U.S. patent application number 11/277324 was filed with the patent office on 2007-09-27 for articulating endoscopic accessory channel.
This patent application is currently assigned to Ethicon Endo-Surgery, Inc.. Invention is credited to Mark S. Ortiz, Frederick E. IV Shelton, James T. Spivey.
Application Number | 20070225562 11/277324 |
Document ID | / |
Family ID | 38566320 |
Filed Date | 2007-09-27 |
United States Patent
Application |
20070225562 |
Kind Code |
A1 |
Spivey; James T. ; et
al. |
September 27, 2007 |
ARTICULATING ENDOSCOPIC ACCESSORY CHANNEL
Abstract
Methods and devices are provided for controlling movement of a
working end of a surgical device. In one embodiment, methods and
devices are provided for moving an end effector on a distal end of
a surgical fastening device. Movement can include rotational
movement of the end effector about an axis of the shaft,
articulation of the end effector relative to the shaft, and
actuation of an end effector, e.g., closing, firing, and/or
cutting. In other embodiments, a single cable actuator is provided
and is movable between a first position, in which it is effective
to rotate an end effector without actuating (i.e., closing and
firing) the end effector, and a second position, in which it is
effective to actuate the end effector without rotating the end
effector. In other aspects, methods and devices are provided for
moving a flexible neck formed on a distal end of an accessory
channel for use with an endoscope. Movement of the flexible neck
can be used to control positioning of a tool extending through the
flexible neck.
Inventors: |
Spivey; James T.; (Loveland,
OH) ; Ortiz; Mark S.; (Milford, OH) ; Shelton;
Frederick E. IV; (Hillsboro, OH) |
Correspondence
Address: |
NUTTER MCCLENNEN & FISH LLP
WORLD TRADE CENTER WEST
155 SEAPORT BOULEVARD
BOSTON
MA
02210-2604
US
|
Assignee: |
Ethicon Endo-Surgery, Inc.
Cincinnati
OH
|
Family ID: |
38566320 |
Appl. No.: |
11/277324 |
Filed: |
March 23, 2006 |
Current U.S.
Class: |
600/121 |
Current CPC
Class: |
A61B 17/32002 20130101;
A61B 1/0057 20130101; A61B 2017/003 20130101; A61B 2017/2905
20130101; A61B 2017/0042 20130101; A61B 2017/291 20130101; A61B
2017/2927 20130101; A61B 17/068 20130101; A61B 1/0052 20130101;
A61B 90/37 20160201; A61B 2017/2947 20130101; A61B 2017/2919
20130101; A61B 2034/306 20160201; A61B 2090/372 20160201 |
Class at
Publication: |
600/121 |
International
Class: |
A61B 1/00 20060101
A61B001/00 |
Claims
1. An accessory channel for releasable attachment to an endoscope,
the accessory channel comprising: an elongate tube having an inner
lumen extending therethrough between proximal and distal ends
thereof for receiving a tool; a flexible neck extending from the
distal end of the elongate tube and configured to flex to orient a
tool extending through the elongate tube; and a handle coupled to
the proximal end of the elongate tube and being operatively
associated with the flexible neck such that movement of the handle
is mimicked by the flexible neck.
2. The device of claim 1, wherein the flexible neck include a
plurality of slits formed therein to facilitate flexion
thereof.
3. The device of claim 2, wherein the flexible neck includes a
distal region of slits and a proximal region of slits, and wherein
the slits are configured such that tension applied to the flexible
neck will cause the flexible neck to bend at the proximal and
distal regions.
4. The device of claim 1, wherein the handle includes a stationary
member and a movable member adapted to articulate relative to the
stationary member.
5. The device of claim 4, wherein the movable member is coupled to
the stationary member by a joint selected from the group consisting
of a ball and socket joint, a hinge joint, and a flexing joint.
6. The device of claim 1, further comprising an actuator extending
between the handle and the flexible neck, the actuator being
configured to transfer movement from the handle to the flexible
neck.
7. The device of claim 6, wherein the actuator comprises at least
one cable extending along a length of the elongate tube.
8. The device of claim 7, further comprising a locking mechanism
positioned to engage at least one of the handle and the at least
one cable to lock the handle and the at least one cable in a fixed
position.
9. The device of claim 7, wherein the at least one cable comprises
a plurality of cables that are equally spaced apart from one
another around a circumference of the elongate tube.
10. The device of claim 7, wherein the elongate tube includes at
least one lumen formed in a sidewall thereof and extending along
the length thereof, and wherein the at least one actuator is
slidably disposed within the at least one lumen.
11. The device of claim 1, wherein the elongate tube includes a
mating element formed on and extending along a length of an
external surface thereof for mating to a complementary mating
element formed on an endoscope or endoscope sleeve.
12. An endoscopic system, comprising: an elongate sleeve configured
to be disposed around an endoscope; and an accessory channel
removably matable to the elongate sleeve, the accessory channel
having an inner lumen extending therethrough between proximal and
distal ends thereof for receiving a tool, a flexible portion formed
on a distal portion thereof and being made flexible by a plurality
of slits formed therein, and at least one handle coupled to the
proximal end of the accessory channel and operatively associated
with the flexible portion such that the at least one handle is
configured to cause the flexible portion to articulate in at least
one plane.
13. The system of claim 12, wherein the at least one handle is
operatively associated with the flexible portion by at least one
cable, and wherein the at least one handle is configured to axially
move the at least one cable relative to the accessory channel to
cause the at least one cable to apply tension to the flexible
portion of the accessory channel such that the flexible portion
articulates in at least one plane.
14. The system of claim 12, wherein the at least one handle
comprises a single handle configured to cause the flexible portion
to articulate in multiple planes.
15. The system of claim 14, wherein the single handle includes a
stationary member coupled to the proximal end of the accessory
channel, and a movable member configured to articulate relative to
the stationary member.
16. The system of claim 14, wherein the single handle and the
flexible portion are operatively associated such that movement of
the single handle is mimicked by the flexible portion.
17. The system of claim 12, wherein the at least one handle
includes a first member configured to cause the flexible portion to
articulate in a first plane, and a second member configured to
cause the flexible portion to articulate in a second plane.
18. The system of claim 17, wherein the at least one handle
includes a stationary member coupled to the proximal end of the
accessory channel, and wherein the first and second members are
rotatably coupled to the stationary member.
19. The system of claim 18, further comprising a first spool
coupled to the first member and having at least one cable extending
therefrom and coupled to the flexible portion, and a second spool
coupled to the second member and having at least one cable
extending therefrom and coupled to the flexible portion, and
wherein the first and second members are effective to rotate the
first and second spools and thereby move the cables axially to
cause the flexible portion to articulate.
20. A method for positioning a tool, comprising: slidably mating an
accessory channel to an endoscope disposed within a body cavity to
position a distal end of the accessory channel in proximity to a
distal end of the endoscope; inserting a tool through a lumen in
the accessory channel such that the tool extends distally beyond
the distal end of the accessory channel; and moving a handle
coupled to a proximal end of the accessory channel to cause a
flexible neck on the distal end of the accessory channel to
articulate, thereby causing a working end of the tool to be
oriented in a desired position.
21. The method of claim 20, further comprising locking the flexible
neck in a fixed, articulated position.
22. The method of claim 20, wherein moving the handle comprises
pivotally articulating the handle relative to the accessory
channel.
23. The method of claim 22, wherein the flexible neck mimics
movement of the handle.
24. The method of claim 20, wherein moving the handle comprises
rotating at least one rotatable member on the handle.
25. The method of claim 20, wherein, when the flexible neck
articulates, the flexible neck bends at a plurality of locations
along a length thereof.
26. The method of claim 20, wherein slidably mating the accessory
channel to an endoscope comprises coupling a mating element formed
along a length of the accessory channel with a mating element
formed along a length of a sleeve disposed around the endoscope.
