Remote catheter manipulator

Information

  • Patent Grant
  • 11376085
  • Patent Number
    11,376,085
  • Date Filed
    Monday, January 13, 2020
    4 years ago
  • Date Issued
    Tuesday, July 5, 2022
    2 years ago
Abstract
A robotic instrument driver for elongate members includes a first elongate member, and at least one manipulator mechanism configured to manipulate the first elongate member, and at least one articulating drive configured to articulate the first elongate member, positionable on a bed and beside a patient access site. The manipulator and articulating drive are positioned relative to each other a distance less than the insertable length of the first elongate member, stationary in position.
Description
BACKGROUND

Robotic interventional systems and devices are well suited for performing minimally invasive medical procedures as opposed to conventional techniques wherein the patient's body cavity is open to permit the surgeon's hands access to internal organs. Advances in technology have led to significant changes in the field of medical surgery such that less invasive surgical procedures, in particular, minimally invasive surgery (MIS), are increasingly popular.


MIS is generally defined as surgery that is performed by entering the body through the skin, a body cavity, or an anatomical opening utilizing small incisions rather than large, open incisions in the body. With MIS, it is possible to achieve less operative trauma for the patient, reduced hospitalization time, less pain and scarring, reduced incidence of complications related to surgical trauma, lower costs, and a speedier recovery.


MIS devices and techniques have advanced to the point where an elongated catheter instrument is controllable by selectively operating tensioning control elements within the catheter instrument. In one example, a remote catheter manipulator (RCM) or robotic instrument driver utilizes four opposing directional control elements which extend to the distal end of the catheter. When selectively placed in and out of tension, the opposing directional control elements may cause the distal end to steerably maneuver within the patient. Control motors are coupled to each of the directional control elements so that they may be individually controlled and the steering effectuated via the operation of the motors in unison.


At least two types of catheters may be employed for surgical procedures. One type includes an electrophysiology (EP) catheter that only requires a navigating distance of 15 cm or less. EP catheters also may be relatively thick and stiff and thus, due their short navigating length and high stiffness, EP catheters typically do not suffer from a tendency to buckle during use.


In comparison to EP procedures, vascular procedures include a greater amount of catheter insertion length, a greater number of catheter articulation degrees of freedom (DOFs), and a mechanism for manipulation of a guide wire. For that reason, known bedside systems provides mounting for splayer actuation hardware configured to provide the catheter insertion lengths, mounting which accounts for an increase in splayer size due to added DOFs, and mounting for a guide wire manipulator. Thus, vascular catheters typically include a relatively long stroke, such as one meter or more. Relative to EP catheters, vascular catheters are typically smaller, thinner and more flexible, and therefore have a greater tendency to buckle than EP catheters. As such, it is typically desirable to feed vascular catheters into the patient with minimal bending to reduce the tendency to buckle. Known vascular robotic catheter systems are therefore typically suspended over the patient that is lying prone on a bed.


A vascular catheter (elongate member) catheter system typically includes elongate members that include an outer catheter (sheath), an inner catheter (leader), and a guidewire. Each is separately controllable and therefore they can telescope with respect to one another. For instance, a sheath carriage controls operation of the sheath and is moveable about a generally axial motion along the patient, and a leader carriage controls operation of the guidewire and is likewise moveable about the generally axial direction of the patient. Typically, the leader carriage and the sheath carriage are positioned on a remote catheter manipulator (RCM), which is supported by a setup joint (SUJ). Because the sheath carriage and leader carriage are traditionally aligned along the insertion axis, this configuration results in the RCM taking up significant space and the RCM being restricted to a specific orientation and alignment based on the insertion location. The SUJ is typically positioned on a rail that is itself mounted to the bed, below which the patient is positioned.


The RCM typically carries the weight of both carriages as well as the other hardware that are used to operate the system. And, to provide a full stroke, the SUJ is passed through the full range of motion which, as stated, can exceed one meter. To do so, typically the SUJ is moved or rotated with respect to the rail and the rail is stationary. For this reason, a bedside system is typically included that provides mounting for splayer actuation hardware configured to provide catheter insertion lengths, and mounting for a guide wire manipulator. Because this hardware is supported by the SUJ, the system can not only be cumbersome to work with, but it can interfere with other system operation (such as the C-arm and monitors), as well as provide significant weight that is carried by the bed.


However, in some clinical situations, it is difficult, if not impossible to orient the RCM such that it is aligned along the insertion axis. For instance, in some MIS procedures an imaging device may be required in addition to the RCM. In order for the imaging device to scan the entire body, the RCM should be oriented so that it is not obstructing the imaging devices ability to capture the entire body. For example, if the insertion location is at the patient's thigh and catheter is directed towards the patient's heart, the current RCM configuration would require the RCM to be located at the base of the patient's bed below their feet. The likelihood of the catheter buckling between the RCM and the insertion location also increases as the distance between the RCM and the insertion location increases and often requires more than one person to assist in operation of the RCM, especially during tool exchanges.


As such, there is a need for an improved catheter system that can handle functional challenges experienced with long catheters and provides greater flexibility with regard to the orientation of the RCM with regard to the insertion axis. There is also a need to for an improved catheter system that operates over a smaller footprint and weighs less.


SUMMARY

A medical device comprising a sheath catheter and at least one feed mechanism is disclosed herein. The feed mechanism includes a pair of radially arranged drive wheels opposite one another, each wheel having a wheel rotation axis. The drive wheels cooperate to define a feed axis along which the sheath catheter is advanced and retracted. The feed axis is oriented generally orthogonal to the wheel rotation axes. The feed axis is configured to change the orientation of the sheath catheter when the sheath catheter is disposed within the feed mechanism.


An alternative configuration for a medical apparatus comprises a robotic instrument driver, a sheath splayer and a guide splayer. The sheath splayer and guide splayer are operatively engaged with the robotic instrument driver. The sheath splayer carries the catheter sheath, and the guide splayer carries the sheath catheter. The sheath splayer is defined by a catheter sheath operational axis and the guide splayer is defined by a guide catheter operational axis, wherein the sheath operational axis and guide catheter operational axis are oriented parallel to one another and laterally spaced apart from one another. First and second feed mechanisms are also provided. The first feed mechanism is positioned between the sheath splayer and the guide splayer and configured to orient the guide catheter about 180° from the guide catheter operational axis so as to be coaxial with the catheter sheath operational axis. The second feed mechanism is positioned distally of the sheath splayer and is configured to orient the sheath catheter about 180° from the catheter sheath operational axis so as to be coaxial with a feed axis that is oriented parallel to the catheter sheath operational axis.


A further alternative configuration of a medical device comprises a robotic instrument driver, a sheath splayer and a guide splayer. The sheath splayer and guide splayer are operatively engaged with the robotic instrument driver. The sheath splayer carries the sheath catheter, and the guide splayer carries the guide catheter. The guide splayer is positioned over the sheath splayer in a stacked relationship. The sheath catheter is defined by a sheath catheter operational axis and the guide splayer is defined by a guide catheter operational axis and the sheath operational axis and guide operational axis are oriented parallel to one another and spaced apart from one another. First and second feed mechanisms are also provided. The first feed mechanism is positioned between an entrance of the sheath splayer and an exit of the guide splayer and configured to orient the guide catheter about 180° from the guide catheter operational axis so as to be coaxial with the catheter sheath operational axis. The second feed mechanism is positioned distally of the sheath splayer and is configured to orient the sheath catheter about 180° from the catheter sheath operational axis so as to be coaxial with a feed axis that is oriented parallel to the catheter sheath operational axis.





