U.S. patent application number 13/570317 was filed with the patent office on 2012-11-29 for surgical instrument.
This patent application is currently assigned to CAMBRIDGE ENDOSCOPIC DEVICES, INC.. Invention is credited to Andres Chamorro, Marvin A. Guiles, Eileen M. Heneberry, James C. Hollenbeck, Woojin Lee, Richard Ross.
Application Number | 20120303006 13/570317 |
Document ID | / |
Family ID | 40432715 |
Filed Date | 2012-11-29 |
United States Patent
Application |
20120303006 |
Kind Code |
A1 |
Lee; Woojin ; et
al. |
November 29, 2012 |
SURGICAL INSTRUMENT
Abstract
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 movable members that respectively intercouple the proximal
control handle and the distal tool with the instrument shaft, cable
control means disposed between the movable members, an actuation
member at the handle for controlling the distal tool through the
movable members, and a coupler for selectively engaging or
disengaging separable cable segments of the actuation member.
Inventors: |
Lee; Woojin; (Hopkinton,
MA) ; Chamorro; Andres; (Natick, MA) ; Ross;
Richard; (South Richford, VT) ; Guiles; Marvin
A.; (Stow, MA) ; Heneberry; Eileen M.;
(Westwood, MA) ; Hollenbeck; James C.; (Brighton,
MA) |
Assignee: |
CAMBRIDGE ENDOSCOPIC DEVICES,
INC.
Framingham
MA
|
Family ID: |
40432715 |
Appl. No.: |
13/570317 |
Filed: |
August 9, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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11900417 |
Sep 11, 2007 |
8257386 |
|
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13570317 |
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Current U.S.
Class: |
606/1 |
Current CPC
Class: |
A61B 50/30 20160201;
A61B 17/2909 20130101; A61B 2017/292 20130101; A61B 2017/2929
20130101; A61B 2017/0046 20130101 |
Class at
Publication: |
606/1 |
International
Class: |
A61B 17/00 20060101
A61B017/00 |
Claims
1-14. (canceled)
15. A method of controlling a medical instrument that has a
proximal end including a control handle and a distal end including
a distal tool, said control handle and distal tool being
intercoupled by an elongated instrument shaft and said tool
actuated from a tool control cable, said method including providing
proximal and distal movable members that respectively intercouple
said proximal control handle and said distal tool with said
instrument shaft, said proximal and distal movable members being
intercoupled so that a motion at said proximal movable member
controls said distal movable member, dividing the tool control
cable into separate cable segments and interlocking the separate
cable segments so that the tool control cable is operable.
16. The method of claim 15 including manually controlling, from the
proximal end of the instrument, the rotation of said distal tool
about its longitudinal distal tool axis.
17-22. (canceled)
Description
TECHNICAL FIELD
[0001] The present invention relates in general to medical
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 a laparoscopic
procedure, 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
[0002] 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
location 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. Moreover, existing instruments require the
use of both hands in order to effectively control the
instrument.
[0003] An improved instrument is shown in U.S. Pat. No. 7,147,650
having enhanced dexterity and including, inter alia, a rotation
feature with proximal and distal bendable members. Even though this
instrument has improved features there remains the need for a more
economically feasible instrument, and one in which the handle can
be re-used while the tip of the instrument is disposable or
reposable.
[0004] Accordingly, an object of the present invention is to
provide an improved laparoscopic or endoscopic instrument in which
a portion of the instrument is re-useable and a portion is
disposable. In embodiments described herein the handle end of the
instrument is re-useable and the distal portion or tip of the
instrument is disposable. By being able to re-use the handle
portion, the instrument is more economically feasible.
[0005] A further 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.
[0006] Another object of the present invention is to provide an
improved surgical or medical instrument that has a wide variety of
applications, through incisions, through natural body orifices or
intraluminally.
[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 medical instrument that can be effectively controlled
with a single hand of the user.
[0009] Still another object of the present invention is to provide
an improved medical instrument that is characterized by the ability
to lock the position of the instrument in a pre-selected position
while enabling rotation of the tip of the instrument while
locked.
SUMMARY OF THE INVENTION
[0010] To accomplish the foregoing and other advantages and
features of the present invention there is provided a surgical
instrument comprising: an instrument shaft having proximal and
distal ends; a tool disposed from the distal end of the instrument
shaft; a control handle coupled from the proximal end of the
instrument shaft; a distal motion member for coupling the distal
end of the instrument shaft to the distal tool; a proximal motion
member for coupling the proximal end of the instrument shaft to the
handle; actuation means extending between the distal and proximal
motion members for coupling motion of the proximal motion member to
the distal motion member for controlling the positioning of the
tool; and an actuation cable extending from the handle to the tool
for controlling the actuation of the tool. The actuation cable is
separated into two inter-engagable cable segments that enable the
proximal motion member to be disconnected from the control
handle.
[0011] In accordance with other aspects of the present invention
the surgical instrument may further include a rotation means
disposed adjacent the control handle and rotatable relative to the
control handle for causing a corresponding rotation of the
instrument shaft and tool; at least the proximal motion member may
comprise a proximal bendable member, the rotation means may
comprise a rotation knob that is adapted to rotate the tool about a
distal tool roll axis and the rotation knob may be disposed between
the control handle and proximal bendable member; an actuation lever
may be supported from the handle at a pivot point on the handle and
for controlling the actuation cable; a slider may be provided for
capturing the proximal end of said tool actuation cable and an
actuation lever supported at the handle for controlling the
translation of the slider and, in turn, the operation of the tool;
a locking mechanism may be provided for fixing the position of the
tool at a selected position and having locked and unlocked states,
the locking mechanism including a ball and socket arrangement
disposed about the proximal motion member and a cinch member for
locking the ball and socket arrangement; the socket member may
comprise a split socket and the cinch member closes the split
socket to lock the socket on the ball; a horn may be provided that
is pivotally supported from the handle and that is operable to
engage and disengage the cable segments; and a collet may be
supported in the handle for closing about the cable segments.
[0012] In accordance with another embodiment of the 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 movable members that respectively intercouple
the proximal control handle and the distal tool with the instrument
shaft, cable control means disposed between the movable members, an
actuation member at the handle for controlling the distal tool
through the movable members, and a coupler for selectively engaging
or disengaging separable cable segments of the actuation
member.
[0013] In related aspects of the present invention the coupler may
include a collet attached to one of the cable segments and a
capture lug on the other of the cable segments, the collet for
retaining the capture lug to engage the cable segments; a pivot
member may be provided on the handle including at least one link
that is operable to control a cam that sets open and closed
positions of the collet; the pivot member may be in the form of a
horn at the top of the handle to assist in a comfort grip of the
handle; and collet may include a quick disconnect mechanism having
a base in which the collet is positioned and a spring that biases
the base to a closed position of the collet.
