surgical instrument

专利摘要:
ULTRASONIC SURGICAL INSTRUMENTS WITH TRANSDUCERS LOCATED IN DISTAL POSITION. Various embodiments refer to a surgical instrument comprising an end actuator, an articulating rod, and an ultrasonic transducer assembly. The end actuator may comprise an ultrasonic blade. The pivotable stem may extend proximally from the end actuator along a longitudinal axis, and may comprise a proximal stem member and a distal stem member pivotally coupled to a swivel joint. The ultrasonic transducer assembly may comprise an ultrasonic transducer acoustically coupled to the ultrasonic blade. The ultrasonic transducer assembly can be positioned distally to the swivel joint.
公开号:BR112014032928B1
申请号:R112014032928-1
申请日:2013-06-14
公开日:2022-02-01
发明作者:Gary W. Knight；Richard W. Timm；Timothy G. Dietz
申请人:Ethicon Endo-Surgery, Inc；
IPC主号:

专利说明:

CROSS REFERENCE TO RELATED ORDERS
[0001] The present application relates to the following concurrently filed US patent applications, which are incorporated herein by reference, in their entirety:
[0002] US patent application Serial No., entitled "Haptic Feedback Devices for Surgical Robot", Attorney No. END7042USNP/110388,
[0003] US Patent Application Serial No., entitled "Lockout Mechanism for Use with Robotic Electrosurgical Device", Attorney Document No. END7043USNP/110389,
[0004] US Patent Application Serial No., entitled "Closed Feedback Control for Electrosurgical Device", Attorney Document No. END7044USNP/110390,
[0005] US patent application Serial No. entitled "Surgical Instruments with Articulating Shafts", Attorney Document No. END6423USNP/110392,
[0006] US patent application Serial No., entitled "Surgical Instruments with Articulating Shafts", Attorney Document No. END7047USNP/110394,
[0007] US Patent Application Serial No., entitled "Ultrasonic Surgical Instruments with Distally Positioned Jaw Assemblies", Attorney Document No. END7048USNP/110395,
[0008] US patent application Serial No., entitled "Surgical Instruments with Articulating Shafts", Attorney Document No. END7049USNP/110396,
[0009] US Patent Application Serial No., entitled "Ultrasonic Surgical Instruments with Control Mechanisms", Attorney Document No. END7050USNP/110397, and
[00010] US Patent Application Serial No. entitled "Surgical Instruments With Fluid Management System", Attorney Document No. END7051USNP/110399. BACKGROUND
[00011] Various modalities refer to surgical instruments, including ultrasonic instruments with distally positioned transducers.
[00012] Ultrasonic surgical devices such as ultrasonic scalpels are used in many applications in surgical procedures because of their unique performance characteristics. Depending on specific device configurations and operating parameters, ultrasonic surgical devices can offer substantially simultaneous tissue transection and coagulation homeostasis, desirably minimizing patient trauma. An ultrasonic surgical device comprises a proximally positioned ultrasonic transducer and an instrument coupled to the ultrasonic transducer, with a distally mounted end actuator comprising an ultrasonic blade for cutting and cauterizing tissue. The end actuator is typically attached to a handle and/or robotic surgical implement via a rod. The blade is acoustically coupled to the transducer via a waveguide extending through the shaft. Ultrasonic surgical devices of this nature can be configured for use in open, laparoscopic or endoscopic surgical procedures, including robotically assisted procedures.
[00013] Ultrasonic energy cuts and coagulates tissue using temperatures lower than those used in electrosurgical procedures. Vibrating at high frequencies (eg 55,500 times per second), the ultrasonic blade denatures protein present in tissues to form a sticky clot. The pressure exerted on the tissues by the surface of the blade flattens the blood vessels and allows the clot to form a hemostatic seal. A surgeon can control cutting and clotting speed through the force applied to tissues by the extremity actuator, the time for which the force is applied, and the level of excursion selected for the extremity actuator.
