MOTORIZED SURGICAL SYSTEM

专利摘要:
motorized surgical system a surgical system includes an instrument driver having a distal end positionable in a body cavity and a user input device. the instrument driver and user input device are positioned to detachably receive distal and proximal portions, respectively, of a surgical instrument. the user input device is configured to generate movement signals in response to manual manipulation of the proximal portion of the surgical instrument. at least one motor operable to actuate the instrument driver in response to motion signals and thereby to change the position of the distal portion of the surgical instrument within the body cavity.
公开号:BR112014019193B1
申请号:R112014019193-0
申请日:2013-02-04
公开日:2021-06-15
发明作者:Carson Shellenberger；Keith Phillip Laby；Richard M. Mueller
申请人:Great Belief International Limited；
IPC主号:

专利说明:

technical field
[001] The present invention relates to the field of devices and access holes through which flexible medical instruments can be inserted into a body cavity and directed or deflected. prior technique
[002] In conventional laparoscopic procedures, multiple small incisions are formed through the skin, underlying muscle, and peritoneal tissue to provide access to the peritoneal cavity for the various medical instruments and endoscopes needed to complete the procedure. The peritoneal cavity is typically inflated using insufflation gas to expand the cavity, thus improving visualization and working space. In a typical laparoscopic medical procedure, four holes are strategically placed around the abdominal area allowing the surgeon to visualize and use instruments using triangulation principles to approach the surgical target. Although this procedure is very effective and has held up as the golden standard for minimally invasive surgery, it suffers from a number of disadvantages. One such disadvantage is the need for multiple incisions to place the four holes, which increases the risk of complications such as postoperative hernia and prolonged patient recovery. The four-hole method also leaves room for cosmesis concerns, leaving the patient with four abdominal scars.
[003] Further developments have led to systems allowing procedures to be performed using multiple instruments passed through a single incision or orifice. In some such single-hole procedures, visualization and triangularization are compromised due to linear manipulation of instrumentation, and spatial confinement resulting in what has been known as “sword fighting” between instruments.
[004] Improvements to prior single-hole techniques are found in multi-instrument access devices suitable for use in SPS procedures and other laparoscopic procedures and described in co-pending US patent application series No. 11/804,063 (application '063) filed at May 17, 2007 and entitled SYSTEM AND METHOD FOR MULTI-INSTRUMENT SURGICAL ACCESS USING A SINGLE ACCESS PORT [System and Method for Multi-Instrument Surgical Access Using a Single Access Orifice], US Patent Application Serial No. 12/209,408 filed September 12, 2008 and entitled MULTIINSTRUMENT ACCESS DEVICES AND SYSTEMS, US Patent Application Serial No. 12/511,043, filed July 28, 2009, entitled MULTI-INSTRUMENT ACCESS DEVICES AND SYSTEMS [Multi-Instrument Access Devices and Systems], and US Patent Application Serial No. 12/649,307, filed December 29, 2009 (Publication US 2011/02307 23) entitled ACTIVE INSTRUMENT PORT SYSTEM FOR MINIMALLY-INVASIVE SURGICAL PROCEDURES, each of which is incorporated herein by reference.
[005] US patent application series No. 12/649,307 (Publication US 2011/0230723) filed on December 29, 2009 and entitled ACTIVE INSTRUMENT PORT FOR MINIMALLY- INVASIVE SURGICAL PROCEDURES describes a system for use in performing minimally medical procedures invasive multitool using a plurality of instruments passed through a single incision in a body cavity. The disclosed system includes an insertion tube and a pair of instrument supply tubes (IDTs) extending from the distal end of the insertion tube. Each TDI has a steerable distal portion positioned distal to the distal end of the insertion tube. In use, flexible instruments passed through the IDTs are aimed at actively deflecting the distal deflectable portions of the IDTs. In particular, proximal actuators (shown as ball-and-socket or gimbal suspension actuators) for the IDTs are positioned proximate to the insertion tube. Instruments to be installed from the IDTs into the body cavity are inserted through the proximal actuators into the IDTs. Proximal actuators are movable in response to manipulation of instrument handles extending through the IDTs. Movement of the proximal actuators engages pull elements (eg, wires, cables, etc.) that extend from the proximal actuators to the deflectable sections of the IDTs, thus directing the distal portions of the IDTs (and therefore the distal ends instruments themselves). Additional instruments such as endoscopes and other instruments can also be passed through the insertion tube (such as rigid instrument channels) and used simultaneously with instruments installed through the IDTs.
[006] Additional examples of proximal actuators and/or RTD shafts that can be used in such access systems are described in US 2011/0184231, entitled DEFLECTABLE INSTRUMENT PORTS, US 2011/00601183, entitled MULTI- INSTRUMENT ACCESS DEVICES AND SYSTEMS, and US 2011/0251599 entitled DEFLECTABLE INSTRUMENT SHAFTS, each of which is incorporated herein by reference.
[007] The present patent application describes new multi-instrument surgical access systems for use in minimally invasive procedures. Brief description of drawings
[008] Figure 1A is a perspective view of a motorized multi-instrument surgical system. Figures 1B to 18 are several views of components of the first configuration, in which:
[009] Figure 1B shows the system supported by an arm and positioned in relation to an operating table;
[0010] Figure 1C is a partially exploded perspective view of the base unit, scroll drive and finger drive assembly;
[0011] Figure 1D is a perspective view of a proximal part of the finger drive assembly;
[0012] Figure 2A is a perspective view of the distal portion of the installation mechanism;
[0013] Figure 2B is a perspective view of the proximal portion of the installation mechanism;
[0014] Figure 2C is an underside plan view of the proximal portion of the installation mechanism;
[0015] Figure 3 is a perspective view of a finger drive including the pulley housing;
[0016] Figure 4A is similar to Figure 3, but without the pulley housing;
[0017] Figure 4B is a bottom perspective view of the finger drive components, without the pulley housing, proximal tube and cables;
[0018] Figure 5A shows a pulley of a finger drive;
[0019] Figures 5B and 5C are partially exploded views of the pulley of figure 5A;
[0020] Figures 6A and 6B schematically illustrate the operation of the finger drive pulleys;
[0021] Figure 7A is a perspective view showing the underside of the finger drive assembly;
[0022] Figure 7B is a perspective view showing the upper side of the base unit;
[0023] Figure 8A is a plan view showing the layout of motors, sensors and gear sets within one half of the base unit;
[0024] Figure 8B is a perspective view of one of the motors and gear assemblies of Figure 8A;
[0025] Figure 9 is a perspective view of a scroll actuator;
[0026] Figure 10 is a perspective view of the scroll drive tube and scroll drive gear assembly;
[0027] Figure 11A is a side elevation view of an instrument that can be used with the system;
[0028] Figure 11B is a perspective view of the handle and proximal axis of the instrument of Figure 11A;
[0029] Figure 12A is a perspective view of the instrument drive segment of Figure 11A;
[0030] Figure 12B shows the drive segment of figure 12A positioned inside the scroll drive tube;
[0031] Figures 13A and 13B are end views of an alternative scroll drive tube and drive segment, respectively;
[0032] Figure 13C shows the rotational engagement of the scroll drive tube and drive segment of figures 13A and 13B;
[0033] Figure 14 shows the rotational engagement of a second alternative drive tube and drive segment;
[0034] Figure 15 is an exploded view of a tubular connector positionable between the roller actuator housing of Figure 1A;
[0035] Figure 16 is a perspective view of the command interface, showing the instrument box separated from the supports. An instrument's handle, but not its distal axis, is shown;
[0036] Figure 17A is a proximal perspective view of the instrument case with the housing removed and with an instrument handle removed from the operative position. The instrument's distal axis is not shown;
[0037] Figure 17B is a distal perspective view of the instrument case with the housing removed;
[0038] Figure 18A is a block diagram schematically illustrating components of a variation of the system;
[0039] Figure 18B schematically illustrates an exemplary algorithm for controlling the movement of fingers through the system;
[0040] Figure 19 is a perspective view of a second configuration;
[0041] Figure 20 is a perspective view of a third configuration;
[0042] Figure 21 is a perspective view of a fourth configuration;
[0043] Figure 22 is a perspective view of a fifth configuration;
[0044] Figure 23 is a perspective view of a sixth configuration;
[0045] Figure 24 is a perspective view of a seventh configuration;
[0046] Figure 25 is a perspective view of a user interface that may be part of the sixth and seventh configurations; and
[0047] Figure 26 is a perspective view of an eighth configuration. Detailed Description
[0048] The present patent application discloses a new motorized multi-instrument surgical system having certain advantages over prior art systems. Overview
[0049] Referring to Figure 1, a first configuration of a surgical access system 2 includes a finger drive assembly 200 comprising a housing 210 and an insertion cannula 212 extending distally from the housing 210. Tubular tubes or fingers steerable instrument supply tubes 214 extend distally from insertion cannula 212. Tubular fingers 214 have a lumen for passively receiving flexible surgical instruments 100. As will be described below, motor driven finger drives within finger drive assembly 200 guide fingers 214 using cables anchored at the distal ends of the fingers. Associated with each tubular finger 214 is a corresponding motor driven scroll actuator 216 - which acts on a distal portion of the instrument shaft to rotate it axially.
[0050] In the first configuration, the motors used to drive the finger drives and the scroll drives, as well as controllers and associated electronics, are housed within a 218 base unit, and the finger drive assembly 200 and the scroll drives 216 are detachably mounted to the base in a manner that provides movement from the motors to the finger drives and scroll drives. Spring locks 255 (figure 1A) are positioned to engage finger drive assembly 200 and roll drivers 216 with base 218 when they are placed over the base in the correct orientation. Alignment features 215 (figure 1C) on the upper surface of base unit 218 match or contact corresponding features on the lower surface of finger drive assembly 200 and scroll drives 216. Alignment features help align assembled components and prevent the components mounted on the base 218 to slide relative to the surface of the base during use.
[0051] The base unit 218 can be a reusable component isolated from the sterile field using a sterile drape or bag (not shown), while the finger drive assembly 200 and scroll drives 216 can be manufactured as single-use components or components reusable for a number of times before disposal. Reusable components can be designed for autoclaving or other forms of sterilization.
[0052] Command interfaces 250 are provided for each of the tubular fingers 214. Command interfaces 250 include instrument cases 252 that support instrument handles. Command Interfaces 250 are user input devices that generate signals in response to user manipulation of the instrument handle (eg, pan, tilt and scroll) and/or other user inputs. In response to signals generated at the command interface 250, the system motors are controlled to make the finger trigger and scroll trigger trigger the fingers and instrument in accordance with user input.
[0053] Referring to Figure 1B, system 2 is supported by a support arm 204 extending from a side patient cart 205, operating table 206, a ceiling support, or another device. to position the arm 204 where it can support the finger and scroll drives, associated motors, and control unit near the operating table, allowing the surgeon to stand beside the patient with their hands on the instruments 100. The arm can be one allowing the repositioning of system 2 in multiple degrees of freedom. Although a robotically controlled arm can be used with arm 2, since control and manipulation of instruments is achieved using system 2 instead of maneuvering arm 204, the arm can be much simpler in design and be smaller in size than those used for conventional robotic surgery. The illustrated arm 204 is manually positionable over multiple joints and lockable in a selected position. The multiple degrees of freedom movement allows the user to position the system 2 to place the insertion cannula 212 and command interfaces 250 in the desired position relative to the patient and surgeon. Cart 205 can be used to load other equipment intended for use with System 2, such as components supporting visualization, insufflations, clamping, electrosurgery, etc. Arm 204 has internal springs that counterbalance the weight of system 2, allowing it to remain stable in space while the arm is unlocked, and reduces the force required to move the system. Although many joint combinations are possible, the four bar connections shown in the depicted configuration allow system 2 to pivot about the center of gravity, which reduces the force required to reposition the system.
[0054] The system power supply, computer, and user controls (eg, touch screen computer 201), which are discussed in relation to the system schematic in Figure 18, can be mounted on cart 205 with its associated cabling routed through arm 204 to base unit 218.
[0055] A quick overview of the way in which system 2 is used will facilitate an understanding of the more specific description of the system given below. During use, fingers 214 and a portion of insertion tube 212 are positioned through an incision within a body cavity. The distal end of a surgical instrument 100 is manually, removably, inserted through an instrument case 252 of the command interface 250, and the corresponding scroll driver 216 and into the corresponding tubular finger 214 via the finger drive assembly 200 The instrument is positioned with its distal tip away from the distal end of tubular finger 214 in the patient's body cavity and such that instrument handle 104 is proximal to command interface 250.
[0056] The user manipulates the handle 104 in an instinctive way, and in response the system causes the corresponding movement of the distal end of the instrument. The motors associated with the finger trigger are energized in response to the signals generated when the user moves the instrument handles from side to side and up and down, resulting in motorized steering of the finger and therefore of the instrument tip in accordance with manipulation by the user of the instrument handle. Combinations of up and down and side-to-side movements of an instrument grip will drive the instrument tip into the body cavity up to 360 degrees. Manually scrolling the instrument handle about the instrument's longitudinal axis (and/or manually rotating a rotation knob or collar proximal to the instrument handle) results in motorized scrolling of the distal portion of the instrument axis 103 (identified in Figure 11) using scroll trigger 216.Finger trigger set
[0057] Referring to Figures 1A, 1C and 1D, insertion tube 212 of finger drive assembly 200 is an elongated tube positionable through an incision in a body cavity. The system is arranged such that multiple instruments can be introduced into the body cavity via the insertion tube. The illustrated configuration allows for the simultaneous use of three or four instruments - two that are actively steered using the tubular fingers 214, and one or two that enter the body via passive holes in the finger drive assembly 200. Different numbers of active channels (fingers) steerables 214) and passive orifices can be used instead in the system without departing from the scope of the invention. For example, an alternative system can include a single steerable finger 214 and no passive holes, or the illustrated system can be modified to add one or more steerable fingers 214 or to add or eliminate passive holes. Installation Mechanism
[0058] The finger drive assembly 200 has an installation mechanism that is operable to simultaneously or independently reposition the distal portion of each finger 214 to increase or decrease its lateral separation from the longitudinal axis of the insertion cannula 212. The installation moves fingers 214 between an insertion position in which the fingers are generally parallel to each other for expedited insertion, and one or more installed positions in which the fingers are laterally pivoted away from the longitudinal axis of the insertion tube as shown in the figure. 1A. U.S. Publication Nos. 2007-0299387 and US 20110230723 illustrate installation mechanisms that can be used for system 2.
[0059] The first configuration uses an installation mechanism shown in Figure 2A using pivotable links 12 for this purpose, with each link 12 pivotally coupled between a finger 214 (only a portion of which is shown in the figure) and one or more elongated members 14, which are slidable relative to (and, in the illustrated configuration, partially within) insertion tube 212. Additional connections 15 may extend between the distal end of insertion tube 212 and fingers 214, providing additional support for the fingers. . In the drawings, these additional links 16 have a rectangular cross section with their long edges oriented to resist bending when fingers are loaded - such as when finger instruments are being used to grip and lift fabric. The proximal ends of the links 16 form a hinge coupled to the insertion tube as shown.
[0060] As shown in Figures 2B and 2C the proximal ends of the members 14 are connected to a block 18 movable relative to the finger drive assembly housing 210 between distal and proximal positions to slide the members 14 between the distal and proximal positions. . Sliding the limbs 14 in this way causes the link arms 12 to pivot and thereby move the fingers laterally.
[0061] A ratchet feature 224 (figure 2B) is used to retain the longitudinal positioning of block 18 relative to housing 210 and to thereby maintain fingers 214 in a selected installation position. To install, or otherwise change the lateral finger spacing, the user disengages the ratchet and slides the block 18 proximally or distally to move the fingers from a first position to a second position. Re-engaging the ratchet causes the ratchet to engage the fingers in the second position. A spring (not shown) forces the ratchet into the engaged position. Other features related to ratchet installation and retention are disclosed in US Publication No. US 2011-0230723.
[0062] The system 2 can include features that allow it to detect changes in the position of the installation mechanism as an indicator of the finger positions in relation to the longitudinal axis of the insertion tube 212.
[0063] As shown in Figure 2B, the pulleys 20 are rotatably mounted in the housing 210. Each pulley 20 is coupled by a connecting arm 22 to the block 18, such that the longitudinal movement of the block 18 to install the fingers 214 makes the pulleys 20 rotate. At least one of the pulleys 20 includes a magnet 24 on its axis, as shown in Figure 2C, in which magnets 24 are shown positioned on the axes of each pulley 20. The magnet 24 includes north and south poles positioned diametrically and is preferably facing downwards. against base 218.
[0064] Encoder chips 26 (figure 1C) in a distal portion of base 218 (figure 2) are positioned to align with magnets 24 when finger drive assembly 200 is mounted on base 218. used, each of the encoder chips 26 detects the rotational position of the nearest magnet 24, which indicates the rotational position of the pulley 20 and therefore the longitudinal position of the block 18. This information allows the system to know the installation status (i.e., the lateral or geometric axis x) position of finger 214. Signals generated by encoder chips 26 can be used by the system to coordinate the correct transformation between a user input instruction and corresponding output commands.
[0065] In alternative configurations, each finger can be installed independently using a separately movable sliding member 14, so as to allow each finger to be repositioned laterally independently of the other finger.
[0066] Although the first configuration uses a manual installation mechanism, in a modified system, one or more motors can be used to drive the installation mechanism. In some such systems, motorized installation can be performed independently of finger direction. In others, the system can dynamically control both the installation mechanism and the finger triggers as a means of moving fingers to target positions and orientations based on the user's positioning of the instrument handles on the control unit 250. Installation and finger triggers at a given point in time can be based on the calculated current position and orientation of the fingers using signals from the encoder chips 26 along with other sensed information described below. instrument trajectories
[0067] Referring to Figure 1D, the finger assembly housing 210 has a generally u- or v-shaped configuration, with each u- or v-shaped housing "leg" of the drive fingers associated with a different one of the fingers. steerables 214. While not a requirement, this format leaves working space between the “legs” for additional instruments, as discussed below.
[0068] Holes 222 for instruments 100 are positioned at the proximal end of each leg of the u- or v-shaped housing. These holes 222 may have seals disposed within the housing 210 to prevent loss of inflation pressure through the holes 222 when no instruments are present in the holes and/or to seal around the instrument shafts disposed in the holes. Additionally peelable seals can be placed proximal to holes 222. An example of this configuration of seals is illustrated in Figure 15.
[0069] Each hole 222 defines the entrance to an instrument trajectory through housing 210 and insertion tube 212 into a corresponding one of the steerable fingers 214. The instrument trajectory includes a tube or series of tubes extending from from orifice 222, through housing 210 and insertion tube 212, and out of the distal end of insertion tube 212 to form finger 214. Instrument path 221 has a proximal tube 221a that extends distally from orifice 222 , and a distal tube 221b whose proximal end is positioned over proximal tube 221a and whose distal end extends through housing 210 and insertion tube 212. The central lumens in proximal and distal tubes 221a, 221b are continuous to form the path of instrument 221. Actuation elements or cables 223 used to drive finger 214 extend through the lumen in distal tube 221b as shown.
[0070] Passive holes 220 (two are shown) are positioned to allow the passage of additional instruments through housing 210 and insertion tube 212. In the drawings, these additional holes 220 are shown positioned on the underside of the housing shaped like u or v 210. These holes allow instruments such as endoscopes, rigid instruments, and other instruments to be passed through the insertion tube and used simultaneously with instruments installed through the steerable fingers 214. Seals (not shown) in these holes 220 are positioned to prevent the loss of inflation pressure through the orifices when no instrument is present in the orifices, and also to seal around the instrument shafts disposed in the orifices 220. Finger
[0071] Referring again to Figure 1, each finger 214 includes a deflectable distal portion 216, which may be formed of a plurality of vertebrae or connections, or flexible tubing, slit or laser cut metal tubing, or other capable materials to be steered without elbowing or warping. Examples of steerable channels that may be suitable for use with a steerable finger 214 are shown and described in US 2011/0251599 and other patent applications referenced herein. A flexible sleeve/liner (not shown) covers the deflectable distal portion 216 to prevent tissue trapping in gaps between vertebrae or crevices.
[0072] The distal end of each finger 214 may be equipped with a telescopic gusset feature positioned at its distal end such that as an instrument tip exits the distal end of the finger, the gusset expands distally in a longitudinal direction - encircling the portion of the instrument tip that extends beyond the end of the finger 214. This feature helps to support any portion of the instrument shaft that extends beyond the distal end of the finger 214, thus preventing unwanted deflection of the instrument shaft within the body cavity.
[0073] Fingers 214 are guided by selective pulling and/or pushing of actuating elements 223 (eg, wires, cables, rods, etc.). In this description the term “cable” will be used to represent any such type of actuation element. Cables 223 are anchored at the distal end portions of steerable fingers 214 and extend proximally through steerable fingers 214 into housing 210. The number of strands to be used in a steerable finger may vary. For example, each steerable finger may include two or four handles, where the distal portions of the handles are arranged 180 or 90 degrees apart, respectively, at the distal end of the finger. In other configurations, three cables can be used for each finger.
[0074] In the illustrated configuration four cables are used. By “four” actuation cables is meant that there can be four separate cables/wires etc. or two cables/wires each of which has a U-turn anchored to the distal end of the finger such that four proximal ends of the cable are disposed within housing 210. Additional cables that are not used for actuation can be positioned through the fingers and used to provide feedback on the position of the corresponding fingertips, using methods similar to those described below. finger trigger
[0075] This section describes the finger trigger for one of the fingers 214 shown in figure 1A. It should be understood that the steerable finger shown on the right is manipulated using a finger trigger having similar characteristics.
[0076] The proximal end of each cable 223 extends outward from the proximal end of tube 221b and is engaged with a pulley 232a or 232b. Each pulley 232a, 232b includes a spur gear 231a, 231b as shown. Although the drawings show the geometric axes of rotation of the pulleys 232a, 232b to be non-parallel to each other, in other configurations the pulleys may be oriented to have parallel axes of rotation.
[0077] A first pair of pulleys 232a is engaged with two cables 223 which are anchored at points 180 degrees apart at the distal end of the corresponding steerable finger. The components in the finger drives are arranged such that each drive motor in the base unit drives such a pair of cables - although in other configurations each cable has a dedicated drive motor. To allow each drive motor to drive two cables, each finger drive 203 is arranged with a first gear 230a disposed between and engaged with the teeth of gears 231a on the first pair of pulleys 232a, such that gear 230a rotates in a first direction (by action of a steering motor as discussed below) pull one cable in the pair and reduce the tension on the other cable in the pair, thus deflecting the distal end of the corresponding steerable finger in a first direction. Similarly, rotation of gear 230a in the opposite direction (reversing the operation of the corresponding drive motor) deflects the distal end of steerable finger 214 (not shown) in the opposite direction pulling the opposite cable. A second pair of pulleys 232b is similarly driven by a second gear 230b disposed between and engaged with teeth in the gears of the second pulleys 232b. The cables associated with the second gear 230b are also preferably arranged 180 degrees apart at the distal end of the steerable finger (and offset 90 degrees from the strands associated with the first gear 230a) allowing for 360 degrees of deflection of the steerable finger 214.
