ES2248917T3 - Aparato para obturar y cortar tejidos. - Google Patents
Aparato para obturar y cortar tejidos.Info
- Publication number
- ES2248917T3 ES2248917T3 ES98944778T ES98944778T ES2248917T3 ES 2248917 T3 ES2248917 T3 ES 2248917T3 ES 98944778 T ES98944778 T ES 98944778T ES 98944778 T ES98944778 T ES 98944778T ES 2248917 T3 ES2248917 T3 ES 2248917T3
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- tissue
- bipolar
- chassis
- cutter
- shutter
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Classifications
-
- 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
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
-
- 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
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00601—Cutting
-
- 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
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/0063—Sealing
-
- 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
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00696—Controlled or regulated parameters
- A61B2018/00702—Power or energy
-
- 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
- A61B2018/00636—Sensing and controlling the application of energy
- A61B2018/00773—Sensed parameters
- A61B2018/00875—Resistance or impedance
-
- 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
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B2018/145—Probes having pivoting end effectors, e.g. forceps wherein the effectors remain parallel during closing and opening
Abstract
Un obturador o cortador (10) de tejido bipolar alargado a lo largo de un eje para aplicación por parte de un cirujano de energía electroquirúrgica al tejido y fluidos corporales de un paciente, comprendiendo el obturador o cortador: un mango (11) para la sujeción y manipulación por parte del cirujano; un chasis (15) portado por el mango, que se extiende axialmente respecto al mango y hacia fuera respecto al cirujano, teniendo el chasis un extremo de mango y un extremo distal dispuesto a lo largo del eje; un tubo (19) portado para movimiento axial relativo hasta y a lo largo del chasis y del mango, siendo el tubo alargado y relativo al chasis, teniendo el tubo un extremo (23) de cirujano y un extremo de paciente (20) dispuestos a lo largo del eje de éste; un efector (21) sobre el extremo del paciente en posición para hacer primero contacto con el tejido tras el movimiento del tubo relativo al chasis y axialmente hacia fuera desde el mango por parte del cirujano, siendo el efector de un material para conducir energía electroquirúrgica; un miembro (24) soportado por el extremo distal del chasis que se extiende más allá del extremo de paciente del tubo.
Description
Aparato para obturar y cortar tejidos.
Este invento se refiere a un aparato para cortar
y obturar vasos o tejidos sanguíneos usando un dispositivo de
movimiento lineal bipolar que comprime el tejido o vaso y después se
aplica potencia RF para obturar el tejido y cortar el tejido.
Para sellar vasos sanguíneos en operaciones de
cirugía, con el propósito de desactivar el vaso sanguíneo o para
detener o evitar el sangrado, se puede aplicar energía de
radiofrecuencia (RF) a la estructura del vaso sanguíneo en lugar de
grapas o clips. Tradicionalmente, se usan fórceps para crear una
única obturación por aplicación con energía RF bipolar. Normalmente,
se abrazan sobre el tejido fórceps que tienen una bisagra entre los
dientes que presionan contra cada lado del vaso sanguíneo y se
aplica energía. A veces aparecen problemas con esta técnica debido
al doblado de los fórceps o la falta de paralelismo entre los
dientes afectando por consecuencia a cómo se comprime y obtura el
tejido o vaso
sanguíneo.
sanguíneo.
El documento
US-A-4.985.030 describe en
combinación las características de la parte de precaracterización de
la reivindicación 1 que hay más adelante.
La patente de EEUU 5.585.896 tiene un dispositivo
percutor para obturar aberturas en vasos sanguíneos. Se inserta un
balón dentro del vaso y después se infla para forzar la pared del
vaso dentro de un collarín de fijación.
La patente de EEUU 5.383.897 tiene un dispositivo
para obturar perforaciones en vasos sanguíneos conformándose al
lumen interno del vaso y colocar arpones en el vaso con el fin de
obturar.
La patente de EEUU 5.391.183 tiene un dispositivo
para sellar perforaciones en vasos insertando un material
hemostático dentro del lugar de la perforación y alrededor del
exterior del vaso, con el fin de cerrar el lugar de la
perforación.
La patente de EEUU 5.437.292 tiene un dispositivo
percutor para obturar zonas de perforaciones arteriales o venosas,
ya sean accidentales o intencionales, que mezcla fibrinógeno y
trombina para formar un gel alrededor del lugar del lugar de la
perforación para crear la oclusión.
La patente de EEUU 5.411.520 tiene un dispositivo
para obturar vasos sanguíneos mediante percutores que desliza hacia
abajo un catéter de sujeción y entra en el vaso sanguíneo con un
ancla y un tapón de colágeno.
La patente de EEUU 5.415.657 tiene un dispositivo
que se acerca a la perforación en el vaso sanguíneo, se acopla con
la superficie exterior y aplica energía para crear hemostasis.
La patente de EEUU 5.429.616 tiene un dispositivo
para obturar perforaciones en vasos aplicando un fluido y después
comprimiendo los bordes cuando se obturan.
La patente de EEUU 5.441.517 tiene un sistema
para obturar perforaciones en vasos sanguíneos insertando
mecánicamente un tapón con un ancla para obturar la perforación.
La patente de EEUU 5.425.739 describe una espiral
colocada dentro del vaso para obturarlo o colocarlo de tal modo que
anastomose los bordes de los vasos.
La patente de EEUU 5.354.271 describe un
revestimiento deslizante para cerrar lugares de perforación que
tienen dos partes que se expanden radialmente hacia fuera y pueden
usar una forma de acordeón de un catéter.
La patente de EEUU 5.342.393 es un dispositivo
que repara perforaciones en vasos abrazando el tejido desde dentro y
desde fuera del vaso. Se usa el remachado para cerrar las secciones
abrazadas y se puede aplicar calor para separar el remache del
sistema de suministro. Este dispositivo no aplica energía en forma
de calor sino sólo para separar el remache del lugar de cierre.
La patente de EEUU 5.176.695 es un dispositivo de
corte mecánico laparoscópico monopolar con una cuchilla oscilante
lineal que corta de forma afilada tejidos que se sitúen en su
ranura. El presente invento bipolar no contiene una cuchilla afilada
puesto que obtura y corta usando energía RF.