[00014] With regard to both ultrasonic and electrosurgical devices, it is often desirable for clinicians to be able to articulate a distal portion of the instrument shaft in order to direct the application of ultrasonic and/or RF energy. Obtaining and controlling this type of articulation, however, is often a considerable challenge. DRAWINGS
[00015] Aspects of the various modalities are particularly presented in the appended claims. The various modalities, however, as regards both the organization and the methods of operation, together with the advantages thereof, can be better understood with reference to the description given below, considered in conjunction with the attached drawings as follows:
[00016] Figure 1 illustrates an embodiment of a surgical system that includes a surgical instrument and an ultrasonic generator.
[00017] Figure 2 illustrates an embodiment of the surgical instrument shown in Figure 1.
[00018] Figure 3 illustrates an embodiment of an ultrasonic end actuator.
[00019] Figure 4 illustrates another embodiment of an ultrasonic end actuator.
[00020] Figure 5 illustrates an exploded view of an embodiment of the surgical instrument shown in Figure 1.
[00021] Figure 6 illustrates a cutout view of a modality of the surgical instrument shown in Figure 1.
[00022] Figure 7 illustrates various internal components of a modality of the surgical instrument shown in Figure 1
[00023] Figure 8 illustrates a top view of an embodiment of a surgical system that includes a surgical instrument and an ultrasonic generator.
[00024] Figure 9 illustrates an embodiment of a rotation set included in an exemplary embodiment of the surgical instrument of Figure 1.
[00025] Figure 10 illustrates an embodiment of a surgical system that includes a surgical instrument having a single element end actuator.
[00026] Figure 11 illustrates a block diagram of an embodiment of a robotic surgical system.
[00027] Figure 12 illustrates an embodiment of a robotic arm car.
[00028] Figure 13 illustrates an embodiment of the robotic manipulator of the robotic arm car of Figure 12.
[00029] Figure 14 illustrates an embodiment of a robotic arm car with a joint structure of alternative configuration.
[00030] Figure 15 illustrates an embodiment of a controller that can be used in conjunction with a robotic arm car, such as the robotic arm cars of Figures 11 to 14.
[00031] Figure 16 illustrates an embodiment of an ultrasonic surgical instrument adapted for use with a robotic system.
[00032] Figure 25 illustrates an embodiment of an electrosurgical instrument adapted for use with a robotic system.
[00033] Figure 17 illustrates one embodiment of an instrument drive assembly, which can be coupled to a surgical manipulator to receive and control the surgical instrument shown in Figure 16.
[00034] Figure 18 illustrates another view of the actuation assembly modality of the instrument of Figure 26, which includes the surgical instrument of Figure 16.
[00035] Figure 28 illustrates another view of the actuation assembly modality of the instrument of Figure 26, which includes the electrosurgical instrument of Figure 25.
[00036] Figures 19 to 21 illustrate additional views of the adapter portion of the drive assembly mode of the instrument of Figure 26.
[00037] Figures 22 to 24 illustrate an embodiment of the instrument mounting portion of Figure 16, showing components intended to convert motion of driven elements into motion of the surgical instrument.
[00038] Figures 25 to 27 illustrate an alternative embodiment of the instrument mounting portion of Figure 16, showing an alternative example mechanism for converting the rotation of driven elements into rotary motion around the geometric axis of the rod, and an example mechanism alternative to generate reciprocating translation of one or more elements along the geometric axis of the rod.
[00039] Figures 28 to 32 illustrate an alternative embodiment of the instrument mounting portion of Figure 16, showing another alternative exemplary mechanism for converting the rotation of driven elements into rotary motion around the axis of the rod.
[00040] Figures 33 to 36A illustrate an alternative embodiment of the instrument mounting portion, showing an alternative exemplary mechanism for differential translation of elements along the geometric axis of the rod (eg, for articulation).
[00041] Figures 36B to 36C illustrate one embodiment of a tool mounting portion comprising internal sources of power and energy.
[00042] Figure 37 illustrates an embodiment of a articulable surgical instrument, which comprises an ultrasonic transducer assembly located in a distal position.
[00043] Figure 38 illustrates an embodiment of the stem and end actuator of Figure 37, used in conjunction with an instrument mounting portion of a robotic surgical system.
