U.S. patent application number 13/538601 was filed with the patent office on 2014-01-02 for ultrasonic surgical instruments with distally positioned transducers.
This patent application is currently assigned to Ethicon Endo-Surgery, Inc.. The applicant listed for this patent is Timothy G. Dietz, Gary W. Knight, Richard W. Timm. Invention is credited to Timothy G. Dietz, Gary W. Knight, Richard W. Timm.
Application Number | 20140005702 13/538601 |
Document ID | / |
Family ID | 48803596 |
Filed Date | 2014-01-02 |
United States Patent
Application |
20140005702 |
Kind Code |
A1 |
Timm; Richard W. ; et
al. |
January 2, 2014 |
ULTRASONIC SURGICAL INSTRUMENTS WITH DISTALLY POSITIONED
TRANSDUCERS
Abstract
Various embodiments are direct to a surgical instrument
comprising and end effector, an articulating shaft and an
ultrasonic transducer assembly. The end effector may comprise an
ultrasonic blade. The articulating shaft may extend proximally from
the end effector along a longitudinal axis and may comprise a
proximal shaft member and a distal shaft member pivotably coupled
at an articulation joint. The ultrasonic transducer assembly may
comprise an ultrasonic transducer acoustically coupled to the
ultrasonic blade. The ultrasonic transducer assembly may be
positioned distally from the articulation joint.
Inventors: |
Timm; Richard W.;
(Cincinnati, OH) ; Dietz; Timothy G.; (Terrace
Park, OH) ; Knight; Gary W.; (West Chester,
OH) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Timm; Richard W.
Dietz; Timothy G.
Knight; Gary W. |
Cincinnati
Terrace Park
West Chester |
OH
OH
OH |
US
US
US |
|
|
Assignee: |
Ethicon Endo-Surgery, Inc.
Cincinnati
OH
|
Family ID: |
48803596 |
Appl. No.: |
13/538601 |
Filed: |
June 29, 2012 |
Current U.S.
Class: |
606/169 |
Current CPC
Class: |
A61B 2017/320069
20170801; A61B 17/2804 20130101; A61B 2017/00323 20130101; A61B
2017/00415 20130101; A61B 2017/2929 20130101; A61B 2017/320089
20170801; A61B 17/2202 20130101; A61B 2017/2932 20130101; A61B
17/29 20130101; A61B 2017/320095 20170801; A61B 2017/2939 20130101;
A61B 2017/2938 20130101; A61B 2017/320071 20170801; A61B 2017/003
20130101; A61B 2017/320093 20170801; A61B 2017/320074 20170801;
A61B 2017/2927 20130101; A61B 2017/2908 20130101; A61B 2017/320094
20170801 |
Class at
Publication: |
606/169 |
International
Class: |
A61B 17/32 20060101
A61B017/32 |
Claims
1. A surgical instrument comprising: an end effector to treat
tissue, wherein the end effector comprises an ultrasonic blade; an
articulating shaft extending proximally from the end effector along
a longitudinal axis, wherein the articulating shaft comprises: a
proximal shaft member; and a distal shaft member pivotably coupled
to the proximal shaft member at an articulation joint; and an
ultrasonic transducer assembly comprising an ultrasonic transducer
acoustically coupled to the ultrasonic blade, wherein the
ultrasonic transducer assembly is positioned distally from the
articulation joint.
2. The surgical instrument of claim 1, further comprising: a first
control member extending through the shaft; and a second control
member extending through the shaft at a position substantially
opposite the longitudinal axis from the first control member,
wherein proximal translation of the first control member causes the
distal shaft member and end effector to pivot towards the first
control member.
3. The surgical instrument of claim 1, further comprising a clamp
arm pivotable about a clamp arm pivot point from an open position
to a closed position substantially parallel to the ultrasonic
blade.
4. The surgical instrument of claim 3, wherein the clamp arm pivot
point is offset from the longitudinal axis, and wherein the
surgical instrument further comprises: a clamp arm control member
coupled to the clamp arm at a position offset from the longitudinal
axis such that distal translation of the clamp arm control member
pivots the clamp arm to the open position and proximal translation
of the clamp arm control member pivots the clamp arm to the closed
position.
5. The surgical instrument of claim 3, wherein the ultrasonic blade
extends distally from the ultrasonic transducer, wherein the clamp
arm defines a clamp portion extending distally from the clamp arm
pivot point and a proximal portion extending proximally from the
clamp arm pivot point, and wherein the surgical instrument further
comprises: a clamp arm control member extending through the shaft;
a first linkage member defining a proximal end pivotably coupled to
the clamp arm control member and a distal end pivotably coupled to
a proximal portion of the ultrasonic transducer assembly; a second
linkage member defining a proximal end pivotably coupled to the
clamp arm control member and a distal end pivotably coupled to the
proximal portion of the clamp arm.
6. The surgical instrument of claim 5, wherein proximal translation
of the clamp arm control member pivots the ultrasonic blade and
clamp portion of the clamp arm to the closed position, and where
distal translation of the clamp arm control member pivots the
ultrasonic blade and clamp portion of the clamp arm to the open
position.
7. The surgical instrument of claim 3, wherein the ultrasonic blade
extends distally from the ultrasonic transducer, wherein the clamp
arm defines a clamp portion extending distally from the clamp arm
pivot point and a proximal portion extending proximally from the
clamp arm pivot point, and wherein the surgical instrument further
comprises: a clamp arm control member extending through the shaft;
a first linkage member defining a proximal end pivotably coupled to
the clamp arm control member and a distal end pivotably coupled to
a proximal portion of the ultrasonic transducer assembly; wherein
the a proximal portion of the ultrasonic transducer assembly and a
distal portion of the ultrasonic transducer assembly are separated
by a bendable, acoustically transmissive section having a
transverse area less than a longitudinal diameter of the distal and
proximal portions of the ultrasonic transducer assembly; and
wherein the proximal portion of the ultrasonic transducer assembly
is coupled to the clamp arm control member.
8. The surgical instrument of claim 3, wherein the ultrasonic blade
extends distally from the ultrasonic transducer, wherein the clamp
arm defines a clamp portion extending distally from the clamp arm
pivot point and a proximal portion extending proximally from the
clamp arm pivot point, and wherein the surgical instrument further
comprises: a clamp arm control member extending through the shaft;
a first linkage member defining a proximal end pivotably coupled to
the clamp arm control member and a distal end pivotably coupled to
the proximal portion of the clamp arm; an ultrasonic blade control
member extending through the shaft; a second linkage member
defining a proximal end pivotably coupled to the ultrasonic blade
control member and a distal end pivotably coupled to a proximal
portion of the ultrasonic transducer assembly.
9. The surgical instrument of claim 3, wherein the ultrasonic blade
extends distally from the ultrasonic transducer, wherein the clamp
arm defines a clamp portion extending distally from the clamp arm
pivot point and a proximal portion extending proximally from the
clamp arm pivot point, and wherein the surgical instrument further
comprises: a clamp arm pulley rotatable about a clamp arm pulley
axis substantially perpendicular to the longitudinal axis; a first
linkage member defining a distal end pivotably coupled to the
proximal portion of the clamp arm and a proximal end pivotably
coupled to the clamp arm pulley at a position offset from the clamp
arm pulley axis; a clamp arm control member positioned around the
clamp arm pulley and defining first and second ends extending
proximally through the proximal shaft member.
10. The surgical instrument of claim 3, wherein the ultrasonic
blade extends distally from the ultrasonic transducer, wherein the
clamp arm defines a clamp portion extending distally from the clamp
arm pivot point and a proximal portion extending proximally from
the clamp arm pivot point, and wherein the surgical instrument
further comprises: a ultrasonic blade pulley rotatable about a
ultrasonic blade pulley axis substantially perpendicular to the
longitudinal axis; a first linkage member defining a distal end
pivotably coupled to the proximal portion of the ultrasonic blade
and a proximal end pivotably coupled to the ultrasonic blade pulley
at a position offset from the ultrasonic blade pulley axis; a
ultrasonic blade control member positioned around the ultrasonic
blade pulley and defining first and second ends extending
proximally through the proximal shaft member.
11. The surgical instrument of claim 1, wherein the articulating
shaft further comprises an inner shaft coupled to and extending
proximally from the end effector such that rotation of the inner
shaft causes rotation of the end effector.
12. The surgical instrument of claim 11, wherein the inner shaft
comprises a flexible rod.
13. The surgical instrument of claim 11, wherein the inner shaft
comprises: an inner shaft distal member coupled to the end
effector; an inner shaft joint member pivotably coupled to the
inner shaft distal member; and an inner shaft proximal member
pivotably coupled to the inner shaft joint member.
14. The surgical instrument of claim 1, wherein the articulating
shaft further comprises: a joint member positioned at about the
articulation joint, wherein the joint member is: pivotably coupled
to the distal shaft member such that the distal shaft member is
pivotable relative to the joint member about a first pivot axis
substantially perpendicular to the longitudinal axis; pivotably
coupled to the proximal shaft member such that the joint member is
pivotable relative to the proximal shaft member about a second
pivot axis substantially perpendicular to the longitudinal axis and
substantially perpendicular to the first pivot axis.
15. The surgical instrument of claim 14, further comprising: a
first control member extending through the proximal shaft member;
and a second control member extending through the proximal shaft
member at a position substantially opposite the longitudinal axis
from the first control member, wherein proximal translation of the
first control member causes the distal shaft member to pivot
towards the first control member about the first pivot axis.
16. The surgical instrument of claim 14, further comprising: a
third control member coupled to the joint member and extending
proximally through the proximal shaft member; and a fourth control
member coupled to the joint member at a position substantially
opposite the longitudinal axis from the third control member and
extending proximally through the proximal shaft member, wherein
proximal translation of the third control member causes the joint
member and distal shaft member to pivot towards the third control
member about the second pivot axis.
17. The surgical instrument of claim 1, wherein the distal shaft
member comprises a pulley at about the articulation joint, and
wherein the surgical instrument further comprises a control member
positioned around the pulley and defining first and second ends
extending proximally through the proximal shaft member, wherein
proximal translation of the first end of the control member rotates
the pulley to pivot the distal shaft member and end effector about
the articulation joint.
18. A surgical instrument comprising: an end effector to treat
tissue, wherein the end effector comprises an ultrasonic blade; an
articulating shaft extending proximally from the end effector along
a longitudinal axis, wherein the articulating shaft comprises: a
proximal shaft member; and a distal shaft member pivotably coupled
to the proximal shaft member at an articulation joint; and an
ultrasonic transducer assembly comprising an ultrasonic transducer
acoustically coupled to the ultrasonic blade, wherein the
ultrasonic transducer assembly is coupled to the distal shaft
member and comprises a proximal portion that extends proximally
past the articulation joint.
19. The surgical instrument of claim 18, wherein the proximal
portion of the ultrasonic transducer assembly pivots away from the
longitudinal axis in a first direction when the distal shaft member
and end effector pivot away from the longitudinal axis about the
articulation joint in a second direction opposite the first
direction.
20. The surgical instrument of claim 18, wherein the proximal shaft
member defines a first clevis arm and a second clevis arm at a
distal end of the proximal shaft member, wherein the proximal
portion of the transducer assembly is positioned between the first
and second clevis arms when the shaft is straight.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] The present application is related to the following,
concurrently-filed U.S. patent applications, which are incorporated
herein by reference in their entirety: [0002] U.S. application Ser.
No. ______, entitled "Haptic Feedback Devices for Surgical Robot,"
Attorney Docket No. END7042USNP/110388; [0003] U.S. application
Ser. No. ______, entitled "Lockout Mechanism for Use with Robotic
Electrosurgical Device," Attorney Docket No. END7043USNP/110389;
[0004] U.S. application Ser. No. ______, entitled "Closed Feedback
Control for Electrosurgical Device," Attorney Docket No.
END7044USNP/110390; [0005] U.S. application Ser. No. ______,
entitled "Surgical Instruments with Articulating Shafts," Attorney
Docket No. END6423USNP/110392; [0006] U.S. application Ser. No.
______, entitled "Surgical Instruments with Articulating Shafts,"
Attorney Docket No. END7047USNP/110394; [0007] U.S. application
Ser. No. ______, entitled "Ultrasonic Surgical Instruments with
Distally Positioned Jaw Assemblies," Attorney Docket No.
END7048USNP/110395; [0008] U.S. application Ser. No. ______,
entitled "Surgical Instruments with Articulating Shafts," Attorney
Docket No. END7049USNP/110396; [0009] U.S. application Ser. No.
______, entitled "Ultrasonic Surgical Instruments with Control
Mechanisms," Attorney Docket No. END7050USNP/110397; and [0010]
U.S. application Ser. No. ______, entitled "Surgical Instruments
With Fluid Management System" Attorney Docket No.
END7051USNP/110399.
BACKGROUND
[0011] Various embodiments are directed to surgical instruments
including ultrasonic instruments with distally positioned
transducers.
[0012] Ultrasonic surgical devices, such as ultrasonic scalpels,
are used in many applications in surgical procedures by virtue of
their unique performance characteristics. Depending upon specific
device configurations and operational parameters, ultrasonic
surgical devices can provide substantially simultaneous transection
of tissue and homeostasis by coagulation, desirably minimizing
patient trauma. An ultrasonic surgical device comprises a
proximally-positioned ultrasonic transducer and an instrument
coupled to the ultrasonic transducer having a distally-mounted end
effector comprising an ultrasonic blade to cut and seal tissue. The
end effector is typically coupled either to a handle and/or a
robotic surgical implement via a shaft. The blade is acoustically
coupled to the transducer via a waveguide extending through the
shaft. Ultrasonic surgical devices of this nature can be configured
for open surgical use, laparoscopic, or endoscopic surgical
procedures including robotic-assisted procedures.
[0013] Ultrasonic energy cuts and coagulates tissue using
temperatures lower than those used in electrosurgical procedures.
Vibrating at high frequencies (e.g., 55,500 times per second), the
ultrasonic blade denatures protein in the tissue to form a sticky
coagulum. Pressure exerted on tissue by the blade surface collapses
blood vessels and allows the coagulum to form a hemostatic seal. A
surgeon can control the cutting speed and coagulation by the force
applied to the tissue by the end effector, the time over which the
force is applied and the selected excursion level of the end
effector.
[0014] With respect to both ultrasonic and electrosurgical devices,
it is often desirable for clinicians to articulate a distal portion
of the instrument shaft in order to direct the application of
ultrasonic and/or RF energy. Bringing about and controlling such
articulation, however, is often a considerable challenge.
DRAWINGS
[0015] The features of the various embodiments are set forth with
particularity in the appended claims. The various embodiments,
however, both as to organization and methods of operation, together
with advantages thereof, may best be understood by reference to the
following description, taken in conjunction with the accompanying
drawings as follows:
[0016] FIG. 1 illustrates one embodiment of a surgical system
including a surgical instrument and an ultrasonic generator.
[0017] FIG. 2 illustrates one embodiment of the surgical instrument
shown in FIG. 1.
[0018] FIG. 3 illustrates one embodiment of an ultrasonic end
effector.
[0019] FIG. 4 illustrates another embodiment of an ultrasonic end
effector.
[0020] FIG. 5 illustrates an exploded view of one embodiment of the
surgical instrument shown in FIG. 1.
[0021] FIG. 6 illustrates a cut-away view of one embodiment of the
surgical instrument shown in FIG. 1.
[0022] FIG. 7 illustrates various internal components of one
embodiment of the surgical instrument shown in FIG. 1
[0023] FIG. 8 illustrates a top view of one embodiment of a
surgical system including a surgical instrument and an ultrasonic
generator.
[0024] FIG. 9 illustrates one embodiment of a rotation assembly
included in one example embodiment of the surgical instrument of
FIG. 1.
[0025] FIG. 10 illustrates one embodiment of a surgical system
including a surgical instrument having a single element end
effector.
[0026] FIG. 11 illustrates a block diagram of one embodiment of a
robotic surgical system.
[0027] FIG. 12 illustrates one embodiment of a robotic arm
cart.
[0028] FIG. 13 illustrates one embodiment of the robotic
manipulator of the robotic arm cart of FIG. 12.
[0029] FIG. 14 illustrates one embodiment of a robotic arm cart
having an alternative set-up joint structure.
[0030] FIG. 15 illustrates one embodiment of a controller that may
be used in conjunction with a robotic arm cart, such as the robotic
arm carts of FIGS. 11-14.
[0031] FIG. 16 illustrates one embodiment of an ultrasonic surgical
instrument adapted for use with a robotic system.
[0032] FIG. 25 illustrates one embodiment of an electrosurgical
instrument adapted for use with a robotic system.
[0033] FIG. 17 illustrates one embodiment of an instrument drive
assembly that may be coupled to a surgical manipulators to receive
and control the surgical instrument shown in FIG. 16.
[0034] FIG. 18 illustrates another view of the instrument drive
assembly embodiment of FIG. 26 including the surgical instrument of
FIG. 16.
[0035] FIG. 28 illustrates another view of the instrument drive
assembly embodiment of FIG. 26 including the electrosurgical
instrument of FIG. 25.
[0036] FIGS. 19-21 illustrate additional views of the adapter
portion of the instrument drive assembly embodiment of FIG. 26.
[0037] FIGS. 22-24 illustrate one embodiment of the instrument
mounting portion of FIG. 16 showing components for translating
motion of the driven elements into motion of the surgical
instrument.