La patente de EEUU 3.862.630 es un dispositivo en
el que se usa energía de ultrasonidos para cerrar vasos sanguíneos
mediante vibración mecánica y rozamiento de fricción. Cualquier
calentamiento del tejido es un derivado mínimo y superficial de la
vibración mecánica usada para obturar vasos.
La patente de EEUU 2.011.169 es un electrodo
quirúrgico con mordazas de extremo que tienen forma de U y se
encajan una dentro de la otra. No están aisladas una de otra y por
tanto son monopolares. En el presente invento las mordazas están
aisladas y son bipolares. Las mordazas del documento `169 están
montadas en un endoscopio. No ajustan entre si como en el presente
invento y están diseñadas más con el fin de retirar mordeduras del
tejido y coagular al mismo tiempo.
Todos los dispositivos anteriores son diferentes
de la descripción actual por varias razones. Estos dispositivos
están hechos para el cierre de perforaciones de heridas. Esto
implica que un canal de flujo viable permanecerá dentro del lumen
del vaso sanguíneo después de que se aplique cada dispositivo. El
dispositivo ahora descrito permanece externo al vaso sanguíneo donde
no existirá una perforación ni antes ni después del procedimiento.
El presente dispositivo obtura el vaso sanguíneo, y por consiguiente
no crea un camino para la sangre como hacían los anteriores
dispositivos discutidos. En la mayoría de los casos, después de
obturar con el dispositivo instantáneo, el vaso seguirá intacto,
aunque con una obturación transversal a él. Además, el simple abrazo
por medio del dispositivo descrito no obtura el vaso sanguíneo. Es
la aplicación de energía RF lo que forma un grapado o abrazo de
autotransfusión haciendo que una fusión de la íntima proporcione la
obturación.
Por consiguiente, para resolver las dificultades
de los dispositivos anteriores se muestra y describe un instrumento
de contacto con el paciente para sujetar y aplicar energía
eletroquirúrgica. Durante la disección quirúrgica, se encuentra
frecuentemente que los vasos necesitan ser obturados y por
consiguiente desactivados. Para hacer esto de una manera segura,
fiable para que el vaso quede obturado y no tenga fugas, se requiere
y es útil una herramienta que aplique energía para crear un clip de
autotransfusión. Se describe brevemente el dispositivo (y un método
para el cual es útil). Un tubo largo se conecta a un lado de un
suministro de energía bipolar. El tubo se mueve longitudinalmente,
es decir, a lo largo de su eje mayor para hacer tope contra y
comprimir el vaso con una parte de extremo. Las dos partes que se
ponen a cada lado del vaso podrían ser planas, curvas, triangulares,
en ángulo, entalladas, o con otras formas, siempre y cuando ajusten
entre si. Si las partes de extremo son de otra forma que no sea
plana, esto aumenta el área de la superficie que atraviesa el vaso
creando una mayor obturación en el vaso sin aumentar el diámetro de
las partes de extremo. Un pulso de energía RF aplicado corta el
tejido después de la obturación. El dispositivo y método, cuando se
probó en vasos sanos producía una presión de ruptura adecuada para
comprobar una obturación sólida.
Las ventajas del actual dispositivo y método son
el cierre axial paralelo de las partes de extremo para crear un
obturador bipolar compacto y evitar el cortocircuitado. Un
transductor de fuerza en línea podría proporcionar información de
realimentación sobre la fuerza aplicada usada durante la cirugía. El
dispositivo es bipolar para asegurar seguridad añadida mediante el
confinamiento de flujo de corriente RF a través del tejido entre los
electrodos bipolares en el extremo del dispositivo.
El invento está definido más adelante en la
reivindicación 1. Las reivindicaciones dependientes están dirigidas
a características opcionales o preferentes del invento.
Un obturador o cortador de tejidos bipolar
alargado axialmente para la aplicación de energía electroquirúrgica
por parte de un cirujano al tejido y a fluidos corporales de un
paciente, tiene preferentemente un mango para que el cirujano lo
sujete y manipule. Un chasis colocado sobre el mango puede
extenderse axialmente respecto al mango y hacia fuera desde el
cirujano. El chasis puede ser movido hasta y desde el mango a lo
largo del eje. El chasis puede tener un extremo de mango y un
extremo distal. Podría llevarse un tubo para movimiento axial
respecto a, o a lo largo del, chasis. El tubo es alargado respecto
al chasis y tiene un extremo de cirujano y un extremo de paciente
dispuestos a lo largo de su eje en la realización preferente.
Un efector sobre el extremo del paciente y más
preferentemente está en posición para hacer contacto primero con el
tejido tras el movimiento axial desde el mango por parte del
cirujano. El efector es preferentemente de un material para conducir
energía electroquirúrgica. Un miembro puede estar soportado por el
extremo distal del chasis en una posición opuesta al extremo del
paciente del tubo. Una parte sobre el miembro en el extremo distal
de éste está situado más preferentemente transversalmente respecto
al eje del tubo. La parte puede estar hecha de un material para
conducir energía electroquirúrgica y para actuar como un efector de
extremo opuesto.
Un primer electrodo electroquirúrgico bipolar
puede estar conectado eléctricamente al efector del extremo del
paciente. Un segundo electrodo electroquirúrgico bipolar podría
estar conectado eléctricamente a la parte o efector de extremo
opuesto. El segundo electrodo electroquirúrgico bipolar está aislado
eléctricamente del primer electrodo electroquirúrgico bipolar. Un
generador electroquirúrgico puede estar acoplado eléctricamente a
los primer y segundo electrodos electroquirúrgicos. El generador
electroquirúrgico puede estar dispuesto para proporcionar
selectivamente energía electroquirúrgica bipolar a través del primer
y segundo electrodos electroquirúrgicos bipolares.
Un activador mecánico está soportado más
preferentemente de forma móvil sobre el mango para ser usado por el
cirujano. El activador se conecta más preferentemente al tubo para
mover axialmente el extremo del paciente y su efector de extremo de
éste hacia o desde la parte o efector de extremo opuesto. El tejido
y fluido corporal entre los efectores de extremo puede ser obturado
o cortado mediante la aplicación de compresión axial y energía
electroquirúrgica bipolar entre el primer y segundo electrodos
electroquirúrgicos.
