Patent Publication Number: US-8968278-B2

Title: Robotic arms DLUs for performing surgical tasks

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a divisional of patent application Ser. No. 13/191,560, filed on Jul. 27, 2011, which is a continuation of U.S. patent application Ser. No. 11/928,053, filed on Oct. 30, 2007, which is a continuation of U.S. patent application Ser. No. 10/851,819, filed on May 21, 2004, now abandoned, which is a continuation of U.S. patent application Ser. No. 09/804,531, filed on Mar. 12, 2001, now U.S. Pat. No. 6,827,712, which is a divisional of U.S. patent application Ser. No. 09/099,740, filed on Jun. 18, 1998, now U.S. Pat. No. 6,231,565, which claims the benefit of, and priority to, U.S. Provisional Patent Application Ser. No. 60/049,923, filed on Jun. 18, 1997, now expired, the entire contents of each application being incorporated by reference herein in its entirety. 
    
    
     BACKGROUND 
     1. Technical Field 
     The present disclosure relates to an apparatus and method for performing surgical tasks. In particular, the disclosure relates to disposable loading units (DLUs) configured for mounting to a robotic arm and having at least one automatically actuated surgical tool for performing a surgical task. 
     2. Description of Related Art 
     Accurate and precise manipulation of surgical instruments at or near a surgical site is required during surgical procedures, especially during minimally invasive procedures such as laparoscopic and endoscopic procedures. In laparoscopic and endoscopic surgical procedures, a small incision is made in the patient&#39;s body to provide access for a tube or cannula device. Once extended into the patient&#39;s body, the cannula allows insertion of various surgical instruments for acting on organs, blood vessels, ducts, or body tissue far removed from the incision site. Such instruments may include apparatus for applying surgical clips as disclosed in U.S. Pat. No. 5,084,057; apparatus for applying surgical staples as disclosed in U.S. Pat. Nos. 5,040,715 and 5,289,963; and apparatus for suturing body tissue as disclosed in U.S. Pat. No. 5,403,328. 
     In minimally invasive procedures, the ability to perform surgical tasks is complicated due to limited maneuverability and reduced visibility. Therefore, a need exists for an apparatus and a procedure that enables the remote actuation of surgical instruments during minimally invasive procedures in a consistent, easy and rapid manner. 
     In non-laparoscopic and non-endoscopic procedures, accurate and precise manipulation and operation of surgical instruments is also required. For example, in a transmyocardial vascularization (TMR) procedure, wherein holes are formed in the heart wall to provide alternative blood flow channels for ischemic heart tissue, careful advancement and control of a lasing or coring device is necessary to form holes in the ischemic areas of the heart tissue. 
     In other cardiovascular procedures such as laser angioplasty wherein an optical fiber is inserted and advanced into a patient&#39;s vasculature to apply laser energy to obstructions and/or restrictions typically caused by plaque build-up, precise manipulation and operation is also required. Both continuous wave and pulsed high energy lasers have been used to provide the vaporizing laser energy. Insuring the plaque is actually ablated and not just pushed aside is important to prevent or delay restenosis. 
     The advent of computer imaging systems have enabled surgeons to precisely position and map the direction of travel of a surgical instrument prior to the utilization of the instrument in the operation. For example, an imaging system can locate the exact location of a lesion within a patient and allocate X, Y and Z coordinates to that lesion in space. A coring device can then be manually advanced to that location to slice the distal flat end face of the core so that a complete specimen can be removed for biopsy. 
     Robotic systems have also been developed to aid a surgeon in precisely mounting and positioning surgical instruments to perform a surgical task. For example, U.S. Pat. No. 5,571,110 to Matsen, III et al. discloses an orthopedic saw guide for confining the blade of a surgical saw to movement in a single plane while allowing translational and rotational movement of the blade within the plane to facilitate the performance of a surgical bone alteration task. The saw guide is positioned relative to a patient&#39;s bone by a robot-aided system. 
     However, known robotic systems, such as the saw guide disclosed in the Matsen et al. &#39;110 patent, are typically limited to specific surgical tasks and are not adaptive for performing a wide variety of surgical tasks. Therefore, there is a need for a robotic system for aiding a surgeon to perform a wide variety of surgical tasks. 
