Methods using a robotic catheter system

• US 20060095022A1
• Filed: 07/06/2005
• Published: 05/04/2006
• Est. Priority Date: 03/05/2004
• Status: Active Grant

• Current Assignee: Auris Health, Inc. (Johnson & Johnson)
• Original Assignee: Hansen Medical Incorporated (Johnson & Johnson)
• Inventors: Niemeyer, Gunter D., Wallace, Daniel T., Martin, Kenneth M., Moll, Frederic H., Moore, David F., Zinn, Michael R., Younge, Robert G.
• Granted Patent: US 7,850,642 B2
• Time in Patent Office: Days
• US Class Current: 606/1
• CPC Class Codes: A61B 10/06 Biopsy forceps , e.g. with cup-shaped jaws
• 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 18/00 Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body eye surgery A61F9/007; ear surgery A61F11/00
• CPC Class Codes: A61B 2017/00199 with a console, e.g. a control panel with a display
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00477 Coupling A61B2017/0046 takes precedence
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 2034/102 Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/301 for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
• CPC Class Codes: A61B 2034/715 Cable tensioning mechanisms for removing slack
• CPC Class Codes: A61B 2034/742 Joysticks
• CPC Class Codes: A61B 2090/035 preventing further rotation
• CPC Class Codes: A61B 2090/065 for measuring contact or contact pressure
• CPC Class Codes: A61B 2090/367 creating a 3D dataset from 2D images using position information
• CPC Class Codes: A61B 2090/374 NMR or MRI
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 2090/3925 : ultrasonic
• CPC Class Codes: A61B 2090/397 : electromagnetic other than visible, e.g. microwave
• CPC Class Codes: A61B 34/20 : Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 34/25 : User interfaces for surgical systems
• CPC Class Codes: A61B 34/30 : Surgical robots
• CPC Class Codes: A61B 34/37 : Master-slave robots A61B34/35 takes precedence
• 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: A61B 46/10 : specially adapted for instruments, e.g. microscopes
• CPC Class Codes: A61B 5/7285 : for synchronising or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal A61B6/5205, A61B6/541, A61B8/5207, A61B8/543 take precedence
• CPC Class Codes: A61B 6/503 : for diagnosis of the heart
• CPC Class Codes: A61B 6/504 : for diagnosis of blood vessels, e.g. by angiography
• CPC Class Codes: A61B 6/541 : involving acquisition triggered by a physiological signal
• CPC Class Codes: A61B 8/0891 : for diagnosis of blood vessels
• CPC Class Codes: A61B 8/12 : in body cavities or body tracts, e.g. by using catheters catheters per se A61M25/00
• CPC Class Codes: A61B 8/4254 : using sensors mounted on the probe
• CPC Class Codes: A61B 8/4461 : Features of the scanning mechanism, e.g. for moving the transducer within the housing of the probe
• CPC Class Codes: A61B 8/4466 : involving deflection of the probe
• CPC Class Codes: A61B 8/543 : involving acquisition triggered by a physiological signal
• CPC Class Codes: A61B 90/50 : Supports for surgical instruments, e.g. articulated arms
• CPC Class Codes: B33Y 80/00 : Products made by additive manufacturing

Abstract

A methods using a robotic catheter system to perform a procedure on a patient includes generating a control signal corresponding to movement of a master input device, and moving a plurality of drive elements of an instrument driver in response to the control signal, the drive elements operatively coupled to a corresponding plurality of control elements of an elongate guide instrument, the control elements secured to a distal end of the guide instrument and moveable axially relative to the guide instrument such that movement of the drive elements causes a corresponding movement of the guide instrument distal end.

Claims

1. A method using robotic catheter system to perform a procedure on a patient, comprising:

generating a control signal corresponding to movement of a master input device; and

moving a plurality of drive elements of an instrument driver in response to the control signal, the drive elements operatively coupled to a corresponding plurality of control elements of an elongate guide instrument, the control elements secured to a distal end of the guide instrument and moveable axially relative to the guide instrument such that movement of the drive elements causes a corresponding movement of the guide instrument distal end,

wherein the control signal causes individual ones of the plurality of drive elements to move independently of one another in order to achieve a desired bending of the guide instrument distal end.

