Búsqueda Imágenes Maps Play YouTube Noticias Gmail Drive Más »
Iniciar sesión
Usuarios de lectores de pantalla: deben hacer clic en este enlace para utilizar el modo de accesibilidad. Este modo tiene las mismas funciones esenciales pero funciona mejor con el lector.

Patentes

  1. Búsqueda avanzada de patentes
Número de publicaciónUS20040176751 A1
Tipo de publicaciónSolicitud
Número de solicitudUS 10/639,785
Fecha de publicación9 Sep 2004
Fecha de presentación12 Ago 2003
Fecha de prioridad14 Ago 2002
También publicado comoUS7959557, US8671950, US20070232855, US20070238924, US20070239178, US20070239186, US20070250072, US20070250097, US20080177281
Número de publicación10639785, 639785, US 2004/0176751 A1, US 2004/176751 A1, US 20040176751 A1, US 20040176751A1, US 2004176751 A1, US 2004176751A1, US-A1-20040176751, US-A1-2004176751, US2004/0176751A1, US2004/176751A1, US20040176751 A1, US20040176751A1, US2004176751 A1, US2004176751A1
InventoresBarry Weitzner, Gary Rogers, Albert Solbjor, Dwight Meglan, Robert Ailinger, David Brock, Woojin Lee, David Driscoll
Cesionario originalEndovia Medical, Inc.
Exportar citaBiBTeX, EndNote, RefMan
Enlaces externos: USPTO, Cesión de USPTO, Espacenet
Robotic medical instrument system
US 20040176751 A1
Resumen
A robotic medical apparatus for performing a medical procedure or application on an anatomy, said apparatus comprising: a first medical instrument member having a working end adapted to be disposed at an internal target area at which the medical procedure or application is to be performed; and a second medical instrument member having a working end adapted to be disposed at an internal target area at which the medical procedure or application is to be performed. The first medical instrument member is disposed so as to extend into the anatomy at a first ingress location and passing intraluminally; and the second medical instrument member is disposed so as to extend into the anatomy at a second ingress location different than said first ingress location and passing extraluminally. A controller is provided for receiving remotely generated control commands for respectively controlling the motion of said first and second medical instrument members so that said first and second medical instrument members are separately and controllably operable to perform the medical procedure or application.
Imágenes(20)
Previous page
Next page
Reclamaciones(41)
What is claimed is:
1. A robotic medical apparatus for performing a medical procedure or application on an anatomy, said apparatus comprising:
a first medical instrument member having a working end adapted to be disposed at an internal target area at which the medical procedure or application is to be performed;
a second medical instrument member having a working end adapted to be disposed at an internal target area at which the medical procedure or application is to be performed;
said first medical instrument member disposed so as to extend into the anatomy at a first ingress location and passing intraluminally;
said second medical instrument member disposed so as to extend into the anatomy at a second ingress location different than said first ingress location and passing extraluminally; and
a controller for receiving remotely generated control commands for respectively controlling the motion of said first and second medical instrument members so that said first and second medical instrument members are separately and controllably operable to perform the medical procedure or application.
2. The robotic medical apparatus of claim 1 wherein said first and second medical instrument members are separately and controllably operable, in unison, to perform the medical procedure or application.
3. The robotic medical apparatus of claim 1 wherein said first medical instrument member comprises a rigid shaft instrument, and said second medical instrument member comprises a flexible shaft instrument.
4. The robotic medical apparatus of forth in claim 3 wherein said first medical instrument member extends into the anatomy at the first ingress location defined by a small incision.
5. The robotic medical apparatus of claim 4 wherein said second medical instrument member extends into the anatomy at the second ingress location defined by a percutaneous or surgical access, or by introduction through a natural orifice.
6. The robotic medical apparatus of claim 1 wherein said first medical instrument member comprises a rigid shaft instrument, and said second medical instrument member comprises a flexible shaft instrument, said flexible shaft instrument adapted to extend intralumenally through an anatomic vessel, or the like.
7. The robotic medical apparatus of claim 6 wherein said rigid shaft instrument is adapted to extend extralumenally about the anatomic vessel.
8. The robotic medical apparatus of claim 1 wherein both said first and second medical instruments are flexible shaft instruments.
9. The robotic medical apparatus of claim 1 wherein both said first and second medical instruments are rigid shaft instruments.
10. The robotic medical apparatus of claim 1 wherein said first medical instrument member is rigid entering the anatomy laparoscopically, while the second medical instrument member is flexible and meant to enter a body lumen such as through a natural body orifice or percutaneously.
11. The robotic medical apparatus of claim 1 wherein the working end of each instrument member is at its distal end and includes a tool for performing the medical procedure or application.
12. The robotic medical apparatus of claim 11 wherein said tool is for sewing.
13. The robotic medical apparatus of claim 11 wherein said tool is for suturing.
14. The robotic medical apparatus of claim 11 wherein said tool is for grasping.
15. The robotic medical apparatus of claim 11 wherein said tool is for applying clips, staples, or clamps.
16. The robotic medical apparatus of claim 1 including separate input devices communicating with the controller.
17. The robotic medical apparatus of claim 16 wherein the input devices issue the control commands for respectively controlling the motion of said first and second medical instrument members, and are disposed at a master control station remote from said instrument members.
18. A robotic medical apparatus for performing a securing procedure, at an internal body site, said apparatus comprising:
a medical instrument member having a working end adapted to be disposed at the internal body site at which the securing procedure is to be performed;
and a controller for receiving a remotely generated control command for controlling the motion of said medical instrument member to perform the securing procedure;
said medical instrument member including, at a distal section thereof, a securing tool having one and another ends adapted to be disposed at opposite sides of a tissue that is to be secured; and
at least one of said tool ends adapted to hold a securing member for securing said tissue.
19. The robotic medical apparatus of claim 18 wherein said medical instrument member includes an instrument shaft.
20. The robotic medical apparatus of claim 19 including a controllably bendable section along said instrument shaft for directing the position of said tool.
21. The robotic medical apparatus of claim 20 including a remote input device controlled by an operator, and coupled by way of said controller to remotely control said bendable section.
22. The robotic medical apparatus of claim 19 wherein said instrument shaft is rigid.
23. The robotic medical apparatus of claim 18 wherein said tool is for sewing.
24. The robotic medical apparatus of claim 18 wherein said tool is for suturing.
25. The robotic medical apparatus of claim 11 wherein said tool is for applying clips, staples, or clamps.
26. The robotic medical apparatus of claim 18 wherein one end of said tool is active while another end is passive.
27. A robotic medical apparatus for performing a medical procedure or application on an anatomy, said apparatus comprising:
a first medical instrument member having a working end adapted to be disposed at an internal target area at which the medical procedure or application is to be performed;
a second medical instrument member having a working end adapted to be disposed at an internal target area at which the medical procedure or application is to be performed;
said first medical instrument member disposed so as to extend into the anatomy at a first ingress location;
said second medical instrument member disposed so as to extend into the anatomy at a second ingress location different than said first ingress location;
a controller for receiving remotely generated control commands for respectively controlling the motion of said first and second medical instrument members so that said first and second medical instrument members are separately and controllably operable to perform the medical procedure or application;
both said first and second medical instrument members comprising active work elements at said respective member working ends and disposed at opposite sides of an anatomic wall; and
said active work elements being controlled cooperatively to perform the medical procedure or application.
28. The robotic medical apparatus of claim 27 wherein said active work elements include at least one element that extends a securing piece through said body vessel wall.
29. The robotic medical apparatus of claim 27 wherein said active work element comprises an end effector.
30. A robotic medical apparatus for performing a medical procedure or application on an anatomy, said apparatus comprising:
a first medical instrument member having a working end adapted to be disposed at an internal target area at which the medical procedure or application is to be performed;
a second medical instrument member having a working end adapted to be disposed at an internal target area at which the medical procedure or application is to be performed;
said first medical instrument member disposed so as to extend into the anatomy at a first ingress location;
said second medical instrument member disposed so as to extend into the anatomy at a second ingress location different than said first ingress location;
and
a controller for receiving remotely generated control commands for respectively controlling the motion of said first and second medical instrument members so that said first and second medical instrument members are separately and controllably operable to perform the medical procedure or application.
31. The robotic medical apparatus of claim 30 wherein said first medical instrument passes intralumenally and said second medical instrument passes extralumenally.
32. The robotic medical apparatus of claim 30 including a first master input device remote from said first medical instrument for control thereof, and a second master input device remote from said second medical instrument for control thereof.
33. A robotic medical apparatus for performing a securing procedure, at an internal body site, said apparatus comprising:
a medical instrument member having a working end adapted to be disposed at the internal body site at which the securing procedure is to be performed;
a controller for receiving a remotely generated control command for controlling the motion of said medical instrument member to perform the securing procedure;
said medical instrument member including, at a distal section thereof, a securing tool having one and another ends adapted to be disposed at opposite sides of a tissue that is to be secured; and
at least one of said tool ends adapted to hold a securing member for securing said tissue.
34. The robotic medical apparatus of claim 33 wherein said medical instrument member includes an instrument shaft.
35. The robotic medical apparatus of claim 34 including a controllably bendable section along said instrument shaft for directing the position of said tool.
36. The robotic medical apparatus of claim 35 including a remote input device controlled by an operator, and coupled by way of said controller to remotely control said bendable section.
37. The robotic medical apparatus of claim 34 wherein said instrument shaft is rigid.
38. The robotic medical apparatus of claim 33 wherein said tool is for sewing.
39. The robotic medical apparatus of claim 33 wherein said tool is for suturing.
40. The robotic medical apparatus of claim 33 wherein said tool is for applying clips, staples, or clamps.
41. The robotic medical apparatus of claim 33 wherein one end of said tool is active while another end is passive.
Descripción
    RELATED APPLICATION
  • [0001]
    This application claims the benefit of U.S. Provisional Application No. 60/403,621, filed Aug. 14, 2002. The entire teachings of the above application are incorporated herein by reference.
  • BACKGROUND OF THE INVENTION
  • [0002]
    Robotically controlled surgical instruments are usually controlled from a master station at which a surgeon or other medical practitioner is situated. The master station may include one or more input devices manipulated by the user for, in turn, controlling, at an operative site, respective instruments used in performing a surgical procedure or application.
  • SUMMARY OF THE INVENTION
  • [0003]
    Reference is made to co-pending U.S. patent applications identified as Ser. No. 10/023,024 filed Nov. 16, 2001, and Ser. No. 10/014,143 filed Nov. 16, 2001 relating, respectively, to a flexible instrument system and a rigid instrument system, both applications of which are hereby incorporated by reference herein in their entirety. Reference is also made to copending application Ser. No. 10/077,233 filed Feb. 15, 2002 and Ser. No. 10/097,923, filed Mar. 15, 2002 both relating to interchangeable instrument concepts, and both applications of which are hereby incorporated by reference herein in their entirety.
  • [0004]
    The descriptions set forth herein use instrument systems as described in these earlier applications but in a different combination so as to provide instrument use combining both flexible and rigid instruments for performing surgical procedures in a more efficient and effective manner. These combined uses include, but are not limited to, use of a flexible instrument intralumenally and the use of a rigid instrument extralumenally. This technique greatly enhances the efficiency of a wide variety of surgical procedures. These flexible and rigid instruments also preferably carry active work elements usually for the purpose of tissue manipulation. These work elements or end effectors may be used for grasping, dissection, resection, cauterizing, etc. Several examples of uses are set forth hereinafter.
  • [0005]
    One embodiment covers the concept of using two separate robotically controlled instruments with their operative ends locatable at a target site at which a medical procedure or application is performed, and which are disposed, respectively, intralumenally (within an anatomic lumen) and extralumenally (outside of an anatomic lumen). In a preferred embodiment the first instrument is rigid, entering the anatomy, for example, laparoscopically, while the second instrument is flexible and meant to enter a body lumen such as through a natural body orifice or percutaneously. If used, for example, in a procedure to be performed in the bowel, the rigid instrument may be used with a MIS incision, while the flexible instrument enters the bowel through a natural body orifice (anus). Both instruments are robotically and computer controlled from the same master station at input devices such as illustrated in the aforementioned incorporated applications.
  • [0006]
    Position control means may be employed to keep track of the relative positions of the instruments. This enables fine control of interaction between instruments which is important in many surgical procedures. The concepts described herein cover many different combinations of rigid and flexible instruments. Also covered is the use of more than two instruments for certain surgical procedures. The instruments may be used for surgical procedures or for other reasons such as, for example, drug (stem cells) delivery. Both instruments preferably have end effectors or the like and are deemed active instruments with articulating shafts or the like, used for the purpose of tissue holding, securing, dissecting, manipulating, etc.
  • [0007]
    Also described herein is a novel instrument that incorporates two functions in a single instrument system. This may be used for sewing, suturing or a number of other surgical procedures. This single instrument system eliminates the need for separate instrument coordination at different locations.
  • [0008]
    In accordance with one concept, there is provided a robotic medical apparatus for performing a medical procedure or application on an anatomy. The apparatus comprises a first medical instrument member having a working end adapted to be disposed at an internal target area at which the medical procedure or application is to be performed, and a second medical instrument member having a working end adapted to be disposed at an internal target area at which the medical procedure or application is to be performed. The said first medical instrument member is disposed so as to extend into the anatomy at a first ingress location and passes intraluminally. The second medical instrument member is disposed so as to extend into the anatomy at a second ingress location different than said first ingress location and passes extraluminally. There is also provided a controller for receiving remotely generated control commands for respectively controlling the motion of said first and second medical instrument members so that the first and second medical instrument members are separately and controllably operable to perform the medical procedure or application.
  • [0009]
    In accordance with other important concepts, the first and second medical instrument members are separately and controllably operable, in unison, to perform the medical procedure or application. The first medical instrument member comprises a rigid shaft instrument, and said second medical instrument member comprises a flexible shaft instrument. The first medical instrument member may extend into the anatomy at the first ingress location defined by a small incision. The second medical instrument member may extend into the anatomy at the second ingress location defined by a percutaneous or surgical access, or by introduction through a natural orifice. The first medical instrument member may comprise a rigid shaft instrument, and said second medical instrument member may comprise a flexible shaft instrument, with the flexible shaft instrument adapted to extend intralumenally through an anatomic vessel, or the like. The rigid shaft instrument may be adapted to extend extralumenally about the anatomic vessel. In another version the first and second medical instruments may be flexible shaft instruments. Alternatively, the first and second medical instruments may both be rigid shaft instruments.
