robotic surgical system and method for attaching a surgical instrument to a manipulator arm of a rob

专利摘要:
SURGICAL SYSTEM ASSEMBLY INSTRUMENT. The present invention relates to robotic surgical systems and methods for coupling a surgical instrument to a manipulator arm. In one embodiment, a system includes a base (208); a configuration connection (222, 218) operationally coupled to the base, where the configuration connection is located in a remote movement center to the robotic surgical system; a proximal connection (226) operationally coupled to the configuration connection; and a distal connection (238) operationally coupled to the proximal connection. A plurality of instrument manipulators (242a) are rotatably coupled to a distal end of the distal connection, each instrument manipulator including a plurality of driver outputs (442b, c, d, e) projecting distally from of a distal end of a structure.
公开号:BR112012028375B1
申请号:R112012028375-8
申请日:2011-05-04
公开日:2021-01-12
发明作者:Daniel Gomez；Jeffrey D. Brown；Thomas G. Cooper；Eugene F. Duval；Robert E. Holop；Anthony K. Mcgrogan；Craig R. Ramstad；Theodore W. Rogers；Todd Solomon
申请人:Intuitive Surgical Operations, Inc.；
IPC主号:

专利说明:

[0001] [0001] This application claims the benefit of North American Provisional Application No. 61 / 334,978 entitled "Surgical System" filed on May 14, 2010, the content of which is incorporated by reference in its entirety into this document for all purposes.
[0002] [0002] This application is related to North American Patent Application No. 11 / 762,165, filed on June 13, 2007, which is incorporated by reference in this document for all purposes. US Patent Application No. 11 / 762,165 claimed the priority benefit of the following provisional North American Patent Applications, all of which are incorporated by reference in this document: 60 / 813,028 entitled "Single port system 2" filed in June 13, 2006 by Cooper and others; 60 / 813,029 entitled "Single port surgical system 1" deposited on June 13, 2006 by Cooper; 60 / 813,030 entitled "Independently actuated optical train" filed on June 13, 2006 by Larkin and others; 60 / 813,075 entitled "Modular cannula architecture" filed on June 13, 2006 by Larkin and others; 60 / 813.125 entitled "Methods for delivering instruments to a surgical site with minimal disturbance to intermediate structures" filed on June 13, 2006 by Larkin and others; 60 / 813.126 entitled "Rigid single port surgical system" deposited on June 13, 2006 by Cooper; 60 / 813.129 entitled "Minimum net force actuation" deposited on June 13, 2006 by Cooper and others; 60 / 813,131 entitled "Side working tools and camera" filed on June 13, 2006 by Duval and others; 60 / 813,172 entitled "Passing cables through joints" deposited on June 13, 2006 by Cooper; 60 / 813,173 entitled "Hollow smoothly bending instrument joints" filed on June 13, 2006 by Larkin and others; 60 / 813,198 entitled "Retraction devices and methods" filed on June 13, 2006 by Mohr and others; 60 / 813,207 entitled "Sensory architecture for endoluminal robots" filed on June 13, 2006 by Diolaiti and others; and 60 / 813,328 entitled "Concept for single port laparoscopic surgery" filed on June 13, 2006 by Mohr and others
[0003] [0003] This application is additionally related to the following pending US Patent applications, all of which are incorporated by reference in this document: 11 / 762,217 entitled "Retraction of tissue for single port entry, robotically assisted medical procedures" by Mohr; 11 / 762,222 entitled "Bracing of bundled medical devices for single port entry, robotically assisted medical procedures" by Mohr et al; 11 / 762,231 "Extendable suction surface for bracing medical devices during robotically assisted medical procedures by Schena; 11 / 762,236 titled" Control system configured to compensate for non-ideal actuator- to-joint linkage characteristics in a medical robotic system ”by Diolaiti and others ; 11 / 762,185 entitled "Surgical instrument actuation system" by Cooper and others; 11 / 762,172 entitled "Surgical instrument actuator" by Cooper and others; 11 / 762,161 entitled "Minimally invasive surgical instrument advancement" by Larkin and others; 11 / 762,158 entitled "Surgical instrument control and actuation" by Cooper and others; 11 / 762,154 entitled "Surgical instrument with parallel motion mechanism" by Cooper; 11 / 762,149 titled "Minimally invasive surgical apparatus with side exit instruments" by Larkin; 11 / 762,170 entitled "Minimally invasive surgical apparatus with side exit instruments" by Larkin; 11 / 762,143 entitled "Minimally invasive surgical instrument system" by Larkin; 11 / 762,135 titled "Side looking minimally invasive surgery instrument assembly" by Cooper et al; 11 / 762,132 entitled "Side looking minimally invasive surgery instrument assembly" by Cooper et al; 11 / 762,127 entitled "Guide tube control of minimally invasive surgical instruments" by Larkin and others; 11 / 762,123 titled "Minimally invasive surgery guide tube" by Larkin and others; 11 / 762,120 entitled "Minimally invasive surgery guide tube" by Larkin and others; 11 / 762,118 titled "Minimally invasive surgical retractor system" by Larkin; 11 / 762,114 entitled "Minimally invasive surgical illumination" by Schena et al; 11 / 762,110 entitled "Retrograde instrument" by Duval and others; 11 / 762,204 entitled "Retrograde instrument" by Duval and others; 11 / 762,202 entitled "Preventing instrument / tissue collisions" by Larkin; 11 / 762,189 entitled "Minimally invasive surgery instrument assembly with reduced cross section" by Larkin et al; 11 / 762,191 entitled "Minimally invasive surgical system" by Larkin and others; 11 / 762,196 entitled "Minimally invasive surgical system" by Duval and others; and 11 / 762,200 entitled "Minimally invasive surgical system" by Diolaiti.
[0004] [0004] This application is also related to the following North American Patent Applications, all of which are incorporated by reference in this document: 12 / 163,051 (filed June 27, 2008; entitled "Medical Robotic System with Image Referenced Camera Control Using Partitionable Orientation and Translational Modes "); 12 / 163,069 (filed on June 27, 2008; entitled "Medical Robotic System Having Entry Guide Controller with Instrument Tip Velocity Limiting"); 12 / 494,695 (deposited on June 30, 2009; entitled "Control of Medical Robotic System Manipulator About Kinematic Singularities"); 12 / 541,913 (filed on August 15, 2009; entitled "Smooth Control of an Articulated Instrument Across Areas with Different Work Space Conditions"); 12 / 571,675 (filed on October 1, 2009; entitled "Laterally Fenestrated Cannula"); 12 / 613,328 (filed on November 5, 2009; entitled "Controller Assisted Reconfiguration of an Articulated Instrument During Movement Into and Out Of an Entry Guide"); 12 / 645,391 (deposited on December 22, 2009; entitled "Instrument Wrist with Cycloidal Surfaces"); 12 / 702.200 (filed on February 8, 2010; entitled "Direct Pull Surgical Gripper"); 12 / 704,669 (filed on February 12, 2010; entitled "Medical Robotic System Providing Sensory Feedback Indicating a Difference Between a Commanded State and a Preferred Pose of an Articulated Instrument"); 12 / 163,087 (filed June 27, 2008; entitled "Medical Robotic System Providing an Auxiliary View of Articulatable Instruments Extending Out Of a Distal End of an Entry Guide"); 12 / 780,071 (deposited on May 14, 2010; entitled "Medical Robotic System with Coupled Control Modes"); 12 / 780,747 (deposited on May 14, 2010; entitled "Cable Re-ordering Device"); 12 / 780,758 (deposited on May 14, 2010; entitled "Force Transmission for Robotic Surgical Instrument"); 12 / 780,773 (deposited on May 14, 2010; entitled "Overforce Protection Mechanism"); 12 / 832,580 (deposited on July 8, 2010; entitled "Sheaths for Jointed Instruments"); North American Patent Application No. 12 / 855,499 (filed on August 12, 2010; entitled "Surgical System Sterile Drape" (Legal Registration Number ISRG02430 / US)); US Patent Application No. 12 / 855,488 (filed on August 12, 2010; entitled "Surgical System Entry Guide" (Legal Registration Number. ISRG02450 / US)); North American Patent Application No. 12 / 855,413 (filed on August 12, 2010; entitled "Surgical System Instrument Manipulator" (Legal Registration Number. ISRG02460 / US)); US Patent Application No. 12 / 855,434 (filed on August 12, 2010; titled Surgical System Architecture "(Legal Registration Number. ISRG02550 / US)); US Patent Application No. 12 / 855,475 (filed on August 12, 2010; entitled "Surgical System Counterbalance" (Legal Registration Number. ISRG02560 / US)); and U.S. Patent Application No. 12 / 855,461 (filed on August 12, 2010; titled "Surgical System Instrument Sterile Adapter" (Legal Registration Number. ISRG02820 / US)). BACKGROUND
[0005] [0005] In robotically assisted or telerobotic surgery, the surgeon typically operates a master controller to remotely control the movement of surgical instruments in the surgical site from a location that can be remote to the patient (for example, through the operating room, in a different room or a completely different building for the patient). The main controller usually includes one or more handheld input devices, such as joysticks, exoskeletal gloves, or the like, which are attached to surgical instruments with servo motors to articulate instruments in the operating room. Servo motors are typically part of an electromechanical device or surgical manipulator ("the slave") that supports and controls surgical instruments that have been introduced directly into an open surgical site or through trocar cannulas into a body cavity, such as the patient's abdomen. During the operation, the surgical manipulator provides mechanical articulation and control of a variety of surgical instruments, such as tissue clamps, needle conductors, electrocauterizing surgical probes, etc., in which each performs various functions for the surgeon, for example, holding or directing a needle, compressing a blood vessel, or dissecting, cauterizing or clotting tissue.
[0006] [0006] The number of degrees of freedom (DOFs) is the number of independent variables that uniquely identify the constitution / configuration of a telerobotic system. Since robotic manipulators are kinematic currents that map the space of the joint (entrance) within the (exit) Cartesian Space, the notion of DOF can be expressed in either of these two spaces. In particular, the DOF joint set is the set of joint variables for all independently controlled joints. Without loss of generality, joints are mechanisms that provide, for example, a single translational (prismatic joints) or rotational (revolute joints) DOF. Any mechanism that provides more than one DOF movement is considered, from a kinematic modeling perspective, as two or more separate joints. The set of Cartesian DOFs is usually represented by the three translational variables (position) (for example, drop, raise, oscillate) and the three rotational variables (orientation) (for example, Euler angles or angles of rotation / inclination / change of direction) ) that describe the position and orientation of a terminal effector structure (or tip) with respect to a given Cartesian frame of reference.
[0007] [0007] For example, a planar mechanism with a terminal effector mounted on two independent and perpendicular rails has the ability to control the x / y position within the area reached by the two rails (prismatic DOFs). If the end effector can be rotated around a geometric axis perpendicular to the plane of the tracks, then there are three DOF inputs (the two rail positions and the angle of change of direction) corresponding to three DOF outputs (the x / yeo position) orientation angle of the terminal effector).
[0008] [0008] Although the number of non-redundant Cartesian DOFs that describe a body within a Cartesian frame of reference, in which all translational and orientational variables are controlled independently, can be six, the number of DOF joints is usually the result of choices that involve considerations of the complexity of the mechanism and task specifications. Consequently, the number of DOF joints can be greater than, equal to, or less than six. For non-redundant kinematic currents, the number of independently controlled joints is equal to the degree of mobility for the terminal effector structure. For a certain number of prismatic and revolute DOF joints, the terminal effector structure will have an equal amount of DOFs (except when in singular configurations) in the Cartesian Space that will correspond to a combination of translational (x / y / z) and rotational ( orientation angle of rotation / inclination / change of direction).
[0009] [0009] The distinction between input and output DOFs is extremely important in situations with redundant or "imperfect" kinematic currents (for example, mechanical manipulators). In particular, "imperfect" manipulators have fewer than six independently controlled joints and therefore do not have the ability to fully control the position and orientation of the end effector. Instead, imperfect manipulators are limited to controlling only a subset of the position and orientation variables. On the other hand, redundant handlers have more than six DOF joints. Therefore, a redundant manipulator can use more than one hinge configuration to establish a desired 6 DOF terminal effector configuration. In other words, additional degrees of freedom can be used to control not only the position and orientation of the terminal effector, but also the "shape" of the manipulator itself. Form for the degrees of kinematic freedom, the mechanisms may have other DOFs, such as the pivoting lever movement of clamping jaws or scissor blades.
[0010] [00010] Telerobotic surgery through remote manipulation has been able to reduce the size and amount of incisions required in surgery to improve patient recovery while also helping to reduce trauma and patient discomfort. However, telerobotic surgery has also created many new challenges. Robotic manipulators adjacent to the patient have sometimes made patient access difficult for staff alongside the patient, and for robots designed particularly for single door surgery, access to the single door is vitally important. For example, a surgeon will typically employ a large number of different surgical instruments / tools during a procedure and ease of access for the manipulator and single port and ease of instrument change are highly desirable.
[0011] [00011] Another challenge results from the fact that a part of the electromechanical surgical manipulator will be positioned adjacent to the operating site. Consequently, the surgical handler can become contaminated during surgery and typically be discarded or sterilized between operations. From a cost perspective, it would be preferable to sterilize the device. However, the servo motors, sensors, encoders, and electrical connections that are necessary to robotically control the motors typically cannot be sterilized using conventional methods, for example, steam, heat and pressure, or chemicals, due to parts of the system being able to be damaged or destroyed in the sterilization process.
[0012] [00012] A sterile cloth has previously been used to cover the surgical manipulator and has previously included holes through which an adapter (for example, a wrist unit adapter or a cannula adapter) must enter the sterile field. However, this disadvantageously requires separation and sterilization of the adapters after each procedure and also causes a high probability of contamination through the holes in the cloth.
[0013] [00013] In addition, with the current sterile cloth designs for multibrace surgical robotic systems, each individual arm of the system is draped, but these designs are not applicable to a single door system, particularly when all instrument actuators are moved together by a single slave manipulator.
[0014] [00014] What is needed, therefore, are telerobotic systems, devices, and improved methods to remotely control surgical instruments in a surgical location on a patient. In particular, these systems, devices, and methods must be configured to minimize the need for sterilization to improve cost efficiency while also protecting the system and the surgical patient. In addition, these systems, devices, and methods must be designed to minimize time and difficulty in changing the instrument and during the surgical procedure while providing a precise interface for the instrument and the manipulator. In addition, these systems and devices must be configured to minimize form factor to provide the largest available space around the entrance door for the surgical team while also providing a variety of enhanced movements. In addition, these systems, devices, and methods must provide organization, support, and efficient operation of multiple instruments through a single port while reducing collisions between instruments and other devices. SUMMARY
[0015] [00015] The present description provides improved surgical systems, devices, and methods for telerobotic surgery. According to one aspect, a system, apparatus, and method provide at least one telemanipulated surgical instrument at a distal end of an instrument manipulator and draped manipulator arm with a precise and robust interface while also providing ease of changing instrument and improved instrument handling, each surgical instrument working independently of the other and each having a terminal effector with at least six degrees of freedom actively controlled in Cartesian space (ie, drop, raise, swing, rotate, tilt, change direction ).
[0016] [00016] In one embodiment, a robotic surgical system includes a base, and a configuration connection operationally coupled to the base, the configuration connection is located in a remote movement center to the robotic surgical system. The system additionally includes a proximal connection operatively coupled to the configuration connection, a distal connection operatively coupled to the proximal connection, and a plurality of instrument manipulators rotatably coupled to a distal end of the distal connection, each of the instrument manipulators includes a plurality of driver outputs that protrude distally from a distal end of a structure.
[0017] [00017] In another embodiment, a robotic surgical system includes the elements described above and a plurality of surgical instruments operationally coupled to the distal end of the corresponding instrument manipulator, in which each instrument has trigger inputs on a proximal face of a transmission mechanism coupled with corresponding trigger outputs of the corresponding instrument manipulator.
[0018] [00018] In yet another embodiment, a method for coupling a surgical instrument to a manipulator arm of a robotic surgical system includes providing a robotic surgical system as described above and mounting a proximal face of a surgical instrument to the distal end of an instrument manipulator corresponding to operationally couple the trigger outputs of the instrument manipulator and trigger inputs of the surgical instrument.
[0019] [00019] A more complete understanding of the modalities of the present description will be provided for individuals skilled in the art, as well as an understanding of additional advantages thereof, by considering the detailed description below of one or more modalities. Reference will be made to the attached drawings, which will first be described shortly. BRIEF DESCRIPTION OF THE FIGURES
[0020] [00020] Figures 1A and 1B illustrate schematic views of a support set on the patient's side in a telesurgical system with and without a sterile cloth, respectively, according to an embodiment of the present description.
[0021] [00021] Figure 2A is a diagrammatic perspective view that illustrates a modality of a telesurgical system with a sterile cloth and assembled instruments.
[0022] [00022] Figures 2B and 2C illustrate side and top views, respectively, of the telesurgical system of figure 2A without a sterile cloth being shown.
[0023] [00023] Figure 3 is a perspective view that illustrates a modality of a base manipulator platform, set of instrument manipulators, and assembled instruments.
[0024] [00024] Figures 4A and 4B illustrate perspective views of an extended and retracted instrument manipulator, respectively, together with an insertion axis.
[0025] [00025] Figures 5A1 and 5B1 illustrate the operation of support hooks for coupling a proximal face of a transmission instrument mechanism to a distal face of the instrument manipulator, and figures 5A2 and 5B2 illustrate section views of figures 5A1 and 5B1, respectively.
[0026] [00026] Figures 5C1 to 5C4 illustrate different views of the instrument manipulator without an external cabinet.
[0027] [00027] Figures 6A and 6B illustrate different views of an instrument manipulator claw module according to an embodiment of the present description.
[0028] [00028] Figure 7A illustrates a view of a cardan drive module of the instrument manipulator according to an embodiment of the present description.
[0029] [00029] Figure 7B illustrates a view of a rotation module of the instrument manipulator according to an embodiment of the present description.
[0030] [00030] Figure 8 shows a view of a geometric axis of telescopic insertion of the instrument manipulator according to an embodiment of the present description.
[0031] [00031] Figures 9A and 9B illustrate perspective views of a proximal part and a distal part, respectively, of an instrument configured to mount for an instrument manipulator.
[0032] [00032] Figure 10 illustrates a section diagram of an instrument manipulator operationally coupled to an instrument according to an embodiment of the present description.
[0033] [00033] Figures 11A and 11B illustrate perspective views of a part of a sterile cloth in a retracted state and an extended state, respectively, according to an embodiment of the present description.
[0034] [00034] Figure 11C illustrates a sectional view of a part of sterile rotating cloth mounted to a distal end of a manipulator arm that includes a base platform according to an embodiment of the present description.
[0035] [00035] Figure 11D illustrates an extended sterile cloth according to an embodiment of the present description.
[0036] [00036] Figure 12 illustrates a perspective view of a part of an extended sterile cloth that includes a sterile adapter according to an embodiment of the present description.
[0037] [00037] Figures 13A and 13B illustrate a perspective view of an assembled sterile adapter and an exploded view of the sterile adapter, respectively, according to an embodiment of the present description.
[0038] [00038] Figure 13C illustrates an enlarged view of a rotary drive interface according to an embodiment of the present description.
[0039] [00039] Figures 14A and 14B illustrate a bottom perspective view and a bottom view of an instrument manipulator according to an embodiment of the present description.
[0040] [00040] Figure 15 illustrates a bottom perspective view of the instrument manipulator operationally coupled to the sterile adapter according to an embodiment of the present description.
[0041] [00041] Figures 16A to 16E illustrate a sequence for coupling the instrument manipulator and the sterile adapter according to an embodiment of the present description.
[0042] [00042] Figures 17A to 17C illustrate a sequence for coupling a surgical instrument to the sterile adapter according to an embodiment of the present description.
[0043] [00043] Figures 18A and 18B illustrate an enlarged perspective view and side view, respectively, of the sterile instrument and adapter before coupling.
[0044] [00044] Figures 19A and 19B illustrate perspective views of a mobile cannula assembly in a retracted and an implanted position, respectively.
[0045] [00045] Figures 20A and 20B illustrate a front and rear perspective view of a cannula mounted on a cannula hitch according to an embodiment.
[0046] [00046] Figure 21 illustrates a perspective view of a cannula alone.
[0047] [00047] Figure 22 shows a cross-sectional view of the cannula of figure 21 and an entry guide of figures 23A and 23B mounted in combination with instruments mounted to instrument manipulators on a manipulator platform according to an embodiment of the present description .
[0048] [00048] Figures 23A and 23B illustrate a perspective view and a top view of the entry guide of figure 22.
[0049] [00049] Figure 24 illustrates a cross-sectional view of another cannula and another entry guide mounted in combination with instruments mounted to instrument manipulators on a manipulator platform according to an embodiment of the present description.
[0050] [00050] Figures 24A to 24B illustrate perspective views of another movable cannula arm assembly in a retracted position and an implanted position, respectively.
[0051] [00051] Figure 24C illustrates a top section of a cannula according to another embodiment.
[0052] [00052] Figure 24D illustrates a cannula engagement at a distal end of a cannula support arm according to another embodiment.
[0053] [00053] Figures 25A to 25C, 26A to 26C, and 27A to 27C illustrate different views of a surgical system with a geometric axis of rotation of instrument manipulator assembly or geometric axis of instrument insertion pointed in different directions.
[0054] [00054] Figure 28 is a diagrammatic view of a centralized motion control system for a minimally invasive telesurgical system according to a modality.
[0055] [00055] Figure 29 is a diagrammatic view of a distributed motion control system for a minimally invasive telesurgical system according to a modality.
[0056] [00056] Figures 30A and 30B illustrate different views of a counterbalance connection for a robotic surgical system according to a modality.
[0057] [00057] Figure 31 illustrates a view of the counterbalance connection without an external cabinet according to a modality.
[0058] [00058] Figures 32A and 32B illustrate a bottom perspective view and a sectional view, respectively, of a distal part of the counterbalance connection according to an embodiment.
[0059] [00059] Figure 33 illustrates a side view of the distal part of the counterbalance connection without an end plug, Figure 34 illustrates an enlarged perspective view of the linear end plug guide, and Figure 35 illustrates a perspective view of an adjustment pin according to various aspects of the present description.
[0060] [00060] Figures 36A to 36C illustrate side section views showing a range of movement of the adjusting pin for moving an end plug relative to the linear guide in accordance with various aspects of the present description.
[0061] [00061] Figures 37A to 37C illustrate detailed views of a distal end of the proximal counterbalance connection in accordance with various aspects of the present description.
[0062] [00062] Modalities of the present description and its advantages are best understood by reference to the detailed description below. It should be noted that similar reference numerals are used to identify similar elements illustrated in one or more of the figures. It must also be assessed that the figures may not necessarily be drawn to scale. DETAILED DESCRIPTION
[0063] [00063] This description and the accompanying drawings that illustrate aspects and modalities of this description should not be taken as limiting. Various mechanical, compositional, structural, electrical, and operational changes can be made without departing from the spirit and scope of this description. In some instances, well-known circuits, structures, and techniques were not shown in detail in order not to obscure the description. Similar numbers in two or more figures represent the same or similar elements.
[0064] [00064] Additionally, the terminology of this description is not intended to limit the description. For example, especially relative terms, such as "below", "below", "lower", "above", "upper" "proximal", "distal", and the like, can be used to describe an element relationship or component to another element or component as illustrated in the figures. These especially relative terms are intended to cover positions and orientations different from the device in use or operation in addition to the position and orientation shown in the figures. For example, if the device in the figures is flipped, elements described as "below" or "below" other elements or components can then be "above" or "over" the other elements or components. Therefore, the exemplary term "below" can cover both the above and below positions and orientations. The device can be oriented in another way (rotated 90 degrees or in other orientations), and the spatially related descriptors used in this document are interpreted accordingly. Likewise, descriptions of movement along and around various geometry axes include various positions and special device orientations. In addition, the singular forms "one", "one", and "o", "a" are also intended to include plural forms, unless the context indicates otherwise. And, the terms "comprises", "which comprises "," includes ", and the like specify the presence of certain components, steps, operations, elements, but do not prevent the presence or addition of one or more other components, steps, operations, elements, components, and / or groups. Components described as coupled can be coupled directly electrically or mechanically, or they can be coupled indirectly through one or more intermediate components.
