EP3861973B1 - Komponente eines operationstisches - Google Patents
Komponente eines operationstisches Download PDFInfo
- Publication number
- EP3861973B1 EP3861973B1 EP20156314.5A EP20156314A EP3861973B1 EP 3861973 B1 EP3861973 B1 EP 3861973B1 EP 20156314 A EP20156314 A EP 20156314A EP 3861973 B1 EP3861973 B1 EP 3861973B1
- Authority
- EP
- European Patent Office
- Prior art keywords
- component
- operating table
- information
- transmission unit
- characteristic
- 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.)
- Active
Links
- 230000005540 biological transmission Effects 0.000 claims description 39
- 238000004891 communication Methods 0.000 claims description 26
- 238000001514 detection method Methods 0.000 claims description 21
- 238000000034 method Methods 0.000 claims description 13
- 238000003306 harvesting Methods 0.000 claims description 6
- 230000003213 activating effect Effects 0.000 claims description 5
- 230000033001 locomotion Effects 0.000 description 14
- 230000008878 coupling Effects 0.000 description 8
- 238000010168 coupling process Methods 0.000 description 8
- 238000005859 coupling reaction Methods 0.000 description 8
- 238000005265 energy consumption Methods 0.000 description 6
- 238000004146 energy storage Methods 0.000 description 3
- 230000004044 response Effects 0.000 description 3
- 230000006870 function Effects 0.000 description 2
- 230000000977 initiatory effect Effects 0.000 description 2
- 230000001419 dependent effect Effects 0.000 description 1
- 238000011161 development Methods 0.000 description 1
- 230000018109 developmental process Effects 0.000 description 1
- 238000006073 displacement reaction Methods 0.000 description 1
- 238000005516 engineering process Methods 0.000 description 1
- 230000007774 longterm Effects 0.000 description 1
- 230000003287 optical effect Effects 0.000 description 1
- 210000004197 pelvis Anatomy 0.000 description 1
- 238000011477 surgical intervention Methods 0.000 description 1
Images
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
- A61G13/00—Operating tables; Auxiliary appliances therefor
- A61G13/02—Adjustable operating tables; Controls therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
- A61G13/00—Operating tables; Auxiliary appliances therefor
- A61G13/10—Parts, details or accessories
- A61G13/12—Rests specially adapted therefor; Arrangements of patient-supporting surfaces
- A61G13/128—Rests specially adapted therefor; Arrangements of patient-supporting surfaces with mechanical surface adaptations
- A61G13/1285—Rests specially adapted therefor; Arrangements of patient-supporting surfaces with mechanical surface adaptations having modular surface parts, e.g. being replaceable or turnable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
- A61G2203/00—General characteristics of devices
- A61G2203/70—General characteristics of devices with special adaptations, e.g. for safety or comfort
- A61G2203/72—General characteristics of devices with special adaptations, e.g. for safety or comfort for collision prevention
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61G—TRANSPORT, PERSONAL CONVEYANCES, OR ACCOMMODATION SPECIALLY ADAPTED FOR PATIENTS OR DISABLED PERSONS; OPERATING TABLES OR CHAIRS; CHAIRS FOR DENTISTRY; FUNERAL DEVICES
- A61G2205/00—General identification or selection means
- A61G2205/60—General identification or selection means using magnetic or electronic identifications, e.g. chips, RFID, electronic tags
Definitions
- the invention relates to a component of an operating table, in particular, to a component comprising a communication module.
- EP2702974A2 discloses a system comprising a control device to enable displacement of operating table elements and an accessory only within a virtual collision-free movement space.
- a radio identification data element stores an identification data element related to the accessory.
- a radio reading device reads the identification data element and is connected with a memory device and the control device, where the accessories of the memory- and control devices are determined again and stored in the virtual collision-free movement space as a function of the read identification data element.
- the radio identification element is configured as passive radio identification element such as passive transponder.
