text:
|Numéro de publication
|Type de publication
|Numéro de demande
|Date de publication
|19 mai 2011
|Date de dépôt
|13 nov. 2009
|Date de priorité
|13 nov. 2009
|Autre référence de publication
|Numéro de publication
|Robert M. Trusty
|Cessionnaire d'origine
|Ethicon Endo-Surgery, Inc.
|Exporter la citation
|BiBTeX, EndNote, RefMan
|Citations de brevets (40), Référencé par (48), Classifications (28), Événements juridiques (1)
|Liens externes: USPTO, Cession USPTO, Espacenet
Minimally invasive surgical procedures may employ endoscopic, laparoscopic, thoracoscopic, open surgical procedures, or any combinations thereof. Such minimally invasive procedures typically employ the use of a scope such as an endoscope, laparoscope, or thoracoscope, which comprises a rigid or flexible tube with a lens based system that is usually connected to a video camera (single chip or multi chip) or a distal electronic integrated circuit (chip) based system that places the video camera optics and electronics at the tip of the scope. Also attached to the proximal end of the scope may be a fiber optic cable system connected to a light source (halogen or xenon) to illuminate the operative field. Alternatively, illumination may be achieved using a solid-state element, such as a light emitting diode (LED) placed at the distal end of the scope. Laparoscopes may be inserted through 5 mm or 10 mm trocars or keyholes to view the operative field. In laparoscopic procedures, the abdomen is usually insufflated with carbon dioxide gas elevating the abdominal wall above the internal organs like a dome to create a working and viewing space. Carbon dioxide gas is used because it is common to the human body and can be removed by the respiratory system if it is absorbed through tissue. Flexible endoscopes are usually flexible and may be inserted in natural openings of a patient such as the mouth, anus, and/or vagina and used intralumenally, but in Natural Orifice Trans-lumenal Endoscopic Surgery (NOTES™) procedures, the scope may transit the lumen wall and enter the abdominal or thoracic cavity. Thoracoscopes are generally inserted through the chest to access the lungs.
Electronic devices are routinely deployed inside a patient's body. Devices such as pacemakers may be permanently deployed whereas devices such as illumination sources or visualization devices may be temporarily deployed inside a patient's body during minimally invasive surgical procedures. Such electronic devices require a source of electrical energy in order to operate. Conventionally, energy is supplied to such energy consuming electronic devices by way of wires and/or optical fibers embedded in the instrument shaft. Recently, a new class of temporarily deployable visualization and therapy devices have been contemplated and published. These devices may be suspended inside of the abdominal or thoracic cavity from magnets or other mechanical elements, such as discussed in commonly owned U.S. patent application Ser. No. 12/170,862, Titled "TEMPORARILY POSITIONABLE MEDICAL DEVICES," filed on Jul. 10, 2008, which is incorporated herein by reference in its entirety. Typically, energy is supplied to these devices by way of over electronic tethers, which can tend to somewhat restrict movement and flexibility. These tethers can take up valuable space in trocars or cause leaks if run alongside a trocar. One way to overcome these issues is to make additional incisions in the patient's body in order to provide the energy supplying wires to the energy consuming device away from the trocar. Another alternative, batteries, provide a limited amount of energy and may run out of energy during a procedure. Furthermore, batteries are bulky and costly to replace.
In the context of minimally invasive surgical or diagnostic procedures, energy consuming electronic medical devices are routinely deployed inside a patient for viewing portions of the patient's anatomy. To view a desired site of the anatomy (e.g., treatment region worksite, treatment site, target site), a clinician (e.g., a surgeon) may insert a rigid or flexible scope inside the patient. Surgical devices also may be inserted through one or more channels of the scope, through a trocar, or other conduit or lumen to perform various surgical activities, manipulate tissue, or take a sample from a site to test for diseased tissue, e.g., remove a biopsy sample. Visualization systems including cameras, illumination sources, and communication electronics are used to navigate through body cavities or lumens, locate the distal end of the scope at the site, render images of the site, and transmit the images to a display device where they are used by the clinician during the surgical procedure to locate and operate the surgical devices introduced through channels within the scope or the trocar. As previously discussed, however, wiring necessary to supply electrical energy to the visualization system (e.g., camera, light source, transmitter electronics) takes up valuable space within the scope channels that could be used for more sophisticated and/or larger therapeutic or surgical medical devices.
In multi-port and single-port laparoscopic, and natural orifice endoscopic translumenal procedures developed by Ethicon Endo-Surgery, Inc., known in the art as NOTES™ procedures, a significant amount of real estate can be used by the visualization system. In multi-port procedures, one 5 mm or 10 mm port is typically dedicated to providing percutaneous illumination and imaging. In single-port procedures, the same laparoscope may be used in one of the keyholes within the trocar, or an independent flexible scope may be inserted via a natural orifice to provide visualization without using one of the limited numbers of keyholes available in a multi-port trocar. In NOTES™ and NOTES™ hybrid procedures, a flexible endoscope is typically used to access, visualize, and provide channels to deliver therapy to the site. A significant portion of the scope is dedicated to supporting the illumination (optical fibers or LEDs) and imaging devices such as (charge coupled devices (CCD) or complementary metal oxide semiconductor (CMOS) integrated circuit based cameras, lenses, lens-cleaning). This limits the number and size of channels available for therapy or is cause for a scope diameter to be larger than desired.
Additionally, in NOTES™ and multi-port procedures, it is also anticipated that surgeons will want to maintain the same reference viewpoint provided in open or laparoscopic surgeries without accepting any loss of quality in the visualization system. In a laparoscopic procedure, the clinician controls the orientation of the visualization system by panning, zooming, and by rotating the scope about its optical axis, rotating the scope about the trocar/tissue pivot point, and moving the laparoscope in and out. All of these capabilities will continue to be desirable to a surgeon and may need to be accomplished independently of tissue manipulation operations. Thus, in addition to providing a remote source of energy to energy consuming visualization devices, the disclosed embodiments also provide a visualization system that is remotely positionable and manipulatable.
In one embodiment, an apparatus comprises an electronic component suitable for use within a body cavity. An antenna is coupled to the electronic component to communicate signals. A wireless energy module is coupled to the electronic component. A positioning element is used to locate the electronic component within the body cavity. A housing supports the electronic component, the antenna, the wireless energy module, and the positioning element.
The novel features of the various embodiments are set forth with particularity in the appended claims. The various embodiments, however, both as to organization and methods of operation may be best understood by reference to the following description, taken in conjunction with the accompanying drawings as follows.
Various embodiments are disclosed for supplying energy to energy consuming medical electronic devices. More particularly, various embodiments are disclosed for supplying energy to visualization and illumination devices deployable inside a patient's body.