     Another disadvantage of known robotic systems having surgical application is that the surgeon is required to manually control the position and operation of the surgical instrument. For example, systems have been developed wherein the surgeon is fitted with a mechanism which translates the surgeon&#39;s movements into mechanical movements whereby servo motors are actuated to manipulate the surgical instrument. For example, U.S. Pat. No. 5,624,398 to Smith et al. discloses a robotic system having a pair of articulate robotic arms responsive to the surgeon&#39;s movements during the surgery. However, any error in the surgeon&#39;s movements results in undesired manipulation of the robotic arms. Therefore, a fully automatic robotic system for aiding a surgeon to perform a wide variety of surgical tasks would be advantageous. 
     Another disadvantage with known robotic systems is their inability to remotely operate a conventional surgical tool, such as an apparatus for applying surgical staples or an apparatus for suturing body tissue which is mounted to the robotic arm. 
     Therefore, it would be advantageous to provide disposable loading units (DLUs) configured for mounting to a robotic arm of a robotic system and having at least one surgical tool extending from one end for performing a surgical task. The DLU would be actuated by an actuation assembly operatively associated with the robotic arm for controlling the operation and movement of the DLU. The DLU would include an electro-mechanical assembly operatively associated with the actuation assembly for controlling the operation and movement of the surgical tool. 
     SUMMARY 
     The subject disclosure is directed to disposable loading units configured for mounting to a robotic arm and having at least one automatically actuated surgical tool for performing a surgical task. The robotic arm acts on the DLUs with the dexterity and mobility of a surgeon&#39;s hand and can be programmed via an actuation assembly to actuate the surgical tool to perform the surgical task. Actuation commands are transmitted by electrical signals via cables from the actuation assembly to an electro-mechanical assembly within the DLUs. The electro-mechanical assembly within each DLU is configured to move and operate the surgical tool for performing the surgical task. For example, the electromechanical assembly may include servo motors for advancing, rotating and retracting a coring member of a coring DLU device; for harmonically oscillating a scalpel of a cutting DLU device; or for pivotally moving a suturing needle positioned on an axis of a longitudinal casing of a suturing DLU device. 
     One DLU presented and configured for mounting to the robotic arm is a coring DLU device for minimally invasive surgery, such as removing a specimen for biopsy. Still another DLU presented is a lasing DLU device for performing surgical procedures entailing the use of laser energy, such as TMR and angioplasty. Additional DLUs presented include a surgical fastener applying DLU device, a vessel clip applying DLU device, a cutting DLU device, a hole punching DLU device, and a vascular suturing DLU device. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Various robotic arm DLUs for performing surgical tasks will be described hereinbelow with reference to the drawings wherein: 
         FIG. 1  is a perspective view of a robotic system constructed in accordance with the present disclosure and illustrating a coring DLU device; 
         FIG. 1A  is a block diagram illustrating the components of a DLU device; 
         FIG. 2  illustrates a surgeon utilizing the apparatus of  FIG. 1  in the performance of a surgical procedure; 
         FIG. 3  is a perspective view of a lasing DLU device; 
         FIG. 4  is a perspective view of a surgical fastener applying DLU device; 
         FIG. 5  is a perspective view of a vessel clip applying DLU device; 
         FIG. 6A  is a perspective view of a first embodiment of a cutting DLU device; 
         FIG. 6B  is a perspective view of a second embodiment of a cutting DLU device; 
         FIG. 7  is a perspective view of a hole-punching DLU device; and 
         FIG. 8  is a perspective view of a vascular suturing DLU device. 
     
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
     The robotic arm disposable loading units (DLUS) and accompanying robotic system of the present disclosure shall be discussed in terms of performing a variety of surgical tasks, which include but not limited to endoscopic, arthroscopic and/or laparoscopic procedures. The present disclosure introduces and discusses several DLUs, which include a coring DLU, two cutting DLUs, an aortic hole-punching DLU, a lasing DLU, a fastener applying DLU, and a vascular suturing DLU. However, the present disclosure should not be construed to limit the present application to only these DLUs. 