Description
FIELD OF THE INVENTION
[0001] The present invention relates broadly to methods and devices
for controlling movement of a working end of a surgical device.
BACKGROUND OF THE INVENTION
[0002] Endoscopic surgical instruments are often preferred over
traditional open surgical devices since the use of a natural
orifice tends to reduce the post-operative recovery time and
complications. Consequently, significant development has gone into
a range of endoscopic surgical instruments that are suitable for
precise placement of a working end of a tool at a desired surgical
site through a natural orifice. These tools can be used to engage
and/or treat tissue in a number of ways to achieve a diagnostic or
therapeutic effect.
[0003] Endoscopic surgery requires that the shaft of the device be
flexible while still allowing the working end to be articulated to
angularly orient the working end relative to the tissue, and in
some cases to be actuated to fire or otherwise effect movement of
the working end. Integration of the controls for articulating and
actuating a working end of an endoscopic device tend to be
complicated by the use of a flexible shaft and by the size
constraints of an endoscopic instrument. Generally, the control
motions are all transferred through the shaft as longitudinal
translations, which can interfere with the flexibility of the
shaft. There is also a desire to lower the force necessary to
articulate and/or actuate the working end to a level that all or a
great majority of surgeons can handle. One known solution to lower
the force-to-fire is to use electrical motors. However, surgeons
typically prefer to experience feedback from the working end to
assure proper operation of the end effector. The user-feedback
effects are not suitably realizable in present motor-driven
devices.
[0004] Accordingly, there remains a need for improved methods and
devices for controlling movement of a working end of an endoscopic
surgical device.
SUMMARY OF THE INVENTION
[0005] In one embodiment, a surgical device is provided having an
elongate shaft with a proximal end having a handle movably coupled
thereto, and a distal end having a flexible neck extending
therefrom. The handle and the flexible neck can be operatively
associated such that movement of the handle is effective to cause
the flexible neck to articulate in multiple planes. In certain
exemplary embodiments, movement of the handle can be mimicked by
the flexible neck. The device can also include an actuator
extending between the handle and the flexible neck and configured
to transfer movement from the handle to the flexible neck.
[0006] The handle of the device can have a variety of
configurations, but in one embodiment the handle can be adapted to
articulate relative to the proximal end of the elongate shaft. For
example, the handle can be coupled to the proximal end of the
elongate shaft by a joint, such as a ball and socket joint, a hinge
joint, or a flexing joint. The actuator of the device can also have
a variety of configurations, and in one embodiment the actuator can
be at least one cable extending along a length of the elongate
shaft. For example, the device can include a plurality of cables
extending along a length of the shaft and equally spaced apart from
one another around a circumference of the actuator. The cables are
configured to slide relative to an axis of the elongate shaft and
to apply tension to the elongate shaft to cause at least a portion
of the elongate shaft to flex and bend. The handle and/or the
cables can also optionally include a locking mechanism associated
therewith and configured to maintain the handle and/or cables in a
fixed position. In an exemplary embodiment, the elongate shaft is
configured to passively flex and bend when it is inserted through a
tortuous lumen.
[0007] The elongate shaft can also have a variety of
configurations, but in one embodiment the device can be in the form
of a surgical stapler and the elongate shaft can include an end
effector coupled to a distal end of the flexible neck and adapted
to engage tissue and deliver at least one fastener into the engaged
tissue. The handle and the end effector can be coupled such that
movement of the handle is mimicked by the end effector. For
example, the handle can be coupled to the proximal end of the
elongate shaft by a joint, such as a ball and socket joint, a hinge
joint, and a flexing joint, and the flexible neck can be formed on
or coupled to the end effector to allow the end effector to
proportionally mimic movement of the handle. The device can also
include an actuator extending between the handle and the end
effector and configured to transfer movement from the handle to the
flexible neck. The actuator can be, for example, a plurality of
cables extending along a length of the elongate shaft. The cables
can be equally spaced apart from one another around a circumference
of the elongate shaft.
[0008] In another embodiment, the device can be in the form of an
accessory channel and the elongate shaft can be in the form of a
tube having an inner lumen adapted to receive a tool therethrough.
The flexible neck extending from the distal end of the elongate
tube can be configured to flex to orient a tool extending through
the elongate tube. The flexible neck can have a variety of
configurations, but in one embodiment it includes a plurality of
slits formed therein to facilitate flexion thereof. The slits can
be configured to cause the flexible neck to flex into a desired
orientation. For example, the flexible neck can include a distal
region of slits and a proximal region of slits, and the slits can
be configured such that tension applied to the flexible neck will
cause the flexible neck to bend at the proximal and distal regions.
A handle can be coupled to the proximal end of the elongate tube,
and it can operatively associated with the flexible neck such that
movement of the handle is mimicked by the flexible neck. The handle
can also have a variety of configurations, and in one embodiment
the handle can include a stationary member and a movable member
adapted to articulate relative to the stationary member. The
movable member can be coupled to the stationary member by a joint,
such as a ball and socket joint, a hinge joint, and a flexing
joint. In use, the accessory channel can be configured to
releasably attach to an endoscope. For example, a mating element
can be formed on and extend along a length of an external surface
thereof for mating to a complementary mating element formed on a
sleeve adapted to receive an endoscope. The device can also include
an actuator extending between the handle and the flexible neck. The
actuator can be configured to transfer movement from the handle to
the flexible neck. In certain exemplary embodiments, the actuator
is in the form of at least one cable extending along a length of
the elongate tube. Where the actuator includes multiple cables, the
cables are preferably equally spaced apart from one another around
a circumference of the elongate tube. The cables can extend along
the elongate tube using various techniques. For example, the
elongate tube can include at least one lumen formed in a sidewall
thereof and extending along the length thereof, and the cable(s)
can be slidably disposed within the lumen(s). The device can also
include a locking mechanism positioned to engage at least one of
the handle and the cable(s) to lock the handle and the cable(s) in
a fixed position.
[0009] The present invention also provides an endoscopic system
having an elongate sleeve configured to be disposed around an
endoscope, and an accessory channel removably matable to the
elongate sleeve. The accessory channel can have an inner lumen
extending therethrough between proximal and distal ends thereof for
receiving a tool, a flexible portion formed on a distal portion
thereof and being made flexible by a plurality of slits formed
therein, and at least one handle coupled to the proximal end
thereof and operatively associated with the flexible portion such
that the handle(s) is configured to cause the flexible portion to
articulate in at least one plane. The handle(s) can be operatively
associated with the flexible portion by at least one cable, and the
handle(s) can be configured to axially move the cable(s) relative
to the accessory channel to cause the cable(s) to apply tension to
the flexible portion of the accessory channel such that the
flexible portion articulates in at least one plane. In one
embodiment, the device can include a single handle configured to
cause the flexible portion to articulate in multiple planes. The
single handle can include a stationary member coupled to the
proximal end of the accessory channel, and a movable member
configured to articulate relative to the stationary member. The
single handle and the flexible portion can be operatively
associated such that movement of the single handle is mimicked by
the flexible portion. In another embodiment, the handle can include
a first member configured to cause the flexible portion to
articulate in a first plane, and a second member configured to
cause the flexible portion to articulate in a second plane. In
particular, the handle can include a stationary member coupled to
the proximal end of the accessory channel, and the first and second
members can be rotatably coupled to the stationary member. The
device can further include a first spool coupled to the first
member and having at least one cable extending therefrom and
coupled to the flexible portion, and a second spool coupled to the
second member and having at least one cable extending therefrom and
coupled to the flexible portion. The first and second members can
be effective to rotate the first and second spools and thereby move
the cables axially to cause the flexible portion to articulate.
[0010] The surgical devices disclosed herein can also include a
variety of other features. For example, the device can include an
optical image gathering unit disposed on a distal end of the
elongate shaft. The optical image gathering unit can be adapted to
acquire images during endoscopic procedures. An image display
screen can be disposed on a proximal portion of the device and
adapted to communicate with the optical image gathering unit to
display the acquired images. In other embodiments, the end effector
of the device can include a cartridge removably disposed therein
and containing a plurality of staples for stapling tissue and a
blade for cutting stapled tissue.
