Performing cardiac surgery without cardioplegia

• US 6,468,265 B1
• Filed: 11/09/1999
• Issued: 10/22/2002
• Est. Priority Date: 11/20/1998
• Status: Expired due to Term

• Current Assignee: Intuitive Surgical Operations, Inc. (Intuitive Surgical Holdings, LLC)
• Original Assignee: Intuitive Surgical Incorporated (Intuitive Surgical Holdings, LLC)
• Inventors: Wilson, Christopher P., Pendleton, Rand P., Evans, Philip C., Rosa, David J., Guthart, Gary S., Ramans, Andris D., Falk, Volkmar, Nowlin, William C., Moll, Frederic H., Younge, Robert G.
• Primary Examiner(s): SHAW, SHAWNA JEANNINE
• Application Number:
  US09/436,982
• Time in Patent Office: 1,078 Days
• Field of Search: 600/103, 600/109, 600/111, 600/227-231, 600/102, 600/407, 600/595, 606/241, 606/1, 606/130, 700/245, 901/2, 901/30
• US Class Current: 606/1
• CPC Class Codes: A61B 17/04 for suturing wounds; Holders or packages for needles or suture materials suture materials A61L17/00
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00703 correcting for movement of heart, e.g. ECG-triggered
• CPC Class Codes: A61B 2034/2065 Tracking using image or pattern recognition
• CPC Class Codes: A61B 2034/305 Details of wrist mechanisms at distal ends of robotic arms
• CPC Class Codes: A61B 2034/742 Joysticks
• CPC Class Codes: A61B 2090/064 for measuring force, pressure or mechanical tension
• 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 34/32 operating autonomously
• 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 34/77 Manipulators with motion or force scaling
• CPC Class Codes: A61B 90/361 Image-producing devices, e.g. surgical cameras

Abstract

A surgical system or assembly for performing cardiac surgery includes a surgical instrument; a servo-mechanical system engaged to the surgical instrument for operating the surgical instrument; and an attachment assembly for removing at least one degree of movement from a moving surgical cardiac worksite to produce a resultant surgical cardiac worksite. The surgical system or assembly also includes a motion tracking system for gathering movement information on a resultant surgical cardiac worksite. A control computer is engaged to the attachment assembly and to the motion tracking system and to the servo-mechanical system for controlling movement of the attachment assembly and for feeding gathered information to the servo-mechanical system for moving the surgical instrument in unison with the resultant surgical cardiac worksite such that a relative position of the moving surgical instrument with respect to the resultant surgical cardiac worksite is generally constant. A video monitor is coupled to the control computer; and an input system is coupled to the servo-mechanical system and to the control computer for providing a movement of the surgical instrument. The video monitor displays movement of the surgical instrument while the resultant surgical cardiac worksite appears substantially stationary, and while a relative position of the surgical instrument moving in unison with the resultant surgical cardiac worksite, as a result from the movement information gathered by the motion tracking system, remains generally constant. A method of performing cardiac surgery without cardioplegia comprising removing at least one degree of movement freedom from a moving surgical cardiac worksite to produce at least a partially stationary surgical cardiac worksite while allowing a residual heart section, generally separate from the at least partially stationary surgical cardiac worksite, to move as a residual moving heart part. Cardiac surgery is performed on the at least partially stationary cardiac worksite with a surgical instrument such as needle drivers, forceps, blades and scissors.

Claims

1. A method of performing a surgical procedure on a beating heart of a patient, the method including:

positioning an end effector in close proximity to a surgical site on the heart at which site a surgical procedure is to be performed, the end effector being mounted on a robotically controlled arm;

providing a brace member mounted on another robotically controlled arm;

forwarding command signals to actuators operatively associated with the another robotically controlled arm to cause the arm to move the brace member from a position clear of the heart to a position in contact with the heart;

bracing the beating heart with a brace member to at least reduce motion of the surgical site;

inputting an end effector movement command signal; and

forwarding the end effector movement command signal to actuators operatively associated with the robotically controlled arm to cause the end effector to move relative to the surgical site so as to perform at least part of the surgical procedure at the surgical site.

2. A method as claimed in claim 1, in which the another robotically controlled arm is connected to a stationary base positioned outside the patient, bracing the beating heart including contacting the heart with the brace member.

3. A method as claimed in claim 2, in which the brace member is arranged to operate under suction, the method including displacing air relative to the brace member to cause the brace member to attach itself to the heart by suction.

