SURGICAL DEVICE

专利摘要:
abstract of the disclosure devices and systems are provided for controlling movement of a working end of a surgical device by means of a robotic system. in one embodiment, systems and devices are provided for moving an end effector on a distal end of a surgical fastening device. movement can include rotational movement of the end effector about an axis of the shaft, articulation of the end effector relative to the shaft, and actuation of an end effector, e.g., closing, firing, and / or cutting. ************************* translation of the patent invention summary summary: "robotically controlled endoscopic accessory channel". the present invention relates to devices and systems for controlling the movement of a working end of a surgical device through a robotic system. in one embodiment, systems and devices are provided for moving an end actuator over a distal end of a surgical fixation device. the movement may include the pivoting movement of the end actuator about an axis of the stem, articulation of the end actuator in relation to the stem, and actuation of an end actuator, for example, closing, firing, and / or cutting. 19870674v1
公开号:BR112013030440B1
申请号:R112013030440-5
申请日:2012-05-24
公开日:2021-04-13
发明作者:James T. Spivey；Mark S. Ortiz；Frederick E. Shelton, Iv
申请人:Ethicon Endo-Surgery, Inc；
IPC主号:

专利说明:

CROSS REFERENCE TO RELATED REQUESTS
[0001] This non-provisional patent application is a continuation-in-part patent application and benefit claims on US Patent Application Serial No. 11 / 277,324, filed March 23, 2006, the publication US Patent No. 2007 / 0225562- A1, the description of which is incorporated herein by reference in its entirety. FIELD OF THE INVENTION
[0002] The present invention relates in general to methods and devices for controlling the movement of a working end of a surgical device. BACKGROUND OF THE INVENTION
[0003] Endoscopic surgical instruments are often preferred over traditional open surgery devices, since the use of a natural orifice tends to reduce recovery time and complications in the postoperative period. As a consequence, significant development has been invested in a range of endoscopic surgical instruments that are suitable for precise placement of the working end of a tool in a desired surgical location through a natural orifice. These tools can be used to engage and / or treat tissue in various ways to achieve a diagnostic or therapeutic effect.
[0004] Endoscopic surgery requires that the axis of the device be flexible, but allows the working end to be articulated so that such end can be oriented angularly in relation to the tissue and, in some cases, be driven or moved. The integration of controls to articulate and activate a working end of an endoscopic device tends to be complicated by the use of a flexible shaft and the size limitations of an endoscopic instrument. In general, the control movements are all transferred through the axis as longitudinal translations, which can interfere with the flexibility of the axis. There is also a desire to reduce the force required to articulate and / or activate the working end to a level that all or a large majority of surgeons can handle. A known solution to decrease the force-to-trigger is the use of electric motors. However, surgeons typically prefer feedback from the working end to ensure proper operation of the end actuator. The effects of user feedback are not adequately feasible on motor-driven devices.
[0005] Consequently, there is a need for improved methods and devices to control the circulation of a working end of an endoscopic surgical device. SUMMARY OF THE INVENTION
[0006] In one embodiment, a surgical device is provided, which has an elongated rod with a proximal end that has a cable movably attached to it and a distal end that has a flexible neck extending from it. The cable and flexible neck can be operatively linked so that the movement of the cable is effective in making the flexible neck articulate in multiple planes. In certain exemplifying modalities, the movement of the cable can be imitated by the flexible neck. The device may also include an actuator that extends between the cable and the flexible neck and is configured to transfer movement from the cable to the flexible neck.
[0007] The cable of the device can have a variety of configurations, but in one embodiment, the cable can be adapted to articulate in relation to the proximal end of the elongated rod. For example, the cable can be attached to the proximal end of the rod elongated by a joint, such as a ball and socket joint, an articulated joint or a flexing joint. The actuator of the device can also have a variety of configurations and, in one embodiment, the actuator can be at least one cable that extends along a length of the elongated stem. For example, the device may include a plurality of cables that extend along a length of the stem and are equally spaced from each other around a circumference of the actuator. The cables are configured to slide in relation to an axis of the elongated stem and to apply tension to the elongated stem to cause at least a portion of the elongated stem to flex and bend. The cable and / or cables can also optionally include a locking mechanism associated with them and configured to maintain the cable and / or cables in a fixed position. In an exemplary modality, the elongated stem is configured to passively flex and bend when inserted through a sinuous lumen.
[0008] The elongated rod may also have a variety of configurations, but in one embodiment, the device may be in the form of a surgical stapler and the elongated rod may include an end actuator coupled to a distal end of the flexible neck and adapted to engage fabric and deliver at least one closure to the engaged fabric. The cable and the end actuator can be coupled so that the movement of the cable is imitated by the end actuator. For example, the cable can be attached to the proximal end of the elongated stem by a joint, such as a ball and socket joint, an articulated joint and a flexion joint, and the flexible neck can be formed into or coupled to the end actuator to allow that the end actuator proportionally mimics the movement of the cable. The device may also include an actuator that extends between the cable and the end actuator and is configured to transfer movement from the cable to the flexible neck. The actuator can be, for example, a plurality of cables that extend along a length of the elongated stem. The cables can be evenly spaced from one another around an elongated rod circumference.
[0009] In another embodiment, the device can be in the form of an accessory channel and the elongated rod can be in the form of a tube that has an internal lumen adapted to receive a tool through it. The flexible neck that extends from the distal end of the elongated tube can be configured to flex to guide a tool that extends through the elongated tube. The flexible neck can have a variety of configurations, but in one embodiment it includes a plurality of slits formed in it to facilitate its flexing. Slots can be configured to cause the flexible neck to flex to a desired orientation. For example, the flexible neck can include a distal slit region and a proximal region of slits and the slits can be configured so that the tension applied to the flexible neck will cause the flexible neck to flex in the proximal and distal regions. A cable can be attached to the proximal end of the elongated tube and can be operationally associated with the flexible neck, so that the movement of the cable is imitated by the flexible neck. The cable may also have a variety of configurations and in one embodiment the cable may include a stationary member and a movable member adapted to articulate with respect to the stationary member. The movable member can be coupled to the stationary member by a joint, such as a ball and socket joint, an articulated joint and a flexion joint. In use, the accessory channel can be configured to attach securely to an endoscope. For example, a combination element can be formed and extends along a length of an external surface thereof to be combined with a complementary combination element formed in a cylindrical socket adapted to receive an endoscope. The device may also include an actuator that extends between the cable and the flexible neck. The actuator can be configured to transfer movement from the cable to the flexible neck. In certain exemplary embodiments, the actuator is in the form of at least one cable that extends along a length of the elongated tube. Where the actuator includes multiple cables, the cables are preferably equally spaced from one another around a circumference of the elongated tube. The cables can extend along the elongated tube using various techniques. For example, the elongated tube may include at least one lumen formed on a side wall thereof and extending along its length and the cable (s) can be slidably arranged inside the (s) lumen (s). The device may also include a locking mechanism positioned to engage at least one of the cable and the cable (s) to lock the cable and cable (s) in a fixed position.
[00010] The present invention also provides an endoscopic system that has an elongated cylindrical socket configured to be disposed around an endoscope and an accessory channel removably removable to the elongated cylindrical socket. The accessory channel may have an internal lumen that extends through it between the proximal and distal ends of the same to receive a tool, a flexible portion formed in a distal portion of the same and that is made flexible by a plurality of slits formed in the same and at least one cable coupled to the proximal end thereof and operatively associated with the flexible portion, so that the cable (s) is configured to cause the flexible portion to pivot in at least one plane. The cable (s) can be operationally associated with the flexible portion by at least one cable and the cable (s) can be configured to axially move the cable (s). ) cable (s) relative to the accessory channel to cause the cable (s) to apply tension to the flexible portion of the accessory channel, so that the flexible portion is articulated in at least one plane. In one embodiment, the device may include a single cable configured to cause the flexible portion to be articulated in multiple planes. The single cable may include a stationary member coupled to the proximal end of the accessory channel and a movable member configured to pivot with respect to the stationary member. The single cable and the flexible portion can be operatively linked so that the movement of the single cable is imitated by the flexible portion. In another embodiment, the cable may include a first member configured to cause the flexible portion to pivot in a foreground and a second member configured to cause the flexible portion to pivot in a second plane. In particular, the cable can include a stationary member coupled to the proximal end of the accessory channel and the first and second members can be pivotally coupled to the stationary member. The device can also include a first coil coupled to the first member and which has at least one cable extending from it and coupled to the flexible portion and a second coil coupled to the second member and which has at least one cable which extends from it and coupled to the flexible portion. The first and second members can be effective for rotating the first and second coils and thus move the cables axially to make the flexible portion pivot.
[00011] The surgical devices presented in this document can also include a variety of other characteristics. For example, the device may include an optical imaging assembly unit arranged at a distal end of the elongated rod. The optical imaging assembly unit can be adapted to obtain images during endoscopic procedures. An image display screen can be arranged on a proximal portion of the device and adapted to communicate with the optical imaging assembly unit to display the acquired images. In other embodiments, the end actuator of the device may include a cartridge removably disposed and containing a plurality of staples for stapling fabric and a blade for cutting stapled fabric.
[00012] In other respects, a surgical method is provided and includes inserting an elongated stem into a body lumen to position a flexible neck attached to a distal end of the elongated stem adjacent to the tissue to be treated and moving an attached pivotable cable to a proximal end of the elongated rod to cause the flexible neck to mimic the movement of the cable. The flexible neck can mimic the movement of the cable or the movement of the flexible neck can correspond directly to the movement of the cable. In certain exemplifying modalities, the movement is proportional.
[00013] In an exemplary embodiment, an end actuator coupled to a distal end of the elongated stem is positioned adjacent to the tissue to be attached and a cable pivotally coupled to a proximal end of the elongated stem is moved to cause the actuator the end proportionally imitate the movement of the cable. The end actuator can mimic the movement of the cable, or the movement of the end actuator can directly correspond to the movement of the cable. In an exemplary embodiment, the cable is pivotally articulated around the proximal end of the elongated stem to cause the end actuator to mimic the movement of the cable. The method may also include engaging fabric between opposing jaws of the end actuator and triggering at least one closure from the end actuator on the fabric. The fabric can be engaged by moving a translation member formed on the cable from a first position to a second position to close the opposing jaws and the latches can be activated by rotating a rotating member formed on the cable to drive an actuating mechanism arranged in the interior of the end actuator to cause the actuator mechanism to actuate a plurality of closures on the fabric. In another embodiment, prior to the movement of the translation member from the first position to the second position, the rotating member can be rotated to rotate the end actuator in relation to the flexible neck without activating the actuating mechanism.
[00014] In yet another aspect, the elongated rod may be in the form of an accessory channel that is slidably combined with an endoscope disposed within a body cavity to position a distal end of the accessory channel in proximity to a distal end of the endoscope. A tool is inserted through a lumen into the accessory channel, so that the tool extends distally beyond the distal end of the accessory channel and a cable attached to a proximal end of the accessory channel can be moved to make a flexible neck on the distal end of the accessory channel articulates, thus making sure that a working end of the tool is oriented in a desired position. The cable can be moved by pivoting the cable relative to the accessory channel or, alternatively, it can be moved by rotating at least one rotating member on the cable.
[00015] In accordance with other general aspects of the various embodiments of the present invention, a surgical device is provided that includes an end actuator that is configured to perform at least one surgical procedure in response to at least one control movement applied to it at from a control unit of a robotic system. An elongated stem is coupled to the end actuator and is configured to facilitate the transmission of at least one control movement to the end actuator from the robotic system. The elongated stem defines a stem axis and is configured to facilitate articulation of the end actuator in two planes that are substantially perpendicular to the stem axis by manipulating the control unit in relation to the elongated stem, so that the movement of the unit control is imitated by the end actuator.
[00016] In accordance with still other general aspects of the various modalities of the present invention, an accessory channel for the removable fixation to an endoscope is provided. In various embodiments, the accessory channel comprises an elongated tube that has an internal lumen that extends through it between proximal and distal ends of the same to receive a tool. The accessory channel further comprises a flexible neck that extends from the distal end of the elongated tube and is configured to flex in order to orient a tool that extends through the elongated tube. The flexible neck is configured to be operationally coupled to at least a portion of a robotic system so that the movement of at least a portion of the robotic system is imitated by the flexible neck.
[00017] In accordance with yet other general aspects of various embodiments of the present invention, an endoscopic system is provided for use with a robotic system. In various forms, the endoscopic system comprises an elongated cylindrical socket that is configured to be arranged around an endoscope. An accessory channel can be removably combined with the elongated cylindrical fitting. The accessory channel has an internal lumen that extends through it between the proximal and distal ends of the same to receive a tool. A flexible portion is formed in a distal portion thereof and is made flexible by a plurality of slits formed therein. The proximal end of the accessory channel is configured for operable fixation to at least a portion of the robotic system, so that the actuation of at least a portion of the robotic system causes the flexible portion to articulate in at least one plane. BRIEF DESCRIPTION OF THE DRAWINGS
[00018] The invention will be more fully understood from the following detailed description, taken in conjunction with the accompanying drawings, in which:
[00019] Figure 1A is a perspective view of a modality of a surgical stapling and cutting device, showing a working end of the device in its initial position;
[00020] Figure 1B is a perspective view of the surgical stapling and cutting device of Figure 1A, showing the working end of the device in an articulated position;
[00021] Figure 2 is a perspective view of a portion of a flexible neck of the device shown in Figures 1A and 1B;
[00022] Figure 3A is a perspective view of a distal portion of the device shown in Figures 1A and 1B, showing an end actuator and the flexible neck of Figure 2 coupled thereto;
[00023] Figure 3B is a cross-sectional view taken through line 3B-3B of the end actuator shown in Figure 3A;
[00024] Figure 4A is a perspective view of a proximal portion of the device shown in Figures 1A and 1B, showing a movable cable coupled to a proximal end of an axis of the device;
[00025] Figure 4B is an exploded view of the proximal portion of the device shown in Figure 4A;
[00026] Figure 5 is a perspective view of the coupling element disposed between the flexible neck and the elongated rod of the device shown in Figures 1A and 1B, showing an optical image collection device;
[00027] Figure 6 is a perspective view of the device cable shown in Figures 1A and 1B, showing an image display screen;
[00028] Figure 7 is a perspective view of an accessory channel for use with an endoscope;
[00029] Figure 8A is a perspective view of a flexible neck, of the device shown in Figure 7;
[00030] Figure 8B is a perspective view of the flexible neck shown in Figure 8A, showing the neck articulated in a first direction;
[00031] Figure 8C is a perspective view of the flexible neck shown in Figure 8A, showing the neck articulated in a second direction;
[00032] Figure 9A is a perspective view of another embodiment of a flexible neck for use with an accessory channel;
[00033] Figure 9B is a perspective view of the flexible neck shown in Figure 9A, showing the neck articulated in a first direction;
[00034] Figure 9C is a perspective view of the flexible neck shown in Figure 9A, showing the neck articulated in a second direction;
[00035] Figure 10 is a perspective view of a plurality of cable actuators for use with the device of Figure 7;
[00036] Figure 11 is a cross-sectional view of a rod of the accessory channel of Figure 7;
[00037] Figure 12 is a perspective view of an embodiment of a plug for use with the accessory channel of Figure 7;
[00038] Figure 13A is an exploded view of the cable and a proximal portion of the elongated rod of the device shown in Figure 7;
[00039] Figure 13B is a cross-sectional view of the cable and the proximal part of the elongated rod of Figure 13A in an assembled configuration;
[00040] Figure 14A is a perspective view of another modality of an accessory channel;
[00041] Figure 14B is a cross-sectional view of the accessory channel shown in Figure 14A;
[00042] Figure 15A is a side view of a cable assembly of the device shown in Figures 14A and 14B;
[00043] Figure 15B is an exploded view of the cable assembly of Figure 15A;
[00044] Figure 16A is a perspective view of an embodiment of a locking mechanism;
[00045] Figure 16B is a perspective view of the locking mechanism of Figure 16A coupled to the surgical stapling and cutting device of Figures 1A and 1B;
[00046] Figure 17 is a perspective view of a robotic controller modality;
[00047] Figure 18 is a perspective view of a robotic surgical arm carriage / manipulator of a robotic system that operably supports a plurality of surgical tool modalities of the present invention;
[00048] Figure 19 is a side view of the car / robotic surgical arm manipulator shown in Figure 18;
[00049] Figure 20 is a perspective view of an exemplary carriage structure with positioning links to operably support robotic manipulators that can be used with various surgical tool embodiments of the present invention;
[00050] Figure 21 is a perspective view of a modality of the surgical tool of the present invention;
[00051] Figure 22 is an exploded view of an adapter and tool retainer arrangement for attaching various surgical tool modalities to a robotic system;
[00052] Figure 23 is a side view of the adapter shown in Figure 22;
[00053] Figure 24 is a bottom view of the adapter shown in Figure 22;
[00054] Figure 25 is a top view of the adapter of Figures 22 and 23;
[00055] Figure 26 is a partial bottom perspective view of the surgical tool modality of Figure 21;
[00056] Figure 27 is a partial exploded view of a portion of a pivotable surgical end actuator modality of the present invention;
[00057] Figure 28 is a perspective view of the surgical tool modality of Figure 26 with the tool mounting housing removed;
[00058] Figure 29 is a rear perspective view of the surgical tool modality of Figure 26 with the tool mounting housing removed;
[00059] Figure 30 is a front perspective view of the surgical tool modality of Figure 26 with the tool mounting housing removed;
[00060] Figure 31 is a partial exploded perspective view of the surgical tool modality of Figure 30;
[00061] Figure 32 is a side view of partial cross section of the surgical tool modality of Figure 26;
[00062] Figure 33 is an enlarged cross-sectional view of a portion of the surgical tool shown in Figure 32;
[00063] Figure 34 is an exploded perspective view of a portion of the tool mounting portion of the surgical tool embodiment shown in Figure 26;
[00064] Figure 35 is an enlarged exploded perspective view of a portion of the tool mounting portion of Figure 34;
[00065] Figure 36 is a partial cross-sectional view of a portion of the elongated nail assembly of the surgical tool of Figure 26;
[00066] Figure 37 is a side view of a half portion of a threaded closure modality of a surgical tool modality of the present invention;
[00067] Figure 38 is a perspective view of another embodiment of the surgical tool of the present invention;
[00068] Figure 39 is a side cross-sectional view of a portion of the surgical end actuator and the elongated shank assembly of the surgical tool modality of Figure 38 with the claw fixed in the open position and the closing clutch assembly in a neutral position;
[00069] Figure 40 is another cross-sectional side view of the surgical end actuator and elongated stem assembly shown in Figure 39 with the clutch assembly engaged in a closed position;
[00070] Figure 41 is another cross-sectional side view of the surgical end actuator and the elongated stem assembly shown in Figure 39 with the clutch assembly engaged in a firing position;
[00071] Figure 42 is a top view of a portion of a tool assembly portion embodiment of the present invention;
[00072] Figure 43 is a perspective view of another embodiment of the surgical tool of the present invention;
[00073] Figure 44 is a side cross-sectional view of a portion of the surgical end actuator and the elongated stem assembly of the surgical tool modality of Figure 43 with the claw fixed in the open position;
[00074] Figure 45 is another cross-sectional side view of a portion of the surgical end actuator and the elongated stem assembly of the surgical tool modality of Figure 43 with the claw fixed in the closed position;
[00075] Figure 46 is a perspective view of a closing drive thread and a portion of a knife bar embodiment of the present invention;
[00076] Figure 47 is a top view of another tool assembly portion of the present invention;
[00077] Figure 48 is a perspective view of another embodiment of the surgical tool of the present invention;
[00078] Figure 49 is a side cross-sectional view of a portion of the surgical end actuator and the elongated stem assembly of the surgical tool modality of Figure 48 with the claw fixed in the open position;
[00079] Figure 50 is another cross-sectional side view of a portion of the surgical end actuator and the elongated stem assembly of the surgical tool modality of Figure 49 with the claw fixed in the closed position;
[00080] Figure 51 is a cross-sectional view of a mounting collar modality of a surgical tool modality of the present invention showing the knife bar and the distal portion of the closing drive rod end;
[00081] Figure 52 is a cross-sectional view of the modality of the mounting collar of Figure 51;
[00082] Figure 53 is a top view of another tool assembly portion of another surgical tool embodiment of the present invention;
[00083] Figure 53A is an exploded perspective view of a portion of a gear arrangement of another embodiment of the surgical tool of the present invention;
[00084] Figure 53B is a cross-sectional perspective view of the gear arrangement shown in Figure 53A;
[00085] Figure 54 is a side cross-sectional view of a portion of a surgical end actuator and the elongated stem assembly of another embodiment of the surgical tool of the present invention that employs a pressure sensor arrangement with the claw attached to the open position;
[00086] Figure 55 is another cross-sectional side view of a portion of the surgical end actuator and the elongated stem assembly of the surgical tool modality of Figure 54 with the claw fixed in the closed position;
[00087] Figure 56 is a side view of a portion of another surgical tool modality of the present invention in relation to a tool retaining portion of a robotic system with some of its components in cross section;
[00088] Figure 57 is a side view of a portion of another embodiment of the surgical tool of the present invention in relation to a tool retaining portion of a robotic system with some of its components shown in cross section;
[00089] Figure 58 is a side view of a portion of another embodiment of the surgical tool of the present invention with some of its components shown in cross section;
[00090] Figure 59 is a side view of a portion of another surgical end actuator embodiment of a portion of a surgical tool embodiment of the present invention with some components thereof shown in cross section;
[00091] Figure 60 is a side view of a portion of another surgical end actuator modality of a portion of a surgical tool modality of the present invention with some components thereof shown in cross section;
[00092] Figure 61 is a side view of a portion of another surgical end actuator modality of a portion of a surgical tool modality of the present invention with some components thereof shown in cross section;
[00093] Figure 62 is an enlarged cross-sectional view of a portion of the end actuator of Figure 61;
[00094] Figure 63 is another cross-sectional view of a portion of the end actuator of Figures 61 and 62;
[00095] Figure 64 is a side cross-sectional view of a portion of a surgical end actuator and the elongated stem assembly of another embodiment of the surgical tool of the present invention with the claw fixed in the open position;
[00096] Figure 65 is an enlarged cross-sectional side view of a portion of the surgical end actuator and the elongated stem assembly of the surgical tool modality of Figure 64;
[00097] Figure 66 is another side cross-sectional view of a portion of the surgical end actuator and of the elongated stem assembly of Figures 64 and 65 with the claw fixed in the closed position;
[00098] Figure 67 is an enlarged cross-sectional side view of a portion of the surgical end actuator and the elongated stem assembly of the surgical tool modality of Figures 64 to 66;
[00099] Figure 68 is a top view of a tool assembly portion embodiment of a surgical tool embodiment of the present invention;
[000100] Figure 69 is an overall perspective view of another embodiment of the surgical tool of the present invention;
[000101] Figure 70 is a front perspective view of a disposable loading unit arrangement that can be employed with various surgical tool embodiments of the present invention;
[000102] Figure 71 is a rear perspective view of the disposable loading unit of Figure 70;
[000103] Figure 72 is a bottom perspective view of the disposable loading unit of Figures 70 and 71;
[000104] Figure 73 is a bottom perspective view of another disposable loading unit that can be used with various surgical tool embodiments of the present invention;
[000105] Figure 74 is an exploded perspective view of an assembly portion of a disposable loading unit shown in Figures 70 to 72;
[000106] Figure 75 is a perspective view of a portion of a disposable loading unit and an elongated rod assembly modality of a surgical tool modality of the present invention with the disposable loading unit in a first position;
[000107] Figure 76 is another perspective view of a portion of the disposable loading unit and the elongated rod assembly of Figure 75 with the disposable loading unit in a second position;
[000108] Figure 77 is a cross-sectional view of a portion of the disposable loading unit and elongated rod assembly mode shown in Figures 75 and 76;
[000109] Figure 78 is another cross-sectional view of the disposable loading unit and elongated rod assembly mode shown in Figures 75 to 77;
[000110] Figure 79 is a partial exploded perspective view of a portion of another disposable loading unit modality and an elongated rod assembly modality of a surgical tool modality of the present invention;
[000111] Figure 80 is a partial exploded perspective view of a portion of another disposable loading unit modality and an elongated rod assembly modality of a surgical tool modality of the present invention;
[000112] Figure 81 is another partial exploded perspective view of the disposable loading unit modality and an elongated rod assembly modality of Figure 80;
[000113] Figure 82 is a top view of another tool assembly portion of a surgical tool embodiment of the present invention;
[000114] Figure 83 is a side view of another type of surgical tool of the present invention with some of its components shown in cross section and in relation to a robotic tool retainer of a robotic system;
[000115] Figure 84 is an exploded view of a surgical end actuator modality that can be used in connection with various surgical tool embodiments of the present invention;
[000116] Figure 85 is a side view of a portion of a cable-driven system for driving a cutting instrument used in various surgical end actuator modalities of the present invention;
[000117] Figure 86 is a top view of the cable-driven system and cutting instrument of Figure 85;
[000118] Figure 87 is a top view of a cable drive transmission mode of the present invention in a closed position;
[000119] Figure 88 is another top view of the cable drive transmission mode of Figure 87 in a neutral position;
[000120] Figure 89 is another top view of the cable drive transmission mode of Figures 87 and 88 in a firing position;
[000121] Figure 90 is a perspective view of the cable drive transmission mode in the position shown in Figure 87;
[000122] Figure 91 is a perspective view of the cable drive transmission mode in the position shown in Figure 88;
[000123] Figure 92 is a perspective view of the cable drive transmission mode in the position shown in Figure 89;
[000124] Figure 93 is a perspective view of another embodiment of the surgical tool of the present invention;
[000125] Figure 94 is a side view of a portion of another type of cable-driven system for driving a cutting instrument used in various modalities of the surgical end actuator of the present invention;
[000126] Figure 95 is a top view of the cable-driven system modality of Figure 94;
[000127] Figure 96 is a top view of a tool mounting portion of another embodiment of the surgical tool of the present invention;
[000128] Figure 97 is a top cross-sectional view of another embodiment of the surgical tool of the present invention;
[000129] Figure 98 is a cross-sectional view of a portion of a surgical end actuator modality of a surgical tool modality of the present invention;
[000130] Figure 99 is an end view in cross section of the surgical end actuator of Figure 103 taken along line 99-99 in Figure 98;
[000131] Figure 100 is a perspective view of the surgical end actuator of Figures 98 and 99 with portions thereof shown in cross section;
[000132] Figure 101 is a side view of a portion of the surgical end actuator of Figures 98 to 100;
[000133] Figure 102 is a perspective view of a frame assembly embodiment of various surgical tool embodiments of the present invention;
[000134] Figure 103 is a cross-sectional view of the frame assembly embodiment of Figure 102 and a portion of the elongated channel of Figure 101;
[000135] Figures 104 to 109 diagrammatically show the sequential firing of staples in a surgical tool modality of the present invention;
[000136] Figure 110 is a partial perspective view of a portion of a surgical end actuator embodiment of the present invention;
[000137] Figure 111 is a partial cross-sectional perspective view of a portion of a surgical end actuator modality of a surgical tool modality of the present invention;
[000138] Figure 112 is another perspective view in partial cross section of the surgical end actuator modality of Figure 111 with a frame assembly that advances axially through it;
[000139] Figure 113 is a perspective view of another embodiment of the frame assembly of another embodiment of the surgical tool of the present invention;
[000140] Figure 114 is a partial top view of a portion of the surgical end actuator modality shown in Figures 111 and 112 with the frame assembly advancing axially through it;
[000141] Figure 115 is another partial top view of the surgical end actuator type of Figure 114 with the top surface of the surgical clamp cartridge omitted for clarity;
[000142] Figure 116 is a partial lateral cross-sectional view of a rotary actuator and clamp thruster modality of the surgical end actuator shown in Figures 111 and 112;
[000143] Figure 117 is a perspective view of an automated refill system modality of the present invention with a surgical end actuator in extractive engagement with the extraction system thereof;
[000144] Figure 118 is another perspective view of the automated charging system modality shown in Figure 117;
[000145] Figure 119 is a cross-sectional elevation view of the automated charging system modality shown in Figures 117 and 118;
[000146] Figure 120 is another elevation view in cross section of the automated refill system modality shown in Figures 117 to 119, the extraction system of which removes a worn surgical staple cartridge from the surgical end actuator. ;
[000147] Figure 121 is another elevation view in cross section of the automated refill system modality shown in Figures 117 to 120 that illustrates the loading of a new surgical clamp cartridge in a surgical end actuator;
[000148] Figure 122 is a perspective view of another embodiment of the automated refill system of the present invention with some components shown in cross section;
[000149] Figure 123 is an exploded perspective view of a portion of the automated charging system modality of Figure 122;
[000150] Figure 124 is another exploded perspective view of the portion of the automated charging system modality shown in Figure 123;
[000151] Figure 125 is a cross-sectional elevation view of the automated refill system of Figures 122 to 124;
[000152] Figure 126 is a cross-sectional view of an orientation tube modality that supports a disposable loading unit in it;
[000153] Figure 127 is a perspective view of another embodiment of the surgical tool of the present invention;
[000154] Figure 128 is a partial perspective view of an articulation joint modality of a surgical tool modality of the present invention;
[000155] Figure 129 is a perspective view of a closure tube embodiment of a surgical tool embodiment of the present invention;
[000156] Figure 130 is a perspective view of the closing tube modality of Figure 129 mounted in the modality of the articulation joint of Figure 128;
[000157] Figure 131 is a top view of a portion of a tool mounting portion of a surgical tool embodiment of the present invention;
[000158] Figure 132 is a perspective view of a joint drive assembly modality employed in the tool assembly portion of Figure 131;
[000159] Figure 133 is a perspective view of another embodiment of the surgical tool of the present invention; and
[000160] Figure 134 is a perspective view of another embodiment of the surgical tool of the present invention. DETAILED DESCRIPTION
[000161] The Applicant for this application also holds the following patent applications that were filed on the same date as this application and which are each incorporated by reference in their respective totalities: - US patent application no. , as standard, entitled "Surgical Instrument With Wireless Communication Between a Control Unit of a Robotic System and Remote Sensor", Attorney Document No. END5924U.S.CIP2 / 060339CIP2; - U.S. Patent Application No. Serial, entitled "Robotically-Controlled Disposable Motor Driven Loading Unit", Attorney Document No. END6213U.S.CIP1 / 070330CIP1; - U.S. Patent Application No. Serial, entitled "Robotically-Controlled Motorized Surgical Instrument", Attorney Document No. END6416U.S.CIP1 / 080205CIP1; - U.S. Patent Application No., Serial, entitled "Robotically-Controlled Surgical Devices That Produce Formed Staples Having Different Lenghts", Attorney Document No. END5675U.S.CIP6 / 050504CIP6; - U.S. Patent Application No., Serial, entitled "Robotically-Controlled Motorized Cutting and Fastening Instrument", Attorney Document No. END6269U.S.CIP1 / 070391CIP1; - U.S. Patent Application No., Serial, entitled "Robotically-Controlled Shaft Based Rotary Drive Systems For Surgical Instruments", Attorney Document No. END6089U.S.CIP1 / 070059CIP1; - U.S. Patent Application No., Serial, entitled "Robotically-Controlled Surgical Instrument Having Recording Capabilities", Attorney Document No. END5773U.S.CIP4 / 050698CIP4; - U.S. Patent Application No., Serial, entitled "Robotically-Controlled Surgical Instrument With Force Feedback Capabilities", Attorney Document No. END5773U.S.CIP5 / 050698CIP5; - U.S. Patent Application No., Serial, entitled "Robotically-Driven Surgical Instrument With E-Beam Driver", Attorney Document No. END0908U.S.CIP2 / 100810CIP2; - U.S. Patent Application No., Serial, entitled "Surgical Stapling Instruments With Rotatable Staple Deployment Arrangements", Attorney Document No. END7002U.S.NP/110262.
[000162] Certain exemplary embodiments will now be described to provide a general understanding of the principles of structure, function, manufacture and use of the devices and methods of the present invention presented. One or more examples of these modalities are illustrated in the attached drawings. Those skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are exemplary non-limiting modalities, and that the scope of the various modalities of the present invention is defined only by the claims. The characteristics illustrated or described in conjunction with an exemplary modality can be combined with the characteristics of other modalities. Such modifications and variations are designed to be included within the scope of the present invention.
[000163] Uses of the expressions "in various modalities", "in some modalities," "in a modality" or "in a modality" or similar, through the specification, are not necessarily referring, all, to the same modality. Furthermore, the resources, structures or specific characteristics of one or more modalities can be combined in any suitable way in one or more different modalities. Such modifications and variations are designed to be included within the scope of the present invention.
[000164] The present invention features a method and devices for controlling a working end of an endoscopic surgical device. In general, endoscopic surgical devices include an elongated rod that has a distal working end with a flexible neck, a proximal end and a handle to control the movement of the flexible neck at the distal working end. In certain exemplary embodiments, this can be achieved by using, for example, one or more cables that extend between the cable and the flexible neck in such a way that the movement of the cable applies a force to one or more of the cables to make cause the flexible portion to be flexed and thereby move the working end of the device. Several other features are also presented to facilitate the use of the device. The person skilled in the art will understand that the specific device being controlled, and the particular configuration of the working end, may vary and that the various control techniques described herein can be used in virtually any surgical device, in which it is desirable to control the movement of the end of work.
[000165] Figures 1A and 1B illustrate an exemplary embodiment of a technique for controlling the articulation of the end actuator, and in particular for causing the end actuator to imitate and move simultaneously with the cable. In this embodiment, the device is in the form of a linear stapler and cutting device 10 for applying multiple linear rows of staples to the fabric and for cutting the stapled fabric. As shown, device 10 generally includes an elongated rod 12 having a proximal end 12a with a cable 14 attached thereto, and a distal working end 12a, which has an end actuator 16 attached thereto or formed therein, such as will be discussed in more detail below. In use, the end actuator 16 is configured to mimic the movement of the cable 14. The imitation movement between the cable 14 and the end actuator 16 can generally be achieved with the use of an actuator (not shown) that extends between cable 14 and end actuator 16, and which is effective for transferring forces from cable 14 to end actuator 16. In an exemplary embodiment, the actuator is in the form of several cables that are spaced around a circumference of the elongated rod 12, and extending along the length of the elongated rod 12. The movement of the cable 14 around the proximal end 12a of the rod 12 will apply a force to one or more of the cables to cause the cables to apply a force on the end actuator 16, thereby causing the end actuator 16, to imitate the movement of the cable 14. The imitate movement may include the corresponding movement, so that the end actuator 16 moves in the same the direction and orientation of the cable 14, or mirrored movement, so that the end actuator 16 moves in a direction and orientation opposite to the cable 14. The imitation movement can also be proportional to the movement of the cable.
[000166] The elongated rod 12 of the device 10 can have a variety of configurations. For example, it can be solid or hollow, and it can be formed from a single component or multiple segments. As shown in Figure 2, the elongated rod 12 is hollow and is formed from several connecting segments to allow the elongated rod 12 to be flexed. The flexibility of the rod 12, as well as a relatively small diameter, allows the elongated rod 12 to be used in endoscopic procedures, so that the device is introduced transluminally through a natural orifice. The rod can also vary in size, depending on the intended application.
[000167] Figure 2 further illustrates an exemplary embodiment of an actuator 22, in the form of several cables 34a, 34b, 34c, 34d, which are spaced around a circumference of the elongated stem 12, and which extend along the elongated rod length 12. The number and location of cables may vary. For example, three cables can be spaced about 120 ° from each other around the circumference of the rod 12. In the embodiment shown in Figure 2, four cables 34a, 34b, 34c, 34d are spaced approximately 90 ° from each other around the circumference of the rod 12. Each cable 34a-d can extend through a path, like a lumen, formed over, inside or around the elongated rod 12. Figure 2 illustrates each cable 34a-d that extends through a indentation formed on an external surface of each segment of the rod 12. Thus, each segment includes four spaced spacings equidistant around the circumference of the rod 12, to keep the cables 34a-d equidistant from each other. The cutouts are preferably of a size that is effective in securing the cables 34a-d there while allowing the cables 34a-d to slide freely in relation to the rod 12.
[000168] The distal end of the cables 34a-d can be coupled to the end actuator 16 to control the movement of the end actuator 16. While the end actuator 16 can have a variety of configurations, and several end actuators known in the art can be used, Figure 3A illustrates an exemplary embodiment of an end actuator 16 which generally includes the opposing first and second jaws 18, 20 which are adapted to receive tissue from each other. The first claw 18 is adapted to contain a staple cartridge with multiple clamps disposed there and configured to be guided to the fabric, and the second claw 20 forms an anvil to deform the clamps. The particular configuration and basic operation of the end actuator 16 may vary, and several end actuators 16 known in the art can be used. As a non-limiting example, US patent No. 6,978,921, entitled "Surgical Stapling Instrument Incorporating an E-Beam Firing Mechanism", which is incorporated in the present invention in its entirety, presents an embodiment of an end actuator , which can be used with the present invention.
[000169] To allow movement of the end actuator 16 in relation to the elongated stem 12, the end actuator 16 can be removably attached to the distal end 12b of the elongated stem 12 For example, the end actuator 16 can be connected articulated to the distal end 12b of the elongated stem 12 by a swivel or articulation joint. Alternatively, the end actuator 16 can include a flexible neck 26 formed therein, as shown, to allow movement of the end actuator 16 with respect to the elongated stem 12. The flexible neck 26 can be integrally formed with the distal end 12b of the stem 12 and / or the proximal end of the claws 18, 20, or it can be a separate element that extends between the stem 12 and the claws 18, 20. As shown in Figure 3A, the flexible neck 26 includes a first coupler 28 for coupling the flexible neck 26 to the proximal end of the opposing jaws 18, 20, and a second coupling 30 for coupling the flexible neck 26 to the distal end of the elongated rod 12. Couplers 28, 30 can be fixedly or removably coupled to the flexible neck 26 , and / or to the claws 18, 20 and the rod 12. Couplers 28, 30 also serve to house certain components of the end actuator 16. For example, the first coupler 28 can serve to anchor the cables there, as will be discussed below, and can also serve to house a set of actuator and gear for the actuation (for example, closing and firing) of the claws 18, 20.
[000170] To facilitate flexion of the flexible neck 26, the neck 26 may include one or more slits 32 formed there. The number, location and size of the slits 32 can vary to achieve the desired flexibility. In the embodiment shown in Figure 3A, the flexible neck 26 includes several rows of slits 32, each row extends radially around the flexible neck 26 and each row being axially spaced along the length of the flexible neck 26. Each row of slits contains two slits extending around the circumference of the neck 26, and each row of slits 32 is axially displaced from each other. As a result, the flexible neck 26 includes alternating slits 32. Someone skilled in the particular pattern of the slits 32 may vary, and that Figure 3A merely illustrates a pattern for the formation of slits 32 to allow flexion of the flexible rod 26. Other configurations of exemplary slits will be discussed in more detail below.
[000171] As indicated above, the cables 34a-d can be coupled to the end actuator 16 to allow the end actuator 16 to move in coordination with the cable 14. The connection location of the cables 34a-d with the actuator end 16 may vary depending on the desired movement. In the illustrated embodiment, the distal end of the cables 34a-d is connected to the distal end of the flexible neck 26, and in particular, extend inward and connect to the first coupler 28. Figure 3B illustrates a cross-sectional view of the first coupler 28 showing four holes 28a, 28b, 28c, 28d for receiving the four cables 34a, 34b, 34c, 34d, respectively. Virtually any technique known in the art can be used to connect cables 34a-d to coupler 28, including, for example, mechanical coupling techniques such as adhesives, an interference fit, a ball-and-socket connection (ball -and-socket connection), threads, etc. In use, connecting cables 34a-d at the distal end of flexible neck 26 will allow cables 34a-d to apply tension to flexible neck 26 when an axial force is applied to cables 34a-d by cable 14. This tension it will cause the neck 26 to be flexed in a direction dictated by the amount of tension applied to each cable 34a-d, as will be discussed in more detail below.
[000172] The cable 14 of the device 10 can be used to control the movement of the end actuator 16 and, in particular, to articulate the end actuator 16 and, thus, orient it angularly in relation to a longitudinal axis A of the elongated rod 12. While the cable 14 can have a variety of configurations, in an exemplary embodiment the cable 14 is removably attached to the proximal end 12a of the elongated rod 12, so that the movement of the cable 14 can be imitated by the actuator of end 16. Although various techniques can be used to couple the cable 14 to the rod 12 in a mobile manner, in the embodiment shown in Figures 4A-4C, a "ball-and-socket" connection is formed between the cable 14 and the end proximal 12a of the elongated rod 12. As best shown in Figure 4B, the proximal end 12a of the elongated rod 12 includes a socket 24 formed there, and the handle 14 includes a hemispherical ball 13a formed at a distal end thereof and confi secured to be rotatably placed in socket 24. Socket 24 can be integrally formed with the proximal end 12a of the elongated stem, or it can be formed by coupling a hollow housing 12c, as shown, to the proximal end 12a of the elongated stem 12. The hemispherical ball 13a can also be integrally formed with the cable 14, or it can be a separate element, which is coupled to the cable 14. To movably couple the cable 14 to the axis 12, the hemispheric ball 13a in the cable 14 can be retained in socket 24 the cables 34a-d, which are attached to the cable 14, as will be discussed below. However, other coupling techniques can be used to mobilely attach the cable 14 to the rod 12. For example, the ball 13a can be spherical and can be captured within a spherical socket formed at the proximal end 12a of the elongated rod 12, or a coupling element, such as a pin, can extend through the ball 13 to retain the ball 13 in the socket 24. While Figure 4B illustrates a ball 13a formed in the cable 14 and a socket 24 formed in the rod 12, the connection of the type "ball-and-socket" can be inverted so that the ball is on the rod 12 and the socket is on the cable 14. Furthermore, the person skilled in the art will understand that a variety of other techniques can be used to couple the cable 14 of the proximal end 12a of the elongated nail 12 movably.
[000173] In use, the cable 14 can articulate or move in an articulated manner in relation to the rod 12 to cause the end actuator 16 to imitate the movement of the cable 14. This can be achieved by coupling the proximal end of the cables 34a-d to cable 14. The connection location of cables 34a-d to cable 14 may vary, depending on the desired movement. In the illustrated embodiment, the cables (only three cables 34a, 34b and 34c are shown in Figure 4A) and extend from the elongated rod 12, through the hollow housing 12c, and out of cracks or openings formed at a proximal end of the hollow housing 12c. The cables 34a-d then extend around the ball 13a on the cable 14 and connect to a distal-facing surface on the cable 14 that surrounds the ball 13a. Virtually any technique known in the art can be used to connect cables 34a-d to cable 14, including, for example, mechanical coupling techniques such as adhesives, interference fit, threads, etc. As shown in Figure 4A, the cable 14 includes openings formed there, and the proximal ends (not shown) of the cables 34a-d can have a ball or other element formed there and configured to be captured in the openings. As additionally shown in Figure 4A, the cables (only three cables 34a, 34b and 34c are shown) can remain circumferentially spaced around the cable 14. This will allow the movement of the cable 14 to be mirrored by the end actuator 16, as will be discussed in more detail below. Alternatively, cables 34a-d can cross before connecting to cable 14 to cause end actuator 16 to move in the same direction as cable 14. For example, opposite cables 34a and 34c can cross each other and can connect to opposite sides of cable 14, and opposite cables 34b and 34d can also cross each other and can connect to opposite sides of cable 14. Cables 34a-d can cross at any location, such as in the housing hollow 12c at the proximal end 12a of stem 12.
[000174] As additionally shown in Figures 4A and 4B, the cable 14 can also include other features to facilitate the use of the device. For example, the cable 14 can include a translation element 38, which is effective for closing the jaws 18, 20 on the end actuator 16, and a rotating element 40, which is effective for selectively rotating and activating the end actuator 16. The translation and rotation elements 38, 40 are described in more detail in an application entitled "Surgical Fastener And Cutter With Single Cable Actuator" by Mark Ortiz et al. and deposited on the same date as this application, which is hereby incorporated by reference in its entirety. In other embodiments, the cable 14 may include triggers, buttons, etc., for turning and / or activating the end actuator 16.
[000175] Referring again to Figure 1B, in use, the cable 14 can be hinged or oriented angularly with respect to the proximal end 12a of the elongated stem 12 to create movement to mimic the end actuator 16. In particular, rotate the cable 14 , around the elongated rod 12 in a first direction will apply force to one or more of the cables 34a-d to pull the cable (s) axially. As a result, the activated cables will apply tension to the flexible neck 26, to cause the neck 26 to be flexed. To prevent the elongated rod 12 from flexing in response to the tension applied to the cables 34a-d by the cable 14, the flexible neck 26 may have greater flexibility than the elongated rod 12. This can be achieved, for example, with the use alternating slits 32, as described above, or in other embodiments, the material may differ, or the elongated rod may include a stabilizing member, such as a rod extending through it to make the shaft more rigid than the flexible neck.
[000176] The direction of movement of the cable 14 will be imitated by the end actuator 16, either in the same direction (that is, the corresponding movement), or in an opposite direction (that is, the mirrored movement), thus allowing the user precisely control the position of the end actuator 16. In an exemplary embodiment, the particular amount of movement of the end actuator 16 can be proportional to the amount of movement of the cable 14. That is, the amount of movement of the end actuator 16 can be directly equivalent to the amount of movement of the cable 14, or it can be increased or reduced proportionally in relation to the amount of movement of the cable 14. In certain embodiments, it may be desirable for the amount of movement of the end actuator 16 to be increased in relation to the amount of of movement of the cable 14. As a result, only small movements of the cable 14 will be necessary to allow large movements of the end actuator 16. Although several techniques can be implemented to proportionally multiply or increase the movement of the end actuator 16, an exemplary embodiment of a force multiplier mechanism is an eccentric cam that is coupled to the cables and that increases the mechanical advantage, force or displacement, of the cables 34a-d as voltage is applied to cables 34a-d by cable 14.
