Patent Description:
Robotic surgical systems have been used in minimally invasive medical procedures in which surgical instruments were inserted through surgical portals at fixed entry points into the patient's body. These systems incorporated a Remote Center of Motion (RCM) to ensure that the surgical instruments did not move beyond these fixed entry points as the instruments were manipulated inside the patient's body. Many of these surgical robots used a mechanical RCM with a portion of robotic arm attaching directly to the surgical portal. Unlike surgical robots using mechanical RCM's, software-based RCM's typically did not mechanically connect to the surgical portal in order to provide an increased range of motion and reduce collisions between robotic arms of the surgical robot. Unfortunately, many of the surgical robots with software-based RCM's tend to complicate instrument exchanges as the surgical portals moved out of alignment with the robotic arms when the surgical instruments were removed.

During an instrument exchange, the surgical instrument was pulled out of the surgical port and removed from the robotic arm. A new or different surgical instrument was then connected to the robotic arm and introduced back through the surgical portal. Surgical robots with mechanical based RCM's facilitated the exchange because the surgical portal was continually held in alignment with the linear axis of the instrument motion by a linkage or connection to the surgical portal. In contrast, surgical robots with software-based RCM's did not have a connection or linkage to the surgical portal and therefore lost alignment when the surgical instrument was removed from the surgical portal. Inserting another surgical instrument required the clinician to manually align the surgical portal with the surgical instrument. This process increased the time required for conducting the instrument exchange.

<CIT> discloses a surgical port feature including a funnel portion, a tongue, a waist portion, and surgical instrument channels. The waist portion may be located between the funnel portion and the tongue. The surgical instrument channels may extend from the funnel portion through the waist portion. The surgical port feature may further include a second tongue, with the wait portion being located between the funnel portion, the tongue, and the second tongue.

Accordingly, there is a need for robotic surgical systems with software-based RCM's that facilitate instrument exchange by maintaining alignment of the surgical portal and robotic arm.

The present disclosure relates to a robotic surgical system as recited in the Claims.

The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the disclosure and, together with a general description of the disclosure given above, and the detailed description of the embodiment(s) given below, serve to explain the principles of the disclosure, wherein:.

Embodiments of the present disclosure are described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein, the term "distal" refers to that portion of a device that is farther from the user, while the term "proximal" refers to that portion of a device that is closer to the user.

Referring initially to <FIG>, a surgical system, such as, for example, a robotic surgical system is shown generally as robotic surgical system <NUM> and generally includes a plurality of robotic arms <NUM>, <NUM>; a controller or control device <NUM>; and an operating console <NUM> coupled with control device <NUM>. Operating console <NUM> includes a display device <NUM>, which is set up in particular to display three-dimensional images; and manual input devices <NUM>, <NUM>, by means of which a person (not shown), for example a surgeon, is able to telemanipulate robotic arms <NUM>, <NUM> in a first operating mode, as known in principle to a person skilled in the art.

Robotic surgical system <NUM> also includes a surgical assembly <NUM> connected to a distal end of each of robotic arms <NUM>, <NUM>. Surgical assembly <NUM> may support one or more surgical instruments such as surgical instruments <NUM>, <NUM>, as will be described in greater detail below.

Each of the robotic arms <NUM>, <NUM> is composed of a plurality of members, which are connected through joints. Referring also to <FIG>, robotic arm <NUM> (and/or robotic arm <NUM>) includes a mounting portion 2a having an outer surface 2b and an inner surface 2c. Inner surface 2c defines a receiving passage 2d therethrough and outer surface 2b that may support a sterile drape 2e thereon. Sterile drape 2e can be disposable and/or replaceable. Inner surface 2c may form a shoulder <NUM> that functions to support one of surgical instruments <NUM>, <NUM>.

Robotic arms <NUM>, <NUM> may be driven by electric drives (not shown) that are connected to control device <NUM>. Control device <NUM> (e.g., a computer) is set up to activate the drives, in particular by means of a computer program, in such a way that robotic arms <NUM>, <NUM>, their surgical assemblies <NUM> and/or surgical instruments <NUM>, <NUM> execute a desired movement according to a movement defined by means of manual input devices <NUM>, <NUM>. Control device <NUM> may also be set up in such a way that it regulates movement of robotic arms <NUM>, <NUM> and/or of the drives. While electrically coupled to controller or control device <NUM>, as described above, robotic arms <NUM>, <NUM> are configured to receive signals from controller <NUM>, which may be software-based, to establish a remote center of motion at any suitable location as described in greater detail below.

Robotic surgical system <NUM> is configured for use on a patient "P" lying on a patient table <NUM> to be treated in a minimally invasive manner by means of an end effector of one or more of the surgical instruments. Surgical system <NUM> may also include more than two robotic arms <NUM>, <NUM>, the additional robotic arms likewise being connected to control device <NUM> and being telemanipulatable by means of operating console <NUM>. One or more additional surgical assemblies <NUM> and/or surgical instruments <NUM>, <NUM> may also be attached to the additional robotic arm.

