The present invention generally relates to controlling articulated instruments in medical robotic systems and in particular, to controller assisted reconfiguration of an articulated instrument during movement into and out of an entry guide for tool exchange and other purposes.
Medical robotic systems such as teleoperative systems used in performing minimally invasive surgical procedures offer many benefits over traditional open surgery techniques, including less pain, shorter hospital stays, quicker return to normal activities, minimal scarring, reduced recovery time, and less injury to tissue. Consequently, demand for such medical robotic systems is strong and growing.
One example of such a medical robotic system is the da Vinci® Surgical System from Intuitive Surgical, Inc., of Sunnyvale, Calif., which is a minimally invasive robotic surgical system. The da Vinci® Surgical System has a number of robotic arms that move attached medical devices, such as an image capturing device and Intuitive Surgical's proprietary EndoWrist® articulated surgical instruments, in response to movement of input devices by a surgeon viewing images captured by the image capturing device of a surgical site. Each of the medical devices is inserted through its own minimally invasive incision into the patient and positioned to perform a medical procedure at the surgical site. The incisions are placed about the patient's body so that the surgical instruments may be used to cooperatively perform the medical procedure and the image capturing device may view it without their robotic arms colliding during the procedure.
A minimally invasive surgery may employ a number of different surgical instruments. When a different tool is desired during the surgical procedure, the surgical instrument may be withdrawn from the surgical site so that it can be removed from its associated arm and replaced with an instrument bearing the desired end effector. The desired surgical instrument is then inserted into the surgical site. A surgical instrument may also be withdrawn from a surgical site for reasons other than to replace the end effector. For example, the loading of a clip in a clip applier used in affixing tissue may occur outside the patient's body. In this case, each time a new clip is desired, the clip applier may be removed from the surgical site to load the clip and then reintroduced into the patient's body to apply the clip. As another example, removal of tissue or an object within a patient may involve grasping the tissue or object with an end effector while withdrawing the surgical instrument from the patient's body so that the tissue or object held by its end effector may be removed.
To perform a tool exchange for a medical robotic system, however, takes time. Moreover, it may be difficult to bring the new tool into the field of view manually after a tool exchange operation. It is also possible for the operator to misjudge the depth of insertion and place the tool too deep into the surgical site, which may cause unintended contact between the tool and the patient's anatomy. To avoid such contact, the operator is likely to move the new tool very slowly into the surgical site. These factors contribute to make a tool exchange operation a time-consuming process.
U.S. Pat. No. 6,645,196, which is incorporated herein by reference, describes a guided tool exchange procedure employable in a medical robotic system, such as the afore-described da Vinci® Surgical System, to guide a new tool quickly and precisely, after a tool exchange operation, into close proximity to the operating position of the original tool prior to its removal from a surgical site.
To perform certain medical procedures, it may be advantageous to use a single entry aperture, such as a minimally invasive incision or a natural body orifice, to enter a patient to perform a medical procedure. For example, an entry guide may first be inserted, positioned, and held in place in the entry aperture. Instruments such as an articulated camera and a plurality of articulated surgical tools, which are used to perform the medical procedure, may then be inserted into a proximal end of the entry guide so as to extend out of its distal end. Thus, the entry guide provides a single entry aperture for multiple instruments while keeping the instruments bundled together as it guides them toward the work site.
Due to the limited number of articulated instruments that may be disposed in the entry guide at one time, it may be necessary to exchange one articulated instrument in the entry guide for another instrument that performs a different function during the performance of a medical procedure. Alternatively, in lieu of exchanging the articulated instrument, only its end effector may be changed. As used herein, the phrase “tool exchange” is to be understood to cover both cases. To perform the tool exchange, the articulated instrument is retracted back into the entry guide and taken out through the entry guide's proximal end while other articulated instruments extending out of the distal end of the entry guide are either held in place or controlled by associated input devices. A new instrument (or old instrument with a new end effector) is then inserted into the entry guide and extended out of the entry guide's distal end. To retract the articulated instrument back into the entry guide, it may be necessary to first change the pose of the instrument (i.e., reconfigure its joints and links) so that it can be fully retracted into the entry guide. Since the instrument being retracted into the entry guide may be outside the field of view of an articulated camera instrument also extending out of and fixed in position relative to the distal end of the entry guide, possible collisions with other objects is a safety concern during blind retractions of an old tool into the entry guide from a surgical site and blind insertions of a new tool out of the entry guide towards the surgical site.
