U.S. patent application number 10/912305 was filed with the patent office on 2005-01-27 for robotic surgical tool with ultrasound cauterizing and cutting instrument.
This patent application is currently assigned to Intuitive Surgical, Inc., A Delaware corporation. Invention is credited to Anderson, Stephen C., Julian, Christopher A..
Application Number | 20050021018 10/912305 |
Document ID | / |
Family ID | 26824721 |
Filed Date | 2005-01-27 |
United States Patent
Application |
20050021018 |
Kind Code |
A1 |
Anderson, Stephen C. ; et
al. |
January 27, 2005 |
Robotic surgical tool with ultrasound cauterizing and cutting
instrument
Abstract
A surgical instrument for enhancing robotic surgery generally
includes an elongate shaft with an ultrasound probe, an end
effector at the distal end of the shaft, and a base at the proximal
end of the shaft. The end effector includes an ultrasound probe tip
and the surgical instrument is generally configured for convenient
positioning of the probe tip within a surgical site by a robotic
surgical system. Ultrasound energy delivered by the probe tip may
be used to cut, cauterize, or achieve various other desired effects
on tissue at a surgical site. In various embodiments, the end
effector also includes a gripper, for gripping tissue in
cooperation with the ultrasound probe tip. The base is generally
configured to removably couple the surgical instrument to a robotic
surgical system and to transmit forces from the surgical system to
the end effector, through the elongate shaft. A method for
enhancing robotic surgery generally includes coupling the surgical
instrument to a robotic surgical system, positioning the probe tip
in contact with tissue at a surgical site, and delivering
ultrasound energy to the tissue.
Inventors: |
Anderson, Stephen C.;
(Northampton, MA) ; Julian, Christopher A.; (Los
Gatos, CA) |
Correspondence
Address: |
TOWNSEND AND TOWNSEND AND CREW, LLP
TWO EMBARCADERO CENTER
EIGHTH FLOOR
SAN FRANCISCO
CA
94111-3834
US
|
Assignee: |
Intuitive Surgical, Inc., A
Delaware corporation
Sunnyvale
CA
|
Family ID: |
26824721 |
Appl. No.: |
10/912305 |
Filed: |
August 4, 2004 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10912305 |
Aug 4, 2004 |
|
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10126499 |
Apr 18, 2002 |
|
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6783524 |
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60285485 |
Apr 19, 2001 |
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Current U.S.
Class: |
606/28 |
Current CPC
Class: |
A61B 2017/320093
20170801; A61B 34/30 20160201; A61B 34/70 20160201; A61B 90/361
20160201; A61B 34/76 20160201; A61B 2017/320071 20170801; A61B
17/320092 20130101; A61B 2017/320095 20170801; A61B 2017/320094
20170801; A61B 2017/320069 20170801; A61B 8/4405 20130101; A61B
34/37 20160201; A61B 2034/305 20160201; A61B 34/71 20160201; A61B
2017/00477 20130101 |
Class at
Publication: |
606/028 |
International
Class: |
A61B 018/04 |
Claims
What is claimed is:
1. A method of performing a robotic surgical procedure on a
patient, the method comprising: coupling a surgical instrument with
a robotic surgical system, the surgical instrument having a distal
end having an ultrasound probe tip; positioning, with the robotic
surgical system, the ultrasound probe tip in contact with tissue at
a surgical site in the patient; and delivering ultrasound energy to
the tissue with the ultrasound probe tip.
2. A method as in claim 1, wherein the distal end of the surgical
instrument further includes a gripping member, the method further
comprising: transmitting at least one force from the robotic
surgical system to the gripping member; and moving the gripping
member with the at least one force to hold a portion of the tissue
between the gripping member and the ultrasound probe tip.
3. A method as in claim 2, wherein the transmitting and moving
steps further comprise transmitting the at least one force from an
interface member on the robotic surgical system to a first
rotatable shaft on the surgical instrument, the first rotatable
shaft being coupled to a second rotatable shaft by a cable, the
cable being coupled to an actuator rod, and the actuator rod being
coupled to the gripping member, wherein the at least one force
causes the first shaft, the second shaft and the cable to rotate,
causing the actuator rod to move the gripping member.
4. A method as in claim 2, further comprising releasing the portion
of tissue after delivering a desired amount of ultrasound energy to
the portion of tissue.
5. A method as in claim 1, further comprising using the ultrasound
probe tip to cut the tissue, cauterize the tissue, or both.
Description
CROSS-REFERENCES TO RELATED APPLICATIONS
[0001] This application is a divisional application of U.S. patent
application Ser. No. 10/126,499 filed on Apr. 18, 2002, which
claims the benefit of prior provisional application No. 60/285,485,
filed on Apr. 19, 2001, under 37 CFR .sctn.1.78(a)(4), the full
disclosures of which are incorporated herein by reference.
BACKGROUND OF THE INVENTION
[0002] The present invention generally relates to surgical
apparatus and methods. More specifically, the invention relates to
a surgical instrument and method for use with a robotic surgical
system, the instrument including an ultrasonic probe.
[0003] Minimally invasive surgical techniques generally reduce the
amount of extraneous tissue damage during surgical procedures,
thereby reducing patient recovery time, discomfort, and deleterious
side effects. One effect of minimally invasive surgery, for
example, is reduced post-operative hospital recovery times. Because
the average hospital stay for a standard surgery is typically
significantly longer than the average stay for an analogous
minimally invasive surgery, increased use of minimally invasive
techniques could save millions of dollars in hospital costs each
year. Patient recovery times, patient discomfort, surgical side
effects, and time away from work can also be reduced by increasing
the use of minimally invasive surgery.
[0004] In theory, a significant number of surgical procedures could
potentially be performed by minimally invasive techniques to
achieve the advantages just described. Only a small percentage of
procedures currently use minimally invasive techniques, however,
because certain instruments, systems and methods are not currently
available in a form for providing minimally invasive surgery.
[0005] Traditional forms of minimally invasive surgery typically
include endoscopy, which is visual examination of a hollow space
with a viewing instrument called an endoscope. One of the more
common forms of endoscopy is laparoscopy, which is visual
examination and/or treatment of the abdominal cavity. In
traditional laparoscopic surgery a patient's abdominal cavity is
insufflated with gas and cannula sleeves are passed through small
incisions in the musculature of the patient's abdomen to provide
entry ports through which laparoscopic surgical instruments can be
passed in a sealed fashion. Such incisions are typically about 1/2
inch (about 12 mm) in length.
[0006] The laparoscopic surgical instruments generally include a
laparoscope for viewing the surgical field and working tools
defining end effectors. Typical surgical end effectors include
clamps, graspers, scissors, staplers, and needle holders, for
example. 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 a long
extension tube, typically of about 12 inches (about 300 mm) in
length, for example, so as to permit the surgeon to introduce the
end effector to the surgical site and to control movement of the
end effector relative to the surgical site from outside a patient's
body.
[0007] To perform a surgical procedure, a surgeon typically passes
the working tools or instruments through the cannula sleeves to the
internal surgical site and manipulates the instruments from outside
the abdomen by sliding them in and out through the cannula sleeves,
rotating them in the cannula sleeves, levering (i.e., pivoting) the
instruments against the abdominal wall and actuating the end
effectors on distal ends of the instruments from outside the
abdominal cavity. The instruments normally pivot around centers
defined by the incisions which extend through the muscles of the
abdominal wall. The surgeon typically monitors the procedure by
means of a television monitor which displays an image of the
surgical site captured by the laparoscopic camera. Typically, the
laparoscopic camera is also introduced through the abdominal wall
so as to capture the image of the surgical site. Similar endoscopic
techniques are employed in, for example, arthroscopy,
retroperitoneoscopy, pelviscopy, nephroscopy, cystoscopy,
cisternoscopy, sinoscopy, hysteroscopy, urethroscopy, and the
like.
[0008] Although traditional minimally invasive surgical instruments
and techniques like those just described have proven highly
effective, newer systems may provide even further advantages. For
example, traditional minimally invasive surgical instruments often
deny the surgeon the flexibility of tool placement found in open
surgery. Difficulty is experienced in approaching the surgical site
with the instruments through the small incisions. Additionally, the
added length of typical endoscopic instruments often reduces the
surgeon's ability to feel forces exerted by tissues and organs on
the end effector. Furthermore, coordination of the movement of the
end effector of the instrument as viewed in the image on the
television monitor with actual end effector movement is
particularly difficult, since the movement as perceived in the
image normally does not correspond intuitively with the actual end
effector movement. Accordingly, lack of intuitive response to
surgical instrument movement input is often experienced. Such a
lack of intuitiveness, dexterity and sensitivity of endoscopic
tools has been found to be an impediment in the increased the use
of minimally invasive surgery.
[0009] Minimally invasive robotic (or "telesurgical") surgical
systems have been developed to increase surgical dexterity as well
as to permit a surgeon to operate on a patient in an intuitive
manner. Telesurgery is a general term for surgical operations using
systems where the surgeon uses some form of remote control, e.g., a
servomechanism, or the like, to manipulate surgical instrument
movements, rather than directly holding and moving the tools by
hand. In such a telesurgery system, the surgeon is typically
provided with an image of the surgical site on a visual display at
a location remote from the patient. The surgeon can typically
perform the surgical procedure at the location remote from the
patient whilst viewing the end effector movement on the visual
display during the surgical procedure. While viewing typically a
three-dimensional image of the surgical site on the visual display,
the surgeon performs the surgical procedures on the patient by
manipulating master control devices at the remote location, which
master control devices control motion of the remotely controlled
instruments.
[0010] Typically, such a telesurgery system can be provided with at
least two master control devices (one for each of the surgeon's
hands), which are normally operatively associated with two robotic
arms on each of which a surgical instrument is mounted. Operative
communication between master control devices and associated robotic
arm and instrument assemblies is typically achieved through a
control system. The control system typically includes at least one
processor which relays input commands from the master control
devices to the associated robotic arm and instrument assemblies and
from the arm and instrument assemblies to the associated master
control devices in the case of, e.g., force feedback, or the like.
One example of a robotic surgical system is the DAVINCI.TM. system
available from INTUITIVE SURGICAL, INC. of Mountain View,
Calif.