Before explaining the various embodiments in detail, it should be noted that the embodiments are not limited in their application or use to the details of construction and arrangement of parts illustrated in the accompanying drawings and description. The illustrative embodiments may be positioned or incorporated in other embodiments, variations and modifications, and may be practiced or carried out in various ways. For example, the energy transfer delivery devices and energy consuming modules disclosed herein are illustrative only and not meant to limit the scope or application thereof. Furthermore, unless otherwise indicated, the terms and expressions employed herein have been chosen for the purpose of describing the illustrative embodiments for the convenience of the reader and not to limit the scope thereof.
In the following description, like reference characters designate like or corresponding parts throughout the several views. Also, in the following description, it is to be understood that terms such as "inside" and "outside," and the like are words of convenience and are not to be construed as limiting terms. Terminology used herein is not meant to be limiting insofar as devices described herein, or portions thereof, may be attached or utilized in various orientations. The various embodiments will be described in more detail with reference to the drawings.
The described embodiments of devices and methods for remotely supplying energy to (e.g., remotely-powering) energy consuming electronic medical devices can eliminate the need for dedicated laparoscope trocars or use of dedicated keyholes in single and multi-port laparoscopic procedures, and can eliminate the need for a secondary access point (natural orifice or others) into the patient's body for visualization and/or therapeutic purposes. The described embodiments of devices and methods for remotely-powering energy consuming electronic medical devices can also eliminate the need for a tether that connects the electronic devices to a power source located outside the patient's body. Additionally, certain embodiments described herein provide devices and methods for remotely-powering energy consuming electronic medical devices to reduce or eliminate the need for batteries, and thus greatly reducing the required volume and eliminating battery-based limitations on operating time. Such devices also can allow for larger channels and more flexible NOTES™ platform designs by eliminating the need for visualizing the site via the scope or platform.
The various embodiments described throughout this specification provide an energy consuming visualization system. The energy consuming visualization system generally comprises an imaging device, an illumination source, wireless energy transmission circuit elements, signal transceivers, image display electronics, a display, tissue engaging elements (either internal/external magnet arrangement, sutures, adhesives, clamps, corkscrews, or "fangs" to attach to a wall in an internal body cavity), and manipulation devices.
A manipulation module 110 (e.g., handle) is located outside the patient's body cavity 104 to manipulate the energy consuming module 102. In one embodiment, the manipulation module 110 comprises a positioning element, which is used to manipulate the positioning element located within the energy consuming module 102. In various embodiments, the manipulation module 110 also includes transceivers to communicate with the energy consuming module 102 via the antenna and a wireless energy transfer circuit elements to wirelessly supply energy to the energy consuming module 102. As shown in
In one embodiment, the energy consuming module 102 may comprise a visualization system that is deployable within the body cavity 104 through the abdominal wall 108, for example. The visualization system comprises electronic components configured for recording and transmitting images using wireless data transmission techniques. The electronic component and associated imaging and transmitting electronics are powered by the wireless energy module by way of wireless energy transfer techniques. In the embodiment illustrated in
It will be appreciated that in various embodiments, the energy consuming module 102 may be implemented in a variety of systems. In the context of a visualization system embodiment, the energy consuming module 102 comprises an imaging device having a camera. In other embodiments, the energy consuming module 102 may comprise a light source (e.g., LED), circuit elements in a camera module to transmit video signals wirelessly through the abdominal wall 108, circuit elements in a camera module to adjust focus or zoom by driving a motor that moves one or more than one lens, a motor to pan and tilt a camera, circuit elements to charge a battery or capacitor, a motor to close a grasper, a motor to drive an endocutter to close, form staples, and cut tissue, a motor to raise or lower a tissue retractor, a monopolar or bipolar electro-cautery device, a solenoid or motor to lock and cut a suture device, an electromagnet to enhance magnetic attraction to an external magnet, a laser to weld and/or solder tissue, or any combinations thereof, among other embodiments of energy consuming modules.
As shown in
Various embodiments of the energy consuming module 102 described herein may comprise temporarily positionable devices inserted in the body cavity 104 of a patient to provide visualization of a target site or treatment region. The energy consuming module 102 may be introduced into the patient using any of the minimally invasive procedures previously discussed, for example. Visualization embodiments of the energy consuming modules 102 may be wirelessly powered and include wireless transceivers for transmitting signals representative of images captured by a camera and receiving control signals for controlling elements of the energy consuming module 102. Once located at a desired site within the body cavity 104, the energy consuming module 102 may be adapted to provide images of the site including portions of the internal anatomy within the diaphragm or peritoneal cavity such as the lungs, liver, stomach, digestive tract including the small and large intestines and the colon, gall bladder, kidneys, urinary tract, and/or reproductive tract, for example. Images may be obtained during the deployment process as the energy consuming module 102 advances through internal body lumens and cavities. Once the energy consuming module 102 is attached to internal tissue, images of the site may be obtained of to provide a view of the operative field during surgical, therapeutic, or diagnostic procedures. Once positioned proximate to the site, images captured and transmitted by the energy consuming module 102 enable a clinician or surgeon to more accurately diagnose, treat, and observe the treatment region. Embodiments of the energy consuming module 102 may provide images during in-vivo treatment procedures for ablating or destroying live cancerous tissue, tumors, masses, lesions, and other abnormal tissue growths present at the treatment site. Other embodiments of the energy consuming module 102 may be configured to transmit electrical signals to a receiver, which then converts the signals into a viewable image. The signals may be wirelessly transmitted outside the patient, where they are detected by a receiver and coupled to the display 112. In various other embodiments, the energy consuming module 102 may be powered by on-board power sources, such as rechargeable batteries, capacitors, or wireless power transmitters. The embodiments, however, are not limited in the context of positionable energy consuming modules 102 with integrated visualization and illumination devices.
In various embodiments, the energy consuming module 102 described herein may be employed in preoperative patients to screen and diagnose diseases, evaluate tissue without surgery, and to monitor, scan, or otherwise visualize a treatment site inside the patient prior to surgery. The embodiments of the energy consuming module 102 described herein may be employed in surgical or therapeutic procedures to administer sedatives, anesthetics, perform surgical procedures, and to visualize the treatment site or site within the patient during surgery. When positioned at the site, embodiments of the energy consuming module 102 comprising visualization elements illuminate, record images, and transmit the images to an external display 112 located outside the patient. Visualization of the site enables the clinician to accurately diagnose the treatment region and provide a more effective treatment to the patient.
The electronic component 128 may comprise one or more than one discrete or integrated electronic element having one or more than one connecting lead or metallic pad. Typical electronic elements include resistors, capacitors, transistors, diodes, amplifiers, logic gates, microprocessors, microcontrollers, memory, inductors, amplifiers, among others, for example.
