Patent Publication Number: US-2016242800-A1

Title: Articulating surgical hand instrument

Description:
TECHNICAL FIELD 
     The present disclosure relates generally to articulating surgical hand instruments, and more particularly to an articulating surgical hand instrument suitable for use in laparoscopic surgery. 
     BACKGROUND 
     Sometimes when performing a laparoscopic procedure, the surgeon will need to get access to an internal organ/tissue, manipulate it into a given position, and hold it there while surgery is taking place. This can sometimes be extremely difficult to impossible with currently available surgical hand instruments. While access to an internal organ/tissue may be accomplished by adding an alternative trocar access location to the patient, this option is often less than desirable, and sometimes not a realistic option. 
     The present disclosure is directed toward overcoming one or more of the problems set forth above. 
     SUMMARY OF THE DISCLOSURE 
     In one aspect, a surgical hand instrument includes a pair of handles attached to a hub. The pair of handles includes a left handle pivotable relative to a right handle between a spread configuration and a contracted configuration. An elongate hollow shaft is attached to the hub. An end effector is movable between a first configuration and a second configuration. An articulation segment is attached at opposite ends to the elongate hollow shaft and the end effector, respectively. An articulation actuator is positioned between the pair of handles, and operably connected to the articulation segment by a left turn cable and a right turn cable. The end effector is operably coupled to the pair of handles by an effector cable, such that the end effector moves between the first and second configurations responsive to the pair of handles moving between the spread and contracted configurations. The end effector has a cross sectional dimension equal to, or less than, an outer diameter of the elongate hollow shaft in the second configuration, but the cross sectional dimension is greater than the outer diameter of the elongate shaft in the first configuration. A pair of meshed gear sections of the articulation segment rotates with respect to each other to articulate the end effector relative to the elongate hollow shaft responsive to movement of the articulation actuator. 
     In another aspect, a surgical instrument assembly includes the surgical hand instrument extending through a trocar. 
     In still another aspect, a method of operating a surgical hand instrument includes moving an end effector through a trocar while the end effector is in a second configuration. The surgical hand instrument is rotated about a trocar axis. The end effector is articulated relative to an elongate hollow shaft responsive to movement of an articulation actuator, a left turn cable and a right turn cable. The end effector is moved from a second configuration to a first configuration responsive to pivoting a left handle relative to a right handle, and moving an end effector cable. The surgical hand instrument is repositioned relative to the trocar. The end effector is moved from the first configuration to the second configuration. The step of articulating the end effector includes rotating a pair of meshed gear sections of an articulation segment relative to each other. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a side view of a surgical instrument assembly according to the present disclosure; 
         FIG. 2  is a side view of the surgical instrument assembly of  FIG. 1 , except showing the end effector articulated at an angle; 
         FIG. 3  is a side view of the surgical instrument assembly of  FIG. 1 , except showing the end effector in the second configuration; 
         FIG. 4  is a partial side schematic view of the surgical hand instrument according to the present disclosure; 
         FIG. 5  is a perspective view of the steering wheel articulation actuator with the turn cable mountings; 
         FIG. 6  is a side schematic view of the articulation segment and adjacent portions of a surgical hand instrument according to the present disclosure; 
         FIG. 7  is a partial perspective isometric view of surgical hand instrument, with the handle in a spread configuration; 
         FIG. 8  is a view similar to  FIG. 6  except showing the handle in the contracted configuration; 
         FIG. 9  is a partial side view of a surgical hand instrument in which the end effector is a pair of scissors; and 
         FIG. 10  is a partial side view of still another surgical hand instrument in which the end effector is a spreader. 
