic yenerator 20 provides power to drive the tip 11 of the handplece 12, pre~erably at a frequency of 23 kH~, and, by way of a signal derived from a handplece feed-back coll, which monltors and controls the amplitude of the stroke of the tlp. A prlor art feedback control system ls shown ln U.S. Patent 4,063,557 whlch may be utlllzed to achleve these Eunctlons. In lts physlcal embodlment, the control system 18 lncludes a control lnput cooperatlng wlth the foot switch 22 for adju~ting the vlbration in circuit wlth an lnput relay on a control circuit module. The foot swltch ls connec-ted to the control lnput for controlllng the continuous on/off state. While the control system 18 includes, ln a pr~ctlcal embodlment, a number of other control subsystems, such are not relevant or modlfied by the applicatlon of the lnventlon here dlsclosed.
The control panel 21 lncludes a potentlometer 24 for ad~ustlng the maximum stroke amplitude for the vlbr~ting tlp 11 ~ 3 2 ~ rJ I~J 6 Oll the handpiece, whic~l is usually set by the surgeon. Thus, with the power to the sy.stem 10 on, and the footswitch 22 depressed, ultrasonic power is con-tinuously, and selectively adjustably, del.ivered from the ultrasonic generator 20 to the handpiece 12 and hence to the vibrating tip 11. Fig. 3A shows the continuous application of such energy in the curve 21 at a typical frequency of 23 kHz. As illustrated by the curve 21a, the amplitude of -the stroke may be adjusted (by adjustment of the potentiometer 24) while the footswitch is off, thereby to establish a differing stroke amplitude for the tip.
Fig. 2 illustrates the basic concept of the invention in a simplified block diagram of a portion of the block diagram of Fig. 1~ A switching circuit 26 is connected to the con-trol system 18 and cooperates therewith for periodically interrupting the ultrasonic vibra-tions from the ultrasonic generator 20 to the vibrating tip 21. The connection between the switching control 26 and the contro.l system 18 is depicted by the solid line 27.
However, the circuit 26 could alternatively be connected to or cooperate with other systems, as shown by the dotted lines 27a, 27b, 27c, and 27d. In effect, the ultrasonic carrier wave form normally applied to the handpiece 11 (Fig. 3A) while the foot-switch 22 is depressed is modulated by a modulating wave form, as shown in Figs. 3B and 3C, to rapidly interrupt the ultrasonic power seen by the tip 11 Eor reasons to be discussed~ thus -to produce the applied wave form shown for a generalized case in Fig. 3E~
The apparatus shown in Fig. 2 is arranged and constructed so that the switching or modulating control circuit 26 causes the ultrasonic power for the ultrasonic generator to be delivered to the tip 11 of the handp.iece 12 in a precisely controlled fashion~ In one aspect of the invention, the :1~2~22~
ultrasonic power, preferably delivered at 23 k~lz is periodically i~terrupted by the modulating output from the switching control circuit 26 to vary the amplitude of the delivered wave form to the handpiece 12 continuously between a high amplitude, governed by the amplitude of the control setting on the potentiometer 24 on the control panel, and a low amplitude dete.rmined e:Lectronically at a suitable low level. Another aspect of the invention according to ~he method is to vary the amplitude between a predetermined high amplitude and an off state on a modulated periodic basis, as shown in Fig. 3D. The repetition rate is determined to be sufficiently rapid so that while the foot switch is depressed, the surgeon does not distractedly sense that he is wait.ing for the machine to operate while the periodic interruption of the delivered ultrasonic signal is providing a beneficial effect to his cutting. Thus, the repetition rate must be sufficiently high that the surgeon is not aware that the handpiece has shut off. Thuc., for example, a suitable repetition rate is believed to be at least 30 Hz or higher, and the exact frequency is determined by the system response and the optimum fragmentation rate for particular hard tissue.
The repeti-tion rate of the modulating frequency establishes the wave form of the delivered modulated ultrasonic carrier wave form as is shown in Fig. 3E. Thusf Fig. 3E shows a modulated 23 kHz carrier wave~ shown unmodulated in Fig. 3B and delivered while the footswitch 22 is depressed representing ultrasonic energy as normally applied in the embodiment in Fig.
1, modulated according to the high/low (or on/off) modulating influence established by the switching control circuit 26.
The wave form of Fig. 3E is presently preferred rather than an on/off wave form, such as shown in Fig. 3D, because one of the problems of an electro-acoust.ic system is that it is ~322~2~
difficult and relatively slow in a mechanical sense to start and to sh~t off. That relative slowness is not determined by the electronic portion of the system limi~ing the s~ar~up or repetition rate, but rather by the mechanical parts in the vibrator itself. It has been learned that it takes significan~
amounts of times, measured in tens of milliseconds, to initiate vibration of the vibrati~g tip on the handpiece 12. During this startup or translent period, the conditions for the driving circuit Eor the tip 11 are relatively adverse in that the load is very low and is changing Erom inductive to capacitive~ These adverse conditions must therefore be accommodated in the physical characteris~ics of the vibra~or on the handpiece 12 and by the tip 11 to handle additional stresses. In addition, when the vibrating tip 11 is subjected to such significant additional stresses, a shorter and possibly a significant shorter life will result.
Thus, in order to shorten the start up time and reduce the related stresses on both the electronic and mechanical compo-nents, it is advantageous not to turn off the vibrations completely, as in one embodiment of this invention as shown in Fig. 3D, but rather to switch between two amplitudes, i.e., a working amplitude Ahi selected by the surgeon by manipulation of the potientiometer 24 on the control panel 21, and a standby amplitude Alow which will be a low amplitude as shown in FigO
3E. The low amplitude can either be preset electronically, as in another embodiment of this invention, or may be as low as practical so that its only function is to keep the system vibra-ting~ On the other hand, the low amplitude can also be made adjustable by the surgeon.
The modulating frequency of Fig. 3C determines the periodicity of the modulating wave and the rel.ative periods ~222~
between the application of thle high amplitude and the application of the low amplitude de-termines the duty cycle. Thus, referring to Fig. 3-E, for a period T, the duty Gycle is determined by the ratio of Tl/Tl ~ T2, where the period T is determined by the sum o Tl + T2; Tl is the periGd in which the amplitude is high, and T2 is the period in which the amplitude is low. Stated ~nother way, the duty cycle is the ratio of the perio~ of application of high power to the total period of application of power in each cycle. Thus, it is another aspect of the method and apparatus of this invention to ~ontrol the duty cycle Eor the applied ultrasonic energy from the ultrasonic generator 20 to the handpiece 12.
Such a method and apparatus according to the invention control ~he fragmenta-tion rate of the ultrasonic surgical system 10 wherein a surgeon may select the duty cycle or, the duty cyc].e may be set electronically or even automatically in response to a derived control signal to vary the duty cycle. Moreover, the use of a variable duty cycle by varying the relative amplitudes and periods of the application of the high and low strokes of the vibrating tip 11 act to control the temperature of the tissues surrounding the operating areas. Such control of the duty cycle will thus permit hard tissue to be fragmented by increasing the stroke to a hiyh amplitude for some limited period within the period of the modulating wave while permitting the heat trans~erred to the tissue to be con-trolled. It is known that when tissue i~ being fragmented, ultrasonic energy is transferred from the tip oE the handpiece to the tissueO Some portion of the energy transferred is used to fragment the tissue, while a subportion is absorbed by the ~issue and results in heating it.
In an extreme case, tissue may be burned or vaporized creating an undesirable effect. Thus, a control of the type utilized in this - 12 ~
:~3~2~
invention prevents overheating of healthy tissues to the point of destruction.
On the other hand, such control is of value in -therapeutically ~reating tumor cells. It is known ~hat certain fast growing tumor cells are sensitive to elevated temperatures and are damaged by such higher temperaturesO In accordance with another aspect of the invention, by sensing the temperature of the healthy tissue adjacent to the tumorous tissue being removed, such temperature as sensed can be utilized to vary automatically the duty cycle of high and low strokes to individually elevate the temperature of the tumor signals to a maximum without destroying the adjacent healthy tissues. In accordance wit'n the method for this applicationl the low amplitude should be set as low as possible, for example 1 mil or less and the duty cycle may be variable frcm about 10% to about 95% to nearly 100~ as a function of temperature.
A convenient way for providing ~unctional circuitry to perform the method according to the invention is to utilize a standard PWM controller as used in switching power supplies modified in one aspect of the invention to utilize a signal for controlling the switch as a function of temperature and noting that the switching frequency is low, such as in the 30 to 100 Hz range.
Fig. 2 thus shows a functional block diagram for modifying the conventional control system 18 of the surgical aspirator 10 as shown in Fig. 1. In the main, the existing equipment is modified to add a low amplitude adjustment potentiometer and utilizing the high adjustment potentiometer in the switching sircuit in combination with a controlled switch to achieve the desired results of the invention~
~..
~ ~22~2~
Thus, as more specifically shown in Fig. 4, the switching circuit for the CUSA lOO as shown to the right of the broken line 40 is modified by the inclusion of a duty cycle modulator designated generally by the reference numeral 41. The duty cycle ~odulator 41 is responsive, in one embodiment, to a thermal probe or other rernote sensor of a selected parameter designated generally by the reference number 42. The high ampli-tude adjustment potentiome~ee 24 on the control panel is shown as comprising a potentiometer 43, a bias source i5 shown at 44 and a vibration adjustment control at 45 as are known in the existing system. The bias source 44 is also connected to a low ampli~ude adjustment potentiometer 46 which provides an input for a low amplitude control switch 47. A high amplitude control switch 48 has its input control connected to a wiper 49 on the high amplitude adjustment potentiometer 43.
An oscillator 50 is set to operate at the desired frequency, such as 30 Hz or more, and generates a ramp voltage for a comparator 51. The oscillator is connected to a source of reEerence potential, such as ground 52, through a resistor 53;
while the input to the comparator 51 is connected to a source of reference potential 52 through a capacitor 54. A reference signal, or the output signal from the remote sensor 42, is applied through an error amplifier 56 to the other input of the comparator 51. The output of the comparator 51 controls the bilateral switch 47, while the complementary output of the comparator 51 through the an inverter 58 controls the output of the second bilateral switch 48.
The switches 47 and 48 thus form a multiplexer which alternately and for varying time durations switches the voltage from the surgeon-cont.rolled high vibration adjustment potentiometer 24 and from the preset low amplitude potentiometer ~3~2~P6 46 to the vibration adjustment control on the system on Fig. 1.
In the alternative, the low amplitude adjustment potentiometer could be a preset source of reference voltage to predetermine the low amplitude or, in a limiting case, could be ground~ wherein the switch 47 could be eliminated, in order to switch the circuit between an on/off position subject to the limitations discussed above.
The remote sensor 42 comprises a thermal probe 60 for sensing the temperature at a predetermined site in the vicinity of the surgery, such as at adjacent tissue. In the alternative, other parameters, such as fragmentation rate, vapor generation, or the like, may be used as a control parameter for the input to the duty cycle modulator 41. The output of -the probe 60 is amplified by an amplifier 59 prior to providing the input to the error amplifier 56.
In operation, when the sensed temperature input is low, the duty cycle is high, permitting a relatively longer period of high amplitude vibration, caused by a relatively longer on period for the switch 48. When the temperature is increasing, or higher than desired, the duty cycle modulator acts to increase the period of low amplitude stroke of the tip of the ultrasonic vibrator 11, thus reducing the energy applied to the overheatlng or overheated tissue.
Fig. 5 shows a block diagram in slightly greater detail for implementing the features of Fig. 5 using a CD3524 controller 41~ to achieve the same resul~s and functions. Thusl detailed discussion is not believed to be necessary.
The circuit of FigO 5 further includes a modification for interrupting its operation in the event of excessively high temperature at the operating site. Thus, a signal is applied via a lead 61 to a shutdown signal amplifier 62, having an output :~22~2~
connected to an input o~ the comparator on the PWM controller41A.
The circuit of Fig. 6 is a convenient one for providing a continuous on time adjustment to the input of the system of Fig. l, and in particular to its input control relay. In FigO 6, a trigger circuit 62 provides a timed output signal as shown in the figure. A resistor 63 in series with a variable resistor 64 determines the on time for the output of the trigger circuit, so that the minimum on time is established by the value of the resistor 63. The variable resistor 64 adjusts the on time in cooperation with the resistor 65 and the capacitor 66, whereas the off time is determined only by the resistor 65 and the capacitor 66~ as is well known in the art. During the on time for the trigger circuit 62, the output signal is high to trigger the ultrasonic generator 20 through the control system 18 of Fig.
1.
Fig. 7 shows a suitable schematic, incorporatin~
circuit elements like those shown in Fig. 6, for controlling the temperature of the operating field to less than a predetermined valve by limiting the on time of the ultrasonic vibrations. The impedance of a negative temperature coefficient thermosensor 70 will change with the sensed temperature. The sensor 70 is located at the site where temperature is to be monitored. Since the thermosensor 70 is part of the feedback of a comparator 71, the desired temperature is set by the value of a potentiometer 72 connected between the output and input of the comparator 71, when the temperature rises, the output of the comparator 71 rises and the value of the impedance of the thermosensor 70 rises. This cumulative effect results in decreasing the on period because a second thermosensor 74 having its input in circuit with the out-put of the comparator 71 is in parallel with a resistor 75 in 'he ~3222~6 feedback circuit oE a logic switching circuit 62~ Since the impedance of sensor 74 is in parallel with the resistor 75, the on period from the switching circuit 62 decreases, and in response to increasing sensed temperature~ On the other hand when the temperature decreases, the on ~ime increases. The output, as in Fig. S~ is connected to a relay in the control circuit of the existing system shown in Fig. 1.
As can thus be understood, during the on timel the output of the trigger circuit 62 is hlyh so that the vibrating tip of the handpiece 10 is actuated. When the signal becomes low, ultrasonic power is momentarily deaccuated before again being actuated when the signal again goes high. The trigger circuit shown in Fig. 8 operates the same way as the circuit shown in Fig. 5 except that the on time may be discretely varied by selectively connecting any one of the plurality of resistors 64A, 64B, 64C, or 64D, or some combination thereof, into the RC
network of the trigger circuit 62. Thus, the off time is determined by the resistor 65 and capacitor 66 as it was in connection with the trigger circuit shown in Fig. 5.
Each of the resistors 64A, 64B, 64C, and 64D is respectively in a series circuit with an associated switch 64A', 64B', 64C', and 64D', respectively controlled by the logic control circuit, designated generally by the reference numeral 78.
The trigger circuit 62 shown in Fig. 9 provides, similarly to FigO 81 a fixed off time determined by the resistor 65 and capacitor 66, but the on time provided by the RC network varies se~uentially. Resistors 64A-64D are sequentially connected into the RC network by a counter switch 82 which is actuated each time the output of the trigger circuit 62 becomes low~ Thus, when resistors 64A - 64D are set to respective ~3222~
suita~le values, a first on time, a second on time, a third on time, and a fourth on time are predetermined values, such as 50, 100, lS0, and 200 m sec.~ which can be produced in a repeated sequence, thereby providing a sequentially varied repetition rate.
The control circuit according ko the invention may be used to provlde a number of different modes of operation for khe circuit of Fig. 1. For example, mode 1 may be a continuously operating mode which operates the handpiece in a normal manner as described in connection with Fig. 1. A second mode is a rapid on-off interruption of ultrasonic power typically at a frequency rate of 33 Hz with an on-off duty cycle of 1 to 2. A third mode is a rapid medium speed mode and operates at a frequency of 18 Hz and an on-oEf duty cycle of 1 to 4, as representatively illustrated by the right hand portion of Fig. 3E. Mode 4 is a slow mode which operates at a frequency of 7 Hz and an on off duty cycle of 1 to 4. Finally, mode 5 is a slow mode which operates at a frequency of 5 Hz with an on-off duty cycle of 1 to 6. In each of the modes, the vibration setting is adjusted by the external vibration adjusting potentiometer 45 in Fig. 4, while the frequency and duty cycle are adjusted electronically.
Preferably, the amplitude is set while the system 10 is in the continuous mode, and an automatic interruption mode selected from among exemplary modes 1 to 4. The selected mode is thereafter locked in when the footswitch 22 is depressed and cannot be changed until the footswitch 22 is released. Further modifica-tion of the prior art circuitry to implement the teachings of this invention is within the skill in this art.
The ultrasonic fragmentation produced according to methGd and by the described apparatus in accordance with the present invention provides enhanced cutting action in both hard - 18 ~
1 322.'~ ~
and soft tissue, particularly in bone and cartilage ~here ultrasonic f~agmentation at a constant stroke amplitude provided by a known aspirator apparatus had little effect. In addition, since the present invention permits an average stroke amplitude to be used that is smaller than the stroke needed by constant amplitude aspirators for effective fragmentation, heating o tissue adjacent to the fragmentation sight can be reduced without sacrificing surgical efEectiveness.
The increased ragmentation effectiveness provided by the present invention both increases the speed o~ operation and reduces the force needed to push through hard tissue such as bone, thereby reducing operator fatigue and improving the operator 7 S control of the aspirators. The use of a variable stroke amplitude in an ultrasonic surgical aspirator in accordance with the present invention also provides improved visual control of incisions made in soft tissue by providing improved fragmentation, thereby enhancing debri~ removal by the aspirator.
The improved control provided by varying the duty cycle of the high arnplitude stroke of the vibrator, when used in cooperation with means for sensing the temperature of tissue adjacent to or near the incision made by an ultrasonic surgical aspirator is also well suited for use in providing hypothermic treatment to surrounding tissue while removing a cancerous or tumorous growth. The improved thermal control provided by apparatus in accordance with the present invention permits adjacent tissue to be raised to a precisely controlled temperature that would not destroy healthy tissue but, at the same time would reduce the viability of any fast growing tumor cells that may have invaded adjacent tissue.
?. fi The invention has been described with particular reerence to its presently preferred embodiments, but numerous modiications and variations ~ithin the spirit and scope of the invention as described herein and is deined by the claims will be apparent to one skilled in the art. For example, a feedback signal indicating fragmentation rate could be used to control the ampli-tude or duty cycle of the high amplitude stroke.
Claims (64)
PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:
1. An ultrasonic surgical apparatus comprising:
a surgical handpiece, an ultrasonic tissue fragmenting tool adapted for ultrasonically fragmenting tissue at a surgical site of a patient, said tool being supported by said handpiece, said tool having an ultrasonically-vibratable tool tip, a supplying means for supplying ultrasonic vibrations to said tool tip, a switching means for automatically and repeatedly switching the amplitude of the ultrasonic vibrations of said tool, during a tissue fragmenting procedure at the surgical site, back and forth between a working high amplitude and a standby low amplitude which is a lower amplitude than said which amplitude, an aspirating means connected to said handpiece for aspirating, from the surgical site, fluid and tissue fragmented by said ultrasonically-vibrating tool tip, and an irrigating means connected to said handpiece for supplying an irrigating solution to the area of the surgical site for suspending the tissue particles fragmented by said tool tip.
a surgical handpiece, an ultrasonic tissue fragmenting tool adapted for ultrasonically fragmenting tissue at a surgical site of a patient, said tool being supported by said handpiece, said tool having an ultrasonically-vibratable tool tip, a supplying means for supplying ultrasonic vibrations to said tool tip, a switching means for automatically and repeatedly switching the amplitude of the ultrasonic vibrations of said tool, during a tissue fragmenting procedure at the surgical site, back and forth between a working high amplitude and a standby low amplitude which is a lower amplitude than said which amplitude, an aspirating means connected to said handpiece for aspirating, from the surgical site, fluid and tissue fragmented by said ultrasonically-vibrating tool tip, and an irrigating means connected to said handpiece for supplying an irrigating solution to the area of the surgical site for suspending the tissue particles fragmented by said tool tip.
2. The apparatus of claim 1 wherein said switching means switches the delivered vibration amplitude between said high and low amplitudes at a switching repetition rate which is sufficiently rapid whereby the operator of the apparatus does not distractedly sense said low amplitude.
3. The apparatus of claim 2 wherein said repetition rate is at least 30 Hz.
4. The apparatus of claim 1 wherein said low amplitude allows the tissue at the surgical site to cool off during the tissue fragmenting procedure.