In various embodiments, the energy consuming module 102 and/or the electronic component 128 are remotely powered using wireless power transmission techniques, such as inductive coupling 124, resonant energy transfer, or other techniques. Wireless energy coupling/transfer, or wireless power transmission, is the process of transmitting electrical energy from an energy source to an electronic load, without interconnecting wires, using electromagnetic fields. Such wireless energy coupling/transfer techniques use alternating current (AC) magnetic fields generated in a first inductive coil (e.g., conductor) located outside the patient to stimulate electrical current through a second inductive coil (e.g., conductor) located inside the patient. An electric transformer is the simplest instance of wireless energy transfer. The primary and secondary circuits of a transformer are not directly connected. In the transformer, the coupling/transfer of energy takes place by electromagnetic coupling through a process known as mutual induction. The embodiments, however, are not limited in this context. Other wireless energy transfer technology also may be employed without limitation. For example, radio frequency (RF) energy transfer devices produced by Powercast, Inc., can be used to transfer energy across a distance. The Powercast system is capable of achieving a maximum output of about 6 volts for a little over one meter. Other low-power wireless power technology has been proposed and is described in U.S. Pat. No. 6,967,462, for example.
In one embodiment, the wireless energy transmitter module 136 of the manipulation module 110 is coupled to the energy source 114, which provides power (voltage and current) to the wireless energy transmitter module 136. A generator circuit 120 converts the power received from the energy source 114 and supplies alternating current (AC) power to a generating element 122. In various embodiments, the generating element 122 may comprise one or more than one single or multi-turn inductive coil, for example. In one embodiment, the energy consuming module 102 comprises a wireless energy module 140, which comprises a collection element 126 to couple energy generated by the generating element 122. In one embodiment, the collection element 126 may comprise one or more than one single or multi-turn inductive coil, for example. The transfer of energy from the generating element 122 to the collection element 126 may be via inductive coupling 124 as shown, or via resonant energy transfer, for example, in both instances without employing interconnecting wires. Thus, energy is transmitted wirelessly via inductive coupling 124 from the manipulation unit 110 to the energy consuming module 102. As shown in
Inductive coupling 124 uses magnetic fields that are generated by the movement of electric current through a wire forming the generating element 122. The magnetic field induces a current in the collection element 126. As is well known in the art, when electrical current moves through the wire, it creates a circular magnetic field around the wire. Bending the wire into a first coil amplifies the magnetic field. The more loops the coil makes, the bigger the field will be. If a second coil of wire is placed in the magnetic field, the field can induce a current in the wire of the second coil. This is essentially how a transformer works and how the wireless energy module 140 supplies energy to the electronic component 128 and/or charges a rechargeable element 146 such as a rechargeable battery by inductive coupling 124. Alternatively, the rechargeable element 146 may be implemented as a capacitor circuit that may be charged to store energy and power circuits connected thereto. Current from the energy source 114 flows through the generator circuit 120 and the generating element 122 (e.g., first coil) portion of the wireless energy transmitter module 136, creating a magnetic field. In a transformer, the first coil is called the primary winding. When the wireless energy transmitter module 136 is energized and placed near the wireless energy module 140, the magnetic field generated by the first coil induces a current in the energy collection element 126 (e.g., second coil), or secondary winding, which connects to a conditioning circuit 116 and/or the rechargeable element 146. The conditioning circuit 116 converts this current into a suitable voltage and current for operating the electronic component 128 by or for charging the rechargeable element 146.
Resonant energy transfer techniques can produce larger and stronger fields that can induce current from farther away than can be achieved by inductive coupling alone. This non-radiative energy transfer involves stationary fields around transmitting and receiving coils rather than fields that spread in all directions. Power can be transferred efficiently between coils separated by a few meters by adding resonance to the system. Induction can take place if the electromagnetic fields around the coils resonate at the same frequency. In one embodiment, a curved coil of wire is used as an inductor and a capacitance plate, which can hold a charge, is attached to each end of the coil. As electricity travels through the coil, the coil begins to resonate at a resonant frequency, which is the product of the inductance of the coil and the capacitance of the plates. The coil and capacitive plates may be curved. Electricity, traveling along an electromagnetic wave, can tunnel from a transmitting coil to a collecting or receiving coil located within a few meters of each other. As long as both coils have the same resonant frequency, streams of energy move from the transmitting coil to the receiving coil. In another embodiment, one coil can send electricity to several receiving coils, as long as they all resonate at the same frequency. One coil can recharge any device that is in range, as long as the coils have the same resonant frequency.
The collection element 126 of the wireless energy module 140 is coupled to the conditioning circuit 116 that generates a suitable operating voltage and current for use by the electronic component 128. In one embodiment, the conditioning circuit 116 may be coupled to the optional rechargeable element 146 (e.g., the rechargeable battery or capacitive circuit shown in phantom) that can be charged using the energy coupled/transferred to the collection element 126 via inductive coupling 124. The rechargeable element 146 is charged by inductively coupling 124 energy from the generating element 122 (e.g., generating coil) to the collection element 126 (e.g., collection coil). The conditioning circuit 116 provides a voltage and current that is suitable for charging the rechargeable element 146.
In one embodiment, the communication circuit 138 comprises a receiver to receive imaging signals 134 generated by an imaging device portion of the electronic component 128. The electronic component 128 comprises a transmitter coupled to an antenna 224 for transmitting imaging signals 134 to the receiver portion of the communication circuit 138. In one embodiment, the communication circuit 138 comprises a transmitter to transmit control signals 135 to the electronic component 128. In one embodiment, the control signal 135 may be employed to adjust the focus of a lens system. In various embodiments, the control signals 135 may be used to control the operation of the energy consuming module 102, the electronic component 128, or any other component of the energy consuming module 102.
The positioning element 130 of the manipulation module 110 interacts with the positioning element 132 of the energy consuming module 102. The interaction between the positioning elements 130, 132 is exploited to locate and position the energy consuming module 102 and/or to fix the energy consuming module 102 in place once it is located in a desired position within the body cavity. In one embodiment, the positioning elements 130, 132 are permanent magnets. In other embodiments, the positioning elements 130, 132 may be electromagnets and/or combinations of permanent magnets and electromagnets. In other embodiments, the positioning element 132 of the energy consuming module 102 also may comprise hooks or other tissue engaging elements to hold the energy consuming module 102 in place within the body cavity 104 (
As previously discussed, the energy source 226 may comprise the wireless energy module 140 and optionally the rechargeable element 146. The energy source 226 may be an on-board energy source located within a housing or body of the imaging device 210, such as the rechargeable element 146 or may be a remote energy source located outside the housing or body of the imaging device 210. In other embodiments, the imaging device 210 may be powered by remote energy sources using wireless energy transfer techniques such as induction or resonant transfer, as previously discussed with reference to
It will be appreciated that a plurality of CCD or CMOS imaging cameras 218 may be used in the imaging device 210 and system. Each CCD or CMOS based imaging camera 218 may include its own optical system 220 and either one or more illumination sources 216 in accordance with specific requirements of the device or system.
