Articulated surgical probe and method for use

A surgical probe includes an articulated digit located at a distal end of a positioning shaft having a longitudinal axis. An actuator is located at a proximal end of the positioning shaft that is operatively connected to the articulated digit so as to move it between a continuous range of positions from an extended position to a substantially curved position while maintaining a kinesthetic relationship between a surgeon's finger engaging the actuator and the articulated digit. Preferably, the surgeons finger position and shape directly correspond to the position and shape of the articulated digit. A method is provided for probing, dissecting, and retracting anatomical structures.

FIELD OF THE INVENTION

The present invention relates to surgical devices, and more particularly to an articulated finger-like probe adapted for positioning within a patient's body, and suitable for assisting minimally-invasive surgery. The present invention further relates to surgical procedures in which one or more articulated finger-like probes of the present invention are used to assist minimally-invasive surgical procedures.

BACKGROUND OF THE INVENTION

There has been a discernible tendency in surgery to develop procedures and devices that reduce the need for major surgical incisions which entails extended hospitalization, and increased wound complications such as infections and post operative hernias. These minimally-invasive surgical procedures and devices (i.e., endoscopic and/or laparoscopic surgical procedures and devices) have been especially, but not exclusively, important in abdominal, thoracic, gynecologic, urologic and orthopedic operations. Typically, a scope that is arranged with an external camera and light source, enter the abdominal cavity or joint through two or more small incisions along with one or more surgical instruments. The indicated surgical procedure is then performed by manipulating the long-handled surgical instruments while viewing their actions on a video monitor that receives images of the surgical site from the video camera.

While certain minimally invasive surgical techniques are in practice, there are significant disadvantages which have, to date, limited the applications for these techniques. For example, the standard laparoscopic instruments used in many minimally invasive procedures do not provide the surgeon the ability to mimic open surgical hand dissection techniques. Additionally, manipulation of fragile friable tissues can be difficult and often damaging while manipulating sharp and or small tipped tools inside the body cavity from outside the body. It is often the case that the surgeon would ideally prefer, to actually handle, manipulate, or even dissect a portion of tissue with his or her fingers during surgery, as this activity often provides the most sensitive feedback to the surgeon.

Many minimally invasive techniques are difficult due to the limited access provided to the surgical site, in which tools and viewing scopes are often inserted through narrow cannulae. Some surgeons, therefore, adopt a “hand assisted” approach. To accomplish this approach an incision large enough to accommodate a surgeon's hand is made in the abdomen. The surgeon then views his or her hand dissecting, on a video monitor, enabled by a laparoscope positioned appropriately. Unfortunately most of the time the surgeon's dissecting hand blocks the view of the dissection performed by the fingers. In addition only the operating surgeon can appreciate the course of the operation when the dissection is accomplished by palpation and direct vision is not possible. For certain operations, the hand assisted approach is a link along the learning curve to a laparoscopic approach. Again, with a hand assisted approach, an incision large enough to accommodate a surgeon's hand is created. An incision that is capable of accommodating a surgeons hand renders the procedure conventionally invasive, even though the laparoscope and other instruments are inserted through other small abdominal openings.

A number of devices have been proposed in the prior art that attempt to simulate the manipulative capabilities of a surgeon's finger during surgery. For example, in U.S. Pat. No. 5,522,788, issued to Kuzmak, a blunt laparoscopic dissector device is provided which includes an elongate dissector element including a “finger-like” flexible distal end portion. A cylinder or barrel member disposed at one end of a pair of pivotable control arms provides rotatable mounting of the dissector element. A control assembly, including a control rod connected to the other control arm and extending along the length of the dissector element, exerts a force on the dissector element so as to produce the desired curvature of the flexible distal end portion. A locking mechanism maintains the force on the dissector element so as to maintain the desired curvature. Rotation of the dissector element within the cylinder allows for control of the movement of the device's tip while holding the device in a comfortable stationary position. This device has a “pistol” style handle and forceps-style finger grips. There is no kinesthetic relationship between the tip of the index finger and the tip of the instrument, such that the precise movement of the finger tip is not reflected exactly by the instrument tip. Tactile feedback may be attenuated by the use of concatenated driving and driven elements.

