阅读说明：本技术 手术系统无菌帷帘 (Surgical system sterile drape ) 是由 A·K·麦克格罗甘 J·D·布朗 T·G·库珀 E·F·杜瓦尔 D·戈麦斯 R·E·霍鲁普 于 2011-05-04 设计创作，主要内容包括：本申请题为“手术系统无菌帷帘”。本申请提供一种无菌帷帘、带有帷帘的手术系统以及覆盖方法。在一个实施例中,无菌帷帘包括多个帷帘袋,帷帘袋中的每个包括外部表面和内部表面,其中所述外部表面邻近用于执行手术程序的无菌区域,以及所述内部表面邻近与机器人手术系统的操纵器臂连接的非无菌器械操纵器。帷帘进一步包括：在每个帷帘袋的远侧面处的多个柔性薄膜,该多个柔性薄膜用于在器械操纵器的输出端和相应手术器械的输入端之间接口连接；以及适于将每个帷帘袋的近侧开口在操纵器臂远端处连接于可旋转元件的可旋转密封件。(The present application is entitled "surgical system sterile drape". A sterile drape, a surgical system with the drape, and a draping method are provided. In one embodiment, a sterile drape includes a plurality of drape bags, each of the drape bags including an exterior surface and an interior surface, wherein the exterior surface is adjacent to a sterile field for performing a surgical procedure and the interior surface is adjacent to a non-sterile instrument manipulator connected to a manipulator arm of a robotic surgical system. The drape further comprises: a plurality of flexible membranes at a distal face of each drape bag for interfacing between an output of an instrument manipulator and an input of a respective surgical instrument; and a rotatable seal adapted to connect the proximal opening of each drape bag to the rotatable element at the distal end of the manipulator arm.)

1. A surgical system drape, comprising:

a plurality of pouches, each pouch of the plurality of pouches comprising an exterior surface configured to be adjacent to a sterile field and an interior surface configured to be adjacent to a non-sterile instrument manipulator connected to a manipulator arm of a robotic surgical system; and

a rotatable seal adapted to connect the proximal opening of each of the plurality of pouches to a rotatable element at the distal end of the manipulator arm.

2. The surgical system drape of claim 1, wherein each bag of the plurality of bags comprises a flexible membrane configured to be disposed between the non-sterile instrument manipulator received in the bag and an instrument mounted on the non-sterile instrument manipulator.

3. The surgical system drape of claim 2, wherein the flexible film is at a distal end of the bag.

4. The surgical system drape of claim 1, wherein the rotatable seal comprises a labyrinth seal.

5. The surgical system drape of claim 4, wherein the labyrinth seal includes:

a base comb portion rotatably connected to the roller covering portion.

6. The surgical system drape of claim 1, further comprising a drape bag extension at a distal face of each bag of the plurality of bags.

7. The surgical system drape of claim 1, at least a portion of a bag of the plurality of bags configured to allow extension of an insertion mechanism connected to the non-sterile instrument manipulator received in the bag.

Background

In robotic-assisted or telerobotic surgery, a surgeon typically operates master controllers to remotely control the movement of surgical instruments at a surgical site at a location remote from the patient (e.g., across an operating room, in a different room or building completely different from the patient). The master controller typically includes one or more manual input devices, such as joysticks, exoskeleton gloves or the like, that are coupled to the surgical instruments through servomotors that articulate the instruments at the surgical site. The servo motors are typically part of an electromechanical device or surgical manipulator (slave) that supports and controls a surgical instrument that has been introduced directly into an open surgical site or into a body cavity (e.g., a patient's abdomen) through a trocar sleeve. During surgery, the surgical manipulator provides articulation and control of various surgical instruments, such as tissue graspers, needle drivers, electrocautery probes, and the like, each of which performs a different function for the surgeon, such as grasping or driving a needle, grasping a blood vessel, or dissecting, cauterizing, or coagulating tissue.

The number of degrees of freedom (DOF) is the number of independent variables that uniquely identify the telerobotic system pose/configuration. Since the robotic manipulator is a kinematic chain that maps (input) joint space to (output) cartesian space, the concept of DOF can be expressed in either of these two spaces. In particular, the joint DOF set is a set of joint variables for all independently controlled joints. Without loss of generality, a joint is a mechanism that provides a single translational (prismatic joint) or rotational (revolute joint) DOF. From a kinematic modeling perspective, any mechanism that provides more than one DOF motion is considered to be two or more independent joints. The cartesian DOF set is typically represented by three translational (position) variables (e.g., fore and aft movement, up and down movement, left and right movement) and three rotational (orientation) variables (e.g., euler angles or roll/pitch/yaw angles) that describe the position and orientation of the end effector (or tip) reference frame relative to a given reference cartesian reference frame.

For example, a planar mechanism with an end effector mounted on two independent and perpendicular rails has the ability to control the x/y position (prismatic DOF) within the two rail crossing region. If the end effector is able to rotate about an axis perpendicular to the plane of the rail, there are three input DOFs (two rail positions and the yaw angle) corresponding to three output DOFs (x/y position and orientation angle of the end effector).

While the number of non-redundant cartesian DOFs describing the body within a cartesian reference frame may be 6 (with all translation and orientation variables being independently controlled), the number of joint DOFs is typically a result of design choices involving consideration of mechanism complexity and task specifications. Thus, the number of joint DOFs may be more, equal, or less than 6. For non-redundant kinematic chains, the number of independently controlled joints is equal to the degree of mobility of the end effector frame of reference. For a certain number of prismatic and revolute joint DOFs, the end effector frame of reference will have an equivalent number of DOFs (except in a singular configuration) in cartesian space where the degrees of freedom in cartesian space will correspond to a combination of translational (x/y/z position) and rotational (roll/pitch/yaw orientation angle) motions.

The distinction between input and output DOF is very important with redundant or "incomplete" kinematic chains (e.g., mechanical manipulators). In particular, an "incomplete" manipulator has fewer than 6 independently controlled joints and thus does not have the ability to fully control the position and orientation of the end effector. In contrast, incomplete manipulators are limited to controlling only a subset of the position and orientation variables. On the other hand, redundant manipulators have more than 6 joint DOF. Thus, the redundant manipulator is able to establish a desired 6-DOF end effector pose using more than one joint configuration. In other words, the additional degrees of freedom can be used to control not only the end effector position and orientation, but also the "shape" of the manipulator itself. In addition to freedom of movement, the manipulator has other DOF, such as pivoting lever movement of a grasping jaw or scissors blade.

Telerobotic surgery by remote manipulation has enabled a reduction in the size and number of incisions required in the surgery to enhance patient recovery and to help reduce patient trauma and discomfort. However, telerobotic surgery also creates many new challenges. Robotic manipulators adjacent to the patient make it sometimes difficult for patient-side medical personnel to access the patient, and for robots designed specifically for single port surgery, access to a single port is very important. For example, a surgeon typically employs a large number of different surgical instruments/tools during a procedure, and it is highly advantageous to have easy access to the manipulator and single port, and easy exchange of instruments.

Another challenge is because a portion of the electromechanical surgical manipulator will be located adjacent to the surgical site. As a result, surgical manipulators can become contaminated during surgery, and are often handled or sterilized between surgeries. From a cost point of view it is preferred to sterilize the device. However, the servo motors, sensors, encoders and the electrical connections necessary for the robot control motor cannot be sterilized using conventional methods, such as steam, heat and pressure or chemical methods, because the system components can be damaged or destroyed during the sterilization process.

The surgical manipulator has previously been draped with a sterile drape and has previously included a hole through which an adapter enters the sterile field (e.g., a wrist unit adapter or a cannula adapter). However, this disadvantageously requires the adapter to be detached and sterilized after each procedure, and also has a greater potential for causing contamination when passing through the drape aperture.

Also, with the sterile drape design of existing multi-arm surgical robotic systems, each individual arm of the system is covered, but such a design is not suitable for single port systems, especially when all instrument actuators are moved together by a single slave manipulator.

Accordingly, what is needed are improved telerobotic systems, devices, and methods for remotely controlling surgical instruments at a surgical site on a patient. In particular, these systems, devices and methods should be configured to minimize the need for sterilization, thereby increasing cost effectiveness and protecting the system and surgical patient. In addition, these systems, devices, and methods should be designed to minimize instrument exchange time and difficulty in a surgical procedure while providing accurate interfacing between the instruments and the manipulator. Moreover, these systems and methods should be configured to minimize form factors in order to provide the surgical personnel with the most efficient space at the access port while also providing an improved range of motion. Moreover, these systems, devices, and methods should provide for organizing, supporting, and efficiently manipulating multiple instruments through a single port while reducing collisions between the instruments and other devices.

Disclosure of Invention

The present disclosure provides improved surgical systems, devices, and methods for telerobotic surgery. According to one aspect, the systems, devices, and methods provide at least one remotely manipulated surgical instrument at the distal end of a draped instrument manipulator and manipulator arm with an accurate and robust interface, and also provide easy instrument exchange and enhanced instrument manipulation, each surgical instrument working independently of the other, and each surgical instrument having at least 6 actively/actively controlled degrees of freedom end effectors in cartesian space (i.e., back and forth movement, up and down movement, left and right movement, roll, pitch, yaw).

In one embodiment, a sterile drape includes a plurality of drape bags, each of the drape bags including an exterior surface and an interior surface, wherein the exterior surface is adjacent to a sterile field for performing a surgical procedure and the interior surface is adjacent to a non-sterile instrument manipulator connected to a manipulator arm of a robotic surgical system. The drape further includes a plurality of flexible membranes at a distal face of each of the drape pockets for interfacing between an output of an instrument manipulator and an input of a corresponding surgical instrument; and a rotatable seal adapted to connect the proximal opening of each of the drape bags to the rotatable element at the distal end of the manipulator arm.

In another embodiment, a robotic surgical system for performing a surgical procedure within a sterile field includes: a manipulator arm having an instrument manipulator in a non-sterile region; a surgical instrument in the sterile field; and a sterile drape covering the manipulator arm to shield the manipulator arm from a sterile field, the sterile drape comprising the elements as described above.

In yet another embodiment, a method of draping a manipulator arm of a robotic surgical system with a sterile drape includes: positioning a flexible membrane of a sterile drape adjacent an output at a distal end of an instrument manipulator; and draping the instrument manipulator with a drape bag of the sterile drape from a distal end of the instrument manipulator to a proximal end of the instrument manipulator. The method further includes connecting a rotatable seal of a sterile drape to a frame of the manipulator arm and a rotatable base plate of the manipulator arm, and covering a remainder of the manipulator arm from a distal end of the manipulator arm to a proximal end of the manipulator arm.

A more complete understanding of embodiments of the present disclosure will be afforded to those skilled in the art, as well as a realization of additional advantages thereof, by a consideration of the following detailed description of one or more embodiments. The accompanying drawings are first briefly described.

Drawings

Fig. 1A and 1B show schematic views of a patient side support assembly in a teleoperated surgical system with and without a sterile drape, respectively, according to an embodiment of the present disclosure.

FIG. 2A shows a diagrammatic perspective view of an embodiment of a teleoperated surgical system with a sterile drape and mounting apparatus.

Fig. 2B and 2C show side and top views, respectively, of the teleoperated surgical system of fig. 2A without showing a sterile drape.

Fig. 3 illustrates a perspective view of an embodiment of a manipulator base platform, instrument manipulator cluster, and mounted instrument.

Fig. 4A and 4B illustrate perspective views of the instrument manipulator extending and retracting along the insertion axis, respectively.

Fig. 5A-1 and 5B-1 illustrate the operation of the support hook connecting the proximal face of the instrument transmission to the distal face of the instrument manipulator, and fig. 5A-2 and 5B-2 illustrate cross-sectional views of fig. 5A1 and 5B1, respectively.

Fig. 5C-1 through 5C-4 illustrate different views of the instrument manipulator without the housing.

Fig. 6A-6B illustrate different views of a clamp module of an instrument manipulator according to an embodiment of the present disclosure.

Fig. 7A illustrates an instrument manipulator gimbal actuator module view according to an embodiment of the present disclosure.

Fig. 7B illustrates a rolling module view of an instrument manipulator according to an embodiment of the present disclosure.

Fig. 8 illustrates a telescopic (telescopic) insertion axis view of an instrument manipulator according to an embodiment of the present disclosure.

Fig. 9A and 9B illustrate perspective views of proximal and distal portions, respectively, of an instrument configured to be mounted to an instrument manipulator.

Fig. 10 illustrates a cross-sectional view of an instrument manipulator operably coupled to an instrument according to an embodiment of the present disclosure.

11A-11B illustrate perspective views of a portion of a sterile drape in a retracted state and an extended state, respectively, according to an embodiment of the present disclosure.

FIG. 11C shows a cross-sectional view of a rotating sterile drape portion mounted to a distal end of a manipulator arm including a base platform according to an embodiment of the present disclosure.

FIG. 11D shows an unfolded sterile drape according to an embodiment of the present disclosure.

FIG. 12 shows a perspective view of an unfolded sterile drape portion including a sterile adapter, according to an embodiment of the present disclosure.

FIGS. 13A and 13B show a perspective view and an exploded view, respectively, of an assembled sterile drape adapter, according to an embodiment of the present disclosure.

Fig. 13C shows an enlarged view of a rolling actuator interface according to an embodiment of the present disclosure.

Fig. 14A and 14B illustrate bottom perspective and bottom views of an instrument manipulator according to an embodiment of the present disclosure.

Fig. 15 illustrates a bottom perspective view of an instrument manipulator operably coupled to a sterile adapter according to an embodiment of the present disclosure.

Fig. 16A-16E illustrate a sequence of connecting an instrument manipulator and a sterile adapter according to an embodiment of the present disclosure.

Fig. 17A-17C illustrate a sequence of connecting a surgical instrument to a sterile adapter according to an embodiment of the present disclosure.

Fig. 18A and 18B show an enlarged perspective view and a side view, respectively, of an instrument and a sterile adapter prior to engagement.

Fig. 19A and 19B show perspective views of the movable sleeve mount in a retracted position and an extended position, respectively.

Fig. 20A and 20B illustrate front and rear perspective views of a ferrule mounted on a ferrule holder, according to an embodiment.

Fig. 21 shows a perspective view of the cannula in isolation.

Fig. 22 illustrates a cross-sectional view of the cannula of fig. 21 and the installed entry guide of fig. 23A and 23B incorporating the instrument of the instrument manipulator installed on the manipulator platform, in accordance with an embodiment of the present disclosure.

Fig. 23A and 23B show perspective and top views of the entry guide of fig. 22.

Fig. 24 illustrates another cannula and another installed entry guide in cross-section view incorporating an instrument of an instrument manipulator installed on a manipulator platform according to an embodiment of the present disclosure.

24A-24B show perspective views of another moveable collar mounting arm in a retracted position and an extended position, respectively.

Fig. 24C shows a cannula proximal tip in accordance with another embodiment.

FIG. 24D illustrates a cannula clamp at the distal end of the cannula mounting arm according to another embodiment.

Fig. 25A-25C, 26A-26C, and 27A-27C illustrate different views of a surgical system with an instrument manipulator assembly roll axis or instrument insertion axis pointing in different directions.

Fig. 28 shows a schematic diagram of a centralized motion control system for a minimally invasive teleoperated surgical system, according to an embodiment.

Fig. 29 shows a schematic diagram of a distributed motion control system for a minimally invasive teleoperated surgical system, according to an embodiment.

Fig. 30A-30B illustrate different views of a balancing link of a robotic surgical system, according to an embodiment.

Fig. 31 shows a view of a balance link without an outer housing, according to an embodiment.

Fig. 32A and 32B illustrate bottom perspective and cross-sectional views, respectively, of a distal portion of a balancing link, according to an embodiment.

Fig. 33 shows a side view of a distal portion of a balancing link without an end plug, fig. 34 shows an enlarged perspective view of an end plug linear guide, and fig. 35 shows a perspective view of an adjustment pin according to aspects of the present disclosure.