[0038] FIGS. 25-27 illustrate an alternate embodiment of the
instrument mounting portion of FIG. 16 showing an alternate example
mechanism for translating rotation of the driven elements into
rotational motion about the axis of the shaft and an alternate
example mechanism for generating reciprocating translation of one
or more members along the axis of the shaft.
[0039] FIGS. 28-32 illustrate an alternate embodiment of the
instrument mounting portion FIG. 16 showing another alternate
example mechanism for translating rotation of the driven elements
into rotational motion about the axis of the shaft.
[0040] FIGS. 33-36A illustrate an alternate embodiment of the
instrument mounting portion showing an alternate example mechanism
for differential translation of members along the axis of the shaft
(e.g., for articulation).
[0041] FIGS. 36B-36C illustrate one embodiment of a tool mounting
portion comprising internal power and energy sources.
[0042] FIG. 37 illustrates one embodiment of an articulatable
surgical instrument comprising a distally positioned ultrasonic
transducer assembly.
[0043] FIG. 38 illustrates one embodiment of the shaft and end
effector of FIG. 37 used in conjunction with an instrument mounting
portion of a robotic surgical system.
[0044] FIG. 39 illustrates a cut-away view of one embodiment of the
shaft and end effector of FIGS. 37-38.
[0045] FIGS. 40-40A illustrate one embodiment for driving
differential translation of the control members of FIG. 39 in
conjunction with a manual instrument, such as the instrument of
FIGS. 37-38.
[0046] FIG. 41 illustrates a cut-away view of one embodiment of the
ultrasonic transducer assembly of FIGS. 37-38.
[0047] FIG. 42 illustrates one embodiment of the ultrasonic
transducer assembly and clamp arm of FIGS. 37-38 arranged as part
of a four-bar linkage.
[0048] FIG. 43 illustrates a side view of one embodiment of the
ultrasonic transducer assembly and clamp arm, arranged as
illustrated in FIG. 42, coupled to the distal shaft portion, and in
an open position.
[0049] FIG. 44 illustrates a side view of one embodiment of the
ultrasonic transducer assembly and clamp arm of FIGS. 37-38,
arranged as illustrated in FIG. 42, coupled to the distal shaft
portion and in a closed position.
[0050] FIGS. 45-46 illustrate side views of one embodiment of the
ultrasonic transducer assembly and clamp arm of FIGS. 37-38,
arranged as illustrated in FIG. 42, including proximal portions of
the shaft.
[0051] FIGS. 47-48 illustrate one embodiment of an end effector
having an alternately shaped ultrasonic blade and clamp arm.
[0052] FIG. 49 illustrates one embodiment of another end effector
comprising a flexible ultrasonic transducer assembly.
[0053] FIG. 50 shows one embodiment of a manual surgical instrument
having a transducer assembly extending proximally from the
articulation joint.
[0054] FIG. 51 illustrates a close up of the transducer assembly,
distal shaft portion, articulation joint and end effector arranged
as illustrated in FIG. 50.
[0055] FIG. 52 illustrates one embodiment of the articulation joint
with the distal shaft portion and proximal shaft portion removed to
show one example embodiment for articulating the shaft and
actuating the haw member.
[0056] FIG. 53 illustrates one embodiment of a manual surgical
instrument comprising a shaft having an articulatable, rotatable
end effector.
[0057] FIG. 54 illustrates one embodiment of the articulation lever
of the instrument of FIG. 53 coupled to control members.
[0058] FIG. 55 illustrates one embodiment of the instrument showing
a keyed connection between the end effector rotation dial and the
central shaft member.
[0059] FIG. 56 illustrates one embodiment of the shaft of FIG. 53
focusing on the articulation joint.
[0060] FIG. 57 illustrates one embodiment of the central shaft
member made of hinged mechanical components.
[0061] FIG. 58 illustrates one embodiment of the shaft of FIG. 53
comprising a distal shaft portion and a proximal shaft portion.
[0062] FIG. 59 illustrates one embodiment of the shaft of and end
effector of FIG. 53 illustrating a coupling between the inner shaft
member and the clamp arm.
[0063] FIGS. 60-61 illustrate a control mechanism for a surgical
instrument in which articulation and rotation of the end effector
1312 are motorized.
[0064] FIGS. 62-63 illustrate one embodiment of a shaft that may be
utilized with any of the various surgical instruments described
herein.
[0065] FIG. 64 illustrates one embodiment of a shaft that may be
articulated utilizing a cable and pulley mechanism.
[0066] FIG. 65 illustrates one embodiment of the shaft of FIG. 64
showing additional details of how the distal shaft portion may be
articulated.
[0067] FIG. 66 illustrates one embodiment of an end effector that
may be utilized with any of the various instruments and/or shafts
described herein.
[0068] FIG. 67 illustrates one embodiment of the shaft of FIG. 64
coupled to an alternate pulley-driven end effector.
[0069] FIG. 68 illustrates one embodiment of the end effector.
DESCRIPTION
[0070] Example embodiments described herein are directed to
articulating ultrasonic surgical instruments, shafts thereof, and
methods of using the same. In various example embodiments, an
ultrasonic instrument comprises a distally positioned end effector
comprising an ultrasonic blade. The ultrasonic blade may be driven
by a distally positioned ultrasonic transducer assembly. A shaft of
the instrument may comprise proximal and distal shaft members
pivotably coupled to one another at an articulation joint. The end
effector may be coupled to a distal portion of the distal shaft
member such that the end effector (and at least a portion of the
distal shaft member) are articulatable about a longitudinal axis of
the shaft. To facilitate articulation, the distally positioned
ultrasonic transducer assembly may be positioned partially or
completely distal from the articulation joint. In this way, the
ultrasonic blade may be acoustically coupled to the ultrasonic
transducer assembly such that neither the ultrasonic blade itself
nor any intermediate waveguide spans the articulation joint.
[0071] Reference will now be made in detail to several embodiments,
including embodiments showing example implementations of manual and
robotic surgical instruments with end effectors comprising
ultrasonic and/or electrosurgical elements. Wherever practicable
similar or like reference numbers may be used in the figures and
may indicate similar or like functionality. The figures depict
example embodiments of the disclosed surgical instruments and/or
methods of use for purposes of illustration only. One skilled in
the art will readily recognize from the following description that
alternative example embodiments of the structures and methods
illustrated herein may be employed without departing from the
principles described herein.
[0072] FIG. 1 is a right side view of one embodiment of an
ultrasonic surgical instrument 10. In the illustrated embodiment,
the ultrasonic surgical instrument 10 may be employed in various
surgical procedures including endoscopic or traditional open
surgical procedures. In one example embodiment, the ultrasonic
surgical instrument 10 comprises a handle assembly 12, an elongated
shaft assembly 14, and an ultrasonic transducer 16. The handle
assembly 12 comprises a trigger assembly 24, a distal rotation
assembly 13, and a switch assembly 28. The elongated shaft assembly
14 comprises an end effector assembly 26, which comprises elements
to dissect tissue or mutually grasp, cut, and coagulate vessels
and/or tissue, and actuating elements to actuate the end effector
assembly 26. The handle assembly 12 is adapted to receive the
ultrasonic transducer 16 at the proximal end. The ultrasonic
transducer 16 is mechanically engaged to the elongated shaft
assembly 14 and portions of the end effector assembly 26. The
ultrasonic transducer 16 is electrically coupled to a generator 20
via a cable 22. Although the majority of the drawings depict a
multiple end effector assembly 26 for use in connection with
laparoscopic surgical procedures, the ultrasonic surgical
instrument 10 may be employed in more traditional open surgical
procedures and in other embodiments, may be configured for use in
endoscopic procedures. For the purposes herein, the ultrasonic
surgical instrument 10 is described in terms of an endoscopic
instrument; however, it is contemplated that an open and/or
laparoscopic version of the ultrasonic surgical instrument 10 also
may include the same or similar operating components and features
as described herein.
[0073] In various embodiments, the generator 20 comprises several
functional elements, such as modules and/or blocks. Different
functional elements or modules may be configured for driving
different kinds of surgical devices. For example, an ultrasonic
generator module 21 may drive an ultrasonic device, such as the
ultrasonic surgical instrument 10. In some example embodiments, the
generator 20 also comprises an electrosurgery/RF generator module
23 for driving an electrosurgical device (or an electrosurgical
embodiment of the ultrasonic surgical instrument 10). In the
example embodiment illustrated in FIG. 1, the generator 20 includes
a control system 25 integral with the generator 20, and a foot
switch 29 connected to the generator via a cable 27. The generator
20 may also comprise a triggering mechanism for activating a
surgical instrument, such as the instrument 10. The triggering
mechanism may include a power switch (not shown) as well as a foot
switch 29. When activated by the foot switch 29, the generator 20
may provide energy to drive the acoustic assembly of the surgical
instrument 10 and to drive the end effector 18 at a predetermined
excursion level. The generator 20 drives or excites the acoustic
assembly at any suitable resonant frequency of the acoustic
assembly and/or derives the therapeutic/sub-therapeutic
electromagnetic/RF energy.
[0074] In one embodiment, the electrosurgical/RF generator module
23 may be implemented as an electrosurgery unit (ESU) capable of
supplying power sufficient to perform bipolar electrosurgery using
radio frequency (RF) energy. In one embodiment, the ESU can be a
bipolar ERBE ICC 350 sold by ERBE USA, Inc. of Marietta, Ga. In
bipolar electrosurgery applications, as previously discussed, a
surgical instrument having an active electrode and a return
electrode can be utilized, wherein the active electrode and the
return electrode can be positioned against, or adjacent to, the
tissue to be treated such that current can flow from the active
electrode to the return electrode through the tissue. Accordingly,
the electrosurgical/RF module 23 generator may be configured for
therapeutic purposes by applying electrical energy to the tissue T
sufficient for treating the tissue (e.g., cauterization).
[0075] In one embodiment, the electrosurgical/RF generator module
23 may be configured to deliver a subtherapeutic RF signal to
implement a tissue impedance measurement module. In one embodiment,
the electrosurgical/RF generator module 23 comprises a bipolar
radio frequency generator as described in more detail below. In one
embodiment, the electrosurgical/RF generator module 12 may be
configured to monitor electrical impedance Z, of tissue T and to
control the characteristics of time and power level based on the
tissue T by way of a return electrode provided on a clamp member of
the end effector assembly 26. Accordingly, the electrosurgical/RF
generator module 23 may be configured for subtherapeutic purposes
for measuring the impedance or other electrical characteristics of
the tissue T. Techniques and circuit configurations for measuring
the impedance or other electrical characteristics of tissue T are
discussed in more detail in commonly assigned U.S. Patent
Publication No. 2011/0015631, titled "Electrosurgical Generator for
Ultrasonic Surgical Instrument," the disclosure of which is herein
incorporated by reference in its entirety.
[0076] A suitable ultrasonic generator module 21 may be configured
to functionally operate in a manner similar to the GEN300 sold by
Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio as is disclosed in
one or more of the following U.S. patents, all of which are
incorporated by reference herein: U.S. Pat. No. 6,480,796 (Method
for Improving the Start Up of an Ultrasonic System Under Zero Load
Conditions); U.S. Pat. No. 6,537,291 (Method for Detecting Blade
Breakage Using Rate and/or Impedance Information); U.S. Pat. No.
6,662,127 (Method for Detecting Presence of a Blade in an
Ultrasonic System); U.S. Pat. No. 6,977,495 (Detection Circuitry
for Surgical Handpiece System); U.S. Pat. No. 7,077,853 (Method for
Calculating Transducer Capacitance to Determine Transducer
Temperature); U.S. Pat. No. 7,179,271 (Method for Driving an
Ultrasonic System to Improve Acquisition of Blade Resonance
Frequency at Startup); and U.S. Pat. No. 7,273,483 (Apparatus and
Method for Alerting Generator Function in an Ultrasonic Surgical
System).
[0077] It will be appreciated that in various embodiments, the
generator 20 may be configured to operate in several modes. In one
mode, the generator 20 may be configured such that the ultrasonic
generator module 21 and the electrosurgical/RF generator module 23
may be operated independently.
[0078] For example, the ultrasonic generator module 21 may be
activated to apply ultrasonic energy to the end effector assembly
26 and subsequently, either therapeutic sub-therapeutic RF energy
may be applied to the end effector assembly 26 by the
electrosurgical/RF generator module 23. As previously discussed,
the sub-therapeutic electrosurgical/RF energy may be applied to
tissue clamped between claim elements of the end effector assembly
26 to measure tissue impedance to control the activation, or modify
the activation, of the ultrasonic generator module 21. Tissue
impedance feedback from the application of the sub-therapeutic
energy also may be employed to activate a therapeutic level of the
electrosurgical/RF generator module 23 to seal the tissue (e.g.,
vessel) clamped between claim elements of the end effector assembly
26.
[0079] In another embodiment, the ultrasonic generator module 21
and the electrosurgical/RF generator module 23 may be activated
simultaneously. In one example, the ultrasonic generator module 21
is simultaneously activated with a sub-therapeutic RF energy level
to measure tissue impedance simultaneously while the ultrasonic
blade of the end effector assembly 26 cuts and coagulates the
tissue (or vessel) clamped between the clamp elements of the end
effector assembly 26. Such feedback may be employed, for example,
to modify the drive output of the ultrasonic generator module 21.
In another example, the ultrasonic generator module 21 may be
driven simultaneously with electrosurgical/RF generator module 23
such that the ultrasonic blade portion of the end effector assembly
26 is employed for cutting the damaged tissue while the
electrosurgical/RF energy is applied to electrode portions of the
end effector clamp assembly 26 for sealing the tissue (or
vessel).
[0080] When the generator 20 is activated via the triggering
mechanism, electrical energy is continuously applied by the
generator 20 to a transducer stack or assembly of the acoustic
assembly. In another embodiment, electrical energy is
intermittently applied (e.g., pulsed) by the generator 20. A
phase-locked loop in the control system of the generator 20 may
monitor feedback from the acoustic assembly. The phase lock loop
adjusts the frequency of the electrical energy sent by the
generator 20 to match the resonant frequency of the selected
longitudinal mode of vibration of the acoustic assembly. In
addition, a second feedback loop in the control system 25 maintains
the electrical current supplied to the acoustic assembly at a
pre-selected constant level in order to achieve substantially
constant excursion at the end effector 18 of the acoustic assembly.
In yet another embodiment, a third feedback loop in the control
system 25 monitors impedance between electrodes located in the end
effector assembly 26. Although FIGS. 1-9 show a manually operated
ultrasonic surgical instrument, it will be appreciated that
ultrasonic surgical instruments may also be used in robotic
applications, for example, as described herein as well as
combinations of manual and robotic applications.
[0081] In ultrasonic operation mode, the electrical signal supplied
to the acoustic assembly may cause the distal end of the end
effector 18, to vibrate longitudinally in the range of, for
example, approximately 20 kHz to 250 kHz. According to various
embodiments, the blade 22 may vibrate in the range of about 54 kHz
to 56 kHz, for example, at about 55.5 kHz. In other embodiments,
the blade 22 may vibrate at other frequencies including, for
example, about 31 kHz or about 80 kHz. The excursion of the
vibrations at the blade can be controlled by, for example,
controlling the amplitude of the electrical signal applied to the
transducer assembly of the acoustic assembly by the generator 20.
As noted above, the triggering mechanism of the generator 20 allows
a user to activate the generator 20 so that electrical energy may
be continuously or intermittently supplied to the acoustic
assembly. The generator 20 also has a power line for insertion in
an electro-surgical unit or conventional electrical outlet. It is
contemplated that the generator 20 can also be powered by a direct
current (DC) source, such as a battery. The generator 20 can
comprise any suitable generator, such as Model No. GEN04, and/or
Model No. GEN11 available from Ethicon Endo-Surgery, Inc.
[0082] FIG. 2 is a left perspective view of one example embodiment
of the ultrasonic surgical instrument 10 showing the handle
assembly 12, the distal rotation assembly 13, the elongated shaft
assembly 14, and the end effector assembly 26. In the illustrated
embodiment the elongated shaft assembly 14 comprises a distal end
52 dimensioned to mechanically engage the end effector assembly 26
and a proximal end 50 that mechanically engages the handle assembly
12 and the distal rotation assembly 13. The proximal end 50 of the
elongated shaft assembly 14 is received within the handle assembly
12 and the distal rotation assembly 13. More details relating to
the connections between the elongated shaft assembly 14, the handle
assembly 12, and the distal rotation assembly 13 are provided in
the description of FIGS. 5 and 7.
[0083] In the illustrated embodiment, the trigger assembly 24
comprises a trigger 32 that operates in conjunction with a fixed
handle 34. The fixed handle 34 and the trigger 32 are ergonomically
formed and adapted to interface comfortably with the user. The
fixed handle 34 is integrally associated with the handle assembly
12. The trigger 32 is pivotally movable relative to the fixed
handle 34 as explained in more detail below with respect to the
operation of the ultrasonic surgical instrument 10. The trigger 32
is pivotally movable in direction 33A toward the fixed handle 34
when the user applies a squeezing force against the trigger 32. A
spring element 98 (FIG. 5) causes the trigger 32 to pivotally move
in direction 33B when the user releases the squeezing force against
the trigger 32.