In U.S. Pat. No. 5,810,716, issued to Mukherjee et al., a surgical device is provided for use in minimally invasive surgery that is suited for tele-surgery. The surgical device provides dexterity through articulation of a plurality of concatenated segments that transfer angular rotational motion from a driving device located at its base to the distal end. Each segment in the mechanism acts as both a driven element and a driving element whereby each segment is articulated so that the total articulation of the mechanism is the sum of the articulation motions of each segment. Here again the kinesthetic relationship between the surgeon's fingertip and the tip of the instrument is not exactly reproduced. The tactile feedback needed by the surgeon may be obfuscated by the use of concatenated driving and driven elements.

In U.S. Pat. No. RE38,335, reissued to Aust et al., a surgical device is provided for use in minimally invasive surgery that includes a handle, a first stem section having a longitudinal axis and extending from the handle, and a tissue engaging member for engaging tissue. A second stem section, connected between the first stem section and the tissue engaging member, has a portion which is bendable and supports the tissue engaging member for movement between a plurality of orientations relative to the axis and to the first stem section. The surgical instrument includes a system for bending the bendable portion of the second stem section to change the orientation of the tissue engaging member relative to the axis and to the first stem section from a first orientation to a second orientation. The bendable portion of the second stem section includes a member for enabling bending movement of the bendable portion to locate the tissue engaging member at the same angle relative to the longitudinal axis of the first stem section at more than one location along the length of the bendable portion. However the exact kinesthetic relationship between the surgeon's fingertip and the instrument tip is not possible. Once again the tactile feedback may be filtered by the handle articulation mechanisms.

The foregoing and other prior art devices do not allow a precise kinesthetic relationship between a surgeon's fingertip and the dissecting instrument tip. Those prior art devices may have a limited tactile sensing ability transferred to the surgeon. PCT/US97/11494 teaches a number of surgical instruments which can be mounted directly on a surgeon's fingertip in a way that the surgeon can insert his or her hand into a natural cavity of the patient or through one or more minimal incisions to perform surgical procedures, and also to use his or her fingers to manipulate tissues, thus enabling the surgeon to perform the procedures with the benefits of minimally invasive surgery, but with much greater tactile sense, control, and ease of manipulation. However, these surgical instruments (i) are carried by a finger and operated by the thumb, and are not applicable for procedures in which a single finger is employed for tactile sensing of an intrabody location; (ii) include an operating head which permanently extends far beyond the fingertip on which the surgical instrument is mounted, which limits the tactile sensing for the surgeon; and/or (iii) prevent tactile sensing by the instrument carrying the fingertip altogether.

There is a widely recognized need for, and it would be highly advantageous to have, a finger-like surgical probe devoid of the limitations associated with prior art instruments, and which closely simulates a surgeon's finger, or fingers, so as to enable a surgeon to handle, manipulate, or dissect a portion of tissue through an incision of the type employed during minimally invasive surgical procedures, and maintain a kinesthetic relationship with the surgeon's fingertip.

SUMMARY OF THE INVENTION

The present invention provides a surgical probe having an articulated digit located at a distal end of a positioning shaft that defines a longitudinal axis. An actuator is located at a proximal end of the positioning shaft and is operatively connected to the articulated digit so as to move the articulated digit between a continuous range of positions from an extended position to a substantially curved position while maintaining a kinesthetic relationship between a surgeon's finger engaging the actuator and the articulated digit, i.e., the extent of flexion or extension of the surgeon's finger is mimicked by the flexion or extension of the articulated digit such that forces transmitted between the surgeon's finger and the articulated digit are transmitted in a manner that provides functional sensation to the operator.

