U.S. patent application number 13/470193 was filed with the patent office on 2012-09-06 for coaxial catheter system.
This patent application is currently assigned to HANSEN MEDICAL, INC.. Invention is credited to Gary S. ROGERS, Albert SOLBJOR, Barry WEITZNER.
Application Number | 20120226227 13/470193 |
Document ID | / |
Family ID | 38560235 |
Filed Date | 2012-09-06 |
United States Patent
Application |
20120226227 |
Kind Code |
A1 |
WEITZNER; Barry ; et
al. |
September 6, 2012 |
COAXIAL CATHETER SYSTEM
Abstract
A medical system includes first and second medical probes in an
arrangement and configured for insertion into a lumen or vessel of
a patient, the first medical probe having indicia, and a detector
is fixedly coupled to the second medical probe and configured for
insertion into and advancement through the lumen or vessel along
with the second medical probe, wherein the detector detects passage
of the indicia as the first and second medical probes are moved
relative to each other within the lumen or body vessel. An
electromechanical driver is coupled to, and operable to move the
first and second medical probes. A system controller is configured
for directing the electromechanical driver to move the first and
second medical probes relative to each other within the lumen or
body vessel based on signals received from the detector when the
detector is positioned within the lumen or body vessel.
Inventors: |
WEITZNER; Barry; (Acton,
MA) ; ROGERS; Gary S.; (Wenham, MA) ; SOLBJOR;
Albert; (Waltham, MA) |
Assignee: |
HANSEN MEDICAL, INC.
Mountain View
CA
|
Family ID: |
38560235 |
Appl. No.: |
13/470193 |
Filed: |
May 11, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11762749 |
Jun 13, 2007 |
8187229 |
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13470193 |
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11467886 |
Aug 28, 2006 |
7766894 |
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11762749 |
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10270740 |
Oct 11, 2002 |
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11467886 |
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10216069 |
Aug 8, 2002 |
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10270740 |
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10023024 |
Nov 16, 2001 |
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10216069 |
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10011371 |
Nov 16, 2001 |
7090683 |
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10023024 |
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10011449 |
Nov 16, 2001 |
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10011371 |
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10010150 |
Nov 16, 2001 |
7214230 |
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10011449 |
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10022038 |
Nov 16, 2001 |
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10010150 |
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10012586 |
Nov 16, 2001 |
7371210 |
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10022038 |
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60332287 |
Nov 21, 2001 |
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60313495 |
Aug 21, 2001 |
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60276152 |
Mar 15, 2001 |
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60276086 |
Mar 15, 2001 |
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60276217 |
Mar 15, 2001 |
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60269200 |
Feb 15, 2001 |
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60293346 |
May 24, 2001 |
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Current U.S.
Class: |
604/95.01 |
Current CPC
Class: |
A61B 2017/3409 20130101;
A61M 25/10184 20131105; A61B 2017/22075 20130101; A61M 2025/1059
20130101; A61B 2034/301 20160201; A61M 2025/1072 20130101; A61M
2025/0008 20130101; A61M 25/1011 20130101; A61B 2090/0811 20160201;
A61M 25/1002 20130101; A61M 2025/1015 20130101; A61M 25/0113
20130101; A61B 17/12045 20130101; A61M 2025/0175 20130101; A61B
17/12136 20130101; A61B 2017/12127 20130101; A61M 2025/0004
20130101; A61M 2025/1052 20130101; A61B 34/70 20160201 |
Class at
Publication: |
604/95.01 |
International
Class: |
A61M 25/092 20060101
A61M025/092 |
Claims
1. A medical system for performing a surgical procedure on a
patient, comprising: a first medical probe having indicia, the
first medical probe being configured for insertion into a lumen or
vessel of the patient; a second medical probe positioned in an
arrangement with the first medical probe, the second medical probe
being configured for insertion into the lumen or vessel; a detector
fixedly coupled to the second medical probe and configured for
insertion into and advancement through the lumen or vessel along
with the second medical probe, wherein the detector detects passage
of the indicia as the first and second medical probes are moved
relative to each other within the lumen or body vessel; an
electromechanical driver coupled to the first and second medical
probes, the electromechanical driver being operable to move the
first and second medical probes; and a controller configured for
directing the electromechanical driver to move the first and second
medical probes relative to each other within the lumen or body
vessel based on signals received from the detector when the
detector is positioned within the lumen or body vessel.
2. The medical system of claim 1, further comprising a user
interface configured for receiving at least one command, wherein
the controller is configured for directing the electromechanical
driver in response to the at least one command.
3. The medical system of claim 1, wherein the controller is coupled
to the electromechanical driver via external cabling.
4. The medical system of claim 1, wherein the first and second
medical probes are flexible catheters in a coaxial arrangement.
5. The medical system of claim 1, wherein the detector is an
optical detector.
6. The medical system of claim 1, wherein the controller is
configured for directing the electromechanical driver to linearly
translate the first and second medical probes relative to each
other, the indicia is disposed along a length of the first medical
probe, the detector is configured for detecting a linear passage of
the indicia as the first and second medical probes are linearly
translated relative to each other, and the controller is configured
for receiving signals from the detector indicating the relative
linear translation between the first and second medical probes.
7. The medical system of claim 1, wherein the controller is
configured for directing the electromechanical driver to axially
rotate the first and second medical probes relative to each other,
the indicia is disposed along a circumference of the first medical
probe, the detector is configured for detecting a rotational
passage of the indicia as the first and second medical probes are
axially rotated relative to each other, and the controller is
configured for receiving signals from the detector indicating the
relative axial rotation between the first and second medical
probes.
8. The medical system of claim 1, wherein the first medical probe
further includes an articulating tool, and the controller is
configured for directing the electromechanical driver to actuate
the articulating tool.
9. The medical system of claim 1, wherein the controller is
operable to direct the electromechanical driver to move the second
medical probe relative to the first medical probe.
10. The medical system of claim 1, wherein the controller is
operable to direct the electromechanical driver to move the first
medical probe and the second medical probe.
11. A method for monitoring relative positions of a first medical
probe and a second medical probe inside of a patient, the method
comprising: directing an electromechanical driver coupled to the
first medical probe and the second medical probe to move the first
medical probe and the second medical probe relative to each other,
the first medical probe and the second medical probe being inserted
into a lumen or vessel in the patient, the first medical probe
having indicia, the second medical probe having a detector for
sensing a passage of the indicia as the first medical probe and the
second medical probe are moved relative to each other, wherein the
detector is inserted into the lumen or vessel, and wherein a
position of the detector changes with movement of the second
medical probe as the second medical probe is repositioned within
the lumen or vessel; and detecting signals indicating the relative
movement between the first medical probe and the second medical
probe.
12. The medical system of claim 11, wherein the first and second
medical probes are flexible catheters in a coaxial arrangement.
13. The method of claim 12, wherein the first medical probe is an
inner medical probe and the second medical probe is an outer
medical probe.
14. The method of claim 11, wherein the detector is an optical
detector.
15. The method of claim 11, wherein the first medical probe and the
second medical probe are linearly translated relative to each
other, and the relative linear movement between the first medical
probe and the second medical probe is detected.
16. The method of claim 15, wherein the first medical probe and the
second medical probe are rotationally translated relative to each
other, and the relative rotational movement between the first
medical probe and the second medical probe is detected.
17. The method of claim 11, wherein an articulating tool is
attached to the first medical probe, the method further comprising
directing the electromechanical driver to actuate the articulating
tool.