Pulleys 232a, b and gears 230a, b are housed within a sealed pulley housing 219. The proximal end of tube 221b and the entire length of tube 221a (figure 4) are housed within sealed housing 219. Each pulley housing is mounted within housing 210 of finger drive assembly 200 and oriented with hole 222 exposed at the proximal end of housing 210 and with tube 221b extending into insertion tube 212. Seals surround hole 222 and tube 221 to seal the pulley housing against the passage of moisture and contamination into the space surrounding the gears and pulleys during cleaning.
[0079] Figures 5A-5C show a configuration of a pulley 232a. Each such pulley includes a spool 225 rotationally secured to a shaft 227. Gear 231a is positioned on shaft 227 and is rotatable relative to shaft 227. Pulley 232a is biased by a helical spring 229 disposed around the shaft, with one end of spring 229 connected to gear 231a and the other end connected to spool 225. The spool includes a pair of posts 235 spaced 180 degrees apart. The gear has a pair of stops 237 spaced 180 degrees apart and separated by an annular space 241. Posts 235 of spool 225 extend into annular space 241.
[0080] Cable 223 is wound onto spool 225. Each pair of cables is tensioned such that when one finger is in a straight orientation as shown schematically in figure 6A, each column 235 is positioned against one of stops 237. used to drive the pulleys to deflect the finger to the left as shown in figure 6B, the gear 231a of the pulley 232a on the left rotates in a counterclockwise direction, and as it rotates its stops 237 remain in contact with the columns 235 of the corresponding spool - therefore the gear and spool move as a solid body. Rotating the spool pulls the 223L cable, causing the finger to deflect to the left as shown schematically. At the same time, pulley gear 232a on the right rotates in a counterclockwise direction and cable 223R slackens due to compliant transmission members and cable body. As the gear rotates, its stops 237 rotate away from columns 235 of the corresponding gear. Because gear 231a and spool 225 are connected by spring 229 (figure 5C), spring force eventually acts on the spool to rotate it counterclockwise, absorbing extra slack in cable 223R.
[0081] The output from sensors associated with the pulleys is used to calculate the position of the fingertips, force on the cable or fingertip by extension, and to provide redundant detection of the position of the fingertip in relation to that detected by the engine encoder. The following discussion of the use of sensors will focus on the situation in which a finger is pulled to the left as in Figure 6B, but it should be understood that the same principles apply for each direction in which the finger is directed.
[0082] In general, the system makes use of the passive cable in each pair of cables (a pair of cables being a pair of cables tensioned by a common gear of gears 230a, 230b) to provide positional feedback corresponding to the position of the fingertip corresponding. Referring to Figures 4B and 5A, each pulley 232a, 232b has a disc magnet 243 having a distally facing surface having diametrically positioned north and south poles. Encoder chips 245 in base unit 218 (Figure 8A, discussed below) are positioned to detect the rotational position of each such magnet. When the finger is directed to a deflected position, such as the bending to the left in Figure 6A, the cable 223L tensioned to produce the bending undergoes elastic stretching under load, and also deforms the axis of the tubular passage 221 through which the cable stretches out. Thus, the distance cable 223L was pulled to cause flexing does not directly correspond to the amount by which cable 223R advanced in response to flexion. Since passive cable 223R is not under the high loads being experienced by active cable, the distance that passive cable 223R has advanced (as indicated by the degree of rotation of magnet 243 detected by the encoder chip), reflects the amount by which the finger is deflected and can be used by the system to derive a more accurate measurement of finger position in three-dimensional space. This system is beneficial in that it eliminates the need for a cable, pulley and sensor arrangement devoted solely to position sensing.
[0083] In addition, the difference between the amount by which the active cable 223L was pulled and the passive cable 223R advanced represents the amount of force applied by the active cable 223L at the instrument tip. While tip force feedback also comes from measuring current in drive motors, tip force provides a more direct measure of force.
[0084] The feedback from the motor encoder can be compared with the positional information obtained from the magnet associated with the 223L cable and used to detect if there is an error in the system. For example, if the measured position on the motor is significantly different from the position derived from the positions of magnets 243, the system can alert the user to the possibility that active cable 223L is broken and disable system 2.
[0085] If the pulley associated with an active rope is determined to have rotated out of its normal range of motion to its extreme relaxed position (eg to a position against stop 237 opposite the stop it should be positioned against to be driven by the gear), it will indicate a system error that could potentially be a system error. Feedback indicating that both pulleys in a pulley pair are in a relaxed state, or both have rotated into a position against a stop where one of the ropes is in tension, is indicative of a broken rope. When error conditions are detected in the system, the system can disengage the motors and provide an error message to the user via the 201 computer interface. Motion Transfer - Base Unit for Finger Drives
[0086] Finger drive 203 receives motion from drive motors 236a, b in base unit 218 by rotational coupling between elements in finger drive assembly and elements in base 218. In finger drive assembly 200, such members as driven shafts 226a, 226b (figure 7A) are exposed at the bottom of the housing 210. Each of the driven shafts 226a, 226b is rotationally fixed to and axially aligned with one of the gears 230a, 230b (figures 4A and 4B) within the housing 210, such that turning each driven shaft 226a, 226b turns the corresponding gear 230a, 230b, thereby directing the steering finger 214 as described above. Driven shafts 226a, 226b may extend from or be embedded in the lower surface of housing 210.
[0087] As shown in Figure 7B, second members such as drive shafts 228a, 228b are exposed on the upper surface of base 218 and may extend from or be embedded in the upper surface of base 218. Each drive shaft 228a, 228b is releasably engageable with a corresponding one of the driven shafts 226a, 226b at the bottom of housing 210 (Fig. 7A). Drive shafts 226a, 226b (figure 7A) and drive shafts 228a, 228b (figure 7B) are designed for combined engagement or any alternative form of engagement that allows torque transmission from each drive shaft to its corresponding driven shaft . In the arrangement shown in the drawing, driven shafts 226a, 226b are male components that match drive shafts 228a, 228b as their female counterparts. The illustrated male components include hex spherical heads with spherical hex keys and the female components include hex sockets to receive the hex heads. In this configuration the rotational axis of each first member 226a, 226b angularly intersects the rotational axis of the corresponding drive axis 228a, 228b. In other configurations, however, each first member may share a common rotation axis with the corresponding drive axis.
[0088] Although the driven shafts and drive shafts are shown as matching hexagonal parts, any alternative engagement characteristics that will likewise allow torque transmission from the drive shafts 228a, 228b to the driven shafts 226a, 226b can be used when instead.
[0089] To facilitate engagement between drive shafts 228a, b and driven shafts 236a, b, drive shafts 228a, b are displaceable down into base unit 218 when first contacted by driven shafts 226a, b. Springs force drive shafts 228a, b into their outermost position such that they will act as an upward spring as the combined characteristics of drive shafts 228a, 228b and driven shafts 226a, 226b engage. Sensors can be positioned on the base unit 218 to detect when each axle has returned to its fully extended position, allowing the system to know if any of the drive shafts 228a have not been properly engaged with the corresponding driven shaft 226a. This detected information can be used to lock out system usage until all axes are properly engaged. It can also be used to initiate small rotation of drive motors associated with shafts 228a that have not acted as a spring up, to allow shaft 228 hex head to move to an orientation where it will engage with corresponding shaft hex socket 226a .
[0090] As will be evident from the following section, engaging the driven shafts and drive shafts allows the transfer of motion from the system's steering motors to the pulleys that manipulate the cables to drive the fingers. base unit
[0091] The base unit 218 houses the drive motors 236a, b and a scroll motor 238. The illustrated system has a u- or v-shaped configuration similar to that of the housing 210. The base unit 218 is arranged such that the associated motors with left-hand finger 214 steering and axially rolling an instrument extending through left-hand finger 214 are on the left side of base unit 218 (eg, left leg of V- or U-shaped housing ), and such motors associated with the right-hand finger and its instrument are on the right-hand side of the base unit. Computer controllers, motor drives, and associated electronics for each side of the system are also housed within base unit 218. In this configuration, two real-time computer controllers/processors are included in base unit 218, each associated with one of fingers, although in other configurations a single real-time processor may be associated with both fingers. Communication between these computers and the user interface computer (eg, touch screen computer 201 of figure 1A) can use ethernet TCP/IP connection through a router, or other means. In other configurations, a touch screen processor and real-time processor are housed within a single computer, eliminating the need for a router.
[0092] Figure 8A shows an arrangement of motors 236a, b and their corresponding gear sets within the base unit housing (not shown). Each drive motor 236a, b housed within base 218 drives the gears of its corresponding gear set 240a, b.
[0093] A gear in each gear set 240a, 240b is rotationally fixed to one of the exposed drive shafts 228a, 228b such that activation of motors 236a, b produces axial rotation of each of the drive shafts 228a, 228b. Two such drive motors 236a,b are shown for each finger, each with a corresponding gear set 240a,b. Motor 236a is positioned to drive gear assembly 240a to produce axial rotation of drive shaft 228a. Motor 236b drives gear set 240b to produce axial rotation of drive shaft 228b.
[0094] Referring again to Figure 8A, the output of the scroll motor 238 in the base unit is coupled via gear set 242 to a member such as a scroll drive shaft 244 so as to cause axial rotation of the scroll member 244 when the scroll motor 238 is operated. Scroll drive shaft 244 may be similar in configuration to drive shafts 228a, 228b. scroll trigger
[0095] The scroll drive 216 (figures 1A, 1B and 9) includes a housing 217. As shown in figure 10, a scroll drive tube 248 is axially swivelable within the scroll drive housing 217 (not shown in figure). 10). Roller drive tube 248 includes a lumen for receiving a portion of instrument shaft 100 (FIG. 1A). The exterior of the scroll drive tube 248 forms a spiral gear, which engages with a scroll gear assembly such as a driven scroll shaft 234 that is exposed on the lower surface of housing 217 (not shown). Driven scroll shaft 234 is axially rotatable relative to scroll drive housing 217.
[0096] The scroll drive 216 is positionable on the base unit 218 such that the driven scroll shaft 234 rotationally engages with the scroll drive shaft 244 (figure 7B) of the base unit 218. This rotational engagement allows the transfer of torque from the shaft 244 to shaft 234 - thus allowing rotation of the scroll drive tube 248 (and therefore of the instrument shaft) by activating the scroll motor 238. Shafts 234, 244 can be matched parts similar to those described for the driven shafts and drive shafts 226a, b and 228a, b used for steering.
[0097] The 248 scroll drive tube has features designed to rotationally engage with corresponding features on the axis of the surgical instrument. This coupling allows axial rotation of the scroll drive tube 248 to produce axial rotation of the distal portion of the instrument shaft. Preferred features are those that create rotational engagement between the instrument shaft and the scroll drive tube 238, but not sliding or longitudinal engagement. In other words the features are engaged such that the axial rotation of the scroll drive tube 248 axially rotates the instrument axis, but allows the instrument to be advanced and retracted through the scroll drive tube 248 for "z-axis geometric" movement from the tip of the instrument. The rotational engagement between the instrument shaft and the scroll drive tube 248 should preferably be maintained through the entire useful range of motion of the axis z of the instrument tip (eg, between a first position in which the tip of the instrument is at the distal end of the finger to a second position in which the tip of the instrument is distal to the distal end of the finger by a predetermined distance).
[0098] The engagement characteristics for instrument 100 and scroll drive tube 248 include first surface elements on a drive segment 260 of shaft 102 of instrument 100 (figure 11) and corresponding second surface elements on the inner surface of the tube scroll drive 248 (figure 10). Examples of surface elements 256, 258 are shown in figures 12A-14. Referring to Figures 12A and 12B, drive segment 260 of instrument axis 102 includes first surface elements 256 in the form of ridges or ribs extending radially from the instrument axis and longitudinally along the axis. The scroll drive tube lumen 248 includes second surface elements 258 in the form of longitudinally extending ribs (also visible in Figure 12B). The surface elements 256, 258 are positioned such that when the scroll drive tube 248 is rotated, the second surface elements 258 in the inner lumen of the scroll shaft contact and cannot rotationally deviate from the surface elements on the instrument shaft. The distal ends of the ribs 256 may be tapered such that they are narrower (in a circumferential direction) at their distal ends than they are more proximally, to facilitate insertion of the ribs/ribs between the corresponding ribs while minimizing play between the splines 256 and adjacent ribs 258 as the scroll shaft rotates the instrument shaft. The longitudinal length of splines 256 is selected to maintain rotational engagement between the instrument axis and the scroll axis through the entire desired z-axis motion range.
[0099] Instrument shaft drive segment 260 may have a larger diameter than proximally and distally adjacent sections as shown in Figure 11. To facilitate insertion of drive segment 260 into scroll drive tube 248, the segment drive 260 includes a beveled distal edge 262.
[00100] As another example, shown in Figures 13A-13C, the drive segment 260 has a hexagonal cross section and the scroll drive tube 248 has longitudinal grooves with v-shaped radial cross sections as shown. The edges 256a of the drive segment 260 formed by the corner regions of the hexagonal cross section sit on rails 258a to allow longitudinal sliding of the instrument through the lumen, but prevent rotation of the instrument within the lumen.
[00101] In another configuration shown in Figure 14, the drive segment 260 includes longitudinally extending grooves 256b. One or more pins 258b extend radially inwardly from the luminal wall of the roller drive tube 248 and into engagement with one of the slots 256b.
[00102] It should be noted that instrument 100 is preferably constructed such that the scroll drive tube 248 will cause the drive segment 260 and all portions of the instrument shaft 102 that are distal to it to roll (including the extreme effector ), without causing the instrument handle 104 to axially roll. Thus the handle and shaft are coupled together in a way that allows the instrument shaft to rotate freely relative to the handle when actuated by the scroll drive tube 248. For example, instrument 100 may include a scroll joint within, or proximal to, the drive segment. Tubular Connectors
[00103] Apertures 264 and 266 (figure 1C) in the proximal and distal surfaces of the scroll drive housing 217 allow the passage of an instrument shaft through the lumen of the scroll drive tube 248. If, as in the first configuration, the finger drive assembly and the scroll actuators are separate components, any clearance between the components is connected by a tubular connector 268 mounted between the distal opening 266 of the scroll actuator housing 217 and the proximal hole 222 of the housing 210 so as to provide a continuous instrument trajectory. Tubular connector 268 may be detachably connected to scroll actuator housing 217 and housing 210, or it may be more permanently connected to one or both of them. There may also be a similar tubular connector between the instrument case 252 and opening 264 in the roll driver to guide the instrument shaft into the roll driver.
[00104] Referring to Figure 15, the tubular connector 268 may include a Luer orifice 274 for use as a flush orifice or for directing insufflation gas through the finger drive assembly 200 and into the body cavity. A valve 270 such as a cross-slit valve is positioned within the tubular connector 268 to prevent the loss of inflation pressure through its proximal end when no instrument is present. A second seal 272 is positioned to seal against the shaft in an instrument passing through the tubular connector, thus minimizing pressure loss around the shafts of an instrument disposed through connector 268. In other configurations, the Luer orifice 274, valve 370, and seal 272 may be disposed in housing 210. A single seal, or other seal configurations may also be used with and without an instrument present. command interface
[00105] Referring again to Fig. 1A, the base unit includes a command interface 250 equipped to generate signals corresponding to the position of, and/or a change in position of, a proximal portion of the surgical instrument 200 when the handle 104 is manually moved by a user (as well as other signals discussed below). The system generates control signals in response to signals generated at the command interface. Such control signals are used to drive motors 236a, b 238 to drive fingers and roll the instrument shaft as per user manipulation of the instrument handle. Thus, manual movement of the instrument handle by the user results in motor-driven steering of the instrument's distal end and motor-driven axial roll of the instrument's shaft.
[00106] In this configuration, it is the instrument handle 104 (figure 1) whose movement triggers the command interface signals that result in the direction of the fingers and scrolling of the instruments. In other configurations, a proximal portion of the instrument shaft, or another instrument component may be used. Still other configurations use a separate user input device to generate the signals feeding the desired instrument position, rather than user input devices that respond to user movement of the instrument's own grip.
[00107] Turning to Figure 16, the command interface 250 includes a first portion or bracket 276a that is anchored to the base 218 (not shown) and swivelable about a geometric axis A1 (which may be generally normal to the base surface). A second portion or support 276b is mounted on the first support 276a and is rotatable about a geometric axis A2 (which may be generally parallel to the surface of the base and perpendicular to A1).
[00108] The instrument box 252 is positioned on the second bracket 276b as shown in Figure 1. Referring again to Figure 1A, the instrument box includes a housing 253a detachably attached to the second bracket 276b such that the instrument box can be detached after surgery for disposal or sterilization and reuse. A passage 275 for the surgical instrument 100 extends through the housing as shown. As shown in Figure 16, in the first configuration, an opening 253b in housing 253a is slidable over the proximal portion of second support 276b. A spring latch 255 (figure 1A) between instrument box 252 and bracket 276b engages the two components once instrument box 252 has been advanced into position.
[00109] The instrument box 252 is configured to receive the surgical instrument 100 and to allow the instrument axis to slide relative to the instrument box 252 during positioning on the z axis of the instrument. The arrangement of the first and second brackets 276a, 276b with the instrument case 252 (and therefore with instrument 100) makes the interface 250 moveable about the geometry axes A1, A2 when the user moves the instrument handle. Up and down movement of the instrument handle results in longitudinal tilt movement of bracket 276b about geometric axis A2, and side-to-side movement of instrument handle results in directional deviation movement of bracket 276a about axis geometric A1 with the combined up and down and side-to-side motion resulting in combined side-slope and steer movement.
[00110] Encoders within command interface 250 generate signals in response to motion about geometry axes A1, A2. In particular, a first encoder is positioned such that it will generate signals corresponding to the direction deviation movement of the first support 276a (about the axis A1). A second encoder is positioned to generate such signals corresponding to the longitudinal tilt movement of the second bracket 276b (about the axis A2). Suitable encoder types include optical or magnetic incremental rotary encoders which generate signals corresponding to the velocity and incremental amount of angular movement are suitable for this purpose. The signals generated by these encoders are received by electronics housed within the base unit 218 and used to control and drive the drive motors 236a,b (figure 7B).
[00111] The instrument box houses components that cause various types of input signals to be generated by the system in response to user action, including: (a) signals representing the amount by which the user axially rotates the instrument handle or a knob associated scroll; (b) signs indicating the correct placement of an instrument 100 in engagement with the system in the instrument case; (c) signals from the user operable engage/disengage button which allows a user to selectively engage or disengage the command interface 250 upon activation of the engines; and (d) signals generated in response to z-axis motion of the instrument to indicate the position on the z-axis of the instrument 100.
[00112] Referring to Fig. 17A, instrument case 252 includes an elongated tube 278 having a knob 254 at its proximal end. A lubricated inner tube 279 extends through elongated tube 278 and has a proximal block 282 surrounded by knob 254. Block 282 supports one or more exposed metallic elements, such as proximally facing metallic elements 284. A magnetic sensor 286 is within of block 282. An opening in block 282 is positioned to receive an instrument shaft 100 such that the instrument shaft can pass through tube 278. A spring-loaded pin 281 extends into the opening in block 282.
[00113] In figure 17A, the instrument handle 100 is only partially shown and advances against the knob 254 to allow certain features to be visible. A collar 106 is located on a proximal portion 108 of the instrument shaft. The distal side of collar 106 is most easily seen in Figure 11B. It includes a distal portion having a notch 109. A magnet 110 on collar 106 faces distally. These features are located such that when a user advances instrument 100 through the opening in block 282 with notch 109 facing pin 281, notch 109 captures pin 281 to rotationally engage instrument handle with block 282. Magnet 110 adheres magnetically to the metallic elements 284 when brought into proximity to them, thus retaining the instrument in position against the block 282.
[00114] Sensor 286, which can be a Hall sensor, is positioned such that it will generate an instrument presence signal when magnet 110 is positioned on metallic elements 284. This signal alerts the system that an instrument is correctly positioned at the interface command 250 and the system is therefore ready to control the steerable fingers and scroll position of the instrument when the user is ready to do so.
[00115] The system can therefore be configured such that the motors used to drive a given finger will not activate in the absence of an instrument presence signal from sensor 286, unless the user otherwise overrides this feature. This feature prevents inadvertent movement of a finger when there is no instrument extending through it.
[00116] A user actuated switch is positioned to generate a signal indicating whether the user wishes to place the system into an “engaged” state. The switch can be located close to the user's hand for easy access, such as on the 252 instrument box, the instrument, or elsewhere in system 2. Alternatively, the switch can be a foot or voice activated circuit.
[00117] In the first configuration, the switch is actuated using a button 288 positioned adjacent to the button 254 and supported by a button assembly (not shown). A magnet (not shown) is carried by the button assembly. When the engage button 288 is depressed, the button assembly moves the magnet into or out of alignment with a Hall sensor, causing the Hall sensor to generate a signal that the button has been pressed. When pressure on button 288 is released, a spring (not shown) returns the button to its original position. Feedback is provided to the user when the system is moved into and out of the engaged state. For example, an LED 245 on the instrument case can light up, or change color, when the system part is engaged and go out when it is disengaged. An auditory tone can be additionally sounded when the system is moved between the engaged and not engaged state. An electrical connector 99 (figure 17B) is connected between the instrument case and bracket 276b to apply a voltage to the LED.
[00118] When the engagement button has been pressed, the system moves from an “not engaged” state to an “engaged” state with respect to the instrument on that side of the system. When in the engaged state (assuming the instrument presence has been detected as discussed above), the system will activate the motors in response to motion detected at the command interface 250. Pressing that engagement button 288 again will generate another signal used by the system to move the system to an “not engaged” state with respect to the instrument on that side of the system. When the system is in the “not engaged” state, the drive and scroll motors will not activate and the orientations of fingers 214 and scroll drive tube 248 remain fixed. The instrument presence sensor 286 and user-actuated engagement button 288 are therefore useful safety and convenience features designed to prevent activation of the drive and roll motors 236a,b,238 even in the presence of motion detected at the command interface 250. This is beneficial in a variety of circumstances, such as when the user wishes to remove their hand from the instrument grip without causing inadvertent movement of the fingers within the body as the command interface 250 changes position or is inadvertently struck. The user may also wish to disengage the system to maintain the orientation of a finger 214 within the body cavity while he/she repositions the command interface to a more ergonomic position, or while he/she replaces the instrument by extending through that finger by another instrument he/she wants to supply to the same place within the body.
