U.S. patent application number 15/874189 was filed with the patent office on 2018-07-26 for surgical positioning and support system.
This patent application is currently assigned to Medrobotics Corporation. The applicant listed for this patent is Ian Darisse, Robert Didomenico, J. Christopher Flaherty, Kevin Gilmartin, Arnold Oyola, Joseph Stand. Invention is credited to Ian Darisse, Robert Didomenico, J. Christopher Flaherty, Kevin Gilmartin, Arnold Oyola, Joseph Stand.
Application Number | 20180206923 15/874189 |
Document ID | / |
Family ID | 45530657 |
Filed Date | 2018-07-26 |
United States Patent
Application |
20180206923 |
Kind Code |
A1 |
Oyola; Arnold ; et
al. |
July 26, 2018 |
SURGICAL POSITIONING AND SUPPORT SYSTEM
Abstract
A system for performing a medical procedure is provided
comprising at least one tool and a tool support for supporting a
distal portion of the tool. An operator manipulates a human
interface device and produces control signals sent to a controller.
The controller manipulates the tool support based on the received
control signals.
Inventors: |
Oyola; Arnold;
(Northborough, MA) ; Stand; Joseph; (Holden,
MA) ; Gilmartin; Kevin; (Boston, MA) ;
Darisse; Ian; (Newport, MA) ; Didomenico; Robert;
(Norfolk, MA) ; Flaherty; J. Christopher;
(Topsfield, MA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Oyola; Arnold
Stand; Joseph
Gilmartin; Kevin
Darisse; Ian
Didomenico; Robert
Flaherty; J. Christopher |
Northborough
Holden
Boston
Newport
Norfolk
Topsfield |
MA
MA
MA
MA
MA
MA |
US
US
US
US
US
US |
|
|
Assignee: |
Medrobotics Corporation
Raynham
MA
|
Family ID: |
45530657 |
Appl. No.: |
15/874189 |
Filed: |
January 18, 2018 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
13812324 |
Sep 17, 2013 |
9901410 |
|
|
PCT/US2011/044811 |
Jul 21, 2011 |
|
|
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15874189 |
|
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61368257 |
Jul 28, 2010 |
|
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 2017/00314
20130101; A61B 2017/3445 20130101; A61B 2090/508 20160201; A61B
34/30 20160201; A61B 2090/309 20160201; A61B 90/50 20160201; A61B
1/0055 20130101; A61B 34/76 20160201; A61B 2034/742 20160201; A61B
2017/3447 20130101; A61B 2034/715 20160201; A61B 17/24 20130101;
A61B 2034/302 20160201; A61B 2090/3614 20160201 |
International
Class: |
A61B 34/30 20160101
A61B034/30; A61B 90/50 20160101 A61B090/50; A61B 34/00 20160101
A61B034/00 |
Claims
1. (canceled)
2. A system, comprising: a tool support comprising an articulated
probe, the articulated probe comprising an outer sleeve comprising
a plurality of outer links and an inner core comprising a plurality
of inner links; a first tool comprising a proximal portion and a
distal portion with a distal end, the first tool being coupled to
the tool support; a second tool comprising a proximal portion and a
distal portion with a distal end, the second tool being coupled to
the tool support; and a human interface device constructed and
arranged to generate control signals based on operator input, and
wherein a position of the tool support is manipulated based on the
control signals, the proximal portion of the first tool being
separated from the proximal portion of the second tool by a first
distance, the distal portion of the first tool being separated from
the distal portion of the second tool by a second distance, the
first distance being greater than the second distance.
3. The system of claim 2, wherein the tool support further
comprises: a first side lobe radially extending from the outer
sleeve constructed and arranged to support the distal portion of
the first tool, and a second side lobe radially extending from the
outer sleeve constructed and arranged to support the distal portion
of the second tool.
4. The system of claim 3, wherein the outer sleeve comprises: a
proximal outer link, a distal outer link, and a plurality of
intermediate outer links between the proximal outer link and the
distal outer link.
5. The system of claim 4, wherein the first side lobe extends
radially from an outermost surface of at least one of the
intermediate links of the outer sleeve and the second side lobe
extends radially from an outermost surface of at least one of the
intermediate links of the outer sleeve.
6. The system of claim 3, wherein the first side lobe comprises a
first guide hole and the second side lobe comprises a second guide
hole.
7. The system of claim 6, further comprising a first guide tube
positioned in the first guide hole and a second guide tube
positioned in the second guide hole.
8. The system of claim 7, wherein the first tool is positioned in
the first guide tube and the second tool is positioned in the
second guide tube.
9. The system of claim 2, wherein the distal portion of the first
tool is steerable.
10. The system of claim 2, wherein the human interface device is
constructed and arranged to simultaneously advance and steer the
tool support.
11. The system of claim 10, wherein the system is constructed and
arranged to advance and steer the outer sleeve of the tool
support.
12. The system of claim 11, wherein the system is constructed and
arranged to advance the inner core relative to the outer sleeve
without operator input after the outer sleeve has been
simultaneously advanced and steered.
13. The system of claim 2, wherein the tool support further
comprises a distal portion comprising a distal end, at least one
tool channel, and an exit hole.
14. The system of claim 13, wherein the distal portion of the first
tool passes through the exit hole.
15. The system of claim 13, wherein the first tool is coupled to
the distal portion of the tool support.
16. The system of claim 13, further comprising at least one guide
tube coupled to the distal portion of the tool support.
17. The system of claim 16, wherein the first tool is inserted into
the at least one guide tube.
18. The system of claim 2, wherein the proximal portion of the
first tool is oriented towards a first operator location and the
proximal portion of the second tool is oriented towards a second
operator location.
19. The system of claim 18, wherein the distal portion of the first
tool is oriented in a same direction as the proximal portion of the
first tool.
