U.S. patent application number 13/307352 was filed with the patent office on 2012-10-04 for surgical instrument.
This patent application is currently assigned to CAMBRIDGE ENDOSCOPIC DEVICES, INC.. Invention is credited to Jeffrey C. Cerier, Andres Chamorro, Richard C. Fortier, Woojin LEE.
Application Number | 20120253324 13/307352 |
Document ID | / |
Family ID | 38750495 |
Filed Date | 2012-10-04 |
United States Patent
Application |
20120253324 |
Kind Code |
A1 |
LEE; Woojin ; et
al. |
October 4, 2012 |
SURGICAL INSTRUMENT
Abstract
The surgical instrument includes a distal tool, a rigid or
flexible elongated shaft that supports the distal tool, and a
proximal handle or control member, where the tool and the handle
are coupled to the respective distal and proximal ends of the
elongated shaft via distal and proximal bendable motion members.
Actuation means extends between said distal and proximal member to
control bending. A manually rotatable member rotates the instrument
shaft and working member relative to the control handle. A locking
member is supported from the control handle and has locked and
unlocked states; in the unlocked state enabling control of the
distal work member from the proximal control handle via the
bendable members; and in the locked state, holding the bendable
members in a pre-selected relative fixed position.
Inventors: |
LEE; Woojin; (Hopkinton,
MA) ; Chamorro; Andres; (Waltham, MA) ;
Fortier; Richard C.; (Concord, MA) ; Cerier; Jeffrey
C.; (Franklin, MA) |
Assignee: |
CAMBRIDGE ENDOSCOPIC DEVICES,
INC.
Framingham
MA
|
Family ID: |
38750495 |
Appl. No.: |
13/307352 |
Filed: |
November 30, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11505003 |
Aug 16, 2006 |
8105350 |
|
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13307352 |
|
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60802885 |
May 23, 2006 |
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Current U.S.
Class: |
606/1 |
Current CPC
Class: |
A61B 2090/508 20160201;
A61B 2017/00323 20130101; A61B 2017/00314 20130101; A61B 1/0052
20130101; A61B 2017/2905 20130101; A61B 90/03 20160201; A61B
1/00071 20130101; A61B 2017/291 20130101; A61B 1/008 20130101; A61B
2017/2929 20130101; A61B 1/00078 20130101; A61B 17/29 20130101 |
Class at
Publication: |
606/1 |
International
Class: |
A61B 17/00 20060101
A61B017/00 |
Claims
1. A surgical instrument comprising: a proximal control handle; a
distal work member; a proximal turnable member controlled from said
proximal control handle; a distal turnable member controlled from
said proximal turnable member to provide controlled movement of
said distal work member from said proximal control handle; an
instrument shaft that intercouples said proximal and distal tamable
members; and a locking member supported from said proximal control
handle and having locked and unlocked states; said locking member
in both said locked and unlocked state enabling control of the
orientation of said distal work member from said proximal control
handle via said turnable members; said locking member, in said
locked state, holding said turnable members in a particular fixed
relative position.
2. The surgical instrument of claim 1 wherein at least one of said
turnable members comprises a bendable member.
3. The surgical instrument of claim 1 wherein both of said turnable
members are bendable members.
4. The surgical instrument of claim 1 wherein said locking member,
in the locked state, fixes the position of the proximal turnable
member.
5. The surgical instrument of claim 1 wherein said locking member,
in the locked state, fixes the position of the distal turnable
member.
6. The surgical instrument of claim 4 wherein said locking member,
in the locked state, also fixes the position of the distal turnable
member.
7. The surgical instrument of claim 1 wherein a single locking
member locks both the proximal and distal bendable members
8. The surgical instrument of claim 1 including first cable means
between said proximal and distal turnable members for providing
control therebetween and second cable means coupled from said
locking member to control at least one of said proximal and distal
turnable members.
9. The surgical instrument of claim 8 including a pair of locking
members for respectively controlling said proximal and distal
turnable members.
10. The surgical instrument of claim I including a rotation control
member adjacent said proximal control handle for controlling said
distal work member to rotate about a distal axis.
11. The surgical instrument of claim 10 wherein said instrument is
comprised of coaxial inner and outer instrument sections, said
outer instrument section including at least said rotation member
and work member, said outer instrument section being mounted for
rotation relative to said inner instrument section, said inner
instrument section including at least one of said turnable
members.
12. The surgical instrument of claim 11 wherein said instrument
shaft includes an outer sheath that forms part of the outer
instrument section and an inner sheath that forms part of the inner
instrument section, said outer sheath being mounted for rotation
relative to a non-rotatable inner sheath.
13. The surgical instrument of claim 10 including cable means
disposed between the proximal and distal turnable members.
14. The surgical instrument of claim 13 wherein said cable means
forms part of the outer instrument section and rotates
therewith.
15. The surgical instrument of claim 13 wherein said cable means
forms part of the inner instrument section and is
non-rotatable.
16. The surgical instrument of claim 1 including first cable means
between said proximal and distal turnable members for providing
control therebetween and a carriage for supporting the proximal
ends of the cable means, said locking member controlling said
carriage.
17. The surgical instrument of claim 16 wherein said cable means
comprises a plurality of cables that are all attached to said
carriage and that are pulled in unison under control of said
locking member.
18. The surgical instrument of claim 1 wherein each said turnable
member comprises a bendable member that includes a plurality of
nestable discs and an outer bellows.
19. The surgical instrument of claim 1 wherein said instrument
shaft is flexible for intraluminal use.
20. In a medical instrument having a proximal control handle and a
distal tool that are intercoupled by an elongated instrument shaft
that is meant to pass internally to an anatomic site, proximal and
distal bendable members that respectively intercouple said proximal
control handle and said distal tool with said instrument shaft, a
locking member that is manually operable by a user and is adapted
to lock the position of the bendable members in a desired position,
said locking member having locked and unlocked states, and a
rotation control member manually controllable to rotate said tool
about a distal tool axis, said rotation control member operable in
at least the locked state of said locking member to rotate said
tool about the distal tool axis.
21-45. (canceled)
Description
RELATED APPLICATION
[0001] The present application claims priority to U.S. Provisional
Application Ser. No. 60/802,885 filed on May 23, 2006. The content
of all of the aforementioned application is hereby incorporated by
reference herein in its entirety.
TECHNICAL FIELD
[0002] The present invention relates in general to surgical
instruments, and more particularly to manually-operated surgical
instruments that are intended for use in minimally invasive surgery
or other forms of surgical or medical procedures or techniques. The
instrument described herein is primarily for laparoscopic or
endoscopic procedures, however, it is to be understood that the
instrument of the present invention can be used for a wide variety
of other procedures, including intraluminal procedures.
BACKGROUND OF THE INVENTION
[0003] Endoscopic and laparoscopic instruments currently available
in the market are extremely difficult to learn to operate and use,
mainly due to a lack of dexterity in their use. For instance, when
using a typical laparoscopic instrument during surgery, the
orientation of the tool of the instrument is solely dictated by the
locations of the target and the incision. These instruments
generally function with a fulcrum effect using the patients own
incision area as the fulcrum. As a result, common tasks such as
suturing, knotting and fine dissection have become challenging to
master. Various laparoscopic instruments have been developed over
the years to overcome this deficiency, usually by providing an
extra articulation often controlled by a separately disposed
control member for added control. However, even so these
instruments still do not provide enough dexterity to allow the
surgeon to perform common tasks such as suturing, particularly at
any arbitrarily selected orientation. Also, existing instruments of
this type do not provide an effective way to hold the instrument in
a particular position.
[0004] Accordingly, an object of the present invention is to
provide an improved laparoscopic or endoscopic surgical instrument
that allows the surgeon to manipulate the tool end of the surgical
instrument with greater dexterity.
[0005] Another object of the present invention is to provide an
improved surgical instrument that has a wide variety of
applications, through incisions, through natural body orifices or
intraluminally.
[0006] A further object of the present invention is to provide an
improved medical instrument that is characterized by the ability to
lock the instrument in a particular position.
[0007] Another object of the present invention is to provide a
locking feature that is an important adjunct to the other controls
of the instrument enabling the surgeon to lock the instrument once
in the desired position. This makes it easier for the surgeon to
thereafter perform surgical procedures without having to, at the
same time, hold the instrument in a particular bent
configuration.
[0008] Still another object of the present invention is to provide
an improved surgical instrument that can be locked in a particular
position and yet is rotatable in the locked position about a distal
tool axis.
