Robotic system including a cable interface assembly

A system and method for performing a medical procedure includes a first multi-linked mechanism comprising a plurality of first links, and a lumen therethrough; a second multi-linked mechanism comprising a plurality of second links, wherein the second multi-linked mechanism is constructed and arranged to be slidingly received by the lumen of the first multi-linked mechanism, and where the first and second multi-linked mechanisms are configured to transition from a limp state to a rigid state; a set of proximal cables comprising at least a first proximal cable and a second proximal cable; a set of distal cables comprising at least a first distal cable and a second distal cable; a cable control assembly constructed and arranged to independently apply tension to the first proximal cable and the second proximal cable; a cable interface assembly constructed and arranged to receive a force from at least the first proximal cable and the second proximal cable and to transmit a corresponding force to at least the first distal cable and the second distal cable. The force applied to the first distal cable and the second distal cable steers at least one of the first multi-linked mechanism or the second multi-linked mechanism.

RELATED APPLICATIONS

This application is related to U.S. Provisional Application No. 61/406,032, filed Oct. 22, 2010, the content of which is incorporated herein by reference in its entirety.

This application is related to PCT Application No PCT/US2011/057282, filed Oct. 21, 2011, the content of which is incorporated herein by reference in its entirety.

This application is related to U.S. patent application Ser. No. 13/880,525, filed Apr. 19, 2013, the content of which is incorporated herein by reference in its entirety.

This application is related to U.S. Provisional Application No. 61/492,578, filed Jun. 2, 2011, the content of which is incorporated herein by reference in its entirety.

This application is related to PCT Application No. PCT/US12/40414, filed Jun. 1, 2012, the content of which is incorporated herein by reference in its entirety.

This application related to U.S. patent application Ser. No. 14/119,316, filed Nov. 21, 2013, the content of which is incorporated herein by reference in its entirety.

This application is related to U.S. Provisional Application No. 61/412,733, filed Nov. 11, 2010, the content of which is incorporated herein by reference in its entirety.

This application is related to PCT Application No PCT/US2011/060214, filed Nov. 10, 2011, the content of which is incorporated herein by reference in its entirety.

This application is related to U.S. patent application Ser. No. 13/884,407, filed May 9, 2013, the content of which is incorporated herein by reference in its entirety.

This application is related to U.S. Provisional Application No. 61/472,344, filed Apr. 6, 2011, the content of which is incorporated herein by reference in its entirety.

This application is related to PCT Application No. PCT/US12/32279, filed Apr. 5, 2012, the content of which is incorporated herein by reference in its entirety.

This application is related to U.S. patent application Ser. No. 14/008,775, filed Sep. 30, 2013, the content of which is incorporated herein by reference in its entirety.

This application is related to U.S. Provisional Application No. 61/534,032 filed Sep. 13, 2011, the content of which is incorporated herein by reference in its entirety.

This application is related to PCT Application No. PCT/US12/54802, filed Sep. 12, 2012, the content of which is incorporated herein by reference in its entirety.

This application is related to U.S. patent application Ser. No. 14/343,915, filed Mar. 10, 2014, the content of which is incorporated herein by reference in its entirety.

This application is related to U.S. Provisional Application No. 61/368,257, filed Jul. 28, 2010, the content of which is incorporated herein by reference in its entirety.

This application is related to PCT Application No PCT/US2011/044811, filed Jul. 21, 2011, the content of which is incorporated herein by reference in its entirety.

This application is related to U.S. patent application Ser. No. 13/812,324, filed Jan. 25, 2013, the content of which is incorporated herein by reference in its entirety.

This application is related to U.S. Provisional Application No. 61/578,582, filed Dec. 21, 2011, the content of which is incorporated herein by reference in its entirety.

This application is related to PCT Application No. PCT/US12/170,924, filed Dec. 20, 2012, the content of which is incorporated herein by reference in its entirety.

This application is related to U.S. Provisional Application No. 61/681,340, filed Aug. 9, 2012, the content of which is incorporated herein by reference in its entirety.

This application is related to PCT Application No. PCT/US13/54326, filed Aug. 9, 2013, the content of which is incorporated herein by reference in its entirety.

This application is related to U.S. Provisional Application No. 61/751,498, filed Jan. 11, 2013, the content of which is incorporated herein by reference in its entirety.

This application is related to PCT Application No. PCT/US14/01808, filed Jan. 9, 2014, the content of which is incorporated herein by reference in its entirety.

This application is related to U.S. Provisional Application No. 61/656,600, filed Jun. 7, 2012, the content of which is incorporated herein by reference in its entirety.

This application is related to PCT Application No. PCT/US13/43858, filed Jun. 3, 2013, the content of which is incorporated herein by reference in its entirety.

This application is related to U.S. patent application Ser. No. 11/630,279, filed Dec. 20, 2006, published as U.S. Patent Application Publication No. 2009/0171151, the content of which is incorporated herein by reference in its entirety

This application claims the benefit of U.S. Provisional Application No. 61/921,858, filed Dec. 30, 2013, the content of which is incorporated herein by reference in its entirety

This application claims the benefit of U.S. Provisional Application No. 61/825,297, filed May 20, 2013, the content of which is incorporated herein by reference in its entirety.

This application claims the benefit of U.S. Provisional Application No. 61/818,878, filed May 2, 2013, the content of which is incorporated herein by reference in its entirety.

This application claims the benefit of U.S. Provisional Application No. 61/909,605, filed Nov. 27, 2013, the content of which is incorporated herein by reference in its entirety.

FIELD

Embodiments of the inventive concepts relate generally to the field of robotics and, more particularly, to three-dimensional, flexible, steerable robotic devices, and methods of forming and controlling the same.