Fig. 36A-36C show side cross-sectional views of the range of motion of the adjustment pin moving the end plug relative to the linear guide according to aspects of the present disclosure.

Fig. 37A-37C show detailed views of balancing the distal end of the proximal link according to aspects of the present disclosure.

Embodiments of the present disclosure and their advantages are best understood by referring to the detailed description that follows. It should be understood that like reference numerals are used to identify like elements in one or more of the figures. It should also be understood that the figures are not necessarily drawn to scale.

Detailed Description

The description and drawings illustrating aspects and embodiments of the disclosure should not be taken to be limiting of the invention. Various mechanical, compositional, structural, electrical, and operational changes may be made without departing from the spirit and scope of this specification. In some instances, well-known circuits, structures and techniques have not been shown in detail in order not to obscure the disclosure. Like reference symbols in two or more drawings indicate like or similar elements.

Furthermore, the terminology of the description is not intended to be limiting of the disclosure. For example, spatially relative terms, such as "below …," "below …," "lower," "above …," "upper," "proximal," "distal," and the like, may be used to describe one element or feature's relationship to another element or feature as illustrated. These spatially relative terms are intended to encompass different positions and orientations 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 oriented "above" or "over" the other elements or features. Thus, the exemplary term "below …" can encompass positions and orientations above … and above …. The device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly. Similarly, descriptions of movement along and about various axes include various specific device positions and orientations. In addition, the singular forms "a", "an" and "the" include plural referents unless the context clearly dictates otherwise. And the terms "comprises," "comprising," "includes" and/or 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 connected may be directly connected, electrically or mechanically, or they may be indirectly connected via one or more intermediate components.

In one example, the term "proximal" or "proximal" is used generally to describe an object or element that is closer to the manipulator arm base along the kinematic chain of system motion or further from the remote center of motion (or surgical site) along the kinematic chain of system motion. Similarly, the terms "distal" or "distal" are generally used to describe objects or elements that are further away 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.

It is known to control a robotic slave device with an operator input at a master device and to perform work at a work site. Such systems are known by various names, such as teleoperated, or telerobotic systems. One type of teleoperated system provides the operator with a sense of being at the work site, for example such a system is known as a telepresence system. Da Vinci, sold by Intuitive Surgical Inc. of Sunnyvale, Calif. (Intuitive Surgical Inc.)The surgical system is an example of a teleoperated system with telepresence. The basic principles of telepresence of such a surgical system are disclosed in U.S. patent No. 6574355 (filed 3/21/2001), which is incorporated herein by reference. A teleoperated surgical system (with or without telepresence features) may be referred to as a teleoperated surgical system.

To avoid repetition of the various aspects and illustrative embodiments in the following figures and description, it should be understood that many features are common to many aspects and embodiments. Omission of a description or drawing aspect does not imply that embodiments incorporating this aspect omit this aspect. Rather, this aspect is omitted for clarity and to avoid lengthy description. Thus, aspects described with reference to one depicted and/or described embodiment may exist or be applied to other depicted and/or described embodiments unless it is impractical to do so.

Accordingly, several general aspects apply to the various descriptions that follow. Various surgical instruments, guide tubes, and instrument assemblies suitable for use in the present disclosure are further described in U.S. patent application No.11/762165 (filed 6/13 2007; U.S. patent application publication No. US2008/0065105a1), which is incorporated herein by reference. A single surgical instrument or a surgical instrument assembly including a guide tube, multiple instruments, and/or multiple guide tubes is suitable for use in the present disclosure. Thus, a variety of surgical instruments may be used, each operating independently of the other, and each having an end effector. In certain examples, the end effector operates in at least 6 actively controlled DOF (i.e., back and forth movement, up and down movement, left and right movement, roll, pitch, yaw) in cartesian space via a single access port in the patient. One or more additional end effector DOF may be applied to, for example, jaw movement of the end effector in a clamping or shearing instrument.

For example, at least one surgical end effector is shown or described in the various figures. The end effector is part of a minimally invasive surgical instrument or assembly (e.g., forceps/holder, needle driver, scissors, fulguration hook, stapler, clip applier/remover, etc.) that performs a particular surgical function. Many end effectors have a single DOF in themselves (e.g., grippers that open and close). The end effector may be attached to the surgical instrument body by a mechanism that provides one or more additional DOF, such as a "wrist" type mechanism. Examples of such mechanisms are shown in US6371952(Madhani et al, 28.6.1999) and US6817974(Cooper et al, 28.6.2002), both of which are incorporated herein by reference, and may be referred to as such as those commonly used in da VinciEndowrist of various intuitive surgical companies on 8mm and 5mm instruments of a surgical systemAnd (4) a mechanism. While the surgical instruments described herein generally include end effectors, it should be understood that in some aspects the end effectors may be omitted. For example, a blunt distal tip of the instrument body shaft may be used to retract/contract tissue. As another example, a suction or irrigation opening may be present at the distal tip of the body shaft or wrist mechanism. In these aspects, it should be understood that the description of positioning and orienting the end effector includes positioning and orienting of a surgical instrument tip without an end effector. For example, descriptions that recite an end effector tip reference frame should be read to include references that do not have an endA frame of reference of a tip of a surgical instrument of the end effector.

Throughout the specification, it will be understood that a single stereoscopic imaging system or a stereoscopic imaging system/image acquisition component/camera device may be placed at the distal end of the instrument, whether the end effector is shown or described (the device may be considered a "camera instrument"), or it may be placed near or at the distal end of any guide tube or other instrument assembly element. Thus, the terms "imaging system" and the like as used herein should be broadly construed to include image acquisition components and combinations of image acquisition components and their associated circuitry and hardware within the context of the aspects and embodiments described. Such endoscopic imaging systems (e.g., optical, infrared, ultrasound, etc.) include systems with distally located image sensing chips and associated circuitry that relays acquired images to the exterior of the body via a wired or wireless connection. Such endoscopic imaging systems also include systems that relay acquired images to the outside of the body (e.g., by using rod lenses or optical fibers). In some instruments or instrument assemblies, a direct view optical system (direct view of the endoscopic image at the eyepiece) may be used. An example of a distally positioned semiconductor stereoscopic imaging system is described in U.S. patent application No.11/614661 (published by Shafer et al, "stereoscopic endoscopy" on 21.12.2006), which is incorporated herein by reference. For clarity, well-known endoscopic imaging system components (such as electrical and fiber optic illumination connections) are omitted or symbolically represented. Illumination for endoscopic imaging is generally represented in the figures by a single illumination port. It should be understood that these representations are exemplary. The size, location and number of illumination ports may vary. The illumination ports are typically disposed on multiple sides of or completely around the imaging aperture(s) in order to minimize deep shadows.

In this specification, a cannula is typically used to prevent a surgical instrument or guide tube from rubbing against the patient's tissue. Cannulas may be used for incisions and natural orifices. For situations where the instrument or guide tube does not translate or rotate frequently relative to its insertion (longitudinal) axis, a cannula may not be used. For situations where insufflation is required, the cannula may include a seal to prevent leakage of excess insufflation gas through the instrument or guide tube. An example of a cannula assembly that supports insufflation and procedures requiring insufflation of gas at a surgical site can be found in U.S. patent application No.12/705439 (filed 2/12 2010; published as "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 procedures that do not require insufflation, the cannula seal may be omitted, and the cannula itself may be omitted if the instrument or guide tube insertion axis movement is minimal. In certain configurations of instruments inserted relative to the guide tube, the rigid guide tube may function as a cannula. The cannula and guide tube may be, for example, steel or molded plastic. Plastics that are less expensive than steel may be suitable for disposable use.

Various examples and assemblies of flexible surgical instruments and guide tubes are shown and described in the above-referenced U.S. patent application No. 11/762165. In this specification, this flexibility is achieved in various ways. For example, a segment of an instrument or guide tube may be a continuously curved flexible structure, such as one segment of a tube based on a helically wound coil or based on the removal of various segments (e.g., a slit-type cut). Alternatively, the flexible portion may be comprised of a series of short, pivotally connected segments ("vertebrae") that provide a serpentine-like continuous curved structure. The instrument and guide tube structures may include those described in U.S. patent application publication No. US2004/0138700 (filed 12/2/2003 by Cooper et al), which is incorporated herein by reference. For clarity, the drawings and associated description generally show only two sections of the instrument and guide tube, termed proximal (closer to the drive mechanism; further from the surgical site) and distal (further from the drive mechanism; closer to the surgical site). It will be appreciated that the instrument and guide tube may be divided into three or more segments, each segment being rigid, passive/passive or active/active flexible. For the sake of clarity, the flexibility and bending for the distal section, the proximal section or the entire mechanism also apply to the intermediate section which has been omitted. For example, the intermediate section between the proximal and distal sections may be curved in a simple or compound curve manner. The flexible segments may be of various lengths. The smaller outer diameter segment may have a smaller minimum radius of curvature than the larger outer diameter segment. For cable control systems, unacceptably high cable friction or binding limits the minimum radius of curvature and overall bend angle when bending. The minimum bend radius of the guide tube (or of any joint) is such that it does not kink or otherwise inhibit smooth movement of the internal surgical instrument mechanism. The flexible member may be, for example, up to about 4 inches in length and about 0.6 inches in diameter. Other lengths and diameters (e.g., shorter, smaller) and degrees of flexibility of a particular mechanism may be determined by the target anatomy for which the mechanism is specifically designed.

In certain instances, only the distal section of the instrument or guide tube is flexible and the proximal section is rigid. In other examples, the entire section of the instrument or guide tube within the patient is flexible. In still other examples, the distal-most segment may be rigid and one or more other proximal segments are flexible. The flexible segments may be passive/passive or they may be actively/actively controllable ("steerable"). Such active control may be accomplished using, for example, opposing sets of cables (e.g., one set controlling "pitch" and a vertical set controlling "yaw"; similar actions may be accomplished using three sets of cables). Other control elements may be used, such as small electrical or magnetic actuators, shape memory alloys, electroactive polymers ("artificial muscles"), pneumatic or hydraulic bellows or pistons, and the like. In instances where the instrument or guide tube segment is located wholly or partially within another guide tube, various combinations of passive and active flexibility may exist. For example, an active flexible instrument in a passive flexible guide tube may exert sufficient lateral force to bend the surrounding guide tube. Similarly, an active flexible guide tube may bend a passive flexible instrument therein. The active flexible segments of the guide tube and the instrument may work in concert. For instruments and guide tubes that are both flexible and rigid, control cables located away from the central longitudinal axis may provide mechanical advantage over cables located closer to the central longitudinal axis, depending on compliance considerations of various designs.

The compliance (stiffness) of the flexible segment can be changed from being almost completely relaxed (there is little internal friction) to being substantially rigid. In certain aspects, the compliance is controllable. For example, a segment or all flexible segments of an instrument or guide tube may be made substantially (i.e., effectively but not infinitely) rigid (a segment is "rigidizable" or "lockable"). The lockable segment can be locked in a straight, simple curve or compound curve shape. Locking may be accomplished by applying tension to one or more cables extending longitudinally along the instrument or guide tube sufficient to create friction against movement of the adjacent vertebrae. One or more cables may extend through a large central hole in each vertebra or may extend through smaller holes near the outer circumference of the vertebra. Alternatively, the drive elements of one or more motors that move one or more control cables may be soft locked in position (e.g., by servo control) to hold the cables in position to prevent movement of the instrument or guide tube, thus locking the vertebrae in place. The motor drive element is held in place to effectively hold the other movable instrument and guide tube components in place as well. It will be appreciated that the stiffness under servo control, although effective, is generally less than with the stiffness obtained from a brake directly on the joint, such as a brake used to hold a passively set joint in place. The cable stiffness is usually dominant because it is usually less than the stiffness of the servo system or brake joints.

In some cases, the compliance of the flexible segment may be continuously varied between relaxed and rigid states. For example, the tension of the locking cables may be increased to increase stiffness without locking the flexible segments in a rigid state. Such intermediate compliance may allow for teleoperated surgery while reducing tissue trauma that may occur due to movement caused by surgical site forces. Suitable bending sensors incorporated into the flexible section allow the telesurgical system to determine the position of the instrument and/or guide tube as it bends. Fiber optic position shape sensing devices and methods are disclosed in U.S. patent application publication No. US2006/0013523(Childers et al, 2005-7-13), which is incorporated herein by reference. U.S. patent application No.11/491384(Larkin et al, 26.7.2006) discloses a fiber optic bend sensor (e.g., a fiber bragg grating) for such segment and flexible device control, which is incorporated herein by reference.

The surgeon input for controlling the minimally invasive surgical instrument assembly, instrument, end effector, and manipulator arm configuration as described herein is typically accomplished using an intuitive, camera-referenced control interface. For example, da VinciThe surgical system includes a surgeon console with such a control interface, which can be modified to control the various aspects described herein. The surgeon manipulates one or more master manual input mechanisms having, for example, 6 DOF, in order to control the slave instrument assembly and the instrument. The input mechanism includes a finger operated gripper that controls one or more end effector DOF (e.g., closing a gripping jaw). Intuitive control is provided by orienting the relative positions of the end effector and the endoscopic imaging system by the position of the surgeon input mechanism and the image output display. This orientation allows the surgeon to manipulate the input mechanisms and end effector controls if the surgical work site is viewed in a substantially realistic presentation. This teleoperation is truly present meaning that the surgeon views the image from an angle as if the operator were looking directly at and working at the surgical site. Further information on reference control of a camera in a minimally invasive surgical device is contained in US6671581 (filed by Niemeyer et al, 6/5 2002), which is incorporated herein by reference.

Single port surgical system

Reference is now made to fig. 1A and 1B, which illustrate side and front views of aspects of a robotically-assisted (teleoperated) minimally invasive surgical system that uses aspects of the minimally invasive surgical instruments, instrument assemblies, and steering and control systems described herein. The three main components are an endoscopic imaging system 102, a surgeon console 104 (master) and a patient side support system 100 (slave), all interconnected as shown by a wired (electrical or optical) or wireless connection 106. One or more electronic data processors may be variously located in these main components to provide system functionality. Examples are disclosed in the above-referenced U.S. patent application No. 11/762165. A sterile drape 1000, shown in phantom, advantageously covers at least a portion of patient-side support system 100 to maintain a sterile field during a surgical procedure, while providing effective and simple instrument exchange and accurate interfacing between instruments and their associated manipulators.

The imaging system 102 performs image processing functions, for example, on acquired surgical site endoscopic imaging data and/or pre-operative or real-time image data of other imaging systems external to the patient. The imaging system 102 outputs processed image data (e.g., an image of the surgical site and associated control and patient information) to a surgeon at a surgeon console 104. In some aspects, the processed image data is output to an optional external monitor visible to other operating room personnel or to one or more locations remote from the operating room (e.g., a surgeon at another location may monitor the video; live video may be used for training; etc.).

The surgeon console 104 includes, for example, a multi-DOF mechanical input ("master") device and an imaging system ("slave") device that allow the surgeon to manipulate the surgical instruments and guide tubes described herein. In certain aspects, these input devices provide tactile feedback from the instruments and instrument assemblies to the surgeon. The console 104 also includes a stereoscopic video output display positioned such that the images on the display are generally centered at a distance: this distance corresponds to the surgeon's hand working behind/below the display screen. These aspects are more fully discussed in US6671581, which is incorporated herein by reference.

Control during insertion may be achieved, for example, by the surgeon actually moving the image with one or both masters; the surgeon, using the master controller, moves the image left and right and pulls it toward itself, thus commanding the imaging system and its associated instrument assembly (e.g., flexible guide tube) 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 master is fixed to the image so that the image moves in the same direction as the master handle moves. This design forces the master to control the instrument in the correct position when the surgeon exits the camera control, thus it avoids the need to grasp (disengage), move, and disengage (engage) the master to return to the position prior to starting or resuming instrument control. In certain aspects, the master position may be proportional to the insertion speed, thereby avoiding the use of large master workspaces. Alternatively, the surgeon may grasp (clutch) and disengage (clutch) the master in order to employ a progressive insertion motion. In certain aspects, insertion may be manually controlled (e.g., via a manual wheel) and then automatically inserted (e.g., a servomotor driven roller) as the distal end of the surgical instrument assembly approaches the surgical site. Preoperative and real-time image data (e.g., MRI, X-ray) of the patient anatomy and space useful for the insertion trajectory may be used to assist in insertion.

