Abstract:
An articulating surgical instrument for laparoscopic, endoscopic, and natural orifice translumenal endoscopic surgical procedures consisting of a separable combination of a reusable operational handpiece section and a separable reusable or disposable articulation section. The handpiece section which remains external to the patient incorporates various control and command devices and assemblies, while the articulation section is composed of various linkages, rods, and cables which transmit positioning and operating commands from the handpiece to end effectors positioned at the distal tip of the articulation section within the patient. Improved positioning and operating configurations for the end effectors suitable for the invention as well as the general class of these instruments are also disclosed.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is based on the disclosure of Provisional Application Ser. No. 61/271,765 filed Jul. 27, 2009 which is hereby incorporated by reference. 
     
    
     BACKGROUND OF THE INVENTION 
       [0002]    1. Field of the Invention 
         [0003]    The invention resides in the field of surgical apparatus and more particularly relates to instruments for performing laparoscopic, endoscopic, and natural orifice translumenal endoscopic surgery. 
         [0004]    2. Description of the Prior Art 
         [0005]    Devices of the type to which the invention is directed are well known in the prior art. Generally classed as laparoscopic or endoscopic surgical instruments, their purpose is to perform surgical procedures within the body through relatively small incisions which allow the insertion of small surgical tools or end effectors mounted on elongated shafts which are manipulated or articulated to position the surgical tool and then are further operated to achieve the desired surgical procedure. The articulation, positioning and activation of the tools are all controlled by a corresponding handpiece located outside the body. 
         [0006]    Illumination and viewing of the internal surgical site is accomplished by, for example, an additional device of the same general type employing a light source and miniature-imaging device such as a TV camera. 
         [0007]    In contrast to the prior art, the present invention provides improved devices and assemblies for operating an end effecter, rotating the end effecter about the longitudinal axis of the articulation portion of the instrument, as well as for a control and operation system for articulating or bending the tip of the articulation portion and an attached end effecter. 
         [0008]    The handpiece and articulation sections may also be separable in order to prolong the life of one or the other components of the instrument, to use multiple articulation sections with different end effecters with a single handpiece, and to provide for the prevention of reuse of a particular articulation portion or section. 
         [0009]    Examples of prior art instruments which are illustrative of and relate to the invention are shown in U.S. Pat. Nos. 5,454,827, Aust et al., a distal tip articulation mechanism; 5,578,052, Koros et al., a separable handpiece and articulation section; and 5,860,995, Berkelaar, an end effecter articulation assembly. 
       SUMMARY OF THE INVENTION 
       [0010]    The invention may be summarized as a laparoscopic surgical instrument composed of an operational handpiece and an elongated articulation section having a flexible bending portion. These two components may be permanently connected, or separate and connectable. The mechanism joining the two components may optionally include an arrangement for preventing reuse of the articulation section by, for example, destroying or altering a portion of the connecting linkage to preclude the possibility of reconnection. 
         [0011]    The handpiece contains the control mechanisms for positioning and operating a surgical tool or end effector disposed at the tip of the articulation section. These controls may include a knob or lever for rotating a flexible link or rod connected to the end effecter for rotating the end effecter, means to laterally move the same or an additional link to activate the end effector, such as a scissors, and hand or motor operated means to simultaneously pull and release appropriate cable or wire connections to the bending portion to alter or articulate its position or orientation to any point within a spherical space along the longitudinal axis of the instrument. 
         [0012]    Electronic controls for achieving the articulation of the bending portion through the use of motor driven gear assemblies are also disclosed. 
         [0013]    The articulation section, in general, an elongated hollow shaft with a flexible bending portion, contains the above mentioned wires, links, and/or rods as well as suitable protective sheaths or coverings. The shaft, providing the main support structure for the end effecter, may be comprised in part of a series of segments or links which will move in relation to one another to produce the articulation. 
         [0014]    These and other features and advantages of the invention will be more fully understood from the following description of the preferred embodiment in conjunction with the accompanying drawings. 
