Abstract:
A surgical instrument system having an instrument member or shaft with a distal portion positionable through an incision of a patient to an internal site and for operation by a surgeon from outside the patient. A tool is carried at the distal end of the instrument shaft controlled by the surgeon in performing a procedure at an operative site of the patient. At least first and second turnable members are spacedly disposed along the instrument shaft distal portion, both disposed within the internal site, and each controlled from outside the patient for providing at least respective first and second degrees of freedom of control of the tool. The turnable members may be either a pivot joint or a bendable section.

Description:
RELATED APPLICATIONS 
     This application claims the benefit of U.S. Provisional Application No. 60/476,344, filed on Jun. 6, 2003. The entire teachings of the above application are incorporated herein by reference. 
    
    
     BACKGROUND OF THE INVENTION 
     Just as the unique curved guide tube concepts represent an improvement over past systems, particularly ones using a “center-of-rotation” of the instrument at the incision, the concepts set forth herein represent still other improvements by further minimizing the rotation or pivoting at the incision. In some embodiments described herein only rotation occurs at the incision and no pivoting. Such pivoting causes stress at the incision and can damage tissue. In other embodiments described herein neither pivoting, rotation nor translation occur at the incision. 
     SUMMARY OF THE INVENTION 
     The systems that are described herein use a novel combination of internal (of the patient) degrees-of-freedom to achieve a fully articulated telesurgical instrument system. Unlike traditional telesurgical systems, which use complex and heavy robotic arm assemblies to simulate human movement, the systems described herein preferably use a combination of internal and external motions, preferably with the remote and stationary location of motors. 
     In accordance with one aspect of the invention there is provided a system that includes an instrument member or instrument shaft that includes, internally of the incision, two degrees-of-motion members, one that can be referred to as a “wrist” member or wrist turnable member disposed proximal of the distal end effector of the instrument, and another that can be referred to as a “elbow” or elbow turnable member, disposed proximal of the wrist member. These turnable members are to be remotely controlled from a master interface device to control the disposition of the end effector. These turnable members may be implemented by a pivot joint or a bendable section of the instrument shaft. For a pivot joint, in addition to one degree of freedom by pivoting at the wrist, one degree of freedom by pivoting at the elbow, two degrees of freedom at the end effector, there may also be provided rotation of the instrument shaft, linear translation of the instrument shaft and rotation of a forearm member that is disposed between the wrist and elbow members. This provides 7 DOF (Degrees Of Freedom), while providing only rotation and linear translation in the area of the incision, but no pivoting thereat. In essence, motions at the incision are replaced by motions that are internal of the patient. 
     If the turnable member is a bendable section of the instrument shaft this can be controlled in a manner similar to the pivot joint to provide only one degree of freedom thereat, or alternatively, each bendable section may have two degrees of freedom by orthogonal control at the bendable section. This may be implemented to provide more than 7 DOF for the instrument system, or alternatively, the extra degrees of freedom at the bendable section can be used to substitute for other motions. For example, with the use of one or more bendable sections, one can then provide an instrument shaft that neither rotates nor transitions linearly, thus, in essence, providing all degrees of freedom internal of the incision. 
     In accordance with a further aspect of the invention there may additionally be provided a “shoulder” member or shoulder turnable member disposed proximal of the elbow member. For this arrangement the “shoulder” member provides a degree of freedom and thus the instrument shaft only has one degree of freedom, namely rotation thereof. In this embodiment the shoulder turnable member may also be formed either as a pivot joint or as a bendable section. 
     In accordance with another aspect of the invention there is provided a surgical instrument system that includes an instrument member having a distal portion positionable through an incision of a patient to an internal site and for operation by a surgeon from outside the patient; a tool carried at the distal end of the instrument member controlled by the surgeon in performing a procedure at an operative site of the patient; and at least first and second turnable members disposed along the instrument member distal portion, both disposed within the internal site, and each controlled from outside the patient and for providing at least respective first and second degrees of freedom of control of the tool. Each turnable member may comprise a remotely controllable pivot connection, or alternatively each turnable member may comprise a remotely controllable bendable section. Also, a third turnable member may be provided at an internal location, essentially substituting for one of the degrees of freedom at the incision. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The following are drawings of several different embodiments that are considered as falling within the scope of the invention. 