- US10314758B2 discloses systems and processes of controlling a function of a person support apparatus are provided.
- An example system includes a person support apparatus adapted to support a patient.
- the person support apparatus comprising a controller adapted to communicatively couple with at least one removable component of the person support apparatus.
- the controller is adapted to determine the absence or presence of the at least one removable component.
- the controller is further adapted to disable at least one movement of the person support apparatus in response to a determination that the at least one removable component is not present or enable the at least one movement in response to a determination that the at least one removable component is present.
- US2018344559A1 discloses a system for supporting or positioning a patient before, during, or after a medical procedure, including a surgical table.
- the surgical table is configured to use radio-frequency identification (RFID), or another identification protocol.
- An upper platform or another portion of the surgical table can include two or more spaced-apart sockets. Each socket can be configured to receive at least a portion of an extension of a second attachment.
- the RFID technology can allow the respective socket and extension to communicate with each other and/or remaining portions of the surgical table.
- One or more RFID tags and/or readers can be positioned in or on one or both of the extensions and/or in or on one or more of the sockets.
- Operating tables can be configured with a wide range of components for different disciplines of surgical interventions. These components are, e.g., leg sections, pelvis extensions, back sections, and head sections.
- the applicants provide operating tables comprising components that can be coupled to a basic configuration of the operating table and to other components by means of a coded coupling system.
- a control of the operating table in view of collisions of attached components with the ground or with other components are possible. For example, a collision of the head section with the floor in a low operating table position in combination with a Trendelenburg position or a collision of the leg section with a column of the operating table if the leg section is downwardly moved 90° in combination with a reverse Trendelenburg position are avoided by algorithms of the control.
- the object underlying the invention is to remedy the above disadvantage and to provide a component of the operating table, the operating table, and a method which enable a safe use of the operating table in a maximum possible range of movement.
- a component of an operating table comprises a communication module for transmitting information of the component and a detection device comprising a switch which can detect a characteristic of a further component to which the component is attachable.
- the switch is configured to activate the communication module.
- the communication module comprises a memory device configured to store information of the component, a transmission unit configured to transmit at least a part of the information of the component and to transmit the characteristic of the further component detected by the detection device, and a power supply device configured to supply the transmission unit with energy.
- the information of the component of the operating table can be transmitted autonomously without providing a separate power supply.
- a receiver of the operating table can determine the type of the component attached to the operating table. Therefore an algorithm of a control of the operating table can consider the actual configuration of the operating table for determining the range of movement without collision.
- the further component to which the component is attached can be identified so that an exact determination of the configuration of the operating table is possible since not only a presence of the component can be determined by also the location of the component.
- the switch for detecting the characteristic of the further component is a simple element which is easily to provide at low costs.
- provision of a further switch can be refrained from so that procurement costs and costs for assembly can be saved.
- the type of the further component and its location can be passed to a control device for further processing this information in order to determine the exact configuration of the operating table.
- the transmission unit is configured as having a low energy consumption.
- a transmission range can approximately correspond to dimensions of the operating table, so that no information from components of other operating tables can be received by a receiver of the control of the operating table.
- the transmission unit comprises a radio transmission device.
- the radio transmission device provides a reliable transmission of the information also in case of obstacles preventing a direct view from the transmission device of the communication module to a receiver of a controller of the operating table. Moreover, the small transmission range allows a provision of a transmission unit having low energy consumption.
- the transmission unit comprises an infrared emitter.
- the provision of the infrared emitter facilitates the operation of the transmission unit since safety requirements concerning a use of radio transmission which can be strict regulations are not to be considered.
- the power supply device comprises a battery.
- the battery which can be a rechargeable battery, enables a simple power supply. In particular when using batteries having a long term lifetime of ten years or when using the rechargeable batteries, an effort for service is minimized.
- the power supply device comprises an energy harvesting device.
