Patent Publication Number: US-11653989-B2

Title: Surgical instrument apparatus, actuator, and drive

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     The present application is a Continuation Application claiming the benefit of and priority to U.S. patent application Ser. No. 17/859,276, filed on Jul. 7, 2022, which is a Continuation Application claiming the benefit of and priority to U.S. patent application Ser. No. 17/511,658, filed on Oct. 27, 2021, now U.S. Pat. No. 11,382,708, which is a Continuation Application claiming the benefit of and priority to U.S. patent application Ser. No. 17/406,147, filed on Aug. 19, 2021, which is a Continuation Application claiming the benefit of and priority to U.S. patent application Ser. No. 16/427,164, filed on May 30, 2019, now U.S. Pat. No. 11,123,146, the entire content of each of which being incorporated herein by reference. 
    
    
     TECHNICAL FIELD 
     This disclosure relates generally to a surgical instrument apparatus for performing a surgical procedure within a body cavity of a patient. 
     DESCRIPTION OF RELATED ART 
     Surgical instruments used in laparoscopic and/or robotic surgery generally have a proximally located actuator that may be used to actuate a distal end effector for performing a surgical task within a body cavity of a patient. Such instruments may be used in applications where there is an area of limited access for an operator. The distal end of the instrument may be inserted into the area of limited access and the operator may remotely manipulate the instrument via the actuator. The actuator may be located outside the area of limited access, but there may still be constraints placed on the extents of the actuator. There remains a need for actuators and drivers that are suitable for laparoscopic and/or robotic instruments. 
     SUMMARY 
     In accordance with one disclosed aspect there is provided a surgical instrument apparatus for performing a surgical procedure within a body cavity of a patient. The apparatus can include an elongate manipulator with a distal end configured to receive an end effector and including a plurality of control links extending through the manipulator and configured to cause movement of the distal end of the manipulator in response to movement of the control links in a longitudinal direction generally aligned with a length of the manipulator. The apparatus can also include an actuator chassis disposed at a proximal end of the manipulator, the actuator chassis including a plurality of actuators slidingly mounted within the actuator chassis and configured to move linearly in a direction aligned with the longitudinal direction, each actuator being coupled to one of the control links. The actuators are adjacently disposed about a curved periphery of the actuator chassis and including an outwardly oriented portion configured to couple a drive force to the actuator to cause movement of the control link. 
     The curved periphery of the actuator chassis may be cylindrically shaped and the plurality of actuators may be mounted within slots extending longitudinally along the periphery and radially arranged about the periphery. 
     The actuator chassis periphery may include a curved portion and a flat portion and the plurality of actuators may be mounted within slots extending longitudinally along the curved portion and radially arranged about the curved portion, the flat portion facilitating location of the surgical instrument apparatus adjacent (for example, closely adjacent) to another apparatus including a corresponding flat portion. 
     The another apparatus including the corresponding flat portion may include another of the surgical instrument apparatus and the respective flat portions may facilitate location of the respective elongate manipulators in proximity (for example, close proximity) for insertion through a common access port inserted or positioned to provide access to the body cavity of the patient. 
     The outwardly oriented portions of the plurality of actuators may be each shaped to engage a corresponding drive coupler configured to couple the drive force to the actuator. 
     The actuator coupling portion of the actuator may include a protrusion that extends outwardly beyond the curved periphery of the actuator chassis. 
     The apparatus may include a drive chassis including a respective plurality of drive couplers configured to couple drive forces to the plurality of actuators, the drive couplers arranged about the periphery of the actuator chassis, each drive coupler may include an open channel portion configured to receive the respective actuator protrusions when the actuator chassis is inserted into the drive chassis, and a retaining portion configured to receive and retain the respective actuator protrusions when the drive chassis and the actuator chassis are rotated thorough an angle to cause the retaining portions to engage the respective actuator protrusions. 
     The drive chassis may be configured to permit the manipulator to be inserted through the drive chassis to cause the open channel portions to receive the respective actuator protrusions. 
     The actuator chassis may include a transition portion between the manipulator and the actuator chassis, the transition portion configured to laterally displace the control links for coupling to the respective actuators. 
     The manipulator may include at least one end effector control link configured to couple to an end effector and the actuator chassis may include at least one end effector actuator coupled to the end effector control link to actuate movements of the end effector. 
