U.S. patent application number 10/005734 was filed with the patent office on 2002-04-11 for in vivo accessories for minimally invasive robotic surgery.
This patent application is currently assigned to Intuitive Surgical, Inc.. Invention is credited to Freund, John G., Hill, John W., Hoornaert, Dean F., Julian, Christopher A., Moll, Frederic H., Rosa, David J., Wallace, Daniel T..
Application Number | 20020042620 10/005734 |
Document ID | / |
Family ID | 23802808 |
Filed Date | 2002-04-11 |
United States Patent
Application |
20020042620 |
Kind Code |
A1 |
Julian, Christopher A. ; et
al. |
April 11, 2002 |
In vivo accessories for minimally invasive robotic surgery
Abstract
Surgical accessories are presented in vivo and used by surgical
tools in the surgical site to perform additional tasks without the
need to remove the tools from the surgical site for tool change or
instrument loading. Examples of in vivo accessories include
fastening accessories such as surgical clips for use with a clip
applier, single working member accessories such as a blade which
can be grasped and manipulated by a grasping tool for cutting,
sheath accessories that fit over working members of a tool, flow
tubes for providing suction or introducing a fluid into the
surgical site, and a retraction member resiliently biased to
retract a tissue to expose an area in the surgical site for
treatment. The accessories can be introduced into the surgical site
by a dedicated accessory introducer, or can be supported on the
body of a surgical tool inserted into the surgical site and be
manipulated using another surgical tool in the surgical site. The
accessory introducer can be resiliently biased to bias the
accessories toward a predetermined position in the surgical
site.
Inventors: |
Julian, Christopher A.; (Los
Gatos, CA) ; Wallace, Daniel T.; (Redwood City,
CA) ; Moll, Frederic H.; (Woodside, CA) ;
Hoornaert, Dean F.; (Mountain View, CA) ; Rosa, David
J.; (San Jose, CA) ; Freund, John G.; (Redwood
City, CA) ; Hill, John W.; (Palo Alto, CA) |
Correspondence
Address: |
TOWNSEND AND TOWNSEND AND CREW, LLP
TWO EMBARCADERO CENTER
EIGHTH FLOOR
SAN FRANCISCO
CA
94111-3834
US
|
Assignee: |
Intuitive Surgical, Inc.
1340 W. Middlefield Road
Mountain View
CA
94043
|
Family ID: |
23802808 |
Appl. No.: |
10/005734 |
Filed: |
November 6, 2001 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
10005734 |
Nov 6, 2001 |
|
|
|
09453978 |
Dec 2, 1999 |
|
|
|
Current U.S.
Class: |
606/130 |
Current CPC
Class: |
A61B 2017/00265
20130101; A61B 2017/00349 20130101; A61B 34/76 20160201; A61B 17/29
20130101; A61B 17/0218 20130101; A61B 17/062 20130101; A61B
2017/00477 20130101; A61B 2017/2825 20130101; A61B 34/30 20160201;
A61B 2017/2931 20130101; A61B 17/064 20130101; A61B 2017/2829
20130101; A61B 2034/305 20160201; A61B 34/37 20160201; A61B 17/068
20130101; A61B 17/00234 20130101; A61B 2017/00362 20130101; A61B
17/1285 20130101; A61B 17/0469 20130101; A61B 17/320016 20130101;
A61B 34/70 20160201; A61B 34/72 20160201 |
Class at
Publication: |
606/130 |
International
Class: |
A61B 019/00 |
Claims
What is claimed is:
1. A method of performing minimally invasive robotic surgery in a
body cavity of a patient, the method comprising: introducing at
least one surgical accessory into the cavity; introducing a robotic
surgical tool into the cavity; and coupling the surgical accessory
with the robotic surgical tool inside the cavity after introducing
the surgical accessory and the robotic surgical tool into the
cavity.
2. The method of claim 1 wherein the robotic surgical tool is
manipulated by a servomechanism from outside the cavity to couple
the robotic surgical tool with the surgical accessory inside the
cavity.
3. The method of claim 2 wherein the robotic surgical tool is
connected with a robot arm which is disposed outside the cavity and
robotically controlled to manipulate the robotic surgical tool.
4. The method of claim 1 wherein the surgical accessory is coupled
with the robotic surgical tool by grasping the surgical accessory
with the robotic surgical tool.
5. The method of claim 1 wherein the surgical accessory is coupled
with the robotic surgical tool by mating the surgical accessory
with the robotic surgical tool to form a mated connection.
6. The method of claim 1 wherein the robotic surgical tool is a
first robotic surgical tool, and wherein the surgical accessory is
coupled with the first robotic surgical tool by introducing a
second robotic surgical tool into the cavity and manipulating the
surgical accessory with the second robotic surgical tool.
7. The method of claim 1 wherein the at least one surgical
accessory is introduced into the cavity through a cannula.
8. The method of claim 1 wherein the at least one surgical
accessory is introduced into the cavity supported by a surgical
accessory support, and is removable from the surgical accessory
support within the cavity.
9. The method of claim 8 wherein the surgical accessory support
includes a container.
10. The method of claim 9 wherein the container includes a door,
and wherein the method further comprises remotely manipulating the
door between a closed position and an open position from outside
the cavity.
11. The method of claim 8 wherein the surgical accessory support
includes a block having a material which deflects to releasably
secure one or more surgical accessories therein.
12. The method of claim 8 wherein the surgical accessory support is
provided on the body of another robotic surgical tool introduced
into the cavity.
13. The method of claim 8 wherein the surgical accessory support
includes a cartridge releasably supporting a plurality of surgical
accessories.
14. The method of claim 13 wherein the at least one surgical
accessory includes a plurality of surgical clips supported on the
cartridge, and wherein the robotic surgical tool comprises a clip
applier, the method further comprising sequentially loading the
surgical clips in the clip applier within the cavity and affixing
the loaded clips to a target tissue with the clip applier.
15. The method of claim 1 wherein the at least one surgical
accessory includes at least one of a scalpel, a blade, a dissection
finger, an electrode, a clip, a tube, and a hook.
16. The method of claim 1 wherein the surgical accessory is
introduced into the cavity through an opening in a cavity wall by
connecting the surgical accessory with a distal portion of an
extension line and inserting the surgical accessory and the distal
portion of the extension line into the cavity through the cavity
wall, the surgical accessory being movable between a first position
close to the opening and a second position away from the
opening.
17. The method of claim 16 wherein the surgical accessory is
resiliently biased toward the first position.
18. The method of claim 1 further comprising decoupling the
surgical accessory from the robotic surgical tool inside the
cavity.
19. The method of claim 18 wherein the surgical accessory is
supported by a surgical accessory support which is introduced into
the cavity before the surgical accessory is coupled with the
robotic surgical tool inside the cavity, and wherein the decoupled
surgical accessory is returned to the surgical accessory support
inside the cavity.
20. The method of claim 18 wherein a plurality of surgical
accessories are introduced into the cavity, the method further
comprising coupling another surgical accessory inside the cavity
with the robotic surgical tool after the decoupling step.
21. The method of claim 1 wherein the surgical accessory comprises
a tool tip which is releasably coupled with a working member of the
robotic surgical tool to form a tool tip of the tool.
22. The method of claim 21 wherein the robotic surgical tool
includes a pair of working members and a pair of tool tips are
releasably coupled with the pair of working members of the robotic
surgical tool to form tool tips of the tool.
23. The method of claim 1 wherein the surgical accessory comprises
a sheath which is releasably coupled with the robotic surgical
tool.
24. The method of claim 1 wherein the robotic surgical tool
comprises a pair of working members, and wherein the surgical
accessory comprises a pair of fingers movably supported on a collar
which is releasably coupled with the robotic surgical tool in a
coupled position, the pair of fingers mating with the pair of
working members to be movable by the pair of working members in the
coupled position.
25. The method of claim 1 further comprising: manipulating the
robotic surgical tool from outside the patient's body to position
the surgical accessory within the body cavity; and causing the
surgical accessory to interact with a portion of the body
cavity.
26. The method of claim 25 wherein the surgical accessory is caused
to interact with a portion of the body cavity by a user actuating
the accessory from outside the patient's body.
27. The method of claim 4 further comprising actuating a portion of
a master control device located remotely from the patient by a user
to control the robotic surgical tool to grasp the surgical
accessory.
28. The method of claim 27 further comprising instructing the
robotic surgical tool to continue to grasp the surgical accessory
without requiring the user to continue to actuate the actuatable
portion of the master control device.
29. A method of performing minimally invasive robotic surgery in a
body cavity of a patient, the method comprising: introducing a
robotic fastening tool into the cavity; introducing a surgical
accessory support into the cavity, the surgical accessory support
supporting a plurality of fastening accessories; loading one of the
fastening accessories in the robotic fastening tool inside the
cavity; and affixing the loaded fastening accessory to a target
tissue inside the cavity with the robotic fastening tool.
30. The method of claim 29 wherein the robotic fastening tool is a
clip applier, and the fastening accessories include a plurality of
surgical clips.
31. The method of claim 30 wherein the surgical accessory support
includes a clip cartridge.