18. The method of claim 11, wherein the second medical probe is
moved relative to the first medical probe.
19. The method of claim 11, wherein the first medical probe and the
second medical probe are independently moved relative to each
other.
20. A method for monitoring relative positions of a first medical
probe and a second medical probe inside of a patient, comprising:
directing an electromechanical driver coupled to the first medical
probe and the second medical probe to controllably bend the first
medical probe and the second medical probe and to move the first
medical probe and the second medical probe relative to each other,
the first medical probe and the second medical probe being inserted
into the patient, the first medical probe having indicia, the
second medical probe having a detector for sensing a passage of the
indicia as the first medical probe and the second medical probe are
moved relative to each other, wherein the detector is inserted into
the patient, and wherein a position of the detector changes with
movement of the second medical probe and as the second medical
probe is repositioned within the patient; and detecting signals
indicating the relative movement between the first medical probe
and the second medical probe.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of application Ser. No.
11/762,749, filed Jun. 13, 2007, which is a continuation of
application Ser. No. 11/467,886, filed Aug. 28, 2006, which is a
continuation of application Ser. No. 10/270,740, filed Oct. 11,
2002 (now abandoned), which claims the benefit of Provisional
Application No. 60/332,287, filed Nov. 21, 2001, and is a
continuation-in-part of application Ser. No. 10/216,069, filed Aug.
8, 2002 (now abandoned), which claims the benefit of Provisional
Application No. 60/313,495, filed Aug. 21, 2001, and is a
continuation-in-part of application Ser. Nos. 10/023,024 (now
abandoned), 10/011,371 (now U.S. Pat. No. 7,090,683, issued Aug.
15, 2006), Ser. No. 10/011,449 (now abandoned), Ser. No. 10/010,150
(now U.S. Pat. No. 7,214,230, issued May 8, 2007), Ser. No.
10/022,038 (now abandoned), and Ser. No. 10/012,586 (now U.S. Pat.
No. 7,371,210, issued May 13, 2008), all filed Nov. 16, 2001, and
all of which claim the benefit of Provisional Application Nos.
60/269,200, filed Feb. 15, 2001, 60/276,217, filed Mar. 15,2001,
60/276,086, filed Mar. 15, 2001, 60/276,152, filed Mar. 15, 2001,
and 60/293,346, filed May 24, 2001.
[0002] This application is related in subject matter to application
Ser. No. 11/467,886, filed Aug. 28, 2006 (now U.S. Pat. No.
7,766,894, issued Aug. 3, 2010), and application Ser. Nos.
11/762,751 (now U.S. Pat. No. 7,931,586, issued Apr. 26, 2011), and
Ser. No. 11/762,748 (now U.S. Pat. No. 7,727,185, issued Jun. 1,
2010), both of which were filed Jun. 13, 2007. The entire
disclosures of the above applications are hereby expressly
incorporated herein by reference in their entireties.
BACKGROUND OF THE INVENTION
[0003] Catheters are used extensively in the medical field in
various types of medical procedures, as well as other invasive
procedures. In general, minimally invasive medical procedures
involve operating through a natural body opening or orifice of a
body lumen, or through small incisions, typically 5 mm to 10 mm in
length, through which instruments are inserted. In general,
minimally invasive surgery is less traumatic than conventional
surgery, due, in part, because no incision is required in certain
minimally invasive procedures, or the significant reduction in the
incision size in other procedures. Furthermore, hospitalization is
reduced and recovery periods are shortened as compared with
conventional surgical techniques.
[0004] Catheters maybe provided in a variety of different shapes
and sizes depending upon the particular application. It is typical
for a clinician to manipulate the proximal end of the catheter to
guide the distal end of the catheter inside the body, for example,
through a vein or artery. Because of the small size of the incision
or opening and the remote location of the distal end of the
catheter, much of the procedure is not directly visible to the
clinician. Although clinicians can have visual feedback from the
procedure site through the use of a video camera or endoscope
inserted into the patient, or through radiological imaging or
ultrasonic imaging, the ability to control even relatively simple
instruments remains difficult.
[0005] In view of the above, some have proposed using robotic
tele-surgery to perform minimally invasive procedures. Typically,
these robotic systems use arms that reach over the surgical table
and manipulate the surgical instruments inserted into the patient,
while the surgeon sits at a master station located a distance from
the table and issues commands to the arms.
SUMMARY OF THE INVENTION
[0006] In accordance with the present inventions, a medical system
comprises a first medical probe (e.g., a flexible catheter) having
indicia, and a second medical probe (e.g., a flexible catheter) in
a coaxial arrangement with the first medical probe. The second
medical probe has a detector (e.g., an optical detector) configured
for detecting a passage of the indicia as the first and second
medical probes are moved relative to each other. In one embodiment,
the first medical probe is an inner medical probe, and the second
medical probe is an outer medical probe. The medical system further
comprises an electromechanical driver coupled to the first and
second medical probes, and a controller configured for directing
the electromechanical driver to move the first and second medical
probes relative to each other, and for receiving signals from the
detector indicating the relative movement between the first and
second medical probes. In one embodiment, the first medical probe
further includes an articulating tool, in which case, the
controller may be configured for directing the electromechanical
driver to actuate the articulating tool. In another embodiment, the
controller is coupled to the electromechanical driver via external
cabling. In still another embodiment, the medical system further
comprises a user interface configured for receiving at least one
command, in which case, the controller may be configured for
directing the electromechanical driver in response to the
command(s).
[0007] The controller can control relative movement between the
first and second medical probes based on the detected indicia. For
example, the controller may be configured for directing the
electromechanical driver to linearly translate the first and second
medical probes relative to each other. In this case, the indicia
may be disposed along a length of the first medical probe, the
detector may be configured for detecting a linear passage of the
indicia as the first and second medical probes are linearly
translated relative to each other, and the controller may be
configured for receiving signals from the detector indicating the
relative linear translation between the first and second medical
probes. As another example, the controller may be configured for
directing the electromechanical driver to axially rotate the first
and second medical probes relative to each other. In this case, the
indicia may be disposed along a circumference of the first medical
probe, the detector may be configured for detecting a rotational
passage of the indicia as the first and second medical probes are
axially rotated relative to each other, and the controller may be
configured for receiving signals from the detector indicating the
relative axial rotation between the first and second medical
probes.
BRIEF DESCRIPTION OF THE DRAWINGS
[0008] The foregoing and other objects, features and advantages of
the invention will be apparent from the following more particular
description of preferred embodiments of the invention, as
illustrated in the accompanying drawings in which like reference
characters refer to the same parts throughout the different views.
The drawings are not necessarily to scale, emphasis instead being
placed upon illustrating the principles of the invention.