  • [0010]
    In accordance with other concepts and embodiments, the first medical instrument member is rigid entering the anatomy laparoscopically, while the second medical instrument member is flexible and meant to enter a body lumen such as through a natural body orifice or percutaneously. The working end of each instrument member is preferably at its distal end and includes a tool for performing the medical procedure or application. The tool may be for sewing, suturing, grasping, or for applying clips, staples, or clamps. There are also separate input devices communicating with the controller. The input devices issue the control commands for respectively controlling the motion of the first and second medical instrument members, and are disposed at a master control station remote from the instrument members.
  • [0011]
    In accordance with other aspects of the disclosed embodiments there is provided a robotic medical apparatus for performing a securing procedure, at an internal body site. The apparatus comprises a medical instrument member having a working end adapted to be disposed at the internal body site at which the securing procedure is to be performed, and a controller for receiving a remotely generated control command for controlling the motion of the medical instrument member to perform the securing procedure. The medical instrument member includes, at a distal section thereof, a securing tool having one and another ends adapted to be disposed at opposite sides of a tissue that is to be secured. At least one of the tool ends is adapted to hold a securing member for securing said tissue.
  • [0012]
    In accordance with other aspects the medical instrument member includes an instrument shaft including a controllably bendable section along the instrument shaft for directing the position of the tool. There is included a remote input device controlled by an operator, and coupled by way of the controller to remotely control the bendable section. The instrument shaft may be rigid or flexible and the tool may be for sewing, suturing, or applying clips, staples or the like.
  • [0013]
    In accordance with other embodiments there is provided a robotic medical apparatus for performing a medical procedure or application on an anatomy. The apparatus comprises a first medical instrument member having a working end adapted to be disposed at an internal target area at which the medical procedure or application is to be performed, and a second medical instrument member having a working end adapted to be disposed at an internal target area at which the medical procedure or application is to be performed. The first medical instrument member is disposed so as to extend into the anatomy at a first ingress location, while the second medical instrument member is disposed so as to extend into the anatomy at a second ingress location different than the first ingress location. A controller is for receiving remotely generated control commands for respectively controlling the motion of the first and second medical instrument members so that the first and second medical instrument members are separately and controllably operable to perform the medical procedure or application. Both the first and second medical instrument members comprise active work elements at respective member working ends and disposed at opposite sides of an anatomic wall. The active work elements are being controlled cooperatively to perform the medical procedure or application.
  • [0014]
    Still other aspects include the active work elements having at least one element that extends a securing piece through the anatomic wall. The active work element preferably comprises an end effector. The first medical instrument preferably passes intralumenally and the second medical instrument preferably passes extralumenally. The system preferably also is robotic including a first master input device remote from the first medical instrument for control thereof, and a second master input device remote from the second medical instrument for control thereof.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • [0015]
    The foregoing and other objects, features and advantages of the invention will be apparent from the following more particular description of preferred embodiments of the invention, as illustrated in the accompanying drawings in which like reference characters refer to the same parts throughout the different views. The drawings are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention.
  • [0016]
    [0016]FIG. 1 is a perspective view of one embodiment of a robotic surgical system in which the principles of the present invention are applied;
  • [0017]
    [0017]FIG. 2 schematically illustrates a surgical procedure using intralumenal and extralumenal instruments, one flexible and one rigid;
  • [0018]
    [0018]FIG. 3 illustrates respective end effectors of rigid and flexible instruments used in performing a suturing procedure at a wall of a lumen;
  • [0019]
    [0019]FIG. 3A shows a next step in the suturing process with the needle having punctured the anatomic wall;
  • [0020]
    [0020]FIG. 3B shows still another suturing step with the suture being pulled through the wall, and further illustrating the placement of a viewing endoscope attached internally;
  • [0021]
    [0021]FIG. 3C is a schematic illustration of dual end effectors used in a sewing technique for attaching vessel segments together;
  • [0022]
    [0022]FIG. 3D illustrates the completion of the sewing technique of FIG. 3C;
  • [0023]
    [0023]FIG. 3E illustrates a surgical procedure in the stomach using dual instruments, a flexible instrument passing into the stomach and either a rigid or flexible instrument outside the stomach wall;
  • [0024]
    [0024]FIG. 3F schematically shows the end of the sewing or suturing technique at the stomach wall;
  • [0025]
    [0025]FIG. 3G illustrates the dual instruments used for securing or re-securing an internal object such as a stent in an artery, vein, or other anatomic lumen or vessel;
  • [0026]
    [0026]FIG. 3H illustrates a first step in a procedure for attaching one vessel to another such as in bypass surgery;
  • [0027]
    [0027]FIG. 3I illustrates a second step in a procedure for attaching one vessel to another;
  • [0028]
    [0028]FIG. 3J illustrates a third step in a procedure for attaching one vessel to another;
  • [0029]
    [0029]FIG. 3K shows the use of dual instruments in a bladder procedure;
  • [0030]
    [0030]FIG. 3L illustrates the use of dual instruments in a stomach procedure;
  • [0031]
    [0031]FIG. 4 is an exploded perspective view of another version of the cable drive mechanism and tool in accordance with the present invention;
  • [0032]
    [0032]FIG. 5 is a top plan view of the instrument insert itself;
  • [0033]
    [0033]FIG. 6 is a perspective view of another embodiment of the present invention;
  • [0034]
    [0034]FIG. 7 is an enlarged detail perspective view of the tool;
  • [0035]
    [0035]FIG. 8 is a perspective view at the tool;
  • [0036]
    [0036]FIG. 9 is a side elevation view of the needle driver;
  • [0037]
    [0037]FIG. 10 is a perspective view of an embodiment of a flexible or bendable wrist just proximal to the tool;
  • [0038]
    [0038]FIGS. 11-14 illustrate different end effector constructions that may be used with either flexible or rigid instruments;
  • [0039]
    [0039]FIG. 15 is a perspective view at the slave station of the system of FIG. 1 illustrating the interchangeable instrument concepts;
  • [0040]
    [0040]FIG. 16 is a cross-sectional view through the storage chamber and as taken along line 16-16 of FIG. 15;
  • [0041]
    [0041]FIG. 17 is a longitudinal cross-sectional view, as taken along line 17-17 of FIG. 15, and showing both a stored articulating instrument and a stored fluid dispensing;
  • [0042]
    [0042]FIG. 18 is schematic diagram of the instrument systems of the present invention as deployed through the urethra for a surgical procedure in the bladder;
  • [0043]
    [0043]FIG. 19 gives further details of the bladder procedures of FIG, 18; and
  • [0044]
    [0044]FIG. 20 illustrates still another concept using a single controllable instrument.
  • DETAILED DESCRIPTION OF THE INVENTION
  • [0045]
    A description of preferred embodiments of the invention follows.
  • [0046]
    [0046]FIG. 1 is a perspective view of one embodiment of a robotic surgical system in which the principles of the present invention are applied. FIG. 1 illustrates a surgical instrument system 10 that includes a master M at which a surgeon 2 manipulates an input device, and a slave station S at which is disposed a surgical instrument. In FIG. 1 the input device is illustrated at 3 being manipulated by the hand or hands of the surgeon. The surgeon is illustrated as seated in a comfortable chair 4. The forearms of the surgeon are typically resting upon armrests 5.
  • [0047]
    [0047]FIG. 1 illustrates a master assembly 7 associated with the master station M and a slave assembly 8 associated with the slave station S. Assembly 8 may also be referred to as a drive unit. Assemblies 7 and 8 are interconnected by means of cabling 6 with a controller 9. As illustrated in FIG. 1, controller 9 typically has associated therewith one or more displays and a keyboard. Reference is also made to, for example, the aforementioned U.S. Ser. No. 10/014,143, for further detailed descriptions of the robotic and computer controller operation and associated operating algorithm.
  • [0048]
    As noted in FIG. 1, the drive unit 8 is remote from the operative site and is preferably positioned a distance away from the sterile field. The drive unit 8 is controlled by a computer system, part of the controller 9. The master station M may also be referred to as a user interface vis-à-vis the controller 9. Commands issued at the user interface are translated by the computer into an electronically driven motion in the drive unit 8. The surgical instrument, which is tethered to the drive unit through the cabling connections, produces the desired replicated motion. FIG. 1, of course, also illustrates an operating table T upon which the patient P is placed.
  • [0049]
    [0049]FIG. 1 illustrates both a flexible system and a rigid system. Only one drive unit is depicted it being understood that there is also a drive unit associated with the rigid instrument system such as shown in FIG. 4. Each of the drive units is controlled from cabling that couples from the controller. This is electrical cabling that drives corresponding motors in each drive unit.
  • [0050]
    Thus, the controller couples between the master station M and the slave station S and is operated in accordance with a computer algorithm. The controller receives a command from the input device 3 and controls the movement of the surgical instrument so as to replicate the input manipulation. The controller may also receive commands from the master station for controlling instrument interchange.
  • [0051]
    With further reference to FIG. 1, associated with the patient P is the surgical instrument 14, which in the illustrated embodiment actually comprises two separate instruments one rigid and one flexible, along with an endoscope E. The endoscope includes a camera to remotely view the operative site. The camera may be mounted on the distal end of the instrument insert, or may be positioned away from the site to provide additional perspective on the surgical operation. In certain situations, it may be desirable to provide the endoscope through an opening other than the one used by the rigid surgical instrument. In this regard, in FIG. 1 three separate ingress locations are shown, two for accommodating the rigid surgical instrument and the endoscope, and the third accommodates the flexible instrument through a natural body orifice. A drape is also shown.
  • [0052]
    The viewing endoscope may also be formed integral with the instrument whether it be a rigid instrument or a flexible instrument. The optics and camera may be mounted directly on the distal part of the instrument such as at or adjacent the end effector. In particular, with respect to a flexible instrument the optics and camera may be supported at the distal end of the instrument.
  • [0053]
    In FIG. 1, as indicated previously two separate instruments are depicted, a rigid instrument system 14 and a flexible instrument system 500. In the rigid instrument system there is an instrument insert that carries at its distal end an end effector 18A entering the anatomy through a small incision. This may be for the purpose of providing access to the area about the bowel or bladder, for example. In the flexible instrument system there is a flexible and bendable instrument section terminating at the end effector 500A, and entering the anatomy, for example, through a natural body orifice such as through the anus in the case of a bowel procedure.
  • [0054]
    An end effector is usually associated with each of the instrument systems. In FIG. 1 this is illustrated by the end effectors 18A and 500A. These can take on a variety of different form such as scissors, graspers or needle drivers. Both of the medical instrument members comprise active work elements at respective member working ends and are usually disposed at opposite sides of an anatomic wall. By “active”, reference is made to end effectors that are useable in performing a surgical procedure or application and that are capable of being manipulated from a master station such as from a surgeon controlled input device.
  • [0055]
    The instrument system 14 is generally comprised of two basic components, including a surgical adaptor or guide 15 and an instrument insert 16. FIG. 1 illustrates the surgical adaptor 15, which is comprised primarily of the guide tube 24, but also includes a mechanical interface that interfaces with a corresponding mechanical interface of the instrument itself. In FIG. 1 the instrument 14 is not clearly illustrated but extends through the guide tube 24. The instrument 14 carries at its distal end the instrument member or insert. The surgical adaptor 15 is basically a passive mechanical device, driven by the attached cable array.
  • [0056]
    In FIG. 1 there is illustrated cabling that couples from the instrument 14 to the drive unit. The cabling 22 is preferably detachable from the drive unit. Furthermore, the surgical adaptor 15 may be of relatively simple construction. It may thus be designed for particular surgical applications such as abdominal, cardiac, spinal, arthroscopic, sinus, neural, etc. As indicated previously, the instrument 14 couples to the adaptor 15 and essentially provides a means for exchanging the instrument tools. The tools may include, for example, forceps, scissors, needle drivers, electrocautery etc. Other tool interchanges are also shown in further drawings herein.
  • [0057]
    Referring still to FIG. 1, the surgical system 10 includes a surgeon's interface 11, computation system or controller 9, drive unit 8 and the surgical instrument 14. The surgical system 10, as mentioned previously, is comprised of an adaptor or guide 15 and the instrument insert 16. The system is used by positioning the instrument, which is inserted through the surgical adaptor or guide 15. During use, a surgeon may manipulate the input device 3 at the surgeon's interface 11, to affect desired motion of the distal end of the instrument within the patient. The movement of the handle or hand assembly at input device 3 is interpreted by the controller 9 to control the movement of the guide tube 24, instrument, and, when an articulating instrument is used, the end effector or tool 18A. Also, movements at the master station may control instrument exchange.
  • [0058]
    The surgical instrument 14, along with the guide tube 24 is mounted on a rigid post 19 which is illustrated in FIG. 1 as removably affixed to the surgical table T. This mounting arrangement permits the instrument to remain fixed relative to the patient even if the table is repositioned. As indicated previously, connecting between the surgical instrument 14 and the drive units 8, are cablings. These include two mechanical cable-in-conduit bundles. These cable bundles may terminate at two connection modules, not illustrated in FIG. 1, which removably attach to the rigid instrument drive unit 8. Although two cable bundles are described here, it is to be understood that more or fewer cable bundles may be used. Also, the drive unit 8 is preferably located outside the sterile field, although it may be draped with a sterile barrier so that it may be operated within the sterile field.
  • [0059]
    In the preferred technique for setting up the system, and with reference to FIG. 1, the surgical instrument 14 is inserted into the patient through an incision or opening. The instrument 14 is then mounted to the rigid post 19 using a mounting bracket. The cable bundle or bundles are then passed away from the operative area to the drive unit. The connection modules of the cable bundles are then engaged into the drive unit. The separate instrument members of instrument 14 are then selectively passed through the guide tube 24. This action is in accordance with the interchangeable instrument concepts also described herein.
  • [0060]
    The instrument 14 is controlled by the input device 3, which is be manipulated by the surgeon. Movement of the hand assembly produces proportional movement of the instrument 14 through the coordinating action of the controller 9. It is typical for the movement of a single hand control to control movement of a single instrument. However, FIG. 1 shows a second input device that is used to control an additional instrument. Accordingly, in FIG. 1 two input devices are illustrated and two corresponding instruments. These input devices are usually for left and right hand control by the surgeon. Many other forms of input device control may also be used. For example, instead of finger graspers a joystick arrangement may be used.
