JP6594910B2 - 外科用器具用のクロージャロックアウトシステム - Google Patents
外科用器具用のクロージャロックアウトシステム Download PDFInfo
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- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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Description
描かれている実施形態は、装置10の細長い軸線A−Aの周りでのエンドエフェクタ200の関節運動を容易にするように構成された関節運動組立体62を備えている。しかしながら、様々な実施形態は、非関節式外科用ステープル留め装置と関連して有効に使用することも可能である。図2に見られるように、例えば、細長いシャフト組立体30は、ハンドル20上に支持されたノズル60によって操作可能に支持される近位閉鎖管セグメント151を備えている。ハンドル20は、発射システム100及びクロージャシステム150を操作可能に収容する2つのハンドルケース21、23から形成され得る。近位閉鎖管セグメント151の近位端部分153は、細長い軸線A−Aの周りでの選択的回転を容易にするために、ハンドル20によって回転可能に支持される。図1を参照されたい。同様に図1及び図2に見られるように、少なくとも一実施形態では、近位閉鎖管セグメント151の遠位端部分157は、可撓性ネック組立体70に連結される。可撓性ネック組立体70は、第1及び第2の可撓性ネック部分72及び74を有し、これら第1及び第2の可撓性ネック部分72及び74は、第1及び第2の細長い可撓性運動伝達用バンド組立体83、85を受容する。第1及び第2の運動伝達用バンド組立体83、85は、バンドの構造部分から遠位に延びる外側補強バンド部分86、87をそれぞれ有する。外側補強バンド部分86、87は、第1及び第2の内側関節運動用バンド89、90を固定するための複数の取り付けラグ88を有している。図2を参照されたい。運動伝達用バンド組立体83、85は、例えば、プラスチック、特にEMS−American Grilonより商品名Grivory GV−6Hで市販のガラス繊維強化非晶質ポリアミドから構成され得る。それに対して、運動伝達用バンド組立体83、85の内側関節運動用バンド89、90は金属、有利にはフルハード301ステンレス鋼又はその同等品で構成されるのが望ましい場合もある。運動伝達用バンド83、85の外側補強バンド部分86、87の取り付けラグ88は、対応する内側関節運動用バンド89、90の複数のラグ穴91に受容され、かつ該ラグ穴91内に固定される。第1及び第2の内側関節運動用バンド組立体89、90の遠位端には、第1及び第2のコネクター92、93がある。関節運動組立体は、第1及び第2のコネクター92、93にそれぞれ掛止式に係合するように構成された遠位関節運動用バンド96及び97を更に備える。関節運動用バンド96及び97は、以下により詳述に説明されるように、バンド96、97をエンドエフェクタ200に連結するためのレセプタクル98、99を有する。
以下により詳述に説明されるように、エンドエフェクタ200は、外科用ステープルカートリッジ300を操作可能に受容するように構成された細長い溝210を備える。アンビル220は細長い溝210に対して移動可能に支持され、かつ、開放位置(図16及び図17)から、組織を切断及びステープル留めすることができる閉鎖位置(図24及び25)まで移動される。アンビル220の開放位置と閉鎖位置との間の移動は、少なくとも部分的には、全体を150として示すクロージャシステムによって制御され、このクロージャシステムは、前述の通り、閉鎖トリガ152によって制御される。クロージャシステム150は近位閉鎖管セグメント151を備え、この近位閉鎖管セグメント151は、可撓性ネック組立体70に移動不能に連結される関節運動用バンド組立体83、85を上述の方法で操作可能に収納する。