[000177] An individual skilled in the art will find that, although the movement between the cable and the working end of the device may in theory be proportional, in practice some loss of strength is likely to occur, as the force is transferred through the elongated rod. Consequently, the proportional movement, for use in the present invention, is intended to include applications in which the cable and working end are configured to move in proportional quantities, but in which some loss of strength may occur during the operation itself the device.
[000178] The various devices described in the present invention can also include a variety of other features that facilitate their use. For example, the device 10 of Figure 1A may include an optical image collection unit arranged on a distal end of the elongated rod 12 and configured to acquire images during endoscopic procedures. Although the location of the unit may vary, in one embodiment of the optical image collection unit it can be arranged on the second coupler 30. In particular, Figure 5 illustrates a ramp-shaped housing 42, which protrudes from an external surface of the coupler 30, and which contains the optical image collection unit therein. The viewing window 44 is formed on a surface facing the distal side of the housing 42 to allow the unit to acquire images of the end actuator 16 and surrounding the surgical site. The images from the optical image collection unit can be transferred to an external image display screen, or alternatively, the device 10 can include an image display screen arranged in or coupled to a proximal portion of the device. Figure 6 illustrates an embodiment of an image display screen 46 projecting out of cable 14.
[000179] As indicated earlier, the various techniques disclosed in the present invention for controlling the movement of a working end of an endoscopic surgical device can be used in conjunction with a variety of medical devices. Figure 7 illustrates another embodiment of a medical device that has an actuator to control the movement of the working end thereof. In this embodiment, the medical device is in the form of an accessory channel 100 for use with an endoscope. An accessory channel 100 is an external device that can be attached to, and slide along, an endoscope to allow other tools, such as tweezers, cutters, etc., to be inserted through it and positioned in close proximity to the viewing edge of the endoscope. While the accessory channel 100 can have virtually any configuration, shape and size in the embodiment illustrated in Figure 7, the accessory channel 100 includes an elongated tube or rod 102 having an internal lumen extending between the proximal and distal ends 102a, 102b thereof to receive a tool through it. Accessory channel 100 may also include a coupling element formed there to couple accessory channel 100 directly to an endoscope or to a cylindrical socket or other device arranged around an endoscope. While virtually any coupling technique can be used, in the illustrated embodiment, the coupling element in the accessory channel 100 is in the form of a rail 104 that extends along the length of the elongated rod 102. The rail 104 is configured to be received on a complementary track formed over an endoscope or a device arranged around an endoscope, such as a cylindrical fitting. The person skilled in the art will understand that a variety of other techniques can be used to attach an accessory channel, either directly or indirectly, to an endoscope.
[000180] To control the movement of a working end of accessory channel 100, device 100 may include characteristics similar to those described above. In particular, device 100 may be a flexible neck 108 formed at, or coupled to, the distal end 102b of the elongated stem 102, a cable 106 formed on or coupled to the proximal end 102a of the elongated stem 102, and an actuator extending between the cable 106 and the flexible neck 108. In this embodiment, the actuator is configured to transfer forces from the cable 106 to the flexible neck 108 so that the movement of the cable 106 is imitated by the flexible neck 108, thus allowing a tool extending through accessory channel 100 to be positioned in a desired angular orientation.
[000181] The flexible neck 108 can have a variety of configurations, and it can be a separate element that is coupled to the elongated stem 102, or it can be integrally formed with the elongated stem 102, as shown in Figure 7. The neck 108 can be flexible with the use of various techniques. For example, the neck 108 can be formed from one or more segments that move in relation to each other, and / or can be formed from a flexible material. In the exemplary embodiment shown in Figure 8A, the neck 108 includes several slits 112 formed there and configured to provide maximum flexibility of the neck 108. While the size, quantity, and orientation of the slits 112 can vary to obtain the desired results, in the illustrated embodiment the flexible neck 108 includes four columns of openings (only three columns of openings, indicated by arrows 112a, 112b, 112c, are shown). Each column extends axially along a length of flexible neck 108, and each column includes four rows of slits radially spaced around the circumference of the neck 108. Each column of slits 112 is also axially displaced from each other to allow the 112 slits overlap. In use, when tension is applied to the actuator, the slits 112 will allow the neck 108 to flex or assume a curved configuration so that the neck 108 articulates in relation to the remaining part of the elongated stem 102, as shown in Figures 8B and 8C.
[000182] In other modalities, the slits can be positioned to allow the neck to flex at various places or flexion points, or otherwise to allow the neck to be flexed to a predetermined position. As a non-limiting example, Figure 9A illustrates another embodiment of a flexible neck 108 'having two slit regions 112' formed there. In particular, the flexible neck 108 'includes a distal slit region 112a' and a proximal slit region 112b '. Each region 112a ', 112b' can include any number of slots positioned at any location to provide a desired degree of flexibility in one or more desired directions. As shown in Figure 9A, each of the distal regions at the proximal end of the slits 112a ', 112b' includes two rows of slits formed on opposite sides and extending along the length of the flexible rod 108. In use, when the tension is applied to flexible neck 108 ', as will be discussed in more detail below, neck 108' will be flexed both proximally and distally 112a ', 112b' and thus articulate in relation to the rest of the elongated stem 102 'as shown in Figure 9B, flexion can occur primarily in the distal region 112a 'of the neck 108' '. The additional tension applied to the neck 108 'can then cause the proximal region 112b' to be flexed, as shown in Figure 9C. In other embodiments, the position of the slits and / or the size of the slits can be configured to cause flexion to occur in the proximal region 112b 'before it occurs in the distal region 112a', or alternatively, the slits can be configured to cause simultaneous flexion of the proximal and distal regions 112b ', 112a'. The person skilled in the art will understand that the amount, position, size and shape of the slits can be adjusted to obtain the desired results. The particular configuration of the cut used to form each crack can also vary. For example, the length and width of the slit may remain constant from an external surface of the elongated rod to an inner surface of the elongated rod, or alternatively, the width and length may increase or decrease so that the slit tapers or it varies in another way. As a non-limiting example, a tapered configuration can be formed by forming a slot that has a triangular configuration, where the length and width of the slot decrease from the outer surface to the inner surface of the elongated stem.
[000183] As indicated above, the actuator is configured to apply tension to the flexible neck 108 to cause the neck 108 to be articulated. The actuator can have a variety of configurations, but in an exemplary embodiment, the actuator is similar to the mentioned actuator and includes one or more cables that extend between the cable 106 and the distal end of the flexible neck 108 so that the cable 106 and the flexible neck 108 is operatively associated. Each cable can be configured to apply tension to the flexible neck 108 to cause the neck 108 to articulate in a plane of movement. Thus, when the device 100 includes only one cable, the flexible neck 108 can be articulated in a plane of movement. Each additional cable may allow the neck 108 to be articulated in a different plane of movement. Where multiple cables are provided, the neck 108 can be articulated in multiple planes of movement. In addition, the cables can be simultaneously tensioned, potentially allowing 360 ° articulation of the flexible rod 108.
[000184] Although the number of cables may vary, and device 100 may include only one cable, in the embodiment shown in Figure 7, device 100 includes four cables (only three cables 110a, 110b, 110c are shown). A portion of the cables 110a, 110b, 110c, 110d is shown in more detail in Figure 10. As noted above, the cables 110a-d extend along a length of the elongated rod 102 between the cable 106 and the flexible neck 108 The particular location of the cables 110a-d may vary, but in an exemplary embodiment, the cables 110a-d are spaced radially around an elongated rod circumference 102, and extend between the most distal end of the flexible neck 108 and of cable 106. Cables 110a-d may extend internally or externally along elongated stem 102, or may extend through lumens or paths formed on the side wall of elongated stem 102. Figure 11 illustrates a sectional view section of the elongated rod 102, showing four lumens 103a, 103b, 103c, 103d formed there. The lumens 103a-d are preferably of a size that allows the cables 116a-d to slide there, and are spaced circumferentially around the elongated stem 102. The lumens 103a-d extend between the proximal and distal ends 102a, 102b of the elongated rod 102 to allow the cables 110a-d to extend between the cable 106 and the most distal end of the flexible neck 108.
[000185] The distal end of cables 110a-d can be coupled to the more distal end of flexible neck 108, using a variety of techniques, but in one embodiment, shown in Figure 12, flexible neck 108 includes a cap termination 114 conjugated to or formed at the most distal end thereof. While the configuration of the end cap 114 may vary depending on the configuration of the actuator, in the embodiment illustrated, the end cap 114 includes four holes 114a, 114b, 114c, 114d formed therein and spaced around the circumference of the end cap 114 so that the holes 114a-d are aligned with the lumens 103a-d of the elongated stem 102. Each hole 114a-d, is configured to receive one of the cables 110a-d. Various coupling techniques can be used to retain cables 110a-d in holes 114a-d. For example, Figure 10 illustrates the ball formed at the end of each cable 110a-d to retain the ends of the cables 110a-d in the holes 114a-d in the termination cap 114. The termination cap 114 can also include a central lumen 116 formed there, to receive a tool through it. The lumen 116 can also serve to facilitate the positioning of a tool inserted through the accessory channel 100.
[000186] The proximal end of the cables 110a-d can be coupled to a cable 106, which is coupled to a proximal end of the stem 102. While the cable 106 can have a variety of configurations, in an exemplary embodiment, shown previously in Figure 7, the cable 106 may be in the form of a control that is movably coupled to the proximal end 102a of the elongated stem 102, and in particular, which is configured to pivot with respect to the proximal end 102a of the elongated stem 102. The movement of The articulation of the cable 106 may allow the movement of the cable 106 to be imitated by the flexible neck 108, as will be discussed below.
[000187] While the articulation movement can be achieved with the use of a variety of types of joints, in the illustrated embodiment a ball and socket connection is formed between the cable 106 and the elongated rod 102. In particular, as shown in greater detail in Figures 13A and 13B, the proximal end 102a of the elongated stem 102 includes a housing 103 formed there and defining a socket 118 at a proximal end thereof. Cable 106 includes a ball 120 which is movably disposed in socket 118, and the control extends proximally from ball 120 thereby allowing handle 106 to be pivoted in relation to elongated rod 102. A pin or another mechanism can be used to retain ball 120 movably in socket 118. The person skilled in the art will understand that the cable can have a variety of other shapes, and that several other techniques can be used to mobilely connect cable 106 to the elongated stem 102.
[000188] As indicated above, the proximal end of the cable 110a-d, is configured to attach to the cable 106. In this way, the cable 106 can include characteristics for the coupling of the cables 110a-d. Although the coupling characteristics in particular may vary depending on the configuration of the actuator, in an exemplary embodiment, control 122 on cable 106 includes four legs 124a, 124b, 124c, 124d formed there. The legs 124a-d are spaced around a circumference of the control 122, so that they are substantially aligned with the cables, and each leg 124a-d, is configured to mate with a terminal end of one of the cables 110a-d. A ball and socket connection, as described above with respect to the distal ends of the cables 110a-d, can be used to couple the cables 110a-d to the legs, or, alternatively, by any other coupling technique known in the art can be used.
[000189] With reference to Figure 7, in use, the handle 106 can be rotated or oriented angularly in relation to the proximal end 102a of the elongated stem 102 to effect the imitation movement of the flexible neck 108, and, thus, to position a tool that extends through flexible neck 108. As shown in Figures 7 and 13B, the control on handle 106 can include a lumen 107 formed through it and axially aligned with lumen 102c on the elongated shank 102 to allow a tool to be inserted through of the device 100. In other embodiments, the cable 106 can be displaced from the proximal end 102a of the elongated stem 102, so that the cable 106 is coupled to the cables, but does not interfere with direct access to the lumen 102c of the elongated stem 102.
[000190] To control the movement of the flexible neck 108 and, thus, a tool positioned through it, the cable 106 is rotatable or articulated over the proximal end 102a of the elongated stem 102. For example, the movement of the cable 106 in a first direction will cause legs 124a-d on cable 106 to apply force to one or more of the cables 110a-d when pulling the cable (s) axially. As a result, the activated cables will apply tension force to the flexible neck 108, to cause the neck 108 to be flexed. In order to prevent the elongated rod 102 from being flexed in response to the tension applied to the cables -d 110a by the cable 106, the flexible neck 108 may have greater flexibility than the elongated rod 102. This can be achieved, for example, with the use of of the slots as described previously, or in other embodiments the axis 102 may include a stabilizing element, such as a rod, which extends through it to make the rod 102 more rigid than the flexible neck 108. The direction of movement of the cable 106 will be imitated by the flexible neck 108, either in the same direction (that is, the corresponding movement), or in an opposite direction (that is, the mirrored movement), thus allowing the user to precisely control the position of the flexible neck 108, and , in this way, to control the position of a tool that extends through the flexible neck 108. In an exemplary embodiment, the particular amount of movement of the flexible neck 108 can be proportional to the amount of of movement of the cable 106. That is, the amount of movement of the flexible neck 108 can be directly equivalent to the amount of movement of the cable 106, or it can be increased or reduced proportionally in relation to the amount of movement of the cable 106. In certain embodiments , it may be desirable for the amount of movement of the flexible neck 108 to be increased over the amount of movement of the cable 106. As a result, only small movements of the cable 106 will be necessary to allow for large movements of the flexible neck 108. Although various techniques can be implemented to proportionally multiply or increase the movement of the flexible neck 108, an exemplary embodiment of a force multiplier mechanism is an eccentric cam that is coupled to the cables and that increases the mechanical advantage, force or displacement, of the cables -d 110a according to the tension is applied to cables -d 110a by cable 106.
[000191] As explained earlier, while the movement between the cable and the working end of the device can be proportional in theory, in practice, some loss of force is likely to occur as the force is transferred through the elongated rod. Consequently, the proportional movement, for use in the present invention, is intended to include applications in which the cable and working end are configured to move in proportional quantities, but in which some loss of strength may occur during the operation itself the device.
[000192] While Figures 1A and 7 illustrate devices in which the working end mimics the movement of the cable, the cable can have a variety of other configurations in which it is effective for pivoting the working end of the device without the working end imitate the movement of the cable. Figures 14A and 14B illustrate another embodiment of a device 200 that has a handle 204 that includes a pivot element that is effective for articulating a flexible neck 206 in one or more planes of movement with respect to an elongated rod 202 of the device. In general, the elongated rod 202 of the device 200 is very similar to the elongated rod 102 described above, and in general includes a flexible neck 206 coupled to or formed at a distal end thereof. Four cable actuators (not shown) extend through the elongated stem between cable 106 and flexible neck 206. Rod 102 and cable actuators are similar to shaft 102 and cable actuators 110a-d previously described that relate to the device 100, and as such, they will not be described in detail.
[000193] The cable 204 of the device 200 is shown in greater detail in Figures 15A and 15B. In general, cable 204 includes one or more coils, rotatably arranged there. Each coil is configured to couple and control one of the cable actuators. In this way, the rotation of each coil will wind or loosen the cable, causing the flexible neck 108 to be flexed and articulated in a particular direction. Although the number of coils may vary, depending on the number of cable actuators, in the embodiment shown in Figures 15A and 15B, cable 204 includes four coils 208a, 208b, 210a, 210b. The first two coils 208a, 208b are coupled together, and the second two coils 210a, 210b are coupled together. A first cable 212a is coupled to and wound around the first coil 208a and a second cable 212b is coupled and wound around the second coil 208b. The first and second cables 212a, 212b are positioned at and extend along opposite sides of the elongated rod 202. As a result, the tension applied to the first cable 212a will cause the flexible neck 206 to be pivoted towards the foreground plane. movement, and tension applied to the second cable 212b will cause the flexible neck 206 to be hinged in the opposite direction in the same plane of movement. To allow tension to be applied to only one of the cables 212a, 212b, the first and second cables 212a, 212b are wound around the first and second coils 208a, 208b in opposite directions. In this way, the rotation of the first and second coils 208a, 208b will wind and apply tension to one of the cables 212a, 212b while unwinding and releasing the tension on the other of the cables 212a, 212b. The third and fourth cables 212C, 212D are also wound around the third and fourth rollers 210a, 210b such that the rotation of the third and fourth and second coils 210a, 210b will wind and apply tension to one of the 212C cables , 212D, while unwinding and releasing tension from the other cable 212C, 212D. The third and fourth cables 212C, 212D can extend along axis 102 in a position that is radially offset from the first and second cables 212a, 212b so that the third and fourth cables 212C, 212D cause the flexible neck to pivot 206 in a different motion background. For example, the third and fourth cables 212C, 212D may be offset with the first and second cables 212a, 212b, by approximately 90 ° so that the cables 212a-d are all spaced substantially equidistant around the circumference of the elongated stem 202. The person skilled in the art will understand that cable 204 can include any number of coils and cables to effect articulation on a desired number of planes.
[000194] To control the coils 208a, 208b, 210a, 210b, the device may include one or more clamping elements. As shown in Figures 15A and 15B, a first rotary knob 214 is attached to the first and second coils 208a, 208b, and a second rotary knob 216 is attached to the third and fourth coil 210a, 210b. Buttons 214 and 216 can be integrally formed with coils 208a, 208b, 210a, 210b, or they can be coupled to coils 208a, 208b, 210a, 210b by an axis that extends through coils 208a, 208b, 210a, 210b . In the illustrated embodiment, the first button 214 is formed on or directly coupled to the first coil 208a and the second button 216 is coupled to the third and fourth coils 210a, 210b by an axis 218 extending from the button 216 through the first and of the second coils 208a, 208b, and this is coupled to the third and fourth coils 210a, 210b. In other words, the first and second coils 208a, 208b are pivotally arranged around the rod 218.
[000195] In certain exemplary embodiments, the coils and rotary buttons can also be different in size. In the embodiment shown in Figures 15A and 15B, the first and second coils 208a, 208b, as well as the first rotary knob 214, have a diameter that is greater than a diameter of the third and fourth coils 210a, 210b and the second knob swivel 216. Although not necessary, such a configuration can be advantageous, since cables 212a-d are spaced apart to prevent cables 212a-d from coming into contact with each other.
[000196] In use, a tool can be positioned through the elongated shank 202, and the knobs 214, 216 can be rotated to articulate the flexible neck 206 on the shank 202 and thereby position the tool as desired. As shown in Figures 14A and 14B, the handle 204 may include a lumen 205 that extends through it and in alignment with the lumen on the elongated shank 202 to allow a tool to be passed through the cable 204 and the shaft 202. In others embodiments, the handle 204 can be displaced from the elongated stem 202 to provide direct access to the lumen on the elongated stem 202. Once the tool is positioned through the stem 202, the buttons 214, 214 can be rotated to articulate the flexible neck 206 at the distal end of the elongated rod 202. In particular, the first knob 214 can be rotated in a first direction, for example, clockwise, to apply tension to one of the cables, for example, the first cable 212a, while releasing or unwinds the other cable, for example, the second cable 212b. As a result, the tension applied to the first cable 212a will pull the most distal end of the flexible neck 206 in a proximal direction, causing the flexible neck 206 to be flexed and thereby articulate in a first direction. Rotating the first button 214 in an opposite direction, for example, counterclockwise, will unwind the first cable 212a while winding the second cable 212b. The flexible neck 206 will return to its initial, linear configuration. The additional rotation of the first button 214 will continue to wind the second cable 212b while unwinding the first cable 212a, thereby causing the flexible neck 206 to flex and articulate in an opposite direction along the same plane of movement. The second button 216 can also be rotated to articulate the flexible in a different plane of movement. The buttons 214, 216 can also optionally be rotated simultaneously to articulate the flexible neck 206 in additional planes of movement other than the first and second planes of movement.
[000197] In other embodiments, the various devices described in the present invention may include a locking mechanism for locking the cable (s) and / or the actuator in a fixed position, to keep the working end of a device in orientation desired, articulated or angular. Although the locking mechanism can have a variety of configurations, in an exemplary embodiment the locking mechanism can be in the form of a claw that is effective for grabbing cables and thereby preventing the movement of the cables to lock the end work in a desired orientation. The grapple can have a variety of shapes and sizes, and can be positioned at various locations on the device. Figures 16A and 16B illustrate an exemplary embodiment of a claw 300 which is arranged around the hollow housing 12c in the surgical cutting and closing device 10 of Figures 1A and 1B. The claw 300 is generally ring shaped and can be configured to slide or rotate to the hollow housing 12c adjacent to the openings through which the cables (only three cables 34a, 34b, 34c are shown in Figure 16B) extend. In an initial position, the claw 300 is spaced from the openings to allow free movement of the cables 34a-d through it. Once the working end of the device, for example, the end actuator 16, is pivoted to a desired position, the claw 300 can be moved axially along the hollow housing 12c until it extends in relation to the openings and engagement the cables 34a-d extending from that. The claw 300 will thus prevent movement of the cables 34a-d when the claw 300 is in the locked position. To move the claw 300 axially and to lock the claw 300 to the housing 12c, the claw 300 may include a coupling element formed thereon and configured to engage a corresponding coupling element formed in the housing 12c. As shown in Figures 16A and 16B, the jaw includes threads 302 formed therein that are configured to match corresponding threads (not shown) formed in housing 12c. As a result, rotation of the claw 300 over the housing 12c will cause the claw 300 to move between the initial and locked positions. The person skilled in the art will understand that several other coupling techniques can be used. In addition, the locking mechanism can have a variety of other configurations. For example, the cable may include a locking element formed thereon and configured to lock the cable in a hinged and fixed position.
[000198] In other embodiments, the cables can be used to passively allow the elongated rod to be articulated through a lumen structure, and the clamping mechanism of the claw 300 or other can be used to lock the working end of the device in position when desired. In such a configuration, the cable can simply be used to facilitate grasping the device.
[000199] In other embodiments, the cable actuators shown in the present invention for articulating a working end of a device can be formed from an electroactive polymeric material. Electroactive polymers (EAP), also known as artificial muscles, are materials that have piezoelectric, pyroelectric or electro-restrictive properties in response to electrical or mechanical fields. In particular, WBSs are a set of conductive doped polymers that change shape when electrical voltage is applied. The conductive polymer can be paired with some form of ionic liquid or gel and electrodes, and the flow of ions from the fluid / gel into or out of the conductive polymer can induce a change in the shape of the polymer. Typically, a voltage potential in the range of about 1 V to 4 kV can be applied, depending on the particular polymer and the ionic fluid or gel used. It is important to note that WBSs do not change in volume when energized, but simply expand in one direction and contract in a transverse direction. In this way, the cable actuators previously presented in the present invention can be replaced by EAP actuators, and the identifier can be configured to activate a power source to selectively supply power to one or more of the cables. In an exemplary mode, the movement of the cable can be configured to dictate the amount of energy source, as well as the cable (s) that receive the energy source. As a result, the movement of the cable can further be imitated by the working end of the device to provide the user with the same precise control over the position of the working end. The power source can be from an internal source, such as a battery, or it can be from an external source. In other embodiments, EAP cable actuators can supplement the axial force applied to the cables through the movement of the cable and thereby proportionally increase the amount of movement of the working end in relation to the cable.
[000200] In other respects, cable actuators can be formed from a material with a format memory, such as Nitinol. Such a configuration allows tension to be applied to the cables to articulate the end actuator, and still allows the cables to return to an initial linear configuration, without having to manipulate the cable.
[000201] In yet another embodiment, the various devices presented in the present invention, including portions thereof, can be designed to be discarded after a single use, or can be designed to be used multiple times. In either case, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of steps to disassemble the device, followed by cleaning or replacing particular parts, and subsequent reassembly. As an example, the surgical fixation and stapling device shown in Figures 1A and 1B can be reconditioned after the device has been used in a medical procedure. The device can be disassembled, and any number of particular parts of the device can be selectively exchanged or removed, in any combination. For example, for the surgical stapling and cutting device, a cartridge placed on the end actuator and containing a plurality of fasteners can be replaced by the addition of a new closure cartridge to the end actuator. After cleaning and / or exchanging particular parts, the device can be reassembled for subsequent use in a reconditioning facility or by a surgical team immediately before a surgical procedure. Those skilled in the art will appreciate that the reconditioning of a device can use a variety of techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques, and the resulting refurbished device are all within the scope of the present application.
[000202] The person skilled in the art will appreciate other features and advantages of the invention based on the modalities described above. Consequently, the invention should not be limited by what has been particularly shown and described, except as indicated by the appended claims. All publications and references cited herein are hereby expressly incorporated, by reference, in their entirety.
[000203] Over the years, a variety of minimally invasive (or "telesurgical") robotic systems have been developed to increase surgical dexterity, as well as to allow a surgeon to intuitively operate a patient. Many such systems are presented in the following US Patents, which are each incorporated herein by reference in their respective totalities: US Patent No. 5,792,135, entitled "Articulated Surgical Instrument For Performing Minimally Invasive Surgery With Enhanced Dexterity and Sensitivity ", US patent No. 6,231,565, entitled" Robotic Arm DLU.S.For Performing Surgical Tasks ", US patent No. 6,783,524, entitled" Robotic Surgical Tool With Ultrasound Cauterizing and Cutting Instrument ", US patent No. 6,364,888, entitled "Alignment of Master and Slave In a Minimally Invasive Surgical Apparatus", US patent No. 7,524,320, entitled "Mechanical Actuator Interface System For Robotic Surgical Tools", US patent No. 7,691,098, entitled "Platform Link Wrist Mechanism", US patent No. 7,806,891, entitled "Repositioning and Reorientation of Master / Slave Relationship in Minimally Invasive Telesurgery", and US patent No. 7,824,401, entitled "Surgical Tool With Writed Monopolar Electroefector End Effectors ". Many of such systems, however, have been unable, in the past, to generate the magnitude of forces necessary to effectively cut and trap tissue.
[000204] Figure 17 shows a version of a master controller 1001 that can be used in connection with an 1100 robotic arm slave car of the type shown in Figure 18. Master controller 1001 and the robotic arm slave car 1100, as well as their respective components and control systems are collectively referred to herein as a robotic system 1000. Examples of such systems and devices are shown in US Patent No. 7,524,320 which is incorporated herein by way of reference. Therefore, various details of such devices will not be described in detail in the present document beyond what may be necessary to understand various modalities and forms of the present invention. As is known, master controller 1001 generally includes master controllers (usually represented as 1003 in Figure 17) that are held by the surgeon and manipulated in space while the surgeon sees the procedure through a stereo display 1002. The controllers masters 1001 generally comprise manual insertion devices that move, preferably with multiple degrees of freedom and that often have an actionable handle to act on tools (for example, to close gripping saws, apply an electrical container to an electrode or similar).
[000205] As can be seen in Figure 18, in one way, the robotic arm carriage 1100 is configured to act on a plurality of surgical tools, generally designated as 1200. Various robotic methods and surgical systems that employ controller provisions master and robotic arm carriage are presented in US patent No. 6,132,368, entitled "Multi-component Telepresence System and Method", the full description of which is hereby incorporated by reference. In various forms, the robotic arm carriage 1100 includes a base 1002 from which, in the illustrated embodiment, three surgical tools 1200 are supported. In various forms, surgical tools 1200 are each supported by a series of manually articulated connections, generally called adjustment joints 1104, and a robotic manipulator 1106. These cultures are illustrated in this document with protective covers that are extend over much of the robotic link. These protective covers can be optional and can be limited in size or completely eliminated in some ways to minimize the inertia that is found by the servo mechanisms used to manipulate such devices, to limit the volume of moving components, in order to avoid collisions and to limit the total weight of the 1100 car. The 1100 car will, in general, have adequate dimensions to transport the 1100 car between operating rooms. The 1100 car can be configured to typically fit through standard operating room doors and on standard hospital elevators. In various forms, the 1100 car would preferably have a weight and would include a wheel system (or other transport) that allows the 1100 car to be positioned adjacent to an operating table by a single attendant.
[000206] Now referring to Figure 19, in at least one form, robotic manipulators 1106 may include a connection 1108 that restricts movement of the surgical tool 1200. In various embodiments, connection 1108 includes rigid coupled connections joined by rotating joints in one parallelogram arrangement, so that the surgical tool 1200 rotates around a point in space 1110, as more fully described in US Patent No. 5,817,084 granted, the full description of which is hereby incorporated by reference. The parallelogram arrangement restricts rotation to rotate about an axis 1112a, sometimes called a pitch axis. The joints that support the parallelogram connection are pivotally mounted to adjustment joints 1104 (Figure 18) so that the surgical tool 1200 additionally rotates around an axis 1112b, occasionally called the yaw axis. The yaw and pitch axes 1112a, 1112b intersect at the remote center 1114, which is aligned along a rod 1208 of the surgical tool 1200. The surgical tool 1200 can have additional degrees of freedom driven as sustained by the manipulator 1106, including the movement of slide of the surgical tool 1200 along the longitudinal axis of the "LT-LT" tool. As the surgical tool 1200 slides along the axis of the LT-LT tool in relation to the manipulator 1106 (arrow 1112c), the remote center 1114 remains attached to the base 1116 of the manipulator 1106. Therefore, the entire manipulator is, in general, moved to reposition the remote center 1114. Link 1108 of manipulator 1106 is driven by a series of engines 1120. These engines actively move link 1108 in response to commands from a processor in a control system. As will be discussed in more detail below, 1120 motors are also used to handle surgical tool 1200.
[000207] An alternative fitting joint structure is illustrated in Figure 20. In this embodiment, a surgical tool 1200 is supported by an alternative manipulator structure 1106 'between two tissue manipulation tools. Those of ordinary skill in the art will find that various embodiments of the present invention can incorporate a wide variety of alternative robotic structures, including those described in US Patent No. 5,878,193, entitled "Automated Endoscope System For Optimal Positioning", the full description of which is here incorporated as a reference. Additionally, although the communication of data between a robotic component and the processor of the robotic surgical system is primarily described in this document with reference to the communication between the surgical tool 1200 and the master controller 1001, it should be understood that similar communication can occur between the circuits of a manipulator, an adjustment joint, an endoscope or other image capture device or similar and the processor of the robotic surgical system for the verification of component compatibility, identification of the type of component, communication of component calibration (such as displacement or similar), confirmation of coupling the component to the robotic surgical system or similar.
[000208] An exemplary non-limiting surgical tool 1200 that is well adapted for use with a robotic system 1000 that has a tool drive set 1010 (Figure 22) that is operationally coupled to a master controller 1001 that is operable through inputs from a operator (i.e., a surgeon) is shown in Figure 21. As can be seen in that Figure, surgical tool 1200 includes a surgical end actuator 2012 that comprises an endoscopic cutter. In at least one form, the surgical tool 1200 generally includes an elongated stem assembly 2008 that has a proximal closure tube 2040 and a distal closure tube 2042 that are coupled by a hinge joint 2011. The surgical tool 1200 it is operationally coupled to the manipulator by a tool assembly portion, generally designated as 1300. Surgical tool 1200 also includes an interface 1230 that mechanically and electrically couples the tool assembly portion 1300 to the manipulator. An interface form 1230 is illustrated in Figures 22 to 26. In various embodiments, the tool mounting portion 1300 includes a tool mounting plate 1302 that operationally supports a plurality of (four are shown in Figure 26) rotating body portions , disks or driven elements 1304, which each include a pair of pins 1306 extending from a surface of the driven element 1304. A pin 1306 is closer to an axis of rotation for each of the driven elements 1304 than the other pin 1306 on the same driven element 1304, which helps to ensure positive angular alignment of driven element 1304. Interface 1230 includes an adapter portion 1240 that is configured to engage mounting plate 1302 in an assembled manner, as will be further discussed bellow. The adapter portion 1240 may include an arrangement of electrical connection pins 1242 (Figure 24) that can be coupled to a memory structure by a circuit board in the tool mounting portion 1300. Although the interface 1230 is described in this document with reference to mechanical, electrical and magnetic coupling elements, it should be understood that a wide variety of telemetry modalities can be used, including infrared, inductive coupling or the like.
[000209] As can be seen in Figures 22 to 25, the adapter portion 1240 generally includes a tool side 1244 and a retainer side 1246. In various forms, a plurality of rotating bodies 1250 are mounted to a plate float 1248 which has a limited range of movement relative to the normal surrounding adapter structure for the main surfaces of adapter 1240. Axial movement of float plate 1248 helps to decouple rotating bodies 1250 from tool mounting portion 1300 when levers 1303 along the sides of the tool mounting portion housing 1301 are actuated (see Figure 21). Other mechanisms / arrangements can be employed for releasably coupling the tool mounting portion 1300 to the adapter 1240. In at least one way, rotating bodies 1250 are mounted resiliently to the floating plate 1248 by resilient radial members that extend in a circumferential indentation around the rotating bodies 1250. The rotating bodies 1250 can move axially in relation to the plate 1248 by deflecting these resilient structures. When arranged in a first axial position (towards the tool side 1244), the rotating bodies 1250 are free to rotate without angular limitation. However, as the rotating bodies 1250 move axially towards the tool side 1244, the flaps 1252 (extending radially from the rotating bodies 1250) laterally engage detent on the floating plates, in order to limit the angular rotation of the rotating bodies 1250 around its axes. This limited rotation can be used to assist in engaging the rotating bodies 1250 to the driving pins 1272 of a corresponding tool retaining portion 1270 of the robotic system 1000, as the driving pins 1272 press the rotating bodies 1250 to the position of limited rotation until pins 1234 are aligned (and slide into) to openings 1256 '. The openings 1256 on the tool side 1244 and the openings 1256 'on the retainer side 1246 of the rotating bodies 1250 are configured to precisely align the driven elements 1304 (Figure 26) of the tool mounting portion 1300 with the driving elements 1271 of the retainer of tool 1270. As discussed above in relation to the inner and outer pins 1306 of the driven elements 1304, the openings 1256, 1256 'are at different distances from the axis of rotation of their respective rotating bodies 1250 in order to ensure that the alignment is not 180 degrees from your intended position. In addition, each of the openings 1256 is slightly radially elongated in order to receive pins 1306 in a circumferential orientation. This allows pins 1306 to slide radially into openings 1256, 1256 ’and accommodate some axial misalignment between tool 1200 and tool retainer 1270, while minimizing any angular misalignment and adverse reaction between drive and driven elements. The openings 1256 on the tool side 1244 are displaced by about 90 degrees from the openings 1256 '(shown in dashed lines) on the retainer side 1246, as can be seen most clearly in Figure 25.
[000210] Various embodiments may also include an arrangement of electrical connector pins 1242 located on the retainer side 1246 of the adapter 1240 and the tool side 1244 of the adapter 1240 may include slots 1258 (Figure 25) to receive a pin arrangement (not shown) of the tool mounting portion 1300. In addition to transmitting electrical signals between the surgical tool 1200 and the tool retainer 1270, at least some of these electrical connections can be coupled to an adapter memory device 1260 (Figure 24) by a 1240 adapter circuit board.
[000211] A removable latch arrangement 1239 can be employed to releasably secure adapter 1240 to tool retainer 1270. As used herein, the term "tool drive assembly" when used in the context of the robotic system 1000 , covers at least several modalities of adapter 1240 and tool retainer 1270 and which has been designated, in general, as 1010 in Figure 22. For example, as can be seen in Figure 22, tool retainer 1270 can include a first latch pin arrangement 1274 that is dimensioned to be received in the corresponding fork slots 1241 provided in the adapter 1240. In addition, the tool retainer 1270 can also have second latch pins 1276 that are dimensioned to be retained in latch forks corresponding to 1243 on adapter 1240. See Figure 24. In at least one way, a latch assembly 1245 is movably supported over adapter 1240 and is tiltable between a first closed position where the latch pins 1276 are retained in their respective latch fork 1243 and an unclosed position where the second latch pins 1276 can be inside or removed from the latch forks 1243. One spring or springs (not shown) are used to tilt the latch assembly to the closed position. A lip on the tool side 1244 of the adapter 1240 can slidably receive laterally extending tool mounting housing tabs 1301.
[000212] Turning to Figures 26 to 33 below, in at least one embodiment, surgical tool 1200 includes a surgical end actuator 2012 which comprises, in this example, among other things, at least one component 2024 which is selectively moving between first and second positions in relation to at least one other 2022 component in response to various control movements applied to it, as will be discussed in more detail below. In various embodiments, component 2022 comprises an elongated channel 2022 configured to operably support a surgical clamp cartridge 2034 therein and component 2024 comprises a translatable pivotable jaw member such as a fixed jaw 2024. Various actuator modalities surgical end 2012 are configured to keep the claw fixed 2024 and the elongated channel 2022 in a spacing that guarantees the effective stapling and cutting of the tissue gripped by the surgical end actuator 2012. As can be seen in Figure 37, the end actuator surgical end 2012 also includes a 2032 cutting instrument and a 2033 frame. The 2032 cutting instrument can be, for example, a knife. The surgical clamp cartridge 2034 operatively houses a plurality of surgical clamps (not shown) in it, which are held in movable clamp drivers (not shown). As the cutting instrument 2032 is driven distally through a centrally arranged slot (not shown) in the surgical clamp cartridge 2034, it forces the frame 2033 distally, too. As the 2033 frame is driven distally, its "wedge-shaped" configuration comes into contact with the movable clamp actuators and drives them vertically towards the closed fixed jaw 2024. Surgical clamps are formed as they are actuated on the surface of formation located on the underside of the fixed jaw 2024. The frame 2033 can be part of the surgical clamp cartridge 2034, so that when the cutting instrument 2032 is retracted according to the cutting operation, the frame 2033 does not retract. The fixed claw 2024 can be pivoted open and closed at a pivot point 2025 located at the proximal end of the elongated channel 2022. The fixed claw 2024 can also include a flap 2027 at its proximal end that interacts with a component of the closing system mechanical (further described below) to facilitate opening of the fixed claw 2024. The elongated channel 2022 and the fixed claw 2024 can be made of electrically conductive material (such as metal) so that it can serve as part of an antenna that communicates with a sensor (s) on the end actuator, as described above. The 2034 surgical clamp cartridge could be made of a non-conductive material (such as plastic) and the sensor can be connected to or disposed in the 2034 surgical clamp cartridge, as also described above.
[000213] As can be seen in Figures 26 to 33, the surgical end actuator 2012 is fixed to the tool mounting portion 1300 by an elongated stem assembly 2008, according to various modalities. As shown in the illustrated embodiment, the stem set 2008 includes a hinge joint indicated, in general, as 2011 that allows the surgical end actuator 2012 to be selectively hinged around an AA-AA hinge shaft that is substantially transversal to a longitudinal axis of the LT-LT tool. See Figure 27. In other embodiments, the articulation joint is omitted. In various embodiments, the stem assembly 2008 may include a closure tube assembly 2009 comprising a proximal closure tube 2040 and a distal closure tube 2042 that are pivotally connected by pivot joints 2044 and operably supported in a column assembly generally shown as 2049. In the illustrated embodiment, the column assembly 2049 comprises a distal column portion 2050 that is attached to the elongated channel 2022 and is pivotally coupled to the proximal column portion 2052. The assembly closing tube 2009 is configured to slide axially on the 2049 column assembly in response to actuation movements applied to it. The distal closing tube 2042 includes an opening 2045 into which the flap 2027 in the fixed jaw 2024 is inserted to facilitate the opening of the fixed jaw 2024 as the distal closing tube 2042 is moved axially in the proximal direction "PD". The closing tube 2040, 2042 can be made of electrically conductive material (such as metal) so that it can serve as part of the antenna, as described above. The components of the main drive rod assembly (for example, the drive rods 2048, 2050) can be made of a non-conductive material (such as plastic).
[000214] In use, it may be desirable to rotate the surgical end actuator 2012 around the longitudinal axis of the LT-LT tool. In at least one embodiment, the tool mounting portion 1300 includes a rotational drive assembly 2069 that is configured to receive a corresponding rotary output movement from the tool drive assembly 1010 of the robotic system 1000 and converts that exit movement rotating in a rotary control movement to rotate the elongated stem assembly 2008 (and surgical end actuator 2012) around the longitudinal axis of the LT-LT tool. In various embodiments, for example, the proximal end 2060 of the proximal closing tube 2040 is pivotally supported on the tool mounting plate 1302 of the tool mounting portion 1300 by a front support cradle 1309 and a closing frame 2100 that it is also movably supported on tool mounting plate 1302. In at least one way, rotary drive assembly 2069 includes a pipe gear segment 2062 that is formed at (or attached to) the proximal end 2060 of the closing pipe proximal 2040 for engagement operable by a rotating gear set 2070 that is operationally supported on the tool mounting plate 1302. As can be seen in Figure 29, the rotating gear set 2070, in at least one embodiment, comprises a gear of rotation drive 2072 that is coupled to a first correspondent of one of the driven disks or elements 1304 on the adapter side 1307 of the tool mounting plate 1302 when tool mounting portion 1300 is coupled to tool drive assembly 1010. See Figure 26. The rotary gear assembly 2070 additionally comprises a rotary driven gear 2074 that is pivotally supported on the plate mounting tool 1302 in network engagement with the pipe gear segment 2062 and the rotary drive gear 2072. The application of a first rotating outward movement from the tool drive assembly 1010 of the robotic system 1000 to the element corresponding drive 1304 will then cause the rotation drive gear rotation 2072 to rotate. The rotation of the rotation drive gear 2072 ultimately results in the rotation of the elongated stem assembly 2008 (and the surgical end actuator 2012) around the longitudinal axis of the LT-LT tool (represented by the arrow "R" in Figure 29). It will be seen that the application of a rotating outward movement from the tool drive assembly 1010 in one direction will result in the rotation of the elongated stem assembly 2008 and the surgical end actuator 2012 around the longitudinal axis of the LT-LT tool in a first direction and an application of the rotating outlet movement in an opposite direction will result in the rotation of the elongated stem assembly 2008 and the surgical end actuator 2012 in a second direction that is opposite the first direction.
[000215] In at least one embodiment, the closing of the fixed jaw 2024 in relation to the clamp cartridge 2034 is carried out by axially moving the closing tube assembly 2009 in the distal direction "DD" in the column assembly 2049. As indicated above, in various embodiments, the proximal end 2060 of the proximal closing tube 2040 is supported by the closing frame 2100 which comprises a portion of a closing transmission, shown, in general, as 2099. In at least one form, the closing frame 2100 it is configured to support the closing tube 2009 on the tool mounting plate 1320 so that the proximal closing tube 2040 can rotate in relation to the closing frame 2100, and also travel axially with the closing frame 2100. In particular , as can be seen in Figure 34, the closing frame 2100 has a vertical flap 2101 that extends in a radial groove 2063 at the proximal end portion of the close closing tube to 2040. In addition, as can be seen in Figures 31 and 34, the closing frame 2100 has a flap portion 2102 that extends through a slot 1305 in the tool mounting plate 1302. Flap portion 2102 is configured to hold the closing frame 2100 in sliding engagement with the tool mounting plate 1302. In various embodiments, the closing frame 2100 has a vertical portion 2104 that has a closing panel gear 2106 formed therein. The closing panel gear 2106 is configured to drive the engagement with a closing gear set 2110. See Figure 31.
[000216] In various forms, the closing gear set 2110 includes a closing gear wheel 2112 which is coupled to a corresponding second of the driven disks or elements 1304 on the adapter side 1307 of the tool mounting plate 1302. See Figure 26. Therefore, the application of a second rotating output movement from the tool drive assembly 1010 of the robotic system 1000 to the corresponding second driven element 1304 will cause the closing sprocket gear 2112 to rotate when the tool assembly 1300 is coupled to tool drive assembly 1010. Closing gear assembly 2110 further includes a closing reduction gear assembly 2114 which is supported in network engagement with closing gear sprocket 2112 As can be seen in Figures 30 and 31, the closing reduction gear set 2114 includes an active gear nothing 2116 which is swiveled in network engagement with the closing sprocket gear 2112. The closing reduction gear assembly 2114 also includes a first closing drive gear 2118 that is in network engagement with a second closing drive gear 2120 which is pivotally supported on the tool mounting plate 1302 in network engagement with the closing panel gear 2106. Therefore, the application of a second pivoting output movement from the set of tool drive 1010 of the robotic system 1000 for the corresponding second driven element 1304 will cause the closing sprocket gear 2112 and the closing transmission 2110 to rotate and finally drive the closing frame 2100 and the closing pipe assembly 2009 axially. The axial direction in which the closing tube assembly 2009 moves ultimately depends on the direction in which the second driven element 1304 is rotated. For example, in response to a rotating output movement received from the tool drive assembly 1010 of the robotic system 1000, the closing frame 2100 will be driven in the distal direction "DD" and finally will drive the closing pipe assembly 1009 in the distal direction. As the distal closing tube 2042 is driven distally, the end of the closing tube segment 2042 will engage a portion of the fixed jaw 2024 and cause the fixed jaw 2024 to rotate to a closed position. By applying an "opening" exit movement of the tool drive set 1010 of the robotic system 1000, the closing frame 2100 and the stem set 2008 will be driven in the proximal direction "PD". As the distal closing tube 2042 is activated in the proximal direction, the opening 2045 in it interacts with the flap 2027 in the fixed claw 2024 to facilitate its opening. In various embodiments, a spring (not shown) can be used to tilt the fixed claw to the open position when the distal closing tube 2042 has been moved to its initial position. In various embodiments, the various gears in the closing gear assembly 2110 are sized to generate the closing forces necessary to satisfactorily close the claw 2024 in the tissue to be cut and stapled by the surgical end actuator 2012. 2110 closing transmission can be sized to generate approximately 311.4 to 533.8 Newton (70 to 120 pounds).
[000217] In several modalities, the 2032 cutting instrument is driven through the surgical end actuator 2012 by a 2200 knife bar. See Figures 32 and 34. In at least one way, the 2200 knife bar can be manufactured from from, for example, stainless steel or other similar material and has a substantially rectangular cross-sectional shape. Such a knife bar configuration is rigid enough to press the cutting instrument 2032 through the tissue attached to the surgical end actuator 2012, while still flexible enough to allow the surgical end actuator 2012 to articulate with respect to the closing tube proximal 2040 and the proximal column portion 2052 around the AA-AA articulation axis, as will be discussed in more detail below. As can be seen in Figures 35 and 36, the proximal column portion 2052 has a rectangular shaped passage 2054 that extends through it to provide support for knife bar 2200 as it is pressed axially through it. The proximal column portion 2052 has a proximal end 2056 that is pivotally mounted to a column mounting bracket 2057 attached to the tool mounting plate 1032. See Figure 34. Such an arrangement allows the proximal column portion 2052 to rotate , but do not move axially, inside the 2040 proximal closing tube.