SUMMARY OF THE INVENTION
[0009] To accomplish the foregoing and other objects, features and
advantages of the present invention there is provided a medical
instrument that comprising a proximal control handle; a distal work
member; a proximal turnable member controlled from the proximal
control handle; a distal turnable member controlled from the
proximal turnable member to provide controlled movement of the
distal work member from the proximal control handle; an instrument
shaft that intercouples the proximal and distal turnable members;
and a locking member supported from the proximal control handle and
having locked and unlocked states. The locking member, in its
unlocked state enables control of the distal work member from the
proximal control handle via the turnable members. The locking
member, in its locked state, holds the turnable members in a
pre-selected relative fixed position.
[0010] In accordance with other aspects of the present invention at
least one of the turnable members may comprise a bendable member;
alternatively both of the turnable members may be bendable members;
the locking member, in the locked state, fixes the position of the
proximal turnable member; the locking member, in the locked state,
may also fix the position of the distal turnable member. First
cable means may be provided between the proximal and distal
turnable members for providing control therebetween and second
cable means may be coupled from the locking member to control at
least one of the proximal and distal turnable members. A pair of
locking members may be provided for respectively controlling the
proximal and distal turnable members. A rotation control member may
be disposed adjacent the proximal control handle for controlling
the distal work member to rotate about a distal axis.
[0011] In accordance with still other aspects of the present
invention the instrument is comprised of coaxial inner and outer
instrument sections with the outer instrument section including at
least the rotation member and work member, the outer instrument
section being mounted for rotation relative to the inner instrument
section, and the inner instrument section including at least one of
the bendable members. The instrument shaft may include an outer
sheath that forms part of the outer instrument section and an inner
sheath that forms part of the inner instrument section, the outer
sheath being mounted for rotation relative to a non-rotatable inner
sheath. Cable means may be disposed between the proximal and distal
turnable members. The cable means may form part of the outer
instrument section and rotates therewith, or may form part of the
inner instrument section and is non-rotatable. First cable means
may be provided between the proximal and distal turnable members
for providing control therebetween and a carriage for supporting
the proximal ends of the cable means, the locking member
controlling the carriage. The cable means may comprise a plurality
of cables that are all attached to the carriage and that are pulled
in unison under control of the locking member. Each turnable member
may comprise a bendable member that includes a plurality of
nestable discs and an outer bellows. The instrument shaft may be
flexible for intraluminal use.
[0012] In accordance with another embodiment of the present
invention there is provided a medical instrument having a proximal
control handle and a distal tool that are intercoupled by an
elongated instrument shaft that is meant to pass internally of an
anatomic body, proximal and distal bendable members that
respectively intercouple the proximal control handle and the distal
tool with the instrument shaft, and a locking member that is
manually operable by a user and is adapted to lock the position of
the bendable members in a desired position, the locking member
having locked and unlocked states, and a rotation control member
manually controllable to rotate the tool about a distal tool axis,
the rotation control member operable in at least the locked state
of the locking member to rotate the tool about the distal tool
axis.
[0013] In accordance with still other aspects of the present
invention there is provided a medical instrument including cable
means coupled from the locking member and for locking at least one
of the proximal and distal bendable members in a desired fixed
position; an outer sheath may extend between the rotation control
member and the distal tool, with the rotation control member being
controllable to rotate the tool about the distal tool axis via the
outer sheath; control cables may be disposed between the proximal
and distal bendable members and further including means for
supporting the proximal ends of the cables and constructed and
arranged to move the cables in response to the locking member;
wherein the support means for the cables may comprise a carriage
and the locking member may be constructed and arranged to move the
carriage to pull the cables in unison; wherein the instrument shaft
may be flexible for intraluminal use; wherein the rotation control
member is operable in both the locked and unlocked states of the
locking member to rotate the tool about the distal tool axis;
wherein the instrument is comprised of coaxial inner and outer
instrument sections, said outer instrument section including at
least said rotation control member and tool, said outer instrument
section being mounted for rotation relative to said inner
instrument section, said inner instrument section including at
least one of said bendable members; including control cables
between the proximal and distal bendable members; and wherein the
proximal ends of the control cables are supported at the handle or
alternatively at the rotation control member.
[0014] In accordance with another embodiment of the present
invention there is provided a surgical instrument comprising: an
elongated instrument shaft having proximal and distal ends; a tool
disposed at the distal end of the instrument shaft; and a control
handle disposed at the proximal end of the instrument shaft; the
tool being coupled to the distal end of the elongated instrument
shaft via a distal bendable member; the control handle coupled to
the proximal end of the elongated instrument shaft via a proximal
bendable member; actuation means extending between the distal and
proximal bendable members whereby any deflection of the control
handle with respect to the elongated instrument shaft causes a
corresponding bending of the distal motion member for control of
the tool; and locking means for controlling the actuation means to
hold the bendable members in a pre-selected position.
[0015] In accordance with still further aspects of the present
invention the actuation means may comprise cable means; the cable
means may comprise a plurality of separate cables and the locking
means may comprise a carriage for supporting a proximal end of each
cable; the locking means may further include a lever and a wedge
member that moves in response to the lever to, in turn, control the
carriage; including a rotation control member adjacent the control
handle for controlling the tool to rotate about a distal tool axis;
wherein the instrument is comprised of coaxial inner and outer
instrument sections, the outer instrument section including at
least the rotation member and tool, the outer instrument section
being mounted for rotation relative to the inner instrument
section, and the inner instrument section including at least one of
the bendable members; wherein the instrument shaft includes an
outer sheath that forms part of the outer instrument section and an
inner sheath that forms part of the inner instrument section, the
outer sheath being mounted for rotation relative to a non-rotatable
inner sheath; wherein each bendable member includes a plurality of
nestable discs and an outer bellows; and wherein the instrument
shaft may be flexible for intraluminal use.
BRIEF DESCRIPTION OF THE DRAWINGS
[0016] It should be understood that the drawings are provided for
the purpose of illustration only and are not intended to define the
limits of the disclosure. The foregoing and other objects and
advantages of the embodiments described herein will become apparent
with reference to the following detailed description when taken in
conjunction with the accompanying drawings in which:
[0017] FIG. 1 is a perspective view of a preferred embodiment of
the surgical instrument of the present invention;
[0018] FIGS. 2A, 2B and 2C are sequential side views of one
embodiment of the surgical instrument wherein the distal bendable
member bends in the same direction as the proximal bendable
member;
[0019] FIG. 3 is a schematic side view of the surgical instrument
depicted in FIGS. 1 and 2 illustrating the instrument extending
through an incision and adapt to be controlled by a surgeon to lock
the instrument and to roll the instrument tool about its
longitudinal or Z axis;
[0020] FIG. 4 is a side elevation view of the surgical instrument
of FIG. 1 with the lock member unlocked;
[0021] FIG. 5 is a longitudinal cross-sectional side view of the
instrument illustrated in FIGS. 1-4 in an unlocked and straight
position;
[0022] FIG. 6 is a somewhat enlarged fragmentary cross-sectional
view of the instrument of FIG. 5 with the instrument in a bent and
locked position;
[0023] FIG. 7 is an exploded perspective view of the instrument in
FIGS. 1-6 taken at the proximal bendable member;
[0024] FIGS. 7A and 7B are schematic diagrams of the instrument
shown in FIGS. 4-6 illustrating, respectively, inner and outer
instrument sections;
[0025] FIG. 8 is a cross-sectional view taken along line 8-8 of
FIG. 7;
[0026] FIG. 9 is a side elevation view of a second embodiment of
the instrument using a locking member that locks the distal motion
member;
[0027] FIG. 10 is a side elevation cross-sectional view of a third
embodiment of the instrument of the present invention in which
there is provided both proximal and distal locking members;
[0028] FIG. 11 is a fragmentary enlarged cross-sectional view at
the end effector and distal bendable member of the embodiment of
FIG. 10;
[0029] FIG. 12 is a fragmentary enlarged cross-sectional view of a
fourth embodiment of the instrument at the end effector and distal
bendable member;
[0030] FIG. 13 is a fragmentary cross-sectional view of the
embodiment of FIG. 12 with the instrument in a bent condition and
locked;
[0031] FIG. 14 is a cross-sectional view taken along line 14-14 of
FIG. 13;
[0032] FIG. 15 is a fragmentary cross-sectional view of the tension
adjustment member used in the embodiment of FIG. 13;
[0033] FIG. 16 is a fragmentary cross-sectional view of an
alternate locking member;
[0034] FIG. 17 is a side elevation cross-sectional view of a
further embodiment of the present invention in which all control
cables are used to lock the instrument; and
[0035] FIG. 18 is a cross-sectional view taken along line 18-18 of
FIG. 17.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
[0036] The instrument of the present invention may be used to
perform minimally invasive procedures. "Minimally invasive
procedure," refers herein to a surgical procedure in which a
surgeon operates through small cut or incision, the small incision
being used to access the operative site. In one embodiment, the
incision length ranges from 1 mm to 20 mm in diameter, preferably
from 5 mm to 10 mm in diameter. This procedure contrasts those
procedures requiring a large cut to access the operative site.