     The at least one end effector actuator may be mounted within the actuator chassis to permit at least one of longitudinal movement configured to actuate opening or closing of an end effector, or rotational movement configured to cause a corresponding rotation of the end effector. 
     The at least one end effector actuator may include a single end effector actuator configured to perform both the longitudinal movement and the rotational movement. 
     The at least one end effector control link may be routed along a central bore of the actuator chassis and the end effector actuator may be mounted at a distal portion of the actuator chassis. 
     The manipulator may include a rigid portion connected to the actuator chassis, and an actuatable articulated portion configured to cause the movement of the distal end of the manipulator in response to the longitudinal movement of the control links. 
     The apparatus may include an unactuated articulated portion disposed between the rigid portion and the chassis, the unactuated articulated portion configured to permit the manipulator to be bent to reduce an overall length of the manipulator and actuator chassis during cleaning and sanitizing of the apparatus. 
     In accordance with another disclosed aspect there is provided a surgical instrument apparatus for performing a surgical procedure within a body cavity of a patient. The apparatus can include an elongate manipulator with a distal end configured to receive an end effector and including a plurality of control links extending through the manipulator and configured to cause movement of a distal end of the manipulator in response to movement of the control links in a longitudinal direction generally aligned with a length of the manipulator. The apparatus can also include an actuator chassis disposed at a proximal end of the manipulator, the actuator chassis including a plurality of actuators mounted within the actuator chassis, each actuator being coupled to one of the control links configured to couple a drive force to the actuator to cause movement of the control link. The proximate end of the manipulator can be laterally offset to facilitate location or positioning of the surgical instrument apparatus adjacent (such as, closely adjacent) to another surgical instrument apparatus for insertion or positioning through a common access port inserted to provide access to the body cavity of the patient. 
     The manipulator may include a rigid portion connected to the actuator chassis, and an actuatable articulated portion configured to cause the movement of the distal end of the manipulator in response to longitudinal movement of the control links. 
     The apparatus may include an unactuated articulated portion disposed between the rigid portion and the actuator chassis, the unactuated articulated portion configured to permit the manipulator to be bent to reduce an overall length of the manipulator and actuator chassis during cleaning and sanitizing of the apparatus. 
     The proximate end of the manipulator can be laterally offset to facilitate positioning of the surgical instrument adjacent to the another surgical instrument apparatus so that spacing between the manipulator and another manipulator of the another surgical instrument is between about 10 millimeters and about 35 millimeters. 
     In accordance with another disclosed aspect there is provided a surgical instrument apparatus for performing a surgical procedure within a body cavity of a patient. The apparatus can include an elongate manipulator with a distal end configured to receive an end effector and including a plurality of control links extending through the manipulator and configured to cause movement of a distal end of the manipulator in response to movement of the control links in a longitudinal direction generally aligned with a length of the manipulator. The apparatus can also include an actuator chassis disposed at a proximal end of the manipulator, the actuator chassis including a plurality of actuators mounted within the actuator chassis, each of the plurality of actuators being coupled to one of the control links configured to couple a drive force to the actuator to cause movement of the control link. The manipulator can include a rigid portion connected to the actuator chassis, and an actuatable articulated portion configured to cause the movement of the distal end of the manipulator in response to longitudinal movement of the control links. The apparatus can further include an unactuated articulated portion disposed between the rigid portion and the chassis, the unactuated articulated portion configured to permit the manipulator to be bent to reduce an overall length of the manipulator and actuator chassis during cleaning and sanitizing of the apparatus. 
