CN117295457A - 用于在低位前切除手术过程中缩短直肠残端的装置及方法 - Google Patents
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Abstract
一种用于圆形缝合装置的装载单元，该装载单元包括外壳构件、可操作地设置在外壳构件内的推钉器组件、可操作地设置在外壳构件内的推刀器组件、可操作地设置在外壳构件内的套管针组件、以及设置在外壳构件内的位于推刀器组件与套管针组件之间的组织牵缩组件。外壳构件包括长形管状部分。套管针组件包括可在推进位置与缩回位置之间移动的套管针构件。组织牵缩组件包括组织牵缩器。
Description
技术领域
本披露内容总体上涉及用于在从管状器官切除病变组织部分之后形成吻合的装置及方法，更具体地涉及用于在低位前切除手术过程中在形成吻合之前缩短直肠残端的装置及方法。
背景技术
用于进行低位前切除(LAR)手术以治疗直肠癌的装置是已知的。在LAR手术过程中，切除直肠的病变部分，并且将直肠的健康部分与结肠重新连接。用于形成端对端吻合的圆形缝合装置是已知的。通常，将结肠的一部分固定于圆形缝合装置的抵钉座组件，并且将直肠残端的一部分固定于圆形缝合装置的装载单元周围。通常尽可能缩短直肠残端。使用传统方法将直肠残端缩短到所需长度需要附加装置，这些装置可能是笨重的或者难以操作。
因此，将圆形缝合装置构造用于在形成吻合之前缩短直肠残端是有益的。
发明内容
一种用于圆形缝合装置的装载单元，该装载单元包括外壳构件、可操作地设置在外壳构件内的推钉器组件、可操作地设置在外壳构件内的推刀器组件、可操作地设置在外壳构件内的套管针组件、以及设置在外壳构件内的位于推刀器组件与D套管针组件之间的组织牵缩组件。外壳构件包括长形管状部分。套管针组件包括可在推进位置与缩回位置之间移动的套管针构件。组织牵缩组件包括组织牵缩器。
在本披露内容的某些方面，外壳构件的长形管状部分的长度为六至十二英寸。长形管状部分可以包括内部部分和外部部分，并且在内部部分与外部部分之间限定有空腔。推钉器组件和推刀器组件可以可操作地接纳在空腔内，并且可以在推进位置与缩回位置之间移动。
在本披露内容的其他方面，组织牵缩组件包括固持件。固持件可以限定纵向开口，并且可以选择性地沿外壳构件的内部部分移动。组织牵缩器可以延伸穿过固持件内的纵向开口。组织牵缩器可以相对于固持件纵向固定。
一种圆形缝合器，包括适配器组件和装载单元，该适配器组件被构造成可操作地连接到致动组件。该装载单元包括外壳构件、可操作地设置在外壳构件内的推钉器组件、可操作地设置在外壳构件内的推刀器组件、可操作地设置在外壳构件内的套管针组件、以及设置在外壳构件内的位于推刀器组件与套管针组件之间的组织牵缩组件。外壳构件包括长形管状部分。套管针组件包括可在推进位置与缩回位置之间移动的套管针构件。组织牵缩组件包括组织牵缩器。
在本披露内容的某些方面，外壳构件的长形管状部分的长度为六至十二英寸。长形管状部分可以包括内部部分和外部部分，并且在内部部分与外部部分之间限定有空腔。推钉器组件和推刀器组件可以可操作地接纳在空腔内，并且可以在推进位置与缩回位置之间移动。
在本披露内容的其他方面，组织牵缩组件包括固持件。固持件可以限定纵向开口，并且可以选择性地沿外壳构件的内部部分移动。组织牵缩器可以延伸穿过固持件内的纵向开口。组织牵缩器可以相对于固持件纵向固定。
一种形成吻合的方法，该方法包括：将装载单元接纳在患者的直肠残端内；从装载单元推进组织牵缩器；将组织牵缩器固定于直肠残端；使组织牵缩器缩回装载单元内，以便使直肠残端被拉入装载单元内以缩短直肠残端；夹紧、缝合和切割直肠残端。
在本披露内容的某些方面，将组织牵缩器固定于直肠残端包括将直肠残端缝到组织牵缩器上。从装载单元推进组织牵缩器还可以包括推进固持件。使组织牵缩器缩回包括使固持件缩回。该方法可以进一步包括：随着直肠残端被拉入装载单元内，装载单元的钉仓定位在患者的肛门附近。该方法还可以包括：将结肠固定于抵钉座组件，并且使抵钉座组件相对于装载单元固定。
附图说明
