treatment system for aspirating and/or infusing fluid in the dissection area

专利摘要:
MANUAL DISSECTION TOOL WITH VACUUM MEANS TO REDUCE THE APPEARANCE OF CELLULITE. A device for the dermatological treatment of the skin is provided. The device comprises a hand tool and a cutting tool, characterized in that the tool is inserted through the conduit and percutaneously inserted into an existing tissue inside a recessed area of the hand tool. The device and method cut the fibrous structures under the skin that cause cellulite at an angle substantially parallel to the surface of the skin and replace these structures with a non-cellulite forming structure by placing a highly fibrous mesh through a single den hole. way to create a highly fibrous layer directly or through wound healing processes. A tool is provided to aspirate excess fluid and tissue from the treatment area.
公开号:BR112013015915B1
申请号:R112013015915-4
申请日:2011-11-29
公开日:2021-05-18
发明作者:Chomas James E；Merchant Adnan I；Robert L. Clark；Ben F Brian Iii
申请人:Ulthera, Inc.；
IPC主号:

专利说明:

DESCRIPTIVE REPORT REFERENCES TO RELATED ORDERS
[001] This Order is related to US Application No. 12/555,746, filed September 8, 2009, which is incorporated by reference in its entirety. This application is also related to US Application No. 12/247,853, filed October 8, 2008, which claims priority to US Provisional Application No. 60/978,607, October 9, 2007, both of which are incorporated by reference. This application is also related to US Provisional Application No. 61/232,385, filed August 7, 2009, and US Provisional Application No. 61/286,750, December 15, 2009, both of which are incorporated by reference. in its entirety. FIELD OF THE INVENTION
[002] The present invention relates to surgical tools and implantable devices that modify the subdermal structures to decrease the appearance of cellulite. BACKGROUND
[003] Most of the aesthetic issues for which patients seek treatment from doctors today are "more than superficial". For example, gynoid lipodystrophy is a localized disease of the subcutaneous tissue that leads to a change in the topography of the skin surface (skin), or a pit effect. It is thought to be caused by increased fluid retention and/or adipose tissue proliferation in certain subdermal regions, but is known to be structure-related. This condition, commonly known as cellulite, affects more than 90% of post-pubescent women, and some men. Cellulite commonly appears on the hips, buttocks and legs, but it is not necessarily caused by being overweight, as is a common perception. Cellulite is formed at the subcutaneous tissue level, in the subdermal fat layer below the epidermis and dermis layers. In this region, fat cells are arranged in chambers surrounded by bands of connective membrane called septa. Cellulite is partially due to the parallel orientation of these fibrous septal structures. Fibrous structures being oriented parallel (and perpendicular to the skin) are unique to women, whereas men typically have more random orientation of fibrous structures. This difference in fibrous structure may be partially or totally responsible for the fact that men do not exhibit predominant cellulite compared to women. As fat cells held within the perimeters defined by these fibrous septa expand, they stretch the septa and adjacent connective membrane. What's more, adipocyte expansion from weight gain can also stretch the septa. Eventually, this connective membrane contracts and hardens (sclerosis) keeping the skin at a non-flexible length, while the chambers between the septa continue to expand with weight gain, or water gain. This results in areas of the skin being held down while other sections arch outward, resulting in a lumpy, 'orange peel' or 'cottage cheese' appearance on the surface of the skin. Although obesity is not considered a root cause of cellulite, it can certainly worsen the hollow appearance of a cellulite region due to the increased number of fat cells in the region.
[004] Over the years, a variety of approaches to the treatment of skin irregularities, such as cellulite and removal of unwanted adipose tissue, have been proposed. For example, methods and devices that provide mechanical massage to the affected area, through a combination of suction and massage or suction, massage and energy application, in addition to the application of various topical agents, are currently available. Developed in 1950, mesotherapy is an injection of various treatment solutions through the skin that has been widely used in Europe for conditions ranging from sports injuries to chronic pain, to cosmetic procedures to treat wrinkles and cellulite. This treatment consists of injecting or transferring a variety of agents through the skin to provide increased circulation and the potential for fat oxidation, such as aminophylline, hyaluronic acid, Novocaine, plant extracts and other vitamins. Another treatment called Acthyderm (Tumwood International, Ontario, Canada) uses a cylinder system that performs electroporation of the stratum comum to open small channels in the dermis, followed by the application of various mesotherapy agents, such as vitamins, antifibrotics, lipolytics, anti -inflammatory and the like.
[005] Several other approaches employing dermatological creams, lotions, vitamins and herbal supplements have also been proposed to treat cellulite. Private spas and salons offer cellulite massage treatments that include scrubs, pressure point massage, essential oils and herbal products using extracts from plant species such as seaweed, horsetail, clematis and ivy have also been proposed. . Although a multitude of therapies exist, most of them do not provide a lasting effect on skin irregularity, and some therapies may even cause cellulite to worsen in certain patients. Still other cellulite treatments have negative side effects that limit their adoption. Regardless, most of these therapies require multiple treatments on a continuous basis to maintain their effect at significant expense and with mixed results.
[006] Massage techniques have been tried since 1930 as a method to increase lymphatic drainage and improve the appearance of cellulite. Mechanical massage devices, or Pressotherapy, were also developed, such as the “Endermologie” device (LPG Systems, France), the “Synergie” device (Dynatronics, Salt Lake City, UT) and the “Silklight” device (Lumenis , Tel Aviv, Israel), all using subdermal massage via vacuum and mechanical cylinders. Other approaches have included a variety of energy sources such as Cynosure's “TriActive” device (Cynosure, Westford, MA) utilizing a pulsed semiconductor laser in addition to mechanical massage, and the “Cellulux” device (Palomar Medical, Burlington, MA) which emits infrared light through a cooled cooler to target subcutaneous fatty tissue. The “VelaSmooth” system (Syneron, Inc., Yokneam Illit, Israel) employs bipolar radio frequency energy in conjunction with suction massage to increase metabolism in adipose tissue, and the “Thermacool” device (Thermage, Inc., Hayward, CA) uses radio frequency energy to shrink subdermal fibrous septa to treat wrinkles and other skin defects. Other energy-based therapies, such as electrolipophoresis, using multiple pairs of needles to apply a low-frequency interstitial electromagnetic field to aid circulatory drainage have also been developed. Similarly, non-invasive ultrasound is used in the “Dermosonic” device (Symedex Medical, Minneapolis, MN) to promote increased fat reabsorption and drainage of retained fluids and toxins.
[007] Methods and devices using ultrasound to disrupt subcutaneous tissues directly have been described in the known art. Such techniques can use high-intensity ultrasound that is targeted to tissue within the body, thus causing localized destruction or damage to cells. High-intensity ultrasound targeting can be achieved using, for example, a concave transducer or am acoustic lens. The use of high-density targeted ultrasound to break up fat, sometimes in combination with the removal of fat by liposuction, has been described in the known prior art. Such use of high-density directed ultrasound is differentiated from therapeutic low-sound pressure ultrasound.
[008] Recently, it has also become possible to exploit ultrasound waves for the purposes of tissue disruption and tissue ablation without heating tissue to a tissue disruption level. Such a device is disclosed in U.S. Publication No. 15 2007/0055179 to Deem et al., incorporated herein by reference, which includes a method of infiltrating exogenous microbubbles into target tissue, followed by applying low acoustic pressure ultrasound to the infiltrated tissue. to cavitate the bubbles and destroy target tissue without direct thermal injury to the dermis. Although low acoustic pressure ultrasound can sometimes heat tissue, the tissue is not heated sufficiently to cause direct tissue disruption or enhance ablation, and thus significantly reduces the risk of thermal damage to the dermis and associated structures (nerves). , hair follicles, blood vessels). Liposonix (Bothell, WA) and Ultrashape (Tel Aviv, Israel) employ the use of targeted ultrasound to non-invasively destroy adipose tissue. In addition, cryogenic cooling has been proposed to destroy adipose tissue.
[009] Certain other techniques known as liposuction, tumescent liposuction, lipolysis and the like, target the adipose tissue in the subdermal regions and deep fat regions of the body. These techniques can also include removing fat cells as they are broken down, or leaving them to be reabsorbed by the body's immune/lymphatic system. Liposuction is the most commonly performed cosmetic surgical procedure. Traditional liposuction includes using a surgical cannula placed at the site of the fat to be removed, and then using a fluid infusion and mechanical movement of the cannula to break down fat tissue, and “vacuum” suction of the torn fat tissue directly. out of the patient. A variation of the traditional liposuction technique known as tumescent liposuction was introduced in 1985 and is now considered by some to be the standard of care in the United States. It involves the infusion of tumescent fluids to the targeted region prior to mechanical disruption and removal through the suction cannula. Fluids can help alleviate the pain of mechanical disruption in some patients, while also swelling the tissues to make them more susceptible to mechanical removal. Various combinations of fluids can be employed in the tumescent solution including a local anesthesia such as lidocaine, a vasoconstrictor agent such as adrenaline, saline, potassium and the like. The benefits of such an approach are detailed in the articles, “Comparative Laboratory and Histopathological Study of Ultrasound-Assisted Internal Lipoplasty and Tumescent Lipoplasty” Plastic and Reconstructive Surgery, September 15 (2002) 110:4, 11581164, and “When A Liter Is Not 1000 Milliliters: Implications for the Tumescent Technique” Dermatol. Surg. (2000) 26:1024-1028, the contents of which are expressly incorporated herein by reference in their entirety.
[0010] Traditional fat extraction techniques, such as liposuction, target the deep fat and larger regions of the anatomy and can sometimes worsen the appearance of cellulite. Subdermal fat pockets remain and are accentuated by the loss of underlying mass (deep fat) in the region. Liposuction is often performed and patients still seek therapy for remaining skin irregularities such as cellulite. The tools used in these procedures often have sharp edges and are intended to dissect subcutaneous tissue and fibrous septa. Representative of such conventional tools is the “Toledo” cannula, illustrated in Toledo LS, Mauas R, Body Sculpting Complications: Prevention and Treatment. Plastic Clin Surg. 2006:33; 1-11. There are doctors who target more superficial subdermal fat pockets with liposuction, but with a higher risk of directly creating surface irregularities than treating them. Liposuction is not considered a viable treatment for cellulite for these reasons.
[0011] Another issue that must be factored in with liposuction is the amount of drugs inoculated with the tumescent solution. With large volume liposuctions, Lidocaine infusion (for pain) can be as high as 50mg/kg, well above the intravascular toxicity limit of 7mg/kg. The reason liposuction patients can tolerate such a large volume of lidocaine is that lidocaine is injected subcutaneously, is highly diluted, and is slowly absorbed over time. Therefore, the effective systemic level of lidocaine is lower. However, in some cases, lidocaine can spread to the circulation and resulted in patient mortality. For this reason, doctors monitor Lidocaine closely and often limit the area or treatment as a result.
[0012] More recently, energy sources have been added to the cannula to aid in the breakdown and liquefaction of fat which, in turn, improves ease of use. The “Lysonix” system (Mentor Corporation, Santa Barbara, CA) and “Vaser” system (Sound Surgical, Louisville, CO) utilize an ultrasonic transducer within the suction cannula to assist in tissue disruption (by cavitation of tissue at the targeted location ). Laser-assisted cannulae are offered by several companies including “Smartlipo” (Cynosure, Westford, MA), “Slimlipo” (Palomar Medical, Burlington, MA), and “Smoothlipo” (Eleme Medical, Merrimack, NH).
[0013] Subcutaneous dissection without fat aspiration is another approach to the treatment of skin irregularities such as scarring and cavity. A technique called “subcision” was described by Orentreich in 1995. See Orentreich DS, Orentreich N. Surgery without a subcutaneous incision for the correction of depressed scars and wrinkles. Dermatologic Surgery June 1995; 21 (6): 543-9. This technique involves inserting a relatively large gauge needle subdermally into the cavity or scar region, and then mechanically manipulating the needle beneath the skin to break the fibrous septa in the subdermal region. In at least one known method of subcision, a solution containing an anesthesia (Lidocaine) and vasoconstrictor is injected into the targeted region and allowed to take effect. An 18 gauge needle is then inserted 10-20 mm below the skin surface. The needle is then pulled back and directed parallel to the epidermis to create a plane of dissection beneath the skin to essentially tear or “release” the tight septa causing the cavity or scarring. Pressure is then applied to acutely control bleeding, and then by wearing compressive garments after the procedure. While clinically effective in some patients, pain, bruising, bleeding, and scarring can result. Other cutting implements include the aforementioned Toledo cannula, and several string- or wire-based cutting methods including “Surgiwire” (Coapt Systems, Palo Alto, CA) and “ReleaseWire” (MicroAire, Charlottesville, VA).
[0014] The cutting or relief of fibrous septa in the subdermal region by current methods of subcision, is labor intensive, time-consuming and the techniques are highly variable. Significant physician time must be devoted to the procedure and there are technical limits, as well as anesthetic limits, to the size of a treatable area.
[0015] There is a lack of clinical evidence that the techniques work for most patients and that the effects are long-lasting. For these reasons, and because of the potential side effects and extended time required for healing, subcision and liposuction have largely been abandoned as a treatment for cellulite in the United States.
[0016] In light of the foregoing, it would be desirable to provide the methods and mechanism to treat skin irregularities such as cellulite and to provide a sustained aesthetic result to a region of the body such as the face, neck, arms, legs , thighs, buttocks, breasts, stomach and other targeted regions. There is a need to provide a method and mechanism for treating skin irregularities that improve upon prior techniques and make them less durable, more controlled, minimally invasive and subject the patient to fewer side effects. The present invention adds a minimally invasive device and method for skin treatment by providing a controlled and less traumatic means for subcutaneous dissection and cutting of fibrous septa in the subdermal fat or in the layer between the subdermal fat layers and the dermis, responsible for the appearance of cellulite as well, a controlled means of delivering anesthesia. Enhanced lasting effect is provided by inserting fibrous mesh through a single needle hole to create a highly fibrous layer directly or through wound healing processes. The device and method use a reciprocating blade to provide an even level of cut, parallel to the skin surface and with adequate skin traction, without puncture or additional skin cutting. In addition to treating cellulite, this device and method can be used to treat hyperhidrosis, acne or other scars, and wrinkles. This treatment can also be used in conjunction with known methods of removing fat, skin tightening or skin thickening.
[0017] A reciprocating blade provides a clean, precise, and deep adjustable release (cut) of the fibrous tissue responsible for cellulite. However, fluid (eg, anesthesia, blood, dissected cell release fluid, and the like) will enter the released area. To remove this fluid, a treating physician can “milk” this fluid out of the blade's entry hole into the skin at the end of the procedure to bring the two opposite sides of the dissection together before dressing the area. Other physicians may use an increased amount of the volume of anesthesia in place of any compression or milking of the site. In both clinical settings, there were instances when a stream of blood-infused anesthetic solution was sprayed onto the physician's clothing or lab coat when the site was inadvertently compressed. Therefore, there is also a need for a blade assembly including an aspiration means to facilitate the removal of such fluid. SUMMARY OF THE INVENTION
[0018] A minimally invasive skin treatment device is disclosed. The device comprises a hand tool having a perimeter elevation and an upper portion that cooperatively defines a recessed area with an inner side of the perimeter elevation and the upper portion defining a juxtaposition surface in front of the recessed area; a conduit extending through one side of the perimeter elevation to the recessed area; a tool configured to at least partially extend through the conduit and into the recessed area; and a guide rail operably connected to the hand tool, characterized in that the guide rail is configured to constrain a portion of the tool in contact with the guide rail to move along a predetermined path to cooperatively moving a distal end of the tool within the recessed area in a plane substantially parallel to the top of the hand tool and within a region of a predetermined shape defined by the predefined path. In one embodiment, the tool is configured to aspirate excess fluids, fabric, vapors and other materials from the treatment site. The tool includes a vacuum supply connection that is connected to a vacuum source to draw fluids and the like through the tool, out of the connection, and into a waste disposal container.
[0019] In some aspects, the device further comprises an inlet hole disposed on an inner side of the conduit and opposite said recessed area, said inlet hole defining a tool axis point when a distal end of the tool is inserted through the conduit and the recessed area, characterized by the fact that the conduit widens outwards towards an outside of the perimeter elevation so that a distal end of the tool inserted through the inlet port moves in one direction when a proximal end of the tool outside the conduit moves in an opposite direction.
[0020] In some aspects, the device may also comprise a platform operatively connected to the hand tool, characterized in that the platform includes the guide rail; and a guide pin operably connected to the tool, said guide pin slidingly engaging the guide rail so that the tool is restricted to move in accordance with the predetermined path. In some aspects, the platform can be secured relative to the hand tool and substantially orthogonal to a lower edge of the hand tool. The guide rail can form a groove in a top of the platform, or, in some respects, the guide rail is an outline formed from an edge of the platform. The guide rail may include a recessed portion and the guide pin may be a flared head so that interference between the flared head and the guide rail recess portion inhibits removal of the flared head from the guide rail while allowing the guide pin is moved in accordance with the predetermined path.
[0021] In some aspects, the tool comprises a cutting blade and a reciprocating motor coupled to the cutting blade, said reciprocating motor alternating the cutting blade. The tool may further include a sleeve, characterized in that the cutting blade is at least partially slidably disposed within the sleeve. The tool may also include an injection device and a nozzle, characterized in that the nozzle is configured to discharge a fluid in a direction parallel to the top of the hand tool and configured to increase a kinetic energy of the fluid when the fluid is injected. by the injection device through the nozzle.
[0022] In additional aspects, the top of the hand tool is configured to be adjustable and configured to change the distance between an inner side of the top of the hand tool and a lower edge of the perimeter elevation and changes a volume of the recessed area when the top is adjusted. In some aspects, the hand tool includes a reversible cap, and, the top of the hand tool being configured to be adjustable includes the reversible cap being configured to be disconnected from the hand tool, tumbled and reconnected. In certain aspects, the upper portion of the hand tool includes a rigid top cap and the rigid bottom cap, the rigid top cap being secured with respect to the perimeter elevation, the device further including an inflatable balloon disposed between the rigid top cap and the bottom cap. rigid, characterized in that the rigid bottom cap is configured to move up and down with respect to a wall of the perimeter elevation, the rigid inner cap being at its lowest point when the balloon is fully expanded, and being at its highest point when the balloon is deflated. In other aspects, the top of the hand tool is operably connected to a perimeter wall of the perimeter elevation by a threaded fitting, the top of the hand tool being pivotally mounted to the perimeter wall, and characterized by the fact that that the rotation of the top relative to the perimeter wall adjusts the volume of the recessed area. The upper part of the hand tool may also include an upper rim disposed between an upper edge of an outer wall and an upper edge of the inner wall, a recessed surface disposed at a lower edge of the inner wall, a perimeter of the recessed surface being substantially defined by a lower edge of the inner wall; and a first and second fiducial, the first fiducial being spaced a rotational distance from the second fiducial such that the rotational distance corresponds to the predetermined vertical distance along the threaded fitting. An O-ring can be interposed between the top of the hand tool and the perimeter wall of the hand tool.
[0023] The device may also be configured to include an elastomeric septum, the elastomeric septum being configured to be penetrated by the tool and substantially self-seal when the tool is removed so as to substantially prevent a vacuum leak from the recessed area when a vacuum is provided to the sunken area. Other aspects may include the device comprising a support arm having a guide pin, the tool being mounted to the support arm, characterized in that the guide rail operably connected to the hand tool includes the guide rail being disposed at a top surface of the hand tool and glidable receiving the guide pin, the guide rail facilitating movement of the pin and support arm along the predetermined path.
[0024] In a still further aspect, the tool is an elongated RF cutting probe. In this regard, the device may further include an RF generator operably connected and supplying power to the RF cut-off probe, and a circuit for measuring the impedance of a tissue disposed within the recessed area, characterized in that the RF generator includes a feedback control on the energy supplied to the probe based on a measured tissue impedance so that the RF generator delivers consistent energy. In certain aspects, a temperature medium on the RF cut probe is also included. The temperature measurement means is used to communicate information indicative of a tissue temperature to the RF generator, characterized by the fact that the feedback control for the power supply to the RF cut probe when a tissue temperature reaches a pre- defined.
[0025] Some aspects of the device may include a vacuum connection operably connected to one of the top and perimeter elevation and in fluid communication with the recessed area. These aspects may also include a vacuum pump in fluid communication with the vacuum connection, characterized in that the vacuum pump is configured to provide a suction force to the recessed area and configured to pull fabric comfortably and comfortably. securely against the juxtaposition surface when the recessed area is placed over the fabric.
[0026] It may also be desirable in some respects to use the device to inject a solution. In some aspects, the tool may be a needle, and the device may further include a pump and a source of injectable fluids in fluid communication with the pump, characterized in that the needle is in fluid communication with the pump, and the needle is configured to inject injectable fluids into tissue disposed in the recessed area. In certain aspects, the needle may include a lumen, a tip for piercing a dermis, and at least two injection ports in communication with the lumen, characterized in that the ports are linearly disposed along an outer surface of the needle. In some respects, ports can be washed with one side of the needle. Ports can be configured to discharge a fluid in a direction substantially orthogonal to an axis of the needle and substantially parallel to the top of the hand tool. Some aspects of the foregoing may further include a microprocessor having a graphical user interface, characterized in that the pump is configured to communicate information specifying a volume of a fluid injected into tissue to the microprocessor. The microprocessor can be configured to use the graphical user interface to prompt a user to enter information specifying at least one of a concentration of a fluid component and a patient weight, and the microprocessor can include logic to determine a maximum dose of the fluid. fluid injected based on the patient's weight, the concentration of the fluid component, and the volume of fluid injected. In some respects, the microprocessor is configured to cause the graphical interface to display at least one warning message when the injected fluid volume exceeds a predefined threshold that is less than the maximum dosage, and it can also be configured to instruct the pump to terminate an injection when the volume of fluid injected reaches the maximum dosage. In additional aspects, the graphical user interface can be configured to allow the user to override the maximum dosage so that the pump continues to inject fluid once the maximum dosage has been reached. In still additional aspects, the microprocessor can be configured to track an amount of time elapsed as the pump has started pumping the fluid and calculate a recommended end-of-treatment time using information selected from a group consisting of the fluid volume. injected and the elapsed time. In certain aspects, including a vacuum pump, the vacuum pump can be configured to communicate with the microprocessor and the graphical user interface to display an elapsed amount of time that a vacuum has been supplied to the hand tool by the vacuum pump . The vacuum pump can also be, in some respects, configured to communicate with the microprocessor and the graphical user interface to display a vacuum pressure. It is not necessary for these aspects of injecting a microprocessor control and solution to be limited to a device where the tool is a needle, but it may also be desirable to include these aspects and/or limitations in any of the aspects described herein.
[0027] Also disclosed is a method of treating cellulite, the method comprising the steps of (1) providing a hand tool having a perimeter elevation and an upper part that cooperatively defines a recessed area, an inner side of the elevation of perimeter and top defining a fabric juxtaposition surface in front of the recessed area, and a conduit extending across one side of the perimeter elevation to the recessed area; (2) position the hand tool over a first treatment area located in a dermis; (3) apply a force on the hand tool to move a portion of the dermis to the recessed area to substantially fill the recessed area so that a portion of the dermis is in contact with a substantial area of the tissue juxtaposition surface and a subcutaneous tissue is arranged in the lowered area; (4) insert a distal end of a tool through the conduit and through the dermis and subcutaneous tissue; and, (4) orienting the tool along a predetermined path of a guide rail to move a distal end of the tool in a plane parallel to the top of the hand tool and within the recessed area, to create a surgical lesion of a pre-determined format defined by the pre-defined path.
[0028] In certain respects, the method may also include moving the distal end of the tool in an x and y direction along the plane parallel to the top of the hand tool. Certain aspects may also include providing a vacuum-assisted suction force to the recessed area to move the dermis to the recessed area.
[0029] The method may include adjusting a height of the top of the hand tool with respect to a conduit entry point within the recessed area to adjust the volume of the recessed area and a depth of subcutaneous tissue accessible by the tool when inserted through of the conduit. In some respects, the top includes a reversible cap, and the weight is adjusted by disconnecting the reversible cap from the hand tool, rotating it, and reconnecting it to the hand tool.
[0030] Some aspects of adjusting a height of the top of the hand tool may include rotating the top of the hand tool with respect to the perimeter elevation along a threaded fit between the top of the hand tool and the perimeter elevation of the tool manual. In other aspects, the upper part of the hand tool may include a rigid top cover and a rigid lower cover, the rigid top cover being fixed with respect to the perimeter elevation, characterized in that the adjustment of a height of the upper part of the tool manual includes inflating a balloon disposed between the rigid top cap and rigid bottom cap to move the rigid bottom cap up and down with respect to a wall of the perimeter elevation, the rigid inner cap being at its lowest point when the balloon is fully expanded and being at its highest point when the balloon is deflated.
[0031] Some aspects of the method may include the additional steps of (a) removing the distal end of the cutting device from the subcutaneous tissue; (b) positioning the hand tool over a second treatment area located in the dermis, characterized in that the second treatment area is proximal to the first treatment area; (c) applying a force to the hand tool to move a portion of the second dermis treatment area to the recessed area to substantially fill the recessed area so that a portion of the second dermis treatment area is in contact with a substantial area of the tissue juxtaposition surface and a second layer of subcutaneous tissue is disposed in the recessed area; (d) inserting a distal end of a tool through the conduit and through the dermis and into the second layer of subcutaneous tissue; and (e) orienting the tool along the predetermined path of the guide rail to move the distal end of the tool in the plane parallel to the top of the hand tool and within the recessed area to create a second surgical lesion of the predetermined shape. determined defined by the guide rail. In some aspects, the second treatment area may also at least partially overlap the first treatment area, and/or adjust a height of the hand tool top relative to a conduit entry point within the recessed area to change the volume of the recessed area and a depth of subcutaneous tissue accessible by the tool.
[0032] In some aspects of the method, the tool is an elongated RF probe, and creating a surgical lesion includes applying either an RF energy or heat to remove a portion of the subcutaneous tissue. In additional aspects, the subcutaneous tissue portion may include adipose tissue, or, include fibrous septa and creating a surgical lesion includes cutting the fibrous septa. In some respects, the tool is a catheter having a jet of high pressure fluid, and characterized in that the method of creating a surgical lesion includes injecting a fluid at a high pressure and parallel to the top of the hand tool to displace a part of the subcutaneous tissue.
[0033] In still further aspects of the invention, it may be desirable to position a mesh within the subcutaneous tissue or other treatment area. Thus, the method may include the additional steps of (a) inserting a distal end of a shaft and a retainer rod through the conduit and to the surgical wound, the shaft and retainer rod having a bent around the distal end of the shaft and the retainer rod; (b) simultaneously rotate the shaft about its longitudinal axis while anchoring an edge of the mesh with the retainer rod and move the distal end of the shaft along the distal end of the retainer rod by pivoting the shaft over a conduit entry point to unroll the mesh on the surgical lesion; and (c) withdrawing the retainer shaft and rod from the surgical wound and recessed area. In some aspects, a method of treating cellulite by placing a mesh is revealed. In this aspect, the method includes the steps of (1) providing a hand tool having a perimeter elevation and an upper portion that cooperatively defines a recessed area, an inner side of the perimeter elevation, and an upper portion defining a juxtaposition surface of the fabric in front of the recessed area, and a conduit extending across one side of the perimeter rise to the recessed area; (2) position the hand tool over a first treatment area located in a dermis; (3) apply a force on the hand tool to move a portion of the dermis to the recessed area to substantially fill the recessed area so that the portion of the dermis is in contact with a substantial area of the tissue juxtaposition surface and a subcutaneous tissue is arranged in the lowered area; (4) insert a cutting tool through the conduit to create a subdermal treatment area defined by a surgical lesion of a predetermined shape in the subcutaneous tissue, and insert a mesh through the conduit and into the subdermal treatment area. In additional aspects, inserting the mesh may include (5) inserting a distal end of a shaft and retainer rod through conduit and into a treatment area in the subcutaneous tissue and substantially parallel to the dermis, the shaft and retainer rod having a mesh folded around distal end of shaft and retainer rod; (6) Simultaneously rotate the shaft about its longitudinal axis by anchoring an edge of the mesh with the retainer rod and move the distal end of the shaft away from the distal end of the retainer rod by pivoting the shaft over a conduit entry point to unroll the mesh; and, (7) withdrawing the retainer shaft and rod from the treatment area.
[0034] In at least one aspect of this method, a first end of the mesh is releasably attached to the shaft through a first longitudinal slot at the distal end of the shaft, and a second end of the mesh is releasably attached to the retainer rod through a second longitudinal slot at the distal end of the retainer rod, characterized in that withdrawing the shaft and retainer rod from the open treatment area includes the mesh sliding out of the first and second longitudinal slots. In some aspects, the method may further include securing the mesh within the open treatment area by suturing one end of the mesh to a portion of the subcutaneous tissue.
[0035] In further aspects, a method of treating cellulite by repositioning a hand dissection tool is disclosed. In some aspects, this method includes (1) positioning a hand tool having a recessed area over a first section of the dermis; (2) apply a force to the hand tool to move a portion of the first section of the dermis to the recessed area to substantially fill the recessed area so that a portion of the first section of the dermis is in contact with an inner surface of the hand tool and a first subcutaneous tissue is arranged in the recessed area; (3) inserting a tool through a hand tool conduit and through the first section of the dermis and into the first subcutaneous tissue; and (4) cut a first lesion in the first subcutaneous tissue to a first depth. In certain aspects of this method, it may also be desirable to include the additional step of adjusting a hand tool cutting depth.
[0036] In some aspects, this method may further include repositioning the hand tool over a second section of the dermis, characterized in that the second section of the dermis applies a force on the hand tool to move a portion of the second section of dermis into the recessed area to substantially fill the recessed area, so that a portion of the second section of dermis is in contact with the inner surface of the hand tool and a second subcutaneous tissue is disposed in the recessed area, and to cut a second lesion in the second subcutaneous tissue at a second depth. In some respects, the first and second depths are substantially the same depth. In other respects, the hand tool is adjusted so that the second depth is a different depth than the first depth. In one aspect, adjusting the depth may include applying a different force to move the second dermis portion into the recessed area than the force used to move the first section of the dermis portion into the recessed area. In another aspect, adjusting depth might include rotating a hand tool top along a threaded socket. In an additional aspect, the depth is adjusted by disconnecting a reversible cap from the hand tool, turning it and reconnecting it to the hand tool. In a still further aspect, adjusting a depth of cut may include changing an atmospheric pressure within the hand tool to move an inner surface at an upper portion of the recessed area in a vertical direction relative to the hand tool. BRIEF DESCRIPTION OF THE DRAWINGS
[0037] FIGS. 1A through 1C illustrate a dissection device, including a hand tool and a cutting tool.
[0038] FIGS. 2A and 2B illustrate a cut-away side view and perspective view of the hand tool used in conjunction with a cutting tool.
[0039] FIGS. 3A and 3B illustrate a perspective view of the hand tool and motor-controlled cutting mechanism.
[0040] FIG. 4A is an exploded view of the motor-controlled cutting mechanism.
[0041] FIG. 4B is a bottom view of the motor-controlled cutting mechanism.
[0042] FIGS. 4C and 4D illustrate an enlarged view of an embodiment of the cutting tool used in connection with the motor-controlled cutting mechanism.
[0043] FIGS. 5A through 5E illustrate an alternative embodiment of the cutting tool, including the separate motor control assembly of a disposable reciprocal cutting mechanism.
[0044] FIGS. 6A and 6B illustrate the hand tool used in connection with a removable guide rail.
[0045] FIG. 7 illustrates a perspective view of the hand tool and motor-controlled cutting mechanism used in connection with the method.
[0046] FIGS. 8A through 8C illustrate the operational range of the hand tool and motor-controlled cutting mechanism used in connection with a guide rail realization.
[0047] FIGS. 9A through 9C illustrate the setup and placement of the hand tool in a patient's dermis and an alternative guide rail realization.
[0048] FIGS. 10A and 10B illustrate an embodiment of the guide rail, including a syringe pump connected to the needle or cannula and a source of injectable fluids.
[0049] FIGS. 11A through 11D illustrate an embodiment of the dissecting device and cutting tool, including a guide rail positioned on top of the device.
[0050] FIGS. 12A and 12B illustrate the hand tool with the reversible cap and a detachable guide rail embodiment.
[0051] FIGS. 13A and 13B illustrate the exploded and cut-away views of the hand dissection tool, including an inflatable balloon to control the depth of cut.
[0052] FIGS. 14A and 14B illustrate exploded and cut-away views of the hand dissection tool, including a threaded insert to control the depth of cut.
[0053] FIG. 15 illustrates a microprocessor and display for use with the realizations.
[0054] FIG. 16A illustrates an embodiment of the cutting device including an RF cutter.
[0055] FIG. 16B illustrates a block diagram of the system including the hand tool and RF cutting tool.
[0056] FIG. 17 illustrates an embodiment of an RF device including an inflatable member having an RF electrode provided on an exterior surface.
[0057] FIG. 18 illustrates an embodiment of a cutting tool.
[0058] FIGS. 19A through 19C illustrate cutting tool embodiments with one or more retractable blade members.
[0059] FIG. 20 illustrates a blade support mechanism.
[0060] FIGS. 21A and 21B illustrate the embodiments of the cutting tool.
[0061] FIGS. 22A through 22D illustrate another embodiment of the cutting tool.
[0062] FIGS. 23A through 23E illustrate a first embodiment of a mesh positioning applicator.
[0063] FIGS. 24A through 24B illustrate a second embodiment of a mesh positioning applicator, including a positioning shaft and retainer rod.
[0064] FIG. 25 illustrates a cut-away side view of the hand tool in use with the mesh placement applicator.
[0065] FIGS. 26A and 26B illustrate the hand tool and guide rail for use with a solution injection device.
[0066] FIGS. 27A through 27D illustrate a method of using the hand tool and cutting tool in a dermis, including partially overlapping adjacent treatment areas.
[0067] FIGS. 28A and 28B illustrate an embodiment of the cutting tool including a vacuum connection for aspirating a fluid from the dissection area.
[0068] FIG. 29 illustrates a cut-away side view of the hand tool in a method of using the cutting tool to aspirate fluid from the dissection area.
[0069] FIG. 30 illustrates a perspective view of the hand tool and cutting tool including a vacuum connection connected to a vacuum source for aspirating a fluid from the dissection area.
[0070] FIG. 31 illustrates an alternative embodiment of a cutting tool axis.
[0071] FIG. 32 illustrates the dissection device in use in a method for separating an endocrine sweat gland. DETAILED DESCRIPTION OF PREFERRED ACHIEVEMENTS
