# Patent

## Title
Articulated surgical probe and method for use

## Abstract

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.

## Background
This nonprovisional patent application claims priority from provisional patent application Ser. No. 60/625,153, filed Nov. 4, 2004, entitled Laparoscopic Finger, which provisional application is incorporated herein by reference in its entirety.


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.



BRIEF DESCRIPTION OF THE DRAWINGS
These and other features and advantages of the present invention will be more fully disclosed in, or rendered obvious by, the following detailed description of the preferred embodiment of the invention, which are to be considered together with the accompanying drawings wherein like numbers refer to like parts and further wherein:
FIG. 1 is a perspective view of an articulated surgical probe formed in accordance with the present invention;
FIGS. 2-3 are broken-away cross-sectional views of the articulated surgical probe shown in FIG. 1, illustrating the correspondence between a toggle actuator position and the shape of an articulated digit formed in accordance with the invention;
FIG. 4 is a further broken-away cross-sectional view of the articulated surgical probe of FIG. 1, including a so-called “peanut” gauze wad dissection implement assembled to a bulbous tip of an articulated digit;
FIG. 5 is a broken-away cross-sectional view, similar to that of FIG. 4, a “peanut” gauze wad dissection implement wrapped around the entire tip of the articulated digit;
FIG. 5a is a broken-away, enlarged view of an alternative embodiment of the present invention including a detachable peanut dissector tip;
FIG. 5b is a cross-sectional view, similar to that of FIG. 5, but including a cautery tool disposed at the tip of the articulated digit;
FIG. 6 is a broken-away cross-sectional view similar to FIGS. 4-5, showing a light source protruding from a tip of the articulated digit;
FIG. 7 is a broken-away cross-sectional view similar to FIGS. 4-6, showing an abrasive surface disposed upon a bulbous tip of the articulated digit;
FIG. 8 is a side elevational view of an articulated surgical probe similar to that shown in FIG. 1, and illustrating the correspondence between a surgeon's finger, a toggle actuator, and an extended position of an articulated digit;
FIG. 9 is a side elevational view, similar to FIG. 8, illustrating another correspondence between a surgeon's finger, the toggle actuator, and a curving position of an articulated digit;
FIG. 10 is a side elevational view, similar to FIGS. 8 and 9, showing yet a further illustration of the correspondence between a surgeon's finger, the toggle actuator, and a crook position of the articulated digit;
FIG. 11 is an end-on view of an articulated surgical probe illustrating a rotational handle located behind a toggle actuator of the device;
FIG. 12 is a perspective view, partially in phantom and partially broken-away, of an alternative embodiment of the articulated surgical probe including a detachable and disposable articulated digit;
FIG. 13 is a broken-away side elevational view of a fully assembled distal portion of the articulated surgical probe shown in FIG. 12;
FIG. 14 is a broken-away side elevational view of a fully detached distal portion of the articulated surgical probe shown in FIG. 12;
FIG. 15 is a broken-away side elevational view of the interface region of the distal portion if the articulated surgical probe shown in FIGS. 12-14;
FIG. 16 is a perspective view, partially broken-away, of another alternative embodiment of the articulated surgical probe including a single phalange articulated digit;
FIGS. 17-20 are broken-away side elevational views of the single knuckle articulated digit of FIG. 16, illustrating its range of motion;
FIG. 21 is a perspective view of an articulated surgical probe formed in accordance with another embodiment of the invention having an articulated digit with a plurality of phalanges;
FIG. 22 is a perspective view, partially in phantom and partially broken-away, of yet another alternative embodiment of the articulated surgical probe formed in accordance with the present invention;
FIGS. 23-24 are broken-away cross-sectional views, partially in phantom of a distal portion of the articulated surgical probe shown in FIG. 22, illustrating an alternative actuation mechanism;
FIG. 25 is a side perspective view, partially broken-away, showing one method of interaction between two articulated surgical probes a portion of a liver and a portion of an esophagus;
FIG. 26 is a side perspective view, partially broken-away, showing an enlarged view of the interaction between an articulated surgical probe of the present invention and a portion of an esophagus;
FIG. 27 is a side perspective view, partially broken-away, showing one method of interaction between two articulated surgical probes and a portion of a spleen; and
FIG. 28 is a side perspective view, partially broken-away, showing another method of interaction between two articulated surgical probes and portion of bowel.



DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
This description of preferred embodiments is intended to be read in connection with the accompanying drawings, which are to be considered part of the entire written description of this invention. The drawing figures are not necessarily to scale and certain features of the invention may be shown exaggerated in scale or in somewhat schematic form in the interest of clarity and conciseness. In the description, relative terms such as “horizontal,” “vertical,” “up,” “down,” “top” and “bottom” as well as derivatives thereof (e.g., “horizontally,” “downwardly,” “upwardly,” etc.) should be construed to refer to the orientation as then described or as shown in the drawing figure under discussion. These relative terms are for convenience of description and normally are not intended to require a particular orientation. Terms including “inwardly” versus “outwardly,” “longitudinal” versus “lateral” and the like are to be interpreted relative to one another or relative to an axis of elongation, or an axis or center of rotation, as appropriate. Terms concerning attachments, coupling and the like, such as “connected” and “interconnected,” refer to a relationship wherein structures are secured or attached to one another either directly or indirectly through intervening structures, as well as both movable or rigid attachments or relationships, unless expressly described otherwise. The term “operatively connected” is such an attachment, coupling or connection that allows the pertinent structures to operate as intended by virtue of that relationship. In the claims, means-plus-function clauses, if used, are intended to cover the structures described, suggested, or rendered obvious by the written description or drawings for performing the recited function, including not only structural equivalents but also equivalent structures.
Referring to FIGS. 1-3, an articulated surgical probe 1 formed 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 probe 1 comprises a digit 3, a positioning shaft 5, and an actuator assembly 7. More particularly, digit 3 includes an elongate proximal phalanx 10 having a curved distal end 12 and a proximal end 14, a middle phalanx 18 having a flat distal end 22 and a curved proximal end 24, a distal phalanx 26 having a distal end 28 and a curved proximal end 30, and a bulbous probe-tip 32 (FIGS. 2 and 3). In one embodiment, proximal phalanx 10 also includes a pair of radially spaced-apart, longitudinally oriented through-bores 36a, 36b, middle phalanx 18 includes a pair of radially spaced-apart, longitudinally oriented through-bores 37a, 37b, and distal phalanx 26 includes a pair of radially spaced-apart, longitudinally oriented through-bores 38a, 38b. 
When digit 3 is assembled, curved proximal end 30 of distal phalanx 26 is pivotally connected to flat distal end 22 of middle phalanx 18 by, e.g., a pivot pin 40, and curved distal end 12 of elongate proximal phalanx 10 is pivotally connected to curved proximal end 24 of middle phalanx 18 by a pivot pin 41. In this way, the phalanges may pivot relative to one another so that digit 3 comprises a range of motion that is continuous between a first fully extended position that may be, for example, aligned with a longitudinal axis 43 of positioning shaft 5, and often substantially coaxial with positioning shaft 5, and a final substantially curved, flexed, crook, or “hook-shaped” position, i.e., curved or bent relative to positioning shaft 5.
This range of motion of digit 3 is limited by the interactive engagement of curved proximal end 30 of distal phalanx 26 with flat distal end 22 of middle phalanx 18 and curved distal end 12 of elongate proximal phalanx 10 with curved proximal end 24 of middle phalanx 18. In the first fully extended position, the upper or dorsal portion of curved proximal end 30 of distal phalanx 26 is blocked from further pivotal rotation by the upper or dorsal portion of flat distal end 22 of middle phalanx 18, and the upper or dorsal portion of curved distal end 12 of elongate proximal phalanx 10 is blocked from further pivotal rotation by the upper or dorsal portion of curved proximal end 24 of middle phalanx 18. Likewise, in the final flexed or crook position, the lower or anterior portion of curved proximal end 30 of distal phalanx 26 is blocked from further pivotal rotation by the lower or anterior portion of flat distal end 22 of middle phalanx 18 and the lower or anterior portion of curved distal end 12 of elongate proximal phalanx 10 is blocked from further pivotal rotation by the lower or anterior portion of curved proximal end 24 of middle phalanx 18. Thus digit 3 can be operated so as to simulate or mimic the range of movements and configurations of a surgeon's finger 42, while at the same time, maintaining a kinesthetic relationship between the surgeon's finger 42 and digit 3 (FIGS. 9 and 10). In other words, the surgeon's perception or sensing of the motion, weight, and position of digit 3, relative to the tissue being probed, is maintained as the muscles, tendons, and joints of the surgeon's finger 42 move. For example, spring and damper sensations may be sensed by the surgeon when actuating articulated digit 3 so as to palpate a vein or a mass lodged in a bowel wall or muscle structure.
