Surgical instrument

• US 7,169,141 B2
• Filed: 11/16/2001
• Issued: 01/30/2007
• Est. Priority Date: 02/24/1998
• Status: Expired due to Fees

• Current Assignee: Auris Health, Inc. (Johnson & Johnson)
• Original Assignee: Hansen Medical Incorporated (Johnson & Johnson)
• Inventors: Brock, David L., Lee, Woojin
• Primary Examiner(s): Philogene; Pedro
• Application Number:
  US10/012,845
• Publication Number:
  US 20020128633A1
• Time in Patent Office: 1,901 Days
• Field of Search: 608/1, 608/1.3, 608/705, 744/900.1, 744/900.4, 744/900.5, 744/900.6, 403/316, 403/349, 604/905
• 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 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 17/0483 Hand-held instruments for holding sutures A61B17/0469 takes precedence; other holders for needles or sutures A61B17/06061; surgical forceps A61B17/28; surgical pincettes A61B17/30
• CPC Class Codes: A61B 17/0487 Suture clamps, clips or locks, e.g. for replacing suture knots; Instruments for applying or removing suture clamps, clips or locks suture anchors A61B17/0401; wound clamps or clips A61B17/08; ligaturing clamps or clips A61B17/122
• CPC Class Codes: A61B 17/0644 penetrating the tissue, deformable to closed position
• CPC Class Codes: A61B 17/0682 for applying U-shaped staples or clamps, e.g. without a forming anvil
• CPC Class Codes: A61B 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/3421 Cannulas
• CPC Class Codes: A61B 17/3462 with means for changing the diameter or the orientation of the entrance port of the cannula, e.g. for use with different-sized instruments, reduction ports, adapter seals expandable cannulas A61B17/3417
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00088 using thermistors
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/003 Steerable
• CPC Class Codes: A61B 2017/00331 with preformed bends
• CPC Class Codes: A61B 2017/00477 Coupling A61B2017/0046 takes precedence
• CPC Class Codes: A61B 2017/00876 magnetic
• CPC Class Codes: A61B 2017/00986 Malecots, e.g. slotted tubes, of which the distal end is pulled to deflect side struts
• CPC Class Codes: A61B 2017/0409 Instruments for applying suture anchors for applying suture clamps, clips or locks A61B2017/0488
• CPC Class Codes: A61B 2017/0414 having a suture-receiving opening, e.g. lateral opening lateral eyelet for attaching suture to needle A61B2017/06019
• CPC Class Codes: A61B 2017/0437 the barbs being resilient or spring-like
• CPC Class Codes: A61B 2017/0464 : for soft tissue
• CPC Class Codes: A61B 2017/0645 : being elastically deformed for insertion
• CPC Class Codes: A61B 2017/0648 : threaded, e.g. tacks with a screw thread
• CPC Class Codes: A61B 2017/22069 : Immobilising; Stabilising
• CPC Class Codes: A61B 2017/2927 : the angular position of the head being adjustable with respect to the shaft
• CPC Class Codes: A61B 2017/2939 : Details of linkages or pivot points
• CPC Class Codes: A61B 2034/2051 : Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2059 : Mechanical position encoders
• 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 2034/305 : Details of wrist mechanisms at distal ends of robotic arms
• CPC Class Codes: A61B 2034/715 : Cable tensioning mechanisms for removing slack
• CPC Class Codes: A61B 2034/742 : Joysticks
• CPC Class Codes: A61B 2034/744 : Mouse
• CPC Class Codes: A61B 2090/365 : augmented reality, i.e. correlating a live optical image with another image
• CPC Class Codes: A61B 2090/378 : using ultrasound
• CPC Class Codes: A61B 2090/506 : using a parallelogram linkage, e.g. panthograph
• CPC Class Codes: A61B 34/10 : Computer-aided planning, simulation or modelling of surgical operations
• 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 34/35 : 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 34/72 : Micromanipulators
• CPC Class Codes: A61B 34/77 : Manipulators with motion or force scaling
• CPC Class Codes: A61B 5/0084 : for introduction into the body, e.g. by catheters A61B5/1459 takes precedence
• CPC Class Codes: A61B 5/015 : By temperature mapping of body part
• CPC Class Codes: A61B 5/4893 : Nerves
• CPC Class Codes: A61B 90/36 : Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: A61B 90/361 : Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61F 2/2445 : Annuloplasty rings in direct contact with the valve annulus
• CPC Class Codes: A61F 2/2466 : Delivery devices therefor
• 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