  • [0061]
    The surgeon's interface 11 is in electrical communication with the controller 9. This electrical control is primarily by way of the cabling 6 illustrated in FIG. 1 coupling from the bottom of the master assembly 7. Cabling 6 also couples from the controller 9 to the actuation or drive units. This cabling 6 is electrical cabling. Each of the actuation or drive units, however, is in mechanical communication with the corresponding instrument. The mechanical communication with the instrument allows the electromechanical components to be removed from the operative region, and preferably from the sterile field. The surgical instrument provides a number of independent motions, or degrees-of-freedom, when an articulating type instrument such as a tool, gripper, etc. is used. These degrees-of-freedom are provided by both the guide tube 24 and the instrument insert.
  • [0062]
    [0062]FIG. 1 shows primarily the overall surgical system. FIGS. 15-17 show further details particularly of the interchangeable instrument concepts as applied to this system. The rigid instrument part of the system is adapted to provide seven degrees-of-freedom when an articulating tool is used such as the tool 18A shown in FIG. 1. Three of the degrees-of-freedom are provided by motions of the adaptor 15, while four degrees-of-freedom may be provided by motions of the instrument. As will be described in detail later, the adaptor is remotely controllable so that it pivots, translates linearly, and has its guide tube rotate. The instrument insert also rotates (via rotation of the instrument driver), pivots at its wrist, and has two jaw motions at the tool.
  • [0063]
    Now, mention has been made of bowel and bladder procedures illustrated schematically in FIG. 2. This shows the two separately controlled instruments including rigid instrument system 14 that may be engaged laparoscopically through a small incision, and flexible instrument system 500 that may be engaged through the anus in the case of a bowel procedure or the urethra in the case of a bladder procedure. FIG. 2 also shows the respective end effectors 18A and 500A. These end effectors are shown positioned on either side of an anatomic wall W shown schematically in dotted outline in FIG. 2.
  • [0064]
    Refer now also to FIG. 3 for an illustration of further details showing the end effectors 18A and 500A positioned to perform a suturing step with a needle 19A being grasped by the end effector 18A. The rigid instrument has been passed through a small incision and is positioned outside the vessel wall 20A. The flexible instrument with end effector 500A is positioned within the lumen 20C between walls 20A and 20B. The end effector 500A is shown grasping a tissue at the wall, assisting in the suturing step. In FIG. 3 both of the instruments include at their distal ends, proximal of the end effectors, bendable sections 18B and 500B. Each of these bendable sections or segments is remotely controllable from the master input devices, allowing additional degrees of freedom of motion of the respective end effectors. The end effectors of both instruments are preferably also remotely computer-controlled from a master station input device or devices. Also, illustrated is a viewing endoscope VE directed at the operative site where the end effectors are acting.
  • [0065]
    Reference is now made to FIG. 3A showing a next step in the suturing procedure. The needle 19A has now passed through the vessel wall 20A. The suture 19B is attached to the end of the needle 19A, as illustrated. In FIG. 3A there is illustrated a viewing endoscope 19C that is attached to the instrument 18 just proximal of the end effector 18A.
  • [0066]
    In FIG. 3B the needle 19A is shown in the next step with the suture 19B having passed through the anatomic wall 20A. In this arrangement the viewing endoscope 19C is shown secured to the chest wall 19E. There may be provided a clamp 19D, or the like for holding the viewing endoscope in place and in a good viewing location for the surgical procedure that is being performed. In both FIGS, 3A and 3B the instrument system 500 is within the lumen 20C, while the instrument system 14 is outside the lumen 20C. The instrument systems 500 within the lumen are usually of the flexible type so as to be able to maneuver through an anatomic body part. The instrument system outside the lumen is illustrated as being of the rigid type but could also be of the flexible type.
  • [0067]
    [0067]FIG. 3C shows the use of another dual instrument system that is adapted for intralumenal/extralumenal positioning. This particular arrangement is for sewing between two separate vessels V1 ands V2. This procedure may be used in a variety of different types of operations in which it is desirable to secure together two vessels or lumens, end-to-end. For this purpose there are provided two instrument systems, both of which are preferably robotically controlled from a master station input device. The control of the two systems may be under direct surgeon control such as from an input device manipulated by the surgeon, or, alternatively the systems may be automatically controlled so that once a sequence is initiated the ensuing steps are performed automatically. For example in a sewing procedure it may be desirable to position the instrument systems and, once positioned, it may be desirable to initiate a sequence of suturing steps or stitches so that the suturing occurs essentially automatically, with little or no surgeon intervention except for safety concerns.
  • [0068]
    Now, in FIG. 3C there is illustrated a dual instrument system that includes an internally disposed system 150, and an externally disposed system 160. The system 150 is usually of the flexible type as the instrument shaft has to negotiate a vessel or lumen that typically has non-straight portions. The instrument system 160, on the other hand, may be flexible or rigid, but would usually be rigid as it would enter the anatomy through an incision or percutaneously. In FIG. 3C the instrument systems together define a sewing system including, on the instrument system 150 a hook end effector 152, and on the instrument system 160 a needle end effector 162. Together these instrument systems are adapted to be operated in unison and usually in an automatic manner, although the sewing steps can also be performed under manual control of the surgeon from a master station.
  • [0069]
    The combination of the instrument systems 150 and 160 provide a sewing technique. The system 150 with its hook end effector 152 cooperates with the needle end effector 162 supported by the instrument system 160. This arrangement may be used to provide a chain stitch. Both of the end effectors are controllable with multiple degrees of freedom. Thus, if the systems are used under manual robotic control the hook end effector 152 is moved in unison with the needle end effector 162 to provide the stitch 164. The needle end effector 162 is adapted to reciprocate relative to its presser foot 166. At the beginning of each stitch, the needle end effector 160 pulls a loop of suture material through the tissue. The hook end effector 150 moves in synchronism with the needle end effector 160 and grabs the loop of suture material before the needle end effector 160 pulls up. The instrument system proceed about the vessel portions and FIG. 3D shows the final stitch 164 that attaches the vessels or lumens together, end-to-end.
  • [0070]
    In connection with the systems shown in FIGS. 3C and 3D these instrument systems may also be controlled automatically and under computer control. In that case, once the instrument systems are in place, sensors associated with each instrument system detects the relative position between them. Then the computer at the controller that is disposed between master and slave stations, controls the instrument systems in unison to perform the stitching action. In other words the computer controls the action of the needle end effector and hook end effector to perform the stitch such as a chain stitch.
  • [0071]
    In the arrangement shown in FIGS. 3C and 3D the needle end effector is shown outside the lumen while the hook end effector is shown inside the lumen. In an alternate embodiment the positions of the instruments may be interchanged do the hook end effector is outside the lumen and the needle end effector is inside the lumen. The positioning between the end effectors can be controlled by sensing electromagnetic signals associated with sensors associated with each instrument system. The stitching sequences described can provide a variety of different stitch patterns. Inversion or eversion of sewed edges can be provided depending upon the particular surgical procedure being performed. For example, for cardiac procedures a slight inversion of the stitch is desired.
  • [0072]
    [0072]FIG. 3E illustrates a surgical procedure in the stomach using dual instruments, a flexible instrument passing into the stomach and either a rigid or flexible instrument outside the stomach wall. FIG. 3F schematically shows the end of the sewing or suturing technique at the stomach wall. The flexible instrument system 160A passes through the esophagus 167 entering initially through the patient's mouth. The outlet from the stomach is at the duodenum 168. This flexible instrument system is illustrated as having an operative segment O controlled by the surgeon in a telerobotic manner to control bending at that segment for guidance of the distal end effector 160. An outside instrument system 150 is also illustrated which may be either a flexible or rigid instrument system. This is illustrated in FIG. 3E by system 150A carrying the end effector 150. In FIGS. 3E and 3F the end effectors may be the same as shown in FIGS. 3C and 3D used in performing a sewing or suturing operation. The instrument systems are controlled to perform the sewing or suturing action forming stitches 170 as illustrated in FIG. 3F. This stitching action closes the hole 169.
  • [0073]
    [0073]FIGS. 3E and 3D illustrate a surgical procedure on the stomach 165 particularly at the stomach wall 171. An ulcerated hole 169 is disclosed and it is the purpose of the instrument system shown to close up this hole by means of a sewing or suturing technique employing the instrument systems 150A and 160A. The procedure shown in FIGS. 3E and 3F can be performed manually from the master station or can be performed automatically under computer control initiated from the master station. The same or a similar procedure can also be used for gastric ulcers or for repairing a bowel wall defect.
  • [0074]
    [0074]FIG. 3G shows still another technique that can be practiced with the instrument systems described herein. In FIG. 3G the same reference characters are used to identify similar components as previously described in connection with FIGS. 3C and 3D. In this instance an object is being stitched within the body vessel 174. The object may be, for example, a stent 173 that is being secure or re-secured within the vessel walls. For this purpose in FIG. 3G there is illustrated the instrument systems 150A and 160A. Usually the instrument system 150A is flexible as it has to conform to the shape and contour of the inside of the vessel or lumen. The instrument systems 150A and 160A carry respective end effectors 150 and 160. These may be the same type end effectors described in connection with FIGS. 3C and 3D. FIG. 3G shows the stitching being completed at 175 at one end of the stent 173, and further shows the instrument systems in action at the other end of the stent securing the other end thereof by means of the illustrated instrument systems 150A and 160A.
  • [0075]
    In FIG. 3G the instrument system 150A may enter the anatomy through a lumen from a natural body orifice, or percutaneously. The instrument system 160A may be positioned at the lumen via an incision at a convenient location proximal to the operative site. The stitching action may be direct surgeon controlled my manipulation at a master station or can be under automatic control. In FIG. 3G the securing may be for a newly placed object or can be used to repair an existing object. For example, the technique explained can be used for AAA stent failures.
  • [0076]
    Refer now to FIGS. 3H through 3J for an illustration of another surgical procedure that can be performed using the present inventive techniques. This example relates to the attachment of one vessel or lumen 177 to another vessel or lumen 178. This is a technique that can be used, for example, in performing a cardiac by-pass. In the illustrated steps the same instrument systems may be employed as previously discussed in connection with earlier embodiments that are described herein. This may include both flexible and rigid systems. Furthermore it is noted in this particular procedure that more than two instrument systems are employed. For example, refer to FIG. 31 where three instrument systems are shown, two positioned within respective lumens and one positioned outside the lumens.
  • [0077]
    [0077]FIG. 3H shows the lumen or vessel 178 to which the vessel or lumen 177 is to be attached. This illustrates the first step in the procedure of positioning the lumen 177 by means of the instrument system 180 that is disposed within the lumen 177. The instrument system 180 may carry a balloon 181 for example, that is inflated to hold the lumen 177 in place. The instrument system 180 may then be advanced to position the lumen 177 toward the position illustrated in FIG. 31. The control of movement of the instrument system 180 may be by means of surgeon control from a master station input device. In this procedure, as well as other procedures described herein a viewing endoscope is used to assist in the positioning of instrument systems.
  • [0078]
    [0078]FIG. 3I now shows the next step in the procedure of attaching the tapered end of the vessel 177 to the side wall of the vessel 178. For this purpose there is provided the previously described instrument systems 150A and 160A. These instrument systems are used to sew or suture about the open end of the vessel 177 to attach it to the side wall of the vessel 178. This sewing or suturing step is performed with the use and control of the end effectors 150 and 160. In FIG. 3I it is noted that the instrument system 180 may be kept in place during this step to hold the vessel or lumen 177 against the vessel or lumen 178 to assure accurate attachment. At least parts of the procedures may be performed automatically, particularly the sewing or suturing technique.
  • [0079]
    After the step illustrated in FIG. 3I is completed then an opening is to be cut in the sidewall of lumen 178 to allow fluid flow between lumens. This is illustrated in FIG. 3J where additional instrument systems are now employed. One instrument system 182 may carry a cutting blade to perform the opening of the sidewall in the lumen 178. In the other lumen 178 there is disposed the instrument system 183 that carries a balloon 184 that is meant to hold the sidewall in place as the cutting operation is performed. For the purpose of illustration only one balloon id shown in FIG. 3J, however, instead a pair of balloons may be used, one positioned on either side of the opening so that there is no interference between the cutting instrument and the supporting balloons.
  • [0080]
    Refer now to another use of the concepts of the invention illustrated in FIG. 3K.
  • [0081]
    This illustrates a surgical procedure that is performed in the bladder 185. FIG. 3K shows one instrument system 160A passing through the urethra 188 into the interior of the bladder. This is the instrument system 160A carrying the needle end effector 160. FIG. 3K also illustrates the other instrument system 150A carrying the hooked end effector 150. Both of these instrument systems are shown in relative proximity to each other and can be used to perform any one of a number of different procedures. For example, the instrument systems may be used to close the sphincter at the base of the ureter tube 186 that couples to the kidney 187.
  • [0082]
    [0082]FIG. 3L is a further illustration of the use of the instrument systems of the invention in closing the sphincter leading into the stomach 190 at the gastro-esophageol juncture. This is a procedure that is useable to reduce acid reflux that can occur in some patients. By reducing the size of the port at that point acids from the stomach are impeded from backing up into the esophagus. Thus, in FIG. 3L the aforementioned instrument systems 150A and 160A are used to perform a sewing or suturing operation so as to constrict the sphincter at the area 192 illustrated in FIG. 3L. The instrument system 150A carries the hook end effector 150 while the instrument system 160A carries the needle end effector 160. Both the instrument systems may be operated in the same manner as described previously in connection with other procedures that have been described herein.
  • [0083]
    [0083]FIG. 4 is an exploded perspective view of another version of the cable drive mechanism and tool. FIG. 5 is a top plan view of the rigid instrument insert itself. FIG. 4 is an exploded perspective view of the cable drive mechanism and instrument illustrating the de-coupling concepts at the slave station S. A section of the surgical tabletop T which supports the rigid post 19 is shown. The drive unit 8 is supported from the side of the tabletop by an L-shaped brace 210 that carries an attaching member 212. The brace 210 is suitably secured to the table T. The drive unit 8 is secured to the attaching member 212 by means of a clamp 214. Similarly, the rigid support rod 19 is secured to the attaching member 212 by means of another clamping mechanism 216.
  • [0084]
    Also in FIG. 4 the instrument 14 is shown detached from (or not yet attached to) support post 19 at bracket 25. The instrument 14 along with cables 21 and 22 and lightweight housing section 856 provide a relatively small and lightweight decoupleable slave unit that is readily manually engageable (insertable) into the patient at the guide tube 24.