[00119] If the user chooses to change the position of knob 288 relative to instrument handle 104, he/she can do so by rotating instrument collar 106 relative to rotation knob 254.
[00120] A lanyard (not shown) extending between block 282, button 254 or adjacent structures can be used to carry signals from instrument presence sensor 286 and sensor associated with user actuated button 288 to base circuitry or command interface 250. scroll entry
[00121] Instrument Box 250 provides the user with two modes in which to trigger motorized roll of the instrument shaft. The first way is to turn knob 254; the second way is to rotate the instrument handle 104. In the first configuration, the rotation knob 254 is positioned next to the instrument handle 104, allowing the user to find the knob in a position similar to the position of a rotation knob on a instrument. standard hand.
Brackets 290, 292 are mounted in fixed positions within instrument case 252. A first gear 294 is rotationally engaged with the outer surface of tube 278, and a second gear 296 is adjacent to and engaged with first gear 294. button 254, tube 278, and therefore gear 294 are rotatable axially with respect to instrument case 252, and their rotation produces corresponding rotation of second gear 296. Rotation of second gear 296 produces rotation of a magnet positioned such that the rotational position of the magnet is detected by an encoder at the command interface 250. There may be a sterile sheet present between the magnet and encoder. Referring to Figure 17B, the magnet is a disk magnet 300 supported on a column 298. The column 298 extends distally from the second gear 296 and rotates as the gear rotates. Magnet 300 includes a distally facing surface having diametrically positioned north and south poles.
[00123] When instrument case 252 is mounted on bracket 276b, column 298 extends into a corresponding opening 302 (figure 16) in bracket 276b. An encoder chip 304 is positioned within aperture 302 so as to detect the rotational position of magnet 300 in column 298 (which indicates the rotational position of knob 254). The signals generated by the 304 encoder chip are used to generate drive signals for the instrument handle scroll motor. Because instrument collar 106 is rotationally coupled to tube 278 (via block 282), rotating instrument handle rotates tube 278, and results in the generation of a signal at encoder chip 204 as described above.
[00124] In an alternative configuration, a swivel knob on the instrument handle can be swiveled to generate the scroll input signals in a similar manner.
[00125] Because there is friction in the instrument roll joint 260 (figure 11A) between the instrument shaft distal portion 102 and the instrument shaft proximal portion 108, the rolling of the distal portion may result in a slight roll of the portion proximal 108 which can generate scroll input by scroll encoder chip 204. Referring to Fig. 17A, instrument case 252 is designed to apply friction against rotational movement of gear 296 using an element positioned between the housing of the instrument case 252 (or another fixed support within the instrument case) and gear 296 or column 298. A friction plate 247 has a first face in contact with the proximal end of gear 296 or column 298, and a second face in contact with the interior of instrument case 252 (not shown in figure 17A). Friction plate 247 imposes frictional resistance against rotation of gear 296. The amount of friction is selected such that it is greater than the friction present between distal axis 102 and proximal axis 108 at instrument roll joint 260. of the proximal portion of instrument shaft 108 resulting from friction in the bearing joint 260 is thereby prevented from becoming input to the encoder chip 204, thus preventing transmission of feedback. Movement on the Z axis
[00126] Movement in the Z axis of the instrument to move the instrument tip proximally or distally within the body cavity is performed manually by pushing/pulling instrument handle 104. Instrument case 250 is configured such that button 254 and instrument handle 104 can be used to generate instrument scroll input independent of the position on the z-axis of the instrument handle relative to instrument case 252. When instrument collar 106 is coupled with block 282, movement on the axis The instrument's geometric z (i.e., advancing and retracting the instrument between the distal and proximal positions) causes the knob 254 and tube 278 to likewise move along the z axis - maintaining the instrument and input scroll characteristics engaged through the entire path on the z axis. A constant force spring 320 (Fig. 17B) is connected between a collar 280 on a distal portion of tube 278 and bracket 290. When the instrument is advanced in a distal direction, tube 278 pushes collar 280 distally against the force. of spring 320. When the user removes instrument handle 104 from instrument case 252, spring 320 retracts tube 278 and therefore collar 280 returns to the proximal position. When an instrument is present the force of spring 320 would be less than the frictional force required to move the instrument, and the instrument would maintain position on user input.
[00127] The instrument box may include a lock to prevent tube 278 from advancing distally during insertion of an instrument into tube 278. The lock may be a mechanical lock manually releasable by the user or released electronically in response to a produced signal by the instrument presence sensor.
[00128] The characteristics of the instrument case allowing the position on the geometric z axis of the instrument to be determined will be described below with continued reference to figure 17B. A pin 208 extends laterally from the collar 280. A lever arm 310 has a first end having a slot 312 slidable over the pin 308. A second end of the lever arm 310 is pivotally coupled to a lever arm post stationary 314 mounted inside the instrument case. A magnet 316 is positioned on the pivot axis of lever arm 310, and rotates as lever arm 310 pivots. Magnet 316 includes a distally facing surface having diametrically positioned north and south poles.
[00129] Referring to figure 16, when instrument box 252 is mounted on bracket 276b, magnet 316 (figure 17A) is positioned in alignment with an encoder chip 318 mounted on bracket 276b. Encoder chip 318 generates signals representing the rotational position of magnet 316 and hence lever arm 310, from which the axial position of tube 278 and hence instrument 100 can be derived by the system.
[00130] A scale factor is the amount per movement of the instrument or finger that is scaled up or down in relation to the movement by the user of the instrument handle. System 2 uses the determined position on the instrument's geometric z axis to dynamically adjust the scaling factors used in controlling the steering motors. For example, smaller scale factors can be used for steering when the instrument is fully extended from the finger than they would be used when the instrument tip is closer to the finger tip to provide consistent steering against user input regardless of the position on the geometric z axis of the instrument.
[00131] The first and second brackets 276a, b of the command interface 250 can be covered with a sterile sheet for use, while the instrument case 250 remains external to the sheet. Electromechanical block diagram
[00132] Figure 18A shows an electromechanical block diagram of system 2, as slightly modified for a configuration in which a scroll input handwheel is positioned on the instrument shaft rather than on the instrument case as discussed above. Certain other features, including the installation sensor, are not shown, and in the configuration in figure 18A the scroll drive is included as part of the base unit (labeled “Drive Assembly”) rather than as a separate component.
[00133] To use system 2, the base unit 218 and the first and second portions 276a, 276b of the command interface 250 are covered by a sterile sheet. Housing 210 of finger drive assembly 200 and scroll drive 216 are mounted on the base unit to engage the motor driven members 228a, 228b, 244 of the base unit 218 with the driven members 226a,b, 234. The system monitors the engagement between shafts 228a, 228b, 244 of the base unit with shafts 226a, b, 234 of the finger and scroll drives, and shafts 228a, 228b, 244 uncovered not having engaged with their counterparts can be rotated slightly by motor activation as described in the “Motion Transfer” section below.
[00134] The instrument box 252 is mounted on the second portion 276b of the command interface 250. Spring latches 255 engage to secure the housing 210 and roll driver 216 to the base unit 218 when the components are properly aligned. Similar spring latches are engaged to secure instrument case 250 to portion 276b of the command interface.
[00135] Sterile tubular connectors 268 are mated between roll driver 216 and hole 222 in housing 210, and similar connectors can be positioned between instrument box 252 and roll driver 216. Once system 2 is assembled , the distal end of the finger drive assembly 200 is positioned within the patient's body cavity. Alternatively, the finger trigger assembly can also be positioned inside the patient and then mounted on system 2. For easy insertion into the body cavity, the installation mechanism is used to position fingers 214 in a simplified side-by-side configuration using connections 12. Fingers 214 and a portion of insertion tube 212 are passed through the incision into the body cavity. The distal tip of a medical instrument (eg, forceps, claws, or other flexible shaft hand instruments) is inserted through instrument case 252 and advanced distally. Advancing the instrument causes the tip to exit the instrument case 252, past the roller driver 216, then into hole 222 at the proximal end of the finger drive assembly housing 210, and through the corresponding finger 214 until the distal end of the instrument extends from the distal end of the finger 214.
[00136] When an instrument is completely inserted through the command interface 250, instrument presence signals are generated at sensor 286 (figure 17A).
[00137] Additional instruments such as endoscopes, grips and the like are passed through the insertion cannula via holes 220 for use simultaneously with instruments installed through the fingers.
[00138] The installation mechanism is used to adjust the lateral spacing of each finger (and therefore the instrument passed through it) in relation to the longitudinal axis of the insertion cannula as described with respect to figures 2A to 2C.
[00139] Before the user can steer or roll the instrument using the system, he/she presses the engage button 288 to make the system enter the engaged state.
[00140] At least when the system is placed in an engaged state, the system detects the positions of the brackets 276a, b and the scroll input magnet 300 to determine the starting position of the instrument handle 104.
[00141] If the system is in an engaged state and the presence of the instrument has been detected, the system will respond to the steering and scroll input on the command interface 250 by engaging the steering and scroll motors to drive the finger and roll the instrument. To direct instrument 100 inside the body, the user manipulates that instrument handle 104. For example, to move the instrument's extreme effector upward, the user will lower the handle; to move the tip to the left, the user will move the handle to the right. (Although in alternative arrangements, the system can be configured such that the extreme effector moves in the same direction as the handle - such that, for example, raising the handle raises the extreme effector). The encoders in the command interface 250 detect the movement or position of the handle by detecting the rotation of the brackets 276a,b with respect to the geometry axes A1, A2. In response, the system generates control signals to activate motors 236a,b to thereby direct the finger and the instrument extending through it. To axially scroll the instrument, the user axially rolls instrument handle 104 or rotation knob 254 relative to instrument case 252, producing signals on scroll encoder chip 304. In response, scroll motor 238 is activated to scroll the distal part 102 of the instrument shaft. To position the instrument further into the body cavity, the user pushes the instrument handle 104 distally. This movement in the instrument's geometric z axis is detected by encoder 318, and the position in the instrument's geometric z axis can be used by the system to dynamically adjust scaling factors for finger steering and/or instrument scrolling.
[00142] Figure 18B is a schematic of an exemplary drive control sequence for controlling drive motors to drive fingers based on detected information (eg, finger position approximations, user interface positions, etc.) using forward and reverse mapping and PID control.
[00143] Actuation of the instrument extreme effector, such as opening/closing jaws, is performed in a conventional manner using manual actuators (eg levers, buttons, triggers, sliders, etc.) on the instrument handle. If desired, an instrument can be extracted from the system during the procedure, and replaced with a different instrument, which again can be steered and rotated axially by manipulating the handle as described.
[00144] The first configuration is just an example of ways in which the mechanized system can be configured. Various modifications can be made to that configuration without departing from the scope of the invention.
[00145] A few such modifications will be described below, but many others are possible and are within the scope of the invention.
[00146] Although the drawings show the two finger drives in housing 210 and each scroll drive 216 in a separate housing, other configurations use different layouts. For example, the design can be modified to position the 216 scroll drives in a common housing with the finger drives. As a second example, the finger drives 216 may both be mounted in a common housing that is separate from the housing 210 containing the finger drives. In another configuration, the scroll trigger and finger trigger associated with the left instrument may have a common housing, with a separate housing used for both the scroll trigger and finger trigger associated with the right instrument. Other configurations can package each of the scroll triggers and finger triggers as four separate components.
[00147] In other configurations, motors are integrated into sets of corresponding finger drives and scroll drives rather than being detachable from them. second configuration
[00148] The 2A system of the second configuration, shown in Figure 19, differs from the first configuration primarily in that the scroll drive features are incorporated into the base. More particularly, a base 218a includes a raised portion 216a that houses the scroll drive tube 248 (not shown). An instrument passage extends between a proximal opening 264a and a distal opening (not shown) in raised portion 216a. The instrument shaft extends through the raised passageway 216a. The instrument shaft extends through the raised portion of passage 216a between the control interface 250 and the finger drive assembly 200. A sterile tubular insert (not shown) is insertable through the instrument passage in the raised portion 216a to prevent the instrument 100 to contaminate the passage. third configuration
[00149] Referring to Figure 20, a third configuration of a surgical access system 2B includes a body 210a and an insertion cannula 212 extending distally from the body 210a. Fingers 214 extend from insertion cannula 212. Finger 214 may have properties similar to those described elsewhere in this patent application.
[00150] Each finger includes a dedicated installation mechanism operable to independently reposition the distal portion of the fingers 214 to increase or decrease their lateral separation from the longitudinal axis of the insertion cannula 212. Each development mechanism includes a rigid longitudinally slideable member 14a and at least one connecting arm 12a (two are shown for each finger). The rigid member 1a may be constructed of a proximal portion comprising a straight, single-lumen tube made of stainless steel or rigid polymeric material, and a distal bar extending from the tubular proximal portion. The distal bar may be integral with a portion of the wall of the tubular proximal portion. Each finger 214 extends distally from the lumen of the tubular proximal portion of rigid member 14a.
[00151] The installation system works similarly to that described for the first setup. Each link 12a has a first end hingedly coupled to rigid member 118 and a second end hingedly coupled to a corresponding finger 214 proximate its distal end. In the illustrated configuration, these pivotal connections are formed into collars 122 disposed on the fingers. Rigid member 14a is movable longitudinally with respect to insertion cannula 212 to pivot links 120 inwardly and outwardly. In the illustrated configuration, sliding 14a in a distal direction pivots the second ends of the links 120 outwardly to install the corresponding finger or to further separate the finger from the longitudinal axis of the insertion cannula 212. Alternative configurations may operate in reverse, such that the member 14a retraction increases finger separation.
[00152] Each finger may additionally include a member or support structure 124 having a first end pivotally connected to the collar 122 and a second end pivotally connected to the corresponding one of the members 14a or the insertion cannula 212. The support structures 124 support the assisting fingers. to maintain the longitudinal orientation of the fingers, and prevent them from loosening or twisting during use.
[00153] Slip rings 126 are shown to independently slide each member 14a longitudinally for finger installation, allowing the user to advance/retract member 14a by advancing/retracting ring 126 relative to body 210a. The ring may include a ratchet feature function as described in the '307 patent application, which releasably locks the finger in a releasably selected longitudinal and lateral position by releasably engaging the longitudinal position of member 14a. Figure 20 shows that this arrangement allows each finger to be installed to have a different amount of lateral separation and longitudinal extension.
[00154] The T tips of instruments 100 are shown extending from the distal ends of the fingers. Body 210a includes proximal openings 128 for receiving instruments. To install an instrument 100 from a finger 214, the tip of that instrument is inserted through one of the proximal openings 128 and advanced through body 210a, insertion cannula 212 and finger until its tip T or extreme effector extends outward of the finger. In the drawing of Figure 20, the handle 104 for the finger-worn instrument on the left is not shown, so as to allow the proximal opening 128 to be seen.
[00155] A primary difference between the third and first configurations is that the features described for inclusion in finger drives, scroll drives, command interface (including instrument box) and base unit of the first configuration are incorporated in housing 210a.
[00156] Sensors 130 are positioned in body 210a to detect longitudinal tilt movement and deviation of direction of instrument handle 104. Motors 236a, b in body 210a are engaged with cables that extend through the fingers and are anchored to the fingers (eg at 90 degree intervals) to deflect the fingers according to the detected grip position. For example, a first motor 236a can be positioned to drive a first pair of cables corresponding to directional offset movement of the distal end of the finger, and a second motor 236b can be positioned to drive a second pair of cables corresponding to tilting movement. lengthwise of the distal end of the finger.
[00157] Automation can also be provided to trigger the axial rotation of an instrument arranged via a finger. A grip sensor 304 is positioned to detect axial rotation of the instrument grip 104, and is operatively associated with a scroll motor 238 which will produce or assist an axial scroll of the instrument or a finger using gear 134.
[00158] As with the first setup, instrument extreme effector actuation, such as jaw opening/closing, is performed in a conventional manner using actuators (eg levers, knobs, triggers, sliders, etc.) on the instrument handle. If desired, an instrument can be extracted from the system during the procedure, and replaced with a different instrument, which again can be steered and rotated axially by manipulating the handle as described.
[00159] System 100 may include an upright 90 engageable with a stabilization arm such as arm 204 (figure 1B) that may be coupled to a trolley, operating table or other device within the operating room. The stabilization arm can be positionable or manually adjustable using motor driven joints and telescopic members, allowing the height and orientation of the 2B system to be adjusted using a user input such as pedals or other input devices. fourth configuration
[00160] The configuration of figure 21 is similar to the configuration of figure 20, but additionally incorporates a mechanism for movement in the geometric z axis of each finger 214. Although the use of the slip ring 126 in the configuration of figure 20 produces a change in the axis geometric z of the corresponding finger position, the arrangement of figure 21 allows movement on the axis z that is independent of the lateral position of the finger relative to the insertion cannula 212.
[00161] In particular, the system has two body sections 210c, each of which is longitudinally slidable along a central track 136. Each body section is coupled to one of the fingers and its corresponding installation system (member 14a, connections 12a, support frame 124, installation ring 126). In one configuration, insertion cannula 212 is attached to track 136, and each finger and its installation systems move longitudinally relative to the cannula in response to manual push/pull by the user. Although the primary adjustment on the geometry z axis is now performed by a platform with a linear support for each side of the system, the installation mechanism remains for the adjustment of tool separation (identified as the geometry axis x in the drawings). Note that each side has an independent installation system such that the extension is independently controlled for each instrument. fifth configuration
[00162] The configuration of figure 22 is similar to the configuration of figure 21, but is provided in a more modular format. This configuration includes independent body sections 210d that house the tilt, steer and roll motors 236a, b, 230, sensors 130, 304, and which includes opening 128 for receiving instrument 100. finger/scroll 203a each having pulleys 232, cables (not shown), and a scroll drive tube 248 is provided, with each finger/scroll drive 203a connected to one of the fingers 214. Each finger/scroll drive 203a is releasably engageable with a body section 210d in a manner that allows the motors in the body section 210d to modulate to actuate pulleys 232 on the finger/roll drive 203a so as to pull the cables and roll the finger/roll drive 203a to point your finger and roll the instrument. Slip rings 126 for finger separation (geometric x axis) are located on finger/scroll drives 203a. sixth configuration
[00163] In the configurations of figures 20-22, longitudinal tilt, roll and direction deviation are detected and the finger is electromechanically controlled to position the instrument, however the jaw grip action or other extreme effector action of the instrument is mechanically actuated by a mechanical actuator on the instrument handle. The configuration of figure 23 is very similar to the configuration of figure 22, but instead of using a handheld instrument having a mechanical actuator, it uses an alternative surgical instrument 100a. Instrument 100a engages with a motor 138 in the motor module which is activated to operate the extreme effector (eg, jaw) of the tool. In one configuration, control of finger and scroll triggers is responsive to user manipulation of instrument 103a to control pitch, roll, and steer deviation as discussed with respect to previous configurations, but the system is configured per instrument to receive signals to from an input device (eg, a switch, foot pedal) to initiate extreme effector actuation via motor 138. In other configurations, tilt, roll, and steer shift motors may be operable in response to signals received from a separate user input device such as a joystick or other forms of input devices rather than manual manipulation of instrument 103a. seventh configuration
[00164] The configuration of figure 24 is similar to the configuration of figure 23, but it automates motion on the geometric z axis using a motor 140 that advances/retracts bodies 210e and finger/scroll drive 203a along track 136. In addition, it eliminates the mechanical installation mechanism and instead automates positioning on the x axis or lateral finger axis using an additional motor 142 in each body 210e. Motor 142 advances/retracts element 14a to expand links 12a for installation and positioning on the x-axis.
[00165] Automating movements in the geometric z and x axes allows for complex volumetric movements of the instrument beyond what can be achieved using mechanical movement in the geometric z and x axes. Providing a dynamic geometric z axis increases the instrument's range while introducing a dynamic geometric x axis allows for complex orienting movements of the instrument tips. Tip movement in the x direction can be in a direction decoupled from movement in the z direction, automatically adjusting the position on the z axis of the finger to offset changes in the z axis resulting from pivoting of links 12a during adjustments on the x axis.
[00166] Figure 25 shows a further example of a user input device that can be used in systems such as the systems in figures 23 and 24 that use input devices that are separate from the instrument handle and shaft. An input device 500 shown in Figure 25 includes a handle to be manipulated by a user in accordance with the desired position of the surgical instrument. The input device incorporates at least four sensors (associated with multiple pivot joints of a control handle) and an actuator 502 to simulate the grip load to be achieved on the extreme effector of the instrument. The input device is connected to body 210d, 210e by digital communication wires and may be located at or near body 210d, 210e at the patient's bedside, preferably within the sterile field. For example, input device 500 and body can be positioned on a common arm (such as arm 204), on different arms supported by a common cart or other device (eg, the operating table or a stand on the ceiling), or on separate arms on the same or different devices. The systems of figures 23 and 24 can be provided with a number of interchangeable tools 100a, each having a different extreme effector, allowing the user to change tool modules as needed during the course of a surgical procedure.
[00167] Figure 26 shows a 2E system that is similar to the first configuration. However, the finger drive assembly 203, scroll drives 216, command interfaces 250, motor drives and associated electronics are integrated into a single component. Two 236a,b drive motors are shown on each side of the 2E system, one for each cable pair. However, each cable can instead have its own dedicated motor.
[00168] Although certain configurations have been described above, it should be understood that these configurations are presented for purposes of example and not limitation. It will be apparent to persons skilled in the relevant art that various changes in form and detail can be made therein without departing from the spirit and scope of the invention. This is especially true in light of technology and terms within the relevant techniques that can be further developed. Furthermore, characteristics of the various disclosed configurations can be combined in various ways to produce several additional configurations.
[00169] Any and all patents, patent applications and printed publications referred to above, including for priority purposes, are hereby incorporated by reference.