The patient side support system 100 includes a floor mounted base 108 or, alternatively, a ceiling mounted base 110 shown by an alternate line. The base is movable or fixed (e.g., fixed to the ground, ceiling, wall, or other device such as an operating table).

The base 108 supports the arm assembly 101. the arm assembly 101 includes a passive/passive uncontrolled "setup" (setup) portion and an active/active controlled "manipulator" portion. In one example, the setup portion includes two passive rotational "setup" joints 116 and 120 that allow manual positioning of the connected setup links 118 and 122 when the joint brakes are released. A passive prismatic setting joint (not shown) between the arm assembly and the base connected to the linkage 114 may be used to allow for large vertical adjustment 112. Alternatively, some of these setup joints may be actively controlled, and more or fewer setup joints may be used in various configurations. The provision of joints and linkages allows one to place the robotic manipulator portion of the arm in various positions and orientations in cartesian x, y, z space. The remote center of motion is the location where the yaw, pitch, and roll axes intersect (i.e., the location where the kinematic chain remains effectively stationary as the joints move through their range of motion). As described in detail below, some of the actively controlled joints are robotic manipulators associated with controlling DOF of various surgical instruments, and others of the actively controlled joints are associated with controlling DOF of individual assemblies of the robotic manipulators. The active joints and linkages are movable by motors or other actuators and receive movement control signals associated with master arm movement at surgeon console 104.

As shown in fig. 1A and 1B, the manipulator assembly yaw joint 124 is coupled between the distal end of the setup link 122 and the proximal end of the first manipulator link 126. The yaw joint 124 allows the link 126 to move relative to the link 122 in any motion defined as "yaw" about the manipulator assembly yaw axis 123. As shown, the axis of rotation of the yaw joint 124 is aligned with a remote center of motion 146, which remote center of motion 146 is generally the location where instruments (not shown) enter the patient (e.g., at the umbilicus for laparoscopic surgery). In one embodiment, the setup link 122 is rotatable in a horizontal plane or x, y plane, and the yaw joint 124 is configured to allow the first manipulator link 126 to rotate about the yaw axis 123 such that the setup link 122, the yaw joint 124, and the first manipulator link 126 provide a constant vertical yaw axis 123 for the robotic arm assembly, as shown by the dashed vertical line from the yaw joint 124 to the remote center of motion 146.

The distal end of the first manipulator link 126 is connected to the proximal end of the second manipulator link 130, the distal end of the second manipulator link 130 is connected to the proximal end of the third manipulator link 134, and the distal end of the third manipulator link 134 is connected to the proximal end of the fourth manipulator link 138 by actively controlled rotational joints 128, 132, and 136, respectively. In one embodiment, the links 130, 134, and 138 are coupled together as a coupled kinematic mechanism. Linked kinematic mechanisms are well known (e.g., when the input and output link motions are held parallel to each other, such mechanisms are referred to as parallel kinematic linkages). For example, if rotary joint 128 is actively rotated, joints 132 and 136 are also rotated, causing link 138 to move to link 130 in a constant relationship. Thus, it can be seen that the axes of rotation of the joints 128, 132, and 136 are parallel. When these axes are perpendicular to the axis of rotation of joint 124, joints 130, 134, and 138 move with respect to link 126 in any motion defined as "pitch" about manipulator assembly pitch axis 139. Since, in one embodiment, links 130, 134, and 138 move as a single assembly, first manipulator link 126 may be considered an active proximal manipulator link, while second through fourth manipulator links 130, 134, and 138 may be collectively considered an active distal manipulator link.

A manipulator assembly platform 140 is connected to the distal end of the fourth manipulator link 138. Manipulator platform 140 includes a rotatable base plate that supports a manipulator assembly 142, which includes two or more surgical instrument manipulators described in detail below. The rotating base plate allows the manipulator assembly 142 to rotate as a single unit with respect to the platform 140 in any motion defined as "rolling" about the manipulator assembly roll axis 141.

For minimally invasive surgery, the instruments must remain substantially stationary relative to their position of entry into the patient's body (whether at the incision or natural orifice) to avoid unnecessary tissue damage. Thus, yaw and pitch motions of the instrument shaft should be centered at a single position on the manipulator assembly roll axis or instrument insertion axis that remains relatively stationary in space. This position is called the remote centre of motion. For single port minimally invasive procedures, where all instruments (including camera instruments) must be accessed via a single small incision or natural orifice (e.g., at the umbilicus), all instruments must be moved about such a generally stationary remote center of motion. Thus, the center of remote motion of the manipulator assembly 142 is defined by the intersection of the manipulator assembly yaw axis 123 and the manipulator assembly pitch axis 139. The arrangement of links 130, 134 and 138 and joints 128, 132 and 136 is such that the remote center of motion 146 is located at the distal end of the manipulator assembly 142 and is of sufficient distance to allow the manipulator assembly to move freely relative to the patient. It can be seen that the manipulator assembly roll axis 141 also intersects the remote center of motion 146.

As described in detail below, surgical instruments are mounted on and actuated by each surgical instrument manipulator of manipulator assembly 142. The instruments are removable so that the various instruments can be interchangeably mounted on a particular instrument manipulator. In one aspect, one or more instrument manipulators may be configured to support and actuate a particular type of instrument, such as a camera instrument. A shaft of the instrument extends distally from the instrument manipulator. The shaft member extends through a common cannula placed in the access port into the patient (e.g., through the body wall or at a natural orifice). In one aspect, the entry guide is positioned within the cannula and each instrument shaft extends through a channel in the entry guide to provide additional support for the instrument shaft. The cannula is removably coupled to a cannula mount 150, which in one embodiment is coupled to a proximal end of the fourth manipulator link 138. In one implementation, the cannula mount 150 is connected to the link 138 by a rotational joint that allows the mount to move between a stowed position adjacent the link 138 and an operative position that holds the cannula in the correct position so that the remote center of motion 146 is at a position along the cannula. During surgery, according to one aspect, the cannula mount is fixed in position relative to the linkage 138. The instrument(s) may be slid through the entry guide and cannula assembly mounted to the distal end of the cannula mount 150, examples of which are explained in further detail below. Various passively and actively disposed joints/links allow positioning of the instrument manipulator to move the instrument and imaging system with a large range of motion while the patient is positioned on the movable table in various positions. In certain embodiments, the cannula mount can be connected to the proximal or first manipulator link 126.

Some of the arrangements in the manipulator arm and the active joints and links may be omitted in order to reduce the size and shape of the robot, or the joints and links may be added in order to increase the degrees of freedom. It should be understood that the manipulator arm may include various combinations of links, passive/passive joints, and active/active joints (which may provide redundant DOF) in order to achieve the necessary pose ranges for the procedure. Moreover, various surgical instruments alone or instrument assemblies including a guide tube, multiple instruments and/or multiple guide tubes, as well as 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) are suitable for use with aspects of the present disclosure.

Fig. 2A-2C are perspective, side and top views, respectively, of a patient side support cart 200 in a teleoperated surgical (teleoperated) system. The cart 200 is described as an example of the general configuration described above with reference to fig. 1A and 1B. The surgeon console and video system are not shown, but are adapted for use with a telerobotic surgical system architecture (e.g., da Vinci) as described and known in FIGS. 1A and 1BSurgical system architecture). In this embodiment, the cart 200 includes a floor-mounted base 208. The base may be movable or fixed (e.g., fixed to a floor, ceiling, wall, or other substantially rigid structure). The base 208 supports a support post 210, and the arm assembly 201 is connected to the support post 210. The arm assembly includes two passive rotational setting joints 216 and 220, which setting joints 216 and 220 allow manual positioning of the connected setting links 218 and 222 when their brakes are released. In the illustrated embodiment, the links 218 and 222 are arranged to move in a horizontal plane (parallel to the ground). The arm assembly is connected to the support column 210 at a passive slide set joint 215 between the support column 210 and the vertically set link 214. The joints 215 allow the manipulator arm to be adjusted vertically (perpendicular to the ground). Accordingly, passively setting the joints and links can be used to properly position the remote center of motion 246 with respect to the patient. Once the remote center of motion 246 is properly positioned, the stops at each of the joints 215, 216, and 220 are configured to prevent the set portion of the arm from moving.

Further, the arm assembly includes active joints and links for manipulator arm configuration and movement, instrument manipulation, and instrument insertion. The proximal end of the first manipulator link 226 is connected to the distal end of the setup link 222 via an actively controlled rotary manipulator assembly yaw joint 224. As shown, the rotational manipulator assembly yaw axis 223 of the yaw joint 224 is aligned with the remote center of motion 246, as indicated by the vertical dashed line from the yaw joint 224 to the remote center of motion 246.

The distal end of first manipulator link 226 is coupled to the proximal end of second manipulator link 230, the distal end of second manipulator link 230 is coupled to the proximal end of third manipulator link 234, and the distal end of third manipulator link 234 is coupled to the proximal end of fourth manipulator link 238 via actively controlled rotational joints 228, 232, and 236, respectively. As described above, the links 230, 234, and 238 serve as a link motion mechanism such that the fourth manipulator link 238 automatically moves in unison with the second manipulator link 230 when the link 230 is actuated. In the illustrated embodiment, a similar mechanism is disclosed in U.S. patent No. 7594912 (filed on 9/30 2004), which is modified for use (see also, for example, U.S. patent application No.11/611849 (filed on 12/15 2006; U.S. patent application publication No. US2007/0089557a 1)). Thus, the first manipulator link 226 may be considered an active proximal link, while the second through fourth links 230, 234, and 238 may be collectively considered an active distal link. In one embodiment, the first link 226 may include a compression spring counterbalance mechanism that equalizes the force of the distal link moving about the joint 228 as described below.

The manipulator assembly platform 240 is coupled to the distal end of the fourth link 238. The platform 240 includes a base plate 240a, and the instrument manipulator assembly 242 is mounted on the base plate 240 a. As shown in FIG. 2A, the platform 240 comprises a "halo" ring within which a disk-shaped base plate 240a rotates. Other configurations other than a halo and puck may be used in other embodiments. The center of rotation of the base plate 240a coincides with the manipulator arm roll axis 241 as shown by the dashed line extending through the center of the manipulator platform 240 and the center of remote motion 246. In one embodiment, instrument 260 is mounted to an instrument manipulator of manipulator assembly 242 on a distal side of the instrument manipulator.

As shown in fig. 2A and 2B, instrument manipulator assembly 242 includes four instrument manipulators 242A. Each instrument manipulator supports and actuates its associated instrument. In the illustrated embodiment, one instrument manipulator 242a is configured to actuate a camera instrument and three instrument manipulators 242a are configured to actuate various other interchangeable surgical instruments that perform surgical and/or diagnostic work at a surgical site. More or fewer instrument manipulators may be used. In some operating configurations, one or more manipulators do not necessarily have an associated surgical instrument during part or all of a surgical procedure. Instrument manipulators are disclosed in more detail below.

As mentioned above, surgical instruments 260 are mounted to and actuated by respective instrument manipulators 242 a. According to an aspect of the present disclosure, each instrument is mounted to its associated manipulator only at the proximal end of the instrument. As can be seen in fig. 2A, this proximal mounting feature keeps the instrument manipulator assembly 242 and support platform 240 as far away from the patient as possible, which allows the actively controlled portion of the manipulator arm to move freely with respect to the patient within a maximum range of motion for a given instrument geometry without impacting the patient. Instruments 260 are mounted such that their shafts are clustered about manipulator arm roll axis 241. Each shaft extends distally from the force transmission mechanism of the instrument, and all of the shafts extend into the patient through a single cannula disposed at the port. The cannula is removably held in a fixed position relative to the base plate 240a by a cannula mount 250, wherein the cannula mount 250 is coupled to the fourth manipulator link 238. A single guide tube is inserted into the cannula and is free to rotate therein, and each instrument shaft extends through an associated channel in the guide tube. The longitudinal axes of the cannula and guide tube coincide with the roll axis 241. Thus, as the base plate 240a rotates, the guide tube rotates within the sleeve. In certain embodiments, the cannula mount is operably connected to the first manipulator link 226.

Each instrument manipulator 242a is movably coupled to an active retractable insertion mechanism 244 (fig. 2B) and is used to insert and retrieve surgical instrument(s), wherein the active retractable insertion mechanism 244 is operably coupled to the base plate 240 a. Fig. 2A shows instrument manipulator 242A extending a distance distally of retractable insertion mechanism 244 (see also fig. 3 and 4A), and fig. 2B shows instrument manipulator 242 retracted proximally of retractable insertion mechanism 244 (see also fig. 4B). The active joints 224, 228, 232, 236 and the manipulator platform 240 move in unison and/or independently to move a surgical instrument (or assembly) around the remote center of motion 246 at an access port (e.g., the patient's umbilicus) after the remote center of motion 246 has been established by the passively placed arm and joint.

As shown in fig. 2A, the cannula mount 250 is coupled to the fourth link 238 near the proximal end of the fourth manipulator link. In other aspects, the cannula mount 250 can be coupled to another portion of the proximal link. As described above, the cannula mount 250 is hinged so that it can swing to a retracted position (stowed position) adjacent the fourth link 238 and to an extended position (as shown) to support the cannula. In operation, according to one aspect, cannula mount 250 is held in a fixed position relative to fourth link 238.

In one example, it can be seen that the illustrated embodiment of first manipulator link 226 is generally shaped as an inverted "L". The proximal leg of the "L" shaped link is connected to link 226 at a yaw joint 224 and the distal leg of the link is connected to a second manipulator link 238 at a rotation joint 228. In this illustrative embodiment, the two legs are generally vertical, and the proximal leg of the first manipulator link rotates about a plane that is perpendicular to the manipulator assembly yaw axis 223 (e.g., a horizontal (x, y) plane when the yaw axis is vertical). Thus, the distal leg extends generally parallel to the manipulator assembly yaw axis 223 (e.g., vertically (z) when the yaw axis is vertical). This shape allows the manipulator links 230, 234 and 238 to move below the yaw joint 224 such that the links 230, 234 and 238 provide a manipulator assembly pitch axis 239 that intersects the remote center of motion 246. Other configurations of the first link 226 are possible. For example, the proximal and distal legs of the first link 226 may not be perpendicular to each other, the proximal leg may rotate in a plane other than a horizontal plane, or the link 226 may have a shape that is not generally "L" shaped, such as an arc.

It can be seen that vertical yaw axis 223 allows link 226 to rotate substantially 360 degrees, as shown by dashed line 249 (fig. 2C). In one example, the manipulator assembly yaw rotation may be continuous, and in another example, the manipulator assembly yaw rotation is about ± 180 degrees. In yet another example, the manipulator assembly yaw rotation may be about 660 degrees. During such yaw axis rotation, pitch axis 239 may or may not remain constant. Since the instrument is inserted into the patient in a direction aligned with the manipulator assembly roll axis 241, the arms may be actively controlled to position and reposition the instrument insertion direction in any desired direction about the manipulator assembly yaw axis (see, e.g., fig. 25A-25C for instrument insertion directions toward the patient's head and fig. 26A-26C for instrument insertion directions toward the patient's foot). This function is clearly beneficial in certain procedures. In some abdominal procedures, instruments are inserted via a single port positioned in the umbilicus, for example, the instruments may be positioned proximate all four quadrants of the abdomen without requiring a new port to be opened in the patient's body wall. For example, lymph node access/approach through the abdomen may require multi-quadrant access/approach. In contrast, the use of multi-port telerobotic systems may require the placement of additional ports in the patient's body wall to more fully approximate the other abdominal quadrants.