本文参考附图描述了用于在低位前切除手术过程中缩短直肠残端的装置及方法的各方面，在附图中：
图1是根据本披露内容的各方面的圆形缝合设备的立体侧视图；
图2是图1所示的圆形缝合设备的立体端视图；
图3是图1和图2所示的圆形缝合设备的装载单元的各部件分离的立体侧视图；
图4是图2所示的细节指示区域的放大视图；
图5是接纳在患者的直肠残端内的图3所示的装载单元的截面侧视图；
图6是图5所示的细节指示区域的放大视图；
图7是图5所示的细节指示区域的放大视图；
图8是沿图6所示的线8-8截取的截面端视图；
图9是图3所示的装载单元的外壳构件的立体端视图；
图10是图3所示的装载单元的远侧部分的截面侧视图，其中装载单元的组织牵缩器处于推进位置并且固定于直肠残端；
图11是图10所示的装载单元的截面侧视图，其中组织牵缩器处于缩回位置；
图12是图11所示的装载单元的截面侧视图，其中抵钉座组件固定于装载单元的套管针组件；
图13是图12所示的装载单元的截面侧视图，其中抵钉座组件处于夹紧位置，并且推钉器组件和推刀器组件各自处于推进位置；
图14是图13所示的装载单元在吻合形成之后从肛门取出后的截面侧视图；以及
图15是用于在低位前切除手术过程中形成吻合的方法的流程图。
具体实施方式
现在将参考附图来详细描述所披露的装置及方法，其中在若干视图中的每个视图中，相似的附图标记表示相同或对应的要素。然而，应当理解，本文提供的披露内容的各方面仅是本披露内容的示例，并且可以体现为多种不同的形式。未详细描述众所周知的功能或构造，以避免不必要的细节使本披露内容模糊不清。因此，本文所披露的具体的结构性和功能性细节不应当被解释为限制性的，而是仅应当解释为权利要求的基础并且解释为用于教导本领域技术人员在实际上任何适当详细描述的结构中以各种方式采用本披露内容的代表性基础。
在本说明书中，术语“近侧”通常用于指装置的更靠近临床医生的部分，而术语“远侧”通常用于指装置的更远离临床医生的部分。此外，术语“内窥镜的”通常用于指内窥镜、腹腔镜、关节镜和/或通过小直径切口或套管进行的任何其他手术。进一步地，术语“临床医生”通常用于指包括医生、护士和支持人员在内的医务人员。如本文所使用的，术语“大约”意味着数值是近似值，并且微小的变化不会显著影响所披露实施例的实践。在使用数值限制的情况下，除非上下文另有指示，否则“大约”意指数值可以变化±10％，并且保持在所披露实施例的范围内。
图1和图2展示了通常示为圆形缝合器10的圆形缝合装置，包括通常示为装载单元100的圆形装载单元。圆形缝合器10包括手柄组件12、适配器组件或长形本体14、装载单元100、以及抵钉座组件18，该抵钉座组件可被支撑以相对于装载单元100在间隔位置(图12)与接近位置(图13)或夹紧位置之间移动，如本领域已知的。适配器组件14的近侧部分14a可释放地联接到手柄组件12，并且装载单元100可释放地联接到适配器组件14的远侧部分14b。手柄组件12包括固定式握持部20，该固定式握持部支撑用于控制圆形缝合器10的各种功能的操作的致动按钮22，这些操作包括使装载单元100和抵钉座组件18接近、从圆形重装载器100击发缝钉、以及对夹在装载单元100与抵钉座组件18之间的组织(未示出)进行切割或取芯。尽管手柄组件12、适配器组件14和装载单元100被示出为是可释放地彼此联接的单独的部件，但是可以设想到任何一个或所有部件可以一体成形。
圆形缝合器10被展示为电动缝合装置，该电动缝合装置包括可以支撑一个或多个电池(未示出)的电动手柄组件12。长形本体14呈适配器组件的形式，该适配器组件将动力从手柄组件12传递到装载单元100和抵钉座组件18。可以在美国专利号9,055,943、9,023,014以及美国公开号2018/0125495(“‘495号公开物”)和2017/0340351中找到电动缝合装置的示例，这些专利和公开物通过援引以其全文并入本文。尽管示出和披露为涉及动力手柄组件，但是可以设想，本披露内容的各方面可以结合到手动操作的缝合装置中。对于示例性手动致动的缝合装置，请参见美国专利号7,364,060和7,303,106。还可以设想，本披露内容的各方面可以结合到机器人控制的缝合装置中。