Control device <NUM> may control a plurality of motors (Motor <NUM>. n) with each motor configured to drive a pushing or a pulling of one or more cables of surgical instruments <NUM>, <NUM>. As described below, the plurality of motors can include a plurality of motors 202a of an instrument drive unit <NUM> of surgical instruments <NUM>, <NUM> as shown in <FIG>. In use, as these cables are pushed and/or pulled, the one or more cables effect operation and/or movement of end effectors <NUM>, <NUM> of surgical instruments <NUM>, <NUM>. It is contemplated that control device <NUM> coordinates the activation of the various motors (Motor <NUM>. n) to coordinate a pushing or a pulling motion of these cables in order to coordinate an operation and/or movement of end effectors <NUM>, <NUM>. Reference may be made to International Application No. <CIT>, entitled "Wrist and Jaw Assemblies for Robotic Surgical Systems," for a detailed discussion of the construction and operation of end effectors <NUM>, <NUM>.

In embodiments, each motor can be configured to actuate a drive rod or a lever arm to effect operation and/or movement of end effectors <NUM>, <NUM> in addition to, or instead of one or more cables.

Control device <NUM> can include any suitable logic control circuit adapted to perform calculations and/or operate according to a set of instructions. Control device <NUM> can be configured to communicate with a remote system "RS," either via a wireless (e.g., Wi-Fi, Bluetooth, LTE, etc.) and/or wired connection. Remote system "RS" can include data, instructions and/or information related to the various components, algorithms, and/or operations of work station <NUM>. Remote system "RS" can include any suitable electronic service, database, platform, cloud "C," or the like. Control device <NUM> may include a central processing unit operably connected to memory. The memory may include transitory type memory (e.g., RAM) and/or non-transitory type memory (e.g., flash media, disk media, etc.). In some embodiments, the memory is part of, and/or operably coupled to, remote system "RS.

Control device <NUM> can include a plurality of inputs and outputs for interfacing with the components of robotic surgical system <NUM>, such as through a driver circuit. Control device <NUM> can be configured to receive input signals and/or generate output signals to control one or more of the various components (e.g., one or more motors) of robotic surgical system <NUM>. The output signals can include, and/or can be based upon, algorithmic instructions which may be preprogrammed and/or input by a user. Control device <NUM> can be configured to accept a plurality of user inputs from a user interface (e.g., switches, buttons, touch screen, etc. of operating console <NUM>) which may be coupled to remote system "RS.

A database <NUM> can be directly and/or indirectly coupled to control device <NUM>. Database <NUM> can be configured to store pre-operative data from living being(s) and/or anatomical atlas(es). Database <NUM> can include memory which can be part of, and/or or operatively coupled to, remote system "RS.

Reference may be made to <CIT>, entitled "Medical Workstation," for a detailed discussion of the construction and operation of components of robotic surgical system <NUM>.

Referring now to <FIG>, surgical assembly <NUM> includes a guide tube <NUM>, a first surgical instrument <NUM>, a second surgical instrument <NUM>, and one or more surgical portals <NUM>. First and second surgical instruments <NUM>, <NUM> can be the same and/or different types of instruments (e.g., a grasper, stapler, cutter, sealer, or the like). In some embodiments, surgical assembly <NUM> includes a second surgical portal <NUM> and a further second surgical instrument <NUM> such as an endoscope, for example.

Guide tube <NUM> extends between a proximal or trailing end 110a of guide tube <NUM> and a distal or leading end 110b of guide tube <NUM>. A housing <NUM> is disposed at trailing end 110a of guide tube <NUM>, and an elongated tubular body <NUM> extends distally from housing <NUM> to distal end 110b of guide tube <NUM>. Guide tube <NUM> can be formed from any suitable material such as stainless steel for example to enable sterilization and reuse of guide tube <NUM>. Additionally, and or alternatively guide tube <NUM> or portions thereof can be formed of transparent material. For example, leading end 110b can be transparent to provide visualization for determining a location/position of surgical instruments advanced therethrough. Guide tube <NUM> can also be grounded (e.g., via a grounding rod or the like not shown) during electrosurgery, for example, to provide electrical isolation. Guide tube <NUM> may be electrically configured to detect faulty insulation of an electrosurgery instrument.

Housing <NUM> includes an outer surface 112a and an inner surface 112b. Housing <NUM> includes a top surface 112c and a bottom surface 112d. Top surface 112c can form an annular flange 112e that extends radially outwardly from housing <NUM>, and bottom surface 112d can form an annular shoulder 112f that couples elongated tubular body <NUM> to housing <NUM>.