20. The system of claim 18, wherein the distal portion of the first
tool is oriented in a same direction as a distal portion of the
tool support.
21. The system of claim 2, further comprising a tool holder
constructed and arranged to attach to the proximal portion of the
first tool.
22. The system of claim 21, wherein the tool holder is constructed
and arranged to allow the distal portion of the tool support to
advance and/or retract when the first tool is attached to the tool
holder.
23. The system of claim 2, further comprising a channel that
extends along the tool support.
24. The system of claim 23, wherein at least one of the first or
second tool is inserted into the channel.
25. The system of claim 2, wherein the tool support comprises a
proximal end and a distal end, the distal end of the tool support
extending along a first axis, the proximal portion of the first
tool extending along a second axis, and the proximal portion of the
second tool extending along a third axis.
26. The system of claim 25, wherein the distal portion of the first
tool extends in a direction parallel to the first axis.
27. The system of claim 26, wherein the distal portion of the
second tool extends in a direction parallel to the first axis.
28. The system of claim 25, wherein the second axis is transverse
relative to the first axis.
Description
RELATED APPLICATIONS
[0001] This application is a continuation application of U.S.
application Ser. No. 13/812,324, filed Sep. 17, 2013, which is a
371 application of PCT/US2011/044811, filed Jul. 21, 2011, which
claims the benefit of U.S. Provisional Application Ser. No.
61/368,257 filed Jul. 28, 2010, which is incorporated herein by
reference, in its entirety.
FIELD
[0002] Embodiments relate generally to the field of robotics and
more particularly, to three dimensional, flexible, steerable
robotic devices.
BACKGROUND
[0003] There are numerous types of steerable multi-linked probes,
and such devices are utilized in a variety of different
applications. Robert Sturges' U.S. Pat. No. 5,759,151, which is
hereby incorporated by reference in its entirety, discloses a
flexible, steerable device for conducting exploratory procedures.
The device includes at least one spine, each having stiffening
means for selectively rendering the spine rigid and flexible along
its length. A flexible sheath surrounds the spine and is axially
slidably moveable relative to the spine so that the sheath will
follow and conform to the shape of a spine in the rigid state and
resist further flexure when the spine is in a relaxed state. A
steerable distal tip is provided on the distal end of the device.
Controls for the distal tip are mounted on the proximal end of the
device. Mechanisms are provided on the distal end of the device for
selectively activating and deactivating the stiffening means of the
spine. An instrument conduit may be mounted on the sheath. Howie
Choset's U.S. patent application Ser. No. 11/630,279, which is
hereby incorporated by reference in its entirety, discloses a
feeder mechanism for advancing and retracting both an inner core
and an outer sleeve, as well as selectively applying tension to
control cables used for steering and causing either the inner core
or outer sleeve to transition between a rigid state and a limp
state.
[0004] U.S. Pat. No. 6,610,007 to Amir Belson, et. al.,
incorporated herein by reference in its entirety, discloses a
steerable endoscope having an elongated body with a selectively
steerable distal portion and an automatically controlled proximal
portion. The endoscope body is inserted into a patient and the
selectively steerable distal portion is used to select a desired
path within the patient's body. When the endoscope body is
advanced, an electronic motion controller operates the
automatically controlled proximal portion to assume the selected
curve of the selectively steerable distal portion. Another desired
path is selected with the selectively steerable distal portion and
the endoscope body is advanced again. As the endoscope body is
further advanced, the selected curves propagate proximally along
the endoscope body, and when the endoscope body is withdrawn
proximally, the selected curves propagate distally along the
endoscope body. This creates a serpentine motion in the endoscope
body allowing it to negotiate tortuous curves along a desired path
through or around and between organs within the body.
[0005] For medical use and other critical applications, it is
extremely important that each device not only perform as intended
and within known specifications, but have repeatable performance
and otherwise consistent operation from use to use. For these and
other reasons, there is a need for systems, devices and methods
which provide integrated calibration routines and mechanisms.
SUMMARY
[0006] According to a first aspect, a system for performing a
medical procedure, such as a TransOral Robotic Surgery (TORS)
procedure, is disclosed. The system includes at least one tool
comprising a proximal portion and a distal portion with a distal
end. A tool support is configured to support the distal portion of
the tool. A human interface device (HID) is used by an operator to
manipulate the tool support. The human interface device produces
control signals which are received by a controller which
manipulates the tool support. In a preferred embodiment, the
operator receives direct tactile feedback from the at least one
tool. For example, during advancement, retraction, rotation or
flexion, forces imparted on a distal portion of the tool are
transmitted down the tool shaft to a handle held by the
operator.
[0007] In one embodiment, the tool support comprises an inner core
of links and an outer sleeve of links, each configured to
transition between a limp state and a rigid state. In another
embodiment, the tool support is malleable, or includes a malleable
component, such as to be hand formed into a preferred shape. In
another embodiment, the tool support is made rigid by one or more
of: cables; temperature change; chemical change such as change to
an epoxy, glue or cement, or combinations of these.
[0008] The tool support may include one or more guide holes or
guide tubes configured to slidingly receive the shaft of one or
more tools.
[0009] According to another aspect, a method of performing a
medical procedure is disclosed.
[0010] In one aspect, a system for performing a medical procedure
comprises: at least one tool comprising a proximal portion and a
distal portion with a distal end; a tool support constructed and
arranged to support the distal portion of the at least one tool; a
human interface device constructed and arranged to create control
signals based on operator input; and a controller constructed and
arranged to receive the control signals and manipulate the tool
support based on the received control signals.
[0011] In some embodiments, the system is constructed and arranged
to perform a TORS procedure.
[0012] In some embodiments, the system is constructed and arranged
to provide direct tactile feedback of forces encountered by the at
least one tool.
[0013] In some embodiments, the forces are forces encountered
during advancement or retraction of the at least one tool.