[00044] Figure 39 illustrates a cutaway view of an embodiment of the rod and end actuator of Figures 37 to 38.
[00045] Figures 40 to 40A illustrate a modality for conducting the differential translation of the control elements of Figure 39 in conjunction with a handheld instrument, such as the instrument of Figures 37 to 38.
[00046] Figure 41 illustrates a cutaway view of an embodiment of the ultrasonic transducer assembly of Figures 37 to 38.
[00047] Figure 42 illustrates an embodiment of the ultrasonic transducer and clamp arm assembly of Figures 37 to 38, arranged as part of a four-bar linkage.
[00048] Figure 43 illustrates a side view of an embodiment of the ultrasonic transducer assembly and the clamp arm, arranged as illustrated in Figure 42, coupled to the distal stem portion and in an open position.
[00049] Figure 44 illustrates a side view of an embodiment of the ultrasonic transducer assembly and the clamp arm of Figures 37 to 38, arranged as illustrated in Figure 42, coupled to the distal stem portion and in a closed position.
[00050] Figures 45 to 46 illustrate side views of an embodiment of the ultrasonic transducer assembly and clamp arm of Figures 37 to 38, arranged as illustrated in Figure 42, including proximal portions of the stem.
[00051] Figures 47 to 48 illustrate an embodiment of an end actuator that has a gripper arm and an alternatively shaped ultrasonic blade.
[00052] Figure 49 illustrates an embodiment of another end actuator, which comprises a flexible ultrasonic transducer assembly.
[00053] Figure 50 shows an embodiment of a manual surgical instrument, which has a transducer assembly extending proximally from the hinge joint.
[00054] Figure 51 illustrates an approximation of the transducer assembly, the distal rod portion, the articulated joint and the end actuator, arranged as shown in Figure 50.
[00055] Figure 52 illustrates an embodiment of the hinge joint with the distal stem portion and the proximal stem portion removed to show an exemplary embodiment for articulating the stem and actuation of the yaw member.
[00056] Figure 53 illustrates an embodiment of a manual surgical instrument, which comprises a rod with a pivotable rotary end actuator.
[00057] Figure 54 illustrates an embodiment of the articulation lever of the instrument of Figure 53, coupled to the control elements.
[00058] Figure 55 illustrates an embodiment of the instrument showing a specially shaped connection between the end actuator rotation selector and the center stem element.
[00059] Figure 56 illustrates an embodiment of the rod of Figure 53, focusing on the articulated joint.
[00060] Figure 57 illustrates an embodiment of the central rod element produced from articulated mechanical components.
[00061] Figure 58 illustrates an embodiment of the stem of Figure 53, which comprises a distal stem portion and a proximal stem portion.
[00062] Figure 59 illustrates an embodiment of the rod and end actuator of Figure 53, illustrating a coupling between the inner rod element and the gripper arm.
[00063] Figures 60 to 61 illustrate a control mechanism for a surgical instrument, in which the articulation and rotation of the end actuator 1312 are motorized.
[00064] Figures 62 to 63 illustrate an embodiment of a rod that can be used with any of the various surgical instruments described herein.
[00065] Figure 64 illustrates an embodiment of a rod that can be articulated using a cable and pulley mechanism.
[00066] Figure 65 illustrates an embodiment of the stem of Figure 64, which shows additional details of how the distal stem portion can be pivoted.
[00067] Figure 66 illustrates an embodiment of an end actuator that can be used with any of the various instruments and/or rods described herein.
[00068] Figure 67 illustrates an embodiment of the rod of Figure 64, coupled to an alternate end actuator driven by a pulley.
[00069] Figure 68 illustrates an end actuator embodiment. DESCRIPTION
[00070] The exemplifying modalities described here refer to articulated ultrasonic surgical instruments, their shafts, and methods for using them. In various exemplary embodiments, an ultrasonic instrument comprises an end actuator situated distally, which comprises an ultrasonic blade. The ultrasonic blade can be driven by an ultrasonic transducer set located in a distal position. An instrument stem may comprise proximal and distal stem elements pivotally coupled to one another at a pivot joint. The end actuator may be coupled to a distal portion of the distal stem member so that the end actuator (and at least a portion of the distal stem member) are pivotable about a longitudinal axis of the stem. To facilitate articulation, the distal ultrasonic transducer assembly can be placed partially or completely distal to the articulating joint. In this way, the ultrasonic blade can be acoustically coupled to the ultrasonic transducer assembly, so that neither the ultrasonic blade itself nor any intermediate waveguides span the swivel joint.