El efector de extremo y la parte o efector de
extremo opuesto incluyen superficies de obturación y corte
complementarias de acoplamiento parcial tras el movimiento axial de
uno hacia el otro a lo largo del eje. El efector y/o la parte de
extremo pueden ser unidos de forma separable al extremo y/o miembro
del paciente. Las superficies complementarias pueden ser de
acoplamiento parcial y curvilíneas para crear más área de contacto
con tejidos de lo que lo harían las superficies planas.
Alternativamente, las superficies complementarias de encaje parcial
pueden ser paralelas pero oblicuas al eje para crear un contacto
alargado con movimiento axial entre el efector de extremo y el
puerto. Las superficies complementarias de encaje parcial podrían
ser esencialmente planas. Las superficies complementarias de encaje
parcial pueden ser circulares. Las superficies complementarias de
acoplamiento parcial podrían ser elípticas. Las superficies
complementarias de encaje parcial podrían ser también triangulares.
Las superficies complementarias de encaje parcial pueden incluir
como mínimo un nervio y una ranura conjugados. Las superficies
complementarias de encaje parcial podrían incluir uno o más nervios
y correspondientes ranuras de encaje.
Un método para usar un obturador o cortador de
tejidos de energía electroquirúrgica bipolar alargado a lo largo de
un eje para ser aplicado por un cirujano al tejido o fluidos
corporales de un paciente puede obturar o cortar. El método puede
tener los pasos sujeción y manipulación del mango por parte de un
cirujano. Un paso del método podría ser extender axialmente un
chasis y/o un tubo portado por el mango. El método puede tener el
paso de mover a lo largo del eje el chasis y/o el tubo con el mango.
Un paso del método podría ser llevar el tubo para movimiento axial
relativo a, y a lo largo del, chasis. El paso del método puede
incluir situar un efector sobre un extremo de paciente del tubo para
un primer contacto con el tejido después de que el cirujano realice
un movimiento axial hacia fuera del mango. Usar un miembro soportado
en un extremo distal del chasis en posición hacia fuera desde el
extremo de paciente del tubo, puede ser un paso del método. El
método puede tener el paso de tener una parte situada
transversalmente respecto al eje y sobre el miembro.
El método de uso puede ser realizado con un
primer electrodo electroquirúrgico bipolar acoplado al efector de
extremo del extremo del paciente y un segundo electrodo
electroquirúrgico bipolar acoplado a la parte. Aislar eléctricamente
el segundo electrodo electroquirúrgico bipolar del primer electrodo
electroquirúgico bipolar es otro paso preferente del método de uso.
El método preferentemente tiene el paso de acoplar eléctricamente
selectivamente un generador electroquirúgico al primer y segundo
electrodos electroquirúrgicos para suministrar energía RF
electroquirúrgica bipolar desde el generador electroquirúrgico al
primer y segundo electrodos electroquirúrgicos bipolares. El método
más preferente tiene el paso de que un cirujano use un activador
mecánico que esté soportado de forma móvil sobre el mango. Mover
axialmente con el activador el extremo del paciente y/o el efector
del extremo opuesto para que el tejido y el fluido corporal entre
ellos pueda ser obturado o cortado entre el efector de extremo y la
parte a través de la aplicación de compresión y la energía
electroquirúrgica bipolar entre el primer y segundo electrodos
electroquirúrgicos es un paso preferente.
El método puede tener los pasos de aplicar el
efector creado con las superficies de obturación o corte
complementarias de acoplamiento parcial, y acoplamiento de encaje
parcial de las superficies de obturación o corte complementarias
tras un movimiento axial de una hacia la otra a lo largo del eje. El
método podría usar el paso de unir de forma separable la parte y/o
el efector de extremo al miembro y al chasis respectivamente. El
método tiene el paso de usar superficies complementarias de
acoplamiento parcial acoplables a lo largo de las trayectorias
curvilíneas para proporcionar más área de contacto con el tejido que
la que habría entre superficies planas. El método puede tener el
paso de usar las superficies complementarias parcialmente acoplables
preferentemente paralelas pero a lo largo de un plano oblicuo al eje
para crear un contacto alargado con movimiento axial entre el
efector de extremo y la parte.
El método puede tener el paso de usar superficies
planas complementarias de acoplamiento parcial que están quizás a
lo largo de los planos de las superficies planas. El método podría
tener el paso de usar superficies circulares complementarias de
acoplamiento parcial que podrían estar a lo largo de los arcos de
las superficies circulares. El método podría tener el paso de usar
superficies elípticas complementarias de acoplamiento parcial que
están preferentemente a lo largo de las curvas de elipses. El método
puede tener el paso de usar superficies triangulares complementarias
de acoplamiento parcial a lo largo de bordes de los triángulos. El
método podría tener el paso de usar superficies complementarias de
acoplamiento parcial acoplando como mínimo un nervio con una ranura
conjugada. El método puede tener el paso de usar superficies
complementarias de acoplamiento parcial que pueden incluir uno o
más nervios y ranuras de acoplamiento.
La Figura 1 es una vista en perspectiva de un
obturador o cortador de tejidos bipolar alargado tubular para la
aplicación por parte de un cirujano de energía electroquirúrgica al
tejido. El obturador o cortador se desliza a lo largo de su eje con
una porción interna, deslizante concéntricamente para juntar
axialmente los efectores de extremo.
La Figura 2 es una vista en sección transversal
tal como se vería a lo largo de las líneas 2-2 de la
Figura 1.
La Figura 3 es una vista lateral de un obturador
o cortador de tejidos bipolar alargado tubular reutilizable como en
la Figura 1 en el que uno de los variados efectores de extremo tiene
superficies complementarias de acoplamiento parcial.
La Figura 4 es una vista lateral de un obturador
o cortador de tejidos bipolar alagado tubular desechable como en la
Figura 1 en el que uno de los variados efectores de extremo tiene
superficies complementarias parcialmente acoplables.
La Figura 5 es una vista desde arriba ampliada de
la parte y del efector de extremo con superficies complementarias de
acoplamiento parcial que encajan entre si con mordazas conjugadas
en forma de V.
La Figura 6 es una vista desde arriba ampliada de
la parte y del efector de extremo con superficies complementarias de
acoplamiento parcial que encajan entre si con mordazas conjugadas
de nervio y ranura.
