SURGERY METHODS USING A ROBOTIC INSTRUMENT SYSTEM

• US 20090036900A1
• Filed: 02/01/2008
• Published: 02/05/2009
• Est. Priority Date: 02/02/2007
• Status: Abandoned Application

• Current Assignee: Hansen Medical Incorporated (Johnson & Johnson)
• Original Assignee: Hansen Medical Incorporated (Johnson & Johnson)
• Inventors: Moll, Frederic H.
• Application Number:
  US12/024,760
• Publication Number:
  US 20090036900A1
• Time in Patent Office: Days
• US Class Current: 606/130
• CPC Class Codes: A61B 1/009 with bending or curvature detection of the insertion part
• CPC Class Codes: A61B 2017/00261 Discectomy
• CPC Class Codes: A61B 2034/102 Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2061 using shape-sensors, e.g. fiber shape sensors with Bragg gratings
• 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 34/30 Surgical robots
• CPC Class Codes: A61B 34/71 Manipulators operated by drive cable mechanisms
• CPC Class Codes: A61B 90/361 Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61B 90/50 Supports for surgical instruments, e.g. articulated arms
• CPC Class Codes: A61G 13/10 Parts, details or accessories surgical drape sheets A61B46/00
• CPC Class Codes: A61G 13/101 Clamping means for connecting accessories to the operating table supports as part of surgical instruments A61B90/50
• CPC Class Codes: A61G 7/0503 Holders, support devices for receptacles, e.g. for drainage or urine bags hanging-up devices for infusion A61M5/1414

Abstract

Various methods for performing various surgical procedures using a robotic instrument system are disclosed. In one embodiment, the method comprises advancing a guide instrument into a patient'"'"'s body and to the vicinity of a treatment area. The guide instrument may be a robotically controlled catheter which is controlled by a robotic catheter system. The guide instrument comprises an elongate flexible body having a proximal end and a distal end, and an end effector coupled to the distal end. The end effector may comprise various devices for assisting and performing the surgical procedure. For example, the end effector may be a clip applier, a laser fiber, a cryo fiber, or a needle and grasper. An image capture device may also be coupled to the distal end to assist in positioning and operating the guide instrument.

Claims

1. A method for repairing a detached retina in a patient'"'"'s eye, comprising:

robotically maneuvering a guide instrument in the vitreous body of the eye, the guide instrument comprising an elongate flexible body having a proximal end, a distal end, and a clip applier couple to the distal end, the clip applier configured to dispense and apply clips into tissue;

pushing the detached retina toward the wall of the eye using the guide instrument under robotic control;

robotically maneuvering a guide instrument to thereby position the clip applier proximate the detached retina; and

using the clip applier to apply clips into tissue to fasten the detached retina to the sclera of the eye.

2. The method of claim 1, wherein the clips are fabricated from resorbable material that is metabolized by the patient'"'"'s body over a period of time.

3. The method of claim 2, wherein the resorbable material is polyglycolide.

4. A method for repairing a detached retina in a patient'"'"'s eye, comprising:

robotically maneuvering a guide instrument in the vitreous body of the eye, the guide instrument comprising an elongate flexible body having a proximal end, a distal end, an image capture device, an arcuate needle and a grasper coupled to the instrument distal end;

pushing the detached retina toward the wall of the eye using the guide instrument under robotic control; and

applying sutures to suture the retina to the sclera using the arcuate needle and grasper.

5. The method of claim 4, wherein the sutures are fabricated from resorbable material that is metabolized by the patient'"'"'s body over a period of time.

6. The method of claim 5, wherein the resorbable material is a polyglycolide selected from the group of Ethicon Vicryl, Spenco Polysorb, or Syneture Dexon.

7. The method of claim 4, further comprising imaging the area of the detached retina using the image capture device to assist in positioning the guide instrument and applying the sutures.

8. A method for repairing a detached retina in a patient'"'"'s eye, comprising:

robotically maneuvering a guide instrument in the vitreous body of the eye, the guide instrument comprising an elongate flexible body having a proximal end, a distal end, an image capture device, and a laser fiber coupled to the distal end;

pushing the detached retina toward the wall of the eye using the instrument guide catheter under robotic control;

positioning the laser fiber to thereby aim the laser at the area of the detached retina; and

applying laser photocoagulation to the detached retina using the laser fiber.

9. The method of claim 8, further comprising imaging the area of the detached retina using the image capture device to assist in positioning the guide instrument and aiming the laser fiber.

10. A method for repairing a detached retina in a patient'"'"'s eye, comprising:

robotically maneuvering a guide instrument in the vitreous body of the eye, said the guide instrument comprising an elongate flexible body having a proximal end, a distal end, an image capture device, and a cryo-ablation element coupled to the distal end;

pushing the detached retina toward the wall of the eye using the guide instrument guide catheter under robotic control;

positioning the cryo fiber at a position for applying cryotherapy to the area of the detached retina; and

applying cryotherapy to the detached retina using the cryo fiber.

11. The method of claim 10, further comprising imaging the area of the detached retina using the image capture device to assist in positioning the instrument guide catheter and aiming the cryo fiber.

