Articulated surgical instrument for performing minimally invasive surgery with enhanced dexterity and sensitivity

• US 20020103476A1
• Filed: 02/15/2002
• Published: 08/01/2002
• Est. Priority Date: 05/20/1996
• Status: Active Grant

• Current Assignee: Intuitive Surgical Operations, Inc. (Intuitive Surgical Holdings, LLC)
• Original Assignee: Intuitive Surgical Incorporated (Intuitive Surgical Holdings, LLC)
• Inventors: Madhani, Akhil J., Salisbury, J. Kenneth
• Granted Patent: US 6,991,627 B2
• Time in Patent Office: Days
• US Class Current: 606/1
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 2017/2927 the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/2929 with a head rotatable about the longitudinal axis of the shaft
• CPC Class Codes: A61B 2017/2939 Details of linkages or pivot points
• CPC Class Codes: A61B 2034/305 Details of wrist mechanisms at distal ends of robotic arms
• CPC Class Codes: A61B 2034/306 Wrists with multiple vertebrae
• CPC Class Codes: A61B 2034/715 Cable tensioning mechanisms for removing slack
• CPC Class Codes: A61B 34/30 Surgical robots
• CPC Class Codes: A61B 34/35 for telesurgery
• CPC Class Codes: A61B 34/37 Master-slave robots A61B34/35 takes precedence
• CPC Class Codes: A61B 34/70 Manipulators specially adapted for use in surgery
• CPC Class Codes: A61B 34/71 Manipulators operated by drive cable mechanisms
• CPC Class Codes: A61B 34/76 Manipulators having means for providing feel, e.g. force or tactile feedback
• CPC Class Codes: A61B 34/77 Manipulators with motion or force scaling
• CPC Class Codes: B25J 3/04 involving servo mechanisms servo-actuated heads B25J15/02
• CPC Class Codes: B25J 9/104 with cables, chains or ribbons
• CPC Class Codes: Y10T 74/20329 Joint between elements
• CPC Class Codes: Y10T 74/20335 Wrist

Abstract

An articulated surgical instrument for enhancing the performance of minimally invasive surgical procedures. The instrument has a high degree of dexterity, low friction, low inertia and good force reflection. A unique cable and pulley drive system operates to reduce friction and enhance force reflection. A unique wrist mechanism operates to enhance surgical dexterity compared to standard laparoscopic instruments. The system is optimized to reduce the number of actuators required and thus produce a fully functional articulated surgical instrument of minimum size.

Claims

1. An articulated instrument for minimally invasive surgery, comprising:

an elongate support member having a proximal portion and a distal end with a longitudinal axis therebetween;

a pivotal wrist member disposed at the distal end of the elongate support member; and

a surgical end effector coupled to the wrist member, the end effector including at least one end effector work member, the work member being removably fixed to the wrist member;

said articulated instrument having a size and shape suitable for distal insertion into an internal surgical site through an aperture.

2. The articulated instrument of claim 1, further comprising at least one wrist drive element coupled to the wrist member and adapted for coupling to at least one actuator for pivoting the wrist member about a wrist joint.

3. The articulated instrument of claim 2, wherein the wrist drive element includes a cable.

4. The articulated instrument of claim 1, wherein the at least one end effector work member includes at least a pair of work members pivotally coupled to the wrist member, wherein at least one work member can pivot relative to the other work member of the pair.

5. The articulated instrument of claim 4, further comprising at least one end effector drive element coupled to at least one end effector work member and adapted for coupling to at least one actuator for pivoting the work member relative to the wrist member.

6. The articulated instrument of claim 5, wherein the end effector includes at least one pivotally-mounted capstan coupled to the end effector drive element, and the at least one end effector work member is removably fixed to the capstan.

7. The articulated instrument of claim 6, wherein the end effector drive element includes a cable.

8. The articulated instrument of claim 4, wherein one of said work members is pivotally connected to the other work member, and both work members are pivotally connected to the wrist member.

9. The articulated instrument of claim 1, wherein the at least one end effector work member is removably fixed to the wrist member by at least one of a screw and a clip.

10. The articulated instrument of claim 1, wherein the end effector comprises a gripper, a scissors, a cutter, a graspers, a forceps, a needle holder, a retractor, an electrocautery instrument, a microforceps, a microneedle holder, a dissecting tool, a blade, or an irrigator, or a combination of these.

11. The articulated instrument of claim 1, further comprising at least one substitute member adapted to be removably fixed to the wrist member to replace the at least one end effector work member.

12. The articulated instrument of claim 11, wherein the substitute member is of a different surgical type than the at least one end effector work member.