In one embodiment, a surgical probe is provided that includes an articulated digit located at a distal end of a positioning shaft having a longitudinal axis. An actuator is located at a proximal end of the positioning shaft so as to be operatively connected to the articulated digit. In this way, when the actuator moves, a kinesthetic relationship is maintained between a surgeon's finger engaging the actuator and the articulated digit. The articulated digit moves through a continuous range of positions that directly correspond with a continuous range of surgeon's finger positions attained when engaging the actuator so that the articulated digit moves between a fully extended position and a substantially curved or crook position.

In another embodiment, a surgical probe is provided that includes an articulated digit located at a distal end of a positioning shaft having a longitudinal axis, with a bulbous probe-tip that supports a sponge or gauze wad for use in blunt dissection. An actuator is located at a proximal end of the positioning shaft that is operatively connected to the articulated digit. In this way, the articulated digit may move between a continuous range of positions from an extended position to a substantially curved position while maintaining a kinesthetic relationship between a surgeon's finger engaging the actuator and the articulated digit. Preferably, the surgeon's finger position and shape directly correspond to the position and shape of the articulated digit.

In a surgical method according to the invention, a surgeon is provided with a surgical probe that includes an articulated digit located at a distal end of a positioning shaft having a longitudinal axis. An actuator located at a proximal end of the positioning shaft is operatively connected to the articulated digit so as to move the articulated digit between a continuous range of positions from an extended position to a substantially curved or crook position while maintaining a kinesthetic relationship between the surgeon's finger engaging the actuator and the articulated digit. The surgeon positions the surgical probe adjacent to an anatomical structure to be manipulated or palpated, and moves the actuator with a finger so as to arrange the articulated digit in a configuration that closely corresponds to the configuration of that finger. An anatomical structure may then be engaged and retracted, palpated, dissected, or otherwise probed with the articulated digit in a manner corresponding to manual manipulation and palpation of the anatomical structure during open surgical procedures with either gentle or firm movements of the articulated digit, including the application of torque to the anatomical structure.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring toFIGS. 1-3, an articulated surgical probe1formed in accordance with the present invention may be remotely and continuously contracted and extended in concert with a surgeon's finger, for remote manipulation or dissection of soft tissue and the like during minimally invasive surgical procedures, and without substantial loss of kinesthetic feedback or haptic sensation. One preferred embodiment of articulated surgical probe1comprises a digit3, a positioning shaft5, and an actuator assembly7. More particularly, digit3includes an elongate proximal phalanx10having a curved distal end12and a proximal end14, a middle phalanx18having a flat distal end22and a curved proximal end24, a distal phalanx26having a distal end28and a curved proximal end30, and a bulbous probe-tip32(FIGS. 2 and 3). In one embodiment, proximal phalanx10also includes a pair of radially spaced-apart, longitudinally oriented through-bores36a,36b, middle phalanx18includes a pair of radially spaced-apart, longitudinally oriented through-bores37a,37b, and distal phalanx26includes a pair of radially spaced-apart, longitudinally oriented through-bores38a,38b.

When digit3is assembled, curved proximal end30of distal phalanx26is pivotally connected to flat distal end22of middle phalanx18by, e.g., a pivot pin40, and curved distal end12of elongate proximal phalanx10is pivotally connected to curved proximal end24of middle phalanx18by a pivot pin41. In this way, the phalanges may pivot relative to one another so that digit3comprises a range of motion that is continuous between a first fully extended position that may be, for example, aligned with a longitudinal axis43of positioning shaft5, and often substantially coaxial with positioning shaft5, and a final substantially curved, flexed, crook, or “hook-shaped” position, i.e., curved or bent relative to positioning shaft5.