La Figura 7 es una vista desde arriba ampliada de
la parte y del efector de extremo con superficies complementarias de
acoplamiento parcial que encajan con un macho colocado en pedestal
y una hembra a nivel en los que ambos son mordazas conjugadas en
forma de V.
La Figura 8 es una vista desde arriba ampliada de
la parte y del efector de extremo con superficies complementarias de
acoplamiento parcial que encajan con un macho colocado en pedestal
y una hembra a nivel en los que ambos son mordazas conjugadas en
forma de U.
La Figura 9 es una vista desde arriba ampliada de
la parte y del efector de extremo con superficies complementarias de
acoplamiento parcial que encajan con un macho en forma de terraza y
una hembra rebajada a los que se ha dado forma para que encajen como
mordazas conjugadas.
La Figura 10 es una vista desde arriba ampliada
de la parte y del efector de extremo con superficies complementarias
de acoplamiento parcial que encajan con un par de nervios
verticales y un par conjugado de entallas como mordazas.
La Figura 11 es una vista desde arriba ampliada
de la parte y del efector de extremo con superficies complementarias
de acoplamiento parcial que encajan con un único nervio vertical y
una entalla conjugada como mordazas.
La Figura 12 es una vista desde arriba ampliada
de la parte y del efector de extremo con superficies complementarias
de acoplamiento parcial que encajan con un par de nervios
verticales y entallas conjugadas en los que un nervio y una entalla
están en el efector de extremo enfrente de su entalla y nervio
complementarios sobre la parte como mordazas.
La Figura 13 ilustra las mordazas conjugadas de
la Figura 5 con un vaso entre ellas antes de la obturación.
La Figura 14 ilustra las mordazas conjugadas de
la Figura 5 con un vaso entre ellas durante la obturación.
La Figura 15 es una vista parcial ampliada del
efector de extremo y la parte de la Figura 1 vista desde arriba con
un vaso abierto abrazado entre ellas durante el proceso de
obturación.
La Figura 16 es una ilustración en perspectiva de
un vaso obturado.
La Figura 17 muestra la tensión, corriente,
impedancia, potencia, y energía captadas durante la obturación de
una arteria esplénica.
La Figura 1 es una vista en perspectiva de un
obturador o cortador 10 de tejidos bipolar alargado tubular para la
aplicación por parte de un cirujano de energía electroquirúrgica al
tejido. Un mango 11, para ser sujetado y manipulado por el cirujano,
está sobre un extremo proximal 12 del obturador o cortador 10 de
tejidos bipolar alargado. El mango 11 tiene ambos primer y segundo
asideros 13 y 14 de mango, respectivamente. Un chasis 15, portado
sobre el mango 11 por la conexión mecánica con el primer asidero 13
de mango, se extiende axialmente a lo largo del eje "A"
relativamente al mango 11 y hacia fuera desde el cirujano una
distancia adecuada para alcanzar el lugar de operación del paciente.
El chasis 15 comprende al menos dos partes. La primera es un tubo
exterior 16 que se extiende desde el mango 11 a lo largo del eje
"A". Un tubo interno 19 es móvil hasta y desde el mango 11 en
la realización preferente. El tubo interno 19 está guiado a lo largo
del eje "A". El tubo interno 19 se conecta con el segundo
asidero 14 de mango para el acceso del cirujano. Un extremo distal
20 está sobre el tubo interno 19 y frente al lugar de operación. El
obturador o cortador 10 alargado tubular se desliza por consiguiente
en parte a lo largo de su eje "A" con el tubo interno 19 que es
una corredera interna, concéntrico, para juntar axialmente los
efectores de extremo 21 y 22. El tubo interno 19 es llevado
telescópicamente, en la realización preferente, sobre el chasis 15
para movimiento axial relativo hasta y desde él. El tubo interno 19
tiene, relativo al chasis 15, un extremo 23 de cirujano y el extremo
20 distal que están dispuestos a lo largo del eje "A" de este
como se muestra en las Figuras 1 y 3. La Figura 2 es una vista de
los tubos interno y externo 19 y 16 en sección transversal como se
verían a lo largo de las líneas 2-2 de la Figura 1.
Los tubos preferentes exterior e interior 16 y 19 son metálicos y
por consiguiente deberían estar aislados uno de otro y con respecto
al usuario mediante un recubrimiento 19' como se ve en la Figura
2.
El efector de extremo 21 sobre el extremo distal
20 está en posición de hacer contacto con el tejido tras el
movimiento axial del mango 11 mediante la manipulación del cirujano
del segundo asidero 14 del mango. La Figura 3 es una vista lateral
de la estructura tubular alargada reutilizable de la Figura 1 con
ambos de los variados efectores de extremo 21 y 22 mostrados
lateralmente. El efector 21 y 22 están hechos de materiales para
conducir energía electroquirúrgica tal como metal, polímeros
conductores o cerámica. El efector de extremo 22 tiene un miembro 24
soportado por la extensión de chasis 17 normal a este situada
enfrente del extremo 20 del paciente del tubo interno 19. Una parte
25 sobre el miembro 24 de éste está situada transversalmente
respecto al eje "A" de la Figura 1. Los efectores de extremo 21
y 22 están por consiguiente opuestos para acoplamiento tras un
desplazamiento axial relativo del tubo interno 19 y/o el chasis 15.
La Figura 4 es una vista lateral de una estructura tubular alargada
desechable de la Figura 1 con uno de los variados efectores de
extremo 21 y 22 mostrados lateralmente en la Figura 3. Como se
muestra en la Figura 3, la extensión de chasis 17, el miembro 24, y
la parte 25 están hechos para conducir energía electroquirúrgica.
Por supuesto, se puede añadir aislamiento según se necesite para
dirigir la electrocirugía bipolar al espacio entre los efectores de
extremo 21 y 22.
