Hybrid robotic surgery with locking mode

Methods and devices are provided for performing robotic surgery. In general, a surgical system is provided including an electromechanical tool with a first mode of operation in which the electromechanical tool mimics movement of a controller, and a second mode of operation in which the tool mirrors movement of the controller. A hybrid surgical device is also provided including an adapter matable to a handle assembly such that the adapter is electronically coupled to a motor of the handle assembly and is configured to communicate with the motor. A robotic laparoscopic surgical device is also provided including a motion sensor configured to sense movement of an electromechanical tool and an electromechanical arm that assists movement of the tool. A robotic surgical device is also provided including an electromechanical driver associated with a trocar and being configured to rotate and to translate a tool disposed through a passageway.

FIELD OF THE INVENTION

Methods and devices are provided for performing robotic surgery, and in particular for performing hybrid surgery using both manually and robotically operated tools.

BACKGROUND OF THE INVENTION

Minimally invasive surgical (MIS) instruments are often preferred over traditional open surgical devices due to the reduced post-operative recovery time and minimal scarring. Laparoscopic surgery is one type of MIS procedure in which one or more small incisions are formed in the abdomen and a trocar is inserted through the incision to form a pathway that provides access to the abdominal cavity. The trocar is used to introduce various instruments and tools into the abdominal cavity, as well as to provide insufflation to elevate the abdominal wall above the organs. The instruments and tools can be used to engage and/or treat tissue in a number of ways to achieve a diagnostic or therapeutic effect. Endoscopic surgery is another type of MIS procedure in which elongate flexible shafts are introduced into the body through a natural orifice.

Various robotic systems have been developed to assist in MIS procedures. Robotic systems can allow for more intuitive hand movements by maintaining natural eye-hand axis. Robotic systems can also allow for more degrees of freedom in movement by including a “wrist” joint on the instrument, creating a more natural hand-like articulation. One drawback with robotic systems, however, is the loss of direct human contact with the tissue. There can be no true force feedback given to the surgeon. Another drawback is the high expense to manufacture such systems.

Accordingly, there remains a need for improved methods, systems, and devices for use in robotic surgery.

SUMMARY OF THE INVENTION

Various methods and devices are provided for performing robotic surgery.

In one embodiment, a robotic surgical device is provided and includes an electromechanical arm, and a trocar having a tool-receiving passageway extending therethrough and defining a longitudinal axis. The trocar can be coupled to a distal end of the electromechanical arm and it can be configured to articulate to allow a tool extending through the passageway to be angularly oriented. The device can also include at least one electromechanical driver operatively associated with the trocar. The electromechanical driver can be configured to rotate a tool disposed through the passageway about the longitudinal axis, and the electromechanical driver can be configured to translate a tool disposed through the passageway along the longitudinal axis. The electromechanical driver can also be configured to selectively lock a tool extending through the passageway in a desired position with respect to one of articulation, translation, and rotation, while allowing movement of the tool with respect to another one of articulation, translation, and rotation.

Another embodiment can include a trocar with a sensor configured to sense a position of the tool extending through the passageway relative to the trocar. The position of a tool can include a position of an end effector on a distal end of the tool. A sensor can be a magnetic sensor. A sensor can also be a mechanical displacement sensor. A sensor can include a wheel configured to rotate against a tool extending through a passageway. The wheel can be configured to determine how far the tool has been inserted based on a number of rotations of the wheel. A sensor can also include a plurality of magnetic sensors spaced at known intervals and configured to detect magnetically active areas on the shaft of the tool extending through the passageway. At least one electromechanical driver can also include at least one motor and at least one gear. The at least one gear can be selected from the group consisting of a circular gear, a frictional gear, and a gear track. The at least one gear can include a gear track configured to engage a plurality of gear notches positioned on a shaft of the tool extending through the passageway.

In another embodiment, a robotic surgical device can be provided with a trocar having a tool-receiving passageway extending therethrough and defining a longitudinal axis. The trocar can be configured to articulate to angularly position a tool extending through the tool-receiving passageway. The robotic surgical device can also include at least one electromechanical driver operatively associated with the trocar. The electromechanical driver can be configured to selectively rotate a tool about a longitudinal axis and can be configured to selectively translate a tool along the longitudinal axis. The electromechanical driver can also be configured to maintain an orientation of a tool when the tool is not in motion.

