Surgical system with variable entry guide configuration
阅读说明:本技术 具有可变进入引导器配置的外科手术系统 (Surgical system with variable entry guide configuration ) 是由 A·K·麦克格罗甘 T·G·库珀 D·Q·拉金 K·M·安德森 J·D·布朗 P·E·里拉 于 2015-08-12 设计创作,主要内容包括:一种外科手术系统在各种外科手术中使用单个进入端口。为了通过单个进入端口将多个外科手术仪器插入患者,要求外科手术仪器中的至少一个(260A1)的轴(262A1)在外科手术仪器(260A1)的底座与轴接触进入引导器(270A)中的通道的点之间弯曲。每个外科手术仪器(260A1、260A2)由仪器操纵器定位系统(231A)定位,使得当轴插在进入引导器(270A)的通道中时,轴的任何弯曲不损坏外科手术仪器并且不抑制外科手术仪器的适当操作。(A surgical system uses a single access port in various surgical procedures. To insert multiple surgical instruments into a patient through a single access port, the shaft (262a1) of at least one of the surgical instruments (260A1) is required to bend between the base of the surgical instrument (260A1) and the point at which the shaft contacts the channel in the entry guide (270A). Each surgical instrument (260A1, 260A2) is positioned by an instrument manipulator positioning system (231A) such that when the shaft is inserted in the channel of the entry guide (270A), any bending of the shaft does not damage the surgical instrument and does not inhibit proper operation of the surgical instrument.)
1. A medical device apparatus, the medical device apparatus comprising:
an entry guide comprising a proximal end, a distal end, and a longitudinal axis extending from the proximal end of the entry guide to the distal end of the entry guide; and
an instrument manipulator including a mount for an instrument, the instrument manipulator configured to move along a trajectory in a plane perpendicular to the longitudinal axis, wherein the trajectory is different from a rotation of the instrument manipulator about the longitudinal axis of the entry guide.
2. The medical device apparatus of claim 1, further comprising:
a lateral motion mechanism coupled to the instrument manipulator, the lateral motion mechanism configured to move the instrument manipulator laterally along the trajectory in the plane perpendicular to the longitudinal axis of the entry guide.
3. The medical device apparatus of claim 2, wherein:
the entry guide further comprises a first channel;
the medical device apparatus further includes the instrument coupled to the instrument manipulator, the instrument including a shaft including a distal end; and is
The lateral motion mechanism is configured to move the instrument manipulator such that the distal end of the shaft is aligned with the first channel when the instrument is coupled to the instrument manipulator.
4. The medical device apparatus of claim 3, wherein:
the instrument manipulator is a first instrument manipulator;
the instrument is a first instrument;
the shaft of the first instrument is a first shaft;
the track is a first track;
the entry guide further comprises a second channel; and is
The medical device apparatus further comprises:
a second instrument manipulator configured to move laterally along a second trajectory in the plane perpendicular to the longitudinal axis of the entry guide, wherein the second trajectory is different from a rotation of the second instrument manipulator about the longitudinal axis of the entry guide; and
a second instrument coupled to the second instrument manipulator, the second instrument including a second shaft,
the second shaft comprises a distal end;
wherein the lateral motion mechanism is configured to move the second instrument manipulator along the second trajectory such that the distal end of the second shaft is aligned with the second channel when the second instrument is coupled to the second instrument manipulator.
5. The medical device apparatus of claim 2, wherein:
the lateral motion mechanism is configured to move the instrument manipulator along the trajectory to a first position on the trajectory; and is
In the first position, a shaft of an instrument coupled to the instrument manipulator is positioned such that stresses caused by bending of the shaft remain within a predetermined stress profile as the shaft passes through a first channel defined by the entry guide.
6. The medical device apparatus of claim 2, wherein:
the lateral motion mechanism also includes an adjustment dial coupled to the instrument manipulator to move the instrument manipulator along the trajectory as the adjustment dial rotates.
7. A medical device, the medical device comprising:
an entry guide mount;
a first instrument manipulator;
a second instrument manipulator;
a first instrument manipulator positioning system coupled to the first instrument manipulator; and
a second instrument manipulator positioning system coupled to the second instrument manipulator;
the first and second instrument manipulators are positioned in a first positional state of the first and second instrument manipulator positioning systems to insert first surgical instruments mounted on the first instrument manipulator and second surgical instruments mounted on the second manipulator into corresponding instrument channels of a first entry guide mounted on the entry guide mount; and is
The first and second instrument manipulators are positioned in a second positional state of the first and second instrument manipulator positioning systems to insert the first surgical instrument mounted on the first instrument manipulator and the second surgical instrument mounted on the second instrument manipulator into corresponding channels of a second entry guide mounted on the entry guide mount;
the first positional state of the first and second instrument manipulator positioning systems is different from the second positional state of the first and second instrument manipulator positioning systems; and is
The cross-sectional configuration of the channel of the first entry guide is different from the cross-sectional configuration of the channel of the second entry guide.
8. The medical device of claim 7: further comprising:
an entry guide manipulator;
the entry guide mount is coupled to the entry guide manipulator; and
the first and second instrument manipulator positioning systems are coupled to the entry guide manipulator.
9. The medical device of claim 7, wherein:
at least one of the first and second surgical instruments is elastically bent when inserted into the corresponding channel of the first entry guide during the first positional state of the first and second instrument manipulator positioning systems; and is
At least one of the first and second surgical instruments is elastically bent when inserted into the corresponding channel of the second entry guide during the second positional state of the first and second instrument manipulator positioning systems.
10. The medical device of claim 7, wherein:
at least one of the first and second surgical instruments is not bent when inserted into the corresponding channel of the first entry guide during the first positional state of the first and second instrument manipulator positioning systems; and is
At least one of the first and second surgical instruments is not bent when inserted into the corresponding channel of the second entry guide during the second positional state of the first and second instrument manipulator positioning systems.
11. A medical device apparatus, the medical device apparatus comprising:
an entry guide, a lateral motion mechanism, and an instrument manipulator coupled to the lateral motion mechanism;
wherein:
the entry guide comprising a proximal end, a distal end, a longitudinal axis defined through the proximal end and the distal end of the entry guide, and a channel extending parallel to the longitudinal axis extending from the proximal end of the entry guide to the distal end of the entry guide; and is
The lateral motion mechanism is configured to move the instrument manipulator laterally along the trajectory in a plane perpendicular to the longitudinal axis, the trajectory being different from a rotation of the instrument manipulator about the longitudinal axis of the entry guide.
12. The medical device apparatus of claim 11, wherein:
the lateral motion mechanism is configured to move the instrument manipulator along the trajectory from a first position to a second position;
at the first position, an end of an instrument mounted to the instrument manipulator is not aligned with the channel of the entry guide; and
in the second position, the end of the instrument mounted to the instrument manipulator is aligned with the channel of the entry guide.
13. The medical device apparatus of claim 11, wherein:
the instrument manipulator is a first instrument manipulator and the trajectory is a first trajectory;
the medical device apparatus further comprises a second instrument manipulator coupled to the lateral motion mechanism; and is
The lateral motion mechanism is configured to move the second instrument manipulator laterally along a second trajectory in a plane perpendicular to the longitudinal axis, the second trajectory being different from a rotation of the instrument manipulator about the longitudinal axis of the entry guide and different from the trajectory of the first instrument manipulator.
14. The medical device apparatus of claim 13, wherein:
the channel of the entry guide is a first channel;
the entry guide comprises a second channel extending parallel to the longitudinal axis from the proximal end of the entry guide to the distal end of the entry guide;
a lateral motion mechanism configured to move the second instrument manipulator along the second trajectory from a third position to a fourth position;
at the third position, an end of a second instrument mounted to the second instrument manipulator is not aligned with the second channel of the entry guide; and
at the fourth position, the end of the second instrument mounted to the second instrument manipulator is aligned with the second channel of the entry guide.
15. The medical device apparatus of any one of claims 11-14, wherein:
the lateral movement mechanism comprises a gear box; and is
The instrument manipulator is coupled to the gearbox.
16. The medical device apparatus of claim 15, wherein:
the gear box includes a gear and a pin;
the gear includes a side surface; and is
The pin is coupled to the side surface of the gear and movably coupled to the instrument manipulator such that movement of the pin moves the instrument manipulator.
17. The medical device apparatus of claim 16, wherein:
the side surface of the gear comprises a cam;
the pin rides on the cam; and is
The pin moves in two degrees of freedom.
18. The medical device apparatus of any one of claims 11 or 12, wherein:
the instrument manipulator comprises a movable platform;
the medical device apparatus further comprises a tray and a locking member;
the disc comprises a plurality of through holes or adjustment paths; and is
The lock is configured to lock the movable platform to any one of the plurality of through-holes or a position along the adjustment path.
19. The medical device apparatus of any one of claims 11 or 12, wherein:
the entry guide includes identification information;
the medical device apparatus further comprises a control system configured to receive the identification information; and is
The control system commands the lateral-motion mechanism to move along the trajectory based on the identification information.
20. The medical device apparatus of claim 19, wherein:
the identification information is first identification information;
the instrument mounted to the instrument manipulator further comprises second identification information;
the controller is configured to receive the second identification information; and is
The control system commands the lateral movement mechanism to move along the trajectory based on the second identification information.
21. A surgical system, the surgical system comprising:
a lateral movement mechanism;
an instrument manipulator coupled to the lateral motion mechanism;
the lateral motion mechanism includes an adjustment member and a lateral adjustment portion configured to move the instrument manipulator relative to the adjustment member in a lateral direction having a component perpendicular to a central axis of the adjustment member; and
with an entry guide installed in the surgical system, the lateral motion mechanism is configured to move the instrument manipulator to a predetermined position guided by the lateral adjustment portion such that an instrument coupled to the instrument manipulator moves in the lateral direction relative to the adjustment member to align the instrument with an instrument channel of the entry guide.
22. The surgical system of claim 21, wherein:
the lateral motion mechanism includes an anchor, a support coupled to the anchor, and a platform coupled to the support;
the instrument manipulator is coupled to the platform;
the support is configured to rotate about the anchor so as to move the platform along a first axis in a plane perpendicular to a longitudinal axis of the entry guide; and is
The platform is configured to move on the support along a second axis in the plane perpendicular to the longitudinal axis of the entry guide.
23. The surgical system of claim 22, wherein:
the support is configured to rotate about a third axis; and is
The platform is configured to move on the support along a rail system, the platform being movable along the rail system about a fourth axis.
24. The surgical system of claim 21, wherein:
the lateral motion mechanism includes a platform to which the instrument manipulator is coupled; and is
The platform is configured to move in a plane perpendicular to a longitudinal axis of the entry guide.
25. The surgical system of claim 24, wherein:
the lateral movement mechanism comprises a rail system;
the platform is coupled to the rail system; and is
The platform is configured to move on the rail system in the plane perpendicular to the longitudinal axis of the entry guide.
26. The surgical system of any one of claims 22 or 24, wherein:
the lateral adjustment portion is an adjustment cam defined in the adjustment member;
the platform includes a rod extending into the adjustment cam; and is
The predetermined position of the instrument manipulator is defined by the lever at a lever position relative to the adjustment cam.
Technical Field
The present invention relates generally to surgical instruments and, more particularly, to positioning of surgical instruments.
Background
Surgical systems, such as those employed for minimally invasive medical procedures, can include large and complex equipment to precisely control and drive relatively small tools or instruments. FIG. 1A shows an example of a known teleoperational control system 100, which system 100 may be, for example, da, commercialized by visual surgery, Inc
Part of a surgical system, the system 100 includes a patient side cart 110 having a plurality of arms 130. Each arm 130 has a docking port 140, the docking port 140 generally including a drive system with a mechanical interface for mounting and providing mechanical power for operation of the instrument 150. The arms 130 can be used during a medical procedure to move and position the respective medical instrument 150 for the procedure.Fig. 1B shows a bottom view of the known instrument 150. The instrument 150 generally includes a delivery or backend mechanism 152, a main tube 154 extending from the backend mechanism 152, and a functional tip 156 at a distal end of the main tube 154. The tip 156 typically includes a medical tool such as scissors, forceps, or a cauterizing instrument that can be used during a medical procedure. A drive cable or drive tendon (tenton) 155 is connected to tip 156 and extends through main tube 154 to backend mechanism 152. Backend mechanism 152 typically provides a mechanical coupling between the drive tendon 155 of instrument 150 and the motorized axis of the mechanical interface of docking port 140. Specifically, the gear or disk 153 engages a feature on the mechanical interface of the docking port 140. The instruments 150 of the system 100 can be interchanged by removing one instrument 150 from the drive system 140 and then installing another instrument 150 in place of the removed instrument.
Disclosure of Invention
The surgical system includes a single access port that can be used in a variety of different surgical procedures. The various surgical procedures use various combinations of instruments that enter the patient through a single access port. In one aspect, instruments are grouped into instrument groups based on instrument shaft characteristics, e.g., standard surgical instruments (graspers, retractors, scissors, cauterizers, etc.), advanced surgical instruments (staplers, vascular sealers, etc.) that may have larger cross-sections or unique cross-sections than standard surgical instruments, and camera instruments (visible light, infrared light, ultrasound, etc.) that may also have larger cross-sections or unique cross-sections than standard surgical instruments. These instruments can be controlled manually, with computer-assisted control (either fully or cooperatively), or remotely.
Different surgical procedures that can be performed using the at least one access port can be performed on different areas of the body. For example, one surgical procedure may be performed through the mouth of a patient; another surgical procedure may be performed between the patient's ribs; and other surgical procedures may be performed through other natural or incision orifices of the patient. The surgical system is not only configured to use a variety of instruments, but the surgical system is configured to use a variety of different entry guides (entryguides) that guide the instruments into the patient toward the surgical site. At least a portion of each instrument is inserted through a corresponding channel in the entry guide. Typically, a different entry guide is used for each different type of surgical procedure. If necessary, the entry guide selected for a particular surgical procedure may maintain an inflatable seal (inflation seal) and the entry guide supports the shaft of the instrument into the patient's body at the entry point.
