Suture securement devices
Disclosed herein are exemplary embodiments of suture securement devices that replace the need to tie knots in sutures. Some embodiments comprise an annular outer body and one or more suture engagement tabs extending inwardly from the outer body. The devices can comprise a superelastic and/or shape-memory material and have a generally in-plane initial configuration. The suture engagement portions are deformable out-of-plane to an active configuration with the outer body compressed and the tabs interlocked with each other. The device can be heat-set in the deformed configuration. The interlocked tabs exert a pinching force on sutures passing between them that restricts the sutures from sliding through the opening in one longitudinal direction.
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This application is a Reissue Application of U.S. Pat. No. 9,498,202, issued Nov. 22, 2016, which claims priority under 35 U.S.C. §119 to U.S. Provisional Application No. 61/720,886, filed Oct. 31, 2012, and to U.S. Provisional Application No. 61/670,001, filed Jul. 10, 2012.
FIELDThis disclosure relates to devices for securing sutures.
BACKGROUNDProsthetic devices are often implanted using sutures. For example, prosthetic heart valves and annuloplasty rings can be secured to a native valve annulus using sutures. Conventionally, the loose ends of the sutures are tied in knots to secure them together and/or to secure the prosthetic device to the adjacent tissue. However, the process of tying knots in sutures can be time consuming and difficult, the amount of slack left in the sutures can be difficult to control, the knots can be difficult or impossible to untie, and/or the knots can accidentally come loose. Thus, there is a need in the art for ways to secure sutures without tying knots.
SUMMARYDisclosed herein are exemplary embodiments of suture securement devices that replace the need to tie knots in sutures. Some embodiments of a suture securement device comprise an outer body, an opening passing through the outer body for receiving one or more sutures, and at least one suture engagement portion extending from the outer body to the opening. The device comprises a resiliently deformable material and has a natural configuration when no sutures are positioned in the opening. The opening has a width that is smaller than a diameter of the suture when the device is in the natural configuration. The at least one suture engagement portion is resiliently deformable to an active configuration when a suture is positioned through the opening. In the active configuration, the at least one suture engagement portion exerts a pinching force on the suture that restricts the suture from sliding through the opening in at least one longitudinal direction of the suture.
In some of these embodiments, the device comprises two, three, four, or more suture engagement portions extending inwardly from the outer body that are resiliently deformable to an active configuration when one or more sutures are positioned through the opening.
In some embodiments, the outer body comprises a fully annular body that encloses the opening, while in other embodiments, the outer body comprises a radial slit or opening that communicates with the opening to allow a suture to be slid laterally through the slit into the opening. In some of the embodiments with a slit, the device further comprises an open region between a portion of the outer body and the suture engagement portions, and the open region communicates with the opening and the slit.
In some embodiments, at least one of the suture engagement portions projects out-of-plane from the outer body in the natural configuration, such that the device is biased to allow a suture positioned in the opening to slide through the opening with relatively little resistance in one longitudinal direction while preventing the suture from sliding through the opening in the other longitudinal direction.
Some exemplary devices for securing one or more sutures comprising a first end portion, a second end portion, and an intermediate third portion coupling the first end portion to the second end portion. Each of the first, second and third portions comprise an at least partially annular body having an internal passageway extending therethrough in a longitudinal direction of the device. The first, second and third portions are resiliently deformable relative to one another in a plane generally perpendicular to the longitudinal direction. The device has a natural configuration, free of elastic deformation, wherein at least one of the first, second and third portions is twisted relative to the other portions such that the internal passageways are misaligned with one another; and the device has a deformed configuration wherein at least one of the first, second and third portions is resiliently deformed relative the other portions such that the internal passageways of the first, second and third portions are substantially aligned in the longitudinal direction. One or more sutures can be positioned through the aligned internal passageways when the device is in the deformed configuration and the device is configured to pinch the one or more sutures between the first, second and third portions when the device is allowed to return toward its natural configuration.
Some embodiments comprise a first spine segment flexibly coupling the first end portion to the third portion and a second spine segment flexibly coupling the second end portion to the third portion. Each of the first, second and third portions can comprise a partially annular body having an open section, wherein the open sections of the first, second and third portions are misaligned in the natural configuration and are aligned in the deformed configuration to allow one or more sutures to be laterally inserted into the internal passageways. The first and second end portions can be aligned with each other in the longitudinal direction in both the natural and deformed configurations.
