U.S. patent application number 13/174638 was filed with the patent office on 2012-03-22 for user interface and method for operating a robotic medical system.
Invention is credited to Christopher M. Sewell, Neal A. Tanner, Sean P. Walker.
Application Number | 20120071752 13/174638 |
Document ID | / |
Family ID | 45818356 |
Filed Date | 2012-03-22 |
United States Patent
Application |
20120071752 |
Kind Code |
A1 |
Sewell; Christopher M. ; et
al. |
March 22, 2012 |
USER INTERFACE AND METHOD FOR OPERATING A ROBOTIC MEDICAL
SYSTEM
Abstract
System and methods for interfacing user in the control of
elongated flexible members for use inside a patient's body is
described herein. In one embodiment, a system includes a processor
configured for generating a virtual representation of a catheter on
a viewing screen, a first control for allowing a user to rotate the
virtual representation of the catheter about a first axis, until a
heading direction of the virtual representation of the catheter
aligns with a heading direction of the catheter as it appears in a
first fluoroscopic image, and a second control for allowing the
user to rotate the virtual representation of the catheter about a
second axis, until a tilt angle of the virtual representation of
the catheter aligns with a tilt angle of the catheter as it appears
in the first fluoroscopic image or in a second fluoroscopic
image.
Inventors: |
Sewell; Christopher M.; (Los
Alamos, NM) ; Tanner; Neal A.; (Mountain View,
CA) ; Walker; Sean P.; (Mountain View, CA) |
Family ID: |
45818356 |
Appl. No.: |
13/174638 |
Filed: |
June 30, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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61384220 |
Sep 17, 2010 |
|
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61482598 |
May 4, 2011 |
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Current U.S.
Class: |
600/424 ;
345/650; 345/651; 604/95.01 |
Current CPC
Class: |
A61B 34/74 20160201;
G06T 2210/41 20130101; A61B 2034/715 20160201; A61B 34/20 20160201;
A61B 46/10 20160201; A61B 34/37 20160201; A61B 34/30 20160201; A61B
2034/102 20160201; A61B 8/12 20130101; A61B 6/4423 20130101; A61B
34/71 20160201; A61B 90/361 20160201; A61B 6/12 20130101; G06T
19/00 20130101; A61B 34/25 20160201; A61B 34/35 20160201; A61B
8/0841 20130101; A61B 2034/301 20160201; A61B 2017/00991 20130101;
A61B 2034/303 20160201; A61B 2034/742 20160201; A61B 6/487
20130101; A61B 8/4218 20130101 |
Class at
Publication: |
600/424 ;
604/95.01; 345/650; 345/651 |
International
Class: |
A61B 6/00 20060101
A61B006/00; G06T 3/60 20060101 G06T003/60; A61M 25/092 20060101
A61M025/092 |
Claims
1. A system, comprising: a processor configured for generating a
virtual representation of a catheter on a viewing screen; a first
control for allowing a user to rotate the virtual representation of
the catheter about a first axis, until a heading direction of the
virtual representation of the catheter aligns with a heading
direction of the catheter as it appears in a first fluoroscopic
image; and a second control for allowing the user to rotate the
virtual representation of the catheter about a second axis, until a
tilt angle of the virtual representation of the catheter aligns
with a tilt angle of the catheter as it appears in the first
fluoroscopic image or in a second fluoroscopic image.
2. The system of claim 1, wherein the first control comprises a
first slider in a touchscreen.
3. The system of claim 2, wherein the second control comprises a
second slider in the touchscreen.
4. The system of claim 1, wherein the first control comprises a
trackball.
5. The system of claim 1, wherein the first control is configured
for rotating the virtual representation of the catheter about the
first axis in a plane of the screen.
6. The system of claim 1, further comprising an actuator coupled to
the catheter and configured for bending the catheter, and a third
control coupled to the actuator for allowing the user to move the
bent catheter into alignment with a roll of the virtual
representation of the catheter.
7. The system of claim 1, further comprising a third control for
allowing the user to move the virtual representation of the
catheter into alignment with a roll of the catheter.
8. The system of claim 7, wherein the catheter has a bent
configuration.
9. The system of claim 1, wherein the processor is configured for
generating the virtual representation of the catheter using
kinematic information regarding the catheter.
10. The system of claim 1, wherein the processor is configured for
generating the virtual representation of the catheter based at
least in part on a signal transmitted through a fiber optic that
extends along a length of the catheter.
11. The system of claim 1, wherein the processor is configured for
generating the virtual representation of the catheter based at
least in part on localization data obtained from electromagnetic
sensors.
12. A method, comprising: generating a virtual representation of
the catheter on a viewing screen; providing a first control for
allowing a user to rotate the virtual representation of the
catheter about a first axis, until a heading direction of the
virtual representation of the catheter aligns with a heading
direction of the catheter as it appears in a first fluoroscopic
image; and providing a second control for allowing the user to
rotate the virtual representation of the catheter about a second
axis, until a tilt angle of the virtual representation of the
catheter aligns with a tilt angle of the catheter as it appears in
the first fluoroscopic image or in a second fluoroscopic image.
13. The method of claim 12, wherein the first control comprises a
first slider in a touchscreen.
14. The method of claim 13, wherein the second control comprises a
second slider in the touchscreen.
15. The method of claim 12, wherein the first control comprises a
trackball.
16. The method of claim 12, wherein the first control is provided
for rotating the virtual representation of the catheter about the
first axis in a plane of the screen.
17. The method of claim 12, further comprising providing a third
control coupled to an actuator configured for moving the catheter
for allowing the user to move the catheter until the appearance of
the catheter in the first or second fluoroscopic image is in
alignment with a roll of the virtual representation of the
catheter.
18. The method of claim 12, further comprising providing a third
control for allowing the user to move the virtual representation of
the catheter into alignment with a roll of the catheter as it
appears in the first or second fluoroscopic image.
19. The method of claim 18, wherein the catheter has a bent
configuration.
20. The method of claim 12, wherein the virtual representation is
generated using kinematic information regarding the catheter.
21. The method of claim 12, wherein the virtual representation is
generated based at least in part on a signal transmitted through a
fiber optic that extends along a length of the catheter.
22. A computer product having a non-transitory medium storing a set
of instructions, an execution of which causes a method for
registering an image of a catheter with a virtual representation of
the catheter to be performed, the set of instructions comprising:
one or more instructions for generating a virtual representation of
the catheter on a viewing screen; one or more instructions for
allowing a user to manipulate a first control to rotate the virtual
representation of the catheter about a first axis, until a heading
direction of the virtual representation of the catheter aligns with
a heading direction of the catheter as it appears in a first
fluoroscopic image; and one or more instructions for allowing the
user to manipulate a second control to rotate the virtual
representation of the catheter about a second axis, until a tilt
angle of the virtual representation of the catheter aligns with a
tilt angle of the catheter as it appears in the first fluoroscopic
image or in a second fluoroscopic image.
23. The computer product of claim 22, wherein the first control
comprises a first slider in a touchscreen.
24. The computer product of claim 23, wherein the second control
comprises a second slider in the touchscreen.
25. The computer product of claim 22, wherein the first control
comprises a trackball.
26. The computer product of claim 22, wherein manipulation of the
first control allows the user to rotate the virtual representation
of the catheter about the first axis in a plane of the screen.
27. The computer product of claim 22, wherein the set of
instructions further comprise one or more instructions for allowing
the user to manipulate a third control for moving the catheter,
until the catheter as it appears in the first or second
fluoroscopic image is in alignment with a roll of the virtual
representation of the catheter.
28. The computer product of claim 22, wherein the set of
instructions further comprise one or more instructions for allowing
the user to manipulate a third control for moving the virtual
representation of the catheter into alignment with a roll of the
catheter as it appears in the first or second fluoroscopic
image.
29. The computer product of claim 28, wherein the catheter has a
bent configuration.
30. The computer product of claim 22, wherein the one or more
instructions for generating the virtual representation comprise one
or more instructions for using kinematic information regarding the
catheter to generate the virtual representation.
31. The computer product of claim 22, wherein the one or more
instructions for generating the virtual representation comprises
one or more instructions for generating the virtual representation
based at least in part on a signal transmitted through a fiber
optic that extends along a length of the catheter.
32. A user interface for controlling a robotic system, comprising:
a screen displaying an image of a catheter and a dome at a distal
end of the catheter; wherein the dome represents a constraint for
the distal end of the catheter so that at least a part of the
distal end of the catheter is required to be on an outline of the
dome regardless of how the catheter is driven.
33. The user interface of claim 32, further comprising: a first
control for allowing the user to advance or retract the catheter;
and a second control for allowing the user to steer the
catheter.
34. The user interface of claim 33, wherein advancement or
retraction of the catheter changes a size of the dome in the
screen.
35. The user interface of claim 33, wherein a steering of the
catheter does not change a size of the dome in the screen.
36. The user interface of claim 32, further comprising a user
control configured to provide force feedback to a user.
37. The user interface of claim 36, wherein the user control is
configured to provide force feedback when the user attempts to
position the at least a part of the distal end of the catheter away
from the outline of the dome.
38. The user interface of claim 32, wherein the image of the
catheter comprises a computer model of the catheter.
Description
RELATED APPLICATION DATA
[0001] This application claims priority to and the benefit of U.S.
Provisional Patent Application No. 61/384,220, filed Sep. 17, 2010,
and U.S. Provisional Application No. 61/482,598, filed May 4, 2011,
the entire disclosures of all of which are expressly incorporated
by reference herein for all purposes.
[0002] This application is related to U.S. patent applications
entitled "Steerable catheters" having Attorney Docket No.
HNMD-20075.00, "Robotic medical systems and methods" having
Attorney Docket No. HNMD-20075.01, "Systems and methods for
positioning an elongate member inside a body" having Attorney
Docket No. HNMD-20075.02, "Anti-buckling mechanisms and methods"
having Attorney Docket No. HNMD-20075.03, and "Systems and methods
for manipulating an elongate member" having Attorney Docket No.
HNMD-20075.04, all filed on Jun. 30, 2011.
INCORPORATION BY REFERENCE
[0003] All of the following U.S. patent applications are expressly
incorporated by reference herein for all purposes: [0004] U.S.
patent application Ser. No. 11/179,007, filed on Jul. 6, 2005,
[0005] U.S. patent application Ser. No. 12/079,500, filed on Mar.
26, 2008, [0006] U.S. patent application Ser. No. 11/678,001, filed
on Feb. 22, 2007, [0007] U.S. Patent Application No. 60/801,355,
filed on May 17, 2006, [0008] U.S. patent application Ser. No.
11/804,585, filed on May 17, 2007, [0009] U.S. patent application
Ser. No. 11/640,099, filed on Dec. 14, 2006, [0010] U.S. patent
application Ser. No. 12/507,727, filed on Jul. 22, 2009, [0011]
U.S. patent application Ser. No. 12/106,254, filed on Apr. 18,
2008, [0012] U.S. patent application Ser. No. 12/192,033, filed on
Aug. 14, 2008, [0013] U.S. patent application Ser. No. 12/236,478,
filed on Sep. 23, 2008, [0014] U.S. patent application Ser. No.
12/833,935, filed on Jul. 9, 2010, [0015] U.S. patent application
Ser. No. 12/822,876, filed on Jun. 24, 2010, and [0016] U.S. patent
application Ser. No. 12/614,349, filed on Nov. 6, 2009
FIELD
[0017] The application relates generally to robotically controlled
surgical systems, and more particularly to flexible instruments and
instrument drivers that are responsive to a master controller for
performing surgical procedures.
BACKGROUND
[0018] Robotic surgical systems and devices are well suited for use
in performing minimally invasive medical procedures, as opposed to
conventional techniques wherein the patient's body cavity is open
to permit the surgeon's hands access to internal organs. For
example, there is a need for a highly controllable yet minimally
sized system to facilitate imaging, diagnosis, and treatment of
tissues which may lie deep within a patient, and which may be
preferably accessed only via naturally-occurring pathways such as
blood vessels or the gastrointestinal tract.
SUMMARY
[0019] The subject application describes, among other things, a
robotic system for controlling an elongate instrument. By means of
non-limiting examples, the elongate instrument may include a
catheter and a sheath surrounding at least a part of the catheter
or other flexible and elongated medical instruments. In some
embodiments, the sheath may be consider a catheter itself. Also, in
other embodiments, the elongate instrument may optionally further
include a guidewire that is at least partially surrounded by the
catheter.
[0020] The elongate instrument may have different configurations in
different embodiments. In accordance with some embodiments, an
elongated medical device includes an elongated body having a
proximal section, a distal section, and a working lumen extending
through the proximal and distal sections, a first coil having a
distal portion, and a proximal portion, the proximal portion of the
first coil being slidable relative to the proximal section of the
elongated body, and being closer to a wall of the elongated body
than to an axis of the elongated body, wherein a lengthwise portion
of the distal portion of the first coil is anchored to the distal
section of the elongated body, and a first steering wire located
within a lumen of the first coil. By means of non-limiting
examples, the elongated medical device may be a catheter, a sheath,
or any medical instrument having a working lumen. In one or more of
the embodiments described herein, the working lumen may have a
cross sectional area that is at least 30% of a cross sectional area
of the elongated body. In one or more of the embodiments described
herein, the lengthwise portion may be at least 10 mm. Also, in one
or more of the embodiments described herein, the lengthwise portion
may be at least 5% of an entire length of the first coil. In one or
more of the embodiments described herein, the elongated body may
have a proximal tip, and the proximal portion of the first coil may
have a proximal tip that is proximal to the proximal tip of the
elongated body.
[0021] The elongated medical device may have a variety of different
configurations in different embodiments. In one or more of the
embodiments described herein, the first coil may be anchored to the
elongated body at a transition location between the proximal and
distal sections of the elongated body. In one or more of the
embodiments described herein, a loop at the distal portion of the
first coil may be embedded into a wall of the distal section of the
elongated body.
[0022] Also, in some embodiments described herein, the device may
include a second coil having a distal portion anchored to the
distal section of the elongated body, and a proximal portion
slidable relative to the proximal section of the elongated body,
and a second steering wire located within a lumen of the second
coil. The steering wires allow the device to be steered in
different directions during use.
[0023] The device may be mechanically driven in some embodiments.
For example, in one or more of the embodiments described herein,
the device may include a drivable instrument coupled to a proximal
end of the elongated body and to the first and second steering
wires, wherein the drivable instrument is configured to apply
tension to the first and second steering wires. Also, in one or
more of the embodiments described herein, the device may include a
processor coupled to the drivable instrument, the processor
configured to receive a user command and generate a control signal
based on the user command to control the drivable instrument.
[0024] The device may also optionally include other features in
different embodiments. For example, in one or more of the
embodiments described herein, the device may include first and
second hypotubes fixedly secured to the drivable instrument,
wherein the proximal portion of the first coil is secured to the
first hypotube, and the proximal portion of the second coil is
secured to the second hypotube. Also, in one or more of the
embodiments described herein, the device may include a liner
surrounding the proximal portion of the first coil, wherein the
first coil is slidable relative to the liner.
[0025] In some embodiments, the elongated body may be a body of a
catheter, a guidewire, or another elongated device. In such cases,
the device may include an additional elongated body that is movably
disposed around at least a part of the elongated body. The
additional elongated body may be another catheter, a sheath, or
another elongated device.
[0026] In some embodiments, the elongated medical device may have a
steerable distal section and a proximal section that remains very
flexible even while the distal section is being steered. Also, one
or more of the embodiments described herein, the first coil and the
first steering wire may be configured to maintain a bent
configuration for the distal section of the elongated body, while
allowing the proximal section of the elongated body to remain
flexible.
[0027] The elongate instrument may have other configurations in
other embodiments. For example, in accordance with other
embodiments, an elongated medical device includes an elongated body
having a proximal section, a distal section, and a working lumen
extending through the proximal and distal sections, a first coil,
wherein at least a lengthwise portion of the first coil is anchored
to the distal section of the elongated body, a second coil in the
proximal section of the elongated body that is slidable relative to
the proximal section of the elongated body, wherein the second coil
is axially aligned with the first coil along a length of the
elongated body, and a steering wire located within a lumen of the
first coil and within a lumen of the second coil. In one or more of
the embodiments described herein, the lengthwise portion may be at
least 10 mm. Also, in one or more of the embodiments described
herein, the lengthwise portion may be at least 5% of a combined
length of the first coil and the second coil. In one or more of the
embodiments described herein, the first coil may be embedded within
a wall of the elongated body. Also, in one or more of the
embodiments described herein, a distal end of the second coil may
be anchored to the elongate body at a location in which there is a
transition between the first and second coils. In some embodiments,
each of the first coil and the second coil may have an open pitch.
In other embodiments, each of the first coil and the second coil
may have a closed pitch. In further embodiments, the first coil may
have an open pitch, and the second coil may have a closed pitch. In
some embodiments, the first coil, the second coil, and the steering
wire may be configured to maintain a bent configuration for the
distal section of the elongated body, while allowing the proximal
section of the elongated body to remain flexible. Also, in one or
more of the embodiments described herein, the elongated body may
have a proximal tip, and the second coil may have a proximal tip
that is proximal to the proximal tip of the elongated body.
[0028] The device may be mechanically driven in some embodiments.
For example, in some embodiments, the device may include a drivable
instrument coupled to a proximal end of the elongated body and to
the steering wire, wherein the drivable instrument is configured to
apply tension to the steering wire. Also, in some embodiments, the
device may include a processor coupled to the drivable instrument,
the processor configured to receive a user command and generate a
control signal based on the user command to control the drivable
instrument.
[0029] The device may optionally include other features in other
embodiments. For example, in one or more of the embodiments
described herein, the device may include a hypotube fixedly secured
to the drivable instrument, wherein a proximal portion of the
second coil is secured to the hypotube. Also, in one or more of the
embodiments described herein, the device may include a liner
surrounding the second coil, wherein the second coil is slidable
relative to the liner.
[0030] In some embodiments, the elongated body may be a body of a
catheter, a guidewire, or another elongated device. In such cases,
the device may include an additional elongated body that is movably
disposed around at least a part of the elongated body.
[0031] Embodiments of the elongated medical device described herein
may be used to perform different procedures in different
embodiments. In accordance with some embodiments, a method
performed using an elongated medical device includes providing the
elongated medical device having an elongated body having a proximal
section, a distal section, and a working lumen extending through
the proximal and distal sections, a fist coil having a distal
portion and a proximal portion, and a first steering wire located
within a lumen of the first coil, and applying tension to the first
steering wire, while allowing the proximal portion of the first
coil to slide relative to the proximal section of the elongated
body, wherein while the tension is being applied to the first
steering wire, a lengthwise portion of the distal portion of the
first coil is prevented from being moved relative to the distal
section of the elongated body. In one or more of the embodiments
described herein, the lengthwise portion may be at least 10 mm.
Also, in one or more of the embodiments described herein, the
lengthwise portion may be at least 5% of an entire length of the
first coil. In one or more of the embodiments described herein, the
elongated medical device may further include a second coil having a
distal portion anchored to the distal section of the elongated
body, and a proximal portion slidable relative to the proximal
section of the elongated body, and a second steering wire located
within a lumen of the second coil.
[0032] During the method, in some embodiments, the first coil may
be prevented from being moved relative to the elongated body at a
first region that is distal to a transition location between the
proximal and distal sections of the elongated body, and may be
allowed to slide relative to the elongated body at a second region
that is proximal to the transition location. Also, in other
embodiments, the lengthwise portion of the distal portion of the
first coil may be prevented from being moved by embedding a loop at
the distal portion of the first coil into a wall of the distal
section of the elongated body.
[0033] The method may be performed using a robotic system in some
embodiments. For example, in some embodiments, the tension may be
applied using a drivable instrument. Also, in one or more of the
embodiments described herein, the method may include generating a
control signal by a processor based on a user command received by
the processor, wherein the drivable instrument applies the tension
to the first steering wire in response to the control signal.
[0034] In one or more of the embodiments described herein, the
tension may be applied to steer the distal section of the elongated
body while steering force may be isolated from the proximal section
of the elongated body. Also, in some embodiments described herein,
the tension may be applied to steer the distal section while a
bending stiffness of the proximal section of the elongated body is
not significantly affected. In still further embodiments, the
tension may be applied to steer the distal section of the elongated
body without creating unwanted curvature at the proximal section of
the elongated body. In other embodiments described herein, the
tension may be applied to steer the distal section of the elongated
body while a shape of the proximal section of the elongated body is
unaffected by the steering of the distal section.
[0035] The elongate instrument that may be used with the robotic
system may have other configurations in other embodiments. For
example, in accordance with other embodiments, an elongated medical
device includes an elongated body having a proximal section, a
distal section, and a working lumen extending through the proximal
and distal sections, wherein the distal section has a tapered
profile, a first coil having a distal portion anchored to the
distal section of the elongated body, and a proximal portion
slidable relative to the proximal section of the elongated body, a
first steering wire located within a lumen of the first coil, a
second coil having a distal portion anchored to the distal section
of the elongated body, a second steering wire located within a
lumen of the second coil, a control ring located at the distal
section of the elongated body, and a spine located in the elongated
body, wherein the first coil and the second coil are located
radially away from an axis of the spine. In one or more of the
embodiments described herein, the working lumen may have a tapered
configuration. Also, in one or more of the embodiments described
herein, the device may include a drivable instrument coupled to a
proximal end of the elongated body and to the first and second
steering wires, wherein the drivable instrument is configured to
apply tension to the first and second steering wires. In one or
more of the embodiments described herein, the device may include a
processor coupled to the drivable instrument, the processor
configured to receive a user command and generate a control signal
based on the user command to control the drivable instrument.
[0036] The robotic system may control the elongate instrument in
different configurations. In accordance with some embodiments, a
robotic surgical system includes a flexible elongated member, a
first member movably disposed around at least a portion of the
flexible elongated member, a second member movably disposed around
at least a portion of the first member, a drive assembly coupled to
each of the flexible elongated member, the first member, and the
second member, and a control interface for receiving an input
command from a user, wherein the drive assembly is configured to
automatically move one or both of the first member and the second
member while maintaining the flexible elongated member at a fixed
axial position in response to the received input command.
[0037] In some embodiments, the drive assembly may be configured to
move the first member distally, without moving the second member,
while maintaining the flexible elongated member at the fixed
position, in response to the received input command. Also, in some
embodiments, the drive assembly may be configured to move the first
member proximally, without moving the second member, while
maintaining the flexible elongated member at the fixed position, in
response to the received input command. In other embodiments, the
drive assembly may be configured to move the second member
distally, without moving the first member, while maintaining the
flexible elongated member at the fixed position, in response to the
received input command. In further embodiments, the drive assembly
may be configured to move the second member proximally, without
moving the first member, while maintaining the flexible elongated
member at the fixed position, in response to the received input
command. In still further embodiments, the drive assembly may be
configured to move each of the first member and the second member
distally, while maintaining the flexible elongated member at the
fixed position, in response to the received input command. In other
embodiments, the drive assembly may be configured to move each of
the first member and the second member proximally, while
maintaining the flexible elongated member at the fixed position, in
response to the received input command.
[0038] In one or more of the embodiments described herein, the
first member may include a first pull wire, and wherein the drive
assembly may be further configured to adjust a tension in the first
pull wire. In some embodiments, the drive assembly may be
configured to move the first member proximally relative to the
second member after releasing at least some tension in the first
pull wire, while maintaining the flexible elongated member at the
fixed position, in response to the received input command. In other
embodiments, the second member may include a second pull wire, and
wherein the drive assembly may be further configured to adjust a
tension in the second pull wire. In further embodiments, the drive
assembly may be configured to move each of the first member and the
second member proximally relative to the flexible elongated member
after releasing at least some tension in the second pull wire,
while maintaining the flexible elongated member at the fixed
position, in response to the received input command. Also, in some
embodiments, the drive assembly may be configured to translate
and/or rotate the flexible elongated member.
[0039] In some embodiments, the flexible elongated member may
include a guidewire. In one or more of the embodiments described
herein, the guidewire may have a preformed configuration. Also, in
one or more of the embodiments described herein, the system may
include a mechanism for controlling and/or maintaining the
preformed configuration.
[0040] In accordance with other embodiments, a robotic surgical
system includes a member having a first controllable section and a
second controllable section distal of the second controllable
section, a drive assembly coupled to the tubular member, and a
control interface for allowing a user to select one of the first
and second controllable sections of the tubular member to move,
wherein the drive assembly is configured to independently move the
first controllable section or the second controllable section in
response to an input command from the user received at the control
interface. In one or more of the embodiments described herein, the
first controllable section and the second controllable section may
be in a telescopic configuration. In some embodiments, the drive
assembly may be configured to move the first controllable section
while maintaining the second controllable section in a fixed
position. Also, in some embodiments, the first controllable section
may have a bent configuration, and the drive assembly may be
configured to move the second controllable section while
maintaining the bent configuration for the first controllable
section. In some embodiments, the system may include a flexible
elongated member disposed inside the tubular member, wherein the
drive assembly is configured to move the member while maintaining
the flexible elongated member at a fixed position. Also, in other
embodiments, the drive assembly may be configured to translate
and/or rotate the flexible elongated member.
[0041] In some embodiments, the flexible elongated member may
include a guidewire. In one or more of the embodiments described
herein, the guidewire may have a preformed configuration. Also, in
one or more of the embodiments described herein, the system may
include a mechanism for controlling and/or maintaining the
preformed configuration.
[0042] The robotic surgical system may have other configurations in
other embodiments. For example, in accordance with other
embodiments, a robotic surgical system includes an elongate member
having a pre-shaped configuration, a member disposed over the
elongate member, a drive assembly coupled to the elongate member
and the member, and a control interface for receiving an input
command from a user, wherein the drive assembly is configured to
move the member distally relative to the elongate member along the
pre-shaped configuration of the elongate member in response to the
input command received at the control interface.
[0043] In some embodiments, the elongate member may include a
flexible elongated member. In one or more of the embodiments
described herein, the flexible elongated member may include a
guidewire. Also, in some embodiments, the drive assembly may be
configured to translate and/or rotate the guidewire. In other
embodiments, the elongate member may have a tubular configuration.
In one or more of the embodiments described herein, the tubular
member may include a pull wire located in a wall thereof, and
wherein the drive assembly may be configured to adjust a tension in
the pull wire before moving the tubular member distally relative to
the elongate member.
[0044] Also, in other embodiments, the robotic system may control
two elongate members of an elongate instrument in a telescopic
fashion to thereby advance the elongate instrument inside a body.
For example, in accordance with some embodiments, a robotic method
includes positioning a flexible elongated member that has a
preformed configuration, wherein at least a part of the flexible
elongated member has a first member disposed around it, and wherein
the first member includes a first wire for bending the first member
or for maintaining the first member in a bent configuration,
releasing at least some tension in the first wire to relax the
first member, and advancing the first member distally relative to
the flexible elongated member while the first member is in a
relaxed configuration. In some embodiments, the act of positioning
the flexible elongated member may include advancing the flexible
elongated member. Also, in some embodiments, the act of positioning
the flexible elongated member may include using a drive mechanism.
In some embodiments, the first member may include a tubular member.
Also, in some embodiments, the flexible elongated member may
include a guidewire. In one or more of the embodiments described
herein, the guidewire may have a preformed configuration. In other
embodiments, the act of positioning may include advancing and/or
rotating the flexible elongated member.
[0045] In other embodiments, the method may include re-tensioning
the first wire to stiffen the first member. Also, in other
embodiments, the method may include repeating the acts of releasing
at least some tension and advancing the first member. In still
further embodiments, at least a part of the first member may have a
second member disposed around it, and wherein the second member may
include a second wire for bending the second member or for
maintaining the second member in a bent configuration, and the
method may include releasing at least some tension in the second
wire to relax the second member, and advancing the second member
distally relative to the flexible elongated member while the second
member is in a relaxed configuration.
[0046] In some embodiments, the acts of advancing the first member
and the second member may be performed simultaneously so that both
the first member and the second member are advanced together. In
other embodiments, the first member may be advanced before the
second member. In further embodiments, the method may include
re-tensioning the first wire to stiffen the first member, and
re-tensioning the second wire to stiffen the second member. In
still further embodiments, the first member may be advanced until a
distal end of the first member has passed through an opening in a
body.
[0047] The method may be performed using a drivable instrument in
accordance with some embodiments. For example, in some embodiments,
the first wire may be coupled to a drivable instrument, and wherein
the at least some tension in the first wire may be released by the
drivable instrument in response to a control signal received from a
processor. Also, in some embodiments, the first member may be
coupled to a drivable instrument, and wherein the first member may
be advanced by the drivable instrument in response to a control
signal received from a processor.
[0048] In accordance with other embodiments, a robotic method
includes rolling a first member, wherein the first member is
disposed around a flexible elongated member, positioning the
flexible elongated member to compensate for the rolling of the
first member. In one or more of the embodiments described herein,
the act of rolling the first member may include rotating the first
member about its longitudinal axis. In one or more of the
embodiments described herein, the act of rolling the first member
may include bending the first member in different radial directions
to create an artificial rolling.
[0049] In accordance with other embodiments, a robotic system
includes a flexible elongated member that has a preformed
configuration, a first member disposed around at least a part of
the flexible elongated member, wherein the first member includes a
first wire, a drive assembly configured to position the flexible
elongated member, a first drive mechanism configured to manipulate
the first wire to bend the first member or to maintain the first
member in a bent configuration, a second drive mechanism configured
to move the first member relative to the flexible elongated member,
and a controller coupled to the first drive mechanism and the
second drive mechanism, wherein the controller is configured to
transmit first control signals to operate the first drive mechanism
so that the first drive mechanism releases at least some tension in
the first wire to relax the first member, and to operate the second
drive mechanism to advance the first member distally relative to
the flexible elongated member while the first member is in a
relaxed configuration. In some embodiments, the drive assembly may
be configured to advance the flexible elongated member distally
relative to the first member. In other embodiments, the controller
may be configured to operate the first drive mechanism to
re-tension the first wire to stiffen the first member after the
first member is relaxed. Also, in other embodiments, the controller
may be configured to operate the first and second drive mechanisms
to repeat the acts of releasing at least some tension and advancing
the first member.
[0050] In one or more of the embodiments described herein, the
system may include a second member disposed around at least a part
of the first member, wherein the second member includes a second
wire, a third drive mechanism configured to manipulate the second
wire to bend the second member or to maintain the second member in
a bent configuration, and a fourth drive mechanism configured to
move the second member, wherein the controller may be further
configured to transmit second control signals to operate the third
drive mechanism to release at least some tension in the second wire
to relax the second member, and to operate the fourth drive
mechanism to advance the second member distally relative to the
flexible elongated member while the second member is in a relaxed
configuration. In some embodiments, the controller may be
configured to control the second drive mechanism and the fourth
drive mechanism to advance the first member and the second member
together and simultaneously. In other embodiments, the controller
may be configured to cause the first member to be advanced before
the second member. In further embodiments, the controller may be
configured to operate the first drive mechanism to re-tension the
first wire to stiffen the first member, and to operate the third
drive mechanism to re-tension the second wire to stiffen the second
member.
[0051] Embodiments of the system described herein may be used to
perform various methods in different embodiments. In accordance
with some embodiments, a robotic method includes inserting a first
elongate member and a second elongate member into a body, wherein
the second elongate member is slidably disposed around at least a
portion of the first elongate member, applying tension to one or
more steering wires in the first elongate member to bend a distal
portion of the first elongate member, maintaining the applied
tension so that the bent distal portion of the first elongate
member stays stiffened, and advancing the second elongate member
distally relative to the first elongate member while using the
stiffened distal portion of the first elongate member as a first
guide to direct the second elongate member. In some embodiments,
the method may also include releasing at least some tension in one
or more steering wires in the second elongate member to un-stiffen
the second elongate member before the act of advancing. In some
embodiments, the first elongate member may include a catheter, and
the second elongate member may include a sheath. Also, in some
embodiments, the second elongate member may not include any
steering wire.
[0052] In one or more of the embodiments described herein, after
the act of advancing, the method may include releasing at least
some tension in the one or more steering wires in the first
elongate member to un-stiffen the first elongate member, applying
tension to one or more steering wires in the second elongate member
to bend a distal portion of the second elongate member, maintaining
the applied tension in the one or more steering wires in the second
elongate member so that the bent distal portion of the second
elongate member stays stiffened, and advancing the first elongate
member distally relative to the second elongate member while using
the stiffened distal portion of the second elongate member as a
second guide to direct the first elongate member
[0053] In some embodiments, the method may include adjusting the
applied tension. In one or more of the embodiments described
herein, the applied tension may be adjusted automatically. Also, in
one or more of the embodiments described herein, the tension may be
adjusted to maintain the distal portion of the first elongate
member in a desired bent configuration.
[0054] The robotic system may also optionally include an
anti-buckling device for supporting the elongate instrument as the
elongate instrument is being advanced into the body in accordance
with some embodiments. Such feature may prevent the elongate
instrument from buckling.
[0055] One or more of the embodiments of the robotic system
described herein may optionally further include a mechanism for
preventing buckling of the elongate instrument. For example, in
accordance with some embodiments, an anti-buckling device includes
a first coupler for coupling to a first device, a second coupler
for coupling to a second device that is configured to position a
catheter member, a first set of support members coupled between the
first coupler and the second coupler, and a plurality of holders
coupled to the support members, the holders configured for
supporting the catheter member, wherein the first set of support
members form a support frame that can be extended by moving the
first and second couplers away from each other, and can be
collapsed by moving the first and second couplers towards each
other. In some embodiments, the first set of support members may
form a planar configuration. Also, in some embodiments, the device
may further include a second set of support members that are
disposed next to the first set of support members. In one or more
of the embodiments described herein, the second set of support
members may be configured to maintain the holders in a same
orientation relative to each other, wherein the orientation may be
perpendicular to a longitudinal axis of the catheter member. In
further embodiments, the device may include a third set of support
members that are disposed between the first and second sets of
support members. In one or more of the embodiments described
herein, the third set of support members may be configured to
maintain the holders in a same orientation relative to each other.
Also, in some embodiments, the support members may be arranged in a
scissor-like configuration. In one or more of the embodiments
described herein, the first set of support members may be
configured to provide a variable buckling resistance for the
catheter member supported by the support members in response to an
advancement of the catheter member. In some embodiments, the first
device may include a stabilizer that is configured to be attached
to a patient. Also, in some embodiments, the first device may
include a first driver and the second device comprises a second
driver.
[0056] The holders in the anti-buckling device may have different
features in different embodiments. For example, in one or more of
the embodiments described herein, each of the holders may have an
opening for accommodating a portion of the catheter member
supported by the holders. Also, in one or more of the embodiments
described herein, the holders may be moveable relative to a
catheter member supported by the holders in a manner such that the
holders are maintained at a substantially equal distance from one
another as they are moved.
[0057] Other devices for supporting an elongate member are also
described herein. For example, in accordance with other
embodiments, a support device includes a first set of support
members arranged in a scissor-like configuration to form a support
frame, wherein the support frame has a first end and a second end,
and can be extended by moving the first and second ends away from
each other, or collapsed by moving the first and second ends
towards each other, and a plurality of holders coupled to the
support members, the holders configured for supporting a catheter
member, wherein the holders are moveable relative to the catheter
member supported by the holders, such that the holders are
maintained at a substantially same distance from one another
regardless of a distance between the first and second ends of the
support frame. In some embodiments, the device may include a first
coupler disposed at the first end of the support frame for coupling
to a driver that is configured to position a catheter member. Also,
in some embodiments, the device may include a second coupler
disposed at the second end of the support frame for coupling to a
stabilizer that is configured to be attached to a patient. In one
or more of the embodiments described herein, the device may include
a second coupler disposed at the second end of the support frame
for coupling to a driver. Also, in one or more of the embodiments
described herein, the support members may form a scissor-like
configuration. In some embodiments, each of the holders may have an
opening for accommodating a portion of the catheter member
supported by the holders. Also, in some embodiments, the support
frame may be configured to provide a variable buckling resistance
for the catheter member supported by the holders in response to an
advancement of the catheter member.
[0058] In some embodiments, the device may include a second set of
support members disposed next to the first set of support members.
In one or more of the embodiments described herein, the second set
of support members may be configured to maintain the holders in a
same orientation relative to each other. In further embodiments,
the device may include a third set of support members disposed
between the first and second sets of support members. In one or
more of the embodiments described herein, the third set of support
members may be configured to maintain the holders in a same
orientation relative to each other.
[0059] The anti-buckling device may have different configurations
in different embodiments. For example, in accordance with other
embodiments, an anti-buckling device includes a first coupler for
coupling to a first device, a second coupler for coupling to a
second device, a first set of support members disposed between the
first and second couplers, wherein the first set of support members
are arranged in a scissor-like configuration, and a plurality of
holders coupled to the first set of support members, the holders
configured for supporting an elongated medical device. In some
embodiments, the elongated medical device may include a catheter
member, an endoscope, or an ablation device. Also, in some
embodiments, the first set of support members may be configured to
provide a variable buckling resistance for the elongated medical
device being supported by the holders in response to an advancement
of the elongated medical device.
[0060] Devices having other configurations that are configured to
support an elongate instrument are also described herein. For
example, in accordance with other embodiments, a support system
includes a first elongated member with a lumen, a second elongated
member slidably disposed within the lumen of the first elongated
member, a first anti-buckling device configured to support the
first elongated member, and a second anti-buckling device
configured to support the second elongated member. In some
embodiments, the first elongated member may include a sheath, and
the second elongated member comprises a catheter. Also, in some
embodiments, the first anti-buckling device may include support
members arranged in a scissor-like configuration. In one or more of
the embodiments described herein, the support members may include
telescoping tubes. Also, in one or more of the embodiments
described herein, the first anti-buckling device may have a first
end configured to detachably couple to a first drive assembly, and
a second end configured to detachably couple to a patient. In one
or more of the embodiments described herein, the second
anti-buckling device may have a first end configured to detachably
couple to a second drive assembly, and a second end configured to
detachably couple to the first drive assembly.
[0061] The support system may have different configurations in
different embodiments. For example, in accordance with other
embodiments, a support system includes a catheter having a first
end for insertion into a patient, and a second end for coupling to
a first drive assembly, and a first anti-buckling device configured
to laterally support the catheter as the first end of the catheter
is being advanced distally by the first drive assembly. In some
embodiments, the system may include a sheath with a first end for
insertion into the patient, a second end for coupling to a second
drive assembly, and a lumen in which the catheter is slidably
disposed, and a second anti-buckling device configured to laterally
support the sheath as the sheath is being advanced by the second
drive assembly. Also, in some embodiments described herein, the
system may include the first drive assembly and the second drive
assembly. In one or more of the embodiments described herein, the
first anti-buckling device may have a first end configured to
detachably couple to the first drive assembly, and a second end
configured to detachably couple to the second drive assembly. Also,
in one or more of the embodiments described herein, the second
anti-buckling device may have a first end configured to detachably
couple to the second drive assembly, and a second end configured to
detachably couple to the patient. In one or more of the embodiments
described herein, the first anti-buckling device may include
support members arranged in a scissor-like configuration.
[0062] Embodiments of the anti-buckling/support device may be used
to perform different methods in different embodiments. For example,
in accordance with some embodiments, a method includes advancing a
first flexible elongated member distally relative to a patient, and
laterally supporting at least a part of the first flexible
elongated member using a first anti-buckling device to prevent the
first flexible elongated member from buckling during the act of
advancing. In some embodiments, the act of laterally supporting at
least a part of the first flexible elongated member may include
providing a plurality of lateral supports along a length of the
first flexible elongated member, and wherein the lateral supports
may be slidable relative to the first flexible elongated member.
Also, in some embodiments, the method may include changing a
spacing of the lateral supports in response to the act of
advancing. In other embodiments, the method may include advancing a
second flexible elongated member distally relative to the patient,
the second flexible elongated member disposed circumferentially
around the first flexible elongated member, and laterally
supporting at least a part of the second flexible elongated member
using a second anti-buckling device to prevent the second flexible
elongated member from buckling during the act of advancing the
second flexible elongated member. In one or more of the embodiments
described herein, the first flexible elongated member may include a
catheter.
[0063] The robotic system may also optionally include a manipulator
for manipulating an elongate member, such as a guidewire, in
accordance with some embodiments. For example, in accordance with
some embodiments, an elongate member manipulator includes an
elongate member holder having first and second rotary members
configured to hold an elongate member, wherein the rotary members
are actuated in opposite rotational directions to generate a
corresponding linear motion of the elongate member held by the
rotary members along a longitudinal axis of the elongate member,
and wherein the rotary members are actuated in opposite linear
directions to generate a corresponding rotational motion of the
elongate member held by the rotary members about the longitudinal
axis of the elongate member. In some embodiments, the manipulator
may include a drive assembly for actuation of the first and second
rotary members, wherein the elongate member holder is releasably
coupled to the drive assembly. Also, in some embodiments, the
manipulator may include a sterile barrier positioned between the
drive assembly and the elongate member holder, wherein the drive
assembly is configured to transfer rotational motion across the
sterile barrier to the rotary members to generate the corresponding
linear motion of the elongate member along the longitudinal axis of
the elongate member. In other embodiments, the manipulator may
include a sterile barrier positioned between the drive assembly and
the elongate member holder, wherein the drive assembly is
configured to transfer linear motion across the sterile barrier to
the rotary members to generate the corresponding rotational motion
of the elongate member about the longitudinal axis of the elongate
member.
[0064] In one or more of the embodiments described herein, the
drive assembly may be configured to actuate the rotary members in
rotational and linear directions simultaneously. Also, in one or
more of the embodiments described herein, the rotary members may be
actuated in the rotational and linear directions at different
respective rates. Also, in one or more of the embodiments described
herein, the drive assembly may be configured to provide rotational
actuation and linear actuation for the rotary members separately,
and wherein the rotary members may be configured to maintain
engagement with the elongate member between the rotational
actuation and linear actuation of the rotary members.
[0065] In some embodiments, the elongate member may include a guide
wire. Also, in some embodiments, the first and second rotary
members may include first and second feed rollers. In one or more
of the embodiments described herein, the first feed roller may have
a groove cut around an outer diameter of the first feed roller,
wherein the groove may be configured for receiving an elongate
member. Also, in one or more of the embodiments described herein,
the first feed roller may be motor driven and the second feed
roller may be idle. In addition, in some embodiments, the first
rotary member may include a first flexible member with a first
engagement surface, and the second rotary member may include a
second flexible member with a second engagement surface. Also, in
some embodiments, the first rotary member may be motor driven and
the second rotary member may be idle. In further embodiments, the
manipulator may include an elongate member support configured to
hold the elongate member and to prevent buckling of the elongate
member during rotational or linear motion of the elongate member.
Also, in some embodiments, the rotary members may include a first
rotary member and a second rotary member, and the first rotary
member is a first feed belt assembly comprising two or more belts
with spacing between the belts to accommodate at least a portion of
the elongate member support. In further embodiments, the second
rotary member may include a second feed belt assembly comprising a
belt wound around a plurality of pulleys to create a multiple
segmented belt, the multiple segmented belt configured to contact
the first feed belt assembly while providing clearance for a
portion of the elongate member support extending between the belts
of the first feed belt assembly. In one or more of the embodiments
described herein, the first and second rotary members and the
elongate member support may be arranged such that the elongate
member can be held between the first and second rotary members
while being supported by the elongate member support. Also, in one
or more of the embodiments described herein, the elongate member
support may have one or more protrusions with grooves, wherein the
grooves may be configured to hold the elongate member to prevent
buckling of the elongate member during rotational or linear motion
of the elongate member, and the protrusions may be positioned
within the spacing between the belts.
[0066] In some embodiments, the manipulator may include a roll
support configured to position the elongate member so that a bend
at the elongate member faces towards a first direction, and to
position the elongate member so that the bend faces towards a
second direction that is opposite from the first direction. In one
or more of the embodiments described herein, the roll support may
include a scissor jack. Also, in some embodiments, the manipulator
may include a force sensor to measure force at a distal tip of the
elongate member. In other embodiments, the manipulator may include
one or more slip rollers for gripping the elongate member, wherein
the slip rollers may be decoupled from the rotary members to detect
sliding or slipping of the elongate member between the rotary
members. In further embodiments, the manipulator may include a
controller including a master input device, and an instrument
driver in communication with the controller, the instrument driver
configured to interface with a guide member and a sheath
member.
[0067] In some embodiments, an elongate member manipulator may be
implemented as a part of a robotic system. For example, in
accordance with some embodiments, a robotic surgical system
includes a controller including a master input device, an
instrument driver in communication with the controller, the
instrument driver configured to interface with an inner tubular
member and an outer tubular member that surrounds at least a
portion of the inner tubular member, and an elongate member
manipulator comprising a drive assembly responsive to control
signals generated, at least in part, by the master input device,
and an elongate member holder releasably coupled to the drive
assembly, the elongate member holder having first and second rotary
members configured to hold an elongate member, wherein the drive
assembly is configured to actuate the rotary members in opposite
rotational directions to generate a corresponding linear motion of
the elongate member along a longitudinal axis of the elongate
member, wherein the drive assembly is configured to actuate said
rotary members in opposite linear directions to generate a
corresponding rotational motion of the elongate member about the
longitudinal axis of the elongate member, and wherein the elongate
member manipulator is configured to feed the elongate member into
the inner tubular member. In some embodiments, the system may
optionally further include a sterile barrier positioned between the
drive assembly and the elongate member holder, wherein the drive
assembly may be configured to transfer rotational motion across the
sterile barrier to the rotary members to generate the corresponding
linear motion of the elongate member along the longitudinal axis of
the elongate member. Also, in some embodiments, the system may
include a sterile barrier positioned between the drive assembly and
the elongate member holder, wherein the drive assembly may transfer
linear motion across the sterile barrier to the rotary members to
generate the corresponding rotational motion of the elongate member
about the longitudinal axis of the elongate member.
[0068] In some embodiments, the drive assembly may be configured to
actuate the rotary members in rotational and linear directions
simultaneously. Also, in some embodiments, the rotary members may
be actuated in the rotational and linear directions at different
respective rates. In one or more of the embodiments described
herein, the drive assembly may be configured to provide rotational
actuation and linear actuation for the rotary members separately,
and wherein the rotary members may be configured to maintain
engagement with the elongate member between the rotational
actuation and linear actuation of the rotary members. In some
embodiments, the elongate member may include a guide wire. Also, in
some embodiments, the first and second rotary members may include
first and second feed rollers. In one or more of the embodiments
described herein, the first feed roller may have a groove cut
around an outer diameter of the first feed roller, wherein the
groove may be configured for receiving an elongate member. Also, in
one or more of the embodiments described herein, the first feed
roller may be motor driven and the second feed roller may be idle.
In addition, in one or more of the embodiments described herein,
the first rotary member may include a first flexible member with a
first engagement surface, and the second rotary member may include
a second flexible member with a second engagement surface. In other
embodiments, the first flexible member may be motor driven and the
second flexible member may be idle. In further embodiments, the
system may include an elongate member support configured to hold
the elongate member and to prevent buckling of the elongate member
during rotational or linear motion of the elongate member. In still
further embodiments, the rotary members may include a first rotary
member and a second rotary member, and wherein the first rotary
member comprises a first feed belt assembly comprising two or more
belts with spacing between the belts to accommodate at least a
portion of the elongate member support.
[0069] In some embodiments, the second rotary member may include a
second feed belt assembly comprising a belt wound around a
plurality of pulleys to create a multiple segmented belt, the
multiple segmented belt configured to contact the first feed belt
assembly while providing clearance for a portion of the elongate
member support extending between the belts of the first feed belt
assembly. Also, in some embodiments, the first and second rotary
members and the elongate member support may be arranged such that
the elongate member can be held between the first and second rotary
members while being supported by the elongate member support. In
one or more of the embodiments described herein, the elongate
member support may have one or more protrusions with grooves,
wherein the grooves are configured to hold the elongate member to
prevent buckling of the elongate member during rotational or linear
motion of the elongate member, and the protrusions are positioned
within the spacing between the belts. In further embodiments, the
system may optionally further include a roll support configured to
position the elongate member so that a bend at the elongate member
faces towards a first direction, and to position the elongate
member so that the bend faces towards a second direction that is
opposite from the first direction. In one or more of the
embodiments described herein, the roll support may include a
scissor jack. Also, in some embodiments, the system may include a
force sensor to measure force at a distal tip of the elongate
member. In further embodiments, the system may include one or more
slip rollers for gripping the elongate member, wherein the slip
rollers are decoupled from the rotary members to detect sliding or
slipping of the elongate member between the rotary members.
[0070] Various methods for manipulating an elongate member are
provided. For example, in accordance with some embodiments, a
method of manipulating an elongate member in two degrees of freedom
includes holding an elongate member between two rotary members,
actuating the rotary members in opposite rotational directions to
generate a corresponding linear motion of the elongate member along
a longitudinal axis of the elongate member, and actuating the
rotary members in opposite linear directions to generate a
corresponding rotational motion of the elongate member about the
longitudinal axis of the elongate member. In some embodiments, the
rotary members may include feed belts. Also, in some embodiments,
the acts of actuating may be performed simultaneously. In other
embodiments, the acts of actuating may be performed at different
respective rates. In still further embodiments, the acts of
actuating may be performed separately, and wherein between the acts
or actuating, the rotary members maintain engagement with the
elongate member. In some embodiments, the method may optionally
further include loading an elongate member by separating the two
rotary members, and placing the elongate member on a surface of one
of the two rotary members. Also, in one or more of the embodiments
described herein, the method may include removing the elongate
member from the first and second rotary members while maintaining
the elongate member in a patient's anatomy.
[0071] Other methods for manipulating an elongate member are also
provided. For example, in accordance with other embodiments, a
method of manipulating an elongate member in two degrees of freedom
includes transferring rotational motion across a sterile barrier to
generate a corresponding linear motion of the elongate member along
a longitudinal axis of the elongate member, and transferring linear
motion across the sterile barrier to generate a corresponding
rotational motion of the elongate member about the longitudinal
axis of the elongate member. In some embodiments, the rotational
motion and the linear motion may be transferred simultaneously.
Also, in some embodiments, the rotational motion and linear motion
may be transferred at different respective rates. In one or more of
the embodiments described herein, the rotational motion and the
linear motion may be transferred separately, and wherein between
the acts of transferring, the elongate member may be maintained in
engagement with rotary members.
[0072] In accordance with other embodiments, a method of
manipulating an elongate member in two degrees of freedom includes
engaging a first continuous surface with the elongate member,
engaging a second continuous surface with the elongate member,
actuating the first surface and second surface in opposite linear
directions to generate a rotational motion of the elongate member
about the longitudinal axis of the elongate member, and actuating
the first surface and second surface in opposite rotational
directions to generate a linear motion of the elongate member along
the longitudinal axis of the elongate member. In some embodiments,
the rotational motion and the linear motion may be generated
simultaneously. Also, in some embodiments, the rotational motion
and the linear motion may be generated at different respective
rates. In one or more of the embodiments described herein, the
rotational motion and the linear motion may be generated
separately, and wherein the first and second continuous surfaces
maintain engagement with the elongate member between the generation
of the rotational motion and the linear motion.
[0073] The robotic system may also optionally include a user
interface for allowing a user to operate the robotic system in
accordance with some embodiments. The user interface may provide a
variety of features. By means of non-limiting examples, the user
interface may allow a user to align a representation of a catheter
with an image of the catheter in a screen in some embodiments. In
other embodiments, the user interface may provide a graphic for
informing a user a constraint that is imposed by the system on
manipulating the elongate instrument.
[0074] In some embodiments, the user interface may be implemented
using a processor. For example, in accordance with some
embodiments, a system includes a processor configured for
generating a virtual representation of a catheter on a viewing
screen, a first control for allowing a user to rotate the virtual
representation of the catheter about a first axis, until a heading
direction of the virtual representation of the catheter aligns with
a heading direction of the catheter as it appears in a first
fluoroscopic image, and a second control for allowing the user to
rotate the virtual representation of the catheter about a second
axis, until a tilt angle of the virtual representation of the
catheter aligns with a tilt angle of the catheter as it appears in
the first fluoroscopic image or in a second fluoroscopic image. In
some embodiments, the first control may include a first slider in a
touchscreen. Also, in some embodiments, the second control may
include a second slider in the touchscreen. In other embodiments,
the first control may include a trackball. In one or more of the
embodiments described herein, the first control may be configured
for rotating the virtual representation of the catheter about the
first axis in a plane of the screen. In some embodiments, the
system may also include an actuator coupled to the catheter and
configured for bending the catheter, and a third control coupled to
the actuator for allowing the user to move the bent catheter into
alignment with a roll of the virtual representation of the
catheter. In one or more of the embodiments described herein, the
system may include a third control for allowing the user to move
the virtual representation of the catheter into alignment with a
roll of the catheter. Also, in one or more of the embodiments
described herein, the catheter may have a bent configuration.
[0075] In some embodiments, the processor may be configured for
generating the virtual representation of the catheter using
kinematic information regarding the catheter. In one or more of the
embodiments described herein, the processor may be configured for
generating the virtual representation of the catheter based at
least in part on a signal transmitted through a fiber optic that
extends along a length of the catheter. In one or more of the
embodiments described herein, the processor may be configured for
generating the virtual representation of the catheter based at
least in part on localization data obtained from electromagnetic
sensors.
[0076] In some embodiments, a method may be implemented using a
user interface that allows a user to align a representation of an
elongate device with an image of an elongate device. For example,
in accordance with some embodiments, a method includes generating a
virtual representation of the catheter on a viewing screen,
providing a first control for allowing a user to rotate the virtual
representation of the catheter about a first axis, until a heading
direction of the virtual representation of the catheter aligns with
a heading direction of the catheter as it appears in a first
fluoroscopic image, and providing a second control for allowing the
user to rotate the virtual representation of the catheter about a
second axis, until a tilt angle of the virtual representation of
the catheter aligns with a tilt angle of the catheter as it appears
in the first fluoroscopic image or in a second fluoroscopic image.
In some embodiments, the first control may include a first slider
in a touchscreen. Also, in some embodiments, the second control may
include a second slider in the touchscreen. In other embodiments,
the first control may include a trackball. In some embodiments, the
virtual representation may be generated using kinematic information
regarding the catheter. In other embodiments, the virtual
representation may be generated based at least in part on a signal
transmitted through a fiber optic that extends along a length of
the catheter. In one or more of the embodiments described herein,
the first control may be provided for rotating the virtual
representation of the catheter about the first axis in a plane of
the screen. Also, in one or more of the embodiments described
herein, the method may include providing a third control coupled to
an actuator configured for moving the catheter for allowing the
user to move the catheter until the appearance of the catheter in
the first or second fluoroscopic image is in alignment with a roll
of the virtual representation of the catheter. In other
embodiments, the method may include providing a third control for
allowing the user to move the virtual representation of the
catheter into alignment with a roll of the catheter as it appears
in the first or second fluoroscopic image. In one or more of the
embodiments described herein, the catheter may have a bent
configuration.
