WO2007104331A1 - Dispositif écarteur - Google Patents

Dispositif écarteur Download PDF

Info

Publication number
WO2007104331A1
WO2007104331A1 PCT/EP2006/002372 EP2006002372W WO2007104331A1 WO 2007104331 A1 WO2007104331 A1 WO 2007104331A1 EP 2006002372 W EP2006002372 W EP 2006002372W WO 2007104331 A1 WO2007104331 A1 WO 2007104331A1
Authority
WO
WIPO (PCT)
Prior art keywords
spreading device
light
light emitter
spreading
jaws
Prior art date
Application number
PCT/EP2006/002372
Other languages
German (de)
English (en)
Inventor
Ingeborg Rolle
Axel Rolle
Original Assignee
Rolle + Rolle Gmbh & Co Kg
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Rolle + Rolle Gmbh & Co Kg filed Critical Rolle + Rolle Gmbh & Co Kg
Priority to PCT/EP2006/002372 priority Critical patent/WO2007104331A1/fr
Priority to DE212006000093U priority patent/DE212006000093U1/de
Publication of WO2007104331A1 publication Critical patent/WO2007104331A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/02—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors
    • A61B17/0206—Surgical instruments, devices or methods, e.g. tourniquets for holding wounds open; Tractors with antagonistic arms as supports for retractor elements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure

Definitions

  • the invention relates to a spreading device with the features of the preamble of claim 1.
  • Known spreading devices of this genus are z. B. used as so-called rib obstruction in the thoracic surgery. Here they serve to spread surgically created body openings in order to give the surgeon good access to the treated tissue or organ such. As the heart, the lung, the esophagus or the spine.
  • a disadvantage of the use of such spreading devices from the prior art are the limited visibility. Often, the expansions of the body orifices are less than the dimensions of the exposed body cavity, so that the tissue or organ to be treated is restrictedly accessible and visible through the body orifice.
  • the body cavities are usually illuminated with ceiling mounted surgical lights. For better visibility operators use so-called head lights, which illuminate the area located in front of the field of view and see through turns of the head and lateral areas of the body cavity.
  • the invention has the object to improve a spreading device of the type mentioned in that despite about the same size body opening and good handling by the attending physician, z. As a surgeon, zuehendes treatment area is more visible.
  • the arrangement of a light emitter on at least one of the spreading jaws allows a good illumination, including the edge regions of the treatment area. Areas that were difficult to recognize in conventional lighting can be illuminated in this way become.
  • the light emitter on the spreading jaws protruding into the body opening the shadow cast in the treatment area can be reduced. Since the light emitter is located very close to or in the patient, a good illumination of the entire treatment area is ensured and the shadow is reduced, compared to a further away from the patient light source.
  • the light emitter can emit light into a body cavity accessible through the body opening.
  • the entire body cavity and thus the treatment area is well lit.
  • cladding rays of a light cone emitted by the light emitter may be below or at most in an ebene defined by the opening edge of the body opening. As a result, the light emission is largely limited to the treatment area.
  • the light emitted by the light emitter may have a color temperature in the range of about 1,000 to 10,000 K, preferably in the range of about 3,000 to 8,000 K and in particular in the range of about 4,000 to 7,000 K. Light with such a color temperature allows a largely realistic color perception and is thus well suited for operations.
  • the color temperature of the light emitted by the light emitter light can be changed.
  • the lighting can be adapted to the needs of the treating physician and / or the respective treatment area. Even unfavorable lighting conditions of the environment can be compensated if necessary.
  • the brightness of the light emitted by the light emitter can be changeable.
  • the light can be as ambient conditions such. B. the attending physician, the treatment area, etc. adapt.
  • the light emitter may have a diffuse light emission. This helps to reduce shadows. Conveniently, the light emitted by the light emitter may be colourfast. This gives the doctor a largely realistic color impression of the tissue in the treatment area. This helps the doctor to correctly interpret the treatment situation and thus increases the safety.
  • the light emitter may consist of biocompatible material. This allows a gentle treatment of the patient. Treatment risks such. As a contact allergy or possible late effects can be reduced.
  • the light emitter can be sterilized. This allows reuse and thus economical use of the spreading device.
  • the light emitter can lie approximately flush with the jaw material.
  • the flush system allows a largely gap-free transition from the material of the expanding jaws to the light emitter. This facilitates sterilization.
  • the light emitter can be connected via at least one conductor element to a power source. This allows a good and lasting energy supply and thus a good light output of the light emitter over the treatment period.
  • the energy source may be a light source, which is connected via an optical conductor to the light emitter.
  • the light emitter can be connected to an existing light source z.
  • the light source may be a cold light source.
  • the cold light reduces dehydration and heating of the illuminated fabric.
  • the light source may be a laser light source.
  • the energy source can be connected via an electrical conductor to the light emitter. This allows the light emitter to be connected to an existing power source.
  • the conductor element can be provided extending in and / or on the spreading device.
  • the leadership of the conductor within and / or along individual components of the spreading of the conductor is largely protected from external influences such.
  • the treatment area is kept clear and the patient can be protected from any unwanted contact with the conductor.
  • the spreading device may have a guide for the conductor element.
  • the conductor is securely guided when moving the expanding jaws.
  • the cross section of the expanding jaws may have a curved shape.
  • the spreading jaws can safely hold the opening edge and optionally, depending on the embodiment, also encompass.
  • the light emitter may extend approximately along the spreader jaw.
  • the longitudinal extension of the light emitter allows a large emission area.
  • the light emitter may be provided on the side of the spreading jaw projecting into the body opening. This ensures a good illumination of the body cavity or the treatment area.
  • the light emitter may extend approximately to half the height of the spreader jaw. As a result, the emission surface of the light emitter is further increased. A radiation of light beyond the body opening is still largely reduced.
  • Figure 1 is a perspective view of a spreading device according to the invention.
  • FIG. 2 shows the spreading device according to the invention from FIG. 1 in a state inserted into a body opening
  • FIG. 3 shows a section through the spreading jaws of the spreading device according to the invention from FIG. 2.
  • Figure 1 shows a perspective view of a spreading device 1 according to the invention with two expanding jaws 2, 3.
  • the spreading jaws are here integrally formed with mounting rails 4, 5, via which the expanding jaws 2, 3 are connected to a jaw holder 6.
  • the jaw holder 6 allows the spacing of the two expanding jaws 2, 3 and has a rack and pinion mechanism in this embodiment.
  • the rack 7 is firmly connected to the first support rail 4.
  • the foot 8 of the support rail 5 of the second expanding jaw 3 surrounds the rack 7 and houses in its interior a gear (not shown here), which meshes with the teeth 9 of the rack 7.
  • Via a lever 10 which is pivotally connected to the axis 11 of the gear, the gear and thus the clamping jaw 3 can be moved manually.
  • the rack and pinion mechanism shown here is self-locking and thus at the same time allows a fixation of the clamping jaw 3.
  • other embodiments of the invention may alternatively but other adjustment and jaw holding mechanisms such.
  • B. lever and / or screw mechanisms have.
  • the expanding jaws 2, 3 are here flat and curved in itself. Each expanding jaw carries at its end facing away from the mounting rail 12 a light emitter 13. The light emitter 13 are connected via a conductor element 14 with a connecting element 15 z. B. a plug, a socket or the like. The connecting element 15 is in this embodiment on the mounting rail
  • connection element 15 is not necessarily, as here, be arranged in the lower region of the support rail. Depending on the application, it may be located at any point of the conductor element 14.
  • the connection element can be designed, for example, as a sterilizable, integrated socket into which jack plugs or screw plugs are inserted.
  • the conductor element 14 consists in this embodiment of two internal 16 and an external conductor 17.
  • the internal conductors 16 extend inside the expanding jaws 2, 3 and the support rails 4, 5 and are indicated here by dashed lines.
  • the external conductor 17 connects the two internal conductors 16 with each other. Provides an insulating layer of plastic and is sterilizable. At the same time it allows by its mechanical properties and / or by its shape an elongation of the conductor. In this embodiment, the external conductor 17 has a spiral-wound shape. This allows an elongation of the conductor when the spreader jaws are moved away from each other. At the same time, it allows the conductor to return to its original shape when the spreading jaws are moved towards each other again.
  • the conductors 16, 17 are designed with a sterilizable cable insulation, which is impregnated for example with polyurethane PUR or acrylic paint.
  • the external conductor 17 is held in this embodiment by a guide 18 which extends approximately parallel to the rack 7. It is firmly connected to the mounting rail 4 of the first expanding jaw 2 and extends, as the rack 7, also through an opening in the foot 8 of the support rail 5 of the second expanding jaw third
  • the number of internal and external conductors 16, 17 and the course of the conductor element 14 may vary depending on the embodiment of the invention. If only one light emitter 13 is provided on one of the expanding jaws 2 or 3, z. B. an internal conductor which runs within the corresponding support rail 4 or 5, be sufficient. If both expanding jaws 2, 3 are equipped with light emitters 13, as here, the conductor element 14 can alternatively also run only externally. It can, for. B. be moved along the individual components 2 to 5 of the spreading along.
