U.S. patent application number 14/240022 was filed with the patent office on 2014-07-03 for actuating knob for a surgical instrument.
The applicant listed for this patent is ENDOCONTROL. Invention is credited to Herve Collet, Patrick Henri, Clement Vidal.
Application Number | 20140188091 14/240022 |
Document ID | / |
Family ID | 47745977 |
Filed Date | 2014-07-03 |
United States Patent
Application |
20140188091 |
Kind Code |
A1 |
Vidal; Clement ; et
al. |
July 3, 2014 |
ACTUATING KNOB FOR A SURGICAL INSTRUMENT
Abstract
The invention relates to a surgical instrument comprising: --a
distal tool (5) securely fastened at a distal end of a rotation
shaft (4) and rotatably mounted on and in the extension of a distal
member (30) rotatably mounted at an end of an elongated arm (3),
--motorized means (20) for actuating the distal motion of the
distal tool (5) and further comprising controlling means (21) for a
user to control the motorized means (20); characterized in that the
controlling means (21) comprise electronic components (210) for
actuation of the motorized means (20), and switch elements (211)
for the user to control the electronic components (210), the switch
elements (211) comprising at least one magnet (2110) for
contactless signal transmission to hall sensors (2100) of the
electronic components (210), wherein the switch elements (211)
comprise an outer knob (2111) and an inner knob (2112), with the
magnet (2110) being fastened to the outer knob (2111) and being
mounted in translation within a longitudinal groove (2113) provided
in the inner knob (2112) along an axis parallel to the longitudinal
axis, said inner knob (2112) being rotatably mounted around the
longitudinal axis.
Inventors: |
Vidal; Clement; (Grenoble,
FR) ; Collet; Herve; (Chatenay, FR) ; Henri;
Patrick; (Bois Colombes, FR) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
ENDOCONTROL |
La Tronche |
|
FR |
|
|
Family ID: |
47745977 |
Appl. No.: |
14/240022 |
Filed: |
August 24, 2012 |
PCT Filed: |
August 24, 2012 |
PCT NO: |
PCT/EP2012/066499 |
371 Date: |
February 20, 2014 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
61527519 |
Aug 25, 2011 |
|
|
|
Current U.S.
Class: |
606/1 |
Current CPC
Class: |
A61B 2017/00323
20130101; A61B 2017/2923 20130101; A61B 2017/00738 20130101; A61B
17/00 20130101; A61B 2017/0042 20130101; A61B 2017/00398 20130101;
A61B 2017/003 20130101; A61B 2017/291 20130101; A61B 2017/2903
20130101; A61B 2017/00017 20130101; A61B 2017/2929 20130101; A61B
2017/2908 20130101; A61B 2017/0069 20130101; A61B 17/2909 20130101;
A61B 17/00234 20130101; A61B 2017/2927 20130101; A61B 2017/00367
20130101 |
Class at
Publication: |
606/1 |
International
Class: |
A61B 17/00 20060101
A61B017/00 |
Foreign Application Data
Date |
Code |
Application Number |
Aug 26, 2011 |
EP |
11306065.1 |
Aug 26, 2011 |
EP |
11306066.9 |
Claims
1. A surgical instrument comprising: an elongated arm (3) extending
along a longitudinal axis and having a distal member (30) mounted
at a distal end of the elongated arm (3) with means forming a pivot
joint around a pivot axis orthogonal to the longitudinal axis; a
rotation shaft (4) coaxial with the elongated arm (3) comprising
means forming a universal joint facing the pivot joint; a distal
tool (5) securely fastened at a distal end of the rotation shaft
(4) and rotatably mounted on and in the extension of the distal
member (30) of the elongated arm (3), such that the distal tool (5)
has two rotational degrees of freedom, distinct and independent of
each other, one degree of freedom being around the pivot axis and
the other degree of freedom being around an axis collinear to an
own axis of the distal tool; an actuation unit (2) mounted on and
in the extension of a proximal end of the elongated arm (3), said
actuation unit (2) comprising motorized means (20) for actuating
the motion of the distal tool (5) through the two rotational
degrees of freedom, and further comprising controlling means (21)
for a user to control the motorized means (20); and a handle (1)
extending from the actuation unit (2); wherein the controlling
means (21) comprise electronic components (210) for actuation of
the motorized means (20), and switch elements (211) for the user to
control the electronic components (210), the switch elements (211)
comprising at least one magnet (2110) for contactless signal
transmission to hall sensors (2100) of the electronic components
(210), wherein the switch elements (211) comprise an outer knob
(2111) and an inner knob (2112), with the magnet (2110) being
fastened to the outer knob (2111) and being mounted in translation
within a longitudinal groove (2113) provided in the inner knob
(2112) along an axis parallel to the longitudinal axis, said inner
knob (2112) being rotatably mounted around the longitudinal
axis.
2. The surgical instrument of claim 1, wherein the motorized means
(20) and electronic components (210) are enclosed in a sealed
compartment, the switch elements (211) being located out of said
sealed compartment.
3. The surgical instrument of claim 1, wherein the switch elements
(210) comprise at least eight hall sensors (2100), two of said at
least eight hall sensors being arranged for providing signal to the
motorized means (20) upon translation of the outer knob (2111), two
others of said at least eight hall sensors being arranged for
providing signal to the motorized means upon rotation of the outer
knob (2111), and the four remaining of said at least eight hall
sensors being arranged for providing signal to the motorized means
(20) upon combined translation and rotation of the outer knob
(2111).
4. The surgical instrument of claim 1, wherein the hall sensors
(2100) are used as potentiometers.
5. The surgical instrument of claim 1, wherein the hall sensors
(2100) are used for controlling the speed of the motorized
means.
6. The surgical instrument of claim 1, wherein a translation of the
outer knob (2111) controls the motorized means (20) for actuation
of the distal tool (5) through a rotation around the pivot axis,
and wherein a rotation of the outer knob (2111) controls the
motorized means (20) for actuation of the distal tool (5) through a
rotation around the axis collinear to the own axis of the distal
tool (5).
7. The surgical instrument of claim 1, wherein the handle (1)
comprises a lever (11) mechanically coupled to the distal tool (5)
for actuation of said distal tool (5) via an actuation cable (6)
extending coaxially within said elongated arm (3) and rotation
shaft (4).
8. The surgical instrument of claim 1, wherein the actuation unit
(2) further comprises complementary motorized means for actuation
of said distal tool (5) via an actuation cable (6) extending
coaxially within said elongated arm (3) and rotation shaft (4).
9. The surgical instrument of claim 1, further comprising a first
actuation cable (314) and a second actuation cable (312) arranged
parallel to each other within the elongated arm (3) along the
longitudinal axis, said first (314) and second (312) actuation
cables having each an end fastened to the distal member (30) so
that translation of one of the first and second actuation cables
(314,312) relative to the other one of the first and second
actuation cables (314,312) actuates the distal tool (5) through the
rotation around the pivot axis, wherein the motorized means (20)
comprise a motor (200) with a driving shaft (201) having first
(202) and second (203) transmission members for coupling the
driving shaft (201) with the first (314) and second (312) actuation
cables respectively, wherein the first transmission member (202)
comprises means for translating the first actuation cable (314) in
a first direction collinear to the longitudinal axis upon clockwise
rotation of the driving shaft (201), and the second transmission
member (203) comprises means for translating the second actuation
cable (312) in the first direction upon anticlockwise rotation of
the driving shaft (201).
10. The surgical instrument of claim 9, wherein the first (202) and
second (203) transmission members are coupled to the driving shaft
(201) with coupling means adapted for translating the transmission
members (202,203) in opposite directions along the longitudinal
axis of the driving shaft (201) upon rotation of the driving shaft
(201) of the motor (200).
11. The surgical instrument of claim 9, wherein the driving shaft
(201) comprises a first threaded portion and a second threaded
portion for cooperation with a first threaded bore of the first
transmission member (202) and with a second threaded bore of the
second transmission member (203) respectively, wherein said first
and second threaded portions have opposite threads.
