Suture end effector
阅读说明：本技术 缝合末端执行器 (Suture end effector ) 是由 曹林 潘福田 彭树捷 于 2018-12-12 设计创作，主要内容包括：缝合末端执行器包括钳夹组件,该钳夹组件包括具有通孔的第一钳夹和具有通孔的第二钳夹。钳夹相对于彼此是可打开的和可关闭的。缝合末端执行器还可以包括中空缝合针,该中空缝合针具有第一尖端、第二尖端和内部通道。在收起布置中,针可以被平坦地夹持在钳夹之间,并且引导线可以以这样的方式穿过第一钳夹的通孔、针的内部通道以及第二钳夹的通孔,即钳夹打开且张紧引导线使得引导线对准针,其中第一尖端指向第一钳夹的通孔,第二尖端指向第二钳夹的通孔。还公开了一种配置为将缝合针交替地锁定到第一钳夹和第二钳夹的筋和滑轮机构。(The stapling end effector includes a jaw assembly including a first jaw having a through-hole and a second jaw having a through-hole. The jaws are openable and closable relative to each other. The suturing end effector may further comprise a hollow suture needle having a first pointed end, a second pointed end, and an interior passage. In the stowed arrangement, the needle may be held flat between the jaws and a guide wire may be passed through the through hole of the first jaw, the internal channel of the needle and the through hole of the second jaw in such a way that the jaws open and tension the guide wire so that the guide wire is aligned with the needle, with a first pointed end directed to the through hole of the first jaw and a second pointed end directed to the through hole of the second jaw. A bar and pulley mechanism configured to alternately lock the suture needle to the first jaw and the second jaw is also disclosed.)
1. A suturing end effector comprising:
a jaw assembly comprising
A first jaw having a through-hole disposed at an end of the first jaw and extending therethrough from an engaging surface of the first jaw to an opposing surface of the first jaw,
a second jaw having a through hole disposed at an end of the second jaw and extending therethrough from an engagement surface of the second jaw to an opposite surface of the second jaw,
wherein the first jaw and the second jaw are openable and closable relative to each other with the engagement surface of the first jaw and the engagement surface of the second jaw directed toward each other; and
a suture needle assembly comprising a hollow suture needle having a first pointed end, a second pointed end, and an internal passage extending through the hollow suture needle from the first pointed end to the second pointed end,
wherein, in a stowed arrangement of the suturing end effector, the hollow suturing needle is clamped flat between the engagement surface of the first jaw and the engagement surface of the second jaw, and a guide wire is passed through the through-hole of the first jaw, the internal passage of the hollow suturing needle, and the through-hole of the second jaw such that the first jaw and the second jaw open relative to each other and the guide wire is tensioned such that the guide wire is aligned with the hollow suturing needle, wherein the first pointed end of the hollow suturing needle is directed toward the through-hole of the first jaw and the second pointed end of the hollow suturing needle is directed toward the through-hole of the second jaw.
2. The suturing end effector of claim 1, wherein the hollow suturing needle has a hole along a location of the hollow suturing needle between the first pointed end and the second pointed end, the hole providing access to the interior passage of the hollow suturing needle.
3. The suturing end effector of claim 2, wherein the suture needle assembly further comprises a suture thread connected to the hole along the hollow suture needle.
4. The suturing end effector of claim 3, wherein an end of the suture is inserted into the hollow suturing needle along the hollow suturing needle through the hole, and the suturing needle assembly further comprises a tube inserted through the interior channel of the hollow suturing needle in a manner such that an insertion end of the suture is wedged between an interior surface of the interior channel of the hollow suturing needle and an exterior surface of the tube to secure the suture to the hollow suturing needle.
5. The suturing end effector of claim 4, wherein the guide wire passes through an interior passage of the tube.
6. The suturing end effector of any one of claims 1-5, wherein a cross-sectional profile of a first end section of the hollow suturing needle facing the first tip is a non-rotationally symmetric shape, and a cross-sectional profile of the through-bore of the first jaw is a corresponding shape such that the first end section of the hollow suturing needle fits into the through-bore of the first jaw in one orientation of the hollow suturing needle relative to the through-bore of the first jaw.
7. The suturing end effector of claim 6, wherein the cross-sectional profile of the first end section of the hollow suturing needle is shaped like a circle with a cut-away circle segment.
8. The suturing end effector of claim 7, wherein the first end section of the hollow suturing needle comprises a flat surface corresponding to the cut-out circular segment of the cross-sectional profile of the first end section of the hollow suturing needle, wherein a shoulder projects from an edge of the flat surface distal from the first point.
9. The suturing end effector of any one of claims 1-8, wherein a cross-sectional profile of a second end segment of the hollow suturing needle toward the second tip is a non-rotationally symmetric shape and a cross-sectional profile of the through-bore of the second jaw is a corresponding shape such that the second end segment of the hollow suturing needle fits into the through-bore of the second jaw in one orientation of the hollow suturing needle relative to the through-bore of the second jaw.
10. The suturing end effector of claim 9, wherein the cross-sectional profile of the second end section of the hollow suturing needle is a shape resembling a circle having a cut-away circle segment.
11. The suturing end effector of claim 10, wherein the second end section of the hollow suturing needle comprises a flat surface corresponding to the cut-out circular segment of the cross-sectional profile of the second end section of the hollow suturing needle, wherein a shoulder protrudes from an edge of the flat surface distal from the second tip.
12. The stapling end effector of any one of claims 1-11, wherein the first jaw and the second jaw are connected to one another via a pivot joint in a manner that provides pivotal movement relative to one another about a pivot axis of the pivot joint such that the first jaw and the second jaw are openable and closable relative to one another.
13. The suturing end effector of any one of claims 1-12, further comprising a yaw link connected to the jaw assembly via a yaw joint in a manner that provides yaw movement of the jaw assembly about a yaw axis of the jaw assembly relative to the yaw link.
14. The stapling end effector of any one of claims 1-13, further comprising a pitch link connected to the jaw assembly via a pitch joint in a manner that provides the jaw assembly with a pitch motion about a pitch axis of the jaw assembly relative to the pitch link.
15. The stapling end effector of any one of claims 12-14, wherein the pivot joint and/or the yaw joint and/or the pitch joint each comprise a bar and pulley mechanism configured to control a respective motion, wherein the bar and pulley mechanism comprises: pulleys, which are rotatably arranged coaxially with the respective axes; and a rib wound around the pulley in such a manner that pulling either side of the rib relative to the pulley causes the pulley to rotate in a respective direction, thereby producing a respective movement of a respective joint.
16. The suturing end effector of claim 15, wherein the pulley includes a retaining element and the tendon includes a knot held in the retaining element of the pulley in a manner such that the knot engages the retaining element to rotate the pulley when the tendon is pulled.
17. The suturing end effector of claim 16, wherein the retention element of the pulley includes a recessed portion cut into a sector of the pulley, and the nodes of the ribs include crimping beads crimped onto the ribs.
18. The suturing end effector of any one of claims 1-15, wherein the jaw assembly further includes a bar and pulley locking mechanism configured to alternately lock the hollow suturing needle to the first jaw and the second jaw.
19. The suturing end effector of claim 18,
it is characterized in that the rib and pulley locking mechanism comprises: a first pulley disposed in the first jaw; a second pulley disposed at a joint between the first jaw and the second jaw; a third pulley disposed in the second jaw,
wherein a wire is wrapped around the first pulley, the second pulley, and the third pulley in such a manner that a first section of the wire between the first pulley and the second pulley is parallel to the engagement surface of the first jaw, and a second section of the wire between the second pulley and the third pulley is parallel to the engagement surface of the second jaw,
wherein a first locking element is attached to the first section of the rib and a second locking element is attached to the second section of the rib,
wherein pulling the first end of the tendon causes the first locking element to move and be placed across at least a portion of the through-hole of the first jaw to engage the hollow suture needle, thereby locking the hollow suture needle to the first jaw, and causes the second locking element to move and move away from the through-hole of the second jaw to disengage the hollow suture needle, and
wherein pulling the second end of the tendon causes the second locking element to move and be positioned across at least a portion of the through-hole of the second jaw to engage the hollow suture needle to lock the hollow suture needle to the second jaw and causes the first locking element to move and move away from the through-hole of the first jaw to disengage the hollow suture needle.
20. The suturing end effector of claim 18,
characterized in that the rib and pulley locking mechanism comprises
A first lock stator mechanism including a first pulley disposed in the first jaw and a first rib wound around the first pulley,
a second lock sub-mechanism including a second pulley disposed in the second jaw and a second rib wrapped around the second pulley,
wherein the first locking element is attached to the first rib and the second locking element is attached to the second rib,
wherein pulling the first end of the first tendon causes the first locking element to move and be positioned across at least a portion of the through-hole of the first jaw to engage the hollow suture needle to lock the hollow suture needle to the first jaw, pulling the second end of the first tendon causes the first locking element to move and move away from the through-hole of the first jaw to disengage the hollow suture needle,
wherein pulling the first end of the second tendon causes the second locking element to move and be positioned across at least a portion of the through-hole of the second jaw to engage the hollow suture needle to lock the hollow suture needle to the second jaw, pulling the second end of the second tendon causes the second locking element to move and move away from the through-hole of the second jaw to disengage the hollow suture needle,
wherein the first and second lock sub-mechanisms are independently operable.
