Patent Application
20220241029
A portion of the disclosure of this patent document contains material that is subject to copyright protection. The copyright owner has no objection to the reproduction of the patent document or the patent disclosure, as it appears in the U.S. Patent and Trademark Office patent file or records, but otherwise reserves all copyright rights whatsoever.
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The present invention relates to surgical devices and associated methods for performing surgery. More particularly, the present invention relates to tools and methods for minimally invasive surgery using concentric tube assemblies.
Minimally invasive surgery using electromechanical robots is a developing field of medicine. Conventional devices for performing minimally invasive surgery, such as endoscopes and resectoscopes, generally include a distal tip that is inserted through an incision or a natural orifice in a patient's body. The distal tip includes an optical lens which allows a surgeon to see a field of view proximate to the distal tip when placed inside the body. The endoscope will typically have a camera attached to the lens to display the field of view on an operating room monitor. In some applications the endoscope includes a camera installed on the distal tip of the endoscope. The device also includes a narrow working channel extending through the device. One or more elongated surgical tools may be inserted through the working channel. A tool such as a cutting device, a basket or a laser optic may be included on the surgical tool. The distal end of the surgical tool protrudes from the distal tip of the device, thereby allowing the surgeon to visually observe operation of the tool inside the patient's body during an operation.
Conventional surgical tools for use through the narrow working channel of an endoscope or resectoscope are generally limited in size, and are particularly limited in the range of motion and freedom of manipulation of the tool ends extending from the distal end of the endoscope or resectoscope. Curved channels within the endoscope or resectoscope have been proposed as a possible solution to achieve a better range of motion and better ability to manipulate tools in the workspace. However, providing curved channels for passage of surgical tools inside the narrow confines of an endoscope or resectoscope present additional challenges. For example, curved concentric tubes tend to align with the plane of curvature of the channel in which the concentric tube is housed. As a result, a curved tube of a surgical tool positioned inside a curved channel on an endoscope may provide improved range of motion when extended from the distal end of the channel, but such a configuration does not provide an optimal solution when manipulation outside of the plane of curvature of the channel is desired.
Over the past few decades, it has become increasingly clear that entering the body in the most minimally invasive way possible during surgery provides tremendous patient benefit. Minimally invasive surgery is a general term used to describe any surgical procedure that enters the body without large, open incisions. Conventional devices for performing minimally invasive surgery, such as endoscopes and resectoscopes, are generally rigid and include a distal tip that is inserted through an incision in a patient's body or a natural orifice in a patient's body. The distal tip includes an optical lens which allows a surgeon to see a field of view proximate to the distal tip when placed inside the body. The endoscope will typically have a camera attached to it to display the field of view on an operating room monitor. In some applications the endoscope includes a camera installed on the distal tip of the endoscope. The device also includes a working channel extending through the device. One or more elongated surgical tools may be inserted through the working channel. A tool such as a cutting device, a basket or a laser optic may be included on the surgical tool. The distal end of the surgical tool protrudes from the distal tip of the device, thereby allowing the surgeon to visually observe operation of the tool inside the patient's body during an operation.
Minimally invasive surgery includes laparoscopic surgery, which uses a tube to deliver visualization (i.e. an endoscope) and view the surgical field and long, rigid instruments that pass through small ports in the body. In conventional laparoscopic surgery, the endoscope is usually used only for visualization of the surgical field and does not have tools passing through it. The tools are pivoted outside of the body and through the incision port to provide instrument manipulation at the surgical site. The tool manipulation in laparoscopic surgery is created by pivoting long, rigid shafts through ports in the body. For surgery in the insufflated abdomen, chest cavity, pelvis or any other anatomical working volume with sufficient space, this concept often provides an excellent minimally invasive solution for delivering instrument manipulation. However, when the surgical site is down a long, narrow channel, the ability to pivot these long, rigid shafts diminishes. The tool's manipulation ability drops off sharply as access channels become longer and/or narrower.