12. The surgical instrument of claim 11, wherein the first and
second threaded portions have different pitches.
13. The surgical instrument of claim 9, wherein the first
transmission member (202) comprises means for releasing the first
actuation cable (314) upon anticlockwise rotation of the driving
shaft (201), and the second transmission member (203) comprises
means for releasing the second actuation cable (312) upon clockwise
rotation of the driving shaft (201).
14. The surgical instrument of claim 13, wherein the first (314),
respectively second (312), actuation cable comprises an abutment
adapted to cooperate with the first (202), respectively second
(203), transmission member so that translation of the first (202),
respectively second (203), transmission member in the first
direction causes the first (314), respectively second (312),
actuation cable to translate in said first direction, whereas a
translation of the first (202), respectively second (203),
transmission member in a second direction opposite the first
direction releases the first (314), respectively second (312),
actuation cable.
15. The surgical instrument of claim 14, wherein the first (314),
respectively second (312), actuation cable comprises an end
(3140,3120) with a threaded portion and a threaded bolt (3141,3121)
mounted on said threaded portion for adjustment of the length of
said first (314), respectively second (312), actuation cable, said
threaded bolt (3141,3121) forming the abutment.
16. The surgical instrument of claim 9, wherein the first
transmission member (202) comprises means for translating the first
actuation cable (314) in a second direction opposite to the first
direction upon anticlockwise rotation of the driving shaft (201),
and the second transmission member (203) comprises means for
translating the second actuation cable (312) in the second
direction upon clockwise rotation of the driving shaft (201).
17. The surgical instrument of claim 16, wherein the first (314),
respectively second (312), actuation cable has an end securely
fastened to the first (202), respectively second (203),
transmission member.
18. The surgical instrument of claim 9, wherein the motorized means
(20) comprise another motor (205) with another driving shaft (206)
fixed to an end of the rotation shaft (4) for actuating rotation of
the distal tool (5) around the axis collinear to the own axis of
said distal tool (5).
Description
FIELD OF THE INVENTION
[0001] The invention relates to a surgical instrument designed for
endoscopic or laparoscopic surgical operations.
TECHNICAL BACKGROUND
[0002] Within the scope of minimally-invasive surgery, such as
endoscopic or laparoscopic surgery, access to the operating site is
made via small incisions in the body of the patient (such as the
abdomen or thorax), in which the practitioner places a cannula
formed by a tube whereof the diameter varies from 3 to 15 mm, via
which the practitioner can insert into the body of the patient
either an endoscope for obtaining a video image on a monitor, or
long and fine instruments for performing a procedure at the
operating site.
[0003] The majority of existing instruments is constituted by a
fine (typically around 5 mm in diameter) and rigid elongated body
(typically around 30 cm long). The proximal end of the instrument
comprises a grip handle for the practitioner and the distal end of
the instrument is often fitted with a forceps or scissors,
optionally capable of transmitting electric current for cutting
(monopolar or bipolar).
[0004] The main advantage of laparoscopic surgery is the minimum
incisions. However, the main limitation is the decrease in
dexterity associated with a remote access by long instruments.
Indeed, when the instrument is rigid, its passage via a fixed
incision point is a planar kinematic constraint which limits the
number of degrees of freedom (DoF) to four, i.e. three movements of
rotation about the point of incision and a penetration translation
movement of the instrument. In particular, with conventional
laparoscopic rigid instruments, it is impossible to bend the distal
end of the instrument to orient the forceps optimally relative to
the practitioner. This is a major application limitation of
laparoscopic surgical tools for surgical procedures.
[0005] This has led to the development of novel instruments
comprising a distal part exhibiting mobility relative to the
principal body of the instrument. For example, for suturing
exercise, the surgeon uses a curved needle. When he carries out
this exercise in optimal conditions, the surgeon: [0006] 1. grasps
the needle such that the plane of the needle is perpendicular to
the axis of the forceps; [0007] 2. places the plane of the needle
perpendicularly to the edges to be sutured; [0008] 3. turns the
needle according to an axis perpendicular to its plane to insert it
into the tissue to be sutured.
[0009] Therefore, to make a suture in favorable conditions, there
must be means for placing the axis of the instrument substantially
parallel to the edges to be sutured and turning the forceps about
its axis. During some interventions, positioning the points of
incision relative to the operating site is such that it is not
possible to align the axis of the forceps with the edges to be
sutured when using rigid instruments, substantially complicating
the way to make the suture. Thus instruments have been developed
which are adapted for orienting the axis of the forceps relative to
the principal axis of insertion of the instrument in the body, due
to distal mobility.
[0010] It should be noted that the final rotation movement of the
forceps around its own axis (intrinsic rotation of the forceps),
which controls penetration of the needle, must be made with a high
precision and a maximal stability of the direction of the axis of
the forceps while applying sufficient force to perforate
tissue.
[0011] There have been a lot of different developments of surgical
Instruments having a distal mobility. Generally, these surgical
instruments are such that the axis of the forceps can be oriented
relative to the main axis of insertion of the instrument through a
rotation made about any axis perpendicular to such main axis of
insertion. These instruments may be supported by a robotic arm but
are more often hand held.
[0012] With these kind instruments, the user further wants to be
able to orient the axis of the forceps in any direction relative to
the main axis of insertion of the instrument. This requires that
the forceps is mounted with two orthogonal pivot joints on the
instrument shaft and that each pivot joint has a 180.degree. range
of motion to provide a right angle orientation of the forceps in
both directions. Instruments fulfilling this requirement have for
instance been described in U.S. Pat. No. 7,147,650, U.S. Pat. No.
7,338,513, U.S. Pat. No. 7,686,826, U.S. Pat. No. 7,842,028,
US2006111210, US2007250113, US2010286480, or US2010331860. However
the more complex the joint between the forceps and the instrument
shaft, the bigger the joint. Moreover overall instrument diameter
is an issue in minimally invasive surgery where 5 mm diameter is a
gold standard. Some have chosen to use flexible material in between
shaft and forceps to reduce joint diameter, but it then compromises
overall strength and rigidity. Further, most of the proposed
solutions can unfortunately not be adapted for motorization of the
motion of the forceps--or any other distal tool--which is a major
drawback since motion of such distal tool generally need to be very
accurate.
[0013] In WO2010112608 and WO2010112609, is described an instrument
having a forceps mounted on an outer arm comprising a pivot joint
around a single axis. This enables using assembly element such as
vertebrae which provide a good resistance to forces applied off the
plane that is perpendicular to the pivot axis. Also, when the
instrument is motorized, using one pivot only exhibits the
advantage of requiring only one actuator dedicated to the
orientation of the forceps. However as described above, this does
not allow to orient forceps in any direction.
[0014] A solution to overcome this problem is to use a further
rotation around the insertion axis. This rotation can for instance
be manually controlled by the surgeon at the handle level. However,
a drawback to this hand rotation is the limited range of possible
rotation, induced by the limited range of human wrist motion. When
handling an instrument handle, it can be considered that the
maximum range of rotation is 180.degree. degrees, which is the
range of the pronation-supination wrist motion. If a 360.degree.
rotation is required, it may be used the instrument described in
WO2011013100 that comprises a handle and control means with a
cylindrical symmetry, which enables the user to rotate the
instrument in its hand and to still be able to use instrument
normally (no preferential orientation). However, manipulating such
an inline instrument imposes the user to put elbow up which
involves shoulder abduction. This anatomical posture is known not
to be ergonomic in the long run.