[0077] In accordance with other embodiments, a computer product
includes a non-transitory medium storing a set of instructions, an
execution of which causes a method for registering an image of a
catheter with a virtual representation of the catheter to be
performed, the set of instructions comprising one or more
instructions for generating a virtual representation of the
catheter on a viewing screen, one or more instructions for allowing
a user to manipulate a first control to rotate the virtual
representation of the catheter about a first axis, until a heading
direction of the virtual representation of the catheter aligns with
a heading direction of the catheter as it appears in a first
fluoroscopic image, and one or more instructions for allowing the
user to manipulate a second control to rotate the virtual
representation of the catheter about a second axis, until a tilt
angle of the virtual representation of the catheter aligns with a
tilt angle of the catheter as it appears in the first fluoroscopic
image or in a second fluoroscopic image. In some embodiments, the
first control may include a first slider in a touchscreen. Also, in
some embodiments, the second control may include a second slider in
the touchscreen. In other embodiments, the first control may
include a trackball. In one or more of the embodiments described
herein, manipulation of the first control may allow the user to
rotate the virtual representation of the catheter about the first
axis in a plane of the screen. Also, in one or more of the
embodiments described herein, the set of instructions may further
include one or more instructions for allowing the user to
manipulate a third control for moving the catheter, until the
catheter as it appears in the first or second fluoroscopic image is
in alignment with a roll of the virtual representation of the
catheter. In one or more of the embodiments described herein, the
set of instructions may further include one or more instructions
for allowing the user to manipulate a third control for moving the
virtual representation of the catheter into alignment with a roll
of the catheter as it appears in the first or second fluoroscopic
image. In some embodiments, the one or more instructions for
generating the virtual representation may include one or more
instructions for using kinematic information regarding the catheter
to generate the virtual representation. In other embodiments, the
one or more instructions for generating the virtual representation
may include one or more instructions for generating the virtual
representation based at least in part on a signal transmitted
through a fiber optic that extends along a length of the catheter.
In one or more of the embodiments described herein, the catheter
may have a bent configuration.
[0078] In accordance with other embodiments, a user interface for
controlling a robotic system includes a screen displaying an image
of a catheter and a dome at a distal end of the catheter, wherein
the dome represents a constraint for the distal end of the catheter
so that at least a part of the distal end of the catheter is
required to be on an outline of the dome regardless of how the
catheter is driven. By means of non-limiting examples, the dome may
have a cardiod shape, a spherical shape, or any shape that is user
defined/computer calculated. In some embodiments, the user
interface may include a first control for allowing the user to
advance or retrace the catheter, and a second control for allowing
the user to steer the catheter. Also, in some embodiments,
advancement or retraction of the catheter may change a size of the
dome in the screen. In further embodiments, a steering of the
catheter may not change a size of the dome in the screen. In one or
more of the embodiments described herein, the user interface may
include a user control configured to provide force feedback to a
user. Also, in one or more of the embodiments described herein, the
user control may be configured to provide force feedback when the
user attempts to position the at least a part of the distal end of
the catheter away from the outline of the dome. In some
embodiments, the image of the catheter may include a computer model
of the catheter.
BRIEF DESCRIPTION OF THE DAWINGS
[0079] The drawings illustrate the design and utility of
embodiments, in which similar elements are referred to by common
reference numerals. These drawings are not necessarily drawn to
scale. In order to better appreciate how the above-recited and
other advantages and objects are obtained, a more particular
description of the embodiments will be rendered, which are
illustrated in the accompanying drawings. These drawings depict
only typical embodiments and are not therefore to be considered
limiting of its scope.
[0080] FIG. 1 illustrates a robotic surgical system in which
apparatus, system and method embodiments may be implemented.
[0081] FIG. 2 illustrates an example of an operator workstation of
the robotic surgical system shown in FIG. 1 with which a catheter
instrument can be manipulated using different user interfaces and
controls.
[0082] FIG. 3A illustrates a support assembly or mounting brace for
a instrument driver of a robotic surgical system.
[0083] FIG. 3B further illustrates the support assembly illustrated
in FIG. 3A.
[0084] FIG. 3C is another view of the support assembly shown in
FIGS. 3A-B with an attached instrument driver.
[0085] FIG. 3D is a perspective view of a support arm adapter base
plate assembly configured for attaching a support assembly to an
operating table or surgical bed.
[0086] FIG. 3E further illustrates how the adapter base plate
assembly is utilized to attach a support assembly and instrument
driver to an operating table or surgical bed.
[0087] FIG. 4 illustrates an instrument driver mounted to a distal
segment of a support assembly.
[0088] FIG. 5A illustrates a sheath and guide catheter assembly
mounted on an instrument driver.
[0089] FIG. 5B further illustrates the instrument driver shown in
FIG. 5A without the sheath and guide catheter assembly.
[0090] FIG. 5C further illustrates the instrument driver shown in
FIG. 5B with skins removed and one of the mounting plates being
moved relative to the mounting plate arrangement shown in FIG.
5B.
[0091] FIG. 6A illustrates a sheath and guide catheter assembly
positioned over respective mounting plates.
[0092] FIG. 6B further illustrates how sheath and guide splayers
interface with respective mounting plates.
[0093] FIG. 7 illustrates an exploded view of the sheath splayer
shown in FIG. 6B without a purge tube.
[0094] FIG. 7A illustrates a pulley assembly of the splayer shown
in FIG. 7.
[0095] FIG. 7B illustrates an exploded view of the pulley assembly
shown in FIG. 7A.
[0096] FIG. 7C illustrates the top portion of the pulley assembly
shown in FIG. 7A.
[0097] FIG. 7D illustrates the bottom portion of the pulley
assembly shown in FIG. 7A.
[0098] FIG. 7E illustrates a bottom perspective view of a cover of
the splayer shown in FIG. 7.
[0099] FIG. 7F illustrates an exploded view of a splayer base
assembly of the splayer shown in FIG. 7.
[0100] FIG. 8A illustrates a guide carriage of the instrument
driver shown in FIG. 5C coupled to cabling and guide motors.
[0101] FIG. 8B is a perspective view of a slidable carriage or
funicular assembly of an instrument driver and receiver slots
configured to receive and engage with splayer shafts.
[0102] FIG. 9A is a perspective view of a drive shaft positioned
for insertion into a sleeve receptacle located on an instrument
driver.
[0103] FIG. 9B of a drive shaft that is inserted into a sleeve
receptacle.
[0104] FIG. 10 illustrates a sheath block and guide insert motor
and leadscrew removed from the instrument driver shown in FIG.
5C.
[0105] FIGS. 10A and 10B illustrate different perspective views of
the sheath block.
[0106] FIGS. 11A-11H illustrate side and cross-sectional views of a
catheter bent in various configurations with pull wire
manipulation.
[0107] FIG. 12 shows an example of an overview block diagram of a
basic topology for controlling flexible devices.
[0108] FIG. 13 illustrates forward kinematics and inverse
kinematics in accordance with some embodiments.
[0109] FIG. 14 illustrates task coordinates, joint coordinates, and
actuation coordinates in accordance with some embodiments.
[0110] FIG. 15 illustrates variables associated with a geometry of
a catheter in accordance with some embodiments.
[0111] FIG. 16 illustrates a conventional open loop control
model.
[0112] FIG. 17 illustrates a control system in accordance with some
embodiments.
[0113] FIG. 18 illustrates a user interface for a master input
device.
[0114] FIGS. 19-29 illustrate software control schema in accordance
with various embodiments.
[0115] FIG. 30 illustrates a distal portion of a guide catheter
extending beyond a distal end of a sheath instrument by a distance
or length L.sub.1 and a force F imparted on the distal tip of the
guide catheter that may cause the distal portion of the guide
catheter to bend or flex.
[0116] FIG. 31 illustrates a distal portion of a guide catheter
extending beyond a distal end of a sheath instrument by a distance
or length L.sub.2 that is less than the length L.sub.1 shown in
FIG. 30.
[0117] FIG. 32 illustrates assessing reachability and viewability
or field of view according to one embodiment.
[0118] FIG. 33A illustrates a cross-sectional view of a flexible
and steerable elongate instrument with variable or changeable shape
control and support elements in accordance with one embodiment.
[0119] FIG. 33B illustrates another cross-sectional view (View 1-1)
of a flexible and steerable elongate instrument with variable or
changeable shape control and support elements in accordance with
one embodiment.
[0120] FIG. 34A illustrates an elongate instrument with passively
controlled flex member in accordance with one embodiment.
[0121] FIG. 34B illustrates a passively controlled flex member with
a service or buffer loop in accordance with one embodiment.
[0122] FIG. 34C illustrates support tubes or support members
sliding along the flex tubes or flex members in accordance with one
embodiment.
[0123] FIG. 34D illustrates slidable couplings of variable shape
control and support components near the proximal section of a
flexible and steerable elongate instrument in accordance with one
embodiment.
[0124] FIGS. 35A-35C illustrate the operation of a substantially
flexible and steerable elongate instrument in accordance with one
embodiment.
[0125] FIG. 36A and FIG. 36B illustrate curve aligned steering of a
flexible and steerable elongate instrument in accordance with one
embodiment.
[0126] FIG. 36C illustrates an embodiment of an elongate instrument
that does not have coil pipes.
[0127] FIG. 36D illustrates a mechanics of a coil pipe in
accordance with some embodiments.
[0128] FIGS. 37A-37E illustrate another catheter in accordance with
other embodiments.
[0129] FIGS. 38-44 illustrate a sheath in accordance with some
embodiments, and variations thereof.
[0130] FIGS. 45-48 illustrate methods of using a catheter and a
sheath in accordance with different embodiments.
[0131] FIGS. 49-50C illustrate a valve in accordance with some
embodiments.
[0132] FIGS. 51A-51F illustrate another robotic surgical system 400
in accordance with other embodiments.
[0133] FIG. 51G illustrates a rail system configured to tilt a
setup mount in accordance with some embodiments.
[0134] FIG. 52A illustrates driving mode(s) in accordance with some
embodiments.
[0135] FIG. 52B illustrates driving mode(s) in accordance with
other embodiments.
[0136] FIG. 52C illustrates driving mode(s) in accordance with
other embodiments.
[0137] FIG. 52D illustrates driving mode(s) in accordance with
other embodiments.
[0138] FIGS. 53A-67C illustrate different anti-buckling devices,
and components that operate with the anti-buckling devices, in
accordance with different embodiments; and
[0139] FIGS. 68-78A illustrate different lubricating mechanisms in
accordance with different embodiments.
[0140] FIG. 79A illustrates a front perspective view of a variation
of an elongate member manipulator.
[0141] FIG. 79B illustrates an end perspective view of the elongate
member manipulator of FIG. 79A.
[0142] FIG. 79C illustrates a cross sectional view of the elongate
member manipulator of FIG. 79A.
[0143] FIG. 79D illustrates a top cross sectional view of the
elongate member manipulator of FIG. 79A.
[0144] FIGS. 80A-80B are schematic illustrations showing top and
front views of feed rollers actuating an elongate member.
[0145] FIG. 81 illustrates a cross sectional view of one variation
of a roller actuator.
[0146] FIG. 82 illustrates a cross sectional view of one variation
of a feed roller with a drape,
[0147] FIG. 83 illustrates a perspective view of the instrument
driver, the guide splayer and a variation of an elongate member
manipulator.
[0148] FIG. 83A illustrates a closer view of the instrument driver,
the elongate member manipulator, and the guide splayer of FIG.
83.
[0149] FIG. 84 illustrates a perspective view of the elongate
member manipulator of FIG. 83, showing the manipulator in an open
configuration and mounted to a manipulator mounting bracket.
[0150] FIG. 85A illustrates the elongate member manipulator of FIG.
84, showing the manipulator in a closed configuration.
[0151] FIGS. 85B-85C illustrate the elongate member manipulator of
FIG. 84 with an idler belt assembly removed, showing the
manipulator open by varying degrees.
[0152] FIG. 85D illustrates the elongate member manipulator of FIG.
85B in a closed configuration.
[0153] FIG. 85E illustrates a cross-sectional view of the elongate
member manipulator of FIG. 85A.
[0154] FIG. 86A illustrates a back view of the elongate member
manipulator of FIG. 84.
[0155] FIGS. 86B-86C illustrates various perspective views of the
elongate member manipulator of FIG. 85.
[0156] FIG. 87A illustrates a side view of the elongate member
manipulator of FIG. 85, showing a hinge mechanism in a closed
configuration.
[0157] FIG. 87B illustrates the elongate member manipulator of FIG.
87A, showing the hinge mechanism in an open configuration.
[0158] FIG. 87C illustrates a cross sectional perspective view of
the elongate member manipulator of FIG. 84.
[0159] FIG. 88 illustrates a perspective view of the elongate
member manipulator of FIG. 84 with wire holders installed, showing
both the manipulator and wire holders in open configurations.
[0160] FIG. 89 illustrates the elongate member manipulator of FIG.
88, showing the manipulator and wire holders in closed
configurations.
[0161] FIG. 90A illustrates an exploded perspective view of the
elongate member manipulator of FIG. 84, showing the idler belt
assembly and a drive belt assembly partially removed.
[0162] FIG. 90B illustrates a cross sectional view of the elongate
member manipulator of FIG. 84, showing the idler belt assembly and
the drive belt assembly partially un-installed.
[0163] FIG. 90C illustrates a cross sectional view of the elongate
member manipulator of FIG. 84, showing the idler belt assembly and
the drive belt assembly fully installed.
[0164] FIGS. 91A-91C illustrate perspective views of the instrument
driver, the guide splayer and another alternative variation of an
elongate member manipulator.
[0165] FIGS. 91D-91E illustrate perspective views of the elongate
member manipulator of FIG. 91A.
[0166] FIG. 91F illustrates a perspective view of the elongate
member manipulator of FIG. 91A, showing the elongate member
manipulator in an open configuration.
[0167] FIG. 91G illustrates a side view of the elongate member
manipulator of FIG. 91A, showing the manipulator mounting bracket,
a roll motor, and an insert motor all removed.
[0168] FIG. 91H illustrates a cross sectional side view of the
elongate member FIG. 91A, showing the manipulator mounting bracket,
the roll motor, and the insert motor all removed.
[0169] FIGS. 92A-92B illustrate perspective views of an idler belt
assembly of the elongate member manipulator of FIG. 91A.
[0170] FIGS. 93A-93D illustrate various perspective views of a
drive belt assembly of the elongate member manipulator of FIG.
91A.
[0171] FIG. 94A illustrates a perspective view of an elongate
member support of the elongate member manipulator of FIG. 91A.
[0172] FIG. 94B illustrates a cross sectional top view of the
elongate member support of FIG. 94A.
[0173] FIG. 94C illustrates an alternative perspective view of the
elongate member manipulator of FIG. 91A, showing the manipulator
mounted to a manipulator mounting bracket.
[0174] FIG. 94D illustrates the elongate member manipulator of FIG.
94C, showing an insert motor cover removed.
[0175] FIG. 94E illustrates a zoomed in view of the insert motor of
the elongate member manipulator of FIG. 94D.
[0176] FIG. 95A illustrates a perspective view of a valve holder of
the elongate member manipulator of FIG. 91A, showing the valve
holder in a closed configuration.
[0177] FIGS. 95B-95C illustrate various perspective views of the
valve holder of FIG. 95A in an open configuration.
[0178] FIGS. 95D-95E illustrate front and back perspective views of
a valve assembly of the elongate member manipulator of FIG. 91A,
showing a support tube and guide wire installed.
[0179] FIG. 95F illustrates an exploded perspective view of the
valve assembly of FIG. 95D, showing the support tube and guide wire
removed.
[0180] FIG. 96 illustrates the drive belt assembly and idler belt
assembly of FIG. 91A, showing a portion of the drape.
[0181] FIG. 96A illustrates a cross sectional bottom view of the
drive belt assembly of FIG. 94A.
[0182] FIG. 96B illustrates a cross sectional bottom view of the
idler belt assembly of FIG. 92A.
[0183] FIG. 96C illustrates a perspective view of a representation
of an alternative elongate member manipulator with a guide wire
installed.
[0184] FIGS. 96D-96E illustrate side views of the elongate member
manipulator of FIG. 96C showing roll actuation of the guide
wire.
[0185] FIG. 97 illustrates a perspective view of another variation
of an elongate member manipulator mounted to a variation of an
instrument driver.
[0186] FIGS. 97aa-97ab illustrate various views of the elongate
member manipulator of FIG. 97 with a cover removed.
[0187] FIGS. 97A1-97A2 illustrate a front view of the elongate
member manipulator of FIG. 97 in an closed and open configuration
respectively.
[0188] FIGS. 97A3-97A4 illustrate a back view of the elongate
member manipulator of FIG. 97 in an closed and open configuration
respectively.
[0189] FIGS. 97B1-97B2 illustrate front and back perspective views
of the elongate member manipulator of FIG. 97A1 with the cover
removed.
[0190] FIG. 97B3 illustrates a zoomed in view of a roll motor and
accompanying roll mechanisms.
[0191] FIG. 97C illustrates the elongate member manipulator of
FIGS. 97B1-97B2 with only insert mechanical components and a drive
belt assembly displayed.
[0192] FIG. 97D1 illustrates a perspective view of the drive belt
assembly of FIG. 97C.
[0193] FIG. 97D2 illustrates a cross sectional view of the drive
belt assembly of FIG. 97D1.
[0194] FIG. 97D3 illustrates a zoomed in view of a drive shaft
shown in FIG. 97D2.
[0195] FIGS. 97E1-E2 illustrate upper and lower slide assemblies of
the elongate member manipulator of FIG. 97C with the drive belt
assembly and an idler belt assembly installed and un-installed
respectively.
[0196] FIG. 97F illustrates an exploded view of the upper slide
assembly of FIGS. 97E1-97E2.
[0197] FIG. 97G illustrates a top, front and side view of a
simplified representation of an alignment bar and cradle of the
upper slide assembly shown in FIG. 97F.
[0198] FIG. 97H1 illustrates the elongate member manipulator of
FIG. 97A1 with the drive and idler belt assemblies removed.
[0199] FIG. 97H2 illustrates a view of the elongate member
manipulator of FIG. 97H1 with an elongate member holder exploded
from the elongate member manipulator.
[0200] FIG. 97J1 illustrates the elongate member holder of FIGS.
97H1-97H2 with a guide wire and valve installed.
[0201] FIG. 97J2 illustrates the elongate member holder of FIG.
97J1 with a valve holder in an open configuration and the guide
wire and valve exploded from the elongate member holder.
[0202] FIGS. 97J3-97J4 illustrate different perspective views of
the valve holder of FIGS. 97J1-97J2 in closed and open
configurations respectively.
[0203] FIGS. 97K1 and K2 illustrate perspective views of a drape
assembly.
[0204] FIGS. 97L1-97L2 illustrate top and bottom perspective views
of a tenting frame of the drape assembly shown in FIGS.
97K1-97K2.
[0205] FIGS. 97M1-97M5 illustrate the drape assembly of FIG. 97K
being installed on a simplified model of the elongate member
manipulator of FIG. 97A1.
[0206] FIGS. 97M6-97M7 illustrate the drape installed on the
elongate member manipulator of FIG. 97A1 in a closed and open
configuration respectively.
[0207] FIG. 98A illustrates a perspective view of an instrument
driver with a guide splayer and another variation of an elongate
member manipulator.
[0208] FIG. 98B illustrates a closer view of the instrument driver,
guide splayer, and elongate member manipulator of FIG. 98A.
[0209] FIG. 99 illustrates a perspective view of the elongate
member manipulator of FIG. 98A.
[0210] FIGS. 100A-100B illustrate perspective views of the elongate
member manipulator of FIG. 99, showing a motor pack cover
removed.
[0211] FIGS. 101A-101B illustrate front and back perspective views
of a belt assembly of the elongate member manipulator of FIG.
99.
[0212] FIG. 101C illustrates a back view of the belt assembly of
FIG. 101A.
[0213] FIG. 102A illustrates a side view of the belt assembly of
FIG. 101A.
[0214] FIG. 102B illustrates the belt assembly of FIG. 102A, shown
in an open configuration.
[0215] FIG. 103 illustrates a perspective view of the instrument
driver, guide splayer, and an alternative variation of an elongate
member manipulator, showing the manipulator un-installed.
[0216] FIGS. 103AA-103AB illustrate perspective and side views of
an adapted Tiny-Vise clamp.
[0217] FIG. 103A illustrates a top view of the elongate member
manipulator of FIG. 103, showing a guide wire and a roll support
tube.
[0218] FIG. 103B illustrates a top view of the elongate member
manipulator of FIG. 103, showing a guide wire and a scissor jack
support.
[0219] FIG. 104 illustrates a perspective view of the elongate
member manipulator of FIG. 103, showing a motor pack cover
removed.
[0220] FIG. 105 illustrates a perspective view of a feed roller
assembly of the elongate member manipulator of FIG. 104.
[0221] FIG. 106A illustrates a closer view of the feed roller
assembly of FIG. 105.
[0222] FIGS. 106B-107A illustrate a top view of the feed roller
assembly of FIG. 105.
[0223] FIG. 107B illustrates a bottom view of the feed roller
assembly of FIG. 105.
[0224] FIG. 108A illustrates a representation of the bottom view of
a gear train of the feed roller assembly of FIG. 105.
[0225] FIG. 108B illustrates the gear train representation of FIG.
108A, showing the gear train pivoted in an open configuration.
[0226] FIG. 109 illustrates a side view of a drive roller and feed
roller of FIG. 105, showing a guide wire installed.
[0227] FIG. 110A illustrates a top view of the feed roller assembly
of FIG. 105, showing an insert assembly removed from an actuation
assembly.
[0228] FIG. 110B illustrates a perspective view of the feed roller
assembly.
[0229] FIGS. 111A-111F illustrate top views of simplified
representations of various feed roller and feed belt
combinations.
[0230] FIG. 112A illustrates a bottom perspective view of the
elongate member manipulator of FIG. 85.
[0231] FIG. 112B illustrates a bottom perspective view of the
elongate member manipulator of FIG. 104.
[0232] FIG. 113 illustrates a top view of a variation of a control
console of the operator workstation of FIG. 1.
[0233] FIG. 114A illustrates a perspective view of a patient bed of
the robotic instrument system of FIG. 1, showing a standalone
console mounted to the patient bed.
[0234] FIG. 114B illustrates a side view of the standalone console
of FIG. 114A, showing the standalone console mounted to a mounting
bracket and a bed rail.
[0235] FIG. 115 illustrates a top view of a variation of the
standalone console of FIG. 114A.
[0236] FIGS. 116 and 117A-117M illustrate variations of a master
input device.
[0237] FIGS. 118A-D illustrate flow diagrams of various
master-slave control options.
[0238] FIG. 119 illustrates a perspective view of the instrument
driver and the elongate member manipulator of FIG. 91A with an
anti-buckling mechanism installed.
[0239] FIG. 120 illustrates a flow diagram of a variation of a
control scheme for control of the elongate member manipulator of
FIG. 79A, 85, 91A, 99, 103A, or 124A.
[0240] FIGS. 121A-121B illustrate block diagrams representing the
instrument driver, the elongate member manipulator, the guide
catheter, and the sheath catheter.
[0241] FIG. 122 illustrates a flow diagram of the controller for
the configuration with a movable carriage and a coupled elongate
member manipulator of FIG. 121B.
[0242] FIG. 123 illustrates a representation of a variation of a
virtual guide wire.
[0243] FIG. 124A illustrates a perspective view of another
alternative variation of an elongate member manipulator.
[0244] FIGS. 124B-C illustrates perspective views of the elongate
member manipulator of FIG. 124A, showing the manipulator cover
removed.
[0245] FIGS. 125A and 127A illustrate a perspective views of a
rotation drive of the elongate member manipulator of FIG. 124C.
[0246] FIG. 125B illustrates a side perspective view of the
rotation drive of FIG. 125A with the guide wire installed.
[0247] FIG. 125C illustrates a closer perspective view of the
rotation drive of FIG. 125A.
[0248] FIG. 126 illustrates a side cross sectional view of the
elongate member manipulator of FIG. 124B.
[0249] FIG. 127B illustrates a side cross sectional view of the
rotation drive of FIG. 125A.
[0250] FIG. 127C illustrates a side and a cross sectional view of
the rotation drive of FIG. 125A.
[0251] FIG. 128A illustrates a control system in accordance with
some embodiments.
[0252] FIG. 128B illustrates a localization sensing system having
an electromagnetic field receiver in accordance with some
embodiments.
[0253] FIG. 128C illustrates a localization sensing system in
accordance with other embodiments.
[0254] FIG. 128D illustrates a user interface for a master input
device in accordance with some embodiments.
[0255] FIG. 128E illustrates a configuration of a catheter in
accordance with some embodiments.
[0256] FIG. 128F illustrates another configuration of a catheter in
accordance with other embodiments.
[0257] FIG. 128G illustrates a catheter that is haptically
constrained to a surface of a "dome" in accordance with some
embodiments.
[0258] FIG. 129a is a perspective view of an instrument driver with
a sheath and guide splayer installed.
[0259] FIG. 129b is a zoomed in view of the sheath splayer mounted
to the instrument driver of FIG. 129a.
[0260] FIG. 129c is an exploded view of the sheath splayer and
instrument driver of FIG. 129b.
[0261] FIGS. 130a and 130b are top and bottom perspective view
respectively of a sheath output plate.
[0262] FIG. 130c is an exploded bottom perspective view of the
sheath output plate of FIG. 130a.
[0263] FIGS. 131a and 131b are top and bottom perspective views
respectively of a base plate.
[0264] FIG. 131c is a perspective view of a guide output plate.
[0265] FIGS. 132a and 132b are top and bottom perspective views
respectively of a drive interface apparatus.
[0266] FIG. 132c is an exploded perspective view of the drive
interface apparatus of FIG. 132a.
[0267] FIGS. 133a and 133b are top perspective views respectively
of a drive interface base.
[0268] FIGS. 134a and 134b are top and bottom perspective view
respectively of the drive interface base of FIG. 133a populated
with a plurality of drive interface pulley shafts and a pair of
EEPROM pins.
[0269] FIG. 135a is a perspective view of a drape assembly.
[0270] FIG. 135b is a zoomed in perspective view of a portion of
the drape assembly of FIG. 135a including a sheath foam pad.
[0271] FIG. 135c is a zoomed in perspective view of a portion of
the drape assembly of FIG. 135a including a guide foam pad.
[0272] FIG. 136a is a perspective view of a sheath splayer.
[0273] FIG. 136b is a perspective view of a guide splayer.
[0274] FIG. 136c is a perspective view of the sheath splayer of
FIG. 136a with a splayer cover exploded from the sheath
splayer.
[0275] FIGS. 137a and 137b are top and bottom perspective views
respectively of a splayer body.
[0276] FIG. 137c is an exploded perspective view of the splayer
body of FIG. 137a.
[0277] FIG. 138 is a bottom view of a splayer cover.
[0278] FIGS. 138a and 138b are perspective and exploded views
respectively of a splayer pulley assembly.
[0279] FIGS. 139a and 139b are top and bottom perspective views
respectively of a splayer base.
[0280] FIGS. 140a and 140b are top and bottom perspective views
respectively of the splayer base of FIG. 139a populated with a
plurality of splayer pulley assemblies, a splayer presence magnet,
and a splayer ID chip.
[0281] FIGS. 141a and 141b illustrate methods of installing the
drape assembly of FIG. 135a over the instrument driver.
[0282] FIG. 142a is a perspective view of the instrument assembly
with the drape assembly installed and the drive interface apparatus
exploded from the instrument driver.
[0283] FIG. 142b is a perspective view of the instrument assembly
and drape assembly of FIG. 142a with the drive interface apparatus
installed.
[0284] FIG. 143a is a top perspective view of the sheath output
plate with the drape assembly installed and the drive interface
apparatus exploded.
[0285] FIG. 143b is a bottom perspective view of the sheath output
plate, drape assembly, and drive interface apparatus of FIG.
143a.
[0286] FIG. 143c is a bottom perspective view of the sheath output
plate with the drape and drive interface apparatus installed.
[0287] FIGS. 144a and 144b are perspective views of a drive
interface pulley shaft installed and uninstalled respectively to a
sleeve receptacle.
[0288] FIGS. 144c and 144d are side and front views of the drive
interface pulley and sleeve receptacle illustrated in FIG.
144b.
[0289] FIGS. 145a and 145b are top and bottom perspective view of
the sheath splayer exploded from the drive interface apparatus.
[0290] FIG. 146a is a top view of the splayer pulley assembly.
[0291] FIG. 146b is a top view of the drive interface pulley
shaft.
[0292] FIGS. 147a and 147b are top and bottom perspective views
respectively of the splayer pulley assembly exploded from the drive
interface pulley shaft.
[0293] FIGS. 148a and 148b are top and bottom exploded views
respectively of the instrument driver with the drape assembly
installed and the drive interface apparatus and sheath splayer
un-installed.
DESCRIPTION OF THE EMBODIMENTS
[0294] Various embodiments are described hereinafter with reference
to the figures. It should be noted that the figures are not drawn
to scale and that elements of similar structures or functions are
represented by like reference numerals throughout the figures. It
should also be noted that the figures are only intended to
facilitate the description of the embodiments. They are not
intended as an exhaustive description of the invention or as a
limitation on the scope of the invention. In addition, an
illustrated embodiment needs not have all the aspects or advantages
shown. An aspect or an advantage described in conjunction with a
particular embodiment is not necessarily limited to that embodiment
and can be practiced in any other embodiments even if not so
illustrated.
[0295] I. Robotic Surgical Systems
[0296] Embodiments described herein generally relate to apparatus,
systems and methods for robotic surgical systems. A robotic
surgical systems in which embodiments described herein may be
implemented is described with reference to FIGS. 1-10B. Various
embodiments of apparatus, system and method, including control and
electronic architectures, are described with reference to FIGS.
11A-19K. Various embodiments directed to indicating catheter
insertion forces as the catheter engages tissue or another object
are described with reference to FIGS. 20A-B. Various embodiments
directed to determining reachability of catheter instrument and
viewability or fields of view at different reachable locations are
described with reference to FIG. 21.
[0297] Referring to FIG. 1, a robotically controlled surgical
system (S) in which embodiments of apparatus, system and method may
be implemented includes a robotic catheter assembly (A) having a
first or outer robotic steerable complement, otherwise referred to
as a sheath instrument 30 (generally referred to as "sheath" or
"sheath instrument") and/or a second or inner steerable component,
otherwise referred to as a robotic catheter or guide or catheter
instrument 18 (generally referred to as "catheter" or "catheter
instrument"). The sheath instrument 30 and catheter instrument 18
are controllable using a robotic instrument driver 16 (generally
referred to as "instrument driver"). During use, a patient is
positioned on an operating table or surgical bed 22 (generally
referred to as "operating table") to which a robotic catheter
assembly (A) is coupled or mounted. In the illustrated example, the
system (S) includes an operator workstation 2, an electronics rack
6 and associated bedside electronics box, a setup joint mounting
brace 20, and an instrument driver 16. A surgeon is seated at the
operator workstation 2 and can monitor the surgical procedure,
patient vitals, and control one or more catheter devices.
[0298] Various system (S) components in which embodiments described
herein may be implemented are illustrated in close proximity to
each other in FIG. 1, but embodiments may also be implemented in
systems (S) in which components are separated from each other,
e.g., located in separate rooms. For example, the instrument driver
16, operating table 22, and bedside electronics box may be located
in the surgical area with the patient, and the operator workstation
2 and the electronics rack 6 may be located outside of the surgical
area and behind a shielded partition. System (S) components may
also communicate with other system (S) components via a network to
allow for remote surgical procedures during which the surgeon may
be located at a different location, e.g., in a different building
or at a different hospital utilizing a communication link transfers
signals between the operator control station 2 and the instrument
driver 16. System (S) components may also be coupled together via a
plurality of cables or other suitable connectors 14 to provide for
data communication, or one or more components may be equipped with
wireless communication components to reduce or eliminate cables 14.
In this manner, a surgeon or other operator may control a surgical
instrument while being located away from or remotely from radiation
sources, thereby decreasing the operator's exposure to
radiation.
[0299] Referring to FIG. 2, one example of an operator workstation
2 that may be used with the system (S) shown in FIG. 1 includes
three display screens 4, a touch screen user interface 5, a control
button console or pendant 8, and a master input device (MID) 12.
The MID 12 and pendant 8 serve as user interfaces through which the
surgeon can control operation of the instrument driver 16 and
attached instruments. By manipulating the pendant 8 and the MID 12,
a surgeon or other operator can cause the instrument driver 16 to
remotely control a catheter instrument 18 and/or a sheath
instrument 30 mounted thereon. A switch 7 may be provided to
disable activity of an instrument temporarily. The console 2 in the
illustrated system (S) may also be configurable to meet individual
user preferences. For example, in the illustrated example, the
pendant 8 and the touch screen 5 are shown on the left side of the
console 2, but they may also be relocated to the right side of the
console 2. Further, optional keyboard may be connected to the
console 2 for inputting user data. The workstation 2 may also be
mounted on a set of casters or wheels to allow easy movement of the
workstation 2 from one location to another, e.g., within the
operating room or catheter laboratory. Further aspects of examples
of suitable MID 12, and workstation 2 arrangements are described in
further detail in U.S. patent application Ser. No. 11/481,433 and
U.S. Provisional Patent Application No. 60/840,331, the contents of
which were previously incorporated herein by reference. Additional
embodiments of various MIDs and pendants will also be described
later.
[0300] Referring to FIGS. 3A-C, a system (S) includes a setup joint
or support assembly 20 (generally referred to as "support
assembly") for supporting or carrying the instrument driver 16 over
the operating table 22. One suitable support assembly 20 has an
arcuate shape and is configured to position the instrument driver
16 above a patient lying on the table 22. The support assembly 20
may be configured to movably support the instrument driver 16 and
to allow convenient access to a desired location relative to the
patient. The support assembly 20 may also be configured to lock the
instrument driver 16 into a certain position.
[0301] In the illustrated example, the support assembly 20 is
mounted to an edge of the operating table 22 such that a catheter
and sheath instruments 18, mounted on the instrument driver 16 can
be positioned for insertion into a patient. The instrument driver
16 is controllable to maneuver the catheter and/or sheath
instruments 18, 30 within the patient during a surgical procedure.
The distal portion of the setup joint 20 also includes a control
lever 33 for maneuvering the setup joint 20. Although the figures
illustrate a single guide catheter 18 and sheath assembly 30
mounted on a single instrument driver 16, embodiments may be
implemented in systems (S) having other configurations.
[0302] For example, embodiments may be implemented in systems (S)
that include a plurality of instrument drivers 16 on which a
plurality of catheter/sheath instruments 18, 30 can be controlled.
Further aspects of a suitable support assembly 20 are described in
U.S. patent application Ser. No. 11/481,433 and U.S. Provisional
Patent Application No. 60/879,911, the contents of which are
expressly incorporated herein by reference. Referring to FIG. 3D-E,
the support assembly 20 may be mounted to an operating table 22
using a universal adapter base plate assembly 39, similar to those
described in detail in U.S. Provisional Patent Application No.
60/899,048, incorporated by reference herein in its entirety. The
adapter plate assembly 39 mounts directly to the operating table 22
using clamp assemblies 39b, 39c, and the support assembly 20 can be
mounted to the adapter plate assembly 39. One suitable adapter
plate assembly 39 includes a large, flat main plate 39a which is
positioned on top of the operating table 22. The assembly 39
provides for various adjustments to allow it to be mounted to
different types of operating tables 22. An edge of the adapter
plate assembly 39 may include a rail 39d that mimics the
construction of a traditional surgical bedrail. By placing this
rail on the adapter plate 39a itself, a user may be assured that
the component dimensions provide for proper mounting of the support
assembly 20. Furthermore, the large, flat surface of the main plate
39a provides stability by distributing the weight of the support
assembly 20 and instrument driver 16 over an area of the table 22,
whereas a support assembly 20 mounted directly to the operating
table 22 rail may cause its entire load to be placed on a limited
and less supportive section of the table 22.
[0303] With further reference to FIGS. 4 and 5A, an instrument
assembly (A) comprised of a sheath instrument 30 and an associated
guide or catheter instrument 18 is mounted to associated mounting
plates 37, 38 on a top portion of the instrument driver 16. FIG. 5B
illustrates the instrument driver 16 without an attached instrument
assembly (A). FIG. 5C illustrates the instrument driver 16 with
skins removed to illustrate internal components which will be
described in further detail. Embodiments described are similar to
those described in detail in U.S. patent application Ser. Nos.
11/678,001, 11/678,016, and 11/804,585, each incorporated by
reference herein in its entirety.
[0304] Referring to FIGS. 6A-B, the assembly (A) that includes a
sheath instrument 30 and a guide or catheter instrument 18
positioned over their respective mounting plates 38, 37 is
illustrated removed from the instrument driver 16. The guide
catheter instrument member 61a is coaxially interfaced with the
sheath instrument member 62a by inserting the guide catheter
instrument member 61a into a working lumen of the sheath catheter
member 62a. As shown in FIG. 6A, the sheath instrument 30 and the
guide or catheter instrument 18 are coaxially disposed for mounting
onto the instrument driver 16. However, it should be understood
that a sheath instrument 16 is used without a guide or catheter
instrument 18, or a guide or catheter instrument 18 is used without
a sheath instrument 30 may be mounted onto the instrument driver 16
individually. With the coaxial arrangement as shown in FIG. 6A, the
guide catheter splayer 61 is located proximally relative to, or
behind, the sheath splayer 62 such that the guide catheter member
61a can be inserted into and removed from the sheath catheter
member 61b.
[0305] Examples of how sheath and guide splayers 62, 61 may be
structured are shown in FIGS. 7-7F. FIG. 7 illustrates the sheath
splayer 62 of one embodiment illustrated without a purge tube 32.
As shown in FIG. 6A, the sheath and guide splayers 62, 61, appear
similar physically in construction with the exception that the
guide splayer 62 includes the purge tube 32. It should be noted
that the purge tube 32 may or may not be included for either the
guide or sheath splayer. The sheath splayer 62 will be described
herein. However it should be understood that the guide splayer 61
is of similar construction, and components of the sheath splayer 62
can be repeated for the guide splayer 61.
[0306] As illustrated in FIG. 7, the splayer 62 includes a splayer
cover 72 fixably coupled to a splayer base assembly 78 using four
screws 79. The splayer base 78 having four cavities to receive and
house pulley assemblies 80 is used for both the guide splayer 61
and sheath splayer 62. For this embodiment of a sheath splayer 62,
two cavities of the splayer base 78 are populated with pulley
assemblies 80 and the remaining cavities are left open. The guide
splayer 61 may have all its cavities populated with four pulley
assemblies 80, as can be seen in FIG. 6B. The splayer base 78 of
this implementation can be constructed from injection molded
polycarbonate.
[0307] One implementation uses substantially identical pulley
assemblies 80 in both the guide and sheath splayers 61,62 which are
illustrated in FIGS. 7A-D. FIG. 7A illustrates the full pulley
assembly 80. FIG. 7B illustrates an exploded view of the pulley
assembly 80. Each pulley assembly 80 includes a top portion 82 and
a bottom portion 84 held together with four screws 86 and four
washers 88. Note that in FIG. 7B, only two screws 86 and two
washers 88 are shown for clarity. Referring to FIG. 7C, the top
portion 82 of the pulley assembly 80 includes a stainless steel
insert mold or drive shaft 90 with a drive pin 90b. The drive shaft
90 includes a flat portion 90a allowing it to form a D-shaped cross
section. The bottom portion 84 includes four tapped holes 84a to
receive the ends of the four screws 86 and also a wire securing
slot 84b. As a pulley assembly 80 is put together and mated with a
catheter pull wire or control element (not shown), the pull wire
can be secured to the pulley assembly 80 by inserting the pull wire
into the wire securing slot 84b. The pull wire (not shown) runs
down the length of a catheter from distal to proximal end then is
wound about the pulley. By rotating the pulley, the pull wire bends
the distal tip of the catheter controlling its bend. The kinematics
of robotically controlled catheters with pull wires will be
described in further detail below.
[0308] FIG. 7E illustrates the splayer cover 72 of one embodiment.
The splayer cover 72 in this example includes a pair of latches 74
located on its inner surface. These latches are designed to engage
with corresponding notches 38b located on the mounting plates 38
illustrated in FIG. 6B. The splayer cover 72 also includes four
holes 72a to receive the mounting screws 79 used to couple the
splayer cover 72 to the splayer base assembly 78. The splayer cover
72 and the latches 74 of this embodiment can be ABS molded. A pair
of urethane based compliant members 82 located on the sides of the
splayer cover 72 is over molded with the splayer cover 72 such that
the splayer cover 72 is results as a single piece. Along opposing
sides on the inside of the splayer cover 72 in this embodiment are
two pairs of foam pads 84. Each pair of foam pads 84 are located
adjacent to the latch 74 and serve to provide its latch 74 some
spring tension wherein better engagement between the splayer cover
72 and the mounting plate 38 can be achieved. In one
implementation, a user can remove a splayer 62 mounted to an RCM by
squeezing at the compliant member 82, which in turn depress and
disengage the latches 74 from the notches 38b of the RCM mounting
plate 38.
[0309] FIG. 7F illustrates an exploded view of the splayer base
assembly 78 of one embodiment which includes the splayer base 78, a
printed circuit assembly 94, a set of magnets 96, and a back panel
98. During assembly of a splayer in accordance with some
embodiments, the control cables of the catheter instrument are
pre-tensioned by hand when the pulleys 80 are installed. Data
related to individual catheter and splayer characteristics,
including, but not limited to, full range of motion and critical
parameters captured during the characterization process, are stored
into a memory for later retrieval in the printed circuit assembly
or PCA 94 which can act as a catheter identification (ID)
programmable read-only memory (PROM). In alternative embodiments,
other types non-volatile of memories such as flash memory or
electrically programmable read-only memory (EPROM) can be used to
store data. The PCA of this embodiment includes a pair of pogo pins
76 to detect contact with an RCM interface plate. The pogo pins 76
are positioned to make contact with the PCA 94 upon which the PROM
is mounted as the splayer is placed onto the RCM mounting plate 38.
Also located on the underside of this splayer base assembly 78 are
a pair of magnets 96. In one embodiment, the magnets 96 are made of
a neodymium material. As will be later described, the magnets are
configured to be detected by read switches on the RCM interface to
indicate splayer presence when a splayer is mounted on the RCM. The
back panel 98 covers portions of the splayer base assembly 78,
which is also shown in FIG. 7F. This back panel 98 includes
openings for the pogo pins 76 to pass through.
[0310] Referring back to FIGS. 6A-6B, when a catheter is prepared
for use with an instrument, its splayer is mounted onto its
appropriate interface plate. In this case, the sheath splayer 62 is
placed onto the sheath interface plate 38 and the guide splayer 61
is place onto the guide interface plate 37. In the illustrated
example, each mounting plates 37, 38 has four openings 37a, 38a
that are designed to receive the corresponding drive shafts 90
attached to and extending from the pulley assemblies 80 of the
splayers 61, 62. In the example illustrated in FIG. 6B, two shafts
90 of the pulley assembly 80 are insertable within the right
apertures or two openings 38a of the sheath interface plate 38 as
the splayer 62 is mounted onto the RCM. Similarly, four shafts 90
of the guide splayer pulley assembly 80 are insertable within the
four apertures or openings 37a of the guide interface plate 37.
[0311] The RCM mounting plate in accordance with some embodiments
includes a flex circuit with contacts and four read switches (not
shown) for detecting the presence of a splayer and to indicate that
a splayer has been mounted onto the interface plate. In some
embodiments, the switches are also used to read the data from the
memory. In alternative embodiments, various types of contacts and
switches can be implemented to detect presence and/or access the
PCA 94. For this implementation, the switches are triggered by the
magnets 96 of the splayer.
[0312] A user sets up the catheter by fastened it to the RCM
initially. When the bottom surface of the splayer is within 180
thousandths of an inch from the interface plate, a magnetic field
engages with the contact switches. The splayer 62/61 is mounted to
an RCM, and the latches 73,74 are inserted through openings 38b,37b
on the mounting plate to latch onto the interface plate 38,37, thus
securely coupling the splayer 62/61 to the RCM. Once the splayer is
engaged with the RCM, characterization parameters can be read from
the PCA 94 by the RCM, allowing the RCM to set the splayer in its
nominal position. In one embodiment, the data read from the PCA may
include catheter length information, relative length information
for zeroing up a sheath catheter and a guide catheter, and roll
correction information. For example, the computer system may use
the length information to initialize or configure the catheters for
use by adjusting the guide catheter with respect to the guide
catheter to ensure the catheters are zeroed up or that the guide
catheter is located in a predefined position relative to the sheath
catheter on the RCM. Similarly, the computer system may take the
roll correction information, and roll off the catheter if any of
the control wires are a bit offset or skewed, so that the catheter
is oriented in the proper predefined direction (i.e., the `up`
direction on the catheter is really up). The data of one embodiment
is gathered through bench testing during the manufacturing process
and programmed into the PROM. In alternative embodiments, the data
may have originated from a different part of the process. In one
implementation, the PROM may also include a unique identifier or a
code to prevent the catheter from being reused. The system of one
embodiment is designed to recognize whether a catheter is brand new
or whether it has already been used, and is capable of rejecting a
previously used catheter. For this embodiment, the catheter is
pre-tensioned through load sensing so that slack is removed from
the control wires. The catheters are then prepared to be
driven.
[0313] The sheath interface mounting plate 38 as illustrated in
FIGS. 6A and 6B is similar to the guide interface mounting plate
37, and thus, similar details are not repeated. One difference
between the plates 37, 38 may be the shape of the plates. For
example, the guide interface plate 37 includes a narrow, elongated
segment, which may be used with, for example, a dither mechanism.
Both plates 37, 38 include a plurality of openings 37a, 38a to
receive drive shafts 90 and latches 73,74 from splayers 61, 62,
respectively.
[0314] Referring back to FIG. 5C the instrument driver 16 is
illustrated with mounting plates 37,38 fixably coupled to a guide
carriage 50, and a sheath drive block 40, respectively. FIG. 8A
illustrates the guide carriage 50 removed from the instrument
driver 16 coupled to cabling 51 and associated guide motors 53.
[0315] The guide carriage 50 includes a funicular assembly 56 which
is illustrated in FIG. 8B. The funicular assembly 56 includes four
sleeve receptacles 56b. As previously described, the drive shafts
90 of the splayer 61 (such as that shown in FIG. 5B) first insert
through the openings 37a in the mounting plate 37. They then engage
with the sleeve receptacles 56b. FIGS. 9A-9B illustrate the shafts
90 of the splayer pulley assembly 61 engaging with the sleeve
receptacles (56b) in further detail. Referring back to FIG. 7C, the
drive shaft 90 has a flat edge 90a on one side of its cylindrical
surface such that when the drive shaft 90 is viewed along its
longitudinal axis, the shaft has the shape of a letter "D". It
should be understood that the drive shaft 90 may include other
cross-sectional shapes. The shaft 90 has an opening through which a
cross pin 90b may be located. The drive shaft 90 may be keyed such
that the shaft is designed to fit or be received within the
receiving sleeve 56b having a certain shape. The sleeve 56b in the
illustrated example includes a pair of V-shaped or wing shaped
notches 56c to receive and hold the pin 90b of a shaft 90 as the
shaft 90 is inserted into the sleeve 56b. In the illustrated
example, the sleeve 56b does not employ capture pins, although such
pins may be utilized.
[0316] Referring back to FIG. 8A, a set of cables 51 wound around a
set of pulleys 52, are coupled on one end to a set of guide motors
53 and the other end to the sleeve receptacles 56b. The drive
motors 53 are actuated to rotationally drive the sleeves 56b. A
catheter assembly 30 with its splayer 61 mounted onto the
instrument drive 16 would have its pulley assemblies 80 positioned
inside a plurality of corresponding sleeves 56b. As the sleeves 56b
are rotated, the pins 90b of the shafts 90 are seated in the
V-shaped notches 56c and are engaged by the rotating sleeves 56b,
thus causing the shafts 90 and associated pulley assemblies 80 to
also rotate. The pulley assemblies 80 in turn cause the control
elements (e.g., wires) coupled thereto to manipulate the distal tip
of the catheter instrument 30 member in response thereto. To remove
a splayer from the instrument driver in this implementation, less
force is needed as the V-shaped notches 56c allow for quick and
easy disengagement of the shafts 90 from the sleeves 56b.
[0317] FIGS. 10A and 10B illustrate perspective views of the sheath
block 40 and motor driven interfaces 42 which are coupled to sheath
articulation motors 43. The sheath articulation motors 43 are
coupled the motor driven interfaces 42 which includes a set of
belts, shafts, and gears which drive receptacle sleeves 56b (which
are similar in construction and functionality to the receptacle
sleeves previously described for the guide funicular assembly).
When the sheath splayer drive shafts 90 are coupled to the
receptacle sleeves 56b, the sheath articulation motors 43 drive the
receptacle sleeves 56b causing the sheath instrument 30 to
bend.
[0318] During use, the catheter instrument 18 is inserted within a
central lumen of the sheath instrument 30 such that the instruments
18, 30 are arranged in a coaxial manner as previously described.
Although the instruments 18, 30 are arranged coaxially, movement of
each instrument 18, 30 can be controlled and manipulated
independently. For this purpose, motors within the instrument
driver 16 are controlled such that the drive and sheath carriages
coupled to the mounting plates 37, 38 are driven forwards and
backwards independently on linear bearings each with leadscrew
actuation. FIG. 10 illustrates the sheath drive block 40 removed
from the instrument driver coupled to two independently-actuated
lead screw 45, 46 mechanisms driven by insert motors 47. Note only
the guide insert motor 47 is shown. The sheath insert motor is not
shown in FIG. 10. In the illustrated embodiment, the sheath
insertion motor is coupled to a drive or output shaft (not shown)
that is designed to move the sheath articulation assembly forwards
and backwards, thus sliding a mounted sheath catheter instrument 18
forwards and backwards. The insert motion of the guide carriage can
be actuated with a similar motorized leadscrew configuration.
[0319] Referring back to FIGS. 1, 2 and 6A, in order to accurately
steer a robotic sheath 62a or guide catheter 61a from an operator
work station 2, a control structure should be implemented which
allows a user to send commands through input devices such as the
pendant 8 or MID 12 that will result in desired motion of the
sheath 62a and guide 61a. FIGS. 11A-11H and 12-16 illustrate
examples of a control structure, which are described in further
detail in the applications previously incorporated by
reference.
[0320] The kinematic relationships for many catheter instrument
embodiments may be modeled by applying conventional mechanics
relationships. In summary, a control-element-steered catheter
instrument is controlled through a set of actuated inputs. In a
four-control-element catheter instrument, for example, there are
two degrees of motion actuation, pitch and yaw, which both have +
and -directions. Other motorized tension relationships may drive
other instruments, active tensioning, or insertion or roll of the
catheter instrument. The relationship between actuated inputs and
the catheter's end point position as a function of the actuated
inputs is referred to as the "kinematics" of the catheter.
[0321] Referring to FIGS. 11A-H, the basic kinematics of a catheter
120 with four control elements 122a, 122b, 122c, 122d is reviewed.
The catheter 120 may be component 61a or component 62a in some
embodiments. Referring to FIGS. 11A-B, as tension is placed only
upon the bottom control element 122c, the catheter bends downward,
as shown in FIG. 11A. Similarly, pulling the left control element
122d in FIGS. 11C-D bends the catheter left, pulling the right
control element 122b in FIGS. 11E-F bends the catheter right, and
pulling the top control element 122a in FIGS. 11G-H bends the
catheter up. As will be apparent to those skilled in the art,
well-known combinations of applied tension about the various
control elements results in a variety of bending configurations at
the tip of the catheter member 120. One of the challenges in
accurately controlling a catheter or similar elongate member with
tension control elements is the retention of tension in control
elements, which may not be the subject of the majority of the
tension loading applied in a particular desired bending
configuration. If a system or instrument is controlled with various
levels of tension, then losing tension, or having a control element
in a slack configuration, can result in an unfavorable control
scenario. As previously described, each of these control elements
or pull wires can be wound around a pulley which is motor actuated
within the instrument driver. Maintaining adequate tension with
these pulleys can be important for accurate catheter control.
[0322] FIG. 12 illustrates one example of a control flow for basic
catheter control. The operator enters a command to designate a
desired tip position for the device via some input mechanism (a
master input device, computer software, or other user interface,
etc.). Next, one or more inverse kinematic algorithms compute a
desired catheter configuration in order to achieve the commanded
tip position. The inverse kinematic algorithm can be varied
depending on the construction of the shapeable device. The desired
catheter configuration is then fed to one or more catheter
mechanics algorithm to compute the positioning element
displacements necessary to achieve the desired catheter
configuration. These positioning element commands are then provided
to the robots control algorithms (or in some cases actuators in the
robot that interface with positioning elements in the shapeable
element).
[0323] Based upon the applied positioning element displacements,
the actual (physical) catheter mechanics including any constraints
and obstructions acting on the catheter determine the real
configuration or shape that the shapeable device achieves. This is
illustrated on the right (slave/actual) side of FIG. 12. This real
catheter configuration/shape determines the real catheter tip
position. These kinematic relationships of the physical device are
represented in the figure with a forward kinematics block 124.
Assuming that the operator is observing the catheter tip through
some sort of visualization (fluoro, endoscopy, etc), the operator
can then use this visual feedback to make corrections to the
commanded tip position.
[0324] Referring to FIG. 13, the "forward kinematics" expresses the
catheter's end-point position as a function of the actuated inputs
while the "inverse kinematics" expresses the actuated inputs as a
function of the desired end-point position. In certain embodiments,
accurate mathematical models of the forward and inverse kinematics
are useful for the control of a robotically controlled catheter
system. For clarity, the kinematics equations are further refined
to separate out common elements, as shown in FIG. 13. The basic
kinematics describes the relationship between the task coordinates
and the joint coordinates. In such case, the task coordinates refer
to the position of the catheter end-point while the joint
coordinates refer to the bending (pitch and yaw, for example) and
length of the active catheter. The actuator kinematics describes
the relationship between the actuation coordinates and the joint
coordinates. The task, joint, and bending actuation coordinates for
the robotic catheter are illustrated in FIG. 14. By describing the
kinematics in this way we can separate out the kinematics
associated with the catheter structure, namely the basic
kinematics, from those associated with the actuation
methodology.