In some implementations, a tool can be used with the device to hold the device in the deformed configuration and then release the device to return toward the natural configuration. The tool can comprise a handle and first and second jaws that are configured to apply a compression force on the device to hold it in the deformed position while one or more sutures are inserted laterally through the aligned open sections.
Some embodiments of suture securement devices described herein can have a curved body that has a generally uniform thickness and/or generally parallel convex and concave major surfaces. In some embodiments, the curved devices can be cut from a sidewall of a tube, such as tube having a circular cross-sectional profile and a uniform wall thickness. The curved devices can be biased such that suture(s) can be readily inserted through the device from the concave side and are prevented from sliding back out through the concave side.
An exemplary method of forming a suture clip can comprise first forming a flat or curved suture clip having an annular outer body and an a two opposing tabs extending toward each other within the outer body, with the tabs being in-plane with the outer body. For instance, curved slots on either side of the tabs and a middle slit between the tabs connect to each other but do not intersect with an outer edge of the body, thus forming a “closed” generally H-shaped opening extending from one face of the device to the other. The method can further comprise bending the suture clip to a deformed configuration with the outer body compressed in an in-plane direction and the tabs extending out-of-plane from the outer body. The method can further comprise heat-setting the suture clip in the deformed configuration. The clip can comprise a superelastic and/or shape-memory material such as Nitinol. In some embodiments, the two tabs interlock with each other in the deformed configuration. In some embodiments, the outer body is compressed in the direction that the tabs extend from the outer body. In some embodiments, bending the suture clip comprises compressing the outer body from a generally elliptical shape to a generally circular shape, or from a generally circular shape to a generally elliptical shape.
Some exemplary suture clips comprising an upper panel and a lower panel coupled together along a fold line at one end. The upper panel can comprise a slit and a biased tab configured to allow a suture engaged in the slit to slide more freely in one axial direction and less freely in an opposite axial direction, and the lower panel can comprise a slot configured to constrain a sutured engaged in the slit from migrating along the length of the slit.
The foregoing and other objects, features, and advantages of the invention will become more apparent from the following detailed description, which proceeds with reference to the accompanying figures.
Rather than tying knots to secure sutures, suture clips or other suture securement devices can be placed on sutures to secure them. Several exemplary embodiments of suture securement devices are disclosed herein and shown in the attached figures. These embodiments should not be construed as limiting in any way. Instead, the present disclosure is directed toward all novel and nonobvious features and aspects of the various disclosed embodiments, alone and in various combinations and sub-combinations with one another.
The disclosed devices can secure a single suture or to two or more sutures at the same time. For ease of description, this disclosure generally describes the various embodiments in use with only a single suture, though it should be understood that the disclosed embodiments may be used with two or more sutures in the same or similar manner, unless otherwise described.
The disclosed devices can be positioned on a suture by threading a free end of the suture through an opening in the device and/or by sliding the suture laterally through a slit in the side of the device, depending on the particular embodiment. For example, the embodiment shown in
Once a suture securement device is positioned on a suture, the device can prevent the suture from sliding axially through the device in one or both longitudinal directions of the suture. In some embodiments, the device can be biased to allow the suture to slide through the device in one longitudinal direction, but prevent the suture from sliding in the opposite direction, forming a one-way suture lock, or ratchet mechanism. In other embodiments, the device can prevent the suture from sliding in both longitudinal directions, forming a more restrictive two-way suture lock.
While
By using the disclosed suture securement devices rather than tying knots in the sutures, the sutures can be secured in less time and with less difficulty (especially in hard-to-reach locations). In addition, some suture securement devices can allow the amount of slack left in the sutures to be more precisely controlled, the devices can be less likely to come loose than knots, and some embodiments of the devices can be easily removed or adjusted after they are initially deployed. Furthermore, the suture securement devices can be small, durable, biocompatible, and inexpensive.
To help retain sutures in the midsection of the slit 142′, the slit includes serpentine sections 147 on either side. The tabs 134′, 136′ are identical, or mirror images of each other, though one may be larger than the other. Small circular enlargements 148 on the terminal end of each curved slot 138′, 140′ facilitate bending of the tabs 134′, 136′ and act as stress relievers to reduce the chance of fracture at those points. Two semi-circular cutouts 149 are provided on opposite sides of the outer edge 132′ perpendicular to the straight section of the slit 142′. The cutouts 148 provide orientation features for the suture fastening device 146 that cooperate with features on a tool (not shown) which can hold and deploy multiple devices in series.