BACKGROUND

As less invasive medical techniques and procedures become more widespread, medical professionals, such as surgeons, may employ snake-like robotic systems having highly articulated multi-link probes to access parts of the human anatomy that were otherwise difficult to reach. With the use of such robotic systems, medical professionals may be able to replace open-cavity surgical procedures with less invasive procedures.

Such articulating probes can be subject to significant forces in order to control or lock the linking mechanism, and subject the probe to undesired movements and adversely affect the performance of the articulating probe.

SUMMARY

In an aspect, a system for performing a medical procedure is provided. The system comprises: a first multi-linked mechanism comprising a plurality of first links, a proximal end, a distal end and a lumen therethrough; wherein the first multi-linked mechanism is constructed and arranged to transition from a limp state to a rigid state; a second multi-linked mechanism comprising a plurality of second links, wherein the second multi-linked mechanism is constructed and arranged to be slidingly received by the lumen of the first multi-linked mechanism and to transition from a limp state to a rigid state; a set of proximal cables comprising at least a first proximal cable and a second proximal cable; a set of distal cables comprising at least a first distal cable and a second distal cable; a cable control assembly constructed and arranged to independently apply tension to the first proximal cable and the second proximal cable; a cable interface assembly constructed and arranged to receive a force from at least the first proximal cable and the second proximal cable and to transmit a corresponding force to at least the first distal cable and the second distal cable. The system can be constructed and arranged such that the force applied to the first distal cable and the second distal cable steers the first multi-linked mechanism and/or the second multi-linked mechanism.

The system can comprise a first portion and a second portion and wherein at least the first portion is constructed and arranged to be used in multiple medical procedures. The first portion can comprise at least one of: an input portion of the cable interface assembly; the set of proximal cables; a user interface of the system; the cable control assembly; a pulley of the system; a linear drive of the system; or the second multi-linked mechanism. The system can further comprise a second portion constructed and arranged to be used in fewer medical procedures than the first portion. The second portion can comprise at least one of: an output portion of the cable interface assembly; the set of distal cables; a pulley of the system; or the first multi-linked mechanism.

The cable interface assembly can comprise a first portion and a second portion, wherein the first portion is constructed and arranged to be used in more medical procedures than the first portion. The first portion can comprise an input constructed and arranged to attach to the set of proximal cables and the second portion can comprise an output constructed and arranged to attach to the set of distal cables. The second portion can be constructed and arranged to be used in a single medical procedure.

The cable interface assembly can comprise an input constructed and arranged to attach to the set of proximal cables and an output constructed and arranged to attach to the set of distal cables.

The cable interface assembly can be constructed and arranged to transmit a first force to the first distal cable and a second force to the second distal cable simultaneously.

The cable interface assembly can be constructed and arranged to transmit a first force to the first distal cable and a second force to the second distal cable sequentially.

The cable interface assembly can be constructed and arranged to provide a mechanical advantage between the proximal cables and the distal cables. The mechanical advantage can comprise a proportional mechanical advantage. The mechanical advantage can comprise a disproportional mechanical advantage. The mechanical advantage can comprise an increase in force transmitted between a proximal cable and a distal cable. The mechanical advantage can comprise an increase in translation distance transmitted between a proximal cable and a distal cable.

The cable interface assembly is positioned proximal to the first and second multi-linked mechanisms. The cable interface assembly can be positioned within the first multi-linked mechanism. The cable interface assembly can be positioned within the second multi-linked mechanism.

The cable interface assembly can comprise at least one gimbal. The at least one gimbal can comprise an input surface that attaches to the set of proximal cables and an opposing output surface that attaches to the set of distal cables. The at least one gimbal can comprise at least two gimbals. The at least two gimbals can comprise a first gimbal that rotates about a first axis and a second gimbal that rotates about a second axis oriented relatively 90° to the first axis.

The cable interface assembly can comprise at least one multi-diameter pulley. The at least one multi-diameter pulley can comprise a first pulley that attaches to the first proximal cable and the first distal cable, and a second pulley that attaches to the second proximal cable and the second distal cable. The cable interface assembly can further comprise at least one brake assembly constructed and arranged to apply a braking force to the at least one multi-diameter pulley.

The cable interface assembly can be constructed and arranged to amplify translation between the first proximal cable and the first distal cable. The amplification can comprise an amplification ratio selected from the group consisting of: 1:100:1:50; 1:25:1:10; 1:5:1:2:1:1; 2:1:5:1:10:1; 25:1; 50:1; 100:1; and combinations thereof. The cable interface assembly comprises a first multi-diameter pulley and a second multi-diameter pulley. The cable interface assembly can be constructed and arranged to provide a different amplification between the second proximal cable and the second distal cable.

The cable interface assembly can be constructed and arranged to amplify force applied between the first proximal cable and the first distal cable. The amplification can comprise an amplification ratio selected from the group consisting of: 1:100:1:50; 1:25:1:10; 1:5:1:2:1:1; 2:1:5:1:10:1; 25:1; 50:1; 100:1; and combinations thereof. The cable interface assembly can comprise a first multi-diameter pulley and a second multi-diameter pulley. The cable interface assembly can be constructed and arranged to provide a different amplification between the second proximal cable and the second distal cable.

The system can further comprise a second cable interface assembly constructed and arranged to receive a force from at least one cable and transmit a force to at least one cable. The second cable interface assembly can be dissimilar to the first cable interface assembly. The system can further comprise a control conduit between the first and second cable interface assemblies. The second cable interface assembly can be positioned in series with the first cable interface assembly. The system can further comprise a middle set of cables positioned between and operably attached to the first cable interface assembly and the second cable interface assembly. The second cable interface assembly can be attached to a second set of proximal cables and a second set of distal cables.

The distal cables can be constructed and arranged to steer the first multi-linked mechanism. The distal cables can be constructed and arranged to steer the second multi-linked mechanism.