[0065] [00065] In one example, the terms "proximal" or "proximally" are used in general to describe an object or element that is closest to a base of the manipulator arm along with a kinematic current of movement of the system or more to away from a remote movement center (or a surgical site) along with the system's motion kinematic current. Similarly, the terms "distal" or "distally" are generally used to describe an object or element that is further away from the base of the manipulator arm along with the kinematic current of movement of the system or closer to the center of remote movement (or a surgical site) together with the system's motion kinematic current.
[0066] [00066] The use of operator inputs on a master device to control a robotic slave device and perform work in a workplace is well known. These systems are called by various names, such as teleoperation, telemanipulation, or telerobotic systems. A type of telemanipulation system gives the operator a perception of being present at the workplace, and these systems are called, for example, telepresence systems. The da Vinci® Surgical System, marketed by Intuitiva Surgical, Inc. of Sunnyvale, California, is an example of a telemanipulation system with telepresence. Telepresence fundamentals for surgical systems like these are described in US Patent No. 6,574,355 (filed March 21, 2001), which is incorporated by reference in this document. A teleoperated surgical system (with or without a telepresence component) can be referred to as a telesurgical system.
[0067] [00067] To avoid repetition in the figures and descriptions below of the various aspects and illustrative modalities, it must be understood that many components are common to many aspects and modalities. The omission of an aspect of a description or figure does not imply that the aspect is missing from the modalities that incorporate that aspect. Instead, the aspect may have been omitted for clarity and to avoid long-winded description. Consequently, aspects described with reference to a represented and / or described modality may be present in or applied to other represented and / or described modalities unless it is not practical to do so.
[0068] [00068] Consequently, several general aspects apply to the various descriptions below. Various surgical instruments, guide tubes, and instrument assemblies are applicable in the present description and are further described in US Patent Application No. 11 / 762,165 (filed June 13, 2007; US Patent Application for Pub. No. US 2008/0065105 A1), which is incorporated herein by reference. Surgical instruments alone, or sets that include guide tubes, multiple instruments, and / or multiple guide tubes, are applicable in the present description. Therefore, several surgical instruments can be used, each surgical instrument working independently of the other, and each having a terminal effector. In some instances, the end effectors operate with at least six DOFs actively controlled in the Cartesian space (that is, drop, lift, oscillate, rotate, tilt, change direction), through a single port of entry in a patient. One or more additional DOF end effectors can be applied to, for example, end effector jaw movement in clamping or cutting instruments.
[0069] [00069] For example, at least one surgical end effector is shown or described in several figures. A terminal effector is the part of the surgical instrument or minimally invasive set that performs a specific surgical function (for example, forceps / tweezers, needle conductors, scissors, electrocautery hooks, clamps, clip applicators / removers, etc.). Many terminal effectors have a single DOF (for example, clamps that open and close). The terminal effector can be attached to the body of the surgical instrument with a mechanism that provides one or more additional DOFs, such as "claw" mechanisms. Examples of these mechanisms are shown in U.S. Patent No. 6,371,952 (filed June 28, 1999; Madhani et al.) And U.S. Patent No. 6,817,974 (filed June 28, 2002; Cooper and others), both of which are incorporated by reference in this document, and may be known as various mechanisms of Intuitiva Surgical, Inc. Endowrist® as used in both 8 mm and 5 mm instruments for da Vinci® surgical systems. Although the surgical instruments described in this document generally include terminal effectors, it should be understood that in some respects a terminal effector can be omitted. For example, the distal blunt tip of an instrument body axis can be used to retract tissue. As another example, suction or irrigation openings may exist at the distal end of a body shaft or in the claw mechanism. In these aspects, it should be understood that descriptions of the position and orientation of a terminal effector include positioning and orientation of the tip of a surgical instrument that does not have a terminal effector. For example, a description that addresses the reference structure for a tip of a terminal effector should also be read to include the reference structure of a tip of a surgical instrument that does not have a terminal effector.
[0070] [00070] Throughout this description, it should be understood that an imaging system / image capture component / mono or stereoscopic camera device can be placed at the distal end of an instrument wherever a terminal effector is shown or described (the device can be considered a "camera instrument"), or it can be placed near or at the distal end of any guide tube or other element of the instrument set. Consequently, the terms "imaging system" and something similar as used in this document should be interpreted broadly to include both image capture components and combinations of image capture components with associated circuitry and hardware, within the context of the aspects and modalities that are described. These endoscopic imaging systems (for example, optical, infrared, ultrasound, etc.) include systems with distally positioned sensor microcircuit inserts and associated circuits that relay captured image data via a wired or wireless connection outside the body. These endoscopic imaging systems also include systems that relay images for capture outside the body (for example, using rod lenses or optical fibers). In some instruments or instrument assemblies an optical system for direct visualization can be used (the endoscopic image is visualized directly in an eyepiece). An example of a distally positioned semiconductor imaging system is described in U.S. Patent Application No. 11 / 614,661 (filed December 21, 2006; which discloses "Stereoscopic Endoscope"; Shafer and others), which is incorporated by reference. Components of well-known endoscopic imaging systems, such as electrical lighting connections and fiber optic connections, are omitted or represented symbolically for clarity. Lighting for endoscopic imaging is typically represented in the drawings by a single lighting port. It should be understood that these representations are exemplary. The sizes, positions, and quantities of lighting ports may vary. The lighting doors are typically arranged on multiple sides of the imaging openings, or completely surrounding the imaging openings, to minimize deep shadows.
[0071] [00071] In this description, cannulas are typically used to prevent a surgical instrument or guide tube from rubbing against the patient's tissue. Cannula can be used for both incisions and natural orifices. For situations in which an instrument or guide tube does not move or rotate frequently relative to its geometric insertion axis (longitudinal), a cannula may not be used. For situations requiring insufflation, the cannula may include a seal to prevent leakage of excess insufflation gas from passing the instrument or guide tube. Examples of cannula sets that support inflation and procedures that require gas inflation at the surgical site can be found in North American Patent Application No. 12 / 705,439 (filed February 12, 2010; which reveals "Entry Guide for Multiple Instruments in a Single Port System "), the content of which is incorporated by reference in this document in its entirety for all purposes. For thoracic surgery that does not require insufflation, the cannula seal can be omitted, and if the movement of the geometric axis of the insertion of instruments or guide tube is minimal, then the cannula itself can be omitted. A rigid guide tube can act as a cannula in some configurations for instruments that are inserted relative to the guide tube. Cannulas and guide tubes can be, for example, steel or extruded plastic. Plastic, which is cheaper than steel, may be suitable for single use.
[0072] [00072] Various instances and sets of surgical instruments and flexible guide tubes are shown and described in U.S. Patent Application No. 11 / 762,165, cited above. This flexibility, in this description, is achieved in several ways. For example, a segment of an instrument or guide tube can be a continuous flexible structure that curves, such as one based on a coiled helical spiral or tubes with several segments removed (for example, incision-like cuts). Or, the flexible part can be made up of a series of short, hingedly connected segments ("vertebrae") that provide a snake-like approach to a continuously curving structure. Instrument and guide tube structures may include those in North American Patent Application Publication No. US 2004/0138700 (filed December 2, 2003; Cooper et al.), Which is incorporated by reference in this document. For clarity, the figures and associated descriptions generally show only two segments of instruments and guide tubes, called proximal (closer to the transmission mechanism; farther from the surgical site) and distal (farther from the transmission mechanism; closer to the site) surgical). It should be understood that instruments and guide tubes can be divided into three or more segments, where each segment is rigid, passively flexible, or actively flexible. Flexing and bending as described for a distal segment, a proximal segment, or an entire mechanism also applies to intermediate segments that have been omitted for clarity. For example, an intermediate segment between proximal and distal segments can bend into a single or compound curve. Flexible segments can be of various lengths. Segments with a smaller outside diameter may have a smaller minimum radius of curvature when bending than segments with a larger outside diameter. For cable-controlled systems, unacceptable high friction of the cable or connection that limits the minimum bending radius and the total bending angle while bending. The minimum bending radius of the guide tube (or any joint) is such that it does not twist or otherwise inhibits the smooth movement of the mechanism of the internal surgical instrument. Flexible components can be, for example, up to approximately 1.20 meters (four feet) in length and approximately 1.52 centimeters (0.6 inches) in diameter. Other lengths and diameters (for example, shorter, shorter) and the degree of flexibility for a specific mechanism can be determined for the targeted anatomy for which the mechanism was designed.
[0073] [00073] In some instances, only one distal segment of an instrument or guide tube is flexible, and the proximal segment is rigid. In other instances, the entire segment of the instrument or guide tube that is inside the patient is flexible. In still other instances, an extreme distal segment can be rigid, and one or more other proximal segments are flexible. The flexible segments can be passive or they can be actively controllable ("airships"). This active control can be done using, for example, opposing cable sets (for example, one set controls "tilt" and one orthogonal set controls "change of direction"; three cables can be used to perform similar action). Other control elements such as small electric or magnetic actuators, shape memory alloys, electroactive polymers ("artificial muscle"), pneumatic or hydraulic bellows or pistons, and the like can be used. In instances in which a segment of an instrument or a guide tube is completely or partially within another guide tube, various combinations of passive and active flexibility may exist. For example, an actively flexible instrument within a passively flexible guide tube can exert sufficient lateral force to flex the surrounding guide tube. Similarly, an actively flexible guide tube can flex a passively flexible instrument within it. Guide tube segments and actively flexible instruments can work together. For instruments and guide tubes both flexible and rigid, control cables placed farther from the longitudinal center of the geometry axis can provide a mechanical advantage over cables placed closer to the geometric axis of the longitudinal center, depending on the considerations in the various designs.
[0074] [00074] The compliance of flexible segments (stiffness) can vary from being almost completely flaccid (there are small internal frictions) to being substantially rigid. In some respects, compliance is manageable. For example, a segment or all flexible segments of an instrument or guide tube can be made substantially (that is, effectively, but not infinitely) rigid (the segment is "hardenable" or "lockable"). The lockable segment can be locked in a straight, simple curve or a composite curve. Locking can be achieved by applying tension to one or more cables that run longitudinally together with the instrument or guide tube which is sufficient to cause friction to prevent adjacent vertebrae from moving. The cable or cables can run through a large central hole in each vertebra or it can run through smaller holes close to the outer circumference of the vertebra. Alternatively, the conductive element of one or more motors that move one or more control cables can be gently locked in position (for example, by servo control) to keep the cables in position and thereby prevent the instrument or guide tube therefore move around, locking the vertebrae in place. Keeping a conductive motor element in place can be done to effectively keep other components of the movable instrument and guide tube in place as well. It should be understood that the stiffness under servo control, while effective, is generally less than the stiffness that can be obtained with braking placed directly on the joints, such as the braking used to hold passively configured joints in place. The stiffness of the cable generally dominates because it is generally less than the stiffness of the servo system or locked joints.
[0075] [00075] In some situations, the compliance of the flexible segment can be varied continuously to a flabby and rigid state. For example, the cable locking tension can be increased to increase rigidity, but without locking the flexible segment in a rigid state. These intermediate conformities can allow the telesurgical operation while reducing tissue trauma that can occur due to movements caused by reactive forces from the surgical site. Sensors that bend properly incorporated within the flexible segment allow the tele-surgical system to determine the position of the instrument and / or guide tube when it bends. US Patent Application Publication No. US 2006/0013523 (filed July 13, 2005; Childers et al.), Which is incorporated by reference in this document, discloses a position position sensing device and method optical fiber. US Patent Application No. 11 / 491,384 (filed July 20, 2006; Larkin et al.), Which is incorporated by reference in this document, discloses fiber optic fold sensors (for example, Bragg fiber grids ) used to control these segments and flexible devices.
[0076] [00076] Surgeon's inputs for control aspects of minimally invasive configurations of sets of surgical instruments, instruments, end effectors, and manipulator arms as described in this document are generally made using an intuitive control interface, referenced by camera. For example, the da Vinci® Surgical System includes a surgeon console with this control interface, which can be modified to control aspects described in this document. The surgeon manipulates one or more main manual entry mechanisms that have, for example, 6 DOFs to control the ensemble of instruments and slave instruments. The entry mechanisms include a finger operated clamp to control one or more DOF end effectors (for example, closing clamping jaws). Intuitive control is provided by guiding the relative positions of the terminal effectors and the endoscopic imaging system with the positions of the surgeon's input mechanisms and output image display. This orientation allows the surgeon to manipulate the controls of the entry and end effector mechanisms as if visualizing the surgical workplace in a substantially real presence. This real presence of teleoperation means that the surgeon visualizes an image from a perspective that appears to be that of an operator viewing and working directly at the surgical site. U.S. Patent No. 6,671,581 (filed June 5, 2002; Niemeyer et al.), Which is incorporated by reference, contains additional information on camera-referenced control in a minimally invasive surgical device. Single Door Surgical System
[0077] [00077] Now with reference to figures 1A and IB, schematic side and front views are shown that illustrate aspects of a minimally invasive robot-assisted (telemanipulative) surgical system that uses aspects of surgical instruments, instrument assemblies, and handling systems and minimally invasive control systems described in this document. The three main components are an endoscopic imaging system 102, a surgeon console 104 (main), and a patient side support system 100 (slave), all interconnected by wire (electrical or optical) or wireless connection 106 as shown. One or more electronic data processors can be located variously in these main components to provide system functionality. Examples are described in U.S. Patent Application No. 11 / 762,165, cited above. A sterile cloth 1000, shown in a dotted line, advantageously wraps at least part of the support system on the patient side 100 to maintain a sterile field during a surgical procedure while also providing efficient and simple instrument exchange in conjunction with a precise interface between the instrument and its associated manipulator.
[0078] [00078] Imaging system 102 performs image processing functions on, for example, endoscopic imaging data captured from the surgical site and / or pre-operative or real-time image data from other imaging systems external to the patient. The imaging system 102 provides processed image data (for example, images of the surgical site, as well as relevant control and patient information) to the surgeon on the surgeon's console 104. In some respects the processed image data is provided to a optional external monitor visible to another operating personnel room or to one or more remote locations in the operating room (for example, a surgeon at another location can monitor the video; live video feed can be used for training; etc.) .
[0079] [00079] The surgeon console 104 includes, for example, multiple DOF mechanical input devices ("main") that allow the surgeon to manipulate surgical instruments, guide tubes, and imaging system devices ("slave") as described in this document. These input devices can in some respects provide tactile feedback from instrument components and instrument sets to the surgeon. Console 104 also includes a stereoscopic video output display positioned so that images on the display are generally focused at a distance that corresponds to the surgeon's hands working behind / below the display screen. These aspects are discussed more fully in U.S. Patent No. 6,671,581 which is incorporated by reference in this document.
[0080] [00080] Control during insertion can be achieved, for example, by the surgeon moving the image virtually with one or both of the main ones; it uses the main ones to move the image from side to side and to pull it towards itself, consequently commanding the imaging system and its set of associated instruments (for example, a flexible guide tube) to drive towards a fixed central point on the exit display and to advance into the patient. In one respect, the camera control is designed to give the impression that the main ones are fixed to the image so that the image moves in the same direction as the main handles are moved. This design makes the principals stay in the correct place to control the instruments when the surgeon leaves control of the camera, and consequently avoids the need to grab (disengage), move, and release (engage) the principals back to the position before the start or resume control of the instrument. In some respects the position of the principal can be made proportional to the insertion speed to avoid using a large workspace of the principal. Alternatively, the surgeon can grab and release the main ones to use a ratchet action for insertion. In some respects, insertion can be controlled manually (for example, by hand-operated wheels), and automated insertion (for example, rollers driven by a servo motor) is done when the distal end of the joint surgical instrument is close to the surgical site. Preoperative or real-time image data (eg, MRI, X-rays) of the patient's anatomical structures and spaces available for insertion trajectories can be used to assist insertion.
[0081] [00081] The patient-side support system 100 includes a floor mounted base 108, or alternatively a ceiling mounted base 110 as shown by the alternating lines. The base can be movable or fixed (for example, to the floor, ceiling, wall, or other equipment such as an operating table).
[0082] [00082] The base 108 supports an arm assembly 101 that includes an uncontrolled passive "configuration" part and an actively controlled "manipulator" part. In one example, the configuration part includes two passive "configuration" rotational hinges 116 and 120, which allow for the manual positioning of the attached configuration connections 118 and 122 when the hinge locks are released. A passive joint of prismatic configuration (not shown) can be used between the arm assembly and the attached base for a connection 114 to allow for large vertical adjustments 112. Alternatively, some of these configuration joints can be actively controlled, and more can be used or less configuration joints in various configurations. Configuration joints and connections allow a person to position the robotic manipulator part of the arm in various positions and orientations in the Cartesian space x, y, z. The remote center of motion is the location at which the change in geometric axes of direction, inclination, and rotation intersect (that is, the location at which the kinematic current remains effectively stationary at the same time that the joints move through their ranges of motion ). As described in more detail below, some of these actively controlled joints are robotic manipulators that are associated with DOF control of individual surgical instruments, and others of these actively controlled joints are associated with DOF control of a single set of these robotic manipulators. Active joints and connections are moved by motors or other actuators and receive motion control signals that are associated with main arm movements on the surgeon console 104.
[0083] [00083] As shown in figures 1A and 1B, a manipulator assembly change direction joint 124 is coupled by a distal end of configuration connection 122 and a proximal end of a first manipulator connection 126. The change direction joint 124 allows connection 126 to move with reference to connection 122 in a movement that can be arbitrarily defined as "change of direction" around a manipulator assembly 123 change direction axis. As shown, the rotation axis change of direction joint 124 is aligned with a remote center of movement 146, which is generally the position in which an instrument (not shown) enters the patient (e.g., navel for abdominal surgery). In one embodiment, the configuration connection 122 is rotatable together with a horizontal or x plane, y, and the turn joint 124 is configured to allow the first manipulator connection 126 to rotate around the turn axis 123, so so that the configuration connection 122, direction change joint 124, and first manipulator connection 126 provide a constantly vertical direction change axis 123 for the robot arm assembly, as illustrated by the vertical dashed line of the change joint from direction 124 to remote movement center 146.
[0084] [00084] A distal end of first manipulator connection 126 is coupled to a proximal end of a second manipulator connection 130, a distal end of second manipulator connection 130 is coupled to a proximal end of a third manipulator connection 134, and a distal end of the third manipulator connection 134 is coupled to a proximal end of a fourth manipulator connection 138, by actively controlled rotational joints 128, 132, and 136, respectively. In one embodiment, connections 130, 134, and 138 are coupled together to act as a coupled movement mechanism. Coupled movement mechanisms are well known (for example, these mechanisms are known as parallel movement connections when incoming and outgoing connection movements are kept parallel to each other). For example, if the rotational joint 128 is actively rotated, then the joints 132 and 136 also rotate so that the connection 138 moves with a constant relationship to the connection 130. Therefore, it can be seen that the rotational geometric axes of the joints 128 , 132, and 136 are parallel. When these geometry axes are perpendicular to the rotational axes of the joint 124, connections 130, 134, and 138 move with reference to connection 126 in a movement that can be arbitrarily defined as "slope" around a set slope geometric axis manipulator 139. Since connections 130, 134, and 138 move as a single set in one embodiment, the first manipulator connection 126 can be considered to be an active proximal manipulator connection, and the second to fourth manipulator connections 130, 134, and 138 can be collectively considered an active distal manipulator connection.
[0085] [00085] A manipulator assembly platform 140 is coupled to a distal end of the fourth manipulator connection 138. The manipulator platform 140 includes a rotating base plate that supports the manipulator assembly 142, which includes two or more surgical instrument manipulators that are described in more detail below. The rotating base plate allows the manipulator assembly 142 to rotate as a single unit with reference to platform 140 in a movement that can be arbitrarily defined as "rotation" around a manipulator assembly rotation axis 141.
[0086] [00086] For minimally invasive surgery, the instruments must remain substantially stationary with respect to where they enter the patient's body, either in an incision or in a natural orifice, to avoid unnecessary tissue damage. Consequently, the movements of change of direction and inclination of the instrument axis must be centered in a single location on the geometric axis of rotation of the manipulator set or geometric axis of instrument insertion that remains relatively stationary in space. This location is referred to as a remote movement center. For minimally invasive, single-port surgery, in which all instruments (including a camera instrument) have to enter through a single small incision (eg navel) or natural orifice, all instruments have to move with reference to this a remote station of movement generally stationary. Therefore, a remote center of motion for the manipulator assembly 142 is defined by the intersection of the manipulator assembly geometry axis 123 and the manipulator assembly slope geometric axis 139. Connection configurations 130, 134, and 138, and of articulations 128, 132, and 136 are such that the remote movement center 146 is located distal to the manipulator assembly 142 with sufficient distance to allow the manipulator assembly to move freely with respect to the patient. It can be seen that the geometric axis of rotation of the manipulator assembly 141 also crosses the remote movement center 146.
[0087] [00087] As described in more detail below, a surgical instrument is assembled and operated by each surgical instrument manipulator of the manipulator assembly 142. The instruments are removably mounted so that several instruments can be interchangeably mounted on a manipulator. particular instrument. In one aspect, one or more instrument manipulators can be configured to support and drive a particular type of instrument, such as a camera instrument. The instrument axes extend distally from the instrument handlers. The axes extend through a common cannula placed on the patient's entrance door (for example, through the body wall or in a natural orifice). In one aspect, an entry guide is positioned inside the cannula, and each axis of the instrument extends through a channel in the entry guide, to provide additional support for the instrument axes. The cannula is removably attached to a cannula support 150, which in one embodiment is attached to the proximal end of the fourth manipulator connection 138. In one implementation, the cannula support 150 is attached to connection 138 by a rotational joint that allows the holder to move through a guarded position adjacent to connection 138 and an operational position that keeps the cannula in the correct position so that the remote movement center 146 is located together with the cannula. During operation, the cannula holder is fixed in position relative to connection 138 according to one aspect. The instrument (s) can (s) slide through an entry guide and cannula assembly mounted at a distal end of the cannula holder 150, examples of which are explained in further detail below. The various configurations of passive joints / connections and active joints / connections allow the positioning of instrument manipulators to move instruments and the imaging system with a wide range of motion when a patient is placed in various positions on a movable table. In some embodiments, a cannula support can be attached to the proximal connection or first manipulator connection 126.