[0014] In some embodiments, the tool support comprises at least a
malleable portion.
[0015] In some embodiments, the tool support comprises a highly
articulated probe comprising at least a portion that is
controllably rigid and flexible.
[0016] In some embodiments, the system further comprises at least
one cable, wherein the tool support is constructed and arranged to
transition between flexible and rigid when the at least one cable
is tensioned.
[0017] In some embodiments, the tool support is constructed and
arranged to transition between flexible and rigid by a temperature
change.
[0018] In some embodiments, the tool support is constructed and
arranged to transition between flexible and rigid by a chemical
change.
[0019] In some embodiments, the system further comprises a
substance selected from the group consisting of: an epoxy; a
cement; a glue; and combinations thereof, wherein the chemical
change is a chemical change to said substance.
[0020] In some embodiments, the tool support comprises at least a
rigid portion.
[0021] In some embodiments, the tool support comprises at least a
flexible portion.
[0022] In some embodiments, the tool support further comprises at
least a rigid portion.
[0023] In some embodiments, the tool support comprises a sleeve
comprising a first set of links.
[0024] In some embodiments, the set of links comprises a distal
portion and the distal portion comprises at least one guide
hole.
[0025] In some embodiments, the system further comprises a guide
tube.
[0026] In some embodiments, the tool support further comprises an
inner core surrounded by the sleeve and comprising a second set of
links.
[0027] In some embodiments, the at least one second set link is
shorter than at least one first set link.
[0028] In some embodiments, the tool support further comprises at
least one flange surrounding at least one link of the first set of
links and the at least one flange comprises at least one guide
hole.
[0029] In some embodiments, the flange comprises at least two guide
holes.
[0030] In some embodiments, the tool support further comprises at
least two flanges surrounding at least two links of the first set
of links.
[0031] In some embodiments, a first flange has a geometry different
than a second flange.
[0032] In some embodiments, the tool support comprises at least
three flanges surrounding at least three links of the first set of
links.
[0033] In some embodiments, the at least one flange is fixedly
attached to the at least one link of the first set of links.
[0034] In some embodiments, the at least one flange is rotatably
attached to the at least one link of the first set of links.
[0035] In some embodiments, the at least one flange is removably
attached to the at least one link of the first set of links.
[0036] In some embodiments, the first set of links includes at
least one guide hole.
[0037] In some embodiments, the system further comprises a guide
tube positioned into or through the at least one guide hole.
[0038] In some embodiments, the first set of links includes at
least two guide holes.
[0039] In some embodiments, a first guide hole is linearly aligned
with a second guide hole. In some embodiments, a first guide hole
is positioned approximately 180.degree. from a second guide hole.
In some embodiments, a first guide hole is positioned approximately
120.degree. from a second guide hole.
[0040] In some embodiments, the system further comprises a camera
lens positioned approximately 120.degree. from the first guide hole
and the second guide hole.
[0041] In some embodiments, the tool support comprises a distal
portion comprising at least one guide hole.
[0042] In some embodiments, the system further comprises a guide
tube comprising a lumen that is collinear with the at least one
guide hole.
[0043] In some embodiments, the guide tube is constructed and
arranged to be inserted into the guide hole.
[0044] In some embodiments, the guide tube is fixedly attached to
the guide hole.
[0045] In some embodiments, the system further comprises at least
one guide tube.
[0046] In some embodiments, the tool support comprises a distal
portion and the at least one guide tube is attached to said distal
portion.
[0047] In some embodiments, the at least one guide tube is
removably attached to said distal portion.
[0048] In some embodiments, the system further comprises a tool
support introducer wherein the at least one guide tube is attached
to the tool support introducer.
[0049] In some embodiments, the at least one guide tube is
removably attached to the tool support introducer.
[0050] In some embodiments, the at least one guide tube comprises
at least one flexible portion.
[0051] In some embodiments, the at least one guide tube comprises
at least one rigid portion.
[0052] In some embodiments, the at least one guide tube comprises
at least one flexible portion and at least one rigid portion.
[0053] In some embodiments, the tool support comprises a distal
portion comprising a distal end.
[0054] In some embodiments, the distal portion comprises a distal
link.
[0055] In some embodiments, the distal link is constructed and
arranged to be rotated.
[0056] In some embodiments, the distal portion further comprises a
camera component selected from the group consisting of: a camera
such as a CCD; a lens; a fiber optic; and combinations thereof.
[0057] In some embodiments, the camera component comprises a center
and said center is positioned off center from a central axis of the
distal portion.
[0058] In some embodiments, the distal end comprises a diameter and
said camera component center is positioned at least 25% of the
diameter from the central axis.
[0059] In some embodiments, the system further comprises a guide
hole wherein the camera component is constructed and arranged to
move in synchrony with an axis of the guide hole.
[0060] In some embodiments, the distal portion further comprises at
least one light element.
[0061] In some embodiments, the at least one light element
comprises at least one LED.
[0062] In some embodiments, the at least one light element is
constructed and arranged to emit one or more of: visible light;
infrared light; and ultraviolet.
[0063] In some embodiments, the distal portion further comprises at
least one tool channel and exit hole.
[0064] In some embodiments, the tool support comprises an outer
sleeve and an inner core, and wherein the tool channel extends
proximally between the outer sleeve and the inner core.
[0065] In some embodiments, the at least one tool channel is
constructed and arranged to supply a tool to the distal end of the
tool support.
[0066] In some embodiments, the distal end is constructed and
arranged to minimize reflections of visible light.
[0067] In some embodiments, the distal end comprises a matte
surface.
[0068] In some embodiments, the distal end comprises a color
approximating black.
[0069] In some embodiments, the distal portion comprises at least
one recess along its length.
[0070] In some embodiments, the at least one tool comprise a shaft
and wherein the recess is constructed and arranged to allow said
shaft to pass therethrough.
