JP5001848B2 - Surgical fasteners coated with wound treatment material - Google Patents
Surgical fasteners coated with wound treatment material Download PDFInfo
- Publication number
- JP5001848B2 JP5001848B2 JP2007537950A JP2007537950A JP5001848B2 JP 5001848 B2 JP5001848 B2 JP 5001848B2 JP 2007537950 A JP2007537950 A JP 2007537950A JP 2007537950 A JP2007537950 A JP 2007537950A JP 5001848 B2 JP5001848 B2 JP 5001848B2
- Authority
- JP
- Japan
- Prior art keywords
- surgical fastener
- wound treatment
- surgical
- treatment material
- crown
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related
Links
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Images
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/064—Surgical staples, i.e. penetrating the tissue
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0643—Surgical staples, i.e. penetrating the tissue with separate closing member, e.g. for interlocking with staple
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/00491—Surgical glue applicators
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B2017/00004—(bio)absorbable, (bio)resorbable or resorptive
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B2017/00831—Material properties
- A61B2017/00889—Material properties antimicrobial, disinfectant
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B2017/00831—Material properties
- A61B2017/00893—Material properties pharmaceutically effective
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Materials For Medical Uses (AREA)
- Surgical Instruments (AREA)
Description
（関連出願の援用）
本願は、２００４年１０月１８日に出願された米国特許仮出願第６０／６２０，０６８号の恩恵およびその優先権を主張する。この米国特許仮出願第６０／６２０，０６８号の内容全体が、本明細書において参考として援用される。
(Incorporation of related applications)
This application claims the benefit and priority of US Provisional Application No. 60 / 620,068, filed Oct. 18, 2004. The entire contents of this US provisional application 60 / 620,068 are hereby incorporated by reference.
（技術分野）
本開示は、外科用ファスナーに関し、より具体的には、創傷処置材料でコーティングされた外科用ファスナーに関する。
(Technical field)
The present disclosure relates to surgical fasteners, and more particularly to surgical fasteners coated with a wound treatment material.
（関連分野の説明）
一般的には、医療デバイスのコーティングは、外科用器具のため、留置生体材料（例えば、ステント、ネジ、および内部副子）のため、ならびにチュービング、カテーテル、ワイヤガイドなどのための、吸水剤コーティングおよび潤滑剤コーティングを生成するために有用である。そのようなコーティングは、組織および体液とその医療デバイスとの接触の外傷を最小限にする。具体的には、コーティングは、医療デバイスの表面の摩擦計数を減少させてそのデバイスの移動および操縦性を助長するために、滑りやすい潤滑性のコーティングを提供するために使用されている。親水性ポリマーから作製される潤滑性コーティングが、当該分野において周知である。
(Description of related fields)
In general, medical device coatings are water absorbent coatings for surgical instruments, for indwelling biomaterials (eg, stents, screws, and internal splints), and for tubing, catheters, wire guides, and the like. And is useful for producing lubricant coatings. Such coatings minimize the trauma of contact between tissue and body fluids and the medical device. Specifically, the coating has been used to provide a slippery, lubricious coating to reduce the friction coefficient of the surface of the medical device to facilitate movement and maneuverability of the device. Lubricious coatings made from hydrophilic polymers are well known in the art.
医療デバイス（例えば、外科用ファスナーおよび外科用ステープル）は、種々の身体構造（例えば、腸または気管支）を接続または吻合する場合に、縫合に取って代わっている。これらのステープルを適用するために使用される外科用ステープルデバイスは、一般的には、患者における組織の長いセグメントを同時に切断およびシールするように設計されており、それによって、そのような手順の時間およびリスクを大いに低減する。 Medical devices (eg, surgical fasteners and surgical staples) have replaced sutures when connecting or anastomosing various body structures (eg, intestine or bronchi). Surgical stapling devices used to apply these staples are generally designed to simultaneously cut and seal long segments of tissue in a patient, thereby reducing the time of such procedures. And greatly reduce the risk.
直線状外科用ステープルデバイスまたは環状外科用ステープルデバイスが、体組織セグメントを一緒に接続するため、かつ／または吻合を作製するために、１つ以上の直線状の外科用ファスナー列（例えば、ステープルまたは二部分（ｔｗｏ−ｐａｒｔ）ファスナー）を連続的にかまたは同時に体組織に適用するために、外科医によって使用される。直線状外科用ステープルデバイスは、一般的には、接続されるべき体組織が間に配置される一対のジョー様またはフィンガー様の構造を備える。その外科用ステープルデバイスが、作動および／または「発射（ｆｉｒｅ）」される場合、発射バーが、長手軸方向に移動し、それらのジョーのうちの１つにおけるステープルデバイスメンバーと接触し、外科用デバイスが、その体組織を介して、かつ／または反対側のジョーにおけるアンビルに対して押され、それによって閉じたステープルをクリンプ（ｃｒｉｍｐ）する。ナイフブレードが、ステープルの列／ライン（ｌｉｎｅ）の間を切断するために提供され得る。そのような直線状外科用ステープルデバイスの例は、Ｕｎｉｔｅｄ Ｓｔａｔｅｓ Ｓｕｒｇｉｃａｌ（Ｔｙｃｏ Ｈｅａｌｔｈ−Ｃａｒｅ Ｇｒｏｕｐ，ＬＰの一部門），ＬＰ，Ｎｏｒｗａｌｋ，ＣＴから入手可能なモデル「ＧＩＡ（登録商標）」装置、「Ｅｎｄｏ ＧＩＡ（登録商標）」装置、および「Ｐｒｅｍｉｕｍ Ｍｕｌｔｉ−ｆｉｒｅ ＴＡ（登録商標）」装置、ならびに特に、Ａｌｌｅｎらに対する特許文献１、Ｍｉｌｌｉｍａｎらに対する特許文献２、およびＲａｃｅｎｅｔらに対する特許文献３（これらの各々の内容全体は、本明細書において参考として援用される）に開示されている。 A linear surgical stapling device or an annular surgical stapling device may connect one or more linear surgical fastener rows (e.g., staples or splices) to connect body tissue segments together and / or create an anastomosis. Used by surgeons to apply two-part fasteners to body tissue either sequentially or simultaneously. Linear surgical stapling devices typically comprise a pair of jaw-like or finger-like structures between which the body tissue to be connected is placed. When the surgical stapling device is actuated and / or “fired”, the firing bar moves longitudinally and contacts the staple device members in one of their jaws, The device is pushed through its body tissue and / or against the anvil on the opposite jaw, thereby crimping the closed staple. A knife blade may be provided to cut between staple rows / lines. Examples of such linear surgical stapling devices include the model “GIA®” device, “Endo” available from United States Surgical (a division of Tyco Health-Care Group, LP), LP, Norwalk, CT. GIA® device, and “Premium Multi-fire TA®” device, and in particular, US Pat. No. 6,057,028 to Allen et al., US Pat. The entire contents of which are incorporated herein by reference).