32. The method of claim 31 wherein the clip cartridge is provided
on the body of another robotic surgical tool introduced into the
cavity.
33. A robotic surgical system for effecting a predetermined
treatment of a target tissue at an internal surgical site within a
patient body, the system comprising; a surgical accessory adapted
for effecting the treatment; an accessory introducer having a
proximal end and a distal end with an opening therebetween, the
distal end of the introducer insertable into the patient body so
that the opening defines a first minimally invasive aperture, the
surgical accessory being coupled with the distal end of the
introducer and passable through the opening to the internal
surgical site; and a robotic arm supporting a surgical tool, the
surgical tool having an end effector suitable for insertion through
a second minimally invasive aperture to the internal surgical site,
the end effector coupleable with the surgical accessory within the
internal surgical site so that the robot arm can manipulate the
surgical accessory to direct the treatment to the target
tissue.
34. The robotic surgical system of claim 33, wherein the accessory
comprises a member selected from the group consisting of a scalpel,
a blade, a dissection finger, an electrode, a clip, a tube, and a
hook.
35. The robotic surgical system of claim 33 wherein the accessory
introducer includes a block having a material which deflects to
releasably secure the surgical accessory therein.
36. The robotic surgical system of claim 33 wherein the accessory
introducer includes a container having a door and a mechanism
coupled with the door for remotely moving the door between an open
position and a closed position from outside the internal surgical
site.
37. The robotic surgical system of claim 33 wherein the surgical
accessory is a clip and the surgical tool is a clip applier.
38. The robotic surgical system of claim 33 further comprising
means for resiliently biasing the surgical accessory toward the
first minimally invasive aperture.
39. The robotic surgical system of claim 33 wherein the accessory
introducer includes a container having a door openable by the
surgical tool, the container containing one or more surgical
accessories.
40. The robotic surgical system of claim 33 wherein the accessory
comprises a tool tip configured to be releasably coupled to the end
effector of the surgical tool to form a tool tip for the end
effector.
41. The robotic surgical system of claim 33 wherein the end
effector comprises a pair of working members and the accessory
comprises a pair of fingers movably supported on a collar which is
configured to be releasably coupled with the surgical tool in a
coupled position, the pair of fingers mating with the pair of
working members to be movable by the pair of working members in the
coupled position.
42. An apparatus for providing a surgical accessory in vivo through
a wall of a patient body into an internal cavity of the patient
body for effecting a desired treatment of a target tissue in the
patient body, the apparatus comprising: a surgical accessory
adapted for effecting the treatment; an accessory introducer having
a proximal end and a distal end with an opening therebetween, the
distal end of the introducer insertable into the patient body so
that the opening defines a first minimally invasive aperture, the
surgical accessory being coupled with the distal end of the
introducer and passable through the opening to the internal cavity;
and a resilient member connected with the accessory introducer to
resiliently bias the surgical accessory to a preset desired
location within the internal cavity.
43. The apparatus of claim 42 wherein the accessory introducer
comprises a support member configured to be anchored to the wall of
the patient body at the opening; and a slidable member coupled with
the surgical accessory, the slidable member being slidable relative
to the support member.
44. The apparatus of claim 43 wherein the resilient member
comprises a spring coupled between the support member and the
slidable member.
45. The apparatus of claim 42 wherein the accessory introducer
comprises a needle portion for piercing through the wall of the
patient body into the internal cavity, the needle portion including
a hollow core for introducing the surgical accessory.
46. A method of performing minimally invasive robotic surgery in an
internal cavity of a patient body, the method comprising:
supporting a portion of a target tissue with a first robotic
surgical tool introduced into the internal cavity, the first
robotic surgical tool being electrically conductive; contacting
another portion of the target tissue with an electrically
conductive cautery member introduced into the internal cavity; and
energizing the first robotic surgical tool and the cautery member
for coagulating the target tissue.
47. The method of claim 46 wherein the first robotic surgical tool
and the cautery member are energized by connection to opposite
leads of a radiofrequency power source to form a bipolar
system.
48. The method of claim 46 wherein the cautery member is held by a
second robotic surgical tool.
49. The method of claim 48 wherein the second robotic surgical tool
is electrically insulated from the cautery member.
50. A robotic surgical system for performing a procedure on a body,
the system comprising: a surgical tool having an end effector
comprising at least two end effector members, the members capable
of grasping an object; a master control device having an actuatable
portion, the portion operatively connected to the surgical tool
such that actuation of the portion causes the at least two end
effector members to grasp the object; and an input device for
accepting an input from a user to cause the end effector members to
continue to grasp without further actuation of the actuatable
portion of the master control device.
Description
CROSS-REFERENCES TO RELATED APPLICATIONS
[0001] This application claims benefit from U.S. Pat. application
Ser. No. 09/478,953, filed on Jan. 7, 2000 which claims priority
from U.S. Pat. application Ser. No. 09/453,978, filed Dec. 2, 1999,
which issued as U.S. Pat. No. 6,309,397 on Oct. 30, 2001, the
complete disclosures of which are incorporated herein by
reference.
[0002] This application is related to the following patents and
patent applications, the full disclosures of which are incorporated
herein by reference: PCT International application Ser. No.
PCT/US98/19508, entitled "Robotic Apparatus", filed on Sep. 18,
1998, U.S. application Ser. No. ______ (Attorney Docket No.
17516-003210), entitled "Surgical Robotic Tools, Data Architecture,
and Use", filed on Oct. 15, 1999; U.S. application Ser. No.
60/111,711, entitled "Image Shifting for a Telerobotic System",
filed on Dec. 8, 1998; U.S. application Ser. No. 09/378,173,
entitled "Stereo Imaging System for Use in Telerobotic System",
filed on Aug. 20, 1999; U.S. application Ser. No. 09/398,507,
entitled "Master Having Redundant Degrees of Freedom", filed on
Sep. 17, 1999, U.S. application Ser. No. 09/399,457, entitled
"Cooperative Minimally Invasive Telesurgery System", filed on Sep.
17, 1999; U.S. Provisional Application Serial No. 09/373,678,
entitled "Camera Referenced Control in a Minimally Invasive
Surgical Apparatus", filed on Aug. 13, 1999; U.S. Provisional
Application Serial No. 09/398,958, entitled "Surgical Tools for Use
in Minimally Invasive Telesurgical Applications", filed on Sep. 17,
1999; and U.S. Pat. No. 5,808,665, entitled "Endoscopic Surgical
Instrument and Method for Use", issued on Sep. 15, 1998.
BACKGROUND OF THE INVENTION
[0003] Advances in minimally invasive surgical technology could
dramatically increase the number of surgeries performed in a
minimally invasive manner. Minimally invasive medical techniques
are aimed at reducing the amount of extraneous tissue that is
damaged during diagnostic or surgical procedures, thereby reducing
patient recovery time, discomfort, and deleterious side effects.
The average length of a hospital stay for a standard surgery may
also be shortened significantly using minimally invasive surgical
techniques. Thus, an increased adoption of minimally invasive
techniques could save millions of hospital days, and millions of
dollars annually in hospital residency costs alone. Patient
recovery times, patient discomfort, surgical side effects, and time
away from work may also be reduced with minimally invasive
surgery.
[0004] The most common form of minimally invasive surgery may be
endoscopy. Probably the most common form of endoscopy is
laparoscopy, which is minimally invasive inspection and surgery
inside the abdominal cavity. In standard laparoscopic surgery, a
patient's abdomen is insufflated with gas, and cannula sleeves are
passed through small (approximately 1/2 inch) incisions to provide
entry ports for laparoscopic surgical instruments. The laparoscopic
surgical instruments generally include a laparoscope (for viewing
the surgical field) and working tools. The working tools are
similar to those used in conventional (open) surgery, except that
the working end or end effector of each tool is separated from its
handle by an extension tube. As used herein, the term "end
effector"means the actual working part of the surgical instrument
and can include clamps, graspers, scissors, staplers, and needle
holders, for example. To perform surgical procedures, the surgeon
passes these working tools or instruments through the cannula
sleeves to an internal surgical site and manipulates them from
outside the abdomen. The surgeon monitors the procedure by means of
a monitor that displays an image of the surgical site taken from
the laparoscope. Similar endoscopic techniques are employed in,
e.g., arthroscopy, retroperitoneoscopy, pelviscopy, nephroscopy,
cystoscopy, cisternoscopy, sinoscopy, hysteroscopy, urethroscopy
and the like.
[0005] There are many disadvantages relating to current minimally
invasive surgical (MIS) technology. For example, existing MIS
instruments deny the surgeon the flexibility of tool placement
found in open surgery. Most current laparoscopic tools have rigid
shafts, so that it can be difficult to approach the worksite
through the small incision. Additionally, the length and
construction of many endoscopic instruments reduces the surgeon's
ability to feel forces exerted by tissues and organs on the end
effector of the associated tool. The lack of dexterity and
sensitivity of endoscopic tools is a major impediment to the
expansion of minimally invasive surgery.
