Patent Description:
A variety of powered and unpowered surgical tools are used in performing robotic surgeries. Many surgical tools used in robotic procedures are similar or identical to those used manually by surgeons in conventional surgical procedures. Such conventional surgical tools may be powered or unpowered and may be held directly or indirectly by a gripper or other tool holder mounted on a robotic surgical arm. For example, as described in commonly owned PCT application no. <CIT>(published as <CIT>) and <CIT>, a shaft of a conventional ("off-the-shelf") tool may be grasped directly by a gripper or the tool shaft may be inserted through a tubular cannula held by the gripper. In both cases, the robotically manipulated gripper will be used primarily if not exclusively to position the tool relative to the patient, and the tools will be manually operated by the surgeon just as they would be in non-robotic surgeries.

In contrast, other surgical robotic systems both hold and operate surgical tools which are designed to interface with specific tool holders. Such tool holders will have both attachment features and drive features, and the tools can be both positioned and operated by the associated surgical robotic controller.

As the tool-holding interfaces for each type of tool are usually quite different, many robotic surgeries are limited to using tools which are either (a) designed for robotic use but proprietary to the particular robot being used or (b) non-proprietary but not optimized for robotic use. While in many cases it might be desirable to be able to employ a combination of both specialized (proprietary) robotic tools and generic (non-proprietary), that is often difficult or impossible with currently available surgical robotic systems.

For example, some spinal surgical procedures require a range of tools having different purposes and different power and speed requirements. Some applications require high speed and low torque (e.g., drilling), and some applications require low speed and high torque (e.g., screw insertion). Still others require reciprocation, such as sawing.

Even within a particular category of tool, a number of specific tools having different sizes, power and other characteristics will often be required. Given the high complexity and cost of conventional surgical power tools, it is expensive to supply a full range of conventional tools that provide surgeons with a complete selection of size, force and other characteristics.

There is thus a strong need for robotic surgical systems that can use conventional, off-the-shelf surgical tools as well as specialized, proprietary tools with a unique tool-robot interface. In particular, it would be desirable to provide tool holders for use with robotic surgical systems that can interface with a wide variety of surgical tools, including both (a) surgical tools designed to be held, powered, and controlled by the tool holder and robotic surgical system and (b) off-the-shelf surgical tools which are intended primarily for manual use or which for any reason require only that they be held and oriented in a surgical space. It would also be desirable to provide surgical robotic systems intended for use with surgical tools having only mechanical elements which can be sterilized for reuse. At least some if these objectives will be met by the technologies disclosed herein.

Robotic surgical tool holders and interfaces are described in <CIT>; <CIT>; <CIT>; <CIT>;<CIT>: and <CIT>. Grippers for holding elongate surgical tools and cannulas are described in commonly owned PCT application no. <CIT> (published as <CIT>) and <CIT>. Other commonly owned publications and applications describing surgical robots and tools include PCT application no. <CIT> (published as <CIT>); PCT application no. <CIT>(published as <CIT>); PCT application no. <CIT> (published as <CIT>); PCT application no. <CIT> (published as <CIT>); PCT application no. <CIT> (published as <CIT>); PCT application no. <CIT> (published as <CIT>); PCT application no. <CIT> (published as <CIT>); PCT application no. <CIT> (published as <CIT>); PCT Applications nos. :<CIT>; <CIT>; <CIT>; <CIT>; PCT/IB2023/<NUM>; <CIT>; and <CIT>, <CIT>, <CIT>; <CIT>; <CIT>; <CIT>; <CIT>. <CIT> describes an instrument device manipulator (IDM) that is attached to a surgical arm of a robotic system and comprises a surgical tool holder and an outer housing. <CIT> describes an instrument drive transmission mechanism of a surgical robot and an instrument drive assembly mechanism of a surgical robot.