One or more proximal cables and one or more distal cables can comprise different construction. The different construction can comprise a different construction property selected from the group consisting of: elasticity; flexibility; pushability; column strength; torqueability; diameter; materials of construction; braiding parameter such as pitch or pick count; and combinations thereof.

The set of proximal cables can be operably attached to the cable interface assembly in a first pattern and the set of distal cables are operably attached to the cable interface assembly in a second pattern. The first pattern and the second pattern can comprise similar geometric patterns. The first pattern and the second pattern can comprise dissimilar geometric patterns.

The set of proximal cables can comprise a first quantity and the set of distal cables can comprise a second quantity similar to the first quantity. The set of proximal cables can comprise a first quantity and the set of distal cables can comprise a second quantity different than the first quantity. The quantity of proximal cables can be more than the quantity of distal cables. The quantity of proximal cables can be less than the quantity of distal cables.

The system can further comprise one or more pulleys. The one or more pulleys can operably engage a portion of at least one proximal cable. The one or more pulleys can operably engage a portion of at least one distal cable.

The system can further comprise at least one linear drive. The at least one linear drive can be attached to the first multi-linked mechanism and the cable interface assembly. The system can further comprise a second cable interface assembly and a second linear drive attached to the second multi-linked mechanism and the second cable interface assembly. The at least one linear drive can be attached to the second multi-linked mechanism and the cable interface assembly.

The system can further comprise a linear compensator constructed and arranged to allow motion between the cable interface assembly and at least one of the first multi-linked mechanism and the second multi-linked mechanism. The linear compensator can comprise a spring. The linear compensator can comprise an element selected from the group consisting of: a spring; a linear actuator; a magnet; a piston; a compressible element; and combinations thereof.

The system can further comprise a sensor constructed and arranged to measure a parameter of the cable interface assembly. The parameter can comprise a parameter selected from the group consisting of: displacement; force; pressure; velocity; proximity; acceleration; strain; and combinations thereof. The sensor can comprise a sensor selected from the group consisting of: a pressure sensor; a strain gauge; a magnetic sensor such as a Hall effect sensor; a piezoelectric sensor; a capacitive sensor; and combinations thereof. The sensor can be constructed and arranged to quantify a parameter of the cable interface assembly selected from the group consisting of: an amplification of proximal to distal cable translation; an amplification of proximal to distal cable tension; an angular rotation of a component of the cable interface assembly such as a rotating gimbal or a rotating pulley; a linear displacement of a component of the cable interface assembly; a linear displacement of a proximal cable; a linear displacement of a distal cable; tension in a proximal cable; tension in a distal cable; and combinations thereof.

The first multi-linked mechanism can further comprise at least one sideport. The first multi-linked mechanism can further comprise at least two channels each constructed and arranged to slidingly receive one of the first or second distal cables.

The set of distal cables can further comprise a third distal cable, wherein the first multi-linked mechanism comprises at least three channels each constructed and arranged to slidingly receive one of the first, second, or third distal cables.

The system can further comprise at least one working channel between the first multi-linked mechanism and the second multi-linked mechanism.

The system can further comprise a user interface.

The system can further comprise a tool with a flexible distal portion. The system can further comprise a lumen for slidingly receiving at least a distal portion of the tool. The lumen can be positioned in at least one of: a sideport of the first multi-linked mechanism; a Lumen of the first multi-linked mechanism; a lumen of the second multi-linked mechanism; or a working channel positioned between the first multi-linked mechanism and the second multi-linked mechanism. The tool can comprise one or more tools selected from the group consisting of: cameras, light or other radiation sources, cutters, graspers, scissors, energy appliers, suturing assemblies, biopsy removal elements, ventilators, lasers, cautery, clip appliers, scissors, needles, needle drivers, scalpels, RF energy delivery devices, cryogenic energy delivery devices, drug delivery devices, EKG electrodes, pressure sensors, a blood sensors, magnets, heating elements, and combinations thereof.

According to another aspect, a method of performing a medical procedure comprises selecting a system in accordance with an aspect of the inventive concepts; and performing a medical procedure using the system.

According to another aspect, a system as described in reference to the drawings is provided.

According to another aspect, a method as described in reference to the drawings is provided.

The technology described herein, along with the attributes and attendant advantages thereof, will best be appreciated and understood in view of the following detailed description taken in conjunction with the accompanying drawings in which representative embodiments are described by way of example.

DETAILED DESCRIPTION OF THE DRAWINGS

Reference will now be made in detail to the present embodiments of the technology, examples of which are illustrated in the accompanying drawings. The same reference numbers are used throughout the drawings to refer to the same or like parts.

It will be further understood that the words “comprising” (and any form of comprising, such as “comprise” and “comprises”), “having” (and any form of having, such as “have” and “has”), “including” (and any form of including, such as “includes” and “include”) or “containing” (and any form of containing, such as “contains” and “contain”) when used herein, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof.

It will be understood that, although the terms first, second, third etc. may be used herein to describe various limitations, elements, components, regions, layers and/or sections, these limitations, elements, components, regions, layers and/or sections should not be limited by these terms. These terms are only used to distinguish one limitation, element, component, region, layer or section from another limitation, element, component, region, layer or section. Thus, a first limitation, element, component, region, layer or section discussed below could be termed a second limitation, element, component, region, layer or section without departing from the teachings of the present application.

It will be further understood that when an element is referred to as being “on”, “attached”, “connected” or “coupled” to another element, it can be directly on or above, or connected or coupled to, the other element or intervening elements can be present. In contrast, when an element is referred to as being “directly on”, “directly attached”, “directly connected” or “directly coupled” to another element, there are no intervening elements present. Other words used to describe the relationship between elements should be interpreted in a like fashion (e.g., “between” versus “directly between,” “adjacent” versus “directly adjacent,” etc.).

For example, it will be appreciated that all features set out in any of the claims (whether independent or dependent) can be combined in any given way.