4. A method as claimed in claim 2, which includes maintaining the brace member in a stationary condition relative to the base when in contact with the beating heart so as to inhibit heart motion by at least one degree of freedom of movement.

5. A method as claimed in claim 2, which includes permitting the brace member to move in sympathy with the heart whilst in contact therewith and restraining motion of the brace member so as to restrain motion of the surgical site.

6. A method as claimed in claim 1, wherein the surgical procedure is to be performed in a minimally invasive manner, positioning the end effector in close proximity to the surgical site on the heart then including the prior step of passing the end effector through a relatively small aperture in the patient.

7. A method as claimed in claim 6, which comprises the prior step of forming an incision in the chest region of the patient to define the aperture.

8. A method as claimed in claim 1, which further includes capturing an image of the surgical site by means of an image capture device.

9. A method as claimed in claim 8, which further includes forwarding the image of the surgical site captured by the image capture device to a remote image display.

10. A method as claimed in claim 9, wherein the image capture device is arranged to capture an image of the surgical site from each of two different vantage points, the method then including forwarding the images to the remote image display so as to display a stereo image of the surgical site.

11. A method as claimed in claim 8, in which the surgical procedure is to be performed in a minimally invasive manner, capturing an image of the surgical site by means of the image capture device then including the prior step of passing the image capture device through a relatively small aperture in the patient.

12. A method as claimed in claim 11, which comprises the prior step of forming an incision in the chest region of the patient to define the aperture.

13. A method as claimed in claim 1, in which the motion of the surgical site is reduced, the method further including:

monitoring the reduced motion of the surgical site;

computing end effector tracking command signals in response to the reduced monitored motion of the surgical site; and

forwarding the tracking command signals to the actuators to cause the arm to move the end effector generally to track motion of the surgical site.

14. A method as claimed in claim 13, in which monitoring motion of the surgical site includes contacting the surgical site with a motion detector, permitting the motion detector to move in sympathy with the surgical site and monitoring movement of the motion detector so as to monitor motion of the surgical site.

15. A method of performing a surgical procedure on a beating heart of a patient, the method including:

positioning an end effector in close proximity to a surgical site on the heart at which site a surgical procedure is to be performed, the end effector being mounted on a robotically controlled arm;

bracing the beating heart with a brace member to at least reduce motion of the surgical site;

monitoring the reduced motion of the surgical site by securing at least one target marker on the surgical site and monitoring movement of the target marker so as to monitor motion of the surgical site;

computing end effector tracking command signals in response to the reduced monitored motion of the surgical site; and

forwarding the tracking command signals to actuators to cause the arm to move the end effector generally to track motion of the surgical site.

16. A method as claimed in claim 15, wherein securing at least one target marker includes securing a plurality of target markers at spaced apart positions on the surgical site and monitoring movement of the target markers so as to monitor motion of the surgical site.

17. A method as claimed in claim 16, in which the movement of the target markers differ, monitoring motion of the surgical site then including monitoring a computed motion derived from the motions of at least some of the target markers.

18. A method as claimed in claim 16, in which the target markers are arranged to cooperate with a sensor, the method further including positioning a sensor at an appropriate position to detect motion of the target markers.

19. A method as claimed in claim 18, in which the sensor is arranged cooperate with the markers so as to sense their movement electromagnetically.

20. A method of performing a surgical procedure on a beating heart of a patient, the method including:

positioning an end effector in close proximity to a surgical site on the heart at which site a surgical procedure is to be performed, the end effector being mounted on a robotically controlled arm;

bracing the beating heart with a brace member to at least reduce motion of the surgical site;

directing an image capture device at the surgical site to capture an image of the surgical site;

displaying the image of the surgical site on an image display operatively connected to the image capture device; and

compensating for motion of the surgical site to cause the image of the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device.

21. A method as claimed in claim 20, wherein the image capture device is mounted on a robotically controlled arm, compensating for motion of the surgical site to cause the image of the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device including:

computing tracking command signals in response to monitored motion of the surgical site; and

forwarding the tracking command signals to actuators operatively associated with the robotically controlled arm to cause the arm to move the image capture device generally to track motion of the surgical site.

22. A method as claimed in claim 20, wherein the image capture device is arranged to capture at least two images of the surgical site from two different vantage points, compensating for motion of the surgical site to cause the image of the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device including processing information related to the two images so as to cause the image of the surgical site displayed on the image display to be displayed as if the surgical site were generally stationary relative to the image capture device.

