DE19506363A1 - Verfahren zur nicht-invasiven Thermometrie in Organen unter medizinischen Hyperthermie- und Koagulationsbedingungen - Google Patents
Verfahren zur nicht-invasiven Thermometrie in Organen unter medizinischen Hyperthermie- und KoagulationsbedingungenInfo
- Publication number
- DE19506363A1 DE19506363A1 DE19506363A DE19506363A DE19506363A1 DE 19506363 A1 DE19506363 A1 DE 19506363A1 DE 19506363 A DE19506363 A DE 19506363A DE 19506363 A DE19506363 A DE 19506363A DE 19506363 A1 DE19506363 A1 DE 19506363A1
- Authority
- DE
- Germany
- Prior art keywords
- procedure
- organs
- coagulation conditions
- coagulation
- ultrasonic
- 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.)
- Ceased
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
- A61F9/007—Methods or devices for eye surgery
- A61F9/008—Methods or devices for eye surgery using laser
- A61F9/00821—Methods or devices for eye surgery using laser for coagulation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
- A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
- A61F9/007—Methods or devices for eye surgery
- A61F9/008—Methods or devices for eye surgery using laser
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N7/00—Ultrasound therapy
- A61N7/02—Localised ultrasound hyperthermia
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00084—Temperature
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
- A61F9/007—Methods or devices for eye surgery
- A61F9/008—Methods or devices for eye surgery using laser
- A61F2009/00844—Feedback systems
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
- A61F9/007—Methods or devices for eye surgery
- A61F9/008—Methods or devices for eye surgery using laser
- A61F2009/00853—Laser thermal keratoplasty or radial keratotomy
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
- A61F9/007—Methods or devices for eye surgery
- A61F9/008—Methods or devices for eye surgery using laser
- A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
- A61F2009/00863—Retina
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
- A61F9/007—Methods or devices for eye surgery
- A61F9/008—Methods or devices for eye surgery using laser
- A61F2009/00861—Methods or devices for eye surgery using laser adapted for treatment at a particular location
- A61F2009/00868—Ciliary muscles or trabecular meshwork
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F9/00—Methods or devices for treatment of the eyes; Devices for putting-in contact lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
- A61F9/007—Methods or devices for eye surgery
- A61F9/008—Methods or devices for eye surgery using laser
- A61F2009/00885—Methods or devices for eye surgery using laser for treating a particular disease
- A61F2009/00891—Glaucoma
Description
Die gezielte Überwärmung begrenzter Gewebevolumina wird als
nichtchirurgische Zusatztherapie zur Unterstützung der Chemo- und
Radiotherapie eingesetzt. Darüberhinaus finden laserinduzierte
Koagulationsprozesse in der Onkologie (bspw. endoskopische
Chirurgie in der Gastroenterologie und minimalinvasiven Chirurgie)
sowie der Ophthalmologie (bspw. Glaukombehandlung) ihre Anwendung.
Die klinische Durchsetzbarkeit dieser Therapieformen ist mit der
Verfügbarkeit eines Verfahrens zu deren Kontrolle eng verknüpft.
Unter Hyperthermie versteht man die Überwärmung eines im Körper
inneren gelegenen Volumens durch Einstrahlung von hochfrequenten
Feldern von außen. Als Signifikanzgröße dient die Temperatur
erhöhung im Zielvolumen gegenüber der physiologischen Körper
temperatur des Gesamtorganismus. Nach dem gegenwärtig geübten
Stand der medizinischen Anwendung werden nadelartige Sonden mit
einem temperaturempfindlichen Halbleiterelement an ihrer Spitze in
den Patienten eingestochen und bis zum Zielvolumen vorgeschoben
Es sind Versuche unternommen worden, die erreichte Überwärmung nicht-invasiv nachzuweisen (bspw. Messung der NMR-Relaxations zeiten der Protonen des Zielvolumens, aktive und passive Mikro wellentomografie; einen Überblick bietet [I]). Aufgrund der teilweise sich widersprechenden Anforderungen (im wesentlichen: ausreichende Nachweistiefe und -empfindlichkeit, Darstellung der Kontrollparameter in Echtzeit, Kompensation von Störeinflüssen, verursacht durch Patientenbewegungen sowie die Kompatibilität mit dem Hyperthermiesystem) ist bis heute noch kein handhabbares und universell einsetzbares Kontrollsystem bekannt geworden. Es sind auch Versuche publiziert worden, die Änderung der Schallgeschwin digkeit bei Einstrahlung von Ultraschall als Signifikanzgröße zur Temperaturbestimmung heranzuziehen [II]. Da sich aber die Schall geschwindigkeit in Abhängigkeit von der Temperatur des biologi schen Materials nur sehr gering und monoton ändert, hat sich daraus kein technisches Meßverfahren ableiten lassen.