[0088] [00088] Certain joints and configuration connections and active in the manipulator arm can be omitted to reduce the size and shape of the robot, or joints and connections can be added to increase degrees of freedom. It should be understood that the manipulator arm may include various combinations of connections, passive joints, and active joints (redundant DOFs may be provided) to achieve the required range of constitutions for surgery. In addition, several surgical instruments alone or instrument assemblies that include guide tubes, multiple instruments, and / or multiple guide tubes, and instruments coupled to instrument manipulators (eg, actuator sets) through various configurations (eg , on a proximal or distal face of the transmission medium of the instrument or the instrument manipulator), are applicable in aspects of the present description.
[0089] [00089] Figures 2A to 2C are seen in diagrammatic, lateral, and upper perspective, respectively, of a support trolley on the side of the patient 200 in a teleoperated (telesurgical) surgical system. The cart 200 shown is an embodiment illustrating the general configuration described above with reference to figures 1A and 1B. A surgeon console and video system are not shown, but are applicable as described above with respect to figures 1A and 1B and known robotic telesurgical system architectures (for example, the da Vinci® Surgical System architecture). In this embodiment, the cart 200 includes a base mounted on the floor 208. The base can be movable or fixed (for example, to the floor, ceiling, wall, or other sufficiently rigid structure). The base 208 supports the support column 210, and an arm assembly 201 is coupled to the support column 210. The arm assembly includes two passive rotational configuration joints 216 and 220, which when their locks are released allows manual positioning of the connections coupled configurations 218 and 222. In the represented mode, the configuration connections 218 and 222 move in a horizontal plane (parallel to the floor). The arm assembly is coupled to the support column 210 in a passive slide configuration joint 215 through the column 210 and a vertical configuration connection 214. The joints 215 allow the manipulator arm to be adjusted vertically (perpendicular to the floor). Consequently, passive configuration joints and connections can be used to position a remote movement center 246 appropriately with reference to the patient. Once the remote movement center 246 is properly positioned, the latches on each of the hinges 215, 216, and 220 are established to prevent the arm configuration portion from moving.
[0090] [00090] Additionally, the arm assembly includes active joints and connections for configuration and manipulator arm movement, instrument manipulation, and instrument insertion. The proximal end of a first manipulator connection 226 is coupled to the distal configuration connection end 222 via an actively controlled rotating manipulator assembly direction change joint 224. As shown, the rotational geometric axis of the manipulator assembly change direction Directional articulation 223 224 is aligned with the remote center of movement 246, as illustrated by the vertical dashed line of the directional articulation 224 to the remote center of movement 246.
[0091] [00091] The distal end of the first manipulator connection 226 is coupled to the proximal end of a second manipulator connection 230, the distal end of the second manipulator connection 230 is coupled to the proximal end of a third manipulator connection 234, and the end distal of the third manipulator connection 234 is coupled to the proximal end of a fourth manipulator connection 238, by the actively controlled rotational joints 228, 232, and 236, respectively. As described above, connections 230, 234, and 238 function as a coupled movement mechanism, so that the fourth manipulator connection 238 automatically moves together with the second manipulator connection 230 when connection 230 is actuated. In the represented embodiment, a mechanism similar to those described in US Patent No. 7,594,912 (filed September 30, 2004) is modified to use (see also, for example, US Patent Application No. 11 / 611,849 (filed December 15, 2006; U.S. Patent Application Publication No. US 2007/0089557 A1)). Therefore, the first manipulator connection 226 can be considered a proximal active connection, and the second to fourth connections 230, 234, and 238 can be considered collectively a distal active connection. In one embodiment, the first connection 226 may include a compression spring counterbalance mechanism, as further described below, to counteract movement forces of the distal connection around the joint 228.
[0092] [00092] A platform of the manipulator assembly 240 is coupled to a distal end of the fourth connection 238. The platform 240 includes a base plate 240a on which the instrument manipulator assembly 242 is mounted. As shown in figure 2A, platform 240 includes a "halo" ring within which a disk-shaped base plate 240a rotates. Different halo and disco configurations can be used in other modalities. The center of rotation of the base plate 240a coincides with the axis of rotation of the manipulator assembly 241, as shown by the dashed line that extends through the center of the manipulator platform 240 and the remote movement center 246. The instruments 260 in one embodiment are mounted to the instrument manipulators of the manipulator assembly 242 on a distal face of the instrument manipulators.
[0093] [00093] As shown in figures 2A and 2B, the instrument manipulator assembly 242 includes four instrument manipulators 242a. Each instrument handler supports and drives its associated instrument. In the represented embodiment, an instrument manipulator 242a is configured to drive a camera instrument, and three instrument manipulators 242a are configured to drive several other interchangeable surgical instruments that perform surgical and / or diagnostic work at the surgical site. More or less instrument manipulators can be used. In some operational configurations, one or more manipulators may not have an associated surgical instrument during part or all of the surgical procedure. Instrument handlers are described in more detail below.
[0094] [00094] As mentioned above, a surgical instrument 260 is assembled and driven by a respective instrument handler 242a. According to one aspect of the description, each instrument is mounted to its associated manipulator only at the proximal end of the instrument. It can be seen in figure 2A that this mounting feature at the proximal end of the mount keeps the instrument manipulator assembly 242 and support platform 240 as far away from the patient as possible, which for the given instrument geometries allows the actively controlled part of the arm manipulator moves freely within a maximum range of motion with reference to the patient while not colliding with the patient. Instruments 260 are assembled so that their axes are grouped around the geometric axis of rotation of manipulator assembly 241. Each axis extends distally from the instrument's power transmission mechanism, and all axes extend through a single cannula placed on the door inside the patient. The cannula is held removably in a fixed position with reference to the base plate 240a by a cannula holder 250, which is attached to the fourth manipulator connection 238. A single guide tube is inserted and rotates freely within the cannula, and each instrument axis extends through an associated channel in the guide tube. The longitudinal geometric axes of the cannula and guide tube are generally coincident with the geometric axis of rotation 241. Therefore, the guide tube rotates within the cannula when the base plate 240a rotates. In some embodiments, a cannula holder can be operationally coupled to the first 226 manipulator connection.
[0095] [00095] Each instrument manipulator 242a is movably coupled to a telescopic active insertion mechanism 244 (figure 2B) operationally coupled to the base plate 240a and can be used to insert and remove the surgical instrument (s) ( s). Figure 2A illustrates instrument manipulators 242a extended a distance towards a distal end of the telescopic insertion mechanism 244 (see also figures 3 and 4A), and figure 2B illustrates instrument manipulators 242 retracted to a proximal end of the telescopic mechanism. insert 244 (see also figure 4B). The active joints 224, 228, 232, 236 and the manipulator platform 240 move together and / or independently so that a surgical instrument (or set) moves around the remote movement center 246 in an entrance door, such as a patient's navel, after the remote movement center has been established by the passive configuration arms and joints.
[0096] [00096] As shown in figure 2A, the cannula support 250 is coupled to the fourth connection 238 near the fourth proximal connection end of the manipulator. In other respects, the cannula support 250 can be coupled to another section of the proximal connection. As described above, the cannula support 250 is pivoted so that it can swing in a guarded position adjacent to the fourth connection 238 and in an extended position (as shown) to support the cannula. During operation, according to one aspect, the cannula support 250 is held in a fixed position relative to the fourth connection 238.
[0097] [00097] It can be seen that in the represented embodiment the first 226 manipulator connection is generally formed as an inverted "L" in an example. A proximal leg of the "L" shaped connection is coupled to the connection 226 on the change-over link 224, and a distal leg on the connection is attached to the second manipulator connection 238 on the rotational link 228. In this illustrative embodiment, the two legs they are generally perpendicular, and the proximal leg of the first manipulator connection rotates around a plane generally perpendicular to the geometric axis of direction change of the manipulator assembly 223 (for example, a horizontal plane (x, y) if the geometric axis of change direction is vertical (z)). Consequently, the distal leg extends generally parallel to the manipulator assembly 223 geometry axis (for example, vertically (z) if the geometry axis is vertical). This shape allows the manipulator connections 230, 234, and 238 to move under the turn link 224, so that the connections 230, 234, and 238 provide a manipulator assembly tilt geometric axis 239 that crosses the center of remote movement 246. Other configurations of first connection 226 are possible. For example, the proximal and distal legs of the first connection 226 may not be perpendicular to each other, the proximal leg may rotate in a plane other than a horizontal plane, or the connection 226 may have a different shape from the general "L" shape, such as an arc shape.
[0098] [00098] It can be seen that a vertical axis of change of direction 223 allows connection 226 to rotate substantially 360 degrees, as shown by the dashed line 249 (figure 2C). In one instance the rotation of the direction of the manipulator set can be continuous, and in another instance the rotation of the direction of the manipulator set is approximately +180 degrees. In yet another instance, the rotation of the change of direction of the manipulator assembly can be approximately 660 degrees. The tilting geometry axis 239 may or may not be kept constant during this change of direction of the geometry axis. Since the instruments are inserted into the patient in a direction generally aligned with the manipulator assembly's geometric axis of rotation 241, the arm can be actively controlled to position and reposition the instrument's insertion direction in any desired direction around the geometric axis change direction of the manipulator set (see, for example, figures 25A to 25C showing the direction of insertion of the instrument towards a patient's head, and figures 26A to 26C showing the direction of insertion of the instrument towards to a patient's foot). This ability can be significantly beneficial during some surgeries. In certain abdominal surgeries in which instruments are inserted through a single door positioned at the navel, for example, instruments can be positioned to access all four quadrants of the abdomen without requiring a new door to be opened on the patient's body wall. Multi-quadrant access may be required, for example, for access to the lymph node throughout the abdomen. In contrast, the use of a multiport robotic telesurgical system may require additional doors to be made on the patient's body wall for more complete access to other abdominal quadrants.
[0099] [00099] Additionally, the manipulator can direct the instrument vertically downwards and in a slightly tilted configuration (see, for example, figures 27A to 27C showing the insertion direction of the instrument tilted upwards). Therefore, the entry angles (both change of direction and inclination around the remote center) for an instrument via a single entry door can be easily manipulated and changed while also providing increased space around the door for patient safety and for maneuvers of the patient side.
[0100] [000100] In addition, connections 230, 234, and 238 in conjunction with active joints 228, 232, and 236 can be used to easily manipulate an instrument's input tilt angle through the single input port at the same time where it creates space around the single entrance door. For example, connections 230, 234, and 238 can be positioned to have an "arc-shaped form factor" away from the patient. These distant arc shapes allow the rotation of the manipulator arm around the geometric axis of direction change 223 not to cause the manipulator arm to collide with the patient. These arc-to-distance shapes also allow staff on the patient side to easily access the manipulator to change instruments and easily access the entry door to insert and operate hand instruments (for example, laparoscopic hand instruments or retraction devices). In yet another example, the fourth connection 238 has a form factor that arches away from the center of remote movement and therefore the patient, allowing greater patient safety. In other words, the working casing of the instrument manipulator assembly 242a can approach a cone, with the tip of the cone at the center of remote movement 246 and the circular end of the cone at the proximal end of the instrument manipulators 242a. This work wrap results in less interference by the patient and the robotic surgical system, greater range of motion for the system allowing improved access to the surgical site, and improved access to the patient by the surgical team.
[0101] [000101] Consequently, the configuration and geometry of the manipulator arm assembly 201 in conjunction with its greater range of motion allows for multi-quadrant surgery through a single door. Through a single incision, the manipulator can steer the instrument in one direction and easily change directions; for example, working towards a patient's head or pelvis (see, for example, figures 25A to 25C) and then changing direction towards the patient's pelvis or head (see, for example, figures 26A to 26C) , moving the manipulator arm around the geometric axis of constant vertical change of direction.
[0102] [000102] This illustrative manipulator arm set is used, for example, for instrument assemblies that are operated to move with reference to the remote movement center. Certain joints and configuration connections and active on the manipulator arm can be omitted, or joints and connections can be added for increased degrees of freedom. It should be understood that the manipulator arm may include various combinations of active and passive connections and joints (redundant DOFs may be provided) to achieve the required range of constitutions for surgery. In addition, several surgical instruments alone or instrument assemblies that include guide tubes, multiple instruments, and / or multiple guide tubes, and instruments coupled to instrument manipulators (actuator sets) through various configurations (for example, in one proximal face or a distal face of the drive assembly or transmission mechanism), are applicable in the present description.
[0103] [000103] Now with reference to figures 3, 4A and 4B, 5A-1 to 5B-2, 5C-1 to 5C-4, and 8, aspects and modalities of the instrument manipulator will be described in greater detail without the intention of limiting the description of these aspects and modalities. Figure 3 is a perspective view of an embodiment of a rotating base plate 340a of a manipulator assembly platform, a set of four instrument manipulators 342 mounted on the base plate 340a to form an instrument manipulator assembly, and four instruments 360 (the proximal parts are illustrated) each mounted on the distal face of an associated instrument manipulator 342. The base plate 340a is rotatable about a geometric axis of rotation of the manipulator assembly 341, as described above. In one embodiment, the geometric axis of rotation 341 runs through the longitudinal center of a set of cannula and entry guide, through which the 360 instruments enter the patient's body. The axis of rotation 341 is also substantially perpendicular to a substantially single plane of the distal face of each instrument handler 342, and consequently to a substantially single plane of the proximal face of an instrument mounted on the distal face of an instrument handler.
[0104] [000104] Each instrument manipulator 342 includes an insertion mechanism 344 which is coupled to the base plate 340a. Figure 8 is a cut-away perspective view that illustrates an embodiment of the instrument insertion mechanism in more detail. As shown in figure 8, an instrument insertion mechanism 844 includes three connections that slide linearly with reference to each other in a telescopic manner. The insertion mechanism 844 includes a transport 802, a transport connection 804, and a connection to the base 808. As described in North American Patent Application No. 11 / 613,800 (filed December 20, 2006; Patent Application Publication North American No. US 2007/0137371 A1), which is hereby incorporated by reference, transport connection 804 slides together with connection to base 808, and transport 802 slides together with transport connection 804. Transport 802 and connections 804, 808 are interconnected by a coupling loop 806 (which in one instance includes one or more flexible metal straps; alternatively, one or more cables can be used). A front screw 808a in connection with the base 808 directs a slider 808b that is coupled to a fixed location on the coupling loop 806. The transport 802 is coupled to the coupling loop 806 at a fixed location too, so that when sliding 808b slips a particular distance x with reference to connection to base 808, transport 802 slides 2x with reference to connection to base 808. Several other linear movement mechanisms (for example, front screw and transport) can be used in alternative implementations of the insertion mechanism.
[0105] [000105] As shown in figures 3 and 8, the proximal end connecting to the base 808 is coupled to the rotating base plate 340a, and the transport 802 is coupled to the outer housing or internal structure of a 342 instrument manipulator (for example, inside the internal structure opening 542i 'of figures 5C-1 to 5C-3). A servo motor (not shown) drives the front screw 808a, and as a result the instrument manipulator 342 moves proximally and distally with reference to the base plate 340a in a direction generally parallel to the geometric axis of rotation 341. Once an instrument surgical 360 is coupled to the manipulator 342, the insertion mechanism 344 works to insert and remove the instrument through the cannula towards and away from the surgical site (DOF instrument insertion). Flat electrically conductive flexible cables (not shown) that run adjacent to the coupling loop can supply power, signals, and ground to the instrument manipulator.
[0106] [000106] It can be seen that an advantage of the telescopic device of the insertion mechanism 344 is that it provides a greater range of movement when the instrument manipulator moves from its totally proximal to totally distal position, with an insertion mechanism that it projects less when the manipulator is in its fully proximal position, than if only a single piece of stationary insertion stage is used (see, for example, figures 4A (fully distal position) and 4B (fully proximal position)). The shortened protrusion prevents the insertion mechanism from interfering with the patient during surgery and with the operating room staff, for example, during instrument change, when the instrument handler is in its proximal position.
[0107] [000107] As further illustrated in figure 3, the telescopic insertion mechanism 344 is mounted symmetrically to the rotating base plate 340a in one embodiment, and therefore, instrument handlers 342 and mounted instruments 360 are grouped symmetrically around the geometric axis of rotation 341. In one embodiment, instrument manipulators 342 and their associated instruments 360 are arranged around the geometric axis of rotation in a generally circle sector arrangement, with the instrument axes positioned close to the overall axis of rotation of the set manipulator 341. Therefore, when the base plate rotates around the axis of rotation 341, the set of instrument manipulators 342 and mounted instruments 360 also rotate around the axis of rotation.
[0108] [000108] Figures 4A and 4B are perspective views illustrating an instrument manipulator 442 in an extended and retracted position, respectively, together with an insertion mechanism 444 mounted to a rotating base plate 440a. As noted above, instrument manipulator 442 is able to extend and retract along with a longitudinal geometric axis of the insertion mechanism 444 through the base plate 440a and a free distal end 444a of the insertion mechanism, as shown by the arrows on both sides adjacent to the insertion mechanism 444. In this illustrative embodiment, instruments mount against the distal face 442a of instrument manipulator 442.
[0109] [000109] The distal face 442a includes several drive outputs that transfer drive forces to an assembled instrument. As shown in figures 4A and 4B, these drive outputs can include a claw output lever 442b (control the tightening movement of an instrument end effector), a cardan plug output 442c (control movement from side to side and the up and down movement of a distal end parallel connection ("push" or "elbow" mechanism)), a 442d pulse output cardan (controlling the turn and tilt movement of a instrument terminal effector), and a 442e rotation output disc (controlling the rotation movement of an instrument). Details of these outlets, and of the associated parts of the power transmission mechanism of the instrument receiving these outlets, can be found in US Patent Application No. 12 / 060,104 (filed March 31, 2008; United States Patent No. US 2009/0248040 A1), which is incorporated herein by reference. Examples of the proximal ends of illustrative surgical instruments that can receive these entries can be found in U.S. Patent Application No. 11 / 762,165, which is referenced above. Briefly, side-to-side and up-and-down DOFs are provided by a distal end parallel connection, end effector shift and end effector tilt DOFs are provided by a distal flexible handle mechanism, the instrument rotation is provided by rotating the instrument axis while maintaining the terminal effector in an essentially constant position and tilt / change of direction, and the tightening DOF the instrument is provided by two opposing movable end jaws. These DOFs are illustrative of more or less DOFs (for example, in some implementations a camera instrument omits the DOFs for rotation and instrument tightness).
[0110] [000110] In order to facilitate the support of an instrument against the distal face of the instrument manipulator, supports such as support hooks 442f are positioned on the instrument manipulator. In the represented embodiment, the support hooks are stationary with reference to the main case of the instrument manipulator, and the distal face of the instrument manipulator moves proximally and distally to provide a secure interconnection between the instrument manipulator and the instrument. A 442g locking mechanism is used to move the distal face of the instrument handler towards a proximal face of the instrument. In an alternative embodiment, a locking mechanism can be used to move the proximal face of the instrument towards the distal face of the manipulator in order to engage or disengage the manipulator outputs and instrument inputs.
[0111] [000111] Figures 5A-1 and 5B-1 are perspective views that illustrate an exemplary architecture of an instrument manipulator 542. Figures 5A-2 and 5B-2 are cross-sectional views of figures 5A-1 and 5B- 1 along cut lines II and II-II, respectively. As shown, the manipulator includes an internal structure 542i movably coupled to an external housing 542h, for example, by sliding joints, rails, or the like. The internal structure 542i moves distally and proximally with reference to the external housing 542h as the result of the action of the lock mechanism 542g.
[0112] [000112] Now with reference to figures 5A-1 to 5B-2, the operation of support hooks 542f and locking mechanism 542g is illustrated to mount an instrument (not shown) to the instrument manipulator 542. As shown, a distal face 542a of instrument manipulator 542 is substantially a single plane, and it is operatively coupled to a proximal face of an instrument force transmission mechanism (e.g., proximal face 960 'of instrument 960 in figures 9A and 9B). The locking mechanism 542g may include a drive mechanism, such as a pulley and wire, to move the internal structure and external housing of the instrument manipulator relative to each other, and to hold the distal face 542a against the instrument during operation.
[0113] [000113] In the represented embodiment, instrument support hooks 542f are rigidly mounted to the external housing of the instrument manipulator 542h, and when the locking mechanism 542g is activated, the distal face 542a of the internal structure 542i of the instrument manipulator moves distally towards a distal end of the support hooks 542f and away from a proximal face 542j of the external housing of the instrument manipulator. Therefore, when an instrument force transmission mechanism is mounted on the support hooks 542f, the distal face 542a of the instrument manipulator moves towards the proximal face of the instrument transmission mechanism, which is contained by support hooks 542f, in order to engage or otherwise operationally interface the instrument manipulator outputs with the instrument's power transmission inputs, as illustrated by arrow A1 in figures 5A-1 and 5A-2. As illustrated by this mode, the trigger outputs of the manipulator compress against the interface with the proximal face of the instrument to transmit signals from the instrument trigger to the instrument. When the lock 542g is operated in a reverse direction, the distal face 542a of the instrument handler moves toward the proximal face 542j of the instrument handler (that is, away from the distal ends of stationary support hooks 542f) in order to disengage the instrument manipulator outputs from the instrument inputs, as illustrated by arrow A2 in figures 5B-1 and 5B-2. An advantage of the represented modality is that when the locking mechanism is activated, the driving parts of the instrument manipulator move relative to a stationary instrument fixed in space in the support hooks. The movement of the instrument manipulator actuators towards or away from the instrument minimizes unnecessary or unintended movements of the instrument during the locking and unlocking process. Consequently, since the instrument does not move relative to the patient during the process of assembling the instrument, potential tissue damage is avoided, since the distal end of the instrument may still be inside the patient.
[0114] [000114] In alternative embodiments, the support hooks 542f can be retracted towards the proximal face 542j to move a proximal face of an instrument towards the distal face 542a of a stationary instrument handler in order to engage the outputs of the handler of the instrument. instrument with the instrument inputs, as shown by the arrows B1 in figures 5A-1 and 5A-2. When the latch is opened or reversed, the process is reversed and the support hooks 542f move away from the distal face 542a of the stationary instrument manipulator to disengage the outputs from the instrument manipulator with the instrument inputs, as illustrated arrows B2 in figures 5B-1 and 5B-2.