Bulbous probe-tip 32 projects outwardly from distal end 28 of distal phalanx 26 so as to provide a tactile pad or surface 29 for use in manipulating, palpating or dissecting tissue during surgery (FIGS. 4-7). Each phalanx, along with bulbous probe-tip 32, may be coated with either a compliant covering 45 that 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, digit 3 may 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 digit 3 or bulbous probe-tip 32 is adapted to receive and hold a so-called “peanut”, i.e., a sponge or gauze wad 51, 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 digit 3 or bulbous probe-tip 32. In addition, a detachable peanut dissector tip may also be employed (FIG. 5a). In yet another embodiment, bulbous probe-tip 32 may 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 digit 3, particularly bulbous probe-tip 32 which 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-tip 32 (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-tip 32 may 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 shaft 5 comprises an elongate tube having a distal end 44, a proximal end 46, and a central passageway 48 (FIGS. 2-7). In one embodiment of the invention, actuator 7 includes a pair of crossed wires 50a,50b that each extend through radially spaced-apart, longitudinally oriented through-bores 36a,36b, 37a, 37b, 38a,38b of elongate proximal phalanx 10, middle phalanx 18, and distal phalanx 26, and are each terminated to a portion of a toggle lever 60 in a handle 62 and within distal phalanx 26. When toggle lever 60 is pivoted relative to handle 62 so as to move or pivot in alignment with longitudinal axis 43, i.e., travel in a plane containing longitudinal axis 43, one of crossed wires 50a,50b is placed in tension while the other is released from tension. In this way, articulated phalanxes 10, 18, and 26 are pivoted about their respective pivot connections so as to cause digit 3 to move continuously from a substantially extended configuration to a substantially flexed, curved shape. As a result, digit 3 may be articulated so as to match a variety of finger positions normally used by a surgeon during open surgical procedures. Advantageously, digit 3 cannot bend backward, i.e., in a dorsal direction beyond parallel with longitudinal axis 43, but instead moves continuously from a first, extended position, that is often substantially longitudinally aligned with positioning shaft 5, and a second substantially curved flexed position where bulbous probe-tip 32 is located adjacent to proximal phalanx 10. The in-line or longitudinally aligned relationship of articulated digit 3, positioning shaft 5, wires 50a,50b, and actuator 7 provide for significantly improved tactile feedback. In particular, the longitudinally aligned relationship between actuator 7, positioning shaft 5, and articulated digit 3 provides a surgeon force feedback or tactile feedback, via the portion of wire 50a,50b that are in tension, and more generally known as “haptic feedback”, that yields physical sensations which are felt by the surgeon while manipulating articulated digit 3 via toggle 62. A lock 52 may be incorporated in handle 62 so that toggle 60, and thereby articulated digit 3, may be locked in a desired position.
Referring to FIGS. 12-15, an alternative embodiment of articulated surgical probe 70 that comprises a detachable articulated digit 73, a positioning shaft 75 and an actuator assembly 7 that is substantially similar to that used with articulated surgical probe 1. More particularly, detachable articulated digit 73 includes an elongate proximal phalanx 80 having a distal end 82 and a proximal end 84, a middle phalanx 88 having a distal end 92 and a proximal end 94, a distal phalanx 96 having a distal end 98 and a proximal end 103, a linking assembly 106, and a bulbous probe-tip 32 (FIGS. 12-14 and 3). Proximal phalanx 80, middle phalanx 88, and distal phalanx 96 are substantially similar in construction and assembly to proximal phalanx 10, middle phalanx 18, and distal phalanx 26, and each also includes a pair of radially spaced-apart, longitudinally oriented through-bores (not shown) that are substantially similar to 36a,36b, 37a,37b, and 38a,38b. Additionally, proximal phalanx 80 includes a mounting hub 110 that projects outwardly from proximal end 84. Mounting hub 110 is often hollow with a cylindrical shape and a smaller outer diameter than proximal phalanx 80. A blind recess 111 is defined in the outer surface of proximal end 84, adjacent to the intersection of mounting hub 111 and proximal phalanx 80.
Referring to FIGS. 13-15, linking assembly 106 includes a pair of wires 115a,115b that each extend through the radially spaced-apart, longitudinally oriented through-bores located within elongate proximal phalanx 80, middle phalanx 88, and distal phalanx 96, where each are terminated to an inner portion of distal phalanx 96. A terminal 117 is fastened to the end portion of each of wires 115a,115b that extends from within mounting hub 110. Each terminal 117 includes a releasable mounting knob 119 at a mating end 120. Positioning shaft 75 comprises an elongate tube having a distal end 118, a proximal end 46, and a central passageway 48. A pair of crossed wires 115c, 115d extend through central passageway 48 from actuator assembly 7 to a position adjacent to an open end 121 of positioning shaft 75. A receptacle 122 is fastened to the end portion of each of wires 115c, 115d, with each receptacle 122 including a releasable mounting socket 124 that is sized and shaped to receive and releasably grasp each releasable mounting knob 119 at mating end 120 of each terminal 117. A pivotable shaft lock 126 is located on an outer surface of positioning shaft 75 adjacent to open end 121, and a pair of pivotable receptacle clamps 130 are arranged on the outer surface of positioning shaft 75 at a location corresponding to the location of releasable mounting sockets 124 within central passageway 48.