[000218] As shown in Figure 32, the distal end 2202 of the knife bar 2200 is attached to the cutting instrument 2032. The proximal end 2204 of the knife bar 2200 is swiveled to a knife panel gear 2206 of so that knife bar 2200 is free to rotate with respect to knife panel gear 2206. See Figure 34. As can be seen in Figures 28 to 33, knife panel gear 2206 is slidably supported in a panel housing 2210 which is attached to the tool mounting plate 1302, so that the knife panel gear 2206 is retained in network engagement with a knife gear assembly 2220. More specifically and with reference to Figure 31, in at least one embodiment, the knife gear assembly 2220 includes a knife gear wheel 2222 which is coupled to a corresponding third of the driven disks or elements 1304 on the adapter side 1307 of the mounting plate m of tool 1302. See Figure 26. Therefore, the application of another rotating output movement of the robotic system 1000 through the tool drive set 1010 to the corresponding third driven element 1304 will cause the rotating of the toothed gear 2222. the knife gear set 2220 further includes a knife gear reduction set 2224 that includes a first driven knife gear 2226 and a second knife drive gear 2228. The knife gear reduction set 2224 is mounted pivoting mode on tool mounting plate 1302, so that the first knife driven gear 2226 is in network engagement with the knife gear gear 2222. Likewise, the second knife driving gear 2228 is engaged in network with a third knife drive gear 2230 that is rotatably supported on tool mounting plate 1302 in network engagement with the engraver knitting panel 2206. In various embodiments, the gears in the 2220 knife gear assembly are sized to generate the forces necessary to drive the cutting element 2032 through the tissue attached to the surgical end actuator 2012 and actuate the clamps on it . For example, the gears in the 2230 knife drive assembly can be sized to generate approximately 177.9 to 444.8 Newtons (40 to 100 pounds). It will be seen that the application of a rotary exit movement from the tool drive assembly 1010 in one direction will result in the axial movement of the cutting instrument 2032 in a distal direction and the application of the rotary exit movement in an opposite direction will result in the axial path of the 2032 cutting tool in a proximal direction.
[000219] In several modalities, the surgical tool 1200 employs a 2007 articulation system that includes a 2011 articulation joint that allows the surgical end actuator 2012 to be articulated around an AA-AA articulation axis that is substantially transversal to the longitudinal axis of the LT-LT tool. In at least one embodiment, the surgical tool 1200 includes first and second pivot bars 2250a, 2250b that are slidably supported in the corresponding passages 2053 provided through the proximal column portion 2052. See Figures 39 and 41. In at least one In this way, the first and second hinge bars 2250a, 2250b are actuated by a hinge transmission in general called 2249 that is operatively supported on the tool mounting plate 1032. Each of the hinge bars 2250a, 2250b has an end proximal 2252 that has a guide rod that protrudes from it that extends laterally through a corresponding slot in the proximal end portion of the proximal column portion 2052 and into a corresponding arched slot in a 2260 joint thread that comprises a portion of the hinge transmission. Figure 35 illustrates the pivot bar 2250a. It will be understood that the pivot bar 2250b is similarly constructed. As can be seen in Figure 35, for example, the articulation bar 2250a has a guide rod 2254 that extends laterally through a corresponding slot 2058 in the proximal end portion 2056 of the distal column portion 2050 and into a corresponding arched slot 2262 in the hinge thread 2260. In addition, the hinge bar 2250a has a distal end 2251a which is pivotally coupled to the distal column portion 2050 by, for example, a pin 2253a and the hinge bar 2250b has a distal end 2251b which is pivotally coupled to the distal column portion 2050 by, for example, a pin 2253b. In particular, the pivot bar 2250a is laterally displaced in a first lateral direction from the longitudinal axis of the LT-LT tool and the pivot bar 2250b is laterally displaced in a second lateral direction from the longitudinal axis of the LT-LT tool. . Therefore, the axial movement of the articulation bars 2250a and 2250b in opposite directions will result in the articulation of the distal column portion 2050, as well as the surgical end actuator 2012 fixed to it around the articulation axis AA-AA, as will be discussed with more details below.
[000220] The articulation of the surgical end actuator 2012 is controlled by turning the articulation thread 2260 around the longitudinal axis of the LT-LT tool. The articulation thread 2260 is rotatably seated on the proximal end portion 2056 of the distal column portion 2050 and is rotatably acted on it by a 2270 articulation gear assembly. More specifically and with reference to Figure 29, at least at least one embodiment, the pivot gear assembly 2270 includes a toothed pivot wheel gear 2272 that is coupled to a corresponding quarter of the driven disks or elements 1304 on the adapter side 1307 of the tool mounting plate 1302. See Figure 26. Therefore, the application of another rotating input movement from the robotic system 1000 through the tool drive assembly 1010 to the corresponding fourth driven element 1304 will cause the toothed gear wheel 2272 to rotate when the interface 1230 is coupled to the 1270 tool retainer. A 2274 pivot drive gear is pivotally supported on the p tool mounting lacquer 1302 in network engagement with toothed gear wheel gear 2272 and gear portion 2264 of gear thread 2260, as shown. As can be seen in Figures 34 and 35, the articulation thread 2260 has a shoulder 2266 formed therein that defines an annular groove 2267 to receive retaining posts 2268 therein. The retaining posts 2268 are attached to the tool mounting plate 1302 and serve to prevent the hinge thread 2260 from moving axially in the proximal column portion 2052 while maintaining the ability to be rotated with respect to it. Therefore, rotation of the hinge thread 2260 in a first direction will result in the axial movement of the hinge bar 2250a in a distal "DD" direction and the axial movement of the hinge bar 2250b in a proximal "PD" direction due to the interaction of the rods. guide 2254 with spiral slots 2262 in the hinge gear 2260. Similarly, rotation of the hinge thread 2260 in a second direction that is opposite the first direction will result in axial movement of the hinge bar 2250a in the proximal "PD" direction, as well how it will cause the pivot bar 2250b to move axially in the distal "DD" direction. Therefore, the surgical end actuator 2012 can be selectively pivoted around the "AA-AA" pivot axis in a first "FD" direction by simultaneously moving the pivot bar 2250a in the distal direction "DD" and the pivot bar 2250b in the "PD" proximal direction. Likewise, the surgical end actuator 2012 can be selectively pivoted around the "AA-AA" pivot axis in a second "SD" direction by simultaneously moving the 2250a pivot bar in the proximal "PD" direction and the articulation 2250b in the distal direction "DD." See Figure 27.
[000221] The tool embodiment described above employs an interface arrangement that is particularly suitable for assembling the controllable medical tool in a robotic manner on at least one robotic arm-shaped arrangement that generates at least four different rotary control movements. Those of ordinary skill in the art will find that such rotating output movements can be selectively controlled through programmable control systems employed by the robotic / controller system. For example, the tool arrangement described above may be suitable for use with those robotic systems manufactured by Intuitive Surgical, Inc. of Sunnyvale, California, USA, many of which may be described in detail in various patents incorporated herein by way of reference. The unique and innovative aspects of the various modalities of the present invention serve to use the rotary outlet movements provided by the robotic system to generate specific control movements that are of sufficient magnitude to allow the end actuators to cut and staple tissue. Therefore, the unique provisions and principles of the various embodiments of the present invention may allow for a variety of different forms of the tool systems presented and claimed in this document as effectively employed in connection with other types and forms of robotic systems that provide rotating or rotating exit movements. others scheduled. Furthermore, as will become additionally apparent as the present Detailed Description proceeds, various types of end actuator of the present invention that require other forms of actuation movements can also be effectively acted with the use of one or more of the control movements generated by the system robotic.
[000222] Figures 38 to 42 illustrate yet another surgical tool 2300 that can be effectively employed in connection with the robotic system 1000 that has a tool drive assembly that is operationally coupled to a controller of the robotic system that is operable by inserts a from an operator and which is configured to provide at least one pivoting output movement to at least one portion of the pivoting body supported on the tool drive assembly. In various forms, the surgical tool 2300 includes a surgical end actuator 2312 that includes an elongated channel 2322 and a translatable pivotable jaw member, such as a fixed jaw 2324, which are maintained at a spacing that ensures stapling and tearing tissue holders on the surgical end actuator 2312. As shown in the illustrated embodiment, the surgical end actuator 2312 may include, in addition to the elongated channel 2322 and the fixed claw 2324 mentioned above, a cutting instrument 2332 that has a frame portion 2333 formed therein, a surgical staple cartridge 2334 which is seated in the elongated channel 2322 and a rotating end actuator drive rod 2336 which has a helical screw thread formed thereon. The cutting instrument 2332 can be, for example, a knife. As will be discussed in more detail below, the rotation of the actuating rod of the end actuator 2336 will cause the cutting instrument 2332 and the frame portion 2333 to travel axially through the surgical clamp cartridge 2334 to move between an initial position and a final position. The direction of the axial travel of the 2332 cutting instrument depends on the direction in which the drive rod of the 2336 end actuator is rotated. The fixed claw 2324 can be pivoted open and closed at a pivot point 2325 connected to the end of the elongated channel 2322. The fixed claw 2324 can also include a flap 2327 at its close end that interfaces operatively with a component of the mechanical locking system (further described below) for opening and closing the fixed jaw 2324. When the actuating rod of the end actuator 2336 is rotated, the cutting instrument 2332 and the frame 2333 will run longitudinally through the surgical clamp cartridge 2334 a from the initial position to the final position, thus cutting the tissue attached to the surgical end actuator 2312. The movement of the frame 2333 through the surgical staple cartridge 2334 causes the staples in it to be driven through the broken tissue and against the closed fixed jaw 2324, which rotates the clamps to hold the broken fabric. In one form, the elongated channel 2322 and the fixed claw 2324 can be made of an electrically conductive material (such as metal) so that they can serve as part of the antenna that communicates with the sensor (s) on the end actuator, as described above . The 2334 surgical clamp cartridge could be made of a non-conductive material (such as plastic) and the sensor can be connected to or disposed in the 2334 surgical clamp cartridge, as described above.
[000223] It should be noted that, although the surgical tool 2300 modalities described in this document employ a surgical end actuator 2312 that clips the ruptured tissue, in other different technical modalities for securing or sealing the ruptured tissue can be used. For example, end actuators that use RF (radio frequency) energy or adhesives to join the sectioned tissue can also be used. US Patent No. 5,709,680, entitled "Electrosurgical Hemostatic Device" to Yates et al., And US Patent No. 5,688,270, entitled "Electrosurgical Hemostatic Device With Recessed And / Or Offset Electrodes" to Yates et al., As which are incorporated here, for reference, feature cutting instruments that use RF energy to trap broken tissue. U.S. Patent Application No. 11 / 267,811 to Morgan et al. and U.S. Patent Application No. 11 / 267,363 to Shelton et al., which are also incorporated herein by way of reference, disclose cutting instruments that use adhesives to secure the broken fabric. Consequently, although the description of the present invention refers to cutting / stapling operations and the like, it must be considered that this is an exemplary modality and should not be understood as limiting. Other tissue joining techniques can also be used.
[000224] In the illustrated embodiment, the surgical end actuator 2312 is coupled to an elongated stem assembly 2308 that is coupled to a tool mounting portion 2460 and defines a longitudinal axis of the LT-LT tool. In this embodiment, the elongated stem assembly 2308 does not include an articulation joint. Those of ordinary skill in the art will understand that other modalities may have an articulation joint in it. In at least one embodiment, the elongated stem assembly 2308 comprises a hollow outer tube 2340 that is swiveled on a tool mounting plate 2462 of a tool mounting portion 2460, as will be discussed in more detail below. In various embodiments, the elongated stem assembly 2308 further includes a distal column stem 2350. The distal column stem 2350 has a distal end portion 2354 that is coupled to, or otherwise integrally formed with, , a distal stationary base portion 2360 that is non-movably coupled to channel 2322. See Figures 39 to 41.
[000225] As shown in Figure 39, the distal column stem 2350 has a proximal end portion 2351 that is slidably received inside a slot 2355 in a proximal column stem 2353 that is non-movably supported inside of the hollow outer tube 2340 with at least one support collar 2357. As can be seen further in Figures 39 and 40, the surgical tool 2300 includes a closing tube 2370 that is restricted to move only axially with respect to the distal base stationary portion 2360 The closing tube 2370 has a proximal end 2372 that has an internal thread 2374 formed in it that is in threaded engagement with a transmission arrangement, shown, in general, as 2375, which is operationally supported on the tool mounting plate 2462 In a number of ways, the 2375 drive arrangement includes a rotary drive rod assembly, generally referred to as 2381. When rotated, the drive rod assembly Rotating 2381 will cause the closing tube 2370 to move axially, as will be described in more detail below. In at least one form, the 2381 rotary drive rod assembly includes a closing drive thread 2382 of a closing clutch assembly generally designated 2380. More specifically, the closing drive thread 2382 has a portion proximal end 2384 which is pivotally supported in relation to the outer tube 2340 and is threaded in engagement with the closing tube 2370. For mounting fins, the proximal end portion 2384 can be threadedly secured to a retaining ring 2386. The retaining ring 2386, in cooperation with an end 2387 of the closing drive thread 2382, defines an annular slot 2388 in which a shoulder 2392 of a locking collar 2390 extends. The locking collar 2390 is fixed in a non-movable way (eg welded, glued etc.) to the end of the outer tube 2340. This arrangement serves to affix the closing drive thread 2382 to the outer tube 2340 while allowing the locking thread closing drive 2382 rotate in relation to the outer tube 2340. The closing drive thread 2382 also has a distal end 2383 that has a threaded portion 2385 that threadably engages the inner thread 2374 of the closing tube 2370. Therefore, rotation of the closing drive thread 2382 will cause the closing tube 2370 to move axially, as represented by the arrow "D" in Figure 40.
[000226] The closing of the fixed claw 2324 and the actuation of the cutting instrument 2332 are carried out by control movements that are transmitted by a hollow cylindrical socket 2400. As can be seen in Figures 39 and 40, the cylindrical socket of hollow drive 2400 is received in a rotating and sliding manner on the distal column stem 2350. The cylindrical drive socket 2400 has a proximal end portion 2401 that is pivotally mounted to the proximal column stem 2353 protruding from the tool assembly 2460 so that the cylindrical drive socket 2400 can rotate with respect to it. See Figure 39. As can also be seen in Figures 39 to 41, the 2400 drive cylindrical insert is rotated around the longitudinal axis of the "LT-LT" tool by a 2440 drive rod. The 2440 drive rod has a drive gear 2444 which is attached to its distal end 2442 and is engaged in network with a driven gear 2450 which is attached to the cylindrical drive socket 2400.
[000227] The drive cylindrical insert 2400 also has a distal end portion 2402 that is coupled to a portion of the closing clutch assembly 2380 of the closing clutch 2410 that has a proximal face 2412 and a distal face 2414. A proximal face 2412 has a series of proximal teeth 2416 formed in it that are adapted for selective engagement with corresponding proximal tooth cavities 2418 formed in the proximal end portion 2384 of the closing drive thread 2382. Therefore, when the proximal teeth 2416 are in network engagement with the proximal tooth cavities 2418 on the closing drive thread 2382, rotation of the driving cylindrical socket 2400 will result in rotation of the closing drive thread 2382 and finally causes the closing tube 2370 to move axially, as will be discussed in more detail below.
[000228] As can be seen more particularly in Figures 39 and 40, the distal face 2414 of the drive clutch portion 2410 has a series of distal teeth 2415 formed therein that are adapted for selective engagement with corresponding distal tooth cavities 2426 formed on a face plate portion 2424 of a knife drive rod assembly 2420. In various embodiments, the knife drive rod assembly 2420 comprises a hollow knife stem segment 2430 which is rotatably received in a corresponding portion of the distal column stem 2350 that is attached to or protrudes from the stationary base 2360. When the distal teeth 2415 of the closing clutch portion 2410 are in network engagement with the distal tooth cavities 2426 in the plate portion face 2424, the rotation of the drive cylindrical socket 2400 will result in the rotation of the drive shaft segment 2430 around the stationary stem 2350. As can be bserve in Figures 44 to 46, a knife drive gear 2432 is attached to the segment of the drive stem 2430 and is engaged in network with a knife drive gear 2434 which is attached to the drive stem of the end actuator 2336. Therefore , the rotation of the drive rod segment 2430 will result in the rotation of the drive rod of the end actuator 2336 to drive the cutting instrument 2332 and the frame 2333 distally through the surgical staple cartridge 2334 to cut and staple tissue attached to the actuator. surgical end 2312. Sliding part 2333 may be made, for example, of plastic, and may have an inclined distal surface. As the frame 2333 passes through the elongated channel 2322, the forward sloping surface of the frame 2333 presses up or "drives" the clamps on the surgical clamp cartridge 2334 through the clamped tissue and against the fixed clamp 2324. The fixed clamp 2324 rotates or "forms" the staples, thus stapling the broken fabric. As used in this document, the term "firing" refers to the beginning of the actions necessary to drive the cutting instrument and the frame portion and a distal direction through the surgical clamp cartridge to cut the tissue attached to the surgical end actuator and trigger the clips through the broken fabric.
[000229] In use, it may be desirable to rotate the surgical end actuator 2312 around the longitudinal axis of the LT-LT tool. In at least one embodiment, the transmission arrangement 2375 includes a rotational transmission assembly 2465 that is configured to receive a corresponding rotary output movement from the tool drive assembly 1010 of the robotic system 1000 and convert that rotary output movement into a rotary control movement to rotate the elongated stem assembly 2308 (and surgical end actuator 2312) around the longitudinal axis of the LT-LT tool. As can be seen in Figure 42, a proximal end 2341 of the outer tube 2340 is swiveled within a cradle arrangement 2343 attached to the tool mounting plate 2462 of the tool mounting portion 2460. A rotating gear 2345 is formed on or attached to the proximal end 2341 of the outer tube 2340 of the elongated shank assembly 2308 for network engagement with a rotating gear assembly 2470 operatively supported on the tool mounting plate 2462. In at least one embodiment , a rotating drive gear 2472 is coupled to a first correspondent among the driven disks or elements 1304 on the adapter side of the tool mounting plate 2462 when the tool mounting portion 2460 is coupled to the tool driving assembly 1010. See Figures 26 and 42. The 2470 rotary drive assembly additionally comprises a 2474 rotary driven gear that is swiveled on the tool mounting plate 2462 in network connection with the rotating gear 2345 and the rotating drive gear 2472. The application of a first rotating outward movement from the robotic system 1000 via the drive assembly of tool 1010 for the corresponding driven element 1304 will thus cause rotation of the drive gear of rotation 2472 due to being operationally coupled to it. The rotation of the rotating drive gear 2472 ultimately results in the rotation of the elongated stem assembly 2308 (and the end actuator 2312) around the longitudinal axis of the LT-LT tool (primary rotary movement).
[000230] The closing of the fixed jaw 2324 in relation to the clamp cartridge 2034 is achieved by axially moving the closing tube 2370 in the distal direction "DD". The axial movement of the closing tube 2370 in the distal direction "DD" is achieved by applying a rotary control movement to the closing drive thread 2382. To apply the rotating control movement to the closing drive thread 2382, the closing clutch 2410 must first be engaged in mesh with the proximal end portion 2384 of the closing drive thread 2382. In several embodiments, the transmission arrangement 2375 also includes a displacement drive assembly 2480 that is operationally supported on the tool mounting plate 2462. More specifically and with reference to Figure 42, it can be seen that a proximal end portion 2359 of the proximal column portion 2353 extends through the rotating gear 2345 and is rotatably coupled to a shifter gear panel 2481 that is slidably attached to the tool mounting plate 2462 through slots 2482. The assembly the shifter drive 2480 additionally comprises a shifter drive gear 2483 which is coupled to a corresponding second of one of the driven disks or elements 1304 on the adapter side of the tool mounting plate 2462 when the tool mounting portion 2460 is coupled to tool retainer 1270. See Figures 26 and 42. Shifter drive assembly 2480 additionally comprises shifter driven gear 2478 which is swiveled on tool mounting plate 2462 in network engagement with gear displacer drive 2483 and displacer panel gear 2482. Applying a second rotating output movement from robotic system 1000 through tool drive assembly 1010 to the corresponding driven element 1304 will therefore cause rotation of the drive gear displacement drive 2483 due to being coupled to it. The rotation of the displacer drive gear 2483 ultimately results in the axial movement of the displacer gear panel 2482 and the proximal column portion 2353, as well as the cylindrical drive insert 2400 and the closing clutch 2410 attached to it. The direction of the axial travel of the closing clutch 2410 depends on the direction in which the shifter drive gear 2483 is rotated by the robotic system 1000. Therefore, rotation of the shifter drive gear 2483 in a first rotating direction will result in axial movement of the closing clutch 2410 in the proximal direction "PD" to bring the proximal teeth 2416 into mesh with the proximal tooth cavities 2418 on the closing drive thread 2382. Conversely, the rotation of the shifter drive gear 2483 in one second rotating direction (opposite to the first rotating direction) will result in axial movement of the closing clutch 2410 in the distal direction "DD" to bring the distal teeth 2415 into mesh with the corresponding distal tooth cavities 2426 formed in the face plate portion 2424 of the knife drive rod assembly 2420.
[000231] Once the closing clutch 2410 has been engaged in network engagement with the closing drive thread 2382, the closing drive thread 2382 is rotated by turning the closing clutch 2410. The rotation of the closing clutch 2410 is controlled by applying rotary output movements to a rotary drive transmission portion 2490 of the 2375 transmission arrangement that is operationally supported on tool mounting plate 2462, as shown in Figure 42. In at least one embodiment, the drive transmission rotary drive 2490 includes a rotary drive assembly 2490 'which includes a gear 2491 which is coupled to a corresponding third of the driven disks or elements 1304 on the adapter side of the tool mounting plate 2462 when the tool mounting portion 2460 is attached to the 1270 tool retainer. See Figures 26 and 42. The 2490 rotary drive transmission comprises additionally, a first swivel driven gear 2492 which is swiveled on the tool mounting plate 2462 in network engagement with a second swivel driven gear 2493 and the swivel drive gear 2491. The second swivel driven gear 2493 is coupled to a proximal end portion 2443 of drive rod 2440.
[000232] Rotation of the rotating drive gear 2491 in a first rotating direction will result in the rotation of the drive rod 2440 in a first direction. Conversely, rotation of the rotating drive gear 2491 in a second rotating direction (opposite the first rotating direction) will cause the drive rod 2440 to rotate in a second direction. As indicated above, the drive rod 2440 has a drive gear 2444 which is attached to its distal end 2442 and is in network engagement with a drive gear 2450 which is attached to the cylindrical drive socket 2400. Therefore, the rotation of the rod 2440 drive shaft results in the rotation of the 2400 drive cylindrical socket.
[000233] A method for operating the 2300 surgical tool will now be described. Since the tool mounting portion 2462 has been operationally coupled to the tool retainer 1270 of the robotic system 1000 and oriented to the position adjacent to the target tissue to be cut and stapled, if the fixed claw 2334 is not yet in the open position (Figure 39), the robotic system 1000 can apply the first rotating output movement to the shifter drive gear 2483 which results in the axial movement of the closing clutch 2410 in network engagement with the closing drive thread 2382 (if it is not already in network coupling with the same). See Figure 40. Once controller 1001 of robotic system 1000 has confirmed that closing clutch 2410 is in network engagement with closing drive thread 2382 (for example, through sensor (s)) on surgical end actuator 2312 which is in communication with the robotic control system), the robotic controller 1001 can then apply a second rotary output movement to the rotary drive gear 2492 which, as described above, ultimately results in rotation of the rotating drive thread 2382 in the first direction which results in the axial path of the closing tube 2370 in the distal direction "DD". As the closing tube 2370 moved in the distal direction, it comes into contact with a portion of the fixed jaw 2323 and causes the fixed jaw 2324 to rotate to the closed position to grab the target tissue between the fixed jaw 2324 and the staple cartridge surgical 2334. Once the robotic controller 1001 determines that the fixed claw 2334 has been turned to the closed position by the corresponding sensor (s) on the surgical end actuator 2312 in communication with it, the robotic system 1000 interrupts the application of the second rotating output movement to the rotating drive gear 2491. The robotic controller 1001 can also provide the surgeon with an indication that the 2334 fixed jaw has been fully closed. The surgeon can then start the firing procedure. In alternative modes, the triggering procedure can be automatically initiated by the robotic controller 1001. The robotic controller 1001 then applies the primary rotary control movement 2483 to the shifter drive gear 2483 which results in the axial movement of the closing clutch 2410 in network engagement with the face plate portion 2424 of the knife drive rod assembly 2420. See Figure 41. Once the robotic system controller 1001 has confirmed that the closing clutch 2410 is in network engagement with the face plate portion 2424 (via sensor (s)) on end actuator 2312 that are in communication with robotic controller 1001), robotic controller 1001 can then apply the second rotating output movement to the rotary drive gear 2492 which, as described above, ultimately results in the axial movement of the cutting instrument 2332 and the frame portion 2333 in the distal direction "DD "through the surgical staple cartridge 2334. As the cutting instrument 2332 moves distally through the surgical staple cartridge 2334, the tissue attached to it is broken. As the frame portion 2333 is driven distally, it causes the clamps on the surgical clamp cartridge to be driven through the ruptured tissue to form contact with the fixed jaw 2324. Once the robotic controller 1001 has determined that the cutting instrument 2324 reached the final position on the surgical clamp cartridge 2334 (via sensor (s)) on the end actuator 2312 which are in communication with the robotic controller 1001), the robotic controller 1001 interrupts the application of the second rotating output movement for the swivel drive gear 2491. Thereafter, robotic controller 1001 applies the secondary swivel outward motion to swivel drive gear 2491 which ultimately results in the axial path of the cutting instrument 2332 and the frame portion 2333 in the proximal direction " PD "to the starting position. Once the robotic controller 1001 has determined that the cutting instrument 2324 has reached the starting position via sensor (s) on the surgical end actuator 2312 that are in communication with the robotic controller 1001, the robotic controller 1001 stops the movement application rotary output shaft to rotary drive gear 2491. Subsequently, robotic controller 1001 applies the primary rotary output motion to shifter drive gear 2483 to cause closing clutch 2410 to move into engagement with the drive thread rotary 2382. Once the closing clutch 2410 has been moved to network engagement with the rotary drive thread 2382, the robotic controller 1001 then applies the secondary output movement to the rotary drive gear 2491 which ultimately results in the rotation of the rotating drive thread 2382 in the second direction to cause the closing tube 2370 to move the in the proximal direction "PD". As can be seen in Figures 39 to 41, the closing tube 2370 has an opening 2345 in which it engages the flap 2327 in the fixed claw 2324 to cause the fixed claw 2324 to rotate to the open position. In alternative embodiments, a spring can also be used to rotate the fixed claw 2324 to the open position when the closing tube 2370 has been returned to the starting position (Figure 39).
[000234] Figures 43 to 47 illustrate yet another 2500 surgical tool that can be effectively employed in connection with the robotic system 1000. In various forms, the 2500 surgical tool includes a 2512 surgical end actuator that includes a "first portion" in the in the form of an elongated channel 2522 and a "second movable portion" in the form of a pivotally translatable claw member, such as a fixed claw 2524, which are maintained at a spacing that ensures the clamping and effective tearing of the tissue attached to the actuator surgical end actuator 2512. As shown in the illustrated embodiment, the surgical end actuator 2512 may include, in addition to the elongated channel 2522 previously mentioned, and the fixed claw 2524, a "third movable portion" in the form of a cutting instrument 2532, a frame (not shown) and a surgical clamp cartridge 2534 that is removably seated in the elongated channel 2522. The cutting instrument 2532 can be, for example, a knife. The fixed claw 2524 can be pivoted open and closed at a pivot point 2525 connected to the close end of the elongated channel 2522. The fixed claw 2524 can also include a flap 2527 at its close end that is configured to interface operatively. with a component of the mechanical closing system (further described below) to open and close the fixed claw 2524. When activated, knife 2532 and the frame run longitudinally along the elongated channel 2522, thus cutting the tissue attached to the actuator. surgical end 2512. The movement of the frame along the elongated channel 2522 causes the clamps of the surgical clamp cartridge 2534 to be driven through the ruptured tissue and against the closed fixed jaw 2524, which rotates the clamps to secure the ruptured tissue. In one form, the elongated channel 2522 and the fixed claw 2524 can be made of an electrically conductive material (such as metal) so that they can serve as part of the antenna that communicates with the sensor (s) on the end actuator surgical procedure, as described above. The 2534 surgical clamp cartridge could be made of a non-conductive material (such as plastic) and the sensor can be connected to or disposed in the 2534 surgical clamp cartridge, as described above.
[000235] It should be noted that, although the surgical tool modalities 2500 described in this document employ a surgical end actuator 2512 that clips the ruptured tissue, in other different technical modalities for fixing or sealing the ruptured tissue can be used. For example, end actuators that use RF (radio frequency) energy or adhesives to join the sectioned tissue can also be used. US Patent No. 5,709,680, entitled "Electrosurgical Hemostatic Device" to Yates et al., And US Patent No. 5,688,270, entitled "Electrosurgical Hemostatic Device With Recessed And / Or Offset Electrodes" to Yates et al., As which are incorporated here, for reference, feature cutting instruments that use RF energy to trap broken tissue. U.S. Patent Application No. 11 / 267,811 to Morgan et al. and U.S. Patent Application No. 11 / 267,363 to Shelton et al., which are also incorporated herein by way of reference, disclose cutting instruments that use adhesives to secure the broken fabric. Consequently, although the description of the present invention refers to cutting / stapling operations and the like, it must be considered that this is an exemplary modality and should not be understood as limiting. Other tissue joining techniques can also be used.
[000236] In the illustrated embodiment, the elongated channel 2522 of the surgical end actuator 2512 is coupled to an elongated stem assembly 2508 that is coupled to a tool mounting portion 2600. In at least one embodiment, the elongated stem assembly 2508 comprises a hollow column tube 2540 which is non-movably coupled to a tool mounting plate 2602 of the tool mounting portion 2600. As can be seen in Figures 44 and 45, the proximal end 2523 of the elongated channel 2522 comprises a hollow tubular structure configured to be attached to the distal end 2541 of the column tube 2540. In one embodiment, for example, the proximal end 2523 of the elongated channel 2522 is welded or glued to the distal end of the column tube 2540.
[000237] As can be seen additionally in Figures 44 and 45, in at least one non-limiting modality, the surgical tool 2500 also includes an axially movable actuating member in the form of a closing tube 2550 which is constrained to move axially with respect to the elongated channel 2522 and the column tube 1540. The closing tube 2550 has a proximal end 2552 which has an internal thread 2554 formed in it that is in threaded engagement with a rotatingly movable portion in the form of a thread closing drive 2560. More specifically, closing drive thread 2560 has a proximal end portion 2562 that is pivotally supported in relation to elongated channel 2522 and column tube 2540. For mounting fins, the end portion proximal 2562 is threadably attached to a retaining ring 2570. Retaining ring 2570 is received in a groove 2529 formed between a shoulder 2527 at the proximal end 2523 of the ca elongated end 2522 and distal end 2541 of column tube 1540. This arrangement serves to rotate the closing drive thread 2560 rotatively within the elongated channel 2522. Rotation of the closing drive thread 2560 will cause the pipe closure 2550 moves axially, as represented by the arrow "D" in Figure 44.
[000238] Extending through the column tube 2540 and the closing drive thread 2560 is a drive member that, in at least one embodiment, comprises a knife bar 2580 that has a distal end portion 2582 that is coupled with rotary mode to the cutting instrument 2532 so that the knife bar 2580 can rotate in relation to the cutting instrument 2582. As can be seen in Figure 44 to 46, the closing drive thread 2560 has a slit 2564 in it through from which the knife bar 2580 can extend in a sliding manner. Such an arrangement allows knife bar 2580 to move axially with respect to closing drive thread 2560. However, rotation of knife bar 2580 around the longitudinal axis of the LT-LT tool will also result in the rotation of the drive screw of closing 2560. The axial direction in which the closing tube 2550 moves ultimately depends on the direction in which the knife bar 2580 and the closing drive thread 2560 are rotated. As the closing tube 2550 is added distally, the distal end of it will contact the fixed jaw 2524 and cause the fixed jaw 2524 to rotate to a closed position. By applying a rotating outlet opening of the robotic system 1000, the closing tube 2550 will be activated in the proximal direction "PD" and will pivot the fixed claw 2524 to the open position by engaging the flap 2527 with the opening 2555 in the tube closing time 2550.
[000239] In use, it may be desirable to rotate the surgical end actuator 2512 around the longitudinal axis of the LT-LT tool. In at least one embodiment, the tool mounting portion 2600 is configured to receive a corresponding first rotary output movement from the robotic system 1000 and convert that first rotary output movement and a rotary control movement to rotate the elongated stem assembly 2508 around the longitudinal axis of the LT-LT tool. As can be seen in Figure 42, a proximal end 2542 of the hollow column tube 2540 is swiveled within a cradle arrangement 2603 attached to a tool mounting plate 2602 of the tool mounting portion 2600. Various embodiments of the surgical tool 2500 further include a transmission arrangement, generally shown as 2605, which is operationally supported on the tool mounting plate 2602. In various forms, the transmission arrangement 2605 includes a rotating gear 2544 that is formed in or attached to the proximal end 2542 of column tube 2540 for network engagement with a 2610 rotary drive assembly that is operationally supported on the tool mounting plate 2602. In at least one embodiment, a 2612 rotary drive gear it is coupled to a first correspondent among the rotational bodies, disks or driven elements 1304 on the adapter side of the mounting plate of f tool 2602 when the tool mounting portion 2600 is coupled to the tool retainer 1270. See Figures 26 and 47. The rotary drive assembly 2610 additionally comprises a rotary driven gear 2614 that is pivotally supported on the mounting plate of tool 2602 in network engagement with the rotating gear 2544 and the rotating drive gear 2612. The application of a first rotating output movement from the robotic system 1000 through the tool drive set 1010 to the corresponding driven rotational body 1304 thus, it will cause rotation of the rotating drive gear 2612 by virtue of being operatively coupled to it. The rotation of the rotating drive gear 2612 ultimately results in the rotation of the elongated stem assembly 2508 (and end actuator 2512) around the longitudinal axis of the LT-LT tool.
[000240] The closing of the fixed claw 2524 relative to the surgical clamp cartridge 2534 is carried out by axially moving the closing tube 2550 in the distal direction "DD". The axial movement of the closing tube 2550 in the distal direction "DD" is performed by applying a rotary control movement to the closing drive thread 2382. In various embodiments, the closing drive thread 2560 is rotated when applying an outward movement swivel to knife bar 2580. The rotation of knife bar 2580 is controlled by applying swiveling outward movements to a swivel lock system 2620 that is operationally supported on tool mounting plate 2602, as shown in Figure 47. At least In one embodiment, the rotary closing system 2620 includes a closing drive gear 2622 that is coupled to a corresponding second of the rotating disks or body portion elements driven 1304 on the adapter side of the tool mounting plate 2462 when the portion tool mounting bracket 2600 is attached to tool retainer 1270. See Figures 26 and 47. The drive gear the closing gear 2622, in at least one embodiment, is in network engagement with a closing gear train, generally shown as 2623. The closing gear drive train 2623 comprises a first driven closing gear 2624 that is rotatably supported on the tool mounting plate 2602. The first driven closing gear 2624 is attached to a second closing gear driven 2626 by a driving rod 2628. The second driven closing gear 2626 is in network engagement with a third driven closing gear 2630 which is pivotally supported on tool mounting plate 2602. Rotating the closing driving gear 2622 in a second rotating direction will result in the rotation of the third driven closing gear 2630 in a second direction. Conversely, rotation of the closing drive gear 2483 in a secondary rotating direction (opposite the second rotating direction) will cause the third driven closing gear 2630 to rotate in a secondary direction.
[000241] As can be seen in Figure 47, a 2640 drive rod assembly is coupled to a proximal end of the 2580 knife bar. In several embodiments, the 2640 drive rod assembly includes a proximal portion 2642 that has a square cross-sectional shape. The proximal portion 2642 is configured to slidably engage a correspondingly shaped opening in the third driven gear 2630. Such an arrangement results in the rotation of the driving rod assembly 2640 (and knife bar 2580) when the third driven gear 2630 is rotated. . The drive rod assembly 2640 is axially advanced in the distal and proximal directions by a knife drive assembly 2650. One shape of the knife drive assembly 2650 comprises a rotary drive gear 2652 that is coupled to a corresponding third of the disks rotating elements, elements or body portions 1304 on the adapter side of the tool mounting plate 2462 when the tool mounting portion 2600 is coupled to the tool retainer 1270. See Figures 26 and 47. The rotary driven gear 2652 is in network drive coupling with a gear train, generally shown as 2653. In at least one way, the 2653 gear train additionally comprises a first rotary driven gear assembly 2654 which is pivotally supported on the tool mounting plate 2602. The first set of rotary driven gear 2654 is in network coupling with a third set of rotary driven gear 2656 which is pivotally supported on tool mounting plate 2602 and which is in network engagement with a fourth set of rotary driven gear 2658 which is in network engagement with a threaded portion 2644 of the drive rod assembly 2640. Rotating the 2652 swivel drive gear in a third swivel direction will result in axial advance of the 2640 drive shank and 2580 knife bar assembly in the distal "DD" direction. Conversely, rotation of the rotating drive gear 2652 in a tertiary rotating direction (opposite the third rotating direction) will cause the drive rod assembly 2640 and knife bar 2580 to move in the proximal direction.
[000242] A method of operating the 2500 surgical tool will now be described. Since the tool mounting portion 2600 has been operatively coupled to the tool retainer 1270 of the robotic system 1000, the robotic system 1000 can orient the surgical end actuator 2512 in the position adjacent to the target tissue to be cut and stapled. If the fixed claw 2524 is no longer in the open position (Figure 44), the robotic system 1000 can apply the second rotating output movement to the closing drive gear 2622, which results in the rotation of the knife bar 2580 in a second direction . Rotation of knife bar 2580 in the second direction will result in rotation of the closing drive thread 2560 in a second direction. As the closing drive thread 2560 runs in the second direction, the closing tube 2550 moves in the proximal "PD" direction. As the closing tube 2550 moves in the proximal direction "PD", the flap 2527 on the anvil 2524 interfaces with the opening 2555 on the closing tube 2550 and causes the anvil 2524 to rotate to the open position. In additional or alternative modes, a spring (not shown) can be used to turn the anvil 2354 to the open position when the closing tube 2550 is returned to the starting position (Figure 44). The open surgical end actuator 2512 can then be manipulated by the robotic system 1000 to position the target tissue between the open fixed jaw 2524 and the surgical clamp cartridge 2534. Thereafter, the surgeon can initiate the closing process by activating the system control robot 1000 to apply the second rotating output movement to the closing drive gear 2622 which, as described above, ultimately results in the rotation of the closing drive thread 2382 in the second direction which results in the axial path of the tube closing 2250 in the distal direction "DD". As the closing tube 2550 moves in the distal direction, it comes into contact with a portion of the fixed jaw 2524 and causes the fixed jaw 2524 to rotate to the closed position to grab the target tissue between the fixed jaw 2524 and the staple cartridge 2534. Once the robotic controller 1001 determines that the fixed claw 2524 has been rotated to the closed position by corresponding sensor (s) on the end actuator 2512 that is communicating with it, the robotic controller 1001 discontinues the application of the second rotating output movement for the closing drive gear 2622. The robotic controller 1001 can also provide the surgeon with an indication that the fixed claw 2524 has been closed successfully. The surgeon can then start the firing procedure. In alternative modes, the triggering procedure can be automatically initiated by the robotic controller 1001.
[000243] After the robotic controller 1001 determines that the fixed claw 2524 is in the closed position, the robotic controller 1001 then applies the third rotating output movement to the rotating drive gear 2652, which results in the axial movement of the rod assembly drive 2640 and knife bar 2580 in the distal direction "DD". As the cutting instrument 2532 moves distally through the surgical clamp cartridge 2534, the tissue attached to it is broken. As the frame portion (not shown) is activated distally, it causes the clamps inside the surgical clamp cartridge 2534 to be activated through the broken tissue to contact the fixed claw 2524. Once the robotic controller 1001 has determined that the cutting instrument 2532 has reached the final position of the surgical clamp cartridge 2534 by means of sensor (s) on the surgical end actuator 2512 which is in communication with the robotic controller 1001, the robotic controller 1001 stops the application of the second movement of rotary output for rotary drive gear 2652. Subsequently, the robotic controller 1001 applies the secondary rotary control movement to the rotary drive gear 2652 which ultimately results in the axial path of the cutting instrument 2532 and the frame portion in the direction proximal "PD" to the starting position. Once the robotic controller 1001 has determined that the cutting instrument 2524 has reached the starting position via the sensor (s) on the end actuator 2512 that is in communication with the robotic controller 1001, the robotic controller 1001 stops the application from the secondary rotary output movement to the rotary drive gear 2652. Subsequently, the robotic controller 1001 can apply the secondary rotary output movement to the closing drive gear 2622, which results in the rotating knife bar 2580 in a secondary direction. Rotation of knife bar 2580 in the secondary direction results in rotation of the closing drive thread 2560 in a secondary direction. As the closing drive thread 2560 rotates in the secondary direction, the closing tube 2550 moves in the proximal direction "PD" to the open position.
[000244] Figures 48 to 53B illustrate yet another surgical tool 2700 that can be efficiently employed in connection with the robotic system 1000. In various forms, the surgical tool 2700 includes a surgical end actuator 2712 that includes a "first portion" in the shape of an elongated channel 2722 and a "second movable portion" in a shape comprising a translatable pivotable claw member, such as a fixed claw 2724, which are maintained at a spacing that ensures effective clamping and tearing of the attached tissue on the surgical end actuator 2712. As shown in the illustrated embodiment, the surgical end actuator 2712 may include, in addition to channel 2722 and the fixed claw 2724 mentioned earlier, a "third movable portion" in the form of a cutting instrument 2732, a frame (not shown) and a 2734 surgical staple cartridge that is removably seated in the elongated channel 2722. The cutting instrument 2732 can and be, for example, a knife. The fixed claw 2724 can be pivoted open and closed at a pivot point 2725 connected to the proximal end of the elongated channel 2722. The fixed claw 2724 can also include a flap 2727 at its proximal end that interfaces with a component of the system. mechanical closure (further described below) to open and close the fixed claw 2724. When activated, knife 2732 and the frame run longitudinally along the elongated channel 2722, thus cutting the tissue clamped inside the surgical end actuator 2712. The movement of the frame along the elongated channel 2722 causes the clamps of the surgical clamp cartridge 2734 to be driven through the ruptured tissue and against the closed fixed jaw 2724, which rotates the clamps to secure the ruptured tissue. In one form, the elongated channel 2722 and the fixed claw 2724 can be made of an electrically conductive material (such as metal) so that they can serve as part of the antenna that communicates with the sensor (s) on the end actuator surgical procedure, as described above. The 2734 surgical clamp cartridge could be made of a non-conductive material (such as plastic) and the sensor can be connected to or disposed in the 2734 surgical clamp cartridge, as described above.
[000245] It should be noted that, although the surgical tool modalities 2500 described in this document employ a surgical end actuator 2712 that clips the ruptured tissue, in other different technical modalities for securing or sealing the ruptured tissue can be used. For example, end actuators that use RF (radio frequency) energy or adhesives to join the sectioned tissue can also be used. US Patent No. 5,709,680, entitled "Electrosurgical Hemostatic Device" to Yates et al., And US Patent No. 5,688,270, entitled "Electrosurgical Hemostatic Device With Recessed And / Or Offset Electrodes" to Yates et al., As which are incorporated here, for reference, feature cutting instruments that use RF energy to trap broken tissue. U.S. Patent Application No. 11 / 267,811 to Morgan et al. and U.S. Patent Application No. 11 / 267,363 to Shelton et al., which are also incorporated herein by way of reference, disclose cutting instruments that use adhesives to secure the broken fabric. Consequently, although the description of the present invention refers to cutting / stapling operations and the like, it must be considered that this is an exemplary modality and should not be understood as limiting. Other tissue joining techniques can also be used.
[000246] In the illustrated embodiment, the elongated channel 2722 of the surgical end actuator 2712 is coupled to an elongated stem assembly 2708 that is coupled to a tool mounting portion 2900. Although this is not shown, the elongated stem assembly 2708 it can include a pivot joint to allow the surgical end actuator 2712 to be selectively pivoted around an axis that is substantially transverse to the LT-LT tool axis. In at least one embodiment, the elongated stem assembly 2708 comprises a hollow column tube 2740 that is non-movably coupled to a tool mounting plate 2902 of the tool mounting portion 2900. As can be seen in Figures 49 and 50, the proximal end 2723 of the elongated channel 2722 comprises a hollow tubular structure that is attached to the column tube 2740 by means of a 2790 mounting collar. A cross-sectional view of the 2790 mounting collar is shown in Figure 51. In In various embodiments, the mounting collar 2790 has a proximal flange end 2791 that is configured for attachment to the distal end of the 2740 column tube. In at least one embodiment, for example, the 2791 proximal flange end of the 2790 mounting collar it is welded to or glued to the distal end of the column tube 2740. As can be seen further in Figures 54 and 55, the mounting collar 2790 also has a portion of the mounting hub 2792 which is dimensioned to receive the proximal end 2723 of the elongated channel 2722 therein. The proximal end 2723 of the elongated channel 2722 is fixed non-movably to the mounting hub portion 2792 by, for example, welding, adhesive etc.
[000247] As can be seen additionally in Figures 49 and 50, the surgical tool 2700 also includes an axially movable actuating member in the form of a closing tube 2750 which is restricted to move axially in relation to the elongated channel 2722. The closing tube 2750 has a proximal end 2752 which has an internal thread 2754 formed therein that is threaded in engagement with a rotatable movable portion in the form of a closing drive thread 2760. More specifically, the closing drive thread 2760 has a proximal end portion 2762 that is pivotally supported in relation to the elongated channel 2722 and the column tube 2740. For mounting fins, the proximal end portion 2762 is threaded to a retaining ring 2770. The retaining ring 2770 is received in a groove 2729 formed between a shoulder 2727 at the proximal end 2723 of the channel 2722 and the mounting hub 2729 of the mounting collar 2790. Such dis This position serves to rotate the closing drive thread 2760 inside the channel 2722. Rotating the closing drive thread 2760 will cause the closing tube 2750 to move axially, as represented by the arrow "D" in Figure 49.
[000248] Extending through the column tube 2740, the mounting collar 2790 and the closing drive thread 2760 is a drive member, which, in at least one embodiment, comprises a knife bar 2780 having a distal portion of the end 2782 which is coupled to the cutting instrument 2732. As can be seen in Figures 49 and 50, the mounting collar 2790 has a passage 2793 through it to allow the knife bar 2780 to slide through it . Similarly, the closing drive thread 2760 has a slot 2764 therein through which the knife bar 2780 can slide. Such an arrangement allows the knife bar 2780 to move axially with respect to the closing drive thread 2760.
[000249] The performance of the fixed claw 2724 is controlled by a rotating driven rod 2800. As can be seen in Figures 49 and 50, a distal portion of the 2802 end of the closing drive rod 2800 extends through a passage 2794 on the mounting collar 2790 and a closing gear 2804 is attached to it. Closing gear 2804 is configured for the drive hitch with the inner surface 2761 of the closing drive thread 2760. Therefore, the rotation of the closing rod 2800 will also result in the rotation of the closing drive thread 2760. The axial direction in the which the closing tube 2750 moves ultimately depends on the direction in which the closing rod 2800 and the closing drive thread 2760 are rotated. For example, in response to a rotary closing movement received from the robotic system 1000, the closing tube 2750 will be activated in the distal direction "DD". As the closing tube 2750 is driven distally, the opening 2745 will engage the flap 2727 on the fixed claw 2724 and cause the fixed claw 2724 to rotate to a closed position. By applying a rotating opening movement of the robotic system 1000, the closing tube 2750 will be activated in the proximal direction "PD" and the fixed claw 2724 will rotate to the open position. In various embodiments, a spring (not shown) can be used to tilt the fixed claw 2724 to the open position (Figure 49).
