SURGICAL INSTRUMENT

专利摘要:
robotically operated surgical instrument with electronic beam actuator. the present invention relates to a surgical sectioning and stapling instrument, suitable for laparoscopic and endoscopic clinical procedures, which holds the tissue inside an end actuator of an elongated channel opposite in an articulated manner by an anvil. various modalities are configured to be operationally fixed to a robotic system to receive activation / control movements.
公开号:BR112013030553B1
申请号:R112013030553-3
申请日:2012-05-23
公开日:2021-03-23
发明作者:Frederick E. Shelton Iv；Michael E. Setser；Ii William B. Weisenburgh
申请人:Ethicon Endo-Surgery, Inc.；
IPC主号:

专利说明:

[0001] [001] This application is a continuation-in-part and claims benefit from US patent application serial number 11 / 538,154, filed on October 3, 2006, entitled "ARTICULATING SURGICAL STAPLING INSTRUMENT INCORPORATING A TWO-PIECE E -BEAM FIRING MECHANISM ", for Shelton, IV et al. which is a continuation-part patent application of US Patent Application Serial No. 10 / 443,617, now US Patent No. 6,978,921, entitled "SURGICAL STAPLING INSTRUMENT INCORPORATING AN E-BEAM FIRING MECHANISM" to Shelton et al., granted on December 27, 2005, the descriptions of which are incorporated herein by reference in their respective totalities. FIELD OF THE INVENTION
[0002] [002] The present invention generally relates to surgical instruments that are suitable for endoscopically inserting an end actuator that is activated by a longitudinally activated firing member, and more particularly, a surgical stapling and sectioning instrument that has an articulated rod. BACKGROUND OF THE INVENTION
[0003] [003] Endoscopic surgical instruments are often preferred over traditional open surgery devices, as a smaller incision tends to reduce recovery time and complications in the postoperative period. Consequently, significant development has been applied to a variety of endoscopic surgical instruments that are suitable for the precise positioning of a distal end actuator in a surgical site, through the trocar cannula. These distal end actuators engage the tissue in various ways to obtain a diagnosis or a therapeutic effect (for example an endoscopic surgical instrument, forceps, cutter, staplers, clamp applicator, access device, therapy delivery device pharmacological / genetic, and energy device using ultrasound, RF, laser, etc.).
[0004] [004] The positioning of the end actuator is constrained by the trocar. In general, these endoscopic surgical instruments include a long shank between the end actuator and a portion of the handle handled by the physician. This long stem allows insertion to a desired depth and rotation around the longitudinal axis of the stem, thus positioning the end actuator by one degree. With careful placement of the trocar and use of claws, for example, through another trocar, this amount of positioning is often sufficient. Stapling and surgical sectioning instruments, as described in US Patent No. 5,465,895, are an example of an endoscopic surgical instrument that correctly positions an end actuator by insertion and rotation.
[0005] [005] More recently, Pat. US Serial No. 10 / 443,617, "SURGICAL STAPLING INSTRUMENT INCORPORATING AN EBEAM FIRING MECHANISM" for Shelton et al., Filed on May 20, 2003, which is hereby incorporated in full, by way of reference, describes a firing bar enhanced "electronic beam (E-beam)" for sectioning tissue and activating staples. Some of the additional advantages include positively spacing the claws of the end actuator, or, more specifically, a clamp application structure, even if too much or too little tissue is attached for optimal clamp formation. In addition, the electronic beam firing bar engages the end actuator and the clamp cartridge in a way that allows several beneficial locks to be incorporated.
[0006] [006] Depending on the nature of the operation, it may be desirable to further adjust the position of the end actuator of an endoscopic surgical instrument. In particular, it is often desirable to orient the end actuator on an axis transverse to the longitudinal axis of the instrument stem. The transverse movement of the end actuator in relation to the instrument axis is conventionally called "articulation". This is typically done by a pivot joint (or joint) that is placed on the extended rod in a position immediately proximal to the clamp application structure. This allows the surgeon to remotely articulate the staple application structure to any side for better surgical placement of the staple lines and easier manipulation and orientation of the tissue. This articulated positioning allows the doctor to engage the tissue more easily, in some cases, such as behind an organ. In addition, the articulated positioning advantageously allows an endoscope to be positioned behind the end actuator without being blocked by the instrument stem.
[0007] [007] Approaches to articulate a stapling and surgical sectioning instrument tend to be complicated by integrating joint control together with the control of the closure of the end actuator to staple tissue and trigger the end actuator (ie, staple and section) ) among the small diameter limitations of an endoscopic instrument. In general, the three control movements are all transferred through the rod as longitudinal translations. For example, US Patent No. 5,673,840 features an accordion-shaped articulation mechanism ("flex-neck)" that is articulated by selectively pulling one of the two connecting rods through the implementing rod, each stem moving, respectively, on opposite sides of the stem center line. The connecting rods engage in the form of a ratchet through a series of different positions.
[0008] [008] Another example of longitudinal control of a hinge mechanism is US Patent No. 5,865,361 which includes a hinge connection away from a cam pivot so that pushing or pulling the longitudinal translation of the hinge connection generates hinge for respective side. Similarly, US Patent No. 5,797,537 discloses a similar rod that passes through the rod to make articulation.
[0009] [009] In the copending US patent application and the same holder serial number 10 / 615,973, "SURGICAL INSTRUMENT INCORPORATING AN ARTICULATION MECHANISM HAVING ROTATION ABOUT THE LONGITUDINAL AXIS", by Frederick E. Shelton IV et al, with its description incorporated as a reference, in its entirety, a rotating movement is used to transfer the articulation movement as an alternative to longitudinal movement.
[0010] [0010] In the application entitled "SURGICAL STAPLING INSTRUMENT INCORPORATING AN E-BEAM FIRING MECHANISM" to Shelton et al., Serial number 10 / 443,617, filed on May 20, 2003, the description of which was previously incorporated in full, the reference title, a surgical sectioning and stapling instrument, suitable for laparoscopic and endoscopic clinical procedures, secures the tissue inside an elongated end of an elongated channel in opposition to an anvil. An electronic beam firing bar moves distally through the attached end actuator to section the tissue and trigger clips on each side of the cut. The electronic beam firing bar positively separates the anvil from the elongated groove to ensure properly formed closed clips, especially when a quantity of tissue is attached, which is inadequate to space the end actuator. In particular, an upper pin of the firing bar moves longitudinally through a slit in the anvil and a groove in the groove is captured between a lower cover and an intermediate pin of the firing bar to ensure minimum spacing. Although this electronic beam firing bar has several advantages, additional features are desirable to improve its manufacturing feasibility and minimize dimensional variations.
[0011] [0011] Consequently, there is a significant need for a surgical instrument with a firing bar that advantageously guarantees adequate spacing between claws attached to an end actuator and that facilitates the articulation of its stem. SUMMARY
[0012] [0012] The invention solves the deficiencies indicated above and other deficiencies of the prior art by providing a trigger mechanism that vertically and positively separates an end actuator from a surgical stapling and sectioning instrument. In this way, the instrument structurally guarantees adequate spacing to obtain proper stapling, even in cases where there is very little tissue stuck to the end actuator. Integrally forming these members into an electronic beam that includes a cutting edge creates consistent spacing and performance when the electronic beam fires through an end actuator as a sectioning and stapling assembly. Additionally, the proximal fixation of a thin and separate firing bar to the electronic beam intensifies the use in surgical articulation instruments, in which an area in reduced cross section and the ability to flex in a joint plane are desirable.
[0013] [0013] In one aspect of the invention, a surgical instrument includes a portion of handle operable to produce a firing motion to activate an implementation portion. This implementation portion has an elongated channel that receives a staple cartridge opposite an anvil fixed in an articulated manner. A triggering device includes a cutting edge presented distally received longitudinally between the elongated groove and the anvil, an upper member engageable with the anvil groove, a lower member interconnecting the groove of the groove, and an intermediate member operable to actuate the body sliding support cuneiform, which is integral with the staple cartridge. The intermediate member advantageously opposes the tightening of the end actuator, ensuring proper clamp formation even when an otherwise very small amount of fabric has been attached. These spacing and cutting members are advantageously formed in an electronic beam while the flexibility for the articulation is provided by a thin firing bar attached to the electronic beam.
[0014] [0014] In another general aspect of at least one embodiment of the present invention, a surgical instrument is provided that comprises an implementation portion that is responsive to firing movements applied to it from a robotic system. In various embodiments, the implementation portion comprises an elongated channel that is configured for attachment to an elongated rod that interfaces operationally with the robotic system and includes a channel slot. A staple cartridge is received by the elongated groove and incorporates a wedge-shaped body member located in a proximal position that is aligned to slide up a trigger that supports a clamp. An anvil is hingedly coupled to the elongated groove and includes an anvil groove. comprising a vertical slit that is opened inwardly along a longitudinal axis of the anvil. The anvil additionally comprises left-and-right recesses with a rectangular prism shape that communicate with, are cut by, and cross the vertical slit, in which said left-and-right recesses with a rectangular prism shape extend substantially along the longitudinal length of the vertical slit. Several modalities also include a firing device that has a cutting edge presented distally that is received longitudinally between the elongated groove and the vertical groove of the anvil groove of the anvil. Several modalities also include an upper limb that is comprised of left-and-right upper lateral pins that are dimensioned to slide the upper and lower inner surfaces of the left-and-right recesses with rectangular shape of the anvil channel. Several modalities also include a lower member that engages the slot of the channel and an intermediate member that is operable to actuate the staple cartridge by distally translating the cuneiform body member of the staple cartridge. In various modalities, the triggering device positively engages the elongated channel and the anvil during the longitudinal firing path to provide a spacing between them for the formation of the clamp. The engagement of the firing device during firing maintains the vertical spacing between the elongated groove and the anvil and serves to resist tightening due to inadequate trapped tissue and partial opening caused by an excessive amount of trapped tissue.
[0015] [0015] In accordance with yet another general aspect of an embodiment of the present invention, a surgical instrument is provided which comprises an implementation portion which is responsive to firing movements of a robotic system which is in communication with it. The implementation portion is diametrically dimensioned for endo-surgical use and in at least one form, it comprises an elongated channel that is coupled to an elongated rod that interfaces in an operational way with the robotic system. the elongated groove has a groove in it and an anvil is pivotally coupled to the elongated groove. The anvil is responsive to the closing movements generated by the robotic system and which are applied to the anvil by the elongated rod. The anvil includes an anvil channel. In at least one embodiment, the implementing portion further comprises a firing device that includes a cutting edge presented distally that is received longitudinally between the elongated channel and the anvil. The trigger device is configured to positively space the anvil of the elongated channel during the longitudinal path between the anvil and the elongated channel, the trigger device being configured to positively space the anvil of the elongated channel during the longitudinal path between the anvil and the elongated channel for including an upper limb that has an upper surface and a lower surface that slidably engages slidingly with the anvil.
[0016] [0016] In accordance with another general aspect of at least one embodiment of the present invention, a surgical instrument is provided that includes a robotic system that is operable to produce a plurality of control movements, including a firing movement. The modality additionally includes an implementation portion that is responsive to the firing motion of the robotic system. In various embodiments, the implementation portion comprises an elongated channel that is coupled to the robotic system and includes a channel slot. A staple cartridge is received by the elongated groove and incorporates a wedge-shaped body member located in a proximal position that is aligned to slide up a trigger that supports a clamp. An anvil is articulated coupled to the elongated groove and includes an anvil channel . One embodiment includes a firing device that has a cutting edge presented distally that is received longitudinally between the elongated channel and the anvil. An upper limb engages with the anvil channel and a lower limb engages the groove in the channel. An intermediate member has the purpose of acting on the staple cartridge by translating the edge member of the staple cartridge distally. The triggering device is configured to positively engage the elongated channel and the anvil during the longitudinal triggering path to provide a spacing between them for the formation of the clamp. An articulation joint is proximally coupled to the elongated channel and a thinning firing strip is attached proximally to the triggering device to transfer the firing motion of the robotic system through the articulation joint.
[0017] [0017] These and other objectives and advantages of the present invention will be apparent from the attached drawings and their description. BRIEF DESCRIPTION OF THE DRAWINGS
[0018] [0018] The attached drawings, which are incorporated into this specification and form part of it, illustrate modalities of the invention and, together with the general description provided above and the detailed description of the modalities provided below, serve to explain the principles of present invention.
[0019] [0019] Figure 1 is a perspective view of an endoscopic surgical stapling instrument for stapling and surgical sectioning in an open and non-articulated state;
[0020] [0020] Figure 2 is a left anterior perspective view of an open staple structure of the surgical stapling instrument of Figure 1 with a right half portion of a replaceable staple cartridge included in a staple channel;
[0021] [0021] Figure 3 is an exploded perspective view of the staple application structure of Figure 2 with a complete replaceable staple cartridge and a non-articulated shank configuration;
[0022] [0022] Figure 4 is a perspective view of a firing bar and cut in two pieces (electronic beam ("E-beam")) of the structure of application of clamps of Figure 2;
[0023] [0023] Figure 5 is a perspective view of a wedge-shaped sliding support of a staple cartridge of the staple application structure of figure 1;
[0024] [0024] Figure 6 is a left side elevation view taken in longitudinal cross section along a center line 6-6 of the staple application structure of Figure 2;
[0025] [0025] Figure 7 is a perspective view of the open staple structure of Figure 2 without the replaceable staple cartridge, a portion of the staple channel next to an intermediate pin on the firing bar and cut into two pieces, and without a distal portion of a staple channel;
[0026] [0026] Figure 8 is a front elevation view taken in cross section along line 8-8 of the staple application structure of Figure 2 representing the internal staple actuators of the staple cartridge and portions of the firing and cutting bar in two pieces;
[0027] [0027] Figure 9 is a left side elevation view generally taken along the longitudinal axis of line 6-6 of a closed clamping structure of Figure 2 to include central contact points between the wedge body sliding support and knife in two pieces, but also moved laterally to show staples and staple triggers inside the staple cartridge;
[0028] [0028] Figure 10 is a detail view of the left side in elevation of the staple application structure of Figure 9 with the knife in two pieces slightly more retracted than the typical one for replacing the staple cartridge;
[0029] [0029] Figure 11 is a view in detail of the left side in elevation of the structure of application of staples of Figure 10 with the knife in two pieces starting to fire, corresponding to the configuration represented in figure 9;
[0030] [0030] Figure 12 is a cross-sectional view of the left side in elevation of the closed clamping structure of Figure 9 after the firing bar and cutting in two pieces have fired distally;
[0031] [0031] Figure 13 is a cross-sectional view on the left in elevation of the closed staple application structure of Figure 12 after unloading the staple cartridge and retracting the knife in two pieces;
[0032] [0032] Figure 14 is a cross-sectional view of the left side in elevation of the clamping structure of Figure 13 with the two-piece knife dropped in a locking position;
[0033] [0033] Figure 15 is a top view in section taken along lines 15-15 of a joint joint (flexed neck) of the surgical stapling instrument of Figure 1;
[0034] [0034] Figure 16 is a frontal elevation view taken in vertical cross section along lines 16-16 of the articulation joint of Figure 15, showing the articulation actuators of the electroactive polymer plate (PEA) and support plates of PEA for a firing bar;
[0035] [0035] Figure 17 is a top view in section along lines 15-15 of the articulation joint of Figure 16 after the articulation;
[0036] [0036] Figure 18 is a perspective view of the articulation joint of Figure 15;
[0037] [0037] Figure 19 is a perspective view of a robotic controller modality;
[0038] [0038] Figure 20 is a perspective view of a robotic surgical arm manipulator / vehicle of a robotic system that operationally supports a plurality of surgical tool modalities of the present invention;
[0039] [0039] Figure 21 is a side view of the robotic surgical arm manipulator / vehicle shown in Figure 20;
[0040] [0040] Figure 22 is a perspective view of an exemplary vehicle structure with positioning links to operably support robotic manipulators that can be used with various surgical tool embodiments of the present invention;
[0041] [0041] Figure 23 is a perspective view of a surgical tool modality of the present invention;
[0042] [0042] Figure 24 is an exploded view of an adapter and tool retainer arrangement for attaching various surgical tool modalities to a robotic system;
[0043] [0043] Figure 25 is a side view of the adapter shown in Figure 24;
[0044] [0044] Figure 26 is a bottom view of the adapter shown in figure 24;
[0045] [0045] Figure 27 is a top view of the adapter of figures 24 and 25;
[0046] [0046] Figure 28 is a partial bottom perspective view of the surgical tool modality of Figure 23;
[0047] [0047] Figure 29 is a partial exploded view of a portion of an articulated surgical end actuator modality of the present invention;
[0048] [0048] Figure 30 is a perspective view of the surgical tool modality of Figure 28 with the tool mounting housing removed;
[0049] [0049] Figure 31 is a rear perspective view of the surgical tool modality of Figure 28 with the tool mounting housing removed;
[0050] [0050] Figure 32 is an anterior perspective view of the surgical tool modality of Figure 28 with the tool mounting housing removed;
[0051] [0051] Figure 33 is a partial exploded perspective view of the surgical tool modality of Figure 32;
[0052] [0052] Figure 34 is a partial cross-sectional side view of the surgical tool modality of Figure 28;
[0053] [0053] Figure 35 is an enlarged cross-sectional view of a portion of the surgical tool shown in Figure 34;
[0054] [0054] Figure 36 is an exploded perspective view of a portion of the tool mounting portion of the surgical tool embodiment shown in Figure 28;
[0055] [0055] Figure 37 is an exploded perspective view enlarged of a portion of the tool mounting portion of Figure 36;
[0056] [0056] Figure 38 is a partial cross-sectional view of a portion of the elongated nail assembly of the surgical tool of Figure 28;
[0057] [0057] Figure 39 is a side view of a half portion of a lock nut embodiment of a surgical tool embodiment of the present invention;
[0058] [0058] Figure 40 is a perspective view of another embodiment of the surgical tool of the present invention;
[0059] [0059] Figure 41 is a cross-sectional side view of a portion of the surgical end actuator and the elongated stem assembly of the surgical tool modality of Figure 40 with the anvil in the open portion and the closing gear assembly in one neutral position;
[0060] [0060] Figure 42 is another side view in cross section of the surgical end actuator and the elongated stem assembly shown in Figure 41 with the gear assembly engaged in a closed position;
[0061] [0061] Figure 43 is another cross-sectional side view of the surgical end actuator and the elongated stem assembly shown in Figure 41 with the clutch assembly engaged in a firing position;
[0062] [0062] Figure 44 is a top view of a portion of a tool assembly portion embodiment of the present invention;
[0063] [0063] Figure 45 is a perspective view of another embodiment of the surgical tool of the present invention;
[0064] [0064] Figure 46 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 45 with the anvil in the open position;
[0065] [0065] Figure 47 is another side view in cross section of a portion of the surgical end actuator and the elongated stem assembly of the surgical tool modality of Figure 45 with the anvil in the closed position;
[0066] [0066] Figure 48 is a perspective view of a closing drive nut and a portion of a knife bar embodiment of the present invention;
[0067] [0067] Figure 49 is a top view of another tool assembly portion of the present invention;
[0068] [0068] Figure 50 is a perspective view of another embodiment of the surgical tool of the present invention;
[0069] [0069] Figure 51 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 50 with the anvil in the open position;
[0070] [0070] Figure 52 is another side view in cross section of a portion of the surgical end actuator and the elongated stem assembly of the surgical tool modality of Figure 51 with the anvil in the closed position;
[0071] [0071] Figure 53 is a cross-sectional view of an assembly collar embodiment of a surgical tool embodiment of the present invention showing the knife bar and the distal end portion of the closing drive shaft;
[0072] [0072] Figure 54 is a cross-sectional view of the mounting collar modality of Figure 53;
[0073] [0073] Figure 55 is a top view of another embodiment of the tool mounting portion of another embodiment of the surgical tool of the present invention;
[0074] [0074] Figure 55A is an exploded perspective view of a portion of a gear arrangement of another embodiment of the surgical tool of the present invention;
[0075] [0075] Figure 55B is a cross-sectional perspective view of the gear arrangement shown in Figure 58A;
[0076] [0076] Figure 56 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 anvil in position open;
[0077] [0077] Figure 57 is another side view in cross section of a portion of the surgical end actuator and the elongated stem assembly of the surgical tool modality of Figure 56 with the anvil in the closed position;
[0078] [0078] Figure 58 is a side view of a portion of another surgical tool modality of the present invention in relation to a tool holding portion of a robotic system with some of its components shown in cross section;
[0079] [0079] Figure 59 is a side view of a portion of another embodiment of the surgical tool of the present invention in relation to a tool holding portion of a robotic system with some of the components thereof shown in cross section;
[0080] [0080] Figure 60 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;
[0081] [0081] 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;
[0082] [0082] Figure 62 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;
[0083] [0083] Figure 63 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;
[0084] [0084] Figure 64 is an enlarged cross-sectional view of a portion of the end actuator of Figure 63;
[0085] [0085] Figure 65 is another cross-sectional view of a portion of the end actuator of Figures 63 and 64;
[0086] [0086] Figure 66 is a cross-sectional side view of a portion of a surgical end actuator and an elongated stem assembly of another embodiment of the surgical tool of the present invention with the anvil in the open portion;
[0087] [0087] Figure 67 is a side view in enlarged cross section of a portion of the surgical end actuator and the elongated stem assembly of the surgical tool modality of Figure 66;
[0088] [0088] Figure 68 is another side cross-sectional view of a portion of the surgical end actuator and of the elongated stem assembly of Figures 66 and 67 with the anvil thereof in the closed position;
[0089] [0089] Figure 69 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 66 to 68;
[0090] [0090] Figure 70 is a top view of a tool assembly portion embodiment of a surgical tool embodiment of the present invention;
[0091] [0091] Figure 71 is an overall perspective view of another embodiment of the surgical tool of the present invention;
[0092] [0092] Figure 72 is a front perspective view of a disposable loading unit arrangement that can be used with various surgical tool embodiments of the present invention;
[0093] [0093] Figure 73 is a rear perspective view of the disposable loading unit of Figure 72;
[0094] [0094] Figure 74 is a bottom perspective view of the disposable loading unit of Figures 72 and 73;
[0095] [0095] Figure 75 is a bottom perspective view of another modality of disposable loading unit that can be used with various surgical tool modalities of the present invention;
[0096] [0096] Figure 76 is an exploded perspective view of a mounting portion of a disposable loading unit shown in Figures 72 to 74;
[0097] [0097] Figure 77 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;
[0098] [0098] Figure 78 is another perspective view of a portion of the disposable loading unit and the elongated rod assembly of Figure 77 with the disposable loading unit in a second position;
[0099] [0099] Figure 79 is a cross-sectional view of a portion of the disposable loading unit and elongated rod assembly mode shown in Figures 77 and 78;
[0100] [00100] Figure 80 is another cross-sectional view of the disposable loading unit and the elongated rod assembly mode shown in Figures 77 to 79;
[0101] [00101] Figure 81 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;
[0102] [00102] Figure 82 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;
[0103] [00103] Figure 83 is another partial exploded perspective view of the disposable loading unit modality and an elongated rod assembly modality of Figure 82;
[0104] [00104] Figure 84 is a top view of another tool assembly portion of a surgical tool embodiment of the present invention;
[0105] [00105] Figure 85 is a side view of another modality 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;
[0106] [00106] Figure 86 is an exploded view of a surgical end actuator modality that can be used in conjunction with various surgical tool embodiments of the present invention;
[0107] [00107] Figure 87 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;
[0108] [00108] Figure 88 is a top view of the cable-driven system and cutting instrument of Figure 87;
[0109] [00109] Figure 89 is a top view of a cable drive transmission modality of the present invention in a closed position;
[0110] [00110] Figure 90 is another top view of the cable drive transmission mode of Figure 89 in a neutral position;
[0111] [00111] Figure 91 is another top view of the cable drive transmission mode of Figures 89 and 90 in a firing position;
[0112] [00112] Figure 92 is a perspective view of the cable drive transmission mode in the position shown in Figure 89;
[0113] [00113] Figure 93 is a perspective view of the cable drive transmission mode in the position shown in Figure 90;
[0114] [00114] Figure 94 is a perspective view of the cable drive transmission mode in the position shown in Figure 91;
[0115] [00115] Figure 95 is a perspective view of another embodiment of the surgical tool of the present invention;
[0116] [00116] Figure 96 is a side view of a portion of another modality of cable driven system for driving a cutting instrument employed in various modalities of the surgical end actuator of the present invention;
[0117] [00117] Figure 97 is a top view of the cable-driven system modality of Figure 96;
[0118] [00118] Figure 98 is a top view of a tool assembly portion of another embodiment of the surgical tool of the present invention;
[0119] [00119] Figure 99 is a top cross-sectional view of another embodiment of the surgical tool of the present invention;
[0120] [00120] Figure 100 is a cross-sectional view of a portion of a surgical end actuator modality of a surgical tool modality of the present invention;
[0121] [00121] Figure 101 is an end view in cross section of the surgical end actuator of Figure 100 taken along line 101-101 in Figure 100;
[0122] [00122] Figure 102 is a perspective view of the surgical end actuator of Figures 100 and 101 with portions thereof shown in cross section;
[0123] [00123] Figure 103 is a side view of a portion of the surgical end actuator of Figures 100 to 102;
[0124] [00124] Figure 104 is a perspective view of a sliding support assembly embodiment of various surgical tool embodiments of the present invention;
[0125] [00125] Figure 105 is a cross-sectional view of the sliding support assembly mode of Figure 104 and a portion of the elongated channel of Figure 103;
[0126] [00126] Figures 106 to 111 diagrammatically show the sequential firing of clamps in a surgical tool modality of the present invention;
[0127] [00127] Figure 112 is a partial perspective view of a portion of a surgical end actuator embodiment of the present invention;
[0128] [00128] Figure 113 is a partial perspective cross-sectional view of a portion of a surgical end actuator modality of a surgical tool modality of the present invention;
[0129] [00129] Figure 114 is another perspective view in partial cross section of the type of surgical end actuator of Figure 113 with a frame assembly that advances axially through it;
[0130] [00130] Figure 115 is a perspective view of another modality of the sliding support set of another modality of the surgical tool of the present invention;
[0131] [00131] Figure 116 is a partial top view of a portion of the surgical end actuator modality shown in Figures 113 and 114 with the frame assembly advancing axially through it;
[0132] [00132] Figure 117 is another partial top view of the surgical end actuator mode of Figure 116 with the top surface of the surgical clamp cartridge omitted for clarity;
[0133] [00133] Figure 118 is a partial lateral cross-sectional view of a rotary actuator and clamp thruster modality of the surgical end actuator shown in Figures 113 and 114;
[0134] [00134] Figure 119 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;
[0135] [00135] Figure 120 is another perspective view of the automated charging system modality shown in Figure 119;
[0136] [00136] Figure 121 is a cross-sectional elevation view of the automated reloading system modality shown in Figures 119 and 120;
[0137] [00137] Figure 122 is another cross-sectional elevation view of the automated reloading system modality shown in Figures 119 to 121 with the extraction system thereby removing a worn surgical staple cartridge from the surgical end actuator;
[0138] [00138] Figure 123 is another elevation view in cross section of the automated reloading system modality shown in Figures 119 to 122 that illustrates the loading of a new surgical staple cartridge on a surgical end actuator;
[0139] [00139] Figure 124 is a perspective view of another embodiment of the automated refill system of the present invention with some components shown in cross section;
[0140] [00140] Figure 125 is an exploded perspective view of a portion of the automated reloading system modality of Figure 124;
[0141] [00141] Figure 126 is another exploded perspective view of the portion of the automated charging system modality shown in Figure 125;
[0142] [00142] Figure 127 is a cross-sectional elevation view of the mode of the automated reloading system of Figures 124 to 126;
[0143] [00143] Figure 128 is a cross-sectional view of an orientation tube modality that supports a disposable loading unit in this;
[0144] [00144] Figure 129 is a perspective view of another embodiment of the surgical tool of the present invention;
[0145] [00145] Figure 130 is a partial perspective view of an articulation joint modality of a surgical tool modality of the present invention;
[0146] [00146] Figure 131 is a perspective view of a closure tube modality of a surgical tool modality of the present invention;
[0147] [00147] Figure 132 is a perspective view of the closure tube modality of Figure 131 mounted in the articulation joint mode of Figure 130;
[0148] [00148] Figure 133 is a top view of a portion of a tool mounting portion embodiment of a surgical tool embodiment of the present invention;
[0149] [00149] Figure 134 is a perspective view of an articulation drive assembly modality employed in the tool assembly portion modality of Figure 133;
[0150] [00150] Figure 135 is a perspective view of another embodiment of the surgical tool of the present invention; and