Further, the manipulator may direct the instrument vertically downward and in a slightly pitched upward configuration (see fig. 27A-27C, which illustrate the pitched instrument insertion direction). Thus, the entry angle (yaw and pitch about the center of the distal end) of an instrument through a single access port can be easily manipulated and changed while providing increased space around the access port to facilitate patient safety and patient side worker manipulation.

Moreover, links 230, 234, and 238, along with active joints 228, 232, and 236, can be used to easily manipulate the entry pitch angle of an instrument through a single access port while creating space around the single access port. For example, the links 230, 234, and 238 may be positioned to have a form factor that is "arced away" from the patient. Such arc distancing allows rotation of the manipulator arm about the yaw axis 223 without causing a collision of the manipulator arm with the patient. Such arc distancing also allows patient side personnel to easily access the manipulator for exchanging instruments and the access port for inserting and manipulating manual instruments (e.g., manual laparoscopic instruments or retraction devices). In yet another example, the fourth link 238 has a form factor with an arc away from the center of motion and thus the arc away from the patient, allowing for greater patient safety. In other conditions, the working envelope of the cluster of instrument manipulators 242a may approximate a vertebral body with the vertebral body tip at the remote center of motion 246 and the vertebral body rounded end at the proximal end of the instrument manipulator 242 a. Such a working envelope results in less interference between the patient and the surgical robotic system, a greater range of system motion that allows improved access to the surgical site, and improved access to the patient by the surgical personnel.

Thus, the configuration and geometry of the manipulator arm assembly 201, along with its large range of motion, allows for multi-quadrant surgery through a single port. Through a single incision, the manipulator can guide the instrument in one direction and easily change direction; for example, work toward the patient's head or pelvis (see, e.g., fig. 25A-25C), and then change direction toward the patient's pelvis or head by moving the manipulator arm about a constant vertical deflection axis (see, e.g., fig. 26A-26C).

This illustrative manipulator arm assembly is used, for example, in an instrument assembly that is operable to move about a remote center of motion. Some of the setup joints and links and active joints and links in the manipulator arm may be omitted, 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 and active joints (which may provide redundant DOF) to achieve the necessary range of poses for the surgical procedure. Also, a variety of surgical instruments alone or instrument assemblies including guide tubes, multiple instruments and/or multiple guide tubes, as well as instruments connected to an instrument manipulator (actuator assembly) via various configurations (e.g., on a proximal or distal side of the actuator assembly or transmission mechanism) are suitable for use with the present disclosure.

Referring now to fig. 3, 4A-4B, 5A-1-5B-2, 5C-1-5C-4, and 8, aspects and embodiments of the instrument manipulator are described in greater detail without limiting the aspects and embodiments of the present disclosure. Fig. 3 illustrates a perspective view of an embodiment of a rotatable base plate 340a of the manipulator assembly platform, a cluster of four instrument manipulators 342 mounted on the base plate 340a to form an instrument manipulator assembly, and four instruments 360 (proximal portions shown), wherein each of the four instruments 360 is mounted on a distal face of an associated instrument manipulator 342. As described above, the base plate 340a is rotatable about the manipulator assembly roll axis 341. In one embodiment, the roll axis 341 extends through the longitudinal center of the cannula and the entry guide assembly through which the instrument 360 enters the patient's body. Roll axis 341 is also substantially perpendicular to a single plane of the distal face of each instrument manipulator 342, and thus substantially perpendicular to a single plane of the proximal face of the instrument mounted to the distal face of the instrument manipulator.

Each instrument manipulator 342 includes an insertion mechanism 344 coupled to the base plate 340 a. FIG. 8 illustrates a cutaway perspective view of an embodiment of an instrument insertion mechanism in more detail. As shown in fig. 8, the instrument insertion mechanism 844 includes three links that slide linearly with respect to one another in a telescoping manner. The insertion mechanism 844 includes the carriage 802, the carriage link 804, and the base link 808. Slide carriage link 804 slides along base link 808 and slide carriage 802 slides along slide carriage link 804 as described in U.S. patent application No.11/613800 (filed on 20/12/2006; U.S. patent application publication No. US2007/0137371a1, which is incorporated herein by reference). The slider 802 and the links 804, 808 are interconnected by a connecting ring 806 (which in one example comprises one or more flexible metal bands; alternatively, one or more cables may be used). A lead screw 808a in a base link 808 drives a slide 808b, which slide 808b is attached to a fixed position on the connection ring 806. The slider 802 is also connected to the connection ring 806 in a fixed position such that the slider 808b slides a certain distance x with respect to the base link 808 and the slider 802 slides 2x with respect to the base link 808. In alternative implementations of the insertion mechanism, various other linear motion mechanisms (e.g., lead screw and carriage) may be used.

As shown in fig. 3 and 8, the proximal end of the base link 808 is connected to the rotatable base plate 340a, and the sled 802 is connected to the outer shell or inner frame of the instrument manipulator 342 (e.g., within the inner frame aperture 542 i' of fig. 5C-1 to 5C-3). A servo motor (not shown) drives the lead screw 808a, resulting in proximal and distal movement of the instrument manipulator 342 relative to the base plate 340a in a direction generally parallel to the roll axis 341. Since the surgical instrument 360 is connected to the manipulator 342, the insertion mechanism 344 functions to insert and remove the instrument through the cannula to and from the surgical site (instrument insertion DOF). A flat conductive compliance cable (not shown) extending adjacent the attachment ring provides power, signals and ground to the instrument manipulator.

It can be seen that the telescoping feature of insertion mechanism 344 is advantageous in that it provides a greater range of motion when the instrument manipulator is moved from its fully proximal position to its fully distal position (see, e.g., fig. 4A (fully distal position) and 4B (fully proximal position)) compared to using only a single stationary insertion stage, which has a smaller extension of the insertion mechanism when the manipulator is in its fully proximal position. The shortened extension prevents the insertion mechanism from interfering with the patient and the operating room staff during the surgical procedure (e.g., during instrument changes) when the instrument manipulator is in its proximal position.

As further shown in fig. 3, in one embodiment, the telescoping insertion mechanisms 344 are symmetrically mounted to the rotatable base plate 340a such that the instrument manipulators 342 and the mounted instruments 360 are symmetrically clustered about the roll axis 341. In one embodiment, instrument manipulator 342 and its associated instrument 360 are arranged about the roll axis in a generally fan-shaped (pie-wedge) arrangement with the instrument shaft positioned closer to manipulator assembly roll axis 341. Thus, as the base plate rotates about the roll axis 341, the cluster of instrument manipulators 342 and the mounted instruments 360 also rotate about the roll axis.

Fig. 4A and 4B show perspective views of the instrument manipulator 442 in extended and retracted positions, respectively, along an insertion mechanism 444 mounted to the rotatable base plate 440 a. As described above, the instrument manipulator 442 is capable of extending and retracting along the longitudinal axis of the insertion mechanism 444 between the base plate 440a and the insertion mechanism free distal end 444a, as indicated by the double-headed arrow adjacent the insertion mechanism 444. In this illustrative embodiment, the instrument is mounted against distal face 442a of instrument manipulator 442.

Distal face 442a includes various actuation outputs that transmit actuation forces to the installation instrument. As shown in fig. 4A and 4B, such actuation outputs may include a grip output lever 442B (controlling the gripping motion of the instrument end effector), a waggle output gimbal 442c (controlling the distal parallel linkage left-right and up-down motion ("waggle" or "elbow" mechanism)), a wrist output gimbal 442d (controlling the instrument end effector yaw and pitch motions), and a roll output disk 442e (controlling the instrument roll motion). Details of such outputs, as well as associated components of instrument force transmission mechanisms receiving such outputs, may be found in U.S. patent application No.12/060104 (filed 3/31, 2008; U.S. patent application publication No. US2009/0248040a1), which is incorporated herein by reference. An illustrative proximal example of a surgical instrument that can receive such input can be found in U.S. patent application No.11/762165, which has been mentioned above. Briefly, left-right and up-down DOFs are provided by a distal parallel linkage, end effector yaw and end effector pitch DOFs are provided by a distal flexible wrist mechanism, an instrument roll DOF is provided by rolling an instrument shaft while maintaining an end effector in a substantially constant position and pitch/yaw orientation, and an instrument grip DOF is provided by two relatively movable end effector jaws. Such DOFs are illustratively more or fewer DOFs (e.g., in certain implementations, the camera instrument omits instrument roll and grip DOFs).

To facilitate mounting of the instrument against the distal face of the instrument manipulator, a support (e.g., support hook 442f) is positioned on the instrument manipulator. In the illustrated embodiment, the support hook is stationary with respect to the main housing of the instrument manipulator, and the distal face of the instrument manipulator moves proximally and distally to provide a secure interconnection between the instrument manipulator and the instrument. Latch mechanism 442g is used to move the distal face of the instrument manipulator toward the proximal face of the instrument. In an alternative embodiment, a latch mechanism may be used to move the instrument proximal face toward the manipulator distal face to engage or disengage the manipulator output and the instrument input.

Fig. 5A-1 and 5B-1 show perspective views of an exemplary architecture of instrument manipulator 542. FIGS. 5A-2 and 5B-2 are cross-sectional views of FIGS. 5A-1 and 5B-1, respectively, taken along cut lines I-I and II-II. As shown, the manipulator includes an inner frame 542i that is movably connected to an outer shell 542h, such as by sliding joints, rails, or the like. As a result of the action of latch mechanism 542g, inner frame 542i moves distally and proximally with respect to outer shell 542 h.

Reference is now made to fig. 5A-1 and 5B-2, which illustrate the operation of support hook 542f and latch mechanism 542g to mount an instrument (not shown) to instrument manipulator 542. As shown, the distal face 542a of the instrument manipulator 542 is substantially a single plane and is operably coupled to a proximal face of an instrument force transmission mechanism (e.g., the proximal face 960' of the instrument 960 in fig. 9A-9B). Latch mechanism 542g may include an actuation mechanism, such as a pulley and wire, to move the inner frame and outer shell of the instrument manipulator relative to one another and to hold distal surface 542a against the instrument when operated.

In the illustrated embodiment, instrument support hook 542f is rigidly mounted to instrument manipulator outer housing layer 542h, and when latch mechanism 542g is actuated, distal face 542a of instrument manipulator inner frame 542i moves distally toward the distal end of support hook 542f and away from proximal face 542j of instrument manipulator outer housing layer. Thus, when the instrument force transmission mechanism is mounted on the support hooks 542f, the distal face 542a of the instrument manipulator moves toward the proximal face of the instrument force transmission mechanism, which is restrained by the support hooks 542f, to engage or otherwise operably interface the instrument manipulator output and the instrument force transmission input, as indicated by arrow a1 in fig. 5A-1 and 5A-2. As shown in this embodiment, the actuator output of the manipulator presses against and interfaces with the proximal face of the instrument to transmit instrument actuator signals to the instrument. When latch 542g is actuated in the opposite direction, distal face 542a of the instrument manipulator moves toward proximal face 542j of the instrument manipulator (i.e., away from the distal end of stationary support hook 542 f), thereby separating the instrument manipulator output from the instrument, as indicated by arrow a2 in fig. 5B-1 and 5B-2. An advantage of the illustrated embodiment is that when the latch mechanism is actuated, the actuator portion of the instrument manipulator moves relative to a stationary instrument fixed in space on the support hook. Movement of the instrument manipulator actuator toward or away from the instrument during a latching or tripping process minimizes unnecessary or unintended instrument motion. Thus, since the instrument does not move relative to the patient during the instrument installation procedure, potential damage to tissue is avoided since the distal end of the instrument remains stationary within the patient.

In an alternative embodiment, support hook 542f may be retracted toward proximal face 542j to move the proximal face of the instrument toward distal face 542a of the stationary instrument manipulator to engage the instrument manipulator output with the instrument input, as indicated by arrow B1 in fig. 5A-1 and 5A-2. When the latch is open or actuated in reverse, the process is reversed and the support hook 542f is moved away from the distal face 542a of the stationary instrument manipulator, thereby separating the instrument manipulator output from the instrument input, as indicated by arrow B2 in fig. 5B-1 and 5B-2.

Fig. 5C-1 through 5C-4 show different views of instrument manipulator 542 without outer shell layer 542h to reveal independent drive modules for actuating instrument manipulator outputs. The drive module is mounted in modular form to an inner frame 542i of the instrument manipulator, which moves with the drive module relative to an outer housing layer 542h and support hooks 542f of the instrument manipulator. When the latch is closed, the inner frame of the instrument manipulator moves a set distance toward the instrument and the spring-loaded module output passes through a sterile drape-engaging instrument input, which is described further below. When the latch is open, the process is reversed. The spring-loaded actuator drive module output provides a robust interfacing through the drape with the instrument force transmission input, which is described in more detail below.

As shown in the illustrated embodiment, instrument manipulator 542 includes a grip actuator drive module 542b 'for actuating grip output tension rods 542b, a sway actuator drive module 542 c' for actuating sway output gimbals 542c, a wrist actuator drive module 542d 'for actuating wrist output gimbals 542d, and a roll actuator drive module 542 e' for actuating roll disk 542 e. Outputs 542b, 542C, 542d, and 542e extend distally from a distal face 542a of instrument manipulator 542, as shown for example in fig. 5C-4. And they are adapted to engage instrument force transmission mechanism inputs to actuate mounted instrument X-Y translation and end effector grasping, pitch, yaw and roll motions.

Fig. 6A-6B are upper and lower perspective views of a grip actuator drive module 642B' of the instrument manipulator. The grip actuator drive module 642 b' includes a linear slide 602, a drive spring mechanism 604 including a spring 606, and a grip drive output link 642 b. The drive spring mechanism 604 is connected to the inner frame 542i of the instrument manipulator. When the latch 542g is actuated to engage the instrument, the inner frame moves and the grip drive module 642 b' moves along the linear slide 602 until the output pull rod 642b contacts its mating input on the instrument. This contact preloads spring 606 so that when the instrument is latched in place, the spring is loaded so that grip output 642b abuts the instrument input. Preloaded spring 606 then ensures that proper actuator drive output/input contact is maintained during operation so that no gaps are formed in the output/input contact that would make precise kinematic control difficult.

FIG. 7A illustrates a bottom perspective view of a gimbal drive module 742 c/d' of an instrument manipulator that can be used to provide yaw output gimbal control of X-Y translation of an instrument yaw mechanism or to provide wrist output gimbal control of pitch and yaw of an instrument end effector. In this embodiment, the gimbal drive module 742 c/d' includes a linear slide 702, a drive spring mechanism 704 including a spring 706, and an actuator output gimbal 742c/d on a gimbal pin 710. The drive spring mechanism 704 is connected to the inner frame 542i of the instrument manipulator. When the latch 542f is actuated to engage the instrument, the inner frame moves distally and the actuator drive module 742 c/d' moves along the linear slide 702 until the output gimbal 742c/d contacts its mating input on the instrument. This contact preloads spring 706 so that when the instrument is latched in place, the spring is loaded so that output gimbal 742c/d abuts the instrument input. With the gripping actuator drive module, the preloaded spring 606 then ensures that proper actuator drive output/input contact is maintained during operation so that no gaps are formed in the output/input contact that would make precise motion control difficult. The gimbal drive module 742 c/d' further includes two "dog bone" linkages 712, two ball screws 714, two motors 716, two hall effect sensors 718, and two rotary or linear motion encoders 720. A motor 716 drives an associated ball screw 714, which ball screw 714 actuates the dog bone link 712. The proximal end of the dog bone link 712 is connected to a linear slide 721, the linear slide 721 moves along an axis parallel to the ball screw 714. The distal end of dog-bone link 712 is connected to output gimbals 742c/d, each of which rotates about two orthogonal axes perpendicular to the longitudinal axis through gimbal pin 710. In one aspect, the gimbal of the drive module has two degrees of freedom, but no orthogonal axes.