Images obtained by the imaging camera 218 are transmitted to a receiving system, e.g., imaging signals 134 transmitted to the communication circuit 138 in the manipulation module 110 as shown in and described with reference to
The imaging device 210 may be formed in any shape suitable for insertion into an internal body cavity. Furthermore, the imaging device 210 may be attached or affixed on to an instrument that can be inserted into various body lumens and cavities, such as on an endoscope, laparoscope, thoracoscope, stent, needle, and catheter. Thus, the imaging device 210 may be introduced into the internal body cavity 104 (
A suitable imaging camera 218 is, for example, a "camera on a chip" type CMOS imager with integrated active pixel and post processing circuitry. The single chip camera can provide either black and white or color signals. The imaging camera 218 may be designed such that it is less sensitive to light in the red spectrum than known CMOS cameras. The imaging camera 218 may comprise one or more CCD arrays or CMOS devices such as active-pixel sensors. As used herein, the term "camera" is intended to cover any imaging device comprising image sensors suitable for capturing light and converting images to electronic signals that can be stored in electronic storage media or transmitted, by wire or wireless techniques, to external devices for displaying the images on video monitors. The images may include still photographs or a sequence of images forming a moving picture (e.g., movies or videos). Optical systems comprising one or more lenses may be optically coupled to the one or more image sensors, similar to those employed in digital cameras and other electronic imaging devices, to convert an optical image to an electric signal. The image sensor portion of the imaging camera 218 may comprise one or more arrays of CCD or CMOS devices such as active-pixel sensors. The imaging camera 218 captures light and converts it into electric signals. A large area image sensor may be used to provide a substantially high quality image equivalent to that obtainable with standard laparoscopes, for example. In one embodiment, the imaging camera 218 may comprise a sensor array having approximately a 10 mm diameter image input area. In other embodiments, motors may be employed for orienting, panning, zooming, and/or focusing the imaging camera 218 and providing an optimal viewing angle of the target anatomy in a desired orientation. As previously discussed, these functions may be remotely controlled by the control signals 135 transmitted by the manipulation module 110.
The optical system 220 comprises at least one lens and optionally mirrors and/or prisms for collecting and collimating remitted light on to the pixels of the imaging camera 218. Typically, the optical system comprises an aspherical focusing lens. A suitable lens may be designed in accordance with specific object plane, distortion, and resolution parameters.
The illumination source 216 transmits light to the walls of the internal body cavity 104 (
A single or plurality of illumination sources 216 or a specific integrated illumination source may be used and positioned in accordance with specific imaging requirements, such as to avoid stray light. Also, the optical window 212 may be positioned and shaped according to the device shape and according to specific imaging requirements. For example, imaging conditions can be obtained when the optical window 212 is formed to define an ellipsoid shaped dome and the imaging camera 218 and illumination sources 216 are positioned in proximity of the focal plane of the shape defined by the optical dome.
The in-vivo sites imaged are usually very close to the imager. It is therefore possible to satisfy the illumination requirements of the imaging process utilizing solid state illumination sources, such as one or more than one LED. Accordingly, in one embodiment, the illumination source 216 comprises one or more than one white LED and preferably one or more than one white LED. The white light emitted from a white LED has a small fraction of red light and even smaller fraction of infrared (IR) light. Hence, a white LED is beneficial for use with silicon based image sensors (such as CMOS imaging cameras) because of the sensitivity of silicon to red and IR light. In a system which includes the imaging camera 218 with its reduced sensitivity to light in the red spectrum and a white LED illumination source 216, no IR reject filters (photopic filters) are needed. One or more than one illumination source 216 may be located on either ends of the body to illuminate the site to be imaged. The illumination source 216 may comprise one or more than one light source. In one embodiment, the illumination source 216 may comprise a single LED or a combination of LEDs selected to produce light of a desired spectrum. In one embodiment, the illumination source 216 may be coupled to motors for orienting, panning, zooming, and/or focusing the illumination source 216 to provide optimal illumination of the site. As previously discussed, these functions may be controlled by the control signals 135.
A suitable transmitter 222 may comprise a modulator which receives the video signal (either digital or analog) from the imaging camera 218, a RF amplifier, an impedance matcher, and an antenna 224. In wireless applications, the imaging device 210 may comprise a transceiver (e.g., transmitter/receiver) to transmit the video signal (e.g., imaging signals 134 in
A suitable antenna 224 may comprise any suitable RF antennas. Examples of suitable antennas includes, without limitation, embedded antennas designed for video telemetry, rectangular microstrip antennas (e.g., patch or planar antennas) comprising a conductor (square or otherwise) formed over a ground plane, slot antennas, tapered slot antennas, wire antennas, stub antennas, or blade antennas, among numerous other suitable antenna devices and/or configurations. The antenna 224 may comprise a single radiating element or an array of radiating elements.
In various embodiments, the imaging device 210 may be coupled to a circuit comprising any necessary electronic components or elements for processing, storing, and/or transmitting the images received by the image sensor. The images may be processed by any suitable digital or analog signal processing circuits and/or techniques implemented in logic, software, or firmware. Furthermore, the images may be stored in electronic storage media such as, for example, memory devices. The circuits may be coupled by one or more connectors. It will be appreciated by those skilled in the art that a single circuit or multiple circuits may be employed to process, store, and transmit the images without limiting the scope of the illustrated embodiments.
The circuits, image sensors, batteries, illumination sources, transmitters, transceivers, antennas, and/or any other electronic component, may be disposed on a variety of substrates such as a printed circuit board and/or ceramic substrate and may be connected by one or more connectors.
One or more substrates (e.g., printed circuit boards, ceramic) may be used to mechanically support and electrically connect any of the electronic components associated with the imaging device 210 using conductive pathways, or traces. The substrate may be a rigid or flexible printed circuit board, ceramic, or may be formed of other suitable materials, and may be interconnected by one or more connectors.
In various other embodiments, the imaging device 210 may be implemented in a manner similar to that described in U.S. Pat. Nos. 5,604,531 and 7,009,634, each of which is incorporated herein by reference in its entirety.
As shown in
As illustrated in
Additional embodiments are disclosed herein that provide "in flight" recharging of energy consuming modules located within the patient, particularly wireless cameras and light source systems. As previously discussed, in minimally invasive surgery, it is desirable to deliver devices into the patient's body via an access port in a way that allows the port to be available for other uses once the device is delivered. One class of such devices is magnetically-based and typically includes an internal end-effector that provides therapy to the patient (e.g., electro-cautery) or information to the surgeon (e.g., video camera) and an external magnet used by the surgeon to control the internal device.
Some of the devices delivered through the port may be electronic in nature and require power or electronic data to be delivered to them to operate, for example, to adjust the focus of a lens system. They also may need to deliver electronic information to personnel in the operating room in the form of an imaging stream, for example. Other devices may employ an electronic connector, such as a motorized stapler, electro-cautery device, harmonic scalpel, bi-polar forceps, among others. Even other devices may require a mechanical input, for example, a drive system to lower a camera or an electro-cautery pencil on an arm.