[0084] In one example embodiment, the trigger 32 comprises an
elongated trigger hook 36, which defines an aperture 38 between the
elongated trigger hook 36 and the trigger 32. The aperture 38 is
suitably sized to receive one or multiple fingers of the user
therethrough. The trigger 32 also may comprise a resilient portion
32a molded over the trigger 32 substrate. The overmolded resilient
portion 32a is formed to provide a more comfortable contact surface
for control of the trigger 32 in outward direction 33B. In one
example embodiment, the overmolded resilient portion 32a may be
provided over a portion of the elongated trigger hook 36. The
proximal surface of the elongated trigger hook 32 remains uncoated
or coated with a non-resilient substrate to enable the user to
easily slide their fingers in and out of the aperture 38. In
another embodiment, the geometry of the trigger forms a fully
closed loop which defines an aperture suitably sized to receive one
or multiple fingers of the user therethrough. The fully closed loop
trigger also may comprise a resilient portion molded over the
trigger substrate.
[0085] In one example embodiment, the fixed handle 34 comprises a
proximal contact surface 40 and a grip anchor or saddle surface 42.
The saddle surface 42 rests on the web where the thumb and the
index finger are joined on the hand. The proximal contact surface
40 has a pistol grip contour that receives the palm of the hand in
a normal pistol grip with no rings or apertures. The profile curve
of the proximal contact surface 40 may be contoured to accommodate
or receive the palm of the hand. A stabilization tail 44 is located
towards a more proximal portion of the handle assembly 12. The
stabilization tail 44 may be in contact with the uppermost web
portion of the hand located between the thumb and the index finger
to stabilize the handle assembly 12 and make the handle assembly 12
more controllable.
[0086] In one example embodiment, the switch assembly 28 may
comprise a toggle switch 30. The toggle switch 30 may be
implemented as a single component with a central pivot 304 located
within inside the handle assembly 12 to eliminate the possibility
of simultaneous activation. In one example embodiment, the toggle
switch 30 comprises a first projecting knob 30a and a second
projecting knob 30b to set the power setting of the ultrasonic
transducer 16 between a minimum power level (e.g., MIN) and a
maximum power level (e.g., MAX). In another embodiment, the rocker
switch may pivot between a standard setting and a special setting.
The special setting may allow one or more special programs to be
implemented by the device. The toggle switch 30 rotates about the
central pivot as the first projecting knob 30a and the second
projecting knob 30b are actuated. The one or more projecting knobs
30a, 30b are coupled to one or more arms that move through a small
arc and cause electrical contacts to close or open an electric
circuit to electrically energize or de-energize the ultrasonic
transducer 16 in accordance with the activation of the first or
second projecting knobs 30a, 30b. The toggle switch 30 is coupled
to the generator 20 to control the activation of the ultrasonic
transducer 16. The toggle switch 30 comprises one or more
electrical power setting switches to activate the ultrasonic
transducer 16 to set one or more power settings for the ultrasonic
transducer 16. The forces required to activate the toggle switch 30
are directed substantially toward the saddle point 42, thus
avoiding any tendency of the instrument to rotate in the hand when
the toggle switch 30 is activated.
[0087] In one example embodiment, the first and second projecting
knobs 30a, 30b are located on the distal end of the handle assembly
12 such that they can be easily accessible by the user to activate
the power with minimal, or substantially no, repositioning of the
hand grip, making it suitable to maintain control and keep
attention focused on the surgical site (e.g., a monitor in a
laparoscopic procedure) while activating the toggle switch 30. The
projecting knobs 30a, 30b may be configured to wrap around the side
of the handle assembly 12 to some extent to be more easily
accessible by variable finger lengths and to allow greater freedom
of access to activation in awkward positions or for shorter
fingers.
[0088] In the illustrated embodiment, the first projecting knob 30a
comprises a plurality of tactile elements 30c, e.g., textured
projections or "bumps" in the illustrated embodiment, to allow the
user to differentiate the first projecting knob 30a from the second
projecting knob 30b. It will be appreciated by those skilled in the
art that several ergonomic features may be incorporated into the
handle assembly 12. Such ergonomic features are described in U.S.
Pat. App. Pub. No. 2009/0105750 entitled "Ergonomic Surgical
Instruments" which is incorporated by reference herein in its
entirety.
[0089] In one example embodiment, the toggle switch 30 may be
operated by the hand of the user. The user may easily access the
first and second projecting knobs 30a, 30b at any point while also
avoiding inadvertent or unintentional activation at any time. The
toggle switch 30 may readily operated with a finger to control the
power to the ultrasonic assembly 16 and/or to the ultrasonic
assembly 16. For example, the index finger may be employed to
activate the first contact portion 30a to turn on the ultrasonic
assembly 16 to a maximum (MAX) power level. The index finger may be
employed to activate the second contact portion 30b to turn on the
ultrasonic assembly 16 to a minimum (MIN) power level. In another
embodiment, the rocker switch may pivot the instrument 10 between a
standard setting and a special setting. The special setting may
allow one or more special programs to be implemented by the
instrument 10. The toggle switch 30 may be operated without the
user having to look at the first or second projecting knob 30a,
30b. For example, the first projecting knob 30a or the second
projecting knob 30b may comprise a texture or projections to
tactilely differentiate between the first and second projecting
knobs 30a, 30b without looking.
[0090] In one example embodiment, the distal rotation assembly 13
is rotatable without limitation in either direction about a
longitudinal axis "T." The distal rotation assembly 13 is
mechanically engaged to the elongated shaft assembly 14. The distal
rotation assembly 13 is located on a distal end of the handle
assembly 12. The distal rotation assembly 13 comprises a
cylindrical hub 46 and a rotation knob 48 formed over the hub 46.
The hub 46 mechanically engages the elongated shaft assembly 14.
The rotation knob 48 may comprise fluted polymeric features and may
be engaged by a finger (e.g., an index finger) to rotate the
elongated shaft assembly 14. The hub 46 may comprise a material
molded over the primary structure to form the rotation knob 48. The
rotation knob 48 may be overmolded over the hub 46. The hub 46
comprises an end cap portion 46a that is exposed at the distal end.
The end cap portion 46a of the hub 46 may contact the surface of a
trocar during laparoscopic procedures. The hub 46 may be formed of
a hard durable plastic such as polycarbonate to alleviate any
friction that may occur between the end cap portion 46a and the
trocar. The rotation knob 48 may comprise "scallops" or flutes
formed of raised ribs 48a and concave portions 48b located between
the ribs 48a to provide a more precise rotational grip. In one
example embodiment, the rotation knob 48 may comprise a plurality
of flutes (e.g., three or more flutes). In other embodiments, any
suitable number of flutes may be employed. The rotation knob 48 may
be formed of a softer polymeric material overmolded onto the hard
plastic material. For example, the rotation knob 48 may be formed
of pliable, resilient, flexible polymeric materials including
Versaflex.RTM. TPE alloys made by GLS Corporation, for example.
This softer overmolded material may provide a greater grip and more
precise control of the movement of the rotation knob 48. It will be
appreciated that any materials that provide adequate resistance to
sterilization, are biocompatible, and provide adequate frictional
resistance to surgical gloves may be employed to form the rotation
knob 48.
[0091] In one example embodiment, the handle assembly 12 is formed
from two (2) housing portions or shrouds comprising a first portion
12a and a second portion 12b. From the perspective of a user
viewing the handle assembly 12 from the distal end towards the
proximal end, the first portion 12a is considered the right portion
and the second portion 12b is considered the left portion. Each of
the first and second portions 12a, 12b includes a plurality of
interfaces 69 (FIG. 5) dimensioned to mechanically align and engage
each another to form the handle assembly 12 and enclosing the
internal working components thereof. The fixed handle 34, which is
integrally associated with the handle assembly 12, takes shape upon
the assembly of the first and second portions 12a and 12b of the
handle assembly 12. A plurality of additional interfaces (not
shown) may be disposed at various points around the periphery of
the first and second portions 12a and 12b of the handle assembly 12
for ultrasonic welding purposes, e.g., energy direction/deflection
points. The first and second portions 12a and 12b (as well as the
other components described below) may be assembled together in any
fashion known in the art. For example, alignment pins, snap-like
interfaces, tongue and groove interfaces, locking tabs, adhesive
ports, may all be utilized either alone or in combination for
assembly purposes.
[0092] In one example embodiment, the elongated shaft assembly 14
comprises a proximal end 50 adapted to mechanically engage the
handle assembly 12 and the distal rotation assembly 13; and a
distal end 52 adapted to mechanically engage the end effector
assembly 26. The elongated shaft assembly 14 comprises an outer
tubular sheath 56 and a reciprocating tubular actuating member 58
located within the outer tubular sheath 56. The proximal end of the
tubular reciprocating tubular actuating member 58 is mechanically
engaged to the trigger 32 of the handle assembly 12 to move in
either direction 60A or 60B in response to the actuation and/or
release of the trigger 32. The pivotably moveable trigger 32 may
generate reciprocating motion along the longitudinal axis "T." Such
motion may be used, for example, to actuate the jaws or clamping
mechanism of the end effector assembly 26. A series of linkages
translate the pivotal rotation of the trigger 32 to axial movement
of a yoke coupled to an actuation mechanism, which controls the
opening and closing of the jaws of the clamping mechanism of the
end effector assembly 26. The distal end of the tubular
reciprocating tubular actuating member 58 is mechanically engaged
to the end effector assembly 26. In the illustrated embodiment, the
distal end of the tubular reciprocating tubular actuating member 58
is mechanically engaged to a clamp arm assembly 64, which is
pivotable about a pivot point 70, to open and close the clamp arm
assembly 64 in response to the actuation and/or release of the
trigger 32. For example, in the illustrated embodiment, the clamp
arm assembly 64 is movable in direction 62A from an open position
to a closed position about a pivot point 70 when the trigger 32 is
squeezed in direction 33A. The clamp arm assembly 64 is movable in
direction 62B from a closed position to an open position about the
pivot point 70 when the trigger 32 is released or outwardly
contacted in direction 33B.
[0093] In one example embodiment, the end effector assembly 26 is
attached at the distal end 52 of the elongated shaft assembly 14
and includes a clamp arm assembly 64 and a blade 66. The jaws of
the clamping mechanism of the end effector assembly 26 are formed
by clamp arm assembly 64 and the blade 66. The blade 66 is
ultrasonically actuatable and is acoustically coupled to the
ultrasonic transducer 16. The trigger 32 on the handle assembly 12
is ultimately connected to a drive assembly, which together,
mechanically cooperate to effect movement of the clamp arm assembly
64. Squeezing the trigger 32 in direction 33A moves the clamp arm
assembly 64 in direction 62A from an open position, wherein the
clamp arm assembly 64 and the blade 66 are disposed in a spaced
relation relative to one another, to a clamped or closed position,
wherein the clamp arm assembly 64 and the blade 66 cooperate to
grasp tissue therebetween. The clamp arm assembly 64 may comprise a
clamp pad 69 to engage tissue between the blade 66 and the clamp
arm 64. Releasing the trigger 32 in direction 33B moves the clamp
arm assembly 64 in direction 62B from a closed relationship, to an
open position, wherein the clamp arm assembly 64 and the blade 66
are disposed in a spaced relation relative to one another.
[0094] The proximal portion of the handle assembly 12 comprises a
proximal opening 68 to receive the distal end of the ultrasonic
assembly 16. The ultrasonic assembly 16 is inserted in the proximal
opening 68 and is mechanically engaged to the elongated shaft
assembly 14.
[0095] In one example embodiment, the elongated trigger hook 36
portion of the trigger 32 provides a longer trigger lever with a
shorter span and rotation travel. The longer lever of the elongated
trigger hook 36 allows the user to employ multiple fingers within
the aperture 38 to operate the elongated trigger hook 36 and cause
the trigger 32 to pivot in direction 33B to open the jaws of the
end effector assembly 26. For example, the user may insert three
fingers (e.g., the middle, ring, and little fingers) in the
aperture 38. Multiple fingers allows the surgeon to exert higher
input forces on the trigger 32 and the elongated trigger hook 326
to activate the end effector assembly 26. The shorter span and
rotation travel creates a more comfortable grip when closing or
squeezing the trigger 32 in direction 33A or when opening the
trigger 32 in the outward opening motion in direction 33B lessening
the need to extend the fingers further outward. This substantially
lessens hand fatigue and strain associated with the outward opening
motion of the trigger 32 in direction 33B. The outward opening
motion of the trigger may be spring-assisted by spring element 98
(FIG. 5) to help alleviate fatigue. The opening spring force is
sufficient to assist the ease of opening, but not strong enough to
adversely impact the tactile feedback of tissue tension during
spreading dissection.
[0096] For example, during a surgical procedure either the index
finger may be used to control the rotation of the elongated shaft
assembly 14 to locate the jaws of the end effector assembly 26 in a
suitable orientation. The middle and/or the other lower fingers may
be used to squeeze the trigger 32 and grasp tissue within the jaws.
Once the jaws are located in the desired position and the jaws are
clamped against the tissue, the index finger can be used to
activate the toggle switch 30 to adjust the power level of the
ultrasonic transducer 16 to treat the tissue. Once the tissue has
been treated, the user the may release the trigger 32 by pushing
outwardly in the distal direction against the elongated trigger
hook 36 with the middle and/or lower fingers to open the jaws of
the end effector assembly 26. This basic procedure may be performed
without the user having to adjust their grip of the handle assembly
12.
[0097] FIGS. 3-4 illustrate the connection of the elongated shaft
assembly 14 relative to the end effector assembly 26. As previously
described, in the illustrated embodiment, the end effector assembly
26 comprises a clamp arm assembly 64 and a blade 66 to form the
jaws of the clamping mechanism. The blade 66 may be an
ultrasonically actuatable blade acoustically coupled to the
ultrasonic transducer 16. The trigger 32 is mechanically connected
to a drive assembly. Together, the trigger 32 and the drive
assembly mechanically cooperate to move the clamp arm assembly 64
to an open position in direction 62A wherein the clamp arm assembly
64 and the blade 66 are disposed in spaced relation relative to one
another, to a clamped or closed position in direction 62B wherein
the clamp arm assembly 64 and the blade 66 cooperate to grasp
tissue therebetween. The clamp arm assembly 64 may comprise a clamp
pad 69 to engage tissue between the blade 66 and the clamp arm 64.
The distal end of the tubular reciprocating tubular actuating
member 58 is mechanically engaged to the end effector assembly 26.
In the illustrated embodiment, the distal end of the tubular
reciprocating tubular actuating member 58 is mechanically engaged
to the clamp arm assembly 64, which is pivotable about the pivot
point 70, to open and close the clamp arm assembly 64 in response
to the actuation and/or release of the trigger 32. For example, in
the illustrated embodiment, the clamp arm assembly 64 is movable
from an open position to a closed position in direction 62B about a
pivot point 70 when the trigger 32 is squeezed in direction 33A.
The clamp arm assembly 64 is movable from a closed position to an
open position in direction 62A about the pivot point 70 when the
trigger 32 is released or outwardly contacted in direction 33B.
[0098] As previously discussed, the clamp arm assembly 64 may
comprise electrodes electrically coupled to the electrosurgical/RF
generator module 23 to receive therapeutic and/or sub-therapeutic
energy, where the electrosurgical/RF energy may be applied to the
electrodes either simultaneously or non simultaneously with the
ultrasonic energy being applied to the blade 66. Such energy
activations may be applied in any suitable combinations to achieve
a desired tissue effect in cooperation with an algorithm or other
control logic.
[0099] FIG. 5 is an exploded view of the ultrasonic surgical
instrument 10 shown in FIG. 2. In the illustrated embodiment, the
exploded view shows the internal elements of the handle assembly
12, the handle assembly 12, the distal rotation assembly 13, the
switch assembly 28, and the elongated shaft assembly 14. In the
illustrated embodiment, the first and second portions 12a, 12b mate
to form the handle assembly 12. The first and second portions 12a,
12b each comprises a plurality of interfaces 69 dimensioned to
mechanically align and engage one another to form the handle
assembly 12 and enclose the internal working components of the
ultrasonic surgical instrument 10. The rotation knob 48 is
mechanically engaged to the outer tubular sheath 56 so that it may
be rotated in circular direction 54 up to 360.degree.. The outer
tubular sheath 56 is located over the reciprocating tubular
actuating member 58, which is mechanically engaged to and retained
within the handle assembly 12 via a plurality of coupling elements
72. The coupling elements 72 may comprise an O-ring 72a, a tube
collar cap 72b, a distal washer 72c, a proximal washer 72d, and a
thread tube collar 72e. The reciprocating tubular actuating member
58 is located within a reciprocating yoke 84, which is retained
between the first and second portions 12a, 12b of the handle
assembly 12. The yoke 84 is part of a reciprocating yoke assembly
88. A series of linkages translate the pivotal rotation of the
elongated trigger hook 32 to the axial movement of the
reciprocating yoke 84, which controls the opening and closing of
the jaws of the clamping mechanism of the end effector assembly 26
at the distal end of the ultrasonic surgical instrument 10. In one
example embodiment, a four-link design provides mechanical
advantage in a relatively short rotation span, for example.
[0100] In one example embodiment, an ultrasonic transmission
waveguide 78 is disposed inside the reciprocating tubular actuating
member 58. The distal end 52 of the ultrasonic transmission
waveguide 78 is acoustically coupled (e.g., directly or indirectly
mechanically coupled) to the blade 66 and the proximal end 50 of
the ultrasonic transmission waveguide 78 is received within the
handle assembly 12. The proximal end 50 of the ultrasonic
transmission waveguide 78 is adapted to acoustically couple to the
distal end of the ultrasonic transducer 16 as discussed in more
detail below. The ultrasonic transmission waveguide 78 is isolated
from the other elements of the elongated shaft assembly 14 by a
protective sheath 80 and a plurality of isolation elements 82, such
as silicone rings. The outer tubular sheath 56, the reciprocating
tubular actuating member 58, and the ultrasonic transmission
waveguide 78 are mechanically engaged by a pin 74. The switch
assembly 28 comprises the toggle switch 30 and electrical elements
86a,b to electrically energize the ultrasonic transducer 16 in
accordance with the activation of the first or second projecting
knobs 30a, 30b.