[0011] Just as robotic surgical systems have been found
advantageous, so too has use of ultrasound energy in surgery been
found beneficial. A number of patents disclose ultrasonic treatment
instruments for both open surgery and manually-performed endoscopic
surgery. These patents include U.S. Pat. No. 6,056,735 issued May
2, 2000, entitled "Ultrasound Treatment System"; U.S. Pat. No.
6,066,151 issued May 23, 2000, entitled "Ultrasonic Surgical
Apparatus"; U.S. Pat. No. 6,139,561 issued Oct. 31, 2000, entitled
"Ultrasonic Medical Instrument"; U.S. Pat. No. 6,165,191 issued
Dec. 26, 2000, entitled "Ultrasonic Treating Tool"; and U.S. Pat.
No. 6,193,709 issued Feb. 27, 2001, entitled "Ultrasonic Treatment
Apparatus". The full disclosure of each of these patents is
incorporated herein by reference.
[0012] A typical ultrasound treatment instrument for manual
endoscopic surgery is the SonoSurg.RTM. instrument model T3070 made
by OLYMPUS OPTICAL Co., LTD., of Tokyo, Japan. Other examples of
manually operated ultrasound treatment instruments are the Harmonic
Scalpel.RTM. LaparoSonic.RTM. Coagulating Shears, made by ETHICON
ENDO-SURGERY, INC., of Cincinnati, Ohio; and the AutoSonix.RTM.
Ultra Shears.RTM. made by UNITED STATES SURGICAL CORPORATION of
Norwalk, Conn. Such an ultrasound treatment instrument may comprise
ultrasonic transducers for generating ultrasonic vibrations; a
handpiece including the ultrasonic transducers and serving as an
operation unit; a generally elongate probe connected to the
ultrasonic transducers and serving as a vibration conveyer for
conveying ultrasonic vibrations to a distal end effector member or
tip used to treat a living tissue; a sheath serving as a protective
member for shielding the probe. The instrument typically includes a
movable holding, grasping or gripping end effector member pivotally
opposed to the distal tip and constituting a movable section which
clamps a living tissue in cooperation with the distal tip; an
operating mechanism for moving the grasping member between a closed
position in which the grasping member engages the distal tip of the
vibration transmitting member and an open position in which the
grasping member is separated from distal tip portion. The operating
mechanism includes handle portions for manipulation and actuation
by a surgeon's hands.
[0013] Surgical ultrasound instruments are generally capable of
treating tissue with use of frictional heat produced by ultrasonic
vibrations. For example, the heat may be use to cut and/or
cauterize tissue. With many currently available instruments, tissue
may first be grasped by an ultrasound surgical device and then
ultrasound energy may be delivered to the tissue to cut, cauterize
or the like. Ultrasound instruments provide advantages over other
cutting and cauterizing systems, such as reduced collateral tissue
damage, reduced risk of unwanted bums, and the like. Currently,
however, ultrasound instruments for use with a robotic surgical
system are not available.
[0014] Therefore, a need exists for a surgical instrument, for use
with a robotic surgical system, that provides ultrasound energy at
a surgical site. Such an instrument would allow the advantages of
ultrasound and minimally invasive robotic surgery to be
combined.
BRIEF SUMMARY OF THE INVENTION
[0015] Surgical apparatus and methods for enhancing robotic surgery
generally include a surgical instrument with an elongate shaft
having an ultrasound probe, an end effector at the distal end of
the shaft, and a base at the proximal end of the shaft. The end
effector includes an ultrasound probe tip and the surgical
instrument is generally configured for convenient positioning of
the probe tip within a surgical site by a robotic surgical system.
Ultrasound energy delivered by the probe tip may be used to cut,
cauterize, or achieve various other desired effects on tissue at a
surgical site. By providing ultrasound energy via a robotic
surgical instrument for use with a robotic surgical system, the
apparatus and methods of the present invention enable the
advantages associated with ultrasound to be combined with the
advantages of minimally invasive robotic surgery.
[0016] In accordance with one aspect, the present invention
provides a method of performing a robotic surgical procedure on a
patient. Generally, the method includes coupling a surgical
instrument with a robotic surgical system, the surgical instrument
having a distal end with an ultrasound probe tip, positioning with
the robotic surgical system the ultrasound probe tip in contact
with tissue at a surgical site in the patient, and delivering
ultrasound energy to the tissue with the ultrasound probe tip.
Optionally, the distal end of the surgical instrument further
includes a gripping member. In embodiments including a gripping
member, the method further includes transmitting at least one force
from the robotic surgical system to the gripping member and moving
the gripping member with the at least one force to hold a portion
of the tissue between the gripping member and the ultrasound probe
tip.
[0017] In some embodiments, the method further includes
transmitting the at least one force from an interface member on the
robotic surgical system to a first rotatable shaft on the surgical
instrument, the first rotatable shaft being coupled to a second
rotatable shaft by a cable, the cable being coupled to an actuator
rod, and the actuator rod being coupled to the gripping member,
wherein the at least one force causes the first shaft, the second
shaft and the cable to rotate, causing the actuator rod to move the
gripping member. In other embodiments, the method further includes
releasing the portion of tissue after delivering a desired amount
of ultrasound energy to the portion of tissue. In various
embodiments, the method also includes using the ultrasound probe
tip to cut the tissue, cauterize the tissue, or both.
[0018] In another aspect, the present invention provides a surgical
instrument for use with a robotic surgical system. Generally, the
surgical instrument includes an elongate shaft having a proximal
end and a distal end, the elongate shaft including an ultrasound
probe, an end effector disposed at the distal end, the end effector
including an ultrasound probe tip of the ultrasound probe, and a
base disposed at the distal end for connecting the surgical
instrument to the robotic surgical system. Optionally, the elongate
shaft may be configured to rotate in relation to the base about an
axis drawn from the proximal end to the distal end.
[0019] Also optionally, the base of the surgical instrument may
include: at least two shafts rotatably mounted within the base,
each of the shafts having two ends, at least one of the ends of one
of the shafts protruding from the base to engage a corresponding
interface member on the robotic surgical system; at least two
spools, each spool being mounted on one of the shafts; at least one
cable for connecting two of the spools; and a rotating member
coupled to the cable and to the elongate shaft, the rotating member
being configured to rotate the elongate shaft in response to
movements of the interface member, the at least two shafts, the at
least two spools and the at least one cable.
[0020] In some embodiments, the end effector of the surgical
instrument includes a gripping member hingedly attached to the end
effector for gripping tissue in cooperation with the ultrasound
probe tip. In those embodiments, the surgical instrument may
optionally include at least one force transmitting member for
transmitting one or more forces between the robotic surgical system
and the gripping member to move the gripping member. In various
embodiments, the transmitting member may include: at least two
shafts rotatably mounted within the base, each of the shafts having
two ends, at least one of the ends of one of the shafts protruding
from the base to engage a corresponding interface member on the
robotic surgical system; at least two spools, each spool being
mounted on one of the shafts; at least one cable for connecting two
of the spools; and an actuator rod coupled to the cable and to the
gripping member and extending through the elongate shaft, the
actuator rod being configured to move the gripping member in
response to movements of the interface member, the at least two
shafts, the at least two spools and the at least one cable.
[0021] In some embodiments, the base of the surgical instrument
includes an ultrasound source connector for connecting the
ultrasound probe to an external ultrasound source. In other
embodiments, the base includes an internal ultrasound source for
providing ultrasound energy to the ultrasound probe.
[0022] Generally, the ultrasound probe of the surgical instrument
may include various components. For example, in one embodiment the
probe includes an ultrasound transducer for generating ultrasonic
vibrations and one or more amplifying horns for amplifying the
ultrasonic vibrations.
[0023] In some embodiments, the ultrasonic probe assembly may be
arranged to be axially movable within the elongate shaft, and the
proximal portion of the probe may be mechanically coupled to one or
more movable interface members so that the probe is movable in a
reciprocating manner in response to movement of the interface
member. The distal portion of the probe assembly may be coupled to
the grip member, so that the grip opens or closes as the probe
moves axially. In this manner the movable probe assembly may serve
the function of a grip actuator rod in addition to transmitting
ultrasound energy to the surgical site.
[0024] Certain exemplary surgical instrument embodiments having
aspects of the invention may be described or characterized in
general terms as comprising an instrument probe assembly having a
distal end configured to be insertable into a patient's body
through a small aperture, such as a minimally invasive surgical
incision or the like, typically defined by a cannula or trocar. The
instrument probe assembly comprises a proximal end coupled to an
instrument base. The instrument probe assembly typically is
elongate, having an axis extending between the distal and proximal
probe ends, and may have a generally straight or shaft-like medial
portion. In alternative embodiments, the medial probe portion may
be curved and/or may be flexible in shape relative to the axis. The
instrument base includes an instrument interface assembly which is
engagable to a robotic surgical system. Preferably, the instrument
interface assembly is removably engageable to the robotic surgical
system, and may include a latch mechanism permitting quick
connection and disconnection.
[0025] The instrument interface assembly is engagable with provides
for one or more instrument actuation inputs from the robotic
surgical system in response to an input by an operator (i.e., an
activation input to the instrument, being an activation output from
the robotic surgical system, which in turn is a response by the
robotic control system to an operator control input). Preferably
the one or more instrument activation inputs include an input to
activate at least one degree of freedom of motion of the all or a
portion of the instrument probe assembly relative to the instrument
base. The activation input may be a mechanical input, an electrical
input, a magnetic input, a signal input, an optical input, a
fluidic input, a pneumatic input, and the like, or a combination of
these, without departing from the spirit of the invention.
[0026] In certain exemplary embodiments of surgical instruments
having aspects of the invention, at least one activation input
includes an operative engagement of a rotatable interface body
(activation interface body) of the robotic surgical system with a
corresponding rotatable shaft (instrument interface body or
instrument interface shaft) of the instrument interface assembly in
the instrument base. The rotatable shaft is in turn mechanically
coupled by one or more drive elements to all or a portion of the to
the instrument probe assembly, so as to impart a corresponding
degree of freedom to all or a portion of the instrument probe
assembly relative to the base.