Elongated tubular body <NUM> includes an outer surface 114a and an inner surface 114b. Inner surface 114b of elongated tubular body <NUM> and inner surface 112b of housing <NUM> define a passage <NUM> that opens through leading and trailing ends 110a, 110b of guide tube <NUM>.

An internal seal <NUM>, such as a disc seal and/or duckbill valve, for example, is supported in housing <NUM> and extends from inner surface 112b of housing <NUM>. Internal seal <NUM> is positioned within housing <NUM> to receive first and/or second surgical instruments <NUM>, <NUM> therethrough in a sealed relationship with a respective one of the first and/or second surgical instruments <NUM>, <NUM>.

Each of surgical instruments <NUM>, <NUM> includes an instrument drive unit <NUM> supported at a proximal end thereof and a shaft assembly <NUM> that extends distally from instrument drive unit <NUM>. Shaft assembly <NUM> includes one or more cables such as cables <NUM>, <NUM> that extend therealong and/or therethrough to an end effector <NUM> and/or an end effector <NUM> coupled to a distal end of shaft assembly <NUM>. For example, end effectors <NUM>, <NUM> can include any suitable end effector known in the art such as a grasper, stapler, sealer or the like that functions to manipulate, fasten, cut, and/or seal tissue. Proximal ends of cables <NUM>, <NUM> are coupled to instrument drive unit <NUM> and actuatable in response to activation of one or more motors 202a supported within instrument drive unit <NUM> to operate end effectors <NUM>, <NUM>.

Surgical portals <NUM>, <NUM> are substantially identical and thus in the interest of brevity, only surgical portal <NUM> is described in detail herein. As shown in <FIG>, surgical portal <NUM> includes a body <NUM> having an outer surface 410a and an inner surface 410b. Inner surface 410b defines a passage <NUM> that opens at trailing and leading ends 410c, 410d of body <NUM>. Body <NUM> includes an annular flange <NUM> that extends radially outwardly from body <NUM> at trailing end 410c of body <NUM>. An internal seal <NUM>, such as a disc seal and/or a duck-bill valve, for example, is supported in passage <NUM> that functions to establish a sealed relationship with instruments such as first and second instruments <NUM>, <NUM> and/or endoscope <NUM> advanced therethrough into a surgical site "S" while body <NUM> is positioned within a tract of tissue "T.

In use, as illustrated in <FIG>, for example, during a laparoscopic procedure, in which an abdominal region of a patient is insufflated to create a working space at the surgical site "S" (although the presently described surgical system can be used in any suitable open or minimally invasive procedure), surgical portals <NUM>, <NUM> are positioned within tissue "T. " As shown in <FIG>, with endoscope <NUM> advanced through surgical portal <NUM> into surgical site "S" adjacent to surgical portal <NUM>, endoscope <NUM> functions to establish a field of view "F" within surgical site "S" to view surgical site "S," first instrument <NUM>, second instrument <NUM>, guide tube <NUM>, and/or surgical portal <NUM>.

Referring to <FIG>, mounting portion 2a of robotic arm <NUM> is positioned adjacent to, and in alignment with, surgical portal <NUM> to establish/set a remote center of motion (RCM), for example, a set software-based RCM, based upon the location of surgical portal <NUM>. The location of surgical portal <NUM> can be stored (e.g., electronically via controller) as desired. The RCM and/or location of robotic arm <NUM> can be based on a longitudinal axis "L" that extends through leading and trailing ends 410c, 410d of surgical portal <NUM>. Mounting portion 2a of robotic arm <NUM> may be positioned relative to surgical portal <NUM> such that a longitudinal axis "L2" that extends through receiving passage 2d of robotic arm <NUM> is coaxial with longitudinal axis "L" of surgical portal <NUM>. Positioning of robotic arm <NUM> may be based on electrical communications from control device <NUM> corresponding to the location of surgical portal <NUM> and/or longitudinal axis "L" thereof.

Elongated tubular body <NUM> of guide tube <NUM> is then advanced through receiving passage 2d of robotic arm <NUM> such that mounting portion 2a and sterile drape 2e support housing <NUM> on robotic arm <NUM> and leading end 110b of guide tube <NUM> extends into passage <NUM> of surgical portal <NUM> with internal seal <NUM> of surgical portal <NUM> sealingly engaged with outer surface 114a of guide tube <NUM>. Housing <NUM> of guide tube <NUM> can be received in receiving passage 2d of robotic arm <NUM> such that annular flange 112e of housing <NUM> engages sterile drape 2e to provide a sterile connection between guide tube <NUM> and robotic arm <NUM>.