[0014] In accordance with still another embodiment of the invention
there is provided a method of controlling a medical instrument that
has a proximal end including a control handle and a distal end
including a distal tool, with the control handle and distal tool
being intercoupled by an elongated instrument shaft and the tool
actuated from a tool control cable. The method includes providing
proximal and distal movable members that respectively intercouple
the proximal control handle and the distal tool with the instrument
shaft, the proximal and distal movable members being intercoupled
so that a motion at the proximal movable member controls the distal
movable member, dividing the tool control cable into separate cable
segments and interlocking the separate cable segments so that the
tool control cable is operable. A further step may include manually
controlling, from the proximal end of the instrument, the rotation
of the distal tool about its longitudinal distal tool axis.
[0015] In accordance with another embodiment of the invention there
is provided an instrument having a proximal control handle and a
distal tool that are intercoupled by an elongated instrument shaft,
proximal and distal movable members that respectively intercouple
the proximal control handle and the distal tool with the instrument
shaft, means disposed between the movable members so that a motion
at the proximal movable member controls the distal movable member
and, in turn, the distal tool, means supported at the handle for
controlling the distal tool including a tool control cable that
extends between the handle and distal tool, the tool control cable
including separate control cable segments that are adapted to have
one of an engaged state and a dis-engaged state.
[0016] In accordance with still other aspects of the present
invention there is provided a control member at the control handle
and manipulable by a user to control, via the proximal and distal
movable members, the rotation of the distal tool about its distal
tool axis; the proximal motion member can be disconnected from the
control handle when the control cable segments are in their
dis-engaged state; including a coupler for selectively engaging or
disengaging the separable cable segments; wherein the coupler may
include a collet attached to one of the cable segments and a
capture lug on the other of the cable segments, the collet for
retaining the capture lug to engage the cable segments; and wherein
the collet may include a quick disconnect mechanism having a base
in which the collet is positioned and a spring that biases the base
to a closed position of the collet.
DESCRIPTION OF THE DRAWINGS
[0017] Numerous other advantages can be realized in accordance with
the present invention by referring to the accompanying drawings, in
which:
[0018] FIG. 1 is a perspective view of a first embodiment of a
surgical instrument constructed in accordance with the present
invention with a disposable shaft portion and a reusable handle
portion;
[0019] FIG. 2 is a fragmentary exploded perspective view of the
instrument and shaft of FIG. 1;
[0020] FIG. 3 is a partial cross-sectional side view of the
instrument as taken along line 3-3 of FIG. 1 and with the
instrument in an engaged or locked position;
[0021] FIG. 4 is a cross-sectional end view of the instrument taken
along line 4-4 of FIG. 3 showing a locked and a first released
position of the cinch ring;
[0022] FIGS. 4A and 4B are further perspective views of respective
positions of the release/lock lever;
[0023] FIG. 5 is a cross-sectional view like that shown in FIG. 3
but with the instrument shaft portion being released from the
handle portion and with the handle moved upwardly;
[0024] FIG. 6 is a cross-sectional view like that shown in FIG. 5
but with the instrument shaft portion being removed from the handle
portion;
[0025] FIG. 7 is a fragmentary cross-sectional end view of the
instrument taken along line 7-7 of FIG. 6 showing a rotated and a
second released position of the cinch ring and the shaft ball being
removed;
[0026] FIG. 8 is a cross-sectional view similar to that shown in
FIG. 6 but with the instrument shaft portion being fully removed
from the handle portion;
[0027] FIG. 9 is a fragmentary exploded perspective detail view of
the instrument on a somewhat enlarged scale;
[0028] FIG. 10 is an exploded perspective view of one embodiment of
a coupling means for the end effector actuation cable;
[0029] FIG. 11 is a cross-sectional end view of an actuation means
for operating the coupling means of FIG. 10 taken along line 11-11
of FIG. 8;
[0030] FIG. 12 is a cross-sectional end view of a means to lock the
instrument shaft portion to the handle portion taken along line
12-12 of FIG. 8;
[0031] FIG. 13 is a cross-sectional plan view of the instrument
shaft locking means and the cable coupling means engaged as taken
along line 13-13 of FIG. 3 but showing the end effector cable being
pulled as in use;
[0032] FIG. 14 is a cross-sectional plan view of the instrument
shaft locking means and the cable coupling means in a released
position as seen along line 14-14 of FIG. 8;
[0033] FIG. 15 is a fragmentary exploded perspective view of a
second embodiment of a means to attach the instrument shaft to the
handle portion;
[0034] FIG. 16 is an exploded cross-sectional side view of the
attachment means of FIG. 15;
[0035] FIG. 17 is a cross-sectional side view of the embodiment
illustrated in FIGS. 15 and 16 and showing the instrument shaft
attached to the handle portion;
[0036] FIG. 18 is a fragmentary exploded perspective view of a
third embodiment of a means for attaching the instrument shaft to
the handle portion;
[0037] FIG. 19 is an exploded cross-sectional side view of the
attachment means of FIG. 18;
[0038] FIG. 20 is a cross-sectional side view of the embodiment
illustrated in FIGS. 18 and 19 and showing the instrument shaft
attached to the handle portion;
[0039] FIG. 21 is a fragmentary cross-sectional view of a means to
detach the cinch ring as taken along line 21-21 of FIG. 18;
[0040] FIG. 22 is a cross-sectional view similar to that
illustrated in FIG. 21 and showing the cinch ring partially
detached;
[0041] FIG. 23 is a fragmentary exploded perspective view of a
fourth embodiment of a means to attach the instrument shaft to the
handle portion;
[0042] FIG. 24 is a fragmentary exploded side view of an indexing
means to match the proper instrument shaft and end effector with
the correct handle configuration;
[0043] FIG. 25 is an end view of the proximal end of the instrument
shaft as taken along line 25-25 of FIG. 24;
[0044] FIG. 26 is an end view of the distal end of the rotation
knob and shaft receiver as taken along line 26-26;
[0045] FIG. 27 is a schematic end view of a first alternate
embodiment of an indexing means;
[0046] FIG. 28 is a schematic end view of a second alternate
embodiment of an indexing means;
[0047] FIG. 29 is a fragmentary cross-sectional side view of an
alternate embodiment of a cable coupling means;
[0048] FIG. 30 is a cross-sectional view similar to that
illustrated in FIG. 29 but showing the end effector cable being
pulled as in use;
[0049] FIG. 31 is an exploded perspective view of the cable
coupling means of FIG. 29;
[0050] FIG. 32 is a cross-sectional view similar to that
illustrated in FIG. 19 but showing the cable coupling means being
released;
[0051] FIG. 33 is an exploded cross-sectional view of the
embodiment of FIG. 32 and showing the instrument shaft portion
removed from the handle portion;
[0052] FIG. 34 is a cross-sectional side view of a further
alternate embodiment of a cable coupling means;
[0053] FIG. 35 is a cross-sectional view similar to that
illustrated in FIG. 34 but showing the end effector cable being
pulled as in use;
[0054] FIG. 36 is an exploded perspective view of the cable
coupling means of FIG. 34;
[0055] FIG. 37 is a cross-sectional view similar to that
illustrated in FIG. 34 but showing the cable coupling means being
released; and
[0056] FIG. 38 is an exploded perspective view of the embodiment of
FIG. 37 and showing the instrument shaft portion removed from the
handle portion.