In a first aspect, the disclosed technology provides a robotic surgical tool holder configured to (a) hold but not drive a first type of surgical tool and (b) hold and drive a second type of surgical tool. The robotic surgical tool holder comprises a housing configured to be detachably mounted on a distal end of a surgical robotic arm and has at least one tool-receiving opening configured to removably receive individual surgical tools of either the first type or the second type therethrough. A drive train in the housing includes an input drive member configured to couple to an output drive member on the surgical robotic arm when the housing is mounted on the distal end of the surgical robotic arm. A tool gripper mechanism controllably couplable to the drive train is configured to selectively grasp and release an exterior surface of a surgical tool of the first type of when the surgical tool is positioned in the tool-receiving opening. A tool driver mechanism controllably couplable to the drive train includes an output drive element configured to mechanically engage an input drive element on a surgical tool of the second type when the second type of surgical tool is positioned in the tool-receiving opening or otherwise attached to the tool holder.

While it will often be preferred to stabilize the driven tool within the tool-receiving opening, such positioning is not necessary, and in some instances the driven tool can have one or more operative elements that project from the tool housing into the surgical space without passing through the tool-receiving opening of the tool holder.

The drive train comprises a mechanical arrangement of gears and shafts configured to selectively transmit rotational motion and torque from the output drive member of the surgical robotic arm to each of the tool gripper mechanism and the tool driver mechanism one at a time. In such instances, the robotic surgical tool holder may further comprise a selector mechanism configured to selectively couple the drive train to either the tool gripper mechanism or the tool driver mechanism. In other such instances, the drive train may be configured to automatically couple to either the tool gripper mechanism or the tool driver mechanism.

In some instances, the tool-receiving opening may comprise a cylindrical aperture. In some instances, the tool gripper mechanism may comprise at least one pair of opposed bodies each having a cylindrical peripheral surface with a circumferentially oriented tapered groove formed therein. The tapered grooves are shaped similarly and have partial circular cross-sections with radii that decrease from an initial end of the groove to a terminal end of the groove and wherein the opposed bodies are configured to rotate about their respective axes to orient the tapered grooves to form a gripping surface with a generally continuous circular periphery with (<NUM>) a diameter that depends on the rotational positions of the opposed bodies and (<NUM>) a center that remains fixed relative to the gripper mechanism regardless of the rotational positions of the opposed bodies. In such instances, the opposed bodies of the tool gripper mechanism may be configured to counterrotate, for example, comprising a shaft having a distal end connected to the tool gripper mechanism and a proximal end driven by the drive train to rotate the shaft to counterrotate the opposed bodies. In specific instances, the drive train includes a vertical shaft having a bevel gear which drives gear wheels connected to each of the opposed bodies.

In some instances, the robotic surgical tool holder further comprises a pair of jaws pivotally attached to the housing, where each jaw may carry one of the opposed bodies of each pair of opposed bodies. For example, the jaws may be configured to move the tapered grooves on the opposed bodies into and out of proximity to facilitate positioning tools therebetween, and the robotic surgical tool holder may further comprise a lever assembly coupled to the shaft and configured to transfer axial translation of the shaft to open and close the jaws.

In some instances, the opposed bodies are configured to control an amount of friction applied to a tool held by the opposed bodies in response to a degree of rotation of the opposed bodies.

In some instances, the output drive element of the tool driver mechanism may be rotatably driven by the drive train and configured to mate with and rotationally drive the input drive element on the second type of surgical tool when an interventional component of said second type of surgical tool is positioned in the tool-receiving opening. For example, the input drive element and the interventional component may be separate, and the housing may have a separate opening for coupling the input drive element to the drive train.

In a second aspect, the disclosed technology provides a robotic surgical system comprising a robotic surgical tool holder as just described in combination with at least one surgical tool of the second type, often with a plurality of surgical tools of the second type.

In a third aspect, the disclosed technology provides an unclaimed method for performing a robotic surgical procedure using at least one of a first type of surgical tool and a second type of surgical tool. The unclaimed method comprises providing a tool holder mounted on a distal end of a surgical robotic arm, where the tool holder includes both (a) a tool gripper mechanism configured to selectively grip and release an exterior surface of the first type of surgical tool and (b) a tool driver mechanism having an output drive element configured to mechanically engage an input drive element on the second type of surgical tool. A surgical tool is selected to be held by the tool holder. If the selected surgical tool is of the first type, the selected surgical tool will be removably gripped in the gripper mechanism of the tool holder. Conversely, if the selected surgical tool is of the second type, the selected surgical tool will be coupled to the tool driver mechanism of the tool holder so that the input drive element of the selected surgical tool couples to the output drive element of the tool driver mechanism.