[0006] Minimally invasive telesurgical robotic systems are being
developed to increase a surgeon's dexterity when working within an
internal surgical site, as well as to allow a surgeon to operate on
a patient from a remote location. In a telesurgery system, the
surgeon is often provided with an image of the surgical site at a
computer workstation. While viewing a three-dimensional image of
the surgical site on a suitable viewer or display, the surgeon
performs the surgical procedures on the patient by manipulating
master input or control devices of the workstation. The master
controls the motion of a servomechanically operated surgical
instrument. During the surgical procedure, the telesurgical system
can provide mechanical actuation and control of a variety of
surgical instruments or tools having end effectors such as, e.g.,
tissue graspers, needle drivers, or the like, that perform various
functions for the surgeon, e.g., holding or driving a needle,
grasping a blood vessel, or dissecting tissue, or the like, in
response to manipulation of the master control devices.
[0007] A typical surgery employs a number of different surgical
instruments. When a different tool is desired during the surgical
procedure, the surgical instrument is typically withdrawn from the
surgical site so that it can be removed from its associated arm and
replaced with an instrument bearing the desired end effector. The
desired surgical instrument is then inserted into the surgical
site.
[0008] A surgical instrument may also be withdrawn from a surgical
site for reasons other than to replace the end effector. For
example, the loading of a clip in a clip applier used in affixing
tissue typically occurs outside of the patient's body. Each time a
new clip is desired, the clip applier is removed from the surgical
site to load the clip and then reintroduced into the patient's body
to apply the clip. Tool exchange and instrument loading for a
robotic system takes time. Providing additional surgical
instruments in the surgical site (and the typically associated need
to make additional incisions in the patient's body) may be an
undesirable alternative for any number of reasons, e.g., due to
space constraints, increase in system complexities, and/or
cost.
SUMMARY OF THE INVENTION
[0009] The present invention is generally directed to robotic
surgery methods, devices, and systems. The invention overcomes the
problems and disadvantages of the prior art by providing surgical
clips and/or other in vivo accessories at the surgical site. These
in vivo accessories can be manipulated by robotic surgical tools in
the site for performing different tasks. The accessories can be
held by a dedicated accessory holder or support that is introduced
into the surgical site through a separate opening. Alternatively,
the accessories can be supported on the body of one of the surgical
tools, and can be manipulated using another surgical tool in the
surgical site. The surgical tools in the surgical site can use the
accessories for performing a wide range of additional tasks without
leaving the surgical site. In this way, the need to exchange tools
and load instruments outside the surgical site is reduced, thereby
minimizing "down time".
[0010] In accordance with an aspect of the present invention, a
method of performing minimally invasive robotic surgery in a body
cavity of a patient includes introducing at least one surgical
accessory and a robotic surgical tool into the cavity. The surgical
accessory is coupled with the robotic surgical tool inside the
cavity after introducing the surgical accessory and the robotic
surgical tool into the cavity. The surgical accessory may be
decoupled from the robotic surgical tool inside the cavity.
[0011] In some embodiments, the robotic surgical tool is used to
grasp the surgical accessory inside the cavity of the patient. In
other embodiments, the surgical accessory is mated with the robotic
surgical tool to form a mated connection. The surgical accessory
may be coupled with the robotic surgical tool by introducing a
second robotic surgical tool into the cavity and using it to
facilitate coupling of the surgical accessory with the first
surgical tool.
[0012] In certain preferred embodiments, the surgical accessory is
introduced into the cavity supported by a surgical accessory
support and the surgical accessory is removable from the surgical
accessory support within the cavity. In a specific embodiment, the
surgical accessory support includes a container. In another
embodiment, the surgical accessory support includes a block having
a material which deflects to releasably secure one or more surgical
accessories therein. In yet another embodiment, the surgical
support is provided on the body of another robotic surgical tool
introduced into the cavity.
[0013] In a specific embodiment, a cartridge is introduced into the
cavity to provide a plurality of surgical clips. The surgical tool
is a clip applier. The clips are sequentially loaded in the clip
applier within the cavity and the loaded clips are affixed to a
target tissue with the clip applier.
[0014] In some embodiments, a portion of a master control device
located remotely from the patient is actuated by a user to control
the robotic surgical tool to grasp the surgical accessory. The
robotic surgical tool may be instructed to continue to grasp the
surgical accessory without requiring the user to continue to
actuate the actuatable portion of the master control device.
[0015] In accordance with another aspect of the invention, a method
of performing minimally invasive robotic surgery in a body cavity
of a patient includes introducing a robotic fastening tool and a
surgical accessory support into the cavity. The surgical accessory
support supports a plurality of fastening accessories. One of the
fastening accessories is loaded in the robotic fastening tool
inside the cavity. The loaded fastening accessory is affixed to a
target tissue inside the cavity with the robotic fastening
tool.
[0016] In a specific embodiment, the robotic fastening tool is a
clip applier and the fastening accessories include a plurality of
surgical clips. The clips are supported on a clip cartridge or on
the body of another robotic surgical tool introduced into the
cavity.
[0017] Another aspect of the present invention is directed to a
robotic surgical system for effecting a predetermined treatment of
a target tissue at an internal surgical site within a patient body.
The system includes a surgical accessory adapted for effecting the
treatment, and an accessory introducer having a proximal end and a
distal end with an opening therebetween. The distal end of the
introducer is insertable into the patient body so that the opening
defines a first minimally invasive aperture. The surgical accessory
is coupled with the distal end of the introducer and is passable
through the opening to the internal surgical site. A robotic arm
supports a surgical tool having an end effector suitable for
insertion through a second minimally invasive aperture to the
internal surgical site. The end effector is coupleable with the
surgical accessory within the internal surgical site so that the
robot arm can manipulate the surgical accessory to direct the
treatment to the target tissue.
[0018] In some embodiments, the accessory comprises a tool tip
configured to be releasably coupled to an end effector working
member of the surgical tool to form a tool tip for the end
effector. In specific embodiment, the end effector comprises a pair
of working members and the accessory comprises a pair of fingers
movably supported on a collar which is configured to be releasably
coupled with the surgical tool in a coupled position. The pair of
fingers mate with the pair of working members to be movable by the
pair of working members in the coupled position.
[0019] Another aspect of the invention is directed to an apparatus
for providing a surgical accessory in vivo through a wall of a
patient body into an internal cavity of the patient body for
effecting a desired treatment of a target tissue in the patient
body. The apparatus includes a surgical accessory adapted for
effecting the treatment and an accessory introducer having a
proximal end and a distal end with an opening therebetween. The
distal end of the introducer is insertable into the patient body so
that the opening defines a first minimally invasive aperture. The
surgical accessory is coupled with the distal end of the introducer
and passable through the opening to the internal cavity. A
resilient member is connected with the accessory introducer to
resiliently bias the surgical accessory to a preset desired
location within the internal cavity.
[0020] In a specific embodiment, the accessory introducer includes
a support member configured to be anchored to the wall of the
patient body at the opening. A slidable member is coupled with the
surgical accessory and is slidable relative to the support member.
The resilient member includes a spring coupled between the support
member and the slidable member.
[0021] In accordance with another aspect of the invention, a method
of performing minimally invasive robotic surgery in an internal
cavity of a patient body includes supporting a portion of a target
tissue with a first robotic surgical tool introduced into the
internal cavity. The first robotic surgical tool is electrically
conductive. The method further includes contacting another portion
of the target tissue with an electrically conductive cautery member
introduced into the internal cavity. The first robotic surgical
tool and the cautery member are energized for coagulating the
target tissue. In some embodiments, the first robotic surgical tool
and the cautery member are energized by connecting them to opposite
leads of a radiofrequency power source to form a bipolar system. In
a specific embodiment, the cautery member is held by a second
robotic surgical tool and electrically insulated therefrom.
[0022] In accordance with yet another aspect of the invention, a
robotic surgical system for performing a procedure on a body
comprises a surgical tool having an end effector including at least
two end effector members, the members capable of grasping an
object. A master control device has an actuatable portion which is
operatively connected to the surgical tool such that actuation of
the portion causes the at least two end effector members to grasp
the object. The system includes an input device for accepting an
input from a user to cause the end effector members to continue to
grasp without further actuation of the actuatable portion of the
master control device.
BRIEF DESCRIPTION OF THE DRAWINGS
[0023] FIG. 1A is a perspective view of an operator station of a
telesurgical system in accordance with an embodiment of the
invention;
[0024] FIG. 1B is a perspective view of a cart or surgical station
of the telesurgical system according to an embodiment of the
invention, the cart of this particular embodiment carrying three
robotically controlled arms, the movement of the arms being
remotely controllable from the operator station shown in FIG.