S. The apparatus of claim 1 wherein said ultrasonic vibrations comprise an ultrasonic carrier wave of about 23 KHz.
6. The apparatus of claim 5 wherein said switching means provides a periodically-applied pulse modulating wave which modulates said ultrasonic carrier wave.
7. The apparatus of claim 1 wherein said switching means includes a feed-back loop, said high amplitude remains at a constant level during the tissue fragmenting procedure, and said switching means limits the amount of energy allowed by said feed-back loop.
8. The apparatus of claim 1 wherein said switching means includes a feed-back means for measuring temperatures at the surgical site or surrounding area to ensure that the energy transmitted by said tool to the patient does not exceed allowable limits.
9. The apparatus of claim 1 wherein said switching means interrupts said high amplitude so that the energy levels delivered do not harm the patient.
10. The apparatus of claim 1 wherein said supplying means comprises an ultrasonic generator.
11. The apparatus of claim 1 further comprising a controlling means for controlling the operation of said supplying means.
12. The apparatus of claim 11 wherein said switching means is operatively connected to and cooperates with said controlling means.
13. The apparatus of claim 1 further comprising a manual switch means having "on" and "off" positions for operatively connecting said supplying means to said tool.
14. The apparatus of claim 13 wherein said switching means switches between said low and high amplitudes when said manual switch means is in said "on" position.
15. The apparatus of claim 14 wherein said low amplitude is a zero amplitude.
16. The apparatus of claim 1 wherein said tool has a distal tool tip, said tool is hollow and defines a fluid passageway which communicates with said distal tool tip, and said aspirating means includes an applying means for applying suction to said tool to aspirate material adjacent said tool tip through said fluid passageway and away from the surgical site.
17 The apparatus of claim 1 wherein said switching means causes a duty cycle which is between about 15% and less than 100%.
18. The apparatus of claim 1 wherein said supplying means comprises a closed loop generator feed-back system.
19. The apparatus of claim 18 wherein said supplying means includes a high amplitude adjust potentiometer means which provides a reference signal for said closed loop generator feed-back system for setting said high amplitude.
20. The apparatus of claim 19 wherein said supplying means further includes a low amplitude adjust potentiometer means which provides a reference signal for said closed loop generator feed-back system for setting said low amplitude.
21. The apparatus of claim 19 wherein said switching means includes a timer circuit which switches with a predetermined sequence between said high and low amplitudes.
22. The apparatus of claim 1 wherein said low amplitude is zero, whereby said ultrasonic vibrations at a predetermined frequency are provided between an "on" state and an "off"
skate.
skate.
23. The apparatus of claim 1 further comprising an adjusting means for adjusting said high amplitude.
24. The apparatus of claim 1 wherein said switching means includes a low amplitude adjusting means for adjusting said low amplitude.
25. The apparatus of claim 24 wherein said low amplitude adjusting means includes a potentiometer means for adjustably setting said low amplitude.
26. The apparatus of claim 24 wherein said low amplitude adjusting means includes a circuit means for adjustably setting said low amplitudes.
27. The apparatus of claim 1 wherein said switching means includes an oscillator means for providing a predetermined modulating frequency to said tool.
28. The apparatus of claim 27 wherein said oscillator means provides a modulating frequency at about 30 Hz or greater.
29. The apparatus of claim 1 wherein said tool is pulsed by said switching means between said high amplitude and said low amplitude at a frequency of about 5 Hz or more.
30. The apparatus of claim 1 wherein said switching means includes a duty cycle control means for providing a variable preselected duty cycle for said high and said low amplitude vibrations.
31. The apparatus of claim 1 wherein said switching means includes a duty cycle control means for providing a variable preselected duty cycle for said high and said low amplitude vibrations, said duty cycle control means being responsive to a remotely sensed parameter.
32. The apparatus of claim 31 wherein said remotely-sensed parameter is temperature.
33. The apparatus of claim 32 wherein said duty cycle is decreased in response to increasing temperature.
34. The apparatus of claim 32 wherein said duty cycle is decreased when said remotely-sensed temperature rises to a predetermined value.
35. The apparatus of claim 32 wherein said duty cycle is increased when said remotely-sensed temperature is below a predetermined value to increase the temperature at the surgical site.
36. The apparatus of claim 31 wherein said remotely-sensed parameter is the rate said tool is fragmenting tissue at the surgical site.
37. The apparatus of claim 31 wherein said remotely-sensed parameter is the vapor generation at the surgical site.
38. The apparatus of claim 1 wherein said tool provides surgical removal of at least a part of the tissue to which it is applied, and wherein said switching means causes a change of the stroke amplitude of said tool at a repetition rate and a duty cycle so that the fragmenting procedure is not interrupted while said tool is fragmenting and aspirating the tissue.
39. The apparatus of claim 1 further comprising a temperature sensing means for sensing the temperature of tissue adjacent to the tissue to which said tool is being applied while applied thereto, and said switching means is responsive to said temperature sensing means to vary the amplitude of the stroke of said tool with a duty cycle that is a function of the adjacent tissue temperature.
40. The apparatus of claim 39 wherein said duty cycle is an inverse cycle function of said temperature.
41. The apparatus of claim 1 wherein said switching means includes a varying means for sequentially varying the repetition rate with which said amplitude is automatically varied between said high amplitude and said low amplitude according to a predetermined sequence.
42. The apparatus of claim 1 wherein said switching means controls the total time cycle of the interruption of said ultrasonic vibrations by the application of vibrations of said low amplitudes to less than 1,000 ms.
43. The apparatus of claim 1 wherein said switching means includes a modulating means for modulating an ultrasonic carrier signal at a frequency on the order of 30 Hz or more.
44. The apparatus of claim 43 further comprising a sensing means for sensing a parameter, to produce a parameter-based control signal representative thereof, said switching means being responsive to said parameter-based control signal to vary the duty cycle of the modulated ultrasonic signal.
45. The apparatus of claim 44 wherein said duty cycle lies within a range of about 50% to about 100%.
46. The apparatus of claim 1 wherein said supplying means comprises a general loop feed-back control system including a generator, and said switching means switches the amplitude setting of said generator, when said supplying means is in an "on" cycle thereof, between said high and low amplitudes.
47. The apparatus of claim 46 wherein said low amplitude is a zero amplitude.
48. An ultrasonic surgical apparatus for removing tumorous tissue from a patient with minimal resulting damage to the healthy tissue adjacent to the tumorous tissue comprising:
an ultrasonic tissue fragmenting tool, a pulsing means for pulsing said tool with ultrasonic vibrations during the ultrasonic tumorous tissue fragmenting procedures at a rapid pulse rate between a working high amplitude for a first period of time and a standby low amplitude which is lower than said high amplitude for a second period of time, a cycle time defined by said first period of time plus said second period of time, a duty cycle defined by said first period of time divided by said cycle time, a sensing means for sensing the temperature of the adjacent healthy tissue while the tumorous tissue is being fragmented during a fragmenting procedure, and an adjusting means for automatically varying,as a function of the temperature sensed by said sensing means, said duty cycle.
an ultrasonic tissue fragmenting tool, a pulsing means for pulsing said tool with ultrasonic vibrations during the ultrasonic tumorous tissue fragmenting procedures at a rapid pulse rate between a working high amplitude for a first period of time and a standby low amplitude which is lower than said high amplitude for a second period of time, a cycle time defined by said first period of time plus said second period of time, a duty cycle defined by said first period of time divided by said cycle time, a sensing means for sensing the temperature of the adjacent healthy tissue while the tumorous tissue is being fragmented during a fragmenting procedure, and an adjusting means for automatically varying,as a function of the temperature sensed by said sensing means, said duty cycle.
49. The apparatus of claim 48 wherein said low amplitude is one nil or less.
50. The apparatus of claim 48 wherein said duty cycle is variable by said adjusting means from about 10% to nearly 100%.
51. The apparatus of claim 48 wherein said duty cycle is an inverse cycle function of the temperature sensed by said sensing means.
52. A method for the controlled fragmenting of unwanted tissue at a surgical site with reduced resulting heat damage comprising:
during an ultrasonic tissue fragmenting procedure at the surgical site using a vibratable tool of an ultrasonic fragmenting device, automatically and periodically interrupting at a rapid rate the amplitude of the ultrasonic vibrations delivered to the tool between a working high amplitude and a standby low amplitude which is a lower amplitude than said high amplitude.
during an ultrasonic tissue fragmenting procedure at the surgical site using a vibratable tool of an ultrasonic fragmenting device, automatically and periodically interrupting at a rapid rate the amplitude of the ultrasonic vibrations delivered to the tool between a working high amplitude and a standby low amplitude which is a lower amplitude than said high amplitude.
53. The method of claim 52 wherein said periodically interrupting is characterized in that the duty cycle thereof is between about 15% and less than 100%.
54. The method of claim 52 wherein said low amplitude is a zero amplitude.
55. The method of claim 52 further comprising sequentially varying the repetition rate with which the stroke amplitude of said tool is varied between said high and low amplitudes according to a predetermined sequence.
56. An ultrasonic surgical apparatus comprising:
an ultrasonic tissue fragmenting tool adapted for ultrasonically fragmenting tissue at a surgical site of patient, a supplying means for supplying ultrasonic vibrations to said tool, a switching means for switching the amplitude of the ultrasonic vibrations of said tool, during a tissue fragmenting procedure at the surgical site, back and forth between a working high amplitude and a standby low amplitude which is a lower amplitude than said high amplitude, and said supplying means further includes a low amplitude adjust potentiometer means which provides a reference signal for said closed loop generator feed-back system for setting said low amplitude.
an ultrasonic tissue fragmenting tool adapted for ultrasonically fragmenting tissue at a surgical site of patient, a supplying means for supplying ultrasonic vibrations to said tool, a switching means for switching the amplitude of the ultrasonic vibrations of said tool, during a tissue fragmenting procedure at the surgical site, back and forth between a working high amplitude and a standby low amplitude which is a lower amplitude than said high amplitude, and said supplying means further includes a low amplitude adjust potentiometer means which provides a reference signal for said closed loop generator feed-back system for setting said low amplitude.
57. An ultrasonic surgical apparatus comprising:
an ultrasonic tissue fragmenting tool adapted for ultrasonically fragmenting tissue at a surgical site of patient, a supplying means for supplying ultrasonic vibrations to said tool, a switching means for switching the amplitude of the ultrasonic vibrations of said tool, during a tissue fragmenting procedure at the surgical site, back and forth between a working high amplitude and a standby low amplitude which is a lower amplitude than said high amplitude, said switching means including a duty cycle control means for providing A variable preselected duty cycle for said high and said low amplitude vibrations, said duty cycle control means being responsive to a remotely-sensed parameter, and said remotely-sensed parameter being temperature.
an ultrasonic tissue fragmenting tool adapted for ultrasonically fragmenting tissue at a surgical site of patient, a supplying means for supplying ultrasonic vibrations to said tool, a switching means for switching the amplitude of the ultrasonic vibrations of said tool, during a tissue fragmenting procedure at the surgical site, back and forth between a working high amplitude and a standby low amplitude which is a lower amplitude than said high amplitude, said switching means including a duty cycle control means for providing A variable preselected duty cycle for said high and said low amplitude vibrations, said duty cycle control means being responsive to a remotely-sensed parameter, and said remotely-sensed parameter being temperature.
58. An ultrasonic surgical apparatus comprising:
an ultrasonic tissue fragmenting tool adapted for ultrasonically fragmenting tissue at a surgical site of a patient, a supplying means for supplying ultrasonic vibrations to said tool, a switching means for switching the amplitude of the ultrasonic vibrations of said tool, during a tissue fragmenting procedure at the surgical site, back and forth between a working high amplitude and a standby low amplitude which is a lower amplitude than said high amplitude, said switching means including a duty cycle control means for providing a variable preselected duty cycle for said high and said low amplitude vibrations, said duty cycle control means being responsive to a remotely-sensed parameter, and said remotely-sensed parameter being vapor generation a the surgical site.
an ultrasonic tissue fragmenting tool adapted for ultrasonically fragmenting tissue at a surgical site of a patient, a supplying means for supplying ultrasonic vibrations to said tool, a switching means for switching the amplitude of the ultrasonic vibrations of said tool, during a tissue fragmenting procedure at the surgical site, back and forth between a working high amplitude and a standby low amplitude which is a lower amplitude than said high amplitude, said switching means including a duty cycle control means for providing a variable preselected duty cycle for said high and said low amplitude vibrations, said duty cycle control means being responsive to a remotely-sensed parameter, and said remotely-sensed parameter being vapor generation a the surgical site.
59. An ultrasonic surgical apparatus comprising:
an ultrasonic tissue fragmenting tool adapted for ultrasonically fragmenting tissue at a surgical site of a patient, a supplying means for supplying ultrasonic vibrations to said tool, a switching means for switching the amplitude of the ultrasonic vibrations of said tool, during a tissue fragmenting procedure at the surgical site, back and forth between a working high amplitude and a standby low amplitude which is a lower amplitude than said high amplitude, a temperature sensing means for sensing the temperature of tissue adjacent to the tissue to which said tool is being applied while applied thereto, and said switching means being responsive to said temperature sensing means to vary the amplitude of the stroke of said tool with a duty cycle that is a function of the adjacent tissue temperature.
an ultrasonic tissue fragmenting tool adapted for ultrasonically fragmenting tissue at a surgical site of a patient, a supplying means for supplying ultrasonic vibrations to said tool, a switching means for switching the amplitude of the ultrasonic vibrations of said tool, during a tissue fragmenting procedure at the surgical site, back and forth between a working high amplitude and a standby low amplitude which is a lower amplitude than said high amplitude, a temperature sensing means for sensing the temperature of tissue adjacent to the tissue to which said tool is being applied while applied thereto, and said switching means being responsive to said temperature sensing means to vary the amplitude of the stroke of said tool with a duty cycle that is a function of the adjacent tissue temperature.
60. An ultrasonic surgical apparatus comprising:
an ultrasonic tissue fragmenting tool, a pulsing means for pulsing said tool with ultrasonic vibrations at a rapid pulse rate during an ultrasonic tissue fragmenting procedure between a working high amplitude for a first period of time and a standby low amplitude which is lower than said high amplitude for a second period of time, a cycle time defined by said first period of time plus said second period of time, duty cycle defined by said first period of time divided by said cycle time, a controlling means for controlling said duty cycle, said controlling means controlling said duty cycle continuously based upon a remotely-sensed parameter in the operative field of said tool to yield a closed loop system, and said remotely-sensed parameter comprising temperature of tissue of a patient.
an ultrasonic tissue fragmenting tool, a pulsing means for pulsing said tool with ultrasonic vibrations at a rapid pulse rate during an ultrasonic tissue fragmenting procedure between a working high amplitude for a first period of time and a standby low amplitude which is lower than said high amplitude for a second period of time, a cycle time defined by said first period of time plus said second period of time, duty cycle defined by said first period of time divided by said cycle time, a controlling means for controlling said duty cycle, said controlling means controlling said duty cycle continuously based upon a remotely-sensed parameter in the operative field of said tool to yield a closed loop system, and said remotely-sensed parameter comprising temperature of tissue of a patient.
61. The apparatus of claim 1 wherein said controlling means controls said duty cycle continuously during the fragmenting procedure of said tool.
62. The apparatus of claim 60 wherein said controlling means controls said duty cycle in discrete preset increments.
63. The apparatus of claim 60 wherein said controlling means controls said duty cycle in variable preprogrammed groups.
64. A method for the controlled fragmenting of unwanted tissue at a surgical site with reduced resulting heat damage comprising:
during an ultrasonic tissue fragmenting procedure at the surgical site using a vibratable tool of an ultrasonic fragmenting device, periodically interrupting at a rapid rate the amplitude of the ultrasonic vibrations delivered to the tool between a working high amplitude and a standby low amplitude which is a lower amplitude than said high amplitude, sensing a remote parameter, and varying the duty cycle of said interrupting step as a function of said remotely-sensed parameter, and said remotely-sensed parameter being temperature.