[0009] FIG. 1 is a schematic perspective view of a coaxial catheter
in accordance with the present invention;
[0010] FIG. 2A is a side view of the coaxial catheter system of
FIG. 1;
[0011] FIG. 2B is a cross-sectional view of the catheter system
illustrated in FIG. 2A;
[0012] FIG. 3 is a schematic and block diagram of the coaxial
catheter system in accordance with the present invention;
[0013] FIG. 4 is a block diagram of another embodiment of the
present invention employing controllable balloons for controlled
movement of the coaxial catheter system;
[0014] FIG. 5 is a timing diagram associated with the block diagram
of FIG. 4;
[0015] FIG. 6 is a schematic diagram illustrating the coaxial
catheter arrangement and associated proximal and distal balloons,
associated with the block diagram of FIG. 4;
[0016] FIG. 7 is a schematic diagram illustrating another aspect of
the present invention employing a detector;
[0017] FIG. 8 is a schematic and block diagram of still another
embodiment of the present invention;
[0018] FIG. 9 illustrates another principle of the present
invention in a coaxial catheter system illustrated being used in a
vein or artery;
[0019] FIG. 9A illustrates a multi-lobed balloon of the system of
FIG. 9;
[0020] FIG. 10 illustrates another embodiment of the invention for
distal drive of one of the catheters;
[0021] FIG. 11A a block and schematic view a catheter drive system
with a fluid delivery system in accordance with the invention;
[0022] FIG. 11B is a close-up view of a manifold of the fluid
delivery system of FIG. 11A;
[0023] FIG. 12 illustrates a catheter coupled to a catheter drive
mechanism in accordance with the invention;
[0024] FIG. 12A is a cross-sectional view of the drive mechanism of
FIG. 12;
[0025] FIG. 13 illustrates the catheter of FIG. 12 and a guide wire
coupled to respective drive mechanisms in accordance with the
invention;
[0026] FIG. 14 illustrates the linear movement of the drive
mechanisms of FIG. 13;
[0027] FIGS. 15A-15C illustrate various devices used to move the
drive mechanisms of FIG. 13 in a linear manner;
[0028] FIG. 16 is a perspective view of the catheter and guide wire
of FIG. 13 shown coupled to respective drive mechanisms of a base
unit;
[0029] FIG. 16A is a top view of one of the drive mechanisms shown
in FIG. 16;
[0030] FIG. 16B is a view of the drive mechanism of FIG. 16A taken
along the line 16B-16B;
[0031] FIGS. 17A-17C illustrate a connector used to couple the
catheter and guide wire to their respective drive mechanisms;
[0032] FIGS. 18 and 18A illustrate an alternative embodiment of the
connector; and
[0033] FIGS. 19, 19A and 19B illustrate yet another embodiment of
the connector.
[0034] FIGS. 20A and 20B illustrate yet another embodiment of the
connector.
DETAILED DESCRIPTION OF THE INVENTION
[0035] A description of preferred embodiments of the invention
follows. Referring to FIG. 1 there is shown a catheter system 5
including three separate catheter shafts 10, 20, and 30, with an
end effector 12 supported at the distal end of the catheter shaft
10. The end effector 12 may be, for example, an articulated tool
such a grasper with a pair of jaws 12a and 12b that pivot about a
joint 15 to grasp an item between the two jaw members. Other
articulated tools that may be used as the end effector 12 include
scissors, needle holders, micro dissectors, staple appliers,
tackers, suction irrigation tools, and clip appliers. The end
effector 12 can also be a non-articulated tool, such as a cutting
blade, probe, irrigator, catheter or suction orifice, and dilation
balloon. Further details of catheter systems, particularly those
relating to mechanisms for multiple degrees-of-freedom of motion of
catheter shafts can be found in application Ser. Nos. 10/023,024
(now abandoned), 10/011,449 (now abandoned), 10/022,038 (now
abandoned), 10/012,586 (now U.S. Pat. No. 7,371,210, issued May 13,
2008), Ser. No. 10/011,371 (now U.S. Pat. No. 7,090,683, issued
Aug. 15, 2006), and Ser. No. 10/010,150 (now U.S. Pat. No.
7,214,230, issued May 8, 2007), all by Brock et al., and all filed
Nov. 16, 2001, and all of which are hereby incorporated herein by
reference in their entireties.
[0036] Each of the catheter shafts 10, 20, and 30 has a different
diameter that is able to move with multiple degrees-of-freedom. The
catheter shafts shown in FIG. 1 are arranged in a coaxial manner
with the small diameter catheter 10 positioned inside the medium
diameter catheter 20 which in turn is positioned inside the large
catheter 30. The arrangement in FIG. 1 is a coaxial arrangement
with the small diameter catheter 10 adapted for sliding inside of
the medium diameter catheter 20.
[0037] As illustrated in FIG. 1, as well as FIG. 2A, the catheter
30 is able to move with a linear translation in the direction 31,
while the medium diameter catheter 20 is able to slide inside the
catheter 30 with a linear translation motion in the direction 21,
and the small catheter 10 is able to slide inside the medium
catheter with a linear translation motion in the direction 11.
[0038] In addition to the translation motions, each of the catheter
shafts 10, 20, and 30 is able to rotate and bend. Hence, the shafts
10, 20, and 30 have three degrees-of-freedom of movement. The
rotational motion of the catheters 10, 20, and 30 is indicated by
the double arrows S.sub.3R, S.sub.2R and S.sub.1R, respectively,
and the orthogonal bending motions of the catheters 10, 20, and 30
are indicated by the double arrows S.sub.3B1 and S.sub.3B2,
S.sub.2B1 and S.sub.2B2 and S.sub.1B1 and S.sub.1B2
[0039] Referring also to FIG. 2B, there is shown the coaxial
arrangement of the catheters 10, 20, and 30, as well as the
rotational motions of the catheters identified by the double arrows
13, 23, and 33, respectively. Indicated in FIG. 2A are the
operative segments 01, 02, and 03 of the respective catheters 10,
20, and 30 where the bending may occur in each of the catheters. As
shown, this bending generally occurs near the distal end of the
respective catheters. However, the operative segments may also be
located at different places along each of the catheters or may not
be required at all.
[0040] Turning now to FIG. 3, the multiple coaxial catheters 10,
20, and 30 are shown coupled to a drive system 35. Also shown in
FIG. 3 are the operative sections 01,02, and 03 of the catheters
10, 20, and 30, respectively, as well as the linear translational
degree-of-freedom 11, 21, and 31. At some position along the
catheters, there is a patient interface, not specifically
illustrated in FIG. 3 but considered to be the location where the
catheter enters the anatomic body. The entry of the catheter may,
for example, be percutaneously, via an incision, or even through a
natural body orifice. Procedures to be described below are
particularly adapted for transitioning a multi-shaft catheter
constriction through an anatomic body vessel such as through the
intestines. Of course, the concepts of the illustrated embodiments
may be used in association with the control and transition of the
catheters through other body vessels or body cavities as well.
[0041] Each catheter 10, 20, and 30 is arranged and supported in a
manner to enable multiple degrees-of-freedom of the catheter
including movement of the catheter to an anatomic body target site,
as well as rotation of the catheter. In particular, there are
respective support blocks 40, 50, and 60 associated with the
catheters 10, 20, and 30. In the embodiment illustrated in FIG. 3,
these support blocks 40, 50, and 60 are coupled to the respective
proximal ends of the catheters identified as 10A, 20A, and 30A.
Each of the support blocks controls linear translational movements
of the catheters with the use of wheels 42, 52, and 62. In support
block 40, there is also illustrated control of the rotational
motion 46 of the catheter 10. Similarly, support blocks 50 and 60
provide rotational control 56 and 66 to the respective catheters 50
and 60.
[0042] The drive system 35 also includes an electromechanical drive
member 70 coupled to the support blocks 40, 50, and 60 with
mechanical cablings 80, 81, and 82, respectively. The drive member
70 is a under the direction of a controller 72 that is also coupled
to an input device 76 which interfaces the drive system 35, and
hence the catheter system 5, with a user who is typically a
surgeon.