The devices of
The disclosed suture securement devices can comprise any resiliently deformable, corrosion-resistant, biocompatible material, such as stainless steel, cobalt-chrome (Co—Cr), Elgiloy, MP35N, and Nitinol. Some embodiments can comprise more than one material, such as a more rigid material for the outer body and a more elastically flexible material for the arms/tabs. Desirably, the disclosed embodiments are comprised of material with a recoverable strain that is sufficient to retain sutures, such as a recoverable strain that ranges from about 5% to about 15%.
The device 200 can be elastically deformed to align all of the sections in a cylindrical configuration such that the openings 216, 218, 220 are also aligned, as shown in
In its natural state (not shown), the sections 242, 244, 246 of the device 240 are misaligned, like the device 200 in
With the suture positioned through the axial passageway, the device 240 can be released from compression and allowed to elastically return toward the natural position. Before reaching the natural position, the engagement surfaces 258, 260, 262 contact the suture and exert opposing lateral forces on the suture to hold the suture in the device 240 and prevent the suture from sliding longitudinally out of the device in either direction. Because the annular bodies of the sections 242, 244, 246 are thicker than those in the device 200, the engagement surfaces 258, 260, 262 contact the suture with less recoil motion compared to the device 200. This can allow for a stronger clamping force and more durability.
Some suture securement devices can have a generally curved shape. The embodiments shown in
In some embodiments, such curved devices can be formed from a sidewall of a tube. The outer radius of the tube can define the curvature of the convex major surface of the device while the inner radius of the tube can define the curvature of the concave major surface of the device. The uniform thickness of a curved device can be equal to the wall thickness of the tube that the device is cut from. In other embodiments, the devices can be formed from a sidewall of a non-cylindrical tube, or from a wall of other three-dimensional objects having a curved wall, such as a hollow sphere, spheroid, ellipsoid, etc., or from other three-dimensional objects having a curvature.
In some embodiments, the device 350 can further comprise an opening 362 in one end of the outer body 352 adjacent the slit 358 and an opening 364 in an opposite end of the outer body 352 adjacent the slit 360. The openings 362 and 364 can be used to secure (e.g., suture) the device 350 to another surface, such as a surface of a prosthetic device or underlying tissue. Any of the suture clip embodiments disclosed herein can comprise additional openings, similar to the openings 362 and 364, for securing the clip to an underlying surface.
Any of the curved embodiments described herein can have a thickness of, for example, from about 0.001 inches to about 0.100 inches, such as about 0.010 inches. Any of the curved embodiments described herein can have a radius of curvature of the convex major surface of, for example, greater than about 2.0 mm, such as about 4.0 mm. Any of the curved embodiments described herein can comprise superelastic and/or shape memory material, such as Nitinol.
The clip embodiment 400 shown in
The clip 400 can be comprised of a superelastic and/or shape memory material, such as Nitinol, such that the clip 400 can be heat-set in the deformed configuration shown in
The deflection of the tabs 404, 406 twists the annular body 402 at each of the end portions 420, causing those end portions 420 to deflect downward, as shown in
In the embodiments 400, 430 and 460, the opposing tabs may not interlock together in a deformed, out-of-plane configuration unless the annular outer body is compressed together to allow the opposing tabs to move closer together. Without the compression of the outer body, a gap is formed between the ends of the two tabs when they are bent out-of-plane from the outer body and gaps are formed between the arms of the one tab and the shoulders of the other tab. These gaps may not allow the two tabs to properly interlock in the deformed position. Thus, by compressing the annular body together, and heat-setting the clip in the compressed state, the tabs are provided with the ability to engage each other in the interlocked configuration. The touching interface between the end portions of the tabs allows the tabs to exert a clamping force on any diameter of sutures, even very small diameter sutures.
General Considerations
For purposes of this description, certain aspects, advantages, and novel features of the embodiments of this disclosure are described herein. The disclosed methods, apparatuses, and systems should not be construed as limiting in any way. Instead, the present disclosure is directed toward all novel and nonobvious features and aspects of the various disclosed embodiments, alone and in various combinations and sub-combinations with one another. The methods, apparatuses, and systems are not limited to any specific aspect or feature or combination thereof, nor do the disclosed embodiments require that any one or more specific advantages be present or problems be solved.