  • [0085]
    After insertion, the instrument assembly, with attached cables 21, 22 and housing 856, is attached to the support post 19 by means of the knob 26 engaging a threaded hole in base 452 of adapter 15. At the other end of the support post 19, bracket 216 has a knob 213 that is tightened when the support rod 19 is in the desired position. The support rod 19, at its vertical arm 19A, essentially moves up and down through the clamp 216. Similarly, the mounting bracket 25 can move along the horizontal arm 19B of the support rod to be secured at different positions therealong. A further clamp 214 supports and enables the drive unit 8 to be moved to different positions along the attaching member 212. FIG. 4 also shows the coupler 230 which is pivotally coupled from base piece 234 by means of the pivot pin 232. The coupler 230 is for engaging with and supporting the proximal end of the instrument insert 16.
  • [0086]
    The first housing section 855 also carries oppositely disposed thumb screws 875 (see FIG. 4). These may be threaded through flanges 876. When loosened, these set screws enable the second housing section 856 to engage with the first housing section 855. For this purpose, there is provided a slot 878 illustrated in FIG. 4. Once the second housing section 856 is engaged with the first housing section 855, then the thumb screws 875 may be tightened to hold the two housing sections together, at the same time facilitating engagement between the coupler disks 862 and the coupler spindles 860.
  • [0087]
    As illustrated in FIG. 4, the two housing sections 855 and 856 are separable from each other so that the relatively compact slave unit can be engaged and disengaged from the motor array, particularly from the first housing section 855 that contains the motors 800. The first housing section 855, as described previously, contains the motors 800 and their corresponding coupler disks 862. In FIG. 4, the second housing section 856 primarily accommodates and supports the coupler spindles 860 and the cabling extending from each of the spindles to the cable bundles 21 and 22 depicted in FIG. 4.
  • [0088]
    [0088]FIG. 4 also shows details of the adaptor including the carriage 226 supported on rails 224. The carriage 226 holds the base piece 234 that, in turn, supports the instrument insert. The coupler 230 of the adaptor provides mechanical drive to the instrument insert. The carriage and rails are pivoted at 225 to provide one degree of freedom, while the in and out motion of the carriage provides another degree of freedom to the instrument.
  • [0089]
    As shown in FIG. 5, each wheel of the instrument coupler 300 has two cables 376 that are affixed to the wheel and wrapped about opposite sides at its base. The lower cable rides over one of the idler pulleys or capstans (e.g., capstan 34), which routes the cables toward the center of the instrument stem 301. It is desirable to maintain the cables near the center of the instrument stem. The closer the cables are to the central axis of the stem, the less disturbance motion on the cables when the insert stem is rotated. The cables may then be routed through fixed-length plastic tubes that are affixed to the proximal end of the stem section 301 and the distal end of the stem section 302. The tubes maintain constant length pathways for the cables as they move within the instrument stem.
  • [0090]
    The instrument coupler 300 is also provided with a registration slot 350 at its distal end. The slot 350 engages with a registration pin 352 supported between the bars 270 and 272 of base piece 234. The coupler 300 is also provided with a clamping slot 355 on its proximal end for accommodating the threaded portion of the clamping knob 327 (on adapter coupler 230). The knob 327 affirmatively engages and interconnects the couplers 230 and 300.
  • [0091]
    In operation, once the surgeon has selected a particular instrument insert 16, it is inserted into the adapter 15. The proximal stem 301, having the distal stem 302 and the tool 18 at the distal end, extend through the adapter guide tube 24. FIG. 4 shows the tool 18 extending out of the guide tube 24 when the surgical instrument 16 is fully inserted into the adaptor 15. When it is fully inserted, the tab 281 on the axial wheel 306 engages with the mating detent 280 in pulley 279. Also, the registration slot 350 engages with the registration pin 352. Then the coupler 230 is pivoted over the base 300 of the instrument insert 16. As this pivoting occurs, the respective wheels of the coupler 230 and the coupler 300 interengage so that drive can occur from the coupler 230 to the insert 16. The knob 327 is secured down so that the two couplers 230 and 300 remain in fixed relative positions.
  • [0092]
    [0092]FIG. 6 is a perspective view of one embodiment of the flexible instrument system 500 illustrated in FIG. 1. FIG. 7 is an enlarged detailed perspective view of the end effector that may be used with the flexible instrument system. FIG. 1 depicts flexible instrument system 500 supported from support bracket 502, which extends to the operating table. Usually the support bracket is supported from the side of the operating table and may be adjustable in position relative to the operating table, to dispose system 500 in a convenient position over or relative to the patient. In one embodiment, bracket 502 is secured to the operating table at one end. The other end of bracket 502 supports the entire flexible instrument by means of a two-piece structure similar to that described in copending U.S. Provisional Applications Serial No. 60/279,087 filed Mar. 27, 2001 the entire teachings of which are concorporated herein by reference. A knob may be provided on support base 504, not shown in FIG. 1. Once the support base 504 is fixed to the support bracket 502, then the flexible instrument system is maintained in a fixed position at base 504, providing a stable and steady structure during the medical procedure. Like the rigid system in FIG. 1, system 500 can be positioned at an acute angle with respect to the operating table or can be arranged at other convenient positions depending upon the surgical procedure being performed.
  • [0093]
    Flexible instrument system 500 illustrated in FIG. 6 comprises flexible instrument 510 having a shaft 528 extending to mechanically drivable mechanism 526, which interlocks with base (or receiver) 506. Base 506 is supported on carriage 508. Carriage 508, in turn, is adapted for linear translation and supported by elongated rails 512 and 514. Rails 512 and 514 terminate at one end via end piece 516 which provides further support. Support base 504 terminates rails 512 and 514 at their other end. Carriage 508 includes bearings or bushings 509 that support the carriage from rails 512 and 514.
  • [0094]
    Flexible instrument system 500 employs two separate cable bundles for mechanically driving the flexible instrument along rails 512 and 514. Pulley 521 (dotted outline), residing within carriage control module 520, receives a first pair of cables 518. Pulley 521 also receives a second set of cables, which runs through carriage 508 to a further pulley 522 supported by end piece 516. The second set of cables controls the translational motion of carriage 508 and terminates at point 519.
  • [0095]
    [0095]FIG. 6 also shows a set of cables 524 for driving control elements, e.g. pulleys within receiver 506. These control elements move the shaft and the tool in several degrees-of-freedom. Arrow J1 indicates the linear translation via module 520. Rotational arrow J2 indicates rotation of flexible shaft 528 of flexible instrument 510 about the inner axis parallel with the shaft length. Arrow J3 represents the flexing or bending of flexible shaft 528 at controlled flexible segment 530. In this embodiment, flexible segment 530 is positioned directly adjacent tool 534 at the distal end of shaft 528. Arrow J4 represents the pivot action of a wrist joint, which links tool 534 to shaft 528, about axis 532. In this embodiment, tool 534 is exemplified as a grasper, and arrows J5 and J6 represent the opening and closing actions of the tool jaws. Motions indicated by arrows J2-J6 are controlled from cabling 524 originating at receiver 506.
  • [0096]
    [0096]FIG. 7 provides an enlarged perspective view of the distal end of shaft 528 including flexible segment 530 and tool 534. The segment 530 corresponds to the section 500B illustrated in FIG. 3, while the end effector 534 corresponds to the end effector 500A illustrated in FIG. 3. Tool 534 comprises upper grip or jaw 602 and lower grip or jaw 603, both supported from link 601. Base 600 is affixed to or integral with flexible shaft 528. Link 601 is rotatably connected to base 600 about axis 532. A pivot pin may be provided for this connection. Upper and lower jaws 602 and 603 are rotatably connected to link 601 about axis 536 and again, a pivot pin can provide this connection.
  • [0097]
    [0097]FIG. 7 shows eight cables at 538 extending through the hollow inside of shaft 528 for control of tool 534 and flexible segment 530. Two of these cables operate the bend of flexible segment 530, two cables operate one of the jaws 602, two cables operate the other of the jaws 603 and the last two cables operate the wrist action about the axis 532. All of these cables travel through the hollow shaft 528 and through appropriate holes in flexible segment 530 e.g. wire 525, as well as holes in base 600. Each of these pairs of cables operates in concert to open and close jaws, pivot about the wrist, and bend flexible segment 530.
  • [0098]
    One pair of cables travels through shaft 528 and through appropriate holes in the base 600, wrapping around a curved surface of the link 601 and then attaching to the link. Tension on this pair of cables rotates the link 601 along with the upper and lower grips or jaws 602 and 603 about axis 532.
  • [0099]
    Two other pairs of cables also extend through the shaft 528 and through holes in the base and then pass between fixed posts 612. These posts constrain the cables to pass substantially through axis 532, which defines rotation of link 601. This construction essentially allows free rotation of link 601 with minimal length changes in the cables passing to jaws 602 and 603. Thus, the cables actuating jaws 602 and 603 are essentially decoupled from the motion of link 601 and are not effected by any rotation of link 601. Cables controlling jaw movement terminate on jaws 602 and 603. These cables permit independent operation of the jaws 602 and 603 in respective clockwise and counter clockwise directions with respect to axis 536. A similar set of cables is present on the under-side of the link 601 (not shown). Each of the jaws 602 and 603, as well as the link 601, may be constructed of metal. Alternatively, link 601 may be constructed of a hard plastic material. Base 600 may also be constructed of a plastic material and may be integral with shaft 528.
  • [0100]
    Bending of flexible segment 530 is provided via diametrically disposed slots 662, which define spaced ribs 664. Flexible segment 530 also has a longitudinally extending wall 665 through which cabling may extend, particularly for the operation of the tool. One of the pairs of cables of bundle 538 controlling flexible segment 530 terminates where base 600 intercouples with shaft 528. This pair of cables works in concert to cause bending as indicated by arrow J3, i.e. in a direction orthogonal to the pivoting provided at wrist axis 532. The flexible segment 530 may also be provided with additional degrees of freedom by controlling bending in two axes, direction J3 that is illustrated and a direction orthogonal thereto.
  • [0101]
    [0101]FIGS. 8, 9 and 10 show different embodiments that can be used with either instrument but that are illustrated, in particular, for the rigid instrument system. FIG. 8 illustrates the construction of one form of a tool. FIG. 8 is a perspective view. The tool 18 is comprised of four members including a base 600, link 601, upper grip or jaw 602 and lower grip or jaw 603. The base 600 is affixed to the flexible stem section 302 (see FIG. 5). The flexible stem may be constructed of a ribbed plastic. This flexible section is used so that the instrument will readily bend through the curved part of the guide tube 24.
  • [0102]
    The link 601 is rotatably connected to the base 600 about axis 604. FIG. 8 illustrates a pivot pin 620 at axis 604. The upper and lower jaws 602 and 603 are rotatably connected by pivot pin 624 to the link 601 about axis 605, where axis 605 is essentially perpendicular to axis 604.
  • [0103]
    Six cables 606-611 actuate the four members 600-603 of the tool. Cable 606 travels through the insert stem (section 302) and through a hole in the base 600, wraps around curved surface 626 on link 601, and then attaches on link 601 at 630. Tension on cable 606 rotates the link 601, and attached upper and lower grips 602 and 603, about axis 604. Cable 607 provides the opposing action to cable 606, and goes through the same routing pathway, but on the opposite sides of the insert. Cable 607 may also attach to link 601 generally at 630.
  • [0104]
    Cables 608 and 610 also travel through the stem 301, 302 and though holes in the base 600. The cables 608 and 610 then pass between two fixed posts 612. These posts constrain the cables to pass substantially through the axis 604, which defines rotation of the link 601. This construction essentially allows free rotation of the link 601 with minimal length changes in cables 608-611. In other words, the cables 608-611, which actuate the jaws 602 and 603, are essentially decoupled from the motion of link 601. Cables 608 and 610 pass over rounded sections and terminate on jaws 602 and 603, respectively. Tension on cables 608 and 610 rotate jaws 602 and 603 counter-clockwise about axis 605. Finally, as shown in FIG. 8, the cables 609 and 611 pass through the same routing pathway as cables 608 and 610, but on the opposite side of the instrument. These cables 609 and 611 provide the clockwise motion to jaws 602 and 603, respectively. At the jaws 602 and 603, as depicted in FIG. 8, the ends of cables 608-611 may be secured at 635, for example by the use of an adhesive such as epoxy glue, or the cables could be crimped to the jaws.
  • [0105]
    Reference is now made to FIG. 9. FIG. 9 is a side elevation view of a needle driver version of end effector. This embodiment employs an over-center camming arrangement so that the jaw is not only closed, but is done so at a forced closure.
  • [0106]
    In FIG. 9, similar reference characters are employed with respect to the embodiment of FIG.8. Thus, there is provided a base 600, a link 601, an upper jaw 650 and a lower jaw 652. The base 600 is affixed to the flexible stem section 302. Cabling 608-611 operate the end jaws. Linkages 654 and 656 provide the over-center camming operation. The two embodiments of FIGS. 8 and 9 employ a fixed wrist pivot. An alternate construction is illustrated in FIG. 10 in which there is provided, in place of a wrist pivot, a flexible or bending section. This type of bendable section may be used with either flexible or rigid instrument systems.
  • [0107]
    [0107]FIG. 10 is a perspective view of an embodiment of a flexible or bendable wrist just proximal to the tool. FIG. 10 illustrates the manner in which the previously disclosed tools may be used with a flexible or bendable segment of the instrument shaft, whether used with a rigid shaft body or a flexible shaft body or combinations thereof. One of the advantages is that only a single cable needs to be coupled to the tool for actuation thereof. The pitch and yaw of the tool is controlled at the flexible section 100 shown in FIG. 10. This arrangement also lends itself to making the tool disposable or at the very least detachable from the instrument body such as for substitution of another tool. Because the construction becomes more simplified at the tip of the instrument, it makes it possible to construct a tool that is readily detachable from the instrument.
  • [0108]
    In FIG. 10 there is disclosed one embodiment of a tool, illustrated in conjunction with a flexible shaft or tube having a remotely controllable bending or flexing section 100. The medical instrument may comprise an elongated shaft, such as shaft section 110, having proximal and distal ends; and a tool, such as graspers 102 and 104, supported from the distal end of the elongated shaft and useable in performing a medical procedure on a subject. The tool is actuated preferably by a single tendon or cable that extends through the flexible section 100. In order to provide the pitch and yaw action at the tool, the bending or flexing section 100 is constructed so as to have orthogonal bending by using four cables separated at 90° intervals and by using a center support with ribs and slots about the entire periphery. Refer to the ribs 112 that define corresponding slots 114. The ribs define at each of their centers a center support passage 118 that has extending therethrough the cable 136. The bending section 100 is at the end of tube section 110. The section 110 may be flexible itself, may be smooth as shown, or may be fluted.