Abstract

A robotic surgery apparatus comprising: a surgical instrument for use at an internal operative site of a subject; a mechanically drivable mounting unit on which the surgical instrument is mounted, the mounting unit being drivably movable outside the operative site of the subject; an electrically driven drive unit for driving movement of the mounting unit; mechanical cabling drivably intercoupled to the mounting unit at one end of the cabling; the mechanical cabling having another end which is readily drivably couplable to and decouplable from the drive unit. The drive unit being readily manually portable and readily attachable to and detachable from a fixed support on or relative to which the subject is mounted.

Claims

1. A medical procedure instrument comprising:

a medical implement including a mechanically drivable mechanism coupled with a tool used in executing a medical procedure;

a drive unit for mechanically driving said medical implement; and

said medical implement being decouplable from said drive unit and manually insertable into a patient so as to dispose said tool at an operative site within the patient;

and said medical implement being attachable and detachable with said drive unit for coupling and decoupling said drive unit to said mechanically drivable mechanism;

said medical implement further comprising an elongated guide and an elongated instrument shaft that supports said tool at a distal end thereof and said mechanically drivable mechanism at the proximal end thereof;

said elongated guide member for removably receiving said elongated instrument so that a distal end of said elongated guide member is adapted, upon insertion into the patient, to be positioned at the operative site.

2. The medical procedure instrument of claim 1 wherein said instrument shaft includes a stem section with said tool at its distal end and said tool extends beyond the distal end of said elongated guide member at the operative site when received within said guide member.

3. The medical procedure instrument of claim 2 wherein said mechanically drivable mechanism, stem section and tool is an integral disposable unit.

4. The medical procedure instrument of claim 1 wherein said drive unit comprises an electromechanical unit.

5. The medical procedure instrument of claim 1 including mechanically cabling that intercouples said drive unit and said mechanically drivable mechanism.

6. The medical procedure instrument of claim 5 including an interface between said mechanical cabling and said drive unit to couple and decouple said mechanical cabling with said drive unit.

7. The medical procedure instrument of claim 1 wherein said elongated instrument shaft includes a bendable section, and wherein said drive unit is configured for manipulating said bendable section.

8. The medical procedure instrument of claim 5 wherein said mechanical cabling includes first cabling coupled to said elongated guide member for controlling motion thereof, and second cabling coupled to said instrument shaft for controlling motion thereof.

9. The medical procedure instrument of claim 1 wherein said drive unit is drivably interconnected to said elongated guide member.

10. The medical procedure instrument of claim 9 wherein said elongated guide member includes a first drive interface drivably interconnected to said drive unit and said mechanically drivable mechanism includes a second drive interface, said first and second drive interfaces being engageable with and disengageable from each other.

11. The medical procedure instrument of claim 1 wherein said elongated instrument shaft includes a flexible section, and wherein said drive unit is configured for manipulating said flexible section.

12. The medical procedure instrument of claim 1 wherein said elongated guide member has its distal end maintained at the operative site even upon withdrawal of said instrument shaft away from the operative site.

13. The medical procedure instrument of claim 1 wherein an adjacent portion of said mechanically drivable mechanism and said tool is an integral disposable unit.

14. The medical procedure instrument of claim 1 wherein said drive unit is adapted to receive remote commands from a manually controllable device and drive said medical implement in accordance with the remote commands.

15. The medical procedure instrument of claim 14 wherein said manually controllable device is electrically interconnected to said drive unit through a electrical drive control element.

16. A slave station of a robotic surgery system in which manipulations by a surgeon control motion of a surgical instrument at the slave station, said slave station comprising:

a manually portable support for holding the surgical instrument at a position over an operating table so that the instrument may be disposed at an operative site;

mechanical cabling coupled to said instrument for controlling movement of said surgical instrument;

a plurality of remotely-disposed motors controlled, by way of a computer interface, and by surgeon manipulations for driving said mechanical cabling;

said mechanical cabling being driven by said plurality of motors in a manner to be attachable to and detachable therefrom;

an attachable and detachable two-section housing, one housing section accommodating the ends of said mechanical cabling, and another housing section accommodating said plurality of motors; and

a plurality of coupler spindles by said one housing section, each coupler spindler receiving a cable of the mechanical cabling.