[0011] In other aspects, a surgical method is provided and includes
inserting an elongate shaft into a body lumen to position a
flexible neck coupled to a distal end of the elongate shaft
adjacent to tissue to be treated, and moving a handle pivotally
coupled to a proximal end of the elongate shaft to cause the
flexible neck to mimic the motion of the handle. The flexible neck
can mirror movement of the handle, or movement of the flexible neck
can directly correspond to movement of the handle. In certain
exemplary embodiments, the movement is proportional.
[0012] In one exemplary embodiment, an end effector coupled to a
distal end of the elongate shaft is positioned adjacent to tissue
to be fastened, and a handle pivotally coupled to a proximal end of
the elongate shaft is moved to cause the end effector to
proportionally mimic the motion of the handle. The end effector can
mirror movement of the handle, or movement of the end effector can
directly correspond to movement of the handle. In an exemplary
embodiment, the handle is pivotally articulated about the proximal
end of the elongate shaft to cause the end effector to mimic the
motion of the handle. The method can further include engaging
tissue between opposed jaws of the end effector, and driving at
least one fastener from the end effector into the tissue. Tissue
can be engaging by moving a translating member formed on the handle
from a first position to a second position to close the opposed
jaws, and the fasteners can be fired by rotating a rotatable member
formed on the handle to actuate a driver mechanism disposed within
the end effector to cause the driver mechanism to drive a plurality
of fasteners into the tissue. In another embodiment, prior to
moving the translating member from the first position to the second
position, the rotatable member can be rotated to rotate the end
effector relative to the flexible neck without actuating the driver
mechanism.
[0013] In yet another aspect, the elongate shaft can be in the form
of an accessory channel that is slidably mated to an endoscope
disposed within a body cavity to position a distal end of the
accessory channel in proximity to a distal end of the endoscope. A
tool is inserted through a lumen in the accessory channel such that
the tool extends distally beyond the distal end of the accessory
channel, and a handle coupled to a proximal end of the accessory
channel can be moved to cause a flexible neck on the distal end of
the accessory channel to articulate, thereby causing a working end
of the tool to be oriented in a desired position. The handle can be
moved by pivotally articulating the handle relative to the
accessory channel, or alternatively is can be moved by rotating at
least one rotatable member on the handle.
BRIEF DESCRIPTION OF THE DRAWINGS
[0014] The invention will be more fully understood from the
following detailed description taken in conjunction with the
accompanying drawings, in which:
[0015] FIG. 1A is a perspective view of one embodiment of a
surgical stapling and cutting device, showing a working end of the
device in an initial position;
[0016] FIG. 1B is a perspective view of the surgical stapling and
cutting device of FIG. 1A, showing the working end of the device in
an articulated position;
[0017] FIG. 2 is a perspective view of a portion of a flexible neck
of the device shown in FIGS. 1A and 1B;
[0018] FIG. 3A is a perspective view of a distal portion of the
device shown in FIGS. 1A and 1B, showing an end effector and the
flexible neck of FIG. 2 coupled thereto;
[0019] FIG. 3B is a cross-sectional view taken across line 3B-3B of
the end effector shown in FIG. 3A;
[0020] FIG. 4A is a perspective view of a proximal portion of the
device shown in FIGS. 1A and 1B, showing a handle movably coupled
to a proximal end of a shaft of the device;
[0021] FIG. 4B is an exploded view of the proximal portion of the
device shown in FIG. 4A;
[0022] FIG. 5 is a perspective view of coupling element disposed
between the flexible neck and elongate shaft of the device shown in
FIGS. 1A and 1B, showing an optical image gathering apparatus;
[0023] FIG. 6 is a perspective view of the handle of the device
shown in FIGS. 1A and 1B, showing an image display screen;
[0024] FIG. 7 is a perspective view of an accessory channel for use
with an endoscope;
[0025] FIG. 8A is a perspective view of a flexible neck of the
device shown in FIG. 7;
[0026] FIG. 8B is a perspective view of the flexible neck shown in
FIG. 8A, showing the neck articulated in a first direction;
[0027] FIG. 8C is a perspective view of the flexible neck shown in
FIG. 8A, showing the neck articulated in a second direction;
[0028] FIG. 9A is a perspective view of another embodiment of a
flexible neck for use with an accessory channel;
[0029] FIG. 9B is a perspective view of the flexible neck shown in
FIG. 9A, showing the neck articulated in a first direction;
[0030] FIG. 9C is a perspective view of the flexible neck shown in
FIG. 9A, showing the neck articulated in a second direction;
[0031] FIG. 10 is a perspective view of a plurality of cable
actuators for use with the device of FIG. 7;
[0032] FIG. 11 is a cross-sectional view of a shaft of the
accessory channel of FIG. 7;
[0033] FIG. 12 is a perspective view of one embodiment of an end
cap for use with the accessory channel of FIG. 7;
[0034] FIG. 13A is an exploded view of the handle and a proximal
portion of the elongate shaft of the device shown in FIG. 7;
[0035] FIG. 13B is a cross-sectional view of the handle and the
proximal portion of the elongate shaft of FIG. 13A in an assembled
configuration;
[0036] FIG. 14A is a perspective view of another embodiment of an
accessory channel;
[0037] FIG. 14B is a cross-sectional view of the accessory channel
shown in FIG. 14A;
[0038] FIG. 15A is a side view of a handle assembly of the device
shown in FIGS. 14A and 14B;
[0039] FIG. 15B is an exploded view of the handle assembly of FIG.
15A;
[0040] FIG. 17A is a perspective view of one embodiment of a
locking mechanism; and
[0041] FIG. 17B is a perspective view of the locking mechanism of
FIG. 17A coupled to the surgical stapling and cutting device of
FIGS. 1A and 1B.
DETAILED DESCRIPTION OF THE INVENTION
[0042] Certain exemplary embodiments will now be described to
provide an overall understanding of the principles of the
structure, function, manufacture, and use of the devices and
methods disclosed herein. One or more examples of these embodiments
are illustrated in the accompanying drawings. Those of ordinary
skill in the art will understand that the devices and methods
specifically described herein and illustrated in the accompanying
drawings are non-limiting exemplary embodiments and that the scope
of the present invention is defined solely by the claims. The
features illustrated or described in connection with one exemplary
embodiment may be combined with the features of other embodiments.
Such modifications and variations are intended to be included
within the scope of the present invention.
[0043] The present invention provides method and devices for
controlling a working end of an endoscopic surgical device. In
general, the endoscopic surgical devices include an elongate shaft
having a distal working end with a flexible neck, and a proximal
end with a handle for controlling movement of the flexible neck on
the distal working end. In certain exemplary embodiments, this can
be achieved using, for example, one or more cables that extend
between the handle and the flexible neck such that movement of the
handle applies a force to one or more of the cables to cause the
flexible portion to flex and thereby move the working end of the
device. Various other features are also provided to facilitate use
of the device. A person skilled in the art will appreciate that the
particular device being controlled, and the particular
configuration of the working end, can vary and that the various
control techniques described herein can be used on virtually any
surgical device in which it is desirable to control movement of the
working end.