[0072] As described herein, cellulite is partially due to the parallel orientation of the fibrous structures in the subdermal fat layer. In general, the device and method described herein are used to minimally invasively cut fibrous septa. One goal is to create a minimally invasive planar dissection at a defined depth below the dermis. Specifically, the dissection plane is created parallel to and at a predefined depth below the dermis. Throughout this application, reference to a depth below the dermis or the like is to be understood to refer to a depth measured orthogonally from the outer surface of the skin. It should also be noted that the utility of the disclosed devices extends beyond cellulite treatment. The device and method can, for example, be useful in treating acne scars by creating a very localized dissection freeing the dermis from underlying connective tissue. If desired, a suitable filler can be injected into the dissection.
[0073] According to some embodiments, it may be desirable to implant a mesh of fiber promoting material such as proteins, actin, collagen or the like in the planar dissection. In the context of cellulite, it may be desirable to perform a planar dissection within the shallow fat layer (3-15 mm below the dermis), at the fat/skin interface, or within the deeper fat layer 16-30 mm below the dermis to cut the fibrous septa and disrupt the fat cell chambers. Inserting a mesh implant at the site of the planar dissection (subcision) can neutralize the predominantly parallel structures of the fibrous septa in women and create a highly fibrous layer directly or through wound healing processes. This treatment can be used in conjunction with known methods of removing fat, skin tightening, or skin thickening.
[0074] The devices and methods disclosed herein can also be used in a variety of applications where it is necessary to create a tissue pocket to receive an implant. In this way, a minimally invasive pocket can be created in the cheek, breasts or buttocks to receive the implant.
[0075] The device and method are also applicable to the treatment of hyperhidrosis.
[0076] Notably, a planar surgical lesion can be created within the lower level of the dermis or at the interface between the dermis and the shallow fat layer. This surgical injury separates or damages the eccrine duct from the eccrine sweat gland and/or destroys the eccrine sweat gland.
[0077] According to some embodiments, it may also be desirable to employ energy, such as Radio Frequency (hereinafter "RF"), to provide the means of dissection. The energy can be configured to provide coagulation or a controlled thermal injury, which, in turn, can provide fat cell damage/shrinkage or create a more fibrous layer directly or through the wound healing processes. Thermal energy can enhance the treatment effect. For example, in the case of hyperhidrosis, thermal injury can increase the number of eccrine glands damaged in the procedure. This treatment can be useful in conjunction with known methods of removing fat, skin tightening, or dermal thickening.
According to some embodiments, it may be desirable to provide a controlled means of delivering anesthesia to the treatment area prior to the cutting mechanism.
[0079] It should be understood that the term “may” as used throughout the specification refers to an optional feature or component.
[0080] As illustrated by FIGS. 1A through 1C, embodiments utilize a hand tool 100 to capture and control a location of the skin, or dermis 101, as well as precisely control the use of a cutting tool 102. The hand tool preferably has an upper 103 and an elevation of perimeter 104 cooperatively defining an recessed area 105 that may be placed over a patient's dermis. By applying a force 106 to the top of the hand tool or by a vacuum provided to the hand tool, a portion of the dermis 101 can be moved into the recessed area to substantially fill the recessed area, thus capturing it within the hand tool and providing some control over the captured tissue area. This allows a distal portion of cutting tool 102 or other suitable dissection device to be inserted through conduit 107 extending across one side of the hand tool's perimeter elevation, percutaneously through tissue disposed in the recessed area, and in the subcutaneous tissues covered by the recessed area of the hand tool. Cutting tool 102 is maneuvered in such a way as to cut a surgical lesion of a predetermined shape within the subcutaneous tissues within the recessed area parallel to the top of the hand tool. The surgical lesion (dissection) is targeted to be in a range as shallow as 1 mm to 2 mm below the interface between the dermis and the shallow fat, as deep as 20 mm below the skin/fat interface. Depositors now define percutaneous as meaning a puncture or incision through the skin between 0.4 mm and 4.0 mm. It should be understood that hand tool 100 can be used in conjunction with any of the dissection devices disclosed herein.
[0081] With reference to FIG. 2A, a top wall 201 and perimeter wall 202 define a fabric juxtaposition surface (facing surface) 203 opposite recessed area 105. The fabric juxtaposition surface 203 can be curved into the hand tool , or concave, or recessed, so that when hand tool 100 is disposed against an epidermis 204, additional pressure against hand tool 100 will cause the hand tool to cover a subcutaneous level of tissue 205, specifically the subdermal fat layer below of the epidermis and dermis layers, characterized in that these layers will be positioned within the recessed area 105. In some embodiments, the tissue juxtaposition surface 203 includes the perimeter wall 202 as a relatively small inner wall around the perimeter of the recessed area 105. In some embodiments, hand tool 100 may include a transparent cover 206 so that a physician can clear Before seeing and verifying that the dermis is properly positioned within the dissection region. In the illustrated embodiments, the perimeter walls (side walls) of the hand tool are shown generally circular. However, those of ordinary skill in the technique will appreciate that the hand tool can be of any shape.
[0082] The device also allows for three-dimensional control of the treatment or delivery of anesthetic solution and dissection of subcutaneous tissues, not performed by the present technique. The device typically controls a depth 215 between 4 mm and 20 mm below the surface of the skin (measured orthogonally from the dermis); however a depth less than 4 mm or greater than 20 mm is also contemplated. Depth 215 is generally defined as being measured from the tissue juxtaposition surface 203. For the purposes of this disclosure, however, the measurement is obtained when the epidermis 204 is washed against the juxtaposition surface 203 and the thickness of the epidermis is considered insignificant. As such, depth 215 can also be considered to be a depth below the surface of the skin or a depth below the epidermis 204. The variation of movement in the lateral direction is controlled by the length and movement of the cutting blade and/or RF probe, however, it typically spans a length between 2 mm and 100 mm in either direction. As the needle/blade/probe is placed further into the skin, larger arches are achieved.
[0083] In general, device 100 is pressed against tissue to move subcutaneous layer 205 in recessed area 105 and against tissue juxtaposition surface 203. In some embodiments, vacuum (suction) is used to enhance capture of the fabric. A vacuum source 1606 (FIG. 16B) may be placed in fluid connection with hand tool 100 via an optional vacuum port 208 on hand tool 100. The vacuum source may include a vacuum pump in fluid communication with the recessed area 105. The 1606 vacuum pump provides suction to the recessed area to pull fabric comfortably and securely into it. In some embodiments, the vacuum pump is configured to communicate with a microprocessor 1501 (eg, FIG. 15) and a graphical user interface 1502 to display a vacuum pressure. The system may also include a display indicating the elapsed amount of time the vacuum has been supplied to the hand tool by the vacuum pump. The vacuum pump can also modulate the suction so that a higher suction force is initially applied to pull the tissue into the recess, and a somewhat lower suction force is used to hold/hold the tissue in place thereafter.
[0084] Vacuum port 208 may be located on top wall 201 and/or perimeter wall 202 of hand tool 100. In some embodiments, fabric juxtaposition surface 203 includes two or more vacuum ports 208 disposed at its surface and configured to apply suction from the vacuum source to the recessed area and tissue from different locations of the hand tool.
[0085] In the embodiment illustrated by FIG. 2A, the hand tool 100 is seen in use with a vacuum pressure (suction) applied to a portion of the skin 101. The suction applied to the vacuum port 208 causes the skin 101 to be pulled into contact with the juxtaposition surface 205 of the hand tool 100. Upon applying sufficient suction force, a portion of the epidermis 204 is pulled into the chamber of the vacuum hand tool 100 and conforms to the internal recessed area 105. While the skin surface 204 is positioned rigidly against the top wall 201 and perimeter wall 202 of the recessed area 105, the fat layer 205 (subcutaneous tissue) is also withdrawn into the chamber. A cutting tool 102 (eg, a cutting blade or RF probe, or needle) may be inserted through conduit 213 on one side of hand tool 100 and through inlet port 214, through the skin, and into the subcutaneous tissue. Significantly, the hand tool allows the cutting tool to be consistently inserted to the desired depth of treatment 215. The hand tool 100 thus provides precise control of the depth of the dissection plane and allows cutting and/or movement of the tool 102 substantially parallel to the surface. of the tissue along a plane 225 (FIG. 2B).
[0086] A membrane 217 formed of a flexible and resilient material can also be applied to the perimeter wall (side wall) through the proximal (away from the recessed area) or distal (closer to the recessed area) end of conduit 213 to minimize the vacuum leakage through it. The membrane 217 preferably is sufficiently resilient to seal around the cutting tool as it pierces (self-seals) therethrough and minimizes vacuum leakage. Membrane 217 can be formed from silicone. However, one of ordinary skill in the art will appreciate that other materials may be useful in creating the self-sealing membrane.
[0087] Conduit 213 is disposed in side wall 202 of hand tool 100, preferably adjacent lower or side of fabric juxtaposition surface 203. In some embodiments, conduit 213 is a complete hole defined in perimeter wall 202 or in the top wall 201. In other embodiments, conduit 213 is a tube-like member inserted and/or mounted in a complete hole in the perimeter or top wall. Conduit 213 is configured to allow passage of a hypodermic needle, subdermal catheter, cutting tool (as described above), positioning applicator or other suitably configured tool through the conduit and into the recessed area 105 of the device. The tool can pass through conduit 213 far enough to penetrate tissue.
[0088] Conduit 213 is preferably located near a lower edge 218 of perimeter wall (side wall) 202 to allow a cutting tool or needle to be inserted into tissue (captured in the recessed area) in a plane parallel to the dermis. In some embodiments, conduit 213 provides a penetration angle 219 so that the tool inserted through the conduit will penetrate fabric disposed within the recessed area, and substantially parallel to the fabric surface and parallel to the top wall surface 201 in depth. 215. Specifically, this configuration can provide tool stability to maintain an even level, for example, when the cutting tool is cutting through the fibrous structures 220 between the epidermis 204 (and dermis) and the subdermal fat 221. In some embodiments, conduit 213 provides an entry angle to tilt the plane of dissection toward or away from the dermis. As illustrated in Fig. 2B, inlet port 214 is preferably disposed on an inner side of the conduit and opposite the recessed area. Conduit 213 preferably flares outwardly toward an outer side of the perimeter elevation so that a distal end 222 of the cutting tool inserted through the inlet port moves in a direction 223 when a proximal end of the cutting tool is out. of conduit moves in an opposite direction 224. Inlet port 214 thus defines a cutting tool axis point when a distal end 222 of cutting tool 102 is inserted through conduit 213 and recessed area 105, and the tool moves primarily in an xy 225 plane parallel to the surface of the top hand tool. In some embodiments, inlet 214 may include an optional locking mechanism 226 that locks the tool in place upon insertion into the conduit. In some embodiments where a vacuum is provided to the recessed area, an optional gasket or seal 217 (not shown in Fig. 2B) may be placed in, in front of, behind or around inlet port 214 to minimize vacuum leakage .
[0089] In some embodiments, conduit 213 restricts side-by-side movement of a tool such that tool movement through conduit is limited to a backward direction 227 and forward direction 228. In some embodiments, conduit 213 restricts up and down movement of a tool such that tool movement maintains the tool in a plane parallel to the surface of the skin 225. In other embodiments, conduit 213 is configured to allow the cutting tool to be moved in a arc 223 parallel to the recessed area of the surface in front of the tissue (apposition) so as to permit cutting within a subdermal area substantially the size of the recessed surface area.
[0090] In some embodiments, conduit 213 has a tool control mechanism (not shown) that allows cutting tool 102 or other suitably configured tool device to be controlled by a microprocessor. In such an embodiment, hand tool 100 and/or microprocessor (not shown) controls cutting device 102 to precisely cut an area of tissue disposed within recessed area 105. The area being cut is predetermined and programmed into the microprocessor by the operator of the hand tool.
[0091] As illustrated in Fig. 3A and 3B, the dissection system may include a motor-controlled cutting module 301 and a guide rail 302 operably connected to the hand tool 100. In this embodiment, the cutter module includes an embodiment of the cutting tool 102 (an alternating cutting blade 303 disposed in a sleeve 304) and a housing 305 and a base 306. The guide rail 302 is generally configured to restrain a portion of the guide pin of the cutting module 307 in contact. with the guide rail to move along a predetermined path. In this way, a distal end of the cutting tool, complete through-entry hole 214, cooperatively moves within the recessed area 105 in a plane substantially parallel to the top of the hand tool and within a region of a pre-shaped shape. -determined set by predefined path. The motor operation of the cutter module 301 is preferably manually controlled by an electrical switch or button 308, but it can also be activated by means of electrical contact or other contact means known in the art within the guide rail.
[0092] FIG. 4A illustrates an exploded view of the cutter module 301. The cutter module 301 includes a housing 305 and a base 306. In the illustrated embodiment, a motor mount 401 is mounted on the base 306 and included by the housing 305, and a blade. alternating cut 303 is operably connected to motor assembly 401. Motor assembly 401 includes a motor 402, a crank 403, a connecting rod 404, and a crank slide 405. In one embodiment, the motor 402 is an motor DC which can incorporate a gear reduction. In the illustrated embodiment, the crank slide 405 converts motor rotation to cutter reciprocation. However, it should be understood that other designs that convert rotary to alternating motion (eg triangular connecting rod) may also be employed. For example, motor 402 within frame 305 moves reciprocating cutter blade 303 within sleeve 304. As motor 402 rotates, a crank 403 operates connecting rod 404 to move crank slide 405. As shown by FIG. 4B , when the motor mount 401 is assembled, the crankshaft 405 is attached to a proximal end 406 of the cutter 303 via a set screw 407 or other suitable connection means known in the art. In some embodiments, the engine assembly 401 is battery powered. In other embodiments, power is supplied from an external power source (not shown), for example, by a power cord 409. The power cord 409 typically provides electrical power; however, other energy sources, such as pneumatic energy, are also contemplated. Cutter blade 303 may include a needle or bayonet which may further include one or more sharp edges.
[0093] The cutting blade 303 is slidably disposed within and/or passes through the sleeve 304. As illustrated by FIGS. 4B and 4C, sleeve 304 does not alternate and is typically comprised of a thin-walled polymer tube and is sterile for patient use only. Sleeve 304 contacts housing 305, does not move, and minimizes the amount of fabric in direct contact with shaft 402 of cutter blade 303 to minimize tugging or tugging on fabric. Sleeve 304 may be affixed to housing 305 and/or motor mount 401 via connection point 410. Connection point 410 may be a 301 disposable protective connector maintenance cutter module and 401 gear motor assembly at fluid isolation of sleeve 304 and cutter blade 303.
[0094] Thus, sleeve 304 and cutter blade 303 are typically disposable. Sleeve 304 also allows isolation and/or capture of any fluid that may travel along the axis of blade 303.
[0095] Connector 410 may also include a cut-off module including barrier (not shown) 301 during device operation. In this way, the cutting blade 303 and sleeve 304 can be disposed along the connection point 410 after such a procedure. Correspondingly, cutter module 301 including motor assembly 401 and base 306 can be reused in subsequent procedures.
[0096] With reference to FIGS. 5A through 5E, in another embodiment, the cutting blade 303, sleeve 304 and reciprocating mechanism can be incorporated in the base 306 so that the combined assembly is detached from and operably coupled to the engine 402. discarded after each procedure. For example, in the illustrated embodiment, housing 305 includes electrical components, including the motor and an exposed pinion gear 501. The base portion 306 is a separate yet connectable cartridge that includes an upper base housing 502 and lower recessed chamber 503 with the cutter blade 303 connected to a triangular connecting rod 505, a drive gear 506 and a drive pin 507 included therein. Upper base housing 502 further includes an opening 508 for receiving pinion gear 501 when base 306 is connected to housing 305. Motor 402 (not shown) drives pinion gear 501, which, when received by opening 508, engages and rotates drive gear 506. Drive pin 507 is orthogonally attached to the underside of drive gear 506 and engages a substantially linear gear channel 509 disposed on connecting rod 505. As drive gear 506 rotates, the drive pin 507 moves within gear channel 509 and causes connecting rod 505 (which is linearly movable in a direction orthogonal to gear channel) to alternate the movement of cutter blade 303.
[0097] Sleeve 304 is slidably disposed over cutting blade 502 and sleeve 304 mounted in a snap channel 510 at a distal end of base 306. In some embodiments, a pair of locking tabs 511 is mounted on the opposite sides of cartridge 306. Tabs 511 may be made of a foldable material (eg, plastic or flexible alloy) and face the cartridge. In another embodiment, rather than being separate components, tabs 511 may be integrally formed as features of one of the other components comprising cartridge 306, although the function of tabs 511 remains unchanged. Housing 305 includes receiving spaces 512 to receive a locking portion 513 of tabs 511. A user wishing to attach or detach cartridge 306 from housing 305 needs to align cartridge 306 with the bottom of housing 305 and apply a slight force to move locking portions 513 of tabs 511 into corresponding receiving spaces 512 to lock cartridge 306 against housing 305. In one embodiment, cartridge 306 can then be removed, and disposed of, by cooperatively pressing a button. pressure 514 on a lower portion of tabs 511 while removing cartridge 306 from housing 305.
[0098] In one embodiment, radio frequency identification (RFID) or other interlock could prevent reuse of the blade assembly. In some embodiments, the cutting blade 303 is a bayonet. In other embodiments, a cutting means, such as an RF cutting device, harmonic scalpel or similar cutting means, can be substituted or used in conjunction with the blade and/or bayonet. If an RF cut-off device is used, then the device is operably connected to an RF amplifier (see FIG. 16B).
[0099] With reference to FIGS. 3A and 3B, the hand tool also preferably includes a platform 309 integral with or affixed to a proximal side of the hand tool 100. The platform 309 may be affixed to the hand tool 100, for example, by screws 310 (e.g., Allen screws) , a clip mechanism 1209, 1210 (FIG. 12), or any other similar fastening means. Platform 309 preferably includes guide rail 302, characterized in that guide rail 302 is used to position, guide and support cutter module 301 by means of guide pin 307. guidance is in the form of a maze. Guide pin 307 moves in and along the path of guide rail 301 to stabilize cutter module in a suitable position close to hand tool 100. FIG. 3B illustrates the undersides of hand tool 100 and cutter module 301. Guide pin 307 is located on a side of base 306 proximal to sleeve 204. In the illustrated embodiments, guide pin 307 is a protruding feature that interfaces with, or is received by, the guide rail 302; however, the guide pin is defined herein to be any feature that engages the guide rail 302 so as to provide definite movement of the cutting tool along a predetermined path. For example, the guide pin may be a recess or groove where the guide rail is a raised edge or groove along the guide rail 302 so that the cutting module runs along the raised guide rail to move the guide. cutting tool along the predetermined path.
[00100] In this embodiment, the guide pin 307 protrudes through the base 306 of the cutter module 301; however, in other embodiments, the guide pin 307 may be part of the base 306 or cutter module 301. The guide pin can serve dual purposes. The guide pin 307 serves to guide the disclosed embodiments of the cutting module to create a surgical lesion defined by the path of the guide rail 302. In addition, the guide pin may include a feature such as an enlarged head or the like, which interacts with guide rail 302 and prevents cutter module 301 from being lifted from platform 309 and/or supports cutter module 301 in a predefined planar orientation relative to platform 309. In the drawings, guide rail 302 it retains the cutting module 301 so that the cutting blade 303 creates a lesion parallel to the tissue juxtaposition surface 203, i.e., parallel to the dermis. However, the guide rail 302 could also retain the cutting module so that the cutting blade creates a lesion in a different predefined orientation relative to the dermis. In another embodiment, the guide pin could be motorized and assist or automate the movement of the cutting module through the guide rail.
[00101] Referring now to FIGS. 6A and 6B, in one embodiment, the path of guide rail 302 is defined by a central channel 601 passing through multiple arcs 602, each of the arcs having a radius measured from a center point located beyond the guide rail at a direction apart from the cutting tool that will provide the cutting action. Moving toward the center point, each successive arc 602 decreases in length and grows smaller. In this embodiment, the penultimate arc is joined with a final inverted arc 603 of the same size to create a closed loop between the penultimate arc and final inverted arc. Center channel 601 does not intersect with inverted arc 603, however, guide pin 307 traveling along the path of center channel 601 will move to the final inverted arc as it travels along and beyond. one end of the penultimate arch. In the illustrated embodiment, there are three primary arcs, the only one joining the inverted arc. The central channel 601 also has an enlarged opening 604 at its starting position, farthest from the arches, wherein the central channel is in the form of a substantially elongated straight rail moving towards the arches.
[00102] This regular part allows the cutting module to be positioned within the rail at its start and move in a forward direction to insert the cutting tool through the conduit and entry point and into the recessed area. The center channel 601 is also balanced between the first and second arcs and between the second and third arcs to prevent a cutting module from traveling along the guide rail from still sliding towards the last arc before providing the module holder with cut off the opportunity to move the cutter module through the entire range of the predefined path. In such embodiments where the guide pin 307 has a flared head, the flared opening of the central channel is suitable for receiving the flared head, and the guide rail 302 includes an flared underside for passing the flared head along the path. while preventing the cutting module from being lifted from the platform 309 and/or supporting the cutting module 301 in a predefined planar orientation relative to the platform 309. In an alternative embodiment, the arcs of the guide rail 302 are connected at the outer edges to allow alternating movements of the cutting module between the rails. This is specifically useful once the dissection is complete so that the motor can be easily moved from the last inverted act to the center channel 601.
[00103] In alternative embodiments, with continued reference to FIGS. 6A and 6B, guide rail 302 can be removable and replaced with a different pattern that creates a different dissection profile. For example, a variety of guide rail inserts can be provided so that the clinician can adjust the procedure to the patient's anatomy and/or size of lesion to be created. Guide rail 302 can be inserted into a pre-defined setback or incision 605 in platform 309 and restrained by a locking mechanism 606. The mechanism can include the platform having swivel arms or levers 607 which pivot within a setback 608 to overlap. a portion of the guide rail 302 to restrain it within the platform incision. FIG. 6A illustrates an embodiment of the platform having a removable guide rail 302 with a predetermined path for use with a cutting tool to cut a predetermined shape defined by the predetermined path. FIG. 6B illustrates an embodiment of the platform having a removable guide rail with a predetermined path for use with an injection device to coordinate the movement of a complementary device having a hypodermic needle or other injection device for injecting a solution into a tissue. disposed within the recessed area in a treatment area defined by the pre-defined path.
[00104] Referring briefly to FIG. 12, platform 309, including guide rail 302, may also be detachably detachable from hand tool 100 by a clip mechanism. In this embodiment, the hand tool may include locking receiving spaces 1209 configured to receive complementary insertable 1210 clips affixed to platform 309. Clips 1210 may be made of a collapsible material (e.g., plastic or flexible alloy) and forward out from platform 309 at its end in front of hand tool 1211. The hand tool is formed so that the receiving spaces 1209 are integrally formed from the body 1212 of the hand tool 100, in a gap left open between the perimeter wall 104 and recessed area 104 and an outer surface of body 1212. A user wishing to attach or detach platform 309 from hand tool 100 only needs to cooperatively squeeze clips 1210 inward while inserting or removing them from the spaces of receiving 1209. Releasing the 1210 clips as they are inserted into the 1209 receiving spaces will lock the 309 platform against the hand tool 100.
[00105] FIG. 7 illustrates the cutting module in use with the guide rail for cutting into the subcutaneous layers of fat 205 at depth 215. Sleeve 304 passes the complete entry hole 214 of hand tool 100, effectively creating a shaft at point 801 of contact. with the skin. With further reference to FIGS. 8A through 8C, conduit 213 is wider at a point farther from inlet hole 214. This allows cutting attachment 102 or cutting module 301 to rotate over inlet hole 214 and move within the desired treatment area. 802. Guide pin 307 on the underside of cutter module 301 fits into guide rail 302 of deck 309. Correspondingly, the bottom of cutter module 301 remains in contact with deck 309 during operation, thus restricting the cutter to operate only in one plane at the desired depth. The fit between the pin and rail, combined with the shaft in the shaft entry hole 214, restricts the cutter to only operate within the desired region. Guide rail 302 may be constructed in any number of ways consistent with the practice of the invention. The shape of guide rail 302 is not limited to that illustrated by the figures attached herein. In some embodiments, guide rail 302 may be recessed and guide pin 307 may include a flange so that the interface between the flange and recess prevents cutter module 301 from being lifted from platform 309 and/or hand tool 100 .
[00106] The cut region 802 is dependent on conduit 213 so that, as the cutter 102 is restricted by the inlet 214, it is also restricted by the guide pin 307 to move along the guide rail 302. Correspondingly, the cutting tool moves in a side-to-side fashion to allow a distal end of the device (including a cutting device, eg needle, blade, RF cutter, water jet, laser) , ultrasonic or harmonic scalpel) move along the maximum limit (laterally and longitudinally) of the cut region 802. FIG. 8A shows the cutting blade entering the cutting region 802. Guide pin 307 is fitted to guide rail 302 as cutter module 301 is advanced in the Y direction 803 until guide pin 307 reaches the proximal arc of the rail. At this point, the cutting blade is through the skin and the motor is energized to initiate blade reciprocation. In further embodiments, the guide rail incorporates a contact (eg, a sensor) to prevent premature energizing of the motor module, or automated energizing of the motor module when the motor module has reached the proper portion of the guide rail.
[00107] As the cutter module 301 is advanced towards the hand tool pin 307, it moves along and is constrained by the labyrinth-like path of the guide rail 302, so that as illustrated by FIG. 8B, as guide pin 307 moves within guide rail 302, a distal end of the cutting tool will move from side to side within cutting region 802 in a controlled manner. Guide rail path 302 defines the size and shape of region 802. Considering the z-axis as the centerline of the hand tool from top to bottom, the path preferably restricts the movement of the cutting module, and thus the cutting tool moves in an x and y direction within a plane parallel to the top of the hand tool. The interaction between pin 307 and rail 302 defines a maximum width 804, or x-direction. A physician moves the cutting module 301 along the rail by initiating the cut deep into the skin, and after the rail works inward, the fixed shaft portion (uncut) is always within a region where tissue is separated. ; otherwise, the unseparated fabric will prevent the shaft from rotating freely over the desired region.
[00108] As shown in Fig. 8C, the interaction between pin 307 and rail 302 also defines a maximum length 805, or y direction, of region 802. Guide rail path 301 preferably defines the region in which the tool The cutting edge will move within the recessed area of the hand tool. The rail geometry together with the blade length and reciprocating stroke define the dissection area. After following the entire track, the engine is turned off and the cutter is removed. After power is turned off and prior to removing the cutter, dissection can be confirmed by retracing the path with the engine module turned off. Power can be turned back on to cut off any areas not previously cleared. This same method would apply to any cutting instrument disclosed here. In the illustrated embodiment, the resulting overall region 802 is drop-shaped. However, the path of guide rail 302 and/or conduit 213 and/or entry point 214 can be changed to modify the shape of region 802 to be any shape.
[00109] An alternative variation of motion can be enabled by selecting the guide rails illustrated in FIGS. 6A and 6B. A clinician may also choose to constrain the motor module within multiple 602 arcs and not complete the outer regions of any of the arcs. The balanced center rail 601 can still be used to advance the module towards the final inverted arc 603. In an additional method, the practitioner may choose not to complete the successive arc(s). Thus, by these methods, a reduced area of dissection can be created.
[00110] FIGS. 9A through 9C illustrate an embodiment of platform 309 and guide rail 302. In this embodiment, guide rail 302 is a semi-ovoid shape formed along an outer edge 901 of platform 309. Guide pin 307 is positioned in a side of the cutting device (eg, cutting implement 102 or sleeve 304) so that guide pin 307 moves along the curvature of guide rail 302 and so that dissection can only occur within the defined limit 902 (similar to FIGS. 8A to 8C). Although FIGS. 9A through 9C illustrate the guide rail used with an anesthesia needle, it should be recognized that the illustrated guide rail (or any guide rail disclosed herein) can be used with an anesthesia needle or any cutting instrument disclosed herein.
[00111] In a further realization of platform 309, illustrated by FIGS. 10A and 10B, guide rail 302 is configured to provide controlled delivery of treatment solution through needle 1001. Needle 1001 may be a tube, a hypodermic needle, and may have a plurality of holes for increased lateral fluid dispersion. A supply tube 1002 provides the fluid connection of needle 1001 with a syringe 1003, syringe pump, roller pump, or other injection mechanism known in the art. In certain embodiments, a needle control module 1004 is included to house needle 1001 and to provide support for movement along guide rail 302. Movement of needle 1001 along guide rail 302 provides for delivery of solution treatment at precise sites in the dissection region and minimizes the amount of infusion solution required for a single treatment and/or over multiple treatment sites. Needle control module 1004 preferably includes a guide pin to be fitted to guide rail 302 of platform 309. The guide pin guides the needle/cannula to ensure that injectable fluid is injected into tissue at the desired depth and desired locations. within a predefined treatment area defined by guide rail path 302.
[00112] One embodiment of guide rail 302 for use with needle control module 1004 includes three radial channels 1005 converging toward a center point located beyond the guide rail in a direction to the part of the needle delivering solution to the area of treatment. A center channel provides a regular part 1006 that allows the guide pin of needle control module 1004 to be positioned within the rail at its start and move in a forward direction so as to insert needle 1001 through conduit 213 and entry point 214 and in the recessed area. Downward from the start position of the center channel, the center channel crosses and passes through a cross channel 1007. In this embodiment, the cross channel 1007 is in the form of a wide arc having a center in a direction toward the center point. A radial channel starts at each end of the cross channel so that a guide pin moving along the path of the cross channel will move in a radial channel as it travels along and beyond one end of the cross channel. . Each radial channel converges towards the center channel as the needle control module moves in a direction towards the center point. An enlarged opening 1008 of the center channel marks the starting point of the center channel. In such embodiments where the guide pin has a flared head, the flared opening of the central channel is suitable for receiving the flared head, and the guide rail has a flared underside for passage of the flared head along the way while preventing the cutting module can be lifted from platform 309 and/or supports needle control module 1004 1004 in a predefined planar orientation relative to platform 309.
[00113] In one embodiment, with continued reference to FIGS. 10A and 10B, when the guide pin in the needle control module 1004 reaches the cross path 1007 along the center channel 1006, the needle has pierced the skin captured in the recess 105. When the guide pin is moved along the cross channel 1007, the needle rotates within the pierced area, but does not move forward or out of the skin. Therefore, when the needle is moved by the control module 1004 down a converging radial channel and back again, the cross channel 1007 provides a stop that holds the needle within the skin. In this way, the solution can be infused over the entire area through a single needle puncture. In a further embodiment, with reference to FIG. 12A, central channel 1006 stops at cross path 1007, four converging radial channels 1005 can be used for fluid infusion.
[00114] In this way, all converging channels 1004 start and stop, and the cross path 1007 prevents the needle from being removed from the skin by requiring the guide pin in the control module 1004 to move directly through the cross path 1007 to from radial channel to central channel 1006.
[00115] FIGS. 11A through 11D illustrate a still further embodiment of the platform. In this embodiment, the platform 309 of the previous embodiments is replaced by support arm 1101 movably coupled to hand tool 100. Support arm 1101 includes a guide pin 1102 that interacts with a guide rail 1103 defined in the upper portion. of hand tool 100. A cable 1104 is used to advance support arm 1101 as guided by the interaction of guide pin 1102 and guide rail 1103. Guide pin 1102 moves in and along guide rail 1103 to stabilize a cutter module 1105 in a suitable position close to the hand tool 100. The cutter module 1105 can be adapted for use with any cutting mechanism disclosed herein. In one aspect, cutter module 1105 may include cutting implement 102. In another aspect, cutter module 1105 is manually controlled. In the illustrated embodiment, the cutter module 1105 is motor controlled and includes a housing, a gear motor, cutter blade 1106 and sleeve 1107 similar to the embodiment illustrated by FIGS. 3 and 4. Guide pin 1102 is located on an underside of support arm 1101 proximal to sleeve 1107. Cutting module 1105 is secured to support arm 1101, and thus support arm is moved to advance the cutter blade 1106. In certain aspects, the cutter module 1105 may include an RF cutter. The compact size of this third embodiment is specifically suited for facial applications.
[00116] In additional platform embodiments, the hand tool may not have a perimeter wall and/or a defined recessed area. In such embodiments, the hand tool 100 can include an apposition platform to cover a portion of the dermis to be treated. The affixation platform may include a guide rail 1103 and support arm 1101 to support the cutting tool from above. In some embodiments, the perimeter wall does not span the entire perimeter of the device, but instead spans only what is needed to support conduit 213 and/or inlet 214. guidance is omitted completely, and the stability and control of the cutting and cutting tool below the apposition platform is achieved by manual operation and skill of the medical professional operating the device.
[00117] Some hand tool embodiments may include an adjustable top or cap to change the distance between an inner side of the top of the hand tool and the bottom edge of the perimeter elevation of the hand tool. Furthermore, in such embodiments, the upper portion of the hand tool 100 is adjustable with respect to the entry point 214 of the conduit 213 to adjust the volume of the recessed area 105 and the depth 215 at which the cutting tool 102 cuts the subcutaneous tissue. when inserted through conduit 213.
[00118] In some embodiments, illustrated by FIG. 12, the hand tool includes a reversible cap 1201. In the illustrated embodiment, cap 1201 has a recessed side 1202 and a raised side 1203. Both sides of cap 1201 are configured to fit snugly over perimeter wall 104 so as to be easily removed and still maintain a waterproof seal to prevent vacuum leakage when a vacuum is supplied to the hand tool 100.
[00119] Depending on which side of cover 1201 is positioned on perimeter wall 104, the depth 215 of recessed area 105 will vary. The recessed side 1202 has a shallow rim 1204 that is sized to fit the profile of an upper 1205 portion of the perimeter wall 104. When the cover 1201 is attached to the hand tool 100 with the recessed side 1202 down and toward to the recessed area 105, the depth 215 is increased and the volume of the recessed area 105 is correspondingly increased. Conversely, raised side 1203 has a platform 1206 which is sized to fit snugly within the profile of top 1205 of perimeter wall 104. When cap 1201 is attached to hand tool 100 with raised side 1203 down and towards the recessed area 105, the depth 215 is decreased and the volume of the recessed area 105 is correspondingly reduced. As in the illustrated embodiment, the hand tool may further include latches 1207 spaced about the perimeter of the top 1205 of the perimeter wall 104 to securely secure the cap 1201 to the hand tool 100 via corresponding locking openings 1208. Each corresponding opening lock 1208 is configured to receive a latch 1207 such that when latch 1207 is inserted into opening 1208 and cap 1201 is subsequently rotated 1209, latch 1207 becomes locked within opening 1208, and cap 1201 is secured. with respect to the opening communication by click.
[00120] Correspondingly, cover 1201 is reversible so that to change depth 215, the hand tool operator only needs to remove the cover, turn it over and reattach it. In some embodiments, an O-ring (not shown) or rubber-like material may optionally be interposed on cap 1201 over rim 1204 and/or platform 1206, or on top 1205 of perimeter wall 104, to provide a secure fit. and/or prevent vacuum leakage. In additional embodiments, several covers can be provided with multiple and diverse recess areas to allow the depth to be changed, whether the covers are reversible or not.
[00121] In a further embodiment, illustrated by FIGS. 13A and 13B, an inflatable balloon 1301 fits the inner diameter of the hand tool 100 and is disposed between a rigid outer cap 1302 and a rigid inner cap 1303. The inner cap 1303 is slidably disposed within the circumference of the hand tool 100 , whereas the outer rigid cap is rigidly mounted to the perimeter wall 1304. The tubing 1305 fluidly connects the balloon 1301 to the pressure source (not shown) for inflation of the bladder 1301. The inflatable balloon 1301, the rigid outer cap 1302 and rigid inner cap 1303 are then positioned to mate with the top of hand tool 100, tubing 1305 protruding through a port or top recess 1306 located along top rim 1307 portion of perimeter wall 1304. components fit together so that outer rigid cap 1302 is coupled to perimeter wall 1304 of hand tool 100, and including balloon 1301 and inner rigid cap 1 303 are slidably disposed within hand tool 100. As seen in FIG. 13B, adjusting the pressure in balloon 1301 causes inner cap 1303 to raise or lower 1308 correspondingly, thereby changing the volume of recessed area 105 and allowing selection of a desired depth of dissection.