     
    
     
       DESCRIPTION OF THE DRAWINGS 
         [0015]      FIG. 1  is a perspective frontal (distal) view of the preferred embodiment of the invention; 
           [0016]      FIG. 2  is a perspective rear (proximal) view of the preferred embodiment of the invention; 
           [0017]      FIG. 3  is a perspective frontal view of a separated portion of the embodiment of  FIG. 1 ; 
           [0018]      FIG. 4  is a perspective frontal view of an additional separated portion of the embodiment of  FIG. 1 ; 
           [0019]      FIG. 5  is a cross-sectional view of a portion of  FIG. 2  along line A-A; 
           [0020]      FIG. 6  is a side view of a component of  FIG. 1 ; 
           [0021]      FIG. 7  is a partial cross-sectional view of the component of  FIG. 6 ; 
           [0022]      FIG. 8  is a perspective view of a component of  FIG. 5 ; 
           [0023]      FIG. 9  is a perspective view of the component of  FIG. 5 ; 
           [0024]      FIG. 10  is a perspective detailed view of an internal assembly of a component of  FIG. 3 ; 
           [0025]      FIG. 11  is an exploded perspective view of a component of  FIG. 4 ; 
           [0026]      FIG. 12  is a side view of a component of  FIG. 11 ; 
           [0027]      FIG. 13  is a perspective view of a portion of the assembly of  FIG. 10 ; 
           [0028]      FIG. 14  is a side view of a portion of the assembly of  FIG. 10 ; 
           [0029]      FIG. 15  is a side view of a portion of the assembly of  FIG. 14 ; 
           [0030]      FIG. 16  is a detailed perspective view of the component of  FIG. 4 ; 
           [0031]      FIG. 17  is a perspective view of a component of  FIG. 9 ; and 
           [0032]      FIG. 18  is an additional perspective view of a portion of  FIG. 9   
       
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENT 
       [0033]      FIG. 1  is a perspective frontal view of the preferred embodiment of the laparoscopic instrument  10  of the invention for performing multiscopic surgery that is capable of holding, grasping, cutting, hooking, manipulating, burning, and coagulating tissue along a non linear trajectory. This instrument is a combination of an operational handpiece  12  and an articulation section  14 . A variety of different articulation sections and their associated end effectors are used to perform different surgical tasks. 
         [0034]    Handpiece  12  has an outer case  16  surrounding and supporting control mechanisms to be described in detail below, a trigger handle  18 , and an opposing finger grip  20 . Articulation section  14  consists of an elongated hollow shaft  22 , a flexible bending portion  24 , and joining nut  26  for attaching handpiece  12  and articulation section  14 . An end effecter or surgical tool is attached or mounted on tip  24 . 
         [0035]      FIG. 2  is a rearward or proximal view of the instrument of  FIG. 1  further showing an articulation control backplate  30  mounted on case  16  for controlling the position or orientation of bending portion  24 . A rotary thumb actuator  32  for rotating end effecter  28  is also mounted on case  16  in conjunction with backplate  30 . An electrical connection post  34  for enabling cauterization procedures is further positioned atop case  16 . 
         [0036]      FIGS. 3 and 4  illustrate handpiece  12  and articulation section  14  separated from one another.  FIGS. 1-4  above present an overview of the general configuration of the invention, the components and operation of which will now be described in accordance with  FIGS. 5-18  in more particular detail as follows. 
         [0037]      FIG. 5  shows, in cross-sectional format, the components and control assembly which provide for the axis rotation of articulation section  14 , more specifically, a selected end effecter  28  disposed at the distal tip of bending portion  24  as indicated by motion arrow  29 . This is accomplished by the rotation of pushrod  36  disposed in shaft  22  as controlled or moved by thumb actuator  32  mounted on handpiece  12 . 
         [0038]    Pushrod  36  is cylindrical with a non-round shaped tip that is pushed through the center of the teeth  38  that are mounted on lock assembly  40  disposed in handpiece  12 . Pushrod  36  is aligned with the center of teeth  38  of the lock assembly and extends through the center of the assembly. Pushrod  36  continues further until it engages and is positioned inside rotary thumb actuator  32  where it mechanically mates against a non-round inside wall. Pushrod  36  does not bottom out against the proximal end of actuator  32 . Instead, it is allowed clearance to slide back and forth axially inside actuator  32 . The total linear distance in which pushrod  36  can slide is determined by the travel needs of bending portion  24  as it bends from a straight line to its maximum deflected position. Also compensated for is the travel distance of end effecter  28  as it opens and closes as or if required. Both events are able to occur simultaneously. Rotary thumb actuator  32  is fixed to the control backplate  30 . Actuator  32  rotates radially about the center axis but is fixed in position axially to backplate  30  and does not move forward or backward. 