[0027] As described above, in alternative embodiments another type
of activation modality may be substituted for the rotatable
interface body of the robotic surgical system. For example, an
electrical power/control interface (e.g., including a multi-pin
connector) may be included in the interface assembly to transmit
electrical power and/or control signals from the robotic surgical
system to actuate a motor pack mounted in the instrument base, the
motor pack output may in turn may be coupled to the instrument
probe assembly so as to impart one or more corresponding degrees of
freedom to all or portions of the instrument probe assembly
relative to the base. The motor pack may include one or more
electrical motors, transmission gearing, position encoders, torque
sensors, feedback sensors, and the like, and may transmit feedback
or sensor signals to the robotic surgical system via the
interface.
[0028] In certain exemplary embodiments of surgical instruments
having aspects of the invention, the at least one degree of freedom
of motion in response to an activation input from the robotic
surgical system includes the pivotal activation of a clamp or grip
member of an end effector coupled to the distal probe end. In
certain exemplary embodiments, the at least one degree of freedom
of motion includes the axial rotation of at least the major portion
of the instrument probe assembly about its axis relative to the
instrument base.
[0029] In alternative embodiments other types of degrees of freedom
of motion of all or a portion of the instrument probe assembly may
be activated by engagement of the robotic surgical system. For
example, the instrument probe assembly may include at least one
distal joint to controllably orient the distal probe end relative
to the probe axis, such as a wrist-like rotational or pivotal joint
supporting a distal end effector. In another example, the probe
medial portion may have a flexible section which is controllably
variable in shape by one or more degrees of freedom, being
driveable by longitudinal tendon members extending within the
instrument probe assembly.
[0030] In these alternative embodiments, the instrument interface
assembly is coupled to drive members of the instrument probe
assembly to activate such degrees of freedom and is engagable with
the robotic surgical system to receive activation inputs to
activate such drive members. Further examples of alternative
instrument embodiments include instrument probe assemblies having
controllable shape-memory components, movable piezo-electric drive
elements, hydraulic drive elements, and the like, or combinations
of these. As describe above, the robotic activation input may
include a corresponding activation modality suitable for any of
these instrument probe assembly movement modalities, without
departing from the spirit of the invention.
[0031] To reduce costs and for manufacturing convenience, the
instrument may include OEM parts. For example, the instrument probe
assembly may include parts or components generally similar or
identical to parts or components (OEM components) of current or
future commercially-available endoscopic instruments for surgical
or diagnostic uses (OEM medical systems), including manually
operated instruments. The surgical instruments of the invention may
perform some or all of the functions of such OEM medical systems.
For example, the instrument probe assembly of the surgical
instruments of the invention may include OEM components of
ultrasound treatment probes, electrocautery probes, ultrasound
diagnostic probes, diagnostic imagery probes. In further examples,
the instrument probe assembly may include suitable OEM components
of biopsy probes, suction probes, substance injection probes,
surgical accessory application probes, stapler probes, tissue
grasping and cutting probes, and the like. Likewise, the instrument
probe assembly may combine more than one of the medical functions
of the above described instruments.
[0032] In certain exemplary embodiments of surgical instruments
having aspects of the invention, the instrument probe assembly
comprises a distally disposed end effector coupled to the probe
distal end to engage tissue employing a medical energy modality.
For example, the instrument probe assembly may include a conduction
element or conduction core coupled to the end effector; and
extending along the probe axis. The conduction element may be
configured and composed to communicate the medical energy between
the end effector and a medical energy source. For example, the
instrument may include one or more energy connector devices coupled
to the conduction element, the connector devices being engagable
operatively communicate to a power, signal and/or control system
external to the instrument to enable medical functions of the
instrument (medical energy system).
[0033] The medical energy system may include a power, signal and/or
control system which is distinct from the robotic surgical system,
such as the power, signal and/or control system of an OEM medical
system. Such medical energy systems may likewise be responsive to a
control input of an operator. For example, instrument embodiments
of the invention may include a cable connector configured to
connect to an OEM surgical ultrasound generator, an OEM
electrocautery generator, and the like.
[0034] Optionally, the energy connector device of the instrument
may be configured for "wireless" engagement with the medical energy
system, so that operative reception and/or transmission of the
medical energy signal may be by non-contact communication with the
medical energy system.
[0035] In a further option, the medical energy system may be
integrated with the robotic surgical system. Optionally, the
respective energy connector devices may be integrated with the
instrument interface assembly, and optionally operator input
devices of the medical energy system may be integrated with the
operator input devices of the robotic surgical system.
[0036] In the particular instrument examples shown in the figures,
the medical energy modality is ultrasound energy for tissue
treatment, and the instrument probe assembly comprises an
ultrasonic treatment assembly or ultrasonic treatment probe. The
ultrasonic treatment probe includes a transducer coupled to an
ultrasonic acoustical conduction core, the transducer preferably
being supported at least partially by the instrument base. The
medical energy system comprises an OEM ultrasonic generator. The
interface connector device includes a cable connector mounted to
the base and engagable with a cable to communicate with an OEM
ultrasonic generator. The ultrasonic treatment probe includes a
probe tip coupled to the conduction core and configured to engage
tissue and controllably transmit ultrasound energy to the engaged
tissue.
[0037] As described above, in alternative embodiments an instrument
probe assembly employing another type of medical energy modality
may be included. For example, the instrument probe assembly may
comprise an electrosurgical treatment probe including a electrical
conduction element coupled to an end effector, and the base may
include a connector interface coupled to the electrocautery
treatment probe, and configured to be connectable to an OEM
electrosurgical generator. In further examples, the instrument
probe assembly may include a conduction element for communicating a
diagnostic energy modality, e.g., signals to and/or from an end
effector having an diagnostic ultrasound transducer or other
diagnostic sensor and or transmitter.
BRIEF DESCRIPTION OF THE DRAWINGS
[0038] FIG. 1 is a perspective illustration of a robotic surgical
system with which various embodiments of the present invention may
be used.
[0039] FIG. 2 is a perspective illustration of a robotic surgical
tool which may be used with a robotic surgical system as in FIG.
1.
[0040] FIG. 3 is a perspective illustration of the robotic surgical
tool in FIG. 2, with a cover of a tool base removed to show
internal structures of the tool base.
[0041] FIG. 4 is a side-view illustration of a manually operated
ultrasound treatment apparatus as described in U.S. Pat. No.
6,193,709.
[0042] FIG. 5 is a side-view illustration of a manually operated
ultrasound treatment apparatus as in FIG. 4, with a portion of the
operative end of the apparatus shown in exploded view.
[0043] FIG. 6 is a side-view illustration of the distal end of a
manually operated ultrasound treatment apparatus as in FIGS. 4 and
5, with a jaw of the distal end in an open position.
[0044] FIG. 7 is a side-view illustration of the distal end of a
manually operated ultrasound treatment apparatus as in FIGS. 4 and
5, with a jaw of the distal end in a closed position.
[0045] FIG. 8 is a cross-sectional side-view illustration of a
portion of a manually operated ultrasound treatment apparatus as in
FIGS. 4 and 5.
[0046] FIG. 9 is a cross-sectional side-view illustration of a
portion of a manually operated ultrasound treatment apparatus as in
FIGS. 4 and 5.
[0047] FIG. 10 is a perspective illustration of a distal portion of
a robotic surgical tool according to an embodiment of the present
invention.
[0048] FIGS. 11a-b are perspective illustrations of a proximal
portion of a surgical tool according to an embodiment of the
present invention, with a cover on a tool base of the surgical tool
removed to show internal structures of the tool base.
[0049] FIG. 11c is a perspective illustration of a distal portion
of a robotic surgical tool according to an embodiment of the
present invention.
[0050] FIG. 12a is a perspective illustration of a proximal portion
of a surgical tool according to an embodiment of the present
invention, including a tool base of the surgical tool.
[0051] FIG. 12b is a perspective illustration of a proximal portion
of a surgical tool as in FIG. 12a, with a cover on the tool base
removed to show internal structures of the tool base.
[0052] FIG. 12c is a perspective illustration of a proximal portion
of a surgical tool as in FIG. 12b, with a an upper chassis further
removed from the tool base to show internal structures of the tool
base.
[0053] FIG. 12d is a perspective illustration of a surgical tool
according to an embodiment of the present invention.
[0054] FIG. 13 is an enlarged perspective illustration of a tool
base as shown in FIG. 12c.
[0055] FIG. 14a is a top-view illustration of a tool base as shown
in FIGS. 12c and 13.
[0056] FIG. 14b is a side-view illustration of a tool base
according to an embodiment of the present invention.
[0057] FIG. 15a is an enlarged view of a tool base as shown in FIG.
14a.
[0058] FIG. 15b is an enlarged view of a tool base as shown in FIG.
14b.
[0059] FIGS. 16a-d are perspective illustrations of a tool base
according to an embodiment of the present invention, in progressive
stages of disassembly.
[0060] FIG. 17 is a perspective illustration of a portion of a tool
base according to an embodiment of the present invention.
[0061] FIG. 18 is an exploded perspective illustration of a portion
of a tool base according to an embodiment of the present
invention.
[0062] FIG. 19 is an exploded perspective illustration of a portion
of a tool base according to an embodiment of the present
invention.
[0063] FIG. 20 illustrates an alternative example of an instrument
including aspects of the invention.
[0064] FIG. 21 is a top view of a proximal portion of the
alternative instrument embodiment shown in FIG. 20.
[0065] FIG. 22 is a side view of the proximal portion shown in FIG.
21.
[0066] FIG. 23 is a side view of the removable treatment assembly
of the instrument embodiment shown in FIG. 20.
[0067] FIG. 24 is a side view of the proximal portion of the
instrument embodiment shown in FIG. 22, with the treatment assembly
removed.
[0068] FIG. 25 is a perspective view of a molded half portion of
the adaptor housing of the removable treatment assembly shown in
FIGS. 21 and 22.
[0069] FIG. 26 is a side perspective view of another alternate
embodiment of an ultrasonic instrument in an open position, as
described in U.S. Pat. No. 6,280,407.
[0070] FIG. 27 is a perspective view of an elongated body portion
of the ultrasonic instrument shown in FIG. 26.
[0071] FIG. 28A is a side perspective view of the clamp of the
ultrasonic instrument shown in FIG. 26.
[0072] FIG. 28B is a side perspective view of the tissue contact
surface of the clamp shown in FIG. 28A.
[0073] FIG. 28C is a side perspective view of the distal end of the
elongated body portion of the ultrasonic instrument shown in FIG.
26.
