U.S. patent application number 13/198876 was filed with the patent office on 2011-12-01 for system and method for releasably holding a surgical instrument.
This patent application is currently assigned to SRI International.. Invention is credited to Philip S. Green, Joel F. Jensen.
Application Number | 20110295315 13/198876 |
Document ID | / |
Family ID | 23928711 |
Filed Date | 2011-12-01 |
United States Patent
Application |
20110295315 |
Kind Code |
A1 |
Jensen; Joel F. ; et
al. |
December 1, 2011 |
SYSTEM AND METHOD FOR RELEASABLY HOLDING A SURGICAL INSTRUMENT
Abstract
The invention is directed to a system and method for releasably
holding a surgical instrument (14), such as an endoscopic
instrument configured for delivery through a small percutaneous
penetration in a patient. The instrument comprises an elongate
shaft (100) with a pair of mounting pins (116) laterally extending
from the shaft between its proximal and distal ends. An instrument
holder comprises a support having a central bore (202) and an
axially extending slot (204) for receiving the instrument shaft and
the mounting pins. A pair of locking slots (206) are cut into the
support transversely to and in communication with the axial slot so
that the mounting pins can be rotated within the locking slots. The
instrument support further includes a latch assembly for
automatically locking the mounting pins within the locking slots to
releasably couple the instrument to the instrument holder. With
this twist-lock motion, the surgeon can rapidly engage and
disengage various instruments from the holder during a surgical
procedure, such as open surgery, laparoscopy or thoracoscopy.
Inventors: |
Jensen; Joel F.; (Redwood
City, CA) ; Green; Philip S.; (Palo Alto,
CA) |
Assignee: |
SRI International.
Menlo Park
CA
|
Family ID: |
23928711 |
Appl. No.: |
13/198876 |
Filed: |
August 5, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11522576 |
Sep 18, 2006 |
8012160 |
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13198876 |
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11195494 |
Aug 1, 2005 |
7824424 |
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11522576 |
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10265285 |
Oct 4, 2002 |
7204844 |
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11195494 |
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09521253 |
Mar 8, 2000 |
6461372 |
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10265285 |
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09105706 |
Jun 26, 1998 |
6080181 |
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09521253 |
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08848934 |
May 1, 1997 |
5810880 |
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09105706 |
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08485587 |
Jun 7, 1995 |
5649956 |
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08848934 |
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Current U.S.
Class: |
606/205 |
Current CPC
Class: |
A61B 2034/305 20160201;
B25J 15/04 20130101; B25J 18/04 20130101; A61B 2017/2932 20130101;
Y10T 403/587 20150115; Y10T 403/581 20150115; A61B 34/76 20160201;
A61B 2017/00477 20130101; A61B 2017/00464 20130101; A61B 34/35
20160201; B25J 9/1065 20130101; A61B 34/71 20160201; A61B 2090/506
20160201; A61B 17/29 20130101; A61B 34/70 20160201 |
Class at
Publication: |
606/205 |
International
Class: |
A61B 17/28 20060101
A61B017/28 |
Goverment Interests
[0002] This invention was made with Government support under
contract awarded by the National Institute for Health (NIH) under
grant number 5 R01GM-44902-02. The Government has certain rights in
this invention.
Claims
1-10. (canceled)
11. A method for performing minimally invasive surgery comprising:
coupling an instrument to an actuating mechanism, said instrument
comprising proximal and distal portions, said proximal portion
comprising an actuated body engageable with an actuating body on
said actuating mechanism, said instrument including at least one
distal joint coupled to an end effector member, said actuated body
coupled to said distal joint by at least one elongate element, and
said elongate element being housed in a shaft portion of said
instrument extending between said proximal and distal portions;
controlling the operation of said actuating mechanism from a remote
location so that said actuating body on said actuating mechanism
drives said actuated body of the instrument, thereby causing the at
least one distal joint of the instrument to move; and affecting
tissue with the end effector member to perform surgery.
12. The method of claim 11, the actuated body of the instrument
causing the at least one distal joint of the instrument to move by
pulling said elongate element.
13. The method of claim 11, further comprising axially sliding a
pair of actuator pins in said at least one actuated body to open
and close a pair of jaws in said end effector member.
14. The method of claim 11, further comprising rotating said
actuating body to drive said actuated body.
15. The method of claim 11, said actuating mechanism further
comprising a second rotatable actuating body for moving said shaft
in a second degree of freedom.
16. The method of claim 15, said second degree of freedom
comprising rotating said shaft about its longitudinal axis.
17. The method of claim 11, further comprising sliding said shaft
axially along its longitudinal axis.
18. The method of claim 11, wherein said end effector member
comprises a scalpel.
19. The method of claim 11, said coupling the instrument to the
actuating mechanism comprising coupling the instrument to a
manipulator arm supporting said actuating mechanism.
20. The method of claim 19, wherein said manipulator arm is part of
a remote centering mechanism operable to pivot said shaft about a
fixed incision point.
Description
[0001] This application is a continuation of U.S. application Ser.
No. 11/195,494 filed Aug. 1, 2005, which is a continuation of U.S.
application Ser. No. 10/265,285 filed Oct. 4, 2002, which is a
continuation of U.S. application Ser. No. 09/521,253 filed on Mar.