DETAILED DESCRIPTION
[0057] The present invention is illustrated in the drawings as a
surgical instrument that has two portions such that a detachable
instrument shaft portion may be disposable and a re-usable handle
portion may be sterilized and reused numerous times. This allows
for a higher quality instrument handle portion while keeping the
overall price of the instrument reasonable.
[0058] 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 a 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, vessel or cavity,
or by introduction through a natural orifice in the anatomy.
[0059] 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, prostate,
transvaginal, orthopedic and cardiac procedures. Depending upon the
particular procedure, the instrument shaft may be rigid, semi-rigid
or flexible.
[0060] 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.
[0061] There are a number of unique features embodied in the
instrument that is described herein. For example, there is provided
a locking mechanism that is constructed using a ball and socket
arrangement disposed about the proximal motion member that follows
the bending action and in which an annular cinch ring is used to
retain the ball and socket arrangement in a fixed particular
position, and thus also maintain the proximal and distal bendable
members in a particular bent condition, or in other words locked in
that position. The cinch ring includes a locking lever that is
conveniently located adjacent to the instrument handle and that is
easily manipulated to lock and unlock the cinch ring and, in turn,
the position of the end effector. The cinch ring is also preferably
rotatable to that the locking lever can be positioned conveniently
or can be switched (rotated) between left and right handed users.
This lock control allows the surgeon one less degree of freedom to
concentrate on when performing certain tasks. By locking the
bendable sections at a particular position, this enables the
surgeon to be more hands-free for controlling other degrees of
freedom of the instrument such as manipulation of the rotation knob
to, in turn, control the orientation of the end effector.
[0062] A main feature of the present invention relates to the
ability of the instrument to be partially disposable and partially
re-useable. In that way the instrument cost can be substantially
reduced as it is not necessary to replace the entire instrument for
each procedure. In one embodiment a disconnect means is provided at
the handle where the distal motion member, tool, instrument shaft
and proximal motion member are separable from the handle of the
instrument. This enables the distal components to be engageable and
dis-engageable from the handle. The handle portion of the
instrument is re-useable and thus the cost of that part of the
instrument is essentially spread over several instrument uses.
[0063] FIG. 1 is a perspective view of one 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 (preferably four 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 any motion (deflection) at the handle
immediately controls the proximal bendable member which, in turn,
via cabling controls a corresponding bending or deflection at the
distal bendable member. This action, in turn, controls the
positioning of the distal tool.
[0064] The proximal bendable member is preferably generally larger
than the distal bendable member so as to provide enhanced ergonomic
control. In the illustrated embodiment the ratio of proximal to
distal bendable member diameters may be on the order of three to
one. In one version in accordance with the invention there may be
provided 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.
[0065] As has been noted, 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 embodiment described the proximal bendable
member is generally larger than 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. 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. 1, the surgeon is able to bend and roll the
instrument's tool about its longitudinal axis to any orientation
simply by rolling the axial rotation knob 24 about a rotation
direction indicated in FIG. 1 by the rotation arrow R1.
[0066] In this description reference is made to bendable members.
These members may also be referred to as turnable members, bendable
sections or flexible members. In the descriptions set out herein,
terms such as "bendable section," "bendable segment," "bendable
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 term "movable member" is considered as
generic to bendable sections and joints. 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, all preferably with a single unitary or uni-body
structure. A definition of a "unitary" or "uni-body" structure
is--a structure that is constructed only of a single integral
member and not one that is formed of multiple assembled or mated
components--.
[0067] A definition of these bendable members is--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--. Bendable
members may be in the form of unitary structures, such as of the
type shown herein in FIG. 3 for the proximal bendable member, may
be constructed of engageable discs, or the like, may include
bellows arrangements or may comprise a movable ring assembly. For
several forms of bendable members refer to co-pending application
Ser. No. 11/185,911 filed on Jul. 20, 2005; Ser. No. 11/505,003
filed on Aug. 16, 2006 and 11/523,103 filed on Sep. 19, 2006, all
of which are hereby incorporated by reference herein in their
entirety.
[0068] FIG. 1 shows a preferred embodiment of the instrument of the
present invention. Further details are illustrated in FIGS. 2
through 14. FIG. 1 depicts the surgical instrument 10 in a
perspective view, as may occur during a surgical procedure. For
example, the instrument may be used for laparoscopic surgery
through the abdominal wall. For this purpose there is provided an
insertion site at which there is disposed a cannula or trocar. The
shaft 14 of the instrument 10 is adapted to pass through the
cannula or trocar so as to dispose the distal end of the instrument
at the operative site. The end effector 16 is depicted in FIG. 1.
The embodiment of the instrument shown in FIG. 1 is typically used
with a sheath 98 covering the distal member 20 to keep bodily
fluids from entering the distal bending member 20. The shaft 14
includes an outer shaft tube 32 and an inner shaft tube 34 as in
previous applications incorporated herein.
[0069] FIG. 2 shows a separate sheath 46 that is temporarily used
to cover the entire distal bendable member and end effector. This
sheath 46 is only used for shipping the instrument and may be
discarded once the instrument is in place on the handle. The sheath
46 keeps the jaws in an open position, as illustrated in FIG. 2,
and also keeps the distal bendable member in a substantially
straight position. By doing that the actuation cable is maintained
in a particular aligned position and ready for engagement with the
handle portion of the instrument. Instead of using a pre-formed
sheath one may alternatively use a biasing means in the instrument
to maintain a predetermined position of the instrument cable,
usually one in which the jaws are maintained open.
[0070] A rolling motion 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 a longitudinal
shaft axis. This is represented in FIG. 1 by the rotation 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. 1 by the rotational arrow R2. This same motion
also causes a rotation of the distal bendable member and end
effector 16 about an axis that corresponds to the instrument tip,
depicted in FIG. 1 as about the longitudinal tip or tool axis P. In
FIG. 1 refer to the rotational arrow R3 at the tip of the
instrument.
[0071] Any rotation of the rotation knob 24 while the instrument is
locked (or unlocked) maintains the instrument tip at the same
angular position, but rotates the orientation of the tip (tool).
For a further explanation of the tip rotational feature refer to
co-pending application Ser. No. 11/302,654, filed on Dec. 14, 2005,
particularly FIGS. 25-28, which is hereby incorporated by reference
in its entirety.