23. A method as claimed in claim 22, in which processing the information related to the two images includes transforming optical information related to the two images into digital information and processing the digital information so as to cause the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device.

24. A method as claimed in claim 22, in which monitoring motion of the surgical site includes the processing of the information related to the two images.

25. A method as claimed in claim 24, in which computing tracking command signals in response to monitored motion of the surgical site includes computing tracking command signals in the form of vectors derived from monitored information corresponding to the two images.

26. A method as claimed in claim 24, in which processing the two images includes defining a plurality of discrete locations on the surgical site and monitoring the motion of the discrete locations by means of information derived from the two images.

27. A method as claimed in claim 24, which includes securing markers on the surgical site at the discrete locations.

28. A method as claimed in claim 27, in which the markers are distinctively colored, monitoring the motion of the discrete locations then including monitoring motion of the distinctively colored markers.

29. A method as claimed in claim 20, in which the image capture device is in the form of a stereo endoscope, directing the image capture device at the surgical site then including passing a viewing end of the endoscope through a relatively small aperture in the chest region of the patient.

30. A method as claimed in claim 20, which includes analyzing information corresponding to monitored motion history of the surgical site to predict motion of the surgical site.

31. A method as claimed in claim 30, in which computing tracking command signals in response to monitored motion of the surgical site includes computing the tracking command signals from predicted motion of the surgical site.

32. A method as claimed in claim 30, in which predicting motion of the surgical site includes comparing the information corresponding to monitored motion of the surgical site with an ECG signal.

33. A robotically controlled surgical system for performing a surgical procedure on a beating heart of a patient body, the system comprising:

a robotically controlled arm;

a brace member operatively mounted on the robotically controlled arm, the brace member being arranged to brace, or stabilize, a beating heart so as at least to reduce motion of a surgical site on the beating heart, at which site a surgical procedure is to be performed;

at least one other robotically controlled arm;

a surgical end effector operatively mounted on the other robotically controlled arm, the surgical end effector being arranged to perform at least part of the surgical procedure on the surgical site;

at least one master control input device; and

a control system in which the robotically controlled arms, the brace member, the end effector and the master control input device are operatively connected, so as to enable movement of the robotically controlled arms, the brace member, and the end effector to be remotely controlled in response to input through the master control input device.

34. A robotically controlled surgical system as claimed in claim 33, wherein the end effector is mounted on an elongate shaft operatively connected to its associated robotically controlled arm so as to permit the end effector to be positioned at the surgical site by passing it through a relatively small aperture in the patient body.

35. A robotically controlled system as claimed in claim 34, wherein the brace member is mounted on an elongate shaft operatively connected to its associated robotically controlled arm so as to permit the brace member to be positioned at the surgical site by passing it through a relatively small aperture in the patient body.

36. A robotically controlled system as claimed in claim 35, wherein the brace member comprises at least two members moveable relative to each other between a collapsed condition, in which the brace member has a relatively small outermost lateral dimension, to permit it to be passed through the aperture, and a deployed condition, in which the brace member is arranged to brace the heart and in which it has a relatively large outermost lateral dimension.

37. A robotically controlled system as claimed in claim 35, wherein the robotically controlled arms are mounted on a common base.

38. A robotically controlled system as claimed in claim 37, wherein the base is defined on a mobile cart or trolley.

39. A robotically controlled system as claimed in claim 35, wherein the brace member defines at least one aperture through which air is to be displaced to cause the brace member to attach itself to the heart by suction.

40. A surgical system as claimed in claim 35, which comprises a pivotal connection between the brace member and the shaft and a drive system operatively associated with the brace member to enable the brace member to be moved about the pivotal connection and relative to the shaft by means of the drive system.

41. A surgical system as claimed in claim 40, wherein the drive system is operatively connected in the control system to enable the brace member to be moved about the pivotal connection in response to master control device input.

42. A surgical system as claimed in claim 40, further comprising a wrist assembly coupling the brace member to the shaft, the wrist assembly providing the brace member with first and second degrees of freedom of movement relative to the shaft.

43. A surgical system as claimed in claim 42, wherein the wrist assembly defines a first pivotal axis extending laterally relative to the shaft and a second pivotal axis extending laterally relative to the shaft and angularly relative the first pivotal axis.

44. A surgical system as claimed in claim 42, wherein the drive system comprises actuators and first and second drive elements moveable relative to the shaft by means of the actuators to cause movement of the brace member about the pivotal axes.