         [0039]    As shown in  FIGS. 6 and 7 , the proximal end  42  of pushrod  36 , which fits within handpiece  12  and is of a larger diameter than the much longer distal portion, has a cylindrical notch  44 . The backside of notch  44  engages the front side of teeth  38  mounted on lock assembly  40  by locator screws  46 . Teeth  38  provide a clamping force against pushrod segment  42  within notch  44  thereby keeping the entire pushrod fixed within lock assembly  40 . 
         [0040]    Therefore, when rotary thumb actuator  32  is turned in either radial direction, end effecter  28  mounted on pushrod endplate  47  will turn in compliance with the rotation of the actuator. Actuator  32  thereby drives the rotation of end effecter using by way of pushrod  36 . 
         [0041]    As described above, flexible metal teeth  38 , as shown in perspective in  FIG. 8 , are secured to lock assembly  40  with two locator screws  46 , one for each tooth. Lock assembly  40  travels forward and in reverse and is controlled by the trigger handle  18  closing against finger grip  20 . The front side of each tooth pushes against the backside of the cylindrical notch and drives the pushrod forward. End effecter  28  then closes. When the trigger handle  18  is pulled in the opposite direction away from the finger grip  20 , lock assembly  40  travels in reverse, the opposite side of notch  44  is pushed, and end effecter opens  28 . 
         [0042]    As shown in  FIG. 7 , the backsides of the teeth are also beveled to allow the disengagement of the pushrod when handpiece  12  and articulation section  14  are separated. The cylindrical nature of notch  44  allows pushrod  36  to be rotated radially while simultaneously fixing it into position axially. 
         [0043]    As further illustrated by  FIG. 9 , lock assembly  40  is shuttled forward and in reverse, proximally and distally, as indicated by arrow  45 , by the action, arrow  51 , of trigger handle  18 . Lock assembly  40  also travels axially over the distal portion of rotary actuator  32 , using the rotary actuator as a guide. Lock assembly  40  is also connected to trigger  18  by means of two outboard pins  49  (one not shown) that may be a molded feature of assembly  40 . Trigger  18  is further connected to handpiece  12  on swing pivots  50 . The swing pivot is a molded feature of the handpiece  12 . Engagement slots  52  in trigger handle  18  receive the outboard pins  49 . When the trigger handle  18  is moved, outboard pins  49  impart the driving force to move lock assembly  40 . Engagement slots  52  allow the required clearance necessary for the arc travel of trigger handle  18  without binding against assembly  40 . The user places their thumb into the ring of trigger handle  18  and their fingers into the ring of finger grip  20 . Closing the hand provides the force to shuttle the lock assembly  40  back and forth thereby manipulating end effecter  28 . 
         [0044]    The positioning of an end effecter at a desired orientation at a surgical site within the body can be provided by articulation and in this instrument is achieved by the use of four cables extending from the handpiece to the distal end of the bending portion where they are attached in an orthogonal array such that by withdrawing one cable toward the proximal end and simultaneously releasing it&#39;s corresponding opposite cable disposed directly across from the cable being withdrawn, the end effecter will move up or down, left or right, and toward or away from the surgeon depending upon which cable pair is selected for manipulation. This may be carried out manually by, for example, thumbwheel devices or preferably as described below by a motorized system using driving motors, appropriate gear systems and a hand operated control to select the desired angle and amount of articulation. 
         [0045]    Referring to  FIG. 10 , there are two sets of two rotatable motion motor gears  54  mounted on motor gear frame  55  which drive two sets of associated linear motion gear rack pairs  56   a  and  56   b  and  58   a  and  58   b  all of which are mounted inside handpiece  12 . When used in combination they cause articulation up and down and also articulation left and right. The resultant motion of articulation is not limited to up, down, left or right. The hand operated control, as indicated by control backplate directional arrows  60 , allows for any angle between these positions. In this instrument the two motors convert rotary motion to linear motion using the gear drive that causes the end effecters to travel in a circular trajectory. 