Un primer electrodo 26 electroquirúrgico bipolar
para hacer contacto con el tejido del paciente o fluidos corporales
está acoplado eléctricamente al efector 22 más allá del extremo del
paciente 18. Un segundo electrodo 27 electroquirúrgico bipolar está
acoplado eléctricamente a los efectores 21 y 22 para hacer contacto
con el tejido del paciente o fluidos corporales. El segundo
electrodo 27 electroquirúrgico bipolar está aislado eléctricamente
del primer electrodo 26 electroquirúrgico bipolar pero está en
posición para entregar energía electroquirúrgica bipolar a través
del tejido sujetado entre ellos. Un generador electroquirúrgico 28,
en la Figura 3, está acoplado eléctricamente al primer y segundo
electrodos electroquirúrgicos 26 y 27 mediante los terminales 29 y
30, respectivamente. El generador electroquirúrgico 28 puede estar
dispuesto para suministrar selectivamente energía electroquirúrgica
al primer y segundo electrodos 26 y 27 electroquirúrgicos bipolares.
La aplicación selectiva de energía electroquirúrgica se hace en
respuesta al control del cirujano y/o a un sensor 31 que hay en el
generador 28 electroquirúrgico. El sensor 31 puede medir la
impedancia a través del tejido entre los electrodos 26 y 27.
Un activador mecánico 32, en la Figura 3, está
soportado preferentemente de forma móvil sobre el mango 11 para uso
por parte del cirujano. El activador mecánico 32 se conecta al tubo
interno 19 para mover axialmente el efector de extremo 21 desde éste
hacia o desde el efector de extremo 22 en la realización preferente.
El tejido y fluido corporal que entre medias puede ser obturado o
cortado entre los efectores de extremo 21 y 22 mediante la
aplicación combinada de compresión y energía electroquirúrgica
bipolar entre los primer y segundo electrodos electroquirúrgicos 26
y 27.
Los efectores de extremo 21 y 22 incluyen obturar
o cortar complementariamente las superficies 33 y 34 para
acoplamiento de encaje parcial tras su movimiento axial de una hacia
la otra a lo largo del eje "A". La Figura 13 ilustra los
efectores de extremo 21 y 22 de las mordazas conjugadas de la Figura
5 con un vaso entre ellas antes de ser obturado. De forma similar,
la Figura 14 ilustra los efectores de extremo 21 y 22 de las
mordazas conjugadas de la Figura 5 con un vaso entre ellas durante
la obturación. Los efectores de extremo 21 y 22 están unidos de
forma separable al miembro 24 y/o al tubo interno 19,
respectivamente. La Figura 15 es una vista parcial ampliada de los
efectores de extremo 21 y 22 de la Figura 1 vistos desde el lateral
con un vaso abierto abrazado entre ellos durante el método o proceso
de obturación. Las superficies complementarias de encaje parcial 33
y 34 de la Figura 8 son curvilíneas para crear más área de contacto
de tejidos de la que crearían superficies planas del mismo espesor.
En la Figura 8, los efectores de extremo 21 y 22 tienen superficies
complementarias conjugadas 33 y 34 que encajan configuradas con una
parte macho 49 colocado en pedestal y un parte hembra 50 en forma de
U acoplable con ella como mordazas. La Figura 9 es una vista
superior ampliada de los efectores de extremo 21 y 22 que muestra
superficies conjugadas que encajan con un parte macho 35 con forma
de terraza y una parte hembra 36 a las que se ha dado forma para que
ajusten como mordazas. La Figura 10 es una vista superior ampliada
de los efectores de extremo 21 y 22 que muestra superficies
conjugadas que encajan con un par de nervios 38 verticales y un par
complementario de entallas 37 como mordazas. La Figura 11 es una
vista superior ampliada de los efectores de extremo 21 y 22 que
muestra las superficies conjugadas que encajan con un único nervio
39 vertical y una entalla 40 complementaria como mordazas. La Figura
12 una vista superior ampliada de los efectores de extremo 21 y 22
que muestra superficies conjugadas que encajan con un par de nervios
41 opuestos verticales y entallas opuestas 42 complementarios en los
que un nervio 41 está sobre cada uno de los efectores de extremo 21
y 22 a través de su entalla complementaria 42 y los efectores de
extremo opuestos 21 ó 22.
Cualesquiera mordazas curvilíneas acoplables
complementarias incluso en forma de "S" o aquellas mostradas en
la Figura 1 podrían estar dispuestas para proporcionar más área de
superficie para contacto con las superficies planas definidas por
los conductores a través de ellas. La Figura 5 es una vista superior
ampliada de los efectores de extremo 21 y 22 que muestra las
superficies conjugadas 33 y 34 que encajan con las mordazas de
formas complementarias 43 y 44. La Figura 6 es una vista superior
ampliada de los efectores de extremo 21 y 22 que muestra las
superficies conjugadas 33 y 34 que encajan con un nervio 45 y un
canal 46 como mordazas complementarias. La Figura 7 es una vista
superior ampliada de los efectores de extremo 22 y 23 que muestra
las superficies conjugadas 33 y 34 que encajan con una parte macho
47 colocado en pedestal y una parte hembra 48 en forma de V como
mordazas complementarias.
Las superficies complementarias acoplables 33 y
34 pueden ser paralelas pero oblicuas al eje "A" como en la
Figura 15 para crear contacto alargado con movimiento axial entre el
tubo interno 19 y el chasis 15 manteniendo así el tamaño del portal
laparoscópico a través del cual los efectores de extremo 21 y 22
deben pasar a una dimensión transversal mínima. Las superficies
complementarias de acoplamiento parcial 33 y 34 podrían ser
esencialmente planas como en las Figuras 3 y 4. Las superficies
complementarias de acoplamiento parcial 33 y 34 pueden ser
secciones circulares tal como aparece en las Figuras 1 y 8. Las
superficies complementarias de acoplamiento parcial 33 y 34 podrían
ser elípticas y por tanto similares a las Figuras 1 y 8 siendo las
curvaturas una parte de una elipse en lugar de un círculo. Debido a
la perspectiva mostrada en la Figura 1, no se pueden percibir las
diferencias observables en tal ilustración entre un círculo y una
elipse. Las superficies complementarias 33 y 34 de acoplamiento
parcial podrían también ser triangulares como en las Figuras 5, 7,
13 y 14. Las superficies complementarias de acoplamiento parcial 33
y 34 pueden incluir como mínimo un nervio y ranura conjugados como
en las Figuras 6 y 11. Las superficies complementarias de
acoplamiento parcial 33 y 34 podrían incluir varios nervios como en
las Figuras 10 y 12.