17. The slave station of claim 16 wherein said plurality of motors and said plurality of coupler spindles are disposed in aligned arrays.

18. The slave station of claim 17 including a plurality of coupler disks, one associated with and supported by each motor of said plurality of motors.

19. The slave station of claim 18 wherein said housing sections support said coupler spindles and said coupler disks in aligned engagement.

20. The slave station of claim 19 including a securing member holding said housing sections together and said coupler spindles and disks in engagement.

21. The slave station of claim 20 wherein said coupler spindles are of different diameters.

22. The slave station of claim 21 wherein the diameters of said coupler spindles progressively increase from one end of said array to the other.

23. The slave station of claim 20 wherein said securing member comprises a pair of screws holding said housing sections together.

24. The slave station of claim 18 wherein said coupler spindles and coupler disks each have an engagement element to lock said coupler spindles and disks against relative rotation.

25. The slave station of claim 24 including a conduit stop at one end of said coupler spindles array for receiving in slots thereof cables of said mechanical cabling.

26. The slave station of claim 25 wherein one of said cables wraps about and is fixed onto each coupler spindle.

27. The slave station of claim 26 wherein the said housing sections are separable to render said surgical instrument portable and are engageable to couple said plurality of motors to said surgical instrument.

28. A robotic surgery system comprising:

a mechanically driven surgical instrument;

a fixed position support for holding said instrument from a fixed position directly over an operating table so that said instrument may be disposed at an operative site in a patient for remote control thereof via a computer interface from a manually operated input device;

mechanical cabling drivably coupled to said instrument for controlling movement or operation of said instrument;

an array of stationary electrically driven actuators controlled by way of said computer interface from the input device for driving said mechanical cabling; and

an engagement member coupling said mechanical cabling to said array of actuators so that said mechanical cabling is attachable and detachable from said array of actuators;

said engagement member comprising separate sections that are engageable for attaching the mechanical cabling with the actuators and disengageable for detaching the mechanical cabling from the actuators.

29. The system of claim 28 wherein said fixed position support comprises a rigid support post adapted to be mounted to an operating table.

30. The system of claim 29 wherein said rigid support post has a verticle arm adapted to be mounted to the operating table, and a horizontal arm which the instrument is adapted to be mounted.

31. The system of claim 28 further comprising an attachment member mounted to an operating table, wherein said rigid fixed position support is adapted to be mounted to said attachment member.

32. The system of claim 31 wherein said rigid fixed position support is adapted to be mounted to said attachment member, such that said rigid fixed position support can be adjusted along said table.

33. A robotic surgery apparatus comprising:

a mechanically drivable surgical instrument for use at an internal operative site of a subject;

an electrically driven drive unit for driving said surgical instrument and disposed at a location remote from said surgical instrument; and

mechanical cabling having one end readily drivably couplable to and decouplable from said surgical instrument;

said mechanical cabling having another end readily drivably couplable to and decouplable from said drive unit;

wherein said drive unit is manually portable and readily attachable to and detachable from a fixed support on which the subject is positioned.

34. The apparatus of claim 33 wherein said drive unit is disposed at a location remote from the operative site of the subject and below a plane of said fixed support on which the subject is positioned.

35. The apparatus of claim 34 wherein said drive unit is adapted for being remotely controlled by a computer from a manually operated input device.

36. The apparatus of claim 33 wherein said surgical instrument includes one or more mechanically drivable components driven by said mechanical cabling.

37. The system of claim 33 wherein said surgical instrument is an elongated surgical instrument having a proximal end, and wherein said one end of said mechanical cabling is is readily drivably couplable to said proximal end of said surgical instrument.

38. A robotic surgery apparatus comprising:

a surgical instrument for use at an internal operative site of a subject;

a mechanically drivable mounting unit on which said surgical instrument is mounted, said mounting unit being drivably movable outside the operative site of the subject; and

an electrically driven drive unit for driving movement of said mounting unit;

mechanical cabling having one end drivably coupled to said mounting unit.

said mechanical cabling having another end readily drivably couplable to and decouplable from said drive unit via an engageable interface;

wherein said drive unit is manually portable and readily attachable to and detachable from a fixed support upon which the subject rests;

wherein said drive unit is remotely controlled by a computer from a manually operated input device.