[0015] In US2010249497 it has been proposed two different
embodiments of a surgical instrument provided with means to orbit
the distal tool relative to the longitudinal axis of the main
shaft, said orbit of the distal tool being made by an own rotation
of the instrument shaft. The first embodiment which is disclosed in
this document is fully manually operated, with only mechanical
coupling. In particular, there is proposed to use a mechanical ball
& neck assembly for manually actuating the bending of the
distal tool. The second embodiment disclosed in US2010249497
comprises a motorized push/pull cable drive mechanism that replaces
the ball & neck assembly. The motorized assembly does however
complexify the structure of the surgical instrument. In particular,
an own rotation of the distal tool can only be operated by
combination of the pivot and orbit movements of the tool, more
precisely a combination of the own rotation of the instrument shaft
and two pivots of the distal tool made about two axis perpendicular
to the longitudinal axis of the instrument and perpendicular to
each other. However, such combination of movements necessarily
requires an electronic control of the corresponding motors, which
complexifies the instrument. Such surgical instrument has further
the drawback of being relatively voluminous, when full motorization
is used.
[0016] A goal of the present invention is thus to propose a
surgical instrument that does not present the above drawbacks.
[0017] More precisely, a goal of the present invention is to
propose a surgical instrument that enables the distal tool to have
any desired position, where control of the motion of the distal
tool being very accurate, and which manipulation is easy and
comfortable for the surgeon.
[0018] Another goal of the present invention is to propose a
surgical instrument with an innovative actuation mechanism of the
bending motion of the distal tool.
SUMMARY OF THE INVENTION
[0019] To this end, is proposed a surgical instrument as defined in
the appended claims.
[0020] According to a first aspect, it is proposed a surgical
instrument comprising: [0021] an elongated arm extending along a
longitudinal axis and having a distal member mounted at a distal
end of the elongated arm with means forming a pivot joint around a
pivot axis orthogonal to the longitudinal axis; [0022] a rotation
shaft coaxial with the elongated arm comprising means forming a
universal joint facing the pivot joint; [0023] a distal tool
securely fastened at a distal end of the rotation shaft and
rotatably mounted on and in the extension of the distal member of
the elongated arm, such that the distal tool has two rotational
degrees of freedom, distinct and independent of each other, one
degree of freedom being around the pivot axis and the other degree
of freedom being around an axis collinear to an own axis of the
distal tool; [0024] an actuation unit mounted on and in the
extension of a proximal end of the elongated arm, said actuation
unit comprising motorized means for actuating the motion of the
distal tool through at least one of the two rotational degrees of
freedom and further comprising controlling means for a user to
control the motorized means; [0025] a handle extending from the
actuation unit and comprising a lever mechanically coupled to the
distal tool for actuation of said distal tool via an actuation
cable extending coaxially within said elongated arm and rotation
shaft; characterized in that the handle has a non-axially-symmetric
shape and is mounted on and in the extension of the actuation unit
with coupling means enabling rotation of the handle relative to the
actuation unit around the longitudinal axis, and wherein the
controlling means are adapted to be operated by the user whatever
the rotational position of the handle relative to the actuation
unit.
[0026] Preferable but not limited aspects of such surgical
instrument, taken alone or in combination, are the following:
[0027] the actuation unit comprises a casing for receiving the
motorized means and the controlling means. [0028] the casing
comprises prehensile means for holding the surgical instrument
while rotating the handle and the actuation unit relative to one
another. [0029] the lever is coupled to the actuation cable with a
transmission mechanism being non-axial for enabling an electric
cable to run axially out of the actuation unit along the
longitudinal axis from the motorized means to the handle. [0030]
the transmission mechanism comprises: [0031] at least one rod
arranged within the actuation unit offset of the longitudinal axis,
said rod being translatable along an axis parallel to the
longitudinal axis; [0032] a coupling member between said rod and
the actuation cable, said coupling member being shaped and arranged
to transmit the translation motion of the rod to the actuation
cable and to enable a free rotation of the actuation cable around
the longitudinal axis; [0033] an annular member arranged within the
actuation unit to be coupled with the lever of the handle, said
annular member being fixed to an end of said rod, and said annular
member being arranged to surround the electric cable and to be
translatable along an axis parallel to the longitudinal axis;
[0034] and wherein the annular member further comprises a circular
groove for insertion of at least two pins provided at an end of the
lever, said circular groove and pins forming a coupling enabling
the lever to cause the annular member and rod to translate while
enabling a free rotation of the handle and lever relative to the
actuation unit. [0035] the controlling means comprise electronic
components for actuation of the motorized means, and switch
elements for the user to control the electronic components, wherein
the motorized means and electronic components are enclosed in a
sealed compartment. [0036] the switch elements are located out of
the sealed compartment, said switch elements and electronic
components comprising means for contactless signal transmission.
[0037] the switch elements comprise at least one magnet for
contactless signal transmission to hall sensors of the electronic
components. [0038] the at least one magnet is mounted on the sealed
compartment and arranged to be displaced through two different
degrees of freedom in order to vary the position of the magnet
relative to the hall sensors. [0039] the switch elements comprise
one magnet, an outer knob and an inner knob, wherein the magnet is
fastened to the outer knob and is mounted in translation within a
longitudinal groove provided in the inner knob along an axis
parallel to the longitudinal axis, said inner knob being rotatably
mounted around the longitudinal axis. [0040] the switch elements
comprise at least eight hall sensors, two of said at least eight
hall sensors being arranged for providing signal to the motorized
means upon translation of the outer knob, two others of said at
least eight hall sensors being arranged for providing signal to the
motorized means upon rotation of the outer knob, and the four
remaining of said at least eight hall sensors being arranged for
providing signal to the motorized means upon combined translation
and rotation of the outer knob. [0041] the hall sensors are used as
potentiometers, preferably for controlling the speed of the
motorized means. [0042] a translation of the outer knob controls
the motorized means for actuation of the distal tool through a
rotation around the pivot axis, and wherein a rotation of the outer
knob controls the motorized means for actuation of the distal tool
through a rotation around the axis collinear to the own axis of the
distal tool. [0043] the coupling means comprise a clutch assembly
for preventing rotation of the handle relative to the actuation
unit.
[0044] According to another aspect, there is provided a surgical
instrument comprising: [0045] an elongated arm extending along a
longitudinal axis and having a distal member mounted at a distal
end of the elongated arm with means forming a pivot joint around a
pivot axis orthogonal to the longitudinal axis; [0046] a rotation
shaft coaxial with the elongated arm comprising means forming a
universal joint facing the pivot joint; [0047] a distal tool
securely fastened at a distal end of the rotation shaft and
rotatably mounted on and in the extension of the distal member of
the elongated arm, such that the distal tool has two rotational
degrees of freedom, distinct and independent of each other, one
degree of freedom being around the pivot axis and the other degree
of freedom being around an axis collinear to an own axis of the
distal tool; [0048] an actuation unit mounted on and in the
extension of a proximal end of the elongated arm, said actuation
unit comprising motorized means for actuating the motion of the
distal tool through at least one of the two rotational degrees of
freedom; and [0049] a first actuation cable and a second actuation
cable arranged parallel to each other within the elongated arm
along the longitudinal axis, said first and second actuation cables
having each an end fastened to the distal member so that
translation of one of the first and second actuation cables
relative to the other one of the first and second actuation cables
actuates the distal tool through the rotation around the pivot
axis; characterized in that the motorized means comprise a motor
with a driving shaft having first and second transmission members
for coupling the driving shaft with the first and second actuation
cables respectively, wherein the first transmission member
comprises means for translating the first actuation cable in a
first direction collinear to the longitudinal axis upon clockwise
rotation of the driving shaft, and the second transmission member
comprises means for translating the second actuation cable in the
first direction upon anticlockwise rotation of the driving
shaft.
[0050] Preferable but not limited aspects of such surgical
instrument, taken alone or in combination, are the following:
[0051] the first and second transmission members are coupled to the
driving shaft with coupling means adapted for translating the
transmission members in opposite directions along the longitudinal
axis of the driving shaft upon rotation of the driving shaft of the
motor. [0052] the driving shaft comprises a first threaded portion
and a second threaded portion for cooperation with a first threaded
bore of the first transmission member and with a second threaded
bore of the second transmission member respectively, wherein said
first and second threaded portions have opposite threads. [0053]
the first and second threaded portions have different pitches.