     Other aspects and features will become apparent to those ordinarily skilled in the art upon review of the following description of specific disclosed embodiments in conjunction with the accompanying figures. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       In drawings which illustrate disclosed embodiments, 
         FIG.  1    is a perspective view of a surgical instrument apparatus for performing a surgical procedure within a body cavity of a patient; 
         FIG.  2    is a partially cut away perspective view of an actuator chassis of the surgical instrument apparatus shown in  FIG.  1   ; 
         FIG.  3 A  is a perspective view of an actuator of the actuator chassis shown in partial engagement with a drive coupler; 
         FIG.  3 B  is a perspective view of the actuator shown in full engagement with the drive coupler; 
         FIG.  4 A  is a perspective view of a drive chassis including a plurality of the drive couplers shown in  FIGS.  3 A and  3 B  and the actuator chassis of  FIG.  2    being inserted into the drive chassis; 
         FIG.  4 B  is a perspective view of the drive chassis of  FIG.  4 A  showing the actuator chassis in partial engagement with the drive chassis; 
         FIG.  4 C  is a perspective view of the drive chassis of  FIG.  4 B  showing the actuator chassis in full engagement with the drive chassis; 
         FIG.  5 A  is a perspective view of a surgical instrument apparatus in accordance with another embodiment; 
         FIG.  5 B  is a perspective view of a pair of the surgical instrument apparatus shown in  FIG.  5 A  disposed adjacently for insertion through a common access port; 
         FIG.  6    is a perspective view of a pair of surgical instruments disposed adjacently for insertion through a common access port operation in accordance with another embodiment; and 
         FIG.  7    is a perspective view a surgical instrument apparatus in accordance with another embodiment. 
     
    
    
     DETAILED DESCRIPTION 
     Referring to  FIG.  1   , a surgical instrument apparatus for performing a surgical procedure within a body cavity of a patient is shown generally at  100 . The apparatus  100  includes an elongate manipulator  102  having a distal end  104  for receiving an end effector  106 . The manipulator  102  includes a plurality of control links  108  extending through the manipulator. The plurality of control links  108  are operable to cause movement of the distal end  104  of the manipulator in response to movement of the control links in a longitudinal direction  110  generally aligned with a length of the manipulator. The apparatus  100  also includes an actuator chassis  120  disposed at a proximal end  112  of the manipulator  102 . The actuator chassis  120  includes a plurality of actuators  122  slidingly mounted within the actuator chassis for linear movement in a direction aligned with the longitudinal direction  110 . In the embodiment shown, the actuators  122  are adjacently mounted within respective slots  124  disposed on a curved periphery  126  of the actuator chassis  120 . 
     In the embodiment shown, the manipulator  102  includes a rigid portion  114  connected to the actuator chassis  120  and an articulated portion  116  that is actuatable to cause the movement of the distal end  104  of the manipulator in response to the longitudinal movement of the control links  108 . The articulated portion  116  includes a plurality of coupled guides  118  mounted end-to-end and operable to move in response to pulling or pushing of the plurality of control links  108  as described in commonly owned PCT patent publication WO2014/201538 entitled “ARTICULATED TOOL POSITIONER AND SYSTEM EMPLOYING SAME” filed on Dec. 20, 2013 and incorporated herein by reference in its entirety. In other embodiments, the manipulator  102  may include structures other than the coupled guides  118  for causing movement of the distal end  104  of the manipulator. 
     Referring to  FIG.  2   , the proximal end  112  of the manipulator  102  and the actuator chassis  120  are shown with the actuator chassis partially cut away. In one embodiment, the plurality of control links  108  are implemented as wires routed through respective bores  200  extending through the manipulator  102 . The actuator chassis  120  has a transition portion  202  between the proximal end  112  of the manipulator  102  and the actuator chassis. In this embodiment the transition portion  202  includes a bulkhead  204  having openings  206  that cause the respective control links  108  to be laterally displaced toward the curved periphery  126  of the actuator chassis  120 . The transition portion  202  facilitates the movement of the control links  108  along their respective axes while preventing drift of the control links  108 . In one embodiment, the transition portion  202  may include curved conduit (not shown) extending between the proximal end  112  of the manipulator  102  and the bulkhead  204  for receiving and guiding control links  108  through the transition portion. Each actuator  122  is coupled to one of the control links  108 . The control links  108  may be implemented using nitinol wire, which is capable of bending through an arc while still transmitting force in tension or compression. Nitinol is an alloy of nickel and titanium having shape memory and superelasticity and is capable of transmitting forces of about 200N. In other embodiments, the control links  108  may be implemented using other commonly used wires such as stranded cables used in laparoscopic instruments. 
