In conventional surgery, a surgeon has to cut openings in a patient large enough to allow visualization of and manual access to the surgical site. In the past two decades, however, medical surgery has steadily advanced to include Minimally Invasive Surgery (MIS), which includes surgical techniques that are less invasive than conventional surgery.
Minimally invasive diagnostic and/or surgical procedures benefit patients with reduced trauma and faster healing time by providing doctors and surgeons with access to internal organs via a limited number of small incisions in a patient's body. Typically, cannulas or sleeves are inserted through small incisions to provide entry ports through which surgical instruments are passed. These access ports, however, constrain instruments for the procedures to only four degrees-of-freedom (DoFs) and limit their distal dexterity. To help doctors and surgeons overcome these difficulties, a large number of robotic devices and systems have been designed for many minimally invasive procedures.
Despite the large number of previous works, however, current robotic instruments are still too large and/or have insufficient dexterity for some clinical applications. For instance, clinical applications characterized by deep and narrow diagnostic/surgical fields, such as neurosurgery, fetal surgery, and transurethral resection of bladder tumors, are beyond the capabilities of existing commercial diagnostic/surgical systems owing to size and dexterity limitations.
In addition, current robotic instruments require a long pre-operative and intra-operative preparation for deployment. Deploying the robotic instruments for a surgery, for instance, requires the instruments to be precisely positioned in the operating room before the patient is brought in and then still further adjusted to orient the instruments towards the surgical site after the patient is brought in to the operating room. This pre-operative preparation can be cumbersome for pre-scheduled surgeries, and it is a critical bottleneck for the surgeries that cannot be pre-scheduled, such as emergency operations. In fact, surgeons in emergency operations are often left with no choice but to revert to conventional open surgery due to unacceptable delays in deploying the robotic instruments.
Rapidly deployable flexible robotic systems and methods are provided. The disclosed subject matter allows for rapid deployment of flexible robotic instrumentation for minimally invasive diagnosis and intervention. The disclosed subject matter also facilitates minimally invasive surgery in deep surgical sites where rigid manual instruments, such as rigid endoscopy and laparascopy equipment, are cumbersome, or unable to navigate around and gain access to targeted tissues or organs.
In one embodiment, a robotic system is provided. The robotic system includes a continuum robot, an actuation unit, and a flexible positioning shaft. The continuum robot is configured to perform minimally invasive diagnostic, surgical or therapeutic techniques, and includes at least one continuum segment including a plurality of backbones. The continuum segment carries at least one diagnostic, surgical or therapeutic instrument in a flexible instrumentation housing that has a plurality of instrumentation channels. The actuation unit is configured to actuate the continuum robot by providing linear actuation to each of the plurality of backbones, and includes force sensors for measuring actuation forces. The flexible positioning shaft is configured to direct a position and orientation of the continuum robot and to couple the actuation unit to the continuum robot.
In another embodiment, a method for deploying a robotic device is provided. The method includes: providing a robotic device including an actuation unit, a flexible positioning shaft, and a continuum robot that is actuated by the actuation unit for performing minimally invasive procedures, wherein the robotic device is mounted on a linear stage and wherein the flexible positioning shaft is configured to couple the actuation unit to the continuum robot; positioning the robotic device with respect to a surgical bed; adjusting the flexible positioning shaft to orient the robotic device towards an entry to a targeted surgical site; and inserting the robotic device into the entry by advancing the linear stage.
In yet another embodiment, a robotic system for minimally invasive urologic procedures is provided. The robotic system includes a continuum robot, an actuation unit, and a flexible shaft section. The continuum robot is configured for performing minimally invasive urologic procedures and includes a proximal continuum segment that is serially coupled to a distal continuum segment. The serially coupled segments include a plurality of backbones and carry at least one diagnostic, surgical or therapeutic instrument. The actuation unit is configured for actuating the continuum robot by providing linear actuation to each of the plurality of backbones and includes force sensors for measuring actuation forces. The flexible shaft section is configured for directing a position and orientation of the continuum robot and for coupling the actuation unit to a transurethral resectoscope. The transurethral resectoscope guides a flexible instrument housing and the at least one instrument from the actuation unit to the continuum robot. An adjustment arm rigidly anchors a proximal end and a distal end of the flexible shaft for adjusting the flexible shaft section to a desired position and orientation.
Rapidly deployable flexible robotic systems and methods are provided. In some embodiments of the disclosed subject matter, rapidly deployable flexible robotic systems are provided for minimally invasive diagnosis and surgery in deep surgical sites where rigid manual instrumentation is unable to navigate around or gain access to targeted tissues or organs.
In some embodiments, adjustable positioning shaft 103 may allow rapid positioning of continuum robot 105 in a manner in which surgical and/or diagnostic instruments can be brought in and out of the surgical workflow rapidly. In some embodiments, adjustable positioning shaft 103 may use an internal cable tension that is controlled either manually or by computer such that the cable can be loosened when manual repositioning of adjustable positioning shaft 103 is desired and tightened when repositioning is complete to lock in the newly positioned configuration.