- the transmission unit can be supplied with energy without providing an energy storage or by a rechargeable energy storage so that the effort for service for replacing the energy storage can be eliminated or further reduced.
- the power supply device comprises a solar panel.
- a provision of the solar panel as the energy harvesting device, as the case may be, in combination with the rechargeable battery, is sufficient for providing the power supply for the communication module.
- the power supply device comprises a piezo element.
- the piezo element as the energy harvesting device, which may be, e.g., provided below a lying surface of a tabletop section or on a handle for installing the component, and due to the use of the low energy transmission unit, the piezo element, as the case may be, in combination with the rechargeable battery, is sufficient for providing the power supply for the communication module.
- an operating table comprises the component comprising a first interface device, at least one further component to which the component is attachable, wherein the at least one further component comprises a second interface device, and a controller comprising a receiver configured to receive an information transmitted by the transmission unit.
- the stored information of the component of the operating table can be transmitted autonomously without providing a separate power supply.
- a receiver of the operating table can unambiguously determine the type of the component attached to the operating table. Therefore an algorithm of a control of the operating table can consider the actual configuration of the operating table for determining the range of movement without collision.
- the operating table comprises several further components, wherein at least two of the second interface devices of the further components are different from each other, the first interface device comprises the detection device comprising a switch, and the detection device is configured to distinguish different second interface devices, and the transmission unit is configured to transmit an information of the component including an identifier of the component and a characteristic of the further component to which the component is attached.
- the characteristics thereof can be considered when controlling the operating table in order to determine to which further component the component is attached in order to determine the exact configuration of the operating table.
- a method for determining a configuration of an operating table comprising a component and at least a further component to which the component is attachable includes the steps: detecting a characteristic of the further component to which the component is to be attached by a detection device comprising a switch, activating the communication module of the component by actuating the switch when attaching the component to the further component, transmitting at least a part of stored information of the component and the characteristic of the further component to which the component is to be attached, and determining the configuration of the operating table from the transmitted information of the component and the transmitted characteristic of the further component.
- the operating table can unambiguously determine the type of the component and a location where the component is attached to the operating table. Therefore an algorithm of a control of the operating table can consider the actual configuration of the operating table, e.g., for determining the range of movement without collision.
- the detection device comprises a switch
- the method comprises the step: activating a communication module of the component by activating the switch when attaching the component to the further component.
- the communication module can be switched off when not being attached to the operating table in order to save energy.
- the communication module is automatically activated so that the controller of the operating table can reliably determine the configuration of the operating table.
- the stored information comprises an identifier of the component.
- characteristics of the component stored in the controller of the operating table can be used, e.g., for determining the range of movement without collision.
- Fig. 1 shows a principle view of an operating table 1 comprising components 2 respectively comprising a communication module 3. In an alternative embodiment, not all of the components 2 comprise a communication module 3.
- the operating table 1 comprise further components 2' to which the components 2 are attachable.
- the components 2 respectively comprise a first interface device 4 and the further components 2' respectively comprise a second interface device 5.
- the first interface device 4 interacts with the second interface device 5.
- Some elements of the operating table 1 are merely one of the further components 2' comprising second interface devices 5.
- a base 6 of the operating table 1 is one of the further components 2'. Therefore, several different further components 2' are provided.
- Other elements of the operating table 1 are merely components 2 comprising the first interface device 4.
- a head section 7 and a leg section 8 respectively are one of the components 2.
- add-on modules 9 or a back section 10 form one of the elements being both one of the components 2 and one of the further components 2'.
- elements comprising the first interface device 4 and the second interface device 5 are not provided, or merely one further component 2' is provided.
- Fig. 2 shows an enlarged portion of Fig. 1 depicting the component 2 comprising a first interface device 4 having a detection device 18 and a further component 2' comprising a second interface 5 device.
- the communication module 3 comprises a memory device 11, a transmission unit 12, and a power supply device 13.
- the communication module 3 transmits information of the component 2 of the operating table 1.