To insert multiple instruments into a patient through a single access port, one or more of the shafts of the instruments may be required to bend between the location where the shaft is connected to the housing of the instrument and the point where the shaft contacts the channel of the entry guide. This bending may be permanently pre-formed in a rigid instrument, such as a camera instrument, or may occur non-permanently when the shaft of the instrument is inserted into the channel of the entry guide. If the shaft of the instrument is bent too much, the shaft of the instrument may be damaged and/or the instrument may not perform properly during the surgical procedure.
The entry guide manipulator controls the position and orientation of the entry guide. The entry guide includes two or more channels. Each channel receives and guides a surgical instrument toward a surgical site. Thus, two or more instruments are directed toward the surgical site via a single opening (port) in the body. The entry guide channel may be configured to receive a separate instrument type, such as a camera having an oval cross-section. Alternatively, the entry guide channel may be configured to receive many instrument types, such as therapeutic instruments having a circular cross-section. Various combinations of entry guide channel configurations may be used. The entry guide manipulator also controls the position and orientation of an instrument extending through the entry guide channel. Thus, in one aspect, each whole instrument is positioned by the entry guide manipulator such that when the shaft of the instrument is inserted in the channel of the entry guide, any bending of the shaft is not permanent and does not inhibit proper operation of the instrument, such as for insertion/removal or rolling (if applicable). This positioning ensures that any bending does not damage the instrument and that any bending does not affect the correct operation of the instrument. Various entry guide channel arrangements may be used, each arrangement being associated with a different single entry port region in the patient. For example, the entry guide may have a circular cross-section, wherein the channels of the entry guide are typically arranged at equal intervals in the cross-section. As a second example, the entry guide may have an elliptical cross-section, with the passages of the entry guide generally arranged in a line. Thus, in one aspect, for each entry guide having a different channel configuration, each instrument is positioned such that the stress caused by any bending in the shaft remains within a predetermined stress profile (profile) for the individual instrument, i.e., the stress on the shaft is controlled such that the shaft does not yield and does not permanently change shape. In addition, the maintenance stress is such that as the shaft rolls in or is inserted and removed through the entry guide, the cyclic stress does not fatigue and break the shaft. This cyclic stress loading is a consideration associated with instrument life. And thus, an individual instrument type is placed at a first location for entry into a corresponding channel in a first entry guide configuration, and an individual instrument type is placed at a different second location for entry into a corresponding channel in a second entry guide configuration.
In one aspect, the entry guide manipulator simultaneously positions an instrument mounting interface for an instrument relative to a channel in the entry guide such that when a shaft of the instrument is inserted into the channel in the entry guide, any bending of the instrument shaft does not damage the instrument and does not inhibit operation of the instrument. The instrument is considered to be damaged if the instrument shaft bends to a point where the shaft does not return to its original shape when removed from the entry guide. The entry guide manipulator is configured to make these positional adjustments for each entry guide in the family of entry guides, and in one aspect, little or no user input is made for the overall instrument.
In addition, the instrument manipulator positioning system eliminates the need for surgical procedure-specific instruments. In other words, the instrument manipulator positioning system allows for the use of a common set of instruments with various entry guides by moving the instrument shaft, as appropriate for the use of each entry guide.
The surgical system includes an entry guide. In one aspect, the entry guide has a first channel and a second channel. The surgical system also includes a first instrument with a first shaft and a second instrument with a second shaft. A manipulator in the system is coupled to the first instrument and the second instrument.
The manipulator includes an instrument manipulator positioning system. The instrument manipulator positioning system is configured to move a first instrument mounting interface for a first instrument and move a second instrument mounting interface for a second instrument such that a first shaft of the first instrument is positioned for insertion into a first channel of the entry guide and such that a second shaft of the second instrument is positioned for insertion into a second channel of the entry guide. Thus, movement of the two interfaces by the instrument manipulator positioning system effectively aligns the two axes with corresponding channels in the entry guide. In one aspect, the first instrument mounting interface and the second instrument mounting interface are moved before the first instrument and the second instrument are mounted on the respective interfaces. In one aspect, although two instruments are used as an example, the instrument manipulator positioning system can position any combination of a desired number of instruments such that the shafts of the instruments can be inserted into corresponding channels in the entry guide.
As used herein, "aligned" does not require that the longitudinal axis of the channel and the longitudinal axis of the shaft coincide. Rather, "aligned" means that the shaft is in position for accessing the passageway without damage, and that access may require a non-permanent bend in the shaft. However, in some cases, the longitudinal axes of one or more instrument shafts and one or more corresponding entry guide channels are truly coincident, and thus no shaft bending occurs. Thus, in a first positioning state of the two or more instruments, the instruments are positioned such that their axes each enter a corresponding channel of a first entry guide arranged in the first configuration without bending, and in a second positioning state of the two or more instruments, the instruments are positioned such that their axes each enter a corresponding channel of a second entry guide arranged in the second configuration without bending. Optionally, in a second positioned state of the two or more instruments, the instruments are positioned such that one or more of the instrument shafts bends as the shafts enter the corresponding channels of the second entry guide arranged in the second configuration. Thus, for various positioning states of the instrument with reference to the corresponding entry guide configuration, various combinations of shaft bending or no bending are made as desired based on the instrument shaft and entry guide channel configuration.
In one aspect, an instrument manipulator positioning system includes an adjustment gear coupled to each of a first instrument mounting interface for a first instrument and a second instrument mounting interface for a second instrument. In one aspect, movement of the adjustment gear simultaneously moves the first and second instrument mounting interfaces into a position in which insertion of the shaft into the first and second channels is possible without damage to the instruments, e.g., when the first and second instruments are mounted on the first and second instrument mounting interfaces, respectively, the shafts of the first and second instruments are substantially aligned with the first and second channels, respectively. In a further aspect, the instrument manipulator positioning system also includes a manually operated knob coupled to the adjustment gear. The user turns the knob, which in turn rotates the adjustment gear and moves the instrument coupled to the adjustment gear. Again, the use of two instrument mounting interfaces is an example and not intended to be limiting. Typically, the adjustment gear can be coupled to several instrument mounting interfaces, e.g., four instrument mounting interfaces, necessary to move the instrument into position for use with the entry guide of interest.
In another aspect, the user manually moves each of the plurality of instrument mounting interfaces to the appropriate position as needed in a direction perpendicular to the longitudinal axis of the entry guide. A pin may be used to lock each instrument mounting interface in a desired position. In some cases, not all of the plurality of instrument mounting interfaces may need to be moved. The appropriate location for a particular instrument mounting interface can be determined by, for example, the location of through holes in the tray of the instrument manipulator positioning system. Alternatively, the appropriate position can be determined by allowing the instrument mounting interface to move to a position that minimizes any bending in the shaft of an instrument mounted to the instrument mounting interface after the shaft is inserted into the entry guide (where the longitudinal axis of the entry guide is vertical).
In another aspect, the instrument manipulator positioning system includes a first plurality of motors and a second plurality of motors. Each of the plurality of motors is coupled to a different instrument mounting interface. Each of the plurality of motors positions a corresponding instrument mounting interface for an instrument such that when the instrument is mounted on the instrument mounting interface, a shaft of the instrument is aligned with a channel in the entry guide, e.g., the shaft can be positioned in the channel.
In another aspect, the instrument manipulator positioning system further includes a first gearbox coupled to the first instrument and a second gearbox coupled to the second instrument. The gear is coupled to the first gearbox and the second gearbox. As the gears move, the movement of the gears causes the first and second gear boxes to simultaneously move the first and second instrument mounting interfaces to a position where insertion of the shaft into the first and second channels is possible without damaging the instrument. On the one hand, the gear is a rolling gear, and on the other hand, the gear is an adjusting gear.
In one aspect, the first gearbox includes a gear having a side surface. The pin is coupled to a side surface of the gear. In one aspect, the pin has one degree of freedom. The pin is coupled to the instrument mounting interface such that as the pin moves, the first instrument mounting interface moves and, thus, the distal end of the shaft effectively moves in the same arc as the pin. Herein, "effectively move" means that even if the whole instrument may not be mounted to the instrument mounting interface when the instrument mounting interface is moved, if the instrument is already mounted before the instrument mounting interface is moved, the position of the shaft relative to the entry guide has been moved compared to the position of the shaft relative to the entry guide when the whole instrument is mounted to the instrument mounting interface.
In another aspect, the second gearbox includes a gear having a side surface. The pin is coupled to a side surface of the gear. The side surface of the gear of the second gearbox comprises a cam. The pin rides on the cam. On the one hand, the pin has one degree of freedom, and on the other hand, the pin has two degrees of freedom. The pin is coupled to the second instrument mounting interface such that as the pin moves, the second instrument mounting interface moves and, thus, the distal end of the shaft of the second instrument is effectively moved with the same motion as the pin.
In another aspect, the entry guide includes first identification information and the first instrument includes second identification information. The device includes a control system configured to receive the first identification information and to receive the second identification information. In an aspect, the control system configures the device based on the first identification information.
An apparatus includes a first entry guide having a first channel configuration and a second entry guide having a second channel configuration. The first channel configuration is different from the second channel configuration.
The apparatus also includes a surgical system. Only one of the first entry guide and the second entry guide is installed in the surgical system during the surgical procedure.
The surgical system includes an instrument having a shaft. An instrument manipulator positioning system is coupled to the instrument. Based on the channel configuration of the entry guide installed in the surgical system, the instrument manipulator positioning system moves the instrument to a predetermined position to align the shaft with the channel of the entry guide, e.g., positions the shaft to enable insertion of the shaft into the channel of the entry guide. In one aspect, the predetermined location maintains bending stress on the shaft within a predetermined stress profile.
Since multiple entry guides having different channel configurations can be used in the surgical system, the instrument manipulator positioning system of the entry guide manipulator is configured to move the multiple instrument mounting interfaces to enable insertion of the shafts of the first plurality of instruments into the first entry guide having the first channel configuration. The instrument manipulator positioning system is also configured to move the plurality of instrument mounting interfaces to effect insertion of the shafts of a second plurality of instruments into a second entry guide having a second channel configuration. The second channel configuration is different from the first channel configuration. The first plurality of instruments can be the same as or different from the second plurality of instruments.
In one aspect, a method includes an instrument manipulator positioning system simultaneously moving a first instrument manipulator and a second instrument manipulator such that an axis of the first instrument is aligned with a first channel in a first entry guide if the first instrument is mounted to the first instrument manipulator and such that an axis of the second instrument is aligned with a second channel of the first entry guide if the second instrument is mounted to the second instrument manipulator. The method also includes the instrument manipulator positioning system simultaneously moving the first instrument manipulator and the second instrument manipulator such that the axis of the third surgical instrument is aligned with the first channel in the second entry guide if the third instrument is mounted to the first instrument manipulator and such that the axis of the fourth instrument is aligned with the second channel of the second entry guide if the fourth instrument is mounted to the second instrument manipulator. The channel configuration of the first entry guide is different from the channel configuration of the second entry guide, and the first entry guide and the second single guide are used at different times.
In another aspect, a method includes moving an entry guide having a longitudinal axis such that the longitudinal axis is vertical. The shaft of the surgical device assembly is then inserted into the channel of the entry guide and the entire surgical device assembly is allowed to move to a position of least energy. Finally, the surgical device assembly is locked to the tray.
In one aspect, the first entry guide has a circular cross-section and the second entry guide has a non-circular cross-section. One or both of the first entry guide and the second entry guide can include a manual instrument channel.
The apparatus also includes a first camera instrument having a first axis with a first bend at a first location. The first camera instrument is installed in the surgical system when the first entry guide is installed in the surgical system. The second camera instrument has a second axis with a second bend at a second location. The second camera instrument is installed in the surgical system when the second entry guide is installed in the surgical system. The first position is different from the second position.
In one aspect, a kit of entry guides includes a plurality of entry guides. Each entry guide includes a plurality of channels. The channel configuration of each entry guide is different from the channel configuration in each of the other entry guides in the plurality of entry guides. Each entry guide of the plurality of entry guides may be individually installed in the same surgical system.
In one aspect, a first guide of the plurality of guides includes a camera channel and a plurality of surgical instrument channels. A second entry guide of the plurality of entry guides includes a camera channel and a manual instrument channel.
In another aspect, a first entry guide of the plurality of entry guides includes a camera channel and a plurality of surgical instrument channels. A second entry guide of the plurality of entry guides includes a camera channel and an advanced surgical instrument channel.
In another aspect, the first entry guide comprises a circular cross-section. The second entry guide includes a non-circular cross-section.
In another aspect, a first entry guide of the plurality of entry guides includes a camera channel and a plurality of surgical instrument channels. A second entry guide of the plurality of entry guides has an oval-shaped cross-section. The elliptical shape has a major axis. The second entry guide includes a camera channel having a first longitudinal axis, a first surgical instrument channel having a second longitudinal axis, and a second surgical instrument channel including a third longitudinal axis. The longitudinal axis extends from the proximal end of the channel to the distal end of the channel. The first longitudinal axis, the second longitudinal axis, and the third longitudinal axis are transverse to a major axis of the elliptical cross-section of the second entry guide.
In yet another aspect, a first entry guide of the plurality of entry guides includes a camera channel and a plurality of surgical instrument channels. A second entry guide of the plurality of entry guides includes a camera channel. The camera channel has an elliptical shape in cross-section. The cross-section of the elliptical shape has a major axis and a minor axis. The second entry guide also includes a first surgical instrument channel having a first longitudinal axis, a second surgical instrument channel having a second longitudinal axis, and a third surgical instrument channel having a third longitudinal axis. The first longitudinal axis and the second longitudinal axis traverse a first line extending from the long axis. The first line includes a long axis. The third longitudinal axis traverses a second line extending from the minor axis. The second line includes a minor axis. The major axis is perpendicular to the minor axis, and thus the first line is perpendicular to the second line.