[0071] In some embodiments, the tool support comprises a highly
articulated probe, comprising: an outer sleeve comprising a first
plurality of links; an inner core comprising a second plurality of
links; a first cable extending through either said plurality of
links of the inner core or said plurality of links of the outer
sleeve and a plurality of cables running through the other of said
plurality of links of the inner core or said plurality of links of
the outer sleeve.
[0072] In some embodiments, the system further comprises a feeder
assembly constructed and arranged to alternate each of said inner
core and outer sleeve between a limp mode and a rigid mode, for
advancing and retracting said inner core and outer sleeve, and for
steering at least one of said inner core and outer sleeve.
[0073] In some embodiments, the controller comprises a CPU.
[0074] In some embodiments, the controller comprises a cable
tensioning assembly.
[0075] In some embodiments, the controller comprises a temperature
modifying assembly.
[0076] In some embodiments, the controller comprises a delivery
device.
[0077] In some embodiments, the controller is constructed and
arranged to deliver one or more of: epoxy; cement; and glue.
[0078] In some embodiments, the at least one tool comprises a
handle attached to the at least one tool proximal portion.
[0079] In some embodiments, the handle comprises a control.
[0080] In some embodiments, the control is selected from the group
consisting of: a trigger; a knob; a lever; a button; a lock; and
combinations thereof.
[0081] In some embodiments, the control is constructed and arranged
to perform one or more of the following actions; operate the at
least one tool such as to apply power to the at least one tool; and
move a potion of the at least one tool such as to advance, retract
or rotate a portion of the tool.
[0082] In some embodiments, the at least one tool distal portion
comprises a functional element.
[0083] In some embodiments, the functional element is selected from
the group consisting of: grasper; cutter; ablater; cauterizer; drug
delivery element; radiation source; sensor such as an EKG
electrode, pressure sensor or blood sensor; magnet; heating
element; cryogenic element; and combinations thereof.
[0084] In some embodiments, the at least one tool distal portion is
a steerable.
[0085] In some embodiments, the at least one tool comprises a rigid
portion proximal said steerable tool distal portion.
[0086] In some embodiments, the at least one tool comprises a
flexible portion proximal said rigid portion.
[0087] In some embodiments, the at least one tool comprises a
flexible portion proximal said steerable tool distal portion.
[0088] In some embodiments, the at least one tool comprises a rigid
portion proximal said tool flexible portion.
[0089] In some embodiments, the at least one tool comprises a rigid
portion between said tool steerable portion and said tool flexible
portion.
[0090] In some embodiments, the system further comprises a tool
holder constructed and arranged to attach to the at least one tool
proximal portion.
[0091] In some embodiments, the tool holder comprises mounting
means.
[0092] In some embodiments, the mounting means is configured to
rapidly release.
[0093] In some embodiments, the mounting means is configured to
rapidly rotate.
[0094] In some embodiments, the tool holder is constructed and
arranged to operably position the at least one tool.
[0095] In some embodiments, the tool holder is constructed and
arranged to allow the distal portion to advance and/or retract when
the at least one tool is attached to the tool holder.
[0096] In some embodiments, the tool holder is constructed and
arranged to allow the distal portion to rotate when the at least
one tool is attached to the tool holder.
[0097] In some embodiments, the tool holder is constructed and
arranged to prevent movement of at least a portion of the at least
one tool when the at least one tool is attached to the tool
holder.
[0098] In some embodiments, the human interface device is
constructed and arranged to simultaneously advance and steer the
tool support.
[0099] In some embodiments, the tool support comprises an outer
sleeve comprising a first set of links and an inner core comprises
a second set of links.
[0100] In some embodiments, the system is constructed and arranged
to advance and steer the outer sleeve simultaneously based on input
from the human interface device.
[0101] In some embodiments, the outer sleeve comprises a distal end
and the inner core comprises a distal end and wherein the system is
constructed and arranged to advance the outer sleeve distal end up
to approximately 2.5 cm beyond the inner core distal end.
[0102] In some embodiments, the system is constructed and arranged
to advance the inner core distal end up to the outer sleeve distal
end without operator input after the outer sleeve has been
simultaneously advanced and steered.
[0103] In some embodiments, the human interface device comprises a
haptic controller.
[0104] In some embodiments, the system further comprises a
console.
[0105] In some embodiments, the human interface device is attached
and/or integral to the console.
[0106] In some embodiments, the console comprises a user
interface.
[0107] In some embodiments, the system further comprises a second
tool comprising a proximal portion and a distal portion with a
distal end.
[0108] In some embodiments, the tool support is further constructed
and arranged to support the second tool distal portion.
[0109] In some embodiments, the system further comprises a tool
support introducer comprises a tube constructed and arranged to
slidingly receive the tool support.
[0110] In some embodiments, the tool support introducer is
constructed and arranged for insertion into the esophagus.
[0111] In some embodiments, the tool support introducer further
comprises at least one guide tube.
[0112] In some embodiments, the at least one guide tube comprises a
rotatable coupler along its length.
[0113] In some embodiments, the rotatable coupler is constructed
and arranged to frictionally engage and gravitationally support the
at least one guide tube.
[0114] In some embodiments, the rotatable coupler is constructed
and arranged to lock the at least one guide tube such that movement
is prevented when a force is applied to the at least one guide
tube.
[0115] In some embodiments, the rotatable coupler comprises a cam
lock.
[0116] In some embodiments, the cam is operably attached to a
lever.
[0117] In some embodiments, the at least one guide tube comprises a
flared proximal end.
[0118] In some embodiments, the tool support tube comprises at
least one radially extending side lobe.
[0119] In some embodiments, the tool support comprises a proximal
end comprising two or more projections constructed and arranged to
guide and/or orient insertion of the tool support.