Thus, the flexible instrument is preferably used for insertion
through such small incisions and/or through a natural body lumen or
cavity, so as to locate the instrument at an internal target site
for a particular surgical or medical procedure. The introduction of
the surgical instrument into the anatomy may also be by
percutaneous or surgical access to a lumen or vessel, or by
introduction through a natural orifice in the anatomy.
[0037] In addition to use in a laparoscopic procedure, the
instrument of the present invention may be used in a variety of
other medical or surgical procedures including, but not limited to,
colonoscopic, upper GI, arthroscopic, sinus, thorasic, transvaginal
and cardiac procedures. Depending upon the particular procedure,
the instrument shaft may be rigid, semi-rigid or flexible.
[0038] Although reference is made herein to a "surgical
instrument," it is contemplated that the principles of this
invention also apply to other medical instruments, not necessarily
for surgery, and including, but not limited to, such other
implements as catheters, as well as diagnostic and therapeutic
instruments and implements.
[0039] FIG. 1 is a perspective view of a preferred embodiment of
the surgical instrument 10 of the present invention. In this
surgical instrument both the tool and handle motion members or
bendable members are capable of bending in any direction. They are
interconnected via cables in such a way that a bending action at
the proximal member provides a related bending at the distal
member. The proximal bending is controlled by a motion or
deflection of the control handle by a user of the instrument. In
other words the surgeon grasps the handle and once the instrument
is in position, such as shown in FIG. 3, any motion at the handle
(deflection) immediately controls the proximal bendable member
which, in turn, via cabling controls a corresponding bending or
deflection at the distal bendable member.
[0040] As will be described in further detail hereinafter, the
proximal member is preferably larger than the distal member so as
to provide enhanced ergonomic control. FIGS. 2a-2c show a bending
action in which the distal bendable member bends in the same
direction as the proximal bendable member. In an alternate
embodiment the bendable, turnable or flexible members may be
arranged to bend in opposite directions by rotating the actuation
cables through 180 degrees, or could be controlled to bend in
virtually any other direction depending upon the relationship
between the distal and proximal support points for the cables.
[0041] It should be noted that the amount of bending motion
produced at the distal bending member is determined by the
dimension of the proximal bendable member in comparison to that of
the distal bendable member. In the disclosed embodiment the
proximal bendable member is at least two times the diameter of the
distal bendable member, and as a result, the magnitude of the
motion produced at the distal bendable member is greater than the
magnitude of the motion at the proximal bendable member. Although
FIGS. 2 and 3 show only the side view where only pitch motion is
illustrated, it should be noted that the proximal bendable member
can be bent in any direction (about 360 degrees) controlling the
distal bendable member to bend in either the same or an opposite
direction, but in the same plane at the same time. Also, as
depicted in FIG. 3, the surgeon is able to bend and roll the
instrument's tool about its longitudinal axis at any orientation
simply by rolling the axial rotation knob 24.
[0042] In this description reference is made to bendable members.
These members may also be referred to as turnable members or
flexible members. In the descriptions set out herein, terms such as
"bendable section," "bendable segment," "bendable motion member,"
or "turnable member" refer to an element of the instrument that is
controllably bendable in comparison to an element that is pivoted
at a joint. The bendable elements of the present invention enable
the fabrication of an instrument that can bend in any direction
without any singularity and that is further characterized by a
ready capability to bend in any direction. A definition of these
bendable motion members is [0043] an instrument element, formed
either as a controlling means or a controlled means, and that is
capable of being constrained by tension or compression forces to
deviate from a straight line to a curved configuration without any
sharp breaks or angularity.
[0044] Referring to FIG. 1, the surgical instrument 10 is comprised
of a handle 12 at the proximal end of the instrument, an elongated
instrument shaft 14 and a tool or end effector 16 disposed at the
distal end of the surgical instrument. The tool may take on a
number of different configurations including, but not limited to,
articulating and non-articulating tools. In the disclosed
embodiment the instrument shaft 14 is rigid, usually of a metal
material, although it may also be constructed so as to be at least
partially inherently flexible or bendable. For normal laproscopic
procedures the instrument shaft 14 is usually rigid. For an example
of a flexible instrument shaft used intraluminally refer herein to
FIGS. 14 and 15 of related U.S. application Ser. No. 10/822,081,
filed on Apr. 12, 2004 which is hereby incorporated by reference
herein in its entirety. Also incorporated by reference in their
entirety is Ser. No. 11/185,911 filed on Jul. 20, 2005; Ser. No.
11/242,642 filed on Oct. 3, 2005 and Ser. No. 11/302,654 filed on
Dec. 14, 2005.
[0045] In FIG. 1 the handle 12 is illustrated as comprised of two
handle halves 12a and 12b. A lever 22 is manipulatable by the
surgeon as the handle is grasped for opening and closing the end
effector 16 at the distal end of the instrument shaft 14. In FIG. 1
the end effector is illustrated as comprised of a movable jaw 44
and a fixed jaw 46. The rotation knob 24 at the proximal end of the
instrument is used to rotate the instrument shaft and end effector.
This rotation is illustrated in FIG. 1 by the circular arrow R.
Also note in FIG. 1 the illustration of a coordinate system
expressed by the X-Y-Z axes. The roll of the instrument indicated
by the arrow R is about the Z axis. The Z axis corresponds to the
longitudinal axis of the shaft 14 of the instrument 10.
[0046] FIG. 1 also illustrates an adaptor cover 26 for partially
retaining a portion of the proximal bendable member 18. At the
distal end of the instrument shaft 14, there is provided the distal
motion or bendable member 20. In FIG. 1 this is illustrated at
least partially covered by the sheath-like cover 98. The cover 98
may be a thin plastic or rubber flexible tube that readily deflects
as the distal bendable member is actuated from the proximal
bendable member via the handle. For instruments such as a needle
holder or a suture assist device, the compliant cover 98 is
beneficial in preventing the suture from catching while tying a
knot. However, for other applications one may choose not to use the
cover 98 so as to simplify the instrument and its fabrication.
Other components, such as the knob 24, adaptor cover 26 and
bendable members are preferably formed of a plastic material.
[0047] The instrument of the present invention is preferably
constructed to be disposable or alternatively resposable.
Accordingly, to make the instrument as inexpensively as possible
most of the components are made of a plastic material.
[0048] FIGS. 2A-2C depict one embodiment for the surgical
instrument in which the handle and end effector are controlled to
turn or bend in the same direction. If the handle is turned
upwardly then the tool turns upwardly and vice-versa. FIG. 2A shows
the handle in a straight position and the corresponding tool in a
likewise straight position. FIG. 2B illustrates the handle end of
the instrument having been moved upwardly in the direction of arrow
A. This causes a corresponding movement downwardly of the end
effector 16 in the direction of arrow B. Similarly, FIG. 2C
illustrates the handle 12 being moved downwardly in the direction
of arrow C causing a corresponding movement upwardly of the end
effector 16 in the direction of arrow D. The bending forces
depicted in FIGS. 2B and 2C are imposed upon the proximal bendable
member 18 from the handle 12 and when the proximal bendable member
is bent or turned, this causes a corresponding bending or turning
of the distal bendable member so as to control the position of and
orient the end effector. The bending forces are imposed at the
handle of the instrument by the surgeon moving the handle in the
desire direction and are conveyed to the proximal bendable member,
and, in turn, to the distal bendable member. Also, although FIGS.
2A-2C only depict "up" and "down" movement essentially in the plane
of the paper, it is understood that the handle can be actuated in
any direction (about 360 degrees) including planes in and out of
the paper.
[0049] FIG. 3 depicts the surgical instrument 10 in position, as
may occur during a surgical procedure. For example, the instrument
may be used for laproscopic surgery through the abdominal wall 4.