DETAILED DESCRIPTION OF THE INVENTION

In general, methods and devices for performing hybrid robotic surgery are provided. In particular, the methods and devices disclosed herein allow an operator to perform a surgical procedure using a robotically controlled instrument, and to use a selectively manually operated surgical instrument. The robotic and manual instruments are capable of performing a variety of functions and the procedure can be selectively performed using an entirely manual operation of the instrument(s), a partially-manual and partially-powered operation of the instrument(s), and an entirely powered operation of instrument(s). Manually operated surgical instruments are further provided that are capable of receiving movement assistance from robotic arms during surgery. Robotic trocars are also provided that are capable of receiving instruments and providing controlled movement to those instruments within certain degrees of freedom.

Terminology

There are a number of ways in which to describe the movement of a surgical system, as well as its position and orientation in space. One particularly convenient convention is to characterize a system in terms of its degrees of freedom. The degrees of freedom of a system are the number of independent variables that uniquely identify its pose or configuration. The set of Cartesian degrees of freedom is usually represented by the three translational or position variables, e.g., surge, heave, and sway, and by the three rotational or orientation variables, e.g., Euler angles or roll, pitch, and yaw, that describe the position and orientation of a component of a surgical system with respect to a given reference Cartesian frame. As used herein, and as illustrated inFIG. 1, the term “surge” refers to forward and backward movement, the term “heave” refers to movement up and down, and the term “sway” refers to movement left and right. With regard to the rotational terms, “roll” refers to tilting side to side, “pitch” refers to tilting forward and backward, and “yaw” refers to turning left and right. In a more general sense, each of the translation terms refers to movement along one of the three axes in a Cartesian frame, and each of the rotational terms refers to rotation about one of the three axes in a Cartesian frame.

Although the number of degrees of freedom is at most six, a condition in which all the translational and orientation variables are independently controlled, the number of joint degrees of freedom is generally the result of design choices that involve considerations of the complexity of the mechanism and the task specifications. For non-redundant kinematic chains, the number of independently controlled joints is equal to the degree of mobility for an end effector. For redundant kinematic chains, the end effector will have an equal number of degrees of freedom in Cartesian space that will correspond to a combination of translational and rotational motions. Accordingly, the number of degrees of freedom can be more than, equal to, or less than six.

With regard to characterizing the position of various components of the surgical system and the mechanical frame, the terms “forward” and “rearward” may be used. In general, the term “forward” refers to an end of the surgical system that is closest to the distal end of the input tool, and when in use in a surgical procedure, to the end disposed within a patient's body. The term “rearward” refers to an end of the surgical system farthest from the distal end of the input tool, and when in use, generally to the end farther from the patient.

The terminology used herein is not intended to limit the invention. For example, spatially relative terms, e.g., “superior,” “inferior,” “beneath,” “below,” “lower,” “above,” “upper,” “rearward,” “forward,” etc., may be used to describe one element's or feature's relationship to another element or feature as illustrated in the figures. These spatially relative terms are intended to encompass different positions and orientations of the device in use or operation in addition to the position and orientation shown in the figures. For example, if the device in the figures is turned over, elements described as “inferior to” or “below” other elements or features would then be “superior to” or “above” the other elements or features. Likewise, descriptions of movement along and around various axes include various special device positions and orientations. As will be appreciated by those skilled in the art, specification of the presence of stated features, steps, operations, elements, and/or components does not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups described herein. In addition, components described as coupled may be directly coupled, or they may be indirectly coupled via one or more intermediate components.

There are several general aspects that apply to the various descriptions below. For example, at least one surgical end effector is shown and described in various figures. An end effector is the part of a surgical instrument or assembly that performs a specific surgical function, e.g., forceps/graspers, needle drivers, scissors, electrocautery hooks, staplers, clip appliers/removers, suction tools, irrigation tools, etc. Any end effector can be utilized with the surgical systems described herein. Further, in exemplary embodiments, an end effector can be configured to be manipulated by a user input tool. The input tool can be any tool that allows successful manipulation of the end effector, whether it be a tool similar in shape and style to the end effector, such as an input tool of scissors similar to end effector scissors, or a tool that is different in shape and style to the end effector, such as an input tool of a glove dissimilar to end effector graspers, and such as an input tool of a joystick dissimilar to end effector graspers. In some embodiments, the input tool can be a larger scaled version of the end effector to facilitate ease of use. Such a larger scale input tool can have finger loops or grips of a size suitable for a user to hold. However, the end effector and the input tool can have any relative size.