14. The surgical system of claim 13, further comprising a drive system including at least one wrist drive element coupled to the wrist member and adapted for coupling to at least one actuator for pivoting the wrist member about a wrist joint.

15. The surgical system of claim 14, wherein the wrist drive element includes a cable.

16. The surgical system of claim 13, wherein the at least one end effector work member includes at least a pair of work members pivotally coupled to the wrist member, wherein at least one work member can pivot relative to the other work member of the pair.

17. The surgical system of claim 16, further comprising at least one end effector drive element coupled to at least one end effector work member and adapted for coupling to at least one actuator for pivoting the work member relative to the wrist member.

18. The surgical system of claim 17, wherein the end effector includes at least one pivotally-mounted capstan coupled to the end effector drive element, and the at least one end effector work member is removably fixed to the capstan.

19. The surgical system of claim 18, wherein the end effector drive element includes a cable.

20. The surgical system of claim 16, wherein one of said work members is pivotally connected to the other work member, and both work members are pivotally connected to the wrist member.

21. The surgical system of claim 13, wherein the at least one end effector work member is removably fixed to the wrist member by at least one of a screw and a clip.

22. The surgical system of claim 13, wherein the end effector comprises a gripper, a scissors, a cutter, a graspers, a forceps, a needle holder, a retractor, an electrocautery instrument, a microforceps, a microneedle holder, a dissecting tool, a blade or an irrigator, or a combination of these.

23. The surgical system of claim 13, further comprising at least one substitute member adapted to be removably fixed to the wrist member to replace the at least one end effector work member.

24. The articulated instrument of claim 13, wherein the substitute member is of a different surgical type than the at least one end effector work member.

26. The method of claim 25, further comprising the steps of:

(h) prior to the removing step (d), retracting the distal portion from the aperture in the patient'"'"'s body; and

(i) following the replacing step (f), inserting the distal portion of the surgical instrument through an aperture in a patient'"'"'s body to a location adjacent a surgical worksite.

27. The method of claim 25, further comprising the step of:

(j) moving the wrist member to position the end effector for surgical treatment.

28. The method of claim 27, wherein:

the articulated instrument provided in step (a) further includes at least one wrist drive element coupled to the wrist member and adapted for coupling to at least one actuator for pivoting the wrist member about a wrist joint; and

the moving step (j) includes actuating the wrist drive element to move the wrist member.

29. The method of claim 28, wherein the wrist drive element includes a cable.

30. The method of claim 25, wherein:

the articulated instrument provided in step (a) further includes at least one end effector drive element coupled to at least one end effector work member and adapted for coupling to at least one actuator for pivoting the work member relative to the wrist member; and

at least one of the treatment performing steps (c) and (g) includes actuating the end effector drive element to pivot the at least one end effector work member.

31. The method of claim 30, wherein the end effector includes at least one pivotally-mounted capstan coupled to the end effector drive element, and the at least one end effector work member is removably fixed to the capstan.

32. The method of claim 31, wherein the end effector drive element includes a cable.

33. The method of claim 25, wherein the at least one end effector work member of the articulated instrument provided in step (a) is removably fixed to the wrist member by at least one of a screw and a clip.

34. The method of claim 25, wherein the end effector of the articulated instrument provided in step (a) comprises a gripper, a scissors, a cutter, a graspers, a forceps, a needle holder, a retractor, an electrocautery instrument, a microforceps, a microneedle holder, a dissecting tool, a blade or an irrigator, or a combination of these.

35. The method of claim 25, wherein the substitute member provided in step (e) is a different surgical instrument type than the at least one end effector work member provided in step (a).

37. The surgical system of claim 36, wherein the positioning mechanism further comprises a linear bearing coupling the articulated surgical instrument assembly to the distal end of the support linkage, to permit axial translation of the articulated surgical instrument assembly relative to the base.

38. The surgical system of claim 36, wherein the cable elements are configured to hold the plurality of pivotal joints at fixed angles when the actuators do not move the cable elements and the articulated surgical instrument assembly is translated axially.

39. The surgical system of claim 36, wherein the elongate elements comprise cable elements including at least one portion of cable.

40. The surgical system of claim 39, wherein the cable elements are configured to twist within the elongate support assembly so that the distal portion of the articulated surgical instrument assembly can rotate about the axis relative to the positioning mechanism and the actuators.

41. The surgical system of claim 39, wherein at least one of the plurality of cable element comprises a continuous loop.

42. The surgical system of claim 39, wherein the positioning mechanism is configured to cause the articulated surgical instrument assembly to pivot about at least a first axis relative to the base.