For this purpose there is provided an insertion site 6 at which
there is disposed a cannula or trocar 8. The shaft of the
instrument 14 is adapted to pass through the cannula 8 so as to
dispose the distal end of the instrument at an operative site. The
end effector 16 is depicted in FIG. 4 at such an operative site.
FIG. 3 also depicts the rolling motion that can be carried out with
the instrument of the present invention. This can occur by virtue
of the rotation of the rotation knob 24 relative to the handle 12
about axis T which is essentially the longitudinal center line of
the handle. This is illustrated in FIG. 3 by the circular arrow R1.
When the rotation knob 24 is rotated, in either direction, this
causes a corresponding rotation of the instrument shaft 14. This is
depicted in FIG. 3 by the rotational arrow R2. This same motion
also causes a rotation of the end effector 16 about axis P as
illustrated by the rotational arrow R3 in FIG. 3. In FIG. 3 the
handle 12, via proximal bendable member 18, is shown tilted along
axis T at an angle B1 to the instrument shaft longitudinal center
axis. This tilting, deflecting or bending may be considered as in
the plane of the paper. By means of the cabling this action causes
a corresponding bend at the distal bendable member 20 to a position
wherein the tip is directed along axis P and at an angle B2 to the
instrument shaft longitudinal center axis. The proximal bendable
member is controlled by virtue of its connection with the handle,
so that movement of the handle causes control of the proximal
bendable member and, in turn, the distal bendable member.
[0050] The combination of manipulation via the bendable members and
rotation via the knob 24 provide a very precise and ergonomically
comfortable degree of control for the surgeon. The instrument is
adapted to be held in a number of different ways in use. In one
technique, the instrument handle may be grasped so that the middle,
ring and small fingers are about the surface 12c while the thumb
engages the lever 22 and release button 96. The index finger may
extend to engage the rotation knob 24. In this way all
manipulations can be easily coordinated by the surgeon with one
hand. The instrument may also be grasped in the following manner.
The thumb may rest on the surface 12c while the fingers grasp the
lever 22. The index finger may manipulate the knob 24. The thumb
may also assist in manipulating the knob 24.
[0051] In the drawings a set of jaws is depicted, however, other
tools or devices may be readily adapted for use with the instrument
of the present invention. These include, but are not limited to,
cameras, detectors, optics, scope, fluid delivery devices,
syringes, etc. The tool may include a variety of articulated tools
such as: jaws, scissors, graspers, needle holders, micro
dissectors, staple appliers, tackers, suction irrigation tools and
clip appliers. In addition, the tool may include a non-articulated
tool such as: a cutting blade, probe, irrigator, catheter or
suction orifice.
[0052] Reference is now made to FIGS. 4-8 for further details of
the instrument 10 depicted in FIG. 1. In this particular embodiment
the cabling within the instrument shaft is shown in a straight
configuration such as illustrated in FIG. 5, and is shown in a bent
condition in FIG. 6. The end effector or tool 16 is actuated by
means of a jaw actuation means which is comprised primarily of the
elongated lever 22 at the proximal end of the instrument. The lever
22 is supported from the housing at the lever pivot pin 23. Refer
to FIGS. 4-6. The closing of the lever 22 against the handle 12
acts upon the slider 28 which is used to capture the very proximal
end of the actuation cable 38. When the lever 22 is un-actuated
(separated from the handle housing) this corresponds to the end
effector jaws being in a fully open position. When the lever 22
closes this causes the slider 28 to move toward the right as
depicted in FIG. 5, and then the jaws 44 and 46 are moved toward a
closed position. In FIG. 5 the jaws are illustrated as closed so as
to grasp, for example, a needle 45.
[0053] The instrument shaft 14 includes an outer shaft tube 32 that
may be constructed of a light weight metal material or may be a
plastic material. The shaft 32 may also be constructed to be
inherently flexible, particularly for intraluminal use of the
instrument. The proximal end of the tube 32 is received by the
adaptor cover 26. The distal end of the tube 32 is secured to the
distal bendable member 20. Refer to FIG. 6 for some further details
of the distal bendable member 20. Within the outer shaft tube 32
there is provided a support tube 34 that is preferably constructed
of a plastic material. Tube 34 extends between the distal bendable
or flexible member 20 and the proximal bendable or flexible member
18. The jaw actuator cable 38 extends within this support tube 34.
The support tube 34 may support along its length a plurality of
spacers (not shown). Each of the spacers may be evenly spaced and
provided with diametric guide slots for the cables.
[0054] Refer also now to FIGS. 5 and 6 for further details of the
tool end of the instrument. The end effector 16 is comprised of a
pair of jaws 44 and 46. As indicated previously these jaws may be
used to grasp a needle 45 or other item. The upper jaw 44 fits
within a channel in the lower jaw 46. A pivot pin 48 is used
between the jaws to enable rotation therebetween. A translation pin
42 extends through slots of the jaws and engages with the jaw
actuator cable 38. When the lever 22 is in its rest position the
jaws are fully open. In that position the pin 42 is at a more
distal location maintaining the jaw in an open position. As the
cable 38 is pulled, then the pin 42 moves to the right in the
slots, causing the jaws 44 and 46 to pivot toward a closed position
as depicted in FIG. 5.
[0055] FIG. 5 also depicts a base wall 54 of the jaw 46. One end of
the distal bendable member 20 is supported at this end wall 54. The
member 20 may be secured to the wall 54 by an appropriate means.
Adjacent to the base wall 54 there is provided an end disc 110a of
the distal bendable member 20. Refer also to FIG. 11. The end disc
110a supports anchors for the flex control cables 100. FIG. 8
illustrates four such cables 100a, 100b, 100c and 100d.
[0056] The jaw actuator cable 38 terminates at its respective ends
at the end effector and the rotation barrel 66 (see FIG. 5). Within
each of the bendable sections or bendable members 18 and 20 there
is provided a plastic tube. This includes a distal tube 60 and a
proximal tube 62. Both of these tubes or sheaths may be constructed
of a plastic such as polyethyletherkeytone (PEEK). The material of
the tubes 60 and 62 is sufficiently rigid to retain the cable 38
and yet is flexible enough so that it can readily bend with the
bending of the bendable members 18 and 20. The tubes have a
sufficient strength to receive and guide the cable, yet are
flexible enough so that they will not kink or distort, and thus
keep the cable in a proper state for activation, and also defines a
fixed length for the cable. The tubes 60 and 62 are longitudinally
stiff, but laterally flexible.
[0057] The control of the end effector 16 is by means of the jaw
actuator cable 38. As mentioned previously the very proximal end of
the jaw actuator cable 38 is retained in the rotational barrel 66.
As illustrated, for example, in FIG. 5 the cable 38 is secured to
the rotational barrel 66. The rotational barrel 66 is supported
within the slider 28. The slider 28 is also provided with a slot 74
that extends from the pocket and accommodates the link 70. The link
70 is the main means for actuating the slider 28 and, in turn, the
actuator cable 38 from the lever 22.
[0058] The actuation link 70 is supported at one end from the lever
22 by means of the pivot pin 71. The opposite end of the link 70 is
supported at another pin, referred to herein as slider pin 72. The
pin 72 is retained for longitudinal movement in the slot 74 in the
slider 28. FIG. 5 shows the respective pins 71 and 72 at the
opposite ends of the link 70. FIG. 5 also illustrates the slider
pin 72 urged against the actuator spring 76. The spring 76 is
disposed within a compartment of the slider 28. The opposite end of
the actuator spring 76 is retained by means of a retaining pin 80
that is disposed in the bore that accommodates the spring 76. FIG.
5 also shows the return spring 82 which is disposed within a bore
in the handle for accommodating the spring 82. One end of the
spring 82 is urged against an interior wall of the handle and the
opposite end of the spring is urged against an end wall of the
slider 28. The spring 76 is a preferably stronger spring than the
spring 82 so that the spring 82 compresses first as the lever 22 is
activated. Additional motion of the lever then causes the spring 76
to compress as the item is grasped. This dual spring arrangement
prevents damage to the instrument cabling, particularly at the
distal end of the instrument due to excessive forces imposed by the
lever action.
[0059] The lever 22 actuates the end effector as it is pressed
toward the handle body. The lever 22 operates with a ratchet and
pawl arrangement with the lever capable of being depressed in
ratcheted increments. This ratchet and pawl arrangement includes
the ratchet 86 and pawl 88. To accommodate the ratchet 86, the
slider 28 is provided with an end dish out or cut out. The pawl 88
is retained by the handle members 12a and 12b. In this regard in
handle part 12a there may be a pocket for the pawl 88 and in the
handle part 12b there may be provided a leg for retaining the pawl.