Un método de aplicar el obturador o cortador 10
de tejidos bipolar alargado tubular a lo largo de un eje "A"
incluye el uso por parte de un cirujano para suministrar energía
electroquirúrgica bipolar al tejido y a los fluidos corporales de un
paciente. El método tiene los pasos de sujetar y manipular el mango
11 por parte del cirujano. Un paso del método consiste en extender
axialmente el tubo interno 19 y/o el chasis 15 llevado en el mango
11 hacia fuera del cirujano. El método puede tener el paso de mover
el tubo interno 19 relativo al chasis 15 a lo largo del eje
"A". Llevar el tubo interno 19 para movimiento axial relativo a
y a lo largo del chasis 15 es un paso del método preferente. El paso
del método incluye colocar el efector de extremo 22 sobre el extremo
del paciente 18 para hacer primero contacto con el tejido tras el
movimiento axial del tubo interno 19 por parte del cirujano. Usando
un miembro soportado 24 el chasis es un paso del método. El método
puede tener el paso de usar una parte 25 situada transversalmente
relativa al eje "A" y sobre el miembro 24.
El método de uso puede tener un primer electrodo
26 electroquirúrgico bipolar acoplado al efector de extremo 22 que
se extiende desde el extremo de paciente 18 y un segundo electrodo
electroquirúrgico 27 bipolar acoplado al efector de extremo 21. Otro
paso preferente del método de uso es aislar eléctricamente el
segundo electrodo 27 electroquirúrgico bipolar del primer electrodo
26 electroquirúrgico bipolar. El método tiene preferentemente el
paso de acoplar eléctricamente selectivamente un generador 28
electroquirúrgico al primer y segundo electrodos electroquirúrgicos
para suministrar energía electroquirúrgica bipolar desde el
generador electroquirúrgico al primer y segundo electrodos 26 y 27
bipolares electroquirúrgicos. El método más preferentemente tiene el
paso de que un cirujano use un activador mecánico 32 soportado de
forma móvil sobre el mango 11. Mover axialmente, con el activador
mecánico 32, el tubo interno 19 y el efector de extremo 21 de éste
hacia o desde fuera del efector de extremo 22 para que el tejido y
el fluido corporales entre medias puedan ser obturados o cortados
entre los efectores de extremos 21 y 22 la aplicación de compresión
y energía electroquirúrgica bipolar entre el primer y segundo
electrodos electroquirúrgicos 26 y 27 es un paso preferente.
El método puede tener los pasos de aplicar los
efectores de extremos proporcionados con superficies obturadoras o
cortadoras 33 y 34, y acoplar con encaje parcial las superficies 33
y 34 complementarias obturadoras o cortadoras tras el movimiento
axial de una hacia la otra a lo largo del eje "A". Figura 16 es
una ilustración en perspectiva de un vaso obturado 51 como
consecuencia de realizar el método para formar la obturación 52. El
método incluye el paso de elegir unir de forma separable los efector
de extremo 26 y 27, el tubo interno 19 y el chasis 15,
respectivamente. El método puede tener el paso de usar superficies
33 y 34 complementarias de acoplamiento parcial acoplables a lo
largo de caminos curvilíneos para proporcionar más área de contacto
con los tejidos que la que hay entre superficies planas. El método
puede tener el paso de usar las superficies 33 y 34 complementarias
de acoplamiento parcial preferentemente paralelas a lo largo de un
plano oblicuo al eje "A" para crear contacto alargado con
movimiento axial entre el tubo interno 19 y el chasis 15.
El método puede tener el paso de usar superficies
planas 33 y 34 complementarias de acoplamiento parcial que estén a
lo largo de los planos de superficies planas. El método puede tener
el paso de usar superficies 33 y 34 circulares complementarias de
acoplamiento parcial que estén a lo largo de los arcos de las
superficies circulares. El método puede tener el paso de usar
superficies 33 y 34 elípticas complementarias de acoplamiento
parcial que estén a lo largo de las curvas de las elipses. El
método puede tener el paso de usar superficies 33 y 34 triangulares
complementarias de acoplamiento parcial que estén a lo largo de
bordes de los triángulos. El método puede tener el paso de usar
superficies 33 y 34 complementarias de acoplamiento parcial
acoplando como mínimo un nervio y una ranura conjugados. El método
puede tener el paso de usar superficies complementarias 33 y 34 de
acoplamiento parcial que incluyan uno o más nervios.
Un resultado de los resultados de una prueba de
laboratorio de un modelo del obturador o cortador de tejidos bipolar
ha mostrado un comportamiento excelente obturando un rango de vasos
de varios tamaños. El obturador o cortador de tejido bipolar con
recorrido lineal fue probado en arterias esplénicas porcinas
cortadas en fresco variando desde 1,8 hasta 3,3 mm. Se usó una única
potencia de activación (14 W, 500 kHz) en cada vaso abrazado
firmemente entre los electrodos bipolares de efectores de extremo.
La Figura 17 muestra la tensión, corriente, impedancia, potencia, y
energía durante la activación de una arteria esplénica de porcino de
2,6 mm con el dispositivo bipolar mostrado en la Figura 15. La
tensión varía desde 18-23 voltios hasta que la
impedancia sube hasta aproximadamente 14 s. En este punto, el vaso
es obturado y se apaga el suministro de energía manualmente. La
curva de impedancia muestra un decremento inicial cuando el vaso es
calentado con energía de radiofrecuencia, hasta aproximadamente 20
ohmios. El aumento rápido hasta aproximadamente 200 ohmios muestra
que el vaso está seco y que el proceso de obturación ha
finalizado.
Los datos, mostrados en los gráficos de la Figura
17, muestran la tensión, corriente, impedancia, potencia y energía
durante la activación de 17 s lograda con un obturador o cortador de
tejidos bipolar alargado tubular como se muestra en la Figura 15.
Los tiempos de activación varían de 12 a 28 s. La energía aplicada
varía de 170 a 400 julios. La impedancia de contacto variaba desde
20-80 ohmios, dependiendo del tamaño del vaso y la
forma de los efectores de extremo. Si se usasen los efectores de
extremo de la Figura 5, la impedancia de contacto disminuiría debido
a un mayor área de contacto con el vaso. El tamaño del vaso afecta
también a la impedancia.