Detachable articulated digit 73 may be fastened to positioning shaft 75 of articulated surgical probe 70 by first arranging proximal end 84 of proximal phalanx 80 in confronting coaxial relation with open end 121 of positioning shaft 75. Once in this position, articulated digit 73 is moved toward positioning shaft 75 so that mounting hub 110 slips into open end 121 and central passageway 48 of positioning shaft 75. As this occurs, each terminal 117 on wires 115a and 115b are received within a corresponding receptacle 122 so that each releasable mounting knob 119 at mating end 120 engages a releasable mounting socket 124. Once mounting hub 110 is fully received within open end 121 of positioning shaft 75, pivotal shaft lock 126 is pivoted about its position on the outer surface of positioning shaft 75 until it engages blind recess 111 in the outer surface of proximal end 84 of proximal phalanx 80. Each pivotable receptacle clamp 130 is then actuated so as to releasably clamp each mounting knob 110 within its respective mounting socket 124 thereby completing the operative interconnection of wires 115a, 115b, 115c and 115d. With detachable articulated digit 73 fully engaged with positioning shaft 75, operation of articulated surgical probe 70 follows in accordance with the operation of articulated surgical probe 1.
As with articulated digit 3, the phalanges of detachable digit 73 may pivot relative to one another so that articulated digit 73 comprises 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 shaft 75, and often substantially coaxial with positioning shaft 75, and a final substantially curved, flexed, crook, or “hook-shaped” position, i.e., curved or bent relative to positioning shaft 75. Thus digit 73 can be operated so as to simulate the range of movements and configurations of a surgeon's finger 42, while at the same time, maintaining a kinesthetic relationship between the surgeon's finger 42 and articulated digit 73. The surgeon's perception or sensing of the motion, weight, and position of articulated digit 73, relative to the tissue being probed, is maintained as the muscles, tendons, and joints of the surgeon's finger 42 move.
Referring to FIGS. 16-20, a further alternative embodiment of articulated surgical probe 140 comprises a single phalange digit 143, a positioning shaft 5 and an actuator assembly 7. The construction and arrangement of positioning shaft 5 and actuator assembly 7 are substantially similar to that used with articulated surgical probe 1. Single phalange articulated digit 143 includes an elongate proximal phalanx 146 having a distal end 148 and a proximal end 150, and a distal phalanx 151 having a distal end 152 and a proximal end 154. Proximal phalanx 146 comprises a blade hinge 160 that projects longitudinally outwardly from proximal end 150, 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-bores 36a, 36b of articulated digit 3 (FIGS. 2-7). Distal phalanx 151 comprises a yokel 62 that is sized and arranged on the distal end of positioning shaft 5 so as to receive blade hinge 160. Yoke 162 is pivotally fastened to blade hinge 160 by a pivot pin 164. In this way, proximal phalanx 146 may pivot relative to distal phalanx 151 so that single knuckle digit 143 comprises 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 shaft 5, and often substantially coaxial with positioning shaft 5, and a final substantially, flexed position, i.e., bent relative to positioning shaft 5. Referring to FIG. 21, an articulated surgical probe may also be formed in accordance with another embodiment of the invention having an articulated digit 3 comprising 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 probes 1, 70, and 140 may 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 finger 42 and the articulated digit 3, 74, or 143 are maintained. Alternatively, and now referring to FIGS. 21-23, actuator assembly 7 comprising a toggle lever 60 and wires 50a,50b may be replaced by a toggle lever 60 and linkage assembly 170 to form an operative connection to an articulated digit 173. More particularly, articulated surgical probe 172 includes articulating digit 173 located at distal end 44 of positioning shaft 5. More particularly, articulating digit 173 includes an elongate, hollow proximal phalanx 178 having a distal end 180 and a proximal end 182, a hollow middle phalanx 184 having a distal end 186 and a proximal end 188, and a hollow distal phalanx 190 having a distal end 192 and a proximal end 193. Proximal end 180 of proximal phalanx 178, includes a pair of spaced apart, diametrically confronting hinge arms 198a,198b that project longitudinally outwardly from proximal end 182. Each of hinge arms 198a,198b defines a through-hole sized to receive a corresponding hinge pin 200. Middle phalanx 184 includes two pair of hinge arms 202a,202b and 203a,203b that project longitudinally outwardly from each of proximal end 188 and distal end 186, while distal phalanx 190 includes a single pair of hinge arms 204a,204b that project longitudinally outwardly from proximal end 193. Each of hinge arms 202a,202b, 203a,203b, and 204a,204b define a through-hole sized to receive a corresponding hinge pin 200.