     Referring now to the drawings wherein like reference numerals indicate similar structural elements, there is illustrated in  FIG. 1  a robotic system designated generally by reference numeral  10 . Robotic system  10  can be used to performing a wide variety of surgical tasks, such as operate surgical instrumentation within the abdominal cavity of a patient with a fine degree of dexterity and accuracy. 
     The robotic system  10  includes an actuation assembly  12 , a monitor  14 , a robot  16 , and a DLU  18  releasably attached to the robot  16  and having at least one surgical tool  20  for performing at least one surgical task. The robot  16  includes a trunk  22  extending from a base  24 , a shoulder  26  connecting the trunk to an upper arm  28 , an elbow  30  connecting the upper arm  28  to a lower arm  32 , and a wrist  34  attached to the lower arm  32  from which extends a mounting flange  36 . The mounting flange  36  is capable of moving in six degrees of freedom. 
     The DLU  18  further includes a head portion  40  for housing an electromechanical assembly  19  ( FIG. 1A ) therein for operating the surgical tool  20  and an attachment platform  42  for releasably attaching the DLU  18  to the robot  16  via the mounting flange  36 . The mounting flange  36  includes two slots  35  which matingly engage protrusions  38  of the attachment platform  42  to connect the mounting flange  36  with the DLU  18 . Other forms of releasable mechanical attachment of these components are envisioned as well, such as bayonet coupling, tongue and groove arrangements, snap-fit arrangements, interference fit arrangements, and locking screw arrangements. It is also contemplated to provide an electrical connection  33  between the slots  35  and the protrusions  38  for powering the electromechanical assembly  19  as shown by  FIG. 1A . 
     The DLU  18  can be removed from the mounting flange  36  and be replaced with another DLU having a different surgical tool for performing a different surgical procedure. It is also contemplated to design a DLU having several surgical tools capable of performing several surgical procedures where the robot  16  can rotate the mounting flange  36  to select one of the surgical tools of the DLU when required. 
     In operation, the surgeon controls the actuation assembly  12  to control the movement and operation of the robot  16  and the DLU  18 . Depending on the amount of rotation of the knobs  44  on the actuation assembly  12 , the actuation assembly  12  transmits electrical signals to the robot  16  to electro-mechanically operate the moveable parts of the robot  16 , such as to rotate the robot  16  about the vertical trunk  22  or to advance the mounting flange  36 . The actuation assembly  12  may include a processor therein for storing operational commands and for transmitting digital signals to the electromechanical assembly  19 . The actuation assembly  12  can also transmit electrical signals to the mounting flange  36  in the form of electrical signals for positioning and operating the DLU  18 . 
     The actuation assembly  12  further transmits electrical signals to the electromechanical assembly  19  housed within the head portion  40  of the DLU  18  for actuating the electromechanical assembly  19  which in turn actuates the surgical tool  20 . The electromechanical assembly  19  includes mechanisms for moving and operating the surgical tool  20 , such as servo motors for harmonically oscillating a scalpel of a cutting DLU device, or rods for pivotally moving a suturing needle positioned on an axis of a longitudinal casing of a suturing DLU device. The DLU  18  may further include integrated circuitry, including a receiver  21  and a processor  23  for receiving digital signals from the actuation assembly. The receiver  21  and processor  23  are included within control means  25  electrically connected to the electromechanical assembly  19  as shown by  FIG. 1A . 
     One type of electromechanical assembly can be used to advance, rotate and retract a coring portion  46  of a coring DLU device  48  as shown by  FIG. 1 . Coring DLU device  48  is suited for performing a coring procedure, such as coring body tissue for removing a specimen for biopsy, as shown by  FIG. 2 . The coring portion  46  includes a tubular member  50  having a cutting edge  52 . The linear advancement of the tubular member  50  is automatically controlled by the electromechanical assembly  19 . 
     When the coring DLU device  48  is actuated by transmitting electrical signals to the electromechanical assembly  19 , the tubular member  50  can be distally and proximally moved by rods traversing the longitudinal axis of the coring portion  46  and operatively associated with the electromechanical assembly  19 . 