[0074] FIG. 29 is a side perspective view of the elongated body
portion and rotation assembly of the ultrasonic instrument shown in
FIG. 26.
[0075] FIG. 30 is a side perspective view of the handle assembly
and transducer assembly of the ultrasonic instrument shown in FIG.
26.
[0076] FIG. 31 is a side partial cross-sectional view of the
ultrasonic instrument shown in FIG. 26 in the open position.
[0077] FIG. 31A is an enlarged perspective view of a C-clip locator
for the vibration coupler.
[0078] FIG. 32 is an enlarged view of the indicated area of detail
of FIG. 31 illustrating the clamp in the open position.
[0079] FIG. 33 is a side perspective view of the distal end of the
elongated body portion of the ultrasonic instrument shown in FIG.
33.
[0080] FIG. 34 is a side perspective, partial cutaway view of the
distal end of the elongated body portion of the ultrasonic
instrument shown in FIG. 33.
[0081] FIG. 35 is a side partial cross-sectional view of the
ultrasonic instrument of FIG. 26 in the closed position.
[0082] FIG. 36 is an enlarged view of the indicated area of detail
of FIG. 35 illustrating the clamp in the closed position.
DETAILED DESCRIPTION OF THE INVENTION
[0083] The present invention provides robotic surgical apparatus
and methods for applying ultrasound energy in robotic surgery. In
various embodiments, the invention includes a robotic surgical
apparatus for use with a robotic surgical system. The apparatus
typically incudes an elongate shaft with an end effector at one end
and a base at the opposite end. In some embodiments, the end
effector includes an ultrasound tip and a gripper for gripping
tissue and the like between the gripper and the ultrasound tip.
Optionally, the gripper may also pivot around one or more axes in
relation to the apparatus. The tool base is generally configured to
engage the robotic surgical system and to transmit forces from the
robotic surgical system to the gripper, for example to pivot the
gripper. Use of ultrasound in robotic surgery, as provided by
apparatus and methods of the present invention, will allow for more
precise, safe cutting and cauterization of tissues as well as other
advantages typically seen with ultrasound.
[0084] Referring now to FIG. 1, a robotic surgical system 10
suitably includes a user-operated control station 12 and a surgical
work station, or "cart" 20. The control station 12 includes an
image display module 14 for displaying an image of a surgical site,
a support 16 on which an operator may rest his/her forearms, and a
space 18 where two master control devices are located (not shown).
When using control station 12, a surgeon or other user typically
sits in a chair in front of control station 12, positions views the
surgical site through display module 14 and grips the master
controls one in each hand while resting the forearms on support 16.
One example of a robotic surgical system as described in FIG. 1 is
the DAVINCI.TM. system available from Intuitive Surgical, Inc. of
Mountain View, Calif.
[0085] Control station 12 is generally coupled to cart 20 such that
command from master controls may be transmitted to cart 20. In use,
cart 20 is positioned adjacent a patient requiring surgery and is
then normally caused to remain stationary until a surgical
procedure to be performed by means of surgical system 10 is
complete. Cart 20 typically has wheels or castors to render it
mobile. Control station 12 is typically positioned remote from cart
20 and in some embodiments may be separated from cart 20 by a great
distance, for example miles away, but will typically be used within
an operating room with cart 20.
[0086] In various embodiments, cart 20 includes at least three
robotic arm assemblies 22, 26, 26, one of which is configured to
hold an image capture device 24 and the others of which are
configured to hold surgical instruments 28. Alternatively, cart may
include more or fewer than three robotic arm assemblies and the
robotic arm assemblies may be configured to hold any suitable tool,
instrument, imaging device and/or the like. Image capture device 24
may include any suitable device, such as an endoscope, fiber optic
camera, or the like. Image capture device 24 generally includes an
object viewing end 24.1 at a remote end of an elongate shaft
configured to enable viewing end 24.1 to be inserted through an
entry port in a patient's body to capture an image of a surgical
site. Coupling of cart 20 to control station 12 generally enables
display module 14 to display an image captured by image capture
device 24.
[0087] Coupling of cart 20 to control station 12 also typically
allows each of master controls on control station 12 (not shown) to
control one robotic arm assembly 26 and one surgical instrument 28.
In various embodiments, each master control may alternatively be
used to control more than one robotic arm assembly 26 and/or more
than one surgical instrument 28.
[0088] Surgical instruments 28 on the robotic arm assemblies 26
typically include elongate shafts, with proximal and distal ends.
End effectors are generally mounted on wrist-like mechanisms
pivotally mounted on the distal ends of the shafts, for enabling
the instruments 28 to perform one or more surgical tasks.
Generally, the elongate shafts of surgical instruments 28 allow the
end effectors to be inserted through entry ports in a patient's
body so as to access the internal surgical site. Movement of the
end effectors is generally controlled via master controls on
control center 12.
[0089] Referring now to FIG. 2, surgical instrument 28 suitably
includes an elongate shaft 28.1 having a proximal end 33 and a
distal end 31, a pivot 32 and end effector 38 disposed at the
distal end, and an instrument base 34 disposed at the proximal end.
Base 34 is generally configured to releasably engage a robotic
surgical system, such as robotic surgical system 10 in FIG. 1. In
general, instrument 28 is engaged with system via base 34 (base not
shown in FIG. 1) such that instrument 28 is releasably mountable on
a carriage 37 which can be driven to translate along a linear guide
formation 38 of the arm 26 in the direction of arrows P.
[0090] With reference to FIGS. 2 and 3, shaft 28.1 is rotatably
mounted on base 34 for rotation about an axis 28.2 extending
longitudinally along the shaft 28.1 as indicated by the arrows E.
Thus, when mounted on an arm assembly 26, end effector 38 may have
a plurality of degrees of freedom of movement relative to
manipulator arm 26, in addition to actuation movement of the end
effector itself. The instrument may be translated along an
insertion axis (Arrows P in FIG. 1). Typically, the instrument
degrees of freedom include rotation about the axis 28.2 as
indicated by arrows E, and in the case of instruments 28 including
pivots 32, angular displacement as a whole about pivot 32 as
indicated by arrows D. Alternatively, the distal pivoting degree of
freedom may be omitted. A single pivot wrist, a multi-pivot wrist,
a distal roll joint mechanism or other joints may be included to
provide additional operational degrees of freedom to the end
effector. Movement of end effector 38 relative to manipulator arm
26 controlled by appropriately positioned actuators, such as
electric motors, or the like, which respond to inputs from an
associated master control at the control station 12, so as to drive
the end effector 38 to a required orientation as dictated by
movement of the associated master control.
[0091] Referring now to FIG. 3, base 34 of surgical instrument 28
suitably includes transmission members 70, 72, 74, and 76, which
include spools secured on shafts 70.1, 72.1, 74.1, and 76.1. Ends
of shafts 70.1, 72.1, 74.1, 76.1 generally extend from a side 77 of
base 34 to a mounting plate 78 within base 34 and are configured to
rotate. Generally, the ends of shafts 70.1, 72.1, 74.1, 76.1 at
side 77 of base 34 extend through side 77, to an outer surface of
side 77 (not shown). At the outer surface, each shaft 70.1, 72.1,
74.1, 76.1 includes an engaging member (not shown) configured to
releasably couple with a complementary engaging member (not shown)
rotatably mounted on the carriage 37 of a robotic arm assembly 26
(see FIG. 1). The engaging members on carriage 37 are generally
coupled to actuators (not shown), such as electric motors or the
like, to cause selective angular displacement of each engaging
member on the carriage 37 in response to actuation of its
associated actuator. Thus, selective actuation of the actuators is
transmitted through the engaging members on the carriage 37, to the
engaging members on the opposed ends of the shafts 70.1, 72.1,
74.1, 76.1 to cause selective angular displacement of the spools
70, 72, 74, 76. Where more or fewer degrees of freedom are desired,
the number of spools may be decreased or increased.
[0092] Referring now to FIGS. 4 and 5 an ultrasound treatment
system 201 for manually-performed endoscopic surgery, as described
in U.S. Pat. No. 6,193,709 (previously incorporated by reference),
suitably includes a handle unit 202, a probe unit 203, and a
vibrator unit 204. The following description of FIGS. 4-9
corresponds generally to the description of FIGS. 12-23 in U.S.
Pat. No. 6,193,709.
[0093] As shown in FIGS. 5 and 9, the vibrator unit 204 is formed
as a hand piece 241. The hand piece 241 includes a cylindrical
cover 242 that forms a grasping section. An ultrasonic transducer
243 and a horn 244 are arranged inside the cover 242. A hand piece
cord 245 extends from the proximal end of the vibrator unit 204,
and a hand piece plug 246 is provided on an end portion of the cord
245 (see FIG. 4). The plug 246 is connected electrically to an
ultrasonic oscillator (not shown). The vibrator unit 243 is
vibrated as it is supplied with electric power from the ultrasonic
oscillator.
[0094] The horn 244, which is coupled to the ultrasonic transducer
243, amplifies ultrasonic vibration generated by the ultrasonic
transducer 243 and enlarges its amplitude to a first phase. The
distal end of the horn 244 is formed having an internal-thread
portion to which the probe unit 203 is attached.
[0095] A connecting member 247 is attached to the distal end of the
cover 242. The member 247 connects the vibrator unit 204, along
with the probe unit 203 combined therewith, to the handle unit 202.
More specifically, the connecting member 247 is provided with an
engaging ring (C-shaped ring) 248 having a semicircular profile.
The vibrator unit 204 is connected to the handle unit 202 as the
ring 248 is caused elastically to engage an engaging groove 211a of
a vibrator connecting section 211 (mentioned later) of the unit
202.
[0096] As shown in FIG. 5, the probe unit 203 is formed as a
rod-shaped vibration transmitting member 251 for transmitting the
ultrasonic vibration generated by the ultrasonic transducer 243. An
external-thread portion 251e to be screwed into the internal-thread
portion at the distal end of the horn 244 of the vibrator unit 204
is formed on the proximal end of the transmitting member 251. The
transmitting member 251 includes a proximal-side horn 251d,
intermediate portion 251c, distal-side horn 251b, and columnar
distal end portion 251a. The proximal-side horn 251d further
enlarges the amplitude of the ultrasonic vibration, amplified by
the horn 244, to a second phase. The intermediate portion 251c is
situated on the distal end side of the horn 251d. The distal-side
horn 251b, which is situated on the distal end side of the
intermediate portion 251c, enlarges the amplitude of the ultrasonic
vibration, amplified by the horn 251d, to a final phase. The distal
end portion 251a is situated on the distal end side of the horn
251b (or on the distal end side of the vibration transmitting
member 251).