As used herein, the terms “a”, “an” and “at least one” encompass one or more of the specified element. That is, if two of a particular element are present, one of these elements is also present and thus “an” element is present. The terms “a plurality of” and “plural” mean two or more of the specified element.
As used herein, the term “and/or” used between the last two of a list of elements means any one or more of the listed elements. For example, the phrase “A, B, and/or C” means “A,” “B,” “C,” “A and B,” “A and C,” “B and C” or “A, B and C.”
As used herein, the term “coupled” generally means physically coupled or linked and does not exclude the presence of intermediate elements between the coupled items absent specific contrary language.
In view of the many possible embodiments to which the principles of this disclosure may be applied, it should be recognized that the illustrated embodiments are only preferred examples and should not be taken as limiting the scope of the disclosure.
Claims
1. A device for securing one or more sutures, comprising:
- a generally disk-shaped body having an annular outer body that defines an annular outer edge, a first tab extending radially inwardly from a first side of the annular outer body and a second tab extending radially inwardly from a second side of the annular outer body;
- first and second curved slots passing through the disk-shaped body within the annular outer body, wherein the first and second curved slots define sides of the first and second tabs; and
- a middle slit connecting the curved slots and separating the first and second tabs, the slit and curved slots generally forming a closed H-shaped opening through the body within the annular outer body, the slit being sized to receive and hold one or more sutures, and opposed edges of the first and second tabs positioned across the slit from each other form suture engagement portions;
- wherein each of the first and second tabs has a base end that connects to the annular outer body and a free end that borders the slit, the base ends having a width that extends between an end of the first curved slot and an opposing end of the second curved slot, and the widths of the base ends of the first and second tabs are shorter than widths of the free ends of the first and second tabs, such that the first and second tabs are encouraged to articulate relative to the annular outer body along the width of their base ends;
- wherein the device comprises an elastically resilient material and has a flat natural configuration when no sutures are positioned in the slit;
- wherein the device has an active configuration wherein the first and second tabs are elastically deformed out of a plane defined by the annular outer body when one or more sutures are positioned through the slit in a direction generally perpendicular to the plane defined the annular outer body;
- wherein the elastically deformable first and second tabs allow the device to change from the natural configuration to the active configuration to receive and secure one or more sutures between the suture engagement portions; and
- wherein, in the active configuration, the suture engagement portions exert a pinching force on the one or more sutures that restricts the sutures from sliding through the slit in at least one longitudinal direction of the sutures.
2. The device of claim 1, wherein the device has a substantially uniform thickness in the natural configuration.
3. The device of claim 1, wherein the slit has a straight suture receiving portion and first and second angled end portions on opposite ends of the suture receiving portion configured to block received sutures from sliding laterally along the slit from the suture receiving portion of the slit into the curved slots, wherein the first angled end portion of the slit is adjacent to the first curved slot and the second angled end portion of the slit is adjacent to the second curved slot.
4. The device of claim 1, wherein the slit has a straight suture receiving portion and first and second serpentine end portions on opposite sides of the suture receiving portion configured to block received sutures from sliding laterally along the slit from the suture receiving portion into the curved slots, wherein the first serpentine end portion of the slit is adjacent to the first curved slot and the second serpentine end portion of the slit is adjacent to the second curved slot.
5. The device of claim 1, wherein the curved slots terminate in enlarged circular portions located where the first and second tabs join with the annular outer body, such that the enlarged circular portions reduce stress concentrations when the tabs elastically deform out of the plane defined by the annular outer body.
6. The device of claim 1, wherein the tabs are equal in size.
7. The device of claim 1, wherein the tabs are dissimilar, with one being larger than the other.
8. The device of claim 1, wherein elastic deformation of the first and second tabs occurs at locations where the first and second tabs join with the annular outer body.
9. The device of claim 1, wherein the curved slots have curved radially inner surfaces, the curved radially inner surfaces being curved lateral surfaces of the first and second tabs.
10. The device of claim 1, wherein each of the curved slots has a constant width along a majority of the length of the respective curved slot.
11. The device of claim 1, wherein the annular outer body comprises two opposing radial cutouts in the outer edge of the device.
12. The device of claim 1, wherein the slit extends a distance between the first and second tabs that is at least 50% of an outer diameter of the device.