BRIEF DESCRIPTION OF THE DRAWINGS

While the claims are not limited to a specific illustration, an appreciation of the various aspects is best gained through a discussion of various examples thereof. Referring now to the drawings, exemplary illustrations are shown in detail. Although the drawings represent the illustrations, the drawings are not necessarily to scale and certain features may be exaggerated to better illustrate and explain an innovative aspect of an example. Further, the exemplary illustrations described herein are not intended to be exhaustive or otherwise limiting or restricted to the precise form and configuration shown in the drawings and disclosed in the following detailed description. Exemplary illustrations are described in detail by referring to the drawings as follows:



FIG. 1 illustrates an exemplary robotic surgical system.



FIG. 2 is an illustration of an exemplary catheter assembly of the surgical system of FIG. 1.



FIG. 3 is a schematic plan view of an embodiment of a robotically controlled medical apparatus.



FIG. 4A illustrates a schematic plan view of a robotically controlled medical apparatus having a selectively positionable feed mechanism.



FIG. 4B is a partial elevational view of a distal end of the robotically controlled medical apparatus of FIG. 4A.



FIG. 5 illustrates a schematic plan view of an alternative configuration for a robotically controlled medical apparatus having operational axes of catheter splayers and guide splayers oriented parallel to one another.



FIG. 6 illustrates a schematic plan view of an alternative configuration for a robotically controlled medical apparatus of FIG. 5, wherein the catheter splayer and guide splayer are configured as a combined unit.



FIG. 7 illustrates a schematic perspective view of an alternative configuration for an exemplary robotically controlled medical apparatus including a guide splayer and sheath splayer assembled together in a stacked relationship.



FIG. 8A-8C illustrates an exemplary process for removing a tool from the robotically controlled medical apparatus of FIG. 5.





DETAILED DESCRIPTION OF THE INVENTION

Referring to FIG. 1, a robotic surgical system 100 is illustrated in which an apparatus, a system, and/or method may be implemented according to various exemplary illustrations. System 100 may include a robotic catheter assembly 102 having a sheath instrument 104 and/or a catheter instrument 106. Catheter assembly 102 is controllable using a robotic instrument driver 108 (generally referred to as “instrument driver”). During use, a patient is positioned on an operating table or surgical bed 110 to which robotic instrument driver 108 is coupled or mounted. In the illustrated example, system 100 includes an operator workstation 112, an electronics rack 114 including a control system, such as a computer (not shown). In some instances, a setup joint mounting brace 116 may be used to support the robotic catheter assembly 102. In certain procedures, a surgeon is seated at operator workstation 112 and can monitor the surgical procedure, patient vitals, and control one or more catheter devices.


Operator workstation 112 may include a computer monitor to display a three dimensional object, such as a catheter displayed within or relative to a three dimensional space, such as a body cavity or organ, e.g., a chamber of a patient's heart. In one example, an operator uses one or more input devices 120 to control the position of a catheter or other elongate instrument. In response to actuation of the input device by a user, the input device can output positioning information for the desired position of the catheter instrument, including the three-dimensional spatial position of the distal end of a steerable catheter. System components, including the operator workstation, electronics rack and the instrument driver, may be coupled together via a plurality of cables or other suitable connectors 118 to provide for data communication, or one or more components may be equipped with wireless communication components to reduce or eliminate cables 118. Communication between components may also be implemented over a network or over the internet. In this manner, a surgeon or other operator may control a surgical instrument while located away from or remotely from radiation sources. Because of the option for wireless or networked operation, the surgeon may even be located remotely from the patient in a different room or building.


An exemplary instrument driver 108 is illustrated in FIG. 2. The instrument driver 108 may robotically insert/retract a leader catheter 103 relative to a sheath catheter 105. To this end, the proximal ends of sheath catheter 105 and leader catheter 103 are mechanically interfaced to a housing of the instrument driver 108 in such a manner that the sheath and leader catheters 105, 103 may be axially translated relative to each other via operation of motors, thereby effecting insertion or retraction movements of the respective sheath catheter 105 and leader catheter 103. In the illustrated embodiment, the sheath catheter 105 and leader catheter 103 respectively include proximal steering adapters 104, 106 (“splayers”) mounted to associated mounting plates 202, 204 on a top portion of the instrument driver 108. The mounting plate 202 is affixed to the distal end of the instrument driver 108, whereas the mounting plate 204 is affixed to a carriage (not shown) within the housing of the instrument driver 108 that can be translated relative to the mounting plate 202 via one or more motors (not shown) within the housing of the instrument driver 1, thereby allowing the splayer 106 to be translated relative to the splayer 104, and thus, the associated leader catheter 103 to be inserted/retracted within the sheath catheter 105. In the illustrated embodiment, each of the splayers 104, 106 can be actuated via motors (not shown) within the housing of the instrument driver 108 to deflect or articulate the distal ends of the respective catheters 103, 104 in any direction.


It is desirable to have the instrument driver 108 positioned close to the patient for a number of reasons, including, for example to facilitate tool removal over the table 110 rather than risk tools falling to the floor. However, the instrument drivers 108 are generally heavy, due to the internal components required to advance and articulate the catheters. Moreover, for procedures where a relatively long stroke of a catheter is used, the instrument driver 108 has a sufficient length to operate the catheter system. Thus, known systems use a setup joint 116 to support the instrument driver 108 close to the patient. The positioning of the instrument driver 108 on the setup joint, however, may lead to other issues, such as blocking intra-operative imaging equipment, such as a C-arm or monitor (not shown).


Further, certain issues are experienced when tool exchanges are required during a procedure. For example, therapeutic tools are inserted into the sheath catheter 105. To accomplish this task, the guide catheter 103 is removed from the sheath catheter 105. A separate guide wire (not shown) is also included, but the tool is advanced over the guide wire for delivery, which takes two people.


To address some of these issues, alternative arrangements of the guide and sheath splayers are proposed herein, which serve to minimize the length and weight of the instrument driver, thereby eliminating the requirement of a SUJ, and even permitting the instrument driver to be mounted directly to a bed rail. Moreover, the exemplary arrangements disclosed herein also provide for positioning of the instrument driver close to the patient, thus permitting the instrument driver to be positioned adjacent an introducer.


Referring to FIG. 3, a first exemplary configuration will be described. FIG. 3 illustrates a schematic plan view of an exemplary configuration of an instrument driver 308. A guide splayer 306 and a sheath splayer 304 are operatively mounted to the instrument drive 308. Guide splayer 306 is mounted on a carriage 313 that can translate relative to sheath splayer 304. Operatively connected to the guide splayer 306 is a guide catheter 303, and operatively connected to the sheath splayer 304 is a sheath catheter 305. The carriage 313 inserts the guide catheter 303 into the sheath catheter 305. A guide wire 307 may extend proximally of the guide splayer 306 and further include a guide wire manipulator 309.