[0054] the first transmission member comprises means for releasing
the first actuation cable upon anticlockwise rotation of the
driving shaft, and the second transmission member comprises means
for releasing the second actuation cable upon clockwise rotation of
the driving shaft. [0055] the first, respectively second, actuation
cable comprises an abutment adapted to cooperate with the first,
respectively second, transmission member so that translation of the
first, respectively second, transmission member in the first
direction causes the first, respectively second, actuation cable to
translate in said first direction, whereas a translation of the
first, respectively second, transmission member in a second
direction opposite the first direction releases the first,
respectively second, actuation cable. [0056] the first,
respectively second, actuation cable comprises an end with a
threaded portion and a threaded bolt mounted on said threaded
portion for adjustment of the length of said first, respectively
second, actuation cable, said threaded bolt forming the abutment.
[0057] the first transmission member comprises means for
translating the first actuation cable in a second direction
opposite to the first direction upon anticlockwise rotation of the
driving shaft, and the second transmission member comprises means
for translating the second actuation cable in the second direction
upon clockwise rotation of the driving shaft. [0058] the first,
respectively second, actuation cable has an end securely fastened
to the first, respectively second, transmission member. [0059] the
motorized means comprise another motor with another driving shaft
fixed to an end of the rotation shaft for actuating rotation of the
distal tool around the axis collinear to the own axis of said
distal tool. [0060] the surgical instrument further comprises
electronic components for actuation of the motorized means and
switch elements for a user to control the electronic components,
wherein the motorized means and electronic components are enclosed
in a sealed compartment, the switch elements being located out of
said sealed compartment, and wherein the switch elements and
electronic components comprise means for contactless signal
transmission. [0061] the switch elements comprise at least one
magnet for contactless signal transmission to hall sensors of the
electronic components. [0062] the at least one magnet is mounted on
the sealed compartment and arranged to be displaced through two
different degrees of freedom in order to vary the position of the
magnet relative to the hall sensors. [0063] the switch elements
comprise one magnet, an outer knob and an inner knob, wherein the
magnet is fastened to the outer knob and is mounted in translation
within a longitudinal groove provided in the inner knob along an
axis parallel to the longitudinal axis, said inner knob being
rotatably mounted around the longitudinal axis. [0064] the hall
sensors are used as potentiometers, preferably for controlling the
speed of the motorized means.
[0065] According to still another aspect, there is provided a
surgical instrument comprising: [0066] an elongated arm extending
along a longitudinal axis and having a distal member mounted at a
distal end of the elongated arm with means forming a pivot joint
around a pivot axis orthogonal to the longitudinal axis; [0067] a
rotation shaft coaxial with the elongated arm comprising means
forming a universal joint facing the pivot joint; [0068] a distal
tool securely fastened at a distal end of the rotation shaft and
rotatably mounted on and in the extension of the distal member of
the elongated arm, such that the distal tool has two rotational
degrees of freedom, distinct and independent of each other, one
degree of freedom being around the pivot axis and the other degree
of freedom being around an axis collinear to an own axis of the
distal tool; [0069] an actuation unit mounted on and in the
extension of a proximal end of the elongated arm, said actuation
unit comprising motorized means for actuating the motion of the
distal tool through the two rotational degrees of freedom, and
further comprising controlling means for a user to control the
motorized means; and [0070] a handle extending from the actuation
unit; characterized in that the controlling means comprise
electronic components for actuation of the motorized means, and
switch elements for the user to control the electronic components,
the switch elements comprising at least one magnet for contactless
signal transmission to hall sensors of the electronic components,
wherein the switch elements comprise an outer knob and an inner
knob, with the magnet being fastened to the outer knob and being
mounted in translation within a longitudinal groove provided in the
inner knob along an axis parallel to the longitudinal axis, said
inner knob being rotatably mounted around the longitudinal
axis.
[0071] Preferable but not limited aspects of such surgical
instrument, taken alone or in combination, are the following:
[0072] the motorized means and electronic components are enclosed
in a sealed compartment, the switch elements being located out of
said sealed compartment. [0073] the switch elements comprise at
least eight hall sensors, two of said at least eight hall sensors
being arranged for providing signal to the motorized means upon
translation of the outer knob, two others of said at least eight
hall sensors being arranged for providing signal to the motorized
means upon rotation of the outer knob, and the four remaining of
said at least eight hall sensors being arranged for providing
signal to the motorized means upon combined translation and
rotation of the outer knob. [0074] the hall sensors are used as
potentiometers. [0075] the hall sensors are used for controlling
the speed of the motorized means. [0076] a translation of the outer
knob controls the motorized means for actuation of the distal tool
through a rotation around the pivot axis, and wherein a rotation of
the outer knob controls the motorized means for actuation of the
distal tool through a rotation around the axis collinear to the own
axis of the distal tool. [0077] the handle comprises a lever
mechanically coupled to the distal tool for actuation of said
distal tool via an actuation cable extending coaxially within said
elongated arm and rotation shaft. [0078] the actuation unit further
comprises complementary motorized means for actuation of said
distal tool via an actuation cable extending coaxially within said
elongated arm and rotation shaft. [0079] the surgical instrument
further comprises a first actuation cable and a second actuation
cable arranged parallel to each other within the elongated arm
along the longitudinal axis, said first and second actuation cables
having each an end fastened to the distal member so that
translation of one of the first and second actuation cables
relative to the other one of the first and second actuation cables
actuates the distal tool through the rotation around the pivot
axis, wherein the motorized means comprise a motor with a driving
shaft having first and second transmission members for coupling the
driving shaft with the first and second actuation cables
respectively, wherein the first transmission member comprises means
for translating the first actuation cable in a first direction
collinear to the longitudinal axis upon clockwise rotation of the
driving shaft, and the second transmission member comprises means
for translating the second actuation cable in the first direction
upon anticlockwise rotation of the driving shaft. [0080] the first
and second transmission members are coupled to the driving shaft
with coupling means adapted for translating the transmission
members in opposite directions along the longitudinal axis of the
driving shaft upon rotation of the driving shaft of the motor.
[0081] the driving shaft comprises a first threaded portion and a
second threaded portion for cooperation with a first threaded bore
of the first transmission member and with a second threaded bore of
the second transmission member respectively, wherein said first and
second threaded portions have opposite threads. [0082] the first
and second threaded portions have different pitches. [0083] the
first transmission member comprises means for releasing the first
actuation cable upon anticlockwise rotation of the driving shaft,
and the second transmission member comprises means for releasing
the second actuation cable upon clockwise rotation of the driving
shaft. [0084] the first, respectively second, actuation cable
comprises an abutment adapted to cooperate with the first,
respectively second, transmission member so that translation of the
first, respectively second, transmission member in the first
direction causes the first, respectively second, actuation cable to
translate in said first direction, whereas a translation of the
first, respectively second, transmission member in a second
direction opposite the first direction releases the first,
respectively second, actuation cable. [0085] the first,
respectively second, actuation cable comprises an end with a
threaded portion and a threaded bolt mounted on said threaded
portion for adjustment of the length of said first, respectively
second, actuation cable, said threaded bolt forming the abutment.
[0086] the first transmission member comprises means for
translating the first actuation cable in a second direction
opposite to the first direction upon anticlockwise rotation of the
driving shaft, and the second transmission member comprises means
for translating the second actuation cable in the second direction
upon clockwise rotation of the driving shaft. [0087] the first,
respectively second, actuation cable has an end securely fastened
to the first, respectively second, transmission member. [0088] the
motorized means comprise another motor with another driving shaft
fixed to an end of the rotation shaft for actuating rotation of the
distal tool around the axis collinear to the own axis of said
distal tool.