Fig. 7B illustrates a bottom perspective view of a rolling actuator drive module 742 e' of the instrument manipulator that may be used to provide a rolling output disk that controls the rolling movement of the installation instrument. In this embodiment, the rolling actuator drive module 742 e' includes a motor 734 that drives a harmonic drive 736, which harmonic drive 736 in turn drives a spur gear 740. Spur gear 740 rotates rolling output disk 742e to drive the rolling input disk on the instrument. The encoder 732 is used to sense position and communicate with the motor 734. An absolute encoder 738 is connected to the scroll output disk 742e and senses the absolute position of the instrument roll.

In one aspect, the system driver modules are operably independent and sufficiently isolated from each other such that large forces applied through one interface output are not transferred to the other interface output. In other words, large forces through one interface output are not transmitted to the other interface output and therefore do not affect the instrument component actuated by the other interface output. In one aspect, the drive module and its respective actuator output are substantially free of unintended forces input from another drive module and/or its respective actuator output. This feature improves instrument handling and thus patient safety.

Fig. 9A and 9B show perspective views of proximal and distal portions 960a and 960B, respectively, of an instrument 960 configured to be mounted to the instrument manipulator of fig. 4A-4B and 5A-1 to 5C-4. The actuator proximal face 960' of the instrument 960 includes an instrument grip input rod 962b that interfaces with grip output rod 542b, an instrument swing input gimbal 962c that interfaces with swing output gimbal 542c, an instrument wrist input gimbal 962d that interfaces with wrist output gimbal 542d, and an instrument roll input disk 962e that interfaces with roll output disk 542 e. Fig. 9B illustrates an example of the distal end 960B of a flexible surgical instrument 960 that includes a wrist 964, a rocking mechanism 966, and an end effector 968. In one embodiment, the proximal face 960' of the transmission mechanism of the instrument 960 has a substantially single plane that operably interfaces with the distal face of the instrument manipulator when the manipulator output and instrument input are operably engaged. Further details of suitable distal and proximal portions of a Surgical Instrument, such as Instrument 960, are disclosed in U.S. patent application No.11/762165 entitled "minimally invasive Surgical System" filed by Larkin et al and U.S. patent application No.11/762154 entitled "Surgical Instrument With Parallel Motion Mechanism" filed by Cooper et al, both of which are incorporated herein by reference.

In the illustrative aspect shown in fig. 9A and 9B, the instrument 960 includes a drive section at its proximal end, an elongated instrument body, one of a variety of surgical end effectors 968, and a serpentine 2-degree-of-freedom wrist mechanism 964 that connects the end effector 968 to the yaw mechanism 966 and the instrument body. As in da VinciAs in surgical systems, in some aspects, the drive portion includes a disk that interfaces with an electrical actuator (e.g., a servo motor) permanently mounted on the support arm to facilitate easy changing of the instrument. Other linkages, such as mating gimbal plates and tie rods, may be used to transmit the actuation force at the mechanical interface. Mechanical mechanisms in the transmission part (e.g. gears)Pull rod, universal joint) transfers actuation forces from the puck to the plurality of cables, the plurality of wires and/or a cable, a wire, and a hypotube combination that extends through one or more channels (which may include one or more articulation segments) in the instrument body to control wrist 964 and end effector 970 movement. In certain aspects, one or more discs and their associated mechanisms transmit an actuation force that rolls the instrument body about its longitudinal axis. The main section of the instrument body is a substantially rigid single tube, although in some aspects it may be slightly resiliently flexible. This small flexibility allows the proximal body section of the guide tube (i.e., outside the patient) to be slightly flexed so that several instrument bodies can be more closely distributed within the guide tube than their individual drive section housings allow, as if several cut flowers of equal length were placed in a small vase. This flexion is minimal (e.g., less than or equal to about 5 degrees in one embodiment) and does not result in significant friction because the control cables and hypotube bend angles within the instrument body are small. In other words, in one embodiment, the instrument shaft may exit the force transmission mechanism distal end at a slight angle rather than normal to the force transmission mechanism distal or proximal face. The instrument shaft may then be slightly bent and continue to straighten to form a slight arc in the proximal portion of the instrument shaft, withdrawing the instrument shaft from the distal end of the force transmission mechanism. Thus, the instrument may have an instrument shaft with a proximal curved portion proximal to the guide tube and a distal straight portion. In one example, the instrument shaft may pitch about 0 degrees to about 5 degrees as it exits the distal end of the force transmission mechanism.

As shown in fig. 9A and 9B, instrument 960 includes a proximal body segment 968 (which extends through the guide tube in one example) and at least one distal body segment or wag mechanism 966 (which is positioned beyond the distal end of the guide tube in one example). For example, instrument 960 includes a proximal body section 968, a rocking mechanism 966 connected to proximal body section 968 at a joint 967, a wrist mechanism 964 (the connection may include another short distal body section) connected to rocking mechanism 966 at another joint 965, and an end effector 970. In certain aspects, the rocking mechanism 966 and joints 965 and 967 function as a parallel motion mechanism, wherein the reference frame position at the distal end of the instrument can be changed relative to the reference frame at the proximal end of the instrument without changing the distal reference frame orientation. Details of suitable parallel motion or rocking mechanisms including associated joints of available instruments are further disclosed in U.S. patent application No.11/762165, which is incorporated herein by reference.

Fig. 10 illustrates a cross-sectional side view of an instrument manipulator 542 operably coupled to an instrument 960 in accordance with aspects of the present disclosure. As shown in FIG. 10, actuator outputs 542b-542e on the distal side of the instrument manipulator 542 interface with actuator inputs 962b-962e on the proximal side of the surgical instrument 960.

Since the instrument end effector is provided with seven degrees of freedom (instrument insertion, grasping, 2 DOF wrist rotation, 2 DOF rocking (wrist translation), and instrument roll) to facilitate the surgical procedure, the requirements for instrument actuation accuracy are high, and a high fidelity, low gap interface between the instrument and the instrument manipulator is desired. Independently operating drive system modules (e.g., modules 542b ', 542 c', 542d ', and 542 e') of the instrument manipulator allows various drive trains to be attached to the surgical instrument through inexact manufacturing drapes without a performance compromise. Since the drive system modules are not connected to each other and are sufficiently isolated from each other, large forces exerted through one interface output are not transmitted to the other interface output. In other words, a large force passing through one interface output is not transferred to the other interface output. In one aspect, the drive module and its respective actuator output are substantially free of unintended forces input from another drive module and/or its respective actuator output. This feature provides for instrument handling and thus improved patient safety.

In one aspect, matching discs may be used for force transmission and actuation features, as with da VinciThe same applies to the surgical system instrument interface. In another aspect, matched gimbal plates and pull straps are usedA rod. Various mechanical components (e.g., gears, tie rods, cables, pulleys, cable guides, universal joints, etc.) may be used in the transmission mechanism to transfer mechanical force from the interface to the control element. Each actuator mechanism includes at least one actuator (e.g., a servo motor (brushed or brushless)) that controls movement at the distal end of the associated instrument. For example, the actuator may be an electrical servo motor that controls the surgical instrument end effector grip DOF. The instrument (including the introducer probe described herein) or guide tube (or a collection of instrument assemblies) may be disconnected from the associated actuator mechanism and slid out. It may then be replaced with another instrument or guide tube. In addition to the mechanical interface, there is also an electronic interface between each transmission mechanism and the actuator mechanism. The electronic interface allows for the transfer of data (e.g., instrument/guide tube type). Examples of sterile drapes for mechanical and electrical interfaces for various instruments, guide tubes, and imaging systems, and for protecting sterile areas are discussed in U.S. Pat. Nos. 6866671 (filed by Tierney et al on 8/13 of 2001) and 6132368 (filed by Cooper on 11/21 of 1997), both of which are incorporated herein by reference.

A single surgical instrument or assembly including a guide tube, multiple instruments and/or multiple guide tubes, as well as instruments connected to an actuator assembly via various configurations (e.g., on a proximal or distal side of the instrument/actuator assembly) are suitable for use with the present disclosure. Thus, a variety of surgical instruments may be employed via a single access port of a patient, each working independently of the other and incorporating an end effector having at least 6 actively controlled DOF (i.e., back and forth, up and down, left and right, roll, pitch, yaw) in cartesian space.

The instrument shaft forming the ends of these kinematic chains may be guided for insertion into the patient through a cannula and/or an entry guide, as described further below. Examples of useful accessory clips and accessories (e.g., sleeves) are disclosed in pending U.S. patent application No.11/240087 filed on 30.9.2005, the entire disclosure of which is incorporated herein by reference for all purposes.

Sterile curtain

Embodiments of sterile drapes will now be described in more detail. Referring back to fig. 1A-1B and 2A-2C, sterile drapes 1000 and 2000 are shown covering portions of arm assemblies 101 and 201, respectively, shielding non-sterile portions of the manipulator arm from sterile areas, and shielding the arm and portions thereof from the materials of the surgical procedure (e.g., bodily fluids, etc.). In one embodiment, the sterile drape includes a drape bag configured to receive an instrument manipulator of the instrument manipulator assembly. The drape bag includes an exterior surface adjacent the sterile field and an interior surface adjacent the non-sterile instrument manipulator. The drape further includes a flexible membrane at a distal end of the drape bag for interfacing between an instrument manipulator output (e.g., an interface that transmits an actuation force to an associated instrument) and a surgical instrument input (e.g., an interface that receives an actuation force from an associated instrument manipulator), and a rotatable seal operably connected to a proximal opening of the sterile bag.

In another embodiment, the sterile drape comprises a plurality of drape bags, wherein each drape bag comprises a plurality of flexible membranes at a distal end for interfacing between a respective instrument manipulator output and a respective surgical instrument input, wherein the surgical instrument controls wrist, roll, grip, and translational movement of the surgical instrument. A rotatable seal (such as a labyrinth seal) is operably connected to the proximal opening of the drape bag so as to allow all of the drape bags to rotate together as a group about more proximal portions of the drape. In one example, a first portion of a rotatable seal comprising a plurality of drape bags is connected to a rotatable base plate of the manipulator assembly platform and a second portion of the rotatable seal is connected to a frame of the manipulator assembly platform.

In yet another embodiment, a method of draping a robotic surgical system manipulator arm includes first positioning a distal end of a sterile drape at a distal end of an instrument manipulator and then draping each instrument manipulator from the distal end of the instrument manipulator to a proximal end of the instrument manipulator. Next, the rotatable seal of the sterile drape is attached to the frame and the rotatable base plate of the instrument assembly platform. The remainder of the manipulator arm is then covered from the distal end of the manipulator arm to the proximal end of the manipulator arm as desired. In this example, the manipulator arm is covered from the instrument manipulator to the yaw joint.

Advantageously, as described above, the configuration and geometry of the manipulator arm and instrument manipulator with sterile drape provides a large range of motion that allows for multi-quadrant surgery through a single port (i.e., surgical access from a single access port to all quadrants of the patient), increased space around the patient and access port, and increased patient safety, while providing reliable instrument/manipulator interfacing, ease of instrument exchange, and maintenance of a sterile environment.

Referring back to FIG. 10, the actuator output of instrument manipulator 542 passes through the actuator input of sterile drape 1000 or 2000 engaging instrument 960. As described above, in one embodiment, when latch 542g is actuated, the inner frame of instrument manipulator 542 moves a set distance toward instrument 960 and spring-loaded module outputs 542b-542e engage instrument inputs 962b-962e through drape 1000 or 2000. As described above, independent actuator drive modules 542b ', 542 c', 542d ', and 542 e' in instrument manipulator 542 provide actuator outputs 542b, 542c, 542d, and 542e, respectively, that engage instrument inputs 962b, 962c, 962d, and 962e, respectively, through sterile drapes when latch mechanism 542g is actuated.

Referring now to FIGS. 11A-11D in conjunction with FIG. 10, FIGS. 11A-11B show perspective views of a first drape portion 1100a (FIG. 11D) of sterile drape 1100 in a retracted state and an extended state, respectively, and FIG. 11C shows a cross-sectional view of drape portion 1100a mounted to a distal end of a rotatable base plate 1140a of a manipulator platform, according to an embodiment of the present disclosure. The above description of sterile drapes 1000 and 2000 applies to sterile drape 1100. For example, sterile drape 1100 covers a portion of the manipulator arm assembly, particularly the instrument manipulator, shielding the non-sterile portion of the manipulator arm from the sterile field. Drape portion 1100a includes a plurality of drape bags 1105 (e.g., four wedge-shaped drape bags 1105a-1105d are shown), each including an exterior surface configured to be adjacent to a sterile field, and an interior surface configured to be adjacent to a non-sterile instrument manipulator. Each of the drape bags 1105 further includes a plurality of flexible membranes 1102 at a distal end 1101 of the drape bag 1105 for interfacing between the instrument manipulator output and the surgical instrument input. In one example, flexible membranes 1102b, 1102c, 1102d, and 1102e interface between instrument manipulator outputs 542b, 542c, 542d, and 542e and instrument inputs 962b, 962c, 962d, and 962e to control instrument grip, translation, wrist, and roll motions, respectively, of the surgical instrument. The flexible membrane provides a bag extension 1106 for a telescoping insertion mechanism (e.g., insertion mechanism 444) of each instrument manipulator, along which the instrument manipulator can translate.

In one aspect, the bag extension 1106 is distally attached to the insertion mechanism such that the drape bag extension 1106 moves with the insertion mechanism and remains in a compact form away from the patient, thereby providing space and access to the surgical port. In one example, the distal end of the bag extension 1106 can be attached to the slider link 804 of the insertion mechanism 844 (FIG. 8) by any suitable attachment means, such as clips, tabs, velcro, and the like.

Rotatable seal 1108 operatively connects drape bag 1105 proximal opening 1103 to the manipulator platform of the manipulator arm assembly. In one example, the rotatable seal 1108 comprises a rotatable labyrinth seal (labyrinth seal) having a roller cover portion 1108a and a base comb portion 1108b, wherein the base comb portion 1108b is rotatable within the roller cover portion 1108a relative to the roller cover portion 1108 a. In one embodiment, the base comb portion 1108b comprises a disk with ribs 1104, wherein the ribs 1104 form a plurality of wedge-shaped "frames" with holes, each frame sized to circumscribe (circumscript) an instrument manipulator. In one embodiment, base comb portion 1108b includes ribs 1104 formed 90 degrees apart within the puck. The proximal end of the drape bag 1105 is attached to each frame of the base comb portion 1108 b. Thus, ribbed base comb portion 1108b helps to cover the individual instrument manipulators closely clustered on the instrument manipulator rotatable base plate and further helps to maintain the orientation and arrangement of drape bag 1105 as the covered instrument manipulators move during a surgical procedure.

The roller cover portion 1108a is fixedly mounted to the frame of the manipulator platform and the base comb portion 1108b is fixedly mounted to the rotatable base plate 1140a such that when the base plate 1140a is rotated, the base comb portion 1108b also rotates with the covered instrument manipulator, while the roller cover portion 1108a fixedly mounted to the manipulator platform frame is stationary.

FIGS. 11A and 11B show drape bag 1105 in a retracted and an extended state, respectively, as the instrument manipulator is retracted and extended along its respective insertion axis. Although the four drape bags shown are retracted and extended equally, the drape bags may be retracted and extended independently when the instrument manipulators are independent and/or depend controls relative to one another.

It should be noted that base comb portion 1108b may include a different number of ribs oriented at angles other than 90 degrees, so long as space is provided for each frame of the base comb portion through which an instrument manipulator passes. In one example, the base comb portion 1108b may be comprised of ribs that divide the circular area into a plurality of segments, each segment sized to enclose an instrument manipulator.

Sterile drape 1100 also allows for transfer from the draping individual instrument manipulator to the remainder of the manipulator arm assembly, as shown in FIG. 11D. Drape 1100 may continue from rotatable seal 1108 (e.g., roller cover portion 1108a) to synthesize a larger second drape portion 1100b, which second drape portion 1100b is designed to cover the manipulator arm remainder (e.g., joints and links) as desired, in one example, continuously covering the manipulator arm to manipulator assembly deflection joints (e.g., deflection joints 124, 224). Thus, the rotatable seal 1108 allows the instrument manipulator cluster to rotate freely relative to the remaining manipulator arm assembly while maintaining substantially the entire arm assembly covered, thereby maintaining the sterile environment of the surgical site.