[0072] The handle 12, via proximal bendable member 18, may be
tilted at an angle 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 an axis and at a corresponding
angle to the instrument shaft longitudinal center axis. The bending
at the proximal bendable member 18 is controlled by the surgeon
from the handle 12 by manipulating the handle in essentially any
direction including in and out of the plane of the paper in FIG. 1.
This manipulation directly controls the bending at the proximal
bendable member. For further descriptions relating to the bending
refer to co-pending application Ser. Nos. 11/528,134 filed on Sep.
27, 2006 and 11/649,352 filed on Jan. 2, 2007, both of which are
hereby incorporated by reference in their entirety.
[0073] Thus, the control at the handle is used to bend the
instrument at the proximal motion member to, in turn, control the
positioning of the distal motion member and tool. The "position" of
the tool is determined primarily by this bending or motion action
and may be considered as the coordinate location at the distal end
of the distal motion member. Actually, one may consider a
coordinate axis at both the proximal and distal motion members as
well as at the instrument tip. This positioning is in three
dimensions. Of course, the instrument positioning is also
controlled to a certain degree by the ability of the surgeon to
pivot the instrument at the incision point or at the cannula or
trocar. The "orientation" of the tool, on the other hand, relates
to the rotational positioning of the tool, from the proximal
rotation control member, about the illustrated distal tip or tool
axis P.
[0074] 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.
[0075] The surgical instrument of FIG. 1 shows a preferred
embodiment of a surgical instrument 10 according to the invention
in use and may be inserted through a cannula at an insertion site
through a patient's skin. Many of the components shown herein, such
as the instrument shaft 14, end effector 16, distal bending member
20, and proximal bending member 18 may be similar to and interact
in the same manner as the instrument components described in the
co-pending U.S. application Ser. No. 11/185,911 filed on Jul. 20,
2005 and hereby incorporated by reference herein in its entirety.
For example, the proximal bendable member 18 is a unitary slotted
structure as shown in FIG. 6 including discs 130, nibs 131 and
slots 132. Many other components shown herein, particularly at the
handle end of the instrument may be similar to components described
in the co-pending U.S. application Ser. No. 11/528,134 filed on
Sep. 27, 2006 and hereby incorporated by reference herein in its
entirety. Also incorporated by reference in their entirety are U.S.
application Ser. No. 10/822,081 filed on Apr. 12, 2004; U.S.
application Ser. No. 11/242,642 filed on Oct. 3, 2005 and U.S.
application Ser. No. 11/302,654 filed on Dec. 14, 2005, all
commonly owned by the present assignee.
[0076] As illustrated in, for example, FIGS. 1-3, the control
between the proximal bendable member 18 and distal bendable member
20 is provided by means of the bend control cables 100. In the
illustrated embodiment four such control cables 100 may be provided
in order to provide the desired all direction bending. However, in
other embodiments of the present invention fewer or less numbers of
bend control cables may be used. The bend control cables 100 extend
through the instrument shaft 14 and through the proximal and distal
bendable members. The bend control cables 100 may be constrained
along substantially their entire length so as to facilitate both
"pushing" and "pulling" action as discussed in further detail in
the aforementioned co-pending application Ser. No. 11/649,352 filed
on Jan. 2, 2007. The cables 100 may also be constrained as they
pass over the conical cable guide portion of the proximal bendable
member, and through the proximal bendable member itself.
[0077] The locking means interacts with the ball and socket
arrangement to lock and unlock the positioning of the cables which
in turn control the angle of the proximal bending member and thus
the angle of the distal bendable member and end effector. This lock
control allows the surgeon one less degree of freedom to
concentrate on when performing certain tasks. By locking the
bendable sections at a particular position, this enables the
surgeon to be more hands-free for controlling other degrees of
freedom of the instrument such as manipulation of the rotation knob
24 and, in turn, orientation of the end effector.
[0078] The instrument shown in FIG. 1 is considered as of a pistol
grip type. However, the principles of the present invention may
also apply to other forms of handles such as a straight in-line
handle. In FIG. 1 there is shown a jaw clamping or actuation means
30 that is comprised mainly of the lever 22 which may have a single
finger hole in the gimbaled ball 27. The ball 27 is mounted at the
free end of the lever 22. The surgeon uses the ball 27 for
controlling the lever 22. There may also be provided a related
release function controlled either directly by the lever 22 or a
separate release button. The release function is used to release
the actuated or closed tool or end effector.
[0079] In the instrument that is illustrated the handle end of the
instrument may be tipped or deflected in any direction as the
proximal bendable member is constructed and arranged to preferably
enable full 360 degree bending. This movement of the handle
relative to the instrument shaft bends the instrument at the
proximal bendable member 18. This action, in turn, via the bend
control cables 100, bends the distal bendable member in the same
direction. As mentioned before, opposite direction bending can be
used by rotating or twisting the control cables through 180 degrees
from one end to the other end thereof.
[0080] In the main embodiment described herein, the handle 12 is in
the form of a pistol grip and includes a horn 13 to facilitate a
comfortable interface between the action of the surgeon's hand and
the instrument. In this embodiment the horn has the other function
of providing the actuation pivot for locking and unlocking the tool
control cable, as described in more detail later. The tool
actuation lever 22 is shown in FIG. 1 pivotally attached at the
base of the handle. The lever 22 actuates a slider 28 (see FIG. 3)
that controls the tool actuation cable 38 that extends from the
slider to the distal end of the instrument. The cable 38 controls
the opening and closing of the jaws, and different positions of the
lever control the force applied at the jaws. The cable is depicted,
for example, in FIG. 8 as including proximal cable portion 38A and
distal cable portion 38B.
[0081] The instrument 10 has a handle portion 12 and a detachable
shaft portion 14, as shown in FIG. 1. The main components of the
instrument may be like that shown in Ser. No. 11/649,352 filed on
Jan. 2, 2007, particularly as to the construction of the bendable
members, instrument shaft and end effector. This includes means for
enabling rotation of the shaft and proximal bendable member within
bearings or bearing surfaces 208 and 210 (FIG. 3). The bearing 208
interfaces between the adaptor 26 and the ball 120, while the
bearing surface 210 is between the neck portion 206 and the
instrument shaft. The separate portions 12 and 14, or alternatively
the assembled instrument, may be sealed in a sterile package or
packages prior to storage or shipping.
[0082] As shown in FIG. 2, the shaft portion 14 can be easily
separated from the handle portion 12 by releasing the cinch ring
200. The shaft portion includes a shaft connector 212. The cable
portion 38B is provided with an end connector lug 40. The shaft
connector 212 and cable connector lug 40 are disengaged by raising
the horn 13 about a pivot 272 thus enabling the shaft portion 14
and handle portion 12 to be disengaged from each other. A new shaft
portion can then be easily attached to the sterilized handle by
insertion and locking into the handle as described in further
detail below. FIG. 1 shows the shaft and handle portions engaged
which happens when the horn 13 is pivoted to the locked or down
position. See also the locked position in FIG. 3.