[00122] In a still further embodiment, illustrated in FIGS. 14A and 14B, the hand tool includes a threaded fit 1401 between a threaded cap 1402 and perimeter open wall 1403 of the hand tool. The lid 1402 is threaded onto the upper rim 1404 of the wall 1403 similar to a food pot. Cover 1402 includes an outer edge and an inner edge 1405 that grip the rim 1404. The cover 1402 may further include a recessed area 1406 defined by the circumference of the inner edge 1405. An inner side 1407 of the recessed area 1406, along with an associated portion of perimeter wall 1403 forms the fabric juxtaposition surface 203 previously described. Hoop 1404 is threaded so that as cap 1402 is rotated 1408, recessed area 1406 (including fabric juxtaposition surface 203) moves in direction 1409 (orthogonal to dermis) to a desired depth within the hand tool 100. An O-ring option 1410 can be positioned along the outer circumference of inner edge 1405, between inner edge 1405 and an inner side of rim 1404 to prevent leakage of the vacuum applied to the device. Threaded cap 1402 may further include reference numerals (e.g., 9mm, 10mm, etc.) defining the depths of fabric juxtaposition surface 203 as cap 1402 is rotated. A reference mark 1411 is placed on the hand tool body 100 to mark and indicate the current depth setting. Cover 1402 may include additional supplemental markings 1412 to be aligned with marking 1411 at various depths.
[00123] In a still further embodiment, the depth is adjustable by means of a sliding platform that moves the input of the device tool up or down relative to the inside of the cover. Based on the illustrated embodiments, one of ordinary skill in the art will appreciate that there are other ways of constructing a vacuum-assisted hand tool of varying depth and such designs are within the scope of the device and method disclosed herein.
[00124] Referring back to FIGS. 10A and 10B, the device and system may further include a syringe pump 1003 connected to the needle or cannula 1001 and a source of injectable fluids. The treatment solution can be injected before or after positioning the cutting tool. The treatment solution can include a local anesthetic or pain relief solution, a vasoconstrictor, an antibiotic, a steroid in normal saline or buffered, or a combination of the treatment solutions useful in similar medical procedures. The 1001 needle or cannula can be used to inject the injectable fluid into tissue before, during, or after creating a surgical incision. Correspondingly, the needle or cannula can be inserted through conduit 213 and full inlet port 214, through the skin, and into the subcutaneous tissue. The needle or cannula may optionally be disposed on a needle control module 1004 for use with an embodiment of guide rail 302.
[00125] In some embodiments, needle 1001 includes multiple injection ports along one side of the needle and flushed with its outer surface. The ports are configured to discharge a fluid in a direction substantially orthogonal to an axis of the needle and substantially parallel to the top of the hand tool. Multiple ports are used to allow wider distribution of fluid delivered by the needle control module throughout the treatment area during an injection. The solution will infuse into subcutaneous tissues, including subcutaneous fat and adipose tissue. Ports can, in one embodiment, be aligned on one side of needle 1001 so that when needle 1001 is positioned in the subcutaneous area of treatment, it can be further oriented so that infusion occurs predominantly in the tissue plane, parallel to the surface of the skin, ensuring that the fluid is even distributed over the largest possible area. In other embodiments, the ports can be balanced.
[00126] A specific advantage of a balanced configuration is increased mechanical strength. Another advantage is the ability to infuse the solution across the entire treatment area without requiring perfect alignment of needle 1001. In a further embodiment, the needle may include a partially curled tip to pierce a dermis while maintaining the ability to discharge the solution from treatment from the wavy tip while allowing a simultaneous discharge of the injection ports on its side.
[00127] As illustrated by FIG. 15, the system may further include a microprocessor unit 1501 having a graphical user interface 1502 to be operably connected and used with the injection device 1003, 1004, the injectable solution source 1503, a microprocessor controller 1504, and , an optional waste bin 1505. A microprocessor and software (not shown) may be included and used to control the microprocessor unit 1501 to measure the infusion according to parameters set by the clinician. The system can display drug dose and other infusion information and provide warnings or alarms. Needle injection module 1002 and/or syringe pump 1003 communicates information from microprocessor unit 1501 specifying the volume of injectable fluids injected into tissue. The graphical user interface can prompt a user to enter information specifying a concentration of fluid for injection and a patient's weight. The microprocessor can include logic to determine a maximum safe dosage of injectable fluid based on the patient's weight and concentration of injectable fluid. In one aspect, the microprocessor can also cause the graphical user interface 1502 to display at least one warning message when the volume of fluid injected by the syringe pump exceeds a pre-set limit that is less than the maximum safe dosage and can instruct the syringe pump to terminate the injection when the volume of fluid injected by the syringe pump reaches the maximum safe dosage. In a still further aspect, the graphical user interface can allow the user to override the maximum safe dosage so that the syringe pump continues to inject the injectable fluids once the maximum safe dosage has been reached.
[00128] The graphical user interface also optionally displays an elapsed amount of time since the injection control module and/or syringe pump started pumping injectable fluids. In some respects, the microprocessor tracks the amount of time that has elapsed since the system started pumping injectable fluids and can calculate a recommended treatment start time and a recommended treatment end time. For example, if the injectable fluid includes anesthesia and/or a vasoconstrictor, the microprocessor indicates when the surgical incision can be created, that is, when anesthesia is in effect. The microprocessor can also use information such as the volume of injectable fluids pumped by the syringe pump and time elapsed since the syringe pump started pumping injectable fluids to determine a treatment start time and an end time of recommended treatment. The microprocessor 1501 and graphical display 1502 can be further configured in some embodiments to control and/or display other information regarding the use of the hand tool or cutting tool. For example, the microprocessor 1501 can control the vacuum pump used to capture tissue in the treatment area and the graphical display 1502 can be used to display a vacuum pressure or a vacuum elapsed time provided to hand tool 100 by the vacuum pump .
[00129] In a further embodiment, the device and method can be configured to use a high pressure stream of fluid such as saline to create the lesion or separate fibrous septa or disrupt subcutaneous fat. A cutting device suitable for use with some aspects of the present invention is commercially labeled HYDROCISION™. HydroCision's proprietary FLUIDJET™ technology is the foundation of a new surgical modality, HydroSurgery. HydroSurgery uses a supersonic current with precisely controlled head thickness of water to provide an effective cutting, ablation and collection system for medical applications. HydroSurgery has the energy density of laser and radio frequency technologies without causing collateral damage to tissue. HydroSurgery also has the unique benefit of simultaneously cutting, amputating and removing target tissue and debris.
[00130] In some embodiments, needle 1001 is configured to increase a kinetic energy of the solution when injected by injection device 1004. Injection device 1004 is guided along guide rail 302 to inject a solution at a high pressure orthogonal to the surface of the dermis, and at depth 215, to cut fibrous septa 220 located in a treatment area located in the subcutaneous tissue 205. A pressure between 20 and 60 Bar of a water jet with sufficient cutting energy to cut 8 was determined. mm into the subcutaneous tissue in a single pass or rotation of the needle. Deeper cuts can be achieved by repeated application on the same cut. Water jet dissection can also lead to water uptake of the cut tissue. Morphologically, all vessels, in the cut, are not damaged if the pressure does not exceed the pressure range of 40 Bar. Preferably, the pressure is thus defined as above 50 bar (in the range of 50 to 60 bar) to ensure that the fibrous septa 220 located in the treatment area are cut. In this embodiment, needle 1001 includes a mouthpiece 1506 at a distal end of the needle. Preferably, the nozzle 1506 is configured to increase a kinetic energy of a solution injected by the injection device through the needle. In some embodiments, the nozzle is a converging nozzle. In this way, the mouthpiece throat converges towards the needle tip. In other embodiments, the nozzle can be a divergent nozzle and/or be configured to reduce the kinetic energy of the injected solution.
[00131] In a still further embodiment, the device and method may also use the energized high-pressure overflow device described in, and incorporated by reference from, Patent Application No. 12/555,746, filed September 8, 2009, which is a continuation in part and claims priority to US Application 11/515,634, filed September 5, 2006 and US Application 11/334,794, filed January 17, 2006, now US Patent US 7,588,547, both of which are incorporated by reference in their entirety.
[00132] FIG. 16A illustrates an embodiment of the cutting mechanism. In this embodiment, an RF 1601 cutter is used. In other embodiments, another cutter, such as a harmonic scalpel (eg Ultracision® harmonic scalpel) or the like, may also be used. The RF cutter 1601 can be positioned in an insulating sleeve 1602 that electrically insulates the cutter RF 1601 from the RF cutter module body 1603. In some embodiments, the shaft or blunt portion of the RF cutter 1601 can also be coated with an electrically coating insulating. The body of the cutter module 1603 can include a cable 1604 that is also electrically isolated from the RF cutter 1601. The cutter module 1603 can include a guide pin 307 (as shown in Fig. 3B), and the cable 1604 can be used to guide the cutter module 1603 along guide rail 302. This embodiment illustrates a specialized handle and RF cutting mechanism for use with guide rail 302 and hand tool 100. Similar to FIGS. 10 and 11A through 11C, guide pin 814 moves within guide rail 822 to properly position RF cutter 1301 within the cutting region. The cable may have control buttons (not shown) that activate coagulation or RF energy cut-off modes. In some embodiments, the use of an alternative engine, such as as illustrated by FIG. 4, can be used to toggle, move or vibrate the RF cutter 1601. It should also be understood that, in some embodiments, the RF cutter may be provided with a reciprocating mechanism or motor control to toggle the RF cutter similar to the cutter module 301 illustrated in Fig. 4.
[00133] In some embodiments, the RF 1603 cutter may include a bayonet and/or blade at least partially coated with an insulating coating. For example, if the blade/bayonet has two sides, the insulating coating may only cover one side, leaving the other side exposed. An added benefit of leaving the side in front of the dermis exposed would be to direct additional energy upward for skin tightening. An electrical connection point 1605 connects the RF cutter 1601 via an electrical cable (not shown) to an RF generator 1609 (FIG. 16B).
[00134] FIG. 16B illustrates a block diagram of a system for reducing the appearance of cellulite in a patient. The system includes an RF 1601 cutting probe, a vacuum assisted hand tool 100 and an RF generator 1606. The hand tool 100 supports the RF probe so that the probe creates a planar surgical lesion at a predefined depth below the dermis. through a minimally invasive puncture between 0.4 mm and 4.0 mm in diameter. In other words, the surgical lesion is created without exposing the wound or creating a flap of skin. Hand tool 100 has a surface that fits fabric defined into a recess configured to capture a predefined thickness of fabric. The RF 1601 cutter is inserted percutaneously into tissue captured within the recess so that the planar surgical lesion is created at a depth defined by the height of the recess. The 1609 RF generator supplies power to the RF cut probe and includes an impedance measurement circuit to measure tissue impedance. The RF generator includes feedback control logic which may include a permanent electronic circuit and/or software or microcode on a RAM (random access memory) or ROM (read only memory) chip executed by a microprocessor or the like within the generator RF. Feedback control logic optimizes the power supplied to the probe based on the measured impedance so the RF cut probe cuts efficiently.
[00135] The aforementioned system may further include a thermistor or thermocouple (not shown) which may, for example, be provided in the RF cutoff probe 1601. In certain embodiments, the thermistor or thermocouple is preferably operably coupled to the RF generator 1609 and communicates information indicative of a tissue temperature. Feedback control for the RF generator to supply energy to tissue when a tissue temperature reaches a predefined threshold.
[00136] The aforementioned system may contain the controlled infusion of a conductive fluid, such as saline solution, to provide additional RF energy dispersion, maintain tissue impedance and/or provide anesthetic benefit.
[00137] In some embodiments, a monopolar RF electrode may also be used with hand tool 100 as the return electrode. In this embodiment, the system includes active electrode 1601, an RF amplifier 1609, a vacuum assisted hand tool 100, and a vacuum pump 1606. In one embodiment, the hand tool 100 can include an electrically conductive layer (not shown) attached to the surface interior 203 of the hand tool, so that, in use, the conductive layer is placed in electrical contact with the skin 204. The conductive layer may be a mesh screen affixed to the hand tool or it may be a layer that is ejected or vacuum deposited on the inner surface of the hand tool. According to some embodiments, the conductive layer can be translucent or transparent.
[00138] The conductive layer is electrically coupled to the 1609 RF generator and, in this way, a conductor electrically coupled to the conductive layer passes through an opening in the hand tool or under the hand tool. The conductive layer can traverse the entire interior surface of the hand tool or it can include one or more windows used to view the placement of the hand tool. The conductive layer can be composed of any electrically conductive material such as copper or aluminum and/or incorporating an electrically conductive gel. Certain conductive materials can be ejected or vacuum deposited on the hand tool, providing an additional advantage of being optically transparent (eg, indium tin oxide (ITO)).
[00139] According to one embodiment, the system includes a hand tool fluidically coupled with a vacuum pump 1606 (FIG. 16B), and a needle-like RF electrode 1601 (FIG. 16A) that is inserted through the conduit 213 on the hand tool to create a lesion parallel to the skin surface and at a depth 215 defined by the hand tool (FIGS. 2A and 2B). The 1601 RF electrode is coupled to the 1609 RF generator which includes impedance feedback control logic that can be incorporated into software and/or hardware or firmware. The impedance feedback control logic monitors the tissue impedance and modulates the energy delivered to the electrode to prevent the tissue from drying out, that is, preventing a premature rise in impedance. In the embodiments disclosed herein, a subdermal pocket is created using the aforementioned vacuum hand tool in combination with various cutting modalities including the cutting blade, laser, high pressure fluid injection (eg hydrocision) or RF electrode. After the subdermal pocket is created, the cutting tool is exchanged for an RF electrode that is operated in a coagulation mode (as opposed to a cut mode) to stop any bleeding. Using the RF electrode in coagulation mode can result in collagen contraction in the tissue leading to skin tightening and may dissolve some of the tissue. Thus, if the subdermal pocket is created within the shallow fat layer, then operating the RF electrode in coagulation mode may dissolve some fatty tissue. Using the RF electrode in coagulation mode can increase the healing response time and can lead to less bruising.
[00140] In the aforementioned embodiment, the same RF electrode 1601 can be used both to create the subdermal pocket and to induce hemostasis. That is, the RF electrode 1601 can be operated in a cut mode to create the subdermal pocket and then can be operated in a coagulation mode to create or induce hemostasis.
[00141] In one embodiment, illustrated by FIG. 17, an inflatable member 1701 having an RF electrode 1702 provided on its outer surface is used to facilitate coagulation. More specifically, a subdermal pocket below the dermis 204 is created using the hand tool 100 in combination with any of the aforementioned cutting modalities, including cutting blade, laser, high pressure fluid injection (eg hydrocision) or electrode RF. The inflatable limb 1701 is inflated inside the subdermal pocket and the electrode 1702 attached therein is operated in a coagulation mode to stop any bleeding. It should be understood that the device may also utilize a 1703 return electrode placed in contact with the patient's tissue. In some embodiments, the return electrode 1703 can be placed in a location remote from the treatment site. In the illustrated embodiment, electrode 1702 includes multiple circular bands disposed about the circumference of inflatable member 1701. However, it should be recognized that the electrode may be shaped in other configurations, for example, one or more bands linearly disposed along the length of the inflatable member 1701. As described above, the vacuum hand tool may include a return electrode, or the return electrode may be a discrete item separate and remote from the hand tool.
[00142] In a further embodiment, the cutting member (ie, any tool disclosed herein capable of cutting tissue or creating a lesion within tissue) may include an electrode or a heating element. In an embodiment where the cutter includes an electrode, the cutter itself can be the electrode or the cutter can be a discrete element provided in and electrically isolated from the remainder of the cutter. In an embodiment where the cutter includes a heating element, such as a resistive heating element, the heating element may be provided on a surface of the cutter or it may be fully or partially embedded within the cutter. In all such embodiments, the cutter may include a thermocouple to measure the temperature of the cutter and/or fabric. The electrode/heating element can be used to coagulate tissue, minimize bleeding/bruising, and/or provide skin strengthening.
[00143] Referring back to FIG. 2A, the cutting tool 102 is configured to cut the fibrous septa 220 at the interface between the dermis and the fat layer, within the shallow fat layer 205 which the depositor defines as the layer 0-10 mm below the dermis, or, in the deep fat layer 220, defines as the layer 10-30 mm below the dermis, for example, between the subdermal fat layers and the skin 204, at depth 215. The previously described embodiments included a motor-controlled bayonet-like device or mechanical, RF cutter, a high pressure injection system, needle-type injection, and the like. Referring now to FIG. 18, cutting tool 102 may also include an instrument similar to elongated thin hollow subdermal catheter 1801 having a retractable cutting blade 1802.
[00144] The term "subdermal catheter" is used herein to describe any elongated object that can be used to penetrate the skin or be placed through a hole in the skin, including, but not limited to, a hypodermic needle, a cutting tool, a catheter or other device that can puncture or be placed through the surface of the skin. The subdermal catheter is inserted through an incision (made by a sharp distal end of the catheter or other cutting device) between 0.4 and 4 mm to avoid or minimize residual scarring that is undesirable in an aesthetic procedure. Subdermal catheter 1801 can be rigid or flexible, and can be made of an alloy of stainless steel, metal, plastic, or any other material known in the art.
[00145] Distal end 1803 of subdermal catheter 1801 is preferably configured to be inserted percutaneously into a treatment area and move within the treatment area substantially parallel to the surface of the skin. In some embodiments, the distal end 1803 of the subdermal catheter 1801 can be affiliated, composed of a separate sharp tip, such as a trocar tip, or it can be equipped with the sharp, non-beveled tip. It can be placed through the skin with an introducer.
[00146] The retractable cutting blade 1802 includes one or more blade members 1804 positionable from a retracted position to an extended lateral position. In some embodiments, one or more blade members 1804 are positionable from one or more sides of subdermal catheter 1801 at or near a distal end 1803. In this embodiment, cutting tool 102 preferably maintains a narrow profile, obtaining dimensions. of a relatively large gauge needle, so that when the 1804 blade members are fully contracted they can be inserted percutaneously at the subcutaneous tissue level, in the subdermal fat layer below the epidermis and dermis layers. Blade members 1802 are preferably configured to remain substantially parallel to the skin surface when in the extended position. Once positioned, the blade members 1802 can be used to trim the fibrous septa 220 that form the aforementioned chambers of fat cells contributing to the appearance of cellulite in the subdermal region by manipulating the device in a parallel back and forth motion to the epidermis to create a dissection plane below the skin. The device has been shown to be especially useful for breaking down fibrous structures that are oriented parallel (and perpendicular to the skin).
[00147] In one embodiment, illustrated by FIG. 19A, a single blade member 1901 is shapely associated with cutting tool 102 at or near a distal end of the cutting tool so that when blade member 1901 is retracted or retracted, it is parallel to the device, and when it is positioned, the ends of the blade member extend laterally away from the device. In another embodiment, as shown by FIG. 19B, a single blade member 1902 is pivotally connected at a proximal pivot point 1903 of the blade member such that blade member 1902 bendably pivots from a closed position in which the end is not connected. (distal) 1904 is near or within subdermal catheter 1801, to an open position where the unconnected end 1904 of the blade member extends outwardly from pivot point 1903.
[00148] In a further embodiment as shown by FIG. 19C, the device includes two blade members 1902 pivotally connected at one end (proximal) of each blade member so that the blades pivot foldably from a closed position where the ends are not connected (distal). ) 1904 are close together to an open position where the unconnected ends 1904 extend outward from pivot point 1903. In one aspect of this embodiment, the two blade members 1902 are connected together at pivot point common 1903. In another aspect, blade members 1902 may be connected at independent pivot points (each blade having its own pivot point 1903) attached or associated with a common rigid member. As shown by the illustrative embodiments, one or more blade members can be contracted to and from the subdermal catheter 1801 via an elongated opening 1906 on each respective side of the device.
[00149] In some embodiments, as illustrated by FIG. 20, the blade members 1902 are associated with a support structure 2001. The support structure 2001 may include a hollow tube or it may be a flat support surface on which the blade members are fixedly affixed about the axis. In some embodiments, subdermal catheter 1801 may comprise at least a portion of support structure 2001. A positioning member 2002 may move within subdermal catheter 1801 and/or be associated with support structure 2001. In some embodiments, the axis location of one or more blade members (comprising a common axis point or a common rigid member having multiple axis points) is connected or associated with support structure 2001 and elongated positioning member 2002 to position the blades. The 2002 positioning member moves to release the blade from a limited position, and can move to retract the blade members from an implanted position. Positioning member 2002 is preferably rigid and may be made of stainless steel, metal alloy, plastic or any similar material. The material of the positioning member 2002 may also be non-rigid or semi-rigid depending on the device's construction and application.
[00150] Due to the narrow profile of the device and protruding cutting blades, it is preferable to provide a maximum support force for each blade member against the internal lever force imposed on the blade members when it contacts and/or cuts through of the fibrous septa. In this way, two realizations of mechanisms that provide efficient positioning and support are explained for illustrative purposes.
[00151] With continued reference to FIG. 20, the location of shaft 1903 is fixed at a point near or at the end of the device. A distal end 2003 of a detachable support member 2004 is connected to a respective blade member at a location between its axis point 1903 and distal end 1904 of the respective blade members 1902. A proximal end 2005 of the support member 2004 is located proximal to the device 102 and the rails parallel to the device such that movement of the proximal end 2005 of the support member 2004 toward the fixed location of the shaft 1903 applies an outward force 2006 on the blade member 1902 to move the blade member to off from the device.
[00152] In some aspects, the positioning member 2002 may be associated with the proximal end 2005 of the support member 2004 from a location distal from the location of axis 1903 to a location proximal to the location of axis 1903. holder may have a self-locking mechanism that selectively locks/unlocks the holder member in place, thus extending the blade member to the desired location. The self-locking mechanism can be any means known in the art. For example, the self-locking mechanism can lock and unlock by sudden force on the support member's common joint as a result of an equal force placed on the positioning member. As the support beam is closed, typically by moving the positioning member 2002 in a backward direction, it acts on the blade member to move the blade member from an deployed position to a contracted position. In those embodiments where there are two blade members, the support member 2004 can be comprised of two rigid members 2004 joined together on the axis at and bendable from a common center by a common joint 2005, and connected to the respective members. of blade 1902 at opposite ends 2003 of rigid members 2004. The proximal end of each rigid member 2004 is located proximal to the device and the rails parallel to the device so that movement of the center joint 2005 positions or retracts each blade member simultaneously from a similar shape to that described with a blade member. The two rigid members can lock in a straight rigid position when fully positioned.
[00153] In another embodiment, each respective blade member can be positioned using a channel and pin mechanism. A pin can be associated with the blade member close to the pivot point. As the positioning member is moved from a proximal to a distal position, the pin associated with the respective blade moves within a respective channel disposed in a support structure. The channel can widen at the distal end to open the blade member in a fully deployed position. In some aspects, the shaft location may also move proximally as the blade member opens and distally as the blade member closes. In some aspects, one or more of the channels may have a latch to secure the blade member via the pin when a respective blade member is in the deployed position. In other aspects, the subdermal catheter or other support structure may have a locking channel at a distal end into which the blade member will lock as it completes placement. The lock channel can be in a lower part or an upper part of the support structure and the blade member and/or the shaft location can be actuated in the lock channel by a spring or by the linear curvature and/or resilient flexibility of the positioning member or any other method known in the art. In some aspects, the positioning member may have a locking mechanism to secure the positioning member in position and thereby secure the blades in a retracted or deployed position. The locking mechanism can be actuated from a control located at or near a proximal end of the cutting tool. In these embodiments, support members 301, 306 may be optional.
[00154] The above descriptions of support mechanisms are not intended to be exhaustive or to limit the invention to those precise forms of support disclosed. Other similar support mechanisms found to be technically useful in microdevices can also be constructed. For example, the blades can use a pocketknife-like mechanism for quick positioning with a counter-lever to retract the blades, or an electric motor to move the blades between a retracted and extended position.
[00155] In some embodiments, for example with reference back to FIGS. 19A-19C, one or more blade members can be collected to and from the subdermal catheter device via an elongated opening 1906 on each respective side of the device. The elongated opening 1906 can be narrow enough that the opening and closing mechanism (e.g., as illustrated in FIG. 20) and inner area of subdermal catheter 1801 are substantially shielded from the outside. Including the blade members within the 1801 subdermal catheter during placement allows the subdermal catheter to be inserted or removed from a patient minimally invasively. A thin membrane (not shown) can be disposed on either or both sides of the opening, such as to protect bodily fluids from entering the subdermal catheter. In some embodiments, the aforementioned membranes may overlap each other to provide the best closure. The membrane can be made from any biocompatible material known in the art, for example any of the non-absorbable polymeric materials described above.
[00156] In some embodiments, positioning member 2002 and cutting blades 1902 are positionable from within the body of subdermal catheter 1801. In these embodiments, blades 1902 can be positioned from a contracted position at or near the distal end. 1803 of the subdermal catheter. In these embodiments, blades 1902 are proximal to each other within hollow shaft 2001 and move to an outwardly positioned outer axis 2001. The mechanics of blade members 1902 may be fully or partially exposed, thus not requiring elongated openings 1906 along the side of the device. In still further embodiments, elongated openings 1906 are not required, or the device may have partial elongated openings along the side of the cutting device.
[00157] In some embodiments, the blade members will collapse in such a way that they substantially or completely may overlap each other end to end in the retracted position. In other embodiments, in the case where blade members 1902 do not have the same axis location, the blade members may collapse in such a way that, when in the contracted position, the blades are parallel and adjacent to each other end to end, for example, as illustrated in Fig. 21. The positioning angle for each blade member can range from 0 degrees in a fully retracted position to 90 degrees in a fully deployed position. Depending on the stability of the support beam or other locking mechanism, it may be more preferable to allow a variation between 45-75 degrees so that the device can maintain a narrow profile during positioning, and maintain maximum blade stability during the action of cut forward and reverse. Other angles, including an angle greater than 90 degrees, are possible depending on a number of factors, including the type of skin or fat density of the patient being treated.
[00158] In the illustrated embodiment, device 102 has a cable 1804 located at or near a proximal end of the device for control and positioning of device 102. Cable 1804 preferably includes at least one control wire or rod to trigger the positioning and retracting cutter blade 1802.
The control wire extends through a lumen in the catheter from handle 1804 to cutting blade 1802.
[00160] The device preferably has a similar positioning or control knob 1805 located at the proximal end of the device which actuates the control wire and/or positioning member 2002 to move the blade members from an implanted and contracted position. Positioning control can, for example, include a control rod or wire that extends through a lumen in a catheter. The lumen supports the lateral sides of the control wire, thus allowing the wire to exert a pressing force without bending. Pressure from the 1805 positioning control can retract the blades while pulling the control can position the blades. In some embodiments, pushing the control can position the blades while pulling the control can retract the blades. In other embodiments, pushing or pulling the controller can do both. In some embodiments, the cutting device may have a handle or hand tool on a proximal end of the positioning member.
[00161] In some embodiments, the device, including the subdermal catheter, will have a round cross section, while in other embodiments, the device will maintain a flat or oval profile. Generally speaking, the cutting device preferably maintains a narrow profile so that it can be inserted percutaneously with minimal invasion of the treatment area. The nominal outside diameter of the cutting device typically ranges from 0.5 mm to 3.5 mm (25 gauge to 10 gauge), but may be smaller or larger depending on the patient's tolerance. Each of the embodiments disclosed here includes a cutting blade.
[00162] Generally, cutting blades have a nominal width of about 0.5 mm to 3.3 mm and a nominal thickness of about 0.1 mm to 0.8 mm, however, the blade may have a width smaller or larger and/or thick depending on several factors, including the area to be treated or skin type. For purposes of illustration, the blade members are substantially flat. Other achievements might include blade members that are curved, arched or angled, or any other design that could be useful to improve cutting action.
[00163] In each of the embodiments described herein, the cutting blade includes a shaft part and a cutting part wherein the shaft is defined as that part that does not contribute to tissue cutting and the cutting part is the part. active and/or sharp cutting blade. Cutting blade length may vary depending on the specific application and material properties of the blade. Generally speaking, the larger the cutter blade, the more difficult it is to prevent bending or deflection (which is undesirable). For facial treatment applications (treatment of acne scars), the cutting blade can range from 2mm to 5mm in length; whereas, for a cellulite treatment, the cutting blade can vary from 5mm to 25mm in length.
[00164] In each of the embodiments described herein, the blades may have a sharp or blunt edge to separate the fibrous septa. In some embodiments, the blades are double-sided thus having an edge on each of the longer sides. In other embodiments, the blades have one side. In some embodiments, the distal and/or proximal ends may have a sharp edge and/or may reach a point. For example, the end proximal to the shaft location can be sharpened so that the sharp end proximal to the shaft location can be used as a spear to puncture the skin when inserting the device into a treatment area.
[00165] One or more of the 1902 blade members may be an RF electrode (monopolar or bipolar). If the blade members are RF electrodes, they can be electrically insulated from each other by providing an electrically non-conductive coating on parts of the 1902 blade members.
[00166] The term cutting blade as used herein is to be understood to include an RF electrode, harmonic scalpel or the like, useful for cutting tissue in a minimally invasive manner. In this way, the cutting blade may or may not include sharp edges and/or a sharp tip. The term cutting blade can be a single blade having one or more cutting surfaces and also encompasses two or more blades. An RF electrode cutting blade can be either monopolar or bipolar, as these terms are commonly understood in medical device techniques.
[00167] As illustrated by FIGS. 21A and 21B, in some embodiments, subdermal catheter 1801 may include an outer housing 2101 that is part of or associated with the cutting tool and/or other blade mechanisms described herein. In some aspects, subdermal catheter 1801 may also include an outer housing 2101 that is part of or associated with a mesh positioning applicator (described below). The 1801 subdermal catheter can be used in conjunction with a hand tool 100. Furthermore, the vacuum-assisted hand tool supports the cutting tool, thus facilitating a planar dissection parallel to the dermis. In one embodiment, the cross-sectional profile of the subdermal catheter is substantially flat so as to maintain a low profile when inserted between the skin and fat layers. In other embodiments, the cross-sectional profile of the subdermal catheter may be round, square, triangular, hexagonal, or any other shape configured for the embodiments described herein.
[00168] In one embodiment, the cutting device 102 is included in a hollow shaft 2101 that includes a hypodermic needle or skin penetration means 2102 located at the distal end of the shaft. The 2102 needle is rigid enough to allow skin piercing. In the illustrated embodiment, the axis 2101 of the hypodermic needle has a nominal inside diameter sufficient to include the cutting tool 102, including the blades and its positioning mechanism. In some embodiments, hollow shaft 2101 includes at least a portion of subdermal catheter 102. In one embodiment, as illustrated by FIG. 21B, the penetration means may include a case or notched needle 2103 so that the end of the blades 2104 protrude from a distal end 2105 of the device and form at least a portion of the penetration means. Each blade may have a sharpened proximal end so that when the blade is retracted, the combination of blade members forms a cutting edge 2106. In additional embodiments, the retractable cutting blade members can travel over the support structure 2103 near its distal end.
[00169] FIGS. 22A through 22E illustrate an additional embodiment of the cutting tool 102 for creating a dissection plane that cuts or amputates the fibrous septa responsible for creating the fat cell chambers. FIG. 22A illustrates an embodiment of the cutting device including a 2201 fluid injection port in fluid connection with a 2202 lumen in the subdermal catheter. The 2201 fluid injection port can be used to inject a treatment solution such as an anesthetic and/or a vasoconstrictor into the cut area before, during or after the tool is being used in the treatment area. A thin tube can be disposed within the subdermal catheter (or a lumen can be defined in a wall of the catheter) along with the other mechanics of the cutting device. The thin tube (or lumen) can then be attached to a connection at the proximal end of the subdermal catheter for fluid connection with a syringe, syringe pump, or other injection mechanism known in the art. In certain embodiments, the treatment solution can be injected using the subdermal catheter. The treatment solution can include a local anesthetic or pain relief solution, an antibiotic, or a combination of treatment solutions useful in similar medical procedures. In some embodiments, it may even be desirable to replace port 2201 with an aspiration port operably connected to a vacuum source to draw fluid and minimize fluid buildup.
[00170] FIGS. 22B through 22D illustrate how the wire can be sharpened or formed into a blade. It is possible for blade 1802 to be made of a 2203 sharpened wire, where the wire diameter is 0.5 mm to 3.3 mm and, as best seen in Fig. 22D, becomes a non-circular cross section after the sharpening. FIGS. 22B-22D show how the cross section of the wire changes from circular (FIG. 22B) to non-circular (FIGS. 22C and 22D) as the wire is sharpened. In some embodiments, the pre-sharpened wire may also have a rectangular cross section, and one or more of the edges of the rectangle may be sharpened (not shown). FIG. 22A shows thread deployment, where the thread is positioned on one side 2204 and exits proximal to distal end 2205 of cutting tool 102. Preferably, the exit location of thread 2203 may vary from distal end 2205 to about 3 cm. proximal to the distal end of the catheter. In one embodiment, the sharpened aspect of the wire is opposite the distal end 2205 of the cutting device 102, and the cutting function occurs when the device is pushed in the distal direction. In a further embodiment, the sharpened aspect of the wire faces the proximal end, opposite distal end 2205 and the cutting function occurs when the device is pulled back from the distal position.
[00171] Optionally, both edges of the wire can be sharpened to cut in any direction. The 2203 cutting wire can also be optionally positioned gradually in a series of cutting sweeps, where with each sweep the wire is further positioned to achieve a wide plane of dissection. FIG. 22B represents an unsharp part of the wire, FIG. 22C represents a semi-sharp portion and FIG. 22D illustrates a fully sharpened edge for cutting when positioned from device 102. Port 2201 can dispense to disperse a solution in the treatment area or remove tissue from the treatment area as the device is used to cut fibrous structures and/or destroy the adipose tissue.
[00172] Sharp cutting wire 2203 can also form an RF cutter and include an RF (radio frequency) electrode connected to an RF amplifier (see FIG. 16B). Like the previously described embodiments, the insulating coating can be applied to the length of the electrode, leaving only a relatively small (active) exposed portion at or near the distal end of the wire. Wire 2203 can be used with or without activating RF energy. In this way, RF can assist in cutting. RF energy can be supplied to wire 2203 in a cut or coagulate mode, as desired. It may be desirable to activate RF energy only after wire 2203 is positioned subdermally to the desired depth to prevent or minimize skin damage. Furthermore, the 2203 wire electrode can be used to confirm the resection by sweeping the non-energized wire electrode through the cut plane. RF amplifier 1609 supplies RF energy to probe 2203 or any other RF probes disclosed herein.