In some instances, the tool holder may comprise a drive train having an input drive member coupled to an output drive member on the surgical robotic arm and an output drive member configured to selectively couple to either the tool gripper mechanism or the tool driver mechanism. In such instances, the method may further comprise (a) configuring the drive train to couple the output driver member to the tool gripper mechanism and decouple the output driver member from the tool driver mechanism and (b) coupling a surgical tool of the first type to the tool gripper mechanism.

In some instances, such configuring may be effected manually using a mechanical selector coupled to the drive train. Alternatively, such configuring may be effected automatically.

In some instances, the disclosed methods may further comprise (a) configuring the drive train to couple the output driver member to the tool driver mechanism and decouple the output driver member from the tool gripper mechanism and (b) coupling a surgical tool of the second type to the tool driver mechanism. For example, such configuring may be effected manually using a mechanical selector coupled to the drive train. Alternatively, such configuring may be effected automatically.

In some instances, the first type of surgical tools does not require external powering. For example, the first type of surgical tool may be any one of cannulas, independently powered drills, independently powered screw drivers, and independently powered saws which do not require mechanical power from the surgical robot.

In some instances, the second type of surgical tool may comprise any one of drills, screw drivers, and saws which require mechanical power from the surgical robot.

In some instances, performing a robotic surgical procedure may comprise exchanging at least one tool of the first type for at least one tool of the second type or vice versa in the tool holder during the procedure.

The novel features of the disclosure are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present disclosure will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the disclosure are utilized, and the accompanying drawings of which:.

Unless otherwise defined, all technical terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs.

As used herein, the singular forms "a," "an," and "the" include plural references unless the context clearly dictates otherwise. Any reference to "or" herein is intended to encompass "and/or" unless otherwise stated.

As used herein, the term "about" in some cases refers to an amount that is approximately the stated amount.

As used herein, the term "about" refers to an amount that is near the stated amount by <NUM>%, <NUM>%, or <NUM>%, including increments therein.

As used herein, the term "about" in reference to a percentage refers to an amount that is greater or less the stated percentage by <NUM>%, <NUM>%, or <NUM>%, including increments therein.

As used herein, the phrases "at least one", "one or more", and "and/or" are open-ended expressions that are both conjunctive and disjunctive in operation.

An exemplary robotic surgical system <NUM> intended particularly for use in the unclaimed methods of the disclosed technology is shown in <FIG>, in accordance with some embodiments. The robotic surgical system <NUM> can comprise a chassis <NUM>, typically a single, rigid frame which provides a base or platform for three robotic arms <NUM>, <NUM> and <NUM> that are placed relatively far apart on opposite longitudinal ends <NUM> and <NUM> of an upper surface <NUM> of the chassis <NUM>, typically approximately one meter apart, thus allowing for desirable attributes such as reachability, maneuverability, and an ability to apply significant force. In the illustrated embodiment, robotic surgical arms <NUM> and <NUM> are on the first end <NUM> of the chassis <NUM> and robotic surgical arm <NUM> is on the second end <NUM> of the chassis. The chassis can be mobile, e.g., being in the form of a mobile cart as described in commonly owned PCT application no. <CIT>(published as <CIT>). In other embodiments and implementations, the surgical arms <NUM>, <NUM> and <NUM> can be mounted on a base or other structure of a surgical table. Placement of the robotic surgical arms on a common, stable platform allows the arms to be moved kinematically or otherwise within a common robotic coordinate system under the control of a surgical robotic controller, typically an on-board controller have a user interface, such as display screen <NUM>.

The single, rigid chassis of the disclosed technology will usually comprise, consist of, or consist essentially of a single mobile cart, as disclosed for example in commonly owned PCT application no. <CIT> (published as <CIT>). In other instances, however, the single, rigid chassis may comprise separate modules, platforms, or components, that are assembled at or near the surgical table, as described for example in commonly owned PCT application no. The only requirement of the single, rigid chassis is that it provide a stable base for all the surgical arms so that they may be accurately and precisely kinematically positioned and tracked by the surgical robotic controller in a single surgical robotic coordinate space.