[0151] [00151] Figure 136 is a perspective view of another embodiment of the surgical tool of the present invention. DETAILED DESCRIPTION
[0152] [00152] The applicant for this application is also the author of the following patent applications that were filed on the same date as this application and that are each incorporated by reference in their respective totalities: US patent application serial number __________, entitled "Surgical Instrument With Wireless Communication Between a Control Unit of a Robotic Tool System and Remote Sensor", proxy document number END5924USCIP2 / 060339CIP2; US patent application serial number __________, entitled "Robotically-Controlled Disposable Motor Driven Loading Unit", proxy document number END6213USCIP1 / 070330CIP1; US patent application serial number __________, entitled "Robotically-Controlled Endoscopic Accessory Channel", attorney's document number END5568USCIP2 / 100809CIP2; US patent application serial number __________, entitled "Robotically-Controlled Motorized Surgical Instrument", attorney's document number END6416USCIP1 / 080205CIP1; US patent application Serial No. __________, entitled "Robotically-Controlled Surgical Devices That Produce Formed Staples Having Different Lenghts", Attorney Document No. END5675USCIP6 / 050504CIP6; US patent application Serial No. __________, entitled "Robotically-Controlled Motorized Cutting and Fastening Instrument", Attorney Document No. END6269USCIP1 / 070391CIP1; US patent application serial number __________, entitled "Robotically-Controlled Shaft Based Rotary Drive Systems For Surgical Instruments", proxy document number END6089USCIP1 / 070059CIP1; US patent application Serial No. __________, entitled "Robotically-Controlled Surgical Instrument Having Recording Capabilities", Attorney Document No. END5773USCIP4 / 050698CIP4; and US patent application serial number __________, entitled "Robotically-Controlled Surgical Instrument With Force Feedback Capabilities", proxy document number END5773USCIP5 / 050698CIP5; and US patent application serial number __________, entitled "Surgical Stapling Instruments With Rotatable Staple Deployment Arrangements", proxy document number END7002USNP / 110262.
[0153] [00153] 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 embodiments, and that the scope of the various embodiments 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.
[0154] [00154] The uses of phrases "in various modalities", "in some modalities", "in one modality", or "in modality", or similar, in places from beginning to end of the specification are not necessarily all referring to to the same modality. Furthermore, the particular attributes, structures or characteristics of one or more modalities can be combined in any suitable way into one or more other modalities. Such modifications and variations are designed to be included within the scope of the present invention.
[0155] [00155] In Figures 1 to 3, a surgical stapling instrument 10 has an end actuator at its distal end, shown as a clamping structure 12, distanced from a cable 14 (Figure 2) by an elongated rod 16. The staple application structure 12 includes a staple groove 18 for receiving a replaceable staple cartridge 20. Hingedly attached to the staple groove 18 is an anvil 22 that attaches the fabric to the staple cartridge 20 and serves to deform the staples 23 (Figure 3) driven from the staple holes 24 in the staple cartridge 20 against the staple forming recesses 26 (Figure 6) on the underside of the anvil 28 to a closed shape. When the clamping structure 12 is closed, its cross-sectional area, as well as the elongated nail 16, are suitable for insertion through a small surgical opening, such as through a trocar cannula (not shown).
[0156] [00156] With particular reference to Figure 1, the correct placement and orientation of the clamping structure 12 is facilitated by the controls on the cable 14. In particular, a rotation button 30 causes rotation of the axis 16 around its longitudinal axis and therefore, rotation of the clamp application structure 12. Additional positioning is permitted on a joint joint 32 on the axis 16 which rotates the clamp application structure 12 in an arc from the longitudinal axis of the stem 16, thus allowing the placing behind an organ or allowing other instruments, such as an endoscope (not shown) to be oriented behind the clamp application structure 12. This articulation is advantageously made by an articulation control key 34 on the cable 14 that transmits an electrical signal for the articulation joint 32 for an electroactive polymer (PEA) actuator 36, powered by a PEA controller and the power supply 38 contained in the cable 14.
[0157] [00157] Once positioned with the tissue in the staple application structure 12, a surgeon closes anvil 22 by pulling a locking actuator 40 proximally towards the grip of the pistol 42. When attached, then the surgeon can hold a trigger trigger shown in the most distal position 44, pulling it back to trigger the application structure of clamps 12, which in some applications is done in a single trigger stroke and, in other applications, by multiple trigger strokes . The shot simultaneously staples at least two rows of staples while sectioning the fabric between them.
[0158] [00158] The retraction of the firing components can be started automatically after a complete passage. Alternatively, a retract lever 46 can be pulled back to retract. With the firing components retracted, the clamping structure 12 can be loosened and opened by the surgeon by slightly pulling the rear closing trigger 40 towards the pistol grip 42 and pressing a closing release button 48 and then releasing the closing actuator 40, thus releasing the two stapled ends of cut fabric from the staple application structure 12. Structure of application of staples.
[0159] [00159] Although a joint joint 32 is shown in Figure 1, for clarity and as an alternative application, the surgical stapling instrument 10 of Figures 2 to 14 omits a joint joint 32. It should be appreciated, however, that aspects of the present invention have particular advantages for articulation, as described below with respect to Figures 15 to 18.
[0160] [00160] In Figures 1 to 3, the structure for applying staples 12 performs the functions of stapling the fabric, activating staples and sectioning fabric by two distinct movements transferred longitudinally downward on the stem 16 in relation to the structure of the stem 70. This structure the stem 70 is fixed proximally to the handle 14 and coupled for rotation with the rotation knob 30. An illustrative multi-course handle 14 for the surgical stapling and sectioning instrument 10 of figure 1 is described in more detail in the copending US patent application and the same holder, entitled "SURGICAL STAPLING INSTRUMENT INCORPORATING A MULTISTROKE FIRING POSITION INDICATOR AND RETRACTION MECHANISM" for Swayze and Shelton, serial number 10 / 374,026, their description being incorporated by reference in its entirety, with additional features and variations described here. Although a multi-course cable 14 advantageously supports applications with high shooting forces over a long distance, applications compatible with the present invention can incorporate a single shooting course, as described in the copending US patent application and from the same holder "SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS "for Frederick E. Shelton IV, Michael E. Setser, and Brian J. Hemmelgarn, serial number 10 / 441,632, the description of which is hereby incorporated by reference in its entirety.
[0161] [00161] With particular reference to Figure 3, the distal end of the stem structure 70 is fixed to the staple groove 18. The anvil 22 has a proximal pivoting end 72 which is hingedly inside a proximal end 74 of the groove of staples 18, in a position immediately distal to their engagement with the stem structure 70. The pivoting end 72 of the anvil 22 includes a closing member 76 close to, but distal to its pivoting fixation with the staple channel 18. Thus, a tube closure 78, the distal end of which includes a horseshoe opening 80 that engages this closing member 76, selectively imparts an opening movement to the anvil 22 during the proximal longitudinal movement and a closing movement to the anvil 22 during the distal longitudinal movement of the tube closure 78 by sliding over the stem structure 70 in response to the closing driver 40.
[0162] [00162] The stem structure 70 includes and guides a firing movement of the cable 14 through a firing bar and cutting into two pieces longitudinally reciprocating 90. In particular, the stem structure 70 includes a slit in the longitudinal firing bar 92 receiving a proximal portion of the firing bar and cutting it into two pieces 90, specifically, a tapered and rolled firing bar 94. It should be understood that the tapered and rolled firing bar 94 can be replaced by a solid firing bar and by any other materials in applications not intended to pass through a hinge joint, as shown in Figures 2 to 14.
[0163] [00163] An electronic beam (E-beam) 102 is the distal portion of the firing bar and cut into two pieces 90, which facilitates the separate closing and firing as well as the spacing of the anvil 22 of the elongated staple channel 18 during the firing. With particular reference to Figures 3 to 4, in addition to any fixation treatment, such as solder or an adhesive, the firing and cutting bar 90 is formed by a vertical female fixation opening 104 formed proximally in the electronic beam 102 that receives a limb corresponding male fixation 106 presented distally by the tapered and rolled firing bar 94, allowing each portion to be formed by a selected material and by a process suitable for its different functions (for example, resistance, flexibility, friction). The electronic beam 102 can advantageously be formed from a material that has suitable material properties to form a pair of top pins 110, a pair of intermediate pins 112 and a lower pin or foot 114, as well as being able to acquire a cutting edge. sharp 116. In addition, the integrally formed and proximally projecting top guide 118 and the intermediate guide 120 that includes each vertical edge of the cutting edge 116 further defines a tissue preparation area 122 that helps guide the fabric towards the edge sharp cutter 116 before cutting. The intermediate guide 120 also serves to engage and trigger the clamp application apparatus 12 by contiguously placing a central member in steps 124 of a sliding body support wedge 126 (Figure 5) that forms the clamp by the application structure of clamps 12, as described in more detail below.
[0164] [00164] The formation of these members (for example, top pins 110, intermediate pins 112, and bottom foot 114) integrally with the electronic beam 102 facilitates the manufacture in tighter tolerances in relation to the others in comparison with the assembly from a plurality of parts, ensuring the desired operation during firing and / or effective interaction with various locking members of the clamping structure 12.
[0165] [00165] In Figures 6 to 7, the surgical stapling instrument 10 is shown open, with the electronic beam 102 completely retracted. During assembly, the lower leg 114 of the electronic beam 102 is released through an enlarged hole 130 of the staple channel 18 and the electronic beam 102 is then advanced so that the electronic beam 102 slides distally along a lower rail 132 formed in the clamp groove 18. In particular, the lower rail 132 includes a narrow groove 133 that opens like an enlarged groove 134 on a lower surface of the clamp groove 18 to form an inverted T shape in the lateral cross section as shown particularly in the Figures 7 and 8, communicating with the widened orifice 130. Once assembled, the components coupled proximally to the rolled and tapered firing bar 94 do not allow the smaller foot 114 to move proximally again to the widened orifice 130 to allow disengagement .
[0166] [00166] In figure 9, the laminated and tapered firing bar 94 facilitates the insertion of the structure for applying staples 12 through a trocar. In particular, a more distal downward projection 136 raises the beam 102 when completely retracted. This is done by placing the downward projection 136 at a point where it slides upward over a proximal edge of the enlarged orifice 130 in the clamp channel 18.
[0167] [00167] In figure 10, the rolled and tapered firing bar 94 also intensifies the operation of certain locking members that can be incorporated in the clamp channel 18 by including a more proximal upward projection 138 that is driven downward by the structure of the rod 70 during an initial portion of the firing path. In particular, a sidebar 140 is defined between a pair of square openings 142 in the stem structure 70 (Figure 3). A clip spring 144 covering the side bar 140 pushes down a portion of the rolled and tapered firing bar 94 that protrudes distally out of the longitudinal slot of the firing bar 92, which ensures that certain advantageous locking members are engaged when appropriate. This thrust is more pronounced or confined only to that portion of the firing path when the upward projection 138 comes into contact with the clip spring 144.
[0168] [00168] In Figures 6 to 7, the electronic beam 102 is retracted with its top pins 110 contained within an anvil pocket 150 close to the pivoting proximal end of the anvil 22. A vertical slit of the anvil opened downwards 152 ( Figure 2) extends laterally on the anvil 22 into an inner rail of the anvil 154 that captures the top pins 110 of the electronic beam 102 when they advance distally during firing, as shown in Figures 9 to 10, positively spacing the anvil 22 of the staple channel 18. Thus, with the electronic beam 102 retracted, the surgeon is able to open and close the structure of application of staples 12 repeatedly until he is satisfied with the placement and orientation of the tissue captured there for stapling and sectioning, in addition to In addition, the electronic beam 102 assists in the proper positioning of the fabric even for a clamping structure 12 with reduced diameter and correspondingly reduced stiffness.
[0169] [00169] In Figures 2 to 3, 5 to 6, 8 to 14, the staple application structure 12 is shown with the replaceable staple cartridge 20 which includes the wedge body sliding support 126. A plurality of wedge body slots longitudinally aligned and parallel openings 202 (Figure 8) receive the respective triangular bodies 204 integral with the wedge body sliding support 126. In Figures 8 to 10, the wedge body sliding support 126 then slides upwards a plurality of actuators. staples 206 that slide vertically into the recesses of the staple trigger 208. In this illustrative version, each staple trigger 206 includes two vertical extensions, each translating upward into a respective staple hole 210 to force up and deform a clamp 23 that rests against a clamp forming surface 214 (Figure 10) of the anvil 22. A central firing recess 216 (Figu 3) defined inside the staple cartridge 20 next to the staple channel 18 allows the passage of the horizontal bottom portion 218 (Figure 5) of the sliding body support wedge 126 as well as the intermediate pins 112 of the electronic beam 102. Specifically, a staple cartridge tray 220 (Figures 3, 8) attaches and sits under a polymer staple cartridge body 222 that has the staple driver recesses 208, the staple holes 210, and the central firing recess 216 formed in him. When staples 23 are then formed to either side, the sharp cutting edge 116 enters a vertical through slot 230 that passes through the longitudinal axis of the staple cartridge 20, except for only one more distal end thereof.
[0170] [00170] The triggering of the clamping structure 12 starts as shown in figure 10 with the firing bar and cutting in two pieces 90 pulled proximally until the downward projection 136 slides the intermediate guide 120 in the electronic beam 102 up and back , allowing a new staple cartridge 20 to be inserted into the staple groove 18 when the anvil 22 is open, as shown in Figures 2, 6.
[0171] [00171] In Figure 11, the two-piece firing and cutting bar 90 has been advanced distally a short distance, allowing the downward projection 136 to fall into the widened hole 130 of the lower rail 132 under the push of the clip spring 144 against the upward projection 138 of the laminated and tapered firing bar 94. The intermediate guide 120 prevents further downward rotation by resting on the stepped center member 124 of the wedge body sliding support 126, thus maintaining the intermediate pin 112 of the electronic beam inside of the central trigger recess 216.
[0172] [00172] In Figure 12, the firing and cutting bar in two pieces 90 was fired distally, advancing the wedge-shaped sliding support 126 to cause the formation of staples 23 while sectioning the tissue 242 trapped between the anvil 22 and the staples 20 with the sharp cutting edge 116. Subsequently, in Figure 13, the firing and cutting bar in two pieces 90 is retracted, leaving the sliding body support wedge 126 positioned distally.
[0173] [00173] In Figure 14, the intermediate pin 112 is allowed to translate down into a locking recess 240 formed in the staple channel 18 (see also Figures 7, 10). In this way, the operator receives a tactile indication when the intermediate pin 112 meets the distal edge of the locking recess 240 when the sliding body support wedge 126 (not shown in Figure 14) is not located in a proximal position (that is, staples 20 missing or staple cartridge 20 worn out).
[0174] [00174] In Figure 1, a hinge joint 32 is shown, which advantageously benefits from the flexible force of the firing bar and cut into two pieces 90. In Figures 15 to 18, the hinge joint 32 is shown as a hinge flexed neck 300 formed by the body of the spine 302 which has laterally symmetrical pairs of arch recesses 304 that allow articulation in an articulation plane. It is common knowledge how to simultaneously compress and expand the respective side sides 306, 308 by the selective movement of the control rods (not shown) that pass longitudinally through the respective side sides 306, 308. However, PEA 310 plate actuators are shown, 312, each being capable of performing deflection fed to one or both lateral directions.
[0175] [00175] A central passage 320 (Figure 16) defined longitudinally through the body of the spine 302 receives a pair of support plates 322, 324 that prevent the bending and connection of the rolled and tapered firing bar 94. In the illustrative version, each support plate 322, 324 has a fixed proximal end 326 (Figure 15) and a sliding end 328 to accommodate changes in radial distance during articulation. Having a firing bar 94 with a thinner thickness is then supported.
[0176] [00176] Although the present invention has been illustrated by describing various modalities and although the illustrative modalities have been described in considerable detail, it is not the applicants' intention to restrict or in any way limit the scope of the appended claims to such details. Additional advantages and modifications can be readily available to those skilled in the art.
[0177] [00177] For example, although there are several advantages of having an integral wedge body sliding support with a staple cartridge, in some applications compatible with aspects of the present invention, the wedge body sliding support can be integral with an electronic beam. For example, the entire end actuator can be replaceable instead of just the staple cartridge.
[0178] [00178] Over the years, a variety of minimally invasive robotic (or "telesurgical") systems have been developed in order to increase surgical dexterity as well as to allow the surgeon to intuitively operate a patient. Many of these systems are disclosed in the following US patents which are each incorporated herein by reference in their entirety: 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 DLUS 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 El ectrosurgical End Effectors ". Many of these systems, however, did not, in the past, have the ability to generate the magnitude of forces necessary to cut and fix tissue effectively.
[0179] [00179] Figure 19 reveals a version of a master controller 1001 that can be used in conjunction with an 1100 robotic arm slave vehicle of the type shown in Figure 20. Master controller 1001 and the robotic arm slave vehicle 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 given in US Patent No. 7,524,320 which has been incorporated into this document for reference. Accordingly, various details of such devices will not be described in detail here in addition to what may be necessary to understand the various modalities and forms of the present invention. As is well known, master controller 1001 generally includes master controllers (generically represented as 1003 in Figure 19) that are held by the surgeon and manipulated in space while the surgeon observes the procedure through a stereo display 1002. The master controllers 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 potential to an electrode or similar).
[0180] [00180] As can be seen in Figure 20, in one form, the robotic arm vehicle 1100 is configured to operate a plurality of surgical tools, generically designated as 1200. Various methods and systems of robotic surgery that employ master controller and of robotic arm vehicles 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 vehicle 1100 includes a base 1002 from which, in the illustrated embodiment, three surgical tools 1200 are supported. In various forms, the surgical tools 1200 are each supported by a series of manually articulated connections, generally called adjustment joints 1104, and a robotic manipulator 1106. These structures are illustrated here with protective covers extending over much of the robotic connection. 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 vehicle 1100. Vehicle 1100 will, in general, have adequate dimensions to transport vehicle 1100 between operating rooms. The 1100 vehicle can be configured to typically fit through standard operating room doors and on standard hospital elevators. In various forms, the 1100 vehicle would preferably have a weight and would include a wheel system (or other transport) that allows the 1100 vehicle to be positioned adjacent to an operating table by a single attendant.
[0181] [00181] Now, referring to Figure 21, in at least one form, robotic manipulators 1106 can include a connection 1108 that restricts movement of the surgical tool 1200. In various embodiments, connection 1108 includes rigid coupled connections joined by joints rotatable in a 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 incorporated herein by reference. The parallelogram arrangement restricts rotation to rotate about an axis 1112a, sometimes called a pitch axis. The links that support the parallelogram connection are pivotally mounted on the installation joints 1104 (Figure 20) so that the surgical tool 1200 additionally rotates about an axis 1112b, sometimes 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.
[0182] [00182] In Figure 22, an alternative configuration joint structure is illustrated. In this embodiment, a surgical tool 1200 is supported by an alternative manipulator structure 1106 'between two tissue manipulation tools. Those skilled in the art will understand 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 incorporated herein by way of reference. In addition, although data communication 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 circuitry of the a manipulator, an adjustment joint, an endoscope or other image capture device or the like 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.
[0183] [00183] 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 24) that is operationally coupled to a master controller 1001 that is operable through inputs of an operator (i.e., a surgeon) is shown in Figure 23. 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 24 to 28. 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 28) portions of rotating body, members or driven discs 1304, which each include a pair of pins 1306 that extend from a surface of the driven element 1304. A pin 1306 is closest to an axis of rotation for each of the driven members 1304 of the than the other pin 1306 on the same driven element 1304, which helps to ensure positive angular alignment of the driven element 1304. The interface 1230 includes an adapter portion 1240 that is configured to engage the mounting plate 1302 in an assembled manner, as will be additionally discussed below. The adapter portion 1240 may include an arrangement of electrical connecting pins 1242 (Figure 26) that can be coupled to a memory structure by a circuit board inside the tool mounting portion 1300. Although 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.
[0184] [00184] As can be seen in Figures 24 to 27, 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 23). 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 support side 1246 of rotatable bodies 1250 are configured to precisely align the driven members 1304 (Figure 28) of the tool mounting portion 1300 with the drive elements 1271 of the holder of tool 1270. As discussed above in relation to the inner and outer pins 1306 of the driven members 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 members. The openings 1256 on the tool side 1244 are displaced about 90 degrees from the openings 1256 '(shown in dashed lines) on the retainer side 1246, as can be seen most clearly in Figure 27.
[0185] [00185] Several embodiments may additionally include an arrangement of electrical connector pins 1242 located on the support side 1246 of the adapter 1240 and the tool side 1244 of the adapter 1240 may include grooves 1258 (Figure 27) for receiving a pin arrangement (no shown) of the tool mounting portion 1300. In addition to transmitting electrical signals between the surgical tool 1200 and the tool holder 1270, at least some of these electrical connections can be coupled to an adapter memory device 1260 (Figure 26) by a circuit board of the 1240 adapter.
[0186] [00186] 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 the adapter 1240 and tool retainer 1270 and which was generally designated as 1010 in Figure 24. For example, as can be seen in Figure 24, 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 26. In at least one way, a latch assembly 1245 is movably supported over adapter 1240 and is inc 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. A spring or springs (not shown) are used to orient the lock assembly in the locked position. A lip on the tool side 1244 of the adapter 1240 can slidably receive laterally extending tool mounting housing tabs 1301.
[0187] [00187] Turning to Figures 28 to 35, in at least one embodiment, the surgical tool 1200 includes a surgical end actuator 2012 that comprises, in this example, among other things, at least one component 2024 that is selectively mobile between first and second positions with respect to at least one other component 2022 in response to various control movements applied to this as will be discussed in further 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 pivotally translatable gripping member, such as an anvil 2024. Various embodiments of the plunger actuator. surgical end 2012 are configured to keep the anvil 2024 and the elongated groove 2022 in a spacing that ensures effective stapling and sectioning of the tissue attached by the 2012 surgical end actuator. As can be seen in Figure 34, the surgical end actuator 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 frame 2033 is activated distally, its configuration "in the shape of a wedge-shaped body" comes into contact with the movable clamp actuators and drives them vertically towards the closed anvil 2024. Surgical clamps are formed as they are activated for the surface of formation located on the underside of the anvil 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 anvil 2024 can be pivoted open and closed at a pivot point 2025 located at the proximal end of the elongated channel 2022. The anvil 2024 may also include a flap 2027 at its proximal end that interacts with a component of the mechanical closure system ( described further below) to facilitate the opening of the anvil 2024. the elongated channel 2022 and the anvil 2024 can be made of electrically conductive material (such as metal) so that it can serve as part of an antenna that communicates with sensor (s) in 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.
[0188] [00188] As can be seen in Figures 28 to 35, the surgical end actuator 2012 is attached 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 29. In other modalities, 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 on the anvil 2024 is inserted to facilitate opening of the anvil 2024 as the distal closing tube 2042 is moved axially in the proximal "PD" direction. 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 shaft assembly (for example, the 2048, 2050 drive rods) can be made of a non-conductive material (such as plastic).
[0189] [00189] 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 structure 1309 and a sliding closing support 2100 which is also movably supported on tool mounting plate 1302. In at least one way, the rotary drive assembly 2069 includes a pipe gear segment 2062 that is formed at (or attached to) the proximal end 2060 of the pipe proximal lock 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 31, the rotating gear set 2070, in at least one embodiment, comprises a gear rotary drive system 2072 which is coupled to a first of the corresponding driven members or disks 1304 on the adapter side 130 7 of the tool mounting plate 1302 when the tool mounting portion 1300 is coupled to the tool drive assembly 1010. See Figure 28. The rotary gear assembly 2070 additionally comprises a rotary driven gear 2074 that is rotatably supported on the tool mounting plate 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 corresponding driven element 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 tool axis LT-LT (represented by the arrow "R" in Figure 31). 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.
[0190] [00190] In at least one embodiment, the closing of the anvil 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 In various embodiments, the proximal end 2060 of the proximal closing tube 2040 is supported by the closing sliding support 2100 comprising a portion of a closing transmission, shown, in general, as 2099. In at least one form, the closing sliding support 2100 is configured to support the 2009 closing tube assembly on the tool mounting plate 1320 so that the proximal closing tube 2040 can rotate with respect to the closing sliding support 2100, yet travel axially with the closing sliding support 2100. In particular, as can be seen in Figure 36, the closing slide support 2100 has a vertical flap 2101 that extends in a radial groove 2063 in the proximal end portion of the proximal closing tube 2040. In addition, as seen in 33 and 36, the closing slide support 2100 has a flap portion 2102 that extends through a slot 1305 in the tool mounting plate 1302 The flap portion 2102 is configured to hold the closing sliding bracket 2100 in sliding engagement with the tool mounting plate 1302. In various embodiments, the closing sliding bracket 2100 has a vertical portion 2104 that has a panel gears. closure 2106 formed therein. The closing panel gear 2106 is configured to drive the engagement with a closing gear set 2110. See Figure 33.
[0191] [00191] In various forms, the closing gear assembly 2110 includes a closing gear wheel 2112 that is coupled to a corresponding second of the driven disks or members 1304 on the adapter side 1307 of the tool mounting plate 1302. See Figure 28. 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 mounting portion of tool 1300 is coupled to the tool drive set 1010. The closing gear set 2110 further includes a set of closing reduction gear 2114 which is supported in network engagement with the closing gear wheel 2112. As can be seen in Figures 32 and 33, the closing reduction gear set 2114 includes a driven gear 2116 which is swiveled in network engagement with the closing sprocket gear 2112. The closing reduction gear assembly 2114 further includes a first closing drive gear 2118 that is in network engagement with a second closing drive gear 2120 which is pivotally supported on tool mounting plate 1302 in network engagement with closing panel gear 2106. Therefore, the application of a second pivoting output movement from the drive assembly of tool 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 slide support 2100 and the closing tube 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 slide support 2100 will be driven in the distal direction "DD" and will finally trigger the closing pipe assembly 2009 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 anvil 2024 and cause the anvil 2024 to rotate to a closed position. By applying an "opening" output movement of the tool drive assembly 1010 of the robotic system 1000, the closing slide support 2100 and the closing pipe assembly 2009 will be driven in the proximal direction "PD". As the distal closing tube 2042 is activated in the proximal direction, the opening 2045 interacts with the flap 2027 on the anvil 2024 to facilitate its opening. In various embodiments, a spring (not shown) can be used to tilt the anvil 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 anvil 2024 on the tissue to be cut and stapled by the surgical end actuator 2012. For example, the transmission gears 2110 closures can be sized to generate approximately 311.4 to 533.8 Newtons (70 to 120 pounds).
[0192] [00192] In several modalities, the cutting instrument 2032 is driven through the surgical end actuator 2012 by a 2200 knife bar. See Figures 34 and 36. In at least one shape, the 2200 knife bar is manufactured from , for example, stainless steel or other similar materials and has a substantially rectangular cross-sectional shape. Such a knife bar configuration is rigid enough to press the 2032 cutting instrument through the tissue attached to the surgical end actuator 2012, while still flexible enough to allow the 2012 surgical end actuator to articulate with respect to the closure 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 37 and 38, 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 axially pushed 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 36. Such an arrangement allows the proximal column portion 2052 to rotate, but do not move axially, inside the 2040 proximal closing tube.