[0044] FIGS. 1A and 1B illustrate one exemplary embodiment of a
technique for controlling articulation of the end effector, and in
particular for causing the end effector to mimic and simultaneously
move with the handle. In this embodiment, the device is in the form
of a linear stapling and cutting device 10 for applying multiple
linear rows of staples to tissue and for cutting the stapled
tissue. As shown, the device 10 generally includes an elongate
shaft 12 having a proximal end 12a with a handle 14 coupled
thereto, and a distal, working end 12a having an end effector 16
coupled thereto or formed thereon, as will be discussed in more
detail below. In use, the end effector 16 is configured to mimic
movement of the handle 14. Mimicking motion between the handle 14
and the end effector 16 can generally be achieved using an actuator
(not shown) that extends between the handle 14 and the end effector
16, and that is effective to transfer forces from the handle 14 to
the end effector 16. In an exemplary embodiment, the actuator is in
the form of several cables that are spaced around a circumference
of the elongate shaft 12, and that extend along the length of the
elongate shaft 12. Movement of the handle 14 about the proximal end
12a of the shaft 12 will apply a force to one or more of the cables
to cause the cables to apply a force to the end effector 16,
thereby causing the end effector 16 to mimic the motion of the
handle 14. Mimicking motion can include corresponding motion,
whereby the end effector 16 moves in the same direction and
orientation as the handle 14, or mirrored motion, whereby the end
effector 16 moves in an opposite direction and orientation as the
handle 14. The mimicking motion can also be proportional to the
movement of the handle.
[0045] The elongate shaft 12 of the device 10 can have a variety of
configurations. For example, it can be solid or hollow, and it can
be formed from a single component or multiple segments. As shown in
FIG. 2, the elongate shaft 12 is hollow and is formed from multiple
connecting segments to allow the elongate shaft 12 to flex. The
flexibility of the shaft 12, as well as a relatively small
diameter, allows the shaft 12 to be used in endoscopic procedures,
whereby the device is introduced translumenally through a natural
orifice. The shaft can also vary in length depending on the
intended application.
[0046] FIG. 2 further illustrates one exemplary embodiment of an
actuator 22 in the form of several cables 34a, 34b, 34c, 34d that
are spaced around a circumference of the elongate shaft 12, and
that extend along the length of the elongate shaft 12. The number
and location of the cables can vary. For example, three cables can
be spaced approximately 120.degree. apart from one another around
the circumference of the shaft 12. In the embodiment shown in FIG.
2, four cables 34a, 34b, 34c, 34d are spaced approximately
90.degree. apart from one another around the circumference of the
shaft 12. Each cable 34a-d can extend through a pathway, such as a
lumen, formed on, in, or around the elongate shaft 12. FIG. 2
illustrates each cable 34a-d extending through a cut-out formed on
an external surface of each segment of the shaft 12. Thus, each
segment includes four cut-outs spaced equidistant around the
circumference of the shaft 12 to maintain the cables 34a-d
equidistant from one another. The cut-outs preferably have a size
that is effective to retain the cables 34a-d therein while allowing
the cables 34a-d to freely slide relative to the shaft 12.
[0047] The distal end of the cables 34a-d can be mated to the end
effector 16 to control movement of the end effector 16. While the
end effector 16 can have a variety of configurations, and various
end effectors known in the art can be used, FIG. 3A illustrates one
exemplary embodiment of an end effector 16 which generally includes
opposed first and second jaws 18, 20 that are adapted to receive
tissue therebetween. The first jaw 18 is adapted to contain a
staple cartridge having multiple staples disposed therein and
configured to be driven into tissue, and the second jaw 20 forms an
anvil for deforming the staples. The particular configuration and
the basic operation of the end effector 16 can vary, and various
end effectors 16 known in the art can be used. By way of
non-limiting example, U.S. Pat. No. 6,978,921 entitled "Surgical
Stapling Instrument Incorporating an E-Beam Firing Mechanism,"
which is incorporated herein in its entirety, discloses one
embodiment of an end effector that can be used with the present
invention.
[0048] In order to allow movement of the end effector 16 relative
to the elongate shaft 12, the end effector 16 can be movably
coupled to the distal end 12b of the elongate shaft 12. For
example, the end effector 16 can be pivotally coupled to the distal
end 12b of the elongate shaft 12 by a pivoting or rotating joint.
Alternatively, the end effector 16 can include a flexible neck 26
formed thereon, as shown, for allowing movement of the end effector
16 relative to the elongate shaft 12. The flexible neck 26 can be
formed integrally with the distal end 12b of the shaft 12 and/or
the proximal end of the jaws 18, 20, or it can be a separate member
that extends between the shaft 12 and the jaws 18, 20. As shown in
FIG. 3A, the flexible neck 26 includes a first coupler 28 for
mating the flexible neck 26 to the proximal end of the opposed jaws
18, 20, and a second coupler 30 for mating the flexible neck 26 to
the distal end of the elongate shaft 12. The couplers 28, 30 can be
removably of fixedly mated to the flexible neck 26 and/or to the
jaws 18, 20 and the shaft 12. The couplers 28, 30 also function to
house certain components of the end effector 16. For example, the
first coupler 28 can function to anchor the cables therein, as will
be discussed below, and it can also function to house a gear and
driver assembly for actuating (e.g., closing and firing) the jaws
18, 20.
[0049] In order to facilitate flexion of the flexible neck 26, the
neck 26 can include one or more slits 32 formed therein. The
quantity, location, and size of the slits 32 can vary to obtain a
desired flexibility. In the embodiment shown in FIG. 3A, the
flexible neck 26 includes multiple rows of slits 32, each row
extending radially around the flexible neck 26 and each row being
spaced axially along the length of the flexible neck 26. Each row
of slits contains two slits extending around the circumference of
the neck 26, and each row of slits 32 is axially offset from one
another. As a result, the flexible neck 26 includes alternating
slits 32. A person skilled in the particular pattern of the slits
32 can vary, and that FIG. 3A merely illustrates one pattern for
forming slits 32 to allow flexion of the flexible neck 26. Other
exemplary slit configurations will be discussed in more detail
below.
[0050] As indicated above, the cables 34a-d can be coupled to the
end effector 16 to allow the end effector 16 to move in
coordination with the handle 14. The connecting location of the
cables 34a-d with the end effector 16 can vary depending on the
desired movement. In the illustrated embodiment, the distal end of
the cables 34a-d is connected to the distal end of the flexible
neck 26, and in particular they extend into and connect to the
first coupler 28. FIG. 3B illustrates a cross-sectional view of the
first coupler 28 showing four bores 28a, 28b, 28c, 28d for
receiving the four cables 34a, 34b, 34c, 34d, respectively.
Virtually any technique known in the art can be used to connect the
cables 34a-d to the coupler 28 including, for example, mechanical
mating techniques such as adhesives, an interference fit, a
ball-and-socket connection, threads, etc. In use, the connection of
the cables 34a-d at the distal end of the flexible neck 26 will
allow the cables 34a-d to apply a tension to the flexible neck 26
when an axial force is applied to the cables 34a-d by the handle
14. This tension will cause the neck 26 to flex in a direction
dictated by the amount of tension applied to each cable 34a-d, as
will be discussed in more detail below.
[0051] The handle 14 of the device 10 can be used to control
movement of the end effector 16, and in particular to articulate
the end effector 16 and thus angularly orient it relative to a
longitudinal axis A of the elongate shaft 12. While the handle 14
can have a variety of configurations, in one exemplary embodiment
the handle 14 is movably coupled to the proximal end 12a of the
elongate shaft 12 such that movement of the handle 14 can be
mimicked by the end effector 16. While various techniques can be
used to movably couple the handle 14 to the shaft 12, in the
embodiment shown in FIGS. 4A-4C, a ball-and-socket connection is
formed between the handle 14 and the proximal end 12a of the
elongate shaft 12. As best shown in FIG. 4B, the proximal end 12a
of the elongate shaft 12 includes a socket 24 formed therein, and
the handle 14 includes a hemi-spherical ball 13a formed on a distal
end thereof and configured to be rotatably seated within the socket
24. The socket 24 can be integrally formed with the proximal end
12a of the elongate shaft, or it can be formed by coupling a hollow
housing 12c, as shown, to the proximal end 12a of the elongate
shaft 12. The hemi-spherical ball 13a can also be formed integrally
with the handle 14, or it can be a separate member that is coupled
to the handle 14. In order to movably mate the handle 14 to the
shaft 12, the hemi-spherical ball 13a on the handle 14 can be
retained within the socket 24 using the cables 34a-d, which attach
to the handle 14 as will be discussed below. However, other mating
techniques can be used to movably mate the handle 14 to the shaft
12. For example, the ball 13a can be spherical and it can be
captured within a spherical socket formed in the proximal end 12a
of the elongate shaft 12, or a mating element, such as a pin, can
extend through the ball 13a to retain the ball 13a within the
socket 24. While FIG. 4B illustrates a ball 13a formed on the
handle 14 and a socket 24 formed in the shaft 12, the
ball-and-socket connection can be reversed such that the ball is on
the shaft 12 and the socket is in the handle 14. Moreover, a person
skilled in the art will appreciate that a variety of other
techniques can be used to movably couple the handle 14 to the
proximal end 12a of the elongate shaft 12.