[0083] FIG. 3 shows a somewhat schematic cross-sectional view of
the connections between the shaft 14 and handle portion 12. The
split hub 202 is constructed and arranged to allow the ball 120 to
be pulled out of the split hub 202. The cinch ring 200 is used to
lock and unlock the split hub 202, as described in more detail
later. For other details of the split hub 202 refer also to FIGS. 2
and 9. The proximal bending member 18 is mounted to the shaft
connector 212 that is indexed with the handle portion, and
particularly with the rotation knob 24. In FIG. 3, the shaft
connector 212 is shown connected to the rotation knob 24 by means
of a shaft receiver portion 300 (see FIG. 8) of the rotation knob
24. The shaft connector 212 is locked into the handle portion 12 by
means of the shaft locking assembly or means 260. The shaft
connector is locked linearly but the assembly 260 allows rotation
of the shaft portion relative to the handle portion. In FIG. 3 the
jaw actuation distal cable portion 38B (see also FIG. 8) is shown
terminated at the coupling lug 40. It is the coupling lug 40 that
is captured by the cable coupling member or means 320 so as to in
essence connect together both portions 38A and 38B of the tool
actuation cable 38.
[0084] The split hub portions or petals 202A-202D each have a
tapered face 378 (see FIGS. 3 and 4) so as to function as a ramp to
force the petals apart when the ball 120 is pushed proximally
against them during an insertion of the shaft portion into the
handle portion. These inward faces or edges of the portions
202A-202D are beveled or tapered to allow easier passage of the
ball. The split hub 202 is supported from the handle by means of
struts 230 which are thinned as shown at 382 as illustrated in
FIGS. 6 and 9 so as to function as flexible living hinges to thus
allow more ready expansion of the hub petals. This structure
assists in the engagement and disengagement between the shaft and
handle.
[0085] The cinch ring 200 has two flanges 201A and 201B, shown in
FIG. 5 that ride in respective circumferential grooves 203A and
203B. The grooves 203A and 203B are disposed on the outer surface
of the split hub 202. This interface captures the cinch ring while
allowing the split hub to be separated linearly as is discussed in
more detail hereinafter. The cinch ring 200 is basically controlled
from the angle locking member or means 140, as shown in FIGS. 2 and
9. The angle locking member 140 is pivotally attached with the
cinch ring 200. The angle locking member 140 is constructed and
arranged to allow the cinch ring 200 to, not only be loosened
enough to adjust the angle of the shaft relative to the handle, but
to also expand to a size that is sufficient to allow enough
expansion of the split hub portions to thus allow the ball 120 to
be removed or inserted in the split hub 202, as illustrated in
FIGS. 6 and 7. This enables the shaft portion to be dis-engaged
from the handle portion.
[0086] The cinch ring flanges 201A and 201B and grooves 203A and
203B are dimensioned so that when the cinch ring 200 is loosened
enough for the ball 120 to be removed from the split hub, the cinch
ring 200 cannot be removed from the split hub without detaching the
ends 200A and 200B of the cinch ring 200, as illustrated in the
position of FIG. 23. The flanges 201 are approximately the same
depth and the grooves are slightly deeper so as to not impede the
pressure applied at surface 384 of the cinch ring on surface 386 of
the split hub portions when the cinch ring is tightened, as in the
position that is illustrated in FIG. 3.
[0087] In the preferred embodiment of the instrument of the present
invention there are actually considered to be three separate
operational positions of the cinch ring 200. Also, a fully
disassembled position of the cinch ring 200 is illustrated in FIG.
23. FIG. 4 shows the cinch ring in a locked first position in solid
line. The phantom position shown in FIG. 4 and the position shown
in solid line in FIG. 4A depict a second position in which the
cinch ring has been sufficiently released so that the shaft angle
can be changed or, alternatively, the cinch ring can be rotated for
left or right hand use. From the position of FIG. 4A the link 390
can be rotated clockwise as seen in FIG. 4B to a third position
which further relaxes the cinch ring enough for the disposable
shaft portion to be removed from the handle portion with the cinch
ring still loosely attached to the split hub, as in FIG. 15, or to
the ball portion of the shaft, as in FIG. 18. The fourth position
is shown in FIG. 23 where the cinch ring ends have been
disconnected so It can be fully removed by itself from either the
throw away shaft portion or from the handle portion.
[0088] The connector 212 has an indexing feature that can be used
to index the cables 100 to the rotation knob 24 and/or match shafts
with different tools or end effectors to certain handles. As
illustrated in FIGS. 8 and 24-26, the shaft receiver portion 300 of
rotation knob 24 is provided with ribs 302 (see also FIG. 9) that
mate with slots 306 on the outside surface of the connector 212.
There is also preferably provided a tapered end 304 on each of the
ribs 302 and a taper 216 on connector 212 to help align these
members during assembly. Different rib patterns can be used as well
as different thicknesses such as ribs 302A and slots 306A shown in
FIG. 26. FIG. 27 schematically shows a pattern of three ribs 302B
spaced 120 degrees apart in the receiver 300 mating with three
equally spaced grooves 306B on the outside of the connector 212,
shown in phantom outline. One set of ribs and grooves may be wider
than the others as a further indexing feature. FIG. 28 depicts an
arrangement of eight ribs 302C mating with eight slots 306C. When
the connector is fully inserted in the receiver as shown in FIG. 3,
the shoulder 308 on the connector 212 contacts seat 310 in the
receiver and the cable crimps 102 sit in recess 312.
[0089] The rotation knob 24 is keyed to the proximal bending member
18 and when the rotation knob is rotated through rotation angle R1,
the shaft portion 14 and proximal bending member rotate on bearings
or bearing surfaces 208, 210. There is also a rotation on bearing
surfaces between the clearance hole 316 against post 214. To retain
the rotation knob and receiver portion in the correct position when
the connector is absent there is provided a rim 234 on the proximal
end of the rotation knob that fits loosely in the radial groove 236
in the handle halves, as shown in FIGS. 3 and 8.
[0090] The shaft connector 212 is locked in place by actuation of
shaft locking member or means 260 which include a gate 262 with a
semi-circular rim 264 that loosely engages the groove 218 in the
post 214 when the gate is in a down position. The gate 262 rides in
slides 266 on wall 318. A link 268 pivotally connects the gate 262
to a lug 270 on the horn 13. When the horn is raised as shown in
FIGS. 8 and 12, the rim 264 is clear of the groove 218 and the
shaft connector is free to slide distally out of the receiver. The
horn is hinged to the handle at pin 272 and has two positions as
seen in respective FIGS. 3 and 5. There is a bump 274 on the horn
that snaps into dimples 276 in the handle to hold the handle in
either position. The horn structure includes a shroud 278 that
closely fits the opening 280 in the handle to keep out
contaminants. Other locking means may be used and may not be
necessary if the split hub and cinch ring sufficiently contain the
ball 120 within the split hub 202 when the lever 220 is in a
relaxed position.