[00071] Reference will now be made, in detail, to various modalities, including modalities that show exemplary implementations of manual and robotic surgical instruments with end actuators comprising ultrasonic and/or electrosurgical elements. Whenever possible, similar or similar reference numbers may be used in the figures, and may indicate similar or similar functionality. The figures represent exemplifying modalities of the surgical instruments and/or methods of use presented, for illustrative purposes only. One of skill in the art will readily recognize from the description below that alternative exemplary embodiments of the structures and methods illustrated herein may be used without departing from the principles described herein.
[00072] Figure 1 is a right side view of an embodiment of an ultrasonic surgical instrument 10. In the illustrated embodiment, the ultrasonic surgical instrument 10 can be used in various surgical procedures, including traditional endoscopic or open surgical procedures. In an exemplary embodiment, the ultrasonic surgical instrument 10 comprises a handle assembly 12, an elongated shaft assembly 14 and an ultrasonic transducer 16. The handle assembly 12 comprises a trigger assembly 24, a distal rotation assembly 13 and an 28. The elongated stem assembly 14 comprises an end actuator assembly 26, which comprises elements for dissecting tissue or mutually grasping, cutting and coagulating blood vessels and/or tissue, and actuator elements for actuating the actuator assembly. end 26. Handle assembly 12 is adapted to receive ultrasonic transducer 16 at the proximal end. The ultrasonic transducer 16 is mechanically engaged with the elongated stem assembly 14 and portions of the end actuator assembly 26. The ultrasonic transducer 16 is electrically coupled to a generator 20 via a cable 22. Although most drawings depict a in conjunction with multiple end actuators 26, for use in conjunction with laparoscopic surgical procedures, the ultrasonic surgical instrument 10 can be used in more traditional open surgical procedures and, in other embodiments, can be configured for use in endoscopic procedures. For purposes of the present invention, the ultrasonic surgical instrument 10 is described in terms of an endoscopic instrument, but it is contemplated that an open procedure and/or laparoscopic version of the ultrasonic surgical instrument 10 may also include equal components and operational features. or similar to those described herein.
[00073] In various embodiments, the generator 20 comprises various functional elements, such as modules and/or blocks. Different functional elements or modules can be configured to trigger different types of surgical devices. For example, an ultrasonic generator module 21 can drive an ultrasonic device, such as the ultrasonic surgical instrument 10. In some exemplary embodiments, the generator 20 also comprises an electrosurgery/RF generator module 23 to drive an electrosurgical device (or an ultrasonic surgical instrument electrosurgical instrument 10). In the exemplary embodiment illustrated in Figure 1, the generator 20 includes a control system 25 integral with the generator 20, and a foot switch 29 connected to the generator via a cable 27. The generator 20 may also comprise an activation mechanism. to activate a surgical instrument such as instrument 10. The activation mechanism may include a power switch (not shown) as well as a foot switch 29. When activated by foot switch 29, the generator 20 may provide power to drive the assembly of the surgical instrument 10 and to drive the end actuator 18 at a predetermined level of excursion. Generator 20 drives or excites the acoustic array at any suitable resonant frequency of the acoustic array, and/or derives therapeutic/subtherapeutic electromagnetic or RF energy.
[00074] In one embodiment, the electrosurgical/RF generator module 23 may be implemented as an electrosurgical unit (ESU) capable of providing sufficient power to perform bipolar electrosurgery using radio frequency (RF) energy. In one embodiment, the ESU may be bipolar ERBE ICC 350 equipment, available from ERBE USA, Inc. from Marietta, GA, USA. In bipolar electrosurgery applications, as previously discussed, a surgical instrument with an active electrode and a return electrode may be used, where the active electrode and the return electrode may be positioned against, or adjacent to, the tissue to be treated. , so that current can flow from the active electrode to the return electrode through the tissue. Accordingly, the generator of the electrosurgical/RF module 23 can be configured for therapeutic purposes by applying sufficient electrical energy to the T tissue to treat the tissue (eg, cauterization).