[0097] The ultrasonic vibration from the probe ultrasonic
transducer 243, amplified by the horns 244, 251d and 251b, is
transmitted to the distal end portion 251a, whereupon the end
portion 251a vibrates. Further, the distal end portion 251a, along
with a distal acting section 205 (mentioned later) of the handle
unit 202, constitutes a treatment section 210 of the ultrasonic
treatment apparatus 201.
[0098] As shown in FIG. 5, the handle unit 202 includes an
operating section 206, the insertable sheath section 231 formed of
a long sheathing tube 220 that is rotatably attached to the
operating section 206, and the distal acting section 205 on the
distal end of the insertable sheath section 231.
[0099] The operating section 206 includes an operating section body
212, a fixed handle 213 formed integrally with the body 212, and a
movable handle 214. The operating section body 212 is provided with
the vibrator connecting section 211 on its proximal end. The
vibrator unit 204 is removably connected to the connecting section
211. The movable handle 214 is rockably mounted on the operating
section body 212 (fixed handle 213) by means of a handle pivot 217.
In this case, the handle pivot 217 is situated on the opposite side
of the longitudinal central axis of the insertable sheath section
231 from the fixed handle 213. Thus, the movable handle 214 is
rocked around a fulcrum that is situated above the longitudinal
central axis of the sheath section 231. Further, the handle 214 has
engaging pins 219 on or near the central axis of the sheath section
231. The pins 219 can engage a transmitting member 258 (see FIG. 8,
mentioned later) in the operating body 212.
[0100] As shown in detail in FIGS. 8 and 9, a cylindrical
interpolative member 212b is inserted and fastened in the operating
section body 212. In this case, the distal end portion of the
member 212b is held between a nut 212d, which is fitted in the
distal end portion of the operating section body 212, and a
cylindrical rotating member 212c, which is inserted and fastened in
the distal end portion of the member 212b. Further, the cylindrical
transmitting member (rotor) 258 is disposed inside the
interpolative member 212b. The vibration transmitting member 251 is
passed through a bore of the member 258. In an assembled state, the
proximal-side horn 251d of the transmitting member 251 and the
proximal-side portion thereof are arranged in the bore of the
transmitting member 258. Moreover, an engaging groove 262 is formed
on the outer peripheral surface of the transmitting member 258.
Fitted in the groove 262 are the engaging pins 219 of the movable
handle 214, which individually penetrate through-holes 212a in the
operating section body 212 and the interpolative member 212b.
[0101] The annular vibrator connecting section 211 is attached to
the inner peripheral surface of the proximal end portion of the
interpolative member 212b by screwing and/or an adhesive such as
glue. The engaging groove 211a is formed on the inner peripheral
surface of the connecting section 211. The groove 211 has a conical
engaging surface 211b on its proximal end side. The engaging
surface 211b is designed to fit the curved outer peripheral surface
of the engaging ring 248 that is attached to the connecting member
247 of the vibrator unit 204.
[0102] A cylindrical rotary knob 232 is attached to the nut 212d by
means of a V-groove on the nut 212d and a cone-point setscrew. The
proximal end portion of the sheathing tube 220 of the insertable
sheath section 231 is inserted in a bore of the knob 232. An end
member 220a is fitted on the outer periphery of the proximal end
portion of the tube 220 in the bore of the knob 232. The distal end
portion of a connecting cylinder 220b is fitted and fixed on the
outer periphery of the end member 220a by adhesive bonding. A
thread portion 224 is formed on the outer peripheral surface of the
distal end portion of the cylinder 220b. The distal end portion of
the rotating member 212c, which extends in the bore of the rotary
knob 232, is screwed on the thread portion 224. Further, the
proximal end side of the connecting cylinder 220b is inserted into
a bore of the rotating member 212c, and is held between the member
212c and the distal end portion of the transmitting member 258 in a
manner such that it can move back and forth. The position (or
longitudinal movement) of the cylinder 220b in the member 212c can
be adjusted by rotating a nut 220c, which is screwed on the thread
portion 224 of the cylinder 220b and engages the distal end of the
member 212c. The connecting cylinder 220b has an engaging groove
220d on its proximal end. As a positioning pin 220e that protrudes
from the transmitting member 258 engages the engaging groove 220d,
the cylinder 220b is restrained from rotating relatively to the
member 258.
[0103] As shown in FIGS. 4 and 5, the distal acting section 205
includes a holding member 270, which is attached to the distal end
portion of the sheathing tube 220, and an open-close member 275 of
a single-swing type, which is rockably (pivotably) attached to the
member 270 by means of pivots 274. The acting section 205, along
with the distal end portion 251a of the vibration transmitting
member 251 of the probe unit 203, constitutes the treatment section
210 of the ultrasonic treatment apparatus 201.
[0104] The open-close member 275 can hold a living organism in
cooperation with the distal end portion 251a of the vibration
transmitting member 251 so that the organism is pressed against the
distal end portion 251a that is undergoing the ultrasonic
vibration. Thus, vibration energy can be transmitted from the
distal end portion 251a to the organism. The member 275 also
functions as an exfoliating forceps for exfoliating living
organisms.
[0105] As shown in FIGS. 6 and 7, the open-close member 275 is
composed of a pair of opposite side walls 275a and 275b, a
proximal-side connecting portion 275c connecting the respective
proximal-side upper end portions of the side walls 275a and 275b, a
distal-side connecting portion 275d connecting the respective
distal end portions of the side walls 275a and 275b, and attachment
portions 275e extending individually downward from the respective
proximal end portions of the side walls 275a and 275b.
[0106] A slit 234 is defined between the side walls 275a and 275b,
and a grasping member 282 is located in the slit 234 for rocking
motion. The member 282 can grasp the living organism in cooperation
with the vibration transmitting member 251. More specifically, the
grasping member 282 is connected integrally to a jaw 278 by means
of a cylindrical collar member 277a so that the jaw 278 is held
between the members 282 and 277a. Further, an attachment portion
282a of the member 282, which is situated in the slit 234, is
rockably attached to the open-close member 275 by means of a pivot
pin 277. In this case, the collar member 277a penetrates the
attachment portion 282a of the grasping member 282 in the slit 234
and the jaw 278, while the pin 277 is passed through the member
277a. The width of the slit 234 is made greater than that of the
attachment portion 282a of the grasping member 282 that is fitted
in the slit 234.
[0107] FIGS. 10-19 show a preferred embodiment of a robotic tool 80
having aspects of the present invention. The tool 80 includes an
ultrasound treatment instrument assembly which may have a number of
features which are generally similar to portions of the ultrasonic
treatment instrument shown in FIGS. 5-9. As a matter of cost and
convenience, portions of a suitable OEM ultrasound instrument (for
example, the SonoSurg.RTM. ultrasonic treatment instrument model
T3070 made by Olympus Optical Co., Ltd., of Tokyo, Japan) may be
modified and included as a subassembly of the robotic tool 80. The
above referenced U.S. Pat. No. 6,193,709 describes an ultrasound
treatment instrument generally similar to the SonoSurg.RTM.
instrument. Likewise, portions of the generally similar
Ultracision.RTM. Harmonic Scalpel.RTM. LaparoSonic.RTM. Coagulating
Shears, now made by Ethicon Endo-Surgery, Inc, of Cincinnati, Ohio,
may be included as subassemblies of the robotic tool 80. A
description of an ultrasound treatment instrument generally similar
to the LaparoSonic.RTM. Coagulating Shears is included in U.S. Pat.
No. 5,322,055, which patent is hereby incorporated by reference.
The tool 80 may be used in operative association with a suitable
prior art OEM ultrasound driver transducer, power supply and
control system (for example, the SonoSurg.RTM. model T2H made by
Olympus Optical Co., Ltd., of Tokyo, Japan) to provide ultrasound
energy supply and control functions.
[0108] Referring now to FIGS. 10 and 11c, a distal portion of a
robotic surgical instrument 80 according to various embodiments of
the present invention suitably includes a shaft 84, covered by a
sheath 86, with an end effector 81 at the distal end of shaft 84.
End effector 81 includes a gripper 82 hingedly attached to shaft 84
at a hinge 83, and an ultrasonic probe tip 85b. In one embodiment,
the distal portion of surgical instrument 80 also includes a distal
sealing ring 87 (FIG. 11c).
[0109] Generally, ultrasound probe tip 85b is configured to
delivery ultrasound energy at a surgical site for cutting,
cauterization or any other suitable purpose. As such, ultrasound
probe may be designed to have any suitable configuration. For
example, ultrasound probe tip 85b may comprise a cylindrical probe
with a rounded tip, as in FIG. 10, or may alternatively comprise a
triangle-shaped probe, a square probe, a probe with a flat or
pointed tip, a shorter probe, a longer probe or the like.
[0110] According to an aspect of the present invention, gripper 82
is configured to be movable at hinge 83 such that the distal end of
gripper 82 may be moved toward ultrasound probe tip 85, 85b to grip
tissue or other substances between gripper 82 and probe tip 85b,
and may be moved away from probe tip 85b to release tissue. For
example, gripper 82 may be used to grip tissue and position it in
contact with ultrasound probe tip 85b to enable cutting or
cauterization by probe tip 85b. As such, gripper 82 may have any
suitable configuration for holding, gripping or otherwise moving
tissue against probe tip 85b. For example, gripper 82 may include
teeth, as in FIG. 10, or may have straight, flat edges, or one
tooth or other gripping mechanism or the like.
[0111] According to another aspect of the invention, one or more
axes for freedom of motion of end effector 81 may be included in
the distal portion. For example, in one embodiment, shaft 84 is
configured to rotate with sheath 86, enabling end effector 81 to
rotate about the long axis of the surgical instrument. In another
embodiment, a wrist-like mechanism at the connection of shaft 84 to
end effector 81 allows hinge-like movement of end effector 81 in
relation to shaft 84. In another embodiment, as already described,
hinge 83 allows movement of gripper 82. Any suitable combination of
such hinges, wrist-like mechanisms, rotational devices and the like
are contemplated within the scope of the present invention.