Accordingly, one object of one or more aspects of the present invention is a medical robotic system and method implemented therein which provides controller assisted reconfiguration of a pose of an articulated instrument during movement of the articulated instrument into and out of an entry guide for tool exchange and other purposes.
Another object of one or more aspects of the present invention is a medical robotic system and method implemented therein that places the articulated instrument into an entry pose so that the articulated instrument may be fully retracted into the entry guide in response to user initiated retraction of the articulated instrument towards and into the entry guide.
Another object of one or more aspects of the present invention is a medical robotic system and method implemented therein that places a new tool being extended out of an entry guide in the same pose that an old tool it has replaced was in prior to the tool exchange in response to user initiated insertion of the tool out of the entry guide.
Another object of one or more aspects of the present invention is a medical robotic system and method implemented therein that facilitates selective retraction/insertion of one or more articulated instruments into/out of an entry guide under user control while other articulated instruments extending out of the entry guide are either fixed in position or responsive to manipulation of associated input devices.
Still another object of one or more aspects of the present invention is a medical robotic system and method implemented therein that assists a user to perform a tool exchange without harming a patient or damaging any devices of the medical robotic system.
Yet another object of one or more aspects of the present invention is a medical robotic system and method implemented therein that provides sensory information to a user of the medical robotic system to aid the user in safely performing a tool exchange.
These and additional objects are accomplished by the various aspects of the present invention, wherein briefly stated, one aspect is a medical robotic system comprising: an entry guide; an articulated instrument disposed within the easy guide; means for allowing a user to command the articulated instrument to be retracted into the entry guide; and a controller configured to cause the articulated instrument to be reconfigured from a deployed pose in which the articulated instrument is incapable of being retracted into the entry guide to an entry pose in which the articulated instrument is capable of being retracted into the entry guide in response to the user commanding the articulated instrument to be retracted into the entry guide.
Another aspect is a method for moving an articulated instrument into and out of an entry guide, the method comprising: receiving a retraction command; determining whether a current configuration of the articulated instrument is in an entry pose in which the articulated instrument is capable of being retracted into the entry guide; causing the articulated instrument to be configured into the entry pose in response to the retraction command if the current configuration is determined not to be in the entry pose; and causing the articulated instrument to be retracted into the entry guide in response to the retraction command after the current pose is determined to be in the entry pose.
Additional objects, features and advantages of the various aspects of the present invention will become apparent from the following description of its preferred embodiment, which description should be taken in conjunction with the accompanying drawings.
In the present example, an entry guide (EG) 200 is inserted through a single entry aperture 150 into the Patient 40. Although the entry aperture 150 is a minimally invasive incision in the present example, in the performance of other medical procedures, it may instead be a natural body orifice. The entry guide 200 is held and manipulated by a robotic arm assembly 130.
As with other parts of the medical robotic system 100, the illustration of the robotic arm assembly 130 is simplified in
The console 10 includes a three-dimensional (3-D) monitor 104 for displaying a 3-D image of a surgical site to the Surgeon, left and right hand-manipulatable input devices 108, 109, and a processor 102. The input devices 108, 109 may include any one or more of a variety of input devices such as joysticks, gloves, trigger-guns, hand-operated controllers, or the like. Other input devices that are provided to allow the Surgeon to interact with the medical robotic system 100 include a foot pedal 105, a voice recognition system 160 and a Graphical User Interface (GUI) 170.
The console 10 is usually located in the same room as the Patient so that the Surgeon may directly monitor the procedure, is physically available if necessary, and is able to speak to the Assistant(s) directly rather than over the telephone or other communication medium. However, it will be understood that the Surgeon can also be located in a different room, a completely different building, or other remote location from the Patient allowing for remote surgical procedures.