In the embodiment illustrated in FIG. 3, sheath splayer 304 and guide splayer 306 are arranged to be generally aligned along a common axis A-A. In this manner, the guide catheter 303 is positioned within the sheath catheter 305, such that the guide catheter 303 and the sheath catheter 305 are arranged in a coaxial manner. Although splayers 304 and 306 are axially aligned, movement of guide catheter 303 and catheter sheath 305 can be controlled and manipulated independently, as will be explained in further detail below. The instrument driver 308 articulates guide and sheath splayer driveshafts by motors positioned in the rear of the instrument driver 308.


In the exemplary arrangement illustrated in FIG. 3, as the sheath catheter 305 exits the sheath splayer 304, the sheath catheter 305 is positioned within a manipulator or feed mechanism 330. This manipulator 330 may be configured to advance, retract or roll sheath catheter 305. It may also be configured to orientate the sheath catheter 305 such that it bends 180 into the feed mechanism 330. More specifically, the mechanism 330 is oriented such that an axis B-B extending through the mechanism 330 is generally parallel with the axis A-A along which the sheath and guide splayers 304, 306 are arranged. The sheath catheter 305 exits the mechanism 330 and can be directed into an introducer 335. This configuration permits a compact design, which can reduce the required length of the instrument driver 308, and also allow for easy draping of the surgical system. Surgical draping is in reference to the use of a curtain, bag, cloth or other acceptable sterile items that may be utilized to separate a sterile area from an unsterile area. It is advantageous to be able to place a surgical drape over items that are difficult to clean or items that need to be in the sterile field but are not sterile. By placing a surgical drape over these items, these items are prevented from coming into contact with sterile items. For example, the instrument driver 308 contains delicate and sensitive parts, so by placing a surgical drape over the instrument driver 308, it will not come into contact with blood or other contaminating materials and may not require cleaning.


In one embodiment, the manipulator mechanism 330 includes two radially oppositely arranged drive wheels 340. The drive wheels 340 may include an idle wheel 342 and an active wheel 344. The drive wheels 340 are each configured to rotate about an axes C-C that are orthogonal to the feed mechanism axis B-B. In one exemplary arrangement, the feed mechanism 330 may be fixedly connected to the instrument driver 308, along a side surface of the instrument driver 308. This configuration permits the feed mechanism to be placed next to the axis A-A so as to minimize wasted catheter length. As the drive wheels 340 are rotated in a first direction, the feed mechanism 330 serves to propel the sheath catheter 305, the guide catheter 303 inserted therein, and the guide wire 307 toward the patient. As the drive wheels 340 are rotated in a second direction, the catheter assembly is moved away from the patient. A similar manipulator mechanism (not shown) disposed within the instrument driver 308 proximal of the sheath splayer 304 serves to propel guide catheter 303. This manipulation may also involve insertion retraction or roll of the guide catheter relative to the sheath. In addition, a similar manipulator mechanism (not shown) disposed within the instrument driver 308 proximal of the leader splayer 306, or disposed proximal of instrument driver 308 (as shown) serves to propel the guide wire 307. It should be understood that sheath catheter 305, guide catheter 303 and guide wire 307 may all be manipulated independently from each other. Manipulation may involve insertion, retraction and roll for all 3 manipulators but preferred embodiments involve just insertion and retract for the sheath and guide manipulators and insertion, retraction and roll for the guidewire manipulator. It should be understood that while drive wheels are shown for the sheath manipulator 330 and a gripping pad 309 is shown for the guidewire manipulator, any active drive or manipulation device such as rotating pads, grippers, rollers, chucks etc. may be used in all cases


In one alternative embodiment, the manipulator 330 may be configured to pitch with respect to the drive wheels axes C-C, while the sheath splayer 304 and guide splayer 306 remain generally level with respect to the table 110. With this configuration, the opposing drive wheels 340 may be configured to selectively adjust an insertion angle of the catheter assembly as the catheter sheath 305 passes through the manipulator 340.


An alternative configuration of an instrument driver 408 is illustrated in FIG. 4A. Instrument driver 408 is substantially similar to the instrument driver 308 of FIG. 3 and may include corresponding features identified with reference numerals in the 400 series. More specifically, the instrument driver 408 includes a guide splayer 406 and a sheath splayer 404 operatively connected thereto. A guide catheter 403 is connected to the guide splayer 406 and the catheter sheath 405 is operatively connected to the sheath splayer 404. The guide splayer 406 is installed on a slidable carriage 413 that translates relative to sheath splayer 404. A guide catheter manipulator (not shown) is placed proximal to the sheath splayer to manipulate the guide catheter A guide wire 407 may extend proximally from the guide splayer 406 and further include a guide wire manipulator 409.


In the exemplary arrangement illustrated in FIG. 4A, as the sheath catheter 405 exits the sheath splayer 404, the sheath catheter 405 is positioned within a manipulator 430. However, in this embodiment, the manipulator 430 is connected to the instrument driver 408 such that the manipulator 430 may be selectively rotated about axis A-A along an arc. In one exemplary arrangement, the feed mechanism 430 may be mounted to a shaft 433 that is secured to a wheel 437 (shown in FIG. 4B) mounted for rotation about an axis D-D. With this configuration, feed mechanism 430 may be selectively repositioned from one side of the instrument driver 408 to the other, as illustrated by feed mechanism 440 displayed in phantom in FIG. 4A. The selective positioning of feed mechanism 440 allows for repositioning of the instrument driver 408 during a procedure to clear the surgical site so as to allow for fluoroscopy imaging. The selective positioning of feed mechanism 440 also allows for selective placement of the instrument driver 408 on either side of patient.


In another exemplary arrangement, sheath splayer 404 may rotate about an axis D-D to minimize wasted length on the sheath catheter. For example, as sheath 405 is inserted into the patient, via manipulator 409, the sheath splayer 404 may be configured to rotate toward the manipulator to minimize the length of catheter outside of the patient.


In one exemplary arrangement, the manipulator 430 may be configured to pitch with respect to an axis E-E that extends through the shaft 433, while the sheath splayer 404 and guide splayer 406 remain generally level with respect to the table 110. With this configuration, the opposing drive wheels 440 may be configured to selectively adjust an insertion angle of the catheter assembly as the catheter sheath 405 passes through the mechanism 440.


An alternative configuration of an instrument driver 508 is illustrated in FIG. 5. Instrument driver 508 has similar elements to the instrument driver 408 of FIG. 4 and may include corresponding features identified with reference numerals in the 500 series. More specifically, the instrument driver 508 includes guide splayer 506 and a sheath splayer 504 operatively connected thereto. A guide catheter 503 is connected to the guide splayer 506 and the catheter sheath 505 is operatively connected to the sheath splayer 504. A guide wire 507 may extend proximally of the guide splayer 506 and further include a guide wire manipulator 560.


The configuration of the instrument driver 508 in FIG. 5 differs from the arrangements shown in FIGS. 3-4 in that the guide splayer 506 and the sheath splayer 504 are arranged parallel to one another, as opposed to in-line with one another. In addition, the guide splayer 506 does not translate relative to sheath splayer 504. The guide catheter 503 bends 180° and feeds into the sheath splayer 504 by a guide manipulator mechanism 550 that is disposed at the entrance of the sheath splayer 504. The sheath catheter 505 also bends 180°, but in the opposite direction than the guide catheter 503, such that the catheter assembly is arranged in a general “S-shape”. The sheath catheter 505 feeds into an introducer 535 by a sheath manipulator mechanism 540.