The ratchet 88 pivots at the pivot pin 90 and is provided with a
series of ratchet teeth that can hold the ratchet in successive
positions corresponding to successive degrees of closure of the end
effector. A torsion spring 92 is disposed partially about the pivot
90 and urges the ratchet teeth into contact with the pawl 88.
[0060] The ratchet and pawl arrangement also includes an integral
release means that is usually engageable by the surgeon's thumb. As
depicted in FIG. 5, on one side of the pivot 90 there is the pawl
86 and on the other side of the pivot there is the arm 94. A
release button 96 is formed at the base of the arm 94. When a force
is directed against the button 96 in the direction of arrow M in
FIG. 5 then this releases the ratchet and pawl arrangement and
returns the lever 22 to its released position with the jaws fully
opened. The pressing of the button 96 rotates the ratchet 86 out of
engagement with the pawl 88.
[0061] Reference is now made to the cabling that extends between
the proximal and distal bendable members. This cabling is provided
so that any bending at the proximal bendable member is converted
into a corresponding bending at the distal bendable member. The
proximal bending causes the cabling on one side to tension and on
the opposite side to relax. The bendable members that are described
herein enable bending in all directions. In the preferred
embodiment described herein, the distal bendable member is
approximately 1/2 the diameter of the proximal bendable member as
illustrated in FIG. 35. However, as indicated before other diameter
relationships can be used depending upon the particular use of the
instrument and the medical procedure in which it is being used.
[0062] The control between the proximal bendable member 18 and the
distal flexible member 20 is carried out by means of the flex
control cables 100. There are four such cables in the illustrated
embodiment identified, for example, in FIG. 8 as cables 100a, 100b,
100c and 100d. At the distal end of these cables, as has been
described hereinbefore, the cables connect to the anchors at the
most distal disc 110. Cables 100 are retained at their proximal
ends by cable end lugs 102. Four springs 104 are retained between
these end lugs 102 and a wall of the hub 101. Refer to FIG. 5 for
an illustration of the end lugs 102 and the springs 104. The
springs 104 tension or take up the slack on the cables. Between the
bendable members, the cables 100 may be guided by means of the
slots in spacers (not shown) that may be disposed along the support
tube 34. Within the adaptor cover 26, the cables 100 extend through
the transition member 106. The cables then extend to a larger outer
diameter locus as they extend through the proximal bendable member
as depicted in FIGS. 5 and 6. The stepped transition member 106 may
be of metal and is disposed adjacent to the end of tube 34.
[0063] FIGS. 5 and 6 depict the distal end of the instrument and,
in particular, the distal flexible member 20. This is in the form
of an interlocking disc arrangement comprised of a series of discs
or disc elements 110 that are of semi-spherical configuration and
that are adapted to nest with each other and to inter-engage from
one to the next. See also FIG. 11. Each of these discs have holes
for receiving the actuating cables 100 that are positioned at 90
degree intervals corresponding to the desired position of the
cables. These discs also include opposite end discs 110a and 110b.
FIG. 6 shows the cables 100 passing through the end disc 110b. The
other end disc 100a supports the cable ends at anchors. A bearing
112 is disposed between the base wall 54 of the end effector 16 and
the end disc 110a. This bearing enables the end effector 16 to
readily rotate relative to the discs 110. A second bearing 114 is
also provided at the end disc 110b to enable rotation between the
end disc 110b and the outer tube 32. Thus, the inner tube 60,
cables 100 and discs 110 are non-rotational while the outer tube
32, along with the end effector are rotational from the rotation
knob 24. The distal bendable member 20 receives the aforementioned
PEEK tube 60 which extends through a center hole in each disc,
similar to that shown in FIG. 7 for the proximal bendable
member.
[0064] The distal motion member 20 also includes an outer bellows
116 that is attached at opposite ends to the outer tube 32 and the
base wall 54. A sleeve 117 may be used to attach the bellows 116 to
the tube 32. A similar sleeve 118 may be used to attach the
opposite end of the bellows 116 to the base wall 54. Refer also to
FIG. 11. Any rotation imparted to the outer instrument shaft 32 is
coupled via the bellows 116 to the end effector 16. Thus, there is
an inner instrument section that is maintained stationary during
instrument rotation and that includes the inner discs, cables and
inner sleeves. At the same time there is an outer instrument
section that is capable of rotation relative to the inner
instrument section and that includes the outer sleeve, bellows and
end effector.
[0065] The proximal motion member 18 is constructed in a similar
manner to the distal motion member and includes a series of discs
120 that are of semi-spherical configuration and that are adapted
to nest with each other and to inter-engage from one to the next.
Each of these discs have holes for receiving the actuating cables
100 that are positioned at 90 degree intervals corresponding to the
desired position of the cables. These discs also include opposite
end discs 120a and 120b. FIGS. 6 and 7 show the cables 100 passing
through the end disc 120a. The other end disc 120b engages the hub
101 which is secured within the handle 12. A bearing or bushing 122
is disposed between the hub 101 and the rotation knob 24. This
bearing 122 enables the rotation knob 24 to readily rotate relative
to the hub 101. A second bearing or bushing 124 is also provided at
the adaptor 26 to enable rotation between the transition member 106
and the adaptor 26. The inner tube 62, cables 100 and discs 120 are
non-rotational while the outer tube 32, along with the adaptor are
rotational from the rotation knob 24. Cables 100 are retained at
their proximal ends by cable end lugs 102. Four springs 104 are
retained between these end lugs 102 and a wall of the hub 101.
Refer to FIGS. 6 and 7 for an illustration of the end lugs 102 and
the springs 104. The springs 104 tension or take up the slack on
the cables. The distal bendable member 18 receives the
aforementioned PEEK tube 62 which extends through a center hole in
each disc.
[0066] The proximal motion member 18 also includes an outer bellows
126 that is attached at opposite ends to the adaptor 26 and the
rotation knob 24. A sleeve 127 may be used to attach the bellows
126 to the adaptor 26. A similar sleeve 128 may be used to attach
the opposite end of the bellows 126 to the rotation knob 24. Any
rotation imparted to the rotation knob 24 is coupled via the
bellows 126 to the adaptor and instrument shaft, and from there to
the distal end of the instrument to rotate the end effector. Thus,
there is a proximal inner instrument section that is maintained
stationary during instrument rotation and that includes the inner
discs, cables and inner sleeves. At the same time there is an outer
instrument section that is capable of rotation relative to the
inner instrument section and that includes the outer sleeve,
bellows and rotation knob.
[0067] The embodiment described in FIGS. 4-8 also includes a lock
feature that enables the position between the proximal and distal
motion members to be fixed in a desired position, such as the
position illustrated in FIG. 6 where the handle has been bent
downwardly causing a corresponding bending of the tool upwardly. In
FIG. 6 the top cable is in tension and the bottom cable in
relaxation. Once the surgeon has the instrument in the desired bent
position then a locking member is used to conveniently hold the
instrument in that position. The locking member is shown in FIGS. 5
and 6 as the lock lever 140 that is pivotally supported from the
handle by means of the pivot pin 142. See also the locking lever
140 in FIGS. 1-3. FIG. 5 shows the lock lever 140 in its released
position in which the bendable members are permitted to bend in the
normal operation of the instrument without being locked.
[0068] This locking feature is an important adjunct to the other
controls of the instrument enabling the surgeon to lock the
instrument once in the desired position. This makes it easier for
the surgeon to thereafter perform surgical procedures without
having to, at the same time, hold the instrument in a particular
bent configuration. The relatively rotatable inner and outer
instrument sections also enable the surgeon, in the locked state,
to use the rotation knob to control the end effector to rotate
about the distal end effector longitudinal axis. Also, having the
locking lever or similar locking mechanism directly at the handle
within reach of the user's hand provides an effective and
convenient way of controlling the instrument tool with one
hand.
[0069] Thus, the control at the handle is used to bend the
instrument at the proximal bendable member to, in turn, control the
positioning of the distal bendable member and tool. The "position"
of the tool is determined primarily by this bending action and may
be considered as the coordinate location at the distal end of the
distal bendable member. This positioning is in three dimensions.
The "orientation" of the tool, on the other hand, relates to the
rotational positioning of the tool about the illustrated distal tip
axis (see axis P in FIG. 3).