Throughout this disclosure, the term mesh will be used to refer generally to any generally planar foreign body sheet of material that is implanted in the subcutaneous tissue. The mesh can be composed of sutures, filaments, fibers, fibrous structures, scaffolding, hollow shafts or the like. The mesh used in any embodiment described herein may be bioabsorbable so that the mesh dissolves or is otherwise absorbed by the body over time. Each of the embodiments disclosed herein can be used to treat target areas such as the thigh below the buttocks where cellulite is most visible.
[00174] The mesh can be implanted under the skin for the purpose of promoting increased connections between the skin and fat and increasing the durability of the reduced cavity cellulite appearance. In one embodiment, the mesh can be made from any of a variety of materials, including, but not limited to, polypropylene, nylon, collagen, polyester polymers, glycolide, or other suture materials. The mesh can be absorbent or non-absorbent. The mesh thickness can range from 0.01 mm to 0.05 mm and the mesh area can range from 1 mm to 100 mm. The mesh can be formed into square shapes, circles, rectangles or shapes that are custom cut to the patient's needs.
[00175] In the embodiments disclosed herein, it is preferred that the mesh includes a plurality of pores to promote tissue ingrowth. More specifically, the pores preferably have a pore size ranging from 50 mm to 5 mm, so that they can become wedged with tissue at such a location to serve a useful therapeutic purpose. Pore size is patient dependent, and different pore sizes will be indicated for different patients. The target pore size is as small as possible to create a regular appearance and maximum amount of fibrous attachment across the mesh; however, large enough to promote rapid cell attachment and maintain a highly flexible, natural-looking appearance.
[00176] In one embodiment, the implantable mesh is crosslinked, so that it is comprised of an interconnected network of pores, as it is formed having a crosslinked structure and/or subjected to a crosslinking process. This provides fluid permeability through the implantable mesh and allows for cell ingrowth and proliferation within the implantable mesh. In additional embodiments, the mesh may include hollow shafts, sutures or other structures that bond into adjacent tissue.
[00177] The mesh can be textured or treated on one side to promote bonding to the skin or fat side. The mesh can be textured or treated on both sides to promote bonding to the skin side and the fat side. The mesh treatment can be a growth promoting chemical to encourage rapid ingrowth into the mesh from the body, and/or biologically acceptable glue can be used to bond one or both sides of the mesh.
[00178] The mesh can be composed of rigid materials or flexible materials. Preferably, the mesh is highly flexible and easily bypasses any curvature. The mesh can be made from component material that is elastic or non-elastic. In addition to being flexible, it may be desirable for the mesh to be composed of elastic materials. Furthermore, according to one embodiment, the mesh can be attached to the fabric on both its upper and lower planar sides (parallel to the dermis). Attachment of the mesh can be by means of adhesive glue or the like, sutures, staples, barbs, hooks or the like. In the case of inelastic material, the mesh will likely need to be bonded on one side and free to move on the other side. Upon implantation, the mesh reduces the cavity by creating a substantially high density of attachments (new fibrous septa) between the skin and fat, thus reducing the appearance of dimples and heterogeneity in the skin surface. With long term, for example, 3-6 months after implantation, the mesh promotes more fibrous tissue that further reduces the appearance of cellulite.
[00179] In some embodiments, a self-expanding structure is used to position the mesh in its correct position and orientation. The mesh can be releasably attached to a self-expanding structure for delivery to subcutaneous tissue, subdermal fat, or the layer between subdermal fat and skin. The self-expanding structure can be constructed of any self-expanding material, such as a nickel-titanium alloy (eg, NITINOL®). The mesh can be attached to the structure by any suitable method known in the art, for example, it can be sutured to the structure with a biocompatible suture material, glued to the structure using the biocompatible glue, or even hot glued to the structure, where the structure has been pre-coated with a suitable heat activated polymer or adhesive. In certain embodiments, the implantable device (mesh and/or frame) can be constructed to conform to different shapes and sizes to accommodate a range of patient skin types, weight, height, diameter, or the like. The intention is to remove the structure after the mesh is delivered.
[00180] The implantable device may also include a biocompatible, cross-linked (ie, resembling or forming a network), resiliently compressible elastomeric material that is generally flat, flexible and can regain its shape and most of its size upon compression. In some of these embodiments, the elastomeric material can be comprised of a bioabsorbable polymer material.
[00181] In some embodiments, the implantable device (frame and/or mesh) has a resilient compressibility that allows the implantable device to be compressed under ambient conditions, for example, at 25°C, from a relaxed configuration in a first compact configuration for in vivo delivery via one delivery device and expand to a second operational configuration, in situ. The implantable device may be suitable for long-term implantation and having sufficient porosity to encourage cellular ingrowth and proliferation in vivo. Preferably, the implantable device is constructed so that it can encapsulate and grow internally within the treatment area, and does not interfere with the function of the regrowth cells and/or tissue, and does not have a tendency to migrate.
[00182] In some embodiments, the implantation period will be at least sufficient for cell ingrowth and proliferation to start, for example, in at least about 4-8 weeks. In these embodiments, the device can be sufficiently well characterized as suitable for long-term implantation as having been shown to have such chemical, physical and/or biological properties as to provide a reasonable expectation of biodurability, meaning that the device will continue to exhibit biodurability when implanted for extended periods of time, for example, the device may include a biocompatible elastomer that can be considered biodurable for the life of a patient.
[00183] Furthermore, in certain implantation applications, it is anticipated that the implantable device will become, over time, for example, in 2 weeks to 1 year, completely absorbed, tissue encapsulated, scar tissue or the like, or incorporated and fully integrated into, for example, the repaired fibrous septa. In some embodiments, the implantable device is completely biocompatible so that the chances of biochemical degradation or release of unwanted, possibly harmful, products in the host organism can be alleviated, if not eliminated.
[00184] As shown by FIGS. 23A through 23E, the system can include a mesh positioning applicator 2301 to position a fibrous mesh 2302 through a single needle hole in a dermis to create a highly fibrous layer directly or through wound healing processes. The implantable mesh can be self-expanding, and is generally flat, flexible, and can regain its shape and most of its size after compression. In other embodiments, mesh 2302 may be detachably coupled to a resiliently compressible self-expanding structure (not shown). In a first embodiment, the implantable mesh 2302 is preferably disposed at or near a distal end 2303 of the positioning applicator 2301. The applicator is inserted percutaneously through the skin using a subdermal catheter, such as the one described above, or itself through a hole in the skin, to position the implantable mesh located near its distal end to a treatment area in the subdermal fat or in the layer between the subdermal fat and the skin. It should be noted that the mesh applicator can be combined in a kit or system with any of the dissection devices and/or the vacuum-assisted handpiece described herein. Specifically, the mesh applicator can be included with hand tool 100 to be positioned through conduit 213. The dissection devices disclosed herein can be used to create a subdermal pocket sized to receive the mesh.
[00185] As illustrated in FIGS. 23A through 23C, the implantable mesh 2302 can be folded and/or stretched into a guide wire (not shown) or an inner case 2304 (which can also house a guide wire) in order to achieve a cross section narrow enough to be pre-loaded into a second case 2305, that second outer case includes a hollow portion 2306 of positioning applicator 2301, or similar delivery catheter associated with positioning applicator 2301.
[00186] In one embodiment, illustrated by FIGS. 23A through 23B, the implantable device can be folded into the inner case 2304 and disposed within the outer case 2305 and is positioned when the device becomes unrestricted by the outer case 505.
[00187] In other embodiments, illustrated by FIG. 23C, the implantable device 2302 can be rolled onto itself and disposed within the outer case 2305. The implantable device 2302 can be positioned by removing the outer case 2305. For example, the mechanism can be positioned by pushing the inner case 2304 or guide wire in a distal direction 2307 away from device 2301.
[00188] In some embodiments, the positioning applicator 2301 may include a containment member that is actuated by heat, electricity or other means known in the art to release the mesh mechanism from its retracted and restricted position to its relaxed and expanded position.
[00189] In one embodiment, the outer casing 2305 may include the previously described subdermal catheter 1801 or may be positioned within the subdermal catheter 1801 along with the cutting blade members 1902. In this embodiment, the cutting tool 102 includes a hollow end illustrated in Fig. 21A.
[00190] Preferably, the retracted applicator has a profile sufficiently narrow to be threaded through the positioning applicator 2301 or subdermal catheter, previously described. The applicator is preferably inserted percutaneously through the incision made by cutting tool 102, or another hole or incision in the skin created by the various dissection devices described herein. While the applicator 2301 can be used with the hand tool 100, the applicator 2301 can be positioned through any needle hole in a dermis. In one embodiment, the thickness of the implantable device when in retracted form, i.e. when folded, rolled and/or stretched to be accommodated by the applicator, has an outer diameter of from about 0.65 mm to about 2.2 mm. Suitable delivery kits 2305 can have an outer diameter of from about 1 mm to about 3.3 mm. In other embodiments, the outer diameter of the positioned device or delivery cases may be larger or smaller depending on the configuration of the dissection needle.
[00191] As illustrated by FIG. 23E, mesh 2302 (with or without a corresponding structure (not shown)), when in a relaxed and expanded form, has a length and/or width 2307 typically in a range of about 1 cm to about 5 cm. In other embodiments, the range can be up to 10 cm or more depending on the size and configuration of the positioning applicator and dissection needle. Mesh 2302 is illustrated as substantially square, but can be any shape suitable to be placed in the subdermal fat or in the layer between the subdermal fat and skin. For example, and without limitation, the fully expanded mesh can be circular, rectangular, triangular, hexagonal or even irregularly shaped.
[00192] FIGS. 24A through 24F illustrate a second embodiment of a mesh positioning applicator. In this embodiment, a holster 2305 may include or be interchangeable with an introducer needle 2401, and a guidewire may be omitted. A positioning shaft 2402 and retainer rod 2403 are disposed within introducer needle 2401. Mesh 2404 is configured to be bent (i.e., wound) about shaft 2402 and retainer rod 2403. Introducer needle 2401 (with mesh inside) can then be inserted through an entry wound 2405 created by tool 102. After insertion, needle 2401 slides over a proximal end 2406 of shaft 2402 and retainer rod 2403, leaving folded mesh 2404 positioned with the region of subcision 2407. Shaft 2402 is simultaneously rotated about its longitudinal axis 2408 to unwind mesh 2404, and rotated about skin entry point 2405 to pull mesh 2404 through subcision region 2407. Retainer rod 2403 is maintained in a fixed position as mesh 2404 is unfolded so as to anchor the edge of mesh 2404 in the desired location within subcision region 2407. As shown by FIG. 24C, shaft 2402 rotates 2408 about skin entry point 2405, aided by hand dissection tool 100 (discussed above). As mesh 2404 continues to unfold, a major portion of mesh 2404 is positioned across treatment area 2407. FIG. 24E illustrates mesh 2404 in a fully deployed position. As illustrated in Fig. 24F, after positioning, retainer rod 2403 and shaft 2402 can then be withdrawn through entry point 2405, leaving mesh 2404 in the desired position within subcut region 2407. In one embodiment, a slot longitudinal 2409 is present at a distal end 2410 of shaft 2402 and retainer rod 2403. Mesh 2404 is secured when mesh 2404 is wound about shaft 2402 or retainer rod 2403, however slots 2409 are open at distal end 2410 so that when axle 2402 and rod 2403 are withdrawn as illustrated, mesh 2404 slides off the end of axle 2402 and rod 2403.
[00193] With reference to FIG. 16B, in some embodiments, the system includes an energy device 1608. In accordance with these embodiments, the insertable tool and/or hand tool may be configured to apply energy such as RF, ultrasound, or microwave energy to tissue prior to or after the mesh has been inserted into the treatment area. Although not specifically illustrated, it should be understood that a suitable 1609 power source (ultrasound amplifier, RF amplifier, microwave) will need to be operably connected to hand tool 100.
[00194] In some embodiments, the 1608 power source can be used to create sites of damage along the mesh that will heal as fibrous structures, and/or shrink the mesh and create a strengthening of the subcutaneous tissues. Power device 1608 may include a microwave, conductive heat, ultrasound, or RF. In some embodiments, energy can also be applied to shrink the self-expanding implantable device after it has been positioned under the skin.
[00195] One method of using the present embodiments is directed to providing a hand tool (described above) configured to minimally invasively create a dissection plane. The hand tool can be used to reduce the appearance of cellulite by cutting the fibrous structures between and creating the fat cell chambers. Notably, it is the chamber of fat cells created by the fibrous structures that creates the aesthetically unattractive cavity known as cellulite. The fat cell chambers and the fibrous structures that create them can be in either the shallow fat layer or the deeper fat layer. The hand tool and cutting tools are suitable for cutting fibrous structures that may be at the interface between the dermis and the fat, in the shallow fat layer 0-10 mm below the dermis, or in the deep fat layer 10-30 mm below of the dermis. The hand tool supports the cutting tool and allows the user to create a dissection plane at a precisely defined depth and, if desired, to position a mesh implant in the treatment area. If desired, the treatment area can be injected with one of the commonly used anesthetic components or collagen-promoting material. It should be understood that any of the cutting devices disclosed in this disclosure can be used with any of the mesh insertion devices and methods disclosed herein. The depth of the dissection plane can be defined by the orthogonal distance from the tissue apposition surface (tissue front) of the top wall to the tool insertion conduit.
[00196] Referring to FIGS. 9A and 9C, a physician first applies a reference mark 904 to the dermis to identify a cellulite dimple for treatment, and hand tool 100 is positioned on an outside of the skin 903 to be treated. The hand tool 100, including the transparent cover 206, is subsequently placed over the mark 904 in the dermis 903 and a vacuum is applied. The mark 904 is then sucked against the juxtaposition surface of the upper tissue 203 so that the mark 904 on the dermis 902 is visible through the clear upper portion 206 of the hand tool 100. A reference feature 905 on the hand tool 100 indicates the region where dissection will occur, and the physician verifies that mark 904 is within dissection region 902. FIG. 9C illustrates hand tool 100 used in conjunction with a NOKOR™-like subslicing device capable of cutting septa and infusing a tumescent solution, however, any cutting device or device disclosed above can be used with this embodiment.
[00197] One embodiment of using the device includes percutaneously inserting a cutting tool through the epidermis of the skin and into the subdermal fat layer or into the layer between the fat and the skin. (1) A first step, illustrated by FIGS. 1A and 1B, includes capturing tissue having cellulite with a cavity in the recessed portion of the hand tool. In some embodiments, this entails the application of hand pressure or force on the hand tool. In other embodiments, this entails the use of a vacuum-enabled hand tool to bring the fabric into contact with the recessed portion of the fabric's juxtaposition surface. Suction from a remote vacuum source 1606 (FIG. 16B) is provided to one or more ports 208 (FIG. 2) on the hand tool to pull fabric into a recess connected on the top and side surfaces. Precise depth control, where depth is measured orthogonally down (in the tissue) of the dermis is believed to be an important factor in achieving consistent and uniform results. In other words, it is important to create a planar lesion at a fixed depth below the dermis. FIG. 2 illustrates a portion of subcutaneous tissue 205 disposed within the recessed area of the hand tool. (2) A positionable tool (102, 303, 1001, 2401) is then placed in and through the conduit on one side of the hand tool so that the tool is placed at a precise tissue depth in the subdermal fat or in the layer between. the fat and the skin. The tool can have a detachable blade or it can pierce the skin like a bayonet. In one embodiment, the tool can be any cutting tool as described in the preceding paragraphs. In another embodiment, the tool can be a hypodermic needle for administering anesthetic fluid. In another embodiment, the tool may be a specialized larger diameter hypodermic needle, or subdermal catheter, configured to allow positioning of a cutting tool and/or other positioning devices through its center. (3) Once in place, the cutting tool is activated. In some embodiments, driving the cutting tool entails positioning the cutting blades. In some embodiments, the cutting blade is simply inserted percutaneously through the dermis to a desired depth. In some embodiments, the cutting tool is an RF needle. The RF needle can be provided with a sharp tip to penetrate the dermis. In some embodiments, the tip may be blunt or bevelled. RF needle actuation entails the delivery of RF frequency current from an RF amplifier to the needle in either a cutting mode or a coagulation mode. To avoid damaging the dermis, it is desirable to provide the minimum amount of energy during cutting to avoid or minimize dermis heating.
[00198] Optionally, one or more cutting blades of the cutting tools are then positioned from the cutting tool. In one embodiment, positioning the cutting blades includes actuating a control on a proximal end of the tool. Control can be actuated by a simple switch, lever or control rod that is pulled, rotated or pushed to control the actuation of the cutting blades. In some of the embodiments, the cutting tool is not retracted, so the unretracted cutting blade is inserted percutaneously and there is no need to position the cutting tool. (4) The tool is then manipulated to separate the fibrous structures 220 (FIG. 2) between the skin and fat at a precisely defined depth maintained by the hand tool and tissue juxtaposition surface. In one embodiment, the tool cuts on the reverse stroke as it is pulled back (retracted) 227 to separate the fibrous structures 220. In another embodiment, the tool cuts on the forward stroke as the tool is positioned and pushed forward 228 to separate the fibrous structures. In a further embodiment, the cutting tool is optionally moved in a forward and reverse direction, ie alternated. In a further embodiment, conduit 213 is configured to provide some lateral movement parallel to the skin surface (FIG. 2B). In other words, the conduit is sometimes larger in gauge than the cutting tool, thus allowing the cutting tool to be rotated in an arc from side to side. In a still further embodiment, the advance and sweep of the tool during cutting are microprocessor controlled. (5) Upon completion of cutting the fibrous septa, the tool is collected and/or removed from the tissue and hand tool. Optionally, the cutting blades are then retracted by any of the described means for positioning the blades. Or as described above, in some embodiments, there is no step to poorly position or position the blade. In one embodiment, the blades are retracted by moving the driver in the opposite direction as they were moved to position the blades. In another embodiment, the blades are retracted by moving the driver in the same direction. As previously noted, some of the cutting tools may not use the retracting of the cutting blades, in which case the cutting tool is simply withdrawn. Optionally, users can sweep the cutting tool to verify a clean dissection of the fibrous structures. If resistance is encountered when sweeping the cutting tool, then steps 4 and 5 can be repeated.
[00199] A further embodiment of using the device includes percutaneously inserting a mesh between the subdermal fat layers and the epidermis. (1) Referring to FIG. 25, a mesh applicator 2501 is optionally placed in the treatment area through conduit 213 of hand tool 100. Mesh applicator 2501 contains a self-expanding mesh 2502 initially collected and small in shape. In additional embodiments where hand tool 100 is not used, applicator 2501 is inserted through a needle size hole 2503 through dermis 204.
[00200] The 2502 mesh or other bioabsorbable implantable device is configured at a distal end of a mesh applicator. In one embodiment, configuring the implantable device includes attaching the mesh to a self-expanding structure and placing the implantable device in a contracted position retained at the distal end of the mesh applicator. In another embodiment, the mesh is self-expanding and positioned in a collapsed shape without the use of a framework. (2) The distal end of the 2501 Mesh applicator is then inserted percutaneously into a treatment area between the subdermal fat and epidermis layers. (3) Once the applicator mesh 2501 is placed on the fabric and treatment area via conduit 213 or dermis orifice 204, the mesh 2502 is expanded into the fabric to stretch under the skin. In one embodiment, the 2502 mesh self-expands when released from the applicator. In another embodiment, mesh 2502 is positioned by a self-expanding structure. In a further embodiment, the mesh is positioned by manually manipulating a retainer shaft and rod (FIGS. 24A-24F), and/or other percutaneous tools useful to position the mesh. Positioning the mesh may include any means described herein, including by applicator 2301 or by positioning shaft 2402 and retainer rod 2403 (via applicator 2401). Positioning mesh 2502 may further include actuating a control to release a retention mechanism retaining the implantable device in a collapsible shape. (4) The correct placement and alignment of the 2502 mesh is then verified, if possible, by the treating physician. (5) Once the mesh is positioned and verified, it is optionally fixed in the treatment area. In one embodiment, mesh 2502 is simply placed on the fabric. In one embodiment, the implantable device can be anchored in place, and suture anchors, staples or other material are placed at the corners of the mesh to hold it in place. The implantable device can be anchored close to its outer corners or edge, or any method that would secure the implantable device in place. Anchors can include hollow shafts, sutures or other structures that attach to adjacent tissue. The implantable device can be textured or it can have been treated on both sides to promote bonding to both the skin side and the fat side. The implantable device may include a treatment in the implantable device including a growth promoting chemical to encourage rapid ingrowth in the implantable device of the body. In a further embodiment, the implantable device can be textured or treated on one or more sides to promote attachment to the skin or fat side. In a further embodiment, the mesh is coated with the biologically acceptable glue on one or both sides and the tool stretches the mesh so that the glue can cure into the skin and/or fat. The mesh preferably covers the treatment area including the separate fibrous structures 220 that were previously separated by cutting tool 102 or other cutting implement described herein. (6) Once the mesh is in place and/or anchored, the mesh applicator is then retracted from the fabric and treatment area. In certain embodiments, this step may also include removing applicator 2501 from hand tool 100. If a mesh positioning structure was used, this step may first include applying a form of heat to shrink the structure, or using a control to retract the structure before removing the mesh applicator from the fabric. (7) Once the mesh is implanted, a thermal energy such as microwave, conductive heat, ultrasound, RF can be applied to the fabric after the mesh is in place. In one embodiment, energy is then applied to the fabric after the mesh is in place. In one realization, energy can be used to create damage sites along the mesh that will heal as fibrous structures, and/or shrink the mesh and create a strengthening of the subcutaneous tissues. In another embodiment, a thermal energy such as microwave, conductive heat, ultrasound, RF can be applied to shrink the implant as it is in place in the subdermal fat and create a strengthening of the subcutaneous tissues. In another embodiment, thermal energy can be applied to shrink the self-expanding mesh positioning structure. When adequate heat is applied to the framework, the framework will contract to its collapsed shape for easy removal of the device from the tissue.
[00201] In some embodiments, a treatment solution may be injected into the cutting area at or between any step of cutting into the tissue. The treatment solution can also be injected before or after positioning the blades and/or cutting steps. The treatment solution can include a local anesthetic or pain-relieving solution, a vasoconstrictor agent or an antibiotic, or a combination of the treatment solutions useful in similar medical procedures. If the cutting tool includes the application of energy, the treatment solution can be selected to improve energy delivery. For example, if the cutting tool is an RF electrode, the treatment solution may include saline or similar conductive solution to prevent tissue carbonization. It may be desirable to control such energy based on measuring an applicable parameter, such as tissue impedance or temperature. As someone of ordinary skill in the art would realize, such feedback control would be understood by a microprocessor-based algorithm. As used throughout this disclosure, any reference to applying energy is to be understood as defining the application of either radio frequency (RF), ultrasound, microwave or thermal energy. As in the previous embodiments, and as illustrated by FIGS. 26A and 26B, and with further reference to FIG. 10A, a treatment solution can be inserted before or after the dissection process. Injection device 1004 is inserted into guide rail 302 preferably at entry point 1008. The fabric to be treated is disposed in recessed area 105 as previously described. Needle 1001 can then be easily guided through conduit 213 and inlet 214 and into tissue by moving injection device 1004 along radial rails 1005 towards hand tool 100. For example, injection device 1004 is primarily moved down from the center channel in a forward direction 2601 to directly insert needle 1001 into the fabric. The treatment solution is then injected using needle 1001 manually using syringe 1003 or, in some embodiments, by a microprocessor driven injection pump (eg, FIG. 15). After the solution is injected, needle 1001 is removed by reversing direction along rail 1005. The injection device can then be rotated in an arc 2602 along cross rail 1007 to be positioned on an alternate radial rail 1005. Injection device 1004 is then moved a second time to radial rail 1005 in a forward direction 2603 to insert needle 1001 at an additional location within the treatment area. Needle 1001 passes through the same entry point 214 while the wider shape of conduit 213 allows repositioning of needle 1001 with respect to rotational angle 2602 and radial tracks 1005. The process can be repeated again for third track 1005, or how many times as determined as necessary by the treating physician. In some embodiments, needle 1001 is a 22-gauge, multi-hole single-use needle. Needle 1001 includes multiple holes along its sides so as, once fully inserted, to saturate tissue along its injection path. Inject the solution along the paths defined by the revealed injection guide rail, thereby allowing a solution, such as an anesthetic and/or a vasoconstrictor, to fully saturate the treatment area while providing precise needle guidance and specific depth . The method has been found to reduce the number of needle holes required to infuse the area to be treated, increase anesthesia effectiveness and substantially minimize pain. Because the hand tool remains in the same position between solution injection and location of dissection (subcision) of anesthesia relative to dissection is guaranteed and the exchangeable guide rail provides fast switching between drug delivery and dissection and vice versa in order to increase fluid retention throughout the process. Furthermore, the modularity of the platform and guide rail ensures that the process is repeatable and scalable.
[00202] The device allows three-dimensional control of the delivery of treatment solution and dissection of subcutaneous tissues, not performed by the present technique. The device typically controls a depth between 4 mm and 20 mm below the surface of the skin; however, a depth less than 4 mm or greater than 20 mm is contemplated. The variation of movement from the lateral direction is controlled by the effective length of the needle or blade or other cutting device, however, it typically covers an area between 2 mm and 50 mm in any direction. As the cutting device is still placed in the subcutaneous space, larger areas are possible to be realized.
It is generally recognized that a large treatment site heals more slowly than a series of small treatment sites. Furthermore, the larger the treatment site, the greater the risk of seromas, irregular healing, fibrosis and even skin necrosis. Referring to FIGS. 27A through 27D, this problem is addressed, in one embodiment, by using an adjustable depth feature (eg FIGS. 12, 13, 14). Each treatment site 2701 is an island surrounded by tissue 2702 that has not been treated (the fibrous septa were not separated in the same plane). As illustrated by FIG. 27A, the hand tool 100 is used to treat a first treatment area 2701. In some embodiments, after tissue within the first treatment site is treated, the hand tool may be repositioned in a different treatment area 2701 at the same depth, or at different or alternative depths, such as a chessboard shape.
[00204] According to further embodiments, a relatively large treatment area is divided into a plurality of small treatment sites. FIGS. 27B and 27C show two or more treatment sites 2701a, 2701b, 2701c surrounded by untreated tissue 2702. In some embodiments, the spacing in the X-Y plane (parallel to the dermis) between adjacent treatment sites is reduced or eliminated. In some embodiments, treatment sites could still overlap. Zero spacing (or overlap) between adjacent sites is possible if the adjacent treatment sites are at different treatment depths (measured perpendicular to the dermis) and the untreated tissue bridge can be greatly decreased without impacting the time of treatment. tissue healing. In the embodiment illustrated by FIG. 27C, treatment sites 2701a and 2701c are at a different depth of treatment than 2701b. According to a further realization, the treatment sites may not be contiguous, meaning that there are no multiple lesions connected. For example, an additional treatment area may include unconnected treatment sites 2703.
[00205] According to yet another aspect of the invention, the adjacent treatment sites 2701 touch or even overlap, but are at different treatment depths (measured in a perpendicular direction of the dermis). Thus, from a top view (FIG. 27C), the plurality of treatment zones 2701a, 2701b, 2701c appear to be continuous, but from a side view, illustrated by FIG. 27D, it is clear that the “chessboard” injuries 2701a, 2701b, 2701c are at different depths of treatment. In other words, adjacent sites are at different depths of treatment.
[00206] Intercalation of treatment sites at different treatment depths is believed to accommodate rapid healing. More specifically, interspersing treatment sites at different treatment depths allows for closer spacing between treatment sites while accommodating a faster healing response time of injured tissue. As the treatment area(s) heals, tissue in the treated subcutaneous area regrows with minimal fatty tissue and minimal thickness, such as to alleviate and substantially reduce the appearance of cellulite.
[00207] According to yet another aspect of the invention, the benefits realized by the multiple depth treatment enabled by the embodiments may be based on the severity of the specific lesion(s) or specific area on the body being treated. For example, it may be desirable to treat a deeper lesion at a deeper depth. Dimples or injuries to the thighs, for example, can be treated to a different depth than injuries to the buttocks.
[00208] According to yet another aspect of the invention, the size of the dissection can also be adjusted by incomplete or partial movement of the cutting means within the guide rail. For example, with reference to FIGS. 6A and 6B, a smaller area can be treated than the total area accessible by guide rail 302 by not completing cutting module movement through all arcs 602 or by not moving laterally to the arcs.
[00209] The 303 Alternating Cutter Blade provides a clean, precise and adjustable depth (cut) release of the fibrous tissue responsible for cellulite. Cutting under the dermis will create an amount of fluid (eg, anesthesia, blood, dissected cell release fluid, and the like) that accumulates in the release area during and after the cutting procedure. To remove this fluid, the blade assembly may include an aspiration means.
[00210] Briefly referring to FIG. 4C and 4D, the blade 303 is carried by an axle 303A which travels within a hollow tube 304 (eg, a polyamide tube) and which penetrates the skin along with the blade. In some embodiments, the tube is connected to a bearing 410 that is connected to the user-driven motor module 301 (in this embodiment, the tube does not alternate). As shown by FIG. 4B, in some embodiments, a proximal end 406 of the cutter blade shaft 303A is connected to the reciprocating mechanism 405 of blade cartridge 306 (or motor module 301) via a setscrew 407 or other suitable connection means known in the art. Referring to FIGS. 28A and 28B, in some embodiments, gap 2801 between the axis of blade 303A and tube 304 is connected to a vacuum supply connection 2802 to aspirate fluid from the dissected area. As suction is applied to connection 2802, fluid is withdrawn from gap entry point 2803 around blade axis 303A and along gap 2801 to be withdrawn from suction connection 2802. In some embodiments, to increase In flow, the gap 2801 between the blade shaft and the tube is increased in size, and a seal 2804 is added between the tube 304 and bearing 410 at a location near the end 2805 of the bearing 410 as illustrated in Fig. 28B. In one embodiment (not shown), tube size is increased only where tube 304 is included by bearing 410. In another embodiment, shown in FIGS. 28A-28B, gap 2801 between blade shaft 303A and tube 304 is connected to an infusion fitting 3810 that is used to infuse fluid (anesthesia, therapeutic agent, tissue sealant, etc.) across the gap and out. from tube 304 to the area to be cut. Fluid infusion may be required before, during and after cutting, and the infusion connection is piped to a fluid source. Excess fluid may also be removed as revealed by aspiration through connection 2802 as described above.
[00211] In the embodiment illustrated by FIG. 29, a suction applied to the vacuum port 208 causes the skin 204 to be pulled into contact with the juxtaposition surface 205 of the hand tool 100. While the skin surface 204 is rigidly positioned against the top wall 201 and wall of perimeter 202 of the recessed area 105, the fat layer 205 (subcutaneous tissue) is also removed in the chamber. Tube 304 and corresponding blade shaft 303A (or instrument 1801) are inserted through conduit 213 on one side of hand tool 100 and full inlet port 214, through skin 204, and into the subcutaneous tissue to perform the cutting action. When a vacuum is applied at connection 2802 (see FIG. 28A), the negative pressure created in gap 2801 along blade 303 causes fluid accumulated within subcutaneous area 205 resulting from the cutting action to be withdrawn at 2901 at the point of gap entry 280 around blade 303.
[00212] In some embodiments, the aspiration step occurs simultaneously with the cutting and releasing action. In other embodiments, the aspiration step is performed after the release operation. In one embodiment, a device similar to anesthesia cable 1004 of FIG. 15 is used, where the anesthesia delivery is replaced by an aspiration cannula 1001. In this embodiment, the user leaves the hand tool 100 in place after cutting and releasing the tissue, and inserts the aspiration cannula 1001 through the entry wound. created by blade 303 (or cutting tool 102). Referring to FIGS. 26A and 26B, the handle provides location control for the aspiration cannula in a similar fashion as it does for anesthesia delivery. The suction cannula is connected to a vacuum pump (eg pump 3001 of FIG. 30) to remove fluid from the release area and into a waste bin 1505 (FIG. 15). In some embodiments, cable 1004 is configured in accordance with the various embodiments to be moved along guide rail 309 to sweep the cannula through the entire area of tissue released in area 205 to aspirate fluid (as, for example, in FIGS 26A and 26B).
[00213] In the embodiment illustrated by FIG. 30, vacuum connection 2802 is part of blade or base cartridge 306, and is connected to a vacuum source 3001. In some embodiments, connection 2802 extends from a proximal end of bearing 410 within housing 305. of the cutting module 301 and through an outer wall 3002 of the housing 305. In some embodiments, the connection 2802 is connected to the bearing 410 at a location outside the housing 305. In some embodiments, the connection 2802 is connected to an outer side of the tube 304. In some embodiments, connection 2802 may be connected to the same vacuum source 1606 connected to vacuum port 208 on hand tool 100.
[00214] There are a variety of ways to access this fluid path in current design. For example, blade shaft 303A (or cutter 102) could also have grooves or slots to facilitate flow around the shaft. In this embodiment, illustrated by FIG. 31, a blade shaft section is in the form of a cross 303B. In another embodiment, the aspiration system may include blade shaft 303A as a hollow tube rather than a solid component, allowing aspirated fluid to travel through the hollow center of shaft 303A.
[00215] The aspiration means disclosed in FIGS. 28A-31 may also be incorporated into fabric cutting embodiments, except for the cutter blade 303. For example, in FIGS. 16A-16B, an RF 1601 cutter is used to release (cut) the fibrous tissue.
[00216] The use of the RF 1601 cutter to cut fibrous tissue results in an accumulation of fluid (blood, anesthetic solution, vapors and a liquid releasing the dissected cells) that can be aspirated in the same way as described for FIGS. 28A-31. Thus, with reference to FIGS. 28A-31, cutter blade 303 can be replaced by cutter RF 1601 (shown in FIGS. 16A-16B) and aspiration of fluid (or vapors) along gap 2801 and out through connection 2802 operates similarly. When using the RF 1601 cutter, it may be beneficial during cutting or after to infuse a therapeutic agent or tissue sealant and then aspirate the fluids from the cut tissue area.
[00217] FIG. 32 is a sectional view of human tissue showing subcutaneous fat layer 2801, dermis 2802, epidermis 2803, eccrine sweat gland 2805, and eccrine duct 2806. As shown in FIG. 28, sweat gland 2805 is found near the interface between the dermis and fat layer 2801. The above-described hand tool 100 and any of the cutting devices disclosed herein can be used to separate the eccrine sweat gland 2805 from the eccrine duct 2806 or injure the eccrine sweat gland to stop sweat excretion. This could be specifically beneficial for treating hyperhidrosis in which the sweat gland produces an excessive amount of sweat. Separating the sweat duct can provide permanent relief if the duct does not regenerate or reconnect with the sweat gland. Similarly, damaging the sweat gland can provide permanent relief if the sweat gland is damaged enough to permanently neutralize the sweat gland.
[00218] The above description for the preferred embodiments of the invention has been presented for the purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise form disclosed. Many modifications and variations are possible in light of the above teaching. It is intended that the scope of the invention is not limited by this detailed description, but by the Claims and equivalents to the Claims attached herein.
[00219] Although the present invention has been described in detail with respect to preferred embodiments and their drawings, it should be apparent to those of ordinary skill in the art that various adaptations and modifications of the present invention can be made without departing from the spirit and scope of the invention . Correspondingly, it is to be understood that the detailed description and accompanying drawings as set forth above are not intended to limit the scope of the present invention.