The guide feed mechanism 550 is configured to orient the guide catheter 503 such that it bends 180° into the guide mechanism 550. More specifically, the mechanism 550 is oriented such that an axis extending through the guide mechanism 550 is generally coaxial with an axis A′-A′ along which the sheath splayer 504 is positioned. The sheath mechanism 540 is configured to orient the sheath catheter 505 such that it bends 180° into the sheath mechanism 540. More specifically, the sheath mechanism 540 is oriented such that an axis B-B extending through the sheath mechanism 540 is generally parallel to the axis A′-A′ along which the sheath splayer 504 is positioned at the start of a procedure. The sheath splayer 504 may be configured to rotate towards manipulator 540 as the sheath 505 is inserted through introducer 535 and the available sheath length outside the patient gets shorter.


A guidewire manipulator mechanism 560 is positioned adjacent an entrance to the guide splayer 506. The guidewire mechanism 560 is oriented such that an axis extending through the guide feed mechanism 560 is generally coaxial with an axis A2-A2 along which the guide splayer 506 is positioned. The guidewire manipulator 560 may also be configured to insert, retract and roll a guidewire. It should be understood that the feed roller embodiment of the guidewire manipulator 560 shown here and the gripper embodiment 409 shown above are representative embodiments of active drive manipulators. Any of these manipulation mechanisms may be used in any of the configurations.


The orientation of the sheath and guide splayers 504, 506 eliminates a linear insertion axis of the catheter sheath 505 and guide catheter 503, thereby reducing the size of the instrument driver 508. Reducing the size of the instrument driver 508 lends itself to a simple surgical drape of the catheter system.


The configuration of a catheter system with three different manipulator mechanisms 540, 550, 560 also allows the guide wire 507, guide catheter 503 and/or the sheath catheter 505 to be propelled or held in place individually. More specifically, the sheath mechanism 540 may be configured to insert, retract or roll the sheath catheter 505. The guide mechanism 550 inserts, retracts or rolls the guide catheter 503 and the guide wire mechanism 560 inserts, retracts or rolls guidewire 507. Thus, the combination of the three feed mechanisms 540, 550, and 560 allows the guide wire 507, sheath catheter 505, and/or guide catheter 503 (as shown in FIG. 5) to be propelled or held in place individually, altering the shape of the catheter system relative to a tip of the guide wire 507.


In such fashion and in one example, a robotic instrument driver for elongate members 508 includes a first elongate member 505, and at least one manipulator mechanism 540 configured to manipulate the first elongate member 505, and at least one articulating drive 504 configured to articulate the first elongate member 505, positionable on a bed 110 and beside a patient access site, wherein the manipulator 540 and articulating drive 504 are positioned relative to each other a distance less than the insertable length of the first elongate member, stationary in position. That is, a distance between manipulator 540 (and particularly between wheels 542, 544) and articulating drive 504 is less than a length of the first elongate member 505 that passes between them—i.e., the insertable length.


In one exemplary configuration, the sheath mechanism 540 may be configured to pitch with respect to an axis B-B that is generally transverse to the feed axis B-B, while the sheath splayer 504 and guide splayer 506 remain generally level with respect to the table 110. With this configuration, opposing drive wheels 542, 544 may be configured to selectively adjust an insertion angle of the catheter assembly as the catheter sheath 505 passes through the catheter feed mechanism 540.


The configuration in FIG. 5 also provides for ease of tool exchange during an intra-operative procedure. In fact, tool exchange can be performed by a single individual with the configuration set forth in FIG. 5, allowing for improved workflow. The tool exchange operation will be explained in further detail below.


Referring to FIG. 6, another alternative configuration for an exemplary instrument driver 608 is illustrated. Instrument driver 608 is substantially similar to the instrument driver 508 of FIG. 5 and may include corresponding features identified with reference numerals in the 600 series. However, the instrument driver 608 includes a combined sheath splayer 604/guide splayer 606, which are oriented in a parallel manner creating an S-shape catheter configuration similar to that which is shown and discussed above in connection with FIG. 5.


Referring to FIG. 7, a further exemplary arrangement of for an instrument driver 708 will now be described. Instrument driver 708 is similar to the configuration of instrument driver 608 of FIG. 6 and may include corresponding features identified with reference numerals in the 700 series. The instrument driver 708 has the guide splayer 706 and sheath splayer 704 stacked on top of one another. Stacking the guide splayer 706 on top of the sheath splayer 704 may further reduce the size of the instrument driver 708 as compared to other configurations. The guider catheter 703, as it exits the guide splayer 706, bends approximately 180° to where it is received by the sheath manipulator mechanism 750 and directed into the sheath splayer 704, orienting the guide catheter 703 in a generally vertical C-shape guide. The catheter sheath 705 exits the sheath splayer 704 and bends approximately 180° to where it is received by the sheath mechanism 740, orienting the catheter sheath 705 in a generally horizontal C-shape.


Referring to FIG. 8A-8C, an exemplary process for removing guide 503 or any other tool robotically or manually from the sheath catheter 505 will now be explained. For ease of description, the configuration of the instrument driver 508 will be used to explain the tool exchange process. FIGS. 8A-C illustrate the instrument driver 508 including guide or tool 503 connected to the guide splayer 506, sheath splayer 504, catheter manipulator mechanism 540 and tool (guide) manipulator mechanism 550 arranged so as to configure the catheter system in a generally S-shape configuration. To remove the guide or tool 503, the tool 503 and the guide wire 507 are both pulled in unison in direction R. In other words, the guide wire is inserted into the tool or guide at the same rate as the tool or guide is retracted from the sheath. This action will cause the guide wire 507 to be pulled through the guide splayer 506, as indicated by the phantom lines. This results in maintaining the tip of the guidewire in a fixed position relative to the sheath or relative to the patient. Once the guide catheter 503 is free from the sheath splayer 504, clamping or pinching 810 of the tool (guide) feed mechanism 550 may be applied to the wire 507 at the rear of the sheath splayer 504 to hold the tip of the wire 507 at the distal end thereof (located in the introducer 535 and thus not visible). The guide or tool may then be slid along the guide wire 507, until the guide or tool 503 is free from the guide wire 507, thereby removing the guide or tool 503 from the instrument driver 508. Once the guide or tool 503 is removed from the guide wire 507, a new tool may be installed over the guide wire 507. A similar but opposite sequence of moves enables the new tool to be loaded robotically into the sheath 505. This time, the guidewire 507 is retracted through manipulator 560 at the same rate as the new tool is inserted through manipulator 550 resulting in the distal tip of the wire not moving relative to the patient. The ability to change tools may allow the user to perform multiple procedures without having to remove the catheter sheath 505 from the patient between procedures. For example, a patient may require multiple therapeutic devices to be delivered at the same location. The ability to maintain the tip of the guide wire 507 at a deployed location in the body after a first tool is delivered allows the user to switch the tool 503 and insert the second therapeutic device without removing the entire catheter. Using a robotic system to exchange tools enable the tool exchange procedure to be carried out without image guidance such as fluoroscopy. With a manual procedure, the doctor would need to retract the guide with one hand at the same rate as he is inserting the wire with the other hand to ensure the wire tip stays in a fixed position. It is not possible for a human to coordinate movement of both hands reliably with long catheters and so fluoroscopic guidance is used to ensure the wire is not moving. Fluoroscopic imaging exposes doctors and staff to significant radiation. A robotic system with active drive manipulators as described here addresses this issue


With regard to the processes, systems, methods, heuristics, etc. described herein, it should be understood that, although the steps of such processes, etc. have been described as occurring according to a certain ordered sequence, such processes could be practiced with the described steps performed in an order other than the order described herein. It further should be understood that certain steps could be performed simultaneously, that other steps could be added, or that certain steps described herein could be omitted. In other words, the descriptions of processes herein are provided for the purpose of illustrating certain embodiments, and should in no way be construed so as to limit the claims.