[000250] In use, it may be desirable to rotate the surgical end actuator 2712 around the longitudinal axis of the LT-LT tool. In at least one embodiment, the tool mounting portion 2900 is configured to receive a corresponding first pivoting output movement from the robotic system 1000 to rotate the elongated shank assembly 2708 about the LT-LT tool axis. As can be seen in Figure 53, a proximal end 2742 of the hollow column tube 2740 is swiveled in a cradle arrangement 2903 and a bearing assembly 2904 that is attached to a tool mounting plate 2902 of the 2900 tool assembly. A 2744 rotation gear is formed on or attached to the proximal end 2742 of the column tube 2740 for network engagement with a 2910 rotation drive assembly that is operatively supported on the 2902 tool mounting plate. In at least one embodiment, a 2912 rotating drive gear is coupled to a first match between the driven disks or elements 1304 on the adapter side of the tool mounting plate 2602 when the tool mounting portion 2600 is coupled to the retainer tool number 1270. See Figures 26 and 53. The 2910 rotary drive assembly additionally comprises a 2914 rotary driven gear that is pivotally supported on tool mounting plate 2902 in network engagement with rotation gear 2744 and rotation drive gear 2912. The application of a first rotary control movement from the robotic system 1000 through the tool retainer 1270 and the adapter 1240 to the corresponding driven element 1304 will thus cause the rotation of the 2912 drive gear to rotate by virtue of being operationally coupled thereto. The rotation of the 2912 rotation drive gear ultimately results in the rotation of the elongated stem assembly 2708 (and the end actuator 2712) around the longitudinal axis of the LT-LT tool (primary rotary movement).
[000251] The closing of the fixed claw 2724 relative to the staple cartridge 2734 is carried out by axially moving the closing tube 2750 in the distal direction "DD". The axial movement of the closing tube 2750 in the distal direction "DD" is performed by applying a rotary control movement to the closing drive thread 2760. In various embodiments, the closing drive thread 2760 is rotated when applying an outward movement rotating to the closing drive rod 2800. As can be seen in Figure 53, a proximal end portion 2806 of the closing drive rod 2800 has a driven gear 2808 in it that is in network engagement with a drive assembly of closing 2920. In several embodiments, the closing drive system 2920 includes a closing drive gear 2922 that is coupled to a corresponding second among the rotational bodies or driven elements 1304 on the adapter side of the tool mounting plate 2462 when the tool mounting portion 2900 is attached to tool retainer 1270. See Figures 26 and 53. The above gear closing gear 2922 is supported in network engagement with a closing gear train, generally shown as 2923. In at least one way, the closing gear train 2923 comprises a first driven closing gear 2924 that is supported in a manner swiveling on the tool mounting plate 2902. The first driven closing gear 2924 is attached to a second closing gear driven 2926 by a 2928 drive rod. The second driven closing gear 2926 is in network engagement with a gear set planetary 2930. In several embodiments, the 2930 planetary gear assembly includes a 2932 driven planetary locking gear that is pivotally supported on bearing assembly 2904 that is mounted on tool mounting plate 2902. As can be seen in the Figures 53 and 53B, the proximal end portion 2806 of the closing drive rod 2800 is supported by m rotating anode on the proximal end portion 2742 of column tube 2740 so that driven gear 2808 is in network engagement with the teeth of central gear 2934 formed on planetary gear 2932. As can also be seen in Figure 53A, two gears of additional supports 2936 are fixed to or swiveled with respect to the proximal end portion 2742 of the column tube 2740 to provide bearing support thereto. Such an arrangement with the planetary gear set 2930 serves to accommodate the rotation of the column rod 2740 through the rotation drive set 2910 while allowing the driven closing gear 2808 to remain in network engagement with the closing drive system 2920. In addition, the rotation of the closing drive gear 2922 in a first direction will ultimately result in the rotation of the closing drive rod 2800 and the closing drive thread 2760 will ultimately result in the closing of the fixed jaw 2724, as described above. Conversely, the rotation of the closing drive gear 2922 in a second opposite direction will ultimately result in the rotation of the closing drive thread 2760 in an opposite direction which results in the opening of the fixed jaw 2724.
[000252] As can be seen in Figure 53, the proximal end 2784 of knife bar 2780 has a portion of threaded shank 2786 attached to it that is in engagement with a 2940 knife drive assembly. the threaded shank portion 2786 is pivotally supported by a bearing 2906 attached to the 2902 tool mounting plate. This arrangement allows the threaded shank portion 2786 to rotate and move axially with respect to the 2902 tool mounting plate. knife bar 2780 is advanced axially in the distal and proximal directions by the knife drive assembly 2940. A shape of the knife drive assembly 2940 comprises a rotary drive gear 2942 that is coupled to a corresponding third within one of the rotating bodies, discs or driven elements 1304 on the adapter side of the tool mounting plate 2902 when the tool mounting portion 2900 is coupled to the screw retainer tool 1270. See Figures 26 and 53. The 2942 rotary drive gear is in network engagement with a knife gear train, generally shown as 2943. In various embodiments, the 2943 knife gear train comprises a first set 2944 rotary drive gear that is rotatably supported on the 2902 tool mounting plate. The first 2944 rotary drive gear set is in network engagement with a third 2946 rotary drive gear set that is rotatably supported on the tool plate. tool assembly 2902 and which is in network engagement with a fourth set of 2948 rotary driven gear which is in network engagement with the threaded portion 2786 of knife bar 2780. Rotation of the 2942 rotary drive gear in one direction will result in axial feed of knife bar 2780 in the distal direction "DD". Conversely, rotating the 2942 rotary drive gear in an opposite direction will cause the knife bar 2780 to move in the proximal direction. The 2700 tool can be used in another way as described above.
[000253] Figures 54 and 55 illustrate a modality of surgical tool 2700 which is substantially identical to the tool 2700 which has been described in detail above. However, tool 2700 'includes a pressure sensor 2950 that is configured to provide feedback to the robotic controller 1001 in relation to the amount of clamping pressure experienced by the fixed jaw 2724. In various embodiments, for example, the pressure sensor may comprise a spring-loaded contact switch. For a continuous signal, either a cantilever beam with a stretch gauge would be used or a button top around the dome with a stretch gauge inside. Another version may comprise a switch for deactivating that only contacts a desired known load. Such a provision would include a dome at the base where the dome is an electrical pole and the base is the other electrical pole. Such an arrangement allows the robotic controller 1001 to adjust the amount of clamping pressure that is applied to the tissue inside the surgical end actuator 2712 by adjusting the amount of closing pressure applied to the fixed claw 2724. Individuals of ordinary skill in the art will understand that such a pressure sensor arrangement can be effectively employed with several of the surgical tool modalities described in this document, as well as their equivalent structures.
[000254] Figure 56 illustrates a portion of another surgical tool 3000 that can be effectively used in connection with a robotic system 1000. The surgical tool 3003 employs motor (s) on board to feed various components of an actuator cutting instrument. surgical end. In at least one non-limiting modality, for example, the surgical tool 3000 includes a surgical end actuator in the form of an endoscopic cutter (not shown) that has a fixed claw (not shown) and surgical clamp cartridge arrangement (not shown) ) of the types and constructions described above. The surgical tool 3000 also includes an elongated shank (not shown) and a fixed jaw closure arrangement (not shown) of the types described above. Therefore, this portion of the Detailed Description will not repeat the description of those components beyond what is necessary to verify the unique and innovative attributes of the various modalities of the 3000 surgical tool.
[000255] In the modality shown, the end actuator includes a cutting instrument 3002 that is coupled to a knife bar 3003. As can be seen in Figure 56, the surgical tool 3000 includes a tool mounting portion 3010 that includes a tool mounting plate 3012 that is configured to interface in a mounted manner with the adapter portion 1240 'that is coupled to the robotic system 1000 in the various ways described above. The tool mounting portion 3010 is configured to operably support a transmission arrangement 3013 thereon. In at least one embodiment, the adapter portion 1240 'may be identical to the adapter portion 1240 described in detail above without the rotating bodies fed and disc members employed by the adapter 1240. In other embodiments, the adapter portion 1240' may be identical to the adapter portion 1240. Still other modifications that are considered to be in the essence and scope of the various forms of the present invention may employ one or more of the mechanical movements (i.e., rotating movement (s)) from the tool holding portion 1270 (as described earlier in this document) to feed / actuate the 3013 transmission arrangement while also employing one or more motors in the tool mounting portion 3010 to energize one or more other components of the surgical end actuator. Furthermore, although the end actuator of the modality shown comprises an endoscopic cutter, those of ordinary skill in the art will understand that the unique and innovative attributes of the modality shown can be used effectively in connection with other types of surgical end actuators without leave the essence and scope of the various forms of the present invention.
[000256] In various embodiments, the tool mounting plate 3012 is configured to at least accommodate a first firing motor 3011 to provide firing and retracting movements to the knife bar 3003 which is coupled to, or otherwise makes interface operable with the cutting instrument 3002. The tool mounting plate 3012 has an arrangement of electrical connection pins 3014 that are configured to interface with slots 1258 (Figure 25) on adapter 1240 '. This arrangement allows the controller 1001 of the robotic system 1000 to supply control signals to the electronic control circuit 3020 of the surgical tool 3000. Although the interface is described in this document with reference to mechanical, electrical and magnetic coupling elements, it must be understood that a wide variety of telemetry modalities can be used, including inductive, infrared, or similar coupling.
[000257] The 3020 control circuit is shown schematically from Figure 56. In one form or embodiment, the 3020 control circuit includes a power supply in the form of a 3022 battery that is coupled to a switch powered by 3024 activated / deactivated solenoid. The 3020 control circuit also includes a 3026 activated / deactivated trip solenoid that is coupled to a 3028 double pole switch to control the rotational direction of the 3011 motor. Therefore, when the 1001 controller of the robotic system 1000 provides an appropriate control signal, switch 3024 will allow the battery 3022 to power the double pole switch 3028. The controller 1001 of the robotic system 1000 will also provide an appropriate signal to the double pole switch 3028 to supply power to the 3011 engine When it is desired to fire the surgical end actuator (that is, activate the cutting instrument 3002 distally through the tissue attached to the surgical end), the 3028 double pole switch will be in the first position. When it is desired to retract the cutting instrument 3002 to the initial position, the double pole switch 3028 will be moved to the second position by controller 1001.
[000258] Various embodiments of the surgical tool 3000 also employ a 3030 gearbox which is dimensioned, in cooperation with a firing gear train 3031 which, in at least one non-limiting embodiment, comprises a firing drive gear 3032 which is in network engagement with a triggering gear driven 3034 to generate a desired amount of drive force required to drive the cutting instrument 3002 through the fabric and to drive and form clamps in the various ways described in this document. In the embodiment shown in Figure 56, the driven gear 3034 is coupled to a screw rod 3036 that is threaded in engagement with a screw thread arrangement 3038 that is restricted to move axially (represented by the arrow "D"). The screw thread arrangement 3038 is fixed to the firing bar 3003. Therefore, when turning the screw stem 3036 in a first direction, the cutting instrument 3002 is activated in the distal direction "DD" and when turning the screw stem in a second opposite direction, the cutting instrument 3002 can be retracted in the proximal direction "PD".
[000259] Figure 57 illustrates a portion of another surgical tool 3000 'that is substantially identical to the tool 3000 described above, except that the driven gear 3034 is attached to a drive rod 3040. The drive rod 3040 is attached to a second drive gear 3042 which is in network engagement with a third drive gear 3044 which is in network engagement with a screw 3046 coupled to the firing bar 3003.
[000260] Figure 58 illustrates another surgical tool 3200 that can be effectively used in connection with a robotic system 1000. In this embodiment, the surgical tool 3200 includes a 3212 surgical end actuator that, in a non-limiting way, comprises a portion component which is selectively movable between the first and second positions with respect to at least one other end actuator component portion. As will be discussed in more detail below, the surgical tool 3200 employs on-board motors to feed various components of a 3305 transmission arrangement. The 3212 surgical end actuator includes an elongated 3222 channel that operationally supports a 3234 surgical clamp cartridge. elongated 3222 has a proximal end 3223 that slidably extends into a hollow elongated stem assembly 3208 that is coupled to a tool mounting portion 3300. In addition, surgical end actuator 3212 includes a fixed claw 3224 that it is pivotally coupled to the elongated channel 3222 by a pair of rotating pins 3225 which are received inside the corresponding openings 3229 in the elongated channel 3222. A distal end portion 3209 of the stem assembly 3208 includes an opening 3245 in which a flap 3227 in the fixed jaw 3224 it is inserted to open the fixed jaw 3224 as the elongated channel 3222 is moved axially in the proximal direction "PD" to the distal end of the 3209 end of the stem assembly 3208. In various embodiments, a spring (not shown) can be employed to tilt the fixed claw 3224 into the open position.
[000261] As indicated above, the surgical tool 3200 includes a tool mounting portion 3300 that includes a tool mounting plate 3302 that is configured to operably support the transmission arrangement 3305 and to interface in a mounted manner with the adapter portion 1240 ', which is coupled to the robotic system 1000 in the various ways described above. In at least one embodiment, the adapter portion 1240 'may be identical to the adapter portion 1240 described in detail above without the powered disk members employed by the adapter 1240. In other embodiments, the adapter portion 1240' may be identical to the portion of adapter 1240. However, in such embodiments, because the various components of the 3212 surgical end actuator are all powered by motor (s) in the 3300 tool mounting portion, the 3200 surgical tool will not employ or require any mechanical movements (ie , non-electrical) actuation from the tool holding portion 1270 to feed the 3200 surgical end actuator components. Still other modifications that are considered to be in the essence and scope of the various forms of the present invention may employ one or more of the movements mechanical from the tool holding portion 1270 (as described earlier in this document) to feed have one or more of the components of the surgical end actuator while also employing one or more motors in the tool mounting portion to power one or more other components of the surgical end actuator.
[000262] In several embodiments, the tool mounting plate 3302 is configured to support a first firing motor 3310 to provide firing and retracting movements to the 3305 transmission arrangement to drive a 3335 knife bar that is coupled to an instrument cut 3332 of the type described above. As can be seen in Figure 58, the tool mounting plate 3212 has an arrangement of electrical connection pins 3014 that are configured to interface with slots 1258 (Figure 25) on adapter 1240 ’. This arrangement allows the controller 1001 of the robotic system 1000 to provide control signals to the electronic control circuits 3320, 3340 of the surgical tool 3200. Although the interface is described in this document with reference to mechanical, electrical and magnetic coupling elements, it is understood that a wide variety of telemetry modalities can be used, including inductive, infrared, or similar coupling.
[000263] In one form or embodiment, the first 3320 control circuit includes a first power supply in the form of a first 3322 battery that is coupled to a first switch powered by 3324 activated / deactivated solenoid. The first control circuit of trigger 3320 also includes a first trigger solenoid on / off 3326 that is coupled to a first double pole switch 3328 to control the rotational direction of the first trigger motor 3310. Therefore, when robotic controller 1001 provides a appropriate control, the first switch 3324 will allow the first battery 3322 to power the first double pole switch 3328. The robotic controller 1001 will also provide an appropriate signal to the first double pole switch 3328 to power the first trigger motor 3310. When desired trigger the surgical end actuator (ie, drive the 3232 cutting instrument distally through the tec Once held on the surgical end actuator 3212, the first switch 3328 will be positioned in a first position by the robotic controller 1001. When it is desired to retract the cutting instrument 3232 to the starting position, the robotic controller 1001 will send the appropriate control signal to move the first 3328 switch to the second position.
[000264] Various embodiments of the 3200 surgical tool also employ a first 3330 gearbox which is dimensioned, in cooperation with a 3332 firing drive gear coupled to it that cooperatively interfaces with a 3333 firing gear train. at least one non-limiting mode, the firing gear train 333 comprises a driven firing gear 3334 which is in network engagement with the driving gear 3332, to generate a desired amount of driving force required to drive the cutting instrument 3232 through the fabric and to trigger and form staples in the various ways described in this document. In the modality shown in Figure 58, the driven gear 3334 is coupled to a driving rod 3335 which has a second driven gear 3336 coupled to it. The second driven gear 3336 is supported in mesh engagement with a third driven gear 3337 that is engaged in mesh with a fourth gear driven 3338. The fourth driven gear 3338 is engaged in mesh with a proximal threaded portion 3339 of the knife bar 3235 which is restricted to moving axially. Therefore, by turning the 3335 drive rod in a first direction, the 3232 cutting instrument is driven in the distal "DD" direction and rotates the 3335 driving rod in a second opposite direction, and the 3232 cutting instrument can be retracted in the "PD" proximal direction.
[000265] As indicated above, the opening and closing of the fixed jaw 3224 are controlled by axially moving the elongated channel 3222 in relation to the elongated stem assembly 3208. The axial movement of the elongated channel 3222 is controlled by a closing control system 3339. In various embodiments, the closing control system 3339 includes a closing rod 3340 that has a hollow threaded end portion 3341 that threadably engages a threaded closing rod 3342. The threaded end portion 3341 is supported in a manner rotatable on a 3343 column stem that operatively interfaces with the tool mounting portion 3300 and extends through a portion of the stem assembly 3208, as shown. The closing system 3339 additionally comprises a closing control circuit 3350 that includes a second power supply in the form of a second battery 3352 that is coupled to a second switch powered by a solenoid activated / deactivated 3354. The closing control circuit 3350 also includes a second solenoid on / off trigger 3356 that is coupled to a second double pole switch 3358 to control the rotation of a second 3360 closing motor. Therefore, when robotic controller 1001 provides a control signal the second switch 3354 will allow the second battery 3352 to power the second double pole switch 3354. The robotic controller 1001 will also provide an appropriate signal to the second double pole switch 3358 to power the second engine 3360. When it is desired to close the claw fixed 3224, the second switch 3348 will be in a first position. When it is desired to open the fixed claw 3224, the second switch 3348 will be moved to a second position.
[000266] Various embodiments of the 3300 tool mounting portion also employ a second 3362 gearbox that is coupled to a 3364 closing drive gear. The 3364 closing drive gear is in network engagement with a gear train of a 3363 closing gear. In several non-limiting forms, the 3363 closing gear train includes a 3365 driven closing gear that is attached to a 3366 closing driving rod. closing 3367 which is in network engagement with a closing rod 3360 gear attached to closing rod 3340. Figure 63 shows the end actuator 3212 in the open position. As indicated above, when the threaded closing rod 3342 is in the position shown in Figure 58, a spring (not shown) tilts the fixed claw 3224 to the open position. When it is desired to close the fixed claw 3224, the robotic controller 1001 will activate the second motor 3360 to rotate the closing rod 3340 to extract the threaded closing rod 3342 and the channel 3222 in the proximal 'PD' direction. As the fixed claw 3224 comes into contact with the distal portion of the end 3209 of the stem 3208, the fixed claw 3224 is rotated to a closed position.
[000267] A method for operating the 3200 surgical tool will now be described. Once the tool mounting portion 3302 has been operationally coupled to the tool retainer 1270 of the robotic system 1000, the robotic system 1000 can orient the end actuator 3212 in the position adjacent to the target tissue to be cut and stapled. If the fixed claw 3224 is no longer in the open position, the robotic controller 1001 can activate the second closing motor 3360 to drive channel 3222 in the direction distal to the position shown in Figure 58. Once the robotic controller 1001 determines that the actuator surgical end cap 3212 is in the open position by sensor (s) on the end actuator and / or the tool mounting portion 3300, robotic controller 1001 can provide the surgeon with a signal to inform the surgeon that the fixed clamp 3224 can then , be closed. Once the target tissue is positioned between the open fixed jaw 3224 and the surgical clamp cartridge 3234, the surgeon can then initiate the closing process by activating the robotic controller 1001 to apply a closing control signal to the second motor closing motor 3360. The second closing motor 3360 applies a rotating movement to the closing rod 3340 to extract channel 3222 in the proximal direction "PD" until the fixed claw 3224 has been pivoted to the closed position. Once the robotic controller 1001 determines that the fixed claw 3224 has been moved to the closed position by sensor (s) on the surgical end actuator 3212 and / or the tool mounting portion 3300 that is communicating with the robotic control system , the 3360 engine can be deactivated. Subsequently, the triggering process can be initiated or manually by the surgeon who activates a trigger, button etc. on controller 1001 or controller 1001 can automatically start the triggering process.
[000268] To start the firing process, the robotic controller 1001 activates firing motor 3310 to drive firing bar 3235 and cutting instrument 3232 in the distal direction "DD". Once the robotic controller 1001 has determined that the cutting instrument 3232 has moved to a final position on the surgical clamp cartridge 3234 via sensors on the surgical end actuator 3212 and / or the motor drive portion 3300, the robotic controller 1001 can provide the surgeon an indication signal. Thereafter, the surgeon can manually activate the first 3310 engine to retract the 3232 cutting instrument to the home position, or the robotic controller 1001 can automatically activate the first 3310 engine to retract the 3232 cutting element.
[000269] The modality shown in Figure 58 does not include an articulation joint. Figures 64 and 65 illustrate surgical tools 3200 'and 3200 "which have 3212', 3212" end actuators, respectively, which can be employed with an elongated rod modality that has a hinge joint of the various types presented in this document. For example, as can be seen in Figure 59, a threaded locking rod 3342 is attached to the proximal end 3223 of the elongated channel 3222 by a flexible cable or other flexible member 3345. The location of a hinge joint (not shown) in the assembly elongated stem 3208 will coincide with flexible member 3345 to allow flexible member 3345 to accommodate such a joint. In addition, in the embodiment described above, flexible member 33345 is pivotally attached to the proximal end portion 3223 of elongated channel 3222 to allow flexible member 3345 to rotate with respect to it to prevent flexible member 3229 from "wrapping" in relation to to channel 3222. Although not shown, the cutting element can be operated in one of the ways described above by a knife bar that can also accommodate the elongated shank assembly hinge. Figure 60 shows a 3212 ”surgical end actuator that is substantially identical to the 3212 surgical end actuator described above, except that the threaded closure rod 3342 is attached to a closure thread 3347 that is restricted to moving only axially in the elongated shank assembly 3208. The flexible member 3345 is attached to the closing thread 3347. This arrangement also prevents the threaded closing rod 3342 from wrapping the flexible member 3345. A flexible knife bar 3235 'can be employed to facilitate the articulation of the 3212 ”surgical end actuator.
[000270] The surgical tools 3200, 3200 ’and 3200” described above can also employ any of the cutting instrument modalities described in this document. As discussed above, the fixed jaw of each of the end actuators of these tools is closed by extracting the elongated channel from contact with the distal end of the elongated stem assembly. Therefore, once the target tissue has been located between the staple cartridge 3234 and the fixed jaw 3224, the robotic controller 1001 can begin to draw channel 3222 inward into stem assembly 3208. In several embodiments, however, to prevent the 3212, 3212 ', 3212 ”end actuator from moving the target tissue with the end actuator during this closing process, controller 1001 can simultaneously move the tool retainer and, finally, the tool to compensate the movement of the elongated channel 3222 so that, in effect, the target tissue is gripped between the fixed jaw and the elongated channel without being moved in any other way.
[000271] Figures 61 to 63 show another type of surgical tool 3201 that is substantially identical to the surgical tool 3200 "described above, except for the differences discussed below. In this embodiment, the threaded closing rod 3342 'has grooves of varying inclinations. More specifically, as can be seen in Figure 62, the closing rod 3342 'has a distal groove section 3380 and a proximal groove section 3382. The distal and proximal groove sections 3380, 3382 are configured to engage with a pin 3390 supported within the hollow threaded end portion 3341 '. As can be seen in Figure 62, the distal groove section 3380 has a finer inclination than the groove section 3382. Therefore, such a variable inclination arrangement allows the elongated channel 3222 to be drawn into the stem 3208 in a first speed or rate due to engagement between pin 3390 and proximal groove segment 3382. When pin 3390 engages the distal groove segment, channel 3222 will be drawn into the stem 3208 at a second speed or rate. Because the proximal groove segment 3382 is rougher than the distal groove segment 3380, the first speed will be greater than the second speed. Such an arrangement serves to accelerate the initial closure of the end actuator for fabric handling and, after the fabric has been properly positioned therein, to generate the amount of closing forces to properly grasp the fabric for cutting and sealing. Therefore, the fixed claw 3234 initially closes quickly with a lower force and then applies a higher closing force as the fixed claw closes more slowly.
[000272] The opening and closing movements of the surgical end actuator are employed to allow the user to use the end actuator to grasp and manipulate tissue previously to completely grasp the same in the desired location for cutting and sealing. The user can, for example, open and close the surgical end actuator several times during this process to orient the end actuator in an appropriate position that allows the tissue to be kept in a desired location. Therefore, in at least some modalities, to produce the high load for firing, the fine thread may require up to 5 to 10 complete turns to generate the necessary load. In some cases, for example, this action could take up to 2 to 5 seconds. If it also takes an equally long time to open and close the end actuator each time during the tissue positioning / manipulation process, only positioning the end actuator can occur for an undesirably long time. If this happens, it is possible that a user may abandon such use of the end actuator by the use of a conventional clamp device. The use of tweezers etc. may undesirably increase the costs associated with completing the surgical procedure.
[000273] The modalities described above employ a battery or batteries to power the motors used to drive the end actuator components. The activation of the motors is controlled by the robotic system 1000. In alternative modalities, the power supply can comprise the alternating current "AC" that is supplied to the motors by the robotic system 1000. That is, the AC power would be supplied from the system which powers the robotic system 1000 through the tool holder and adapter. In still other embodiments, a power cable or cable can be attached to the 3300 tool mounting portion to provide the required power from a separate source of alternating or direct current.
[000274] In use, controller 1001 can apply an initial pivoting motion to the closing rod 3340 (Figure 58) to draw the elongated channel 3222 axially inward into the elongated stem assembly 3208 and move the fixed jaw from the first position to an intermediate position at a first rate that corresponds to the point where the distal groove section 3380 transitions to the proximal groove section 3382. The additional application of pivoting motion to the closing rod 3340 will cause the fixed jaw to move from the intermediate position to the closed position in relation to the surgical staple cartridge. When in the closed position, the tissue to be cut and stapled is appropriately gripped between the fixed jaw and the surgical staple cartridge.
[000275] Figures 64 to 68 illustrate another embodiment of the 3400 surgical tool of the present invention. This embodiment includes an elongated shank assembly 3408 that extends from a 3500 tool mounting portion. The elongated shank assembly 3408 includes a rotating proximal closing tube segment 3410 that is rotatably seated on a column member proximal 3420 which is rigidly coupled to a tool mounting plate 3502 of the tool mounting portion 3500. The proximal column member 3420 has a distal end 3422 which is coupled to an elongated channel portion 3522 of a surgical end actuator 3412 For example, in at least one embodiment, the elongated channel portion 3522 has a distal portion of the end 3523 that "hooks in" the distal end 3422 of the column member 3420. The elongated channel 3522 is configured to hold a cartridge surgical clamp 3534 on it. This modality can employ one of the various cutting instrument modalities presented in this document to break the tissue that is attached to the surgical end actuator 3412 and fire the clips on the 3534 clip cartridge in the broken tissue.
[000276] The surgical end actuator 3412 has a fixed claw 3524 that is pivotally coupled to the elongated channel 3522 by a pair of rotating pins 3525 that are received in corresponding openings 3529 in the elongated channel 3522. The fixed claw 3524 is moved between the open (Figure 64) and closed (Figures 65 to 67) positions by a distal closing tube segment 3430. A distal end portion 3432 of the distal closing tube segment 3430 includes an opening 3445 in which a flap 3527 in the jaw fixed 3524 is inserted to open and close the fixed claw 3524 as the distal closing tube segment 3430 moves axially with respect to it. In various embodiments, opening 3445 is shaped so that the closing tube segment 3430 is moved in the proximal direction, with the closing tube segment 3430 causing the fixed jaw 3524 to rotate to an open position. Additionally or alternatively, a spring (not shown) can be used to tilt the fixed claw 3524 to the open position.
[000277] As can be seen in Figures 64 to 67, the segment of the distal closing tube 3430 includes a pin 3442 extending from its distal end 3440 for threaded engagement with a variable inclination groove / thread 3414 formed in the distal end 3412 of the rotating proximal closing tube segment 3410. The variable inclination groove / thread 3414 has a distal section 3416 and a proximal section 3418. The inclination of the distal groove / thread section 3416 is less than the inclination of the proximal groove / thread 3418. As can also be seen in Figures 64 to 67, the segment of distal closing tube 3430 is restricted to axial movement in relation to the column member 3420 by an axial retaining pin 3450 which is received in a axial slot 3424 at the distal end of the column member 3420.
[000278] As indicated above, the fixed claw 2524 is opened and closed by rotating the proximal closing tube segment 3410. The threaded inclination arrangement allows the distal closing tube segment 3430 to be driven in the distal direction "DD "at a first speed or rate due to the engagement between pin 3442 and the groove / proximal thread section 3418. When pin 3442 engages in the distal groove / thread section 3416, the segment of distal closing tube 3430 will be triggered in the distal direction at a second speed or rate. Because the proximal thread / groove section 3418 is rougher than the distal thread / thread 3416, the first speed will be greater than the second speed.
[000279] In at least one embodiment, the tool mounting portion 3500 is configured to receive a corresponding first spinning motion from the robotic controller 1001 and converting that first spinning motion into a primary spinning motion to rotate the closing pipe segment proximal rotary 3410 around a longitudinal axis of the LT-LT tool. As can be seen in Figure 68, a proximal end 3460 of the proximal closing tube segment 3410 is swiveled and a cradle arrangement 3504 attached to a tool mounting plate 3502 of the tool mounting portion 3500. A rotation gear 3462 is formed on or attached to the proximal end 3460 of the closing tube segment 3410 for network engagement with a rotation drive assembly 3470 that is operationally supported on the tool mounting plate 3502. In at least one embodiment , a rotating drive gear 3472 is coupled to a first correspondent of the driven disks or elements 1304 on the adapter side of the tool mounting plate 3502 when the tool mounting portion 3500 is coupled to the tool retainer 1270. See Figures 26 and 68. The 3470 rotary drive assembly additionally comprises a 3474 rotary driven gear that is supported d and rotary mode on tool mounting plate 3502 in network engagement with rotation gear 3462 and rotation drive gear 3472. The application of a first rotary control movement from robotic controller 1001 through tool retainer 1270 and from the adapter 1240 to the corresponding driven element 1304 will thus cause the rotation drive gear rotation 3472 to be rotated by virtue of being operationally coupled thereto. The rotation of the rotation drive gear 3472 ultimately results in the rotation of the closing tube segment 3410 to open and close the fixed claw 3524, as described above.
[000280] As indicated above, the surgical end actuator 3412 employs a cutting instrument of the type and construction described above. Figure 68 illustrates a knife drive assembly form 3480 for axially advancing a knife bar 3492 that is attached to such a cutting instrument. One form of the knife drive assembly 3480 comprises a rotary drive gear 3482 that is coupled to a corresponding third of the driven disks or elements 1304 on the adapter side of the tool mounting plate 3502 when the tool drive portion 3500 is coupled to tool retainer 1270. See Figures 26 and 68. The knife drive assembly 3480 additionally comprises a first set of rotary driven gear 3484 that is pivotally supported on tool mounting plate 5200. The first set of gear swivel drive 3484 is in network engagement with a third set of swivel driven gear 3486 which is swiveled on tool mounting plate 3502 and which is in network engagement with a fourth set of swivel driven gear 3488 which is in engagement with a 3494 threaded portion of the 3490 drive rod assembly that it is coupled to the 3492 knife bar. Rotating the 3482 rotating drive gear in a second rotating direction will result in axial advancement of the 3490 drive rod assembly and 3492 knife bar in the distal "DD" direction. Conversely, rotation of the rotating drive gear 3482 in a secondary rotating direction (opposite the second rotating direction) will cause the drive shaft assembly 3490 and the knife bar 3492 to move in the proximal direction.
[000281] Figures 69 to 78 illustrate another modality of surgical tool 3600 of the present invention that can be used in connection with a robotic system 1000. As can be seen in Figure 69, tool 3600 includes an end actuator in the form of a disposable loading unit 3612. Various forms of disposable loading units that can be used in connection with the 3600 tool are presented, for example, in US Patent Application Publication No. 2009/0206131 A1, entitled "End Effector Arrangements For the Surgical Cutting and Stapling Instrument ", the description of which is hereby incorporated by reference in its entirety for reference.
[000282] In at least one form, the disposable loading unit 3612 includes a fixed claw assembly 3620 that is supported to pivotally travel relative to a carrier 3630 that operationally supports a staple cartridge 3640 therein. A 3650 mounting assembly is pivotally coupled to the 3630 cartridge carrier to allow the 3630 carrier to rotate around a pivot axis AA-AA with respect to a longitudinal axis of the LT-LT tool. Referring to Figure 74, mounting set 3650 includes upper and lower mounting portions 3652 and 3654. Each mounting portion includes a threaded hole 3656 on each side of it sized to receive threaded screws (not shown) to secure the end proximal of carrier 3630 to it. A pair of centrally located pivot members 3658 extends between the upper and lower mounting portions through a pair of coupling members 3660 that engage a distal end of a housing portion 3662. Coupling members 3660 each include , a proximal interlocking portion 3664 configured to be received in grooves 3666 formed at the proximal end of the housing portion 3662 to retain the mounting assembly 3650 and the housing portion 3662 in a longitudinally fixed position with respect to them.
[000283] In various forms, the housing portion 3662 of the disposable loading unit 3614 includes an upper housing half 3670 and a lower housing half 3672 contained in an outer compartment 3674. The proximal end of the housing half 3670 includes protrusions of engagement 3676 to releasably engage an elongated stem 3700 and an insertion tip 3678. The protrusions 3676 form a bayonet-type coupling with the distal end of the elongated stem 3700 which will be discussed further below. The housing halves 3670, 3672 define a channel 3674 for slidingly receiving the axial drive assembly 3680. A second hinge joint 3690 is dimensioned to be slidably positioned within a slot 3679 formed between the housing halves 3670 , 3672. A pair of purging plates 3691 is positioned adjacent to the distal end of housing portion 3662 adjacent to the distal end of axial drive assembly 3680 to prevent expansion out of drive assembly 3680 during hinge carrier 3630.
[000284] In various embodiments, the second hinge joint 3690 includes at least one elongated metal plate. Preferably, two or more metal plates are stacked to form the joint 3690. The proximal end of the hinge joint 3690 includes a hook portion 3692 configured to engage the first hinge joint 3710 that extends through the elongated stem 3700. The end distal of the second hinge joint 3690 includes a loop 3694 dimensioned to engage a projection formed in the mounting set 3650. The projection is displaced laterally from the pivot pin 3658 so that the linear movement of the second hinge joint 3690 causes the assembly 3650 mounting bracket rotate around 3658 pivot pins to articulate the 3630 carrier.
[000285] In various forms, an axial drive assembly 3680 includes an elongated drive beam 3682, including a distal working head 3684 and a proximal hitch section 3685. Drive beam 3682 can be constructed from a single sheet of material or, preferably, multiple sheets stacked. The hitch section 3685 includes a pair of hitch fingers which are sized and configured to engage a pair of corresponding retaining slots formed in the drive member 3686 in an assembled manner. The drive member 3686 includes a proximal hatch 3687 configured to receive the distal end 3722 of control stick 2720 (see Figure 78) when the proximal end of the disposable loading unit 3614 is engaged with the elongated stem 3700 of the surgical tool 3600.
[000286] Referring to Figures 69 and 76 to 78, to use the surgical tool 3600, a disposable loading unit 3612 is first attached to the distal end of the elongated stem 3700. It will be seen that the surgical tool 3600 can include a loading unit articulated or non-articulated disposable. To secure the disposable loading unit 3612 to the elongated stem 3700, the distal end 3722 of the control rod 3720 is inserted into the insertion tip 3678 of the disposable loading unit 3612 and the insertion tip 3678 is slid along the distal end of the elongated stem 3700 in the direction indicated by the arrow "A" in Figure 76, so that the hook portion 3692 of the second hinge joint 3690 slides into a channel 3702 on the elongated stem 3700. The protrusions 3676 will each be aligned in a respective channel (not shown) on the elongated rod 3700. When the hook portion 3692 engages the proximal wall 3704 of channel 3702, the disposable loading unit 3612 is rotated in the direction indicated by the arrow "B" in Figures 75 and 78 to move the hook portion 3692 of the second hinge joint 3690 for engagement with the finger 3712 of the first hinge joint 3710. The protrusions 3676 also form a "bay-type" coupling neta "in the annular channel 3703 on the elongated stem 3700. During the rotation of the loading unit 3612, the protrusions 3676 engage the cam surface 3732 (Figure 76) of the block plate 3730 to initially move the plate 3730 in the direction indicated by the arrow" C "in Figure 81 to lock the coupling member 3734 into the recess 3721 of the control rod 3720 to prevent longitudinal movement of the control rod 3720 while fixing the disposable loading unit 3612. During the final degree of rotation, the protrusions 3676 disengage from the cam surface 3732 to allow the plate lock 3730 to move in the direction indicated by the arrow "D" in Figures 75 and 78 behind the coupling member 3734 to again allow the longitudinal movement of the control rod 3720. Although the The fixation method described above reflects that the disposable loading unit 3612 is manipulated in relation to the elongated rod 3700, the person of ordinary skill in the art will find the disposable loading unit 3612 can be supported in a stationary position and the robotic system 1000 can manipulate the elongated rod portion 3700 in relation to the disposable loading unit 3612 to perform the coupling procedure described above.
[000287] Figure 79 illustrates another disposable loading unit 3612 'that is fixable in a bayonet arrangement on the elongated stem 3700' which is substantially identical to the stem 3700 except for the differences discussed below. As can be seen in Figure 79, the elongated stem 3700 'has slots 3705 that extend over at least a portion of it and that are configured to receive protrusions 3676 therein. In various embodiments, the disposable loading unit 3612 'includes arms 3677 extending from it that, prior to rotation of the disposable loading unit 3612', can be aligned or at least substantially aligned, with protrusions 3676 extending to from housing portion 3662. In at least one embodiment, arms 3677 and protrusions 3676 can be inserted into slots 3705 on elongated stem 3700 ', for example, when disposable loading unit 3612' is inserted into elongated stem 3700 ' . When the disposable loading unit 3612 'is rotated, the arms 3677 can be sufficiently confined within the slits 3705 so that the slits 3705 can hold them in position, while the lumps 3676 can be positioned so that they are not confined to the inside the slots 3705 and can be rotated in relation to the arms 3677. When rotated, the hook portion 3692 of the hinge joint 3690 is engaged with the first hinge joint 3710 which extends through the elongated stem 3700 '.
[000288] Other methods of coupling the disposable loading units to the end of the elongated rod can be employed. For example, as shown in Figures 80 and 81, the disposable loading unit 3612 "can include connector portion 3613, which can be configured to engage with connector portion 3740 of elongated stem 3700". In at least one embodiment, the connector portion 3613 can include at least one projection and / or groove that can be combined with at least one projection and / or groove of the connector portion 3740. In at least one such embodiment, the portions of connector may include cooperative dovetail portions. In various embodiments, the connector portions can be configured to be interlocked with each other and to prevent, or at least inhibit, the distal and / or proximal movement of the disposable loading unit 3612 ”along axis 3741. In at least one embodiment , the distal end of the axial drive assembly 3680 'can include opening 3681, which can be configured to receive projection 3721 extending from control rod 3720'. In various embodiments, such an arrangement may allow the disposable loading unit 3612 ”to be mounted to the elongated stem 3700 in a direction that is not collinear or parallel to the 3741 axis. Although not shown, the axial drive assembly 3680 'and the rod 3720 control panels can include any other suitable arrangement of projections and openings to connect them operationally to each other. Also in this modality, there is the first hinge joint 3710 that can be operationally engaged in the second hinge joint 3690.
[000289] As can be seen in Figures 69 and 82, the surgical tool 3600 includes a 3750 tool mounting portion. The 3750 tool mounting portion includes a 3751 tool mounting plate that is configured for attachment to the assembly tool drive 1010. The tool mounting portion has a 3752 transmission arrangement operably supported therein. In use, it may be desirable to rotate the disposable loading unit 3612 around the longitudinal axis of the tool defined by the 3700 elongated shank. In at least one embodiment, the transmission arrangement 3752 includes the rotary drive assembly 3753 which is configured to receive a corresponding rotary exit movement from the tool drive assembly 1010 of the robotic system 1000 and convert that rotary exit movement in a pivoting motion to rotate the 3700 elongated rod (and the disposable loading unit) l 3612) around the longitudinal axis of the LT-LT tool. As can be seen in Figure 82, a proximal end 3701 of the elongated shank 3700 is pivotally supported in a cradle arrangement 3754 that is attached to the tool mounting plate 3751 of the tool mounting portion 3750. A rotating gear 3755 is formed on or attached to the proximal end 3701 of the elongated stem 3700 for network engagement with the 3756 rotating gear assembly operably supported on the 3751 tool mounting plate. In at least one embodiment, a 3757 rotating drive gear actuatedly coupled to a first one corresponds to the driven disks or elements 1304 on the adapter side of the tool mounting plate 3751 when the tool mounting portion 3750 is coupled to the tool driving assembly 1010. The rotating drive assembly 3753 additionally comprises a rotary driven gear 3758 which is pivotally supported on the mounting plate tooling 3751 in network engagement with rotation gear 3755 and rotation drive gear 3757. The application of a first rotating output movement of the robotic system 1000 through the tool drive set 1010 to the corresponding driven element 1304 will cause thus, the rotation of the 3757 rotation drive gear due to being operationally coupled to it. The rotation of the 3757 rotary drive gear ultimately results in the rotation of the elongated rod 3700 (and the disposable loading unit 3612) around the longitudinal axis of the LT-LT tool (primary rotary movement).
[000290] As can be seen in Figure 82, the 3760 actuating rod assembly is coupled to a proximal end of the 2720 control rod. In several embodiments, the 2720 control rod is axially advanced in the distal and proximal directions by one 3762 knife drive / lock transmission. A 3762 knife drive / lock assembly shape comprises a rotary drive gear 3763 that is coupled to a second counter among rotating disks, elements or rotating body portions 1304 on the adapter side of the tool mounting plate 3751 when tool mounting portion 3750 is coupled to tool retainer 1270. Swivel driven gear 3763 is in network drive engagement with a gear train, usually shown as 3764. In at least one In this way, the 3764 gear train additionally comprises a first set of rotary driven gear 3765 which is rotatably supported on the 3751 tool mounting plate. The first 3765 rotary driven gear set is in network engagement with a second 3766 rotary driven gear set which is pivotally supported on the 3751 tool mounting plate and which is engaged in network with a third set of rotary driven gear 3767 which is in network engagement with a threaded portion 3768 of the drive rod assembly 3760. Rotation of the rotary drive gear 3763 in a second rotary direction will result in axial advance of the rod assembly drive 3760 and control stick 2720 in the distal direction "DD". Conversely, rotating the 3763 rotary drive gear in a secondary rotary direction that is opposite the second rotary direction will cause the 3760 drive rod assembly and 2720 control rod to move in the proximal direction. When the 2720 control rod moves in the distal direction, it activates the driving beam 3682 and the working head 3684 of the same distally through the surgical clamp cartridge 3640. As the working head 3684 is driven distally, the same engagement operationally the fixed claw 3620 to rotate it to a closed position.
[000291] The cartridge carrier 3630 can be selectively pivoted around the pivot axis AA-AA by applying axial pivot control movements to the first and second pivot joints 3710 and 3690. In various embodiments, the transmission arrangement 3752 includes , furthermore, a hinge drive 3770 that is operationally supported on the tool mounting plate 3751. More specifically and with reference to Figure 82, it can be seen that a proximal end portion 3772 of a hinge drive stem 3771 configured for operationally engaged with the first hinge joint 3710 extends through the rotating gear 3755 and is pivotally coupled to a 3774 shifter panel gear that is slidably attached to the 3751 tool mounting plate through slots 3775. The The articulation drive 3770 additionally comprises a displacement drive gear 3776 that is coupled to a te corresponding third of the driven disks or elements 1304 on the adapter side of the tool mounting plate 3751 when the tool mounting portion 3750 is coupled to the tool retainer 1270. The hinge drive assembly 3770 additionally comprises a displacer driven gear 3778 which is swiveled on the 3751 tool mounting plate in network engagement with the shifter drive gear 3776 and the shifter panel gear 3774. The application of a third rotary outward movement of the robotic system 1000 through the tool drive set 1010 to corresponding driven element 1304 will therefore cause the displacement drive gear 3776 to rotate because it is operationally coupled to it. The rotation of the shifter drive gear 3776 ultimately results in the axial movement of the shifter gear panel 3774 and the hinge drive stem 3771. The direction of the axial travel of the hinge drive stem 3771 depends on the direction in which the shifter drive gear 3776 is rotated by the robotic system 1000. Therefore, rotation of the shifter drive gear 3776 in a first rotating direction will result in the axial movement of the hinge drive stem 3771 in the proximal direction "PD" and will cause the cartridge carrier 3630 rotates in a first direction around the pivot axis AA-AA. Conversely, rotation of the shifter drive gear 3776 in a second pivoting direction (opposite the first pivoting direction) will result in axial movement of the 3771 pivoting drive rod in the distal "DD" direction to thereby cause the cartridge 3630 rotate around the pivot shaft AA-AA in the opposite direction.
[000292] Figure 83 illustrates yet another modality of surgical tool 3800 of the present invention that can be used with a robotic system 1000. As can be seen in Figure 83, surgical tool 3800 includes a 3812 surgical end actuator in the form of a 3814 endoscopic cutter that employs several cable-driven components. Various forms of cable-driven endoscopic cutters are described, for example, in US Patent No. 7,726,537, entitled "Surgical Clamp With Universal Articulation and Tissue Pre-Clamp" and in US Patent Application Publication No. US 2008 / 0308603A1 , entitled "Cable Driven Surgical Stapling and Cutting Instrument With Improved Cable Attachment Arrangements", whose descriptions are hereby incorporated by reference in their respective totalities. Such 3814 endoscopic cutters can be called a "disposable loading unit" because they are designed to be discarded after a single use. However, the various unique and innovative arrangements of the various embodiments of the present invention can also be employed in connection with cable actuated end actuators that are reusable.
[000293] As can be seen in Figure 83, In at least one form, the endoscopic cutter 3814 includes an elongated channel 3822 that operationally supports a 3834 surgical staple cartridge in it. A fixed claw 3824 is pivotally supported for movement relative to the surgical clamp cartridge 3834. The fixed claw 3824 has a cam surface 3825 that is configured to interact with a 3840 pre-clamping collar that is supported for axial movement in relation to it. The end actuator 3814 is coupled to an elongated stem assembly 3808 which is attached to a tool mounting portion 3900. In various embodiments, a 3850 lock cable is employed to move the pre-clamping collar 3840 distally over and over the cam surface 3825 for closing the fixed claw 3824 in relation to the surgical clamp cartridge 3834 and compressing the tissue between them. Preferably, the closing cable 3850 attaches to the pre-clamping collar 3840 at or near point 3841 and is fed through a passage in the fixed jaw 3824 (or under a proximal portion of the fixed jaw 3824) and fed proximally through of the stem 3808. The actuation of the closing cable 3850 in the proximal direction "PD" forces the pre-clamping collar 3840 distally against the cam surface 3825 to close the fixed claw 3824 in relation to the 3834 clamp cartridge assembly. A mechanism return, for example, a spring, cable system or the like, can be employed to return the 3840 pre-clamping collar to a pre-clamping orientation that reopens the 3824 fixed claw.