[0325] An inverse kinematic model translates intended device motion
into the commands that will adjust the actuator and/or control
element to position the shapeable instrument as desired. Referring
back to FIG. 12, the shapeable instrument kinematics are the
mathematical relationships between the task space description of
the instrument (e.g., tip position) and the configuration space
description of the instrument (e.g., shape). Specifically, the
inverse kinematics (task to configuration space) are used as part
of the chain that translates desired tip positions into actuator
commands (leading to displacements of the control elements) that
move tip position of the actual device for reaching a desired tip
position.
[0326] These inverse kinematic algorithms are derived based upon
certain assumptions about how the shapeable instrument moves.
Examples of these assumptions may include, but are not limited to:
1) Each catheter segment bends in a constant curvature arc; 2) Each
catheter segment bends within a single plane; 3) Some catheter
segments have fixed (constant) lengths; 4) Some catheter segments
have variable (controllable) lengths.
[0327] In one variation, the development of the catheter's
kinematics model is derived using a few assumptions. In one
example, the included are assumptions that the catheter structure
is approximated as a simple beam in bending from a mechanics
perspective, and that control elements, such as thin tension wires,
remain at a fixed distance from the neutral axis and thus impart a
uniform moment along the length of the catheter.
[0328] In addition to the above assumptions, the geometry and
variables shown in FIGS. 14 and 15 are used in the derivation of
the forward and inverse kinematics. The basic forward kinematics,
relating the catheter task coordinates X.sub.c, Y.sub.c, Z.sub.c)
to the joint coordinates (.phi..sub.yaw, .phi..sub.pitch, L), is
given as follows:
[0329] X.sub.c=.omega. cos(.theta.)
[0330] Y.sub.c=R sin(.alpha.)
[0331] Z.sub.c=.omega. sin(.theta.)
Where
[0332] w=R(1-cos(.alpha.))
.alpha.=[(.phi..sub.pitch).sup.2+(.phi..sub.yaw).sup.2].sup.1/2(total
bending)
R = L .alpha. ( bend radius ) ##EQU00001## .theta.=a tan
2(.phi..sub.pitch,.phi..sub.yaw)(roll angle)
[0333] The actuator forward kinematics, relating the joint
coordinates (.phi..sub.yaw, .phi..sub.pitch, L) to the actuator
coordinates (.DELTA.L.sub.x,.DELTA.L.sub.z,L) is given as
follows:
.phi..sub.pitch=(2.DELTA.L.sub.2)/D.sub.c
.phi. yaw = 2 .DELTA. L x D c ##EQU00002##
[0334] As illustrated in FIG. 13, the catheter's end-point position
can be predicted given the joint or actuation coordinates by using
the forward kinematics equations described above.
[0335] Calculation of the catheter's actuated inputs as a function
of end-point position, referred to as the inverse kinematics, can
be performed numerically, using a nonlinear equation solver such as
Newton-Raphson. In another approach, shown in the illustrative
embodiment, is to develop a closed-form solution which can be used
to calculate the required actuated inputs directly from the desired
end-point positions.
[0336] As with the forward kinematics, we separate the inverse
kinematics into the basic inverse kinematics, which relates joint
coordinates to the task coordinates, and the actuation inverse
kinematics, which relates the actuation coordinates to the joint
coordinates. The basic inverse kinematics, relating the joint
coordinates (.phi..sub.yaw, .phi..sub.pitch, L), to the catheter
task coordinates (Xc, Yc, Zc) is given as follows:
.phi..sub.pitch=.alpha. sin(.theta.)
.phi..sub.yaw=.alpha. cos(.theta.)
L=R.alpha.
.fwdarw. where .fwdarw. .fwdarw. .theta. = a tan 2 ( Z c , X c ) R
= l sin .beta. sin 2 .beta. .alpha. = .pi. - 2 .beta. .fwdarw.
.beta. = a tan 2 ( Y c , W c ) W c = ( X c 2 + Z c 2 ) 1 / 2 l = (
W c 2 + Y c 2 ) 1 / 2 ##EQU00003##
[0337] The actuator inverse kinematics, relating the actuator
coordinates (.DELTA.L.sub.x,.DELTA.L.sub.z,L) to the joint
coordinates (.phi..sub.yaw, .phi..sub.pitch, L) is given as
follows:
.DELTA. L x = D c .phi. yaw 2 ##EQU00004## .DELTA. L z = D c .phi.
pitch 2 ##EQU00004.2##
[0338] In one embodiment, the catheter (or other shapeable
instrument) is controlled in an open-loop manner as shown in FIG.
16. In this type of open loop control model, the shape
configuration command comes in to the beam mechanics, is translated
to beam moments and forces, then is translated to tendon tensions
given the actuator geometry, and finally into tendon displacement
given the entire deformed geometry. However, there are numerous
reasons why the assumed motion of the catheter may not match the
actual motion of the catheter. One important factor is the presence
of unanticipated or unmodeled constraints imposed by the patient's
anatomy.
[0339] Accordingly, a control system that directs catheters or
shapeable instruments can command joint configurations that can
achieve a desired tip position. However, the presence of modeling
inaccuracies and environment interaction causes a differential
between the actual position from that intended. A simple tip
position can quantify this error, but addressing the source of the
error requires the additional information regarding the shapeable
instrument. Data defining the actual or real shape of the
instrument can provide much of this information.
[0340] The term "localization" is used in the art in reference to
systems for determining and/or monitoring the position of objects,
such as medical instruments, in a reference coordinate system. In
one embodiment, the instrument localization software is a
proprietary module packaged with an off-the-shelf or custom
instrument position tracking system, which may be capable of
providing not only real-time or near real-time positional
information, such as X-Y-Z coordinates in a Cartesian coordinate
system, but also orientation information relative to a given
coordinate axis or system. For example, such systems can employ an
electromagnetic based system (e.g., using electromagnetic coils
inside a device or catheter body). Other systems utilize potential
difference or voltage, as measured between a conductive sensor
located on the pertinent instrument and conductive portions of sets
of patches placed against the skin, to determine position and/or
orientation. In another similar embodiment, one or more conductive
rings may be electronically connected to a
potential-difference-based localization/orientation system, along
with multiple sets, preferably three sets, of conductive skin
patches, to provide localization and/or orientation data.
Additionally, "Fiberoptic Bragg grating" ("FBG") sensors may be
used to not only determine position and orientation data but also
shape data along the entire length of a catheter or shapeable
instrument.
[0341] In other embodiments not comprising a localization system to
determine the position of various components, kinematic and/or
geometric relationships between various components of the system
may be utilized to predict the position of one component relative
to the position of another. Some embodiments may utilize both
localization data and kinematic and/or geometric relationships to
determine the positions of various components. The use of
localization and shape technology is disclosed in detail in U.S.
patent application Ser. Nos. 11/690,116, 11/176,598, 12/012,795,
12/106,254, 12/507,727, 12/822,876, 12/823,012, and 12/823,032, the
entirety of all of which is incorporated by reference herein for
all purposes.
[0342] To accurately coordinate and control actuations of various
motors within an instrument driver from a remote operator control
station such as that depicted in FIG. 1, an advanced computerized
control and visualization system is preferred. The control system
embodiments that follow are described in reference to a particular
control systems interface, namely the SimuLink.TM. and XPC.TM.
control interfaces available from The Mathworks Inc., and PC-based
computerized hardware configurations. However, one of ordinary
skilled in the art having the benefit of this disclosure would
appreciate that many other control system configurations may be
utilized, which may include various pieces of specialized hardware,
in place of more flexible software controls running on one or more
computer systems.
[0343] Referring to FIG. 17, an overview of an embodiment of a
controls system flow is depicted. A master computer 400 running
master input device software, visualization software, instrument
localization software, and software to interface with operator
control station buttons and/or switches is depicted. In one
embodiment, the master input device software is a proprietary
module packaged with an off-the-shelf master input device system,
such as the Phantom.TM. from Sensible Devices Corporation, which is
configured to communicate with the Phantom.TM. hardware at a
relatively high frequency as prescribed by the manufacturer. Other
suitable master input devices, such as the master input device 12
depicted in FIG. 2 are available from suppliers such as Force
Dimension of Lausanne, Switzerland. The master input device 12 may
also have haptics capability to facilitate feedback to the
operator, and the software modules pertinent to such functionality
may also be operated on the master computer 126.
[0344] Referring to FIG. 17, in one embodiment, visualization
software runs on the master computer 126 to facilitate real-time
driving and navigation of one or more steerable instruments. In one
embodiment, visualization software provides an operator at an
operator control station, such as that depicted in FIG. 2, with a
digitized "dashboard" or "windshield" display to enhance
instinctive drivability of the pertinent instrumentation within the
pertinent tissue structures. Referring to FIG. 18, a simple
illustration is useful to explain one embodiment of a preferred
relationship between visualization and navigation with a master
input device 12. In the depicted embodiment, two display views 142,
144 are shown. One preferably represents a primary 142 navigation
view, and one may represent a secondary 144 navigation view. To
facilitate instinctive operation of the system, it is preferable to
have the master input device coordinate system at least
approximately synchronized with the coordinate system of at least
one of the two views. Further, it is preferable to provide the
operator with one or more secondary views which may be helpful in
navigating through challenging tissue structure pathways and
geometries.
[0345] Referring still to FIG. 18, if an operator is attempting to
navigate a steerable catheter in order to, for example, contact a
particular tissue location with the catheter's distal tip, a useful
primary navigation view 142 may comprise a three dimensional
digital model of the pertinent tissue structures 146 through which
the operator is navigating the catheter with the master input
device 12, along with a representation of the catheter distal tip
location 148 as viewed along the longitudinal axis of the catheter
near the distal tip. This embodiment illustrates a representation
of a targeted tissue structure location 150, which may be desired
in addition to the tissue digital model 146 information. A useful
secondary view 144, displayed upon a different monitor, in a
different window upon the same monitor, or within the same user
interface window, for example, comprises an orthogonal view
depicting the catheter tip representation 148, and also perhaps a
catheter body representation 152, to facilitate the operator's
driving of the catheter tip toward the desired targeted tissue
location 150.
[0346] In one embodiment, subsequent to development and display of
a digital model of pertinent tissue structures, an operator may
select one primary and at least one secondary view to facilitate
navigation of the instrumentation. By selecting which view is a
primary view, the user can automatically toggle a master input
device 12 coordinate system to synchronize with the selected
primary view. In an embodiment with the leftmost depicted view 142
selected as the primary view, to navigate toward the targeted
tissue site 150, the operator should manipulate the master input
device 12 forward, to the right, and down. The right view will
provide valued navigation information, but will not be as
instinctive from a "driving" perspective.
[0347] To illustrate: if the operator wishes to insert the catheter
tip toward the targeted tissue site 150 watching only the rightmost
view 144 without the master input device 12 coordinate system
synchronized with such view, the operator would have to remember
that pushing straight ahead on the master input device will make
the distal tip representation 148 move to the right on the
rightmost display 144. Should the operator decide to toggle the
system to use the rightmost view 144 as the primary navigation
view, the coordinate system of the master input device 12 is then
synchronized with that of the rightmost view 144, enabling the
operator to move the catheter tip 148 closer to the desired
targeted tissue location 150 by manipulating the master input
device 12 down and to the right. The synchronization of coordinate
systems may be conducted using fairly conventional mathematic
relationships which are described in detail in the aforementioned
applications incorporated by reference.
[0348] Referring back to embodiment of FIG. 17, the master computer
126 also comprises software and hardware interfaces to operator
control station buttons, switches, and other input devices which
may be utilized, for example, to "freeze" the system by
functionally disengaging the master input device as a controls
input, or provide toggling between various scaling ratios desired
by the operator for manipulated inputs at the master input device
12. The master computer 126 has two separate functional connections
with the control and instrument driver computer 128: one connection
132 for passing controls and visualization related commands, such
as desired XYZ (in the catheter coordinate system) commands, and
one connection 134 for passing safety signal commands. Similarly,
the control and instrument driver computer 128 has two separate
functional connections with the instrument and instrument driver
hardware 130: one connection 136 for passing control and
visualization related commands such as required-torque-related
voltages to the amplifiers to drive the motors and encoders, and
one connection 138 for passing safety signal commands.
[0349] Also shown in the signal flow overview of FIG. 17 is a
pathway 140 between the physical instrument and instrument driver
hardware 130 back to the master computer 126 to depict a closed
loop system embodiment wherein instrument localization technology,
previously described, is utilized to determine the actual position
of the instrument to minimize navigation and control error, as
described in further detail below.
[0350] FIGS. 19A-K depict various aspects of one embodiment of a
SimuLink.TM. software control schema for an embodiment of the
physical system, with particular attention to an embodiment of a
"master following mode." In this embodiment, an instrument is
driven by following instructions from a master input device, and a
motor servo loop embodiment, which comprises key operational
functionality for executing upon commands delivered from the master
following mode to actuate the instrument.
[0351] FIG. 19 depicts a high-level view of an embodiment wherein
any one of three modes may be toggled to operate the primary servo
loop 154. In idle mode 156, the default mode when the system is
started up, all of the motors are commanded via the motor servo
loop 154 to servo about their current positions, their positions
being monitored with digital encoders associated with the motors.
In other words, idle mode 156 deactivates the motors, while the
remaining system stays active. Thus, when the operator leaves idle
mode, the system knows the position of the relative components. In
auto home mode 158, cable loops within an associated instrument
driver, such as that depicted in FIG. 5A-5C, are centered within
their cable loop range to ensure substantially equivalent range of
motion of an associated instrument in both directions for a various
degree of freedom, such as + and - directions of pitch or yaw, when
loaded upon the instrument driver. This is a setup mode for
preparing an instrument driver before an instrument is engaged.
[0352] In master following mode 160, the control system receives
signals from the master input device, and in a closed loop
embodiment from both a master input device and a localization
system, and forwards drive signals to the primary servo loop 154 to
actuate the instrument in accordance with the forwarded commands.
Aspects of the primary servo loop and motor servo block 162 are
depicted in further detail in FIGS. 20-23.
[0353] Referring to FIG. 24, a more detailed functional diagram of
an embodiment of master following mode 160 is depicted. As shown in
FIG. 24, the inputs to functional block 170 are XYZ position of the
master input device in the coordinate system of the master input
device which, per a setting in the software of the master input
device may be aligned to have the same coordinate system as the
catheter, and localization XYZ position of the distal tip of the
instrument as measured by the localization system in the same
coordinate system as the master input device and catheter.
Referring to FIG. 25 for a more detailed view of functional block
170 of FIG. 24, a switch 186 is provided to allow switching between
master inputs for desired catheter position, to an input interface
188 through which an operator may command that the instrument go to
a particular XYZ location in space. Various controls features may
also utilize this interface to provide an operator with, for
example, a menu of destinations to which the system should
automatically drive an instrument, etc. Also depicted in FIG. 25 is
a master scaling functional block 184 which is utilized to scale
the inputs coming from the master input device with a ratio
selectable by the operator. The command switch 186 functionality
includes a low pass filter to weight commands switching between the
master input device and the input interface 188, to ensure a smooth
transition between these modes.
[0354] Referring back to FIG. 24, desired position data in XYZ
terms is passed to the inverse kinematics block 174 for conversion
to pitch, yaw, and extension (or "insertion") terms in accordance
with the predicted mechanics of materials relationships inherent in
the mechanical design of the instrument. The pitch, yaw, and
extension commands are passed from the inverse kinematics 174 to a
position control block 172 along with measured localization data.
FIG. 29 provides a more detailed view of the position control block
172. After measured XYZ position data comes in from the
localization system, it goes through a inverse kinematics block 189
to calculate the pitch, yaw, and extension the instrument needs to
have in order to travel to where it needs to be. Comparing 191
these values with filtered desired pitch, yaw, and extension data
from the master input device, integral compensation is then
conducted with limits on pitch and yaw to integrate away the error.
In this embodiment, the extension variable does not have the same
limits 193, as do pitch and yaw 195. As will be apparent to those
skilled in the art, having an integrator in a negative feedback
loop forces the error to zero. Returning to FIG. 24, desired pitch,
yaw, and extension commands are next passed through a catheter
workspace limitation 176, which may be a function of the
experimentally determined physical limits of the instrument beyond
which componentry may fail, deform undesirably, or perform
unpredictably or undesirably. This workspace limitation defines a
volume similar to a cardioid-shaped volume about the distal end of
the instrument. Desired pitch, yaw, and extension commands, limited
by the workspace limitation block, are then passed to a catheter
roll correction block 178.
[0355] This functional block is depicted in further detail in FIG.
26, and comprises a rotation matrix for transforming the pitch,
yaw, and extension commands about the longitudinal, or "roll", axis
of the instrument--to calibrate the control system for rotational
deflection at the distal tip of the catheter that may change the
control element steering dynamics. For example, if a catheter has
no rotational deflection, pulling on a control element located
directly up at twelve o'clock should urge the distal tip of the
instrument upward. If, however, the distal tip of the catheter has
been rotationally deflected by, say, ninety degrees clockwise, to
get an upward response from the catheter, it may be necessary to
tension the control element that was originally positioned at a
nine o'clock position. The catheter roll correction schema depicted
in FIG. 26 provides a means for using a rotation matrix to make
such a transformation, subject to a roll correction angle, such as
the ninety degrees in the above example, which is input, passed
through a low pass filter, turned to radians, and put through
rotation matrix calculations.
[0356] In one embodiment, the roll correction angle is determined
through experimental experience with a particular instrument and
path of navigation. In another embodiment, the roll correction
angle may be determined experimentally in-situ using the accurate
orientation data available from the preferred localization systems.
In other words, with such an embodiment, a command to, for example,
bend straight up can be executed, and a localization system can be
utilized to determine at which angle the defection actually
went--to simply determine the in-situ roll correction angle.
[0357] Referring briefly back to FIG. 24, roll corrected pitch and
yaw commands, as well as unaffected extension commands, are output
from the roll correction block 178 and may optionally be passed to
a conventional velocity limitation block 180. Referring to FIG. 27,
pitch and yaw commands are converted from radians to degrees, and
automatically controlled roll may enter the controls picture to
complete the current desired position 190 from the last servo
cycle. Velocity is calculated by comparing the desired position
from the previous servo cycle, as calculated with a conventional
memory block (192) calculation, with that of the incoming commanded
cycle. A conventional saturation block 187 keeps the calculated
velocity within specified values, and the velocity-limited command
194 is converted back to radians and passed to a tension control
block 182.
[0358] Tension within control elements may be managed depending
upon the particular instrument embodiment, as described above in
reference to the various instrument embodiments and tension control
mechanisms. As an example, FIG. 28 depicts a pre-tensioning block
196 with which a given control element tension is ramped to a
present value. An adjustment is then added to the original
pre-tensioning based upon a preferably experimentally-tuned matrix
pertinent to variables, such as the failure limits of the
instrument construct and the incoming velocity-limited pitch, yaw,
extension, and roll commands. This adjusted value is then added 198
to the original signal for output, via gear ratio adjustment, to
calculate desired motor rotation commands for the various motors
involved with the instrument movement. In this embodiment,
extension, roll, and sheath instrument actuation 199 have no
pre-tensioning algorithms associated with their control. The output
is then complete from the master following mode functionality, and
this output is passed to the primary servo loop 154.
[0359] Referring back to FIG. 19, incoming desired motor rotation
commands from either the master following mode 160, auto home mode
158, or idle mode 156 in the depicted embodiment are fed into a
motor servo block 162, which is depicted in greater detail in FIGS.
20-23.
[0360] Referring to FIG. 20, incoming measured motor rotation data
from digital encoders and incoming desired motor rotation commands
are filtered using conventional quantization noise filtration 164
at frequencies selected for each of the incoming data streams to
reduce noise while not adding undue delays which may affect the
stability of the control system. As shown in FIGS. 22 and 23,
conventional quantization filtration is utilized on the measured
motor rotation signals at about 200 hertz in this embodiment, and
on the desired motor rotation command at about 15 hertz. The
difference 166 between the quantization filtered values forms the
position error which may be passed through a lead filter, the
functional equivalent of a proportional derivative ("PD")+low pass
filter. In another embodiment, conventional PID, lead/lag, or state
space representation filter may be utilized. The lead filter of the
depicted embodiment is shown in further detail in FIG. 21.
[0361] In particular, the lead filter embodiment in FIG. 21
comprises a variety of constants selected to tune the system to
achieve desired performance. The depicted filter addresses the
needs of one embodiment of a 4-control element guide catheter
instrument with independent control of each of four control element
interface assemblies for .+-.pitch and .+-.yaw, and separate roll
and extension control. As demonstrated in the depicted embodiment,
insertion and roll have different inertia and dynamics as opposed
to pitch and yaw controls, and the constants selected to tune them
is different. The filter constants may be theoretically calculated
using conventional techniques and tuned by experimental techniques,
or wholly determined by experimental techniques, such as setting
the constants to give a sixty degree or more phase margin for
stability and speed of response, a conventional phase margin value
for medical control systems.
[0362] In an embodiment where a tuned master following mode is
paired with a tuned primary servo loop, an instrument and
instrument driver, such as those described above, may be "driven"
accurately in three-dimensions with a remotely located master input
device. Other preferred embodiments incorporate related
functionalities, such as haptic feedback to the operator, active
tensioning with a split carriage instrument driver, navigation
utilizing direct visualization and/or tissue models acquired
in-situ and tissue contact sensing, and enhanced navigation
logic.
[0363] I-A. Insertion Force Indicator
[0364] Referring to FIGS. 30-31, a further embodiment is directed
systems and methods for indicating catheter 61a insertion forces.
When the guide catheter 61a extends from the sheath 62a and makes
contact with tissue, a certain force F is imparted onto the guide
catheter 61a. Depending on how far the distal tip 92 of the guide
catheter 61a is extended from the sheath 62a, the force F may
result in different interactions between the guide catheter 61a and
tissue.
[0365] In one variation as illustrated in FIG. 30, a length L.sub.1
of the guide catheter instrument 61a extends beyond the distal tip
91 of the sheath 62a. As the distal tip 92 of the guide catheter
61a makes contact with tissue with a force F, an equal and opposite
force F is imparted to the guide catheter instrument 61a
(represented by arrow F). Depending upon the magnitude of the force
F, a portion of the guide catheter 61a, e.g., adjacent to the
distal tip 92, may be caused to bend, flex or buckle under the
force F, thereby reducing the force exerted on the tissue.
[0366] FIG. 31 illustrates a guide catheter 61a that extends a
shorter length L.sub.2 beyond the distal tip 91 of the sheath 62a.
In this example, when the distal tip 92 of the guide catheter 61a
makes contact with tissue with the same force F, the shorter length
L2 reduces or eliminates flexing since the distal portion of the
guide catheter 61a is reinforced by the distal end of the stiffer
sheath 62a, resulting in a larger force F that is applied to the
tissue due to less flexing.
[0367] In one system (S), motors of the instrument driver 16 are
controlled to robotically control and manipulate catheter
instruments 18. The amount of current supplied to the motor is
proportionally related to the amount of torque generated by the
motors and catheter 18 insertion force is proportional to the motor
torque. Thus, the motor current is proportional to the insertion
force. If the motors are driven by the same amount of current
regardless of how far the guide catheter 61a extends out from the
sheath 62a, the force imparted on the tissue at the contact point
may differ based on length L. For example, if a high motor current
causes a high insertion force for a guide catheter 61a extending
length L.sub.1, the catheter 61a may dissipate a portion of that
force due to flexing or bending. However, when the guide catheter
61a extends a much smaller length L.sub.2, it may not yield, and
the insertion force is not attenuated. In one embodiment, a
kinematic model of the instrument configuration may be utilized, in
concert with sensed motor torques at driveshafts within the
instrument driver, to calculate, or "back out", the loads and
vectors thereof that are theoretically applied to the distal end of
the instrument, or other portion of the instrument in contact with
an external load-applying structure.
[0368] In one embodiment, a system (S) may be configured to
generate a visual or audible warning message to a user, control
element or processor indicating that corrective action is required
and/or to indicate a possibility of high insertion forces exerted
to tissue at the distal tip 92. In one embodiment, a warning
message is displayed when length L is less than a minimum length
L.sub.min and/or the motor current I is greater than I.sub.max. For
example, the minimum length L.sub.min may be about 30 mm or less,
and the maximum motor current I.sub.max may be about 250 mA or
higher current levels. In cases in which the length or motor
current exceeds these pre-determined values, the operator may
adjust the motor current accordingly or proceed carefully to avoid
causing injury. This type of force indication message may be useful
for instrument driver 16 that do not have force sensing
capabilities.
[0369] I-B. Reachability/Viewability
[0370] Another alternative embodiment is directed to methods and
systems for assessing reachability and viewability at a particular
location. More particularly, embodiments advantageously assess
locations within the body that can be reached by a catheter
instrument 18 of the system (S), as well as assessing the
viewability or field of view at a particular location that can be
reached by the catheter instrument 18. This ability is particularly
significant since the field of view at a particular location may
not be desirable even if it is reachable. Thus, embodiments
advantageously assess field of view at reachable locations in order
to provide more meaningful surgical planning and results.
[0371] For example, in the context of cardiac surgery utilizing an
intracardiac (ICE) catheter. During the planning stage, an operator
can determine offline before a procedure where a catheter should be
driven to provide for a desired field of view that allows a region
of interest to be scanned. Alternatively, a previously acquired CT
model may be registered and fused with real time ultrasound data
during a surgical procedure. During use, embodiments allow the ICE
catheter to be driven to a position within the heart with a desired
or optimum field of view for scanning of, e.g., the left atrium, or
another internal tissue or segment thereof that is of interest.
[0372] Referring to FIG. 32, in one embodiment, a robotic medical
system includes an outer sheath 62a with a working lumen, and an
inner guide catheter 61a extending through the sheath lumen, with a
distal end portion of the guide catheter 61a extending out a distal
end opening of the sheath 62a in an anatomic workspace 116 in a
body. An intracardiac (ICE) ultrasound imaging catheter 112 is
positioned in a working lumen of the guide catheter 61a, with a
distal end portion of the ICE catheter 112 extending out a distal
end opening of the guide catheter 61a. The ICE catheter 112 may be
extended out of, and retracted into, respectively, the distal end
opening in the guide catheter 61a, as indicated by arrow 115A, and
may be rotated about its longitudinal axis, as indicated by arrow
115B, such that a transducer array 113 on the ICE catheter 112 is
positionable within the anatomic workspace 116 to capture
ultrasound images within a field of view 114 of the array 113. The
depicted ICE catheter 112 comprises a substantially linear array
113 defining a field of view 114 having a substantially trapezoidal
shape; ICE catheters with such configurations are available from
suppliers such as the Ultrasound division of Siemens AG under the
tradename AcuNav.TM.. In other embodiments, substantially
circular/disc shaped fields of view may be created utilizing an
ultrasound transducer configuration which may be rotated along with
a portion of the ICE catheter with a drive shaft, as in the ICE
catheters available from Boston Scientific, or utilizing multiple
ultrasound transducers placed circumferentially around a catheter
body, as in the ultrasound imaging catheters available from Volcano
Corporation. For illustrative purposes, FIG. 32 depicts a linear
array, AcuNav.TM. type configuration--but each of the
aforementioned other configurations may be similarly employed.
[0373] Depending on factors such as the anatomical boundaries and
tissue structures in the anatomical workspace 116, and the relative
positions and prior trajectories of the sheath 62a, guide catheter
61a, and ICE catheter 112 within the workspace 116, the system
controller (not shown in FIG. 32) can model the potential relative
movement the respective sheath 62a, guide 61a, and ICE catheter
112, and thus the potential movement of the field of view 114 of
the transducer array 113 within the work space 116. In particular,
certain tissue walls and/or structures within the anatomic
workspace 116 can be readily imaged (or "viewable") by the ICE
transducer 113 without requiring anything more than a relatively
simple repositioning of the respective sheath 62a, guide 61a, and
ICE catheter 112, respectively, such as tissue structure 117 in
FIG. 21. Other tissue wall locations and/or structures may be
viewable, but only by more complicated maneuvering techniques,
including iterative movements of one or more of the sheath 62a,
guide 61a, and/or ICE catheter 112, respectively, in order to
position the transducer 113 and field of view 114, such as tissue
structure 118 in FIG. 32. Still further tissue wall locations
and/or structures may be difficult or impossible to capture within
the field of view 114 of the ICE transducer 113 without a major
repositioning of the collective instruments (sheath 62a, guide 61a,
ICE catheter 112), if at all.
[0374] This "ICE viewability" analysis may be useful for both
pre-operative planning, and during a procedure, wherein the robotic
system controller is configured to determine a respective reach of
the distal end portion of the ICE catheter 112, and thus the
potential fields of view 114 that may be captured by the transducer
array 113 within the anatomical workspace 116, based at least in
part upon a planned or a present relative position of the
respective sheath 62a, guide 61a, and ICE catheter 112 instruments.
By way of non-limiting examples, the controller may determine the
viewability of the various anatomic wall surfaces and/or tissue
structures based at least in part on a kinematic model of one or
both of the sheath and guide catheter instruments 62a and 61a.
Further, the controller may display the possible field of views,
viewable tissue walls and/or structures, or both, overlaying an
image of the anatomic workspace on a display associated with the
robotic system, wherein the image of the anatomic workspace is
obtained from a model of the workspace, from an imaging system, or
both.
[0375] While various embodiments haven been described herein, such
disclosure is provided for purposes explanation and illustration.
Further, various embodiments may be used in combination with other
embodiments. Additionally, although certain embodiments are
described with reference to particular dimensions or parameters, it
should be understood that these dimensions and parameters are
provided for purposes of explanation, and that other dimensions and
parameters may also be utilized.
[0376] Embodiments and instruments of robotic systems (S) may be
used in various minimally invasive surgical procedures that involve
different types of tissue including heart, bladder and lung tissue,
for example. Depending on the procedure, distal portions of various
instruments may not be easily visible to the naked eye. Various
imaging modalities including magnetic resonance (MR), ultrasound,
computer tomography (CT), X-ray, fluoroscopy, etc. may be used for
this purpose to visualize the surgical procedure and location of
instruments. Further, it may be desirable to know the precise
location of a given catheter instrument and/or working tool at any
given moment to avoid undesirable contacts or movements. For this
purpose, one or more localization techniques that are presently
available may be applied to any of the apparatuses and methods
disclosed above. For example, one or more localization coils may be
built into a flexible catheter instrument. In other
implementations, a localization technique using radio-opaque
markers may be used with embodiments of the present invention.
Similarly, a fiber optic Bragg sensing fiber may be built into the
sidewall of a catheter instrument to sense position and
temperature. Embodiments may also be implemented in systems that
include a plurality of sensors, including those for sensing patient
vitals, temperature, pressure, fluid flow, force, etc., may be
combined with the various embodiments of flexible catheters and
distal orientation platforms disclosed herein.
[0377] Embodiments of flexible catheters and other related
instruments used in a robotic surgical system may be made of
various materials, including materials and associated techniques
that are the same as or similar to those described in U.S. patent
application Ser. No. 11/176,598, the contents of which were
previously incorporated by reference. For example, suitable
materials may include stainless steel, copper, aluminum,
nickel-titanium alloy (Nitinol), Flexinol.TM. (available from Toki
of Japan), titanium, platinum, iridium, tungsten, nickel-chromium,
silver, gold, and combinations thereof, may be used to manufacture
parts such as control elements, control cables, spine elements,
gears, plates, ball units, wires, springs, electrodes,
thermocouples, etc. Similarly, non-metallic materials including,
but not limited to, polypropylene, polyurethane (Pebax.TM.), nylon,
polyethylene, polycarbonate, Delrin.TM., polyester, Kevlar.TM.,
carbon, ceramic, silicone, Kapton.TM. polyimide, Teflon.TM.
coating, polytetrafluoroethylene (PTFE), plastic (non-porous or
porous), latex, polymer, etc. may be used to make the various parts
of a catheter and other system components.
[0378] Further, although embodiments are describe with reference to
a catheter in the form of a guide catheter and working instruments,
it is also contemplated that one or more lumens of catheters may be
used to deliver fluids such as saline, water, carbon dioxide,
nitrogen, helium, for example, in a gaseous or liquid state, to the
distal tip. Furthermore, it is contemplated that some embodiments
may be implemented with a open loop or closed loop cooling system
wherein a fluid is passed through one or more lumens in the
sidewall of the catheter instrument to cool the catheter or a tool
at the distal tip.
[0379] Further, although various embodiments are described with
reference to a sheath and/or a guide catheter having four control
elements or pull wires, it may be desirable to have a guide
instrument with different numbers of control elements, e.g., less
than four control elements. Further, although certain embodiments
are described with reference to a guide catheter in combination
with a steerable sheath, other embodiments may be implemented in
systems that include a guide catheter (or other catheter) in
combination with a pre-bent, unsteerable sheath, or perhaps with no
sheath at all. Further, embodiments described above may be utilized
with manually or robotically steerable instruments, such as those
described in U.S. patent application Ser. No. 11/481,433,
incorporated herein by reference. The instrument driver can be
configured and adapted to meet the needs of different system and
instrument configurations, e.g., using different numbers of motors
and gearboxes for driving control elements, or variation in the
configuration for actuating a given control element interface
assembly, and associated variation in the tensioning mechanism and
number of control element pulleys associated with the pertinent
control element interface assembly (one pulley and one cable per
control element interface assembly, two pulleys and two cables per
control element interface assembly, slotted, split carriage, and
winged split carriage embodiments, various tensioning embodiments,
etc.
[0380] II. Catheter
[0381] FIG. 33A illustrates a cross-sectional view of a section or
portion of a flexible and steerable elongate instrument or catheter
300 of an instrument assembly in accordance with some embodiments.
The catheter 300 may be coupled to the drivable assembly 182 in
some embodiments. The steerable elongate instrument 300 may be
substantially pliable or flexible such that when it is advanced
into a patient, an operator or surgeon may easily manipulate the
instrument 300 to conform, adopt, or match the shape or curvatures
of the internal pathways (e.g., gastrointestinal tract, blood
vessels, etc.) of the patient. As illustrated, the flexible and
steerable elongate instrument or catheter 300 may be comprised of
multiple layers of materials and/or multiple tube structures. For
example, the elongate instrument 300 may include an outer layer or
outer tube 302, a main lumen, primary lumen, or central lumen 318
defined by an inner layer or inner tube 312, and minor, secondary,
or peripheral lumens incorporated in the body of the elongate
instrument 300 substantially between the outer layer 302 and the
inner layer 312 where operational tubes 304, flexible tubes 306,
push tubes 308, and support tubes 310 are disposed or contained.
The lumen 318 may be used to deliver one or more surgical
instruments or tools from the proximal portion of the elongate
instrument 300 to the distal portion of the elongate instrument 300
where they may be positioned and used to treat a target tissue
structure inside a patient. The outer layer or outer tube 302 and
the inner layer or inner tube 312 may be made of any flexible,
pliable, or suitable polymer material or bio-compatible polymer
material (e.g., nylon-12, Pebax.RTM., Pellathane, Polycarbonate,
etc.) or braided plastic composite structure. In some embodiments,
outer layer or outer tube 302 and the inner layer or inner tube 312
may be one layer of material or one tube structure instead of
separate layers of material or separate tube structures.
Operational tubes 304 may not be actual tubes but may be the minor,
secondary, or peripheral lumens or channels through the body of the
outer layer or outer tube 302 or the operational tubes 304 may be
separate operational tube structures that are disposed inside the
minor, secondary, or peripheral lumens or channels in the body
structure of the outer layer or outer tube 302. The operational
tubes 304 may be made of any suitable polymer material,
bio-compatible polymer material or metallic material (e.g.,
polyimide, stainless steel or spiral cut stainless steel, Nitinol,
etc.). The separate operational tubes 304 may be melted and/or
braided into the wall of the minor, secondary, or peripheral lumens
of the outer tube 302 or inner tube 312. The operational tubes 304
may provide a substantially slidable surface and interface for the
flex tubes 306, such that the flex tubes 306 may slide
substantially freely about the interior of the operational tubes
304 in a substantially decoupled configuration. In some
embodiments, a distal end or portion of the flex tubes 306 may be
fixedly coupled to the elongate instrument. In some variations, a
proximal end or portion of the flex tubes may also be fixedly
coupled to the elongate instrument 300 as in a passively controlled
configuration of the flex tubes 306.
[0382] For example, in a passively controlled configuration, the
flex tubes 306 may passively slide along the interior of the
operational tubes as the elongate instrument or catheter 300 is
navigated through the anatomy, articulated or steered. As will be
discussed in more detail, the slidable interface between the flex
tubes 306 and the operational tubes 304 together with buffer loops
of the flex tubes in the control unit substantially decouple the
flex tubes 306 from the elongate instrument or catheter 300.
Because of the decoupled configuration of these two structures,
articulation forces supported by the flex tubes may be decoupled
from at least a portion of the catheter body or structure 300. As a
result of decoupling the flex tubes 306 from at least a portion the
catheter body or structure, articulation forces applied to
articulate or steer the distal portion of the elongate instrument
or catheter 300 may not be transmitted through or along the body of
the elongate instrument from the distal portion to the proximal
portion of the elongate instrument, for example. Consequently, as
described in this example, articulation forces may be prevented or
minimized from compressing the proximal portion of the elongate
instrument or catheter body; such compression if allowed to occur,
may affect the stiffness or bending stiffness of the proximal
portion of the catheter. In addition, this decoupling of the
articulation forces for the elongate member allows that changes in
the shape or length of the elongate member as it is navigated
through the anatomy may not have any impact or minimal impact on
the articulation performance of the distal section of the elongate
instrument. As will be also discussed in more detail, in some
embodiments, the flex tubes 306 may also be utilized as support or
reinforcing structures to vary or change the stiffness and/or bend
radius of at least a portion of the catheter. In particular, the
flex tubes 306 may be very effective support or reinforcing
structures when they are compressed and stiffened. In other words,
an elongate instrument 300 or a section of the elongate instrument
without any flex tubes 306 may be substantially flexible. With the
introduction of one or more flex tubes 306 into the body of the
elongate instrument or a section of the elongate instrument, the
elongate instrument or the section of the elongate instrument with
the flex tubes 306 may become less flexible; even though the flex
tubes 306 are flexible in bending, they have axial stiffness.
Several axially stiff members spread throughout the cross section
of a catheter may add significant bending stiffness to the
catheter. When the flex tubes 306 are compressed, such as using
pull wires to apply a compressible force or load to the flex tubes,
for example, they may become substantially more stiff laterally,
such that the stiffened structures may affect or alter the
stiffness and/or bend radius of at least a portion of the catheter
where the flex tubes 306 are located. Accordingly, the flex tubes
306 may be utilized to vary or change the stiffness and/or bend
radius of a portion or certain portion of the catheter by changing
the positioning or placement of the flex tubes 306 in the elongate
instrument 300. For example, the flex tubes 306 may be moved from
one portion of the elongate instrument or catheter to another
portion of the catheter. The portion from which where the flex
tubes 306 were moved may become substantially more flexible or
pliable without the flex tubes 306. Whereas, the portion to which
where the flex tubes 306 were moved to may become substantially
more stiff or less flexible or pliable. Consequently, the changes
of stiffness along various portions of the elongate instrument or
catheter may substantially affect the bend radius of at least a
portion of the elongate instrument as pull wires are operated to
articulate or steer the elongate instrument.
[0383] Referring back to the structural make up of the steerable
instrument 300 as illustrated in FIG. 33A, the flex tubes 306 may
be made from a coil of wire, a stack of rings, or a tube with
spirally cut features. As may be appreciated by one of ordinary
skilled in the art, a substantially stiff tube may become less
stiff or more flexible or more pliable as a spiral cut or spirally
cut feature is imparted onto a substantially stiff tube. The tube
may be made from a of a high durometer plastic such as Peek.TM. or
stainless steel or other suitable material. One of the features of
the flex tube 306 is that it may provide structural support to the
elongate instrument (e.g., axial and lateral support) as well as
being substantially flexible (e.g., able to bend in various
directions and orientations). In some embodiments, the flex tubes
306 may be constructed from one continuous coil of wire, e.g., coil
tube. In other embodiments, each flex tube 306 may include a
plurality of coils that are axially aligned in series. In some
other embodiment, the flex tube 306 may be constructed from a stack
of rings, e.g., ring tube. For a ring tube, the rings may be
stacked, grouped, or maintained together in any suitable manner. In
some of the embodiments, the rings may be stacked, grouped, or
maintained together by a substantially flexible sleeve, sheath,
membrane, or covering. The coil of wire or rings may be made from a
polymer material or metallic material. For example, a coil wire or
rings may be made from stainless steel, Nitinol, etc. The coil wire
may be made from a round stock or a flat stock or a stock having
any cross-section or profile. Similarly, the rings of the ring tube
may be made from a round stock or a flat stock or a stock having
any cross-section or profile. In accordance with some embodiments,
the flex tubes 306 may be generally constructed from a
substantially tightly wound coil of wire or a stack of rings.
[0384] Still referring to FIG. 33A, the support tubes 310 may be
made of any suitable polymer material, bio-compatible polymer
material, or metallic material (e.g., polyimide, stainless steel,
Nitinol, etc.). The inner layer or inner tube 312 may be made of
any suitable polymer material or bio-compatible polymer material
(e.g., nylon-12, Pebax.RTM., Pellathane, Polycarbonate, etc.). In
addition, the elongate instrument 300 may include a control ring
316 that may be secured near a distal portion of the elongate
instrument 300. In various embodiments, the proximal end or portion
of one or more pull wires 314 may be operatively coupled to various
mechanisms (e.g., gears, pulleys, etc.) of a control unit or
splayer (such as the drivable instrument 182) of the instrument
assembly. The pull wire 314 may be a metallic wire, cable or
thread, or it may be a polymeric wire, cable or thread. The pull
wire 314 may also be made of natural or organic materials or
fibers. The pull wire 314 may be any type of suitable wire, cable
or thread capable of supporting various kinds of loads without
deformation, significant deformation, or breakage. The distal end
or portion of one or more pull wires 314 may be anchored or mounted
to the control ring 316, such that operation of the pull wires 314
by the control unit or splayer may apply force or tension to the
control ring 316 which may steer or articulate (e.g., up, down,
pitch, yaw, or any direction in-between) certain section or portion
(e.g., distal section) of the elongate instrument 300. In other
embodiments, no control ring may be used, instead the distal
portion of the pull wires may be attached directly to a section or
portion of the elongate instrument 300 where it may be steered,
articulated, or bent. The wires may be crimped, soldered, welded or
interlocked in any suitable manner to a specific location on a
bending section or portion of the elongate instrument 300. The
control ring 316 or the attachment point(s) may be located at any
location, section, portion, or region along the length of the
elongate instrument 300. Operation of the pull wires 314 may steer
or articulate any of the location, section, portion, or region of
the elongate instrument 300, which may in effect provide or define
various bend radii for the articulated portion of the elongate
instrument 300. In addition, in some embodiments there may be more
than one control ring 316 mounted or installed to the elongate
instrument 300 or more than one control wire attachment control
locations, sections, or portions for controlling, steering, or
articulating more than one section or portion of the elongate
instrument 300. In some embodiments, the flexible and steerable
elongate instrument 300 having more than one control rings 316 or
more than one control sections may be steered, articulated, or
deflected into various complex shapes or curvatures (e.g., "S"
curved shapes or "J" curved shapes, etc.). For example, the
steerable elongate instrument 300 may be steered, articulated, or
deflected into various complex shapes or curvatures that may
conform to various complex shapes or curvatures of internal
pathways of a patient to reach a target tissue structure of an
organ inside the patient.
[0385] In some embodiments, one or more portions of the flex tubes
306 may be incorporated or coupled to the wall of the catheter 300
and such incorporation or coupling may be used for multiple
functional purposes. For example, the coupling of the flex tubes
306 to the elongate instrument 300 may be used to support
articulation forces as the elongate instrument or catheter is
steered or articulated. Also, in some embodiments, proximal
portions of the flex tubes 306 may be slidable relative to the
elongate instrument 300. As one or more of the pull wires 314 are
operated by the control unit to steer or articulate the elongate
instrument 300, the articulation or steering forces may be
substantially transmitted along the body of the elongate instrument
300 from the portion (e.g., distal portion) of the elongate
instrument 300 where the distal end or portion of the pull wires
314 may be anchored to the proximal portion of the elongate
instrument 300. Since the flex tubes 306 are incorporated or
coupled to the wall of the elongate instrument 300 and the flex
tubes 306 are substantially configured to support axial loading,
the articulation or steering loads may be decoupled from the
elongate instrument 300 at the point or location where the flex
tubes 306 are incorporated or coupled to the wall of the elongate
instrument 300. Hence, the proximal portion of the elongate
instrument may be substantially unaffected by the articulation or
steering of the particular section or portion (e.g., distal section
or portion) of the elongate instrument 300. The proximal portion of
the elongate instrument may remain substantially flexible and
pliable even when a particular portion (e.g., distal portion) of
the elongate instrument is being articulated or steered. The above
feature allows tension to be applied to steer the distal section of
the elongate instrument 300 while steering force is isolated from
the proximal section of the elongate instrument 300 (and as a
result, a bending stiffness of the proximal section of the elongate
instrument 300 is not significantly affected). The above feature
also allows tension to be applied to steer the distal section of
the elongate instrument 300 without creating unwanted curvature at
the proximal section of the elongate instrument 300, and thus, a
shape of the proximal section of the elongate instrument 300 is
unaffected by the steering of the distal section. As such, an
operator or surgeon may easily manipulate the elongate instrument
300 and urge it to conform, adopt, or match the various shape or
curvatures of the internal pathways of a patient while the elongate
instrument is being advanced and steered to reach various tissue
structures or target sites inside a patient. In another example or
application of the elongate instrument 300, the flex tubes 306 may
be used as a structural support member to the catheter 300; in
particular, when the flex tubes are stiffened by tensioning pull
wires that may be attached to the flex tubes 306. In such
application, the flex tubes 306 may support not only axial forces
or loads, but also lateral forces or loads. As such, the flex tubes
may increase the lateral as well as bending stiffness of at least a
portion or section of the elongate instrument 300. In addition, the
flex tubes 306 may also affect the bending radius of at least a
portion or section of the elongate instrument 300 as the elongate
instrument is steered, articulated, or manipulated.
[0386] In some embodiments, each flex tubes 306 may be located
closer to a wall of the elongate instrument 300 than an axis (e.g.,
central axis) of the elongate instrument 300. For example, in some
variations, each flex tubes 306 may be located close to a wall of
the elongate instrument 300. This allows the elongate instrument
300 to have a central working lumen extending therethrough. In some
cases, such central working lumen may have a cross sectional area
that is at least 30% of the cross sectional area of the elongate
instrument 300. Also, in one or more of the embodiments described
herein, each flex tube 306 may have a proximal tip that is proximal
to a proximal tip of the tubular body of the elongate instrument
300.
[0387] FIG. 33B illustrates another cross-sectional view (View 1-1)
of a section or portion of a steerable elongate instrument or
catheter 300. As illustrated in FIG. 33B, the components of the
elongate instrument 300 may be contained within or between the
outer layer of material or outer tube 302 and the inner layer of
material or inner tube 312. A primary, main, central, or working
lumen 318 may be provided or defined by the inner layer of material
or inner tube 312. The main lumen or central lumen 318 may be used
to pass surgical instruments from the proximal end to the distal
end of the elongate instrument 300 for performing various minimally
invasive surgical procedures. Many of the components of the
elongate instrument 300, e.g., operational tubes 304, flexible
tubes 306, push tubes 308, and support tubes 310, are disposed
within the minor, secondary, or peripheral lumens in the body
structure of the elongate instrument, as illustrated in FIG. 33A
and FIG. 33B. In some embodiments, one or more pull wires 314 may
be disposed within lumens of the support tubes 310, lumens of the
flex tubes 306, and lumens of the push tubes 308. As illustrated in
FIG. 33A, the distal end or portion of the support tubes 310 may be
secured or anchored near the distal portion of the elongate
instrument 300 and the proximal end of the support tubes 310 may be
slidably coupled to the distal end or portion of the flex tubes
306. In one embodiment, the distal portion of the flex tubes 306
may be secured at respective anchor points or regions 320 of the
elongate instrument 300. Anchoring the flex tubes 306 to the
elongate instrument 300 may provide the connections or couplings
that allow force or load to be transferred from the flex tubes 306
to the elongate instrument 300 when force or load is applied to the
flex tubes. For example, in some embodiments the flex tubes 306 may
be actively controlled, that is one or more push tubes 308 or
control members 308 may be configured to push against respective
flex tubes 306. The applied force from the push tubes or control
members 308 may be transmitted by way of the anchoring points 320
through the flex tubes 306 to the elongated instrument 300. In this
way, at least a portion of the elongate instrument 300 may be
steered or shaped by the push tubes or control members 308.
Similarly, articulation or steering forces or loads may be
transferred or coupled at the anchor points 320 from one portion
(e.g., distal portion) of the elongate instrument 300 to the flex
tubes 306, such that the flex tubes 306 may act as load bearing
support elements for another portion (e.g., proximal portion) of
the elongate instrument 300 where the force or load may be
decoupled or not transmitted. In other words, the anchor points 320
may function as coupling points from one portion (e.g., distal
portion) of the elongate instrument 300 to the flex tubes 306 where
force or load may be transferred from one portion (e.g., distal
portion) of the elongate instrument to the flex tubes. Similarly,
the anchor points 320 may also function as decoupling points
between one portion (e.g., distal portion) of the elongate
instrument 300 to another portion (e.g., proximal portion) of the
elongate instrument 300 where force or load may be decoupled or not
transferred from one portion (e.g., distal portion) of the elongate
instrument to another portion (e.g., proximal portion) of the
elongate instrument.
[0388] In some embodiments, the location of the anchor points 320
may be varied to control the radius of curvature of a bending
section of the elongate instrument 300 as the elongate instrument
is articulated or steered. In some embodiments, the flex tubes 306
may be anchored at substantially the same points or regions of the
elongated instrument 300. In some embodiments, the flex tubes 306
may be anchored at substantially different points or regions of the
elongate instrument 300 to affect the bend radius of various
portions of the elongate instrument 300 and/or various directions
of steering or bending. The flex tubes 306 may be secured to the
elongate instrument 300 in any suitable manner. In some
embodiments, the distal portion of the flex tubes 306 may be fused
with the material of the outer layer or outer tube 302, such as by
thermal fusion. Similarly, the material of the outer layer or outer
tube 302 may be fused to the flex tubes 306. For example, the flex
tubes 306 may be fused to the outer layer or outer tube 302 at
various places where it is not covered by the operational tubes
304, as illustrated in FIG. 33A. In some embodiments, the elongate
instrument may be configured with displacement control of the flex
members 306. That is, a flex tube 306 may not be fixedly coupled to
the elongate instrument, instead it may be displaced along the
length of the elongate instrument 300. Once the flex tube 306 is
displaced to a desired location, the distal portion of the flex
tube 306 may be secured or coupled to the elongate instrument 300
by a deployable and retractable anchor. The displacement of
proximal portion of the flex tube 306 may be controlled by the push
tube or control member 308. The deployable anchor may be deployed
to couple the flex tube 306 to a particular anchor point at a
particular location on the elongate instrument. The anchor may also
be retracted such that the flex tube 306 may be disengaged or
separated from the elongate instrument 300 such that it may be
displaced to a different location along the elongate instrument
300.
[0389] As illustrated in FIG. 34A, an elongate instrument 300 with
passively controlled flex members 300 may be similarly configured
as the elongate instrument structure illustrated in FIG. 33A with
the exception that the proximal portion of the flex members 300 may
be fixedly coupled to the body of the elongate instrument, the
control unit or splayer (such as the drivable instrument 182), or
some other structural element or component. In some embodiments,
the push tube or control member 308 may not be included as a
component of the elongate instrument 300 for a passively controlled
flex member. In the passively controlled configuration, the flex
members 306 may include a service or buffer loop 320, as more
clearly illustrated in FIG. 34B. The service loop or buffer loop
320 on the flex members 306 may provide the extra service length or
buffer length needed to isolate the articulation loads as the
elongate instrument 300 is pushed through the anatomy, articulated
or steered.
[0390] As the elongate instrument is pushed through the anatomy,
steered or articulated, the support tubes 310 in the distal section
may slide along the flex tubes 306 as indicated by the arrows in
FIG. 34C. The support tubes 310 may provide a lumen or path for the
pull wires 314 to connect to the distal section of the catheter.
The support tubes 310 may also provide some amount of structural
rigidity or support to the distal portion of the elongate
instrument 300. In some embodiments, the elongate instrument 300
may not include any support tubes 310. In some embodiments, one or
more flex tubes 306 may be extended further into the distal portion
of the elongate instrument 300 to provide some structural rigidity
or support to the distal portion of the elongate instrument. In
some embodiments, the flex tubes 306 may be substantially more
stiff or more rigid than the support tubes 310, such that when one
or more flex tubes 306 are used as support structures to reinforce
the distal portion of the elongate instrument 300, the distal
portion of the elongate instrument may be substantially more stiff
or more rigid than when it is supported by the support tubes 310.
In some embodiments, the flex tube 306 may provide substantially
the same or similar stiffness or structural support as the support
tubes 310, such that there may not be any significant difference if
the flex tubes 306 or support tubes 310 are used to provide
structural support to the distal portion of the elongate instrument
300. In some embodiments, the flex tubes 306 may be substantially
more flexible than the support tubes 310, such that the distal
portion of the elongate instrument may be substantially more
flexible or less rigid than when it is supported by the flex tubes
306.
[0391] Referring back to FIG. 34A, the flex tubes 306 may be
slidably coupled to the operational tubes 304 while fixed at the
distal end 320. As the elongate instrument 300 is steered or
articulated, or as the catheter is advanced through the natural
curvature of the body lumens, the flex tubes 306 may slide along
the operational tubes 304 as indicated by the arrows illustrated in
FIG. 34D. In one scenario, for example, the elongate instrument 300
may be steered by operating or applying tension to one of the pull
wires (e.g., 314A) through operation of one or more gears and/or
pulleys in the control unit or splayer. The tension on one of the
pull wires (e.g., 314A) may cause the elongate instrument 300 to
bend, as illustrated in FIG. 34D. The inside edge or inside region
of the bend may be contracted or foreshortened, while the outside
edge or outside region of the bend may be lengthened or stretched.