2. The method of claim 1, further comprising

generating a further control signal using the master input device;

and

moving one or more further drive elements of the instrument driver in response to the further control signal, the one or more further drive elements operatively coupled to a corresponding one or more control elements of an elongate sheath, the one or more control elements secured to a distal end of, and moveable axially relative to, the sheath, such that movement of the one or more further drive elements causes a corresponding movement of the sheath, the sheath comprising a lumen through which the guide instrument is coaxially disposed.

3. The method of claim 2, further comprising manipulating the master input device so as to cause the guide instrument to move axially relative to the sheath.

4. The method of claim 2, further comprising manipulating the master input device so as to cause the respective guide instrument to rotate relative to the sheath.

5. The method of claim 4, wherein an outer surface of the guide instrument and a surface defining the sheath lumen are jointly configured to limit rotational movement of the guide instrument relative to the sheath.

6. The method of claim 1, wherein the master input device is operatively coupled to a controller that determines a tensioning to be applied by a respective drive element to a respective guide instrument control element based on a kinematic relationship between the desired bending and a linear movement of the guide instrument control element relative to the guide instrument.

7. The method of claim 1, wherein the desired bending may be in any one of at least three different planes.

8. The method of claim 1, further comprising positioning a working instrument in a working lumen of the guide instrument.

9. The method of claim 8, wherein the working instrument is an ablation catheter positioned such that an electrode located on the ablation catheter is sticking out of a distal end opening of the working lumen, the method further comprising using the master input device to position the guide instrument distal end in a heart chamber of the patient such that the electrode is contacting tissue in a surface of the heart chamber.

10. The method of claim 8, wherein the working instrument is a guidewire.

11. The method of claim 8, wherein the working instrument comprises a needle and dilator positioned such that the needle is protruding through a distal end opening of the working lumen, the method further comprising using the master input device to

position the guide instrument distal end adjacent an atrial wall of the patient,

move the guide instrument to cause the needle to puncture through the atrrial wall, and

move the guide instrument to cause the dilator to move through an opening in the atrial wall created by the needle puncture.

12. The method of claim 1, further comprising displaying, proximate the master input device, acquired images of anatomy of the patient proximate the guide instrument distal end.

13. The method of claim 12, wherein the images are acquired with an imaging system comprising an elongate imaging instrument configured for placement in a body passage or cavity of the patient and having an operative imaging element located on a distal portion thereof.

14. The method of claim 12, wherein the controller determines a tensioning to be applied to a respective guide instrument control element based on data from the acquired images.

15. The method of claim 12, wherein the images are acquired by an imaging system selected from the group comprising an ultrasound imaging system, an optical imaging system, a fluoroscopic imaging system, a computer tomography imaging system, and an MR imaging system.

16. The method of claim 1, further comprising obtaining position information regarding the guide instrument from a localization system operatively coupled to the controller.

17. The method of claim 16, wherein the controller determines a tensioning to be applied to a respective guide instrument control element based on position data from the localization system.

18. The method of claim 16, wherein the localization system is selected from the group comprising an ultrasound localization system and an electromagnetic localization system.

19. The method of claim 1, further comprising using the master input device to position an operative contact sensing element carried on the distal end of the guide instrument in contact with internal body tissue of the patient.

20. A method using robotic catheter system to perform a procedure on a patient, comprising:

generating a control signal corresponding to movement of a master input device;

moving a plurality of drive elements of an instrument driver in response to the control signal, the drive elements operatively coupled to a corresponding plurality of control elements of an elongate guide instrument, the control elements secured to a distal end of the guide instrument and moveable axially relative to the guide instrument such that movement of the drive elements causes a corresponding movement of the guide instrument distal end, wherein the control signal causes individual ones of the plurality of drive elements to move independently of one another in order to achieve a desired bending of the guide instrument distal end;

generating a further control signal using the master input device; and

moving one or more further drive elements of the instrument driver in response to the further control signal, the one or more further drive elements operatively coupled to a corresponding one or more control elements of an elongate sheath, the one or more control elements secured to a distal end of, and moveable axially relative to, the sheath, such that movement of the one or more further drive elements causes a corresponding movement of the sheath, the sheath comprising a lumen through which the guide instrument is coaxially disposed.

21. The method of claim 20, wherein the master input device is operatively coupled to a controller that determines a tensioning to be applied by a respective drive element to a respective guide instrument control element based on a kinematic relationship between the desired bending and a linear movement of the guide instrument control element relative to the guide instrument.