  • [0109]
    The bending section 100 has alternating ridges 120 to provide universal bending. This version enables bending in orthogonal directions by means of four cables 106, 107, 116 and 117. The operation of cables 106 and 107 provides flexing in one degree-of-freedom while an added orthogonal degree-of-freedom is provided by operation of cables 116 and 117. Each of the cables 106, 107, 116, and 117 have at their terminating ends respective balls 106A, 107A, 116A, and 117A that may be held in corresponding recesses in a distal end wall 119 of the flexible section 100.
  • [0110]
    The bending section 100, as indicated previously, includes a series of spaced ribs 112 disposed, in parallel, with the plane of each rib extending orthogonal to the longitudinal axis of the section 100. At the proximal end of the bendable section an end rib connects to the shaft section 110, while at the distal end there is provided the distal end wall 119 that supports the ends of the cables. Each of the ribs 112 are held in spaced relationship by means of the alternating ridges 120. As depicted in FIG. 10 these ribs are identified as horizontal ribs 120A, alternating with vertical ribs 120B. This structure has been found to provide excellent support at the center passage for the actuating cable 136, while also providing enhanced flexibility in orthogonal directions of bending or flexing.
  • [0111]
    The grippers 102 and 104 are supported for opening and closing by means of a pivot pin 135 that extends along a pivot axis. These grippers may be supported in link 140. Refer to the exploded perspective view of FIG. 10 showing the pin 135, and grippers 102 and 104. The pin 135 may be supported at its ends in opposite sides of link 140.
  • [0112]
    Reference is now made to FIGS. 11-14 for an illustration of different end effector devices that can be used with the instrument systems described herein. FIG. 11 shows a clip applier 410. FIG. 12 shows a cutting jaw 420. FIG. 13 shows a device 430 for applying a solution or agent to an operative site. FIG. 14 shows a syringe type device 440 useable as an end effector.
  • [0113]
    The surgical robotic system, as illustrated in FIGS. 15-17, although preferably used to perform minimally invasive surgery, may also be used to perform other procedures as well, such as open or endoscopic surgical procedure. FIG. 15 is a perspective view at the slave station of the system of FIG. 1 illustrating the interchangeable instrument concepts as applied in a dual instrument system. FIG. 16 is a cross-sectional view through the storage chamber and as taken along line 16-16 of FIG. 15. FIG. 17 is a longitudinal cross-sectional view, as taken along line 17-17 of FIG. 15, and showing both a stored articulating instrument and a stored fluid dispensing.
  • [0114]
    Reference is now made to FIG. 15 which is a perspective view illustrating the instrument 14 and the adaptor 15 at the slave station S. This instrument system is secured in the manner illustrated in FIG. 1 to the rigid post 502 that supports the surgical instrument by way of a mounting bracket. FIG. 15 also shows several cables that may be separated into five sets for controlling different motions and actions at the slave station. These are individual cables of the aforementioned bundles 21 and 22 referred to in FIG. 4. FIG. 15 also illustrates the support yoke 220 that is secured to the mounting bracket 31, the pivot piece 222, and support rails 224 for the carriage 226. The rails are supported in end pieces 241 and 262 with the end piece 241 attached to the pivot piece 222. The pivot piece 222 pivots relative to the support yoke 220 about pivot pin 225. A base piece 234 is supported under the carriage 226 by means of the support post 228. The support post 228 in essence supports the entire instrument assembly, including the adaptor 15 and the instrument 14.
  • [0115]
    As indicated previously, the support yoke 220 is supported in a fixed position from the mounting bracket 31. The support yoke 220 may be considered as having an upper leg 236 and a lower leg 238. In the opening 239 between these legs 236 and 238 is arranged the pivot piece 222. Cabling extends into the support yoke 220. This is illustrated in FIG. 15 by the cable set 501. Associated with the pivot piece 222 and the carriage 226 are pulleys (not shown) that receive the cabling for control of two degrees-of-freedom. This control from the cable set 501 includes pivoting of the entire instrument assembly about the pivot pin 225. This action pivots the guide tube 24 essentially in a single plane. This pivoting is preferably about an incision of the patient which is placed directly under, and in line with, the pivot pin 225. Other cables of set 501 control the carriage 226 in a linear path in the direction of the arrow 227. See also the cables 229 extending between the carriage 226 and the end pieces 241 and 262. The carriage moves the instrument and guide tube 24 back and forth in the direction of the operative site OS. Incidentally, in FIG. 15 the instrument is in its fully advanced state with the tool at the operative site OS.
  • [0116]
    The base piece 234 is the main support for the interchangeable instrument apparatus of the invention. The base piece 234 supports the guide tube 24, the instrument storage chamber 540, and the instrument driver 550. The instrument driver 550 is supported from another carriage, depicted in FIGS. 15 and 17 as the carriage 552, and that, in turn, is supported for translation on the carriage rails 554. The rails 554 are supported at opposite ends at end pieces 556 and 558, in a manner similar to the support for the other carriage 226. A support post 560 interconnects the carriage 552 with the instrument driver housing 570.
  • [0117]
    With further reference to FIG. 15, and as mentioned previously, there are a number of cable sets from bundles 21 and 22 coupled to and for controlling certain actions of the instrument system. Mention has been made of the cable set 501 for controlling instrument pivoting and translation, as previously explained. In addition, FIG. 15 depicts four other cable sets 503, 505, 507, and 509. Cable set 503 controls rotation of the guide tube 24. Cable set 505 controls the carriage 552, and, in turn, the extending and retracting of the instrument driver for instrument exchange. Cable set 507 controls rotation of the instrument through rotation of the instrument driver. Finally, cable set 509 controls the tool via the instrument driver and instrument. There is also one other set of control cables not specifically illustrated in FIG. 15 that controls the indexing motor 565, to be discussed in further detail later.
  • [0118]
    [0118]FIG. 17 shows a cross-sectional view through the interchangeable instrument portion of the overall instrument system. This clearly illustrates the internal cable and pulley arrangement for the various motion controls. There is a pulley 301 driven from the cable set 503 that controls rotation of the guide tube 24. There is also a pulley 303 driven from cable set 505, along with a companion pulley 305 that provides control for the carriage 552. FIG. 17 also illustrates another pulley 307 driven from cable set 507, and for controlling the rotation of the instrument driver 550, and, in turn, the selected instrument.
  • [0119]
    [0119]FIG. 17 illustrates the guide tube 24 supported from the base piece 234. The guide tube 24 is hollow, has a curved distal end as illustrated in FIG. 15, and is adapted to receive the individual instruments or work sections 541 (articulating) or 590 (fluid-filled) disposed in the instrument storage chamber 540, as well as the instrument driver 550. Refer to FIG. 17 for an illustration of the instrument and instrument driver positioned in the guide tube 24. FIG. 17 shows the instrument driver 550 in its rest or disengaged position. The proximal end 24A of the guide tube 24 is supported in the base piece 234 by means of a pair of bearings 235 so that the guide tube 24 is free to rotate in the base piece 234. This rotation is controlled from the pulley 237 which is secured to the outer surface of the guide tube 24 by means of a set screw 231. The pulley 237 is controlled to rotate by means of the cabling 310 that intercouples the pulleys 301 and 237 and that is an extension of the cabling 503. Thus, by means of the cable and pulley arrangement, and by means of the rotational support of the guide tube 24, the rotational position of the guide tube 24 is controlled from cable set 503. Of course, this controlled rotation is effected from the master station via the controller 9, as depicted in the system view of FIG. 1, and as a function of the movements made by the surgeon at the user interface 15.
  • [0120]
    As indicated before the proximal end 24A of the guide tube 24 is supported from the base piece 234. The distal end of the guide tube 24, which is adapted to extend through the patient incision, is disposed at the operative site OS illustrated about the instrument member 20 in FIG. 15, and where a medical or surgical procedure is to be performed. In the system shown in FIG. 15 the distal end of the guide tube 24 is curved at 24B. In this way by rotating the guide tube 24 about its longitudinal axis there is provided a further degree-of-freedom so as to place the distal end of the instrument at any position in three-dimensional space. The rotation of the guide tube 24 enables an orbiting of the instrument end about the axis of the guide tube 24. The guide tube 24 is preferably rigid and constructed of a metal such as aluminum.
  • [0121]
    [0121]FIG. 17 also illustrates a cross-section of the instrument storage chamber 540 including the storage magazine 549, and showing two of the six instrument passages 542 in the storage magazine 549. The instrument storage chamber may also be referred to herein as an instrument retainer. In FIG. 17 one of the fluid retaining instruments 590 is about to be engaged by the instrument driver 550. The other articulating type instrument 541 is in place (storage or rest position) in the instrument storage chamber 540, and out of the path of the instrument driver 550. The instrument 541 carries a gripper tool, but other instruments may also be carried such as a scissors. Because these instruments are adapted to pass to the guide tube 24 and be positioned at the distal end 24B thereof, the body 548 of each instrument is flexible so as to be able to curve with the curvature of the guide tube 24.
  • [0122]
    Although reference is made herein to the separate instrument and instrument driver, such as illustrated in FIG. 17, once they are engaged they function as a single piece instrument member. Accordingly reference is also made herein to the instrument driver 550 as a “driver section” of the overall one piece instrument member, and the instrument 541 or 590 as a “working section” of the instrument member. The instrument member has also been previously discussed as having a “coupling section” or “interface section”, which is defined between the working section and the driver section where the cables interlock by means of an engaging hook arrangement. This is shown in FIG. 17 at 559.
  • [0123]
    The carriage 552 illustrated in FIG. 17 is moved linearly by the cables 555 that extend between pulleys 303 and 305. These cables attach to the carriage 552. The carriage movement is controlled from cable set 505. It is the movement of the carriage 552 that drives the instrument driver (driver section) 550. The instrument driver 550, in its rest or disengaged position, is supported between the instrument driver housing 570 and the wall 562 that is used for support of the instrument storage chamber 540. The instrument magazine 549 is rotationally supported by means of the axle or shaft 547, with the use of bushings or bearings, not shown. This support is between walls 562 and 563.
  • [0124]
    [0124]FIG. 17 shows the very distal end 525 of the instrument driver (transporter) 550 supported at wall 562. In the rest position of the instrument driver 550 the driver is out of engagement with the instruments and the magazine 549, thus permitting rotation of the instrument storage chamber 540. The proximal end 526 of the instrument driver 550 is supported at the instrument driver housing 570. It may be rotationally supported by means of a bushing 527. The instrument driver 550 is supported for rotation, but rotation is only enabled once the driver has engaged the instrument and preferably is at the operative site. The rotation of the instrument driver 550 is controlled from cable set 507 by way of the pulley 307.
  • [0125]
    In FIG. 15 the cable set 509 is illustrated as controlling the instrument motions including tool actuation. These cables control a series of pulleys shown in FIG. 17 as pulleys 529. As indicted in FIG. 17 these pulleys control cabling that extends through the instrument driver and the instrument for control of instrument and tool motions when articulating type tools are selected. The cables that are controlled from these pulleys may control three degrees-of-freedom of the instrument, including pivoting at the wrist and two for gripper action. The same engagement arrangement can be used in this second embodiment of the invention including the mating hook arrangement, interlocked at interface 559 when the instrument driver and instrument are engaged.
  • [0126]
    In one version of the invention a rotating member may be used for control of actuating rods. In the illustrated embodiment of the invention a different arrangement is used that includes a lead screw type of mechanism. This mechanism 591 is illustrated in FIG. 17 next to the pulleys 529. This mechanism includes a drive nut 593 having an internal threaded passage for receiving the actuating rod 592. The actuating rod 592 also has a threaded outer surface and further includes an elongated slot or keyway 594. An anti-rotation key 595 is fixed in position and is adapted to be received in the keyway 594. This engagement between the key 595 and the actuating rod 592, prevents rotation of the actuating rod 592. However, the threaded engagement between the drive nut 593 and the outer threads of the actuating rod 592 enable linear (screw advance) translation of the actuating rod 592. This linear translation of the actuating rod initiates dispensing from the fluid-filled instrument by actuating the instrument member piston.
  • [0127]
    The drive nut 593 is journaled to the housing 570, but is free to rotate relative to the housing. A bearing 596 is provided to enable rotation of the drive nut 593 relative to the housing 570. The cable set 511 couples about the drive nut 593 to cause rotation thereof. Because the key 595 is fixed in position, then the actuating rod 592 can only move linearly in the direction of the arrow 597. The linear translation of the actuating rod 592 is transferred, via the driver 550, to the actuating rod of the instrument member. This action is, in turn, transferred to the dispensing piston of the syringe member 590. For further details refer to the pending applications referred to before and incorporated by reference herein.
  • [0128]
    [0128]FIG. 17 shows one fluid-filled instrument 590. The cable control via the cable set 511 can provide precise movement of the actuating rod 592 so that all or any portion of the liquid in the dispensing member can be ejected at the appropriate body site. If less than all the liquid is ejected then the instrument can be returned to the storage magazine in readiness for a subsequent use. By keeping track of the degrees of rotation of the drive nut 593, one can ascertain how much of the liquid has been dispensed and how much remains in the syringe member.
  • [0129]
    [0129]FIG. 18 is schematic diagram of the catheter system of the present invention as deployed through the urethra for a surgical procedure in the bladder. FIG. 18 provides a schematic cross-sectional diagram illustrating a surgical procedure where catheter K1 enters a natural body orifice, such as the urethra for carrying out procedures in, for example, the bladder. In FIG. 18 catheter K1 is shown extending into bladder B1. In this example, the computer controlled segment, identified as operative, bendable or flexible segment O in FIG. 18, is positioned at a more proximal section of catheter K1. Bladder B1, being an open cavity, does not have lumens leading from the urethra that would naturally guide a catheter towards any particular operative site. Upon entering bladder B1, catheter K1 can bend in any direction including the direction of the operative site. In this embodiment, because of the more proximal positioning of operative segment O, a surgeon can controllably bend the distal end of catheter K towards the operative site. In the embodiment shown in FIG. 18, the distal end of the catheter, labeled P1, can be rigid or be “passively” flexible, i.e. made of a flexible material and not necessarily controlled for flexure under remote computer control. FIG. 18 also shows another instrument system preferably a rigid instrument system including an instrument C extending through an incision D. The instrument shaft carries an end effector C1 that may be a set of jaws. Similarly, the bendable instrument K1 may carry an end effector C2. These instruments are coordinated in their action so that they can operate together in performing a surgical procedure. Refer also to the previous discussion regarding FIG. 3K.