The chassis <NUM> of the robotic surgical system <NUM> can be configured to be temporarily placed under a surgical table (not shown) when performing the robotic surgical procedure, allowing the robotic surgical system <NUM> to be stored remotely before and after the procedure. The robotic arms <NUM>, <NUM>, and <NUM> may optionally be configured to be retracted into the chassis <NUM> of the robotic surgical system, allowing the system to be moved into or out of the surgical field in a compact configuration.

The first and second robotic surgical arms <NUM> and <NUM> can have flanges <NUM> and <NUM>, respectively, mounted at their distal ends. The flanges <NUM> and <NUM> each may hold a tool holder 100a and 100b, respectively, which in turn may hold a surgical tool for use in the particular robotic surgical procedure that is being performed. The flanges <NUM> and <NUM> can include all electronics and other sensitive system components that cannot be sterilized under harsh conditions, for example, using heat (autoclave) or radiation. The tool holders <NUM>, in contrast, can include only robust mechanical components that can be sterilized and reused in a conventional manner. By providing a surgical drape or other isolation barrier between the tool holder <NUM> and the flange <NUM> or <NUM>, the flange can be used in a non-sterile environment and can be reused without needing full sterilization.

The first robotic arm <NUM> can hold a first tool holder 100a, and the second robotic arm <NUM> can hold a second tool holder 100b, typically but not necessarily identical to the first tool holder. While the tool holders need not be the same, in order to simplify the present discussion, a single tool holder design will be described hereinafter and be referred by reference number <NUM>.

The structure and use of the tool holders <NUM> is a central aspect of the disclosed technology and, while the tool holders are particularly suitable for use with mobile and other surgical carts as just described, the disclosed tool holders are suitable for use with most or all surgical robots which include at least one surgical arm for manipulating the tool holders and the tools held by the tool holders in a robotic surgical procedure.

Referring now to <FIG>, the surgical tool holder <NUM> comprises a housing <NUM> having a base <NUM> and an input drive member <NUM> on the base, in accordance with some embodiments. The base <NUM> can be configured to be removably (detachably) attached to an interface, such as flange <NUM> or <NUM>, at the distal end of robotic surgical arm <NUM> or <NUM>, as shown in <FIG>. The input drive member <NUM> can be configured to be coupled to an output drive member <NUM> (<FIG>) disposed on the flange when the tool holder is mounted on the robotic surgical arm. The output drive member <NUM> can be powered, driven and controlled by the surgical robot, typically but not necessarily being driven by a motor mounted in the flange. A mechanical drive train <NUM> can be disposed in the housing <NUM> and configured to selective drive both a gripper mechanism and a tool driver mechanism, as described in more detail with reference to <FIG>. A tool type selector <NUM> can be located on an exterior of the housing.

A tool-receiving opening <NUM>, typically having a gap <NUM> along one side thereof, can be formed in an upper surface and near a distal end of the tool holder <NUM>, and a separate tool driver port <NUM> can also be formed on the upper surface of the tool holder and typically disposed a short distance proximally of the tool receiving opening <NUM>. The tool-receiving opening <NUM> can be configured to receive both robotically controlled (active) surgical tools and physician-controlled (passive) surgical tool.

The surgical tool holders disclosed herein can be used to hold and manipulate two types or classes of surgical tools, including both (a) OTS "off-the-shelf" surgical tools, such as those suitable for use in non-robotic procedures and typically having a handle, motor, batteries, and the like, which allow them to be used without mechanical or electrical power from a surgical robot or other external source and (b) proprietary and other robotic surgical tools designed specifically to interface with and be mechanically driven by the surgical robot.

As shown in <FIG>, the surgical tool holder <NUM> can be used with an OTS "off-the-shelf" surgical tool <NUM>, such as a hand-held grinder, which may be placed directly into the tool-receiving opening <NUM> of the surgical tool holder <NUM>. In such instances, an internal gripper mechanism (described with reference to <FIG> below) may be actuated to grasp an outside surface of a component of the tool, such as a cylindrical shaft <NUM>. An initial location of a grinder tip <NUM> or other active component of the OTS surgical tool can be kinematically registered with the robotic surgical coordinates using conventional techniques, and subsequent positions of the tip <NUM> can be kinematically tracked based on controlled movements of the supporting robotic surgical arm <NUM>, as shown in <FIG>. The surgical tool <NUM> can also be optically tracked using camera <NUM> or other sensor-based trackers. While positioning of the OTS tool <NUM> can be controlled by or through the controller <NUM> of the robotic surgical system <NUM>, a handle <NUM> of the tool can remain accessible for direct, manual use by the surgeon.