[0115] [000115] Figures 5C-1 to 5C-4 illustrate different views of instrument manipulator 542 without external housing 542h in order to reveal independent drive modules to drive the outputs of the instrument manipulator. The drive modules are mounted in a modular way to the internal structure 542i of the instrument manipulator, which moves together with the conductor modules, relative to the external housing 542h and support hooks 542f of the instrument manipulator. When the lock is closed, the internal structure of the instrument manipulator moves towards the instrument at a specified distance, and outputs from the spring loaded module engage the instrument inputs through a sterile field, as further described below. When the latch is opened, the process is reversed. The outputs of the spring loaded driver conductor module provide a robust interface with the inputs of the instrument force transmission mechanism across the field, as described in more detail below.
[0116] [000116] As illustrated in the embodiment shown, instrument manipulator 542 includes a claw driver driver module 542b 'to drive a claw output lever 542b, a plug driver driver module 542c' to drive a claw drive card. socket 542c, a handle trigger driver module 542d 'to drive a pulse output card 542d, and a driver trigger module 542e' to drive a rotation output disk 542e. Outputs 542b, 542c, 542d, and 542e project distally from the distal face 542a of instrument manipulator 542, as shown, for example, in figure 5C-4, and they are adapted to engage with transmission mechanism inputs of instrument force to trigger XY translation of the mounted instruments and clamping, tilting, changing direction, and terminal effector rotation.
[0117] [000117] Figures 6A and 6B are top and bottom perspective views of a claw driver conductor module 642b 'of an instrument manipulator. The claw drive driver module 642b 'includes a linear slide 602, a drive spring mechanism 604 that includes a spring 606, and a claw drive output lever 642b. The actuation spring mechanism 604 is coupled to the internal structure 542i of the instrument manipulator. When the lock 542g is activated to engage an instrument, the internal structure moves, and the claw conductor module 642b 'moves together with the linear slide 602 until the output lever 642b contacts its corresponding entry in the instrument. This contact preloads the spring 606, thereby loading the claw outlet 642b with the spring against an instrument inlet when the instrument is locked in place. The preloaded spring 606 then ensures that the proper outlet / inlet contact of the driver conductor is maintained during operation, so that a gap in the outlet / inlet contact does not develop, which would make precise kinematic control difficult.
[0118] [000118] Figure 7A is a bottom perspective view of a 742c / d 'cardan conductor module of the instrument manipulator that can be used to supply or the plug-in output cardan that controls the XY translation to the plug-in mechanism. instrument or the pulse output cardan that controls the inclination and change of direction to the instrument end effector. In this embodiment, the cardan conductor module 742c / d 'includes a linear slide 702, a drive spring mechanism 704 that includes a 706 spring, and a driver output card 742c / d on a pin on the cardan 710. The mechanism spring clip 704 is coupled to the internal structure 542i of the instrument manipulator. When lock 542f is activated to engage an instrument, the internal structure moves distally, and the driver module 742c / d 'moves along linear slide 702 until the output card 742c / d contacts its corresponding input on the instrument . This contact preloads the spring 706, thereby loading the output cardan 742c / d with the spring against an instrument input when the instrument is locked in place. As with the claw driver conductor module, the preloaded spring then ensures that proper contact of the driver conductor outlet / inlet is maintained during operation, so that no gap develops in the exit / inlet contact, which would make it difficult precise kinematic control. The cardan conductor module 742c / d 'additionally includes two "pressure" connections 712, two ball screws 714, two motors 716, two Hall effect sensors 718, and two rotary or linear motion encoders 720. Motors 716 drive associated ball screws 714, which drive the pressure connections 712. The proximal ends of the pressure connections 712 are coupled to the linear slides 721, which move along the geometric axes parallel to the ball screws 714. The distal end of the lines of pressure 712 is coupled to the output cardans 742c / d, in which each rotates around two orthogonal geometric axes perpendicular to the longitudinal geometric axis through the pin of card 710. In one aspect, the cardans of the drive modules have two degrees of freedom, but do not have orthogonal geometric axes.
[0119] [000119] Figure 7B is a bottom perspective view of a rotary drive driver module 742e 'of the instrument manipulator that can be used to provide rotary control movement of the rotating output of a mounted instrument. In this mode, the rotary drive driver module 742e 'includes a motor 734 that drives a harmonic conductor 736, which in turn drives gears 740. Gears 740 rotate the rotating output disk 742e and therefore drive the input disk of rotation on the instrument. An encoder 732 is used to determine the position and switch the motor 734. An absolute encoder 738 is coupled to the rotation output disk 742e and determines the absolute position of the instrument's rotation.
[0120] [000120] In one aspect, the conducting modules of the system are operationally independent and sufficiently isolated from each other, so that large forces applied through one interface output are not transferred to the other output interfaces. In other words, large forces through an interface output do not transfer to other output interfaces, and therefore, do not affect the instrument components driven by the other output interfaces. In one aspect, a driver module and its corresponding driver outputs have substantially no unintended force input from another driver module and / or its corresponding driver outputs. This feature improves the operation of the instrument and, consequently, patient safety.
[0121] [000121] Figures 9A and 9B are seen in perspective of a proximal part 960a and a distal part 960b, respectively, of an instrument 960 configured to be mounted on the instrument manipulators of figures 4A to 4B and 5A-1 to 5C-4 . A proximal face 960 'of an instrument transmission mechanism 960 includes an instrument claw entry lever 962b that interfaces with claw exit lever 542b, an instrument socket entry card 962c that interfaces with the plug-in output card 542c, a 962d instrument handle input card that interfaces with the 542d output pulse card, and a 962e instrument rotation input disk that interfaces with the output rotation disk 542e. Figure 9B illustrates an example of a distal end 960b of a flexible surgical instrument 960 that includes a handle 964, a locking mechanism 966, and an end effector 968. In one embodiment, the proximal face 960 'of the instrument transmission mechanism 960 has a substantially unique plane that interfaces operationally with the distal face of the instrument manipulator when the manipulator outputs and instrument inputs are operationally engaged. US Patent Application No. 11 / 762,165 entitled "Minimally Invasive Surgical System" by Larkin et al., Which is incorporated herein by reference, and US Patent Application No. 11 / 762,154 entitled "" Surgical Instrument With Parallel Motion Mechanism "by Cooper et al., Which is incorporated into this document by reference, reveals additional details in part distal and proximal parts of applicable surgical instruments, such as the 960 instrument.
[0122] [000122] In the illustrative aspect shown in figures 9A and 9B, instrument 960 includes a transmission part at its proximal end, an elongated instrument body, one of several surgical terminal effectors 968, and a two degree of freedom handle mechanism snake type 964 that couples the terminal effector 968 to the 966 locking mechanism and the instrument body. As with da Vinci® surgical systems, in some respects the transmission part includes discs that interface with electric actuators (for example, servo motors) permanently mounted on a support arm so that instruments can be easily changed. Other connections such as corresponding cardan plates and levers can be used to transfer drive forces at the mechanical interface. Mechanical mechanisms (for example, gears, levers, cardans) in the transmission part transfer drive forces from discs to cables, wires, and / or cable, wire, and hypotube combinations that run through one or more channels in the body of the instrument (which may include one or more articulated segments) to control the movement of the handle 964 and terminal effector 970. In some aspects, one or more disks and associated mechanisms transfer driving forces that rotate the instrument body around its geometric axis longitudinal. The main segment of the instrument body is a single, substantially rigid tube, although in some respects it may be slightly elastically flexible. This small flexibility allows a body segment proximal to a guide tube (ie, outside the patient) to be slightly flexed so that several instrument bodies can be separated more closely within a guide tube than their transmission segment cabinets individual would otherwise allow, such as several cut flowers of equal size being placed in a vase with a small neck. This bending is minimal (for example, less than or equal to approximately a 5 degree bend angle in one embodiment) and does not induce significant friction due to the bending angle for control cables and hypotubes within the instrument body being small. In other words, in one embodiment, an instrument axis may protrude distally from a force transmission mechanism at a slight angle instead of orthogonal to a distal or proximal face of the force transmission mechanism. The instrument axis can then bend slightly and remain straight to form a smooth arc in a proximal section of the instrument axis that exits distally from the force transmission mechanism. Therefore, the instrument may have an instrument axis with a curved proximal section proximal to the guide tube and a straight distal section. In one example, the axis of the instrument can be tilted by approximately zero degrees and approximately five degrees when it exits distally from the force transmission mechanism.
[0123] [000123] As shown in figures 9A and 9B, instrument 960 includes a proximal body segment 968 (which extends through a guide tube in an example) and at least one body segment or distal locking mechanism 966 (which is positioned beyond the distal end of the guide tube in an example). For example, instrument 960 includes proximal body segment 968, locking mechanism 966 that is coupled to proximal body segment 968 at a joint 967, wrist mechanism 964 that is attached to locking mechanism 966 at other joints 965 (the coupling may include another, short distal body segment), and a terminal effector 970. In some respects the locking mechanism 966 and hinges 965 and 967 function as a parallel movement mechanism in which the position of a reference structure at the distal end of the mechanism can be changed with respect to a reference structure at the proximal end of the mechanism without changing the orientation of the distal reference structure. Details of an applicable parallel fit movement or mechanism that includes related joints of an applicable instrument are further described in U.S. Patent Application No. 11 / 762,165, which is incorporated by reference.
[0124] [000124] Figure 10 is a side cross-sectional view of an instrument manipulator 542 operationally coupled to an instrument 960 according to aspects of the present description. As shown in figure 10, the driver outputs 542b to 542e on a distal face of the instrument manipulator 542 interface with driver inputs 962b to 962e on a proximal face of the surgical instrument 960.
[0125] [000125] Since the instrument end effector is provided with seven degrees of freedom (instrument insertion, claw, 2-DOF wrist joint, 2-DOF fitting (wrist translation), and instrument rotation) to facilitate In surgery, the requirement for accurate instrument performance is high and a small gap and high fidelity interface between the instrument and the instrument manipulator is desirable. The drive system modules operated independently of the instrument manipulator (for example, modules 542b ', 542c', 542d ', and 542e') allow the various drive transports to be coupled to a surgical instrument using a fabric made without precision substantially without compromise in performance. When the drive system modules are not coupled to each other and sufficiently insulated from each other, large forces applied through one interface output are not transferred to the other interface outputs. In other words, large forces through one interface output do not transfer to other interface outputs, and therefore do not affect the components of the instrument driven by the other interface outputs. In one aspect, a driver module and its corresponding driver outputs have substantially no unintended power input from another driver module and / or its corresponding driver outputs. This feature improves the operation of the instrument and, consequently, patient safety.
[0126] [000126] In one aspect, matched discs can be used as components of power transmission and drive components as in the instrument interface of the Vinci® Surgical System. In another aspect, cardan and married levers are used. Various mechanical components (for example, gears, levers, cables, pulleys, guide cables, cardan, etc.) in the transmission mechanisms are used to transfer the mechanical force from the interface to the controlled element. Each actuating mechanism includes at least one actuator (for example, servo motor (brushed or brushless)) that controls movement at the distal end of the associated instrument. For example, a driver could be an electric servo motor that controls a surgical instrument DOF claw end effector. An instrument (which includes a guide probe as described in this document) or guide tube (or, collectively, the instrument assembly) can be detached from the associated trigger mechanisms and slide out. It can then be replaced with another instrument or guide tube. In addition to the mechanical interface, there is an electronic interface for each transmission mechanism and drive mechanism. This electronic interface allows data (for example, instrument type / guide tube) to be transferred. Examples of the mechanical and electrical interfaces for the various instruments, guide tubes, and imaging systems, and also on sterile draping to preserve the sterile field, are discussed in Nos. 6,866,671 (deposited on August 13, 2001; Tierney et al.) And 6,132,368 (deposited on November 21, 1997; Cooper), both of which are incorporated by reference in this document.
[0127] [000127] Surgical instruments alone or sets that include guide tubes, multiple instruments, and / or multiple guide tubes, and instruments coupled to the trigger assemblies through various configurations (for example, on a proximal face or a distal face of the instrument / driver set), are applicable in this description. Therefore, several surgical instruments can be used, each surgical instrument working independently of the other and each having a terminal effector with at least six DOFs actively controlled in the Cartesian space (ie, drop, raise, swing, rotate, tilt, change direction ), through a single port of entry in a patient.
[0128] [000128] The instrument axes that form the ends of these kinematic currents described above can be guided through cannulas and / or entry guides for insertion into a patient, as further described below. Examples of applicable accessory tweezers and accessories, such as cannulas, are described in North American Pending Order No. 11 / 240,087, filed on September 30, 2005, the content of which is incorporated by reference in its entirety into this document for all purposes. Sterile Cloth
[0129] [000129] Now, modalities of the sterile field will be described in more detail. With reference again to figures 1A and 1B and 2A to 2C, the sterile cloths 1000 and 2000 are shown covering a part of the arm assembly 101 and 201, respectively, to protect non-sterile parts of the manipulator arm of the sterile cloth, and also for protect the arm and its various parts from materials for surgical procedure (eg body fluids, etc.). In one embodiment, the sterile cloth includes a cloth pouch configured to receive an instrument handler from a set of instrument handlers. The cloth pouch includes an outer surface adjacent to the sterile cloth, and an inner surface adjacent to the non-sterile instrument handler. The cloth additionally includes a flexible membrane at a distal end of the cloth pouch to interface between an output from the instrument handler (eg, the interface that transmits a driving force to the associated instruments) and an input from the surgical instrument (eg , the interface that receives the actuation force of the associated instrument manipulators), and a rotating seal operationally coupled to a proximal opening of the cloth bag.
[0130] [000130] In another embodiment, the sterile cloth includes a plurality of cloth pouches, each cloth pouch including a plurality of flexible membranes at a distal end to interface between the outputs of a respective instrument handler and the inputs of a respective instrument surgical instrument that controls wrist, rotation, tightening, and translational movements of the surgical instrument. A rotating seal, such as a labyrinth seal, can be operatively coupled to a proximal opening of the cloth pockets to allow all the cloth pockets to rotate together as a group with reference to a more proximal part of the cloth. In one example, a first part of the rotating seal that includes the multiple cloth pockets is coupled to the rotating base plate of the manipulator assembly platform and a second part of the rotating seal is coupled to a platform structure of the manipulator assembly.
[0131] [000131] In yet another embodiment, a method of draping the manipulator arm of a robotic surgical system includes first placing a distal end of a sterile cloth on the distal ends of the instrument handlers, and then draping each instrument handler with a cloth pouch from the distal end of the instrument handler to a proximal end of the instrument handler. The rotating seal of the sterile cloth is then coupled to a rotating frame and base plate of the manipulator assembly platform. The remaining parts of the manipulator arm can then be draped as desired from a distal end of the manipulator arm to a proximal end of the manipulator arm. In this example, the manipulator arm is draped from instrument manipulators for the change of direction joint.
[0132] [000132] Advantageously, the configuration and geometry of the manipulator arm and instrument manipulators with a sterile cloth provide a wide range of movement allowing multi-quadrant surgery through a single door (that is, surgical access in all quadrants of the patient from the single doorway), increased space around the patient and the doorway, and increased patient safety, while also providing a robust instrument / manipulator interface, ease of changing instruments, and maintaining a sterile environment, as described above.
[0133] [000133] With reference again to figure 10, the trigger outputs of the instrument manipulator 542 engage with the trigger inputs of the instrument 960 through the sterile cloth 1000 or 2000. As noted above, in one mode, when the lock 542g is activated , the internal structure of the instrument manipulator 542 moves towards the instrument 960 at a specified distance and outputs from the module loaded by springs 542b to 542 and engage the inputs of the instrument 962b-962e through the cloth 1000 or 2000. The driver conductor modules independent 542b ', 542c', 542d ', and 542e' on instrument manipulator 542 provide trigger outputs 542b, 542c, 542d, and 542e, respectively, that engage instrument inputs 962b, 962c, 962d, and 962e, respectively, through of the sterile cloth as a result of the activation of the locking mechanism 542g, as described above.
[0134] [000134] Now with reference to figures 11A to 11D together with figure 10, figures 11A to 11B illustrate perspective views of a first piece of cloth 1100a from a sterile cloth 1100 (figure 11D) in a retracted state and a state extended, respectively, and figure 11C illustrates a sectional view of part of cloth 1100a mounted at a distal end of a rotating base plate 1140a of a manipulator platform according to an embodiment of the present description. The sterile cloth descriptions 1000 and 2000 above are applicable with respect to sterile cloth 1100. For example, sterile cloth 1100 covers part of the manipulator arm assembly, and in particular instrument manipulators, to protect non-sterile parts of the manipulator arm the sterile cloth. In addition, the cloth part 1100a includes a plurality of cloth pockets 1105 (for example, four wedge-shaped cloth pockets 1105a to 1105d are shown), each of which includes an outer surface configured to be adjacent to the sterile cloth , and an internal surface configured to be adjacent to non-sterile instrument handlers. Each of the cloth pouches 1105 additionally includes a plurality of flexible membranes 1102 at a distal end 1101 of the cloth pouches 1105 to interface between outlets of instrument handlers and inlets of surgical instruments. In one example, flexible membranes 1102b, 1102c, 1102d, and 1102e interface between the outputs of the instrument manipulator 542b, 542c, 542d, and 542e and the instrument inputs 962b, 962c, 962d, 962e to control claw movements, translation , wrist, and rotation, respectively, of the surgical instrument. A flexible membrane provides a pocket extension 1106 for the telescopic insertion mechanism of each instrument handler (e.g., insertion mechanism 444) along with which the instrument handler can move.
[0135] [000135] In one aspect, a distal end of bag 1106 is attached to the insertion mechanism so that the cloth bag extension 1106 moves with the insertion mechanism and remains in a compact form away from the patient to provide space and access to a surgical door. In one example, the distal end of the pouch 1106 can be attached to the transport connection 804 of an insertion mechanism 844 (figure 8) by any suitable attachment means, such as clips, clips, Velcro strips, and the like.
[0136] [000136] A rotating seal 1108 operationally couples proximal openings 1103 of the cloth bags 1105 to the manipulator platform of the manipulator arm assembly. In one example, the rotary seal 1108 includes a rotary labyrinth seal that has a rotation cover part 1108a and a comb part of the rotating base 1108b within and relative to the rotation cover part 1108a. In one embodiment, the comb portion of the base 1108b includes a grooved disk 1104 that forms a plurality of wedge-shaped "structures" with openings, each of the structures dimensioned to circumscribe an instrument manipulator. In one embodiment, the comb portion of the base 1108b includes ridges 1104 formed ninety degrees apart within the disc. The proximal ends of the cloth pockets 1105 are coupled to each of the comb part structures of the base 1108b. Consequently, the comb portion of the grooved base 1108b helps to drape individual instrument handlers that are closely grouped on the rotating base plate of the instrument handler and additionally helps to maintain the orientation and arrangement of the cloth pouches 1105 when using the instrument handlers. drapes move during a surgical procedure.
[0137] [000137] The cover part of the rotation 1108a is fixedly mounted to the structure of the manipulator platform and the comb part of the base 1108b is fixedly mounted to the rotating base plate 1140a, so that when the base plate 1140a is rotated, the comb part of base 1108b also rotates in combination with draped instrument handlers while the cover portion of rotation 1108a is stationary being fixedly attached to the structure of the handler platform.
[0138] [000138] Figures 11A and 11B illustrate the cloth pockets 1105 in retracted and extended states, respectively, when the instrument handlers retract and extend together with their respective geometric insertion axes. Although the four cloth bags 1105 are shown to be equally retracted and extended, the cloth bags can retract and extend independently since the instrument handlers are controlled independently and / or dependent with respect to each other.
[0139] [000139] It is also noted that the comb part of the base 1108b may include various amounts of splines oriented at different angles of ninety degrees provided that space is provided to adjust an instrument manipulator through each of the structures of the comb part of the base . In one example, the comb portion of the base 1108b can be comprised of splines that divide a circular area into a multitude of segments that are each sized to enclose an instrument manipulator.
[0140] [000140] The 1100 sterile cloth also allows the transition from draping the individual instrument manipulators to the remaining parts of the manipulator arm assembly, as shown in figure 11D. The cloth 1100 can continue from the rotating seal 1108 (for example, the cover portion of the rotation 1108a) to blend into a second larger cloth part 1100b designed to cover the remaining parts (for example, joints and connections) of the manipulator arm as desired, in an example continuously covering the manipulator arm up to the steering joint joint (e.g., steering joint 124, 224). Consequently, the rotating seal 1108 allows the instrument manipulator assembly to rotate freely relative to the rest of the manipulator arm assembly while substantially the entire arm assembly remains draped, thereby preserving the sterile environment of the surgical site.
[0141] [000141] According to another embodiment, the sterile cloth part 1100b includes a cannula support arm bag 1110 designed to drape a retractable cannula support arm as described in further details below. In one embodiment, a movable cannula assembly includes a base part attached to the manipulator arm and a retractable part movably attached to the base part. The retractable part can be moved by a retracted position and an implanted position through a rotating joint so that the retractable part can be rotated upwards or folded towards the base part to create more space around the patient and / or to more easily wear a cloth over the cannula support when draping the manipulator arm. Other joints can be used to couple the retractable part and the base part, which include, but are not limited to, a ball and socket joint or a universal joint, a sliding joint to create a telescopic effect, and the like, of so that the retractable part can be moved closer to the base part in order to reduce the overall shape factor of the cannula assembly. In another embodiment, the entire cannula support may be telescopic internally relative to the manipulator arm. Consequently, the mobile cannula support arm allows for the draping of a larger robot arm with a relatively smaller opening in the field. The cloth can be positioned on the retracted cannula support arm and then after being draped into the 1110 bag, the cannula support arm can be extended into an operating position. According to one aspect, the cannula support arm is fixed in the operating position during the operation of an instrument.
[0142] [000142] In one instance, the cloth bag 1110 may include a section of reinforced cloth 1111 that fits over a clamp (see, for example, clamps 1754 in figures 19A and 19B and 20A and 20B, and clamp 2454 and receptacle 2456 figures 24A to 24D) at a distal end of the cannula support arm.
[0143] [000143] The cloth 1100a may additionally include a lock cover 1107 on the side of individual cloth bags 1105 to cover the individual locks 1342g (figures 14A, 15, 16A, and 17A to 17C) that can extend outside the circumference of the instrument handler during use.
[0144] [000144] Advantageously, due to the distal face of the instrument manipulator interfacing with an instrument, the loaded spring and independent outputs of the instrument manipulator and advantageous sterile cloth, the instruments can be easily and robustly exchanged in the instrument manipulator at the same time maintain a robust sterile environment during a surgical procedure. In addition, the sterile cloth allows the robotic surgical system to be quickly and easily prepared while also providing a variety of enhanced movements (for example, rotational movement) with a small form factor, thereby reducing time and handling costs. preparation of the operating room. Sterile Adapter
[0145] [000145] Now another type of cloth that includes a sterile adapter will be described in greater detail. Figure 12 illustrates a perspective view of a cloth portion 1200a of an extended sterile cloth that includes a sterile adapter 1250 according to another embodiment of the present description. The cloth part 1200a can replace the cloth part 1100a in figure 11D, and the cloth part 1100b is operationally coupled by means of a rotating seal 1208 which is substantially similar to the rotating seal 1108. The cloth part 1200a includes a plurality of cloth gloves 1205 coupled by rotary seal 1208 and sterile adapter 1250. Cloth part 1200a additionally includes cloth extensions 1206 attached to sterile adapter 1250 to drape over the insertion mechanisms of instrument handlers.