during an ultrasonic tissue fragmenting procedure at the surgical site using a vibratable tool of an ultrasonic fragmenting device, periodically interrupting at a rapid rate the amplitude of the ultrasonic vibrations delivered to the tool between a working high amplitude and a standby low amplitude which is a lower amplitude than said high amplitude, sensing a remote parameter, and varying the duty cycle of said interrupting step as a function of said remotely-sensed parameter, and said remotely-sensed parameter being temperature.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
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US06/847,301 US4827911A (en) | 1986-04-02 | 1986-04-02 | Method and apparatus for ultrasonic surgical fragmentation and removal of tissue |
US847,301 | 1986-04-02 |
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CA1322226C true CA1322226C (en) | 1993-09-14 |
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Application Number | Title | Priority Date | Filing Date |
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CA000533538A Expired - Fee Related CA1322226C (en) | 1986-04-02 | 1987-04-01 | Method and apparatus for ultrasonic surgical fragmentation and removal of tissue |
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US (1) | US4827911A (en) |
EP (1) | EP0261230B1 (en) |
JP (1) | JPH07106208B2 (en) |
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Families Citing this family (899)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5209221A (en) * | 1988-03-01 | 1993-05-11 | Richard Wolf Gmbh | Ultrasonic treatment of pathological tissue |
JPH05170Y2 (en) * | 1988-09-21 | 1993-01-06 | ||
US4989583A (en) * | 1988-10-21 | 1991-02-05 | Nestle S.A. | Ultrasonic cutting tip assembly |
US5139509A (en) * | 1989-08-25 | 1992-08-18 | Site Microsurgical Systems, Inc. | Phacoemulsification system with handpiece simulator |
US5076276A (en) * | 1989-11-01 | 1991-12-31 | Olympus Optical Co., Ltd. | Ultrasound type treatment apparatus |
US5344395A (en) * | 1989-11-13 | 1994-09-06 | Scimed Life Systems, Inc. | Apparatus for intravascular cavitation or delivery of low frequency mechanical energy |
IL93141A0 (en) * | 1990-01-23 | 1990-11-05 | Urcan Medical Ltd | Ultrasonic recanalization system |
US5269291A (en) * | 1990-12-10 | 1993-12-14 | Coraje, Inc. | Miniature ultrasonic transducer for plaque ablation |
US5279547A (en) * | 1991-01-03 | 1994-01-18 | Alcon Surgical Inc. | Computer controlled smart phacoemulsification method and apparatus |
US5160317A (en) * | 1991-01-03 | 1992-11-03 | Costin John A | Computer controlled smart phacoemulsification method and apparatus |
US5368557A (en) * | 1991-01-11 | 1994-11-29 | Baxter International Inc. | Ultrasonic ablation catheter device having multiple ultrasound transmission members |
US5380274A (en) * | 1991-01-11 | 1995-01-10 | Baxter International Inc. | Ultrasound transmission member having improved longitudinal transmission properties |
US5267954A (en) * | 1991-01-11 | 1993-12-07 | Baxter International Inc. | Ultra-sound catheter for removing obstructions from tubular anatomical structures such as blood vessels |
US5368558A (en) * | 1991-01-11 | 1994-11-29 | Baxter International Inc. | Ultrasonic ablation catheter device having endoscopic component and method of using same |
US5447509A (en) * | 1991-01-11 | 1995-09-05 | Baxter International Inc. | Ultrasound catheter system having modulated output with feedback control |
US5324255A (en) * | 1991-01-11 | 1994-06-28 | Baxter International Inc. | Angioplasty and ablative devices having onboard ultrasound components and devices and methods for utilizing ultrasound to treat or prevent vasopasm |
US5304115A (en) * | 1991-01-11 | 1994-04-19 | Baxter International Inc. | Ultrasonic angioplasty device incorporating improved transmission member and ablation probe |
US5957882A (en) * | 1991-01-11 | 1999-09-28 | Advanced Cardiovascular Systems, Inc. | Ultrasound devices for ablating and removing obstructive matter from anatomical passageways and blood vessels |
US5405318A (en) * | 1992-05-05 | 1995-04-11 | Baxter International Inc. | Ultra-sound catheter for removing obstructions from tubular anatomical structures such as blood vessels |
US5184605A (en) * | 1991-01-31 | 1993-02-09 | Excel Tech Ltd. | Therapeutic ultrasound generator with radiation dose control |
US5190517A (en) * | 1991-06-06 | 1993-03-02 | Valleylab Inc. | Electrosurgical and ultrasonic surgical system |
US5697909A (en) * | 1992-01-07 | 1997-12-16 | Arthrocare Corporation | Methods and apparatus for surgical cutting |
DE69224911T2 (en) * | 1991-11-04 | 1998-12-03 | Baxter Int | ULTRASONIC DEVICE FOR ABLATION WITH CHANNEL FOR GUIDE WIRE |
US5697882A (en) | 1992-01-07 | 1997-12-16 | Arthrocare Corporation | System and method for electrosurgical cutting and ablation |
US6159194A (en) * | 1992-01-07 | 2000-12-12 | Arthrocare Corporation | System and method for electrosurgical tissue contraction |
WO1993015850A1 (en) * | 1992-02-07 | 1993-08-19 | Valleylab, Inc. | Ultrasonic surgical apparatus |
US5382228A (en) * | 1992-07-09 | 1995-01-17 | Baxter International Inc. | Method and device for connecting ultrasound transmission member (S) to an ultrasound generating device |
EP0582766A1 (en) * | 1992-08-13 | 1994-02-16 | Ministero Dell' Universita' E Della Ricerca Scientifica E Tecnologica | Ultrasonic recanalization system and transducer therefor |
US5388569A (en) * | 1992-09-04 | 1995-02-14 | American Cyanamid Co | Phacoemulsification probe circuit with switch drive |
US5331951A (en) * | 1992-09-04 | 1994-07-26 | American Cyanamid Company | Phacoemulsification probe drive circuit |
US5370602A (en) * | 1992-09-04 | 1994-12-06 | American Cyanamid Company | Phacoemulsification probe circuit with pulse width Modulating drive |
US6749604B1 (en) | 1993-05-10 | 2004-06-15 | Arthrocare Corporation | Electrosurgical instrument with axially-spaced electrodes |
US5427118A (en) * | 1993-10-04 | 1995-06-27 | Baxter International Inc. | Ultrasonic guidewire |
US5390678A (en) * | 1993-10-12 | 1995-02-21 | Baxter International Inc. | Method and device for measuring ultrasonic activity in an ultrasound delivery system |
US5591127A (en) | 1994-01-28 | 1997-01-07 | Barwick, Jr.; Billie J. | Phacoemulsification method and apparatus |
JP3162723B2 (en) * | 1994-01-28 | 2001-05-08 | アラーガン・セイルズ・インコーポレイテッド | Apparatus for controlling fluid irrigation and fluid aspiration in ophthalmic surgery |
US6689086B1 (en) | 1994-10-27 | 2004-02-10 | Advanced Cardiovascular Systems, Inc. | Method of using a catheter for delivery of ultrasonic energy and medicament |
GB2303552A (en) * | 1995-07-24 | 1997-02-26 | Gar Investment Corp | Ultrasound apparatus for non invasive cellulite reduction |
US6620155B2 (en) | 1996-07-16 | 2003-09-16 | Arthrocare Corp. | System and methods for electrosurgical tissue contraction within the spine |
US6203516B1 (en) | 1996-08-29 | 2001-03-20 | Bausch & Lomb Surgical, Inc. | Phacoemulsification device and method for using dual loop frequency and power control |
US7169123B2 (en) * | 1997-01-22 | 2007-01-30 | Advanced Medical Optics, Inc. | Control of pulse duty cycle based upon footswitch displacement |
US6780165B2 (en) | 1997-01-22 | 2004-08-24 | Advanced Medical Optics | Micro-burst ultrasonic power delivery |
US6629948B2 (en) * | 1997-01-22 | 2003-10-07 | Advanced Medical Optics | Rapid pulse phaco power for burn free surgery |
US5827203A (en) * | 1997-04-21 | 1998-10-27 | Nita; Henry | Ultrasound system and method for myocardial revascularization |
WO1999007296A1 (en) * | 1997-08-07 | 1999-02-18 | Cardiogenesis Corporation | System and method of intra-operative myocardial revascularization using pulsed sonic energy |
US6083193A (en) * | 1998-03-10 | 2000-07-04 | Allergan Sales, Inc. | Thermal mode phaco apparatus and method |
US6231578B1 (en) | 1998-08-05 | 2001-05-15 | United States Surgical Corporation | Ultrasonic snare for excising tissue |
US7276063B2 (en) * | 1998-08-11 | 2007-10-02 | Arthrocare Corporation | Instrument for electrosurgical tissue treatment |
US7435247B2 (en) | 1998-08-11 | 2008-10-14 | Arthrocare Corporation | Systems and methods for electrosurgical tissue treatment |
US6402748B1 (en) | 1998-09-23 | 2002-06-11 | Sherwood Services Ag | Electrosurgical device having a dielectrical seal |
US6214017B1 (en) | 1998-09-25 | 2001-04-10 | Sherwood Services Ag | Ultrasonic surgical apparatus |
US7901400B2 (en) | 1998-10-23 | 2011-03-08 | Covidien Ag | Method and system for controlling output of RF medical generator |
JP4245277B2 (en) | 1998-10-23 | 2009-03-25 | コビディエン アクチェンゲゼルシャフト | Electrosurgical device having a dielectric seal |
AU1128600A (en) | 1998-11-20 | 2000-06-13 | Joie P. Jones | Methods for selectively dissolving and removing materials using ultra-high frequency ultrasound |
US6428532B1 (en) | 1998-12-30 | 2002-08-06 | The General Hospital Corporation | Selective tissue targeting by difference frequency of two wavelengths |
US8506519B2 (en) | 1999-02-16 | 2013-08-13 | Flowcardia, Inc. | Pre-shaped therapeutic catheter |
US6855123B2 (en) * | 2002-08-02 | 2005-02-15 | Flow Cardia, Inc. | Therapeutic ultrasound system |
US6726698B2 (en) * | 1999-03-02 | 2004-04-27 | Sound Surgical Technologies Llc | Pulsed ultrasonic device and method |
US6027515A (en) | 1999-03-02 | 2000-02-22 | Sound Surgical Technologies Llc | Pulsed ultrasonic device and method |
US6193683B1 (en) * | 1999-07-28 | 2001-02-27 | Allergan | Closed loop temperature controlled phacoemulsification system to prevent corneal burns |
EP1110509A1 (en) * | 1999-12-21 | 2001-06-27 | Tomaso Vercellotti | Surgical device for bone surgery |
US6884252B1 (en) * | 2000-04-04 | 2005-04-26 | Circuit Tree Medical, Inc. | Low frequency cataract fragmenting device |
DE10029581C1 (en) * | 2000-06-15 | 2002-01-17 | Ferton Holding Sa | Device for removing body stones with an intracorporeal lithotripter |
DE10029582A1 (en) | 2000-06-15 | 2002-01-03 | Ferton Holding Sa | Device for removing body stones using an intracorporeal lithotripter |
EP1607060B1 (en) * | 2000-12-15 | 2007-06-06 | Sherwood Services AG | Electrosurgical electrode shroud |
US7347855B2 (en) * | 2001-10-29 | 2008-03-25 | Ultrashape Ltd. | Non-invasive ultrasonic body contouring |
AU2007202082B2 (en) * | 2001-01-16 | 2008-07-24 | Johnson & Johnson Surgical Vision, Inc. | Rapid pulse phaco power for burn free surgery |
JP2002263579A (en) * | 2001-03-07 | 2002-09-17 | Olympus Optical Co Ltd | Ultrasonic transducer drive unit |
US11229472B2 (en) | 2001-06-12 | 2022-01-25 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with multiple magnetic position sensors |
CH695288A5 (en) * | 2001-08-21 | 2006-03-15 | Tecpharma Licensing Ag | Fixing device for injection needles. |
US6997935B2 (en) * | 2001-11-20 | 2006-02-14 | Advanced Medical Optics, Inc. | Resonant converter tuning for maintaining substantially constant phaco handpiece power under increased load |
AU2007240154B2 (en) * | 2001-12-21 | 2010-08-12 | Sound Surgical Technologies, Llc | Pulsed ultrasonic device and method |
ATE371413T1 (en) | 2002-05-06 | 2007-09-15 | Covidien Ag | BLOOD DETECTOR FOR CHECKING AN ELECTROSURGICAL UNIT |
JP2003339729A (en) * | 2002-05-22 | 2003-12-02 | Olympus Optical Co Ltd | Ultrasonic operation apparatus |
AU2002345319B2 (en) * | 2002-06-25 | 2008-03-06 | Ultrashape Ltd. | Devices and methodologies useful in body aesthetics |
US7393354B2 (en) * | 2002-07-25 | 2008-07-01 | Sherwood Services Ag | Electrosurgical pencil with drag sensing capability |
US8133236B2 (en) | 2006-11-07 | 2012-03-13 | Flowcardia, Inc. | Ultrasound catheter having protective feature against breakage |
US9955994B2 (en) | 2002-08-02 | 2018-05-01 | Flowcardia, Inc. | Ultrasound catheter having protective feature against breakage |
US6942677B2 (en) | 2003-02-26 | 2005-09-13 | Flowcardia, Inc. | Ultrasound catheter apparatus |
US7335180B2 (en) | 2003-11-24 | 2008-02-26 | Flowcardia, Inc. | Steerable ultrasound catheter |
US7220233B2 (en) | 2003-04-08 | 2007-05-22 | Flowcardia, Inc. | Ultrasound catheter devices and methods |
US7137963B2 (en) | 2002-08-26 | 2006-11-21 | Flowcardia, Inc. | Ultrasound catheter for disrupting blood vessel obstructions |
US7604608B2 (en) * | 2003-01-14 | 2009-10-20 | Flowcardia, Inc. | Ultrasound catheter and methods for making and using same |
US6747218B2 (en) | 2002-09-20 | 2004-06-08 | Sherwood Services Ag | Electrosurgical haptic switch including snap dome and printed circuit stepped contact array |
WO2004026150A2 (en) * | 2002-09-20 | 2004-04-01 | Sherwood Sevices Ag | Electrosurgical instrument for fragmenting, cutting and coagulating tissue |
US7077820B1 (en) * | 2002-10-21 | 2006-07-18 | Advanced Medical Optics, Inc. | Enhanced microburst ultrasonic power delivery system and method |
US7316664B2 (en) | 2002-10-21 | 2008-01-08 | Advanced Medical Optics, Inc. | Modulated pulsed ultrasonic power delivery system and method |
US20040092921A1 (en) * | 2002-10-21 | 2004-05-13 | Kadziauskas Kenneth E. | System and method for pulsed ultrasonic power delivery employing cavitation effects |
US7244257B2 (en) | 2002-11-05 | 2007-07-17 | Sherwood Services Ag | Electrosurgical pencil having a single button variable control |
US7044948B2 (en) | 2002-12-10 | 2006-05-16 | Sherwood Services Ag | Circuit for controlling arc energy from an electrosurgical generator |
WO2004073753A2 (en) | 2003-02-20 | 2004-09-02 | Sherwood Services Ag | Motion detector for controlling electrosurgical output |
CA2830583C (en) * | 2003-03-12 | 2015-06-09 | Abbott Medical Optics Inc. | System and method for pulsed ultrasonic power delivery employing cavitation effects |
US7220778B2 (en) * | 2003-04-15 | 2007-05-22 | The General Hospital Corporation | Methods and devices for epithelial protection during photodynamic therapy |
EP1617776B1 (en) | 2003-05-01 | 2015-09-02 | Covidien AG | System for programing and controlling an electrosurgical generator system |
US20070084897A1 (en) | 2003-05-20 | 2007-04-19 | Shelton Frederick E Iv | Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism |
US9060770B2 (en) | 2003-05-20 | 2015-06-23 | Ethicon Endo-Surgery, Inc. | Robotically-driven surgical instrument with E-beam driver |
US7846126B2 (en) * | 2003-07-14 | 2010-12-07 | Abbott Medical Optics, Inc. | System and method for modulated surgical procedure irrigation and aspiration |
EP1651127B1 (en) | 2003-07-16 | 2012-10-31 | Arthrocare Corporation | Rotary electrosurgical apparatus |
US7758510B2 (en) | 2003-09-19 | 2010-07-20 | Flowcardia, Inc. | Connector for securing ultrasound catheter to transducer |
EP1675499B1 (en) | 2003-10-23 | 2011-10-19 | Covidien AG | Redundant temperature monitoring in electrosurgical systems for safety mitigation |
WO2005050151A1 (en) | 2003-10-23 | 2005-06-02 | Sherwood Services Ag | Thermocouple measurement circuit |
US7396336B2 (en) | 2003-10-30 | 2008-07-08 | Sherwood Services Ag | Switched resonant ultrasonic power amplifier system |
US7241294B2 (en) | 2003-11-19 | 2007-07-10 | Sherwood Services Ag | Pistol grip electrosurgical pencil with manual aspirator/irrigator and methods of using the same |
US7156842B2 (en) * | 2003-11-20 | 2007-01-02 | Sherwood Services Ag | Electrosurgical pencil with improved controls |
US7156844B2 (en) * | 2003-11-20 | 2007-01-02 | Sherwood Services Ag | Electrosurgical pencil with improved controls |
US7131860B2 (en) | 2003-11-20 | 2006-11-07 | Sherwood Services Ag | Connector systems for electrosurgical generator |
US7503917B2 (en) | 2003-11-20 | 2009-03-17 | Covidien Ag | Electrosurgical pencil with improved controls |
US7879033B2 (en) | 2003-11-20 | 2011-02-01 | Covidien Ag | Electrosurgical pencil with advanced ES controls |
US7766905B2 (en) | 2004-02-12 | 2010-08-03 | Covidien Ag | Method and system for continuity testing of medical electrodes |
US8182501B2 (en) | 2004-02-27 | 2012-05-22 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical shears and method for sealing a blood vessel using same |
US7780662B2 (en) | 2004-03-02 | 2010-08-24 | Covidien Ag | Vessel sealing system using capacitive RF dielectric heating |
US7811255B2 (en) * | 2004-03-22 | 2010-10-12 | Alcon, Inc. | Method of controlling a surgical system based on a rate of change of an operating parameter |
US7645256B2 (en) * | 2004-08-12 | 2010-01-12 | Alcon, Inc. | Ultrasound handpiece |
US7297137B2 (en) * | 2004-03-22 | 2007-11-20 | Alcon, Inc. | Method of detecting surgical events |
US7651490B2 (en) * | 2004-08-12 | 2010-01-26 | Alcon, Inc. | Ultrasonic handpiece |
US7625388B2 (en) * | 2004-03-22 | 2009-12-01 | Alcon, Inc. | Method of controlling a surgical system based on a load on the cutting tip of a handpiece |
US7645255B2 (en) * | 2004-03-22 | 2010-01-12 | Alcon, Inc. | Method of controlling a surgical system based on irrigation flow |
US7572242B2 (en) * | 2004-03-22 | 2009-08-11 | Alcon, Inc. | Method of operating an ultrasound handpiece |
US7641686B2 (en) * | 2004-04-23 | 2010-01-05 | Direct Flow Medical, Inc. | Percutaneous heart valve with stentless support |
US7435257B2 (en) | 2004-05-05 | 2008-10-14 | Direct Flow Medical, Inc. | Methods of cardiac valve replacement using nonstented prosthetic valve |
JP4343778B2 (en) * | 2004-06-16 | 2009-10-14 | オリンパス株式会社 | Ultrasonic surgical device |
US11896225B2 (en) | 2004-07-28 | 2024-02-13 | Cilag Gmbh International | Staple cartridge comprising a pan |
US8215531B2 (en) | 2004-07-28 | 2012-07-10 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having a medical substance dispenser |
US8905977B2 (en) | 2004-07-28 | 2014-12-09 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having an electroactive polymer actuated medical substance dispenser |
US7540852B2 (en) * | 2004-08-26 | 2009-06-02 | Flowcardia, Inc. | Ultrasound catheter devices and methods |
EP3162309B1 (en) | 2004-10-08 | 2022-10-26 | Ethicon LLC | Ultrasonic surgical instrument |
US9119700B2 (en) | 2004-11-30 | 2015-09-01 | Novartis Ag | Graphical user interface system and method for representing and controlling surgical parameters |
US7945341B2 (en) * | 2004-11-30 | 2011-05-17 | Alcon, Inc. | Graphical user interface for selecting pulse parameters in a phacoemulsification surgical system |
JP2006158525A (en) * | 2004-12-03 | 2006-06-22 | Olympus Medical Systems Corp | Ultrasonic surgical apparatus, and method of driving ultrasonic treatment instrument |
US8221343B2 (en) | 2005-01-20 | 2012-07-17 | Flowcardia, Inc. | Vibrational catheter devices and methods for making same |
JP2008529580A (en) * | 2005-02-06 | 2008-08-07 | ウルトラシェイプ エルティーディー. | Non-thermal sonic texture modification |
US20060241440A1 (en) * | 2005-02-07 | 2006-10-26 | Yoram Eshel | Non-thermal acoustic tissue modification |
US8092475B2 (en) * | 2005-04-15 | 2012-01-10 | Integra Lifesciences (Ireland) Ltd. | Ultrasonic horn for removal of hard tissue |
US8142460B2 (en) * | 2005-04-15 | 2012-03-27 | Integra Lifesciences (Ireland) Ltd. | Bone abrading ultrasonic horns |
US20060235378A1 (en) * | 2005-04-18 | 2006-10-19 | Sherwood Services Ag | Slider control for ablation handset |