Referring to FIGS. 22 and 23, linkage assembly 170 is operatively positioned within, and extends throughout the interior of each of proximal phalanx 178, a hollow middle phalanx 184, and a hollow distal phalanx 190, and comprises a plurality of dorsal links 207a, 207b, 207c, a plurality of anterior links 208a, 208b, 208c, and at least two cross-links 209a,209b. Each of dorsal links 207a, 207b, 207c and anterior links 208a, 208b, 208c comprises a pair of longitudinally spaced apart holes that are sized so as to accept a hinge pin 210, while each of cross-links 209a,209b comprises three longitudinally spaced apart holes. The outer most two of which are sized so as to accept a hinge pin 210, with a centrally located hole sized to accept hinge pin 200. Anterior link 208c and dorsal link 207c cross one another, and are each pivotally terminated to a portion of the interior of toggle lever 60 in handle 62, and within a portion of the interior of hollow distal phalanx 190. Once again, when toggle lever 60 is pivoted relative to handle 62 so as to move or pivot, one of crossed anterior link 208c and dorsal link 207c is placed in tension while the other is released from tension. In this way, articulated phalanxes 178, 184, and 190 are pivoted about their respective pivot connections, via toggling of cross-links 209a,209b caused by the relative longitudinal movements of dorsal links 207a, 207b, 207c and anterior links 208a, 208b, 208c, so as to cause articulated digit 172 to move continuously from a substantially extended configuration to a substantially flexed, curved shape.
As with articulated digit 3, when articulated digit 173 is in a first fully extended position, the upper or dorsal portion of the proximal end of distal phalanx 190 is blocked from further pivotal rotation by the upper or dorsal portion of the distal end of middle phalanx 184, and the upper or dorsal portion of the distal end of proximal phalanx 178 is blocked from further pivotal rotation by the upper or dorsal portion of the proximal end of middle phalanx 184. Likewise, in a final flexed or crook position, the lower or anterior portion of the proximal end of distal phalanx 190 is blocked from further pivotal rotation by the lower or anterior portion of the distal end of middle phalanx 184, and the lower or anterior portion of the distal end of proximal phalanx 178 is blocked from further pivotal rotation by the lower or anterior portion of the proximal end of middle phalanx 184.
Advantages of the Invention
Numerous advantages are obtained by employing the present invention. The position of any of articulated digits 3, 74, 143, or 173 in, e.g., the abdomen of a patient, is mirrored by the position of the surgeon's finger 42 on toggle 60 (FIGS. 2-3) with the extent and types of motion being quite similar. Because the configuration of articulated digit 3, 74, 143, or 173 transitions 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 probes 1, 70, or 140 are 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 digit 3, 73, 143, or 173 allows for more blunt retraction of such obstructing tissue. Articulated surgical probe 1 also allows dissection movements similar in range to a surgeon's finger. Compared to hand assisted laparoscopy, articulated digit 3 allows 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 probes 1 and 100 may 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 probe 1 allows dissection movements similar in force to a surgeon's finger. The force applied by articulated digit 3, 73, 143, or 173 can 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 probes 1, 70, or 140. Articulated surgical probes 1, 70, or 140 additionally provide for increased retraction, when digit 3, 73, 143, or 173 is flexed, as compared to a straight prior art instrument. In this technique, handle 62 remains 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 probe 1 also 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 handle 62, positioning shaft 5, and digit 3, 73, 143, or 173, the retracting or dissecting with digit 3, 73, 143, or 173 is 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 mechanism 52, allows the surgeon to hold articulated surgical probe 1 anywhere 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 probe 1 as 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 probe 1 allows palpation of masses, such as tumors inside the colon, with bulbous probe-tip 32. The tactile feed-back provided by the in-line relationship of handle 62, positioning shaft 5, wires 50a,50b, and digit 3 helps 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 digit 3, 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 digit 3 of articulated surgical probe 1 flexes, bulbous probe-tip 32 can 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 probe 1 or 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 digits 3, 74, 143, or 173 of articulated surgical probes 1, 70, 140, and 172 can 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.