As shown in
Preferably, input devices 108, 109 will be provided with at least the same degrees of freedom as their associated tools 231, 241 to provide the Surgeon with telepresence, or the perception that the input devices 108, 109 are integral with the tools 231, 241 so that the Surgeon has a strong sense of directly controlling the tools 231, 241. To this end, the monitor 104 is also positioned near the Surgeon's hands so that it will display a projected image that is oriented so that the Surgeon feels that he or she is actually looking directly down onto the work site and images of the tools 231, 241 appear to be located substantially where the Surgeon's hands are located.
In addition, the real-time image on the monitor 104 is preferably projected into a perspective image such that the Surgeon can manipulate the end effectors 331, 341 of the tools 231, 241 through their corresponding input devices 108, 109 as if viewing the work site in substantially true presence. By true presence, it is meant that the presentation of an image is a true perspective image simulating the viewpoint of an operator that is physically manipulating the end effectors 331, 341. Thus, the processor 102 transforms the coordinates of the end effectors 331, 341 to a perceived position so that the perspective image being shown on the monitor 104 is the image that the Surgeon would see if the Surgeon was located directly behind the end effectors 331, 341.
The processor 102 performs various functions in the system 100. One important function that it performs is to translate and transfer the mechanical motion of input devices 108, 109 through control signals over bus 110 so that the Surgeon can effectively manipulate devices, such as the tools 231, 241, camera 211, and entry guide 200, that are selectively associated with the input devices 108, 109 at the time. Another function is to perform various methods and implement various controllers described herein.
Although described as a processor, it is to be appreciated that the processor 102 may be implemented in practice by any combination of hardware, software and firmware. Also, its functions as described herein may be performed by one unit or divided up among different components, each of which may be implemented in turn by any combination of hardware, software and firmware. Further, although being shown as part of or being physically adjacent to the console 10, the processor 102 may also comprise a number of subunits distributed throughout the system.
For additional details on the and operation of various aspects of a medical robotic system such as described herein, see, e.g., U.S. Pat. No. 6,493,608 “Aspects of a Control System of a Minimally Invasive Surgical Apparatus,” and U.S. Pat. No. 6,671,581 “Camera Referenced Control in a Minimally Invasive Surgical Apparatus,” which are incorporated herein by reference.
If it is necessary to change a tool being used during a procedure, the Assistant may remove the tool from the entry guide 200 and perform a tool exchange by replacing either the entire articulated instrument with another instrument or just its end effector with another end effector, such as the tool 131 from a Tray (“T”) in the operating room wherein both the instrument and its end effector is referred to herein as a “tool”. Either the Assistant or the Surgeon may control the retraction of the old tool back into the entry guide 200 for replacement and control the insertion (also referred to herein as “extension”) of the new tool out of the entry guide 200 back to the surgical site. If the Surgeon wants the Assistant to perform the retraction and insertion of the tool, the Surgeon may directly instruct the Assistant to do so if they are within hearing distance of each other or the Surgeon may speak into a microphone on the console 10 so that the Assistant can hear the Surgeon's instructions on a headset or speaker. The Surgeon may also indicate to the Assistant which tool is to be exchanged by causing a light emitting diode (“LED”) on the tool's manipulator to blink on and off. If the Assistant is to perform the retraction and insertion of the tool, then the tool is preferably disassociated from the input devices 108, 109 during the tool exchange, so that the Surgeon may use the input devices 108, 109 to operate other instruments in the medical robotic system 100.
Each of the devices 231, 241, 251, 211, 200 is manipulated by its own manipulator. In particular, the camera 211 is manipulated by a camera manipulator (ECM) 212, the first surgical tool 231 is manipulated by a first tool manipulator (PSM1) 232, the second surgical tool 241 is manipulated by a second tool manipulator (PSM2) 242, the third surgical tool 251 is manipulated by a third tool manipulator (PSM3), and the entry guide 200 is manipulated by an entry guide manipulator (EGM) 202.