JP5119148B2 (en) | 2005-06-07 | 2013-01-16 | ダイレクト フロウ メディカル、 インク. | Stentless aortic valve replacement with high radial strength |
ITMI20051172A1 (en) | 2005-06-21 | 2006-12-22 | Fernando Bianchetti | "PIEZOELECTRIC SURGICAL DEVICE AND METHOD FOR THE PREPARATION OF IMPLANT SITE" |
US20070000301A1 (en) * | 2005-06-21 | 2007-01-04 | Todd Kirk W | Reflux control in microsurgical system |
US7500974B2 (en) | 2005-06-28 | 2009-03-10 | Covidien Ag | Electrode with rotatably deployable sheath |
US7766946B2 (en) | 2005-07-27 | 2010-08-03 | Frank Emile Bailly | Device for securing spinal rods |
US7828794B2 (en) | 2005-08-25 | 2010-11-09 | Covidien Ag | Handheld electrosurgical apparatus for controlling operating room equipment |
JP5266345B2 (en) * | 2005-08-31 | 2013-08-21 | アルコン,インコーポレイティド | How to generate energy for use in ophthalmic surgery equipment |
US9237891B2 (en) | 2005-08-31 | 2016-01-19 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical stapling devices that produce formed staples having different lengths |
US11484312B2 (en) | 2005-08-31 | 2022-11-01 | Cilag Gmbh International | Staple cartridge comprising a staple driver arrangement |
US7934630B2 (en) | 2005-08-31 | 2011-05-03 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US7669746B2 (en) | 2005-08-31 | 2010-03-02 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US8800838B2 (en) | 2005-08-31 | 2014-08-12 | Ethicon Endo-Surgery, Inc. | Robotically-controlled cable-based surgical end effectors |
US11246590B2 (en) | 2005-08-31 | 2022-02-15 | Cilag Gmbh International | Staple cartridge including staple drivers having different unfired heights |
US8353297B2 (en) * | 2005-08-31 | 2013-01-15 | Novartis Ag | Pulse manipulation for controlling a phacoemulsification surgical system |
US10159482B2 (en) | 2005-08-31 | 2018-12-25 | Ethicon Llc | Fastener cartridge assembly comprising a fixed anvil and different staple heights |
US7673781B2 (en) | 2005-08-31 | 2010-03-09 | Ethicon Endo-Surgery, Inc. | Surgical stapling device with staple driver that supports multiple wire diameter staples |
US20070191713A1 (en) | 2005-10-14 | 2007-08-16 | Eichmann Stephen E | Ultrasonic device for cutting and coagulating |
US8734438B2 (en) | 2005-10-21 | 2014-05-27 | Covidien Ag | Circuit and method for reducing stored energy in an electrosurgical generator |
US20070106317A1 (en) | 2005-11-09 | 2007-05-10 | Shelton Frederick E Iv | Hydraulically and electrically actuated articulation joints for surgical instruments |
US7947039B2 (en) | 2005-12-12 | 2011-05-24 | Covidien Ag | Laparoscopic apparatus for performing electrosurgical procedures |
US20070135760A1 (en) * | 2005-12-14 | 2007-06-14 | Williams David L | Occlusion clearance in microsurgical system |
US7621930B2 (en) | 2006-01-20 | 2009-11-24 | Ethicon Endo-Surgery, Inc. | Ultrasound medical instrument having a medical ultrasonic blade |
US20110024477A1 (en) | 2009-02-06 | 2011-02-03 | Hall Steven G | Driven Surgical Stapler Improvements |
US8708213B2 (en) | 2006-01-31 | 2014-04-29 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a feedback system |
US20110006101A1 (en) | 2009-02-06 | 2011-01-13 | EthiconEndo-Surgery, Inc. | Motor driven surgical fastener device with cutting member lockout arrangements |
US8820603B2 (en) | 2006-01-31 | 2014-09-02 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US20120292367A1 (en) | 2006-01-31 | 2012-11-22 | Ethicon Endo-Surgery, Inc. | Robotically-controlled end effector |
US9861359B2 (en) | 2006-01-31 | 2018-01-09 | Ethicon Llc | Powered surgical instruments with firing system lockout arrangements |
US8763879B2 (en) | 2006-01-31 | 2014-07-01 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of surgical instrument |
US7753904B2 (en) | 2006-01-31 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Endoscopic surgical instrument with a handle that can articulate with respect to the shaft |
US8186555B2 (en) | 2006-01-31 | 2012-05-29 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting and fastening instrument with mechanical closure system |
US20110290856A1 (en) | 2006-01-31 | 2011-12-01 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical instrument with force-feedback capabilities |
US11278279B2 (en) | 2006-01-31 | 2022-03-22 | Cilag Gmbh International | Surgical instrument assembly |
US11224427B2 (en) | 2006-01-31 | 2022-01-18 | Cilag Gmbh International | Surgical stapling system including a console and retraction assembly |
US7845537B2 (en) | 2006-01-31 | 2010-12-07 | Ethicon Endo-Surgery, Inc. | Surgical instrument having recording capabilities |
US8161977B2 (en) | 2006-01-31 | 2012-04-24 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US11793518B2 (en) | 2006-01-31 | 2023-10-24 | Cilag Gmbh International | Powered surgical instruments with firing system lockout arrangements |
US7651493B2 (en) | 2006-03-03 | 2010-01-26 | Covidien Ag | System and method for controlling electrosurgical snares |
US8394115B2 (en) | 2006-03-22 | 2013-03-12 | Ethicon Endo-Surgery, Inc. | Composite end effector for an ultrasonic surgical instrument |
US8992422B2 (en) | 2006-03-23 | 2015-03-31 | Ethicon Endo-Surgery, Inc. | Robotically-controlled endoscopic accessory channel |
US8236010B2 (en) | 2006-03-23 | 2012-08-07 | Ethicon Endo-Surgery, Inc. | Surgical fastener and cutter with mimicking end effector |
US9675375B2 (en) | 2006-03-29 | 2017-06-13 | Ethicon Llc | Ultrasonic surgical system and method |
WO2017037789A1 (en) * | 2015-08-28 | 2017-03-09 | オリンパス株式会社 | Surgery system and operation method for surgery system |
US9282984B2 (en) * | 2006-04-05 | 2016-03-15 | Flowcardia, Inc. | Therapeutic ultrasound system |
US20070255196A1 (en) * | 2006-04-19 | 2007-11-01 | Wuchinich David G | Ultrasonic liquefaction method and apparatus using a tapered ultrasonic tip |
US20070260240A1 (en) | 2006-05-05 | 2007-11-08 | Sherwood Services Ag | Soft tissue RF transection and resection device |
US20080125695A1 (en) * | 2006-06-23 | 2008-05-29 | Hopkins Mark A | Reflux control in microsurgical system |
US8322455B2 (en) | 2006-06-27 | 2012-12-04 | Ethicon Endo-Surgery, Inc. | Manually driven surgical cutting and fastening instrument |
US7785336B2 (en) | 2006-08-01 | 2010-08-31 | Abbott Medical Optics Inc. | Vacuum sense control for phaco pulse shaping |
US7740159B2 (en) | 2006-08-02 | 2010-06-22 | Ethicon Endo-Surgery, Inc. | Pneumatically powered surgical cutting and fastening instrument with a variable control of the actuating rate of firing with mechanical power assist |
US8348131B2 (en) | 2006-09-29 | 2013-01-08 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with mechanical indicator to show levels of tissue compression |
US10568652B2 (en) | 2006-09-29 | 2020-02-25 | Ethicon Llc | Surgical staples having attached drivers of different heights and stapling instruments for deploying the same |
US10130359B2 (en) | 2006-09-29 | 2018-11-20 | Ethicon Llc | Method for forming a staple |
US7947053B2 (en) * | 2006-10-10 | 2011-05-24 | Mckay Raymond G | Suturing device and technique |
US7935144B2 (en) | 2006-10-19 | 2011-05-03 | Direct Flow Medical, Inc. | Profile reduction of valve implant |
US8133213B2 (en) | 2006-10-19 | 2012-03-13 | Direct Flow Medical, Inc. | Catheter guidance through a calcified aortic valve |
US20080172076A1 (en) * | 2006-11-01 | 2008-07-17 | Alcon, Inc. | Ultrasound apparatus and method of use |
US8246643B2 (en) | 2006-11-07 | 2012-08-21 | Flowcardia, Inc. | Ultrasound catheter having improved distal end |
US8579929B2 (en) * | 2006-12-08 | 2013-11-12 | Alcon Research, Ltd. | Torsional ultrasound hand piece that eliminates chatter |
US8684253B2 (en) | 2007-01-10 | 2014-04-01 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor |
US8459520B2 (en) | 2007-01-10 | 2013-06-11 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and remote sensor |
US11291441B2 (en) | 2007-01-10 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with wireless communication between control unit and remote sensor |
US8652120B2 (en) | 2007-01-10 | 2014-02-18 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and sensor transponders |
US11039836B2 (en) | 2007-01-11 | 2021-06-22 | Cilag Gmbh International | Staple cartridge for use with a surgical stapling instrument |
US8540128B2 (en) | 2007-01-11 | 2013-09-24 | Ethicon Endo-Surgery, Inc. | Surgical stapling device with a curved end effector |
US7438209B1 (en) | 2007-03-15 | 2008-10-21 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments having a releasable staple-forming pocket |
US8057498B2 (en) | 2007-11-30 | 2011-11-15 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instrument blades |
US8226675B2 (en) | 2007-03-22 | 2012-07-24 | Ethicon Endo-Surgery, Inc. | Surgical instruments |
US20080234709A1 (en) | 2007-03-22 | 2008-09-25 | Houser Kevin L | Ultrasonic surgical instrument and cartilage and bone shaping blades therefor |
US8911460B2 (en) | 2007-03-22 | 2014-12-16 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8142461B2 (en) | 2007-03-22 | 2012-03-27 | Ethicon Endo-Surgery, Inc. | Surgical instruments |
US8893946B2 (en) | 2007-03-28 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Laparoscopic tissue thickness and clamp load measuring devices |
US8303530B2 (en) * | 2007-05-10 | 2012-11-06 | Novartis Ag | Method of operating an ultrasound handpiece |
US9271751B2 (en) * | 2007-05-29 | 2016-03-01 | Ethicon Endo-Surgery, Llc | Ultrasonic surgical system |
US8157145B2 (en) | 2007-05-31 | 2012-04-17 | Ethicon Endo-Surgery, Inc. | Pneumatically powered surgical cutting and fastening instrument with electrical feedback |
US7905380B2 (en) | 2007-06-04 | 2011-03-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a multiple rate directional switching mechanism |
US11857181B2 (en) | 2007-06-04 | 2024-01-02 | Cilag Gmbh International | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US7832408B2 (en) | 2007-06-04 | 2010-11-16 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a directional switching mechanism |
US8534528B2 (en) | 2007-06-04 | 2013-09-17 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a multiple rate directional switching mechanism |
US8931682B2 (en) | 2007-06-04 | 2015-01-13 | Ethicon Endo-Surgery, Inc. | Robotically-controlled shaft based rotary drive systems for surgical instruments |
GR1006435B (en) * | 2007-06-07 | 2009-06-15 | Μιχαηλ Θεμελη Σιδερης | Ultrasound diathermy system of completely controlled operation. |
US8408439B2 (en) | 2007-06-22 | 2013-04-02 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with an articulatable end effector |
US7753245B2 (en) | 2007-06-22 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments |
CA2724949A1 (en) * | 2007-06-27 | 2008-12-31 | The General Hospital Corporation | Method and apparatus for optical inhibition of photodynamic therapy |
US11849941B2 (en) | 2007-06-29 | 2023-12-26 | Cilag Gmbh International | Staple cartridge having staple cavities extending at a transverse angle relative to a longitudinal cartridge axis |
US8348967B2 (en) | 2007-07-27 | 2013-01-08 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8523889B2 (en) | 2007-07-27 | 2013-09-03 | Ethicon Endo-Surgery, Inc. | Ultrasonic end effectors with increased active length |
US8882791B2 (en) | 2007-07-27 | 2014-11-11 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8808319B2 (en) | 2007-07-27 | 2014-08-19 | Ethicon Endo-Surgery, Inc. | Surgical instruments |
US8512365B2 (en) | 2007-07-31 | 2013-08-20 | Ethicon Endo-Surgery, Inc. | Surgical instruments |
US8430898B2 (en) | 2007-07-31 | 2013-04-30 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8252012B2 (en) | 2007-07-31 | 2012-08-28 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instrument with modulator |
US9044261B2 (en) | 2007-07-31 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Temperature controlled ultrasonic surgical instruments |
US8506565B2 (en) | 2007-08-23 | 2013-08-13 | Covidien Lp | Electrosurgical device with LED adapter |
US20090088836A1 (en) | 2007-08-23 | 2009-04-02 | Direct Flow Medical, Inc. | Translumenally implantable heart valve with formed in place support |
WO2009036917A1 (en) | 2007-09-13 | 2009-03-26 | Carl Zeiss Surgical Gmbh | Phacoemulsification device and method for operating the same |
EP2796102B1 (en) | 2007-10-05 | 2018-03-14 | Ethicon LLC | Ergonomic surgical instruments |
US7901423B2 (en) | 2007-11-30 | 2011-03-08 | Ethicon Endo-Surgery, Inc. | Folded ultrasonic end effectors with increased active length |
US10010339B2 (en) | 2007-11-30 | 2018-07-03 | Ethicon Llc | Ultrasonic surgical blades |
US8235987B2 (en) | 2007-12-05 | 2012-08-07 | Tyco Healthcare Group Lp | Thermal penetration and arc length controllable electrosurgical pencil |
US8348129B2 (en) | 2009-10-09 | 2013-01-08 | Ethicon Endo-Surgery, Inc. | Surgical stapler having a closure mechanism |
US8453908B2 (en) | 2008-02-13 | 2013-06-04 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with improved firing trigger arrangement |
US8561870B2 (en) | 2008-02-13 | 2013-10-22 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument |
US7766209B2 (en) | 2008-02-13 | 2010-08-03 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with improved firing trigger arrangement |
US7819298B2 (en) | 2008-02-14 | 2010-10-26 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with control features operable with one hand |
US8758391B2 (en) | 2008-02-14 | 2014-06-24 | Ethicon Endo-Surgery, Inc. | Interchangeable tools for surgical instruments |
US8657174B2 (en) | 2008-02-14 | 2014-02-25 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument having handle based power source |
US8622274B2 (en) | 2008-02-14 | 2014-01-07 | Ethicon Endo-Surgery, Inc. | Motorized cutting and fastening instrument having control circuit for optimizing battery usage |
US8584919B2 (en) | 2008-02-14 | 2013-11-19 | Ethicon Endo-Sugery, Inc. | Surgical stapling apparatus with load-sensitive firing mechanism |
US8573465B2 (en) | 2008-02-14 | 2013-11-05 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical end effector system with rotary actuated closure systems |
US8752749B2 (en) | 2008-02-14 | 2014-06-17 | Ethicon Endo-Surgery, Inc. | Robotically-controlled disposable motor-driven loading unit |
US8636736B2 (en) | 2008-02-14 | 2014-01-28 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument |
US8459525B2 (en) | 2008-02-14 | 2013-06-11 | Ethicon Endo-Sugery, Inc. | Motorized surgical cutting and fastening instrument having a magnetic drive train torque limiting device |
US9179912B2 (en) | 2008-02-14 | 2015-11-10 | Ethicon Endo-Surgery, Inc. | Robotically-controlled motorized surgical cutting and fastening instrument |
US7866527B2 (en) | 2008-02-14 | 2011-01-11 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with interlockable firing system |
RU2493788C2 (en) | 2008-02-14 | 2013-09-27 | Этикон Эндо-Серджери, Инк. | Surgical cutting and fixing instrument, which has radio-frequency electrodes |
US7793812B2 (en) | 2008-02-14 | 2010-09-14 | Ethicon Endo-Surgery, Inc. | Disposable motor-driven loading unit for use with a surgical cutting and stapling apparatus |
US8608044B2 (en) | 2008-02-15 | 2013-12-17 | Ethicon Endo-Surgery, Inc. | Feedback and lockout mechanism for surgical instrument |
US20090206142A1 (en) | 2008-02-15 | 2009-08-20 | Ethicon Endo-Surgery, Inc. | Buttress material for a surgical stapling instrument |
US20090206131A1 (en) | 2008-02-15 | 2009-08-20 | Ethicon Endo-Surgery, Inc. | End effector coupling arrangements for a surgical cutting and stapling instrument |
US11272927B2 (en) | 2008-02-15 | 2022-03-15 | Cilag Gmbh International | Layer arrangements for surgical staple cartridges |
US10390823B2 (en) | 2008-02-15 | 2019-08-27 | Ethicon Llc | End effector comprising an adjunct |
US8636733B2 (en) * | 2008-03-31 | 2014-01-28 | Covidien Lp | Electrosurgical pencil including improved controls |
US8663218B2 (en) | 2008-03-31 | 2014-03-04 | Covidien Lp | Electrosurgical pencil including improved controls |
US8597292B2 (en) | 2008-03-31 | 2013-12-03 | Covidien Lp | Electrosurgical pencil including improved controls |
US8162937B2 (en) | 2008-06-27 | 2012-04-24 | Tyco Healthcare Group Lp | High volume fluid seal for electrosurgical handpiece |
US8058771B2 (en) | 2008-08-06 | 2011-11-15 | Ethicon Endo-Surgery, Inc. | Ultrasonic device for cutting and coagulating with stepped output |
US9089360B2 (en) | 2008-08-06 | 2015-07-28 | Ethicon Endo-Surgery, Inc. | Devices and techniques for cutting and coagulating tissue |
US20100036256A1 (en) * | 2008-08-08 | 2010-02-11 | Mikhail Boukhny | Offset ultrasonic hand piece |
US8747400B2 (en) | 2008-08-13 | 2014-06-10 | Arthrocare Corporation | Systems and methods for screen electrode securement |
WO2010021951A2 (en) | 2008-08-18 | 2010-02-25 | The Brigham And Women's Hospital, Inc. | Integrated surgical sampling probe |
US8083120B2 (en) | 2008-09-18 | 2011-12-27 | Ethicon Endo-Surgery, Inc. | End effector for use with a surgical cutting and stapling instrument |
US7857186B2 (en) | 2008-09-19 | 2010-12-28 | Ethicon Endo-Surgery, Inc. | Surgical stapler having an intermediate closing position |
PL3476312T3 (en) | 2008-09-19 | 2024-03-11 | Ethicon Llc | Surgical stapler with apparatus for adjusting staple height |
US9386983B2 (en) | 2008-09-23 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Robotically-controlled motorized surgical instrument |
US8210411B2 (en) | 2008-09-23 | 2012-07-03 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument |
US11648005B2 (en) | 2008-09-23 | 2023-05-16 | Cilag Gmbh International | Robotically-controlled motorized surgical instrument with an end effector |
US9050083B2 (en) * | 2008-09-23 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US9005230B2 (en) | 2008-09-23 | 2015-04-14 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US20100094321A1 (en) * | 2008-10-10 | 2010-04-15 | Takayuki Akahoshi | Ultrasound Handpiece |
US8608045B2 (en) | 2008-10-10 | 2013-12-17 | Ethicon Endo-Sugery, Inc. | Powered surgical cutting and stapling apparatus with manually retractable firing system |
US8355799B2 (en) | 2008-12-12 | 2013-01-15 | Arthrocare Corporation | Systems and methods for limiting joint temperature |
US8397971B2 (en) | 2009-02-05 | 2013-03-19 | Ethicon Endo-Surgery, Inc. | Sterilizable surgical instrument |
US8517239B2 (en) | 2009-02-05 | 2013-08-27 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument comprising a magnetic element driver |
US8414577B2 (en) | 2009-02-05 | 2013-04-09 | Ethicon Endo-Surgery, Inc. | Surgical instruments and components for use in sterile environments |
US8485413B2 (en) | 2009-02-05 | 2013-07-16 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument comprising an articulation joint |
US8444036B2 (en) | 2009-02-06 | 2013-05-21 | Ethicon Endo-Surgery, Inc. | Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector |
BRPI1008667A2 (en) | 2009-02-06 | 2016-03-08 | Ethicom Endo Surgery Inc | improvement of the operated surgical stapler |
US8231620B2 (en) | 2009-02-10 | 2012-07-31 | Tyco Healthcare Group Lp | Extension cutting blade |