[000294] The 3808 elongated stem assembly can be cylindrical in shape and defines a 3811 channel that can be sized to receive a 3870 tube adapter. See Figure 84. In various embodiments, the 3870 tube adapter can be received sliding in friction fitting with the internal channel of the elongated stem 3808. The external surface of the 3870 tube adapter may also include at least one mechanical interface, for example, a cutout or notch 3871, oriented to be compatible with a corresponding mechanical interface, for example, a protrusion or detent that extends radially inward (not shown), arranged on the inner periphery of the inner channel 3811 to lock the 3870 tube adapter to the elongated stem 3808. In various embodiments, the distal end of the Tube adapter 3870 may include a pair of opposing flanges 3872a and 3872b that define a cavity to pivot a 3873 pivot block therein. Each flange 3872a and 3872b may include an opening 3874a and 3874b which is oriented to receive a pivot pin 3875 that extends through an in-pivot block opening 3873 to allow pivoting movement of pivot block 3873 around an axis that it is perpendicular to the longitudinal axis of the "LT-LT" tool. The channel 3822 can be formed with two upwardly extending flanges 3823a, 3823b which have openings therein, which are sized to receive a 3827 pivot pin. In turn, the 3875 pivot pin is mounted through block openings pivot plate 3873 to allow rotation of the 3814 surgical end actuator around the "Y" axis as needed during a given surgical procedure. Rotating pivot block 3873 around pin 3875 along the "Z" axis turns the surgical end actuator 3814 around the "Z" axis. See Figure 84. Other methods for attaching elongated channel 3822 to pivot block 3873 can be effectively employed without departing from the essence and scope of the present invention.
[000295] The 3834 surgical clamp cartridge can be assembled and assembled inside the elongated channel 3822 during the manufacturing or assembly process and marketed as part of the 3812 surgical end actuator, or the 3834 surgical clamp cartridge can be designed for Selective assembly inside the 3822 elongated channel as needed and sold separately, for example, as a single use, replaceable or replaceable replacement clamp cartridge. It is within the scope of the present description that the surgical end actuator 3812 can be pivotally, operationally or integrally attached, for example, to the distal end 3809 of the elongated stem assembly 3808 of a disposable surgical stapler. As is known, a used or worn disposable 3814 loading unit can be removed from the elongated stem assembly 3808 and replaced with an unused disposable unit. The endoscopic cutter 3814 may also preferably include an actuator, preferably a dynamic gripping member 3860, a frame 3862, as well as a clip propellers (not shown) and staples (not shown) since the cartridge does not worn or unused 3834 is mounted on the elongated 3822 channel. See Figure 84.
[000296] In various embodiments, the dynamic gripping member 3860 is associated with, for example, mounted on or resting on, or is connected to or integral to and / or resting behind the 3862 frame. It is designed that the dynamic gripping member 3860 can have cam wedges or cam surfaces fixed or integrally formed or can be pressed by a front distal surface thereof. In various embodiments, the dynamic gripping member 3860 may include an upper portion 3863 that has a transverse opening 3864 with a pin 3865 mountable or mounted thereto, a central support or upward extension 3866 and a substantially T-shaped bottom flange 3867 which cooperates to slide the dynamic gripping member 3860 slidingly along an ideal cutting path during the longitudinal movement, distal from the 3862 frame. The leading cutting edge 3868, here, knife blade 3869, is dimensioned to rest inside from slot 3835 of the 3834 staple cartridge assembly and separate the fabric once stapled. As used herein, the term "knife assembly" may include the aforementioned dynamic gripping member 3860, knife 3869 and frame 3862 or other knife / beam / frame drive arrangements and cutting instrument arrangements. In addition, the various embodiments of the present invention can be employed with the knife / cutting instrument mounting arrangements that can be fully supported on the 3834 staple cartridge or partially supported on the 3834 staple cartridge and elongated channel 3822 or fully supported within the elongated channel 3822.
[000297] In several embodiments, the dynamic gripping member 3860 can be operated in the proximal and distal directions by a 3870 cable drive assembly. In a non-limiting manner, the cable drive assembly comprises a pair of 3880 lead cables , 3882 and a 3884 trigger cable. Figures 85 and 86 illustrate cables 3880, 3882, 3884 in diagrammatic form. As can be seen in those Figures, a first feed cable 3880 is operationally supported by a first distal cable transition support 3885 which can comprise, for example, a pulley, rod, capstan shaft etc. which is attached to the distal end of the elongated channel 3822 and a first proximal cable transition support 3886 which may comprise, for example, a pulley, rod, capstan shaft etc. which is operationally supported by the elongated channel 3822. A distal end 3881 of the first lead cable 3880 is attached to the dynamic gripping assembly 3860. The second lead cable 3882 is operationally supported in a second distal cable transition 3887 which can , for example, comprise a pulley, pole, capstan shaft, etc. which is mounted at the distal end of the elongated channel 3822 and a second proximal cable transition support 3888 which can, for example, comprise a pulley, rod, capstan shaft etc. mounted on the proximal end of the elongated channel 3822. The proximal end 3883 of the second lead cable 3882 can be attached to the dynamic gripping assembly 3860. Also in these embodiments, an infinite firing cable 3884 is employed and seated on a support 3889 which can comprise a pulley, pole, capstan shaft etc. mounted inside the elongated stem 3808. In one embodiment, the retraction cable 3884 can be formed into a loop and coupled to a connector 3889 'which is fixedly attached to the first and second advance cables 3880, 3882.
[000298] Various non-limiting embodiments of the present invention include a 3920 cable drive transmission that is operationally supported on a 3902 tool mounting plate of the 3900 tool mounting portion. The 3900 tool mounting portion has an arrangement of 3904 electrical connection pins that are configured to interface with slots 1258 (Figure 25) on adapter 1240 '. Such an arrangement allows the robotic system 1000 to provide control signals to a 3910 control circuit of the 3800 tool. Although the interface is described in this document with reference to mechanical, electrical and magnetic coupling elements, it should be understood that a wide variety telemetry modalities can be used, including inductive, infrared coupling, or the like.
[000299] The 3910 control circuit is shown schematically in Figure 83. In one form or embodiment, the 3910 control circuit includes a power source in the form of a 3912 battery that is coupled to a switch powered by an activated solenoid / disabled 3914. In other embodiments, however, the power supply may comprise an alternating current source. The 3910 control circuit also includes a 3916 activated / deactivated solenoid that is coupled to a 3918 double pole switch to control the direction of rotation of the motor. Therefore, when the robotic system 1000 provides an appropriate control signal, switch 3914 will allow battery 3912 to supply power to the 3918 double pole switch. The robotic system 1000 will also provide an appropriate signal to the 3918 double pole switch to supply power to a 3922 displacement engine.
[000300] Turning to Figures 87 to 92, at least one modality of the 3920 cable drive transmission comprises a 3930 drive pulley which is operationally mounted on a 3932 drive rod which is attached to a driven element 1304 of the type and construction described above that are designed to interface with a corresponding drive element 1250 of adapter 1240. See Figures 25 and 90. Therefore, when the tool mounting portion 3900 is operationally coupled to the tool retainer 1270, the robotic system 1000 can rotate the drive pulley 3930 in a desired direction. A first drive member or drive belt 3934 drives the drive pulley 3930 and the second drive shaft 3936 in a rotating manner on a fork of the displacer 3940. The fork of the displacer 3940 is operationally coupled to the drive motor. displacement 3922, so that rotation of stem 3923 of displacement motor 3922 in a first direction displaces the displacement fork in a first direction "FD" and rotation of the displacement motor 3923 in a second direction displaces the displacement fork 3940 in a second direction "SD". Other embodiments of the present invention may employ a shifter solenoid arrangement to move the shifter yoke in said first and second directions.
[000301] As can be seen in Figures 87 to 90, a 3950 closing drive gear is mounted on a second 3936 drive rod and is configured to selectively merge with the closing drive set, generally called 3951. Likewise, a 3960 trigger drive gear is also mounted to the second 3936 drive shaft and is configured to selectively merge with a general trigger drive assembly called 3961. Rotating the second 3936 drive shaft causes the closing drive gear 3950 and the trigger drive gear 3960 rotate. In a non-limiting embodiment, the 3951 closing drive assembly comprises a 3952 driven closing gear that is coupled to a first 3954 closing pulley that is pivotally supported on a third 3956 driving rod. The 3850 closing cable is received in a triggered manner on the first closing pulley 3954 so that the rotation of the driven closing gear 3952 activates the closing cable 3850. Likewise, the triggering assembly 3961 comprises a triggering drive 3962 that is coupled to a first firing pulley 3964 which is pivotally supported on the third driving rod 3956. The first and second driving pulleys 3954 and 3964 are independently rotated on the third driving rod 3956. The firing cable 3884 is received in a triggered manner at the firing pulley 3964, so that the rotation of the driven firing gear 3962 drives the firing cable 3884.
[000302] In addition, in several embodiments, the 3920 cable drive transmission also includes a 3970 brake assembly. In at least one embodiment, for example, the 3970 brake assembly includes a 3972 closing brake comprising an arm spring 3973 which is attached to a portion of the 3971 transmission housing. The 3972 lock brake has a 3974 gear pin that is sized to engage the teeth of the 3952 driven lock gear, as will be discussed in more detail below. The brake assembly 3970 also includes a trigger brake 3976 which comprises a spring arm 3977 which is attached to another portion of the transmission housing 3971. The trigger brake 3976 has a gear pin 3978 which is dimensioned to engage the teeth of the 3962 driven firing gear.
[000303] At least one modality of the 3800 surgical tool can be used as follows. The tool mounting portion 3900 is operably coupled to the 1240 interface of the robotic system 1000. The controller or control unit of the robotic system is operated to locate the fabric to be cut and stapled between the open fixed jaw 3824 and the cartridge clamp 3834. When in that starting position, the brake assembly 3970 has locked the driven closing gear 3952 and the driven trigger gear 3962 so that they cannot rotate. That is, as shown in Figure 88, gear pin 3974 is in locking engagement with the driven gear 3952 and gear pin 3978 is in locking engagement with the triggering gear driven 3962. Once the actuator end cap 3814 has been properly positioned, controller 1001 of robotic system 1000 will provide a control signal to displacement motor 3922 (or displacer solenoid) to move displacement fork 3940 in the first direction. As the shifter fork 3940 is moved in the first direction, the closing drive gear 3950 moves the gear pin 3974 out of engagement with the driven closing gear 3952, as it moves to network engagement with the driven gear 3952 As can be seen in Figure 87, when in that position, the gear pin 3978 remains in locking engagement with the triggering gear activated 3962 to prevent the triggering system from acting. Subsequently, the robotic controller 1001 provides a first rotating actuation motion to the drive pulley 3930 through the interface between the driven element 1304 and the corresponding components of the tool retainer 1240. As the drive pulley 3930 is rotated in the first direction, the cable closure 3850 is rotated to drive the pre-clamping collar 3840 to the closing engagement with the cam surface 3825 of the fixed claw 3824 to move it to the closed position, thereby gripping the target fabric between the fixed claw 3824 and the staple cartridge 3834. See Figure 83. Once the fixed claw 3824 has been moved to the closed position, the robotic controller 1001 for applying the first rotary motion to the drive pulley 3930. Subsequently, the robotic controller 1001 can start the firing process by sending another control signal to the 3922 displacement motor (or displacer solenoid) to displacer moves in the second "SD" direction, as shown in Figure 94. As the shifter fork 3940 is moved in the second direction, the trigger drive 3960 moves gear pin 3978 out of engagement with the trigger gear driven 3962 as it moves to the network coupling with the triggering gear driven 3962. As can be seen in Figure 89, when in that position, the gear pin 3974 remains in locking engagement with the closing gear driven 3952 to avoid the activation of the closing system. Thereafter, the robotic controller 1001 is activated to provide the first rotary actuation movement to the drive pulley 3930 through the interface between the driven element 1304 and the corresponding components of the tool retainer 1240. As the drive pulley 3930 is rotated in the first direction , the firing cable 3884 is rotated to drive the dynamic gripping member 3860 in the distal "DD" direction, thus firing the clamps and cutting the gripped tissue on the 3814 end actuator. Since the robotic system 1000 determines that the 3860 dynamic gripping member reached its most distal position - either through sensors or by monitoring the amount of swiveling input applied to the 3930 drive pulley, controller 1001 can then apply a second rotary motion to the 3930 drive pulley to rotate the closing cable 3850 in an opposite direction to cause the dynamic gripping member 3860 to retract into the proximal direction "PD". Once the dynamic gripping member has been retracted to the starting position, the application of the second pivoting motion to the 3930 drive pulley is stopped. Thereafter, the 3922 displacement motor (or displacer solenoid) is powered to move the 3940 displacement fork to the closed position (Figure 92.). Since the closing drive gear 3950 is in network engagement with the driven closing gear 3952, the robotic controller 1001 can again apply the second rotary motion to the drive pulley 3930. The rotation of the drive pulley 3930 on the the second direction causes the closing cable 3850 to retract the pre-clamping collar 3840 out of engagement with the cam surface 3825 of the fixed claw 3824 to allow the fixed claw 3824 to move into an open position (by a spring or other means) to release the stapled tissue from the 3814 surgical end actuator.
[000304] Figure 93 illustrates a surgical tool 4000 employing a 4092 gear-driven firing bar, as shown in Figures 94 to 96. This embodiment includes an elongated stem assembly 4008 that extends from a mounting portion of tool 4100. The tool mounting portion 4100 includes a tool mounting plate 4102 that operationally supports a transmission arrangement 4103 thereon. The elongated stem assembly 4008 includes a rotating proximal closing tube 4010 that is rotatably seated over a proximal column member 4020 that is rigidly coupled to the tool mounting plate 4102. The proximal column member 4020 has one end distal which is coupled to an elongated channel portion 4022 of a surgical end actuator 4012. Surgical effector 4012 may be substantially similar to the surgical end actuator 3412 described above. In addition, the fixed claw 4024 of the surgical end actuator 4012 can be opened and closed by a distal closing tube 4030 that interfaces operably with the proximal closing tube 4010. The distal closing tube 4030 is identical to the closing tube distal 3430 described above. Similarly, the proximal closing tube 4010 is identical to the proximal closing tube segment 3410 described above.
[000305] The fixed claw 4024 is opened and closed by rotating the proximal closing tube 4010 in the manner described above in relation to the distal closing tube 3410. In at least one embodiment, the transmission arrangement comprises a closing transmission, in general designated as 4011. As will be further discussed below, the 4011 closing transmission is configured to receive a corresponding first spinning motion from the robotic system 1000 and converting that first spinning motion into a primary spinning motion to rotate the rotating proximal closing tube 4010 around the longitudinal axis of the LT-LT tool. As can be seen in Figure 96, a proximal end 4060 of proximal closing tube 4010 is pivotally supported within a cradle arrangement 4104 that is attached to a tool mounting plate 4102 of the tool mounting portion 4100 A 4062 rotation gear is formed on or attached to the proximal end 4060 of the closing pipe segment 4010 for network engagement with the 4070 rotation drive assembly that is operationally supported on the tool mounting plate 4102. At least one embodiment, a 4072 rotating drive gear is coupled to a first correspondent of the driven disks or elements 1304 on the adapter side of the tool mounting plate 4102 when the tool mounting portion 4100 is coupled to the tool retainer 1270. See Figures 26 and 96. The 4070 rotary drive assembly additionally comprises a 4074 rotary driven gear that is pivotally supported on the tool mounting plate 4102 in network engagement with the 4062 rotation gear and the 4072 rotation drive gear. The application of a first rotary control movement from the robotic system 1000 through the tool 1270 and adapter 1240 to the corresponding driven element 1304 will thus cause the rotation drive gear rotation 4072 to rotate because it is operationally coupled to it. The rotation of the rotation drive gear 4072 finally results in the rotation of the closing pipe segment 4010 to open and close the fixed claw 4024, as described above.
[000306] As indicated above, end actuator 4012 employs a cutting element 3860, as shown in Figures 94 and 95. In at least one non-limiting embodiment, the transmission arrangement 4103 additionally comprises a knife drive transmission that includes the knife drive set 4080. Figure 96 illustrates one of the knife drive set 4080 to axially advance the knife bar 4092 which is attached to such cutting element with the use of cables, as described above in relation to the tool surgical 3800. In particular, knife bar 4092 replaces firing cable 3884 used in a 3800 surgical tool mode. One form of knife drive set 4080 comprises a rotary drive gear 4082 that is coupled to a second correspondent among the driven disks or elements 1304 on the adapter side of the tool mounting plate 4102 when the tool mounting portion 4100 and it is coupled to the tool holder 1270. See Figures 26 and 96. The knife drive set 4080 additionally comprises a first set of rotary driven gear 4084 that is pivotally supported on the tool mounting plate 4102. The first set of swivel driven gear 4084 is in network engagement with a third set of swivel driven gear 4086 which is swiveled on tool mounting plate 4102 and which is in network engagement with a fourth set of swivel driven gear 4088 which is in network engagement with a 4094 threaded portion of the 4090 drive rod assembly that is coupled to the 4092 knife bar. Rotation of the 4082 rotary drive gear in a second rotational direction will result in axial advance of the 4090 drive rod assembly and bar of knife 4092 in the distal direction "DD". Conversely, rotation of the rotating drive gear 4082 in a secondary rotating direction (opposite the second rotating direction) will cause the drive shaft assembly 4090 and the knife bar 4092 to move in the proximal direction. The movement of the firing bar 4092 in the proximal direction "PD" will activate the cutting element 3860 in the distal direction "DD". Conversely, the movement of the firing bar 4092 in the distal direction "DD" will result in the movement of the cutting element 3860 in the proximal direction "PD".
[000307] Figures 97 to 103 illustrate yet another surgical tool 5000 that can be effectively employed in connection with a robotic system 1000. In various forms, the surgical tool 5000 includes a 5012 surgical end actuator in the form of a surgical stapling instrument which includes an elongated 5020 channel and a pivotally translatable claw member, such as a fixed 5070 claw, which are kept at a spacing that ensures effective clamping and tearing of the tissue attached to the 5012 surgical end actuator. As can be seen in Figure 99, the elongated channel 5020 can be substantially U-shaped in cross section and can be manufactured from, for example, titanium, 203 stainless steel, 304 stainless steel, 416 stainless steel, 17-4 stainless steel, steel 17-7 stainless, 6061 or 7075 aluminum, chrome steel, ceramic etc. A substantially U-shaped metal channel container 5022 may be supported at the bottom of the elongated channel 5020, as shown.
[000308] Various modalities include an actuating member in the form of the frame assembly 5030 that is operationally supported on the surgical end actuator 5012 and axially movable therein between a start position and an end position in response to control movements applied to it. In some forms, the metal channel container 5022 has a centrally arranged slot 5024 therein to movably accommodate a base portion 5032 of the frame assembly 5030. The base portion 5032 includes a foot portion 5034 that is sized to be slidably received in a slot 5021 in the elongated channel 5020. See Figure 104. As can be seen in Figures 98, 99, 102 and 103, the base portion 5032 of the frame assembly 5030 includes a threaded hole that extends axially 5036 which is configured to be received in a threaded manner on a 5130 threaded drive rod, as will be discussed in more detail below. In addition, the frame assembly 5030 includes a vertical support portion 5038 that supports a tissue cutting blade or tissue cutting instrument 5040. The vertical support portion 5038 ends at a top portion 5042 that has a pair of flap fins. 5044 laterally extending retention projecting from it. As shown in Figure 99, the fins 5044 are positioned to be received inside the corresponding slots 5072 in the fixed claw 5070. The fins 5044 and the foot 5034 serve to hold the fixed claw 5070 in a desired spaced closed position according to the frame set 5030 is driven distally through the tissue attached inside the 5014 surgical end actuator. As can also be seen in Figures 101 and 103, the frame set 5030 also includes a drive set that can be activated reciprocally or sequentially 5050 to drive the clamp thrusters towards the closed fixed jaw 5070.
[000309] More specifically and with reference to Figures 99 and 100, the elongated channel 5020 is configured to operably support a 5080 surgical staple cartridge therein. In at least one form, the surgical clip cartridge 5080 comprises a body portion 5082 that can be manufactured from, for example, Vectra, nylon (6/6 or 6/12) and includes a centrally arranged slot 5084 to accommodate the 5038 vertical support portion of the 5030 frame assembly. See Figure 99. These materials could also be filled with 10% to 40% glass, carbon or mineral fill. The surgical clamp cartridge 5080 further includes a plurality of cavities 5086 to movably support lines or rows of propellants that support the clamp 5088 therein. Cavities 5086 can be arranged in longitudinally spaced lines or rows 5090, 5092, 5094, 5096. For example, rows 5090 can be referred to herein as first outer end rows. Rows 5092 can be referred to in this document as first rows of inner end. Rows 5094 can be called second rows of inner end and rows 5096 can be called second rows of outer end. The first inner end row 5090 and the first outer end row 5092 are located on a first side side of the longitudinal slot 5084 and the second inner end row 5094 and the second outer end row 5096 are located on a second side side of the longitudinal slot 5084. The first 5088 clamp thrusters in the first inner end row 5092 are misaligned with respect to the first 5088 clamp thrusters in the first outer end row 5090. Similarly, the second 5088 clamp thrusters in the second outer end row 5096 are misaligned with respect to the second 5088 thrusters in the second inner end row 5094. Each thruster 5088 operationally supports a surgical clamp 5098 therein.
[000310] In various embodiments, the reciprocally activable or activable 5050 drive assembly includes a pair of 5052 outer end drivers and a pair of 5054 inner end drivers that are each attached to a common 5056 rod that is mounted rotatingly at the base 5032 of the frame assembly 5030. The outer end drivers 5052 are oriented to sequentially or reciprocally engage a corresponding plurality of outer end activation cavities 5026 provided in the 5022 channel vessel. inner-end actuators 5054 are directed to sequentially or reciprocally engage a corresponding plurality of inner-end activation cavities 5028 provided in the 5022 channel container. Inner-end activation cavities 5028 are arranged in an offset relationship to the activation cavities adjacent outer end plates 5026. See Figure 100. As also as can be seen in Figures 100 and 102, in at least one embodiment, the frame assembly 5030 also includes distal wedge segments 5060 and intermediate wedge segments 5062 located on each side of the orifice 5036 to engage the 5088 thrusters as the 5030 frame assembly is driven distally in the "DD" distal direction. As indicated above, the frame assembly 5030 is threadedly received into a threaded portion 5132 of a 5130 drive rod that is pivotally supported on the 5012 end actuator. In various embodiments, for example, the 5130 drive rod has a distal end 5134 that is supported on a distal bearing 5136 mounted on the 5012 surgical end actuator. See Figures 99 and 100.
[000311] In various embodiments, the surgical end actuator 5012 is coupled to a tool mounting portion 5200 by an elongated shank assembly 5108. In at least one embodiment, the tool mounting portion 5200 operationally supports an arrangement transmission in general designated as 5204 which is configured to receive rotary outward movements from the robotic system. The elongated stem assembly 5108 includes an outer closing tube 5110 that is rotatable and axially movable on a column member 5120 that is rigidly coupled to a tool mounting plate 5201 of the tool mounting portion 5200. The column member 5120 it also has a distal end 5122 which is coupled to the elongated channel portion 5020 of the surgical end actuator 5012.
[000312] In use, it may be desirable to rotate the surgical end actuator 5012 around a longitudinal axis of the LT-LT tool defined by the elongated shank assembly 5008. In various embodiments, the 5110 outer closure tube has a 5112 proximal end which is pivotally supported on the tool mounting plate 5201 of the tool drive portion 5200 by a front support cradle 5203. The proximal end 5112 of the outer closure tube 5110 is configured to interface operationally with a portion of rotation transmission 5206 of the transmission arrangement 5204. In various embodiments, the proximal end 5112 of the outer closure tube 5110 is also supported on a closure frame 5140 which is also movably supported on the tool mounting plate 5201. One segment of the closing gear tube 5114 is formed at the proximal end 5112 of the external closing tube 5110 for network with the 5150 rotary drive assembly of the 5206 rotary drive. As shown in Figure 97, the 5150 rotary gear assembly, in at least one embodiment, comprises a 5152 rotary drive gear that is coupled to a first correspondent of one of the driven disks or elements 1304 on the adapter side 1307 of the tool mounting plate 5201 when the tool mounting portion 5200 is coupled to the tool holder 1270. The rotary drive assembly 5150 additionally comprises a driven gear swivel 5154 which is swiveled on tool mounting plate 5201 in network engagement with the segment of the closing gear tube 5114 and the rotating drive gear 5152. The application of a first rotary movement from the robotic system 1000 through tool retainer 1270 and adapter 1240 to the corresponding driven element 1304 cause thus, the rotation of the rotating drive gear 5152. The rotation of the rotating drive gear 5152 ultimately results in the rotation of the elongated stem assembly 5108 (and end actuator 5012) around the longitudinal axis of the LT-LT tool (represented by the "R" arrow in Figure 97).
[000313] The closing of the fixed claw 5070 in relation to the surgical clamp cartridge 5080 is carried out by axially moving the external closing tube 5110 in the distal direction "DD". Such axial movement of the outer closing tube 5110 can be carried out by a closing transmission portion 5144 of the transmission arrangement 5204. As indicated above, in various embodiments, the proximal end 5112 of the outer closing tube 5110 is supported by the closing frame 5140 that allows the proximal end 5112 to rotate in relation to it, and still travel axially with the closing frame 5140. In particular, as can be seen in Figure 97, the closing frame 5140 has a vertical flap 5141 that extends to the interior of the radial groove 5115 in the proximal end portion 5112 of the external closing tube 5110. Furthermore, as described above, the 5140 closing frame is slidably mounted to the tool mounting plate 5201. In various embodiments, the frame closing mechanism 5140 has a vertical portion 5142 that has a closing panel gear 5143 formed therein. The closing panel gear 5143 is configured to engage the coupling with the closing transmission 5144.
[000314] In various forms, the closing transmission 5144 includes a closing sprocket gear 5145 that is coupled to a corresponding second of the driven disks or elements 1304 on the adapter side 1307 of the tool mounting plate 5201. Therefore, the application of a second rotary control movement from the robotic system 1000 through the tool retainer 1270 and the adapter 1240 to the corresponding second driven element 1304 will cause the closing gear wheel 5145 to rotate when the interface 1230 is coupled to the portion mounting tool 5200. The closing transmission 5144 also includes a set of driven closing gear 5146 that is supported in a network engagement with the closing gear wheel 5145 and the closing panel gear 5143. Therefore, the application of a second rotary control movement from the robotic system 1000 through the tool retainer 1 270 and the adapter 1240 to the corresponding second driven element 1304 will cause the closing sprocket gear 5145 to rotate and, finally, drive the closing frame 5140 and the outer closing tube 5110 axially. The axial direction in which the closing tube 5110 moves ultimately depends on the direction in which the second driven element 1304 is rotated. For example, in response to a rotary closing movement received from the robotic system 1000, the closing frame 5140 will be activated in the distal direction "DD" and, finally, the external closing tube 5110 will be activated in the distal direction as well. The outer closure tube 5110 has an opening 5117 at the distal end 5116 which is configured for engagement with a tab 5071 on the fixed jaw 5070 in the manner described above. As the external closing tube 5110 is driven distally, the proximal end 5116 of the closing tube 5110 will contact the fixed claw 5070 and turn it closed. By applying a rotary "opening" movement from the robotic system 1000, the closing frame 5140 and the external closing tube 5110 will be activated in the proximal direction "PD" and will rotate the fixed claw 5070 to the open position in the same way. described above.
[000315] In at least one embodiment, the driving rod 5130 has a proximal end 5137 which has a proximal rod gear 5138 attached to it. The proximal rod gear 5138 is supported in network engagement with a distal drive gear 5162 attached to a 5160 swivel drive bar that is swiveled with the 5120 column member. The rotation of the 5160 swivel drive bar and, finally, the 5130 rotary drive rod is controlled by a 5207 rotary knife transmission comprising a portion of the transmission arrangement 5204 held on the 5210 tool mounting plate. In various embodiments, the 5207 rotary knife transmission comprises a 5170 rotary knife drive that is operationally supported on tool mounting plate 5201. In several embodiments, the 5170 knife drive system includes a 5172 rotary drive gear that is coupled to a corresponding third of the 1304 disks or driven elements on the adapter side of tool mounting plate 5201 when tool drive portion 520 0 is coupled to the tool retainer 1270. The knife drive system 5170 additionally comprises a first rotary driven gear 5174 which is pivotally supported on the tool mounting plate 5201 in network engagement with a second rotary driven gear 5176 and the rotary drive gear 5172. The second rotary drive gear 5176 is coupled to a proximal end portion 5164 of the rotary drive bar 5160.
[000316] Rotating the 5172 rotary drive gear in a first rotating direction will result in the rotation of the 5160 rotary drive bar and the 5130 rotary drive rod in a first direction. Conversely, rotation of the rotating drive gear 5172 in a second rotating direction (opposite the first rotating direction) will cause the rotary drive bar 5160 and the rotary drive rod 5130 to rotate in a second direction. 2400. Therefore, the rotation of the drive rod 2440 results in the rotation of the cylindrical socket of the drive 2400.
[000317] A method for operating the 5000 surgical tool will now be described. The drive of the tool 5200 is operationally coupled to the interface 1240 of the robotic system 1000. The controller 1001 of the robotic system 1000 is operated to locate the tissue to be cut and stapled between the open fixed jaw 5070 and the surgical staple cartridge 5080. Once the surgical end actuator 5012 has been positioned by the robotic system 1000 so that the target tissue is positioned between the fixed jaw 5070 and the surgical clamp cartridge 5080, the controller 1001 of the robotic system 1000 can be activated to apply the second pivoting output movement to the second driven element 1304 coupled to the closing sprocket gear 5145 to drive the closing frame 5140 and the outer closing tube 5110 axially in the distal direction to rotate the fixed claw 5070 closed in the manner described above. Since the robotic controller 1001 determines that the fixed claw 5070 has been closed by, for example, sensors on the surgical end actuator 5012 and / or the tool drive portion 5200, the robotic controller system 1001 can provide the surgeon with an indication which means closing the fixed jaw. Such indication can be, for example, in the form of an audible light and / or sound, tactile feedback in the control members, etc. Then, the surgeon can start the firing process. In alternative modes, however, the robotic controller 1001 can automatically start the firing process.
[000318] To start the firing process, the robotic controller applies a third rotary output movement to the third disk or driven element 1304 coupled to the rotary drive gear 5172. Rotation of the rotary drive gear 5172 results in the rotation of the actuation bar 5160 swivel and 5130 swivel drive rod in the manner described above. The firing and formation of surgical clamps 5098 can be better understood from the reference to Figures 98, 100 and 101. As the frame set 5030 is activated in the distal direction "DD" through the surgical clamp cartridge 5080, the segments distal wedge 5060 first contact the 5088 clamp thrusters and begin to move them towards the closed 5070 fixed jaw. As the 5030 frame assembly continues to move distally, the 5052 outer end drivers will fall into the corresponding activation cavity 5026 in the channel container 5022. The opposite end of each 5052 outer end driver will then come in contact with the corresponding outer end thruster 5088 that moved the intermediate and distal wedge segments up 5060, 5062 The additional distal movement of the 5030 frame assembly causes the 5052 outer end drives to rotate and drive the corresponding 5088 thrusters towards the fixed claw 5070 to cause the clamps 5098 sustained therein to be formed as they are driven into the fixed claw 5070. It will be understood that as the frame assembly 5030 moves distally, the knife blade 5040 cuts through the fabric that is clamped between the fixed jaw and the staple cartridge. Because the 5054 inner end drivers and the 5052 outer end drivers are fixed to the same rod 5056 and the 5054 inner end drivers are radially displaced from the 5052 outer end drivers on the 5056 rod, as the 5052 outer end drivers are driving their corresponding thrusters 5088 towards the fixed jaw 5070, the 5054 inner end drives fall into their next corresponding activation cavity 5028 to cause the corresponding 5088 inner jaw thrusters to rotate or reciprocate towards the closed 5070 fixed jaw the same way. Therefore, the laterally corresponding outer end clamps 5098 on each side of the centrally arranged slot 5084 are formed simultaneously and the laterally corresponding inner end clamps 5098 on each side of the 5084 slot are formed simultaneously as the frame assembly 5030 is driven distally. . Once the robotic controller 1001 determines that the 5030 frame assembly has reached its most distal position - either through sensors or by monitoring the amount of rotary input applied to the 5130 drive rod and / or the 5160 rotary drive bar, the controller 1001 can then apply a third pivoting output movement to drive stem 5130 to rotate drive stem 5130 in an opposite direction to retract the frame assembly 5030 back to its starting position. Once the frame assembly 5030 has been retracted to the starting position (as signaled by sensors on the end actuator 5012 and / or the actuation of the tool portion 5200), the application of the second pivoting motion to the 5130 drive rod is interrupted. Subsequently, the surgeon can manually activate the fixed jaw opening process or it can be automatically initiated by the robotic controller 1001. To open the 5070 fixed jaw, the second rotating output movement is applied to the 5145 closing sprocket gear to drive the closing frame 5140 and external closing tube 5110 axially in the proximal direction. As the closing tube 5110 moves proximally, the opening 5117 at the distal end 5116 of the closing tube 5110 comes in contact with the flap 5071 on the fixed claw 5070 to rotate the fixed claw 5070 to the open position. A spring can also be used to tilt the fixed claw 5070 to the open position when the closing tube 5116 has been returned to the starting position. Again, the sensors on the surgical end actuator 5012 and / or the tool mounting portion 5200 can provide the robotic controller 1001 with a signal indicating that the fixed claw 5070 is now open. Thereafter, the 5012 surgical end actuator can be removed from the surgical site.
[000319] Figures 104 to 109 diagrammatically show the sequential firing of clamps on a surgical tool set 5000 'which is substantially similar to the surgical tool set 5000 described above. In this embodiment, the inner and outer end actuators 5052 ', 5054' have a cam-like shape with a 5053 cam surface and a 5055 actuator protrusion, as shown in Figures 104 to 110. The 5052 ', 5054' actuators are seated on the same rod 5056 'which is rotatably supported by the frame assembly 5030'. In this embodiment, the frame assembly 5030 'has distal wedge segments 5060' to engage the 5088 thrusters. Figure 104 illustrates an initial position of two outer or inner end actuators 5052 ', 5054', depending on the frame assembly 5030 ' it is activated in the distal direction "DD". As can be seen in that Figure, the 5088a thruster advanced the 5060 'wedge segment and was brought into contact with the 5052', 5054 'thruster. The additional travel of the frame assembly 5030 'in the distal direction causes the driver 5052', 5054 'to rotate in the "P" direction (Figure 105) until the actuator portion 5055 contacts the end wall 5029a of the cavity of activation 5026, 5028, as shown in Figure 111. Continued advancement of the frame assembly 5030 'in the distal direction "DD" causes the driver 5052', 5054 'to rotate in the "D" direction, as shown in Figure 107. As the driver 5052 ', 5054' rotates, the thruster 5088a travels with the cam surface 5053 to the final vertical position shown in Figure 108. When the 5088a thruster reaches the final vertical position shown in Figures 108 and 109, the clamp (not shown) supported on it was activated on the clamp forming surface of the fixed claw to form the clamp.
[000320] Figures 111 to 116 illustrate a 5312 surgical end actuator that can be employed, for example, in connection with the tool mounting portion 1300 and stem 2008 described in detail above. In various forms, the surgical end actuator 5312 includes an elongated channel 5322 that is constructed as described above to support a surgical clamp cartridge 5330 therein. The clamp cartridge 5330 comprises a body portion 5332 that includes a centrally arranged slot 5334 to accommodate a vertical support portion 5386 of the frame assembly 5380. See Figures 111 to 113. The clamp cartridge body portion 5332 further includes , a plurality of cavities 5336 for movably supporting clamp support propellers 5350 therein. Cavities 5336 can be arranged in spaced rows that extend longitudinally 5340, 5342, 5344, 5346. Rows 5340, 5342 are located on one side of longitudinal slot 5334 and rows 5344, 5346 are located on the other side of longitudinal slot 5334. In at least one embodiment, the 5350 thrusters are configured to hold two 5352 surgical clamps on them. In particular, each thruster 5350 located on the side of the elongated slot 5334 supports a clamp 5352 in row 5340 and a clamp 5352 in row 5342 in an offset orientation. Similarly, each thruster 5350 located on the other side of the elongated slit 5334 holds a surgical clamp 5352 in row 5344 and another surgical clamp 5352 in row 5346 in an misaligned orientation. Therefore, each 5350 propellant holds two 5352 surgical clamps.
[000321] As can be seen further in Figures 111, 112, the surgical clamp cartridge 5330 includes a plurality of rotary actuators 5360. More particularly, the rotary actuators 5360 on one side of the elongated slot 5334 are arranged in a single line 5370 and correspond to the 5350 thrusters on lines 5340, 5342. In addition, the rotary drives 5360 on the other side of the elongated slot 5334 are arranged in a single line 5372 and correspond to the 5350 thrusters on lines 5344, 5346. As can be seen in Figure 116, each rotary actuator 5360 is pivotally supported within the 5332 clamp cartridge body. More particularly, each rotary actuator 5360 is pivotally received on a 5362 rotary actuator rod. Each 5360 actuator has an arched ramp portion 5364 formed it is configured to engage a 5354 arched lower surface formed on each 5350 thruster. See Figure 116. Ad furthermore, each actuator 5360 has a lower support portion 5366 extending from it to slide the 5360 thruster in channel 5322. Each actuator 5360 has a downward extending actuating rod 5368 that is configured for the engage with the 5380 frame assembly.
[000322] As can be seen in Figure 113, in at least one embodiment, the frame assembly 5380 includes a base portion 5382 that has a foot portion 5384 that is sized to be slidably received in a slot 5333 in the channel 5322. See Figure 111. Frame assembly 5380 includes a vertical support portion 5386 that supports a tissue cutting blade or 5388 tissue cutting instrument. The vertical support portion 5386 ends at a top portion 5390 that it has a pair of retaining fins that extend laterally 5392 and protrude from it. The 5392 fins are positioned to be received inside the corresponding slots (not shown) in the fixed jaw (not shown). As in the modalities described above, the fins 5392 and the foot portion 5384 serve to retain the fixed claw (not shown) in a desired spaced closed position as the frame assembly 5380 is distally driven through the fabric gripped inside the end actuator surgical 5312. The vertical support portion 5386 is configured for attachment to a 2200 knife bar (Figure 32). The frame assembly 5380 also has an actuator plate that extends horizontally 5394 that is shaped to engage the engagement with each of the 5368 actuating rods on the 5360 thrusters.
[000323] The operation of the 5312 surgical end actuator will now be explained with reference to Figures 111 and 112. As the frame assembly 5380 is activated in the distal direction "DD" through the 5330 clamp cartridge, the 5394 actuator plate sequentially contacts the 5368 actuating rods on the 5360 thrusters. As the 5380 frame assembly continues to move distally, a 5394 actuator plate comes in contact, sequentially, with the 5368 actuator rods of the 5360 actuators in each side of the elongated slit 5334. This action causes the 5360 actuators to rotate from a first unactivated position to an actuated portion in which the 5350 thrusters are driven towards the fixed fixed jaw. As the 5350 thrusters are driven towards the fixed jaw, the 5352 surgical clamps are triggered to contact the underside of the fixed jaw. Once the robotic system 1000 determines that the frame assembly 5080 has reached its most distal position through sensors or other means, the control system of the robotic system 1000 can then retract the knife bar and frame assembly 5380 from returns to a starting position. Thereafter, the robotic control system can then activate the procedure to return the fixed jaw to the open position to release the stapled tissue.
[000324] Figures 117 to 121 show a form of an automated refill system modality of the present invention, generally designated as 5500. In one form, the 5500 automated refill system is configured to replace a surgical end actuator component "worn" on a manipulative surgical tool portion of a robotic surgical system with a "new" surgical end actuator component. As used herein, the term "surgical end actuator component" may include, for example, a surgical clamp cartridge, a disposable loading unit, or other end actuator components that, when used, are worn and must be removed. replaced by a new component. In addition, the term "spent" means that the end actuator component has been activated and is no longer usable for its intended function in its present state. For example, in the context of a surgical staple cartridge or disposable loading unit, the term "worn" means that at least part of the unformed staples that were previously held therein have been "fired" from it. As used herein, the term "new" surgical end actuator component refers to an end actuator component that is in a condition for its intended use. In the context of a surgical staple cartridge or disposable loading unit, for example, the term "new" refers to such a component that has staples not formed in it and which is otherwise ready for use.
[000325] In various embodiments, the automated refill system 5500 includes a base portion 5502 that can be strategically located in a work envelope 1109 of a robotic arm car 1100 (Figure 18) of a robotic system 1000. As used in In this document, the term "manipulable surgical tool portion" refers collectively to a surgical tool of the various types presented in this document and other forms of robotic actuated surgical tools that are operationally attached to, for example, an arm carriage robotic 1100 or similar device that is configured to automatically manipulate and activate the surgical tool. The term "work envelope", as used in this document, refers to the range of motion of the manipulative surgical tool portion of the robotic system. Figure 18 shows, in general, an area that can comprise a working envelope of the robotic arm carriage 1100. Elements skilled in the art will understand that the shape and size of the working envelope shown in this document is merely illustrative. The final size, shape and location of a work envelope will ultimately depend on the construction, range of path limitations and location of the manipulable surgical tool portion. Therefore, the term "work envelope", as used in this document, is intended to cover a variety of different sizes and shapes of work envelopes and should not be limited to the specific size and shape of the sample work envelope shown in Figure 18.
[000326] As can be seen in Figure 117, the base portion 5502 includes a new section or component support arrangement 5510 that is configured to operably support at least one new surgical end actuator component in one " loading orientation ". As used herein, the term "loading guidance" means that the new end actuator component is supported in such a way as to allow the corresponding component support portion of the manipulable surgical tool portion to be placed in engagement. loading with (i.e., operationally seated or operationally attached to) the new end actuator component (or the new end actuator component to be placed in the load hitch with the corresponding component support portion of the manipulable surgical tool portion ) without human intervention beyond that which may be necessary to operate the robotic system. As will be further verified, as per this Detailed Description proceeds, in at least one mode, the preparation nurse will load the new component support section before surgery with the appropriate color and length cartridges (some surgical clamp cartridges may support certain staple sizes whose size can be indicated by the color of the cartridge body) required to complete the surgical procedure. However, no direct human interaction is required during surgery to reload the robotic endoscopic cutter. In one form, the surgical end actuator component comprises a 2034 clamp cartridge that is configured to be operationally seated on a component support portion (elongated channel) of any of the various other end actuator arrangements described above. For the sake of explanation, new (unused) cartridges will be called "2034a" and spent cartridges will be called "2034b". The Figures show the cartridges 2034a, 2034b designed for use with a surgical end actuator 2012 that includes a 2022 channel and a fixed claw 2024, the construction and operation of which have been discussed in detail above. The cartridges 2034a, 2034b are identical to the cartridges 2034 described above. In various embodiments, cartridges 2034a, 2034b are configured to be retained by pressure (that is, loading coupling) in channel 2022 of a 2012 surgical end actuator. According to the present Detailed Description, however, elements versed in the technique will find that the unique and innovative features of the 5500 automated cartridge refill systems can be effectively employed in connection with the automated removal and installation of other cartridge arrangements without departing from the essence and scope of the present invention.
[000327] In the embodiment shown, the term "loading orientation" means that the distal tip portion 2035a of a new surgical clamp cartridge 2034a is inserted into a corresponding support cavity 5512 in the new cartridge support section 5510, so that the proximal end portion 2037a of the new surgical clamp cartridge 2034a is located in a convenient orientation to allow the arm carriage 1100 to handle the surgical end actuator 2012 to a position where the new 2034a cartridge can be automatically loaded into the channel 2022 of the surgical end actuator 2012. In several embodiments, the base 5502 includes at least one sensor 5504 that communicates with the control system 1003 of the robotic controller 1001 to provide the control system 1003 with the location of the base 5502 and / or the refill length and color for each new or used cartridge 2034a.
[000328] As can also be seen in the Figures, the base 5502 also includes a collection receptacle 5520 that is configured to collect spent cartridges 2034b that have been removed or disengaged from the surgical end actuator 2012 that is operationally attached to the robotic system 1000. In addition, in one form the 5500 automated refill system includes a 5530 extraction system to automatically remove the worn end actuator component from the corresponding support end actuator portion or manipulative surgical tool portion without specific human intervention beyond that which may be involved. be required to activate the robotic system. In various embodiments, the 5530 extraction system includes an extraction hook member 5532. In one form, for example, the extraction hook member 5532 is held rigidly in the base portion 5502. In one embodiment, the extraction hook member The extraction has at least one hook 5534 formed therefrom that is configured to hook the distal end 2035 of a spent cartridge 2034b hooked when held in the elongated channel 2022 of the surgical end actuator 2012. In various forms, the hook member of extraction 5532 is conveniently located within a portion of the collection receptacle 5520, so that when the worn end actuator component (cartridge 2034b) is placed in extractive engagement with the extraction hook member 5532, the actuator component of worn end (cartridge 2034b) is displaced from the corresponding component support portion (elongated channel 2022) and falls into the collection receptacle 5020. Therefore, to use this In this embodiment, the manipulable surgical tool portion manipulates the end actuator attached to it to place the distal end 2035 of the spent cartridge 2034b therein in engagement with hook 5534 and then move the end actuator in such a way as to displace the cartridge spent 2034b of the elongated channel 2022.
[000329] In other arrangements, the extraction hook member 5532 comprises a rotating wheel configuration which has a pair of diametrically opposed hooks 5334 projecting from it. See Figures 122 and 125. The 5532 extraction hook member is swiveled inside the 5520 collection receptacle and is coupled to a 5540 extraction motor that is controlled by controller 1001 of the robotic system. This form of the 5500 automated refill system can be used as follows. Figure 119 illustrates the introduction of the surgical end actuator 2012 which is operationally attached to the manipulative surgical tool portion l200. As can be seen in that Figure, the arm carriage 1100 of the robotic system 1000 positions the surgical end actuator 2012 in the position shown in which the end hook 5534 of the extraction member 5532 hooks the distal end 2035 of the spent cartridge 2034b hooked. on the surgical end actuator 2012. The fixed claw 2024 of the surgical end actuator 2012 is in the open position. After the distal end 2035 of the spent cartridge 2034b is engaged with the end hook 5532, the extraction motor 5540 is actuated to rotate the extraction wheel 5532 to disengage the spent cartridge 2034b from channel 2022. To assist with disengaging the spent cartridge 2034b of channel 2022 (or if the extraction member 5530 is stationary), the robotic system 1000 can move the surgical end actuator 2012 in an upward direction ("U" arrow in Figure 120). As the spent cartridge 2034b is moved from channel 2022, the spent cartridge 2034b falls into the collection receptacle 5520. Once the spent cartridge 2034b has been removed from the surgical end actuator 2012, the robotic system 1000 moves the surgical end actuator 2012 to the position shown in Figure 121.
[000330] In various embodiments, a sensor array 5533 is located adjacent to extraction member 5532 which is in communication with controller 1001 of the robotic system 1000. The sensor array 5533 may comprise a sensor that is configured to capture the presence of the surgical end actuator 2012 and, more particularly, the tip 2035b of the spent surgical clip cartridge 2034b thereof as the distal tip portion 2035b is placed in engagement with the extraction member 5532. In some embodiments, the sensor arrangement 5533 can comprise, for example, a light curtain arrangement. However, other forms of proximity sensors can be employed. In such an arrangement, when the surgical end actuator 2012 with the worn surgical clamp cartridge 2034b is placed in extractive engagement with the extraction member 5532, the sensor captures the distal tip 2035b of the surgical clamp cartridge 2034b (for example, the curtain of light is broken). When the extraction member 5532 rotates and releases the surgical clamp cartridge 2034b and it falls into the collection receptacle 5520, the light curtain is continuous again. Because the surgical end actuator 2012 was not moved during this procedure, the robotic controller 1001 is guaranteed that the worn surgical clamp cartridge 2034b has been removed from it. Other sensor arrangements can also be successfully employed to provide the robotic controller 1001 with an indication that the worn surgical clamp cartridge 2034b has been removed from the surgical end actuator 2012.