[0193] [00193] As shown in Figure 34, 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 36. As can be seen in Figures 30 to 35, knife panel gear 2206 is slidably supported in one panel housing 2210 which is attached to tool mounting plate 1302, so that knife panel gear 2206 is retained in mesh engagement with a knife gear assembly 2220. More specifically and with reference to Figure 33, in at least one embodiment, the knife gear assembly 2220 includes a knife gear 2222 that is coupled to a third corresponding disk or driven element among the driven disks or members 1304 on the adapter side 1307 of the mounting plate of tool 1302. See Figure 28. Therefore, the application of another rotating output movement of the robotic system 1000 through the tool drive set 1010 to the corresponding third driven member 1304 will cause the rotating of the toothed gear 2222. the set 2220 knife gear reduction also includes a 2224 knife gear reduction set that includes a first driven knife gear 2226 and a second knife drive gear 2228. The knife gear reduction set 2224 is pivotally mounted on the tool mounting plate 1302, so that the first knife drive gear 2226 is in network engagement with the knife gear wheel 2222. Likewise, the second knife drive gear 2228 is in network engagement with a third knife drive gear 2230 which is rotatably supported on the tool mounting plate 1302 in network engagement with the gear of knife panel 2206. In various embodiments, the gears of the knife gear assembly 2220 are dimensioned 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.
[0194] [00194] In various 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 which are slidably supported in the corresponding passages 2053 provided through the proximal column portion 2052. See Figures 36 and 38. In at least one form , 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 a proximal end 2252 which has a guide rod projecting from it that extends laterally through a corresponding slot in the proximal end portion of the proximal column portion 2052 and into a corresponding arcuate slot in a 2260 hinge thread comprising a portion of the joint transmission. Figure 37 illustrates the pivot bar 2250a. It will be understood that the pivot bar 2250b is similarly constructed. As can be seen in Figure 37, 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 back portion 2050 and in a corresponding arcuate slot 2262 in the hinge nut 2260. Furthermore, 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 it 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.
[0195] [00195] 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 pivotally seated on the proximal end portion 2056 of the distal column portion 2050 and is pivotally actuated thereon by a pivot gear assembly 2270. More specifically and with reference to Figure 31, at at least one embodiment, the hinge gear assembly 2270 includes a hinge sprocket 2272 that is coupled to a fourth disk or corresponding driven element among the driven disks or members 1304 on the adapter side 1307 of the tool mounting plate 1302. See Figure 28. Therefore, the application of another rotating input movement from the robotic system 1000 through the tool drive set 1010 to the corresponding fourth driven element 1304 will cause the toothed gear wheel 2272 to rotate when the interface 1230 is attached to the 1270 tool retainer. A 2274 pivot drive gear is rotatably supported io on the tool mounting plate 1302 in network engagement with the toothed gear wheel 2272 and a gear portion 2264 of the hinge thread 2260, as shown. As can be seen in Figures 36 and 37, the hinge nut 2260 has a shoulder-shaped part 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 nut 2260 in a second direction that is opposite the first direction will result in axial movement of the hinge bar 2250a in the proximal direction "PD "as well as causing the 2250b pivot bar to move axially in the distal" DD "direction. In this way, the surgical end actuator 2012 can be selectively articulated around the geometric axis of articulation "AA-AA" in a first direction "FD" through the simultaneous movement of the articulation bar 2250a in the distal direction "DD" and the bar articulation 2250b in the proximal direction "PD". Similarly, the surgical end actuator 2012 can be selectively pivoted around the "AA-AA" hinge axis in a second "SD" direction by simultaneously moving the 2250a pivot bar in the "PD" proximal direction and the articulation bar 2250b in the distal direction "DD". See Figure 29.
[0196] [00196] The tool modality described above employs an interface arrangement that is particularly well suited to assemble the robotically controllable medical tool on at least one form of robotic arm arrangement that generates at least four different rotary control movements. Members skilled in the art will observe that such rotating output movements can be selectively controlled through the programmable control systems employed by the robotic system / controller. For example, the tool arrangement described above may be well suited for use with those robotic systems produced by Intuitive Surgical, Inc. of Sunnyvale, California, USA, many of which can 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 supplied by the robotic system to generate specific control movements that are of sufficient magnitude that allow the cut-end actuators and staple the fabric. In this way, the unique provisions and principles of various modalities of the present invention can allow a variety of different forms of the tool systems presented and claimed in the present invention to be used effectively in conjunction with other types and forms of robotic systems that supply programmed rotary movements. or other outgoing movements. In addition, as will become additionally apparent as the progress of the present Detailed Description, various end actuator modalities of the present invention that require other forms of actuation movements can also be acted upon effectively with the use of one or more of the generated control movements. by the robotic system.
[0197] [00197] Figures 40 to 44 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 groove 2322 and a pivotally translatable claw member, such as an anvil 2324, which are kept at a spacing that ensures effective clamping and sectioning of tissue attached to the surgical end actuator 2312. As shown in the illustrated embodiment, the surgical end actuator 2312 may include, in addition to the elongated groove 2322 and the anvil 2324 mentioned above, a cutting instrument 2332 that has a frame portion 2333 formed in the themselves, a surgical clamp cartridge 2334 which is seated on the elongated groove 2322 and a drive shaft of the rotary end actuator 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 drive shaft 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 shaft of the 2336 end actuator is rotated. The anvil 2324 can be pivoted open and closed at a pivot point 2325 connected to the end of the elongated groove 2322. The anvil 2324 may also include a flap 2327 at its close end that interfaces operatively with a component of the system. mechanical closure (further described below) to open and close the anvil 2324. When the drive shaft of the end actuator 2336 is rotated, the cutting instrument 2332 and the frame 2333 will run longitudinally through the surgical clamp cartridge 2334 from the position initial to the final position, thus cutting the tissue trapped in 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 sectioned tissue and against the closed anvil 2324, which rotates the clamps to secure the sectioned fabric. In one form, the elongated channel 2322 and the anvil 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.
[0198] [00198] It should be noted that, although the surgical tool 2300 modalities described in this document employ a surgical end actuator 2312 that clips the sectioned tissue, in other different technical modalities for fixing or sealing the sectioned tissue can be used. For example, end actuators that use RF (radio frequency) energy or adhesives to fix the separate 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., which are incorporated here, as a reference, present cutting instruments that use RF energy to fix the sectioned tissue. US patent application No. 11 / 267,811 to Morgan et al. and US patent application No. 11 / 267,363 to Shelton et al., which are also incorporated herein by way of reference, reveal cutting instruments that use adhesives to secure the sectioned tissue. 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 fixation techniques can also be used.
[0199] [00199] 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. Members skilled in the art will understand that other modalities may have an articulation joint in this. 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 41 to 43.
[0200] [00200] As shown in Figure 41, the distal back axis 2350 has a proximal end portion 2351 that is slidably received inside a groove 2355 on a proximal back axis 2353 that is non-movably supported inside of the hollow outer tube 2340 by at least one support collar 2357. As can be seen in Figures 41 and 42, the surgical tool 2300 includes a closing tube 2370 that is restricted to only move axially in relation to the distal base stationary portion 2360. The closing tube 2370 has a proximal end 2372 that has an internal thread 2374 formed therefrom 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 various forms, the 2375 drive arrangement includes a rotary drive shaft assembly, generally referred to as 2381. When rotated, the drive shaft assembly The rotating insert 2381 will cause the closing tube 2370 to move axially, as will be described in more detail below. In at least one form, the rotary drive shaft assembly 2381 includes a closing drive nut 2382 of a closing clutch assembly generally designated 2380. More specifically, the closing drive nut 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 nut 2382, defines an annular slot 2388 in which a shoulder 2392 of a locking collar 2390 extends. Locking collar 2390 is fixed in a non-movable manner (for example, welded, glued etc.) to the end of the outer tube 2340. This arrangement serves to affix the closing drive nut 2382 to the outer tube 2340 while allowing the lock nut closing drive 2382 rotate in relation to the outer tube 2340. The closing drive nut 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 nut 2382 will cause the closing tube 2370 to move axially, as represented by the arrow "D" in Figure 42.
[0201] [00201] The closing of the anvil 2324 and the actuation of the cutting instrument 2332 are carried out by control movements that are transmitted by a hollow cylindrical fitting 2400. As can be seen in Figures 41 and 42, the hollow actuation sleeve 2400 it is received in a rotating and sliding manner on the distal back axis 2350. The cylindrical drive socket 2400 has a proximal end portion 2401 which is rotatably mounted to the proximal column stem 2353 protruding from the tool mounting portion 2460 so that the cylindrical drive socket 2400 can rotate with respect to it. See Figure 41. As can also be seen in Figures 41 to 43, the cylindrical drive socket 2400 is rotated around the longitudinal axis of the "LT-LT" tool by a drive shaft 2440. The drive shaft 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.
[0202] [00202] The cylindrical drive 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 therein that are adapted for selective engagement with corresponding proximal tooth cavities 2418 formed in the proximal end portion 2384 of the closing drive nut 2382. Therefore, when the proximal teeth 2416 are in network engagement with the proximal tooth cavities 2418 in the closing drive nut 2382, rotation of the driving cylindrical socket 2400 will result in rotation of the closing drive nut 2382 and finally causes the closing tube 2370 to move axially, as will be discussed in more detail below.
[0203] [00203] As can be seen more particularly in Figures 41 and 42, the distal face 2414 of the drive clutch portion 2410 has a series of distal teeth 2415 formed therein which are adapted for selective engagement with corresponding distal tooth cavities 2426 formed in a face plate portion 2424 of a knife drive shaft assembly 2420. In various embodiments, the knife drive shaft assembly 2420 comprises a hollow knife stem segment 2430 which is pivotally received in a corresponding portion of the distal column rod 2350 which 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 face plate portion 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 seen in Figures 41 to 43, a knife drive gear 2432 is attached to the drive shaft segment 2430 and is in interlocking engagement with a drive knife gear 2434 which is attached to the drive shaft of the end actuator 2336. Thus, rotation of the drive shaft segment 2430 will result in rotation of the drive shaft of the end actuator 2336 to drive the cutting instrument 2332 and the sliding support 2333 distally through the surgical staple cartridge 2334 to cut and staple the tissue trapped in the interior of the surgical end actuator 2312. The sliding support 2333 can be made, for example, of plastic, and can have an inclined distal surface. As the sliding support 2333 passes through the elongated groove 2322, the sloping front surface of the sliding support 2333 pushes up or "drives" the clamps on the surgical clamp cartridge 2334 through the attached tissue and against the anvil 2324. The anvil 2324 rotates or " forms "the staples, thus stapling the sectioned fabric. As used here, the term "trigger" refers to the initiation of actions required to drive the cutting instrument and the sliding support portion in a distal direction through the surgical staple cartridge to cut the tissue trapped in the surgical end actuator and trigger staples through the separate fabric.
[0204] [00204] 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 44, a proximal end 2341 of the outer tube 2340 is swiveled within a support arrangement 2343 attached to the tool mounting plate 2462 of the tool mounting portion 2460. A rotating gear 2345 it is formed into 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 rotary drive gear 2472 is coupled to a first match between driven disks or members 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 28 and 44. The rotary drive assembly 2470 additionally comprises a rotary driven gear 2474 which is supported d and rotary mode on the tool mounting plate 2462 in network engagement with the rotating gear 2345 and the rotating drive gear 2472. The application of a first rotating outward movement from the robotic system 1000 through the drive assembly Tool 1010 for the corresponding driven element 1304 will thus cause the rotation of the 2472 drive gear to rotate 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).
[0205] [00205] The closing of the anvil 2324 in relation to the staple 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 nut 2382. To apply the rotating control movement to the closing drive nut 2382, the closing clutch 2410 must first be engaged in mesh with the proximal end portion 2384 of the closing drive nut 2382. In various embodiments, the transmission arrangement 2375 further includes a displacement drive assembly 2480 that is operationally supported on the tool mounting plate 2462. More specifically and with reference to Figure 44, it can be noted that a proximal end portion 2359 of the proximal back portion 2353 extends through the rotating gear 2345 and is rotatably coupled to a shifter gear rack 2481 that is slidably attached to the 2462 tool mounting plate through slots 2482. The c Shifter drive assembly 2480 further comprises a shifter drive gear 2483 that is coupled to a corresponding second within one of the driven disks or members 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 28 and 44. Shifter drive assembly 2480 additionally comprises shifter driven gear 2478 which is swiveled on tool mounting plate 2462 in mesh with the drive gear of displacer 2483 and displacer panel gear 2482. The application of a second rotating output movement from the robotic system 1000 through the tool drive set 1010 to the corresponding driven element 1304 will therefore cause the drive gear to rotate displacer 2483 by virtue of 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 in the closing drive nut 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 shaft assembly 2420.
[0206] [00206] Once the closing clutch 2410 has been engaged in network engagement with the closing drive nut 2382, the closing drive nut 2382 is rotated by turning the closing clutch 2410. The rotation of the closing clutch 2410 it is controlled by applying rotating outgoing 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 44. In at least one embodiment, the rotary drive transmission 2490 includes a rotary drive assembly 2490 'which includes a gear 2491 which is coupled to a corresponding third of the driven disks or members 1304 on the adapter side of the tool mounting plate 2462 when the tool mounting portion 2460 is coupled to the tool retainer 1270. See Figures 28 and 44. The 2490 rotary drive transmission with additionally comprises 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 the drive shaft 2440.
[0207] [00207] The rotation of the rotating drive gear 2491 in a first rotating direction will result in the rotation of the drive shaft 2440 in a first direction. Conversely, rotating the rotating drive gear 2491 in a second rotating direction (opposite the first rotating direction) will cause the drive shaft 2440 to rotate in a second direction. As indicated above, the drive shaft 2440 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. Therefore, the rotation of the shaft 2440 drive shaft results in the rotation of the 2400 drive cylindrical socket.
[0208] [00208] A method for operating the 2300 surgical tool will now be described. When the mounting portion of tool 2462 has been operationally coupled to tool holder 1270 of the robotic system 1000 and oriented to the position adjacent to the target tissue to be cut and stapled, if the anvil 2334 is not already in the open position (Figure 41) , the robotic system 1000 can apply the first rotating outward movement to the drive gear of the shifter 2483 which results in the axial movement of the closing clutch 2410 for interlocking engagement with the closing drive nut 2382 (if it is not already in interlocking engagement with that). See Figure 42. Once the robotic system controller 1001 has confirmed that closing clutch 2410 is in network engagement with closing drive nut 2382 (for example, through sensor (s) - no shown) on the surgical end actuator 2312 which is in communication with the robotic control system), the robotic controller 1001 can then apply a second rotary outward motion to the rotary drive gear 2492 which, as described above, results in finally, the rotation of the rotating drive nut 2382 in the first direction which results in the axial path of the closing tube 2370 in the distal direction "DD". When the closing tube 2370 has moved in the distal direction, it contacts a portion of the anvil 2323 and causes the anvil 2324 to rotate to the closed position to trap the target tissue between the anvil 2324 and the surgical staple cartridge 2334. When the robotic controller 1001 determines that the anvil 2334 has been rotated to the closed position by corresponding sensor (s) on the surgical end actuator 2312 in communication therewith (not shown), the robotic system 1000 stops the application of the second movement rotating outlet to rotary drive gear 2491. The robotic controller 1001 can also provide the surgeon with an indication that the anvil 2334 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 face plate portion 2424 of knife drive shaft assembly 2420. See Figure 43. When controller 1001 of robotic system 1000 has confirmed that closing clutch 2410 is in interlocking engagement with plate portion face 2424 (via the sensor (s)) on the end actuator 2312 which is (are) in communication with the robotic controller 1001), the robotic controller 1001 can then apply the second rotating output movement to the gear rotary drive system 2492 which, as described above, ultimately results in the axial movement of the cutting instrument 2332 and the sliding support portion 2333 in the direction distal "DD" through the surgical staple cartridge 2334. As the cutting instrument 2332 moves distally through the surgical staple cartridge 2334, the tissue trapped in it is sectioned. As the frame portion 2333 is driven distally, it causes the clamps on the surgical clamp cartridge to be driven through the sectioned tissue to form contact with the anvil 2324. When the robotic controller 1001 has determined that the cutting instrument 2324 has reached the final position inside the surgical clamp cartridge 2334 (by means of sensor (s) - (not shown) on the end actuator 2312 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 2491. Thereafter, robotic controller 1001 applies the secondary rotary output movement to rotary 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 by means of sensor (s) on the surgical end actuator 2312 that is (are) in communication with the robotic controller 1001, the robotic controller 1001 interrupts the application of the secondary rotary output movement to the rotary drive gear 2491. Subsequently, the robotic controller 1001 applies the primary rotary output movement to the displacer drive gear 2483 to cause the closing clutch 2410 to move into engagement with the rotary drive thread 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 results, finally, in the rotation of the rotating drive thread 2382 in the second direction to make the closing tube 2370 move in the "PD" proximal direction. As can be seen in Figures 41 to 43, the closing tube 2370 has an opening 2345 in which it engages the flap 2327 on the anvil 2324 to cause the anvil 2324 to rotate to the open position. In alternative embodiments, a spring can also be used to turn the anvil 2324 to the open position when the closing tube 2370 has returned to the starting position (Figure 41).
[0209] [00209] Figures 45 to 49 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 groove 2522 and a "second movable portion" in the form of a pivotally translatable claw member, such as an anvil 2524, which are kept at a spacing that ensures the stapling and effective sectioning of the tissue trapped in the actuator. surgical end 2512. As shown in the illustrated embodiment, the surgical end actuator 2512 may include, in addition to the elongated groove 2522 previously mentioned, and the anvil 2524, a "third movable portion" in the form of a 2532 cutting instrument, a frame ( not shown) and a surgical clamp cartridge 2534 which is removably seated in the elongated groove 2522. The cutting instrument 2532 can be, for example, a knife. The anvil 2524 can be pivoted open and closed at a pivot point 2525 connected to the end near the elongated groove 2522. The anvil 2524 can also include a flap 2527 at its close end that is configured to interface operatively with a component of the mechanical closure system (further described below) for opening and closing the anvil 2524. When activated, knife 2532 and the frame run longitudinally along the elongated channel 2522, thus cutting the tissue trapped in the surgical end actuator 2512 The movement of the frame along the elongated channel 2522 causes the clips of the surgical clip cartridge 2534 to be driven through the sectioned tissue and against the closed anvil 2524, which rotates the clips to secure the sectioned tissue. In one form, the elongated channel 2522 and the anvil 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 surgical end actuator , 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.
[0210] [00210] It should be noted that although the modalities of the surgical tool 2500 described in this document employ a surgical end actuator 2512 that clips the sectioned tissue, in other different technical modalities for fixing or sealing the sectioned tissue can be used. For example, end actuators that use RF (radio frequency) energy or adhesives to fix the separate 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., which are incorporated here, for reference, feature cutting instruments that use RF energy to fix sectioned tissue. US patent application No. 11 / 267,811 to Morgan et al. and US patent application No. 11 / 267,363 to Shelton et al., which are also incorporated herein by way of reference, reveal cutting instruments that use adhesives to secure the sectioned tissue. 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 not be understood as limiting. Other tissue fixation techniques can also be used.
[0211] [00211] 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 that is non-movably coupled to a tool mounting plate 2602 of the tool mounting portion 2600. As can be seen in Figures 46 and 47, the proximal end 2523 of the elongated groove 2522 comprises a hollow tubular structure configured to be attached to the distal end 2541 of the back 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 2540 column tube.
[0212] [00212] As can be seen additionally in Figures 46 and 47, in at least one non-limiting modality, the surgical tool 2500 additionally includes an axially movable actuating member in the form of a closing tube 2550 which is forced to move axially in relation to the elongated channel 2522 and the back tube 1540. The closing tube 2550 has a proximal end 2552 that has an internal thread 2554 formed in it that is in threaded engagement with a rotatingly movable portion in the form of a nut. closing drive 2560. More specifically, the closing drive nut 2560 has a proximal end portion 2562 that is pivotally supported in relation to the elongated groove 2522 and the 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 2 523 of the elongated channel 2522 and the distal end 2541 of the column tube 1540. This arrangement serves to rotatively support the closing drive nut 2560 inside the elongated channel 2522. The rotation of the closing drive nut 2560 will cause the closing tube 2550 moves axially as represented by the arrow "D" in Figure 46.
[0213] [00213] Extending through the column tube 2540 and the closing drive nut 2560 is a drive member which, in at least one embodiment, comprises a knife bar 2580 that has a distal end portion 2582 that is coupled with rotating 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 Figures 46 to 51, the closing drive nut 2560 has a groove 2564 in it, through the which the knife bar 2580 can extend in a sliding way. Such an arrangement allows the knife bar 2580 to move axially with respect to the closing drive nut 2560. However, rotation of the knife bar 2580 around the longitudinal axis of the LT-LT tool will also result in the rotation of the drive nut of the LT-LT. 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 nut 2560 are rotated. As the closing tube 2550 is added distally, the distal end of it will contact the anvil 2524 and cause the anvil 2524 to rotate to a closed position. By means of the application of a rotating outlet opening movement of the robotic system 1000, the closing tube 2550 will be activated in the proximal direction "PD" and will pivot the anvil 2524 to the open position by engaging the flap 2527 with the opening 2555 in the tube. closing 2550.
[0214] [00214] 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 44, a proximal end 2542 of the hollow-back tube 2540 is swiveled within a support 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 is coupled to a first correspondent among the rotational bodies, disks or driven members 1304 on the adapter side of the tool mounting plate ent 2602 when the tool mounting portion 2600 is coupled to the tool retainer 1270. See Figures 28 and 49. The rotary drive assembly 2610 additionally comprises a rotary driven gear 2614 that is rotatably supported on the tool mounting plate. 2602 in network coupling 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 will cause thus, the 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.
[0215] [00215] The closing of the anvil 2524 relative to the surgical clamp cartridge 2534 is carried out by moving axially 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 nut 2382. In various embodiments, the closing driving nut 2560 is rotated when applying an exit movement rotary to knife bar 2580. Rotation of knife bar 2580 is controlled by applying rotating outlet movements to a rotating lock system 2620 that is operationally supported on tool mounting plate 2602 as shown in Figure 49. In at least one embodiment, the rotary locking system 2620 includes a closing drive gear 2622 that is coupled to a corresponding second among the rotating disks or body portion members driven 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 28 and 49. The drive gear The closing gear 2622, in at least one embodiment, is in network drive 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 drive shaft 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.
[0216] [00216] As can be seen in Figure 49, a drive shaft assembly 2640 is coupled to a proximal end of knife bar 2580. In various embodiments, the drive shaft assembly 2640 includes a proximal portion 2642 that has a shape square cross section. 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 drive shaft assembly 2640 (and knife bar 2580) when the third driven gear 2630 is rotated. . The drive shaft 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 body, limbs 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 28 and 49. The rotary driven gear 2652 is in engagement drive system with a gear train, usually shown as 2653. In at least one way, the gear train 2653 additionally comprises a first set of rotary driven gear 2654 which is pivotally supported on the tool mounting plate 2602 The first set of rotary driven gear 2654 is in network engagement with a third set of gear swivel drive 2656 which is rotatably supported on tool mounting plate 2602 and which is in network engagement with a fourth set of swivel driven gear 2658 which is in network engagement with a threaded portion 2644 of the drive shaft assembly 2640 Rotation of the rotary drive gear 2652 in a third rotary direction will result in axial feed of the drive shaft assembly 2640 and knife bar 2580 in the distal direction "DD". Conversely, rotation of the rotary drive gear 2652 in a tertiary rotary direction (opposite the third rotary direction) will cause the drive shaft assembly 2640 and knife bar 2580 to move in the proximal direction.
[0217] [00217] 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 anvil 2524 is no longer in the open position (Figure 46), 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 nut 2560 in a second direction. As the closing drive nut 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 addition or in alternative modalities, a spring (not shown) can be used to turn the anvil 2354 to the open position when the closing tube 2550 has returned to the starting position (Figure 46). The open surgical end actuator 2512 can then be manipulated by the robotic system 1000 to position the target tissue between the open anvil 2524 and the surgical staple cartridge 2534. Thereafter, the surgeon can initiate the closing process by activating the robotic control 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 nut 2382 in the second direction which results in the axial path of the pipe 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 anvil 2524 and causes the anvil 2524 to rotate to the closed position to trap the target tissue between the anvil 2524 and the staple cartridge 2534. When the robotic controller 1001 determines that the anvil 2524 has been pivoted to the closed position by corresponding sensor (s) on the end actuator 2512 which is (are) not communicating with it (the robotic controller 1001 stops the application from the second rotating outlet movement to the closing drive gear 2622. The robotic controller 1001 can also provide the surgeon with an indication that the anvil 2524 has been successfully closed. The surgeon can then start the firing procedure. In alternative modes, the triggering procedure can be automatically initiated by the robotic controller 1001.
[0218] [00218] After the robotic controller 1001 determines that the anvil 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 axle 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 trapped in it is sectioned. As the frame portion (not shown) is activated distally, it causes the clips inside the surgical clip cartridge 2534 to be activated through the sectioned tissue to contact the anvil 2524. When the robotic controller 1001 has determined that the cutting instrument 2532 reached the final position inside the surgical clamp cartridge 2534 by means of sensor (s) - (not shown) on the end actuator 2512 which are in communication with the robotic controller 1001, the robotic controller 1001 stops the application of the second rotary output movement for the 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 portion frame in the proximal direction "PD" to the starting position. When the robotic controller 1001 has determined that the cutting instrument 2524 has reached the starting position by means of sensor (s) (not shown) on the end actuator 2512 that are 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 nut 2560 in a secondary direction. As the closing drive nut 2560 rotates in the secondary direction, the closing tube 2550 moves in the proximal direction "PD" to the open position.
[0219] [00219] Figures 50 to 55B illustrate yet another surgical tool 2700 that can be effectively employed in connection with the robotic system 1000. In various forms, the surgical tool 2700 includes a 2712 surgical end actuator that includes a "first portion" in the the shape of an elongated groove 2722 and a "second movable portion" in a shape comprising a pivotally translatable claw member, such as an anvil 2724, which are kept at a spacing that ensures effective stapling and sectioning of the tissue trapped in the surgical end actuator 2712. As shown in the illustrated embodiment, the surgical end actuator 2712 may include, in addition to the groove 2722 and anvil 2724 mentioned above, a "third movable portion" in the form of a cutting instrument 2732, a frame ( not shown) and a surgical staple cartridge 2734 that is removably seated in the elongated groove 2722. The cutting instrument 2732 can be er, for example, a knife. The anvil 2724 can be pivoted open and closed at a pivot point 2725 connected to the proximal end of the elongated groove 2722. The anvil 2724 may also include a flap 2727 at its proximal end that interfaces with a component of the mechanical locking system (further described below) to open and close the anvil 2724. When activated, the knife 2732 and the frame run longitudinally along the elongated groove 2722, thus cutting the tissue trapped inside the surgical end actuator 2712. The movement of the frame along the elongated groove 2722 causes the clamps of the surgical clamp cartridge 2734 to be driven through the sectioned tissue and against the closed anvil 2724, which rotates the clamps to secure the sectioned tissue. In one form, the elongated channel 2722 and the anvil 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 surgical end actuator , 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.