The bend of the elongate instrument as described may cause one of
the flex tubes (e.g., 306A) to slide "out" near the proximal
portion of the elongate instrument 300 at the contracted or
foreshorten edge or region. In this same example, another one of
the flex tubes (e.g., 306B) may slide "in" near the proximal
portion of the elongate instrument 300 at the lengthened or
stretched edge or region, as illustrated in FIG. 34D. In order to
accommodate the sliding of "in" and "out" of the flex tubes 306,
the flex tubes may include a service loop or buffer loop 320 to
allow for these "in" and "out" displacements or movements of the
flex tubes 306. As discussed, the flex tubes 306 may be passively
constrained or restrained. The flex tubes 306 may be constrained or
restrained by being coupled to the elongate instrument 300, the
control unit, or splayer. In addition, the flex tubes 306 may be
constrained or restrained by hard-stops, tethers, etc. In some
embodiments, the operational tubes 304 may be configured or allowed
to float or slide substantially freely relative to the outer layer
or outer tube 302. In some other embodiments, the operational tubes
304 may not be configured or allowed to float or slide
substantially freely relative to the outer layer or outer tube
302.
[0392] FIG. 35A through FIG. 35C illustrate the operation of a
substantially flexible and steerable elongate instrument in
accordance with one embodiment. FIG. 35A illustrates an elongate
instrument 300 of an instrument assembly in a substantially neutral
state. In this example, the elongate instrument 300 includes an
outer body 302, two sets of support tubes (not shown), operational
tubes 304A, 304B, flex tubes 306A, 306B, and pull wires 308A, 308B.
Each set of support tubes, operational tubes 304A, 304B, flex tubes
306A, 306B, and pull wires 308A and 308B) may be substantially
axially aligned, and the pull wires 308A, 308B may be coupled to a
control ring (not shown) or mounting points that are located at the
distal section or portion of the elongate instrument 300. As
illustrated in FIG. 35A, in the neutral state the flex tubes 306A,
306B and pull wires 308A, 308B may extend out of the operational
tubes 304A, 304B at about the same amount or distance. As the
substantially flexible and steerable elongate instrument 300 is
advanced into the anatomy and natural pathway (e.g., blood vessel,
gastrointestinal tract, etc.) of a patient, it may take on the
shape of the natural pathway, as illustrated in FIG. 35B. In this
example, the proximal section 338 of the elongate instrument may be
bent at a curvature induced by the natural pathway (e.g., blood
vessel, gastrointestinal tract, etc.), while the distal section 336
may remain relatively straight or in a substantially neutral state.
Due to the bend at the proximal section 338, the flex tube 306A and
pull wire 308A may slide "out" of the operational tube 304A near
the inside edge or inside region of the bend as it may be
contracted or foreshortened, as indicated by the arrow illustrated
in FIG. 36B. At the same time, due to the bend at the proximal
section 338, the flex tube 306B and pull wire 308B may slide "in"
to the operational tube 304B near the outside edge or outside
region of the bend as it may be lengthened or stretched, as
indicated by the arrow illustrated in FIG. 35B. As may be
appreciated, it may be advantageous to maintain the induced shape
or curvature of the proximal section 338 of the elongate instrument
300 and at the same time articulate or steer the distal section 336
of the elongate instrument 300 to treat a target site or toward a
different direction down the natural pathway.
[0393] In other embodiments of an elongate instrument where flex
tube or similar control or support structure may not be used,
operating or tensioning a pull wire on the outside edge of a bend
may cause the elongate instrument to rotate or twist as the pull
wire may tend to rotate the distal section of the elongate
instrument until the pull wire is at the inside edge of the bend;
this rotation or twist phenomenon or occurrence is known as curve
alignment.
[0394] FIG. 36C illustrates an embodiment of an elongate instrument
or catheter 300 that does not have coil pipes in the wall of the
catheter. When the proximal section of the catheter is curved (as
it tracked through curved anatomy), and the catheter distal section
is required to be articulated in a direction that is not aligned
with the curvature in the shaft, a wire on the outside of the bend
is pulled. A torsional load (T) is applied to shaft as tension
increases on the pull-wire on the outside of the bend. This
torsional load rotates the shaft until the wire being pulled is on
the inside of the bend. This un-intentional rotation of the shaft
causes instability of the catheter tip and prevents the doctor from
being able to articulate the catheter tip in the direction shown.
The phenomenon is known as curve alignment because the wire that is
under tension is putting a compressive force on both the proximal
and distal sections and so both the proximal and distal curvature
will attempt to align in order to achieve lowest energy state.
[0395] Embodiments described herein may substantially eliminate
this problem by providing support structures such as flex tubes
that could prevent curve alignment and substantially prevent or
eliminate unwanted rotation or twist of the catheter. In other
words, the pull wires, flex tubes, and the distal anchor points of
the pull wires at the control ring or the body of the elongate
instrument may all be substantially aligned, such that operating or
tensioning of the pull wires would allow the elongate instrument to
bend in a substantially aligned or neutral configuration with the
longitudinal axis of the pull wire and flex tube. In this
configuration, there may not be any component or vector of force or
load that could cause the elongate instrument to rotate or twist
resulting in curve alignment as the elongate instrument is steered
or bent.
[0396] The design presented in FIG. 36D and with service loops on
the proximal end of the coils as per FIG. 34B substantially
eliminates or prevents curve alignment and the catheter may be
biased, steered, or articulated in specific planes, e.g., X-Plane,
Y-Plane, Z-Plane, of articulation. By using flex tubes with service
loops as support structures or "backbones" to the catheter shaft,
the path length of the wire under tension does not change as the
proximal shaft is curved. The flex tubes isolate the forces from
the proximal section and therefore there is no tendancy to curve
align the distal section with the proximal section and hence no
rotation of the shaft. In FIG. 36A, as a pull wire is operated
(indicated by the arrow) to steer the elongate instrument, the flex
tube supports the pull wire and prevent it from moving to the
inside edge of the bend, which may produce a force vector that
could cause the elongate instrument to twist or rotate. In this
example, the operation of the pull wire causes the distal section
of the elongate instrument to be steered or articulated in a
substantially upward movement, e.g., the direction or vector of
articulation is in the Y-Plane. Similarly, as illustrated in FIG.
36B, as a pull wire is operated (indicated by the arrow) to steer
the elongate instrument, the flex tube supports the pull wire,
maintain its alignment to the longitudinal axis, and prevent it
from moving to the inside edge of the bend, which may produce a
force vector that could cause the elongate instrument to twist or
rotate. In this example, the operation of the pull wire causes the
distal section of the elongate instrument to be steered or
articulated in a substantial sideway or rightward movement, e.g.,
the direction or vector of articulation is in the X-Plane.
[0397] It should be noted that the catheter 300 is not limited to
the configuration described previously, and that the catheter 300
may have other configurations in other embodiments.
[0398] FIG. 37A illustrates a catheter 412 in accordance with other
embodiments. The catheter 412 has a distal end 430, a proximal end
432 coupled to the drivable assembly 182, and a body 434 extending
between the distal end 430 and the proximal end 432. In some
embodiments, the proximal end 432 is fixedly secured to a hypotube
that is in turn fixedly secured to the drivable assembly 182. The
catheter 412 has a distal section 436 that articulates in response
to control by the drivable assembly 182 and based on commands
received at the workstation 2 or the bedside control 402.
[0399] FIG. 37B illustrates portion of the catheter 412 in further
detail. As shown in the figure, the distal section 436 of the
catheter 412 includes a spine 440 defining a lumen 441 for
accommodating an instrument, such as a guidewire. The spine 440 is
configured to provide support for the catheter 412, and specific
bending pivot point for the catheter 412. The spine 440 may be made
from a coil, or a tube with cutout slots to provide flexibility for
the spine 440. As shown in the figure, the spine 440 extends
partially into the proximal section 438 of the catheter 412.
Alternatively, the spine 440 may extend all the way to the proximal
end 432 of the catheter 412.
[0400] The catheter 412 also includes a plurality of coils 442
positioned radially relative to the spine 440. The coils 442 may be
used to implement the flex tubes 306 in some embodiments. The coils
442 are configured (e.g., sized and/or shaped) to house respective
control wires that are attached at their distal ends to a control
ring 444, and at their proximal ends to the drivable assembly 182.
In other embodiments, the each tube 306 may not be implemented
using the coil 442, and may be implemented using other elongate
elements, such as a continuous tube with a smooth continuous
surface, a wire cage having a tubular configuration, etc.
[0401] In some embodiments, the control wire coils 442 change coil
pitch from the distal section 436 to the proximal section 438. In
particular, the coil loops of the coils 442 are more spaced apart
at the distal section 436, but the coil loops of the coils 448 are
closer together at the proximal section 438. Such configuration is
advantageous in that it provides a more flexible distal section 436
so that the distal section 436 may be bent to a more tight curve.
In one implementation, the coils 442 may have an open pitch while
the coils 448 may have a closed pitch. In such cases, the coils 448
are wound tightly so that they are in a naturally compressed state.
In such configuration, when the steering wires are pulled in
tension, the shaft does not bend and the forces are transmitted to
the proximal end of the catheter. Alternatively, both the coils
442, 448 may have closed pitch.
[0402] In some embodiments, each distal coil 442 and its
corresponding proximal coil 448 may be parts of a same coil
structure, wherein the distal portion of the coil structure is
constructed to have coil loops that are more spaced apart than a
proximal portion of the coil structure. In other embodiments, the
distal coil 442 may be a separate component that is connected to
the proximal coil 448 (e.g., via a weld, adhesive, etc.).
[0403] In some embodiments, the coil 442 is anchored to the distal
section 436 (e.g., the distal end), while the coil 448 is slidable
relative to the proximal section 438. In other embodiments in which
the coils 442, 448 are parts of a same coil, the coil may be fixed
to the catheter body at the transition between the proximal section
438 and the bendable distal section 436. In some embodiments, the
coil 442 is anchored to the distal section 436 by anchoring at
least a lengthwise portion of a distal portion of the coil 442 to
the distal section 436. The lengthwise portion may be at least 10
mm in some embodiments, and more preferably, at least 20 mm, and
even more preferably, at least 30 mm. In other embodiments, the
lengthwise portion may be at least 5% of a combined length of the
coils 442, 448, and more preferably at least 10%, and even more
preferably at least 20% of the combined length of the coils 442,
448. In other embodiments in which the coils 442, 448 are parts of
a same coil, the lengthwise portion may be at least 5% of a total
length of the coil, and more preferably at least 10%, and even more
preferably at least 20% of the total length of the coil.
[0404] During use, the drivable assembly 182 may apply tension to
one or more control wires to thereby cause a corresponding bending
at the distal section 436 of the catheter 412. Although two control
wire coils 442 for housing two respective control wires are shown,
in other embodiments, the catheter 412 may have only one coil 442
for housing one control wire, or more than two coils 442 (e.g.,
four coils 442) for housing more than two control wires (e.g., four
control wires). The control ring 444 is embedded within a soft tip
445, which is configured to minimize injury to tissue as the
catheter 412 is advanced within the patient.
[0405] In some embodiments, the catheter 412 further includes an
outer jacket 446 surrounding the coils 442. The outer jacket 446 is
a low durometer material for providing flexibility for the
articulating distal section 436. In some embodiments, the outer
jacket 446 may be made from 35D or 25D Pebax, or from 70A or 80A
Polyurethane. In other embodiments, the outer jacket 446 may be
made from other materials as long as the distal section 436 is
sufficiently flexible for it to be articulated.
[0406] In some embodiments, the outer jacket material 442 extends
partially into the space that is between the loops of the coil 442
(FIG. 37C). Such configuration prevents the control wire from
contacting the material of the outer jacket material 442, thereby
allowing the control wire to be more easily slide within the lumen
of the coil 442. In other embodiments, the outer jacket material
442 may not extend partially into the space that is between the
loops of the coil 442. Instead, the outer jacket material 442 may
be touching only the outer side of the coil 442. This may allow the
coils 442 to move relative to the outer jacket 446, thereby
improving the flexibility of the distal section 436. In further
embodiments, the outer jacket material 442 may extend completely
into the space that is between the loops of the coil 442 (FIG.
37D).
[0407] The above configurations shown in FIGS. 37C and 37D may be
accomplished through a manufacturing process. For example, during a
manufacturing process, a mandrel may be placed inside the coils 442
to ensure that the lumens remain unobstructed while the jacket is
being laminated. The mandrel is then removed post lamination to
leave a lumen (through the expanded coil encased in plastic) that
the smaller diameter steering wire can slide through freely with
minimum friction. In some embodiments, by varying the size of the
mandrel in the lumen, the amount of encapsulation of the coils 442
with the plastic can be varied. For example, a 0.01'' mandrel
inside a 0.014'' internal diameter coil will lead to a 0.002'' of
plastic inserted in through the coils 448. On the other hand, a
0.014'' mandrel placed inside a 0.014'' coil will ensure that no
plastic encapsulates the inside surface of the coil 442. Limiting
the plastic that is inserted through the coils 442 can reduce the
friction when the steering wire is pulled since the wire slides
more freely on the coils than on the softer plastic, as discussed.
Thus, the catheter designer can trade off friction in the control
wire lumen with structural integrity of the coils 442 by varying
the outer diameter of the mandrel used in the manufacturing
process.
[0408] Also, in some embodiments, during the design of the catheter
412, the pitch of the coil 442 and/or the size of the coil 442 may
be selected to define an amount of maximum bending for the catheter
412. As shown in FIG. 37E, as the distal section 436 of the
catheter 412 is being bent due to a tensioning of a control wire,
the coil loops of the coil 442 that is housing the control wire
will move closer to each other. As a result, the material 456 of
the outer jacket 446 that is between the coil loops will undergo
compression. By varying the pitch of the coil 442 during the design
of the catheter 412, the amount of material 456 between the loops
that would undergo compression would vary. Generally, the more
material 456 that is between the loops (i.e., more spaced apart
loops), the more bending will be allowed for the catheter 412, and
vice versa. Also, in other embodiments in which there is no jacket
material between the loops of the coil 442, the same design
principle may apply. In such cases, the maximum amount of bending
for the catheter 412 may be achieved when the distal section 436 is
bent so much that the coil loops of the coil 442 abuts against each
other. When the coils 442 abut against each other, no further
articulation will be possible. Any additional force on the control
wire will be transmitted directly and fully to the compressed coils
442 rather than the spine or the plastic of the articulation
section. This has the benefit of preventing over-articulation that
may lead to potential spine fracture, plastic deformation of the
spine, or damage to the distal jacket. Thus, during the design of
the catheter 412, the loops of the coil 442 may be spaced apart
further if more bending is desired for the catheter 412, or spaced
closer if less bending is desired. For example, a coil made of
0.003'' wire with a 0.009'' pitch will allow articulation of the
catheter 412 to a smaller radius than a coil with a 0.006'' pitch,
for example.
[0409] In some embodiments, by varying the pitch of the coils 442,
the bend shape at the distal section of the catheter 412 may be
adjusted. A more closely-spaced section of coils (e.g., 0.006'') on
the proximal end will result in a larger minimum radius--i.e., that
section will remain straighter than regions with a larger coil
pitch (e.g., 0.009'' pitch) on the distal end. This technique may
be used to get small bend radii at the very distal end of the
catheter 412, which can be used to reach small vessels with acute
take off angles.
[0410] It should be noted that use of the coils 442 as control wire
lumens in the articulating section has several additional
advantages. The coils 442 have both low axial and bending
stiffnesses. This lowers articulation forces since the lumens on
the inside and outside of the bend will more easily contract and
expand, respectively. The coils 442 also have relatively high
radial strength, ensuring that they do not collapse and pinch the
control wire, which would undesirably increase the wire forces.
Also, the coil's 442 ability to expand and contract will decrease
the resistance to bending, and will yield a more uniform bend when
compared to traditional polyimide lumen constructions. In addition,
the coil 442 will provide a load-bearing surface that will radially
distribute the control wire load about the jacket. The use of coils
442 will also allow the jacket material to be melted around the
coils 442 to thereby secure the coils 442. This will eliminate the
need to braid the coils 442 onto a component of the catheter 412.
The elimination of braid will in turn lower the resistance to
bending (i.e., lowering the bending stiffness) because different
layers may shift relative to each other with a lower force, and
will also yield a lower articulation force for the catheter 412
and/or smaller bending radius for the catheter 412. However, in
other embodiments, the coil 442 may still be braided to a
reinforcement layer, such as a wire mesh or a spine. Alternatively,
bands of higher durometer (e.g. 72D) crosslinked Pebax may be used
to support the expanded coils and fix them to the spine. Cross
linked Pebax has improved mechanical properties and greater
dimensional stability and physical toughness compared to regular
Pebax and ensures the coils are adequately fixed to the spine.
[0411] Returning to FIG. 37B, as the distal section 436 transitions
to the proximal section 438, the material of the outer jacket also
changes. In particular, proximal to the outer jacket 446, the
catheter 412 includes another outer jacket 454 that is stiffer than
the material of the distal outer jacket 446. In some embodiments,
the outer jacket 454 may be made from a 40D or 55D Pebax. In other
embodiments, the outer jacket 454 may be made from other materials
as long as they are stiffer than that of the distal outer jacket
446. In further embodiments, the outer jacket 454 may be made from
the same material as that for the outer jacket 446. In such cases,
the outer jacket 446, 450 may be formed together. Thus, the
designer may vary the position of the jacket transition relative to
the transition in the coil pipe spacing to get a gradual change in
stiffness and hence curvature between the proximal and distal
sections. This reduces the likelihood of any kink points in the
catheter.
[0412] As shown in the figure, the proximal section 438 of the
catheter 412 includes the proximal control wire coils 448. The
proximal section 438 of the catheter 412 also includes an inner
jacket 452 surrounding the coils 448, and an outer jacket 454
surrounding the inner jacket 452. In some embodiments, the inner
and outer jackets 452, 454 are made from different materials. In
other embodiments, the inner and outer jackets 452, 454 may be made
from the same materials. Also, in other embodiments, the inner
jacket 452 and/or the outer jacket 454 may be made from a material
that is stiffer than the material for the outer jacket 446 at the
distal section 436 and/or the outer jacket at the transition
section. In further embodiments, the inner jacket 452 and/or the
outer jacket 454 may be made from the same material as the outer
jacket at the transition section. The embodiments having the outer
jacket and the inner jacket allow the designer flexibility to vary
the stiffness of the catheter as desired throughout the length of
the catheter, while at the same time ensuring that the steering
lumens are encapsulated, that no braid is exposed, and that the
structural integrity of the shaft is maintained. In addition, in
one or more of the embodiments described herein the proximal
section 438 of the catheter 412 may optionally further include a
braid surrounding the coils 448 (e.g., embedded within the way of
the jacket 452 or jacket 454) for strengthening and stiffening the
proximal section 438. The braid can be stainless steel flat wire or
round wire. The braid angle and pic count can be optimized to give
the required stiffness and flexibility. The braid may have a
constant pattern throughout the proximal section, or there may be a
transition in the braid to enable higher bending stiffness at the
proximal end (compared to the distal end) and higher flexibility at
the distal end (compared to the proximal end).
[0413] The sheath 414 will now be described. FIG. 38 illustrates
the sheath 414 in accordance with some embodiments. The sheath 414
includes a bendable distal section 470, a proximal section 471, and
a distal soft tip 472. The distal section 470 that is more flexible
than the proximal section 471. During use, in response to control
by the drivable assembly 184, the distal section 470 will bend
based on commands received at the workstation 2 or the bedside
control 402. In some embodiments, the proximal end 471 is fixedly
secured to a hypotube that is in turn fixedly secured to the
drivable assembly 184.
[0414] As shown in FIGS. 39 and 40, the sheath 414 may also include
a spine 478 in the distal section defining a lumen 441 for
accommodating an instrument, such as the catheter 412. The spine
478 is configured to provide support for the sheath 414, and
specific bending pivot point for the sheath 414. The spine 478 may
be made from a coil, or a tube with cutout slots to provide
flexibility for the spine 478.
[0415] As shown in FIGS. 38 and 39, the sheath 414 may also include
a plurality of coils 474 positioned radially relative to the spine
478. The coils 474 are configured (e.g., sized and/or shaped) to
house respective control wires 475 that are attached at their
distal ends to the tip 472, and at their proximal ends to the
drivable assembly 184. During use, the drivable assembly 184 may
apply tension to one or more control wires 475 to thereby cause a
corresponding bending at the distal section 470 of the sheath 414.
Although four control wire coils 474 for housing four respective
control wires are shown, in other embodiments, the sheath 414 may
have less than four coils 474 and control wires 475, or more than
four coils 474 and control wires 475.
[0416] In the illustrated embodiments, the sheath 414 further
includes an outer jacket 476 surrounding the coils 474. The outer
jacket 476 is a low durometer material for providing flexibility
for the articulating distal section 470. In some embodiments, the
outer jacket 476 may be made from 35D or 55D Pebax, or from 70A or
80A Polyurethane. In other embodiments, the outer jacket 476 may be
made from other materials as long as the distal section 470 is
sufficiently flexible for it to be articulated.
[0417] In the illustrated embodiments, the control wire coils 474
have an open pitch so that the loops of the coils 474 are spaced
apart. Such configuration is advantageous in that it provides a
more flexible distal section 470 so that the distal section 470 may
be bent to a more tight curve. In one implementation, the distal
portion of the coil 474 may have an open pitch while the proximal
portion of the coil 474 may have a closed pitch. In such cases, the
proximal portion of the coil 474 are wound tightly so that they are
in a naturally compressed state. In such configuration, when the
steering wires are pulled in tension, the shaft does not bend and
the forces are transmitted to the proximal end of the sheath.
Alternatively, the entire length of the coil 474 may have a closed
pitch. In some embodiments, each coil 474 may extend all the way to
the proximal end of the sheath 414. In other embodiments, each coil
474 may transition to another coil with a closer loop spacing at
the proximal section 471, as similarly discussed with reference to
the catheter 412. In such cases, each distal coil 474 and its
corresponding proximal coil may be parts of a same coil structure,
wherein the distal portion of the coil structure is constructed to
have coil loops that are more spaced apart than a proximal portion
of the coil structure. In other embodiments, the distal coil 474
may be a separate component that is connected to the proximal coil
(e.g., via a weld, adhesive, etc.).
[0418] In the illustrated embodiments, the distal portion of the
coil 474 is anchored to the distal section (e.g., the distal end)
of the sheath, while the proximal portion of the coil 474 is
slidable relative to the proximal section of the sheath. In other
embodiments, the coil 474 may be fixed to the sheath body at the
transition between the proximal section and the bendable distal
section.
[0419] In some embodiments, the outer jacket material 476 extends
partially into the space that is between the loops of the coil 474
(as similarly discussed with reference to FIG. 37C). Such
configuration prevents the control wire 475 from contacting the
material of the outer jacket material 476, thereby allowing the
control wire 475 to be more easily slide within the lumen of the
coil 474. In other embodiments, the outer jacket material 476 may
not extend partially into the space that is between the loops of
the coil 474. Instead, the outer jacket material 476 may be
touching only the outer side of the coil 474. This may allow the
coils 474 to move relative to the outer jacket 476, thereby
improving the flexibility of the distal section 470. In further
embodiments, the outer jacket material 476 may extend completely
into the space that is between the loops of the coil 474 (as
similarly discussed with reference to FIG. 37D).
[0420] Also, in some embodiments, the pitch of the coil 474 and/or
the size of the coil 474 may be selected to define an amount of
maximum bending for the sheath 414. As similarly discussed with
reference to FIG. 37E, as the distal section 470 of the sheath 414
is being bent due to a tensioning of a control wire, the loops of
the coil 474 that is housing the control wire 475 will move closer
to each other. As a result, the material of the outer jacket 476
that is between the coil loops will undergo compression. By varying
the pitch of the coil 474 during the design of the sheath 414, the
amount of material between the loops that would undergo compression
would vary. Generally, the more the material that is between the
loops (i.e., more spaced apart loops), the more bending will be
allowed for the sheath 414, and vice versa. Also, in other
embodiments in which there is no jacket material between the loops
of the coil 474, the same design principle may apply. In such
cases, the maximum amount of bending for the sheath 414 may be
achieved when the distal section 470 is bent so much that the coil
loops of the coil 474 abuts against each other. Thus, during the
design of the sheath 414, the coil loops of the coil 474 may be
spaced apart further if more bending is desired for the sheath 414,
or spaced closer if less bending is desired.
[0421] In the above embodiments, the coils 474 are surrounded by
the outer jacket 476, which functions to contain the coils 474
during use. In other embodiments, the sheath 414 may further
include a braided layer 480 for reinforcing the structure of the
sheath 414 (FIGS. 41 and 42). In such cases, the coils 474 for
housing the control wires 475 may be coupled to the braided layer.
As shown in FIG. 42, in some embodiments, the coils 474 may be
coupled to the outer surface of the braided layer 480, e.g., by
wrapping part of the coils 474 around the braided layer 480, by
attaching them using adhesive, etc. In other embodiments, the coils
474 may be coupled to the inner surface of the braided layer 480
(FIG. 41), e.g., by wrapping part of the coils 474 around the
braided layer 480, by attaching them using adhesive, etc. In one
approach, the coils 474 are braided by looping around the coil at
the section closest to the sheath body, so that the braid will not
tent over the coil. This braiding method eliminates the potential
for the braid to apply loads on the control wires. This braiding
approach will also minimize the coils natural tendency to peel away
from the sheath 414 when high articulation forces are used, or when
the jacket is made from a material with low durometer.
[0422] As shown in FIG. 43, in some embodiments, different sections
along the length of the sheath 414 may have different
configurations to achieve different stiffnesses. In the
implementation shown, the sheath 414 includes a HDPE liner and two
layers of stainless steel braid that extend all the way from the
drivable assembly 184 to the distal end of the sheath 414. The
liner is a coextrusion of HDPE and plexar. The plexar is a tie
layer and its purpose is to ensure that the liner is properly
bonded to the outer jacket extrusions. The distal 27 mm of the
braid on the top layer is 100 ppi while the remainder of the top
braid is at 40 ppi. In other embodiments, the pic count of the
braid may also change on the bottom layer. This allows for
increased stiffness in the proximal section and increased
flexibility at the distal section (e.g., the distal 27 mm length)
without increasing the risk of kinking. The length of the 100 ppi
section can be longer or shorter than 27 mm to a give longer or
shorter distal segment. In addition, the outer jacket transitions
from a relatively stiff 70D pebax (not shown) in the tracking
section of the sheath to 55D Pebax for a 10 cm region at the
transition to the bending section. This is then followed by
approximately 25 mm of articulation region. This change in
durometer of the outer jacket, combined with the change in braid
coverage contribute to a sharp change in stiffness in the
articulation region which enables a 90.degree. or more articulation
angle to be achieved.
[0423] As shown in FIG. 44, the spine 478 and/or the braided layer
480 of the sheath 414 may have a square cross section in at least a
section along the length of the sheath 414. In such cases, the
coils 474 and the control wires 475 may be placed next to the
straight side of the square cross section. Such configuration
allows more of the jacket material 476 to be surrounding the coils
474, thereby reducing the risk that the coils 474 may cut through
the jacket material 476 due to the tensioning of the control wires
475.
[0424] It should be noted that use of the coils 474 as control wire
lumens in the articulating section has several additional
advantages. The coils 474 have both low axial and bending
stiffnesses. This lowers articulation forces since the lumens on
the inside and outside of the bend will more easily contract and
expand, respectively. The coils 474 also have relatively high
radial strength, ensuring that they do not collapse and pinch the
control wire, which would undesirably increase the wire forces.
Also, the coil's 474 ability to expand and contract will decrease
the resistance to bending, and will yield a more uniform bend when
compared to traditional polyimide lumen constructions. In addition,
the coil 474 will provide a load-bearing surface that will radially
distribute the control wire load about the jacket. The use of coils
474 will also allow the jacket material to be melted around the
coils 474 to thereby secure the coils 474. This will eliminate the
need to braid the coils 474 onto a component of the sheath 414. The
elimination of braid will in turn lower the resistance to bending
(i.e., lowering the bending stiffness) because different layers may
shift relative to each other with a lower force, and will also
yield a lower articulation force for the sheath 414 and/or smaller
bending radius for the sheath 414. However, in other embodiments,
if the anchor strength of the coil 474 is desired to be improved,
the coil 474 may still be braided to a reinforcement layer, such as
a wire mesh or a spine.
[0425] In one or more of the embodiments of the catheter 412 and
the sheath 414 described herein, the catheter 412 and/or the sheath
414 may not include any spine structure and/or any braided layer.
This may have the benefit of further improving the flexibility of
the catheter 412 and/or the sheath 414 at the articulating
section.
[0426] To illustrate the benefits of the configurations of the
catheter 412 and the sheath 414 described herein, a method of
reaching a target region using a catheter and a sheath will be
described. In particular, FIG. 45 shows a catheter C inserted in
the right common femoral artery. The tip of the sheath C is
positioned in the right common iliac artery and the catheter C is
extended from the tip of the sheath to reach the iliac bifurcation.
Next, the steerable distal section of the catheter C is pulled back
and articulated towards the left common iliac artery and the
guidewire G is advanced out from the tip of the catheter C. The
guidewire G is then advanced towards the left external iliac
artery. Once the guidewire G is advanced far enough to provide
sufficient support for the catheter C, the control wires in the
catheter C can be slacked (by removing tension in the control
wires). This lowers the distal stiffness, and allows the catheter C
to track more easily over the guidewire. If the catheter C is
advanced distally at this point, the catheter C may sometimes
follow the guidewire G over the bifurcation and into the left
common iliac artery (as illustrated by the dashed path). However,
in some patients with tight iliac bifurcations, the catheter C may
not follow the guidewire G, but instead will prolapse up into the
aorta. The force applied at the point of insertion is in the
direction of the aorta, and so the catheter C may tend to move in
that direction.
[0427] By providing the sheath 414 with the features described
herein, the sheath 414 can be advanced forward and the distal
articulation section of the sheath 414 can be articulated towards
the left common iliac (FIG. 46) to support the leader. Once the
sheath 414 is in this position, the shape of the sheath 414 can be
locked by maintaining tension on the control wires. Next, the
catheter 412 can be advanced, and the catheter 412 will deflect off
the sheath 414 (rather than the artery wall), and can be advanced
into the left common iliac (instead of prolapsing up into the
aorta). As the catheter 412 is advanced through the deflected
sheath 414, the tension on the control wire(s) of the catheter 412
is removed, and the distal steering section of the catheter 412 is
allowed to straighten or to conform to whatever shape imposed by
the shape of the sheath 414. As such, the shaft of the catheter 412
will follow through the articulated sheath 414. The articulated
sheath 414 functions like a pre-shaped or curved lumen for the
catheter 412 to be advanced therethrough. Since the sheath 414
provides the support to direct the path of the catheter 412 over
the bifurcation, no tension is required on the control wires of the
catheter 412 to track over the bifurcation in this example.
Therefore, even if the iliac bifurcation is at a very tight angle
(in some cases up to 180.degree.), the catheter 412 can still be
advanced through the sheath lumen without placing any stress or
shearing forces on the wall of the artery. The insertion force may
increase on the catheter 412 as the bifurcation angle gets tighter,
but the loads are being applied to the inside of the sheath 414,
and not to the patient anatomy. In some embodiments, the steerable
sheath 414 may be adjusted to ensure that its position and/or shape
can be maintained on the sheath distal section as the catheter 412
is advanced through the sheath 414. For example, the instrument
driver assembly 408 may compensate for the increased load by
pulling more on the control wires or slightly withdraw the sheath
414 to ensure that the sheath 414 will not damage the artery wall.
In some embodiments, during the procedure, the inner surface of the
sheath 414 and/or the outer surface of the catheter 412 may
optionally be coated with a lubricous coating.
[0428] As illustrated in the above example, the sheath 414 or
leader may be articulated to have a tight bend during a procedure.
Embodiments of the sheath 414 and leader described herein allow
this to happen. In particular, the control wire coils 474 in the
sheath 414 or leader isolate the articulation loads from the shaft,
thereby allowing the sheath 414 or leader shaft to be manufactured
from low durometer flexible materials. As a result, the
articulation loads are resolved via the control wire coils 474
which have a relatively high axial stiffness and low bending
stiffness. These control wire coils 474 allow the distal section of
the sheath 414 or leader to be articulated to a small radius, and
at the same time, the proximal section of the sheath 414 or leader
can be maintained very flexible.
[0429] FIGS. 47 and 48 illustrate another method for advancing the
sheath 414 and the catheter 412 over the iliac bifurcation. In this
technique, the catheter 412 is positioned with its distal
articulation section traversing the iliac bifurcation and it is
locked in this position. Embodiments of the catheter 412 described
herein allows the catheter 412 to reach tight angle that may be
encountered during the procedure. Next, the sheath 414 is advanced
over the catheter 412, and the catheter 412 acts as a rail held in
a fixed shape for the sheath 414 to glide over. As the sheath 414
is advanced further, sections with higher bending stiffness on the
sheath 414 will pass over the articulated section of the catheter
412, putting an increase load on the catheter 412. The increase in
load on the catheter 412 may tend to straighten the catheter 412.
Embodiments of the catheter 412 described herein allows the
catheter 412 to maintain its bent shape by tightening the control
wire(s), which has the effect of stiffening the catheter 412. In
some embodiments, the robotic system is configured to detect the
increased load on the control wires (due to the placement of the
sheath 414 over the catheter 412) to be detected. The operator, or
the robotic system, can then apply an equal counteracting load on
all the control wires of the catheter 412 to ensure that its bent
shape is maintained while the sheath 414 is advanced over the iliac
bifurcation.
[0430] The doctor can continue to advance the catheter 412 through
the articulated sheath 414. He can continue to steer the tip of the
catheter 412 to access the required points of interest in the
patient's left leg (FIG. 48). In particular, FIG. 48 shows how the
catheter 412 can be articulated to reach the left internal iliac
artery. This articulation of the catheter 412 is carried out
simultaneously with the continued insertion of the catheter 412.
This requires the shaft of the catheter 412 to remain flexible at
all times even when high articulation loads are being applied to
bend the articulation section. Embodiments of the catheter 412
described herein allow this to happen. In particular, the control
wire coils 442 in the catheter 412 isolate the articulation loads
from the catheter shaft, thereby allowing the catheter 412 shaft to
be manufactured from low durometer flexible materials. As a result,
the articulation loads are resolved via the control wire coils 442
which have a relatively high axial stiffness and low bending
stiffness. These control wire coils 442 allow the distal section of
the catheter 412 to be very bendable, and at the same time, the
proximal section of the catheter 412 can be maintained very
flexible. Also, in some cases, the design of the catheter 412
described herein obviates the need to maintain the proximal section
of the catheter 412 to be straight during use, which may be the
case with some existing catheters. In particular, the embodiments
of the catheter 412 described herein allow high degrees of
bendability at the distal section of the catheter 412 while also
allowing a flexible proximal and middle segments. This achieves
consistent bending at the distal section of the catheter 412 which
is independent of the shape of the proximal section of the catheter
412.
[0431] As illustrated in the above embodiments, the catheter design
is advantageous over existing catheters. In steerable catheters,
when the steering wire in the wall of a catheter is pulled, a pull
force F.sub.p is applied through the centre line of the pullwire. A
reaction force is then generated by the catheter body to resist
this pull force. This reaction force F.sub.r is typically applied
uniformly around the body or circumference of the catheter. The
summation of the reaction force F.sub.R is applied on the center
line of the catheter. The offset between the pull force and the
reaction force generates a moment at the tip of the catheter. This
moment is what causes the catheter to bend. In some catheters in
which the entire length of a catheter is built with a uniform
bending stiffness, then the entire catheter would bend uniformly.
Such configuration does not result in bending of the distal section
only. Some other existing catheters have attempted to address this
issue by substantially increasing the bending stiffness in the
proximal section of the catheter and leaving the distal section of
the catheter very flexible. In this situation, when the wire is
pulled, the proximal section bends only slightly (because it is
stiffer) and the majority of the displacement occurs at the softer
distal section. While this solution (of stiffening the proximal
end) is applicable for some catheters, it will not work where the
proximal section of the catheter is required to remain very
flexible to traverse through tortuous anatomy such as in vascular
applications. Each of the steering wires are offset from the center
line of the catheter and so when the wires are tensioned to steer
the catheter tip, the resulting compressive forces on a flexible
catheter shaft cause unwanted stiffening of the catheter shaft,
especially in the proximal section, which is undesirable. Other
steerable catheters and endoscopes attempt to overcome this problem
by moving the pull wires to the center of the catheter at the
proximal section. By moving the pullwires to the centerline of the
catheter, unwanted deflection in the shaft is eliminated, and
stiffening of the catheter at the proximal section is somewhat
reduced. However, this solution will not work in situation in which
an open lumen down the center of the catheter is required.
[0432] Embodiments of the catheter design described herein
addresses all of the above problems and is specifically applicable
for catheters that require (1) significant articulation performance
at the distal end, (2) a very flexible catheter shaft (especially
at the proximal section), and (3) an open lumen through the middle
of the catheter to deliver therapy or other devices. The design
involves putting an axially stiff tube (e.g., coil) into the wall
of the shaft and using this tube to isolate the steering loads from
the catheter shaft. As a steering wire is pulled, the reaction load
F.sub.r is applied uniformly by the wall of the coil, and the
summation of the reaction force is now applied through the center
of the coil pipe and not the center of the catheter. The proximal
section of the coil may be tightly wound to take the reaction
force. Because of this, the pull force F.sub.p of the steering wire
and the reaction force F.sub.R by the coil are collinear and there
is no moment generated in the proximal section of the catheter. The
coil in the distal section remains loosely wound so it does not
take any axial load and applies no reaction force. Therefore, the
reaction force at the distal section of the catheter will continue
to be applied about the centerline (or cross sectional centroid) of
the catheter. This ensures that there is a moment generated at the
distal section of the catheter and so the tip continues to bend
when a pull force is applied to the wire. The additional benefit of
placing an axially stiff member in the wall of the catheter is that
it shifts the neutral axis from the catheter cross sectional
centroid to the cross sectional centroid of the coil. There is
significant benefit for articulation consistency when the pullwire
is on the neutral axis. Therefore, this design biases the neutral
axis of the catheter to make it collinear with a pullwire in the
wall at the proximal section. The above design allows the catheter
shaft (at least the proximal section) to be made from very flexible
material. This ensures that the proximal section of the catheter
can freely bend independently to fit through tortuous anatomy,
regardless of how the distal section is steered.
[0433] In the above procedures, the catheter 412 and the sheath 414
work together in a telescoping motion to minimize stress on the
wall of the arteries. Although the procedure is described with
reference to traversing a tight iliac bifurcation, in other
embodiments, the similar technique may be used to access other
locations in the patient. For example, in other embodiments,
similar technique may be used to access carotid arteries with tight
take off angles from the aortic arch.
[0434] In some embodiments, after the catheter 412 has been driven
to a desired location, a valve (shown in FIG. 49) on the proximal
end of the catheter 412 or sheath may be tightened, and the doctor
may then inject contrast through the catheter 412 or sheath to
perform a selective angiogram of the region of interest. The
passive hemostatic seal on the proximal end of the sheath is
supported by a Touhy Borst fitting on the illustrated embodiment to
ensure that it can maintain the high injection pressures. Once the
contrast injection is complete, the Touhy Borst fitting is loosened
and the passive valve continues to ensure hemostasis against the
surface of the guidewire. FIGS. 50A-50C show the Touhy Borst valve
in further details. In particular, FIGS. 50A and 50B illustrate
front and back perspective views of a valve assembly 484 which is
configured to be coupled at its distal end to a support tube 483
and configured to receive the guide wire 482 co-axially at its
proximal end. FIG. 50C illustrates an exploded view of the valve
assembly 484 including a tube nut 485, a flush joint 486, a passive
valve 487, a cap 488, a valve body 489, a Touhy Borst body 490, a
Touhy Borst seal 491, and a Touhy Borst nut 492. The passive valve
487 has a slit that is configured to hold hemostasis when nothing
is inserted therethrough. The cap 488 has a hole that is configured
to hold hemostasis when a wire or a catheter is inserted through
it. The support tube 483 which can be coupled to the guide catheter
(not shown) at its distal end can be inserted into the flush joint
486 and locked into position by tightening the tube nut 485. The
guide wire 482 can be inserted through the proximal end of the
Touhy Borst nut 492 and through the central lumen of the remainder
of the valve assembly 484 eventually being fed co-axially into the
support tube 483 and ultimately the guide catheter. Alternatively,
the Touhy Borst can be tightened onto the leader catheter to
facilitate contrast injection through the sheath. The Touhy Borst
nut 492 is tightened to compress the Touhy Borst seal 491 into a
sealed or completely sealed position. During operation, fluid may
be introduced through a flush port 493 on the flush joint 486. The
passive valve 487 acts as a one-way valve which allows the guide
wire 482 to be inserted towards the distal end of the valve
assembly 484 but prevents fluid from flowing towards the proximal
end of the valve assembly. Thus the pressurized fluid is forced to
flow through the support tube 483, and the flush of contrast is
delivered to the region of the vasculature. The Touhy Borst seal
491 may be used as a secondary seal in the case where high pressure
fluid is introduced which cannot be contained by the passive seal
487. In one or more of the embodiments described herein, the valve
may be adjustable such that it will seal automatically as the
contrast injection pressure is being applied. Also, in other
embodiments, instead of using a Touhy Borst valve, other types of
valve may be used.
[0435] Also, in some embodiments, once the guide wire 482 has been
positioned distal of a stenosis in an artery, the catheter 412 can
be withdrawn completely from the sheath 414, leaving the wire 482
and the sheath 414 in place. Next, a therapy of choice can be
selected, and delivered over the wire 482 to the site of interest.
By means of non-limiting examples, the therapy can range from
balloon expandable stents, self expanding covered and/or uncovered
stent, as well as a range of artherectomy devices that can traverse
over the wire 482. As the therapy is being delivered, the user
continues to have the ability to steer the distal end of the sheath
414 to help ensure that the therapy can be delivered to the desired
location. For example, as the therapy is being delivered through
the anatomy, the sheath 414 may tend to move away from the target
location. The doctor can adjust tension on the control wires of the
sheath 414 as required to compensate for this movement and ensure
that the therapy will reach the required location.
[0436] III. Bedside Configuration
[0437] FIGS. 51A-51F illustrate another robotic surgical system 400
in accordance with other embodiments. The robotic surgical system
400 is similar to the embodiment described previously, except that
it further has both a bed-side control 402 and a bed-side display
(not shown). The bed-side control 402 is configured to provide some
or all of the functions that the workstation can provide, so that
the physician can perform most robotic catheter control tasks at
either the workstation or the bed-side.
[0438] The system 400 also includes a setup mount (setup joint) 404
that is similar to that discussed previously. However, in the
illustrated embodiments, the setup mount 404 is mounted to the
patient support 22 via a rail system 406. The rail system 406
allows the setup mount 404 (and therefore, the instrument driver
assembly 16) to translate along the length of the patient support
22. In some embodiments, the rail system 406 includes a motorized
rail 407, that can be actuated to drive movement of the setup mount
404. In other embodiments, other mechanisms may be used, including
but not limited to a lead screw, a ball screw, linear motor, belt,
and/or cable drive, etc. The movement of the setup mount 404 along
the rail may be caused by entering a command at the workstation, or
at the bedside control 402. In other embodiments, the setup mount
404 may be allowed to move by actuating a button at the setup mount
404, thereby releasing the setup mount 404 from a locked position
against the rail system 406. The setup mount 404 can then be
translated manually along the axis of the patient support 22. When
the setup mount 404 has reached a desired position, the button may
be released to lock the setup mount 404 at the desired position.
Setup mount/joint has been described in U.S. Pat. No. 7,789,874,
filed on Jul. 1, 2005, the entire disclosure of which is expressly
incorporated by reference herein. Alternatively, the movement of
the setup mount 404 along the rail may be controlled using the
workstation 2 and/or the bedside control 402. In one or more of the
embodiments described herein, any of the controls, including
release lever/button, may be implemented at any location, such as
at the bedside control 402, at the workstation 2, on the side
opposite from the side at which the bedside control 402 is located,
etc. Also, in some embodiments, two release levers/buttons may be
provided, with one located on the doctor's side (e.g., at the
bedside control 402), and another one on the back side for ease of
service and safety.
[0439] Also, in other embodiments, the rail system 406 may be
configured to tilt the setup mount 404 (as illustrated by the
arrows in FIG. 51G) in response to command entered at the
workstation 2 and/or the bedside control 402. In some cases, the
tilting range of the angle can be up to 20.degree. or higher. Such
configuration allows the insertion trajectory of the catheter 412
and/or the sheath 414 to be tilted (e.g., relative to the bed). In
other embodiments, the rail system 406 may be configured to move in
other directions in other degrees of freedom. For example, in other
embodiments, the rail system 406 may move up and down to adjust the
height, and/or laterally towards either side of the bed. In further
embodiments, the rail system 406 may roll (e.g., tilted about its
longitudinal axis). Also, in one or more of the embodiments
described herein, there may be an angular motion or indexed tilt of
the rail about any axis to better align with the catheter
insertion, and compensate for any sagging of the catheter or an
anti-buckling device (which is described herein). In further
embodiments, the rail system 406 may have a 10 degree angle (or
other angles) incline. In the embodiments shown in FIG. 51A, the
rail shark fin (the triangular plate on one side of the bed) is
configured to allow adjustment of the rail incline in 5 degree
increments up to 20 degrees.
[0440] The robotic system 400 also includes an instrument driver
assembly 408. The instrument driver assembly 408 includes a
catheter drivable assembly 182 for positioning a catheter 412, and
a sheath drivable assembly 184 for positioning a sheath 414 that is
placed coaxially around the catheter 412. The instrument driver
assembly 408 is similar to that discussed previously. In the
illustrated embodiments, the sheath drivable assembly 184 is
moveable relative to the catheter drivable assembly 182. Each of
the drivers 82, 84 has four drivable elements for moving the
catheter 412, and the sheath 414, respectively, in different
directions. In other embodiments, the number of drivable elements
in each of the drivers 82, 84 may be less than four or more than
four. The instrument driver assembly 408 also includes two
anti-buckling devices 500a, 500b for preventing the buckling of the
catheter 412, and the buckling of the sheath 414 during use. The
anti-buckling devices will be described in further detail below.
The instrument driver assembly 408 further includes a guide wire
manipulator 410 for positioning a guidewire (not shown) that may be
placed within a lumen of the catheter 412.
[0441] IV. Driving Modes and Clinical Applications
[0442] The instrument driver assembly 408 may be configured to move
the sheath 414 distally or proximally, move the catheter 412
distally or proximally, and to move the guidewire distally or
proximally. In some cases, the movement of the sheath 414 may be
relative to the catheter 412, while the catheter 412 remains
stationary. In other cases, the movement of the catheter 412 may be
relative to the sheath 414 while the sheath 414 remains stationary.
Also, in other cases, the sheath 414 and the catheter 412 may be
moved together as a unit.
[0443] The guidewire may be moved relative to the sheath 414 and/or
the catheter 412. Alternatively, the guidewire may be moved
together with the sheath 414 and/or the catheter 412.
[0444] In some embodiments, each of the workstation 2 and the
bedside control 402 is configured to provide some or all of the
following commanded motions (driving modes) for allowing the
physician to choose. In some embodiments, each of the driving modes
may have a corresponding button at the workstation 2 and/or the
bedside control 402.
[0445] Guidewire Insert--When this button/command is selected, the
guide wire manipulator 410 inserts the guidewire at a constant
velocity.
[0446] Guidewire Roll--When this button/command is selected, the
guide wire manipulator 410 rolls the guidewire at a constant
angular velocity
[0447] Guidewire Size--When the size or gauge of the guidewire is
inputted into through the user interface, the system will
automatically alter roll and insert actuation at the proximal end
of the guidewire accordingly to achieve desired commanded results.
In one implementation, when a user inputs the guidewire size, the
system automatically changes its kinematic model for driving that
guidewire. So if the user commands a guidewire to move to a certain
position, the system will calculate, based on the kinematic model,
roll and insert commands, which may be different for different
guidewire sizes (e.g., guidewires with different diameters). By
inputting the guidewire size, the system knows which kinematic
model to use to perform the calculation. Such feature is beneficial
because different sized guidewires behave differently.
[0448] Leader/Sheath Select--When this button/command is selected,
it allows the user to select which device (e.g., catheter 412,
sheath 414, guidewire, or any combination of the foregoing) is
active.
[0449] Leader/Sheath Insert/Retract--When this button/command is
selected, the instrument driver assembly 408 inserts or retracts
the catheter 412/sheath 414 while holding the guidewire and any
non-active device fixed relative to the patient. When this motion
causes the protruding section of the catheter 412 to approach zero
(due to insertion of the sheath 414 or retraction of the catheter
412), the system automatically relaxes the catheter 412 as part of
the motion.
[0450] Leader/Sheath Bend--When this button/command is selected,
the instrument driver assembly 408 bends the articulating portion
of the catheter 412/sheath 414 within its currently commanded
articulation plane.
[0451] Leader/Sheath Roll--When this button/command is selected,
the instrument driver assembly 408 uses the pullwires to "sweep"
the articulation plane of the device (catheter 412 and/or sheath
414) around in a circle through bending action of the device. Thus,
this mode of operation does not result in a true "roll" of the
device in that the shaft of the device does not roll. In other
embodiments, the shaft of the device may be configured to rotate to
result in a true roll. Thus, as used in this specification, the
term "roll" may refer to an artificial roll created by seeping a
bent section, or may refer to a true roll created by rotating the
device.
[0452] Leader/Sheath Relax--When this button/command is selected,
the instrument driver assembly 408 gradually releases tension off
of the pullwires on the catheter 412/sheath 414. If in free space,
this results in the device returning to a straight configuration.
If constrained in an anatomy, this results in relaxing the device
such that it can most easily conform to the anatomy.
[0453] Guide Wire Lock--When this button/command is selected, the
guide wire position is locked to the leader position. As the leader
is articulated or inserted, the guide wire moves with the leader as
one unit.
[0454] System Advance/Retract--When this button/command is
selected, the instrument driver assembly 408 advances/retracts the
catheter 412 and sheath 414 together as one unit. The guidewire is
controlled to remain fixed relative to the patient.
[0455] Autoretract--When this button/command is selected, the
instrument driver assembly 408 starts by relaxing and retracting
the catheter 412 into the sheath 414, and then continues by
relaxing and retracting the sheath 414 with the catheter 412 inside
it. The guidewire is controlled to remain fixed relative to the
patient.
[0456] Initialize Catheter--When this button/command is selected,
the system confirms that the catheter 412 and/or the sheath 414 has
been properly installed on the instrument driver assembly 408, and
initiates pretensioning. Pretensioning is a process used to find
offsets for each pullwire to account for manufacturing tolerances
and the initial shape of the shaft of the catheter 412 and/or the
sheath 414.
[0457] Leader/Sheath Re-calibration--When this button/command is
selected, the instrument driver assembly 408 re-pretensions the
catheter 412 and/or the sheath 414 in its current position. This
gives the system the opportunity to find new pretension offsets for
each pullwire and can improve catheter driving in situations where
the proximal shaft of the catheter 412 has been placed into a
significant bend such as after crossing the illiac bifurcation. It
is activated by holding a relax button down for several seconds
which ensures that the device is fully de-articulated.
Alternatively the re-calibration may be activated without holding
down the relax button to de-articulate the device.
[0458] Leader Relax Remove--When this button/command is selected,
the instrument driver assembly 408 initiates a catheter removal
sequence where the catheter 412 is fully retracted into the sheath
414, all tension is released from the pullwires, and the splayer
shafts (at the drivable assembly 182 and/or drivable assembly 184)
are driven back to their original install positions so that the
catheter 412 can be reinstalled at a later time.
[0459] Leader Yank Remove--When this button/command is selected,
the instrument driver assembly 408 initiates a catheter removal
sequence where the leader is removed manually.
[0460] Emergency Stop--When this button/command is selected, the
instrument driver assembly 408 initiates a gradual (e.g., 3 second)
relaxation of both the catheter 412 and the sheath 414. The
components (e.g., amplifier) for operating the catheter 412,
guidewire, or another device are placed into a "safe-idle" mode
which guarantees that no power is available to the motors that
drive these elements, thereby bringing them rapidly to a stop, and
allowing them to be manually back-driven by the user. Upon release
of the emergency stop button, the system ensures that the catheter
412 is still in its allowable workspace and then returns to a
normal driving state.
[0461] Segment control: In some embodiments, the workstation 2
and/or the bedside control 402 allows a user to select individual
segment(s) of a multi-segment catheters (such as the combination of
the catheter 412 and the sheath 414), and control each one. The
advantage of controlling the catheter in this way is that it allows
for many options of how to control the movement of the catheter,
which may result in the most desirable catheter performance. To
execute this method of catheter steering, the user selects a
segment of the catheter to control. Each segment may be telescoping
or non-telescoping. The user may then control the selected segment
by bending and inserting it using the workstation 2 and/or the
bedside control 402 to control the position of the end point of the
catheter. Other segment(s) of the catheter will either maintain
their previous position (if it is proximal of the selected section)
or maintain its previous configuration with respect to the selected
section (if it is distal of that section) (FIG. 52A).
[0462] Follow mode: In some embodiments, the workstation 2 and/or
the bedside control 402 allows the user to control any telescoping
section while the more proximal section(s) follows behind
automatically. This has the advantage of allowing the user to focus
mostly on the movement of a section of interest while it remains
supported proximally. To execute this method of catheter steering,
the user first selects a telescoping section of the catheter to
control.
[0463] This section is then controlled using the workstation 2
and/or the bedside control 402 to prescribe a location of the
endpoint of the segment. Any segment(s) distal of the section of
interest will maintain their previous configuration with respect to
that section. When the button on the workstation 2 or the bedside
control 402 is released, any segment(s) proximal of the section of
interest will follow the path of the selected section as closely as
possible until a predefined amount of the selected section remains
(FIG. 52B). As an alternative to this driving mode, the segment(s)
of the catheter which is proximal of the section of interest could
follow along as that segment is moved instead of waiting for the
button to be released. Furthermore, with either of these automatic
follow options, the system may optionally be configured to
re-pretension the sections that have been driven out and re-align
the sections that are proximal of the driven section.