This range of motion of digit3is limited by the interactive engagement of curved proximal end30of distal phalanx26with flat distal end22of middle phalanx18and curved distal end12of elongate proximal phalanx10with curved proximal end24of middle phalanx18. In the first fully extended position, the upper or dorsal portion of curved proximal end30of distal phalanx26is blocked from further pivotal rotation by the upper or dorsal portion of flat distal end22of middle phalanx18, and the upper or dorsal portion of curved distal end12of elongate proximal phalanx10is blocked from further pivotal rotation by the upper or dorsal portion of curved proximal end24of middle phalanx18. Likewise, in the final flexed or crook position, the lower or anterior portion of curved proximal end30of distal phalanx26is blocked from further pivotal rotation by the lower or anterior portion of flat distal end22of middle phalanx18and the lower or anterior portion of curved distal end12of elongate proximal phalanx10is blocked from further pivotal rotation by the lower or anterior portion of curved proximal end24of middle phalanx18. Thus digit3can be operated so as to simulate or mimic the range of movements and configurations of a surgeon's finger42, while at the same time, maintaining a kinesthetic relationship between the surgeon's finger42and digit3(FIGS. 9 and 10). In other words, the surgeon's perception or sensing of the motion, weight, and position of digit3, relative to the tissue being probed, is maintained as the muscles, tendons, and joints of the surgeon's finger42move. For example, spring and damper sensations may be sensed by the surgeon when actuating articulated digit3so as to palpate a vein or a mass lodged in a bowel wall or muscle structure.

Bulbous probe-tip32projects outwardly from distal end28of distal phalanx26so as to provide a tactile pad or surface29for use in manipulating, palpating or dissecting tissue during surgery (FIGS. 4-7). Each phalanx, along with bulbous probe-tip32, may be coated with either a compliant covering45that simulates the tissue of a human finger, e.g., a biocompatible elastomeric polymer, latex, or the like, a stiff and unyielding material, e.g., surgical steel or bio-grade polymers of the type well known in the art, or a combination of both materials. In addition, digit3may be covered with a biocompatible elastomeric polymer, latex, or the like covering sheath so as to better approximate the diameter, contour, and shape of a human finger. In one embodiment, a dorsal portion of digit3or bulbous probe-tip32is adapted to receive and hold a so-called “peanut”, i.e., a sponge or gauze wad51, so as to replicate this open surgery dissection technique (FIGS. 4-5). Also a simple “sponge” for more blunt dissection or pressure applications, can also fit into the dorsal portion of digit3or bulbous probe-tip32. In addition, a detachable peanut dissector tip may also be employed (FIG. 5a). In yet another embodiment, bulbous probe-tip32may include a cautery attachment (FIG. 5a) to allow direct tissue cautery at bleeding points. Tissue planes may be dissected by teasing apart or pushing or pulling with various portions of digit3, particularly bulbous probe-tip32which is shaped and sized so as to prevent inadvertent puncture of mesentery during manipulations or palpations. Also, a light source, e.g., a fiber optic light, L.E.D., or the like, may be placed at bulbous probe-tip32(FIG. 6). This extra light can illuminate narrow dark passages or transilluminate bowel mesentery, facilitating dissection and/or division of the mesentery of a portion of intestine. Bulbous probe-tip32may be formed so as to have either a smooth finish or be more abrasive, for more blunt dissection (FIG. 7). The entire device can be made for bariatric surgical use and would be longer at, perhaps 45 cm. Also the device can be made thinner, for delicate dissection or for pediatric surgical applications as required without deviating from the scope of the invention.

Positioning shaft5comprises an elongate tube having a distal end44, a proximal end46, and a central passageway48(FIGS. 2-7). In one embodiment of the invention, actuator7includes a pair of crossed wires50a,50bthat each extend through radially spaced-apart, longitudinally oriented through-bores36a,36b,37a,37b,38a,38bof elongate proximal phalanx10, middle phalanx18, and distal phalanx26, and are each terminated to a portion of a toggle lever60in a handle62and within distal phalanx26. When toggle lever60is pivoted relative to handle62so as to move or pivot in alignment with longitudinal axis43, i.e., travel in a plane containing longitudinal axis43, one of crossed wires50a,50bis placed in tension while the other is released from tension. In this way, articulated phalanxes10,18, and26are pivoted about their respective pivot connections so as to cause digit3to move continuously from a substantially extended configuration to a substantially flexed, curved shape. As a result, digit3may be articulated so as to match a variety of finger positions normally used by a surgeon during open surgical procedures. Advantageously, digit3cannot bend backward, i.e., in a dorsal direction beyond parallel with longitudinal axis43, but instead moves continuously from a first, extended position, that is often substantially longitudinally aligned with positioning shaft5, and a second substantially curved flexed position where bulbous probe-tip32is located adjacent to proximal phalanx10. The in-line or longitudinally aligned relationship of articulated digit3, positioning shaft5, wires50a,50b, and actuator7provide for significantly improved tactile feedback. In particular, the longitudinally aligned relationship between actuator7, positioning shaft5, and articulated digit3provides a surgeon force feedback or tactile feedback, via the portion of wire50a,50bthat are in tension, and more generally known as “haptic feedback”, that yields physical sensations which are felt by the surgeon while manipulating articulated digit3via toggle62. A lock52may be incorporated in handle62so that toggle60, and thereby articulated digit3, may be locked in a desired position.