21. The suturing end effector of claim 19 or 20,
characterized in that the first locking element and the second locking element each comprise a locking blade attached in the longitudinal direction to a respective segment of a respective rib, an
Wherein the hollow suture needle comprises: a first slot traversing the hollow suture needle and disposed toward the first tip; and a second slot traversing the hollow suture needle and disposed toward the second tip,
wherein the respective locking blade engages the hollow suture needle by intersecting the respective first and second slots of the hollow suture needle to lock the hollow suture needle to the respective first and second jaws.
22. The suturing end effector of any one of claims 19-21, wherein each pulley of the tendon and pulley locking mechanism comprises a rotating pulley or a stationary circular profile.
23. A method of deploying a suture end effector, comprising:
opening the jaw assembly of the stapling end effector from a stowed arrangement,
wherein the suture end effector comprises
A jaw assembly comprising
A first jaw having a through hole disposed at an end of the first jaw and extending therethrough from an engagement surface of the first jaw to an outer surface of the first jaw, and
a second jaw having a through hole disposed at an end of the second jaw and extending therethrough from an engagement surface of the second jaw to an outer surface of the second jaw, wherein the first jaw and the second jaw are openable and closable relative to each other with the engagement surface of the first jaw and the engagement surface of the second jaw directed toward each other, and
a suture needle assembly comprising a hollow suture needle having a first pointed end, a second pointed end, and an internal passage extending through the hollow suture needle from the first pointed end to the second pointed end,
wherein, in a stowed arrangement of the suturing end effector, the hollow suturing needle is clamped flat between the engagement surfaces of the first and second jaws and a guide wire extends through the through-hole of the first jaw, the internal passage of the hollow suturing needle, and the through-hole of the second jaw; and
tensioning the guide wire when the first jaw and the second jaw are open relative to each other such that the guide wire is aligned with the hollow suture needle, wherein the first pointed end of the hollow suture needle is directed toward the through hole of the first jaw and the second pointed end of the hollow suture needle is directed toward the through hole of the second jaw.
24. The method of claim 23, further comprising closing the jaw assemblies such that the first pointed end of the hollow suture needle is inserted through the through-hole of the first jaw and the second pointed end of the hollow suture needle is inserted through the through-hole of the second jaw.
25. The method of claim 24, wherein the closing the jaw assembly includes the hollow suture needle self-aligning with the through-hole of the first jaw and the through-hole of the second jaw when the respective pointed ends of the hollow suture needle are inserted into the respective through-holes of the first jaw and the second jaw.
26. The method of claim 25, wherein the first end section of the hollow suture needle, having a non-rotationally symmetric shaped cross-sectional profile, toward the first tip is self-aligned with the through-hole of the first jaw having a correspondingly shaped cross-sectional profile when the first end section of the hollow suture needle is inserted into the through-hole of the first jaw.
27. The method of claim 25 or 26, wherein the second end section of the hollow suture needle, having a non-rotationally symmetric shaped cross-sectional profile, toward the second tip is self-aligned with the through-hole of the second jaw having a correspondingly shaped cross-sectional profile when the second end section of the hollow suture needle is inserted into the through-hole of the second jaw.
28. The method of claim 26 or 27, wherein the cross-sectional profile of the first end section of the hollow suture needle and the cross-sectional profile of the second end section of the hollow suture needle are each shaped like a circle with a cut-away circle segment.
29. The method of any one of claims 24-28, further comprising locking the hollow suture needle to one of the first jaw or the second jaw via a tendon and pulley locking mechanism.
30. In accordance with the method set forth in claim 29,
it is characterized in that the rib and pulley locking mechanism comprises: a first pulley disposed in the first jaw; a second pulley disposed at a joint between the first jaw and the second jaw; a third pulley disposed in the second jaw,
wherein the wire is wrapped around the first pulley, the second pulley, and the third pulley in such a manner that a first section of the wire between the first pulley and the second pulley is parallel to the engagement surface of the first jaw, and a second section of the wire between the second pulley and the third pulley is parallel to the engagement surface of the second jaw,
wherein a first locking element is attached to the first section of the rib and a second locking element is attached to the second section of the rib,
wherein locking the hollow suture needle to the first jaw comprises pulling a first end of the tendon to cause the first locking element to move and be placed across at least a portion of the through-hole of the first jaw to engage the hollow suture needle to lock the hollow suture needle to the first jaw and to cause the second locking element to move and away from the through-hole of the second jaw to disengage the hollow suture needle, and
wherein locking the hollow suture needle to the second jaw comprises pulling a second end of the tendon to cause the second locking element to move and be positioned across at least a portion of the through-hole of the second jaw to engage the hollow suture needle to lock the hollow suture needle to the second jaw and to cause the first locking element to move and away from the through-hole of the first jaw to disengage the hollow suture needle.
31. In accordance with the method set forth in claim 29,
characterized in that the rib and pulley locking mechanism comprises
A first lock stator mechanism including a first pulley disposed in the first jaw and a first rib wound around the first pulley,
a second lock sub-mechanism including a second pulley disposed in the second jaw and a second rib wrapped around the second pulley,
wherein the first locking element is attached to the first rib and the second locking element is attached to the second rib,
wherein the first lock sub-mechanism and the second lock sub-mechanism are independently operable,
wherein locking the hollow suture needle to the first jaw comprises pulling a first end of the first tendon to cause the first locking element to move and be placed across at least a portion of the through-hole of the first jaw to engage the hollow suture needle to lock the hollow suture needle to the first jaw,
wherein locking the hollow suture needle to the second jaw comprises pulling a first end of the second tendon to cause the second locking element to move and be placed across at least a portion of the through-hole of the second jaw to engage the hollow suture needle to lock the hollow suture needle to the second jaw.
32. The method according to any one of claims 29 to 31, further comprising withdrawing the guide wire from the jaw assembly and the hollow suture needle.
33. The method of claim 32, wherein withdrawing the guide wire comprises pulling on either end of the guide wire to pull the guide wire out of the through-hole of the first jaw, the internal channel of the hollow suture needle, and the through-hole of the second jaw.
34. The method of claim 32, wherein withdrawing the guide wire comprises cutting a portion of the guide wire between the first jaw and the second jaw, and withdrawing the cut guide wire from the through-holes of the first jaw and the second jaw, respectively.
35. A suturing end effector comprising:
a jaw assembly comprising
A first jaw having a through-hole disposed at an end of the first jaw and extending therethrough from an engaging surface of the first jaw to an opposing surface of the first jaw,
a second jaw having a through hole disposed at an end of the second jaw and extending therethrough from an engagement surface of the second jaw to an opposite surface of the second jaw,
wherein the first jaw and the second jaw are openable and closable relative to each other with the engagement surface of the first jaw and the engagement surface of the second jaw directed toward each other; and
a bar and pulley locking mechanism configured to lock a suture needle to the first jaw, the bar and pulley locking mechanism comprising
A first pulley disposed in the first jaw,
a first rib wrapped around the first pulley in such a manner that a first segment of the first rib extending within a length of the first jaw is parallel to the engagement surface of the first jaw, and
a first locking element attached to the first section of the first bead,
wherein pulling the first end of the first rib causes the first locking element to move and be positioned across at least a portion of the through hole of the first jaw to engage the suture needle, wherein a first tip is inserted into the through hole of the first jaw to lock the suture needle to the first jaw, and pulling the second end of the first rib causes the first locking element to move and move away from the through hole of the first jaw to disengage the suture needle.
36. The suturing end effector of claim 35, wherein the bar and pulley locking mechanism is further configured to lock the suturing needle to the second jaw, the bar and pulley locking mechanism comprising
A second pulley disposed at a joint between the first jaw and the second jaw,
a third pulley disposed in the second jaw, wherein the first rib is further wrapped around the second and third pulleys in such a manner that the first segment of the first rib is between the first and second pulleys and a second segment of the first rib is between the second and third pulleys such that the second segment of the first rib is parallel to the engagement surface of the second jaw,
a second locking element attached to the second section of the first bead,
wherein pulling the second end of the first rib causes the second locking element to move and be positioned across at least a portion of the through hole of the second jaw to engage the suture needle, wherein a second tip is inserted into the through hole of the second jaw to lock the suture needle to the second jaw, and pulling the first end of the first rib causes the second locking element to move and away from the through hole of the second jaw to disengage the suture needle.
37. The suturing end effector of claim 35, wherein the bar and pulley locking mechanism is further configured to lock the suturing needle to the second jaw, the bar and pulley locking mechanism comprising
A second pulley disposed in the second jaw,
a second rib wrapped around the second pulley in such a manner that a first segment of the second rib extending within a length of the second jaw is parallel to the engagement surface of the second jaw, and
a second locking element attached to the first segment of the second bead,
wherein pulling the first end of the second tendon causes the second locking element to move and be positioned across at least a portion of the through hole of the second jaw to engage the suture needle, wherein the second tip is inserted into the through hole of the second jaw to lock the suture needle to the second jaw, and pulling the second end of the second tendon causes the second locking element to move and away from the through hole of the second jaw to disengage the suture needle.
38. The suturing end effector of claim 36 or 37,
characterized in that the first locking element and the second locking element each comprise a locking blade attached in the longitudinal direction to a respective segment of a respective rib, an
Wherein the suture needle comprises: a first slot traversing the suture needle and disposed toward the first tip; and a second slot traversing the needle and disposed toward the second tip,
wherein the respective locking blade engages the suture needle by intersecting the respective first and second slots of the suture needle to lock the suture needle to the respective first and second jaws.
39. The suturing end effector of any one of claims 36-38, wherein each pulley of the tendon and pulley locking mechanism comprises a rotating pulley or a stationary circular profile.