[0052] In use, the handle 14 can articulate or pivotally move
relative to the shaft 12 to cause the end effector 16 to mimic the
movement of the handle 14. This can be achieved by coupling the
proximal end of the cables 34a-d to the handle 14. The connecting
location of the cables 34a-d with the handle 14 can vary depending
on the desired movement. In the illustrated embodiment, the cables
(only three cables 34a, 34b and 34c are shown in FIG. 4A) extend
from the elongate shaft 12, through the hollow housing 12c, and out
of slots or openings formed in a proximal end of the hollow housing
12c. The cables 34a-d then extend around the ball 13a on the handle
14 and connect to a distal-facing surface on the handle 14 that
surrounds the ball 13a. Virtually any technique known in the art
can be used to connect the cables 34a-d to the handle 14 including,
for example, mechanical mating techniques such as adhesives, an
interference fit, threads, etc. As shown in FIG. 4A, the handle 14
includes openings formed therein, and the proximal ends (not shown)
of the cables 34a-d can have a ball or other element formed thereon
and configured to be captured within the openings. As further shown
in FIG. 4A, the cables (only three cables 34a, 34b and 34c are
shown) can remain spaced circumferentially around the handle 14.
This will allow movement of the handle 14 to be mirrored by the end
effector 16, as will be discussed in more detail below.
Alternatively, the cables 34a-d can be crossed before they connect
to the handle 14 to cause the end effector 16 to move in the same
direction as the handle 14. For example, opposed cables 34a and 34c
can cross one another and can connect to opposed sides of the
handle 14, and opposed cables 34b and 34d can likewise cross one
another and can connect to opposed sides of the handle 14. The
cables 34a-d can be crossed at any location, such as within the
hollow housing 12c on the proximal end 12a of the shaft 12.
[0053] As further shown in FIGS. 4A and 4B, the handle 14 can also
include other features to facilitate use of the device. For
example, the handle 14 can include a translating member 38 that is
effective to close the jaws 18, 20 on the end effector 16, and a
rotating member 40 that is effective to selectively rotate and
actuate the end effector 16. The translating and rotating members
38, 40 are described in more detail in an application entitled
"Surgical Fastener And Cutter With Single Cable Actuator" by Mark
Ortiz et al. and filed on even date herewith, which is hereby
incorporated by reference in its entirety. In other embodiments,
the handle 14 can include triggers, knobs, etc. for rotating and/or
actuating the end effector 16.
[0054] Referring back to FIG. 1B, in use the handle 14 can be
pivoted or angularly oriented relative to the proximal end 12a of
the elongate shaft 12 to effect mimicking movement of the end
effector 16. In particular, pivoting the handle 14 about the
elongate shaft 12 in a first direction will apply a force to one or
more of cables 34a-d to pull the cable(s) axially. As a result, the
actuated cables will apply tension to the flexible neck 26 to cause
the neck 26 to flex. In order to prevent the elongate shaft 12 from
flexing in response to tension applied to the cables 34a-d by the
handle 14, the flexible neck 26 can have a greater flexibility than
the elongate shaft 12. This can be achieved, for example, using the
alternating slits 32 as previously described, or in other
embodiments the material can differ, or the elongate shaft can
include a stabilizing element, such as a rod extending therethrough
to render the shaft more rigid than the flexible neck.
[0055] The direction of movement of the handle 14 will be mimicked
by the end effector 16, either in the same direction (i.e.,
corresponding movement) or in an opposite direction (i.e., mirrored
movement), thus allowing a user to precisely control the position
of the end effector 16. In an exemplary embodiment, the particular
amount of movement of the end effector 16 can be proportional to
the amount of movement of the handle 14. That is, the amount of
movement of the end effector 16 can be directly equivalent to the
amount of movement of the handle 14, or it can be proportionally
increased or decreased relative to the amount of movement of the
handle 14. In certain embodiments, it may be desirable to have the
amount of movement of the end effector 16 be increased relative to
the amount of movement of the handle 14. As a result, only small
movements of the handle 14 will be necessary to allow large
movements of the end effector 16. While various techniques can be
achieved to proportionally multiple or increase the movement of the
end effector 16, one exemplary embodiment of a force multiplying
mechanism is an eccentric cam that is coupled to the cables and
that increases the mechanical advantage, either force or
displacement, of the cables 34a-d as tension is applied to the
cables 34a-d by the handle 14.
[0056] A person skilled in the art will appreciate that, while the
movement between the handle and the working end of the device can
be proportional in theory, in practice some lose of force will
likely occur as the force is transferred through the elongate
shaft. Accordingly, proportional movement as used herein is
intended to include applications in which the handle and working
end are configured to move in proportionate amounts, but in which
some lose of force may occur during actual operation of the
device.
[0057] The various devices disclosed herein can also include a
variety of other features to facilitate use thereof. For example,
the device 10 of FIG. 1A can include an optical image gathering
unit disposed on a distal end of the elongate shaft 12 and
configured to acquire images during endoscopic procedures. While
the location of the unit can vary, in one embodiment the optical
image gathering unit can be disposed on the second coupler 30. In
particular, FIG. 5 illustrates a ramp-shaped housing 42 that
protrudes from an outer surface of the coupler 30, and that
contains the optical image gathering unit therein. A viewing window
44 is formed on a distal-facing surface of the housing 42 to allow
the unit to acquire images of the end effector 16 and surrounding
surgical site. The images from the optical image gathering unit can
be transferred to an external image display screen, or
alternatively the device 10 can include image display screen
disposed on or coupled to a proximal portion of the device. FIG. 6
illustrates one embodiment of an image display screen 46 protruding
outward from the handle 14.
[0058] As previously indicated, the various techniques disclosed
herein for controlling movement of a working end of an endoscopic
surgical device can be used in conjunction with a variety of
medical devices. FIG. 7 illustrates another embodiment of a medical
device having an actuator for controlling movement of the working
end thereof. In this embodiment, the medical device is in the form
of an accessory channel 100 for use with an endoscope. An accessory
channel 100 is an external device that can mate to and slide along
an endoscope to allow other tools, such as grasper, cutters, etc.,
to be introduced therethrough and positioned in proximity to the
viewing end of the endoscope. While the accessory channel 100 can
have virtually any configuration, shape, and size, in the
embodiment illustrated in FIG. 7 the accessory channel 100 includes
an elongate tube or shaft 102 having an inner lumen extending
between proximal and distal ends 102a, 102b thereof for receiving a
tool therethrough. The accessory channel 100 can also include a
mating element formed thereon for mating the accessory channel 100
directly to an endoscope or to a sleeve or other device disposed
around an endoscope. While virtually any mating technique can be
used, in the illustrated embodiment the mating element on the
accessory channel 100 is in the form of a rail 104 that extends
along a length of the elongate shaft 102. The rail 104 is
configured to be received in a complementary track formed on an
endoscope or a device disposed around an endoscope, such as a
sleeve. A person skilled in the art will appreciate that a variety
of other techniques can be used to mate the accessory channel
either directly or indirectly to an endoscope.