[0091] FIGS. 15-17 show an alternate means of attachment between
the cinch ring, hub and shaft portion. In this embodiment the split
hub may be separated from the shaft portion by means of a
detachable front portion or ring 420 that is removed along with the
shaft portion 14 and ball 120, as illustrated in FIG. 15-17. The
ring 420 is shown as including a plurality of fingers 422 on the
ring that each align with recesses 424 in the split hub. This
arrangement provide alignment of the ring 420 with the split hub
portions and the cinch ring flanges 201A and 201B with their
respective grooves 203A and 203B. This construction also leaves a
clearance space for the ends of the split hub portions 202A-202D
enabling them to flex without binding against the proximal surface
of the ring 420, as illustrated in FIG. 17. The fingers 422 are
preferably attached to the ring 420 by living hinges 426 to allow
them to flex with the split hub portions when the cinch ring 200 is
tightened and the inside surface 384 of the ring exerts pressure on
surfaces 386. The flanges 201 and grooves 203 are dimensioned so
that the ring 420 can be removed from the split hub and cinch ring,
but the cinch ring can't be removed from the split hub unless the
ends 200A and 200B are disconnected (refer to FIGS. 21-23 for an
illustration of the disconnection of the cinch ring itself).
[0092] Reference is now made to FIGS. 18-20 for still another
embodiment for the connection and disconnection between the handle
and shaft portions. The cinch ring 200 has different depth flanges
201A and 201B. The groove arrangement includes a groove 203A in the
ring 420 and a groove 203B at the split hub. In this embodiment the
flange 201A has a greater depth than the flange 201B so that the
flange 201B may clear the groove 203B and allows the ring 420 to be
removed along with the cinch ring 200 while retaining the cinch
ring 200 on the ring 420, as illustrated in FIGS. 18 and 19. As
shown in FIG. 23, the cinch ring 200 can be totally detached from
both the ring 420 and the split hub by detaching ends 200A and
200B.
[0093] The angle locking member 140 is comprised primarily of the
release/lock lever 220 which controls the length or outer
circumference of the cinch ring 200. For a further explanation of
the function of the lever 220 refer to the two cross-sectional
views of FIGS. 4 and 7, as well as the two perspective views of
FIGS. 4A and 4B. FIG. 4 depicts the instrument in the position
where the shaft portion is fully engaged with the handle portion
and the cinch ring is locked. FIG. 7 on the other hand depicts the
instrument with the cinch ring at least partially released. In the
later position an end 200B of the cinch ring 200 can be further
released, as illustrated in FIG. 23.
[0094] As illustrated in FIG. 4, the lever 220 is pivoted at pin
222 which is connected to end 200A of the cinch ring. The end 200A
is in the shape of a hook (see FIGS. 4A and 4B) and sits in a slot
226 in the lever. Pushing one end or the other of the lever 220
pivots the end 200B of the cinch ring 200 over the center line of
the pivot pin 222 either tightening the cinch ring as shown in
solid line in FIG. 4 or relaxing it as shown in phantom line in
FIG. 4. In the solid line position of lever 220, the angle of the
end effector is locked in place. When the lever 220 is pivoted in
the direction of arrow 410 in FIG. 4 (see also FIG. 4A) the cinch
ring 200 is relaxed as shown in the phantom line position in FIG.
4. In this relaxed or released position the angle of the end
effector is free to be changed by rotation of the ball 120 in the
split hub 202. Also, in the released position the cinch ring 200
may be rotated in its grooves to allow a rotational adjustment of
the position of the lever 220 for ease of use. Such an alternate
rotational position is shown in the cross-sectional view of FIG. 7
wherein the cinch ring has been rotated clockwise from the position
of FIG. 4. FIG. 7 also shows the lever 220 in its relaxed
position.
[0095] The lever 220 supports a link 390 which sits in slot 226 and
pivots about pin 392 at one end. The other end of the link 390
carries opposite posts 394 that pass through holes in the end 200B
of the cinch ring 200. These posts are capped off by means of knobs
400. Knobs 400 retain the end 200B of the cinch ring 200 in a
rotational relationship to the link 390 but end 200B can easily be
released when the cinch ring is to be removed (see FIG. 22). The
post and hole arrangement also provides a grip to rotate link 390
between stations 406 and 408. As shown in FIGS. 4B and 7, the link
390 has been rotated in the direction of arrow 412 from station 406
to station 408 which in effect loosens the cinch ring enough for
the split hub to be expanded enough to remove the shaft and ball.
From that position, the end 200B of the cinch ring can be removed
by indexing the knobs 400 by means of indicators 401 (FIG. 23) in
the direction of arrow 414(FIG. 22) so that lugs 396 on the
respective posts 394 line up with keyways 402 at the end 200B. Once
aligned, the knobs 400 can be pulled outward in the direction of
arrow 416 in FIG. 22 and end 200B can be detached as the recesses
398 in the knobs clear the posts 394. Rims 404 on the knobs prevent
the knobs from detaching from the end 200B. The cinch ring 200 is
then free to be completely removed from the split hub 202 and/or
ring 420 as shown in FIG. 23.
[0096] In previous instrument constructions, the proximal bending
member 18 has been mounted directly to the rotation knob 24 but now
a connector 212 and receiver 300 allow the bending member 18 to be
removed from rotation knob 24. The exploded cross-sectional view of
FIG. 8 depicts the separation of the shaft portion 14 along with
the proximal bendable member 18, ball 120 and connector 212 from
the handle portion 12. The connector 212 is attached to the
proximal end of the bendable member 18 and the cables 100 are
illustrated as passing through the proximal bendable member 18 and
connector 212. The cables terminate at the resilient pads 104 (or
springs) and are crimped at 102. Thus, the proximal ends of the
bend control cables are terminated at the connector 212. The
connector 212 has a post 214 that passes through a clearance hole
314 in the rotation knob and a clearance hole 316 in the radial
wall 318 of the handle. The post 214 has a taper 216 at its'
proximal end to aid in assembly. The post 214 also has a
circumferential groove 218 that is engaged by the shaft locking
member or means 260. As depicted in FIG. 8, the proximal bendable
member 18 and connector post 214 also carry the jaw actuation cable
portion 38B in a central bore thereof. FIG. 8 also shows the cable
end lug 40 that is attached to the very end of the cable portion
38B and extends outwardly from the post 214.