Each of the instrument manipulators 232, 242, 252, 212 is a mechanical assembly that carries actuators and provides a mechanical, sterile interface to transmit motion to its respective articulatable instrument. Each instrument 231, 241, 251, 211 is a mechanical assembly that receives the motion from its manipulator and, by means of a cable transmission, propagates the motion to its distal articulations (e.g., joints). Such joints may be prismatic (e.g., linear motion) or rotational (e.g., they pivot about a mechanical axis). Furthermore, the instrument may have internal mechanical constraints (e.g., cables, gearing, cams, belts, etc.) that force multiple joints to more together in a pre-determined fashion. Each set of mechanically constrained joints implements a specific axis of motion, and constraints may be devised to pair rotational joints (e.g., joggle joints). Note also that in this way the instrument may have more joints than the available actuators.
As an example, as shown in
The first and second joints 323, 325 are referred to as “joggle joints”, because they cooperatively operate together so that as the second link 324 pivots about the first joint 323 in pitch and/or yaw, the third link 326 pivots about the second joint 325 in a complementary fashion so that the first and third links 322, 326 always remain parallel to each other. The first link 322 may also rotate around its longitudinal X-axis in roll 294 as well as move in and out in an insertion/retraction direction 291 (e.g., insertion towards the work site and retraction from the worksite) through the passage 441 of the entry guide 200. The wrist assembly 327 also has pitch and yaw angular movement capability so that the end effector 341 may be oriented up or down and to the right or left, and combinations thereof.
Thus, the manipulator 242 can manipulate the instrument 241 in four degrees of freedom movement. In particular, it has an insertion/retraction 291, roll 294 (about the longitudinal X-axis of the first link 281), pitch 292 (about a Y-axis which is orthogonal to the X-axis), and yaw 293 (about a Z-axis which is orthogonal to the X-axis and Y-axis) degrees of freedom movement. Manipulators 232, 252, 212 may also manipulate their respective instruments 231, 251, 211 in the same four degrees of freedom movement. Consequently, any of the instruments 231, 241, 251, 211 may be coupled to and manipulated by any of the manipulators 232, 242, 252, 212.
Each of the input devices 108, 109 may be selectively associated with one of the devices 211, 231, 241, 251, 200 through a multiplexer (MUX) 270 so that the associated device may be controlled by the input device through its controller and manipulator. For example, the Surgeon may specify the association through the GUI 170 for the left and right input devices 108, 109 to be respectively associated with the first and second surgical tools 231, 241, which are telerobotically controlled through their respective controllers 233, 243 (preferably implemented in the processor 102) and manipulators 232, 242 so that the Surgeon may perform a medical procedure on the Patient while the surgical tool 251, camera 211 and entry guide 200 are each soft locked in place through their respective controllers 253, 213, and 203. If the Surgeon desires to control the surgical tool 251 using one of the input devices 108, 109, then the Surgeon may do so by simply disassociating the input device from its currently associated device and associating it instead to the tool 251. The Surgeon may then instruct the Assistant to perform a tool exchange for the disassociated tool.
As alternatives to the GUI 170 for providing selection input for the MUX 270, the selective association of the input devices 108, 109 to devices may be performed by the Surgeon using voice commands understood by the voice recognition system 160, and/or by the Surgeon depressing a button on one of the input devices 108, 109 or depressing the foot pedal 105, and/or using any other well known mode switching technique.