[0059] In order to control movement of a working end of the
accessory channel 100, the device 100 can include features similar
to those previously described. In particular, the device 100 can a
flexible neck 108 formed on or coupled to the distal end 102b of
the elongate shaft 102, a handle 106 formed on or coupled to the
proximal end 102a of the elongate shaft 102, and an actuator
extending between the handle 106 and the flexible neck 108. In this
embodiment, the actuator is configured to transfer forces from the
handle 106 to the flexible neck 108 such that movement of the
handle 106 is mimicked by the flexible neck 108, thus allowing a
tool extending through the accessory channel 100 to be positioned
at a desired angular orientation.
[0060] The flexible neck 108 can have a variety of configurations,
and it can be a separate member that is coupled to the elongate
shaft 102, or it can be formed integrally with the elongate shaft
102, as shown in FIG. 7. The neck 108 can be made flexible using
various techniques. For example, the neck 108 can be formed from
one or more segments that move relative to one another, and/or it
can be formed from a flexible material. In the exemplary embodiment
shown in FIG. 8A, the neck 108 includes several slits 112 formed
therein and configured to provide maximum flexibility of the neck
108. While the size, quantity, and orientation of the slits 112 can
vary to obtain the desired results, in the illustrated embodiment
the flexible neck 108 includes four columns of slits (only three
columns of slits, indicated by arrows 112a, 112b, 112c, are shown).
Each column extends axially along a length of the flexible neck
108, and each column includes four row of slits spaced radially
around circumference of the neck 108. Each column of slits 112 is
also axially offset from one another to allow the slits 112 to
overlap. In use, when tension is applied to the actuator, the slits
112 will allow the neck 108 to bend or assume a curved
configuration such that the neck 108 articulates relative to the
remainder of the elongate shaft 102, as shown in FIGS. 8B and
8C.
[0061] In other embodiments, the slits can be positioned to allow
flexion of the neck at multiple locations or bend points, or to
otherwise allow the neck to flex into a predetermined position. By
way of non-limiting example, FIG. 9A illustrates another embodiment
of a flexible neck 108' having two regions of slits 112' formed
therein. In particular, the flexible neck 108' includes a distal
region of slits 112a' and a proximal region of slits 112b'. Each
region 112a', 112b' can include any number of slits positioned at
any location to provide a desired degree of flexibility in one or
more desired directions. As shown in FIG. 9A, the proximal end
distal regions of slits 112a', 112b' each include two rows of slits
formed on opposed sides of and extending along the length of the
flexible neck 108'. In use, when tension is applied to the flexible
neck 108', as will be discussed in more detail below, the neck 108'
will flex at both the proximal and distal regions 112a', 112b' and
thereby articulate relative to the remainder of the elongate shaft
102'. As shown in FIG. 9B, flexion can occur first in the distal
region 112a' of the neck 108'. Further tension applied to the neck
108' can then cause the proximal region 112b' to flex, as shown in
FIG. 9C. In other embodiments, the slits positioning and/or size of
the slits can be configured to cause flexion to occur in the
proximal region 112b' before it occurs in the distal region 112a',
or alternatively the slits can be configured to cause simultaneous
flexion of the proximal and distal regions 112b', 112a'. A person
skilled in the art will appreciate that the quantity, position,
size, and shape of the slits can be adjusted to obtain the desired
results. The particular configuration of the cut used to form each
slit can also vary. For example, the width and length of the slit
can remain constant from an outer surface of the elongate shaft to
an inner surface of the elongate shaft, or alternatively the width
and length can increase or decrease such that the slit tapers or
otherwise varies. By way of non-limiting example, a tapering
configuration can be formed by forming a slit having triangular
configuration, where the length and width of the slit decrease from
the outer surface to the inner surface of the elongate shaft.
[0062] As indicated above, the actuator is configured to apply
tension to the flexible neck 108 to cause the neck 108 to
articulate. The actuator can have a variety of configurations, but
in one exemplary embodiment the actuator is similar to the
aforementioned actuator and includes one or more cables that extend
between the handle 106 and the distal end of the flexible neck 108
such that the handle 106 and the flexible neck 108 are operatively
associated. Each cable can be configured to apply tension to the
flexible neck 108 to cause the neck 108 to articulate in a plane of
motion. Thus, where the device 100 includes only one cable, the
flexible neck 108 can articulate in a single plane of motion. Each
additional cable can allow the neck 108 to articulate in a
different plane of motion. Where multiple cables are provided, the
neck 108 can articulate in multiple planes of motion. Moreover, the
cables can be simultaneously tensioned, potentially allow for
360.degree. articulation of the flexible neck 108.
[0063] While the number of cables can vary, and the device 100 can
include only one cable, in the embodiment shown in FIG. 7 the
device 100 includes four cables (only three cables 110a, 110b, 110c
are shown). A portion of the cables 110a, 110b, 110c, 110d is shown
in more detail in FIG. 10. As noted above, the cables 110a-d extend
along a length of the elongate shaft 102 between the handle 106 and
the flexible neck 108. The particular location of the cables 110a-d
can vary, but in an exemplary embodiment the cables 110a-d are
spaced radially around a circumference of the elongate shaft 102
and they extend between the distal-most end of the flexible neck
108 and the handle 106. The cables 110a-d can extend internally
through or externally along the elongate shaft 102, or they can
extend through lumens or pathways formed in the sidewall of the
elongate shaft 102. FIG. 11 illustrates a cross-sectional view of
the elongate shaft 102, showing four lumens 103a, 103b, 103c, 103d
formed therein. The lumens 103a-d preferably have a size that
allows the cables 116a-d to slide therein, and they are spaced
circumferentially about the elongate shaft 102. The lumens 103a-d
extend between the proximal and distal ends 102a, 102b of the
elongate shaft 102 to allow the cables 110a-d to extend between the
handle 106 and the distal-most end of the flexible neck 108.
[0064] The distal end of the cables 110a-d can mate to the distal
most end of the flexible neck 108 using a variety of techniques,
but in one embodiment, shown in FIG. 12, the flexible neck 108
includes an end cap 114 coupled to or formed on the distal-most end
thereof. While the configuration of the end cap 114 can vary
depending on the configuration of the actuator, in the illustrated
embodiment the end cap 114 includes four bores 114a, 114b, 114c,
114d formed therein and spaced around a circumference of the end
cap 114 such that the bores 114a-d align with the lumens 103a-d in
the elongate shaft 102. Each bore 114a-d is configured to receive
one of the cables 110a-d. Various mating techniques can be used to
retain the cables 110a-d within the bores 114a-d. For example, FIG.
10 illustrates ball formed on the end of each cable 110a-d for
retaining the ends of the cables 110a-d in the bores 114a-d in the
end cap 114. The end cap 114 can also include a central lumen 116
formed therein for receiving a tool therethrough. The lumen 116 can
also function to facilitate positioning of a tool inserted through
the accessory channel 100.
[0065] The proximal end of the cables 110a-d can be mated to a
handle 106 that is coupled to a proximal end of the shaft 102.
While the handle 106 can have a variety of configurations, in one
exemplary embodiment, previously shown in FIG. 7, the handle 106
can be in the form of a joystick that is movably coupled to the
proximal end 102a of the elongate shaft 102, and in particular that
is configured to articulate relative to the proximal end 102a of
the elongate shaft 102. The articulating movement of the handle 106
can allow the motion of the handle 106 to be mimicked by the
flexible neck 108, as will be discussed below.
[0066] While articulating movement can be achieved using a variety
of types of joints, in the illustrated embodiment a ball-and-socket
connection is formed between the handle 106 and the elongate shaft
102. In particular, as shown in more detail in FIGS. 13A and 13B,
the proximal end 102a of the elongate shaft 102 includes a housing
103 formed thereon and defining a socket 118 in a proximal end
thereof. The handle 106 includes a ball 120 that is movably
disposed within the socket 118, and the joystick extends proximally
from the ball 120 thus allowing the handle 106 to articulate
relative to the elongate shaft 102. A pin or other mechanism can be
used to movably retain the ball 120 within the socket 118. A person
skilled in the art will appreciate that the handle can have a
variety of other shapes, and that various other techniques can be
used to movably connect the handle 106 to the elongate shaft
102.