[0070] The present invention actually describes a number of
different embodiments of the locking member. In a first embodiment
the locking member 140, as illustrated in FIGS. 4-8, locks the
position of the instrument by locking the proximal bendable member.
Once the proximal bendable member is locked, then this maintains
the cable positions in a fixed position and thus also maintains a
locked position for the distal bendable member. In another
embodiment as described in FIG. 9 and described in further detail
hereinafter, the locking member locks the distal bendable member
rather than the proximal bendable member. However, in this
embodiment the locking of the distal bendable member also maintains
the proximal bendable member in a fixed position. In still another
embodiment of the invention such as illustrated in FIG. 10,
separate locking members are provided, one for locking the proximal
bendable member and the other for locking the distal bendable
member so that both bendable members are affirmatively and
separately locked.
[0071] In the embodiment of FIGS. 4-8, the locking lever 140 is
provided with a detent arrangement that enables it to be normally
maintained in an unlocked position such as the one illustrated in
FIG. 5. The detent arrangement that is referred to includes a
projection 144 on the locking lever 140 and a depression 145 in the
handle. The locking lever 140 is biased to the position illustrated
in FIG. 5 by means of a spring 146. A locking cable 150 extends
about a pulley 152 and is secured at one end with the spring 146.
The opposite end of the cable 150 terminates at 154 at a distal
surface of the end disc 120a. In a position illustrated in FIG. 5,
the cable 150 is relaxed and thus there is no force imposed upon
the end disc 120a to lock it with the other discs. Accordingly, in
the position of the locking lever 140 in FIG. 5, the proximal
bendable member is free to bend and deflect controlling the distal
bendable member.
[0072] The locking of the proximal bendable member is illustrated
in FIG. 6 wherein the locking lever 140 has now been moved in the
direction of arrow 141 to pivot the lever about pin 142 and engage
the protuberance 144 on the lever 140 with the depression 145 in
the handle. This action maintains the locking lever 140 in the
position illustrated in FIG. 6. This action pulls the cable 150
thus providing a clamping force at the end disc 120a. This clamping
force is illustrated by the arrow 155 in FIG. 6. This clamping
action forces the end disc 120a in the direction of arrow 155
against all of the other successive discs 120 that comprise the
proximal bendable member. This action firmly locks the bend at the
particular position of the proximal bendable member as occurs when
the locking lever is depressed. With the proximal bendable member
locked in a particular position, this also maintains the distal
bendable member in its corresponding position such as the bent
position illustrated in FIG. 6. Once the proximal bendable member
is locked that hold the distal bendable member in the corresponding
same position as the bend control cables are of the same length,
and once the proximal bendable member is frozen in a particular
position this retains the distal bendable member in its
corresponding fixed position.
[0073] Refer also to FIGS. 7A and 7B for a further explanation of
the operation of the instrument described in FIGS. 4-8. FIG. 7A
shows only the outer instrument section while FIG. 7B separately
shows the inner instrument section. The outer instrument section
may also be referred to as an outer sheath assembly while the inner
instrument section may also be referred to as an inner armature
assembly. The outer sheath assembly provides for end effector
rotation via the rotation knob 24 and also provides bending or
flexing in three dimensions or axes via the proximal and distal
bellows. The inner armature assembly provides the bending action
between the discs 110 and 120 via cabling from the handle 12. The
outer sheath assembly in FIG. 7A includes, from proximal to distal
end of the instrument, the rotation knob 24, bellows 126, outer
tube 32, bellows 116 and tool 16. The inner armature assembly in
FIG. 7B includes, from proximal to distal ends of the instrument,
handle 12, proximal bendable discs 120, inner tube 34 and distal
bendable discs 110. FIG. 7A also illustrates the position of the
proximal bearings 122, 124 and the distal bearings 112, 114. FIG.
7B illustrates the location of the corresponding bearing seats at
113 and 123.
[0074] FIG. 7A also depicts the rolling motion that can be carried
out with the instrument of the present invention. This can occur by
virtue of the rotation of the rotation knob 24 relative to the
handle 12 about axis T which is essentially the longitudinal center
line of the handle. This is illustrated in FIG. 7A by the circular
arrow R1. When the rotation knob 24 is rotated, in either
direction, this causes a corresponding rotation of the instrument
shaft which is depicted in FIG. 7A by the rotational arrow R2. This
same motion also causes a rotation of the end effector 16 about
axis P as illustrated by the rotational arrow R3 in FIG. 7A. In
FIG. 7B the handle 12, via the proximal bendable member, is shown
tilted along axis T at an angle B1 to the instrument shaft
longitudinal center axis causing a tilting at angle B2 at the
distal end of the instrument.
[0075] Reference is now made to FIG. 9 for an alternate embodiment
of the invention in which the locking member locks the distal
bendable member rather than the proximal bendable member. FIG. 9 is
a longitudinal side elevation view of a surgical instrument
employing such a locking member identified in FIG. 9 as locking
lever 240. In FIG. 9 the same reference characters are used to
identify parts of the instrument that are substantially the same as
the parts of the instrument illustrated in FIGS. 4-8. Thus, the
instrument of FIG. 9 comprises a handle 12, a lever 22, a rotation
knob 24, and a proximal bendable member 18 connected to a distal
bendable member 20 by way of the instrument shaft 14. An end
effector 16 is supported at the very distal end of the
instrument.
[0076] The primary difference between the embodiment illustrated in
FIG. 9 and the previous embodiment illustrated in FIGS. 4-8 is that
the locking member 240 actuates a cable 250 that is coupled to the
very distal end of the instrument for locking the distal bendable
member 20 rather than the proximal bendable member. The locking
lever 240 may be identical to that described in FIGS. 5 and 6 and
includes a detent and spring arrangement for enabling the opposite
position pivoting of the lever member 240. FIG. 9 also illustrates
the very distal end of the cable 250 at end 254. When the lever
member 240 is pivoted in the direction of arrow 242 this pulls the
cable 250 to the right in FIG. 9 and a pulling force is exerted at
the distal end of the instrument, as indicated by the arrow 255 in
FIG. 9. This causes the most distal disc member 110a to firmly
engage with the other successive disc members locking the distal
bendable member in a predetermined position. With the distal
bendable member locked in a particular position, this also
maintains the proximal bendable member in its corresponding
position such as a bent position like that illustrated in FIG. 6.
The distal bendable member is locked in the particular position
that it is disposed at when the locking lever is actuated.
[0077] Reference is now made to FIG. 10 for still a further
embodiment of the present invention in which a pair of locking
members is employed. These are identified in FIG. 10 as locking
levers 140 and 240. FIG. 10 is a longitudinal cross-sectional view
showing the instrument in a bent position where the proximal
bendable member has been deflected through the angle B1 causing a
like deflection of the distal end of the instrument at the end
effector through an angle B2.
[0078] In the embodiment of FIGS. 10 and 11, there are thus two
separate locking levers that can be operated each individually or
they can be operated in tandem. The locking lever 140 controls the
cable 150 which in turn controls the locking of the proximal
bendable member at point 154. The locking lever 240 controls the
cable 250 which extends to the distal end of the instrument and
controls the locking of the distal bendable member 20 at point 254.
In FIG. 10 the locking lever 240 is shown locked while the locking
lever 140 is shown unlocked.
[0079] In FIG. 10 the two locking levers are described as providing
separate control of the locking of the respective proximal and
distal members. As such, the individual locking levers only control
their respective bendable members. In an alternate embodiment the
locking levers 140, 240 may be formed as one single lever for
controlling both of the cables 150, 250 at the same time. Thus,
when the single locking lever is actuated that locks both the
proximal and distal bendable members.
[0080] FIG. 11 is a cross-sectional view at the distal end of the
instrument showing somewhat further details in an enlarged
cross-section. This illustrates the cable 250 that extends to the
end disc 110a and which may be pulled to urge the most distal end
disc 110a against the adjacent discs 110. This action at point 254,
in turn, causes each of the discs that comprise the distal bendable
member to inter-engage thus locking the distal bendable member in a
particular bent state. FIG. 11 also shows the control cables 100
and the tool actuation cable 38.