[00075] In one embodiment, the electrosurgical/RF generator module 23 may be configured to provide a sub-therapeutic RF signal to implement a tissue impedance measurement module. In one embodiment, the electrosurgical/RF generator module 23 comprises a bipolar radio frequency generator, as described in more detail below. In one embodiment, the electrosurgical/RF generator module 12 may be configured to monitor the electrical impedance Z of the tissue T, and to control the time and power level characteristics based on the tissue T, via a return electrode disposed over a gripper element of the end actuator assembly 26. Accordingly, the electrosurgical/RF generator module 23 may be configured for sub-therapeutic purposes to measure impedance or other electrical characteristics of T tissue. Techniques and circuit configurations for measurement of impedance or other electrical characteristics of T-tissue are discussed in more detail in Patent Publication assigned to the same applicant US No. 2011/0015631 entitled "Electrosurgical Generator for Ultrasonic Surgical Instrument", the description of which is incorporated herein in its entirety, by way of reference.
[00076] A suitable ultrasonic generator module 21 can be configured to operate functionally similar to the GEN300 equipment available from Ethicon Endo-Surgery, Inc. of Cincinnati, Ohio, USA, as set forth in one or more of the following US patents, all of which are incorporated herein by reference: US Patent No. 6,480,796 (Method for Improving the Start Up of an Ultrasonic System Under Zero Load Conditions), US Patent No. 6,537,291 (Method for Detecting Blade Breakage Using Rate and/or Impedance Information), US Patent No. 6,662,127 (Method for Detecting Presence of a Blade in an Ultrasonic System), US Patent No. 6,977,495 (Detection Circuitry for Surgical Handpiece System), US Patent No. 7,077,853 (Method for Calculating Transducer Capacitance to Determine Transducer Temperature), US Patent No. 7,179,271 (Method for Driving an Ultrasonic System to Improve Acquisition of Blade Resonance Frequency at Startup), and US Patent No. 7,273,483 (Apparatus and Method for Alerting Generator Function in an Ultrasonic Surgical System).
[00077] It should be understood that, in various embodiments, the generator 20 can be configured to operate in various modes. In one mode, the generator 20 may be configured so that the ultrasonic generator module 21 and the electrosurgical/RF generator module 23 may be independently operated.
[00078] For example, the ultrasonic generator module 21 can be activated to apply ultrasonic energy to the end actuator assembly 26 and subsequently therapeutic or sub-therapeutic RF energy can be applied to the end actuator assembly 26 by the generator module electrosurgical/RF 23. As previously discussed, sub-therapeutic electrosurgical/RF energy can be applied to tissue pinched between jaw elements of the end actuator assembly 26 to measure tissue impedance so as to control activation, or modify the activation of the ultrasonic generator module 21. The tissue impedance feedback from the application of sub-therapeutic energy can also be used to activate a therapeutic level of the electrosurgical/RF generator module 23 to cauterize the tissue (eg (e.g. blood vessel) clamped between clamp elements of the end actuator assembly 26.
[00079] In another embodiment, the ultrasonic generator module 21 and the electrosurgical/RF generator module 23 can be activated simultaneously. In one example, the ultrasonic generator module 21 is simultaneously activated with a sub-therapeutic RF energy level to measure tissue impedance while, simultaneously, the ultrasonic blade of the end actuator assembly 26 cuts and coagulates the tissue (or vessel). blood) clamped between the clamp elements of the end actuator assembly 26. This feedback can be used, for example, to modify the drive output of the ultrasonic generator module 21. In another example, the ultrasonic generator module 21 can be driven simultaneously to the electrosurgical/RF generator module 23 so that the ultrasonic blade portion of the end actuator assembly 26 is used to cut the damaged tissue, while electrosurgical/RF energy is applied to electrode portions of the forceps assembly of the end actuator 26 to cauterize the tissue (or blood vessel).