权利要求:
Claims (17)
[0001]
1. Treatment System for Aspirating and/or Infusing Fluid in Dissection Area, comprising: a handpiece (100) having a recessed area (105) disposed in a lower part of the handpiece and a conduit (213) that extends across one side (202) of the handpiece and into the recessed area, the recessed area defining an area of dissection; a cannula (304, 1001) comprising a suction fitting (2802) and an infusion fitting (2810) in fluid connection with an interior of the cannula, the suction fitting for applying negative pressure to the interior of the cannula; and an implantable tool (102) comprising a cutting tool (303) at least extending through the duct and into the recessed area, characterized in that the tool is housed within the cannula, wherein the part of the tool is housed in the cannula. interior of the cannula, creates a gap (2801) between the outer surface of the tool and the interior of the cannula and a gap entry point (2803) is in fluid communication with the gap and an environment external to the cannula, where the point of gap entry circumferentially surrounds the portion of the tool housed within the cannula and where the gap entry point is facing to oppose a distal end of the tool, where the gap is in fluid connection with the suction fitting and with the infusion fitting and where the application of negative pressure inside the cannula allows aspiration from the dissection area and where the application of positive pressure inside the cannula allows the infusion into the area of dissection.
[0002]
Treatment System for Aspirating and/or Infusing Fluid in Dissection Area, according to Claim 1, characterized in that the cutting tool further includes a cutting blade at least slidably disposed in the cannula and a motor reciprocating (301) coupled to the cutting blade, said reciprocating motor configured to communicate reciprocating motion to a portion of the cutting blade within the cannula; and/or that at least a portion of a shaft (303A) of the cutting blade is grooved.
[0003]
A Treatment System for Aspirating and/or Infusing Fluid in Dissection Area, in accordance with Claim 1, further comprising: a guide rail (302) operatively connected to the handpiece, characterized in that the guide rail is configured to force a portion (307) of the tool in contact with the guide rail to move along a predetermined path to cooperatively move a distal end of the tool within the recessed area in a plane parallel to the top of the handpiece and within. of a region of a predetermined shape defined by the predefined path; and/or wherein the tool includes a handpiece and the portion of the tool in contact with the guide rail includes a portion of the handpiece; and/or wherein the tool further includes a cutting blade at least slidably disposed in the cannula and a reciprocating motor operatively connected to the cutting blade, said reciprocating motor being configured to communicate reciprocating motion to a portion of the blade. cutting inside the cannula; and/or wherein the handpiece of the tool further includes a housing (305) and a base (306) operatively connected to the housing, the housing encapsulating the reciprocating motor, the base including the cutting blade and insert, the housing being and motor in fluid isolation from the base and the cutting blade and fitting, the fitting being configured to connect to a vacuum source (3001) by means of a tube; and a tailings reservoir, wherein the vacuum source and the tailings reservoir are operatively connected to the suction fitting by a second tube (1002), the tailings reservoir being configured to capture fluid or material aspirated from the cannula. , when a low pressure vacuum is applied to the fitting.
[0004]
4. Treatment System for Aspirating and/or Infusing Fluid in the Dissection Area, according to any one of Claims 1 to 3, further comprising: a fluid source, characterized in that the fluid source is operatively connected to an infusion fitting by a tube, the fluid source being configured to inject a fluid through the tube and into the cannula through the infusion fitting.
[0005]
5. Treatment System for Aspirating and/or Infusing Fluid in the Dissection Area, according to Claim 1, characterized in that the tool includes an RF cutter (1601) disposed in the cannula.
[0006]
6. Treatment System for Aspirating and/or Infusing Fluid in the Dissection Area, according to any one of Claims 1 to 5, characterized in that the handpiece comprises an adjustable upper surface and in which the adjustment of the upper part changes a volume of the indented area.
[0007]
Treatment System for Aspirating and/or Infusing Fluid in Dissection Area, according to Claim 6, characterized in that the adjustable upper part comprises a threaded fitting between the adjustable upper part and the handpiece.
[0008]
Treatment system for Aspirating and/or Infusing Fluid in Dissection Area, according to Claim 6, characterized in that the adjustable upper part comprises a reversible upper part.
[0009]
A Treatment System for Aspirating and/or Infusing Fluid in Dissection Area, according to Claim 6, characterized in that the adjustable upper part comprises a rigid upper flap, a rigid inner flap and a bladder disposed between the flap rigid upper and the rigid inner flap, wherein the rigid inner flap is configured to move up and down based on inflation or deflation of the bladder.
[0010]
10. Treatment System for Aspirating and/or Infusing Fluid in Dissection Area, according to any one of Claims 1 to 9, characterized in that: the cutting tool comprises a cutting blade (303) at least arranged slidingly into the cannula, wherein the cutting blade creates a gap (2801) between an outer surface of the cutting blade and the interior of the cannula, wherein the gap is in fluid connection with the suction fitting; and further comprising a reciprocating motor (301) coupled to the cutting blade, said reciprocating motor configured to communicate reciprocating motion to a portion of the cutting blade within the cannula; an accommodation (305); and a base (306) operatively connected to the housing, wherein the housing encapsulates the reciprocating motor, the base includes the cutting blade and suction fitting, and the housing and reciprocating motor are in fluid isolation from the base and the cutting blade and suction fitting.
[0011]
A Treatment System for Aspirating and/or Infusing Fluid in a Dissecting Area, in accordance with Claim 10, further comprising: a handpiece having a recessed area disposed in a lower portion of the handpiece; and a conduit extending through one side of the handpiece and into the recessed area, characterized in that the tool is configured to extend at least through the conduit and into the recessed area.
[0012]
12. Treatment System for Aspirating and/or Infusing Fluid in the Dissection Area, according to any one of Claims 1 to 9, characterized in that: the tool is at least disposed inside the cannula (304, 1001) configured to infuse fluid into the dissection area, where the positionable tool creates the gap (2801) between the outer surface of the tool and the interior of the cannula and the gap entry point is in fluid communication with the gap and an external environment to the cannula.
[0013]
Treatment System for Aspirating and/or Infusing Fluid in Dissection Area, according to Claim 12, characterized in that the tool further includes a cutting blade at least slidably disposed in the cannula and a reciprocating motor coupled to the cutting blade, said reciprocating motor being configured to communicate reciprocating motion to a portion of the cutting blade within the cannula.
[0014]
14. Treatment System for Aspirating and/or Infusing Fluid in the Dissection Area, according to any one of Claims 12 to 13, further comprising: a guide rail operatively connected to the handpiece, characterized in that the guide rail guidance forces a portion of the tool in contact with the guidance rail to move along a predetermined path to cooperatively displace a distal end of the tool within the recessed area in a plane parallel to an upper portion of the handpiece and within a region of a predetermined format defined by the predefined path.
[0015]
15. Treatment System for Aspirating and/or Infusing Fluid in Dissection Area, according to any one of Claims 1 to 9, characterized in that: the positionable tool comprises a cutting blade at least slidably disposed in the cannula, further comprising a guide rail (302) operatively connected to the handpiece, wherein the guide rail forces a portion of the tool in contact with the guide rail to move along a predetermined path to cooperatively displace a distal end. of the tool within the indented area in a plane parallel to the top of the handpiece and within a region of a predetermined shape defined by the predefined path, where the tool comprises a handpiece and the part of the tool in contact with the guide rail includes a portion of the handpiece, wherein the handpiece further includes a housing and a base operatively connected to the housing, including the base to cutting blade and a suction fitting, the housing being in fluid isolation from the base and the cutting blade, wherein the suction fitting is configured to be in fluid communication with the interior of the cannula and to connect to a vacuum source through a tube and wherein the application of negative pressure inside the cannula through the vacuum source and tube allows aspiration from the dissection area external to the cannula through the gap.
[0016]
16. Treatment System for Aspirating and/or Infusing Fluid in Dissection Area, according to any one of Claims 1 to 9, characterized in that: the tool comprises a cutting blade and a blade shaft, comprising the blade shaft a hollow interior, wherein the hollow interior of the blade shaft is in fluid connection with the interior of the cannula.
[0017]
A Treatment System for Aspirating and/or Infusing Fluid in Dissection Area, according to Claim 16, characterized in that negative pressure is applied by connecting a vacuum source to a vacuum port on the handpiece.