The surgical system includes a manipulator system. The manipulator system includes a roll system coupleable to the first and second surgical device assemblies. The rolling system is configured to roll the entire first and second surgical device assemblies as a group. The manipulator system also includes an instrument manipulator positioning system coupled to the rolling system and coupleable to the first and second surgical device assemblies. The instrument manipulator positioning system is configured to position the first and second instrument interface assemblies for the first and second surgical device assemblies to enable insertion of the shafts of the first and second surgical device assemblies into different channels of the entry guide.
The instrument manipulator positioning system includes an adjustment gear and the rolling system includes a rolling ring gear. The manipulator system also includes a drive assembly. The drive assembly is coupled to the roll ring gear and to the adjustment ring gear. The drive assembly is configured to differentially rotate the adjustment gear and the rolling ring gear to cause the instrument manipulator positioning system to move the first instrument interface mount and the second instrument interface mount for the surgical device assembly to effect insertion of the shaft of the surgical device assembly into the respective channels of the entry guide.
In one aspect, the drive assembly is configured to hold the roll ring gear stationary and is configured to rotate the adjustment gear while the roll ring gear is held stationary. In another aspect, the drive assembly is configured to hold the adjustment gear stationary and is configured to rotate the rolling ring gear while the adjustment gear is held stationary.
Drawings
Fig. 1A is a diagrammatic view of a portion of a prior art surgical system.
Fig. 1B is an illustration of a prior art surgical device assembly.
Fig. 2A is a schematic view of an instrument manipulator positioning system and a plurality of surgical device assemblies coupled to the instrument manipulator positioning system.
Fig. 2B is a schematic diagram of the instrument manipulator positioning system and the plurality of instrument manipulators before the instrument has been coupled to the plurality of instrument manipulators.
Fig. 2C is a schematic side view showing aspects of a surgical system including an entry guide manipulator with an instrument manipulator positioning system.
Fig. 2D shows a trajectory implemented in the instrument manipulator positioning system of fig. 2C.
Fig. 2E is an illustration of a surgical system including an entry guide manipulator configured to position an instrument such that any bending of a shaft of the instrument does not damage the instrument when the shaft enters the entry guide.
Fig. 3A and 3B are more detailed illustrations of the configuration of the surgical device assembly in fig. 2E.
Fig. 4A shows the manipulator assembly attached to the insertion assembly, which in turn is attached to the base assembly.
Fig. 4B is a more detailed illustration of the instrument of fig. 2A, 2C, 2E, 3A and 3B.
Figure 5A is a schematic representation of four base assemblies mounted on an entry guide manipulator.
Figure 5B is a cross-sectional view of a first entry guide, referred to as a standard entry guide.
Figure 5C is a cross-sectional view of the second entry guide.
Figure 5D shows the first entry guide overlaid on the second entry guide.
Fig. 5E shows the result of the instrument manipulator positioning system in the entry guide manipulator moving a positioning element coupled to the surgical instrument.
Figure 5F shows a plurality of base assemblies having a hexagonal shape that can be mounted on and moved by the entry guide manipulator.
Figure 6A is an illustration of one embodiment of an instrument manipulator positioning system in an entry guide manipulator.
Figure 6B is a cross-sectional view of an entry guide with at least one angled channel.
Figure 6C is an illustration of another embodiment of an instrument manipulator positioning system in an entry guide manipulator.
Fig. 7A-7C are top, bottom, and oblique views, respectively, of an aspect of a portion of a base assembly including a floating platform.
Fig. 7D is a cutaway illustration of an aspect of a positioning element container assembly.
Fig. 8A, 8B, and 8C are other examples of the instrument manipulator positioning system of fig. 2A and 2B that can be included in the entry guide manipulator of fig. 2C and in the entry guide manipulator of fig. 2E.
Fig. 8D is another example of the instrument manipulator positioning system of fig. 2A and 2B that can be included in the entry guide manipulator of fig. 2C and in the entry guide manipulator of fig. 2E.
Fig. 8E is another example of the instrument manipulator positioning system of fig. 2A and 2B that can be included in the entry guide manipulator of fig. 2C and in the entry guide manipulator of fig. 2E.
Fig. 9 illustrates another example of an instrument manipulator positioning system.
Fig. 10A and 10B are proximal and distal views of a circular motion gearbox in a first set of gearboxes for the instrument manipulator positioning system of fig. 9.
Fig. 10C and 10D are proximal and distal views of a linear motion gearbox in a first set of gearboxes for the instrument manipulator positioning system of fig. 9.
Fig. 11A and 11B are proximal and distal views of a first gear box of a second set of gear boxes for the instrument manipulator positioning system of fig. 9.
Fig. 11C and 11D are proximal and distal views of a second gear box of the second set of gear boxes for the instrument manipulator positioning system of fig. 9.
Fig. 11E and 11F are proximal views of a third gear box of the second set of gear boxes for the instrument manipulator positioning system of fig. 9.
Fig. 11G is a distal view of a third gear box of the second set of gear boxes for the instrument manipulator positioning system of fig. 9.
Fig. 11H is a cross-sectional view of a third gear box of the second set of gear boxes for the instrument manipulator positioning system of fig. 9.
Fig. 11I and 11J are proximal and distal views of a fourth gear box of the second set of gear boxes for the instrument manipulator positioning system of fig. 9.
Fig. 11K is a more detailed illustration of the cam gear of fig. 11J.
Fig. 12A-12D illustrate an aspect of an entry guide manipulator including an instrument manipulator positioning system.
Fig. 13A-13D illustrate alternative aspects of an entry guide manipulator including an instrument manipulator positioning system.
Fig. 14A-14J are illustrations of cross sections of a family of entry guides that can be used with the systems of fig. 2A, 2C, and 2E.
Fig. 15 is a process flow diagram of a method for determining the required range of motion and trajectories to be implemented in each of the four gearboxes in fig. 9 for the family of entry guides in fig. 14A-14J.
Figure 16A is a schematic representation of a base assembly mounted on an entry guide manipulator and a coordinate system used by an instrument manipulator positioning system.
Figure 16B is a schematic representation of a surgical instrument having a shaft entering an entry guide mounted in a cannula, wherein the shaft is bent against the entry guide.
Fig. 16C is a schematic top view of three surgical instruments mounted as shown in fig. 3A and 3B.
Figure 17 shows the acceptable stress region for each positioning element and associated entry guide channel showing allowable deflection from the ideal (minimum stress) instrument shaft position.
Fig. 18A shows surgical and camera instrument trajectories and the range of motion of the gear box in fig. 9 for the family of entry guides of fig. 14A-14J.
Fig. 18B shows seven positions for the instrument manipulator associated with the gear box of fig. 11A and 11B.
Fig. 18C shows seven positions of the output pin in the slot of fig. 11B.
Fig. 18D shows seven positions for the instrument manipulator associated with the gear boxes of fig. 11C and 11D.
Fig. 18E shows seven positions of the output pin in the slot of fig. 11D.
Fig. 18F shows seven positions for the instrument manipulator associated with the gear box of fig. 11E-11H.
Fig. 18G shows seven positions of the output pin in the slot of fig. 11G.
Fig. 18H shows seven positions for the instrument manipulator associated with the gear box of fig. 11I-11J.
Fig. 18I shows seven positions of the output pin in the slot of fig. 11J.
Fig. 19A and 19B are schematic illustrations of a camera instrument with a pre-bent axis.
Fig. 20A is a schematic illustration of an aspect of a control system in the surgical system of fig. 2E.
FIG. 20B is a process flow diagram of an aspect of a method performed by the instrument manipulator positioning system compatibility module of FIG. 20A.
21A and 21B are side views showing a first example of one way of attaching a base assembly to a portion of an entry guide manipulator.
Figure 22A is a side view showing a second example of one way of attaching a base assembly to a portion of an entry guide manipulator.
Fig. 22B and 22C are plan views of the second example of fig. 22A.
23A and 23B are side views illustrating a third example of one way of attaching a base assembly to a portion of an entry guide manipulator.
In the drawings, to a singular reference number, the first digit of a reference number of an element is the number of the figure in which that element first appears. For double-digit reference numbers, the first two digits of a reference number for an element are the number of the figure in which that element first appears.
Detailed Description
Surgical systems, such as teleoperated computer-assisted surgical systems, with a single access port are used in a variety of different surgical procedures. Various surgical procedures use various combinations of instruments that enter a patient through a single access port. In one aspect, instruments are grouped into instrument groups based on instrument shaft characteristics, such as standard surgical instruments, advanced surgical instruments, and camera instruments. These instruments can be controlled manually, by computer-assisted control (either fully or cooperatively), or remotely.
Different surgical procedures that can be performed using a single access port can be performed on different areas of the body. For example, one surgical procedure may be performed through the mouth of a patient; another surgical procedure may be performed between the patient's ribs; and other surgical procedures may be performed through other orifices of the patient or through incisions in the patient. The surgical system is not only configured to use a variety of instruments, but the surgical system is configured to use a variety of different entry guides. Typically, a different entry guide is used for each different type of surgical procedure. If necessary, the entry guide selected for a particular surgical procedure can maintain a pneumatic seal and the entry guide supports the shaft of the instrument entering the patient's body at the entry point.
A single access port refers to a single incision in a patient or a single body orifice of a patient for performing a surgical procedure. While a single access port surgical system is used as an example, this example is not intended to limit the aspects described below to surgical systems using a single access port. The aspects described below can be used in any surgical system in which multiple instruments are inserted into a patient through a single entry guide. For example, if a surgical system uses two or more access ports into a patient, and an entry guide having multiple channels is used in any or all of the two or more access ports, the aspects described below are directly applicable to such a surgical system.
Fig. 2A is a schematic illustration of a plurality of surgical device assemblies in a surgical system. The first surgical device assembly includes a first instrument manipulator 240a1 and a
To insert multiple instruments 260A1, 260A2 into a patient through a single access port, one or more of the shafts 262a1, 262a2 of the instruments 260A1, 260A2 may be required to bend between the position of the shaft connected to the body of the instrument and the point where the shaft contacts the channel of the
Thus, in one aspect, each integral instrument 260A1, 260A2 (fig. 2A) is positioned by an instrument
In one aspect, for each entry guide having a different channel configuration, the instrument
In an aspect, each instrument mounting interface is configured to couple an instrument to an instrument manipulator and to support the instrument when coupled. For example, first instrument mount interface 240a1_ IMI supports instrument 260a1 and couples instrument 260a1 to instrument manipulator 240a1, and second instrument mount interface 240a2_ IMI supports instrument 260a2 and couples instrument 260a2 to
The instrument
In the first state, by moving longitudinal motion mechanism 233a1 and, thus, instrument manipulator 240a1, instrument
In the second state, the instrument
Thus, in the first state, at least a portion of the instrument mounting interface 240a1_ IMI is at a first position in the
Many examples of aspects of instrument
In one aspect, if necessary, the instrument
In one aspect, instrument
As described above, instrument
As used herein, "aligned" does not require that the longitudinal axis of the channel and the longitudinal axis of the shaft coincide. Rather, "aligned" means that the shaft is in position for accessing the passageway without damage, and that access may require a non-permanent bend in the shaft. However, in some cases, the longitudinal axes of one or more instrument shafts and one or more corresponding entry guide channels are truly coincident, and thus no shaft bending occurs. Thus, in a first positioning state of the two or more instruments, the instruments are positioned such that their axes each enter a corresponding channel of a first entry guide arranged in the first configuration without bending, and in a second positioning state of the two or more instruments, the instruments are positioned such that their axes each enter a corresponding channel of a second entry guide arranged in the second configuration without bending. Optionally, in a second positioned state of the two or more instruments, the instruments are positioned such that one or more of the instrument shafts bends as the shafts enter the corresponding channels of the second entry guide arranged in the second configuration. Thus, for various positioning states of the instrument with reference to the corresponding entry guide configuration, various combinations of shaft bending or no bending are made as desired based on the instrument shaft and entry guide channel configuration.
In one aspect described below, instrument
In one aspect, instrument
Each longitudinal motion mechanism is connected to the instrument manipulator assembly, e.g., longitudinal motion mechanism 233A1 is connected to instrument manipulator assembly 240a1 and longitudinal motion mechanism 233A is connected to instrument
In one aspect, each instrument manipulator assembly includes an instrument manipulator interface on a distal face of the instrument manipulator assembly. Each instrument manipulator assembly also includes a plurality of motors that drive elements of an instrument attached to the instrument manipulator interface.
In one aspect, instrument
Fig. 2C is a schematic side view illustrating aspects of a
The patient
As described more fully below, the
Thus, in one aspect, the instrument mounting interface is moved such that when an instrument is attached to the instrument mounting interface, the axis of the instrument is properly aligned with the channel in the entry guide used during the surgical procedure. In another aspect, the instrument is mounted on the instrument mounting interface and then the instrument mounting interface is moved. Movement of the instrument mounting interface moves the entire instrument so that the axis of the instrument is properly aligned with the channel in the entry guide used during the surgical procedure. Thus, the movement of the instrument mounting interface is the same regardless of whether the instrument is mounted prior to or after the movement of the instrument mounting interface.
In one aspect, a positioning element of instrument
As the positioning element moves along the trajectory, the instrument mounting interface moves along the same trajectory, and the distal tip of the shaft of the instrument coupled to the instrument mounting interface effectively moves along the same trajectory. Thus, movement of the positioning element causes the shaft to be moved to a position in which the shaft is aligned with the passage in the
As explained more fully below, different entry guides are used during different surgical procedures. The entry guide that enters the body through the ribs has a different shape than the entry guide that enters the body through the incision in the abdomen. Different shapes of the entry guide require different layouts of the channels extending through the entry guide, i.e. different channel configurations.