少なくとも1つの形態では、外科用器具10は、発射トリガ102の作動に応じて発射ロッド110に発射運動を与えるための、全体を100として示す発射システムを備える。少なくとも1つの形態では、発射システム100は、第1及び第2のギアラック105、106を上に有する駆動部材104を更に備える。第1の切り欠き部109は、駆動部材104の第1のギアラック105と第2のギアラック106との間に設けられる。発射トリガ102が復帰運動している間、ステープルの発射後に駆動部材104をその元の位置に戻すため、発射トリガ102上の歯112は第1の切り欠き部109に係合する。発射されてない位置にある開放ボタン120の上部ラッチアーム122に発射ロッド110をロックするために、第2の切り欠き部114が発射ロッド110の近位端に位置している。発射システム150は、第1及び第2の一体型ピニオンギア111、113を更に備える。第1の一体型ピニオンギア111は、発射ロッド110に設けられた駆動ラック115に係合される。第2の一体型ピニオンギア113は、駆動部材104の第1のギアラック105に係合される。第1の一体型ピニオンギア111は第1の直径を有し、第2の一体型ピニオンギア113は、第1の直径よりも小さい第2の直径を有する。
前述したように、少なくとも1つの形態では、エンドエフェクタ200は、外科用ステープルカートリッジ300を中に操作可能に支持するように構成された細長い溝210を有する。図2及び図6に示すように、細長い溝210は、2つの離間配置された取り付けタブ212を備えた近位端部分を有し、これら取り付けタブ212は、関節運動用バンド96、97の遠位端部のフック98、99によって係合されるように構成される。よって、関節運動用バンド96、97の往復運動により、細長い溝210はフレックスネック組立体70に対して関節運動する。上で詳述したように、エンドエフェクタ200はアンビル220も備えている。少なくとも1つの形態では、アンビル220は、例えば、416 Stainless Steel Hardened and Tempered RC35 Min(又は同様の材料)から製造され、かつ、細長い溝210内に取り付けられるとステープルカートリッジ300と対向して係合するように構成されたステープル形成下面222を有する。アンビル220は、近位側に延びる取り付け部分223を有して形成され、該取り付け部分223は、それぞれがそこから突出するトラニオン30を有する2つのトラニオン壁226、228を有する。図11を参照されたい。加えて、取り付け部分223の下面232には、下方へ向かって突出した旋回タブ234が形成され、該旋回タブ234はこれを通って延びるスロット236を有し、該スロット236は、切断及びステープル留めの間にナイフバー130がエンドエフェクタ200を通って軸方向に進められる際に、ナイフバー130を受容かつ支持するように構成される。更に、取り付け部分223の上にはアンビル開放タブ224が、以下に詳細に説明するように遠位閉鎖管セグメント170の開口部176と操作可能に相互作用するように形成される。図16〜図25に見られるように、アンビルトラニオン230は、細長い溝210の近位端に形成された対応するトラニオンスロット214内に移動可能に受容されるように構成される。各トラニオンスロット214は、係止切り欠き部218に連通する弧状セグメント216を有する。
様々な実施形態は、ステープルカートリッジ300が細長い溝210の中に適切に設置されていない場合にアンビル220が閉鎖するのを防止する、固有の新規なアンビルロックアウトシステム250を備える。図6及び図7を参照すると、例えば、アンビルロックアウトシステム250は、以下により詳述に説明されるように、ステープルカートリッジ300の一部又は複数の部分による接触に応じて移動可能な可動アンビルロック部材260を備える。少なくとも1つの形態では、アンビルロック部材260は本体部分262を備え、該本体部分262は、上に形成された遠位側に突出する中央支持タブ264を有する。スロット266は本体部分262及び中央支持タブ264を通って延在し、ナイフバー130がそこを通過できるようにする。本体部分262は、近位側に延びる取り付けバー268を更に備え、該取り付けバー268は、フレックスネック組立体70の溝案内部79内の対応する取り付け開口部270内に摺動自在に受容されるように構成される。更に、アンビルロック部材260を遠位方向「DD」に付勢するために、例えば、コイルバネ269の形態の付勢部材が開口部270内に支持される。図16を参照されたい。アンビル220が細長い溝210に取り付けられると、トラニオン230は、細長い溝210の中の対応するトラニオンスロット214内に受容され、アンビルロック部材260の中央支持タブ264は、トラニオン壁226と228との間に受容されて、アンビル220に更なる支持を提供する。アンビルロック部材260の本体部分262には更に、トラニオン壁226、228の近位端面227、229と係合するように構成された2つのカム表面263が形成される。図6及び図7を参照されたい。アンビルロック部材の様々な実施形態は、Vectra A435液晶ポリマー−ナチュラル又は同様の材料で製造することができる。