     
    
    
     DETAILED DESCRIPTION 
     Referring initially to  FIGS. 1-3 , a surgical instrument assembly  10  is shown with a surgical hand instrument  20  extending through a trocar  11 . Trocar  11  could be any suitable trocar available that includes a central cylindrical passage that extends along a trocar axis  12  for passing surgical hand instruments, laparoscopes and the like into a patient body cavity (not shown). Surgical hand instrument  20  includes a pair of handles  30  pivotally attached to a hub  21 . The pair of handles  30  includes a left handle  31  and a right handle  32  that are pivotable relative to each other between a spread configuration  34  ( FIGS. 1-2 ) and a contracted configuration  33  as shown in  FIG. 3 . The surgical hand instrument  20  includes an end effector  70  separated from an elongated hollow shaft  40  by an articulation segment  50 . The opposite end of elongate hollow shaft  40  is attached to hub  21 . Articulation segment  50  is attached at opposite ends  51 ,  52  to the elongate hollow shaft  40  and the end effector  70 , respectively. End effector  70 , which is shown as a clamp  76 , is movable between a first configuration  71  as shown in  FIGS. 1 and 2 , and a second configuration  72  as shown in  FIG. 3 . An articulation actuator  60  is positioned between the pair of handles  30  and operably connected to the articulation segment  50  by left and right turn cables that are discussed infra. The end effector  70  is operably coupled to the pair of handles  30  by an effector cable (discussed infra) such that the end effector  70  moves between the first and second configurations  71 ,  72  responsive to the pair of handles  30  moving between the spread and contracted configurations  34 ,  33 . The end effector  70  has a cross sectional dimension  74  that is equal to, or less than, an outer diameter  42  of the elongate hollow shaft  40  in the second configuration  72  ( FIG. 3 ). The cross sectional dimension  74  is greater than the outer diameter  42  of the elongate hollow shaft  40  in the first configuration  71  ( FIGS. 1 and 2 ). A pair of meshed gear sections  53  of the articulation segment  50  rotate with respect to each other to articulate the end effector  70  relative to the elongate hollow shaft  40  responsive to movement of the articulation actuator  60 . As used in this disclosure, articulate and articulation mean a flexible joint between an end effector and an elongate hollow shaft. 
     Although surgical hand instrument  20  could be constructed to have a pistol grip handle configuration typical in some laparoscopic instruments, the illustrated embodiment has a structure where the left handle  31  and the right handle  32  are located on opposite sides of a plane  80  that contains centerline  41  of the elongate hollow shaft  40 . Those skilled in the art will appreciate that other handle configurations relative to the elongate shaft  40  of the surgical hand instrument  20  would also fall within the intended scope of the present disclosure. 
     In the illustrated embodiment of the surgical hand instrument  20 , the articulation actuator  60  takes the form of a steering wheel  63  that is rotatable about a steering axis  64 . Nevertheless, those skilled in the art will appreciate that structures other than a steering wheel  63  could be utilized in order to actuate the articulation feature of the surgical hand instrument  20 . In the illustrated embodiment, steering axis  64  is intersected by, and perpendicular to, the centerline  41  of hollow shaft  40 . Nevertheless, those skilled in the art appreciate that the orientation of steering axis  64  could be different without departing from the intended scope of the present disclosure. 
     Although not necessary, surgical hand instrument  20  may include a ratchet  90  that is operably coupled to lock the pair of handles to prevent the handles from pivoting toward the spread configuration  34 . This feature might be more desirable depending upon a chosen end effector  70 , with the ratchet  90  being particularly useful when end effector  70  takes the form of a clamp  76 . A release  91  may be operably coupled to disengage the ratchet  90  to permit the pair of handles to pivot toward the spread configuration  34 . In the present illustration, ratchet  90  takes the form of two separate toothed extensions extending from the respective left handle  31  and right handle  32 . The extensions include opposing teeth that interact and catch on one another in a manner well known in the art. Release  91  may simply operate by flexing the extensions slightly apart to facilitate spreading of the pair of handles  30 . Nevertheless, those skilled in the art will appreciate that, if included, ratchet  90 , and possibly release  91  could take on other forms known in the art with regard to other surgical hand instruments. 
     Referring now in addition to  FIGS. 4-8 , articulation actuator  60 , which in the illustrated embodiment is a steering wheel  63 , is operably coupled to articulate an effector  70  by left turn cable  61  and a right turn cable  62 . One end of left turn table  61  is fixed to end effector  70  and extends around the left hand side of articulation segment  50 , wraps counterclockwise around capstan  65  ( FIG. 5 ) then to the left side of steering axis  64 , and terminates at its opposite end at a mounting in steering wheel  63 . During assembly, the terminal end of left turn cable  61  may extend out of through hole  68  in steering wheel  63 . Proper tension may be set and held with a set screw  66 , and the excess cable beyond through hole  68  may be cut off. In this way, when steering wheel  63  is rotated in a counter clockwise direction  81 , left turn cable  61  increases in tension and this forces the first gear section  54  of the pair of meshed gear sections  53  to rotate in a counterclockwise direction  81  on second gear section  55 . In a mirrored fashion, the right hand turned cable  62  has one end affixed to end effector  70 , has a middle section that extends around the right hand side of articulation segment  50 , down through elongate hollow shaft  40 , wraps clockwise around capstan  65 , then to the right hand side of steering axis  64  to a mounting location in steering wheel  63 . During assembly, excess cable may extend out of through hole  69  while proper tensioning is set with set screw  67 . The excess cable may then be cut off and discarded. Thus, when steering wheel  63  is rotated in a clockwise direction  82 , tension in right turn table  62  is increased, causing first gear section  54  to rotate in a clockwise direction on second gear section  55  to articulate end effector  70  with respect to elongate hollow shaft  40  in a right hand direction as shown in  FIG. 5 . 