13. The device of claim 1, wherein each of the first and second tabs has a length dimension that extends from the slit to the annular outer body in a direction perpendicular to the slit, wherein the annular outer body has a radial dimension that extends from the curved slot radially outwardly to the annular outer edge, and wherein the length dimension of the first and second tabs is greater than or equal to the radial dimension of the annular outer body.
14. The device of claim 1, further comprising a suture extending through the device between the first and second tabs, wherein the first and second tabs are bent relative to the annular outer body at junctions where the first and second tabs are connected to the annular outer body.
15. A method of using the device of claim 1, comprising inserting a suture through the device between the first and second tabs, the insertion of the suture occurring while the first and second tabs are bent relative to the annular outer body at junctions where the first and second tabs are connected to the annular outer body.
16. A device for securing one or more sutures, comprising:
- a generally disk-shaped body having an annular outer body that defines an annular outer edge; a first tab extending radially inwardly from a first side of the annular outer body and a second tab extending radially inwardly from a second side of the annular outer body;
- first and second slots passing through the disk-shaped body within the annular outer body, wherein the first and second slots define lateral sides of the first and second tabs; and
- a middle slit connecting the first and second slots and separating the first and second tabs, the slit and two slots forming a closed opening through the body within the annular outer body, the slit being configured to receive and hold at least one suture such that opposed edges of the first and second tabs positioned across the slit from each other form suture engagement portions;
- wherein the slit comprises a straight suture receiving portion having a first end closer to the first slot and a second end closer to the second slot, and the slit further comprises first and second non-straight portions on opposite ends of the straight suture receiving portion with the first non-straight portion extending from the first end of the straight suture receiving portion toward the first slot and the second non-straight portion extending from the second end of the straight suture receiving portion toward the second slot, the non-straight portions of the slit being configured to block a received suture from sliding laterally along the slit from the suture receiving portion into either of the slots;
- wherein the device comprises an elastically resilient material and has a natural configuration when no suture is positioned in the slit;
- wherein the device has an active configuration wherein the first and second tabs are elastically deformed when at least one suture is positioned through the slit; and
- wherein, in the active configuration, the suture engagement portions exert a pinching force on at least one suture extending through the slit that restricts the at least one suture from sliding through the slit in at least one longitudinal direction of the suture.
17. The device of claim 16, wherein:
- the slit extends in a first major direction of the device that is perpendicular to the longitudinal direction of a suture passing through the slit, and the first and second tabs extend toward each other in a second major direction of the device that is perpendicular to the first major direction and perpendicular to the longitudinal direction of a suture passing through the slit; and
- the first and second non-straight portions of the of the slit extend back and forth in the second major direction as the slit extends radially outwardly in the first major direction.
18. The device of claim 17, wherein the first and second non-straight portions of the of the slit comprise serpentine sections of the slit that curve back and forth in the second major direction as the slit extends radially outwardly in the first major direction.
19. The device of claim 16, wherein the slit extends a distance across the device that is at least 50% of an outer diameter of the device.
20. The device of claim 16, wherein the first and second slots have a constant radial width along a majority of the length of the respective slot.
21. The device of claim 16, wherein the largest diameter of the device is less than 5 mm.
22. A device for securing one or more sutures, comprising:
- a generally disk-shaped body having a thickness and a radial dimension perpendicular to the thickness, the body having an annular outer body that defines an annular outer radial edge; a first tab extending radially inwardly from a first side of the annular outer body and a second tab extending radially inwardly from a second side of the annular outer body;
- first and second slots passing through the thickness of the disk-shaped body and positioned radially within the annular outer body, wherein the first and second slots define lateral sides of the first and second tabs; and
- a middle slit extending through the thickness of the body and radially connecting the first and second slots and separating the first and second tabs, the slit and two slots forming a closed opening passing through the thickness of the body and positioned radially within the annular outer body, the slit being configured to receive and hold at least one suture such that opposed surfaces of the first and second tabs positioned across the slit from each other form suture engagement portions, and wherein the slit has a constant spacing width between the first and second tabs across the thickness of the body;
- wherein the device comprises an elastically resilient material and has a natural configuration when no suture is positioned in the slit;
- wherein the device has an active configuration wherein the first and second tabs are elastically deformed when at least one suture is positioned through the slit; and
- wherein, in the active configuration, the suture engagement portions exert a pinching force on at least one suture extending through the slit that restricts the at least one suture from sliding through the slit in at least one longitudinal direction of the suture.