       The foregoing and other objects, features and advantages of the invention will be apparent from the following more particular description of preferred embodiments of the invention, as illustrated in the accompanying drawings in which like reference characters refer to the same parts throughout the different views. The drawings are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention. 
         FIG. 1  is a perspective view of one embodiment of the invention using an internal wrist and elbow; 
         FIG. 2  is a schematic perspective view illustrating the degrees of freedom associated with the embodiment of  FIG. 1 ; 
         FIG. 3  is a perspective view of another embodiment of the invention using an internal wrist, elbow and shoulder; 
         FIG. 4  is a schematic perspective view illustrating the degrees of freedom associated with the embodiment of  FIG. 3 ; 
         FIG. 5  is a schematic perspective view illustrating the degrees of freedom associated with an embodiment like that of  FIG. 1 , but using a bendable section instead of a pivot joint; 
         FIG. 6  is a schematic perspective view illustrating the degrees of freedom associated with an embodiment like that of  FIG. 3 , but using a bendable section instead of a pivot joint; 
         FIG. 7  is a view like that depicted in  FIG. 5  but using a bendable section with two degrees of freedom; and 
         FIG. 8  is a view like that depicted in  FIG. 6  but using bendable sections with two degrees of freedom. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     A description of preferred embodiments of the invention follows. 
     The present invention, is related to co-pending U.S. patent application Ser. No. 10/299,588 filed Nov. 18, 2002; co-pending U.S. patent application Ser. No. 10/012,845 filed on Nov. 16, 2001 and published as U.S. Publication No. 2002/0128633 on Sep. 12, 2002 and co-pending U.S. patent application Ser. No. 10/302,804 filed Nov. 21, 2002, the entire teachings of which are incorporated herein by reference. 
     Any reference to figure numbers herein pertains to the above list of drawings that are attached hereto. Reference to any other figure numbers will be by identification as to the co-pending application in which the figure appears. 
       FIG. 1  is a perspective view of one embodiment of the invention using an internal wrist and elbow. This view depicts a motor array or pack  1  mounted to a surgical table  8 . The motor array may be supported from the table rail  9 , and is usually disposed outside the sterile field. A plurality of cables in conduits  2  are driven by the respective motors of the motor array  1 . Further details of the motor array and cabling are included in U.S. patent application Ser. No. 10/012,845 and in particular FIGS. 8E through 8L, and the associated descriptions on pages 16 and 17. As described there, the cabling 2 may be detachably coupled with the motor pack 1, so that the slave unit (slider 3, etc.) is readily detachable from both the support bracket 4, as well as the motor pack 1. This makes the slave unit readily portable, and is relatively light in weight. 
     A linear slider  3  (which may also be referred to as a carriage) is mounted on a static fixture or bracket  4 . The slider  3  supports the instrument shaft or stem  5 . The instrument stem  5  is inserted into the patient through an incision formed during a minimally invasive procedure. The instrument stem is positioned so that the incision is at a location somewhere between the distal end of the slider  3  and the elbow joint  6 . Refer in  FIG. 1  to the dotted line  5 A indicative of the possible location of the incision in the patient. For further details of the slider  3  refer to U.S. patent application Ser. No. 10/012,845, such as in FIGS. 8F, 11 and 15 illustrating the adaptor 15 including the carriage 226 forming a slider arrangement. 
     In  FIG. 1  herein, the elbow joint  6  articulates a pivotal motion inside the patient&#39;s body, as will be described in further detail in  FIG. 2 .  FIG. 1  also illustrates the end effector  7  that is controllable with pitch, yaw, and roll rotation, as well as a gripping motion by the end effector. A wrist  11 , shown in somewhat more detail in  FIG. 2 , is used just proximal of the end effector jaws to provide the desired degrees of freedom. 