     A lasing DLU device  80  is illustrated in  FIG. 3  for performing surgical procedures requiring laser energy, such as a TMR procedure. Laser DLU device  80  includes a laser energy transmission mechanism  82  partially disposed within a body portion  81  and mounted for controlled longitudinal movement relative to a head portion  84  of the DLU  80 . The actuation assembly  12  can be provided with a laser energy generator which is optically connected to the laser energy transmission mechanism  82  for initiating laser energy. The laser energy generator may also be incorporated within the electromechanical assembly  19 . The laser energy transmission mechanism  82  typically includes at least one optical fiber for transmitting laser energy. The at least one optical fiber in the laser energy transmission mechanism  82  traverses the body portion  81  and is optically associated with the laser energy generator. 
     A controlled advancement mechanism is provided within the DLU head portion  84  and in engagement with the laser energy transmission mechanism  82  for advancing the laser energy transmission mechanism  82  at a controlled rate coordinated with the laser energy generator output to ablate body tissue. Controlled advancement mechanisms which can be incorporated within the head portion  84  include constant and/or variable rate springs, motors, and other mechanisms which can be coordinated with the laser energy generator to advance one or both of the laser energy transmission mechanism  82  during ablation. 
     A surgical fastener applying DLU device  90  is illustrated in  FIG. 4  for applying an array of surgical fasteners to body tissue. Surgical fastener applying DLU device  90  includes an actuator incorporated within a head portion  92  to perform fast closure and incremental advancement of a cartridge assembly  94  with respect to an anvil assembly  96  at a distal end of body portion  98 . 
     Reference can be made to U.S. Pat. No. 4,508,253 issued to Green on Apr. 2, 1985 or European Patent Application No. 92 116880.3 published on Apr. 21, 1993, the contents of both documents are incorporated herein by reference, for a more detailed explanation of the operation of the body portion components during a surgical fastening procedure. It is provided that the hand portion of the fastener applying apparatus disclosed in the &#39;006 patent is incorporated within the structure and construction of the electro-mechanical assembly  19  of the surgical fastener applying DLU device  90  for operating the body portion components in the same manner as the hand portion operates the body portion components in the above-noted &#39;006 patent. 
       FIG. 5  is a perspective view of a vessel clip applying DLU device  100  for applying surgical clips to body tissue. Vessel clip applying DLU device  100  includes a head portion  102 , a body portion  104  extending distally from the head portion  102  and defining a longitudinal axis, and a plurality of surgical clips disposed within the body portion  104 . A jaw assembly  106  is mounted adjacent a distal end portion  108  of the body portion  104 . The jaw assembly  106  includes first and second jaw portions  110  movable between a spaced-apart and approximated position. 
     A clip pusher is provided within body portion  104  to individually distally advance a distal-most surgical clip to the jaw assembly  106  while the jaw portions  110  are in the spaced-apart position. An actuator  112  disposed within the body portion  104  is longitudinally movable in response to actuation of the electromechanical assembly  19  within the head portion  102 . A jaw closure member  114  is positioned adjacent the first and second jaw portions  110  to move the jaw portions  110  to the approximated position. The actuator  112  and the jaw closure member  114  define an interlock therebetween to produce simultaneous movement of the actuator  112  and the jaw closure member  114  when the actuator  112  is positioned adjacent the distal end portion of the body portion  104 . 
     Reference can be made to U.S. Pat. No. 5,300,081 issued to Young et al. on Apr. 5, 1994, the contents of which are incorporated herein by reference, for a more detailed explanation of the operation of the body portion components during a vessel clip applying procedure. It is provided that the hand portion of the vessel clip applying apparatus disclosed in the &#39;081 patent is incorporated within the structure and construction of the electro-mechanical assembly  19  of the vessel clip applying DLU device  100  for operating the body portion components in the same manner as the hand portion operates the body portion components in the above-noted &#39;081 patent. 