[0067] As indicated above, the proximal end of the cables 110a-d is
configured to mate to the handle 106. Thus, the handle 106 can
include features for mating to the cables 110a-d. While the
particular mating features can vary depending on the configuration
of the actuator, in an exemplary embodiment the joystick 122 on the
handle 106 includes four legs 124a, 124b, 124c, 124d formed
thereon. The legs 124a-d are spaced around a circumference of the
joystick 122, such that they are substantially aligned with the
cables, and each leg 124a-d is configured to mate to a terminal end
of one of the cables 110a-d. A ball-and-socket connection, as
previously described with respect to the distal ends of the cables
110a-d, can be used to mate the cables 110a-d to the legs, or
alternatively any other mating technique known in the art can be
used.
[0068] Referring back to FIG. 7, in use the handle 106 can be
pivoted or angularly oriented relative to the proximal end 102a of
the elongate shaft 102 to effect mimicking movement of the flexible
neck 108, and to thereby position a tool extending through the
flexible neck 108. As shown in FIGS. 7 and 13B, the joystick on the
handle 106 can include a lumen 107 formed therethrough and axially
aligned with the lumen 102c in the elongate shaft 102 for allowing
a tool to be introduced through the device 100. In other
embodiments, the handle 106 can be offset from the proximal end
102a of the elongate shaft 102 such that the handle 106 is coupled
to the cables, but does not interfere with direct access to the
lumen 102c in the elongate shaft 102.
[0069] In order to control movement of the flexible neck 108 and
thus a tool positioned therethrough, the handle 106 is pivoted or
articulated about the proximal end 102a of the elongate shaft 102.
For example, movement of the handle 106 in a first direction will
cause the legs 124a-d on the handle 106 to apply a force to one or
more of cables 110a-d to pull the cable(s) axially. As a result,
the actuated cables will apply a tension force to the flexible neck
108 to cause the neck 108 to flex. In order to prevent the elongate
shaft 102 from flexing in response to tension applied to the cables
110a-d by the handle 106, the flexible neck 108 can have a greater
flexibility than the elongate shaft 102. This can be achieved, for
example, using the slits as previously described, or in other
embodiments the shaft 102 can include a stabilizing element, such
as a rod, extending therethrough to make the shaft 102 more rigid
than the flexible neck 108. The direction of movement of the handle
106 will be mimicked by the flexible neck 108, either in the same
direction (i.e., corresponding movement) or in an opposite
direction (i.e., mirrored movement), thus allowing a user to
precisely control the position of the flexible neck 108, and thus
to control the position of a tool extending through the flexible
neck 108. In an exemplary embodiment, the particular amount of
movement of the flexible neck 108 can be proportional to the amount
of movement of the handle 106. That is, the amount of movement of
the flexible neck 108 can be directly equivalent to the amount of
movement of the handle 106, or it can be proportionally increased
or decreased relative to the amount of movement of the handle 106.
In certain embodiments, it may be desirable to have the amount of
movement of the flexible neck 108 be increased relative to the
amount of movement of the handle 106. As a result, only small
movements of the handle 106 will be necessary to allow large
movements of the flexible neck 108. While various techniques can be
achieved to proportionally multiple or increase the movement of the
flexible neck 108, one exemplary embodiment of a force multiplying
mechanism is an eccentric cam that is coupled to the cables and
that increases the mechanical advantage, either force or
displacement, of the cables 110a-d as tension is applied to the
cables 110a-d by the handle 106.
[0070] As previously explained, while the movement between the
handle and the working end of the device can be proportional in
theory, in practice some lose of force will likely occur as the
force is transferred through the elongate shaft. Accordingly,
proportional movement as used herein is intended to include
applications in which the handle and working end are configured to
move in proportionate amounts, but in which some lose of force may
occur during actual operation of the device.
[0071] While FIGS. 1A and 7 illustrate devices in which the working
end mimics movement of the handle, the handle can have a variety of
other configurations in which it is effective to articulate the
working end of the device without having the working end of the
device mimic movement of the handle. FIGS. 14A and 14B illustrate
another embodiment of a device 200 having a handle 204 that
includes a rotatable member that is effective to articulate a
flexible neck 206 in one or more planes of motion relative to an
elongate shaft 202 of the device. In general, the elongate shaft
202 of the device 200 is very similar to the elongate shaft 102
previously described, and it generally includes a flexible neck 206
coupled to or formed on a distal end thereof. Four cable actuators
(not shown) extend through the elongate shaft between the handle
106 and the flexible neck 206. The shaft 102 and the cable
actuators are similar to the shaft 102 and cable actuators 110a-d
previously described with respect to device 100, and thus they will
not be described in detail.
[0072] The handle 204 of the device 200 is shown in more detail in
FIGS. 15A and 15B. In general, the handle 204 includes one or more
spools rotatably disposed therein. Each spool is configured to mate
to and control one of the cable actuators. Thus, rotation of each
spool will wind up or release the cable, thereby causing the
flexible neck 108 to flex and articulate in a particular direction.
While the number of spools can vary depending on the number of
cable actuators, in the embodiment shown in FIGS. 15A and 15B, the
handle 204 includes four spools 208a, 208b, 210a, 210b. The first
two spools 208a, 208b are coupled to one another, and the second
two spools 210a, 210b are coupled to one another. A first cable
212a is coupled to and wound around the first spool 208a, and a
second cable 212b is coupled to and wound around the second spool
208b. The first and second cables 212a, 212b are positioned on and
extend along opposite sides of the elongate shaft 202. As a result,
tension applied to the first cable 212a will cause the flexible
neck 206 to articulate in direction within a first plane of motion,
and tension applied to the second cable 212b will cause the
flexible neck 206 to articulate in the opposite direction within
the same plane of motion. To allow tension to be applied to only
one of the cables 212a, 212b, the first and second cables 212a,
212b are wound around the first and second spools 208a, 208b in
opposite directions. Thus, rotation of the first and second spools
208a, 208b will wind and apply tension to one of the cables 212a,
212b while unwinding and releasing tension on the other one of the
cables 212a, 212b. Third and fourth cables 212c, 212d are likewise
wound around the third and fourth spools 210a, 210b such that
rotation of the third and fourth and second spools 210a, 210b will
wind and apply tension to one of the cables 212c, 212d while
unwinding and releasing tension on the other one of the cables
212c, 212d. The third and fourth cables 212c, 212d can extend along
the shaft 102 at a position that is radially offset from the first
and second cables 212a, 212b such that the third and fourth cables
212c, 212d cause articulation of the flexible neck 206 in a second,
different plane of motion. For example, the third and fourth cables
212c, 212d can be offset from the first and second cables 212a,
212b by about 90.degree. such that the cables 212a-d are all spaced
substantially equidistant around the circumference of the elongate
shaft 202. A person skilled in the art will appreciate that the
handle 204 can include any number of spools and cables to effect
articulation in a desired number of planes.
[0073] In order to control the spools 208a, 208b, 210a, 210b, the
device can include one or more grasping members. As shown in FIGS.
15A and 15B, a first rotatable knob 214 is coupled to the first and
second spools 208a, 208b, and a second rotatable knob 216 is
coupled to the third and fourth spools 210a, 210b. The knobs 214,
216 can be integrally formed with the spools 208a, 208b, 210a,
210b, or they can be coupled to the spools 208a, 208b, 210a, 210b
by a shaft that extends through the spools 208a, 208b, 210a, 210b.