Se examinaron atentamente los vasos después de
cada obturación y se encontró que no tenían carbonización. En 2 de
13 pruebas, el vaso era adherente a uno de los efectores de extremo.
El análisis histológico mostró que las paredes del vaso estaban
soldadas completamente con la integridad de la íntima, la túnica
adventicia y medios completamente perdidos. Las proteínas se
fundieron y resultó una soldadura semitraslúcida. la pared del vaso
estaba relativamente norma, en la zona adyacente a la posición de la
soldadura.
El obturador o cortador 10 de tejidos bipolar
alargado tubular para aplicación de energía electroquirúrgica al
tejido por parte de un cirujano como se recoge en las
reivindicaciones que siguen tiene una estructura que se desliza a lo
largo de su eje "A" con una parte deslizante interna,
concéntrica. El tubo deslizante 10 interno o interior está unido al
efector 21 de extremo proximal y el tubo o chasis 15 fijo externo se
conecta al efector 22 de extremo distal en la realización
preferente. Los dos efectores 21 y 22 de extremo se emparejan para
que el efector 22 de extremo distal ajuste bien ajustado contra el
efector 21 de extremo proximal. Estos efectores 21 y 22 de extremo
pueden ser cualquiera de un número de pares de formas conjugadas
incluyendo triangular, esférica, rectangular, con o sin entalla. La
entalla no sólo es para la alineación sino que también define un
borde afilado para cortar el tejido o vaso mediante la aplicación de
un pulso de RF de alta potencia al lugar de tejido abrazado entre
los efectores de extremos 21 y 22. En la realización preferente, el
mango 11 es apretado para que el tubo interno 19 se deslice hacia
fuera del usuario y el chasis 15 está fijo en relación con el tubo
interno 19 cuando los efectores 21 y 22 de extremo actúan sobre el
tejido que hay entre ellos. Por supuesto, esto se puede invertir
para que el chasis 15 se mueva y el tubo 19 esté fijo.
Claims (13)
1. Un obturador o cortador (10) de tejido bipolar
alargado a lo largo de un eje para aplicación por parte de un
cirujano de energía electroquirúrgica al tejido y fluidos corporales
de un paciente, comprendiendo el obturador o cortador:
un mango (11) para la sujeción y manipulación por
parte del cirujano;
un chasis (15) portado por el mango, que se
extiende axialmente respecto al mango y hacia fuera respecto al
cirujano, teniendo el chasis un extremo de mango y un extremo distal
dispuesto a lo largo del eje;
un tubo (19) portado para movimiento axial
relativo hasta y a lo largo del chasis y del mango, siendo el tubo
alargado y relativo al chasis, teniendo el tubo un extremo (23) de
cirujano y un extremo de paciente (20) dispuestos a lo largo del eje
de éste;
un efector (21) sobre el extremo del paciente en
posición para hacer primero contacto con el tejido tras el
movimiento del tubo relativo al chasis y axialmente hacia fuera
desde el mango por parte del cirujano, siendo el efector de un
material para conducir energía electroquirúrgica;
un miembro (24) soportado por el extremo distal
del chasis que se extiende más allá del extremo de paciente del
tubo;
una parte (25) sobre el miembro en el extremo
distal de éste, situada la parte transversalmente respecto al eje en
posición opuesta al extremo de paciente, siendo la parte de un
material para conducir energía electroquirúrgica;
un primer electrodo (27) electroquirúrgico
bipolar conectado eléctricamente al efector del extremo del
paciente;
un segundo electrodo (26) electroquirúrgico
bipolar conectado eléctricamente a la parte, estando aislado
eléctricamente el segundo electrodo electroquirúrgico del primer
electrodo electroquirúrgico bipolar;
un generador (28) electroquirúrgico acoplado
eléctricamente al primer y segundo electrodos electroquirúrgicos,
siendo el generador electroquirúrgico para suministrar
selectivamente energía electroquirúrgica a dichos primer y segundo
electrodos electroquirúrgicos bipolares; y
un activador mecánico (32) soportado de forma
móvil sobre el mango para uso por parte del cirujano, estando el
activador conectado a dicho tubo, siendo adecuado dicho activador
para mover de forma axial el extremo de paciente y el efector de
este hacia la parte o hacia fuera de ella para que el tejido y el
fluido corporal que hay entre medias pueda ser obturado o cortado
entre el efector y la parte mediante la aplicación de compresión y
energía electroquirúrgica entre el primer y segundo electrodos
electroquirúrgicos;
caracterizado porque
la parte y el efector están unidos de forma
separable al miembro y al chasis respectivamente.
2. El obturador o cortador de tejidos bipolar de
la reivindicación 1, en el que el activador mecánico está conectado
al chasis para movimiento relativo del tubo y el chasis.
3. El obturador o cortador de tejido de la
reivindicación 1, en el que el efector y la parte incluyen una
superficie obturadora o cortadora complementaria para acoplamiento
conjugado parcial tras el movimiento axial de uno hacia la otra a lo
largo del eje.
4. El obturador o cortador de tejidos bipolar de
la reivindicación 3, en el que las superficies complementarias de
acoplamiento parcial son curvilíneas para crear más área de
contacto con el tejido de lo que lo harían las superficies
planas.
5. El obturador o cortador de tejidos bipolar de
la reivindicación 3 ó 4, en el que las superficies complementarias
de acoplamiento parcial son paralelas pero oblicuas al eje para
crear un contacto alargado con movimiento axial entre el miembro y
el chasis.
6. El obturador o cortador de tejidos bipolar de
la reivindicación 5, en el que las superficies complementarias de
acoplamiento parcial son sustancialmente planas.
7. El obturador o cortador de tejidos bipolar de
la reivindicación 5, en el que las superficies complementarias de
acoplamiento parcial son circulares.
8. El obturador o cortador de tejidos bipolar de
la reivindicación 3, en el que las superficies complementarias de
acoplamiento parcial son elípticas.
9. El obturador o cortador de tejidos bipolar de
la reivindicación 3, en el que las superficies complementarias de
acoplamiento parcial son triangulares para encontrarse a lo largo de
los bordes de éstas.