環状外科用ステープルデバイスは、一般的には、複数の（代表的には２個の）環状ステープル列を備える環状ステープルカートリッジアセンブリ、その環状カートリッジアセンブリと作動可能に結合しているアンビルアセンブリ、およびそのステープル列の内部に配置された環状ブレードを備える。 Annular surgical stapling devices generally include an annular staple cartridge assembly comprising a plurality (typically two) of annular staple rows, an anvil assembly operatively associated with the annular cartridge assembly, and the An annular blade is disposed within the staple row.
別の型の外科用ステープラーは、端端吻合ステープラーである。そのようなデバイスの例は、Ｕｎｉｔｅｄ Ｓｔａｔｅｓ Ｓｕｒｇｉｃａｌ（Ｔｙｃｏ Ｈｅａｌｔｈ−Ｃａｒｅ Ｇｒｏｕｐ，ＬＰの一部門），ＬＰ，Ｎｏｒｗａｌｋ，ＣＴから入手可能なモデル「ＥＥＡＴＭ」装置であり、特に、Ｇｒｅｅｎらに対する特許文献４（その内容全体が、本明細書において参考として援用される）において開示されている。一般的には、端端吻合ステープラーは、代表的には、患者の腸または他の管状器官の接近した（ａｐｐｒｏｘｉｍａｔｅｄ）セクション中にステープル群を配置する。生じる吻合は、多数の「Ｂ字」型ステープルを含む腸の反転セクションを含んで、腸の接近した（ａｐｐｒｏｘｉｍａｔｅｄ）セクションの間の確実な接続を維持する。 Another type of surgical stapler is an end-to-end anastomosis stapler. An example of such a device is the model “EEA ™ ” device available from United States Surgical (a division of Tyco Health-Care Group, LP), LP, Norwalk, CT, in particular US Pat. (The entire contents of which are incorporated herein by reference). In general, end-to-end anastomosis staplers typically place a group of staples in an approximated section of the patient's intestine or other tubular organ. The resulting anastomosis includes an inversion section of the intestine that contains a number of “B” shaped staples to maintain a secure connection between the approximated sections of the intestine.
外科用ステープルの使用に加えて、シーラント（例えば、生物学的シーラント）が、漏出を防ぐために外科手術部位に適用され得る。代表的には、生物学的シーラントは、スプレーすること、塗ること、塗布すること、またはこれらの任意の組み合わせによって、医師によってステープル線の外側表面に手で適用される。生物学的シーラントのこの手での適用は、ステープル線を通るシーラントの厚みの不均一性および／または望ましい位置を見ることもしくはその位置に到達することができないことが原因である意図する適用範囲領域の一部の省略をもたらし得る。
外科手術手順に対してさらなる工程も合併症も付加することなく標的外科手術部位に創傷処置材料を送達するための外科用ファスナーなどについて、必要性が存在する。 There is a need for surgical fasteners and the like for delivering wound treatment material to a target surgical site without adding additional steps or complications to the surgical procedure.
本開示は、外科用ファスナーに関し、より具体的には、創傷処置材料でコーティングされた外科用ファスナーに関する。 The present disclosure relates to surgical fasteners, and more particularly to surgical fasteners coated with a wound treatment material.
本開示の一局面によると、外科用ファスナー適用装置と組み合わせて使用のための外科用ファスナーが、提供される。上記外科用ファスナーは、一対の脚部と；その一対の脚部を相互接続するクラウン（ｃｒｏｗｎ）と；その脚部および／またはクラウンの少なくとも一部をコーティングするための創傷処置材料と；を備える。 According to one aspect of the present disclosure, a surgical fastener for use in combination with a surgical fastener applying apparatus is provided. The surgical fastener includes a pair of legs; a crown interconnecting the pair of legs; and a wound treatment material for coating at least a portion of the legs and / or the crown. .
上記創傷処置材料は、接着剤、シーラント、止血物質、および薬物（ｍｅｄｉｃａｍｅｎｔ）のうちの少なくとも１つであり得る。一実施形態において、上記外科用ファスナーは、ステープルである。別の実施形態において、上記外科用ファスナーは、二部分（ｔｗｏ−ｐａｒｔ）ファスナーである。 The wound treatment material can be at least one of an adhesive, a sealant, a hemostatic material, and a drug. In one embodiment, the surgical fastener is a staple. In another embodiment, the surgical fastener is a two-part fastener.
上記外科用ファスナーの脚部およびクラウンは、非吸収性材料および生体吸収性材料のうちの少なくとも１つから製造され得る。上記非吸収性材料は、ステンレス鋼およびチタンのうちの少なくとも１つであることが、想定される。上記生体吸収性材料は、モノマーのホモポリマー、コポリマー、および混合物（ｂｌｅｎｄ）からなる群より選択され得、そのモノマーは、グリコリド、グリコール酸、ラクチド、乳酸、ｐ−ジオキサノン、α−カプロラクトン、およびトリメチレンカルボネートからなる群より選択される。上記生体吸収材料は、ポリグリコール酸（ＰＧＡ）およびポリ乳酸（ＰＬＡ）のうちの少なくとも１つであり得る。 The legs and crown of the surgical fastener may be manufactured from at least one of a non-absorbable material and a bioabsorbable material. It is envisioned that the non-absorbable material is at least one of stainless steel and titanium. The bioabsorbable material may be selected from the group consisting of homopolymers, copolymers, and blends of monomers, the monomers comprising glycolide, glycolic acid, lactide, lactic acid, p-dioxanone, α-caprolactone, and triglyceride. Selected from the group consisting of methylene carbonate. The bioabsorbable material may be at least one of polyglycolic acid (PGA) and polylactic acid (PLA).