图3展示了圆形缝合器10的装载单元100，该装载单元包括外壳构件或壳体110、用于支撑多个缝钉“S”的钉仓120、推钉器组件130、可径向定位在推钉器组件130内部的推刀器组件140、可径向定位在推刀器组件140内部的套管针组件150、以及可定位在套管针组件150与推刀器组件140之间的组织牵缩组件160。如从以下披露内容中将变得显而易见的是装载单元100在结构上和功能上类似于已知的装载单元，因此将仅详细描述它们之间的区别。对于示例性装载单元的详细描述，请参见‘495公开物。
装载单元100的外壳构件110包括连接件部分112和管状部分114，该连接件部分在近侧部分110a上、可操作地连接到适配器组件14，该管状部分从连接件部分112延伸。连接件部分112支撑锁定套管116和锁定环118。尽管示出了包括锁定套管116和锁定环118，但是可以设想，装载单元100可以采用任何合适的方式可释放地固定于适配器组件14。外壳构件110的管状部分114包括外壳体部分114a和内壳体部分114b，该内壳体部分与外壳体部分112间隔开而限定环形空腔113(图9)。环形空腔113被构造成可操作地接纳推钉器组件130、推刀器组件140以及组织牵缩组件160。内壳体部分114b被构造成可操作地接纳套管针组件140，并且包括锥形远端114c。装载单元100的外壳构件110限定开口115(图4)，该开口设置在连接件部分112与管状部分114之间并且与环形空腔113流体连通。外壳构件110的远侧部分110b被构造成支撑钉仓120。外壳构件110的长度足以适应将直肠残端缩短，如下所述。外壳构件110的长度可以是传统的圆形缝合装载单元的外壳构件的大约两倍至大约六倍。可以设想，外壳构件110的长度可以是从三英寸(3")到十英寸(10")的任何长度。
装载单元100的钉仓120可支撑在外壳构件110的远侧部分110b上，并且限定环状的各排缝钉凹穴121。缝钉凹穴121各自支撑多个缝钉“S”中的一个。尽管示出了包括三排缝钉凹穴121，但可以设想，钉仓120可以采用任何合适的构型支撑任何环数的缝钉“S”。
装载单元100的推钉器组件130包括推钉器基座132、推钉器延伸部134以及推钉器构件136。推钉器组件130可在外壳构件110的环形空腔113(图4)内在缩回位置(图5)与推进位置(图13)之间移动，以从钉仓120射出缝钉“S”。推钉器组件130的推钉器构件136包括与钉仓120的缝钉凹穴121对应的多个指状件138。当推钉器组件130在外壳构件110内从缩回位置(图5)移动到推进位置(图13)时，多个指状件138可移动穿过相应的缝钉凹穴121以从缝钉凹穴121射出缝钉“S”。推钉器延伸部134的长度被构造成适应外壳构件110的增加的长度。在‘495公开物中提供了示例性推钉器组件的结构和功能的详细描述，该公开物的内容先前已通过援引以其全文并入本文。
装载单元100的推刀器组件140包括推刀器基座142、推刀器延伸部144以及环形刀146。刀组件140可在外壳构件110的环形空腔113(图4)内在缩回位置(图5)与推进位置(图13)之间移动以切割组织。推刀器组件140可独立于推钉器组件130的推进而推进，但是可以设想同时推进。推刀器延伸部144的长度被构造成适应外壳构件110的增加的长度。在‘495公开物中提供了示例性推刀器组件的结构和功能的详细描述。
装载单元100的套管针组件150包括套管针壳体152、从套管针壳体152延伸的套管针构件154、以及可旋转地支撑在套管针壳体152内的驱动构件156。套管158可接纳在套管针构件154周围，并且被构造成减小套管针构件154与外壳构件110的内壁114b之间的摩擦。套管针组件150的套管针壳体152被构造成可释放地固定于圆形缝合器10的适配器组件14(图1)的远侧部分14b内，以允许套管针组件150进行灭菌和重复使用。替代性地，套管针组件150与适配器组件14一体成形。