Minimally invasive surgery also includes endoscopic surgery. While laparoscopic surgery uses endoscopes to provide visualization, endoscopic surgery differs in that the surgical instruments are passed through a working channel of the endoscope tube itself. Some examples of surgical instruments that can be used during endoscopic surgery are scissors, forceps, laser fibers, and monopolar/bipolar cautery. There are both rigid and flexible endoscopes rigid endoscopes being used in surgeries where a straight, linear path can be taken from the outside of the body to the surgical site, and flexible endoscopes being used where winding through curving anatomy is required. Rigid endoscopes are currently used in almost every area of surgery, including but not limited to neurologic, thoracic, orthopedic, urologic and gynecologic procedures. While rigid endoscopy is currently used in surgeries all over the body, it is not without drawbacks. Tools that operate through the working channel of rigid endoscopes are similar to laparoscopic tools in that they are normally straight, rigid tools. Generally, these tools are also limited to two degrees-of-freedom motion relative to the endoscope: they can insert/retract and rotate axially. Sometimes, the surgeon may have the ability to pivot/tilt the endoscope outside of the body, which makes things particularly challenging, as whenever the endoscope moves, the field of view of the endoscope moves along with it. Also, the surgeon can only get one instrument at a time to the surgical site the vast majority of the time due to the size constraints of the working channel of the endoscope effectively eliminating the ability for two-handed bimanual tasks. This limitation to a single tool at a time, the constantly changing field of view, limited degrees of freedom, and lack of instrument dexterity at the tip of the endoscope make endoscopic surgery a particularly challenging type of minimally invasive surgery.
Because they are particularly skilled with precision, spatial reasoning, and dexterity, electromechanical surgical robots have great potential to aid in surgical instrument manipulation and is a rapidly developing field of medicine. Surgical robots have gained widespread adoption throughout the world and have been utilized in hundreds of thousands of procedures. The majority of surgical robotic systems designed thus far that aid in instrument manipulation can be generally categorized into pivoted and flexible tools. Pivoted, laparoscopic-like systems such as the widely used da Vinci Xi robot, made by Intuitive Surgical, Inc., gain instrument manipulation in the same way that laparoscopic tools do: by tilting through a port in the body. For surgical applications where tilting or pivoting of the tools is not possible outside of the body, several groups in the research community have been developing robotic systems based on flexible elements. These systems are often referred to as continuum robots, or a continuously bending, robot with an elastic structure. There also exist concentric tube manipulators, which are a class of miniature, needle-sized continuum robot composed of concentric, elastic tubes. Concentric tube robots appear promising in many kinds of minimally invasive surgical interventions that require small diameter robots with articulation inside the body. Examples include surgery in the eye, ear, sinuses, lungs, prostate, brain, and other areas. In most of these applications, higher curvature is generally desirable to enable the robot to turn “tighter corners” inside the human body and work dexterously at the surgical site. In the context of endoscopic surgery, the precurvatures of the concentric tubes determine how closely the manipulators can work to the tip of the endoscope, which is very important during endoscopic surgery.
With traditional endoscopic procedures, surgeons typically hold the endoscope in one hand and the endoscopic instrument in the other, making it generally not possible for the surgeon to simultaneously manipulate two instruments. Due to the human error aspect, whenever the surgeon needs to swap one endoscopic instrument out for another, it can result in awkward and potentially dangerous endoscope movements. Surgeons often, however, need the ability to accurately and simultaneously manipulate two instruments in certain situations especially when trying to grasp, manipulate, and cut material precisely. Even where endoscopes can accommodate more than one tool simultaneously, the tools can only be oriented straight out and parallel to one another, which prohibits truly collaborative work between the tools. Surgeons can greatly benefit from the increased precision, dexterity, and vision that robotic surgery systems offer, but such conventional systems are limited in their manipulability.
Another problem with conventional surgical robots is that parallel tube configurations extending from endoscopic devices do not provide triangulation of the tools in a workspace in the field of view near the tip of the endoscope. Additionally, such conventional configurations include tubes that extend generally parallel along a longitudinal axis, which makes it nearly impossible to apply off-axis forces for pushing or pulling tissue from side to side. Such configurations place also place a nominal interaction point where first and second tools interact significantly beyond the field of view and effective workspace at the tip of the endoscope. As such, it is difficult to manipulate tissue using two endoscopic tools working together using conventional devices.
What is needed, then, are improvements in devices and methods for performing robotic surgery, and specifically for controlling and manipulating first and second tools in cooperation, in a field of view near the tip of an endoscopic device.
This Brief Summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This Summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to be used as an aid in determining the scope of the claimed subject matter.
A device for performing minimally invasive surgery includes a concentric tube assembly with a distal tip configured for insertion into a patient's body through a small incision or orifice. The tube assembly includes a channel and a guide tube housed within the channel. The guide tube is configured to translate axially and to rotate relative to the channel. An inner tube is positioned inside the guide tube and is also independently moveable in axial translation and rotation relative to the guide tube. The guide tube is operable to steer the distal end of the inner tube to a desired location in a tissue workspace defined at the end of the tube assembly.