上記創傷処置材料は、アクリレート、生体適合性光開始剤の存在下におけるメタクリレート官能性ヒドロゲル、アルキル−シアノアクリレート、アミン官能性マクロマーを伴うイソシアネート官能性マクロマー、アミン官能性マクロマーを伴わないイソシアネート官能性マクロマー、アミン官能性マクロマーを伴うスクシンイミジルエステル官能性マクロマー、スルフヒドリル官能性マクロマーを伴うスクシンイミジルエステル官能性マクロマー、アミン官能性マクロマーを伴うエポキシ官能性マクロマー、アルデヒド架橋剤の存在下におけるタンパク質の混合物、アルデヒド架橋剤の存在下におけるポリペプチドの混合物、ゲニピン（Ｇｅｎｉｐｉｎ）、水溶性カルボジイミド、および多価カチオンの存在下におけるアニオン性多糖からなる群より選択される、シーラント（ｓｅａｌａｎｔ）であり得る。 The wound treatment material comprises an acrylate, a methacrylate functional hydrogel in the presence of a biocompatible photoinitiator, an alkyl-cyanoacrylate, an isocyanate functional macromer with an amine functional macromer, an isocyanate functional macromer without an amine functional macromer Succinimidyl ester functional macromer with amine functional macromer, succinimidyl ester functional macromer with sulfhydryl functional macromer, epoxy functional macromer with amine functional macromer, protein mixture in the presence of aldehyde crosslinker A mixture of polypeptides in the presence of an aldehyde crosslinking agent, genipin, water-soluble carbodiimide, and an anionic polysaccharide in the presence of a multivalent cation. Is selected from the group may be a sealant (Sealant).
上記創傷処置材料は、有機ポリイソシアネートおよびオキシエチレンベースのジオールおよびオキシエチレンベースのポリオールから誘導される、イソシアネート末端親水性ウレタンプレポリマー；α−シアノアクリレートベースの接着剤；アルキルエステルベースのシアノアクリレート接着剤；インサイチュで反応可能かつ架橋可能である吸電子性基を有する水溶性前駆体と吸核性基を有する水溶性前駆体とから形成された、生体適合性架橋ポリマーをベースとする接着剤；二部分接着剤システム（１つ以上のイソシアネート基で置換されたポリアルキレンオキシド骨格と組合わせた生体吸収性ジアミン化合物に基づく二部分接着剤システム、または１つ以上のアミン基で置換されたポリアルキレンオキシド骨格と組合わせた生体吸収性ジイソシアネート化合物に基づく二部分接着剤システムを含む）；ならびに芳香族ジイソシアネートおよびポリオールから誘導される、イソシアネート末端親水性ウレタンプレポリマー；からなる群より選択される、シーラントであり得る。 The wound treatment material is an isocyanate-terminated hydrophilic urethane prepolymer derived from an organic polyisocyanate and an oxyethylene-based diol and an oxyethylene-based polyol; an α-cyanoacrylate-based adhesive; an alkyl ester-based cyanoacrylate bond An adhesive; an adhesive based on a biocompatible crosslinked polymer formed from a water-soluble precursor having an electrophilic group capable of reacting and crosslinking in situ and a water-soluble precursor having a nucleophilic group; Two-part adhesive systems (two-part adhesive systems based on bioabsorbable diamine compounds in combination with a polyalkylene oxide backbone substituted with one or more isocyanate groups, or polyalkylenes substituted with one or more amine groups Bioabsorbable dises combined with oxide skeletons Includes a two part adhesive systems based on isocyanate compound); and derived from aromatic diisocyanates and polyols, isocyanate terminated hydrophilic urethane prepolymer; is selected from the group consisting of may be a sealant.
上記創傷処置材料は、フィブリンベースの局所止血剤、コラーゲンベースの局所止血剤、酸化再生セルロースベースの局所止血剤、およびゼラチンベースの局所止血剤からなる群より選択される、止血剤であることが、想定される。 The wound treatment material may be a hemostatic agent selected from the group consisting of fibrin-based local hemostatic agents, collagen-based local hemostatic agents, oxidized regenerated cellulose-based local hemostatic agents, and gelatin-based local hemostatic agents. ,is assumed.
上記創傷処置材料は、薬品（ｄｒｕｇ）、酵素、増殖因子、ペプチド、タンパク質、色素、診断剤、止血剤、モノクローナル抗体、または狭窄の防止において使用される他の任意の薬剤からなる群より選択される、薬物（ｍｅｄｉｃａｍｅｎｔ）であることが、企図される。 The wound treatment material is selected from the group consisting of drugs, enzymes, growth factors, peptides, proteins, dyes, diagnostic agents, hemostatic agents, monoclonal antibodies, or any other agent used in the prevention of stenosis. It is contemplated that it is a drug.
一実施形態において、上記創傷処置材料は、上記脚部およびクラウン中に染み込まされ得る。別の実施形態において、上記創傷処置材料は、上記脚部およびクラウンを完全にコーティングする。 In one embodiment, the wound treatment material can be soaked into the legs and crown. In another embodiment, the wound treatment material completely coats the legs and crown.
各脚部は、鋭利な遠位端を備えることが、想定される。上記クラウンは、直線状であることが、さらに想定される。 It is envisioned that each leg has a sharp distal end. It is further envisioned that the crown is straight.