     One actuator  208  of the plurality of actuators  122  is shown displaced longitudinally within the slot  124 . The longitudinal displacement of the actuator  208  causes the coupled control link  108  to be correspondingly pulled rearwardly within the actuator chassis  120 . Other actuators  122  such as the adjacent actuators  210  and  212  are similarly moveable within the respective slots  124  to push or pull the associated control link  108 . In the embodiment shown, the curved periphery  126  of the actuator chassis  120  is cylindrically shaped and the slots  124  are radially arranged about the curved periphery. 
     Referring back to  FIG.  1   , in one embodiment pairs of the control links  108  are coupled to coupler segments  130 ,  132 , and  134 . Actuation of the control links  108  by the actuators  122  causes the coupled guides  118  between each of the coupler segments to be displaced laterally to cause the distal end  104  and the end effector  106  to be moved into a desired position and orientation. A portion of the coupler segment  132  is shown cut away in an insert  136 . In this embodiment a first pair  138 ,  140  of the plurality of control links  108  terminate within the coupler segment  132  and when the control link  138  is pushed by advancing the associated actuator  122  while the control link  140  is pulled by rearwardly retracting the associated actuator  122  within its slot, the coupler segment  132  is moved laterally. Similarly, a second pair  142 ,  144  of the plurality of control links  108  terminate within the coupler segment  132  and when the control link  142  is pushed by advancing the associated actuator  122  within its slot while the control link  144  is pulled by rearwardly retracting the associated actuator  122  within its slot, the coupler segment  132  is moved vertically upward. Reversal of the pushing and pulling of the respective actuators  122  causes a respective lateral movement to the opposite side or downward movement. 
     In another embodiment, the first pair  138 ,  140  of the plurality of control links  108  may be respectively used for pulling motions without a corresponding pushing motion. In this embodiment when the control link  140  is pulled by rearwardly retracting the associated actuator  122  within its slot (while the control link  138  is let out by a corresponding amount, such as, for example, by advancing the associated actuator  122  or by allowing the actuator  122  to feely float), the coupler segment  132  is moved laterally. Similarly, in another embodiment, for the second pair  142 ,  144  of the plurality of control links  108  when the control link  144  is pulled by rearwardly retracting the associated actuator  122  within its slot (while the control link  142  is let out by a corresponding amount, such as, for example, by advancing the associated actuator  122  or by allowing the actuator  122  to freely float), the coupler segment  132  is moved vertically upward. Reversal of the pulling of the respective actuators  122  causes a respective lateral movement to the opposite side or downward movement. 
     Combinations of lateral and vertical movement will cause the  132  to move in any direction within a working volume of the manipulator  102 . The coupler segment  134  may be similarly moved via other pairs of control links  108  actuated by the respective actuators  122  to point in any direction within the working volume. Further as described in commonly owned PCT patent publication WO2014/201538, the coupled guides  118  between the rigid portion  114  and the coupler segment  130  and the coupled guides between the coupler segment  130  and the coupler segment  132  may be configured to maintain the orientation of the coupler segment  132  substantially the same as the rigid portion  114 . In this case, the guides  118  within these portions of the articulated portion  116  are constrained to move as a two-dimensional parallelogram by a set of wire links extending between the rigid portion  114  and the coupler segment  132 . 
     Still referring to  FIG.  1   , each of the actuators  122  includes an outwardly oriented portion  150  that facilitates coupling a drive force to the actuator to cause movement of the coupled control link. In this embodiment, the outwardly oriented portions  150  also protrude outwardly with respect to the curved periphery  126 . Referring to  FIG.  3 A , one of the actuators  122  is shown in isolation in engagement with a drive coupler  300 . The drive coupler  300  may be part of an instrument drive of a robotic surgery system (not shown). The drive coupler  300  includes a curved outer wall  302  and a first end wall  304  extending radially inwardly from the curved outer wall and defining an open channel  306  in the drive coupler. The open channel  306  is sized to receive the protruding portion  150  of the actuator  122  when slid into the drive coupler  300  in the direction indicated by the arrow  308  in  FIG.  3 A . Once received within the opening  306 , the drive coupler  300  is rotated in the direction of the arrow  310  to engage the outwardly oriented portion  150  of the actuator  122  as shown in  FIG.  3 B . 