[0464] Follow mode may be desirable to use to bring the more
proximal segments of the catheter towards the tip to provide
additional support to the distal segment. In cases where there are
three or more controllable sections of the catheter, there are
several options for how to execute a "follow" command. Consider the
example in FIG. 52D where the distal segment has been driven out as
shown in frame 1. The "follow" command could be executed by
articulating and/or inserting only the middle segment of the
catheter as shown in frame 2. The "follow" command could be
executed by articulating and/or inserting only the most proximal
segment of the catheter as shown in frame 3. The "follow" command
could also be executed by coordinating the articulation and/or
insertion of multiple proximal segments of the catheter as shown in
frame 4. Combining the motion of multiple sections has several
potential advantages. First, it increases the total
degrees-of-freedom available to the algorithm that tries to fit the
shape of the following section(s) to the existing shape of the
segment being followed. Also, in comparison to following each
segment sequentially, a multi-segment follow mode simplifies and/or
speeds up the workflow. In addition, multi-segment increases the
distance that can be followed compared to when only one proximal
segment is used to follow the distal segment.
[0465] Mix-and-match mode: In some embodiments, the workstation 2
and/or the bedside control 402 allows the user to have the option
of mixing and matching between articulating and inserting various
sections of a catheter. For example, consider the illustration in
FIG. 52C, and assuming that the distal most section of the catheter
is the "active" segment. If the user commands a motion of the tip
of the catheter as indicated by the arrow in Frame 1, there are
several options available for how to achieve this command: (1)
Articulate and extend the "active" segment, which is illustrated in
frame 3 and is likely considered the normal or expected behavior;
(2) Articulate the active distal most segment and insert one of the
other proximal segments, as illustrated in frames 2 and 4; (3)
Articulate the active distal most segment and combine inserting
motion of some or all of the segments, as illustrated in frame
5.
[0466] There are multiple potential reasons why the user might want
to choose some of these options. First, by "borrowing" insert
motion from other segments, some of the segments could be
constructed with fixed lengths. This reduces the need for segments
to telescope inside of each other, and therefore reduces the
overall wall thickness. It also reduces the number of insertion
degrees-of-freedom needed. Also, by combining the insert motion
from several segments, the effective insert range-of-motion for an
individual segment can be maximized. In a constrained space such as
the vasculature, the operator may likely be interested in
"steering" the most distal section while having as much effective
insertion range as possible. It would simplify and speed up the
workflow to not have to stop and follow with the other
segments.
[0467] Locking mode: In some embodiments, the workstation 2 and/or
the bedside control 402 may be configured to allow any of the
section (e.g., proximal section) of a catheter to be "locked" into
a given shape. Some driving modes that may take advantage of such
feature include: (1) Locking the proximal segment into its current
shape after each motion of the proximal segment is executed.
[0468] The proximal section would then unlock whenever it is given
another follow motion command. These motion commands would be
either direct driving of the most proximal section or following of
the more distal sections. (2) Leave the proximal section flexible
for insertion by hand, then lock the proximal section once the
catheter is attached to the robotic system. The proximal section
could then be unlocked again for further manual insertions, either
by removing the catheter from the instrument driver assembly 408 or
by releasing the brake on the setup joint 404. For any of these
options, the locking portion could be: (1) The proximal (actively)
articulating segment, (2) some or all of the "body" of the catheter
proximal of the actively articulating segments, or (3) both the
proximal actively articulating segment and some portion of the
non-articulating "body" of the catheter.
[0469] In other embodiments, the "follow" mode may be carried out
using a robotic system that includes a flexible elongated member
(e.g., a guidewire), a first member (e.g., the catheter 412)
disposed around the flexible elongated member, and a second member
(e.g., the sheath 414) disposed around the first member. The
flexible elongated member may have a pre-formed (e.g., pre-bent)
configuration. In some embodiments, the flexible elongated member
may be positioned inside a body. Such may be accomplished using a
drive mechanism that is configured to position (e.g., advance,
retract, rotate, etc.) the flexible elongated member. In one
example, the positioning of the flexible elongated member comprises
advancing the flexible elongated member so that its distal end
passes through an opening in the body.
[0470] Next, the first member is relaxed so that it has sufficient
flexibility that will allow the first member to be guided by the
flexible elongated member (that is relatively more rigid than the
relaxed first member). In some embodiments, the relaxing of the
first member may be accomplished by releasing tension in wires that
are inside the first member, wherein the wires are configured to
bend the first member or to maintain the first member in a bent
configuration. After the first member is relaxed, the first member
may then be advanced distally relative to the flexible elongated
member. The flexible elongated member, while being flexible, has
sufficient rigidity to guide the relaxed first member as the first
member is advanced over it. The first member may be advanced until
its distal end also passes through the opening in the body.
[0471] In some embodiments, the second member may also be relaxed
so that it has sufficient flexibility that will allow the second
member to be guided by the flexible elongated member (that is
relatively more rigid than the relaxed second member), and/or by
the first member. In some embodiments, the relaxing of the second
member may be accomplished by releasing tension in wires that are
inside the second member, wherein the wires are configured to bend
the second member or to maintain the second member in a bent
configuration. After the second member is relaxed, the second
member may then be advanced distally relative to the flexible
elongated member. The flexible elongated member, while being
flexible, has sufficient rigidity to guide the relaxed second
member as the second member is advanced over it. The second member
may be advanced until its distal end also passes through the
opening in the body. In other embodiments, instead of advancing the
second member after the first member, both the first member and the
second member may be advanced simultaneously (e.g., using a drive
mechanism) so that they move together as a unit. In further
embodiments, the acts of advancing the flexible elongated member,
the first member, and the second member may be repeated until a
distal end of the flexible elongated member, the first member, or
the second member has passed through an opening in a body.
[0472] In the above embodiments, tension in pull wires in the
second elongated member is released to make it more flexible than
the first elongated member, and the second elongated member is then
advanced over the first elongated member while allowing the first
elongated member to guide the second elongated member. In other
embodiments, the tension in the pull wires in the first elongated
member may be released to make it more flexible than the second
elongated member. In such cases, the more flexible first elongated
member may then be advanced inside the more rigid second elongated
member, thereby allowing the shape of the second elongated member
to guide the advancement of the first elongated member. In either
case, the more rigid elongated member may be locked into shape by
maintaining the tension in the pull wires.
[0473] In some of the embodiments described herein, the flexible
elongated member may be a guidewire, wherein the guidewire may have
a circular cross section, or any of other cross-sectional shapes.
Also, in other embodiments, the guidewire may have a tubular
configuration. In further embodiments, the robotic system may
further include a mechanism for controlling and/or maintaining the
preformed configuration of the guidewire. In some embodiments, such
mechanism may include one or more steering wires coupled to a
distal end of the guidewire. In other embodiments, such mechanism
may be the catheter 412, the sheath 414, or both. In particular,
one or both of the catheter 412 and the sheath 414 may be stiffened
(e.g., by applying tension to one or more wires inside the catheter
412 and/or the sheath 414). The stiffened catheter 412 and/or the
sheath 414 may then be used to provide support for the
guidewire.
[0474] Also, in some of the embodiments described herein, any
movement of the guidewire, the catheter 412, and/or the sheath 414
may be accomplished robotically using a drive assembly. In some
embodiments, the drive assembly is configured to receive a control
signal from a processor, and actuate one or more driveable elements
to move the guidewire, the catheter 412, and/or the sheath 414.
[0475] It should be noted that the driving modes for the system are
not limited to the examples discussed, and that the system may
provide other driving modes in other embodiments.
[0476] V. Clinical Applications
[0477] The different driving modes and/or different combinations of
driving modes are advantageous because they allow a tubular member
(catheter 412, sheath 414, or combination of both) to access any
part of the vasculature. Thus, embodiments of the system described
herein may have a wide variety of applications. In some
embodiments, embodiments of the system described herein may be used
to treat thoracic aneurysm, thoracoabdominal aortic aneurysm,
abdominal aortic aneurysm, isolated common iliac aneurysm, visceral
arteries aneurysm, or other types of aneurysms. In other
embodiments, embodiments of the system described herein may be used
to get across any occlusion inside a patient's body. In other
embodiments, embodiments of the system described herein may be used
to perform contralateral gait cannulation, fenestrated endograft
cannulation (e.g., cannulation of an aortic branch), cannulation of
internal iliac arteries, cannulation of superior mesenteric artery
(SMA), cannulation of celiac, and cannulation of any vessel (artery
or vein). In further embodiments, embodiments of the system
described herein may be used to perform carotid artery stenting,
wherein the tubular member may be controlled to navigate the aortic
arch, which may involve complex arch anatomy. In still further
embodiments, embodiments of the system described herein may be used
to navigate complex iliac bifurcations.
[0478] In addition, in some embodiments, embodiments of the system
described herein may be used to deliver a wide variety of devices
within a patient's body, including but not limited to: stent (e.g.,
placing a stent in any part of a vasculature, such as the renal
artery), balloon, vaso-occlusive coils, any device that may be
delivered over a wire, an ultrasound device (e.g., for imaging
and/or treatment), a laser, any energy delivery devices (e.g., RF
electrode(s)), etc. In other embodiments, embodiments of the system
described herein may be used to deliver any substance into a
patient's body, including but not limited to contrast (e.g., for
viewing under fluoroscope), drug, medication, blood, etc. In one
implementation, after the catheter 412 (leader) is placed at a
desired position inside the patient, the catheter 412 may be
removed, leaving the sheath 414 and guidewire to provide a conduit
for delivery of any device or substance.
[0479] In further embodiments, embodiments of the system described
herein may be used to access renal artery for treating
hypertension, to treat uterine artery fibroids, atherosclerosis,
and any peripheral artery disease.
[0480] In still further embodiments, embodiments of the system
described herein may be used to access any internal region of a
patient that is not considered a part of the vasculature. For
example, in some cases, embodiments of the system described herein
may be used to access any part of a digestive system, including but
not limited to the esophagus, liver, stomach, colon, urinary tract,
etc. In other embodiments, embodiments of the system described
herein may be used to access any part of a respiratory system,
including but not limited to the bronchus, the lung, etc.
[0481] In some embodiments, embodiments of the system described
herein may be used to treat a leg that is not getting enough blood.
In such cases, the tubular member may access the femoral artery
percutaneously, and is steered to the aorta iliac bifurcation, and
to the left iliac. Alternatively, the tubular member may be used to
access the right iliac. In one implementation, to access the right
iliac, the drive assembly may be mounted to the opposite side of
the bed (i.e., opposite from the side where the drive assembly is
mounted in FIG. 1). In other embodiments, instead of accessing the
inside of the patient through the leg, the system may access the
inside of the patient through the arm (e.g., for accessing the
heart).
[0482] In any of the clinical applications mentioned herein, the
telescopic configuration of the catheter 412 and the sheath 414
(and optionally the guidewire 482) may be used to get past any
curved passage way in the body, like that similarly discussed with
reference to FIGS. 45-48. For example, in any of the clinical
applications mentioned above, the guidewire 482 may be advanced
first, and then followed by the catheter 412, and then the sheath
414, in order to advance the catheter 412 and the sheath 414
distally past a curved (e.g., a tight curved) passage way. In other
embodiments, the catheter 412 may be advanced first, and then
followed by the sheath 414, in order to advance the catheter 412
and the sheath 414 distally past a curved (e.g., a tight curved)
passage way. In still further embodiments, the guidewire 482 may be
advanced first, and then followed by the catheter 412 the sheath
414 (i.e., simultaneously), in order to advance the catheter 412
and the sheath 414 distally past a curved (e.g., a tight curved)
passage way.
[0483] VI. Anti-Buckling Feature
[0484] FIG. 53A illustrates an implementation of the instrument
driver 408 that includes the first and second drivable assemblies
182, 184 removeably coupled to a base. The second drivable assembly
184 is slidable relative to the first drivable assembly 182. In the
illustrated embodiments, the drivable assembly 184 is configured to
control movement of a sheath, and the drivable assembly 182 is
configured to control movement of a catheter member that is
inserted into the sheath. During use, the drivable assembly 184 may
be controlled to move the sheath distally towards the patient, or
proximally. Also, the drivable assembly 182 may be controlled to
move the catheter member towards the patient, or proximally. In
another mode of operation, the drivable assembly 184 may maintain
the sheath to be stationary while the drivable assembly 182 moves
the catheter member distally or proximally relative to the sheath.
In still another mode of operation, the drivable assembly 182 may
maintain the catheter member to be stationary while the drivable
assembly 184 moves the sheath distally or proximally relative to
the catheter member. In another mode of operation, the drivers 182,
184 may cooperate with each other to move the catheter member and
the sheath together (either distally or proximally), so that the
catheter member with the sheath can translate as a unit.
[0485] As discussed, during an operation, the instrument driver
assembly 408 may be configured to advance an elongate member (e.g.,
the sheath, the catheter member, or combination of both, any of
which may be considered a medical device) distally towards the
patient. In some embodiments, the elongate member may be
constructed to be very flexible. In such cases, to prevent the
elongate member from buckling while the elongate member is advanced
towards the patient, an anti-buckling device may be coupled to the
instrument driver assembly 408 to support the elongate member.
[0486] FIG. 53B illustrates an anti-buckling device 500a that is
configured to detachably couple to the drivable assembly 184 and
the drivable assembly 182 during use. As shown in FIG. 53B, the
anti-buckling device 500a has a first end 504 for detachably
coupling to the drivable assembly 182, and a second end 506 for
detachably coupling to the drivable assembly 184. During use, the
anti-buckling device 500a is placed around the elongate member 490
(which may be a catheter member, or another elongate medical
device). The anti-buckling device 500a is then secured to the
drivable assembly 182 at the first end 504, and to the drivable
assembly 184 at the second end 506. The anti-buckling device 500a
provides support along the length of the elongate member 490
between the drivers 82, 84, so that as the elongate member 490 is
pushed towards the patient (resulting in the elongate member 490
being compressed), the catheter elongate 490 is prevented from
buckling.
[0487] FIG. 53C illustrates another variation of an anti-buckling
device 500b that is configured to detachably couple to the drivable
assembly 184 and a stabilizer 502 during use. As shown in FIG. 53C,
the anti-buckling device 500b has a first end 504 for detachably
coupling to the drivable assembly 184, and a second end 506 for
detachably coupling to the stabilizer 502. During use, the
stabilizer 502 is attached to a patient's skin, and the
anti-buckling device 500b is placed around the elongate member 490.
The elongate member 490 may be a sheath, a catheter member, a
combination of both the sheath and the catheter member, or another
elongate medical device. The distal end of the elongate member 490
is then inserted into the patient through the stabilizer 502. The
anti-buckling device 500b is secured to the drivable assembly 184
at the first end 504, and to the stabilizer 502 at the second end
506. The anti-buckling device 500b provides support along the
length of the elongate member 490 between the stabilizer 502 and
the drivable assembly 184, so that as the elongate member 490 is
pushed towards the patient (resulting in the elongate member 490
being compressed), the elongate member 490 is prevented from
buckling.
[0488] FIGS. 53D and 53E illustrate the anti-buckling device 500a
in further detail. The anti-buckling device 500a includes a first
coupler 508 at the first end 504, a second coupler 509 at the
second end 506, and a plurality of support members 510, 512, 514
coupled between the couplers 508, 509. The first coupler 508 has a
slot 530 configured (e.g., shaped and/or sized) to detachably mate
with an anchor element 532 at the drivable assembly 182 (FIG. 53H).
The second coupler 509 has a slot 534 for receiving a protrusion
537 at the drivable assembly 184, and an opening 536 for receiving
a shaft 538 at the drivable assembly 184 (FIG. 53I). The second
coupler 509 may be detachably coupled to the drivable assembly 184
by placing the second coupler 509 over the shaft 538, while
allowing the protrusion 537 to pass the initial entry point at the
coupler 509. The coupler 509 is then rotated to lock the protrusion
537 within the slot 534. In other embodiments, the coupler 509 may
have different configurations. For example, in other embodiments,
the coupler 509 may include an active valve connector hub that is
configured to detachably couple to an active valve release hub
(FIG. 53M). This configuration allows a user to connect the
connector hub to the active valve, and rotate it in order to open
or close the active valve as desired.
[0489] Returning to FIG. 53D, the support members 510 are on one
side of the anti-buckling device 500a, the support members 512 are
on the opposite side of the anti-buckling device 500a, and the
support members 514 are located in the middle between the first and
second sets of support members 510, 512. In the illustrated
embodiments, support members 510m 512 create the scissor mechanism.
The support members 514 create an additional set of linkages that
is offset from the support members 510, 512. The purpose of the
support members 514 is to hold the eyelets 540 in line. The
elongate member held between two eyelets 540 will have much greater
buckling resistance if the eyelets 540 are prevented from being
rotated. In other embodiments, the number of support members 510,
512, 514 may be different from that shown in the figure. In
particular, on one side of the anti-buckling device 500a, the
support members 510a, 510b are rotatably coupled to the coupler 509
via joint 524, and support members 510u, 510v are rotatably coupled
to the coupler 508 via joint 526. The rest of the support members
510c-510t are coupled together via joints 528 between the first and
second ends 504, 506 in a scissor-like configuration. In other
embodiments, the support members 514 are optional, and the
anti-buckling device does not include the support members 514.
[0490] As shown in FIG. 53E, on the other side of the anti-buckling
device 500a, the support members 512a, 512b are rotatably coupled
to the coupler 509 via joint 524, and support members 512u, 512v
are rotatably coupled to the coupler 508 via joint 526. The rest of
the support members 512c-512t are coupled together via joints 528
between the first and second ends 504, 506 in a scissor-like
configuration.
[0491] It should be noted that providing two sets of support
members 510, 512 are advantageous in that they collectively provide
sufficient stiffness for the anti-buckling device 500a in the
Y-direction so that the anti-buckling device 500a will not sag or
deflect significantly in the Y-direction between the supports at
ends 506, 506. In other embodiments, the support members 510 may be
made sufficiently stiff, and the joints coupling the various
components of the anti-buckling device 500a may be configured to
have a tight tolerance. In such cases, the anti-buckling device
500a may not require the second set of support members 512.
[0492] In the illustrated embodiments, the anti-buckling device
500a also includes a plurality of connectors 516 that connects the
support members 510, 512, 514. Each connector 516 includes a first
joint 518 for rotatably coupling to two of the support members 510,
a second joint 520 for rotatably coupling to two of the support
members 512, and a third joint 522 for rotatably coupling to two of
the support members 514.
[0493] As shown in FIG. 53K, the anti-buckling device 500a also
includes a plurality of holders 540 coupled between the first and
second sets of support members 510, 512 at the respective joints
528. Each holder 540 has an opening 542 for accommodating the
elongate member 490, a first joint 544 for rotatably coupling to
one of the support members 514, and a second joint 546 for
rotatably coupling to another one of the support members 514. The
support members 514 together with the holders 540 are configured to
support the elongate member 490 as the elongate member 490 is being
inserted into the patient. In particular, as the anti-buckling
device 500a is being extended (FIG. 52L) (e.g., by moving the ends
504, 506 further away from each other) or collapsed (FIG.
53D)(e.g., by moving the ends 504, 506 closer towards each other),
the support members 514 are configured to move the holders 540
along the longitudinal axis of the elongate member 490 relative to
the elongate member 490 so that the holders 540 are spaced
substantially evenly or equally along the axis of the elongate
member 490. In some embodiments, the holders 540 are considered to
be spaced substantially evenly or equally when their spacing does
not vary by more than 20%. The support members 514 also maintain
all of the holders 540 in the same orientation relative to each
other as the anti-buckling device 500a is being extended or
collapsed.
[0494] In one or more of the embodiments described herein, the
support members 510 (or members 512, or members 14) at one end
(e.g., end 504 or 506) of the anti-buckling device 500 may
optionally have mating gears (FIG. 53J). This ensures that the
support members 510/512/514 on either side of the longitudinal axis
541 along the length of the anti-buckling device 500 will rotate by
the same amount relative to the axis 541. This feature is also
advantageous because it ensures that the holders 540 will be
oriented so that the axis of the opening 542 for each of the
holders 540 is substantially parallel to the longitudinal axis 541
of the anti-buckling device 500.
[0495] As shown in the illustrated embodiments, the anti-buckling
device 500a provides a plurality of supports at the locations of
the holders 540 that are evenly spaced along the length of the
elongate member 490 regardless of how much the elongate member 490
is inserted into the patient (i.e., regardless of the distance
between the first and second ends 504, 506). The plurality of
supports shortens the buckling length of the elongate member 490,
thereby significantly improving the buckling strength of the
elongate member 490. It should be noted that the plurality of
supports will prevent the elongate member 490 from buckling in a
direction within the X-Z plane because the anti-buckling device
500a is very stiff in X-Z plane. Also, since the anti-buckling
device 500a is relatively stiffer than the elongate member 490 in
the Y-direction, the anti-buckling device 500a will also provide
supports for the catheter member in all directions within the Y-Z
plane to prevent the elongate member 490 from buckling in a
direction that is within the Y-Z plane.
[0496] In other embodiments, to increase the rigidity of the
anti-buckling device, the support members 510, 512, 514 may be
implemented using a combination of a composite beam and a plastic
beam (FIG. 53L). As shown in FIG. 53L, the composite beam may be
formed from two stainless steel members that are spaced apart from
each other with two stainless steel spacers therebetween. The
plastic beam may be a PEEK beam. The composite beam and the plastic
beam may be linked together to the connector 516 at one end via a
hinge (e.g., rivet(s)).
[0497] The anti-buckling device 500a may be made from a variety of
different materials. For example, in some embodiments, the support
members 510, 512, 514 may be made from metal, alloys, plastics,
polymers, etc. Also, in some embodiments, the connectors 516, and
the couplers 508, 509 may be made from metal, alloys, plastics,
polymers, etc. In addition, in one or more of the embodiments
described herein, any moving parts in the anti-buckling device that
contact each other may be made from the same material (e.g.,
stainless steel), or different materials (e.g., stainless steel for
one, and PEEK for the other). Making two contacting parts that
interact with each other with different respective materials is
advantageous because it may allow the moving parts to move
relatively to each other more easily without seizing. Furthermore,
in one or more of the embodiments described herein, one or more
components (e.g., support members 510, 512, 514) of the
anti-buckling device may be made from a light weight material, such
as PEEK (plastic), to reduce the overall weight of the
anti-buckling device. Also, in one or more of the embodiments
described herein, any of the joints (e.g., joints 520, joints 522,
or joints 528) may be implemented using pins (e.g., dowel pins),
rivets, or combination thereof. In one implementation, the support
members 510, 512, 514 may be made from stainless steel and/or PEEK,
the holders 540 may be made from PEEK, the rivets/pins may be made
from stainless steel, the component housing the rivets/pins may be
made from PEEK, and the end couplers 508, 509 (and similarly,
couplers 550, 552 in the second anti-buckling device 500b shown in
FIG. 53F) may be made from PEEK/Ultem.
[0498] The second anti-buckling device 500b is illustrated in
further detail in FIG. 53F. The anti-buckling device 500b has the
same configuration as the anti-buckling device 500a, except that it
is used to prevent buckling between the drive assembly 184 and the
insertion site or the patient. This insertion site may be at the
left or right femoral artery or alternatively may be the left or
right brachial artery, etc. Its proximal end 504 has a first
coupler 550 for detachably coupling to the drivable assembly 184,
and its distal end 506 has a second coupler 552 for detachably
coupling to the stabilizer 502 (FIG. 53C). The first coupler 550 of
the anti-buckling device 500b has the same configuration as the
second coupler 509 of the anti-buckling device 500a, and is
configured to detachably couple to a connector at the drivable
assembly 184 (FIG. 53G). As shown in FIG. 53G, the second coupler
552 has an opening 554 for allowing the elongate member 490 to
extend therethrough. The second coupler 552 also has a pair of
protrusions 556 for inserting into a slot at the stabilizer 502,
and a wall 558 for allowing the stabilizer 502 to anchor thereto.
The second coupler 552 may also be directly connected to the
introducer sheath at the insertion site.
[0499] Refer now to FIG. 54, the stabilizer 502 will now be
described in further detail. The stabilizer 502 includes a base 560
with adhesive at its bottom side for attachment to a patient's
skin, and a connector 562 for coupling with the coupler 552 of the
anti-buckling device 500b. Alternatively, the base 560 or the
coupler 552 may be attached to a bed or other support during use.
In some embodiments, the base 560 may be a HDPE platform that
includes a strain relief material underneath for providing
transition from the rigid HDPE material to the patient skin. The
base 560 may also include a butterfly peel-away liner (e.g.,
tear-resistant HDPE liner) that covers the adhesive material at the
bottom side of the platform. During use, the liner may be peeled
away to expose the adhesive at the bottom side of the base 560. The
stabilizer 502 also includes an opening 564 formed at the base 560
for allowing the elongate member 490 to reach the patient's skin.
The interface mechanism 564 includes a pair of slots 566 for
receiving the respective protrusions 556 at the coupler 552, and a
pair of moveable anchors 568 for anchoring against the wall 558 of
the coupler 552.
[0500] FIGS. 55A and 55B illustrate the stabilizer 502 in exploded
view, particularly showing the components of the stabilizer 502.
The connector 562 includes a bottom piece 570 with the two slots
562, a top piece 572, and two rotatable anchoring components 574,
576 located between the bottom piece 570 and the top piece 572. A
screw 580 is provided for extending through the top piece 572, and
the anchoring components 574, 576, to reach screw opening 578 at
the bottom piece 572, thereby coupling the various components
together. The connector 562 also includes a spring 582 (in the form
of an elastic plate, e.g., formed using a metal, alloy, or plastic)
for biasing the anchoring components 574, 576 so that their
respective anchors 568 are urged towards each other. During use,
when the coupler 552 is inserted into the slots 566, the insertion
force will push wall 558 of the coupler 552 towards the anchors
568, thereby spreading the anchors 568. When the coupler 552 is
further inserted into the slots 566, the wall 558 will pass the
anchors 568, thereby allowing the anchors 568 to close towards each
other due to the biasing force provided by the spring element 582.
The anchoring components 574, 576 also include respective levers
584, 586 for allowing a user to move the anchors 568 away from each
other. In particular, when the levers 584, 586 are pressed towards
each other, they bend the spring 582 against the curvilinear
support 588 at the bottom piece 570, thereby overcoming the biasing
force that was urging the anchors 568 towards each other. This
allows a user to remove the coupler 552 from the connector 562 at
the stabilizer 502.
[0501] As shown in FIG. 55C, in some embodiments, the system may
further include a lubricating system 680 coupled to the stabilizer
502. The lubricating system 680 is configured to apply fluid (e.g.,
saline, gel) onto the exterior surface of the catheter 412 as the
catheter 412 is being advanced through the lubricating system 680.
As shown in FIGS. 55D-55F, the lubricating system 680 includes a
base 684 and a cover 682 coupled to the base 684 via a joint 686.
The hinge 686 allows the cover 682 to be rotated relative to the
base 684, so that the system is always in contact with the catheter
irrespective of the angle of entry of the catheter into the
patient. As shown in FIG. 55F, the lubricating system 680 also
includes a slot 688 formed at the base 684, which is configured to
mate with the ring structure formed around the opening 554 at the
coupler 552 (FIG. 53G). The lubricating system 680 also includes an
absorbent material 690 underneath the cover 682, wherein the
material 690 has a slot or cut-portion 692 for applying fluid to
the catheter 412. During use, the catheter 412 exiting from the
opening 554 at the coupler 552 will go through the slot or
cut-portion 692, thereby contacting the absorbent material 690. The
absorbent material 690 will be sterile and will be soaked with
saline by the user at the start of the procedure and then it
automatically applies the fluid onto the surface of the catheter
412 as it passes therethrough. In some embodiments, the catheter
412 may be coated with a hydrophilic coating to reduce friction as
they are pushed through the anatomy. In such cases, the lubricating
system 680 may be used to hydrate the hydrophilic coating to
activate it. As illustrated in the above embodiments, the
lubricating system 680 provides a self lubricating or self
hydration mechanism for robotically controlled catheter. This is
advantageous because the doctor who is controlling the catheter
remotely would be unable to manually wet the catheter with a wet
guaze.
[0502] It should be noted that the anti-buckling device 500 is not
limited to the above configuration, and that the anti-buckling
device 500 may have other configurations in other embodiments. For
example, in other embodiments, instead of having three sets of
supports 510, 512, 514, the anti-buckling device 500 may include
only two sets of supports. FIG. 56 illustrates another
anti-buckling device 500 in accordance with other embodiments. The
anti-buckling device 500 is similar to the embodiments of FIGS. 52
and 53, except that it has one set of support members 510 on one
side of the anti-buckling device 500, and another set of support
members 514 next to the first set of support members 510 for
maintaining the holders 540 in the same orientation relative to
each other. In the embodiment of FIG. 56, the anti-buckling device
500 does not include the set of support members 512 like that shown
in FIG. 52. Also, unlike the embodiments of FIGS. 52 and 53, the
embodiment of FIG. 56 includes support members 514 only on one
side, wherein the support members 514 are coupled to the respective
joints 544 on only one side of the holders 540. In other
embodiments, additional support members 514 may be provided on the
opposite sides, in which case, the support members 514 will be
coupled to the respective joints 546 at the holders 540. The
anti-buckling device 500 shown in FIG. 56 may have different
connectors (not shown) at opposite ends, such as those shown in
FIGS. 52 and 53, for detachably coupling to different medical
devices/components.
[0503] As shown in FIG. 56, the support members 512 are relatively
thicker than those in FIGS. 52 and 53. Such configuration provides
sufficient stiffness for the anti-buckling device 500 in the
Y-direction while obviating the need for the third set of support
members 512, so that the anti-buckling device 500 will not sag or
deflect significantly.
[0504] In the embodiment of FIG. 56, the support members 514
together with the holders 540 are configured to support the
elongate member 490 as the elongate member 490 is being inserted
into the patient. In particular, as the anti-buckling device 500 is
being extended (e.g., by moving the ends 504, 506 further away from
each other) or collapsed (e.g., by moving the ends 504, 506 closer
towards each other), the support members 514 are configured to move
the holders 540 along the longitudinal axis of the elongate member
490 so that the holders 540 are spaced evenly along the axis of the
elongate member 490. The support members 514 also maintain all of
the holders 540 in the same orientation relative to each other as
the anti-buckling device 500 is being extended or collapsed.
[0505] As shown in the illustrated embodiments, the anti-buckling
device 500 provides a plurality of supports at the locations of the
holders 540 that are evenly spaced along the length of the catheter
member 90 regardless of how much the elongate member 490 is
inserted into the patient (i.e., regardless of the distance between
the first and second ends 504, 506). The plurality of supports
shortens the buckling length of the elongate member 490, thereby
significantly improving the buckling strength of the elongate
member 490. It should be noted that the plurality of supports will
prevent the elongate member 490 from buckling in a direction within
the X-Z plane because the anti-buckling device 500 is very stiff in
X-Z plane. Also, since the anti-buckling device 500 is relatively
stiffer than the elongate member 490 in the Y-direction, the
anti-buckling device 500 will also provide supports for the
elongate member 490 in the Y-direction to prevent the catheter
member 90 from buckling in a direction that is within the Y-Z
plane.
[0506] In any of the anti-buckling devices described herein, the
buckle resistance increases as the unsupported length of the
catheter gets shorter. The length of the catheter outside the
patient gets shorter as the catheter is advanced further into the
patient. Thus, as the catheter is being advanced into the patient,
the unsupported length of the catheter becomes shorter, resulting
in a higher buckling resistance provided to the catheter by the
anti-buckling device. Therefore, the anti-buckling device provides
a variable stiffness that allows the catheter's buckling capacity
to increase as the catheter is being advanced into the patient. The
further the catheter is advanced into the patient, the higher the
insertion force is required to advance the catheter. In some
embodiments, the buckle force of the anti-buckling device is always
higher than the catheter insertion force.
[0507] In one or more of the embodiments of the anti-buckling
device 500 described herein, the anti-buckling device 500 should
not be limited to the planar configuration, and the anti-buckling
device 500 may have a non-planar configuration. For example, as
shown in FIG. 57, the anti-buckling device 500 may have a
non-planar configuration that is formed by orienting the support
members 510 and the support members 514 in respective
truss-configurations. FIG. 57 shows the anti-buckling device 500 in
an extended configuration, and FIG. 58 shows the anti-buckling
device 500 in a collapsed configuration. FIG. 59 shows a cross
section of the anti-buckling device 500, particularly showing the
support members 510 forming a truss configuration, and the support
members 514 forming another truss configuration. In particular,
each support member 510 forms an angle 590 relative to the X-Z
plane, and each support member 514 forms an angle 592 relative to
the X-Z plane. In the illustrated embodiments, the anti-buckling
device 500 does not include the second set of support members 512.
However, in other embodiments, the anti-buckling device 500 may
optionally further include the second set of support members 512.
In such cases, the support members 512 will be coupled to the
joints 528 at the holders 540.
[0508] As shown in the illustrated embodiments of FIG. 57-59, the
anti-buckling device 500 provides a plurality of supports at the
locations of the holders 540 that are evenly spaced along the
length of the elongate member 490 regardless of how much the
elongate member 490 is inserted into the patient (i.e., regardless
of the distance between the first and second ends 504, 506). The
plurality of supports shortens the buckling length of the elongate
member 490, thereby significantly improving the buckling strength
of the elongate member 490. It should be noted that the plurality
of supports will prevent the elongate member 490 from buckling in a
direction within the X-Z plane because the anti-buckling device 500
is very stiff in X-Z plane. Also, due to the truss configurations
of the support members 510, 514, the anti-buckling device 500 is
also very stiff in the Y-direction. Thus, the anti-buckling device
500 will also provide supports for the elongate member 490 in the
Y-direction to prevent the elongate member 490 from buckling in a
direction that is within the Y-Z plane.
[0509] The anti-buckling device 500 shown in FIG. 57 may have
different connectors (not shown) at opposite ends, such as those
shown in FIGS. 52 and 53, for detachably coupling to different
medical devices/components.
[0510] FIG. 60 illustrates another anti-buckling device 500 in
accordance with other embodiments. The anti-buckling device 500 is
similar to the embodiment shown in FIG. 57, except that each
support members 510 has a different shape, and that the
anti-buckling device 500 also includes additional support members
512 on the opposite sides. Also, the support members 514 in the
anti-buckling device 500 of FIG. 60 are in the form of tension
wires. During use, the support members 514 keep the holders 542 all
aligned in the same orientation relative to each other.
[0511] In one or more of the embodiments described herein, the
anti-buckling device 500 may not include the set of support members
514 that link the holders 540 together. FIG. 61A illustrates a
variation of the anti-buckling device 500 that does not include any
linkage members 514 for the holders 540. In the illustrated
embodiments, the holders 540 are free to rotate relative to each
other. In such cases, the elongate member 490 may be made to have a
sufficient bending stiffness so that the bending stiffness of the
elongate member 490 will prevent each holder 540 from rotating too
much relative to the longitudinal axis of the anti-buckling device
500. In such cases, while the stiffness of the elongate member 490
is sufficient to rotatably guide the holders 540, it may be
insufficient to prevent buckling of the elongate member 490 (i.e.,
in the situation in which there is no anti-buckling mechanism).
During use, the anti-buckling device 500 may have an extended
configuration, like that shown in FIGS. 61A and 61C, or a collapsed
configuration, like that shown in FIGS. 61B and 61D.
[0512] FIG. 62 illustrates another variation of the anti-buckling
device 500 in accordance with other embodiments. The anti-buckling
device 500 includes a plurality of support members 600. Although
only two support members 600 are shown, in other embodiments, the
anti-buckling device 500 may include more than two support members
600. Each support member 600 has a first portion 602 and a second
portion 604 that are secured to each other at their respective
ends. The first portion 602 has an opening 606 that is aligned with
an opening 608 at the second portion 604. The openings 606, 608
allow the elongate member 490 to extend therethrough during use.
Each of the first and second portions 602, 604 has a curvilinear
profile. In one implementation, each of the portions 602, 604 may
be formed by bending a plate to a desired profile, and then
securing them relative to each other at their respective ends. In
other embodiments, each of the portions 602, 604 may not have a
curvilinear profile, and may instead have a rectilinear profile
(e.g., a U or C shape with straight portions).
[0513] In the illustrated embodiments, each of the support members
600 is elastic, and can be deformed during use. In particular, the
portions 602, 604 may be bent to vary the distance between the
openings 606, 608. For example, during use, the drivable assembly
184 may be moved towards the stabilizer 502 to move the elongate
member 490 distally. Accordingly, the anti-buckling device 500 of
FIG. 62, which is placed around the elongate member 490 during use,
is compressed. The compression of the anti-buckling device 500
causes the portions 602, 604 to bend towards each other, thereby
shortening the unsupported length of the elongate member 490
between the supports at the respective openings 606, 608.
[0514] The configuration of the anti-buckling device 500 of FIG. 62
is advantageous in that it has significantly fewer components
(compared to the embodiments of FIGS. 52 and 53). Also, the
anti-buckling device 500 of FIG. 62 does not require separate
holders and associated linkage for maintaining the holders in the
same orientation. Instead, the openings 606, 608 at the portions
602, 604 of each support member 600 will be aligned in the same
orientation as the anti-buckling device 500 is extended or
collapsed. Furthermore, because each of the openings 606, 608
circumscribes completely around the elongate member 490 during use,
each of the portions 602, 604 provides support against the elongate
member 490 to prevent the elongate member 490 from buckling in any
radial direction during use.
[0515] In other embodiments, the support members 600 do not need to
be oriented in the same direction. Instead, a first set of every
other support members 600 may be orientated in a first direction,
and a second set of every other support members 600 may be oriented
in a second direction that is perpendicular to the first direction
(FIG. 63).
[0516] FIG. 64A illustrates another anti-buckling device 500 in
accordance with other embodiments. The anti-buckling device 500 has
a first portion 620 and a second portion 622 that can be detachably
coupled to the first portion 620 in a zipper-like manner along the
length of the elongate member 490 during use. As shown in FIG. 64B,
the first portion 620 and the second portion 622 have respective
C-shape cross sections, and collectively define a space 624 for
housing the elongate member 490 during use. In other embodiments,
each of the first portion 620 and the second portion 622 does not
need to have a C-shape cross section, and may have other cross
sectional shapes as long as they provide support for the elongate
member 490 to prevent it from buckling. 620 and 622 do not
necessarily need to have C-shaped cross sections, and may have
other cross-sectional shapes in other embodiments. The design can
be adjusted to add bending stiffness as shown in FIG. 64C or
64D.
[0517] During use, the portions 620, 622 of the anti-buckling
device 500 is placed around the elongate member 490 (FIG. 64A). The
distal end of the anti-buckling device 500 is then secured to the
stabilizer 502 (e.g., using coupler 522 or another securing
mechanism). The anti-buckling device 500 may further include
supports 626, 628 that are proximal relative to the distal end of
the anti-buckling device 500. The supports 626, 628 are configured
to hold the portions 620, 622, respectively, as they are un-zipped.
The drivable assembly 184 may be advanced towards the stabilizer
502 to push the elongate member 490 distally, thereby shortening
the length between the stabilizer 502 and the drivable assembly
184. When this occurs, parts of the portions 620, 622 at their
proximal ends unzip and translate through the supports 626, 628.
Alternatively, the drivable assembly 184 may be retracted
proximally to move away from the stabilizer 502, thereby increasing
the length between the stabilizer 502 and the drivable assembly
184. Accordingly, parts of the portions 602, 622 will come together
and zip against each other in increase the support portion for the
elongate member 490. Thus, the amount of anti-buckling support
provided by the anti-buckling device 500 for the elongate member
490 automatically increases in response to an increase in the
unsupported length of the elongate member 490, and automatically
decreases in response to a decrease in the unsupported length of
the elongate member 490.
[0518] In other embodiments, the anti-buckling device 500 of FIG.
64A may be used to support other parts of the elongate member 490.
For example, in other embodiments, the anti-buckling device 500 may
provide anti-buckling support for the elongate member 490 that
spans between the drivable assembly 182 and the drivable assembly
184 (FIG. 53A).
[0519] FIG. 65A illustrates another anti-buckling device 500 in
accordance with other embodiments. The anti-buckling device 500
includes a plurality of tubes 640 that are arranged in a telescopic
configuration. The tubes 640 may have a circular cross section, or
other cross sectional shapes in other embodiments. During use, the
telescopic tubes 640 are placed around the elongate member 490. As
the drivable assembly 184 is advanced distally, the tubes 640
retracts relative to each other to form a shorten configuration. As
the driver is moved proximally, the tubes 640 extends out of their
respective neighboring tubes 640 to form a lengthen configuration.
The elongate member 490 is housed within the lumen formed
collectively by the tubes 640, and is prevented from buckling by
the wall of the tubes 640. It should be noted that at the larger
tubes 640 location, the elongate member 490 may not initially be in
contact with the wall of the tubes 640. However, as the elongate
member 490 is being compressed, the elongate member 490 will bend
slightly due to the axial compression force applied on the elongate
member 490. The bending of the elongate member 490 will bring the
elongate member 490 into contact with the wall of the relatively
larger tubes 640. When this happens, the tubes 640 will prevent the
elongate member 490 from bending further, and will prevent the
elongate member 490 from catastrophic buckling.
[0520] FIGS. 65D-65G illustrates an implementation of the
anti-buckling device 500 of FIG. 65A in accordance with some
embodiments. As shown in FIGS. 65F and 65G, each tube 640 has a
stopper 641 at one end, and another stopper 642 at the opposite
end. The stoppers 641, 642 are configured to couple the tubes 640
together, and prevent the tubes 640 from being detached from each
other.
[0521] FIG. 65B illustrates a variation of the anti-buckling device
500 of FIG. 65A, particularly showing the tubes 640 being arranged
from the smallest size to the largest size in the
proximal-to-distal direction.
[0522] FIG. 65C illustrates another variation of the anti-buckling
device 500 of FIG. 65A, particular showing the tubes 640 being
arranged from the largest size at one end to the smallest size in
the middle section, and then to the largest size again to another
end.
[0523] In the above embodiments, the anti-buckling device 500 may
be provided on a robotic catheter when the drive assembly for the
catheter is at the proximal end of the catheter. However, in other
embodiments, the drive system may be provided at the distal end of
the catheter for "pulling" the flexible catheter rather than
"pushing" it. FIG. 66A illustrates a drive device 500 that provides
an anti-buckling feature in accordance with other embodiments. The
device 500 includes a pair of rollers 660 that grip against the
elongate member 490 at a distal location that is close to the
incision site. The device 500 also includes mechanical linkage 662
connecting the rollers 660 to the drivable assembly 184. During
use, the drivable assembly 184 may be advanced distally to move the
elongate member 490 into the incision site. When this occurs, the
drivable assembly 184 will actuate the rollers 660 to apply tension
to the elongate member 490. This will prevent the elongate member
490 from being compressed (or from being compressed excessively),
and prevent the elongate member 490 from buckling.
[0524] FIG. 66B illustrates another drive device 500 that provides
an anti-buckling feature in accordance with other embodiments. The
device 500 includes a first pair of fingers 670a for gripping
against the elongate member 490 at a distal location that is close
to the incision site. The device 500 also includes a second pair of
fingers 670b for gripping against the elongate member 490 at a
distal location that is close to the incision site. The system 500
also includes mechanical linkage 672 connecting the first and
second pair of fingers 670a, 670b to the drivable assembly 184.
During use, the drivable assembly 184 may be advanced distally to
move the elongate member 490 into the incision site. When this
occurs, the drivable assembly 184 will alternately actuate the
first and second pairs of fingers 670a, 670b in accordance to a
predetermined algorithm to apply tension to the elongate member
490. This will prevent the elongate member 490 from being
compressed (or from being compressed excessively), and prevent the
elongate member 490 from buckling.
[0525] In some embodiments, the algorithm for controlling the pairs
of fingers 670a, 670b may be as follows: (1) Actuate first pair to
grip the elongate member 490, (2) translate the first pair along
the longitudinal axis of the elongate member 490 to pull the
elongate member 490, (3) actuate the second pair to grip the
elongate member 490, (4) release the first pair, (5) translate the
second pair along the longitudinal axis of the elongate member 490
to pull the elongate member 490, (6) move back the first pair by
some distance, (7) actuate the first pair to grip the elongate
member 490, (8) translate the first pair along the longitudinal
axis of the elongate member 490 to pull the elongate member 490,
(9) move back the second pair by some distance, and repeat (3)-(9)
to move the elongate member 490 until the elongate member 490 is
desirable positioned.
[0526] FIGS. 67A-67C illustrate another anti-buckling device 500 in
accordance with other embodiments. The device 500 includes support
members 510 that form into a scissor-like configuration. The device
500 may optionally include another set of support members 512 next
to the support members 510, as similarly described previously. The
device 500 includes a plurality of holders 540 that are coupled to
the support members 510, wherein each holder 540 includes an
opening for accommodating an elongated member 490 (e.g., a sheath,
catheter, etc.). As shown in the figure, the device 500 further
includes another set of support members 514. As illustrated in
FIGS. 67B-67C, the support members 510, 514, holder 540, and
coupler 516 form a parallelogram, which allows the holder 540 and
coupler 516 to be maintained parallel relative to each other as the
support members 510, 514 rotate. Since all of the holders 540 are
maintained in parallel relative to their respective adjacent
couplers 516, all of the holders 540 are also maintained in
parallel relative to each other as the support members 510, 514
rotate to collapse or extend the device 500. The above
configuration is advantageous because by preventing the holders 540
from rotating relative to each other, the device 500 provides a
higher anti-buckling resistance for the elongated member 490 (i.e.,
it will be harder to buckle the elongated member 490). This is
because when the holders 540 stay aligned relative to each other,
the buckling load of the elongated member 490 is
4.pi..sup.2EI/L.sup.2. On the other hand, when the holders 540 are
allowed to freely rotate relative to each other, the buckling load
of the elongated member 490 is .pi..sup.2EI/L.sup.2. Therefore, the
elongated member 490 can undergo four times as much compressive
force when the holders 540 are rotatably constrained than when the
holders 540 are freely rotatable relative to each other.
[0527] As shown in the above embodiments, the device 500 is
advantageous because it shortens the unsupported length of the
elongate member 490, thereby preventing the elongate member 490
from buckling during use. The device 500 is also advantageous
because it provides anti-buckling feature from outside the elongate
member 490, and thus, obviating the need to modify the construction
of the elongate member 490. Also, embodiments of the device 500
described herein provide support(s) along the length of the
elongate member 490 in all circumferential directions at the
location of the support(s). This has the benefit of preventing the
elongate member 490 from buckling in any direction during use.
[0528] Although embodiments of the anti-buckling/drive device 500
have been described with reference to the device 500 being used at
certain location of the robotic system, in other embodiments, one
or more of the embodiments of the device 500 may be used to support
any flexible elongate member anywhere in the robotic system,
including the flexible elongate member between the stabilizer 502
and the drivable assembly 184, the flexible elongate member between
the drivable assembly 184 and the drivable assembly 182, or any
other member that needs support to prevent the member from
buckling.
[0529] Also, although embodiments of the anti-buckling device 500
have been described with reference to a medical robotic system, it
should be noted that the anti-buckling device 500 described herein
may be used to provide anti-buckling feature for any medical device
having an elongate and flexible configuration. For example, in
other embodiments, embodiments of the anti-buckling device 500
described herein may be used to support any flexible tool in the
field of medicine, such as an endoscope, a flexible grasper, laser
fibers, etc.
[0530] Also, one or more of the embodiments of the anti-buckling
device 500 described herein may be used as a distance measurement
tool. For example, in some embodiments, a pull string attached to a
spring and an encoder may be used to track the displacement of the
anti-buckling device 500. In other embodiments, an encoder may be
attached to any of the joints at the anti-buckling device 500 to
measure the angle of a link (or links), and a processor may then
calculate the overall length of the anti-buckling device 500 based
on the measured angle. In other embodiments, an optical device may
be configured to take an image of at least a portion of the
anti-buckling device 500 (or the entire anti-buckling device 500),
and the length of the anti-buckling device 500 may then be
determined (e.g., by a processor) using the image. In still further
embodiments, a short stroke LVDT or similar linear encoder may be
used to measure a displacement between any two links, and the
processor may then calculate the overall length of the
anti-buckling device 500 using the measured displacement. In
further embodiments, an ultrasound transducer may be used to
measure a relative displacement between two links, and the
processor may then calculate the overall length of the
anti-buckling device 500 using the measured displacement.
[0531] In addition, in one or more of the embodiments of the
anti-buckling device 500, the device 500 may further include a
motor coupled to any one of the joints. In such cases, the motor
may be activated to turn the joint, thereby extending or collapsing
the anti-buckling device 500. In other embodiments, a linear motor
may be coupled between two joints or between two support members.
In such cases, the linear motor may be operated to extend or
collapse the anti-buckling device 500. For example, in other
embodiments, any of the joints 528 may be fixed relative to a
global system. In such cases, the proximal end of the anti-buckling
device 500 may be actuated (e.g., by linearly translating a support
member 510/512/514, or by rotating a joint that couples to an end
of a support member 510/512/514). In response to such actuation,
the distal end of the anti-buckling device 500 will translate
distally. The amount of distal translation by the distal end of the
anti-buckling device 500 will depend on which of the joints 528 is
fixed. Fixing a joint 582 that is closer to the proximal end would
allow the distal end of the anti-buckling device 500 to move a
relatively greater distance in response to a small translation of
the proximal end of the anti-buckling device 500, but such
configuration may require a relatively larger actuating force to be
applied at the proximal end (and the force transmitted to the
distal end is relatively small compared to the force applied at the
proximal end). On the other hand, fixing a joint 582 that is closer
to the distal end would allow the distal end of the anti-buckling
device 500 to move a relatively small distance in response to a
large translation of the proximal end of the anti-buckling device
500, but such configuration may require a relatively small
actuating force to be applied at the proximal end (and the force
transmitted to the distal end is relatively large compared to the
force applied at the proximal end). In one or more of the
embodiments described herein, the elongate member 490 may be
coupled to the anti-buckling device 500, the anti-buckling device
500 may be used to move the elongate member 490 proximally and
distally. For example, in some embodiments, the distal end of the
elongate member 490 may be coupled to the distal end of the
anti-buckling device 500.
[0532] As illustrated in the above embodiments, the anti-buckling
device utilizes a scissor-like mechanism that provides a 1:1 motion
for the elongate member 490. That means when the proximal end of
the member 490 is advanced distally by a distance, the distal end
of the member 490 will be advanced by the same distance. Also, when
the proximal end of the member 490 is retracted proximally by a
distance, the distal end of the member 490 will be retracted by the
same distance. This is advantageous over a system that does not
have any anti-buckling mechanism, in which case, advancement of the
proximal end of the elongate member by a distance may not result in
advancement of the distal end of the elongate member by the same
distance (because the elongate member may sag or buckle). Also, due
to sagging or buckling, retraction of the proximal end of the
elongate member by a distance may also not result in retraction of
the distal end of the elongate member by the same distance (because
the sagged or buckled section needs to be straighten out before the
distal end of the elongate member may be pulled proximally).
Accordingly, embodiments of the anti-buckling mechanism described
herein provides a support frame that has no hysteresis between
insert and withdrawal of the elongate member.
[0533] Also, in some embodiments, the compressed length of the
anti-buckling device may be at least 5 times shorter than its
extended length. In other embodiments, the ratio between the
compressed length and the extended length may have any values.
[0534] Also, as illustrated in the above embodiments, the
anti-buckling device provides high lateral stiffness to support an
elongate member laterally, while providing a low axis stiffness so
that the anti-buckling device may be compressed in response to a
decrease in length of the elongate member as the elongate member is
being advanced distally. Thus, the anti-buckling device does not
deflect laterally (e.g., in one plane, or in two planes that form
an angle relative to each other), and can be compressed in response
to axial force.
[0535] VII. Lubrication Mechanism
[0536] In one or more of the embodiments described herein, the
anti-buckling device 500 may further include a lubrication system
for lubricating at least a portion of the elongate member 490. FIG.
68 illustrates a lubricating system 700 attached to one end (e.g.,
the distal end) of the anti-buckling device 500. The lubricating
system 700 includes a container 702 for housing fluid, such as
saline, and an absorption material 704 located in the housing for
absorbing the fluid and applying the fluid to the elongate member
490. The container 702 is coupled to the anti-buckling device 500
via a coupler 710. The lubricating system 700 also includes an
introducer for allowing the elongate member 490 to be inserted
therethrough. In the illustrated embodiments, the coupler 710 has
an opening for allowing the elongate member 490 to extend
therethrough. The elongate member 490, which may be a sheath, a
catheter member, or a combination of both. In some embodiments, the
elongate member 490 may optionally include a hydrophilic coating so
that the elongate member 490 may interact (e.g., dissolve) with the
saline. The dissolved coating becomes a lubricant for lubricating
the elongate member 490 (which may allow the elongate member 490 to
slide easily relative to object(s) that it comes in contact
with--e.g., bodily tissue, supports of anti-buckling device, etc.).
In other embodiments, the sterile fluid in the container 702 may
itself be the lubricant, in which case, the lubricant is applied
directly onto the elongate member 490 by the absorption material
704. During use, fluid (e.g., saline) is placed in the container
702, or may be applied directly to the absorption material 704. The
elongate member 490 is then inserted through the anti-buckling
device 500, and is advanced through the absorption material 704
that is located in the container 702. As the elongate member 490 is
advanced through the absorption material 704, the absorption
material 704 applies the fluid onto the surface of the elongate
member 490, thereby lubricating the elongate member 490. The
lubricant on the surface of the elongate member 490 allows the
elongate member 490 to more easily slide relative to objects (e.g.,
tissue, introducer, etc.) that it comes in contact with during a
medical procedure. The lubricating system 700 is advantageous in
that it automatically applies lubricant onto the elongate member
490 as the elongate member 490 is advanced through the lubricating
system 700.
[0537] FIG. 69 illustrates another lubricating system 700 in
accordance with other embodiments. The lubricating system 700
includes a bladder 730 attached to a distal end of the
anti-buckling device 500. The lubricating system 700 further
includes a luer lock 732 with a check valve 734, which allow a
syringe to fill the bladder 730 with fluid (e.g., saline). In
particular, the check valve 734 is configured so that when the
syringe is not coupled to the bladder 730, fluid inside the bladder
730 is prevented from escaping out of the bladder 730 through the
check valve 734. When the syringe is coupled to the bladder 730,
the check valve 734 is pushed open by the syringe, thereby allowing
the syringe to deliver the fluid into the bladder 730. The
lubricating system 700 also includes a flow restrictor 736 at the
bottom of the bladder 730 for allowing fluid to be applied onto the
surface of the elongate member 490 in a controlled manner. In some
embodiments, the elongate member 490 may optionally include a
hydrophilic coating so that the elongate member 490 may interact
(e.g., dissolve) with the saline. The dissolved coating becomes a
lubricant for lubricating the elongate member 490. In other
embodiments, the fluid in the bladder 730 may itself be the
lubricant, in which case, the lubricant is applied directly onto
the elongate member 490 by the flow restrictor 736.