[0101] In one example embodiment, the outer tubular sheath 56
isolates the user or the patient from the ultrasonic vibrations of
the ultrasonic transmission waveguide 78. The outer tubular sheath
56 generally includes a hub 76. The outer tubular sheath 56 is
threaded onto the distal end of the handle assembly 12. The
ultrasonic transmission waveguide 78 extends through the opening of
the outer tubular sheath 56 and the isolation elements 82 isolate
the ultrasonic transmission waveguide 24 from the outer tubular
sheath 56. The outer tubular sheath 56 may be attached to the
waveguide 78 with the pin 74. The hole to receive the pin 74 in the
waveguide 78 may occur nominally at a displacement node. The
waveguide 78 may screw or snap into the hand piece handle assembly
12 by a stud. Flat portions on the hub 76 may allow the assembly to
be torqued to a required level. In one example embodiment, the hub
76 portion of the outer tubular sheath 56 is preferably constructed
from plastic and the tubular elongated portion of the outer tubular
sheath 56 is fabricated from stainless steel. Alternatively, the
ultrasonic transmission waveguide 78 may comprise polymeric
material surrounding it to isolate it from outside contact.
[0102] In one example embodiment, the distal end of the ultrasonic
transmission waveguide 78 may be coupled to the proximal end of the
blade 66 by an internal threaded connection, preferably at or near
an antinode. It is contemplated that the blade 66 may be attached
to the ultrasonic transmission waveguide 78 by any suitable means,
such as a welded joint or the like. Although the blade 66 may be
detachable from the ultrasonic transmission waveguide 78, it is
also contemplated that the single element end effector (e.g., the
blade 66) and the ultrasonic transmission waveguide 78 may be
formed as a single unitary piece.
[0103] In one example embodiment, the trigger 32 is coupled to a
linkage mechanism to translate the rotational motion of the trigger
32 in directions 33A and 33B to the linear motion of the
reciprocating tubular actuating member 58 in corresponding
directions 60A and 60B. The trigger 32 comprises a first set of
flanges 98 with openings formed therein to receive a first yoke pin
92a. The first yoke pin 92a is also located through a set of
openings formed at the distal end of the yoke 84. The trigger 32
also comprises a second set of flanges 96 to receive a first end
92a of a link 92. A trigger pin 90 is received in openings formed
in the link 92 and the second set of flanges 96. The trigger pin 90
is received in the openings formed in the link 92 and the second
set of flanges 96 and is adapted to couple to the first and second
portions 12a, 12b of the handle assembly 12 to form a trigger pivot
point for the trigger 32. A second end 92b of the link 92 is
received in a slot 384 formed in a proximal end of the yoke 84 and
is retained therein by a second yoke pin 94b. As the trigger 32 is
pivotally rotated about the pivot point 190 formed by the trigger
pin 90, the yoke translates horizontally along longitudinal axis
"T" in a direction indicated by arrows 60A,B.
[0104] FIG. 8 illustrates one example embodiment of an ultrasonic
surgical instrument 10. In the illustrated embodiment, a
cross-sectional view of the ultrasonic transducer 16 is shown
within a partial cutaway view of the handle assembly 12. One
example embodiment of the ultrasonic surgical instrument 10
comprises the ultrasonic signal generator 20 coupled to the
ultrasonic transducer 16, comprising a hand piece housing 99, and
an ultrasonically actuatable single or multiple element end
effector assembly 26. As previously discussed, the end effector
assembly 26 comprises the ultrasonically actuatable blade 66 and
the clamp arm 64. The ultrasonic transducer 16, which is known as a
"Langevin stack", generally includes a transduction portion 100, a
first resonator portion or end-bell 102, and a second resonator
portion or fore-bell 104, and ancillary components. The total
construction of these components is a resonator. The ultrasonic
transducer 16 is preferably an integral number of one-half system
wavelengths (n.lamda./2; where "n" is any positive integer; e.g.,
n=1, 2, 3 . . . ) in length as will be described in more detail
later. An acoustic assembly 106 includes the ultrasonic transducer
16, a nose cone 108, a velocity transformer 118, and a surface
110.
[0105] In one example embodiment, the distal end of the end-bell
102 is connected to the proximal end of the transduction portion
100, and the proximal end of the fore-bell 104 is connected to the
distal end of the transduction portion 100. The fore-bell 104 and
the end-bell 102 have a length determined by a number of variables,
including the thickness of the transduction portion 100, the
density and modulus of elasticity of the material used to
manufacture the end-bell 102 and the fore-bell 22, and the resonant
frequency of the ultrasonic transducer 16. The fore-bell 104 may be
tapered inwardly from its proximal end to its distal end to amplify
the ultrasonic vibration amplitude as the velocity transformer 118,
or alternately may have no amplification. A suitable vibrational
frequency range may be about 20 Hz to 32 kHz and a well-suited
vibrational frequency range may be about 30-10 kHz. A suitable
operational vibrational frequency may be approximately 55.5 kHz,
for example.
[0106] In one example embodiment, the piezoelectric elements 112
may be fabricated from any suitable material, such as, for example,
lead zirconate-titanate, lead meta-niobate, lead titanate, barium
titanate, or other piezoelectric ceramic material. Each of positive
electrodes 114, negative electrodes 116, and the piezoelectric
elements 112 has a bore extending through the center. The positive
and negative electrodes 114 and 116 are electrically coupled to
wires 120 and 122, respectively. The wires 120 and 122 are encased
within the cable 22 and electrically connectable to the ultrasonic
signal generator 20.
[0107] The ultrasonic transducer 16 of the acoustic assembly 106
converts the electrical signal from the ultrasonic signal generator
20 into mechanical energy that results in primarily a standing
acoustic wave of longitudinal vibratory motion of the ultrasonic
transducer 16 and the blade 66 portion of the end effector assembly
26 at ultrasonic frequencies. In another embodiment, the vibratory
motion of the ultrasonic transducer may act in a different
direction. For example, the vibratory motion may comprise a local
longitudinal component of a more complicated motion of the tip of
the elongated shaft assembly 14. A suitable generator is available
as model number GEN11, from Ethicon Endo-Surgery, Inc., Cincinnati,
Ohio. When the acoustic assembly 106 is energized, a vibratory
motion standing wave is generated through the acoustic assembly
106. The ultrasonic surgical instrument 10 is designed to operate
at a resonance such that an acoustic standing wave pattern of
predetermined amplitude is produced. The amplitude of the vibratory
motion at any point along the acoustic assembly 106 depends upon
the location along the acoustic assembly 106 at which the vibratory
motion is measured. A minimum or zero crossing in the vibratory
motion standing wave is generally referred to as a node (i.e.,
where motion is minimal), and a local absolute value maximum or
peak in the standing wave is generally referred to as an anti-node
(e.g., where local motion is maximal). The distance between an
anti-node and its nearest node is one-quarter wavelength
(.lamda./4).
[0108] The wires 120 and 122 transmit an electrical signal from the
ultrasonic signal generator 20 to the positive electrodes 114 and
the negative electrodes 116. The piezoelectric elements 112 are
energized by the electrical signal supplied from the ultrasonic
signal generator 20 in response to an actuator 224, such as a foot
switch, for example, to produce an acoustic standing wave in the
acoustic assembly 106. The electrical signal causes disturbances in
the piezoelectric elements 112 in the form of repeated small
displacements resulting in large alternating compression and
tension forces within the material. The repeated small
displacements cause the piezoelectric elements 112 to expand and
contract in a continuous manner along the axis of the voltage
gradient, producing longitudinal waves of ultrasonic energy. The
ultrasonic energy is transmitted through the acoustic assembly 106
to the blade 66 portion of the end effector assembly 26 via a
transmission component or an ultrasonic transmission waveguide
portion 78 of the elongated shaft assembly 14.
[0109] In one example embodiment, in order for the acoustic
assembly 106 to deliver energy to the blade 66 portion of the end
effector assembly 26, all components of the acoustic assembly 106
must be acoustically coupled to the blade 66. The distal end of the
ultrasonic transducer 16 may be acoustically coupled at the surface
110 to the proximal end of the ultrasonic transmission waveguide 78
by a threaded connection such as a stud 124.
[0110] In one example embodiment, the components of the acoustic
assembly 106 are preferably acoustically tuned such that the length
of any assembly is an integral number of one-half wavelengths
(n.lamda./2), where the wavelength .lamda. is the wavelength of a
pre-selected or operating longitudinal vibration drive frequency
f.sub.d of the acoustic assembly 106. It is also contemplated that
the acoustic assembly 106 may incorporate any suitable arrangement
of acoustic elements.
[0111] In one example embodiment, the blade 66 may have a length
substantially equal to an integral multiple of one-half system
wavelengths (n.lamda./2). A distal end of the blade 66 may be
disposed near an antinode in order to provide the maximum
longitudinal excursion of the distal end. When the transducer
assembly is energized, the distal end of the blade 66 may be
configured to move in the range of, for example, approximately 10
to 500 microns peak-to-peak, and preferably in the range of about
30 to 64 microns at a predetermined vibrational frequency of 55
kHz, for example.
[0112] In one example embodiment, the blade 66 may be coupled to
the ultrasonic transmission waveguide 78. The blade 66 and the
ultrasonic transmission waveguide 78 as illustrated are formed as a
single unit construction from a material suitable for transmission
of ultrasonic energy. Examples of such materials include Ti6Al4V
(an alloy of Titanium including Aluminum and Vanadium), Aluminum,
Stainless Steel, or other suitable materials. Alternately, the
blade 66 may be separable (and of differing composition) from the
ultrasonic transmission waveguide 78, and coupled by, for example,
a stud, weld, glue, quick connect, or other suitable known methods.
The length of the ultrasonic transmission waveguide 78 may be
substantially equal to an integral number of one-half wavelengths
(n.lamda./2), for example. The ultrasonic transmission waveguide 78
may be preferably fabricated from a solid core shaft constructed
out of material suitable to propagate ultrasonic energy
efficiently, such as the titanium alloy discussed above (i.e.,
Ti6Al4V) or any suitable aluminum alloy, or other alloys, for
example.
[0113] In one example embodiment, the ultrasonic transmission
waveguide 78 comprises a longitudinally projecting attachment post
at a proximal end to couple to the surface 110 of the ultrasonic
transmission waveguide 78 by a threaded connection such as the stud
124. The ultrasonic transmission waveguide 78 may include a
plurality of stabilizing silicone rings or compliant supports 82
(FIG. 5) positioned at a plurality of nodes. The silicone rings 82
dampen undesirable vibration and isolate the ultrasonic energy from
an outer protective sheath 80 (FIG. 5) assuring the flow of
ultrasonic energy in a longitudinal direction to the distal end of
the blade 66 with maximum efficiency.
[0114] FIG. 9 illustrates one example embodiment of the proximal
rotation assembly 128. In the illustrated embodiment, the proximal
rotation assembly 128 comprises the proximal rotation knob 134
inserted over the cylindrical hub 135. The proximal rotation knob
134 comprises a plurality of radial projections 138 that are
received in corresponding slots 130 formed on a proximal end of the
cylindrical hub 135. The proximal rotation knob 134 defines an
opening 142 to receive the distal end of the ultrasonic transducer
16. The radial projections 138 are formed of a soft polymeric
material and define a diameter that is undersized relative to the
outside diameter of the ultrasonic transducer 16 to create a
friction interference fit when the distal end of the ultrasonic
transducer 16. The polymeric radial projections 138 protrude
radially into the opening 142 to form "gripper" ribs that firmly
grip the exterior housing of the ultrasonic transducer 16.
Therefore, the proximal rotation knob 134 securely grips the
ultrasonic transducer 16.
[0115] The distal end of the cylindrical hub 135 comprises a
circumferential lip 132 and a circumferential bearing surface 140.
The circumferential lip engages a groove formed in the housing 12
and the circumferential bearing surface 140 engages the housing 12.
Thus, the cylindrical hub 135 is mechanically retained within the
two housing portions (not shown) of the housing 12. The
circumferential lip 132 of the cylindrical hub 135 is located or
"trapped" between the first and second housing portions 12a, 12b
and is free to rotate in place within the groove. The
circumferential bearing surface 140 bears against interior portions
of the housing to assist proper rotation. Thus, the cylindrical hub
135 is free to rotate in place within the housing. The user engages
the flutes 136 formed on the proximal rotation knob 134 with either
the finger or the thumb to rotate the cylindrical hub 135 within
the housing 12.
[0116] In one example embodiment, the cylindrical hub 135 may be
formed of a durable plastic such as polycarbonate. In one example
embodiment, the cylindrical hub 135 may be formed of a siliconized
polycarbonate material. In one example embodiment, the proximal
rotation knob 134 may be formed of pliable, resilient, flexible
polymeric materials including Versaflex.RTM. TPE alloys made by GLS
Corporation, for example. The proximal rotation knob 134 may be
formed of elastomeric materials, thermoplastic rubber known as
Santoprene.RTM., other thermoplastic vulcanizates (TPVs), or
elastomers, for example. The embodiments, however, are not limited
in this context.
[0117] FIG. 10 illustrates one example embodiment of a surgical
system 200 including a surgical instrument 210 having single
element end effector 278. The system 200 may include a transducer
assembly 216 coupled to the end effector 278 and a sheath 256
positioned around the proximal portions of the end effector 278 as
shown. The transducer assembly 216 and end effector 278 may operate
in a manner similar to that of the transducer assembly 16 and end
effector 18 described above to produce ultrasonic energy that may
be transmitted to tissue via blade 226'
[0118] Over the years, a variety of minimally invasive robotic (or
"telesurgical") systems have been developed to increase surgical
dexterity as well as to permit a surgeon to operate on a patient in
an intuitive manner. Robotic surgical systems can be used with many
different types of surgical instruments including, for example,
ultrasonic instruments, as described herein. Example robotic
systems include those manufactured by Intuitive Surgical, Inc., of
Sunnyvale, Calif., U.S.A. Such systems, as well as robotic systems
from other manufacturers, are disclosed in the following U.S.
patents which are each herein incorporated by reference in their
respective entirety: U.S. Pat. No. 5,792,135, entitled "Articulated
Surgical Instrument For Performing Minimally Invasive Surgery With
Enhanced Dexterity and Sensitivity", U.S. Pat. No. 6,231,565,
entitled "Robotic Arm DLUs For Performing Surgical Tasks", U.S.
Pat. No. 6,783,524, entitled "Robotic Surgical Tool With Ultrasound
Cauterizing and Cutting Instrument", U.S. Pat. No. 6,364,888,
entitled "Alignment of Master and Slave In a Minimally Invasive
Surgical Apparatus", U.S. Pat. No. 7,524,320, entitled "Mechanical
Actuator Interface System For Robotic Surgical Tools", U.S. Pat.
No. 7,691,098, entitled Platform Link Wrist Mechanism", U.S. Pat.
No. 7,806,891, entitled "Repositioning and Reorientation of
Master/Slave Relationship in Minimally Invasive Telesurgery", and
U.S. Pat. No. 7,824,401, entitled "Surgical Tool With Writed
Monopolar Electrosurgical End Effectors". Many of such systems,
however, have in the past been unable to generate the magnitude of
forces required to effectively cut and fasten tissue.
[0119] FIGS. 11-26 illustrate example embodiments of robotic
surgical systems. In some embodiments, the disclosed robotic
surgical systems may utilize the ultrasonic or electrosurgical
instruments described herein. Those skilled in the art will
appreciate that the illustrated robotic surgical systems are not
limited to only those instruments described herein, and may utilize
any compatible surgical instruments. Those skilled in the art will
further appreciate that while various embodiments described herein
may be used with the described robotic surgical systems, the
disclosure is not so limited, and may be used with any compatible
robotic surgical system.
[0120] FIGS. 11-16 illustrate the structure and operation of
several example robotic surgical systems and components thereof.
FIG. 11 shows a block diagram of an example robotic surgical system
1000. The system 1000 comprises at least one controller 508 and at
least one arm cart 510. The arm cart 510 may be mechanically
coupled to one or more robotic manipulators or arms, indicated by
box 512. Each of the robotic arms 512 may comprise one or more
surgical instruments 514 for performing various surgical tasks on a
patient 504. Operation of the arm cart 510, including the arms 512
and instruments 514 may be directed by a clinician 502 from a
controller 508. In some embodiments, a second controller 508',
operated by a second clinician 502' may also direct operation of
the arm cart 510 in conjunction with the first clinician 502'. For
example, each of the clinicians 502, 502' may control different
arms 512 of the cart or, in some cases, complete control of the arm
cart 510 may be passed between the clinicians 502, 502'. In some
embodiments, additional arm carts (not shown) may be utilized on
the patient 504. These additional arm carts may be controlled by
one or more of the controllers 508, 508'. The arm cart(s) 510 and
controllers 508, 508' may be in communication with one another via
a communications link 516, which may be any suitable type of wired
or wireless communications link carrying any suitable type of
signal (e.g., electrical, optical, infrared, etc.) according to any
suitable communications protocol. Example implementations of
robotic surgical systems, such as the system 1000, are disclosed in
U.S. Pat. No. 7,524,320 which has been herein incorporated by
reference. Thus, various details of such devices will not be
described in detail herein beyond that which may be necessary to
understand various embodiments of the claimed device.