[0097] As indicated previously, the horn 13 is shown in its locked
position in FIGS. 1 and 3 and is shown in its released position in
FIGS. 2 and 5. As mentioned previously the pivoting of the horn
causes the locking in of the shaft portion of the instrument
relative to the handle portion thereof. Also, the pivoting of the
horn is also used to control the inter-engagement between the cable
portions by capturing the cable lug 40. This is accomplished by a
clamping or releasing via a cable coupling member or means 320
which is illustrated in at least FIGS. 3, 10, 11, 13 and 14. The
clamping member or means 320 includes a main collet member having
plurality of jaws 322 each with recesses 324 that capture the lug
40 on the cable 38. The jaws are shown most clearly in the enlarged
perspective view of FIG. 10. The jaws are disposed at the ends of
respective spring arms 328 that are circumferentially disposed
about the base 330 which may, in turn, be cemented to the handle
portion 38A of cable 38. The jaws 322 are normally biased to an
open position such as shown in FIG. 14 by means of the action of
the spring arms 328.
[0098] The jaws 322 of the clamping member 320 have ramped surfaces
326 on their outside surfaces that interact with the tapered
surface 334 of the collet 332. This interaction controls the
opening and closing of the clamping member. The collet 332 is
normally urged distally by spring 336 that is loaded against the
wall of the carriage 338 as illustrated in FIG. 13. The spring 336
is disposed in a pocket between a seat at the proximal end of the
jaw members 322 and a seat in the carriage 338. The neck 340 of the
carriage 338 is fixedly attached to the base 330 of the jaws 322,
as well as to the cable portion 38B. This attachment may be by a
number of different means such as by being cemented together. Refer
to the cross-sectional view of FIG. 13 illustrating the cementing
at 342.
[0099] The carriage 338 is adapted for sliding motion inside of the
guide 344 which is, in turn, fixed to the handle 12. The guide 344
is supported by the sleeve 346 which is molded as part of the
handle. In FIG. 13 the spring 336 is shown urging the collet 332,
with its' tapered surface 334, against ramped surfaces 326 under
the bias of the spring arms 328. This action maintains the jaws
closed, thus capturing the cable lug 40 therein and essentially
thus joining together the separate cable portions 38A and 38B. Once
the cable portions are joined then the actuation cable functions as
a single operable cable that is controlled from the proximal part
of the instrument. The carriage 338 enables the cable to slide in
performing its tool actuation function. The carriage 338 is shown
as pulled proximally in the direction of arrow 348 in FIG. 13 to
show the manner in which the carriage 338 with the closed jaws 322
is free to move proximally from the at rest position illustrated in
FIG. 3.
[0100] Refer now to FIG. 14 for an illustration of the release
function which enables the shaft portion of the instrument to be
separated or detached from the handle portion of the instrument.
The jaws 322 are opened to release the lug 40 by the action of the
cams 352 against the face 354 of the collet 332. The action of the
cams 352 pushes the collet 332 proximally as illustrated in FIG. 14
to release the jaws from about lug 40. The spring arms 328 are
constructed and arranged so as to normally urge the arms apart.
[0101] FIG. 14 depicts a rest position of the instrument in which
the slider 28 has normally urged the cable 38 in the direction of
arrow 350. This action places the face of the jaws 322 against
posts 356. This positioning ensures the proper alignment between
the connector 212 and the cable coupling member 320. This assures
alignment at the cable lug 40 when the horn 13 is either raised or
lowered. Raising the horn lifts the lug 270 and along with it the
pin 372 as illustrated in FIG. 11. This action pulls up on arms 366
of the yoke 364 which spread around the connector 212. Yoke 364 is
supported at arms 370. Arms 366 carry pivot pins 368 that are
attached to the arms 362 of posts 356 that are, in turn, mounted on
pins 358 protruding from bosses 360 molded to the sides of the
handle. The posts 356 act as stops for the proximal end of the
shaft connector 212 and the face of the jaws 322. The posts 356
have cams 352 which engage and push against the face of the collet
354 when the horn 13 is raised, as depicted in FIG. 14.
[0102] An alternate embodiment of cable coupling member is shown in
FIGS. 29-33, as coupling member 460. In this embodiment, the cable
end lug 40 has been replaced with a spring loaded cable connector
440 that is contained in a passage 450 in the post 214 of the
connector 212. A spring 446 biases the connector 440 distally to
maintain the end effector jaws in an open position when the shaft
portion 14 is removed. The spring 446 pushes flange 448 against the
proximal end of the bendable member 18, such as depicted in FIG.
29. This eliminates a need for a sheath 46, as in FIG. 2, and helps
keep the jaws open at an at rest position. Connector 440 has a
tapered end 444 to aid in assembly and a groove 442 that can be
captured by a finger 462 that is shown engaged in the position of
FIGS. 29 and 30, and is normally biased to an open position as
illustrated in FIG. 31.
[0103] The finger 462 is attached to sleeve 466 at a living hinge
portion 464 that enables the finger 462 to flex inward when biased
by flex arm 472 of the guide 470. Movement of the guide 470 over
the sleeve 466 drops the finger 462 into groove 442 and thus
captures the connector 440, as shown in FIG. 30. The finger 462 is
molded as part of the sleeve 466 and has a key 480 that slides in
keyway 478 of guide 470 to ensure proper alignment of the finger
462 and the flex arm 472. The sleeve 466 is cemented at 468 to the
cable 38 and slides in the guide 470 which is attached to the
handle 12. When the horn is raised, a cam surface 474 of the shroud
278 lifts off cam follower 476 on the end of the flex arm 472,
allowing it to return to its at rest position as illustrated in
FIG. 32. This allows the finger 462 to return to its at rest
position thus releasing the connector 440. FIG. 33 is an exploded
cross-sectional view of the embodiment of FIG. 32 and showing the
instrument shaft portion removed from the handle portion. When the
horn 13 is pushed down, the cam surface 474 pushes the flex arm 472
at the follower 476, and likewise pushes the finger 462 to the
position shown in FIG. 29. This is a locked position for the cable
coupler. The sleeve 466 functions as a carriage as depicted in FIG.
30 when the cable 38 is pulled by the slider 28.
[0104] FIGS. 29 and 30 both show the coupling lug 441 captured so
that both proximal and distal portions of the actuation cable are
interconnected. FIG. 29 shows more of an at rest position while
FIG. 30 depicts the cable 38 pulled in the direction of arrow 443
so as to actuate the end effector. In FIG. 30 the sleeve is shown
moved to the right and the spring 446 more compressed. FIG. 32
illustrates the horn having been raised to enable release of the
distal portion of the instrument with the finger 462 and the flex
arm 472 both released to a dis-engaged position. Finally, in FIG.
33 the shaft portion is shown separated from the handle
portion.
[0105] FIGS. 34-38 show still a further alternate embodiment of a
cable coupling member or means 500. In this embodiment, the
connector 440 with its end lug 441 is inserted into a bore 518 in
block 502 which also functions as a carriage. A spring loaded gate
504 with a keyhole shaped opening 506 is slidably mounted in
transverse passage 507 of the block 502. The upper rim 508 of the
keyhole opening is urged downward by spring 510 to engage groove
442 of the connector 440 in a rotational relationship. A neck 512
on the top of the gate 504 supports the spring 510 against a
bracket 514 which, in turn, supports a stop 516 on the end of the
neck 512. This arrangement ensures that the gate 504 does not drop
out of the block 502 when there is no connector 440 present.