Accordingly, various embodiments illustrated with reference to
With reference still to
As shown in
A method of providing images of a treatment site inside the patient in now described with reference to
Once the energy consuming module 102 is inserted into the body cavity 104, the housing 106 of the energy consuming module 102 may be attached to a wall of the body cavity 104. Once attached to the wall of the body cavity 104, the housing 108, and thus the energy consuming module 102 and components thereof, can be positioned with the manipulation module 110.
Once in position and desirably oriented, the imaging device 210 portion of the electronic component 128 is used to capture video images within the body cavity 104. Video signals 134 corresponding to the captured video images are transmitted via the antenna 224 to the manipulation module 110, for example. The video signals 134 are received by a receiver portion of the communication circuit 138 at the manipulation module 110. The video signal 134 is transmitted to a display device 112 where the video is displayed.
With reference now to
In summary, numerous benefits have been described which result from employing the concepts described herein. The foregoing description of the one or more than one disclosed embodiment has been presented for purposes of illustration and description. It is not intended to be exhaustive or limiting to the precise form disclosed. Modifications or variations are possible in light of the above teachings. The one or more than one disclosed embodiment was chosen and described in order to illustrate principles and practical applications to thereby enable one of ordinary skill in the art to utilize the various embodiments and with various modifications as are suited to the particular use contemplated. It is intended that the claims submitted herewith define the overall scope.
The energy consuming devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, the energy consuming devices can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the energy consuming device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, the energy consuming device can be disassembled, and any number of the particular pieces or parts of the energy consuming device can be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, the energy consuming device can be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of an energy consuming device can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned energy consuming device, are all within the scope of the present application.
Preferably, the various embodiments described herein will be processed before surgery. First, a new or used energy consuming device is obtained and if necessary cleaned. The energy consuming device can then be sterilized. In one sterilization technique, the energy consuming device is placed in a closed and sealed container, such as a plastic or TYVEK® bag. The container and the energy consuming device are then placed in a field of radiation that can penetrate the container, such as x-rays, or high-energy electrons. The radiation kills bacteria on the instrument and in the container. Other sterilization techniques, such as Ethylene Oxide (EtO) gas sterilization also may be employed to sterilize the energy consuming device prior to use. The sterilized energy consuming device can then be stored in the sterile container. The sealed container keeps the energy consuming device sterile until it is opened in the medical facility.
It is preferred that the energy consuming device is sterilized. This can be done by any number of ways known to those skilled in the art including beta or gamma radiation, ethylene oxide, steam.
Although various embodiments have been described herein, many modifications and variations to those embodiments may be implemented. For example, different types of end effectors may be employed. Also, where materials are disclosed for certain components, other materials may be used. The foregoing description and following claims are intended to cover all such modification and variations.
Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.
|Brevet cité
|Date de dépôt
|Date de publication
|18 mars 1998
|31 oct. 2000
|Linvatec Corporation
|Video camera system and related method
|23 oct. 1998
|29 mai 2001
|Robert R. Alfano
|Remote-controllable, micro-scale device for use in in vivo medical diagnosis and/or treatment
|30 aoűt 2005
|3 mars 2009
|Stryker Corporation
|Apparatus and method for using RFID to track use of a component within a device
|25 juil. 2002
|31 mars 2009
|Olympus Corporation
|Capsule-type medical apparatus
|29 déc. 2005
|16 mars 2010
|Given Imaging, Ltd.
|Device, system and method for in-vivo sensing of a body lumen
|27 sept. 2005
|23 mars 2010
|Given Imaging, Ltd.
|System and method to detect a transition in an image stream
|28 juin 2007
|13 avr. 2010
|Olympus Corporation
|Medical apparatus, medical apparatus guide system, capsule type medical apparatus, and capsule type medical apparatus guide apparatus
|31 janv. 2007
|28 juin 2011
|Olympus Corporation
|Image-pickup apparatus
|26 mars 2001
|13 déc. 2001
|Gazdzinski Robert F.
|Endoscopic smart probe and method
|4 avr. 2002
|7 nov. 2002
|Arkady Glukhovsky
|Induction powered in vivo imaging device
|18 juin 2002
|26 déc. 2002
|Olympus Optical Co., Ltd.
|Capsule type endoscope
|29 aoűt 2002
|27 mars 2003
|Rainer Kuth
|Minimally invasive medical system employing a magnetically controlled endo-robot
|11 févr. 2003
|20 nov. 2003
|Iddan Gavriel J.
|Self propelled device having a magnetohydrodynamic propulsion system
|12 sept. 2002
|18 mars 2004
|Sungho Jin
|Magnetic navigation system for diagnosis, biopsy and drug delivery vehicles
|1 aoűt 2003
|13 mai 2004
|Igal Madar
|Techniques for identifying molecular structures and treating cell types lining a body lumen using fluorescence
|10 nov. 2003
|3 juin 2004
|Fuji Photo Optical Co., Ltd.
|Electronic endoscope apparatus transmitting radio signals by wire
|22 juil. 2003
|8 juil. 2004
|Pentax Corporation
|Capsule endoscope guidance system, capsule endoscope holder, and capsule endoscope
|16 oct. 2003
|15 juil. 2004
|Alex Harel
|Navigating and maneuvering of an in vivo vehicle by extracorporeal devices
|16 janv. 2004
|21 oct. 2004
|Ntt Docomo, Inc.
|Method and system for measuring a position, position measuring device, and an in vivo radio device
|3 mars 2005
|29 sept. 2005
|Isao Aoki
|Detecting system of position and posture of capsule medical device
|28 juin 2005
|29 déc. 2005
|Makoto Teraura
|Moving device in pipe lines
|6 févr. 2007
|26 juil. 2007
|Olympus Corporation
|Capsule-type medical device
|25 sept. 2007
|3 avr. 2008
|Semiconductor Energy Laboratory Co., Ltd.
|Wireless sensor device
|17 févr. 2005
|17 avr. 2008
|Korea Institute Of Science And Technology
|Teleoperated Endoscopic Capsule Equipped With Active Locomotion System
|15 nov. 2007
|12 juin 2008
|Reid Cover
|Wireless endoscopic camera
|5 déc. 2007
|26 juin 2008
|Carl Zeiss Surgical Gmbh
|Remote control system for medical apparatus
|18 juil. 2008
|29 janv. 2009
|Hoya Corporation
|Electrical power supply device for endoscope and endoscope
|6 oct. 2008
|9 avr. 2009
|Olympus Corporation
|Living body information acquiring apparatus, living body observation system, and method of driving living body observation system
|26 mai 2009
|26 nov. 2009
|Olympus Medical Systems Corp.
|Capsule medical apparatus and method of charging capsule medical apparatus
|21 nov. 2007
|4 mars 2010
|Kolen Co., Ltd.