（実施形態の詳細な説明）
本明細書に開示される外科用ファスナーの実施形態が、ここで図面を参照して詳細に説明される。図面において、同様の参照番号は、類似するエレメントまたは同じエレメントを特定する。本明細書において使用される場合、従来のように、用語「遠位」とは、使用者から最も遠い部分を指し、用語「近位」とは、使用者に最も近い部分を指す。
(Detailed description of embodiment)
Embodiments of the surgical fastener disclosed herein will now be described in detail with reference to the drawings. In the drawings, like reference numbers identify similar or identical elements. As used herein, as is conventional, the term “distal” refers to the portion that is furthest from the user, and the term “proximal” refers to the portion that is closest to the user.
図１および図２を参照すると、外科用ファスナーが、外科用ステープルの形態で、一般的に１００として示される。本開示の外科用ステープルは、代表的には、組織部分および／または隣接組織を一緒に接続するために使用される任意の金属製ステープルを含む。外科用ステープル１００は、金属（例えば、ステンレス鋼もしくはチタン、または当業者によって公知である他の任意の材料）から作製され得る。例えば、外科用ステープル１００はまた、生体吸収性材料などから製造され得る。
With reference to FIGS. 1 and 2, a surgical fastener is shown generally as 100 in the form of surgical staples. The surgical staples of the present disclosure typically include any metallic staple that is used to connect tissue portions and / or adjacent tissue together.
外科用ステープル１００のために使用される生体吸収性材料としては、１つ以上のモノマーのホモポリマー、コポリマー、および混合物から製造されるが挙げられるが、これらに限定はされず、これらのモノマーは、グリコリド、グリコール酸、ラクチド、乳酸、ｐ−ジオキサノン、α−カプロラクトン、およびトリメチレンカルボネートからなる群より選択される。他の生体吸収性材料としては、例えば、ポリグリコール酸（ＰＧＡ）およびポリ乳酸（ＰＬＡ）が挙げられるが、これらに限定はされない。
Bioabsorbable materials used for
継続して図１および図２を参照すると、外科用ステープル１００は、一対の脚部１０２、１０４を備え、これらの一対の脚部は、それらの第一端（それぞれ、１０２ａ、１０４ａ）の間に延びるクラウンまたはバックスパン（ｂａｃｋｓｐａｎ）１０６によって互いに相互接続されている。図１および図２において観察されるように、クラウン１０６は、脚部１０２、１０４に対して実質的に垂直である。しかし、クラウン１０６は、必要とされる場合および／または望ましい場合には、任意の形状および／もしくは形態を採り得、そして脚部１０２、１０４に対して任意の方向を有し得ることが、想定される。例えば、クラウン１０６は、脚部１０２、１０４から角度をなして（ａｎｇｕｌａｒｌｙ）延びて交叉点において接続される（示されず）、２つのセクションを備え得る。
With continued reference to FIGS. 1 and 2, the
図１および図２において観察されるように、脚部１０２、１０４のそれぞれの遠位端１０２ｂ、１０４ｂは、組織などの中への脚部１０２、１０４の貫入を助長するように鋭利であう。
As observed in FIGS. 1 and 2, the distal ends 102b, 104b of each of the
本開示に従って、外科用ステープル１００は、創傷処置材料「Ｗ」でコーティングされる。創傷処置材料「Ｗ」が、（図１および図２において観察されるように）外科用ステープル１００全体に適用され得るか、または組織などと接触すべき外科用ステープル１００の任意の特定領域に適用され得ることが、想定される。例えば、創傷処置材料「Ｗ」が、脚部１０２、１０４のみ適用され得る（図３参照）か；脚部１０２、１０４のうちの一方にのみ適用され得る（示されず）か；クラウン１０６にのみ適用され得る（示されず）か；またはそれらの任意の部分に適用され得る。創傷処置材料「Ｗ」は、図４において観察されるように、外科用ステープル１００の脚部１０２、１０４、およびクラウン１０６に染み込まされ得ることが、さらに想定される。
In accordance with the present disclosure,
一実施形態において、外科用ステープル１００は、創傷処置材料「Ｗ」を望ましくは染み込ませた生体吸収材料から製造され得る。従って、使用時には、外科用ステープル１００の創傷処置材料成分は、シーラントの様式で、組織から生じ得るあらゆる出血を遅らせるように機能し得、そして接着剤の様式で、接近している（ａｐｐｒｏｘｉｍａｔｅｄ）組織を一緒に固定するように機能し得る。外科用ステープル１００の生体吸収性によって、所定時間の後の、外科用ステープル１００のうちの少なくとも一部が身体中に吸収されることが可能になる。例えば、外科用ステープル１００は、身体中に外科用ステープル１００が吸収される前に吻合が充分に治癒するために、身体中の適所に約２〜３週間残り得る。
In one embodiment,
上記に記載されるように、そして図３において示されるように、外科用ステープル１００は、予め硬化している接着剤またはシーラントである創傷処置材料「Ｗ」に浸漬され得ることが、想定される。この予め硬化しているシーラントまたは接着剤は、身体組織の水分および／または熱と反応し、それによってそのシーラントまたは接着剤のシール特性および／または接着剤特性を活性化する。上記の予め硬化しているシーラントまたは接着剤は、ヒドロゲルなどであり得ることが、想定される。
As described above, and as shown in FIG. 3, it is envisioned that
上記創傷処置材料「Ｗ」は、組織を接続、治癒、シール、または他の方法で処理するための、任意の材料であることが、企図される。好ましい実施形態において、上記創傷処置材料は、生体適合性シーラントであり、この生体適合性シーラントとしては、組織接触時に硬化するシーラント、紫外（ＵＶ）光に対する曝露時に硬化するシーラント、互いから分離された状態で維持されて合わせられる二部分システムであるシーラント、またはこれらの任意の組み合わせが挙げられるが、これらに限定はされない。公知の適切な任意の接着剤が、使用され得る。一実施形態において、このようなシーラントおよび／または接着剤は、硬化可能であることが、企図される。例えば、約１０秒間〜約１５秒間という硬化時間を有し得るシーラントが、使用され得る。好ましい実施形態において、上記シーラントおよび／または接着剤は、生体吸収性かつ／または生体再吸収性の材料である。別の実施形態において、約３０秒間という硬化時間を有するシーラントおよび／または接着剤が使用され得ることが、企図される。創傷処置材料「Ｗ」は、予め硬化している接着剤またはシーラントであり得ることが、さらに想定される。 It is contemplated that the wound treatment material “W” is any material for connecting, healing, sealing, or otherwise treating tissue. In a preferred embodiment, the wound treatment material is a biocompatible sealant that includes a sealant that cures upon tissue contact, a sealant that cures upon exposure to ultraviolet (UV) light, separated from each other. Examples include, but are not limited to, sealants, which are two-part systems that are maintained and matched in state, or any combination thereof. Any suitable adhesive known in the art can be used. In one embodiment, it is contemplated that such sealants and / or adhesives are curable. For example, a sealant that can have a cure time of about 10 seconds to about 15 seconds can be used. In a preferred embodiment, the sealant and / or adhesive is a bioabsorbable and / or bioresorbable material. In another embodiment, it is contemplated that a sealant and / or adhesive having a cure time of about 30 seconds may be used. It is further envisioned that the wound treatment material “W” may be a pre-cured adhesive or sealant.