8, 2000, now U.S. Pat. No. 6,461,372, which is a continuation of
U.S. application Ser. No. 09/105,706 filed on Jun. 26, 1998, now
U.S. Pat. No. 6,080,181, which is a division of U.S. application
Ser. No. 08/848,934, filed on May 1, 1997, now U.S. Pat. No.
5,810,880, which is a division of application Ser. No. 08/485,587,
filed on Jun. 7, 1995, now U.S. Pat. No. 5,649,956, all of which
are incorporated herein by reference.
BACKGROUND OF THE INVENTION
[0003] This invention relates to surgical manipulators and more
particularly to robotic assisted apparatus for use in surgery.
[0004] In standard laparoscopic surgery, a patient's abdomen is
insufflated with gas, and trocar sleeves are passed through small
(approximately 1/2 inch) incisions to provide entry ports for
laparoscopic surgical instruments. The laparoscopic surgical
instruments generally include a laparoscope for viewing the
surgical field, and working tools such as clamps, graspers,
scissors, staplers, and needle holders. The working tools are
similar to those used in conventional (open) surgery, except that
the working end of each tool is separated from its handle by an
approximately 12 inch long extension tube. To perform surgical
procedures, the surgeon passes instruments through the trocar
sleeves and manipulates them inside the abdomen by sliding them in
and out through the sleeves, rotating them in the sleeves, levering
(e.g., pivoting) the sleeves in the abdominal wall, and actuating
end effectors on the distal end of the instruments.
[0005] In robotically-assisted and telerobotic surgery (both open
surgery and endoscopic procedures), the position of the surgical
instruments is controlled by servo motors rather than directly by
hand or with fixed clamps. The servo motors follow the motions of a
surgeon's hands as he/she manipulates input control devices at a
location that may be remote from the patient. Position, force, and
tactile feedback sensors may be employed to transmit position,
force, and tactile sensations from the surgical instrument back to
the surgeon's hands as he/she operates the telerobotic system.
[0006] The servo motors are typically part of an electromechanical
device that supports and controls the surgical instruments that
have been introduced directly into an open surgical site or through
trocar sleeves into the patient's abdomen becomes a body cavity.
During the operation, the electromechanical device or instrument
holder provides mechanical actuation and control of a variety of
surgical instruments, such as tissue graspers, needle drivers, etc,
that each perform various functions for the surgeon, i.e., holding
or driving a needle, grasping a blood vessel or dissecting
tissue.
[0007] This new method of performing telesurgery through remote
manipulation will create many new challenges. One such challenge is
that different surgical instruments will be attached and detached
from the same instrument holder a number of times during an
operation. In laparoscopic procedures, for example, the number of
entry ports into the patient's abdomen is generally limited during
the operation because of space constraints as well as a desire to
avoid unnecessary incisions in the patient. Thus, a number of
different surgical instruments will typically be introduced through
the same trocar sleeve during the operation. Likewise, in open
surgery, there is typically not enough room around the surgical
site to position more than one or two surgical manipulators, and so
the surgeon's assistant will be compelled to frequently remove
instruments from the holder and exchange them with other surgical
tools.
[0008] What is needed, therefore, is an improved system and method
for releasably coupling a surgical instrument to an instrument
holder. The system should be configured to quickly and easily
engage and disengage the instrument from the holder to minimize the
instrument exchange time during endoscopic surgery. Preferably, the
system is part of an electromechanical device that can be coupled
to a controller mechanism to form a telerobotic system for
operating the surgical instrument by remote control.
BRIEF SUMMARY OF THE INVENTION
[0009] According to the invention, a system and method provide for
releasably holding a surgical instrument during conventional open
surgery or endoscopic procedures, such as laparoscopy. The
instrument comprises an elongate shaft with proximal and distal
ends and a mounting means having a protrusion extending radially
from the shaft between the proximal and distal ends. An instrument
holder comprises a support having a body with an axial passage for
receiving the instrument shaft and a first hole in communication
with the axial passage for receiving the protrusion. A second hole
is cut into the body transversely to and in communication with the
first hole so that the protrusion can be rotated within the second
hole. To prevent the instrument from being accidently twisted and
thereby disengaged from the instrument holder during surgery, the
holder further includes a locking means coupled to the body for
automatically locking the protrusion within the second hole thereby
releasably locking the instrument to the instrument holder.
[0010] In a preferred configuration, the protrusion of the mounting
means comprises a pair of opposing arms, such as mounting pins,
extending outward from the instrument shaft. The first hole is an
axially extending slot for receiving the mounting pins and the
second hole is a perpendicular locking slot having a first portion
aligned with the axial slot and a second portion extending
circumferentially around the body of the instrument support. With
this configuration, the mounting pins can be slid through the axial
slot and rotated into the locking slot to attach the instrument to
the holder. The instrument can be removed by performing the same
two steps in reverse order. With this twist-lock motion, the
surgeon can rapidly engage and disengage various instruments from
the instrument holder during a surgical procedure.
[0011] The locking means preferably comprises a releasable latch
assembly for locking the mounting pins to the instrument holder.