40. The stapling end effector of any one of claims 35-39, wherein the first jaw and the second jaw are connected to one another via a pivot joint in a manner that provides pivotal movement relative to one another about a pivot axis of the pivot joint such that the first jaw and the second jaw are openable and closable relative to one another.
41. The suturing end effector of any one of claims 35-40, further comprising a yaw link connected to the jaw assemblies via a yaw joint in a manner that provides yaw movement of the jaw assemblies about a yaw axis of the jaw assemblies relative to the yaw link.
42. The stapling end effector of any one of claims 35 to 41, further comprising a pitch link connected to the jaw assembly via a pitch joint in a manner that provides the jaw assembly with a pitch motion about a pitch axis of the jaw assembly relative to the pitch link.
43. The stapling end effector of any one of claims 40 to 42, wherein the pivot joint and/or the yaw joint and/or the pitch joint each comprise a bar and pulley mechanism configured to control the respective movement, wherein the bar and pulley mechanism comprises: pulleys, which are rotatably arranged coaxially with the respective axes; and a rib wound around the pulley in such a manner that pulling either side of the rib relative to the pulley causes the pulley to rotate in a respective direction, thereby producing a respective movement of a respective joint.
44. The suturing end effector of claim 43, wherein the pulley includes a retaining element and the tendon includes a knot held in the retaining element of the pulley in a manner such that the knot engages the retaining element to rotate the pulley when the tendon is pulled.
45. The suturing end effector of claim 44, wherein the retention element of the pulley includes a recessed portion cut into a sector of the pulley, and the nodes of the ribs include crimping beads crimped onto the ribs.
Technical Field
Various embodiments are generally directed to a stapling end effector. In particular, various embodiments are generally directed to a stapling end effector for an endoscopic instrument that may be used to perform endoscopic closures.
Background
Natural orifice endoscopic surgery (NOTES) is an endoscopic surgical technique used for treatment in peritoneal cavities such as the stomach and colon through natural orifices such as the mouth, vagina and anus. NOTES avoids incisions in the abdominal wall, and is therefore less invasive, safer, and allows the patient to recover more quickly than open and laparoscopic procedures. Despite the tremendous advances in NOTES technology in recent years, the full potential of NOTES cannot be realized without the closure of a reliable, secure flaw. These defects may be caused by unplanned complications of diagnostic and therapeutic endoscopy (perforation), or full-thickness resection of gastrointestinal (GI tract) lesions, or planned perforations for NOTES access. Endoscopic closure of GI tract defects is challenging due to the limited size of the endoscopic channel and gastrointestinal tract, the narrow space at the target site, the size and strength requirements for wound closure, and the complexity of the suturing/closure procedure itself. Over the years, various instruments and accessories have been deployed for closure of GI tract defects. However, each configuration has inherent problems that need to be addressed during surgery. For example, with The commercially available Over-The-Scope-Clip System (OVsco Endoscopic Co., Ltd., Germany) and The OVstimoth Endoscopic Suturing System (OVstimoth Endoscopic Suturing System, AppoloEndossurgery, USA), The end effector must be pre-loaded onto The outer tip of The endoscope, and The endoscope must be withdrawn to replace The tool.
Further, U.S. patent No.8747424B2 discloses a suturing apparatus that has a flexible delivery system and thus may be adapted for use in endoscopy. A flexible drive shaft is employed to drive both jaws and a locking blade in each jaw, and another pair of cables is employed to manipulate the end effector for triangulation. By pulling (or pushing) the drive shaft, the two jaws can be closed (or opened). By twisting the drive shaft (twist), the locking blade may be moved/translated along the longitudinal axis of the instrument to lock the suture needle to one of the two jaws. This is achieved by a cam hub which converts the torsion of the drive shaft into a translational movement. In this manner, the suture needle may be switched from one jaw to the other. However, the instrument disclosed in said patent has several drawbacks. First, the outer diameter of the device of said patent is rather large, since the suture needle is always standing upright between the two jaws, resulting in the jaws being always half-open when closed, and therefore the outer diameter of the device must be greater than or equal to the length of the needle (6 mm to 10mm in length), which makes it practically impossible to deliver the device to the surgical site through the tool channel of the endoscope. Secondly, the force and motion transmission mechanisms of the apparatus of said patent for locking the blade are unreliable and inefficient. The locking blade translates along the longitudinal axis by twisting a proximal end of a flexible shaft, wherein a distal end of the flexible shaft is connected to a torsion-translation cam mechanism. In endoscopy, where the path of the GI tract is tortuous and lengthy, torsional transmission is unreliable. The reliability of locking the blades is greatly limited by the low transmission efficiency and precision of the torsion from the proximal end to the distal end of the flexible shaft and the efficiency of the cam mechanism (torsion to translation). In addition, because the opening of the jaws is accomplished by pushing on a flexible shaft, the jaws may be difficult to open in some cases because the flexible shaft may not be good at transmitting a pushing force to accomplish the opening of the jaws. Third, the instrument of the patent has only two cables for manipulation, which results in the instrument being manipulable in only one plane, limiting the instrument's flexibility and utility.
Therefore, there is a need for a reliable, effective and efficient tool for endoscopic closure of GI tract defects.
Disclosure of Invention
According to various embodiments, a suturing end effector (or a suturing device having a suturing end effector) is provided. The stapling end effector may include a jaw assembly comprising: a first jaw having a through hole disposed at an end of the first jaw and extending through the first jaw from an engagement surface of the first jaw to an opposite surface of the first jaw; and a second jaw having a through hole disposed at an end of the second jaw and extending through the second jaw from an engagement surface of the second jaw to an opposite surface of the second jaw. The first jaw and the second jaw may be openable and closable relative to each other, with an engagement surface of the first jaw and an engagement surface of the second jaw directed toward each other. The suturing end effector may further comprise a suture needle assembly comprising a hollow suture needle having: a first tip; a second tip; and an internal passage extending through the hollow suture needle from the first tip to the second tip. In a stowed arrangement of the suture end effector, the hollow suture needle may be clamped flat between the engagement surface of the first jaw and the engagement surface of the second jaw, and the guide wire may be passed through the through-hole of the first jaw, the interior channel of the hollow suture needle, and the through-hole of the second jaw in such a manner that the first jaw and the second jaw are open relative to each other and the guide wire is tensioned, which may cause the guide wire to be aligned with the hollow suture needle with the first pointed end of the hollow suture needle directed toward the through-hole of the first jaw and the second pointed end of the hollow suture needle directed toward the through-hole of the second jaw.
According to various embodiments, a method of deploying a stapling end effector is provided. The method may include opening a jaw assembly of the stapling end effector from a stowed arrangement. The stapling end effector may include a jaw assembly comprising: a first jaw having a through hole disposed at an end of the first jaw and extending through the first jaw from an engagement surface of the first jaw to an outer surface of the first jaw; and a second jaw having a through hole disposed at an end of the second jaw and extending through the second jaw from an engagement surface of the second jaw to an outer surface of the second jaw. The first jaw and the second jaw may be openable and closable relative to each other, with an engagement surface of the first jaw and an engagement surface of the second jaw pointing towards each other. The suturing end effector may comprise a suture needle assembly including a hollow suture needle having: a first tip; a second tip; and an internal passage extending through the hollow suture needle from the first tip to the second tip. In the stowed arrangement of the suturing end effector, the hollow suture needle may be clamped flat between the engagement surfaces of the first jaw and the second jaw, and the guide wire may pass through the through-hole of the first jaw, the interior channel of the hollow suture needle, and the through-hole of the second jaw. The method may further include tensioning the guide wire when the first jaw and the second jaw are open relative to each other, which may cause the guide wire to align with a hollow suture needle, wherein a first pointed end of the hollow suture needle is directed toward the through hole of the first jaw and a second pointed end of the hollow suture needle is directed toward the through hole of the second jaw.
Drawings
In the drawings, like reference numerals generally refer to the same parts throughout the several views. The drawings are not necessarily to scale, emphasis instead generally being placed upon illustrating the principles of the invention. In the following description, various embodiments will be described with reference to the following drawings, in which:
1A-1D illustrate schematic views of a suturing end effector in accordance with various embodiments;
fig. 2A-2K illustrate a suturing device having a suturing end effector in accordance with various embodiments;
fig. 3A-3D illustrate a suture needle assembly according to various embodiments;
FIG. 4A illustrates a cross-sectional side view, right side view, front view, left side view and left front perspective view of a hollow suture needle in accordance with various embodiments;
FIG. 4B illustrates a cross-sectional view of a hollow suture needle in a needle bore in accordance with various embodiments;
fig. 5A and 5B illustrate cutaway views of a lower jaw of a stapling end effector, in accordance with various embodiments;
fig. 6 illustrates a perspective view of the suturing device of fig. 2A-2K, in accordance with various embodiments.
FIGS. 7A and 7B illustrate a schematic of a tendon and pulley locking mechanism for a suturing apparatus in accordance with various embodiments;
FIG. 7C illustrates a schematic view of a tendon and pulley locking mechanism for a suturing apparatus in accordance with various embodiments;
FIGS. 8A and 8B illustrate a tendon and pulley locking mechanism for use in a suturing end effector in accordance with various embodiments;
FIGS. 9A-9C illustrate movement of a locking blade for switching a hollow suture needle between jaws, in accordance with various embodiments;
fig. 10 illustrates routing of tendons for locking blades, wherein the jaws, connector links, and outer sheath are removed to aid in viewing the tendons, according to various embodiments.