In addition, the shape and/or size of the shaft of the instrument may be different for different instruments. An entry guide is used that is adapted to the shape and size of the shaft of the instrument used in a particular surgical procedure. Trajectories, such as those shown in fig. 2D, are designed to accommodate a set of entry guides that can be used with the patient
When an entry guide, such as
If
In one aspect, at least one of the surgical device assemblies of the plurality of
The ability to separately position the instrument, and thus its axis, relative to the channel in the entry guide by moving the instrument mounting interface provides versatility to the patient
Before considering the
The surgeon's
Control during insertion of the instrument may be accomplished, for example, by the surgeon moving the instrument presented in the image with one or both of the active members; the surgeon uses the active to move the instrument side-to-side in the image and pull the instrument toward the surgeon. Movement of the active member commands the imaging system and associated surgical device assembly to steer toward a fixed center point on the output display and advance within the patient. In one aspect, the camera control is designed to give the impression that the active part is fixed to the image such that the image moves in the same direction in which the handle of the active part is moved. This design causes the active piece to be in the correct position to control the instrument when the surgeon is departing from the camera control, and thus avoids the need to grasp (disengage), move, and disengage (engage) the active piece back into position prior to starting or resuming instrument control. In some aspects, the master position may be made proportional to the insertion speed to avoid using a large master workspace. Alternatively, the surgeon may grasp and separate the active piece to use a ratcheting action for insertion. In some aspects, insertion may be controlled manually (e.g., by hand operating a wheel), and then automatic insertion is completed (e.g., a servo motor driven roller) as the distal end of the surgical device assembly approaches the surgical site. Preoperative or real-time image data (e.g., MRI, X-ray) of the patient's anatomy and space available for an insertion trajectory may be used to assist in insertion.
The patient
The
In one example, the setting portion includes a
The remote center of
As shown in fig. 2C, the manipulator assembly yaw joint 211C is coupled between an end of the set link 206C and a first end (e.g., proximal end) of the
In one embodiment, the
The distal end of
In one embodiment, links 215C, 217C, and 219C are coupled together to act as a coupled motion mechanism. Coupled motion mechanisms are well known (e.g., when the input link motion and the output link motion remain parallel to each other, such mechanisms are referred to as parallel motion linkages). For example, if rotary joint 214C is actively rotated,
An entry guide
Each of the plurality of
For minimally invasive surgery, the instrument must remain substantially stationary relative to the position of the instrument into the patient's body at the incision or at the natural orifice to avoid unnecessary tissue damage. Thus, the yaw and pitch motions of the instrument should be centered around a single position on the manipulator
For single port surgery, where all instruments (including camera instruments) must be accessed via a single small incision (e.g., at the navel) or natural orifice, all instruments must be moved with reference to such a typically stationary remote center of
In this description, a cannula is typically used to prevent instruments or entry guides from scraping against patient tissue. The cannula may be used for both incisions and natural orifices. For cases where the instrument or entry guide does not frequently translate or rotate relative to its insertion (longitudinal) axis, a cannula may not be used. For situations requiring insufflation, the cannula may include a seal to prevent leakage of excess insufflation gas through the instrument or entry guide. An example of a cannula assembly supporting insufflation and a process requiring insufflation of gas at a surgical site can be found in U.S. patent application No.12/705,439 (filed 2/12 2010; disclosing "Entry Guide for Multiple Instruments in a Single Port System"), the entire disclosure of which is incorporated herein by reference for all purposes. For thoracic surgery that does not require inflation, the cannula seal may be omitted, and the cannula itself may be omitted if instrument or entry guide insertion axis motion is minimal. The rigid entry guide may function as a cannula in some configurations for instruments inserted relative to the entry guide. The cannula and entry guide may be, for example, steel or extruded plastic. Plastics that are less expensive than steel may be suitable for a single use.
Various passive setup and active joints/links allow for positioning of the instrument manipulator to move the instrument and imaging system with a wide range of motion as the patient is placed in various positions on the moveable table. In some embodiments, the cannula mount can be coupled to the proximal or
Certain settings in the manipulator arm and active joints and links may be omitted to reduce the size and shape of the surgical system, or joints and links may be added to increase the degrees of freedom. It should be understood that the manipulator arm may include various combinations of links, passive joints, and active joints (which may provide redundant DOF) to achieve the necessary range of poses for the surgical procedure. Further, various instruments are applicable in aspects of the present disclosure, either alone or including an entry guide, multiple instruments and/or multiple entry guides, as well as surgical device assemblies of instruments coupled to an instrument manipulator (e.g., an actuator assembly) via various configurations (e.g., on a proximal or distal face of an instrument transmission or instrument manipulator).
Each of the plurality of
In one aspect,
Each instrument manipulator assembly 240C1, 240C2 includes a plurality of motors that drive a plurality of outputs in the output interfaces of the instrument manipulator assemblies 240C1,
Each of instruments 260C1, 260C2 is coupled to an instrument mounting interface of a corresponding instrument manipulator assembly 240C1, 240C2 such that a plurality of inputs in the input interface of the gearing unit in instruments 260C1, 260C2 are driven by a plurality of outputs in the instrument mounting interface of instrument manipulator assemblies 240C1,
In one aspect, a septum interface that is part of a sterile surgical drape may be placed between an instrument mounting interface of instrument manipulator assembly 240C and an input interface of a transmission unit in instrument 260C. For examples of septum interfaces and sterile surgical drapes, see, e.g., U.S. patent application publication No. us2011/
In an aspect, one or more instrument manipulator assemblies may be configured to support and actuate a particular type of instrument, such as a camera instrument. As shown in fig. 2C, the shafts of the plurality of
The surgical procedures that can be performed using
An entry guide suitable for abdominal surgery may not be suitable for surgery through the mouth or between the ribs. The size and shape of the entry guide limits the location of the passage through the entry guide for the shafts 262C1, 262C2 of the multiple
Fig. 2D is an illustration of an example path 226-
Fig. 2E is an illustration of one
In one aspect, at least one of the plurality of surgical device assemblies includes
An
Different surgical procedures that can be performed using patient-
The patient
When a rib entry guide for surgery between ribs is substituted for
Returning to the configuration shown in fig. 2E, the multiple surgical device assemblies mounted on
In one aspect, the instrument
In an aspect, to further simplify the design and size of the instrument
Thus, as explained more fully below,
In one aspect, the control system automatically checks the compatibility of the surgical device assembly mounted on
If the instrument is compatible with the entry guide, the control system checks the compatibility of the other elements of the surgical system with the entry guide, such as drapes, cameras, foot switch control assemblies, master control assemblies, and the like. Finally, the control system makes any required adjustments in the user interface elements, allowable control modes, types and behaviors of control modes, etc., based on the entry guide configuration, the surgeon and the patient side assistant. For example, if the entry guide is used in ear, throat, and nose surgery, the configuration and allowable range of motion of the various instruments will be different than the
As explained more fully below, in one aspect, each
In fig. 2E,
Although not shown in fig. 2E, the surgical system also includes a control system and a master console, which are identical to those described with respect to fig. 2C. In fig. 2E, the surgery is in the abdomen of the
For convenience, instruments are grouped into instrument groups based on instrument axis characteristics in one aspect, such as standard surgical instruments, advanced surgical instruments, and camera instruments, as explained more fully below. Simply, the shaft of advanced surgical instruments has a larger diameter than that of standard surgical instruments. The grouping of instruments is for ease of discussion, and the name of a group is not intended to limit the instruments to any particular surgical instrument. In some surgical procedures, one or more manual instruments may be used in conjunction with a teleoperated surgical instrument. A manual instrument is an instrument that a person controls using the handle or grip of the instrument itself.
The shaft of the camera instrument has a fixed curvature. In one aspect, two different camera instruments are provided. One of the camera instruments has a fixed bend at a first location in the axis of the camera instrument and the other of the camera instruments has a fixed bend at a second location in the axis of the camera instrument. The first position and the second position are different positions.
Fig. 3A and 3B are illustrations of multiple surgical device assemblies 300 mounted on
The proximal end of each insert assembly in fig. 3A and 3B is shown floating. As explained more fully below, in one aspect, the proximal end of each insertion assembly is mounted on a movable platform. The moveable platform is coupled to an instrument
Fig. 3A and 3B show configurations used as examples in the following description. The instrument 260_0 is a camera instrument. The instruments 260_1 to 260_3 are standard surgical instruments or advanced surgical instruments. Instrument 260_1 is referred to as a first surgical instrument, instrument 260_2 is referred to as a second surgical instrument, and instrument 260_3 is referred to as a third surgical instrument. Thus, the camera instrument is roughly mounted at a twelve point position on the clock; the first surgical instrument is roughly mounted at the three o' clock position, and so on. The first surgical instrument, the second surgical instrument, and the third surgical instrument may be the same type of instrument or different types of instruments. The type of surgical instrument is selected for compatibility with the channel dimensions in the entry guide, as explained more fully below.
As shown in fig. 3B, each insert assembly includes three components. Using the add-in component 331_1 as an example, the add-in component 331_1 includes a frame 331A _1, a middle compartment 331B _1, and a far compartment 331C _ 1. The middle box 331B _1 rides on a ball screw in the frame 331B _ 1. In one aspect, the ball screw has a 6mm pitch and is therefore back-drivable. The middle carriage 331B _1 includes a metal belt that drives the far carriage 331C _ 1. Distal carriage 331C _1 is attached to surgical device assembly 300 including surgical instrument 260_ 1.
Thus, as described more fully below, when the positioning element in instrument
Before considering the positioning of instruments in more detail in the multiple surgical device assemblies 300, one aspect of the surgical device assemblies is described. Fig. 4A and 4B are more detailed illustrations of an aspect of a surgical device assembly of the plurality of surgical device assemblies 300.
Base assembly 432 (fig. 4A) is connected to a rotatable base in
In this example, the housing of the
The
Fig. 4B is a more detailed illustration of an example of a
The driven
Mechanical components (e.g., gears, levers, gimbals, cables, etc.) in the
The instrument manipulator assembly 240 (fig. 4A) includes a Radio Frequency Identification (RFID)
FIG. 5A is a schematic representation of four base assemblies 432_0, 432_1, 432_2, and 432_3 mounted on
The use of a wedge-shaped base assembly is merely illustrative and not intended to be limiting. The foot assembly may have a square shape, a rectangular shape, or other shape as long as the foot assembly is capable of being mounted on the
Fig. 5B is a cross-sectional view of a
In this aspect, one of the surgical device assemblies includes an endoscope and a camera. This instrument is called a camera instrument. The camera instrument has a pre-bent axis. The bending of the shaft is maintained between the distal portion of the
Thus, a standard entry guide has a
In fig. 5A, the channels in the
Fig. 5C is a cross-sectional view of the second entry guide 570 MS. An entry guide 570MS is positioned in the
The entry guide 570MS has one elliptical camera channel 571MS and two standard circular surgical instrument channels 572MS1 and
In FIG. 5D, the x-axis 590 and the y-axis 591 have origins at the center of the entry guide 570 MS. The
Assuming that the entry guide 570MS is being used and the positioning elements for the surgical instruments attached to the base assemblies 432_1 and 432_3 are in the standard position as shown in fig. 5A, the shafts of the surgical instruments 260_1 and 260_3 (fig. 3A) are not properly positioned for insertion through the channels 572MS1 and
In one aspect, instrument
Similarly, the instrument
In fig. 5E, the dashed lines indicate the position of the insertion assembly 531 and the surgical device assembly 500 having a shaft 567 that is configured for a first entry guide, such as
The solid lines in fig. 5E show the results of instrument manipulator positioning system 550 in entry guide manipulator 530 moving positioning element 549 coupled to surgical device assembly 500. Specifically, the insert assembly 531 is mounted on a floating platform 532A that is connected to the positioning element 549. As positioning element 549 is moved by instrument manipulator positioning system 550, floating platform 532A moves, which in turn moves unitary surgical device assembly 500 including shaft 567.
Thus, to reposition the surgical device assembly 500 for entry into the guide 570MS, the instrument manipulator positioning system 550 moves the positioning element 549, which in turn moves the floating platform 532A, such that the insertion assembly 531 and the unitary surgical device assembly 500 including the shaft 567 move from the position indicated by the dashed lines to the position shown by the solid lines in fig. 5E. In one aspect, the positioning element 549 is moved by manually turning a knob. In another aspect, the positioning element 549 is moved using a servo motor.
Only one surgical device assembly 500 and its associated base assembly 532 are shown in fig. 5E. However, in one aspect this represents each of the four base assemblies, and thus the description is applicable to a total number of base assemblies, for example each of the four base assemblies, or in some aspects to a fewer number of base assemblies than the total number of base assemblies. In addition, the use of an insertion assembly to couple a surgical device assembly to an associated base assembly is illustrative only and not intended to be limiting. In another aspect, the surgical device assembly is directly coupled to the base assembly.
Fig. 5E also shows a circular curvature of shaft 567. In a circular curve, the curve of axis 567 is an arc of a circle. When the shaft 567 is bent circularly, the circular bend introduces minimal stress on the length of the bend in all possible bends, as discussed more fully below.
Figure 6A is an illustration of one embodiment of an instrument manipulator positioning system 640A in an entry guide manipulator 530. Only one surgical device assembly 500 and its associated base assembly 532 are shown in fig. 6A. However. This represents, in one aspect, each of the total number of base assemblies, and thus the description is applicable to each of the four base assemblies, or in some aspects to a fewer number of base assemblies than the total number of base assemblies.
A floating platform 600A, e.g., a movable platform, in the base assembly 532 is connected to the insert assembly 531. Thus, as indicated above, movement of floating platform 600A moves the position of axis 567. Positioning element 610 in the lateral motion mechanism of instrument manipulator positioning system 640A is coupled to floating platform 600A. In this example, the positioning element 610 and the floating platform 600A are capable of moving in four degrees of freedom, e.g., along a first axis 601, along a second axis 602, in pitch 603, and in yaw 604. The first axis 601 and the second axis 602 are in a plane perpendicular to the longitudinal axis of the entry guide, as previously shown.