套管针组件150的套管针构件154包括内螺纹的近侧部分154a(图5)、长形的中心部分154b以及尖锐的远侧部分154c。近侧部分154a、中心部分154b和远侧部分154c可以一体成形和/或成形为以任何合适的方式固定在一起的单独的部件。套管针组件150的驱动构件156包括近侧部分156a和螺纹远侧部分156b，该近侧部分被构造成与延伸穿过适配器组件14的旋转驱动构件(未示出)接合，该螺纹远侧部分用于与套管针构件154的内螺纹近侧部分154a接合。驱动构件156沿第一方向旋转导致套管针构件154相对于套管针壳体154推进，而驱动构件156沿第二方向旋转导致套管针构件154相对于套管针壳体152缩回。套管针构件154的长形中心部分154b的长度被构造成适应外壳构件110的增加的长度。在‘495公开物中提供了示例性套管针组件的结构和功能的详细描述。
装载单元100的组织牵缩组件160包括固持件或引导件162以及延伸穿过固持件162的组织牵缩器164。固持件162被构造成接纳在外壳构件110的管状部分114的内壳体部分114b周围。如将在下文进一步详细描述的，组织牵缩组件160的固持件162被构造成在组织缩回过程中沿外壳组件110的内壳体部分114a滑动。固持件162限定用于接纳组织牵缩器164的远侧部分的纵向开口163。组织牵缩器164包括穿刺远侧尖端164b，并且沿其远侧部分限定有孔眼165。
装载单元100包括衬套170，该衬套可以定位在外壳构件110的连接件部分112内，以确保推钉器组件130的推钉器基座132与缝钉驱动器(未示出)之间以及推刀器组件140的推刀器基座142与刀驱动件(未示出)之间的连接。
将参考图5至图15详细描述在低位前切除(LAR)手术过程中采用装载单元100进行吻合手术(包括缩短直肠残端)的方法。首先，临床医生使用传统方式切除管状器官的病变部分，留下直肠残端“St”(图5)。直肠残端“St”可以包括任何长度“L”，并且不需要在使用圆形缝合器10(图1)之前缩短。
图5至图8展示了圆形缝合器10的装载单元100在LAR手术过程中通过肛门“A”接纳在患者的直肠残端“St”内。装载单元100被构造成使得外壳构件110的近侧部分保持在肛门“A”的外部，而外壳构件110的远侧部分上的钉仓组件120定位在直肠残端“St”的远侧部分附近。以这种方式，临床医生仍然可触及组织牵缩组件160的组织牵缩器164。
在引导装载单元100通过肛门“A”进入患者的直肠残端“St”之前，装载单元100的推钉器组件130、推刀器组件140、套管针组件150的套管针构件154、以及组织牵缩组件160各自处于其缩回位置。更具体地，推钉器组件130和推刀器组件140位于外壳构件110内其最近侧位置，并且套管针构件154完全由外壳构件110的内壳体部分114b保持。组织牵缩组件160定位在空腔113中位于推刀器组件130与内壳体部分114b之间。组织牵缩组件160的固持件162处于其在外壳构件110的内壳体部分114b周围的最远侧位置，并且组织牵缩组件160的组织牵缩器164的穿刺远侧尖端164b与钉仓120间隔开。
图10展示了将直肠残端“St”固定于组织牵缩组件160的组织牵缩器164。更具体地，组织牵缩器164向远侧移动(例如，推进，如箭头“a”所指示的)，使得组织牵缩器164的穿刺远侧尖端164b刺入直肠残端“St”。推进组织牵缩器164，直到组织牵缩器164的孔眼165定位在直肠残端“St”的远侧部分附近。然后以任何合适的方式将直肠残端“St”固定于组织牵缩器164。如图所示，使用缝合线“s”将直肠残端“St”固定于组织牵缩器164。可以设想，组织牵缩器可以包括用于将直肠残端“St”固定于组织牵缩器164上的钩或其他抓持机构。如图所示，组织牵缩组件160的组织牵缩器164相对于固持件162纵向固定。以这种方式，组织牵缩器164的推进导致固持件162的推进，并且组织牵缩器164的缩回导致固持件162的缩回。可以设想，组织牵缩器164可以独立于固持件162移动。