[0081] The control between the proximal bendable member 18 and the
distal flexible member 20 is carried out by means of the flex
control cables 100. There are four such cables in the illustrated
embodiment identified, for example, in FIG. 8 as cables 100a, 100b,
100c and 100d. At the distal end of these cables, as has been
described hereinbefore, the cables connect to the anchors at the
most distal disc 110. Cables 100 are retained at their proximal
ends by cable end lugs 102. Four springs 104 are retained between
these end lugs 102 and a wall of the hub 101. Refer to FIG. 5 for
an illustration of the end lugs 102 and the springs 104. The
springs 104 tension or take up the slack on the cables. Between the
bendable members, the cables 100 may be guided by means of the
slots in spacers (not shown) that may be disposed along the support
tube 34. Within the adaptor cover 26, the cables 100 extend through
the transition member 106. The cables then extend to a larger outer
diameter locus as they extend through the proximal bendable member
as depicted in FIGS. 5 and 6. The stepped transition member 106 may
be of metal and is disposed adjacent to the end of tube 34.
[0082] Reference is now made to a further embodiment of the present
invention illustrated in FIGS. 12-15. In the previous embodiments
described herein, the bend control cables 100 were non-rotatable
and formed part of the inner instrument section. In the embodiment
illustrated in FIGS. 12-15, the control cables 200 are positioned
through the bellows at both the proximal and distal ends of the
instrument and are adapted to rotate upon rotation of the rotation
knob 24, the instrument shaft 14 and the end effector 16. In the
embodiment of FIGS. 12-15 there may be provided two locking levers
140 and 240 for respectively controlling the cables 150 and 250.
The cable 150 controls the locking of the proximal bendable member
while the cable 250 controls the locking of the distal bendable
member.
[0083] FIG. 12 depicts the distal end of the instrument and, in
particular, the distal flexible member and end effector. This is in
the form of an interlocking disc arrangement comprised of a series
of discs or disc elements 210 that are of semi-spherical
configuration and that are adapted to inter-engage from one to the
next. The discs 210 in FIG. 12 are of somewhat different
construction than the discs shown before in FIG. 11. Each of these
discs have a tapered center passage for receiving the inner sleeve
260 and the actuation cable 38 which extends in the sleeve 260.
These distal discs 210 also include opposite end discs 210a and
210b. FIG. 12 shows the cables 200 passing through holes in the
outer bellows 216 rather than through the discs. This somewhat
simplifies the disc construction for this embodiment.
[0084] One end disc 210a is supported adjacent to the end wall 54
and the other end disc 210b is supported adjacent the collar 211. A
bearing or bushing 212 is disposed between the base wall 54 of the
end effector 16 and the end disc 210a. This bearing 212 enables the
end effector 16 to readily rotate relative to the discs 210. A
second bearing or bushing 214 is also provided at the end disc 210b
to enable rotation between the collar 211 and the outer tube 32.
Thus, the inner tube 260 and discs 210 are non-rotational while the
outer tube 32, along with the cables, bellows and end effector are
rotational from the rotation knob 24. The distal bendable member 20
receives the aforementioned PEEK tube 260 which extends through a
center hole in each disc.
[0085] The distal motion member 20 has the outer bellows 216
attached at opposite ends to the outer tube 32 and the base wall
54. A sleeve 217 may be used to attach the bellows 216 to the tube
32. A similar sleeve 218 may be used to attach the opposite end of
the bellows 216 to the base wall 54. Any rotation imparted to the
outer instrument shaft 32 is coupled via the bellows 216 to the end
effector 16. Thus, there is an inner instrument section that is
maintained stationary during instrument rotation and that includes
the inner discs and inner sleeves. At the same time there is an
outer instrument section that is capable of rotation relative to
the inner instrument section and that includes the outer sleeve,
bellows, cabling and end effector.
[0086] The proximal motion member is constructed in a similar
manner to the distal motion member and includes a series of discs
220 that are of semi-spherical configuration and that are adapted
to inter-engage from one to the next. Each of these discs has a
main tapered center hole for receiving the tool actuator cable 38
and tube 262. The tapers in both proximal and distal discs enable
the bending without interfering with the cabling and tubes that
extend therethrough. These discs also include opposite end discs
220a and 220b. FIG. 13 shows the cables 200 passing through the
bellows 226. The end disc 220b engages the hub 201 which is secured
within the handle 12. A bearing or bushing 222 is disposed between
the disc 220a and the adaptor 26. This bearing 222 enables the
adaptor 26 to readily rotate relative to the disc 220a. The inner
tube 262 and discs 220 are non-rotational while the outer tube 32,
along with the adaptor and bellows are rotational from the rotation
knob 24. Cables 200 are retained at their proximal ends by cable
end lugs 202. Four springs 204 are retained between these end lugs
202 and a wall of the hub 201. The springs 204 tension or take up
the slack on the cables. The distal bendable member receives the
aforementioned PEEK tube 262 which extends through a center hole in
each disc.
[0087] The proximal motion member has the outer bellows 226
attached at opposite ends to the adaptor 26 and the rotation knob
24. A sleeve 227 may be used to attach the bellows 226 to the
adaptor 26. A similar sleeve 228 may be used to attach the opposite
end of the bellows 226 to the rotation knob 24. Any rotation
imparted to the rotation knob 24 is coupled via the bellows 226 to
the adaptor and instrument shaft, and from there to the distal end
of the instrument to rotate the end effector. Thus, there is a
proximal inner instrument section that is maintained stationary
during instrument rotation and that includes the inner discs and
inner sleeve. At the same time there is an outer instrument section
that is capable of rotation relative to the inner instrument
section and that includes the outer sleeve, bellows, cables and
rotation knob.
[0088] In all the embodiments that use a bellows, such as the
bellows 126 in FIG. 6 or the bellows 226 in FIG. 13, it is noted
that the bellows itself functions as a torque transmission means
whether cabling passes therethrough or not. In other words the
bellows have a sufficient rigidity thereto so as to be able to
transmit the rotational motion from the rotation knob to the
instrument shaft. This may be referred to as the bellows providing
rotational torque to distal members such as the instrument shaft
and end effector. At the same time the bellows is constructed and
arranged to be sufficiently flexible so as to flex (compress or
expand) as the bending action is performed. Refer, for example, to
FIG. 6 where the bellows 126 is shown flexed to a more open
position on the top while flexed to a more closed position at the
bottom. Other foldable members may also be used as an alternative
to a bellows.
[0089] The embodiment described in FIGS. 12-15 also includes a lock
feature that enables the relative position between the proximal and
distal motion members to be fixed in a particular position, such as
the position illustrated in FIG. 13 where the handle has been bent
downwardly causing a corresponding bending of the tool upwardly.
Once the surgeon has the instrument in the desired bent position
then a locking member is used to hold the instrument in that
position. The locking member is shown in FIG. 13 as the locking
levers 140, 240 that are pivotally supported from the handle by
means of one or separate pivot pins. FIG. 13 shows the lock lever
in its engaged position in which the bendable members are locked in
a predetermined position. This locking feature is an important
adjunct to the other controls of the instrument enabling the
surgeon to lock the instrument once in the desired position. This
makes it easier for the surgeon to thereafter perform surgical
procedures without having to, at the same time, hold the instrument
in a particular bent configuration. Instrument rotation is capable
even in the locked state.
[0090] FIGS. 13-15 also illustrate the lock cables 150 and 250 that
are controlled respectively from the lock levers 140 and 240. The
cable 150 terminates at node or point 154 where the termination
ends at the disc 220a. Pulling on the cable 150 causes the discs
220 to be tightly engaged holding the bendable section in a
particular configuration such as shown in FIG. 13. Similarly, the
cable 250 terminates at node or point 254 at the distal end of the
instrument where the termination ends at the disc 210a. Pulling on
the cable 250 causes the discs 210 to be tightly engaged holding
the bendable section in a particular configuration such as shown in
FIG. 13. In the embodiment described in FIGS. 12-15 the locking
levers 140, 240 are adjustable by means of the turnbuckle
arrangement shown in an enlarged fragmentary view in FIG. 15. This
arrangement includes a rotation wheel 180 positioned on the lever
and having an internal threaded passage for receiving the threaded
end 182 of the lock control cable. The wheel 180 can be rotated to
adjust the level of tension imposed on the control cable. In both
the proximal and distal discs by pulling on the most distal disc
this causes pressure to be applied to all more proximal discs
keeping their bendable member in a particular curvature, such as
shown in FIG. 13.
[0091] In the embodiments of the present invention illustrated
previously in FIGS. 1-15, the locking member has been in the form
of a pivotal lever. However, various other types of locking members
may be employed. These locking members are preferably mounted on
the handle or close to the handle so that they are in easy reach of
the user of the instrument. The locking member is also preferably
manually controllable so as to be in either a released position or
an activated position. Reference is now made to FIG. 16 for an
alternate embodiment of a locking means in the form of a slide
switch 270 that is appropriately mounted in the handle 12. The
slide switch 270 retains the proximal end of the control cable 151.