Referring toFIGS. 12-15, an alternative embodiment of articulated surgical probe70that comprises a detachable articulated digit73, a positioning shaft75and an actuator assembly7that is substantially similar to that used with articulated surgical probe1. More particularly, detachable articulated digit73includes an elongate proximal phalanx80having a distal end82and a proximal end84, a middle phalanx88having a distal end92and a proximal end94, a distal phalanx96having a distal end98and a proximal end103, a linking assembly106, and a bulbous probe-tip32(FIGS. 12-14and3). Proximal phalanx80, middle phalanx88, and distal phalanx96are substantially similar in construction and assembly to proximal phalanx10, middle phalanx18, and distal phalanx26, and each also includes a pair of radially spaced-apart, longitudinally oriented through-bores (not shown) that are substantially similar to36a,36b,37a,37b, and38a,38b. Additionally, proximal phalanx80includes a mounting hub110that projects outwardly from proximal end84. Mounting hub110is often hollow with a cylindrical shape and a smaller outer diameter than proximal phalanx80. A blind recess111is defined in the outer surface of proximal end84, adjacent to the intersection of mounting hub111and proximal phalanx80.

Referring toFIGS. 13-15, linking assembly106includes a pair of wires115a,115bthat each extend through the radially spaced-apart, longitudinally oriented through-bores located within elongate proximal phalanx80, middle phalanx88, and distal phalanx96, where each are terminated to an inner portion of distal phalanx96. A terminal117is fastened to the end portion of each of wires115a,115bthat extends from within mounting hub110. Each terminal117includes a releasable mounting knob119at a mating end120. Positioning shaft75comprises an elongate tube having a distal end118, a proximal end46, and a central passageway48. A pair of crossed wires115c,115dextend through central passageway48from actuator assembly7to a position adjacent to an open end121of positioning shaft75. A receptacle122is fastened to the end portion of each of wires115c,115d, with each receptacle122including a releasable mounting socket124that is sized and shaped to receive and releasably grasp each releasable mounting knob119at mating end120of each terminal117. A pivotable shaft lock126is located on an outer surface of positioning shaft75adjacent to open end121, and a pair of pivotable receptacle clamps130are arranged on the outer surface of positioning shaft75at a location corresponding to the location of releasable mounting sockets124within central passageway48.

Detachable articulated digit73may be fastened to positioning shaft75of articulated surgical probe70by first arranging proximal end84of proximal phalanx80in confronting coaxial relation with open end121of positioning shaft75. Once in this position, articulated digit73is moved toward positioning shaft75so that mounting hub110slips into open end121and central passageway48of positioning shaft75. As this occurs, each terminal117on wires115aand115bare received within a corresponding receptacle122so that each releasable mounting knob119at mating end120engages a releasable mounting socket124. Once mounting hub110is fully received within open end121of positioning shaft75, pivotal shaft lock126is pivoted about its position on the outer surface of positioning shaft75until it engages blind recess111in the outer surface of proximal end84of proximal phalanx80. Each pivotable receptacle clamp130is then actuated so as to releasably clamp each mounting knob110within its respective mounting socket124thereby completing the operative interconnection of wires115a,115b,115cand115d. With detachable articulated digit73fully engaged with positioning shaft75, operation of articulated surgical probe70follows in accordance with the operation of articulated surgical probe1.