[000331] As can be seen in Figure 121, the surgical end actuator 2012 is positioned to pick up a new surgical clamp cartridge 2034a between channel 2022 and fixed clamp 2024. More specifically, as shown in Figures 118 and 121, each well 5512 has a corresponding vertical pressure block 5514 associated with it. The surgical end actuator 2012 is located so that the pressure block 5514 is located between the new cartridge 2034a and the fixed jaw 2024. Once in that position, the robotic system 1000 closes the fixed jaw 2024 in the pressure block 5514 that serves to press the new cartridge 2034a in pressure engagement with channel 2022 of the surgical end actuator 2012. Once the new cartridge 2034a has been snapped into position in the elongated channel 2022, the robotic system 1000 then removes the actuator from 2012 surgical end of the 5500 automated cartridge refill systems for use in connection with performing another surgical procedure.
[000332] Figures 122 to 126 show another 5600 automated refill system that can be used to remove a worn disposable loading unit 3612 from a manipulative surgical tool arrangement 3600 (Figures 69 to 82) that is operationally attached to a cart. arm 1100 or another portion of a robotic system 1000 and reload a new disposable loading unit 3612 in it. As can be seen in Figures 122 and 123, a form of the automated reloading system 5600 includes a housing 5610 that has a movable support assembly in the form of a rotating carousel top plate 5620 supported on it that cooperates with the housing 5610 to form a closed area 5612. The 5600 automated refill system is configured to be operationally supported in the work envelope of the manipulative surgical tool portion of a robotic system, as described above. In various embodiments, the rotating carousel plate 5620 has a plurality of holes 5622 to support a plurality of guide tubes 5660 therein. As can be seen in Figures 123 and 124, the rotating carousel plate 5620 is attached to a spindle rod 5624. Spindle rod 5624 is centrally arranged in the enclosed area 5612 and has a spindle gear 5626 attached to it . The spindle gear 5626 is in network engagement with a drive gear carousel 5628 which is coupled to a carousel drive motor 5630 which is in operational communication with the robotic controller 1001 of the robotic system 1000.
[000333] Various modalities of the 5600 automated refill system may also include a carousel locking assembly, generally referred to as 5640. In various forms, the 5640 carousel locking assembly includes a 5642 cam disk that is attached to the spindle 5624. Spindle gear 5626 can be attached to the underside of cam disk 5642 and cam disk 5642 can be switched over spindle stem 5624. In alternative arrangements, spindle gear 5626 and cam disk 5642 they can be independently attached non-pivotally to the spindle rod 5624. As can be seen in Figures 123 and 124, a plurality of notches 5644 is spaced by the perimeter of the cam disk 5642. A locking arm 5648 is pivotally mounted in housing 5610 and is inclined to engage the perimeter of the cam disk 5642 by a locking spring 5649. As can be seen in Figure 122, the outer perimeter of the cam disk 5642 is rounded to facilitate the rotation of the cam disk 5642 in relation to the locking arm 5648. The edges of each notch 5644 are also rounded, so that when the cam disk 5642 is rotated, the locking arm 5648 is removed from the cam hitch with the notches 5644 around the perimeter of the cam disc 5642.
[000334] Various forms of the 5600 automated refill system are configured to support a 5650 portable / replaceable tray assembly that is configured to support a plurality of disposable loading units 3612 in individual guide tubes 5660. More specifically and with reference to the Figures 123 and 124, the replaceable tray assembly 5650 comprises a tray 5652 having a centrally arranged locator spindle 5654 projecting from the underside thereof. The locator spindle 5654 is sized to be received at a hollow end 5625 of the spindle rod 5624. Tray 5652 has a plurality of holes 5656 in it that are configured to hold a guide tube 5660 therein. Each guide tube 5660 is oriented through a corresponding hole 5656 in the replaceable tray assembly 5650 in a desired orientation by a location fin 5666 in the guide tube 5660 which is designed to be received inside a corresponding location slot 5658 in the assembly of 5650 tray. In at least one embodiment, the location flap 5666 has a substantially V-shaped cross-sectional shape that is sized to fit into a 5658 V-shaped location slot. orientation 5660 in a desired starting position while allowing it to rotate inside the 5656 hole when a pivoting motion is applied to it. That is, when a rotating motion is applied to the 5660 orientation tube, the 5666 V-shaped location fin will come out of its corresponding location slot, allowing the 5660 tube to rotate in relation to the 5652 tray, as will be discussed in more detail below . As can also be seen in Figures 122 to 124, the replaceable tray 5652 can be provided with one or more portions of cable 5653 to facilitate transport of the 5652 tray assembly when loaded with 5660 guide tubes.
[000335] As can be seen in Figure 126, each guide tube 5660 comprises a body portion 5662 that has an open end of flange 5664. Body portion 5662 defines a cavity 5668 that is sized to receive a portion of a unit of disposable loading 3612 in it. In order to properly orient the disposable loading unit 3612 in the guide tube 5660, the cavity 5668 has a flat locating surface 5670 formed therein. As can be seen in Figure 126, the flat location surface 5670 is configured to facilitate insertion of the disposable loading unit into cavity 5668 in a predetermined or desired non-rotating orientation. In addition, the 5669 end of the cavity 5668 may include a foam material or cushion 5672 that is designed to cushion the distal end of the disposable loading unit 3612 in the cavity 5668. In addition, the length of the locating surface can cooperate with a support member slide 3689 of the axial drive assembly 3680 of the disposable loading unit 3612 to further locate the disposable loading unit 3612 in a desired position within the guidance tube 5660.
[000336] The 5660 guide tubes can be manufactured from nylon, polycarbonate, polyethylene, liquid crystal polymer, aluminum 6061 or 7075, titanium, stainless steel of the 300 or 400 series, coated or painted steel, clad steel, etc. and, when loaded on the replaceable tray 5662 and the locator spindle 5654 is inserted into the hollow end 5625 of the spindle stem 5624, the guide tubes 5660 extend through the corresponding holes 5662 in the 5620 roundabout top plate. Each replaceable tray 5662 it is equipped with a 5663 location sensor that communicates with the control system 1003 of the controller 1001 of the robotic system 1000. The sensor 5663 serves to identify the location of the charging system and the number, length, color and firing status of each refill housed in the tray. In addition, a 5665 optical sensor or sensors that communicates with the robotic controller 1001 can be used to capture the type / size / length of the disposable loading units that are loaded inside the 5662 tray.
[000337] Various modalities of the 5600 automated refill system also include a drive assembly 5680 to apply a pivoting motion to the 5660 guide tube that holds the disposable loading unit 3612 to be attached to the 3700 stem of the 3600 surgical tool (collectively , the "manipulable surgical tool portion") that is operationally coupled to the robotic system. The drive assembly 5680 includes a support fork 5682 which is attached to the locking arm 5648. Therefore, the support fork 5682 rotates with the locking arm 5648. The support fork 5682 pivots an idle tube wheel 5684 pivotally. and a tube drive wheel 5686 which is driven by a tube engine 5688 attached thereto. The 5688 tube motor communicates with and is controlled by the 1003 control system. Tube idle wheel 5684 and tube drive wheel 5686 are made from, for example, natural rubber, sanoprene, isoplast etc., so that the outer surfaces of the same create a sufficient amount of friction to result in rotation of a 5660 guide tube in contact with it by activating the 5688 tube motor. The idle wheel 5684 and the tube drive wheel 5686 are oriented relative to each other to create a cradle area 5687 between them for receive a 5060 guide tube in the actuation coupling in them.
[000338] In use, one or more of the 5660 guidance tubes loaded in the 5600 automated refill system are left deflated, while the other 5660 guidance tubes can operably support a corresponding new disposable loading unit 3612 therein. As will be discussed in more detail below, 5660 empty guide tubes are employed to receive a spent disposable 3612 loading unit in them.
[000339] The 5600 automated refill system can be used as follows after the 5600 system is positioned inside the work envelope of the manipulative surgical tool portion of a robotic system. If the manipulable surgical tool portion has a worn out disposable loading unit 3612 operably coupled to it, one of the guide tubes 5660 that are held in the replaceable tray 5662 is left deflated to receive the spent disposable loading unit 3612 therein. If, however, the manipulable surgical tool portion does not have a disposable loading unit 3612 operatively coupled to it, each of the 5660 guide tubes can be provided with a new properly disposable loading unit 3612.
[000340] As described earlier in this document, the disposable loading unit 3612 employs a "bayonet-type" rotating coupling arrangement to operationally couple the disposable loading unit 3612 to a corresponding portion of the manipulable surgical tool portion. That is, to attach a disposable loading unit 3612 to the corresponding portion of the manipulable surgical tool portion (3700 - see Figure 75, 76), a rotating installation movement has to be applied to the disposable loading unit 3612 and / or the portion corresponding portion of the manipulable surgical tool when those components have been moved to the loading hitch with each other. Such installation movements are collectively referred to in this document as "load movements". Likewise, to decouple a spent disposable loading unit 3612 from the corresponding portion of the manipulable surgical tool, a rotary uncoupling movement has to be applied to the spent disposable loading unit 3612 and / or to the corresponding portion of the manipulated surgical tool portion while simultaneously moves the spent disposable loading unit and the corresponding portion of the manipulable surgical tool away from each other. Such decoupling movements are collectively referred to in this document as "extraction movements".
[000341] To initiate the loading process, the robotic system 1000 is activated to manipulate the manipulable surgical tool portion and / or the automated refill system 5600 to place the manipulable surgical tool portion in a loading hitch with the new storage unit. disposable loading 3612 which is supported on the guide tube 5660 which is in drive engagement with the drive assembly 5680. Once the robotic controller 1001 (Figure 17) of the robotic control system 1000 has located the portion of the manipulable surgical tool in engagement loading with the new disposable loading unit 3612, robotic controller 1001 activates drive assembly 5680 to rotate the 5660 guide tube on which the new disposable loading unit 3612 is supported and / or apply another loading movement rotating to the corresponding portion of the manipulable surgical tool portion. By applying such a rotary loading movement (s), the robotic controller 1001 also causes the corresponding portion of the manipulable surgical tool portion to be moved towards the new disposable loading unit 3612 in coupling. loading with it. Since the disposable loading unit 3612 is in a loading hitch with the corresponding portion of the manipulable tool portion, the loading movements are interrupted and the manipulable surgical tool portion can be moved away from the 5600 automated loading system that loads with the new disposable loading unit 3612 that has been operationally coupled to it.
[000342] To decouple a spent disposable loading unit 3612 from a corresponding manipulable surgical tool portion, the robotic controller 1001 of the robotic system manipulates the manipulated surgical tool portion to insert the distal end of the spent disposable loading unit 3612 on the empty guide tube 5660 that remains in drive engagement with the drive assembly 5680. Subsequently, the robotic controller 1001 activates drive assembly 5680 to apply a pivoting movement to the guidance pipe 5660 in which the loading unit disposable waste 3612 is sustained and / or applies a pivoting movement to the corresponding portion of the manipulable surgical tool portion. The robotic controller 1001 also causes the manipulable surgical tool portion to withdraw from the spent 3612 disposable rotary loading unit. Thereafter, the rotating extraction movement (s) are interrupted.
[000343] After the spent 3612 disposable loading unit has been removed from the manipulable surgical tool portion, the robotic controller 1001 can activate the 5630 carousel drive motor to index the 5620 carousel top plate to place another 5660 guidance tube which supports a new disposable loading unit 3612 on it in drive engagement with the 5680 drive set. Subsequently, the loading process can be repeated to fix the new disposable loading unit 3612 on it to the portion of the manipulable surgical tool portion . Robotic controller 1001 can record the number of disposable loading units that have been used from a particular replaceable tray 5652. Since controller 1001 determines that all new disposable loading units 3612 have been used from that tray, the controller 1001 can provide the surgeon with a signal (visual and / or audible) indicating that tray 5652 that holds all spent disposable loading units 3612 has to be replaced with a new tray 5652 containing new disposable loading units 3612.
[000344] Figures 127 to 132 show another non-limiting modality of a surgical tool 6000 of the present invention that is well adapted for use with a robotic system 1000 that has the tool drive set 1010 (Figure 22) that is operationally coupled to a master controller 1001 that is operable through inputs from an operator (ie, a surgeon). As can be seen in Figure 127, surgical tool 6000 includes a surgical end actuator 6012 that comprises an endoscopic cutter. In at least one form, the surgical tool 6000 generally includes an elongated stem assembly 6008 that has a proximal closure tube 6040 and a distal closure tube 6042 that are coupled together by a hinge joint 6100. The surgical tool 6000 is operationally coupled to the manipulator by a tool assembly portion, generally referred to as 6200. The surgical tool 6000 also includes a 6030 interface that can mechanically and electrically couple the tool assembly portion 6200 to the manipulator in the various ways described in detail above.
[000345] In at least one embodiment, the surgical tool 6000 includes a surgical end actuator 6012 which comprises, among other things, at least one component 6024 which is selectively mobile between the first and second positions in relation to at least one other component 6022 in response to the various control movements applied to component 6024, as will be discussed in more detail below to perform a surgical procedure. In various embodiments, component 6022 comprises an elongated channel 6022 configured to operably support a surgical clamp cartridge 6034 therein and component 6024 comprises a translatable pivotable jaw member such as a fixed jaw 6024. Various actuator modalities surgical end caps 6012 are configured to hold the fixed claw 6024 and the elongated channel 6022 at a spacing that ensures effective clamping and tearing of tissue attached to the surgical end actuator 6012. Unless otherwise specified, the end actuator 6012 is similar to the surgical end actuator 2012 described above and includes a cutting instrument (not shown) and a frame (not shown). The fixed jaw 6024 may include a flap 6027 at its proximal end that interacts with a component of the mechanical locking system (described below) to facilitate opening of the fixed jaw 6024. The elongated channel 6022 and the fixed jaw 6024 can be made from one electrically conductive material (such as metal) so that they can serve as part of an antenna that communicates with the sensor (s) on the end actuator, as described above. The 6034 surgical clamp cartridge could be made of a non-conductive material (such as plastic) and the sensor can be connected to or disposed in the 6034 surgical clamp cartridge, as also described above.
[000346] As can be seen in Figure 127, the surgical end actuator 6012 is fixed to the mounting portion of the tool 6200 by an elongated stem assembly 6008, according to various modalities. As shown in the illustrated embodiment, the elongated stem assembly 6008 includes a hinge joint generally designated as 6100, which allows the surgical end actuator 6012 to be selectively hinged around a first tool hinge shaft AA1-AA1 which is substantially transverse to a longitudinal axis of the LT-LT tool and a second tool pivot axis AA2-AA2 which is substantially transverse to the longitudinal axis of the LT-LT tool, as well as the first pivot axis AA1-AA1. See Figure 128. In various embodiments, the elongated stem assembly 6008 includes the closing tube assembly 6009 comprising a proximal closing tube 6040 and a distal closing tube 6042 that are pivotally connected by pivot joints 6044 and 6046. The closing tube assembly 6009 is movably supported on the column assembly generally designated as 6102.
[000347] As can be seen in Figure 129, the proximal closing pipe 6040 is pivotally connected to an intermediate pipe joint 6043 by an upper pivot joint 6044U and a lower pivot joint 6044L, so that the joint of the intermediate closing tube 6043 is pivoting in relation to the proximal closing tube 6040 around a first closing axis CA1-CA1 and a second closing axis CA2-CA2. In various embodiments, the first closing axis CA1-CA1 is substantially parallel to the second closing axis CA2-CA2 and both closing axes CA1-CA1, CA2-CA2 are substantially transversal to the longitudinal axis of the LT-LT tool. As can be seen further in Figure 129, the joint of the intermediate closing pipe 6043 is pivotally connected to the distal closing pipe 6042 by a left pivot joint 6046L and a right pivot joint 6046R, so that the joint of the pipe intermediate lock 6043 is pivotal to the distal closure tube 6042 around a third CA3-CA3 closure axis and a fourth CA4-CA4 closure axis. In various embodiments, the third closing axis CA3-CA3 is substantially parallel to the fourth closing axis CA4-CA4 and both closing axes CA3-CA3, CA4-CA4 are substantially transversal to the first and second closing axes CA1-CA1, CA2-CA2, as well as the longitudinal axis of the LT-LT tool.
[000348] The closing tube assembly 6009 is configured to slide axially on the column assembly 6102 in response to actuation movements applied to it. The distal closing tube 6042 includes an opening 6045 that interfaces with the flap 6027 on the anvil 6024 to facilitate the opening of the anvil 6024 as the distal closing tube 6042 is moved axially in the proximal direction "PD". The closing tubes 6040, 6042 can be made of electrically conductive material (such as metal) so that they can serve as part of the antenna, as described above. The components of the column set 6102 can be made of a non-conductive material (with plastic).
[000349] As indicated above, the surgical tool 6000 includes a tool assembly portion 6200 that is configured for operational attachment to the tool assembly set 1010 of the robotic system 1000 in the various ways described in detail above. As can be seen in Figure 131, the tool mounting portion 6200 comprises a tool mounting plate 6202 that operationally supports a transmission arrangement 6204 therein. In various embodiments, the transmission arrangement 6204 includes an articulation transmission 6142 comprising a portion of an articulation system 6140 for articulating the surgical end actuator 6012 around a first tool articulation axis TA1-TA1 and a second axis articulation tool TA2-TA2. The first tool pivot axis TA1-TA1 is substantially transverse to the second tool pivot axis TA2-TA2 and both the first and second tool pivot axes are substantially transverse to the longitudinal axis of the LT-LT tool. See Figure 128.
[000350] To facilitate the selective articulation of the surgical end actuator 6012 around the first and second tool articulation axes TA1-TA1, TA2-TA2, column assembly 6102 comprises a proximal column portion 6110 that is coupled in a manner pivoting to a portion of distal column 6120 by pivot pins 6122 for the selective pivotal path around TA1- TA1. Similarly, the distal column portion 6120 is pivotally attached to the elongated channel 6022 of the surgical end actuator 6012 by pivot pins 6124 to allow the surgical end actuator 6012 to rotate selectively around the second axis of the TA2-TA2 tool in relation to the 6120 distal column portion.
[000351] In several embodiments, the articulation system 6140 also includes a plurality of articulation elements that interface operationally with the surgical end actuator 6012 and an articulation control arrangement 6160 that is operationally supported on the limb. 6200 tool assembly, as will be described in more detail below. In at least one embodiment, the hinge elements comprise a first pair of first hinge cables 6144 and 6146. The first hinge cables are located on a first side or right side of the longitudinal axis of the tool. Therefore, the first articulation cables in this document are called an upper right cable 6144 and a lower right cable 6146. The upper right cable 6144 and the lower right cable 6146 extend through corresponding passages 6147, 6148, respectively to the along the right side of the proximal column portion 6110. See Figure 132. The articulation system 6140 also includes a second pair of second articulation cables 6150, 6152. The second articulation cables are located on a second side or side left of the longitudinal axis of the tool. Therefore, the second hinge cables are referred to herein as an upper left hinge cable 6150 and a left hinge cable 6152. The upper left hinge cable 6150 and the lower left hinge cable 6152 extend through passages 6153, 6154, respectively in the proximal column portion 6110.
[000352] As can be seen in Figure 128, the upper right cable 6144 extends around an upper pivot joint 6123 and is attached to an upper left side of the elongated channel 6022 in a left pivot joint 6125. The cable lower right 6146 extends around a lower pivot joint 6126 and is attached to a lower left side of the elongated channel 6022 on the left pivot joint 6125. The upper left cable 6150 extends around the upper pivot joint 6123 and is fixed to an upper right side of the elongated channel 6022 on a right pivot joint 6127. The lower left cable 6152 extends around the lower pivot joint 6126 and is fixed to an lower right side of the elongated channel 6022 on the right pivot joint 6127. Therefore, to rotate the surgical end actuator 6012 around the first tool pivot axis TA1-TA1 to the left (arrow "L"), the upper right cable 6144 and the lower right cable 6146 have to be pulled on the di proximal "PD" resection. To articulate the surgical end actuator 6012 to the right (arrow "R") around the first tool articulation axis TA1-TA1, the upper left cable 6150 and the lower left cable 6152 have to be pulled in the proximal direction "PD ". To articulate the surgical end actuator 6012 around the second tool articulation axis TA2-TA2, in an upward direction ("U" arrow), the upper right cable 6144 and the upper left cable 6150 have to be pulled in the direction proximal "PD". To articulate the surgical end actuator 6012 in the downward direction (arrow "DW") around the second tool articulation axis TA2-TA2, the lower right cable 6146 and the lower left cable 6152 have to be pulled in the proximal direction " PD ".
[000353] The 6144, 6146, 6150, 6152 hinge proximal end cables are coupled to the 6160 hinge control arrangement which comprises a ball joint assembly which is a part of the 6142 hinge transmission. More specifically and with reference to the Figure 132, the ball joint assembly 6160 includes a ball-shaped member 6162 that is formed in a proximal portion of the proximal column 6110. Movably supported on the ball-shaped member 6162 is a hinge control ring 6164. As you can see further seen in Figure 132, the proximal ends of the hinge cables 6144, 6146, 6150, 6152 are coupled to the hinge control ring 6164 by the corresponding ball joint arrangements 6166. The hinge control ring 6164 is controlled by an assembly 6170 articulation drive. As can be seen more particularly in Figure 132, the proximal ends of the first articulation cables 6144, 6146 are attached to the hinge control ring 6164 at the corresponding first spaced points 6149, 6151 which are located on the 6159 plane. Likewise, the proximal ends of the second hinge cables 6150, 6152 are attached to the hinge control ring joint 6164 at the corresponding second spaced points 6153, 6155 which are also located along the 6159 plane. As the Detailed Description goes on, elements skilled in the art will find that such a cable fixing configuration on the 6164 joint control ring facilitates the desired range of articulation movements according to the articulation control ring 6164 are handled by the articulation drive assembly 6170.
[000354] In several forms, the hinge drive assembly 6170 comprises a horizontal hinge assembly designated as 6171. In at least one form, the hinge assembly 6171 comprises a horizontal pressure cable 6172 that is attached to a mounting arrangement. horizontal gear 6180. The pivot drive assembly 6170 additionally comprises a vertical pivot assembly generally referred to as 6173. In at least one form, the vertical pivot assembly 6173 comprises a vertical pressure cable 6174 that is attached to an arrangement of vertical gear 6190. As can be seen in Figures 131 and 132, the horizontal pressure cable 6172 extends through a support plate 6167 which is attached to the proximal column portion 6110. The distal end of the horizontal pressure cable 6174 is fixed to the articulation control ring 6164 by a corresponding spherical / pivot joint 6168. The vertical pressure cable 6174 is it tends through the support plate 6167 and its distal end is fixed to the articulation control ring 6164 by a corresponding spherical / pivot joint 6169.
[000355] The horizontal gear arrangement 6180 includes a driven horizontal gear 6182 which is pivotally mounted on a horizontal rod 6181 which is attached to a proximal portion of the proximal column portion 6110. The proximal end of the horizontal pressure cable 6172 is pivotally attached to the driven horizontal gear 6182 so that as the driven horizontal gear 6172 is rotated around the horizontal pivot axis HA, the horizontal pressure cable 6172 applies a first pivot movement to the 6164 articulation control ring. Likewise, the vertical gear arrangement 6190 includes a vertical driven gear 6192 that is pivotally supported on a vertical rod 6191 attached to the proximal portion of the proximal column portion 6110 for the pivoting path around a vertical VA pivot axis . The proximal end of the vertical pressure cable 6174 is pivotally attached to the vertical driven gear 6192, so that the vertical driven gear 6192 is rotated around the vertical pivot axis VA, with the vertical pressure cable 6174 applying a second pivot movement to the 6164 articulation control ring.
[000356] The driven horizontal gear 6182 and the driven vertical gear 6192 are driven by a 6300 hinge gear train that interfaces operationally with a 6320 hinge shifter assembly. In at least one way, the shifter assembly The articulation comprises a 6322 articulation drive gear that is coupled to a corresponding one among the disks or driven elements 1304 on the adapter side 1307 of the tool mounting plate 6202. See Figure 26. Therefore, the application of a rotary input movement from the robotic system 1000 through the tool drive set 1010 to the corresponding driven element 1304 will cause the articulation drive gear 6322 to rotate when the interface 1230 is coupled to the tool retainer 1270. A 6324 driven link gear is attached to a 6330 splined displacer rod that is pivotally supported on the mounting plate in tool 6202. The 6324 driven gear link is in network engagement with the 6322 link drive gear, as shown. Therefore, rotation of the 6322 pivot drive gear will result in the rotation of the 6330 stem. In various forms, a displacement driven gear assembly 6340 is movably supported on the splined portion 6332 of the 6330 displacer stem.
[000357] In various embodiments, the 6340 displacer driven gear includes a 6342 driven displacer gear that is attached to a 6344 displacer plate. The 6344 displacer plate interfaces operationally with a 6350 displacer solenoid assembly. The displacement solenoid 6350 assembly is coupled to the corresponding pins 6352 by conductors 6352. See Figure 131. The pins 6352 are oriented to communicate electrically with slots 1258 (Figure 25) on the 1244 tool side of the 1240 adapter. to electrically couple the displacement solenoid 6350 assembly to the robotic controller 1001. Therefore, activating the displacement solenoid 6350 will displace the displacement driven gear assembly 6340 in the splined portion 6332 of the 6330 displacer stem, as represented by the "S" arrow in Figures 131 and 132. Various modalities of the 6300 articulation gear train also include an assembly of horizontal gear 6360 which includes a first horizontal drive gear 6362 which is mounted on a rod 6361 which is pivotally attached to the tool mounting plate 6202. The first horizontal drive gear 6362 is supported in mesh engagement with a second gear horizontal drive 6364. As can be seen in Figure 137, the driven horizontal gear 6182 is in network engagement with the distal face portion 6365 of the second driven horizontal gear 6364.
[000358] Various embodiments of the 6300 articulation gear train also include a vertical gear assembly 6370 that includes a first vertical drive gear 6372 which is mounted on a rod 6371 which is pivotally supported on the tool mounting plate 6202 The first vertical drive gear 6372 is supported in network engagement with a second vertical drive gear 6374 which is concentrated concentrically with the second horizontal drive gear 6364. The second vertical drive gear 6374 is pivotally supported in the proximal column 6110 to run around it. The second horizontal drive gear 6364 is pivotally sustained in a portion of said second vertical drive gear 6374 for the independent pivoting path thereon. As can be seen in Figure 132, the vertical driven gear 6192 is in network engagement with the distal face portion 6375 of the second vertical driven gear 6374.
[000359] In various forms, the first horizontal drive gear 6362 has a first diameter and the first vertical drive gear 6372 has a second diameter. As can be seen in Figures 131 and 132, stem 6361 is not on a common axis with stem 6371. That is, the first horizontal driven gear 6362 and the first vertical driven gear 6372 do not rotate around a common axis. Therefore, when shifter gear 6342 is positioned in a center "locking" position so that shifter gear 6342 is in network engagement with both the first driven horizontal gear 6362 and the first vertical driven gear 6372, being that the components of the 6140 articulation system are locked in position. Therefore, the displaceable displacement gear 6342 and the arrangement of the first horizontal and vertical drive gears 6362, 6372, as well as the articulation displacement assembly 6320, can be collectively called a joint locking system, generally referred to as 6380.
[000360] In use, the robotic controller 1001 of the robotic system 1000 can control the articulation system 6140 as follows. To pivot the end actuator 6012 to the left around the first tool pivot axis TA1-TA1, the robotic controller 1001 activates the shifter solenoid assembly 6350 to place the shifter gear 6342 in mesh with the first gear horizontal drive 6362. Subsequently, controller 1001 causes a first pivoting output movement to be applied to the articulation drive gear 6322 to drive the shifter gear in a first direction to ultimately drive the driven horizontal gear 6182 in another first direction. The driven horizontal gear 6182 is driven to rotate the articulation ring 6164 in the sphere-shaped portion 6162 to thus pull the upper right cable 6144 and the lower right cable 6146 in the proximal direction "PD". To pivot end actuator 6012 to the right around the first tool pivot axis TA1-TA1, robotic controller 1001 activates shifter solenoid 6350 to shift shifter 6342 into mesh with the first gear horizontal drive 6362. Thereafter, controller 1001 causes the first pivoting output movement in an opposite direction to be applied to hinge drive gear 6322 to drive shifter gear 6342 in a second direction to finally drive the driven horizontal gear 6182 in another second direction. Such actions result in the articulation control ring 6164 moving in such a way as to pull the upper left cable 6150 and the lower left cable 6152 in the proximal direction "PD". In various embodiments, the gear ratios and frictional forces generated between the gears of the vertical gear assembly 6370 serve to prevent rotation of the vertical driven gear 6192 as the horizontal gear assembly 6360 is driven.
[000361] To articulate the end actuator 6012 in the upper direction around the second tool articulation axis TA2-TA2, the robotic controller 1001 activates the displacement solenoid 6350 assembly to place the displacement gear 6342 in network engagement with the first vertical drive gear 6372. Subsequently, controller 1001 causes the first pivoting output movement to be applied to hinge drive gear 6322 to drive shifter gear 6342 in a first direction to ultimately drive the gear vertical driven 6192 in another first direction. The vertical driven gear 6192 is driven to rotate the articulation ring 6164 over the ball-shaped portion 6162 of the proximal column portion 6110 to thereby pull the upper right cable 6144 and the upper left cable 6150 in the proximal direction "PD" . To pivot the end actuator 6012 in the downward direction around the second tool pivot axis TA2-TA2, the robotic controller 1001 activates the displacement solenoid 6350 assembly to place the displacement gear 6342 in network engagement with the first vertical drive gear 6372. Subsequently, controller 1001 causes the first pivoting output movement to be applied in a direction opposite to articulation drive gear 6322 to drive displacer gear 6342 in a second direction to ultimately drive the vertical driven gear 6192 in another second direction. Such actions thus cause the articulation control ring 6164 to pull the lower right cable 6146 and the lower left cable 6152 in the proximal direction "PD". In various embodiments, the gear ratios and frictional forces generated between the gears of the 6360 horizontal gear assembly serve to prevent rotation of the driven horizontal gear 6182 as the vertical gear assembly 6370 is driven.
[000362] In various modalities, a variety of sensors communicate with the robotic controller 1001 to determine the hinged position of the end actuator 6012. Such sensors can interface with, for example, the hinge joint 6100 or can be located inside of the tool mounting portion 6200. For example, sensors can be used to detect the position of the articulation control ring 6164 in the 6162 sphere-shaped portion of the proximal column portion 6110. Such feedback from the sensors to the controller 1001 allows that controller 1001 adjusts the amount of rotation and the direction of the swiveling output for the 6322 pivoting drive gear. Additionally, as indicated above, when the displacer drive gear 6342 is positioned centrally in network engagement with the first horizontal gear drive 6362 and the first vertical drive gear 6372, end actuator 6012 is locked in the hinged position. Therefore, after the desired amount of pivot is obtained, controller 1001 can activate the displacement solenoid 6350 assembly to place the displacement gear 6342 in network engagement with the first horizontal drive gear 6362 and the first vertical drive gear 6372 In alternative embodiments, the 6350 displacement solenoid assembly can be spring activated to the central locked position.
[000363] In use, it may be desirable to rotate the surgical end actuator 6012 around the longitudinal axis of the LT-LT tool. In at least one embodiment, the transmission arrangement 6204 in the tool mounting portion includes the rotational transmission assembly 6400 which is configured to receive a corresponding rotary output movement from the tool drive assembly 1010 of the robotic system 1000 and convert that pivoting output movement in a pivoting motion to rotate the elongated stem assembly 6008 (and the surgical end actuator 6012) around the longitudinal axis of the LT-LT tool. In various embodiments, for example, a proximal end portion 6041 of proximal closing tube 6040 is pivotally supported on tool mounting plate 6202 of tool mounting portion 6200 by a front support cradle 6205 and a closing frame 6510 which is also movably supported on the tool mounting plate 6202. In at least one form, the 6400 rotational drive assembly includes a tube gear segment 6402 that is formed (or attached to) at the proximal end 6041 of the tube proximal closing mechanism 6040 for the operable hitch by the swivel gear assembly 6410 that is operationally supported on the tool mounting plate 6202. As can be seen in Figure 131, the swivel gear assembly 6410, in at least one mode, comprises a rotating drive gear 6412 which is coupled according to a first correspondent of one of the driven disks or elements 1304 on the ad side aptador 1307 of the tool mounting plate 6202 when the tool mounting portion 6200 is coupled to the tool drive assembly 1010. See Figure 26. The swivel gear assembly 6410 additionally comprises a first swivel driven gear 6414 that is sustained by pivoting mode on the 6202 tool mounting plate in network engagement with the rotating drive gear 6412. The first pivoting drive gear 6414 is attached to a 6416 drive rod that is pivotally supported on the 6202 tool mounting plate. A second rotary driven gear 6418 is attached to the drive rod 6416 and is in network engagement with the pipe gear segment 6402 in the proximal closing tube 6040. The application of a second rotary outward movement of the tool drive set 1010 from the robotic system 1000 to the corresponding driven element 1304 will thus cause the gear to rotate 6412 rotation drive gear. The rotation of the 6412 rotation drive gear ultimately results in the rotation of the elongated shank assembly 6008 (and the surgical end actuator 6012) around the longitudinal axis of the LT-LT tool. It will be seen that the application of a rotating output movement from the tool drive assembly 1010 in one direction will result in the rotation of the elongated shank assembly 6008 and surgical end actuator 6012 around the longitudinal axis of the LT-LT tool in a first direction and an application of the rotating outlet movement in an opposite direction will result in the rotation of the elongated stem assembly 6008 and the surgical end actuator 6012 in a second direction that is opposite the first direction.
[000364] In at least one embodiment, the closing of the fixed jaw 2024 in relation to the clamp cartridge 2034 is carried out by axially moving a portion of the elongated closing rod assembly 2008 in the distal direction "DD" in the column assembly 2049. According to indicated above, in various embodiments, the proximal end portion 6041 of the proximal closing tube 6040 is supported by the closing frame 6510 which comprises a portion of a closing transmission, generally shown as 6512. As can be seen in Figure 131 , the proximal end portion 6041 of the proximal closing tube portion 6040 has a collar 6048 formed therein. The closing frame 6510 is attached to the collar 6048 by a fork 6514 that engages an annular groove 6049 in the collar 6048. This arrangement serves to allow the collar 6048 to rotate around the longitudinal axis of the LT-LT tool while still attached to the transmission closing frame 6512. In various embodiments, the closing frame 6510 has a vertical portion 6516 that has a closing panel gear 6518 formed therein. The 6518 closing panel gear is configured to engage the engagement with a 6520 closing gear assembly. See Figure 131.
[000365] In various forms, the closing gear set 6520 includes a closing gear wheel 6522 that is coupled to a corresponding second among the driven disks or elements 1304 on the adapter side 1307 of the tool mounting plate 6202. See Figure 26. Therefore, the application of a third rotary output movement from the tool drive assembly 1010 of the robotic system 1000 to the corresponding second driven element 1304 will cause the closing gear wheel 6522 to rotate when the tool assembly 6202 is coupled to tool drive assembly 1010. Closing gear assembly 6520 further includes the closing reduction gear assembly 6524 which is supported in the network engagement with closing gear wheel 6522 and the closing panel gear 2106. Therefore, the application of a third rotating outward movement from the set the tool drive 1010 from the robotic system 1000 to the corresponding second driven element 1304 will cause the closing sprocket gear 6522 and the closing transmission 6512 to rotate and ultimately drive the closing frame 6510 and the proximal closing tube 6040 axially in the proximal column portion 6110. The axial direction in which the proximal closing tube 6040 moves ultimately depends on the direction in which the third driven element 1304 is rotated. For example, in response to a rotating output movement received from the tool drive assembly 1010 of the robotic system 1000, the closing frame 6510 will be activated in the distal direction "DD" and, finally, will trigger the proximal closing tube. 6040 in the distal direction "DD". As the proximal closing tube 6040 is driven distally, the distal closing tube 6042 is also driven distally due to its connection with the proximal closing tube 6040. As the distal closing tube 6042 is driven distally, the end of the closing 6042 will engage a portion of the fixed jaw 6024 and cause the fixed jaw 6024 to rotate to a closed position. By applying an "opening" exit movement from the tool drive assembly 1010 of the robotic system 1000, the closing frame 6510 and the proximal closing tube 6040 will be driven in the proximal direction "PD" on the column portion proximal 6110. As the proximal closing tube 6040 is activated in the proximal direction "PD", the distal closing tube 6042 will also be activated in the proximal direction "PD". As the distal closing tube 6042 is activated in the proximal direction "PD", opening 6045 in it interacts with the flap 6027 in the fixed claw 6024 to facilitate its opening. In various embodiments, the spring (not shown) can be used to tilt the fixed claw 6024 to the open position when the distal closing tube 6042 has been moved to its initial position. In various embodiments, the various gears in the 6520 closing gear assembly are sized to generate the closing forces necessary to satisfactorily close the fixed claw 6024 to the tissue to be cut and stapled by the 6012 surgical end actuator. 6520 closing transmission can be sized to generate approximately 311.4 to 533.8 Newton (70 to 120 pounds) of closing forces.
[000366] In several modalities, the cutting instrument is driven through the surgical end actuator 6012 by a 6530 knife bar. See Figure 131. In at least one way, the 6530 knife bar is manufactured with a joint arrangement (not shown) and / or is made from material that can accommodate the 6102 surgical end actuator joint around the first and second tool pivot axes while remaining sufficiently rigid to press the cutting instrument through fabric gripped in the surgical end actuator 6012. The knife bar 6530 extends through a hollow passage 6532 in the proximal column portion 6110.
[000367] In various embodiments, a proximal end 6534 of knife bar 6530 is pivotally attached to a knife panel gear 6540, so that knife bar 6530 is free to rotate relative to the knife panel gear 6540. The distal end of the 6530 knife bar is attached to the cutting instrument in the various ways described above. As can be seen in Figure 131, the 6540 knife panel gear is slidably supported in a 6542 panel housing that is attached to the 6202 tool mounting plate, so that the 6540 knife panel gear is retained in network engagement with a 6550 knife drive transmission portion of the 6204 transmission arrangement. In various embodiments, the 6550 knife drive transmission comprises the 6560 knife gear assembly. More specifically and with reference to Figure 131, in at least one embodiment, the knife gear set 6560 includes a knife gear wheel 6562 that is coupled to a corresponding quarter of the driven disks or elements 1304 on the adapter side 1307 of the tool mounting plate 6202. See Figure 26. Therefore, the application of another rotating output movement of the robotic system 1000 through the tool drive set 1010 to the fourth corresponding element Driven tooth 1304 will cause knife gear wheel 6562 to rotate. Knife gear set 6560 includes, even includes a knife gear reduction set 6564 that includes a first driven knife gear 6566 and a second drive gear. knife 6568. The 6564 knife gear reduction assembly is pivotally mounted on the 6202 so that the first 6566 knife driven gear is in network engagement with the 6562 knife sprocket gear. Likewise, the second gear 6568 knife drive gear is in network engagement with a third 6570 knife mount drive gear. As shown in Figure 131, the second 6568 knife drive gear is in network engagement with a third 6572 knife drive gear. knife assembly drive gear 6570. The fourth knife drive gear 6572 is in network engagement with a fifth knife drive gear assembly 657 4 which is in network engagement with the 6540 knife panel gear. In various embodiments, the gears in the 6560 knife gear assembly are sized to generate the forces necessary to drive the cutting instrument through the fabric attached to the end actuator. surgical 6012 and activate the clamps on it. For example, the gears in the 6560 knife gear assembly can be sized to generate approximately 177.9 to 444.8 Newton (40 to 100 pounds) of drive force. It will be seen that the application of a rotary exit movement from the tool drive assembly 1010 in one direction will result in the axial movement of the cutting instrument in a distal direction and the application of the rotary exit movement in an opposite direction will result in the path axial runs through the cutting instrument in a proximal direction.
[000368] As can be seen from the previous description, the surgical tool 6000 represents a major improvement over the previous robotic tool arrangements. The unique and innovative transmission arrangement employed by the surgical tool 6000 allows the tool to be operationally coupled to a tool retaining portion 1010 of a robotic system that has only four rotating outlet bodies, and still obtains the rotating outlet movements of the same for: (i) articulating the end actuator around two different articulation axes that are substantially transversal to each other, as well as to the longitudinal axis of the tool; (ii) rotate the end actuator 6012 around the longitudinal axis of the tool; (iii) closing the fixed claw 6024 in relation to the surgical clamp cartridge 6034 to varying degrees to allow the end actuator 6012 to be used to manipulate tissue and then grasp it in position for cutting and stapling; and (iv) firing the cutting instrument to cut through the tissue attached to the 6012 end actuator. The unique and innovative displacer arrangements of the various embodiments of the present invention described above allow two different articulation actions to be fed from a single rotating body portion of the robotic system.
[000369] The various embodiments of the present invention have been described above with respect to surgical cutting instruments. It should be noted, however, that in other embodiments, the surgical instrument disclosed in the present invention need not be a cut-type surgical instrument, but can be used in any type of surgical instrument including remote sensor transponders. For example, it could be a blunt endoscopic instrument, a claw, a stapler, a clamp applicator, an access device, a device for applying pharmacological / gene therapy, an energy device using ultrasound, RF, laser, etc. In addition, the present invention can be used in laparoscopic instruments, for example. The present invention also has application in conventional endoscopic and open surgical instrumentation as well as surgery assisted by robots.
[000370] Figure 133 shows the use of various aspects of certain embodiments of the present invention in connection with a surgical tool 7000 that has an end actuator 7012 fed in an ultrasonic manner. The end actuator 7012 is operably attached to a tool mounting portion 7100 by an elongated shank assembly 7008. The tool mounting portion 7100 may be substantially similar to the various tool mounting portions described above. In one embodiment, the end actuator 7012 includes an ultrasonic-fed jaw portion 7014 that is powered by alternating current or direct current in a known manner. Such ultrasonic powered devices are disclosed, for example, in U.S. Patent No. 6,783,524, entitled "Robotic Surgical Tool With Ultrasound Cauterizing and Cutting Instrument", the full description of which is hereby incorporated by reference. In the illustrated embodiment, a separate power cable 7020 is shown. It will be understood, however, that power can be supplied to them from the robotic controller 1001 through the tool mounting portion 7100. The surgical end actuator 7012 also includes a movable jaw 7016 that can be used to grab tissue in the ultrasonic jaw portion 7014. The movable jaw portion 7016 can be selectively actuated by the robotic controller 1001 through the tool mounting portion 7100 in any of the various ways described in this document.
[000371] Figure 134 illustrates the use of various aspects of certain embodiments of the present invention in connection with a surgical tool 8000 having an 8012 end actuator comprising a linear stapling device. The end actuator 8012 is operably attached to a tool mounting portion 8100 by an elongated stem assembly 3700 of the type and construction described above. However, the 8012 end actuator can be attached to the 8100 tool mounting portion by a variety of other elongated stem assemblies described herein. In one embodiment, the tool mounting portion 8100 may be substantially similar to the tool mounting portion 3750. However, several other tool mounting portions of their respective transmission arrangements described in detail herein can also be employed. Such portions of linear stapling heads are also described, for example, in US Patent No. 7,673,781, entitled "Surgical Stapling Device With Staple Driver That Supports Multiple Wire Diameter Staples", the complete description of which is incorporated herein by way of reference.
[000372] Various sensor modalities described in US Patent Publication No. 2011/0062212 A1 to Shelton, IV et al., The description of which is incorporated in this document for reference in its entirety, can be used with many of the modalities of surgical tool presented in this document. As indicated above, master controller 1001 generally includes master controllers (usually represented by 1003) that are picked up by the surgeon and manipulated in space while the surgeon views the procedure through a stereo viewfinder 1002. See Figure 17. Master controllers 1001 are manual insertion devices that preferably move with multiple degrees of freedom and often have an actionable handle for operating surgical tools. Some of the surgical tool modalities described in this document employ a motor or motors in their tool drive portion to provide various control movements for the tool end actuator. Such modalities can also obtain additional control movement (s) from the motor arrangement used in the robotic system components. Other modalities presented in this document obtain all the movements of control of the motor dispositions in the robotic system.
[000373] Such engine powered arrangements may employ several sensor arrangements which are described in the published U.S. patent application cited above to provide the surgeon with a variety of forms of feedback without departing from the spirit and scope of the present invention. For example, those master controller 1003 provisions that employ a manually triggered trigger can employ engine operating sensor (s) to provide the surgeon with feedback regarding the amount of force applied or being experienced by the cutting member. The motor run sensor (s) can be configured to communicate with the trigger trigger portion to detect when the trigger trigger portion has been actuated to begin the cutting / stapling operation by the end actuator. The motor operating sensor can be a proportional sensor, such as a rheostat or variable resistor. When the trigger is pulled, the sensor detects movement and sends an electrical signal indicating the voltage (or power) to be supplied to the corresponding motor. When the sensor is a variable resistor or similar, the rotation of the motor can, in general, be proportional to the amount of movement of the trigger trigger. That is, if the operator only pulls or closes the trigger on a small amount, the engine speed is relatively low. When the trigger is fully pulled (or is in the fully closed position), the engine speed is at its maximum. In other words, the greater the force with which the surgeon pulls the trigger, the greater the tension that is applied to the engine, causing higher rates of rotation. Other provisions can provide the surgeon with a 1005 feedback meter that can be viewed through screen 1002 and provides the surgeon with a visual indication of the amount of force that is applied to the cutting instrument or dynamic gripping member. Other sensor arrangements can be employed to provide the master controller 1001 with an indication as to whether a clamp cartridge has been loaded on the end actuator, whether the fixed jaw has been moved to a closed position prior to firing, etc.
[000374] In alternative modalities, a motor-controlled interface can be used in connection with controller 1001 that limits the maximum relative traction based on the amount of loading (for example, clamping force, cutting force, etc.) experienced by the actuator surgical extremity. For example, the harder it is to trigger the cutting instrument through the tissue attached to the end actuator, the more difficult it would be to pull / actuate the activation trigger. In still other embodiments, the trigger on controller 1001 is arranged so that the location of the trigger pull is proportional to the location / condition of the end actuator. For example, the trigger is only fully lowered when the end actuator is fully released.
[000375] The devices described here can be designed to be discarded after a single use, or they can be designed for use multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of steps to disassemble the device, followed by cleaning or replacing particular parts, and subsequent reassembly. In particular, the device can be disassembled, and any number of particular parts or parts of the device can be selectively exchanged or removed, in any combination. After cleaning and / or exchanging particular parts, the device can be reassembled for subsequent use in a reconditioning facility or by a surgical team immediately before a surgical procedure. Those skilled in the art will appreciate that the reconditioning of a device can use a variety of techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques, and the resulting refurbished device are all within the scope of the present application.
[000376] Although the present invention has been described here in connection with certain modalities presented, many modifications and variations to these modalities can be implemented. For example, different types of end actuators can be employed. Also, where materials are developed for certain components, other materials can be used. The aforementioned description and the following claims are intended to cover all such modifications and variations.
[000377] Any patent, publication or other description material, in whole or in part, which is said to be incorporated into the present invention for reference purposes, is incorporated into the present invention only to the extent that the incorporated materials do not come into effect. conflict with existing definitions, statements or other description material presented in this description. Accordingly, and as far as necessary, the description as explicitly stated herein replaces any conflicting material incorporated herein by way of reference. Any material, or portion thereof, that is deemed to be incorporated by reference in the present invention, but which conflicts with definitions, statements, or other description materials existing herein will be incorporated here only to the extent that no conflict will appear between the embedded material and the existing description material.