In the illustrated embodiment, the first knob 214 is formed on or
coupled directly to the first spool 208a, and the second knob 216
is coupled to the third and fourth spools 210a, 210b by a shaft 218
that extends from the knob 216 through the first and second spools
208a, 208b, and that couples to the third and fourth spools 210a,
210b. In other words, the first and second spools 208a, 208b are
rotatably disposed around the shaft 218.
[0074] In certain exemplary embodiments, the spools and the
rotatable knobs can also differ in size. In the embodiment shown in
FIGS. 15A and 15B, the first and second spools 208a, 208b, as well
as the first rotatable knob 214, have a diameter that is greater
than a diameter of the third and fourth spools 210a, 210b and the
second rotatable knob 216. While not necessary, such a
configuration can be advantageous as it spaces the cables 212a-d
apart to prevent the cables 212a-d from coming into contact with
one another.
[0075] In use, a tool can be positioned through the elongate shaft
202, and the knobs 214, 216 can be rotated to articulate the
flexible neck 206 on the shaft 202 and thereby position the tool as
desired. As shown in FIGS. 14A and 14B, the handle 204 can include
a lumen 205 extending therethrough and in alignment with the lumen
in the elongate shaft 202 for allowing a tool to be passed through
the handle 204 and the shaft 202. In other embodiments, the handle
204 can be offset from the elongate shaft 202 to provide direct
access to the lumen in the elongate shaft 202. Once the tool is
positioned through the shaft 202, the knobs 214, 214 can be rotated
to articulate the flexible neck 206 on the distal end of the
elongate shaft 202. In particular, the first knob 214 can be
rotated in a first direction, e.g., clockwise, to apply tension to
one of the cables, e.g., the first cable 212a, while releasing or
unwinding the other cable, e.g., the second cable 212b. As a
result, the tension applied to the first cable 212a will pull the
distal-most end of the flexible neck 206 in a proximal direction,
causing the flexible neck 206 to flex and thereby articulate in a
first direction. Rotation of the first knob 214 in an opposite
direction, e.g., counterclockwise, will unwind the first cable 212a
while winding the second cable 212b. The flexible neck 206 will
return to its initial, linear configuration. Further rotation of
the first knob 214 will continue to wind the second cable 212b
while unwinding the first cable 212a, thereby causing the flexible
neck 206 to flex and articulate in an opposite direction along the
same plane of motion. The second knob 216 can be likewise rotated
to articulate the flexible in a different plane of motion. The
knobs 214, 216 can also optionally be rotated simultaneously to
articulate the flexible neck 206 in additional planes of motion
different than the first and second planes of motion.
[0076] In other embodiments, the various devices disclosed herein
can include a locking mechanism for locking the handle(s) and/or
actuator in a fixed position to maintain the working end of a
device in desired articulated or angular orientation. While the
locking mechanism can have a variety of configurations, in one
exemplary embodiment the locking mechanism can be in the form of a
clamp that is effective to clamp down onto the cables and thereby
prevent movement of the cables to lock the working end in a desired
orientation. The clamp can have a variety of shapes and sizes, and
it can be positioned at various locations on the device. FIGS. 17A
and 17B illustrate one exemplary embodiment of a clamp 300 that is
disposed around the hollow housing 12c on the surgical fastening
and cutting device 10 of FIGS. 1A and 1B. The clamp 300 is
generally ring-shaped and can be configured to be slidably or
rotatably mated to the hollow housing 12c adjacent to the openings
through which the cables (only three cables 34a, 34b, 34c are shown
in FIG. 17B) extend. In an initial position, the clamp 300 is
spaced apart from the openings to allow free movement of the cables
34a-d therethrough. Once the working end of the device, e.g., the
end effector 16, is articulated into a desired position, the clamp
300 can moved axially along the hollow housing 12c until it extends
over the openings and engages the cables 34a-d extending therefrom.
The clamp 300 will thus prevent movement of the cables 34a-d when
the clamp 300 is in the locked position. In order to move the clamp
300 axially and to lock the clamp 300 to the housing 12c, the clamp
300 can include a mating element formed thereon and configured to
engage a corresponding mating element formed on the housing 12c. As
shown in FIGS. 17A and 17B, the clamp includes threads 302 formed
therein that are configured to mate with corresponding threads (not
shown) formed on the housing 12c. As a result, rotation of the
clamp 300 about the housing 12c will cause the clamp 300 to move
between the initial and locked positions. A person skilled in the
art will appreciate that various other mating techniques can be
used. Moreover, the locking mechanism can have a variety of other
configurations. For example, the handle can include a locking
element formed thereon and configured to lock the handle in a
fixed, articulated position.
[0077] In other embodiments, the cables can be used to passively
allow articulation of the elongate shaft through a body lumen, and
the clamp 300 or other locking mechanism can be used to lock the
working end of the device into position when desired. In such a
configuration, the handle can merely be used to facilitate grasping
of the device.
[0078] In other embodiments, the cable actuators disclosed herein
used to effect articulation of a working end of a device can be
formed from an electroactive polymer material. Electroactive
polymers (EAPs), also referred to as artificial muscles, are
materials that exhibit piezoelectric, pyroelectric, or
electrostrictive properties in response to electrical or mechanical
fields. In particular, EAPs are a set of conductive doped polymers
that change shape when an electrical voltage is applied. The
conductive polymer can be paired to some form of ionic fluid or gel
and electrodes, and the flow of ions from the fluid/gel into or out
of the conductive polymer can induce a shape change of the polymer.
Typically, a voltage potential in the range of about 1V to 4 kV can
be applied depending on the particular polymer and ionic fluid or
gel used. It is important to note that EAPs do not change volume
when energized, rather they merely expand in one direction and
contract in a transverse direction. Thus, the cable actuators
previously disclosed herein can be replaced by EAP actuators, and
the handle can be configured to activate an energy source to
selectively deliver energy to one or more of the cables. In an
exemplary embodiment, movement of the handle can be configured to
dictate the amount of the energy source, as well as the cable(s)
receiving the energy source. As a result, movement of the handle
can still be mimicked by the working end of the device to provide
the user with the same, precise control over the position of the
working end. The energy source can be an internal source, such as a
battery, or it can be an external source. In other embodiments, the
EAP cable actuators can supplement the axial force applied to the
cables by movement of the handle and thereby proportionally
increase the amount of movement of the working end relative to the
handle.
[0079] In other aspects, the cable actuators can be formed from a
shape-memory material, such as Nitinol. Such a configuration allows
tension to be applied to the cables to articulate the end effector,
yet allows the cables to return to an initial linear configuration
without having to manipulate the handle.
[0080] In yet another embodiment, the various devices disclosed
herein, including portions thereof, can be designed to be disposed
of after a single use, or they can be designed to be used multiple
times. In either case, the device can be reconditioned for reuse
after at least one use. Reconditioning can include any combination
of the steps of disassembly of the device, followed by cleaning or
replacement of particular pieces, and subsequent reassembly. By way
of example, the surgical stapling and fastening device shown in
FIGS. 1A and 1B can be reconditioned after the device has been used
in a medical procedure. The device can be disassembled, and any
number of the particular pieces can be selectively replaced or
removed in any combination. For example, for the surgical stapling
and cutting device, a cartridge disposed within the end effector
and containing a plurality of fasteners can be replaced by adding a
new fastener cartridge to the end effector. Upon cleaning and/or
replacement of particular parts, the device can be reassembled for
subsequent use either at a reconditioning facility, or by a
surgical team immediately prior to a surgical procedure. Those
skilled in the art will appreciate that reconditioning of a device
can utilize a variety of techniques for disassembly,
cleaning/replacement, and reassembly. Use of such techniques, and
the resulting reconditioned device, are all within the scope of the
present application.
[0081] One skilled in the art will appreciate further features and
advantages of the invention based on the above-described
embodiments. Accordingly, the invention is not to be limited by
what has been particularly shown and described, except as indicated
by the appended claims. All publications and references cited
herein are expressly incorporated herein by reference in their
entirety.
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