The latch assembly includes a spring-loaded plunger coupled to a
latch that normally locks the instrument in place by capturing the
mounting pin in the locking slot. The plunger has a button
extending outward from the instrument holder for moving the latch
away from the locking slot. The button can be depressed manually or
automatically to release the mounting pins and allow instrument
exchange when the instrument is easily accessible to the
surgeon.
[0012] The invention is particularly useful for releasably holding
an endoscopic instrument configured for introduction through a
small percutaneous penetration into a body cavity, e.g., the
abdominal or thoracic cavity. To that end, the instrument
preferably includes an end effector, such as a pair of
jaws,--coupled to the distal end for engaging a tissue structure
within the body cavity. To actuate the end effector, the instrument
has a second pair of arms, such as actuator pins, laterally
extending from the shaft and operatively coupled to the end
effector. Preferably, the actuator pins are axially displaceable
with respect to the shaft to actuate the end effector (e.g., open
and close the jaws). The instrument holder further includes an
actuator driver releasably coupled to the actuator arms and to an
external driver for actuating the end effector. The actuator driver
preferably includes a twist-lock interface having transverse slots
similar to that described for the instrument support so that--the
instrument can be simultaneously engaged or disengaged from both
the instrument support and the actuator driver.
[0013] Other features and advantages of the invention will appear
from the following description in which the preferred embodiment
has been set forth in detail in conjunction with the accompanying
drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
[0014] FIG. 1 is a partial sectional elevational view of a robotic
endoscopic surgical instrument mounted to a manipulator assembly
according to the present invention;
[0015] FIG. 1A is a partial sectional elevational view of the
manipulator assembly of FIG. 1 illustrating the removal of an
instrument holder from the rest of the assembly;
[0016] FIGS. 2A and 2B are enlarged side and front cross-sectional
views, respectively, of the surgical instrument of FIG. 1;
[0017] FIGS. 3A and 3B are perspective views of an instrument
support and an actuator pin catch, respectively, for releasably
mounting the surgical instrument to the manipulator assembly;
[0018] FIG. 4 is a front elevational view of the surgical
instrument mounted within the instrument support and actuator pin
catch of FIGS. 3A and 3B;
[0019] FIG. 5 is a front elevational view of an actuator driver for
providing axial movement of the actuator pin catch of FIG. 3B;
[0020] FIGS. 6A and 6B are enlarged cross-sectional views of an
actuator carriage assembly and a helical actuator of the actuator
driver of FIG. 5;
[0021] FIG. 7 is an enlarged detail of a portion of the frame of
the manipulator assembly of FIG. 1 illustrating a coupling
mechanism for removing the shafts from the frame;
[0022] FIG. 8 is a partial cross-sectional view of the instrument
support of FIG. 3A illustrating a locking mechanism for a twist
lock interface according to the present invention; and
[0023] FIG. 9 is an elevational view of a remote center positioner
for holding the manipulator assembly of FIG. 1.
[0024] FIG. 10 shows a fragmentary portion of the insertion portion
of an endoscope for use with the present invention.
DETAILED DESCRIPTION OF THE INVENTION
[0025] Referring to the drawings in detail, wherein like numerals
indicate like elements, a manipulator assembly 2 is illustrated
according to the principles of the invention. Manipulator assembly
2 generally includes an instrument holder 4 removably mounted to a
base 6 and a drive assembly 7 for manipulating a surgical
instrument 14 releasably coupled to instrument holder 4.
[0026] Referring to FIG. 1, base 6 comprises a frame 16 having
proximal and distal elongate support members 17, 19 and first and
second ball-spline shafts 18, 20 rotatably coupled to support
members 17, 19 via bearings 22. Frame 16 further includes a support
bracket 24 for attaching manipulator assembly 2 to a remote center
positioner 300, as discussed in more detail below (see FIG. 9).
Drive assembly 7 comprises first, second and third drives 8, 10,
12, which are mounted to frame 16 and configured to provide three
degrees of freedom to surgical instrument 14. In the preferred
embodiment, first drive 8 rotates instrument 14 around its own
axis, second drive 10 actuates an end effector 120 on the distal
end of instrument 14 and third drive 12 axially displaces
instrument 14 with respect to frame 16. Of course, it will be
readily recognized by those skilled in the art that other
configurations are possible. For example, assembly 2 may include
additional drives for providing additional degrees of freedom to
surgical instrument 14, such as rotation and flexion of an
instrument wrist.
[0027] First drive 8 comprises a rotation drive motor 26 fixed to
frame 16 and coupled to first shaft 18 by a drive belt 28 for
rotating first shaft 18 with respect to frame 16. Second drive 10
comprises a gripper drive motor 30 fixed to frame 16, and coupled
to second shaft 20 by a drive belt-32 for rotating second shaft 20
with respect to frame 16. Third drive 12 comprises a vertical drive
motor 34 coupled to instrument holder 4 via a drive belt 36 and two
pulleys 38 for axially displacing instrument holder 4 with respect
to frame 16. Drive motors 26, 30, 34 are preferably coupled to a
controller mechanism via servo-control electronics (not shown) to
form a telerobotic system for operating surgical instrument 14 by
remote control. The drive motors follow the motions of a surgeon's
hands as he/she manipulates input control devices at a location
that may be remote from the patient. A suitable telerobotic system
for controlling the drive motors is described in commonly assigned
co-pending application Ser. No. 08/623,932 filed Jan. 21, 1992
TELEOPERATOR SYSTEM AND METHOD WITH TELEPRESENCE, which is
incorporated herein by reference.