BRIEF DESCRIPTION OF THE DRAWINGS
[0089] Other characteristics and advantages of the invention will
become clear from the following description which is only given for
illustrative purposes and is in no way limitative and should be
read with reference to the attached drawings on which:
[0090] FIG. 1 is a perspective view of the surgical instrument of
the invention, with the handle in a first position;
[0091] FIG. 2 is a perspective view of the surgical instrument of
FIG. 1, with the handle in a second position opposite to the first
position;
[0092] FIG. 3 is a partial cross sectioned view of the surgical
instrument of the invention;
[0093] FIG. 4 is an exploded perspective view of a possible
operational portion of a surgical instrument according the
invention;
[0094] FIG. 5 is an enlarged view, in an exploded perspective view,
of the portion referenced as A of the operational portion of FIG.
4;
[0095] FIG. 6 is a perspective view of the operational portion of
FIG. 4, the distal end being in a straight position;
[0096] FIG. 7 is a cross sectioned view of the operational portion
of FIG. 4, the distal end being in a straight position;
[0097] FIG. 8 is a perspective view of the operational portion of
FIG. 4, the distal end being in a fully folded position;
[0098] FIG. 9 is a cross sectioned view of the operational portion
of FIG. 4, the distal end being in a fully folded position.
[0099] FIG. 10 is a perspective view of the handle and actuation
unit of the surgical instrument of the invention;
[0100] FIG. 11 is a similar perspective view as FIG. 10,
illustrating the non-axial transmission mechanism;
[0101] FIG. 12 is an enlarged perspective view of part of the
actuation unit of the surgical instrument of the invention;
[0102] FIG. 13 is an enlarged perspective view of the controlling
means of the actuation unit of the surgical instrument of the
invention;
[0103] FIG. 14 is another enlarged perspective view of the
controlling means of the actuation unit of the surgical instrument
of the invention;
[0104] FIG. 15 is an enlarged perspective view of the motorized
means of the actuation unit of the surgical instrument of the
invention;
[0105] FIG. 16 is another enlarged perspective view of the
motorized means of the actuation unit of the surgical instrument of
the invention.
DETAILED DESCRIPTION OF THE DRAWINGS
[0106] The general structure of the surgical instrument of the
invention is described in reference to FIGS. 1 to 3. Thus, the
surgical instrument comprises: [0107] an elongated arm 3 extending
along a longitudinal axis and having a distal member 30 mounted at
a distal end 31 of the elongated arm 3 with means forming a pivot
joint around a pivot axis orthogonal to the longitudinal axis;
[0108] a rotation shaft 4 coaxial with the elongated arm 3
comprising means forming a universal joint facing the pivot joint;
[0109] a distal tool 5--for instance a forceps--securely fastened
at a distal end of the rotation shaft 4 and rotatably mounted on
and in the extension of the distal member 30 of the elongated arm
3, such that the distal tool 5 has two rotational degrees of
freedom, distinct and independent of each other, one degree of
freedom being around the pivot axis and the other degree of freedom
being around an axis collinear to an own axis of the distal tool;
[0110] an actuation unit 2 mounted on and in the extension of a
proximal end of the elongated arm 3, said actuation unit 2
comprising motorized means 20 for actuating the distal mobility of
the tool, i.e. the motion of the distal tool through at least one
of said two rotational degrees of freedom, and further comprising
controlling means 21 for a user to control the motorized means 20;
[0111] a handle 1 extending from the actuation unit 2.
[0112] Preferably, the handle 1 comprises a lever 11 mechanically
coupled to the distal tool 5 for actuation of said distal tool 5
via an actuation cable extending coaxially within said elongated
arm 3 and rotation shaft 4.
[0113] However, according to another embodiment, the handle 1 does
not comprise any lever. In such case, the actuation unit 2 may
comprise complementary motorized means for actuation of said distal
tool 5 via an actuation cable 6 extending coaxially within said
elongated arm 3 and rotation shaft 4.
[0114] It should here be noted that in conventional terms, a
universal joint is a kinematic joint used for connecting two shafts
and adapted for transmission of the rotational movement of one
shaft to another, whatever the angular position of one shaft
relative to the other is. There exist several types of universal
joint.
[0115] Such arrangement for a surgical instrument enables direct
transmission that produces an infinite rotation of the forceps
about its own axis, without having to modify the position of the
axis of the forceps, or reconfiguring movements or using a clutch
system. All rotations are maintained and/or actuated independently.
Further, all rotations may be actuated simultaneously if required.
It is not necessary to reverse or cancel rotation to describe any
movement on the other rotation. Because of this, distal movements
are selected optimally to ensure simple control of the instrument
while a suturing exercise for example is carried out.
[0116] The universal joint of the rotation shaft may for instance
comprise a flexible drive sleeve, which is preferably rigid with
regard to torsion stress according to the longitudinal axis, and is
flexible and elastically deformable with regard to torsion stress
according to any axis perpendicular to the longitudinal axis. For a
detailed description of such arrangement, the person skilled in the
art may refer to PCT application published as WO2010112608, the
content of which is incorporated by reference.
[0117] Alternatively, the universal joint may comprise a Cardan
joint. For a detailed description of such arrangement, the person
skilled in the art may refer to PCT application published as
WO2010112609, the content of which is incorporated by reference.
Basically, a Cardan joint consists of a mechanical linking system
comprising two end elements mounted on either side of a central
element, wherein each end element is mounted in a pivot joint with
the central element, the axis of two pivot joints in the central
element being perpendicular. Using a Cardan joint as universal
joint in combination with linking elements mounted in series for
forming the distal member of the elongated arm greatly simplifies
manufacturing of the surgical instrument.
[0118] FIGS. 4 to 9 illustrate a specific embodiment of a surgical
instrument wherein are used Cardan joints as universal joint in
combination with linking elements mounted in series for forming the
distal member. Here the elongated arm 3 comprises a plurality of
linking elements making up the pivot function, where the set of
linking elements can be similar to a set of hollow vertebrae, each
of the vertebrae being mounted with a pivot joint about an axis
perpendicular to the pivot axis of the elongated arm with the
preceding vertebra. More precisely, the elongated arm 3 comprises a
distal member 30 with five linking elements (301, 302, 303, 304,
305) forming the pivot joint (also called overall pivot joint). The
elongated arm 3 is hollow and distally comprises a hollow base
linking element 301, comprising one set of pivot lugs (female side
only) extending in the direction of the distal end 31 of the
elongated arm 3 and opposite one another to define an axis 310
substantially perpendicular to the longitudinal axis of the
elongated arm 3. The elongated arm 3 further comprises hollow
intermediate linking elements (302, 303, 304), comprising two lugs
extending in the extension of said intermediate linking elements
(302, 303, 304) and opposite one another to enable rotation about
an axis parallel to the axis 310 of the base linking element 301
and located at a distal end of the intermediate linking elements
(302, 303, 304). The intermediate linking element 302 is mounted in
rotation relative to the axis 310 on the base linking element 301,
thus forming a first limited pivot joint (also called wedged pivot
joint, as the form of the linking elements naturally restrict the
amplitude of the pivot). Similarly, the intermediate linking
elements (302, 303, 304) are mounted in mutual rotation relative to
an axis parallel to the axis 310, thus forming a second and third
limited pivot joint. The elongated arm 3 further comprises a hollow
end linking element 305. Similarly, the end linking element 305 is
mounted in rotation relative to an axis parallel to the axis 310 on
the final intermediate linking element 304, thus forming a fourth
limited pivot joint. This end linking element 305 forms the distal
end of the elongated arm 3. The series of the limited pivot joints
produces an accumulative pivot with respect to the whole body,
which corresponds to the overall pivot joint. All the axes of the
pivot joints 310 are parallel such that the total angle of flexion
is the sum of the angles of rotation between each pair of linking
elements. In addition, the vertebrae are pierced to allow two
cables (312, 314) placed on either side of the axis of the pivot
310 to slide. The cables (312, 314) are attached to the final
vertebra and slide in the openings of the others, which allow all
the pivots to be actuated after mounting and therefore flexes by
pulling on one or the other of the two cables (312, 314).