A slave tool, e.g., a surgical instrument, of the surgical system can be positioned inside a patient's body cavity through an access point in a tissue surface for minimally invasive surgical procedures. Typically, cannulas such as trocars are used to provide a pathway through a tissue surface and/or to prevent a surgical instrument or guide tube from rubbing on patient tissue. Cannulas can be used for both incisions and natural orifices. Some surgical procedures require insufflation, and the cannula can include one or more seals to prevent excess insufflation gas leakage past the instrument or guide tube. In some embodiments, the cannula can have a housing coupled thereto with two or more sealed ports for receiving various types of instruments besides the slave assembly. As will be appreciated by a person skilled in the art, any of the surgical system components disclosed herein can have a functional seal disposed thereon, therein, and/or therearound to prevent and/or reduce insufflation leakage while any portion of the surgical system is disposed through a surgical access port, such as a cannula. The surgical systems can also be used in open surgical procedures. As used herein, a surgical access point is a point at which the slave tool enters a body cavity through a tissue surface, whether through a cannula in a minimally invasive procedure or through an incision in an open procedure.

Computer Systems

The systems, devices, and methods disclosed herein can be implemented using one or more computer systems, which may also be referred to herein as digital data processing systems and programmable systems.

FIG. 2illustrates one exemplary embodiment of a computer system100. As shown, the computer system100can include one or more processors102which can control the operation of the computer system100. “Processors” are also referred to herein as “controllers.” The processor(s)102can include any type of microprocessor or central processing unit (CPU), including programmable general-purpose or special-purpose microprocessors and/or any one of a variety of proprietary or commercially available single or multi-processor systems. The computer system100can also include one or more memories104, which can provide temporary storage for code to be executed by the processor(s)102or for data acquired from one or more users, storage devices, and/or databases. The memory104can include read-only memory (ROM), flash memory, one or more varieties of random access memory (RAM) (e.g., static RAM (SRAM), dynamic RAM (DRAM), or synchronous DRAM (SDRAM)), and/or a combination of memory technologies.

The various elements of the computer system100can be coupled to a bus system112. The illustrated bus system112is an abstraction that represents any one or more separate physical busses, communication lines/interfaces, and/or multi-drop or point-to-point connections, connected by appropriate bridges, adapters, and/or controllers. The computer system100can also include one or more network interface(s)106, one or more input/output (IO) interface(s)108, and one or more storage device(s)110.

The network interface(s)106can enable the computer system100to communicate with remote devices, e.g., other computer systems, over a network, and can be, for non-limiting example, remote desktop connection interfaces, Ethernet adapters, and/or other local area network (LAN) adapters. The IO interface(s)108can include one or more interface components to connect the computer system100with other electronic equipment. For non-limiting example, the IO interface(s)108can include high speed data ports, such as universal serial bus (USB) ports, 1394 ports, Wi-Fi, Bluetooth, etc. Additionally, the computer system100can be accessible to a human user, and thus the IO interface(s)108can include displays, speakers, keyboards, pointing devices, and/or various other video, audio, or alphanumeric interfaces. The storage device(s)110can include any conventional medium for storing data in a non-volatile and/or non-transient manner. The storage device(s)110can thus hold data and/or instructions in a persistent state, i.e., the value(s) are retained despite interruption of power to the computer system100. The storage device(s)110can include one or more hard disk drives, flash drives, USB drives, optical drives, various media cards, diskettes, compact discs, and/or any combination thereof and can be directly connected to the computer system100or remotely connected thereto, such as over a network. In an exemplary embodiment, the storage device(s) can include a tangible or non-transitory computer readable medium configured to store data, e.g., a hard disk drive, a flash drive, a USB drive, an optical drive, a media card, a diskette, a compact disc, etc.

The elements illustrated inFIG. 2can be some or all of the elements of a single physical machine. In addition, not all of the illustrated elements need to be located on or in the same physical machine. Exemplary computer systems include conventional desktop computers, workstations, minicomputers, laptop computers, tablet computers, personal digital assistants (PDAs), mobile phones, and the like.

The computer system100can include a web browser for retrieving web pages or other markup language streams, presenting those pages and/or streams (visually, aurally, or otherwise), executing scripts, controls and other code on those pages/streams, accepting user input with respect to those pages/streams (e.g., for purposes of completing input fields), issuing HyperText Transfer Protocol (HTTP) requests with respect to those pages/streams or otherwise (e.g., for submitting to a server information from the completed input fields), and so forth. The web pages or other markup language can be in HyperText Markup Language (HTML) or other conventional forms, including embedded Extensible Markup Language (XML), scripts, controls, and so forth. The computer system100can also include a web server for generating and/or delivering the web pages to client computer systems.

In an exemplary embodiment, the computer system100can be provided as a single unit, e.g., as a single server, as a single tower, contained within a single housing, etc. The single unit can be modular such that various aspects thereof can be swapped in and out as needed for, e.g., upgrade, replacement, maintenance, etc., without interrupting functionality of any other aspects of the system. The single unit can thus also be scalable with the ability to be added to as additional modules and/or additional functionality of existing modules are desired and/or improved upon.