权利要求:
Claims (15)
[0001]
1. Motorized surgical system, characterized in that it comprises: - at least one support (204) having a distal portion positionable within a sterile field in proximity to a patient positioned on a surgical table (206); - an instrument driver ( 200) carried by the distal portion of at least one said holder (204), the instrument driver (200) having a steerable distal end positionable in a body cavity; - a user input device (250) carried by the distal portion of at least one said holder (204), the user input device (250) configured to generate motion signals in response to manual manipulation of a portion of the user input device (250) by a user; and - at least one motor operably coupled with the instrument driver (200), the motor operable to deflect the steerable distal end of the instrument driver (200) in response to motion signals; - the instrument driver (200) and the user input device (250) are positioned to removably receive the distal and proximal portions, respectively, of a surgical instrument (100), the user input device (250) configured to generate movement signals in response to manipulation. manual of the proximal portion of the surgical instrument (100); e- the motor is operable to actuate the instrument driver (200) in response to movement signals and to thereby change the position of the distal portion of the surgical instrument (100) within the body cavity.
[0002]
2. System according to claim 1, characterized in that: - the instrument driver (200) comprises a steerable finger (214) having a lumen provided to receive a distal portion of a surgical instrument (100), - by the at least one actuating element (223) extends at least partially through the finger (214); and - the motor is operable in response to motion signals to cause the actuation element (223) to be tensioned so as to deflect the finger (214).
[0003]
3. System according to claim 2, characterized in that:- the input device (250) includes a base (218) and an instrument receiver (252) on the base (218), the instrument receiver (252 ) manually movable in relation to the base (218) in at least two degrees of freedom to generate the movement signals; - said at least one actuation element comprises a plurality of actuation elements (223); - said motor comprises at least at least two motors operable in response to motion signals to deflect the finger (214) by at least two degrees of freedom.
[0004]
4. System according to claim 2, characterized in that it further includes: - a scroll driver (216) positioned to rotationally couple with a surgical instrument (100) received by the instrument driver (200) and the input device (250);- a scroll input device configured to generate scroll signals in response to manual manipulation of at least one of a movable member (254) in the scroll input device and a proximal portion (104) of the surgical instrument ( 100); and - a scroll motor (238) operably coupled to the scroll actuator (216), the scroll motor (238) operable to move the scroll actuator (216) in response to the scroll motion signals, such that said actuator (216) axially rotate the distal portion of the surgical instrument (100).
[0005]
5. System according to claim 4, characterized in that the scroll input device is configured to generate the scroll signals in response to axial rotation of a surgical instrument (100) positioned in contact with the Scrolling.
[0006]
6. System according to claim 4, characterized in that the scroll input device is configured to generate the scroll signals in response to the manual rotation of a handle on the scroll input device.
[0007]
7. System according to claim 4, characterized in that the scroll actuator (216) is configured to allow longitudinal movement of a surgical instrument (100) in relation to the scroll actuator (216) when the surgical instrument ( 100) is rotationally coupled with the scroll drive (216).
[0008]
8. System according to claim 7, characterized in that it additionally includes a sensor (318) positioned to generate signals in response to a change in a longitudinal position of a surgical instrument (100).
[0009]
9. System according to claim 4, characterized in that:- the scroll driver (216) comprises a scroll drive member (248) having an opening provided for receiving a portion (260) of a surgical instrument ( 100) and features surrounding the opening lumen that are rotationally engageable with the axis of the surgical instrument (103); and - the scroll motor (238) is operable to axially rotate the scroll drive member (216).
[0010]
10. System according to claim 2, characterized in that it additionally includes: - an insertion holder (212) insertable through an incision within a body cavity; - a second steerable finger (214), the first and second steerable fingers extending from a distal end of the insert holder (212), the second steerable finger (214) having a lumen provided to receive a distal portion of a second surgical instrument;- a second user input device , wherein the second finger (214) and second user input device are positioned to removably receive distal and proximal portions, respectively, of a second surgical instrument, the second user input device configured to generate second movement signals in response. manual manipulation of the proximal portion of the second surgical instrument; and - at least one second motor operably coupled to the second finger (214), the second motor operable to deflect the second finger (214) in response to the second motion signals.
[0011]
11. System according to claim 10, characterized in that at least one of the first and second fingers is laterally movable from a first position in which the distal portion of said finger is spaced from a longitudinal geometric axis of the support. insert (212) by a first distance, and a second position in which a distal portion of said finger is spaced from a longitudinal axis of the insert holder (212) by a second distance, the second distance being greater than the first. distance.
[0012]
12. System according to claim 11, characterized in that the first and second fingers are simultaneously installable between the first and second positions.
[0013]
13. System according to claim 11, characterized in that the first and second fingers are independently installable between the first and second positions.
[0014]
14. System according to claim 11, characterized in that it additionally includes a sensor (26) positioned to generate a signal in response to the movement of at least one of the fingers between the first and second positions.
[0015]
15. The system of claim 1, further including a sensor (286) positioned to generate an instrument presence signal in response to the positioning of a proximal portion of a surgical instrument (100) in the input device (250).