In one aspect, the platform 600A is suspended on a rail system such that the positioning element 610 is able to move the floating platform 600A, and thus the insert assembly 531, in the directions 601, 602. The platform 600A is also movably suspended on a support 620 that allows the pitch of the positioning element 610 and the platform 600A to be varied, for example a rail system mounted on the support 620. The support 620 is also able to rotate about the anchor 630 to alter the deflection of the positioning element 610 and the platform 600A.
As indicated above, the patient
Fig. 6B is a cross-sectional view of the entry guide 670 having at least one angled channel 670C, e.g., the channel 670C is angled from the longitudinal axis 690. The longitudinal axis 690 extends from the distal end 670D of the entry guide 670 to the proximal end 670P of the entry guide 670. The longitudinal axis 670C of the passage 670C is angled relative to the longitudinal axis 690. The entry guide 670 may have more than two channels visible in fig. 6B.
In one aspect, the channel 670C is a manual channel. The angle of the manual path is selected to facilitate aiming a manual instrument (e.g., a stapler) at the center of the surgical site.
Fig. 6C shows an example of an instrument manipulator positioning system 640C that moves the insertion assembly 531, and thus the shaft 567, in two perpendicular directions 601, 602, i.e., in two degrees of freedom, in a plane perpendicular to the longitudinal axis of the entry guide. Insert assembly 531 extends through an opening 653 in second floating platform 600C. The proximal end of the insert assembly 531 is mounted to the first floating platform 600B. The platform 600B rides on the first set of rails 663. The set of rails 663 are mounted on the platform 600C. The servo motor 660 is connected to the platform 600B by a first positioning element, in this regard by a lead screw 661 and a nut.
Platform 610C rides on a second set of rails 652. The servo motor 650 is connected to the platform 600B by a second positioning element, in this regard by a lead screw 651 and nut. Servomotor 650 moves platform 600C and thus insert assembly 531 in direction 601. The servomotor 660 moves the platform 600B and thus the insertion assembly 531 in direction 602. To increase the ability to change pitch and yaw, the set of rails 652 is mounted on a support having two degrees of freedom. The configuration of the positioning mechanism 640C is illustrative only and is not intended to limit the specific elements shown.
Fig. 7A-7C are top, bottom, and oblique views, respectively, of an aspect of a portion of a base assembly 732 that includes floating platform 700. Base assembly 732 represents an aspect of
Floating platform 700 includes a first platform 700A and a second platform 700B. The first platform 700A has legs 700L1, 700L2 (fig. 7B). Leg 700L1 has an outer side surface 700L1S that lies in a plane perpendicular to the plane that includes inner side surface 700L2S of
The outboard surface 700L1S of the leg 700L1 is coupled to a first set of precision linear rails 752. The set of rails 752 is attached to an inside surface of base assembly 732. In fig. 7B and 7C, only the distal rail of the set of rails 752 is visible. A proximal rail is also attached to the base assembly 732. Bearing set 701 is mounted on the outboard surface 700L1S of
The side surface of the second platform 700B is coupled to the inside surface 700L2S of the
A second set of precision linear tracks 763 are attached to the inside surface 700L2S of the
The proximal portion 700B1 of the second platform 700B includes a positioning element receptacle 710, the positioning element receptacle 710 being positioned in a circular opening 715 in the proximal end surface of a base assembly housing 732. As explained more fully below, the unit including the positioning elements is mounted on the housing 732 such that the positioning elements, such as pins, mate with the positioning element receptacles 710. In one aspect, both the pin and the positioning element receptacle 710 are made of high strength steel and are precisely machined to minimize backlash in the coupling of the pin in the positioning element receptacle 710. In one aspect, second platform 700B is made from stainless steel, such as, for example, thirty percent cold worked Nitronic 60. However, any high strength steel that performs well, e.g., does not exhibit wear or cold welding with other steels, can be used.
Fig. 7D is a cutaway illustration of an aspect of a positioning element receptacle 710. The positioning element container assembly 714 is mounted on the proximal portion 700B1 of the second platform 700B. The positioning element container assembly 714 includes a housing 714H, a positioning element container 710, and two bearings 711, 712. The positioning element receptacle 710 is a hollow cylinder that, in this aspect, is open at a proximal end and open at a distal end. A bearing 711 is positioned between the housing 714H and the positioning member receptacle 710 adjacent the proximal end of the positioning member receptacle 710. Bearing 712 is positioned between housing 714H and positioning element receptacle 710 adjacent the distal end of positioning element receptacle 710. Bearings 711 and 712 allow positioning element receptacle 710 to rotate relative to housing 714H and thus relative to second platform 700B. The use of bearings 711 and 712 is illustrative only and not intended to be limiting. In one aspect, the bearing is not included in the positioning element container assembly 714.
Platform 700 floats on the set of rails 752 and 763. When the positioning element is engaged with positioning receptacle 710, the motion of the positioning element moves floating platform 700 along one or both of axes 790, 791. The instrument
Fig. 8A is a first example of an instrument
However, to position the shaft of the instrument for insertion into a particular entry guide,
For movement in a straight line,
For motion along an arc, link 845 (fig. 8B) connects cam follower 832A to
In one aspect (fig. 8C), a
Although only a single fixed slot, a single cam follower, and a single adjustment cam are shown in fig. 8A,
Fig. 8D illustrates another example of an instrument
To position the shaft of the instrument for insertion into a particular entry guide, the user manually moves floating platform 700 until positioning element receptacle 710 is aligned with one of five positions P0 through P5, which are through holes in fixed
When positioning element receptacle 710 is aligned with the correct position in fixed
Fig. 8E illustrates another example of an instrument
For a given set of entry guides, the acceptable position of the positional element receptacle 710 is known for the channel in each entry guide. In this example, the acceptable position is along
However, to move the shaft of the instrument for insertion into a particular entry guide, the
Fig. 9 illustrates another aspect of instrument manipulator positioning system 940 included in
Each of the gearboxes 942_0, 942_1, 942_2, 942_3 is mounted with a release pin 943_0, 943_1, 943_2, 943_ 3. The release pin locks each gearbox during installation, which ensures that the gearboxes are properly synchronized. In fig. 9, the release pin 943_1 has been removed from the gear box 942_ 1.
In one aspect, turning adjustment gear 941 causes each of gear boxes 942_0, 942_1, 942_2, 942_3 to move a positioning element such that a floating platform coupled to the positioning element moves on a particular trajectory. As previously described, the insert assembly is attached to the floating platform and the surgical device assembly is attached to the insert assembly. Thus, as the positioning element moves the floating platform in a particular trajectory, the distal end of the surgical instrument shaft follows the particular trajectory.
In fig. 9, the gearboxes 942_0, 942_1, 942_2, 942_3 represent a group of gearboxes. In fig. 10A to 10D, a first group of gearboxes is shown. In fig. 11A to 11K, a second group of gearboxes is shown. The combination of gearboxes in a group is merely illustrative and not intended to be limiting. As explained more fully below, the particular combination of gearboxes used in the set of gearboxes of fig. 9 is determined by the entry guide and instrumentation used with the patient-
Additionally, the use of four gearbox sets is merely illustrative and not intended to be limiting. In view of the present disclosure, a set of gearboxes can include any number of gearboxes, e.g., one for each
In one aspect, two types of gearboxes are used in the first set of gearboxes. The first gear box moves the positioning element on a circular track. The second gearbox moves the positioning element on a straight trajectory. In this regard, for gearbox 942_0 (fig. 9), straight trajectory gearbox 942_0_1 (fig. 1010C and 10D) is used, while for each of gearboxes 942_1, 942_2, 942_3 (fig. 9), circular trajectory gearbox 942 (fig. 10A encircles fig. 10B) is used. Such combinations of gearboxes are merely illustrative and not intended to be limiting. As explained more fully below, the particular combination of gearboxes used in fig. 9 is determined by the entry guide and instrumentation used with the patient-
Fig. 10A is a proximal side view of the gear box 942. In this regard, the gearbox 942 represents each of the gearboxes 942_1, 942_2 and 942_3 of fig. 9 having a circular trajectory. Fig. 10B is a distal view of the gear box 942. In fig. 10A and 10B, portions of the gearbox housing have been removed.
The gear box 942 has a housing that supports a gear train including an input gear 1001_ a and an output gear 1002_ a. In the above, the input gear 1001_ a is referred to as an input spur gear.
An output pin 1049_ B, e.g., a positioning element, is mounted on the distal surface 1002S _ B of the output gear 1002_ a. In this regard, the output pin 1049_ B is mounted on the output gear 1002_ a which is offset from the rotational center of the output gear 1001_ a. Thus, the trajectory of output pin 1049_ B, and thus the shaft of the surgical instrument, is a constant radius arc. In one aspect, output pin 1049_ B is a stainless steel pin, for example, a thirty percent cold worked Nitronic 60. However, any high strength steel that operates well, i.e. does not exhibit wear or cold welding with other steels, can be used.
The output pin 1049_ B extends distally from the surface 1002S _ B through an opening 1044_ B in the distal side 1032S _ B of the housing. The shape of the opening 1044_ B is selected to control the range of motion of the output pin 1049_ B. Thus, opening 1044_ B is a motion stop for output pin 1049_ B.
Fig. 10C is a proximal side view of the gear box 942_0_1, the gear box 942_0_1 being a straight trajectory gear box. Gearbox 942_0_1 is an example of gearbox 942_0 (FIG. 9). Fig. 10D is a distal view of the gear box 942_0_ 1. In fig. 10C and 10D, the gearbox housing is transparent so that the components within the housing can be seen.
The gear box 942_0_1 has a housing that supports a gear train including an input gear 1001_ C and a cam gear 1002_ C. Cam gear 1002_ C includes an adjustment cam 1043, adjustment cam 1043 being a slot machined into cam gear 1002_ C from distal surface 1002S _ D (fig. 10D). Therefore, the adjustment gear 1043 is sometimes referred to as a cam slot 1043.
The proximal end of output pin 1049_ D, e.g., the proximal end of the positioning element, rides in adjustment cam 1043. Output pin 1049_ D is mounted on carriage 1005, which carriage 1005 rides on a pair on linear track 1052. A linear track 1052 is mounted on the inner distal surface of the housing. In one aspect, output pin 1049_ D is a stainless steel pin, for example, a thirty percent cold worked Nitronic 60. However, any high strength steel that operates well, i.e. does not exhibit wear or cold welding with other steels, can be used.
The output pin 1049_ D extends distally through a fixed slot 1044_ D in the distal side 1032S _ D of the housing. The size of fixed slot 1044_ D is selected to control the range of motion of output pin 1049_ D. Thus, fixed slot 1044_ D is a motion stop for output pin 1049_ D.
As the input gear 1001_ C drives the cam gear 1002_ C, the adjustment cam 1043 moves the output pin 1049_ D. Normally, as cam gear 1002_ C rotates, there will be a reasonable amount of friction between output pin 1049_ D and cam slot 1043. However, in one aspect, a pair of bearings are mounted on output pin 1049_ D, with output pin 1049_ D located in cam slot 1043 such that gearbox 942_0_1 transmits pin movement through a bearing rolling action rather than a sliding movement.
In the gear box 942_0_1, the position of the output pin 1049_ D is guided by the profile of the adjustment cam 1043_ D. However, carriage 1005 and linear track 1052 limit the movement of output pin 1049_ D to movement in a straight line. This configuration has the advantage of being reversible, which makes the sequencing of the output pin positions more flexible.
In another aspect, the second group of gearboxes comprises four different gearboxes as shown in fig. 11A to 11K. Fig. 11A is a proximal side view of the gearbox 942_0_2, the gearbox 942_0_2 being a straight trajectory gearbox. Gearbox 942_0_2 is an example of 942_0 (fig. 9). Gearbox 942_0_2 is the first gearbox in the second set of gearboxes and is typically used to position the camera instrumentation. Fig. 11B is a distal view of the gear box 942_0_ 2. In fig. 11A and 11B, the gearbox housing is transparent so that the components within the housing can be seen. In fig. 11A, the release pin 943_0_2 has been removed from the gear box 942_0_2 and is therefore not shown.
Gearbox 942_0_2 has a housing that supports a gear train including input gear 1101_ a and cam gear 1102_ a. Cam gear 1102_ a includes an adjustment cam 1143_ B, which is a slot machined in cam gear 1102_ a from distal surface 1102DS _ B (fig. 11B). Therefore, adjustment cam 1143_ B is sometimes referred to as cam slot 1143_ B.
The proximal end of output pin 1149_ B is coupled to a cam follower, e.g., the proximal end of the positioning element is coupled to a cam follower that rides in adjustment cam 1143_ B. Output pin 1149_ B extends distally through a fixed slot 1144_ B in the distal side 1132DS _ B of the housing. The size of fixed slot 1144_ B is selected based on the range of motion of output pin 1149_ B. The width of the fixed slot 1144_ B is wide enough to accommodate the portion of the output pin 1149_ B that rolls on the edge surface of the slot (toleranced).
In this regard, stop pin 1103_ a extends in a proximal direction from proximal surface 1102PS _ a of cam gear 1102_ a. Stop pin 1103_ a rides in slot 1104_ a in the inner surface of proximal side 1132PS _ a of the housing. Stop pin 1103_ a in combination with slot 1104_ a limits the range of motion of cam gear 1102_ a, and thus the combination is a range of motion stop.
As input gear 1101_ a rotates cam gear 1102_ a, adjustment cam 1143_ B moves output pin 1149_ B in slot 1144_ B. The position of output pin 1149_ B is guided by the profile of adjustment cam 1143_ D. However, slot 1144_ B limits the movement of output pin 1149_ B to movement in a straight line. See fig. 18C.