A computer system can also include any of a variety of other software and/or hardware components, including by way of non-limiting example, operating systems and database management systems. Although an exemplary computer system is depicted and described herein, it will be appreciated that this is for sake of generality and convenience. In other embodiments, the computer system may differ in architecture and operation from that shown and described here.

Robotic Surgical Systems

As will be appreciated by a person skilled in the art, electronic communication between various components of a robotic surgical system can be wired or wireless. A person skilled in the art will also appreciate that all electronic communication in the system can be wired, all electronic communication in the system can be wireless, or some portions of the system can be in wired communication and other portions of the system can be in wireless communication.

FIG. 3schematically illustrates a robotic surgical system200configured to be used by a user202(e.g., a surgeon, a surgical assistant, etc.) during performance of a surgical procedure on a patient204. In this illustrated embodiment, the robotic surgical system200includes a controller206, one or more motors208, and a movement mechanism210. The controller206can be configured to receive an input from the user202requesting movement, relative to the patient204, of a surgical instrument coupled to the movement mechanism210. The controller206can be configured to cause the motors208to drive movement of the movement mechanism210, thereby causing the movement of the surgical instrument as requested by the user202. The robotic surgical system200can include a plurality of motors, or it can include a single motor. Similarly, the robotic surgical system200can include a single controller and a single movement mechanism, or the robotic surgical system can include a plurality of controllers and/or a plurality of movement mechanisms.

In an exemplary embodiment, the movement mechanism210includes an arm. The arm can be configured to move so as to cause movement of a surgical instrument coupled thereto in any one or more of the three translational directions (surge, heave, and sway) and in any one or more of the three rotational directions (roll, pitch, and yaw) in response to control by the controller206. In an exemplary embodiment, the arm is configured to provide a plurality of degrees of freedom. More than six degrees of freedom can be provided in a variety of ways, as mentioned above and as will be appreciated by a person skilled in the art. In general, the arm can include a mechanical member configured to move in response to an input received by the system200from the user202. The user's input can be configured to cause the controller206to transmit an electronic signal to the motors208that causes the motors208to provide a force (e.g., torque) to the arm, thereby causing movement of the arm. The arm can include a plurality of members jointed together, which can facilitate movement of the arm in a plurality of degrees of freedom via bending, twisting, etc. at one or more of the joints.

In an exemplary embodiment, the arm is an electromechanical arm. The electromechanical arm can include one or more mechanical members configured to move in response to an electronic input. Examples of mechanical members that can form the arm include elongate shafts, coupling mechanisms configured to removably and replaceably couple a surgical instrument to the arm, and joints (e.g., hinges, gimbals, etc.). The coupling mechanism can be, for example, clips, magnets, snap fit mechanisms, shaped members configured to seat an instrument therein by interference fir or press fit, clamps, protrusions configured to be seated in corresponding depressions formed in a surgical instrument, depressions configured to receive therein corresponding protrusions extending from a surgical instrument, etc.

FIGS. 4 and 5illustrate one embodiment of an arm300in the form of an electromechanical arm. The arm300inFIG. 4is shown mounted to a surgical table302using a frame304, however the arm300can be mounted to any of a variety of stationary items, a wall, a table, a cart, the ceiling, etc., in any of a variety of ways to help stabilize the arm300for use during a surgical procedure. The illustrated arm300includes an active portion300aconfigured to be actively controlled, e.g., configured to move in response to an electronic input, and a passive portion300bconfigured to be passively controlled, e.g., configured to move in response to manual movement thereof. The passive portion300bcan lack motors or other electrical features, while the active portion300acan include motors and other electrical features that are associated with the joints to facilitate electronic control thereof. In at least some embodiments, an arm can lack a passive portion so as to be configured to be entirely actively controlled. While the active and passive portions300a,300bare sometimes referred to herein as components of a single arm, a person skilled in the art will appreciate that the active portion300aand the passive portion300bcan be separate arms that are matable to each other.

As shown, the arm300can include a plurality of mechanical members306, a plurality of joints308, and a coupling mechanism310. Adjacent ones of the mechanical members306can be attached together by a joint308. In this embodiment, the active portion300aof the arm300includes four mechanical members306and five joints308, the passive portion300bof the arm300includes three mechanical members306and three joints308, and the arm300includes another joint308between the active and passive portions300a,300b. A person skilled in the art will appreciate that the arm can have any number of mechanical members and associated joints in its active and passive portions.