According to another embodiment, sterile drape portion 1100b includes a sleeve mount arm pocket 1110 designed to cover a collapsible sleeve mount arm, which is described in further detail below. In one embodiment, the movable sleeve mount includes a base portion coupled to the manipulator arm and a retractable portion movably coupled to the base portion. The retractable portion may be moved between the retracted position and the deployed position via a rotational joint so that the retractable portion may be rotated upward or folded toward the base portion to create more space around the patient and/or to more easily cover the cannula mount when covering the manipulator arm. Other joints may be used to connect the retractable portion and the base portion, including but not limited to ball and socket joints or universal joints, sliding joints that produce a telescoping effect, and the like, so that the retractable portion may be moved closer to the base portion, thereby reducing the overall form factor of the cannula holder. In another embodiment, the entire cannula mount may be internally retractable with respect to the manipulator arm. Thus, the movable cannula mounting arm allows a larger robot arm to be covered with a relatively small opening in the drape. The drape may be positioned over the collapsible sleeve mounting arm, and after being draped into the bag 1110, the sleeve mounting arm may be extended to an operative position. According to one aspect, the cannula mounting arm is fixed in an operative position during operation of the instrument.

In one example, drape bag 1110 can include a reinforced drape portion 1111 that fits over a clip on the distal end of the cannula mounting arm (see, e.g., clip 1754 in fig. 19A-19B, and clip 2454 and receptacle 2456 in fig. 24A-24D).

Drape 1100a may further include a latch cover 1107 at the side of each drape pocket 1105 for covering each latch 1342g (fig. 14A, 15, 16A, and 17A-17C) that extends beyond the outer perimeter of the instrument manipulator during use.

Advantageously, due to the instrument manipulator distal face, the instrument manipulator spring-loaded and independent output, and the advantageous sterile drape, which interface with the instrument, the instrument can be easily and reliably exchanged on the instrument manipulator while maintaining a stable sterile environment during the surgical procedure. Moreover, the sterile drape allows for quick and easy preparation of the surgical robotic system while providing an improved range of motion (e.g., rotational motion) with a small form factor, thereby reducing operating room preparation time and cost.

Sterile adapter

Another embodiment of a drape including a sterile adapter is now described in more detail. FIG. 12 shows a perspective view of a drape portion 1200a including a sterile adapter 1250 deploying a sterile drape, according to another embodiment of the present disclosure. Drape portion 1200a may replace drape portion 1100a in FIG. 11D, and is operatively connected to drape portion 1100b in a manner substantially similar to rotatable seal 1208 of rotatable seal 1108. Drape portion 1200a includes a plurality of drape sleeves 1205 connected between a rotatable seal 1208 and a sterile adapter 1250. Drape portion 1200a further includes a bag extension 1206 attached to sterile adapter 1250 for covering the instrument manipulator insertion mechanism.

A rotatable seal 1208 operatively connects the proximal opening 1203 of drape sleeve 1205 to the manipulator platform of the manipulator arm assembly. In one example, the rotatable seal 1208 comprises a rotatable labyrinth seal having a roller cover portion 1208a and a base comb portion 1208b that is rotatable relative to the roller cover portion 1208 a. In one embodiment, the base comb portion 1208b comprises a disk with ribs 1204, wherein the ribs 1204 form a plurality of wedge-shaped "frames" with holes, each of the frames sized to circumscribe an instrument manipulator. In one example, the base comb portion 1208b includes ribs formed 90 degrees apart within the disk. The proximal end of the drape sleeve 1205 is attached to each frame of the base comb portion 1208 b. Thus, ribbed base comb portion 1208b helps to cover a close clustering of individual instrument manipulators on the instrument manipulator rotatable base plate, and further helps to maintain the orientation and arrangement of drape bag 1205 as the covered instrument manipulators move during a surgical procedure.

While FIG. 12 shows all of drape sleeves 1205 in an extended state, such as when instrument manipulators extend along their respective insertion mechanisms, it should be understood that the drape sleeves may be independently retracted and extended when the instrument manipulators are independently controlled and/or controlled in adherence to one another.

It should also be understood that the base comb portion 1208b can include a different number of ribs oriented at other angles than 90 degrees, so long as space is provided for each frame of the base comb portion through which an instrument manipulator passes. In one example, base comb portion 1208b can be comprised of ribs that divide the circular area into a number of segments, each segment sized to enclose an instrument manipulator.

The roller cover portion 1208a is fixedly mounted to the frame of the manipulator platform (e.g., manipulator halo) and the base comb portion 1208b is fixedly mounted to the rotatable base plate 1140a such that when the base plate 1140a is rotated, the base comb portion 1208b also rotates along with the covered instrument manipulator. In one example, since the proximal ends of the drape sleeves 1205 are connected to the base comb portion 1208b, all of the drape sleeves 1205 rotate together as a group relative to the more proximal drape portion 1100 b.

Fig. 13A and 13B illustrate a perspective view of an assembled sterile drape adapter 1250 and an exploded view of sterile adapter 1250, respectively, in accordance with embodiments of the present disclosure. Sterile adapter 1250 includes a boot 1252, boot 1252 having a boot wall 1252a and a cylindrical bore 1252b that serves as a passageway for a post on an instrument manipulator, which is described further below. The distal end of the drape sleeve 1205 may be attached to the outer surface of the shield wall 1252 a. Adapter 1250 further includes a pair of supports 1258 for properly aligning, positioning and retaining a surgical instrument beneath the sterile adapter for engaging an instrument manipulator on the upper surface of the sterile adapter. Adapter 1250 further includes a flexible membrane interface 1254 that interfaces between a respective instrument manipulator output and a respective surgical instrument input for controlling wrist, roll, grip, and translational movement of the surgical instrument. In one embodiment, membrane interface 1254 includes a grip actuator interface 1254b, a sway actuator interface 1254c, a wrist actuator interface 1254d, and a roll actuator interface 1254e for interfacing with an associated instrument manipulator output.

In one embodiment, the rolling actuator interface 1254e is designed to rotate and maintain a sterile barrier within the sterile adapter 1250. As shown in fig. 13C, in one aspect, the rolling actuator interface 1254e includes a rolling disk 1257a having a slot or groove 1257B around the disk periphery that receives a flat retaining plate 1254f (fig. 13B). A flat retainer plate 1254f is attached to the flexible membrane interface 1254 and allows the rolling disk to rotate while maintaining the sterile barrier of sterile adapters and drapes.

A membrane interface 1254 is positioned between the boot 1252 and a support 1258, and a tube 1256 connects the boot 1252, the membrane interface 1254, and the support 1258 together. The tube 1256 is aligned with the boot aperture 1252b and the membrane aperture 1254b, and a shaft portion of the tube 1256 is positioned within the aperture. Tube lip 1256a is retained within boot aperture 1252b and tube end 1256 is fixedly connected to support 1258 such that tube 1256 and, therefore, support 1258, may move a longitudinal distance of the tube axis, as indicated by the double-headed arrow in fig. 13A.

Optionally, a grip actuator interface board 1254b ', a sway actuator interface board 1254c ', and a wrist actuator interface board 1254d ' are connected to the underside of the grip actuator interface 1254b, the sway actuator interface 1254c, and the wrist actuator interface 1254d, respectively, for enhanced engagement and connection with the associated instrument inputs.

Fig. 14A and 14B illustrate a bottom perspective view and a bottom view of an instrument manipulator 1300 according to an embodiment of the present disclosure. In this illustrative embodiment, the instrument is mounted against the distal face 1342a of the instrument manipulator 1300. Distal face 1342a includes various actuation outputs that transmit actuation forces to a mounting instrument, similar to the instrument manipulator of fig. 3-8 described above. As shown in fig. 14A and 14B, such actuation outputs may include a grip output lever 1342B (controlling the gripping action of the instrument end effector), a swing output gimbal 1342c (controlling the side-to-side and up-and-down motion of the distal parallel linkage (the "swing" or "elbow" mechanism)), a wrist output gimbal 1342d (controlling the yaw and pitch motion of the instrument end effector), and a roll output disk 1342e (controlling the roll motion of the instrument). Independent actuator drive modules (similar to modules 542b ', 542 c', 542d ', and 542 e' described above) in the instrument manipulator 1300 provide actuator outputs 1342b, 1342c, 1342d, and 1342 e. In a similar manner, actuator outputs 1342b-1342e may be spring-loaded. Details of suitable outputs and associated components of an instrument force transmission mechanism receiving such outputs may be found in U.S. patent application No.12/060104 (filed 3/31, 2008; U.S. patent application publication No. US2009/0248040a1), which is incorporated herein by reference. An example of a proximal end of an illustrative surgical instrument that receives such an input may be found in U.S. patent application No.11/762165, which is incorporated herein by reference. Briefly, left-to-right and up-and-down DOFs are provided by a distal parallel linkage, end effector yaw and end effector pitch DOFs are provided by a distal flexible wrist mechanism, an instrument roll DOF is provided by rolling an instrument shaft while maintaining an end effector in a substantially constant position and pitch/yaw orientation, and an instrument grip DOF is provided by two movable opposing end effector jaws. Such DOFs are illustrative DOFs of more or fewer DOFs (e.g., in certain implementations, the camera instrument omits instrument roll and grip DOFs).

Instrument manipulator 1300 further includes a latch mechanism 1342g, which latch mechanism 1342g is used to engage the actuator output of instrument manipulator 1300 with the actuator input of the installed instrument via sterile adapter 1250. In one embodiment, similar to the latch mechanism described above, when the latch 1342g is actuated, the inner frame 1342i of the instrument manipulator 1300 moves a set distance toward the installation instrument relative to the outer shell 1342 h. Spring-loaded module outputs 1342b-1342e engage appropriate instrument inputs through sterile adapter 1250, in one example through membrane interface 1254. Thus, the installation instrument is sandwiched between the upper surface of support 1258 and the spring-loaded output through the membrane interface of the sterile adapter.

As described above, drape 1100a may include latch covers 1107 (fig. 11D) on respective drape pockets 1105 for covering respective latches 1342g, wherein the respective latches 1342g may extend to the instrument manipulator periphery during use. Each of the latch handles is foldable within a respective instrument manipulator periphery to enable the rotatable seal of the drape to pass beyond the instrument manipulator.

Instrument manipulator 1300 further includes a post 1350 that operably couples instrument manipulator 1300 to sterile adapter 1250, which is described further below.

Referring now to fig. 15 and 16A-16E, the connection of the instrument manipulator 1300 to the sterile adapter 1250 is shown and described. Fig. 15 illustrates a bottom perspective view of an instrument manipulator 1300 operably coupled to a sterile adapter 1250 in accordance with an embodiment of the present disclosure. Fig. 16A-16E illustrate a sequence of connection of the instrument manipulator 1300 to the sterile adapter 1250 in accordance with an embodiment of the present disclosure. As shown in fig. 16A, posts 1350 align with tubes 1256 within boot apertures 1252 b. Next, as shown in FIG. 16B, the free ends of posts 1350 are positioned through tubes 1256 until the post 1350 end tabs engage the associated support holes, as shown in FIG. 16E. Thus, one end of the post 1350 is fixedly mounted to the support 1258. In one embodiment, the support 1258 includes a slider 1258a having a keyway 1258b, as shown in FIGS. 16C-1 and 16C-2. When the sterile adaptor is lifted to a final position as shown by arrow II, the support 1258 slides in the direction of arrow I to allow the post 1350 to pass to the end of the keyway 1258 b. The support 1258 is then returned by the biasing means in the direction of arrow III such that the elongate portion of the keyhole 1258b locks into a groove 1350a in the post 1350 (fig. 16E).

After sterile adapter support 1258 has been attached to the posts on the instrument manipulator housing, boot 1252 of sterile adapter 1250 is attached to distal face 1342a of instrument manipulator 1300. In one embodiment, this attachment is achieved by protrusions on the inner wall of the boot registering with recesses on the sides of the inner frame 1342i of the instrument manipulator. This attachment allows the boot to remain attached to the inner frame as the inner frame is lifted or lowered by the latches 1342 g.

Reference is now made to fig. 17A-17C and 18A-18B, which illustrate and describe the connection of a surgical instrument 1460 to the sterile adapter 1250. Fig. 17A-17C illustrate a connection sequence of a surgical instrument 1460 to the sterile adapter 1250, according to an embodiment of the present disclosure. As shown in fig. 17A, the instrument 1460 includes a force transmission mechanism 1460a and a shaft 1460 b. The tip of the shaft 1460b is disposed within the entry guide 1500, which is freely rotatable within the sleeve 1600. Fig. 17B shows a joint (joint 1462 of fig. 18A) on the force transmission mechanism 1460a of the instrument 1460 engaged with and aligned with a pair of supports 1258, and fig. 17C shows the force transmission mechanism 1460a further translated along the top surface of the supports 1258.

Fig. 18A and 18B illustrate enlarged perspective and side views, respectively, of the instrument 1460 and sterile adapter 1250 prior to full translation of the force transmission mechanism 1460a along the support 1258. Instrument 1460 translates along support 1258 until a retaining mechanism, which in one example can be a protrusion on the underside of tab 1462 that aligns with and connects to a hole on the top surface of support 1258, is reached along the support. Latch 1342g may then be actuated to engage the instrument manipulator output with the instrument input through sterile adapter 1250. In one embodiment, support 1258 is prevented from falling off of posts 1350 after the instrument has been installed. In one aspect, a projection on the support may engage a recess on a side of the instrument force transmission mechanism housing to prevent movement of the support after the instrument has been installed.

Entry guide device

Embodiments of the entry guide, cannula, and cannula mounting arm will now be described in more detail. As described above, a surgical instrument is mounted on and actuated by each surgical instrument manipulator. The instruments are removably mounted so that the various instruments can be interchangeably mounted on a particular manipulator. In one aspect, one or more manipulators may be configured to support and actuate a particular instrument type, such as a camera instrument. A shaft of the instrument extends distally from the instrument manipulator. The shaft extends into the patient through a common cannula placed at the access port (e.g., through the body wall at a natural orifice). The cannula is connected to a cannula mount arm that is removably connected to the manipulator arm. In one aspect, the entry guide is positioned at least partially within the cannula, and each instrument shaft extends through a channel in the entry guide to provide additional support to the instrument shaft.

Fig. 19A and 19B show perspective views of the removable and/or detachable cannula mount 1750 in a retracted position and an extended position, respectively. Cannula mount 1750 includes an extension 1752 movably connected to manipulator arm link 1738, such as adjacent a proximal end of fourth manipulator link 138 (fig. 1A and 1B). Cannula mount 1750 further includes a clamp 1754 on the distal end of extension 1752. In one implementation, the extension 1752 is connected to the link 1738 by a rotatable joint 1753, wherein the rotatable joint 1753 allows the extension 1752 to move between a stowed position adjacent the link 1738 and an operating position that holds the cannula in the correct position so that the remote center of motion is located along the cannula position. In one implementation, extension 1752 may be rotated upward or folded toward link 1738, as shown by arrow C, to create more space around the patient and/or to make it easier to cover a drape over the cannula when covering the manipulator arm with a drape. Other joints may be used to connect the extension 1752, including but not limited to ball and socket joints or universal joints, sliding joints that create a telescoping effect, and the like, so that the extension may be moved closer to the link in order to reduce the overall form factor of the cannula mount and manipulator arm. In another embodiment, the extension 1752 may be internally retractable with respect to the manipulator arm, or the extension 1752 may be detachable from and operably connected to the linkage. Extension 1752 remains in the operative position during operation of the surgical system.