Referring now toFIG. 1, a schematic view of a system for performing a medical procedure is illustrated, consistent with the present inventive concepts. System10can be constructed and arranged as a robotic introducer system for performing a medical procedure, such as a transoral robotic surgery procedure. System10can include one or more features of a surgical positioning and support system, for example, as described in U.S. patent application Ser. No. 13/812,234, filed Jan. 25, 2013, U.S. patent application Ser. No. 13/812,324, filed Jul. 21, 2011, U.S. patent application Ser. No. 14/008,775, filed Apr. 5, 2012, and International PCT Application Number PCT/US2013/054326, filed Aug. 9, 2013, the contents of each being incorporated herein by reference in their entirety.

System10can be constructed and arranged to position one or more tools (not shown) for performing a medical procedure on a patient, for example, a transoral robotic surgery procedure or the like, or other surgical procedure that includes inserting one or more tools into a cavity of the patient, or a region of the patient formed by an incision or related opening. A surgical procedure can include one or more transoral procedures, including but not limited to resections at or near the base of a tongue, tonsils, a base of a skull, hypopharynx, larynx, trachea, esophagus and within the stomach and small intestine. Other medical procedures can include but not be limited to single or multiple transaxilla procedures, such as a laryngectomy; single or multiple thoracoscopic procedures, such as a mediastinal nodal dissection; single or multiple pericardial procedures, for example, related to measuring and treating arrhythmias; single or multiple laparoscopic procedures, such as revision of bariatric lap-band procedures; single or multiple transgastric or transenteric procedures, such as a cholecystectomy or splenectomy; and/or single or multiple transanal or transvaginal procedures, such as a hysterectomy, oophorectomy, cystectomy and colectomy.

System10includes a probe100comprising a first multi-linked mechanism, outer probe120, and a second multi-linked mechanism, inner probe140. Outer probe120includes a lumen124configured to slidingly receive inner probe140, where lumen124terminates at a location proximal to distal end126of outer probe120. System10includes multiple flexible filaments (“cables”) configured to apply forces to control one or more parameters of outer probe120and inner probe140, as described in detail herebelow. System10can include one or more pulleys, such as pulleys205shown inFIG. 1, which operably engage one or more cables of system10, such as to allow a cable to assume a non-linear path from its proximal end to its distal end and efficiently transmit applied forces along its length. System10includes a set of one or more cables125(e.g. the three cables125shown inFIG. 1). Cables125can be constructed and arranged to control outer probe120, such as to steer, change the rigidity of, maintain the rigidity of and/or otherwise control outer probe120. System10can also include an additional set of one or more cables145(e.g. the single cable145shown inFIG. 1). Cables145can be constructed and arranged to control inner probe140, such as to steer, change the rigidity of, maintain the rigidity of and/or otherwise control inner probe140. In some embodiments, probe100, outer probe120, inner probe140and cables125and145are constructed and arranged as has been described in applicant's co-pending application International PCT Application Serial Number PCT/US2012/70924, filed Dec. 20, 2012, the content of which is incorporated herein by reference in its entirety, such as to be advanced, retracted, steered, transitioned between a rigid mode and a flexible mode, and/or otherwise operated to support system10. Changing the rigidity of outer probe120and/or inner probe140includes transitioning between a limp mode and a rigid mode.

System10includes at least one cable interface200, such as cable interface200aor cable interface200bas shown. Each cable interface200comprises an input290(e.g. inputs290aand290bshown) configured to operably attach to a set of controlling cables, such as proximal cables225or245. Each cable interface200further comprises an output295(e.g. outputs295aand295bshown) configured to operably attach to a set of cables to be controlled, such as distal cables125or145. Each cable interface200can be constructed and arranged to provide a mechanical advantage between one or more cables attached in input290and one or more cables attached to output295. Input290and output295are operably connected to each other with one or more mechanisms of cable interface200that are configured such that any motion and/or forces applied to interface200by one or more attached proximal cables, causes a resultant motion and/or forces to be applied by interface200to one or more attached distal cables. Various mechanisms, such as those described herein, can be used to proportionally or disproportionally translate an input signal (e.g. force or motion) applied to input290to an output signal (e.g. force or motion) applied by output295.

Cables125, which control outer probe120, can be attached to and controlled by cable interface200a. Cable interface200ais attached to and is controlled by a set of cables225which are in turn controlled by cable control assembly300. In these embodiments, cables125are referred to as a set of one or more distal cables (i.e. distal to cable interface200a) and cables225are referred to as a set of one or more proximal cables (i.e. proximal to cable interface200a). Cable interface200ais constructed and arranged to control distal cables125based on the forces applied to cable interface200aby proximal cables225. Alternatively, cables125can attach directly to and be controlled by cable control assembly300(i.e. when system10does not include cable interface200anor proximal cables225).

Cables145, which control inner probe140, can be attached to and controlled by cable interface200b. Cable interface200bis attached to and is controlled by a set of cables245which are in turn controlled by cable control assembly300. In these embodiments, cables145are referred to as a set of one or more distal cables (i.e. distal to cable interface200b) and cables245are referred to as a set of one or more proximal cables (i.e. proximal to cable interface200b). Cable interface200bcan be constructed and arranged to control one or more distal cables, such as distal cable145, based on the forces applied to cable interface200bby one or more proximal cables245. Alternatively, cables145can attach directly to and be controlled by cable control assembly300(i.e. when system10does not include cable interface200bnor proximal cables245).