- the memory device 11 stores information of the component 2. This information includes an identifier (not shown) of the component 2, i.e., a component ID. Alternatively, not a component ID but another information describing a type or characteristics of the component 2 is stored.
- the transmission unit 12 comprises a radio transmission device 14 and transmits at least a part of the information of the component 2.
- the transmission unit 12 comprises an infrared transmitter.
- the operating table 1 comprises a controller 15 comprising two receivers 16.
- the receivers 16 receive the information transmitted by the transmission unit 12. Alternatively, another suitable quantity of receivers 16 are provided.
- the transmission unit 12 is a low energy consumption transmission unit and transmits a short information including an initiation signal which awakes the controller 15 of the operating table 1. Further, the information includes a security code which is a bit sequence in order to verify the transmitted information. As mentioned above, the information includes the component ID and, moreover, a coupler ID elucidated below. Alternatively, the information does not include all of these parts or further information parts are provided.
- the power supply device 13 supplies the transmission unit 12 with energy. Therefore, the power supply device 13 comprises a battery 17.
- the power supply device 13, additionally or alternatively, is provided with an energy harvesting device, as, e.g., a solar panel, a piezo element, or a device receiving energy from electromagnetic waves, e.g., WLAN, for generating energy.
- an energy harvesting device as, e.g., a solar panel, a piezo element, or a device receiving energy from electromagnetic waves, e.g., WLAN, for generating energy.
- the component 2 in particular a first interface device 4 of the component 2, further comprises a detection device 18.
- the detection device 18 detects a characteristic of the further component 2' to which the component 2 is attached.
- the detection device 18 comprises three switches 19 which detect the characteristic of the further component 2'.
- the detection device 18 comprises three switches 19 which detect the characteristic of the further component 2'.
- four different second interface devices 5 are provided.
- at least one switch 19 or another quantity of switches 19 is provided.
- the further components 2' in particular, the second interface devices 5 thereof, have different characteristics which can be detected by the three switches 19.
- the second interface devices 5 have a flat surface 21 or a recess 22 or hole at locations corresponding to a respective switch 19 so that a specific switch 19 can distinguish whether, at the location corresponding to the specific switch 19, the second interface devices are provided with the flat surface 21, or the recess 22 or hole.
- no switches 19 and flat surfaces 21, recesses 22 and holes are provided but another kind of detector, e.g., an optical detector, and appropriate different surfaces of the second interface device 5 are provided.
- the detection device 18 distinguishes different further components 2'.
- two types Mb, Lb of the different second interfaces devices 5 belong to the base 6, one type Sc of the different second interface devices 5 respectively belong to the add-on modules 9, and one type Lc of the different interface devices 5 belong to the back plate 10.
- the second interface devices 5 of the base 6 are distinguished by the controller 15 by the location of the second interface device 5 on the base 6.
- the second interface devices 5 of the two add-on modules 10 are distinguished by the controller 15 by the second interface devices 5 of the back plate 10 and of the base 6 to which the two add-on modules 9 are respectively attached.
- the coupler ID includes the information of the type of the further component 2' to which the component 2 is attached, and a type and the location of the second interface 5 on the further component 2'. Alternatively, the coupler ID does not include all this information.
- Fig. 3 shows the operating table of Fig. 1 depicting the locations of coupling points of the components 2, i.e. of the different second interfaces 5: coupler ID coupling point description 001 Mb coupling point "Medium” on base 6 010 Lb coupling point “Large” on base 6 011 Mc coupling point "Medium” on further component 2', i.e. back plate 10 100 Sc coupling point "Small” on further component 2', i.e. add-on module 9
- Fig. 4 shows a flowchart of a method for determining a configuration of the operating table 1.
- a characteristic of the further component 2' to which the component 2 is attached is detected by the detection device 18.
- step S2 at least a part of stored information of the component 2 and the characteristic of the further component 2' to which the component 2 is attached is transmitted.