     For further details of the structures schematically depicted in  FIG. 1  refer to details shown in U.S. patent application Ser. No. 10/012,845. In U.S. patent application Ser. No. 10/012,845 refer to FIGS. 8-11, and associated descriptive text on pages 15 and 17-19. This supporting description shows a carriage 226 in FIGS. 8-11 that functions as a slider for carrying the instrument. The instrument stem may be like that shown in FIG. 15A by instrument 16. FIG. 16 also shows various versions of end effectors including a wrist pivot joint in FIGS. 16A-16D and bendable sections in FIGS. 16E-16K, along with accompanying text descriptions. Also refer to U.S. patent application Ser. No. 10/299,588 for further descriptions of end effectors and bendable sections, such as in FIGS. 26-48, and associated descriptions in the specification. 
     Refer now to  FIG. 2  for further details of the embodiment of  FIG. 1 .  FIG. 2  shows, in particular, the degrees of freedom or motions of the instrument system. Motion M 1  indicates the linear translation of the slider  3 . Motion M 2  indicates the axial rotation of the instrument stem  5  about its longitudinal axis.  FIG. 2  also illustrates the elbow member or joint  6 . This member provides pivotal motion within the patient. This joint itself may be substantially the same as the joint shown in U.S. patent application Ser. No. 10/012,845 in FIG. 16A.  FIG. 2  also depicts the wrist joint  11  which also may be the same as described in U.S. patent application Ser. No. 10/012,845, such as in FIG. 16A or FIG. 16C. The joints  6  and  11  are intercoupled by the forearm member  12 . The control cabling that operates the various degrees of freedom couples through the instrument stem  5 , and one cable controls the rotation of the forearm member  12 . Refer in  FIG. 2  to the motion M 3  indicating pivoting at the elbow  6  and the motion M 4  indicating rotation of the forearm member  12  which, in turn, rotates the end effector  7 . The forearm member  12  may thus have a rotational joint at its more proximal end, adjacent member  6 , to facilitate motion M 4 . 
     In  FIG. 2  there are also illustrated motions associated with the wrist and end effector. Motion M 5  indicates yaw rotation at the wrist member  11 . The motions M 6  and M 7  are remotely controlled at the end effector pivot axis to provide instrument pitch and grip (opening and closing of the end effector jaws). 
       FIG. 3  is a perspective view of another embodiment of the invention using an internal wrist, elbow and additionally a shoulder. This view depicts a motor array or pack  21  mounted to the surgical table  19 . The motor array may be supported from the table rail  20 , and is usually disposed outside the sterile field. A plurality of cables in conduits  22  are driven by the respective motors of the motor array  1 . For further details of the motor array and cabling refer to U.S. patent application Ser. No. 10/012,845 and in particular FIGS. 8E through 8L, and the associated descriptions on pages 16 and 17. As described there, the cabling 22 may be detachably coupled with the motor pack 21, so that the slave unit (slider 13, etc.) is readily detachable from both the support bracket 14, as well as the motor pack 21. This makes the slave unit readily portable, and is light in weight. 
     A linear slider  13  is mounted on a static fixture or bracket  14 . The slider  13  supports the instrument shaft or stem  15 . The instrument stem  15  is inserted into the patient through an incision. The instrument stem is positioned so that the incision is at a location somewhere between the distal end of the slider  13  and the shoulder member or joint  16 . Refer in  FIG. 3  to the dotted line  15 A indicative of the possible location of the incision in the patient. The shoulder member  16  and elbow member  17 , in this particular version, articulate pivotal motions inside the patient&#39;s body, as will be described in further detail in conjunction with  FIG. 4 .  FIG. 3  also illustrates the end effector  18  that is controllable with pitch, yaw, and roll rotation, as well as a gripping motion by the end effector. A wrist  23 , shown in somewhat more detail in  FIG. 4 , is used just proximal of the end effector jaws to provide an additional degree of freedom. 
     For further details of the structures schematically depicted in  FIG. 3  refer to previous descriptions referenced in U.S. patent application Ser. No. 10/012,845. In U.S. patent application Ser. No. 10/012,845 refer to FIGS. 8-11, and the associated descriptive text on pages 15 and 17-19. This supporting description shows a carriage 226 in FIGS. 8-11 that functions as a slider for carrying the instrument. The instrument stem may be like that shown in FIG. 15A by instrument 16. FIG. 16 also shows various versions of end effectors including a wrist pivot joint in FIGS. 16A-16D and bendable sections in FIGS. 16E-16K, along with accompanying text descriptions. Also refer to U.S. patent application Ser. No. 10/299,588 for further descriptions of end effectors and bendable sections, such as in FIGS. 26-48, and associated descriptions in the specification. These disclosed members may be used for any one of the wrist, elbow or shoulder members of  FIGS. 3 and 4 . 