  • [0130]
    Refer now to FIG. 19 for added details of the bladder procedure referenced in FIGS. 3K and 18. This drawing also shows the cross-section through the wall WI of the bladder B1, illustrating the ureter tube T1 that extends through the muscle wall to the kidney. This also shows an inside instrument system I1 with a corresponding end effector, as well as an outside instrument system I2 that likewise carries an end effector. These end effectors may be for sewing or for other purposes depending upon the particular procedure that is to be performed. The inside instrument system is usually flexible, while the outside instrument system may be either flexible or rigid.
  • [0131]
    Reference to a rigid instrument system usually refers to an instrument in which there is a shaft that is primarily rigid and usually meant for insertion into the patient through a small incision such as a laparoscopic incision. However, rigid instruments may also be used to some extent within a natural body orifice. Flexible shaft instruments may be used through a natural body orifice, by percutaneous entry, through an incision or by other means for entry into the patient.
  • [0132]
    [0132]FIG. 20 shows still another instrument system that may be used for suturing, sewing or other surgical procedures in a body cavity or vessel such as in the cavity 193 illustrated. The instrument system 194 uses a single instrument arrangement that actually has two or more work areas. By way of example in FIG. 20 there is, at the very distal end of the instrument system 194, an active work element 195. This may be the same as the instrument end effector 160 illustrated in FIG. 3K or may be a set of jaws. In addition to the active work element 195 the instrument system is also provided with an intermediate work element 197. This is another end effector that is adapted to cooperate with the end effector 195 in performing a surgical procedure. For sewing the end effector 197 may be a hook end effector previously described, or it may be an anvil construction. The end effectors shown in FIG. 20 may also be of other types such as, but not limited to, graspers, needle drivers, cauterizing tools, scalpels, etc. The instrument system shown in FIG. 20 is simple in construction using only a single controlled instrument member. Preferably the shaft of the instrument system is curved back upon itself as illustrated at 198 in FIG. 20. This construction enables the one instrument system to be used for performing a complete surgical procedure such as passing a suture through a fold of tissue as illustrated in FIG. 20.
  • [0133]
    Another concept relates to arthroscopic procedures, but could also apply to other medical procedures. This relates to the use of a single flexible instrument that might be used in, for example, a knee operation through a single entry point, rather than present instrumentation that uses multiple instruments and associated multiple incisions. The procedures described herein are also advantageous in that they can be carried out without requiring open incisions, thus lessening recovery times.
  • [0134]
    The following are some of the additional features that characterize these inventions and relating to the use of multiple instruments, particularly multiple instruments of different types and adapted for different locations of access to anatomic parts of the body.
  • [0135]
    (A) The use of instruments intralumenally minimizes the number of incisions that have to be made in a particular procedure.
  • [0136]
    (B) The intralumenal instrument can be used as a “locator” to assist in locating the extralumenal instrument. For example, one can locate the coronary vessel (often hidden by fat and muscle, and not on the heart surface) for anastomosis by means of the intralumenal instrument.
  • [0137]
    (C) Provides for multiple instruments in a small space. For example, in bowel anastomosis/resection two instruments may be used intralumenally and one used extralumenally.
  • [0138]
    (D) Provides for internal and external control of a surgical procedure. For example, in the repair of a failed AAA stent (see FIG. 3G), the intralumenal instrument stabilizes the stent, bringing the loose stent against the vessel wall, while the extralumenal instrument performs an anchoring through the vessel wall.
  • [0139]
    (E) In all of the above the instruments are preferably computer controllable from a master station with an input device and in coordination with each other. For that purpose the instruments are provided with sensors so each knows the position of the other, and their accurate manipulation can thus be controlled.
  • [0140]
    (F) The control of operations described herein such as sewing or suturing techniques employs algorithms when operation is substantially totally computer controlled. These algorithms can control such parameters as stitch patterns, stitch tension, stitch spacing, tightness and precision of the stitching.
  • [0141]
    While this invention has been particularly shown and described with references to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the invention encompassed by the appended claims.
Citas de patentes
Patente citada Fecha de presentación Fecha de publicación Solicitante Título
US2978118 *3 Nov 19594 Abr 1961Raymond C GoertzManipulator for slave robot
US3923166 *11 Oct 19732 Dic 1975Blaise Herman TRemote manipulator system
US4604016 *3 Ago 19835 Ago 1986Joyce Stephen AMulti-dimensional force-torque hand controller having force feedback
US4654024 *4 Sep 198531 Mar 1987C.R. Bard, Inc.Thermorecanalization catheter and method for use
US4750475 *1 Ago 198614 Jun 1988Kabushiki Kaisha Machida SeisakushoOperating instrument guide mechanism for endoscope apparatus
US4853874 *20 Nov 19871 Ago 1989Hitachi, Ltd.Master-slave manipulators with scaling
US4941454 *5 Oct 198917 Jul 1990Welch Allyn, Inc.Servo actuated steering mechanism for borescope or endoscope
US4977886 *27 Oct 198918 Dic 1990Olympus Optical Co., Ltd.Position controlling apparatus
US5052402 *24 Ene 19911 Oct 1991C.R. Bard, Inc.Disposable biopsy forceps
US5072361 *1 Feb 199010 Dic 1991Sarcos GroupForce-reflective teleoperation control system
US5078140 *23 Sep 19867 Ene 1992Kwoh Yik SImaging device - aided robotic stereotaxis system
US5084054 *5 Mar 199028 Ene 1992C.R. Bard, Inc.Surgical gripping instrument
US5086401 *11 May 19904 Feb 1992International Business Machines CorporationImage-directed robotic system for precise robotic surgery including redundant consistency checking
US5116180 *3 May 199026 May 1992Spar Aerospace LimitedHuman-in-the-loop machine control loop
US5172700 *17 Sep 199022 Dic 1992C. R. Bard, Inc.Disposable biopsy forceps
US5184601 *5 Ago 19919 Feb 1993Putman John MEndoscope stabilizer
US5217003 *18 Mar 19918 Jun 1993Wilk Peter JAutomated surgical system and apparatus
US5238002 *8 Jun 199224 Ago 1993C. R. Bard, Inc.Disposable biopsy forceps
US5238005 *18 Nov 199124 Ago 1993Intelliwire, Inc.Steerable catheter guidewire
US5271381 *18 Nov 199121 Dic 1993Vision Sciences, Inc.Vertebrae for a bending section of an endoscope
US5287861 *30 Oct 199222 Feb 1994Wilk Peter JCoronary artery by-pass method and associated catheter
US5325845 *8 Jun 19925 Jul 1994Adair Edwin LloydSteerable sheath for use with selected removable optical catheter
US5339799 *17 Abr 199223 Ago 1994Olympus Optical Co., Ltd.Medical system for reproducing a state of contact of the treatment section in the operation unit
US5347987 *4 May 199220 Sep 1994Feldstein David ASelf-centering endoscope system
US5350355 *14 Feb 199227 Sep 1994Automated Medical Instruments, Inc.Automated surgical instrument
US5368015 *7 Jun 199329 Nov 1994Wilk; Peter J.Automated surgical system and apparatus
US5397323 *30 Oct 199214 Mar 1995International Business Machines CorporationRemote center-of-motion robot for surgery
US5409019 *3 Nov 199325 Abr 1995Wilk; Peter J.Coronary artery by-pass method
US5410638 *3 May 199325 Abr 1995Northwestern UniversitySystem for positioning a medical instrument within a biotic structure using a micromanipulator
US5429144 *5 Abr 19944 Jul 1995Wilk; Peter J.Coronary artery by-pass method
US5441505 *28 Ene 199415 Ago 1995Mitaka Kohki Co., Ltd.Medical locating apparatus
US5497784 *30 Jun 199412 Mar 1996Intelliwire, Inc.Flexible elongate device having steerable distal extremity
US5515478 *13 Sep 19947 May 1996Computer Motion, Inc.Automated endoscope system for optimal positioning
US5520644 *1 Jul 199328 May 1996Intelliwire, Inc.Flexible elongate device having steerable distal extremity and apparatus for use therewith and method
US5524180 *3 Jun 19934 Jun 1996Computer Motion, Inc.Automated endoscope system for optimal positioning
US5572999 *26 Ene 199512 Nov 1996International Business Machines CorporationRobotic system for positioning a surgical instrument relative to a patient's body
US5586968 *15 Dic 199324 Dic 1996Gruendl; AndreasMethod and apparatus for moving an endoscope along a canal-shaped cavity
US5618294 *21 Jul 19958 Abr 1997Aust & Taylor Medical CorporationSurgical instrument
US5624398 *8 Feb 199629 Abr 1997Symbiosis CorporationEndoscopic robotic surgical tools and methods
US5626553 *29 Abr 19966 May 1997Vision-Sciences, Inc.Endoscope articulation system to reduce effort during articulation of an endoscope
US5626595 *11 Oct 19946 May 1997Automated Medical Instruments, Inc.Automated surgical instrument
US5631973 *5 May 199420 May 1997Sri InternationalMethod for telemanipulation with telepresence
US5632758 *5 Jul 199427 May 1997Automated Medical Instruments, Inc.Automated surgical instrument
US5640649 *2 Jun 199417 Jun 1997Canon Kabushiki KaishaImage forming apparatus with detachably mounted cartridge and image light path formed upon attachment
US5649956 *7 Jun 199522 Jul 1997Sri InternationalSystem and method for releasably holding a surgical instrument
US5667476 *5 Jun 199516 Sep 1997Vision-Sciences, Inc.Endoscope articulation system to reduce effort during articulation of an endoscope
US5762458 *20 Feb 19969 Jun 1998Computer Motion, Inc.Method and apparatus for performing minimally invasive cardiac procedures
US5784542 *23 Oct 199621 Jul 1998California Institute Of TechnologyDecoupled six degree-of-freedom teleoperated robot system
US5792135 *16 May 199711 Ago 1998Intuitive Surgical, Inc.Articulated surgical instrument for performing minimally invasive surgery with enhanced dexterity and sensitivity
US5800423 *20 Jul 19951 Sep 1998Sri InternationalRemote center positioner with channel shaped linkage element
US5807377 *16 May 199715 Sep 1998Intuitive Surgical, Inc.Force-reflecting surgical instrument and positioning mechanism for performing minimally invasive surgery with enhanced dexterity and sensitivity
US5807378 *6 Oct 199715 Sep 1998Sri InternationalSurgical manipulator for a telerobotic system
US5808665 *9 Sep 199615 Sep 1998Sri InternationalEndoscopic surgical instrument and method for use
US5810880 *1 May 199722 Sep 1998Sri InternationalSystem and method for releasably holding a surgical instrument
US5814038 *27 Mar 199729 Sep 1998Sri InternationalSurgical manipulator for a telerobotic system
US5815640 *31 Jul 199729 Sep 1998Computer Motion, Inc.Automated endoscope system for optimal positioning
US5817084 *20 Jul 19956 Oct 1998Sri InternationalRemote center positioning device with flexible drive
US5823993 *27 Nov 199520 Oct 1998Lemelson; Jerome H.Computer controlled drug injection system and method
US5833656 *3 Ene 199710 Nov 1998Symbiosis CorporationEndoscopic robotic surgical tools and methods
US5845646 *5 Nov 19968 Dic 1998Lemelson; JeromeSystem and method for treating select tissue in a living being
US5855583 *22 Nov 19965 Ene 1999Computer Motion, Inc.Method and apparatus for performing minimally invasive cardiac procedures
US5861024 *20 Jun 199719 Ene 1999Cardiac Assist Devices, IncElectrophysiology catheter and remote actuator therefor
US5876325 *30 Sep 19972 Mar 1999Olympus Optical Co., Ltd.Surgical manipulation system
US5878193 *16 Oct 19962 Mar 1999Computer Motion, Inc.Automated endoscope system for optimal positioning
US5907664 *11 Mar 199625 May 1999Computer Motion, Inc.Automated endoscope system for optimal positioning
US5928248 *25 Feb 199827 Jul 1999Biosense, Inc.Guided deployment of stents
US5931832 *20 Jul 19953 Ago 1999Sri InternationalMethods for positioning a surgical instrument about a remote spherical center of rotation
US5954692 *9 Jul 199721 Sep 1999SymbiosisEndoscopic robotic surgical tools and methods
US5964717 *6 Ene 199712 Oct 1999Symbiosis CorporationBiopsy forceps having detachable handle and distal jaws
US5976122 *25 Feb 19982 Nov 1999Integrated Surgical Systems, Inc.Articulated surgical instrument for performing minimally invasive surgery with enhanced dexterity and sensitivity
US6001108 *30 Dic 199714 Dic 1999Computer Motion, Inc.Method and apparatus for performing minimally invasive cardiac procedures
US6024695 *6 May 199915 Feb 2000International Business Machines CorporationSystem and method for augmentation of surgery
US6035856 *6 Mar 199714 Mar 2000Scimed Life SystemsPercutaneous bypass with branching vessel