45. A surgical system as claimed in claim 42, in which the brace member defines a stabilizing surface arranged to engage the heart so as at least to reduce movement of the surgical site.

46. A surgical system as claimed in claim 34, which comprises an end effector pivotal connection between the end effector and the shaft and a drive system operatively associated with the end effector to enable the end effector to be moved about the pivotal connection and relative to the shaft by means of the drive system.

47. A surgical system as claimed in claim 46, wherein the drive system is operatively connected in the control system to enable the end effector to be moved about the pivotal connection in response to master control device input.

48. A surgical system as claimed in claim 47, further comprising an end effector wrist assembly coupling the end effector to the shaft, the wrist assembly providing the end effector with first and second degrees of freedom of movement relative to the shaft.

49. A surgical system as claimed in claim 48, wherein the end effector wrist assembly defines a first pivotal axis extending laterally relative to the shaft and a second pivotal axis extending laterally relative to the shaft and angularly relative to the first pivotal axis.

50. A surgical system as claimed in claim 49, wherein the drive system comprises actuators and first and second drive elements movable relative to the shaft by the actuators to cause movement of the end effector about the pivotal axes.

51. A robotically controlled surgical system for performing a surgical procedure on a beating heart of a patient body, the system comprising:

a robotically controlled arm;

a brace member operatively mounted on the robotically controlled arm, the brace member comprising two elongate members each defining a stabilizing surface arranged to engage the heart so as at least to reduce movement of a surgical site on the beating heart;

at least one other robotically controlled arm;

a surgical end effector operatively mounted on the other robotically controlled arm, the surgical end effector being arranged to perform at least part of the surgical procedure on the surgical site;

at least one master control input device;

a control system in which the robotically controlled arms, the brace member, the and effector and the master control input device are operatively connected, so as to enable movement of the robotically controlled arms, the brace member, and the end effector to be remotely controlled in response to input through the master control input device; and

a drive system operatively connected to the control system to enable the brace member to be moved in response to the master control device input, the drive system also being operatively associated with the elongate members to selectively spread the elongate members apart.

52. A surgical system as claimed in claim 51, wherein the stabilizing surfaces of the elongate members remain aligned when the drive system moves the elongate members relative to each other.

53. A surgical system as claimed in claim 52, further comprising a flexible element extending from one elongate member to the other elongate member, the flexible element being arranged to urge the members toward each other when the one member is moved away relative to the other member.

54. A surgical system as claimed in claim 52, wherein the elongate members each have an anchor formation on which an elongate flexible tension member is anchorable so as to enable tissue to be engaged by looping the tension member around the tissue to form a loop around the tissue, anchoring opposed portions of the tension member on the anchor formations and spreading the elongate members to cause the loop to tighten thereby to engage the tissue.

55. A surgical system as claimed in claim 54, wherein the elongate members each have at least two spaced-apart anchor formations on which elongate flexible tension members are anchorable to enable tissue to be engaged at opposed positions by looping the tension members around the tissue to form spaced loops around the tissue, anchoring opposed portions of the tension members on the anchor formations and spreading the elongate members apart to cause the loops to tighten thereby to engage the tissue at the opposed positions.

56. A surgical system as claimed in claim 54 or 55, wherein each anchor formation comprises a channel, or slit, in which the flexible member or members are receivable.

57. A surgical system as claimed in claims 54 or 55, wherein the anchor formations stand proud of the elongate members at positions opposed from the tissue engaging surfaces.

58. A surgical system as claimed in claim 51, wherein the elongate members are displaceable relative to each other between a collapsed condition, in which the elongate members overlap each other, and a deployed condition, in which the elongate members are spread apart relative to each other.

59. A surgical system as claimed in claim 58, wherein each elongate member is in the form of an elongate flat finger.

60. A surgical system as claimed in claim 59, wherein each finger has at least one bend.

61. A robotically controlled surgical system for performing a surgical procedure on a beating heart of a patient body, the system comprising:

a robotically controlled arm;

a brace member operatively mounted on the robotically controlled arm, the brace member being arranged to brace, or stabilize, a beating heart so as at least to reduce motion of a surgical site on the beating heart, at which site a surgical procedure is to be performed;

at least one other robotically controlled arm;

a surgical end effector operatively mounted on the other robotically controlled arm, the surgical end effector being arranged to perform at least part of the surgical procedure on the surgical site;

at least one master control input device;

a control system in which the robotically controlled arms, the brace member, the end effector and the master control input device are operatively connected, so as to enable movement of the robotically controlled arms, the brace member, and the end effector to be remotely controlled in response to input through the master control input device; and

an image capture device for capturing an image of the surgical site and remote display for displaying the captured image at a position outside the patient body.