Fig. 11C is a proximal side view of the gear box 942_1_2, the gear box 942_1_2 being a first two-degree-of-freedom trajectory gear box. Gearbox 942_1_2 is an example of 942_1 (FIG. 9). Gearbox 942_1_2 is a second gearbox in the second set of gearboxes. Fig. 11D is a distal view of the gear box 942_0_ 2. In fig. 11C and 11D, the gearbox housing is transparent so that the elements within the housing can be seen. In fig. 11C, the release pin 943_1_2 has been removed from the gear box 942_1_2 and is therefore not shown.
Gearbox 942_1_2 has a housing that supports a gear train including input gear 1101_ C and cam gear 1102_ C. Cam gear 1102_ C includes an adjustment cam 1143_ D, which is a slot machined into cam gear 1102_ C from distal surface 1102DS _ D (fig. 11B). Therefore, adjustment gear 1143_ D is sometimes referred to as cam slot 1143_ D.
The proximal end of output pin 1149_ D is coupled to a cam follower, e.g., the proximal end of the positioning element is coupled to a cam follower that rides in adjustment cam 1143_ D. Output pin 1149_ D extends distally through a fixed slot 1144_ D in the distal side 1132DS _ D of the housing. The size of fixed slot 1144_ D is selected based on the range of motion of output pin 1149_ D. The width of fixed slot 1144_ D is wide enough to accommodate the portion of output pin 1149_ D that rolls on the edge surface of the slot (plus tolerance).
In this regard, stop pin 1103_ C extends in a proximal direction from proximal surface 1102PS _ C of cam gear 1102_ C. Stop pin 1103_ C rides in slot 1104_ C in the inner surface of proximal side 1132PS _ C of the housing. Stop pin 1103_ C in combination with slot 1104_ C limits the range of motion of cam gear 1102_ C, and thus the combination is a range of motion stop.
As input gear 1101_ C rotates cam gear 1102_ C, adjustment cam 1143_ D moves output pin 1149_ D in slot 1144_ D. The position of output pin 1149_ D is guided by the profile of adjustment cam 1143_ D. However, slot 1144_ D limits the movement of output pin 1149_ D to movement on a combination of two arcs. Output pin 1149_ D has two degrees of freedom. See fig. 18E.
Fig. 11E and 11F are proximal side views of the gear box 942_2_2, the gear box 942_2_2 being a second two degree of freedom trajectory gear box. Gearbox 942_2_2 is an example of 942_2 (fig. 9). Gearbox 942_2_2 is a third gearbox in the second group of gearboxes. Fig. 11G is a distal view of the gear box 942_2_ 2. Fig. 11H is a cross-sectional view of the gear box 942_2_ 2. In fig. 11E, 11F and 11G, the gearbox housing is transparent so that the elements within the housing can be seen.
Gearbox 942_2_2 has a housing that supports a gear train including input gear 1101_ E and cam gear 1102_ E. Cam gear 1102_ E includes adjustment cam 1143_ G, which is a slot machined into cam gear 1102_ E from distal surface 1102DS _ G (fig. 11B). Therefore, adjustment gear 1143_ G is sometimes referred to as cam slot 1143_ G.
In fig. 11E, a release pin 943_2_2 is shown inserted in the gear box 943_2_ 2. As previously described, each release pin, e.g. release pin 943_2_2, locks its gearbox during installation, which ensures that the gearbox is properly synchronized with the adjustment gear 941. In fig. 11F, the release pin 943_2_2 has been removed from the gear box 942_2_ 2.
The proximal end of output pin 1149_ G is coupled to a cam follower, e.g., the proximal end of the positioning element is coupled to a cam follower that rides in adjustment cam 1143_ G. Output pin 1149_ G extends distally through a fixed slot 1144_ G in the distal side 1132DS _ G of the housing. The size of fixed slot 1144_ G is selected based on the range of motion of output pin 1149_ G. The width of fixed slot 1144_ G is wide enough to accommodate the portion of output pin 1149_ G that rolls on the edge surface of the slot (plus tolerance).
In this regard, stop pin 1103_ E extends in a proximal direction from proximal surface 1102PS _ E of cam gear 1102_ E. Stop pin 1103_ E rides in slot 1104_ E in the inner surface of proximal side 1132PS _ E of the housing. Stop pin 1103_ E in combination with slot 1104_ E limits the range of motion of cam gear 1102_ a, and thus the combination is a range of motion stop.
As input gear 1101_ E rotates cam gear 1102_ E, adjustment cam 1143_ G moves output pin 1149_ G in slot 1144_ G. The position of output pin 1149_ G is guided by the profile of adjustment cam 1143_ G. However, slot 1144_ G limits the movement of output pin 1149_ G to movement on a combination of straight and arc. Output pin 1149_ G has two degrees of freedom. See fig. 18G.
Each of the other gearboxes in the second group of gearboxes, namely gearboxes 942_0_2, 942_1_2 and 942_3_2, has a cross-sectional view similar to that of gearbox 942_2_2 in fig. 11H. Thus, the cross-sectional view of each gearbox 942_0_2, 942_1_2 and 942_3_2 does not add any additional information and is therefore not presented. As shown in fig. 11H, in this regard, output pin 1149_ G is coupled to cam follower 1160 by bushing 1161. Cam follower 1160 rides in cam slot 1104_ E. In this regard, no bearings are used to support output pin 1149_ G, as output pin 1149_ G is supported by bearings 711 and 712 in positioning element container assembly 714 (fig. 7D). In this aspect, the housing of gearbox 942_2_2 includes a base 1170_ G and a cover 1171_ G.
Fig. 11I is a proximal side view of the gear box 942_3_2, the gear box 942_3_2 being a third two degree of freedom trajectory gear box. Gearbox 942_3_2 is an example of 942_3 (fig. 9). Gearbox 942_3_2 is a fourth gearbox in the second group of gearboxes. Fig. 11J is a distal view of the gear box 942_3_ 2. In fig. 11I and 11J, the gearbox housing is transparent so that the elements within the housing can be seen. In fig. 11I, the release pin 943_3_2 has been removed from the gear box 942_3_2 and is therefore not shown.
Gearbox 942_3_2 has a housing that supports a gear train including reverse idler gear 1108_ I, input gear 1101_ I, and cam gear 1102_ I. Reverse idler gear 1108_ I rides on adjustment cam 941 and drives cam gear 1102_ I. In this regard, a reverse idler gear 1108_ I is used to ensure that the manipulator positioning system does not enter an unstable state. Cam gear 1102_ I includes an adjustment cam 1143_ J, which is a slot machined into cam gear 1102_ I from distal surface 1102DS _ J (fig. 11J). Therefore, adjustment gear 1143_ J is sometimes referred to as cam slot 1143_ J.
The proximal end of output pin 1149_ J is coupled to a cam follower, e.g., the proximal end of the positioning element is coupled to a cam follower that rides in adjustment cam 1143_ J. Output pin 1149_ J extends distally through a fixed slot 1144_ J in the distal side 1132DS _ J of the housing. The size of fixed slot 1144_ J is selected based on the range of motion of output pin 1149_ J. The width of fixed slot 1144_ J is wide enough to accommodate the portion of output pin 1149_ J that rolls on the edge surface of the slot (plus tolerance).
In this regard, stop pin 1103_ I extends in a proximal direction from proximal surface 1102PS _ I of cam gear 1102_ I. Stop pin 1103_ I rides in a slot 1104_ I in the inner surface of proximal side 1132PS _ I of the housing. Stop pin 1103_ I in combination with slot 1104_ I limits the range of motion of cam gear 1102_ I, and thus the combination is a range of motion stop.
As input gear 1101_ I rotates cam gear 1102_ I, adjustment cam 1143_ J moves output pin 1149_ J in slot 1144_ J. The position of output pin 1149_ J is guided by the profile of adjustment cam 1143_ J. However, slot 1144_ J limits the movement of output pin 1149_ J to movement on a combination of two arcs. Output pin 1149_ J has two degrees of freedom. See fig. 18I.
Fig. 11K is a more detailed illustration of cam gear 1102_ I. In one aspect, output pin 1149_ J is moved to one of seven positions by rotation of cam gear 1102_ I. The seven positions of output pin 1149_ J are represented by dashed lines 1149_ J _1 through 1149_ J _7 in cam slot 1143_ J. The lighter colored lines in fig. 11K are working lines and are not necessary.
At each position where output pin 1149_ J stops in cam slot 1143_ J, the cam surface is flat, i.e., the flat surface of the cam is perpendicular to a radial line passing through the center of cam gear 1102_ I. This prevents back driving of the cam gear 1102_ I. In some cases, the surgical device assembly 300 may be positioned such that the weight of the surgical device assembly transfers force to the corresponding output pin for the assembly. The flat point at the detent position of output pin 1149_ J ensures that the only force transmitted by the pin to cam gear 1102_ I is a radial force passing through the center of cam gear 1102_ I, and thus back-driving of cam gear 1102_ I is not an issue. Cam gear 1102_ I also represents a cam gear in each of the other gearboxes in the second set of gearboxes, although the cam surfaces are not the same in each gearbox.
Another feature of cam gear 1102_ I is that output pin 1149_ J is moved to the appropriate stop position by an average increment of rotation of
In one aspect, each gearbox in the second set of gearboxes is constructed using the same material. The base is made of 2024-T4 aluminum. The lid is made of 6061-T6 aluminum. All gears, including the cam gear, were made of 2024-T4 aluminum. In one aspect, each of the output pins is a stainless steel pin, such as 416 stainless steel or thirty percent cold worked Nitronic 60. However, any high strength steel that operates well, i.e. does not exhibit wear or cold welding with other steels, can be used. The materials mentioned herein are illustrative only and not intended to be limiting. Other equivalent metals and/or plastics may also be used.
In one aspect, both the roll system and the instrument manipulator positioning system are housed in the
The output pin in each gearbox is moved, for example, in one of two ways. The roll ring gear remains stationary and the adjustment ring gear rotates, or the adjustment ring gear remains stationary and the roll ring gear rotates. In general, however, a proper positioning can be obtained if one of the two gears moves differently with respect to the other gear, for example, the two gears move at different angular velocities.
Fig. 12A-12D illustrate an example of an entry guide manipulator in which a rolling ring gear remains stationary and adjusts ring gear rotation to simultaneously move each of the surgical device assemblies so that its instrument shaft is in position for passage through a passage in the entry guide without damaging the surgical instruments. Fig. 13A and 13D illustrate an example of an entry guide manipulator in which the adjustment ring gear remains stationary and the rolling ring gear rotates to simultaneously move each of the surgical device assemblies so that its instrument shaft is in position for passage through a passage in the entry guide without damaging the surgical instruments. In both examples, during normal operation, the rotation of the rolling ring gear and the adjusting ring gear are synchronized, which means that the two ring gears rotate together at the same angular velocity.
These examples are merely illustrative and are not intended to be limiting. In view of the present disclosure, other methods of moving the rolling ring gear and the adjustment ring gear asynchronously, such as moving the two gears differentially, can be used to move the surgical device assemblies into position to pass their shafts through the entry guide, e.g., the two ring gears can rotate at different angular velocities.
Figure 12A is a schematic diagram of another aspect of an
The
The
In fig. 12A, only a
The
During operator position adjustment,
Fig. 12B shows one configuration with a
In one aspect, the rolling
Movement of the adjusting
To drive
The gear ratios of all components in the planetary differential 1250 are selected to ensure that the
In this regard, manual control of the
Figure 13A is a schematic diagram of another aspect of
The rolling system 1310 includes a rolling
In fig. 13A, only a
In this regard, the
The
In one aspect, the clutch 1392 and
In one aspect,
TABLE 1
Mode(s)
Scrolling
Power-on and release
Is not openElectric bonding
Fault of
Bonding without electrical conduction
Bonding without electrical conduction
Regulating
Bonding without electrical conduction
Power-on and release
Returning to fig. 13A, in the rolling mode, the
In the fault mode, electrical power to both the clutch 1392 and the
In the regulation mode, the clutch 1392 is released and the
In the previous example of fig. 12A-12D, the gearbox remains stationary and movement of the
Fig. 13B-13D are more detailed illustrations of an aspect of implementing the
Fig. 13C is a cutaway illustration showing the interface between
Fig. 13D is a cut-away illustration of
The
Adjusting
The ratio of the gears in the rolling
In this example, the rolling
As is known to those skilled in the art, the
The
The
The
The
When power is applied to the
The rolling
The
An
The rolling
Thus, the first digital potentiometer 1350 (fig. 13B) measures the absolute position of the rolling
As described above, the patient
In one aspect, each standard surgical instrument has a shaft with a specified outer diameter, such as a 6mm (0.237 inch) outer diameter. The outer diameter of the shaft of the advanced surgical instrument is larger than the outer diameter of the shaft of the standard surgical instrument. In one aspect, the advanced surgical instrument has a shaft with outer diameters of 8mm (0.315 inch) and 12mm (0.473 inch). Examples of advanced surgical instruments include staplers and vascular sealers.
The
The entry guide and cannula size selection for the
In one aspect, the minimum spacing between channels in the entry guide is selected to provide a minimum webbing thickness based on manufacturability, e.g., a minimum thickness between adjacent channels of 0.046 inches (1.17 mm). Similarly, a minimum outer wall thickness of the entry guide, such as a minimum outer wall thickness of 0.035 inches (0.89mm), is selected based on manufacturability. The diameter of the entry guide for manual instruments is made as large as possible while maintaining a minimum outer wall thickness and a minimum thickness between adjacent channels.
Fig. 14A-14J are illustrations of cross-sections of a family of entry guides that can be used with
As indicated above, each entry guide is inserted in the cannula. Each cannula has a common wall thickness. The walls of the cannula are made as thin as possible to minimize incision size, but thick enough to support the working load. In addition, the thickness of the wall is large enough that the distal end of the cannula does not have a knife edge (knife edge). The entry guide is selected to minimize the number of different sized cannulas required. For entry guides having a circular cross-section, two cannula sizes were selected, for example, cannulas having inner diameters of about 25mm (0.986 inches) and about 31mm (1.222 inches). For entry guides having non-circular cross-sections, assuming rolling is allowed, the minimum circular cannula size that allows the non-circular entry guide to roll about the longitudinal axis of the entry guide manipulator 230 is reported. However, typically the non-circular entry guide and cannula do not roll.