US8066167B2 (en) | 2009-03-23 | 2011-11-29 | Ethicon Endo-Surgery, Inc. | Circular surgical stapling instrument with anvil locking system |
EP2415067B1 (en) | 2009-04-01 | 2017-12-20 | Prosolia, Inc. | Method and system for surface sampling |
US9700339B2 (en) | 2009-05-20 | 2017-07-11 | Ethicon Endo-Surgery, Inc. | Coupling arrangements and methods for attaching tools to ultrasonic surgical instruments |
US8226566B2 (en) | 2009-06-12 | 2012-07-24 | Flowcardia, Inc. | Device and method for vascular re-entry |
US8319400B2 (en) | 2009-06-24 | 2012-11-27 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8623040B2 (en) | 2009-07-01 | 2014-01-07 | Alcon Research, Ltd. | Phacoemulsification hook tip |
US8461744B2 (en) | 2009-07-15 | 2013-06-11 | Ethicon Endo-Surgery, Inc. | Rotating transducer mount for ultrasonic surgical instruments |
US8663220B2 (en) | 2009-07-15 | 2014-03-04 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US9017326B2 (en) | 2009-07-15 | 2015-04-28 | Ethicon Endo-Surgery, Inc. | Impedance monitoring apparatus, system, and method for ultrasonic surgical instruments |
US8672938B2 (en) | 2009-07-23 | 2014-03-18 | Covidien Lp | Active cooling system and apparatus for controlling temperature of a fluid used during treatment of biological tissue |
US8207651B2 (en) | 2009-09-16 | 2012-06-26 | Tyco Healthcare Group Lp | Low energy or minimum disturbance method for measuring frequency response functions of ultrasonic surgical devices in determining optimum operating point |
US8317786B2 (en) | 2009-09-25 | 2012-11-27 | AthroCare Corporation | System, method and apparatus for electrosurgical instrument with movable suction sheath |
US8323279B2 (en) | 2009-09-25 | 2012-12-04 | Arthocare Corporation | System, method and apparatus for electrosurgical instrument with movable fluid delivery sheath |
US9168054B2 (en) | 2009-10-09 | 2015-10-27 | Ethicon Endo-Surgery, Inc. | Surgical generator for ultrasonic and electrosurgical devices |
US11090104B2 (en) | 2009-10-09 | 2021-08-17 | Cilag Gmbh International | Surgical generator for ultrasonic and electrosurgical devices |
US10441345B2 (en) | 2009-10-09 | 2019-10-15 | Ethicon Llc | Surgical generator for ultrasonic and electrosurgical devices |
USRE47996E1 (en) | 2009-10-09 | 2020-05-19 | Ethicon Llc | Surgical generator for ultrasonic and electrosurgical devices |
US9050093B2 (en) | 2009-10-09 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Surgical generator for ultrasonic and electrosurgical devices |
US8899466B2 (en) | 2009-11-19 | 2014-12-02 | Ethicon Endo-Surgery, Inc. | Devices and methods for introducing a surgical circular stapling instrument into a patient |
US8070711B2 (en) * | 2009-12-09 | 2011-12-06 | Alcon Research, Ltd. | Thermal management algorithm for phacoemulsification system |
US8136712B2 (en) | 2009-12-10 | 2012-03-20 | Ethicon Endo-Surgery, Inc. | Surgical stapler with discrete staple height adjustment and tactile feedback |
US8220688B2 (en) | 2009-12-24 | 2012-07-17 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument with electric actuator directional control assembly |
US8851354B2 (en) | 2009-12-24 | 2014-10-07 | Ethicon Endo-Surgery, Inc. | Surgical cutting instrument that analyzes tissue thickness |
US8267300B2 (en) | 2009-12-30 | 2012-09-18 | Ethicon Endo-Surgery, Inc. | Dampening device for endoscopic surgical stapler |
US8608046B2 (en) | 2010-01-07 | 2013-12-17 | Ethicon Endo-Surgery, Inc. | Test device for a surgical tool |
US8323302B2 (en) | 2010-02-11 | 2012-12-04 | Ethicon Endo-Surgery, Inc. | Methods of using ultrasonically powered surgical instruments with rotatable cutting implements |
US8961547B2 (en) | 2010-02-11 | 2015-02-24 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments with moving cutting implement |
US8469981B2 (en) | 2010-02-11 | 2013-06-25 | Ethicon Endo-Surgery, Inc. | Rotatable cutting implement arrangements for ultrasonic surgical instruments |
US8579928B2 (en) | 2010-02-11 | 2013-11-12 | Ethicon Endo-Surgery, Inc. | Outer sheath and blade arrangements for ultrasonic surgical instruments |
US8531064B2 (en) | 2010-02-11 | 2013-09-10 | Ethicon Endo-Surgery, Inc. | Ultrasonically powered surgical instruments with rotating cutting implement |
US9259234B2 (en) | 2010-02-11 | 2016-02-16 | Ethicon Endo-Surgery, Llc | Ultrasonic surgical instruments with rotatable blade and hollow sheath arrangements |
US8486096B2 (en) | 2010-02-11 | 2013-07-16 | Ethicon Endo-Surgery, Inc. | Dual purpose surgical instrument for cutting and coagulating tissue |
US8951272B2 (en) | 2010-02-11 | 2015-02-10 | Ethicon Endo-Surgery, Inc. | Seal arrangements for ultrasonically powered surgical instruments |
US8419759B2 (en) | 2010-02-11 | 2013-04-16 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instrument with comb-like tissue trimming device |
US8382782B2 (en) | 2010-02-11 | 2013-02-26 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments with partially rotating blade and fixed pad arrangement |
US8258886B2 (en) | 2010-03-30 | 2012-09-04 | Tyco Healthcare Group Lp | System and method for improved start-up of self-oscillating electro-mechanical surgical devices |
US8696659B2 (en) | 2010-04-30 | 2014-04-15 | Arthrocare Corporation | Electrosurgical system and method having enhanced temperature measurement |
GB2480498A (en) | 2010-05-21 | 2011-11-23 | Ethicon Endo Surgery Inc | Medical device comprising RF circuitry |
US8795327B2 (en) | 2010-07-22 | 2014-08-05 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument with separate closure and cutting members |
US9192431B2 (en) | 2010-07-23 | 2015-11-24 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instrument |
US8789740B2 (en) | 2010-07-30 | 2014-07-29 | Ethicon Endo-Surgery, Inc. | Linear cutting and stapling device with selectively disengageable cutting member |
US8783543B2 (en) | 2010-07-30 | 2014-07-22 | Ethicon Endo-Surgery, Inc. | Tissue acquisition arrangements and methods for surgical stapling devices |
US8672207B2 (en) | 2010-07-30 | 2014-03-18 | Ethicon Endo-Surgery, Inc. | Transwall visualization arrangements and methods for surgical circular staplers |
US8360296B2 (en) | 2010-09-09 | 2013-01-29 | Ethicon Endo-Surgery, Inc. | Surgical stapling head assembly with firing lockout for a surgical stapler |
US8784357B2 (en) | 2010-09-15 | 2014-07-22 | Alcon Research, Ltd. | Phacoemulsification hand piece with two independent transducers |
US10258505B2 (en) | 2010-09-17 | 2019-04-16 | Alcon Research, Ltd. | Balanced phacoemulsification tip |
US9289212B2 (en) | 2010-09-17 | 2016-03-22 | Ethicon Endo-Surgery, Inc. | Surgical instruments and batteries for surgical instruments |
US8632525B2 (en) | 2010-09-17 | 2014-01-21 | Ethicon Endo-Surgery, Inc. | Power control arrangements for surgical instruments and batteries |
US9877720B2 (en) | 2010-09-24 | 2018-01-30 | Ethicon Llc | Control features for articulating surgical device |
US8733613B2 (en) | 2010-09-29 | 2014-05-27 | Ethicon Endo-Surgery, Inc. | Staple cartridge |
US9301753B2 (en) | 2010-09-30 | 2016-04-05 | Ethicon Endo-Surgery, Llc | Expandable tissue thickness compensator |
US9414838B2 (en) | 2012-03-28 | 2016-08-16 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprised of a plurality of materials |
US9220501B2 (en) | 2010-09-30 | 2015-12-29 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensators |
US8893949B2 (en) | 2010-09-30 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Surgical stapler with floating anvil |
US9386988B2 (en) | 2010-09-30 | 2016-07-12 | Ethicon End-Surgery, LLC | Retainer assembly including a tissue thickness compensator |
US9566061B2 (en) | 2010-09-30 | 2017-02-14 | Ethicon Endo-Surgery, Llc | Fastener cartridge comprising a releasably attached tissue thickness compensator |
US9364233B2 (en) | 2010-09-30 | 2016-06-14 | Ethicon Endo-Surgery, Llc | Tissue thickness compensators for circular surgical staplers |
AU2011308701B2 (en) | 2010-09-30 | 2013-11-14 | Ethicon Endo-Surgery, Inc. | Fastener system comprising a retention matrix and an alignment matrix |
US9241714B2 (en) | 2011-04-29 | 2016-01-26 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator and method for making the same |
US11298125B2 (en) | 2010-09-30 | 2022-04-12 | Cilag Gmbh International | Tissue stapler having a thickness compensator |
US9314246B2 (en) | 2010-09-30 | 2016-04-19 | Ethicon Endo-Surgery, Llc | Tissue stapler having a thickness compensator incorporating an anti-inflammatory agent |
US9113862B2 (en) | 2010-09-30 | 2015-08-25 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with a variable staple forming system |
US9517063B2 (en) | 2012-03-28 | 2016-12-13 | Ethicon Endo-Surgery, Llc | Movable member for use with a tissue thickness compensator |
US9629814B2 (en) | 2010-09-30 | 2017-04-25 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator configured to redistribute compressive forces |
US9332974B2 (en) | 2010-09-30 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Layered tissue thickness compensator |
US8740038B2 (en) | 2010-09-30 | 2014-06-03 | Ethicon Endo-Surgery, Inc. | Staple cartridge comprising a releasable portion |
US11925354B2 (en) | 2010-09-30 | 2024-03-12 | Cilag Gmbh International | Staple cartridge comprising staples positioned within a compressible portion thereof |
US9216019B2 (en) | 2011-09-23 | 2015-12-22 | Ethicon Endo-Surgery, Inc. | Surgical stapler with stationary staple drivers |
US10123798B2 (en) | 2010-09-30 | 2018-11-13 | Ethicon Llc | Tissue thickness compensator comprising controlled release and expansion |
US9307989B2 (en) | 2012-03-28 | 2016-04-12 | Ethicon Endo-Surgery, Llc | Tissue stapler having a thickness compensator incorportating a hydrophobic agent |
US11812965B2 (en) | 2010-09-30 | 2023-11-14 | Cilag Gmbh International | Layer of material for a surgical end effector |
US10945731B2 (en) | 2010-09-30 | 2021-03-16 | Ethicon Llc | Tissue thickness compensator comprising controlled release and expansion |
US8695866B2 (en) | 2010-10-01 | 2014-04-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a power control circuit |
USD650074S1 (en) | 2010-10-01 | 2011-12-06 | Ethicon Endo-Surgery, Inc. | Surgical instrument |
US9033204B2 (en) | 2011-03-14 | 2015-05-19 | Ethicon Endo-Surgery, Inc. | Circular stapling devices with tissue-puncturing anvil features |
US8857693B2 (en) | 2011-03-15 | 2014-10-14 | Ethicon Endo-Surgery, Inc. | Surgical instruments with lockable articulating end effector |
US8926598B2 (en) | 2011-03-15 | 2015-01-06 | Ethicon Endo-Surgery, Inc. | Surgical instruments with articulatable and rotatable end effector |
US9044229B2 (en) | 2011-03-15 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Surgical fastener instruments |
US8800841B2 (en) | 2011-03-15 | 2014-08-12 | Ethicon Endo-Surgery, Inc. | Surgical staple cartridges |
US8968293B2 (en) | 2011-04-12 | 2015-03-03 | Covidien Lp | Systems and methods for calibrating power measurements in an electrosurgical generator |
AU2012250197B2 (en) | 2011-04-29 | 2017-08-10 | Ethicon Endo-Surgery, Inc. | Staple cartridge comprising staples positioned within a compressible portion thereof |
US8444664B2 (en) | 2011-05-16 | 2013-05-21 | Covidien Lp | Medical ultrasound instrument with articulated jaws |
US9072535B2 (en) | 2011-05-27 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments with rotatable staple deployment arrangements |
US11207064B2 (en) | 2011-05-27 | 2021-12-28 | Cilag Gmbh International | Automated end effector component reloading system for use with a robotic system |
US8414605B2 (en) | 2011-07-08 | 2013-04-09 | Alcon Research, Ltd. | Vacuum level control of power for phacoemulsification hand piece |
US9259265B2 (en) | 2011-07-22 | 2016-02-16 | Ethicon Endo-Surgery, Llc | Surgical instruments for tensioning tissue |
USD700699S1 (en) | 2011-08-23 | 2014-03-04 | Covidien Ag | Handle for portable surgical device |
US9050627B2 (en) | 2011-09-02 | 2015-06-09 | Abbott Medical Optics Inc. | Systems and methods for ultrasonic power measurement and control of phacoemulsification systems |
US8833632B2 (en) | 2011-09-06 | 2014-09-16 | Ethicon Endo-Surgery, Inc. | Firing member displacement system for a stapling instrument |
US9050084B2 (en) | 2011-09-23 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Staple cartridge including collapsible deck arrangement |
US8662745B2 (en) | 2011-11-11 | 2014-03-04 | Covidien Lp | Methods of measuring conditions of an ultrasonic instrument |
WO2013109269A1 (en) | 2012-01-18 | 2013-07-25 | Bard Peripheral Vascular, Inc. | Vascular re-entry device |
US10076383B2 (en) | 2012-01-25 | 2018-09-18 | Covidien Lp | Electrosurgical device having a multiplexer |
US9351753B2 (en) | 2012-01-30 | 2016-05-31 | Covidien Lp | Ultrasonic medical instrument with a curved waveguide |
JP6165780B2 (en) | 2012-02-10 | 2017-07-19 | エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. | Robot-controlled surgical instrument |
US9044230B2 (en) | 2012-02-13 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status |
US9078653B2 (en) | 2012-03-26 | 2015-07-14 | Ethicon Endo-Surgery, Inc. | Surgical stapling device with lockout system for preventing actuation in the absence of an installed staple cartridge |
JP6105041B2 (en) | 2012-03-28 | 2017-03-29 | エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. | Tissue thickness compensator containing capsules defining a low pressure environment |
MX353040B (en) | 2012-03-28 | 2017-12-18 | Ethicon Endo Surgery Inc | Retainer assembly including a tissue thickness compensator. |
BR112014024102B1 (en) | 2012-03-28 | 2022-03-03 | Ethicon Endo-Surgery, Inc | CLAMP CARTRIDGE ASSEMBLY FOR A SURGICAL INSTRUMENT AND END ACTUATOR ASSEMBLY FOR A SURGICAL INSTRUMENT |
US9198662B2 (en) | 2012-03-28 | 2015-12-01 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator having improved visibility |
US9439668B2 (en) | 2012-04-09 | 2016-09-13 | Ethicon Endo-Surgery, Llc | Switch arrangements for ultrasonic surgical instruments |
US9724118B2 (en) | 2012-04-09 | 2017-08-08 | Ethicon Endo-Surgery, Llc | Techniques for cutting and coagulating tissue for ultrasonic surgical instruments |
US9226766B2 (en) | 2012-04-09 | 2016-01-05 | Ethicon Endo-Surgery, Inc. | Serial communication protocol for medical device |
US9241731B2 (en) | 2012-04-09 | 2016-01-26 | Ethicon Endo-Surgery, Inc. | Rotatable electrical connection for ultrasonic surgical instruments |
US9237921B2 (en) | 2012-04-09 | 2016-01-19 | Ethicon Endo-Surgery, Inc. | Devices and techniques for cutting and coagulating tissue |
US11871901B2 (en) | 2012-05-20 | 2024-01-16 | Cilag Gmbh International | Method for situational awareness for surgical network or surgical network connected device capable of adjusting function based on a sensed situation or usage |
US9149291B2 (en) | 2012-06-11 | 2015-10-06 | Tenex Health, Inc. | Systems and methods for tissue treatment |
US11406415B2 (en) | 2012-06-11 | 2022-08-09 | Tenex Health, Inc. | Systems and methods for tissue treatment |
US9101358B2 (en) | 2012-06-15 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Articulatable surgical instrument comprising a firing drive |
US9119657B2 (en) | 2012-06-28 | 2015-09-01 | Ethicon Endo-Surgery, Inc. | Rotary actuatable closure arrangement for surgical end effector |
US20140001234A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Coupling arrangements for attaching surgical end effectors to drive systems therefor |
US11202631B2 (en) | 2012-06-28 | 2021-12-21 | Cilag Gmbh International | Stapling assembly comprising a firing lockout |
US8747238B2 (en) | 2012-06-28 | 2014-06-10 | Ethicon Endo-Surgery, Inc. | Rotary drive shaft assemblies for surgical instruments with articulatable end effectors |
US9204879B2 (en) | 2012-06-28 | 2015-12-08 | Ethicon Endo-Surgery, Inc. | Flexible drive member |
US9125662B2 (en) | 2012-06-28 | 2015-09-08 | Ethicon Endo-Surgery, Inc. | Multi-axis articulating and rotating surgical tools |
US9289256B2 (en) | 2012-06-28 | 2016-03-22 | Ethicon Endo-Surgery, Llc | Surgical end effectors having angled tissue-contacting surfaces |
BR112014032776B1 (en) | 2012-06-28 | 2021-09-08 | Ethicon Endo-Surgery, Inc | SURGICAL INSTRUMENT SYSTEM AND SURGICAL KIT FOR USE WITH A SURGICAL INSTRUMENT SYSTEM |
EP2866686A1 (en) | 2012-06-28 | 2015-05-06 | Ethicon Endo-Surgery, Inc. | Empty clip cartridge lockout |
US9561038B2 (en) | 2012-06-28 | 2017-02-07 | Ethicon Endo-Surgery, Llc | Interchangeable clip applier |
US20140001231A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Firing system lockout arrangements for surgical instruments |
US9101385B2 (en) | 2012-06-28 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Electrode connections for rotary driven surgical tools |
US9028494B2 (en) | 2012-06-28 | 2015-05-12 | Ethicon Endo-Surgery, Inc. | Interchangeable end effector coupling arrangement |
US9649111B2 (en) | 2012-06-28 | 2017-05-16 | Ethicon Endo-Surgery, Llc | Replaceable clip cartridge for a clip applier |
US20140005705A1 (en) | 2012-06-29 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Surgical instruments with articulating shafts |
US9072536B2 (en) | 2012-06-28 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Differential locking arrangements for rotary powered surgical instruments |
US9408622B2 (en) | 2012-06-29 | 2016-08-09 | Ethicon Endo-Surgery, Llc | Surgical instruments with articulating shafts |
US9351754B2 (en) | 2012-06-29 | 2016-05-31 | Ethicon Endo-Surgery, Llc | Ultrasonic surgical instruments with distally positioned jaw assemblies |
US9820768B2 (en) | 2012-06-29 | 2017-11-21 | Ethicon Llc | Ultrasonic surgical instruments with control mechanisms |
US9283045B2 (en) | 2012-06-29 | 2016-03-15 | Ethicon Endo-Surgery, Llc | Surgical instruments with fluid management system |
US9198714B2 (en) | 2012-06-29 | 2015-12-01 | Ethicon Endo-Surgery, Inc. | Haptic feedback devices for surgical robot |
US9393037B2 (en) | 2012-06-29 | 2016-07-19 | Ethicon Endo-Surgery, Llc | Surgical instruments with articulating shafts |
US20140005702A1 (en) | 2012-06-29 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments with distally positioned transducers |
US9226767B2 (en) | 2012-06-29 | 2016-01-05 | Ethicon Endo-Surgery, Inc. | Closed feedback control for electrosurgical device |
US9326788B2 (en) | 2012-06-29 | 2016-05-03 | Ethicon Endo-Surgery, Llc | Lockout mechanism for use with robotic electrosurgical device |
RU2640564C2 (en) | 2012-08-02 | 2018-01-09 | Бард Периферэл Васкьюлар | Ultrasonic catheter system |
US9492224B2 (en) | 2012-09-28 | 2016-11-15 | EthiconEndo-Surgery, LLC | Multi-function bi-polar forceps |
US9386985B2 (en) | 2012-10-15 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Surgical cutting instrument |
US10201365B2 (en) | 2012-10-22 | 2019-02-12 | Ethicon Llc | Surgeon feedback sensing and display methods |
US9095367B2 (en) | 2012-10-22 | 2015-08-04 | Ethicon Endo-Surgery, Inc. | Flexible harmonic waveguides/blades for surgical instruments |
WO2014074806A1 (en) * | 2012-11-08 | 2014-05-15 | Smith & Nephew, Inc-- | Improved reattachment of detached cartilage to subchondral bone |