62. A surgical system as claimed in claim 61, wherein the image capture device comprises an elongate shaft having a surgical site viewing end, the shaft being insertable into the patient body through a relatively small aperture so as to introduce the object viewing end to the surgical site thereby to enable an image of the surgical site to be captured.

63. A surgical system as claimed in claim 62, wherein the image capture device is arranged to capture a stereo image of the surgical site.

64. A surgical system as claimed in claim 63, which further comprises monitoring means for monitoring reduced motion of the surgical site, and computing means for computing end effector tracking command signals in response to the monitored reduced motion of the surgical site.

65. A surgical system as claimed in claim 64, in which the monitoring means comprises a motion detector arranged to contact the surgical site and to move in sympathy with the surgical site thereby to monitor movement of the surgical site.

66. A surgical system as claimed in claim 64, in which the monitoring means comprises an image processor for monitoring motion of at least one target marker secured on the surgical site so as to monitor movement of the target marker thereby to monitor motion of the surgical site.

67. A surgical system as claimed in claim 66, further comprising computing means arranged to compute a computed motion derived from the motion of a plurality of target markers secured on the surgical site.

68. A surgical system as claimed in claim 67, in which the image processing means is arranged to compensate for reduced motion of the surgical site thereby to cause the image of the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device.

69. A surgical system as claimed in claim 67, further comprising an image capture device robotically controlled arm the image capture device being mounted on the image capture device robotically controlled arm, and in which the computing means is arranged to compute image capture device tracking command signals to be forwarded to the image capture device robotically controlled arm to cause the image capture device robotically controlled arm to move the image capture device generally to track motion of the surgical site.

70. A method of performing a surgical procedure on a beating heart of a patient, the method including:

positioning an end effector in close proximity to a surgical site on the heart at which site a surgical procedure is to be performed, the end effector being mounted on a robotically controlled arm;

bracing the beating heart with a brace member to at least reduce motion of the surgical site;

inputting an end effector movement command signal;

forwarding the end effector movement command signal to actuators operatively associated with the robotically controlled arm to cause the end effector to move relative to the surgical site so as to perform at least part of the surgical procedure at the surgical site;

monitoring the reduced motion of the surgical site;

computing end effector tracking command signals in response to the reduced monitored motion of the surgical site;

forwarding the tracking command signals to the actuators to cause the arm to move the end effector generally to track motion of the surgical site; and

analyzing information corresponding to monitored motion history of the surgical site to predict motion of the surgical site.

71. A method as claimed in claim 70, in which computing tracking command signals in response to monitored motion of the surgical site includes computing the tracking command signals from predicted motion of the surgical site.

72. A method as claimed in claim 70, in which predicting motion of the surgical site includes comparing the information corresponding to monitored motion of the surgical site with an ECG signal.

73. A method of performing a surgical procedure on a beating heart of a patient, the method including:

positioning an end effector in close proximity to a surgical site on the heart at which site a surgical procedure is to be performed, the end effector being mounted on a robotically controlled arm;

bracing the beating heart with a brace member to at least reduce motion of the surgical site;

inputting an end effector movement command signal;

forwarding the end effector movement command signal to actuators operatively associated with the robotically controlled arm to cause the end effector to move relative to the surgical site so as to perform at least part of the surgical procedure at the surgical site;

monitoring the reduced motion of the surgical site;

computing end effector tracking command signals in response to the reduced monitored motion of the surgical site;

forwarding the tracking command signals to the actuators to cause the arm to move the end effector generally to track motion of the surgical site;

directing an image capture device at the surgical site to capture an image of the surgical site;

displaying the image of the surgical site on an image display operatively connected to the image capture device;

compensating for motion of the surgical site to cause the image of the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device; and

analyzing information corresponding to monitored motion history of the surgical site to predict motion of the surgical site.

74. A method as claimed in claim 73, in which computing tracking command signals in response to monitored motion of the surgical site includes computing the tracking command signals from predicted motion of the surgical site.

75. A method as claimed in claim 73, in which predicting motion of the surgical site includes comparing the information corresponding to monitored motion of the surgical site with an ECG signal.