     By fixing first gear section  54  with regard to end effector  70 , and fixing second gear section  55  with respect to the elongate hollow shaft  40 , a centerline  56  of the articulation segment  50  will be at respective angles  58  and  59  with respect to the elongate hollow shaft  40  and the end effector  70  as best shown in  FIG. 2 . Both of the respective angles  58  and  59  will be greater than zero when the end effector  70  is articulated in either direction away from the straight configuration shown in  FIG. 3 . Although each of the gear sections  54  and  55  are shown as having equal radii  57 , those skilled in the art will appreciate that different radii could be utilized without departing from the present disclosure. Those skilled in the art will recognize that angles  58  and  59  will be equal when gear sections  54  and  55  have equal radii  57  as shown, but be different when the radii are different. 
     As best shown in  FIG. 5 , when end effector  70  is in the form of a clamp  76 , a biasing spring  75  may be operably positioned to bias the movable jaw  96  away from fixed jaw  95 . Jaws  96  and  95  may be closed by pivoting the pair of handles  30  from their spread configuration  34  to the contracted configuration  33 . This may be accomplished by utilizing an effector cable  73  that has one end attached to movable jaw  96  and its opposite end attached to a pull rod  43 . The middle section of effector cable  73  extends through fixed jaw  95 , through articulation segment  50  and down through elongate hollow shaft  40 . Handles  31  and  32  may be coupled to pull rod  43  via struts  45 ,  46 ,  47  and  48 . A pin  49  may connect the end of the struts  45 - 48  to the end of pull rod  43  remote from its connection to effector cable  73 . In this way, pivotal motion of handles  31  and  32  is transformed into linear motion of pull rod  43  in order to increase tension in effector cable  73  to move end effector  70  from its first configuration toward its second configuration against the action biasing spring  75 . Although not necessary, an additional biasing spring may be located between handles  31  and  32  to bias them toward either the contracted configuration  33  or the spread configuration  34  as desired. 
     When end effector  70  takes the form of a clamp  76 , as shown, the respective fixed jaw  95  and movable jaw  96  may be equipped with gripping features to better enable the device to gain purchase on internal body tissues and/or organs. The fixed jaw  95  and movable jaw  96  may include a plurality of pyramid shaped teeth  77  that are received in pyramid shaped indentations  78  when the clamp  76  is in its second configuration  72 . In the illustrated embodiment, both the fixed jaw  95  and the movable jaw  96  include counterpart pyramid shaped teeth  77  and pyramid shaped indentations  78  as best shown in  FIG. 6 . 
     So that surgical hand instrument  20  might be operated by a user with one hand, the steering wheel  63  may be sized and positioned as shown so that the operators thumb could rotate steering wheel  63  simultaneously with movement of handles  31  and  32 . This may be accomplished by mounting steering axis  64  between a pair of hub extensions  22 , and shaping each of the handles  31  and  32  to define a slot  35  that may receive a portion of steering wheel  63 , as best shown in  FIGS. 7 and 8 . Thus, the steering axis  64  remains fixed with regard to hub  21  regardless of the positioning of the pair of handles  30 , and allows for independent operation of the articulation feature separate from opening and closure of the end effector  70 . 