様々な実施形態は、細長い溝210内に設置されるとアンビルロックアウトシステム250と相互作用するように構成された、固有の新規な外科用ステープルカートリッジ300を含む。図14及び図15に見られるように、少なくとも1つの形態では、外科用ステープルカートリッジ300は、例えば、Vectra A435、20% PTFE/15%GF−ナチュラルで製造され得るカートリッジ本体302を備える。カートリッジ本体302は、細長い溝210内に受容されるような寸法及び形状にされる。少なくとも1つの形態では、カートリッジ本体302は、その中に取り外し可能に保持されるよう、細長い溝210内に着座するように構成される。カートリッジ本体302は、ナイフバー130を受容するために、中央に配置されたスロット304を中に有して形成されてもよい。スロット304の両側には、ステープル開口部312の列306、308、310が設けられ、これらの列は、外科用ステープルを中に支持するように構成される。描かれている実施形態では、スロット304の両側には3つの列306、308、310が設けられている。外科用ステープルは、ステープル開口部312内に移動可能に支持されるステープルドライバ上に支持され得る。ステープルカートリッジ本体302内には、更に、切断バーが接触するとカートリッジ本体302を通って軸方向運動するように構成された楔形スレッドも支持される。楔形スレッドは楔形の駆動部材を備えて構成され、該楔形の駆動部材はステープルドライバと接触し、楔形スレッドがカートリッジ本体302を通って遠位側に駆動されると、ドライバ及び対応するステープルを閉じたアンビルに向けて駆動する。利用可能なステープルドライバの構成例及び楔形スレッドの構成例は、その開示全体が参照により本明細書に組み込まれる米国特許第7,669,746号により詳細に記載されている。様々な実施形態では、カートリッジ本体302内への楔形スレッド及びドライバの設置を容易にするため、図14及び図15に示されるように、金属製のカートリッジパン314、316が、カートリッジ本体302に取り付けられてもよい。カートリッジパン314及び316は、楔形スレッド及びドライバをカートリッジ本体302内に保持する役割を果たす。
図16〜図25を参照することにより、アンビルロックアウトシステムの操作を理解することができる。図16及び図17は、ステープルカートリッジ300内に設置される前の、細長い溝210に対するアンビル220の位置を示している。この「装填されておらず」かつ開放位置にあるとき、アンビルロック部材260はバネ269によって遠位方向に付勢され、これによりアンビルロック部材260のカム表面263は、トラニオン壁226、228の端面227、229と接触する。アンビルロック部材260はアンビル取り付け部分223を遠位方向「DD」に押し、これによりトラニオン230は、それらの対応の係止切り欠き部218の中に着座する。アンビルロック部材260のカム表面263はまた、端部壁面227、229と協働してアンビルを旋回させ、かつこのアンビルを図16及び図17に示される開放位置に保持する役割を果たす。図16に見られるように、トラニオン壁226、228は、開放位置にあるとき、旋回軸取り付け部240のロッカー面248上に支持される。この開放位置にあるとき、外科医は、遠位閉鎖管170を前進させるために閉鎖トリガ152を作動させることによってアンビル220を閉じることができない。アンビル220を閉じるために位閉鎖管セグメントを遠位側に前進させることができないので、発射トリガ102を作動させることができる閉鎖トリガ152の完全閉鎖位置まで閉鎖トリガ152を作動させることができない。よって、カートリッジ300が存在しない場合には、エンドエフェクタ200を作動させることはできない。
(1) ステープル留め器具組立体であって、
旋回スロットを含み、前記旋回スロットが、閉鎖経路を画定する第1の部分と、ロックを含む第2の部分と、を含む、カートリッジ支持部分と、
前記カートリッジ支持部分へ挿入可能なステープルカートリッジであって、前記ステープルカートリッジが、その中に取り外し可能に貯蔵された複数のステープルを含む、ステープルカートリッジと、