[0043] In the illustrated embodiment, the electromechanical drive
member 70 is a motor array with a plurality of drive motors. The
mechanical cablings 80, 81, and 82 provide control of the
respective blocks and controls the linear and rotational movement
of the respective catheters. Thus, in the motor array 70, there can
be at least one motor for controlling linear translation, and a
separate motor for controlling rotational translation relative to
each of the support blocks.
[0044] Thus, when the system 35 is in use, the surgeon provides
instructions to the controller 72 through the input device 72. In
turn, the controller 72 directs the operation of the motor array 70
and hence the support blocks 40, 50, and 60 which drive the
respective catheters with multiple degrees-of-freedom of
movement.
[0045] The motor array 70 also includes separate motors for driving
the bending movements S.sub.3B1 and S.sub.3B2, S.sub.2B1 and
S.sub.2B2 and S.sub.1B1 and S.sub.1B2 of the catheters as
previously indicated in FIG. 1. In FIG. 3, in addition to the
operative segments 01, 02, and 03 where the bending of the
individual catheter occurs, there are also shown in cut-out
cross-section in each of the catheters respective cablings C1, C2,
and C3. These cablings extend along the length of the respective
catheters and can be used for controlling the bending of the
operative segments. Also, cabling that extends through catheters
10, 20, and 30 can be used to operate the end effector 12 as well.
The cabling C1, C2, and C3 can extend through the catheters and
through the corresponding support blocks, coupling through the
various mechanical cablings 80, 81, and 82. Accordingly, there may
be control motors in the motor array 70 that control the bending
movements of the catheters, as well as operation of the end
effector 12. Further details of mechanical cabling used for the
operation of catheters including bending and flexing thereof may be
found in the application Ser. Nos. 10/023,024. 10/011,371,
10/011,449, 10/010,150, 10/022,038, and 10/012,586, mentioned
above.
[0046] In some embodiments, the controller 72 is a microprocessor
that receives input commands from the input device 76. The input
device 76 can be one of various types of controls such as a dial,
joystick, wheel, or mouse. A touch-screen can also be employed as
the input device 76 to allow the surgeon to input information about
the desired location of a particular portion of the catheter by
touching the screen. In this regard, reference may also be made to
Application No. 10/216,669, filed August 8, 2002 (now abandoned),
which application is hereby incorporated herein by reference in its
entirety, which describes a catheter tracking system that enables
an operator at the input device to select a particular anatomic
body site and direct the catheter automatically to that site.
[0047] Referring to FIGS. 4, 5 and 6, there is shown another
implementation of the catheter control. Here, the system employs
multiple catheters with multiple balloons in combination with a
control mechanism by which the balloons are inflated and deflated
to move the catheters in increments through a body vessel. In FIG.
6, a set of catheters 110, 120, and 130 are located within a body
vessel 100. Associated with catheter 120 is a distal balloon D. and
similarly, associated with the distal end of catheter 130 is a
proximal balloon P. In FIG. 6 there are also shown ports Dl and P1
through which air or other fluid is introduced into each of the
balloons to inflate the balloons or removed to deflate the
balloons. In FIG. 6 the proximal balloon P is shown inflated and
the distal balloon D is shown deflated. Note that although only two
balloons are shown, one or more additional balloons can be
associated with a third or even a fourth catheter.
[0048] In the block diagram of FIG. 4 there is identified an inner
catheter 86 and an outer catheter 87, which may correspond
respectively to catheters 120 and 130 in FIG. 6. Also illustrated
in FIG. 4 are an inner catheter control 84 and an outer catheter
control 85. These controls may be similar to the controls
illustrated in FIG. 3 for at least controlling the advancement in a
linear manner of the corresponding catheter. Thus, the catheter
control 84 can be considered as controlling the linear movement of
the inner catheter 86 while the catheter control 85 can be
considered as controlling the linear translation of the outer
catheter 87.
[0049] The outputs of a motor array 90 are coupled to the inner
catheter control 84 and the outer catheter control 85, while a
controller 92 is coupled to and controls the motor any 90. An input
device 96 connected to the controller 92 provides an interface for
a user such as surgeon to operate the inner and outer catheters 86
and 87.
[0050] Also illustrated in FIG. 4 is a balloon controller 94
associated with the controller 92 and that has two separate outputs
coupled to the proximal, P, and distal, D, balloons. Under the
direction of the controller 92 the balloon controller controls the
inflation and deflation of the proximal balloon P and the distal
balloon D. Details about the timing of the inflation and deflation
sequence are illustrated in FIG. 5.
[0051] The proximal, P, and distal, D, balloons are inflated and
deflated in a sequence in association with advancement of the
different catheter segments 86 and 87. This is carried out so that
the catheters can progress in increments under automatic control.
Hence, the surgeon or other operator need not direct the catheter
continuously by hand, but instead the controller 92 initiates a
sequence by which the catheter creeps or advances in increments
through a vessel 100 (FIG. 6).
[0052] An example of the timing sequence for the advancement of the
inner and other catheters 86 and 87 of FIG. 4 or 120 or 130 of FIG.
6 is illustrated in FIG. 5. Once the advancement sequence is
initiated, for example, through the input device 96, no further
control via the input device is necessary. Instead the controller
92 simply repeats a predetermined sequence to cause incremental
movement of the catheter system through the body.
[0053] FIG. 5 depicts certain timing actions relating primarily to
the inflation and deflation of the balloons, P and D, as well as
the forward advancement of the catheters 86 and 87, or 120 and
130.
[0054] In step (a), there is an inflation of the proximal balloon
P. This causes the catheter 130 to lock against the side wall of
the vessel 100 to create an anchor point for the distal end of the
catheter 130.
[0055] Next, in step (b) the inner catheter 120 is advanced by a
certain amount in the vessel 100. Note that, as illustrated in FIG.
6, the distal balloon D is deflated, and thus is not locked in
position but is readily moveable in a forward direction with the
catheters 110 and 120.
[0056] In step (c), the process inflates the distal balloon D,
which locks the distal end of catheter 120 to the inner wall of the
vessel 100. Subsequently, the proximal balloon P is deflated so
that it is no longer locked against the inner wall of the vessel
100. The outer catheter 130 is then free to move.
[0057] In step (e) the outer catheter 130 in FIG. 6 is moved
forward carrying the proximal balloon P. which has previously been
deflated allowing it to move readily through the vessel 100.
[0058] After the catheter 130 and its associated proximal balloon P
has moved a certain distance, then, as illustrated in step (f) the
process again inflates the proximal balloon P, and in step (g)
deflates the distal balloon D. Once this occurs, the catheter
system is then in the position illustrated in FIG. 6, having
advanced by an incremental amount related to the length of movement
of the inner and outer catheters 120 and 130.
[0059] Note that the particular control illustrated in FIGS. 4-6
does not necessarily require the use of an input device.
Alternatively, if an input device is used, it can be of the type
that simply initiates a sequence that is stored in the algorithm of
controller 92. Hence again, in this way, once the sequence is
initiated, then subsequent moves are controlled by the controller
92 and not by any specific manipulations at the input device
96.
[0060] Moreover, there may also be provided a force feedback,
usually associated with a distal catheter 110. If the distal end of
this catheter, or an end effector supported at the distal end,
detects an obstruction or some blockage that provides a force
feedback signal to the controller, then the controller may
interrupt the sequence of steps depicted in the timing diagram of
FIG. 5. This enables the surgeon to observe the position of the
catheters, for example, through the use of known display techniques
including Fluoroscopy, Ultrasound, MRI, CT, or PET.