[0028] The above described telerobotic servo system preferably has
a servo bandwidth with a 3 dB cut off frequency of at least 10 hz
so that the system can quickly and accurately respond to the rapid
hand motions used by the surgeon. To operate effectively with this
system, instrument holder 4 has a relatively low inertia and drive
motors 26, 30, 34 have relatively low ratio gear or pulley
couplings.
[0029] In a specific embodiment, surgical instrument 14 is an
endoscopic instrument configured for introduction through a
percutaneous penetration into a body cavity, such as the abdominal
or thoracic cavity. In this embodiment, manipulator assembly 2
supports a cannula 50 on distal support member 19 of frame 16 for
placement in the entry incision during an endoscopic surgical
procedure (note that cannula 50 is illustrated schematically in
FIG. 1 and will typically be much longer). Cannula 50 is preferably
a conventional gas sealing trocar sleeve adapted for laparoscopic
surgery, such as colon resection and Nissen fundoplication.
[0030] As shown in FIG. 1, cannula 50 preferably includes a force
sensing element 52, such as a strain gauge or force-sensing
resistor, mounted to an annular bearing 54 within cannula 50.
Bearing 54 supports instrument 14 during surgery, allowing the
instrument to rotate and move axially through the central bore of
bearing 54. Bearing 54 transmits lateral forces exerted by the
instrument 14 to force sensing element 52, which is operably
connected to the controller mechanism for transmitting these forces
to the input control devices (not shown) held by the surgeon in the
telerobotic system. In this manner, forces acting on instrument 14
can be detected without disturbances from forces acting on cannula
50, such as the tissue surrounding the surgical incision, or by
gravity and inertial forces acting on manipulator assembly 2. This
facilitates the use of manipulator assembly in a robotic system
because the surgeon will directly sense the forces acting against
the end of instrument 14. Of course, the gravitational forces
acting on the distal end of instrument 14 will also be detected by
force sensing element 52. However, these forces would also be
sensed by the surgeon during direct manipulation of the
instrument.
[0031] As shown in FIG. 1, instrument holder 4 comprises a chassis
60 mounted on shafts 18, 20 via ball-spline bearings 62, 64 so that
chassis 60 may move axially with respect to shafts 18, 20, but is
prevented from rotating with shafts 18, 20. Chassis 60 is
preferably constructed of a material that will withstand exposure
to high temperature sterilization processes, such as stainless
steel, so that chassis 60 can be sterilized after a surgical
procedure. Chassis 60 includes a central cavity 66 for receiving
surgical instrument 14 and an arm 68 laterally extending from
chassis 60. Arm 68 is fixed to drive belt 36 so that rotation of
drive belt 36 moves instrument holder 4 in the axial direction
along shafts 18; 20.
[0032] Instrument holder 4 is removably coupled to base 6 and the
drive motors so that the entire holder 4 can be removed and
sterilized by conventional methods, such as steam, heat and
pressure, chemicals, etc. In the preferred configuration, arm 68
includes a toggle switch 69 that can be rotated to release arm 68
from drive belt 36 (FIG. 1). In addition, shafts 18, 20 are
removably coupled to bearings 22 so that the shafts can be axially
withdrawn from support members 17, 19 of frame 16, as shown in FIG.
1A. To this end, the distal bearings 22 preferably include a
coupling mechanism for allowing the removal of shafts 18, 20. As
shown in FIG. 7, distal support member 19 includes a support collar
71 within each distal bearing 22 having an inner bore 72 for
passage of one of the shafts 18, 20. Each support collar 71 has an
internal groove 73 and shafts 18, 20 each have an annular groove 74
(see FIG. 1A) near their lower ends that is aligned with internal
grooves 73 when the shafts are suitably mounted within frame 16
(FIG. 1). A spring clip 75 is positioned within each internal
groove 73 to hold each shaft 18, 20 within the respective support
collar 71. Spring clip 74 has a discontinuity (not shown) to allow
removal of shafts 18, 20 upon the application of a threshold axial
force on the shafts.
[0033] To remove instrument holder 4 from base 6, the operator
rotates toggle switch 69 to release arm 68 from drive belt 36 and
removes drive belts 28, 32 from drives 8, 10. As shown in FIG. 1A,
the operator holds instrument holder 4 and pulls shafts 18, 20
upwards, providing enough force to release spring clips 75. Shafts
18, 20 will disengage from distal bearings 22 and slide through
ball-spline bearings 62, 64 so that instrument holder 4 is
disconnected from base 6. It should be understood that the
invention is not limited to the above described means for removably
coupling instrument holder 4 to base 6 and drive assembly 7. For
example, distal support member 19 may be removably coupled to the
rest of frame 16 so that the surgeon simply removes member 19 and
slides holder down and off shafts 18, 20. Proximal support member
17 may be removably coupled to frame 16 in a similar manner.