AU2013342255B2 (en) | 2012-11-08 | 2017-05-04 | Smith & Nephew, Inc. | Methods and compositions suitable for improved reattachment of detached cartilage to subchondral bone |
US20140135804A1 (en) | 2012-11-15 | 2014-05-15 | Ethicon Endo-Surgery, Inc. | Ultrasonic and electrosurgical devices |
US9386984B2 (en) | 2013-02-08 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Staple cartridge comprising a releasable cover |
US10092292B2 (en) | 2013-02-28 | 2018-10-09 | Ethicon Llc | Staple forming features for surgical stapling instrument |
MX364729B (en) | 2013-03-01 | 2019-05-06 | Ethicon Endo Surgery Inc | Surgical instrument with a soft stop. |
BR112015021098B1 (en) | 2013-03-01 | 2022-02-15 | Ethicon Endo-Surgery, Inc | COVERAGE FOR A JOINT JOINT AND SURGICAL INSTRUMENT |
US9307986B2 (en) | 2013-03-01 | 2016-04-12 | Ethicon Endo-Surgery, Llc | Surgical instrument soft stop |
US20140263552A1 (en) | 2013-03-13 | 2014-09-18 | Ethicon Endo-Surgery, Inc. | Staple cartridge tissue thickness sensor system |
US9888919B2 (en) | 2013-03-14 | 2018-02-13 | Ethicon Llc | Method and system for operating a surgical instrument |
US9629629B2 (en) | 2013-03-14 | 2017-04-25 | Ethicon Endo-Surgey, LLC | Control systems for surgical instruments |
US10226273B2 (en) | 2013-03-14 | 2019-03-12 | Ethicon Llc | Mechanical fasteners for use with surgical energy devices |
US9241728B2 (en) | 2013-03-15 | 2016-01-26 | Ethicon Endo-Surgery, Inc. | Surgical instrument with multiple clamping mechanisms |
US9572577B2 (en) | 2013-03-27 | 2017-02-21 | Ethicon Endo-Surgery, Llc | Fastener cartridge comprising a tissue thickness compensator including openings therein |
US9795384B2 (en) | 2013-03-27 | 2017-10-24 | Ethicon Llc | Fastener cartridge comprising a tissue thickness compensator and a gap setting element |
US9332984B2 (en) | 2013-03-27 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Fastener cartridge assemblies |
BR112015026109B1 (en) | 2013-04-16 | 2022-02-22 | Ethicon Endo-Surgery, Inc | surgical instrument |
US9867612B2 (en) | 2013-04-16 | 2018-01-16 | Ethicon Llc | Powered surgical stapler |
US9574644B2 (en) | 2013-05-30 | 2017-02-21 | Ethicon Endo-Surgery, Llc | Power module for use with a surgical instrument |
US10898167B2 (en) * | 2013-07-24 | 2021-01-26 | Fujifilm Sonosite, Inc. | Portable ultrasound systems with fine-grained power management associated devices, systems, and methods |
US9775609B2 (en) | 2013-08-23 | 2017-10-03 | Ethicon Llc | Tamper proof circuit for surgical instrument battery pack |
MX369362B (en) | 2013-08-23 | 2019-11-06 | Ethicon Endo Surgery Llc | Firing member retraction devices for powered surgical instruments. |
US20140171986A1 (en) | 2013-09-13 | 2014-06-19 | Ethicon Endo-Surgery, Inc. | Surgical Clip Having Comliant Portion |
US9814514B2 (en) | 2013-09-13 | 2017-11-14 | Ethicon Llc | Electrosurgical (RF) medical instruments for cutting and coagulating tissue |
US9265926B2 (en) | 2013-11-08 | 2016-02-23 | Ethicon Endo-Surgery, Llc | Electrosurgical devices |
JP2016529001A (en) * | 2013-11-14 | 2016-09-23 | ジャイラス・エイシーエムアイ・インコーポレイテッド | Feedback-dependent lithotripsy energy delivery |
GB2521228A (en) | 2013-12-16 | 2015-06-17 | Ethicon Endo Surgery Inc | Medical device |
GB2521229A (en) | 2013-12-16 | 2015-06-17 | Ethicon Endo Surgery Inc | Medical device |
US9642620B2 (en) | 2013-12-23 | 2017-05-09 | Ethicon Endo-Surgery, Llc | Surgical cutting and stapling instruments with articulatable end effectors |
US20150173756A1 (en) | 2013-12-23 | 2015-06-25 | Ethicon Endo-Surgery, Inc. | Surgical cutting and stapling methods |
US20150173749A1 (en) | 2013-12-23 | 2015-06-25 | Ethicon Endo-Surgery, Inc. | Surgical staples and staple cartridges |
US9839428B2 (en) | 2013-12-23 | 2017-12-12 | Ethicon Llc | Surgical cutting and stapling instruments with independent jaw control features |
US9681870B2 (en) | 2013-12-23 | 2017-06-20 | Ethicon Llc | Articulatable surgical instruments with separate and distinct closing and firing systems |
US9724092B2 (en) | 2013-12-23 | 2017-08-08 | Ethicon Llc | Modular surgical instruments |
US9795436B2 (en) | 2014-01-07 | 2017-10-24 | Ethicon Llc | Harvesting energy from a surgical generator |
US9962161B2 (en) | 2014-02-12 | 2018-05-08 | Ethicon Llc | Deliverable surgical instrument |
BR112016019387B1 (en) | 2014-02-24 | 2022-11-29 | Ethicon Endo-Surgery, Llc | SURGICAL INSTRUMENT SYSTEM AND FASTENER CARTRIDGE FOR USE WITH A SURGICAL FIXING INSTRUMENT |
US9757124B2 (en) | 2014-02-24 | 2017-09-12 | Ethicon Llc | Implantable layer assemblies |
US9526556B2 (en) | 2014-02-28 | 2016-12-27 | Arthrocare Corporation | Systems and methods systems related to electrosurgical wands with screen electrodes |
US9554854B2 (en) | 2014-03-18 | 2017-01-31 | Ethicon Endo-Surgery, Llc | Detecting short circuits in electrosurgical medical devices |
BR112016021943B1 (en) | 2014-03-26 | 2022-06-14 | Ethicon Endo-Surgery, Llc | SURGICAL INSTRUMENT FOR USE BY AN OPERATOR IN A SURGICAL PROCEDURE |
US9826977B2 (en) | 2014-03-26 | 2017-11-28 | Ethicon Llc | Sterilization verification circuit |
US10028761B2 (en) | 2014-03-26 | 2018-07-24 | Ethicon Llc | Feedback algorithms for manual bailout systems for surgical instruments |
US9913642B2 (en) | 2014-03-26 | 2018-03-13 | Ethicon Llc | Surgical instrument comprising a sensor system |
US9820738B2 (en) | 2014-03-26 | 2017-11-21 | Ethicon Llc | Surgical instrument comprising interactive systems |
US10463421B2 (en) | 2014-03-27 | 2019-11-05 | Ethicon Llc | Two stage trigger, clamp and cut bipolar vessel sealer |
US10092310B2 (en) | 2014-03-27 | 2018-10-09 | Ethicon Llc | Electrosurgical devices |
US9737355B2 (en) | 2014-03-31 | 2017-08-22 | Ethicon Llc | Controlling impedance rise in electrosurgical medical devices |
US9913680B2 (en) | 2014-04-15 | 2018-03-13 | Ethicon Llc | Software algorithms for electrosurgical instruments |
JP6612256B2 (en) | 2014-04-16 | 2019-11-27 | エシコン エルエルシー | Fastener cartridge with non-uniform fastener |
US9801628B2 (en) | 2014-09-26 | 2017-10-31 | Ethicon Llc | Surgical staple and driver arrangements for staple cartridges |
US20150297225A1 (en) | 2014-04-16 | 2015-10-22 | Ethicon Endo-Surgery, Inc. | Fastener cartridges including extensions having different configurations |
JP6532889B2 (en) | 2014-04-16 | 2019-06-19 | エシコン エルエルシーEthicon LLC | Fastener cartridge assembly and staple holder cover arrangement |
JP6636452B2 (en) | 2014-04-16 | 2020-01-29 | エシコン エルエルシーEthicon LLC | Fastener cartridge including extension having different configurations |
US11517315B2 (en) | 2014-04-16 | 2022-12-06 | Cilag Gmbh International | Fastener cartridges including extensions having different configurations |
US10045781B2 (en) | 2014-06-13 | 2018-08-14 | Ethicon Llc | Closure lockout systems for surgical instruments |
US9597142B2 (en) | 2014-07-24 | 2017-03-21 | Arthrocare Corporation | Method and system related to electrosurgical procedures |
US9649148B2 (en) | 2014-07-24 | 2017-05-16 | Arthrocare Corporation | Electrosurgical system and method having enhanced arc prevention |
US10285724B2 (en) | 2014-07-31 | 2019-05-14 | Ethicon Llc | Actuation mechanisms and load adjustment assemblies for surgical instruments |
US9962181B2 (en) | 2014-09-02 | 2018-05-08 | Tenex Health, Inc. | Subcutaneous wound debridement |
US11311294B2 (en) | 2014-09-05 | 2022-04-26 | Cilag Gmbh International | Powered medical device including measurement of closure state of jaws |
BR112017004361B1 (en) | 2014-09-05 | 2023-04-11 | Ethicon Llc | ELECTRONIC SYSTEM FOR A SURGICAL INSTRUMENT |
US20160066913A1 (en) | 2014-09-05 | 2016-03-10 | Ethicon Endo-Surgery, Inc. | Local display of tissue parameter stabilization |
US10105142B2 (en) | 2014-09-18 | 2018-10-23 | Ethicon Llc | Surgical stapler with plurality of cutting elements |
US11523821B2 (en) | 2014-09-26 | 2022-12-13 | Cilag Gmbh International | Method for creating a flexible staple line |
CN107427300B (en) | 2014-09-26 | 2020-12-04 | 伊西康有限责任公司 | Surgical suture buttress and buttress material |
US10076325B2 (en) | 2014-10-13 | 2018-09-18 | Ethicon Llc | Surgical stapling apparatus comprising a tissue stop |
US9924944B2 (en) | 2014-10-16 | 2018-03-27 | Ethicon Llc | Staple cartridge comprising an adjunct material |
US11141153B2 (en) | 2014-10-29 | 2021-10-12 | Cilag Gmbh International | Staple cartridges comprising driver arrangements |
US10517594B2 (en) | 2014-10-29 | 2019-12-31 | Ethicon Llc | Cartridge assemblies for surgical staplers |
US9844376B2 (en) | 2014-11-06 | 2017-12-19 | Ethicon Llc | Staple cartridge comprising a releasable adjunct material |
US10639092B2 (en) | 2014-12-08 | 2020-05-05 | Ethicon Llc | Electrode configurations for surgical instruments |
US10736636B2 (en) | 2014-12-10 | 2020-08-11 | Ethicon Llc | Articulatable surgical instrument system |
US9987000B2 (en) | 2014-12-18 | 2018-06-05 | Ethicon Llc | Surgical instrument assembly comprising a flexible articulation system |
US10188385B2 (en) | 2014-12-18 | 2019-01-29 | Ethicon Llc | Surgical instrument system comprising lockable systems |
US9844375B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Drive arrangements for articulatable surgical instruments |
US9844374B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member |
US10117649B2 (en) | 2014-12-18 | 2018-11-06 | Ethicon Llc | Surgical instrument assembly comprising a lockable articulation system |
US10245027B2 (en) | 2014-12-18 | 2019-04-02 | Ethicon Llc | Surgical instrument with an anvil that is selectively movable about a discrete non-movable axis relative to a staple cartridge |
US10085748B2 (en) | 2014-12-18 | 2018-10-02 | Ethicon Llc | Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors |
BR112017012996B1 (en) | 2014-12-18 | 2022-11-08 | Ethicon Llc | SURGICAL INSTRUMENT WITH AN ANvil WHICH IS SELECTIVELY MOVABLE ABOUT AN IMMOVABLE GEOMETRIC AXIS DIFFERENT FROM A STAPLE CARTRIDGE |
US10245095B2 (en) | 2015-02-06 | 2019-04-02 | Ethicon Llc | Electrosurgical instrument with rotation and articulation mechanisms |
US10180463B2 (en) | 2015-02-27 | 2019-01-15 | Ethicon Llc | Surgical apparatus configured to assess whether a performance parameter of the surgical apparatus is within an acceptable performance band |
US10182816B2 (en) | 2015-02-27 | 2019-01-22 | Ethicon Llc | Charging system that enables emergency resolutions for charging a battery |
US11154301B2 (en) | 2015-02-27 | 2021-10-26 | Cilag Gmbh International | Modular stapling assembly |
US10226250B2 (en) | 2015-02-27 | 2019-03-12 | Ethicon Llc | Modular stapling assembly |
US9924961B2 (en) | 2015-03-06 | 2018-03-27 | Ethicon Endo-Surgery, Llc | Interactive feedback system for powered surgical instruments |
US9808246B2 (en) | 2015-03-06 | 2017-11-07 | Ethicon Endo-Surgery, Llc | Method of operating a powered surgical instrument |
US10687806B2 (en) | 2015-03-06 | 2020-06-23 | Ethicon Llc | Adaptive tissue compression techniques to adjust closure rates for multiple tissue types |
US9895148B2 (en) | 2015-03-06 | 2018-02-20 | Ethicon Endo-Surgery, Llc | Monitoring speed control and precision incrementing of motor for powered surgical instruments |
US10441279B2 (en) | 2015-03-06 | 2019-10-15 | Ethicon Llc | Multiple level thresholds to modify operation of powered surgical instruments |
JP2020121162A (en) | 2015-03-06 | 2020-08-13 | エシコン エルエルシーEthicon LLC | Time dependent evaluation of sensor data to determine stability element, creep element and viscoelastic element of measurement |
US10052044B2 (en) | 2015-03-06 | 2018-08-21 | Ethicon Llc | Time dependent evaluation of sensor data to determine stability, creep, and viscoelastic elements of measures |
US9993248B2 (en) | 2015-03-06 | 2018-06-12 | Ethicon Endo-Surgery, Llc | Smart sensors with local signal processing |
US10245033B2 (en) | 2015-03-06 | 2019-04-02 | Ethicon Llc | Surgical instrument comprising a lockable battery housing |
US10617412B2 (en) | 2015-03-06 | 2020-04-14 | Ethicon Llc | System for detecting the mis-insertion of a staple cartridge into a surgical stapler |
US10045776B2 (en) | 2015-03-06 | 2018-08-14 | Ethicon Llc | Control techniques and sub-processor contained within modular shaft with select control processing from handle |
US9901342B2 (en) | 2015-03-06 | 2018-02-27 | Ethicon Endo-Surgery, Llc | Signal and power communication system positioned on a rotatable shaft |
US10321950B2 (en) | 2015-03-17 | 2019-06-18 | Ethicon Llc | Managing tissue treatment |
US10342602B2 (en) | 2015-03-17 | 2019-07-09 | Ethicon Llc | Managing tissue treatment |
US10595929B2 (en) | 2015-03-24 | 2020-03-24 | Ethicon Llc | Surgical instruments with firing system overload protection mechanisms |
US10390825B2 (en) | 2015-03-31 | 2019-08-27 | Ethicon Llc | Surgical instrument with progressive rotary drive systems |
US9763689B2 (en) * | 2015-05-12 | 2017-09-19 | Tenex Health, Inc. | Elongated needles for ultrasonic applications |
US10034684B2 (en) | 2015-06-15 | 2018-07-31 | Ethicon Llc | Apparatus and method for dissecting and coagulating tissue |
US11020140B2 (en) | 2015-06-17 | 2021-06-01 | Cilag Gmbh International | Ultrasonic surgical blade for use with ultrasonic surgical instruments |
AU2016280071B2 (en) | 2015-06-17 | 2021-04-01 | Stryker European Operations Holdings Llc | Surgical instrument with ultrasonic tip for fibrous tissue removal |
US10178992B2 (en) | 2015-06-18 | 2019-01-15 | Ethicon Llc | Push/pull articulation drive systems for articulatable surgical instruments |
US10898256B2 (en) | 2015-06-30 | 2021-01-26 | Ethicon Llc | Surgical system with user adaptable techniques based on tissue impedance |
US11129669B2 (en) | 2015-06-30 | 2021-09-28 | Cilag Gmbh International | Surgical system with user adaptable techniques based on tissue type |
US11141213B2 (en) | 2015-06-30 | 2021-10-12 | Cilag Gmbh International | Surgical instrument with user adaptable techniques |
US10034704B2 (en) | 2015-06-30 | 2018-07-31 | Ethicon Llc | Surgical instrument with user adaptable algorithms |
US11051873B2 (en) | 2015-06-30 | 2021-07-06 | Cilag Gmbh International | Surgical system with user adaptable techniques employing multiple energy modalities based on tissue parameters |
US10357303B2 (en) | 2015-06-30 | 2019-07-23 | Ethicon Llc | Translatable outer tube for sealing using shielded lap chole dissector |
US10154852B2 (en) | 2015-07-01 | 2018-12-18 | Ethicon Llc | Ultrasonic surgical blade with improved cutting and coagulation features |
US10835249B2 (en) | 2015-08-17 | 2020-11-17 | Ethicon Llc | Implantable layers for a surgical instrument |
US11103248B2 (en) | 2015-08-26 | 2021-08-31 | Cilag Gmbh International | Surgical staples for minimizing staple roll |
CN108348233B (en) | 2015-08-26 | 2021-05-07 | 伊西康有限责任公司 | Surgical staple strip for allowing changing staple characteristics and achieving easy cartridge loading |
MX2022009705A (en) | 2015-08-26 | 2022-11-07 | Ethicon Llc | Surgical staples comprising hardness variations for improved fastening of tissue. |
WO2017037790A1 (en) * | 2015-08-28 | 2017-03-09 | オリンパス株式会社 | Ultrasonic surgery system and method for operating ultrasonic surgery system |
US10314587B2 (en) | 2015-09-02 | 2019-06-11 | Ethicon Llc | Surgical staple cartridge with improved staple driver configurations |
MX2022006191A (en) | 2015-09-02 | 2022-06-16 | Ethicon Llc | Surgical staple configurations with camming surfaces located between portions supporting surgical staples. |
US10085751B2 (en) | 2015-09-23 | 2018-10-02 | Ethicon Llc | Surgical stapler having temperature-based motor control |
US10327769B2 (en) | 2015-09-23 | 2019-06-25 | Ethicon Llc | Surgical stapler having motor control based on a drive system component |
US10238386B2 (en) | 2015-09-23 | 2019-03-26 | Ethicon Llc | Surgical stapler having motor control based on an electrical parameter related to a motor current |
US10105139B2 (en) | 2015-09-23 | 2018-10-23 | Ethicon Llc | Surgical stapler having downstream current-based motor control |
US10363036B2 (en) | 2015-09-23 | 2019-07-30 | Ethicon Llc | Surgical stapler having force-based motor control |
US10076326B2 (en) | 2015-09-23 | 2018-09-18 | Ethicon Llc | Surgical stapler having current mirror-based motor control |
US10299878B2 (en) | 2015-09-25 | 2019-05-28 | Ethicon Llc | Implantable adjunct systems for determining adjunct skew |
US10265549B2 (en) * | 2015-09-28 | 2019-04-23 | Olympus Corporation | Treatment method |
US10201366B2 (en) * | 2015-09-28 | 2019-02-12 | Olympus Corporation | Treatment method |
US10194932B2 (en) * | 2015-09-28 | 2019-02-05 | Olympus Corporation | Treatment method |
US20170086874A1 (en) * | 2015-09-28 | 2017-03-30 | Olympus Corporation | Treatment method using ultrasonic surgical system |
US10980539B2 (en) | 2015-09-30 | 2021-04-20 | Ethicon Llc | Implantable adjunct comprising bonded layers |
US10736633B2 (en) | 2015-09-30 | 2020-08-11 | Ethicon Llc | Compressible adjunct with looping members |
US10172620B2 (en) | 2015-09-30 | 2019-01-08 | Ethicon Llc | Compressible adjuncts with bonding nodes |
US11058475B2 (en) | 2015-09-30 | 2021-07-13 | Cilag Gmbh International | Method and apparatus for selecting operations of a surgical instrument based on user intention |
US11890015B2 (en) | 2015-09-30 | 2024-02-06 | Cilag Gmbh International | Compressible adjunct with crossing spacer fibers |
US10595930B2 (en) | 2015-10-16 | 2020-03-24 | Ethicon Llc | Electrode wiping surgical device |
US10292704B2 (en) | 2015-12-30 | 2019-05-21 | Ethicon Llc | Mechanisms for compensating for battery pack failure in powered surgical instruments |
US10368865B2 (en) | 2015-12-30 | 2019-08-06 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10179022B2 (en) | 2015-12-30 | 2019-01-15 | Ethicon Llc | Jaw position impedance limiter for electrosurgical instrument |
US10265068B2 (en) | 2015-12-30 | 2019-04-23 | Ethicon Llc | Surgical instruments with separable motors and motor control circuits |
US10575892B2 (en) | 2015-12-31 | 2020-03-03 | Ethicon Llc | Adapter for electrical surgical instruments |
US10716615B2 (en) | 2016-01-15 | 2020-07-21 | Ethicon Llc | Modular battery powered handheld surgical instrument with curved end effectors having asymmetric engagement between jaw and blade |
US10842523B2 (en) | 2016-01-15 | 2020-11-24 | Ethicon Llc | Modular battery powered handheld surgical instrument and methods therefor |
US11129670B2 (en) | 2016-01-15 | 2021-09-28 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with selective application of energy based on button displacement, intensity, or local tissue characterization |
US11229471B2 (en) | 2016-01-15 | 2022-01-25 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with selective application of energy based on tissue characterization |
US11213293B2 (en) | 2016-02-09 | 2022-01-04 | Cilag Gmbh International | Articulatable surgical instruments with single articulation link arrangements |
CN108882932B (en) | 2016-02-09 | 2021-07-23 | 伊西康有限责任公司 | Surgical instrument with asymmetric articulation configuration |
US10588625B2 (en) | 2016-02-09 | 2020-03-17 | Ethicon Llc | Articulatable surgical instruments with off-axis firing beam arrangements |