[0061] Referring now to FIG. 7, there is shown another embodiment
of a catheter system having separate catheters 210, 220 and 230,
and a detector 240. For illustrative purposes, the catheter 220 may
be considered a proximal catheter, while the catheter 210 may be
considered a distal catheter. A drive system such as that shown in
FIG. 3 is used for the linear translation of the catheters. A
particular feature of the catheter system shown in FIG. 7 is a
feedback signal provided to the detector 240 to indicate movement
of the catheters, as well as relative movement between catheters.
To accomplish this, each of the catheters 210, 220, and 230 is
provided with indicia 211, 221, and 231, respectively, which may be
of the optical type. The detector 240 may be or include a counter
that counts passing indicia.
[0062] As an example, if the catheter 220 is stationary and the
catheter 210 is being moved forward linearly, then the detector 240
such as an optical system can simply read the indicia 211 as the
catheter 210 moves coaxially out of the catheter 220. Each of the
indicia is separated by a predetermined length and the optical
system simply reads each indicia as it moves relative to an
adjacent fixed catheter to determine the overall distance of
movement of the catheter system.
[0063] The detection system 240 illustrated in FIG. 7 may be used
with the incremental advancement system depicted in FIGS. 4-6. In
connection with the balloons illustrated in FIGS. 4 and 6, mention
has been made of the incremental forward movement of the inner and
outer catheters 86 and 87, or 120 and 130. The optical detection
scheme illustrated in FIG. 7 can be used to measure the distance of
movement of either or both of the catheters.
[0064] A further embodiment is illustrated in the schematic and
block diagram of FIG. 8. Unlike the drive arrangement shown in FIG.
3 where coaxial catheters are driven from their proximal ends, the
catheters 210, 220, and 230 shown in FIG. 8 are driven from their
distal ends. The catheter system also implements the indicia and
detector 240 described with reference to FIG. 7.
[0065] Here, the catheter 220 is considered the proximal catheter
and the catheter 210 is considered the distal catheter. The
operation of the catheters 210, 220, and 230 are controlled from
the drive member 160. The drive member 160 may be placed at the
master station of FIG. 3, or controlled from a remote location such
as at the master station, usually with surgeon input control.
[0066] Each catheter is driven relative to an adjacent coaxial
catheter member, such as catheter 220 relative to catheter 230,
with drive mechanisms 150 and 140 mounted to frame pieces 225 and
235 extending from more proximal catheters.
[0067] In FIG. 8 there are illustrated two drive blocks 140 and 150
which control the respective catheters 210 and 220. Note that the
catheter system of FIG. 8 may also include the proximal drive
arrangement of FIG. 3 for one or more of the catheters. If both
proximal and distal drive is used for any one particular catheter,
then the proximal drive may be considered as a "coarse" drive while
the more distal drive may be considered as a "fine" drive.
[0068] The drive block 140 includes wheels 142 for controlling
linear translation of the catheter 210, as illustrated by arrow
144. In the drive block 140 there is also illustrated rotational
translation of the catheter 210, as illustrated by the arrow 146.
In a similar manner, the linear translation relating to drive block
150 is represented by wheels 152 indicated by the arrow 154. Also,
with regard to drive block 150, and catheter 220, the arrow 156
illustrates rotational movement of the catheter 220 produced by the
drive block 150.
[0069] FIG. 8 also illustrates the feedback signal to the detector
240 to sense incremental of movement of the respective catheters.
For this purpose, on each of the catheters there is provided
indicia that may be of the optical type described earlier. In FIG.
8 these are indicated as indicia 211 on catheter 210, indicia 221
on catheter 220, and indicia 231 on catheter 230. The detector 240
may include a counter that counts passing indicia to indicate the
liner distance of relative movement between catheters.
[0070] Although the drive blocks 140 and 150 are shown in a
schematic fashion about each of their respective catheters, it is
understood that the drive mechanisms can also be employed within
the catheter construction, such as shown in FIG. 10, or other
drives may be employed between adjacent catheters. Also, the block
160 illustrated in FIG. 8 as a drive block may in practice be
cabling that connects back through the catheters to the motor
array, such as the motor array 70 depicted in FIG. 3. In this way,
at an input device, such as the input device 76 in FIG. 3, the
surgeon can control the movement of the catheters in both a
proximal manner and in a distal manner, or either manner.
[0071] The feedback at detector 240 may be incorporated with the
drive 160 so that the drive provides for "fine` movement of
catheters in an incremental manner. The movement is fed back by way
of detector 240 to provide for fine adjustment of the catheters,
particularly the smaller diameter distal catheter 210.
[0072] Mention has been made that control of the movement of the
catheters can be provided at both the proximal and distal ends of
the coaxial catheter system. For certain procedures, it may be
advantageous to control the proximal end of the catheters, as well
as directly control the movement at the distal end of the
catheters. For example, FIG. 9 depicts a coaxial catheter system
extending through the aorta 300 of the heart 304 and used in a
vascular artery 302 that may be considered as including a main
artery and several branches of the artery that are to be negotiated
by the catheter system.
[0073] In the particular embodiment illustrated in FIG. 9 the
coaxial catheter system includes a large outer catheter 330, a
middle catheter 320, and a small distal or inner catheter 310. The
distal end of the catheter 310 supports or carries an end effector
312 which may be in the form of a jaw member. For the particular
system depicted in FIG. 9, the outer catheter 330 and the middle
catheter 320 are driven from their respective proximal ends in a
manner as illustrated in FIG. 3 with the use of the input device
76, controller 72, and motor array 70.
[0074] To position each of the separate catheters, there is
illustrated in FIG. 9 a fixing or securing means such as balloon
332 located at the distal end of large outer catheter 330 and
balloon 322 located at the distal end of the middle catheter 320.
Each of these balloons may be inflated to hold its corresponding
catheter in a relatively fixed position in the body vessel.
Alternatively, rather than the use of balloons, other securing
devices may be employed such as sonic type of expandable mechanical
member. Regardless of the type of securing member employed, it is
capable of being operated by the surgeon from a remote location at
the master station, and at the appropriate time selected by the
surgeon. The balloons 322 and 332 can be a single lobed balloon
that totally obstructs the vessel when inflated. Alternatively, the
balloons may have a multi-lobed configuration as illustrated in
FIG. 9A. The balloon 322 or 332 shown in FIG. 9A has three lobes
305 that when inflated in a vessel 306 allows fluid to flow in the
space 307 between the lobes. The balloon 322 or 332 can have fewer
or more than three lobes in other arrangements. In certain
implementations, the individual lobes can be inflated independently
of each other.
[0075] Initially, both the middle catheter 320 and the small inner
catheter 310 may be in a withdrawn position, coaxially positioned
within the outer catheter 330. When the outer catheter 330 is
controlled by the surgeon to be positioned in the manner
illustrated in FIG. 9, the surgeon can then instruct the balloon
332 to inflate to secure the outer catheter 330 in the position
illustrated in FIG. 9. The balloon 332 expands against the walls of
the vessel and essentially locks the outer catheter in position,
particularly at its distal end.
[0076] Next, under the control of the surgeon through the use of an
input device, the middle catheter 320 is moved forward linearly
through the vessel of the anatomy. The control of the forward
movement of the catheter 320 relative to the catheter 330 may be
carried out in a manner illustrated in FIG. 3 from the proximal end
of the catheter 320.