[0120] In some embodiments, the tool support tube comprises a
proximal portion and a distal portion.
[0121] In some embodiments, the tool support further comprises a
second proximal portion different than the first proximal
portion.
[0122] In some embodiments, the tool support further comprises a
second distal portion different than the first distal portion.
[0123] In some embodiments, the tool support introducer further
comprises an attachment mechanism.
[0124] In some embodiments, the system further comprises an
intubation tube.
[0125] In some embodiments, the tool support is constructed and
arranged to be positioned anterior to the intubation tube in the
esophagus.
[0126] In some embodiments, the operator is a clinician.
[0127] In some embodiments, the clinician is a surgeon.
[0128] In another aspect, a method of performing a surgical
procedure comprises: selecting the system of any embodiments
described herein; and manipulating the tool support to position the
at least one tool.
[0129] In some embodiments, the method further comprises placing
the tool support in a curvilinear configuration and transitioning
the tool support to a rigid state.
[0130] In some embodiments, transitioning the tool support to a
rigid state comprises placing one or more cables in tension.
[0131] In some embodiments, transitioning the tool support to a
rigid state comprises freezing at least a portion of the tool
support.
[0132] In some embodiments, transitioning the tool support to a
rigid state comprises hardening one or more of: cement; epoxy;
glue; and combinations thereof.
[0133] In some embodiments in a system as described in reference to
the figures, the tool shafts exit the patient's mouth and travel in
a superior direction.
[0134] In some embodiments in a system as described in reference to
the figures, the tool support shaft exits the patient's mouth and
does not travel in a superior direction.
[0135] In some embodiments in a system as described in reference to
the figures, the tool support shaft exits the patient's mouth and
travels in an inferior direction.
[0136] In another aspect, a tool support is described in reference
to the embodiments described herein.
[0137] In another aspect, a method of performing a medical
procedure is described in reference to the system of any of the
embodiments described herein.
BRIEF DESCRIPTION OF THE DRAWINGS
[0138] The accompanying drawings, which are incorporated in and
constitute a part of this specification, illustrate various
embodiments of the present inventive concepts, and together with
the description, serve to explain the principles of the inventive
concepts. In the drawings:
[0139] FIG. 1 illustrates a perspective view of a system for
performing a medical procedure, in accordance with the present
inventive concepts;
[0140] FIG. 2 illustrates a perspective view of the system of FIG.
1 with a tool support in a curvilinear configuration, in accordance
with the present inventive concepts;
[0141] FIG. 3 illustrates a perspective view of the system of FIG.
1 with a tool support advanced, in accordance with the present
inventive concepts;
[0142] FIG. 4 illustrates a side view of the distal end of a tool
support and the distal portions of two tools, in accordance with
the present inventive concepts;
[0143] FIG. 4A illustrates a perspective view of handles of the two
tools of FIG. 4, in accordance with the present inventive
concepts;
[0144] FIG. 5 illustrates a perspective view of the distal end of
the tool support and tools of FIG. 4, in accordance with the
present inventive concepts;
[0145] FIG. 5A illustrates a perspective view of the handles of
FIG. 5;
[0146] FIG. 6 illustrates a perspective view of the distal end of
the tool support and tools of FIG. 4, in accordance with the
present inventive concepts;
[0147] FIG. 6A illustrates a perspective view of the handles of
FIG. 5;
[0148] FIG. 7 illustrates a perspective view of a system for
performing a medical procedure, in accordance with the present
inventive concepts;
[0149] FIG. 8 illustrates a perspective view of a tool support
introducer, in accordance with the present inventive concepts;
[0150] FIG. 9 illustrates a side view of a tool, in accordance with
the present inventive concepts;
[0151] FIG. 9A illustrates a side view of the tool of FIG. 9 with a
distal portion manipulated to a curvilinear configuration, in
accordance with the present inventive concepts;
[0152] FIG. 10 illustrates a side sectional view of a tool support
and two tools, in accordance with the present inventive
concepts;
[0153] FIG. 10A illustrates an end view of the distal end of the
tool support of FIG. 10, in accordance with the present inventive
concepts;
[0154] FIG. 11 illustrates a side sectional view of a tool support
and two tools, in accordance with the present inventive
concepts;
[0155] FIG. 11A illustrates a side sectional view of the distal end
of the tool support of FIG. 10, in accordance with the present
inventive concepts;
[0156] FIG. 12 illustrates a side sectional view of a tool support
and two tools, in accordance with the present inventive
concepts;
[0157] FIG. 13 illustrates a perspective view of a system for
performing a medical procedure, in accordance with the present
inventive concepts;
[0158] FIG. 13A illustrates a close-up perspective view of a system
for performing a medical procedure, in accordance with the present
inventive concepts;
[0159] FIG. 14A illustrates a perspective view of a tool support
introducer including lockable, rotatable couplers, in accordance
with the present inventive concepts; and
[0160] FIG. 14B illustrates a detailed view of the lockable,
rotatable couplers of FIG. 14A, in accordance with the present
inventive concepts.
DETAILED DESCRIPTION OF EMBODIMENTS
[0161] Reference will now be made in detail to the present
embodiments of the invention, examples of which are illustrated in
the accompanying drawings. Wherever possible, the same reference
numbers will be used throughout the drawings to refer to the same
or like parts.
[0162] Provided herein is a system for performing a medical
procedure including one or more tools that are operably attached to
a tool support. An operator, such as a clinician, operates a human
interface device (HID) to manipulate or otherwise control the tool
support. A controller receives signals from the HID and controls
the tool support based on these signals.
[0163] Referring now to FIG. 1, a system in accordance with the
present inventive concepts is illustrated, with the patient removed
for clarity. System 100 comprises probe 10, such as a highly
articulated probe described in U.S. patent application Ser. No.
