Patent Publication Number: US-11660151-B2

Title: Robotic surgical system with patient support

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 15/876,509 (filed Jan. 22, 2018), which is a continuation of U.S. patent application Ser. No. 14/721,966 (filed May 26, 2015)(now U.S. Pat. No. 9,872,734), which is a continuation of U.S. patent application Ser. No. 13/784,650 (filed Mar. 4, 2013)(now U.S. Pat. No. 9,078,686), which is a continuation of U.S. patent application Ser. No. 11/963,429 (filed Dec. 21, 2007)(now U.S. Pat. No. 8,400,094), each of which is hereby incorporated by reference in its entirety. 
    
    
     BACKGROUND 
     Field 
     Embodiments of the invention generally relate to surgical devices, systems, and methods, especially for minimally invasive surgery, and more particularly provides structures and techniques for supporting a surgical patient and a robotic surgery system at a desired surgical site. 
     Background 
     The present invention describes techniques for supporting a patient and robotic surgical manipulators of a robotic surgery system within an operating theater, and methods of improving the stability of the patient-robot system. 
     Minimally invasive medical techniques are aimed at reducing the extraneous physiologic impact and damage to tissue in carrying out a diagnostic or surgical procedure, thereby reducing patient recovery time, discomfort, and deleterious side effects. The average length of a hospital stay for a standard surgery is significantly longer than the average length for the equivalent surgery performed in a minimally invasive surgical manner. Patient recovery times, patient discomfort, surgical side effects, and time away from work are also reduced with minimally invasive surgery. 
     In traditional minimally invasive surgery, such as endoscopy, surgical instruments are introduced to an internal surgical site, often through trocar sleeves or cannulas. A body cavity, such as a patient&#39;s abdomen, may be insufflated with gas to provide improved access to a surgical site, and cannula or trocar sleeves are passed through small (approximately ½ inch) incisions to provide entry ports for endoscopic surgical instruments. The surgical instruments or tools used in traditional endoscopy may have elongate handles extending out from the cannula, to permit the surgeon to perform surgical procedures by manipulating the tools from outside the body. The portion of the tool inserted into the body may include an end effector, by which tissue is manipulated. Typically minimally invasive procedures are performed under the direction of a surgical imaging system, such as by introducing an endoscope to the surgical site for viewing the surgical field. Typically the endoscope is coupled to a digital camera, to permit remote display, the surgeon then activating the surgical instruments while viewing the surgical site on a video monitor. Similar endoscopic techniques are employed in, e.g., laparoscopy; arthroscopy, retroperitoneoscopy, pelviscopy, nephroscopy, cystoscopy, cisternoscopy, sinoscopy, hysteroscopy, urethroscopy, and the like. 
     Minimally invasive surgical systems have been and continue to be developed to increase a surgeon&#39;s dexterity by means of robotic telesurgical systems, so that the surgeon performs the surgical procedures on the patient by manipulating master control devices to control the motion of servo-mechanically operated instruments. In contrast to the elongate handles of traditional endoscopic tools, in robotically assisted minimally invasive surgery, or telesurgery, a servomechanism is used to actuate the surgical end effectors of the instruments. This allows the surgeon to operate in a comfortable position without looking one direction (towards the monitor) while manipulating handles of surgical instruments that are oriented in another direction (for example, into the patient&#39;s abdomen). Telesurgical or robotically operated instruments also may greatly increase the range of motion and degrees of freedom achievable for end effectors at the internal surgical site. 
     As more fully described in U.S. Pat. No. 5,696,837, the full disclosure of which is incorporated herein by reference, a computer processor of the servomechanism can be used to maintain the alignment between hand input devices of the controller with the image of the surgical end effectors displayed on the monitor using coordinate system transformations. This allows the surgeon to operate in a natural position using anthropomorphic hand input devices and motions aligned with the image display, despite the fact that the actual surgical instruments are inserted via otherwise awkward arbitrary access positions. The endoscope may optionally provide the surgeon with a stereoscopic image to increase the surgeon&#39;s ability to sense three-dimensional information regarding the tissue and procedure. Typically the image captured by the endoscope is digitized by a camera, such as a charge-coupled device (CCD), and processed for display to the surgeon and surgical assistants. 