In some embodiments, system10includes cable interface200abut does not include cable interface200b(i.e. cables145attach to and are controlled directly by cable control assembly300). In other embodiments, system10includes cable interface200bbut does not include cable interface200a(i.e. cables125attach to and are controlled directly by cable control assembly300). In some embodiments, multiple cable interfaces200are connected in series, such that a middle set of cables (not shown) are controlled by a proximal set of cables (e.g. cables225or245), each attached to an output and input, respectively of a first cable interface200. A distal set of cables (e.g. cables125or145) are controlled by the middle set of cables, each attached to an output and input, respectively, of a second cable interface200. Alternatively or additionally, in some embodiments, cable interface200ais operably connected or otherwise influenced by cable interface200b, such as via a control conduit203constructed and arranged to transfer a force, motion or control signal between cable interface200aand200bto adjust the operation of either or both.

Cable interface200aand200bcan be of similar or dissimilar construction. Cable interface200aand/or200b, collectively cable interface200, can be configured to apply a mechanical advantage between the proximal and distal cables, such as to improve or enhance (hereinafter “improve”) the control of outer probe120and/or inner probe140. For example, a mechanical advantage applied by cable interface200abetween proximal cables225and distal cables125can be configured to provide improved steering of outer probe120, such as smoother or more precise steering. Alternatively or additionally, a mechanical advantage can be applied by cable interface200ato achieve greater steering or locking forces for outer probe120. Similarly improvements can be achieved with cable interface200bin the control of inner probe140.

In some embodiments, proximal cables225or245, cable interface200aor cable interface200b, and distal cables125or145, respectively, are attached (e.g. in a particular pattern of attachment) and are otherwise constructed and arranged such that a translation or force applied by each proximal cable to cable interface200results in a proportional (e.g. a proportionally amplified or attenuated) response in the translation or force applied by cable interface200to each corresponding distal cable. In these proportional transfer configurations, the proximal cables can be attached to a portion of cable interface200in a first geometric pattern (e.g. in a triangular pattern attached to one side of a gimbal), and the distal cables can be attached to a portion of the cable interface in a second geometric pattern similar to the first geometric pattern (e.g. a triangular pattern attached to the opposite side of the gimbal), such as is described in the gimbal design described in reference toFIGS. 2-3herebelow. Alternatively, the first and second geometric patterns can be different. In some embodiments, each proximal cable is operably attached to a first diameter portion of a multiple diameter pulley, and each distal cable can be operably attached to a corresponding second diameter portion of the corresponding pulley, such as is described in reference toFIG. 4herein. In other embodiments, cable interface200can be constructed and arranged such that translation or force applied by proximal cables can result in a disproportional translation or force applied to distal cables. In these embodiments, the resultant force or translation, although not proportional, is known and/or otherwise can be determined by system10and can be used by one or more components of system10to control outer probe120or inner probe140. In these embodiments, different patterns of cable attachment to cable interface can be used, different numbers of proximal versus distal wires can be included, and the like, with a known transfer response of cable interface200.

In some embodiments, a cable interface200is configured such that a relative proximal cable translation (e.g. linear advancement or retraction of a cable225or245) results in less translation in distal cables (e.g. less advancement or retraction of a corresponding cable125or145respectively). In these mechanisms configured for proportionally attenuating cable translation, the force applied to the distal cables by cable interface200is proportionally increased (e.g. a 1:2 ratio of proximal to distal cable translation corresponds to a 2:1 ratio of applied proximal cable tension to resultant distal cable tension). In other embodiments, a cable interface200is configured such that a relative proximal cable translation results in more translation in the corresponding distal cable. In these mechanisms configured for proportionally amplifying cable translation, the force applied to the distal cable by cable interface200is proportionally decreased (e.g. a 2:1 ratio of proximal to distal cable translation corresponds to a 1:2 ratio of applied proximal cable tension to resultant distal cable tension). Cable interface200can be constructed and arranged to have a broad range of amplification or attenuation (hereinafter “amplification”) of cable translation, such as an amplification of: 1:100:1:50; 1:25:1:10; 1:5:1:2:1:1; 2:1:5:1:10:1; 25:1; 50:1; or 100:1. Cable interface200can be constructed and arranged to have a broad range of amplification of applied proximal cable tension to resultant distal cable tension, such as an amplification of: 1:100:1:50; 1:25:1:10; 1:5:1:2:1:1; 2:1:5:1:10:1; 25:1; 50:1; or 100:1. Cable interface200can comprise various constructions that amplify or attenuate cable translation and/or applied tension, proportionally or otherwise.

In some embodiments, cable interface200applies a first amplification level to a first corresponding pair of proximal and distal cables, and a second, different amplification level to a second corresponding pair of proximal and distal cables, wherein the first pair and second pair are each attached to the same cable interface200. The first and second amplification levels can be each be proportional or disproportional amplification levels.

System10includes a first linear drive400aconstructed and arranged to allow outer probe120to be advanced and retracted. Linear drive400ais attached to a proximal portion of outer probe120via connector410aas shown. Linear drive400acan be attached to and controlled by cable control assembly300, attachment not shown but typically one or more wires or other information and/or power conduits. In embodiments where system10includes cable interface200a, connector410ais further attached to cable interface200asuch that interface200aand outer probe120move in unison. System10further includes a second linear drive400bconstructed and arranged to allow inner probe140to be advanced and retracted. Linear drive400bis attached to a proximal portion of inner probe140with connector410bas shown. Linear drive400bcan be attached to and controlled by cable control assembly300, attachment not shown but typically one or more wires or other information and/or power conduits.

In some embodiments, cable interface200comprises a sensor, such as sensor201aand/or201bof cable interfaces200aand/or200b, respectively. Sensor201aand/or201b, collectively sensor201, can be a sensor constructed and arranged to measure displacement, force, pressure, velocity, proximity, acceleration, strain and/or another parameter. In some embodiments, sensor201aand/or201bcomprises a sensor selected from the group consisting of: a pressure sensor; a strain gauge; a magnetic sensor such as a Hall effect sensor; a piezoelectric sensor; a capacitive sensor; and combinations of these. Sensor201can be configured to quantify a parameter selected from the group consisting of: the amplification of proximal or distal cable translation; the amplification of applied proximal cable tension to resultant distal cable tension; angular rotation of a component of cable interface200(e.g. a rotating gimbal or pulley); linear displacement of a component of cable interface200or a cable of system10; tension in a cable of system10; and combinations of these.