Accordingly, it is to be understood that the above description is intended to be illustrative and not restrictive. Many embodiments and applications other than the examples provided would be apparent upon reading the above description. The scope should be determined, not with reference to the above description, but should instead be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. It is anticipated and intended that future developments will occur in the technologies discussed herein, and that the disclosed systems and methods will be incorporated into such future embodiments. In sum, it should be understood that the application is capable of modification and variation.


All terms used in the claims are intended to be given their broadest reasonable constructions and their ordinary meanings as understood by those knowledgeable in the technologies described herein unless an explicit indication to the contrary in made herein. In particular, use of the singular articles such as “a,” “the,” “said,” etc. should be read to recite one or more of the indicated elements unless a claim recites an explicit limitation to the contrary.

Claims
  • 1. A robotic system, comprising: a medical instrument comprising an elongate member configured for insertion into a patient;a splayer coupled to a first portion of the elongate member, the splayer configured to articulate a distal end of the elongate member; anda manipulator comprising drive wheels configured to axially translate the elongate member along a feed axis along which the elongate member is insertable into and retractable from the patient;wherein the splayer and the manipulator are oriented such that the elongate member bends and follows a non-linear path between the splayer and the manipulator.
  • 2. The robotic system of claim 1, wherein the manipulator and the splayer are repositionable relative to each other.
  • 3. The robotic system of claim 2, wherein the splayer is configured to be rotated toward the manipulator.
  • 4. The robotic system of claim 1, further comprising an instrument driver operatively coupled to the medical instrument through a mechanical interface on the splayer.
  • 5. The robotic system of claim 1, wherein the manipulator is configured to hold and propel the elongate member.
  • 6. The robotic system of claim 1, wherein the manipulator is configured to roll the elongate member.
  • 7. The robotic system of claim 1, wherein the elongate member bends at least 180 degrees.
  • 8. The robotic system of claim 1, wherein the first portion of the elongate member and a second portion of the elongate member are substantially parallel to each other.
  • 9. The robotic system of claim 1, wherein the elongate member is further coupled to an introducer.
  • 10. The robotic system of claim 1, wherein a distance between the splayer and the manipulator is less than a length of the elongate member between the splayer and the manipulator.
  • 11. The robotic system of claim 1, wherein the splayer is positioned along a first axis, wherein the first axis and the feed axis are non-coaxial.
  • 12. A method comprising: articulating a distal end of an elongate member of a medical instrument with a splayer; andaxially translating the elongate member along a feed axis to insert and retract the elongate member within a patient with drive wheels of a manipulator;wherein the splayer and the manipulator are oriented such that the elongate member bends and follows a non-linear path between the splayer and the manipulator.
  • 13. The method of claim 12, further comprising repositioning the manipulator relative to the splayer.
  • 14. The method of claim 13, further comprising rotating the splayer toward the manipulator.
  • 15. The method of claim 12, further comprising articulating the distal end of the elongate member in response to actuation from an instrument driver operatively coupled to the medical instrument through a mechanical interface on the splayer.
  • 16. The method of claim 12, further comprising advancing, retracting, or rolling the elongate member in response to actuation from an instrument driver operatively coupled to the medical instrument through a mechanical interface on the splayer.
  • 17. The method of claim 12, further comprising holding and propelling the elongate member with a drive mechanism of the manipulator.
  • 18. The method of claim 12, further comprising feeding the elongate member into an introducer with the manipulator.
  • 19. The method of claim 12, further comprising positioning the splayer and the manipulator at a distance less than a length of the elongate member between the splayer and the manipulator.
  • 20. The method of claim 12, further comprising adjusting an insertion angle of the elongate member with the manipulator.
CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No. 15/390,355, filed Dec. 23, 2016 and entitled “REMOTE CATHETER MANIPULATOR,” which is a continuation of U.S. patent application Ser. No. 13/839,967, filed Mar. 15, 2013 and entitled “VASCULAR REMOTE CATHETER MANIPULATOR.” The foregoing applications are hereby incorporated by reference in their entireties for all purposes.