[0121] FIG. 12 shows one example embodiment of a robotic arm cart
520. The robotic arm cart 520 is configured to actuate a plurality
of surgical instruments or instruments, generally designated as 522
within a work envelope 519. Various robotic surgery systems and
methods employing master controller and robotic arm cart
arrangements are disclosed in U.S. Pat. No. 6,132,368, entitled
"Multi-Component Telepresence System and Method", the full
disclosure of which is incorporated herein by reference. In various
forms, the robotic arm cart 520 includes a base 524 from which, in
the illustrated embodiment, three surgical instruments 522 are
supported. In various forms, the surgical instruments 522 are each
supported by a series of manually articulatable linkages, generally
referred to as set-up joints 526, and a robotic manipulator 528.
These structures are herein illustrated with protective covers
extending over much of the robotic linkage. These protective covers
may be optional, and may be limited in size or entirely eliminated
in some embodiments to minimize the inertia that is encountered by
the servo mechanisms used to manipulate such devices, to limit the
volume of moving components so as to avoid collisions, and to limit
the overall weight of the cart 520. Cart 520 will generally have
dimensions suitable for transporting the cart 520 between operating
rooms. The cart 520 may be configured to typically fit through
standard operating room doors and onto standard hospital elevators.
In various forms, the cart 520 would preferably have a weight and
include a wheel (or other transportation) system that allows the
cart 520 to be positioned adjacent an operating table by a single
attendant.
[0122] FIG. 13 shows one example embodiment of the robotic
manipulator 528 of the robotic arm cart 520. In the example shown
in FIG. 13, the robotic manipulators 528 may include a linkage 530
that constrains movement of the surgical instrument 522. In various
embodiments, linkage 530 includes rigid links coupled together by
rotational joints in a parallelogram arrangement so that the
surgical instrument 522 rotates around a point in space 532, as
more fully described in issued U.S. Pat. No. 5,817,084, the full
disclosure of which is herein incorporated by reference. The
parallelogram arrangement constrains rotation to pivoting about an
axis 534a, sometimes called the pitch axis. The links supporting
the parallelogram linkage are pivotally mounted to set-up joints
526 (FIG. 12) so that the surgical instrument 522 further rotates
about an axis 534b, sometimes called the yaw axis. The pitch and
yaw axes 534a, 534b intersect at the remote center 536, which is
aligned along a shaft 538 of the surgical instrument 522. The
surgical instrument 522 may have further degrees of driven freedom
as supported by manipulator 540, including sliding motion of the
surgical instrument 522 along the longitudinal instrument axis
"LT-LT". As the surgical instrument 522 slides along the instrument
axis LT-LT relative to manipulator 540 (arrow 534c), remote center
536 remains fixed relative to base 542 of manipulator 540. Hence,
the entire manipulator 540 is generally moved to re-position remote
center 536. Linkage 530 of manipulator 540 is driven by a series of
motors 544. These motors 544 actively move linkage 530 in response
to commands from a processor of a control system. As will be
discussed in further detail below, motors 544 are also employed to
manipulate the surgical instrument 522.
[0123] FIG. 14 shows one example embodiment of a robotic arm cart
520' having an alternative set-up joint structure. In this example
embodiment, a surgical instrument 522 is supported by an
alternative manipulator structure 528' between two tissue
manipulation instruments. Those of ordinary skill in the art will
appreciate that various embodiments of the claimed device may
incorporate a wide variety of alternative robotic structures,
including those described in U.S. Pat. No. 5,878,193, the full
disclosure of which is incorporated herein by reference.
Additionally, while the data communication between a robotic
component and the processor of the robotic surgical system is
primarily described herein with reference to communication between
the surgical instrument 522 and the controller, it should be
understood that similar communication may take place between
circuitry of a manipulator, a set-up joint, an endoscope or other
image capture device, or the like, and the processor of the robotic
surgical system for component compatibility verification,
component-type identification, component calibration (such as
off-set or the like) communication, confirmation of coupling of the
component to the robotic surgical system, or the like.
[0124] FIG. 15 shows one example embodiment of a controller 518
that may be used in conjunction with a robotic arm cart, such as
the robotic arm carts 520, 520' depicted in FIGS. 12-14. The
controller 518 generally includes master controllers (generally
represented as 519 in FIG. 15) which are grasped by the clinician
and manipulated in space while the clinician views the procedure
via a stereo display 521. A surgeon feed back meter 515 may be
viewed via the display 521 and provide the surgeon with a visual
indication of the amount of force being applied to the cutting
instrument or dynamic clamping member. The master controllers 519
generally comprise manual input devices which preferably move with
multiple degrees of freedom, and which often further have a handle
or trigger for actuating instruments (for example, for closing
grasping saws, applying an electrical potential to an electrode, or
the like).
[0125] FIG. 16 shows one example embodiment of an ultrasonic
surgical instrument 522 adapted for use with a robotic surgical
system. For example, the surgical instrument 522 may be coupled to
one of the surgical manipulators 528, 528' described hereinabove.
As can be seen in FIG. 16, the surgical instrument 522 comprises a
surgical end effector 548 that comprises an ultrasonic blade 550
and clamp arm 552, which may be coupled to an elongated shaft
assembly 554 that, in some embodiments, may comprise an
articulation joint 556. FIG. 17 shows one example embodiment of an
instrument drive assembly 546 that may be coupled to one of the
surgical manipulators 528, 528' to receive and control the surgical
instrument 522. The instrument drive assembly 546 may also be
operatively coupled to the controller 518 to receive inputs from
the clinician for controlling the instrument 522. For example,
actuation (e.g., opening and closing) of the clamp arm 552,
actuation (e.g., opening and closing) of the jaws 551A, 551B,
actuation of the ultrasonic blade 550, extension of the knife 555
and actuation of the energy delivery surfaces 553A, 553B, etc. may
be controlled through the instrument drive assembly 546 based on
inputs from the clinician provided through the controller 518. The
surgical instrument 522 is operably coupled to the manipulator by
an instrument mounting portion, generally designated as 558. The
surgical instruments 522 further include an interface 560 which
mechanically and electrically couples the instrument mounting
portion 558 to the manipulator.
[0126] FIG. 18 shows another view of the instrument drive assembly
of FIG. 17 including the ultrasonic surgical instrument 522. The
instrument mounting portion 558 includes an instrument mounting
plate 562 that operably supports a plurality of (four are shown in
FIG. 17) rotatable body portions, driven discs or elements 564,
that each include a pair of pins 566 that extend from a surface of
the driven element 564. One pin 566 is closer to an axis of
rotation of each driven elements 564 than the other pin 566 on the
same driven element 564, which helps to ensure positive angular
alignment of the driven element 564. The driven elements 564 and
pints 566 may be positioned on an adapter side 567 of the
instrument mounting plate 562.
[0127] Interface 560 also includes an adaptor portion 568 that is
configured to mountingly engage the mounting plate 562 as will be
further discussed below. The adaptor portion 568 may include an
array of electrical connecting pins 570, which may be coupled to a
memory structure by a circuit board within the instrument mounting
portion 558. While interface 560 is described herein with reference
to mechanical, electrical, and magnetic coupling elements, it
should be understood that a wide variety of telemetry modalities
might be used, including infrared, inductive coupling, or the
like.
[0128] FIGS. 19-21 show additional views of the adapter portion 568
of the instrument drive assembly 546 of FIG. 17. The adapter
portion 568 generally includes an instrument side 572 and a holder
side 574 (FIG. 19). In various embodiments, a plurality of
rotatable bodies 576 are mounted to a floating plate 578 which has
a limited range of movement relative to the surrounding adaptor
structure normal to the major surfaces of the adaptor 568. Axial
movement of the floating plate 578 helps decouple the rotatable
bodies 576 from the instrument mounting portion 558 when the levers
580 along the sides of the instrument mounting portion housing 582
are actuated (See FIG. 16) Other mechanisms/arrangements may be
employed for releasably coupling the instrument mounting portion
558 to the adaptor 568. In at least one form, rotatable bodies 576
are resiliently mounted to floating plate 578 by resilient radial
members which extend into a circumferential indentation about the
rotatable bodies 576. The rotatable bodies 576 can move axially
relative to plate 578 by deflection of these resilient structures.
When disposed in a first axial position (toward instrument side
572) the rotatable bodies 576 are free to rotate without angular
limitation. However, as the rotatable bodies 576 move axially
toward instrument side 572, tabs 584 (extending radially from the
rotatable bodies 576) laterally engage detents on the floating
plates so as to limit angular rotation of the rotatable bodies 576
about their axes. This limited rotation can be used to help
drivingly engage the rotatable bodies 576 with drive pins 586 of a
corresponding instrument holder portion 588 of the robotic system,
as the drive pins 586 will push the rotatable bodies 576 into the
limited rotation position until the pins 586 are aligned with (and
slide into) openings 590.
[0129] Openings 590 on the instrument side 572 and openings 590 on
the holder side 574 of rotatable bodies 576 are configured to
accurately align the driven elements 564 (FIGS. 18, 28) of the
instrument mounting portion 558 with the drive elements 592 of the
instrument holder 588. As described above regarding inner and outer
pins 566 of driven elements 564, the openings 590 are at differing
distances from the axis of rotation on their respective rotatable
bodies 576 so as to ensure that the alignment is not 33 degrees
from its intended position. Additionally, each of the openings 590
may be slightly radially elongated so as to fittingly receive the
pins 566 in the circumferential orientation. This allows the pins
566 to slide radially within the openings 590 and accommodate some
axial misalignment between the instrument 522 and instrument holder
588, while minimizing any angular misalignment and backlash between
the drive and driven elements. Openings 590 on the instrument side
572 may be offset by about 90 degrees from the openings 590 (shown
in broken lines) on the holder side 574, as can be seen most
clearly in FIG. 21.
[0130] Various embodiments may further include an array of
electrical connector pins 570 located on holder side 574 of adaptor
568, and the instrument side 572 of the adaptor 568 may include
slots 594 (FIG. 21) for receiving a pin array (not shown) from the
instrument mounting portion 558. In addition to transmitting
electrical signals between the surgical instrument 522, 523 and the
instrument holder 588, at least some of these electrical
connections may be coupled to an adaptor memory device 596 (FIG.
20) by a circuit board of the adaptor 568.
[0131] A detachable latch arrangement 598 may be employed to
releasably affix the adaptor 568 to the instrument holder 588. As
used herein, the term "instrument drive assembly" when used in the
context of the robotic system, at least encompasses various
embodiments of the adapter 568 and instrument holder 588 and which
has been generally designated as 546 in FIG. 17. For example, as
can be seen in FIG. 17, the instrument holder 588 may include a
first latch pin arrangement 600 that is sized to be received in
corresponding clevis slots 602 provided in the adaptor 568. In
addition, the instrument holder 588 may further have second latch
pins 604 that are sized to be retained in corresponding latch
clevises 606 in the adaptor 568. See FIG. 20. In at least one form,
a latch assembly 608 is movably supported on the adapter 568 and is
biasable between a first latched position wherein the latch pins
600 are retained within their respective latch clevis 606 and an
unlatched position wherein the second latch pins 604 may be into or
removed from the latch clevises 606. A spring or springs (not
shown) are employed to bias the latch assembly into the latched
position. A lip on the instrument side 572 of adaptor 568 may
slidably receive laterally extending tabs of instrument mounting
housing 582.
[0132] As described the driven elements 564 may be aligned with the
drive elements 592 of the instrument holder 588 such that
rotational motion of the drive elements 592 causes corresponding
rotational motion of the driven elements 564. The rotation of the
drive elements 592 and driven elements 564 may be electronically
controlled, for example, via the robotic arm 612, in response to
instructions received from the clinician 502 via a controller 508.
The instrument mounting portion 558 may translate rotation of the
driven elements 564 into motion of the surgical instrument 522,
523.
[0133] FIGS. 22-24 show one example embodiment of the instrument
mounting portion 558 showing components for translating motion of
the driven elements 564 into motion of the surgical instrument 522.
FIGS. 22-24 show the instrument mounting portion with a shaft 538
having a surgical end effector 610 at a distal end thereof. The end
effector 610 may be any suitable type of end effector for
performing a surgical task on a patient. For example, the end
effector may be configured to provide ultrasonic energy to tissue
at a surgical site. The shaft 538 may be rotatably coupled to the
instrument mounting portion 558 and secured by a top shaft holder
646 and a bottom shaft holder 648 at a coupler 650 of the shaft
538.
[0134] In one example embodiment, the instrument mounting portion
558 comprises a mechanism for translating rotation of the various
driven elements 564 into rotation of the shaft 538, differential
translation of members along the axis of the shaft (e.g., for
articulation), and reciprocating translation of one or more members
along the axis of the shaft 538 (e.g., for extending and retracting
tissue cutting elements such as 555, overtubes and/or other
components). In one example embodiment, the rotatable bodies 612
(e.g., rotatable spools) are coupled to the driven elements 564.
The rotatable bodies 612 may be formed integrally with the driven
elements 564. In some embodiments, the rotatable bodies 612 may be
formed separately from the driven elements 564 provided that the
rotatable bodies 612 and the driven elements 564 are fixedly
coupled such that driving the driven elements 564 causes rotation
of the rotatable bodies 612. Each of the rotatable bodies 612 is
coupled to a gear train or gear mechanism to provide shaft
articulation and rotation and clamp jaw open/close and knife
actuation.
[0135] In one example embodiment, the instrument mounting portion
558 comprises a mechanism for causing differential translation of
two or more members along the axis of the shaft 538. In the example
provided in FIGS. 22-24, this motion is used to manipulate
articulation joint 556. In the illustrated embodiment, for example,
the instrument mounting portion 558 comprises a rack and pinion
gearing mechanism to provide the differential translation and thus
the shaft articulation functionality. In one example embodiment,
the rack and pinion gearing mechanism comprises a first pinion gear
614 coupled to a rotatable body 612 such that rotation of the
corresponding driven element 564 causes the first pinion gear 614
to rotate. A bearing 616 is coupled to the rotatable body 612 and
is provided between the driven element 564 and the first pinion
gear 614. The first pinion gear 614 is meshed to a first rack gear
618 to convert the rotational motion of the first pinion gear 614
into linear motion of the first rack gear 618 to control the
articulation of the articulation section 556 of the shaft assembly
538 in a left direction 620L. The first rack gear 618 is attached
to a first articulation band 622 (FIG. 22) such that linear motion
of the first rack gear 618 in a distal direction causes the
articulation section 556 of the shaft assembly 538 to articulate in
the left direction 620L. A second pinion gear 626 is coupled to
another rotatable body 612 such that rotation of the corresponding
driven element 564 causes the second pinion gear 626 to rotate. A
bearing 616 is coupled to the rotatable body 612 and is provided
between the driven element 564 and the second pinion gear 626. The
second pinion gear 626 is meshed to a second rack gear 628 to
convert the rotational motion of the second pinion gear 626 into
linear motion of the second rack gear 628 to control the
articulation of the articulation section 556 in a right direction
620R. The second rack gear 628 is attached to a second articulation
band 624 (FIG. 23) such that linear motion of the second rack gear
628 in a distal direction causes the articulation section 556 of
the shaft assembly 538 to articulate in the right direction 620R.
Additional bearings may be provided between the rotatable bodies
and the corresponding gears. Any suitable bearings may be provided
to support and stabilize the mounting and reduce rotary friction of
shaft and gears, for example.
[0136] In one example embodiment, the instrument mounting portion
558 further comprises a mechanism for translating rotation of the
driven elements 564 into rotational motion about the axis of the
shaft 538. For example, the rotational motion may be rotation of
the shaft 538 itself. In the illustrated embodiment, a first spiral
worm gear 630 coupled to a rotatable body 612 and a second spiral
worm gear 632 coupled to the shaft assembly 538. A bearing 616
(FIG. 17) is coupled to a rotatable body 612 and is provided
between a driven element 564 and the first spiral worm gear 630.
The first spiral worm gear 630 is meshed to the second spiral worm
gear 632, which may be coupled to the shaft assembly 538 and/or to
another component of the instrument 522, 523 for which longitudinal
rotation is desired. Rotation may be caused in a clockwise (CW) and
counter-clockwise (CCW) direction based on the rotational direction
of the first and second spiral worm gears 630, 632. Accordingly,
rotation of the first spiral worm gear 630 about a first axis is
converted to rotation of the second spiral worm gear 632 about a
second axis, which is orthogonal to the first axis. As shown in
FIGS. 22-23, for example, a CW rotation of the second spiral worm
gear 632 results in a CW rotation of the shaft assembly 538 in the
direction indicated by 634CW. A CCW rotation of the second spiral
worm gear 632 results in a CCW rotation of the shaft assembly 538
in the direction indicated by 634CCW. Additional bearings may be
provided between the rotatable bodies and the corresponding gears.
Any suitable bearings may be provided to support and stabilize the
mounting and reduce rotary friction of shaft and gears, for
example.