[0538] In other embodiments, the lubricating system 700 of FIG. 69
may optionally further include a brush 740 attached to the bottom
of the flow restrictor 736 (FIG. 70). During use, the brush 740
applies the fluid from the bladder 730 onto the elongate member
490. In other embodiments, the device 700 itself may function as an
applicator. In such cases, the user may hold the applicator 700 and
may apply fluid in the bladder onto the surface of the elongate
member 490 before it is inserted into a patient. The fluid may
interact with a hydrophilic coating on the elongate member 490 to
form lubricant. Alternatively, the fluid itself may be lubricant
that is applied directly onto the elongate member 490.
[0539] In other embodiments, the lubricating system 700 may include
a container (e.g., saline bag) 750 that is compressed by a pressure
cuff 752, and fluid from the container 750 is then routed to the
drivable assembly 184 (FIG. 71). In the illustrated embodiments,
the drivable assembly 184 has internal plumbing and a flow
restricting nozzle that would allow droplets to escape. As droplets
are escaped from the drivable assembly 184, they travel down the
body of the elongate member 490. In some cases, the elongate member
490 may be oriented at an angle 756 that is at least 15.degree.
relative to a horizontal axis, so that the droplets may flow down
the elongate member 490 more easily. The droplets travelling down
the body of the elongate member 490 will reach eyelets (e.g., AB
eyelets) 754 that are placed around the elongate member 490. Each
eyelet 754 is configured to capture a small amount of fluid so that
the elongate member 490 can absorb later. As more and more droplets
leave the drivable assembly 184, all of the eyelets 754 will
eventually be filled up, and the elongate member 490 will be
completely hydrated. In some embodiments, each eyelet 754 has an
optimized surface area (or pressure head to viscosity ratio) for
capturing a desired amount of fluid. The eyelets 754 may be coupled
to the anti-buckling device 500 in some embodiments, in which case,
the eyelets 754 may be considered to be components of the
anti-buckling device 500. For example, each eyelet 754 may be
implemented at a respective holder 540 in the anti-buckling device
500. Also, in some embodiments, the holders 540 themselves may be
considered to be the eyelets 754. In other embodiments, the eyelets
754 may be considered components of the lubricating system 700.
[0540] In other embodiments, a hydrogel 768 may be manually applied
onto the elongate member 490 via a gauze or cotton pad at several
discrete locations through openings 770 of the anti-buckling device
500 (FIG. 72). As the anti-buckling device 500 is extended or
collapsed, the hydrogel 768 is spread out along the length of the
elongate member 490 through the holders 540. In some embodiments,
the holders 540 have eyelets that store a small amount of hydrogel
for later use.
[0541] In further embodiments, the lubricating system 700 may
include a gel compartment 780 proximal to an incision site for
applying gel to the elongate member 490 (FIG. 73). The gel
compartment 780 includes an inlet 782 for filling the compartment
780 with a gel substance 784. During use, as the elongate member
490 is inserted distally, it picks up the gel substance 784. In
some embodiments, the elongate member 490 may optionally include a
hydrophilic coating so that the elongate member 490 may interact
(e.g., dissolve) with the gel. The dissolved coating becomes a
lubricant for lubricating the elongate member 490. In other
embodiments, the gel 784 may itself be the lubricant, in which
case, the lubricant is applied directly onto the elongate member
490 by the gel compartment 780. In some embodiments, the gel
compartment 780 may be coupled to a distal end of the anti-buckling
device 500 through an adaptor 786. Also, in some embodiments, if
the elongate member 490 includes a sheath surrounding a catheter
member, the gel compartment 780 may be placed proximal to the
introducer sheath.
[0542] FIG. 74 illustrates another lubricating system 700 in
accordance with other embodiments. The lubricating system 700
includes a collapsible tube 800 that contains gel 802. The
lubricating system 700 also includes one or more inlets in fluid
communication with the tube 800 for delivering the gel 802 into the
tube 800. In the illustrated embodiments, the collapsible tube 800
is incorporated into the center of the anti-buckling device 500.
During use, the elongate member 490 is inserted through the
collapsible tube 800 at the anti-buckling device 500. The inlet(s)
804 is then used to deliver gel into the tube 800. The
anti-buckling device 500 is then extended and collapsed several
times to evenly spread out the gel onto the surface of the elongate
member 490 before the elongate member 490 is inserted into the
patient. In some embodiments, the collapsible tube 800 may be
implemented using a rigid telescoping tube, a flexible accordion
tube, or a bellow.
[0543] FIG. 75 illustrates another lubricating system 700 in
accordance with other embodiments. The lubricating system 700
includes a plurality of pockets 820, wherein each pocket 820 has a
nozzle 822 that points towards the elongate member 490. The pockets
820 may be made from a resilient material, such as polyurethane,
and may be attached at several locations (e.g., at joints between
two support members) at the anti-buckling device 500. In the
illustrated embodiments, mini pouches of hydrogel are contained
inside the pockets 820. During use, the closing action of the
anti-buckling device 500 squeezes the pockets 820 down to eject the
gel out of the pockets 820 and onto the surface of the elongate
member 490. The anti-buckling device 500 may be extended and
collapsed to distribute the gel through eyelets (e.g., holders 540)
along the elongate member 490.
[0544] In other embodiments, the lubricating device 700 may be a
drape made from a resilient material, such as polyurethane. Gel is
applied to one side of the drape, and the drape is used to apply
the gel onto the elongate member 490, the anti-buckling device 500,
or both. For example, in some embodiments, the elongate member 490
together with the anti-buckling device 500 may be covered by the
drape, and the drape is used to apply the gel onto the elongate
member 490 and/or the anti-buckling device 500. The drape is then
removed from the elongate member 490 and/or the anti-buckling
device 500 before use of these devices. The anti-buckling device
500 may be extended and collapsed to distribute the gel through
eyelets (e.g., holders 540) along the elongate member 490.
[0545] FIGS. 76-77 illustrate another lubricating device 700 in
accordance with other embodiments. The lubricating device 700
includes a stabilizing device 840 with a base for attachment to the
patient or a bed, and a coupling 842 that joins the anti-buckling
device 500 to the stabilizing device 840. The stabilizing device
840 is configured to limit the motion of the distal end of the
anti-buckling device 500 as the elongate member 490 is introduced
and retracted relative to the patient. In some embodiments, as the
catheter is being inserted and retracted, the stabilizer may be
subjected to loads that may create a displacement in the direction
of the catheter motion. In the illustrated embodiments, the
lubricating device 700 includes a small membrane filled with fluid
or gel at the base of the stabilizer 840, which would be actuated
by the displacement of the stabilizer 840. The hydrating fluid
would be delivered directly through the coupling 842, or can be
delivered elsewhere by incorporating delivery conduits or a
spraying mechanism.
[0546] FIG. 78 illustrates another lubricating device 700 in
accordance with other embodiments. The lubricating device 700
includes a container 860 containing fluid or gel. The container 860
is coupled to the stabilizer 502, which is described previously. As
the elongate member 490 is being inserted into the patient's skin,
the elongate member 490 is extended through the container 860,
which applies the fluid or gel onto the elongate member 490. The
fluid or gel may directly lubricate the surface of the elongate
member 490. Alternatively, the fluid or gel may react with an
optional hydrophilic coating on the elongate member 490 to form a
lubricating substance.
[0547] In further embodiments, the lubricating device 700 may
include a membrane 890 that encapsulates the anti-buckling device
500, wherein the membrane 890 is filled with fluid or gel during
use (FIG. 78A). The membrane 890 may have a bellow configuration,
which allows the membrane 890 to extend and contract together with
the anti-buckling device 500.
[0548] It should be noted that although the term "catheter" and the
term "sheath" are used to describe some of the embodiments of the
components, these terms should not be limited to the configuration
shown. For example, in other embodiments, what was referred to as a
"catheter" may also be called a "sheath" and vice versa. Also, in
some embodiments, the term "catheter" or the term "sheath" may
refer to two or more tubular structures that are arranged
telescopically, or that are coupled to each other.
[0549] VIII. Guidewire Manipulator
[0550] Typical manual surgical procedures include the use of a
guide wire curved at its distal tip so that the guide wire can be
navigated through tortuous anatomy by hand-actuated roll and insert
motion at its proximal end. Once in place, catheters can be
inserted co-axially over the guide wire, the guide wire can be
retracted and removed, and the catheter can remain in place
providing a delivery device for other minimally invasive tools.
[0551] Guide wires or distal protection devices for certain
vascular and other interventions, may be difficult to position due
to their relatively minimal navigation degrees of freedom from a
proximal location, and the tortuous pathways through which
operators attempt to navigate them. Additionally, minimally
invasive medical procedures can be time consuming and physically
demanding on an operator causing not only operator fatigue but an
excessive amount of exposure of the operator to radiation fields.
Providing robotically and remotely precision controlled additional
navigation and operational functionality options for minimally
invasive interventions, would be useful.
[0552] Certain variations of systems as shown in FIG. 1 may include
additional remote motorized control of other pull wire or non pull
wire elongate members such as guide wires, which utilize roll and
insert motions at their proximal ends to steer their distal tips.
Different variations of elongate member manipulators which can
provide motorized actuation of a guide wire or other elongate
member are herein described. Many of the manipulator assemblies
disclosed herein can be used to provide any motorized roll and
insert or retraction actuation of any elongate instrument or member
including but not limited to ablation probes, needles, scissors,
clamps, forceps, graspers, guide wires, catheters, endoscopes, and
other minimally invasive tools or surgical instruments.
[0553] FIGS. 79A-79D illustrate different views of a variation of
an elongate member manipulator 1100. The elongate member
manipulator 1100 includes a set of right and left motor actuated
rotary members 1124, 1104. The rotary members can be used to
robotically control the insertion and retraction of an elongate
member, e.g., a guide wire, along a longitudinal axis of the
elongate member and/or the roll or twist of the elongate member
about a longitudinal axis of the elongate member. In this
variation, the rotary members are in the form of cylinders or feed
rollers. However, the rotary members may include any other device
suitable for providing rotary motion including belts.
[0554] As shown in FIG. 79A, the elongate member manipulator 1100
includes a right roller assembly 1122 and a left roller assembly
1102. Each roller assembly provides rotation and up-down or axial
translation to their respective feed rollers 1124, 1104. The left
roller assembly 1102 includes the left spline actuator 1106 and the
left leadscrew actuator 1108. The right roller assembly 1122
includes a right spline actuator 1126 and a right leadscrew
actuator 1128.
[0555] As illustrated in FIG. 79C, (a cross sectional view of the
elongate member manipulator 1100), the internal elements of the
left spline actuator 1106 may be identical to the internal elements
of the right spline actuator 1126. Also, the internal components of
the left leadscrew actuator 108 may be identical to the internal
components of the right leadscrew actuators 1128. Thus both right
and left spline actuators 1126, 1106 may include a spline shaft
1174, coupled to a spline nut 1176 which is driven by a gear train
which will be described in further detail below. Similarly, the
right and left leadscrew actuators 1128, 1108 may include a
leadscrew shaft 1184, coupled to a leadscrew nut 1186, driven by a
similar gear train.
[0556] The spline nut 1176 and leadscrew nut 1186 may be sized such
that two axially adjacent gears can create a gear stack that covers
the entire axial length of each nut. Thus the left spline actuator
1106 may include a left spline gear stack 1110, which acts as one
gear driving the spline shaft 1174 which in turn drives the left
roller 1104. The left leadscrew actuator 1108 may also have a
similar left leadscrew gear stack 1114 which functions in a similar
manner. In alternative variations, a smaller spline nut and smaller
leadscrew nut may be utilized allowing for a single gear to be used
as opposed to a gear stack.
[0557] The right roller assembly 122 may include gears that are
driven (in a manner as will be described below), and instead of
stacking two adjacent gears, the right spline actuator 1126 can
include a smooth shaft 1132 and a right spline output gear 1130.
The right leadscrew actuator 1128 can include a smooth shaft 1138
and a right leadscrew output gear 1136. The right spline output
gear 1130 and right leadscrew output gear 1136 are coupled to the
spline shaft 1174 and leadscrew shaft 1184 respectively and the
gears drive the motion of the roller 1124.
[0558] In operation, the right and left rollers 1124, 1104 may
rotate at substantially the same rate but in opposite directions to
facilitate insertion or retraction of an elongate member, such as
the guide wire 1060 (shown in FIGS. 79A-79B and 79D). Idler gears
may be used to couple the motion of the right and left actuator
assemblies 1122, 1102.
[0559] As shown in FIG. 79B the elongate member manipulator 1100
may include a right spline coupling gear 1134, a left spline
coupling gear 1135, a right leadscrew coupling gear 1140 and a left
leadscrew coupling gear 1141. To rotate the rollers 1104, 1124, the
left spline gear stack 1110 is driven by a spline belt 1112, which
in turn can be directly driven by a motor or driven indirectly by a
series of gears, belts or pulleys (not shown). As previously
described, this rotation will cause a direct rotation of the left
roller 1104. Simultaneously, the left spline gear stack 1110 may
use the coupling gears to drive the right roller 1124 in an
opposite direction to that of the left roller 1104.
[0560] FIG. 79D, shows a top view of the elongate member
manipulator 1100 (the feed rollers are not shown for clarity). In
this example, the left spline gear stack 1110 is driven in the CW
direction 1150, the left spline coupling gear 1135 will rotate in
the CCW direction 1152, rotating the right spline coupling gear
1134 in the CW direction 1150, and the right spline output gear
1130 in the CCW direction 1152. If all the gears are sized equally,
the left spline gear stack 1110 and right spline output gear 1130
will rotate at the same rate in opposite directions, rotating the
rollers 1104, 1124 at equal rates in opposite directions, which
would drive the guide wire 1060 in a forward propelling motion
1159. Reversing the direction of the spline belt 1112 would reverse
the directions of both the left spline gear stack 1110 and right
spline output gear 1130, and as a result, reverse the direction of
rotation of the rollers 104, 124, thereby driving the guide wire in
the reverse propelling motion.
[0561] The leadscrew actuators 1108, 1128 may function in a similar
manner but alternatively cause one roller to translate upwards
while the other roller translates downwards at a substantially
similar rate. This motion will drive the guide wire 1060 in a roll
or torque motion. The clockwise or counterclockwise directions of
roll are dependent on the direction of rotation of the leadscrew
belt 1116. Both insert/propelling motion and roll/torque motion can
be accomplished with varying speed rates for each axis. The
propelling and torque axes motions can be simultaneous, or they can
be independent of each other.
[0562] FIG. 81 illustrates a cross sectional view of one variation
of a roller actuator 1170 that may be utilized to provide motorized
rotation and translation actuation of one or more rotary members,
such as a feed roller. Such a roller actuator may be utilized to
provide rotation and translation actuation of various rollers,
including, for example, the rollers of elongate member manipulator
1100 described above.
[0563] The roller actuator 1170 includes a one or more spline
actuators 1172 having a spline shaft 1174 coupled to a spline nut
1176 mounted on spline nut bearings 1178. The spline nut 176 is
rotated by a spline gear 1180 which can either be directly motor
driven or indirectly motor driven via a series of gears, belts or
pulleys (not shown). The spline shaft 1174 may be fixably coupled
to a rotary member such as a feed roller 1104, so that the rotation
of the spline nut creates rotation of the feed roller. A single
leadscrew actuator 1182 which includes a leadscrew shaft 1184,
leadscrew nut 1186, leadscrew nut bearings 1188, and a leadscrew
gear 1190 is provided adjacently below the spline actuator 1172 to
provide up-down translation of a feed roller. The leadscrew nut
1186 is driven by the leadscrew gear 1190 which can either be
directly motor driven or indirectly motor driven via a series of
gears, belts or pulleys (not shown). Rotation of the leadscrew nut
1186 lifts and lowers the leadscrew shaft 1184 and spline shaft
1174, creating the up and down lift or axial translation of the
feed roller.
[0564] In certain variations, the spline shaft 1174 and leadscrew
shaft 1184 may be coupled so that rotation of one may cause
rotation of the other. Because the spline shaft 1174 is constructed
as a spline, it can be driven up and down by the leadscrew shaft
1184 without lifting the spline nut 1176, spline bearings 1178, or
spline gear 1180. To actuate only rotation of the feed roller, both
spline nut 1176 and leadscrew nut 1186 may be rotated at the same
rate. As a result, the leadscrew shaft 1184 will rotate at the same
rate as the leadscrew nut 1186 so that no lift motion will occur.
To actuate only lift of a feed roller, the leadscrew nut 1186 may
be rotated without movement of the spline nut 1176. Alternatively,
simultaneous rotational and translational motion of a feed roller
may be provided by slowing and speeding up the leadscrew nut 1186
relative to the spline nut 1176 or vice versa.
[0565] In an alternative variation, the spline shaft 1174 and the
leadscrew shaft 1184 may not be coupled so that movement of the
spline actuator 1172 and the leadscrew actuator 1182 are completely
independent. Alternatively, the spline shaft 1174 and leadscrew
shaft 1184 could be free to rotate independently by joining the two
shafts in a ball and socket type configuration. Additional bearing
support may be utilized in such a variation.
[0566] FIGS. 80A-80B illustrate examples of feed rollers in use,
showing how an elongate member, e.g., a guide wire 1060, may be
actuated by the feed rollers 1124, 1104. FIG. 80A illustrates a top
view of a pair of feed rollers 1124, 1104 illustrating how the feed
rollers can rotate about their axes in opposite directions 1152,
1150 to drive a guide wire 1060 in a backwards propelling motion or
a retract motion 1158. The feed rollers can also be rotated in
opposing directions to provide forward propelling or insert motion
(not shown). FIG. 80B shows a front view of the feed rollers 1124,
1104 illustrating how the feed rollers can translate axially along
their axes in opposite translation directions 1154 to torque or
roll 1160 the guide wire 1060.
[0567] Forward or reverse insert/retract motion 1158 is dependent
on the direction of rotation 1152, 1150 of the rollers 1124, 1104
while clockwise or counter-clockwise roll motion 1160 is dependent
on the direction of up and down linear or axial translation 1154 of
the rollers 1124, 1104. Both insert/retract motion and roll motion
can be accomplished with varying speed rates for each axis. The
insert and roll actuations can be independent of one another, or
they may occur simultaneously. Also simultaneous roll and insert
actuation can be desirable in part because traditional manual
procedures are performed in that manner. Currently physicians
articulate and steer manual guidewires by inserting and rolling
simultaneously resulting in more of a spiraling insertion. It can
be desirable for robotic systems to emulate manual procedures for
physician ease of use.
[0568] In alternative variations, insert motion can be provided by
feed rollers while roll motion actuation may be provided by
clamping the guide wire in a clamp mechanism and rolling the clamp
mechanism. In this variation roll and insert motion may be
alternated between insert and roll with typical clutching
mechanisms that release grip from one actuator assembly while the
alternate assembly provides actuation. For example, in a feed
roller variation with clutching, feed rollers used to actuate
insert may release the guide wire while actuators providing
rotation to roll the guide wire. The release of the guide wire from
one actuator during activation of the alternate actuator in systems
which use feed rollers for insert but roll the guide wire with a
separate mechanism allows the guide wire to overcome friction
experienced from the feed rollers during roll actuation. If insert
and roll are simultaneously actuated the wire may be gripped in the
insert feed rollers which could result in the stripping or winding
up the wire.
[0569] Systems which clutch between insert and roll actuators
typically release grip of the guide wire by one actuator to allow
the alternate actuator to grip the guide wire. By releasing the
wire, any tracking of guide wire position using encoders may be
lost which could decrease the accuracy of position tracking. Also,
additional actuators may result in a more complex or more costly
system.
[0570] In certain variations, a guide wire 1060 may be loaded into
the elongate member manipulator 1100 by being back or front loaded
or fed into the feed rollers 1104, 1124 while rotating the feed
rollers 1104, 1124 in an insert or retract motion.
[0571] In certain variations, the elongate member manipulator 1100
may be designed such that at least a portion of the elongate member
manipulator 1100 remains in a sterile field. For example, the
motors and drive mechanisms or drive components of the elongate
member manipulator may be situated in a non-sterile field and a
sterile drape could be placed in-between the drive components and
the feed rollers. Thus, the elongate member, e.g., a guide wire,
held by the feed rollers will remain sterile for insertion into a
patient's anatomy. In certain variations, components of an elongate
member manipulator which are meant to remain sterile may be
disposable and/or the complexity of such components may be
minimized in order to minimize or reduce overall costs of such
disposable components or the elongate member manipulator.
[0572] Referring back to FIGS. 79A-79C, one variation of a sterile
drape 1070 used to create a sterile field that includes the feed
rollers 1104, 1124 and guide wire 1060 is illustrated. All other
components could be positioned in a non-sterile field.
[0573] FIG. 82 shows an example of the sterile drape 1070 installed
between the left feed roller 1104 and the spline shaft 1174. The
sterile drape 1070 may be designed such that the roller 1104 can be
removeably replaceable where the drape 1070 could be placed over
the spline shaft 1174 and the rollers could be installed over the
drape in the sterile field. The sterile drape 1070 could have a
sterile drape bushing 1072 that is fixably attached to the drape
1070. The roller 1104 could be coupled to the bushing 1072 via a
roller shaft 1105 extending through the bushing 1072 which is
coupled to the spline shaft 1074 in the non-sterile field. The
roller shaft 1105 and spline shaft 1074 could be coupled by keying
each shaft to mate, thus allowing rotation of the spline shaft 1074
to cause a one to one rotation of the roller shaft 1105. The key
can be shaped as a hexagon, triangle, star, cross or any other
shape. The roller 1104 may rotate relative to the bushing and may
translate up and down like a piston. A fastener may be provided to
secure the roller 1104 in place to prevent slippage in the axial
direction. Alternatively, the roller shaft 1105 may be threaded and
coupled to a threaded hole in the spline shaft 1174. As the roller
1104 moves up and down, a left roller groove 1123 on the roller may
create a labyrinth seal and maintain a sterile boundary between the
bushing 1072 and roller 1104. Optionally, an o-ring or lip seal can
be placed between the bushing 1072 and roller 1104 to prevent fluid
ingress and create an improved sterile boundary. The sterile drape
1070 could provide for a sterile interface for the right feed
roller 1124 in the same manner.
[0574] FIGS. 83-83A illustrate another variation of an elongate
member manipulator 1200 which includes rotary members in the form
of belts. The elongate member manipulator 1200 is shown mounted on
an instrument driver 16. The elongate member manipulator 200 may by
utilized to feed an elongate member, such as guide wire 60,
co-axially into a guide catheter splayer 1052. The guide wire 1060
may be fed into a support tube 1056 which subsequently feeds into
the guide catheter splayer 1052, and ultimately into a guide
catheter (not shown). In certain variations, the elongate member
manipulator may be mounted on the instrument driver along with a
guide and/or a sheath splayer/catheter or the elongate member
manipulator may be mounted alone. Optionally, the elongate member
manipulator may be utilized to feed an elongate member, such as
guide wire, co-axially into a sheath and or catheter. Optionally,
the elongate member manipulator may be utilized to feed an elongate
member, such as guide wire, directly into a patient's body or
anatomy.
[0575] FIG. 84 illustrates the elongate member manipulator 1200 in
an open hinged configuration. The elongate member manipulator can
include a drive assembly and an elongate member holder. The
components of the elongate member holder include a drive belt
assembly 1210 and an idler belt assembly 1220. Both belt assemblies
include belts 1212, 1222 with pulleys 1214, 1224. The drive pulley
1084 may be directly driven by an insert servo motor 1102 or other
mechanism to turn the drive belt 1212. The idler belt 1222 is free
to rotate about the idler pulley 1224. The belts may be constructed
from various materials known to person having ordinary skill in the
art. The belts may have various dimensions. For example, about 1''
wide Texin.RTM. or silicon rubber, durometer 90A profiled timing
belts may be utilized covering a length of about 4.5'' from
opposite outer diameter edges of the belt. Other variations may use
alternative widths, other dimensions, and materials with
alternative durometers for the belts. In one variation the belts
can be constructed from any gamma sterilizable material which is
well known in the art including but not limited to thermoplastics
such as ABS or PET, fluoropolymers such as polyvinyl fluoride,
polymides, polystyrenes, polyurethanes, polyesters, or polyesters.
Optionally, bands or feed rollers could be used in place of
belts.
[0576] As shown in FIGS. 85A, 85B and 85C, the drive assembly can
include an upper slide assembly 1234, a lower slide assembly 1230,
an insert motor 1202, and a roll motor 1204, as well as a set of
rails, a rack and a pinion (not shown here but described in detail
below). In use, as illustrated in FIGS. 84 and 85A, the upper slide
assembly 1234 can hinge open a plurality of degrees for workflow
clearance, the guide wire 1060 can be placed on the drive belt
1212, and the elongate member manipulator 1200 or system can be
closed so that the guide wire 1060 is held between the drive belt
1212 and the idler belt 1222. This allows a guide wire to be loaded
into the elongate member manipulator 1200 anywhere along the length
of the guide wire 1060, which may expedite the loading procedure
instead of being restricted to load the wire by feeding the wire
from the back of the system. Also the guide wire can be loaded when
the belts are in any position. For example, the drive belt 1212 may
be at an arbitrary position such that the drive motor 1202 does not
require any type of initialization or homing before installation of
the guide wire 1060. Additionally a guide wire can be removed from
the elongate member manipulator 1200 or system mid procedure if the
operator desires to switch from using the robotic manipulator to
manual control of the guide wire.
[0577] In alternative variations a guide wire can be backloaded
into a manipulator. A back loaded guide wire would be retracted or
pulled out of a patient's body before removing the guide wire from
the manipulator to switch to manual control
[0578] To ensure that the upper slide assembly 1234 and lower slide
assembly 1230 stay closed during operation, a captive screw 1254
can be used. A variation including a captive screw 1254 is shown in
FIGS. 85B-E which illustrate an isometric view of the elongate
member manipulator 1200 with only the drive belt assembly 1210
shown (idler belt assembly not shown for clarity). FIG. 85B
illustrates the elongate member manipulator 1200 in an open
position, FIG. 85C illustrates the elongate member manipulator 1200
as it is partially closed, and FIG. 85D shows the elongate member
manipulator 1200 closed and locked. The captive screw 1254 remains
captive with the upper slide assembly 1234 and locks into a
threaded hole 1256 in the lower slide assembly 1230. FIG. 85E
illustrates a cross section of the elongate member manipulator
illustrating the operation of the captive screw 1254. In
alternative variations, a latch, fastener or other type of locking,
fastening or latching mechanism may be used instead of a captive
screw.
[0579] As illustrated in FIG. 85A, once the guide wire 1060 is
loaded and held between the drive belt 1212 and the idler belt
1222, the insert motor 1202 drives the drive pulley 1214, turning
the drive belt 1212 and propelling the guide wire 1060 forward or
backwards (insert or retract) depending on the rotational direction
of the motor and pulley. With sufficient frictional pinching,
gripping, pressing, or holding force holding the guide wire 1060
between the drive belt 1212 and idler belt 1222, the idler belt
1222 will turn at the same rate as the drive belt 1212, and the
belts will hold the guide wire 1060 such that lateral linear
movement or displacement of the guide wire relative to the belts
may be eliminated, minimized or reduced.
[0580] FIGS. 86A-86C illustrate various views of the elongate
member manipulator 1200 showing various components of the elongate
member manipulator that function to provide roll actuation of the
guide wire 1060. (Some components of the elongate member
manipulator 1200 are hidden for clarity.)
[0581] FIG. 86A illustrates an end view of the elongate member
manipulator 1200. FIGS. 86B-86C illustrate perspective views of the
elongate member manipulator 1200 providing different angles showing
the lower slide assembly 1230 and the upper slide assembly 1234.
The lower slide assembly 1230 and upper slide assembly 1234 may
each be attached to linear rails 1240. The lower slide assembly
1230 includes the insert motor 1202 and a slip detection encoder
1204. The drive belt assembly 1210 attaches to the lower slide
assembly 1230 while the idler belt assembly 1220 attaches to the
upper slide assembly 1234. Both lower and upper assemblies 1230,
1234 have a rack 1232, 1236 that is coupled to a pinion 1238 driven
by a roll motor 1206. The roll motor 1204 is mounted stationary
relative to the instrument driver so that when the pinion 1238 is
turned, the slide assemblies 1230, 1234 move or translate in
opposing directions, driving both the drive belt assembly 1210 and
the idler belt assembly 1220 in opposing translational directions
1154. This motion will roll, rotate or torque the guide wire 1060
as shown by the arrow 1160. Translation of the drive belt assembly
1210 and idler belt assembly 1220 in directions opposite those
shown in FIG. 86A would result in roll of the guide wire in the
direction opposite that of arrow 1160.
[0582] In an alternative variation (not depicted), either the upper
or lower slide assemblies could be coupled to a leadscrew so that
motorized rotation of the leadscrew would result in translation of
one slide assembly relative to the other. Roll and insert can be
independently actuated or actuated simultaneously as described
previously.
[0583] When the elongate member manipulator 1200 is in a closed
configuration holding the guide wire 1060, a sufficient pinching
force between the drive belt 1212 and idler belt 1222 may be
necessary to provide adequate frictional force to actuate insert,
or retraction, and/or roll of the guide wire 1060. As various guide
wires 1060 with varying wire diameters may be loaded into the
elongate member manipulator 1200, it may be desirable to adjust the
pinching force such that the applied pinching force is high enough
to provide for insert and roll actuation while low enough to
prevent damage or buckling of the guide wire 1060.
[0584] Thus, in certain variations, the upper slide assembly 1234
of an elongate member manipulator can include a hinge 1242 and a
suspension mechanism 1244. FIGS. 87A-87B show a left side view of
an elongate member manipulator 1200 with the suspension mechanism
1244 in an open and closed configuration respectively, while FIG.
87C shows a cross section of the assembly 1234 with the suspension
mechanism 1244. The suspension mechanism 1244 may include a lever
arm 1246, a lever shaft 1248, a lever spring 1250 and a tightening
nut 1252. The suspension mechanism 1244 may provide a mechanism by
which the force applied by the lever spring 1250 to hold the guide
wire between the idler belt assembly 1220 and the drive belt
assembly 1210 may be adjusted in order to accommodate a variety of
guide wire diameters while providing sufficient pinching force for
a variety of guide wire diameters.
[0585] As illustrated in FIG. 87B, the tightening nut 1252 may be
used to control the swing of the lever arm 1246 to adjust the grip
force between the upper slide assembly 1234 and the lower slide
assembly 1230 to apply the necessary grip force for various wire
diameters and to provide an increased force ratio for wire
compression. By way of example but not limitation, if a 2 to 1
force ratio could be applied where a 201b wire load was required, a
101b spring would be applied to the lever. The range of guide wire
diameters that could be accommodated for this example may range
from about 0.014''-0.038''.
[0586] FIGS. 88 and 89 illustrate a pair of elongate member
brackets or wire holders 1260, 1262 that can be used to prevent a
guide wire 1060 or other elongate member from sliding or slipping
laterally or in the direction of slide assembly or belt assembly
translation while the guide wire or elongate member is being rolled
or twisted. Such wire holders may hold or grip a guide wire in
addition to or in place of the frictional pinching force provided
by the rotary member, rollers or belts. FIG. 88 illustrates the
elongate member manipulator 1200 with a pair of wire holders 1260,
1262 where both the elongate member manipulator and the wire
holders are in an open configuration. FIG. 89 illustrates the
manipulator 1200 and wire holders 1260, 1262 in a closed
configuration.
[0587] The wire holders 1260, 1262 may be in the form of simple
clamps or other configurations that can open and close to load and
hold the guide wire 1060 and/or the guide wire support tube 1056.
Cut outs in the holders may be sized to allow for the guide wire
1060 and/or the valve assembly 1352 to be held in place along a
longitudinal axis of a belt assembly while also allowing the guide
wire to move in a propelling motion or a roll motion without excess
friction. In order to prevent or minimize any undesired slippage in
the translation direction 1154 (See FIG. 86A) during roll of the
guide wire, which may result from the tolerance provided by such
cut outs, dimensions of the wire holders can be varied. The wire
holders may be designed to minimize or prevent such slippage in the
translation direction while also minimizing or preventing
propelling and/or roll friction. Additionally, lubricants could be
used to minimize or prevent propelling and/or roll friction while
still minimizing or preventing slippage in the translation
direction.
[0588] Alternatively, some situations may require minimizing
lubrication of the guide wire in order to provide adequate gripping
of the wire. In one variation, as the guide wire is retracted or
de-inserted from the patient, sections of the guide wire may become
coated with blood or fluid. When the sections are retracted between
the drive belt assembly 1210 and idler belt assembly 1220, the
guide wire 1060 may become slippery preventing the guide wire
manipulator 1200 from adequately rolling and de-inserting the guide
wire 1060. Thus, an absorbent material (not shown) may be
integrated or included into the wire holder 1260 to remove blood or
fluid from the guide wire 1060 as it is retracted into the guide
wire manipulator 1200. In certain variations, the absorbent
material could be integrated only in the distal wire holder 1260
and not the proximal wire holder 1262 since the length of guide
wire proximal to the drive and idler assembly belts 1210, 1220 is
no longer engaged in the guide wire manipulator 1200. In
alternative embodiments the absorbent material can be integrated
into both wire holders 1260, 1262 or only the wire holder 1262
preventing any outside fluids from coating the guide wire during
the insert forward propelling actuation motion as well or to
provide additional fluid removal of the guide wire during
retraction. The absorbent material can included but is not limited
to any type of sponge, wicking cloth, or polymer. Alternatively, a
wiper mechanism can be integrated into the wire holders 1260,
1262.
[0589] In addition to the slippage that may occur during roll
motions, a guide wire 1060 or other elongate members may also be
susceptible to slippage between the drive belt 1212 and idler belt
1222 in the direction of insertion or retraction motion while the
guide wire is being propelled forward or backward, despite
maximizing pinching force and optimizing belt materials. Roll
and/or insert motors 1202, 1204 can be provided with encoders to
measure the commanded insert and roll of a guide wire. To help
improve the accuracy of this measurement, a mechanism for slippage
detection during insert or retraction may be provided.
[0590] Referring back to FIG. 84, in certain variations, the
elongate member manipulator 1200 may include a drive side slip
roller 1216 and idler side slip roller 1226 for guide wire
insertion or retraction tracking. One or more fo the drive and
idler slip rollers 1216, 1226 may be decoupled from motion of the
drive and idler belts 1212, 1222. The drive roller 1216 is shown
directly coupled to an encoder 1206 (illustrated in FIG. 85) for
guide wire slip detection. The drive side slip roller 1216 can be
constructed from a harder material, e.g., PET, and the idler side
slip roller 1226 can be constructed from a softer material, e.g.,
an open celled rubber. The harder PET will not deform from contact
with the guide wire 1060 preventing the outside diameter of the
drive side slip roller 1216 from varying. Since the insertion or
retraction distance may be calculated from encoder counts (where
encoders are used) and roller diameter, it is important that the
roller coupled to the encoder be non-deformable material such as
PET. Conversely, the softer material, e.g. the open celled rubber
could allow for compression compliance which will assist with guide
wire grip. The combination of materials allows for a tight grip on
the guide wire 1060 during insertion/retraction, but provides for a
smooth slip during roll. Alternative materials could be used to
allow for this smooth slip while still providing adequate gripping
of the wire during insertion and retraction. Any type of gamma
sterileizable material can be used which can be chosen based on
durometer. Alternatively, the drive side slip roller 1216 may be
constructed form a softer material and the idler side slip roller
1226 may be constructed from a harder material and the encoder may
beshould be coupled to the idler slip roller 1226.
[0591] In order to maximize workflow while keeping the guide wire
1060 and belt assemblies 1210, 1220 in the sterile field, a
mechanism that allows for easy removal and replacement of the
sterile components, including the guide wire and belt assemblies,
may be provided. The belt assemblies may be detachable or removable
from the slide assemblies and/or remaining components of the
elongate member manipulator such that a drape or other sterile
barrier may be installed or inserted between the sterile
components, e.g., the belt assemblies, and the non-sterile
components, e.g. the slide assemblies. Additionally, the sterile
components may be disposable. Accordingly, the complexity of the
sterile components or assembly of the elongate member manipulator
may be minimized to reduce cost, and many components of the
elongate member manipulator, such as certain motors, gears,
capstans, etc., may be designed or configured such that they remain
in the non-sterile field.
[0592] FIGS. 90A-90C illustrate the drive belt assembly 1210 and
the idler belt assembly 1220 as sterile assemblies of minimal
complexity having pulleys and belts, where the assemblies can be
removed and replaced easily. FIG. 90A illustrates the elongate
member manipulator 1200 with the drive belt assembly 1210 and the
idler belt assembly 1220 removed or detached from the slide
assemblies 1230, 1234. The belt assemblies may include a drive
shaft 1264 having a cross pin 1266 to key into socket 1268 provided
in the slide assemblies 1230, 1234. Alternatively a spline or taper
element could be used. A captive nut 1270 may be attached to the
disposable drive and idler belt assemblies 1210, 1220 and remain in
the sterile environment. FIG. 14B shows a cross section of the
elongate member manipulator where the drive belt assembly 1210 is
fully installed and the idler belt assembly 1220 partially
installed in the slide assemblies while FIG. 90C shows the same
cross section with both belt assemblies 1210, 1220 fully installed
in the slide assemblies.
[0593] FIGS. 91A-C illustrate another variation of an elongate
member manipulator 1300. The elongate member manipulator 1300 may
be mounted to a manipulator mounting bracket 1058 which is mounted
to the instrument driver 1016. The elongate member manipulator 1300
may be utilized to feed an elongate member, such as guide wire (not
shown), co-axially into a support tube 1056 which subsequently
feeds into the guide catheter splayer 1052, and ultimately into a
guide catheter 1054. In certain variations, the elongate member
manipulator 1300 may be mounted on the instrument driver 1016 along
with a guide and/or a sheath splayer/catheter or the elongate
member manipulator 1300 may be mounted alone.
[0594] FIGS. 91D-H illustrate various views of the elongate member
manipulator 1300. FIGS. 91D-E show perspective views of the
elongate member manipulator 1300 in a closed configuration, FIG.
91F shows a perspective view of the elongate member manipulator
1300 in an open configuration, and FIGS. 91G-H show right and left
side views of the elongate member manipulator 1300 in a closed
configuration.
[0595] The elongate member manipulator 1300 may include an upper
slide assembly 1334, a lower slide assembly 1330, a drive belt
assembly 1310, an idler belt assembly 1320, an insert motor 1302, a
roll motor 1304, and an elongate member support 1332. The insert
motor 1302 may be fixably mounted to the upper slide assembly 1334
while the roll motor 1304 may be fixably mounted to a manipulator
base 1306 or to the lower slide assembly 1330. The elongate member
support 1332 may also be mounted to the manipulator base 1306 or
lower slide assembly 1330 using one or more screws 1336 or other
attachment mechanisms. The drive belt assembly 1310 may be
removeably coupled to the upper slide assembly 1334 while the idler
belt assembly 1320 may be removeably coupled to the lower slide
assembly 1330 both using one or more screw assemblies 1372 or other
attachment mechanisms.
[0596] FIGS. 92A-B illustrate perspective views of a variation of
an idler belt assembly 1320. In this variation, three small,
separate idler belts 1322 are free to rotate about passive idler
pulleys 1324 rotatably mounted to an idler frame 1326. The multiple
small idler belts 1322 may be spaced apart allowing the elongate
member support 1332 to be inserted, positioned or to extend between
two or more of the belts 1322 as shown in FIG. 91F. In certain
variations, two or more idler belts may be utilized in an idler
belt assembly.
[0597] FIGS. 93A-93D illustrate perspective top and bottom views of
a variation of a drive belt assembly 1310. In this variation, the
serpentine belt 1312 is snaked in a "serpentine" like or weaving
manner around one or more of the drive pulley 1319, the serpentine
idler pulleys 1314 and the reverse idlers 1315, which are each
rotateably mounted to the drive frame 1316. This provides a mating,
multiple segmented belt that may make contact with the multiple
small idler belts 1322 while still providing clearance for the
elongate member support 1332. The drive pulley 1319 may be fixably
coupled to a drive shaft 1318. Materials for various components for
both the idler belt assembly 1320 and drive belt assembly 1310
could include but are not limited to Polyurethane 90A for the belts
1212, 1322, and anodized Al 16061-T6 for the frames 1316, 1326 and
pulleys (1315, 1315, 1319, 1324). Other similar materials may be
utilized.
[0598] FIGS. 94A-94B show another variation of an elongate member
support 1332 that may be used in the elongate member manipulator
1300. FIG. 94B illustrates a cross-sectional top view of the
elongate member support 1332. Certain portions of the support 1332
or the entire support 1332 may be sterilizable. The support 1332
may include a support body 1334 and one or more screws 1336
embedded in support rods 1338 which are controlled by screw knobs
1340 may also be provided on the support 1332. The support body
1334 may have arms or protrusions 1341 and/or grooves 1342 for
holding an elongate member. In one variation, the elongate member
support 1332, the support rods 1338 and/or the screw knobs 1340 may
be made of a softer material such as a PET (poly ethylene
terephthalate) thermoplastic, while the screws 1336 may be made of
stainless steel. In alternative variations, the above components
may be made from a variety of materials and the materials could
vary based on desired hardness of materials as well as costs.
[0599] During operation, the upper slide assembly 1334 may hinge or
rotate open as shown back in FIG. 91F to allow for the guide wire
1060 to be installed onto the elongate member support 1332. The
elongate member support 1332 provides a holder for the guide wire
1060 while centering the guide wire 1060 in a desirable position.
The multiple belt configuration provided by the idler belts 1322
allows for positioning and clearance of the elongate member support
1332 in between the idler belts 1322. The positioning of the
elongate member support 1332 may be such that the guide wire 1060
is supported while still being adequately held between the multiple
small idler belts 1322. Also various elongate member supports could
be provided each with different sized grooves to allow for use of
varying sized guide wires. The elongate member supports may also be
sterile and/or disposable or they may be non-sterile. For example,
the elongate member support 1332 could be provided as a sterile
disposable and be removed and replaced with an alternatively sized
elongate member support if a different sized guide wire was
necessary mid-procedure.
[0600] FIG. 94C illustrates an alternative perspective view of the
elongate member manipulator 1300 with an insert motor cover 1303
mounted thereon, FIG. 94D illustrates the same perspective view
with the insert motor cover removed, and FIG. 94E illustrates a
zoomed in view of the elongate member manipulator 1300 with the
motor cover 1303 removed displaying the insert motor 1302 mounted
to the upper slide assembly 1334. The insert motor 1302 has a shaft
(not shown) which is coupled to helical gear1 1308, which drives
bevel gear2 1309, which is directly coupled to the drive shaft
1318. The drive shaft 1318 is rotatably mounted to a drive frame
1316. The drive shaft 1318 may be driven by the insert motor 1302,
thereby turning the drive pulley (not shown), to actuate the
serpentine belt 1312 in a forwards or reverse direction.
[0601] In the closed configuration of the elongate member
manipulator 1300, as shown in FIGS. 91D and 91E, the idler belt
assembly 1320 and the drive belt assembly 1310 may hold the guide
wire 1060 with enough frictional force to propel the guide wire
1060 in the insert or retract directions when the insert motor 1302
is actuating the serpentine belt 1312. The multiple small idler
belts 1322 will passively roll in the opposite rotational direction
as the serpentine drive belt 1312.
[0602] The upper slide assembly 1334 may be actuated by a roll
motor 1304 which causes the upper slide assembly 1334 to translate
relative to the lower slide assembly 1330 to roll the guide wire
1060 held between the belt assemblies. The roll motor can drive a
pinion which is coupled to racks on both the upper and lower slide
assemblies 1334, 1330 to actuate the translational movement the
slide assemblies as previously described Alternatively, any
equivalent type of mechanism such as a leadscrew configuration
could be used to actuate translation of the upper and lower slide
assemblies. The elongate member support 1332 not only positions or
holds the guide wire 1060 or other elongate member in the elongate
member manipulator 1300 as previously described, but it also
prevents the guide wire 1060 from buckling during guide wire
insertion, retraction or roll actuation.
[0603] Other variations of the idler belt assembly 1320 could
include any number of idler belts and pulleys, spaced apart by
various distances which may allow for installation or positioning
of the elongate member support 1332 between the belts. Accordingly
the elongate member support 1332 could be provided with any number
of support protrusions, spaced at any distance, and the drive belt
assembly 1310 could be provided with any number of pulleys spaced
apart at varying distances to provide for a plurality of windings.
The idler belt assembly 1320 and drive belt assemblies 1310 can be
configured to have mating belt segments such that the distances
between each small idler belt 1322 is minimized to maximize belt
contact with the guide wire 1060. The number of protrusions
provided by the elongate member support 1332 could vary based on
the diameter of the elongate member. For example, a greater number
of protrusions and/or grooves may be provided for an elongate
member having a smaller sized diameter which may require more
support to prevent buckling of the elongate member.
[0604] Referring to FIGS. 95A-95C, an elongate member manipulator
(not shown) can also include a valve holder 1350 which provides a
mount for a valve assembly 1352 that encapsulates the elongate
member (not shown). The valve holder 1350 may include an elongate
member holder 1354 and a cover 1356. The valve holder 1350 can be
mounted to an elongate member manipulator mounting bracket (not
shown) with a screw 1358 and a knob 1360. A set of magnets (not
shown) may be embedded in the cover 1356 and/or in the elongate
member holder 1354 to provide a locking mechanism which holds the
valve holder 1350 in a closed configuration. In other variations,
different types of locking mechanisms such as, but not limited to
clamps, latches, screws, etc., may alternatively be used. In one
variation, the cover 1356, the elongate member holder 1354, and the
knob 1360 could be made of a softer material such as a PET (poly
ethylene terephthalate) thermoplastic while the screw 1358 could be
made of stainless steel and the magnets could be made of neodymium.
In alternative variations the materials could vary based on desired
hardness of materials as well as costs.
[0605] If an operator desires to manually control the guide wire
1060 and decouple it from a robotic elongate member manipulator,
such as manipulator 1300, the drive belt assembly 1310 can be
pivoted open as illustrated in FIG. 15F, the valve holder 1350 can
be opened, and the guide wire can be removed from the system along
with the valve assembly 1352 and support tube 1056. The guide wire
1060 can then be rolled and inserted by hand in a manual manner
which is well known in the art. The guide wire 1060 and valve
assembly 1352 at any time can be quickly re-installed in the
elongate member manipulator 1300 and robotic operation can continue
seamlessly.
[0606] As shown in FIG. 96, both the drive belt assembly 1310 and
idler belt assembly 1320 can be removeably replaceable to allow for
installation of a sterile drape 1370 separating the sterile field
portion of the elongate member manipulator from the non-sterile
field portion of the elongate member manipulator (not shown). FIG.
96 illustrates the drive belt assembly 1310 and idler belt assembly
1320 being mounted using screw assemblies 1372. While similar
captive screw mechanisms as previously described in reference to
FIGS. 90A-C can be used, FIG. 96 illustrates an alternative
variation. It should be understood that either variation shown in
FIGS. 90A-C and the variation shown in FIG. 96 can be used for any
elongate member manipulators described herein along with any other
comparable type of mechanism which is well known in the art.
[0607] FIGS. 96A and 96B illustrate cross sectional top views of
the drive belt assembly 1310 and idler belt assembly 1320. In one
variation, the screw assemblies 1372 can be identical for the idler
and drive belt assemblies or can vary in materials and dimensions
if necessary to support different weights of each idler and drive
belt assembly.
[0608] In an alternative variation, the drive belt assembly 1310
and idler belt assembly 1320 may need to be electrically isolated.
Accordingly, the screw assembly 1372 can include a screw 1374, a
knob 1376, an isolation cap 1378, and an isolation sleeve 1380. The
screw 1374 can be made of stainless steel while the knob 1376 and
isolation sleeve can be made of a thermoplastic, such as PET, and
the isolation cap can be made of a thermoplastic, such as Ultem,
providing for electric isolation. Alternatively, any other
non-conductive material or thermoplastic can be used to manufacture
the knob 1376, isolation sleeve 1380, and isolation cap 1378 or the
drive frame 1316 and idler frame 1326 can be manufactured from a
plastic or any other non-conductive material allowing for the screw
assembly to be simplified and manufactured from stainless steel or
any other type of metal.
[0609] The variation of elongate member manipulator 1300 shown in
FIGS. 91-91F provides the idler belt assembly 1320 and elongate
member support 1332 on the lower half of the manipulator 1300 while
the drive belt assembly 1310 is provided on the upper half of the
manipulator 1300 such that the drive belt assembly 1310 may pivot
open to allow loading of a guide wire 1060. In this variation, the
insert motor 1302 may be mounted to the upper slide assembly 1334.
In an alternative variation, the drive belt assembly 1310 may be
provided on the lower stationary half of the manipulator 1300 so
the idler belt assembly 1320 with elongate member support 1332
could pivot for guide wire 1060 loading. In the latter variation,
optionally, the insert motor 1302 may remain mounted to the
stationary half of the manipulator 1300 which could be
desirable.
[0610] FIGS. 96C-96E illustrates a representation of an alternative
elongate member manipulator 1700 which provides insert actuation
using linear slide motion as opposed to feed rollers or feed belts
as described in previous variations (see e.g., FIGS. 84, 91D, 99,
and 104). FIG. 96C illustrates a perspective view of the guide wire
manipulator 1700 which can include a pad assembly 1702 mounted on a
linear slide 1704 which The guide wire 1060 can be held between two
pads of the pad assembly 1702. To insert or retract the guide wire
1060, the pad assembly 1702 can driven by a motorized leadscrew or
motorized belt and pulley configuration (not shown) in the same
manner which the guide splayer or sheath splayer is inserted as
described in detail in the aforementioned incorporated references.
FIGS. 96D and E illustrate side views of the elongate member
manipulator 1700 during roll actuation where the two pads of the
pad assembly 1702 could be translated relative to one another to
actuate roll of the guide wire 1060. Sizing of the pads can vary as
can pad material to provide the optimum frictional hold on the
guide wire 1060 during roll and also during insert. Wire holders
(not shown) can also be used to prevent slippage during roll.
Insert and roll actuations can be completely independent motions
actuated simultaneously or individually.
[0611] FIG. 97 illustrates another variation of an elongate member
manipulator 1800 mounted to a variation of an instrument driver
1016. The instrument driver includes a guide output plate 1053, a
sheath output plate 1043. FIGS. 97aa-ab illustrate different
perspective views of the elongate member manipulator 1800 shown
without a cover 1801 for clarity. The elongate member manipulator
1800 can be fixably mounted to a manipulator mounting bracket 1858
which in turn can be fixably mounted to the guide output plate
1053.
[0612] FIGS. 97A1 and 97A3 illustrate different perspective views
of the elongate member manipulator 1800 in a closed configuration
while FIGS. 97A2 and 97A4 illustrate the elongate member
manipulator in an open configuration. The elongate member
manipulator 1800 includes the cover 1801, a drive belt assembly
1810, an idler belt assembly 1820, and an elongate member support
1860. The cover 1801 is configured in three sections such that a
middle section may hinge open to allow the elongate member
manipulator to open for loading and unloading of a guide wire 1060
and valve assembly 1352 into and out of the elongate member support
1860. The elongate member manipulator 1800 can be locked in a
closed configuration by securing a locking knob 1813 into a locking
knob threaded hole 1815.
[0613] FIGS. 97B1-B2 illustrate different perspective views of the
elongate member manipulator 1800 with the cover 1801 removed.
Several components including but not limited to the drive belt
assembly 1810, the idler belt assembly 1820, an upper slide
assembly 1834, a lower slide assembly 1830, an insert motor 1802, a
roll motor 1804, and the elongate member support 1860 are
structurally and functionally similar to corresponding components
of the elongate member manipulators 1200, 1300 of FIGS. 9B and
15D-F previously described. Referring to FIG. 97B2 both the roll
and insert mechanism can be seen. FIG. 97B3 illustrates a zoomed in
view of the roll motor and accompanying mechanisms with the
manipulator mounting bracket (1858 shown in FIG. 97B2) hidden for
clarity. The roll motor 1804 directly drives a roll drive shaft
1806 which is coupled to a roll belt 1808 which in turn drives a
pinion 1838. As previously described in detail, the pinion 1838
drives a rack which controls linear movement of the upper slide
assembly 1834 relative to the lower slide assembly 1830 along
linear bearings 1836. The belt drive assembly provides increased
torque when actuating the upper slide assembly 1834. The drive belt
assembly 1810 can be fixably coupled to the upper drive assembly
1834 while the idler belt assembly 1820 can be fixably coupled to
the lower drive assembly 1830. Thus linear movement between the
drive and idler belt assemblies 1810, 1820 provide for roll of a
guide wire held between the belt assemblies 1834, 1820. Foot
supports 1812 may be provided to provide cantilever support of the
belt assemblies 1810, 1820 as they are mounted to the upper and
lower slide assemblies respectively 1834, 1830. The upper slide
assembly 1834 may then be locked to the lower slide assembly 1830
in a closed configuration using the locking knob 1813 which threads
into the lower slide assembly 1830.
[0614] FIG. 97C illustrates the insert motor 1802 mounted to the
upper slide assembly 1834 with the drive belt assembly 1810
installed. Other components of the guide wire manipulator 1800 are
hidden for clarity. The insert motor 1802 drives a set of helical
gears 1803 that actuate an insert shaft 1814. When the drive belt
assembly 1810 is coupled to the upper slide assembly 1834, a drive
shaft (not shown) is engaged with the insert shaft 1814. As the
insert shaft 1814 is actuated by the insert motor 1802, the drive
shaft actuates a drive belt 1818 in a manner previously described
in detail for the elongate member manipulator 1300 shown in FIGS.
15A-D. The drive shaft 1816 can be seen in FIGS. 97D1-D3. FIG. 97D1
illustrates a perspective view of the drive belt assembly 1810,
FIG. 97D2 illustrates a cross sectional bottom view of the drive
belt assembly 1810, and FIG. 97D3 illustrates a zoomed in view of
the end of the drive shaft 1816 which is coupled to the upper slide
assembly 1834. A drape which will be described in detail below can
be installed between the drive and idler belt assemblies 1810, 1820
and the upper and lower slide assemblies 1834, 1830 respectively.