The control cable 151 is illustrated in FIG. 16 as passing over a
pair of pulleys 152 and 153. Of course, the distal end of the
control cable 151 can couple to either the proximal or distal
bendable member. Also, in another alternate embodiment a pair of
such slide switches 270 may be provided for controlling respective
proximal end distal bendable members.
[0092] In FIG. 16 the slide button 270 is illustrated as supported
in the handle 12 in an opening 274. The locking mechanism is also
provided with a ratchet surface 272 for engagement with a like
ratchet surface on the slide switch 270 so as to provide selective
incremental positioning of the slide switch 270. In FIG. 16 the
slide switch 270 is shown in its released position and would be
moved to the right in the opening 274 to move toward its locked
position. A leaf spring 275 is supported in the slide switch 270.
The leaf spring 275 urges the teeth into engagement. Pushing down
on the switch 270 in the direction of arrow 276 releases the
engagement between the teeth so that the slide switch can be moved
to its release position.
[0093] In the previous embodiments described herein, a separate
cable or cables have been provided to provide the locking function
of the instrument. A proximal bendable member locking cable has
been employed and/or a distal bendable member locking cable. Thus,
the bending control cables 100, 200 in these embodiments have been
devoted to only the bending function. An alternate embodiment of
the invention is illustrated in FIGS. 17 and 18 in which the bend
control cables function, not only for the bending action, but also
for the locking function. This is carried out by virtue of pulling
all cables in unison to perform the locking function. At the same
time, during locking, the rotation function is operable through the
rotation knob 24.
[0094] In the embodiment of FIGS. 17 and 18 the same reference
characters are used to identify similar parts of the instrument as
found in the earlier embodiment described in FIGS. 4-8. In this
embodiment the instrument comprises a handle 12, a proximal
bendable member 18, an instrument shaft 14, a distal bendable
member 20 and an end effector 16. As in the embodiment illustrated
in FIG. 6, in FIG. 17 there is also provided a rotation knob 24
rotatable relative to the hub 101 mounted within the handle
housing. This instrument also has the aforementioned inner and
outer instrument sections that enable relative rotation
therebetween.
[0095] FIG. 17 also illustrates the four cables 100 that are used
to control the deflection of the bendable members. In the
embodiment of FIG. 6 these cables were secured within the hub 101.
In the embodiment of FIG. 17 the proximal end of these cables are
secured instead to a carriage 165 that can be moved between
released and locked positions. The locking occurs by means of
pulling on all four cables 100 at the same time so as to freeze or
fix the instrument in a particular bent position. By pulling
longitudinally on the cables there is a force imposed illustrated
by the arrows 170 in FIG. 17 that causes the discs of the distal
bendable member to lock, one to the next. This action also
correspondingly freezes the position of the proximal bendable
member.
[0096] In the embodiment of FIGS. 17 and 18 the locking member
comprises a pivotal locking lever that may have a detent
arrangement associated therewith similar to that disclosed in FIG.
6. The lever 160 is pivoted at pivot pin 171. A linkage 161 couples
from the lever 160 to a slider 163. The slider 163 has a wedge or
tapered shape as illustrated in the cross-sectional view of FIG. 17
and, at one side, bears against a proximal end 164 of the carriage
165. The carriage 165 is adapted to translate in a journal 169
provided in the handle housing. A wedge shaped boss 175 is provided
on the handle. The distal end of the carriage 165 is in the form of
a plate that supports the four cables 100. Each of the cables has
associated therewith an end lug 167 and a spring or resilient pad
168. The carriage is also provided with opposed pins 177 that
constrain the carriage movement by moving in associated handle
slots.
[0097] In the position illustrated in FIG. 17, the carriage 165 may
be considered as at its released or normal position. This permits
the bending action to occur between the proximal and distal
bendable members without any locking. When the locking lever 160 is
moved in the direction of arrow 173, then the slider 163 bears
against the end 164 and boss 175, thus causing the carriage 165 to
translate toward the right as viewed in FIG. 17. This action pulls
all of the cables 100 toward the right thus imposing the force at
the distal end of the instrument as illustrated by the arrows 170.
This compresses together both proximal and distal disc members in
the predetermined and pre-selected position that the user has
assumed.
[0098] Another aspect of the surgical instrument of the present
invention is the ability to adapt the instrument to a wide variety
of medical procedure. This includes, but is not limited to, access
to a body cavity such as through an incision or intraluminal use
such as through a natural body aperture to a body lumen. The
introduction of the surgical instrument into the anatomy may also
be by percutaneous or surgical access to a lumen, cavity or vessel,
or by introduction through a natural orifice in the anatomy.
[0099] There are several improvements brought forth by employing
bendable sections for the motion members particularly as opposed to
other mechanisms such as pivotal joints or ball-and-socket
joints.
[0100] A first important attribute of a bendable member is in its
inherent lateral (bending) stiffness, especially when used for the
proximal handle motion member. In a jointed arrangement the
proximal joint is situated between the elongated shaft and the
control handle, together with the fulcrum at the incision. This
behaves as a "double-joint" and the instrument may have a serious
tool stability issue if the joint is "free" to move. Suppose the
operating surgeon slightly moves his/her wrist while holding the
control handle of the instrument. If the joint is "free" to move
without providing substantial support resistance, due to the
fulcrum effect of the long elongated shaft passing through the
incision, it will result in substantial, unintended swinging of the
tool end of the instrument in opposite direction. In a typical
laparoscopic or endoscopic procedure where the operating field is
small, such instability of the tool will render the tool
potentially dangerous and unusable. Unlike the pivotal or
ball-and-socket joints that are "free" to move, a bendable member
has inherent stiffness which acts to provide necessary support for
stabilizing the operator hand's wrist movement, which in turn
stabilizes the tool motion. By varying the material and geometry of
the bendable member, the appropriate level of stability could be
selected.
[0101] A second important attribute of the bendable member,
especially for bending in two degrees of freedom, is its uniformity
in bending. Because the bendable member can bend in any direction
uniformly, it has no inherent singularity, and as the result, the
operator can produce uniform rolling motion of the tool, an
important motion for tasks such as suturing, simply by rolling the
control handle. On the other hand, if the motion members are
comprised of series of pivotal joints, not only may it bind due to
singularities, but the rolling of the control handle will result in
unwanted side motion of the tool as well, affecting its usability
for surgical procedure.
[0102] A third attribute of the bendable member is its ability to
transmit substantial torque axially. By selecting appropriate
material and geometry, the bendable member can be constructed to
transmit torque axially necessary to perform surgical procedure. On
the other hand, the motion member comprised of ball-and-socket
joints will not be able to transmit the necessary torque from the
handle to the tool end.
[0103] A fourth attribute of the bendable member is that it has no
sharp bending point, location or pivot and thus this results in an
increased life and higher performance. Either pivotal or
ball-and-socket joints on the other hand have sharp corners which
can increase friction, reduce life and decrease performance of the
tool actuation push rod passing through.
[0104] A fifth attribute of the bendable member is in the reduction
of manufacturing cost. The bendable motion member can be injection
molded as a single body, thus significantly reducing the cost.
Pivotal or ball-and-socket joints are comprised of more parts, and
this results in a higher manufacturing cost.
[0105] Lastly, a sixth attribute of the bendable member is that it
can be easily customized. By varying the stiffness at different
points of the bendable member, one can optimize its bending shape
for specific applications.
[0106] 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. For
example, the embodiments described herein have primarily used four
control cables for providing all direction motion of the motion
members. In alternate embodiments fewer or greater numbers of
cables may be provided. In a most simplified version only two
cables are used to provide single DOF action at the bendable motion
member. Also, the disclosed embodiment uses a handle that is
essentially in line with the instrument shaft. In an alternate
embodiment of the invention the handle can be off axis or at an
angle to the instrument shaft in the rest position of the
instrument. In the illustrated embodiments a rotation knob has been
used to perform the function of rotating the distal instrument tip.
In an alternate embodiment of the invention other means may be
provided to accomplish such tip rotation. For example, a slide
member may be used in place of a rotation knob, or any other
moveable member that controls the instrument shaft and instrument
tip for rotation of the end effector about a distal tool axis such
as shown in FIG. 3 (axis P).
* * * * *