[0220] [00220] It should be noted that although the modalities of the surgical tool 2500 described in this document employ a surgical end actuator 2712 that clips the sectioned tissue, in other different technical modalities for fixing or sealing the sectioned tissue can be used. For example, end actuators that use RF (radio frequency) energy or adhesives to fix the separate 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., which are incorporated here, for reference, feature cutting instruments that use RF energy to fix sectioned tissue. US patent application No. 11 / 267,811 to Morgan et al. and US patent application No. 11 / 267,363 to Shelton et al., which are also incorporated herein by way of reference, reveal cutting instruments that use adhesives to secure the sectioned tissue. 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 not be understood as limiting. Other tissue fixation techniques can also be used.
[0221] [00221] In the illustrated embodiment, the elongated groove 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 51 and 52, the proximal end 2723 of the elongated channel 2722 comprises a hollow tubular structure which is attached to the back tube 2740 by means of a 2790 mounting collar. A cross-sectional view of the 2790 mounting collar is shown in Figure 53. In several 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 proximal flange end 2791 of the 2790 mounting collar is welded to or glued to the distal end of the column tube 2740. As can be seen further in Figures 51 and 52, the mounting collar 2790 additionally has a central mounting portion 2792 which is sized 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.
[0222] [00222] As can be seen further in Figures 51 and 52, the surgical tool 2700 additionally includes an axially movable actuating member in the form of a closing tube 2750 which is forced to move axially in relation to the elongated channel 2722. O closing tube 2750 has a proximal end 2752 having an internal thread 2754 formed therefrom that is in threaded engagement with a rotatable movable portion in the form of a closing drive nut 2760. More specifically, the closing drive nut 2760 has a proximal end portion 2762 that is pivotally supported in relation to the elongated groove 2722 and the column tube 2740. For mounting fins, the proximal end portion 2762 is fixed securely 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. This arrangement serves to support rotating mode the closing drive nut 2760 inside the groove 2722. Rotating the closing drive nut 2760 will cause the closing tube 2750 to move axially as represented by the arrow "D" in Figure 51.
[0223] [00223] Extending through the column tube 2740, the mounting collar 2790 and the closing drive nut 2760 is a drive member, which, in at least one embodiment, comprises a knife bar 2780 that has a distal portion from the end 2782 which is coupled to the cutting instrument 2732. As can be seen in Figures 51 and 52, the mounting collar 2790 has a passage 2793 through it to allow the knife bar 2780 to slide through it. Similarly, the closing drive nut 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 nut 2760.
[0224] [00224] The performance of the anvil 2724 is controlled by a rotating driven rod 2800. As can be seen in Figures 51 and 52, a distal end portion 2802 of the closing drive shaft 2800 extends through a passage 2794 in the mounting collar 2790 and a closing gear 2804 are attached to this. The closing gear 2804 is configured for the drive hitch with the inner surface 2761 of the closing drive nut 2760. Therefore, rotation of the closing rod 2800 will also result in the rotation of the closing drive nut 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 nut 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 anvil 2724 and cause the anvil 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 anvil 2724 will be turned to the open position. In various embodiments, a spring (not shown) can be used to pull the anvil 2724 to the open position (Figure 51).
[0225] [00225] 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 around the axis of the LTLT tool. As can be seen in Figure 55, a proximal end 2742 of the hollow-back tube 2740 is swiveled within a support arrangement 2903 and a bearing assembly 2904 that are attached to the 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 driven disks or members 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 28 and 55. The 2910 rotary drive assembly additionally comprises a 2914 rotary driven gear pivoted on the 2902 tool mounting plate in mesh with the 2744 rotary gear and the 2912 rotary drive gear. 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).
[0226] [00226] The closing of the anvil 2724 in relation to the staple cartridge 2734 is carried out through the axial movement of the closing tube 2750 in the distal direction "DD". The axial movement of the closing tube 2750 in the distal direction "DD" is carried out by applying a rotary control movement to the closing actuating nut 2760. In various embodiments, the closing actuating nut 2760 is rotated when applying a movement rotating output shaft to the closing drive shaft 2800. As can be seen in Figure 55, a proximal end portion 2806 of the closing driving shaft 2800 has a driving gear 2808 on it that is in interlocking engagement with a drive assembly of closing 2920. In various embodiments, the closing drive system 2920 includes a closing drive gear 2922 that is coupled to a corresponding second of the rotating bodies or driven members 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 28 and 55. The gear closing drive train 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 sustained by rotating mode on 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 set of 2930 planetary gear. In several embodiments, the 2930 planetary gear assembly includes a 2932 driven planetary closing gear that is pivotally supported on bearing assembly 2904 that is mounted on tool mounting plate 2902. As can be seen in the Figures 55 and 55B, the proximal end portion 2806 of the closing drive shaft 2800 is sustained rotating mode inside the proximal end portion 2742 of the back tube 2740 so that the driven gear 2808 is in interlocking engagement with the central gear teeth 2934 formed on the planetary gear 2932. As can also be seen in Figure 55A, two gears Additional support brackets 2936 are swiveled or supported in relation to the proximal end portion 2742 of the back tube 2740 to provide bearing support for this. 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 nut 2760 will ultimately result in the closing of the anvil 2724, as described above. Conversely, rotation of the closing drive gear 2922 in a second opposite direction will ultimately result in the rotation of the closing drive nut 2760 in an opposite direction resulting in the opening of the anvil 2724.
[0227] [00227] As can be seen in Figure 55, the proximal end 2784 of knife bar 2780 has a threaded shaft portion 2786 attached to it that is in engagement with a 2940 knife drive assembly. In various embodiments, 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. 2780 knife drive is advanced axially in the distal and proximal directions by the 2940 knife drive assembly. One form of the 2940 knife drive assembly comprises a 2942 rotary drive gear that is coupled to a corresponding third within one of the rotating bodies, discs or driven members 1304 on the adapter side of the tool mounting plate 2902 when the tool mounting portion 2900 is coupled to the tool retainer 1270. See Figures 28 and 55. 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 gear set 2944 swivel drive gear that is swiveled on the 2902 tool mounting plate. The first 2944 swivel drive gear set is in network engagement with a third 2946 swivel driven gear set that is swiveled on the tool mounting plate. tool 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 the 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.
[0228] [00228] Figures 56 and 57 illustrate a modality of surgical tool 2700 that is substantially identical to the tool 2700 that 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 gripping pressure experienced by the anvil 2724. In various embodiments, for example, the pressure sensor may comprise a key spring-loaded contact lens. For a continuous signal, this would use a cantilever beam with a strain gauge on it or a dome button top with a strain gauge on the inside. Another version may comprise a disconnect switch which contacts only a known desired load. Such an arrangement 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 grip pressure that is applied to the tissue inside the surgical end actuator 2712 by adjusting the amount of closing pressure applied to the anvil 2724. Those skilled in the art will understand that such Pressure sensor arrangement can be effectively employed with the various surgical tool modalities described here as well as their equivalent structures.
[0229] [00229] Figure 58 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 power various components of an actuator cutting instrument. surgical end. In at least one non-limiting embodiment, for example, the surgical tool 3000 includes a surgical end actuator in the form of an end cutter (not shown) that has an anvil (not shown) to a surgical staple cartridge arrangement (not shown) ) of the types and constructions described above. The surgical tool 3000 also includes an elongated shank (not shown) and an anvil closure arrangement (not shown) of the types described above. Thus, this portion of the Detailed Description will not repeat the description of these components beyond what is necessary to observe the unique and innovative attributes of the various modalities of the 3000 surgical tool.
[0230] [00230] In the embodiment shown, the end actuator includes a cutting instrument 3002 that is coupled to a knife bar 3003. As can be seen in Figure 58, the surgical tool 3000 includes a tool mounting portion 3010 that includes a tool mounting plate 3012 which is configured to interface mountably with adapter portion 1240 'which is coupled to robotic system 1000 in the various ways described above. The tool mounting portion 3010 is configured to operationally support a transmission arrangement 3013 therein. 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. In addition, although the end actuator of the represented modality comprises an end cutter, members skilled in the art will understand that the unique and innovative attributes of the represented modality can be effectively employed in conjunction with other types of surgical end actuators without deviating from the spirit and scope of various forms of the present invention.
[0231] [00231] In several embodiments, the tool mounting plate 3012 is configured to at least accommodate a first firing motor 3011 to supply retraction and firing movements for the knife bar 3003 which is coupled to or, otherwise, makes Operationally interface 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 27) on adapter 1240 '. Such an arrangement allows the controller 1001 of the robotic system 1000 to provide control signals to the electronic control circuit 3020 of the surgical tool 3000. Although the interface is described here with reference to mechanical, electrical and magnetic coupling elements, it must be understood that a wide range of telemetry modalities can be used, including infrared, inductive coupling or the like.
[0232] [00232] The 3020 control circuit is shown schematically in Figure 58. 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 solenoid powered switch. switch-on switch 3024. The control circuit 3020 additionally includes a switch-on trip solenoid 3026 that is coupled to a double pole switch 3028 to control the rotational direction of the 3011 motor. Therefore, when the controller 1001 of the robotic system 1000 provides a appropriate control signal, switch 3024 will allow battery 3022 to power the double pole switch 3028. 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. the surgical end actuator (ie drive the cutting instrument 3002 distally through the tissue attached to the end actuator surgical, the 3028 double-pole spanner 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.
[0233] [00233] Various modalities of the surgical tool 3000 also employ a 3030 gearbox which is dimensioned, in cooperation with a 3031 firing gear train, which, in at least one non-limiting mode, comprises a firing 3032 driving gear in interlocking engagement with a triggered trigger gear 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 various ways described herein. In the embodiment shown in Figure 58, the driven gear 3034 is coupled to a threaded shaft 3036 that is threaded in engagement with a threaded nut arrangement 3038 that is forced to move axially (represented by the arrow "D"). The screw nut arrangement 3038 is fixed to the firing bar 3003. In this way, by rotating the thread axis 3036 in a first direction, the cutting instrument 3002 is driven in the distal direction "DD" and the rotation of the axis of rotation threaded in a second opposite direction, the cutting instrument 3002 can be retracted in the proximal direction "PD".
[0234] [00234] Figure 59 illustrates a portion of another surgical tool 3000 'which is substantially identical to the tool 3000 described above, except that the driven gear 3034 is attached to a driving shaft 3040. The driving shaft 3040 is attached to a second drive gear 3042 which is in interlocking engagement with a third drive gear 3044 which is in interlocking engagement with a thread 3046 coupled to the firing bar 3003.
[0235] [00235] Figure 60 illustrates another surgical tool 3200 that can be effectively used in conjunction with a robotic system 1000. In this embodiment, the surgical tool 3200 includes a 3212 surgical end actuator that, in a non-limiting form, comprises a portion component which is selectively movable between first and second positions with respect to at least one other end actuator component portion. As will be discussed in further detail below, the surgical tool 3200 employs on-board motors to feed various components of a 3305 transmission arrangement. The surgical end actuator 3212 includes an elongated channel 3222 that operationally supports a 3234 surgical clamp cartridge. The elongated groove 3222 has a proximal end 3223 that slidably extends to a hollow elongated stem assembly 3208 that is coupled to a tool mounting portion 3300. In addition, the surgical end actuator 3212 includes an anvil 3224 which is coupled to the elongated channel 3222 by a pair of rotating pins 3225 which are received inside corresponding openings 3229 in the elongated channel 3222. A distal end portion 3209 of the shaft assembly 3208 includes an opening 3245 in which a flap 3227 on the anvil 3224 is inserted in order to open the anvil 3224 as the elongated groove 3222 is moved axially in the proximal direction "PD" with respect to the distal end portion 3209 of shaft assembly 3208. In various embodiments, a spring (not shown) can be employed to orient anvil 3224 to the open position.
[0236] [00236] 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.
[0237] [00237] In several embodiments, the tool mounting plate 3302 is configured to support a first firing motor 3310 to supply retraction and firing movements for the 3305 transmission arrangement to drive a 3335 knife bar that is coupled to an instrument cutting edge of the type described above. As can be seen in Figure 60, the tool mounting plate 3212 has an arrangement of electrical connection pins 3014 that are configured to interface with the slots 1258 (Figure 27) on the adapter 1240 ’. This arrangement allows the controller 1001 of the robotic system 1000 to supply control signals to the electronic control circuits 3320, 3340 of the surgical tool 3200. Although the interface is described here with reference to mechanical, electrical and magnetic coupling elements, it must be understood that a wide variety of telemetry modalities can be used, including infrared, inductive coupling or the like.
[0238] [00238] 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 a 3324 on-off solenoid. The first control circuit trip unit 3320 additionally includes a first on-off trip solenoid 3326 which is coupled to a first double pole switch 3328 to control the rotational direction of the first trip motor 3310. Therefore, when the robotic controller 1001 provides a control signal appropriate, 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 it is desired to fire the surgical end actuator (ie drive the 3232 cutting instrument distally through s of the tissue trapped in 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 initial position, the robotic controller 1001 will send the appropriate control signal to move the first switch 3328 to the second position.
[0239] [00239] Various modalities 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 interfaces operationally with a 3333 firing gear train. at least one non-limiting mode, the firing gear train 333 comprises a firing gear 3334 which is in interlocking engagement with the firing gear 3332, to generate a desired amount of firing force required to drive the 3232 cutting instrument through the fabric and to trigger and form staples in the various ways described herein. In the embodiment shown in Figure 60, the driven gear 3334 is coupled to a driving shaft 3335 which has a second driven gear 3336 coupled thereto. The second driven gear 3336 is held in interlocking engagement with a third driven gear 3337 which is in interlocking engagement with a fourth driven gear 3338. The fourth driven gear 3338 is in interlocking engagement with a threaded proximal portion 3339 of knife bar 3235 which is restricted to moving axially. Thus, by rotating the drive shaft 3335 in a first direction, the cutting instrument 3232 is driven in the distal direction "DD" and by turning the drive shaft 3335 in a second opposite direction, the cutting instrument 3232 can be retracted in the "PD" proximal direction.
[0240] [00240] As indicated above, the opening and closing of the anvil 3224 are controlled through the axial movement of the elongated groove 3222 in relation to the elongated stem assembly 3208. The axial movement of the elongated groove 3222 is controlled by a closing control system 3339. In several embodiments, the closing control system 3339 includes a closing shaft 3340 that has a hollow threaded end portion 3341 that threadably engages a threaded closing rod 3342. The threaded end portion 3341 is sustained so rotatable on a 3343 back shaft that interfaces operatively with the tool mounting portion 3300 and extends through a portion of the shaft 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 the switch-off solenoid 3354. The closing control circuit 3350 additionally includes a second 3356 link-on trip solenoid which is coupled to a second 3358 double pole switch to control the rotation of a second 3360 closing motor. Therefore, when robotic controller 1001 provides an appropriate control signal, the second switch 3354 will allow the second 3352 battery to power the second 3354 double pole switch. The robotic controller 1001 will also provide an appropriate signal to the second 3358 double pole switch to power the second 3360 motor. When the 3224 anvil is to be closed, the second key 3348 will be in a first position. When you want to open the anvil 3224, the second key 3348 will be moved to a second position.
[0241] [00241] Various embodiments of the 3300 tool mounting portion also employ a second 3362 gearbox that is coupled to a closing drive gear 3364. The closing drive gear 3364 is in interlocking engagement with a closing gear train 3363. In various non-limiting forms, the 3363 closing gear train includes a 3365 driven closing gear that is attached to a 3366 closing drive shaft. A 3367 closing driving gear is also attached to the closing driving shaft. 3366, which is in interlocking engagement with a 3360 gear closing shaft attached to the 3340 closing shaft. Figure 60 shows end actuator 3212 in the open position. As indicated above, when the threaded closing rod 3342 is in the position shown in Figure 60, a spring (not shown) guides the anvil 3224 to the open position. When it is desired to close the anvil 3224, the robotic controller 1001 will activate the second motor 3360 to turn the closing rod 3340 to extract the threaded closing rod 3342 and the channel 3222 in the proximal direction 'PD'. As the anvil 3224 comes into contact with the distal end portion 3209 of the shaft 3208, the anvil 3224 is pivoted to the closed position.
[0242] [00242] 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 anvil 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 distal direction to the position shown in Figure 60. 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 anvil 3224 can then be closed. Once the target tissue is positioned between the open anvil 3224 and the surgical staple cartridge 3234, the surgeon can then start the closing process by activating the robotic controller 1001 to apply a closing control signal to the second drive motor. closing 3360. The second closing motor 3360 applies a rotating movement to the closing shaft 3340 to pull the channel 3222 in the proximal direction "PD" until the anvil 3224 has been pivoted to the closed position. Once the robotic controller 1001 determines that the anvil 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 manually by the surgeon who activates a trigger, button, etc. on controller 1001 or controller 1001 can automatically start the triggering process.
[0243] [00243] To start the firing process, the robotic controller 1001 activates firing motor 3310 to activate firing bar 3235 and cutting instrument 3232 in the distal direction "DD". When robotic controller 1001 has determined that the cutting instrument 3232 has moved to a final position on the surgical clamp cartridge 3234 by means of sensors (not shown) on the surgical end actuator 3212 and / or the motor drive portion 3300, the robotic controller 1001 can provide the surgeon with 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.
[0244] [00244] The modality shown in Figure 60 does not include an articulation joint. Figures 61 and 62 illustrate surgical tools 3200 'and 3200 "which have end actuators 3212', 3212", respectively, which can be used with an elongated rod modality that has an articulation joint of the various types presented in the present invention. For example, as can be seen in Figure 61, 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) inside of the elongated stem assembly 3208 will match the flexible member 3345 to allow the 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 pivot thereto to prevent flexible member 3229 from "wrapping" around with respect to channel 3222. Although not shown, the cutting element can be driven in one of the ways described above by a knife bar that can also accommodate the elongated shank assembly hinge. Figure 62 reveals a 3212 ”surgical end actuator that is substantially identical to the 3212 surgical end actuator described above, except that the threaded lock rod 3342 is attached to a lock nut 3347 which is forced to move only axially inside the elongated shank assembly 3208. The flexible member 3345 is attached to the closing nut 3347. This arrangement also prevents the threaded closing rod 3342 from wrapping the flexible member 3345. A flexible knife bar 3235 'can be used to facilitate the articulation of the 3212 ”surgical end actuator.
[0245] [00245] The surgical tools 3200, 3200 ’and 3200” described above can also employ any of the cutting instrument modalities described here. As described above, the anvil of each of the end actuators of these tools is closed by pulling the elongated channel in 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 anvil 3224, the robotic controller 1001 can begin to draw channel 3222 into stem assembly 3208. In several ways, however, to prevent the end actuator 3212, 3212 ', 3212 ”move 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 for the groove movement elongated 3222 so that, in fact, the target tissue is trapped between the anvil and the elongated channel without being moved in any other way.
[0246] [00246] Figures 63 to 65 reveal 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 with varying inclinations. More specifically, as can be seen in Figure 64, the closing rod 3342 'has a distal groove section 3380 and a proximal groove section 3382. The proximal and distal groove sections 3380, 3382 are configured to engage with a 3390 pin sustained within the hollow threaded end portion 3341 '. As can be seen in Figure 64, the distal groove section 3380 has a narrower gap than the groove section 3382. Thus, such a variable inclination arrangement allows the elongated groove 3222 to be pulled on axis 3208 at a first speed or rate due to the engagement between pin 3390 and the proximal groove segment 3382. When pin 3390 engages the distal groove segment, channel 3222 will be pulled on axis 3208 at a second speed or rate. Due to the fact that the proximal groove segment 3382 is thicker than the distal groove segment 3380, a first speed will be greater than the second speed. Such an arrangement serves to accelerate the initial closing of the end actuator for fabric handling and then, after the fabric has been properly positioned therein, to generate a number of closing forces to properly secure the fabric for cutting and sealing. Thus, the 3234 anvil closes quickly with a lower force and then applies a higher closing force as the anvil closes more slowly.
[0247] [00247] The closing and opening movements of the surgical end actuator are employed to allow the user to use the end actuator to pick up and manipulate the tissue before completely securing it 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. Thus, in at least some modalities, to produce the high loading for firing, the fine thread may require 5 to 10 complete revolutions to generate the necessary load. In some cases, for example, this action could take 2 to 5 seconds. If it takes an equally long time to open and close the end actuator each time during the tissue positioning / manipulation process, only the positioning of the end actuator can take an undesirably long time. If this happens, it is possible that a user may abandon such use of the end actuator for use with a conventional gripping device. The use of handles, etc. may undesirably increase the costs associated with completing the surgical procedure.
[0248] [00248] The modalities described above employ a battery or batteries to power the motors used to drive the components of the end actuator. 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 yet other embodiments, a power cord or wire may be attached to the 3300 tool mounting portion to supply the required power from a separate source of alternating or direct current.
[0249] [00249] In use, controller 1001 can apply an initial rotary movement to the closing rod 3340 (Figure 60) to attract the elongated groove 3222 axially into the elongated rod assembly 3208 and move the anvil from the first position to a intermediate position at a first rate that corresponds to the point at which the distal groove section 3380 changes to the proximal groove section 3382. The additional application of pivoting motion to the closing axis 3340 will cause the anvil 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 trapped between the anvil and the surgical staple cartridge.
[0250] [00250] Figures 66 to 69 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 segment of the rotatable proximal closing tube 3410 that is rotatably seated on a 3420 proximal back member. which is rigidly coupled to a tool mounting plate 3502 of the tool mounting portion 3500. The proximal back member 3420 has a distal end 3422 that is coupled to an elongated channel portion 3522 of a 3412 surgical end actuator. For example, in at least one embodiment, the elongated channel portion 3522 has a distal end portion 3523 that "hooks" the distal end 3422 of the back member 3420. The elongated channel 3522 is configured to hold a staple cartridge surgical 3534 on that. This embodiment can employ one of the various cutting instrument embodiments disclosed in the present invention to section the tissue that is attached to the surgical end actuator 3412 and to fire the clips into the 3534 clip cartridge on the separate tissue.
[0251] [00251] The surgical end actuator 3412 has an anvil 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 anvil 3524 is moved between positions opened (Figure 66) and closed (Figures 67 to 69) by a segment of the distal closing tube 3430. A distal end portion 3432 of the segment of the distal closing tube 3430 includes an opening 3445 in which a flap 3527 on the anvil 3524 is inserted in order to open and close the anvil 3524 as the segment of the distal closing tube 3430 moves axially in relation to this. In various embodiments, opening 3445 is shaped so that as the closing tube segment 3430 is moved in the proximal direction, the closing tube segment 3430 causes the anvil 3524 to rotate to an open position. In addition or alternatively, a spring (not shown) can be used to orient the anvil 3524 to the open position.
[0252] [00252] As can be seen in Figures 66 to 69, the segment of the distal closing tube 3430 includes a pin 3442 extending from its distal end 3440 for threaded engagement with a groove / thread of variable range 3414 formed at the end distal 3412 from the segment of the rotating proximal closing tube 3410. The groove / thread of variable slope 3414 has a distal section 3416 and a proximal section 3418. The slope of the distal groove / thread 3416 is thinner than the slope of the section of proximal groove / thread 3418. As can also be seen in Figures 66 to 69, the segment of the distal closing tube 3430 is forced to axial movement in relation to the back member 3420 by an axial retaining pin 3450 which is received in an axial groove 3424 at the distal end of the back member 3420.
[0253] [00253] As indicated above, the anvil 2524 is opened and closed by rotating the proximal closing tube segment 3410. The variable inclination thread 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 the distal groove / thread section 3416, the segment of the distal closing tube 3430 will be driven in the direction distal at a second speed or rate. Due to the fact that the proximal groove / thread section 3418 is thicker than the distal groove / thread segment 3416, the first speed will be greater than the second speed.
[0254] [00254] 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 70, a proximal end 3460 of the proximal closing tube segment 3410 is pivotally supported within a support 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 clamping pipe segment 3410 for interlocking engagement with a rotation drive assembly 3470 that is operationally supported on the tool mounting plate 3502. In at least one In this embodiment, a rotating drive gear 3472 is coupled to a first correspondent of the driven disks or members 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 28 and 70. The 3470 rotary drive assembly additionally comprises a 3474 rotary driven gear that is sustained rotatable on the tool mounting plate 3502 in interlocking engagement with the rotating gear 3462 and the rotating drive gear 3472. The application of a first rotary motion from the robotic controller 1001 through the 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 rotary drive gear 3472 ultimately results in the rotation of the closing tube segment 3410 to open and close the anvil 3524 as described above.
[0255] [00255] As indicated above, the surgical end actuator 3412 employs a cutting instrument of the type and constructions described above. Figure 70 illustrates a form of knife drive assembly 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 members 1304 on the adapter side of the tool mounting plate 3502 when the tool drive portion 3500 is coupled to tool holder 1270. See Figures 28 and 70. The knife drive set 3480 additionally comprises a first set of rotary drive gear 3484 which is swiveled on the tool mounting plate 5200. The first set of tools rotary drive gear 3484 is in interlaced engagement with a third set of rotary drive gear 3486 which is pivotally supported on tool mounting plate 3502 and which is in interlaced engagement with a fourth set of rotary drive gear 3488 which is in interlocking engagement with a threaded portion 3494 of the drive shaft assembly 3490 which is coupled to the 3492 knife bar. Rotating the 3482 rotary drive gear in a second rotating direction will result in axial advance of the 3490 drive shaft assembly and the 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.
[0256] [00256] Figures 71 to 80 illustrate another embodiment of the surgical tool 3600 of the present invention that can be used in conjunction with a robotic system 1000. As can be seen in Figure 71, 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 conjunction with the 3600 tool are disclosed, for example, in patent application publication No. US 2009/0206131 A1, entitled "End Effector Arrangements For a Surgical Cutting and Stapling Instrument ", the disclosure of which is hereby incorporated by reference, in its entirety.
[0257] [00257] In at least one form, the disposable loading unit 3612 includes an anvil set 3620 that is supported for pivoting displacement 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 about an AA-AA pivot axis in relation to an LT-LT longitudinal tool axis. Referring to Figure 76, mounting set 3650 includes lower and upper mounting portions 3652 and 3654. Each mounting portion includes a threaded hole 3656 on each side of it sized to receive threaded bolts (not shown) to secure the proximal end from carrier 3630 to that. A pair of centrally located pivot members 3658 extends between 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 include a proximal fitting 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 therewith.
[0258] [00258] In various forms, the housing portion 3662 of disposable loading unit 3614 includes an upper housing half 3670 and a lower housing half 3672 contained within an outer compartment 3674. The proximal end of the housing half 3670 includes engagement projections 3676 for releasably engaging an elongated stem 3700 and an insertion point 3678. The projections 3676 form a bayonet-type coupling with the distal end of the elongated stem 3700 which will be discussed in further detail below. The housing halves 3670, 3672 define a channel 3674 for slidingly receiving the axial drive assembly 3680. A second hinge link 3690 is dimensioned to be slidably positioned inside a slot 3679 formed between the housing halves 3670 , 3672. A pair of blowing plates 3691 is positioned adjacent to the distal end of housing portion 3662 in a position adjacent to the distal end of axial drive assembly 3680 to prevent external expansion of drive assembly 3680 during carrier articulation 3630.