1A;
[0025] FIG. 2A is a side view of a robotic arm and surgical
instrument assembly according to an embodiment of the
invention;
[0026] FIG. 2B is a perspective view of the robotic arm and
surgical instrument assembly of FIG. 2A;
[0027] FIG. 3 is a perspective view of a surgical instrument
according to an embodiment of the invention;
[0028] FIG. 4 is a schematic kinematic diagram corresponding to the
side view of the robotic arm shown in FIG. 2A, and indicates the
arm having been displaced from one position into another
position;
[0029] FIG. 5 is a perspective view of a wrist member and end
effector of the surgical instrument shown in FIG. 3, the wrist
member and end effector being movably mounted on a working end of a
shaft of the surgical instrument;
[0030] FIG. 6A is a perspective view of a hand held part or wrist
gimbal of a master control device of the telesurgical system;
[0031] FIG. 6B is a perspective view of an articulated arm portion
of the master control device of the telesurgical system on which
the wrist gimbal of FIG. 6A is mounted in use;
[0032] FIG. 6C is a perspective view of the master control device
showing the wrist gimbal of FIG. 6A mounted on the articulated arm
portion of FIG. 6B;
[0033] FIGS. 6D and 6E depict a preferred embodiment of the master
control device shown in FIGS. 6A-6C having a locking mechanism for
locking the slave end effector into an actuated position;
[0034] FIG. 7 is a perspective view of a clip applier end effector
in accordance with the invention;
[0035] FIG. 8 is an exploded view of the clip applier end effector
shown in FIG. 7;
[0036] FIG. 9 is a schematic view of a clip cartridge for supplying
clips in vivo to a clip applier;
[0037] FIG. 10 is a schematic view illustrating supply of clips in
vivo by another surgical tool in the surgical site;
[0038] FIG. 11 is a perspective view showing examples of different
single working member accessories;
[0039] FIG. 11A is a schematic view illustrating a way of
performing electrocautery;
[0040] FIG. 11B is a schematic view illustrating another way of
performing electrocautery;
[0041] FIG. 12 is a side view of forceps;
[0042] FIG. 13 is a perspective view of a surgical accessory
support block according to an embodiment of the invention;
[0043] FIG. 14 is a perspective view of a surgical accessory
container according to another embodiment of the invention;
[0044] FIG. 15A is a perspective view of a surgical accessory
support belt in a deflated state according to another embodiment of
the invention;
[0045] FIG. 15B is a perspective view of the surgical accessory
support belt of FIG. 15A in an inflated state;
[0046] FIG. 16 is an elevational view of a tool tip for a single
working member end effector according to another embodiment of the
invention;
[0047] FIG. 17 is a perspective view of a pair of tool tips for a
double working member end effector according to another embodiment
of the invention;
[0048] FIG. 18A is a perspective view of a dual tip tool glove for
a double working member end effector according to another
embodiment of the invention;
[0049] FIG. 18B is a partial cross-sectional view of the dual tip
tool glove assembled with the double working member end effector of
FIG. 18A;
[0050] FIG. 19 is an exploded perspective view of insulative or
resilient sheaths for forceps;
[0051] FIG. 20 is a schematic view illustrating manipulation of an
in vivo flow tube by a grasping tool;
[0052] FIG. 21 is a schematic view illustrating introduction of an
in vivo flow tube into the surgical site using a needle; and
[0053] FIG. 22 is a schematic view illustrating an in vivo
retraction member.
DESCRIPTION OF THE SPECIFIC PREFERRED EMBODIMENTS
[0054] As used herein, "end effector" refers to the actual working
part that is manipulatable for effecting a predetermined treatment
of a target tissue. For instance, some end effectors have a single
working member such as a scalpel, a blade, or an electrode. Other
end effectors have a pair of working members such as forceps,
graspers, scissors, or clip appliers, for example.
[0055] As used herein, the terms "surgical instrument",
"instrument", "surgical tool", or "tool" refer to a member having a
working end which carries one or more end effectors to be
introduced into a surgical site in a cavity of a patient, and is
actuatable from outside the cavity to manipulate the end
effector(s) for effecting a desired treatment of a target tissue in
the surgical site. The instrument or tool typically includes a
shaft carrying the end effector(s) at a distal end, and is
preferably servomechanically actuated by a telesurgical system for
performing functions such as holding or driving a needle, grasping
a blood vessel, and dissecting tissue.
[0056] As used herein, the terms "surgical accessory" and
"accessory" refer to an assisting member that is introduced into
the surgical site in the cavity of the patient to be used by an
instrument or tool to perform a desired function in the surgical
site.
[0057] One type of accessory is loaded in a surgical instrument and
applied by the surgical instrument to a target tissue. For
instance, fastening accessories are adapted to be used with a
fastening tool for fastening tissues and the like. An example is a
clip for use with a clip applier which affixes or anchors the clip
to a target tissue. Another example is a suture needle with suture
material for use with a suturing tool.
[0058] Another type of accessory is a single working member
accessory such as a blade, a scalpel, a dissection finger, or an
electrode, which does not require the more complex mechanisms for
manipulating multiple working members such as forceps. For
instance, a single working member accessory can be grasped by a
tool having a pair of working members in a jaw-like arrangement,
which is adapted for manipulating different single working member
accessories and providing them with the desired degrees of freedom
in movement to perform different treatments.
[0059] The accessory may be a tool tip that is configured to be
releasably coupled to an end effector working member of the
surgical tool to form a tool tip for the end effector. For an end
effector having a pair of working members, the accessory may
include a pair of fingers movably supported on a collar which is
configured to be releasably coupled with the end effector in a
coupled position. The pair of fingers mate with the pair of working
members to be movable by the pair of working members in the coupled
position.
[0060] The working members of a tool can be modified by sheath
accessories. For instance, forceps on the working end of a tool can
be fitted with insulating sheaths when desired to inhibit electric
current leakage and prevent burning.
[0061] Another example of an accessory is a flow tube introduced
into the cavity of the patient for providing suction, introducing a
gas or a liquid, or transporting other matters into or out of the
cavity. Such a flow tube can be grasped by a grasping tool inside
the cavity and moved to the desired location for treating a
particular area of the patient's body.
[0062] A retraction accessory includes a gripping portion such as a
hook which can be manipulated by a grasping tool and used, e.g., to
grip a tissue inside the surgical site. The retraction accessory is
resiliently biased by a spring, preferably an adjustable spring, to
move to a desired location, thereby retracting the tissue to expose
an area in the surgical site for treatment. The retraction
accessory preferably can be manipulated from inside or outside the
body to further position tissue as desired, e.g., by providing a
friction slide on the spring mechanism to adjust the spring
preload. Further, a selection of springs of different tensions and
spring constants may be provided to the surgeon depending upon the
distances involved between the body wall and the tissue to be
retracted.
[0063] I. Exemplar Telesurgical System
[0064] FIG. 1A shows an operator station or surgeon's console 200
of a minimally invasive telesurgical system. The station 200
includes a viewer 202 where an image of a surgical site is
displayed in use. A support 204 is provided on which an operator,
typically a surgeon, can rest his or her forearms while gripping
two master controls (not shown in FIG. 1A), one in each hand. The
master controls are positioned in a space 206 inwardly beyond the
support 204. When using the control station 200, the surgeon
typically sits in a chair in front of the control station 200,
positions his or her eyes in front of the viewer 202 and grips the
master controls one in each hand while resting his or her forearms
on the support 204.
[0065] FIG. 1B shows a cart or surgical station 300 of the
telesurgical system. In use, the cart 300 is positioned close to a
patient requiring surgery and is then normally caused to remain
stationary until a surgical procedure to be performed has been
completed. The cart 300 typically has wheels or castors to render
it mobile. The station 200 is typically positioned remote from the
cart 300 and can be separated from the cart 300 by a great
distance, even miles away, but will typically be used within an
operating room with the cart 300.
[0066] The cart 300 typically carries three robotic arm assemblies.
One of the robotic arm assemblies, indicated by reference numeral
302, is arranged to hold an image capturing device 304, e.g., an
endoscope, or the like. Each of the two other arm assemblies 10
respectively, includes a surgical instrument 14. The endoscope 304
has a viewing end 306 at a remote end of an elongate shaft thereof.
It will be appreciated that the endoscope 304 has an elongate shaft
to permit its viewing end 306 to be inserted through an entry port
into an internal surgical site of a patient's body. The endoscope
304 is operatively connected to the viewer 202 to display an image
captured at its viewing end 306 on the viewer 202. Each robotic arm
assembly 10 is normally operatively connected to one of the master
controls. Thus, the movement of the robotic arm assemblies 10 is
controlled by manipulation of the master controls. The instruments
14 of the robotic arm assemblies 10 have end effectors that are
mounted on wrist members which are pivotally mounted on distal ends
of elongate shafts of the instruments 14, as is described in
greater detail below. It will be appreciated that the instruments
14 have elongate shafts to permit the end effectors to be inserted
through entry ports into the internal surgical site of a patient's
body. Movement of the end effectors relative to the ends of the
shafts of the instruments 14 is also controlled by the master
controls.
[0067] The robotic arms 10, 10, 302 are mounted on a carriage 97 by
means of setup joint arms 95. The carriage 97 can be adjusted
selectively to vary its height relative to a base 99 of the cart
300, as indicated by arrows K. The setup joint arms 95 are arranged
to enable the lateral positions and orientations of the arms 10,
10, 302 to be varied relative to a vertically extending column 93
of the cart 300. Accordingly, the positions, orientations and
heights of the arms 10, 10, 302 can be adjusted to facilitate
passing the elongate shafts of the instruments 14 and the endoscope
304 through the entry ports to desired positions relative to the
surgical site. When the surgical instruments 14 and endoscope 304
are so positioned, the setup joint arms 95 and carriage 97 are
typically locked in position.