Similar to the instrument 241, the articulated instrument 600 has an end effector 640, three joints 621, 631, 641, and three links 610, 620, 630 coupled to the joints as shown. Joints 621, 631 (referred to as “joggle joints”) are constrained to move together in tandem so that the longitudinal axes 612, 632 respectively of links 610, 630 are always parallel to each other. In addition to being controllably rotated in pitch, the joint 621 may also be controllably rotated in a yaw about a yaw axis that is perpendicular to both the pitch axis and longitudinal axis 612. Although the joints 621, 631, 641 are shown as single joints, each of the joints 621, 631, 641 may comprise a plurality of joints, each of which in turn, provides a different degree-of-freedom movement. For example, the joint 621 may comprise both a pitch joint and a yaw joint that are slightly spaced apart from each other. In addition to joints 621, 631, 641, two additional joints are provided for manipulating the articulated instrument 600. A roll joint allows the link 610 and consequently, all the joints and links attached to it, to be controllably rotated in roll about the longitudinal axis 612 and a prismatic input/output (IO) joint allows the link 610 and consequently, all the joints and links attached to it, to be controllably translated along the longitudinal axis 612. Since the roll and prismatic joints are dedicated to manipulating the link 610 of the articulated instrument 600, they are referred to herein as also being joints of the articulated instrument 600.
To initiate the method of
If the determination in 501 is YES, then in 502, the method monitors a user operated unit to sense a retraction command from the user. For example, the instrument manipulator (e.g., 232, 242) that manipulates the instrument 600 may be used for such a user operated unit, in which case, a button (or other type of switch) may be provided on or near the manipulator which when depressed by the Assistant 30, indicates that retraction mode is believed to have been entered so that the manipulator's controller (e.g., 233, 243) allows the Assistant 30 to manually move a part of the manipulator that causes the instrument 600 to move in and out of the entry guide 601 along the longitudinal axis 612. As another example, the input device (e.g., 108, 109) associated with the instrument 600 may be used for such a user operated unit, in which case, a button (or other type of switch) may be provided on or near the input device which when depressed by the Surgeon 20, indicates that retraction mode is believed to have been entered so that the controller associated with the input device allows the Surgeon 20 to teleoperatively cause the associated instrument 600 to move in and out of the entry guide 601. Other examples of a user operated unit that may be used by a user to enter retraction mode and issue retraction commands include the GUI 170, the voice recognition system 160 and the foot pedal 105.
Alter sensing a retraction command in 502, the method next determines in 503 whether the current configuration of the articulated instrument 600 is in an entry pose in which the instrument 600 can be fully retracted into the entry guide 601. An example of such an entry pose is shown in
In addition to the end effector 640 preferably being lined up with the first link 610 in the entry pose as shown in
If the determination in 503 is NO (i.e., the articulated instrument 600 is not in the entry pose), then the articulated instrument 600 is by default in a deployed pose in which the articulated instrument 600 is incapable of being fully retracted into the passage 602 of the entry guide 601, such as shown in the deployed pose of
If the determination in 504 is NO (i.e., the safety margin has not been reached), then in 505-507, the method performs a number of tasks preferably concurrently through appropriate constraints placed in inverse kinematics equations used in the instrument's manipulator. In 505, the method inhibits a distal end 643 of the articulated instrument 600 from moving in an opposite direction from the retraction direction (i.e., in the insertion direction) beyond its initial position at the start of retraction while the method is changing the current configuration of the articulated instrument 600 towards the entry pose in 506 and moving the articulated instrument 600 in the retraction direction in response to the retraction command in 507. The rate that the method changes the configuration of the instrument to the entry pose is preferably related to the rate that the user is commanding the instrument to be retracted into the entry guide 601 and the initial distance of the proximal end of the articulated instrument 600 (i.e., its most proximal joint outside of the entry guide 601) from the distal end 651 of the entry guide 601. Thus, the faster the user commands the instrument 600 to be retracted, the faster the method changes its configuration to the entry pose; and the closer the proximal end of the instrument is to the distal end 651 of the entry guide 601, the faster the method changes the instrument's configuration to the entry pose.