[0259] [00259] In various embodiments, the second linkage 3690 includes at least one elongated metal plate. Preferably, two or more metal plates are stacked to form link 3690. The proximal end of link 3690 includes a hook portion 3692 configured to engage the first link link 3710 that extends through the elongated stem 3700. The end distal of the second hinge link 3690 includes a loop 3694 dimensioned to engage a projection formed in the assembly 3650. The projection is laterally offset from the pivot pin 3658 so that the linear movement of the second link hinge 3690 causes the set 3650 mounting bracket, rotate about 3658 pivot pins to articulate the 3630 carrier.
[0260] [00260] In various forms, the axial drive assembly 3680 includes an elongated drive beam 3682 that includes 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 engagement section 3685 includes a pair of engagement fingers that are dimensioned and configured to mount a pair of corresponding retaining slots formed in the drive member 3686 mountably. The drive member 3686 includes a proximal hatch 3687 configured to receive the distal end 3722 of control rod 2720 (See Figure 80) when the proximal end of the disposable loading unit 3614 is engaged with the elongated rod 3700 of the surgical tool 3600.
[0261] [00261] Referring to Figures 71 and 78 to 80, 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 understood that the surgical tool 3600 may include a loading unit disposable articulation or non-articulation. To attach 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 78, so that the hook portion 3692 of the second hinge link 3690 slides into a groove 3702 on the elongated stem 3700. The projections 3676 will be aligned in a respective groove ( not shown) on the elongated axis 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 arrow "B" in Figures 78 and 80 to move the hook portion 3692 of the second hinge link 3690 in engagement with the finger 3712 of the first hinge link 3710. The projections 3676 also form a "bayonet-type" coupling on the annular groove 3703 on the elongated stem 3700. During the rotation of the loading unit 3612, the projections 3676 engage the cam surface 3732 (Figure 78) of the block plate 3730 to initially move the plate 3730 in the direction indicated by the arrow "C" on the Fig. 78 for locking the coupling member 3734 into the recess 3721 of the control rod 3720 to prevent longitudinal movement of the control rod 3720 when attaching the disposable loading unit 3612. During the final degree of rotation, the projections 3676 disengage from the surface 3732 to allow the locking plate 3730 to move in the direction indicated by the arrow "D" in Figures 77 and 80 behind the coupling member 3734 to allow the longitudinal movement of the control rod 3720 again. Although the method of attachment above reflects that the disposable loading unit 3612 is handled in relation to the elongated rod 3700, the person of ordinary skill in the art will find that the disposable loading 3612 can be supported in a stationary position and the robotic system 1000 can manipulate the elongated rod portion 3700 relative to disposable loading unit 3612 to perform the coupling procedure described above.
[0262] [00262] Figure 81 illustrates another disposable loading unit 3612 'which is fixable in a bayonet-like arrangement with the elongated axis 3700' which is substantially identical to the 3700 axis except for the differences discussed below. As can be seen in Figure 81, the elongated axis 3700 'has grooves 3705 that extend over at least a portion of them and that are configured to receive the projections 3676 therein. In various embodiments, the disposable loading unit 3612 'includes arms 3677 extending therefrom which, prior to rotation of the disposable loading unit 3612', can be aligned or at least substantially aligned, with the projections 3676 extending to from the housing portion 3662. In at least one embodiment, the arms 3677 and the projections 3676 can be inserted into the grooves 3705 on the elongated axis 3700 ', for example, when the disposable loading unit 3612' is inserted on the elongated axis 3700 ' . When the disposable loading unit 3612 'is rotated, the arms 3677 can be sufficiently confined within grooves 3705 so that the grooves 3705 can hold them in position, while the projections 3676 can be positioned so that they are not confined inside grooves 3705 and can be rotated with respect to the arms 3677. When rotated, the hook portion 3692 of the hinge link 3690 is engaged with the first hinge link 3710 which extends through the elongated axis 3700 '.
[0263] [00263] Other methods of coupling the disposable loading units to the end of the elongated shaft can be employed. For example, as shown in Figures 82 and 83, 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 may include at least one projection and / or groove that can be combined with at least one projection and / or groove of the 3740 connector portion. In at least one embodiment, the connector portions may include cooperative portions of pigtail. In various embodiments, the connector portions can be configured to intertwine with each other and 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 'may include opening 3681 which can be configured to receive the projection 3721 extending from the control rod 3720'. In various embodiments, such an arrangement may allow the disposable loading unit 3612 ”to be mounted on the elongated shaft 3700 in a direction that is not collinear with or parallel to the 3741 axis. Although not shown, the axial drive assembly 3680 'and the stem 3720 control panels can include any other suitable arrangement of projections and openings to operationally connect them to each other. Also in this embodiment, the first hinge link 3710 can be operatively engaged with the second hinge link 3690.
[0264] [00264] As can be seen in Figures 71 and 84, 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 tool set. tool drive 1010. The tool mounting portion operationally supports a transmission arrangement 3752 therein. In use, it may be desirable to rotate the disposable loading unit 3612 around the longitudinal tool axis defined by the elongated stem 3700. In at least one embodiment, the transmission arrangement 3752 includes the rotary transmission assembly 3753 that is configured to receive a corresponding rotary outlet movement from the tool drive assembly 1010 of the robotic system 1000 and converting that rotary outlet movement into a rotary control movement to rotate the elongated stem 3700 (and the disposable loading unit 3612) around the axis longitudinal axis of the LT-LT tool. As can be seen in Figure 84, a proximal end 3701 of the elongated shank 3700 is pivotally supported by a support arrangement 3754 that is attached to the tool mounting plate 3751 of the tool mounting portion 3750. A rotating gear 3755 it is formed on or attached to the proximal end 3701 of the elongated shaft 3700 for interlocking engagement with a 3756 rotating gear assembly operably supported on the 3751 tool mounting plate. In at least one embodiment, a 3757 rotating drive gear coupled so driven by a first matches among the driven disks or members 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 3753 rotating drive assembly additionally comprises a 3758 rotary driven gear that is pivotally supported on the mounting plate tool 3751 in interlocking engagement with the rotating gear 3755 and the rotating 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 thus cause the rotation of the 3757 rotation drive gear because it is operationally coupled to it. The rotation of the 3757 rotary drive gear ultimately results in the rotation of the elongated shaft 3700 (and the disposable loading unit 3612) around the longitudinal tool axis LT-LT (primary rotary movement).
[0265] [00265] As can be seen in Figure 84, a 3760 drive shaft 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 a transmission 3762 knife-drive / closing mechanism. A 3762 knife-drive / closing assembly shape comprises a 3763 rotary drive gear that is coupled to a corresponding second among driven rotating disks, members or body portions 1304 on the adapter side of the plate mounting tool 3751 when tool mounting portion 3750 is coupled to tool retainer 1270. The rotary driven gear 3763 is in interlocking engagement with a gear train, usually shown as 3764. In at least one way, the gear train 3764 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 interlaced engagement with a second 3766 rotary driven gear set that is pivotally supported on the 3751 tool mounting plate and which is interlaced with a third 3767 swivel drive gear assembly that is in interlaced engagement with a threaded portion 3768 of the 3760 drive shaft assembly. Rotating the 3763 swivel drive gear in a second swivel direction will result in axial advance of the 3760 drive shaft and rod assembly control 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, this engages in a operating mode the anvil 3620 to pivot it to a closed position.
[0266] [00266] The cartridge carrier 3630 can be selectively articulated around the articulation axis AA-AA through the application of axial articulation control movements to the first and second articulation links 3710 and 3690. In several modalities, the transmission arrangement 3752 additionally includes a hinge drive 3770 that is operationally supported on the tool mounting plate 3751. More specifically and with reference to Figure 84, it can be noted that a proximal end portion 3772 of a hinge drive shaft 3771 configured to operationally engage with the first hinge link 3710 extends through the rotating gear 3755 and is pivotally coupled to a shifter rack gear 3774 that is slidably attached to the 3751 tool mounting plate via grooves 3775. The hinge drive 3770 additionally comprises a shift drive gear indicator 3776 that is coupled to a corresponding third of the driven disks or members 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 further comprises a displacer driven gear 3778 which is pivotally supported on tool mounting plate 3751 in interlocking engagement with displacer driving gear 3776 and displacer rack gear 3774. The application of a third rotary output movement from the robotic system 1000 through the tool drive set 1010 to the corresponding driven element 1304 will therefore cause the displacement drive gear 3776 to rotate because it is operationally coupled to it. Rotation of the shifter drive gear 3776 ultimately results in axial movement of the shifter gear rack 3774 and the hinge drive shaft 3771. The direction of the axial travel of the hinge drive stem 3771 depends on the direction in which the gear Shifter drive gear 3776 is rotated by the robotic system 1000. Thus, rotation of the shifter drive gear 3776 in a first rotating direction will result in axial movement of the hinge drive shaft 3771 in the proximal direction "PD" and cause the cartridge carrier 3630 to rotate 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.
[0267] [00267] Figure 85 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 85, surgical tool 3800 includes a 3812 surgical end actuator in the form of a 3814 cutter that employs several cable-driven components. Various forms of cable driven cutters are disclosed, for example, in US Patent No. 7,726,537, entitled "Surgical Stapler With Universal Articulation and Tissue PreClamp" and Patent Application Publication No. US 2008 / 0308603A1, entitled "Cable Driven Surgical Stapling and Cutting Instrument With Improved Cable Attachment Arrangements ", whose disclosures are hereby incorporated, as a reference in their respective totalities. Such 3814 cutters can be called a "disposable loading unit", due to the fact that they are designed to be disposed after a single use. However, the various unique and innovative arrangements of the various embodiments of the present invention can also be used in conjunction with cable-operated end actuators that are reusable.
[0268] [00268] As can be seen in Figure 85, in at least one form, the cutter 3814 includes an elongated channel 3822 that operationally supports a 3834 surgical staple cartridge in it. An anvil 3824 is hingedly supported for movement in relation to the 3834 surgical clamp cartridge. The anvil 3824 has a 3825 cam surface that is configured for interaction with a 3840 pre-grip collar that is supported for axial movement in relation to that. End actuator 3814 is coupled to an elongated stem assembly 3808 which is attached to a 3900 tool mounting portion. In various embodiments, a 3850 lock cable is employed to move the pre-hold collar 3840 distally over and above from the cam surface 3825 to close the anvil 3824 in relation to the surgical staple cartridge 3834 and compress the tissue with each other. Preferably, the closing cable 3850 attaches to the pre-grip collar 3840 at or near point 3841 and is fed through a passage in the anvil 3824 (or under a proximal portion of the anvil 3824) and fed proximally through the axis 3808. The actuation of the closing cable 3850 in the proximal direction "PD" forces the preheat collar 3840 distally against the cam surface 3825 to close the anvil 3824 with respect to the 3834 clamp cartridge assembly. For example, a spring, cable system or the like (not shown), can be used to return the 3840 pre-grip collar to a pre-grip orientation that reopens the 3824 anvil.
[0269] [00269] The 3808 elongated stem assembly can be cylindrical in shape and defines a 3811 groove that can be sized to receive a 3870 tube adapter. See Figure 86. In various embodiments, the 3870 tube adapter can be received slidingly in friction engagement with the inner groove of the elongated shaft 3808. The outer surface of the 3870 tube adapter may also include at least one mechanical interface, for example, a cut or notch 3871, oriented to fit into a mechanical interface corresponding, for example, a protrusion or obstacle that extends radially inward (not shown), arranged on the inner periphery of the inner channel 3811 to lock the tube adapter 3870 on the elongated shaft 3808. In various embodiments, the distal end of the adapter tube 3870 may include a pair of opposing flanges 3872a and 3872b that define a cavity to pivotally receive a pivot block 3873 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 opening in pivot block 3873 to allow pivoting movement of pivot block 3873 about an axis that it is perpendicular to the longitudinal tool axis "LT-LT". 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 openings in the block pivot 3873 to allow rotation of the 3814 surgical end actuator about the "Y" axis as needed during a given surgical procedure. Rotating pivot block 3873 around pin 3875 along the "Z" axis rotates the surgical end actuator 3814 around the "Z" axis. See Figure 86. Other methods of fixing the elongated channel 3822 to the pivot block 3873 can be effectively employed without deviating from the character and scope of the present invention.
[0270] [00270] The 3834 surgical clamp cartridge can be assembled and assembled inside the elongated 3822 channel during the manufacturing or assembly process and sold as part of the 3812 surgical end actuator or the 3834 surgical clamp cartridge can be designed for assembly selective within the elongated 3822 channel as needed and sold separately, for example, as a single-use, replaceable or disposable replacement staple cartridge set. It is included in the scope of this disclosure that the surgical end actuator 3812 can be pivoted, operationally or integrally fixed, for example, to the distal end 3809 of the elongated stem assembly 3808 of a disposable surgical stapler. As is known, a used or shipped disposable loading unit 3814 can be removed from the elongated stem assembly 3808 and replaced with an unused disposable unit. The 3814 end cutter may also preferably include an actuator, preferably a dynamic gripping member 3860, a sliding support 3862, as well as clamp thrusters (not shown) and clamps (not shown) when a cartridge not worn or not used 3834 is mounted on the elongated channel 3822. See Figure 86.
[0271] [00271] In various modalities, the 3860 dynamic gripping member is associated with, for example, assembled and seated or with or is connected to or integral with and / or seated behind the 3862 sliding support. It is contemplated that the gripping member dynamic 3860 may have triangular cam bodies or cam surfaces fixed or integrally formed or pushed by an anterior distal surface thereof. In various embodiments, the dynamic gripping member 3860 may include an upper portion 3863 which has a transverse opening 3864 with a pin 3865 that can be mounted or mounted thereon, a central support or upward extension 3866 and a substantially T-shaped bottom flange 3867 which cooperate for slidingly retaining the dynamic gripping member 3860 along an ideal cutting path during the longitudinal distal movement of the sliding support 3862. The leading cutting edge 3868, here, knife blade 3869, is dimensioned to sit inside from slot 3835 of the 3834 staple cartridge assembly and separate the fabric once it is stapled. As used herein, the term "knife assembly" may include the aforementioned dynamic gripping member 3860, knife 3869 and sliding support 3862 or other knife / beam / sliding drive arrangements and cutting instrument arrangements. In addition, the various embodiments of the present invention can be employed with the knife / cutting instrument assembly arrangements that can be entirely supported on the 3834 staple cartridge or partially supported on the 3834 staple cartridge and elongated channel 3822 or entirely supported on the interior of the elongated channel 3822.
[0272] [00272] In various embodiments, the 3860 dynamic gripping member can be driven 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 87 and 88 illustrate cables 3880, 3882, 3884 in diagrammatic form. As can be seen in these Figures, a first advance cable 3880 is operationally supported on a first distal cable transition support 3885 which can comprise, for example, a pulley, rod, rotary 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, rotary axis, 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 on a second distal cable transition support 3887 which can, for example, comprise a pulley, rod, rotary shaft etc. which is mounted on the distal end of the elongated channel 3822 and a second proximal cable transition support 3888 which can, for example, comprise a pulley, rod, rotary axis, 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 endless firing cable 3884 is employed and seated on a support 3889 that can comprise a pulley, rod, rotating shaft, etc. mounted inside the elongated shaft 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.
[0273] [00273] Various non-limiting embodiments of the present invention include a 3920 cable drive transmission that is operably 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 27) on adapter 1240 '. Such an arrangement allows the robotic system 1000 to supply control signals to a 3910 control circuit of the 3800 tool. Although the interface is described here with reference to mechanical, electrical and magnetic coupling elements, it should be understood that a wide variety of modalities telemetry can be used, including infrared, inductive coupling or the like.
[0274] [00274] The 3910 control circuit is shown schematically in Figure 85. In one form or embodiment, the 3910 control circuit includes a power supply in the form of a 3912 battery that is coupled to a solenoid powered switch. switch-off 3914. In other embodiments, however, the power supply may comprise an alternating current source. The control circuit 3910 additionally includes a shutdown / on solenoid 3916 which is coupled to a double pole switch 3918 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.
[0275] [00275] Turning to Figures 89 to 94, at least one mode of the cable drive transmission 3920 comprises a drive pulley 3930 which is operatively mounted on a drive shaft 3932 which is attached to a driven element 1304 of the type and construction described above that is designed to interface with a corresponding drive element 1250 of the adapter 1240. See Figures 27 and 92. Therefore, when the tool mounting portion 3900 is operationally coupled to the tool retainer 1270, the system robotic 1000 can rotate the drive pulley 3930 in a desired direction. A first drive member or drive belt 3934 operably engages the drive pulley 3930 and a second drive shaft 3936 which is rotatably supported on a 3940 displacement fork. The 3940 displacement fork is operably coupled to the drive motor. displacer 3922 so that rotation of shaft 3923 of displacer motor 3922 in a first direction will move the displacer fork in a first direction "FD" and rotation of the displacer motor 3923 in a second direction will displace the fork of shifter 3940 in a second direction "SD". Other embodiments of the present invention can employ a displacer solenoid arrangement to move the displacer yoke in said first and second directions.
[0276] [00276] As can be seen in Figures 89 to 92, a 3950 closing drive gear mounted on a second 3936 drive shaft and configured to selectively interlock with a closing drive assembly, generally designated as 3951. Likewise, a 3960 trigger drive gear is also mounted on the second 3936 drive shaft and is configured to selectively interlace with a trigger drive assembly commonly referred to as 3961. Rotating the second 3936 drive shaft causes the drive gear to closing 3950 and trigger drive 3960 rotate. In a non-limiting embodiment, the closing drive assembly 3951 comprises a driven closing gear 3952 that is coupled to a first closing pulley 3954 that is swivelably supported on a third drive shaft 3956. The closing cable 3850 is actionably received on the first closing pulley 3954 so that the rotation of the driven closing gear 3952 will drive the closing cable 3850. Similarly, the trigger drive assembly 3961 comprises a trigger drive gear 3962 which is coupled to a first firing pulley 3964 which is pivotally supported on the third drive shaft 3956. The first and second driving pulleys 3954 and 3964 are independently rotatable on the third driving shaft 3956. The firing cable 3884 is received from triggerable mode on the first 3964 firing pulley so that the rotation of the 3962 firing gear will drive the firing cable 3884.
[0277] [00277] Also in several embodiments, the 3920 cable drive transmission additionally includes a 3970 braking assembly. In at least one embodiment, for example, the 3970 braking assembly includes a 3972 closing brake comprising a 3973 spring arm 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 further detail below. The 3970 braking assembly additionally includes a 3976 firing brake comprising a 3977 spring arm which is attached to another portion of the 3971 transmission housing. The 3976 firing brake has a 3978 gear pin which is sized to engage the teeth of the 3962 trigger driven gear.
[0278] [00278] At least one modality of the 3800 surgical tool can be used as follows. The tool mounting portion 3900 is operatively 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 anvil 3824 and the staple cartridge 3834. When in the starting position, the braking assembly 3970 locked the driven closing gear 3952 and the driven driving gear 3962 so that they cannot rotate. That is, as shown in Figure 90, 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 displacement head 3940 is moved in the first direction, the closing drive gear 3950 moves the gear terminal 3974 out of the engagement with the driven closing gear 3952 as it moves in the interlocking engagement with the driving driven gear 3952. As can be seen in Figure 89, during this position, the gear terminal 3978 remains in locking engagement with the triggered trigger gear 3962 in order 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-grip collar 3840 in close engagement with the cam surface 3825 of the anvil 3824 to move this to the closed position thereby trapping the target tissue between the anvil 3824 and the staple cartridge 3834. See Figure 85. Once the anvil 3824 has been moved to the closed position, the robotic controller 1001 for the application of the first rotary movement to the drive pulley 3930. Thereafter, the robotic controller 1001 can begin the firing process by sending another control signal to the 3922 displacement motor (or displacer solenoid) to cause the displacer fork to move in the second "SD" direction, as shown in Figure 91. As shifter head 3940 is moved in the second direction, trigger drive 3960 moves gear terminal 3978 out of engagement with trigger driven gear 3962 as it moves in interlocking engagement with driven gear trip point 3962. As can be seen in Figure 91, during this position, the gear terminal 3974 remains in locking engagement with the driven closing gear 3952 to prevent the closing system from acting. 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 direction "DD" thereby firing the clamps and cutting the tissue attached to the 3814 end actuator. Once the robotic system 1000 determines that the gripping member dynamic 3860 has reached its most distal position - either through sensors or by monitoring the amount of rotary input applied to the 3930 drive pulley, controller 1001 can then apply a second rotary motion to the 3930 drive pulley to rotate the cable closing 3850 in an opposite direction to cause the dynamic gripping member 3860 to be retracted in the proximity direction al "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. Subsequently, the 3922 displacer motor (or displacer solenoid) is powered to move the fork of the 3940 displacer 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 preheat collar 3840 out of engagement with the cam surface 3825 of the anvil 3824 to allow the anvil 3824 to move into an open portion (by a spring or other means) to release the stapled tissue from the 3814 surgical end actuator.
[0279] [00279] Figure 95 illustrates a surgical tool 4000 that employs a 4092 gear driven firing bar as shown in Figures 96 to 98. This embodiment includes an elongated shank assembly 4008 that extends from a 4100 tool mounting portion. The tool mounting portion 4100 includes a tool mounting plate 4102 that operationally supports a transmission arrangement 4103 therein. The elongated shank assembly 4008 includes a rotating proximal closing tube 4010 that is rotatably seated on a proximal back member 4020 that is rigidly coupled to the tool mounting plate 4102. The proximal back member 4020 has a distal end that it 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 anvil 4024 of the surgical end actuator 4012 can be opened and closed by a distal closing tube 4030 that interfaces operationally 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.
[0280] [00280] The anvil 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, generically designated such as 4011. As will be further discussed below, the closing transmission 4011 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 proximal spinning closure tube 4010 around the longitudinal axis of the LT-LT tool. As can be seen in Figure 98, a proximal end 4060 of proximal closing tube 4010 is pivotally supported within a support arrangement 4104 which is attached to a tool mounting plate 4102 of the tool mounting portion 4100. A rotation gear 4062 is formed on or attached to the proximal end 4060 of the closing pipe segment 4010 for interlocking engagement with a rotation drive assembly 4070 that is operationally supported on the tool mounting plate 4102. At least one embodiment, a rotating drive gear 4072 is coupled to a first correspondent of the driven disks or members 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 28 and 98. The 4070 rotary drive assembly additionally comprises a 4074 rotary driven gear that is rotatably supported on the tool mounting plate 4102 in interlocking 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 retainer 1270 and the 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 rotary drive gear 4072 ultimately results in the rotation of the closing pipe segment 4010 to open and close the anvil 4024 as described above.
[0281] [00281] As indicated above, end actuator 4012 employs a cutting element 3860, as shown in Figures 96 and 97. In at least one non-limiting embodiment, the transmission arrangement 4103 additionally comprises a knife drive transmission that includes a knife drive assembly 4080. Figure 98 illustrates a way of knife drive assembly 4080 for axially advancing knife bar 4092 that is attached to such a cutting element using cables as described above in relation to the surgical tool 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 driven disks or members 1304 on the adapter side of the tool mounting plate 4102 when the tool mounting portion 4100 is coupled to tool retainer 1270. See Figures 28 and 98. The knife drive set 4080 additionally comprises a first set of rotary drive gear 4084 that is swiveled on tool mounting plate 4102. The first set of swivel drive gear 4084 is in interlaced engagement with a third swivel drive gear set 4086 that is swiveled on tool mounting plate 4102 and that is in interlaced engagement with a fourth swivel drive gear set 4088 that it is in interlocking engagement with a threaded portion 4094 of the drive shaft assembly 4090 that is coupled to the knife bar 4092. Rotation of the rotary drive gear 4082 in a second rotational direction will result in axial advance of the drive shaft assembly 4090 and the knife bar 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".
[0282] [00282] Figures 99 to 105 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 stapling instrument surgery that includes an elongated 5020 channel and a hinged translucent gripping member, such as an anvil 5070, which are kept in a spacing that ensures effective stapling and sectioning of tissue attached to the 5012 surgical end actuator. note in Figure 101, the elongated channel 5020 can have a substantially U-shape in the cross section and can be manufactured from, for example, titanium, 203 stainless steel, 304 stainless steel, 416 stainless steel, 17-4 stainless steel, 17-7 stainless steel, 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.
[0283] [00283] Various modalities include an actuating member in the form of a 5030 sliding support assembly that is operationally supported inside the 5012 surgical end actuator and axially movable therein between an initial position and an end position in response to movements control applied to it. In some forms, a metal channel container 5022 has a centrally arranged slot 5024 therein to movably accommodate a base portion 5032 of the sliding support 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 101. As can be seen in Figures 100, 101, 104, and 105, the base portion 5032 of the sliding support assembly 5030 includes a threaded hole extending axially 5036 which is configured to be received in a threadable manner on a 5130 threaded drive shaft as will be discussed in more detail below. In addition, the sliding support 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 an upper portion 5042 that has a pair of fins 5044 extending laterally from the retaining wall. As shown in Figure 101, the fins 5044 are positioned to be received inside the corresponding slots 5072 in the anvil 5070. The fins 5044 and the foot 5034 are used to hold the anvil 5070 in a desired spaced closed position according to the sliding support set 5030 is driven distally through the tissue trapped inside the 5014 surgical end actuator. As can also be seen in Figures 103 and 105, the sliding support set 5030 additionally includes a drive set that can be reciprocally or sequentially activated 5050 for the actuation of clamp thrusters in the direction of the closed 5070 anvil.
[0284] [00284] More specifically and with reference to Figures 101 and 102, elongated channel 5020 is configured to operationally support a 5080 surgical staple cartridge in it. 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 for the accommodation of the vertical support portion 5038 of the 5030 sliding support assembly. See Figure 101. These materials could also be loaded with glass, carbon or mineral fillers of 10% to 40%. The surgical clamp cartridge 5080 additionally includes a plurality of cavities 5086 to mobilely support lines or rows of clamp support thrusters 5088 therein. Cavities 5086 can be arranged in longitudinally spaced lines or rows 5090, 5092, 5094, 5096. For example, rows 5090 may be referred to herein as first rows away from the center. Rows 5092 can be referred to in this document as first rows close to the center. Rows 5094 can be called second rows close to the center and rows 5096 can be called second rows away from the center. The first row close to the center 5090 and the first row away from the center 5092 are located on a first side side of the longitudinal slot 5084 and the second row close to the center 5094 and the second row away from the center 5096 are located on a second side side of the longitudinal slot 5084. The first 5088 clamp thrusters in the first row close to the 5092 center are misaligned with respect to the first 5088 clamp thrusters in the first row away from the 5090 center. Similarly, the second 5088 clamp thrusters in the second row away from the center. center 5096 are out of alignment with the second thrusters 5088 in the second row close to center 5094. Each thruster 5088 operationally supports a surgical clamp 5098 therein.
[0285] [00285] In several embodiments, the 5050 sequentially or reciprocally activable drive set includes a pair of drives away from the 5052 center and a pair of drives close to the 5054 center that are each attached to a common 5056 axis that is mounted pivotally inside the base 5032 of the sliding support assembly 5030. The actuators distant from the center 5052 are oriented to engage sequentially or reciprocally to a corresponding plurality of activation cavities distant from the center 5026 provided in the channel container 5022. similarly, actuators near center 5054 are oriented to engage sequentially or reciprocally to a corresponding plurality of activation cavities near center 5028 provided in channel container 5022. Activation cavities near center 5028 are arranged in an offset relationship in to the activation cavities distant from the adjacent center 5026. See Figure 102. As can also be seen in Figures 103 and 104, in at least one embodiment, the sliding support assembly 5030 additionally includes distal wedge body segments 5060 and intermediate wedge body segments 5062 located on each side of orifice 5036 to engage the 5088 thrusters when the 5030 sliding support assembly is driven distally in the "DD" distal direction. As indicated above, the sliding support assembly 5030 is threadedly received on a threaded portion 5132 of a drive shaft 5130 that is swiveled within the end actuator 5012. In various embodiments, for example, the drive shaft drive 5130 has a distal end 5134 which is supported on a distal bearing 5136 mounted on the surgical end actuator 5012. See Figures 101 and 102.