[0068] As shown in FIGS. 2A and 2B, each robotic arm assembly 10
includes an articulated robotic arm 12 and a surgical instrument 14
mounted thereon. As best seen in FIG. 3, the surgical instrument 14
includes an elongate shaft 14.1 and a wrist-like mechanism 50
located at a working end of the shaft 14.1. A housing 53, arranged
releasably to couple the instrument 14 to the robotic arm 12, is
located at an opposed end of the shaft 14.1. The shaft 14.1 is
rotatably coupled to the housing 53 at 55 to enable angular
displacement of the shaft 14.1 relative to the housing 53 as
indicated by arrows H. In FIG. 2A, and when the instrument 14 is
coupled or mounted on the robotic arm 12, the shaft 14.1 extends
along an axis 14.2. The instrument 14 typically is releasably
mounted on a carriage 11, which can be driven to translate along a
linear guide formation 24 of the arm 12 in the direction of arrows
P.
[0069] The robotic arm 12 is typically mounted on a base or
platform at an end of its associated setup joint arm 95 by a
bracket or mounting plate 16. The robotic arm 12 includes a cradle
18, an upper arm portion 20, a forearm portion 22, and the guide
formation 24. The cradle 18 is pivotally mounted on the plate 16 in
a gimbaled fashion to permit rocking movement of the cradle 18 in
the direction of arrows 26 about a pivot axis 28 (FIG. 2B). The
upper arm portion 20 includes link members 30, 32 and the forearm
portion 22 includes link members 34, 36. The link members 30, 32
are pivotally mounted on the cradle 18 and are pivotally connected
to the link members 34, 36. The link members 34, 36 are pivotally
connected to the guide formation 24. The pivotal connections
between the link members 30, 32, 34, 36, the cradle 18, and the
guide formation 24 are arranged to constrain the robotic arm 12 to
move in a specific manner.
[0070] The movements of the robotic arm 12 are illustrated
schematically in FIG. 4. The solid lines schematically indicate one
position of the robotic arm and the dashed lines indicate another
possible position into which the arm can be displaced from the
position indicated in solid lines.
[0071] It will be understood that the axis 14.2 along which the
shaft 14.1 of the instrument 14 extends when mounted on the robotic
arm 12 pivots about a pivot center or fulcrum 49. Thus,
irrespective of the movement of the robotic arm 12, the pivot
center 49 normally remains in the same position relative to the
stationary cart 300 on which the arm 12 is mounted. In use, the
pivot center 49 is positioned at a port of entry into a patient's
body when an internal surgical procedure is to be performed. It
will be appreciated that the shaft 14.1 extends through such a port
of entry, the wrist-like mechanism 50 then being positioned inside
the patient's body. Thus, the general position of the mechanism 50
relative to the surgical site in a patient's body can be changed by
movement of the arm 12. Since the pivot center 49 is coincident
with the port of entry, such movement of the arm does not
excessively effect the surrounding tissue at the port of entry.
[0072] As can best be seen in FIG. 4, the robotic arm 12 provides
three degrees of freedom of movement to the surgical instrument 14
when mounted thereon. These degrees of freedom of movement are
firstly the gimbaled motion indicated by arrows 26, pivoting or
pitching movement as indicated by arrows 27 and the linear
displacement in the direction of arrows P. Movement of the arm as
indicated by arrows 26, 27 and P is controlled by appropriately
positioned actuators, e.g., electrical motors or the like, which
respond to inputs from its associated master control to drive the
arm 12 to a desired position as dictated by movement of the master
control. Appropriately positioned sensors, e.g., potentiometers,
encoders, or the like, are provided on the arm and its associated
setup joint arm 95 to enable a control system of the minimally
invasive telesurgical system to determine joint positions, as
described in greater detail below. The term "sensors" as used
herein is to be interpreted widely to include any appropriate
sensors such as positional sensors, velocity sensors, or the like.
By causing the robotic arm 12 selectively to displace from one
position to another, the general position of the wrist-like
mechanism 50 at the surgical site can be varied during the
performance of a surgical procedure.
[0073] Referring now to the wrist-like mechanism 50 of FIG. 5, the
working end of the shaft 14.1 is indicated at 14.3. The wrist-like
mechanism 50 includes a wrist member 52. One end portion of the
wrist member 52 is pivotally mounted in a clevis 17 on the end 14.3
of the shaft 14.1 by means of a pivotal connection 54. The wrist
member 52 can pivot in the direction of arrows 56 about the pivotal
connection 54. An end effector 58 is pivotally mounted on an
opposed end of the wrist member 52. The end effector 58 has two
parts 58.1, 58.2 together defining a jaw-like arrangement.
[0074] The end effector can be in the form of any desired surgical
tool, e.g., having two members or fingers which pivot relative to
each other, such as a clip applier for anchoring clips, scissors,
two-fingered blunt dissection tools, forceps, pliers for use as
needle drivers, or the like. Moreover, it can include a single
working member, e.g., a scalpel, cautery electrode, or the like.
When a different tool is desired during the surgical procedure, the
tool 14 is simply removed from its associated arm and replaced with
an instrument bearing the desired end effector.
[0075] In FIG. 5, the end effector 58 is a grip applier. The end
effector 58 is pivotally mounted in a clevis 19 on an opposed end
of the wrist member 52, by means of a pivotal connection 60. The
free ends 11, 13 of the parts 58.1, 58.2 are angularly displaceable
about the pivotal connection 60 toward and away from each other as
indicated by arrows 62, 63. The members 58.1, 58.2 can be displaced
angularly about the pivotal connection 60 to change the orientation
of the end effector 58 as a whole, relative to the wrist member 52.
Thus, each part 58.1, 58.2 is angularly displaceable about the
pivotal connection 60 independently of the other, so that the end
effector 58, as a whole, is angularly displaceable about the
pivotal connection 60 as indicated in dashed lines in FIG. 5.
Furthermore, the shaft 14.1 is rotatably mounted on the housing 53
for rotation as indicated by the arrows 59. Thus, the end effector
58 has three degrees of freedom of movement relative to the arm 12
in addition to actuation of the end effector members to, e.g., grip
tissue, namely, rotation about the axis 14.2 as indicated by arrows
59, angular displacement as a whole about the pivot 60 and angular
displacement about the pivot 54 as indicated by arrows 56. By
moving the end effector within its three degrees of freedom of
movement, its orientation relative to the end 14.3 of the shaft
14.1 can selectively be varied. The movement of the end effector
relative to the end 14.3 of the shaft 14.1 is controlled by
appropriately positioned actuators, e.g., electrical motors, or the
like, which respond to inputs from the associated master control to
drive the end effector 58 to a desired orientation as dictated by
movement of the master control. Furthermore, appropriately
positioned sensors, e.g., encoders, or potentiometers, or the like,
are provided to permit the control system of the minimally invasive
telesurgical system to determine joint positions.
[0076] One of the master controls 700 is shown in FIG. 6C. As seen
in FIG. 6A, a hand held part or wrist gimbal 699 of the master
control device 700 has an articulated arm portion including a
plurality of members or links 702 connected together by pivotal
connections or joints 704. The surgeon grips the part 699 by
positioning his or her thumb and index finger over a pincher
formation 706. The surgeon's thumb and index finger are typically
held on the pincher formation 706 by straps (not shown) threaded
through slots 710. When the pincher formation 706 is squeezed
between the thumb and index finger, the fingers or end effector
elements of the end effector 58 close. When the thumb and index
finger are moved apart the fingers of the end effector 58 move
apart in sympathy with the moving apart of the pincher formation
706. The joints of the part 699 are operatively connected to
actuators, e.g., electric motors, or the like, to provide for,
e.g., force feedback, gravity compensation, and/or the like.
Furthermore, appropriately positioned sensors, e.g., encoders, or
potentiometers, or the like, are positioned on each joint 704 of
the part 699, so as to enable joint positions of the part 699 to be
determined by the control system.
[0077] The part 699 is typically mounted on an articulated arm 712
as indicated in FIG. 6B. Reference numeral 4 in FIGS. 6A and 6B
indicates the positions at which the part 699 and the articulated
arm 712 are connected together. When connected together, the part
699 can displace angularly about an axis at 4.
[0078] The articulated arm 712 includes a plurality of links 714
connected together at pivotal connections or joints 716. The
articulated arm 712 further has appropriately positioned actuators,
e.g., electric motors, or the like, to provide for, e.g., force
feedback, gravity compensation, and/or the like. Furthermore,
appropriately positioned sensors, e.g., encoders, or
potentiometers, or the like, are positioned on the joints 716 so as
to enable joint positions of the articulated arm 712 to be
determined by the control system.