[0112] Referring now to FIGS. 11a and 11b, a base 90 of surgical
instrument 80 according to various aspects of the present invention
includes multiple components, such as actuator pulleys, idler
pulleys, actuator rods and the like. Embodiments of such components
are described in more detail below, but generally, the components
of base 90 are configured to enable coupling of surgical instrument
80 with a robotic surgical system. More specifically, components of
base 90 enable forces originating at one or more master controllers
of a robotic surgical system to be transmitted to end effector 81
to achieve an effect at a surgical site. Some of the components of
various embodiments of base 90 and surgical instrument 80 are
generally similar to those described in U.S. application Ser. No.
09/398,958, filed Sep. 17, 1999 (Atty. Docket 17516-4410), and U.S.
application Ser. No. 09/418,726, filed Dec. 6, 1999 (Atty. Docket
17516-3210) (both previously incorporated herein by reference).
[0113] Referring now to FIGS. 12a-12c base 90 is shown with an
enclosing cover 91 in place (FIG. 12a), with enclosing cover 91
removed to show an upper chassis 93 (FIG. 12b) and with upper
chassis 93 removed (FIG. 12c). Upper chassis 93 is generally
configured to rotatably hold and support one end of one or more
actuator spools 94, 95 and one or more idler spools 95a. Base also
suitably includes a rear connector 97 for coupling base 90 to an
ultrasound driver (not shown).
[0114] FIG. 12d is a perspective illustration of a surgical
instrument 80, showing base 90 with covering 91, sheath 86
enclosing shaft, and end effector 81.
[0115] Referring now to FIGS. 13, 14a, 14b, 15a and 15b, various
views of base 90 as shown in FIG. 12c are illustrated. In various
embodiments, base 90 includes a shaft receiver 86b, a bearing
housing 98, a roll drum 96, a actuator tube 110, a roll spool 94,
an upper cable 101a, and a lower cable 101b. Shaft receiver 86b is
generally configured to attach roll drum 96 to shaft/sheath 86.
Roll drum 96 is in turn rotatably supported by bearings within
bearing housing 98. Roll drum 96 interconnects to receiver 86b and
surrounds actuator tube 110. Roll cable 101 spans between roll
spool 94 and roll drum 96 as follows: upper cable 101a wraps around
drum 96 at its rear portion (clockwise as seen from rear) and also
wraps around spool 94 upper portion (clockwise as seen from above).
In the opposite sense, lower cable 101b wraps around the front
portion of drum 96 and around the lower portion of spool 94. Thus,
when spool 94 is rotated by an interface member of a robotic
surgical system, as shown by Arrow R1, roll cable 101 transfers
rotational motion to drum 96 by corresponding winding and unwinding
of roll cable 101 around spool 94 and drum 96. For example, as
spool 94 is rotated as shown by Arrow R1, upper cable 101a moves as
shown by Arrow R2 and lower cable 101b moves as shown by Arrow R3,
causing drum 96 and shaft 86 to rotate as shown by Arrow R4. The
motion is reversible and controllable by the robotic surgical
system.
[0116] According to one aspect of the present invention, gripper 82
of end effector 81 is movable by one or more actuator rods housed
within shaft 86. The motive force for actuating the rod is supplied
by actuator spool 95 which engages an interface member (not shown)
on a robotic surgical system. A cable loop 102 wraps around spool
95 and also around idler spool 95b in a closed loop extending in a
longitudinal direction generally parallel as spaced apart on the
right side of shaft 86. The inner portion of loop 102 is fixed to
the right end 104b of pivot bar or rod 104, the left hand end of
bar 104 is pivoted at pivot pin 105 on the left hand side of shaft
86. The bar 104 (also referred to as a "square hole rod") extends
above, below and across shaft 86, and contacts actuator assembly
110 at a medial portion of bar 104 above and below shaft 86.
[0117] Referring now to FIGS. 14a and 14b, various embodiments of
base 90 suitably include additional components, including one or
more: drive shafts 144 for coupling pulleys with a robotic surgical
system; attachment pins and/or rings 140; holders and lock nuts
141; washers and bushings 106a,b to reduce friction; bushings for
pins 142; tube and grip assemblies 148; pins 149 to align roll
pulleys and actuators; retainers 147 to hold square hole rod
washers and bushings in place; pins 146 to align and hold tube and
grip assembly 148; retaining pins, rings and caps 145 to hold roll
pulley and outer tube assembly; and rods 111 to connect actuator to
grip.
[0118] Referring now to FIGS. 17-19, in one embodiment bar 104 is
configured to extend under shaft/sheath 86 and loop around
shaft/sheath 86, with sufficient clearance from the shaft 86 to
enable it to pivot freely within a desired range of motion. As
spool 95 rotates counter-clockwise as shown by Arrow A1 (FIG. 13),
loop 102 moves counter-clockwise as shown by Arrow A2, so that the
inner portion of the loop moves bar 104 pivotally rearwards
(towards the rear or proximal end of base 90). The distal and
proximal side surfaces 104a,b of bar 104 bear on distal and
proximal bushings 106a,b which in turn contact the actuator 110 to
cause it to move rearward, in turn moving the actuator rod 111
rearward so as to close the gripper 82. Typically, due to
mechanical advantage of the system, actuator 110 moves rearward
through about one half of the range of motion of loop 102.
[0119] As discussed further below with respect to FIGS. 17-19,
bushings 106a,b bear on actuator tube or ring 110 which is moved
rearward or forward by bar 104 (as shown). The actuator ring
extends concentrically within drum 96 and transfers this motion to
actuator rod 111 which extends within shaft 86 distally to
pivotally connect to gripper 82. As shown in FIGS. 14, 15, actuator
rod 111 acts about a lever arm of gripper 82 to alternately open
gripper 82 (rearward rod movement) or close gripper 82 (forward rod
movement). Bushings 106a,b slidably bear on bar 104 so as transmit
longitudinal forces to the actuator tube 110 as the shaft 86 is
rotated, thus permitting gripper actuation at any angle of shaft
rotation. Generally, this actuator motion is reversible and
controllable by the robotic system, producing a controllable
forward or rearward actuator 110 and rod 111 motion and in turn
controllably opening and closing gripper 82.
[0120] According to another aspect of the invention, rear connector
97 on base 90 is generally configured to connect to a transducer
driver to permit ultrasound energy to be transmitted through probe
core 85 housed within shaft 86. In other embodiments, base 90 may
include an internal ultrasound source, such that surgical
instrument 80 may contain its own source of ultrasound energy.
[0121] FIGS. 17-19 illustrate details of the longitudinal coupling
from bar 104 (often referred to as "square hole rod" due to the
open midsection of the particular embodiment shown) to actuator
tube 110. The motion of the midsection of bar 104 is transferred
via bushings 106a,b to tube 110, which is moved rearward or forward
by bushings 106a,b. Actuator ring 110 extends distally (drum 96 is
omitted in FIG. 17 for clarity) and transfers this longitudinal
motion to actuator rod 111 which extends within shaft 86 distally
to pivotally connect to gripper 82.
[0122] FIGS. 18 and 19 are exploded views of an actuator tube
assembly 180 according to an embodiment of the present invention.
In addition to components of actuator tube assembly 180 previously
described above, the assembly 180 also suitably includes additional
washers 107a,b to reduce friction in the assembly. According to one
aspect of the invention, as shown in FIGS. 18 and 19, actuator tube
110 includes retainer tube 110b. In one embodiment, retainer tube
110b threads into tube 110 when assembled, so as to "sandwich" or
trap bushings 106a,b between flange portions of rings 110, 110b and
the side surfaces 104a,b of bar 104.
[0123] FIGS. 20 through 23 illustrate an alternative example of an
instrument embodiment 300 including aspects of the invention.
[0124] It should be noted that much of the description above with
respect to the robotic instrument embodiment 80 of FIGS. 10-19,
including incorporated references, is also relevant with respect to
instrument 300, since in many cases generally similar structures of
each instrument serve equivalent functions.
[0125] For convenience and to minimize manufacturing costs,
selected OEM components of commercially available instruments may
optionally be included in the instrument 300 described herein.
FIGS. 24-27 are sheets of reproductions of the FIGS. 26-36 of U.S.
Pat. No. 6,280,407, issued Aug. 28, 2001 to Manna, et al., entitled
"Ultrasonic Dissection And Coagulation System", and assigned to
United States Surgical Corporation of Norwalk, Conn., the entire
contents of which are hereby incorporated by reference. The patent
describes, among other things, a hand-held ultrasonic treatment
instrument example generally similar to the AutoSonix* Ultra
Shears* made by United States Surgical Corporation of Norwalk,
Conn.
[0126] The instruments described in U.S. Pat. No. 6,280,407
include, among other things, a transducer portion, an ultrasonic
core (vibration coupler) portion, a shaft/distal end effector
portion, and an ultrasonic power supply/controller suitable for
employment as parts of the instrument embodiment of FIGS. 20-23.
For simplicity, in the description below the relevant parts shown
and described in U.S. Pat. No. 6,280,407 will be presumed to be
included in the instrument example 300, although it will be clear
to one of ordinary skill in the art how to make and configure the
production details of equivalent dedicated parts.
[0127] For convenience, an excerpt of U.S. Pat. No. 6,280,407, from
column 11, line 50, to column 14, line 55, is included below. This
excerpt includes description of FIGS. 26-36 of that patent,
reproduced and attached as FIGS. 26-36 herein.
[0128] FIG. 26 illustrates another alternate embodiment of the
ultrasonic instrument, shown generally as 412. Ultrasonic
instrument 412 includes housing 422 and elongated body portion 424
extending distally from housing 422. Housing 422 is preferably
formed from molded housing half-sections 422a and 422b and includes
a barrel portion 426 having a longitudinal axis aligned with the
longitudinal axis of body portion 424 and a stationary handle
portion 428 extending obliquely from barrel portion 426. Ultrasonic
transducer 430 is supported within and extends from the proximal
end of housing 422 and includes a proximal fluted portion 431
configured to engage an attachment device to facilitate attachment
and removal of transducer 430 from instrument 412. Jaw assembly 432
is disposed adjacent the distal end of elongated body portion 424
and is actuated by moving movable handle 436 with respect to
stationary handle portion 428. Movable handle 436 and stationary
handle portion 428 include openings 438 and 440, respectively, to
facilitate gripping and actuation of ultrasonic instrument 412.