12. A method for repairing a detached retina in a patient'"'"'s eye, comprising:

advancing a guide instrument into the vitreous body of the eye,

robotically maneuvering a distal end of the guide instrument guide within the vitreous body; and

injecting a gas or fluid bubble into a vitreous cavity of the eye using an irrigation port disposed on a distal end portion of the guide instrument in a manner such that the bubble pushes the detached retina toward the wall of the eye.

13. The method of claim 12, further comprising imaging the area of the detached retina using an image capture device coupled to the distal end portion of the guide instrument.

14. A method for performing a medical procedure in the thoracic cavity of a patient, comprising:

advancing a first instrument assembly into the thoracic cavity via the ribcage and around the lungs, the first instrument assembly comprising a first guide instrument and a first sheath instrument, the first guide instrument comprising an elongate flexible body having a proximal end and a distal end, the sheath instrument comprising an elongate flexible body having a working lumen therethrough, wherein the first guide instrument is inserted through the working lumen of the sheath instrument; and

robotically maneuvering the first instrument assembly into a pericardial space so that a distal end portion of the guide instrument accesses the patient'"'"'s heart.

15. The method of claim 14, further comprising:

advancing a second instrument assembly into the thoracic cavity, the second instrument assembly comprising a second guide instrument and a second sheath instrument, the second guide instrument comprising an elongate flexible body having a proximal end and a distal end, the sheath instrument comprising an elongate flexible body having a working lumen therethrough, wherein the second guide instrument is inserted through the working lumen of the second sheath instrument; and

robotically maneuvering the second instrument assembly into the pericardial space so that a distal end portion of the second guide instrument accesses the patient'"'"'s heart.

16. A method for performing a medical procedure in the thoracic cavity of a patient, comprising:

inserting a first instrument assembly down the patient'"'"'s trachea to the main bronchi, the first instrument assembly comprising a first guide instrument and a first sheath instrument, the first guide instrument comprising an elongate flexible body having a proximal end and a distal end, the first sheath instrument comprising an elongate flexible body having a working lumen therethrough, the first guide instrument being inserted through the working lumen of the first sheath instrument; and

robotically maneuvering a distal end portion of the first guide catheter to puncture through the lung and into the patient'"'"'s pericardial space, and advancing the first instrument assembly into the pericardial space to access the patient'"'"'s heart.

17. The method of claim 16, further comprising:

advancing a second instrument assembly down the patient'"'"'s trachea to the main bronchi, said second instrument assembly comprising a second guide instrument and a second sheath instrument, the second guide catheter comprising an elongate flexible body having a proximal end and a distal end, the sheath instrument comprising an elongate flexible body having a working therethrough, wherein the second guide instrument is inserted through the working lumen of the second sheath instrument; and

robotically maneuvering the second instrument the second instrument assembly to puncture through the lung and into the patient'"'"'s pericardial space, and advancing the second instrument assembly into the pericardial space to access the patient'"'"'s heart.

18. The method of claim 17, wherein the first guide instrument further comprises an ablation catheter disposed on the distal end of the first guide instrument, and said method further comprises the step of ablating the heart with the ablation catheter.

19. The method of claim 17, wherein the second guide instrument comprises an image capture device, and said method further comprises imaging a treatment area of the heart with the image capture device.

20. A method for treating a patent foramen ovale (PFO) in a patient'"'"'s heart, comprising:

robotically maneuvering a guide instrument up the inferior vena cava and into the right atrium of the heart, the guide instrument comprising an elongate flexible body having a proximal end and a distal end, and a balloon coupled to the distal end;

inflating the balloon against the septal wall of the heart; and

advancing a needle through a lumen in said balloon and piercing both sides of the PFO.

21. The method of claim 20, wherein the needle is used to irritate the tissue surrounding the PFO to encourage closure of the PFO.

22. The method of claim 20, wherein the needle is used to apply sutures to the PFO to close the PFO.

23. A method for performing a medical procedure in the thoracic cavity of a patient, comprising:

inserting a first instrument assembly down the patient'"'"'s trachea to the main bronchi, the first instrument assembly comprising a first guide instrument and a first sheath instrument, the first guide instrument comprising an elongate flexible body having a proximal end and a distal end, the first sheath instrument comprising an elongate flexible body having a working lumen therethrough, the first guide instrument being inserted through the working lumen of the first sheath instrument; and

robotically maneuvering a distal end portion of the first guide catheter to puncture through the lung and into the patient'"'"'s mediastinal space, and advancing the first instrument assembly into the mediastinal space to access tissue structures located therein.

24. The method of claim 23, further comprising:

advancing a second instrument assembly into the thoracic cavity, the second instrument assembly comprising a second guide instrument and a second sheath instrument, the second guide instrument comprising an elongate flexible body having a proximal end and a distal end, the sheath instrument comprising an elongate flexible body having a working lumen therethrough, wherein the second guide instrument is inserted through the working lumen of the second sheath instrument; and

robotically maneuvering the second instrument assembly into the mediastinal space so that a distal end portion of the second guide instrument accesses tissue structures located therein.

25. The method of claim 24, wherein the first guide instrument further comprises an ablation catheter disposed on the distal end of the first guide instrument, and said method further comprises the step of ablating a tumor accessible via the mediastinal space.