前記カートリッジ支持部分に移動可能に取り付けられたアンビルであって、前記アンビルが、前記ステープルを変形するように構成されたステープル形成部分を含み、前記アンビルが開放位置と閉鎖位置との間を移動可能であり、かつ、前記アンビルが前記旋回スロットに移動可能に位置付けられたトラニオンを含む、アンビルと、
前記カートリッジ支持部分に摺動自在に位置付けられた摺動可能部材と、
前記ステープルカートリッジが前記カートリッジ支持部分に位置付けられていない場合に、前記アンビルが前記開放位置から前記閉鎖位置へ移動しないよう、前記ロックへ前記トラニオンを付勢するように構成された付勢部材と、を含み、前記ステープルカートリッジが前記カートリッジ支持部分に位置付けられている場合に、前記摺動可能部材に係合し、前記切り欠き部の中から前記旋回スロットの前記第1の部分へ前記トラニオンを押し入れ、前記アンビルが前記開放位置から前記閉鎖位置へ移動されるときに、前記トラニオンが前記閉鎖経路に沿って移動することを可能にするように、前記ステープルカートリッジが構成されている、ステープル留め器具組立体。
(2) ロック部材を更に含み、前記ステープルカートリッジが前記ステープルカートリッジ支持部分に位置付けられていない場合に、前記付勢部材が、前記アンビルと係合するように前記ロック部材を押して、前記アンビルを前記開放位置に保持するように構成されている、実施態様1に記載のステープル留め器具組立体。
(3) ロック部材を更に含み、前記ステープルカートリッジが前記ステープルカートリッジ支持部分に位置付けられていない場合に、前記付勢部材が、前記アンビルと係合するように前記ロック部材を押して、前記アンビルを前記開放位置に向かって回転させるように構成されている、実施態様1に記載のステープル留め器具組立体。
(4) 前記ステープルカートリッジが前記カートリッジ支持部分に位置付けられている場合に、前記摺動可能部材が、前記トラニオンを前記ロックに接近させないようにブロックするように構成されている、実施態様1に記載のステープル留め器具組立体。
(5) 外科用組立体であって、
発射トリガを含むハンドルと、
前記ハンドルから延在するシャフトであって、前記シャフトが発射バーを含む、シャフトと、
前記シャフトから延在する外科用エンドエフェクタであって、前記外科用エンドエフェクタが、
溝を含む第1のジョーであって、複数のスロットが前記溝内に画定され、前記複数のスロットが第1のスロット及び第2のスロットを含み、前記第1のスロットが旋回経路及び係止溝を含む、第1のジョーと、
取り付け部分を含むアンビルを含む第2のジョーであって、前記取り付け部分が前記第1のスロット内に移動可能に位置付けられた第1のピンを含む、第2のジョーと、
前記第1のジョーに位置付けられた変位可能案内部と、含み、前記変位可能案内部が、
本体であって、前記第2のスロット内に移動可能に位置付けられた第2のピンを含み、長手方向スリットが前記本体内に画定されて、前記発射バーに横方向にそろえられている、本体と、
前記本体から延在する障壁と、を含み、前記障壁は、前記第2のピンが前記第2のスロット内の位置範囲内に位置付けられている場合に、前記係止溝と長手方向にそろえられ、前記第2のピンが前記位置範囲外に位置付けられている場合に、前記障壁が前記第1のスロットから長手方向にオフセットされる、外科用エンドエフェクタと、
前記溝に位置付けられた締結具カートリッジと、を含み、前記締結具カートリッジが、
複数の締結具と、
前記変位可能案内部と当接係合するように位置付けられた付勢面と、を含み、前記付勢面が、前記位置範囲の位置へ前記第2のピンを付勢するように構成されている、外科用組立体。
カムを含む本体と、
バネと、を含み、前記バネが、前記カムを前記取り付け部分と当接係合するように付勢するように位置付けられている、実施態様5に記載の外科用組立体。
(7) 前記カムが、前記第1のピンを前記係止溝へ付勢するように構成されている、実施態様6に記載の外科用組立体。
(8) 前記障壁が、前記取り付け部分と当接係合するように位置付けられた当接面を含み、前記第2のピンが前記位置範囲内の位置に位置付けられている場合に、前記当接面が、前記旋回経路へ前記第1のピンを付勢するように構成されている、実施態様7に記載の外科用組立体。
(9) 外科用エンドエフェクタであって、