|Capsule-type image photographing apparatus and endoscopy using the same
|11 janv. 2010
|6 mai 2010
|Olympus Medical Systems Corp.
|Medical apparatus and procedure of installing medical apparatus in patient
|17 déc. 2008
|17 juin 2010
|Ethicon Endo-Surgery, Inc.
|Positionable imaging medical devices
|9 nov. 2008
|21 oct. 2010
|Amir Belson
|Apparatus and methods for capsule endoscopy of the esophagus
|18 déc. 2009
|23 juin 2011
|Ethicon Endo-Surgery, Inc.
|Surgical instrument comprising an electrode
|11 aoűt 2011
|Amling Marc R
|Wireless Camera Coupling With Rotatable Coupling
|31 mai 2012
|Sopro-Comeg Gmbh
|14 juin 2012
|Semion Khait
|Magnetically maneuverable in-vivo device
|26 déc. 2012
|4 juil. 2013
|Given Imaging Ltd.
|System and apparatus for anchoring and operation of in-vivo medical devices
|30 mai 2012
|5 sept. 2013
|Gi-Shih LIEN
|Magnetic maneuvering system for capsule endoscope
|14 aoűt 2013
|12 déc. 2013
|Magnetecs Corporation
|Magnetically maneuverable in-vivo device
|Brevet citant
|Date de dépôt
|Date de publication
|2 févr. 2009
|18 oct. 2011
|Ethicon Endo-Surgery, Inc.
|Surgical scissors
|30 mai 2008
|6 déc. 2011
|Ethicon Endo-Surgery, Inc.
|Surgical fastening device
|26 avr. 2007
|13 déc. 2011
|Ethicon Endo-Surgery, Inc.
|Surgical suturing apparatus
|27 avr. 2007
|24 janv. 2012
|Ethicon Endo-Surgery, Inc.
|Curved needle suturing tool
|30 mai 2008
|14 févr. 2012
|Ethicon Endo-Surgery, Inc.
|Electrical ablation device
|9 sept. 2008
|14 févr. 2012
|Ethicon Endo-Surgery, Inc.
|Surgical grasping device
|17 avr. 2012
|Ethicon Endo-Surgery, Inc.
|Rotational coupling device for surgical instrument with flexible actuators
|11 déc. 2008
|8 mai 2012
|Ethicon Endo-Surgery, Inc.
|Specimen retrieval device
|16 avr. 2009
|15 mai 2012
|Sony Corporation
|Wireless power and communication system
|15 aoűt 2008
|3 juil. 2012
|Ethicon Endo-Surgery, Inc.
|Sterile appliance delivery device for endoscopic procedures
|29 aoűt 2008
|14 aoűt 2012
|Ethicon Endo-Surgery, Inc.
|Articulating end cap
|30 janv. 2009
|28 aoűt 2012
|Ethicon Endo-Surgery, Inc.
|Surgical access device
|14 juil. 2008
|11 sept. 2012
|Ethicon Endo-Surgery, Inc.
|Endoscopic translumenal articulatable steerable overtube
|21 nov. 2007
|11 sept. 2012
|Ethicon Endo-Surgery, Inc.
|Bipolar forceps
|10 mars 2008
|11 sept. 2012
|Ethicon Endo-Surgery, Inc.
|Anastomotic device
|30 mai 2008
|27 nov. 2012
|Ethicon Endo-Surgery, Inc.
|Endoscopic suturing tension controlling and indication devices
|1 oct. 2008
|25 déc. 2012
|Ethicon Endo-Surgery, Inc.
|Overtube with expandable tip
|17 déc. 2009
|15 janv. 2013
|Ethicon Endo-Surgery, Inc.
|User interface support devices for endoscopic surgical instruments
|27 juin 2008
|29 janv. 2013
|Ethicon Endo-Surgery, Inc.
|Surgical suture arrangement
|5 juin 2008
|26 mars 2013
|Ethicon Endo-Surgery, Inc.
|Manually articulating devices
|3 sept. 2008
|2 avr. 2013
|Ethicon Endo-Surgery, Inc.
|Surgical grasping device
|25 aoűt 2011
|23 avr. 2013
|Ethicon Endo-Surgery, Inc.
|Electroporation ablation apparatus, system, and method
|27 janv. 2010
|28 mai 2013
|Ethicon Endo-Surgery, Inc.
|Electroporation ablation apparatus, system, and method
|31 oct. 2007
|9 juil. 2013
|Ethicon Endo-Surgery, Inc.
|Detachable distal overtube section and methods for forming a sealable opening in the wall of an organ
|2 sept. 2008
|9 juil. 2013
|Ethicon Endo-Surgery, Inc.
|Suturing device
|17 déc. 2009
|30 juil. 2013
|Ethicon Endo-Surgery, Inc.
|Selectively positionable camera for surgical guide tube assembly
|18 déc. 2009
|13 aoűt 2013
|Ethicon Endo-Surgery, Inc.
|Surgical instrument comprising an electrode
|25 aoűt 2008
|10 sept. 2013
|Ethicon Endo-Surgery, Inc.
|Electrical ablation devices
|25 avr. 2008
|29 oct. 2013
|Ethicon Endo-Surgery, Inc.
|Electrical ablation surgical instruments
|21 nov. 2007
|12 nov. 2013
|Ethicon Endo-Surgery, Inc.
|Bipolar forceps
|5 nov. 2009
|17 déc. 2013
|Ethicon Endo-Surgery, Inc.
|Vaginal entry surgical devices, kit, system, and method
|30 mai 2008
|18 févr. 2014
|Ethicon Endo-Surgery, Inc.
|Multifunction surgical device
|30 mai 2008
|25 mars 2014
|Ethicon Endo-Surgery, Inc.
|Surgical device and endoscope including same
|30 mai 2008
|8 juil. 2014
|Ethicon Endo-Surgery, Inc.
|Actuating and articulating surgical device
|12 janv. 2009
|9 sept. 2014
|Ethicon Endo-Surgery, Inc.
|Apparatus for forming an anastomosis
|14 juil. 2008
|18 nov. 2014
|Ethicon Endo-Surgery, Inc.
|Tissue apposition clip application devices and methods
|4 juin 2008
|9 déc. 2014
|Ethicon Endo-Surgery, Inc.
|Endoscopic drop off bag
|4 févr. 2011
|27 janv. 2015
|Ethicon Endo-Surgery, Inc.
|Methods for closing a gastrotomy
|17 févr. 2012
|24 mars 2015
|Ethicon Endo-Surgery, Inc.
|Apparatus and methods for cleaning the lens of an endoscope
|29 janv. 2010
|14 avr. 2015
|Ethicon Endo-Surgery, Inc.
|Surgical instrument comprising an electrode
|4 sept. 2012
|21 avr. 2015
|Ethicon Endo-Surgery, Inc.