  • the spreader jaws and / or the mounting rails z. B. no holder may be provided which has a partial attachment of the conductor z. B. allow by gluing.
  • grooves may be provided on the surface of the corresponding components, in which the conductor element 14 can be laid. In principle, depending on the application, any combination of the above possibilities are conceivable.
  • the conductor element 14 in this embodiment is an electrical conductor and allows connection to a 12 volt power supply.
  • the light emitter has one or more light sources such. As an incandescent lamp, a diode, an LED or the like.
  • the light emitters shown here are with a cold light source such. As a Flureszen- tube or a gas discharge lamp provided.
  • the power supply can vary depending on the application. That is, in other embodiments of the invention, the conductor and, in particular, the connection element can also be used for another power supply, for. B. with 24 volts, 220 volts, etc. be designed.
  • the conductor element and an optical conductor so z.
  • Example, a fiber optic cable or the like, and the connection element may be an optical connection element.
  • the actual light source can also be outside the light emitter and / or outside the spreader. So z. B. a present in the OP cold light connection, a laser light or the like can be used.
  • FIG. 2 shows the spreading device 1 according to the invention in a state inserted into an artificial body opening 24.
  • the reference symbols used in FIG. 3 designate the same parts as in FIG. 1, so that reference is made to the description of FIG. 1 in this regard.
  • the spreading jaws 2, 3 extend into the body opening 24 and surround the opening edge 26.
  • the spread-open opening edge 26 provides a view of the underlying body cavity 25 free.
  • the region of the spreading jaws 2, 3 facing away from the carrier rail, which accommodates the light emitter 13, is located almost entirely in the body cavity 25 in this exemplary embodiment.
  • FIG. 3 shows a section through the spreader jaws 2, 3 of the spreading device 1 according to the invention from FIG. 2.
  • the reference symbols used in FIG. 3 designate the same parts as in FIGS. 1 and 2, so that reference is made in this regard to the description of FIGS. 1 and 2.
  • the spreading jaws 2, 3 have in cross section an arcuate, curved shape. Alternatively, however, other cross-sectional shapes z. B. L- or U-like angled cross-sectional shapes conceivable.
  • the light emitter 13 extends approximately along the respective spreading jaws 2, 3 (cf., FIG. 1) and makes up approximately half of the total height H of the spreading jaws 2, 3.
  • the light emitter 13 could also extend over a lower level. He could z. B. only linearly in the region facing away from the support rail area 12 of the expanding jaw 2, 3 extend or be introduced only selectively in this area.
  • the light emitter 13 consists of a sterilizable, translucent, unbreakable, scratch-resistant material and is approximately flush and largely free of gaps in the material of the respective expanding jaw 2, 3 at. This can be z. B. by gluing, direct casting of the light emitter 13 or by other common manufacturing methods can be achieved. As materials come z. As special glasses, ceramics or plastics such. B. PEEK in question. High sodium glasses may be used which have been solidified by ion exchange.
  • the light emission takes place in each of the light emitter 13 shown here over the entire outer radius.
  • the mantle rays of a resulting light cone are provided with the reference numerals 19 and 20.
  • the sheath rays 19, 20 run approximately in or under half a defined by the opening edge 26 level. Preferably, as shown here, they are inclined downwards, that is to say in the direction of the body cavity 25.
  • the exact position of the jacket jets 19, 20 may vary in further embodiments of the invention depending on the application.
  • the maximum angle of deflection ⁇ of the jacket jet 19 is limited by the outer contour or the outermost edge 27 of the opposing expansion jaw. This limiting jacket jet 28 is shown in FIG. 2 by a dashed line.
  • z. B also the inner radius of the light emitter be used as a radiating surface. The emitted light cone would then expand accordingly.
  • the light emitted by the light emitter 13 is diffuse, that is, scattered, and has a color temperature in the range of about 1,000 to 10,000 K, and preferably in the range of about 3,000 to 8,000 K.
  • a color temperature in the range of about 4,000 to 7,000 K is preferred most likely corresponds to the daylight.
  • the emitted light is colorfast. This achieves a realistic color effect and good contrasts.
  • the brightness and the color temperature are variable in this embodiment by two separate controller 21, 22 ( Figure 1). However, in other embodiments of the invention, these regulators may also be omitted altogether, depending on the application.
  • the color temperature can then be set to a fixed value such as. B. 5,500 K or 6,000 K.
  • the two controls shown here can also be replaced by a combined controller that allows varying of both variables.
  • the spreading jaws 2, 3 of the spreading device 1 are introduced into a natural or artificially created body opening 24. Due to the curved shape of the spreading jaws 2, 3, they engage in the body opening 24. In this embodiment, the expanding jaws 2, 3 surround the opening edge 26, as shown in Figure 3. By turning the lever 9 in the direction of arrow 23 about the axis 11, the spreading jaws 2, 3 are moved away from each other via the jaw holder 6 until the body is moved away. Opening 24 is completely spread and thus allows the attending physician good access to the body.
  • the shape of the external conductor 17 changes.
  • the spirally wound shape of the conductor 17 continues to expand, thus allowing the total length of the external conductor 17 to be adapted to the distance of the spreading jaws 2, 3 external conductor 17 is guided by the guide 18.
  • the spreading device 1 is connected via the connecting element 15 with a power source. Alternatively, this can be done even before the introduction of the spreading jaws 2, 3 in the body opening 24.
  • the light emitter 13 As a result of the special shape or arrangement of the light emitter 13 in the area 12 of the spreading jaws 2, 3 which is remote from the mounting rail and thus protruding into the body opening 24, the light mainly becomes vertical or obliquely downward into the body cavity
  • the sheath rays 19, 20 of a light cone emitted by the light emitter 13 are thus below or in a plane defined by the opening edge 26.
  • the area above this level and thus outside of the body opening 24 remains largely lichtstrahlen- and thus glare-free.
  • a good and large-scale illumination of the treatment area is achieved in the body cavity. Since the light emitted by the light emitter in this embodiment is diffuse, the treatment area is illuminated as uniformly as possible. In addition, the shadowing and light reflections are reduced.
  • the color temperature and the brightness of the light emitted by the light emitters 13 light can be varied in this embodiment, depending on the application via two separate controller 21, 22.
  • the attending physician varies the brightness via the controller 21 and the color temperature via the controller 22 until the light emitted by the light emitter 13 satisfies its requirements.
  • the light can be the respective application z. For example according to the treatment area and lighting situation of the environment and the respective doctor.
  • the light emitted by the light emitters 13 is cold light with the lowest possible infrared component. This reduces the heating and dehydration of the irradiated tissue.
  • the right color temperature in this case a color temperature in the range of approximately 4,000 to 7,000 K, and the color fastness of the radiated light ensure good contrasts and that the attending physician perceives the colors as realistically as possible. All these factors contribute to a successful treatment and thus to a good treatment outcome.
  • the spreading jaws 2, 3 are released. That is, they are with the aid of the jaw holder 6 with the rack mechanism by turning the lever 10 against the direction of arrow 23 toward each other.
  • the spiral-like winding of the external conductor 17 thereby changes its shape and thus shortens the total length of the external conductor 17.
  • the expansion jaws are removed from the body opening 24.
  • the conductor element 14 and the connection element 15 are disconnected from the energy source.
  • the spreader is sterilized in preparation for its next use.
  • the materials used such as stainless steel, high quality plastics, etc., and the connection method
  • the spreading device 1 according to the invention is completely autoclavable. In principle, however, other sterilization methods such. As Gastro- sterilization, gamma rays or other common methods conceivable.
  • Gastro- sterilization As Gastro- sterilization, gamma rays or other common methods conceivable.
  • the largely gap-free transition from the light emitter 13 to the jaw material of the respective spreading jaws 2, 3 allows a good sterilization result and a good sterility in the transition region.