11/630,279 titled STEERABLE, FOLLOW THE LEADER DEVICE, or U.S.
patent application Ser. No. 11/838,519 titled STEERABLE MULTI
LINKED DEVICE HAVING MULTIPLE WORKING PORTS, both incorporated by
reference in their entirety herein. Probe 10, an exemplary tool
support of the present invention, comprises feeder 110 which
controllably advances one or more cables within outer sleeve 30 of
probe 10, such as a cable, not shown, but extending to distal link
31. System 100 further comprises console 160 which includes user
interface 161, monitor 120, and HID 150. Monitor 120 may be used to
display output of a camera, such as a camera integral to distal
link 31 of probe 10.
[0164] HID 150, typically a haptic controller, joystick, track
ball, mouse, or other control device known to those of skill in the
art of robotics or other electromechanical device control. HID 150
includes handle 151 configured to manipulate distal end 31 of probe
10.
[0165] Outer sleeve 30 includes near its distal end, guide tube
339a and guide tube 339b, each including at least one lumen, not
shown, but configured to slidingly receive the distal portion of
one or more tools, also not shown but described in detail
herebelow. Guide tubes 339a and 339b may be flexible, rigid, or
include flexible and rigid portions.
[0166] Feeder 110 is mounted to table T via support 111.
Alternatively or additionally, feeder 110 may be mounted to console
160 or a separate support device.
[0167] Referring now to FIG. 2, system 100 of FIG. 1 is illustrated
with the outer sleeve 30 flexed toward the right of the page, such
as via manipulation of handle 151 of HID 150 to the left of the
page, as shown. In an alternative embodiment, handle 151 is
manipulated to the right to cause outer sleeve 30 to flex to the
right. Other manipulations of handle 151 (e.g. rotating, pulling or
pushing, and twisting) and manipulations of other portions or
components of HID 150 can be used to advance or retract outer
sleeve 30, rotate or flex sleeve 30, activate one or more
functional elements of sleeve 30 or probe 10, and the like.
[0168] Referring now to FIG. 3, system 100 of FIG. 1 is illustrated
with the outer sleeve 30 and distal end 31 advanced forward, such
as via manipulation of handle 151 HID 150 forward, bending elbow
152, as shown.
[0169] Referring now to FIG. 4, a tool support of the present
disclosure is illustrated supporting two tools, with the patient
removed for clarity. Probe 10 includes outer sleeve 30 comprising a
plurality of outer links 29. At the distal end of sleeve 30 is
distal link 31 which typically includes a camera, lighting elements
and exits for one or more tool channels, all not shown, but
described in detail herebelow. Outer sleeve 30 further includes
flanges 36a and 36b which comprise guide holes 37a and 37b,
respectively. Tool shaft 230a of tool 200a has been passed through
guide hole 37a and tool shaft 230b of tool 200b has been passed
through guide hole 37b. Located on the distal end of tool 200a is a
functional element, working end 220a. Located on the distal end of
tool 200b is another functional element, working end 220b.
Functional elements are typically selected from the group
consisting of: grasper; cutter; ablater; cauterizer; drug delivery
element; radiation source; sensor such as an EKG electrode,
pressure sensor or blood sensor; magnet; heating element; cryogenic
element; and combinations of these. Referring additionally to FIG.
4A, handle 210a of tool 200a and handle 210b of tool 200b are
illustrated. Handles 210a and 210b may include one or more
controls, such as triggers; knobs; levers; buttons; locks; and
combinations of these. As illustrated, handles 210a and 210b
include triggers 211a and 211b, respectively, such as a trigger to
actuate, deploy or otherwise control the working elements 220a and
220b, respectively. Handles 210a and 210b include rotating knobs
212a and 212b, respectively, such as knobs configured to rotate
shafts 230a and 230b, respectively. Handles 210a and 210b include
locking levers 213a and 213b, respectively, such as levers
configured to lock one or more movable portions of tools 200a and
200b. Handles 210a and 210b include pivot joints 214a and 214b,
respectively, which are configured to allow handles 210a and 210b
to flex such as to flex shafts 230a and 230b, respectively.
[0170] Referring now to FIGS. 5 and 5A, probe 10 of FIGS. 4 and 4A
is illustrated with the distal portion of tool 200b flexed toward
the left of the page, such as by rotating handle 210b left an angle
.beta.. Shaft 230b and working portion 220b have been rotated, such
as by rotating knob 212b. Lock 213b has been engaged such that
shaft 230b will maintain the flexed position shown in FIG. 5.
[0171] Also as shown in FIG. 5, distal link 31 includes camera 50
positioned toward the bottom of distal link 31, as shown on the
page. At 120.degree. separation from camera 50 are channels 32 and
33, preferably working lumens or ports, such as those described in
reference to U.S. patent application Ser. No. 11/838,519, titled
STEERABLE MULTI LINKED DEVICE HAVING MULTIPLE WORKING PORTS,
incorporated herein by reference, in its entirety, and extending
proximally to the proximal end of probe 10 such that one or more
devices can be inserted therethrough. In a particular embodiment,
channels 32 and/or 33 are used as a flush port, such as to improve
an image provided by camera 50. Distal link 31 further includes
light elements, LEDs 51, typically visible light devices, but
alternatively or additionally infrared or ultraviolet sources used
to enhance or create an image from camera 50.
[0172] Distal link 31 also includes recesses 38a and 38b which
allow shafts 230a and 230b of tools 200a and 200b, respectively, to
pass therethrough. Distal link 31 is provided with a chamfered or
rounded edge 34 such as to avoid trauma to tissue during insertion
into the human body.
[0173] Distal link 31 can be constructed to minimize reflections of
visible light, for example, distal link 31 can be a matte material
and/or a dark color, such as black.