- the information transmitted by the communication module 3 is a very short information in order to save energy. This information is transmitted cyclically in respectively after a suitable timespan, in this embodiment after one minute. Alternatively, the information is not very short and it is not cyclically transmitted but merely when attaching the component 2 to the further component 2' or after another timespan.
- the information includes the initiation signal which awakes the controller 15 of the operating table 1. Further, the information includes the security code which is a bit sequence in order to verify the transmitted information and the coupler ID. Alternatively, the information does not include all of these parts or further information parts are provided.
- the configuration of the operating table is determined from the transmitted information of the component 2 and the characteristic of the further component 2'.
- the stored information comprises an identifier of the component 2.
- the stored information does not comprise the identifier of the component 2 but other characteristics, such as dimensions, movement ranges, etc.. Due to a short distance between the transmission unit 12 and the receivers 16 and a very short information transmitted by the transmission unit 12, energy consumption is low. Therefore, providing the energy by a long life battery or by a rechargeable battery in combination with the solar panel and the piezo element is sufficient. Moreover, if not attached to the operating table 1, the communication module 3 is not actuated and, therefore, there is no energy consumption.
- the communication module 3 By pressing one of the three switches 19, i.e., by actuating at least one of the switches 19, when attaching the component 2 to the further component 2', furthermore, the communication module 3 is activated. Alternatively, the communication module 3 is activated by another switch or it is constantly activated.
- the controller 16 gathers an information if a motion of the operating table is to be enabled, which motions are enabled and which motion ranges are allowed in order to avoid a collision.
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- Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Selective Calling Equipment (AREA)
Claims (10)
- Komponente (2) eines Operationstischs (1), wobei die Komponente (2) Folgendes umfasst:ein Kommunikationsmodul (3) zum Übertragen von Informationen über die Komponente (2); undeine Erkennungsvorrichtung (18), die einen Schalter (19) umfasst, der eine Charakteristik einer weiteren Komponente (2') erkennen kann, an der die Komponente (2) angebracht werden kann, und wobei der Schalter (19) zum Aktivieren des Kommunikationsmoduls (3) konfiguriert ist,wobei das Kommunikationsmodul (3) Folgendes umfasst:eine Speichervorrichtung (11), konfiguriert zum Speichern von Informationen über die Komponente (2),eine Übertragungseinheit (12), konfiguriert zum Übertragen zumindest eines Teils der Informationen über die Komponente (2) und zum Übertragen der von der Erkennungsvorrichtung (18) erkannten Charakteristik der weiteren Komponente (2'), undeine Stromversorgungseinrichtung (13), konfiguriert zum Versorgen der Übertragungseinheit (12) mit Energie.
- Komponente (2) nach Anspruch 1, wobei
die Übertragungseinheit (12) eine Funkübertragungsvorrichtung umfasst. - Komponente (2) nach Anspruch 1 oder 2, wobei die Übertragungseinheit (12) einen Infrarot-Sender umfasst.
- Komponente (2) nach einem vorherigen Anspruch, wobei
die Stromversorgungsvorrichtung (13) mindestens eines von einer Batterie, einer Energiegewinnungsvorrichtung, einem Solarpanel und einem Piezoelement umfasst. - Komponente (2) nach einem vorherigen Anspruch, wobei die Komponente (2) eines von einem Kopfteil (7); einem Beinteil (8); einem Zusatzmodul (9); und einem Rückenteil (10) ist.