22. The method of claim 20, further comprising

positioning an ablation catheter in a working lumen of the guide instrument such that an electrode located on the ablation catheter is sticking out of a distal end opening of the working lumen, and

using the master input device to position the guide instrument distal end in a heart chamber of the patient such that the electrode is contacting tissue in a surface of the heart chamber.

23. The method of claim 20, further comprising

positioning a needle and dilator in a working lumen of the guide instrument such that the needle is protruding through a distal end opening of the working lumen, and using the master input device to

position the guide instrument distal end adjacent an atrial wall of the patient,

move the guide instrument to cause the needle to puncture through the atrrial wall, and

move the guide instrument to cause the dilator to move through an opening in the atrial wall created by the needle puncture.

24. The method of claim 21, further comprising displaying, proximate the master input device, acquired images of anatomy of the patient proximate the guide instrument distal end, wherein the controller determines a tensioning to be applied to a respective guide instrument control element based on data from the acquired images.

25. The method of claim 21, further comprising obtaining position information regarding the guide instrument from a localization system operatively coupled to the controller, wherein the controller determines a tensioning to be applied to a respective guide instrument control element based on position data from the localization system.

26. The method of claim 20, further comprising using the master input device to position an operative contact sensing element carried on the distal end of the guide instrument in contact with internal body tissue of the patient.

27. A method using robotic catheter system to perform a procedure on a patient, comprising:

generating control signals corresponding to movement of a master input device, the robotic catheter system including

a controller operatively coupled to the master input device,

an instrument driver in communication with the controller, the instrument driver having a guide instrument interface including a plurality of guide instrument drive elements responsive to the control signals,

an elongate guide instrument having a base, distal end, and a working lumen, the guide instrument base operatively coupled to the guide instrument interface, the guide instrument comprising a plurality of guide instrument control elements operatively coupled to respective guide drive elements and secured to the distal end of the guide instrument, the guide instrument control elements axially moveable relative to the guide instrument such that movement of the guide instrument distal end may be controlled by movement of the master input device, and

an imaging system and a display, each operatively coupled to the controller.

28. The method of claim 27, wherein the controller and instrument driver are configured to independently control the guide instrument drive elements and corresponding guide instrument control elements in order to achieve a desired bending of the guide instrument distal end, and wherein the controller determines a tensioning to be applied to a respective guide instrument control element based on data from images acquired by the imaging system.

29. The method of claim 27, wherein the imaging system selected from the group comprising an ultrasound imaging system, an optical imaging system, a fluoroscopic imaging system, a computer tomography imaging system, and an M imaging system.

30. A method using robotic catheter system to perform a procedure on a patient, comprising:

generating control signals corresponding to movement of a master input device, the robotic catheter system including

a controller operatively coupled to the master input device,

an instrument driver in communication with the controller, the instrument driver having a guide instrument interface including a plurality of guide instrument drive elements responsive to the control signals,

an elongate guide instrument having a base, distal end, and a working lumen, the guide instrument base operatively coupled to the guide instrument interface, the guide instrument comprising a plurality of guide instrument control elements operatively coupled to respective guide drive elements and secured to the distal end of the guide instrument, the guide instrument control elements axially moveable relative to the guide instrument such that movement of the guide instrument distal end may be controlled by movement of the master input device, and

a localization system operatively coupled to the controller, the method further comprising

acquiring position information regarding the guide instrument.

31. The method of claim 30, wherein the controller and instrument driver are configured to independently control the guide instrument drive elements and corresponding guide instrument control elements in order to achieve a desired bending of the guide instrument distal end, and wherein the controller determines a tensioning to be applied to a respective guide instrument control element based on the acquired position data.

32. The method of claim 30, wherein the localization system is selected from the group comprising an ultrasound localization system and an electromagnetic localization system.

33. The method of claim 30, the robotic catheter system further comprising an elongate sheath instrument having a base, distal end, and a lumen through which the guide instrument is coaxially disposed, the instrument driver further comprising a sheath instrument interface operatively coupled to the sheath instrument base, wherein the instrument driver is configured such that the guide instrument interface is moveable relative to the sheath instrument interface, whereby the guide instrument is moveable axially relative to the sheath instrument.