US Referenced Citations (439)
Number Name Date Kind
2556601 Schofield Jun 1951 A
2566183 Forss Aug 1951 A
2623175 Finke Dec 1952 A
2730699 Gratian Jan 1956 A
2884808 Mueller May 1959 A
3294183 Riley et al. Dec 1966 A
3472083 Schnepel Oct 1969 A
3513724 Box May 1970 A
3595074 Johnson Jul 1971 A
3734207 Fishbein May 1973 A
3739923 Totsuka Jun 1973 A
3784031 Nitu Jan 1974 A
3790002 Guilbaud et al. Feb 1974 A
3921536 Savage Nov 1975 A
3926386 Stahmann Dec 1975 A
4141245 Brandstetter Feb 1979 A
4241884 Lynch Dec 1980 A
4243034 Brandt Jan 1981 A
4351493 Sonnek Sep 1982 A
4357843 Peck et al. Nov 1982 A
4384493 Grunbaum May 1983 A
4507026 Lund Mar 1985 A
4530471 Inoue Jul 1985 A
4555960 King Dec 1985 A
4688555 Wardle Aug 1987 A
4745908 Wardle May 1988 A
4784150 Voorhies et al. Nov 1988 A
4857058 Payton Aug 1989 A
4907168 Boggs Mar 1990 A
4945790 Golden Aug 1990 A
5207128 Albright May 1993 A
5234428 Kaufman Aug 1993 A
5256150 Qulachon et al. Oct 1993 A
5277085 Tanimura et al. Jan 1994 A
5350101 Godiewski Sep 1994 A
5398691 Martin et al. Mar 1995 A
5408409 Glassman et al. Apr 1995 A
5426687 Goodall et al. Jun 1995 A
5507725 Savage et al. Apr 1996 A
5524180 Wang et al. Jun 1996 A
5559294 Hoium et al. Sep 1996 A
5631973 Green May 1997 A
5709661 Van Egmond Jan 1998 A
5713946 Ben-Haim Feb 1998 A
5749362 Funda et al. May 1998 A
5767840 Selker Jun 1998 A
5779623 Bonnell Jul 1998 A
5792135 Madhani et al. Aug 1998 A
5797900 Madhani Aug 1998 A
5842390 Bouligny Dec 1998 A
5855583 Wang et al. Jan 1999 A
5859934 Green Jan 1999 A
5876325 Mizuno et al. Mar 1999 A
5921968 Lampropoulos et al. Jul 1999 A
5951475 Gueziec et al. Sep 1999 A
5967934 Ishida et al. Oct 1999 A
6077219 Viebach Jun 2000 A
6084371 Kress et al. Jul 2000 A
6154000 Rastegar et al. Nov 2000 A
6171234 White et al. Jan 2001 B1
6185478 Koakutsu et al. Feb 2001 B1
6226543 Gilboa et al. May 2001 B1
6259806 Green Jul 2001 B1
6272371 Shlomo Aug 2001 B1
6289579 Viza et al. Sep 2001 B1
6394998 Wallace et al. May 2002 B1
6401572 Provost Jun 2002 B1
6424885 Niemeyer et al. Jul 2002 B1
6436107 Wang et al. Aug 2002 B1
6487940 Hart et al. Dec 2002 B2
6491701 Tierney et al. Dec 2002 B2
6550128 Lorenz Apr 2003 B1
6695818 Wollschlager Feb 2004 B2
6726675 Beyar Apr 2004 B1
6786896 Madhani et al. Sep 2004 B1
6827712 Tovey et al. Dec 2004 B2
7044936 Harding May 2006 B2
7155315 Niemeyer et al. Dec 2006 B2
7172580 Hruska et al. Feb 2007 B2
7276044 Ferry et al. Oct 2007 B2
7615042 Beyar et al. Nov 2009 B2
7635342 Ferry et al. Dec 2009 B2
7766856 Ferry et al. Aug 2010 B2
7789874 Yu et al. Sep 2010 B2
7938809 Lampropoulos et al. May 2011 B2
7972298 Wallace et al. Jul 2011 B2
7974674 Hauck et al. Jul 2011 B2
7998020 Kidd et al. Aug 2011 B2
8052636 Moll et al. Nov 2011 B2
8146874 Yu Apr 2012 B2
8157308 Pedersen Apr 2012 B2
8182415 Larkin et al. May 2012 B2
8277417 Fedinec et al. Oct 2012 B2
8291791 Light et al. Oct 2012 B2
8414505 Weitzner Apr 2013 B1
8425465 Nagano Apr 2013 B2
8671817 Bogusky Mar 2014 B1
8720448 Reis et al. May 2014 B2
8746252 McGrogan et al. Jun 2014 B2
8870815 Bhat et al. Oct 2014 B2
8961533 Startler et al. Feb 2015 B2
8968333 Yu et al. Mar 2015 B2
8992542 Hagag et al. Mar 2015 B2
9023068 Viola May 2015 B2
9173713 Hart et al. Nov 2015 B2
9204933 Reis et al. Dec 2015 B2
9259281 Griffiths et al. Feb 2016 B2
9314306 Yu Apr 2016 B2
9326822 Lewis et al. May 2016 B2
9408669 Kokish et al. Aug 2016 B2
9446177 Millman et al. Sep 2016 B2
9452018 Yu Sep 2016 B2
9457168 Moll et al. Oct 2016 B2
9498601 Tanner et al. Nov 2016 B2
9504604 Alvarez Nov 2016 B2
9561083 Yu et al. Feb 2017 B2
9566201 Yu Feb 2017 B2
9622827 Yu et al. Apr 2017 B2
9636184 Lee et al. May 2017 B2
9636483 Hart et al. May 2017 B2
9668814 Kokish Jun 2017 B2
9713509 Schuh et al. Jul 2017 B2
9727963 Mintz et al. Aug 2017 B2
9737371 Romo et al. Aug 2017 B2
9737373 Schuh Aug 2017 B2
9744335 Jiang Aug 2017 B2
9763741 Alvarez et al. Sep 2017 B2
9788910 Schuh Oct 2017 B2
9844412 Bogusky et al. Dec 2017 B2
9867635 Alvarez et al. Jan 2018 B2
9918659 Chopra Mar 2018 B2
9918681 Wallace et al. Mar 2018 B2
9931025 Graetzel et al. Apr 2018 B1
9949749 Noonan et al. Apr 2018 B2
9955986 Shah May 2018 B2
9962228 Schuh et al. May 2018 B2
9980785 Schuh May 2018 B2
9993313 Schuh et al. Jun 2018 B2
9993614 Pacheco Jun 2018 B2
10016900 Meyer et al. Jul 2018 B1
10022192 Ummalaneni Jul 2018 B1
10046140 Kokish et al. Aug 2018 B2
10080576 Romo et al. Sep 2018 B2
10136959 Mintz et al. Nov 2018 B2
10143360 Roelle et al. Dec 2018 B2
10145747 Lin et al. Dec 2018 B1
10149720 Romo Dec 2018 B2
10159532 Ummalaneni et al. Dec 2018 B1
10159533 Moll et al. Dec 2018 B2
10169875 Mintz et al. Jan 2019 B2
10213264 Tanner et al. Feb 2019 B2
10219874 Yu et al. Mar 2019 B2
10231793 Romo Mar 2019 B2
10231867 Alvarez et al. Mar 2019 B2
10244926 Noonan et al. Apr 2019 B2
10258285 Hauck Apr 2019 B2
10285574 Landey et al. May 2019 B2
10299870 Connolly et al. May 2019 B2
10314463 Agrawal et al. Jun 2019 B2
10383765 Alvarez et al. Aug 2019 B2
10398518 Yu et al. Sep 2019 B2
10405939 Romo et al. Sep 2019 B2
10405940 Romo Sep 2019 B2
10426559 Graetzel et al. Oct 2019 B2
10426661 Kintz Oct 2019 B2
10434660 Meyer Oct 2019 B2
10454347 Covington et al. Oct 2019 B2
10464209 Ho et al. Nov 2019 B2
10470830 Hill Nov 2019 B2
10478595 Kokish Nov 2019 B2
10482599 Mintz et al. Nov 2019 B2