[0079] To move the orientation of the end effector 58 and/or its
position along a translational path, the surgeon simply moves the
pincher formation 706 to cause the end effector 58 to move to where
he wants the end effector 58 to be in the image viewed in the
viewer 202. Thus, the end effector position and/or orientation is
caused to follow that of the pincher formation 706.
[0080] The master control devices 700, 700 are typically mounted on
the station 200 through pivotal connections at 717 as indicated in
FIG. 6B. As mentioned above, to manipulate each master control
device 700, the surgeon positions his or her thumb and index finger
over the pincher formation 706. The pincher formation 706 is
positioned at a free end of the part 699 which in turn is mounted
on a free end of the articulated arm portion 712.
[0081] The electric motors and sensors associated with the robotic
arms 12 and the surgical instruments 14 mounted thereon, and the
electric motors and sensors associated with the master control
devices 700 are operatively linked in the control system. The
control system typically includes at least one processor, typically
a plurality of processors, for effecting control between master
control device input and responsive robotic arm and surgical
instrument output and for effecting control between robotic arm and
surgical instrument input and responsive master control output in
the case of, e.g., force feedback. An example of a suitable control
system is described in U.S. application Ser. No. 09/373,678,
entitled "Camera Referenced Control in a Minimally Invasive
Surgical Apparatus", filed on Aug. 13, 1999.
[0082] II. In Vivo Accessories
[0083] To minimize the need to remove tools from the surgical site
for tool replacement or instrument loading, the present invention
provides ways to present a variety of accessories in vivo. The
surgeon can manipulate these in vivo accessories using tools
already in the surgical site and adapt them for performing
different functions without the need to remove the tools from the
surgical site. A number of examples of in vivo accessories are
provided herein below.
[0084] A. Instrument Loading Accessories
[0085] Certain instruments are used by loading accessories
specifically adapted for use with the particular instruments to
perform the intended tasks. For example, fastening accessories such
as clips are specifically adapted for use with a clip applier. The
clips are loaded in a clip applier which affixes or anchors the
clips one at a time to a target tissue.
[0086] FIGS. 7 and 8 show in greater detail the clip applier end
effector 58 for the tool 14 of FIG. 5. The parts 58.1, 58.2 of the
end effector 58 are typically the same so as to keep production
costs low. Accordingly, the parts 58.1, 58.2 each include an
elongate finger portion or end effector element 58.3. The finger
portion 58.3 is integrally formed with an end effector mounting
formation in the form of, e.g., a pulley portion 58.5. The pulley
portion 58.5 defines a circumferentially extending channel 58.6 in
which an elongate element in the form of, e.g., an activation
cable, is carried, as described in greater detail herein below.
[0087] The pulley portion 58.5 includes an axially extending,
centrally disposed hole 58.7 through which a pivot pin of the
pivotal connection 60 extends. A generally circumferentially
directed hole 58.8 extends through a nape region of the finger
portion 58.3 and generally in register with the circumferentially
extending channel 58.6. The hole 58.8 has a first portion 58.9 and
a second portion 58.10 having a diameter greater than the first
portion 58.9. In use, the activation cable has a thickened portion
along its length which seats in the hole portion 58.10, the rest of
the activation cable then extending along the channel 58.6 in
opposed directions. The thickened portion is crimped in its seated
position in the hole portion 58.10 so as to anchor the cable in the
hole 58.8. It will be appreciated that a greater force is necessary
to clamp the free ends together when gripping an object
therebetween, than that which is required to open the free ends 11,
13. Thus, the thickened portion of the cable is urged against an
annular stepped surface between the hole portion 58.9 and the hole
portion 58.10, when the free ends 11, 13 are urged into a closed
condition. The part 58.1, 58.2 has an operatively inwardly directed
face 58.11 which rides against the face 58.11 of the other one of
the parts 58.1, 58.2.
[0088] In use, a clip 75, as indicated in FIG. 8, is positioned
between the finger portions 58.3. Opposed limbs 75.1, 75.2 of the
clip 75 are positioned in longitudinally extending recesses or
seats 58.13 in each of the finger portions 58.1, 58.2. It is
important that the clip is securely seated in the clip applier 58
until the clip applier is caused to anchor the clip in position. If
the clip 75 is not securely seated, the clip 75 could become
dislocated from the clip applier 58. In such a case, valuable time
could be lost in trying to find and recover the clip 75 from the
surgical site. To cause the clip 75 to seat securely on the clipper
pliers 58, the portions 58.1 58.2 are biased or urged in a closing
direction so as to clamp the clip 75 in the opposed seats or
recesses 58.13. The biasing or urging arrangement to cause such
clamping of the clip 75 in the seats 58.13, as well as the
mechanisms for operating the clip applier end effector 58, are
discussed in detail in U.S. application Ser. No. 09/398,958,
entitled "Surgical Tools for Use in Minimally Invasive Telesurgical
Applications", (Docket No. 17516-4410), filed on Sep. 17, 1999, the
entirety of which is herein incorporated by reference.
Alternatively, as described in the '958 application, instead of
being urged or biased towards each other, portions 58.1 and 58.2
can be constructed in such a way (with open-ended recesses 58.13)
as to open (e.g., against mechanical stops) to a predetermined
angular position slightly less than the angle of the clips to be
used. Thus, the natural resistance of the clip to deformation
provides sufficient friction when loaded into the clip applier that
a separate biasing means is unnecessary.
[0089] Normally, in use, the clip applier having the end effector
58 is removed from the surgical site, a clip 75 is then positioned
between the finger portions 58.3, and then the end effector 58 is
reintroduced into the patient's body so as to apply or anchor the
clip 75 where required. To apply the clip, the master controls are
manipulated to cause the clip applier to close so as to bend the
clip 75. When the clip 75 has been applied, the end effector 58 can
again be opened and removed from the surgical site, another clip 75
can then be positioned between the finger portions 58.3, and the
end effector can again be introduced to the surgical site to apply
that clip and so on, until all the required clips have been applied
or anchored in position. This process is time-consuming.
[0090] In accordance with an embodiment of the present invention,
the clips 75 are introduced into the surgical site 77 in a cavity
of a patient by a dedicated surgical accessory support in the form
of a cartridge 76. The end effector 58 of the clip applier can be
manipulated servomechanically or manually from outside the cavity
to load a clip 75 from the cartridge 76 and affix the clip 75 to a
target tissue inside the cavity. The end effector 58 need not be
removed from the surgical site 77 for loading the clip 75 and
reintroduced into the surgical site 77.
[0091] In another embodiment shown in FIG. 10, the clips 75 are
supported on the shaft of another tool 81 having an end effector
81.1 in a "piggyback" arrangement, thereby eliminating the need to
open a separate port for introducing a dedicated accessory support
into the surgical site 77. Cannula sleeves 77.1 are typically
provided through the wall 77.2 of the patient's body for
introducing the surgical tools and accessory support into the
surgical site 77.
[0092] As can be understood with reference to FIG. 10, releasably
mounting a surgical accessory (such as clip 75) to a robotically
controlled structure (such as tool 81) may facilitate mating of the
accessory with tool 14. Tool 81 can be easily and accurately
positioned in a field of view of scope 306 for loading the clip
applier 58. Tool 14 and/or tool 81 may be positioned and moved to
accurately transfer clip 75 from tool 81 to clip applier 58 within
the field of view from the scope using the robotic servomechanism
to generate the desired clip loading forces, without having to
verbally coordinate hand movements of two different persons.
[0093] B. Single Working Member Accessories
[0094] Another type of accessory is a single working member
accessory such as a blade, a scalpel, a dissection finger, or an
electrode, which does not require the more complex mechanisms for
manipulating multiple working members such as forceps and clip
appliers. For instance, the single working member accessory can be
grasped by jaw-like working members such as forceps on a tool which
can be used for manipulating different single working member
accessories and providing them with the desired degrees of freedom
of movement to perform different treatments on tissues in the
surgical site.
[0095] FIG. 11 shows examples of single working member accessories,
including a cautery or electrosurgical hook 118, a cautery blade
119, a scalpel 120, and a dissection finger 121 or Kittner for
blunt dissection. Another example of a single working member
accessory is an electrocautery electrode 122 used to generate an
electrical current at a surgical site so as to bum or seal, e.g.,
ruptured blood vessels. In use, the patient is earthed and a
voltage is supplied to the electrode 122. An electrically
conductive cable 124 is connected to the electrode 122. In use, the
cable 124 couples the electrode 122 to an appropriate electrical
source outside the surgical site, preferably through an accessory
body wall port. The conductive cable 124 is typically sheathed in
an insulative material such as, e.g., TEFLON.TM.. The electrode, in
the form of a blade or hook, e.g., or other accessories may be
dangled into the patient's body cavity through a body wall port by
way of the cable and/or an associated spring mechanism, as
disclosed in the context of FIGS. 16 and 18A. Grasping tool can be
used to grasp one of the single working member accessories and
manipulate its movement to treat the target tissue. Exemplary
electrosurgical implements are disclosed in U.S. Application No.
09/ (Attorney Docket No. 17516-007200), entitled "Minimally
Invasive Surgical Hook Apparatus & Method for Using Same",
filed on Oct. 8, 1999, the entirety of which is herein incorporated
by reference.