     In robotically assisted surgery or telesurgery, a surgeon typically operates at least one master controller to control the motion of at least one surgical instrument at the surgical site. The controller will typically include one or more hand input devices or masters, by which the surgeon inputs control movements. The master controllers and surgeon&#39;s view display of the endoscope image may be separated from the patient by a significant distance, and need not be immediately adjacent the operating table. The master controller mountings and endoscope display may be integrated as a control console, referred to herein as the “surgeon&#39;s console” portion of the telesurgical system, which may be connected by signal and power cables to the servomechanisms, endoscope cameras, processors and other surgical instrumentation. The console is typically located at least far enough from the operating table to permit unobstructed work space for surgical assistants. 
     Each telesurgical master controller is typically coupled (e.g., via a dedicated computer processor system and connector cables) to a servo-mechanism operating a surgical instrument. The servo mechanism articulates and operates the surgical instrument, tool or end effector to carry out the surgical procedure. A plurality of master controllers may operate a plurality of instruments or end effectors (e.g., tissue graspers, needle drivers, cautery probes, and the like) based on the surgeon&#39;s inputs. These tools perform functions for the surgeon, for example, holding or driving a needle, grasping a blood vessel, or dissecting, cauterizing, or coagulating tissue. Similarly, surgeon&#39;s master inputs may control the movement and operation of an endoscope-camera driver servomechanism, permitting the surgeon to adjust the view field and optical parameters of the endoscope as the surgery proceeds. In a typical telesurgical system, the surgeon may operate at least two surgical instruments simultaneously, (e.g., corresponding to right and left hand inputs) and operate an endoscope/camera driver by additional control inputs. Note that optionally the servo-manipulators may support and operate a wide variety of surgical tools, fluid delivery or suction devices, electrical or laser instruments, diagnostic instruments, or alternative imaging modalities (such as ultrasound, fluoroscopy, and the like). 
     U.S. Pat. Nos. 5,184,601; 5,445,166; 5,696,837; 5,800,423; and 5,855,583 describe various devices and linkage arrangements for robotic surgical manipulators. The full disclosure of each of these patents is incorporated by reference. The servo-mechanisms, their supporting/positioning apparatus, the surgical instruments and endoscope/camera of a telesurgical system are typically mounted or portably positioned in the immediate vicinity of the operating table, and are referred to herein collectively as the “patient-side” portion of the telesurgical system. 
     Generally, a linkage mechanism is used to position and align each surgical servo-manipulator or endoscope probe with the respective incision and cannula in the patient&#39;s body. The linkage mechanism facilitates the alignment of a surgical manipulator with a desired surgical access point. Such devices will generally be referred to herein as “setup arms”, it being understood that a number of quite different mechanisms may be used for this purpose. The above referenced pending PCT/US99/17522, published on Feb. 17, 2000 as WO00/07503, describes a number of aspects and examples of manipulator positioning or setup arms, and the full disclosure of this publication is incorporated by reference. 
     The setup arms must be supported in proximity to the surgical patient. The portion of the robotic system supported in proximity to the surgical patient may have a weight of several hundred pounds. It is desirable to support the setup arms in a manner that minimizes the relative motion between support for the setup arms and the surgical patient because the positioning of the surgical end effectors may be relative to the ground reference provided by the support for the setup arms. The mechanical path from the patient to the support for the setup arms should be stiff so that a force between the support and the patient causes a minimal displacement of the system. Various devices have been used to provide a stiff support for the setup arms. 
     In the system disclosed in U.S. Pat. No. 6,837,883 a patient side cart as shown in  FIG.  4    supports the setup arms and the robotic surgical manipulators. While the patient side cart provides a stable support for the setup arms, it places a bulky device in the work space used by the surgical assistants and provides a tenuous connection between the setup arms and the surgical patient. 
     In the system disclosed in U.S. Pat. No. 6,933,695 the setup arms and the robotic surgical manipulators are supported by ceiling and floor mounted structures. While this removes a substantial amount of the support device from the work space used by the surgical assistants, it lengthens the connection between the support for the setup arms and the support for the surgical patient. This decreases the stiffness of the system and the stability of the position of the support device relative to the surgical patient. 
     In the system disclosed in U.S. Pat. No. 7,083,571 the setup arms and the robotic surgical manipulators are supported by the operating table using equipment rails provided along the sides of the table top. This reduces the amount of structure in the work space used by the surgical assistants and shortens the connection between the support for the setup arms and the support for the surgical patient. However, the equipment rail provided on the side of an operating table does not provide a stiff support for the relatively heavy setup arms and robotic surgical manipulators. 