As with articulated digit3, the phalanges of detachable digit73may pivot relative to one another so that articulated digit73comprises a range of motion that is continuous between a first fully extended position that may be, for example, aligned with the longitudinal axis of positioning shaft75, and often substantially coaxial with positioning shaft75, and a final substantially curved, flexed, crook, or “hook-shaped” position, i.e., curved or bent relative to positioning shaft75. Thus digit73can be operated so as to simulate the range of movements and configurations of a surgeon's finger42, while at the same time, maintaining a kinesthetic relationship between the surgeon's finger42and articulated digit73. The surgeon's perception or sensing of the motion, weight, and position of articulated digit73, relative to the tissue being probed, is maintained as the muscles, tendons, and joints of the surgeon's finger42move.

Referring toFIGS. 16-20, a further alternative embodiment of articulated surgical probe140comprises a single phalange digit143, a positioning shaft5and an actuator assembly7. The construction and arrangement of positioning shaft5and actuator assembly7are substantially similar to that used with articulated surgical probe1. Single phalange articulated digit143includes an elongate proximal phalanx146having a distal end148and a proximal end150, and a distal phalanx151having a distal end152and a proximal end154. Proximal phalanx146comprises a blade hinge160that projects longitudinally outwardly from proximal end150, and also includes a pair of radially spaced-apart, longitudinally oriented internal blind-bores (not shown) arranged in similar manner to radially spaced-apart, longitudinally oriented through-bores36a,36bof articulated digit3(FIGS. 2-7). Distal phalanx151comprises a yokel62that is sized and arranged on the distal end of positioning shaft5so as to receive blade hinge160. Yoke162is pivotally fastened to blade hinge160by a pivot pin164. In this way, proximal phalanx146may pivot relative to distal phalanx151so that single knuckle digit143comprises a range of motion that is continuous between a first fully extended position that may be, for example, aligned with the longitudinal axis of positioning shaft5, and often substantially coaxial with positioning shaft5, and a final substantially, flexed position, i.e., bent relative to positioning shaft5. Referring toFIG. 21, an articulated surgical probe may also be formed in accordance with another embodiment of the invention having an articulated digit3comprising three, four or a plurality of phalanges without departing from the scope or spirit of the present invention.

It should be understood that, although less preferred, the toggle lever and wire assembly of articulated surgical probes1,70, and140may be replaced by a motorized motivator, e.g., a miniature servo-motor, of the type well known in the art, so long as, the kinesthetic relationship between the surgeon's actuating finger42and the articulated digit3,74, or143are maintained. Alternatively, and now referring toFIGS. 21-23, actuator assembly7comprising a toggle lever60and wires50a,50bmay be replaced by a toggle lever60and linkage assembly170to form an operative connection to an articulated digit173. More particularly, articulated surgical probe172includes articulating digit173located at distal end44of positioning shaft5. More particularly, articulating digit173includes an elongate, hollow proximal phalanx178having a distal end180and a proximal end182, a hollow middle phalanx184having a distal end186and a proximal end188, and a hollow distal phalanx190having a distal end192and a proximal end193. Proximal end180of proximal phalanx178, includes a pair of spaced apart, diametrically confronting hinge arms198a,198bthat project longitudinally outwardly from proximal end182. Each of hinge arms198a,198bdefines a through-hole sized to receive a corresponding hinge pin200. Middle phalanx184includes two pair of hinge arms202a,202band203a,203bthat project longitudinally outwardly from each of proximal end188and distal end186, while distal phalanx190includes a single pair of hinge arms204a,204bthat project longitudinally outwardly from proximal end193. Each of hinge arms202a,202b,203a,203b, and204a,204bdefine a through-hole sized to receive a corresponding hinge pin200.