Elongated body portion 424 is supported within rotatable knob 434
and may be selectively rotated by rotating knob 434 with respect to
housing 422 to change the orientation of jaw assembly 432.
[0129] FIG. 27 illustrates elongated body portion 424 with parts
separated. Elongated body portion 424 includes an outer tube 442
which is preferably cylindrical and has a proximally located
annular flange 444 dimensioned to engage rotatable knob 434. An
elongated actuator tube 446, which is also preferably cylindrical,
is configured to be slidably received within outer tube 442 and
includes a proximally located annular flange 448 dimensioned to
engage coupling member 498 which is supported within housing 422.
Although not shown, it is contemplated that a portion of actuator
tube 446 and a portion of outer tube 442 adjacent flange 444 flares
outwardly to provide additional clearance for vibration coupler
450. Vibration coupler 450 is dimensioned to extend through
elongated actuator tube 446 and includes an enlarged proximal end
452 having a bore (not shown) configured to operatively engage
ultrasonic transducer 430. The distal end of actuator tube 446
includes a pair of resilient arms 453 having distally located
openings 455. The openings 455 are dimensioned to receive
protrusions 461 formed on an adaptor 457. Arms 453 are flexible
outwardly and engage adaptor 457. Cutting jaw 458 is monolithically
formed with vibration coupler 450. Alternately, cutting jaw 458 and
vibration coupler 450 can be formed separately and fastened
together using any known connector, e.g., screw threads, friction
fit, etc. Although not shown, a plurality of sealing rings can be
molded or otherwise attached to the nodal points along vibration
coupler 450 to seal between vibration coupler 450 and actuator tube
446.
[0130] Referring also to FIGS. 28A-C, a clamp 460 is operably
connected to adaptor 457. Clamp 460 preferably includes a pair of
longitudinally extending rows of teeth 462 which are spaced from
each other a distance which permits cutting jaw 458 to be
positioned between the rows of teeth 462. Teeth 462 function to
grip tissue when the jaw assembly 432 is in a closed position to
prevent tissue from moving with respect to cutting jaw 458 during
vibration of the cutting jaw.
[0131] Pivot members or pins 466 are formed at the proximal end of
clamp 460 and are configured to be received within open ended slots
468 in the distal end of outer tube 442. Slots 468 are open on one
side thereof to permit clamp 460 to be retained therein. A
longitudinally extending guide slot 470 formed in adaptor 457 is
dimensioned to slidably receive pivot pin 466 and permit relative
movement between adaptor 457 and clamp 460. A pair of camming
members 472 are also formed on clamp 462 and are positioned to be
received in cam slots 474 formed in the adaptor in 457.
[0132] Cutting jaw 458 includes blade surface 459 which is flat and
angled downwardly toward its distal end to define a fixed acute
angle .theta. of from about 10 degrees to about 20 degrees with
respect to the longitudinal axis of the elongated body portion 424
and to the axis of vibration. The angled blade surface provides for
good visibility at the surgical site. Preferably, angle .theta. is
about 12 degrees, but greater angles such as 20 to 30 degrees are
also envisioned. Alternately, blade surface 459 may be other than
flat, e.g., sharpened, rounded, etc.
[0133] Clamp 460 is movable relative to cutting jaw 458 from an
open position in which tissue contact surface 464 of clamp 460 is
spaced from blade surface 459 to a closed or clamped position in
which tissue contact surface 464 is in juxtaposed closer alignment
with blade surface 459. In the clamped position, note the
positioning of tissue contact surface 464 with respect to blade
surface 459. Actuation of clamp 460 from the open position to the
clamped position will be described in detail below.
[0134] Referring to FIGS. 29 and 30, housing half-sections 422a and
422b define a chamber 476 configured to house a portion of
ultrasonic transducer 430. Chamber 476 has an 20 opening 478
communicating with the interior of housing 422. Ultrasonic
transducer 430 includes a cylindrical stem 480 configured to be
received in an opening in proximal end 454 of vibration coupler
450. In the assembled condition, proximal end 454 extends through
opening 478 into engagement with cylindrical stem 480. Movable
handle 436 is pivotally connected between housing half-sections
422a and 422b about pivot pin members 482 which are monolithically
formed with housing half-sections 422a. A cam slot 488 formed in
each leg 486 is configured to receive a protrusion 490 projecting
outwardly from coupling member 498.
[0135] Coupling member 498 operatively connects movable handle 436
to actuator tube 446 and is preferably formed from molded
half-sections 498a and 498b to define a throughbore 500 dimensioned
to slidably receive the proximal end of vibration coupler 450.
Coupling member 498 has an inner distally located annular groove
502 dimensioned to receive annular flange 448 of actuator tube 446
and an outer proximally located annular groove 504 positioned to
receive an annular projection 506 formed on the internal wall of
swivel member 508. The projection 506 of swivel member 508 is
movable through groove 504 to permit relative longitudinal movement
between coupling member 498 and swivel member 508. A spring 463 is
positioned between coupling member 498 and swivel member 508 to
bias the swivel member 508 proximally with respect to coupling
member 498. Swivel member 508 is preferably formed from molded
half-sections 508a and 508b and permits rotation of coupling member
498 relative to movable handle 436. Protrusions 490 project
outwardly from sidewalls of swivel member 508 and extend through
cam slots 488 of movable handle 436.
[0136] Rotation knob 434 is preferably formed from molded
half-sections 434a and 434b and includes a proximal cavity 510 for
slidably supporting coupling member 498 and a distal bore 512
dimensioned to receive outer tube 442. An annular groove 514 formed
in bore 512 is positioned to receive annular flange 444 of outer
tube 442. The outer wall of knob 434 has a proximally located
annular ring 516 dimensioned to be rotatably received within
annular slot 518 formed in housing 422, and a scalloped surface 522
to facilitate gripping of rotatable knob 434. Annular ring 516
permits rotation of knob 434 with respect to housing 422 while
preventing axial movement with respect thereto. A pair of rods or
pins 524 extend between half-sections 434a and 434b through a
rectangular opening 526 formed in coupling member 498. Rods 524
engage a pair of flattened surfaces 528 formed on vibration coupler
450, such that rotation of knob 434 causes rotation of vibration
coupler 450 and thus rotation of blade 458 and clamp 460.
Alternately, to provide additional surface contact, instead of pins
524, a C-clip shown generally as 580 in FIG. 31A is provided.
C-clip 580 mounted by pins 586 has an opening 582 to receive the
vibration coupler 450. The flats of vibration coupler 450 contact
the four flat regions 590 of the C-clip 580.
[0137] A retainer ring (not shown) may be mounted on ribs 492 of
housing 422 to provide additional support for actuator tube 446. In
this embodiment, tube 446 would extend proximally past ribs
492.
[0138] FIGS. 31-34 illustrate ultrasonic instrument 412 with clamp
460 in the open position. The elongated body 424 which includes
clamp 460 and blade 458, and housing 422 which includes handles 428
and 436, are packaged as an integral unit that requires no assembly
by the user prior to use, i.e., vibration coupler 450, clamp 460,
and blade 458 are non-detachably connected. That is, the user needs
only to attach transducer 430 to housing 422 to ready instrument
412 for use. In the open position, movable handle 436 is spaced
rearwardly from stationary handle portion 428 and protrusions 490
are positioned in the lower proximal portion of cam slots 488. At
the distal end of ultrasonic instrument 412, pivot members 466 are
positioned near the distal end of guide slots 470 and camming
members 472 are positioned in the upper distal portion of cam slots
474. Tissue contact surface 464 of clamp 460 is spaced from blade
surface 459 to define a tissue receiving area 532. The proximal end
of tissue receiving area 532 is defined by a pair of tissue
receiving stops 535 which are preferably integrally formed with
clamp 460 and extend below blade surface 459. Preferably, the
distal end of blade 458 is devoid of sharp edges which may cause
inadvertent damage to tissue during use of instrument 412.
Alternately, the distal end of blade 458 may be formed having any
shape which may be suitable to a particular surgical application,
i.e., flat, pointed, etc.
[0139] Referring to FIGS. 35 and 36, when movable handle 436 is
pivoted clockwise about pivot member 482 towards stationary handle
portion 428, in the direction indicated by arrow "G" in FIG. 35,
cam slot 488 engages protrusion 490 of swivel member 508 to advance
coupling member 498 distally within cavity 510 of rotation knob
434. Since actuator tube 446 is attached to coupling member 498 by
annular flange 448, actuator tube 446 is also advanced distally in
the direction indicated by arrow "H" in FIG. 36. Movement of
actuator tube 446 distally causes cam slots 474 to move into
engagement with camming members 472 to pivot clamp body 462 about
pivot members 466, in the direction indicated by arrow "I" in FIG.
36, to move clamp member 462 and tissue contact member 464 into the
clamped position. Spring 463 prevents over clamping of tissue by
permitting relative movement between swivel member 508 and coupling
member 498 after a predetermined clamping pressure has been applied
against blade 458. In the clamped position, protrusions 490 are
located in a central portion of cam slots 488, pivot members 466
are located near the proximal end of guide slots 470, and camming
members 472 are located in the proximal lower portion of cam slots
474.
[0140] Elongated body portion 424 can be freely rotated with
respect to housing 422 by rotating rotation knob 434. Rotation of
knob 434 in the direction indicated by arrow "J" causes rotation of
jaw assembly 432 in the direction indicated by arrow "K". Knob 434
is positioned adjacent housing 422 to facilitate one handed
operation of both movable handle 436 and rotation knob 434.
[0141] Returning to FIGS. 10-19, note that in the example of
instrument 80 of FIGS. 10-19, ultrasonic probe 85 is a distinct
part separate from actuator rod 111, the probe 85 being arranged to
be rotatable about its axis, but is not required to translate along
the axis. Rod 111 is arranged to reciprocate axially, and is
coupled to gripper 82 to open and close the gripper.
[0142] In reference to FIGS. 20-25, in the alternative instrument
example 300, the ultrasonic probe assembly 320 is arranged to be
axially movable within the instrument along the instrument axis
311, so that the distal portion 322 of the probe assembly 320 is
movable in a reciprocating manner within the shaft sheath 312. The
probe assembly distal portion 322 is in turn mechanically coupled
to a gripper element of the end effector. For example, see actuator
tube 446 which engages gripper or clamp 460, shown in FIG. 27.