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同族专利:

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公开号 | 公开日

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US20150088158A1|2015-03-26|

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US9345545B2|2016-05-24|

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EP2809245A4|2015-07-08|

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US20140107665A1|2014-04-17|

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US10945800B2|2021-03-16|

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JP6202759B2|2017-09-27|

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EP2809245A1|2014-12-10|

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US20150088159A1|2015-03-26|

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JP2015511148A|2015-04-16|

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KR102088541B1|2020-03-13|

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US9603672B2|2017-03-28|

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WO2013116869A1|2013-08-08|

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KR20140119183A|2014-10-08|

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US20170165019A1|2017-06-15|

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US9333040B2|2016-05-10|

---

US20150066050A1|2015-03-05|

---

EP2809245B1|2020-04-29|

引用文献:

---

公开号 | 申请日 | 公开日 | 申请人 | 专利标题

---

---

JPS6137927B2|1978-12-22|1986-08-26|Olympus Optical Co|

---

IT1235460B|1987-07-31|1992-07-30|Confida Spa|FLEXIBLE ENDOSCOPE.|

---

GB2226245A|1988-11-18|1990-06-27|Alan Crockard|Endoscope, remote actuator and aneurysm clip applicator.|

---

US4941454A|1989-10-05|1990-07-17|Welch Allyn, Inc.|Servo actuated steering mechanism for borescope or endoscope|

---

US5217453A|1991-03-18|1993-06-08|Wilk Peter J|Automated surgical system and apparatus|

---

US5339799A|1991-04-23|1994-08-23|Olympus Optical Co., Ltd.|Medical system for reproducing a state of contact of the treatment section in the operation unit|

---

EP0543738A1|1991-11-22|1993-05-26|Welch Allyn, Inc.|Detachable servo actuated insertion tube for borescope or endoscope|

---

AT155059T|1992-01-21|1997-07-15|Stanford Res Inst Int|TELEOPERATEURSYSTEM AND METHOD WITH TELE PRESENCE|

---

US5626595A|1992-02-14|1997-05-06|Automated Medical Instruments, Inc.|Automated surgical instrument|

---

US5624380A|1992-03-12|1997-04-29|Olympus Optical Co., Ltd.|Multi-degree of freedom manipulator|

---

US5297443A|1992-07-07|1994-03-29|Wentz John D|Flexible positioning appendage|

---

JPH06114000A|1992-09-30|1994-04-26|Olympus Optical Co Ltd|Medical manipulator|

---

DE69417229T2|1993-05-14|1999-07-08|Stanford Res Inst Int|SURGERY DEVICE|

---

WO1995016396A1|1993-12-15|1995-06-22|Computer Motion, Inc.|Automated endoscope system for optimal positioning|

---

JP3339953B2|1993-12-29|2002-10-28|オリンパス光学工業株式会社|Medical master-slave manipulator|

---

JPH07328024A|1994-06-14|1995-12-19|Olympus Optical Co Ltd|Medical manipulator device|

---

US6120433A|1994-09-01|2000-09-19|Olympus Optical Co., Ltd.|Surgical manipulator system|

---

US5649956A|1995-06-07|1997-07-22|Sri International|System and method for releasably holding a surgical instrument|

---

US5624398A|1996-02-08|1997-04-29|Symbiosis Corporation|Endoscopic robotic surgical tools and methods|

---

US5855583A|1996-02-20|1999-01-05|Computer Motion, Inc.|Method and apparatus for performing minimally invasive cardiac procedures|

---

US5762458A|1996-02-20|1998-06-09|Computer Motion, Inc.|Method and apparatus for performing minimally invasive cardiac procedures|

---

US5792135A|1996-05-20|1998-08-11|Intuitive Surgical, Inc.|Articulated surgical instrument for performing minimally invasive surgery with enhanced dexterity and sensitivity|

---

DE19748795B4|1996-11-18|2006-08-17|Olympus Corporation|endoscope|

---

US6132368A|1996-12-12|2000-10-17|Intuitive Surgical, Inc.|Multi-component telepresence system and method|

---

US7789875B2|1998-02-24|2010-09-07|Hansen Medical, Inc.|Surgical instruments|

---

US7766894B2|2001-02-15|2010-08-03|Hansen Medical, Inc.|Coaxial catheter system|

---

US7713190B2|1998-02-24|2010-05-11|Hansen Medical, Inc.|Flexible instrument|

---

US20030135204A1|2001-02-15|2003-07-17|Endo Via Medical, Inc.|Robotically controlled medical instrument with a flexible section|

---

US7169141B2|1998-02-24|2007-01-30|Hansen Medical, Inc.|Surgical instrument|

---

IL123646A|1998-03-11|2010-05-31|Refael Beyar|Remote control catheterization|

---

US6331181B1|1998-12-08|2001-12-18|Intuitive Surgical, Inc.|Surgical robotic tools, data architecture, and use|

---

US6325808B1|1998-12-08|2001-12-04|Advanced Realtime Control Systems, Inc.|Robotic system, docking station, and surgical tool for collaborative control in minimally invasive surgery|

---

JP2001309920A|2000-02-24|2001-11-06|Hitachi Ltd|Forceps and manipulator using the same|

---

JP4014792B2|2000-09-29|2007-11-28|株式会社東芝|manipulator|

---

JP3493579B2|2001-02-19|2004-02-03|技術研究組合医療福祉機器研究所|Work support device|

---

US6793622B2|2001-09-05|2004-09-21|Olympus Optical Co., Ltd.|Electric bending endoscope|

---

JP3680050B2|2002-09-18|2005-08-10|株式会社東芝|Medical manipulator and control method thereof|

---

JP4323150B2|2002-09-30|2009-09-02|オリンパス株式会社|Electric bending endoscope|

---

JP4533695B2|2003-09-23|2010-09-01|オリンパス株式会社|Treatment endoscope|

---

US20050096502A1|2003-10-29|2005-05-05|Khalili Theodore M.|Robotic surgical device|

---

AT501424B1|2003-10-31|2008-08-15|Fronius Int Gmbh|METHOD FOR AN INVERTER AND INVERTER, ESPECIALLY SOLAR CHANGEARK|

---

US20060100610A1|2004-03-05|2006-05-11|Wallace Daniel T|Methods using a robotic catheter system|

---

US8562516B2|2004-04-14|2013-10-22|Usgi Medical Inc.|Methods and apparatus for obtaining endoluminal access|

---

US8512229B2|2004-04-14|2013-08-20|Usgi Medical Inc.|Method and apparatus for obtaining endoluminal access|

---

WO2006059722A1|2004-12-03|2006-06-08|Olympus Corporation|Bendable endoscope of type where insertion section is removable and electrically bendable endoscope device of type where insertion section is removable|

---

US8190238B2|2005-12-09|2012-05-29|Hansen Medical, Inc.|Robotic catheter system and methods|

---

US8556805B2|2006-01-13|2013-10-15|Olympus Medical Systems Corp.|Rotational force transmission mechanism, force-attenuating apparatus, medical device, and medical instrument-operation mechanism|