The guide tube includes a pre-shaped, highly-curved distal end. The channel also has a curved shape near its distal opening. The curved channel and highly-curved guide tube work together to form an elbow-like configuration, allowing the guide tube to enter a tissue workspace at an angle relative to a centerline axis. Such an angled entry into the workspace provides superior triangulation and manipulation of tissue.
In some embodiments, the present disclosure provides an apparatus for performing surgery, comprising a surgical robot including an endoscopic device extending from the surgical robot, the endoscopic device including an outer sheath, an inner sheath and a channel disposed inside the inner sheath. A guide tube is positioned inside the channel, the guide tube including a proximal end extending toward the surgical robot and a highly-curved distal end extending away from the surgical instrument. An inner tube is housed inside the guide tube, wherein the inner tube is axially moveable and rotatable relative to the guide tube. The highly-curved distal end of the guide tube includes a curvature between about 50 m{circumflex over ( )}(−1) and about 100 m{circumflex over ( )}(−1).
In further embodiments, the highly-curved distal end of the guide tube includes a curvature between about 50 m{circumflex over ( )}(−1) and about 100 m{circumflex over ( )}(−1).
In additional embodiments, the present disclosure provides an apparatus for performing surgery, comprising a surgical robot including an endoscopic device extending from the surgical robot, the endoscopic device including an outer sheath, an inner sheath and first and second channels disposed inside the inner sheath. A first guide tube is positioned inside the channel, the first guide tube including a proximal end extending toward the surgical robot and a first highly-curved distal end extending away from the surgical robot. A second guide tube is positioned inside the channel, the second guide tube including a proximal end extending toward the surgical robot and a second highly-curved distal end extending away from the surgical robot. A first inner tube is housed inside the first guide tube, wherein the first inner tube is axially moveable and rotatable relative to the first guide tube. A second inner tube is housed inside the second guide tube, wherein the second inner tube is axially moveable and rotatable relative to the second guide tube. The first highly-curved distal end of the first guide tube includes a curvature between about 50 m{circumflex over ( )}(−1) and about 100 m{circumflex over ( )}(−1), and the second highly-curved distal end of the second guide tube includes a curvature between about 50 m{circumflex over ( )}(−1) and about 100 m{circumflex over ( )}(−1).
In further embodiments, the first highly-curved distal end of the first guide tube includes a curvature of about 72 m{circumflex over ( )}(−1), and the second highly-curved distal end of the second guide tube includes a curvature of about 72 m{circumflex over ( )}(−1).
Another objective of the present disclosure is to provide a device and methods for effectively manipulating tissue using first and second tools in a field of view near the tip of an endoscopic device.
Numerous other objects, advantages and features of the present disclosure will be readily apparent to those of skill in the art upon a review of the following drawings and description of a preferred embodiment.
While the making and using of various embodiments of the present invention are discussed in detail below, it should be appreciated that the present invention provides many applicable inventive concepts that are embodied in a wide variety of specific contexts. The specific embodiments discussed herein are merely illustrative of specific ways to make and use the invention and do not delimit the scope of the invention. Those of ordinary skill in the art will recognize numerous equivalents to the specific apparatus and methods described herein. Such equivalents are considered to be within the scope of this invention and are covered by the claims.
In the drawings, not all reference numbers are included in each drawing, for the sake of clarity. In addition, positional terms such as “upper,” “lower,” “side,” “top,” “bottom,” etc. refer to the apparatus when in the orientation shown in the drawing. A person of skill in the art will recognize that the apparatus can assume different orientations when in use.
The present disclosure provides a minimally invasive surgery apparatus including a guide tube with a highly-curved distal end. The guide tube is housed in a longitudinal channel along the length of an endoscope or resectoscope type tube assembly. The channel many have a straight or a curved profile in various embodiments. The guide tube includes a highly-curved configuration that provides for superior triangulation in the workspace and manipulability for a surgeon to engage tissue near the distal end of an endoscope or resectoscope. The parameters of curvature at the distal end of the guide tube are optimized to provide enhanced performance.
The distal section of the guide tube is highly-curved and is configured for deployment into a tissue workspace beyond the distal tip of the endoscope inside a patient's body. The distal section of the guide tube may be rotated and translated relative to the channel in which it is housed, and an inner tube including a surgical tool (such as an electrosurgery tool or cutting device) may be positioned inside the interior of the guide tube and extending out the distal end of the guide tube to access the tissue workspace within the field of view of a camera lens. The highly-curved distal end of the guide tube provides enhanced triangulation and dexterity in the workspace, and provides optimized performance for minimally invasive surgery.