FIG. 5illustrates the active portion of the arm, and as shown it can be configured to removably and replaceably couple to a surgical instrument312via the coupling mechanism310. A distal end314of the instrument312can be configured to be advanced into a body of a patient, e.g., through an incision, through a natural orifice, etc. The instrument's distal end314can be configured to facilitate performance of a surgical procedure within the patient. For example, the instrument's distal end314can include an end effector, e.g., forceps/graspers, needle drivers, scissors, electrocautery hooks, staplers, clip appliers/removers, suction tools, irrigation tools, etc. As in this illustrated embodiment, the instrument312can be advanced into a patient's body through a cannula316that is mated to the coupling mechanism310.

FIGS. 6-8illustrate the arm300coupled to a surgical table. As shown inFIGS. 6 and 7, the arm300can be included in a robotic surgical system406configured to facilitate performance of a surgical procedure on a patient P.FIG. 8shows an example of the system406in use. As in this illustrated embodiment, the system406can include a user interface sub-system408that can include at least one display410configured to display information thereon to a user U, at least one user input device412configured to receive a user input to control movement of the arm300, a visualization system414that can include at least one display416configured to display thereon image(s) of a surgical procedure being performed using the system406, a freely movable user input device418(shown as pinchers in this illustrated embodiment) configured to receive a user input to control movement of the arm300and configured to be freely moved around by the user U (e.g., handheld and moved around any space in or near an operating room, etc.), an additional arm422that can be configured and used similar to the arm300, and a control system426configured to facilitate control of the arms300,422by transferring user inputs received from the user input devices412,418, e.g., manual movement of a user input device, movement indicated by touch on a touch screen, etc., to one or both of the arms300,422as appropriate. The system406in this illustrated embodiment includes two arms300,422, but it can include any number of arms, e.g., three, four, etc. The display410of the user interface sub-system408can be configured as a user input device, e.g., as a touchscreen configured to receive user touch input thereon. The user interface sub-system408can be in the same room as the patient P, or it can be in a different room.

The control system426can include at least one computer428, one or more cables430, and at least one power supply432. The computer428can include at least one processor (not shown). As mentioned above, some embodiments of control systems can be at least partially wireless, in which case at least some of the cables430need not be present. The robotic surgical system406can include at least one foot pedal434coupled to the computer428via one of the cables430, which can allow the foot pedal434to serve as a user input device.

The robotic surgical system406can further include a frame424for each of the arms300,422. The frames424in the illustrated embodiment are each mounted to a surgical table426, but as mentioned above, frames can be mounted elsewhere. The frames424in the illustrated embodiment each include a vertical extension movably coupled to a rail mounted to the table426. The vertical extension can be configured to move along the rail, thereby facilitating positioning of the arms300,422relative to the patient P.

One or more manually operated surgical instruments420, e.g., instruments not under the control of the robotic surgical system406, can also be used to perform the surgical procedure being performed on the patient P.

FIG. 9illustrates another embodiment of a robotic surgical system500. In this embodiment, the robotic surgical system500includes a display502and a control system504configured to be in electronic communication with the display502. The display502and the control system504are shown in wired electronic communication, but the electronic communication can be wireless. The control system504can include a computer system having a display controller506configured to facilitate the display of images on the display502, such as images of tissue508visualized by an endoscope510coupled to the control system504. The display502can include handles512a,512bconfigured to facilitate manual movement of the display502, a hand-tracking transmitter514configured to generate a field (e.g., an electromagnetic field, an optical field (e.g., light beams), etc.), a surgeon's viewer516(e.g., glasses, etc.) configured to facilitate three-dimensional (3-D) viewing of 3-D images shown on the display502, and a boom518configured to mount the display502to a stable surface (e.g., a wall, a table, etc.). The display502can be configured to show two-dimensional (2-D) and/or 3-D images.

Movement of a user-controlled master tool520in a field generated by the transmitter514can be configured to provide sensed spatial position and orientation information in a 3-D coordinate system, as shown inFIG. 10. The master tool520can be configured to transmit the spatial position and orientation information to the control system504, such as by cables522a,522bor using a wireless transmission. The control system504, e.g., a processor thereof, can be configured to receive the transmitted spatial position and orientation information and, in response thereto, it can cause a slave tool524to move in accordance with the user's movement of the master tool520. The robotic surgical system500can thus allow control of the slave tool524via the master tool520. The master tool520in this illustrated embodiment includes first and second master tool grips520a,520bthat each include a plurality of levers526, a plurality of finger loops528, a palm rest530, and a mode control button532, but the master tool520can have a variety of other configurations, as will be appreciated by a person skilled in the art. The robotic surgical system500can include any number of master tools and any number of slave tools each configured to be controlled by the master tool(s).