---

US8992422B2|2006-03-23|2015-03-31|Ethicon Endo-Surgery, Inc.|Robotically-controlled endoscopic accessory channel|

---

CA2652548C|2006-05-17|2016-09-20|Synecor, Llc|System and method for multi-instrument surgical access using a single access port|

---

EP2012650B1|2006-04-24|2016-07-27|TransEnterix Surgical, Inc.|Natural orifice surgical system|

---

US8518024B2|2006-04-24|2013-08-27|Transenterix, Inc.|System and method for multi-instrument surgical access using a single access port|

---

KR101494283B1|2006-06-13|2015-02-23|인튜어티브 서지컬 인코포레이티드|Minimally invasive surgical system|

---

JP4654165B2|2006-08-08|2011-03-16|テルモ株式会社|Working mechanism and manipulator|

---

US20080243064A1|2007-02-15|2008-10-02|Hansen Medical, Inc.|Support structure for robotic medical instrument|

---

US8465414B2|2007-03-30|2013-06-18|Osaka University|Medical manipulator device and actuator suitable therefor|

---

US8409234B2|2007-05-25|2013-04-02|Hansen Medical, Inc.|Rotational apparatus system and method for a robotic instrument system|

---

JP2009028157A|2007-07-25|2009-02-12|Terumo Corp|Medical manipulator system|

---

JP2009148814A|2007-12-21|2009-07-09|Ihi Corp|Method for producing brazing sheet|

---

US8343034B2|2008-05-13|2013-01-01|Olympus Medical Systems Corp.|Electric medical instrument fitting which is attached to a medical instrument holding device|

---

KR100936928B1|2008-07-25|2010-01-20|미래컴퍼니|Surgical robot|

---

CA2776320C|2008-10-07|2017-08-29|The Trustees Of Columbia University In The City Of New York|Systems, devices, and method for providing insertable robotic sensory and manipulation platforms for single port surgery|

---

US8720448B2|2008-11-07|2014-05-13|Hansen Medical, Inc.|Sterile interface apparatus|

---

EP2324789B1|2008-11-14|2017-06-21|Olympus Corporation|Medical system|

---

US8120301B2|2009-03-09|2012-02-21|Intuitive Surgical Operations, Inc.|Ergonomic surgeon control console in robotic surgical systems|

---

CN102802551B|2009-05-29|2016-01-20|南洋理工大学|For can the robot system of musical form endoscope operation|

---

EP2332459B1|2009-06-23|2014-05-07|Olympus Medical Systems Corp.|Medical system|

---

US20110015648A1|2009-07-16|2011-01-20|Hansen Medical, Inc.|Endoscopic robotic catheter system|

---

US8888789B2|2009-09-23|2014-11-18|Intuitive Surgical Operations, Inc.|Curved cannula surgical system control|

---

US8398633B2|2009-10-30|2013-03-19|Covidien Lp|Jaw roll joint|

---

JP4781492B2|2009-11-10|2011-09-28|オリンパスメディカルシステムズ株式会社|Articulated manipulator device and endoscope system having the same|

---

US9775640B2|2009-11-14|2017-10-03|SPI Surgical, Inc.|Surgical device|

---

CN102573600B|2009-11-18|2014-10-08|奥林巴斯医疗株式会社|Medical device|

---

US20110282357A1|2010-05-14|2011-11-17|Intuitive Surgical Operations, Inc.|Surgical system architecture|

---

EP2706932B1|2011-05-12|2018-03-28|Imperial Innovations Limited|A surgical device|US20070084897A1|2003-05-20|2007-04-19|Shelton Frederick E Iv|Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism|

---

US9060770B2|2003-05-20|2015-06-23|Ethicon Endo-Surgery, Inc.|Robotically-driven surgical instrument with E-beam driver|

---

US8215531B2|2004-07-28|2012-07-10|Ethicon Endo-Surgery, Inc.|Surgical stapling instrument having a medical substance dispenser|

---

US7934630B2|2005-08-31|2011-05-03|Ethicon Endo-Surgery, Inc.|Staple cartridges for forming staples having differing formed staple heights|

---

US9237891B2|2005-08-31|2016-01-19|Ethicon Endo-Surgery, Inc.|Robotically-controlled surgical stapling devices that produce formed staples having different lengths|

---

US10159482B2|2005-08-31|2018-12-25|Ethicon Llc|Fastener cartridge assembly comprising a fixed anvil and different staple heights|

---

US7669746B2|2005-08-31|2010-03-02|Ethicon Endo-Surgery, Inc.|Staple cartridges for forming staples having differing formed staple heights|

---

US11246590B2|2005-08-31|2022-02-15|Cilag Gmbh International|Staple cartridge including staple drivers having different unfired heights|

---

US20070106317A1|2005-11-09|2007-05-10|Shelton Frederick E Iv|Hydraulically and electrically actuated articulation joints for surgical instruments|

---

US11224427B2|2006-01-31|2022-01-18|Cilag Gmbh International|Surgical stapling system including a console and retraction assembly|

---

US7753904B2|2006-01-31|2010-07-13|Ethicon Endo-Surgery, Inc.|Endoscopic surgical instrument with a handle that can articulate with respect to the shaft|

---

US8186555B2|2006-01-31|2012-05-29|Ethicon Endo-Surgery, Inc.|Motor-driven surgical cutting and fastening instrument with mechanical closure system|

---

US20120292367A1|2006-01-31|2012-11-22|Ethicon Endo-Surgery, Inc.|Robotically-controlled end effector|

---

US20110295295A1|2006-01-31|2011-12-01|Ethicon Endo-Surgery, Inc.|Robotically-controlled surgical instrument having recording capabilities|

---

US11207064B2|2011-05-27|2021-12-28|Cilag Gmbh International|Automated end effector component reloading system for use with a robotic system|

---

US7845537B2|2006-01-31|2010-12-07|Ethicon Endo-Surgery, Inc.|Surgical instrument having recording capabilities|

---

US8820603B2|2006-01-31|2014-09-02|Ethicon Endo-Surgery, Inc.|Accessing data stored in a memory of a surgical instrument|

---

US8708213B2|2006-01-31|2014-04-29|Ethicon Endo-Surgery, Inc.|Surgical instrument having a feedback system|

---

US20070225562A1|2006-03-23|2007-09-27|Ethicon Endo-Surgery, Inc.|Articulating endoscopic accessory channel|

---

US8992422B2|2006-03-23|2015-03-31|Ethicon Endo-Surgery, Inc.|Robotically-controlled endoscopic accessory channel|

---

US8322455B2|2006-06-27|2012-12-04|Ethicon Endo-Surgery, Inc.|Manually driven surgical cutting and fastening instrument|

---

US10568652B2|2006-09-29|2020-02-25|Ethicon Llc|Surgical staples having attached drivers of different heights and stapling instruments for deploying the same|

---

US8360297B2|2006-09-29|2013-01-29|Ethicon Endo-Surgery, Inc.|Surgical cutting and stapling instrument with self adjusting anvil|

---

US8652120B2|2007-01-10|2014-02-18|Ethicon Endo-Surgery, Inc.|Surgical instrument with wireless communication between control unit and sensor transponders|

---

US8684253B2|2007-01-10|2014-04-01|Ethicon Endo-Surgery, Inc.|Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor|

---

US11039836B2|2007-01-11|2021-06-22|Cilag Gmbh International|Staple cartridge for use with a surgical stapling instrument|

---

US8540128B2|2007-01-11|2013-09-24|Ethicon Endo-Surgery, Inc.|Surgical stapling device with a curved end effector|

---

US7735703B2|2007-03-15|2010-06-15|Ethicon Endo-Surgery, Inc.|Re-loadable surgical stapling instrument|

---

US8893946B2|2007-03-28|2014-11-25|Ethicon Endo-Surgery, Inc.|Laparoscopic tissue thickness and clamp load measuring devices|

---

US8931682B2|2007-06-04|2015-01-13|Ethicon Endo-Surgery, Inc.|Robotically-controlled shaft based rotary drive systems for surgical instruments|

---

US7753245B2|2007-06-22|2010-07-13|Ethicon Endo-Surgery, Inc.|Surgical stapling instruments|

---

US8573465B2|2008-02-14|2013-11-05|Ethicon Endo-Surgery, Inc.|Robotically-controlled surgical end effector system with rotary actuated closure systems|

---

US7819298B2|2008-02-14|2010-10-26|Ethicon Endo-Surgery, Inc.|Surgical stapling apparatus with control features operable with one hand|

---

US9179912B2|2008-02-14|2015-11-10|Ethicon Endo-Surgery, Inc.|Robotically-controlled motorized surgical cutting and fastening instrument|

---

US8636736B2|2008-02-14|2014-01-28|Ethicon Endo-Surgery, Inc.|Motorized surgical cutting and fastening instrument|

---

US7866527B2|2008-02-14|2011-01-11|Ethicon Endo-Surgery, Inc.|Surgical stapling apparatus with interlockable firing system|

---

JP5410110B2|2008-02-14|2014-02-05|エシコン・エンド−サージェリィ・インコーポレイテッド|Surgical cutting / fixing instrument with RF electrode|

---

US8758391B2|2008-02-14|2014-06-24|Ethicon Endo-Surgery, Inc.|Interchangeable tools for surgical instruments|

---

US9585657B2|2008-02-15|2017-03-07|Ethicon Endo-Surgery, Llc|Actuator for releasing a layer of material from a surgical end effector|

---

US9386983B2|2008-09-23|2016-07-12|Ethicon Endo-Surgery, Llc|Robotically-controlled motorized surgical instrument|

---

US9005230B2|2008-09-23|2015-04-14|Ethicon Endo-Surgery, Inc.|Motorized surgical instrument|

---

US8210411B2|2008-09-23|2012-07-03|Ethicon Endo-Surgery, Inc.|Motor-driven surgical cutting instrument|

---

US8608045B2|2008-10-10|2013-12-17|Ethicon Endo-Sugery, Inc.|Powered surgical cutting and stapling apparatus with manually retractable firing system|

---

US8517239B2|2009-02-05|2013-08-27|Ethicon Endo-Surgery, Inc.|Surgical stapling instrument comprising a magnetic element driver|

---

US8444036B2|2009-02-06|2013-05-21|Ethicon Endo-Surgery, Inc.|Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector|

---

US20110024477A1|2009-02-06|2011-02-03|Hall Steven G|Driven Surgical Stapler Improvements|

---

US8220688B2|2009-12-24|2012-07-17|Ethicon Endo-Surgery, Inc.|Motor-driven surgical cutting instrument with electric actuator directional control assembly|

---

US9364233B2|2010-09-30|2016-06-14|Ethicon Endo-Surgery, Llc|Tissue thickness compensators for circular surgical staplers|

---

JP6224070B2|2012-03-28|2017-11-01|エシコン・エンド−サージェリィ・インコーポレイテッドＥｔｈｉｃｏｎ Ｅｎｄｏ−Ｓｕｒｇｅｒｙ，Ｉｎｃ．|Retainer assembly including tissue thickness compensator|

---

US9220501B2|2010-09-30|2015-12-29|Ethicon Endo-Surgery, Inc.|Tissue thickness compensators|

---

US9204880B2|2012-03-28|2015-12-08|Ethicon Endo-Surgery, Inc.|Tissue thickness compensator comprising capsules defining a low pressure environment|

---

JP6305979B2|2012-03-28|2018-04-04|エシコン・エンド−サージェリィ・インコーポレイテッドＥｔｈｉｃｏｎ Ｅｎｄｏ−Ｓｕｒｇｅｒｙ，Ｉｎｃ．|Tissue thickness compensator with multiple layers|

---

US9232941B2|2010-09-30|2016-01-12|Ethicon Endo-Surgery, Inc.|Tissue thickness compensator comprising a reservoir|

---

US10945731B2|2010-09-30|2021-03-16|Ethicon Llc|Tissue thickness compensator comprising controlled release and expansion|

---

US9320523B2|2012-03-28|2016-04-26|Ethicon Endo-Surgery, Llc|Tissue thickness compensator comprising tissue ingrowth features|

---

US9861361B2|2010-09-30|2018-01-09|Ethicon Llc|Releasable tissue thickness compensator and fastener cartridge having the same|

---

US9839420B2|2010-09-30|2017-12-12|Ethicon Llc|Tissue thickness compensator comprising at least one medicament|

---

US9629814B2|2010-09-30|2017-04-25|Ethicon Endo-Surgery, Llc|Tissue thickness compensator configured to redistribute compressive forces|

---

BR112013027794B1|2011-04-29|2020-12-15|Ethicon Endo-Surgery, Inc|CLAMP CARTRIDGE SET|

---

US8777004B2|2010-09-30|2014-07-15|Ethicon Endo-Surgery, Inc.|Compressible staple cartridge comprising alignment members|

---

US8695866B2|2010-10-01|2014-04-15|Ethicon Endo-Surgery, Inc.|Surgical instrument having a power control circuit|

---

EP2627278B1|2010-10-11|2015-03-25|Ecole Polytechnique Fédérale de Lausanne |Mechanical manipulator for surgical instruments|

---

WO2012127309A1|2011-03-21|2012-09-27|Ontorfano Matteo|Disk-based valve apparatus and method for the treatment of valve dysfunction|

---

US9072535B2|2011-05-27|2015-07-07|Ethicon Endo-Surgery, Inc.|Surgical stapling instruments with rotatable staple deployment arrangements|

---

JP5715304B2|2011-07-27|2015-05-07|エコール ポリテクニーク フェデラル デ ローザンヌ （イーピーエフエル）|Mechanical remote control device for remote control|

---

US9044230B2|2012-02-13|2015-06-02|Ethicon Endo-Surgery, Inc.|Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status|

---

MX350846B|2012-03-28|2017-09-22|Ethicon Endo Surgery Inc|Tissue thickness compensator comprising capsules defining a low pressure environment.|

---

US9101358B2|2012-06-15|2015-08-11|Ethicon Endo-Surgery, Inc.|Articulatable surgical instrument comprising a firing drive|

---

US20140001231A1|2012-06-28|2014-01-02|Ethicon Endo-Surgery, Inc.|Firing system lockout arrangements for surgical instruments|

---

RU2636861C2|2012-06-28|2017-11-28|Этикон Эндо-Серджери, Инк.|Blocking of empty cassette with clips|

---

US9364230B2|2012-06-28|2016-06-14|Ethicon Endo-Surgery, Llc|Surgical stapling instruments with rotary joint assemblies|

---

US11197671B2|2012-06-28|2021-12-14|Cilag Gmbh International|Stapling assembly comprising a lockout|

---

US20140005718A1|2012-06-28|2014-01-02|Ethicon Endo-Surgery, Inc.|Multi-functional powered surgical device with external dissection features|

---

US9289256B2|2012-06-28|2016-03-22|Ethicon Endo-Surgery, Llc|Surgical end effectors having angled tissue-contacting surfaces|

---

CN105073055B|2013-02-15|2018-02-06|直观外科手术操作公司|The system and method that near-end for operating theater instruments controls|

---

RU2669463C2|2013-03-01|2018-10-11|Этикон Эндо-Серджери, Инк.|Surgical instrument with soft stop|

---

RU2672520C2|2013-03-01|2018-11-15|Этикон Эндо-Серджери, Инк.|Hingedly turnable surgical instruments with conducting ways for signal transfer|

---

US9687230B2|2013-03-14|2017-06-27|Ethicon Llc|Articulatable surgical instrument comprising a firing drive|

---

US9629629B2|2013-03-14|2017-04-25|Ethicon Endo-Surgey, LLC|Control systems for surgical instruments|

---

EP2968048B1|2013-03-15|2018-06-06|Intuitive Surgical Operations, Inc.|Surgical patient side cart with steering interface|

---

WO2014151744A1|2013-03-15|2014-09-25|Intuitive Surgical Operations, Inc.|Surgical patient side cart with drive system and method of moving a patient side cart|