Alternatively, the drive motors may be housed in a separate
servo-box (not shown) that is removably attached to base 6. In this
configuration, the servo-box would be removed from base 6 so that
the entire base 6, together with holder 4, can be sterilized.
[0034] The lower portion of base 6 (including distal support member
19) may also be sterilized to decontaminate those parts that come
into contact with holder 4 or instrument 14 (e.g., by dipping the
lower portion of base 6 into a sterilizing bath). To facilitate
this type of sterilization, shafts 18, 20 will preferably be
somewhat longer than shown in FIG. 1 so that the upper portion of
base 6, including drive assembly 7, is disposed sufficiently away
from holder 4 and instrument 14. In this manner, the surgical
manipulator can be easily sterilized after a surgical procedure
without damaging the drive motors or the electrical connections
required for the telerobotic system.
[0035] Instrument holder 4 further includes an instrument support
70 (see detail in FIG. 3A), for releasably coupling surgical
instrument 14 to the manipulator assembly. Instrument support 70 is
rotatably mounted within chassis 60 via mounting bearings 74 so
that support 70 and the instrument can be rotated therein. As shown
in FIG. 1, support 70 is circumscribed by an annular ring gear 76
having teeth that mesh with the teeth of a drive gear 78 mounted to
first shaft 18. Drive gear 78 is configured around first shaft 18
such that it will rotate with first shaft 18, thereby rotating
instrument support 70 and the surgical instrument therewith. Drive
gear 78 is also configured to move axially with respect to first
shaft 18 to allow axial movement of instrument holder 4 with
respect to frame 16.
[0036] Instrument holder 4 further includes an actuator driver 80
(see detail in FIG. 5) movably mounted within axial guide slots 82
on either side of chassis 60. Actuator driver 80 comprises a
helical actuator 84 (see detail in FIG. 6B) having a ring gear 86
that meshes with a gripper drive gear 88 mounted to second shaft
20. Rotation of second shaft 20 causes rotation of gripper drive
gear 88, thereby rotating ring gear 86 and helical actuator 84
within chassis 60. Actuator driver 80 further includes an actuator
carriage assembly 90 (see detail in FIG. 6A) for releasably
coupling an end effector actuator of surgical instrument 14 to
instrument holder 4 (see FIG. 2). Carriage assembly 90 is mounted
within helical actuator 84 and chassis 60 such that rotation of
helical actuator 84 causes a corresponding axial movement of
carriage assembly 90 with respect to chassis 60, as discussed in
greater detail below.
[0037] FIGS. 2A and 2B illustrate a specific embodiment of an
endoscopic surgical instrument 14 capable of being operated by a
motorized manipulator, such as manipulator assembly 2, for
telerobotic surgery. Surgical instrument 14 can be a variety of
conventional endoscopic instruments adapted for delivery through a
percutaneous penetration into a body cavity, such as tissue
graspers, needle drivers, microscissors, electrocautery dissectors,
etc. In the preferred embodiment, instrument 14 is a tissue grasper
comprising a shaft 100 having a proximal end 102, a distal end 104
and a longitudinal axis 106 therebetween. A knurled handle 114 is
attached to proximal end 102 of shaft 100 to facilitate
manipulation of instrument 14.
[0038] Shaft 100 is preferably a stainless steel tube having an
outer diameter in the range of 2-10 mm, usually 4-8 mm, so as to
fit within a cannula having an internal diameter in the range of
2-15 mm. Shaft 100 can also be introduced directly through a
percutaneous incision in the patient. Shaft 100 has a length
selected to reach a target site in a body cavity, such as the
abdomen, and to extend sufficiently out of the body cavity to
facilitate easy manipulation of surgical instrument 14. Thus, shaft
100 should be at least between 10 cm and 40 cm and is preferably
between 17 cm and 30 cm. It should be noted that although shaft 100
is shown as having a circular cross-sectional shape in the
drawings, shaft 100 could alternatively have a rectangular,
triangular, oval or channel cross-sectional shape.
[0039] In a specific configuration, shaft 100 includes a mounting
means for releasably coupling surgical instrument 14 to instrument
support 70 and first drive 8 of manipulator assembly 2. In the
preferred embodiment, mounting means comprises a pair of opposed
mounting pins 116 extending laterally outward from shaft 100.
Mounting pins 116 are rigidly connected to shaft 100 and are
adapted for engaging a twist-lock interface on instrument support
70, as discussed in detail below. It should be understood that the
invention is not limited to a pair of opposing pins and mounting
means can include a single mounting pin or a plurality of pins
extending circumferentially around shaft. Alternatively, pins 116
may have a variety of other shapes, such as spherical or annular,
if desired.
[0040] Instrument 14 includes an end effector 120 extending from
distal end 104 for engaging a tissue structure on the patient, such
as the abdomen during laparoscopic surgery. In the preferred
embodiment, end effector 120 comprises a pair of jaws 122, 124 that
are movable between open and closed positions for grasping a blood
vessel, holding a suture, etc. Jaws 122, 124 preferably have
transverse grooves or other textural features (not shown) on
opposing surfaces to facilitate gripping of the tissue structure.