|Electrical ablation devices
|18 déc. 2009
|12 mai 2015
|Ethicon Endo-Surgery, Inc.
|Surgical instrument comprising an electrode
|15 mars 2012
|9 juin 2015
|Ethicon Endo-Surgery, Inc.
|Hand held surgical device for manipulating an internal magnet assembly within a patient
|3 juil. 2012
|14 juil. 2015
|Ethicon Endo-Surgery, Inc.
|Endoscopic cap electrode and method for using the same
|10 févr. 2011
|18 aoűt 2015
|Covidien Lp
|System and method for transferring power to intrabody instruments
|26 sept. 2012
|8 sept. 2015
|Ethicon Endo-Surgery, Inc.
|Detachable end effector and loader
|8 sept. 2011
|Tyco Healthcare Group Lp
|System and method for transferring power to intrabody instruments
|15 mars 2013
|18 sept. 2014
|Banpil Photonics, Inc.
|Image detecting capsule device and manufacturing thereof
|Classification aux États-Unis
|Classification internationale
|Classification coopérative
|Classification européenne
|13 janv. 2010
Owner name: ETHICON ENDO-SURGERY, INC., OHIO
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:TRUSTY, ROBERT M.;REEL/FRAME:023775/0354
Effective date: 20091123


text:
Clarence Clemons Tribute at U2 Concert (Video)
"This man just carried music, and music carried him, until this day," Bono said before singing "Moment of Surrender" in Anaheim Sunday.
U2 played tribute to Clarence Clemons at a Saturday concert in Anaheim, Calif.
Before launching into "Moment of Surrender, Bono said of the saxophonist, who had died earlier that day, "I want you to think about the beautiful symphonic sound that came out of one man's saxophone. I want you to think about Bruce Springsteen and the E Street Band -- brothers. I want you to think of Clarence Clemons. This man just carried music, and music carried him, until this day."
Bono also added several words from the E Street song "Jungleland" into the end of the song. Watch below.
Clemons died at 69 one week after suffering a stroke. He was at his Florida home.
According to reports, he had undergone two brain surgeries while hospitalized but had taken a turn for the worse in recent days.
Nicknamed "The Big Man," Clemons never missed an E Street Band gig, last performing with them in December 2010.
Clemons also had memorable cameos in the films New York, New York (1977), Bill and Ted's Excellent Adventure (1989) and Fatal Instinct (1993) and in the TV shows Nash Bridges, The Wire and The Simpsons.
He recently contributed to Lady Gaga's "Edge of Glory" video. Clemons also appears in the just-released video for the song, where he is seen on a city-like stoop playing his sax.
Read Bruce Springsteen's message to the saxophonist here, and Hollywood's tributes here.
Never miss a story. Stay up-to-date with THR's Daily Headlines.
Must Reads
'The Martian's' Matt Damon Talks 'Bourne' Return, Politics and PC Flubs: "Oh My God, I Look Like an Asshole"
Hollywood's 100 Favorite TV Shows
The Insane Battle Over Sam Simon's Will — Should the Simpson's Co-Creator's Trust Pay $140,000 Per Year For One Dog's Care?
'Empire's' "Batshit Crazy" Behind-the-Scenes Drama: On the Set of TV's Hottest Show
Drought Panic, Guilt, Finger-Pointing Put Hollywood to the Test
Hollywood's Notable Deaths of 2015

subset: commoncrawl


text:
How to get rid of acne is a challenge that has many people seeking a good answer. Living with acne on your skin is unpleasant. The irritated red pimples and lesions frequently considerably take away from somebody's individual appearance and appeal
Additionally, there are numerous false stereotypes that people can assume about people who suffer from this unattractive skin complaint. Fortunately, it's not impossible to assist yourself to get rid of acne. There are ways that it can be achieved.
Acne happens in a specific way. Grime, dead skin and oil from time to time obstructs the sebaceous glands on your face that are responsible for making sebum. Then the bacteria which in turn prosper throughout the congestion trigger an inflammatory reaction of the skin which results in contaminated how to clear acne regions. The bacterias to blame usually are present normally on our face and bodies, nevertheless in this particular situation they cause our immune defences to operate in the infected area.
As our white blood cells work, pus often fills the infected area. The ensuing swelling is the thing that we view on the surface of the skin as acne. In actual fact, the inflammation that seems apparent today on our skin has been a number of many days in it's gestation. So as you can see now, it's a protracted developmental process which takes time to eliminate.
The initial steps when you want to get rid of acne entails preventative care. The actual bacterias in acne have to be suitably taken care of in an effort to remove their presence. Regular washing with an anti-bacterial agent is among the most important things you can do in your effort to stop your acne from spreading. A thorough clean with an efficient anti-acne wash two times a day will assist to significantly decrease your acne. Care is needed when applying hot water, both when washing your facial area or having lengthy hot showers, since you can suffer a loss of a lot of moisture from your skin area whilst carrying out this. While washing the infected area, being careful is more suitable compared to going at it hard. Try to find the most suitable acne treatments that will keep intact the moisture and condition of the skin whilst getting rid of bacterias as well. Comprehensive healing systems including several items tend to be better than any one item by itself. Remember to plan sufficiently since some treatment plans can be quite costly.
It is also important to take into account the foods you eat when trying to get rid of acne. Your diet really should be a healthy mixture of all food groups with a good amount of fresh fruits as well as vegetables to get your skin acne free. Sweets and fatty food items do not basically cause acne, but it really by no means is painful to eat the right way and take care of your body. Consuming snacks is good in giving your rate of metabolism a lift through the day as well as an excellent method of getting a number of fruits and veggies into your diet.
There's really no one particular solution for every individual. Many treatments may deliver the results for many people, but may inspire grumbles about their inadequacy from other people. Therefore it might take a small amount of trying out to discover which system is best suited because perhaps even the most popular product mightn't be effective for a few people. Give thought to your personal skin care and do not sit by while hoping for a solution. Getting rid of acne is not necessarily straightforward within a short amount of time. Sustaining total epidermis well being is important.
If it relates to you, you should consider using oil free cosmetics. This type possess less of a tendency to result in the actual pore blockages that results in awful skin. It is undoubtedly very important to take your makeup products off every single night after use, and apply your acne facial cleanser to help with the elimination of oil, dirt and grime and makeup products from your epidermis.
Pressing your face too much can certainly spread problems and needs to be avoided , but remember there are other things which come into contact with your face than hands. Remember about your hair, pillowcases, as well as clothing. Be sure to keep your hair nicely cleaned, and out of your face. Be very careful to clean your pillowcases well. Don't squeeze your acne, it can cause it to become more red-looking and spreads the bacterias and oils that are responsible for your condition. This can also result in scarring.Aim for healthier skin instead of looking for over night results which may not last.