US11224426B2 (en) | 2016-02-12 | 2022-01-18 | Cilag Gmbh International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10258331B2 (en) | 2016-02-12 | 2019-04-16 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10448948B2 (en) | 2016-02-12 | 2019-10-22 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10555769B2 (en) | 2016-02-22 | 2020-02-11 | Ethicon Llc | Flexible circuits for electrosurgical instrument |
JP6596577B2 (en) * | 2016-03-31 | 2019-10-23 | オリンパス株式会社 | Ultrasound treatment system for joints |
WO2017168707A1 (en) * | 2016-03-31 | 2017-10-05 | オリンパス株式会社 | Ultrasound surgical instrument and treatment method using ultrasound surgical device |
US10307159B2 (en) | 2016-04-01 | 2019-06-04 | Ethicon Llc | Surgical instrument handle assembly with reconfigurable grip portion |
US11045191B2 (en) | 2016-04-01 | 2021-06-29 | Cilag Gmbh International | Method for operating a surgical stapling system |
US11284890B2 (en) | 2016-04-01 | 2022-03-29 | Cilag Gmbh International | Circular stapling system comprising an incisable tissue support |
US10617413B2 (en) | 2016-04-01 | 2020-04-14 | Ethicon Llc | Closure system arrangements for surgical cutting and stapling devices with separate and distinct firing shafts |
US10485542B2 (en) | 2016-04-01 | 2019-11-26 | Ethicon Llc | Surgical stapling instrument comprising multiple lockouts |
WO2017176715A1 (en) | 2016-04-04 | 2017-10-12 | Briscoe Kurt | Dual function piezoelectric device |
US10335145B2 (en) | 2016-04-15 | 2019-07-02 | Ethicon Llc | Modular surgical instrument with configurable operating mode |
US10492783B2 (en) | 2016-04-15 | 2019-12-03 | Ethicon, Llc | Surgical instrument with improved stop/start control during a firing motion |
US11179150B2 (en) | 2016-04-15 | 2021-11-23 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10405859B2 (en) | 2016-04-15 | 2019-09-10 | Ethicon Llc | Surgical instrument with adjustable stop/start control during a firing motion |
US11607239B2 (en) | 2016-04-15 | 2023-03-21 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10426467B2 (en) | 2016-04-15 | 2019-10-01 | Ethicon Llc | Surgical instrument with detection sensors |
US10456137B2 (en) | 2016-04-15 | 2019-10-29 | Ethicon Llc | Staple formation detection mechanisms |
US10357247B2 (en) | 2016-04-15 | 2019-07-23 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US10828028B2 (en) | 2016-04-15 | 2020-11-10 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US11317917B2 (en) | 2016-04-18 | 2022-05-03 | Cilag Gmbh International | Surgical stapling system comprising a lockable firing assembly |
US10426469B2 (en) | 2016-04-18 | 2019-10-01 | Ethicon Llc | Surgical instrument comprising a primary firing lockout and a secondary firing lockout |
US20170296173A1 (en) | 2016-04-18 | 2017-10-19 | Ethicon Endo-Surgery, Llc | Method for operating a surgical instrument |
USD820441S1 (en) | 2016-06-13 | 2018-06-12 | Integra Lifesciences Nr Ireland Limited | Surgical handpiece nosecone |
AU2017257421B2 (en) | 2016-04-25 | 2021-05-13 | Integra Lifesciences Enterprises, Lllp | Flue for ultrasonic aspiration surgical horn |
US10702329B2 (en) | 2016-04-29 | 2020-07-07 | Ethicon Llc | Jaw structure with distal post for electrosurgical instruments |
US10485607B2 (en) | 2016-04-29 | 2019-11-26 | Ethicon Llc | Jaw structure with distal closure for electrosurgical instruments |
US10646269B2 (en) | 2016-04-29 | 2020-05-12 | Ethicon Llc | Non-linear jaw gap for electrosurgical instruments |
US10456193B2 (en) | 2016-05-03 | 2019-10-29 | Ethicon Llc | Medical device with a bilateral jaw configuration for nerve stimulation |
EP3463125B1 (en) | 2016-05-24 | 2022-08-31 | Integra LifeSciences Enterprises, LLLP | Ergonomic tubing attachment for medical apparatus |
CN109310431B (en) | 2016-06-24 | 2022-03-04 | 伊西康有限责任公司 | Staple cartridge comprising wire staples and punch staples |
USD847989S1 (en) | 2016-06-24 | 2019-05-07 | Ethicon Llc | Surgical fastener cartridge |
USD850617S1 (en) | 2016-06-24 | 2019-06-04 | Ethicon Llc | Surgical fastener cartridge |
US10542979B2 (en) | 2016-06-24 | 2020-01-28 | Ethicon Llc | Stamped staples and staple cartridges using the same |
USD826405S1 (en) | 2016-06-24 | 2018-08-21 | Ethicon Llc | Surgical fastener |
US10245064B2 (en) | 2016-07-12 | 2019-04-02 | Ethicon Llc | Ultrasonic surgical instrument with piezoelectric central lumen transducer |
US10893883B2 (en) | 2016-07-13 | 2021-01-19 | Ethicon Llc | Ultrasonic assembly for use with ultrasonic surgical instruments |
US10842522B2 (en) | 2016-07-15 | 2020-11-24 | Ethicon Llc | Ultrasonic surgical instruments having offset blades |
US10376305B2 (en) | 2016-08-05 | 2019-08-13 | Ethicon Llc | Methods and systems for advanced harmonic energy |
US10285723B2 (en) | 2016-08-09 | 2019-05-14 | Ethicon Llc | Ultrasonic surgical blade with improved heel portion |
USD847990S1 (en) | 2016-08-16 | 2019-05-07 | Ethicon Llc | Surgical instrument |
US10952759B2 (en) | 2016-08-25 | 2021-03-23 | Ethicon Llc | Tissue loading of a surgical instrument |
US10828056B2 (en) | 2016-08-25 | 2020-11-10 | Ethicon Llc | Ultrasonic transducer to waveguide acoustic coupling, connections, and configurations |
JP7030789B2 (en) | 2016-11-16 | 2022-03-07 | インテグラ ライフサイエンシーズ エンタープライジーズ, エルエルエルピー | Ultrasound Surgery Handpiece |
US10687840B1 (en) | 2016-11-17 | 2020-06-23 | Integra Lifesciences Nr Ireland Limited | Ultrasonic transducer tissue selectivity |
US10987124B2 (en) | 2016-11-22 | 2021-04-27 | Covidien Lp | Surgical instruments and jaw members thereof |
US20180140321A1 (en) | 2016-11-23 | 2018-05-24 | C. R. Bard, Inc. | Catheter With Retractable Sheath And Methods Thereof |
US10603064B2 (en) | 2016-11-28 | 2020-03-31 | Ethicon Llc | Ultrasonic transducer |
US11266430B2 (en) | 2016-11-29 | 2022-03-08 | Cilag Gmbh International | End effector control and calibration |
US11596726B2 (en) | 2016-12-17 | 2023-03-07 | C.R. Bard, Inc. | Ultrasound devices for removing clots from catheters and related methods |
US10888322B2 (en) | 2016-12-21 | 2021-01-12 | Ethicon Llc | Surgical instrument comprising a cutting member |
US10945727B2 (en) | 2016-12-21 | 2021-03-16 | Ethicon Llc | Staple cartridge with deformable driver retention features |
US10485543B2 (en) | 2016-12-21 | 2019-11-26 | Ethicon Llc | Anvil having a knife slot width |
BR112019011947A2 (en) | 2016-12-21 | 2019-10-29 | Ethicon Llc | surgical stapling systems |
US10758230B2 (en) | 2016-12-21 | 2020-09-01 | Ethicon Llc | Surgical instrument with primary and safety processors |
US20180168615A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Method of deforming staples from two different types of staple cartridges with the same surgical stapling instrument |
US10542982B2 (en) | 2016-12-21 | 2020-01-28 | Ethicon Llc | Shaft assembly comprising first and second articulation lockouts |
US10695055B2 (en) | 2016-12-21 | 2020-06-30 | Ethicon Llc | Firing assembly comprising a lockout |
US10610224B2 (en) | 2016-12-21 | 2020-04-07 | Ethicon Llc | Lockout arrangements for surgical end effectors and replaceable tool assemblies |
US10993715B2 (en) | 2016-12-21 | 2021-05-04 | Ethicon Llc | Staple cartridge comprising staples with different clamping breadths |
US10639034B2 (en) | 2016-12-21 | 2020-05-05 | Ethicon Llc | Surgical instruments with lockout arrangements for preventing firing system actuation unless an unspent staple cartridge is present |
US11684367B2 (en) | 2016-12-21 | 2023-06-27 | Cilag Gmbh International | Stepped assembly having and end-of-life indicator |
US11134942B2 (en) | 2016-12-21 | 2021-10-05 | Cilag Gmbh International | Surgical stapling instruments and staple-forming anvils |
US20180168648A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Durability features for end effectors and firing assemblies of surgical stapling instruments |
US11419606B2 (en) | 2016-12-21 | 2022-08-23 | Cilag Gmbh International | Shaft assembly comprising a clutch configured to adapt the output of a rotary firing member to two different systems |
US10426471B2 (en) | 2016-12-21 | 2019-10-01 | Ethicon Llc | Surgical instrument with multiple failure response modes |
JP7010956B2 (en) | 2016-12-21 | 2022-01-26 | エシコン エルエルシー | How to staple tissue |
CN110099619B (en) | 2016-12-21 | 2022-07-15 | 爱惜康有限责任公司 | Lockout device for surgical end effector and replaceable tool assembly |
US10835246B2 (en) | 2016-12-21 | 2020-11-17 | Ethicon Llc | Staple cartridges and arrangements of staples and staple cavities therein |
US20180168618A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Surgical stapling systems |
US10898186B2 (en) | 2016-12-21 | 2021-01-26 | Ethicon Llc | Staple forming pocket arrangements comprising primary sidewalls and pocket sidewalls |
US10687810B2 (en) | 2016-12-21 | 2020-06-23 | Ethicon Llc | Stepped staple cartridge with tissue retention and gap setting features |
US10537325B2 (en) | 2016-12-21 | 2020-01-21 | Ethicon Llc | Staple forming pocket arrangement to accommodate different types of staples |
US10980536B2 (en) | 2016-12-21 | 2021-04-20 | Ethicon Llc | No-cartridge and spent cartridge lockout arrangements for surgical staplers |
US10758256B2 (en) | 2016-12-22 | 2020-09-01 | C. R. Bard, Inc. | Ultrasonic endovascular catheter |
US10582983B2 (en) | 2017-02-06 | 2020-03-10 | C. R. Bard, Inc. | Ultrasonic endovascular catheter with a controllable sheath |
US10980537B2 (en) | 2017-06-20 | 2021-04-20 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified number of shaft rotations |
US10813639B2 (en) | 2017-06-20 | 2020-10-27 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on system conditions |
US11653914B2 (en) | 2017-06-20 | 2023-05-23 | Cilag Gmbh International | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument according to articulation angle of end effector |
USD879809S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with changeable graphical user interface |
US10624633B2 (en) | 2017-06-20 | 2020-04-21 | Ethicon Llc | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument |
US10646220B2 (en) | 2017-06-20 | 2020-05-12 | Ethicon Llc | Systems and methods for controlling displacement member velocity for a surgical instrument |
US10888321B2 (en) | 2017-06-20 | 2021-01-12 | Ethicon Llc | Systems and methods for controlling velocity of a displacement member of a surgical stapling and cutting instrument |
US10307170B2 (en) | 2017-06-20 | 2019-06-04 | Ethicon Llc | Method for closed loop control of motor velocity of a surgical stapling and cutting instrument |
US10368864B2 (en) | 2017-06-20 | 2019-08-06 | Ethicon Llc | Systems and methods for controlling displaying motor velocity for a surgical instrument |
US10881399B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Techniques for adaptive control of motor velocity of a surgical stapling and cutting instrument |
US11517325B2 (en) | 2017-06-20 | 2022-12-06 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured displacement distance traveled over a specified time interval |
USD890784S1 (en) | 2017-06-20 | 2020-07-21 | Ethicon Llc | Display panel with changeable graphical user interface |
US11071554B2 (en) | 2017-06-20 | 2021-07-27 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on magnitude of velocity error measurements |
US10390841B2 (en) | 2017-06-20 | 2019-08-27 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
US11382638B2 (en) | 2017-06-20 | 2022-07-12 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified displacement distance |
US10881396B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Surgical instrument with variable duration trigger arrangement |
US11090046B2 (en) | 2017-06-20 | 2021-08-17 | Cilag Gmbh International | Systems and methods for controlling displacement member motion of a surgical stapling and cutting instrument |
US10327767B2 (en) | 2017-06-20 | 2019-06-25 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
USD879808S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with graphical user interface |
US10779820B2 (en) | 2017-06-20 | 2020-09-22 | Ethicon Llc | Systems and methods for controlling motor speed according to user input for a surgical instrument |
US11266405B2 (en) | 2017-06-27 | 2022-03-08 | Cilag Gmbh International | Surgical anvil manufacturing methods |
US11141154B2 (en) | 2017-06-27 | 2021-10-12 | Cilag Gmbh International | Surgical end effectors and anvils |
US10772629B2 (en) | 2017-06-27 | 2020-09-15 | Ethicon Llc | Surgical anvil arrangements |
US10856869B2 (en) | 2017-06-27 | 2020-12-08 | Ethicon Llc | Surgical anvil arrangements |
US11324503B2 (en) | 2017-06-27 | 2022-05-10 | Cilag Gmbh International | Surgical firing member arrangements |
US10993716B2 (en) | 2017-06-27 | 2021-05-04 | Ethicon Llc | Surgical anvil arrangements |
USD869655S1 (en) | 2017-06-28 | 2019-12-10 | Ethicon Llc | Surgical fastener cartridge |
US10211586B2 (en) | 2017-06-28 | 2019-02-19 | Ethicon Llc | Surgical shaft assemblies with watertight housings |
EP3420947B1 (en) | 2017-06-28 | 2022-05-25 | Cilag GmbH International | Surgical instrument comprising selectively actuatable rotatable couplers |
US10903685B2 (en) | 2017-06-28 | 2021-01-26 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies forming capacitive channels |
USD854151S1 (en) | 2017-06-28 | 2019-07-16 | Ethicon Llc | Surgical instrument shaft |
US10786253B2 (en) | 2017-06-28 | 2020-09-29 | Ethicon Llc | Surgical end effectors with improved jaw aperture arrangements |
US10716614B2 (en) | 2017-06-28 | 2020-07-21 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies with increased contact pressure |
USD906355S1 (en) | 2017-06-28 | 2020-12-29 | Ethicon Llc | Display screen or portion thereof with a graphical user interface for a surgical instrument |
US11564686B2 (en) | 2017-06-28 | 2023-01-31 | Cilag Gmbh International | Surgical shaft assemblies with flexible interfaces |
US11246592B2 (en) | 2017-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical instrument comprising an articulation system lockable to a frame |
US11389161B2 (en) | 2017-06-28 | 2022-07-19 | Cilag Gmbh International | Surgical instrument comprising selectively actuatable rotatable couplers |
USD851762S1 (en) | 2017-06-28 | 2019-06-18 | Ethicon Llc | Anvil |
US10765427B2 (en) | 2017-06-28 | 2020-09-08 | Ethicon Llc | Method for articulating a surgical instrument |
US11259805B2 (en) | 2017-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical instrument comprising firing member supports |
US10898183B2 (en) | 2017-06-29 | 2021-01-26 | Ethicon Llc | Robotic surgical instrument with closed loop feedback techniques for advancement of closure member during firing |
US10258418B2 (en) | 2017-06-29 | 2019-04-16 | Ethicon Llc | System for controlling articulation forces |
US10398434B2 (en) | 2017-06-29 | 2019-09-03 | Ethicon Llc | Closed loop velocity control of closure member for robotic surgical instrument |
US10932772B2 (en) | 2017-06-29 | 2021-03-02 | Ethicon Llc | Methods for closed loop velocity control for robotic surgical instrument |
US11007022B2 (en) | 2017-06-29 | 2021-05-18 | Ethicon Llc | Closed loop velocity control techniques based on sensed tissue parameters for robotic surgical instrument |
US10820920B2 (en) | 2017-07-05 | 2020-11-03 | Ethicon Llc | Reusable ultrasonic medical devices and methods of their use |
US11304695B2 (en) | 2017-08-03 | 2022-04-19 | Cilag Gmbh International | Surgical system shaft interconnection |
US11471155B2 (en) | 2017-08-03 | 2022-10-18 | Cilag Gmbh International | Surgical system bailout |
US11944300B2 (en) | 2017-08-03 | 2024-04-02 | Cilag Gmbh International | Method for operating a surgical system bailout |
US10796471B2 (en) | 2017-09-29 | 2020-10-06 | Ethicon Llc | Systems and methods of displaying a knife position for a surgical instrument |
US10729501B2 (en) | 2017-09-29 | 2020-08-04 | Ethicon Llc | Systems and methods for language selection of a surgical instrument |
US10765429B2 (en) | 2017-09-29 | 2020-09-08 | Ethicon Llc | Systems and methods for providing alerts according to the operational state of a surgical instrument |
USD907648S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
US11399829B2 (en) | 2017-09-29 | 2022-08-02 | Cilag Gmbh International | Systems and methods of initiating a power shutdown mode for a surgical instrument |
US10743872B2 (en) | 2017-09-29 | 2020-08-18 | Ethicon Llc | System and methods for controlling a display of a surgical instrument |
USD917500S1 (en) | 2017-09-29 | 2021-04-27 | Ethicon Llc | Display screen or portion thereof with graphical user interface |
USD907647S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
US11911045B2 (en) | 2017-10-30 | 2024-02-27 | Cllag GmbH International | Method for operating a powered articulating multi-clip applier |
US11134944B2 (en) | 2017-10-30 | 2021-10-05 | Cilag Gmbh International | Surgical stapler knife motion controls |
US11801098B2 (en) | 2017-10-30 | 2023-10-31 | Cilag Gmbh International | Method of hub communication with surgical instrument systems |
US11759224B2 (en) | 2017-10-30 | 2023-09-19 | Cilag Gmbh International | Surgical instrument systems comprising handle arrangements |
US11090075B2 (en) | 2017-10-30 | 2021-08-17 | Cilag Gmbh International | Articulation features for surgical end effector |
US10779903B2 (en) | 2017-10-31 | 2020-09-22 | Ethicon Llc | Positive shaft rotation lock activated by jaw closure |
US10842490B2 (en) | 2017-10-31 | 2020-11-24 | Ethicon Llc | Cartridge body design with force reduction based on firing completion |
JP6556808B2 (en) * | 2017-11-14 | 2019-08-07 | ミクロン精密株式会社 | Handpiece type high frequency vibration cutting machine |
US11197670B2 (en) | 2017-12-15 | 2021-12-14 | Cilag Gmbh International | Surgical end effectors with pivotal jaws configured to touch at their respective distal ends when fully closed |
US10743875B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Surgical end effectors with jaw stiffener arrangements configured to permit monitoring of firing member |
US10966718B2 (en) | 2017-12-15 | 2021-04-06 | Ethicon Llc | Dynamic clamping assemblies with improved wear characteristics for use in connection with electromechanical surgical instruments |
US10779826B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Methods of operating surgical end effectors |
US10779825B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Adapters with end effector position sensing and control arrangements for use in connection with electromechanical surgical instruments |
US10687813B2 (en) | 2017-12-15 | 2020-06-23 | Ethicon Llc | Adapters with firing stroke sensing arrangements for use in connection with electromechanical surgical instruments |
US10743874B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Sealed adapters for use with electromechanical surgical instruments |
US10869666B2 (en) | 2017-12-15 | 2020-12-22 | Ethicon Llc | Adapters with control systems for controlling multiple motors of an electromechanical surgical instrument |