     Refer now to  FIG. 4  for further details of the embodiment of  FIG. 3 .  FIG. 4  shows, in particular, the degrees of freedom or motions of the instrument system. It is noted in  FIG. 4  that there is no linear translation at the incision due to the addition of the shoulder member  16 . Motion N 1  indicates axial rotation of the instrument stem  15  about its longitudinal axis. Motion N 2  indicates the motion at the added internal shoulder joint  16 .  FIG. 4  also illustrates the elbow member or joint  17 . Both of the joints  16  and  17  provide pivotal motion within the patient. Both of these joints may be a pivot joint as depicted in U.S. patent application Ser. No. 10/012,845, FIG. 16, or as described later, these motions may be implemented by bendable sections of the instrument shaft.  FIG. 4  also depicts the wrist joint  23  which also may be the same as described in U.S. patent application Ser. No. 10/012,845, such as in FIG. 16A or FIG. 16C. The joints  17  and  23  are intercoupled by the forearm member  24 . The control cabling that operates the various degrees of freedom couples through the instrument stem  5 , and one cable controls the rotation of the forearm member  24 . Refer in  FIG. 4  to the motion N 3  indicating pivoting at the elbow  17  and the motion N 4  indicating rotation of the forearm member  24  which, in turn, rotates the end effector  18 . For the purpose of rotation of the forearm  24 , there may be provided a rotational joint at the proximal end of the forearm  24  adjacent member  17 . 
     In  FIG. 4  there are also illustrated motions associated with the wrist and end effector. Motion N 5  indicates yaw rotation at the wrist member  23 . The motions N 6  and N 7  are remotely controlled at the end effector pivot axis to provide instrument pitch and grip (opening and closing of the end effector jaws). 
     In the two embodiments described so far, pivot joints are described. Reference has been made to U.S. patent application Ser. No. 10/012,845 for different versions of pivot joints, such as in FIGS. 16A and 16C. These same types of joints may also be used for the elbow and shoulder members, such as member  6  in  FIG. 2  or members  16  and  17  in  FIG. 4 . All such joint members are controlled from cables running within the instrument shaft, and under control from a master station where a medical practitioner operates an input user interface device such as handle grips, a joystick, or other input control devices. In this regard refer to U.S. patent application Ser. No. 10/012,845 and FIG. 1 thereof showing an instrument system including master and slave sides, and FIG. 16A showing cables 606 and 607 that control that particular wrist joint. Similar cabling can be used to control other joints, all controlled from motors associated with the slave unit, and preferably disposed outside the sterile field as indicated in  FIGS. 1 and 3 . 
     In  FIGS. 1-4  all of the motions disclosed are implemented by pivot joints. However, in another embodiment of the invention these motions may be implemented by respective bendable sections. One advantage of a bendable section is that it can be constructed to provide two degrees of freedom while the pivot joint is limited to only a single degree of freedom about the pivot axis. For specific embodiments that may be used in implementing these bendable sections refer to U.S. patent application Ser. No. 10/299,588 and U.S. patent application Ser. No. 10/012,845. In particular, in U.S. patent application Ser. No. 10/299,588 in FIGS. 41-47 there is one example of a bendable section that may be used. These sections may be constructed using alternating ribs and slots configured to enable ready bending or flexing where they are located. This action is remotely controlled from a master input device such as in the manner described in U.S. patent application Ser. No. 10/299,588. U.S. patent application Ser. No. 10/299,588 also shows the control cabling used for actuation of the bendable sections. As indicated, one advantage to a bendable section is that it can be operated with two degrees of freedom by orthogonally disposed cable sets to provide bending in orthogonal directions, a characteristic not found in a pivot joint.  FIGS. 5 and 6  describe the instrument system in this embodiment implemented using bendable sections. 