Cable control assembly300can comprise one or more drive mechanisms such as motors, which independently drive (e.g. advance and retract) multiple supplies of cable, such as cables wrapped around bobbins that are motor-driven. In some embodiments, cable control assembly300is constructed and arranged as described in applicant's co-pending application International PCT Application Serial Number PCT/US2012/70924, filed Dec. 20, 2012, the content of which is incorporated herein by reference in its entirety.

Outer probe120includes multiple links121terminating in distal link121′, collectively links121. Each link121includes one or more channels122that slidingly receive a cable125. Each cable125extends through a channel of each link121and terminates at its distal end at anchor point123. In some embodiments, each link121of outer probe120comprises three channels separated by approximately 120° along an inner circumference of each link121. In embodiments where cables125comprise multiple cables, cables125can be used to steer as well as lock outer probe120. Alternatively, cables125can comprise a single cable125, such as a single cable125that is used to transition outer probe120between a limp and rigid mode and/or to partially steer outer probe120.

Inner probe140includes multiple links141which can include one or more channels, such as a single channel142which extends to a distal link of inner probe140. In some embodiments, cable145comprises a single cable145which extends through channel142and terminates at its distal end at anchor point143. In these single cable145embodiments, cable145is used to transition inner probe140between a limp and rigid mode. Alternatively, cables145can comprise multiple cables, such as when channel142comprises three channels separated by approximately 120°, and cables145are positioned within the three channels142to both transition inner probe140between a limp and rigid mode, as well as steer inner probe140. In some embodiments, cable interface200aand/or200bare positioned between the proximal and distal ends of outer probe120and/or inner probe140, such as is described in reference toFIG. 5A-Bherebelow.

System10comprises a user interface500which can be attached at least to cable control assembly300via conduit501. Conduit501can include one or more wires or other information and/or power conduits. User interface500can comprise one or more user interface components selected from the group consisting of: a joystick; a mouse; a keyboard; a touch pad; a video monitor; an indicator light; an alarm transducer; a touch screen; a printer; and combinations thereof. User interface500and/or cable control assembly300include one or more electronic modules including algorithms, transfer functions and/or other software used to convert user input commands (e.g. from a joystick) to control signals. Control signals can be used to perform a function selected from the group consisting of: advancing and retracting cables, such as cables225,245,125and/or145; advancing and/or retracting outer probe120and/or inner probe140via first linear driver400aand/or second linear drive400b; activating, manipulating and/or otherwise controlling one or more tools600; and combinations thereof. In some embodiments, user interface500is constructed and arranged as described in applicant's co-pending U.S. patent application Ser. No. 14/119,316, filed Jun. 1, 2012, the contents of which is incorporated herein by reference in its entirety.

System10can include one or more tools600, such as one or more surgical tools with a flexible distal portion. Tool600can include a flexible shaft configured to pass through a location selected from the group consisting of: one or more channels of inner probe140; one or more channels of outer probe120; one or more channels positioned between inner probe140and outer probe120(e.g. a series of corresponding grooves aligned between the multiple links121. Tool600can comprise a tool selected from the group consisting of: cameras, light or other radiation sources, cutters, graspers, scissors, energy appliers, suturing assemblies, biopsy removal elements, ventilators, lasers, cautery, clip appliers, scissors, needles, needle drivers, scalpels, RF energy delivery devices, cryogenic energy delivery devices, drug delivery devices, EKG electrodes, pressure sensors, a blood sensors, magnets, heating elements, or combinations of these. In some embodiments, outer probe120includes one or more sideports, not shown but such as one or more sideports comprising a radial projection from a link121, wherein the radial projection comprises a lumen configured to slidingly receive one or more tools of system10, such as tool600. In some embodiments, outer probe120includes one or more sideports such as those described in applicant's co-pending U.S. patent application Ser. No. 13/812,324, filed Jul. 21, 2011, the content of which is incorporated herein by reference in its entirety.

The proximal and distal cables of system10, such as proximal cables225and245, and corresponding distal cables125and145, respectively, can have similar or dissimilar construction. In some embodiments, the proximal and distal cables have a dissimilar property selected from the group consisting of: elasticity; flexibility; pushability; column strength; torqueability; diameter; materials of construction; braiding parameter such as pitch or pick count; and combinations of these.

In some embodiments, a first quantity of proximal cables are received from cable control assembly300by an input290of a cable interface200, and a second, similar quantity of distal cables are received by outer probe120or inner probe140by an output295of the cable interface200. In some embodiments, a first quantity of controlling proximal cables (e.g. proximal cables225or245) attach to input290of cable interface200, and a second, different quantity of controlled distal cables (e.g. distal cables125or145) are attached to output295of cable interface200. In these embodiments, the quantity of input cables can be greater than or less than the quantity of output cables. In some embodiments, the quantity of cables attached to input290is the same as the quantity of cables attached to output295, however the pattern of attachment can be different.

In some embodiments, one or more portions of system10are re-used, such are one or more portions that are maintained outside of the sterile barrier of a medical procedure and/or are re-sterilized between a first medical procedure and a second medical procedure. In some embodiments, a cable interface200comprises a first portion and a second portion, where the first portion includes input290and the second portion includes output295. In these embodiments, the first portion can be re-used as described above, and/or it can otherwise be used more times than the second portion is used, such as when the each first portion is used with multiple second portions such as multiple portions including output295that are disposed of after each medical procedure. In some embodiments, the first portion and second portion of cable interface200is configured as described in reference toFIGS. 6A-6Bdescribed herebelow. In these re-use embodiments, in addition to input290and output295, one or more other components or portions of system10can be constructed and arranged for re-use or single use. In some embodiments, at least one of the following components are used in multiple medical procedures: input290a; input290b; proximal cables225; proximal cables245; user interface500; cable control assembly300; one or more pulleys205; first linear drive400a; second linear drive400b; or inner probe140. In some embodiments, at least one of the following components are used fewer times, or in a single medical procedure: output295a; output295b; distal cables125; distal cables145; one or more pulleys205; or outer probe120.