To avoid the possibility of damaging the tissue to which jaws 122,
124 are applied, the jaws may also include atraumatic means (not
shown), such as elastomeric sleeves made of rubber, foam or
surgical gauze wrapped around jaws 122, 124.
[0041] To move jaws 122, 124 between the open and closed positions,
instrument 14 includes an end effector actuator releasably coupled
to actuator driver 80 and second drive 10 of manipulation assembly
2 (see FIG. 4). In the preferred embodiment, end effector actuator
comprises a pair of opposed actuator pins 132 laterally protruding
from axially extending slots 134 in shaft 100. Actuator pins 132
are coupled to an elongate rod 136 slidably disposed within an
inner lumen 138 of shaft 100. Actuator pins 132 are slidable within
slots 134 so that rod 136 is axially movable with respect to shaft
100 and mounting pins 116 to open and close jaws 122, 124, as is
conventional in the art. Elongate rod 136 has a proximal portion
140 that is disposed within an inner lumen 142 within shaft 100 to
prevent actuator pins 132 from moving in the laterally direction
and to ensure that rod 136 remains generally centered within shaft
100 during a surgical procedure.
[0042] Jaws 122, 124 are preferably biased into the closed
positioned by an annular compression spring 144 positioned within
shaft 100 between actuator pins 132 and an annular disc 146 fixed
to the inside surface of shaft 100. During endoscopic procedures,
this allows the surgical team to introduce jaws 122, 124 through
cannula 50 (or any other type of percutaneous penetration) and into
the body cavity without getting stuck within cannula 50 or damaging
surrounding tissue.
[0043] FIGS. 3A, 3B and 4 illustrate a twist lock mechanism for
releasably connecting surgical instrument 14 to manipulator
assembly 2 so that different instruments may be rapidly changed
during an endoscopic surgical procedure. As shown in FIG. 3A,
instrument support 70 comprises an annular collar 200 defining a
central bore 202 for receiving shaft 100 of surgical instrument 14.
Collar 200 further defines an axially extending slot 204 in
communication with bore 202 and sized to allow mounting and
actuator pins 116, 132 of instrument 14 to slide therethrough (see
FIG. 4). Two locking slots 20'6 are cut into annular collar 200 at
a transverse angle, preferably about 900, to axially extending slot
204 (note that only one of the locking slots are shown in FIG. 3A).
Locking slots 206 intersect slot 2.04 near the center of annular
collar 200 and extend circumferentially around bore 202, preferably
about 90.degree., to allow rotation of both mounting pins 116
therethrough, as discussed below.
[0044] As shown in FIGS. 3A and 8, instrument support 70 further
comprises means for locking mounting pins 116 into locking slots
206 so that the instrument cannot be accidently twisted and thereby
disengaged from instrument support 70 during surgery. Preferably,
the locking means comprises a latch assembly having a plunger 210
slidably disposed within a hole 212 in collar 200, as shown in FIG.
3A. Plunger 210 comprises an L-shaped latch 213 coupled to a
release button 214 by a rod 215 extending through hole 212. Plunger
210 is movable between a first position, where latch 213 is not
disposed within locking slots 206 so that mounting pins 116 are
free to rotate therethrough, and a second position, where latch 213
is at least partially disposed within one of the locking slots 206
so as to prevent rotation of mounting pins 116: Latch 213 is
preferably biased into the second or locked position by a
compression spring 216.
[0045] Button 214 is disposed on the upper surface of support 70
for manual actuation by the surgeon or automatic actuation by base
6. Preferably, when instrument holder 4 is moved to its most
proximal position (see FIG. 1), proximal support member 17 of frame
16 depresses release switch 214 to move latch 213 into the first or
open position. With this configuration, instruments can be
exchanged only when the instrument holder 4 is in the most proximal
position, where shaft 100 of instrument 14 is easily accessible. In
addition, this prevents the accidental release of the instrument
when its distal end has penetrated cannula 50 and is disposed
within the body cavity.
[0046] The intersecting axial and locking slots 204, 206 form an
interface for releasably coupling mounting pins 116 of surgical
instrument 14 to instrument holder 4. To insert instrument 14, the
surgeon aligns mounting pins 116 with axial slot 204 and slides the
instrument through bore 202 of annular collar 200 until mounting
pins 116 are aligned with locking slots 206, as shown in FIG. 4.
The instrument is then rotated a sufficient distance, preferably
about a 1/4 turn, through locking slots 206 so that the pins are no
longer aligned with axial slot 204. When instrument 14 is moved
distally, switch 214 is released (FIG. 1) and latch 213 moves into
locking slots 206 to prevent mounting pins 116 from rotating back
into alignment with axial slot 204 so that instrument 14 is secured
to instrument support 70. It should be noted that a single mounting
pin may be utilized with the above described configuration to lock
the surgical instrument to the support. However, two opposing pins
are preferred because this configuration reduces torsional forces
on the inner surface of locking slots 206.
[0047] As shown in FIG. 8, the locking means preferably includes a
ball detent 217 disposed within collar 200. Ball detent 217 is
biased upward into one of the locking slots 206 by a spring 218.