[0146] [000146] Rotating seal 1208 operationally couples proximal openings 1203 of cloth sleeves 1205 to the manipulator platform of the manipulator arm assembly. In one example, the rotary seal 1208 includes a rotary labyrinth seal that has a rotation cover part 1208a and a comb part of the rotating base 1208b relative to the rotation cover part 1208a. In one embodiment, the comb portion of the base 1208b includes a grooved disk 1204 that forms a plurality of wedge-shaped "structures" with openings, each of the structures dimensioned to circumscribe an instrument manipulator. In one embodiment, the comb portion of the base 1208b includes ridges 1204 formed ninety degrees apart within the disc. The proximal ends of the 1205 cloth gloves are attached to each of the comb part structures of the base 1208b. Consequently, the striated part of the base comb 1208b helps to drape individual instrument handlers that are closely grouped on the rotating base plate of the instrument handler and additionally helps to maintain the orientation and arrangement of the cloth gloves 1205 when the handled instrument handlers move during a surgical procedure.
[0147] [000147] Although figure 12 illustrates all 1205 cloth gloves in extended state, for example, when instrument handlers extend together with their respective insertion mechanisms, it is noted that cloth gloves can retract and extend independently as instrument handlers are independent and / or dependent on each other.
[0148] [000148] It is also noted that the comb part of the base 1208b can include various amounts of grooves oriented at different angles of ninety degrees provided that space is provided to adjust an instrument manipulator through each of the structures of the comb part of the base . In one example, the comb portion of the base 1208b can be comprised of splines that divide a circular area into a multitude of segments that are sized for each to enclose an instrument manipulator.
[0149] [000149] The cover part of the rotation 1208a is fixedly mounted to the structure of the manipulator platform (for example, the halo manipulator) and the comb part of the base 1208b is fixedly mounted to the rotating base plate 1140a, so that when the base plate 1140a is rotated, the comb part of base 1208b also rotates in combination with the draped instrument handlers. In one example, since the proximal end of the cloth gloves 1205 are coupled to the comb part of the base 1208b, all of the cloth gloves 1205 rotate together as a group with reference to a more proximal part of cloth 1100b.
[0150] [000150] Figures 13A and 13B illustrate a perspective view of an assembled sterile adapter 1250 and an exploded view of the sterile adapter 1250, respectively, according to an embodiment of the present description. The sterile adapter 1250 includes a boot 1252 that has a boot wall 1252a and cylindrical openings 1252b that serve as passageways for columns in the instrument handler as will be further described below. A distal end of cloth gloves 1205 can be coupled to an outer surface of boot wall 1252a. The adapter 1250 additionally includes a pair of supports 1258 that serves to properly align, position, and retain a surgical instrument on a bottom part of the sterile adapter for engagement with the instrument handler on an upper surface of the sterile adapter. The adapter 1250 additionally includes a flexible membrane interface 1254 that interfaces between the outputs of a respective instrument handler and inputs of a respective surgical instrument to control wrist movements, rotation, jaw, and translation of the surgical instrument. In one embodiment, the membrane interface 1254 includes a claw trigger interface 1254b, a plug-in trigger interface 1254c, a wrist trigger interface 1254d, and a rotary trigger interface 1254e for interfacing with associated instrument manipulator outputs .
[0151] [000151] In one embodiment, the 1254e rotation trigger interface is designed to rotate and maintain a sterile barrier within the 1250 sterile adapter. As illustrated in figure 13C, in one aspect, the 1254e rotation trigger interface includes a rotation 1257a that has a slot or groove 1257b around the circumference of the disc that accepts a flat retaining plate 1254f (figure 13B). The 1254f retaining plate is attached to the 1254 flexible membrane interface and allows the rotating disc to rotate while maintaining a sterile barrier for the adapter and sterile cloth.
[0152] [000152] The membrane interface 1254 is positioned between boot 1252 and supports 1258, and tubes 1256 coupling boot 1252, membrane interface 1254, and support 1258 together. The 1256 tubes are aligned with the boot openings 1252b and membrane openings 1254b and a shaft portion of the 1256 tubes are positioned inside the openings. A tube flap 1256a is retained within the boot opening 1252b and a tube end 1256 is fixedly attached to support 1258 so that tubes 1256 and therefore supports 1258 are movable some longitudinal distance from the tube axis, as shown by double-sided arrows in figure 13 A.
[0153] [000153] Optionally, a grapple driver interface card 1254b ', a plug-in trigger interface card 1254c', and a grapple driver interface board 1254d 'can be attached to a bottom part of the grapple driver interface 1254b , the plug-in driver interface 1254c, and the wrist-drive interface 1254d, respectively, for increased engagement and coupling with the associated instrument inputs.
[0154] [000154] Figures 14A and 14B illustrate a bottom perspective view and a bottom view of an instrument manipulator 1300 according to an embodiment of the present description. In this illustrative embodiment, the instruments are mounted against the distal face 1342a of the instrument manipulator 1300. The distal face 1342a includes several drive outputs that transfer driving forces to an assembled instrument, similar to the instrument manipulators described above with respect to the figures 3 to 8. As shown in figures 14A and 14B, these drive outputs can include a 1342b claw output lever (controlling the tightening movement of an instrument end effector), a plug-in 1342c output cardan (controlling the movement from side to side and the up and down movement of a distal end parallel connection ("push" or "elbow" mechanism)), a 1342d pulse output cardan (controlling the change of direction and the movement of inclination of an instrument terminal effector), and a 1342e rotation output disc (controlling the rotation movement of an instrument). Independent driver conductor modules (similar to those described above with respect to modules 542b ', 542c', 542d ', and 542e') in instrument manipulator 1300 provide driver outputs 1342b, 1342c, 1342d, and 1342e. In a similar manner, the driver outputs 1342b to 1342e can be spring loaded. Details of applicable outputs, and associated parts of the instrument power transmission mechanism that receive these outputs, can be found in U.S. Patent Application No. 12 / 060,104 (filed March 31, 2008; Publication of US Patent Application No. US 2009/0248040 A1), which is hereby incorporated by reference. Examples of the proximal ends of illustrative surgical instruments that can receive these entries can be found in U.S. Patent Application No. 11 / 762,165, which is referenced above. Briefly, DOFs from side to side and up and down are provided by a parallel distal end connection, DOFs of change direction end effector and tilt end effector are provided by a distal flexible handle mechanism, DOF instrument rotation speed is provided by the axis of the rotation instrument while keeping the end effector in an essentially constant tilt / change position and orientation, and the instrument tightening DOF is provided by two opposing end effector jaws furniture. These DOFs are more or less illustrative of DOFs (for example, in some implementations a camera instrument omits the rotation and tightening DOFs of the instrument).
[0155] [000155] The 1300 instrument manipulator additionally includes a 1342g locking mechanism for engaging the trigger outputs of the 1300 instrument manipulator with the trigger inputs of an instrument mounted through the 1250 sterile adapter. In one embodiment, similar to the locking mechanism described above, when the lock 1342g is activated, the internal structure 1342i of the instrument manipulator 1300 moves a determined distance relative to the external housing 1342h and towards an assembled instrument. The outputs of the spring loaded module 1342b to 1342e engage appropriate instrument inputs through the sterile adapter 1250, and in one example through the membrane interface 1254. An assembled instrument is therefore attached to the upper surface of the supports 1258 and the loaded outputs spring-loaded through the membrane interface of the sterile adapter.
[0156] [000156] As noted above, the cloth 1100a may include a lock cover 1107 (figure 11D) on the individual cloth bags 1105 to cover the individual locks 1342g which may extend outside the circumference of the instrument handler during use. The locking cables are each capable of bending within the circumference of a corresponding instrument handler to allow the rotating seal of a cloth to pass over the instrument handlers.
[0157] [000157] The instrument manipulator 1300 additionally includes columns 1350 for operationally coupling the instrument manipulator 1300 to the sterile adapter 1250 as will be further described below.
[0158] [000158] Now with reference to figures 15 and 16A to 16E, the coupling of the instrument manipulator 1300 to the sterile adapter 1250 is illustrated and described. Figure 15 illustrates a bottom perspective view of the instrument manipulator 1300 operationally coupled to the sterile adapter 1250 according to an embodiment of the present description. Figures 16A to 16E illustrate a sequence for coupling the instrument manipulator 1300 and the sterile adapter 1250 according to an embodiment of the present description. As shown in figure 16A, columns 1350 are aligned with tubes 1256 within the openings of boot 1252b. Then, as shown in figure 16B, the free end of the columns 1350 is positioned through the tube 1256 until the clips at the ends of the columns 1350 engage with associated support openings, as shown in figure 16E. Therefore, one end of the columns 1350 is fixedly mounted to the supports 1258. In one embodiment, the supports 1258 include a slide 1258a having a keyhole opening 1258b, as illustrated in figures 16C-1 and 16C-2. Support 1258 is slid in the direction of arrow I to allow column 1350 to pass to the end of keyhole opening 1258b, when the sterile adapter is lifted to a final position as shown by arrow II. Then the support 1258 is returned in a direction of the arrow III by means of an impeller so that the narrow section of the keyhole opening 1258b locks into a groove 1350a in the column 1350 (figure 16E).
[0159] [000159] After the supports 1258 of the sterile adapter have been attached to the columns in the instrument handler's cabinet, the boot 1252 of the sterile adapter 1250 is attached to the distal face 1342a of the instrument handler 1300. In one embodiment, this fixation is achieved by protrusions on the inner walls of the boot that register in depressions on the sides of the internal structure 1342i of the instrument manipulator. A fixation like this allows the boot to remain attached to the internal structure when the internal structure is raised or lowered by the 1342g lock.
[0160] [000160] Now with reference to figures 17A to 17C and 18A and 18B, the coupling of a surgical instrument 1460 to the sterile adapter 1250 is illustrated and described. Figures 17A to 17C illustrate a sequence for coupling the surgical instrument 1460 to the sterile adapter 1250 according to an embodiment of the present description. As shown in figure 17A, instrument 1460 includes a power transmission mechanism 1460a and an axis 1460b. A shaft end 1460b is placed within an entry guide 1500, which is freely rotatable within a cannula 1600. Figure 17B shows clips (for example, clips 1462 in figure 18A) on the power transmission mechanism 1460a of instrument 1460 coupled with and aligned by a pair of supports 1258, and figure 17C shows the force transmission mechanism 1460a being further translated together with an upper surface of the supports 1258.
[0161] [000161] Figures 18A and 18B illustrate an enlarged perspective view and side view, respectively, of the instrument 1460 and sterile adapter 1250 prior to the full translation of the force transmission mechanism 1460a together with the supports 1258. The instrument 1460 is translated together with the supports 1258 until a retention mechanism is achieved together with the supports, which in one example may be a protrusion in a lower part of the clamp 1462 which aligns and couples with an opening in an upper support surface 1258. The lock 1342g can then be actuated to engage the outputs of the instrument manipulator with the instrument inputs through a sterile adapter 1250. In one embodiment, the supports 1258 are prevented from being removed from the columns 1350 after an instrument has been assembled. In one aspect, a protrusion in the holder may engage with a depression in the cabinet side of the instrument force transmission mechanism to prevent the holder from moving at the same time as the instrument is being assembled. Entry Guide
[0162] [000162] Now, the details of an entry guide, cannula, and cannula support arm will be described in greater detail. As previously described, a surgical instrument is assembled and operated by each surgical instrument manipulator. The instruments are removably mounted so that several instruments can be mounted interchangeably on a particular manipulator. In one aspect, one or more manipulators can be configured to support and trigger a particular type of instrument, such as a camera instrument. The instrument axes extend distally from the instrument handlers. The axes extend through a common cannula placed on the patient's entrance door (for example, through the body wall, in a natural orifice). The cannula is attached to a cannula support arm that is movably attached to a manipulator arm. In one aspect, an entry guide is positioned at least partially within the cannula, and each axis of the instrument extends through a channel in the entry guide, to thereby provide additional support for the instrument axes.
[0163] [000163] Figures 19A and 19B illustrate perspective views of a modality of a mobile and / or detachable cannula support 1750 in a retracted position and an implanted position, respectively. The cannula support 1750 includes an extension 1752 that is movably coupled to a connection 1738 of the manipulator arm, such as adjacent to a proximal end of the fourth manipulator connection 138 (figures 1A and IB). The cannula holder 1750 additionally includes a clamp 1754 at a distal end of extension 1752. In one implementation, extension 1752 is coupled to connection 1738 by a rotational joint 1753 that allows extension 1752 to move through a guarded position adjacent to the connection 1738 and an operational position that keeps the cannula in the correct position so that the remote movement center is located along with the cannula. In an implementation, the 1752 extension can be rotated upward or folded towards the 1738 connection, as shown by arrow C, to create more space around the patient and / or to more easily put a cloth over the cannula holder when draping the manipulator arm. Other joints can be used to attach the 1752 extension, which include, but are not limited to, a ball and socket joint or universal joint, a sliding joint to create a telescopic effect, and the like, so that the extension can be moved closer to the connection in order to reduce the overall shape factor of the cannula support and manipulator arm. In another embodiment, the extension 1752 can be telescopic entirely relative to the manipulator arm, or the extension 1752 can be detachable and operably connectable to the connection. During operation of the surgical system, the extension 1752 is held in an operating position.
[0164] [000164] Figures 20A and 20B illustrate perspective views of a cannula 1800 mounted to cannula clamp 1754 as illustrated in figures 19A and 19B, and figure 21 illustrates a perspective view of the independent cannula 1800. In one embodiment , the cannula 1800 includes a proximal part 1804, which is removably coupled to the clamp 1754, and a tube 1802 for passing instrument axes (as shown in figure 22). Since the cannula 1800 is mounted on the clamp 1754, the clamp can hold the rotating cannula 1800. In one example, tube 1802 is comprised of stainless steel, and an inner surface of tube 1802 may be coated or lined with a lubricating or anti-friction material, although the cannula may be comprised of other materials, linings or no liner. The proximal part 1804 can include external ridges 1806, 1808 and an interior space for receiving an entry guide with channels, as shown in figures 22 and 23A and 23B and as described in more detail below. Examples of applicable tweezers and applicable accessories, such as cannulas, are described in North American Pending Order No. 11 / 240,087, filed on September 30, 2005, the content of which is incorporated by reference in its entirety into this document for all purposes.
[0165] [000165] Now with reference to figures 22 and 23A and 23B according to the modalities of the present description, figure 22 illustrates a cross-sectional view of the cannula 1800 of figure 21, and a cross-sectional view of a mounted guide tube 2200. 1942 instrument manipulators are coupled to a 1940 rotating base plate of a manipulator platform, in one example by 1942a telescopic insertion mechanisms, and 2160 instruments are mounted to 1942 instrument manipulators (for example, on one face distal or proximal of the instrument handler). In one embodiment, the telescopic insertion mechanisms 1942a are mounted symmetrically to the rotating base plate 1940, and in one example they are spaced 90 degrees from each other to provide for four instrument manipulators. Other configurations and number of insertion mechanisms (and, therefore, instrument and instrument manipulators) are possible.
[0166] [000166] Therefore, the 2160 instruments are mounted to the 1942 instrument manipulators so that the instrument axes 2160b are grouped around the geometric axis of rotation of the 1941 manipulator assembly. Each axis 2160b extends distally from the force transmission mechanism of the instrument. instrument 2160a, and all axes extend through the cannula 1800 placed on the door inside the patient. The cannula 1800 is held removably in a fixed position with reference to the base plate 1940 by the cannula holder 1750, which is coupled to the fourth manipulator connection 138 in one embodiment. The inlet guide tube 2200 is inserted and rotates freely inside the cannula 1800, and each axis of the instrument 2160b extends through an associated channel 2204 in the guide tube 2200. The central longitudinal geometric axes of the cannula and guide tube are generally coincident with the geometric axis of rotation 1941. Therefore, when the base plate 1940 rotates to rotate the instrument handlers and respective instrument axes, the guide tube 2200 rotates inside the cannula when the base plate 1940 rotates. In one example, the inlet guide tube 2200 is freely rotatable within the cannula around a central longitudinal axis of the guide tube, which is aligned with a central longitudinal axis of the cannula, which in turn is aligned or runs parallel to the 1941 geometric axis of rotation of the manipulator platform. In another embodiment, the inlet guide tube 2200 can be fixedly attached to the cannula if this fixed support for the instrument axes is desirable.
[0167] [000167] The cross-sectional view of the inlet guide tube 2200 is taken together with a MI-MI line in figures 23A and 23B, which illustrate a side view and a top view, respectively, of an inlet guide tube 2200 that has a coupling flap 2202, a tube 2206, and channels 2204a, 2204b. Inlet guide tube 2200 includes flap 2202 at a proximal end of tube 2206 to rotatively couple the inlet guide to the proximal part 1804 of the cannula 1800. In one example, flap 2202 engages between ridges (for example, ridges 1806 and 1808 in the figure 22) of the cannula. In other embodiments, the entry guide does not need a coupling tab, as will be further described below.
[0168] [000168] The entry guide tube 2200 additionally includes channels 2204a, 2204b through the entry guide for passing instrument axes (for example, instrument axes 2160b in figure 22). In one aspect, a channel or path through the axis of the instrument is provided and the channels can have different geometric shapes and sizes. As illustrated in figures 23A and 23B, channel 2204a is of a different shape and size than channels 2204b, and in one example, channel 2204a is used to guide a camera instrument that has a larger, more rigid axis, and channels 2204b are used to guide instrument axes of typical instruments. Other channel shapes and sizes are applicable, which include, but are not limited to, openings that are formed as a circle, an oval, an ellipse, a triangle, a square, a rectangle, and a polygon.
[0169] [000169] When the base plate rotates around the 1941 geometric axis of rotation, the 1942 instrument manipulator and 2160 instrument set also rotates around the geometric axis of rotation. When instrument axes 2160b rotate around the 1941 geometry axis of rotation at the same time as in channels 2204 of the input guide, an instrument axis collides against an internal surface of an input guide channel, and at least an axis of the rotary instrument drives the inlet guide tube 2200 to rotate relative to and within the cannula 1800, which is secured and held stationary by the clamp of a cannula assembly; for example, the clamp 1754 of the cannula holder 1750.
[0170] [000170] The instrument axes can be inserted and retracted through the entrance guide channels independently or in coordination with each other by the movement of the respective insertion mechanisms 1942a. Instruments 2160 can rotate in a clockwise or counterclockwise direction around the 1941 geometry axis of rotation, and consequently, the inlet guide tube 2200 can rotate correspondingly in a clockwise or counterclockwise direction around the geometric axis of rotation. It is further noted that although four channels are illustrated in the entry guide and a plurality of instrument axes are illustrated as passing through the entry guide and cannula, the entry guide and cannula assembly can function within the surgical system with other amounts of channels and axes of the instrument / set of instruments running through the entry guide and cannula. For example, an entry guide tube with one or more channels for running one or more instrument / instrument axis through the entry guide and cannula is within the scope of the present description. In addition, the torque provided by the instrument shafts that rotate the entry guide need not be supplied symmetrically by a plurality of instrument shafts, but can be supplied asymmetrically and independently, including most of the torque being supplied by a single shaft. instrument.
[0171] [000171] In one embodiment, the inlet guide tube 2200 and cannula 1800 may each include an electronic interface or a wireless interface, such as a chip (chip) or radio frequency identification tag (RFID), which includes identification information around the cannula and / or the entry guide tube and allows the surgical system (for example, read by the manipulator arm) to recognize the identification of a particular entry guide and / or cannula. Metal rings, mechanical pins, and inductive sensing mechanisms can also be used to read identification data. This electronic or wireless interface allows data (for example, type of entry tube / cannula) to be transferred to the Surgical system. Details on the mechanical and electrical interfaces for various instruments, guide tubes, and imaging systems, and also on the sterile drape to preserve the sterile cloth, are discussed in Nos. 6,866,671 (Tierney and others) and 6,132,368 (Cooper), both of which are incorporated by reference, and which can be used in a similar manner with the entry guide and cannula.
[0172] [000172] It is further noted that in other embodiments, the inlet guide tube may not include a coupling flap. Figure 24 shows a cross-sectional view of a 2300 inlet guide tube mounted to a cannula 2400. The 2300 inlet guide tube includes channels 2304 and is similar to the 2200 inlet guide tube described above, but does not include a coupling flap. . Instead, the inlet guide tube 2300 is rotatably coupled to the proximal part of the cannula by impacting the instrument axes 2160b against the inner walls of the channels of the inlet guide tube 2304. It is further noted that the cannula does not need to include external ridges in a proximal part. It is further observed that in one aspect, the entry guide tube can move rotationally and longitudinally together with the longitudinal axis of the cannula or the axis of rotation, driven by the instrument axes that run through the entry guide tube.
[0173] [000173] Now with reference to figures 24A to 24D, a different embodiment of a cannula, clamp, and cannula support arm is illustrated which can be used with an entry guide as described above. Figures 24A and 24B illustrate perspective views of an embodiment of a movable and / or detachable cannula support 2450 in a retracted position and an operating position, respectively. The cannula support 2450 includes an extension 2452 which is movably coupled to a connection 2438 of the manipulator arm which has a platform of instrument manipulator assembly 2440, such as adjacent to a proximal end of fourth manipulator connection 138 (figures 1A and 1B). In one implementation, the extension 2452 is coupled to the connection 2438 by a rotational joint 2453 that allows the extension 2452 to move through a guarded position adjacent to connection 2438 and an operational position that keeps the cannula in the correct position so that the center of remote movement is located along with the cannula. In one implementation, extension 2452 can be rotated upward or folded towards connection 2438, as shown by arrow D, to create more space around the patient and / or to more easily put a cloth over the cannula holder when draping the manipulator arm. Other joints can be used to attach the 2452 extension, which include, but are not limited to, a ball and socket joint or a universal joint, a sliding joint to create a telescopic effect, and the like, so that the extension can be moved closer to the connection in order to reduce the overall shape factor of the cannula support and manipulator arm. In another embodiment, the extension 2452 can be telescopic internally relative to the manipulator arm, or the extension 2452 can be detachable and operably connectable to the connection.
[0174] [000174] The cannula holder 2450 additionally includes a clamp 2454 over a receptacle 2456 at a distal end of extension 2452. Figure 24C illustrates a perspective view of a cannula 2470 mountable on the clamp 2454 and cannula support 2456 as 2450 illustrated in figure 24D. In one embodiment, the cannula 2470 includes a proximal part 2474 that has a projection 2476. The projection 2476 includes a lower hemispherical surface 2478 that is positioned within the corresponding receptacle 2456 (as shown by the arrow from the hemispheric surface 2478 to receptacle 2456 ). The projection 2476 additionally includes an upper surface 2479 which is coupled by the clamp 2454 to lock the projection in position and therefore the cannula 2470 in a fixed position relative to the cannula support extension 2452. The clamp 2454 is driven by a lever 2480 The cannula 2470 additionally includes a tube 2472 for passing instrument axes (as shown in figures 22 and 24). Since the cannula 2470 is assembled by the clamp 2454 and receptacle 2456, the clamp can hold the cannula 2470 from turning. In one example, tube 2472 is comprised of stainless steel, and an inner surface of tube 2472 may be coated or lined with a lubricating or anti-friction material, although the cannula may be comprised of other materials, linings or no linings. The proximal part 2474 includes an internal space for receiving an entry guide with channels, as shown in figures 22, 23A to 23B, and 24. Examples of applicable tweezers and applicable accessories, such as cannulas, are described in the North Patent Application -American No. 11 / 240.087, filed on September 30, 2005, the content of which is incorporated by reference in its entirety into this document for all purposes.
[0175] [000175] In one aspect, the entry guide and cannula sets described above support insufflation and procedures that require insufflation gas at the surgical site. Additional description of insufflation through the entry guide and cannula set can be found in U.S. Patent Application No. 12 / 705,439, filed on February 12, 2010 and titled "Entry Guide for Multiple Instruments in a Single Port System ", the content of which is incorporated by reference in its entirety into this document for all purposes.