One or more manually operated surgical instruments534can be used to manipulate the tissue508in addition to the slave tool524that can manipulate the tissue508.

FIG. 9illustrates first, second, third, and fourth coordinate systems C1, C2, C3, C4representing local coordinates that specify the respective position and orientation of the portion of the system500with which they are associated. The first coordinate system C1is associated with the manually operated surgical instrument534. The second coordinate system C2is associated with the slave tool524. The third coordinate system C3is associated with a user (not shown) visualizing the display502, and hence also with the master tool520configured to be manipulated by the user. The fourth coordinate system C4is associated with the control system504, and hence also with images that the control system504and the display controller506cause to be displayed on the display502. In general, the control system504can be configured to transfer the third coordinate system C3into the second coordinate system C2, e.g., transfer movement of the master tool520to movement of the slave tool524. Mapping can be accomplished by, for example, an algorithm such as the Jacobian Matrix.

First, movement of the master tool520in the field generated by the transmitter514, as discussed above, can be mapped into 3-D coordinates within the third coordinate system C3. For example, if the user is holding the master tool520, e.g., one of the first and second master tool grips520a,520b, in one of his/her hands and moves that hand to his/her right, thereby moving the held master tool520to the right, this movement will be mapped into 3-D coordinates X3, Y3, Z3 within the third coordinate system C3. These movement coordinates can be communicated to the control system504. The control system504can be configured to correspondingly transfer this movement from the third coordinate system C3into the second coordinate system C2. For example, the control system504can transfer the 3-D coordinates X3, Y3, Z3 of the third coordinate system C3into 3-D coordinates X2, Y2, Z2 of the second coordinate system C2. The control system504can then cause a working end of the slave tool524to move to the right by moving the slave tool524to the newly translated 3-D coordinates X2, Y2, Z2 of the second coordinate system C2. As the coordinates in the third coordinate system C3change in coordination with movement of the master tool, the coordinates in the second coordinate system C2will likewise simultaneously change, thereby causing the slave tool to move in coordination with the master tool. Thus the slave tool524effectively mimics the movement of the master tool520. This movement is referred to herein as mimicked movement or motion. If the master tool520moves to the right, the slave tool524will move to the right, mimicking the movement. This movement can be accomplished by the control system504causing an arm to which the slave tool524is coupled, similar to the arms discussed herein, to move. The control system504and the display controller506can be configured to orient an image in the display502to the third coordinate system C3.

Aspects of the robotic surgical system500are further described in previously mentioned U.S. Pat. No. 8,831,782 filed Jul. 15, 2013 entitled “Patient-Side Surgeon Interface For A Teleoperated Surgical Instrument,” which is incorporated herein by reference.

Robotic Translation and Locking

Minimally invasive surgery often involves manually-operated instruments passed through trocars into a patient's body cavity. Given the exacting nature of the surgery, it can be important to ensure an instrument does not, for example, penetrate too deeply into the patient's body cavity or rotate at an inappropriate angle within the patient. Minimally invasive surgery can also involve both manually-operated instruments and robotically-controlled and/or remotely-controlled instruments. An operation may require careful coordination between remote user(s) controlling remotely-controlled instrument(s), robotically-controlled instrument(s), and/or local user(s) controlling manually-operated instrument(s). This coordination between any robotically-controlled instruments, any remotely-controlled instruments, and/or any manually-operated instruments can be challenging during an operation.

In one embodiment, a trocar is provided that is capable of receiving an instrument in a tool-receiving passageway extending through the trocar. The trocar can be coupled to an electromechanical arm and is capable of articulating around a longitudinal axis passing through the trocar to allow an instrument extending through the passageway to be angularly oriented to allow for positioning of the instrument. The trocar can also be associated with a driver that is configured to rotate, translate, and/or articulate the instrument about the longitudinal axis. The instrument can be oriented, rotated, and/or translated with respect to one or more of the degrees of freedom set forth inFIG. 1. The driver can also be configured to selectively lock the instrument extending through the trocar in a desired position with respect to one or more of the degrees of freedom set forth inFIG. 1, while allowing movement of the instrument in one or more of the other degrees of freedom. The trocar, driver, and electromechanical arm can be controlled through a control system, such as the control system504inFIG. 9.