The drape will provide a sterile barrier between the mechanisms of
the elongate member manipulator 1800 and the belt assemblies 1810,
1820. In some situations fluids, for example blood, saline, or
water may flow onto the drape. In order to prevent fluid ingress
into the mechanisms of the elongate member manipulator through
particularly the insert shaft 1814 shown in FIG. 97C,21C, a
labyrinth seal 1817 may be provided. The labyrinth shape of the
drive shaft 1816 as shown in FIG. 97D3 in conjunction with the
labyrinth seal creates a winding path which fluid would need to
pass through before leaking into the insert shaft 1814.
Additionally, the drive shaft 1816 rests within a hole 1819 in the
foot support 1812 which may be configured with a ring groove 1819
which can direct fluid away or downwards prior to entering the
labyrinth seal 1817.
[0615] In one variation, to accurately grip the guide wire between
the belt assemblies 1810, 1820, the belt assemblies are configured
such that they are predominantly parallel with respect to one
another. An adjustment mechanism that provides for alignment of the
drive belt assembly to the idler belt assembly is described with
reference to FIGS. 97E1-G. FIGS. 97E1-E2 illustrates the elongate
member manipulator 1800 with several components hidden for clarity
showing the upper and lower slide assemblies 1834, 1830 fixably
coupled to the drive and idler belt assemblies (1810,1810, 1820)
respectively. The drive belt assembly 1810 can be fixably coupled
to the upper drive assembly 1834 while the idler belt assembly 1820
can be fixably coupled to the lower drive assembly 1830 using screw
assemblies 1822 which are configured to thread into belt assembly
mounting holes 1824. Thus adjustment of the upper slide assembly
1834 relative to the lower slide assembly 1830 will result in
corresponding adjustment of the drive belt assembly 1810 with
respect to the idler belt assembly 1820. While the lower slide
assembly 1830 can be mounted stationary to the manipulator mounting
bracket 1858 without adjustments, the upper slide assembly may be
configured with adjustment mechanisms which will now be
described.
[0616] FIG. 97F illustrates a partially exploded view of the
elongate member manipulator (800)1800 of FIG. 97E with the drive
and idler belt assemblies hidden for clarity. The upper slide
assembly 1834 can include a top plate 1840 and a bottom plate 1842.
The top plate 1840 which includes an alignment bar 1844 centered in
a top plate opening 1841, an adjustment set screw 1847, an
adjustment nut screw 1848 and an adjustment spring 1850 is
illustrated exploded from the bottom plate 1842 which includes a
cradle 1846. When assembled, the cradle is configured to hold the
alignment bar 1844 in a manner that allows the alignment bar 1844
to float in three separate axes of motion. FIG. 97G illustrates a
simplified representation of the alignment bar 1844 held within the
cradle 1846 showing top, front and side views. The alignment bar
1844 can rotate about its own axis as shown with roll arrow 1852,
translate up and down as shown with vertical arrow 1854, and also
rotate in a rocking motion as shown with pitch arrow 1856. The
alignment bar 1844 is constrained in this configuration from
rotating in a yaw motion or translating in a side to side
direction. It is also constrained by the fit of the cradle 1846 to
the top slide plate opening 1841.
[0617] In this configuration, because the drive belt assembly 1810
is fixably mounted to the top plate 1840, as the top plate 1840
floats in a roll, vertical, or pitch direction, the drive belt
assembly 1810 and top plate 1840 float as a single component. The
adjustment set screw 1847 can be tightened or loosened to set the
overall height of the top plate 1840 and drive belt assembly 1810
relative to the idler belt assembly 1820. The adjustment not screw
1848 is tightened down increasing the downward force provided by
the adjustment spring 1850 which presses the belt assemblies
together. The adjustment set screw 1847 acts as a reaction or pivot
point allowing the top plate 1840 to gimble about the roll and
pitch axes of the alignment bar 1844. As the drive belt assembly
1810 comes in contact with the idler belt assembly 1820, the latter
of which is stationary, the alignment bar 1844 provides the
capability of self parallel alignment between the two belt
assemblies. The alignment nut is tightened completely to secure the
top plate 1840 to the bottom plate 1842 such that the position of
the drive belt assembly 1810 is securely set.
[0618] FIGS. 97H1-H2 illustrate the elongate member manipulator
1800 with the drive belt assembly and idler belt assembly removed
showing the elongate member support 1860 mounted to the manipulator
mounting bracket 1858 using a pair of mounting set screws 1866
which thread into member support mounting holes 1859. FIG. 97J1
illustrates the elongate member support 1860 with the valve
assembly 1352 and guide wire 1060 installed. The elongate member
support 1860 includes a support body 1862 and a valve holder 1864
which can be securably fixed to the support body 1862 using screws
1863. FIG. 97J2 illustrates the elongate member support 1860 in an
open configuration allowing the valve assembly 1352 and guide wire
1060 to be removed. The valve assembly 1352 and guide wire 1060 can
be coupled as an assembly and can be removed and replaced into the
elongate member manipulator 1800 with opening of the valve holder
1864 and the opening of the drive belt assembly 1810 which hinges
open as previously described. FIG. 97J3 illustrates the valve
holder 1864 in a closed configuration including a set of magnets
1870 are in the top and bottom portions of the valve holder 1864
which lock the valve holder 1864 in a closed position. A stop 1869
can be provided to prevent the valve holder 1864 from opening
beyond a set rotation to prevent collision with any other
components of the elongate member manipulator 1800 or any other
tools or instruments used during a surgical procedure. Magnets 1872
embedded in the stop and top portion of the valve holder 1864 lock
the valve holder 1864 in an open position as shown in FIG.
97J4.
[0619] FIG. 97K1 illustrates a variation of a drape assembly 1900
that may be used to cover the elongate member manipulator and
instrument driver. As previously described, the drape assembly can
be used to create a sterile barrier between the instrument driver
and non-sterile portions of the elongate member manipulator with
the drive belt assembly, idler belt assembly, and guide wire. The
drape assembly allows transfer of mechanical motion from the
instrument driver to each splayer as well as from the motors of the
elongate member manipulator to the drive and idler belt assemblies.
FIG. 97K2 illustrates a zoomed in view of the drape assembly 1900
which can include a drape body 1901, sheath foam pad 1902, a leader
foam pad 1904, a tenting frame 1920, drape member support holes
1936, and a locking knob hole 1938. The drape member support holes
1936 and locking knob hole 1938 can be reinforced with frames that
will provide additional strength to prevent tearing of the drape
when screws are installed through the holes. The sheath and leader
foam pads 1902, 1902 were described previously in detail.
[0620] Referring to FIGS. 97L1-L2, the tenting frame 1920 is
illustrated from top and bottom perspective views respectively
showing flexure bases 1922, flexures 1924, adhesive portions 1926,
and reinforcement members 1928. Each flexure base 1922 of the
tenting frame 1920 can be fixable attached to the drape body 1901
with adhesive. The flexures 1924 of the tenting frame 1920 can
adhere to the drape body 1901 along adhesive portions 1926 of each
flexure 1924 positioned along the centerline of the tenting frame
1920. The remaining length of each flexure 1924 can be free to move
relative to the drape body 1901. The reinforcement members 1928 can
include drape idler belt mounting holes 1934, drape drive belt
mounting holes 1930 and a drape drive shaft hole 1932. The
reinforcement members 1928 are provided to reinforce the mounting
holes 1930, 1934. The reinforcement members 1928 can be made from a
material which is tough enough to provide some strength where high
forces will be imposed while also providing flexibility. Also it
can be desirable for the reinforcement members 1928 to remain as
thin as possible. If the reinforcement member 1928 are thick and
compressible, as mounting screws are tightened down the material is
compressed. As the material settles in the screws may require
re-tightening which can be undesirable for mid-procedure work flow.
The reinforcement members 1928 can be made from polycarbonate or
any other type of plastic which fulfills the stiffness, thickness,
and material strength requirements. Materials for other components
can include but not be limited to polyethelene for the drape body
1901 and high-density polyethylene (HDPE) for the tenting frame
flexure base 1922, flexures 1924, and reinforcement frames for the
drape drive shaft holes 1932, drape idler mounting holes 1934,
drape member support holes 1936, and drape locking knob hole
1938.
[0621] FIG. 97M1 illustrates a simplified model of the elongate
member manipulator 1800. For clarity, only the model of the
elongate member manipulator 1800 and drape assembly 1900 are being
shown. It should be understood that the elongate member manipulator
1800 may be installed on the previously described instrument driver
(1016 of FIG. 15A) and the drape assembly 1900 can be configured to
surround both the instrument driver and elongate member manipulator
1800. In order to install the drape assembly 1900 to the elongate
member manipulator 1800, the sterile components including the drive
and idler belt assemblies, the elongate member support (1810, 1820,
and 1860 respectively), and the locking knob 1813 are removed from
the elongate member manipulator 1800 as shown in FIG. 97M1.
[0622] Referring back to FIGS. 97A2, 97H2, 97K2, 97L1, 97E2 and to
FIGS. 97M2-M5, one variation of a method of installing a drape onto
an elongate member manipulator 1800 can be seen. In this variation,
the drape member support holes 1936 are aligned with the member
support mounting holes 1859 and the elongate member support 1860
can be installed by securing the mounting set screws 1866 into the
member support mounting holes 1859 as shown in FIG. 97M2. The drape
idler belt mounting holes 1934 are aligned with the idler belt
mounting holes 1824 and the idler belt assembly 1820 is installed
to the lower slide assembly 1830 by securing the idler screw
assemblies 1822 into the idler belt mounting holes 1824 as shown in
FIG. 97M3. The tenting frame 1920 is folded over such that the
drape drive belt mounting holes 1930 can be similarly aligned with
the drive belt assembly mounting holes 1825 and the drive belt
assembly 1810 can be installed by securing the drive screw
assemblies 1823 into the drive belt assembly mounting holes 1825 in
the upper slide assembly 1834 as shown in FIG. 97M4. The locking
knob 1813 is then fit through the drape locking knob hole 1938 and
secured into the locking knob thread hole 1815. The drape is held
securely in place between the sterile components including the
elongate member support 1860, the idler and drive belt assemblies
1820, 1810, and locking knob 1813 providing a sterile barrier
between the sterile components and the non-sterile components of
the elongate member manipulator 1800 and instrument driver.
[0623] During use, the locking knob 1813 can be loosened while
being held captive such that the elongate member manipulator 1800
can be opened in order to load a guide wire 1060 as shown in FIG.
97A1-A2.21A1-A2. The tenting frame 1920 is unfolded and stretched
allowing the elongate member manipulator to open while continuing
to cover the non-sterile components of the elongate member
manipulator 1800. The guide wire 1060 and valve assembly 1352 can
then be loaded and the elongate member manipulator 1800 can be
closed for use including the rolling of the guide wire 1060 by
translation of the upper and lower slide assemblies 1834, 1830 as
previously described. The tenting frame 1920 can serve multiple
functions. It pushes the drape body 1901 in an outward direction so
that the drape body 1901 is not pinched between the upper and lower
slide assemblies 1834, 1830 as they are opened and closed. Also
because the upper and lower slide assemblies 1834, 1830 translate
relative to each other during use, excess drape material must be
provided so that the drape body 1901 doesn't tear with this
movement. Because the tenting frame 1920 is secured to the drape
body 1901 only along its centerline along the adhesive portions
1926, the tenting frame 1920 shapes the drape body 1901 to manage
the excess drape material.
[0624] FIGS. 98A-98B illustrate a different variation of an
elongate member manipulator 1400 mounted on the instrument driver
1016 using a manipulator mounting bracket 1058 such that a guide
wire (not shown) can be fed into the valve assembly 1352, then into
the support tube 1056 which subsequently feeds into a guide splayer
1052 or sheath splayer. In alternative variations, the elongate
member manipulator 1400 could be mounted on the instrument driver
1016 with a guide and/or a sheath splayer assembly (e.g., the
assembly 50/40 in FIG. 2), the elongate member manipulator could be
mounted with just a sheath assembly 1040 or the elongate member
manipulator 1400 could be mounted alone.
[0625] FIG. 99 illustrates the elongate member manipulator 1400
mounted to the manipulator mounting bracket 1058 with a guide wire
1060 loaded therein. FIGS. 100A-100B illustrates the elongate
member manipulator 1400 without a motor pack cover 1401 showing an
insert motor 1402, a roll motor 1404 and a belt assembly 1410.
FIGS. 101A-101C illustrate a front and rear perspective view as
well as a end view of the belt assembly 1410 which includes a drive
belt 1412, an idler belt 1422, a drive pulley 1414, idler pulleys
1424, bevel gears 1416, a driving gear 1418, an idler gear 1426, a
driven gear 1420, and a clamp assembly 1440. The belt assembly 1410
can be removably replaceable such that a sterile drape can be
inserted between the belt assembly 1410 and the remaining drive
components, such that the belt assembly 1410 may be positioned in a
sterile field with the guide wire 1060.
[0626] To aid in loading the guide wire 1060 into the belt assembly
1410, the clamp assembly 1440 may be provided to open and close the
belt assembly 1410 as shown in FIGS. 102A and 102B. FIGS. 102A-102B
each illustrate a side view of the drive assembly 1410 where FIG.
102A shows the belt drive assembly in a closed configuration while
FIG. 102B shows the belt drive assembly in an open configuration.
As seen best in FIGS. 101B-101C, the clamp assembly 1326 includes a
clamp 1442 that levers about a pivot 1444 to open and close the
idler belt 1412 portion of the belt drive assembly in a clamping
motion. A pair of clamp springs 1446 can be used to provide the
clamping force for closing the clamp assembly in a nominally closed
position. The clamp springs 1446 can be sized to provide for enough
clamp force to hold the drive and idler belts 1412, 1422 together
and effectively pinch the guide wire 1060 so it can be secured
between the drive and idler belts 1412, 1422 while preventing
damage to the guide wire 1060. To load the guide wire 1060, the
clamp 1442 can be manually opened by compressing the springs 1446
while the guide wire may be back loaded through the belt drive
assembly.
[0627] In order to actuate the belt assembly 1410, FIG. 100B and to
FIG. 101B show the insert motor 1402 driving an insert belt 1406,
turning an insert shaft 1428, turning the driving gear 1418, the
idler gear 1426 and ultimately the driven gear 1420 which is
coupled to a shaft driving the bevel gears 1416. The idler belt
1422 is free to rotate around the passive idler pulleys 1424. As
seen in FIG. 101A, the bevel gears drive the drive pulley 1414
which turns the drive belt 1412 over idler pulleys 1424. The drive
belt 1412 and the idler belt 1422 are pressed together causing the
idler belt 1422 to rotate in the opposite direction as the drive
belt 1412 and thus driving the guide wire 1060 pinched between both
belts in the insert or retract direction depending on the direction
of the drive belt actuation. Referring back to FIG. 100B, roll
actuation of the guide wire 1060 is illustrated. In order to roll
the guide wire 1060 the entire belt assembly 1410 is rolled on a
roll shaft 1430. The roll shaft 1430 is coupled to a roll belt 1408
driven by the roll motor 1404.
[0628] FIG. 103 illustrates another variation of an elongate member
manipulator 1500 coupled to the instrument driver 1016 via a
mounting bracket 1058 positioned such that a guide wire (not shown)
could feed through the elongate member manipulator 1500 and into a
guide catheter splayer 1202 and/or sheath splayer. In alternative
variations, the elongate member manipulator 1500 could be mounted
on the instrument driver 1016 with a guide and/or a sheath splayer
assembly (e.g., assembly 50/40 in FIG. 2), the elongate member
manipulator could be mounted with just a sheath assembly 1040, or
the elongate member manipulator 1400 could be mounted alone.
[0629] FIG. 104 shows the elongate member manipulator 1500 with its
cover removed, mounted to a manipulator base 1570 which in turn is
mounted to the manipulator mounting bracket 1058. The elongate
member manipulator 1500 includes an insert motor 1502, insert belt
1506, feed roller assembly 1510, roll motor 1504, and roll belt
1508. The insert motor 1502 and roll motor 1504 are each fixably
mounted to the manipulator base 1570 and are coupled to an insert
shaft 1528 and roll shaft 1530 respectively.
[0630] FIG. 105 illustrates the feed roller assembly 1510 which
includes the roll shaft 1530 and the insert shaft 1528. The insert
motor 1502 drives the insert belt 1506, which rotates the insert
shaft 1528 coupled to a drive gear 1518, which drives a driven gear
1520 which is coupled to bevel gears 1516, ultimately rotating a
drive feed roller 1512, which can be positioned adjacent to an
insert feed roller 1522. In one variation, the insert feed roller
1522 could be passive such that when the drive feed roller 1512 is
actuated in one rotational direction, the frictional force between
the drive feed roller 1512 and insert feed roller 1522 causes the
insert feed roller to rotate in the opposite rotational direction.
A guide wire (not shown) can be positioned between the drive feed
roller 1512 and insert feed roller 1522 such that rotation of the
feed rollers would result in a propelling actuation of the guide
wire in the insert or retract directions depending on the
rotational direction of the feed rollers.
[0631] An alternative variation for actuation of the feed rollers
is illustrated in FIG. 106A which is a zoomed in view of the feed
roller assembly 1510 with certain components hidden or shown as
transparent for clarity. FIG. 106B is a top view of FIG. 106A. In
this variation, the insert feed roller 1522 is not passive but is
driven at the same rate as drive feed roller 1512 in an opposite
rotational direction thereby inserting or retracting the guide wire
1060 held between the feed rollers.
[0632] FIG. 107A illustrates a top view of the feed roller assembly
1510 while FIG. 107B illustrates a bottom view where certain
components are shown as transparent for clarity. In this figure a
feed roller gear train can be seen which includes four gears with
identical gear ratios including a drive gear 1514, a first idler
gear 1515, a second idler gear 1517 and a driven gear 1519. By way
of example but not limitation, each gear could be sized with a 48
pitch and 27 tooth count which could be coupled to feed rollers
that are 5/8'' in diameter. In alternative variations, the gears
could be sized with varying pitch and tooth count and the feed
roller may have varying diameters.
[0633] Drive gear 1514 is coupled to drive feed roller 1512 such
that rotary motion of drive feed roller 1512 actuates drive gear
1514 in a one-to-one rotary motion. Drive gear 1514 rotates first
idler gear 1515 which rotates second idler gear 1517, rotating
driven gear 1519 which is coupled to driven feed roller 1522 such
that rotation of driven gear 1519 actuates insert feed roller 1522
in a one-to-one rotary motion. Thus rotation of the drive feed
roller 1512 via the gears, belts and motors previously described
rotates insert feed roller 1522 at the same rate in an opposite
rotational direction. By way of example, when drive feed roller
1512 is rotated in the clockwise direction, drive gear 1514 is also
rotated at the same rate in the clockwise direction. Drive gear
1514 then drives first idler gear 1515 in the counterclockwise
direction, which drives second idler gear 1517 in the clockwise
direction, which drives driven gear 1519 in the counterclockwise
direction all at the same rotational rate if all gears have
identical gear ratios. Driven gear 1519 coupled to the idler feed
roller 1414 rotates idler feed roller in the counterclockwise
direction resulting in opposite rotation of the drive feed roller
1512 and the driven feed roller 1522.
[0634] Roll of the guide wire may be actuated by rolling the feed
roller assembly 1510. Referring back to FIG. 104, the roll motor
1504 is illustrated actuating the roll belt 1508 which in turn
rotates the roll shaft 1530 rolling a feed roller assembly 1510 and
ultimately rolling the guide wire (not shown) being held tightly
between the feed rollers 1512, 1522.
[0635] With elongate member manipulators 1400 and 1500, the insert
belt 1406, 1506 and roll belt 1408, 1508 are coupled to shafts
1428, 1528, 1430, 1530 which are rotatably coupled to bearings so
they are free to rotate independently about the same axis of
rotation. However, if either the belt assembly 1410 or feed roller
assembly 1510 is actuated to roll but the insert belt 1406, 1506
remains stationary, the drive belt 1412 or drive feed rollers 1512
will not remain stationary. Using the elongate member manipulator
1400 from FIG. 100B as an example, if the belt assembly 1410 rolls
by actuating the roll motor 1404 and the insert motor 1402 remains
off, the driving gear 1418 remains stationary while the idler gear
1426 circumvents the driving gear 1418 with the motion of the roll
assembly 1402. Thus, the rotation of the idler gear 1426 results in
rotation of the driven gear 1420 and subsequent rotation of the
bevel gears 1416 causing rotation of the drive belt 1412 and
undesired insert of the guide wire 1060. The actuation of the
insert motor may match the actuation of the roll motor such that as
the idler gear 1426 circumvents driving gear 1418 without rotating
about its own axis. The rotation of the insert motor 1402 and roll
motor 1404 may be coordinated to achieve the desired actuation.
[0636] In order to actuate the guide wire in the
feed/insert/retract direction only, the insert motor would be
actuated while the roll motor would remain off. In order to roll
the guide wire only without insertion/retraction, the roll motor is
turned and the insert motor is turned at an identical rate. In
order to feed and roll the guide wire simultaneously, the insert
and roll motors may be actuated at different rates. Because the
current variation actuates roll by rolling the entire structure,
roll and insert of the guide wire can be simultaneously actuated
without the effect of stripping or winding up the guide wire. The
guide wire does not have to overcome any frictional holding effects
at the feed belts when being actuated in a roll direction since the
feed belts themselves are being rolled.
[0637] FIGS. 106A-107B show an example of a spring mechanism 1556
that can provide for a constant force applied to the guide wire
(not shown) by the feed rollers 1512, 1522. The spring mechanism
1556 can provide for the ability to grip variously sized guide wire
diameters, and it can also allow for top loading of the guide wire
into the feed roller assembly 1510. The spring mechanism 1556 can
include a frame 1552, a pivot frame 1554, a spring mount 1558, and
a spring 1560. The frame 1552 is shown in FIG. 106A as a solid case
surrounding second idler gear 1517, first idler gear 1515, and
drive gear 1514. The frame 1552 remains stationary relative to the
insert shaft 1528 such that the only movement experienced by the
frame 1552 is rotation during roll of the feed roller assembly
1510. The pivot frame 1554 is shown as a transparent case fit into
the frame 1552 but surrounding driven gear 1519, second idler gear
1517 and the spring 1560 in a cup 1562. The spring mount 1558 is
shown as a solid flange which holds one end of the spring 1560 in
place constraining it within the cup 1562. The spring mount 1558
may be attached to the main plate 1452 using a pair of screws 1564,
so that it is stationary to the frame 1552 (as best shown in FIG.
31B). The pivot frame 1554 is mounted such that it can rotate about
second idler gear 1517 but due to the spring force the pivot ram
1554 is held in a nominally closed position pinching the feed
rollers 1512, 1522 together. The spring 1560 can be sized to
optimize the force necessary to hold a guide wire with enough
friction to actuate it in the insert and roll directions while not
damaging the guide wire. By way of example but not limitation, the
pivot plate can be sized so that a swing arm allows a 2 to 1 pinch
advantage between feed rollers such that a 2.5 lb spring would
result in a 5 lb pinch force at the feed rollers. With a 2.5 lb
spring, the range of guide wire diameters could be between about
0.014'' and 0.038.'' In this example, a wire diameter smaller than
about 0.014'' may not be gripped adequately to provide insert and
roll motion without slipping and a wire diameter above about
0.038'' may be damaged by the pinch force.
[0638] In one variation, the guide wire 1060 can be back loaded
into the elongate member manipulator by manually loading the guide
wire 1060 into the proximal end of the feed roller assembly 1510,
loading it into the proximal end of the roll shaft 1532 which could
be provided with a thru lumen, and actuating the insert motor 1502
to actuate the feed rollers 512, 522 in the insert direction until
the desired length guide wire 1060 is fed through the elongate
member manipulator 1500. In an alternative variation, the guide
wire 1060 can be back loaded into the roll shaft 1530 as described
above but then top loaded into the feed roller assembly 1510. To
top load the guide wire 1060 the spring 1560 could be compressed by
manually squeezing the pivot frame 1554 towards the cup 1562 on the
frame plate 1552, pivoting both the pivot plate 1554 and idler feed
roller 1522. FIGS. 108A and 1088 show a representation of the
bottom view of the gear train and feed rollers, and illustrate the
spacing between the drive feed roller 1512 and the idler feed
roller 1522 created by squeezing the spring 1560 and pivot frame
1554. The guide wire can then be loaded from above into a groove
1566 shown in FIGS. 106A, 106B, and 107A which helps center the
guide wire between the feed rollers 1512, 1522.
[0639] FIG. 109 illustrates a variation of a feed roller
configuration that may prevent or reduce slippage of the guide wire
1060 between the drive feed roller 1512 and the insert feed roller
1522 when insert or roll motion is actuated. In this variation, the
drive feed roller 1512 is configured with a V-groove 1568 cut
around its diameter. The guide wire 1060 may fit in the V-groove
1568 and be held in position by the insert feed roller 1522. The
guide wire 1060 may be held by three points of contact, two within
the V-groove 1568 and one with the drive feed roller 1512 without a
groove thus constraining the guide wire 1060 vertically and
rotationally. In alternative variations, a similar groove may be
cut into the drive feed roller 1512 or it may be cut in the drive
feed roller 1512 and not the insert feed roller 1522. The groove
may be of various dimensions depending on the range of wire
diameter sizes and the necessary contact between the groove and the
guide wire. The groove may also be of various shapes including but
not limited to semi-circular, square, or any polygon shape which
could provide for necessary contact with the guide wire.
[0640] Referring back to FIG. 107A, a guide wire groove 1566 is
provided to help align the guide wire (not shown) vertically with
the V-groove 1568 in the drive feed roller 1412 as well as center
the guide wire in between both feed rollers 1512, 1522.
[0641] As previously described, it can be desirable to maintain the
guide wire 1060 and a minimal number of disposable components in a
sterile field and the remaining components in a non-sterile field.
As shown in FIGS. 110A-110B, in one variation, the feed roller
assembly 1510 could be separated into two sub-assemblies, an insert
assembly 1511 which is maintained in the sterile field and an
actuation assembly 1513 positioned in the non sterile field. The
insert assembly 1511 could include the gears and rollers provided
for insertion of the guide wire including but not limited to the
spring mechanism 1556, gears (1514, 1515, 1517, 1519), rollers
1512, 1522, driven gear 1520, and bevel gears 1516. The actuation
assembly 1513 could include the driving gear 1518, insert shaft
1528, and roll shaft 1530. While the actuation assembly 1513 still
includes a number of gears and pulleys, a number of expensive
components including gears, the insert and roll motors 1502, 1504,
insert and roll belts 1506, 1508, and instrument driver 1016 would
remain in the non-sterile field.
[0642] FIGS. 109-110 also show one way to mount the insert assembly
1511 to the actuation assembly 1513 allowing for separation of
sterile versus non-sterile components where the insert assembly
1511 could be removeably coupled to the actuation assembly 1513
which is fixably mounted to the other components of the elongate
member manipulator 1500. A sterile drape (not shown) could be
positioned between the insert assembly 1511 and the non-sterile
components. Referring to FIG. 110 as well as back to FIG. 108, the
insert assembly 1511 could be mounted to a mounting plate 1572
using mounting screws 1574. The mounting plate 1570 could be
fixably mounted to a manipulator base 1570 which provides the base
structure for the insert motor 1502, the roll motor 1504 and the
feed roller assembly 1510. In alternative variations, an interface
that allows for quick removal and replacement of the insert
assembly 1511 without the use of tools could be used. Additionally
the interface could include mating components on the sterile
drape.
[0643] It should be understood that any of the previously described
elongate member manipulators could include multiple variations of
feed roller and/or feed belt combinations. FIGS. 111A-111D
illustrate examples of such combinations. FIG. 111A illustrates a
variation using multiple feed roller pairs 1710, 1712a, 1712b,
1712c for actuating the guide wire 1060 where motor driven feed
roller pair 1710 drives the guide wire 1060 in an insert motion
while feed roller pairs 1712a, 1712b, 1712c can be idler rollers
which are free to rotate. FIG. 111B illustrates a variation using
multiple feed belt pairs 1720, 1722a, 1722b for actuating the guide
wire 1060 in an insert motion where feed belt pair 1720 is motor
driven and feed belt pairs 1722a, 1722b are idler belts which are
free to rotate. FIG. 111C illustrates a variation that uses a
combination of feed roller pairs and feed belt pairs where feed
roller pair 1714 is motor driven while feed roller pair 1716 and
feed belt pairs 1724a, 1724b are idle and free to rotate.
[0644] Alternatively feed belt pair 1724a can be motor actuated
while feed belt pair 1724b and feed roller pairs 1714, 1716 are
idle as shown in FIG. 111D. FIGS. 111E and 111F illustrate
alternative variations which feed rollers and feed belts are not
used in pairs but a single set of feed rollers 1718a, 1718b, 1718c
and a feed belt 1726 are used to grip the guide wire 1060. FIG.
111E illustrates a variation in which the feed roller 1718a is
motor driven to actuate the guide wire 1060 while FIG. 111F
illustrates the feed belt 1726 as motor driven.
[0645] It should be understood that alternatively any of the idle
roller pairs and idle belt pairs could be motor driven, any motor
driven feed roller pairs and feed belt pairs could be idle, and
while a specific number of pairs of rollers and/or belts are
illustrated, any number can be used. Additionally in any pair of
feed rollers or feed belts, one feed roller or feed belt could be
motor driven while the other could be idle. In the configuration
illustrated in FIGS. 111C and 111D, any combination of feed roller
pairs and feed belt pairs could be used in any order and
furthermore any combination of feed rollers, feed roller pairs,
feed belts and feed belt pairs from any of the variations
previously described may be used. Motor driven actuation can be
provided in the manner previously described and roll actuation of
the guide wire can be provided with the translation of the feed
rollers/feed belts along their own axes of rotation also previously
described.
[0646] FIGS. 124A-C illustrate another alternative variation of an
elongate member manipulator 1600. FIG. 124A illustrates the
elongate member manipulator 1600 with a manipulator cover 1601
installed while FIG. 124B illustrates the manipulator cover 1601
removed. The elongate member manipulator 1600 includes a member
holder 1608, an insertion drive 1610, and a rotation drive 1620
each of which can be directly or indirectly mounted to a
manipulator base 1606. FIG. 124C shows the insertion drive 1610
which includes an insert motor 1602, a leadscrew 1612, a leadscrew
nut 1614, and/or a linear slide 1616.
[0647] FIGS. 125A-C illustrate a perspective, side, and zoomed in
views of the rotation drive 1620 respectively which includes a
rotation base 1618, a rotation drive bracket 1622, roll motor 1604,
a drive gear 1624, a rotation gear 1626, a collet 1628, a collet
solenoid 1632, and/or a collet mount 1634. The collet 1628 can be
coupled to the collet mount 1634 using collet bearings 1636 such
that the collet 1628 can be free to rotate within the collet mount
1634. The collet 1628 may also be coupled or fixably coupled to the
rotation gear 1626 such that actuation of the rotation gear 1626
would drive rotation of the collet 1628.
[0648] FIG. 125B illustrates the rotational drive 1620 with the
guide wire 1060 loaded. It should be understood as described
previously that the guide wire 1060 is shown for illustrative
purposes and any type of elongate member may be loaded into the
manipulator 1600. In order to load the guide wire 1060 into the
system, the collet 1628 can be opened, the guide wire 1060 can be
backloaded into the system, and the collet 1628 can then be closed
gripping the guide wire 1060. The collet 1628 functions as a
typical chuck or collet chuck as is well known in the art such that
in order to loosen or tighten the collet 1628, one end of the
collet 1628 would be held stationary while the other end is
rotated. Depending on the direction of rotation, the collet is
either tightened around the guide wire 1060 or loosened from the
guide wire 1060. In this variation, the opening and closing of the
collet 1628 can be automatically or remotely controlled. The collet
1628 can be geared such that collet teeth 1630 can mate with the
collet solenoid 1632. When the collet solenoid 1632 is activated to
engage one end of the collet 1628 is held stationary, the roll
motor 1604 can turn the drive gear 1624, which will rotate the
rotation gear 1626, rotating the other end of the collet 1628 which
will loosen or tighten the collet 1628 depending on the direction
of rotation.
[0649] Once the collet 1628 is closed adequately holding the guide
wire 1060, the collet solenoid 1632 can be disengaged from the
collet teeth 1630. In this configuration, rotation of the rotation
gear 1626 which is indirectly driven by the roll motor 1604 will
not cause the collet 1628 to loosen or tighten. Instead, the entire
collet 1628 will rotate with the rotation gear 1626 thus rolling
the guide wire 1060 which is held securely in the collet 1628.
[0650] In order to actuate the guide wire 1060 in the propelling
motion, inserting or retracting it axially, the rotation drive 1620
can be mounted to linear slide 1616 as shown in FIG. 124C. The
leadscrew nut 1614 can be fixably mounted to the rotation base 1618
and coupled to the leadscrew 1612 such that when the insert motor
1602 drives the leadscrew 1612, rotation drive 1620 is controllably
driven linearly and the guide wire 1060 can be controllably
propelled in the insert or retract direction depending on the
rotational direction of the insert motor 1602.
[0651] In one variation, the insert/retract stroke can be limited
by the physical travel of the linear slide 1616. In an alternative
variation, an infinite insert or retract distance may be
achieved.
[0652] FIG. 126 shows a side cross sectional view of the elongate
member manipulator 1600 illustrating the member holder 1608 which
can include a holder solenoid 1638. The holder solenoid 1638 can
include a holder tip 1640 that is actuated to hold or release the
guide wire 1060. When the guide wire 1060 is being actuated in the
roll or propelling directions, the holder solenoid 1638 can be
actuated to release the guide wire 1060 to move freely through the
member holder 1608. When the linear slide 1616 has reached its
forward limit in the propelling direction, the holder solenoid 1638
can be actuated to hold the guide wire 1060 in the member holder
1608, the collet 1628 can be actuated to open, releasing its grip
on the guide wire 1060, and the rotational drive 1620 can be
translated back to the reverse limit of the linear slide 1616. The
collet 1628 can then be actuated to tighten around the guide wire
1060, the holder solenoid 1638 can be actuated to release the guide
wire 1060 within the holder member 1608, and the guide wire 1060
can again be actuated in the propelling and roll directions in the
manner previously described. The same method can be used in the
retract direction.
[0653] In one variation, algorithms for control of the elongate
member manipulator 1600 can be applied such that the sequence of
collet and holder solenoids 1632, 1638 as well as insert and roll
motors 1602, 1604 are coordinated to create rapid and seamless
actuation of the elongate member manipulator 1600. Additionally
algorithms can be implemented that will control the opening and
closing of the collet 1628 based on the size of the guide wire
1060, catheter or any other type of elongate member that would be
loaded into the elongate member manipulator 1600. A lookup table of
rotations based on type of guide wire or elongate member could be
programmed into the system controller and the user could input the
information regarding the type of elongate member into the system
before use. The look up table could be created using empirical data
or calculations based on known mechanical properties of the
elongate member. Alternatively, closing and opening of the collet
could be based on sensed force during of rotation of the rotation
gear 1626. When the collet solenoid 1632 is actuated to hold the
collet teeth 1630 and the collet 1626 is being actuated to close
using the rotation gear 1626, sensing the force imparted on the
gear during rotation could be an indicator of when to cease
rotation as the collet 1626 closes around the guide wire 1060.
Mechanisms for sensing force will be described in further detail
below.
[0654] For certain variations of the elongate member manipulator,
it can be desirable to provide the capability of measuring the
external force applied to the distal end of the elongate member,
e.g., a guide wire. Thus, if the distal tip of the guide wire makes
contact with tissue, the user could be aware of the force being
applied to the tissue. The elongate member manipulator 1600
illustrated in FIGS. 124A-C can include a variation of force
sensing that provides for force sensing during insert/retract and
roll actuation of the guide wire 1060.
[0655] FIG. 127A illustrates the rotation drive 1620 for the
elongate member manipulator 1600 and FIG. 127B illustrates a side
cross sectional side view of rotation drive 1620 displaying a load
cell 1642 mounted stationary relative to the rotation base 1618 and
a fulcrum 1644 which allows the lower portion of the rotation drive
bracket 1622 to pivot towards or away from the load cell 1642. Thus
any forces experienced by the guide wire 1060 which is held
securely in the collet 1628, will cause the rotation drive bracket
1622 to transmit forces to the load cell 1642. With known
kinematics and base-lining of initial load cell readings, force
applied to the distal tip of the guide wire may be calculated.
[0656] FIG. 127C illustrates a side view of the rotation drive 1620
with a back cross sectional view of the rotation drive 1620. In
this variation, the roll motor 1604 is mounted to a motor bracket
1646 which is supported on a set of bearings 1648 which constrain
the bracket 1646 in a fixed vertical and horizontal position yet
allow the bracket 1646 to rotate about the roll motor rotational
axis as illustrated by the arrows 1652. The bracket 1646 can
include a lever 1654 which can be positioned against an LVDT sensor
1656 that can be fixably mounted to the rotation drive bracket
1622. Thus a reactive torque imparted on the motor 1604 in the
rotational direction would be transmitted to the LVDT 1654 and
could be read as resistive force experienced by the guide wire 1060
during a roll actuation. In order to prevent damage to the LVDT
1654, hard stops 1650 could be mounted to the rotation drive
bracket 1622.
[0657] FIG. 112A illustrates a variation of an apparatus that
provides force measurement of a guide wire distal tip during
insert. FIG. 112A shows a bottom perspective view of the elongate
member manipulator 1200. It should be understood that the elongate
member manipulator 1200 is shown by way of example, and this force
sensing apparatus could be used for any of the elongate member
manipulators described herein. The lower slide assembly 1230 is
mounted to the manipulator mounting bracket 1058 to which a strain
gauge 1080 is also mounted. When force is applied to the distal tip
of the guide wire 1060, the lower slide assembly 1230 mounted to
the manipulator mounting bracket 1058 is displaced causing a
reading in the strain gauge 1080. The strain reading can be used to
calculate a guide wire distal tip force.
[0658] An alternative variation of a force measurement apparatus is
illustrated in FIG. 112B. In this variation, the elongate member
manipulator 1500 is shown with a strain gauge load cell 1082
fixably mounted to the manipulator base 1570. The manipulator base
1570 is mounted to the manipulator mounting bracket 1058 using a
pair of linear slides 1084 which allow movement of the manipulator
base 1570 and thus the elongate member manipulator 1500 in the
insert/retract direction or the direction along the axis of the
guide wire (not shown in FIG. 112B). A force sensing block 1086 is
fixably mounted to the manipulator mounting bracket 1058 but is
positioned so that it fits between the arms of the load cell 1082.
When an external force is applied to the distal tip of the guide
wire (not shown), the elongate member manipulator 1500 is moved
back in the retract direction along with the manipulator base 1570
via the linear slides 1084. The load cell 1082 is also pushed in
the retract direction making contact with the force sensing block
1086 resulting in a force reading from the load cell 1082.
[0659] Strain gauges or load cells mounted to the manipulator base
1470, 1570 or bottom of the elongate member manipulator 1200, 1300
may be used to sense distal tip force for any of the variations of
elongate member manipulators described previously in a manner
described above. However, other types of sensors mounted to either
the distal tip of the elongate member or on the proximal end of the
elongate member on the elongate member manipulator may be used to
detect distal tip force including but not limited to strain gauges,
piezoelectric sensors, tactile sensors, and quartz force sensors.
Alternatively, sensors can be used to detect a change in length of
the elongate member which measurement can be used in combination
with known mechanical properties to calculate force. Examples of
such sensors include but are not limited to a fibers, optical
sensors, electromagnetic sensors, inductive sensors, capacitive
sensors, vision systems etc.
[0660] The elongate member manipulators described herein may be
mounted to any type of structure depending on the desired use and
any environmental constraints. In one variation, the elongate
member manipulator may be mounted to a stationary arm mounted to a
bedside rail of a patient bed. In alternative variations, the
elongate member manipulator could be mounted to a bedside cart. In
the variation shown back in FIG. 83A, the elongate member
manipulator 1200 is mounted directly to the manipulator mounting
bracket 1058, which is fixably mounted to the instrument driver
1016. The elongate member manipulator 1300 could be mounted in a
similar fashion. FIGS. 98B and 103 show the elongate member
manipulator (1400 and 1500 respectively) each including a
manipulator base 1470, 1570 which is fixably mounted to the
manipulator mounting bracket 1058, which is fixably mounted to the
instrument driver 1016. The various mounting mechanisms for
mounting the instrument driver to a bedside rail or cart were
described previously.
[0661] One example of a mechanism for mounting the manipulator
mounting bracket 1058 to the instrument driver 1200 is best shown
in FIG. 103. Though the elongate member manipulator 1500 is shown
in this figure, it should be understood that any of the elongate
member manipulators described herein can be mounted in the same
manner using the same apparatus. In this variation, a vise clamp
1062, such as one found from CarrLane Tiny Vise.TM., which provides
a clamp as well as a captured hex screw, can be used to fixably
attach the manipulator mounting bracket 1058 to a tapped hole 1064
on the instrument driver 1200. The vise clamp 1062 provides enough
clamping force as well as thrust force to securely attach the
mounting bracket 1058 to the instrument driver 1200 while
preventing the mounting bracket 1058 from lifting away from the
instrument driver 1200 due to the weight of the elongate member
manipulator 1500. In an alternative variation an adapted vise clamp
1063 may be altered to chamfer the edges 1065 of the vise clamp as
shown in FIGS. 103AA and 103AB. The adapted vise clamp 1063 can be
coupled with a mating bracket (not shown) so that as the adapted
vice clamp 1063 is tightened, it expands within the bracket locking
it into place as shown with the arrows 1067. In one variation, a
sterile drape (not shown) may be placed between the adapted vise
clamp 1063 and the mating bracket (not shown) allowing a separation
between sterile and non-sterile components without puncturing the
sterile drape, preventing any breakage of the sterile barrier.
[0662] In alternative variations, a plurality of different types of
mounting screws, bolts, or any fastener sized properly to obtain
the desired clamping force could be used in place of the vice clamp
1062 while the mounting bracket 1058 can be dimensioned at a
thickness that could prevent lifting due to elongate member
manipulator 1400 weight or due to the weight of any of the various
elongate manipulators described herein.
[0663] FIGS. 103A-B illustrate variations of a roll support 1580,
1582. Depending on the size and type of elongate member or guide
wire being used, it may be difficult to provide enough torque at
the proximal end of a guide wire or elongate member to accurately
roll the distal section. The roll support tube 1580,1582 can
provide any number of opposing bends necessary, creating a wave
with varying pitch and amplitude between successive bends. In one
variation, the roll support may be adjustable such that the number
of bends can be altered depending on required torque.
[0664] Referring to FIG. 103A, the elongate member manipulator 1500
is shown with the roll support tube 1580. The roll support tube
1580 may be configured to receive the guide wire 1060 or various
sizes and types of guide wires co-axially, and can be provided
proximally adjacent to the elongate member manipulator 1500. The
roll support tube 1580 provides rigid curves which place the guide
wire 1060 in several bends. As the guide wire 1060 is actuated in
roll, the roll support tube 1580 remains in the curved
configuration but rotates about the longitudinal axis of the guide
wire 1060. The bends prevent the wire from rolling within the roll
support tube, minimizing or eliminating uncontrolled wind up of the
guide wire within the support tube or guide catheter. Thus the roll
support tube 1580 assists in providing the torque necessary to gain
accurate roll control of the wire through the guide catheter (not
shown) or support tube (not shown) provided at the distal end of
the elongate member manipulator 1500. In alternative variations,
the roll support tube 1580 could be manufactured from a
semi-flexible material which provides rigid support during roll
actuation. The roll support tube 1580 can be hand molded to provide
the necessary bend configuration.
[0665] FIG. 103B illustrates an alternative variation of a roll
support tube 1582 which provides bends of variable pitch and
amplitude. Because the roll controllability of the guide wire is
dependent on the size and material of the wire itself, different
wires may require sharper bends in order to gain accurate
controllability while bends that are too sharp for some types of
wires may cause damage to the wire. Thus a scissor jack support
1582 can be used to provide the bends necessary to provide torque
control in an adjustable manner for various types of wire. The
scissor jack support 1582 may provide torqueability support in the
same manner as the roll support tube 1582 and provides for an
adjustability of curve amplitude and pitch.
[0666] Referring back to FIG. 1, an operator 12 is shown at an
operator workstation 22 which provides remote control of a guide
catheter 1054, sheath catheter 1044, and elongate member
manipulator. Details regarding the control of the sheath catheter,
guide catheter, and instrument driver are provided in the
aforementioned incorporated references. Control of an elongate
member manipulator can be approached in a manner similar to the way
any remotely controlled robotic master slave system would be
controlled according to the references incorporated herein or as is
well known in the art. The elongate member manipulator systems of
any of the previously described variations will be described herein
where the master would be an input device such as the operator
workstation 22 and the slave would be any of the elongate member
manipulators (1100, 1200, 1300, 1400 or 1500). The elongate member
manipulator fundamentally has two degrees of freedom, roll and
insert, that could be controlled with a single master with two
degrees of freedom, or by two separate master devices that each
control one degree of freedom. The following provides various
masters that provide input for these degrees of freedom. In other
variations, the manipulator can provide one or more degrees of
freedom controlled by one or more masters.
[0667] Referring back to FIG. 2, an example of an operator
workstation 22 providing for inputs for control of the guide
catheter, sheath catheter and elongate member manipulator is
illustrated. As previously described the operator workstation 22
includes the master input device 1212 acting as a joystick type
controller along with the pendant 8 acting as a keyboard type input
device. In one variation, the guide catheter is controlled using
the master input device 1212 allowing for steering of the distal
tip of the guide catheter as viewed on the display monitors 44
while the sheath catheter and the guide wire are controlled using
the pendant 8. As previously described in detail, the master input
device 1212 includes several sensors which detect the position of
the master input device 1212 shown in this variation as a joystick.
Those sensors send signals to the controller that are interpreted
as commands.
[0668] FIG. 113 illustrates a variation of the pendant 8 of FIG. 2
which would include controls for the sheath catheter and elongate
member manipulator. In order to steer the sheath catheter, the
bend, insert and rotate controls 1026 located on the right side of
the pendant 8 could be used while the rotate and insert controls
1028 located on the lower left side of the pendant 8 could be used
to control the elongate member manipulator. In alternative
variations, the distal tip of the guide wire could be controlled
using the master input device 6 while the guide and sheath
catheters are controlled by the control console 8 or the sheath
catheter could be controlled by the master input device 6. In fact
any combination of controls could be implemented using either or
both the control console 8 and/or the master input device 6.
[0669] The display and force sensing controls 1030 located on the
upper left of the control console 8 could be used to control the
views on the monitors and activate and control force sensing
capabilities respectively and the trackball controls 1032 could be
used to control cursors on the display. As described in detail in
the aforementioned incorporated references, the display could show
images of patient anatomy in the form of models or fluoroscopic
images. Cartoon images of the guide, sheath, and guide wire within
the patient anatomy can be displayed showing commanded positions.
Actual images of the guide, sheath, and guide wire can be shown
from fluoroscopic data. Additionally the display can also show
force feedback readings
[0670] In an alternative variation, it could be desirable for the
controls to be located closer to the patient bed. Referring to FIG.
114A, a variation of the patient bed 1020 is shown with a
standalone console 1024 mounted to the bedside rail 1021 such that
the operator could control the system from beside the bed. FIG.
114B illustrates a side view of the standalone console 1024 mounted
to the bedside rail 1021 where the patient bed 1020 is not shown
for clarity. The standalone console 1024 can rest on a mounting
tray 1036 that is fixably attached to the bedside rail 1021 via a
clamp 1038. FIG. 115 illustrates one example of standalone console
1024 which eliminates some components from the control console 1008
and retains the controls for the sheath catheter 1026 and the
elongate member manipulator 1028. In alternative variations, the
standalone console 1024 could be used in conjunction with the
control console 1008 with two operators working together in which
case one console could override controls if conflicting commands
are sent from each console of another depending on
configuration.
[0671] Alternatively, several other types of input devices could be
used to provide the signals for the one or more degrees of freedom
necessary to control the elongate member manipulator. In the case
where either the elongate member manipulator is mounted to a setup
structure alone or mounted on the instrument driver, but control of
only the elongate member manipulator is necessary, other types of
input devices may be used.
[0672] FIGS. 116-116N illustrate various master input devices that
could be used in place of a joystick controller and/or console.
[0673] FIG. 116 illustrates an alternative variation of a master
input device. As is well known the art, manual control of guide
wires typically includes a two handed sequence to propel a guide
wire in the insert or retract directions. Typically the guide wire
is coupled to an introducer that can be used as a handle for an
operator. The operator will advance the guide wire, by using a
front hand to support the introducer and the rear hand to grip the
guide wire pushing it through the introducer. This only accounts
for advancement of the guide wire a short distance so the front
hand may release the introducer, grip the guide wire, allowing the
rear hand to release the guide wire in order to grip it a short
distance further back along the guide wire. The front hand can now
release the guide wire to allow the rear hand to advance the wire.
This is repeated until the guide wire is advanced to the desired
position typically advancing the wire 1'' to 2'' at a time. In many
cases, the total insert distance can be as far as 2 meters. The
wire can be rotated manually using one or both hands to rotate the
wire while inserting it.
[0674] The master input device shown in FIG. 116 stimulates the
motion physicians are accustomed to during manual procedures while
eliminating the need for multiple two handed iterations necessary
for manual insert. The master input device 1660 can include an
insert motor 1662, a roll motor 1664, a flexible member 1666, a
handle (not shown), a linear slide 1668, actuation cables 1670,
pulleys 1672, and/or a support 1674. The handle (not shown) is
coupled to the flexible member 1666, which in turn is coupled to
the roll motor 1604, which is fixably mounted to the support 1674,
mounted to the linear slide 1668. Using the pulleys 1672 and
actuation cables 1670 the linear slide 1668 is coupled to the
insert motor 1602. A variety of motors may be utilized, e.g., the
motors can be 13 mm DC brush servo motors and the handle can
include a grasper button (not shown). The support 1674 can be made
from a lightweight material, such as a lightweight plastic and the
linear slide 1668 can also be lightweight and low friction.
[0675] During operation, the user depresses the grasper button and
rotates the handle (not shown). The roll motor 1604 which is
equipped with an encoder reads the rotation of the handle and
transmits this data to the controller which will control the roll
of the elongate member manipulator. In order to control insert, the
user depresses the grasper button, moves the handle forwards or
backwards along the linear slide 1668, while the insert motor 1602
encoder reads the rotation of the motor 1602 and thus the linear
movement of the handle. This data is again transmitted to the
controller. When the user has reached the physical limit of the
linear slide 1668, the grasper button is released and the user may
slide the handle to a nominal linear position without sending a
signal to the controller indicating desired propelling actuation of
the elongate member manipulator.
[0676] FIG. 117A illustrates a master input device based on a
slider that can be moved on a fixed rod. When the engage button is
pressed the translation and rotation of the slider are measured by
sensors and used to command the insert and rotation of the guide
wire. When the engage button is released, the slider can be moved
freely or alternatively can be spring loaded to return to a fixed
position. The slider can be mounted to a handle as shown in FIG.
117AA.
[0677] FIG. 117B illustrates a paddle switch that could be mounted
to the instrument driver 1016 which could control insert, or
retract, and/or roll of the guide wire. The paddle switch can be
provided with recessed contact switches as shown in FIG. 117BB that
may be pressed to enable the paddle switch. Alternatively the
paddle switch can be pinched from both sides as shown in FIG.
117BBB to activate it. FIG. 117C illustrates scroll-wheels that can
be incorporated into the handle of a master input device. Each
scroll-wheel could be used to control a different degree of freedom
on the elongate member manipulator. Alternatively FIG. 117CC shows
buttons incorporated on the master input device handle that could
control different degrees of freedom on the elongate member
manipulator measuring force applied to each button to determine
control of the manipulator. FIG. 117D shows a wheel with a circular
cross-sectioned rim. By hiding most of the wheel inside of a
housing or below the table surface, the user is presented with a
rail that can be moved in a quasi-linear fashion by rolling the
wheel. This gives an infinite range of travel device that could be
used to control insert of the guide wire. The wheel could be tilted
to either side to control roll of the guide wire.
[0678] FIG. 117DD shows another variation where the rail itself is
constructed out a series of rollers so that it can be spun to
control the roll of the guide wire. FIG. 117E shows a control plate
mounted to a 2-DOF (pitch-roll) rotation platform. This control
plate could be manipulated by the physician with either their hand
or foot providing pitch motion to control insert or retraction and
rolling motion to control guide wire roll. FIGS. 117F and 117FF
show linear sliders (with an optional engage button) that can be
used to control one DOF of the elongate member manipulator. FIG.
117G shows a touchpad device that could be used to control the
guide wire manipulator. Moving the user's finger forwards/backwards
would control insertion of the guide wire and moving the user's
finger side-to-side would control roll of the guide wire
manipulator. Alternatively a trackball could be used in a similar
fashion (not shown). FIG. 117H shows a "clothes-line" type
configuration of a wire or cable looped around several pulleys. The
user could directly insert, retract and/or roll this wire by hand
or through the use of an optional wire torque device to allow for
easier gripping of the wire. FIG. 117I shows a wide variety of
buttons that could be used alone or in combination to control the
guide wire manipulation device. Various methods of use of such
buttons will be described in detail later. FIG. 117J shows a
wrist-mounted master input device. FIG. 117K shows a hand-held
inertial master input device. FIG. 117L shows a master input device
that is manipulated by inserting, retractiong and/or rolling the
operator's finger. FIG. 117M shows a haptic feedback master. The
user manipulates the master by inserting, retracting and/or rolling
it. The master is mounted to a compartment that contains sensors
and motors. The master could be free to slide, spring loaded, or
fixed. The active master may sense input and provide feedback to
the user via motors under servo control.
[0679] The input devices may measure a signal from the operator and
map this signal into a command to the slave such as the elongate
member manipulator. Input devices on the master side may measure
various different types of signals including but not limited to
force, position, velocity, acceleration, or discrete events such as
buttons presses. These measured signals could be converted into
commands in the form of force, position, velocity, acceleration, or
a higher level task. A few combinations of various input signals to
commands will be discussed further using the elongate member
manipulator as the slave however it should be understood that these
variations will be presented by way of example and not limitation.
Any combination of the aforementioned signals and commands could be
implemented including types of comparable signals and commands that
are not explicitly mentioned but are well known in the art.