     Although surgical hand instrument  20  has been illustrated as including an end effector  70  in the form of a clamp  76 ,  FIGS. 8 and 9  show alternative end effector strategies.  FIG. 9  shows an end effector  70  in the form of scissors  94 . Those skilled in the art will appreciate that the effector cable  73  for the embodiment shown in  FIG. 9  would be much the same as the set up shown for the clamp  76  of the embodiment shown in  FIGS. 1-8 .  FIG. 10  shows an alternative end effector  70  in the form of a spreader  93 . In such a case, those skilled in the art will appreciate that the end effector cable would be connected in a reversed configuration so that movement of the pair of handles from the spread configuration  34  toward the contracted configuration  33  would result in the spreader  93  moving toward a first configuration. Reconfiguring end effector cable  73  to facilitate this action should be well within ordinary skill in the art and need not be taught here. In either case, no matter what end effector  70  is chosen, and others apart from scissors, clamps and spreaders would also fall within the intended scope of the present disclosure, all versions would include the articulation feature that utilizes a pair of meshed gears  53  as described earlier. 
     In all cases, the surgical hand instrument  20  will have a proximal pair of handles  30  with which the user will interact, and a distal end with an end effector  70  that manipulates the patient&#39;s tissue. Between the handles  30  and the elongate shaft  40  is a hub  21 , off of which the various input features are mounted. These include plier like handles  31  and  32  that are used to actuate the grasper jaws  95  and  96  of clamp  76 . The centralized steering wheel  64  is used to actuate the articulation feature to pivot the end effector  70  relative to the centerline  41  of elongate hollow shaft  40 . The cables  61 ,  62 ,  73  running through the elongate hollow shaft  40  are utilized to transmit forces to the articulation actuator  60  for the articulation segment  50  as well as the end effector  70 . The end effector  70  components, and the elongate hollow shaft  40  may be manufactured from a strong, biocompatible metal, or any other material suitable and known in the art. The pair of handles  30  may be manufactured from a strong biocompatible polymer or a biocompatible metal or any other suitable material. The high stress pieces such as axles and fasteners may be made from a suitable metal. As the surgical hand instrument  20  is being assembled, the flexible cable material of effector cable  73 , left turn cable  61  and right turn cable  62  may all be made from multi-strand, stainless steel or wire rope that is laced through the device and anchored with proper tension. 
     INDUSTRIAL APPLICABILITY 
     The present disclosure is generally applicable to surgical hand instruments. The surgical hand instrument  20  of the present disclosure is specifically applicable to laparoscopic procedures where the surgeon will need to get access to an internal tissue/organ, manipulate it into a given position and hold the tissue in place while surgery is taking place. Thus, the surgical hand instrument  20  of the present disclosure is specifically applicable to a device that could be passed through another device, such as a trocar  11 , to perform any of the wide variety of surgical procedures known in the art and to become known. 
     In a typical procedure, the surgical hand instrument  20  will be first configured with the end effector  70  in its second configuration  72  as shown in  FIG. 3 . At this point, the end effector  70  may be moved through a trocar  10  while the end effector  70  has a cross sectional dimension  74  that is equal to or less than an outer diameter  42  of elongate hollow shaft  40 . The operator may then rotate surgical hand instrument  20  about a trocar axis  12 , which may be coincident with the axis  41  of elongate hollow shaft  40 . This may allow the user to orient the articulation axis, which is parallel to the central axes of the meshed gear sections  53 . The end effector  70  may then be articulated relative to the elongate hollow shaft  40  responsive to movement of the articulation actuator  60 , the left turn cable  61  and the right turn cable  62 . Next, the user may move the end effector  70  from the second configuration  72  to the first configuration  71  for grasping an organ or tissue responsive to pivoting the left handle  31  relative to the right handle  32  and moving the effector cable  73 . With the tissue or organ thus grasped, the surgical hand instrument  20  may then be repositioned relative to trocar  10  by further movement along trocar axis  11 . Before or after this repositioning, the end effector  70  may be moved from the first configuration  71  to the second configuration  72  to grasp the tissue or organ and hold the same in place. Those skilled in the art will appreciate that when the end effector  70  is articulated, the pair of meshed gears section  53  of the articulation segment  50  will rotate relative to each other. If equipped, the position of the end effector  70  may be locked with ratchet  90 . The ratchet  90  of the present disclosure may be useful in maintaining a grasping force on the tissue or organ in question. In addition, an external fixturing device (not shown) may be utilized while the user performs other aspects of the surgical procedure. The ratchet  90  may then be unlocked by actuating release  91  and hence the position of end effector  70 . 
     It should be understood that the above description is intended for illustrative purposes only, and is not intended to limit the scope of the present disclosure in any way. Thus, those skilled in the art will appreciate that other aspects of the disclosure can be obtained from a study of the drawings, the disclosure and the appended claims.