Also, while performing 506, it is necessary for the method to avoid collisions with other instruments or harming the patient while moving the instrument 600 into its entry pose. For example, as shown in
One technique that may be used for performing 505 is illustrated in
On the other hand, if the determination in 504 is YES (i.e., the distance between the proximal end of the articulated instrument 600 and distal end of the entry guide 601 is less than the safety margin), then the method inhibits the articulated instrument 600 from being retracted towards the entry guide 601, proceeds to 508 to move the current configuration of the articulated instrument 600 towards the entry pose, and then loops back to 503. Thus, once the safety margin distance is reached, no further retraction of the articulated instrument 600 is allowed until its configuration is in the entry pose. To provide an indication to the user that the retraction of the instrument 600 is being inhibited, haptic feedback in the form of a resistive force that is proportional to a difference between the current pose of the instrument 600 and the entry pose may be provided to the user operated unit so as to be felt by the user. As long as the user commands a retraction against the haptic force, the method continues to move the current configuration of the articulated instrument 600 towards the entry pose in 508. Conversely, if the user does not command a retraction against the haptic force, the current configuration remains in the same pose by causing its controller to soft lock in place. Once a determination is made in 503, however, that the instrument 600 is in the entry pose, the haptic force may be removed and the method jumps to 507 to allow the instrument 600 to be retracted into the entry guide 601 by looping through 501-503 and 507 until the retraction of the articulated instrument 600 is completed as indicated, for example, by the user turning the retraction mode off. After fully retracting the articulated instrument 600 out of the proximal end of the entry guide 601, it may then be removed so that either a new instrument 900 may be inserted in its place or a new end effector attached to it in place of the end effector 640.
After performing the tool exchange, it may be desirable to put the new articulated instrument into the configuration that the old articulated instrument was in before retraction so that the instrument appears in the same position in the field of view of an image capturing device and consequently, in an image that is captured by the image capturing device and displayed on a monitor to the surgeon. Placing the instrument in the same configuration (i.e., same positions for joints and links of the articulated instrument) may also have the advantage of eliminating or at least simplifying necessary re-alignment between the input device and the instrument's manipulator once complete operator control is re-established for the instrument through a control system used to teleoperate it.
Although the retraction of only a single articulated instrument 600 is described above, the method is also applicable and intended to cover the retraction of multiple articulated instruments at a time into the entry guide. For example, any two or more of the devices (e.g., tools 231, 241) may be retracted together into the entry guide 200 in response to user interaction with the user operated unit (e.g., one of the input devices 108, 109) while the other devices (e.g., camera 211, tool 251) are either held in place (e.g., camera 211) or manipulated (e.g., tool 251) by their associated manipulators (e.g., 252) in response to their associated input devices (e.g., one of the input devices 108, 109 which is not being used as the user operated unit for retraction purposes). In particular, two or more instruments extending out of the entry guide may be selected for retraction, for example, by the surgeon using the GUI 170 so that their respective controllers each implement the method described in reference to
Although a fixed configuration in which the longitudinal axes of the links 610, 620, 630 and end effector 640 all line up as shown in
Since the articulated instrument 600 may not be within the field of view of an image capturing device (such as the articulated stereo camera 211 extending out of the distal end of entry guide 200 as shown in
The auxiliary view 1300 is useful information for the user because the user maintains primary control of the instrument while causing it to be retracted into or inserted out of the entry guide. In particular, although the instrument's controller reconfigures the instrument's pose during its movement into and out of the entry guide, such reconfiguration is in response to the user's action so that it may be stopped or reversed by the user stopping or reversing the direction of its movement. Thus, if the auxiliary view 1300 (or other sensory cue such as an audio cue, other visual cue, or haptic cue) indicates that the instrument is being placed in an unsafe position and/or configuration, the user may prevent it from doing so at any time. Further, if the user decides to abort the retraction of a tool into its entry guide for any reason, its controller using stored information of its initial deployed pose prior to retraction movement may assist the user in repositioning the tool to the initial deployed pose and position.
Although the various aspects of the present invention have been described with respect to a preferred embodiment, it will be understood that the invention is entitled to full protection within the full scope of the appended claims.
This application is a continuation to U.S. application Ser. No. 12/613,328 filed Nov. 5, 2009, now U.S. Pat. No. 9,084,623, which is a continuation-in-part to U.S. application Ser. No. 12/541,913 filed Aug. 15, 2009, now U.S. Pat. No. 8,903,546, each of which is incorporated herein by reference.
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