In some embodiments, bending section of continuum robot 105 can be extended or retracted from the distal end of adjustable positioning shaft 103. In some embodiments, continuum robot 105 may be deployed via a master interface coupled to a master console that includes a display and an interface for controlling continuum robot 105 and inserted instrumentation.
In some embodiments, actuation unit 301 may be a six DoF bundled actuation unit with integrated force sensors. In some embodiments, actuation unit 301 includes three concentric backbone actuation assemblies, each of which includes coupled actuation cylinders. Each of the cylinders actuates one of the six total actuation lines in continuum robot 305. In some embodiments, for instance, each coupled stage includes a primary and a secondary cylinder and actuates the proximal and distal segments of each backbone in continuum robot 305.
In some embodiments, cone assembly 307 routes the actuation lines of continuum robot 305 from actuation unit 301 into flexible instrumentation housing 313 that guides the actuation lines and instrumentation to continuum robot 305. In some embodiments, the instrumentation is inserted into the flexible housing through the proximal end of instrumentation channel 311.
In some embodiments, adjustable positioning shaft 303 provides a manually adjustable flexible section that directs the position and orientation of continuum robot 305. Adjustable positioning shaft 303 enables rapid deployment of robotic system 300 in the operating room by providing the capability to change the position and orientation of robotic system 300, thereby reducing the amount of time required to prepare the system for, e.g., a surgery.
In some embodiments, actuation unit 400 is mounted on an insertion stage 417 through a connection plate 419. In some embodiments, the backbones of a continuum robot coupled to actuation unit 400 are routed from concentric actuation assemblies 401, 403, and 405 through the backbone spacing cone assembly 407 to the continuum robot.
In some embodiments, each of lead screw nuts 517 and 519 inside respective pistons 509 and 511 includes two elements that can be tightened on lead screw 513 or 515 with respect to each other to remove backlash between piston 509 or 511 and lead screw 513 or 515. In some embodiments, linear motion of pistons 509 and 511 can be dually measured by motor encoders, which are integrated into motors 505 and 507, and linear potentiometers 521 and 523. In some embodiments, primary cylinder piston 511 is rigidly connected by shear pins to a connection arm 525 that is clamped to the outside diameter of secondary cylinder 503.
In some embodiments, the secondary backbones of the proximal segment of a continuum robot is connected to a base 527 of secondary cylinder 503, thereby the motion of primary cylinder piston 511 drives the proximal secondary backbone relative to primary cylinder 501. In some embodiments, secondary cylinder piston 509 is attached to the connection of a secondary backbone wire 529 of the distal segment of a continuum robot through a secondary cylinder load cell 531. Secondary cylinder load cell 531 can directly measure actuation forces in the distal secondary backbones of the continuum robot.
In some embodiments, concentric backbone actuation assembly 500 is connected to the base plate of an actuation unit through a primary cylinder load cell 533. Primary cylinder load cell 533 can measure the sum of the actuation forces in a set of coaxial secondary backbones attached to the assembly. In some embodiments, concentric backbone actuation assembly 500 is supported on nylon bushings at the proximal end of primary and secondary cylinders 501 and 503 to prevent moments on primary cylinder load cell 533.
Each of segments 601 and 603 is constructed from one centrally located passive primary backbone 617 and three radially symmetric, actuated secondary backbones 619 and 621 that are bounded by end disks 605 (proximal segment end disk) or 607 (distal segment end disk) and a multitude of spacer disks 609, which maintain approximate radial symmetry as the segment moves through a workspace.
In some embodiments, secondary backbones 619 (proximal secondary backbones) and 621 (distal secondary backbones) are equally spaced with a separation angle β (shown in
Continuum robot 600 provides a set of instrumentation channels 615 for carrying surgical instruments, such as a biopsy forceps 611, and visualization instruments, such as a fiberscope 613. In some embodiments, fiberscope 613 is a flexible 1 mm diameter fiberscope with a 10 k pixel fused image guide. In some embodiments, fiberscope 613 is coupled to a camera system.
Referring to
ψ(k)=[θ(k),δ(k)]T (1)
where (•)(k) for k=1, 2, . . . denotes a variable associated with the kth segment and θ(k) and δ(k) define respectively the bending angle and the orientation of the bending plane of the segment.
The inverse kinematics relating the configuration space, ψ(k), to the joint space
q
(k)
=[q
1,(k)
, . . . ,q
m,(k)]T
is given by
L
j,(k)
=L
(k)
+q
j,(k)
=L
(k)+Δj,(k)Θ(k). j=1, . . . ,m (2)
where Lj,(k) is the length of the jth secondary backbone 703 of the kth segment, L(k) is the length of the primary backbone 701 of the kth segment,
The instantaneous inverse kinematics can be described by differentiating equation (2) to yield
{dot over (q)}(k)=Jqψ
where the Jacobian Jqψ
where cα cos(α) and sα sin(α).