     Refer now to  FIG. 5  for an illustration of the degrees of freedom or motions of the instrument system using bendable sections. In still other embodiments of the invention a combination of pivot joints and bendable sections may be used. In  FIG. 5  motion P 1  indicates the linear translation of the slider  33 . Motion P 2  indicates the axial rotation of the instrument stem  35  about its longitudinal axis.  FIG. 5  also illustrates the elbow member  36 , in the form of a bendable section, such as described in U.S. patent application Ser. No. 10/299,588 or U.S. patent application Ser. No. 10/012,845. This bendable section provides a bending, flexing or turning motion of the instrument stem within the patient.  FIG. 5  also depicts the wrist member  38  which also may be the same as described in U.S. patent application Ser. No. 10/012,845, such as in FIG. 16E through FIG. 16K. The members  36  and  38  may be intercoupled by the forearm member  39 . The control cabling that operates the various degrees of freedom couples through the instrument stem  35 , and one cable may control the rotation of the forearm member  39 . Refer in  FIG. 5  to the motion P 3  indicating bending at the elbow  36  and the motion P 4  indicating rotation of the forearm member  39  which, in turn, rotates the end effector  37 . The forearm member  39  may thus have a rotational joint at its more proximal end to facilitate motion P 4 . 
     In  FIG. 5  there are also illustrated motions associated with the wrist and end effector. Motion P 5  indicates yaw rotation or bending at the wrist member  38 . The motions P 6  and P 7  are remotely controlled at the end effector pivot axis to provide instrument pitch and grip (opening and closing of the end effector jaws). 
     Refer now to  FIG. 6  for further details of the degrees of freedom or motions of the instrument system that includes both elbow and shoulder members  46  and  47 . Motion R 1  indicates axial rotation of the instrument stem  45  about its longitudinal axis. Motion R 2  indicates the motion at the added internal shoulder member  46 .  FIG. 6  also illustrates the bendable elbow member  47 . Both of the bendable sections  46  and  47  provide respective bending motions within the patient (internal of the incision).  FIG. 6  also depicts the wrist member  48  which also may be the same as described in U.S. patent application Ser. No. 10/012,845, such as in FIG. 16E through FIG. 16K. The members  47  and  48  may be intercoupled by the forearm member  49 . The control cabling that operates the various degrees of freedom couple through the instrument stem  45 , and one cable may control the rotation of the forearm member  49 . Refer in  FIG. 6  to the motion R 3  indicating bending at the elbow bendable section  47  and the motion R 4  indicating rotation of the forearm member  49  which, in turn, rotates the end effector  50 . 
     In  FIG. 6  there are also illustrated motions associated with the wrist  48  and end effector  50 . Motion R 5  indicates yaw rotation by bending at the wrist member  48 . The motions R 6  and R 7  are remotely controlled at the end effector pivot axis to provide instrument pitch and grip (opening and closing of the end effector jaws). 
     In the above embodiments, the bendable sections have been described as each providing only a single degree of freedom, or in other words bending in only one direction. However, these bendable sections can also be provided with two degrees of freedom each. In this regard refer, for example, to co-pending U.S. patent application Ser. No. 10/299,588 and the embodiment shown in FIGS. 41-47, and the associated description on page 45 of co-pending U.S. patent application Ser. No. 10/299,588 indicating the two degree of freedom motion at the bendable section, usually, but not necessarily, orthogonal to each other. Refer to page 45 of U.S. patent application Ser. No. 10/299,588 at lines 10-16. FIGS. 16I-16K of U.S. patent application Ser. No. 10/012,845 also shows a bendable section having two degrees of freedom of motion. 
     Regarding the use of bendable sections with two degrees of freedom, in the embodiment of  FIG. 5  such a bendable section may be used for the member  36 . In this case, the motion P 2  may be replaced by the two degree of freedom member  36 , so that there is only translation motion P 1  and no rotation motion P 2 . In this regard refer to  FIG. 7  for an illustration of the elbow member  36 A having two degrees of freedom depicted as motions P 2  and P 3 . These motions P 2  and P 3  are usually orthogonal to each other, but could also be at transverse angles other than 90 degrees to each other. In  FIG. 7  the same reference numbers are used to identify similar parts found in  FIG. 5 . The two degree of freedom bendable member  36 A is advantageous in that the motion at the incision is further minimized, thus further reducing the chance of stress at the incision. Also, the wrist member  38  may be a bendable two degree of freedom member to provide additional control of the end effector. 
