DIRECT DRIVE METHODS

• US 20080188871A1
• Filed: 11/28/2007
• Published: 08/07/2008
• Est. Priority Date: 12/01/2006
• Status: Active Grant

• Current Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Original Assignee: Boston Scientific Scimed (Boston Scientific Corporation)
• Inventors: Weitzner, Barry, Smith, Paul J.
• Granted Patent: US 9,421,071 B2
• Time in Patent Office: Days
• US Class Current: 606/139
• CPC Class Codes: A61B 1/00042 for mechanical operation
• CPC Class Codes: A61B 1/00087 Tools A61B17/00234 takes precedence
• CPC Class Codes: A61B 1/0014 Fastening element for attaching accessories to the outside of an endoscope, e.g. clips, clamps or bands
• CPC Class Codes: A61B 1/00147 Holding or positioning arrangements
• CPC Class Codes: A61B 1/00154 using guiding arrangements for insertion
• CPC Class Codes: A61B 1/00165 with light-conductive means, e.g. fibre optics A61B1/07 takes precedence
• CPC Class Codes: A61B 1/00183 for variable viewing angles
• CPC Class Codes: A61B 1/0052 Constructional details of control elements, e.g. handles
• CPC Class Codes: A61B 1/0057 Constructional details of force transmission elements, e.g. control wires
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 1/12 with cooling or rinsing arrangements
• CPC Class Codes: A61B 1/3132 for laparoscopy
• 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 17/0218 for minimally invasive surgery A61B17/0281, 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 17/29 Forceps for use in minimally invasive surgery
• CPC Class Codes: A61B 17/320016 Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes A61B10/0233, A61B17/29, A61B17/3207 take precedence
• CPC Class Codes: A61B 2017/00212 using remote controls
• CPC Class Codes: A61B 2017/00287 Bags for minimally invasive surgery
• CPC Class Codes: A61B 2017/003 : Steerable
• CPC Class Codes: A61B 2017/00314 : Separate linked members
• CPC Class Codes: A61B 2017/00323 : Cables or rods
• CPC Class Codes: A61B 2017/00331 : with preformed bends
• CPC Class Codes: A61B 2017/0034 : adapted to be inserted through a working channel of an endoscope
• CPC Class Codes: A61B 2017/00353 : one mechanical instrument performing multiple functions, e.g. cutting and grasping channel for multiple instruments A61B2017/3445; instrument channel A61B2017/22072; replaceable heads A61B2017/2931; suction A61M1/00
• CPC Class Codes: A61B 2017/00362 : Packages or dispensers for MIS instruments A61B2017/0479 takes precedence
• CPC Class Codes: A61B 2017/00371 : Multiple actuation, e.g. pushing of two buttons, or two working tips becoming operational
• CPC Class Codes: A61B 2017/00398 : using powered actuators, e.g. stepper motors, solenoids
• CPC Class Codes: A61B 2017/00469 : for insertion of instruments, e.g. guide wire, optical fibre
• CPC Class Codes: A61B 2017/00876 : magnetic
• CPC Class Codes: A61B 2017/00973 : pedal-operated
• CPC Class Codes: A61B 2017/2905 : flexible
• CPC Class Codes: A61B 2017/2906 : Multiple forceps
• CPC Class Codes: A61B 2017/2931 : with releasable head
• CPC Class Codes: A61B 2017/3445 : used as instrument channel for multiple instruments catheters A61B2017/22072
• CPC Class Codes: A61B 2017/3447 : Linked multiple cannulas
• CPC Class Codes: A61B 2090/0811 : for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
• CPC Class Codes: A61B 2090/374 : NMR or MRI
• CPC Class Codes: A61B 34/10 : Computer-aided planning, simulation or modelling of surgical operations
• 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 34/74 : Manipulators with manual electric input means
• CPC Class Codes: A61B 90/11 : with guides for needles or instruments, e.g. arcuate slides or ball joints

Abstract

Described herein are various method of using a direct drive system to perform procedures at a distance. One exemplary method include tying a knot or suturing at a distance with a first and second end effector. The direct drive system can enable sufficient end effector dexterity, including the ability to control various degrees of freedom of end effector movement, and allow a user to perform complicated task at a distance. In one aspect the direct drive system includes flexible tools that permit access to surgical site via a natural orifice.

Claims

1. A method of knot tying at a distance, the method comprising the steps of:

providing a direct drive system including;

a first tool including a first distal end effector and a first proximal controller, the first distal end effector and first proximal controller connected via a first elongate, flexible body configured to transmit inputs from the first controller to the first end effector, wherein the first controller can direct at least two degrees of freedom with respect to the distal end effector;

a second tool including a second distal end effector and a second proximal controller, the second distal end effector and second proximal controller connected via a second elongate, flexible body configured to transmit inputs from the second controller to the second end effector, wherein the controller can direct at least two degrees of freedom with respect to the second distal end effector; and

a frame, the first and second tools movably mated with the frame to provide each of the first and second tools two degrees of freedom with respect to the frame;

grasping a suture filament with the first distal end effector;

wrapping or twisting the suture filament around the second distal end effector to create a loop of suture around the second distal end effector, wherein the step of wrapping is performed by moving the first and/or second distal end effector relative the other of the first and/or second distal end effector;

grasping the suture filament with the second distal end effector; and

pulling the suture grasped by the second distal end effector through the loop formed around the second distal end effector.

2. The method of claim 1, further comprising wrapping the suture filament around the first distal end effector to create a second loop, grasping the suture filament with the first distal end effector;

and pulling the suture through the second loop.

3. The method of claim 1, wherein at least one of the first and second distal end effectors is a forceps.

4. The method of claim 1, wherein at least one of the first and second distal end effectors is a needle driver.

5. The method of claim 1, wherein the step of wrapping includes moving the first and second distal end effectors with respect to one another.

6. The method of claim 5, wherein moving the first and second distal end effectors with respect to one another includes articulation of said second distal end.

7. The method of claim 1, further comprising the step of extending the first and second tools through a natural orifice prior the steps of grasping and wrapping a suture.

8. The method of claim 1, further comprising grasping the suture filament at first and second locations and pulling in opposite directions to tension a knot.

9. A method of knot tying at a distance, the method comprising the steps of:

providing a direct drive system including first and second flexible elongate tools, the first and second tools including first and second proximal controllers and first and second end effectors, wherein the first and second tools allow a single user to control at least six degrees of freedom of the end effectors via the proximal controllers;

inserting the first and second tools through a natural orifice;

movably mating the first and second controllers with a frame;

manipulating the first and/or second proximal controller to form a loop of suture;

grasping the suture filament with the first end effector; and

pulling the suture filament through the loop.

10. The method of claim 9, further comprising creating a second loop of suture, grasping the suture filament with the second end effector, and pulling the suture filament through the second loop.

11. The method of claim 9, wherein the first and second tools allow a single user to control at least eight degrees of freedom of the end effectors via the proximal controllers.

12. A method of directing distal end effectors at a distance, the method comprising the steps of:

providing a direct drive system including first and second flexible elongate tools, the first and second tools including first and second proximal controllers and first and second end effectors, wherein the first and second tools allow a single user to control at least eight degrees of freedom of the end effectors via the proximal controllers;

inserting the first and second tools through a natural orifice;

manipulating the first proximal controller to grasp a suture filament with the first end effector;

looping the suture filament, wherein the looping step include manipulating the second proximal controller to independently control at least four degrees of freedom of the second end effector with respect to the first end effector while the first end effector grasps the suture filament; and

manipulating the first and second controllers to pull a portion of the filament through the looped suture filament.