WO2023214949A1 - A mobile cautery - Google Patents

A mobile cautery Download PDF

Info

Publication number
WO2023214949A1
WO2023214949A1 PCT/TR2022/051503 TR2022051503W WO2023214949A1 WO 2023214949 A1 WO2023214949 A1 WO 2023214949A1 TR 2022051503 W TR2022051503 W TR 2022051503W WO 2023214949 A1 WO2023214949 A1 WO 2023214949A1
Authority
WO
WIPO (PCT)
Prior art keywords
cautery
connector
mobile
battery
power
Prior art date
Application number
PCT/TR2022/051503
Other languages
French (fr)
Inventor
Sinan KIVRAK
Muhammet YİĞİTER
Yunus Emre ATEŞ
Original Assignee
Osti̇m Tekni̇k Üni̇versi̇tesi̇
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 Osti̇m Tekni̇k Üni̇versi̇tesi̇ filed Critical Osti̇m Tekni̇k Üni̇versi̇tesi̇
Publication of WO2023214949A1 publication Critical patent/WO2023214949A1/en

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/08Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by means of electrically-heated probes
    • A61B18/10Power sources therefor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical 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
    • A61B18/1206Generators therefor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical 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
    • A61B18/14Probes or electrodes therefor
    • A61B18/1402Probes for open surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053Mechanical features of the instrument of device
    • A61B2018/00172Connectors and adapters therefor
    • A61B2018/00178Electrical connectors
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00589Coagulation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00601Cutting
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical 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
    • A61B18/1206Generators therefor
    • A61B2018/1226Generators therefor powered by a battery