Referring toFIGS. 22 and 23, linkage assembly170is operatively positioned within, and extends throughout the interior of each of proximal phalanx178, a hollow middle phalanx184, and a hollow distal phalanx190, and comprises a plurality of dorsal links207a,207b,207c, a plurality of anterior links208a,208b,208c, and at least two cross-links209a,209b. Each of dorsal links207a,207b,207cand anterior links208a,208b,208ccomprises a pair of longitudinally spaced apart holes that are sized so as to accept a hinge pin210, while each of cross-links209a,209bcomprises three longitudinally spaced apart holes. The outer most two of which are sized so as to accept a hinge pin210, with a centrally located hole sized to accept hinge pin200. Anterior link208cand dorsal link207ccross one another, and are each pivotally terminated to a portion of the interior of toggle lever60in handle62, and within a portion of the interior of hollow distal phalanx190. Once again, when toggle lever60is pivoted relative to handle62so as to move or pivot, one of crossed anterior link208cand dorsal link207cis placed in tension while the other is released from tension. In this way, articulated phalanxes178,184, and190are pivoted about their respective pivot connections, via toggling of cross-links209a,209bcaused by the relative longitudinal movements of dorsal links207a,207b,207cand anterior links208a,208b,208c, so as to cause articulated digit172to move continuously from a substantially extended configuration to a substantially flexed, curved shape.

As with articulated digit3, when articulated digit173is in a first fully extended position, the upper or dorsal portion of the proximal end of distal phalanx190is blocked from further pivotal rotation by the upper or dorsal portion of the distal end of middle phalanx184, and the upper or dorsal portion of the distal end of proximal phalanx178is blocked from further pivotal rotation by the upper or dorsal portion of the proximal end of middle phalanx184. Likewise, in a final flexed or crook position, the lower or anterior portion of the proximal end of distal phalanx190is blocked from further pivotal rotation by the lower or anterior portion of the distal end of middle phalanx184, and the lower or anterior portion of the distal end of proximal phalanx178is blocked from further pivotal rotation by the lower or anterior portion of the proximal end of middle phalanx184.

Advantages of the Invention

Numerous advantages are obtained by employing the present invention. The position of any of articulated digits3,74,143, or173in, e.g., the abdomen of a patient, is mirrored by the position of the surgeon's finger42on toggle60(FIGS. 2-3) with the extent and types of motion being quite similar. Because the configuration of articulated digit3,74,143, or173transitions in a manner that is very similar to a surgeon's finger, various dissecting maneuvers, not possible with existing small tipped instruments, can be accomplished. Bolder, longer, and firmer movements, as in open surgery can be done, with these movements taking less time than more tedious slower, smaller movements, as with available small tipped instruments.

For example, with a laparosopic approach it is often difficult and time consuming to dissect around certain structures compared to open surgery. Dissection around the esophagus (FIGS. 24 and 25), around the splenic hilar vessels (FIG. 26) or bowel (FIG. 27) is tedious when small-tipped instruments are used, however, articulated surgical probes1,70, or140are able to duplicate or at least approximate the finger positions and movements associated with an open surgical approach, and therefore facilitates dissection of such structures. For example, minimally invasive dissection of adherent omentum will be similar to open surgery when operating an articulated surgical probe formed in accordance with the present invention in either hand, with retraction, pushing, and pulling of the omentum being done substantially as efficiently as in open surgery.

Advantageously, an articulated surgical probe formed in accordance with the foregoing preferred embodiments may be actuated so as to apply a variable amount of force to its articulated digit by flexing and or pulling or pushing the entire device (FIG. 24-27). This often is important, e.g., when holding the stomach or colon away from a surgical site is needed (retracting) so as to enable dissection. It is well known that prior art devices often cause tears in the otherwise healthy tissue further complicating the procedure, because such prior art small tipped instruments tend to be sharp or pointed. Articulated digit3,73,143, or173allows for more blunt retraction of such obstructing tissue. Articulated surgical probe1also allows dissection movements similar in range to a surgeon's finger. Compared to hand assisted laparoscopy, articulated digit3allows dissection without the rest of the surgeon's hand blocking the view of the operative field on the monitor screen. In one embodiment, two articulated surgical probes1and100may be used through two incision ports so as to provide even greater range of tissue manipulation with an unobstructed view, when compared to hand assisted surgery.