In other instances, a cannula <NUM> may be introduced directly into the tool-receiving opening <NUM> of the surgical tool holder <NUM>, typically being used to provide a guide for introducing and exchanging multiple active OTS surgical tools. As indicated by the broken-line paths shown in <FIG>, for example, the OTS grinder <NUM> can be introduced through the cannula <NUM> rather than being paced directly into the gripper mechanism of the tool holder <NUM>. In both instances, the selector switch <NUM> is turned to the "driven tool" setting (D) to properly connect the drive train <NUM>. As shown in <FIG>, the driven surgical tool <NUM> may include a gear housing <NUM> at its upper end, from which the input drive element <NUM> extends.

Referring now to <FIG>, the robotic surgical tool holder <NUM> can also be used to hold and drive surgical tools <NUM> of a type which include both an input drive element <NUM> and a tool shaft <NUM>, in accordance with some embodiments. Such "driven" surgical tools <NUM> can be constructed to selectively mate with the drive train <NUM> within the tool holder <NUM>, as described with reference to. In the illustrated embodiment, the tool shaft <NUM> can be inserted through the tool-receiving opening <NUM> while the input drive element <NUM> is simultaneously inserted into tool driver port <NUM>. The selector switch <NUM> can be turned to the "driven tool" setting (D) to properly connect the drive train <NUM>.

Referring now to <FIG>, the mechanical drive train <NUM> comprises an assembly of gears and shafts which transmit rotational torque from the output transfer member <NUM> of the flange <NUM> or <NUM> to the input drive member <NUM> of the tool holder <NUM>, in accordance with some embodiments. The drive train <NUM> can be located in the tool holder housing <NUM> but is shown in isolation for simplified presentation. The input drive member <NUM> can comprise a main drive shaft <NUM> having a gripper drive gear <NUM> and tool drive gear <NUM> thereon. The main drive shaft <NUM> can be advanced and retracted by the tool-type selector <NUM> to operate either the gripper function or the tool drive function of the tool holder, as described in more detail below.

As shown in full line in <FIG>, to operate the gripper function of the tool holder, the main drive shaft <NUM> can be advanced so that the gripper drive gear <NUM> engages a bevel drive gear on a vertical drive shaft <NUM> having upper and lower worm gears <NUM> (best seen in <FIG>) which engage and drive worm gears <NUM> and <NUM> to rotate the opposed bodies <NUM> and <NUM>. Rotation of the opposed body pairs <NUM> and <NUM> can adjust the diameter of an aperture formed by tapered grooves <NUM> and <NUM> to accommodate surgical tools having shafts or other components of different sizes, as described in detail in in commonly owned PCT application no. <CIT> (published as <CIT>) and <CIT>.

In order to effect the tool drive function of the tool holder <NUM>, the selector switch can be changed to its D position, as shown in <FIG>, causing the main drive shaft <NUM> to retract (move to the left in <FIG>) to both (a) disengage the gripper drive gear <NUM> from the bevel drive gear <NUM> as shown in full line in <FIG> and to (b) engage the tool drive gear <NUM> with an drive shaft gear with an output drive shaft <NUM> having an output coupling member <NUM> exposed through the tool driver port <NUM> (<FIG>). In this way the input drive element <NUM> can connect to the output coupling member <NUM> when the driven surgical tool is mounted on the tool holder housing, as illustrated in <FIG>. The output drive member <NUM> may be driven by a motor (not illustrated) located in the non-sterile flange <NUM> or <NUM>, typically a stepper motor.