     It would be desirable to provide a support for the setup arms and the robotic surgical manipulators of a robotic surgical system that does not unduly add to the amount of structure in the work space used by the surgical assistants and provides a rigid base of support that minimizes movement relative to the surgical patient to create a system with high stiffness. 
     SUMMARY 
     A robotic surgery system for supporting a patient and a robotic surgical manipulator. The robotic surgery system includes a base, a pillar coupled to the base at a first end and extending vertically upwardly to an opposing second end, and an attachment structure coupled to the second end of the pillar. A patient table is coupled to the attachment structure. A robot support arm has a first end coupled to the attachment structure. The robot support arm extends vertically upwardly from the first end to a second end. The robot support arm may further extend horizontally over the patient table to support a robotic surgical manipulator that will extend generally downward from the robot support arm toward a patient supported by the patient table to place an end effector of the robotic surgical manipulator adjacent a desired surgical site on the patient. 
     Other features and advantages of the present invention will be apparent from the accompanying drawings and from the detailed description that follows below. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The invention may best be understood by referring to the following description and accompanying drawings that are used to illustrate embodiments of the invention by way of example and not limitation. In the drawings, in which like reference numerals indicate similar elements: 
         FIG.  1    is a side elevation of a robotic surgery system that embodies the invention. 
         FIG.  2    is a side elevation of a portion of another robotic surgery system that embodies the invention. 
         FIG.  3    is a right end view of the portion of the robotic surgery system shown in  FIG.  2   . 
         FIG.  4    is a side elevation of a portion of another robotic surgery system that embodies the invention. 
         FIG.  5    is a side elevation of a portion of another robotic surgery system that embodies the invention. 
         FIG.  6    is a side elevation of a portion of another robotic surgery system that embodies the invention. 
         FIG.  7    is an oblique top view of a portion of the robotic surgery system shown in  FIG.  6   . 
     
    
    
     DETAILED DESCRIPTION 
     In the following description, numerous specific details are set forth. However, it is understood that embodiments of the invention may be practiced without these specific details. In other instances, well-known circuits, structures and techniques have not been shown in detail in order not to obscure the understanding of this description. 
     Robotic surgical systems have generally been viewed as an addition to a traditional surgical theatre. Systems intended to be added to conventional surgical suites generally make trade-offs in patient access and stiffness to accommodate the equipment found in a standard operating room. In particular, accommodating the standard operating table is a challenge for a robotic surgical system. 
     Embodiments of the present invention provide an integrated robotic surgery system for supporting a patient and a robotic surgical manipulator. Addressing the issues of patient support and robot support with a single system may provide advantages that are difficult to obtain with retrofit type solutions. 
       FIG.  1    shows a robotic surgery system  100  that is supported by a base  110 . A pillar  120  is coupled to the base  110  at a first end  122  and extends vertically upward to an opposing second end  124 . An attachment structure  130  is coupled to the second end  124  of the pillar  120 . 
     A patient table  140  is coupled to the attachment structure  130 . As shown, the patient table  140  may be an articulated structure with sections  140   a ,  140   b ,  140   c  that can be moved relative to one another to position the patient advantageously for surgery. Preferably the patient will be supported by the section  140   b  of an articulated patient table  140  that is most directly coupled to the attachment structure  130 . 
     A robot support arm  150  is coupled to the attachment structure  130  at a first end  152 . The robot support arm  150  extends upward and then over the patient table  140  to a second end  154 . A robotic surgical manipulator  160  may be supported adjacent the second end  154  of the robot support arm  150  and extend generally downward from the robot support arm toward a patient supported by the patient table  140  to place an end effector  162  of the robotic surgical manipulator adjacent a desired surgical site on the patient. 
     Advantageously the attachment structure  130  provides a substantial base that supports both the patient table  140  and the robot support arm  150 . The attachment structure  130  provides a stiff coupling member between the patient support and the robot support in the robotic surgery system  100 . The pillar  120  may be of a telescoping construction that can raise and lower the attachment structure  130  with respect to the base  110 . The height of the attachment structure  130  with respect to the base  110  does not change the relationship between the robot support arm  150  and the patient table  140  because the attachment structure provides a common base for both. 
     It will be appreciated that the patient and the robotic surgical manipulators are both substantial subsystems to be supported and may be somewhat equal in weight. It will be further appreciated that the relative positions of the two subsystems are dictated by the location of the surgical site. This may require supporting one or both of the subsystems as a cantilevered load. It will be recognized that this can result in very substantial forces being imposed on the attachment structure  130 , forces that are not readily borne by conventional operating room equipment. 