     Referring to  FIG.  3 B , the drive coupler  300  further includes a second end wall  312  extending over the full length of the curved outer wall  302 . The outwardly oriented portion  150  of the actuator  122  is engaged between the first end wall  304  and the second end wall, which define a retaining portion for receiving and retaining the actuator protrusion  150  when the drive coupler  300  is rotated thorough an angle to cause the retaining portions to engage the actuator protrusion. Once the drive coupler  300  is engaged, a force F applied to the drive coupler  300  is transmitted to the outwardly oriented portion  150  to cause longitudinal motion of the actuator  122  within the associated slot  124 . 
     Referring to  FIG.  4 A , in the embodiment shown a plurality of the drive couplers  300  shown in  FIGS.  3 A and  3 B  are arranged to provide a drive chassis  400 . The drive couplers  300  are annularly arranged about the periphery  126  of the actuator chassis  120  with the open channels  306  aligned with the outwardly oriented portions  150  of the actuators  122 . The drive chassis  400  is configured to permit the manipulator  102  to be inserted through the drive chassis when loading the surgical instrument apparatus  100 . The open channels  306  of the drive couplers  300  receive the respective actuator protrusions  150  as shown in  FIG.  4 B . Referring to  FIG.  4 B , the drive chassis  400  and/or actuator chassis  120  is then rotated thorough an angle in a direction indicated by the arrow  402  to cause the retaining portions (i.e. first and second end walls  304  and  312 , shown in  FIGS.  3 A and  3 B ) to engage the respective actuator protrusions  150  as shown in  FIG.  4 C . Referring to  FIG.  4 C , once the drive couplers  300  are engaged, each drive coupler is able to independently move back and forward in the longitudinal direction  110  to couple drive forces to the respective actuators  122 . In one embodiment the drive chassis  400  is part of an instrument drive (not shown) that generates and couples individual drive forces to the respective drive couplers  300 . The instrument drive may be implemented as part of a robotic surgery system in which operator input received at an input device is used to generate drive signals, which are used to control the instrument drive for causing manipulation of the manipulator  102  via the drive chassis  400  and actuator chassis  120 . 
     In the embodiment shown in  FIG.  1   , eight actuators  122  and associated control links  108  are provided. Four of these actuators  122  cause movement of the coupler segment  132 , while the remaining four actuators cause movement of the coupler segment  134 . Referring back to  FIG.  2   , the manipulator  102  further includes a central bore  220  that in this embodiment accommodates an end effector control link  222 . The end effector control link  222  is coupled to the end effector  106  for causing opening of the actuator jaws and/or causing rotation of the actuator about a longitudinal axis of the manipulator  102 . The end effector control link  222  is routed through the actuator chassis  120  and coupled to an end cap  224  at a distal end of the actuator chassis. In one embodiment, the end cap  224  is able to rotate in the direction of the arrow  226 , which rotates the end effector control link  222  causing corresponding rotation of the end effector at the distal end  104  of the manipulator  102 . Additionally, the end cap  224  may also be configured to move in the longitudinal direction  110  to actuate longitudinal back and forth movement of the end effector control link  222  for opening and closing the end effector. The single end effector control link  222  may thus be operable to actuate both rotation and opening/closing movements of the end effector  106 . In other embodiments, the end effector control link  222  may be configured as a hollow torque tube that provides the rotational actuation to the end effector  106 , while an additional control link may be routed through the central bore  220  to actuate the opening and closing movements of the end effector  106 . 
     Referring to  FIG.  5 A , an actuator chassis in accordance with another embodiment is shown generally at  500 . The periphery of the actuator chassis  500  includes a curved portion  502  and a flat portion  504 . The actuator chassis  500  includes a plurality of actuators  506  configured generally as described above. The plurality of actuators  506  are mounted in respective slots  508  extending longitudinally along the curved portion  502  of the actuator chassis  500 . The actuators  506  are radially arranged about the curved portion  502  and the actuator chassis  500  is coupled to a manipulator  102  (shown in part) as generally described above. 