43. The surgical system of claim 36, wherein the instrument drive system includes a rotational connection arranged to permit the elongate support assembly to rotate about the longitudinally axis.

44. The surgical system of claim 36, wherein the articulated surgical instrument assembly further includes a second end effector element coupled to the wrist joint by a second pivotal end effector joint so that the first and second end effector elements can manipulate tissues at the worksite therebetween.

45. The surgical system of claim 36, wherein the end effector joints pivot about a common end effector axis, and wherein the instrument drive system can move the first and second end effector elements independently.

46. The surgical system of claim 36, wherein at least one actuator of the instrument drive system includes a rounded drive capstan engaging at least one of the plurality of elongate drive elements, so as to cause the elongate drive element to move when the capstan is rotated so as to cause the rotation of at least one of the plurality of rotary joints of the articulated surgical instrument assembly.

47. The surgical system of claim 46, wherein the elongate drive element comprises a cable element including at least one portion of cable.

48. The surgical system of claim 47, wherein the cable element comprises a continuous loop.

49. The surgical system of claim 36, wherein at least one of the plurality of elongate drive elements engages an idler pulley, so as to guide the elongate element intermediate the corresponding actuator and corresponding rotary joint.

50. The surgical system of claim 36, wherein at least one of the pivotal wrist joint and the first pivotal end effector joint includes a driven capstan portion, the driven capstan portion engaging at least one of the plurality of elongate drive elements, so as to cause the pivotal joint to rotate in response to movement of the elongate drive element.

13. A minimally invasive surgical system including:

an arm having a proximal end portion adapted to be attached to a base so as to permit a distal end portion of the arm to move relative to the base; and

an articulated surgical instrument mounted on the distal end of the arm, the instrument comprising;

an elongate support member having a proximal portion and a distal end with a longitudinal axis therebetween;

a pivotal wrist member disposed at the distal end of the elongate support member; and

at least one surgical end effector work member coupled to the wrist member, the work member being removably fixed to the wrist member;

said instrument having a size and shape suitable for distal insertion into an internal surgical site through an aperture; and

25. A method for minimally invasive surgery in a patient, comprising:

(a) providing an articulated surgical instrument including;

an elongate support member having a proximal portion and a distal end with a longitudinal axis therebetween;

a pivotal wrist member disposed at the distal end of the elongate support member; and

a surgical end effector coupled to the wrist member, the end effector including at least one end effector work member, the work member being removably fixed to the wrist member;

said articulated instrument having a size and shape suitable for distal insertion into an internal surgical site through an aperture.

(b) inserting a distal portion of the surgical instrument through an aperture in a patient'"'"'s body to a location adjacent a surgical worksite, the distal portion including at least the wrist member and the end effector;

(c) performing a surgical treatment using the at least one end effector work member;

(d) removing the at least one end effector work member from the wrist member;

(e) providing a substitute member;

(f) replacing the at least one end effector work member by removably fixing the substitute member to the wrist member; and

(g) performing a surgical treatment using the substitute member.

36. A minimally invasive surgical system comprising:

a base adapted to be fixed relative to a patient'"'"'s body;

an instrument positioning mechanism;

an articulated surgical instrument assembly; and

an instrument drive system;

the instrument positioning mechanism including;

a support linkage having a proximal end and a distal end, the proximal end being coupled the base and the distal end being coupled to the articulated surgical instrument assembly;

a positioning drive system configured to move the distal end of the support linkage so as to move the articulated surgical instrument assembly in a plurality of degrees of freedom relative to the base;

the articulated surgical instrument assembly including;

a proximal portion and a distal portion, and an elongate support assembly having a proximal end and a distal end with a longitudinal axis therebetween;

a pivotal wrist joint disposed adjacent the distal end of the elongate support assembly, and

a surgical end effector including a first end effector element coupled to the wrist joint by a first pivotal end effector joint;

the proximal portion of the articulated surgical instrument assembly being adapted to releasably couple to the distal end of the instrument positioning mechanism;

the distal portion of the articulated surgical instrument assembly having a size and shape suitable for insertion through an aperture in the patient'"'"'s body to extent to an internal surgical site; and

the instrument drive system including;

a plurality of actuators disposed adjacent the distal end of the positioning mechanism;

a plurality of elongate drive elements extending longitudinally from the plurality of actuators to operatively couple to a corresponding plurality of pivotal joints adjacent the distal portion of the articulated surgical instrument assembly;

the plurality of pivotal joints including at least the pivotal wrist joint and the first pivotal end effector joint;

the instrument drive system being configured to move the first end effector element in a plurality of degrees of freedom relative to the distal end of the positioning mechanism.