溝を含む第1のジョーであって、複数のスロットが前記溝内に画定されており、前記複数のスロットが、
旋回ピンスロットと、
摺動ピンスロットと、を含む、第1のジョーと、
第2のジョーであって、
アンビルと、
旋回ピンを含む取り付け部分と、を含み、前記旋回ピンが前記旋回ピンスロット内に移動可能に位置付けられている、第2のジョーと、
前記第1のジョーに位置付けられた摺動可能な発射バー案内部と、を含み、前記摺動可能な発射バー案内部が、
摺動ピンを含む本体であって、前記摺動ピンが前記摺動ピンスロット内に移動可能に位置付けられている、本体と、
前記本体から近位に延在する脚部と、を含み、前記摺動ピンが前記摺動ピンスロット内の位置範囲内に位置付けられている場合に、前記脚部が前記旋回ピンスロットの少なくとも一部と長手方向にそろえられ、前記摺動ピンが前記摺動ピンスロット内の前記位置範囲外に位置付けられている場合に、前記脚部が前記旋回ピンスロットから長手方向にオフセットされる、外科用エンドエフェクタ。
(10) 前記旋回ピンスロットが、弧状部分及び係止部分を含み、前記第2のジョーが前記第1のジョーに対して旋回するときに、前記旋回ピンが前記弧状部分内で移動するように構成され、前記摺動ピンが前記位置範囲内に位置付けられているときに、前記脚部が前記係止部分に長手方向に重なり合う、実施態様9に記載の外科用エンドエフェクタ。
複数の締結具と、
前記摺動可能な発射バー案内部と当接係合するように位置付けられた付勢面と、を含み、前記付勢面が、前記旋回ピンを前記弧状部分へ移動させるように構成されている、実施態様10に記載の外科用エンドエフェクタ。
(12) 前記溝内に位置付けられた締結具カートリッジを更に含み、前記締結具カートリッジが、
複数の締結具と、
近位付勢面と、を含み、前記近位付勢面が、前記摺動可能な発射バー案内部と当接係合するように位置付けられ、前記近位付勢面が、前記位置範囲の位置へ前記摺動ピンを摺動させる、実施態様9に記載の外科用エンドエフェクタ。
(13) カムを含む本体と、
前記取り付け部分と当接係合するように前記カムを付勢するよう、位置付けられているバネと、
を含むロック組立体を更に含む、実施態様9に記載の外科用エンドエフェクタ。
(14) 長手方向スリットが前記摺動可能な発射バー案内部内に画定されており、前記長手方向スリットが並進可能な発射バーを収容するように寸法付けられ、かつ位置付けられている、実施態様9に記載の外科用エンドエフェクタ。
(15) 前記摺動可能な発射バー案内部が壁を含み、前記取り付け部分が前記壁の一部を補足するように構造化された溝を含み、前記壁が前記溝に隣接して位置付けられている、実施態様9に記載の外科用エンドエフェクタ。
(17) 外科用器具であって、
溝を含む第1のジョーであって、複数のスロットが前記溝内に画定されており、前記複数のスロットが、
旋回ピンスロットと、
摺動ピンスロットと、を含む、第1のジョーと、
第2のジョーであって、
アンビルと、
取り付け部分と、を含み、前記取り付け部分が、前記旋回ピンスロット内に移動可能に位置付けられた旋回ピンを含む、第2のジョーと、
発射バーと、
前記第1のジョーに移動可能に位置付けられた案内部と、を含み、前記案内部が、
本体であって、
前記発射バーに横方向にそろえられている長手方向スリットと、
前記摺動ピンスロットに移動可能に位置付けられている摺動ピンと、を含む、本体と、
前記本体から延在する脚部と、を含み、前記摺動ピンが前記摺動ピンスロット内の第1の位置範囲内に位置付けられているときに、前記脚部が前記旋回ピンスロットの少なくとも一部をブロックするように構成されている、外科用器具。
(18) 前記第1のジョー及び前記第2のジョーを含むエンドエフェクタと、
発射トリガを含むハンドルと、
前記ハンドルと前記エンドエフェクタとの中間に位置付けられたシャフトと、を更に含む、実施態様17に記載の外科用器具。
(19) カム表面を含む本体と、
前記取り付け部分と当接係合するように前記カム表面を付勢するよう、位置付けられたバネと、
を含むロック組立体を更に含む、実施態様17に記載の外科用器具。
(20) 前記旋回ピンスロットが、弧状スロットと、前記弧状スロットから延在する係止溝と、を含む、実施態様19に記載の外科用器具。
(22) 前記カム表面が、前記旋回ピンを前記係止溝へ付勢するように構成されている、実施態様20に記載の外科用器具。
(23) 前記溝内に位置付けられた締結具カートリッジを更に含み、前記締結具カートリッジが、前記係止溝の中から前記旋回ピンを変位させるように構成されている、実施態様20に記載の外科用器具。