Figure 11A illustrates a cut-away view of a proximal end of a first jaw according to various embodiments, and figure 11B illustrates a cross-sectional view of the first jaw according to various embodiments;
12A-12C illustrate a method of attaching a locking blade to a rib according to various embodiments;
13A and 13B illustrate a suturing device according to various embodiments;
FIG. 14 illustrates an exploded view of a suturing apparatus in accordance with various embodiments;
fig. 15A-15C depict how a tendon according to various embodiments is connected to a grasper having a jaw.
16A-16C illustrate another pair of ribs that may be used to manipulate the first jaw relative to the first connector link in accordance with various embodiments;
fig. 17A and 17B illustrate perspective and partial cross-sectional views of a first joint link in accordance with various embodiments.
Fig. 18 illustrates front, top, bottom, and left views of a first connector link in accordance with various embodiments;
19A-19B illustrate another pair of ribs that may be used to manipulate a first connector link relative to a second connector link in accordance with various embodiments;
FIG. 20 illustrates a partial cross-sectional view of a second connector link in accordance with various embodiments;
fig. 21 illustrates a front view, a top view, and a left side view of a second joint link in accordance with various embodiments;
FIG. 22 illustrates a coupling between a shaft and a second joint link, in accordance with various embodiments; and
fig. 23A-23E illustrate a suturing process using a suturing device according to various embodiments.
Detailed Description
The embodiments described below in the context of the apparatus are similarly valid for the respective methods and vice versa. Further, it will be understood that the embodiments described below may be combined, e.g., a portion of one embodiment may be combined with a portion of another embodiment.
It will be understood that the terms "on … …", "above … …", "top", "bottom", "down", "side", "back", "left", "right", "front", "lateral", "side", "up", "down", when used in the following description, are used for convenience and to aid in understanding the relative position or orientation, and are not intended to limit the orientation of any device, or structure, or any portion of any device or structure. In addition, the singular terms "a", "an", and "the" include the plural forms as well, unless the context clearly indicates otherwise. Similarly, the word "or" is intended to include "and" unless the context clearly indicates otherwise.
Various embodiments are generally directed to a stapling end effector. In particular, embodiments are generally directed to a stapling end effector for an endoscopic instrument that may be used to perform endoscopic closures. Various embodiments may be a multiple degree of freedom endoscopically placed endoscopic stapling end effector. According to various embodiments, the stapling end-effector may be part of a surgical stapling apparatus or a surgical endoscopic stapling device. In other words, various embodiments also provide devices having the stapling end effector of various embodiments. According to various embodiments, the stapling end-effector and/or device may effectively perform endoscopic closure of the gastrointestinal tract (GI tract), with features such as triangulation (triangulation) capabilities and tool quick changes during operation. According to various embodiments, a surgical stapling apparatus (or a surgical endoscopic stapling device or apparatus) may include: a flexible tubular body shaft; an articulation joint assembly extending from the body shaft for articulation in a direction transverse to a longitudinal axis of the assembly; two jaws pivotally connected to the articulation joint assembly; a suture needle operatively associated with both jaws through respective needle receiving apertures in each jaw; two movable locking blades in the jaws to lock or unlock the suture needle relative to the jaws; and a tendon-sheath mechanism for driving the joint, the two jaws and the two locking blades of the articulating joint assembly. According to various embodiments, methods may be provided for locking or unlocking a suture needle by moving a locking blade through a tendon-sheath mechanism. Additionally, various embodiments may have two modes of operation: a suture mode and a delivery mode. The stapling mode can be a mode when the stapling end effector and/or device according to various embodiments is or is about to perform a stapling task. The delivery mode may be a mode when being or is ready to be delivered through the tool channel of the endoscope by a stapling end effector and/or device according to various embodiments. Further, various embodiments provide a method of reconfiguring a stapling end effector between two modes.
According to various embodiments, the stapling end-effector and/or device may be an "endoscopically placed" device, whereby the stapling end-effector and/or device may be delivered to a surgical target through a tool channel of an endoscope. The "endoscopically placed" tool may allow for efficient tool replacement during operation. According to various embodiments, the suture end effector and/or device may perform both running stitches and interrupted stitches. According to various embodiments, the stapling end effector and/or device may allow for "triangulation," whereby the stapling end effector and/or device may itself have degrees of freedom for triangulation rather than relying on endoscope operability. Triangulation itself may improve the flexibility and ease of use of the stapling end effector and/or device. According to various embodiments, the stapling end effector and/or device may minimize or reduce the risk of puncturing other organs adjacent to the surgical site. According to various embodiments, the suturing end effector and/or device may perform full-thickness closure of the GI tract. Full-thickness closures may allow for a wide range of surgical procedures to be performed, and may also increase the strength of the closure. According to various embodiments, the stapling end effector and/or device may perform closure for relatively large defects (length ≧ 2 cm). Closure of large defects may allow for a greater range of surgical procedures.
Various embodiments may have the following innovation points compared to conventional devices.
Various embodiments provide a stapling end effector and/or device feature having two modes, a delivery mode and a stapling mode. According to various embodiments, the outer diameter of the stapling end effector and/or device in the delivery mode can be substantially less than the outer diameter of the stapling end effector and/or device in the stapling mode. Thus, the various embodiments in the delivery mode may be small enough to be delivered to a surgical site through the tool channel of an endoscope. Once at the surgical site, the stapling end effector and/or device according to various embodiments may be converted to a stapling mode, and the stapling end effector and/or device according to various embodiments may be large enough to perform full-thickness stapling for GI defects. In conventional suturing devices, there is no such mode of delivery, and the outer diameter of conventional suturing devices is often too large for the passage of an endoscope. Furthermore, various embodiments may be provided with a more reliable force and motion transmission system than conventional devices. The movement of the locking vanes of the various embodiments may be controlled by ribs. The locking blade may be moved forward or backward along the longitudinal axis of the various embodiments by pulling on any of the ribs. Further, according to various embodiments, both jaws may be controlled by two further tendons. The jaws can be opened or closed by pulling on either of the other two ribs. In various embodiments, the method may be more reliable than methods employed in conventional devices. Further, the various embodiments may be driven by a flexible tendon-sheath mechanism with multiple degrees of freedom of drive, such that the various embodiments do not rely on movement of the endoscope from one site to another, and such that triangulation with respect to other tools (e.g., grippers or cautery blades) may be obtained. Most conventional devices do not have an articulated joint and therefore rely on the movement of the endoscope.
Various embodiments provide a stapling end effector and/or device that may be small enough to be delivered through a tool channel of an endoscope and may facilitate tool triangulation by having joints powered by a tendon-sheath mechanism. In addition, a suturing end effector and/or device according to various embodiments may produce continuous or interrupted stitches for full-thickness suturing of large defects without blind needle penetration. With the suturing end effector and/or device according to various embodiments, once a stitch is formed, knots can be easily tied due to the dexterity provided by the driven joints.
Various embodiments may have the following significant advantages over conventional devices.
The stapling end effector and/or device according to various embodiments may be convertible between a conventional configuration (stapling mode) and a much smaller configuration (delivery mode) such that the stapling end effector and/or device may be delivered or withdrawn through an endoscopic channel. Once at the surgical site, the stapling end effectors and/or devices of various embodiments may be converted to a stapling mode, thereby making the stapling end effectors and/or devices according to various embodiments large enough to perform full-thickness stapling for GI defects. However, in conventional devices, there is no such mode of delivery, and the outer diameter of the end effector of conventional devices is typically too large to be delivered through the channel of an endoscope. Furthermore, various embodiments may be provided with a more reliable force and motion transmission system. In various embodiments, the movement of the locking blade may be controlled by two ribs. By pulling on either of the two ribs, the locking blade can be moved forward or backward along the longitudinal axis of the respective embodiment. In addition, two jaws in various embodiments may also be controlled by two additional ribs. The jaws may be opened or closed by pulling on either of the two ribs. In various embodiments, the method may be more reliable than methods employed in conventional devices. In addition, a stapling end effector and/or device according to various embodiments may be more powerful and stable in holding a payload than conventional devices. The joints in the various embodiments can be actuated, whereas conventional devices typically have too many under-actuated joints. Under-actuated joints may not be controllable and may be unstable when subjected to external loads, thereby making it difficult to manipulate tissue.
According to various embodiments, a surgical endoscopic suturing device (or surgical suturing apparatus or suturing device or apparatus) may be provided with a flexible body portion and a suturing end effector. According to various embodiments, a suturing end effector may be provided with: an articulation joint assembly extending from the flexible body portion to articulate in a direction (one or two or more) transverse to a longitudinal axis of the stapling end effector; two jaws pivotally connected to the articulation joint assembly; a suture needle operatively associated with both jaws through respective needle-receiving recesses/apertures in each jaw; two movable locking blades located within the jaws for locking or releasing the suture needle; and a tendon-sheath mechanism (one or two or more) for driving the articulating joint assembly, the two jaws and the two locking blades. According to various embodiments, locking or unlocking of the suture needle by moving the locking blade may be accomplished by a tendon-sheath mechanism.