With guide tube <NUM> supported by robotic arm <NUM>, guide tube <NUM> is positionable relative to surgical portal <NUM> such that leading end 110b of guide tube <NUM> can extend distally beyond leading end 410d of surgical portal <NUM> and into surgical site "S. " Robotic arm <NUM> is movable axially relative to longitudinal axes "L" and "L2," as indicated by arrow "A1," (<FIG>) to adjust axial positioning of guide tube <NUM> relative surgical portal <NUM> while maintaining alignment between robotic arm <NUM> and surgical portal <NUM> via guide tube <NUM>. For example, axial movement of guide tube <NUM> may be effectuated at any time during a procedure to provide access to different areas within surgical site "S" based upon a location of leading end 110b of guide tube <NUM>.

Referring to <FIG>, guide tube <NUM> receives, for example, first surgical instrument <NUM> and establishes a sealed relationship with shaft <NUM> of first surgical instrument <NUM> via internal seal <NUM> as first surgical instrument <NUM> is received by guide tube <NUM>. First surgical instrument <NUM> is advanced through guide tube <NUM> so that end effector <NUM> of first surgical instrument <NUM> extends distally beyond leading ends 110b, 410d of guide tube <NUM> and surgical portal <NUM>, respectively, and into field of view "F" of endoscope <NUM> within surgical site "S. " End effector <NUM> can then be utilized to operate within surgical site "S" as desired.

With reference to <FIG>, should a clinician determine that an instrument exchange is required, first surgical instrument <NUM> can be withdrawn and replaced with second surgical instrument <NUM>. To facilitate effectiveness of the instrument exchange, alignment between robotic arm <NUM> and surgical portal <NUM> can be maintained with guide tube <NUM> (via the software-based RCM) during the entirety of the instrument exchange and including when no surgical instrument is positioned within surgical portal <NUM>. Leading end 110b of guide tube <NUM> remains within the field of view "F" of endoscope <NUM> during the procedure and during instrument exchange to enable clinician to determine a final, exact in vivo location of end effector <NUM> of second surgical instrument <NUM>. One or more subsequent instrument exchanges can be effectuated as desired, similar to that described above, with first surgical instrument <NUM>, second surgical instrument <NUM>, and/or other suitable surgical instruments in order effectuate various steps/procedures with the various instruments. As any of these surgical instruments are advanced in and/or out of guide tube <NUM>, guide tube <NUM> provides a barricaded conduit to protect surrounding patient tissue from undesired tissue damage resulting from snagging or the like.

In embodiments outside the scope of the present invention guide tube <NUM> can be utilized without surgical portal <NUM> such that guide tube <NUM> advances directly through the tissue "T. " In embodiments, guide tube <NUM> includes one or more markings, light emitting diodes, and/or light pipes for various identification purposes. For example, light communicated from a diode or light pipe may communicate information such as whether or not a robotic arm is active, an instrument exchange is being undergone, an instrument is armed, etc. Guide tube <NUM> may also include one or more sensors for measuring force such as force exerted by tissue (e.g., abdominal wall) which can be subtracted from measured forces applied to a proximal end of one of the instruments.

To improve safety of removing and inserting endoscope <NUM>, guide tube <NUM> can also be utilized in conjunction with surgical portal <NUM> to facilitate use of one or more endoscopes <NUM> in a manner similar to that described with respect to surgical portal <NUM> and instruments <NUM>, <NUM>. In one embodiment, guide tube <NUM> may define a separate lumen that receives a fluid (e.g. saline) for cleaning a lens of endoscope <NUM>.

Claim 1:
A robotic surgical system (<NUM>), comprising:
a surgical portal (<NUM>);
a surgical robot including a robot arm (<NUM>, <NUM>) and a controller (<NUM>), the controller configured to establish a software-based remote center of motion, RCM, of a surgical instrument (<NUM>, <NUM>) attached to the robot arm based on a location of the surgical portal (<NUM>) in a patient through which the surgical instrument is inserted; and
a guide tube (<NUM>) having a trailing end (110a) supported by the robot arm of the surgical robot, a leading end (110b) inserted in the surgical portal and
wherein alignment is maintained between the robotic arm and the surgical portal during a surgical instrument exchange and including when the surgical instrument is not in the surgical portal via the software based RCM,
the guide tube including an elongated tubular body (<NUM>) through which an elongated shaft of the surgical instrument is inserted or removed during the surgical instrument exchange,
wherein the guide tube is slidably movable relative to the surgical portal in response to movement of the robotic arm, and
wherein the guide tube and the robotic arm define a first longitudinal axis that extends between the leading and trailing ends of the guide tube, and wherein the surgical portal defines a second longitudinal axis that extends between the leading and trailing ends thereof, the guide tube configured to maintain coaxial alignment of the first longitudinal axis and the second longitudinal axis during the surgical instrument exchange via the software based RCM
wherein the robot arm and the surgical instrument are robotically movable axially relative to the first and second longitudinal axes by sliding the guide tube relative to the surgical portal.