[0137] In one example embodiment, the instrument mounting portion
558 comprises a mechanism for generating reciprocating translation
of one or more members along the axis of the shaft 538. Such
translation may be used, for example to drive a tissue cutting
element, such as 555, drive an overtube for closure and/or
articulation of the end effector 610, etc. In the illustrated
embodiment, for example, a rack and pinion gearing mechanism may
provide the reciprocating translation. A first gear 636 is coupled
to a rotatable body 612 such that rotation of the corresponding
driven element 564 causes the first gear 636 to rotate in a first
direction. A second gear 638 is free to rotate about a post 640
formed in the instrument mounting plate 562. The first gear 636 is
meshed to the second gear 638 such that the second gear 638 rotates
in a direction that is opposite of the first gear 636. In one
example embodiment, the second gear 638 is a pinion gear meshed to
a rack gear 642, which moves in a liner direction. The rack gear
642 is coupled to a translating block 644, which may translate
distally and proximally with the rack gear 642. The translation
block 644 may be coupled to any suitable component of the shaft
assembly 538 and/or the end effector 610 so as to provide
reciprocating longitudinal motion. For example, the translation
block 644 may be mechanically coupled to the tissue cutting element
555 of the RF surgical device 523. In some embodiments, the
translation block 644 may be coupled to an overtube, or other
component of the end effector 610 or shaft 538.
[0138] FIGS. 25-27 illustrate an alternate embodiment of the
instrument mounting portion 558 showing an alternate example
mechanism for translating rotation of the driven elements 564 into
rotational motion about the axis of the shaft 538 and an alternate
example mechanism for generating reciprocating translation of one
or more members along the axis of the shaft 538. Referring now to
the alternate rotational mechanism, a first spiral worm gear 652 is
coupled to a second spiral worm gear 654, which is coupled to a
third spiral worm gear 656. Such an arrangement may be provided for
various reasons including maintaining compatibility with existing
robotic systems 1000 and/or where space may be limited. The first
spiral worm gear 652 is coupled to a rotatable body 612. The third
spiral worm gear 656 is meshed with a fourth spiral worm gear 658
coupled to the shaft assembly 538. A bearing 760 is coupled to a
rotatable body 612 and is provided between a driven element 564 and
the first spiral worm gear 738. Another bearing 760 is coupled to a
rotatable body 612 and is provided between a driven element 564 and
the third spiral worm gear 652. The third spiral worm gear 652 is
meshed to the fourth spiral worm gear 658, which may be coupled to
the shaft assembly 538 and/or to another component of the
instrument 522 for which longitudinal rotation is desired. Rotation
may be caused in a CW and a CCW direction based on the rotational
direction of the spiral worm gears 656, 658. Accordingly, rotation
of the third spiral worm gear 656 about a first axis is converted
to rotation of the fourth spiral worm gear 658 about a second axis,
which is orthogonal to the first axis. As shown in FIGS. 26 and 27,
for example, the fourth spiral worm gear 658 is coupled to the
shaft 538, and a CW rotation of the fourth spiral worm gear 658
results in a CW rotation of the shaft assembly 538 in the direction
indicated by 634CW. A CCW rotation of the fourth spiral worm gear
658 results in a CCW rotation of the shaft assembly 538 in the
direction indicated by 634CCW. Additional bearings may be provided
between the rotatable bodies and the corresponding gears. Any
suitable bearings may be provided to support and stabilize the
mounting and reduce rotary friction of shaft and gears, for
example.
[0139] Referring now to the alternate example mechanism for
generating reciprocating translation of one or more members along
the axis of the shaft 538, the instrument mounting portion 558
comprises a rack and pinion gearing mechanism to provide
reciprocating translation along the axis of the shaft 538 (e.g.,
translation of a tissue cutting element 555 of the RF surgical
device 523). In one example embodiment, a third pinion gear 660 is
coupled to a rotatable body 612 such that rotation of the
corresponding driven element 564 causes the third pinion gear 660
to rotate in a first direction. The third pinion gear 660 is meshed
to a rack gear 662, which moves in a linear direction. The rack
gear 662 is coupled to a translating block 664. The translating
block 664 may be coupled to a component of the device 522, 523,
such as, for example, the tissue cutting element 555 of the RF
surgical device and/or an overtube or other component which is
desired to be translated longitudinally.
[0140] FIGS. 28-32 illustrate an alternate embodiment of the
instrument mounting portion 558 showing another alternate example
mechanism for translating rotation of the driven elements 564 into
rotational motion about the axis of the shaft 538. In FIGS. 28-32,
the shaft 538 is coupled to the remainder of the mounting portion
558 via a coupler 676 and a bushing 678. A first gear 666 coupled
to a rotatable body 612, a fixed post 668 comprising first and
second openings 672, first and second rotatable pins 674 coupled to
the shaft assembly, and a cable 670 (or rope). The cable is wrapped
around the rotatable body 612. One end of the cable 670 is located
through a top opening 672 of the fixed post 668 and fixedly coupled
to a top rotatable pin 674. Another end of the cable 670 is located
through a bottom opening 672 of the fixed post 668 and fixedly
coupled to a bottom rotating pin 674. Such an arrangement is
provided for various reasons including maintaining compatibility
with existing robotic systems 1000 and/or where space may be
limited. Accordingly, rotation of the rotatable body 612 causes the
rotation about the shaft assembly 538 in a CW and a CCW direction
based on the rotational direction of the rotatable body 612 (e.g.,
rotation of the shaft 538 itself). Accordingly, rotation of the
rotatable body 612 about a first axis is converted to rotation of
the shaft assembly 538 about a second axis, which is orthogonal to
the first axis. As shown in FIGS. 28-29, for example, a CW rotation
of the rotatable body 612 results in a CW rotation of the shaft
assembly 538 in the direction indicated by 634CW. A CCW rotation of
the rotatable body 612 results in a CCW rotation of the shaft
assembly 538 in the direction indicated by 634CCW. Additional
bearings may be provided between the rotatable bodies and the
corresponding gears. Any suitable bearings may be provided to
support and stabilize the mounting and reduce rotary friction of
shaft and gears, for example.
[0141] FIGS. 33-36A illustrate an alternate embodiment of the
instrument mounting portion 558 showing an alternate example
mechanism for differential translation of members along the axis of
the shaft 538 (e.g., for articulation). For example, as illustrated
in FIGS. 33-36A, the instrument mounting portion 558 comprises a
double cam mechanism 680 to provide the shaft articulation
functionality. In one example embodiment, the double cam mechanism
680 comprises first and second cam portions 680A, 680B. First and
second follower arms 682, 684 are pivotally coupled to
corresponding pivot spools 686. As the rotatable body 612 coupled
to the double cam mechanism 680 rotates, the first cam portion 680A
acts on the first follower arm 682 and the second cam portion 680B
acts on the second follower arm 684. As the cam mechanism 680
rotates the follower arms 682, 684 pivot about the pivot spools
686. The first follower arm 682 may be attached to a first member
that is to be differentially translated (e.g., the first
articulation band 622). The second follower arm 684 is attached to
a second member that is to be differentially translated (e.g., the
second articulation band 624). As the top cam portion 680A acts on
the first follower arm 682, the first and second members are
differentially translated. In the example embodiment where the
first and second members are the respective articulation bands 622
and 624, the shaft assembly 538 articulates in a left direction
620L. As the bottom cam portion 680B acts of the second follower
arm 684, the shaft assembly 538 articulates in a right direction
620R. In some example embodiments, two separate bushings 688, 690
are mounted beneath the respective first and second follower arms
682, 684 to allow the rotation of the shaft without affecting the
articulating positions of the first and second follower arms 682,
684. For articulation motion, these bushings reciprocate with the
first and second follower arms 682, 684 without affecting the
rotary position of the jaw 902. FIG. 36A shows the bushings 688,
690 and the dual cam assembly 680, including the first and second
cam portions 680B, 680B, with the first and second follower arms
682, 684 removed to provide a more detailed and clearer view.
[0142] In various embodiments, the instrument mounting portion 558
may additionally comprise internal energy sources for driving
electronics and provided desired ultrasonic and/or RF frequency
signals to surgical tools. FIGS. 36B-36C illustrate one embodiment
of a tool mounting portion 558' comprising internal power and
energy sources. For example, surgical instruments (e.g., instrument
522) mounted utilizing the tool mounting portion 558' need not be
wired to an external generator or other power source. Instead, the
functionality of the generator 20 described herein may be
implemented on board the mounting portion 558.
[0143] As illustrated in FIGS. 36B-36C, the instrument mounting
portion 558' may comprise a distal portion 702. The distal portion
702 may comprise various mechanisms for coupling rotation of drive
elements 612 to end effectors of the various surgical instruments
522, for example, as described herein above. Proximal of the distal
portion 702, the instrument mounting portion 558' comprises an
internal direct current (DC) energy source and an internal drive
and control circuit 704. In the illustrated embodiment, the energy
source comprises a first and second battery 706, 708. In other
respects, the tool mounting portion 558' is similar to the various
embodiments of the tool mounting portion 558 described herein
above. The control circuit 704 may operate in a manner similar to
that described above with respect to generator 20. For example, the
control circuit 704 may provide an ultrasonic and/or
electrosurgical drive signal in a manner similar to that described
above with respect to generator 20.
[0144] FIG. 37 illustrates one embodiment of an articulatable
surgical instrument 1000 comprising a distally positioned
ultrasonic transducer assembly 1012. An end effector 1014 of the
instrument 1000 comprises an ultrasonic blade 1018 and a clamp arm
1016. The end effector 1014 is coupled to a distal end of a shaft
1004. The shaft 1004 extends along a longitudinal axis 1002 and
comprises a distal shaft member 1007 and a proximal shaft member
1009. For example, the end effector 1014 may be coupled to a distal
portion of the distal shaft member 1007. The distal and proximal
shaft members 1007, 1009 are pivotably coupled to one another at an
articulation joint 1010. For example, the distal and proximal shaft
members 1007, 1009 may be coupled to pivot about an axis 1006 that
is perpendicular to the longitudinal axis 1002. Potential
directions of articulation are indicated by arrow 1008.
[0145] In FIG. 37, a proximal end of the shaft 1009 is coupled to a
handle 1001. The handle 1001 may comprise various controls for
controlling the operation of the shaft 1009 and end effector 1014
including, for example, trigger 1022 and buttons 1024. These
features may operate in a manner similar to that of trigger 24 and
buttons 28 described herein above. In some embodiments, the handle
1001 may comprise one or more electric or other motors to assist
the clinician in operation of the shaft 1007, 1009 and end effector
1014. Examples of such handles are provided in U.S. Pat. No.
7,845,537, which is incorporated herein by reference in its
entirety. FIG. 38 illustrates one embodiment of the shaft 1004 and
end effector 1014 used in conjunction with an instrument mounting
portion 1020 of a robotic surgical system. For example, the shaft
1004, end effector 1014 and instrument mounting portion 1020 may be
used in conjunction with the robotic surgical system 500 described
herein above.
[0146] FIG. 39 illustrates a cut-away view of one embodiment of the
shaft 1004 and end effector 1014. As illustrated, the distal and
proximal shaft portions 1007, 1009 may comprise respective clevises
1026, 1028 joined by a pin 1030 to form the articulation joint
1010. In various embodiments, the pin 1030 is substantially
parallel to the axis 1006 (FIGS. 37-38). Also, although the
articulation joint 1010 is illustrated in FIG. 39 as being
implemented with clevises 1026, 1028 and a pin 1030, it will be
appreciated that any suitable type of pivotable joint mechanism may
be used. FIG. 39 also illustrates a clamp arm control member 1044
that may be coupled to one or more components of the end effector
1014, as described herein, to bring about opening and closure of
the clamp arm 1016. A power wire 1038 may be coupled to the
ultrasonic transducer assembly 1012, and specifically to an
ultrasonic transducer 1040 thereof, so as to connect the ultrasonic
transducer assembly 1012 to a generator, such as the generator 20
described herein.
[0147] In various embodiments, articulation of the distal shaft
member 1007 and end effector 1014 may be brought about utilizing
translating articulation control members 1032, 1034. The control
members 1032, 1034 may be substantially opposite the longitudinal
axis 1002 from one another. Distal portions of the control members
1032, 1034 may be coupled to either the end effector 1014 or the
distal shaft member 1007. For example, the control members 1032,
1034 are illustrated in FIG. 39 to be coupled to the distal shaft
member 1007 by pegs 1046, 1048. The control members 1032, 1034
extend proximally past the articulation joint 1010 and through the
proximal shaft portion 1009.
[0148] The control members 1032, 1034 may be differentially
translated to cause articulation of the end effector 1014 and
distal shaft portion 1007. For example, proximal translation of the
control member 1034 may cause the distal shaft member 1007 and end
effector 1014 to pivot towards the control member 1034, as shown in
FIG. 39 and indicated by arrow 1041. Similarly, proximal
translation of the control member 1032 may cause the distal shaft
member 1007 and end effector 1014 to pivot towards the control
member 1032 in a manner opposite to that shown in FIG. 39. In
various embodiments, proximal translation of one control member
1032, 1034 may occur in conjunction with distal translation of the
opposite control member, for example, to provide slack in the
opposite control member 1032, 1034 so as to facilitate
articulation.
[0149] Differential translation of the control members 1032, 1034
may be brought about in any suitable manner. For example, when used
in conjunction with a robotic surgical system, differential
translation of the control members 1032, 1034 may be initiated
utilizing any of the devices and methods described herein above
with respect to FIGS. 22-36C. FIGS. 40-40A illustrate one
embodiment for driving differential translation of the control
members 1032, 1034 in conjunction with a manual instrument, such as
1000. FIG. 40 shows the instrument 1000 including an articulation
assembly 1050 including an articulation lever 1052. Referring now
to FIG. 40A, the articulation lever 1052 is coupled to a spindle
gear 1058. Each of the control members 1032, 1034 may define
respective proximal rack gears 1054, 1056 interfacing with the
spindle gear 1058. Rotation of the articulation lever 1052 and
spindle gear 1058 in a first direction, indicated by arrow 1060,
may cause distal translation of control member 1032 and proximal
translation of control member 1034. Rotation of the articulation
lever 1052 in the opposite direction, indicated by arrow 1062, may
cause distal translation of control member 1034 and proximal
translation of control member 1032.
[0150] FIG. 41 illustrates a cut-away view of one embodiment of the
ultrasonic transducer assembly 1012. As illustrated, the assembly
1012 comprises an outer housing 1064 enclosing the ultrasonic
transducer 1040. The transducer may be in electrical communication
with a generator via power cable 1038, as described herein. At a
distal portion, the ultrasonic transducer 1040 is acoustically
coupled to the ultrasonic blade 1018. The transducer 1040 may be
secured within the housing 1064 by washers 1070, which may be made
from silicone or another suitable material. In certain embodiments,
the housing 1064 defines proximal (1066) and distal (1068) hinge
portions, which may be utilized, as described herein, to couple the
assembly 1012 to a clamp arm member, for example, as described
herein.
[0151] FIG. 42 illustrates one embodiment of the ultrasonic
transducer assembly 1012 and clamp arm 1016 arranged as part of a
four-bar linkage. The clamp arm 1016 may comprise a clamp pad 1076
positioned to contact the ultrasonic blade 1018 when the clamp arm
1016 is in the closed position. The clamp arm 1016 may further
comprise a proximal member 1078 pivotably coupled to the transducer
assembly 1012 at pivot point 1072. The pivot point 1072 may be any
suitable type of mechanical pivot and may, for example, comprise a
pin, as shown. The proximal member 1078 may extend further
proximally from the pivot point 1072 and, at or near a proximal
end, may be pivotably coupled to a linkage member 1074 at a pivot
point 1075. Similarly, a proximal portion of the ultrasonic
transducer assembly 1012 may be pivotably coupled to a linkage
member 1076 at pivot point 1077. The linkage members 1074, 1076 may
be pivotably coupled to one another, and to the clamp arm control
member 1044, at a pivot point 1080. Proximal and distal translation
of the clamp arm control member 1044 may transition the clamp arm
1016 and ultrasonic blade 1018 between open and closed positions,
as described herein.
[0152] In the example embodiment shown in FIG. 42, the clamp arm
1016 comprises a second proximal member 1078' such that the
proximal members 1078, 1078' straddle the ultrasonic transducer
assembly 1012 and be pivotably coupled to a second linkage member
1074'. Similarly, a second linkage member 1076' may be pivotably
coupled to the ultrasonic transducer assembly 1012 in a manner
similar to that of linkage member 1078. All of the linkage members
1074, 1074', 1078, 1078' may be pivotably coupled to one another at
pivot point 1080. In various embodiments, pivot point 1075 may
comprise a bar 1082 extending between proximal member/linkage
member 1078/1074 and proximal member/linkage member 1078'/1074'. A
similar bar 1084 may be positioned at pivot point 1080.
[0153] FIG. 43 illustrates a side view of one embodiment of the
ultrasonic transducer assembly 1012 and clamp arm 1016, arranged as
illustrated in FIG. 42, coupled to the distal shaft portion 1007
and in an open position. As illustrated in FIG. 43, the distal
shaft portion 1007 comprises a clevis arm 1086 that is pivotably
coupled to the ultrasonic transducer assembly 1012 and clamp arm
1016 at the pivot point 1072 such that the ultrasonic transducer
assembly 1012, the clamp arm 1016 and the clevis arm 1086 are all
pivotable relative to one another. In some embodiments, a second
clevis arm (not shown) is present on an opposite side of the
ultrasonic transducer assembly 1012 and clamp arm 1016. As
illustrated, the clamp arm control member 1044 is translated
distally in the direction indicated by arrow 1088. This pushes the
linkage members 1074, 1076 apart and, in turn, causes the clamp arm
1016 and blade 1018 (e.g., coupled to the assembly 1012) to pivot
away from one another about the pivot point 1072 to the position
shown.