---

US10136887B2|2013-04-16|2018-11-27|Ethicon Llc|Drive system decoupling arrangement for a surgical instrument|

---

JP5687812B1|2013-06-26|2015-03-25|帝人株式会社|Random mat, fiber reinforced composite material molded body, and carbon fiber mat|

---

US9561103B2|2013-07-17|2017-02-07|Cephea Valve Technologies, Inc.|System and method for cardiac valve repair and replacement|

---

CA2918879A1|2013-07-24|2015-01-29|Centre For Surgical Invention & Innovation|Multi-function mounting interface for an image-guided robotic system and quick release interventional toolset|

---

MX369362B|2013-08-23|2019-11-06|Ethicon Endo Surgery Llc|Firing member retraction devices for powered surgical instruments.|

---

US20150053746A1|2013-08-23|2015-02-26|Ethicon Endo-Surgery, Inc.|Torque optimization for surgical instruments|

---

US9962161B2|2014-02-12|2018-05-08|Ethicon Llc|Deliverable surgical instrument|

---

CN106232029B|2014-02-24|2019-04-12|伊西康内外科有限责任公司|Fastening system including firing member locking piece|

---

US9775608B2|2014-02-24|2017-10-03|Ethicon Llc|Fastening system comprising a firing member lockout|

---

JP6153484B2|2014-02-24|2017-06-28|オリンパス株式会社|Wire drive device and manipulator|

---

JP6278747B2|2014-02-28|2018-02-14|オリンパス株式会社|Manipulator calibration method, manipulator, and manipulator system|

---

US10004497B2|2014-03-26|2018-06-26|Ethicon Llc|Interface systems for use with surgical instruments|

---

US10013049B2|2014-03-26|2018-07-03|Ethicon Llc|Power management through sleep options of segmented circuit and wake up control|

---

US20150272580A1|2014-03-26|2015-10-01|Ethicon Endo-Surgery, Inc.|Verification of number of battery exchanges/procedure count|

---

US11259799B2|2014-03-26|2022-03-01|Cilag Gmbh International|Interface systems for use with surgical instruments|

---

US10561422B2|2014-04-16|2020-02-18|Ethicon Llc|Fastener cartridge comprising deployable tissue engaging members|

---

JP6612256B2|2014-04-16|2019-11-27|エシコンエルエルシー|Fastener cartridge with non-uniform fastener|

---

EP3139843A4|2014-05-05|2018-05-30|Vicarious Surgical Inc.|Virtual reality surgical device|

---

US10045781B2|2014-06-13|2018-08-14|Ethicon Llc|Closure lockout systems for surgical instruments|

---

CA2957362A1|2015-09-04|2017-03-04|Memic Innovative Surgery Ltd.|Actuation of a device comprising mechanical arms|

---

LT3188645T|2014-09-04|2020-07-10|Memic Innovative Surgery Ltd.|Device and system including mechanical arms|

---

US9757128B2|2014-09-05|2017-09-12|Ethicon Llc|Multiple sensors with one sensor affecting a second sensor's output or interpretation|

---

BR112017004361A2|2014-09-05|2017-12-05|Ethicon Llc|medical overcurrent modular power supply|

---

BR112017005981A2|2014-09-26|2017-12-19|Ethicon Llc|surgical staplers and ancillary materials|

---

US9801627B2|2014-09-26|2017-10-31|Ethicon Llc|Fastener cartridge for creating a flexible staple line|

---

US10076325B2|2014-10-13|2018-09-18|Ethicon Llc|Surgical stapling apparatus comprising a tissue stop|

---

US9924944B2|2014-10-16|2018-03-27|Ethicon Llc|Staple cartridge comprising an adjunct material|

---

US11141153B2|2014-10-29|2021-10-12|Cilag Gmbh International|Staple cartridges comprising driver arrangements|

---

US10517594B2|2014-10-29|2019-12-31|Ethicon Llc|Cartridge assemblies for surgical staplers|

---

US9844376B2|2014-11-06|2017-12-19|Ethicon Llc|Staple cartridge comprising a releasable adjunct material|

---

US10456061B2|2014-11-12|2019-10-29|Nico Corporation|Holding arrangement for a surgical access system|

---

US9492273B2|2014-12-09|2016-11-15|Cephea Valve Technologies, Inc.|Replacement cardiac valves and methods of use and manufacture|

---

US10736636B2|2014-12-10|2020-08-11|Ethicon Llc|Articulatable surgical instrument system|

---

US9968355B2|2014-12-18|2018-05-15|Ethicon Llc|Surgical instruments with articulatable end effectors and improved firing beam support arrangements|

---

US9844375B2|2014-12-18|2017-12-19|Ethicon Llc|Drive arrangements for articulatable surgical instruments|

---

US9987000B2|2014-12-18|2018-06-05|Ethicon Llc|Surgical instrument assembly comprising a flexible articulation system|

---

US10188385B2|2014-12-18|2019-01-29|Ethicon Llc|Surgical instrument system comprising lockable systems|

---

US10117649B2|2014-12-18|2018-11-06|Ethicon Llc|Surgical instrument assembly comprising a lockable articulation system|

---

US9844374B2|2014-12-18|2017-12-19|Ethicon Llc|Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member|

---

US10085748B2|2014-12-18|2018-10-02|Ethicon Llc|Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors|

---

US10864049B2|2014-12-19|2020-12-15|Distalmotion Sa|Docking system for mechanical telemanipulator|

---

EP3232974B1|2014-12-19|2018-10-24|DistalMotion SA|Articulated handle for mechanical telemanipulator|

---

US10864052B2|2014-12-19|2020-12-15|Distalmotion Sa|Surgical instrument with articulated end-effector|

---

WO2016097868A1|2014-12-19|2016-06-23|Distalmotion Sa|Reusable surgical instrument for minimally invasive procedures|

---

US11039820B2|2014-12-19|2021-06-22|Distalmotion Sa|Sterile interface for articulated surgical instruments|

---

DE102015100694A1|2015-01-19|2016-07-21|Technische Universität Darmstadt|Teleoperation system with intrinsic haptic feedback through dynamic characteristic adaptation for gripping force and end effector coordinates|

---

GB2534558B|2015-01-21|2020-12-30|Cmr Surgical Ltd|Robot tool retraction|

---

JP6113368B2|2015-02-19|2017-04-12|オリンパス株式会社|Manipulator and manipulator system|

---

US10180463B2|2015-02-27|2019-01-15|Ethicon Llc|Surgical apparatus configured to assess whether a performance parameter of the surgical apparatus is within an acceptable performance band|

---

US10321907B2|2015-02-27|2019-06-18|Ethicon Llc|System for monitoring whether a surgical instrument needs to be serviced|

---

US11154301B2|2015-02-27|2021-10-26|Cilag Gmbh International|Modular stapling assembly|

---

US10226250B2|2015-02-27|2019-03-12|Ethicon Llc|Modular stapling assembly|

---

US10617412B2|2015-03-06|2020-04-14|Ethicon Llc|System for detecting the mis-insertion of a staple cartridge into a surgical stapler|

---

US10687806B2|2015-03-06|2020-06-23|Ethicon Llc|Adaptive tissue compression techniques to adjust closure rates for multiple tissue types|

---

US9924961B2|2015-03-06|2018-03-27|Ethicon Endo-Surgery, Llc|Interactive feedback system for powered surgical instruments|

---

US9808246B2|2015-03-06|2017-11-07|Ethicon Endo-Surgery, Llc|Method of operating a powered surgical instrument|

---

US9993248B2|2015-03-06|2018-06-12|Ethicon Endo-Surgery, Llc|Smart sensors with local signal processing|

---

US10245033B2|2015-03-06|2019-04-02|Ethicon Llc|Surgical instrument comprising a lockable battery housing|

---

US10045776B2|2015-03-06|2018-08-14|Ethicon Llc|Control techniques and sub-processor contained within modular shaft with select control processing from handle|

---

US10441279B2|2015-03-06|2019-10-15|Ethicon Llc|Multiple level thresholds to modify operation of powered surgical instruments|

---

US10548504B2|2015-03-06|2020-02-04|Ethicon Llc|Overlaid multi sensor radio frequencyelectrode system to measure tissue compression|

---

US9901342B2|2015-03-06|2018-02-27|Ethicon Endo-Surgery, Llc|Signal and power communication system positioned on a rotatable shaft|

---

CN113040921A|2015-03-10|2021-06-29|柯惠Lp公司|Measuring health of connector components of a robotic surgical system|

---

US10390825B2|2015-03-31|2019-08-27|Ethicon Llc|Surgical instrument with progressive rotary drive systems|

---

EP3280343A1|2015-04-09|2018-02-14|DistalMotion SA|Mechanical teleoperated device for remote manipulation|

---

EP3294184A4|2015-05-11|2019-05-08|Covidien LP|Coupling instrument drive unit and robotic surgical instrument|

---

US10849746B2|2015-05-14|2020-12-01|Cephea Valve Technologies, Inc.|Cardiac valve delivery devices and systems|

---

EP3294221A4|2015-05-14|2019-01-16|Cephea Valve Technologies, Inc.|Replacement mitral valves|

---

US10178992B2|2015-06-18|2019-01-15|Ethicon Llc|Push/pull articulation drive systems for articulatable surgical instruments|

---

EP3310288A4|2015-06-19|2019-03-06|Covidien LP|Controlling robotic surgical instruments with bidirectional coupling|

---

WO2017006377A1|2015-07-09|2017-01-12|川崎重工業株式会社|Surgical robot|

---

WO2017015167A1|2015-07-17|2017-01-26|Deka Products Limited Partnership|Robotic surgery system, mithod, and appratus|

---

EP3326565A4|2015-07-23|2019-03-27|Olympus Corporation|Input mechanism and medical system|

---

EP3326510A4|2015-07-23|2019-04-17|Olympus Corporation|Manipulator and medical system|

---

US11058425B2|2015-08-17|2021-07-13|Ethicon Llc|Implantable layers for a surgical instrument|

---

US10028744B2|2015-08-26|2018-07-24|Ethicon Llc|Staple cartridge assembly including staple guides|

---

US10786272B2|2015-08-28|2020-09-29|Distalmotion Sa|Surgical instrument with increased actuation force|

---

US10617481B2|2016-03-09|2020-04-14|Memic Innovative Surgey Ltd.|Modular device comprising mechanical arms|

---

US10238386B2|2015-09-23|2019-03-26|Ethicon Llc|Surgical stapler having motor control based on an electrical parameter related to a motor current|

---

US10085751B2|2015-09-23|2018-10-02|Ethicon Llc|Surgical stapler having temperature-based motor control|

---

US10076326B2|2015-09-23|2018-09-18|Ethicon Llc|Surgical stapler having current mirror-based motor control|

---

US10363036B2|2015-09-23|2019-07-30|Ethicon Llc|Surgical stapler having force-based motor control|

---

US10327769B2|2015-09-23|2019-06-25|Ethicon Llc|Surgical stapler having motor control based on a drive system component|

---

US10105139B2|2015-09-23|2018-10-23|Ethicon Llc|Surgical stapler having downstream current-based motor control|

---

US10299878B2|2015-09-25|2019-05-28|Ethicon Llc|Implantable adjunct systems for determining adjunct skew|

---

US10561420B2|2015-09-30|2020-02-18|Ethicon Llc|Tubular absorbable constructs|

---

US10980539B2|2015-09-30|2021-04-20|Ethicon Llc|Implantable adjunct comprising bonded layers|

---

US10285699B2|2015-09-30|2019-05-14|Ethicon Llc|Compressible adjunct|

---

CN108024837B|2015-10-01|2021-03-16|索尼公司|Medical support arm apparatus and medical system|

---

US10292704B2|2015-12-30|2019-05-21|Ethicon Llc|Mechanisms for compensating for battery pack failure in powered surgical instruments|

---

US10368865B2|2015-12-30|2019-08-06|Ethicon Llc|Mechanisms for compensating for drivetrain failure in powered surgical instruments|

---

US10265068B2|2015-12-30|2019-04-23|Ethicon Llc|Surgical instruments with separable motors and motor control circuits|

---

US10413291B2|2016-02-09|2019-09-17|Ethicon Llc|Surgical instrument articulation mechanism with slotted secondary constraint|

---

US11213293B2|2016-02-09|2022-01-04|Cilag Gmbh International|Articulatable surgical instruments with single articulation link arrangements|

---

US10448948B2|2016-02-12|2019-10-22|Ethicon Llc|Mechanisms for compensating for drivetrain failure in powered surgical instruments|

---

US11224426B2|2016-02-12|2022-01-18|Cilag Gmbh International|Mechanisms for compensating for drivetrain failure in powered surgical instruments|

---

US10258331B2|2016-02-12|2019-04-16|Ethicon Llc|Mechanisms for compensating for drivetrain failure in powered surgical instruments|

---

US10973592B2|2017-03-09|2021-04-13|Memie Innovative Surgery Ltd.|Control console for surgical device with mechanical arms|

---

US10617413B2|2016-04-01|2020-04-14|Ethicon Llc|Closure system arrangements for surgical cutting and stapling devices with separate and distinct firing shafts|

---

US10376263B2|2016-04-01|2019-08-13|Ethicon Llc|Anvil modification members for surgical staplers|

---

EP3442432A4|2016-04-14|2019-12-11|TransEnterix Surgical, Inc.|Electromechanical surgical system inlcuding linearly driven instrument roll|

---

US10335145B2|2016-04-15|2019-07-02|Ethicon Llc|Modular surgical instrument with configurable operating mode|

---

US10426467B2|2016-04-15|2019-10-01|Ethicon Llc|Surgical instrument with detection sensors|

---

US10456137B2|2016-04-15|2019-10-29|Ethicon Llc|Staple formation detection mechanisms|

---

US10828028B2|2016-04-15|2020-11-10|Ethicon Llc|Surgical instrument with multiple program responses during a firing motion|

---

US10492783B2|2016-04-15|2019-12-03|Ethicon, Llc|Surgical instrument with improved stop/start control during a firing motion|

---

US11179150B2|2016-04-15|2021-11-23|Cilag Gmbh International|Systems and methods for controlling a surgical stapling and cutting instrument|

---

US10357247B2|2016-04-15|2019-07-23|Ethicon Llc|Surgical instrument with multiple program responses during a firing motion|

---

US10405859B2|2016-04-15|2019-09-10|Ethicon Llc|Surgical instrument with adjustable stop/start control during a firing motion|

---

US10368867B2|2016-04-18|2019-08-06|Ethicon Llc|Surgical instrument comprising a lockout|

---

US11134942B2|2016-12-21|2021-10-05|Cilag Gmbh International|Surgical stapling instruments and staple-forming anvils|

---

US20180168598A1|2016-12-21|2018-06-21|Ethicon Endo-Surgery, Llc|Staple forming pocket arrangements comprising zoned forming surface grooves|

---

JP2020501779A|2016-12-21|2020-01-23|エシコン エルエルシーＥｔｈｉｃｏｎ ＬＬＣ|Surgical stapling system|

---

US10779823B2|2016-12-21|2020-09-22|Ethicon Llc|Firing member pin angle|

---

US20180168608A1|2016-12-21|2018-06-21|Ethicon Endo-Surgery, Llc|Surgical instrument system comprising an end effector lockout and a firing assembly lockout|

---

US20180168625A1|2016-12-21|2018-06-21|Ethicon Endo-Surgery, Llc|Surgical stapling instruments with smart staple cartridges|

---

US10426471B2|2016-12-21|2019-10-01|Ethicon Llc|Surgical instrument with multiple failure response modes|

---

US20180168633A1|2016-12-21|2018-06-21|Ethicon Endo-Surgery, Llc|Surgical stapling instruments and staple-forming anvils|

---

US11179155B2|2016-12-21|2021-11-23|Cilag Gmbh International|Anvil arrangements for surgical staplers|