[0077] Previously, mention was made that the balloon 332 is
inflated to secure the outer catheter 330. After the middle
catheter 320 is moved forward some distance, then the balloon 322
may also be inflated. This procedure is under the surgeon's control
at the master station through the input device to now secure the
distal end of the middle catheter 320 at an appropriate position
within a body vessel.
[0078] For "fine" control of the small inner catheter 310, it is
intended, in the embodiment of FIG. 9, that the control of the
inner catheter 310 is implemented in the manner illustrated in FIG.
8 in which the support and drive block 140 can provide direct drive
of the inner catheter's 310 forward linear movement out of the
middle catheter 320. Although the drive is located at the distal
end of the catheter, the drive is remotely controlled by the
surgeon at the master station. Again, this control can be by way of
an input device such as an input interface or a joystick moved in a
direction to cause a consequent movement of the various catheters
depicted in FIG. 9.
[0079] Because of the significant length of the catheters that may
be employed in a surgical procedure, it may be desirable to provide
direct drive of the inner catheter 310 at its distal end, rather
than drive it at its proximal end. For example, this may be
particularly desirable when the length of the entire catheter
system is so long that it may have some tendency to deflect or bend
even when secured by, for example, the balloons 322 and 332.
[0080] After the balloons 322 and 332 are inflated, the surgeon at
the master station can continue to control the forward movement of
the distal end of inner catheter 310. As indicated previously, the
drive for the inner catheter 310 is typically of the type
illustrated in FIG. 8, or in FIG. 10 discussed below.
[0081] In FIG. 10, the small diameter inner catheter 310 is driven
relative to the middle diameter catheter 320. The linear movement
of the catheter 310 is illustrated by the arrow 352 when driven by
the wheels 350. The rotation of the catheter 310 relative to the
catheter 320 is driven the block 354, as indicated by the
rotational arrow 356.
[0082] FIG. 10 also illustrates a detector or reader 360. This
again may be an optical device that detects the passage of the
indicia 311 on the inner catheter 310. Appropriate electrical
signal lines coupled from the detector 360 back to the master
station transmit information related to the movement of the inner
catheter 310 relative to the middle catheter 320.
[0083] The detector 360 may also be used for detecting rotation of
the catheter 310 relative to the catheter 320. For this purpose, in
addition to the linear set of indicia 311 on the catheter 310, the
catheter 310 is also provided with additional indicia 315 that
extend about the circumference of the catheter. The reader 360 is
able to read not only linear passage of indicia 311, but also read
rotation of the indicia 315 from one linear set of indicia 311 to
the next.
[0084] Although a single detector 360 is shown in FIG. 10, other
detectors may also be employed. For example, one detector could be
used for detecting linear translation of the catheter 310, and a
second detector could be used for detecting rotation of the
catheter 310 with the use of indicia 315.
[0085] The catheter drive system described above can be implemented
in other configurations as well. For example, there is shown in
FIG. 11A a catheter drive system associated with a fluid or drug
delivery system. Note in FIG. 11A, emphasis is placed on the
proximal end of a catheter 1070 and guide wire 1072. The more
distal portion of the catheter is identified by the dotted lines.
Details of the distal portions of the catheter 1070 and guide wire
1072 may be found in application Ser. No. 10/216,067, filed Aug. 8,
2002 (now abandoned), which application is hereby incorporated
herein by reference in its entirety.
[0086] At some position along the catheter 1070, there is a patient
interface illustrated at 1074 where the catheter may be considered
as entering into the patient's body. The entry of the catheter may,
for example, be percutaneously, via an incision, or even through a
natural body orifice.
[0087] A support block 1076 supports the catheter 1070 in a manner
to enable at least two degrees-of-freedom of the catheter including
axial movement of the catheter to an anatomic body target sit; as
well as rotation of the catheter. The support block 1076 controls
both the linear translation of the catheter 1070 by the wheels
1078, as indicated by the arrow 1079, and the rotational
translation of the catheter, as illustrated by the arrow 1080.
Again, further details of such a catheter support system
illustrating multiple degrees-of-freedom can be found in the
application Ser. Nos. 10/023,024, 10/011,371, 10/011,449,
10/010,150, 10/022,038, and 10/012,586, mentioned above.
[0088] In FIG. 11 A, there is also a block 1082 which controls the
movement of the guide wire 1072. In particular, the wheels 1084
move the guide wire 1072 in a linear manner in the direction 1085.
The block 1082 is also able to rotate the guide wire 1072 in the
direction 1086. Note that the blocks 1076 and 1082 can be supported
on a common support structure 1120. Although the support 1120
provides a physical connection between the blocks 1076 arid 1082,
the blocks are operated independently so that the guide wire 1072
and the catheter 1070 can be driven independently of each
other.
[0089] The drive or support blocks 1076 and 1082 arc coupled to an
electromechanical drive member or motor array 1090 that controls
the movements of both the catheter 1070 and the guide wire 1072
with at least two degrees-of-freedom. In particular, mechanical
cablings 1087 and 1088 couples the motor array 1090 to the support
blocks 1076 and 1082, respectively. The motor array 1090 is also
coupled to a controller 1092 that directs a plurality of motors in
the motor array. An input device 1096 provides an interface to the
system for use by a surgeon.
[0090] The mechanical cablings 1087 and 1088 transmit the
mechanical movements of the various motors in the motor array 1090
to the respective support blocks 1076 and 1082 to provide the
linear and rotational movements of the catheter 1070 and guide wire
1072. Thus, in the motor array 1090, there may be at least one
motor for the linear translation and a separate motor for the
rotational translation for the block 1076. Similarly, there can be
motors in the motor array 1090 for both the linear and rotational
translations of the support block 1082.
[0091] The controller 1092, maybe a microprocessor that receives
input commands from the input device 1096. The input device 1096
may include various types of controls such as a dial, joystick,
wheel or mouse. A touch screen may also be employed as the input
device 1096 to input information about the desired location of a
particular portion of the catheter. Details of such a tracking
system may be found in application Ser. No. 10/216,669 (now
abandoned), mentioned above. Such a tracking system enables an
operator, such as a surgeon, through the input device to select a
particular anatomic body site and direct the catheter directly and
automatically to that site.
[0092] Although a manifold 1100 is shown with a single port, the
manifold may include multiple ports. The manifold 1100 provides a
delivery conduit to the catheter 1080 for the delivery of fluids to
a site in the patient's body. For example, one of the fluids 1105
employed may be a contrast fluid for purposes of visualization,
which is coupled to a feed line 1107 by a valve A. There may also
be a drug delivery system indicated generally at 1108 coupled to
the feed line 1107 by way of a line 1109 to a valve B.
Alternatively, the manifold 1100 can be provided with two separate
ports with a respective valve A and B in each of these ports.
[0093] As shown in FIG. 11 B, the manifold 1100 includes an end
piece 1200 sealed to the back end of the manifold 1100 and provided
with an opening 1202 through which the guide wire 1072 enters into
the manifold 1100, and hence the catheter 1070. Positioned within
the manifold 1110 and adjacent to the end piece 1200 is a gasket
1204. The guide wire 1072 pierces the gasket 1204 such that the
gasket forms a seal about the guide wire. Thus, as fluid enters
from the feedline 1107 into the manifold 1100, the gasket 1204
prevents the fluid from leaking out the back end of the manifold
1100.