Thus, the ten entry guides presented in fig. 14A-14J require a minimum of three cannula sizes. A standard 25mm inner diameter cannula is used with a standard entry guide 701. A 31mm inner diameter cannula is used with other circular cross-section entry guides. Both the 25mm cannula and the 31mm cannula have two dimensions, short length and long length, for accommodating different patient anatomies. A cannula with a non-circular cross-section would require a cannula with a 36mm (1.420 inch) inner diameter if rolling is possible during surgery. Non-circular entry guides placed between ribs do not typically roll.
The position of the instrument channel in the various non-circular cross-section entry guides is adjusted (inward) by wrapping around the outer periphery of the entry guide to fit within the confines of the instrument manipulator positioning system, as described more fully below. Four unique non-circular cross-section entry guides are included in this family of entry guides, one in a horizontal configuration for transoral pharyngeal access (transoral) surgery, one in a cross-arm configuration for transoral pharyngeal access surgery, and two in a vertical configuration for intercostal surgery.
The entry guide 1401 (fig. 14A) is referred to as a standard entry guide and is the same as the
Entry guide 1402 (fig. 14B) is a first example of an advanced instrument entry guide. The
The entry guide 1403 (fig. 14C) is a second example of an advanced instrument entry guide. The
Entry guide 1404 (fig. 14D) is a first example of a manual port entry guide. The
Entry guide 1405 (fig. 14E) is a second example of a manual port entry guide. Entry guide 1405 has a circular cross-section. Entry guide 1405 includes four channels. The four channels are an elliptical camera channel 1405C, a first circular advanced instrument channel 1405a1, a circular manual channel 1405M, and a second circular advanced surgical instrument channel 1405 A3. In this regard, the first circular standard surgical instrument channel 1405S1 and the second circular advanced surgical instrument channel 1405A3 have the same diameter, e.g., 0.428 inches (10.9 mm). In one aspect, circular manual channel 1405M has a diameter of 0.472 inches (12 mm).
Entry guide 1406 (fig. 14F) is a third example of a manual port entry guide. The
The entry guide 1407 (fig. 14G) is a first example of an oropharyngeal access entry guide, i.e., the
Entry guide 1408 (fig. 14H) is a second example of a transoral access entry guide. Entry guide 1408 has a modified triangular cross-section. The cross-section is a non-circular cross-section and is referred to as a modified triangular cross-section because the vertices of the triangular shape are circular and one side of the triangle has a small arc at the center. Entry guide 1408 includes four channels. The four channels are an elliptical camera channel 1408C and three circular standard instrument channels 1408S1, 1408S2,
The first circular standard surgical instrument channel 1408S1 has a longitudinal axis 1485. The elliptical cross-section of the camera channel 1408C has a major axis 1486 and a minor axis 1487. The third circular standard surgical instrument channel 1408S3 has a longitudinal axis 1488. The second circular standard surgical instrument channel 1408S2 has a longitudinal axis 1489.
Entry guide 1409 (fig. 14I) is a first example of a chest entry guide. The entry guide 1409 has a non-circular cross-section which is a cross-section with two parallel sides connected by two arcs, for example an oval-like cross-section. The entry guide 1409 includes three channels. These three channels are an elliptical camera channel 1409C and two circular standard instrument channels 1409S1,
Entry guide 1410 (fig. 14J) is a second example of a chest entry guide.
Table 2 is a summary of the information presented above for the entry directors 1401-1410. The dimensions presented are merely illustrative and are not intended to limit the entry guide to the specific dimensions presented.
TABLE 2
Ten entry guide configurations with three cannulae were analyzed to determine the required range of motion and trajectories to be performed in each of the four gearboxes. FIG. 15 is a process flow diagram of a method for performing an analysis.
In selecting the family of entry directors 1501, a family of entry directors is selected. This process is equivalent to the considerations described above with respect to fig. 14A-14J and is therefore not repeated here. Generally, the selection of entry guide and cannula sizes in the family is based on clinical needs, system feasibility, logistics, and manufacturability. Clinical needs include surgical instruments needed for various surgical procedures that can be performed by minimally invasive surgical systems. In the above examples, the family includes entry guides for standard surgical instruments, advanced surgical instruments, manual surgical instruments, camera instruments, and combinations of these instruments. In addition, the entry guide is selected to facilitate, on the one hand, the use of as few different cannula sizes as possible. The entry guide channel configuration is laid out according to the flow and manufacturability of the entry guide in use of the surgical instrument.
After a family of entry guides has been selected, a model fixed entry guide parameters process 1502 is performed. Some entry guide parameters can be derived directly from the shape and size of the entry guide without regard to the instrument manipulator positioning system or the surgical device assembly. For example, the camera instrument channel is always centered on the Y-axis and the center of the camera instrument channel is located as far as possible from the longitudinal axis of the entry guide. This provides the most space for other surgical instrument channels and manual instrument channel(s) and results in an intuitive arrangement of the surgical instrument relative to the camera for the surgeon. Similarly, the channels for the shafts of the first and third surgical device assemblies are typically positioned symmetrically about the camera channel, positioned at the periphery of the entry guide, and positioned as close as possible to the camera channel. This provides maximum space for manual access and provides access that provides more flexibility for placement of a shaft for another surgical device assembly mounted on the base assembly.
Upon completion of the model fix entry guide parameters process 1502, stress regions are plotted around each instrument cavity location, showing the allowable offset between the actual instrument location and the ideal (minimum stress) instrument location in the stress region process 1503. The boundaries of each stress region are isolines of stress. Any point within the bounds has less stress than the stress on the equal stress bounds.
Therefore, the location of minimum stress is determined first. In one aspect, the location of minimum stress is selected as the location where the bend in the shaft is a circular bend. With one end of the shaft fixed in place and another portion of the shaft having approximately two points of contact with the entry guide, the shaft follows a circular arc. The stress is being applied by a pure moment. This circular bend is believed to minimize stress on the shaft over the length of the bend, for example, over a six inch (152.2mm) length. In table 3, the ideal position for the positioning element and hence the surgical instrument axis is given in (x, y) coordinates. The x and y directions are defined at the location of each positioning element in the base assembly. The values of the (x, y) coordinates in table 3 (in inches) provide the nominal position for each instrument insert assembly. FIG. 16A is FIG. 5A with the (x, y) coordinate system redrawn added. As known to those skilled in the art, the coordinates in table 3 can be converted to millimeters by multiplying each coordinate by 25.4.
TABLE 3
The transoral and thoracic access guides 1407 to 1410 use only two of the three instrument manipulators, but specify positions for positioning elements in all three base assemblies. This is done to avoid collisions and to provide clearance for sterile drapes. Typically, base assembly 432_1 and base assembly 432_2 are used to position two manipulator assemblies when only two manipulator assemblies and associated surgical instruments are used with the entry guide.
To facilitate placing the channels in the entry guide closer together to minimize the cannula diameter, the shafts of the surgical instruments are angled from the instrument housing (see fig. 4B) and bent against the entry guide as they pass through the cannula. This compensates for the space loss for the shaft bearing and for the space loss of the wall thickness of the instrument housing. Fig. 16B shows a
With one end of the shaft 1667 fixed at the instrument housing and another point on the shaft 1667 having approximately two points of contact with the walls of the channel in the entry guide 1670 (fig. 16B), the shaft 1667 follows a circular arc as shown in fig. 16B. The amount of bend or angle θ required is a function of the distance L from the bottom of the instrument housing to the top of the entry guide 1670 and the relative distance of the channel from the adjacent instrument housing and cavity. The angle θ is an angle away from the axis of the housing. The distance is the distance from the center of shaft 1667 to the outer diameter of bearing B (fig. 16C) mounted at the proximal end of shaft 1667. The distance h is a housing theoretical sharp dimension used to show the resulting position of the instrument housing relative to the channel. The distance G is the minimum distance maintained between adjacent instrument housings.
The circular bend assumption minimizes stress in the shaft over the length of the bend assuming the worst case insertion depth L. However, other bends can be implemented as desired to provide additional offset between the instrument housing and the entry guide lumen. This S-bend increases the axial stress depending on its magnitude and direction (perpendicular or parallel to the circular bend). As used herein, an S-shaped bend, e.g., an S-bend, is produced when a moment and a force are simultaneously applied to a shaft. To understand how much sigmoidal can be tolerated, the region bounded by the iso-stress limits is plotted around the ideal instrument position for a given shaft material. The positioning element can be offset as needed to insert the shaft into the shaft channel as long as the stress on the shaft remains at or within the iso-stress limits. If the positioning element is moved from the ideal position, an additional axis bend is imposed on the instrument axis, but the stress associated with the additional axis bend is within an acceptable stress level as long as the position of the positioning element, and thus the instrument axis, remains within the iso-stress limits.
In one aspect, the shaft material for standard surgical instruments is stainless steel, such as precipitation hardened stainless steel, for example 17-4 or 17-7 stainless steel state H1050. However, for advanced surgical instruments, different materials are used. To allow for increased bending angles on larger shafts, it is necessary to select different materials for the shafts of the vascular sealer and stapler instrument.
Advanced surgical instruments have a high strength plastic shaft to allow bending through the cannula. In one aspect, the shaft is made of Polyetheretherketone (PEEK) plastic. PEEK plastic is an organic thermoplastic polymer. In one aspect, a PEEK plastic having a flexural modulus of 11.8GPa (1,711ksi) is selected for the shaft of an advanced surgical instrument. The PEEK plastic is at 107Tensile fatigue under cycling is a tensile strength of about 14,500 psi. PEEK plastics having these properties are composed of
Manufactured by manufacturing company, PEEK 450GL 30. (VICTREX is a registered trademark of Victrex manufacturing, Inc. of Lankai FY 54 QD, UK). Alternative grades of PEEK with higher stiffness are available. Alternative grades of PEEK have elastic moduli of 45GPa and 22 GPa. These grades may be required for some advanced surgical instruments to prevent shaft buckling under high cable tension.In fig. 17, a stress region, sometimes referred to as a stress profile, bounded by isostress lines, i.e., by isostress boundaries, is presented for each positioning element and associated entry guide channel to show the allowable offset from the ideal (minimum stress) instrument shaft position. Each region has a shape that is roughly a cross-section in the shape of a football, i.e., a cross-section in the shape of an oblate sphere. Stress on the shaft of the instrument is acceptable if the shaft is positioned at a location within the iso-stress limits. Thus, the stress region in fig. 17 is a region of acceptable stress associated with bending of the shaft of the instrument. The reference number for each stress profile points to an ideal location based on the information in table 3, which is at the center of the stress profile. The first part of the reference number is the reference number of the corresponding channel in fig. 14A to 14J and the first part of the reference number is followed by _ P to indicate that the reference number refers to a position. For example, 1408S0_ P is the ideal position for the camera instrument axis when inserted in the channel 1408S0 in the entry guide 1408.
Fig. 17 shows the ideal position of the camera instrument axis relative to the channels 1401S0_ P to 1410S0_ P that fall on a straight line, which is the positive position into the y-axis of the guide manipulator coordinate system. The iso-stress limits are not determined for the camera instrument shaft because, as described above, the camera instrument is pre-bent and therefore the shaft is not subject to bending as it passes through the entry guide.
The stress profile of the instrument shaft controlled by the positioning element associated with base assembly 432_1 is primarily along the x-axis to the right of the y-axis, e.g., the stress profile has centers 1401S1_ P through 1410S1_ P as shown in fig. 17. In FIG. 17, the stress profile of the instrument shaft controlled by the positioning element associated with base assembly 432_2 is below the x-axis, e.g., in this regard, the stress profile has centers 1401S2_ P through 1410S3_ P, 1406S2_ P, and 1408S2_ P through 1410S2_ P.
The stress profile of the instrument shaft controlled by the positioning element associated with base assembly 432_3 is not presented in fig. 17. The reason is that for each (x, y) value that defines a limit of the stress profile controlled by the positioning element associated with base assembly 432_1, the corresponding value on the limit of the stress profile of the instrument axis controlled by the positioning element associated with base assembly 432_3 is (-x, -y). Thus, when a first trajectory is determined for the positioning element associated with base assembly 432_1, a second trajectory for the positioning element associated with base assembly 432_3 is the negative of the first trajectory. Thus, analysis of the stress data associated with positions 1401S1_ P through 1410S1_ P is the same information sufficient to determine the positioning element associated with base assembly 432_ 3.
The stress regions generated in stress region process 1503 are used in select locations process 1504. Initially, in process 1504, a determination needs to be made whether to use a linear trajectory gearbox (fig. 10C, 10D) or a circular trajectory gearbox (fig. 10A, 10B).
Thus, the end points of the preliminary trajectory are defined to limit the overall range of motion required. For a positional element associated with a camera instrument, the range of motion is from
After defining the range of motion, the trajectory and the positions of the constituent trajectories are selected. For camera instruments, a linear trajectory is required. Therefore, for the camera instrument, a linear trajectory gearbox is chosen. For the first surgical instrument, the stress profile in fig. 17 shows that a straight line drawn between
For the second surgical instrument, a straight line between
Next, a set of positions is generated on each track of the positional element. Each selected location is either on the boundary or within the stress profile. When the selected position ensures that the stress on the instrument shaft is acceptable, there is a possibility that the instrument housing will collide when the adjacent instrument is moved to the selected position. Thus, the relationship of the instrument housing at the selected location is analyzed to ensure that the location does not cause any collisions.