39. The apparatus of claim 38 wherein said drive unit is disposed at a location remote from the operative site of the subject.

40. The apparatus of claim 38 wherein said mechanically drivable mounting unit includes a carriage on which said surgical instrument is mounted, and at least one rail on which said carriage slides.

41. The apparatus of claim 38 wherein said one end of said mechanical cabling is readily drivably couplable to and decouplable from said mounting unit.

42. A robotic surgery apparatus comprising:

a mechanically drivable surgical instrument for use at an internal operative site of a subject;

an electrically driven drive unit for driving said surgical instrument;

mechanical cabling drivably coupled to said surgical instrument at one end of said cabling;

said drive unit being readily manually portable and readily attachable to and detachable from a fixed support on or relative to which the subject is positioned.

43. The apparatus of claim 42 wherein said drive unit is disposed at a location remote from the operative site of the subject.

44. The apparatus of claim 42 wherein said drive unit is remotely controlled by a computer, said fixed support comprises comprises an operating table and said drive unit is disposed below a plane defined by the top of said operating table.

45. The apparatus of claim 42 further comprising a fixed position support for holding said surgical instrument from a fixed position directly over an operating table so that said instrument may be disposed at an operative site in a patient.

46. The apparatus of claim 45 wherein said fixed position support is readily attachable to and detachable from said fixed support.

47. The apparatus of claim 42 wherein said fixed support is adapted to be mounted to said fixed support, such that said drive unit can be adjusted along said fixed support.

48. A medical procedure instrument comprising:

a medical implement including an instrument shaft having a mechanically drivable mechanism coupled with a tool used in executing a medical procedure;

a guide member for removeably receiving therethrough said instrument shaft;

said instrument shaft being manually insertable into a patient through said guide member so as to dispose said tool at an operative site within the patient,

said guide member being drivably movable outside the operative site of the patient; and

a drive unit, for mechanically driving said guide member,

the distal end of said guide member, upon insertion into the patient, being disposed at the operative site and maintained at the operative site even upon withdrawal of said instrument shaft away from the operative site.

49. The instrument of claim 48 wherein said drive unit is adapted to be maintained in a stationary position relative to said medical implement even as said medical implement is actuated.

50. The instrument of claim 48 wherein said guide member comprises a tubular member for receiving said medical implement.

51. The instrument of claim 50 wherein said tubular member is curved and rotatable when mechanically driven by said drive unit.

52. The instrument of claim 48 wherein said guide member is fixedly supported at a location over the patient.

53. The instrument of claim 52 further comprising a fixed position support bracket for holding said guide member.

54. The instrument of claim 48 further comprising at least one tendon coupled between said drive unit and said medical implement for controlling at least one degree of freedom of said medical implement.

55. The instrument of claim 54 further comprising an engagement member intercoupling said cable and said drive unit so that said cable is readily attachable to and detachable from said drive unit.

56. The instrument of claim 48 wherein said guide member comprises an adaptor that is controlled for movement in a single plane.

57. The instrument of claim 48 wherein said guide member is rigid, and said instrument shaft is flexible.

58. The instrument of claim 48 wherein said instrument shaft carries a plurality of components for providing said tool with multiple degrees-of-freedom.

59. A medical procedure instrument comprising:

a medical implement including an instrument shaft and a mechanically drivable mechanism coupled with a tool used in executing a medical procedure;

said medical implement being removably introduced through an elongated guide shaft into a patient so as to dispose said tool at an operative site within the patient;

a mechanically drivable mounting unit on which the medical implement is mounted, said mounting unit being drivable outside the operative site of the patient; and

a drive unit for mechanically driving said medical implement through said mechanically drivable mounting unit;

said drive unit being maintained in a stationary position relative to the medical implement even as said medical implement is actuated.

60. The instrument of claim 59 wherein said drive unit comprises a plurality of motors for controlling multiple degrees of motion of said medical implement, including degree of freedoms imparted directly to said medical implement and degrees of freedom imparted via said mounting unit to said medical implement.

61. The instrument of claim 60 wherein all motors associated with all degrees of freedom of said medical implement are maintained in a stationary position.