Landscapes

  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Pathology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Radiation-Therapy Devices (AREA)

Abstract

L'invention concerne un dispositif écarteur (1) servant à maintenir ouvertes des ouvertures (24) réalisées dans le corps, en particulier dans le thorax, avec au moins deux becs d'écartement (2, 3) disposés sensiblement face à face au moyen desquels un bord respectif (26) de l'ouverture corporelle peut être repoussé latéralement et avec un support (6) de becs au moyen duquel les becs d'écartement peuvent être maintenus à distance l'un de l'autre. Pour améliorer ce dispositif écarteur en rendant la zone de traitement mieux visible pour le médecin traitant, malgré une ouverture corporelle de taille sensiblement égale et avec une bonne maniabilité, selon l'invention on prévoit qu'au moins un des becs d'écartement présente un émetteur de lumière (13).
PCT/EP2006/002372 2006-03-15 2006-03-15 Dispositif écarteur WO2007104331A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
PCT/EP2006/002372 WO2007104331A1 (fr) 2006-03-15 2006-03-15 Dispositif écarteur
DE212006000093U DE212006000093U1 (de) 2006-03-15 2006-03-15 Spreizvorrichtung

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/EP2006/002372 WO2007104331A1 (fr) 2006-03-15 2006-03-15 Dispositif écarteur

Publications (1)