Ball detent 217 serves to temporarily capture mounting pins 116 in
a position rotated about 90.degree. from alignment with axial slot
204. This ensures that the mounting pins will be completely rotated
into the proper position (i.e., out of the way of latch 213) when
instrument 14 is twisted into instrument holder. Otherwise, when
switch 214 is released, latch 213 could become engaged with
mounting pins 216 so that the latch is unable to move completely
into the locked position, thereby potentially causing the
accidental release of instrument 14 during surgery.
[0048] As shown in FIGS. 3B, 4 and 5, actuator driver 80 of
instrument holder 4 further comprises an actuator pin catch 220 for
releasably holding and moving actuator pins 132 of instrument 14.
Actuator pin catch 220 is constructed similarly to instrument
support 70 (FIG. 3A), comprising an annular collar 222 that defines
a bore 224 for receiving shaft 100 and an axially extending slot
226 for receiving actuator pins 132. A locking slot 228 is cut into
actuator pin catch 220 at a 90.degree. angle so that actuator pins
can be rotated into the lock slot to couple actuator pins 132 to
actuator driver 66, as discussed above in reference to the mounting
pins. It should be noted that slot 226 need not extend completely
through collar 222 since actuator pins 132 are located distally of
mounting pins 116 (the instrument is preferably inserted jaws
first). Of course, actuator and mounting pins 132, 116 may be
reversed so that the mounting pins are distal to the actuator pins,
if desired.
[0049] Referring to FIG. 6A, actuator pin catch 220 is rotatably
mounted on a ball bearing 230 in actuator carriage assembly 90.
Bearing 230 allows the pin catch 220 to rotate freely in carriage
assembly 90 while preventing relative axial motion. Therefore, when
instrument 14 is rotated by first drive 8, actuator pins 132 will
rotate within carriage assembly 90. Carriage assembly 90 further
comprises two sets of axles 232 for rotatably supporting a pair of
inner rollers 236 and a pair of outer rollers 238. As shown in FIG.
1, outer rollers 238 are slidably disposed within axial guide slots
82 of chassis 60 to prevent rotation of carriage assembly 90 with
respect to chassis 60. Inner and outer rollers 236, 238 cooperate
with helical actuator 84 and chassis 60 of instrument holder 4 to
move axially with respect to the holder, thereby axially moving pin
catch 220 and actuator pins 132 therewith relative to shaft 100 of
instrument 14 (which actuates jaws 122, 124, as discussed
above).
[0050] As shown in FIG. 6B, helical actuator 84 includes a central
bore 240 for receiving carriage assembly 90 and surgical instrument
14 and two opposing helical tracks 242, 244 each extending
circumferentially around helical actuator 84 (preferably slightly
less than 180.degree.) for receiving inner rollers 236 of carriage
assembly 90, as shown in FIG. 5. With outer rollers 238 constrained
in axial guide slots 82 of chassis 60, rotation of helical actuator
84 causes carriage assembly 90 (and actuator pin catch 220) to move
up or down, depending on the sense of the rotation. Because of the
symmetrical design of helical actuator 84, the actuation force
applied by second driver 10 will not generate any effective side
loads on instrument 14, which avoids frictional coupling with other
degrees of freedom such as axial (third driver 12) and rotation
(first driver 8). In the preferred embodiment; helical tracks 242,
244 have a pitch selected such that the mechanism can be easily
back-driven, allowing grip forces to be sensed in a position-served
teleoperation system.
[0051] As shown in FIGS. 3A and 3B, instrument holder 4 further
includes a pair of axial guide pins 250, 252 fixed to instrument
support 70. Actuator pin catch 220 has a pair of openings 254, 256
for receiving guide pins 250, 252. Guide pins 250, 252 prevent
relative rotation between pin catch 220 and support 70 (so that
actuator and mounting pins 116, 132 can both rotate with the
instrument) and allow axial movement relative to each other (so
that end effector 120 can be actuated by axial movement of actuator
pins 132).
[0052] FIG. 9 is an elevational view of a remote center positioner
300 which can be used to support manipulator assembly 2 above the
patient (note that support manipulator 2 is not shown in FIG. 8).
Remote center positioner 300 provides two degrees of freedom for
positioning manipulator assembly 2, constraining it to rotate about
a point 308 coincident with the entry incision. Preferably, point
308 will be approximately the center of bearing 54 in cannula 50
(FIG. 1). Amore complete description of remote center positioner
300 is described in commonly assigned co-pending application Ser.
No. 08/062,404 filed May 14, 1993 REMOTE CENTER POSITIONER, which
is incorporated herein by reference.
[0053] A first linkage means is indicated generally by the numeral
321 and a second linkage in the form of a parallelogram is
indicated by the numeral 323. The first linkage means is pivotally
mounted on a base plate for rotation about an x-x axis. The second
linkage means is pivotally connected to the first linkage means and
is adapted to move in a plane parallel to the first linkage. Five
link members (including extensions thereof), 311, 312, 313, 314,
and 315 are connected together with pivot joints 316-320. A portion
of element 313 extends beyond pivot 320 of the parallelogram
linkage. The parallelogram linkage has an operating end at link
member 313 and a driving end at link member 312. The elongated
element 313 may, as desired later, carry a surgical instrument or
other device, such as support bracket 24 of manipulator assembly 2.