[0096] It will be appreciated that should the distance between the
electrode 122 and the patient be relatively great when a voltage is
applied, current may jump from the electrode 122 to other
conductive parts of the instrument. In such a case, current can be
passed from the grasping tool to the patient along a path of least
resistance, e.g., at the entry port coincident with the center of
rotation 49 (see FIGS. 2A and 2B). This may cause unnecessary
burning at the entry port. One way of avoiding such current flow is
to insulate the electrode 122 from the grasping tool so as to
inhibit current leakage from the electrode 122 to the tool.
Accordingly, the components of the grasping tool may be made of
non-conductive material such as, e.g., ULTEM.TM. or VECTRAN.TM..
The shaft of the tool is typically made entirely from a
nonconductive material, or at least sheathed in such a material, to
insulate the shaft from the patient, in particular in the region of
the port of entry. The preferred nonconductive material for the
shaft 114.1 comprises an electrical grade fiberglass/vinyl ester
composite material. A shaft of stainless steel or carbon fiber may
be coated with, e.g., a nylon or parylene, such as Nylon-11 or
Parylene C.
[0097] FIG. 11A shows one way of performing electrocautery with
superior safety and precision. The electrode 122 is grasped by a
grasping tool such as forceps 125 having insulative components for
making contact with the electrode 122. Alternatively, the electrode
22 can be partially sheathed in nonconductive material for making
contact with the other tool. Another tool 127A is used to hold a
tissue such as a vessel 129A. The portion of the tool 127A in
contact with the tissue 129A is electrically conductive. The
electrode 122 is coupled with one lead of a bipolar system, while
the grasping tool 127A holding the tissue 129A is coupled with the
other lead of the bipolar system. The electrode 122 is an active
electrode and the tool 127A is a passive electrode. The tissue
disposed between the active and passive electrodes complete the
electrical circuit of the bipolar system. When sufficient power is
introduced, coagulation of the tissue between the electrode 122 and
the tool 127A occurs.
[0098] In another embodiment shown in FIG. 11B, the tool 127B is
placed behind the target area of the tissue 129B, while the
electrode 122 approaches the target area from the front to define a
specific coagulation zone. In both FIGS. 11A and 11B, the
coagulation zone for the tissue 129B is well-defined to provide
safe, direct electrocauterization.
[0099] FIG. 12 shows an example of a grasping tool having forceps
110 for grasping and manipulating one of the single working member
accessories inside the surgical site. The forceps 110 is mounted on
a wrist mechanism similar to the wrist mechanism 50. The forceps
110 has two working members 110.1, 110.2. The working members
110.1, 110.2 are slightly bent to define a space 112 between them.
In use, it is difficult to provide force feedback to the master
controls. Thus, it could happen that an organ, or tissue, or the
like, can be grasped by forceps with too much force which may
unnecessarily damage such organ or tissue. To inhibit this, the
space 112 is provided. The members 110.1, 110.2 have a degree of
resilience. Thus, when the forceps is used, the surgeon
manipulating the master controls can obtain an indication of the
force applied when grasping with the forceps 110 by visually
monitoring resilient deflection of the members 110.1, 110.2
relative to each other, all as described in U.S. application Ser.
No. 09/398,958.
[0100] The single working member accessories can be introduced into
the surgical site in any suitable way. For instance, each accessory
can be connected to a cable and inserted through an opening into
the surgical site and be removed from the site by pulling on the
cable from outside the patient's body. Alternatively, an accessory
support can be used to introduce a plurality of accessories into
the surgical site.
[0101] FIG. 13 illustrates a surgical accessory support in the form
of a block 126 for holding the accessories such as the cautery
blade 119, scalpel 120, and dissection finger 121. The block 126 is
introduced through the cavity wall 77.2 via a cannula sleeve 77.1.
The support block 126 in one embodiment is made of a foam material
or the like which deflects to releasably secure the accessories
therein. The accessories can be removed by the grasping tool 110
inside the surgical site to perform a desired treatment and then
returned to the block 126 after use. The block 126 is particularly
suitable for supporting sharp objects such as blades and
scalpels.
[0102] FIG. 14 shows a container or box 130 as another embodiment
of a surgical accessory support. The box 130 extends through the
cavity wall 77.2 via a cannula sleeve 77.1. A handle 132 supports
the box 130 in the surgical site from outside the patient's cavity.
The box 130 includes a compartment 134 for housing accessories and
a door 136 which can be opened to allow access to the accessories,
and be closed during transportation of the box 136 into and out of
the surgical site. A variety of mechanisms can be used to control
movement of the door 136. In the embodiment shown, a control rod
138 is connected with the door 136 and extends through the end of
the handle 132. The control rod 138 allows the operator to open the
door 136 by pushing the rod 138 toward the handle 132 and to close
the door 130 by pulling the rod 138 away from the handle 132. A
physical or solenoid-activated latch might be included to lock the
door in an open configuration during an operation, if desired. It
is appreciated that other devices can be used for introducing the
surgical accessories into the surgical site and supporting them
therein.
[0103] In another embodiment as shown in FIG. 15A, an inflatable
tool belt or support 730 can be used to hold accessories 732 such
as needles, gauze, or blades, and can be inserted into the surgical
site through a port with the tool belt 730 in a deflated state. The
accessories 732 may be releasably attached to the tool belt 730 in
any suitable manner, such as the use of velcro or the like. After
the tool belt 730 has been inserted into the surgical site, it can
be inflated in a manner similar to a balloon catheter to expose the
accessories 732 so that they may be used in the surgical site, as
illustrated in FIG. 15B. The inflated tool belt 730 provides
support for the accessories 732 and may cause the accessories to
stand in an erect position, making them more easily graspable by a
grasping tool such as forceps 110 or the like. The tool belt 730
can be deflated for retraction. A mechanism similar to those used
for balloon catheters can be used for inflating and deflating the
tool belt 730.
[0104] Single working member end effectors, such as a blade or a
scalpel on a surgical tool can also be replaced inside the patient
without removing the tool from the patient's body cavity.
Mechanisms allowing such replacement include, e.g., a blade mounted
on a pliable polymeric sleeve that fits snugly over a finger-like
projection. For replacement, the tool is simply loosened and
attached to an accessory belt of the type disclosed herein, and
replaced with another single member tool having a similar sheath
mounting structure. Alternative methods of mounting single member
tools to the end of a robotic tool are disclosed in FIGS. 17-19 of
U.S. application Ser. No. 09/398,598, which is incorporated herein
by reference in its entirety.
[0105] C. Tool Tip Accessories
[0106] FIG. 16 shows an example of a removable tool tip 740 for a
single working member end effector 742 having a drive pulley 744
connected with a tool end 746. The tool tip 740 is one of a
plurality of tool tip accessories that can be introduced separately
into the surgical tool so that the end effector 742 can be fitted
with different tool tips for performing different procedures as
desired without having to leave the surgical site. Examples of tool
tips include blades, scalpels, electrodes, and the like. The tool
tip 740 and the tool end 746 are configured to form a mating
connection. The tool tip 740 can be grasped by a grasping tool and
be snapped or wedged onto the tool end 746. In the embodiment
shown, the tool tip 740 has a protrusion 747 that detachably fits
into a slot or recess 748 of the tool end 746. To remove the tool
tip 740, the grasping tool can be used to grasp the tool tip 740
and disengage it from the tool end 746. It is understood that other
detachable mechanisms may be used for connecting the tool tip 740
with the tool end 746 including, for example, cantilever-type snaps
or the like.
[0107] In FIG. 17, a double working member end effector 750 has a
pair of tool ends 752 that can be fitted with two tool tips 754 by
mating protrusions 757 of the tool tips 754 with slots 758 of the
tool ends 752. A pair of drive pulleys 756 are connected with the
tool ends 752 to move the tool tips 754 in a jaw-like arrangement.
The tool tips 754 may include sets of forcep tips or other jaw-like
working member tips of varying sizes or shapes.
[0108] Another way to provide different tool tips for a double
working member end effector is to use a dual tip tool glove 760 as
illustrated in FIGS. 18A and 18B. As shown in FIG. 18A, the tool
glove 760 includes a pair of fingers 762 that are pivotally
attached to a tool glove support or collar 764. The collar 764 is a
hollow member configured to be placed over the wrist member 766 of
a double working member end effector 768. The wrist member 766
supports a pair of drive pulleys 770 that are connected to a pair
of tool ends or nubs 772. The tool nubs 772 are inserted into a
pair of openings 774 of the pair of fingers 762 of the tool glove
760 when the tool glove 760 is joined with the wrist member 766 in
the attached position shown in FIG. 18B. The pulleys 770 are
actuatable (typically by cables) to rotate the tool nubs 772 which
in turn cause the fingers 762 to rotate and to move, e.g., in
ajaw-like manner.