[0143] FIG. 20 illustrates an alternative instrument embodiment 300
including aspects of the invention. The proximal potion comprises
an instrument base 330 and a cover 301. Shaft 307 extends distally,
covered by outer sheath 312. An end effector 302 is coupled to the
distal end of the shaft 307, comprising an ultrasonic blade 304,
which cooperatively mates with pivotally mounted gripper or clamp
303. Ultrasonic transducer 305 mounts to the proximal end of base
330, the power/control cable 306 extending to a conventional
ultrasonic surgical generator, such as the Auto Sonix* generator
(not shown) made by United States Surgical Corporation of Norwalk,
Conn.
[0144] FIGS. 21 and 22 are top and side views respectively of the
proximal portion of the alternative instrument embodiment 300,
illustrated with the cover 301 removed from the base 330. The base
330 supports a rotational support structure including, in this
example, front bearing support 332 and medial bushing 333. Bearing
332 and bushing 333 are axially aligned and rotatably mount
receiver 335, which spans between bearing 332 and bushing 333.
Receiver 335 mounts roll drum 336. Receiver 335 has a hollow axial
lumen 340 which is configured to removably mount the treatment
assembly 310 (see also FIG. 23). The removable treatment assembly
310 is generally aligned parallel with the axis 311, and is mounted
by insertion into lumen 340.
[0145] The removable treatment assembly 310 is retained in its
mounted position by a latching mechanism, which in the example
shown includes a pair of latches 337a and 337b mounted to base 330.
The latches 337a and 337b each include a spring-loaded slidable
finger 338a, 338b, oriented generally perpendicular to the axis
311. Fingers 338a and 338b are urged by springs 338a and 338b
towards the axis 311 by springs 339a and 339b, the fingers
overlapping adaptor 313 to bear on rear-facing surface 314 of
adaptor 313, thus securing the treatment assembly 310 by preventing
axial motion of the adaptor 313 relative to the receiver 335. For
insertion or removal of the treatment assembly, the latch fingers
338a and 338b may be retracted by moving the finger against spring
forces. In the example shown, for example shown, finger extension
341 protrudes upwardly through slot 342, permitting the finger to
be manually retracted. The fingers do not interfere with rotational
motion of the receiver and treatment assembly combination about
axis 311.
[0146] Other conventional latching mechanisms known in the
mechanical arts may be used to secure the treatment assembly 310 to
the receiver 313. For example, a latching mechanism may be included
in the receiver 335, removably coupling to adaptor 313.
Alternatively, the contact surface between the receiver lumen 340
and the adaptor 313 may be configured as a threaded joint, to allow
disassembly.
[0147] The roll barrel 336 of instrument 300 functions in generally
the same manner as the roll barrel of instrument 80 shown in FIGS.
10-19. A robotic surgical system interface member (not shown
herein, see incorporated application Ser. Nos. 09/398,958 and
09/418,726, referenced above) is configured to engages the
pivotally mounted instrument roll interface member 344 so as to
controllably rotate interface member 344 in either direction
through a selected range of motion. The instrument roll interface
member is supported by bearing 345 mounted to base 301. The
perimeter of instrument interface member 344 is shown configured to
provide a spool surface 345 which engages cable 346. In the example
shown, cable 346 is guided by front and rear idler pulley pairs
347a,b and 348a,b respectively, to conduct the cable346 to engage
the perimeter of roll drum 336. The two ends of cable 346 (346a,b)
are led to an upper and lower point on the perimeter of drum 336
respectively, wrapping about the drum 336 in opposite directions,
so that rotational motion of interface member 344 (Arrow C) causes
the cable to impart a rotational motion to the drum 336, and in
turn to impart a corresponding rotational motion to the receiver
and treatment assembly, as shown by Arrow B.
[0148] Alternatively, a separate roll spool may be axially coupled
with instrument interface member 344, in the manner shown in the
instrument 80 of FIGS. 10-19. In the example shown, the cable 346
is fixed to the interface member 344 at a medial anchor point 349,
the ratio of the diameters of the member 344 and the drum 336 being
selected to provide a desired range of rotational motion of drum
336 within less than a 360.degree. rotation of member 344.
Alternatively, the cable 346 may be frictionally engaged to member
344 rather than, so as to permit a greater than less than a
360.degree. rotation of member 344. In still another alternative,
to separate cables may be attached to two separate spool members.
In a still further alternative, a gear train or other mechanical
transmission means, e.g., a right-angled helical gear pair, may be
used to rotationally couple the interface member 344 with the
receiver 335.
[0149] It should also be noted that in the instruments examples of
the invention shown in FIGS. 10-25, where a mechanical robotic
actuator interface is described (see the incorporated application
Ser. Nos. 09/398,958 and 09/418,726, referenced above), other
actuation interface devices, such a as an electromechanical drive,
a magnetic interface, a flexible drive interface, hydraulic
interface or the like, may be substituted without departing from
the spirit of the invention. For example, one or more electric
motor assemblies or motor packs (optionally having gears and/or
encoders) may be mounted to base 330 to drive one or more of the
rotational and/or translational degrees of freedom of the
instrument, the motor packs being electrically connected to receive
control/power signals from (and optionally transmit feedback
signals to) the robotic surgical control system.
[0150] FIG. 23 is a side view of the removable treatment assembly
310 of the instrument embodiment 300 shown in FIGS. 20 and 21. FIG.
24 is a corresponding side view of the proximal portion of the
instrument embodiment 300 from the same perspective as shown in
FIG. 22, with the treatment assembly 310 removed.
[0151] As shown in FIGS. 21 through 24, the removable treatment
assembly 310 comprises adaptor housing 313 having an internal
hollow volume 315 communicating between openings at its distal and
proximal ends. FIG. 25 is a perspective view of a molded half
portion of the adaptor housing 313a of the removable treatment
assembly 310 shown in FIGS. 21 and 22.
[0152] The interior of housing halfportion 313a of the adaptor
housing 313 defines half of the internal volume 315, here denoted
as 315a. Internal volume 315 holds and mounts the ultrasound
conducting core assembly 320. The internal volume 315 is shaped and
sized so as to permit the core assembly 320 to move axially through
a selected range of motion, as shown by Arrows A in FIGS. 21 and
22. Return spring 323 is mounted between the proximal face 316 of
receiver 313 and push plate 324, which is mounted at a medial
position on the core assembly 310. Spring 323 serves to bias the
location of core assembly 320 to the proximal extent of the range
of motion shown by Arrows A1-4.
[0153] The adaptor housing mounts the outer sheath 312, which may
comprise a tubular structure, such as the outer tube 442 identified
in FIG. 29. As shown in the example of FIG. 25, adaptor housing 313
has a distal annular groove 316 which is configured receive the
proximal flange of outer tube 442 of FIG. 29.
[0154] The core assembly 320 includes components corresponding in
function and general structure to the following components
described in U.S. Pat. No. 6,280,407 and identified in FIGS. 29 and
30: Coupling member 498; actuator tube 446; vibration coupler 450
and blade 458. The grip or clamp end effector 303 may comprise the
component identified as clamp 460 in FIG. 29. The coupling of the
end effector and shaft components may be in the manner described in
U.S. Pat. No. 6,280,407. The removable treatment assembly comprises
a conventional ultrasound transducer 305, preferably coupled to the
ultrasonic core assembly by threaded connector, such as the
transducer 430 shown in FIG. 29.
[0155] As shown in FIGS. 21 and 22, push plate 324 is activated by
contact with one or more movable paddle plates 350 (a opposed pair
of paddle plates 350a and 350b are shown). Each paddle plate 350 is
supported by a generally vertically oriented paddle shaft 351,
which is offset laterally from the instrument axis 311. Each paddle
350 extend towards the axis 311 to slightly overlap the perimeter
of push plate 324 along the proximal surface of the pushplate. The
paddle shafts 351a and 351b are pivotally mounted to base 301,
being supported by bearings 352a and 352b respectively, and each is
activated by instrument actuator interface member 353a and 353b
respectively. Like the instrument roll interface member 344
described above, the instrument actuator interface member 353 is
configured to engage a robotic surgical system interface member
(not shown herein, see incorporated application Ser. Nos.
09/398,958 and 09/418,726, referenced above).
[0156] As each paddle shaft is rotated (Arrow D), the respective
paddle plate pushes against the pushplate 324 (clockwise as shown
in FIG. 21 for paddle 350a, counterclockwise as shown for paddle
350b), causing the pushplate to move distally as shown by Arrow A2,
in turn causing the core assembly 320 to translate distally as
shown by Arrows A1, A3 and A4. The paddles thus actuate the core
assembly 320 against the bias force of spring 323. Actuation of the
paddles in the opposite direction releases the contact force of the
paddles 350 against the pushplate 324, permitting the core assembly
320 to move proximally (to proximal extent of Arrows A1-4). Note
that the transducer 305 core assembly 320 is slidingly supported by
guide tube 354.
[0157] Through the coupling of the core assembly to the grip 303
(see example of FIGS. 26-36, a reciprocating actuation of paddle
shafts 351 causes the grip or claim 303 to alternately open and
close. In the example shown, the coupling of the grip or clamp 303
is such that the grip is closed and in contact with blade 304 when
the core assembly is in its proximal position (proximal extent of
Arrows A1-4) as urged by bias spring 323. Thus the grip arrangement
is "normally closed", and positive actuation is used to move the
core assembly distally to open the grip. Alternatively, the grip
coupling may be configured to be "normally open" or neutral.
[0158] The materials of the surface of paddles 350 and pushplate
324 may be selected to have a low frictional coefficient, so that
sliding contact of the surfaces permits the treatment assembly to
be rotated about axis 311 (by engagement of the pivotally mounted
instrument roll interface member 344) when the grip 303 is in
either an open position or a closed position. The paddles 350 may
be biased by a torsion spring or like member to have a clearance
from pushplate 324 when actuator torque of the robotic system is
not being applied to the actuation interface member 353.
[0159] While the above is a complete description of the preferred
embodiments of the invention, various alternatives, modifications
and equivalents may be used. Therefore, the above description
should not be taken as limiting the scope of the invention which is
defined by the appended claims.
* * * * *