Articulated surgical probe1allows dissection movements similar in force to a surgeon's finger. The force applied by articulated digit3,73,143, or173can be from very gentle, subtle movements to firm, strong dissection. Gentle movement is often necessary near blood vessels or tenuous tissues. Stronger dissection, for example, is necessary to peel the rectum away from the sacrum. Both types of procedures may be done without any structural change being made to articulated surgical probes1,70, or140. Articulated surgical probes1,70, or140additionally provide for increased retraction, when digit3,73,143, or173is flexed, as compared to a straight prior art instrument. In this technique, handle62remains relatively parallel to the patient's body, e.g., the abdominal wall. In contrast, with a straight prior art instrument, when retracting the stomach, for example, the prior art handle must be levered to about 90 degrees in order to enable the same amount of retraction.

In prior art dissection procedures, viscera is often retracted with stiff grasping tools. This can cause inadvertent tearing of the bowel, which may require surgical repair. Articulated surgical probe1also provides for gentle but secure retraction of viscera when in either a locked or unlocked position. Gentle retraction of soft parts of viscera is essential to avoid inadvertent damage. Because there is tactile feedback resulting from the straight, in-line relation between handle62, positioning shaft5, and digit3,73,143, or173, the retracting or dissecting with digit3,73,143, or173is less apt to cause damage than the straighter, less tactile, instruments of the prior art. Furthermore, the present invention is less apt to cause damage than prior art small tipped instruments of the prior art which often do not transmit forces directly to the surgeon, and often have sharp tips.

A locked position, via actuation of locking mechanism52, allows the surgeon to hold articulated surgical probe1anywhere along the instrument, so that hand fatigue can be avoided. The unlocked position allows for multiple changes as to where the viscera is held for retraction, during dissection. Countertraction of tissue or viscera can be accomplished with articulated surgical probe1as well. This countertraction, i.e., away from the point of dissection, is part of the traction-countertraction action inherent to open surgical maneuvers, and difficult with prior art small tipped laparoscopic instruments.

Advantageously, articulated surgical probe1allows palpation of masses, such as tumors inside the colon, with bulbous probe-tip32. The tactile feed-back provided by the in-line relationship of handle62, positioning shaft5, wires50a,50b, and digit3helps direct a surgeon as to the margins of resection of a tumor. Otherwise, a section of intestine could be removed without encompassing the tumor. In current minimally invasive surgery, this is only discovered upon opening the specimen after it is removed from the patient.

In some instances, dissection of structures, such as the gallbladder from the liver bed with digit3, can copy the techniques used by the surgeon's own finger during open gall bladder dissection, e.g., peeling away the gallbladder from the liver bed. Laparoscopic dissection, particularly in difficult cases, therefore can be made faster and safer. In addition, when there is intra operative bleeding during laparoscopic surgery, it is difficult to apply direct pressure with an “end-on” application of a prior art instrument, especially if the bleeding is slightly above or below the immediate point of dissection. Since digit3of articulated surgical probe1flexes, bulbous probe-tip32can apply direct pressure so that bleeding can be controlled in a quicker, more reliable fashion, approximating very closely the same maneuver utilizing the surgeon's finger.

When various staplers are employed to divide intestine or stomach, tissue planes adjacent to viscera can be dissected in order to explore the anatomy with articulated surgical probe1or prepare an organ or organ part for removal. This manipulation is similar to what is often done in open surgery. Furthermore, the stapler distal tip may be difficult to visualize, on a television monitor. Articulated digits3,74,143, or173of articulated surgical probes1,70,140, and172can support the distal stapler tip so as to optimize the application angle, as well as, assure that the proper amount of intestine is lined up for the division. Inadvertent inclusion of unwanted tissue can be avoided as well as incomplete application of the stapler.

It is to be understood that the present invention is by no means limited only to the particular constructions herein disclosed and shown in the drawings, but also comprises any modifications or equivalents within the scope of the claims.