In addition, according to various embodiments, the suturing device may have two modes: a suture mode and a delivery mode. The stapling mode may be a mode when a stapling end effector of a stapling device is performing or is ready to perform a stapling task. The delivery mode may be a mode when a stapling end effector of a stapling device is being delivered or is ready to be delivered through a tool channel of an endoscope. A method of reconfiguring the suturing device between these two modes can be provided. According to various embodiments, the difference between the suturing mode and the delivery mode is whether the suture needle is engaged with one of the two jaws of the suturing end effector of the suturing device. In the delivery mode, the two jaws may be fully closed (or have a gap that is close to the outer diameter of the suture needle), and the suture needle may not be locked to any of the jaws, but may be positioned only between the two closed jaws (or clamped between the two closed jaws in a horizontal or longitudinal orientation). The thread may pass through a suture needle (which may be hollow) and two recessed holes (or corresponding needle-receiving recesses/holes) in the jaws, with both ends of the thread extendable to the proximal end of the suturing device and may be pulled by a motor or hand. With the suture needle disposed between the jaws, the suturing device may be small enough to be delivered through the tool channel of an endoscope. After reaching the surgical site, the jaws may be opened and the suture needle may be deployed to stand or stand between the two open jaws and then engage one of the two jaws, i.e., the suturing device is switched to its suturing mode and is ready for a suturing task. This may be accomplished by applying tension to (pulling) the thin wire through the recessed hole of the hollow suture needle and jaw. Due to the tension on the thread, the suture needle may stand or may stand upright between the two jaws, and the suture needle may be guided to the recessed bore of the jaws. The locking blade on either jaw may then be advanced to engage a recess (or slot) on the needle, thereby locking the needle in place on the jaw. Thereafter, one end of the thread may be pulled to completely withdraw the thread from the endoscope, and the suturing device may now be in its suturing mode. Alternatively, to withdraw a thin guide wire, endoscopic scissors or a cutter may be used to cut the distal section of the guide wire between the two jaws, and then both proximal ends of the guide wire may be pulled to withdraw the wire from the endoscope. A weak point may also be created initially at the distal section of the guidewire, whereby when a relatively large force is applied (compared to the force of the tension wire used to deploy the needle), the guidewire may break to pull both proximal ends of the guidewire. The suture needle is locked or unlocked by repeatedly closing/opening the jaws and switching the locking blade to produce a stitch on the target tissue. Once the suturing task is completed, the suturing device can be switched back to the delivery mode. The suture needle may be unlocked from the receiving jaw and other cooperating graspers or tools may be used to remove the suture from the needle aperture of the jaw. Next, the two jaws of the suturing device can grasp a suture needle removed from the cooperating grasper so that the suture needle can be stored between the two closed jaws (or can be grasped between the two closed jaws in a horizontal or longitudinal orientation). Alternatively, a cooperating grasper may grasp the needle and withdraw it through the tool channel of the endoscope. Finally, the proximal end of the flexible body portion of the suturing device may be pulled through the endoscope channel to withdraw the suturing device.
Fig. 1A-1D show schematic views of a suturing end effector 1 according to various embodiments. Fig. 1A shows a schematic view of the stapling end-effector 1 in a delivery mode. Fig. 1D shows a schematic view of the suturing end effector 1 in the suturing mode. Fig. 1A to 1D show the suture end effector 1 being shifted or converted from the delivery mode to the suture mode. According to various embodiments, the stapling end effector 1 may be part of a stapling device. According to various embodiments, stapling end effector 1 may include a jaw assembly 2. Jaw assembly 2 may include a first jaw 10 (or lower jaw) and a second jaw 20 (or upper jaw). Each of the first jaw 10 and the second jaw 20 may have an elongated body. According to various embodiments, the first jaw 10 may comprise a through hole 11 provided at an end 14 of the first jaw 10. The end 14 of the first jaw 10 may be a free end of the first jaw 10 that is distal from a joint or connection (not shown) between the first jaw 10 and the second jaw 20. According to various embodiments, the through hole 11 of the first jaw 10 may extend through the first jaw 10 from the engagement surface 16 of the first jaw 10 to the opposite surface 18 of the first jaw 10. Thus, the through hole 11 of the first jaw 10 may be a hole extending through the first jaw 10 from the engaging surface 16 of the first jaw 10 to the opposing surface 18 of the first jaw 10. The engaging surface 16 and the opposing surface 18 may be two surfaces on opposite sides of the first jaw 10. According to various embodiments, the second jaw 20 may comprise a through hole 21 provided at an end 24 of the second jaw 20. The end 24 of the second jaw 20 may be a free end of the second jaw 20 that is distal from a joint or connection (not shown) between the first jaw 10 and the second jaw 20. According to various embodiments, the through-hole 21 of the second jaw 20 may extend through the second jaw 20 from an engagement surface 26 of the second jaw 20 to an opposite surface 28 of the second jaw 20. Thus, the through hole 21 of the second jaw 20 may be a hole extending through the second jaw 20 from the engagement surface 26 of the second jaw 20 to the opposing surface 28 of the second jaw 20. The engaging surface 26 and the opposing surface 28 may be two surfaces on opposite sides of the second jaw 20.
According to various embodiments, the first jaw 10 and the second jaw 20 may be openable and closable relative to each other, with the engagement surface 16 of the first jaw 10 and the engagement surface 26 of the second jaw 20 pointing towards each other. Thus, the first jaw 10 and the second jaw 20 may be coupled or connected to each other in a manner such that the engagement surface 16 of the first jaw 10 and the engagement surface 26 of the second jaw 20 may face each other. Further, the first jaw 10 and the second jaw 20 may be coupled or connected in a manner that enables the first jaw 10 and the second jaw 20 to be movable relative to each other, thereby enabling the engagement surface 16 of the first jaw 10 and the engagement surface 26 of the second jaw 20 to be moved toward each other to close the first jaw 10 and the second jaw 20, and enabling the engagement surface 16 of the first jaw 10 and the engagement surface 26 of the second jaw 20 to be moved away from each other to open the first jaw 10 and the second jaw 20. According to various embodiments, the joint or connection between the first jaw 10 and the second jaw 20 may be a rotational joint or a prismatic joint or any other suitable joint that may open and close the first jaw 10 and the second jaw 20 relative to each other.
According to various embodiments, the stapling end effector 1 may further comprise a stapling needle assembly 3. The suture needle assembly 3 may include a hollow suture needle 30. According to various embodiments, the hollow suture needle 30 may have a first pointed end 32, a second pointed end 34, and an internal passage 36, the internal passage 36 extending through the hollow suture needle 30 from the first pointed end 32 to the second pointed end 34. Accordingly, the hollow suture needle 30 may be in the form of a hollow tube with oblique cuts at both ends to form a first tip 32 and a second tip 34. The interior passage 36 of the hollow suture needle 30 may be a passage or conduit or elongated hollow space surrounded or encircled by the hollow suture needle 30 extending from the first pointed end 32 to the second pointed end 34 throughout the length of the hollow suture needle 30. According to various embodiments, the hollow suture needle 30 may be curved or may be straight or may be angled.
According to various embodiments, when in the delivery mode, as shown in fig. 1A, the hollow suture needle 30 may be clamped flat between the engagement surface 16 of the first jaw 10 and the engagement surface 26 of the second jaw 20 in the stowed arrangement of the suturing end effector 1. Accordingly, the hollow suture needle 30 may be positioned horizontally or longitudinally relative to the first jaw 10 and the second jaw 20 such that the hollow suture needle 30 may be sandwiched by the engagement surface 16 of the first jaw 10 and the engagement surface 26 of the second jaw 20, wherein a longitudinal direction (or a direction of extension of the length) of the hollow suture needle 30 is at least substantially parallel to the engagement surface 16 of the first jaw 10 and the engagement surface 26 of the second jaw 20. According to various embodiments, in order to clamp the hollow suture needle 30 between the first jaw 10 and the second jaw 20 with the hollow suture needle 30 disposed between the first jaw 10 and the second jaw 20 in a horizontal or longitudinal orientation, in a stowed configuration, a minimum distance between the engagement surface 16 of the first jaw 10 and the engagement surface 26 of the jaw of the second jaw 20 may be equal to an outer diameter of the hollow suture needle 30.
According to various embodiments, the guide wire 76 may be threaded through the through hole 11 of the first jaw 10, the internal channel 36 of the hollow suture needle 30, and the through hole 21 of the second jaw 20 in such a manner that the first jaw 10 and the second jaw 20 are relatively open to each other and tensioning the guide wire 76 may align the guide wire 76 with the hollow suture needle 30, wherein the first pointed end 32 of the hollow suture needle 30 is directed to the through hole 11 of the first jaw 10 and the second pointed end 34 of the hollow suture needle 30 is directed to the through hole 21 of the second jaw 20. Accordingly, as the first jaw 10 and the second jaw 20 are moved away from each other to open relative to each other, and the guide wire 76 is tensioned to become taut, the guide wire 76 may be pulled or stretched across the jaw jaws from the through hole 11 of the first jaw 10 to the through hole 21 through the second jaw 20. The guide wire 76 may be pulled at either or both ends to tension or tighten. Since the guide wire 76 extends through the internal channel 36 of the hollow suture needle 30 between the through hole 11 of the first jaw 10 and the through hole 21 of the second jaw 20, the hollow suture needle 30 may be suspended between the through hole 11 of the first jaw 10 and the through hole 21 of the second jaw 20 to form a suspended arrangement of the suturing end effector 1 when the first jaw 10 and the second jaw 20 are opened relative to each other and the guide wire 76 is tightened or tightened.
According to various embodiments, as shown in fig. 1B, in the suspended arrangement of the suturing end effector 1, the hollow suturing needle 30 may be vertically or vertically aligned with respect to the first jaw 10 and the second jaw 20 in such a manner that the first pointed end 32 of the hollow suturing needle 30 may be directed or aligned with the through hole 11 of the first jaw 10, the second pointed end 34 of the hollow suturing needle 30 may be directed or aligned with the through hole 21 of the second jaw 20, and the guide wire 76 extends from the through hole 11 of the first jaw 10, enters the internal channel 36 of the hollow suturing needle 30 via the first pointed end 32 of the hollow suturing needle 30, exits the internal channel 36 of the hollow suturing needle 30 via the second pointed end 34 of the hollow suturing needle 30, and extends to the through hole 21 of the second jaw 20, with the assistance of the guide wire 76.