In an exemplary embodiment, a trocar including a lumen can be coupled to a distal end of an electromechanical arm and can include a trocar housing. The trocar housing can contain features, such as a driver, to move an instrument along and about a central axis that passes through the trocar. As seen inFIG. 11, a trocar1302with a housing is coupled to an electromechanical arm1303and has an instrument1112, similar to that of instrument534, passing through a lumen in the trocar1302. The trocar1302is configured to rotate and translate the instrument1112about a central axis1304. The electromechanical arm1303is configured to angulate the trocar1302with respect to the central axis1304, having an effect of angulating the instrument1112. A person skilled in the art will appreciate that the trocar can include additional features common to trocars known in the art, such as one or more sealing elements for sealing the channel or around an instrument, an insufflation port, etc.

In order to facilitate manipulation of the trocar and/or instrument, in one embodiment the trocar housing can include one or more sensors capable of sensing the position of the instrument relative to the trocar housing. For example, the position of an end effector on the instrument relative to a remote center of the trocar can be determined. The sensor(s) can take a variety of forms, such as mechanical and/or electrical. Exemplary sensors include, for example, a magnetic sensor, a mechanical displacement sensor, or any other sensor for determining the position of the instrument relative to the trocar housing. As an illustrative embodiment,FIG. 12shows a trocar1100coupled to a distal end of the electromechanical arm300ofFIG. 4. A trocar housing1110is configured to move the instrument1113, similar to instrument1112, along and about axis1115. The trocar housing1110includes a sensor1130configured to sense the position of the instrument1113relative to the trocar housing1110, including knowing a position of an end effector1135at a distal end of the instrument1113relative to the remote center1140. The sensor1130includes a number of individual magnetic sensors spaced at known intervals such that, as the instrument1113is inserted into the trocar, magnetically active areas on the shaft of the instrument1113are sensed between the individual sensors of the sensor1130to determine how far the instrument1113has been inserted into the trocar1110. While a magnetic sensor is shown inFIG. 12, a variety of sensors can be used. For example, the sensor can include a wheel that rotates against the instrument when the instrument is inserted into the trocar and determines how far the instrument has been inserted based on the number of rotations of the wheel. The wheel can be positioned and rotate with respect to one or more of the degrees of freedom set forth inFIG. 1such that any rotation, translation, and/or angular orientation of the trocar and the instrument can be matched by the wheel. The instrument can also pass through the trocar until an instrument housing on the instrument contacts an instrument stop that is coupled to the trocar and/or the electromechanical arm and/or the instrument. The stop can be mechanical and/or electrical. As seen inFIG. 12, a stop can include the instrument1113physically contacting the top of the trocar housing1110. The stop can take a variety of forms, though. As another exemplary embodiment shown inFIG. 13, the instrument1113can be passed through the trocar1100until an instrument housing1116bottoms against an instrument stop1120connected to the electromechanical arm300.

The trocar can also be associated with a driver that is configured to rotate, translate, and/or articulate the instrument about the longitudinal axis. The driver can take a variety of forms, such as motor(s) and/or gear(s). One or more motors can engage with one or more gears and/or gear trains to provide rotational motion and translational motion of the instrument.FIG. 13shows an exemplary embodiment where a translational driver1220operates to translate instrument1113relative to trocar110.FIG. 14shows an exemplary embodiment where two motors1305,1306engage with two different gear trains to provide rotational motion and translational motion of the instrument1113within a trocar. In another exemplary embodiment inFIG. 15, a motor1312is attached to the trocar housing1314to engage with a circular gear1311to rotate the instrument1113relative to trocar1302. In another embodiment, shown inFIG. 16, a trocar sleeve assembly1355is similar to trocar1302but can be capable of accepting multiple instruments. The trocar sleeve assembly1355includes a motor1356that rotates two frictional gears1350,1352that engage with the shaft of the instrument1113and cause the translation of the instrument1113along an axis of the instrument. The motor1356directly engages the first frictional gear1350and further includes a large gear1358that engages a rotational gear1357that then drives an idler gear1359. The idler gear1359directly engages the second frictional gear1352. In this way both frictional gears1350,1352rotate in a correct direction to move the shaft of the instrument1112translationally. Another illustrative embodiment is shown inFIGS. 17-18with a gear track1370. The gear track1370is configured to translate an instrument1320, which is similar to the instrument1112but has gear notches1360on a shaft of the instrument1320. The gear track1370engages the gear notches1360to provide translation.