[0174] Referring now to FIGS. 6 and 6A, probe 10 of FIGS. 5 and 5A
is illustrated with the distal portion of tool 200a flexed toward
the right of the page, such as by rotating handle 210a right at
angle .alpha.. Lock 213a has been engaged such that shaft 230a will
maintain the flexed position shown in FIG. 6.
[0175] Referring now to FIG. 7, a system in accordance with the
present inventive concepts is illustrated including two tools and a
tool support, patient not shown for clarity. System 100 includes
feeder 110 which is fixedly attached to support 111, attached to
table T. Probe 10 is positioned and configured as has been
described in detail hereabove, and is operably attached to console
160, attachment not shown but typically a conduit including
electrical wires, fiber optic cables, fluid tubing (e.g. for
flushing or hydraulic/pneumatics), mechanical linkages, and the
like. Tool 200a and tool 200b are shown operably attached to tool
holder 250a and tool holder 250b, respectively. Tools 200a and 200b
include handles 210a and 210b, respectively. Tools shafts 230a and
230b extend from handles 210a and 210b, respectively. Tool shafts
230a and 230b have been inserted into funnels 342a and 342b,
respectively, of guide tubes 339a and 339b, respectively. Guide
tubes 339a and 339b each include a guide hole, as described herein,
typically a lumen extending from one end to the other of guide
tubes 339a and 339b, sized to accommodate the working portions 220a
and 220b, and associated shafts 230a and 230b of tools 200a and
200b.
[0176] Referring now to FIG. 8, a tool support introducer in
accordance with the present inventive concepts is illustrated.
Introducer 300 includes a shaft comprising upper portion 310a which
is attachable to lower portion 310b via coupler 320. Coupler 320
comprises bracket 321 which includes slot 322 positioned and sized
to fit over a device such as a retractor placed in the patient's
mouth.
[0177] Introducer 300 includes lumen 301 extending from its
proximal end 311 to its distal end 312. Lumen 301 is sized to
slidingly receive a tool support of the present disclosure, such as
probe 10 of FIG. 1. Proximal end 311 includes projections 313 which
are sized and positioned to orient a tool support, such as a tool
support including radially extending flanges, such as probe 10 of
FIG. 4. Introducer 300 includes radially extending side lobes 302a
and 302b, which are sized and positioned to slidingly receive a
radially extending member, such as the radially extending flanges
of probe 10 of FIG. 4.
[0178] Introducer 300 includes two guide tubes comprising proximal
portions 340a and 340b, and distal portions 341a and 341b (not
shown but located behind upper shaft 310a), connected with rotating
couplers 330a and 330b, respectively. Rotatable couplers 330a and
330b, typically frictionally engaged ball joints configured to
provide gravitational support, may be detachable. Rotatable
couplers 330a and 330b frictionally engage the guide tubes such
that guide tube proximal portions 340a and 340b are supported and
free to move relative to the rotation means within coupler 330a and
330b, respectively. Rotatable couplers 330a and 330b can be locked
once the guide tubes are in a desired position and orientation
relative to the user. In a locked state, couplers 330a and 330b
prevent movement of the guide tubes when a force is applied, such
as a force applied during manipulation of a tool. Funnels 342a and
342b are configured to ease insertion of the distal portion of one
or more tools, and are attached to guide tube proximal portions
340a and 340b, respectively.
[0179] Referring now to FIG. 9, a tool in accordance with the
present inventive concepts is illustrated. Tool 200 includes handle
210 which includes control 215, typically a button, lever, switch,
knob, trigger, and the like. Extending from handle 210 is shaft
230, shown in a relatively linear orientation, which comprises a
rigid portion 231, a flexible portion 232, a second rigid portion
233, a pivot point 234, and a distal portion 235, typically a
flexible portion. Distal portion 235 includes working end 220, such
as has been described in detail hereabove. Referring now to FIG.
9A, distal portion 235 has been rotated about pivot point 234, such
as via rotation or other form of activation of control 215 of
handle 210.
[0180] Referring now to FIG. 10, a sectional view of a tool support
in accordance with the present inventive concepts is illustrated.
Probe 10 comprises an inner core comprising a set of inner links
21, and an outer sleeve comprising a set of outer links 29. Near
the distal portion of probe 10, multiple flanges 36 surround outer
links 29. One or more flanges 36 may be attachable and/or
detachable to or from outer links 29, and/or they may be
permanently attached. Flanges 36 may be configured to rotate about
outer links 29. At the distal end of probe 10 is distal link 31.
One or more cables passes through a lumen and/or wall of inner link
21, cable not shown but described in detail in reference to U.S.
patent application Ser. No. 11/630,279 titled "STEERABLE FOLLOW THE
LEADER DEVICE", incorporated herein by reference, in its entirety.
Typically three cables 35 (two shown) pass through the walls of
outer links 29 and terminate at fixation point 39 within distal
link 31. Movement of the inner cables or outer cables 35 can be
used to bend probe 10 and make the inner and outer sleeve rigid,
respectively.
[0181] Tools 200a and 200b include shafts 230a and 230b,
respectively, which have been inserted through guide holes 37a and
37b of flanges 36. Tools 200a and 200b include working ends 220a
and 220b, respectively.
[0182] Referring now to FIG. 10A, an end view of the probe of FIG.
10 is illustrated. Distal link 31 includes camera 50, LEDS 51,
channel 32, channel 33, and recess 38a and recess 38b, as has been
described hereabove. Also shown is flange 36 which includes guide
holes 37a and 37b. In one embodiment, guide holes 37a and 37b are
spaced 180.degree. apart. In an alternate embodiment, guide holes
37a and 37b are spaced 120.degree. apart.