According to various embodiments, as shown in fig. 1C, the first jaw 10 and the second jaw 20 may be closed relative to each other to form an insertion arrangement of the stapling end effector 1, depending on the suspension arrangement of the stapling end effector 1. As shown, in the insertion arrangement of the suturing end effector 1, the first pointed end 32 of the hollow suturing needle 30 is inserted through the through bore 11 of the first jaw 10 and the second pointed end 34 of the hollow suturing needle 30 is inserted through the through bore 21 of the second jaw 20. According to various other embodiments, it will be appreciated that the first pointed end 32 of the hollow suture needle 30 may be inserted into the through hole 11 of the first jaw 10 without protruding from the through hole 11 of the first jaw 10, and the second pointed end 34 of the hollow suture needle 30 may be inserted into the through hole 21 of the second jaw 20 without protruding from the through hole 21 of the second jaw 20. According to various embodiments, the hollow suture needle 30 may include a stop or limiter configured to limit the extension of insertion of the hollow suture needle 30 into the through-hole 11 of the first jaw 10 and the through-hole 21 of the second jaw 20, respectively. According to various embodiments, the hollow suture needle 30 may be configured to fit in the through hole 11 of the first jaw 10 only in one orientation of the hollow suture needle 30 relative to the through hole 11 of the first jaw 10. According to various embodiments, the hollow suture needle 30 may be configured to fit in the through hole 21 of the second jaw 20 only in one orientation of the hollow suture needle 30 relative to the through hole 21 of the second jaw 20. According to various embodiments, as the first and second jaws approach each other to form the insertion arrangement, the guide wire 76 may be tensioned or tightened to facilitate insertion of the respective first and second pointed ends 32, 34 of the hollow suture needle 30 into the respective through-holes 11, 21 of the first and second jaws 10, 20. The guide wire 76 may be tensioned or tightened by pulling on either or both ends of the guide wire 76.
According to various embodiments, as shown in fig. 1D, the hollow suture needle 30 may be locked to one of the first jaw 10 or the second jaw 20 with the guide wire 76 withdrawn, and the first jaw 10 and the second jaw 20 may be opened relative to each other such that the suturing end effector 1 may be brought into a deployed arrangement in preparation for suturing in a suturing mode. In the deployed arrangement, the hollow suture needle 30 may stand or stand from one of the first jaw 10 or the second jaw 20. According to various embodiments, the first jaw 10 may include a locking element 15, the locking element 15 being configured to engage with the hollow suture needle 30 to lock the hollow suture needle 30 to the first jaw 10. According to various embodiments, the second jaw 20 may include a locking element 25, the locking element 25 configured to engage with the hollow suture needle 30 to lock the hollow suture needle 30 to the second jaw 20. As shown in fig. 1D, for example, the hollow suture needle 30 may stand or stand from the first jaw 10, with the first pointed end 32 of the hollow suture needle 30 inserted through the through hole 11 of the first jaw 10, and the locking element 15 of the first jaw 10 engaging the hollow suture needle 30 in a manner that locks the hollow suture needle 30 to the first jaw 10. On the other hand, with the first jaw 10 and the second jaw 20 open relative to each other, the second pointed end 34 of the hollow suture needle 30 is free relative to the through hole 21 of the second jaw 20, the locking element 25 of the second jaw 20 is withdrawn from the hollow suture needle 30, and the guide wire 76 is completely withdrawn from the suture end effector 1. According to various embodiments, when the stapling end effector 1 is in the insertion position of fig. 1C, the opposite configuration may be achieved by reversing the engagement and retraction of the locking element 15 of the first jaw 10 and the locking element 25 of the second jaw 20.
Fig. 2A-2K illustrate a
According to various embodiments, a stapling
According to various embodiments, the
According to various embodiments, the stapling
According to various embodiments, when in the delivery mode, as shown in fig. 2A, the
As shown in fig. 2A, according to various embodiments, the two
According to various embodiments, upon reaching the target surgical site, the
According to various embodiments, the
According to various embodiments, according to the suspended arrangement of the
According to various embodiments, as shown in fig. 2C and 2K, the
According to various embodiments, other
According to various embodiments, the
As shown in fig. 2E, according to various embodiments, the two
Fig. 2F illustrates the position of the
According to various embodiments, as shown in fig. 2F, the
Once the suturing task is completed or performed, the
Referring to fig. 2K, according to various embodiments, a
Fig. 3A-3D illustrate a
According to various embodiments, the
Fig. 3A to 3D illustrate a process of assembling the
According to various embodiments, with the above-described method, due to the limited space within the
FIG. 4A illustrates a cross-sectional side view, a right side view, a front view, a left side view, and a front left perspective view of a
Referring back to FIG. 4A, according to various embodiments, there may be two
In other words, according to various embodiments, the cross-sectional profile of the
Further, according to various embodiments, the cross-sectional profile of the
Fig. 6 illustrates a perspective view of the
Fig. 7A and 7B illustrate a schematic of a tendon and pulley locking mechanism 704 for a
Fig. 7C shows a schematic of a tendon and pulley locking mechanism 705 for a
Fig. 8A and 8B illustrate the tendon and pulley locking mechanism 704 of fig. 7A and 7B applied in a stapling
In other words, according to various embodiments, the bar and pulley locking mechanism 704 may include: a
Fig. 9A-9C illustrate movement of locking
Referring back to fig. 8A, according to various embodiments, a
Fig. 11A shows a cut-away view of the proximal end of the first jaw (or lower jaw), and fig. 11B shows a cross-sectional view of the first jaw. According to various embodiments, there are four stepped
Fig. 12A-12C illustrate a method of attaching a
Fig. 13A and 13B illustrate a
Referring to fig. 13B, the two
FIG. 14 illustrates an exploded view of a
According to various embodiments, crimping beads, e.g., 712, may be applied to the exposed ribs (720 and 721) between the two outer sheaths at the distal end. According to various embodiments, the crimping bead may be considered to be sufficiently tightly crimped onto the bead to translate sufficient force. According to various embodiments, crimping
Figures 15A-15C illustrate how the
Fig. 15B illustrates an example of how a pair of ribs may be secured to a pulley by crimping beads, according to various embodiments. According to various embodiments, the
Fig. 16A-16C illustrate another pair of
Fig. 19A and 19B illustrate another pair of
Fig. 22 illustrates a coupling between a
Referring back to fig. 13A-22, in other words, in accordance with various embodiments, stapling
According to various embodiments, the pivot joint of the jaw assembly 902 and/or the yaw joint of the yaw link and/or the pitch joint of the pitch link may each include a bar and pulley mechanism configured to control the respective motions (i.e., the pivot motion of the pivot joint, the yaw motion of the yaw joint, and the pitch motion of the pitch joint). According to various embodiments, each rib and pulley mechanism may comprise: pulleys, which are rotatably arranged coaxially with the respective axes; and one or more tendons wrapped around the pulley in such a way that pulling either side of the tendon (or any tendon) relative to the pulley causes the pulley to rotate in a corresponding direction, thereby producing a corresponding movement of the corresponding joint.
According to various embodiments, the pulley may comprise a retaining element and the tendon may comprise a knot held in the retaining element of the pulley in such a way that the knot engages the retaining element to rotate the pulley when pulling the tendon. According to various embodiments, the retaining element of the pulley may be a capture element or a retainer element, and the node of the rib may be a bump or protrusion on the rib. Accordingly, the catch element or retainer element may retain or retain the protuberance or protrusion on the rib. According to various embodiments, the retaining element of the pulley may comprise a recessed portion cut into a sector of the pulley and the node of the rib may comprise a crimp bead crimped onto the rib.
Fig. 23A-23E illustrate a suturing process using the
The following examples are suitable for the various embodiments.
According to various embodiments, there is provided a suturing end effector (or a suturing device having a suturing end effector) comprising:
a jaw assembly comprising
A first jaw having a through hole disposed at an end of the first jaw and extending through the first jaw from an engaging surface of the first jaw to an opposing surface of the first jaw,
a second jaw having a through hole disposed at an end of the second jaw and extending therethrough from an engaging surface of the second jaw to an opposing surface of the second jaw,
wherein the first jaw and the second jaw are openable and closable relative to each other, wherein an engagement surface of the first jaw and an engagement surface of the second jaw are directed towards each other.
According to various embodiments, a suture end effector may comprise a suture needle assembly including a hollow suture needle having: a first tip; a second tip; and an internal passage extending through the hollow suture needle from the first tip to the second tip.
According to various embodiments, in the stowed arrangement of the suture end effector, the hollow suture needle may be clamped flat between the engagement surface of the first jaw and the engagement surface of the second jaw, and the guide wire may be passed through the through-hole of the first jaw, the internal channel of the hollow suture needle, and the through-hole of the second jaw in such a manner that the first jaw and the second jaw are opened relative to each other, and the guide wire is tensioned, which may cause the guide wire to be aligned with the hollow suture needle with the first pointed end of the hollow suture needle directed toward the through-hole of the first jaw and the second pointed end of the hollow suture needle directed toward the through-hole of the second jaw.