US6058323 *20 Ago 19972 May 2000Lemelson; JeromeSystem and method for treating select tissue in a living being
US6063095 *18 Sep 199816 May 2000Computer Motion, Inc.Method and apparatus for performing minimally invasive surgical procedures
US6080181 *26 Jun 199827 Jun 2000Sri InternationalSystem and method for releasably holding a surgical instrument
US6096004 *10 Jul 19981 Ago 2000Mitsubishi Electric Information Technology Center America, Inc. (Ita)Master/slave system for the manipulation of tubular medical tools
US6102850 *11 Jun 199715 Ago 2000Computer Motion, Inc.Medical robotic system
US6106511 *8 Sep 199822 Ago 2000Sri InternationalMethods and devices for positioning a surgical instrument at a surgical site
US6120433 *14 Oct 199719 Sep 2000Olympus Optical Co., Ltd.Surgical manipulator system
US6132368 *21 Nov 199717 Oct 2000Intuitive Surgical, Inc.Multi-component telepresence system and method
US6197017 *17 Ago 19996 Mar 2001Brock Rogers Surgical, Inc.Articulated apparatus for telemanipulator system
US6206903 *8 Oct 199927 Mar 2001Intuitive Surgical, Inc.Surgical tool with mechanical advantage
US6223100 *25 Mar 199824 Abr 2001Sri, InternationalApparatus and method for performing computer enhanced surgery with articulated instrument
US6231565 *18 Jun 199815 May 2001United States Surgical CorporationRobotic arm DLUs for performing surgical tasks
US6246200 *3 Ago 199912 Jun 2001Intuitive Surgical, Inc.Manipulator positioning linkage for robotic surgery
US6301526 *6 Ene 20009 Oct 2001Institute Of Science And TechnologyMaster device having force reflection function
US6309397 *2 Dic 199930 Oct 2001Sri InternationalAccessories for minimally invasive robotic surgery and methods
US6312435 *8 Oct 19996 Nov 2001Intuitive Surgical, Inc.Surgical instrument with extended reach for use in minimally invasive surgery
US6341231 *11 Oct 200022 Ene 2002Visualization Technology, Inc.Position tracking and imaging system for use in medical applications
US6352503 *15 Jul 19995 Mar 2002Olympus Optical Co., Ltd.Endoscopic surgery apparatus
US6364888 *7 Abr 19992 Abr 2002Intuitive Surgical, Inc.Alignment of master and slave in a minimally invasive surgical apparatus
US6369834 *2 Jun 19999 Abr 2002Massachusetts Institute Of TechnologyMethod and apparatus for determining forces to be applied to a user through a haptic interface
US6371907 *13 Ago 199816 Abr 2002Olympus Optical Co., Ltd.Endoscope apparatus driving manipulation wires with drive motor in drum portion
US6394998 *17 Sep 199928 May 2002Intuitive Surgical, Inc.Surgical tools for use in minimally invasive telesurgical applications
US6398726 *9 Nov 19994 Jun 2002Intuitive Surgical, Inc.Stabilizer for robotic beating-heart surgery
US6459926 *17 Sep 19991 Oct 2002Intuitive Surgical, Inc.Repositioning and reorientation of master/slave relationship in minimally invasive telesurgery
US6569084 *28 Mar 200027 May 2003Olympus Optical Co., Ltd.Endoscope holder and endoscope device
US6997871 *6 Sep 200114 Feb 2006Medigus Ltd.Multiple view endoscopes
Citada por
Patente citante Fecha de presentación Fecha de publicación Solicitante Título
US733851314 Dic 20054 Mar 2008Cambridge Endoscopic Devices, Inc.Surgical instrument
US73645828 May 200629 Abr 2008Cambridge Endoscopic Devices, Inc.Surgical instrument
US7395563 *1 Abr 20058 Jul 2008Civco Medical Instruments Co., Inc.Support system for use when performing medical imaging of a patient
US761506719 Sep 200610 Nov 2009Cambridge Endoscopic Devices, Inc.Surgical instrument
US76452873 May 200512 Ene 2010Ethicon Endo-Surgery, Inc.Articulating anastomotic ring applier
US76485192 Ene 200719 Ene 2010Cambridge Endoscopic Devices, Inc.Surgical instrument
US768682620 Jul 200530 Mar 2010Cambridge Endoscopic Devices, Inc.Surgical instrument
US770875828 Nov 20064 May 2010Cambridge Endoscopic Devices, Inc.Surgical instrument
US771319014 Jun 200711 May 2010Hansen Medical, Inc.Flexible instrument
US776689428 Ago 20063 Ago 2010Hansen Medical, Inc.Coaxial catheter system
US78420283 Oct 200530 Nov 2010Cambridge Endoscopic Devices, Inc.Surgical instrument guide device
US7850642 *6 Jul 200514 Dic 2010Hansen Medical, Inc.Methods using a robotic catheter system
US7922693 *19 Mar 200812 Abr 2011Hansen Medical, Inc.Apparatus systems and methods for flushing gas from a catheter of a robotic catheter system
US795531613 Jun 20077 Jun 2011Han Sen Medical, Inc.Coaxial catheter system
US79722984 Mar 20055 Jul 2011Hansen Medical, Inc.Robotic catheter system
US797467429 Dic 20065 Jul 2011St. Jude Medical, Atrial Fibrillation Division, Inc.Robotic surgical system and method for surface modeling
US7974681 *6 Jul 20055 Jul 2011Hansen Medical, Inc.Robotic catheter system
US797653919 Jul 200512 Jul 2011Hansen Medical, Inc.System and method for denaturing and fixing collagenous tissue
US80027842 May 200723 Ago 2011Terumo Kabushiki KaishaManipulator
US8005537 *12 Ago 200523 Ago 2011Hansen Medical, Inc.Robotically controlled intravascular tissue injection system
US80055713 Jul 200623 Ago 2011Neuroarm Surgical Ltd.Microsurgical robot system
US8021326 *6 Jul 200520 Sep 2011Hansen Medical, Inc.Instrument driver for robotic catheter system
US802953127 Sep 20064 Oct 2011Cambridge Endoscopic Devices, Inc.Surgical instrument
US80414596 Feb 200818 Oct 2011Neuroarm Surgical Ltd.Methods relating to microsurgical robot system
US8052636 *3 Jul 20068 Nov 2011Hansen Medical, Inc.Robotic catheter system and methods
US80837652 Dic 200927 Dic 2011Cambridge Endoscopic Devices, Inc.Surgical instrument
US810535016 Ago 200631 Ene 2012Cambridge Endoscopic Devices, Inc.Surgical instrument
US810806910 Ene 200831 Ene 2012Hansen Medical, Inc.Robotic catheter system and methods
US8123675 *21 Jul 200828 Feb 2012International Business Machines CorporationSystem and method for augmentation of endoscopic surgery
US815591022 Ago 200710 Abr 2012St. Jude Medical, Atrial Fibrillation Divison, Inc.Robotically controlled catheter and method of its calibration
US81707176 Feb 20081 May 2012Neuroarm Surgical Ltd.Microsurgical robot system
US821612524 Oct 200810 Jul 2012Civco Medical Instruments Co., Inc.System and method for positioning a laparoscopic device
US82214503 Mar 200817 Jul 2012Cambridge Endoscopic Devices, Inc.Surgical instrument
US8257303 *2 Sep 20114 Sep 2012Hansen Medical, Inc.Robotic catheter system and methods
US825738611 Sep 20074 Sep 2012Cambridge Endoscopic Devices, Inc.Surgical instrument
US831162621 Jul 201113 Nov 2012Hansen Medical, Inc.Robotically controlled intravascular tissue injection system
US8317746 *22 Jul 200927 Nov 2012Hansen Medical, Inc.Automated alignment
US833320422 Jun 200918 Dic 2012Hansen Medical, Inc.Apparatus and methods for treating tissue
US83770772 Mar 201119 Feb 2013Hansen Medical, Inc.Apparatus systems and methods for flushing gas from catheter of a robotic catheter system
US839405427 May 201112 Mar 2013Hansen Medical, Inc.Robotic catheter system
US839411522 Mar 200612 Mar 2013Ethicon Endo-Surgery, Inc.Composite end effector for an ultrasonic surgical instrument
US839659822 Nov 200612 Mar 2013Neuroarm Surgical Ltd.Microsurgical robot system
US84070236 Abr 201226 Mar 2013St. Jude Medical, Atrial Fibrillation Division, Inc.Robotically controlled catheter and method of its calibration
US840913627 May 20112 Abr 2013Hansen Medical, Inc.Robotic catheter system
US84091756 May 20092 Abr 2013Woojin LeeSurgical instrument guide device
US840924522 May 20072 Abr 2013Woojin LeeSurgical instrument
US84254047 Oct 201023 Abr 2013Civco Medical Instruments Co., Inc.System and method for positioning a laparoscopic device
US844463122 Dic 200821 May 2013Macdonald Dettwiler & Associates IncSurgical manipulator
US849160314 Jun 200723 Jul 2013MacDonald Dettwiller and Associates Inc.Surgical manipulator
US852388318 Ago 20113 Sep 2013Hansen Medical, Inc.Apparatus and methods for treating tissue
US852856529 Dic 200610 Sep 2013St. Jude Medical, Atrial Fibrillation Division, Inc.Robotic surgical system and method for automated therapy delivery
US855108425 Jun 20128 Oct 2013St. Jude Medical, Atrial Fibrillation Division, Inc.Radio frequency ablation servo catheter and method
US860306831 Ene 200810 Dic 2013Hansen Medical Inc.Coaxial catheter system
US861710225 Ene 201231 Dic 2013Hansen Medical, Inc.Robotic catheter system and methods
US865203129 Dic 201118 Feb 2014St. Jude Medical, Atrial Fibrillation Division, Inc.Remote guidance system for medical devices for use in environments having electromagnetic interference
US865778115 Nov 201225 Feb 2014Hansen Medical, Inc.Automated alignment
US87090376 Abr 201029 Abr 2014Woojin LeeSurgical instrument
US875586429 Dic 200617 Jun 2014St. Jude Medical, Atrial Fibrillation Division, Inc.Robotic surgical system and method for diagnostic data mapping
US88016617 Nov 201312 Ago 2014Hansen Medical, Inc.Robotic catheter system and methods
US880175229 Jul 200912 Ago 2014Covidien LpArticulating surgical device
US892659727 May 20086 Ene 2015Cambridge Endoscopic Devices, Inc.Surgical instrument guide device
US89266039 Mar 20116 Ene 2015Hansen Medical, Inc.System and method for denaturing and fixing collagenous tissue
US89563679 Nov 200617 Feb 2015Barry M. FellSystem and method for shaping an anatomical component
US896827620 Dic 20113 Mar 2015Covidien LpHand held surgical handle assembly, surgical adapters for use between surgical handle assembly and surgical end effectors, and methods of use
US896835515 Mar 20113 Mar 2015Covidien LpArticulating surgical device
US8974408 *1 Mar 201310 Mar 2015Hansen Medical, Inc.Robotic catheter system
US900523819 Ago 200814 Abr 2015Covidien LpEndoscopic surgical devices
US901654521 Ago 201428 Abr 2015Covidien LpApparatus for endoscopic procedures
US90230149 Jul 20125 May 2015Covidien LpQuick connect assembly for use between surgical handle assembly and surgical accessories
US903399812 May 201119 May 2015Titan Medical Inc.Independent roll wrist mechanism
US905594331 May 201216 Jun 2015Covidien LpHand held surgical handle assembly, surgical adapters for use between surgical handle assembly and surgical end effectors, and methods of use
US908462128 Nov 200721 Jul 2015Boston Scientific Scimed, Inc.Guide tube systems and methods
US91381667 Dic 201122 Sep 2015Hansen Medical, Inc.Apparatus and methods for fiber integration and registration
US916805019 Mar 201227 Oct 2015Cambridge Endoscopic Devices, Inc.End effector construction
US9186043 *18 Sep 201317 Nov 2015Covidien LpLaparoscopic scaffold assembly
US920493517 Jun 20148 Dic 2015St. Jude Medical, Atrial Fibrillation Division, Inc.Robotic surgical system and method for diagnostic data mapping
US921601318 Feb 201322 Dic 2015Covidien LpApparatus for endoscopic procedures
US922056716 Abr 200729 Dic 2015Neuroarm Surgical Ltd.Microsurgical robot system
US92329796 Feb 201312 Ene 2016Ethicon Endo-Surgery, Inc.Robotically controlled surgical instrument
US923793027 Feb 201319 Ene 2016St. Jude Medical, Atrial Fibrillation Division, Inc.Robotically controlled catheter and method of its calibration
US924172815 Mar 201326 Ene 2016Ethicon Endo-Surgery, Inc.Surgical instrument with multiple clamping mechanisms
US928296318 Sep 201215 Mar 2016Covidien LpAdapter for powered surgical devices
US9283045 *29 Jun 201215 Mar 2016Ethicon Endo-Surgery, LlcSurgical instruments with fluid management system
US928926628 Nov 200722 Mar 2016Boston Scientific Scimed, Inc.On-axis drive systems and methods
US92955228 Nov 201329 Mar 2016Covidien LpMedical device adapter with wrist mechanism
US930169117 Oct 20145 Abr 2016Covidien LpInstrument for optically detecting tissue attributes
US931430630 Jun 201119 Abr 2016Hansen Medical, Inc.Systems and methods for manipulating an elongate member
US932678829 Jun 20123 May 2016Ethicon Endo-Surgery, LlcLockout mechanism for use with robotic electrosurgical device
US932682214 Mar 20133 May 2016Hansen Medical, Inc.Active drives for robotic catheter manipulators
US933304121 May 201310 May 2016Macdonald, Dettwiler And Associates Inc.Surgical manipulator
US933928918 Jun 201517 May 2016Ehticon Endo-Surgery, LLCUltrasonic surgical instrument blades
US934546228 Nov 200724 May 2016Boston Scientific Scimed, Inc.Direct drive endoscopy systems and methods
US93579848 Abr 20147 Jun 2016Covidien LpConstant value gap stabilizer for articulating links
US935807613 Abr 20157 Jun 2016Hansen Medical, Inc.System and method for endoluminal and translumenal therapy
US936422017 Abr 201314 Jun 2016Covidien LpApparatus for endoscopic procedures
US937036111 Jul 201321 Jun 2016Covidien LpSurgical stapler with timer and feedback display
US939303729 Jun 201219 Jul 2016Ethicon Endo-Surgery, LlcSurgical instruments with articulating shafts
US94026048 May 20132 Ago 2016Covidien LpApparatus for endoscopic procedures
US940862229 Jun 20129 Ago 2016Ethicon Endo-Surgery, LlcSurgical instruments with articulating shafts
US940866915 Mar 20139 Ago 2016Hansen Medical, Inc.Active drive mechanism with finite range of motion
US941485325 Mar 201316 Ago 2016Ethicon Endo-Surgery, LlcUltrasonic end effectors with increased active length
US942100318 Feb 201323 Ago 2016Covidien LpApparatus for endoscopic procedures
US942101431 Jul 201323 Ago 2016Covidien LpLoading unit velocity and position feedback
US9421071 *28 Nov 200723 Ago 2016Boston Scientific Scimed, Inc.Direct drive methods