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CN103313663B|2016-08-31|

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US10220122B2|2019-03-05|

---

CA2782089A1|2012-06-28|

---

CA2782089C|2019-11-05|

---

CN103313663A|2013-09-18|

---

AU2011338134B2|2015-05-28|

---

US20190151518A1|2019-05-23|

---

MX2013007382A|2013-09-26|

---

US8439940B2|2013-05-14|

---

KR101727265B1|2017-04-14|

---

EP2504047A4|2017-11-22|

---

EP2504047B1|2019-02-20|

---

US20120165725A1|2012-06-28|

---

MX353501B|2018-01-16|

---

US9039722B2|2015-05-26|

---

KR20140095013A|2014-07-31|

---

WO2012087506A2|2012-06-28|

---

AU2011338134A1|2012-07-12|

---

US11213618B2|2022-01-04|

---

BR112013015915A2|2016-09-20|

---

US20150238666A1|2015-08-27|

引用文献:

---

公开号 | 申请日 | 公开日 | 申请人 | 专利标题

---

---

US2370529A|1942-04-21|1945-02-27|Fuller Katherine|Golf ball teeing device|

---

US2490409A|1947-10-03|1949-12-06|Paul H Brown|Golf practice target element|

---

US2738172A|1952-11-28|1956-03-13|Nat Dairy Res Lab Inc|Apparatus for treatment of products with ultrasonic energy|

---

US2961382A|1957-07-25|1960-11-22|Ortho Pharma Corp|Urokinase-a plasmiogen activator and methods of obtaining the same|

---

US2945496A|1958-08-18|1960-07-19|Fosdal Alfred|Dental instrument for immobilizing tissue|

---

US3129944A|1961-08-24|1964-04-21|Fuller Brush Co|Golf mat composed of a plurality of parallel brush strips|

---

US3324854A|1964-04-23|1967-06-13|Harry Swartz|Apparatus for facilitating the insertion of a hypodermic syringe needle|

---

US3590808A|1968-09-04|1971-07-06|Us Catheter & Instr Corp|Biopsy tool|

---

GB1216813A|1969-02-21|1970-12-23|Shozo Narusawa|Transcutaneous injection device|

---

US3735336A|1971-03-10|1973-05-22|Ampex|Acoustic lens|

---

US3964482A|1971-05-17|1976-06-22|Alza Corporation|Drug delivery device|

---

US4188952A|1973-12-28|1980-02-19|Loschilov Vladimir I|Surgical instrument for ultrasonic separation of biological tissue|

---

US3991763A|1975-04-17|1976-11-16|Arbrook, Inc.|Surgical evacuator|

---

CA1083040A|1976-02-09|1980-08-05|Mostafa Fahim|Topical application of medication by ultrasound with coupling agent|

---

US4309989A|1976-02-09|1982-01-12|The Curators Of The University Of Missouri|Topical application of medication by ultrasound with coupling agent|

---

US4150669A|1977-03-16|1979-04-24|Alvaro Latorre|Apparatus for effecting and enhancing an erection|

---

FR2405485B1|1977-10-07|1981-08-28|Thomson Csf|

---

DE2812729A1|1978-03-23|1979-09-27|Michael Becker|INJECTION DEVICE FOR INTRAMUSCULAR INJECTION, PRESENTLY OF INSULIN|

---

US4373458A|1978-07-14|1983-02-15|Usm Corporation|Method and machine for versatile stitching|

---

US4211949A|1978-11-08|1980-07-08|General Electric Company|Wear plate for piezoelectric ultrasonic transducer arrays|

---

US4248231A|1978-11-16|1981-02-03|Corning Glass Works|Surgical cutting instrument|

---

GB2047543B|1978-12-06|1983-04-20|Svedman Paul|Device for treating tissues for example skin|

---

US4276885A|1979-05-04|1981-07-07|Rasor Associates, Inc|Ultrasonic image enhancement|

---

US4249923A|1979-07-10|1981-02-10|Walda Kim L|Cardioplegic fluid refrigeration and delivery system|

---

US5022414A|1979-12-13|1991-06-11|Joseph J. Berke|Tissue separator method|

---

US4299219A|1979-12-17|1981-11-10|Norris Jr George P|Intravenous needle insertion device|

---

US4657756A|1980-11-17|1987-04-14|Schering Aktiengesellschaft|Microbubble precursors and apparatus for their production and use|

---

US4681119A|1980-11-17|1987-07-21|Schering Aktiengesellschaft|Method of production and use of microbubble precursors|

---

JPS57139358A|1981-02-23|1982-08-28|Hikari Ishii|Guide member for needle inserting direction|

---

US4688570A|1981-03-09|1987-08-25|The Regents Of The University Of California|Ophthalmologic surgical instrument|

---

DE3141641A1|1981-10-16|1983-04-28|Schering Ag, 1000 Berlin Und 4619 Bergkamen|ULTRASONIC CONTRAST AGENTS AND THEIR PRODUCTION|

---

US4497325A|1982-07-15|1985-02-05|Wedel Victor J|Ultrasound needle, biopsy instrument or catheter guide|

---

US4718433A|1983-01-27|1988-01-12|Feinstein Steven B|Contrast agents for ultrasonic imaging|

---

DE3313946A1|1983-04-15|1984-10-18|Schering AG, 1000 Berlin und 4709 Bergkamen|MICROPARTICLES AND GAS BUBBLES CONTAINING ULTRASONIC CONTRASTING AGENTS|

---

DE3313947A1|1983-04-15|1984-10-18|Schering AG, 1000 Berlin und 4709 Bergkamen|MICROPARTICLES AND GAS BUBBLES CONTAINING ULTRASONIC CONTRASTING AGENTS|

---

US4900540A|1983-06-20|1990-02-13|Trustees Of The University Of Massachusetts|Lipisomes containing gas for ultrasound detection|

---

US4536180A|1983-07-22|1985-08-20|Johnson Gerald W|Surgical instrument for suction lipolysis|

---

CH665127A5|1983-12-02|1988-04-29|Debiopharm Sa|COUPLING PART FOR INJECTION SYRINGES.|

---

US4549533A|1984-01-30|1985-10-29|University Of Illinois|Apparatus and method for generating and directing ultrasound|

---

DE3413744C2|1984-04-12|1986-08-28|Richard Wolf Gmbh, 7134 Knittlingen|Applicator for knotting sewing threads|

---

US4608043A|1984-06-22|1986-08-26|Abbott Laboratories|I.V. fluid storage and mixing system|

---

US4762915A|1985-01-18|1988-08-09|Liposome Technology, Inc.|Protein-liposome conjugates|

---

US4646754A|1985-02-19|1987-03-03|Seale Joseph B|Non-invasive determination of mechanical characteristics in the body|

---

US4689986A|1985-03-13|1987-09-01|The University Of Michigan|Variable frequency gas-bubble-manipulating apparatus and method|

---

NZ216003A|1985-05-06|1987-10-30|Phillips Pty Ltd N J|Pellet-implanting injector with indexing mechanism|

---

US4684479A|1985-08-14|1987-08-04|Arrigo Joseph S D|Surfactant mixtures, stable gas-in-liquid emulsions, and methods for the production of such emulsions from said mixtures|

---

US4751921A|1985-10-21|1988-06-21|University Of Iowa Research Foundation|Bone cement syringe|

---

US4797285A|1985-12-06|1989-01-10|Yissum Research And Development Company Of The Hebrew University Of Jerusalem|Lipsome/anthraquinone drug composition and method|

---

US4948587A|1986-07-08|1990-08-14|Massachusetts Institute Of Technology|Ultrasound enhancement of transbuccal drug delivery|

---

US4720075A|1986-07-28|1988-01-19|Buell Industries, Inc.|Shock isolating mount|

---

US4796624A|1986-11-19|1989-01-10|Concept, Inc.|Lashliner|

---

JPH0363913B2|1986-11-26|1991-10-03|Toshiro Tachibana|

---

US4844080A|1987-02-19|1989-07-04|Michael Frass|Ultrasound contact medium dispenser|

---

US4815462A|1987-04-06|1989-03-28|Clark Vickie J|Lipectomy device|

---

US5178433A|1987-06-12|1993-01-12|Frank Wagner|Vehicle body mount|

---

US5083568A|1987-06-30|1992-01-28|Yokogawa Medical Systems, Limited|Ultrasound diagnosing device|

---

US4936303A|1987-11-20|1990-06-26|Ultrathermics|Ultrasonic heating apparatus and method|

---

US5040537A|1987-11-24|1991-08-20|Hitachi, Ltd.|Method and apparatus for the measurement and medical treatment using an ultrasonic wave|

---

DE3741201A1|1987-12-02|1989-06-15|Schering Ag|ULTRASONIC PROCESS AND METHOD FOR IMPLEMENTING IT|

---

DE3741199C2|1987-12-02|1989-11-23|Schering Ag, 1000 Berlin Und 4709 Bergkamen, De|

---

US4844882A|1987-12-29|1989-07-04|Molecular Biosystems, Inc.|Concentrated stabilized microbubble-type ultrasonic imaging agent|

---

KR0133132B1|1988-02-05|1998-04-17|쉐링 아게, 베를린 운트 베르크카멘|Ultrasonic contrast agents, process for producing them and their use as diagnostics|

---

US5143063A|1988-02-09|1992-09-01|Fellner Donald G|Method of removing adipose tissue from the body|

---

US4886491A|1988-02-29|1989-12-12|Tulio Parisi|Liposuction procedure with ultrasonic probe|

---

DE3812816A1|1988-04-16|1989-11-02|Lawaczeck Ruediger Dipl Phys P|METHOD FOR SOLUBILIZING LIPOSOMES AND / OR BIOLOGICAL MEMBRANES AND THE USE THEREOF|

---

US5000172A|1988-05-05|1991-03-19|Smith & Nephew Plc|Dressing system with reference marks|

---

US4844470A|1988-06-06|1989-07-04|Ste-Mak, Inc.|Golf mat|

---

DE3819622A1|1988-06-09|1989-12-14|Daimler Benz Ag|PLASTIC SUCTION CUP|

---

US5158071A|1988-07-01|1992-10-27|Hitachi, Ltd.|Ultrasonic apparatus for therapeutical use|

---

US4920954A|1988-08-05|1990-05-01|Sonic Needle Corporation|Ultrasonic device for applying cavitation forces|

---

US5215104A|1988-08-16|1993-06-01|Steinert Roger F|Method for corneal modification|

---

US4957656A|1988-09-14|1990-09-18|Molecular Biosystems, Inc.|Continuous sonication method for preparing protein encapsulated microbubbles|

---

DE3838530A1|1988-11-14|1990-05-17|Hilti Ag|Packaging for two-component compounds|

---

US4900311A|1988-12-06|1990-02-13|Lawrence Stern|Hypodermic syringe|

---

JPH0445187B2|1988-12-29|1992-07-24|Toshiro Tachibana|

---

US5131600A|1989-02-13|1992-07-21|The Dow Chemical Company|Alkanol amine grinding aids|

---

FR2643252B1|1989-02-21|1991-06-07|Technomed Int Sa|APPARATUS FOR THE SELECTIVE DESTRUCTION OF CELLS INCLUDING SOFT TISSUES AND BONES WITHIN THE BODY OF A LIVING BODY BY IMPLOSION OF GAS BUBBLES|

---

US4936281A|1989-04-13|1990-06-26|Everest Medical Corporation|Ultrasonically enhanced RF ablation catheter|

---

US6193672B1|1993-05-11|2001-02-27|Mectra Labs, Inc.|Lavage|

---

US7422574B2|1995-05-19|2008-09-09|Applied Tissue Technologies, Llc|Microseeding device for gene delivery by microneedle injection|

---

US5585112A|1989-12-22|1996-12-17|Imarx Pharmaceutical Corp.|Method of preparing gas and gaseous precursor-filled microspheres|

---

US5088499A|1989-12-22|1992-02-18|Unger Evan C|Liposomes as contrast agents for ultrasonic imaging and methods for preparing the same|

---

US5733572A|1989-12-22|1998-03-31|Imarx Pharmaceutical Corp.|Gas and gaseous precursor filled microspheres as topical and subcutaneous delivery vehicles|

---

US5209720A|1989-12-22|1993-05-11|Unger Evan C|Methods for providing localized therapeutic heat to biological tissues and fluids using gas filled liposomes|

---

US5069664A|1990-01-25|1991-12-03|Inter Therapy, Inc.|Intravascular ultrasonic angioplasty probe|

---

US5050537A|1990-05-01|1991-09-24|Fox Harvey Z|Automatic animal feeding system|

---

US5203785A|1990-05-10|1993-04-20|Symbrosis Corporation|Laparoscopic hook scissors|

---

US5216130A|1990-05-17|1993-06-01|Albany Medical College|Complex for in-vivo target localization|

---

US5215680A|1990-07-10|1993-06-01|Cavitation-Control Technology, Inc.|Method for the production of medical-grade lipid-coated microbubbles, paramagnetic labeling of such microbubbles and therapeutic uses of microbubbles|

---

US5149319A|1990-09-11|1992-09-22|Unger Evan C|Methods for providing localized therapeutic heat to biological tissues and fluids|

---

DE69110656T2|1990-10-05|1995-11-09|Bracco Int Bv|METHOD FOR PRODUCING STABLE SUSPENSIONS FROM CAVES WITH GAS-FILLED MICROSPHERES FOR USE IN ULTRASOUND CHALOGRAPHY.|

---

US5100390A|1990-10-22|1992-03-31|Norma A. Lubeck|Lubeck spinal catheter needle|

---

WO1992008415A1|1990-11-09|1992-05-29|Arthrotek, Inc.|Surgical cutting instrument|

---

EP0513244A1|1990-11-30|1992-11-19|Michele Dr. Zocchi|Method and apparatus for treating human fat tissue|

---

EP0564567A1|1990-12-27|1993-10-13|Block Medical, Inc.|Closed system for iv site flush|

---

US5425580A|1990-12-28|1995-06-20|Byk Gulden Lomberg Chemische Fabrik Gmbh|Dosage form for micro-bubble echo contrast agents|

---

US6048337A|1992-01-07|2000-04-11|Principal Ab|Transdermal perfusion of fluids|

---

SE9101022D0|1991-01-09|1991-04-08|Paal Svedman|MEDICAL SUSPENSION DEVICE|

---

US5316000A|1991-03-05|1994-05-31|Technomed International |Use of at least one composite piezoelectric transducer in the manufacture of an ultrasonic therapy apparatus for applying therapy, in a body zone, in particular to concretions, to tissue, or to bones, of a living being and method of ultrasonic therapy|

---

CA2063529A1|1991-03-22|1992-09-23|Katsuro Tachibana|Booster for therapy of diseases with ultrasound and pharmaceutical liquid composition containing the same|

---

US5170604A|1991-08-21|1992-12-15|Tamer Industries, Inc.|Wall panel system and fastener therefor|

---

US5902272A|1992-01-07|1999-05-11|Arthrocare Corporation|Planar ablation probe and method for electrosurgical cutting and ablation|

---

US6770071B2|1995-06-07|2004-08-03|Arthrocare Corporation|Bladed electrosurgical probe|

---

US6896674B1|1993-05-10|2005-05-24|Arthrocare Corporation|Electrosurgical apparatus having digestion electrode and methods related thereto|

---

WO1993012742A1|1991-12-20|1993-07-08|Technomed International|Ultrasonic therapy apparatus delivering ultrasonic waves with thermal and cavitational effects|

---

US6436078B1|1994-12-06|2002-08-20|Pal Svedman|Transdermal perfusion of fluids|

---

JP3060690B2|1992-02-04|2000-07-10|富士通株式会社|Optical liquid level sensor|

---

JP2572823Y2|1992-02-13|1998-05-25|株式会社アドバンス|Simple blood sampler|

---

US5261922A|1992-02-20|1993-11-16|Hood Larry L|Improved ultrasonic knife|

---

US5695510A|1992-02-20|1997-12-09|Hood; Larry L.|Ultrasonic knife|

---

US5354307A|1992-04-06|1994-10-11|Porowski Jan S|Surgical means for removing a portion of a body|

---

DE9308460U1|1992-05-15|1993-09-16|Mauser Werke Gmbh|Plastic barrel|

---

US5383858B1|1992-08-17|1996-10-29|Medrad Inc|Front-loading medical injector and syringe for use therewith|

---

US5476368A|1992-08-20|1995-12-19|Ryder International Corporation|Sterile fluid pump diaphragm construction|

---

US5413574A|1992-09-04|1995-05-09|Fugo; Richard J.|Method of radiosurgery of the eye|

---

AU5457394A|1992-11-02|1994-05-24|Drexel University|Surfactant-stabilized microbubble mixtures, process for preparing and methods of using the same|

---

US5352221A|1992-11-04|1994-10-04|Fumich Robert M|Guide tip apparatus for laser surgery|

---

US5323642A|1993-01-26|1994-06-28|Todd Condon|Non-invasive testing apparatus for submersible timepieces|

---

DE4318237A1|1993-06-01|1994-12-08|Storz Medical Ag|Device for the treatment of biological tissue and body concretions|

---

EP1550464A1|1993-07-30|2005-07-06|IMCOR Pharmaceutical Co.|Stabilized microbubble composition for ultrasound|

---

US5419761A|1993-08-03|1995-05-30|Misonix, Inc.|Liposuction apparatus and associated method|

---

US5312364A|1993-08-06|1994-05-17|Pyng|Intraosseous infusion device|

---

US6280401B1|1993-08-23|2001-08-28|Sakharam D. Mahurkar|Hypodermic needle assembly|

---

US5449351A|1993-09-09|1995-09-12|Zohmann; Walter A.|Atraumatic needle for lumbar puncture|

---

FR2710962B1|1993-10-07|1995-11-24|Lpg Systems|Solenoid valve and new type of massage device using such a solenoid valve.|

---

US5409126A|1993-10-13|1995-04-25|Demars; Robert A.|Storage container with reversible lid|

---

US5601584A|1993-10-22|1997-02-11|Zein E. Obagi|Scalpel with integrated visual control aperture|

---

US5980517A|1995-08-15|1999-11-09|Rita Medical Systems, Inc.|Cell necrosis apparatus|

---

US20020169394A1|1993-11-15|2002-11-14|Eppstein Jonathan A.|Integrated tissue poration, fluid harvesting and analysis device, and method therefor|

---

US5997501A|1993-11-18|1999-12-07|Elan Corporation, Plc|Intradermal drug delivery device|

---

US5385561A|1994-01-18|1995-01-31|Bard International, Inc.|Apparatus and method for injecting a viscous material into the tissue of a patient|

---

US5437640A|1994-01-31|1995-08-01|Schwab; Louis|Apparatus and method for inserting hypodermic, tuberculin and other needles and for administering Mantoux tuberculin tests|

---

US5417654A|1994-02-02|1995-05-23|Alcon Laboratories, Inc.|Elongated curved cavitation-generating tip for disintegrating tissue|

---

DE4408108A1|1994-03-10|1995-09-14|Bavaria Med Tech|Catheter for injecting a fluid or a drug|

---

US5415160A|1994-03-15|1995-05-16|Ethicon, Inc.|Surgical lift method and apparatus|

---

US5507790A|1994-03-21|1996-04-16|Weiss; William V.|Method of non-invasive reduction of human site-specific subcutaneous fat tissue deposits by accelerated lipolysis metabolism|

---

US5649547A|1994-03-24|1997-07-22|Biopsys Medical, Inc.|Methods and devices for automated biopsy and collection of soft tissue|

---

US5457041A|1994-03-25|1995-10-10|Science Applications International Corporation|Needle array and method of introducing biological substances into living cells using the needle array|

---

JPH07265329A|1994-03-31|1995-10-17|Fuji Photo Optical Co Ltd|Puncture high frequency treatment device|

---

US6277116B1|1994-05-06|2001-08-21|Vidaderm|Systems and methods for shrinking collagen in the dermis|

---

US5458596A|1994-05-06|1995-10-17|Dorsal Orthopedic Corporation|Method and apparatus for controlled contraction of soft tissue|

---

US5496339A|1994-05-17|1996-03-05|Koepnick; Russell G.|Universal automated keratectomy apparatus and method|

---

JP3679143B2|1994-06-30|2005-08-03|株式会社ニデック|Perfusion suction device|

---

DE4426421A1|1994-07-26|1996-02-01|Heinz Hartmann|Process and device for the production of disperse systems, in particular ointments, creams, suspensions, emulsions, gels or pastes|

---

FR2723310B1|1994-08-05|1996-09-06|Lpg Systems|MASSAGE APPARATUS EXERCISING SUCTION AND MOBILIZATION OF SKIN TISSUE|

---

US5478315A|1994-08-08|1995-12-26|Brothers Family Investments, L.C.|Local anesthetic injection system|

---

US5509896A|1994-09-09|1996-04-23|Coraje, Inc.|Enhancement of thrombolysis with external ultrasound|

---

US5556406A|1994-09-12|1996-09-17|Medjet Inc.|Corneal template and surgical procedure for refractive vision correction|

---

US6397098B1|1994-09-21|2002-05-28|Medrad, Inc.|Data communication and control for medical imaging systems|

---

US5533981A|1994-10-06|1996-07-09|Baxter International Inc.|Syringe infusion pump having a syringe plunger sensor|

---

WO1997040679A1|1996-05-01|1997-11-06|Imarx Pharmaceutical Corp.|Methods for delivering compounds into a cell|

---

US5573497A|1994-11-30|1996-11-12|Technomed Medical Systems And Institut National|High-intensity ultrasound therapy method and apparatus with controlled cavitation effect and reduced side lobes|

---

US5522797A|1995-01-03|1996-06-04|Ivy Laboratories, Inc.|Slide action veterinary implanter|

---

US5573002A|1995-02-27|1996-11-12|Micro Chemical, Inc.|Method and apparatus for measuring internal tissue characteristics in feed animals|

---

US5797627A|1995-02-28|1998-08-25|Salter Labs|Swivel|

---

JP3016348B2|1995-03-23|2000-03-06|株式会社ニッショー|Double chamber container|

---

US5607441A|1995-03-24|1997-03-04|Ethicon Endo-Surgery, Inc.|Surgical dissector|

---

US5494038A|1995-04-25|1996-02-27|Abbott Laboratories|Apparatus for ultrasound testing|

---

GB9508606D0|1995-04-27|1995-06-14|Svedman Paul|Suction blister sampling|

---

US6461378B1|1995-05-05|2002-10-08|Thermage, Inc.|Apparatus for smoothing contour irregularities of skin surface|

---

US7452358B2|1996-01-05|2008-11-18|Thermage, Inc.|RF electrode assembly for handpiece|

---

US5755753A|1995-05-05|1998-05-26|Thermage, Inc.|Method for controlled contraction of collagen tissue|

---

US6350276B1|1996-01-05|2002-02-26|Thermage, Inc.|Tissue remodeling apparatus containing cooling fluid|

---

US5660836A|1995-05-05|1997-08-26|Knowlton; Edward W.|Method and apparatus for controlled contraction of collagen tissue|

---

US7473251B2|1996-01-05|2009-01-06|Thermage, Inc.|Methods for creating tissue effect utilizing electromagnetic energy and a reverse thermal gradient|

---

US6241753B1|1995-05-05|2001-06-05|Thermage, Inc.|Method for scar collagen formation and contraction|

---

US6425912B1|1995-05-05|2002-07-30|Thermage, Inc.|Method and apparatus for modifying skin surface and soft tissue structure|

---

US5855775A|1995-05-05|1999-01-05|Kerfoot; William B.|Microporous diffusion apparatus|

---

US5634911A|1995-05-19|1997-06-03|General Surgical Innovations, Inc.|Screw-type skin seal with inflatable membrane|

---

US20040167558A1|2000-07-26|2004-08-26|Igo Stephen R.|Method and apparatus for accessing the pericardial space|

---

US5827216A|1995-06-07|1998-10-27|Cormedics Corp.|Method and apparatus for accessing the pericardial space|

---

US5571131A|1995-06-07|1996-11-05|Smith & Nephew Endoscopy, Inc.|Back biting punch|

---

US6461350B1|1995-11-22|2002-10-08|Arthrocare Corporation|Systems and methods for electrosurgical-assisted lipectomy|

---

DE19525607A1|1995-07-14|1997-01-16|Boehringer Ingelheim Kg|Transcorneal drug delivery system|

---

US5562693A|1995-08-11|1996-10-08|Alcon Laboratories, Inc.|Cutting blade assembly for a surgical scissors|

---

US5983131A|1995-08-11|1999-11-09|Massachusetts Institute Of Technology|Apparatus and method for electroporation of tissue|

---

US5716326A|1995-08-14|1998-02-10|Dannan; Patrick A.|Method for lifting tissue and apparatus for performing same|

---

US5590657A|1995-11-06|1997-01-07|The Regents Of The University Of Michigan|Phased array ultrasound system and method for cardiac ablation|

---

US5817115A|1995-12-04|1998-10-06|Chiron Vision Corporation|Apparatus for resecting corneal tissue|

---

CA2246332C|1996-02-15|2009-04-14|Biosense, Inc.|Catheter based surgery|

---

US6852075B1|1996-02-20|2005-02-08|Cardiothoracic Systems, Inc.|Surgical devices for imposing a negative pressure to stabilize cardiac tissue during surgery|

---

US5778894A|1996-04-18|1998-07-14|Elizabeth Arden Co.|Method for reducing human body cellulite by treatment with pulsed electromagnetic energy|

---

IE80772B1|1996-06-10|1999-02-10|Elan Corp Plc|Delivery needle|

---

US5766198A|1996-06-10|1998-06-16|Li; Bing|Surgical knife employing a vacuum to ensure precise depth of incisions|

---

DE69719761T2|1996-06-18|2003-12-18|Alza Corp|DEVICE FOR IMPROVING THE TRANSDERMAL ADMINISTRATION OF MEDICINAL PRODUCTS OR THE DETECTION OF BODY LIQUIDS|

---

US5772688A|1996-06-20|1998-06-30|Polytronics, Ltd.|Skin-contact type medical treatment apparatus|

---

US5766164A|1996-07-03|1998-06-16|Eclipse Surgical Technologies, Inc.|Contiguous, branched transmyocardial revascularization channel, method and device|

---

US5942408A|1996-07-29|1999-08-24|Christensen; Dennis E.|Process challenge device and method|

---

FR2752159B1|1996-08-09|1998-09-11|Lpg Systems|MASSAGE APPARATUS EXERCISING SUCTION AND MOBILIZATION OF SKIN TISSUE|

---

CN1159908A|1996-10-12|1997-09-24|姜宪委|Tube for resection of soft tissue and device using the same|

---

WO1998018496A2|1996-10-28|1998-05-07|Nycomed Imaging As|Contrast agents|

---

US5817054A|1996-11-12|1998-10-06|Ivy Laboratories, Inc.|Veterinary implanter with disinfectant dispenser|

---

US5827204A|1996-11-26|1998-10-27|Grandia; Willem|Medical noninvasive operations using focused modulated high power ultrasound|

---

DE19708703C2|1997-02-24|2002-01-24|Co Don Ag|Surgical cutlery|

---

JP3036686B2|1997-02-27|2000-04-24|政夫 高橋|Hemostatic holding device for vascular anastomosis used for coronary artery bypass surgery|

---

US5911700A|1997-03-11|1999-06-15|Microaire Surgical Instruments|Power assisted liposuction and lipoinjection equipment|

---

US5792144A|1997-03-31|1998-08-11|Cathco, Inc.|Stent delivery catheter system|

---

US5884631A|1997-04-17|1999-03-23|Silberg; Barry|Body contouring technique and apparatus|

---

US5937906A|1997-05-06|1999-08-17|Kozyuk; Oleg V.|Method and apparatus for conducting sonochemical reactions and processes using hydrodynamic cavitation|

---

US5792140A|1997-05-15|1998-08-11|Irvine Biomedical, Inc.|Catheter having cooled multiple-needle electrode|

---

US5911703A|1997-05-22|1999-06-15|Avant Drug Delivery Systems, Inc.|Two-stage fluid medicament jet injector|

---

CA2319583C|1998-02-05|2007-08-07|Miwa Science Laboratory Inc.|Ultrasound sonication equipment|

---

US6537246B1|1997-06-18|2003-03-25|Imarx Therapeutics, Inc.|Oxygen delivery agents and uses for the same|

---

GB2327614B|1997-07-30|2002-03-06|Univ Dundee|A hypodermic needle|

---

FR2768051B1|1997-09-11|1999-10-08|Lpg Systems|MASSAGE APPARATUS EXERCISING SUCTION AND MOBILIZATION OF SKIN TISSUE|

---

US6128958A|1997-09-11|2000-10-10|The Regents Of The University Of Michigan|Phased array system architecture|

---

US6592552B1|1997-09-19|2003-07-15|Cecil C. Schmidt|Direct pericardial access device and method|