     In connection with the embodiment described in  FIG. 6 , this also may be constructed with one or more of the bendable sections as two degree of freedom sections. Moreover the wrist member  48  may also be constructed as a two degree of freedom section. By providing one or more of the members  46  and  47  as two degree of freedom bendable sections, it is even possible to eliminate the rotational motion R 1  at the incision, as depicted in  FIG. 6 . This would further reduce stress at the incision. In this regard refer to  FIG. 8  for an illustration of the elbow member  46 A having two degrees of freedom depicted as motions R 1  and R 2 . These motions R 1  and R 2  are usually orthogonal to each other, but could also be at transverse angles other than 90 degree to each other. In  FIG. 8  the same reference numbers are used to identify similar parts found in  FIG. 6 . In the embodiment depicted in  FIG. 8  it is noted that there are no motions at the incision, neither translational nor rotational. In  FIG. 8  the member  47 A may have either one or two degrees of freedom. The rotating arm  49  may be optional. The wrist member  48  may be a pivot wrist, a one degree of freedom bendable section, or a two degree of freedom bendable section. 
     Thus, the present invention provides a concept whereby at least two internally disposed members are provided, each having a minimum of 1 degree of freedom, simulating “wrist” and “elbow” action in controlling the tool or end effector, and that can be either a “joint” (pivot connection) or “bendable section”. Herein, the term “turnable member” is adopted as a generic term intended to cover both pivot joints and bendable sections. 
     In the embodiments depicted in, for example,  FIGS. 5-8  some of the motions may be redundant. An effective instrument can be provided that uses fewer than the degrees of freedom illustrated. For example, in the embodiment of  FIG. 5  both the stem  35  and forearm member  39  are described as being controllably rotatable. However, an instrument can be made in which either one of the stem  35  and forearm member  39  is rotatable while the other is not. Particularly when using two degree of freedom members can one possibly eliminate a rotatable shaft member. In another example, in  FIG. 8 , the forearm member  49  may be non-rotatable. 
     In accordance with still another aspect of the invention there is provided an adaptor for an instrument that combines both adaptor and instrument into one instrument system that is releasably attached with the instrument base, such as with the instrument carriage or slider. In this regard refer to U.S. patent application Ser. No. 10/012,845 and, for example, FIG. 11 where the instrument insert 16 has been fully inserted into the adaptor 15, particularly into the guide tube 17. Also refer to U.S. patent application Ser. No. 10/302,804 a copy of another filed application showing the detachability of the adaptor for replacement thereof. Refer, for example, to FIG. 16A in U.S. patent application Ser. No. 10/302,804 showing the adaptor 49 and the instrument insert 56. In U.S. patent application Ser. No. 10/302,804 the instrument insert is meant to be insertable and retractable from the adaptor. In an alternate embodiment, the adaptor is detachable, such as in the manner depicted in U.S. patent application Ser. No. 10/302,804, but the instrument insert is coupled permanently with the adaptor so that the instrument insert is no longer inserted and retracted from the guide tube. In such as arrangement the structure can be substantially the same as that described in U.S. patent application Ser. No. 10/302,804, the only difference being that the instrument in no longer meant to be withdrawn from the guide tube. Instead, the adaptor and instrument are formed as a unit and the detachability is at the location where the adaptor is separable from the base or carriage, as depicted in U.S. patent application Ser. No. 10/302,804 in FIG. 16A. 
     Reference can also be made to other portions of co-pending U.S. patent application Ser. No. 10/299,588, U.S. patent application Ser. No. 10/012,845 and U.S. patent application Ser. No. 10/302,804 for illustrations of other structures usable in controlling the instruments shown in  FIGS. 1-8  herein. These co-pending U.S. patent applications particularly U.S. patent application Ser. No. 10/012,845 and U.S. patent application Ser. No. 10/302,804 give clear detail as to the structures that are used in providing the motions illustrated in  FIGS. 1-8 . This included, inter alia, teachings of cabling through the instrument for controlling joints or bendable sections, specific carriage or slider arrangements for linear translation, instrument and adaptor couplers with interlocking wheel members, and other structures for carrying out the motions depicted. 
     While this invention has been particularly shown and described with references to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the invention encompassed by the appended claims.