Fig. 20A and 20B show perspective views of a cannula 1800 mounted to a clamp 1754 of a cannula mount 1750 as shown in fig. 19A-19B, and fig. 21 shows a perspective view of a free-standing cannula 1800. In one embodiment, the cannula 1800 includes a proximal portion 1804 that removably couples to a clamp 1754, and a tube 1802 for passage of an instrument shaft (as shown in fig. 22). Once the cannula 1800 is installed in the clamp 1754, the clamp may prevent rotation of the cannula 1800. In one example, tube 1802 is composed of stainless steel, and the inner surface of tube 1802 may be coated or lined with a lubricious or anti-friction material, although the cannula may be composed of other materials, with or without a liner. The proximal portion 1804 can include external ridges 1806, 1808 and an interior space for receiving an access guide channel, as shown in fig. 22 and 23A-23B, described in more detail below. Examples of suitable accessory clamps and accessories, such as cannulas, are disclosed in pending U.S. patent application No.11/240087 filed on 30.9.2005, the entire disclosure of which is incorporated herein by reference.

Referring now to fig. 22 and 23A-23B, fig. 22 shows a cross-sectional view of the cannula 1800 of fig. 21 and a cross-sectional view of an installed access guide tube 2200, in accordance with an embodiment of the present disclosure. Instrument manipulator 1942 is connected to a rotatable base plate 1940 of the manipulator platform, in one example instrument manipulator 1942 is connected to rotatable base plate 1940 of the manipulator platform by a telescoping insertion mechanism 1942a, and instruments 2160 are mounted to instrument manipulator 1942 (e.g., on an instrument manipulator distal or proximal face). In one embodiment, the telescoping insertion mechanisms 1942a are symmetrically mounted to a rotatable base plate 1940, in one example disposed 90 degrees from each other, so as to provide for four instrument manipulators. Other configurations and numbers of insertion mechanisms (and thus instrument manipulators and instruments) are possible.

Accordingly, instruments 2160 are mounted to instrument manipulator 1942 such that instrument shafts 2160b cluster about manipulator assembly roll axis 1941. Each shaft 2160b extends distally from instrument force transmission mechanism 2160a and all shafts extend into the patient through cannula 1800 placed at the port. Cannula 1800 is removably retained in a fixed position with respect to base plate 1940 by cannula mount 1750, which in one embodiment, cannula mount 1750 is coupled to fourth manipulator link 138. The access guide tube 2200 is inserted into the cannula 1800 and is free to rotate within the cannula 1800, and each instrument shaft 2160b extends through an associated channel 2204 into the guide tube 2200. The central longitudinal axes of the cannula and guide tube are generally coincident with the roll axis 1941. Thus, as base plate 1940 rotates to rotate the instrument manipulator and corresponding instrument shaft, guide tube 2200 rotates within the cannula as base plate 1940 rotates. In one example, the entry guide tube 2200 is freely rotatable within the cannula about a central longitudinal axis of the guide tube that is aligned with the cannula central longitudinal axis, which in turn is aligned with or extends parallel to the roll axis 1941 of the manipulator platform. In other embodiments, the entry guide tube 2200 may be fixedly mounted to the cannula, if such fixed support of the instrument shaft is desired.

Side and top cross-sectional views of access guide tube 2200 are taken along line III-III in fig. 23A and 23B, respectively, access guide tube 2200 having attachment lip 2202, tube 2206, and channels 2204a, 2204B. The entry guide tube 2200 includes a lip 2202 on the proximal end of the tube 2206 for rotatably coupling the entry guide to the proximal portion 1804 of the cannula 1800. In one example, the lip 2202 is connected between ridges (e.g., ridges 1806 and 1808 in fig. 22) of the sleeve. In other embodiments, the entry guide does not require an attachment lip, as described further below.

The entry guide tube 2200 further includes channels 2204a and 2204b through the entry guide for passage of an instrument shaft (e.g., instrument shaft 2160b in fig. 22). In one aspect, one channel or passageway is provided for each instrument shaft, and the channels may have different geometries and sizes. As shown in fig. 23A and 23B, channel 2204a is of a different shape and size than channel 2204B, and in one example, channel 2204a is used to guide a camera instrument having a larger and more rigid shaft, while channel 2204B is used to guide an instrument shaft of a conventional instrument. Other shapes and sizes of channels are suitable, including but not limited to openings shaped as circles, ovals, ellipses, triangles, squares, rectangles, and polygons.

As the base plate rotates about roll axis 1941, the cluster of instrument manipulators 1942 and instruments 2160 also rotate about the roll axis. As the instrument shaft 2160 rotates about the roll axis 1941 and enters the guide channel 2204, it strikes the inner surface of the entry guide channel and at least one rotating instrument shaft is driven into the guide tube 2200 to rotate it relative to the cannula 1800 within the cannula 1800, wherein the cannula 1800 is gripped by the cannula holder clamp and held stationary; such as clamp 1754 of cannula mount 1750.

The instrument shafts can be inserted and telescoped independently through the entry guide channel or in coordination with each other by movement of the respective insertion mechanisms 1942 a. Instrument 2160 may rotate in a clockwise or counterclockwise direction about roll axis 1941, and thus entry guide tube 2200 may rotate in a clockwise or counterclockwise direction about the roll axis, respectively. It should further be noted that while four channels in the access guide tube are shown and multiple instrument shaft assemblies are shown passing through the access guide and cannula, the access guide and cannula assemblies within the surgical system may operate with other numbers of channels and instrument/instrument assembly shaft assemblies passing through the access guide and cannula. For example, an access guide tube with one or more channels for extending one or more instrument/instrument assembly shafts through the access guide and cannula is within the scope of the present disclosure. Moreover, the torque provided by the instrument shaft for rotating the entry guide need not be provided symmetrically by multiple instrument shafts, but may be provided asymmetrically and independently, including with most of the torque provided by a single instrument shaft.

In one embodiment, the access guide tube 2200 and the cannula 1800 may each include an electronic or wireless interface, such as a Radio Frequency Identification (RFID) chip or tag, that includes identification information about the cannula and/or access guide tube and allows the surgical system (e.g., read by the manipulator arm) to confirm the identity of the particular access guide device and/or cannula. Metal rings, mechanical pins, and inductive sensing mechanisms may also be used to read the identification data. Such an electronic or wireless interface allows data (e.g., entry guide tube/cannula type) to be transferred to the surgical system. Details of the mechanical and electrical interfaces of the various instruments, guide tubes, and imaging systems, as well as details of the sterile drapes that maintain the sterile field, are discussed in U.S. Pat. Nos. 6866671(Tierney et al) and 6132368(Cooper), both of which similarly use an access guide and a cannula, which are incorporated herein by reference.

It should further be noted that in other embodiments, the access guide tube may not include a connecting lip. Figure 24 shows a cross-sectional view of the entry guide tube 2300 mounted to the cannula 2400. Entry guide tube 2300 includes channel 2304 and is similar to entry guide tube 2200 described above that does not include an attachment lip. Conversely, the entry guide tube 2300 is rotatably connected to the cannula proximal portion by the impact force of the instrument shaft 2160b against the inner wall of the entry guide tube passage 2304. It should further be noted that in one aspect, the access guide tube may be driven by an instrument shaft passing through the access guide tube to move rotationally and longitudinally along the cannula longitudinal or roll axis.

Reference is now made to fig. 24A-24D, which illustrate different embodiments of cannula mounting arms, clamps and cannulas for use with the above described entry guide devices. Fig. 24A and 24B show perspective views of the movable and/or detachable sleeve holder 2450 in a retracted position and a deployed operating position, respectively. The cannula mount 2450 includes an extension 2452 movably connected to a manipulator arm link 2438 having, for example, an instrument manipulator assembly platform 2440 adjacent a proximal end of the fourth manipulator link 138 (fig. 1A and 1B). In one implementation, the extension 2452 is connected to the link 2438 by a rotational joint 2453, wherein the rotational joint 2453 allows the extension 2452 to move between a stowed position adjacent the link 2438 and an operating position that holds the sleeve in a correct position for distribution of the remote center of motion along the sleeve. In one implementation, the extension 2452 can be rotated upward or folded toward the link 2438, as shown by arrow D, to create more space around the patient and/or to more easily drape over the cannula stand when draping over the manipulator arm. Other joints may be used to connect the extension 2452, including but not limited to ball and socket joints or universal joints, sliding joints that create a telescoping effect, and the like, so that the extension may be moved closer to the link in order to reduce the overall form factor of the cannula mount and manipulator arm. In another embodiment, the extension 2452 can be telescoping with respect to the manipulator arm interior, or the extension 2452 can be detachable from and operably connected to the link.

The cannula holder 2450 further includes a clip 2454 over a receptacle 2456 on the distal end of the extension 2452. FIG. 24C shows a perspective view of the cannula 2470 mountable to the cannula mount 2450 clip 2454 and receptacle 2456 as shown in FIG. 24D. In one embodiment, the cannula 2470 includes a proximal portion 2474 having a boss (boss) 2476. Boss 2476 includes a bottom hemispherical surface 2478 that is located within mating receptacle 2456 (as indicated by the arrow from the hemispherical surface to receptacle 2456). The boss 2476 further includes a top surface 2479 that is engaged by the clip 2454 to lock the boss in place, thus holding the sleeve 2470 in a fixed position relative to the sleeve holder extension 2452. The clamp 2454 is actuated by a pull rod 2480. The cannula 2470 further includes a tube 2472 for passage of an instrument shaft (as shown in fig. 22 and 24). Once the sleeve 2470 is installed by the clip 2454 and the receptacle 2456, the clip can prevent the sleeve 2470 from rotating. In one example, the tube 2472 is composed of stainless steel, and the inner surface of the tube 2472 can be coated or lined with a lubricating or anti-friction material, even though the cannula can be composed of other materials, with or without a liner. The proximal portion 2474 includes an interior space for receiving an access guide with a channel, as shown in fig. 22, 23A-23B, and

as shown in fig. 24. Examples of suitable auxiliary clamps and accessories (e.g., sleeves) are disclosed in U.S. patent application No.11/240087 filed on 30.9.2005, hereby incorporated by reference in its entirety.

In one aspect, the above described entry guide and cannula assembly supports insufflation methods and procedures that require insufflation of gas at a surgical site. Further disclosure of insufflation procedures through an Entry Guide and cannula assembly may be found in U.S. patent application No.12/705439 entitled "Entry Guide for Multiple Instruments in a Single Port System" filed on 12.2.2010, the entire disclosure of which is incorporated herein by reference.

Advantageously, because the entry guide is dependently driven by the instrument shaft(s), the need for a motor or other actuation to rotate the entry guide may be eliminated. Moreover, the access guide allows for the removal of a large number of actuator mechanisms near the patient or surgical site. Thus, the entry guide and cannula assembly provides an efficient and robust means for facilitating tissue and supporting multiple instruments through a single port and reducing collisions between the instruments and other devices during a surgical procedure.

Single port surgical system architecture

Fig. 25A-25C, 26A-26C, and 27A-27C illustrate different views of a surgical system 2500 with instrument manipulator assembly roll or instrument insertion axes directed in different directions toward patient P. Fig. 25A-25C illustrate the instrument assembly roll axis 2541 pointing up and down toward the head H of the patient P. Fig. 26A-26C illustrate the instrument assembly roll axis 2541 pointing up and down toward the foot F of the patient P. Fig. 27A-27C illustrate the instrument assembly roll axis 2541 pointing up and down toward the head H of the patient P.

The surgical system 2500 includes a set link 2518 for positioning the remote center of motion of the robotic surgical system, and a manipulator arm assembly 2501 including an active proximal link 2526 and an active distal link 2528, wherein the proximal link 2526 is operably connected to the set link 2518 by an active yaw joint 2524. The plurality of instrument manipulators 2542 form an instrument manipulator assembly that is rotatably coupled to the distal end of the distal link 2528. In one embodiment, a plurality of instrument manipulators are coupled to manipulator assembly platform 2540 by telescoping insertion mechanisms 2544. The plurality of instrument manipulators 2542 are rotatable about a roll axis 2541. In one embodiment, each of the plurality of instrument manipulators includes a distal face from which the plurality of actuator outputs distally project, and the plurality of surgical instruments 2560 are coupled to the distal face of the respective instrument manipulator. The cannula mount 2550 is movably connected to the distal link 2528, and the cannula and access guide tube assembly 2552 is connected to the cannula mount 2550. In one embodiment, the sleeve has a central longitudinal axis that is substantially coincident with the roll axis 2541. Each surgical instrument has a shaft passing through the access guide tube and the cannula such that rotation of at least one instrument shaft rotates the access guide tube about the longitudinal axis of the cannula.

The vertical manipulator assembly yaw axis 2523 at the yaw joint 2524 allows the proximal link 2526 to rotate substantially 360 degrees or more about the remote center of motion of the surgical system (see, e.g., fig. 2C). In one example, the manipulator assembly yaw rotation may be continuous, and in another example, the manipulator assembly yaw rotation is about ± 180 degrees. In yet another example, the manipulator assembly yaw rotation may be about 660 degrees. Because the instrument is inserted into the patient in a direction generally aligned with the manipulator assembly roll axis 2541, the manipulator arm assembly 2501 may be actively controlled to position and reposition the instrument insertion direction in any desired direction about the manipulator assembly yaw axis (see, e.g., fig. 25A-25C showing the instrument insertion direction toward the patient's head and fig. 26A-26C showing the instrument insertion direction toward the patient's foot). This function is clearly beneficial in certain procedures. In some abdominal procedures, instruments are inserted via a single port located in the umbilicus (see, e.g., fig. 25A-25C), for example, the instruments can be positioned to access all four quadrants of the abdomen without the need to open a new port in the patient's body wall. For example, lymph node access/approach through the abdomen may require multi-quadrant access. In contrast, the use of multi-port telerobotic surgical systems may require additional ports to be opened in the patient's body wall for more comprehensive access to other abdominal quadrants.

Further, the manipulator may direct the instrument vertically downward and in a slightly pitched-up configuration (see, e.g., fig. 27A-27C showing the direction of instrument insertion pitched up proximate the body orifice O). Thus, the angle of entry (yaw and pitch about the remote center) of an instrument through a single access port can be easily manipulated and changed while providing increased space around the access port for patient safety and patient side worker manipulation.

Moreover, the links and active joints of the manipulator arm assembly 2501 can be used to easily manipulate the pitch angle of an instrument through a single access port while creating space around the single access port. For example, the links of arm assembly 2501 may be positioned to have a form factor that is "arced away" from the patient. Such arc distancing allows the manipulator arm to rotate about the yaw axis 2523 to create a collision of the manipulator arm with the patient. Such arc distancing also allows patient-side personnel easy access to the manipulator for exchanging instruments and to the access port for inserting and manually operating instruments (e.g., manual laparoscopic instruments or telescopic devices). In other cases, the working envelope of the cluster of instrument manipulators 2542 may approximate a vertebral body with the tip of the vertebral body at the center of remote motion and the rounded end of the vertebral body at the proximal end of the instrument manipulators 2542. Such a working envelope results in less interference between the patient and the surgical robotic system, allowing for greater range of motion of the system for improved access to the surgical site and improved access to the patient by the surgical staff.

Thus, the configuration and geometry of manipulator arm assembly 2501, along with its large range of motion, allows for multi-quadrant surgery through a single port. Through a single incision, the manipulator can guide the instrument in one direction and easily change direction; e.g., toward the patient's head (see, e.g., fig. 25A-25C), and then redirected toward the patient's pelvis by moving the manipulator arm about a constant vertical yaw axis 2523 (see, e.g., fig. 26A-26C).

Reference is now made to fig. 28, which illustrates a centralized motion control and coordination system architecture for a minimally invasive teleoperated surgical system incorporating the surgical instrument assemblies and components described herein. Motion coordination system 2802 receives master input 2804, sensor input 2806, and optimization input 2808.

Master control inputs 2804 may include arm, wrist, hand, and finger movements of the surgeon on the master control mechanisms. The input may also come from other movements (e.g., finger, foot, knee, etc. pressing or moving buttons, levers, switches, etc.) and commands (e.g., sounds) that control the position and orientation of specific components or control task operations (e.g., energizing/powering an electrocautery end effector or laser, imaging system operation, and the like).