特定の好ましい実施形態において、上記創傷処置材料「Ｗ」は、シーラントを含む。そのようなシーラントは、望ましくは、ＰＥＧベースの材料である。上記シーラントおよび／または接着剤として有用である材料の種類の例としては、生体適合性光開始剤の存在下におけるアクリレート官能性ヒドロゲル、生体適合性光開始剤の存在下におけるメタクリレート官能性ヒドロゲル、アルキル−シアノアクリレート、アミン官能性マクロマーを伴うイソシアネート官能性マクロマー、アミン官能性マクロマーを伴わないイソシアネート官能性マクロマー、アミン官能性マクロマーを伴うスクシンイミジルエステル官能性マクロマー、スルフヒドリル官能性マクロマーを伴うスクシンイミジルエステル官能性マクロマー、アミン官能性マクロマーを伴うエポキシ官能性マクロマー、アルデヒド架橋剤の存在下におけるタンパク質の混合物、アルデヒド架橋剤の存在下におけるポリペプチドの混合物、ゲニピン、または水溶性カルボジイミド、多価カチオンの存在下におけるアニオン性多糖などが挙げられる。 In certain preferred embodiments, the wound treatment material “W” comprises a sealant. Such a sealant is desirably a PEG-based material. Examples of the types of materials useful as the sealant and / or adhesive include acrylate functional hydrogels in the presence of biocompatible photoinitiators, methacrylate functional hydrogels in the presence of biocompatible photoinitiators, alkyls Cyanoacrylate, isocyanate functional macromer with amine functional macromer, isocyanate functional macromer without amine functional macromer, succinimidyl ester functional macromer with amine functional macromer, succinimid with sulfhydryl functional macromer Ester functional macromers, epoxy functional macromers with amine functional macromers, mixtures of proteins in the presence of aldehyde crosslinkers, mixtures of polypeptides in the presence of aldehyde crosslinkers, Nipin or water-soluble carbodiimide, such as anionic polysaccharides in the presence of a multivalent cation.
利用され得る一部の具体的な材料としては、有機ポリイソシアネート、およびオキシエチレンベースのジオールまたはオキシエチレンベースのポリオールから誘導される、イソシアネート末端親水性ウレタンプレポリマー（米国特許第６，７０２，７３１号および同第６，２９６，６０７号ならびに米国特許出願公開第２００４／００６８０７８号に開示されるものが挙げられる）；α−シアノアクリレートベースの接着剤（米国特許第６，５６５，８４０号に開示されるものが挙げられる）；アルキルエステルベースのシアノアクリレート接着剤（米国特許第６，６２０，８４６号に開示されるものが挙げられる）；インサイチュで反応可能かつ架橋可能である吸電子性基を有する水溶性前駆体と吸核性基を有する水溶性前駆体とから形成された、生体適合性架橋ポリマーをベースとする接着剤（米国特許第６，５６６，４０６号に開示されるものが挙げられる）；二部分接着剤システム（米国特許出願公開第２００３／００３２７３４号（その内容は、本明細書において参考として援用される）において開示されるような、１つ以上のイソシアネート基で置換されたポリアルキレンオキシド骨格と組合わせた生体吸収性ジアミン化合物に基づく二部分接着剤システム、または１つ以上のアミン基で置換されたポリアルキレンオキシド骨格と組合わせた生体吸収性ジイソシアネート化合物に基づく二部分接着剤システムを含む）；ならびに米国特許出願公開第２００４／０１１５２２９号（その内容は、本明細書において参考として援用される）に開示されるような、芳香族ジイソシアネートおよびポリオールから誘導される、イソシアネート末端親水性ウレタンプレポリマーが、挙げられる。 As a specific material of a part which may be utilized, organic polyisocyanate, and are derived from oxyethylene-based diols or oxyethylene-based polyols, isocyanate terminated hydrophilic urethane prepolymer (U.S. Patent No. 6,702,731 And those disclosed in US Patent Publication No. 6,296,607 and US Patent Application Publication No. 2004/0068078); α-cyanoacrylate based adhesives (disclosed in US Patent No. 6,565,840) Alkyl ester-based cyanoacrylate adhesives (including those disclosed in US Pat. No. 6,620,846); in situ reactive and crosslinkable electrophilic groups Formed from a water-soluble precursor having nucleophilic groups and a water-soluble precursor having a nucleophilic group Biocompatible crosslinked polymer based adhesives (including those disclosed in US Pat. No. 6,566,406); two-part adhesive systems (US 2003/0032734 ( A two-part adhesive based on a bioabsorbable diamine compound in combination with a polyalkylene oxide backbone substituted with one or more isocyanate groups, as disclosed in which is incorporated herein by reference) Systems, or two-part adhesive systems based on bioabsorbable diisocyanate compounds in combination with a polyalkylene oxide backbone substituted with one or more amine groups); and U.S. Patent Application Publication No. 2004/0115229 (contents thereof). Are incorporated herein by reference), as disclosed in Mention may be made of isocyanate-terminated hydrophilic urethane prepolymers derived from cyanates and polyols.