Referring now to <FIG>, certain components of the drive train <NUM> are shown in a cross-section of the tool holder housing <NUM>, in accordance with some embodiments. The worm gears <NUM> and <NUM> have been removed from the view to reveal the worm gears <NUM> that drive the vertical drive shaft <NUM> to rotate the opposed body pairs <NUM> and <NUM> with only one of each pair of opposed bodies be seen. Also, the gripper drive gear <NUM> is shown beneath the bevel drive gear <NUM> in <FIG> in contrast to in <FIG> where the gripper drive gear is shown above the bevel drive gear.

While a specific tool gripping mechanism is described, the term "gripper" and phrase "tool gripper" as used herein and in the claims refers to any mechanical closure device that has a variable aperture for grasping a tool or other surgical object that is to be held and manipulated by the tool gripper. Grippers comprising rotatable opposed bodies can be positioned or adjusted in some way to open and close about a tool or other object positioned therebetween. The opposed bodies can be rotatable (configured to rotate about their respective axes) to orient tapered grooves <NUM> and <NUM> on their outer surfaces to form a gripping surface with a generally continuous circular periphery with (<NUM>) a diameter that depends on the rotational positions of the opposed bodies and (<NUM>) a center that remains fixed relative to the gripper mechanism regardless of the rotational positions of the opposed bodies.

A first alternative drive train assembly <NUM> is illustrated in <FIG>, in accordance with some embodiments. While similar to the arrangement shown in <FIG>, the drive train <NUM> can be configured to drive the gripper so long as no separate driven tool is mounted on the tool holder. A main drive shaft <NUM> can be rotated in the direction of the arrow by a motor in the flange, as previously described. A beveled tool driver gear <NUM> can be fixed to rotate with the main drive shaft <NUM>, but no mating gear is provided in the drive train as was the case with the tool holder <NUM> previously described. A beveled gripper drive gear <NUM> can also be fixed to rotate with the main drive shaft <NUM> but can be located at a distal end of the shaft where it mates with a beveled gripper follower gear <NUM> which drives vertical gripper drive shaft <NUM>. The remainer of the gripper drive train can be identical to that described previously.

When a driven tool is mounted on a tool holder which includes drive train <NUM>, tool drive shaft <NUM> can enter the tool holder housing. The tool drive shaft <NUM> can carry a beveled tool drive gear <NUM> which, when introduced, is out of alignment with beveled tool drive gear <NUM> on the drive shaft <NUM>. The drive shaft <NUM> can be spring mounted so that when the beveled peripheries of the drive gears <NUM> and <NUM> meet, the drive shaft <NUM> can be moved to the left as shown in broken line in <FIG>. Such engagement concurrently can disengage the gripper drive gear <NUM> from the gripper follower gear <NUM>, also shown in broken line. Attaching the tool which carries the tool drive shaft <NUM> and tool drive gear <NUM> to the tool holder can automatically disengage the gripper drive portion of the drive train <NUM>, thus allowing use of the driven tool without need for the user to manually or otherwise disengage the gripper from the drive train <NUM> in the tool holder. Similarly, when the driven tool is removed from the tool holder, the gripper drive gear <NUM> can reengage the gripper follower gear <NUM> under the spring force of the spring mounting of the main drive shaft <NUM> (the spring has not been shown to simplify illustration).

Referring now to <FIG>, a second alternative drive train assembly <NUM> will be described, in accordance with some embodiments. The drive train <NUM> can comprise a main drive shaft <NUM> which carries a beveled main drive gear <NUM> at its distal end. The beveled main drive gear <NUM> can engage a lower bevel gear <NUM> which is on a lower portion of a rotating drive structure <NUM> which also has an upper tool drive gear <NUM> at its upper end. The rotating drive structure <NUM> can be formed as a spindle with all portions free to rotate together. The main drive gear <NUM> can be mounted so that it always engages the lower bevel gear <NUM> so that the rotating drive structure <NUM> will always rotate when the main drive shaft <NUM> is rotated.

The drive train <NUM> can further include a vertical shaft <NUM> which extends upwardly through an open interior of the rotating drive structure <NUM>. As shown in <FIG>, however, the vertical drive shaft <NUM> may not be coupled to rotating drive structure <NUM> so that the vertical shaft will not rotate when the rotating drive structure is rotated. The configuration of <FIG> is intended for driving a tool shaft <NUM> and tool follower gear <NUM> of the driven tool, as shown by the arrows in <FIG>.