[0154] FIG. 44 illustrates a side view of one embodiment of the
ultrasonic transducer assembly 1012 and clamp arm 1016, arranged as
illustrated in FIG. 42, coupled to the distal shaft portion 1007
and in a closed position. In FIG. 44, the clamp arm control member
1044 has been pulled proximally in the direction of arrow 1090.
This pulls linkage members 1074, 1076, moving the pivot points
1075, 1077 towards one another in the directions indicated by
arrows 1092, 1094. Similarly, the blade 1018 and clamp arm 1016 are
pivoted about the pivot point 1072 towards one another in the
direction of arrows 1096, 1098 to the closed position illustrated.
Distal and proximal translation of the clamp arm control member
1044 may be brought about in any suitable manner. For example, in a
handheld instrument, the clamp arm control member 1044 may be
distally and proximally translated in manner similar to that
described above with respect to the tubular actuating member 58.
Also, for example, in a robotic instrument, the clamp arm control
member 1044 may be distally and proximally translated in a manner
similar to that described herein above with respect to FIGS.
22-36C.
[0155] FIGS. 45 and 46 illustrate side views of one embodiment of
the ultrasonic transducer assembly and clamp arm of FIGS. 37-38,
arranged as illustrated in FIG. 42, including proximal portions of
the shaft 1004. In FIG. 45, the blade 1018 and clamp arm 1016 are
shown in the closed position, similar to FIG. 44. Proximal shaft
portion 1009 is shown extending from a trocar 1100. The distal
shaft portion 1007 and end effector 1014 are shown articulated
about the articulation joint 1010 in the direction indicated by
arrows 1102. The clamp arm control member 1044 is pulled
proximally, as indicated by arrow 1090 and is shown bent around the
articulation joint 1010. In FIG. 46, the blade 1018 and clamp arm
1016 are shown in the open position, similar to FIG. 43. The clamp
arm control member 1044 is pushed distally, as indicated by 1088
and, again, is bent about the articulation joint 1010. In the
embodiments shown in FIGS. 37-46, and in various embodiments
described herein, the ultrasonic blade and clamp arm may take any
suitable shape or shapes. For example, FIGS. 47-48 illustrate one
embodiment of an end effector 1014' having an alternately shaped
ultrasonic blade 1018' and clamp arm 1016'.
[0156] FIG. 49 illustrates one embodiment of another end effector
1014'' comprising a flexible ultrasonic transducer assembly 1012'.
The ultrasonic transducer assembly 1012' comprises a distal
transducer portion 1103 and a proximal transducer portion 1104
coupled by a bendable intermediate portion 1106. The proximal
transducer portion 1104 may be coupled to a proximal transducer
bracket 1108. For example, the transducer portion 1104 may be
coupled to the bracket 1108 utilizing various disks 1070 that may
be positioned at nodes of the transducer. The bracket 1108 may be
pivotably coupled to the linkage member 1074 at pivot point 1080.
The distal transducer portion 1103 may be coupled to a distal
bracket 1110, again, for example, utilizing disks 1070 at
transducer nodes. The distal bracket 1110 may be pivotably coupled
to the clamp arm 1016 and the clevis arm 1086 at the pivot point
1072. In various embodiments, the bendable intermediate portion
1106 may have a transverse area that is smaller than that of the
distal transducer portion 1103 and proximal transducer portion
1104. Also, in some embodiments, the intermediate portion 1106 may
be made of a different material than the distal and proximal
transducer portions 1103, 1104. For example, the distal and
proximal transducer portions 1103, 1104 may be made from
piezoelectric elements (such as elements 112 described herein
above). The bendable intermediate portion 1106 may be made from any
suitable flexible material that conducts ultrasonic energy
including, for example, titanium, a titanium alloy, nitanol, etc.
It will be appreciated that the ultrasonic transducer assembly
1012' is illustrated in FIG. 49 without any outer housing so as to
more clearly illustrate the embodiment. In use, the ultrasonic
transducer assembly 1012 may be utilized with a housing such as the
housing 1064 described herein above with respect to FIG. 41.
[0157] In use, the bendable intermediate transducer portion 1106
may serve a function similar to that of the pivot point 1077. For
example, when the clamp arm control member 1044 is pushed distally,
the bendable intermediate transducer portion 1106 may bend, pushing
the blade 1018 and clamp arm 1016 into an open position, shown in
FIG. 49. When the clamp arm control member 1044 is pulled
proximally, the bendable intermediate transducer portion 1106 may
be more straightened, pulling the blade 1018 and clamp arm 1016
into a closed position.
[0158] In some example embodiments, the ultrasonic transducer
assembly may be positioned in the shaft such that a proximal end of
the transducer assembly extends proximally from the articulation
joint. This may serve to minimize a distance between the
articulation and a distal tip of the ultrasonic blade. FIG. 50
shows one embodiment of a manual surgical instrument 1200 having a
transducer assembly 1012 extending proximally from the articulation
joint 1010. It can be seen that a distance 1204 between a
distal-most point of the ultrasonic blade 1018 and the articulation
joint 1010 is less than it would be if all of the ultrasonic
transducer assembly 1012 were distal of the articulation joint.
Although the instrument 1200 shown in FIG. 50 is a manual
instrument, it will be appreciated that the shaft 1004 and end
effector 1014 in the configuration illustrated in FIG. 50 may also
be used with a robotic surgical system, such as the system 500
described herein.
[0159] FIG. 51 illustrates a close up of the transducer assembly
1012, distal shaft portion 1007, articulation joint 1010 and end
effector 1014 arranged as illustrated in FIG. 50. FIG. 52
illustrates one embodiment of the articulation joint 1010 with the
distal shaft portion 1007 and proximal shaft portion 1009 removed
to show one example embodiment for articulating the shaft 1004 and
actuating the haw member 1016. In FIG. 52, articulation control
members 1210, 1212 are coupled to a pulley 1206. The pulley, in
turn, may be coupled to the distal shaft portion 1007, for example,
at the articulation joint 1010 such that rotation of the pulley
1206 causes corresponding pivoting of the distal shaft portion 1007
and end effector 1014. Proximal translation of the control member
1212 may rotate the pulley 1206 clockwise (in the configuration
shown in FIG. 52), thereby articulating the end effector 1014
towards the control member 1212, as shown in FIG. 52. Similarly,
proximal translation of the control member 1210 may rotate the
pulley 1206 counter clockwise (in the configuration shown in FIG.
52), thereby articulating the end effector 1014 towards the control
member 1210, the opposite of what is shown in FIG. 52.
[0160] Clamp arm control member 1044 may extend through a channel
1208 in the pulley 1206. As illustrated, the clamp arm 1016 is
configured to be pivotably coupled to a distal plate 1215 at a
pivot point 1214. The clamp arm control member 1044 is coupled to
the clamp arm 1016 at a point 1216 offset from the pivot point
1214, such that distal and proximal translation of the clamp arm
control member 1044 opens and closes the clamp arm 1016. The plate
1215, for example, may be coupled to the distal shaft portion 1007
(not shown in FIG. 52), the transducer assembly 1012 or any other
suitable component. In some embodiments, the clamp arm 1016 is
pivotably coupled directly to the distal shaft portion 1007 and/or
the transducer assembly 1012.
[0161] The articulation control members 1210, 1212 may be
differentially translated to articulate the distal shaft portion
1007 and end effector 1014. Differential articulation of the
control members 1210, 1212 may be actuated in any suitable manner.
For example, in a manual surgical instrument, the control members
1210, 1212 may be differentially translated utilizing an
articulation lever 1052 and spindle gear 1058 as illustrated in
FIG. 40A. Also, in robotic surgical instruments, the control
members 1210, 1212 may be differentially translated, for example,
utilizing any of the mechanisms described above with respect to
FIGS. 22-36C. The clamp arm control member 1044 may be driven in
various ways including, for example, all of the additional ways
described herein.
[0162] In some embodiments, a surgical instrument has an end
effector that is rotatable independent of the shaft. For example,
the shaft itself may rotate and articulate at an articulation
joint. Additionally, the end effector may rotate independent of the
shaft including, for example, while the shaft is articulated. This
may effectively increase the spatial range of the end effector.
FIG. 53 illustrates one embodiment of a manual surgical instrument
1300 comprising a shaft 1303 having an articulatable, rotatable end
effector 1312. Although the shaft 1303 is illustrated for use with
a manual surgical instrument comprising a handle 1302, it will be
appreciated that a similar shaft may be utilized with a robotic
surgical system, such as those described herein.
[0163] The shaft 1303 comprises an articulation joint 1010 that may
be articulated utilizing articulation lever 1052, for example, as
indicated by arrow 1306. A rotation knob 1314 may rotate the shaft
1303, for example, as the rotation knob 48 rotates the shaft
assembly 14 described herein above. End effector rotation dial 1304
may rotate the end effector, for example, as indicated by arrow
1310. FIG. 54 illustrates a cut-away view of one embodiment of the
instrument 1300 and shaft 1303. FIG. 54 illustrates one embodiment
of the articulation lever 1052 coupled to control members 1032,
1034, for example, as described above with respect to FIGS. 39, 40
and 40A. A central shaft member 1316 may extend through the shaft
1303 and be coupled at a distal end to the end effector 1312 (e.g.,
the ultrasonic blade 1018 and clamp arm 1016). A proximal end of
the central shaft member 1316 may be coupled to the end effector
rotation dial 1304 such that rotation of the dial causes rotation
of the central shaft member 1316 and corresponding rotation of the
end effector 1312.
[0164] The central shaft member 1316 may be made of any suitable
material according to any suitable construction. For example, in
some embodiments, the central shaft member 1316 may be solid (or
hollow for enclosing wires and other components). The central shaft
member 1316 may be made from a flexible material, such as a
surgical grade rubber, a flexible metal such as titanium, nitinol,
etc. In this way, the central shaft member 1316 may bend when the
shaft 1303 is articulated at the articulation joint 1010. Rotation
of the central shaft member 1316 may still be translated to the end
effector 1312 across the articulation joint 1010.
[0165] In some embodiments, the central shaft member 1316, in
addition to rotating the end effector 1312, may also actuate the
clamp arm 1016. For example, the central shaft member 1316 may
actuate the clamp arm 1016 by translating distally and proximally,
for example, in response to actuation of the trigger 1022. FIG. 52,
described above, illustrates one embodiment of a clamp arm 1016
that may be opened and closed with distal and proximal motion. An
additional embodiment is described below with respect to FIG.
59.
[0166] In embodiments where the central shaft member 1316 actuates
the clamp arm 1016, it may be desirable to avoid translating distal
and/or proximal motion of the central shaft member 1316 to the dial
1304. FIG. 55 illustrates one embodiment of the instrument 1300
showing a keyed connection between the end effector rotation dial
1304 and the central shaft member 1316. A proximal portion of the
central shaft member 1316 may be coupled to a collar 1324 defining
a slot 1326. The dial 1304 may be coupled to shaft 1320 positioned
within the collar 1324. The shaft 1320 defines a key or spline 1322
positioned to fit within the slot 1326. In this way, rotation of
the dial 1304 may cause corresponding rotation of the central shaft
member 1316, but distal and proximal translation of the central
shaft member 1316 may not be communicated to the dial 1304. FIG. 55
also illustrates one example method of passing an electrical drive
signal to the transducer assembly 1012. For example, a drive cable
1318 may be coupled to a slip ring 1324. The slip ring 1324, in
turn, may be coupled to a distal drive cable 1330 (FIG. 56) that
may extend through the shaft 1303, for example, through the central
shaft member 1316. FIG. 56 illustrates one embodiment of the shaft
1303 focusing on the articulation joint 1010. In the embodiment
shown in FIG. 56, it may not be necessary for the entirety of the
central shaft member 1316 to be bendable. Instead, as illustrated
in FIG. 56, the central shaft member 1316 comprises a bendable
section 1332 aligned with the articulation joint 1010 of the shaft
1303.
[0167] The bendable section 1332 may be implemented in any suitable
manner. For example, the bendable section 1332 may be constructed
from a flexible material such as, for example, surgical grader
rubber or a bendable metal such as, for example, titanium, nitinol,
etc. Also, in some embodiments, the bendable section 1332 may be
made of hinged mechanical components. For example, FIG. 57
illustrates one embodiment of the central shaft member 1316 made of
hinged mechanical components. As illustrated in FIG. 57, the
central shaft member 1316 comprises a distal member 1340 pivotably
coupled to a central member 1342. The distal (1340) and central
(1342) members may pivot relative to one another in the direction
indicated by arrow 1346. The central member 1342 may also be
pivotably coupled to a proximal member 1344. The central (1342) and
proximal (1344) members may pivot relative to one another in the
direction indicated by arrow 1348. For example, the pivoting
direction of members 1344, 1342 may be substantially perpendicular
to the pivoting direction of the members 1342, 1340. In this way,
the central shaft member 1316 may provide rotating torque to the
end effector 1312 while pivoting with the articulation joint 1010
at bendable section 1332.
[0168] Referring back to FIG. 56, the articulation joint 1010 is
illustrated as a continuous, flexible portion 1350 of the shaft
1303. Various other configurations may be used. For example, FIG.
58 illustrates one embodiment of the shaft 1303 comprising a distal
shaft portion 1356 and a proximal shaft portion 1358. The
respective shaft portions 1356, 1358 may be pivotably coupled, for
example, to an intermediate shaft portion 1360, at pivot points
1352, 1354, respectively. The articulation joint 1010, in the
configuration shown in FIG. 58, may be articulated as described
herein above, for example, with respect to FIGS. 39, 40 and
40A.
[0169] FIG. 59 illustrates one embodiment of the shaft 1303 and end
effector 1312 illustrating a coupling between the central shaft
member 1316 and the clamp arm 1016. In FIG. 59, the central shaft
member 1316 is illustrated as a solid (or hollow) member that is
bendable and/or has a bendable portion at articulation joint 1010.
In FIG. 59, portions of the distal (1356) and proximal (1358) shaft
portions are omitted to show the operation of the central shaft
member 1316. For example, the central shaft member 1316 may extend
around the ultrasonic transducer assembly 1012 and transducer 1040
and be pivotably coupled to the clamp arm 1016 at pivot point 1366.
The clam arm 1016 may also be pivotably coupled to the distal shaft
portion 1356 at pivot point 1364. Pivot points 1364, 1366 may be
offset from one another relative to the longitudinal axis 1002.
When the central shaft portion 1316 is pushed distally, it may push
the clamp arm 1016 distally at pivot point 1366. As pivot point
1364 may remain stationary, the clamp arm 1364 may pivot to an open
position. Pulling the central shaft portion 1316 proximally may
pull the clamp arm 1016 back to the closed position shown in FIG.
59. As illustrated, when the central shaft portion 1316 is
translated distally and proximally, the transducer assembly 1012
and blade 1018 may also be translated distally and proximally.
[0170] Although the instrument 1300 is described herein as a manual
instrument, it will be appreciated that the shaft 1303 in the
various described embodiments may be utilized in a robotic surgical
instrument as well. For example, differential translation of the
control members 1032, 1034, rotation of the shaft 1303 and rotation
of the central shaft member 1316 may be brought about as described
herein above with respect to FIGS. 22-36C. Similarly, the shaft
1303 may be utilized in a manual instrument where articulation and
rotation of the end effector 1312 is motorized. FIGS. 60-61
illustrate a control mechanism for a surgical instrument 1300' in
which articulation and rotation of the end effector 1312 are
motorized. The instrument 1300' comprises a handle 1302' that may
comprise electric motors and mechanisms, for example, similar to
the motors and mechanisms described herein with respect to FIGS.
22-36C. An articulation knob 1370 may be moved in the directions of
arrow 1375 to articulate the end effector 1312 about articulation
joint 1010 and/or may be rotated in the directions indicated by
arrow 1372 to rotate the end effector 1312 (e.g., by rotating the
central shaft member 1316).
[0171] FIGS. 62-63 illustrate one embodiment of a shaft 1400 that
may be utilized with various surgical instruments described herein.
The shaft 1400 may comprise a two-direction articulation joint 1402
that may be articulated in multiple directions, as indicated by
arrows 1410 and 1412. The shaft 1400 may comprise a proximal shaft
member 1404 pivotably coupled to a joint member 1408 such that the
proximal shaft member 1404 is pivotable relative to the joint
member 1408 in the direction of arrow 1412. The joint member 1408
may also be pivotably coupled to a distal shaft member 1406 such
that the distal shaft member 1406 is pivotable relative to the
joint member 1408 in the direction of arrow 1410. The pivotably
couplings between the respective members 1404, 1406, 1408 may be of
any suitable type including, for example, pin and clevis
couplings.
[0172] Referring now to FIG. 63, the articulation joint 1402 may be
actuated by a series of control members. Control members 1414, 1412
may be coupled to the joint member 1408 and may extend proximally
through the proximal shaft member 1404. Differential translation of
the control members 1414, 1412 may cause the end effector 1411 to
pivot away from the longitudinal axis 1002 in the directions of the
arrow 1412. For example, proximal translation of the control member
1412 (e.g., accompanied by distal translation of the control member
1414) may pull the end effector 1411, distal shaft member 1406 and
joint member 1408 away from the longitudinal axis 1002 and towards
the control member 1412. Similarly, proximal translation of the
control member 1414 (e.g., accompanied by distal translation of the
control member 1412) may pull the end effector 1411, distal shaft
member 1406 and joint member 1408 away from the longitudinal axis
1002 and towards the control member 1414.