創傷処置材料「Ｗ」は、接着剤、止血剤、シーラント、または他の任意の組織処理材料もしくは創傷処置材料のうちの１つもしくはそれらの組み合わせを含み得ることが、想定され、そしてそれは本開示の範囲内にある。外科用生体適合性創傷処置材料「Ｗ」（これは、本開示に従って使用され得る）としては、器官、組織、もしくは構造体に付着するかもしくはそれらを保持する機能を有する接着剤；流体漏出を防止するためのシーラント；および出血を停止もしくは防止するための止血剤；が挙げられる。使用され得る接着剤の例としては、タンパク質由来のアルデヒドベースの接着材料（例えば、商標名ＢｉｏＧｌｕｅＴＭの下でＣｒｙｏｌｉｆｅ，Ｉｎｃ．から販売されている市販のアルブミン／グルタルアルデヒド材料、ならびにＴｙｃｏ Ｈｅａｌｔｈｃａｒｅ Ｇｒｏｕｐ，ＬＰおよびＥｔｈｉｃｏｎ Ｅｎｄｏｓｕｒｇｅｒｙ，Ｉｎｃ．によってそれぞれ商標名ＩｎｄｅｒｍｉｌＴＭおよびＤｅｒｍａ ＢｏｎｄＴＭの下で販売されているシアノアクリレートベースの材料）が、挙げられる。使用され得るシーラントの例としては、フィブリンシーラント、ならびにコラーゲンベースの組織シーラントおよび合成ポリエチレングリコールベースの組織シーラントが挙げられる。市販のシーラントの例は、Ｃｏｈｅｓｉｏｎ ＴｅｃｈｎｏｌｏｇｉｅｓおよびＢａｘｔｅｒ Ｉｎｔｅｒｎａｔｉｏｎａｌ，Ｉｎｃ．によって商標名ＣｏＳｅａｌＴＭの下で販売されている合成ポリエチレングリコールベースのヒドロゲル材料である。使用され得る止血材料の例としては、フィブリンベース局所止血剤、コラーゲンベースの局所止血剤、酸化再生セルロースベースの局所止血剤、およびゼラチンベースの局所止血剤、ならびにミョウバンアルミニウム（すなわち、アンモニウムミョウバンまたは硫酸アルミニウムアンモニウム）が挙げられる。市販の止血材料の例は、Ｔｙｃｏ Ｈｅａｌｔｈｃａｒｅ Ｇｒｏｕｐ，ＬＰによって商標名ＣｏＳｔａｓｉｓＴＭの下で販売され、Ｂａｘｔｅｒ Ｉｎｔｅｒｎａｔｉｏｎａｌ，Ｉｎｃ．によって商標名ＴｉｓｓｅｅｌＴＭの下で販売されている、フィブリノーゲン−トロンビン配合材料である。本明細書における止血剤としては、収斂剤（例えば、硫酸アルミニウム）および凝固剤が挙げられる。止血剤のさらなる例としては、Ｚ−Ｍｅｄｉｃａ，Ｉｎｃ．，Ｎｅｗｉｎｇｔｏｎ，Ｃｏｎｎｅｃｔｉｃｕｔから市販されている「Ｑｕｉｃｋ ＣｌｏｔＴＭ」が挙げられる。 It is envisioned that the wound treatment material “W” may include one or a combination of adhesives, hemostats, sealants, or any other tissue treatment material or wound treatment material, which is disclosed herein. It is in the range. Surgical biocompatible wound treatment material “W” (which can be used in accordance with the present disclosure) includes an adhesive that has the function of attaching to or holding an organ, tissue, or structure; fluid leakage; Sealants to prevent; and hemostatic agents to stop or prevent bleeding. Examples of adhesives that may be used include protein-derived aldehyde-based adhesive materials (eg, the commercially available albumin / glutaraldehyde material sold by Cryolife, Inc. under the trade name BioGlue ™ , as well as Tyco Healthcare Group, Cyanoacrylate-based materials sold under the trade names Indermil ™ and Derma Bond ™ by LP and Ethicon Endosurgy, Inc., respectively. Examples of sealants that can be used include fibrin sealants, as well as collagen-based tissue sealants and synthetic polyethylene glycol-based tissue sealants. Examples of commercially available sealants include Cohesion Technologies and Baxter International, Inc. Is a synthetic polyethylene glycol based hydrogel material sold under the trade name CoSeal ™ . Examples of hemostatic materials that may be used include fibrin-based topical hemostatic agents, collagen-based topical hemostatic agents, oxidized regenerated cellulose-based topical hemostatic agents, and gelatin-based topical hemostatic agents, and alum aluminum (ie, ammonium alum or sulfate Aluminum ammonium). An example of a commercially available hemostatic material is sold by Tyco Healthcare Group, LP under the trade name CoStatis ™ and is available from Baxter International, Inc. Is a fibrinogen-thrombin compound sold under the trade name Tisseel ™ . The hemostatic agent herein includes astringents (eg, aluminum sulfate) and coagulants. Additional examples of hemostatic agents include Z-Medica, Inc. "Quick Clot ™ " commercially available from Newington, Connecticut.
上記薬物（ｍｅｄｉｃａｍｅｎｔ）は、１種以上の医学的かつ／または外科的に有用な物質（例えば、薬品（ｄｒｕｇ）、酵素、増殖因子、ペプチド、タンパク質、色素、診断剤、止血剤、モノクローナル抗体、または狭窄の防止において使用される他の任意の薬剤を包含し得る。上記薬物（ｍｅｄｉｃａｍｅｎｔ）は、構造物１００上に配置され得るか、または構造物１００中に染み込まされ得る。
The drug may be one or more medically and / or surgically useful substances (eg, drugs, enzymes, growth factors, peptides, proteins, dyes, diagnostic agents, hemostatic agents, monoclonal antibodies, Or any other agent used in the prevention of stenosis, the drug can be placed on or impregnated into the
創傷処置材料「Ｗ」は、粘弾性フィルム形成材料、架橋反応剤、およびエネルギー硬化性接着剤を包含し得る。創傷処置材料「Ｗ」（特に、接着剤）は、水および／またはグリセリン（１，２，３−プラナテトリオール（グリセロールまたはグリセリンとしても公知である））をそれに適用すると硬化し得ることが、想定される。この様式で、水および／またはグリセリンは、上記接着剤を硬化させ、創傷を水和する。 Wound treatment material “W” may include viscoelastic film-forming materials, cross-linking reagents, and energy curable adhesives. The wound treatment material “W” (especially an adhesive) can be cured when water and / or glycerin (1,2,3-planatetriol (also known as glycerol or glycerin)) is applied thereto, is assumed. In this manner, water and / or glycerin hardens the adhesive and hydrates the wound.