[0106] The carriage 502 travels in a slideway 520 which is affixed
to the handle. A release means or member 522 is operated by
rotating the horn. The member 522 includes a pusher 524 that riding
in guides 526 and is connected to the horn 13 by link 528 which
pivots in end bosses 530. The at rest position which is also the
clamp/release position is shown in FIG. 34. The shaft portion is
shown abutting the distal end of the fixed position slideway 520,
the cable 38 is at rest, the spring 446 is at an extended position,
the carriage 502 is at the distal end of the slideway 520 and the
pusher 524 is shown lined up beneath the gate 504. In the
cross-sectional view of FIG. 35 the connector 440 is clamped by
means of the gate 504. FIG. 35 also illustrates the carriage 502
being pulled proximally, by arrow 534 by the cable 38 which, in
turn, is connected to the slider 28. The spring 510 keeps the gate
504 down and latched but the connector 440 is free to rotate within
block 502. FIG. 37 shows the horn raised and the pusher 524 in
contact with and pushing up on the gate to align the wide portion
of the keyhole opening 506 with the connector shaft so the
connector 440 can be withdrawn as shown in FIG. 38.
[0107] After use of the surgical instrument of the present
invention the used or contaminated shaft portion 14 can be easily
detached from the handle portion 12 and disposed of as hereinafter
described. In this regard reference is now made to the manner in
which the shaft portion is readily detachable for the purpose of
replacement thereof. For this explanation reference is made
primarily to the first embodiment described herein. To release the
shaft portion 14, the cinch ring 200 is released as shown in FIGS.
2 and 5 by manipulation of the angle locking means 140 to allow the
split hub portions 202A-202D to be able to expand enough to allow
clearance for the spherical ball 120. Once the cinch ring is
released the spherical ball can be pulled out of the split hub 202
as the shaft portion 14 is withdrawn, and thus detached from the
handle portion 12. Before detaching the shaft portion, the horn 13
is raised upward as shown in FIGS. 2 and 5, releasing both the
shaft locking member 260 and the cable coupling member 320. The
shaft portion 14 can then be grasped at the neck portion 206 of the
ball 120 and pulled straight out of the handle portion 12 and
disposed of. After sterilizing the handle portion 12, a new shaft
portion 14 can be easily attached to it.
[0108] As shown in FIG. 2, the new shaft portion 14 may be fitted
with a temporary sheath 46 that is semi-rigid and snugly fits over
the end effector and the distal bending member 20 to hold the end
effector jaws open which ensures that the lug 40 at the proximal
end of the shaft portion 14 is fully inserted into the shaft
connector 212. This is needed for proper alignment of the cable
coupling means 320 and the lug 40 when the shaft portion 14 is
inserted into the handle portion 12. The sheath 46 also holds the
distal bending member 20 straight and thus the proximal bending
member 18 straight with respect to the shaft and shaft connector
212 for correct alignment when the shaft portion 14 is inserted
into the handle portion 12. There is also preferably provided an
indexing means described herein in the form of ribs and grooves
that ensure that the shaft connector 212 rotates in a fixed
relationship to the rotation knob 24 and may also provide a
matching means to ensure the correct matching of specific end
effectors or tools to the proper handle configurations.
[0109] Next is described the step of insertion of a new shaft
portion with the handle portion. As the shaft portion 14 enters the
handle portion 12 the spherical surface 204 of the ball 120
contacts the beveled faces 378 of the respective split hub portions
202A-202D and forces them apart until the spherical surface 204 can
clear the points created on the inside diameter of the split hub
and the angled surfaces 380, as depicted in FIGS. 6 and 7. The
angled surfaces 380 allow the spherical ball 120 to clear the split
hub with less expansion of the portions 202A-202D to make it easier
to slip the ball into and out of the split hub. The struts 230 that
attach the split hub portions to the handle have thinned areas 382
that create living hinges that facilitate expansion of the split
hub portions. FIG. 6, although previously described as illustrating
removal of the shaft portion, can also be considered as
illustrative of the relative positioning when the shaft portion 14
is inserted into the handle portion 12.
[0110] Continuing with the insertion step, next the post 214 of the
shaft connector 212 is guided into the clearance hole 314 of the
shaft receiver portion 300 of the rotation knob 24 and the
clearance hole 316 in the wall 318 of the handle with the
assistance of the tapered surface 216 at the free end of the post
214. The shaft 14 can be rotated until the indexing features, such
as ribs 302 on the shaft receiver and grooves 306 on the shaft
connector 212, mate under the urging of the split hub portions
trying to return to a memory position and exerting a proximal
pressure on the distal side of the spherical ball 120. The ribs 302
are tapered at 304 and the connector 212 is tapered at 216 to
assist in the alignment. Once properly aligned, the shaft connector
212 can slide proximally until the shoulder 308 on the connector
contacts the seat 310 of the shaft receiver portion 300 as depicted
in FIG. 5.
[0111] There is provided a recess 312 in the shaft receiver 300 to
allow clearance for the terminal wire crimps 102 and resilient pads
104. As the connector seats in the receiver, the cable connection
lug 40 is guided into the cable coupling jaws 322 guided by the
taper 42 on the lug. When the connector 212 is fully seated in the
receiver 300 the end of the post 214 abuts and contacts one side of
the posts 356, as illustrated in FIG. 14. The faces of the jaws 322
abut the other side of the posts 356 as urged by the carriage
spring 336. FIG. 14 also shows that the proper distance D is
provided that ensures that the lug 40 is abutting and preferably
contacting the portion of the cable 38 that is attached to the
slider 28. Also, this positioning provides alignment of the lug 40
with the recesses 324 in the jaws 322 so that when collet 332 is
released, the jaws 322 capture the lug 40.
[0112] Once the shaft portion is properly seated then the shaft
portion 14 is now ready to be locked to the handle. The horn 13 is
rotated clockwise or downwardly to the position depicted in FIG. 3.
This releases the collet 332 and the jaws 322 capture the lug 40
while the shaft locking means 260 locks the shaft connector 212 in
a rotational relationship with respect to the handle. The cinch
ring 200 is then tightened by the release/lock lever 220 and the
sheath 46 can be removed while gently squeezing the jaw clamping
lever 22 while pulling on the distal end of the sheath. The
instrument is now ready for use.
[0113] Having now described a limited number of embodiments
relating to the principles of the present invention, it should now
be apparent to one skilled in the art that numerous other
embodiments and modifications thereof are contemplated as falling
within the scope of the present invention, as defined by the
appended claims. For example, although the horn member has been
described as the means by which the cable coupling is initiated, it
is to be understood that other existing instrument members or added
members may be used to initiate this action. In one other example
the tool actuation lever may be adapted for the cable coupling
function.
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