In order to drive the gripper mechanism of the tool holder, a coupling sleeve <NUM> can be raised to enter the interior of the rotating drive structure <NUM>, as shown in <FIG>. The coupling sleeve <NUM> can be configured to frictionally engage both an interior surface of the rotating drive structure <NUM> and an exterior surface of the vertical drive shaft <NUM> so that rotation of the rotating drive structure <NUM> is transferred to the vertical drive shaft <NUM> which carries a gripper drive gear at its upper end. The remaining portions of the gripper drive can be similar to the structures described elsewhere herein and commonly owned PCT application no. <CIT> (published as <CIT>) and <CIT>. While the upper drive gear <NUM> will still rotate, the driven tool follower gear <NUM> can be removed so the gear rotation is immaterial. The coupling sleeve <NUM> can be raised and lowered in a variety of ways, using for example manual linkages, springs, solenoids, and the like.

Referring now to <FIG>, several examples of "driven" surgical tools <NUM>, e.g., those designed to be driven by the drive shaft gear <NUM> and output drive shaft <NUM> of the tool holders <NUM>, are illustrated, in accordance with some embodiments. The different driven surgical tools <NUM> can take a variety of forms but will usually share a common external design and identical interface dimensions so that they can be interchangeably mounted on and mechanically coupled to the tool holders of the disclosed technologies. For example, as shown in <FIG>, a surgical grinder <NUM> comprises a housing <NUM> having an interior <NUM> that holds a drive train <NUM>. The drive train <NUM> mechanically links the input drive element <NUM> with the tool shaft <NUM> as described in <FIG>. The drive train <NUM> comprises a drive gear <NUM> attached to the drive element <NUM>, an idler gear <NUM>, and a follower gear <NUM> attached to a rotating drive rod <NUM>. By properly selecting the relative diameters of the gears <NUM>, <NUM>, and <NUM>, the rotational speed of the input drive element <NUM> can be multiplied to achieve high speed (e.g., each having a smaller diameter than the previous gear in the chain), low torque rotation of the rotating rod <NUM>. This is suitable for grinding with the illustrated grinder <NUM>, as well as in a number of applications including drilling, sawing with a rotating blade, polishing, and the like.

As shown in <FIG>, a surgical screwdriver <NUM> comprises a housing <NUM> having an interior <NUM> that holds a drive train <NUM>, in accordance with some embodiments. The drive train <NUM> mechanically links the input drive element <NUM> with the tool shaft <NUM> as described in <FIG>. The drive train <NUM> comprises a drive gear <NUM> attached to the drive element <NUM>, an idler gear <NUM>, and a follower gear <NUM> attached to a rotating drive rod <NUM>. By properly selecting the relative diameters of the gears <NUM>, <NUM>, and <NUM> (e.g., each having a larger diameter than the previous gear in the chain), the rotational speed of the input drive element <NUM> can be reduced to achieve low speed, high torque rotation of the rotating rod <NUM>. This is suitable for screwing in pedicle and other surgical screws with the illustrated screwdriver tip <NUM>, as well as in other low speed, high torque applications.

As shown in <FIG>, a surgical saw <NUM> comprises a housing <NUM> having an interior <NUM> that holds a drive train <NUM>, in accordance with some embodiments. The drive train <NUM> can mechanically link the input drive element <NUM> with the tool shaft <NUM> as described in <FIG>. The drive train <NUM> can comprise a beveled drive gear <NUM> attached to the drive element <NUM>, a beveled follower gear <NUM>, and rotating disc <NUM>. The input drive element <NUM> can rotate on a vertical axis (as viewed in <FIG>), and the beveled gears <NUM> and <NUM> can cooperate to rotate a connecting shaft <NUM> on a horizontal axis. The connecting shaft <NUM>, in turn, can rotate the rotating disc <NUM> in a vertical plane to reciprocate the crank rod <NUM> in a generally vertical direction. Details of the connection of the rotating disc <NUM> to the crank rod <NUM> are not shown, but the connection can be made in a variety of ways known in the art. The crank rod <NUM> will typically by located in a cover shaft <NUM> and will reciprocate a saw blade <NUM> coupled at its distal end by a coupler <NUM> that allows blade selection before a procedure and replacement of the blade during a procedure.