Definitions

  • the invention relates to a mobile cautery developed for use in sectors such as medical, defense industry, veterinary and medicine.
  • the cautery is a device used for cutting and coagulation processes by burning the tissue.
  • Electrocautery devices perform thermal cauterization using electrical energy (alternative or direct current).
  • An electrocautery device can create a temperature of 100-1200°C.
  • the cautery pens have thin, thick, long, short, loop-shaped tips and they can be changed.
  • the soldering iron of the battery-operated heat cautery used in another state of the art offers insufficient treatment opportunity.
  • cautery listed above can be used with long-life batteries in order to provide adequate intervention on-site.
  • the object of the invention is to produce a mobile cautery developed for use in sectors such as medical, defense industry, veterinary and medicine.
  • the invention is a device which offers mobile cauterization intervention to the bleeding wound in a short time on-site in the first aid need of soldiers, security forces, law enforcement officers or any living thing which may suffer from injury and exhibits sufficient working time due to the efficiency of the battery it has.
  • the most important feature which distinguishes the device of the present invention from other cauteries is that it can start mobile intervention during injury, thanks to its being charged. Since the device is compact and single-piece in design, it can be carried easily and can also work without being plugged in. The fact that similar electrocauteries are not mobile causes a delay in the intervention of our security forces, who are injured in the field. Early cautery intervention prevents blood loss, saves the patient's life and has the potential to minimize gangrene-related arm, foot, etc. losses.
  • the mobile cautery of the present invention is a device with both bipolar and unipolar (monopolar) outputs, as in industrial devices.
  • the user can choose the desired output.
  • the device can perform cutting and coagulation process etc.
  • the most important feature which distinguishes the mobile cautery of the present invention from the five types of cautery listed in the state of the art is that it is rechargeable, mobile and can provide its energy needs from its battery.
  • the mobile cautery of the present invention does not need any mains power line for surgical cauterization. Thus, it can be used easily in a mobile way.
  • the dimensions of the device are also quite suitable for being mobile, that is, it is portable.
  • Fig. 1 is the representative rear view of the mobile cautery of the present invention.
  • Fig. 2 is the representative front view of the mobile cautery of the present invention.
  • Fig. 3 is the representative view of the system diagram of the mobile cautery of the present invention.
  • the mobile cautery (1) of the present invention comprises at least one charging connector (1.1) to be charged via sources such as phone adapters, solar panels etc., at least one power switch (1.2) which turns the power on and off, at least one first monopolar connector (1.3) to which at least one cut cautery pen tip is connected, at least one second monopolar connector (1.4) to which at least one coagulation cautery pen tip is connected, at least one cautery plate connector (1.5) to which at least one cautery plate is connected, at least one bipolar connector (1.6) to which at least one bipolar electrode is connected, at least one button (1.7) by which mode selection is performed during use, at least one pot (1.8) by which power selection is performed during use, at least one display (1.9) which is the interface of the device (1), at least one driver circuit (1.10), at least one battery (1.11) which provides energy to the device (1), at least one battery management system (1.12) which fast-charges the said battery (1.11) with balanced or alternative methods, at least one DC/DC converter (1.13) connected to said battery management system (
  • the mobile cautery (1) (or electrocautery) performs surgical procedures such as cutting and coagulation by passing electric current through the patient's body under the control of a doctor at predetermined energy and frequency values, preferably at frequencies of 300kHz- 450kHz.
  • the invention is designed to be mobile to provide immediate intervention in any operation, war and various field injuries. It has a system which minimizes the bleeding of the wound. Unlike the current technique, the most important feature of the device (1) is that it provides the energy required for surgical cauterization from the battery (1.11) it contains. Said battery (1.11) is made of Li-ion, Lipo, NiCd, NiMH, NiZn etc. and should not be considered to be limited to these in practice. A phone charging adapter or equivalents can be used to charge the invention from the charging connector (1.1).
  • Bipolar and/or monopolar outputs can be used according to the choice of the user (or doctor or physician).
  • the operating mode of the mobile cautery (1) is as follows: During use, the product is turned on/off by using the power switch (1.2) (i.e. on-off switch). Probes with monopolar or bipolar outputs are attached to the first monopolar connector (1.3) and/or to the second monopolar connector (1.4) and/or to the bipolar connector (1.6). The desired operating mode is selected and the power level is adjusted.
  • the power switch 1.2
  • Probes with monopolar or bipolar outputs are attached to the first monopolar connector (1.3) and/or to the second monopolar connector (1.4) and/or to the bipolar connector (1.6).
  • the desired operating mode is selected and the power level is adjusted.
  • the device (1) is ready for intervention in a few seconds.
  • the device (1) operates at high frequency and high voltage. If there are combustible and flammable materials in the environment during operation, it should be protected from sparks which may occur during application. When flammable liquids are used, before using the mobile cautery (1), sufficient time must be waited for them to evaporate completely and the surrounding materials must be prevented from absorbing these liquids. In addition, it should be noted that oxygen- impregnated gauze and cotton will easily ignite with sparks from the mobile cautery (1).
  • the invention is a mobile cautery (1) developed especially for use in sectors such as medical, defense industry, veterinary and medicine, and is industrially applicable.

Landscapes

  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Molecular Biology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Plasma & Fusion (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Otolaryngology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Charge And Discharge Circuits For Batteries Or The Like (AREA)
  • Surgical Instruments (AREA)

Abstract

The invention relates to a mobile cautery (1) for performing surgical procedures such as cutting, coagulation and burning especially in sectors such as medical, defense industry, veterinary and medicine comprising at least one power switch (1.2) which turns the power on and off, at least one first monopolar connector (1.3) to which at least one cut cautery pen tip is connected, at least one second monopolar connector to which at least one coagulation cautery pen tip is connected (1.4), at least one cautery plate connector (1.5) to which at least one cautery plate is connected, at least one bipolar connector (1.6) to which at least one bipolar electrode is connected, at least one button (1.7) by which mode selection is performed during use, at least one pot (1.8) by which power selection is performed during use, at least one display (1.9) which is the interface of the device (1), at least one driver circuit (1.10), at least one charging connector (1.1) to be charged via sources such as phone adapters, solar panels etc., at least one battery (1.11) which provides energy to the device (1), at least one battery management system (1.12) which fast-charges the said battery (1.11) with balanced or alternative methods, at least one DC/DC converter (1.13) connected to said battery management system (1.12) with the desired voltage via buck/boost or alternative method.