图11展示了患者的直肠残端“St”缩回，更具体地凹入装载单元100内。更具体地，组织牵缩器164沿近侧方向移动(例如，缩回，如箭头“b”所指示的)，导致直肠残端“St”缩回到外壳构件110的空腔113内位于推刀器组件140的推刀器延伸部144和环形刀146与外壳构件110的内壳体部分114b之间。如上所述，由于组织牵缩器164相对于固持器固持件162纵向固定，所以组织牵缩器164的缩回导致固持件162同时缩回。组织牵缩器164相对于外壳构件110缩回，直到直肠残端“St”包括长度“l”。长度“l”可以包括临床医生确定最适合于吻合手术的任何长度。外壳构件110的增加的长度适应任何长度的直肠残端“St”。
当直肠残端“St”缩回到装载单元100的外壳构件110内时，装载单元100通过肛门“A”逐渐缩回，直到装载单元100的远端上的钉仓120定位在肛门“A”附近。
图12展示了抵钉座组件18固定于装载单元100的套管针组件150的套管针构件154。在将抵钉座组件18固定于套管针构件154之前，将肠段“I”固定于抵钉座组件18的头部组件18a周围。传统上，使用荷包缝合线(未示出)将组织固定于抵钉座组件18的头部组件18a周围。套管针构件154移动到远侧位置以利于抵钉座组件18附接到套管针构件154。
图13展示了在缝合和切割直肠残端“St”和肠段“I”以形成吻合部“α”的过程中的装载单元100。更具体地，示出了处于其推进位置的推钉器组件130和推刀器组件140。如前所述，推钉器组件130和推刀器组件140可以独立地或同时地推进。在推钉器组件130推进之前，套管针组件150的套管针构件154缩回而使抵钉座组件18相对于钉仓120接近，以夹紧直肠残端“St”的组织和抵钉座组件18的头部组件18a与装载单元100的钉仓120之间的肠段“I”。
图14展示了在形成吻合部“α”并从患者的肛门“A”取出装载单元100之后的装载单元100。为了允许抵钉座组件18的头部组件18a倾斜，首先通过推进套管针组件100的套管针构件154而使抵钉座组件18相对于装载单元100推进。一旦抵钉座组件18的头部组件18a远离装载单元100的钉仓120移动，头部组件18a就枢转到倾斜位置，以允许将抵钉座组件18和装载单元100从肛门“A”取出。直肠残端的废弃段“StW”与装载单元100一起取出并以传统方式处置。直肠残端的剩余段“StR”在吻合部“α”处固定于肠段“I”。
可以设想，装载单元可以被构造成用于单次使用，例如是一次性的，或者可以被构造成用于进行灭菌和重复使用。装载单元100可具有多种不同的长度和直径，并且具有多种不同的缝钉构型。
图15是形成吻合500的方法的流程图，该方法包括缩短直肠残端。综上所述，首先，该方法包括确定病变组织并将病变组织与周围的健康组织分离510。接下来，该方法包括引导圆形缝合器的装载单元通过患者的肛门进入直肠残端520。然后，该方法包括向远侧推进装载单元的组织牵缩器以刺入直肠残端530并将直肠残端固定于组织牵缩器540。接下来，该方法包括使组织牵缩器缩回以将直肠残端拉入装载单元中，从而缩短直肠残端550。在形成管状组织的第一段和第二段之后的任何时间，该方法包括将组织的第一段固定于抵钉座组件560。然后，该方法包括完成吻合手术570，这需要使抵钉座组件相对于装载单元固定、夹紧待缝合的组织、缝合被夹紧的组织、以及切割被夹紧的组织。
本领域技术人员将会理解，本文具体描述的且在附图中展示的这些装置和方法是本披露内容的非限制性的示例性方面。可以设想的是，在不脱离本披露内容的范围的情况下，结合本披露内容的一个示例性方面说明或描述的要素和特征可以与另一个示例性方面的要素和特征组合。同样，本领域技术人员将基于上文所描述的本披露内容的各方面了解本披露内容的进一步的特征和优点。因此，除了所附权利要求所指示的之外，本披露内容不受已特别示出和描述的内容的限制。
Claims (20)
1.一种用于圆形缝合装置的装载单元，所述装载单元包括：
外壳构件，所述外壳构件具有长形管状部分；
推钉器组件，所述推钉器组件可操作地设置在所述外壳构件内；
推刀器组件，所述推刀器组件可操作地设置在所述外壳构件内；