权利要求:
Claims (3)
[0001]
1. Surgical device (1300) comprising: an end actuator (2012) configured to perform at least one surgical procedure in response to at least one control movement applied to it from a control unit of a robotic system (1000) ; and an elongated stem (2008) coupled to the end actuator (2012) and defining a stem axis (LT-LT) and having an articulation joint (2011) configured to facilitate the articulation of the end actuator (2012) in two planes which are substantially perpendicular to the stem axis (LT-LT) after manipulating the control unit (1000) in relation to the elongated stem (2008), such that the movement of the control unit (1000) is imitated by the actuator of extremity (2012), the elongated stem (2008) defining at least one internal lumen through it; wherein the end actuator (2012) comprises: an elongated channel (2022) operationally coupled to the elongated stem (2008) and operationally supporting a surgical staple cartridge (2034) therein; and an articulated rotating anvil (2024) movably supported in relation to the elongated channel (2022) and configured to move in response to the control movements of the anvil (2024) applied to it between the open and closed positions to hold the fabric; the surgical device (1300) characterized by the fact that it still comprises: a knife bar (2200) that extends operationally through the internal lumen through the articulation joint (2011), the knife bar (2200) having a proximal end ( 2204) rotatably attached to a knife panel gear (2206) that interacts operationally with the control unit of the robotic system (1000), and which has a distal end (2033) connected to a cutting instrument (2032) on the actuator. end (2012), the knife bar (2200) configured to push the cutting instrument (2032) through fabric attached by axial movement of the knife bar (2200); where the elongated stem (2008) is a rotary actuating stem (2008) in operational interface with the control unit of the robotic system (1000) and the end actuator (2012) to apply a rotary control movement to it after the rotation of the rotating drive rod (2008); and in which the elongated shaft (2008) still comprises articulated closing tubes (2042, 2040) that operate in operational interface with the control unit of the robotic system (1000) and the end actuator (2012), the closing tubes ( 2042, 2040) configured to apply the anvil control movements (2024) when the closing tubes (2042, 2040) are translated axially along the stem axis (LT-LT).
[0002]
2. Surgical device, according to claim 1, characterized by the fact that the elongated rod (2008) comprises: a flexible hollow tube (3345); and a plurality of flexible actuators (3212 ’, 3212”) that functionally interface with the control unit (1000) and are functionally supported along the hollow flexible tube (3345) to be functionally coupled to the end actuator (2012).
[0003]
3. Surgical device, according to claim 1, characterized by the fact that the end actuator (2012) is coupled in an articulated or rotational way to the elongated stem (2008).