According to various embodiments, the hollow suture needle may have a hole along the hollow suture needle between the first pointed end and the second pointed end, the hole providing access to the interior passage of the hollow suture needle. According to various embodiments, the suture needle assembly may further comprise a suture thread connected to the hole along the hollow suture needle. According to various embodiments, the ends of the suture thread may be inserted into the hollow suture needle through the hole and along the hollow suture needle. According to various embodiments, the suture needle assembly may further include a tube inserted through the interior passage of the hollow suture needle in a manner such that the insertion end of the suture thread is wedged between the interior surface of the interior passage of the hollow suture needle and the exterior surface of the tube to secure the suture thread to the hollow suture needle. According to various embodiments, a guide wire may be threaded through the internal passage of the tube. According to various embodiments, the hole may be located at a midpoint of the hollow suture needle between the first pointed end and the second pointed end.
According to various embodiments, a cross-sectional profile of the first end section of the hollow suture needle facing the first pointed end may be a non-rotationally symmetric shape and a cross-sectional profile of the through hole of the first jaw may be a corresponding shape such that the first end section of the hollow suture needle fits into the through hole of the first jaw in one orientation of the hollow suture needle relative to the through hole of the first jaw. According to various embodiments, the cross-sectional profile of the first end section of the hollow suture needle may be a shape similar to a circle with a cut-away circle segment. According to various embodiments, the first end section of the hollow suture needle may comprise a flat surface corresponding to a cut-away circular segment of the cross-sectional profile of the first end section of the hollow suture needle. According to various embodiments, the shoulder may protrude from an edge of the planar surface distal from the first tip.
According to various embodiments, a cross-sectional profile of the second end section of the hollow suture needle towards the second pointed end may be a non-rotationally symmetric shape and a cross-sectional profile of the through hole of the second jaw may be a corresponding shape such that the second end section of the hollow suture needle may fit into the through hole of the second jaw in one orientation of the hollow suture needle relative to the through hole of the second jaw. According to various embodiments, the cross-sectional profile of the second end section of the hollow suture needle may be a shape similar to a circle with a cut-away circle segment. According to various embodiments, the second end section of the hollow suture needle may comprise a flat surface corresponding to a cut-away circular segment of the cross-sectional profile of the second end section of the hollow suture needle. According to various embodiments, the shoulder may protrude from an edge of the planar surface distal from the second tip.
According to various embodiments, the first jaw and the second jaw may be connected to each other via a pivot joint in such a way as to provide a pivoting movement relative to each other about a pivot axis of the pivot joint, such that the first jaw and the second jaw may be openable and closable relative to each other.
According to various embodiments, the stapling end effector may include a yaw link connected to the jaw assemblies via a yaw joint in a manner that provides the jaw assemblies with yaw motion about a yaw axis of the jaw assemblies relative to the yaw link.
According to various embodiments, the stapling end effector may include a pitch link connected to the jaw assembly via a pitch joint in a manner that provides the jaw assembly with a pitch motion about a pitch axis of the jaw assembly relative to the pitch link.
According to various embodiments, the pivot joint and/or the yaw joint and/or the pitch joint may each include a tendon and pulley mechanism configured to control the respective movement. According to various embodiments, the bar and pulley mechanism may comprise: pulleys, which are rotatably arranged coaxially with the respective axes; and a rib wrapped around the pulley in such a manner that pulling either side of the rib relative to the pulley causes the pulley to rotate in a respective direction, thereby producing a respective movement of the respective joint. According to various embodiments, the pulley may comprise a retaining element and the tendon may comprise a knot held in the retaining element of the pulley in such a way that the knot may engage the retaining element to rotate the pulley when pulling the tendon. According to various embodiments, the retaining element of the pulley may comprise a recessed portion cut into a sector of the pulley and the node of the rib may comprise a crimp bead crimped onto the rib.
According to various embodiments, the jaw assembly may further include a bar and pulley locking mechanism configured to alternately lock the hollow suture needle to the first jaw and the second jaw.
According to various embodiments, the bar and pulley locking mechanism may comprise: a first pulley disposed in the first jaw; a second pulley disposed at a joint between the first jaw and the second jaw; a third pulley disposed in the second jaw. According to various embodiments, the wire may be wrapped around the first, second, and third pulleys in such a manner that a first segment of the wire between the first and second pulleys may be parallel to the engagement surface of the first jaw and a second segment of the wire between the second and third pulleys may be parallel to the engagement surface of the second jaw. According to various embodiments, the first locking element may be attached to the first section of the rib and the second locking element may be attached to the second section of the rib. According to various embodiments, the first end of the pull rib may cause the first locking element to move and be positioned across at least a portion of the through hole of the first jaw to engage the hollow suture needle to lock the hollow suture needle to the first jaw, and may cause the second locking element to move and move away from the through hole of the second jaw to disengage the hollow suture needle. According to various embodiments, the second end of the pull rib may cause the second locking element to move and be positioned across at least a portion of the through hole of the second jaw to engage the hollow suture needle to lock the hollow suture needle to the second jaw, and may cause the first locking element to move and move away from the through hole of the first jaw to disengage the hollow suture needle. According to various embodiments, the first end of the tendon and the second end of the tendon may cause corresponding movement of the tendon in opposite directions relative to the respective pulley.
According to various embodiments, the bar and pulley locking mechanism may comprise: a first lock stator mechanism including a first pulley disposed in the first jaw and a first rib wound around the first pulley; and a second lock sub-mechanism including a second pulley disposed in the second jaw and a second rib wrapped around the second pulley. According to various embodiments, the first locking element may be attached to the first section of the rib and the second locking element may be attached to the second section of the rib. According to various embodiments, pulling the first end of the first rib may cause the first locking element to move and be positioned across at least a portion of the through-hole of the first jaw to engage the hollow suture needle to lock the hollow suture needle to the first jaw, and pulling the second end of the first rib may cause the first locking element to move and away from the through-hole of the first jaw to disengage the hollow suture needle. According to various embodiments, pulling the first end of the second tendon may cause the second locking element to move and be positioned across at least a portion of the through-hole of the second jaw to engage the hollow suture needle to lock the hollow suture needle to the second jaw, and pulling the second end of the second tendon may cause the second locking element to move and away from the through-hole of the second jaw to disengage the hollow suture needle. According to various embodiments, the first and second lock sub-mechanisms may be independently operable. According to various embodiments, pulling the respective first end of the respective rib may result in a respective movement in a clockwise direction around the respective first and second pulley and pulling the respective second end of the respective rib may result in a respective movement in a counter-clockwise direction around the respective first and second pulley. According to various embodiments, pulling the respective first ends of the respective first and second ribs may cause the respective first and second pulleys to rotate clockwise, or may cause the respective first and second ribs to slide in a clockwise direction around the respective first and second pulleys. According to various embodiments, pulling the respective second ends of the respective first and second ribs may cause the respective first and second pulleys to rotate counterclockwise, or may cause the respective first and second ribs to slide in a counterclockwise direction around the respective first and second pulleys. According to various embodiments, pulling the respective first ends and pulling the respective second ends may cause opposite movements of the respective first and second ribs.
According to various embodiments, the first locking element and the second locking element may each comprise a locking blade attached to a respective segment of a respective rib in the longitudinal direction. According to various embodiments, a hollow suture needle may comprise: a first slot traversing the hollow suture needle and disposed toward the first tip; and a second slot traversing the hollow suture needle and disposed toward the second tip. According to various embodiments, the respective locking blade may engage the hollow suture needle by intersecting the respective first and second slots of the hollow suture needle to lock the hollow suture needle to the respective first and second jaws. According to various embodiments, each pulley of the tendon and pulley locking mechanism may comprise a rotating pulley or a stationary circular profile.
According to various embodiments, there is provided a method of deploying a stapling end effector, the method comprising:
opening the jaw assembly of the stapling end effector from the stowed arrangement,
wherein the suture end effector comprises
A jaw assembly comprising
A first jaw having a through hole disposed at an end of the first jaw and extending through the first jaw from an engagement surface of the first jaw to an outer surface of the first jaw, and
a second jaw having a through hole disposed at an end of the second jaw and extending therethrough from an engagement surface of the second jaw to an outer surface of the second jaw, wherein the first jaw and the second jaw are openable and closable relative to each other with the engagement surface of the first jaw and the engagement surface of the second jaw directed toward each other, and
a suture needle assembly comprising a hollow suture needle having: a first tip; a second tip; and an internal passage extending through the hollow suture needle from the first tip to the second tip,
wherein, in the stowed arrangement of the suturing end effector, the hollow suture needle is clamped flat between the engagement surfaces of the first jaw and the second jaw, and the guide wire passes through the through-hole of the first jaw, the interior channel of the hollow suture needle, and the through-hole of the second jaw; and
the guide wire is tensioned when the first jaw and the second jaw are opened relative to each other such that the guide wire is aligned with the hollow suture needle, wherein a first pointed end of the hollow suture needle is directed toward the through hole of the first jaw and a second pointed end of the hollow suture needle is directed toward the through hole of the second jaw.
According to various embodiments, the method may further comprise closing the jaw assembly such that a first pointed end of the hollow suture needle may be inserted through the through-hole of the first jaw and a second pointed end of the hollow suture needle may be inserted through the through-hole of the second jaw.
According to various embodiments, closing the jaw assembly may include self-aligning the hollow suture needle with the through-holes of the first jaw and the second jaw when the respective pointed ends of the hollow suture needle are inserted into the respective through-holes of the first jaw and the second jaw.
According to various embodiments, the first end section of the hollow suture needle, having a non-rotationally symmetric shaped cross-sectional profile, towards the first pointed end may be self-aligned with the through-hole of the first jaw having a correspondingly shaped cross-sectional profile when the first end section of the hollow suture needle is inserted into the through-hole of the first jaw.