Sensor input 2806 may include position information from, for example, measuring servo motor position or sensed bending information. U.S. patent application No.11/491384(Larkin et al), entitled "Robotic surgery systems employing fiber Bragg gratings," describes the use of fiber Bragg gratings for position sensing, which is incorporated herein by reference.

The user interface has three connection control modes as follows: modes for instrument(s), modes for imaging systems, and modes for manipulator arm configuration and/or roll axis control. The mode for the guide tube(s) is also applicable. These connection modes enable the user to handle the system as a whole rather than directly controlling the individual parts. Thus, the motion coordinator must determine how to utilize the overall system kinematics (i.e., the overall DOF of the system) in order to achieve certain objectives. For example, one goal may be to optimize the space around the patient or minimize the form factor of the manipulator arm. Another goal may be to optimize a particular configuration of instrument workspace. Another goal may be to keep the field of view of the imaging system centered between the two instruments. Thus, optimization input 2808 may be a high level command, or the input may include more detailed commands or sensed information. An example of a high level command may be a command for an intelligent controller to optimize a workspace. An example of a more detailed command may be that the imaging system starts or stops optimizing its camera. An example of a sensor input may be a signal that a workspace limit has been reached.

Motion coordinator 2802 outputs command signals to the various actuator controllers and actuators (e.g., servomotors) associated with the manipulators of the various teleoperated surgical system arms. Fig. 28 depicts an example of output signals sent to four instrument controllers 2810, to imaging system controller 2812, to roll axis controller 2814, and to manipulator arm controller 2816, which in turn send control signals to instrument actuators, active arm joints, manipulator platform swivel mechanism, and active telescoping insertion mechanism. Other numbers and combinations of controllers may be used. Control and feedback mechanisms, as well as signals such as position information (e.g., from one or more wireless transmitters, RFID chips, etc.) and other data from sensing systems are disclosed in U.S. patent application No.11/762196, which is incorporated herein by reference, and are applicable in this disclosure.

Thus, in certain aspects, a surgeon operating a teleoperated surgical system may automatically use at least three control modes identified above simultaneously: an instrument control mode for moving the instrument, an imaging system control mode for moving the imaging system, and a manipulator arm roll axis control mode for configuring the links of the manipulator arm in certain form factors or relative to each other or the manipulator platform to rotate and for actively moving about an external yaw axis to enable multi-quadrant surgery. A similar centralized architecture may be adapted to work with various other architectural aspects described herein.

FIG. 29 shows a schematic diagram of aspects of a distributed motion control and coordination system architecture for a minimally invasive teleoperated surgical system incorporating the surgical instrument assemblies and components described herein. In the exemplary aspect shown in fig. 29, the control and transformation processor 2902 exchanges information with two master arm optimizers/controllers 2904a, 2904b, with three surgical instrument optimizers/controllers 2906a, 2906b, 2906c, with an imaging system optimizer/controller 2908, and with a roll axis optimizer/controller 2910. Each optimizer/controller is associated with a master or slave arm (which includes, for example, a camera (imaging system) arm, an instrument arm, and a manipulator arm) in a teleoperated surgical system. Each receive arm-specific optimization objective 2912a-2912g in the optimizer/controller.

The double-headed arrows between the control and transform processor 2902 and the various optimizers/controllers indicate the exchange of Following Data (Following Data) associated with the optimizer/controller arms. The follow-up data includes the full cartesian configuration of the entire arm (including the base frame and the distal tip frame). The control and transformation processor 2902 communicates the follow data received from each optimizer/controller to all the optimizers/controllers so that each optimizer/controller has data for the current cartesian configuration of all the arms in the system. Further, the optimizer/controller of each arm receives an optimization objective that is unique to that arm. Each arm optimizer/controller then uses the other arm positions as inputs and constraints while continuing its optimization objective. In one aspect, each optimization controller continues its optimization objective using an embedded local optimizer. The optimization modules for each arm optimizer/controller can be independently turned on or off. For example, optimization modules for only the imaging system and the robot arm may be turned on.

Distributed control architectures provide more flexibility than centralized architectures, although there is a possibility of reduced performance. However, in such a distributed architecture, the optimization of the distributed architecture is local, as opposed to global optimization implemented with a centralized architecture, where a single module can perceive the entire system state.

Link balance

An embodiment of the balancing mechanism in the proximal link will now be described in more detail with reference to fig. 30A-37C. Fig. 30A shows a manipulator arm assembly 3001, which is substantially similar to the arm assembly described above, with features of the manipulator arm assembly described above also being applicable to the assembly 3001, and fig. 30B shows a detailed view of the balanced proximal link of the arm assembly 3001. Fig. 31-37C show different views of aspects of the balancing system without the proximal link housing wall. In particular, fig. 31 shows a perspective view of the balancing system. Fig. 32A-36C illustrate adjustment pins, linear guides, and the range of motion of the adjustment pins to move the end plug relative to the linear guides, and fig. 37A-37C illustrate detailed views of the balanced proximal link distal end showing a rocker arm and a set screw in accordance with aspects of the present disclosure.

Referring now to fig. 30A-30C, the manipulator arm assembly 3001 includes a proximal link 3026 operatively connected to a set link by a yaw joint to form a manipulator assembly yaw axis 3023. The proximal link 3026 is rotatably connected to the distal link 3028 about a pivot axis 3070. In one example, the motor 3073 can be controlled to rotate the distal link 3028 about the pivot axis 3070. In one embodiment, the distal link 3028 includes an instrument manipulator assembly platform 3040 at a distal end of the distal link. The cannula mount 3050 is movably coupled to the distal link 3028. In one embodiment, platform 3040 provides a rotatable base plate upon which an instrument manipulator may be mounted and rotated about instrument manipulator assembly roll axis 3041. The intersection of yaw axis 3023, roll axis 3041, and instrument manipulator assembly pitch axis 3039 forms a remote center of motion 3046 as previously described.

Referring now specifically to fig. 30B and 31, counter link 3026 includes a housing 3084 having a central longitudinal axis 3084c extending between a housing proximal or first end 3084a and a housing distal or second end 3084B. The compression spring 3080 is disposed along a longitudinal axis 3084c and has a spring proximal or first end 3080a and a spring distal or second end 3080 b. In one embodiment, the compression spring is constructed of a silicon-chromium alloy, but may be constructed of other materials. The base 3092 is disposed at the housing first end and is connected to the first end 3080a of the compression spring 3080 by an alignment ring 3090 therebetween. A plug 3074 is disposed at the second end of the housing and is coupled to the second end 3080b of the compression spring 3080. In one embodiment, alignment ring 3090 is fixedly attached to a first end portion 3080a of compression spring 3080, and plug 3074 includes external threads (e.g., threads 3074a) on which spring second end portion 3080b is threaded.

A cable 3088 having a connector 3071 at a first end of the cable is connected to the load of the distal link 3028, and a second end of the cable 3088 is operatively connected to the plug 3074. Starting from the load-bearing end of cable 3088 at connector 3071, cable 3088 passes through a plurality of pulleys 3076 and 3078 outside of housing 3084, and then through pulley 3094 at base 3092 before being attached to plug 3074. The load from the distal link 3028 pulls the cable 3088 (fig. 31) in directions E1 and E2 about the pulley 3094, causing the plug 3074 to compress the spring 3080 in the direction E2, which is positioned to balance at least a portion of the load from the distal link about the pivot axis 3070.

For added safety, the cable 3088 can include redundant cables connected to a cable tension equalizer 3082, which cable tension equalizer 3082 equalizes the tension on the redundant cables. The cable twister 3095 is optionally used to operably connect redundant cables between the pulley 3094 and the connector 3071 to each other. A plurality of cap screws 3075 can be disposed between the cable tension equalizer 3082 and the plugs 3074 and can be used to adjust the force cancellation of the balance link. In one embodiment, three cap screws 3075 connect the cable tension equalizer 3082 and the plug 3074, one of which bears substantially all of the tension, while the remaining two are provided for redundancy and safety purposes.

In one aspect, the portion of the cable 3088 between the pulley 3094 and the plug 3074 extends substantially along the central longitudinal axis 3084c of the proximal link housing. In a further aspect, the spring 3080 compresses along the central longitudinal axis 3084c of the proximal link housing. However, spring compression can produce "bowing" or non-linear compression of the spring along the longitudinal axis of the housing, which can result in scraping and contact of the spring with the inner surface of the proximal link housing. To reduce or substantially eliminate bowing, the orientation of the spring 3080 at the first end 3080a and the second end 3080b can be adjusted according to various aspects of the present disclosure. Also, in one embodiment, the housing includes linear guide rails 3096 arranged parallel to the longitudinal axis of the housing 3084 c. The linear guide 3086, which is movably or slidably coupled to the linear guide rail 3096, is fixedly coupled to the coil of the compression spring 3080. A linear guide device 3072, which movably or slidably engages the linear guide rail 3096, may also be operatively connected to the stopper 3074. The linear guide rail 3096 and linear guide devices 3086 and 3072 further reduce or substantially eliminate bowing of the compression spring 3080. It should be noted that in some embodiments, the balancing system may be operated without the linear guide device and the linear guide rail.

Referring now to the adjustable alignment of the first end or proximal end of the compression spring, in one aspect, the alignment ring 3090 is movably coupled to the base 3092 by a plurality of adjustment screws 3091 such that movement of the adjustment screws 3091 adjusts the orientation of the alignment ring 3090, and thus the orientation of the first end of the spring 3080a fixedly coupled to the alignment ring 3090. In one example, the base 3092 is connected to the alignment ring 3090 by four adjustment screws 3091 disposed away from each other in a square or rectangular configuration. Other geometric configurations of the screws are possible. Each of the adjustment screws 3091 is movable in a direction substantially perpendicular to the flat top surface of the alignment ring 3090 (e.g., via a screwing action through a base hole having internal threads) such that the orientation of the alignment ring is adjustable at each contact point with the adjustment screw. Thus, the orientation of alignment ring 3090 and fixedly connected first end portion 3080a of spring 3080 is adjustable at various points along alignment ring 3090. More or fewer adjustment screws 3091 are within the scope of the present disclosure.

Referring now to fig. 32A-37C, detailed views of the balanced proximal link distal end are shown without the link housing walls. In particular, these figures illustrate the range of motion in which the adjustment pin 3106, rocker arm 3108, and the fixedly attached second end portion 3080b of the adjustment pin and rocker arm adjustment end plug 3074 and spring 3080, according to various aspects of the present disclosure, are oriented.

Fig. 32A shows a bottom perspective view of the counterbalance system, and fig. 32B shows a perspective view of a cross-section along line IV-IV of fig. 31, 32A, and 37A. As described above, a plurality of cap screws 3075a and 3075b are disposed between and connect the cable tension equalizer 3082 and the plug 3074. The cap screw 3075a bears all the tension in this embodiment, while the other two cap screws 3075b are provided for backup and safety purposes. Spring 3080 is distally attached to stopper 3074 by threading onto external threads 3074a of stopper 3074, as described above. Plug 3074 optionally includes a plurality of grooves 3200 formed to reduce the weight of the plug. It should be noted that the linear guide device 3072 may be slidably coupled to the linear guide rail 3096 via the linear guide flange 3072 a.

As shown in fig. 32A-32B, the plug 3074 is coupled to the linear guide 3072 by an adjustment pin 3106, a socket screw 3104 extending through an internal channel of the adjustment pin 3106, and a nut 3102 threaded on a free end 3104a of the socket screw 3104 to lock the adjustment pin 3106 and the linear guide 3072 in position relative to each other. In one embodiment, socket head screw 3104 is a socket head cap screw. The head 3104b of the socket screw 3104, opposite the free end 3104a, is placed in the engagement groove 3105 of the adjustment pin 3106 to lock the socket screw head in the adjustment pin when the nut 3102 fully engages the socket screw free end 3104a, thereby locking the adjustment pin 3106 and the linear guide 3072 relative to each other.

Reference is now made to fig. 33-36C, which describe in more detail the adjustment of the movement of the adjustment pin 3106 relative to the linear guide 3072. Fig. 33 shows the adjustment pin 3106 connected to the linear guide 3072, the circle 3114 and the circle center 3114a, the crankshaft pivoting the adjustment pin 3106 about the circle center 3114a when the adjustment pin is not fully locked in position relative to the linear guide 3072. Fig. 34 shows the linear guide indicia 3072b and the adjustment pin indicia 3106c when the central longitudinal axis 3107 of the adjustment pin 3106 is perpendicular to the central longitudinal axis 3097 of the linear guide 3072 or guide rail 3096. The linear guide markings 3072b and the adjustment pin markings 3106c may be used by the adjusters (and particularly the plug orientation) of the balance system to determine the relative positions of the adjustment pin and the linear guide. Fig. 35 shows a perspective view of the adjustment pin 3106, which includes a pin shaft 3106a and a pin head 3106 b. As can be seen in fig. 33-35, the pin head 3106b has a curved top surface that is operable to match the curved face of the linear guide 3072.

Fig. 36A-36C show side views of the adjustment pin 3106 and the linear guide 3072 and their respective central longitudinal axes 3107 and 3097, respectively. Fig. 36A shows a vertical position of the central longitudinal axis 3107 of the adjustment pin 3106 relative to the central longitudinal axis 3097 of the linear guide 3072, fig. 36B shows a position where the central longitudinal axis 3107 of the adjustment pin 3106 forms an obtuse angle with the central longitudinal axis 3097 of the linear guide 3072, and fig. 36C shows a position where the central longitudinal axis 3107 of the adjustment pin 3106 forms an acute angle with the central longitudinal axis 3097 of the linear guide 3072. Thus, fig. 36A-36C illustrate the pivotal movement of the adjustment pin 3106 relative to the linear guide 3072, such that the orientation of the plug 3074 and the fixedly attached second end 3080b of the spring 3080 can be adjusted.

Fig. 37A shows another bottom perspective view of the balance system showing rocker arm 3108 and set screw 3110, fig. 37B shows fig. 37A with plug 3074 removed, and fig. 37C shows fig. 37B with rocker arm 3108 removed. Rocker arm 3108 is connected to adjustment pin 3106 at the free end of pin member 3106a, and a screw 3110 is provided to connect rocker arm 3108 to plug 3074. The cross disk pin 3112 clamps the rocker arm 3108 to the adjustment pin 3106. The rocker arm 3108 and attached plug 3074 may pivot about a central longitudinal axis 3107 of the adjustment pin 3106 and may be adjusted by movement of the set screw 3110 in a direction substantially perpendicular to the longitudinal axis 3107, such as by a screwing action through a rocker arm hole having internal threads. Accordingly, the orientation of plug 3074 and fixedly coupled second end 3080b of spring 3080 can be adjusted at each point of contact with set screw 3110. More or fewer adjustment screws 3110 are within the scope of the disclosure. Thus, the orientation of the plug, and thus the second or distal end of the spring 3080, can be adjusted at various points by rotating the adjustment pin 3106 and the rotating rocker arm 3108. In one aspect, the adjustment pin 3106 and the rocker arm 3108 rotate about axes that are perpendicular to each other.

Moreover, the balance link of the present disclosure allows for adjustment between the plug and the second end of the compression spring to vary the number of active coils that are compressible in the compression spring. In one aspect, the second end of the compression spring may be threaded deeper or less onto the external threads of the plug in order to vary the number of active coils that can be compressed.

Advantageously, balancing the proximal link 3026 allows for easier movement of the distal link as the motor rotates the distal link 3028 about the pivot axis 3070 for increased and advantageous robotic arm configurations and instrument manipulators, as well as less torque required by the motor to rotate the distal link, while providing increased safety in the event of any motor failure. In some embodiments, the motor turning the distal link may be braked to hold the distal link in place, although the balancing mechanism of the proximal link generally fails.

The foregoing examples are provided for the purpose of illustration only and are not intended to limit the present disclosure. It should be understood that many modifications and variations are possible in light of the principles of this disclosure. For example, in many aspects, the devices described herein function as single port devices; that is, all necessary components to complete a surgical procedure are accessed into the body via a single access port. Although in some aspects multiple devices and ports may be used.