[0286] [00286] 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 system generally designated as 5204 which is configured to receive rotating outward movements from the robotic system. The elongated shank assembly 5108 includes an outer closing tube 5110 that is rotatable and axially movable in a back member 5120 that is rigidly coupled to a tool mounting plate 5201 of the tool mounting portion 5200. The back member 5120 it also has a distal end 5122 which is coupled to the elongated channel portion 5020 of the surgical end actuator 5012.
[0287] [00287] In use, it may be desirable to rotate the surgical end actuator 5012 around a longitudinal tool axis LT-LT 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 an anterior support bracket 5203. The proximal end 5112 of the outer closure tube 5110 is configured to interface operationally with a portion rotation drive 5206 of the transmission arrangement 5204. In various embodiments, the proximal end 5112 of the outer closure tube 5110 is also supported on a slide support 5140 which is also movably supported on the tool mounting plate 5201 A closing tube gear segment 5114 is formed at the proximal end 5112 of the outer closing tube 5110 for interlocking engagement with a 5150 rotation drive assembly of the 5206 rotation transmission. As can be seen in Figure 99, the 5150 rotation drive assembly, in at least one embodiment, comprises a 5152 rotation drive gear which is coupled to a corresponding first driven member or disk among the driven members or disks 1304 on the adapter side 1307 of the tool mounting plate 5201 when the tool drive portion 5200 is coupled to the tool retainer 1270. The rotary drive assembly 5150 additionally comprises a rotary drive gear 5154 which is pivotally supported on the tool mounting plate 5201 in interlaced engagement with the closing tube gear segment 5114 and the rotary drive gear 5152. The application of a first movement of rotary control from the robotic system 1000 through the tool holder 1270 and the adapter ad 1240 to the corresponding driven element 1304 will thus cause the rotation drive gear rotation 5152 to rotate. The rotation of the rotary drive gear 5152 ultimately results in the rotation of the elongated stem assembly 5108 (and end actuator 5012) around the axis of the LT-LT longitudinal tool (represented by the arrow "R" in Figure 99).
[0288] [00288] The closure of the anvil 5070 in relation to the surgical clip cartridge 5080 is carried out by axially moving the external closure tube 5110 in the distal direction "DD". Such axial movement of the outer closure tube 5110 can be performed by a closing transmission portion 5144 of the transmission arrangement 5204. As indicated above, in various embodiments, the proximal end 5112 of the outer closure tube 5110 is supported by the sliding support of closure 5140 that allows the proximal end 5112 to rotate in relation to this, and still travel axially with the closing slide support 5140. In particular, as can be seen in Figure 99, the closing slide holder 5140 has a vertical flap 5141 that extends in a radial groove 5115 at the proximal end portion 5112 of the outer closure tube 5110. In addition, as described above, the 5140 closure frame is slidably mounted on the tool mounting plate 5201. In various embodiments, the closing slide holder 5140 has a vertical portion 5142 that has a closing rack gear 5143 formed thereon . The closing rack gear 5143 is configured to engage with a 5144 closing transmission.
[0289] [00289] In various forms, the closing transmission 5144 includes a closing gear wheel 5145 that is coupled to a second corresponding of the driven disks or members 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. Closing transmission 5144 additionally includes a driven closing gear assembly 5146 which is supported in interlaced engagement with closing gear 5110 and closing rack gear 5143. Therefore, the application of a second rotary control movement from the robotic system 1000 through retainer d and tool 1270 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 to engage with a tab 5071 on the anvil 5070 in the ways described above. As the external closing tube 5110 is activated distally, the proximal end 5116 of the closing tube 5110 will come into contact with the anvil 5070 and rotate it in order to close it. By applying a rotating "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 anvil 5070 to the open position as described above.
[0290] [00290] In at least one embodiment, the drive shaft 5130 has a proximal end 5137 that has a proximal shaft gear 5138 attached to it. The proximal axle gear 5138 is supported in interlocking engagement with a distal axle gear 5162 attached to a 5160 swivel drive bar that is swiveled with the back member 5120. The rotation of the 5160 swivel drive bar and, therefore, Finally, the rotary drive shaft 5130 is controlled by a rotary knife transmission 5207 comprising a portion of the transmission arrangement 5204 held on the 5210 tool mounting plate. In various embodiments, the rotary knife transmission 5207 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 disks or members 1304 on the adapter side of the tool mounting plate 5201 when the nta 5200 is coupled to the tool holder 1270. The knife drive system 5170 additionally comprises a first rotary drive gear 5174 which is pivotally supported on the tool mounting plate 5201 in interlocking engagement with a second rotary drive 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.
[0291] [00291] 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 shaft 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 shaft 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.
[0292] [00292] A method for operating the surgical tool 5000 will now be described. The tool drive 5200 is operationally coupled to interface 1240 of the robotic system 1000. Controller 1001 of the robotic system 1000 is operated to locate the tissue to be cut and stapled between the open anvil 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 anvil 5070 and the surgical staple cartridge 5080, the controller 1001 of robotic system 1000 can be activated to apply the second rotating 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 closed anvil 5070 as described above. Once the robotic controller 1001 determines that the anvil 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 that means closing the anvil. 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.
[0293] [00293] To start the firing process, the robotic controller applies a third rotating output movement to the third disc 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 rotary shaft and 5130 rotary drive shaft as described above. The firing and formation of surgical clamps 5098 can be understood more satisfactorily from the reference to Figures 103, 105 and 106. As the sliding support set 5030 is activated in the distal direction "DD" through the surgical clamp cartridge 5080 , the distal cuneiform body segments 5060 first come into contact with the 5088 clamp thrusters and begin to move them in the direction of the closed anvil 5070. As the 5030 sliding support assembly continues to move distally, the actuators distant from the center 5052 will fall into the corresponding activation cavity 5026 in the channel container 5022. The opposite end of each driver distant from the center 5052 will then come into contact with the propeller distant from the corresponding center 5088 that has been moved to the wedge body segments distal and intermediate 5060, 5062. Additionally, the distal movement of the 5030 sliding support assembly the center 5052 rotate and activate the corresponding thrusters 5088 in the direction of the anvil 5070 to cause the clamps 5098 sustained therein to be formed as they are activated in the anvil 5070. It will be understood that, as the sliding support set 5030 moves distally , the 5040 knife blade cuts through the fabric that is trapped between the anvil and the staple cartridge. Due to the fact that actuators near center 5054 and actuators distant from center 5052 are fixed to the same axis 5056 and actuators near center 5054 are radially displaced from actuators distant from center 5052 on axis 5056, according to actuators distant from center 5052 drive their corresponding thrusters 5088 towards the anvil 5070, the triggers near the center 5054 fall into their next corresponding activation cavity 5028 to cause them to rotate or reciprocate the thrusters near the center 5088 towards the anvil closed 5070 in the same way. In this way, the clamps distant from the center corresponding to the side 5098 on each side of the centrally arranged slot 5084 are simultaneously formed together and the clamps close to the center corresponding to the side 5098 on each side of the slot 5084 are simultaneously formed together according to the sliding support set 5030. distally driven. 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 sliding support assembly 5030 has been retracted to the starting position (as indicated by the sensors on the end actuator 5012 and / or the tool drive portion 5200), the application of the second pivoting motion to the 5130 drive shaft is interrupted . Subsequently, the surgeon can manually activate the anvil opening process or it can be automatically initiated by the robotic controller 1001. To open the 5070 anvil, the second pivoting outward motion is applied to the 5145 closing sprocket gear to drive the sliding support closure tube 5140 and the outer closure 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 into contact with the flap 5071 on the anvil 5070 to rotate the anvil 5070 to the open portion. A spring can also be used to orient the anvil 5070 to the open portion when the closing tube 5116 has 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 anvil 5070 is now open. Thereafter, the 5012 surgical end actuator can be removed from the surgical site.
[0294] [00294] Figures 106 to 111 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 drivers close to the center and away from the center 5052 ', 5054' have a cam-like shape with a 5053 cam surface and a 5055 actuator protrusion as shown in Figures 106 to 112. The 5052 ', 5054' actuators they are seated on the same axis 5056 ', which is rotatably supported by the sliding support assembly 5030'. In this embodiment, the sliding support set 5030 'has distal cuneiform body segments 5060' for the engagement of 5088 thrusters. Figure 106 illustrates an initial position of two actuators close to the center or distant from the center 5052 ', 5054' depending on the set slide support 5030 'is activated in the distal direction "DD". As can be seen in this Figure, the 5088a thruster has advanced on the 5060 'wedge-shaped body segment and has come into contact with the 5052', 5054 'actuator. The additional movement of the sliding support assembly 5030 'in the distal direction causes the driver 5052', 5054 'to rotate in the "P" direction (Figure 107) until the 5055 actuator portion contacts the end wall 5029a of the cavity 5026, 5028 as shown in Figure 108. Continuous advancement of the sliding support assembly 5030 'in the distal direction "DD" causes the driver 5052', 5054 'to rotate in the "D" direction as shown in Figure 109. As shown in Figure 109. the driver 5052 ', 5054' rotates, the thruster 5088a moves upward on the cam surface 5053 to the final vertical position shown in Figure 110. When the 5088a thruster reaches the final vertical position shown in Figures 110 and 111, the clamp ( not shown) sustained therein was actuated on the staple forming surface of the anvil to form the staple.
[0295] [00295] Figures 113 to 119 illustrate a surgical end actuator 5312 that can be used, for example, in conjunction with the tool mounting portion 1300 and the 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 5330 surgical clamp cartridge therein. The surgical clamp cartridge 5330 comprises a body portion 5332 that includes a centrally arranged slot 5334 for accommodating a vertical support portion 5386 of a sliding support assembly 5380. See Figures 113 to 115. The surgical clamp cartridge portion body 5332 additionally includes a plurality of cavities 5336 for mobilely supporting the clamp support thrusters 5350 therein. The cavities 5336 can be arranged in rows extending laterally spaced 5340, 5342, 5344, 5346. The rows 5340, 5342 are located on one side of the longitudinal slot 5334 and the rows 5344, 5346 are located on the other side of the longitudinal slot 5334. In at least one embodiment, the 5350 thrusters are configured to hold two 5352 surgical clamps therein. In particular, each thruster 5350 located on one side of the elongated slot 5334 holds 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. In this way, each 5350 propellant holds two 5352 surgical clamps.
[0296] [00296] As can be further seen in Figures 113, 114, the surgical staple 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 113, each rotary actuator 5360 is pivotally supported within the body of the 5332 staple cartridge. More particularly, each rotary actuator 5360 is received pivotally on a corresponding drive axis 5362. Each actuator 5360 has an arched ramp portion 5364 formed that which is configured to engage an arched lower surface 5354 formed on each 5350 thruster. See Figure 118. In addition , each actuator 5360 has a lower support portion 5366 extending therefrom to slide the propeller 5360 over the channel 5322. Each actuator 5360 has an actuating rod extending downwards 5368 which is configured to engage with an assembly 5380 slide holder.
[0297] [00297] As can be seen in Figure 115, in at least one embodiment, the sliding support 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 113. The slide support assembly 5380 includes a vertical support portion 5386 that supports a tissue cutting blade or tissue cutting instrument 5388. The vertical support portion 5386 ends at an upper portion 5390 that has a pair of laterally extending 5392 retaining fins protruding from it. The 5392 fins are positioned to be received inside corresponding slits (not shown) on the anvil (not shown). As with the modalities described above, the fins 5392 and the foot portion 5384 serve to hold the anvil (not shown) in a desired spaced closed position as the slide support assembly 5380 is distally driven through the tissue trapped inside the actuator. surgical end 5312. The vertical support portion 5386 is configured for attachment to a 2200 knife bar (Figure 34). The slide support assembly 5380 additionally has a horizontally extending actuator plate 5394 that is shaped for actuating engagement with each of the 5368 actuating rods on the 5360 thrusters.
[0298] [00298] The operation of the 5312 surgical end actuator will now be explained with reference to Figures 113 and 114. As the slide support assembly 5380 is activated in the distal direction "DD" through the 5330 clamp cartridge, the 5394 actuator plate enters in sequential contact with the actuating rods 5368 on the 5360 thrusters. As the 5380 sliding support assembly continues to move distally, the 5394 actuator plate comes in sequential contact with the 5368 actuator rods of the 5360 actuators on each side of the elongated slot 5334. This action causes the 5360 actuators to rotate from an unactivated first position to an actuated portion in which the 5350 thrusters are driven in the direction of the closed anvil. As the 5350 thrusters are driven in the direction of the anvil, the 5352 surgical clamps are triggered to form contact with the underside of the anvil. 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. After that, the robotic control system can then activate the procedure to return the anvil to the open portion in order to release the stapled tissue.
[0299] [00299] Figures 119 to 123 show a form of an automated reloading system modality of the present invention, generically designated as 5500. In one form, the 5500 automated reloading 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 staple cartridge, a disposable loading unit, or other end actuator components that, when used, are worn out and need to be replaced with a new component. Furthermore, the term "spent" means that the end actuator component has been activated and is no longer useful for the purpose for which it is intended in its current state. For example, in the context of a surgical staple cartridge or disposable loading unit, the term "spent" means that at least part of the unformed staples that were previously sustained therein has been "fired" from it. As used herein, the term "new" surgical end actuator component refers to an end actuator component that is in 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 therein and that is otherwise ready for use.
[0300] [00300] In various embodiments, the automated reloading system 5500 includes a base portion 5502 that can be strategically located in a work envelope 1109 of a robotic arm vehicle 1100 (Figure 20) 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 vehicle robotic 1100 or similar device that is configured to automatically manipulate and activate the surgical tool. The term "work envelope" as used here refers to the range of motion of the manipulative surgical tool portion of the robotic system. Figure 20 shows, in general, an area that can comprise a working envelope of the robotic arm vehicle 1100. Those skilled in the art will understand that the shape and size of the working envelope shown therein is merely illustrative. The size, shape and final location of a work envelope will ultimately depend on the construction, the range of travel limitations and the location of the manipulable surgical tool portion. As such, the term "work envelope" as used here 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 20.
[0301] [00301] As can be seen in Figure 119, base portion 5502 includes a new arrangement or component support section 5510 that is configured to operationally support at least one new surgical end actuator component in a "position orientation" charge". As used herein, the term "load orientation" 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 put into load engagement with (i.e. is, operationally seated or operationally secured) the new end actuator component (or the new end actuator component is engaged by load with the corresponding component holding portion of the manipulable surgical tool portion) without intervention of the human being beyond what may be necessary to act the robotic system. As will be further understood as this Detailed Description advances, in at least one mode, the grooming nurse will load the new component holding section before surgery with the appropriate length and color cartridges (some surgical clamp cartridges can hold certain sizes of staples of the size that can be indicated by the color of the cartridge body) necessary for the end of the surgical procedure. However, no direct human intervention is required during surgery to recharge the robotic 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 groove) 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 2012 surgical end actuator that includes a 2022 channel and an anvil 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 hitch) in channel 2022 of a 2012 surgical end actuator. As this Detailed Description advances, however, members skilled in the art will understand that the unique and innovative attributes of the 5500 automated cartridge refill system can be employed effectively in conjunction with the automated removal and installation of other cartridge arrangements without deviating from the character and scope of the present invention.
[0302] [00302] In the mode shown, the term "loading orientation" means that the distal tip portion 2035a of a new surgical clip 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 1100 vehicle to handle the surgical end actuator 2012 to a position where the new 2034a cartridge can be automatically loaded into the groove 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 2034a cartridge.
[0303] [00303] 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 reloading system includes a 5530 extraction system to automatically remove the worn end actuator component from the corresponding support portion of the end actuator or manipulable surgical tool portion without specific human intervention beyond that which may be required to activate the robotic system. In various embodiments, the extraction system 5530 includes an extraction hook member 5532. In one form, for example, the extraction hook member 5532 is held rigidly over the base portion 5502. In one embodiment, the hook member The extraction hook has at least one hook 5534 formed in it that is configured to hook the distal end 2035 of a spent cartridge 2034b hooked when held in the elongated groove 2022 of the surgical end actuator 2012. In various forms, the hook member 5532 extractor is conveniently located within a portion of the 5520 collection receptacle, so that when the worn end actuator component (cartridge 2034b) is placed in extractive engagement with the 5532 extraction hook member, the extraction hook member worn end actuator (cartridge 2034b) is displaced from the corresponding component support portion (elongated groove 2022) and falls into the 5020 collection receptacle. When using this modality, the manipulable surgical tool portion manipulates the end actuator attached to it to place the distal end 2035 of the spent cartridge 2034b in it in engagement with hook 5534 and then move the end actuator in such a way moving the spent cartridge 2034b from the elongated groove 2022.
[0304] [00304] In other arrangements, the extraction hook member 5532 comprises a rotating wheel configuration that has a pair of diametrically opposed hooks 5334 protruding from it. See Figures 119 and 123. Extraction hook member 5532 is pivotally supported inside the collection receptacle 5520 and is coupled to an extraction motor 5540 that is controlled by controller 1001 of the robotic system. This form of the 5500 automated reloading system can be used as follows. Figure 121 illustrates the introduction of the surgical end actuator 2012, which is operationally attached to the manipulable surgical tool portion 1200. As can be seen in that Figure, the arm vehicle 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 into the surgical end actuator 2012. The anvil 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 turn the extraction wheel 5532 to disengage the spent cartridge 2034b from channel 2022. To assist in disengaging the spent cartridge 2034b from channel 2022 (or if extraction member 5530 is stationary), robotic system 1000 can move surgical end actuator 2012 in an upward direction ("U" arrow in Figure 137). As the spent cartridge 2034b is moved from the 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 123.
[0305] [00305] In several 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 coupling 5533 may 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.
[0306] [00306] As can be seen in Figure 123, the surgical end actuator 2012 is positioned to hold a new surgical clamp cartridge 2034a between channel 2022 and anvil 2024. More specifically, as shown in Figures 120 and 123, each cavity 5512 has a corresponding vertical damping plate 5514 associated with it. The surgical end actuator 2012 is located so that the damping plate 5514 is located between the new cartridge 2034a and the anvil 2024. Once in that position, the robotic system 1000 closes the anvil 2024 on the damping plate 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 was snapped into position in the elongated channel 2022, the robotic system 1000 then removes the 2012 surgical end actuator from the 5500 automated cartridge refill systems for use in connection with performing another surgical procedure.
[0307] [00307] Figures 124 to 128 show another 5600 automated reloading system that can be used to remove a worn out disposable loading unit 3612 from a manipulative surgical tool arrangement 3600 (Figures 71 to 84) that is operably attached to a arm vehicle 1100 or other portion of a robotic system 1000 and recharges a new disposable loading unit 3612 there. As can be seen in Figures 124 and 125, a form of the automated charging system 5600 includes a housing 5610 that has a set of movable support in the form of a rotating carousel top plate 5620 supported therein that cooperates with housing 5610 to form a hollow confined area 5612. The automated reloading system 5600 is configured to be operationally supported within 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 125 and 126, the rotating carousel plate 5620 is affixed to a spindle shaft 5624. The spindle shaft 5624 is centrally disposed within the confined 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.
[0308] [00308] Various modalities of the 5600 automated reloading system may also include a carousel locking assembly, generically referred to as 5640. In various forms, the 5640 carousel locking assembly includes a 5642 cam disk that is attached to the spindle shaft 5624. Spindle gear 5626 can be attached to the underside of cam disk 5642 and cam disk 5642 can be keyed to spindle 5624. In alternative arrangements, spindle gear 5626 and cam disk 5642 can be attached independently attached in a non-rotating manner to the spindle shaft 5624. As can be seen in Figures 125 and 126, a plurality of notches 5644 are spaced around the perimeter of the cam disk 5642. A locking arm 5648 is pivotally mounted on the interior of compartment 5610 and is oriented to engage with the perimeter of the cam disk 5642 by a locking spring 5649. As can be seen in Figure 127, the outer perimeter of the cam disk 5642 is rounded to facilitate rotation of the cam disc 5642 with respect to the locking arm 5648. The edges of each notch 5644 are also rounded so that when the cam disc 5642 is rotated, the locking arm 5648 is detached from the engage with the notches 5644 along the perimeter of the cam disc 5642.
[0309] [00309] Various forms of the 5600 automated refill system are configured to support a set of portable / replaceable trays 5650 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 125 and 126, the replaceable tray set 5650 comprises a tray 5652 which has a centrally arranged locator spindle 5654 projecting from the underside of the tray. The locating spindle 5654 is dimensioned to be received inside a hollow end 5625 of the spindle shaft 5624. Tray 5652 has a plurality of holes 5656 in it that are configured to support a guide tube 5660 therein. Each 5660 guide tube is oriented through a corresponding hole 5656 in the 5650 replaceable tray set in a desired orientation by a fin location 5666 in the orientation tube 5660 that is designated to be received in a corresponding location slot 5658 in the tray set 5650. In at least one embodiment, the 5666 location fin has a substantially V-shaped cross-sectional shape that is sized to fit into a 5658 V-shaped location slot. This arrangement serves to guide the guide tube 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 124 to 126, the replaceable tray 5652 can be provided with one or more portions of cable 5653 to facilitate transport of the 5652 tray set when loaded with 5660 guide tubes.
[0310] [00310] As can be seen in Figure 128, each guide tube 5660 comprises a body portion 5662 that has an open end provided with flange 5664. Body portion 5662 defines a cavity 5668 that is sized to receive a portion of a disposable loading unit 3612 therein. To properly orient the disposable loading unit 3612 inside the guidance tube 5660, the cavity 5668 has a flat location surface 5670 formed therein. As can be seen in Figure 128, the flat location surface 5670 is configured to facilitate insertion of the disposable loading unit into cavity 5668 in a desired or predetermined non-rotating orientation. In addition, the end 5669 of the cavity 5668 may include a foam or cushioning material 5672 which is designed to cushion the distal end of the disposable loading unit 3612 within the cavity 5668. In addition, the length of the locating surface can cooperate with a sliding support member 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.
[0311] [00311] The 5660 guide tubes can be manufactured from nylon, polycarbonate, polyethylene, liquid crystal polymer, aluminum 6061 or 7075, titanium, stainless steel 300 or 400 series, coated or painted steel, clad steel, etc. and, when loaded on the replaceable tray 5662 and the locating spindle 5654 is inserted into the hollow end 5625 of the spindle shaft 5624, the guide tubes 5660 extend through corresponding holes 5662 in the 5620 roundabout top plate. Each replaceable 5662 tray 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 triggered status of each housed charge 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.
[0312] [00312] Various modalities of the 5600 automated reloading system additionally include a 5680 drive assembly for applying a pivoting motion to the 5660 guide tube that holds the disposable loading unit 3612 to be attached to the 3700 axis 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 head 5682 which is attached to the locking arm 5648. In this way, the support head 5682 rotates with the locking arm 5648. The support head 5682 swivels a crazy tube wheel 5684 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. The tube crazy wheel 5684 and the tube drive wheel 5686 are made from, for example, natural rubber, sanoprene, isoplastic, etc. so that the external surfaces of the same create a sufficient amount of friction to cause the rotation of a 5660 guide tube in contact with this by activating the 5688 tube motor. The idler wheel 5684 and the tube drive wheel 5686 are oriented relative to each other to create a support area 5687 with each other for receiving a 5060 guide tube in actuating engagement thereon.
[0313] [00313] In use, one or more 5660 guidance tubes loaded in the 5600 automated refill system are left empty, while the other 5660 guidance tubes can operationally support a new corresponding disposable loading unit 3612 therein. As will be discussed in more detail below, the 5660 empty guide tubes are employed to receive a disposable charging unit spent 3612 on it.
[0314] [00314] The 5600 automated reloading system can be used as follows after the 5600 system is located inside the work envelope of the manipulative surgical tool portion of a robotic system. If the manipulable surgical tool portion has a spent disposable loading unit 3612 operationally coupled to it, one of the guidance tubes 5660 that is supported on the replaceable tray 5662 is left empty to receive the disposable loading unit spent 3612 on it. However, if the manipulable surgical tool portion does not have a disposable loading unit 3612 operationally coupled thereto, each of the 5660 guiding tubes may be provided with a new appropriately oriented disposable loading unit 3612.
[0315] [00315] As previously described in this document, the disposable loading unit 3612 employs a rotatable "bayonet-type" 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 Figures 77, 81), a rotating installation movement needs to be applied to the disposable loading unit 3612 and / or the corresponding portion of the manipulable surgical tool portion when these components are moved in load coupling with each other. Such installation movements are collectively referred to in this document as "load movements". Similarly, to decouple a worn out disposable loading unit 3612 from the corresponding portion of the manipulable surgical tool, a rotating coupling movement needs to be applied to the worn out disposable loading unit 3612 and / or the corresponding portion of the manipulated surgical tool portion while moving simultaneously the spent disposable loading unit and the corresponding portion of the surgical tool manipulable in the opposite direction to each other. Such coupling movements are collectively referred to in this document as "extraction movements".
[0316] [00316] 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 that is supported on the guide tube 5660 that is in engagement drive with the 5680 drive assembly. When robotic controller 1001 (Figure 19) of robotic control system 1000 has located the manipulable surgical tool portion 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 rotary loading motion 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 engaged by loading with the corresponding portion of the manipulable tool portion, the loading movements are discontinued and the manipulable surgical tool portion can be moved in the opposite direction to the 5600 automated reloading system that door with the new disposable loading unit 3612 that was operationally coupled to it.
[0317] [00317] To decouple a spent 3612 disposable loading unit 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 discontinued.
[0318] [00318] 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 engagement with the drive assembly 5680. After that, the loading process can be repeated to fix the new disposable loading unit 3612 therein 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.
[0319] [00319] Figures 129 to 134 represent 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 a tool drive set 1010 (Figure 24) that is coupled so operational to a master controller 1001 that is operable through inputs from an operator (ie, a surgeon). As can be seen in Figure 129, surgical tool 6000 includes a surgical end actuator 6012 that comprises an end cutter. In at least one form, the surgical tool 6000 generally includes an elongated shank 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, generically referred to as 6200. The surgical tool 6000 additionally 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.
[0320] [00320] 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 movable between the first and second positions in relation to at least another 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 operationally support a surgical clamp cartridge 6034 therein and component 6024 comprises an articulably translatable gripping member, such as an anvil 6024. Various embodiments of the end actuator surgical 6012 are configured to hold the anvil 6024 and the elongated groove 6022 in a spacing that ensures effective stapling and sectioning of tissue trapped in the surgical end actuator 6012. Unless otherwise specified, the end actuator 6012 is similar to the actuator surgical end cap described above and includes a cutting instrument (not shown) and a frame (not shown). The anvil 6024 may include a flap 6027 at its proximal end that interacts with a component of the mechanical closure system (further described below) to facilitate opening of the anvil 6024. The elongated groove 6022 and the anvil 6024 can be produced from a electrically conductive material (such as metal) so that they can serve as part of an antenna that communicates with sensor (s) on the end actuator, as described above. The 6034 surgical clamp cartridge could be produced from a non-conductive material (such as plastic) and the sensor can be connected or disposed in the 6034 surgical clamp cartridge, as will also be described above.