Es sind Versuche unternommen worden, die erreichte Überwärmung nicht-invasiv nachzuweisen (bspw. Messung der NMR-Relaxations zeiten der Protonen des Zielvolumens, aktive und passive Mikro wellentomografie; einen Überblick bietet [I]). Aufgrund der teilweise sich widersprechenden Anforderungen (im wesentlichen: ausreichende Nachweistiefe und -empfindlichkeit, Darstellung der Kontrollparameter in Echtzeit, Kompensation von Störeinflüssen, verursacht durch Patientenbewegungen sowie die Kompatibilität mit dem Hyperthermiesystem) ist bis heute noch kein handhabbares und universell einsetzbares Kontrollsystem bekannt geworden. Es sind auch Versuche publiziert worden, die Änderung der Schallgeschwin digkeit bei Einstrahlung von Ultraschall als Signifikanzgröße zur Temperaturbestimmung heranzuziehen [II]. Da sich aber die Schall geschwindigkeit in Abhängigkeit von der Temperatur des biologi schen Materials nur sehr gering und monoton ändert, hat sich daraus kein technisches Meßverfahren ableiten lassen.
Die Erfindung geht von dem Grundgedanken aus, daß an der Grenz
fläche zwischen biologisch - physiologischem Gewebe und erwärmtem
Volumen eine Ultraschallreflexion auftritt. Der Amplituden
reflexionsfaktor ist als Signal meßtechnisch erfaßbar. Größe und
Änderung des Signals im Nachweispfad hängen eindeutig von der
Temperaturdifferenz und deren zeitliche Änderung während der
Überwärmung ab. Im Bereich der beginnenden irreversiblen Änderung
des biologischen Zielvolumens gestattet das erfindungsgemäße
Verfahren ein Temperaturauflösungsvermögen von ΔT 0.25 grd. Das
Verfahren nach der Erfindung benutzt als Nachweis die Methode des
A-Scans diagnostischer Ultraschallgeräte, jedoch wird zur
Sicherstellung der geforderten strengen Linearität der Reflexions-
Signalamplitude die Ultraschall-Hochfrequenz direkt abgegriffen,
von der eingestrahlten Hyperthermie-Hochfrequenz gesäubert und
durch eine Elektronik nach dem Prinzip des Box Car-Integrators
verarbeitet und dargestellt.
Um eine quantitative Auswertung auch unter dem Einfluß von
Patientenbewegungen zu ermöglichen, darf der Triggerzeitpunkt für
die die Darstellung regierenden Größen wie Verzögerungszeit und
Fensterbreite nicht am Sendesignal festgemacht, sondern muß am
interessierenden Echo selbst verankert werden. Eine Synchronisier
einheit verschafft sich aus Flankenwert und -steigung des n-ten
Echos den Triggerzeitpunkt des darauffolgenden Echos. Die Eindeu
tigkeit des Triggerzeitpunktes wird durch eine Komparatorschaltung
sichergestellt.
Alle Komponenten der Synchronisiereinheit sind analog aufgebaut,
wodurch diese zentrale Steuereinheit wie das gesamte Nachweis
systems in Echtzeit arbeitet.
Unter medizinischen Hyperthermiebedingungen sind auch diejenigen
therapeutischen Verfahren zusammenzufassen, denen Koagulations
prozesse zugrunde liegen. Die Kongruenz der Anforderungen an ein
Kontroll- oder Steuerungssystem bei diesen Behandlungsformen
resultiert daraus, daß auch hier Therapierisiko und -wirkung nach
den erzeugten Temperaturgradienten sowie der räumlichen Ausdehnung
der erzeugten Herde zu bewerten ist. Zur on line-Messung und
geeigneten Darstellung dieser beiden Kriterien am Patienten sind
alle Komponenten des erfindungsgemäßen Verfahrens notwendig, wobei
die Ultraschall-Arbeitsfrequenz der jeweiligen Aufgabenstellung
anzupassen ist.
In der endoskopischen und minimal-invasiven Chirurgie werden
Laser- und Plasmasysteme zur Koagulation maligner Gewebevolumina
eingesetzt. Mit der Festlegung des koagulierten Volumens ist die
Frage der örtlichen Abtötung des Tumors sowie die Frage möglicher
Tumorabsiedelungen eng verknüpft. Da weder tatsächlich erreichte
Temperaturen noch tatsächlich erreichte Eindringtiefen sicher
nachweisbar sind, sind beide Verfahren zur curativen Behandlung
(bspw. in der gastroenterologischen Chirurgie und der Gynäkologie)
bislang nicht anwendbar.