Referring now toFIG. 2, a perspective view of a cable interface is illustrated, consistent with the present inventive concepts. In some embodiments, cable interface200comprises a two-gimbal design having inner ring220and outer ring230. Inner ring220is fixed to outer ring230at pivot points221aand221b(221bnot shown but positioned on Axis B on the opposite side of inner ring220) and can rotate about Axis B. Outer ring230is fixed to linear compensators280aand280bat pivot points283aand283b(283anot shown but positioned on Axis A on the opposite side of outer ring230), respectively, and can rotate about Axis A. Rotation of outer ring230about Axis A allows a second degree of freedom of inner ring220about Axis A. Inner ring220comprises at least two connection points222and223. Connection point222is configured to receive distal cable125, and connection point223is configured to receive proximal cable225, both distal and proximal cables discussed inFIG. 1hereabove. Inner ring220can comprise more than two connection points, for example where the system comprises more than one proximal cable and/or more than one distal cable, as shown inFIG. 3.

The distance between the intersection point of Axis A and Axis B (hereinafter “origin”) and connection points222and223can be represented by Δ1and Δ2, respectively. Cable225applies a tension Tinto inner ring220. In embodiments in which the pattern of attachment of one or more cables225is of similar geometry and alignment (e.g. connection points222and223are radially aligned) to the pattern of attachment of one or more cables125, the resultant tension Toutapplied to cable125is equal to Tinmultiplied by the ratio of Δ1/Δ2. For example, if Δ2is two times Δ1, then a tension Tinapplied to cable225will result in a tension Toutbeing applied to cable125equal to two times Tin.

Linear drive assembly400comprises connector410′ configured to translate along guide rods411aand411band translate carriage210. Guide rods411aand/or411bcan be configured as a linear drive or a lead screw as described herebelow.

Interface200can translate along guide rods282aand282bvia adaptors281aand281b, respectively. Guide rods282aand282bcan be configured to perform one or more functions, for example, maintain alignment of cable interface200; drive one or more components of cable interface200, for example carriage210; or stabilize one or more components of cable interface200. Adaptors281aand281bcan comprise a friction reducing component, not shown but for example a bushing or the like. Linear compensators280aand280bcan translate with respect to adaptors281aand281b, respectively, and can be configured to translate outer ring230, thus also translating inner ring220. For example, linear compensators280aand280bcan translate with or independent of adaptors281aand281b, respectively. Linear compensator280aand280bcan comprise one or more components such as a spring; a linear actuator; a magnet; a piston; a compressible element; and combinations of these.

In some embodiments, cable interface200comprises a sensor201. Sensor201can be constructed and arranged to measure one or more parameters or states of cable interface200. In some embodiments, sensor201is similar to sensor201described inFIG. 1hereabove.

Referring now toFIG. 3, a perspective view a portion of a system for performing a medical procedure is illustrated, consistent with the present inventive concepts. System10comprises probe100having inner probe140and outer probe120; cable interface200a; and a cable control assembly, not shown but the same as or similar to cable control assembly300ofFIG. 1. Components of probe100and interface200acan be configured the same as or similar to those described inFIG. 1andFIG. 2hereabove. Probe140comprises cable145, configured to be operably attached to a cable control assembly such as cable control assembly300ofFIG. 1, such as to control the rigidity of inner probe140, as described hereabove.

In the illustrated embodiment, inner ring220comprises six connection points, connection points222a-cconfigured to receive distal cables225a-cand connection points223a-cconfigured to receive proximal cables325a-c, both distal and proximal cables discussed inFIG. 1andFIG. 2hereabove.

Adaptor211fixedly attaches a proximal portion of outer probe120to carriage210such as via a weld, glue, or other suitable attachment mechanism. Carriage210is fixedly attached to connector410′a. Similarly, support147fixedly attaches a proximal portion of inner probe140to connector410′b. Connector410′band connector410′acan translate independently of one another to independently translate support147and carriage210, respectively. In the embodiment shown, components fixedly attached to connector410′aor410′btranslate in unison with connector410′aand410′b. In some embodiments, guide rods411aand411bare configured as lead screws, such that rotation of lead screw411acauses translation of connector410′a, and rotation of lead screw411bcauses translation of connector410′b.

Linear compensator280aand280bcan each comprise pivot assembly284aand284b(generally284) and a compressible element, spring285aand285b(generally285), respectively. Pivot assembly284can translate along guide rods282with or independently of adaptors281and can be configured to translate outer ring230, thus also translating inner ring220, with respect to carriage210. Pivot assembly284can be translated in a proximal direction independently of carriage210such that spring285is compressed causing distal cables223a-cto tension similarly.

In some embodiments, cable interface200comprises a sensor201. Sensor201can be constructed and arranged to measure one or more parameters or states of cable interface200. In some embodiments, sensor201is similar to sensor201described inFIG. 1hereabove.

Referring now toFIG. 4, a perspective view of a cable interface is illustrated, consistent with the present inventive concepts. Cable interface200″ comprises pulley assemblies250a,250b, and250c. Each pulley assembly250a-ccomprises a first diameter portion251a-c, a second diameter portion252a-c, and a brake assembly253a-c, respectively.