[0183] Referring now to FIG. 11, a sectional view of the tool
support of FIG. 10 is illustrated with the inner core retracted
with its distal link just proximal to the distal link of the outer
sleeve. Distal most inner link 21' has been retracted, such as via
one or more cables, not shown but controlled by a controller of the
present invention, such that no portion of inner link 21' is within
distal link 31. Cable 39' has been retracted such that distal link
31 pivots toward the bottom of the page (cable 39'' may be
simultaneously advanced to support the rotation). Since distal
flange 36' has not rotated, working ends 220a and 220b of tools
200a and 200b remain as positioned in FIG. 10. Camera 50, not shown
but described in reference to FIG. 10a, has its viewing window
moved proportional with the movement of distal link 31. As shown in
FIG. 11a, as distal link 31 is pivoted, tool shaft 230b enters
recess 38b of distal link 31.
[0184] Referring now to FIG. 12, a sectional view of the tool
support of FIGS. 10 and 11 is illustrated with the inner core
retracted with its distal link just proximal to the last outer link
prior to the distal link. Distal most inner link 21' has been
retracted, such as via one or more cables, not shown but controlled
by a controller of the present invention, such that no portion of
inner link 21' is within outer link 29'. Cable 39' has been
retracted such that distal link 31 and outer link 29' pivots toward
the bottom of the page (cable 39'' may be simultaneously advanced
to support the rotation). Distal link 31 and outer link 29' may be
fixedly attached, attachment not shown, such that they remain in
the linear alignment shown in FIG. 12. Distal flange 36' has
rotated with outer link 29', and working ends 220a and 220b of
tools 200a and 200b rotate accordingly. Camera 50, not shown but
described in reference to FIG. 10a, has its viewing window moved
proportional with the movement of distal link 31, outer link 29'
and flange 36'.
[0185] Referring now to FIGS. 13 and 13A, a perspective view of a
system in accordance with the present inventive concepts is
illustrated inserted into the esophagus of a patient. System 100
includes probe 10 which has integral and/or feeder 110 attached to
tool support introducer 300. Outer sleeve 30 is slidingly received
by tool support 300, with both positioned in the esophagus of
patient P. Guide tubes 339a and 339b (339a not shown), each of
which include a lumen or other guide hole of the present invention
therethrough, are attached to outer sleeve 30 at or near distal
link 31. Tool 200b, which includes controls 211b, 212b and 213b as
have been described hereabove, is supported by tool holder 250b
such that shaft 230b can be can be advanced, retracted, and/or
rotated. Tool 200b shaft 230b is inserted through funnel 342b and
into a guide tube 339b. Tool 200a is similarly positioned and
inserted.
[0186] Referring now to FIG. 14A, a tool support introducer
including lockable, rotatable couplers is illustrated. FIG. 14B
illustrates a detailed view of the components of the lockable,
rotatable couplers, with some components removed for clarity.
Introducer 300 includes shaft 310, typically including a lumen, not
shown, but sized to fit a probe, for example, probe 10 as described
in reference to FIG. 1 hereabove.
[0187] Introducer 300 includes two guide tubes 339a and 339b, each
configured for insertion of the shaft of a tool, not shown but
typically a tool configured to controllably manipulate and/or
operate one or more of: a grasper; a cutter; an ablater; a
cauterizer; a drug delivery element; a radiation source; a sensor
such as an EKG electrode, a pressure sensor or blood sensor; a
magnet; a heating element; a cryogenic element; and combinations of
these. Alternatively or additionally, guide tubes 339 and 339 may
be configured for insertion of an additional guide tube, such as a
semi-rigid guide tube or a flexible guide tube that can extend and
provide support beyond the distal ends of guide tube 339a or 339b.
Guide tubes 339a and 339b are connected to lockable, rotatable
couplers 400a and 400b, respectively. Couplers 400a and 400b,
typically cam-lockable ball joints, may be detachable. Coupler 400a
includes an actuator, lever 401a. Movement of lever 401a in one
direction, for example, a downward direction relative to a user,
rotates cam sleeve 402a to apply a force that linearly displaces
cam 403a which closes gap 405a, locking ball 406a in place, thus
placing guide tube 339a in a locked state. In this locked state,
movement of guide tube 339a is prevented, including when a force is
applied, such as a when a force is applied during manipulation of a
tool whose shaft has been inserted through guide tube 339a.
[0188] Conversely, movement of lever 401a in the opposite
direction, i.e. an upward direction relative to the user, rotates
cam sleeve 402a to release the force applied to cam 403a allowing
cam 403a to linearly displace in the opposite direction, increasing
gap 405a. The increase in gap 405a releases the force applied to
ball 406a, placing guide tube 339a in an unlocked state. In this
unlocked state, guide tube 339a remains frictionally engaged with
coupler 400a, such that guide tube 339a is gravitationally
supported but free to move (e.g. by the hand of an operator)
relative to ball 406a. Additionally, coupler 400a may include a
screw, including screw head 407a, that is fixed in place, such as
via an adhesive, to prevent loosening. Screw head 407a can provide
a bearing surface for cam sleeve 402a. Coupler 400a includes insert
404a that provides a surface against which cam 403a translates.
[0189] Coupler 400b components are similar to that of coupler 400a,
for example, coupler 400b includes lever 401b, gap 405b, and ball
406b. Additionally, the functionality of the coupler 400b and its
components are typically the same or similar to that of coupler
400a.
[0190] While the preferred embodiments of the devices and methods
have been described in reference to the environment in which they
were developed, they are merely illustrative of the principles of
the present inventive concepts. Modification or combinations of the
above-described assemblies, other embodiments, configurations, and
methods for carrying out the inventive concepts, and variations of
aspects of the inventive concepts that are obvious to those of
skill in the art are intended to be within the scope of the claims.
In addition, where this application has listed the steps of a
method or procedure in a specific order, it may be possible, or
even expedient in certain circumstances, to change the order in
which some steps are performed, and it is intended that the
particular steps of the method or procedure claim set forth
herebelow not be construed as being order-specific unless such
order specificity is expressly stated in the claim.
* * * * *