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同族专利:

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公开号 | 公开日

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EP2713892A1|2014-04-09|

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US20110295242A1|2011-12-01|

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US20160192997A1|2016-07-07|

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US20160192996A1|2016-07-07|

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US20120199632A1|2012-08-09|

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CN103717147A|2014-04-09|

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WO2012166499A1|2012-12-06|

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US20140291383A1|2014-10-02|

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US9301759B2|2016-04-05|

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US10064688B2|2018-09-04|

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EP2713892B1|2019-03-27|

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US8992422B2|2015-03-31|

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PL2713892T3|2019-09-30|

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EP3560428A1|2019-10-30|

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US10213262B2|2019-02-26|

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BR112013030440A2|2016-09-27|

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US20200093550A1|2020-03-26|

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US20180132952A1|2018-05-17|

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CN103717147B|2017-09-05|

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US20190099229A1|2019-04-04|

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US11234698B2|2019-12-19|2022-02-01|Cilag Gmbh International|Stapling system comprising a clamp lockout and a firing lockout|

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US20210196299A1|2019-12-30|2021-07-01|Biosense WebsterLtd|Deflection mechanism of an ear-nose-throat tool|

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US11246593B2|2020-03-06|2022-02-15|Covidien Lp|Staple cartridge|

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WO2022011177A2|2020-07-08|2022-01-13|Procept Biorobotics Corporation|Hemostasis methods and apparatuses|

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US11266402B2|2020-07-30|2022-03-08|Covidien Lp|Sensing curved tip for surgical stapling instruments|

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CN112998625A|2021-02-08|2021-06-22|首都医科大学附属北京天坛医院|Endoscope adapting device|

法律状态:
2018-03-27| B15K| Others concerning applications: alteration of classification|Ipc: A61B 34/30 (2016.01), A61B 17/068 (2006.01), A61B |

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2018-12-11| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

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2019-10-08| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2020-09-08| B07A| Application suspended after technical examination (opinion) [chapter 7.1 patent gazette]|

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2021-01-12| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2021-04-13| 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 24/05/2012, 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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US13/118,194|US8992422B2|2006-03-23|2011-05-27|Robotically-controlled endoscopic accessory channel|

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US13/118,194|2011-05-27|

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PCT/US2012/039290|WO2012166499A1|2011-05-27|2012-05-24|Robotically-controlled endoscopic accessory channel|

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