[0321] [00321] As can be seen in Figure 129, the surgical end actuator 6012 is attached to the tool mounting portion 6200 by the elongated stem assembly 6008 according to various modalities. As shown in the illustrated embodiment, the elongated stem assembly 6008 includes a hinge joint generically designated as 6100 that allows the surgical end actuator 6012 to be selectively hinged around a first tool hinge axis AA1-AA1 that is substantially transverse to a longitudinal tool axis LT-LT and a second tool pivot axis AA2-AA2 which is substantially transversal to the longitudinal tool axis LT-LT as well as to the first pivot axis AA1-AA1. See Figure 130. In various embodiments, the elongated stem assembly 6008 includes a closure tube assembly 6009 comprising a proximal closure tube 6040 and a distal closure tube 6042 that are pivotally connected by pivot links 6044 and 6046 The closing tube assembly 6009 is movably supported on a back assembly generally designated as 6102.
[0322] [00322] As can be seen in Figure 131, the proximal closing tube 6040 is hingedly connected to a joint of the intermediate closing tube 6043 by an upper pivot link 6044U and a lower pivot link 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 geometry axis CA1-CA1 is substantially parallel to the second closing geometry axis CA2-CA2 and both closing geometry axes CA1- CA1, CA2-CA2 are substantially transversal to the longitudinal tool axis LT- LT. As can be seen further in Figure 131, 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 pipe joint 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 geometry axis CA3-CA3 is substantially parallel to the fourth closing geometry axis CA4-CA4 and both closing geometry axes CA3-CA3, CA4-CA4 are substantially transversal to the first and second closing geometry axes CA1-CA1, CA2-CA2 as well as the LT-LT longitudinal tool axis.
[0323] [00323] The closing tube assembly 6009 is configured to slide axially over the back 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 over the anvil 6024 to facilitate 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 produced from electrically conductive material (such as metal) so that they can serve as part of the antenna, as described above. The components of the 6102 back assembly can be produced from a non-conductive material (such as plastic).
[0324] [00324] As indicated above, the surgical tool 6000 includes a tool assembly portion 6200 that is configured for operational attachment to the assembly tool 1010 of the robotic system 1000 in the various ways described in detail above. As can be seen in Figure 133, 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 hinge axis TA1-TA1 is substantially transverse to the second tool hinge axis TA2-TA2 and the first and second tool hinge axes are substantially transversal to the longitudinal tool axis LTLT. See Figure 130.
[0325] [00325] To facilitate the selective articulation of the surgical end actuator 6012 around the first and second tool articulation axes TA1-TA1, TA2-TA2, the back assembly 6102 comprises a portion of proximal column 6110 that is coupled shape articulated to a portion of distal column 6120 by pivot pins 6122 for selective pivoting displacement around TA1-TA1. Similarly, the distal column portion 6120 is hingedly attached to the elongated groove 6022 of the surgical end actuator 6012 by pivot pins 6124 to allow the surgical end actuator 6012 to rotate selectively around the second tool axis TA2- TA2 in relation to the distal column portion 6120.
[0326] [00326] In several embodiments, the 6140 articulation system additionally includes a plurality of articulation elements that interface operationally with the surgical end actuator 6012 and a joint 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 tool axis. Thus, the first articulation cables are referred to in the present invention as 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 along on the right side of the proximal column portion 6110. See Figure 134. The articulation system 6140 additionally includes a second pair of second articulation cables 6150, 6152. The second articulation cables are located on a second side or left side of the geometry axis longitudinal tool. Accordingly, the second hinge cables are referred to in the present invention 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.
[0327] [00327] As can be seen in Figure 130, 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 groove 6022 on the left pivot joint 6125. The upper left cable 6150 extends around the upper pivot joint 6123 and is attached 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 attached to a lower right side of the elongated channel 6022 on the joint right pivot 6127. Therefore, to pivot 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 need to be pull in the proximal direction "PD". 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 need 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 need to be pulled in the proximal direction "PD". To articulate the surgical end actuator 6012 in the downward direction (arrow "DW") around the second tool pivot axis TA2-TA2, the lower right cable 6146 and the lower left cable 6152 need to be pulled in the proximal direction "PD ".
[0328] [00328] The proximal ends of the articulation cables 6144, 6146, 6150, 6152 are coupled to the articulation control arrangement 6160 which comprises a ball joint assembly which is a part of the articulation transmission 6142. More specifically and with reference to the Figure 134, the ball joint assembly 6160 includes a spherical shaped member 6162 that is formed over a proximal portion of the proximal back 6110. A joint control ring 6164 is held movably on the spherical shaped member 6162. According to can also be seen in Figure 134, the proximal ends of the hinge cables 6144, 6146, 6150, 6152 are coupled to the hinge control ring 6164 by corresponding ball joint arrangements 6166. The hinge control ring 6164 is controlled by a hinge drive assembly 6170. As can be seen more particularly in Figure 134, the proximal ends of the first hinge 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. Similarly, the proximal ends of the second hinge cables 6150, 6152 are attached to the hinge control ring articulation 6164 in second correspondingly spaced points 6153, 6155 which are also located along the plane 6159. As the present Detailed Description continues, members skilled in the art will understand that such a cable fixing configuration on the 6164 articulation control ring facilitates desired range of articulation movements according to the 6164 articulation control ring is handled by the 6170 articulation drive assembly.
[0329] [00329] In various forms, the articulation drive assembly 6170 comprises a horizontal articulation assembly generically designated as 6171. In at least one form, the horizontal articulation assembly 6171 comprises a horizontal thrust cable 6172 which is fixed to an arrangement 6180 horizontal gear assembly. The 6170 pivot drive assembly further comprises a vertical pivot assembly generically designated as 6173. In at least one form, the 6173 vertical pivot assembly comprises a 6174 vertical thrust cable that is attached to a mounting arrangement. vertical gear 6190. As can be seen in Figures 133 and 134, the horizontal thrust cable 6172 extends through a support plate 6167 which is attached to the proximal column portion 6110. The distal end of the horizontal thrust cable 6174 is fixed to the 6164 pivot control ring by a corresponding 6168 ball / pivot joint. The vertical thrust cable 6174 extends through the support plate 6167 and the distal end of it is fixed to the articulation control ring 6164 by a corresponding spherical / pivot joint 6169.
[0330] [00330] The horizontal gear arrangement 6180 includes a horizontal driven gear 6182 which is pivotally mounted on a horizontal axis 6181 which is attached to a proximal portion of the proximal column portion 6110. The proximal end of the horizontal thrust cable 6172 is pivotally attached to the horizontal driven gear 6182 so that, as the horizontal driven gear 6172 is rotated around the horizontal pivot shaft HA, the horizontal thrust cable 6172 applies a first pivoting motion to the 6164 pivot control ring. similarly, the vertical gear arrangement 6190 includes a vertical driven gear 6192 that is pivotally supported on a vertical axis 6191 attached to the proximal portion of the proximal column portion 6110 for pivoting displacement around a vertical VA pivot axis. The proximal end of the vertical thrust cable 6174 is pivotally attached to the vertical driven gear 6192 so that, as the vertical driven gear 6192 is rotated around the vertical pivot axis VA, the vertical thrust cable 6174 applies a second movement pivoting to the 6164 articulation control ring.
[0331] [00331] The horizontal driven gear 6182 and the vertical driven gear 6192 are driven by a 6300 articulation gear train that interfaces operationally with a 6320 articulation displacement assembly. In at least one way, the displacement assembly of The articulation comprises a 6322 articulation drive gear that is coupled to a correspondent between the driven disks or members 1304 on the adapter side 1307 of the tool mounting plate 6202. See Figure 28. Therefore, the application of a rotary input movement to from the robotic system 1000 through the tool drive assembly 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 drive articulation gear 6324 is attached to a 6330 splined shift shaft which is swiveled on the mounting plate tool number 6202. The 6324 pivot driven gear is in interlaced engagement with the 6322 pivot drive gear as shown. In this way, rotation of the articulation drive gear 6322 will result in rotation of the shaft 6330. In various forms, a set of displacer driven gear 6340 is movably supported on the splined portion 6332 of the displacement shaft 6330.
[0332] [00332] In various embodiments, the 6340 driven shifter assembly includes a 6342 driven shifter gear that is attached to a 6344 shifter plate. The 6344 shifter plate interfaces operatively with a 6350 shifter solenoid assembly. The displacement solenoid assembly 6350 is coupled to corresponding pins 6352 by conductors 6352. See Figure 133. Pins 6352 are oriented to communicate electrically with slots 1258 (Figure 27) on the tool side 1244 of adapter 1240. Such arrangement serves to electrically couple the displacement solenoid 6350 assembly to the robotic controller 1001. In this way, the activation of the displacement solenoid 6350 will displace the gear assembly driven by the 6340 displacer in the splined portion 6332 of the 6330 displacer shaft as represented by the "S" arrow in Figures 133 and 134. Various embodiments of the 6300 articulation gear train additionally include a set of e horizontal gear 6360 which includes a first horizontal drive gear 6362 which is mounted on an axis 6361 which is pivotally attached to the tool mounting plate 6202. The first horizontal drive gear 6362 is supported in interlocking engagement with a second gear horizontal drive 6364. As can be seen in Figure 134, the driven horizontal gear 6182 is in interlaced engagement with the distal face portion 6365 of the second driven horizontal gear 6364.
[0333] [00333] Various types of the 6300 articulation gear train additionally include a vertical gear assembly 6370 that includes a first vertical drive gear 6372 that is mounted on an axis 6371 that is swiveled on the tool mounting plate 6202 The first vertical drive gear 6372 is supported in interlocking engagement with a second vertical drive gear 6374 that is supported concentric with the second horizontal drive gear 6364. The second vertical drive gear 6374 is rotationally supported over the proximal column portion 6110 to run around that. The second horizontal drive gear 6364 is pivotally supported over a portion of said second vertical drive gear 6374 for independent displacement therein. As can be seen in Figure 134, the vertical driven gear 6192 is in interlocking engagement with the distal face portion 6375 of the second vertical driven gear 6374.
[0334] [00334] 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 133 and 134, 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. Thus, when shifter gear 6342 is positioned in a central "locking" position so that shifter gear 6342 is in interlocking engagement with both the first horizontal driven gear 6362 and the first vertical driven gear 6372 and the components of the 6140 joint system are locked in position. In this way, the displaceable displacement gear 6342 and the arrangement of the first horizontal and vertical driven gears 6362, 6372 as well as the articulation displacement assembly 6320 can collectively be called a joint locking system, generically referred to as 6380.
[0335] [00335] 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 cause the articulation control ring 6164 to move 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 set 6370 serve to prevent rotation of the vertical driven gear 6192 as the horizontal gear set 6360 is actuated.
[0336] [00336] 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 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 horizontal gear set 6360 serve to prevent rotation of the horizontal driven gear 6182 as the vertical gear set 6370 is actuated.
[0337] [00337] In various modalities, a variety of sensors communicate with the robotic controller 1001 to determine the articulated position of the end actuator 6012. Such sensors can interface with, for example, the articulation joint 6100 or be located inside the tool mounting portion 6200. For example, sensors can be used to detect the position of the articulation control ring 6164 on the spherical shaped portion 6162 of the proximal column portion 6110. Such feedback from the sensors to controller 1001 allows controller 1001 adjusts the amount of rotation and the direction of the swiveling output for the 6322 articulation drive gear. Additionally, as indicated above, when the displacement drive gear 6342 is centrally positioned in interlocking engagement with the first horizontal drive gear 6362 and the first vertical drive gear 6372, the end actuator 601 2 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 modes, the 6350 displacement solenoid assembly can be spring activated to the central locked position.
[0338] [00338] In use, it may be desirable to rotate the surgical end actuator 6012 around the longitudinal tool axis LT-LT. 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 an anterior support bracket 6205 and a sliding support locking device 6510 which is also movably supported on the tool mounting plate 6202. In at least one form, the rotary drive assembly 6400 includes a pipe gear segment 6402 that is formed (or attached) to the proximal end 6041 of the proximal closing tube 6040 for operable engagement by a rotating gear set 6410 that is operationally supported on the tool mounting plate 6202. As can be seen in Figure 133, the rotating gear set 6410, in at least one modality, it comprises a rotating drive gear 6412 which is coupled to the second corresponding of the driven disks or members 1304 in the l the adapter 1307 of the tool mounting plate 6202 when the tool mounting portion 6200 is coupled to the tool drive assembly 1010. See Figure 28. The swivel gear assembly 6410 additionally comprises a first swivel drive gear 6414 which is swiveled on the tool mounting plate 6202 in interlocking engagement with the swivel drive gear 6412. The first swivel drive gear 6414 is attached to a drive shaft 6416 which is swiveled on the mounting plate tool 6202. A second rotary drive gear 6418 is attached to the drive shaft 6416 and is in interlocking engagement with the tube gear segment 6402 on the proximal closing tube 6040. The application of a second rotary output movement of the drive assembly of tool 1010 from the robotic system 1000 to the corresponding driven element 1304 will thus cause , the rotation of the 6412 rotary drive gear. The rotation of the 6412 rotary drive gear ultimately results in the rotation of the elongated shank assembly 6008 (and the surgical end actuator 6012) around the LTLT longitudinal tool shaft. 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.
[0339] [00339] In at least one embodiment, the closing of the anvil 2024 in relation to the 2034 staple cartridge is carried out by axially moving a portion of the 2008 closing elongated stem assembly in the distal direction "DD" in the 2049 column assembly. As indicated above, in various embodiments, the proximal end portion 6041 of the proximal closing tube 6040 is supported by the sliding closing support 6510 which comprises a portion of a closing transmission, generally shown as 6512. As can be seen in Figure 133, the proximal end portion 6041 of the proximal closing tube portion 6040 has a collar 6048 formed there. The closing slide support 6510 is attached to the collar 6048 by a head 6514 that engages an annular groove 6049 in the collar 6048. This arrangement serves to allow the collar 6048 to rotate around the longitudinal tool axis LT-LT while still attached to the closing transmission 6512. In various embodiments, the closing sliding support 6510 has a vertical portion 6516 that has a closing rack gear 6518 formed therein. The 6518 closing rack gear is configured to engage the hitch with a 6520 closing gear set. See Figure 133.
[0340] [00340] In various forms, the closing gear set 6520 includes a closing gear wheel 6522 that is coupled to a corresponding second of the driven disks or members 1304 on the adapter side 1307 of the tool mounting plate 6202. See Figure 28. Therefore, the application of a third 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 gear wheel 6522 to rotate when the mounting portion tool set 6202 is coupled to the tool drive set 1010. The closing gear set 6520 additionally includes a closing reduction gear set 6524 which is held in interlaced engagement with the closing gear wheel 6522 and the closing rack 2106. Therefore, the application of a third rotating outward movement from the going from the tool drive set 1010 of 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 pipe proximal closure 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 anvil 6024 and cause the anvil 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 interacts with flap 6027 on anvil 6024 to facilitate opening it. In various embodiments, a spring (not shown) can be used to orient the anvil 6024 to the open portion when the distal closure tube 6042 has been moved to its initial position. In various embodiments, the various gears in the closing gear assembly 6520 are sized to generate the closing forces necessary to satisfactorily close the anvil 6024 on 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.
[0341] [00341] In several modalities, the cutting instrument is driven through the surgical end actuator 6012 by a 6530 knife bar. See Figure 133. In at least one form, the 6530 knife bar is manufactured with a joint arrangement ( not shown) and / or is made from a material that can accommodate the 6102 surgical end actuator joint around the first and second tool pivot shafts while remaining sufficiently rigid to push the cutting instrument through the tissue attached to the surgical end actuator 6012. The knife bar 6530 extends through a hollow passage 6532 in the proximal column portion 6110.
[0342] [00342] In various embodiments, a proximal end 6534 of the knife bar 6530 is swiveled affixed to a knife rack gear 6540 so that knife bar 6530 is free to rotate relative to the knife rack gear 6540 The distal end of the knife bar 6530 is attached to the cutting instrument in the various ways described above. As can be seen in Figure 133, the knife rack gear 6540 is slidably supported inside a rack housing 6542 that is attached to the tool mounting plate 6202 so that the knife rack gear 6540 is retained in interlocking engagement with a knife drive transmission portion 6550 of the transmission arrangement 6204. In various embodiments, the knife drive transmission portion 6550 comprises a knife gear assembly 6560. More specifically and with reference to Figure 133, in at least one embodiment, the knife gear set 6560 includes a toothed gear gear 6562 which is coupled to a corresponding fourth member or driven disk among the driven members or disks 1304 on the adapter side 1307 of the tool mounting plate 6202 See Figure 28. Therefore, the application of another rotating output movement of the robotic system 1000 through the tool 1010 to the corresponding fourth driven member 1304 will cause the knife gear 6562 to rotate. The knife gear set 6560 additionally includes a knife gear reduction set 6564 that includes a first knife driven gear 6566 and a second 6568 knife drive gear. The 6564 knife gear reduction assembly is pivotally mounted on the 6202 so that the first 6566 knife drive gear is in network engagement with the 6562 knife gear gear. , a second knife drive gear 6568 is in interlaced engagement with a third set of knife drive gear 6570. As shown in Figure 133, the second knife driven gear 6568 is in interlock engagement with a fourth knife driven gear 6572 of the third knife drive gear set 6570. The fourth knife drive gear 6572 is in interlocking housed with a fifth set of 6574 knife driven gear that is interlaced with the 6540 knife rack gear. In various embodiments, the gears in the 6560 knife gear set are sized to generate the forces necessary to drive the instrument. cut through the tissue attached to the 6012 surgical end actuator and actuate 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.
[0343] [00343] As can be understood from the aforementioned description, surgical tool 6000 represents a vast improvement over previous robotic tool provisions. 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 articulating geometric axes that are substantially transversal to each other as well as to the longitudinal tool geometric axis; (ii) rotating the end actuator 6012 around the longitudinal tool axis; (iii) closing the anvil 6024 in relation to the surgical clamp cartridge 6034 to different degrees to allow the end actuator 6012 to be used to manipulate tissue and then hold it in position for cutting and stapling; and (iv) firing the cutting instrument to cut through the tissue trapped inside the 6012 end actuator. The unique and innovative displacer arrangements of 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.
[0344] [00344] 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 does not have to 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.
[0345] [00345] Figure 135 shows the use of various aspects of certain embodiments of the present invention in conjunction with a surgical tool 7000 that has an ultrasonically powered end actuator 7012. End actuator 7012 is operably attached to a mounting portion of the 7100 tool by an elongated shank assembly 7008. The tool mounting portion 7100 may be substantially similar to the various tool mounting portions described earlier in this document. In one embodiment, end actuator 7012 includes an ultrasonically powered claw portion 7014 that is powered by alternating current or direct current in a known manner. Such ultrasonically powered devices are disclosed, for example, in US Patent No. 6,783,524, entitled "Robotic Surgical Tool With Ultrasound Cauterizing and Cutting Instrument", the entire description of which is incorporated herein 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 mounting portion of the tool 7100. The surgical end actuator 7012 additionally includes a movable grab portion 7016 that can be used to hold tissue over the ultrasonic grab portion 7014. The movable grab portion 7016 can be selectively actuated by robotic controller 1001 through the mounting portion of tool 7100 in any of the various ways described herein document.
[0346] [00346] Figure 136 illustrates the use of various aspects of certain embodiments of the present invention with respect to a surgical tool 8000 having an 8012 end actuator comprising a linear stapling device. The 8012 end actuator is operably attached to an 8100 tool mounting portion by an elongated stem assembly 3700 of the type and construction described above. However, the 8012 end actuator can be attached to the tool mounting portion 8100 via a variety of other elongated shaft assemblies described herein. In one embodiment, the tool mounting portion 8100 can be substantially similar to the tool mounting portion 3750. However, several other tool mounting portions and their respective transmission arrangements described here in detail can also be employed. Such linear staple head portions are also disclosed, for example, in US Patent No. 7,673,781, entitled "Surgical Stapling Device With Staple Driver That Supports Multiple -Wire Diameter Staples", the entire description of which is incorporated herein by way of reference.
[0347] [00347] Various sensor modalities described in US patent publication No. 2011/0062212 A1 to Shelton, IV et al., The description of which is incorporated herein by reference in its entirety, can be used with many of the surgical tool modalities disclosed in the present invention. As indicated above, master controller 1001 includes, in general, master controllers (usually represented by 1003) that are picked up by the surgeon and manipulated in space while the surgeon sees the procedure through a stereo viewfinder 1002. See Figure 1. The controllers masters 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 disclosed here employ a motor or motors in their tool drive portion to supply various control movements to the tool end actuator. Such modalities can also obtain additional control movement (s) of the motor arrangement employed in the robotic system components. Other modalities disclosed here obtain all the movements of control of motor dispositions inside the robotic system.
[0348] [00348] Such engine powered arrangements may employ a number of sensor arrangements which are disclosed in the US published 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 actuated trigger trigger may employ engine operating sensor (s) (not shown) to provide the surgeon with feedback regarding the amount of force applied to or being experienced by the limb. cut. The motor sensors in operation can be configured to communicate with the trigger trigger portion to detect when the trigger trigger portion has been actuated to initiate the cutting / stapling operation by the end actuator. The motor sensor in operation 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 generally be proportional to the amount of trigger motion. That is, if the operator pulls or closes the trigger only a little, the engine speed is relatively low. When the trigger is fully pulled (or in the fully closed position), the engine speed is at its maximum. In other words, the more force the surgeon applies when pulling the trigger, the more tension is applied to the engine causing higher rotation speeds. 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 staple cartridge has been loaded on the end actuator, whether the anvil has been moved to a closed position prior to firing, etc.
[0349] [00349] In alternative modes, a motor-controlled interface can be used in connection with controller 1001 which limits the maximum relative traction based on the amount of loading (eg, gripping force, cutting force, etc.) experienced by the actuator surgical extremity. For example, the more difficult it is to activate the cutting instrument through the tissue trapped inside 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 pulled when the end actuator is fully fired.
[0350] [00350] 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.
[0351] [00351] 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.
[0352] [00352] Any patent, publication or other description material, in whole or in part, that is said to be incorporated into the present invention as a reference, is incorporated into the present invention only to the extent that the incorporated materials do not 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 (11)
[0001]
Surgical instrument, characterized by the fact that it comprises: an implementation portion (3000) responsive to firing movements from a robotic system (1000) that communicates with it and is dimensioned diametrically for endo-surgical use, the implementation portion (3000) comprising: an elongated channel (3222) coupled to an elongated rod (3208) that interfaces operationally with the robotic system (1000) and that includes a channel slot, an anvil (3224) coupled articulated to the elongated channel (3222), responsive to the closing movements generated by the robotic system (1000) and applied to it by the elongated rod (3208), and including an anvil channel; and a firing device that includes a cutting edge presented distally received longitudinally between the elongated channel (3222) and the anvil (3224), the firing device configured to affirmly space the anvil (3224) of the elongated channel (3222) along the path longitudinal between the anvil (3224) and the elongated groove (3222), including: an upper member comprised of left and right lateral upper pins dimensioned to slide the upper and lower inner surfaces of the left and right recesses with a rectangular shape of the anvil channel, a lower member having a first upper surface and a first lower surface that slidably engages the anvil longitudinally (3224); a lower pin including a second upper surface adjacent to the elongated channel (3222); and an intermediate pin including a second lower surface that slidably engages the elongated channel (3222).
[0002]
Surgical instrument, according to claim 1, characterized by the fact that it still comprises a staple cartridge (3234) engaged by the elongated channel (3222) and including a proximally opened slot to receive the cutting edge of the firing device, the firing cartridge staples (3234) including a plurality of staples stacked upward by the distal longitudinal displacement of the triggering device.
[0003]
Surgical instrument according to claim 2, characterized by the fact that the staple cartridge (3234) still includes a plurality of actuators that support the plurality of staples and a sliding body support wedge-shaped responsive to the distal longitudinal displacement of the triggering device to slide the actuators upwards and thus form the plurality of clips against the anvil (3224).
[0004]
Surgical instrument, according to claim 2, characterized by the fact that the anvil (3224) forms an inclined relationship into the elongated channel (3222) configured to assist the triggering device in the positive spacing between the anvil (3224) and the elongated groove (3222) while activating the staple cartridge (3234).
[0005]
Surgical instrument according to claim 2, characterized in that the staple cartridge (3234) is a type selected from a plurality of staple cartridge types, each type of staple cartridge characterized by a thickness selected for a spacing between the anvil (3224) and the elongated groove (3222) and characterized by clamps of an appropriate length for the desired spacing.
[0006]
Surgical instrument according to claim 5, characterized by the fact that it still comprises a sliding support (3862) of wedge-shaped body comprising a plurality of connected triangular cam bodies, each having a pre-selected height configured for the selected type of staple cartridge, the intermediate pin of the firing device oriented to touch each of the plurality of types of staple cartridge.
[0007]
Surgical instrument according to claim 1, characterized by the fact that the anvil (3224) includes a longitudinal slot having an upper surface and a lower surface that slide against the first lower surface and the first upper surface of the upper limb respectively. firing time.
[0008]
Surgical instrument according to claim 7, characterized in that the longitudinal slot comprises an internal longitudinal channel that communicates with a narrow vertical slot, and in which the triggering device rotates in the narrow vertical slot so that the upper limb it has the first upper surfaces and the first lower surfaces that reside within the internal longitudinal groove to positively space the anvil (3224) of the elongated groove (3222).
[0009]
Surgical instrument according to claim 1, characterized by the fact that the anvil (3224) includes an internal longitudinal slot with a narrow vertical slot, and in which the triggering device rotates in the narrow vertical slot, so that the first surface upper and the first lower surface reside inside the internal longitudinal slit to affirm the anvil (3224) away from the elongated channel (3222).
[0010]
Surgical instrument, according to claim 1, characterized by the fact that it still comprises: an articulation joint proximally coupled to the elongated channel; and a thinning firing strip is attached proximally to the firing device to transfer the firing movement of the robotic system (1000) through the articulation joint.
[0011]
Surgical instrument, characterized by the fact that it comprises: an implementation portion responsive to firing movements from a robotic system (1000) that communicates with it and is dimensioned diametrically for endosurgical use, the implementation portion comprising: a first claw including a first claw slot; a second claw including a second elongated claw opening and in which at least one of the first and second claws is operatively coupled to an elongated rod that interacts operatively with the robotic system to apply closing movements generated by the robotic system ( 1000) to the implementing portion for moving one of the first and second jaws in relation to the other of the first and second jaws; and a firing device including a distally presented cutting edge received longitudinally between the first and second jaws, the firing device is configured to affirm the first and second jaws affirmatively with respect to each other during longitudinal displacement between the first and the second second claws, the triggering device further comprises: an upper member comprised of left and right lateral upper pins dimensioned to slide the upper and lower inner surfaces of the left and right recesses with a rectangular shape of the anvil channel, a lower member having a first upper surface and a first lower surface that slidably engages the first and second claws longitudinally; a lower pin including a second upper surface adjacent to another of the first and second jaws; and an intermediate pin including a second lower surface that slidably engages another one of the first and second jaws.