---

US5964776A|1997-09-24|1999-10-12|Peyman; Gholam A.|Internal keratome apparatus and method for using the same to form a pocket/flap between layers of a live cornea|

---

US6113558A|1997-09-29|2000-09-05|Angiosonics Inc.|Pulsed mode lysis method|

---

US5984915A|1997-10-08|1999-11-16|Trimedyne, Inc.|Percutaneous laser treatment|

---

US6176854B1|1997-10-08|2001-01-23|Robert Roy Cone|Percutaneous laser treatment|

---

US6071239A|1997-10-27|2000-06-06|Cribbs; Robert W.|Method and apparatus for lipolytic therapy using ultrasound energy|

---

US6375634B1|1997-11-19|2002-04-23|Oncology Innovations, Inc.|Apparatus and method to encapsulate, kill and remove malignancies, including selectively increasing absorption of x-rays and increasing free-radical damage to residual tumors targeted by ionizing and non-ionizing radiation therapy|

---

US6228099B1|1997-11-21|2001-05-08|Alexander Dybbs|Ophthalmic surgical system and method|

---

US6726650B2|1997-12-04|2004-04-27|Bracco Research S.A.|Automatic liquid injection system and method|

---

US20080027328A1|1997-12-29|2008-01-31|Julia Therapeutics, Llc|Multi-focal treatment of skin with acoustic energy|

---

WO1999033391A2|1997-12-31|1999-07-08|Pharmasonics, Inc.|Methods and systems for the inhibition of vascular hyperplasia|

---

IT1298087B1|1998-01-08|1999-12-20|Fiderm S R L|DEVICE TO CONTROL THE NEEDLE PENETRATION DEPTH, IN PARTICULAR APPLICABLE TO AN INJECTION SYRINGE|

---

DE19800416C2|1998-01-08|2002-09-19|Storz Karl Gmbh & Co Kg|Device for the treatment of body tissue, in particular soft tissue close to the surface, by means of ultrasound|

---

US6896659B2|1998-02-06|2005-05-24|Point Biomedical Corporation|Method for ultrasound triggered drug delivery using hollow microbubbles with controlled fragility|

---

CA2319433C|1998-02-09|2008-04-22|Bracco Research S.A.|Targeted delivery of biologically active media|

---

WO1999042138A1|1998-02-19|1999-08-26|University Of Virginia Patent Foundation|The use of bjerknes forces to manipulate contrast agents|

---

US6183442B1|1998-03-02|2001-02-06|Board Of Regents Of The University Of Texas System|Tissue penetrating device and methods for using same|

---

US6517498B1|1998-03-03|2003-02-11|Senorx, Inc.|Apparatus and method for tissue capture|

---

US6047215A|1998-03-06|2000-04-04|Sonique Surgical Systems, Inc.|Method and apparatus for electromagnetically assisted liposuction|

---

EP1066086B1|1998-03-27|2013-01-02|The General Hospital Corporation|Method and apparatus for the selective targeting of lipid-rich tissues|

---

US6039048A|1998-04-08|2000-03-21|Silberg; Barry|External ultrasound treatment of connective tissue|

---

US7625354B2|1998-04-10|2009-12-01|Milestone Scientific, Inc.|Handpiece for fluid administration apparatus|

---

EP0953432A1|1998-04-28|1999-11-03|Academisch Ziekenhuis Utrecht|Method and device for interconnecting two objects|

---

US6440121B1|1998-05-28|2002-08-27|Pearl Technology Holdings, Llc.|Surgical device for performing face-lifting surgery using radiofrequency energy|

---

JP4618964B2|1999-12-30|2011-01-26|パールテクノロジーホールディングスリミテッドライアビリティカンパニー|Facial wrinkle removal device|

---

US6432101B1|1998-05-28|2002-08-13|Pearl Technology Holdings, Llc|Surgical device for performing face-lifting using electromagnetic radiation|

---

US7494488B2|1998-05-28|2009-02-24|Pearl Technology Holdings, Llc|Facial tissue strengthening and tightening device and methods|

---

US6203540B1|1998-05-28|2001-03-20|Pearl I, Llc|Ultrasound and laser face-lift and bulbous lysing device|

---

US6391023B1|1998-05-28|2002-05-21|Pearl Technology Holdings, Llc|Thermal radiation facelift device|

---

JPH11343171A|1998-05-29|1999-12-14|Murata Mfg Co Ltd|Piezoelectric ceramic, its production and piezoelectric oscillator|

---

US5997499A|1998-06-04|1999-12-07|Alcon Laboratories, Inc.|Tip for a liquefaction handpiece|

---

US6080128A|1998-06-04|2000-06-27|Alcon Laboratories, Inc.|Liquefaction handpiece|

---

US6302863B1|1998-06-16|2001-10-16|Nikolai Tankovich|Method for removal of lipids via a perfluorocarbon tumescent solution|

---

US6315777B1|1998-07-07|2001-11-13|Medtronic, Inc.|Method and apparatus for creating a virtual electrode used for the ablation of tissue|

---

US6212433B1|1998-07-28|2001-04-03|Radiotherapeutics Corporation|Method for treating tumors near the surface of an organ|

---

US20030009153A1|1998-07-29|2003-01-09|Pharmasonics, Inc.|Ultrasonic enhancement of drug injection|

---

US6464680B1|1998-07-29|2002-10-15|Pharmasonics, Inc.|Ultrasonic enhancement of drug injection|

---

DE19835833A1|1998-08-07|2000-02-17|Max Planck Gesellschaft|Dosing head for parallel processing of a large number of fluid samples|

---

US6443914B1|1998-08-10|2002-09-03|Lysonix, Inc.|Apparatus and method for preventing and treating cellulite|

---

US6102887A|1998-08-11|2000-08-15|Biocardia, Inc.|Catheter drug delivery system and method for use|

---

US6599305B1|1998-08-12|2003-07-29|Vladimir Feingold|Intracorneal lens placement method and apparatus|

---

US6083236A|1998-08-12|2000-07-04|Feingold; Vladimir|Keratome method and apparatus|

---

US5993423A|1998-08-18|1999-11-30|Choi; Soo Bong|Portable automatic syringe device and injection needle unit thereof|

---

US7517348B2|1998-09-03|2009-04-14|Rubicor Medical, Inc.|Devices and methods for performing procedures on a breast|

---

US6402689B1|1998-09-30|2002-06-11|Sicel Technologies, Inc.|Methods, systems, and associated implantable devices for dynamic monitoring of physiological and biological properties of tumors|

---

EP1125121B1|1998-10-28|2007-12-12|Covaris, Inc.|Apparatus and methods for controlling sonic treatment|

---

US6287456B1|1998-10-30|2001-09-11|Kimberly-Clark Worldwide, Inc.|Filtration system with filtrate volume indicator|

---

US6214018B1|1998-11-04|2001-04-10|Trex Medical Corporation|Method and apparatus for removing tissue from a region of interest using stereotactic radiographic guidance|

---

AU1128600A|1998-11-20|2000-06-13|Joie P. Jones|Methods for selectively dissolving and removing materials using ultra-high frequency ultrasound|

---

US6254601B1|1998-12-08|2001-07-03|Hysterx, Inc.|Methods for occlusion of the uterine arteries|

---

US6309355B1|1998-12-22|2001-10-30|The Regents Of The University Of Michigan|Method and assembly for performing ultrasound surgery using cavitation|

---

JP2000190976A|1998-12-28|2000-07-11|Tsutomu Nagoya|Container having variable capacity for powdered material|

---

AU3209700A|1999-01-15|2000-08-01|Medjet, Inc.|Corneal microjet cutter with adjustable applanation template|

---

DE60022413T2|1999-03-03|2006-01-19|Nidek Co., Ltd., Gamagori|Operating device for the cornea|

---

DE60021063T2|1999-03-09|2006-05-11|Thermage, Inc., Hayward|TREATMENT FOR TREATMENT OF TISSUE|

---

US6575930B1|1999-03-12|2003-06-10|Medrad, Inc.|Agitation devices and dispensing systems incorporating such agitation devices|

---

US6162232A|1999-03-18|2000-12-19|Shadduck; John H.|Instruments and techniques for high-velocity fluid abrasion of epidermal layers with skin cooling|

---

US6042539A|1999-03-26|2000-03-28|Ethicon Endo-Surgery, Inc.|Vacuum-actuated tissue-lifting device and method|

---

US6454730B1|1999-04-02|2002-09-24|Misonix Incorporated|Thermal film ultrasonic dose indicator|

---

US7226446B1|1999-05-04|2007-06-05|Dinesh Mody|Surgical microwave ablation assembly|

---

US6319230B1|1999-05-07|2001-11-20|Scimed Life Systems, Inc.|Lateral needle injection apparatus and method|

---

US7315826B1|1999-05-27|2008-01-01|Accenture, Llp|Comparatively analyzing vendors of components required for a web-based architecture|

---

US6615166B1|1999-05-27|2003-09-02|Accenture Llp|Prioritizing components of a network framework required for implementation of technology|

---

US6957186B1|1999-05-27|2005-10-18|Accenture Llp|System method and article of manufacture for building, managing, and supporting various components of a system|

---

US6721713B1|1999-05-27|2004-04-13|Andersen Consulting Llp|Business alliance identification in a web architecture framework|

---

US20040200909A1|1999-05-28|2004-10-14|Cepheid|Apparatus and method for cell disruption|

---

US6366206B1|1999-06-02|2002-04-02|Ball Semiconductor, Inc.|Method and apparatus for attaching tags to medical and non-medical devices|

---

US6611707B1|1999-06-04|2003-08-26|Georgia Tech Research Corporation|Microneedle drug delivery device|

---

US6256533B1|1999-06-09|2001-07-03|The Procter & Gamble Company|Apparatus and method for using an intracutaneous microneedle array|

---

US6312612B1|1999-06-09|2001-11-06|The Procter & Gamble Company|Apparatus and method for manufacturing an intracutaneous microneedle array|

---

US6258056B1|1999-06-10|2001-07-10|Mark L. Anderson|Implanter apparatus|

---

US6117152A|1999-06-18|2000-09-12|Ethicon Endo-Surgery, Inc.|Multi-function ultrasonic surgical instrument|

---

US6155989A|1999-06-25|2000-12-05|The United States Of America As Represented By The United States Department Of Energy|Vacuum enhanced cutaneous biopsy instrument|

---

GB9915707D0|1999-07-05|1999-09-08|Young Michael J R|Method and apparatus for focused treatment of subcutaneous blood vessels|

---

US6430466B1|1999-08-23|2002-08-06|General Electric Company|System for controlling clamp pressure in an automatic molding machine|

---

US6237604B1|1999-09-07|2001-05-29|Scimed Life Systems, Inc.|Systems and methods for preventing automatic identification of re-used single use devices|

---

US6623457B1|1999-09-22|2003-09-23|Becton, Dickinson And Company|Method and apparatus for the transdermal administration of a substance|

---

US6659982B2|2000-05-08|2003-12-09|Sterling Medivations, Inc.|Micro infusion drug delivery device|

---

US6695781B2|1999-10-05|2004-02-24|Omnisonics Medical Technologies, Inc.|Ultrasonic medical device for tissue remodeling|

---

US20040158150A1|1999-10-05|2004-08-12|Omnisonics Medical Technologies, Inc.|Apparatus and method for an ultrasonic medical device for tissue remodeling|

---

US6391020B1|1999-10-06|2002-05-21|The Regents Of The Univerity Of Michigan|Photodisruptive laser nucleation and ultrasonically-driven cavitation of tissues and materials|

---

US6254614B1|1999-10-18|2001-07-03|Jerry M. Jesseph|Device and method for improved diagnosis and treatment of cancer|

---

US6230540B1|1999-10-19|2001-05-15|Meritor Heavy Vehicle Systems Llc|Method and apparatus for forming an integral bearing shoulder in a tubular axle|

---

US7678097B1|1999-11-12|2010-03-16|Baxter International Inc.|Containers and methods for manufacturing same|

---

US6511463B1|1999-11-18|2003-01-28|Jds Uniphase Corporation|Methods of fabricating microneedle arrays using sacrificial molds|

---

US6743211B1|1999-11-23|2004-06-01|Georgia Tech Research Corporation|Devices and methods for enhanced microneedle penetration of biological barriers|

---

US6325801B1|1999-12-04|2001-12-04|Karl Storz Gmbh & Co. Kg|Instrument for severing tissue with HF current|

---

AU1678000A|1999-12-15|2001-06-25|Tensor Technologies, Llc|Massage device|

---

AU3320001A|2000-01-31|2001-08-07|Univ Texas|Portable sensor array system|

---

US6663622B1|2000-02-11|2003-12-16|Iotek, Inc.|Surgical devices and methods for use in tissue ablation procedures|

---

US6582442B2|2000-02-28|2003-06-24|Dynatronics Corporation|Method and system for performing microabrasion|

---

JP3565758B2|2000-03-09|2004-09-15|株式会社日立製作所|Sensitizer for tumor treatment|

---

WO2001070117A2|2000-03-23|2001-09-27|Microheart, Inc.|Pressure sensor for therapeutic delivery device and method|

---

US6725095B2|2000-04-13|2004-04-20|Celsion Corporation|Thermotherapy method for treatment and prevention of cancer in male and female patients and cosmetic ablation of tissue|

---

US6514250B1|2000-04-27|2003-02-04|Medtronic, Inc.|Suction stabilized epicardial ablation devices|

---

US6629949B1|2000-05-08|2003-10-07|Sterling Medivations, Inc.|Micro infusion drug delivery device|

---

AU782964B2|2000-05-15|2005-09-15|Ares Trading S.A.|Injection device|

---

US6409665B1|2000-06-01|2002-06-25|Corey D. Scott|Apparatus for applying impedence matching fluid for ultrasonic imaging|

---

US6537242B1|2000-06-06|2003-03-25|Becton, Dickinson And Company|Method and apparatus for enhancing penetration of a member for the intradermal sampling or administration of a substance|

---

US6540675B2|2000-06-27|2003-04-01|Rosedale Medical, Inc.|Analyte monitor|

---

DE10030620A1|2000-06-28|2002-01-17|Karlsruhe Forschzent|Device for injecting medical preparations under CT / MRI control|

---

JP4454114B2|2000-06-30|2010-04-21|株式会社日立メディコ|Ultrasonic therapy device|

---

US6440096B1|2000-07-14|2002-08-27|Becton, Dickinson And Co.|Microdevice and method of manufacturing a microdevice|

---

US6273877B1|2000-07-20|2001-08-14|Becton, Dickinson And Company|Epidural needle with secondary bevel|

---

WO2002009575A2|2000-07-31|2002-02-07|Bionix Development Corporation|Method for controlling the pain from injections or minor surgical procedures and apparatus for use therewith|

---

JP4532823B2|2000-08-18|2010-08-25|ベクトン・ディキンソン・アンド・カンパニー|Constant velocity fluid delivery device with bolus button that allows selection of flow rate and titration|

---

GB2366286A|2000-08-29|2002-03-06|Almedica Europ Ltd|Blister pack|

---

US6910671B1|2000-09-06|2005-06-28|Illinois Tool Works Inc.|Shock mount assembly with polymeric thimble tube|

---

DE20016945U1|2000-09-30|2002-02-14|Braun Melsungen Ag|withdrawal spike|

---

US6882884B1|2000-10-13|2005-04-19|Soundskin, L.L.C.|Process for the stimulation of production of extracellular dermal proteins in human tissue|

---

AT448742T|2000-10-25|2009-12-15|Kyphon Inc|SYSTEMS FOR THE REPOSITION OF BROKEN BONE BY MEANS OF A CANNULA FOR THE REPONATION OF BONE FRACTURES|

---

US6629983B1|2000-10-27|2003-10-07|Edge Systems Corporation|Apparatus and method for skin/surface abrasion|

---

US20040006566A1|2000-11-07|2004-01-08|Matt Taylor|System and method for augmenting knowledge commerce|

---

US6821274B2|2001-03-07|2004-11-23|Gendel Ltd.|Ultrasound therapy for selective cell ablation|

---

US6645162B2|2000-12-27|2003-11-11|Insightec - Txsonics Ltd.|Systems and methods for ultrasound assisted lipolysis|

---

US6626854B2|2000-12-27|2003-09-30|Insightec - Txsonics Ltd.|Systems and methods for ultrasound assisted lipolysis|

---

JP4727903B2|2001-01-03|2011-07-20|ウルトラシェイプリミティド|Non-invasive ultrasound body contouring|

---

US6607498B2|2001-01-03|2003-08-19|Uitra Shape, Inc.|Method and apparatus for non-invasive body contouring by lysing adipose tissue|

---

US20020099356A1|2001-01-19|2002-07-25|Unger Evan C.|Transmembrane transport apparatus and method|

---

US6826429B2|2001-01-19|2004-11-30|Dynatronics Corporation|Interferential current treatment apparatus|

---

US6514220B2|2001-01-25|2003-02-04|Walnut Technologies|Non focussed method of exciting and controlling acoustic fields in animal body parts|

---

US6795728B2|2001-08-17|2004-09-21|Minnesota Medical Physics, Llc|Apparatus and method for reducing subcutaneous fat deposits by electroporation|

---

US6892099B2|2001-02-08|2005-05-10|Minnesota Medical Physics, Llc|Apparatus and method for reducing subcutaneous fat deposits, virtual face lift and body sculpturing by electroporation|

---

JP4588977B2|2001-02-28|2010-12-01|レックスメディカルリミテッドパートナーシップ|Device for supplying ablation fluid to treat neoplasm|

---

US7087040B2|2001-02-28|2006-08-08|Rex Medical, L.P.|Apparatus for delivering ablation fluid to treat lesions|

---

US7422586B2|2001-02-28|2008-09-09|Angiodynamics, Inc.|Tissue surface treatment apparatus and method|

---

US6605079B2|2001-03-02|2003-08-12|Erchonia Patent Holdings, Llc|Method for performing lipoplasty using external laser radiation|

---

US20020177846A1|2001-03-06|2002-11-28|Mulier Peter M.J.|Vaporous delivery of thermal energy to tissue sites|

---

US6663820B2|2001-03-14|2003-12-16|The Procter & Gamble Company|Method of manufacturing microneedle structures using soft lithography and photolithography|

---

US20020130126A1|2001-03-19|2002-09-19|Rosenberg Mark L.|Variable-length, multi-sectioned container|

---

FR2822664B1|2001-03-27|2004-07-02|Saint Gobain|SHELF FOR THE SUPPORT OF ARTICLES, ESPECIALLY IN REFRIGERATED PLANTS|

---

US7083580B2|2001-04-06|2006-08-01|Mattioli Engineering Ltd.|Method and apparatus for skin absorption enhancement and transdermal drug delivery|

---

US6687537B2|2001-04-06|2004-02-03|Mattioli Engineering Ltd.|Method and apparatus for skin absorption enhancement and cellulite reduction|

---

US6743215B2|2001-04-06|2004-06-01|Mattioli Engineering Ltd.|Method and apparatus for skin absorption enhancement and cellulite reduction|

---

US6969373B2|2001-04-13|2005-11-29|Tricardia, Llc|Syringe system|

---

WO2002087692A1|2001-04-26|2002-11-07|The Procter & Gamble Company|A method and apparatus for the treatment of cosmetic skin conditioins|

---

US20030092988A1|2001-05-29|2003-05-15|Makin Inder Raj S.|Staging medical treatment using ultrasound|

---

US6942169B2|2001-06-06|2005-09-13|Integrated Sensing Systems|Micromachined lysing device and method for performing cell lysis|

---

US7056331B2|2001-06-29|2006-06-06|Quill Medical, Inc.|Suture method|

---

ITFI20010133A1|2001-07-13|2003-01-13|El En Spa|ANTI-CELLULITE EQUIPMENT WITH COMPOSITE TECHNIQUES|

---

WO2004066899A2|2003-01-24|2004-08-12|Engii Ltd.|System and method for face and body treatment|

---

AU2002326781A1|2001-08-29|2003-03-18|Artemis Medical, Inc.|Undamaged tissue collection assembly and method|

---

CN100450456C|2001-09-28|2009-01-14|锐达医疗系统公司|Impedance controlled tissue ablation apparatus and method|

---

US6689100B2|2001-10-05|2004-02-10|Becton, Dickinson And Company|Microdevice and method of delivering or withdrawing a substance through the skin of an animal|

---

US6795727B2|2001-10-17|2004-09-21|Pedro Giammarusti|Devices and methods for promoting transcutaneous movement of substances|

---

US7429258B2|2001-10-26|2008-09-30|Massachusetts Institute Of Technology|Microneedle transport device|

---

US7347855B2|2001-10-29|2008-03-25|Ultrashape Ltd.|Non-invasive ultrasonic body contouring|

---

US6920883B2|2001-11-08|2005-07-26|Arthrocare Corporation|Methods and apparatus for skin treatment|

---

US6916328B2|2001-11-15|2005-07-12|Expanding Concepts, L.L.C|Percutaneous cellulite removal system|

---

US6889090B2|2001-11-20|2005-05-03|Syneron Medical Ltd.|System and method for skin treatment using electrical current|

---

WO2003047689A1|2001-11-29|2003-06-12|Microlin Llc|Apparatus and methods for fluid delivery using electroactive needles and implantable electrochemical delivery devices|

---

US7937281B2|2001-12-07|2011-05-03|Accenture Global Services Limited|Accelerated process improvement framework|

---

JP2006289098A|2005-04-12|2006-10-26|Inolase 2002 Ltd|Apparatus for vacuum-assisted light-based treatment of skin|

---

US7740600B2|2002-08-02|2010-06-22|Candela Corporation|Apparatus and method for inhibiting pain signals transmitted during a skin related medical treatment|

---

US7935139B2|2001-12-10|2011-05-03|Candela Corporation|Eye safe dermatological phototherapy|

---

US7762965B2|2001-12-10|2010-07-27|Candela Corporation|Method and apparatus for vacuum-assisted light-based treatments of the skin|

---

US7762964B2|2001-12-10|2010-07-27|Candela Corporation|Method and apparatus for improving safety during exposure to a monochromatic light source|

---

EP1627662B1|2004-06-10|2011-03-02|Candela Corporation|Apparatus for vacuum-assisted light-based treatments of the skin|

---

JP4398252B2|2001-12-10|2010-01-13|イノレーズ２００２リミテッド|Method and apparatus for improving safety while exposed to a monochromatic light source|

---

US6829510B2|2001-12-18|2004-12-07|Ness Neuromuscular Electrical Stimulation Systems Ltd.|Surface neuroprosthetic device having an internal cushion interface system|

---

US20030130628A1|2002-01-08|2003-07-10|Duffy David M.|Method and apparatus for the treatment of scar tissue and wrinkles|

---

US20030139740A1|2002-01-22|2003-07-24|Syneron Medical Ltd.|System and method for treating skin|

---

US20030153905A1|2002-01-25|2003-08-14|Edwards Stuart Denzil|Selective ablation system|

---

DE60313586T2|2002-02-06|2008-01-31|The University Of Akron, Akron|TEMPERATURE DISPLAY WITH THERMOCHROMICAL MATERIALS|

---

EP1476080A4|2002-02-20|2010-06-02|Medicis Technologies Corp|Ultrasonic treatment and imaging of adipose tissue|

---

GB0204640D0|2002-02-27|2002-04-10|Torsana Diabetes Diagnostics A|Injection apparatus|

---

US20030171701A1|2002-03-06|2003-09-11|Eilaz Babaev|Ultrasonic method and device for lypolytic therapy|

---

EP2319578B1|2002-03-11|2016-11-02|Nitto Denko Corporation|Transdermal drug delievery patch system, method of making same and method of using same|

---

BR0308642A|2002-03-15|2005-01-18|Gen Hospital Corp|Methods and device for selective disruption of lipid-rich cells by controlled cooling|

---

US6662054B2|2002-03-26|2003-12-09|Syneron Medical Ltd.|Method and system for treating skin|

---

US20030187371A1|2002-03-27|2003-10-02|Insightec-Txsonics Ltd.|Systems and methods for enhanced focused ultrasound ablation using microbubbles|

---

US7115108B2|2002-04-02|2006-10-03|Becton, Dickinson And Company|Method and device for intradermally delivering a substance|

---

US6780171B2|2002-04-02|2004-08-24|Becton, Dickinson And Company|Intradermal delivery device|

---

CN1655834A|2002-05-06|2005-08-17|贝克顿·迪金森公司|Method and device for controlling drug pharmacokinetics|

---

US20030212350A1|2002-05-13|2003-11-13|Mark Tadlock|Apparatus and method for treating scar tissue|

---

US7828827B2|2002-05-24|2010-11-09|Corium International, Inc.|Method of exfoliation of skin using closely-packed microstructures|

---

US6994699B2|2002-06-12|2006-02-07|Baxter International Inc.|Port, a container and a method for accessing a port|

---

AU2002345319B2|2002-06-25|2008-03-06|Ultrashape Ltd.|Devices and methodologies useful in body aesthetics|

---

US7442192B2|2002-07-14|2008-10-28|Knowlton Edward W|Method and apparatus for surgical dissection|

---

US7250047B2|2002-08-16|2007-07-31|Lumenis Ltd.|System and method for treating tissue|

---

AU2003244171B2|2002-09-09|2007-11-15|Fisher & Paykel Healthcare Limited|Limb for Breathing Circuit|

---

US7585281B2|2002-09-10|2009-09-08|Aragon Surgical, Inc.|Vacuum-actuated tissue perforation device for establishing pneumoperitoneum|

---

US7837687B2|2002-09-27|2010-11-23|Surgitech, Llc|Surgical assembly for tissue removal|

---

US20040120861A1|2002-10-11|2004-06-24|Affymetrix, Inc.|System and method for high-throughput processing of biological probe arrays|

---

US20040073144A1|2002-10-11|2004-04-15|Carava Alma Delia|Devices and methods for applying negative pressure to body surfaces|

---

US7175614B2|2002-10-17|2007-02-13|Baxter International Inc.|Peelable seal|

---

US20060264926A1|2002-11-08|2006-11-23|Kochamba Gary S|Cutaneous stabilization by vacuum for delivery of micro-needle array|

---

US6896666B2|2002-11-08|2005-05-24|Kochamba Family Trust|Cutaneous injection delivery under suction|

---

US7483738B2|2002-11-29|2009-01-27|Power Paper Ltd.|Combination stimulating and exothermic heating device and method of use thereof|

---

US7055683B2|2002-12-20|2006-06-06|E. I. Du Pont De Nemours And Company|Multiple compartment pouch and beverage container with smooth curve frangible seal|

---

EP1613229A2|2002-12-20|2006-01-11|Manoa Medical, Inc.|Systems and methods for cutting tissue|

---

US6837848B2|2003-01-15|2005-01-04|Medtronic, Inc.|Methods and apparatus for accessing and stabilizing an area of the heart|

---

WO2004069153A2|2003-01-27|2004-08-19|Medrad, Inc.|Apparatus, system and method for generating bubbles on demand|

---

US7374551B2|2003-02-19|2008-05-20|Pittsburgh Plastic Surgery Research Associates|Minimally invasive fat cavitation method|

---

US7252641B2|2003-02-25|2007-08-07|Ethicon Endo-Surgery, Inc.|Method of operating a biopsy device|

---

US6918907B2|2003-03-13|2005-07-19|Boston Scientific Scimed, Inc.|Surface electrode multiple mode operation|

---

JP4186020B2|2003-03-24|2008-11-26|株式会社メディコスヒラタ|Biopsy needle support device|

---

US9149322B2|2003-03-31|2015-10-06|Edward Wells Knowlton|Method for treatment of tissue|

---

US20040206365A1|2003-03-31|2004-10-21|Knowlton Edward Wells|Method for treatment of tissue|

---

US7273459B2|2003-03-31|2007-09-25|Liposonix, Inc.|Vortex transducer|

---

US7566318B2|2003-04-11|2009-07-28|Cardiac Pacemakers, Inc.|Ultrasonic subcutaneous dissection tool incorporating fluid delivery|

---

US7828744B2|2003-04-23|2010-11-09|Boston Scientific Scimed, Inc.|Method and assembly for breast immobilization|

---

US20040215110A1|2003-04-24|2004-10-28|Syneron Medical Ltd.|Method and device for adipose tissue treatment|

---

US7922735B2|2003-05-02|2011-04-12|Albert Daxer|Device for cutting the cornea of an eye|

---

US7223275B2|2003-05-27|2007-05-29|Yichieh Shiuey|System for cutting the cornea of an eye|

---

US6883729B2|2003-06-03|2005-04-26|Archimedes Technology Group, Inc.|High frequency ultrasonic nebulizer for hot liquids|

---

US20050137525A1|2003-06-04|2005-06-23|Georgia Tech Research Corporation|Drilling microneedle device|

---

US20050163711A1|2003-06-13|2005-07-28|Becton, Dickinson And Company, Inc.|Intra-dermal delivery of biologically active agents|

---

US20040251566A1|2003-06-13|2004-12-16|Kozyuk Oleg V.|Device and method for generating microbubbles in a liquid using hydrodynamic cavitation|

---

US20040253148A1|2003-06-16|2004-12-16|Leaton John R.|Multiple probe expansion accessory device for manual, semi-automated and automated liquid handling equipment federally sponsored research|

---

US20050033338A1|2003-06-19|2005-02-10|Ferree Bret A.|Surgical instruments particularly suited to severing ligaments and fibrous tissues|

---

US7479104B2|2003-07-08|2009-01-20|Maquet Cardiovascular, Llc|Organ manipulator apparatus|

---

NL1024012C2|2003-07-28|2005-02-01|Sara Lee De Nv|Packaging containing a gas and a liquid that can be worked up at least partially into a foam with which a consumption can be prepared.|