Durch Einsatz des erfindungsgemäßen Thermometrieverfahrens hat der
Laserchirurg die Möglichkeit, Temperaturgradienten und koagulierte
Volumenbereiche on line zu überwachen. Daraus resultieren ganz
erhebliche Fortschritte für die Therapie kleiner Tumoren im
Hinblick auf ambulante Operationsmöglichkeiten ohne ausräumende
Exzision und eine Verbreiterung des Anwendungsspektrums.
In der Ophthalmologie wird die Laserkoagulation u. a. bei der
Glaukombehandlung (transskerale Cyclophotokoagulation TSCPC) und
zu Fehlsichtigkeitskorrekturen (Thermokeratoplastik) eingesetzt.
Alleiniger Steuerparameter während der TSCPC sind bislang bei
vorgewählter Laserleistung die vorab geschätzte Bestrahlungsdauer.
Darüberhinaus kann nicht beurteilt werden ob der Ziliarkörper oder
angrenzende Strukturen getroffen werden. Die Effektivität dieses
Eingriffs wird durch die Therapiekontrolle mit dem on line-
Thermometrieverfahren deutlich verbessert.
Bild 1 : Ausführungsbeispiel Therapiekontrolle
1 Zielvolumen
2 Laser, laserübertragender Wellenleiter oder (hochfrequenzübertragende Dipolanordnung)
3 Ein oder mehrere Schallwandler
4 Akustischer Nachweispfad
1 Zielvolumen
2 Laser, laserübertragender Wellenleiter oder (hochfrequenzübertragende Dipolanordnung)
3 Ein oder mehrere Schallwandler
4 Akustischer Nachweispfad
I) M. GAUTHERIE (Hrsg.)
Methods of Hyperthermia Control Springer Berlin Heidelberg (1990)
II) R.L. NASONI, T. BOWEN
Ultrasonic Speed as a Parameter for Non-Invasive Thermometry In: MIZUSHINA (Hrsg.): Non-Invasive Temperature Measurement Gordon & Breach Publishers 1 (1989), 101-107.
Methods of Hyperthermia Control Springer Berlin Heidelberg (1990)
II) R.L. NASONI, T. BOWEN
Ultrasonic Speed as a Parameter for Non-Invasive Thermometry In: MIZUSHINA (Hrsg.): Non-Invasive Temperature Measurement Gordon & Breach Publishers 1 (1989), 101-107.
Claims (10)
1. Verfahren zur nicht-invasiven Thermometrie in Organen unter
medizinischen Hyperthermie- und Koagulationsbedingungen, dadurch
gekennzeichnet, daß die an der Grenzfläche des überwärmten Gewebes
auftretenden Ultraschall-Reflexionssignale zur Tiefenmessung,
Identifikation des Zielvolumens und Temperaturbestimmung
herangezogen werden.
2. Verfahren zur nicht-invasiven Thermometrie in Organen unter
medizinischen Hyperthermie- und Koagulationsbedingungen nach
Anspruch 1), dadurch gekennzeichnet, daß die Ultraschall-
Reflektometrie zur Überwachung oder Steuerung thermisch
induzierter, biologischer Effekte benutzt wird.
3. Verfahren zur nicht-invasiven Thermometrie in Organen unter
medizinischen Hyperthermie- und Koagulationsbedingungen nach
Anspruch 1-2), dadurch gekennzeichnet, daß mittels Ultraschall-
Reflektometrie bei Lasereinstrahlung Temperaturgradienten,
koaguliertes- oder denaturiertes Volumen ermittelt und zur
Therapiekontrolle oder Steuerung des Lasers verwendet werden.
4. Verfahren zur nicht-invasiven Thermometrie in Organen unter
medizinischen Hyperthermie- und Koagulationsbedingungen nach
Ansprüchen 1-3), dadurch gekennzeichnet, daß die medizinische
Methode des diagnostischen Ultraschall-A-Scans verwendet wird,
jedoch die diesen Geräten spezifische Nachweiselektronik durch
eine Integratortechnik (z. B. nach dem Box Car-Prinzip) ersetzt
oder ergänzt wird.