[0119] Mounted substantially coaxially with the elongated arm 3,
the surgical instrument comprises a rotation shaft 4 which extends
in the elongated arm 3 from a proximal end of said elongated arm 3
to a proximal part of the base linking element 301. The rotation
shaft 4 comprises, at its distal end, means forming a universal
joint which extend in the cavity formed by the different linking
elements, these means forming a universal joint comprising at least
one Cardan joint. The means forming a universal joint preferably
comprise at least two Cardan joints. To maintain the full range of
motion (longitudinal and radial rotation), the means forming a
universal joint more preferably comprise as many Cardan joints as
pivot axes 310 formed by the vertebrae (301, 302, 303, 304, 305).
Accordingly, in the example presented in FIGS. 4 to 9, four Cardan
joints (320, 330, 340, 350) are provided, respectively positioned
at the level of the pivot axes 310 formed between the different
linking elements (301, 302, 303, 304, 305), that is adjacent to the
corresponding pivot joint. According to a preferred aspect of this
embodiment, the axes of the two pivot joints defining each Cardan
joint intersect with the pivot axis 310 at the level where it is
positioned. As pointed out earlier, a Cardan joint is a mechanical
linking system comprising two end elements mounted on either side
of a central element, where each end element is mounted in a pivot
joint with the central element. In the embodiment presented in
FIGS. 4 to 9, the pivot joints between the pieces forming the
Cardan joint are made by a sliding guide of one surface on another.
To achieve this, end pieces having at their end of the surfaces
sliding on the surface of the central piece can be provided for
example, these central and end pieces also comprising sliding guide
means.
[0120] A distal tool 5, for example a forceps, is mounted on a
distal end of the end linking element 305, in its extension. The
distal tool 5 is mounted in rotation about a longitudinal axis of
the end linking element 305 on the latter. This distal tool 5 is
preferably actuated by an actuation cable 6 extending inside the
elongated arm 3, for instance an actuation cable 6 arranged to
close the forceps 5 when pulled through activation of the lever 11.
More preferably, the pieces forming the transmission by Cardan
joints are pierced by through-holes along the main axis of the
instrument when the latter is not flexed. These various holes made
in the pieces of the Cardan joints allow a mechanical actuation
cable 6 to pass through for transmission of traction force to
actuate the distal tool 5 placed at the distal end of the
instrument, or of electric cables (not shown) for transmission of a
signal, a command or a monopolar and/or bipolar current.
[0121] Operation of the surgical instrument is described with
reference to FIGS. 8 and 9 that illustrate the folded position at
90.degree., and FIGS. 6 and 7 that illustrate the unfolded
position. In both cases, a rotation movement 370 applied to the
proximal end of the rotation shaft 4 causes rotation movement 371
of the distal tool 5. Perfect transmission of this rotation
movement is ensured by the means forming a universal joint (e.g.
cardan joints 320, 330, 340, 350) and, this being irrespective of
the angular deflection of the distal end turning about axes 310 of
the limited pivot joints. The transition of the folded position to
the unfolded position (or between the two different folded
positions) occurs via translation movement of one of the cables
312, 314 according to its axis. An operator controls the bending of
the distal tool 5 by translating one of these cables relative to
the other.
[0122] Surgical instruments having a rotational symmetry around the
longitudinal axis of said instrument do usually not enable
ergonomic anatomical position, and force user to keep elbow up and
shoulder abducted, which may lead to pain for the user in the long
run. It is thus important for the surgical instrument to be
provided with a non-axially-symmetric shape (i.e. having no
rotational symmetry around the longitudinal axis of said
instrument), such shape providing more ergonomic gripping members
for the user. For instance, a pistol-grip handle allows the user to
keep elbow down to avoid shoulder abduction or any other
non-ergonomic anatomical position. It also allows the user to have
improved gripping abilities, and thus get more accuracy in his
gesture.
[0123] A specificity of the surgical instrument of the invention is
that the handle 1 has an asymmetric shape, preferably a pistol-grip
shape, and is mounted in the extension of the actuation unit 2 with
coupling means forming a pivot joint about the longitudinal axis of
the instrument. These coupling means thus enable rotation of the
handle 1 relative to the actuation unit 2 around the longitudinal
axis of the instrument.
[0124] The fact that the handle 1 is mounted in the extension of
the actuation unit 2 means that the handle 1 and the actuation unit
2 are two distinct members, adjacent to one another, that are
coupled together through a particular pivot joint.
[0125] Preferably, the actuation unit 2 comprises a casing that
encompasses both the motorized means 20 and the controlling means
21. The handle 1 is thus rotatably mounted on this casing of the
actuation unit 2, thereby forming a disengageable handle 1 relative
to the actuation unit 2.
[0126] Further the controlling means 21 are adapted to be operated
by the user from the handle 1, whatever the rotational position of
the handle 1 relative to the actuation unit 2. Preferably, the
controlling means 21 of the actuation unit 2 have a rotational
symmetry around the longitudinal axis of the instrument so that the
distal mobility can be actuated with the same hand position on the
handle 1, whatever the rotational position of said handle relative
to actuation unit 2.
[0127] The lever 11 arranged on the handle 1 to trigger the distal
tool 5 through the actuation cable 6 is also oriented with the
handle 1 so that the user can also actuate the tool without
changing its hand position of the handle 1.
[0128] The distal rotation of the distal tool about the pivot
axis--i.e. the bending of the instrument--is preferably restricted
between 0.degree. and 90.degree., such that one of the two extreme
positions corresponds to the unbent configuration where the distal
tool 5 is in line with the elongated arm 3. Thus, when the surgeon
wants for instance to withdraw the surgical instrument from the
cannula, he then only has to control the tool 5 to be at such
extreme position to be sure that said tool 5 is in line with the
elongated arm 3 which would not be the case if the bending ranged
between -90.degree. and 90.degree..
[0129] The proposed specific arrangement with the rotatable handle
enables the surgical instrument to be used in any rotational
position, in particular of the distal tool, which is of great
advantages as it allows the surgeon to work at ease for any kind of
surgical operation.
[0130] FIGS. 1 and 2 illustrate two opposed rotational positions of
the handle 1 relative to the actuation unit 2. The orientation
illustrated in FIG. 1 corresponds to the situation when the surgeon
needs to work with the distal tool 5 oriented on the left-hand side
of the surgical instrument. In case the surgeon has to work with
the distal tool 5 oriented on the right-hand side of the surgical
instrument, he then only has to rotate the handle 1 relative to the
actuation unit 2 as illustrated in FIG. 2. As the controlling means
21 are adapted to be operated by the user in any rotational
position of the handle 1, then the distal tool 5 may be easily
oriented as required by the user. Preferably, the surgical
instrument is adapted to position the handle 1 in any rotational
position relative to the actuation unit 2, for instance when it is
required to position the tool diagonally.
[0131] Preferably, the actuation unit 2 comprises an outer casing
that is provided with prehensile means, that are adapted for
grasping and holding the surgical instrument, either by hand or
with any mechanical holding means (such as a robot). Consequently,
when in use, it is possible for the user to hold in position the
actuation unit 2, with no movement of the tool unit (including in
particular the elongated arm 3, the rotation shaft 4, and the
distal tool 5), while disengaging and rotating the handle 1
relative to the actuation unit 2. For instance, this allows the
surgeon to angle the handle 1 to a more comfortable position, with
more ease to proceed.