10. El obturador o cortador de tejidos bipolar de
la reivindicación 3, en el que las superficies complementarias de
acoplamiento parcial incluyen como mínimo un nervio y ranura
complementaria conjugados.
11. El obturador o cortador de tejidos bipolar de
la reivindicación 3, en el que las superficies complementarias de
acoplamiento parcial incluyen uno o más nervios.
12. El obturador o cortador de tejidos bipolar de
la reivindicación 3, en el que las superficies complementarias son
superficies encajadas.
13. El obturador o cortador tal como se ha
reivindicado en cualquiera de las reivindicaciones precedentes, que
incluye un sensor (31) para medir la impedancia a través del tejido
entre los electrodos y medios para controlar el generador
electroquirúrgico dependiendo de la impedancia medida.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US08/925,805 US6267761B1 (en) | 1997-09-09 | 1997-09-09 | Apparatus and method for sealing and cutting tissue |
| US925805 | 1997-09-09 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| ES2248917T3 true ES2248917T3 (es) | 2006-03-16 |
Family
ID=25452266
Family Applications (3)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| ES05013895T Expired - Lifetime ES2376063T3 (es) | 1997-09-09 | 1998-09-04 | Aparato para sellar y cortar tejido. |
| ES05015635T Expired - Lifetime ES2349545T3 (es) | 1997-09-09 | 1998-09-04 | Instrumento para obturar y cortar tejido. |
| ES98944778T Expired - Lifetime ES2248917T3 (es) | 1997-09-09 | 1998-09-04 | Aparato para obturar y cortar tejidos. |
Family Applications Before (2)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| ES05013895T Expired - Lifetime ES2376063T3 (es) | 1997-09-09 | 1998-09-04 | Aparato para sellar y cortar tejido. |
| ES05015635T Expired - Lifetime ES2349545T3 (es) | 1997-09-09 | 1998-09-04 | Instrumento para obturar y cortar tejido. |
Country Status (6)
| Country | Link |
|---|---|
| US (4) | US6267761B1 (es) |
| EP (3) | EP1011492B1 (es) |
| AU (1) | AU9223598A (es) |
| DE (2) | DE69832391T2 (es) |
| ES (3) | ES2376063T3 (es) |
| WO (1) | WO1999012487A1 (es) |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US6096037A (en) | 1997-07-29 | 2000-08-01 | Medtronic, Inc. | Tissue sealing electrosurgery device and methods of sealing tissue |
| US6267761B1 (en) * | 1997-09-09 | 2001-07-31 | Sherwood Services Ag | Apparatus and method for sealing and cutting tissue |
| US6726686B2 (en) | 1997-11-12 | 2004-04-27 | Sherwood Services Ag | Bipolar electrosurgical instrument for sealing vessels |
| US7435249B2 (en) * | 1997-11-12 | 2008-10-14 | Covidien Ag | Electrosurgical instruments which reduces collateral damage to adjacent tissue |
| US6228083B1 (en) | 1997-11-14 | 2001-05-08 | Sherwood Services Ag | Laparoscopic bipolar electrosurgical instrument |
| US6045551A (en) | 1998-02-06 | 2000-04-04 | Bonutti; Peter M. | Bone suture |
| EP1595508B1 (en) | 1998-10-23 | 2009-04-08 | Covidien AG | Endoscopic bipolar electrosurgical forceps |
| US7364577B2 (en) | 2002-02-11 | 2008-04-29 | Sherwood Services Ag | Vessel sealing system |
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-
1997
- 1997-09-09 US US08/925,805 patent/US6267761B1/en not_active Expired - Lifetime
-
1998
- 1998-09-04 AU AU92235/98A patent/AU9223598A/en not_active Abandoned
- 1998-09-04 ES ES05013895T patent/ES2376063T3/es not_active Expired - Lifetime
- 1998-09-04 DE DE69832391T patent/DE69832391T2/de not_active Expired - Lifetime
- 1998-09-04 DE DE69841834T patent/DE69841834D1/de not_active Expired - Lifetime
- 1998-09-04 EP EP98944778A patent/EP1011492B1/en not_active Expired - Lifetime
- 1998-09-04 EP EP05015635A patent/EP1586280B1/en not_active Expired - Lifetime
- 1998-09-04 ES ES05015635T patent/ES2349545T3/es not_active Expired - Lifetime
- 1998-09-04 EP EP05013895A patent/EP1586279B1/en not_active Expired - Lifetime
- 1998-09-04 ES ES98944778T patent/ES2248917T3/es not_active Expired - Lifetime
- 1998-09-04 WO PCT/US1998/018576 patent/WO1999012487A1/en active IP Right Grant
-
2001
- 2001-11-14 US US09/992,301 patent/US6932810B2/en not_active Expired - Fee Related
-
2005
- 2005-06-29 US US11/170,616 patent/US7270660B2/en not_active Expired - Fee Related
-
2007
- 2007-09-06 US US11/899,633 patent/US20080004616A1/en not_active Abandoned
Also Published As
| Publication number | Publication date |
|---|---|
| EP1586280A3 (en) | 2005-12-07 |
| US6267761B1 (en) | 2001-07-31 |
| US20060020265A1 (en) | 2006-01-26 |
| DE69841834D1 (de) | 2010-09-23 |
| EP1011492B1 (en) | 2005-11-16 |
| ES2376063T3 (es) | 2012-03-08 |
| US20080004616A1 (en) | 2008-01-03 |
| EP1586280A2 (en) | 2005-10-19 |
| US6932810B2 (en) | 2005-08-23 |
| EP1011492A1 (en) | 2000-06-28 |
| EP1586279B1 (en) | 2011-11-02 |
| US20050101965A1 (en) | 2005-05-12 |
| DE69832391D1 (de) | 2005-12-22 |
| US7270660B2 (en) | 2007-09-18 |
| EP1586279A2 (en) | 2005-10-19 |
| AU9223598A (en) | 1999-03-29 |
| DE69832391T2 (de) | 2006-08-03 |
| EP1011492A4 (en) | 2000-12-20 |
| ES2349545T3 (es) | 2011-01-04 |
| EP1586280B1 (en) | 2010-08-11 |
| EP1586279A3 (en) | 2005-12-07 |
| WO1999012487A1 (en) | 1999-03-18 |
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