As an example, an embodiment of a minimally invasive surgery apparatus 100 is shown generally in
An input console 200 is located remote from the support 12 and surgical robot apparatus 10. Input console 200 provides input to control one or more devices located on surgical robot apparatus 10.
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An embodiment of a tool cartridge 60 with an associated tube array 70 is shown in
During use, guide tube 72 may also be translated and rotated by independent drive components inside tool cartridge 60. As such, due to the curved portion 78 of the guide tube 72, a range of motion may be achieved by rotating and translating guide tube 72 and inner tube 74 using independent drive components in tool cartridge 60.
The tube array 70 is housed inside a longitudinal channel assembly, or sheath insert 30, on the interior of an endoscope or resectoscope type device in some embodiments. As shown in
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Steering plug 40, as shown in
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Steering plug 40 includes a first socket 132 shaped to receive the proximal end of first channel 32, and a second socket 134 shaped to receive the proximal end of second channel 34. Lens guide 43 defines a hollow passage in sheath adapter 45 shaped to receive passage of a lens, such as a fiber optic lens passing through the steering plug toward the distal end of the endoscope or resectoscope. As seen in
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Some prior conventional devices include a guide tube with a curved distal end of about 3% strain. Such embodiments would not be considered highly-curved and would not be capable of the triangulation advantages of the present disclosure. In some embodiments, the present disclosure provides a first guide tube 72 and a second guide tube 172 each with a highly-curved distal end 73, 173 having strain greater than about 5%, forming an elbow-shaped configuration that provides an improved triangulation orientation for performing surgery, as shown in
Inner tubes 74, 174 are provided with a lower curvature geometry in some embodiments to provide a natural feeling to a surgeon, due to common surgical tools having a reduced curvature, or substantially straight, orientation. For example, surgeons trained on laparoscopic equipment are used to having tools that translate axially into the workspace. For this reason, adapting surgical robots using endoscopic tools to have axial translation at the distal tip of the tool provides an intuitive approach for surgeons. As such, by providing inner tubes 74, 174 with a lesser curvature than the guide tube, that can be retracted or extended out the distal tip opening of guide tube 72, the present disclosure provides a system with an intuitive configuration for manipulating tissue using a tool on the distal tip of the inner tube 74 in a field of view of an endoscope or resectoscope.
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In some embodiments, the second curved region 78b includes less than about 10.0 mm of the end of the guide tube 72. In further embodiments, the second curved region 78b includes a curvature of about 40 m{circumflex over ( )}(−1) to provide an improved range of motion. In further embodiments, the second curved region 78b includes about 5.0 mm at the end of the guide tube 72, and includes a curvature of between about 35 m{circumflex over ( )}(−1) and about 45 m{circumflex over ( )}(−1). In some embodiments, the first curved region has a curvature of between about 50 m{circumflex over ( )}(−1) and about 100 m{circumflex over ( )}(−1). In further embodiments, the first curved region has a curvature of about 72 m{circumflex over ( )}(−1), and second curved region has a curvature of about 40 m{circumflex over ( )}(−1).
In further embodiments, the disclosure provides first and second guide tubes, each guide tube including a double-curvature configuration. In some embodiments, the first curved region of each guide tube includes a shape-set curvature between about 70 m{circumflex over ( )}(−1) and about 75 m{circumflex over ( )}(−1). The second curved region of each guide tube includes a shape-set curvature of about 40 m{circumflex over ( )}(−1) along the last five millimeters of each guide tube.
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In further embodiments, the present invention provides a method of performing minimally invasive surgery. The method includes providing a surgical instrument including a base and a tube assembly. The tube assembly includes a channel and a guide tube disposed in the channel, wherein the guide tube is axially moveable and rotatable inside the channel. The guide tube includes a proximal section and a highly-curved distal section positioned away from the base. An inner tube can be housed inside the guide tube from the base to the distal tip of the tube assembly. The method further includes a step of rotating the proximal section of the guide tube to cause a corresponding rotation of the distal end of the guide tube; translating the guide tube to a desired location in a tissue workspace; translating the inner tube through the highly-curved guide tube until the distal end of the inner tube is guided to a desired location in the tissue workspace by the guide tube; and performing a surgical procedure using the surgical tool.
Thus, although there have been described particular embodiments of the present invention of a new and useful CONCENTRIC TUBE APPARATUS FOR MINIMALLY INVASIVE SURGERY, it is not intended that such references be construed as limitations upon the scope of this invention.