[0176] [000176] Advantageously, because the input guide is driven dependent on the instrument axis (s), the need for a motor or other drive mechanism to rotate the input guide is eliminated. In addition, the entry guide allows the removal of a bulky trigger mechanism close to the patient or surgical site. Therefore, the entry guide and cannula assembly provides an efficient and robust means to advantageously organize and support multiple instruments through a single door and reduce collisions by instruments and other devices during a surgical procedure. Single Door Surgical System Architecture
[0177] [000177] Figures 25A to 25C, 26A to 26C, and 27A to 27C illustrate different views of a 2500 surgical system with an instrument manipulator assembly rotation axis or instrument insertion axis pointed in different directions relative to a patient P. Figures 25A- to 25C illustrate a geometric axis of rotation of manipulator assembly 2541 directed downwards and towards the head H of patient P. Figures 26A to 26C illustrate the geometric axis of rotation of manipulator assembly 2541 directed towards down and towards the feet F of patient P. Figures 27A to 27C illustrate the geometric axis of rotation of manipulator assembly 2541 directed upwards and towards the head H of patient P.
[0178] [000178] The 2500 surgical system includes a 2518 configuration connection to locate a remote movement center for the robotic surgical system, and a manipulator arm assembly that includes a proximal active connection 2526 and a distal active connection 2528, in which the connection proximal 2526 is operationally coupled to the configuration connection 2518 by an active turnaround joint 2524. A plurality of instrument manipulators 2542 form an instrument manipulator assembly that is rotatably coupled to a distal end of the distal connection 2528. In one embodiment , the plurality of instrument manipulators is coupled to a platform of the manipulator assembly 2540 by telescopic insertion mechanisms 2544. The plurality of instrument manipulators 2542 are rotatable around the geometric axis of rotation 2541. In one embodiment, each of the plurality of instrument handlers includes a distal face from which distalm projects between a plurality of driver outputs, and a plurality of surgical instruments 2560 are coupled to the distal face of a corresponding instrument manipulator. A cannula holder 2550 is movably attached to the distal connection 2528, and a cannula assembly and inlet guide tube 2552 is attached to the cannula support 2550. In one embodiment, the cannula has a central longitudinal geometric axis substantially coincident with the axis of rotation 2541. Each surgical instrument has an axis that passes through the entry guide tube and the cannula, so that rotation of at least one axis of the instrument rotates the entry guide tube around the longitudinal axis of the cannula. .
[0179] [000179] A vertical geometric axis of change of direction of manipulator assembly 2523 on the change of direction joint 2524 allows the proximal connection 2526 to rotate substantially 360 degrees or more around the remote movement center to the surgical system (see, for example, figure 2C). In one instance the rotation of the direction of the manipulator set can be continuous, and in another instance the rotation of the direction of the manipulator set is approximately +180 degrees. In yet another instance, the rotation of the change of direction of the manipulator assembly can be approximately 660 degrees. Since the instruments are inserted into the patient in a direction generally aligned with the manipulator assembly 2541 geometry axis, the manipulator arm assembly 2501 can be actively controlled to position and reposition the instrument insertion direction in any desired direction in around the geometric axis of change of direction of the manipulator set (see, for example, figures 25A to 25C that show the direction of insertion of the instrument towards the patient's head, and figures 26A to 26C that show the direction of insertion of the instrument. instrument towards the patient's feet). This ability can be significantly beneficial during some surgeries. In certain abdominal surgeries in which the instruments are inserted through a single door positioned at the navel (see, for example, figures 25A to 25C), for example, the instruments can be positioned to access all four quadrants of the abdomen without requiring that a new door is opened on the patient's body wall. Multi-quadrant access may be required, for example, for access to the lymph node throughout the abdomen. In contrast, the use of a multiport robotic telesurgical system may require additional doors to be made on the patient's body wall to more fully access other abdominal quadrants.
[0180] [000180] Additionally, the manipulator can steer the configuration instrument vertically downwards and at a slight upward inclination (see, for example, figures 27A to 27C showing the insertion direction of the instrument tilted up close to a hole O of the body). Therefore, the entry angles (both change of direction and inclination around the remote center) for an instrument via a single entry door can be easily manipulated and changed while also providing increased space around the door entry for patient and team safety for maneuvers.
[0181] [000181] In addition, the active connections and joints of the 2501 manipulator arm assembly can be used to easily manipulate an instrument's input tilt angle through the single entry port while creating space around the single port input. For example, arm assembly 2501 connections can be positioned to have a "arching away" form factor from the patient. These distant arc shapes allow the rotation of the manipulator arm around the 2523 turn axis to not cause the manipulator arm to collide with the patient. These arc-to-distance shapes also allow staff on the patient's side to easily access the manipulator to change instruments and to easily access the entry door to insert and operate hand instruments (for example, laparoscopic hand instruments or retraction devices). In other words, the working case of the 2542 instrument handler set can approach a cone, with the tip of the cone at the center of remote movement and the circular end of the cone at the proximal end of the 2542 instrument handlers. This work results in less interference by the patient and the robotic surgical system, greater range of movement for the system allowing improved access to the surgical site, and improved access to the patient by the surgical team.
[0182] [000182] Consequently, the configuration and geometry of the manipulator arm assembly 2501 together with its wide range of movement allows multi-quadrant surgery through a single door. Through a single incision, the manipulator can steer the instrument in one direction and change direction easily; for example, working towards a patient's head (see, for example, figures 25A to 25C) and then changing direction towards the patient's pelvis (see, for example, figures 26A to 26C), moving the arm manipulator around the constantly vertical geometric axis of change of direction 2523.
[0183] [000183] Now with reference to figure 28, a diagrammatic view illustrates aspects of a centralized movement control and coordination system architecture for minimally invasive surgical tele-systems that incorporate sets of surgical instruments and components described in this document. A motion coordinator system 2802 receives main inputs 2804, sensor inputs 2806, and optimization inputs 2808.
[0184] [000184] The main entries 2804 can include the movements of the surgeon's arm, wrist, hand, and fingers in the main control mechanisms. Entries can also be from other movements (eg, finger, foot, knee, etc. by pressing or moving buttons, levers, switches, etc.) and commands (eg, voice) that control the position and orientation of a particular component or who control a specific task operation (for example, energizing an electrocautery or laser terminal effector, imaging system operation, and the like).
[0185] [000185] Sensor inputs 2806 may include position information of, for example, measured position of the servo motor or sensed bend information. North American Patent Application No. 11 / 491,384 (Larkin, et al.) Entitled "Robotic surgery system including position sensors using fiber Bragg gratings", incorporated by reference, describes the use of Bragg fiber gratings to position sensors. These bending sensors can be incorporated within the various instruments and imaging systems described in this document to be used in determining position and orientation information for a component (for example, a terminal effector tip). Position and orientation information can also be generated by one or more sensors (for example, fluoroscopy, MRI, ultrasound, and the like) positioned outside the patient, and which in real time sense changes in the position and orientation of components within the patient.
[0186] [000186] As described below, the user interface has three control modes coupled: a mode for the instrument (s), a mode for the imaging system, and a control mode of the configuration manipulator arm and / or geometric axis of rotation. A mode for the guide tube (s) may also be available. These coupled modes enable the user to address the system as a whole instead of directly controlling a single part. Therefore, the movement coordinator has to determine how to take advantage of the overall kinematics of the system (ie, all DOFs in the system) in order to achieve certain goals. For example, a goal may be to optimize space around the patient or to minimize the form factor of the manipulative arm. Another goal may be to optimize the instrument's workspace for a particular configuration. Another goal may be to keep the field of view of the imaging system centralized between two instruments. Therefore, 2808 optimization inputs can be high-level commands, or the inputs can include more commands or more detailed sensing information. An example of a high-level command can be a command for an intelligent controller to optimize a workspace. An example of a more detailed command could be for an imaging system to start or stop optimizing your camera. An example of a sensor input can be a sign that a limited working space has been achieved.
[0187] [000187] Motion coordinator 2802 provides command signals for various actuator controllers and actuators (eg, servo motors) associated with manipulators for the various arms of the telesurgical system. Figure 28 depicts an example of output signals being sent to four instrument controllers 2810, to an imaging control system 2812, to a geometry axis control 2814, and to a manipulator arm control 2816, which can then send control signals to instrument actuators, active arm joints, manipulator platform rotation mechanisms, and active telescopic insertion mechanisms. Other quantities and combinations of controllers can be used. Control and feedback mechanisms and signals, such as position information information (for example, from one or more wireless transmitters, RFID chip inserts, etc.) and other data from a sensing system, are described in the Order North American Patent No. 11 / 762,196, which is incorporated by reference, and are applicable in this description.
[0188] [000188] Consequently, in some respects the surgeon who operates the telesurgical system will simultaneously and automatically access at least the three control modes identified above: an instrument control mode for moving instruments, an imaging system control mode for moving the imaging system, and a control mode of the manipulator arm rotation geometric axis to configure the manipulator arm connections within a certain form factor or relative to another or the rotation of the manipulator platform, and also to activate movement around the external geometric axis of change of direction to enable multi-quadrant surgery. A similar centralized architecture can be adapted to work with the other various aspects of mechanisms described in this document.
[0189] [000189] Figure 29 is a diagrammatic view that illustrates aspects of a distributed motion control and coordination system architecture for minimally invasive telesurgical systems that incorporate surgical instrument assemblies and components described in this document. In the illustrative aspects shown in Figure 29, the 2902 control and transformation processor exchanges information with two main arm optimizers / controllers 2904a, 2904b, with three surgical instrument optimizers / controllers 2906a, 2906b, 2906c, with an optimizer / controller system imaging 2908, and with a 2910 rotating geometry axis optimizer / controller. Each optimizer / controller is associated with a main or slave arm (which includes, for example, the camera arm (imaging system), instrument arms, and the manipulator arm) in the telesurgical system. Each of the optimizers / controllers receives optimization targets specific to the 2912a-2912g arm.
[0190] [000190] The double-headed arrows between the 2902 control and transformation processor and the various optimizers / controllers represent the exchange of the following data associated with the optimizer / controller arm. The associated data includes the complete Cartesian configuration of the entire arm, which includes the base structure and the distal tip structure. The 2902 control and transformation processor routes the data received from each optimizer / controller to all optimizers / controllers so that each optimizer / controller has data about the current Cartesian configuration of all arms in the system. In addition, the optimizer / controller for each arm receives optimization goals that are unique to the arm. Each arm optimizer / controller then uses the other arm positions as inputs and constraints when it has its optimization goals. In one respect, each optimization control uses a built-in local optimizer to maintain its optimization goals. The optimization module for each optimizer / arm controller can be connected or slid independently. For example, only the optimization modules for the imaging system and the instrument arm can be connected.
[0191] [000191] The distributed control architecture provides more flexibility than the centralized architecture, although with the potential to reduce performance. In this distributed architecture, however, the optimization is local versus the global optimization that can be performed with the centralized architecture, in which a single module is responsible for the state of the entire system. Connection Counterbalance
[0192] [000192] A modality of a counterbalance mechanism in a proximal connection is now described in greater detail with reference to figures 30A to 37C. Figure 30A illustrates a manipulator arm assembly 3001 which is substantially similar to the arm assemblies described above, the components of which are also applicable with respect to assembly 3001, and Figure 30B illustrates a closer view of the proximal counterbalance connection of the assembly arm 3001. Figures 31 to 37C illustrate different views and aspects of the counterbalance system without the walls of a proximal connection cabinet. In particular, figure 311 illustrates a perspective view of the counterbalance system, figures 32A to 36C illustrate views of an adjustment pin, a linear guide, and a movement range of the adjustment pin move an end plug relative to the linear guide , and figures 37A to 37C illustrate detailed views of a distal end of the proximal counterbalance connection showing an oscillating arm and bolt assembly in accordance with various aspects of the present description.
[0193] [000193] Now with reference to figures 30A and 30B, the manipulator arm assembly 30011 includes a proximal connection 3026 that is operably coupled to a configuration connection by a change of direction joint to form a geometric axis of change of direction of the manipulation set 3023. The proximal connection 3026 is rotatably coupled to a distal connection 3028 around a pivot geometry axis. In one example, a 3073 motor can be controlled to pivot distal connection 3028 around the pivot geometry axis 3070. In one embodiment, the distal connection 3028 includes a 3040 instrument manipulator set platform at a distal end of the distal connection. A cannula holder 3050 is movably coupled to the distal connection 3028. In one embodiment, the platform 3040 provides a rotating base plate on which the instrument manipulators can be mounted and rotated around a geometrical axis of mounting rotation. 3041 instrument manipulator. The intersection of the 3023 turn axis, 3041 rotation axis, and the 3039 instrument manipulator tilt set axis form a remote center of motion 3046 as previously described above.
[0194] [000194] Now with particular reference to figures 30B and 31, the counterbalance connection 3026 includes a cabinet 3084 that has a central longitudinal axis 3084c that runs through a proximal end or first end of cabinet 3084a and a distal end or second end cabinet 3084b. A compression spring 3080 is arranged together with the longitudinal geometry axis 3084c and has a proximal end or first spring end 3080a and a distal end or second spring end 3080b. In one embodiment, the compression spring is comprised of silicon chromium alloy, but can be comprised of other materials. A base 3092 is arranged at the first end of the cabinet and is coupled to the first end 3080a of the compression spring 3080 by an alignment ring 3090 between them. A plug 3074 is disposed at the second end of the enclosure and is attached to the second end 3080b of the compression spring 3080. In one embodiment, the alignment ring 3090 is fixedly attached to the first end 3080a of the compression spring 3080, and the plug 3074 includes an external thread (for example, thread 3074a) to which the second end of spring 3080b is screwed.
[0195] [000195] A 3088 cable that has a 3071 coupler on a first end of the cable is coupled to a load on the distal connection 3028, and a second end of the 3088 cable is operationally coupled to the 3074 plug. From the load-bearing end of the cable 3088 on coupler 3071, cable 3088 passes through a plurality of pulleys 3076 and 3078 outside the case 3084, and then through a pulley 3094 on the base 3092 before coupling to plug 3074. The distal connection load 3028 pulls the cable 3088 in directions E1 and E2 around pulley 3094 (figure 31), causing plug 3074 to compress spring 3080 in direction E2, which is determined to counteract at least part of the load of the distal connection around the pivot geometric axis 3070 .
[0196] [000196] In order to increase security, the 3088 cable may include redundant cables that are coupled to a 3082 cable voltage equalizer that equalizes the voltage across the redundant cables. A 3095 cable reel is optionally used to operationally couple the redundant cables to each other via the 3094 pulley and 3071 coupler. A plurality of 3075 hex head screws can be arranged between the 3082 cable tension equalizer and the 3074 plug, and can be used to adjust the force displacement of the counterbalance connection. In one embodiment, three 3075 hex head screws couple the 3082 cable voltage equalizer and the 3074 plug with a hex head screw supporting substantially all of the voltage and the other two hex head screws provided for redundancy and security purposes.
[0197] [000197] In one aspect, the cable part 3088 between the pulley 3094 and plug 3074 runs substantially together with the central longitudinal axis 3084c of the proximal connection cabinet. In a further aspect, the spring 3080 compresses substantially along the central longitudinal axis 3084c of the proximal connection cabinet. Spring compression, however, can cause "springing" or non-linear compression of the spring along the longitudinal geometric axis of the enclosure, which can lead to scraping and contact of the spring against the inner surface of the enclosure of the proximal connection. In order to reduce or substantially eliminate bending, the spring orientation 3080 at both the first and second ends 3080a and 3080b can be adjusted in accordance with various aspects of the present description. In addition, in one embodiment, the cabinet includes a 3096 linear guide track arranged parallel to the 3084c cabinet's longitudinal geometric axis. A 3086 linear guide that is movably or slidably joined to the 3096 linear guide track is fixedly attached to a 3080 compression spring spiral. A 3072 linear guide that is also movably or slidably joined to the 3096 linear guide track is operationally coupled to plug 3074. The linear guide track 3096 and linear guides 3086 and 3072 additionally reduce or substantially eliminate the bending of the compression spring 3080. It should be noted that in some embodiments, the counterbalance system can be operated without linear guides and a linear guide trail.
[0198] [000198] Now with reference to the adjustable alignment of the first or proximal end of the compression spring, in one aspect, the alignment ring 3090 is movably coupled to the base 3092 by a plurality of adjustment screws 3091, so that the movement of the adjusting screws 3091 adjusts an orientation of the 3090 alignment ring and therefore an orientation of the first spring end 3080a fixedly attached to the alignment ring 3090. In one example, the base 3092 is attached to the alignment ring 3090 by four 3091 adjustment screws installed apart from each other in a square or rectangular configuration. Other geometric configurations of the screws are possible. The adjusting screws 3091 are each movable in a direction substantially perpendicular to an upper planar surface of the 3090 alignment ring (for example, through a tapering action through the base openings that have internal threads) so that the orientation of the alignment ring can be adjusted at each point of contact with the adjustment screws. Consequently, the orientation of the alignment ring 3090 and the first end 3080a of the spring 3080 fixedly coupled can be adjusted at various points together with the alignment ring 3090. More or less adjustment screws 3091 are within the scope of the present description.
[0199] [000199] Now with reference to figures 32A to 37C, detailed views of a distal end of the proximal counterbalance connection without walls of the connection cabinet are illustrated. In particular, the figures illustrate views of an adjusting pin 3106, an oscillating arm 3108, and a range of motion of the adjusting pin and oscillating arm to adjust an orientation of the end plug 3074 and the second end 3080b of spring 3080 coupled according to various aspects of this description.
[0200] [000200] Figure 32A illustrates a bottom perspective view of the counterbalance system, and figure 32B illustrates a perspective view of a section section along line IV-IV of figures 31, 32A, and 37A. As noted above, a plurality of cap screws 3075a and 3075b are arranged between and couple the cable voltage equalizer 3082 and the plug 3074. The hex head screw 3075a supports all tension in this mode and the other two hex head screws 3075b are provided for security and redundancy purposes. As noted further above, a distal spring end 3080 is coupled to plug 3074 by screwing on the external threads 3074a of plug 3074. Plug 3074 can optionally include a plurality of 3200 grooves formed to lighten the weight of the Plug. It is also noted that the linear guide 3072 can be slidably coupled to the linear guide track 3096 by linear guide flanges 3072a.
[0201] [000201] As can be seen in figures 32A and 32B, plug 3074 is coupled to linear guide 3072 by adjusting pin 3106, a nozzle screw 3104 that runs through an inner channel of adjusting pin 3106, and a nut 3102 which screws into a free end 3104a of the nozzle screw 3104 to lock the position of the adjusting pin 3106 and linear guide 3072 relative to each other. In one embodiment, the nozzle screw 3104 is an allen screw. A nozzle screw head 3104b opposite the free end 3104a is placed within a hitch ditch 3105 of the adjustment pin 3106 to lock the head portion of the nozzle screw into the adjustment pin when nut 3102 is fully engaged in the free end 3104a of the nozzle screw, thereby locking the position of the adjusting pin 3106 and linear guide 3072 relative to each other.
[0202] [000202] Now with reference to figures 33 to 36C, the movement adjustment of the adjustment pin 3106 relative to the linear guide 3072 is described in greater detail. Figure 33 illustrates a side view of the adjustment pin 3106 coupled to the linear guide 3072, a circle 3114, and a center circle 3114a around which the adjustment pin 3106 can pivot when the adjustment pin is not completely locked in place relative to the linear guide 3072. Figure 34 illustrates linear guide markings 3072b and markings of the adjustment pin 3106c when a central longitudinal axis 3107 of the adjustment pin 3106 is perpendicular to a central longitudinal axis 3097 of the linear guide 3072 or guide track 3096. Linear guide marks 3072b and adjustment pin marks 3106c can be used by a counterbalance system adjuster (and in particular the guide plug) to determine relative positions of the adjustment pin and linear guide. Fig. 35 illustrates a perspective view of the adjusting pin 3106 which includes a pin shaft 3106a and a pin head 3106b. As can be seen in figures 33 to 35, the pin head 3106b has a curved upper surface that corresponds operationally to a curved surface of the linear guide 3072.
[0203] [000203] Figures 36A to 36C illustrate side views of the adjustment pin 3106 and linear guide 3072 and their respective central longitudinal geometric axes 3107 and 3097, respectively. Figure 36A illustrates a perpendicular position of the central longitudinal axis 3107 of the adjusting pin 3106 relative to the central longitudinal axis 3097 of the linear guide 3072. Figure 36B illustrates a position in which the central longitudinal axis 3107 of the adjusting pin 3106 forms. an obtuse angle with the central longitudinal axis 3097 of the linear guide 3072, and Figure 36C illustrates a position in which the central longitudinal axis 3107 of the adjusting pin 3106 forms an acute angle with the central longitudinal axis 3097 of the linear guide 3072 Consequently, Figures 36A to 36C illustrate the pivoting movement of the adjustment pin 3106 relative to the linear guide 3072, and therefore the orientation adjustment that can be made for plug 3074 and the second end 3080b of spring 3080 fixedly coupled.
[0204] [000204] Figure 37A illustrates another bottom perspective view of the counterbalance system showing an oscillating arm 3108 and adjustment screws 3110, figure 37B illustrates figure 37A with plug 3074 removed, and figure 37C illustrates figure 37B with the swing arm 3108 removed. The swing arm 3108 is attached to the adjusting pin 3106 at a free end of the pin shaft 3106a and the adjusting screws 3110 attach the swing arm 3108 to the plug 3074. A cross disk pin 3112 secures the swing arm 3108 to the adjustment pin. 3106. The swing arm 3108 and coupled plug 3074 can pivot around the central longitudinal axis 3107 of the adjustment pin 3106 and can be adjusted by moving the adjustment screws 3110 in a direction substantially perpendicular to the longitudinal axis 3107, for example, by the tapering action through the openings of the oscillating arm that has internal threads. Therefore, the orientation of plug 3074 and the second end 3080b of spring 3080 fixedly coupled can be adjusted at each point of contact with the adjustment screws 3110. More or less adjustment screws 3110 are within the scope of the present description. Consequently, the orientation of the plug and therefore the second or distal end of the spring 3080 can be adjusted at various points by pivoting the adjustment pin 3106 and pivoting the swing arm 3108. In one aspect, the adjustment pin 3106 and swing arm 3108 pivot around geometry axes that are perpendicular to each other.
[0205] [000205] In addition, the counterbalance connection of the present description allows adjustment between the plug and the second end of the compression spring to change the amount of active spirals that are compressible in the compression spring. In one aspect, the second end of the compression spring can be screwed additionally or less to the external threads of the plug to change the number of active spirals that are compressible.
[0206] [000206] Advantageously, as a motor pivots the distal connection 3028 around the geometric axis of the pivot 3070 for increased and advantageous instrument configuration and manipulation of the robot arm, the proximal counterbalance connection 3026 allows easier movements of the distal connection, and less torque is required from the motor that pivots the distal connection, while also providing increased safety from any motor failure. In some embodiments, although the counterbalance mechanism of the proximal connection may fail entirely, the motor that pivots the distal connection may lock to keep the distal connection in place.
[0207] [000207] The modalities described above illustrate, but do not limit, the description. It should also be understood that various modifications and variations are possible according to the principles of this description. For example, in many ways the devices described in this document are used as single port devices; that is, all the components necessary to complete a surgical procedure enter the body through a single entrance port. In some ways, however, multiple devices and ports can be used.