10493239 Hart et al. Dec 2019 B2
10493241 Jiang Dec 2019 B2
10500001 Yu et al. Dec 2019 B2
10517692 Eyre et al. Dec 2019 B2
10524866 Srinivasan Jan 2020 B2
10524867 Kokish et al. Jan 2020 B2
10539478 Lin Jan 2020 B2
10543047 Yu Jan 2020 B2
10543048 Noonan et al. Jan 2020 B2
10555778 Ummalaneni et al. Feb 2020 B2
10556092 Yu et al. Feb 2020 B2
10569052 Kokish et al. Feb 2020 B2
10765487 Ho Sep 2020 B2
20010042643 Krueger et al. Nov 2001 A1
20020045905 Gerbi et al. Apr 2002 A1
20020098938 Milbourne et al. Jul 2002 A1
20020100254 Dharssi Aug 2002 A1
20020107573 Steinberg Aug 2002 A1
20020117017 Bernhardt et al. Aug 2002 A1
20020161355 Wollschlager Oct 2002 A1
20020161426 Lancea Oct 2002 A1
20020177789 Ferry et al. Nov 2002 A1
20030056561 Butscher et al. Mar 2003 A1
20030167623 Lorenz Sep 2003 A1
20030212308 Bendall Nov 2003 A1
20040015053 Bieger Jan 2004 A1
20040152972 Hunter Aug 2004 A1
20040243147 Lipow Dec 2004 A1
20040254566 Plicchi Dec 2004 A1
20050004579 Schneider et al. Jan 2005 A1
20050177026 Hoeg et al. Aug 2005 A1
20050183532 Najaf et al. Aug 2005 A1
20050222554 Wallace et al. Oct 2005 A1
20060025676 Viswanathan et al. Feb 2006 A1
20060041245 Ferry Feb 2006 A1
20060111692 Hlavka et al. May 2006 A1
20060146010 Schneider Jul 2006 A1
20060201688 Jenner et al. Sep 2006 A1
20060229587 Beyar et al. Oct 2006 A1
20060237205 Sia et al. Oct 2006 A1
20070000498 Glynn et al. Jan 2007 A1
20070013336 Nowlin et al. Jan 2007 A1
20070060879 Weilzner et al. Mar 2007 A1
20070100201 Komiya et al. May 2007 A1
20070100254 Murakami May 2007 A1
20070112355 Salahieh May 2007 A1
20070119274 Devengenzo et al. May 2007 A1
20070149946 Viswanathan Jun 2007 A1
20070185485 Hauck et al. Aug 2007 A1
20070185486 Hauck et al. Aug 2007 A1
20070191177 Nagai et al. Aug 2007 A1
20070239028 Houser Oct 2007 A1
20070245175 Zheng et al. Oct 2007 A1
20070299427 Yeung et al. Dec 2007 A1
20080039255 Jinno et al. Feb 2008 A1
20080046122 Manzo et al. Feb 2008 A1
20080065103 Cooper et al. Mar 2008 A1
20080147011 Urmey Jun 2008 A1
20080177285 Brock et al. Jul 2008 A1
20080214925 Wilson et al. Sep 2008 A1
20080243064 Stabler et al. Oct 2008 A1
20080245946 Yu Oct 2008 A1
20080249536 Stahler et al. Oct 2008 A1
20080253108 Yu et al. Oct 2008 A1
20080262301 Gibbons et al. Oct 2008 A1
20080287963 Rogers et al. Nov 2008 A1
20080302200 Tobey Dec 2008 A1
20090005768 Sharareh Jan 2009 A1
20090082722 Munger et al. Mar 2009 A1
20090098971 Ho et al. Apr 2009 A1
20090105645 Kidd et al. Apr 2009 A1
20090163948 Sunaoshi Jun 2009 A1
20090171371 Nixon Jul 2009 A1
20090247944 Kirschenman et al. Oct 2009 A1
20090248039 Cooper et al. Oct 2009 A1
20100030023 Yoshie Feb 2010 A1
20100069833 Wenderow et al. Mar 2010 A1
20100073150 Olson et al. Mar 2010 A1
20100130923 Cleary et al. May 2010 A1
20100130987 Wenderow et al. May 2010 A1
20100175701 Reis et al. Jul 2010 A1
20100187740 Orgeron Jul 2010 A1
20100204646 Plicchi et al. Aug 2010 A1
20100210923 Li et al. Aug 2010 A1
20100248177 Mangelberger et al. Sep 2010 A1
20100249506 Prisco et al. Sep 2010 A1
20100274078 Kim et al. Oct 2010 A1
20100332033 Diolaiti Dec 2010 A1
20110015484 Alvarez et al. Jan 2011 A1
20110015648 Alvarez et al. Jan 2011 A1
20110015650 Choi et al. Jan 2011 A1
20110028991 Ikeda et al. Feb 2011 A1
20110130718 Kidd et al. Jun 2011 A1
20110147030 Blum et al. Jun 2011 A1
20110152880 Alvarez et al. Jun 2011 A1
20110238083 Moll et al. Sep 2011 A1
20110261183 Ma et al. Oct 2011 A1
20110277775 Holop et al. Nov 2011 A1
20110288573 Yates et al. Nov 2011 A1
20110306836 Ohline et al. Dec 2011 A1
20120071821 Yu Mar 2012 A1
20120071894 Tanner et al. Mar 2012 A1
20120071895 Stabler et al. Mar 2012 A1
20120132018 Tang May 2012 A1
20120143226 Belson et al. Jun 2012 A1
20120150154 Brisson et al. Jun 2012 A1
20120186194 Schlieper Jul 2012 A1
20120191107 Tanner et al. Jul 2012 A1
20120232476 Bhat Sep 2012 A1
20120239012 Laurent et al. Sep 2012 A1
20120277730 Salahieh Nov 2012 A1
20120283747 Popovic Nov 2012 A1
20130018400 Milton et al. Jan 2013 A1
20130066335 Barwinkel Mar 2013 A1
20130144116 Cooper Jun 2013 A1
20130231678 Wenderow Sep 2013 A1
20130304084 Beira et al. Nov 2013 A1
20130317519 Romo et al. Nov 2013 A1
20130345519 Piskun et al. Dec 2013 A1
20140000411 Shelton, IV et al. Jan 2014 A1
20140066944 Taylor et al. Mar 2014 A1
20140069437 Reis et al. Mar 2014 A1
20140142591 Alvarez et al. May 2014 A1
20140166023 Kishi Jun 2014 A1
20140171778 Tsusaka Jun 2014 A1
20140180063 Zhao Jun 2014 A1
20140222019 Brudnick Aug 2014 A1
20140243849 Saglam et al. Aug 2014 A1
20140276233 Murphy Sep 2014 A1
20140276389 Walker Sep 2014 A1
20140276394 Wong et al. Sep 2014 A1
20140276594 Tanner et al. Sep 2014 A1
20140276647 Yu Sep 2014 A1
20140276935 Yu Sep 2014 A1
20140276936 Kokish et al. Sep 2014 A1
20140277334 Yu et al. Sep 2014 A1
20140357984 Wallace et al. Dec 2014 A1
20140364870 Alvarez et al. Dec 2014 A1
20140375784 Massetti Dec 2014 A1
20150012134 Robinson Jan 2015 A1
20150090063 Lantermann et al. Apr 2015 A1
20150133858 Julian et al. May 2015 A1
20150133963 Barbagli May 2015 A1
20150142013 Tanner et al. May 2015 A1
20150144514 Brennan et al. May 2015 A1
20150148600 Ashinuma et al. May 2015 A1
20150150635 Kilroy Jun 2015 A1
20150182250 Conlon et al. Jul 2015 A1
20150231364 Blanchard Aug 2015 A1
20150374445 Gombert et al. Dec 2015 A1