Description

A MOBILE CAUTERY
Technical Field
The invention relates to a mobile cautery developed for use in sectors such as medical, defense industry, veterinary and medicine.
Prior Art
Cauterization is to stop bleeding by burning. The cautery is a device used for cutting and coagulation processes by burning the tissue. In the state of the art, there are 5 types of cautery: heat cautery, electro cautery, plasma cautery, ultrasonic cautery and argon cautery. Electrocautery devices perform thermal cauterization using electrical energy (alternative or direct current). An electrocautery device can create a temperature of 100-1200°C. The cautery pens have thin, thick, long, short, loop-shaped tips and they can be changed. There are two main types of electrocautery: unipolar (monopolar) and bipolar. The soldering iron of the battery-operated heat cautery used in another state of the art offers insufficient treatment opportunity.
Since the electrocauteries used in the current technique are quite large and do not have battery systems, they cannot be used in the military field.
On the other hand, not all cautery listed above can be used with long-life batteries in order to provide adequate intervention on-site. In other words, there are no cautery which offers sufficient working time and offers mobile cauterization intervention on-site and in a short time to the bleeding wound, for example, in the first aid need of soldiers, security forces, law enforcement officers or any living thing which may suffer from injury.
Therefore, it is necessary to develop new devices in order to eliminate the said disadvantages listed in the state of the art.
Summary of the Invention
The object of the invention is to produce a mobile cautery developed for use in sectors such as medical, defense industry, veterinary and medicine. The invention is a device which offers mobile cauterization intervention to the bleeding wound in a short time on-site in the first aid need of soldiers, security forces, law enforcement officers or any living thing which may suffer from injury and exhibits sufficient working time due to the efficiency of the battery it has.
The most important feature which distinguishes the device of the present invention from other cauteries is that it can start mobile intervention during injury, thanks to its being charged. Since the device is compact and single-piece in design, it can be carried easily and can also work without being plugged in. The fact that similar electrocauteries are not mobile causes a delay in the intervention of our security forces, who are injured in the field. Early cautery intervention prevents blood loss, saves the patient's life and has the potential to minimize gangrene-related arm, foot, etc. losses.
The mobile cautery of the present invention is a device with both bipolar and unipolar (monopolar) outputs, as in industrial devices. Thus, the user can choose the desired output. Thus, the device can perform cutting and coagulation process etc.
The most important feature which distinguishes the mobile cautery of the present invention from the five types of cautery listed in the state of the art is that it is rechargeable, mobile and can provide its energy needs from its battery. The mobile cautery of the present invention does not need any mains power line for surgical cauterization. Thus, it can be used easily in a mobile way. The dimensions of the device are also quite suitable for being mobile, that is, it is portable.
Description of the Drawings
Fig. 1 is the representative rear view of the mobile cautery of the present invention.
Fig. 2 is the representative front view of the mobile cautery of the present invention.
Fig. 3 is the representative view of the system diagram of the mobile cautery of the present invention.
Description of the Reference Numbers in the Drawings
For a better understanding of the invention, the corresponding reference numbers in the drawings are given below: 1. Mobile cautery
1.1. Charging connector
1.2. Power switch
1.3. First monopolar connector
1.4.Second monopolar connector
1.5. Plate connector
1.6. Bipolar connector
1.7. Button
1.8. Pot
1.9. Display
1.10.Drive circuit
1.11. Battery
1.12.Battery management system (BMS)
1.13.DC/DC converter
I.P. Internal Parts E.P. External Parts
Detailed Description of the Invention
The mobile cautery (1) of the present invention comprises at least one charging connector (1.1) to be charged via sources such as phone adapters, solar panels etc., at least one power switch (1.2) which turns the power on and off, at least one first monopolar connector (1.3) to which at least one cut cautery pen tip is connected, at least one second monopolar connector (1.4) to which at least one coagulation cautery pen tip is connected, at least one cautery plate connector (1.5) to which at least one cautery plate is connected, at least one bipolar connector (1.6) to which at least one bipolar electrode is connected, at least one button (1.7) by which mode selection is performed during use, at least one pot (1.8) by which power selection is performed during use, at least one display (1.9) which is the interface of the device (1), at least one driver circuit (1.10), at least one battery (1.11) which provides energy to the device (1), at least one battery management system (1.12) which fast-charges the said battery (1.11) with balanced or alternative methods, at least one DC/DC converter (1.13) connected to said battery management system (1.12) with the desired voltage via buck/boost or alternative method. In the device (1) of the present invention, mode selection and/or power selection can be performed by using the button (1.7) and/or the pot (1.8). With the power selection, intermittent, pulsed and sinusoidal pulses can be given to the tissue at the desired intensity.
The mobile cautery (1) (or electrocautery) performs surgical procedures such as cutting and coagulation by passing electric current through the patient's body under the control of a doctor at predetermined energy and frequency values, preferably at frequencies of 300kHz- 450kHz.
The invention is designed to be mobile to provide immediate intervention in any operation, war and various field injuries. It has a system which minimizes the bleeding of the wound. Unlike the current technique, the most important feature of the device (1) is that it provides the energy required for surgical cauterization from the battery (1.11) it contains. Said battery (1.11) is made of Li-ion, Lipo, NiCd, NiMH, NiZn etc. and should not be considered to be limited to these in practice. A phone charging adapter or equivalents can be used to charge the invention from the charging connector (1.1).
Thanks to the unipolar and bipolar connectors on the mobile cautery (1), it ensures the most efficient use of the cautery probe according to the injury situation and procedure. Bipolar and/or monopolar outputs can be used according to the choice of the user (or doctor or physician).
All industrial cautery modes required for cutting, burning etc. procedures are available in the device (1) of the present invention.
The operating mode of the mobile cautery (1) is as follows: During use, the product is turned on/off by using the power switch (1.2) (i.e. on-off switch). Probes with monopolar or bipolar outputs are attached to the first monopolar connector (1.3) and/or to the second monopolar connector (1.4) and/or to the bipolar connector (1.6). The desired operating mode is selected and the power level is adjusted.
Thus, the device (1) is ready for intervention in a few seconds. The device (1) operates at high frequency and high voltage. If there are combustible and flammable materials in the environment during operation, it should be protected from sparks which may occur during application. When flammable liquids are used, before using the mobile cautery (1), sufficient time must be waited for them to evaporate completely and the surrounding materials must be prevented from absorbing these liquids. In addition, it should be noted that oxygen- impregnated gauze and cotton will easily ignite with sparks from the mobile cautery (1).
Industrial Applicability of the Invention
The invention is a mobile cautery (1) developed especially for use in sectors such as medical, defense industry, veterinary and medicine, and is industrially applicable.
The invention is not limited to the above-mentioned exemplary embodiments, and one skilled in the art can easily come up with different embodiments of the invention. These should be considered within the scope of the protection sought by the claims of the invention.