         [0046]    Two reversible motors  62 , one each for manipulating each pair of opposing articulating cables, are wired to backplate  30  and installed in handpiece  12 . Backplate  30  is mounted onto the back of handpiece  12  and is marked with the backplate directional arrows  60  that indicate direction of articulation. Each opposing arrow operates a switch that in turn activates one or the other of the motors in the appropriate direction as indicated by arrows  63 . Backplate  30  is also wired to a remote motor power supply (not shown) that may be controlled by foot pedals set on the floor of an operating room and within easy reach of the surgeon. 
         [0047]    When pressure is applied to any arrow  60  on backplate  30 , the corresponding motor gear turns in the corresponding direction. The appropriate gear rack will move either forward or in reverse, arrows  65 ,  FIG. 13 , depending upon which arrow is pressed. As a gear rack moves forward, it&#39;s opposite corresponding gear rack moves in the opposite direction, the motor gear teeth meshing with the gear rack teeth. When not energized, the motors are used as a positive locking mechanism for the entire assembly, that is, at rest, the gear racks cannot move. 
         [0048]    As shown in  FIGS. 13 and 14 , the distal ends of the gear racks are connected to connector pins  64 . Connector pins  64  are shaped in a specific way that allows them to easily release away from opposing mating connector clips  66 ,  FIG. 12 , which are located in articulator section  14  shown in  FIG. 16   
         [0049]    Articulator section  14  connects to handpiece  12  to form the complete multiscopic surgical instrument. Articulator section includes two sets of opposing cable assemblies and a selected end effecter of choice. Each cable assembly  68 ,  FIG. 11 , is further comprised of a cable  70  assembled to a connector housing  72  by means of a crimp connector  74  which in turn is snapped onto a connector clip  66 . Cable guides  76  and  78  are shown in  FIG. 16 . The two cable sets are paired and are arranged for articulation of bending portion  24  up and down and left and right. When a directional arrow  60  on control backplate  30  is pushed thereby activating one of the appropriate motors  62 , a gear rack pulls on its mating cable assembly while the opposite mating cable assembly is released by the opposite gear rack to travel in the opposite direction.  FIG. 15  shows the attachment of opposing cables  70  to the distal end of bending section  24 . 
         [0050]    Articulation section  14  may be composed of a linked together plurality of individual segments  80  each having two sets of orthogonal ports  82  serving as cable guides, a section of which is shown in  FIGS. 17 and 18 . 
         [0051]    When connecting articulator section  14  to handpiece  12 , the first contact is made by pushrod  36  which extends beyond the base of the articulation section  14  bottom by a length that is long enough to snap the pushrod notch  44  against teeth  38  of the lock assembly  40 . As pushrod  36  enters the center of lock assembly  40 &#39;s teeth set, the four connector clips  66  simultaneously snap and lock onto the four connector pins  64 . Pushrod  36  is longer than the extension of the connector clips  66  and enters handpiece  12  and the lock assembly before connector clips  66  are snapped into the four connector pins  64 . 
         [0052]    Articulation section  14  includes a trocar adapter  84  which engages and locks against handpiece  12 . Compression springs  86  apply pressure against connector pins  64 . The spring force ensures simultaneous constant pressure against all four of the Connector Pins allowing for simultaneous connection of the four connector pins to the four connector clips and additionally provides for slack removal. Articulation section  14  is finally securely joined to handpiece  12  by Nut  26 . 
         [0053]    To separate articulation section  14  and handpiece  12 , nut  26  is unscrewed. As the nut is being unscrewed, the back wall of the nut presses against the back wall of trocar adapter  84  causing the two components, articulator section  14  and handpiece  12  to separate. The clips  66  in the articulation section are pulled at the same time but are stopped by the length of the cable. The continued travel of articulation section  14  causes the right angle clip extension  88  on the clip  66  to go past its yield point and straighten out. In this straightened condition, the four clips  66  cannot be used a second time and thereby rendering articulation section  14  unusable for continued use. 
         [0054]    The scope of the invention is hereby defined by the following claims.