Referring now to <FIG>, two or more tool holders <NUM> and <NUM> can be used in combination for performing a robotic surgical procedure, in accordance with some embodiments. The tool holders <NUM> and <NUM> can be attached to flanges <NUM> and <NUM> which are carried by robotic surgical arms <NUM> and <NUM>, respectively, as described previously with reference to <FIG>. Surgical draping <NUM> can be positioned at the interface between the tools <NUM> and <NUM> and the flanges <NUM> and <NUM>, exposing only the tools to the sterile environment and limiting sterilization for reuse to the tools which include only mechanical components. The flanges <NUM> and <NUM>, which typically include the motors and electronics needed for operating the tool holders <NUM> and <NUM> as well as the surgical tools themselves, can be outside of the sterile field and will not require sterilization for reuse.

Individual surgical tools can be fed to the tool holders in a variety of ways, including both manual and robotically assisted protocols. Manual attachment will rely on the surgeon or a surgical assistant to choose a desired tool from an inventory and manually introduce or attach the tool to the gripper or driver attachment portion of the tool holder. Robotic attachment may utilize dedicated or other mobile carts which carry an inventory of tools and which may incorporate a dedicated arm for selecting tools from the tool inventory and attaching the selected tool to the tool holder, as described in commonly owned PCT application no. <CIT> (published as <CIT>).

The second tool holder <NUM> can carry a rotational driver <NUM> having an output drive shaft <NUM> and an input drive element <NUM> (similar to the arrangements in both <FIG> and <FIG>), and the output drive shaft <NUM> can have a coupling feature <NUM> at a distal tip thereof, as shown in <FIG>. In this way, the robotic controller <NUM> can be used to both position the robotic surgical arm <NUM> in the robotic surgical space and control rotation of the drive shaft <NUM>.

The first tool holder <NUM> can grip a tool <NUM> using opposed bodies <NUM> of an internal gripping mechanism of said first tool holder, generally as described above with reference to <FIG>. The robotic controller <NUM> can be used to align and engage a coupling feature <NUM> on the tool <NUM> with the drive coupling <NUM> on the output drive shaft <NUM> of the rotational driver <NUM> held by the second tool holder <NUM>. Advantageously, the grip of the opposed body pairs <NUM> can be adjusted by small changes in the rotational orientation of the opposed bodies, allowing the output drive shaft <NUM> to both rotate and axially position the driven tool <NUM> relative to the first tool holder <NUM>.

Claim 1:
A robotic surgical tool holder (<NUM>) configured to (a) hold a first type of surgical tool and/or (b) hold and drive a second type of surgical tool, said robotic surgical tool holder (<NUM>) comprising:
a housing (<NUM>) configured to be detachably mounted on a distal end of a surgical robotic arm (<NUM>, <NUM>) and having at least one tool-receiving opening (<NUM>) configured to removably receive individual surgical tools of either the first type or the second type therethrough;
a drive train (<NUM>) in the housing (<NUM>) having an input drive member configured to couple to an output drive member on the surgical robotic arm (<NUM>, <NUM>) when the housing (<NUM>) is mounted on the distal end of the surgical robotic arm (<NUM>, <NUM>);
a tool gripper mechanism controllably couplable to the drive train (<NUM>), said tool gripper mechanism configured to selectively grasp and release an exterior surface of the first type of surgical tool when said first type of surgical tool is positioned in the tool-receiving opening (<NUM>); and
a tool driver mechanism (<NUM>) controllably couplable to the drive train (<NUM>), said tool driver mechanism having an output drive element (<NUM>) configured to mechanically engage an input drive element (<NUM>) on the second type of surgical tool when said second type of surgical tool is attached to the tool holder (<NUM>);
characterized in that
the drive train (<NUM>) comprises a mechanical arrangement of gears and shafts configured to selectively transmit rotational motion and torque from the output drive member of the surgical robotic arm (<NUM>, <NUM>) to each of the tool gripper mechanism and the tool driver mechanism (<NUM>) one at a time.