## Claims

1. A method for remote surgical manipulation of tissue within a body cavity while maintaining a kinesthetic relationship with the tissue, said method comprising:
inserting a probe within said body cavity, where said probe includes an elongated section, and an actuator coupled to at least one segmented digit similar to a human finger by a plurality of link members where a proximal end of said link members are affixed to said actuator, where said segmented digit is configured to move as said actuator pivots relative to said probe and said actuator is coupled to said elongated section by a pivot such that said actuator is limited to move in alignment with an axis of said elongated section; and
moving the actuator to remotely actuate said digit to manipulate said tissue within said body cavity, where said segmented digit moves through a range of motion substantially similar to a range of motion of an operator's finger as the operator's finger pivots said actuator in alignment with said axis of said elongated section and where movement of said actuator in a proximal direction causes a first link member to be placed in tension while a second link member is released from tension such that a surgeon maintains the kinesthetic relationship via said actuator from the link member in tension.

2. The method of claim 1 wherein said digit further comprises a tip having a gauze wad releasably fixed to a dorsal surface for dissection so that remotely actuating said digit moves said gauze pad into dissecting engagement with tissue located within said body cavity.

3. The method of claim 1 wherein said digit is maintained in a selected configuration by a locking mechanism.

4. The method of claim 1 wherein remotely actuating said digit provides a variety of configurations that mimic the shape and contour of the human finger.

5. The method of claim 1 including the step of transluminating tissues by actuating said digit so as to position a tip of said segmented digit behind said tissues.

6. A method for an operator to surgically manipulate tissue remotely within a body cavity while maintaining a kinesthetic relationship with the tissue, said method comprising:
inserting a probe within said body cavity, where said probe includes an elongated section, and an actuator coupled to at least one segmented digit similar to a human finger by a plurality of link members where a proximal end of said link members are affixed to said actuator, where said segmented digit is configured to move as said actuator moves relative to said probe where said actuator is coupled to said elongated section such that said actuator is limited to move in alignment with an axis of said elongated section; and
manipulating tissue within said body cavity by extending a finger of the operator parallel to and in alignment with said axis of said elongated section moving the finger of the operator through a range of motion to move said actuator where said range of motion is limited to a distal and a proximal direction along said axis and in alignment with said axis causing said segmented digit to move through a substantially similar range of motion as the finger of the operator.

7. A method for an operator to surgically manipulate tissue remotely within a body cavity while maintaining a kinesthetic relationship with the tissue, said method comprising:
inserting at least two probes within said body cavity, where said at least two probes each includes an elongated section, and a said actuator coupled to at least one segmented digit similar to a human finger by a plurality of link members where a proximal end of said link members are affixed to said actuator, where said actuator is coupled to said elongated section by a pivot such that said actuator is limited to move in alignment with an axis of said elongated section and each of said segmented digit is configured to move as said respective actuator moves relative thereto; and
manipulating tissue within said body cavity by engaging a finger of the operator against each of said actuators and moving each finger through a range of motion to move said respective actuator in an angular motion, where moving of said actuator causes said respective segmented digit to move through a substantially similar range of motion as the finger of the operator and where movement of each of said actuators in a first direction causes a first link member to be placed in tension while a second link member is released from tension such that the kinesthetic relationship is maintained via said actuator from the link member in tension and such that one link member is in tension at all times.