5. Verfahren zur nicht-invasiven Thermometrie in Organen unter
medizinischen Hyperthermie- und Koagulationsbedingungen nach
Ansprüchen 1-4), dadurch gekennzeichnet, daß die den diagnosti
schen Ultraschallgeräten spezifische Nachweiselektronik durch eine
Synchronisiereinheit zur Ausmittelung von Patientenbewegungen
ergänzt wird.
6. Verfahren zur nicht-invasiven Thermometrie in Organen unter
medizinischen Hyperthermie- und Koagulationsbedingungen nach
Ansprüchen 1-5), dadurch gekennzeichnet, daß ein nach dem
Verfahren des Ultraschall-Compoundscan oder Ultraschall-B-Scan
arbeitendes Diagnosegerät so modifiziert wird, daß eine
zweidimensionale Darstellung der signifikanten, temperatur
zugeordneten Flächenumrandungen erreicht wird.
7. Verfahren zur nicht-invasiven Thermometrie in Organen unter
medizinischen Hyperthermie- und Koagulationsbedingungen nach
Ansprüchen 1-6), dadurch gekennzeichnet, daß ein nach dem
Verfahren des diagnostischen Ultraschall-B-Scans arbeitendes
Gerät so modifiziert wird, daß eine farbcodierte oder räumliche
Darstellung der signifikanten temperaturzugeordneten oder zur
Therapiekontrolle geeigneten Meßgrößen erreicht wird.
8. Verfahren zur nicht-invasiven Thermometrie in Organen unter
medizinischen Hyperthermie- und Koagulationsbedingungen nach
Ansprüchen 1-7), dadurch gekennzeichnet, daß die Ultraschall-
Reflektometrie zur Therapiekontrolle oder zur Therapiesteuerung
von Laserkoagulationen in der Augenheilkunde benutzt wird (z. B.
Thermokeratoplastik, Koagulation der Netzhaut, Trabeculoplastik,
Cyclophotokoagulation oder Cyclokryokoagulation) sowie in
Kombination mit anderen koagulativen Prozessen verwendet wird.
9. Verfahren zur nicht-invasiven Thermometrie in Organen unter
medizinischen Hyperthermie- und Koagulationsbedingungen nach
Ansprüchen 1-8), dadurch gekennzeichnet, daß die Ultraschall-
Reflektometrie zur Kontrolle der autolytischen Denaturierung (z. B.
Viabilitätstest) herangezogen wird.
10. Verfahren zur nicht-invasiven Thermometrie in Organen unter
medizinischen Hyperthermie- und Koagulationsbedingungen nach
Ansprüchen 1-9), dadurch gekennzeichnet, daß aus der
Ultraschall-Reflektometrie im Hinblick auf Temperatur und
Ausdehnungsgrößen ermittelt werden, welche eine Lasereinstrahlung
rückgekoppelt beeinflussen und den Vorgang teilautomatisieren.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
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DE19506363A DE19506363A1 (de) | 1995-02-24 | 1995-02-24 | Verfahren zur nicht-invasiven Thermometrie in Organen unter medizinischen Hyperthermie- und Koagulationsbedingungen |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
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DE19506363A DE19506363A1 (de) | 1995-02-24 | 1995-02-24 | Verfahren zur nicht-invasiven Thermometrie in Organen unter medizinischen Hyperthermie- und Koagulationsbedingungen |
Publications (1)
Publication Number | Publication Date |
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DE19506363A1 true DE19506363A1 (de) | 1996-08-29 |
Family
ID=7754871
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DE19506363A Ceased DE19506363A1 (de) | 1995-02-24 | 1995-02-24 | Verfahren zur nicht-invasiven Thermometrie in Organen unter medizinischen Hyperthermie- und Koagulationsbedingungen |
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DE (1) | DE19506363A1 (de) |
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WO2000024468A1 (de) | 1998-10-27 | 2000-05-04 | Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. | Verfahren und vorrichtung zur regelung einer gezielten wärmedeponierung in ein material |
DE19935455C2 (de) * | 1998-10-27 | 2003-08-14 | Fraunhofer Ges Forschung | Verfahren und Vorrichtung zur Regelung einer gezielten Wärmedeponierung in ein Material |
EP1837051A1 (de) * | 2005-01-10 | 2007-09-26 | Chongqing Haifu(Hifu)Technology Co., Ltd | Fokussiertes therapeutisches hochintensitätsultraschallgerät und verfahren |
EP2174613A1 (de) * | 2008-10-10 | 2010-04-14 | Tyco Healthcare Group LP | Vorrichtung und System zur Überwachung eines Gewebes während einer elektrochirurgischen Prozedur |
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