創傷処置材料「Ｗ」は、例えば、外科手術修復部位にその粒子が適用もしくは曝露された場合に治癒プロセスを加速するかまたは有益に改変する、組成物および／または化合物を包含し得ることが、さらに企図される。例えば、上記創傷処置材料「Ｗ」は、上記修復部位に配置される治療剤であり得る。上記治療剤は、その抗菌特性について、修復もしくは再構築物および／または新規組織成長を促進する能力について、選択され得る。例えば、上記創傷処置材料「Ｗ」は、ＡｃｒｙＭｅｄ，Ｉｎｃ．，Ｐｏｒｌａｎｄ，Ｏｒｅｇｏｎから市販されている「ＳｉｌｖａＳｏｒｂＴＭ」を包含し得る。抗菌剤（例えば、組織中へとゆっくり放出される広スペクトル抗生物質（硫酸ゲンタマイシン、エリスロマイシン、または誘導体化糖ペプチド））が、組織修復部位において臨床的感染症および無症状性感染症と闘うことを補助するためにこの様式で適用され得る。修復および／または組織成長を促進するために、創傷処置材料「Ｗ」は、１個または数個の増殖促進因子（例えば、線維芽細胞増殖因子、骨増殖因子、上皮増殖因子、血小板由来増殖因子、マクロファージ由来増殖因子、肺胞由来増殖因子、単球由来増殖因子、マガイニン（ｍａｇａｉｎｉｎ）など）を含み得る。一部の治療指標は、組織プラスミノーゲンアクチベーターもしくは腎臓プラスミノーゲンアクチベーターとともに血栓症を引き起こすグリセロール；組織損傷性フリーラジカルを除去するためのスーパーオキシドジスムターゼ；癌治療のための腫瘍壊死因子；または免疫系を増強するためのコロニー刺激因子およびインターフェロン、インターロイキン２もしくは他のリンホカインである。
Wound treatment material “W” can include, for example, a composition and / or compound that accelerates or beneficially modifies the healing process when the particles are applied or exposed to a surgical repair site, Further contemplated. For example, the wound treatment material “W” may be a therapeutic agent that is placed at the repair site. The therapeutic agent can be selected for its antimicrobial properties, for its ability to promote repair or reconstruction and / or new tissue growth. For example, the wound treatment material “W” is available from AcryMed, Inc. , Porland, Oregon, commercially available “SilvaSorb ™ ”. Antibacterial agents (eg, broad spectrum antibiotics that are slowly released into tissues (gentamicin sulfate, erythromycin, or derivatized glycopeptides)) to combat clinical and asymptomatic infections at the site of tissue repair Can be applied in this manner to assist. In order to promote repair and / or tissue growth, the wound treatment material “W” may include one or several growth promoting factors (eg, fibroblast growth factor, bone growth factor, epidermal growth factor, platelet derived growth factor). Macrophage-derived growth factor, alveolar-derived growth factor, monocyte-derived growth factor, magainin, etc.). Some therapeutic indicators are glycerol that causes thrombosis with tissue plasminogen activator or kidney plasminogen activator; superoxide dismutase to remove tissue damaging free radicals; tumor necrosis factor for cancer treatment; Or a colony stimulating factor to enhance the immune system and interferon,
創傷処置材料「Ｗ」が、当業者によって公知である任意の抗菌剤、鎮痛剤、増殖因子、および抗炎症剤、またはそれらの任意の組み合わせを含むことが、さらに想定され、それは本開示の範囲内にある。 It is further envisioned that the wound treatment material “W” includes any antibacterial, analgesic, growth factor, and anti-inflammatory agent, or any combination thereof known by those of ordinary skill in the art, and is within the scope of this disclosure. Is in.