Claims

1. A mobile cautery (1) for performing surgical procedures such as cutting, coagulation and burning especially in sectors such as medical, defense industry, veterinary and medicine comprising:
- at least one power switch (1.2) which turns the power on and off, at least one first monopolar connector (1.3) to which at least one cut cautery pen tip is connected, at least one second monopolar connector (1.4) to which at least one coagulation cautery pen tip is connected, at least one cautery plate connector (1.5) to which at least one cautery plate is connected, at least one bipolar connector (1.6) to which at least one bipolar electrode is connected, at least one button (1.7) by which mode selection is performed during use, at least one pot (1.8) by which power selection is performed during use, at least one display (1.9) which is the interface of the device (1), at least one driver circuit (1.10), characterized by comprising at least one charging connector (1.1) to be charged via sources such as phone adapters, solar panels etc., at least one battery (1.11) which provides energy to the device (1), at least one battery management system (1.12) which fast-charges the said battery (1.11) with balanced or alternative methods, at least one DC/DC converter (1.13) connected to said battery management system (1.12) with the desired voltage via buck/boost or alternative method.
2. A mobile cautery (1) according to Claim 1 , characterized by a battery (1.11) made of Li-ion, Lipo, NiCd, NiMH, NiZn etc.
3. A mobile cautery (1) according to Claim 2, characterized by a pot (1.8) which provides intermittent, pulsed and sinusoidal pulses to the tissue at the desired intensity.
4. A mobile cautery (1) according to any one of the preceding claims, characterized in that it operates at predetermined energy and frequency values, preferably at frequencies of 300 kHz-450 kHz.
PCT/TR2022/051503 2022-05-06 2022-12-14 A mobile cautery WO2023214949A1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
TR2022/007453 2022-05-06
TR2022/007453A TR2022007453A2 (en) 2022-05-06 2022-05-06 A MOBILE KOTER