     In many cases two or more of the surgical instrument apparatus  100  may be used during a surgical procedure performed through a single common access port (i.e. a single incision or opening to a body cavity of a patient). Referring to  FIG.  5 B , the flat portion  504  of the actuator chassis  500  facilitates closely spacing the actuator adjacent to a second actuator chassis  510  having a corresponding flat portion  512 . The close spacing has the advantage of spacing the manipulator  102  and a manipulator  514  coupled to the actuator chassis  510  in relatively close proximity for insertion through a common access port and/or trocar (not shown). The spacing D between the manipulators may be less than about 10 millimeters, about 10 millimeters, about 20 millimeters, about 21.5 millimeters, about 35 millimeters, about 40 millimeters, or greater than about 35 millimeters or 40 millimeters, such as about 50 millimeters or 60 millimeters. The spacing D between the manipulators may be between about 10 millimeters (or less) and about 20 millimeters (or more), between about 10 millimeters (or less) and about 35 millimeters (or more), between about 10 millimeters (or less) and about 40 millimeters (or more), between about 20 millimeters (or less) and about 35 millimeters (or more), or between about 20 millimeters (or less) and about 40 millimeters (or more). The further off-center the manipulator  102  and the manipulator  514  are from the respective actuator chassis  500  and  510  such that the spacing D is reduced, the smaller the diameter of the common access port/trocar. Each of the actuator chassis  500  and the actuator chassis  510  would be received within a drive chassis (not shown) configured to accommodate and provide drive forces for operating the side-by-side surgical instruments. 
     Referring to  FIG.  6   , an alternative arrangement for side-by-side surgical instrument operation includes a first actuator chassis  600  disposed spaced apart from a second actuator chassis  602 . Each actuator chassis  600 ,  602  has a respective manipulator  604  and  606  coupled to the chassis. The manipulators  604  and  606  have respective actuatable articulated portions  608  and  610  configured generally as described above in connection with the  FIG.  1    embodiment. The manipulators  604  and  606  each have respective rigid portions  612  and  614 . The rigid portion  612  of the manipulator  604  has a leftward laterally offset portion  620  while the manipulator  606  has a rightward laterally offset portion  622 . The left and right laterally offset portions  620  and  622  facilitate closely adjacent location of the respective articulated portions  608  and  610  of the manipulators  604  and  606  for insertion through a common access port. 
     Referring to  FIG.  7   , a surgical instrument apparatus in accordance with another embodiment is shown generally at  700 . The surgical instrument apparatus  700  includes an actuator chassis  702  configured generally as disclosed above. The actuator chassis  702  is coupled to a manipulator  704  including a rigid portion  706  and an actuatable articulated portion  708  also configured generally as disclosed above. In this embodiment, the surgical instrument apparatus  700  further includes an articulated portion  712  disposed between the rigid portion  706  and the actuator chassis  702 . The articulated portion  712  permits the manipulator to be bent as shown in  FIG.  7    to reduce an overall length of the instrument (i.e. manipulator and actuator chassis). The articulated portion  712  may be actuated during a surgical procedure or may be a passive portion that is not actuated during the procedure. 
     In many cases the surgical instrument apparatus  700  may be reusable and cleaning and sanitization following use in a surgical procedure is thus required. The overall length of the surgical instrument apparatus  100  shown in  FIG.  1    may prohibit its accommodation within the conventional sanitization equipment. The articulated portion  712  facilitates bending of the instrument to reduce the overall dimensions that may make the instrument more readily accommodated in a decontamination sink or a chamber of a washer/disinfector commonly used for cleaning and sanitization in surgical environments. Additional bending to accommodate limited space constraints during cleaning and sanitization may be enabled by having the actuatable articulated portion  708  at least partially bendable/flexible during cleaning and sanitization (i.e. when not in surgical use). This additional bending and/or the bending of articulated portion  712  may be facilitated by may allowing the control links extending through the manipulator  704  to move into a relaxed state, for example by maneuvering the actuators (such as actuators  506  shown in  FIG.  5 A ). 
     Language of degree used herein, such as the terms “approximately,” “about,” “generally,” and “substantially” as used herein represent a value, amount, or characteristic close to the stated value, amount, or characteristic that still performs a desired function or achieves a desired result. For example, the terms “approximately”, “about”, “generally,” and “substantially” may refer to an amount that is within less than 10% of, within less than 5% of, within less than 1% of, within less than 0.1% of, or within less than 0.01% of the stated value. 
     While specific embodiments have been described and illustrated, such embodiments should be considered illustrative only and not as limiting the disclosed embodiments as construed in accordance with the accompanying claims.