62. The instrument of claim 60 including a computation system for receiving electrical control signals received from a user input device for controlling said drive unit, and in turn, the multiple degrees of freedom of said medical implement, and wherein more than one motor of said plurality of motors is maintained in a stationary position and remote from said medical implement.

63. The instrument of claim 62 wherein a majority of said motors are maintained in a stationary position.

64. The instrument of claim 60 wherein at least one motor that controls a degree of freedom imparted directly to said medical implement is maintained in a stationary position.

65. The instrument of claim 59 wherein said guide shaft is rigid, and said medical implement is flexible.

66. The instrument of claim 59 wherein said medical implement carries a plurality of components for providing said tool with multiple deegrees-of-freedom.

67. A robotically controlled medical device comprising:

a medical instrument including an instrument shaft having a proximal end supporting a mechanically drivable mechanism, and a distal end supporting a tool for insertion into a subject to an operative site;

a guide member for removably receiving said instrument shaft so that said tool is, upon insertion into the patient, positioned at the operative site;

a drive unit coupled with said mechanically drivable mechanism and disposed outside of a sterile field, said drive unit capable of activating said medical instrument via said mechanically drivable mechanism for actuation of said tool and positioning of said tool at the operative site within the subject; and

a computation system for receiving electrical control signals receive from a user input device for controlling said drive unit, and in turn, said medical instrument.

68. The medical device of claim 67 further comprising a support for releasably holding said medical instrument at a predetermined position over the patient.

69. The medical device of claim 68 wherein said support comprises a bracket that is fixed in position relative to the patient at least during a medical procedure.

70. The medical device of claim 67 wherein said drive unit comprises a plurality of drive motors, all of which are disposed in a stationary position during a medical procedure performed by said tool.

71. The medical device of claim 67 wherein said guide member further comprises a receiver coupled to the drive unit for receiving said mechanically drivable mechanism.

72. The medical device of claim 71 wherein said receiver and said mechanically drivable mechanism are engageable and disengageable from each other.

73. The medical device of claim 72 wherein said receiver is readily attachable and detachable with said drive unit, and said receiver is readily portable when detached.

74. The medical device of claim 67 wherein said mechanically drivable mechanism together with said tool are constructed and arranged as a single piece disposable unit.

75. The medical device of claim 67 wherein said drive unit is capable of actuating a flexible segment of said instrument shaft to provide a bending thereat, controlled from said user input device.

76. A method of remotely controlling a medical instrument, comprising:

providing an instrument shaft having a distal end supporting a tool, and a proximal end supporting a mechanically drivable mechanism for controlling disposition of the tool at a target site in a patient;

removably inserting the instrument shaft into a subject through a guide member so as to dispose the tool at the target site;

mechanically controlling the tool, via a drive unit, and from an user input device;

activating from the user input device at least one flexible segment associated with a distal end of the instrument shaft by operating the drive unit from a location that is separate from the instrument shaft, so as to thereby bend the distal end of the instrument shaft to effect positioning of the tool at the target site.

77. The method of claim 76 wherein said guide member is rigid, and said instrument shaft is flexible.

78. The method of claim 76 wherein said instrument shaft carries a plurality of components, the method further comprising operating the plurality of components to move the tool in multiple deegrees-of-freedom.

79. A robotically controlled medical instrument comprising:

a medical implement including a mechanically drivable mechanism coupled with a tool used in performing a medical procedure at an internal target site of a subject;

a receiver for the medical implement to hold said medical implement in position;

a drive unit for mechanically driving said medical implement via mechanical cabling, and controlled from a remote location via a user input device;

said medical implement being manually insertable into the subject so as to dispose said tool at the target site;

a first interface for releasably intercoupling said medical implement with said receiver; and

a second interface for releasably intercoupling said medical implement and said receiver with said drive unit.

80. The medical instrument of claim 79 wherein said first interface comprises respective interlockable element of said receiver and said medical implement.

81. The medical instrument of claim 79 including at least one mechanical cable extending between said receiver and said drive unit for transferring mechanical action from said drive unit to said receiver.

82. The medical instrument of claim 81 wherein said second interface comprises an engageable member releasably connecting said at least one cable with said drive unit.

83. The medical instrument of claim 79 wherein said receiver is adapted to removably hold said medical implement.