Publication Number Publication Date
WO2007104331A1 true WO2007104331A1 (fr) 2007-09-20

Family

ID=37387400

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP2006/002372 WO2007104331A1 (fr) 2006-03-15 2006-03-15 Dispositif écarteur

Country Status (2)

Country Link
DE (1) DE212006000093U1 (fr)
WO (1) WO2007104331A1 (fr)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2013005186A1 (fr) * 2011-07-06 2013-01-10 Cabaud Francois Ensemble d'eclairage chirurgical
CN107411785A (zh) * 2017-05-11 2017-12-01 丰丕华 一种普外科创伤手术医疗装置

Families Citing this family (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN113616453B (zh) * 2021-08-11 2023-08-04 泰州市津达电子科技有限公司 一种胸部开刀装置

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4337763A (en) * 1980-04-21 1982-07-06 The United States Of America As Represented By The Department Of Health, Education And Welfare Illuminated surgical instrument
US4627421A (en) * 1984-08-03 1986-12-09 Symbas Panagiotis N Sternal retractor
US20020001202A1 (en) * 1997-07-02 2002-01-03 Williams Jeffrey B. Light delivery systems and applications thereof
US6602189B1 (en) * 1996-02-20 2003-08-05 Cardiothoracic Systems, Inc. Access platform for internal mammary dissection

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4337763A (en) * 1980-04-21 1982-07-06 The United States Of America As Represented By The Department Of Health, Education And Welfare Illuminated surgical instrument
US4627421A (en) * 1984-08-03 1986-12-09 Symbas Panagiotis N Sternal retractor
US6602189B1 (en) * 1996-02-20 2003-08-05 Cardiothoracic Systems, Inc. Access platform for internal mammary dissection
US20020001202A1 (en) * 1997-07-02 2002-01-03 Williams Jeffrey B. Light delivery systems and applications thereof

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2013005186A1 (fr) * 2011-07-06 2013-01-10 Cabaud Francois Ensemble d'eclairage chirurgical
CN107411785A (zh) * 2017-05-11 2017-12-01 丰丕华 一种普外科创伤手术医疗装置

Also Published As

Publication number Publication date
DE212006000093U1 (de) 2008-11-13

Similar Documents

Publication Publication Date Title
EP2895097B1 (fr) Dispositif d'éclairage à usage chirurgical
DE102010055433B4 (de) Knochenschraube und Vorrichtung zur Knochendistraktion
EP2856020B1 (fr) Dispositif destiné à être utilisé dans un local de traitement médical
DE19512518A1 (de) Gerät zur Behandlung von Tumoren
EP1131005B1 (fr) Plaque de retraction pour parties molles
WO2007104331A1 (fr) Dispositif écarteur
DE202008017921U1 (de) Operationsleuchte mit beleuchteten Handgriffen
DE10128629A1 (de) Hautpflaster, Licht bzw. Strahlung emittierende Vorrichtung hierfür, sowie Verfahren zur Anhebung des menschlichen Wohlbefindens
DE102005050554A1 (de) Rektoskop mit lichtabstrahlenden Elementen
DE60106458T2 (de) Dermatologisches verfahren und zugehörige einrichtung
DE10254668A1 (de) Gerät zur Behandlung von Gefäßdefekten
DE3643153C2 (fr)
DE3714574A1 (de) Sonnenenergiebestrahlungsvorrichtung zur medizinischen behandlung
WO2006037599A1 (fr) Dispositif de prevention et de traitement de la mastite/mammite par la lumiere
DE3717607C2 (fr)
EP2060847A1 (fr) Lampe chirurgicale
DE112017007464T5 (de) Am Kopf befestigbare Beleuchtungseinrichtung
DE3128953A1 (de) "lichtzufuehrungsvorrichtung"
DE19710797C1 (de) Moxibustions-Vorrichtung
EP2111896B1 (fr) Dispositif pour rayonnement médical
DE202014103810U1 (de) Krankenhaus-Versorgungseinrichtung mit Patienten-Leselicht
EP3041517B1 (fr) Pièce à main destinée au traitement de blessures
CH672426A5 (de) Einrichtung zur ausstrahlung von sonnenstrahlenergie fuer eine medizinische behandlung.
WO2005102177A1 (fr) Dispositif de manipulation et/ou de traitement et instrument chirurgical
DE102009030606A1 (de) Vorrichtung zum Offenhalten von Operationskanälen mit Innenbeleuchtung

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application
NENP Non-entry into the national phase

Ref country code: DE

122 Ep: pct application non-entry in european phase

Ref document number: 06723445

Country of ref document: EP

Kind code of ref document: A1