[0109] The collar 764 is configured to be releasably locked onto
the wrist member 766. As best seen in FIG. 18B, the collar 764
includes a spring retention ring 776 which applies a resilient
force to wrap around a groove 778 on the wrist member 766 to
resiliently lock the collar 764 onto the wrist member 766 in the
attached position. The spring retention ring 776 is typically a
metal ring held in a groove in the collar 764, and can split to
expand in diameter and allow the collar 764 to be placed over the
wrist member 766. A grasping tool may be used to manipulate the
tool glove 760 for assembly with the wrist member 766. When the
retention ring 776 reaches the groove 778 on the wrist member 766,
it contracts around the groove 778 from the split position, thereby
releasably locking the collar 764 onto the wrist member 766. To
disconnect the tool glove 760 from the wrist member 766, a
sufficient pulling force is applied to the tool glove 760 via the
grasping tool to overcome the resilient force of the retention ring
776. It is appreciated that other releasable locking mechanisms may
be used for locking the tool glove 760 onto the wrist member 766 of
the end effector 768. Further, the fingers 762 of the tool glove
760 may have other configurations.
[0110] It has been found that when a surgeon uses a grasper to grab
and hold an accessory tool for an extended period of time to
perform surgery, in the manner previously described, the surgeon at
some point may wish to relax his grip on the master control without
the grasper losing its grip on the accessory tool. Further, the
surgeon may wish to operate using the accessory tool without having
to constantly grip the master control to actuate the grasper to
grip the accessory. This ability to avoid constantly having to
actuate two-member tools to close/grip is also desirable, e.g.,
during suturing, when the surgeon may need to exert a large
gripping force on a needle while manipulating the needle to sew
tissue. Such maneuvers sometimes can prove awkward and tiring to
the surgeon's hands if too much gripping in involved over a long
period of time. This problem is addressed by providing the surgeon
with the ability to "lock" the graspers closed, after actuation, so
that the graspers remain closed and gripping, e.g., a needle or
accessory tool until the surgeon commands the graspers to do
otherwise. Locking the two-membered tool in a closed/gripping
position allows the surgeon to relax his gripping pressure on the
master control after actuation of the tool. This functionality can
be implemented in any number of ways, such as by the surgeon
physically- or voice-activating a switch or button or latch on the
master control while the tool is actuated, to instruct the system
to maintain the tool's actuation until a further command is
received, or by programming the control computer to detect when the
operator intends to actuate the virtual locking function, e.g., by
detecting a threshold closing force on the masters applied over a
specific period of time, such as two seconds. Several threshold
forces, corresponding to several different closing/locking forces
might be provided as desired. Once the command is given, the
computer would lock that particular tool into position and either
maintain the particular force applied by the surgeon at the time
the locking command was provided, or would maintain a maximum
gripping force (depending upon how the system is configured)
without further gripping force from the surgeon on the
corresponding master control, until a further "unlock" command is
given. Upon activation in this manner, the surgical system
preferably would provide the surgeon with a perceivable indication
that the tool was locked, e.g., through an audible sound,
illumination of a locking light, illumination of an icon on the
surgeon's console screen, etc. One example of a latch locking
mechanism is shown in FIG. 6D. Sliding button 703 in slot 701 has
two positions, as more clearly seen in FIG. 6E. When in a first
position, latches 705 and 707 do not catch when the pincher
formation 706 is closed. When in a second position, however,
latches 705 and 707, preferably made of a resilient metal such as
spring steel (similar to the latching mechanism on the Castro-Viejo
Needle Drivers made by Scanlan), do catch, thereby keeping the
master locked into position and the slave end effector actuated
until released. In this embodiment, the pincher formation remains
in a closed profile. If desired, the end effector could be locked
as described above while leaving the surgeon free to continue to
manipulate the pincher formation as before--e.g., for comfort
reasons--but without giving the surgeon the ability to further
affect the actuation of the end effector until "unlocking" the
mechanism.
[0111] The tool is preferably unlocked in similar manner by a
threshold outward force on the master actuation controls, or
activation of a separate button or voice control. Upon unlocking,
the surgeon would again be able to control the end effector as
before, and preferably would be provided with an indication from
the system that the unlock command had been received, such as
another audible or visual signal or elimination of the previously
illuminated icon.
[0112] D. Sheath Accessories
[0113] Sheath accessories can be used to modify the working members
of a surgical tool. For instance, a pair of jaw-like working
members such as forceps on the working end of a tool can be fitted
with insulating sheaths or resilient sheaths when desired.
[0114] FIG. 19 shows forcep sheaths 140 configured to fit over
working members 110.1, 110.2 of forceps 110, forming a mated
connection therewith. For insulation, the forcep sheaths 140 are
made of an insulative material such as rubber, VECTRAN.TM.,
ULTEM.TM., or the like. In an alternative embodiment, the forcep
sheaths 140 are made of a resilient material such as an elastomer
for protecting tissues from damage caused by excessive pressure
exerted by the forceps 110. The surgeon can visually monitor the
deformation of the resilient sheaths 140 and adjust the gripping
force accordingly. The sheaths 140 can be introduced into the
surgical site by the container of FIG. 14, and be placed over the
forceps 110 while inside the body cavity using another grasping
tool, for example.
[0115] E. Other Accessories
[0116] Another example of an accessory is a flow tube 150
introduced into the cavity of the patient for providing suction,
introducing a gas or a liquid, or transporting other matters into
or out of the cavity, as shown in FIG. 20. The flow tube 150 can be
grasped, for example, by a grasping tool having forceps 110 inside
the cavity and moved to the desired location for treating a
particular area of the patient's body.
[0117] In FIG. 20, the flow tube 150 is inserted through the cavity
wall 77.2 of a patient into the cavity via a tube support 152. The
flow tube 150 is typically flexible. The flow tube 150 includes an
opening 154 at a distal end. The flow tube 150 can be connected
with a vacuum source to provide suction to draw out fluid or other
matters from the cavity through the opening 154, or an external
source for introducing a fluid in the form of a liquid such as
saline or a gas such as CO.sub.2 into the surgical site, or the
like. In one embodiment, the flow through the opening 154 of the
tube 150 can be modulated by adjusting the grip of the grasper on
the tube 150.
[0118] To minimize interference with the manipulation of tools in
the surgical site, the flow tube 150 is advantageously resiliently
biased by a spring 156 to return to the location near the tube
support 152 at the aperture of the cavity wall 77.2. The spring 156
compresses when the tube 150 is pulled further into the surgical
site and causes the tube 150 to automatically return closer to the
wall aperture when the tube 150 is released by the forceps 110. In
this way, the flow tube 150 stays clear of the remaining area of
the surgical site. It is appreciated that other suitable resilient
mechanisms may be employed, and that a similar resilient mechanism
can be adapted for use with other accessory introducing
devices.
[0119] In some cases, the tube 150 is sufficiently small that the
tube support 152 is no larger in cross-section than a typical
hypodermic needle. FIG. 21 shows the use of a hollow needle 158 for
introducing the flow tube 150 into the internal cavity 77. A pad
159 is affixed to the external surface of the cavity wall 77.2 of
the patient. The pad 159 is typically made of a rubber or foam-like
material, and may include a self-adhering surface for affixing to
the external surface. The needle 158 pierces through the pad 159
and cavity wall 77.2 carrying the flow tube 150 through its core
into the cavity 77. In a specific embodiment, the needle is a small
gauge Veress needle.
[0120] Another example of an accessory is a retraction member 160
introduced through the cavity wall 77.2 of a patient via a support
housing 162 for retracting tissue or the like, as illustrated in
FIG. 22. The distal portion of the housing 162 which extends
through the cavity wall 77.2 is desirably small to minimize the
size of the incision. In a specific embodiment, the distal portion
of the housing 162 is as small as a 12 gage needle. The retraction
member 160 includes a gripping portion such as a hook 164 or the
like for securing a tissue 168 or other objects inside the cavity.
The retraction member 160 is connected with a piston 165 which is
slidably disposed in the support housing 162. A spring 166 biases
the piston 165 away from the cavity wall 77.2 and, as a result,
biases the retraction member 160 toward the distal portion of the
support 162 at the opening of the cavity wall 77.2. The retraction
member 160 can be grasped, for example, by a grasping tool inside
the cavity to secure the tissue 168 with the hook 164. When the
retraction member 160 is released, the biasing force of the spring
166 returns the retraction member 160 to the position nearer the
opening of the cavity wall 77.2, thereby retracting the target
tissue 168 from its original location indicated at 168A. The
displacement of the tissue 168 exposes the desired target area for
treatment.
[0121] The above-described arrangements of apparatus and methods
are merely illustrative of applications of the principles of this
invention and many other embodiments and modifications may be made
without departing from the spirit and scope of the invention as
defined in the claims. For instance, other telesurgical systems,
e.g., without a remote center of motion, and surgical tools can be
used to perform surgery with the in vivo accessories. The examples
of surgical accessories and ways of presenting them in vivo are
illustrative and not exhaustive. Additional illustrative examples
of surgical accessories that can be provided in vivo in accordance
with the present invention include various gauge needles and/or
threads or sutures, gauze, and the like. The scope of the invention
should, therefore, be determined not with reference to the above
description, but instead should be determined with reference to the
appended claims along with their full scope of equivalents.
* * * * *