According to various embodiments, the second end section of the hollow suture needle, having a non-rotationally symmetric shaped cross-sectional profile, towards the second pointed end may be self-aligned with the through-hole of the second jaw having a correspondingly shaped cross-sectional profile when the second end section of the hollow suture needle is inserted into the through-hole of the second jaw.
According to various embodiments, the cross-sectional profile of the first end section of the hollow suture needle and the cross-sectional profile of the second end section of the hollow suture needle may each be a shape similar to a circle having a cut-away circle segment.
According to various embodiments, the method may further comprise locking the hollow suture needle to one of the first jaw or the second jaw via a tendon and pulley locking mechanism.
According to various embodiments, the bar and pulley locking mechanism may comprise: a first pulley disposed in the first jaw; a second pulley disposed at a joint between the first jaw and the second jaw; a third pulley disposed in the second jaw. According to various embodiments, the wire may be wrapped around the first, second, and third pulleys in such a manner that a first segment of the wire between the first and second pulleys may be parallel to the engagement surface of the first jaw and a second segment of the wire between the second and third pulleys may be parallel to the engagement surface of the second jaw. According to various embodiments, the first locking element may be attached to the first section of the rib and the second locking element may be attached to the second section of the rib. According to various embodiments, locking the hollow suture needle to the first jaw comprises: the first end of the tendon is pulled such that the first locking element is moved and positioned across at least a portion of the through-hole of the first jaw to engage the hollow suture needle, thereby locking the hollow suture needle to the first jaw, and such that the second locking element is moved and moved away from the through-hole of the second jaw to disengage the hollow suture needle. According to various embodiments, locking the hollow suture needle to the second jaw comprises: the second end of the tendon is pulled such that the second locking element is moved and positioned across at least a portion of the through-hole of the second jaw to engage the hollow suture needle, thereby locking the hollow suture needle to the second jaw, and such that the first locking element is moved and moved away from the through-hole of the first jaw to disengage the hollow suture needle.
According to various embodiments, the bar and pulley locking mechanism may comprise: a first lock stator mechanism including a first pulley disposed in the first jaw and a first rib wound around the first pulley. According to various embodiments, the bar and pulley locking mechanism may further comprise: a second lock sub-mechanism including a second pulley disposed in the second jaw and a second rib wrapped around the second pulley. According to various embodiments, the first locking element may be attached to the first section of the rib and the second locking element may be attached to the second section of the rib. According to various embodiments, the first and second lock sub-mechanisms may be independently operable. According to various embodiments, locking the hollow suture needle to the first jaw comprises: pulling the first end of the first tendon to cause the first locking element to move and be positioned across at least a portion of the through-hole of the first jaw to engage the hollow suture needle, thereby locking the hollow suture needle to the first jaw. According to various embodiments, locking the hollow suture needle to the second jaw comprises: pulling the first end of the second tendon to cause the second locking element to move and be positioned across at least a portion of the through-hole of the second jaw to engage the hollow suture needle, thereby locking the hollow suture needle to the second jaw.
According to various embodiments, the method may further comprise withdrawing a guide wire from the jaw assembly and the hollow suture needle.
According to various embodiments, withdrawing the guide wire may include pulling either end of the guide wire to pull the guide wire out of the through-hole of the first jaw, the internal channel of the hollow suture needle, and the through-hole of the second jaw.
According to various embodiments, withdrawing the guide wire may include cutting a portion of the guide wire between the first jaw and the second jaw, and withdrawing the cut guide wire from the through-hole of the first jaw and the through-hole of the second jaw, respectively.
According to various embodiments, there is provided a suturing end effector (or a suturing device having a suturing end effector) comprising:
a jaw assembly comprising
A first jaw having a through hole disposed at an end of the first jaw and extending through the first jaw from an engaging surface of the first jaw to an opposing surface of the first jaw,
a second jaw having a through hole disposed at an end of the second jaw and extending therethrough from an engaging surface of the second jaw to an opposing surface of the second jaw,
wherein the first jaw and the second jaw are openable and closable relative to each other with an engagement surface of the first jaw and an engagement surface of the second jaw directed toward each other; and
a bar and pulley locking mechanism configured to lock the suture needle to the first jaw, the bar and pulley locking mechanism comprising
A first pulley disposed in the first jaw,
a first rib wrapped around the first pulley in such a manner that a first segment of the first rib extending within the length of the first jaw is parallel to the engagement surface of the first jaw, and
a first locking element attached to a first segment of the first rib,
wherein pulling the first end of the first rib causes the first locking element to move and be positioned across at least a portion of the through hole of the first jaw to engage the suture needle, wherein the first pointed end is inserted into the through hole of the first jaw to lock the suture needle to the first jaw, and pulling the second end of the first rib causes the first locking element to move and move away from the through hole of the first jaw to disengage the suture needle.
According to various embodiments, the rib and pulley locking mechanism may be further configured to lock the suture needle to the second jaw. According to various embodiments, the bar and pulley locking mechanism may further comprise
A second pulley disposed at a joint between the first jaw and the second jaw,
a third pulley disposed in the second jaw, wherein the first rib is further wrapped around the second pulley and the third pulley in such a manner that a first segment of the first rib is between the first pulley and the second pulley and a second segment of the first rib is between the second pulley and the third pulley such that the second segment of the first rib is parallel to the engagement surface of the second jaw,
a second locking element attached to the second section of the first bead,
wherein pulling the second end of the first tendon causes the second locking element to move and be positioned across at least a portion of the through-hole of the second jaw to engage the suture needle, wherein the second tip is inserted into the through-hole of the second jaw to lock the suture needle to the second jaw, and pulling the first end of the first tendon causes the second locking element to move and away from the through-hole of the second jaw to disengage the suture needle.
According to various embodiments, the rib and pulley locking mechanism may be further configured to lock the suture needle to the second jaw. According to various embodiments, the bar and pulley locking mechanism may further comprise
A second pulley disposed in the second jaw,
a second rib wrapped around the second pulley in such a manner that a first segment of the second rib extending within the length of the second jaw is parallel to the engagement surface of the second jaw, and
a second locking element attached to a first segment of a second rib,
wherein pulling the first end of the second tendon causes the second locking element to move and be positioned across at least a portion of the through hole of the second jaw to engage the suture needle, wherein the second tip is inserted into the through hole of the second jaw to lock the suture needle to the second jaw, and pulling the second end of the second tendon causes the second locking element to move and away from the through hole of the second jaw to disengage the suture needle.
According to various embodiments, the first locking element and the second locking element may each comprise a locking blade attached to a respective segment of a respective rib in the longitudinal direction. According to various embodiments, the suturing end effector may comprise a suturing needle. According to various embodiments, a suture needle may include: a first slot traversing the needle and disposed toward the first tip; and a second slot traversing the needle and disposed toward the second tip. According to various embodiments, the respective locking paddle may engage the suture needle by intersecting the respective first and second slots of the suture needle to lock the suture needle to the respective first and second jaws.
According to various embodiments, each pulley of the tendon and pulley locking mechanism may comprise a rotating pulley or a stationary circular profile.
According to various embodiments, the first jaw and the second jaw may be connected to each other via a pivot joint in such a way as to provide a pivoting movement relative to each other about a pivot axis of the pivot joint, such that the first jaw and the second jaw may be openable and closable relative to each other.
According to various embodiments, the stapling end effector may include a yaw link connected to the jaw assemblies via a yaw joint in a manner that provides the jaw assemblies with yaw motion about a yaw axis of the jaw assemblies relative to the yaw link.
According to various embodiments, the stapling end effector may include a pitch link connected to the jaw assembly via a pitch joint in a manner that provides the jaw assembly with a pitch motion about a pitch axis of the jaw assembly relative to the pitch link.
According to various embodiments, the pivot joint and/or the yaw joint and/or the pitch joint may each comprise a tendon and pulley mechanism configured to control the respective movement, wherein the tendon and pulley mechanism may comprise: pulleys, which are rotatably arranged coaxially with the respective axes; and a rib wrapped around the pulley in such a manner that pulling either side of the rib relative to the pulley causes the pulley to rotate in a respective direction, thereby producing a respective movement of the respective joint.
According to various embodiments, the pulley may comprise a retaining element and the tendon may comprise a knot held in the retaining element of the pulley in such a way that the knot may engage the retaining element to rotate the pulley when pulling the tendon. According to various embodiments, the retaining element of the pulley may comprise a recessed portion cut into a sector of the pulley and the node of the rib may comprise a crimp bead crimped onto the rib.
Various embodiments provide a suturing end effector or suturing device having a suturing end effector that can effectively perform endoscopic closure for the GI tract, with features that enable triangulation and quick change of tools during operation. Various embodiments provide a stapling end effector or a stapling device having a stapling end effector that has an outer diameter in a delivery mode that is substantially smaller than an outer diameter in a stapling mode. Thus, the various embodiments in the delivery mode may be small enough to be delivered to a surgical site through the tool channel of an endoscope. Various embodiments provide a reliable force and motion transfer system for locking and unlocking a suture needle relative to jaws of a suture end effector. Various embodiments have multiple degrees of drive freedom, which can be driven by a flexible web and pulley mechanism, such that the stapling end effector or stapling device does not rely on the movement of an endoscope to move from one site to another and does not rely on other tools for triangulation.
While the invention has been particularly shown and described with reference to a particular embodiment, it will be understood by those skilled in the art that various changes, modifications and variations in form and detail may be made therein without departing from the scope of the invention as defined by the appended claims. The scope of the invention is, therefore, indicated by the appended claims, and all changes that come within the meaning and range of equivalency of the claims are therefore intended to be embraced therein.