套管针组件，所述套管针组件可操作地设置在所述外壳构件内并且包括套管针构件，所述套管针构件能够在推进位置与缩回位置之间移动；以及
组织牵缩组件，所述组织牵缩组件设置在所述外壳构件内位于所述推刀器组件与所述套管针组件之间，所述组织牵缩组件包括组织牵缩器。
2.如权利要求1所述的装载单元，其中，所述外壳构件的长形管状部分的长度为六至十二英寸。
3.如权利要求1所述的装载单元，其中，所述长形管状部分包括内部部分和外部部分，并且在所述内部部分与所述外部部分之间限定有空腔。
4.如权利要求1所述的装载单元，其中，所述推钉器组件和所述推刀器组件可操作地接纳在所述空腔内，并且能够在推进位置与缩回位置之间移动。
5.如权利要求3所述的装载单元，其中，所述组织牵缩组件包括固持件，所述固持件限定纵向开口并且能够选择性地沿所述外壳构件的内部部分移动。
6.如权利要求5所述的装载单元，其中，所述组织牵缩器延伸穿过所述固持件内的纵向开口。
7.如权利要求6所述的装载单元，其中，所述组织牵缩器相对于所述固持件纵向固定。
8.一种圆形缝合器，包括：
适配器组件，所述适配器组件被构造成可操作地连接到致动组件；
装载单元，所述装载单元包括，
外壳构件，所述外壳构件具有长形管状部分；
推钉器组件，所述推钉器组件可操作地设置在所述外壳构件内；
推刀器组件，所述推刀器组件可操作地设置在所述外壳构件内；
套管针组件，所述套管针组件可操作地设置在所述外壳构件内并且包括套管针构件，所述套管针构件能够在推进位置与缩回位置之间移动；以及
组织牵缩组件，所述组织牵缩组件设置在所述外壳构件内位于所述推刀器组件与所述套管针组件之间，所述组织牵缩组件包括组织牵缩器。
9.如权利要求8所述的圆形缝合器，其中，所述外壳构件的长形管状部分的长度为六至十二英寸。
10.如权利要求8所述的圆形缝合器，其中，所述长形管状部分包括内部部分和外部部分，并且在所述内壁与所述外壁之间限定有空腔。
11.如权利要求8所述的圆形缝合器，其中，所述推钉器组件和所述推刀器组件可操作地接纳在所述空腔内，并且能够在推进位置与缩回位置之间移动。
12.如权利要求10所述的圆形缝合器，其中，所述组织牵缩组件包括固持件，所述固持件限定纵向开口并且能够选择性地沿所述外壳构件的内部部分移动。
13.如权利要求12所述的圆形缝合器，其中，所述组织牵缩器延伸穿过所述固持件内的纵向开口。
14.如权利要求13所述的圆形缝合器，其中，所述组织牵缩器相对于所述固持件纵向固定。
15.一种形成吻合的方法，所述方法包括：
将装载单元接纳在患者的直肠残端内；
从所述装载单元推进组织牵缩器；
将所述组织牵缩器固定于所述直肠残端；
使所述组织牵缩器缩回到所述装载单元内，以便将所述直肠残端拉入所述装载单元内以缩短所述直肠残端；以及
夹紧、缝合和切割所述直肠残端。
16.如权利要求15所述的方法，其中，将所述组织牵缩器固定于所述直肠残端包括将所述直肠残端缝到所述组织牵缩器上。
17.如权利要求15所述的方法，其中，从所述装载单元推进所述组织牵缩器还包括推进固持件。
18.如权利要求17所述的方法，其中，使所述组织牵缩器缩回包括使所述固持件缩回。
19.如权利要求15所述的方法，进一步包括随着所述直肠残端被拉入所述装载单元内，所述装载单元的钉仓定位在所述患者的肛门附近。
20.如权利要求15所述的方法，进一步包括将结肠固定于抵钉座组件，并且使所述抵钉座组件相对于所述装载单元固定。
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| WO2022243805A1 (en) | 2022-11-24 |
| EP4340748A1 (en) | 2024-03-27 |
| US11642131B2 (en) | 2023-05-09 |
| US20230255633A1 (en) | 2023-08-17 |
| US20220361881A1 (en) | 2022-11-17 |
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