权利要求:
Claims (13)
[0001]
Robotic surgical system, comprising: a base (108); a configuration connection (122) operationally coupled to the base (108), the configuration connection (122) locating a remote movement center (146) for the robotic surgical system; a proximal connection (226) operationally coupled to the configuration connection (122); a distal connection (230, 234, 238) operationally coupled to the proximal connection (226); and a plurality of instrument manipulators (242a) rotatably coupled to a distal end of the distal connection (230, 234, 238), characterized by the fact that the plurality of instrument manipulators (242a) being configured to rotate as a group with respect to the distal end of the distal connection (230, 234, 238), each of the plurality of instrument manipulators (242a) including a plurality of driver outputs (442b-442e) projecting distally from a distal end of a structure.
[0002]
System according to claim 1, characterized by the fact that the plurality of driver outputs (442b-442e) includes a rotation output (442e) to drive a rotation movement of a surgical instrument (260, 1460), a claw outlet (442b) for triggering a tightening movement of the surgical instrument (260, 1460), a pulse outlet (442d) for triggering a wrist movement of the surgical instrument (260, 1460), and a snap outlet (442c) ) to trigger a pulse translation movement of the surgical instrument (260, 1460).
[0003]
System according to claim 1, characterized by the fact that at least one of the plurality of driver outputs (442b-442e) is one among a cardan, a disk, and a lever.
[0004]
System according to claim 1, characterized by the fact that it still comprises a plurality of insertion mechanisms (344), each of the plurality of insertion mechanisms (344) having a base connection (808) and a transport connection (804), the base connection (808) being operationally coupled to a rotating base plate (340a) in the distal connection (230, 234, 238) and the transport connection (804) being operationally coupled to the structure of a corresponding instrument (242a).
[0005]
System according to claim 4, characterized by the fact that a first instrument handler (242a) of the plurality of instrument handlers (242a) is configured to move together with a corresponding insertion mechanism (344) between a proximal end of the base connection (808) and a distal end of the transport connection (804).
[0006]
System according to claim 1, characterized by the fact that a first instrument handler (242a) of the plurality of instrument handlers (242a) still comprises: instrument support components (542f) mounted to the frame; and a locking mechanism (542g); where the locking mechanism (542g) is configured to: moving the distal end of the structure towards a distal end of the instrument support components (542f) to operationally couple the plurality of driver outputs (442b-442e) of the first instrument manipulator (242a) and trigger inputs of an instrument surgical (260, 1460) while the surgical instrument (260, 1460) remains in a fixed position; and move the distal end of the structure away from the distal end of the instrument support components (542f) to operationally decouple the plurality of driver outputs (442b-442e) from the first instrument handler (242a) from the trigger inputs of the surgical instrument ( 260, 1460) while the surgical instrument (260, 1460) remains in a fixed position.
[0007]
System according to claim 1, characterized by the fact that a first instrument handler (242a) of the plurality of instrument handlers (242a) still comprises a plurality of support components (1350) configured to couple a sterile adapter (1250) ) to the distal end of the structure.
[0008]
System according to claim 1, characterized by the fact that it still comprises a plurality of surgical instruments (260, 1460), each surgical instrument (260, 1460) of the plurality of surgical instruments (260, 1460) having driver inputs ( 962b-962e) on a proximal face (960 ') of a force transmission mechanism (1460a) configured to be operationally mounted to the distal end of an instrument handler (242a) corresponding to the plurality of instrument handlers (242a).
[0009]
System according to claim 8, characterized by the fact that at least one of the surgical instruments (260, 1460) is selected from the group consisting of articulated tools with end effectors, such as jaws, scissors, tweezers, needle holders, microdissectors, staple applicators, staplers, and clamp applicators, and non-articulated tools, such as cutting blades, cauterizing probes, irrigators, catheters, and suction holes.
[0010]
Method for coupling a surgical instrument (260, 1460) to a manipulator arm (2501) of a robotic surgical system, the method characterized by the fact that it comprises: positioning a distal face of a first instrument handler (242a) from a plurality of instrument handlers (242a) of a robotic surgical system, where: the robotic surgical system comprises: a base (108); a configuration connection (122) operationally coupled to the base (108), the configuration connection (122) locating a remote movement center (146) for the robotic surgical system; a proximal connection (226) operationally coupled to the configuration connection (122) and; a distal connection (230, 234, 238) operationally coupled to the proximal connection (226); the plurality of instrument manipulators (242a) is rotatably coupled to a distal end of the distal connection (230, 234, 238); the plurality of instrument handlers (242a) are configured to rotate as a group with respect to the distal end of the distal connection (230, 234, 238); and each of the plurality of instrument manipulators (242a) includes a plurality of driver outputs (442b-442e) projecting distally from a distal end of a structure; and mount a proximal face (960 ') of a surgical instrument (260, 1460) to the distal face of the first instrument manipulator (242a) to operationally couple the driver outputs (442b-442e) of the first instrument manipulator (242a) and inlets actuator (962b-962e) of the surgical instrument (260, 1460).
[0011]
Method according to claim 10, characterized by the fact that it still comprises locking brackets on the surgical instrument (260, 1460) for mounting the proximal face (960 ') of the surgical instrument (260, 1460) to the distal end of the first manipulator of instrument (242a).
[0012]
Method according to claim 10, characterized by the fact that it further comprises mounting a sterile adapter to the distal end of the first instrument handler (242a).
[0013]
Method according to claim 10, characterized in that it further comprises driving the distal end of the structure towards or away from a distal end of instrument supports (542f) in the first instrument manipulator (242a) to couple or operationally decouple the driver outputs (442b-442e) from the first instrument handler (242a) and the driver inputs (962b-962e) from the surgical instrument (260, 1460) while the surgical instrument (260, 1460) remains in one position fixed.