US10828033B2 (en) | 2017-12-15 | 2020-11-10 | Ethicon Llc | Handheld electromechanical surgical instruments with improved motor control arrangements for positioning components of an adapter coupled thereto |
US11071543B2 (en) | 2017-12-15 | 2021-07-27 | Cilag Gmbh International | Surgical end effectors with clamping assemblies configured to increase jaw aperture ranges |
US11006955B2 (en) | 2017-12-15 | 2021-05-18 | Ethicon Llc | End effectors with positive jaw opening features for use with adapters for electromechanical surgical instruments |
US11033267B2 (en) | 2017-12-15 | 2021-06-15 | Ethicon Llc | Systems and methods of controlling a clamping member firing rate of a surgical instrument |
US11045270B2 (en) | 2017-12-19 | 2021-06-29 | Cilag Gmbh International | Robotic attachment comprising exterior drive actuator |
USD910847S1 (en) | 2017-12-19 | 2021-02-16 | Ethicon Llc | Surgical instrument assembly |
US11020112B2 (en) | 2017-12-19 | 2021-06-01 | Ethicon Llc | Surgical tools configured for interchangeable use with different controller interfaces |
US10716565B2 (en) | 2017-12-19 | 2020-07-21 | Ethicon Llc | Surgical instruments with dual articulation drivers |
US10835330B2 (en) | 2017-12-19 | 2020-11-17 | Ethicon Llc | Method for determining the position of a rotatable jaw of a surgical instrument attachment assembly |
US10729509B2 (en) | 2017-12-19 | 2020-08-04 | Ethicon Llc | Surgical instrument comprising closure and firing locking mechanism |
US11576668B2 (en) | 2017-12-21 | 2023-02-14 | Cilag Gmbh International | Staple instrument comprising a firing path display |
US11311290B2 (en) | 2017-12-21 | 2022-04-26 | Cilag Gmbh International | Surgical instrument comprising an end effector dampener |
US11129680B2 (en) | 2017-12-21 | 2021-09-28 | Cilag Gmbh International | Surgical instrument comprising a projector |
US11076853B2 (en) | 2017-12-21 | 2021-08-03 | Cilag Gmbh International | Systems and methods of displaying a knife position during transection for a surgical instrument |
US11132462B2 (en) | 2017-12-28 | 2021-09-28 | Cilag Gmbh International | Data stripping method to interrogate patient records and create anonymized record |
US20190201139A1 (en) | 2017-12-28 | 2019-07-04 | Ethicon Llc | Communication arrangements for robot-assisted surgical platforms |
US11896322B2 (en) | 2017-12-28 | 2024-02-13 | Cilag Gmbh International | Sensing the patient position and contact utilizing the mono-polar return pad electrode to provide situational awareness to the hub |
US11166772B2 (en) | 2017-12-28 | 2021-11-09 | Cilag Gmbh International | Surgical hub coordination of control and communication of operating room devices |
US20190201039A1 (en) | 2017-12-28 | 2019-07-04 | Ethicon Llc | Situational awareness of electrosurgical systems |
US11389164B2 (en) | 2017-12-28 | 2022-07-19 | Cilag Gmbh International | Method of using reinforced flexible circuits with multiple sensors to optimize performance of radio frequency devices |
US11109866B2 (en) | 2017-12-28 | 2021-09-07 | Cilag Gmbh International | Method for circular stapler control algorithm adjustment based on situational awareness |
US11058498B2 (en) * | 2017-12-28 | 2021-07-13 | Cilag Gmbh International | Cooperative surgical actions for robot-assisted surgical platforms |
US11864728B2 (en) | 2017-12-28 | 2024-01-09 | Cilag Gmbh International | Characterization of tissue irregularities through the use of mono-chromatic light refractivity |
US11896443B2 (en) | 2017-12-28 | 2024-02-13 | Cilag Gmbh International | Control of a surgical system through a surgical barrier |
US11612444B2 (en) | 2017-12-28 | 2023-03-28 | Cilag Gmbh International | Adjustment of a surgical device function based on situational awareness |
US11818052B2 (en) | 2017-12-28 | 2023-11-14 | Cilag Gmbh International | Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs |
US11857152B2 (en) | 2017-12-28 | 2024-01-02 | Cilag Gmbh International | Surgical hub spatial awareness to determine devices in operating theater |
US11672605B2 (en) | 2017-12-28 | 2023-06-13 | Cilag Gmbh International | Sterile field interactive control displays |
US11832899B2 (en) | 2017-12-28 | 2023-12-05 | Cilag Gmbh International | Surgical systems with autonomously adjustable control programs |
US11076910B2 (en) | 2018-01-22 | 2021-08-03 | Covidien Lp | Jaw members for surgical instruments and surgical instruments incorporating the same |
US11464532B2 (en) | 2018-03-08 | 2022-10-11 | Cilag Gmbh International | Methods for estimating and controlling state of ultrasonic end effector |
US11090047B2 (en) | 2018-03-28 | 2021-08-17 | Cilag Gmbh International | Surgical instrument comprising an adaptive control system |
US11045192B2 (en) | 2018-08-20 | 2021-06-29 | Cilag Gmbh International | Fabricating techniques for surgical stapler anvils |
US10912559B2 (en) | 2018-08-20 | 2021-02-09 | Ethicon Llc | Reinforced deformable anvil tip for surgical stapler anvil |
US10842492B2 (en) | 2018-08-20 | 2020-11-24 | Ethicon Llc | Powered articulatable surgical instruments with clutching and locking arrangements for linking an articulation drive system to a firing drive system |
USD914878S1 (en) | 2018-08-20 | 2021-03-30 | Ethicon Llc | Surgical instrument anvil |
US11291440B2 (en) | 2018-08-20 | 2022-04-05 | Cilag Gmbh International | Method for operating a powered articulatable surgical instrument |
US10779821B2 (en) | 2018-08-20 | 2020-09-22 | Ethicon Llc | Surgical stapler anvils with tissue stop features configured to avoid tissue pinch |
US11083458B2 (en) | 2018-08-20 | 2021-08-10 | Cilag Gmbh International | Powered surgical instruments with clutching arrangements to convert linear drive motions to rotary drive motions |
US11253256B2 (en) | 2018-08-20 | 2022-02-22 | Cilag Gmbh International | Articulatable motor powered surgical instruments with dedicated articulation motor arrangements |
US10856870B2 (en) | 2018-08-20 | 2020-12-08 | Ethicon Llc | Switching arrangements for motor powered articulatable surgical instruments |
US11039834B2 (en) | 2018-08-20 | 2021-06-22 | Cilag Gmbh International | Surgical stapler anvils with staple directing protrusions and tissue stability features |
US11324501B2 (en) | 2018-08-20 | 2022-05-10 | Cilag Gmbh International | Surgical stapling devices with improved closure members |
US11207065B2 (en) | 2018-08-20 | 2021-12-28 | Cilag Gmbh International | Method for fabricating surgical stapler anvils |
CN109528271B (en) * | 2018-10-22 | 2020-04-07 | 珠海维尔康生物科技有限公司 | Ultrasonic knife with double-horizontal pulse output mode |
US11331100B2 (en) | 2019-02-19 | 2022-05-17 | Cilag Gmbh International | Staple cartridge retainer system with authentication keys |
US11696761B2 (en) | 2019-03-25 | 2023-07-11 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
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US11638587B2 (en) | 2019-06-28 | 2023-05-02 | Cilag Gmbh International | RFID identification systems for surgical instruments |
US11523822B2 (en) | 2019-06-28 | 2022-12-13 | Cilag Gmbh International | Battery pack including a circuit interrupter |
US11660163B2 (en) | 2019-06-28 | 2023-05-30 | Cilag Gmbh International | Surgical system with RFID tags for updating motor assembly parameters |
US11426167B2 (en) | 2019-06-28 | 2022-08-30 | Cilag Gmbh International | Mechanisms for proper anvil attachment surgical stapling head assembly |
US11224497B2 (en) | 2019-06-28 | 2022-01-18 | Cilag Gmbh International | Surgical systems with multiple RFID tags |
US11464601B2 (en) | 2019-06-28 | 2022-10-11 | Cilag Gmbh International | Surgical instrument comprising an RFID system for tracking a movable component |
US11564732B2 (en) | 2019-12-05 | 2023-01-31 | Covidien Lp | Tensioning mechanism for bipolar pencil |
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US11529137B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
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US11559304B2 (en) | 2019-12-19 | 2023-01-24 | Cilag Gmbh International | Surgical instrument comprising a rapid closure mechanism |
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US11234698B2 (en) | 2019-12-19 | 2022-02-01 | Cilag Gmbh International | Stapling system comprising a clamp lockout and a firing lockout |
US11931033B2 (en) | 2019-12-19 | 2024-03-19 | Cilag Gmbh International | Staple cartridge comprising a latch lockout |
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US11701111B2 (en) | 2019-12-19 | 2023-07-18 | Cilag Gmbh International | Method for operating a surgical stapling instrument |
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US11877953B2 (en) | 2019-12-26 | 2024-01-23 | Johnson & Johnson Surgical Vision, Inc. | Phacoemulsification apparatus |
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US11937863B2 (en) | 2019-12-30 | 2024-03-26 | Cilag Gmbh International | Deflectable electrode with variable compression bias along the length of the deflectable electrode |
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US20220031351A1 (en) | 2020-07-28 | 2022-02-03 | Cilag Gmbh International | Surgical instruments with differential articulation joint arrangements for accommodating flexible actuators |
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US11517390B2 (en) | 2020-10-29 | 2022-12-06 | Cilag Gmbh International | Surgical instrument comprising a limited travel switch |
USD980425S1 (en) | 2020-10-29 | 2023-03-07 | Cilag Gmbh International | Surgical instrument assembly |
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US11452526B2 (en) | 2020-10-29 | 2022-09-27 | Cilag Gmbh International | Surgical instrument comprising a staged voltage regulation start-up system |
US11534259B2 (en) | 2020-10-29 | 2022-12-27 | Cilag Gmbh International | Surgical instrument comprising an articulation indicator |
USD1013170S1 (en) | 2020-10-29 | 2024-01-30 | Cilag Gmbh International | Surgical instrument assembly |
US11931025B2 (en) | 2020-10-29 | 2024-03-19 | Cilag Gmbh International | Surgical instrument comprising a releasable closure drive lock |
US11779330B2 (en) | 2020-10-29 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a jaw alignment system |
US11737751B2 (en) | 2020-12-02 | 2023-08-29 | Cilag Gmbh International | Devices and methods of managing energy dissipated within sterile barriers of surgical instrument housings |
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US11627960B2 (en) | 2020-12-02 | 2023-04-18 | Cilag Gmbh International | Powered surgical instruments with smart reload with separately attachable exteriorly mounted wiring connections |
US11744581B2 (en) | 2020-12-02 | 2023-09-05 | Cilag Gmbh International | Powered surgical instruments with multi-phase tissue treatment |
US11849943B2 (en) | 2020-12-02 | 2023-12-26 | Cilag Gmbh International | Surgical instrument with cartridge release mechanisms |
US11653915B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Surgical instruments with sled location detection and adjustment features |
US11890010B2 (en) | 2020-12-02 | 2024-02-06 | Cllag GmbH International | Dual-sided reinforced reload for surgical instruments |
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US11944296B2 (en) | 2020-12-02 | 2024-04-02 | Cilag Gmbh International | Powered surgical instruments with external connectors |
US11793514B2 (en) | 2021-02-26 | 2023-10-24 | Cilag Gmbh International | Staple cartridge comprising sensor array which may be embedded in cartridge body |
US11751869B2 (en) | 2021-02-26 | 2023-09-12 | Cilag Gmbh International | Monitoring of multiple sensors over time to detect moving characteristics of tissue |
US11925349B2 (en) | 2021-02-26 | 2024-03-12 | Cilag Gmbh International | Adjustment to transfer parameters to improve available power |
US11950779B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Method of powering and communicating with a staple cartridge |
US11701113B2 (en) | 2021-02-26 | 2023-07-18 | Cilag Gmbh International | Stapling instrument comprising a separate power antenna and a data transfer antenna |
US11950777B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Staple cartridge comprising an information access control system |
US11749877B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Stapling instrument comprising a signal antenna |
US11696757B2 (en) | 2021-02-26 | 2023-07-11 | Cilag Gmbh International | Monitoring of internal systems to detect and track cartridge motion status |
US11723657B2 (en) | 2021-02-26 | 2023-08-15 | Cilag Gmbh International | Adjustable communication based on available bandwidth and power capacity |
US11812964B2 (en) | 2021-02-26 | 2023-11-14 | Cilag Gmbh International | Staple cartridge comprising a power management circuit |
US11744583B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Distal communication array to tune frequency of RF systems |
US11730473B2 (en) | 2021-02-26 | 2023-08-22 | Cilag Gmbh International | Monitoring of manufacturing life-cycle |
US11723658B2 (en) | 2021-03-22 | 2023-08-15 | Cilag Gmbh International | Staple cartridge comprising a firing lockout |
US11826042B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Surgical instrument comprising a firing drive including a selectable leverage mechanism |
US11826012B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising a pulsed motor-driven firing rack |
US11737749B2 (en) | 2021-03-22 | 2023-08-29 | Cilag Gmbh International | Surgical stapling instrument comprising a retraction system |
US11806011B2 (en) | 2021-03-22 | 2023-11-07 | Cilag Gmbh International | Stapling instrument comprising tissue compression systems |
US11759202B2 (en) | 2021-03-22 | 2023-09-19 | Cilag Gmbh International | Staple cartridge comprising an implantable layer |
US11717291B2 (en) | 2021-03-22 | 2023-08-08 | Cilag Gmbh International | Staple cartridge comprising staples configured to apply different tissue compression |
US11896218B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Method of using a powered stapling device |
US11786239B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Surgical instrument articulation joint arrangements comprising multiple moving linkage features |
US11744603B2 (en) | 2021-03-24 | 2023-09-05 | Cilag Gmbh International | Multi-axis pivot joints for surgical instruments and methods for manufacturing same |
US11896219B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Mating features between drivers and underside of a cartridge deck |
US11832816B2 (en) | 2021-03-24 | 2023-12-05 | Cilag Gmbh International | Surgical stapling assembly comprising nonplanar staples and planar staples |
US11849944B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Drivers for fastener cartridge assemblies having rotary drive screws |
US11857183B2 (en) | 2021-03-24 | 2024-01-02 | Cilag Gmbh International | Stapling assembly components having metal substrates and plastic bodies |
US11786243B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Firing members having flexible portions for adapting to a load during a surgical firing stroke |
US11849945B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Rotary-driven surgical stapling assembly comprising eccentrically driven firing member |
US11944336B2 (en) | 2021-03-24 | 2024-04-02 | Cilag Gmbh International | Joint arrangements for multi-planar alignment and support of operational drive shafts in articulatable surgical instruments |
US11903582B2 (en) | 2021-03-24 | 2024-02-20 | Cilag Gmbh International | Leveraging surfaces for cartridge installation |
US11793516B2 (en) | 2021-03-24 | 2023-10-24 | Cilag Gmbh International | Surgical staple cartridge comprising longitudinal support beam |
US20220378425A1 (en) | 2021-05-28 | 2022-12-01 | Cilag Gmbh International | Stapling instrument comprising a control system that controls a firing stroke length |
US11877745B2 (en) | 2021-10-18 | 2024-01-23 | Cilag Gmbh International | Surgical stapling assembly having longitudinally-repeating staple leg clusters |
US11957337B2 (en) | 2021-10-18 | 2024-04-16 | Cilag Gmbh International | Surgical stapling assembly with offset ramped drive surfaces |
US11937816B2 (en) | 2021-10-28 | 2024-03-26 | Cilag Gmbh International | Electrical lead arrangements for surgical instruments |
Family Cites Families (18)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
NL145136C (en) * | 1967-07-25 | 1900-01-01 | ||
US3673475A (en) * | 1970-09-15 | 1972-06-27 | Fred M Hufnagel | Pulse drive circuit for coils of dental impact tools and the like |
US3693613A (en) * | 1970-12-09 | 1972-09-26 | Cavitron Corp | Surgical handpiece and flow control system for use therewith |
US3812858A (en) * | 1972-10-24 | 1974-05-28 | Sybron Corp | Dental electrosurgical unit |
US3980906A (en) * | 1972-12-26 | 1976-09-14 | Xygiene, Inc. | Ultrasonic motor-converter systems |
JPS506711U (en) * | 1973-05-18 | 1975-01-23 | ||
JPS50100891A (en) * | 1973-12-21 | 1975-08-09 | ||
US3941122A (en) * | 1974-04-08 | 1976-03-02 | Bolt Beranek And Newman, Inc. | High frequency ultrasonic process and apparatus for selectively dissolving and removing unwanted solid and semi-solid materials and the like |
SU562279A1 (en) * | 1975-04-02 | 1977-06-25 | Витебский государственный медицинский институт | Ultrasound Therapy Device |
US4063557A (en) * | 1976-04-01 | 1977-12-20 | Cavitron Corporation | Ultrasonic aspirator |
JPS5848225B2 (en) * | 1979-01-09 | 1983-10-27 | オムロン株式会社 | Atomization amount control method of ultrasonic liquid atomization device |
JPS5935743B2 (en) * | 1979-01-24 | 1984-08-30 | 株式会社井上ジャパックス研究所 | Ultrasonic grinding equipment |
US4368410A (en) * | 1980-10-14 | 1983-01-11 | Dynawave Corporation | Ultrasound therapy device |
DE3152827A1 (en) * | 1981-05-06 | 1983-07-07 | Orvosi Mueszer Szoevetkezet | AUTOMATIC DOSING AND CONTROL CIRCUIT ARRANGEMENT |
JPH0677720B2 (en) * | 1981-10-05 | 1994-10-05 | 住友ベークライト株式会社 | Ultrasonic oscillator |
EP0111386B1 (en) * | 1982-10-26 | 1987-11-19 | University Of Aberdeen | Ultrasound hyperthermia unit |
US4587958A (en) * | 1983-04-04 | 1986-05-13 | Sumitomo Bakelite Company Limited | Ultrasonic surgical device |
DE3429487A1 (en) * | 1984-08-10 | 1986-02-20 | Richard Wolf Gmbh, 7134 Knittlingen | Device for generating an alternating voltage for the transducer of a lithotripsy probe |
-
1986
- 1986-04-02 US US06/847,301 patent/US4827911A/en not_active Expired - Lifetime
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1987
- 1987-04-01 CA CA000533538A patent/CA1322226C/en not_active Expired - Fee Related
- 1987-04-02 EP EP87902987A patent/EP0261230B1/en not_active Expired - Lifetime
- 1987-04-02 WO PCT/US1987/000696 patent/WO1987005793A1/en active IP Right Grant
- 1987-04-02 JP JP62502478A patent/JPH07106208B2/en not_active Expired - Fee Related
- 1987-04-02 DE DE87902987T patent/DE3788099T2/en not_active Expired - Fee Related
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DE3788099D1 (en) | 1993-12-16 |
EP0261230A4 (en) | 1989-07-11 |
EP0261230B1 (en) | 1993-11-10 |
US4827911A (en) | 1989-05-09 |
DE3788099T2 (en) | 1994-03-03 |
JPS63502968A (en) | 1988-11-02 |
JPH07106208B2 (en) | 1995-11-15 |
WO1987005793A1 (en) | 1987-10-08 |
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