Additionally, any slave mechanism could be commanded including but
not limited to the mechanisms actuating the guide catheter, sheath
catheter, and instrument driver.
[0680] FIG. 118a-d illustrates flow diagrams of the various
master-slave control mapping options. FIG. 118a illustrates one
variation where a position signal is measured from the input master
device and a position command is sent to the slave. Motions of the
master are translated into motion commands and sent to the slave in
a one to one motion in one variation while in an alternative
variation the motion command could be subject to a scaling factor
or more complex mapping function in a manner described in detail in
the aforementioned incorporated references. In some instances the
elongate member manipulator has a very large range of motion which
may require either the input device to have a comparably large
workspace or the input device to have clutching capability allowing
it to clutch to different portions of the of the slave workspace.
In an alternative variation shown in FIGS. 118b and 118d, a
position signal is measured from the input master device and a
velocity command is sent to the slave. This typically involves a
master device that is spring-loaded to return to its zero position
such that when the user releases, the master returns to zero and
the slave stops moving. This approach has the advantage of using a
master with a relatively small range of motion to control a very
large (up to infinite) range of motion on the slave. In FIG. 118b
the slave is controlled using velocity commands while in FIG. 118d
the slave is controlled using position commands. FIG. 118d further
illustrates a variation where position sensors on the guide wire
manipulator itself are used for closed loop iterative control of
the guide wire manipulator in order to more accurately position the
guide wire manipulator. In yet another variation shown in FIG.
118c, a force signal is measured from the input master device and a
velocity command is sent to the slave such that a higher force
measurement will result in an increased velocity of the slave.
Using a device such as the buttons on the MID handle as illustrated
in FIG. 117CC for example, the harder the operator pushes on the
button, the faster the elongate member manipulator inserts/rolls.
When the operator is not exerting any force, the slave remains
still. This configuration allows for a master with a small (near
zero) range of motion to control a very large (up to infinite)
range of motion on the slave. In further variations, multiple types
of input signals can be combined so that arbitrarily complex
dynamics between the master and slave can be introduced.
[0681] Another configuration may use discrete events such as but
not limited to a button press or activation of a switch as an input
to the master sending a specified task to the slave. Various types
of buttons may be used, as illustrated in FIG. 117J. In this
configuration, a button press of one or several different buttons
can be used to command the execution of a potentially complex task.
In one example for one degree of freedom, holding down of a single
first button may cause a motion in a pre-defined direction at a
pre-defined speed and release of the button would cease motion. A
second button could be used in same manner to cause motion in an
opposite direction at the same pre-defined speed. Using the
elongate member manipulator as an example, holding down the first
button may cause the elongate member to be inserted at a set speed
until the user releases the button. Holding down the second button
may cause the elongate member to be retracted at the same speed
until the button is released. A second pair of buttons could be
used for roll in the clockwise and counterclockwise directions.
Alternatively, the same configuration could be used where a first
single button push may start motion and a second push may stop
motion or one button could start motion and a second button could
stop motion. In another variation, a button push could cause the
elongate member manipulator to move in a pre-determined direction,
by a pre-determined amount, at a pre-determined speed. The
pre-determined amount could be a set distance or a distance based
on a relative position of the elongate member, for example,
distance from the elongate member to tissue or distance to the end
of a guide catheter if the elongate member was traveling co-axially
down the lumen of said guide catheter. Alternatively, the speed
could be based on the duration of time a button is pushed such that
as the button is held longer, the speed gradually increases or
after being pushed for a fixed duration of time, the speed
increases from one predetermined amount to another. Alternatively,
the movement could be based on a pre-determined force, for example
the elongate member may insert until it makes contact with an
object and a pre-set threshold of distal tip force is reached.
[0682] Multiple combinations of buttons, switches, and other types
of on/off input devices could be used with multiple combinations of
elongate member movement. It should be understood that the
aforementioned combinations are by way of example and not
limitation and any combination of inputs to motion including
equivalents well known in the art may be used.
[0683] In the variation shown in FIGS. 1-2 which includes the
operator workstation 22, the controller 55, and the instrument
driver 16, the operator workstation includes the input controls in
the form of a joystick type master input device 1212 and pendant 8.
This variation may be used in a configuration shown in FIG. 119
which displays the sheath catheter assembly 1040, the guide
catheter assembly 1050, and the elongate member manipulator 1300
mounted to the instrument driver 1016 with an elongate member in
the form of a guide wire 1060 loaded in the elongate member
manipulator 1300. The guide wire 1060 is sized to be inserted
co-axially into the lumen of the guide catheter 1054, which in turn
is sized to be inserted co-axially into the lumen of the sheath
catheter 1044.
[0684] As previously described, the two degrees by which an
elongate member, such as a guide wire 1060 may be manipulated using
the elongate member manipulator 1300 are insertion/retraction and
roll. Due to the remote nature of a catheterization treatment, the
elongate member manipulator 1300 will be located a large distance
from the tip of the guide catheter 1054. The insert function
assumes the guide wire has high axial stiffness relative to
frictional forces between the guide wire and the inner wall of the
guide catheter 1054 as well as forces due to contact with tissue.
Thus moving the wire a certain distance proximally should
correspond directly to motion distal to the catheter tip. FIG. 120
illustrates a control scheme for control of the elongate member
manipulator 1300. The control scheme is a more generalized version
of the previously described control schemes shown in FIGS. 118A-D.
In FIG. 120, the elongate member manipulator inserts and rolls a
guide wire according to commands from a master input device. In the
currently described variation, the master input device is the
joystick and control console. The controller translates the desired
actions into voltages and currents which are applied to the guide
wire manipulator motor.
[0685] As described in detail in the aforementioned incorporated
references, both the sheath catheter assembly 1040 and guide
catheter assembly 1050 may be mounted on separate carriages that
are motor actuated to provide a propelling motion in the insert and
retract directions of the guide catheter 1054 and sheath catheter
1044. In one variation, the elongate member manipulator 1300 is
fixably mounted to the same carriage as the guide catheter assembly
1050. By mounting the elongate member manipulator in this fashion,
buckling of the guide wire can be minimized by locating the
elongate member manipulator 1300 as close to the proximal end of
the guide catheter 1054 as possible and/or maintaining a constant
gap between the elongate member manipulator 1300 and guide catheter
1054 proximal end. The constant gap also avoids an inadvertent
collision between the elongate member manipulator 1300 and guide
catheter assembly 1050. FIGS. 121A-B illustrate a block diagram
showing a variation where an elongate member manipulator 1300 is
coupled to the guide catheter assembly 1050 and the sheath catheter
assembly 1040. The sheath catheter assembly 1040 may be
independently actuated in the insert and retract direction from the
guide catheter assembly 1050 and the elongate member manipulator
1300. The elongate member manipulator 1300 and guide catheter
assembly may be coupled to the same carriage and thus are inserted
or retracted on that carriage simultaneously.
[0686] An example of a controls scheme will be described herein for
this configuration of a guide wire, guide catheter, and sheath
catheter. A guide wire is a thin flexible elongated rod. In one
example, the guide wire is sized at roughly half a millimeter in
diameter and about a meter long used during non-invasive vascular
catheterization procedures, generally for medical treatment. It
typically has an extremely flexible distal tip which prevents
interaction trauma by deflecting against tissue rather than
scraping or piercing tissue when inserted through a patient's
vasculature. One possible mode of operation for use of a guide wire
includes positioning the guide wire, holding it in a statically
fixed position, and then sliding a catheter over the guide wire.
When the guide wire is used in conjunction with the robotically
steerable guide catheter 1054 and sheath catheter 1044 as in this
variation, it is convenient for the operator to have the guide wire
be controllable by the robotic system to allow for coordinated
motion of the elongate member manipulator 1300 with the guide
catheter 1054 and sheath catheter 1044. FIG. 122 shows a controller
flow diagram for the construction of a movable carriage and a
coupled elongate member manipulator as shown in FIG. 121B. The
desired action from the master device is coordinated with the
actions of other instrument driver 1016 axes to create a joint
command for the insert/retract and roll motors. Finally, these
commands are applied to the elongate member manipulator motors with
a servo controller to achieve the desired position.
[0687] Because the guide catheter assembly 1050 is coupled to the
elongate member manipulator 1300, as the guide catheter is
inserted, the guide wire is inserted an identical distance. In
order to maintain a static position of the guide wire 1060 while
sliding the guide catheter 1054 over the guide wire 1060, the guide
wire may be retracted an equal distance using the guide wire
manipulator actuation previously described and shown in FIG. 120.
FIG. 121A shows the insert distances traveled as, x.sub.S, x.sub.G,
and x.sub.wd. Where:
x.sub.S=insert distance for sheath catheter x.sub.G=insert distance
for guide catheter x.sub.wd=insert distance for guide wire
[0688] In order for the position of the guide wire 1060 to remain
constant such that the guide wire 1060 is static, .DELTA.x.sub.wd=0
and the commanded guide wire position (x.sub.wp) can be represented
as:
x.sub.wp=x.sub.wd-x.sub.G (1)
[0689] The movement of the sheath catheter is independent of the
guide carriage so is not included in this calculation.
[0690] In another variation shown in FIG. 121B, the elongate member
manipulator 1300 and guide catheter assembly 1050 can be mounted to
the same carriage as the sheath catheter assembly 1040. Thus as the
sheath catheter 1044 is inserted, the guide catheter 1054, and
guide wire 1060 are inserted the same amount. Additionally, if the
guide carriage is independently inserted, the guide catheter 1054
and guide wire 1060 are independently inserted a separate amount.
Thus in order for the position of the guide wire 1060 to be static,
.DELTA.x.sub.wd=0 and the commanded guide wire position (x.sub.wp)
can be represented as:
x.sub.wp=X.sub.wd-x.sub.G-x.sub.S (2)
[0691] In one variation, the elongate member manipulator may not
retract the guide wire behind the distal tip of the guide catheter
such that the guide wire will be immediately available for guiding
when desired by the operator. If the guide wire is retracted within
the catheter tip, it will need to recover this distance before
being available to the physician. This requires the actual guide
wire insert position, and guide catheter insert position to be
known relative to one another and controlled precisely. Various
sensors have been previously described to measure insert of both
the guide catheter and the guide wire.
[0692] Static friction between the guide wire and the guide
catheter can impede distal rotational motion of the guide wire when
the proximal end is rolled. Because of the moderate torsional
stiffness of guide wires, there can be multiple revolutions of
angular difference between the distal and proximal ends of the wire
just due to frictional forces. Once the static friction releases,
the wire may rotate rapidly until friction stops the motion again
creating an undesirable whipping motion. One method of overcoming
the static portion of friction is to dither the guide wire
insertion while rolling by using the propelling actuation provided
by the elongate member manipulator to repeatedly insert and retract
the guide wire 1060 a small distance. The axial stiffness will
translate motion through the length of the wire and proximal
rotation should translate more directly to distal rotation. The
dithering motion could be configured to avoid inserting the wire
past the point commanded by the operator during the insert
dithering.
[0693] Manually operated guide wires include an inherent feedback
to the operator as resistance to insert and roll felt by the
operator's hands. Thus it could be desirable to provide feedback to
the operator during robotic control. Feedback could include but not
be limited to visual, audible and haptic feedback. Live
fluoroscopic images showing the location of the guide wire and
catheters relative to patient anatomy could be provided on the
display as well as a virtual guide wire image. By monitoring the
position of the guide wire in relation to the position of the
catheter, i.e. registering the guide wire to the catheter frame,
the guide wire position may be displayed. One method of determining
relative positions would be to display a virtual wire extended
beyond the catheter tip, to scale with the virtual diameters. A
numerical distance could replace or accompany such a display. Also,
the virtual wire could be striped or otherwise patterned to
indicate movement as displayed in FIG. 123. Another method of
registration could include the use of position sensors including
but not limited to EM or fiber sensors as described in detail in
the aforementioned incorporated references.
[0694] As previously described, insert force can be measured by the
elongate member manipulator. Measured force may be simply displayed
for the operator to see how much force the manipulator is applying
to move the wire. Further, if the wire inputs are provided with a
haptic device, this force could be conveyed to the operator in a
way such as with a direct force resistance in the haptic device or
with a vibration proportional to force. The force may also be used
to detect anomalous insertion conditions in order to avoid or
compensate. High insertion forces may cause the wire to buckle
between the manipulator and catheter. When force exceeds a
threshold, the insertion should be halted to avoid buckling or
abrading the surfaces of the wire or catheter. Force may also be
used to scale motion in an analog manner. For example, slave motion
may correspond directly to master commands, so the master motion
may be de-scaled to result in less slave motion as described in
detail in aforementioned incorporated references.
[0695] Additionally, any feedback sensors including but not limited
to position, force, and encoders including redundant encoders as
well as kinematic data for commanded guide wire position can all be
continuously monitored to detect errors if there is a data
mismatch.
[0696] The above variations of systems and manipulators may be used
with guide wires and/or any other elongate member or
instrument.
[0697] IX. Instinctive Drive
[0698] Referring to FIG. 128A, an overview of an embodiment of a
controls system flow is depicted. A master computer 2400 running
master input device software, visualization software, instrument
localization software, and software to interface with operator
control station buttons and/or switches is depicted. In one
embodiment, the master input device software is a proprietary
module packaged with an off-the-shelf master input device system,
such as the Phantom.TM. from Sensible Devices Corporation, which is
configured to communicate with the Phantom.TM. hardware at a
relatively high frequency as prescribed by the manufacturer. Other
suitable master input devices are available from suppliers such as
Force Dimension of Lausanne, Switzerland. The master input device
12 may also have haptics capability to facilitate feedback to the
operator, and the software modules pertinent to such functionality
may also be operated on the master computer 2400. Preferred
embodiments of haptics feedback to the operator are discussed in
further detail below.
[0699] The term "localization" is used in the art in reference to
systems for determining and/or monitoring the position of objects,
such as medical instruments, in a reference coordinate system. In
one embodiment, the instrument localization software is a
proprietary module packaged with an off-the-shelf or custom
instrument position tracking system, such as those available from
Ascension Technology Corporation, Biosense Webster, Inc.,
Endocardial Solutions, Inc., Boston Scientific (EP Technologies),
Medtronic, Inc., and others. Such systems may be capable of
providing not only real-time or near real-time positional
information, such as X-Y-Z coordinates in a Cartesian coordinate
system, but also orientation information relative to a given
coordinate axis or system. Some of the commercially-available
localization systems use electromagnetic relationships to determine
position and/or orientation, while others, such as some of those
available from Endocardial Solutions, Inc.--St Jude Medical,
utilize potential difference or voltage, as measured between a
conductive sensor located on the pertinent instrument and
conductive portions of sets of patches placed against the skin, to
determine position and/or orientation. Referring to FIGS. 128B and
128C, various localization sensing systems may be utilized with the
various embodiments of the robotic catheter system disclosed
herein. In other embodiments not comprising a localization system
to determine the position of various components, kinematic and/or
geometric relationships between various components of the system
may be utilized to predict the position of one component relative
to the position of another. Some embodiments may utilize both
localization data and kinematic and/or geometric relationships to
determine the positions of various components.
[0700] As shown in FIG. 128B, one preferred localization system
comprises an electromagnetic field transmitter 2406 and an
electromagnetic field receiver 2402 positioned within the central
lumen of a guide catheter 2090 (which may be one or more of the
embodiments of the catheter described herein). The transmitter 2406
and receiver 2402 are interfaced with a computer operating software
configured to detect the position of the detector relative to the
coordinate system of the transmitter 2406 in real or near-real time
with high degrees of accuracy. Referring to FIG. 128C, a similar
embodiment is depicted with a receiver 2404 embedded within the
guide catheter 2090 construction. Preferred receiver structures may
comprise three or more sets of very small coils spatially
configured to sense orthogonal aspects of magnetic fields emitted
by a transmitter. Such coils may be embedded in a custom
configuration within or around the walls of a preferred catheter
construct. For example, in one embodiment, two orthogonal coils are
embedded within a thin polymeric layer at two slightly flattened
surfaces of a catheter 2090 body approximately ninety degrees
orthogonal to each other about the longitudinal axis of the
catheter 2090 body, and a third coil is embedded in a slight
polymer-encapsulated protrusion from the outside of the catheter
2090 body, perpendicular to the other two coils. Due to the very
small size of the pertinent coils, the protrusion of the third coil
may be minimized. Electronic leads for such coils may also be
embedded in the catheter wall, down the length of the catheter body
to a position, preferably adjacent an instrument driver, where they
may be routed away from the instrument to a computer running
localization software and interfaced with a pertinent
transmitter.
[0701] In another similar embodiment (not shown), one or more
conductive rings may be electronically connected to a
potential-difference-based localization/orientation system, along
with multiple sets, preferably three sets, of conductive skin
patches, to provide localization and/or orientation data utilizing
a system such as those available from Endocardial Solutions--St.
Jude Medical. The one or more conductive rings may be integrated
into the walls of the instrument at various longitudinal locations
along the instrument, or set of instruments. For example, a guide
instrument may have several conductive rings longitudinally
displaced from each other toward the distal end of the guide
instrument, while a coaxially-coupled sheath instrument may
similarly have one or more conductive rings longitudinally
displaced from each other toward the distal end of the sheath
instrument--to provide precise data regarding the location and/or
orientation of the distal ends of each of such instruments.
[0702] Referring back to FIG. 128A, in one embodiment,
visualization software runs on the master computer 2400 to
facilitate real-time driving and navigation of one or more
steerable instruments. In one embodiment, visualization software
provides an operator at an operator control station, such as that
depicted in FIG. 1, with a digitized "dashboard" or "windshield"
display to enhance instinctive drivability of the pertinent
instrumentation within the pertinent tissue structures. Referring
to FIG. 128D, a simple illustration is useful to explain one
embodiment of a preferred relationship between visualization and
navigation with a master input device 12. In the depicted
embodiment, two display views 2410, 2412 are shown. One preferably
represents a primary 2410 navigation view, and one may represent a
secondary 2412 navigation view. To facilitate instinctive operation
of the system, it is preferable to have the master input device
coordinate system at least approximately synchronized with the
coordinate system of at least one of the two views. Further, it is
preferable to provide the operator with one or more secondary views
which may be helpful in navigating through challenging tissue
structure pathways and geometries.
[0703] Using the operation of an automobile as an example, if the
master input device is a steering wheel and the operator desires to
drive a car in a forward direction using one or more views, his
first priority is likely to have a view straight out the
windshield, as opposed to a view out the back window, out one of
the side windows, or from a car in front of the car that he is
operating. The operator might prefer to have the forward windshield
view as his primary display view, such that a right turn on the
steering wheel takes him right as he observes his primary display,
a left turn on the steering wheel takes him left, and so forth. If
the operator of the automobile is trying to park the car adjacent
another car parked directly in front of him, it might be preferable
to also have a view from a camera positioned, for example, upon the
sidewalk aimed perpendicularly through the space between the two
cars (one driven by the operator and one parked in front of the
driven car), so the operator can see the gap closing between his
car and the car in front of him as he parks. While the driver might
not prefer to have to completely operate his vehicle with the
sidewalk perpendicular camera view as his sole visualization for
navigation purposes, this view is helpful as a secondary view.
[0704] Referring still to FIG. 128D, if an operator is attempting
to navigate a steerable catheter in order to, for example, contact
a particular tissue location with the catheter's distal tip, a
useful primary navigation view 2410 may comprise a three
dimensional digital model of the pertinent tissue structures 2414
through which the operator is navigating the catheter with the
master input device 12, along with a representation of the catheter
distal tip location 2416 as viewed along the longitudinal axis of
the catheter near the distal tip. This embodiment illustrates a
representation of a targeted tissue structure location 2418, which
may be desired in addition to the tissue digital model 2414
information. A useful secondary view 2412, displayed upon a
different monitor, in a different window upon the same monitor, or
within the same user interface window, for example, comprises an
orthogonal view depicting the catheter tip representation 2416, and
also perhaps a catheter body representation 2420, to facilitate the
operator's driving of the catheter tip toward the desired targeted
tissue location 2418.
[0705] In one embodiment, subsequent to development and display of
a digital model of pertinent tissue structures, an operator may
select one primary and at least one secondary view to facilitate
navigation of the instrumentation. By selecting which view is a
primary view, the user can automatically toggle a master input
device 12 coordinate system to synchronize with the selected
primary view. In an embodiment with the leftmost depicted view 2410
selected as the primary view, to navigate toward the targeted
tissue site 2418, the operator should manipulate the master input
device 12 forward, to the right, and down. The right view will
provide valued navigation information, but will not be as
instinctive from a "driving" perspective.
[0706] To illustrate: if the operator wishes to insert the catheter
tip toward the targeted tissue site 2418 watching only the
rightmost view 2412 without the master input device 12 coordinate
system synchronized with such view, the operator would have to
remember that pushing straight ahead on the master input device
will make the distal tip representation 2416 move to the right on
the rightmost display 2412. Should the operator decide to toggle
the system to use the rightmost view 2412 as the primary navigation
view, the coordinate system of the master input device 12 is then
synchronized with that of the rightmost view 2412, enabling the
operator to move the catheter tip 2416 closer to the desired
targeted tissue location 2418 by manipulating the master input
device 12 down and to the right.
[0707] Instinctive drive techniques have been described in U.S.
patent application Ser. No. 11/176,598, filed on Jul. 6, 2005, the
entire disclosure of which is expressly incorporated by reference
herein for all purposes.
[0708] The synchronization of coordinate systems described herein
may be conducted using fairly conventional mathematic
relationships. For example, in one embodiment, the orientation of
the distal tip of the catheter may be measured using a 6-axis
position sensor system such as those available from Ascension
Technology Corporation, Biosense Webster, Inc., Endocardial
Solutions, Inc., Boston Scientific (EP Technologies), and others. A
3-axis coordinate frame, C, for locating the distal tip of the
catheter, is constructed from this orientation information. The
orientation information is used to construct the homogeneous
transformation matrix, T.sub.C0.sup.G0, which transforms a vector
in the Catheter coordinate frame "C" to the fixed Global coordinate
frame "G" in which the sensor measurements are done (the subscript
C.sub.0 and superscript G.sub.0 are used to represent the O'th, or
initial, step). As a registration step, the computer graphics view
of the catheter is rotated until the master input and the computer
graphics view of the catheter distal tip motion are coordinated and
aligned with the camera view of the graphics scene. The 3-axis
coordinate frame transformation matrix T.sub.Gref.sup.G0 for the
camera position of this initial view is stored (subscripts
G.sub.ref and superscript C.sub.ref stand for the global and camera
"reference" views). The corresponding catheter "reference view"
matrix for the catheter coordinates is obtained as:
T.sub.Cref.sup.C0=T.sub.G0.sup.C0T.sub.Gref.sup.G0T.sub.Cref.sup.Gref=(T-
.sub.C0G0).sup.-#T.sub.Gref.sup.G0T.sub.C1.sup.Gi
Also note that the catheter's coordinate frame is fixed in the
global reference frame G, thus the transformation matrix between
the global frame and the catheter frame is the same in all views,
i.e., T.sub.C0.sup.G0=T.sub.Cref.sup.Gref=T.sub.Ci.sup.Gi for any
arbitrary view i. The coordination between primary view and master
input device coordinate systems is achieved by transforming the
master input as follows: Given any arbitrary computer graphics view
of the representation, e.g. the i'th view, the 3-axis coordinate
frame transformation matrix T.sub.Gi.sup.G0 of the camera view of
the computer graphics scene is obtained from the computer graphics
software. The corresponding catheter transformation matrix is
computed in a similar manner as above:
T.sub.Ci.sup.C0=T.sub.G0.sup.C0T.sub.Gi.sup.G0T.sub.Ci.sup.Gi=(T.sub.Co.-
sup.G0).sup.-1T.sub.Gi.sup.G0T.sub.Ci.sup.Gi
The transformation that needs to be applied to the master input
which achieves the view coordination is the one that transforms
from the reference view that was registered above, to the current
ith view, i.e., T.sub.Cref.sup.Ci. Using the previously computed
quantities above, this transform is computed as:
T.sub.Cref.sup.Ci=T.sub.C0.sup.CiT.sub.Cref.sup.C0
The master input is transformed into the commanded catheter input
by application of the transformation T.sub.Cref.sup.Ci. Given a
command input
r master = [ x master y master z master ] , ##EQU00005##
one may calculate:
r catheter = [ x catheter y catheter z catheter ] = T Cref Ci [ x
master y master z master ] . ##EQU00006##
Under such relationships, coordinate systems of the primary view
and master input device may be aligned for instinctive
operation.
[0709] In one or more of the embodiments, the user interface of the
robotic system may be configured to allow a user to register (or
align) a real image of a catheter (e.g., a fluoroscopic image) with
an image of a computer model of the catheter. This results in the
real image catheter being in a same orientation as that of the
model image, thereby allowing a user to instinctively drive the
catheter (e.g., so that a command to move the catheter model to the
right will result in the catheter moving to the right in the
reference frame of the real image). The model image may be
generated using different techniques in different embodiments. In
some embodiments, the model image may be generated by a processor
using kinematic information (e.g., stress, strain, curvature,
amounts of tensions in respective pull wires inside the catheter,
etc.) regarding the catheter. In other embodiments, the model image
may be generated using a light signal transmitted through a fiber
optic that extends along a length of the catheter. Techniques for
determining a geometric configuration of an elongated member using
light transmitted through a fiber optic have been describe in U.S.
patent application Ser. No. 11/690,116, filed on Mar. 22, 2007, the
entire disclosure of which is expressly incorporated by reference
herein. In further embodiments, the model image of the catheter may
be generated (e.g., by a processor) based at least in part on
localization data obtained from electromagnetic sensors.
Electromagnetic sensors for obtaining localization data for a
medical device are well known in the art, and therefore, will not
be described in detail herein.
[0710] The act of registration (or alignment) between a real image
of the device and a model image may be carried out in different
manners in different embodiments. For example, in some embodiments,
an alignment process may be performed, wherein the user adjusts one
or a few inputs to line up a graphic on screen with a fluoro image
of the actual catheter. In one such embodiment, the user can adjust
one slider on a touchscreen (or a control at a station) to rotate a
virtual representation of the catheter within the plane of the
fluoro image to align its heading direction at a prescribed
location (e.g., location of a control ring in the leader) to that
of the real catheter in the fluoro image, and a second slider (or a
second control at the station) to rotate the virtual catheter in or
out of plane to align its tilt angle to that of the real catheter.
In order to align the roll angle, the user may put a slight bend on
the catheter (e.g., so that a length of the catheter may appear as
a straight line when looking from a proximal or distal end) and
rotate it until the bend is aligned with a bend of an actual
catheter. For example, the virtual representation of the catheter
(in a bent configuration) may be moved using a control (e.g.,
slider in a touch screen) to align its roll with a roll of the
actual catheter that also has a bent configuration. In further
embodiments, instead of rotating the catheter, in order to avoid
unnecessary catheter movements inside the body, the user may rotate
the fluoro C-arm until the catheter bend is in the imaging plane,
pointing either to the left or right in that plane. Variations on
this process include using other user interfaces or input devices,
such as using the trackball on the pendant instead of touchscreen
sliders to align the heading and/or tilt angles of the catheter. In
further embodiments, the alignment process described above may not
be needed. For example, in some cases, if localization information
for the catheter is available, then the alignment process may not
be performed (unless the localization is imperfect and needs to be
adjusted).
[0711] Referring back to embodiment of FIG. 128A, the master
computer 2400 also comprises software and hardware interfaces to
operator control station buttons, switches, and other input devices
which may be utilized, for example, to "freeze" the system by
functionally disengaging the master input device as a controls
input, or provide toggling between various scaling ratios desired
by the operator for manipulated inputs at the master input device
12. The master computer 2400 has two separate functional
connections with the control and instrument driver computer 2422:
one 2426 for passing controls and visualization related commands,
such as desired XYZ (in the catheter coordinate system) commands,
and one 2428 for passing safety signal commands. Similarly, the
control and instrument driver computer 2422 has two separate
functional connections with the instrument and instrument driver
hardware 2424: one 2430 for passing control and visualization
related commands such as required-torque-related voltages to the
amplifiers to drive the motors and encoders, and one 2432 for
passing safety signal commands.
[0712] In some cases, during use of the robotic system, it may or
may not be possible to place the catheter at a desired position,
depending on how the catheter is driven. This may be illustrated in
the example shown in FIGS. 128E and 128F. The catheter tip is shown
in a same Cartesian position relative to a reference frame (which
may be a distal tip of the sheath, or any location along a length
of the catheter or the sheath) in both FIGS. 128E and 128F, while
in very different joint configurations. If the catheter were in the
configuration shown in FIG. 128E, and the user wants to reach a
position incrementally to the left of the catheter tip, but the
catheter is already at its maximum articulation, then the desired
position of the catheter tip could not be achieved by incrementally
moving the tip of the catheter to the left. However, because the
desired position is still in the overall workspace, it could be
achieved by decreasing the articulation of the catheter, and the
insertion, in order to achieve the configuration shown in FIG.
128F. In one approach, an extra constraint is added, such as by
keeping a constant catheter insertion. In this approach, the user
is haptically constrained to the surface of a "dome", as shown in
FIG. 128G, and may orient the catheter but not insert or deinsert
it. In this implementation, a proxy position is computed using the
haptic implicit-surface (e.g., a cardiod-shaped implicit surface
intersected with a plane) proxy algorithm, and a force is returned
based on a vector between the device position and the proxy
position regardless of whether the device position is inside or
outside of the implicit surface. In some embodiments, an artificial
limit (e.g., a prescribed velocity limit) for the commanded
catheter's articulation motion may be provided to prevent the
catheter from moving faster than the robot can command/control it.
The difference in position between the proxy and the catheter may
then be use to provide force feedback that the user is trying to
move the catheter too quickly.
[0713] In some embodiments, a two-handed driving technique may be
provided, in which the user may insert or deinsert the catheter
using a first control (e.g., a pendant button), and orient (e.g.,
steer) it using a second control (e.g., IMC). The two controls may
be configured to allow the user to operate them simultaneously, or
one after the other. In one implementation, the user interface is
configured to allow the user to control both the pendant-based
insertion and the IMC-based orientation simultaneously. In another
embodiment, two functional modes for IMC driving may be provided.
In one mode, the user orients the catheter as previously described.
In the other mode, the user may insert or deinsert the catheter by
pushing against the haptic constraint(s). In some cases, the IMC is
haptically constrained to a line when in this operation mode
because the user may "slip" along the convex top of the dome when
trying to push inward to de-insert the catheter.
[0714] In other embodiments, a haptic "divot" may be placed in the
workspace when de-inserting. Various techniques may be used to
allow switching between the different modes. For example, in some
embodiments, when clutching the IMC, the user may start out in the
orientation mode, but when the force applied against the workspace
exceeds a certain threshold, the user may be switched into the
insert-deinsert mode. In other embodiments, the mode may be
controlled by a secondary IMC button or a foot pedal or a pendant
button.
[0715] In some embodiments, as the user is driving the catheter
using the robotic system, the user interface displays an image of
the catheter (which may be a real image, or a computer generated
model), and the haptic dome of FIG. 27 that follows the distal end
of the catheter. The dome represents a constraint for the distal
end of the catheter so that at least a part (e.g., the distal tip)
of the distal end of the catheter is required to be on an outline
of the dome regardless of how the catheter is driven. For example,
in one implementation, the user interface provides a first control
for allowing the user to advance or retract the catheter, and a
second control for allowing the user to steer the catheter. In such
cases, if the user attempts to advance or retract the catheter, the
tip of the catheter will be constrained to follow the outline of
the dome. As a result, the tip of the catheter may "slide" along
the outline of the dome in response to the command to advance or
retract the catheter. Similarly, if the user attempts to steer the
tip of the catheter, the tip of the catheter will also be
constrained to follow the outline of the dome, thereby causing the
tip of the catheter to "slide" along the outline of the dome in
response to the command to steer the catheter. In some embodiments,
advancement or retraction of the catheter will change the size of
the doom as it is displayed in the screen, while a steering of the
catheter will not change the size of the doom. In some embodiments,
the dome may have a cardiod shape. In other embodiments, the dome
may have other shapes. In some cases, the system is configured to
also provide force feedback at the user interface for the user
based on the haptic dome. For example, if the processor determines
that a command for positioning (advancement, retraction, and/or
steering) of the catheter may result in the distal tip of the
catheter being away from the outline of the dome, then the user
interface will provide a force feedback to indicate to the user
that the tip of the catheter is being "pulled" or "compressed" by
the outline of the dome. If the user "feels" a restraining force
from the user interface as he/she is commanding the catheter to
move, the image of the haptic dome will allow the user to see why
that may be the case.
[0716] In some of the embodiments described herein, the system may
also provide speed control for positioning the catheter so that the
tip of the catheter cannot be positioned (e.g., advanced,
retracted, and/or steered) too fast. In one implementation, a speed
limit may be entered into the system. In such cases, if the user
attempts to position the catheter in a way that exceeds the speed
limit, the processor may control the positioning of the catheter so
that it stays below the speed limit, and may cause the user
interface to provide a tactile feedback indicating that the speed
of the catheter is being controlled.
[0717] In some embodiments, the dome reflects the kinematic
articulation workspace of the elongate member. The dome is not
limited to any particular shape, and may have a cardioid shape, a
spherical shape, a cone shape, or any of other shapes. In some
embodiments, the dome shape may be user defined. In other
embodiments, the dome shape may be determined by the processor. In
one implementation, in order to calculate the shape of the dome,
the software starts with a cardioid shape (or another arbitrary
shape), then searches around that surface for the true limits of
the reach by the elongate member.
[0718] X. Sterile Adaptor
[0719] As described in detail in application Ser. No. 12/614,349
previously incorporated by reference, during surgical robotic
procedures, common practice is to place a sterile drape over a
robotic assembly such as the previously described instrument
driver, then attach sterilized tools onto the robotic assembly over
the drape. In this way, the robotic side of the drape is in a
non-sterile environment while the surgical side is in a sterile
environment. It is often desirable to remove a tool and replace it
with an alternative tool which serves an alternative function, then
exchange the tools again such that the original tool is replaced.
However, once a tool is initially engaged onto the non-sterile
robot, it breaks the sterile field making the tool non-sterile,
preventing a user from re-installing it without re-sterilizing it.
Thus in practice, a user must either sterilize a tool before
re-installing it or must treat the tool as a disposable without the
capability of re-installation. Re-sterilization is an impractical
solution during a procedure and while a disposable tool can be
sterilized and used on a later date, it could be costly to continue
using new tools during the procedure. Additionally, liquids such as
blood or saline are often spilled onto the drape during tool
exchange. While tools are removed from anatomy, they are often
contaminated with blood that spills specifically in the area where
the tool is coupled to the robotic assembly. It is preferable that
liquids do not leak into the robotic assembly which may cause a
loss of functionality in the electro-mechanical assemblies within
the robot. Thus an interface apparatus that prevents fluid ingress
while transferring drive motion across a sterile barrier without
breaking the sterile barrier may be desirable.
[0720] One variation of a drive interface apparatus is illustrated
with reference to FIGS. 129a-129c. FIG. 129a illustrates a version
of the previously described instrument driver 16 which includes a
sheath output plate 3006 and guide output plate 3008. A sheath
splayer 3003 and a guide splayer 3005 are each mounted indirectly
to the sheath output plate 3006 and guide output plate 3008
respectively. It should be noted that the sheath and guide mounting
plates along with the sheath and guide splayers are substantially
similar in construction and functionality. By way of example, the
sheath splayer and sheath output plate will be later described with
the understanding that the same construction and functionality can
apply to the guide splayer and guide output plate.
[0721] FIG. 129b shows a zoomed in view of a front portion of the
instrument driver 16 better illustrating the sheath splayer 3003, a
drive interface apparatus 3004, a drape assembly 1900, and the
sheath output plate 3006. FIG. 129c illustrates an exploded view of
the assembly of FIG. 129b. The sheath splayer 3003 is removably
coupled to the interface apparatus 3004 which in turn is removably
coupled to the sheath output plate 3006. The drape assembly 1900 is
compressed between the drive interface apparatus 3004 and the
sheath output plate 3006. For clarity, only portions of the drape
assembly 1900 are shown. The full drape assembly 1900 will be
described in detail later
[0722] FIGS. 130a and 130b illustrate a top and bottom view
respectively of a variation of the sheath output plate 3006. FIG.
130c illustrates a bottom exploded view of the sheath output plate
3006 which includes a base plate 3010, sliding latches 3012, four
sliding springs 3014, and two retaining plates 3016. FIGS. 131a-b
illustrates a top and bottom perspective view of the base plate
3010 which includes drive interface alignment holes 3026, contact
pin holes 3028, cutouts 3018, latch walls 3020, and latch pins
3022. The sliding latches 3012 can fit into the cutout 3018 in the
bottom of the base plate 3010 with the two sliding springs 3014
each compressed between a ridge of the sliding latch 3012 and the
latch wall 3020 in the cutout 3018. The retaining plates 3016 can
be fixed to the base plate 3010 with screws (not shown in the
figures) holding the sliding latches 3012 and sliding springs 3014
in place. By way of example, the base plate 3010 can be made of
6061-T6 aluminum, the latches can be made of 316 stainless steel,
and the retaining plates 3016 can be made of high hardness
stainless steel.
[0723] FIG. 131c illustrates a variation of the guide output plate
3008 which can utilize an alternatively shaped guide output base
plate 3024 configured to provide a mount for a clamp holding the
handle of a working catheter. The main body 3025 of the guide
output plate 3008 can remain substantially identical to that of the
sheath output plate 3006. Thus the same type of spring loaded
sliding latch mechanisms described for the sheath output plate 3006
can be used for the guide output plate 3008. For both the guide and
sheath output plates 3008,3006 the sliding latches can be used to
attach and detach the drive interface apparatus 3004 as will be
described in detail later.
[0724] FIG. 132a-132b illustrate top and bottom perspective views
of the drive interface apparatus 3004 while FIG. 132c illustrates
an exploded view. The drive interface apparatus 3004 can include a
drive interface base 3030, drive interface pulley shafts 3048,
drive interface shaft pins 3050, conductive spring loaded EEPROM
pins 3052, and a splash deflector 3054.
[0725] FIG. 133a-133b illustrates top and bottom perspective views
of the drive interface base 3030 which includes top static latches
3032, bottom static latches 3034, pulley holes 3036, pin holes
3038, splayer holes 3040, and output plate alignment pins 3042. The
top and bottom static latches 3032, 3034 can be non-adjustable,
non-movable protrusions which as will be described in detail later
could be used to lock the splayer 3002 to the drive interface
apparatus 3004 and the drive interface apparatus 3004 to either the
sheath or guide output plates 3006,3008. The splayer holes 3040 and
output plate alignment pins 3042 can be used to help with
installation of the drive interface apparatus 3004 and the sheath
splayer 3003.
[0726] FIGS. 134a-134b illustrate top and bottom views of the drive
interface base 3030 with the drive interface pulley shafts 3048 and
EEPROM pins 3052 installed into the pulley holes 3036 and pin holes
3038 respectively. The bottom portions of drive interface pulley
shafts 3038 and EEPROM pins 3052 protrude through the drive
interface base 3030 while resting within the drive interface base
3030. Referring back to FIGS. 4132a and 132c, the splash deflector
3044 which is illustrated with cutouts that provide clearance for
the top static latches 3032, drive interface pulley shafts 3048,
and EEPROM pins 3052 can be installed onto the drive interface base
3030. The splash deflector 3044 not only provides for exclusion of
debris and liquids but it also constrains the drive interface
pulley shafts 3048 from movement in the vertical and horizontal
plane while allowing free rotational movement about their
respective axes.
[0727] FIG. 135a-135c illustrates perspective and zoomed in views
of the drape assembly 1900. Among other components that operate
with a guide wire manipulator which will be described later, the
drape assembly includes a drape body 1901, a sheath foam pad 1902,
a guide foam pad 1904, protective tabs 1906, and an alignment aid
1908. The sheath foam pad 1902 is similar in construction to the
guide foam pad 1904, each provided with cutouts to mate with guide
or sheath output plates 3008, 3006 as well as the drive interface
apparatus 3004. The sheath and guide foam pads 1902, 1904 can be
constructed from any number of compressible materials including but
not limited to polyurethane foam while the protective tabs and
alignment aid can be made of High-density polyethylene (HDPE). The
drape body 1901 can be constructed of any type of sheer plastic
including but not limited to polyethelene.
[0728] FIGS. 136a-b illustrate different types of splayers that may
be used in conjunction with the previously described drive
interface apparatus. FIG. 136a illustrates a perspective view of a
variation of the sheath splayer 3003 while FIG. 136b illustrates a
perspective view of a variation of the guide splayer 3005. The
sheath splayer 3003 includes a splayer body 3002, a sheath active
valve assembly 3080, a sheath anti-buckling interface 3074, and a
sheath catheter 3000. The guide splayer 3005 includes a splayer
body 3002, a guide flush assembly 3082, a guide anti-buckling
interface 3076, and a guide catheter 3001. Referring to FIG. 136c
the sheath splayer 3003 is shown with a sheath cover 3062 exploded
from the remaining components of the sheath splayer to illustrate
how the sheath active valve 3080, sheath catheter 3000 and sheath
anti-buckling interface 3074 are integrated with the splayer body
3002. The sheath splayer 3003 has a substantially identical splayer
body 3002 to the guide splayer 3005 so integration of the guide
flush assembly 3082, the guide anti-buckling interface 3076, and
the guide catheter 3001 is similar.
[0729] Referring to FIG. 137a-c, the splayer body 3002 will be
described in more detail. FIG. 137a illustrates a top perspective
view, FIG. 137b illustrates a bottom perspective view, and FIG.
137c illustrates an exploded view. The splayer body 3002 can
include a splayer base 3060, a splayer cover 3062, splayer pulley
assemblies 3064, a splayer ID chip 3066, an ID chip cover 3070, a
splayer presence magnet 3072, and splayer body screws 1073.
[0730] The splayer cover 3062 shown in FIG. 138 can include a pair
of splayer latches 3084 coupled to pair of urethane based compliant
members 3086 allowing the latches to be repositioned with applied
manual forces. Perspective and exploded views of the splayer pulley
assembly 3064 are illustrated in FIGS. 138a-138b respectively. The
pulley assembly 3064 includes a pulley 3102, a set of outer races
3104, a set of ball cages 3110, a set of ball bearings 3108, and a
set of retainer clips 3106. The pulley 3102 can be constructed of
plastic and provided with an internal spline 3112 profile and with
a feature 3114 for coupling with a pull wire crimp ball located at
the end of a catheter pull wire or control wire (well known in the
art and described in detail in applications previously incorporated
by reference). The retainer clips 3106 fit onto the pulley 3102 to
hold the crimp balls (not shown) and bearings 3108 in place. The
inner races of the ball bearings are integrated into the pulley in
order to achieve a low profile package and minimize assembly
processes. The pull wire (not shown) is wound around the pulley
3102 and is run down the length of a catheter shaft as previously
described. The splayer ID chip 3066 includes a pair of pogo pins
3068. The magnet can be constructed of various materials including
but not limited to a single neodymium magnet. The splayer base 3060
illustrated in FIGS. 139a-b can be configured with pulley pockets
3092, an ID chip pocket 3094, a magnet pocket 3096, cover mounting
holes 3090, and latch holes 3091. The bottom of the splayer base
3060 can also include splayer alignment pins 3088.
[0731] FIGS. 140a-b illustrate the splayer base 3060 with the
splayer pulley assemblies 3064, splayer ID chip 3066, and splayer
presence magnet 3072 installed. The splayer pulley assemblies 3064
rest within the pulley pockets 3092 in a manner that allows the
each pulley 3102 to rotate about its own axis within the ball
bearing 3108. The splayer presence magnet 3072 rests in the magnet
pocket 3096. The ID chip pocket 3094 is sized to recess the ID chip
3094 allowing for a low overall splayer profile. The ID chip cover
3070 is installed over the splayer ID chip 3066, protecting the ID
chip while allowing the pogo pins 3068 to protrude through. To hold
the pulley assemblies 3064 in place, the splayer cover 3062 is
mounted to the splayer base 3060 with the splayer body screws 3073
which fit through the cover mounting holes 3090. The splayer
latches 3084 fit through the latch holes 3091, protruding out of
the bottom of the splayer base 3060. While four pulley assemblies
3064 are illustrated, alternative variations can include any number
of pulley assemblies 3064 leaving any number of pulley pockets 3092
empty. The ID chip 3094 is used to transfer device information to
the instrument driver (not shown) while the presence magnet 3072
detects when the splayer 3003 is installed on the instrument
driver.
[0732] Referring to FIG. 141a one method of installation of the
drape assembly 1900 onto the instrument driver 16 is shown. As
shown in FIG. 141b the drape assembly 1900 is placed on top of the
instrument driver 16 aligning the sheath foam pad 1902 and to the
sheath output plate 3006 so that the holes in the foam pad 1902
line up with the holes in the output plate 3006. The same method
can be performed for the guide foam pad 1904 and the guide output
plate 3008.
[0733] A first and second drive interface apparatus can now be
installed over the drape assembly 1900 onto the sheath output plate
3006 and guide output plate 3008. The following will illustrate a
method of installation for the sheath output plate 3006 but it
should be understood that substantially identical methods may be
implemented for the guide output plate 3008. FIGS. 142a and 142b
illustrate the drive interface apparatus 3004 uninstalled and
installed respectively onto the instrument driver 16 with the drape
assembly 1900 installed onto the sheath output plate 3006. FIGS.
143a-143c illustrate top and bottom views of only the sterile face
apparatus 3004 uninstalled on the sheath output plate 3006 and
drape assembly 1900. The drive interface apparatus 3004 can be
installed over the sheath foam pad 1902 inserting the drive
interface pulley shafts 3048 through the holes in the sterile drape
foam pad 1902 and output plate 3006 as shown in FIG. 143. The foam
pad 1902 is compressed between the drive interface apparatus and
the output plates 3004, 3006 creating a seal preventing liquid
ingress. The drive interface pulley shafts 3048 couple to the
sleeve receptacles 56b by engaging the drive interface shaft pins
3050 into notches in the sleeve receptacles 56b as shown in FIGS.
144a-d. To aid in alignment of the drive interface apparatus 3004
with the sheath output plate 3006, the output plate alignment pins
3042 fit into the drive interface alignment holes 3026. As the
drive interface apparatus 3004 is pressed down onto the output
plate 3006, the ramped bottom static latches 3034 on the drive
interface base 3030 force the spring loaded sliding latches 3012
apart allowing the bottom static latches to insert into the latch
holes 3011. The sliding springs 3014 force the sliding latches
apart locking the bottom static latches 3034 to the output plate
3006. The sliding springs 3014 are sized to compress easily enough
to allow a one handed press installation of the drive interface
apparatus 3004 while being strong enough to expand locking the
static latches in place. To un-install the drive interface
apparatus 3004 from the output plate 3006, the sliding latches 3012
on the output plate 3006 can be pressed towards the center of the
output plate 3006, releasing the bottom static latches 3034 from
the output plate 3006.
[0734] Once the drive interface apparatus is installed as described
above, the guide or sheath splayer 3005, 3003 can be installed and
easily uninstalled onto the drive interface apparatus 3004 without
breaking the sterile barrier created by the sterile drape assembly
1900. Referring to FIG. 145a-b, one method of installation of the
sheath splayer 3003 to the drive interface apparatus 3004 is shown.
For clarity, the instrument driver and drape assembly are not
shown. The sheath splayer 3003 can be installed to the drive
interface apparatus 3004 coupling the splayer pulleys 3102 to the
drive interface shafts 3048. The splayer pulleys 3102 are free to
rotate within the splayer 3003 before installation onto the drive
interface apparatus 3004. Once engaged with the drive interface
pulley shafts 3048, the splayer pulley assemblies 3064 lock onto
the drive interface pulley shafts 3048. The splayer pulleys 3102
are configured in a similar manner as VHS type with internal
splines 3112 that are shaped to ensure consistent self alignment of
the pulley 3102 to the interface pulley shaft 3048 and to aid in
minimizing insertion and removal force of the splayer 3003 from the
drive interface apparatus 3004 as shown in FIGS. 146a-b which
illustrates top views of the splayer pulleys 3102 and the interface
pulley shafts 3048. For further illustration, FIGS. 147a-b provide
various perspective views of a single splayer pulley 3102 and
interface pulley shaft 3048.
[0735] To aide in alignment of the sheath splayer to the drive
interface apparatus, the splayer alignment pins 3088 on the bottom
of the splayer 3003 can mate with the splayer holes 3040 on the
drive interface apparatus 3004. To lock the splayer 3003 to drive
interface apparatus 3004 force applied to the top of the splayer
3003 will force the splayer latches 3084 to displace until they
lock with the top static latches 3032 on the drive interface
apparatus. The spring force of the compliant members 3086 in the
splayer cover 3062 force the splayer latches 3084 to return to
their nominal positions locking the splayer latches 3084 to the top
static latches 3032. In order to remove the splayer 3003 from the
system, the splayer latches 3084 are compressed by squeezing either
side of the splayer cover 3062, re-positioning the compliant
members 3086 and releasing the splayer latches 3084 from the drive
interface top static latches 3032.
[0736] Referring to FIGS. 148a-148b, the transfer of motion from
the instrument driver 16 to the sheath splayer 3003 actuating
bending of the sheath catheter 3000 will be shown. FIG. 148a-b
illustrates a top and bottom view respectively of the instrument
driver 16 with its cover removed. As previously described, various
articulation mechanics 3029 including motors, pulleys belts and
gears can drive the motorized rotation of sleeve receptacles 56b
which couple to the drive interface pulley shafts 3048. As was
illustrated in FIGS. 144a-16d, the drive interface pulleys shafts
3038 can each be provided with drive interface shaft pins 3040 that
allow the shafts 3038 to be coupled to the sleeve receptacles 56b.
In turn the splayer pulley assemblies 3064 couple to the drive
interface pulley shafts 3038. Thus motorized rotation of the sleeve
receptacles ultimately actuates rotation of the splayer pulley
assemblies. As previously described, pull wires that run the length
of the catheter are controlled by the rotation of the splayer
pulley assemblies 3064 to actuate bending at the distal tips of the
catheter.
[0737] FIGS. 148a-148b also illustrate the EEPROM pins 3052 of the
drive interface apparatus 3004 which can pass through holes 3028 in
the output plate 3006 in order to couple to a circuit mounted (not
shown) beneath the output plate 3006. Once the splayer 3003 is
installed, the pogo pins 3068 on the splayer ID chip 3066 make
contact with the conductive contacts 3052 shown allowing the ID
chip 3066 to connect to the circuit and transmit catheter parameter
data to the robotic system. Also a splayer presence magnet 3072
shown in FIG. 9c is included on the splayer 3003 that is detected
by a switch (not shown) on the instrument driver 16. The presence
magnet 3072 can be sized appropriately for detection by a switch
mounted within the instrument driver 16 through the drive interface
apparatus 3004.
[0738] Referring back to FIGS. 135a-135c, the drape can be provided
with protective tabs to prevent accidental removal of the drive
interface apparatus during the removal of the splayer. As shown in
FIG. 135b-135c, protective tabs 1906 can be provided on the drape
body 1901 to cover the sliding latches 3012 on the output plate
3006 preventing the user from accidentally compressing the sliding
latches 3006 during a procedure when the intention is to release
the splayer latches 3084. The drape assembly 1900 also includes an
alignment aid 1908 that may be used to aid in positioning of the
instrument driver 16 to a patient entry site. When the instrument
driver 16 is positioned near the patient, the alignment aid 1908
can be positioned such that its distal tip makes contact with the
patient skin setting the distance between the instrument driver
nose and the patient. The alignment aid 1908 can be configured such
that its overall length is longer than the length of an
anti-buckling mechanism (previously described) in its fully
compressed state. Thus the distance between the instrument driver
and patient will be sufficient to allow for installation of the
anti-buckling device without causing undesired force of the
anti-buckling device on the patient tissue. The alignment aid may
also include an alignment line which coincides with the centerline
of the instrument driver 16. The alignment line can be used as a
visual aid in alignment of the instrument driver to an introducer
or guide wire inserted in a patient vessel. Since the introducer or
guide wire will tend to naturally align with the vessel, alignment
of the instrument driver to the introducer or guide wire will help
with better alignment with the patient vessel. The position of the
instrument driver 16 can be saved in the system memory and the
alignment aid can be removed from the drape for the remainder of
the surgical procedure.
[0739] Each of the individual variations described and illustrated
herein has discrete components and features which may be readily
separated from or combined with the features of any of the other
variations. Modifications may be made to adapt a particular
situation, material, composition of matter, process, process act(s)
or step(s) to the objective(s), spirit or scope of the present
application. Also, any of the features described herein with
reference to a robotic system is not limited to being implemented
in a robotic system, and may be implemented in any non-robotic
system, such as a device operated manually.
[0740] Methods recited herein may be carried out in any order of
the recited events which is logically possible, as well as the
recited order of events. Furthermore, where a range of values is
provided, every intervening value between the upper and lower limit
of that range and any other stated or intervening value in that
stated range is encompassed. Also, any optional feature of the
inventive variations described may be set forth and claimed
independently, or in combination with any one or more of the
features described herein.
[0741] All existing subject matter mentioned herein (e.g.,
publications, patents, patent applications and hardware) is
incorporated by reference herein in its entirety except insofar as
the subject matter may conflict with that described herein (in
which case what is present herein shall prevail). The referenced
items are provided solely for their disclosure prior to the filing
date of the present application. Nothing herein is to be construed
as an admission that any claimed invention is not entitled to
antedate such material by virtue of prior invention.
[0742] Reference to a singular item, includes the possibility that
there are plural of the same items present. More specifically, as
used herein and in the appended claims, the singular forms "a,"
"an," "said" and "the" include plural referents unless the context
clearly dictates otherwise. It is further noted that the claims may
be drafted to exclude any optional element. As such, this statement
is intended to serve as antecedent basis for use of such exclusive
terminology as "solely," "only" and the like in connection with the
recitation of claim elements, or use of a "negative" limitation.
Unless defined otherwise, all technical and scientific terms used
herein have the same meaning as commonly understood by one of
ordinary skill in the art in the field of this application.
[0743] Although particular embodiments have been shown and
described, it will be understood that they are not intended to
limit the claimed inventions, and it will be obvious to those
skilled in the art having the benefit of this disclosure that
various changes and modifications may be made. The specification
and drawings are, accordingly, to be regarded in an illustrative
rather than restrictive sense. The claimed inventions are intended
to cover alternatives, modifications, and equivalents.
* * * * *