[0094] As indicated previously, the input device 1096 may take on a
variety of different forms. If a wheel, dial, or pivoting switch is
employed as the input device 1096, then one of these may be used
for controlling the two degrees-of-freedom of movement of the
catheter 1070, while another such device is used to control the two
degrees-of-freedom of movement of the guide wire 1072. Thus, the
operator has independent control of the drive or support blocks
1076 and 1082 byway of the input device 1096. This permits the
operator to selectively move the guide wire 1072 and the catheter
1070 independently of each other. Typically, the operator advances
the guide wire 1072 a certain distance, and then the catheter 1070,
such that the guide wire 1072 can be used to access certain twists
or turns in a body lumen such as an artery or vein.
[0095] The input device 1096 may also operate means such as
buttons, switches, etc. that provide signals through lines 1111 and
1112 to the respective valves A and B for controlling the
dispensing of liquids from the fluid sources 1105 and 1108.
Although shown coupled to the controller 1092, the lines 1111 and
1112 can be coupled directly to the input device 1096 in other
implementations.
[0096] When the system is in operation, the surgeon advances the
catheter 1070 and guide wire 1072 through the patient's body with
the drive system. To provide visualization of the end of the
catheter, the surgeon can instruct, with the input device 1096, the
valve A to open. That is, the surgeon interfaces with the system
through the input device 1096 to generate a signal on line 1111
that opens the valve A to dispense a contrast fluid through the
manifold 1000 and the catheter 1070 to the target site of interest.
Similarly, the surgeon may deliver drugs to the target site by
instructing the valve B to open which would allow drugs from the
source 1108 to flow through the catheter 1070 into the body.
[0097] In the following discussion, greater detail will be provided
about the drive mechanisms (FIGS. 12-16) and various devices (FIGS.
17-19) used to couple the medical instruments to the drive
mechanisms. Although the drive mechanisms and connectors are
described in reference to the catheter 1070 and guide wire 1072
discussed above, they can be used in any number of combinations
with any of the other medical instruments described earlier.
[0098] The catheter 1070 referred to in these figures is of the
type commonly used in angioplasty. The catheter 1070 includes a
first leg 1300 joined with a second leg 1302 at a coupler 1304, and
a single extended leg 1306 that extends from the coupler 1304.
Typically, a part or much of the extended leg 1306 is the portion
of the catheter 1070 that is inserted into the patient. The leg
1302 is connected to an end piece 1305 through which the guide wire
1072 is inserted such that the guide wire 1072 typically extends
from outside the end piece 1305 through the legs 1302 and 1306. As
are the legs 1302 and 1306, the leg 1300 is hollow to allow the
transmission of a liquid or gas through the leg 1306 to the
surgical site. Hence, the leg 1300 would function in much the same
way as the feedline 1107 shown in FIG. 11. The leg 1300 is also
provided with a valve 1307 that controls the delivery rate of the
liquid or gas, and prevents the liquid or gas from escaping once
the liquid or gas source is disconnected from the leg 1300. Note
that a gasket is typically located in the coupler 1304 or the end
piece 1305 that forms a seal with the guide wire 1072 to prevent
the liquid or gas from escaping out the opening of the end piece
1305.
[0099] Referring now to FIGS. 12 and 12A, the drive or support
block described earlier is identified as drive mechanism 1308a
associated with the catheter 1070. As can be seen in FIG. 12A,
which is a view of the drive mechanism along the length of the leg
1306, the drive mechanism 1308 includes a gripping device 1310 in
which the catheter 1070 is secured, and a motor 1312. A belt 1314
is wrapped around pulleys 1315a and 1315b of the motor 1312 and
gripping device 1310, respectively. Hence, as the motor 1312
rotates, this rotary motion is transmitted to the gripping device
1310 through the belt 1314 as indicated by the double arrow 1316,
such that the catheter 1070 rotates accordingly as indicated by the
double arrow 1318 (FIG. 12).
[0100] As shown in FIG. 13, a similar type of drive mechanism 1308b
can be coupled to guide wire 1072 to provide it with a rotary
motion as indicated by the double arrow 1318b. In addition, the
drive mechanisms 1308a and 1308b shown in FIG. 13 also provide the
catheter 1070 and guide wire 1072 with linear motion as indicated
by the double arrows 1319a and 1319b (referred to generally as
direction 1319), respectively. In certain embodiments, as shown in
FIG. 14, the drive mechanisms 1308a and 1308b are supported on and
slide back and forth along respective rails 1350 and 1352.
[0101] To move the drive mechanisms 1308a and 1308b (referred to
generally as drive mechanism 1308) linearly in the direction 1319,
various configurations can be used as illustrated in FIGS. 15A,
15B, and 15C. Referring in particular to FIG. 15A, there is shown a
lead screw drive arrangement 1360 with a threaded connector 1362
attached to the drive mechanism 1308. A lead screw 1364 is threaded
through the connector 1362 and coupled to a stationary motor 1366.
Accordingly, rotary motion of the lead screw 1364 induced by the
motor 1366 in the direction 1368 results in a linear motion of the
connector 1362. Since the connector 1362 is attached to the drive
mechanism 1308, linear motion of the connector 1362 produces a
consequent linear motion of the drive mechanism 1308 in the
direction 1319.
[0102] Referring now to FIG. 15B, there is shown a rack and pinion
drive arrangement 1370 for moving the drive mechanism 1308 in a
linear manner. The rack and pinion drive 1370 includes a rack 1372
attached to the drive mechanism 1308, and a pinion 1374 coupled to
a stationary motor 1376. The teeth of the pinion 1374 engage with
those of the rack 1372 such that as the motor 1376 rotates the
pinion 1374 in the direction 1378, the rack 1372 and hence the
drive mechanism 1308 moves linearly back and forth in the direction
1379.
[0103] Turning now to FIG. 15C, there is illustrated yet another
configuration for moving the drive mechanism 1308 linearly. In
particular there is shown a belt/pulley drive 1380 that includes a
belt, chain or cable 1382 wrapped around a pulley 1386 and a motor
pulley 1384 coupled to a stationary motor. The belt, chain, or
cable 1382 is attached in turn to the drive mechanism 1308 with a
connector 1388. Hence, rotary motion of the motor pulley 1384
produced by the motor is transformed into a linear motion of the
connector 1388. Thus, as the motor rotates the motor pulley 1384,
the drive mechanism 1308 moves back and forth in the direction
1319.
[0104] Greater detail of the catheter 1070 and guide wire 1072
arrangement of FIG. 13 is illustrated in FIG. 16, and that of the
drive mechanism 1308 is shown in FIGS. 16A and 16B. In particular,
the catheter 1070 and guide wire 1072 are shown as a typical
"off-the-shelf" apparatus coupled to a base unit 1400. That is, the
base unit 1400 is meant to be easily coupled to and decoupled from
any number of medical instruments, such as the catheter 1070 and
guide wire 1072 combination. In other implementations, such as some
of those described earlier, the medical instrument and base unit is
considered as a single instrument not to be decoupled from each
other.
[0105] Referring now in particular to FIGS. 16A and 16B, in
addition to the features illustrated in FIG. 12A, the drive
mechanism 1308 includes a housing 1401 which encloses much of the
moving parts of the drive mechanism 1308. As described before,
rotary motion of the motor 1312 is transferred by the belt 1314 to
the guide wire 1072 or the leg 1306 of the catheter 1070 via the
pulley 1315b coupled to the gripping device 1310 (FIG. 12A). The
pulley 1315b itself is supported in the housing 1401 with a pair of
bearings 1402.