---

WO2005011804A2|2003-07-31|2005-02-10|Costantino Peter D|Ultasound treatment and imaging system|

---

WO2005025403A2|2003-09-08|2005-03-24|Board Of Trustees Of The University Of Arkansas|Ultrasound apparatus and method for augmented clot lysis|

---

US20050055018A1|2003-09-08|2005-03-10|Michael Kreindel|Method and device for sub-dermal tissue treatment|

---

JP4409239B2|2003-09-18|2010-02-03|テルモ株式会社|Chemical injection device|

---

US7588557B2|2003-09-24|2009-09-15|Granit-Medical Innovations, Llc|Medical instrument for fluid injection and related method|

---

US7169115B2|2003-09-29|2007-01-30|Ethicon Endo-Surgery, Inc.|Endoscopic mucosal resection device with overtube and method of use|

---

US7186252B2|2003-09-29|2007-03-06|Ethicon Endo-Surgery, Inc.|Endoscopic mucosal resection device and method of use|

---

US6994705B2|2003-09-29|2006-02-07|Ethicon-Endo Surgery, Inc.|Endoscopic mucosal resection device with conductive tissue stop|

---

US7379769B2|2003-09-30|2008-05-27|Sunnybrook Health Sciences Center|Hybrid imaging method to monitor medical device delivery and patient support for use in the method|

---

JP2007516809A|2003-12-30|2007-06-28|ライポソニックス，インコーポレイテッド|Ultrasonic transducer components|

---

US20050154309A1|2003-12-30|2005-07-14|Liposonix, Inc.|Medical device inline degasser|

---

US7857773B2|2003-12-30|2010-12-28|Medicis Technologies Corporation|Apparatus and methods for the destruction of adipose tissue|

---

US9254213B2|2004-01-09|2016-02-09|Rubicon Medical, Inc.|Stent delivery device|

---

US7351246B2|2004-01-20|2008-04-01|Epley John M|Minimally invasive, sustained, intra-tympanic drug delivery system|

---

DE602005007397D1|2004-03-01|2008-07-24|Terumo Corp|Device for introducing elongated medical goods|

---

JP2005245521A|2004-03-01|2005-09-15|Japan Natural Laboratory Co Ltd|Skin care or beauty system using ion introducer, ultrasonic wave facial treatment device, and cosmetic additives|

---

US20050194060A1|2004-03-03|2005-09-08|Vincent Houwaert|Peelable seal closure assembly|

---

US20050203497A1|2004-03-12|2005-09-15|Trevor Speeg|Medical apparatus and method useful for positioning energy delivery device|

---

US9345456B2|2004-03-24|2016-05-24|Devicor Medical Products, Inc.|Biopsy device|

---

US20050268703A1|2004-03-31|2005-12-08|Theodor Funck|Sample receptacle for ultrasonic measurements|

---

JP4865701B2|2004-04-23|2012-02-01|スプレスタエルエルシー|Method for alkylating phosphorus-containing compounds|

---

SE0401145D0|2004-04-30|2004-04-30|Mats Malmqvist|Continuous flow reaction vessel system|

---

US8092477B2|2004-05-13|2012-01-10|Umc Utrecht Holding B.V.|Device for making a cut in a tissue|

---

US20060036300A1|2004-08-16|2006-02-16|Syneron Medical Ltd.|Method for lypolisis|

---

US8409099B2|2004-08-26|2013-04-02|Insightec Ltd.|Focused ultrasound system for surrounding a body tissue mass and treatment method|

---

US7824348B2|2004-09-16|2010-11-02|Guided Therapy Systems, L.L.C.|System and method for variable depth ultrasound treatment|

---

US7530356B2|2004-10-06|2009-05-12|Guided Therapy Systems, Inc.|Method and system for noninvasive mastopexy|

---

US8133180B2|2004-10-06|2012-03-13|Guided Therapy Systems, L.L.C.|Method and system for treating cellulite|

---

US20060111744A1|2004-10-13|2006-05-25|Guided Therapy Systems, L.L.C.|Method and system for treatment of sweat glands|

---

KR101237395B1|2004-10-19|2013-02-27|메간 메디컬, 아이엔씨.|Method and means for electrical stimulation of cutaneous sensory receptors|

---

US7419798B2|2004-10-19|2008-09-02|Zybac Llc|Rapid and sensitive detection of bacteria in blood products, urine, and other fluids|

---

US20060094988A1|2004-10-28|2006-05-04|Tosaya Carol A|Ultrasonic apparatus and method for treating obesity or fat-deposits or for delivering cosmetic or other bodily therapy|

---

US7524318B2|2004-10-28|2009-04-28|Boston Scientific Scimed, Inc.|Ablation probe with flared electrodes|

---

WO2006052779A2|2004-11-05|2006-05-18|Cellutite, Llc|Apparatus and system for treating cellulite|

---

WO2006053588A1|2004-11-17|2006-05-26|Agilent Technologies, Inc.|Supply arrangement with supply reservoir element and fluidic device|

---

US20060122509A1|2004-11-24|2006-06-08|Liposonix, Inc.|System and methods for destroying adipose tissue|

---

US7470237B2|2005-01-10|2008-12-30|Ethicon Endo-Surgery, Inc.|Biopsy instrument with improved needle penetration|

---

DK2058020T3|2005-02-01|2013-01-07|Intelliject Inc|Device for administering drug|

---

EP1965748A4|2005-03-09|2009-11-11|Ronald Allan Greenberg|An apparatus and method of body contouring and skin conditioning|

---

US20060206040A1|2005-03-09|2006-09-14|Greenberg Ronald A| aparatus and method of body contouring and skin conditioning using a mobile suction device|

---

US7857775B2|2005-03-15|2010-12-28|Syneron Medical Ltd.|Method for soft tissue treatment|

---

US7985199B2|2005-03-17|2011-07-26|Unomedical A/S|Gateway system|

---

JP4793806B2|2005-03-22|2011-10-12|Ｔｔｉ・エルビュー株式会社|Iontophoresis device|

---

US20060235371A1|2005-04-07|2006-10-19|Shingo Wakamatsu|Microscopic-spots irradiating device applying a vacuum thereto|

---

EP1874197A4|2005-04-12|2010-02-10|Ekos Corp|Ultrasound catheter with cavitation promoting surface|

---

US20060241673A1|2005-04-21|2006-10-26|Zadini Filiberto P|Subcision device|

---

US20060241672A1|2005-04-21|2006-10-26|Zadini Filiberto P|Infra-epidermic subcision device for blunt dissection of sub-epidermic tissues|

---

US20070005091A1|2005-04-21|2007-01-04|Zadini Filiberto P|Infra-epidermic subcision device for blunt dissection of sub-epidermic tissues|

---

US8357146B2|2005-05-18|2013-01-22|Cooltouch Incorporated|Treatment of cellulite and adipose tissue with mid-infrared radiation|

---

US7217265B2|2005-05-18|2007-05-15|Cooltouch Incorporated|Treatment of cellulite with mid-infrared radiation|

---

US8276590B2|2005-05-18|2012-10-02|Cooltouch Incorporated|Thermally mediated tissue molding|

---

US8127771B2|2005-05-18|2012-03-06|Cooltouch Incorporated|Treatment of cellulite and adipose tissue with mid-infrared radiation|

---

US8256429B2|2005-05-18|2012-09-04|Cooltouch Incorporated|Treatment of cellulite and adipose tissue with mid-infrared radiation|

---

US7850683B2|2005-05-20|2010-12-14|Myoscience, Inc.|Subdermal cryogenic remodeling of muscles, nerves, connective tissue, and/or adipose tissue |

---

US8216254B2|2005-05-20|2012-07-10|Neotract, Inc.|Anchor delivery system with replaceable cartridge|

---

WO2006131840A2|2005-06-07|2006-12-14|Koninklijke Philips Electronics, N.V.|Method and apparatus for ultrasound drug delivery and thermal therapy with phase-convertible fluids|

---

US20070031482A1|2005-08-02|2007-02-08|Ceramoptec Industries, Ind.|PDT treatment method for cellulites and cosmetic use|

---

US7837626B2|2005-08-05|2010-11-23|Siemens Medical Solutions Usa, Inc.|Contrast agent manipulation with medical ultrasound imaging|

---

US7591996B2|2005-08-17|2009-09-22|University Of Washington|Ultrasound target vessel occlusion using microbubbles|

---

US9486274B2|2005-09-07|2016-11-08|Ulthera, Inc.|Dissection handpiece and method for reducing the appearance of cellulite|

---

US9358033B2|2005-09-07|2016-06-07|Ulthera, Inc.|Fluid-jet dissection system and method for reducing the appearance of cellulite|

---

CA2769813C|2009-08-07|2018-01-09|Cabochon Aesthetics, Inc.|Dissection handpiece and method for reducing the appearance of cellulite|

---

US8518069B2|2005-09-07|2013-08-27|Cabochon Aesthetics, Inc.|Dissection handpiece and method for reducing the appearance of cellulite|

---

AU2006287633A1|2005-09-07|2007-03-15|The Foundry, Inc.|Apparatus and method for disrupting subcutaneous structures|

---

US10548659B2|2006-01-17|2020-02-04|Ulthera, Inc.|High pressure pre-burst for improved fluid delivery|

---

US20080195036A1|2005-12-02|2008-08-14|Cabochon Aesthetics, Inc.|Devices and methods for selectively lysing cells|

---

US7967763B2|2005-09-07|2011-06-28|Cabochon Aesthetics, Inc.|Method for treating subcutaneous tissues|

---

US20080014627A1|2005-12-02|2008-01-17|Cabochon Aesthetics, Inc.|Devices and methods for selectively lysing cells|

---

US9011473B2|2005-09-07|2015-04-21|Ulthera, Inc.|Dissection handpiece and method for reducing the appearance of cellulite|

---

US9358064B2|2009-08-07|2016-06-07|Ulthera, Inc.|Handpiece and methods for performing subcutaneous surgery|

---

US20080200864A1|2005-12-02|2008-08-21|Cabochon Aesthetics, Inc.|Devices and methods for selectively lysing cells|

---

US8057408B2|2005-09-22|2011-11-15|The Regents Of The University Of Michigan|Pulsed cavitational ultrasound therapy|

---

JP2007097604A|2005-09-30|2007-04-19|Manii Kk|Medical knife|

---

WO2007052662A1|2005-10-31|2007-05-10|Terumo Kabushiki Kaisha|Puncture device, dosing device and puncture method|

---

US20070156096A1|2005-11-10|2007-07-05|Terumo Kabushiki Kaisha|Puncture device|

---

US7842008B2|2005-11-21|2010-11-30|Becton, Dickinson And Company|Intradermal delivery device|

---

US20080319358A1|2005-12-02|2008-12-25|Chuen Jeou Day Enterprise Co., Ltd|Massage Tool|

---

WO2007070850A2|2005-12-14|2007-06-21|Organogenesis, Inc.|Skin care compositions and treatments|

---

DE102005061359A1|2005-12-21|2007-07-05|Siemens Ag|Object e.g. heart, movement analysis implementing method for diagnosing heart disease, involves computing divergence value from vector field which is formed from displacement vectors for analysis of movement of object|

---

US20070197917A1|2005-12-22|2007-08-23|Bagge Jan P|Continuous-focus ultrasound lens|

---

KR20080107374A|2006-01-17|2008-12-10|엔디미온 메디칼 리미티드|Electrosurgical methods and devices employing phase-controlled radiofrequency energy|

---

US8133191B2|2006-02-16|2012-03-13|Syneron Medical Ltd.|Method and apparatus for treatment of adipose tissue|

---

US9107798B2|2006-03-09|2015-08-18|Slender Medical Ltd.|Method and system for lipolysis and body contouring|

---

US7351295B2|2006-03-23|2008-04-01|Pp6 Industries Ohio, Inc.|Cleaning and polishing rusted iron-containing surfaces|

---

US20070255355A1|2006-04-06|2007-11-01|Palomar Medical Technologies, Inc.|Apparatus and method for skin treatment with compression and decompression|

---

JP2009533091A|2006-04-07|2009-09-17|ザジェネラルホスピタルコーポレイション|Method and apparatus for selective treatment of biological tissue using ultrasonic energy|

---

US20090270789A1|2006-04-14|2009-10-29|Maxymiv George W|Suction dome for atraumatically grasping or manipulating tissue|

---

WO2007124411A1|2006-04-20|2007-11-01|3M Innovative Properties Company|Device for applying a microneedle array|

---

US20070282318A1|2006-05-16|2007-12-06|Spooner Gregory J|Subcutaneous thermolipolysis using radiofrequency energy|

---

US20070270745A1|2006-05-18|2007-11-22|Camran Nezhat|Vacuum actuated tissue lifting device|

---

EP2049173A4|2006-08-01|2013-09-11|Agency Science Tech & Res|Ultrasonic enhanced microneedles|

---

US7789857B2|2006-08-23|2010-09-07|Medtronic Minimed, Inc.|Infusion medium delivery system, device and method with needle inserter and needle inserter device and method|

---

US20080058851A1|2006-09-01|2008-03-06|Edelstein Peter Seth|Method and apparatus for assisting in the introduction of surgical implements into a body|

---

US20080058603A1|2006-09-01|2008-03-06|Edelstein Peter S|Method and Apparatus for Assisting in the Introduction of Surgical Implements into a Body|

---

US20080262527A1|2006-09-01|2008-10-23|Joseph Charles Eder|Method and apparatus for assisting in the introduction of surgical implements into a body|

---

US7559905B2|2006-09-21|2009-07-14|Focus Surgery, Inc.|HIFU probe for treating tissue with in-line degassing of fluid|

---

US8273080B2|2006-10-16|2012-09-25|Syneron Medical Ltd.|Methods and devices for treating tissue|

---

US8257338B2|2006-10-27|2012-09-04|Artenga, Inc.|Medical microbubble generation|

---

AU2007313633A1|2006-10-31|2008-05-08|Zeltiq Aesthetics, Inc.|Method and apparatus for cooling subcutaneous lipid-rich cells or tissue|

---

US20080172012A1|2006-10-31|2008-07-17|Hiniduma-Lokuge Prasanga D|Injection needle having lateral delivery ports and method for the manufacture thereof|

---

US20080109023A1|2006-11-03|2008-05-08|Greer Steven E|Method and apparatus for altering the appearance of a patient's skin|

---

US20080147084A1|2006-12-07|2008-06-19|Baxano, Inc.|Tissue removal devices and methods|

---

US20100106064A1|2007-03-19|2010-04-29|Syneron Medical Ltd.|Method and device for soft tissue destruction|

---

CN101711134B|2007-04-19|2016-08-17|米勒玛尔实验室公司|Tissue is applied the system of microwave energy and in organized layer, produces the system of tissue effect|

---

EP2532320A3|2007-04-19|2013-04-03|Miramar Labs, Inc.|Apparatus for reducing sweat production|

---

ES2471971T3|2007-12-12|2014-06-27|Miramar Labs, Inc.|System and apparatus for non-invasive treatment of tissue using microwave energy|

---

JP5249204B2|2007-04-27|2013-07-31|テルモ株式会社|Puncture device|

---

WO2008136845A2|2007-04-30|2008-11-13|Medtronic Minimed, Inc.|Reservoir filling, bubble management, and infusion medium delivery systems and methods with same|

---

US8323250B2|2007-04-30|2012-12-04|Medtronic Minimed, Inc.|Adhesive patch systems and methods|

---

WO2008139303A2|2007-05-10|2008-11-20|Cadila Pharmaceuticals Ltd.|A novel device for intradermal injection|

---

JP5215591B2|2007-05-18|2013-06-19|Ｎｔｎ株式会社|Grease-filled bearing for inverter drive motor|

---

US7885793B2|2007-05-22|2011-02-08|International Business Machines Corporation|Method and system for developing a conceptual model to facilitate generating a business-aligned information technology solution|

---

US8845630B2|2007-06-15|2014-09-30|Syneron Medical Ltd|Devices and methods for percutaneous energy delivery|

---

US20090012434A1|2007-07-03|2009-01-08|Anderson Robert S|Apparatus, method, and system to treat a volume of skin|

---

US8758366B2|2007-07-09|2014-06-24|Neotract, Inc.|Multi-actuating trigger anchor delivery system|

---

US20090018522A1|2007-07-10|2009-01-15|Anima Ventures Ltd.|Tissue modification by targeted delivery of heat|

---

US8103355B2|2007-07-16|2012-01-24|Invasix Ltd|Method and device for minimally invasive skin and fat treatment|

---

US8568339B2|2007-08-16|2013-10-29|Ultrashape Ltd.|Single element ultrasound transducer with multiple driving circuits|

---

US7740651B2|2007-09-28|2010-06-22|Candela Corporation|Vacuum assisted treatment of the skin|

---

US20090093864A1|2007-10-08|2009-04-09|Anderson Robert S|Methods and devices for applying energy to tissue|

---

US20090124973A1|2007-11-09|2009-05-14|D Agostino Eduardo|Insertion mechanism for use with a syringe|

---

US20090125013A1|2007-11-13|2009-05-14|Roza Sypniewski|Fat retraction apparatus and method for using same|

---

US20090156958A1|2007-12-12|2009-06-18|Mehta Bankim H|Devices and methods for percutaneous energy delivery|

---

US20090171255A1|2007-12-27|2009-07-02|Andrey Rybyanets|Apparatus and method for ultrasound treatment|

---

CN201131982Y|2007-12-31|2008-10-15|邱兆芳|Syringe needle for adding medicine|

---

MX2010007407A|2008-01-24|2010-08-16|Syneron Medical Ltd|A device, apparatus, and method of adipose tissue treatment.|

---

US8489172B2|2008-01-25|2013-07-16|Kardium Inc.|Liposuction system|

---

US20090248004A1|2008-02-28|2009-10-01|Palomar Medical Technologies, Inc.|Systems and methods for treatment of soft tissue|

---

US8369942B2|2008-03-20|2013-02-05|The Invention Science Fund I, Llc|Subdermal material delivery device|

---

US8197504B2|2008-05-01|2012-06-12|Ethicon Endo-Surgery, Inc.|Safe tissue puncture device|

---

US7850667B2|2008-06-27|2010-12-14|Tyco Healthcare Group Lp|Low profile instrument access device|

---

US20100004536A1|2008-07-03|2010-01-07|Avner Rosenberg|Method and apparatus for ultrasound tissue treatment|

---

US8882753B2|2008-07-14|2014-11-11|Syneron Medical Ltd|Devices and methods for percutaneous energy delivery|

---

US8868204B2|2008-07-15|2014-10-21|Venus Technologies LTD.|Esthetic device useful for increasing skin beautification and methods thereof|

---

US20100017750A1|2008-07-16|2010-01-21|Avner Rosenberg|User interface|

---

CA2731435A1|2008-07-21|2010-01-28|Arstasis, Inc.|Devices, methods, and kits for forming tracts in tissue|

---

US20100022999A1|2008-07-24|2010-01-28|Gollnick David A|Symmetrical rf electrosurgical system and methods|

---

WO2010020021A2|2008-08-21|2010-02-25|Samir Antonio Elias Arbache|Laser intradermal therapy procedure|

---

US8652123B2|2008-09-02|2014-02-18|Geoffrey C. GURTNER|Methods and devices for improving the appearance of tissue|

---

WO2010029529A1|2008-09-11|2010-03-18|Syneron Medical Ltd.|A device, apparatus, and method of adipose tissue treatment|

---

US8425410B2|2008-09-30|2013-04-23|Ethicon Endo-Surgery, Inc.|Surgical access device with protective element|

---

WO2010070628A1|2008-12-19|2010-06-24|Janisys Limited|A fluid transfer device and an active substance cartridge for the fluid transfer device, and a method for controlling the pressure at which an active substance is delivered to a subject from a fluid transfer device|

---

EP2382010A4|2008-12-24|2014-05-14|Guided Therapy Systems Llc|Methods and systems for fat reduction and/or cellulite treatment|

---

US8882758B2|2009-01-09|2014-11-11|Solta Medical, Inc.|Tissue treatment apparatus and systems with pain mitigation and methods for mitigating pain during tissue treatments|

---

EP2218404B1|2009-02-13|2018-09-05|Fondazione Istituto Italiano Di Tecnologia|A surgical lift device to assist in surgical access through skin, tissue and organs|

---

US8540705B2|2009-03-05|2013-09-24|Syneron Medical Ltd.|Devices and methods for percutaneous energy delivery|

---

US8357150B2|2009-07-20|2013-01-22|Syneron Medical Ltd.|Method and apparatus for fractional skin treatment|

---

JP2013508065A|2009-10-24|2013-03-07|シネロンメディカルリミテッド|Method and apparatus for real-time monitoring of organizational layers|

---

EP2558006A4|2010-04-12|2013-09-04|Life Care Medical Devices Ltd|A device and method for lifting abdominal wall during medical procedure|

---

US8676338B2|2010-07-20|2014-03-18|Zeltiq Aesthetics, Inc.|Combined modality treatment systems, methods and apparatus for body contouring applications|

---

FI123981B|2010-12-01|2014-01-15|Hld Healthy Life Devices Oy|Pulse massage apparatus|

---

DE102010062449A1|2010-12-06|2012-06-06|Werner THOMAS|Device for at least partially closing an opening of a room|

---

US8439940B2|2010-12-22|2013-05-14|Cabochon Aesthetics, Inc.|Dissection handpiece with aspiration means for reducing the appearance of cellulite|

---

US9314301B2|2011-08-01|2016-04-19|Miramar Labs, Inc.|Applicator and tissue interface module for dermatological device|

---

CN104114115B|2011-10-17|2017-02-22|声外科技术有限公司|ultrasonic probe for treating cellulite|

---

US9867996B2|2011-11-16|2018-01-16|Btl Holdings Limited|Methods and systems for skin treatment|

---

WO2014097288A2|2012-12-21|2014-06-26|Syneron Medical Ltd.|Large area body shaping applicator|

---

EP2869777A2|2012-07-09|2015-05-13|Koninklijke Philips N.V.|Method and apparatus for treating a skin tissue|

---

EP2802281B1|2012-07-09|2015-07-01|Koninklijke Philips N.V.|Skin treatment method and apparatus|

---

US20140025050A1|2012-07-18|2014-01-23|Theradyme, Inc.|Vacuum suction pressure device equipped with heat enabled insert|

---

FR2997013B1|2012-10-19|2016-02-05|Oreal|METHOD AND APPARATUS FOR MASSAGE OF THE SKIN BY SUCTION AND PALPER-ROLL|

---

CN105377211B|2013-01-13|2018-02-23|赛诺龙医疗公司|Equipment for generating pressure pulse in tissue|

---

US20150366611A1|2013-03-14|2015-12-24|Syneron Medical Ltd|Skin treatment apparatus|

---

US20140276693A1|2013-03-15|2014-09-18|Palomar Medical Technologies, Llc|Treatment of tissue|

---

US10117892B2|2013-08-29|2018-11-06|Allergan, Inc.|Devices and methods for reducing the appearance of cellulite|US7856985B2|2005-04-22|2010-12-28|Cynosure, Inc.|Method of treatment body tissue using a non-uniform laser beam|

---

US9358033B2|2005-09-07|2016-06-07|Ulthera, Inc.|Fluid-jet dissection system and method for reducing the appearance of cellulite|

---

US9358064B2|2009-08-07|2016-06-07|Ulthera, Inc.|Handpiece and methods for performing subcutaneous surgery|

---

US8518069B2|2005-09-07|2013-08-27|Cabochon Aesthetics, Inc.|Dissection handpiece and method for reducing the appearance of cellulite|

---

US9011473B2|2005-09-07|2015-04-21|Ulthera, Inc.|Dissection handpiece and method for reducing the appearance of cellulite|

---

US9248317B2|2005-12-02|2016-02-02|Ulthera, Inc.|Devices and methods for selectively lysing cells|

---

US11096708B2|2009-08-07|2021-08-24|Ulthera, Inc.|Devices and methods for performing subcutaneous surgery|

---

US9486274B2|2005-09-07|2016-11-08|Ulthera, Inc.|Dissection handpiece and method for reducing the appearance of cellulite|

---

US10548659B2|2006-01-17|2020-02-04|Ulthera, Inc.|High pressure pre-burst for improved fluid delivery|

---

US7586957B2|2006-08-02|2009-09-08|Cynosure, Inc|Picosecond laser apparatus and methods for its operation and use|

---

US7885793B2|2007-05-22|2011-02-08|International Business Machines Corporation|Method and system for developing a conceptual model to facilitate generating a business-aligned information technology solution|

---

WO2010102246A1|2009-03-05|2010-09-10|Cynosure, Inc.|Thermal surgery safety apparatus and method|

---

US8439940B2|2010-12-22|2013-05-14|Cabochon Aesthetics, Inc.|Dissection handpiece with aspiration means for reducing the appearance of cellulite|

---

US20120253339A1|2011-03-31|2012-10-04|Tyco Healthcare Group Lp|Radio frequency-based surgical implant fixation apparatus|

---

WO2012142473A1|2011-04-15|2012-10-18|University Of Massachusetts|Surgical cavity drainage and closure system|

---

US20140128823A1|2011-06-22|2014-05-08|Twin Star Medical, Inc.|System and method for treating compartment syndrome|

---

US9597149B2|2011-11-04|2017-03-21|Iogyn, Inc.|Tissue extraction devices and methods|

---

WO2013158299A1|2012-04-18|2013-10-24|Cynosure, Inc.|Picosecond laser apparatus and methods for treating target tissues with same|

---

US9700375B2|2012-06-30|2017-07-11|Rollins Enterprises, Llc|Laser NIL liposuction system and method|

---

EP3437575B1|2013-03-15|2021-04-21|Edge Systems LLC|Devices and systems for treating the skin|

---

US9375586B2|2013-03-15|2016-06-28|Pavel V. Efremkin|Apparatus and method for treatment of foot and nail diseases|

---

EP2973894A2|2013-03-15|2016-01-20|Cynosure, Inc.|Picosecond optical radiation systems and methods of use|

---

US10117892B2|2013-08-29|2018-11-06|Allergan, Inc.|Devices and methods for reducing the appearance of cellulite|

---

WO2015047979A2|2013-09-24|2015-04-02|Brigham And Women's Hospital, Inc.|Systems and methods for preparing tissue flaps|

---

US10028762B1|2013-10-14|2018-07-24|Percutaneous Cosmetic Devices LLC|Method of cutting soft tissue under facial skin|

---

US20150285598A1|2014-04-02|2015-10-08|Michael Flynn|Dual Purpose Self-Defense Device|

---

WO2015188174A1|2014-06-07|2015-12-10|Cedar Farms Medical, LLC|Needle aponeurotomy apparatus and method|

---

US10179229B2|2014-12-23|2019-01-15|Edge Systems Llc|Devices and methods for treating the skin using a porous member|

---

WO2016182095A1|2015-05-11|2016-11-17|동국대학교 산학협력단|Automatic fat suction device|

---

US11241357B2|2015-07-08|2022-02-08|Edge Systems Llc|Devices, systems and methods for promoting hair growth|

---

WO2017027586A1|2015-08-10|2017-02-16|Indiana University Research And Technology Corporation|Device and method for scar subcision|

---

US10188777B2|2015-08-20|2019-01-29|Aurastem Llc|Liposuction device and system and use thereof|

---

US11253285B2|2016-04-04|2022-02-22|University Of Utah Research Foundation|Subcutaneous cutting device|

---

CN105997198B|2016-06-16|2018-06-29|黄河科技学院|Surgical operation Rotary Water fluidic device|

---

CN110536648A|2017-04-28|2019-12-03|奥拉斯泰姆有限责任公司|A kind of miniature fat suction needle instrument and its application method and production method|

---

CN107158566A|2017-06-30|2017-09-15|深圳半岛医疗有限公司|Radio frequency body-shaping treatment head and radio frequency body-shaping device|

---

NL2019458B1|2017-08-28|2019-03-11|Umc Utrecht Holding Bv|Device for making a cut in a tissue and method of using the device|

---

WO2020023406A1|2018-07-23|2020-01-30|Nc8, Inc.|Cellulite treatment system and methods|

---

CA3107347A1|2018-07-23|2020-01-30|Nc8, Inc.|Cellulite treatment system and methods|

---

CN109483564A|2018-11-14|2019-03-19|北京航空航天大学|A kind of liposuction robot system and method|

---

RU2714192C1|2019-11-27|2020-02-12|Наталья Евгеньевна Мантурова|Device for skin separation of face from underlying tissues|

---

WO2021150478A1|2020-01-21|2021-07-29|Nc8, Inc.|Systems for improving the appearance of tissue|

---

NL2024926B1|2020-02-17|2021-10-13|Carl Luc Coeman Dirk|Excision apparatus comprising a housing provided with a fixation portion|

---

US20210339033A1|2020-04-29|2021-11-04|Candela Corporation|Treatment apparatus|

法律状态:
2018-01-16| B25A| Requested transfer of rights approved|Owner name: ULTHERA, INC. (US) |

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2018-12-18| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

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2019-09-03| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2020-04-07| B07A| Application suspended after technical examination (opinion) [chapter 7.1 patent gazette]|

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2020-12-15| B06A| Patent application procedure suspended [chapter 6.1 patent gazette]|

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2021-03-30| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2021-05-18| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 29/11/2011, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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申请号 | 申请日 | 专利标题

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US12/975,966|2010-12-22|

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US12/975,966|US8439940B2|2010-12-22|2010-12-22|Dissection handpiece with aspiration means for reducing the appearance of cellulite|

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PCT/US2011/062449|WO2012087506A2|2010-12-22|2011-11-29|Dissection handpiece with aspiration means for reducing the appearance of cellulite|

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