At each actual position, the corresponding instrument housing is drawn based on the layout of fig. 16C. To avoid over-definition problems, a subset of entry guides in a family of entry guides is empirically selected. Adjacent surgical instrument housings for each entry guide configuration are mated and the gap between the housings is measured. If there is a collision, the gap between the housings is set at a predetermined gap G, for example 0.100 inches (2.54mm), and the selected position is adjusted to achieve this spacing. If there is no collision, the gap between the instrument housings is saved for final verification of the trajectory. This process is repeated for each entry guide of the subset of entry guides. The predetermined gap is also used to define the offset of the camera positioning element. For locations not constrained by clearance from adjacent instrument housings, the locations are selected according to convenient attributes such as average spacing along the trajectory or where instrument shaft stress is minimized.
The square boxes along the x-axis in fig. 17 represent positions on the linear trajectory of the first surgical instrument. The position of the linear trajectory is not critical because, as described above, the positioning element is not constrained to move in a single direction. In one aspect, the linear trajectory uses some points more than once as the linear gearbox based design trajectory moves back and forth along the trajectory. The square box along
Fig. 18A shows the surgical and camera instrument trajectories and the range of motion of the output pins for the gearboxes 1842_0, 1842_1, 1842_2 of the family of entry guides of fig. 14A-14J. The graph is oriented looking down the cannula with each gearbox position marked. The trajectory of the output pin of the gearbox 1842_3 (not shown) is not plotted because it is considered the negative of the trajectory and range of motion of the gearbox 1842_ 1. As shown, the trajectory of the output pin of the gearbox 1842_3 is circular and the other trajectories of the other three gearboxes are linear. Table 4 gives the values associated with the reference numerals in fig. 18 for the entry guides 1401 to 1410.
TABLE 4
Reference numerals
Size (inch)
1801
0.461(11.69mm)
1802
0.245(6.21mm)
1803
0.208(5.07mm)
1804
0.454(11.51mm)
1805
0.250(6.34mm)
1806
0.454(11.51mm)
1807
0.040(1.01mm)
1808
0.177(4.49mm)
In one aspect, to reduce the range of motion of the camera instruments, two camera instruments are used in a surgical system, such as
The use of two camera instruments reduces the range of motion required by the linear gear box associated with the camera instrument to the range presented in fig. 18, rather than the 0.0 to 0.461 inch (0.0 to 11.69mm) range of motion shown in fig. 17. On the other hand, only a single camera instrument is used.
The range of motion of the gear box for the three surgical instruments is 0.246 inches (6.24mm) in the radial direction and 0.217 inches (5.50mm) in the lateral direction. The camera gear box has a range of motion of 0.216 inches (5.48mm) in the radial direction. Thus, the combined range of motion required by all instruments is 0.246 inches (6.24mm) in the radial direction and 0.217 inches (5.50mm) in the transverse direction.
The sequence of entry guides as moved by the positioning system in the entry guide manipulator is defined by the circular gear box position for the second surgical instrument. In table 5, the relative position is specified according to the output gear angle in the circular gear box.
TABLE 5
In the above analysis, the bending stress associated with the shaft of the instrument was determined only for the particular channel in which the instrument was designed to be inserted into the entry guide. For example, a standard surgical instrument with a smaller diameter shaft is not considered to be inserted in one of the larger diameter channels designed for advanced surgical instruments.
However, on the other hand, it is assumed that the cannula will be inserted in a larger diameter passage so that standard surgical instruments can be passed through a passage designed for advanced surgical instruments, for example. Therefore, the stress analysis is repeated for a set of guide tubes, where standard surgical instruments are allowed to be used with guide tube channels designed for advanced surgical instruments, for example. In addition, the analysis ensures that instrument collisions are not an issue. Finally, analysis in addition to the constraints imposed by the different channel positions in the entry guide also specifies the overhang position for each instrument manipulator. In particular, the instrument manipulators are moved apart so as to facilitate the draping. The result of this analysis is the second set of gearboxes shown in fig. 11A to 11K.
Analysis of the entry guide in combination with the overhang position reveals that each instrument manipulator, e.g., each surgical device assembly, must be moved to one of seven positions to accommodate a set of entry guides of interest. The first position is a hanging position and the other six positions are based on the combination of the entry guide and the surgical device assembly being used.
Fig. 18B shows seven positions for the instrument manipulator associated with gear box 942_0_2 (fig. 11A and 11B). Fig. 18C shows seven positions of output pin 1149_ B in slot 1144_ B. In fig. 18B-18I, the coordinate system is relative to the manipulator assembly and not relative to any world coordinate system. Table 6A presents values in inches for each dimension shown in fig. 18B. Table 6B presents values in inches for each dimension shown in fig. 18C. The numbers in parentheses in tables 6A and 6B are in units of millimeters.
TABLE 6A
MX0_1
0.1880(4.77)
MY0_1
0.0000(0.00)
MX0_2
-0.0920(-2.33)
MY0_2
0.0000(0.00)
MX0_3
0.1265(3.21)
MY0_3
0.0000(0.00)
MX0_4
0.1265(3.21)
MY0_4
0.0000(0.00)
MX0_5
0.0091(0.23)
MY0_5
0.0000(0.00)
MX0_6
0.1568(3.98)
MY0_6
0.0000(0.00)
MX0_7
0.2250(5.71)
MY0_7
0.0000(0.00)
TABLE 6B
SX0_1
0.048(1.22)
SY0_1
0.00(0.00)
SX0_2
-0.232(-5.88)
SY0_2
0.000(0.00)
SX0_3
-0.014(-0.36)
SY0_3
0.000(0.00)
SX0_4
-0.014(-0.36)
SY0_4
0.000(0.00)
SX0_5
-0.131(-3.32)
SY0_5
0.000(0.00)
SX0_6
0.017(0.43)
SY0_6
0.000(0.00)
SX0_7
0.085(2.16)
SY0_7
0.000(0.00)
Fig. 18D shows seven positions for the instrument manipulator associated with gear box 942_1_2 (fig. 11C and 11D). Fig. 18E shows seven positions of output pin 1149_ D in slot 1144_ D (fig. 11D). Table 7A presents values in inches for each dimension shown in fig. 18D. Table 7B presents values in inches for each dimension in fig. 18E. The numbers in parentheses in tables 7A and 7B are in units of millimeters.
TABLE 7A
TABLE 7B
SX1_1
0.010(0.25)
SY1_1
-0.042(-1.07)
SX1_2
0.085(2.16)
SY1_2
-0.069(-1.75)
SX1_3
0.010(0.25)
SY1_3
-0.042(-1.07)
SX1_4
-0.074(-1.88)
SY1_4
0.070(1.78)
SX1_5
-0.074(-1.88)
SY1_5
0.070(1.78)
SX1_6
-0.197(-5.00)
SY1_6
0.091(2.31)
SX1_7
-0.261(-6.62)
SY1_7
0.089(2.26)
Fig. 18F shows seven positions for the instrument manipulator associated with gear box 942_2_2 (fig. 11E-11H). Fig. 18G shows seven positions of output pin 1149_ G in slot 1144_ G (fig. 11G). Table 8A presents values in inches for each dimension shown in fig. 18F. Table 8B presents values in inches for each dimension shown in fig. 18G. The numbers in parentheses in tables 8A and 8B are in units of millimeters.
TABLE 8A
MX2_1
0.165(4.18)
MY2_1
-0.012(-0.30)
MX2_2
0.014(0.36)
MY2_2
0.000(0.00)
MX2_3
0.024(0.61)
MY2_3
0.000(0.00)
MX2_4
0.084(2.13)
MY2_4
0.000(0.00)
MX2_5
0.094(2.38)
MY2_5
0.000(0.00)
MX2_6
0.198(5.02)
MY2_6
-0.022(-0.56)
MX2_7
0.198(5.02)
MY2_7
-0.022(-0.56)
TABLE 8A
Fig. 18H shows seven positions of the instrument manipulator associated with gear box 942_3_2 (fig. 11I-11J). Fig. 18I shows seven positions of output pin 1149_ J in slot 1144_ J (fig. 11J). Table 9A presents values in inches for each dimension shown in fig. 18D. Table 9B presents values in inches for each dimension shown in fig. 18E. The numbers in parentheses in tables 9A and 9B are in units of millimeters.
TABLE 9A
MX3_1
0.160(4.06)
MY3_1
0.042(1.07)
MX3_2
0.235(5.96)
MY3_2
0.069(1.75)
MX3_3
0.160(4.06)
MY3_3
0.042(1.07)
MX3_4
0.076(1.93)
MY3_4
-0.070(-1.78)
MX3_5
0.076(1.93)
MY3_5
-0.070(-1.78)
MX3_6
-0.047(-1.19)
MY3_6
-0.091(-2.31)
MX3_7
-0.111(-2.81)
MY3_7
-0.089(-2.26)
TABLE 9B
SX3_1
0.010(0.25)
SY3_1
0.042(1.07)
SX3_2
0.085(2.16)
SY3_2
0.069(-1.75)
SX3_3
0.010(0.25)
SY3_3
0.042(1.07)
SX3_4
-0.074(-1.88)
SY3_4
-0.070(-1.78)
SX3_5
-0.074(-1.88)
SY3_5
-0.070(-1.78)
SX3_6
-0.197(-5.00)
SY3_6
-0.091(-2.31)
SX3_7
-0.261(-6.62)
SY3_7
-0.089(-2.26)
In one aspect, a control system 2000 (fig. 20A) of a surgical system includes an instrument manipulator positioning system compatibility module 2010. The control system 2000 also has compatibility and configuration data 2015 stored in memory and system management module 2025.
In fig. 20A, the control system 2000 and the system management module 2025 are shown as elements in a single location. This is for ease of description and is not intended to be limiting. Typically, control system 2000 and system management module 2025 are distributed throughout the surgical system and interconnected such that the various components can communicate as needed. Additionally, those skilled in the art will appreciate that modules can be implemented in hardware, firmware, stored computer code that executes on a processor, or any combination of the three.
In one aspect, instrument manipulator positioning system compatibility module 2010 performs method 2050 (fig. 20B). Before considering the
When
Thus, when each surgical instrument is installed on the
If the user attempts to use the
When all surgical instruments, cannulas, and entry guides have been registered with the control system 2000, the system
If the entry guide is in the family, the
In one aspect, the
When the
In one aspect, the configure
Fig. 21A and 21B are illustrations of side views of base assemblies 2132_0 and 2132_1 mounted to a portion 2130 of entry guide manipulator 230. In one aspect, the insertion assembly with the attached surgical device assembly is connected to a floating platform in each of base assemblies 2132_0 and 2132_1, but the insertion assembly with the attached surgical device assembly is not shown in fig. 21A and 21B.
Base assembly 2132_0 is connected to portion 2130 by hinge assembly 2133_ 0. A plane including the longitudinal axis of hinge assembly 2133_0 is perpendicular to a plane including the longitudinal axis of entry guide manipulator 230. Similarly, base assembly 2132_1 is connected to portion 2130 by hinge assembly 2133_ 1. Each of the other two base assemblies, not visible in fig. 21A, is similarly connected to portion 2130. In fig. 21B, base assemblies 2132_0 and 2132_1 have been pivoted to allow access to base assemblies 2132_0 and 2132_1 for maintenance or other actions. Base assemblies 2132_2 and 2132_3 can be seen in fig. 21B.
Fig. 22A is a side view of base assemblies 2232_0 and 2232_1 mounted to
Base assembly 2232_0 is connected to
Fig. 23A and 23B are illustrations of side views of base assemblies 2332_0 and 2332_1 mounted to
Base assembly 2332_0 is connected to
In some of the above examples, the terms "proximal" or "distal" are used in a general manner to describe objects or elements that are closer to the manipulator arm base along the kinematic chain of movement of the system or farther from the remote center of motion (or surgical site) along the kinematic chain of movement of the system. Similarly, the terms "distal" or "distally" are used in a generic manner to describe objects or elements that are farther from the manipulator arm base along the kinematic chain of system motion or closer to the remote center of motion (or surgical site) along the kinematic chain of system motion.
As used herein, "first," "second," "third," "fourth," and the like are adjectives used to distinguish between different components or elements. Thus, "first," "second," "third," "fourth," etc. are not intended to imply any ordering of parts or elements or any particular number of different types of elements, e.g., three elements of the same type can be labeled as a first element, a second element, and a third element.
The above description and drawings showing aspects and embodiments of the invention should not be taken as limiting, i.e. the claims define the claimed invention. Various mechanical, compositional, structural, electrical, and operational changes may be made without departing from the spirit and scope of the description and claims. In some instances, well-known circuits, structures and techniques have not been shown or described in detail to avoid obscuring the invention.
Furthermore, the terminology of the description is not intended to be limiting of the invention. For example, spatially relative terms, such as "under," "below," "inferior," "upper," "proximal," "distal," and the like, may be used to describe one element or feature's relationship to another element or feature as illustrated in the figures. These spatially relative terms are intended to encompass different positions (i.e., locations) and orientations (i.e., rotational placements) of the device in use or operation in addition to the position and orientation depicted in the figures. For example, if the device in the figures is turned over, elements described as "below" or "beneath" other elements or features would then be "above" or "over" the other elements or features. Thus, the exemplary term "below" can encompass both a position and an orientation of above and below. The device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly. Likewise, the description of motion along and about various axes includes various specific device positions and orientations.
The singular forms "a", "an" and "the" are intended to include the plural forms as well, unless the context clearly indicates otherwise. The terms "comprises," "comprising," and the like, specify the presence of stated features, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups thereof. Components described as coupled may be directly coupled, electrically or mechanically, or they may be indirectly coupled via one or more intermediate components.
All examples and illustrative references are non-limiting and should not be used to limit the claims to the specific embodiments and examples described herein, and their equivalents. Any headings are used for formatting only and should not be used to limit the subject matter in any way, as text under one heading may cross-reference or apply to text under one or more headings. Finally, in view of the present disclosure, certain features described in relation to one aspect or embodiment may be applied to other disclosed aspects or embodiments of the invention, even if not specifically shown in the drawings or described in the text.
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