---

US20180168618A1|2016-12-21|2018-06-21|Ethicon Endo-Surgery, Llc|Surgical stapling systems|

---

US11160551B2|2016-12-21|2021-11-02|Cilag Gmbh International|Articulatable surgical stapling instruments|

---

US10675026B2|2016-12-21|2020-06-09|Ethicon Llc|Methods of stapling tissue|

---

US11191539B2|2016-12-21|2021-12-07|Cilag Gmbh International|Shaft assembly comprising a manually-operable retraction system for use with a motorized surgical instrument system|

---

US10888322B2|2016-12-21|2021-01-12|Ethicon Llc|Surgical instrument comprising a cutting member|

---

US10736629B2|2016-12-21|2020-08-11|Ethicon Llc|Surgical tool assemblies with clutching arrangements for shifting between closure systems with closure stroke reduction features and articulation and firing systems|

---

WO2018136959A1|2017-01-23|2018-07-26|Cephea Valve Technologies, Inc.|Replacement mitral valves|

---

AU2018203053B2|2017-01-23|2020-03-05|Cephea Valve Technologies, Inc.|Replacement mitral valves|

---

US10579961B2|2017-01-26|2020-03-03|Uptake Technologies, Inc.|Method and system of identifying environment features for use in analyzing asset operation|

---

EP3579736A4|2017-02-09|2020-12-23|Vicarious Surgical Inc.|Virtual reality surgical tools system|

---

US10813710B2|2017-03-02|2020-10-27|KindHeart, Inc.|Telerobotic surgery system using minimally invasive surgical tool with variable force scaling and feedback and relayed communications between remote surgeon and surgery station|

---

JP6811676B2|2017-05-01|2021-01-13|株式会社メディカロイド|Drive member, drive mechanism, and manufacturing method of drive mechanism|

---

US11058503B2|2017-05-11|2021-07-13|Distalmotion Sa|Translational instrument interface for surgical robot and surgical robot systems comprising the same|

---

US11071554B2|2017-06-20|2021-07-27|Cilag Gmbh International|Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on magnitude of velocity error measurements|

---

USD879809S1|2017-06-20|2020-03-31|Ethicon Llc|Display panel with changeable graphical user interface|

---

USD879808S1|2017-06-20|2020-03-31|Ethicon Llc|Display panel with graphical user interface|

---

US10881396B2|2017-06-20|2021-01-05|Ethicon Llc|Surgical instrument with variable duration trigger arrangement|

---

US10646220B2|2017-06-20|2020-05-12|Ethicon Llc|Systems and methods for controlling displacement member velocity for a surgical instrument|

---

US10327767B2|2017-06-20|2019-06-25|Ethicon Llc|Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation|

---

US10307170B2|2017-06-20|2019-06-04|Ethicon Llc|Method for closed loop control of motor velocity of a surgical stapling and cutting instrument|

---

US10980537B2|2017-06-20|2021-04-20|Ethicon Llc|Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified number of shaft rotations|

---

US10881399B2|2017-06-20|2021-01-05|Ethicon Llc|Techniques for adaptive control of motor velocity of a surgical stapling and cutting instrument|

---

US10624633B2|2017-06-20|2020-04-21|Ethicon Llc|Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument|

---

US11090046B2|2017-06-20|2021-08-17|Cilag Gmbh International|Systems and methods for controlling displacement member motion of a surgical stapling and cutting instrument|

---

USD890784S1|2017-06-20|2020-07-21|Ethicon Llc|Display panel with changeable graphical user interface|

---

US10813639B2|2017-06-20|2020-10-27|Ethicon Llc|Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on system conditions|

---

US10779820B2|2017-06-20|2020-09-22|Ethicon Llc|Systems and methods for controlling motor speed according to user input for a surgical instrument|

---

US10888321B2|2017-06-20|2021-01-12|Ethicon Llc|Systems and methods for controlling velocity of a displacement member of a surgical stapling and cutting instrument|

---

US10390841B2|2017-06-20|2019-08-27|Ethicon Llc|Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation|

---

US10368864B2|2017-06-20|2019-08-06|Ethicon Llc|Systems and methods for controlling displaying motor velocity for a surgical instrument|

---

US10772629B2|2017-06-27|2020-09-15|Ethicon Llc|Surgical anvil arrangements|

---

US11141154B2|2017-06-27|2021-10-12|Cilag Gmbh International|Surgical end effectors and anvils|

---

US11266405B2|2017-06-27|2022-03-08|Cilag Gmbh International|Surgical anvil manufacturing methods|

---

US10993716B2|2017-06-27|2021-05-04|Ethicon Llc|Surgical anvil arrangements|

---

US10856869B2|2017-06-27|2020-12-08|Ethicon Llc|Surgical anvil arrangements|

---

US10639037B2|2017-06-28|2020-05-05|Ethicon Llc|Surgical instrument with axially movable closure member|

---

USD854151S1|2017-06-28|2019-07-16|Ethicon Llc|Surgical instrument shaft|

---

USD906355S1|2017-06-28|2020-12-29|Ethicon Llc|Display screen or portion thereof with a graphical user interface for a surgical instrument|

---

US20190000474A1|2017-06-28|2019-01-03|Ethicon Llc|Surgical instrument comprising selectively actuatable rotatable couplers|

---

USD869655S1|2017-06-28|2019-12-10|Ethicon Llc|Surgical fastener cartridge|

---

US10716614B2|2017-06-28|2020-07-21|Ethicon Llc|Surgical shaft assemblies with slip ring assemblies with increased contact pressure|

---

US10211586B2|2017-06-28|2019-02-19|Ethicon Llc|Surgical shaft assemblies with watertight housings|

---

US10765427B2|2017-06-28|2020-09-08|Ethicon Llc|Method for articulating a surgical instrument|

---

US11259805B2|2017-06-28|2022-03-01|Cilag Gmbh International|Surgical instrument comprising firing member supports|

---

US11246592B2|2017-06-28|2022-02-15|Cilag Gmbh International|Surgical instrument comprising an articulation system lockable to a frame|

---

US10903685B2|2017-06-28|2021-01-26|Ethicon Llc|Surgical shaft assemblies with slip ring assemblies forming capacitive channels|

---

USD851762S1|2017-06-28|2019-06-18|Ethicon Llc|Anvil|

---

US10398434B2|2017-06-29|2019-09-03|Ethicon Llc|Closed loop velocity control of closure member for robotic surgical instrument|

---

US10898183B2|2017-06-29|2021-01-26|Ethicon Llc|Robotic surgical instrument with closed loop feedback techniques for advancement of closure member during firing|

---

US11007022B2|2017-06-29|2021-05-18|Ethicon Llc|Closed loop velocity control techniques based on sensed tissue parameters for robotic surgical instrument|

---

US10932772B2|2017-06-29|2021-03-02|Ethicon Llc|Methods for closed loop velocity control for robotic surgical instrument|

---

US10258418B2|2017-06-29|2019-04-16|Ethicon Llc|System for controlling articulation forces|

---

AU2018306296B2|2017-07-25|2020-09-24|Cephea Valve Technologies, Inc.|System and method for positioning a heart valve|

---

US10765429B2|2017-09-29|2020-09-08|Ethicon Llc|Systems and methods for providing alerts according to the operational state of a surgical instrument|

---

USD917500S1|2017-09-29|2021-04-27|Ethicon Llc|Display screen or portion thereof with graphical user interface|

---

US10743872B2|2017-09-29|2020-08-18|Ethicon Llc|System and methods for controlling a display of a surgical instrument|

---

US10796471B2|2017-09-29|2020-10-06|Ethicon Llc|Systems and methods of displaying a knife position for a surgical instrument|

---

USD907648S1|2017-09-29|2021-01-12|Ethicon Llc|Display screen or portion thereof with animated graphical user interface|

---

USD907647S1|2017-09-29|2021-01-12|Ethicon Llc|Display screen or portion thereof with animated graphical user interface|

---

US10729501B2|2017-09-29|2020-08-04|Ethicon Llc|Systems and methods for language selection of a surgical instrument|

---

US11134944B2|2017-10-30|2021-10-05|Cilag Gmbh International|Surgical stapler knife motion controls|

---

US11090075B2|2017-10-30|2021-08-17|Cilag Gmbh International|Articulation features for surgical end effector|

---

US10779903B2|2017-10-31|2020-09-22|Ethicon Llc|Positive shaft rotation lock activated by jaw closure|

---

US10842490B2|2017-10-31|2020-11-24|Ethicon Llc|Cartridge body design with force reduction based on firing completion|

---

JP2021502193A|2017-11-13|2021-01-28|ヴィカリアス サージカル インク．|List assembly with virtual reality|

---

CN108013906A|2017-12-01|2018-05-11|微创（上海）医疗机器人有限公司|Snakelike operating theater instruments|

---

US10779825B2|2017-12-15|2020-09-22|Ethicon Llc|Adapters with end effector position sensing and control arrangements for use in connection with electromechanical surgical instruments|

---

US11033267B2|2017-12-15|2021-06-15|Ethicon Llc|Systems and methods of controlling a clamping member firing rate of a surgical instrument|

---

US10687813B2|2017-12-15|2020-06-23|Ethicon Llc|Adapters with firing stroke sensing arrangements for use in connection with electromechanical surgical instruments|

---

US10828033B2|2017-12-15|2020-11-10|Ethicon Llc|Handheld electromechanical surgical instruments with improved motor control arrangements for positioning components of an adapter coupled thereto|

---

US11197670B2|2017-12-15|2021-12-14|Cilag Gmbh International|Surgical end effectors with pivotal jaws configured to touch at their respective distal ends when fully closed|

---

US11006955B2|2017-12-15|2021-05-18|Ethicon Llc|End effectors with positive jaw opening features for use with adapters for electromechanical surgical instruments|

---

US10743874B2|2017-12-15|2020-08-18|Ethicon Llc|Sealed adapters for use with electromechanical surgical instruments|

---

US11071543B2|2017-12-15|2021-07-27|Cilag Gmbh International|Surgical end effectors with clamping assemblies configured to increase jaw aperture ranges|

---

US10779826B2|2017-12-15|2020-09-22|Ethicon Llc|Methods of operating surgical end effectors|

---

US10869666B2|2017-12-15|2020-12-22|Ethicon Llc|Adapters with control systems for controlling multiple motors of an electromechanical surgical instrument|

---

US10743875B2|2017-12-15|2020-08-18|Ethicon Llc|Surgical end effectors with jaw stiffener arrangements configured to permit monitoring of firing member|

---

US10966718B2|2017-12-15|2021-04-06|Ethicon Llc|Dynamic clamping assemblies with improved wear characteristics for use in connection with electromechanical surgical instruments|

---

US11020112B2|2017-12-19|2021-06-01|Ethicon Llc|Surgical tools configured for interchangeable use with different controller interfaces|

---

US11045270B2|2017-12-19|2021-06-29|Cilag Gmbh International|Robotic attachment comprising exterior drive actuator|

---

US10716565B2|2017-12-19|2020-07-21|Ethicon Llc|Surgical instruments with dual articulation drivers|

---

USD910847S1|2017-12-19|2021-02-16|Ethicon Llc|Surgical instrument assembly|

---

US10835330B2|2017-12-19|2020-11-17|Ethicon Llc|Method for determining the position of a rotatable jaw of a surgical instrument attachment assembly|

---

US10729509B2|2017-12-19|2020-08-04|Ethicon Llc|Surgical instrument comprising closure and firing locking mechanism|

---

US11076853B2|2017-12-21|2021-08-03|Cilag Gmbh International|Systems and methods of displaying a knife position during transection for a surgical instrument|

---

US11129680B2|2017-12-21|2021-09-28|Cilag Gmbh International|Surgical instrument comprising a projector|

---

US10743868B2|2017-12-21|2020-08-18|Ethicon Llc|Surgical instrument comprising a pivotable distal head|

---

WO2019155383A1|2018-02-07|2019-08-15|Distalmotion Sa|Surgical robot systems comprising robotic telemanipulators and integrated laparoscopy|

---

US11185376B2|2018-04-09|2021-11-30|Rowan University|Robot for placement of spinal instrumentation|

---

US10912559B2|2018-08-20|2021-02-09|Ethicon Llc|Reinforced deformable anvil tip for surgical stapler anvil|

---

US11253256B2|2018-08-20|2022-02-22|Cilag Gmbh International|Articulatable motor powered surgical instruments with dedicated articulation motor arrangements|

---

US11045192B2|2018-08-20|2021-06-29|Cilag Gmbh International|Fabricating techniques for surgical stapler anvils|

---

US11207065B2|2018-08-20|2021-12-28|Cilag Gmbh International|Method for fabricating surgical stapler anvils|

---

US11083458B2|2018-08-20|2021-08-10|Cilag Gmbh International|Powered surgical instruments with clutching arrangements to convert linear drive motions to rotary drive motions|

---

US10842492B2|2018-08-20|2020-11-24|Ethicon Llc|Powered articulatable surgical instruments with clutching and locking arrangements for linking an articulation drive system to a firing drive system|

---

US11039834B2|2018-08-20|2021-06-22|Cilag Gmbh International|Surgical stapler anvils with staple directing protrusions and tissue stability features|

---

US10779821B2|2018-08-20|2020-09-22|Ethicon Llc|Surgical stapler anvils with tissue stop features configured to avoid tissue pinch|

---

US10856870B2|2018-08-20|2020-12-08|Ethicon Llc|Switching arrangements for motor powered articulatable surgical instruments|

---

USD914878S1|2018-08-20|2021-03-30|Ethicon Llc|Surgical instrument anvil|

---

US11172929B2|2019-03-25|2021-11-16|Cilag Gmbh International|Articulation drive arrangements for surgical systems|

---

US11147551B2|2019-03-25|2021-10-19|Cilag Gmbh International|Firing drive arrangements for surgical systems|

---

US11147553B2|2019-03-25|2021-10-19|Cilag Gmbh International|Firing drive arrangements for surgical systems|

---

US11253254B2|2019-04-30|2022-02-22|Cilag Gmbh International|Shaft rotation actuator on a surgical instrument|

---

US11224497B2|2019-06-28|2022-01-18|Cilag Gmbh International|Surgical systems with multiple RFID tags|

---

US11259803B2|2019-06-28|2022-03-01|Cilag Gmbh International|Surgical stapling system having an information encryption protocol|

---

US11246678B2|2019-06-28|2022-02-15|Cilag Gmbh International|Surgical stapling system having a frangible RFID tag|

---

US11051807B2|2019-06-28|2021-07-06|Cilag Gmbh International|Packaging assembly including a particulate trap|

---

US11241235B2|2019-06-28|2022-02-08|Cilag Gmbh International|Method of using multiple RFID chips with a surgical assembly|

---

US11219455B2|2019-06-28|2022-01-11|Cilag Gmbh International|Surgical instrument including a lockout key|

---

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

---

CN112168306B|2020-11-02|2021-05-14|宋伟|Pneumoperitoneum needle puncture device for laparoscopic surgery|

---

CN113712670A|2021-11-02|2021-11-30|极限人工智能有限公司|Multifunctional channel device and minimally invasive surgery robot|

法律状态:
2018-03-27| B15K| Others concerning applications: alteration of classification|Ipc: A61B 17/29 (2006.01) |

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2018-05-29| B25A| Requested transfer of rights approved|Owner name: GREAT BELIEF INTERNATIONAL LIMITED (VG) |

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2018-12-04| B06F| Objections, documents and/or translations needed after an examination request according [chapter 6.6 patent gazette]|

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2019-12-03| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2021-04-06| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2021-06-15| B16A| Patent or certificate of addition of invention granted|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 04/02/2013, 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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US201261594362P| true| 2012-02-02|2012-02-02|

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US61/594,362|2012-02-02|

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US201261714737P| true| 2012-10-16|2012-10-16|

---

US61/714,737|2012-10-16|

---

PCT/US2013/024679|WO2013116869A1|2012-02-02|2013-02-04|Mechanized multi-instrument surgical system|

---