(24) 前記溝内に位置付けられた締結具カートリッジを更に含み、前記締結具カートリッジが、前記第1の位置範囲の位置へ前記摺動ピンを付勢するように構成されている、実施態様17に記載の外科用器具。
Claims (4)
- ステープル留め器具組立体であって、
旋回スロットを含み、前記旋回スロットが、閉鎖経路を画定する第1の部分と、ロックを含む第2の部分と、を含む、カートリッジ支持部分と、
前記カートリッジ支持部分へ挿入可能なステープルカートリッジであって、前記ステープルカートリッジが、その中に取り外し可能に貯蔵された複数のステープルを含む、ステープルカートリッジと、
前記カートリッジ支持部分に移動可能に取り付けられたアンビルであって、前記アンビルが、前記ステープルを変形するように構成されたステープル形成部分を含み、前記アンビルが開放位置と閉鎖位置との間を移動可能であり、かつ、前記アンビルが前記旋回スロットに移動可能に位置付けられたトラニオンを含む、アンビルと、
前記カートリッジ支持部分に摺動自在に位置付けられた摺動可能部材と、
前記ステープルカートリッジが前記カートリッジ支持部分に位置付けられていない場合に、前記アンビルが前記開放位置から前記閉鎖位置へ移動しないよう、前記ロックへ前記トラニオンを付勢するように構成された付勢部材と、を含み、前記ステープルカートリッジが前記カートリッジ支持部分に位置付けられている場合に、前記ステープルカートリッジが、前記摺動可能部材に係合して、前記摺動可能部材を摺動させることにより、前記トラニオンが、前記ロックの中から前記旋回スロットの前記第1の部分へ押し入れられ、前記アンビルが前記開放位置から前記閉鎖位置へ移動されるときに、前記トラニオンが前記閉鎖経路に沿って移動することができるようになっている、ステープル留め器具組立体。 - ロック部材を更に含み、前記ステープルカートリッジが前記カートリッジ支持部分に位置付けられていない場合に、前記付勢部材が、前記アンビルと係合するように前記ロック部材を押して、前記アンビルを前記開放位置に保持するように構成されている、請求項1に記載のステープル留め器具組立体。
- ロック部材を更に含み、前記ステープルカートリッジが前記カートリッジ支持部分に位置付けられていない場合に、前記付勢部材が、前記アンビルと係合するように前記ロック部材を押して、前記アンビルを前記開放位置に向かって回転させるように構成されている、請求項1に記載のステープル留め器具組立体。
- 前記ステープルカートリッジが前記カートリッジ支持部分に位置付けられている場合に、前記摺動可能部材が、前記トラニオンを前記ロックに接近させないようにブロックするように構成されている、請求項1に記載のステープル留め器具組立体。
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US14/304,077 US10045781B2 (en) | 2014-06-13 | 2014-06-13 | Closure lockout systems for surgical instruments |
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PCT/US2015/030935 WO2015191231A1 (en) | 2014-06-13 | 2015-05-15 | Closure lockout systems for surgical instruments |
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EP (2) | EP2954859B1 (ja) |
JP (1) | JP6594910B2 (ja) |
CN (1) | CN106572853B (ja) |
AU (1) | AU2015275140B2 (ja) |
BR (1) | BR112016029080B1 (ja) |
MX (1) | MX2016016382A (ja) |
PL (1) | PL2954859T3 (ja) |
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EP3315081B1 (en) | 2020-09-09 |
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