[0132] Such arrangement is particularly advantageous as the handle
1 may be disengaged very easily and quickly, while preventing both
the actuation unit 2 and the tool unit, and thus the distal tool 5,
to be moved. FIGS. 10 and 11 illustrate a specific embodiment of
the surgical instrument wherein the coupling means comprise two
annular portions (12,22) respectively provided in the actuation
unit 2 and in the handle 1, said annular portions cooperating
together for a relative rotation, e.g. through a circular groove
and corresponding ridge. With such coupling means, the handle 1 may
rotate on the annular portion 22 of the actuation unit 2. In the
embodiment illustrated on FIG. 10, the actuation unit 2 has a
substantially cylindrical shape.
[0133] Preferably, the coupling means comprise a clutch assembly 13
for locking the handle in position, by preventing rotation of the
handle 1 relative to the actuation unit 2 when required. This
enables maintaining the handle 1 in position relative to the
actuation unit 2 when the surgeon uses the surgical instrument,
such that the surgeon may move the instrument through an axial
rotation about the longitudinal axis in addition to the distal
mobility of the tool 5.
[0134] The distal mobility of the distal tool 5 is actuated by
motorized means 20, which not only eases the work of the surgeon
but also make his gesture much more accurate. Having motorized
means 20, such as motors, however makes the configuration of the
instrument more complex, in particular with regard to the
arrangement of the rotatable handle 1 and the configuration of the
controlling means 21.
[0135] The first issue relates to the motors and their arrangement
in the instrument. It has been chosen to place the motorized means
within the actuation unit 2 to keep most of the mechanical elements
for actuating the distal mobility in a non-rotatable portion of the
instrument, and thus to reduce the mechanical complications, in
particular to avoid complex transmission of movement through the
handle pivot articulation. The motorized means have however to be
electrically connected to an external power source, and/or an
external control unit for transfer of logic and power, such that an
electric cable 24 is necessary. To avoid the surgeon to be bothered
by such electric cable extending from the surgical instrument, it
preferably runs from the motorized means 20 through the handle 1
out of the actuation unit 2.
[0136] As this electric cable 24 is connected into the actuation
unit 2, it must be able to rotate with respect to user handle 1
while passing through said handle 1. To this end, the electric
cable 24 shall be connected axially within the actuation unit 2,
i.e. it should run along the longitudinal axis so that it keeps the
same position whatever the rotational position of the handle 1
relative to the actuation unit 2. This avoids any rotation of the
electric cable 24, and thus of the electric connections, which is
important for ensuring long lifetime of the surgical
instrument.
[0137] However, the mechanical cable 6 for actuating the operation
of the distal tool 5, for instance for opening/closing a forceps,
is traditionally axial as well. As electrical and mechanical cable
cannot be made coaxial, a non-axial mechanism is used to transmit
mechanical actuation of the distal tool 5 from the lever 11 of the
handle 1. This non-axial transmission mechanism 23 enables
offsetting the actuation elements from the lever 11 in the area
where the electric cable 6 is located.
[0138] According to a particular embodiment illustrated in FIGS. 10
to 12, such transmission mechanism 23 comprises two rods 230
arranged within the actuation unit 2 offset of the longitudinal
axis, said rods (230,231) being translatable along an axis parallel
to the longitudinal axis.
[0139] These two rods (230,231) are both connected to a coupling
member 232 that is connected to the actuation cable 6 directly
coupled to the distal tool 5. Such coupling member 232 is
preferably shaped and arranged to transmit the translation motion
of the rods (230,231) to the actuation cable 6 and to enable a free
rotation of the actuation cable 6 around the longitudinal axis.
This avoids torsion of the actuation cable 6 during axial rotation
of distal tool 5 along the axis collinear to its own axis.
[0140] The non-axial transmission mechanism 23 further comprises an
annular member 234 arranged within the actuation unit 2 to be
coupled with the lever 11 of the handle 1. Such annular member 234
is fixed to an end of each of said two rods (230,231) and is shaped
and arranged to surround the electric cable 24 and to be
translatable along an axis parallel to the longitudinal axis. This
annular member 234 further comprises a circular groove 235 for
insertion of at least two pins 236 provided at the end of the lever
11, so that the circular groove 235 and pins 236 form a coupling
enabling the lever 11 to impart a translation motion to the annular
member 234 and rods (230,231) while enabling a free rotation of the
handle 1 and lever 11 relative to the actuation unit 2. Indeed,
when the handle 1 and lever 11 are rotated, the two pins 236 slide
in the circular groove 235, and those pins 236 drive axial
translation of the two rods (and thus actuation of the distal tool)
whatever the rotation of the handle 1. This arrangement enables the
lever 11 to translate the actuation cable 6 in any rotational
position of the handle 1.
[0141] In FIG. 12, is illustrated the coupling between the two
longitudinal rods (230,231) running on each side of electrical
cable 24 and the actuation cable 6 actuating operation of the
distal tool. As described above, the actuation cable 6 can rotate
freely along its longitudinal axis with respect to the two rods
(230,231) thanks to the coupling member 232. The actuation cable 6
then runs in the inner lumen of the axial rotation shaft 4,
coaxially with the elongated arm 3, and finally within the distal
member to be then fixed to the distal tool.
[0142] It should be noted that the above non-axial transmission
mechanism does not necessary comprise only two rods, and that it
may be adapted to comprise only a single rod arranged within the
actuation unit 2 offset of the longitudinal axis, or more than two
rods.
[0143] A second issue concerns the controlling means 21 of the
motorized means 20 which have to be reachable by the user in any
rotational position of the handle 1. A solution to that issue is to
arrange the controlling means 21 so that they have a substantial
axial symmetry along the longitudinal axis of the instrument, which
thus enable the user to reach those controlling means 21 in any
rotational position of the handle 1.
[0144] As illustrated in FIG. 10, the actuation unit 2 has
preferably a cylindrical shape, and the controlling means have in
this case an annular arrangement. It may for instance comprise an
annular joystick 21 as illustrated in FIG. 11 that enables the user
a finger control of the distal mobility, for example a thumb or
forefinger control because of the pistol-grip shape of the handle
1.
[0145] The annular arrangement of the controlling means 21 could be
implemented in various ways. However, to allow for steam
sterilization of the instrument (gold standard for sterilization),
motors and electronics are preferably placed in a sealed
compartment, which thus influences the way the controlling means
are structured.
[0146] To ensure perfect sealing of the instrument, it is
recommended to limit mechanical movements through the sealed
barrier. Thus, it is preferred to provide controlling means 21
adapted for contactless electronic communication, for instance
between the electronics 210 located within the sealed compartment
and a switch 211 located outside.
[0147] According to a preferred embodiment, the switch comprises a
magnet 2110 outside the sealed compartment and a plurality of Hall
sensors 2100 inside the sealed compartment. The magnet 2110 is
arranged to be displaced laterally in two directions by the user.
When such magnet 2110 is placed in front of Hall sensors 2100, the
magnetic field modifications are detected by these Hall sensors
2100, creating an input signal, which is processed by the
electronics to actuate the motors of the motorized means 20 for
distal movement of the distal tool 5.
[0148] As illustrated in FIG. 13, the finger control system is
composed by an outer knob 2111 with a magnet 2110, which is mounted
in translation on an inner knob 2112, wherein said inner knob 2112
is mounted in axial rotation within the actuation unit 2.
Preferably, the inner knob 2112 is mounted in axial rotation on an
external housing 2114 forming the sealed compartment of the
actuation unit 2.
[0149] The magnet 2110 is embedded in or linked to the outer
control knob 2111, said outer knob 2111 being easily movable by the
fingers of the user. The magnet 2111 can be over-molded in resin or
silicone for protection.
[0150] When the outer knob 2111 is translated with respect to inner
knob 2112, then the magnet 2110 slides in a groove 2113 provided in
the inner knob 2112. When the outer knob 2111 is axially rotated on
the actuation unit 2, it drives the inner knob 2112 in the same
movement.
[0151] In a preferred embodiment, the electronics 210 of the
controlling means 21 comprises eight Hall sensors 2100. Four of
these Hall sensors are used for the distal mobility of the distal
tool 5, i.e. for bend/unbend and right/left rotation actuation. The
four additional Hall sensors are positioned in the diagonals to
allow for combined movements.