The pivot joints allow relative motion of the link members only in
the plane containing them.
[0054] A parallelogram linkage is formed by corresponding link
members 314, 315 and link members 312 and 313. The portions of link
members 314 and 315 of the parallelogram are of equal length as are
the portions of members 312 and 313 of the parallelogram. These
members are connected together in a parallelogram for relative
movement only in the plane formed by the members. A rotatable joint
generally indicated by the numeral 322 is connected to a suitable
base 324. The rotatable joint 322 is mounted on a base plate 326
adapted to be fixedly mounted to the base support means 324. A
pivot plate 328 is pivotally mounted to base plate 326 by suitable
means at, such as, pivots 330, 332. Thus pivot plate 328 may be
rotated about axis x-x through a desired angle 62. This may be
accomplished manually or by a suitable pivot drive motor 334.
[0055] A first linkage is pivotally mounted on the pivot plate 328
of the rotatable joint 322. The linkage elements 311, 312 and the
link members are relatively stiff or inflexible so that they may
adequately support an instrument used in surgical operations. Rods
made of aluminum or other metal are useful as such links. The
linkage elements 311 and 312 are pivotally mounted on base plate
328 for rotation with respect to the rotatable joint by pivots 336
and 338. At least one of the pivots 336, 338 is positioned so that
its axis of rotation is normal to and intersects the x-x axis.
Movement may occur manually or may occur using a linkage drive
motor 340. The first linkage is also shaped in the form of a
parallelogram formed by linkage elements 311, and 312; the portion
of link member 315 connected thereto by pivots 316, 318; and base
plate 328. One of the link members 315 is thus utilized in both the
first 321 and second 323 linkage means. Linkage element 312 also
forms a common link of both the first linkage means 321 and the
second linkage means 323. In accordance with the invention, a
remote center of spherical rotation 308 is provided by the above
described embodiment of apparatus when the linkage element 311 is
rotated and/or when pivot plate 328 is rotated about axis x-x.
Thus, the end of element 313 can be moved through desired angles 81
and 92 or rotated about its own axis, while the remote center of
rotation remains at the same location.
[0056] FIG. 9 also shows an inclinometer 350 attached to the base
of remote center positioner 300. The remote center positioner may
be mounted at an arbitrary orientation with respect to vertical
depending on the particular surgery to be performed, and
inclinometer 350 can be used to measure this orientation. The
measured orientation can be used to calculate and implement servo
control signals necessary to control the telerobotic system so as
to prevent gravitational forces acting on the system mechanisms
from being felt by the surgeon.
[0057] Reference now is made to FIG. 10 wherein the distal end
portion or tip, 260 of the insertion section of an endoscope is
shown which is a substantially the same type as shown in the
above-mentioned publication entitled "Introduction to a New Project
for National Research and Development Program (Large-Scale Project)
in FY 1991" which endoscope may be used in the practice of the
present invention. The insertion end of the endoscope includes a
pair of spaced viewing windows 262R and 262L and an illumination
source 264 for viewing and illuminating a workspace to be observed.
Light received at the windows is focused by objective lens means,
not shown, and transmitted through fiber-optic bundles to a pair of
cameras at he operating end of the endoscope, now shown. The camera
outputs are converted to a three-dimensional image of the workspace
which image is located adjacent hand-operated means at the
operator's station, now shown. Right and left steerible catheters
268R and 268L pass through accessory channels in the endoscope
body, which catheters are adapted for extension form the distal end
portion, as illustrated. End effectors 270R and 270L are provided
at the ends of the catheters which may comprise conventional
endoscopic instruments. Force sensors, not shown, also are inserted
through the endoscope channels. Steerible catheters which include
control wires for controlling bending of the catheters and
operation of an end effector suitable for use with this invention
are well known. Control motors for operation of the control wires
are provided at the operating end of the endoscope, which motors
are included in a servomechanism of a type described in U.S. patent
application Ser. No. 07/823,932 for operation of the steerible
catheters and associated end effectors from a remote operator's
station. As with the other embodiments described in U.S. patent
application Ser. No. 07/823,932, the interfacing computer in the
servomechanism system remaps the operator's hand motion into the
coordinate system of the end effectors, and images of the end
effectors are viewable adjacent the hand-operated controllers. With
this embodiment, the operator has the sensation of reaching through
the endoscope to put his hands directly on the end effectors for
control thereof. Endoscopes of different types may be employed in
this embodiment of the invention so long as they include one or
more accessory channels for use in control of end effectors means,
and suitable viewing means for use in providing a visual display of
the workspace. For example, gastric, colonscopic, and like type,
endoscopes may be employed.
[0058] Variations and changes may be made by others without
departing from the spirit of the present invention. For example, it
should be understood that the present invention is not limited to
endoscopic surgery. In fact, instrument holder 4, along with a
telerobotic control mechanism, would be particularly useful during
open surgical procedures, allowing a surgeon to perform an
operation from a remote location, such as a different room or a
completely different hospital.
* * * * *