Publications (1)

Publication Number Publication Date
WO2023214949A1 true WO2023214949A1 (en) 2023-11-09

Family

ID=85161403

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/TR2022/051503 WO2023214949A1 (en) 2022-05-06 2022-12-14 A mobile cautery

Country Status (2)

Country Link
TR (1) TR2022007453A2 (en)
WO (1) WO2023214949A1 (en)

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2535012A1 (en) * 2011-06-13 2012-12-19 Bovie Medical Corporation Hand-held cautery device
WO2014210136A1 (en) * 2013-06-25 2014-12-31 Spears Michael System, method and apparatus for performing electrosurgery through the use of radiating energy
WO2017053945A1 (en) * 2015-09-25 2017-03-30 Gyrus Acmi, Inc. (D/B/A Olympus Surgical Technologies America Multifunctional medical device
US20170128126A1 (en) * 2015-11-09 2017-05-11 First Pass, Llc Cautery device
US20180014877A1 (en) * 2008-11-13 2018-01-18 Covidien Ag Radio frequency generator and method for a cordless medical cauterization and cutting device
WO2021011795A1 (en) * 2019-07-16 2021-01-21 The Henry M. Jackson Foundation For The Advancement Of Military Medicine, Inc. Automated cranial burr hole device and method

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20180014877A1 (en) * 2008-11-13 2018-01-18 Covidien Ag Radio frequency generator and method for a cordless medical cauterization and cutting device
EP2535012A1 (en) * 2011-06-13 2012-12-19 Bovie Medical Corporation Hand-held cautery device
WO2014210136A1 (en) * 2013-06-25 2014-12-31 Spears Michael System, method and apparatus for performing electrosurgery through the use of radiating energy
WO2017053945A1 (en) * 2015-09-25 2017-03-30 Gyrus Acmi, Inc. (D/B/A Olympus Surgical Technologies America Multifunctional medical device
US20170128126A1 (en) * 2015-11-09 2017-05-11 First Pass, Llc Cautery device
WO2021011795A1 (en) * 2019-07-16 2021-01-21 The Henry M. Jackson Foundation For The Advancement Of Military Medicine, Inc. Automated cranial burr hole device and method

Also Published As

Publication number Publication date
TR2022007453A2 (en) 2022-05-23

Similar Documents

Publication Publication Date Title
JP2022046539A (en) Illuminated electrosurgical system and method of use therefor
EP2353533B1 (en) Square wave for vessel sealing
US20190350647A1 (en) Handheld pulsed field ablation generator
CN108472069B (en) Electrosurgical wave generator
EP2371314A2 (en) Electrosurgical system with means for tracking the usage of a reposable instrument
US20020128644A1 (en) Wireless electrosurgical adapter unit and methods thereof
WO2009132190A2 (en) Control circuitry for a tissue ablation system
KR20050040761A (en) Medical system for electrotomy
HK1103611A1 (en) Electrosurgical stapling instrument with disposable severing/stapling unit
EP2606845B1 (en) Pulse generator
US20150305798A1 (en) Portable electrosurgical instrument
AU2014302517B2 (en) System, method and apparatus for performing electrosurgery through the use of radiating energy
JP4249070B2 (en) Electric scalpel device
WO2023214949A1 (en) A mobile cautery
US20130204243A1 (en) Handheld electrosurgical generator
CN211023087U (en) Electric energy device with nerve monitoring function for surgical robot
CN207734218U (en) Double-pole electric coagulation forceps
CN207679523U (en) Electric excision electric coagulating knife
CN215130017U (en) Disposable radio frequency operation electrode
CN218220299U (en) Radio frequency ablation electrode with nerve positioning function
RU191942U1 (en) Portable Microsurgical Plasma Scalpel Coagulator
Swerdlow et al. Electrosurgery: principles and use
NZ716206B2 (en) System, method and apparatus for performing electrosurgery through the use of radiating energy
CZ29956U1 (en) Portable direct current instrument for medicinal purposes

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 22940892

Country of ref document: EP

Kind code of ref document: A1