There are various types of surgical robotic systems on the market or under development. Some surgical robotic systems use a plurality of robotic arms. Each arm carries a surgical instrument, or the camera used to capture images from within the body for display on a monitor. See U.S. Pat. No. 9,358,682 and US 20160058513, which are incorporated herein by reference. Other surgical robotic systems use a single arm that carries a plurality of instruments and a camera that extend into the body via a single incision. See WO 2016/057989, incorporated herein by reference. Each of these types of robotic systems uses motors to position and/or orient the camera and instruments and to, where applicable, actuate the instruments. Typical configurations allow two or three instruments and the camera to be supported and manipulated by the system. Input to the system is generated based on input from a surgeon positioned at a master console, typically using input devices such as input handles and a foot pedal. Motion and actuation of the surgical instruments and the camera is controlled based on the user input. The image captured by the camera is shown on a display at the surgeon console. The console may be located patient-side, within the sterile field, or outside of the sterile field.
Increasingly, medical professionals are interested in advanced instrumentation including diagnostics and tissue characterization. Often, it is desirable to hold the tissue while performing the characterization and/or diagnostic procedure. This is typically done with multiple instruments. In laparoscopy, multiple instruments equates to multiple ports. This application describes dual function instruments that may be used to hold tissue while performing some additional diagnostic or therapeutic function with respect to the tissue. Use of such instruments with surgical robotic systems is also described.
System 10 comprises at least one robot arm 11 which operates under the control of a command console 12 operated by the surgeon, as described in the Background. The robotic manipulator (or each robotic manipulator) has a terminal portion 13 designed to support and operate a surgical device assembly 14. The surgical device assembly includes a surgical instrument having shaft 15 and a distal end effector 17 positionable within a patient 16.
In this configuration, the manipulator arm receives the surgical device assembly 14 at the terminal portion 13 as shown in
The end effector 17 may be one of many different types of that are used in surgery including, without limitation, end effectors 17 having one or more of the following features: jaws that open and close, section at the distal end of the shaft that bends or articulates in one or more degrees of freedom, a tip that rolls axially relative to the shaft 15, a shaft that rolls axially relative to the manipulator arm 11. The system includes instrument actuators for driving the motion of the end effector 17. These actuators, which might be motors or other types of motors (e.g. hydraulic/pneumatic), are positioned in the terminal portion 13 of the robotic manipulator, or in the housing 20 of the surgical device assembly, or some combination of the two. In the latter example, some motion of the end effector might be driven using one or more motors in the terminal portion 13, while other motion might be driven using motors in the housing 20.
During use, the robotic system controls movement of the robotic manipulator and movement of the end effector (e.g. jaw open/close, tip roll, articulating or bending, etc.) based on surgeon input received by the system via the console 12. The control signals used to generate the various types of movement depend in some cases on the geometry, length, weight, or other parameters of the surgical instrument 14.
This application describes embodiment of instruments inside of other instruments for use in surgery or medical diagnostics. In some embodiments these instruments may be rigid instruments designed for use in robotic laparoscopic procedures performed using trocars giving access into a body cavity such as the abdominal cavity. In other embodiments the internal instrument may be a flexible instrument. Embodiments described herein allow support or engagement of a tissue using an outer instrument while allowing diagnostics, characterization or even biopsy using a second instrument extending through an internal working channel of the outer instrument. The diameters of the outer instrument and the inner working channel will be selected as appropriate for the desired application. In one non-limiting example described herein, the diameter of the outer instrument shaft is 5 mm and the working channel is 2 mm. In some embodiments, the outer instrument can also articulate in one or more directions.
Referring to
The distal end of the outer shaft 102 is configured into a jaw end effector 104. The end effector may be comprised of various types and shapes, designed for different surgical interventions. Examples include, fixed-jaw needle drivers, fenestrated graspers, rat tooth graspers, shears, clamps or other atraumatic geometries. The jaw end effector may be laser cut out of the tubular member or affixed to the tubular structure in other methods.
Tendons are used to control the articulation of the outer shaft and may also be capable of controlling the open/close position of the end effector. In some cases, one component/jaw of the end effector may be fixed. In other cases, both jaws in the end effector may be pivotable.
The tendons may extend along the inner wall of the outer shaft and may be constrained between an inner tubular structure and the outer tubular shaft. In the
The inner tubular structure 108 has an open working channel 110 through which other instruments or diagnostic tools 112 can be inserted to perform various functions. As an example, a fiber optic camera could be used to inspect the tissue grasped within the jaws of the outer tube for cancerous tissue. Alternatively, tools used for laser ablation may be inserted into the working channel to perform ablation on the tissue grasped within the jaws. In this case, the jaws may protect other tissue from the laser, reducing the risk of harming adjacent tissue.
In
The instrument can have one of two primary configurations. In a first primary configuration, the outer shaft forms an open working channel through which the users could insert any second instrument or material that fits within the working channel diameter. A second primary configuration is a closed system in which the working channel is already populated within an inner instrument/working channel implement. In the second case, the working channel implement may be controlled through the same robotic manipulator as the external instrument. In the first case, the working channel implements may be controlled manually by an external user, controlled by a second robotic manipulator, or controlled by the first robotic manipulator by attaching the implement to the housing of the instrument in such a way as to enable coupling of the first robotic manipulator to the working channel implement controls.
There are a number of different applications for an instrument such as the one described above. The following examples are intended to illustrate the variety of applications, but not to be all-inclusive.
In the
In the
The
Finally, in the
Other examples within the scope of this disclosure may include clip or tack delivery through the working channel or even the use of diagnostic tools such as catheters to deliver radiopaque materials to targeted tissue for imaging purposes.
The described embodiments allow the surgeon to insert various instruments or tools through a working channel of an instrument that can grasp tissue. Grasping the tissue prior to diagnostics could make the diagnostic procedures more accurate, by holding the tissue still during the characterization. It may also protect adjacent tissue from laser ablation through tissue isolation within the instrument jaws.
All patents and applications referred to herein, including for purposes of priority, are incorporated herein by reference.
Number | Date | Country | |
---|---|---|---|
62612545 | Dec 2017 | US |