类似技术:

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公开号 | 公开日 | 专利标题

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BR112012028375B1|2021-01-12|robotic surgical system and method for attaching a surgical instrument to a manipulator arm of a robotic surgical system

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US11207150B2|2020-02-19|2021-12-28|Globus Medical, Inc.|Displaying a virtual model of a planned instrument attachment to ensure correct selection of physical instrument attachment|

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WO2021202869A1|2020-04-02|2021-10-07|Intuitive Surgical Operations, Inc.|Devices for instrument use recording, devices for recording instrument reprocessing events, and related systems and methods|

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US11253216B2|2020-04-28|2022-02-22|Globus Medical Inc.|Fixtures for fluoroscopic imaging systems and related navigation systems and methods|

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US11153555B1|2020-05-08|2021-10-19|Globus Medical Inc.|Extended reality headset camera system for computer assisted navigation in surgery|

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WO2021258113A1|2020-06-19|2021-12-23|Remedy Robotics, Inc.|Systems and methods for guidance of intraluminal devices within the vasculature|

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CN112618023A|2020-12-30|2021-04-09|上海微创医疗机器人（集团）股份有限公司|Sterile isolation device and surgical robot system|

法律状态:
2018-03-27| B15K| Others concerning applications: alteration of classification|Ipc: A61B 17/34 (2006.01), A61B 17/02 (2006.01), A61B 3 |

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2018-12-26| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

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2019-08-13| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2020-07-07| B06A| Patent application procedure suspended [chapter 6.1 patent gazette]|

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2020-11-24| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2021-01-12| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 04/05/2011, OBSERVADAS AS CONDICOES LEGAIS. |

优先权:

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申请号 | 申请日 | 专利标题

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US33497810P| true| 2010-05-14|2010-05-14|

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US61/334,978|2010-05-14|

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US12/855,452|US8852208B2|2010-05-14|2010-08-12|Surgical system instrument mounting|

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US12/855,452|2010-08-12|

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PCT/US2011/035109|WO2011143020A1|2010-05-14|2011-05-04|Surgical system instrument mounting|

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