[0173] Additional control members 1416, 1418 may be coupled to the
distal shaft member 1406. Differential translation of the control
members 1416 may cause the distal shaft member 1406 and end
effector 1411 to pivot in the directions of the arrow 1410. For
example, proximal translation of the control member 1416 (e.g.,
accompanied by distal translation of the control member 1418) may
pull the end effector 1411 and distal shaft member 1406 away from
the longitudinal axis 1002 and towards the control member 1416.
Similarly, proximal translation of the control member 1418 (e.g.,
accompanied by distal translation of the control member 1416) may
pull the end effector 1411 and distal shaft member 1406 away from
the longitudinal axis 1002 and towards the control member 1418.
Drive signal wires for driving the ultrasonic transducer assembly
1012 may pass through the proximal shaft member 1404, joint member
1408 and distal shaft member 1406.
[0174] Differential translation of the respective control members
1412, 1414, 1416, 1418 may be implemented in any suitable manner.
For example, in a manual instrument, differential translation of
the control members 1412, 1414, 1416, 1418 may be implemented in
the manner described above with respect to FIGS. 39, 40 and 40A. In
a robotic instrument, any method or mechanism may be used
including, for example, those described above with respect to FIGS.
22-36C.
[0175] FIG. 64 illustrates one embodiment of a shaft 1600 that may
be articulated utilizing a cable and pulley mechanism. The shaft
1600 may be utilized with any of the various surgical instruments
described herein. The shaft 1600 comprises a proximal shaft member
1602 and a distal shaft member 1614 coupled at an articulation
joint 1615. An end effector 1617 may be coupled to a distal portion
of the distal shaft member 1614. The end effector 1615, as
illustrated in FIG. 64 may comprise an ultrasonic blade 1018,
ultrasonic transducer assembly 1012, clamp arm 1016 and linkage
members 1608, 1610 arranged in a four-bar linkage configuration
similar to that described herein with respect to end effector 1014
shown at FIGS. 42-46. For example, the end effector 1617 may be
pivotably coupled to the distal shaft member 1614 at clevis arms
1615. Clamp arm control member 1624 may be coupled to the linkage
members 1608, 1610 to open and close the clamp arm member 1016, as
described above. The shaft 1600 may be rotated, as indicated by
arrow 1604. In contrast to the end effector 1014, the end effector
1617 may only comprise a single linkage member 1608 and a single
linkage member 1610, as illustrated. It will be appreciated that
the ultrasonic transducer assembly 1012 is illustrated in FIG. 64
without any outer housing so as to more clearly illustrate the
embodiment. In use, the ultrasonic transducer assembly 1012 may be
utilized with a housing such as the housing 1064 described herein
above with respect to FIG. 41.
[0176] FIG. 65 illustrates one embodiment of the shaft 1600 showing
additional details of how the distal shaft portion 1614 (and end
effector 1617 not shown in FIG. 65) may be articulated. For
example, control members 1620, 1622 may extend through the proximal
shaft member 1602 and around a pulley 1618 coupled to the distal
shaft member 1614. For example, rotation of the pulley 1618 about
the axis 1615 (FIG. 64) may cause pivoting of the distal shaft
portion 1614. The pulley 1618 may be rotated by differential
translation of the control members 1620, 1622, thereby bringing
about articulation of the distal shaft portion 1614 and end
effector 1617 in the direction of the arrow 1606. FIG. 64 shows an
alternate position 1601 of the end effector 1617 and distal shaft
member 1615 articulated in a first direction relative to the
longitudinal axis 1002. It will be appreciated, however, that the
end effector 1617 and distal shaft member 1615 may be articulated
in multiple directions about articulation axis 1619 (FIG. 64).
[0177] The control members 1620, 1622 and clamp arm control member
1624 may be actuated in any suitable manner. For example, the
control members 1620, 1622 may be differentially translated to
articulate the end effector 1617 and distal shaft member 1615. In
use with a manual instrument, the control members 1620, 1622 may be
differentially translated, for example, as described herein above
with respect to FIGS. 39, 40 and 40A. In use with a robotic
instrument, the control members 1620, 1622 may be differentially
translated, for example, utilizing any of the mechanisms described
above with respect to FIGS. 22-36C. In a manual instrument, the
clamp arm control member 1624 may be mechanically coupled to an
instrument trigger, such as tubular actuating member 58 is coupled
to trigger 22 described above. In a robotic instrument, the clamp
arm control member 1624 may be actuated, for example, utilizing any
of the mechanisms described above with respect to FIGS. 22-36C.
[0178] FIG. 66 illustrates one embodiment of an end effector 1700
that may be utilized with any of the various instruments and/or
shafts described herein. The end effector 1700 may facilitate
separate actuation of the clamp arm 1016 and ultrasonic blade 1018.
The end effector 1700 may operate similar to the four-bar linkage
end effector 1014 described herein above. Instead of the linkage
members 1705, 1707 being coupled to a single clamp arm control
member 1044 (FIG. 42), each of the linkage members 1705, 1707 may
be coupled to distinct control members 1702, 1704. For example,
linkage member 1705 may be coupled to a clamp arm control member
1702 while linkage member 1707 may be coupled to a blade control
member 1704. Proximal ends of the linkage member 1705, 1707 may
ride within slots 1706, 1708 defined by the shaft 1710 (or a distal
portion thereof). For example, linkage members 1705, 1076 may
comprise respective pegs 1712, 1714 that ride within the slots
1706, 1708. In some embodiment, linkage members 1705, 1707 may be
singular (similar to linkage members 1608, 1610, or may be double
linkage members (similar to linkage members 1074, 1074' and 1076,
1076').
[0179] Distal and proximal translation of the clamp arm control
member 1702 may cause the clamp arm 1016 to pivot about the pivot
point 1072. For example, proximal translation of the clamp arm
control member 1702 may pull the linkage member 1705 and proximal
portion 1078 of the clamp arm 1016 proximally, tending to pivot the
clamp arm 1016 about the pivot point 1072 in the direction
indicated by arrow 1716. Distal translation of the clamp arm
control member 1702 may push the linkage member 1705 and proximal
portion 1078 of the clamp arm member 1078 distally (shown at 1724)
tending to pivot the clamp arm 1016 about the pivot point 1072 in
the direction indicated by arrow 1718. Similarly, distal and
proximal translation of the blade control member 1704 ma cause the
blade 1018 to pivot about the pivot point 1072. Proximal
translation of the blade control member 1704 may pull the linkage
member 1076 and transducer assembly 1012 proximally, causing the
blade 1018 to pivot about the pivot point 1072 in the direction
indicated by arrow 1720. Distal translation of the blade control
member 1704 may push the linkage member 1076 and transducer
assembly 1012 distally (shown at 1726) tending to pivot the blade
1018 about the pivot point 1072 in the direction indicated by arrow
1722.
[0180] By manipulating the various control members 1702, 1704, the
blade 1018 and clamp arm 1016 of the end effector 1700 may be
opened and closed, and also pivoted together about the pivot point
1072, for example, to provide an additional degree of articulation
to the end effector 1700. For example, although the blade 1018 and
clamp arm 1016 are shown in FIG. 66 to be closed along the
longitudinal axis 1002, it will be appreciated that the components
1018, 1016 could be placed in a close position pivoted away from
the longitudinal axis 1002 as well.
[0181] FIG. 67 illustrates one embodiment of the shaft 1600 coupled
to an alternate pulley-driven end effector 1800. FIG. 68
illustrates one embodiment of the end effector 1800. The end
effector 1800 may comprise linkage members 1810, 1812 that may each
be pivotably coupled to respective pulleys 1814, 1816. The linkage
members 1810, 1812 may be coupled to the pulleys 1814, 1816 at a
position offset from a center 1817 of the pulleys 1814, 1816 such
that rotation of the pulleys 1814, 1816 translates the linkage
members 1810, 1812 distally and proximally. The pulleys 1814, 1816
may be individually driven. For example pulley 1816 may be rotated
by differentially translating control members 1802, 1804.
Similarly, pulley 1814 may be rotated by differentially translating
control members 1806, 1808. As pulley 1814 is rotated, linkage
member 1810 may be translated distally and proximally, causing
pivoting of the clamp arm 1016 about pivot point 1072 in the
directions indicated by arrows 1814, 1816. Similarly, as pulley
1816 is rotated, linkage member 1812 may be translated distally and
proximally, causing pivoting of the ultrasonic transducer assembly
1012 and blade 1018 about the pivot point 1072 in the direction of
arrows 1818, 1820. Differential translation of the control member
pairs 1802/1804 and 1806/1808 may be brought about in any suitable
manner. For example, in manual instruments, the control member
pairs may be differentially translated as described above with
respect to FIGS. 39, 40 and 40A. In robotic instruments, the
control member pairs may be differentially translated as described
above with respect to FIGS. 22-36C. It will be appreciated that the
ultrasonic transducer assembly 1012 is illustrated in FIGS. 67-68
without any outer housing so as to more clearly illustrate the
embodiment. In use, the ultrasonic transducer assembly 1012 may be
utilized with a housing such as the housing 1064 described herein
above with respect to FIG. 41.
Non-Limiting Embodiments
[0182] Various embodiments are direct to a surgical instrument
comprising and end effector, an articulating shaft and an
ultrasonic transducer assembly. The end effector may comprise an
ultrasonic blade. The articulating shaft may extend proximally from
the end effector along a longitudinal axis and may comprise a
proximal shaft member and a distal shaft member pivotably coupled
at an articulation joint. The ultrasonic transducer assembly may
comprise an ultrasonic transducer acoustically coupled to the
ultrasonic blade. The ultrasonic transducer assembly may be
positioned distally from the articulation joint. In some
embodiments, the ultrasonic transducer assembly may be positioned
such that a portion of the ultrasonic transducer assembly is
proximal from the articulation joint and another portion of the
ultrasonic transducer assembly is distal from the articulation
joint.
[0183] In some embodiments, the instrument comprises first and
second control members extending through the shaft such that
proximal translation of the first control member causes the distal
shaft member and end effector to pivot towards the first control
member. Also, in some embodiments, the distal shaft portion may
define a pulley at about the articulation joint such that rotation
of the pulley causes articulation of the distal shaft portion.
First and second control members may be positioned around the
pulley such that differential translation of the first and second
control members causes rotation of the pulley and articulation of
the distal shaft member.
[0184] Also, some embodiments comprise a clamp arm pivotable about
a clamp arm pivot point from an open position to a closed position
substantially parallel to the ultrasonic blade. The clamp arm pivot
point may be offset from the longitudinal axis. A clamp arm control
member may be coupled to the clamp arm at a position offset from
the longitudinal axis such that distal translation of the clamp arm
control member pivots the clamp arm to the open position and
proximal translation of the clamp arm control member pivots the
clamp arm to the closed position.
[0185] In some embodiments, the clamp arm defines a clamp portion
extending distally from the clamp arm pivot point and a proximal
portion extending proximally from the clamp arm pivot point. A
first linkage member may define a proximal end pivotably coupled to
the clamp arm control member and a distal end pivotably coupled to
a proximal portion of the ultrasonic transducer assembly. A second
linkage member may define a proximal end pivotably coupled to the
clamp arm control member and a distal end pivotably coupled to the
proximal portion of the clamp arm. In some embodiments, the first
linkage member may be coupled to a blade control member and the
second linkage member may be coupled to a clamp arm control member.
Also, in some embodiments, the first and second linkage members are
coupled to respective pulleys separately rotatable by respective
control members. Also, in some embodiments, the first and second
linkage members may be coupled to respective first and second
pulleys, where each pulley is separately rotatable to pivot the
clamp arm and blade.
[0186] In some embodiments, a proximal portion of the ultrasonic
transducer assembly and a distal portion of the ultrasonic
transducer assembly are separated by a bendable, acoustically
transmissive section having a transverse area less than a
longitudinal diameter of the distal and proximal portions of the
ultrasonic transducer assembly. The first linkage member may be
connected as described above. The proximal portion of the
ultrasonic transducer assembly may also be coupled to the clamp arm
control member.
[0187] Applicant also owns the following patent applications that
are each incorporated by reference in their respective entireties:
[0188] U.S. patent application Ser. No. 13/536,271, filed on Jun.
28, 2012 and entitled "Flexible Drive Member," (Attorney Docket No.
END7131USNP/120135); [0189] U.S. patent application Ser. No.
13/536,288, filed on Jun. 28, 2012 and entitled "Multi-Functional
Powered Surgical Device with External Dissection Features,"
(Attorney Docket No. END7132USNP/120136); [0190] U.S. patent
application Ser. No. 13/536,295, filed on Jun. 28, 2012 and
entitled "Rotary Actuatable Closure Arrangement for Surgical End
Effector," (Attorney Docket No. END7134USNP/120138); [0191] U.S.
patent application Ser. No. 13/536,326, filed on Jun. 28, 2012 and
entitled "Surgical End Effectors Having Angled Tissue-Contacting
Surfaces," (Attorney Docket No. END7135USNP/120139); [0192] U.S.
patent application Ser. No. 13/536,303, filed on Jun. 28, 2012 and
entitled "Interchangeable End Effector Coupling Arrangement,"
(Attorney Docket No. END7136USNP/120140); [0193] U.S. patent
application Ser. No. 13/536,393, filed on Jun. 28, 2012 and
entitled "Surgical End Effector Jaw and Electrode Configurations,"
(Attorney Docket No. END7137USNP/120141); [0194] U.S. patent
application Ser. No. 13/536,362, filed on Jun. 28, 2012 and
entitled "Multi-Axis Articulating and Rotating Surgical Tools,"
(Attorney Docket No. END7138USNP/120142); and [0195] U.S. patent
application Ser. No. 13/536,417, filed on Jun. 28, 2012 and
entitled "Electrode Connections for Rotary Driven Surgical Tools,"
(Attorney Docket No. END7149USNP/120153).
[0196] In some embodiments, the shaft further comprises a joint
member positioned at about the articulation. The joint member may
be pivotably coupled to the distal shaft member such that the
distal shaft member is pivotable relative to the joint member about
a first pivot axis substantially perpendicular to the longitudinal
axis and pivotably coupled to the proximal shaft member such that
the joint member is pivotable relative to the proximal shaft member
about a second pivot axis substantially perpendicular to the
longitudinal axis and substantially perpendicular to the first
pivot axis.
[0197] It will be appreciated that the terms "proximal" and
"distal" are used throughout the specification with reference to a
clinician manipulating one end of an instrument used to treat a
patient. The term "proximal" refers to the portion of the
instrument closest to the clinician and the term "distal" refers to
the portion located furthest from the clinician. It will further be
appreciated that for conciseness and clarity, spatial terms such as
"vertical," "horizontal," "up," or "down" may be used herein with
respect to the illustrated embodiments. However, surgical
instruments may be used in many orientations and positions, and
these terms are not intended to be limiting or absolute.
[0198] Various embodiments of surgical instruments and robotic
surgical systems are described herein. It will be understood by
those skilled in the art that the various embodiments described
herein may be used with the described surgical instruments and
robotic surgical systems. The descriptions are provided for example
only, and those skilled in the art will understand that the
disclosed embodiments are not limited to only the devices disclosed
herein, but may be used with any compatible surgical instrument or
robotic surgical system.
[0199] Reference throughout the specification to "various
embodiments," "some embodiments," "one example embodiment," or "an
embodiment" means that a particular feature, structure, or
characteristic described in connection with the embodiment is
included in at least one example embodiment. Thus, appearances of
the phrases "in various embodiments," "in some embodiments," "in
one example embodiment," or "in an embodiment" in places throughout
the specification are not necessarily all referring to the same
embodiment. Furthermore, the particular features, structures, or
characteristics illustrated or described in connection with one
example embodiment may be combined, in whole or in part, with
features, structures, or characteristics of one or more other
embodiments without limitation.
[0200] While various embodiments herein have been illustrated by
description of several embodiments and while the illustrative
embodiments have been described in considerable detail, it is not
the intention of the applicant to restrict or in any way limit the
scope of the appended claims to such detail. Additional advantages
and modifications may readily appear to those skilled in the art.
For example, each of the disclosed embodiments may be employed in
endoscopic procedures, laparoscopic procedures, as well as open
procedures, without limitations to its intended use.
[0201] It is to be understood that at least some of the figures and
descriptions herein have been simplified to illustrate elements
that are relevant for a clear understanding of the disclosure,
while eliminating, for purposes of clarity, other elements. Those
of ordinary skill in the art will recognize, however, that these
and other elements may be desirable. However, because such elements
are well known in the art, and because they do not facilitate a
better understanding of the disclosure, a discussion of such
elements is not provided herein.
[0202] While several embodiments have been described, it should be
apparent, however, that various modifications, alterations and
adaptations to those embodiments may occur to persons skilled in
the art with the attainment of some or all of the advantages of the
disclosure. For example, according to various embodiments, a single
component may be replaced by multiple components, and multiple
components may be replaced by a single component, to perform a
given function or functions. This application is therefore intended
to cover all such modifications, alterations and adaptations
without departing from the scope and spirit of the disclosure as
defined by the appended claims.
[0203] Any patent, publication, or other disclosure material, in
whole or in part, that is said to be incorporated by reference
herein is incorporated herein only to the extent that the
incorporated materials does not conflict with existing definitions,
statements, or other disclosure material set forth in this
disclosure. As such, and to the extent necessary, the disclosure as
explicitly set forth herein supersedes any conflicting material
incorporated herein by reference. Any material, or portion thereof,
that is said to be incorporated by reference herein, but which
conflicts with existing definitions, statements, or other
disclosure material set forth herein will only be incorporated to
the extent that no conflict arises between that incorporated
material and the existing disclosure material.
* * * * *