- Operationstisch (1), der Folgendes umfasst:
eine Komponente (2) nach Anspruch 5, die Folgendes umfasst:eine erste Schnittstellenvorrichtung (4),mindestens eine weitere Komponente (2'), an der die Komponente (2) angebracht werden kann, wobei die mindestens eine weitere Komponente (2') eine zweite Schnittstellenvorrichtung (5) umfasst, undeine Steuerung (15), die einen Empfänger (16) umfasst, der zum Empfangen einer von der Übertragungseinheit (12) übertragenen Information konfiguriert ist. - Operationstisch (1) nach Anspruch 6, wobeider Operationstisch (1) mehrere weitere Komponenten (2') umfasst, wobei mindestens zwei der zweiten Schnittstellenvorrichtungen (5) der mehreren Komponenten (2') voneinander verschieden sind,die erste Schnittstellenvorrichtung (4) eine oder die Erkennungsvorrichtung (18) einen Schalter (19) umfasst [sic], unddie Erkennungsvorrichtung (18) zum Unterscheiden der verschiedenen zweiten Schnittstellenvorrichtungen (5) ausgebildet ist, unddie Übertragungseinheit zum Übertragen einer Information über die Komponente (2) einschließlich einer Kennung der Komponente (2) und einer Charakteristik der weiteren Komponente (2') konfiguriert ist, an der die Komponente (2) angebracht ist.
- Operationstisch (1) nach Anspruch 6 oder 7, wobei die weitere Komponente (2') mindestens eines von einer Basis (6) des Operationstischs (1); und einer Komponente (2) ist.
- Verfahren zum Bestimmen einer Konfiguration eines Operationstischs (1) nach Anspruch 6, 7 oder 8, wobei das Verfahren die folgenden Schritte beinhaltet:Erkennen einer Charakteristik der weiteren Komponente (2'), an der die Komponente (2) angebracht werden soll, durch die Erkennungsvorrichtung (18) mit einem Schalter (19) ;Aktivieren des Kommunikationsmoduls (3) der Komponente (2) durch Betätigen des Schalters (19) beim Anbringen der Komponente (2) an der weiteren Komponente (2');Übertragen zumindest eines Teils der gespeicherten Informationen über die Komponente (2) und der Charakteristik der weiteren Komponente (2'), an der die Komponente (2) angebracht ist; undBestimmen der Konfiguration des Operationstischs (1) aus den übertragenen Informationen über die Komponente (2) und der übertragenen Charakteristik der weiteren Komponente (2').
- Verfahren nach Anspruch 9, wobei
die gespeicherten Informationen eine oder die Kennung der Komponente (2) umfassen.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP20156314.5A EP3861973B1 (de) | 2020-02-10 | 2020-02-10 | Komponente eines operationstisches |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP20156314.5A EP3861973B1 (de) | 2020-02-10 | 2020-02-10 | Komponente eines operationstisches |
Publications (2)
Publication Number | Publication Date |
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EP3861973A1 EP3861973A1 (de) | 2021-08-11 |
EP3861973B1 true EP3861973B1 (de) | 2023-11-08 |
Family
ID=69528692
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
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EP20156314.5A Active EP3861973B1 (de) | 2020-02-10 | 2020-02-10 | Komponente eines operationstisches |
Country Status (1)
Country | Link |
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EP (1) | EP3861973B1 (de) |
Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20180344559A1 (en) * | 2017-05-31 | 2018-12-06 | Mizuho Osi | System, apparatus and method for supporting and/or positioning a patient before, during, or after a medical procedure |
Family Cites Families (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
DE102012108086A1 (de) * | 2012-08-31 | 2014-03-06 | Schmitz u. Söhne GmbH & Co. Kommanditgesellschaft | Operationstischsystem |
US10314758B2 (en) * | 2015-07-31 | 2019-06-11 | Allen Medical Systems, Inc. | Person support apparatus with tracking features |
DE102015112738A1 (de) * | 2015-08-03 | 2017-02-09 | Berchtold Holding Gmbh | Patientenauflage |
-
2020
- 2020-02-10 EP EP20156314.5A patent/EP3861973B1/de active Active
Patent Citations (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20180344559A1 (en) * | 2017-05-31 | 2018-12-06 | Mizuho Osi | System, apparatus and method for supporting and/or positioning a patient before, during, or after a medical procedure |
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