The direct kinematics of the kth segment is given by the position b
the kinematics takes the form
where {circumflex over (v)}=[0, 1, 0]T, ŵ=[0, 0, 1]T and the frames {g(k)} and {b(k)} are as shown in
For
the formulation singularity,
resolves to
b
P
b
g
=[00L(k)]T (7) and
b
R
g
=Iε
3×3. (8)
By differentiating Equations (5) and (6), the instantaneous direct kinematics takes the form
b
t=J
tψ
{dot over (ψ)}(k)
where, for
the Jacobian Jqψ
and, for
the formulation singularity, Jqψ
In some embodiments, adjustment shaft 803 may allow rapid positioning of continuum robot 805 in a manner in which surgical and/or diagnostic instruments can be brought in and out of the surgical workflow rapidly. In some embodiments, adjustment shaft 803 may use a manually controlled internal cable tension such that the cable can be loosened when manual adjustment of adjustment shaft 803 is desired and tightened when an adjustment is complete.
In some embodiments, adjustment shaft 803 is constructed using a plurality of segments 811 and a set of locking cables 813. In some embodiments, locking cables 813 lock adjustment shaft 803 when tightened via a cam lock mechanism controlled by locking handle 809. In some embodiments, locking handle 809 may directly tighten locking cables 813 via a capstan.
In some embodiments, actuation unit 901 is equipped with force sensing capability. In some embodiments, flexible shaft section 903 is supported by adjustment arm 909 that is independent and separate from flexible shaft section 903. In some embodiments, adjustment arm 909 is manually adjustable and lockable. In some embodiments, adjustment arm 909 rigidly anchors at the proximal and distal ends of flexible shaft section 903 to support shaft section 903. In some embodiments, adjustment arm 909 is configured to couple to urologic resectoscope 905.
In some embodiments, support struts 921 may be made from stainless steel or other suitable flexible alloy. In some embodiments, adjustment arm 909 rigidly anchors only at the external support structure such that PTFE extrusion 913 can slide in the trajectory defined by the external supporting structure.
Together, adjustment arm 909 and flexible shaft section 903 provide for rapid deployment of robotic instruments into a surgical environment. Flexible shaft section 903 allows insertion of the robotic instruments without requiring the time consuming alignment of the inserted section of the robotic system 900 to a patient's urethra, thereby providing minimal disruption of the clinical work flow for deployment and removal of the robotic instruments.
In order to perform a transurethral resection, in some embodiments, robotic system 1000 is fixed to a surgical bed and positioned relative to a patient with bladder cancer by advancing robotic system 1000 toward the patient's urethra using linear stage 1003. After robotic system 1000 is positioned near the urethra, the flexible shaft section 1005 is further adjusted using adjustment arm 1007 for rapid transurethral deployment.
Once resectoscope 1009 is transurethrally deployed, actuation unit 1001 is used to actuate continuum robot 1011 by manipulating proximal and distal continuum segments 1013 and 1015 to search for and reach the parts of bladder where suspicious tissue and visible lesions 1019 are located for resection using electrocautery loops 1017.
Kinematics analysis was performed in a MATLAB computing environment to assess workspace 1103 relating to resection of tumors throughout the bladder. The analysis shows that a rapidly deployable flexible robotic system, such as robotic system 1000, is capable of visualizing and reaching throughout the bladder, including anterior aspects, as shown in
At 1205, the robotic device is oriented toward an entry to a targeted surgical site, such as urethra, oral opening, or an incision made near a targeted surgical site. In some embodiments, a flexible shaft that couples a continuum robot of the robotic device and an actuation unit for the robot is adjusted for rapid deployment of the robot. In some embodiments, an adjustment arm anchored at the proximal and the distal ends of the flexible shaft section is adjusted for orienting the robotic device to facilitate rapid deployment of the device into a restricted anatomy or opening. As shown in
At 1207, the robotic device is inserted into an entry to a targeted surgical site. For a transurethral resection of bladder tumors, as shown in
At 1209, the robotic device is actuated to perform a minimally invasive procedure. For the transurethral resection of bladder tumors, for instance, suspicious tissue and visible lesions 1019 are resected using electrocautery loop 1017 and removed from the bladder.
Although the invention has been described and illustrated in the foregoing illustrative embodiments, it is understood that the present disclosure has been made only by way of example, and that numerous changes in the details of implementation of the invention can be made without departing from the spirit and scope of the invention. Features of the disclosed embodiments can be combined and rearranged in various ways.
This application claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Patent Application No. 61/368,193, filed on Jul. 27, 2010 and U.S. Provisional Patent Application No. 61/470,730, filed on Apr. 1, 2011, each of which is hereby incorporated by reference herein in its entirety.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/US11/45357 | 7/26/2011 | WO | 00 | 9/3/2013 |
Number | Date | Country | |
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61368193 | Jul 2010 | US | |
61470730 | Apr 2011 | US |