23. The device of claim 22, wherein the slit comprises a straight suture receiving portion having a first end closer to the first slot and a second end closer to the second slot, and the slit further comprises first and second non-straight portions on opposite ends of the straight suture receiving portion with the first non-straight portion extending from the first end of the straight suture receiving portion toward the first slot and the second non-straight portion extending from the second end of the straight suture receiving portion toward the second slot, the non-straight portions of the slit being configured to restrict a received suture from sliding radially along the slit from the suture receiving portion into either of the slots.
24. A device for securing one or more sutures, comprising:
- a disk-shaped body comprising a resiliently deformable material, the disk-shaped body comprising an annular outer body that defines an outer edge of the device, a first tab extending inwardly from the annular outer body, and a second tab extending inwardly from the annular outer body;
- first and second slots passing through the device between the annular outer body and the first and second tabs, wherein the first and second slots define lateral sides of the first and second tabs; and
- a suture-receiving slit connecting the first and second slots and separating the first and second tabs, the slit and slots together forming an opening through the device within the annular outer body, wherein opposed surfaces of the first and second tabs positioned across the slit from each other form suture engagement portions of the tabs;
- wherein each of the first and second tabs has a base end that connects to the annular outer body and a free end that borders the slit, each of the base ends of the first and second tabs having a base end width that extends between an end of the first slot and an end of the second slot, each of the free ends of the first and second tabs having a free end width equal to a length of the slit, and the base end widths are shorter than the free end widths such that the first and second tabs are encouraged to articulate relative to the annular outer body along their base ends;
- wherein the device has a natural configuration when no sutures are positioned in the slit, and the device has an active configuration wherein the first and second tabs are resiliently deformed relative to the annular outer body with one or more sutures are positioned through the slit;
- wherein the resiliently deformable first and second tabs allow the device to change from the natural configuration to the active configuration to receive and secure one or more sutures between the suture engagement portions; and
- wherein, in the active configuration, the suture engagement portions exert a pinching force on the one or more sutures that restricts the sutures from sliding through the slit in at least one longitudinal direction of the sutures.
25. The device of claim 24, wherein the first and second slots terminate in enlarged rounded portions located where the base ends of the first and second tabs join with the annular outer body, such that the enlarged rounded portions reduce stress concentrations when the tabs deform relative to the annular outer body.
26. The device of claim 24, wherein the first and second slots have non-linear radially inner surfaces, the non-linear radially inner surfaces forming lateral surfaces of the first and second tabs.
27. The device of claim 24, wherein each of the first and second slots has a substantially constant width along a majority of the length of the respective slot.
28. The device of claim 24, wherein the annular outer body comprises two opposing radial cutouts in the outer edge of the device.
29. The device of claim 24, wherein the slit extends a distance between the first and second slots that is at least 50% of a maximum outer diameter of the device.
30. The device of claim 24, wherein each of the first and second tabs has a length dimension that extends in a direction perpendicular to the slit from the slit to an imaginary line extending between ends of the first and second slots, wherein the annular outer body has a radial dimension that extends from the slots radially outwardly to the outer edge of the device, and wherein the length dimension of the first and second tabs is greater than or equal to the radial dimension of the annular outer body.
31. The device of claim 24, further comprising a suture extending through the device between the free ends of the first and second tabs, and wherein the first and second tabs are deformed relative to the annular outer body at their base ends where the first and second tabs are connected to the annular outer body.
32. Inserting a suture through the device of claim 24 between the free ends of the first and second tabs, the insertion of the suture occurring while the first and second tabs are deformed relative to the annular outer body at the base ends of the first and tabs.
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Type: Grant
Filed: Apr 27, 2017
Date of Patent: Jan 22, 2019
Assignee: Edwards Lifesciences Corporation (Irvine, CA)
Inventors: Mohammad Jafari (Foothill Ranch, CA), Ming H. Wu (Tustin, CA), Hengchu Cao (Irvine, CA), Ralph Schneider (Trabuco Canyon, CA), Manouchehr A. Miraki (Laguna Hills, CA)
Primary Examiner: Beverly M Flanagan
Application Number: 15/499,611
International Classification: A61B 17/04 (20060101); A61B 17/064 (20060101);