So that you can flourish in your pursuit to get rid of acne it is undoubtedly important to keep working at it and stick to an organised plan, so you should keep on making the effort no matter how hard it often appears. In the event that one thing doesn't work then proceed to your next alternative. Even treatment for acne reliable treatments take some time, and so be patient and remain committed. Be sure to take careful care of your skin on a day-to-day basis and the nice and attractive skin you desire can be yours.


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Bathroom Remodeling For Dummies
(If any tax is payable it will be calculated and shown at checkout.)
moreWe're a nation of countless bathrooms that are on the brink of being torn apart, redesigned, and remodeled. Bathrooms are big! They've gone from being a convenience to a luxury. Welcome to Bathroom Remodeling For Dummies, where you'll discover how to transform your bathroom from blah to beautiful and inefficient to well-designed.
Remodeling a bathroom is a challenge – it's action-oriented and requires extra energy and stamina. But you, undoubtedly, realize it's a challenge you want to take on. This guide can help if you
- Want to make your home more livable and enjoyable by updating, expanding, or improving the bathroom
- Want to find out how to begin the process of appraising your present bathroom so you can improve it
- Don't want to be pressured into selecting materials and fixtures because you want to see everything that's available and know all your options
- Want to know what's involved in demolishing the walls and removing the fixtures and cabinets, and how to install new ones
- Want to decide if you should hire help or do the work yourself
Bathroom Remodeling For Dummies is organized to provide lots of useful information that is easily accessible. You'll uncover tips about:
- Making the most of space in your bathroom
- Taking control and planning the project
- Finding fabulous fixtures, vanities, and faucets
- Decorating the walls, windows, and more
- Creating storage space
You maybe be asking yourself, "Can I remodel my bathroom without spending every penny I have, destroying the harmony of my house, and breaking the spirit of everyone involved?" The answer is yes. Bathroom Remodeling For Dummies can help.less
Wiley; March 2011
360 pages; ISBN 9781118053140
Download in secure EPUB
Title: Bathroom Remodeling For Dummies
Author: Gene Hamilton; Katie Hamilton
360 pages; ISBN 9781118053140
Download in secure EPUB
Title: Bathroom Remodeling For Dummies
Author: Gene Hamilton; Katie Hamilton
Buy, download and read Bathroom Remodeling For Dummies (eBook) by Gene Hamilton; Katie Hamilton today!
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The Life-Changing Magic of Tidying Up 2014 US$ 9.99 192 pages
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Extreme Couponing 2013 US$ 12.99 1 pages
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Coyuchi Return Policy
Pure, Cozy, Beautiful, Guaranteed for 365 Days.
If you don't love it—if you don't find it to be the purest, coziest and most beautiful item in your home—simply send it back.
• Return any item within 30 days of purchase for a complete refund.
• Exchange any item for an equal or lesser valued item within one year of purchase.
So feel free to try that new sheet fabric you've had your eye on, or take a risk on that flashy decorative pillow, because you're guaranteed to find something you love at coyuchi.com.
For purchases made at www.coyuchi.com, please complete the Return & Exchange form inside your box and include with your return. For Coyuchi purchases made on other websites, please contact that store for return instructions.
Please note: furniture and monogrammed items are not eligible for return as they are made to order.
Ship returns to:
Coyuchi Distribution Center
Attn: Returns
2820 W. Winton Avenue
Hayward, CA 94545
Postage and handling charges are not refundable on returns.
Questions? Contact one of our Natural Home Advisors: 888.418.8847 or firstname.lastname@example.com
Hours: 8am-5pm PST


text:
Ringling previews exhibit "Royal Taste: The Art of Princely Courts in Fifteenth-Century China"
Board members, donors and friends got a sneak peek at the new exhibit (Oct. 9 - Jan. 10) featuring 150 pieces from Ming Dynasty China (1368-1644).
The two illustration graduates from Ringling College returned to Sarasota to expand not only their work but also impart tips and skills to the next generation of Ringling students.
The diverse artist collective returns after a three-year hiatus with a fresh lineup, a debut show and a new vision for the Sarasota arts scene.
The 16-member artist collective's first show runs through August 29.
The last show in the theater's inaugural summer season runs until Sept. 6
The first ever exhibition of current Florida State University faculty runs from August 14 to Oct. 25.
The acclaimed soprano will make her Sarasota debut with Anu Tali and the Sarasota Orchestra
On the verge of their 25th anniversary, the Sarasota Ballet begins this season with week-long residency at Jacob's Pillow Dance Festival, the oldest and most prestigious festival of American dance in the country.


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Sandpits & play tables (33 products)
1 - 33 of 33 items
Our sandpits are great for outdoor entertainment. Perfect for building sandcastles, digging for treasure or burying toys, you can�t go wrong! And why not try something a little different with one of our sand tables? They offer the same fun as a sandpit along with a few extra sections and compartments for your toys and water.
Make sure you keep your sandpits topped up with our packs of sand. If water is more your thing, take a look at our paddling pools and water games.


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Mass Effect 3
View Single Post
October 16 2012, 11:12 PM
Rear Admiral
Location: UK
Re: Mass Effect 3
^I've beaten them on gold ONCE only, and I'm pretty sure I was the weakest player on the team. Silver is challenging but doable and I almost never play on bronze since I very rarely promote and a lv20 on bronze is just too easy and not very fair to lower level players.
And yeah, I'm a little surprised the collectors aren't showing up on Omega. Oh well, looks like it'll be fighting Cerberus all the way...though I can't say as I'm looking forward to tackling those Dragoons. Liara is going to get obliterated!
But still, it'd be nice to at least got a canon reason why the collectors are suddenly back and more formidable after spending a whole game supposedly wiping them out. I mean part of the appeal of MP is that you can pretend that your Shepard and the Normandy is out there too. Someone should at least write Shep a memo...
Indeed, I rather wish they'd integrate SP and MP a little more. Like for example instead of just having Shep clear a MP map there could be some missions where you have to help extract a team. Not an actual MP match in progress since that'd be too cumbersome to implement, but just a SP mission where the allied defenders are a random assortment taken from your own stable of MP characters. Or maybe just some procedurally generated after action reports via email or Liara's terminal, based off of your MP matches. Just something other than meaningless war asset points!
P.S. Apparently there's
a new paid SP DLC weapons pack
out. I think I'll pass.
Star Trek Logos
Dark Knight Adventures
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The Lions' fourth-round draft pick, defensive tackle Sammie Lee Hill, will now get the quality coaching he needs.
- Filed Under
Sammie Hill is a big man from a small town. He's a 6-foot-4, 330-pound defensive tackle from West Blocton, Ala., a place that is less than five square miles and has about 1,400 people.
It isn't one-stoplight small. It's smaller.
"Let's see," Hill said Saturday in the Lions' locker room, between practices at rookie orientation. "I could tell you. We got about one, two, three stop signs on the main roads. Well, actually it's six." ...