     With reference to  FIG. 6A , a first embodiment of a cutting DLU device  120  is illustrated for cutting and storing sections of body tissue. Cutting DLU device  120  includes an actuator incorporated within a head portion  122 , a body portion  124  having an outer tube  126  extending from the head portion  122 , and a cutting tube  128  positioned within the outer tube  126  and movable in response to actuation of the electromechanical assembly  19  between a retracted position and a distal position to cut body tissue. The cutting tube  128  has a chamber  130  formed therein for storing the cut tissue sections. 
     A release lever is included within the electro-mechanical assembly  19  and is movable from a blocking position to allow the cutting tube  128  to be removed from the outer tube  126 . An anvil  132  is positioned at a distal end of the outer tube  126  for forcing each cut tissue section proximally into the chamber  130  of the cutting tube  128  as the cutting tube  128  is advanced to cut the body tissue. The electro-mechanical assembly may include an oscillation assembly operatively associated with the cutting tube  128  to harmonically oscillate the cutting tube  128 . 
     A second embodiment of a cutting DLU device  140  is shown by  FIG. 6B . This embodiment includes a scalpel  142  which can be encased within a cylinder  144  capable of being moved proximally and distally. A harmonic oscillator may be incorporated within the head portion  146  to harmonically oscillate the scalpel  142 . In addition, it is contemplated to provide mechanisms within the head portion  146  for rotating and longitudinally moving the scalpel  142 . 
     With reference to  FIG. 7 , there is shown a hole-punching DLU device  150  for facilitating the formation of an elliptical hole in the aorta during a coronary artery bypass grafting (CABG) procedure. Hole-punching DLU device  150  includes a head portion  152  having an actuator therein for actuating an actuating rod  154  disposed in body portion  156  and mounted for longitudinal movement between an unactuated position and an actuated position, and a punch blade  158  disposed at the distal end of the actuating rod  154 . 
     The distal end of body portion  156  includes an elliptical opening  157  to receive punch blade  158  when the actuating rod  154  is moved to the unactuated position. The elliptical opening  157  includes a sharp circumference for cutting tissue disposed between the distal end of body portion  156  and the punch blade  158  when the actuating rod  154  is moved proximally for forming an elliptical hole in a coronary artery for the performance of the CABG procedure. 
     Finally, with reference to  FIG. 8 , a vascular suturing DLU device  180  is illustrated for suturing vascular tissue sections together. Vascular suturing DLU device  180  includes a head portion  182  and a body portion  184  extended distally therefrom. A pair of needle receiving jaws  186 ,  188  are pivotally mounted at a distal end of the body portion  184  and are configured to repeatedly pass a surgical needle and associated length of suture material therebetween. The apparatus further includes needle holding structure  190 , mounted within the jaws  186  for reciprocal movement into and out of needle holding recesses  192  formed in the jaws  186 ,  188 . During an anastomosis procedure, the vascular suturing DLU device  180  will advantageously respond to movement commands transmitted from the actuation assembly to apply fasteners to tissue. 
     Reference can be made to U.S. Pat. No. 5,478,344 issued to Stone et al. on Dec. 26, 1995, the contents of which are incorporated herein by reference, for a more detailed explanation of the operation of the body portion components during a vascular suturing procedure. It is provided that the hand portion of the vascular suturing apparatus disclosed in the &#39;344 patent is incorporated within the structure and construction of the electro-mechanical assembly  19  of the vascular suturing DLU device  180  for operating the body portion components in the same manner as the hand portion operates the body portion components in the above-noted &#39;344 patent. 
     It is contemplated to have feedback forces initiated by pressure and other parameters indicative of the surgical task being performed by the at least one surgical tool of the DLU transmitted back through a microprocessor to a digital-to-analog circuit board. This force feedback control system allows the robotic system to be programmed before the surgical task is performed with guidance, pressure, and other parameters which can be continuously monitored to control the operation and movement of the DLU and of the at least one surgical tool. 
     While the invention has been illustrated and described as embodied in an apparatus and method for performing surgical tasks, it is not intended to be limited to the details shown, since it will be understood that various omissions, modifications, substitutions and changes in the forms and details of the device illustrated and its operation can be made by those skilled in the art without departing in any way from the spirit or scope of the appended claims.