First diameter portions251a-care operably connected to cables225a-c, respectively, and second diameter portions252a-care operably connected to cables125a-c, respectively. Cable interface200″ can be constructed and arranged such that translation or force applied by proximal cables225a-ccan result in a proportional or a disproportional translation or force applied to distal cables125a-cbased on the difference in diameter or shape between first diameter portions251a-cand second diameter portions252a-c. For example, a non-circular diameter portion mated with a circular diameter portion will result in a disproportionally amplified mechanical advantage. In the illustrated embodiment, a high translation and a low force applied by proximal cables225a-cresults in a lower translation and a higher force applied to distal cables125a-c. In another embodiment, for example where first diameter portion251a-ccomprises a smaller diameter than second diameter portion252a-c, a low translation and a high force applied by proximal cables225a-cresults in a higher translation and a lower force applied to distal cables125a-c.

Pulley assemblies250a-ccan independently rotate about axle257. Brake assemblies253a-ccan be configured to lock pulley assemblies250a-c, respectively, about axle257. Upon locking of pulley assemblies, either simultaneously or sequentially, any or all proximal cables225a-ccan be tensioned to cause a relatively constant resultant tension on distal cables125a-c.

Interface200″ can be translated linearly via the translation carriage255along linear guide rods, such as guide rods282or411ofFIG. 2, similar to interface200translating along guide rods282and411via the translation of carriage210ofFIG. 2. Bearing assembly256can be configured to attach axle257to carriage255.

In some embodiments, cable interface200″ comprises a sensor201. Sensor201can be constructed and arranged to measure one or more parameters or states of cable interface200″. In some embodiments, sensor201is similar to sensor201described inFIG. 1hereabove. Alternatively or additionally, one or more brake assembly253a-cand/or bearing assembly256can comprise one or more sensors.

Referring now toFIG. 5A, a schematic view of a system for performing a medical procedure is illustrated, consistent with the present inventive concepts.FIG. 5Billustrates a magnified view of the distal portion of a probe of the system ofFIG. 5A. System10comprises probe100having inner probe140and outer probe120; cable interfaces270aand270b; cable control assembly300; and first and second linear drive assemblies400aand400b. Probe100; cable control assembly300and linear drive assemblies400aand400bcan be configured similar to those described inFIG. 1hereabove.

Inner probe140can comprise a probe of similar construction to probe140ofFIG. 3. Probe140includes links141, and cable145, terminating in anchor point143. Inner probe140is configured to be slidingly received by outer probe120, such as via lumen124.

Cable interfaces270aand270bcan comprise functionality similar to cable interface200adescribed inFIG. 1hereabove, however in the illustrated embodiment, cable interfaces270aand270bare positioned at a location between the proximal and distal end of outer probe120. Additionally or alternatively, cable interfaces270can be positioned at a location between the proximal and distal end of inner probe140. Proximal cables225are received from cable control assembly300by input271aand271bof cable interface270aand270b, respectively, and distal cable125is received by outer probe120by output272aand272bof cable interface270aand270b, respectively. Each cable125extends from cable interface270a, through channel122of each link121and terminates at its distal end at anchor point123.

The position of cable interfaces270aand270bcan be selected to affect the control of links121positioned distally to cable interfaces270aand270b. For example, if cable interfaces270aand270bare positioned in or near the distal portion of outer probe120, more precise control of the links positioned distally to cable interfaces270aand270bcan be achieved.

Proximal225cables and distal cables125of system10can have similar or dissimilar construction. In some embodiments, the proximal and distal cables have a dissimilar property selected from the group consisting of: elasticity; flexibility; pushability; column strength; torqueability; diameter; materials of construction; braiding parameter such as pitch or pick count; and combinations thereof.

Referring now toFIG. 6A, a schematic view of a first portion and a second portion of a system for performing a medical procedure is illustrated.FIG. 6Billustrates a schematic view of a system comprising the first portion and the second portion ofFIG. 6A, consistent with the present inventive concepts. Components of the system illustrated inFIGS. 6A and 6Bcan be configured similarly to components of system10described hereabove. In some embodiments, first portion11of system10comprises at least cable control assembly300; first and second linear drive assemblies400aand400b; proximal cables225; inner probe140; cable145; and a portion of cable interface200′, portion200′a. In some embodiments, second portion12of system10comprises at least outer probe120; distal cables125; and a portion of cable interface200′, portion200′b. Cable interface portion200′acomprises input290′a, connector206, and channel209a. Cable interface portion200′bcomprises output295′a, connector207and channel209a. Brace417fixedly attaches outer probe120to cable interface portion200′b.

In some embodiments, first portion11is re-used as described above inFIG. 1, and/or it can otherwise be used more times than second portion12is used, such as when each first portion11is used with multiple second portions12such as multiple portions that are disposed of after each medical procedure.

As shown inFIG. 6B, cable interface portions200′aand200′bcan be fixedly attached via connectors206and207, respectively, to form cable interface200′, similar to cable interface200,200″,200aand/or200bdescribed herein. Channels209aand209balign such as to slidingly receive a portion of inner probe140. Lumen124is configured to slidingly receive a portion of inner probe140, as described herein.

In some embodiments, cable interface200′ comprises a sensor201. Sensor201can be constructed and arranged to measure one or more parameters or states of cable interface200′. In some embodiments, sensor201is similar to sensor201described inFIG. 1hereabove.

While the preferred embodiments of the devices and methods have been described in reference to the environment in which they were developed, they are merely illustrative of the principles of the inventions. Modification or combinations of the above-described assemblies, other embodiments, configurations, and methods for carrying out the invention, and variations of aspects of the inventive concepts that are obvious to those of skill in the art are intended to be within the scope of the claims. In addition, where this application has listed the steps of a method or procedure in a specific order, it can be possible, or even expedient in certain circumstances, to change the order in which some steps are performed, and it is intended that the particular steps of the method or procedure claim set forth herebelow not be construed as being order-specific unless such order specificity is expressly stated in the claim.