[0106] Turning now to the discussion of the connector 1310, to
facilitate coupling the catheter 1070 and the guide wire 1072 to
their respective drive mechanisms 1308, many types of connectors
can be used. In some implementations, a Toohy Borst type of fitting
may be optimal. Another type of connector 1310 is shown in FIG.
17A, in which the leg 1306 or guide wire 1072 would be placed in an
enlarged portion 1500 of a slot 1502. A clamping force 1504 would
then be provided to secure the leg 1306 or guide wire 1072 to the
drive mechanism. For example, as shown in FIG. 17B, the clamping
force could be provided with a thumb screw 1506 threaded into a
block 1508 in which the connector 1310 is mounted. In another type
of arrangement shown in FIG. 17C, a sliding ring 1510 is fitted
over the connector 1310 in the direction 1512. The clamping force
can also be provided by a vise like device that functions similar
to a collet/pin vise.
[0107] In another embodiment, as shown in FIG. 18A, the connector
1310 and the pulley 1315b are one and the same device. Here, the
leg 1306 or guide wire 1072 snaps into an enlarged portion 1520 of
a slot provided in an extended segment 1522 of the connector device
1310. Since, the enlarged portion 1520 is slightly smaller than the
diameter of the leg 1306 or the guide wire 1072, the legs 1524 of
the segment 1522 provide a sufficient clamping force to the leg
1307 or guide wire 1072. In this arrangement, the belt 1314 is
wrapped around the pulley 1315a of the motor 1312 and attaches to
the two curved segments 1526 of the connector 1310. Thus, rotary
motion of the pulley 1315a produces a rotary motion of the
connector 1310, and hence the leg 1306 or guide wire 1072,
indicated by the double arrow 1318.
[0108] Referring now to FIGS. 19, 19A and 19B, there is shown
another embodiment of the connector 1310. In this embodiment, the
connector 1310 includes an inner 1550 and an outer 1552 C-shaped
rings. To grasp the leg 1306 or guide wire 1072, the outer ring
1552 is slid over the inner ring 1550 in the direction 1554. The
guide wire 1072 or the leg 1306 of the catheter 1070 is placed in
the inner ring 1550, and the outer ring 1552 is then rotated or
twisted in the direction 1556 around the inner ring 1550, thereby
capturing the leg 1306 or guide wire 1072. Alternatively, the leg
1306 or guide wire 1072 can first be placed in the inner 1550 and
outer 1554 rings, and then the outer ring 1554 can be rotated about
the leg or catheter and subsequently slid over the inner ring
1550.
[0109] Yet another embodiment of the connector 1310 is shown in
FIGS. 20A and 20B. In this embodiment, the connector 1310 includes
a pin vise 1600 provided with slot 1602 cut along its length, and a
sleeve 1604 that is threaded onto the pin vise 1600. The pin vise
is operated by turning the sleeve 1604 so that as it threads onto
the vise 1600 in the direction 1606 which causes the slot 1602 to
narrow. Thus to secure the leg 1306 or guide wire 1072 to the drive
mechanism 1308, the leg or guide wire is first placed into the slot
1602 as shown in FIG. 20B. The operator then rotates the sleeve
1604 to thread it over the pin vise 1600, and hence to close the
slot 1602 about the leg or guide wire until the pin vise is
sufficiently tightened about the leg 1306 or guide wire 1072.
[0110] This invention can be implemented and combined with other
applications, systems, and apparatuses, for example, those
discussed in greater detail in Provisional Application No.
60/332,287, filed Nov. 21, 2001, the entire contents of which are
hereby incorporated herein by reference in their entirety, as well
as those discussed in greater detail in each of the following
documents, all of which are hereby incorporated herein by reference
in their entireties: application Ser. No. 09/783,637, filed Feb.
14, 2001 (now abandoned), which is a continuation of International
Application No. PCT/US00/12553, filed May 9, 2000, which claims the
benefit of Provisional Application No. 60/133,407, filed May 10,
1999; application Ser. No. 10/208,087, filed Jul. 29, 2002 (now
U.S. Pat. No. 6,739,715, issued May 25, 2004), which is a
continuation of application Ser. No. 09/827,503, filed Apr. 6, 2001
(now Pat. No. 6,432,112, issued Aug. 13, 2002), which is a
continuation of application Ser. No. 09/746,853, filed Dec. 21,2000
(now U.S. Pat. No. 6,692,485, issued Feb. 17, 2004), which is a
divisional of application Ser. No. 09/375,666, filed Aug. 17, 1999
(now U.S. Pat. No. 6,197,017, issued Mar. 6, 2001), which is a
continuation of application Ser. No. 09/028,550, filed Feb. 24,
1998 (now abandoned); International Application No. PCT/US01/11376,
filed Apr. 6, 2001, which claims priority to application Ser. No.
09/746,853, filed Dec. 21, 2000 (now U.S. Pat. No. 6,692,485,
issued Feb. 17, 2004), and application No. 09/827,503, filed Apr.
6, 2001 (now U.S. Pat. No. 6,432,112, issued Aug. 13, 2002);
application Ser. Nos. 10/014,143 (now abandoned), 10/012,845 (now
U.S. Pat. No. 7,169,141, issued Jan. 30, 2007), Ser. No. 10/008,964
(now abandoned), Ser. No. 10/013,046 (now abandoned), Ser. No.
10/011,450 (now abandoned), Ser. No. 10/008,457 (now U.S. Pat. No.
6,949,106, issued Sep. 27, 2005), and Ser. No. 10/008,871 (now U.S.
Pat. No. 6,843,793, issued Jan. 18, 2005), all filed Nov. 16, 2001,
and all of which claim the benefit of Provisional Application No.
60/279,087, filed Mar. 27, 2001; application Ser. No. 10/077,233,
filed Feb. 15, 2002 (now U.S. Pat. No. 7,297,142, issued Nov. 20,
2007), which claims the benefit of Provisional Application No.
60/269,203, filed Feb. 15, 2001; application Ser. No. 10/097,923,
filed Mar. 15, 2002 (now U.S. Pat. No. 6,860,878, issued Mar. 1,
2005), which claims the benefit of Provisional Application No.
60/276,151, filed Mar. 15.2001; application Ser. No. 10/034,871,
filed Dec. 21,2001 (now U.S. Pat. No. 6,810,281, issued Oct. 26,
2004), which claims the benefit of Provisional Application No.
60/257,816, filed Dec. 21,2000; application No. 09/827,643, filed
Apr. 6, 2001 (now U.S. Pat. No. 6,554,844, issued Apr. 29, 2003),
which claims the benefit of Provisional Application No. 60/257,869,
filed Dec. 21, 2000, and Provisional Application No. 60/195,264,
filed Apr. 7, 2000.
[0111] While this invention has been particularly shown and
described with references to preferred embodiments thereof, it will
be understood by those skilled in the art that various changes in
form and details may be made therein without departing from the
scope of the invention encompassed by the appended claims.
[0112] For example, although a detector for sensing relative
movement between adjacent catheters has been described, a detector
for sensing movement of any one or more of the catheters relative
to a base position that may or may not be a location on a
particular one of the catheters can be employed. Also described
herein is the use of cabling through the catheters for controlling
the movement of the catheters. In certain embodiments a
piezo-electric arrangement may be employed in which electrical
signal wires would extend through the catheter system for actuation
of a mechanical (piezoelectric) member to provide motion of the
distal end of the catheter.
* * * * *