20160000512 Gombert et al. Jan 2016 A1
20160001038 Romo et al. Jan 2016 A1
20160100896 Yu Apr 2016 A1
20160157945 Madhani Jun 2016 A1
20160166234 Zhang Jun 2016 A1
20160192860 Allenby Jul 2016 A1
20160206389 Miller Jul 2016 A1
20160213435 Hourtash Jul 2016 A1
20160235946 Lewis et al. Aug 2016 A1
20160270865 Landey et al. Sep 2016 A1
20160287279 Bovay et al. Oct 2016 A1
20160338783 Romo et al. Nov 2016 A1
20160338785 Kokish et al. Nov 2016 A1
20160346049 Allen et al. Dec 2016 A1
20170007337 Dan Jan 2017 A1
20170007343 Yu Jan 2017 A1
20170119481 Romo et al. May 2017 A1
20170151028 Ogawa et al. Jun 2017 A1
20170165011 Bovay et al. Jun 2017 A1
20170202627 Sramek et al. Jul 2017 A1
20170209073 Sramek et al. Jul 2017 A1
20170252540 Weitzner et al. Sep 2017 A1
20170258534 Hourtash Sep 2017 A1
20170281049 Yamamoto Oct 2017 A1
20170290631 Lee et al. Oct 2017 A1
20170325932 Hoelzle Nov 2017 A1
20170340396 Romo et al. Nov 2017 A1
20170367782 Schuh et al. Dec 2017 A1
20180025666 Ho et al. Jan 2018 A1
20180042464 Arai Feb 2018 A1
20180042686 Peine Feb 2018 A1
20180049792 Eckert Feb 2018 A1
20180056044 Choi et al. Mar 2018 A1
20180194820 Troy et al. Apr 2018 A1
20180116735 Tierney et al. May 2018 A1
20180206927 Prisco et al. Jul 2018 A1
20180214011 Graetzel et al. Aug 2018 A1
20180221038 Noonan et al. Aug 2018 A1
20180221039 Shah Aug 2018 A1
20180243048 Shan Aug 2018 A1
20180250083 Schuh et al. Sep 2018 A1
20180271616 Schuh et al. Sep 2018 A1
20180279852 Rafii-Tar et al. Oct 2018 A1
20180280660 Landey et al. Oct 2018 A1
20180289431 Draper et al. Oct 2018 A1
20180296299 Iceman Oct 2018 A1
20180303566 Soundararajan Oct 2018 A1
20180325499 Landey et al. Nov 2018 A1
20180326181 Kokish et al. Nov 2018 A1
20180333044 Jenkins Nov 2018 A1
20180360435 Romo Dec 2018 A1
20190000559 Berman et al. Jan 2019 A1
20190000560 Berman et al. Jan 2019 A1
20190000576 Mintz et al. Jan 2019 A1
20190083183 Moll et al. Mar 2019 A1
20190110839 Rafii-Tar et al. Apr 2019 A1
20190151148 Alvarez et al. Apr 2019 A1
20190142537 Covington et al. May 2019 A1
20190167366 Ummalaneni Jun 2019 A1
20190175009 Mintz Jun 2019 A1
20190175062 Rafii-Tari et al. Jun 2019 A1
20190175799 Hsu Jun 2019 A1
20190183585 Rafii-Tari et al. Jun 2019 A1
20190183587 Rafii-Tari et al. Jun 2019 A1
20190216548 Ummalaneni Jul 2019 A1
20190216576 Eyre Jul 2019 A1
20190223967 Abbott Jul 2019 A1
20190223974 Romo Jul 2019 A1
20190228525 Mintz et al. Jul 2019 A1
20190231458 DiMaio Aug 2019 A1
20190246882 Graetzel et al. Aug 2019 A1
20190262086 Connolly et al. Aug 2019 A1
20190269468 Hsu et al. Sep 2019 A1
20190274764 Romo Sep 2019 A1
20190290109 Agrawal et al. Sep 2019 A1
20190298160 Ummalaneni et al. Oct 2019 A1
20190298460 Al-Jadda Oct 2019 A1
20190298465 Chin Oct 2019 A1
20190328213 Landey et al. Oct 2019 A1
20190336238 Yu Nov 2019 A1
20190365209 Ye et al. Dec 2019 A1
20190365479 Rafii-Tari Dec 2019 A1
20190365486 Srinivasan et al. Dec 2019 A1
20190374297 Wallace et al. Dec 2019 A1
20190375383 Alvarez Dec 2019 A1
20190380787 Ye Dec 2019 A1
20190380797 Yu Dec 2019 A1
20200000530 DeFonzo Jan 2020 A1
20200000533 Schuh Jan 2020 A1
20200008874 Barbagli et al. Jan 2020 A1
20200022767 Hill Jan 2020 A1
20200039086 Meyer Feb 2020 A1
20200046434 Graetzel Feb 2020 A1
20200054405 Schuh Feb 2020 A1
20200054408 Schuh et al. Feb 2020 A1
20200060516 Baez Feb 2020 A1
20200086087 Hart et al. Mar 2020 A1
20200091799 Covington et al. Mar 2020 A1
20200093549 Chin Mar 2020 A1
20200093554 Schuh Mar 2020 A1
20200100845 Julian Apr 2020 A1
20200100855 Leparmentier Apr 2020 A1
20200101264 Jiang Apr 2020 A1
20200107894 Wallace Apr 2020 A1
20200121502 Kintz Apr 2020 A1
20200129252 Kokish Apr 2020 A1
20200146769 Eyre May 2020 A1
20200155801 Kokish May 2020 A1
20200188043 Yu Jun 2020 A1
20200197112 Chin Jun 2020 A1
20200206472 Ma Jul 2020 A1
20200217733 Lin Jul 2020 A1
20200222134 Schuh Jul 2020 A1
20200230360 Yu Jul 2020 A1
20200237458 DeFonzo Jul 2020 A1
20200261172 Romo Aug 2020 A1
20200268459 Noonan et al. Aug 2020 A1
20200268460 Tse Aug 2020 A1
Foreign Referenced Citations (32)
Number Date Country
101161426 Apr 2008 CN
103037799 Apr 2011 CN
201884596 Jun 2011 CN
102316817 Jan 2012 CN
102327118 Jan 2012 CN
102458295 May 2012 CN
102665590 Sep 2012 CN
102834043 Dec 2012 CN
102973317 Mar 2013 CN
102015759 Apr 2013 CN
103735313 Apr 2014 CN
105147393 Dec 2015 CN
105559850 May 2016 CN
105559886 May 2016 CN
19649082 Jan 1998 DE
102004020465 Sep 2005 DE
1 442 720 Aug 2004 EP
2 567 670 Mar 2013 EP
3 025 630 Jun 2016 EP
07-136173 May 1995 JP
2009-139187 Jun 2009 JP
2010-046384 Mar 2010 JP
WO 0274178 Sep 2002 WO
WO 03086190 Oct 2003 WO
WO 07146987 Dec 2007 WO
WO 09092059 Jul 2009 WO
WO 11005335 Jan 2011 WO
WO 12037506 Mar 2012 WO
WO 13179600 Dec 2013 WO
WO 15127231 Aug 2015 WO
WO 17059412 Apr 2017 WO
WO 17151993 Sep 2017 WO
Non-Patent Literature Citations (2)
Entry
Mayo Clinic, Robotic Surgery, https://www.mayoclinic.org/tests-procedures/robotic-surgery/about/pac-20394974?p=1, downloaded from the internet on Jul. 12, 2018, 2 pp.
European Search Report for European Patent Application No. 14160078.3 dated Feb. 11, 2015. (6 pages).
Related Publications (1)
Number Date Country
20200155245 A1 May 2020 US
Continuations (2)
Number Date Country
Parent 15390355 Dec 2016 US
Child 16740973 US
Parent 13839967 Mar 2013 US
Child 15390355 US