     In some embodiments of the invention the patient table  140  may be slidingly coupled to the attachment structure  130  to allow different portions of the patient to be adjacent to the end effector  162  of the robotic surgical manipulator. It will be appreciated that this may require supporting the patient substantially offset from the pillar  120  and require the base  110  to be sized and weighted to stably support such offset loads. For example, the patient may be supported largely to one side of the pillar  120  to perform head surgery. 
       FIGS.  2  and  3    show a robotic surgery system in which the attachment structure  230  is coupled to the second end  224  of the pillar  220  with a pivotal connection  232  that allows the attachment structure to be placed at an angle to the vertical axis of the pillar. This may allow the attached patient table (not shown) to be inclined which may be desirable for certain surgeries to position internal organs by gravity effects. 
       FIG.  4    shows another robotic surgery system  400  in which the attachment structure  430  is coupled to the pillar  220  with a pivotal connection that allows the attachment structure to be placed at an angle to the vertical axis of the pillar. In this embodiment the first end  452  of the robot support arm  450  is coupled to the attachment structure  430  such that the portion of the robot support arm extending upward is not perpendicular to an upper surface  432  of the attachment structure. The angle of attachment of the robot support arm  450  may be chosen to be equal and opposite to a frequently used angle of inclination of the attachment structure  430  and the attached section  140   b  of the patient table  140 . This allows the upright portion of the robot support arm  450  to be substantially vertical during many surgeries, allowing the patient-side surgeons and surgical room staff greater access to the patient and the robotic surgical equipment. 
     In this embodiment the second end  454  of the robot support arm  450  may be joined to the upright portion at other than a right angle so the second end  454 , which supports the robotic surgical manipulator  160 , is substantially parallel to the upper surface  432  of the attachment structure  430 . This allows the robotic surgical manipulator  160  to be supported in a substantially horizontal position when the attachment structure  430  and the attached section  140   b  of the patient table  140  are horizontal for patient loading and initial setup of the robotic surgical manipulator. 
       FIG.  5    shows another robotic surgery system  500  in which the attachment structure  530  is coupled to the pillar  520  with a pivotal connection that allows the attachment structure to be placed at an angle to the vertical axis of the pillar. In this embodiment the first end  552  of the robot support arm  550  is pivotally coupled  532  to the attachment structure  530 . A mechanism, such as a link  534  coupled between the pillar  520  and the first end  552  of the robot support arm  550 , may operate to keep the portion of the robot support arm extending upward substantially vertical as the attachment structure  530  is inclined. 
       FIG.  6    shows another robotic surgery system  600  in which the first end  652  of the robot support arm  650  is coupled to the attachment structure  630  with a sliding connection  632  that allows the robot support arm to be moved along an axis of the attachment structure as suggested by the double headed arrow  660 . 
     The first end  652  of the robot support arm  650  may be coupled to the attachment structure  630  with a sliding connection  658  that allows a length of the portion of the robot support arm extending upward to be adjusted as suggested by the double headed arrow  662 . The sliding connection  658  may be a telescoping structure. 
     The robotic surgical manipulator  160  may be supported adjacent the second end  654  of the robot support arm  650  by a robot support bar  656  that is pivotally coupled to the robot support arm adjacent the second end.  FIG.  7    shows an oblique view of the second end  654  of the robot support arm  650  looking along the pivot axis of the robot support bar  656 . The robot support bar may support more than one robotic surgical manipulator and the bar may have a curved form to allow the end effectors  162  of several manipulators to converge on a surgical site. The pivoting of the robot support bar  656  may allow the supported robotic surgical manipulators  160  to be rotated away from the patient table  140  during patient loading onto the surgical table. In addition, the pivoting support bar may also allow the robot to be fitted with sterile covers and sterile instrumentation prior to the patient being loaded onto the table, and to maintain this sterility during pre-operative room activities, as the robot can be moved into a position where it at lower risk of being contacted by non-sterile persons or objects. 
     While certain exemplary embodiments have been described and shown in the accompanying drawings, it is to be understood that such embodiments are merely illustrative of and not restrictive on the broad invention, and that this invention is not limited to the specific constructions and arrangements shown and described, since various other modifications may occur to those of ordinary skill in the art. The description is thus to be regarded as illustrative instead of limiting.