8. A method for surgical manipulation of tissue remotely within a body cavity while maintaining a kinesthetic relationship with the tissue, said method comprising:
inserting a probe within said body cavity, where said probe includes an elongated section, and an actuator coupled to a single segmented digit by a plurality of link members where a proximal end of said link members are affixed to said actuator, said actuator being coupled to said elongated section by a pivot such that said actuator is limited, to move in alignment with an axis of said elongated section to move said segmented digit as said actuator moves relative to said probe; and
manipulating tissue within said body cavity by moving a finger of the operator through a range of motion to pivot said actuator, where pivoting of said actuator causes said segmented digit to move through a substantially similar range of motion as the finger of the operator, where pivoting of said actuator causes a first link member to be placed in tension while a second link member is released from tension such that the kinesthetic relationship is maintained via said actuator from the link member in tension.

9. A method for surgical manipulation of tissue remotely within a body cavity while maintaining a kinesthetic relationship with the tissue, said method comprising:
inserting a probe within said body cavity, where said probe includes an elongated section and an articulating digit having a plurality of link members where a proximal end of said link members are affixed to an actuator and said actuator limited to move in alignment with an axis of said elongated section; and
extending an operator's finger of in alignment with said axis of said elongated section to move said actuator in alignment with said axis to remotely actuate said digit to manipulate said tissue within said body cavity using said actuator on a body of said probe, such that flexion of the operator's finger occurs in a distal and a proximal direction along said axis and in alignment with said axis causing flexion of said articulating digit where the operator's finger and said articulating digit move in a longitudinally aligned plane.

10. A surgical method comprising the steps of:
(A) providing a surgical probe comprising: an articulated digit located at a distal end of a positioning shaft having a longitudinal axis; and an actuator located at a proximal end of said positioning shaft and operatively connected to said articulated digit by a plurality of link members where a proximal end of said link members are affixed to said actuator and said actuator is coupled to a handle on said positioning shaft by a pivot such that said actuator is limited to move in alignment with an axis of said positioning shaft so as to move said 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 said actuator and said articulated digit;
(B) positioning said surgical probe adjacent to an anatomical structure to be manipulated;
(C) causing angular movement of said actuator with a finger so as to arrange said articulated digit in a configuration that closely corresponds to the configuration of said finger where said finger and said articulated digit move in a longitudinally aligned plane, and where angular movement of said actuator in a first direction causes a first link member to be placed in tension while a second link member is released from tension such that the kinesthetic relationship is maintained via said actuator from the link member in tension and such that one link member is in tension at all times; and
(D) engaging said anatomical structure with said articulated digit.

11. A method for an individual to manipulate tissue remotely within a body cavity, said method comprising:
inserting a probe within said body cavity, where said probe includes an elongated section and at least one segmented digit similar to a human finger and a plurality of link members where a proximal end of said link members are affixed to an actuator; and
where the individual extend a finger parallel to and in alignment with said axis of said elongated section moves a finger through a range of motion where said range of motion is limited to a distal and a proximal direction along said axis and in alignment with said axis causing to remotely actuate said segmented digit through a substantially similar range of motion via actuation of said actuator, and where the individual's finger and said segmented digit move in a longitudinally aligned plane where movement of said actuator causes a first link member to be placed in tension while a second link member is released from tension such that the kinesthetic relationship between said finger and said segmented digit is maintained via said actuator from the link member in tension and such that one link member is in tension at all times.

12. The method of claim 11 wherein remotely actuating said digit provides a kinesthetic/tactile relationship between the operator's finger actuating said actuator and said segmented digit.

13. The method of claim 11 wherein said digit further comprises a tip having a gauze wad releasably fixed to a dorsal surface for dissection so that remotely actuating said digit moves said gauze pad into dissecting engagement with tissue located within said body cavity.

14. The method of claim 11 wherein said digit is maintained in a selected configuration by a locking mechanism.

15. The method of claim 11 wherein remotely actuating said digit provides a variety of configurations that mimic the shape and contour of a human finger.

16. The method of claim 11 including the step of transluminating tissues by actuating said digit so as to position a tip of said segmented digit behind said tissues.