当業者は、外科用ステープル１００の成功する表面処理は、創傷処置材料「Ｗ」の適用前に、外科用ステープル１００を事前に清浄化すること、および外科用ステープル１００の表面の水分を制御することを包含し得、外科用ステープルの完全なコーティングおよび／または適切なコーティングを確実にし得る。従って、多工程の清浄化および乾燥の操作が、正常な表面を提供するため、および水分を制御するために、使用され得る。一旦、上記のように、外科用ステープル１００の表面が処理された後に、創傷処置材料「Ｗ」を含む溶液が、処理済の外科用ステープル１００に適用される。
Those skilled in the art will appreciate that a successful surface treatment of
本明細書に開示される外科用ステープル１００のうちのいずれもが、直線型外科用ステープラー、非直線型外科用ステープラー、環状型外科用ステープラー、内視鏡型外科用ステープラー、皮膚型外科用ステープラーなどと組合わせて使用されることが、企図され、それは本開示の範囲内にある。
Any of the
本明細書中に開示される外科用ステープル１００のいずれもが、等しい長さの脚部、等しくない長さの脚部、それらの脚部の長さと比較して比較的短いクラウン、それらの脚部と比較して比較的長いクラウン、それらの脚部およびクラウンにおける対称的な横断面プロフィール、ならびにそれらの脚部およびクラウンのうちの少なくとも１つにおける非対称性横断面プロフィールを有することが、さらに企図され、それは本開示の範囲内にある。例えば、各脚部および／またはクラウンは、多角形（例えば、三角形、矩形、六角形、それらの任意の組み合わせなど）である断面プロフィールを有し得る。さらに、各脚部および／またはクラウンは、環状、卵形などである断面プロフィールを有し得る。上記クラウンは、直線状であっても、または非直線状であってもよいことが、さらに想定される。
Any of the
本明細書中に開示される外科用ステープル１００のうちのいずれもが、互いとは同じ面に存在しない脚部を備えることが、なおさらに企図され、それは本開示の範囲内にある。換言すると、外科用ステープル１００の一方の脚部とクラウンとが、第一の面を規定し、その外科用ステープル１００のもう一方の脚部は、その第一の面とは同一平面上にないかその第一の面を横断する、第二の面に存在する。
It is still further contemplated that any of the
図５において観察されるように、外科用ファスナーは、二部分ファスナーの形態であり、一般的に２００として示される。例示的な外科用ファスナー２００の物理的構造が、米国特許第４，５３４，３５２号（その内容全体は、本明細書において参考として援用される）において示されそして記載されている。一般的には、外科用ファスナー２００は、保持装置部材２１０およびファスナー部材２０２（これは、保持装置部材２１０における開口部２１２と係合するように組織（示されず）を通して駆動される２つのプロング（ｐｒｏｎｇ）または脚部２０４を備える）を備える。プロング２０４は、各々が、シャンク２０８に結合されたバーブ（ｂａｒｂ）２０６を備える。
As observed in FIG. 5, the surgical fastener is in the form of a two-part fastener and is generally designated as 200. The physical structure of an exemplary
本開示に従って、外科用ファスナー２００（保持装置部材２１０およびファスナー部材２０２を備える）は、本明細書中で上記に開示された材料のうちのいずれかから、同様に構築（同じ材料から構築）され得るか、または互いから独自に構築（すなわち、別々の材料から構築）され得る。 In accordance with the present disclosure, surgical fastener 200 (comprising retainer member 210 and fastener member 202) is similarly constructed (constructed from the same material) from any of the materials disclosed hereinabove. Or can be built independently from each other (ie, built from separate materials).
本開示の支持体構造の形態、詳細、および適用における種々の変化が、本開示の趣旨および精神から逸脱することなくなされ得ることが、理解されるべきである。 It should be understood that various changes in the form, details, and application of the support structure of the present disclosure can be made without departing from the spirit and spirit of the present disclosure.
Claims (16)
一対の脚部と；
該一対の脚部を相互接続するクラウンと；
該脚部およびクラウンのうちの少なくとも一部をコーティングする創傷処置材料と；
を備え、該創傷処置材料は接着剤またはシーラントを含む、外科用ファスナー。A surgical fastener for use in combination with a surgical fastener applying apparatus, the surgical fastener comprising:
A pair of legs;
A crown interconnecting the pair of legs;
A wound treatment material coating at least a portion of the leg and crown;
Comprising a wound treatment material comprises adhesives or sealants, surgical fasteners.
Applications Claiming Priority (3)
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|---|---|---|---|
| US62006804P | 2004-10-18 | 2004-10-18 | |
| US60/620,068 | 2004-10-18 | ||
| PCT/US2005/037264 WO2006044810A2 (en) | 2004-10-18 | 2005-10-14 | Surgical fasteners coated with wound treatment materials |
Related Child Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP2011129319A Division JP2011200684A (en) | 2004-10-18 | 2011-06-09 | Surgical fastener coated with wound treatment material |
Publications (2)
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|---|---|
| JP2008516732A JP2008516732A (en) | 2008-05-22 |
| JP5001848B2 true JP5001848B2 (en) | 2012-08-15 |
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| JP2007537950A Expired - Fee Related JP5001848B2 (en) | 2004-10-18 | 2005-10-14 | Surgical fasteners coated with wound treatment material |
| JP2011129319A Withdrawn JP2011200684A (en) | 2004-10-18 | 2011-06-09 | Surgical fastener coated with wound treatment material |
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| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP2011129319A Withdrawn JP2011200684A (en) | 2004-10-18 | 2011-06-09 | Surgical fastener coated with wound treatment material |
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| Country | Link |
|---|---|
| US (3) | US8097017B2 (en) |
| EP (1) | EP1804684B1 (en) |
| JP (2) | JP5001848B2 (en) |
| AU (1) | AU2005295487B2 (en) |
| CA (1) | CA2584022C (en) |
| ES (1) | ES2748926T3 (en) |
| WO (1) | WO2006044810A2 (en) |
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2005
- 2005-10-14 JP JP2007537950A patent/JP5001848B2/en not_active Expired - Fee Related
- 2005-10-14 AU AU2005295487A patent/AU2005295487B2/en not_active Ceased
- 2005-10-14 ES ES05810430T patent/ES2748926T3/en active Active
- 2005-10-14 EP EP05810430.8A patent/EP1804684B1/en not_active Not-in-force
- 2005-10-14 US US11/250,231 patent/US8097017B2/en not_active Expired - Fee Related
- 2005-10-14 CA CA2584022A patent/CA2584022C/en not_active Expired - Fee Related
- 2005-10-14 WO PCT/US2005/037264 patent/WO2006044810A2/en active Application Filing
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- 2011-12-19 US US13/329,581 patent/US8435263B2/en active Active
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Also Published As
| Publication number | Publication date |
|---|---|
| JP2008516732A (en) | 2008-05-22 |
| US8435263B2 (en) | 2013-05-07 |
| US20060235469A1 (en) | 2006-10-19 |
| ES2748926T3 (en) | 2020-03-18 |
| US8758404B2 (en) | 2014-06-24 |
| WO2006044810A2 (en) | 2006-04-27 |
| AU2005295487B2 (en) | 2010-12-02 |
| EP1804684A4 (en) | 2012-02-22 |
| US8097017B2 (en) | 2012-01-17 |
| US20130226230A1 (en) | 2013-08-29 |
| EP1804684B1 (en) | 2019-09-04 |
| WO2006044810A3 (en) | 2006-12-21 |
| CA2584022C (en) | 2013-12-10 |
| US20120095503A1 (en) | 2012-04-19 |
| JP2011200684A (en) | 2011-10-13 |
| CA2584022A1 (en) | 2006-04-27 |
| AU2005295487A1 (en) | 2006-04-27 |
| EP1804684A2 (en) | 2007-07-11 |
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