类似技术:

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BR112013030553B1|2021-03-23|SURGICAL INSTRUMENT

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同族专利:

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公开号 | 公开日

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US20190117224A1|2019-04-25|

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US20160235408A1|2016-08-18|

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US20160015391A1|2016-01-21|

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EP3747372A1|2020-12-09|

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US10383633B2|2019-08-20|

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US10736634B2|2020-08-11|

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US20160242780A1|2016-08-25|

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CN103702621A|2014-04-02|

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US20190099184A1|2019-04-04|

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WO2012166465A1|2012-12-06|

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US20170258469A1|2017-09-14|

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US20160242782A1|2016-08-25|

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US10335151B2|2019-07-02|

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US8783541B2|2014-07-22|

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US20180296216A1|2018-10-18|

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US20120203247A1|2012-08-09|

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US20160235403A1|2016-08-18|

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US10342541B2|2019-07-09|

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US10813641B2|2020-10-27|

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US20210315576A1|2021-10-14|

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US20190343525A1|2019-11-14|

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BR112013030553A2|2016-09-27|

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US20210315577A1|2021-10-14|

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CN103702621B|2016-12-14|

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US10420561B2|2019-09-24|

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US20140299648A1|2014-10-09|

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US20210068835A1|2021-03-11|

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EP2713901B1|2020-07-29|

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US20150289873A1|2015-10-15|

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US20160242781A1|2016-08-25|

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US9060770B2|2015-06-23|

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WO2012166465A8|2013-12-19|

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US9913648B2|2018-03-13|

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US10206678B2|2019-02-19|

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EP2713901A1|2014-04-09|

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US20110290853A1|2011-12-01|

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US10485546B2|2019-11-26|

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

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2019-10-22| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2020-08-25| B06A| Patent application procedure suspended [chapter 6.1 patent gazette]|

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2021-01-19| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2021-03-23| 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 23/05/2012, 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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US13/118,246|2011-05-27|

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PCT/US2012/039124|WO2012166465A1|2011-05-27|2012-05-23|Robotically-driven surgical instrument with e-beam driver|

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