[0152] One further advantage of the arrangement described above is
that there is a single joystick, i.e. the outer knob 2111 that
enables the user of the surgical instrument to control the distal
mobility of the distal tool 5. Further, both movements
(translation, axial rotation) can be actuated independently or
simultaneously via the outer knob 2111.
[0153] Moreover, the use of Hall sensors 2100 has the advantage
that they have the ability to be used as potentiometer and not only
as on/off switches. Indeed, the control signal is dependent on the
distance of the magnet relative to the corresponding Hall sensor.
Therefore when it is desired to have a distal mobility proportional
with the displacement of the magnet, then the electronics are
configured so that the Hall sensors are used as potentiometers. For
instance, it enables the user to control not only the type of
movement he wants to provide to the distal tool but also the speed
of this movement, the torque, etc.
[0154] It should be noted that the above described controlling
means of motorized means could be used in many types of surgical
instruments, such that the corresponding teaching is not limited
for use in the surgical instrument presented here.
[0155] In particular, it could be used in a surgical instrument
with a handle provided or not with a lever mechanically coupled to
the distal tool for actuation of said distal tool via an actuation
cable extending coaxially within said elongated arm and rotation
shaft. In case there is no such lever on the handle, the actuation
unit may further comprises complementary motorized means for
actuation of said distal tool via an actuation cable extending
coaxially within said elongated arm and rotation shaft. The
corresponding controlling means could thus be associated or
combined with the above described controlling means of the first
motorized means.
[0156] Another aspect of the surgical instrument concerns the
mechanism in the actuation unit for actuating the bending/unbending
of the distal tool 5, i.e. the rotation movement of the distal tool
around the pivot axis orthogonal to the longitudinal axis.
[0157] As mentioned above, the distal tool 5 is oriented distally
by bending/unbending the elongated arm 3 at the pivot joint of the
distal member 30. Such bending/unbending is made possible by the
presence of two actuation cables (312,314) running along the
elongated arm 3. More precisely, bending is achieved by pulling on
one 314 of the actuation cables and simultaneously releasing the
other one 312 of the actuation cables, whereas unbending is
achieved by pulling on the second cable 312 and releasing the first
314.
[0158] As illustrated on FIGS. 15 and 16, the specific motorized
actuation mechanism which is proposed is such that the motorized
means comprise a motor 200 with a driving shaft 201 having first
202 and second 203 transmission members for coupling the driving
shaft 201 with the first 314 and second 312 actuation cables
respectively, wherein the first transmission member 202 comprises
means for translating the first actuation cable 314 in a first
direction collinear to the longitudinal axis upon clockwise
rotation of the driving shaft 201, and the second transmission
member 203 comprises means for translating the second actuation
cable 312 in the first direction upon anticlockwise rotation of the
driving shaft 201.
[0159] It is preferred that the first 202 and second 203
transmission members are coupled to the driving shaft 201 with
coupling means adapted for translating the transmission members
(202,203) in opposite directions along the longitudinal axis when
the driving shaft 201 of the motor 200 rotates.
[0160] For instance, the coupling means are adapted for translating
the first transmission member 202 in the first direction and for
translating the second transmission member 203 in a second
direction opposite the first direction upon clockwise rotation of
the driving shaft 201, and for translating the second transmission
member 203 in the first direction and for translating the first
transmission member 202 in the second direction upon anticlockwise
rotation of the driving shaft 201.
[0161] Preferably, the driving shaft 201 comprises two threaded
portions of opposite threads (for instance a clockwise thread at
motor exit and a counter clockwise thread further away on the
axis). One transmission member (202,203) is mounted on each thread
so that such transmission members (202,203) translate in opposite
directions when the driving shaft 201 of the motor 200 rotates.
Each of the two bending/unbending cables (314,312) is coupled to
one of the transmission member (202,203).
[0162] As the two threads are opposite, when the motor 200 turns in
one direction, one of the transmission members (202,203) translates
one way thus for instance pulls one actuation cable (312,314) and
the other translates the other way then releasing the other cable
(312,314). Motor shaft axial rotation movement then creates bending
or unbending of the elongated arm 3.
[0163] The two threads could either have the same pitch so that one
motor full rotation will move both transmission members (202,203)
the same distance in translation (in opposite direction), or the
two threads could have different pitches, to create asymmetric
translation of the transmission members (202,203), as one of the
cable will be pulled more in distance than the other is released.
This latter arrangement can be useful as one of the actuation
cables (312,314) runs along the long curve of the elongated arm 3
whereas the other runs along the short curve of the elongated arm
3.
[0164] The transmission members (202,203) may further be
translatable along a guiding shaft 204 provided for preventing the
transmission members (202,203) to rotate. Further, there can be
provided a movable spring on such a guiding shaft 204, positioned
between the transmission members (202,203). Thus, when the
transmission members (202,203) are close to one another, the
movable spring is stressed, such that such spring helps the
transmission members (202,203) to translate in opposite
directions.
[0165] There could also be provided a colar, formed in a soft or
hard material, mounted on the driving shaft 201 between the
transmission members (202,203), preferably movable, and forming a
stop abutment when the transmission members (202,203) are
translated toward one another. Such a colar could also be provided
on one end or the other, or on both ends, of the driving shaft 201
to form a stop abutment when the transmission members (202, 203)
are translated in the other direction. Alternatively or
additionally, such colar(s) could be similarly provided on the
guiding shaft 204.
[0166] According to a preferred embodiment, each actuation cable
comprises an abutment adapted to cooperate with the corresponding
transmission member so that translation of such transmission member
in one direction causes the actuation cable to translate in said
first direction, whereas a translation of said transmission member
in another direction opposite the first direction releases the
actuation cable.
[0167] Preferably, each actuation cable comprises an end
(3140,3120) with a cylindrical element having a threaded portion.
The abutment is formed by a threaded bolt (3141,3121) mounted on
said threaded portion. Further said bolt (3141,3121) enables
adjustment of the length of the actuation cables.
[0168] According to another embodiment, the first transmission
member comprises means for translating the first actuation cable in
a second direction opposite to the first direction upon
anticlockwise rotation of the driving shaft, and the second
transmission member comprises means for translating the second
actuation cable in the second direction upon clockwise rotation of
the driving shaft.
[0169] Preferably, each actuation cable has an end securely
fastened to the corresponding transmission member.
[0170] Preferably, the motorized means 20 comprise another motor
205 with another driving shaft 206 fixed to an end of the rotation
shaft 4 for actuating rotation of the distal tool 5 around the axis
collinear to the own axis of said distal tool 5.
[0171] Even though the above actuation mechanism of the
bending/unbending is presented with reference to the surgical
instrument with a rotatable pistol-grip handle, it should be noted
that it could be used in any other types of surgical instrument
that uses two actuation cables for controlling the rotation of an
arm, such as the surgical instruments as described in WO2010112608
and WO2010112609, that do not necessarily have a rotatable
handle.
[0172] The proposed actuation mechanism is very advantageous as it
is very simple to manufacture. It namely comprises a single motor
for actuating both actuation cables (312,314), which is of great
asset, in particular with regard to compactness of the actuation
unit and thus of the surgical instrument. Not only is it cheaper
and simpler to manufacture, it also enables a more accurate control
of the bending/unbending of the distal tool.
BIBLIOGRAPHIC REFERENCES
[0173] U.S. Pat. No. 7,147,650 [0174] U.S. Pat. No. 7,338,513
[0175] U.S. Pat. No. 7,686,826 [0176] U.S. Pat. No. 7,842,028
[0177] US2006111210 [0178] US2007250113 [0179] US2010286480 [0180]
US2010331860 [0181] WO2010112608 [0182] WO2010112609 [0183]
WO2011013100 [0184] US2010249497
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