While several exemplary embodiments have been described, a number of motor and gear combinations can be used for rotation and translation of an instrument. For example, a variety of motors can be used, such as a single motor where the motor includes a shifting mechanism to selectively engage rotational and the translational gear trains U.S. Pat. Pub. No. 2015/0209059 filed Jan. 28, 2014 entitled “Methods and Devices for Controlling Motorized Surgical Devices,” which is hereby incorporated by reference in its entirety. The gear(s) can be represented by one or more circular gears, frictional gears, large gears, idler gears, gear tracks, spring loaded gears, and/or any other gears and can be combined into one or more gear trains. Any motors can be driven at a same speed as one another or at different speeds such that the motors partially cooperate to drive any gear(s). In this way, both rotation and translation of an instrument may be accomplished simultaneously. If idler gear(s) are used, alternative embodiments can replace one or more idler gears with a second or more motor to directly drive any gears previously driven by the replaced idler gear(s). If frictional gears are used, a single frictional gear can be used or two or more frictional gears can be used on opposite sides of a shaft of the instrument. Furthermore, a single motor or two or more separate motors can be used to drive the frictional gear(s). If spring loaded gear(s) are used, one or more gears can be spring loaded against a gear in a first motor, and one or more additional motors can be used, for example by positioning a second motor opposite to the first motor. When the two or more motors are driven such that they cooperate in rotating the gear, a rotation of the instrument relative to a trocar is accomplished. When the two or more motors are driven such that the motors do not cooperate in rotating the gear, the gear can overcome its spring bias against the gears of the motors and does not rotate. Frictional gear(s) and/or gear track(s) can employ a similar spring loading approach such that, when the two or more motors are driven to cooperate, the instrument translates relative to a trocar. When the two or more motors are not driven cooperatively, the frictional gear(s) and/or the gear track(s) oppose one another and the spring bias is overcome to prevent translational motion of the instrument. Any gear train(s) in this mechanism can be constructed such that when motors cooperate to rotate a gear, the motors do not cooperate to rotate frictional gear(s) or gear track(s). In this way, motions can be independent of one another. Any motors can also be driven at different speeds such that the motors partially cooperate to drive the gear and the frictional gear and/or the gear track. Both rotation and translation can therefore be accomplished simultaneously. Through use of spring loaded gears, translational force and rotational torque on the instrument may be easily limited as a same spring bias can be tuned to ensure that, if desired forces are exceeded, the spring bias on the gears is overcome and the system is prevented from exerting too much force or torque on the instrument. If a gear(s) and/or a gear track(s) are used, the gear and/or gear track can provide translation to an instrument by engaging with gear notches formed on a shaft of the instrument. The interaction between the gear(s)/gear track(s) and the gear notches on the instrument may provide a robust interface for translating the shaft of the instrument relative to a trocar, similar to a rack and pinion arrangement. Also alternatively and/or additionally, a bearing assembly1232shown inFIG. 19can be used with the instrument1113for rotating and translating the instrument1113relative to a trocar.

In another embodiment, an adaptor can be used to couple an instrument to a driver. An exemplary embodiment shown inFIG. 20provides an adaptor1230with a rotational driver1210and the instrument1113. As seen inFIGS. 21-23, the adaptor can interact with a variety of rotational and translational drivers. As shown inFIG. 21, the adapter1230can hold the instrument1113. For example,FIG. 21shows the instrument1113coupled to the adaptor1230, which interacts with a rotational driver1210and a translational driver1222. The rotational driver1210effects rotation of the instrument1113about a longitudinal axis of the instrument11113, while the translational driver1222telescopes in the direction of the longitudinal axis of the instrument11113to translate the instrument1113.FIG. 22shows an exemplary embodiment of a rotational driver1212and a translational driver1224with a gear track capable of interacting with the adaptor1230, whileFIG. 23shows another embodiment of a rotational driver1214and a translational driver1226with a telescoping mechanism capable of interacting with the adaptor1230.

Any of the drivers discussed herein can be configured to selectively lock an instrument extending through a trocar in a desired position with respect to one of articulation, translation, and rotation, while allowing movement of the instrument with respect to another one of articulation, translation, and rotation. The instrument can be locked to the trocar and trocar motion activators, such as gears or other driver mechanisms as discussed above, using one or more locking elements. The motor(s) and gear(s) integrated into the driver can serve as locking elements when not in motion. Additionally, other locking elements can be included in the trocar, such as over-center latches, set screws, spring latches or any other locking means.

Typically, the device is sterilized. This can be done by any number of ways known to those skilled in the art including beta or gamma radiation, ethylene oxide, steam, and a liquid bath (e.g., cold soak). An exemplary embodiment of sterilizing a device including internal circuitry is described in more detail in U.S. Pat. Pub. No. 2009/0202387 filed Feb. 8, 2008 and entitled “System And Method Of Sterilizing An Implantable Medical Device.” It is preferred that device, if implanted, is hermetically sealed. This can be done by any number of ways known to those skilled in the art.