US942724910 May 201330 Ago 2016Ethicon Endo-Surgery, LlcRotatable cutting implements with friction reducing material for ultrasonic surgical instruments
US942725614 Nov 201430 Ago 2016Cambridge Endoscopic Devices, Inc.Surgical instrument guide device
US943966815 Mar 201313 Sep 2016Ethicon Endo-Surgery, LlcSwitch arrangements for ultrasonic surgical instruments
US945687728 Nov 20074 Oct 2016Boston Scientific Scimed, Inc.Direct drive instruments and methods of use
US9457168 *19 Jun 20144 Oct 2016Hansen Medical, Inc.Robotic catheter system and methods
US948049219 Jun 20131 Nov 2016Covidien LpApparatus for endoscopic procedures
US949214610 May 201315 Nov 2016Covidien LpApparatus for endoscopic procedures
US949218913 Mar 201315 Nov 2016Covidien LpApparatus for endoscopic procedures
US9498291 *15 Mar 201322 Nov 2016Hansen Medical, Inc.Touch-free catheter user interface controller
US95044833 Jul 201229 Nov 2016Ethicon Endo-Surgery, LlcSurgical instruments
US950485520 Mar 201529 Nov 2016Ethicon Surgery, LLCDevices and techniques for cutting and coagulating tissue
US951085011 Nov 20136 Dic 2016Ethicon Endo-Surgery, LlcUltrasonic surgical instruments
US953312211 Ene 20083 Ene 2017Boston Scientific Scimed, Inc.Catheter drive system with control handle rotatable about two axes separated from housing by shaft
US9539726 *6 May 201410 Ene 2017Vanderbilt UniversitySystems and methods for safe compliant insertion and hybrid force/motion telemanipulation of continuum robots
US954972019 Abr 201324 Ene 2017Vanderbilt UniversityRobotic device for establishing access channel
US9561021 *26 Abr 20117 Feb 2017Boston Scientific Scimed, Inc.Method and system for intracavitary and extracavitary procedures
US95661199 Ago 201314 Feb 2017St. Jude Medical, Atrial Fibrillation Division, Inc.Robotic surgical system and method for automated therapy delivery
US956612613 Sep 201114 Feb 2017Boston Scientific Scimed, Inc.Direct drive endoscopy systems and methods
US95662015 Jun 201314 Feb 2017Hansen Medical, Inc.Mounting support assembly for suspending a medical instrument driver above an operating table
US95971042 May 201321 Mar 2017Covidien LpHandheld surgical handle assembly, surgical adapters for use between surgical handle assembly and surgical end effectors, and methods of use
US962323728 Sep 201518 Abr 2017Ethicon Endo-Surgery, LlcSurgical generator for ultrasonic and electrosurgical devices
US962968222 Dic 201425 Abr 2017Hansen Medical, Inc.Robotic catheter system
US963613510 Nov 20142 May 2017Ethicon Endo-Surgery, LlcUltrasonic surgical instruments
US964264412 Mar 20159 May 2017Ethicon Endo-Surgery, LlcSurgical instruments
US96491266 Ene 201516 May 2017Ethicon Endo-Surgery, LlcSeal arrangements for ultrasonically powered surgical instruments
US967537529 Mar 200613 Jun 2017Ethicon LlcUltrasonic surgical system and method
US968730319 Abr 201327 Jun 2017Vanderbilt UniversityDexterous wrists for surgical intervention
US97003189 Abr 201311 Jul 2017Covidien LpApparatus for endoscopic procedures
US970033920 May 200911 Jul 2017Ethicon Endo-Surgery, Inc.Coupling arrangements and methods for attaching tools to ultrasonic surgical instruments
US97003432 Nov 201511 Jul 2017Ethicon Endo-Surgery, LlcDevices and techniques for cutting and coagulating tissue
US970698131 Jul 201318 Jul 2017Covidien LpHand-held surgical devices
US970700412 Mar 201518 Jul 2017Ethicon LlcSurgical instruments
US97135074 Ene 201625 Jul 2017Ethicon Endo-Surgery, LlcClosed feedback control for electrosurgical device
US972411815 Mar 20138 Ago 2017Ethicon Endo-Surgery, LlcTechniques for cutting and coagulating tissue for ultrasonic surgical instruments
US973732623 Oct 201522 Ago 2017Ethicon Endo-Surgery, LlcHaptic feedback devices for surgical robot
US97439479 Dic 201529 Ago 2017Ethicon Endo-Surgery, LlcEnd effector with a clamp arm assembly and blade
US976366130 Abr 201519 Sep 2017Covidien LpAdapter assembly for interconnecting electromechanical surgical devices and surgical loading units, and surgical systems thereof
US976416420 Dic 201319 Sep 2017Ethicon LlcUltrasonic surgical instruments
US977561016 May 20143 Oct 2017Covidien LpApparatus for endoscopic procedures
US978213029 Dic 200610 Oct 2017St. Jude Medical, Atrial Fibrillation Division, Inc.Robotic surgical system
US978218730 Dic 201310 Oct 2017Covidien LpAdapter load button lockout
US979540518 Feb 201524 Oct 2017Ethicon LlcSurgical instrument
US979580813 Mar 201524 Oct 2017Ethicon LlcDevices and techniques for cutting and coagulating tissue
US979748623 May 201424 Oct 2017Covidien LpAdapter direct drive with manual retraction, lockout and connection mechanisms
US98016469 May 201431 Oct 2017Covidien LpAdapter load button decoupled from loading unit sensor
US980164828 Oct 201431 Oct 2017Ethicon LlcSurgical instruments
US980824515 Oct 20147 Nov 2017Covidien LpCoupling assembly for interconnecting an adapter assembly and a surgical device, and surgical systems thereof
US20050072260 *3 Oct 20037 Abr 2005Anani AnanievMethod for driving multiple-module mechanisms by a single motor and redundant modular robots produced therefrom
US20050222554 *4 Mar 20056 Oct 2005Wallace Daniel TRobotic catheter system
US20060016006 *1 Abr 200526 Ene 2006Whitmore Willet F IiiSupport system for use when performing medical imaging of a patient
US20060020287 *20 Jul 200526 Ene 2006Woojin LeeSurgical instrument
US20060058617 *10 Ago 200516 Mar 2006Daisuke SanoMethod and system for displaying medical images
US20060084945 *6 Jul 200520 Abr 2006Hansen Medical, Inc.Instrument driver for robotic catheter system
US20060095022 *6 Jul 20054 May 2006Moll Frederic HMethods using a robotic catheter system
US20060095074 *14 Dic 20054 May 2006Cambridge Endoscopic Devices, Inc.Surgical instrument
US20060111692 *12 Ago 200525 May 2006Hlavka Edwin JRobotically controlled intravascular tissue injection system
US20060206101 *8 May 200614 Sep 2006Woojin LeeSurgical instrument
US20060253138 *3 May 20059 Nov 2006Ethicon Endo-Surgery, Inc.Articulating anastomotic ring applier
US20060293643 *6 Jul 200528 Dic 2006Wallace Daniel TRobotic catheter system
US20070021737 *3 Oct 200525 Ene 2007Woojin LeeSurgical instrument guide device
US20070043338 *3 Jul 200622 Feb 2007Hansen Medical, IncRobotic catheter system and methods
US20070049966 *22 Mar 20061 Mar 2007Frank BonadioSurgical instrument
US20070213749 *8 Mar 200613 Sep 2007Olympus Medical Systems Corp.Medical procedure performed inside abdominal cavity
US20070225608 *22 Mar 200627 Sep 2007Ethicon Endo-Surgery, Inc.Composite end effector for an ultrasonic surgical instrument
US20070239028 *29 Mar 200611 Oct 2007Ethicon Endo-Surgery, Inc.Ultrasonic surgical system and method
US20070276430 *16 Ago 200629 Nov 2007Cambridge Endoscopic Devices, Inc.Surgical instrument
US20070282371 *19 Sep 20066 Dic 2007Cambridge Endoscopic Devices, Inc.Surgical instrument
US20070288044 *2 May 200713 Dic 2007Terumo Kabushiki KaishaManipulator
US20080015631 *27 Sep 200617 Ene 2008Woojin LeeSurgical instrument
US20080046000 *28 Nov 200621 Feb 2008Woojin LeeSurgical instrument
US20080188868 *28 Nov 20077 Ago 2008Barry WeitznerDirect drive endoscopy systems and methods
US20080188871 *28 Nov 20077 Ago 2008Smith Paul JDirect drive methods
US20080221391 *28 Nov 200711 Sep 2008Barry WeitznerDirect drive instruments and methods of use
US20080234631 *19 Mar 200825 Sep 2008Hansen Medical, Inc.Apparatus systems and methods for flushing gas from a catheter of a robotic catheter system
US20080262492 *27 May 200823 Oct 2008Cambridge Endoscopic Devices, Inc.Surgical Instrument
US20080269727 *27 May 200830 Oct 2008Cambridge Endoscopic Devices, Inc.Surgical instrument guide device
US20080281335 *9 Nov 200613 Nov 2008Fell Barry MSystem and Method For Shaping an Anatomical Component
US20080287862 *11 Ene 200820 Nov 2008Boston Scientific Scimed, Inc.Drive systems and methods of use
US20080294191 *22 May 200727 Nov 2008Woojin LeeSurgical instrument
US20090023995 *27 May 200822 Ene 2009Cambridge Endoscopic Devices, Inc.Surgical instrument guide device
US20090048611 *21 Jul 200819 Feb 2009International Business Machines CorporationSystem and method for augmentation of endoscopic surgery
US20090054734 *19 Ago 200826 Feb 2009Tyco Healthcare Group LpEndoscopic surgical devices
US20090069842 *11 Sep 200712 Mar 2009Woojin LeeSurgical instrument
US20090171147 *31 Dic 20072 Jul 2009Woojin LeeSurgical instrument
US20090247819 *24 Oct 20081 Oct 2009Wilson Roger FSystem and method for positioning a laparoscopic device
US20090299344 *6 May 20093 Dic 2009Woojin LeeSurgical instrument guide device
US20100030018 *29 Jul 20094 Feb 2010Richard FortierArticulating surgical device
US20100125285 *22 Jul 200920 May 2010Hansen Medical, Inc.Automated alignment
US20100168722 *2 Dic 20091 Jul 2010Cambridge Endoscopic Devices, Inc.Surgical Instrument
US20100228235 *6 Abr 20109 Sep 2010Cambridge Endoscopic Devices, Inc.Surgical instrument
US20100249497 *15 Sep 200930 Sep 2010Peine William JSurgical instrument
US20110022034 *7 Oct 201027 Ene 2011Civco Medical Instruments Co., Inc.System and method for positioning a laparoscopic device
US20110112517 *6 Nov 200912 May 2011Peine Willliam JSurgical instrument
US20110152883 *2 Mar 201123 Jun 2011Hansen Medical, Inc.Apparatus systems and methods for flushing gas from a catheter of a robotic catheter system
US20110184459 *15 Mar 201128 Jul 2011Malkowski Jaroslaw TArticulating Surgical Device
US20110276038 *26 Abr 201110 Nov 2011Boston Scientific Scimed, Inc.Method and system for intracavitary and extracavitary procedures
US20120065467 *2 Sep 201115 Mar 2012Hansen Medical, Inc.Robotic catheter system and methods
US20120136370 *22 Nov 201131 May 2012Olympus CorporationMedical manipulator
US20120143211 *1 Dic 20117 Jun 2012Olympus CorporationSurgical instrument and operation support system having the surgical instrument
US20130190741 *11 Mar 201325 Jul 2013Hansen Medical, Inc.Systems and methods for performing minimally invasive procedures
US20130231679 *1 Mar 20135 Sep 2013Hansen Medical, Inc.Robotic catheter system
US20140005668 *29 Jun 20122 Ene 2014Ethicon Endo-Surgery, Inc.Surgical instruments with fluid management system
US20140018614 *18 Sep 201316 Ene 2014Covidien LpLaparoscopic scaffold assembly
US20140243849 *26 Feb 201428 Ago 2014Remzi SaglamRemotely-operated robotic control system for use with a medical instrument and associated use thereof
US20140276934 *15 Mar 201318 Sep 2014Hansen Medical, Inc.Touch-free catheter user interface controller
US20140296875 *19 Jun 20142 Oct 2014Hansen Medical, Inc.Robotic catheter system and methods
US20140330432 *6 May 20146 Nov 2014Vanderbilt UniversitySystems and methods for safe compliant insertion and hybrid force/motion telemanipulation of continuum robots
US20170086929 *3 Oct 201630 Mar 2017Hansen Medical, Inc.Robotic catheter system and methods
CN102768541A *28 Abr 20127 Nov 2012中国科学院深圳先进技术研究院Control method and system for surgical robot
CN103025225A *26 Jul 20113 Abr 2013纽约市哥伦比亚大学理事会Rapidly deployable flexible robotic instrumentation
EP1719451A1 *2 May 20068 Nov 2006Ethicon Endo-Surgery, Inc.Articulating anastomotic ring applier
EP1839599A1 *28 Mar 20073 Oct 2007Ethicon Endo-Surgery, Inc.Ultrasonic surgical system and method
EP1847223A1 *19 Abr 200624 Oct 2007Hormoz MehmaneshActuator for minimally invasive surgery
EP1854418A18 May 200714 Nov 2007Terumo Kabushiki KaishaManipulator
EP2687164A3 *17 Jul 201323 Abr 2014Covidien LPApparatus for endoscopic procedures
WO2005096764A3 *1 Abr 20054 Jun 2009Civco Medical Instr Co IncSupport system for use when performing medical imaging of a patient
WO2008086493A2 *10 Ene 200817 Jul 2008Hansen Medical, Inc.Robotic catheter system
WO2008086493A3 *10 Ene 20084 Sep 2008Hansen Medical IncRobotic catheter system
WO2012015816A1 *26 Jul 20112 Feb 2012The Trustees Of Columbia University In The City Of New YorkRapidly deployable flexible robotic instrumentation
WO2013170245A3 *13 May 201320 Mar 2014Ethicon, Inc.Applicator instruments with imaging systems for dispensing surgical fasteners during open repair procedures
Clasificaciones
Clasificación de EE.UU.606/1
Clasificación internacionalA61B17/068, A61B17/04, A61B17/11, A61B17/22, A61B19/00, A61B17/28
Clasificación cooperativaA61B2034/305, A61B34/37, A61B17/1114, A61B34/32, A61B90/361, A61B34/71, A61B34/30, A61B2034/301, A61B2017/00477, A61B17/068, A61B17/0469, A61B17/0491, A61B2017/1135, A61B2017/2905, A61B2017/22069, A61B2017/22054, A61B2017/2927, A61B2017/00309
Clasificación europeaA61B19/22B, A61B17/11D, A61B17/04M, A61B17/04E
Eventos legales
FechaCódigoEventoDescripción
22 Jun 2004ASAssignment
Owner name: ENDOVIA MEDICAL INC., MASSACHUSETTS
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:WEITZNER, BARRY D.;ROGERS, GARY S.;SOLBJOR, ALBERT;AND OTHERS;REEL/FRAME:014765/0819;SIGNING DATES FROM 20040323 TO 20040612
6 Sep 2005ASAssignment
Owner name: HANSEN MEDICAL, INC., CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:ENDOVIA MEDICAL, INC.;REEL/FRAME:016489/0395
Effective date: 20050328
Owner name: HANSEN MEDICAL, INC.,CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:ENDOVIA MEDICAL, INC.;REEL/FRAME:016489/0395
Effective date: 20050328