[00080] When generator 20 is activated via the activation mechanism, electrical energy is continuously applied by generator 20 to a stack or array of transducers of the acoustic array. In another embodiment, electrical power is intermittently applied (e.g., pulsed) by generator 20. A phase-sync circuit in generator control system 20 can monitor feedback from the acoustic assembly. The phase synchronized circuit adjusts the frequency of electrical energy sent by generator 20 to match the resonant frequency of the selected longitudinal vibration mode of the acoustic array. Furthermore, a second feedback circuit in the control system 25 maintains the electrical current supplied to the acoustic assembly at a preselected constant level, so as to obtain a substantially constant excursion in the end actuator 18 of the acoustic assembly. In yet another embodiment, a third feedback circuit in control system 25 monitors the impedance between electrodes located on end actuator assembly 26. Although Figures 1 through 9 show a hand-operated ultrasonic surgical instrument, it should be understood that ultrasonic surgical instruments can also be used in robotic applications, for example as described herein, as well as in combinations of manual and robotic applications.
[00081] In the ultrasonic mode of operation, the electrical signal supplied to the acoustic assembly may cause the distal end of the end actuator 18 to vibrate longitudinally in the range of, for example, approximately 20 kHz to 250 kHz. In accordance with various embodiments, the blade 22 may vibrate in the range of about 54 kHz to 56 kHz, for example at about 55.5 kHz. In other embodiments, blade 22 may vibrate at other frequencies including, for example, about 31 kHz or about 80 kHz. The excursion of the blade vibrations can be controlled, for example, by controlling the amplitude of the electrical signal applied to the transducer assembly of the acoustic assembly by the generator 20. As noted above, the activation mechanism of the generator 20 allows a user to activate the generator. 20 so that electrical energy can be supplied continuously or intermittently to the acoustic set. The generator 20 also has an electrical power transmission line for insertion into an electrosurgical unit or a conventional electrical outlet. It is contemplated that the generator 20 may also be powered by a direct current (DC) source, such as a battery. Generator 20 may comprise any suitable generator, such as model #GEN04 and/or model #GEN11, available from Ethicon Endo-Surgery, Inc.
[00082] Figure 2 is a left perspective view of an exemplary embodiment of the ultrasonic surgical instrument 10, showing the handle assembly 12, the distal rotation assembly 13, the elongated stem assembly 14, and the end actuator assembly. 26. In the illustrated embodiment, the elongated stem assembly 14 comprises a distal end 52 sized to mechanically engage the end actuator assembly 26, and a proximal end 50 that mechanically engages the handle assembly 12 and the rotation assembly. 13. The proximal end 50 of the elongated stem assembly 14 is received within the handle assembly 12 and the distal rotation assembly 13. Further details regarding the connections between the elongated stem assembly 14, the grip assembly 12 and the Distal Rotation Assembly 13 are provided in the description of Figures 5 and 7.
[00083] In the illustrated embodiment, the trigger assembly 24 comprises a trigger 32 that works in conjunction with a fixed handle 34. The fixed handle 34 and trigger 32 are ergonomically shaped and adapted to provide a comfortable user interface. The fixed handle 34 is integrally associated with the handle assembly 12. The trigger 32 is able to pivotally move with respect to the fixed handle 34, as explained below in more detail in relation to the operation of the ultrasonic surgical instrument 10. The trigger 32 is able to pivotally move in the direction 33A, towards the fixed handle 34, when the user applies a gripping force against the trigger 32. A spring element 98 (Figure 5) causes the trigger 32 to move in a different direction. articulated form in direction 33B, when the user ceases the gripping force against the trigger 32.
[00084] In an exemplary embodiment, the trigger 32 comprises an elongated trigger hook 36 which defines an opening 38 between the elongated trigger hook 36 and the trigger 32. The opening 38 is suitably sized to receive, therethrough, one or more of the user's fingers. Trigger 32 may also comprise a resilient portion 32a molded onto trigger substrate 32. Overmolded resilient portion 32a is formed to provide a more comfortable contact surface for controlling trigger 32 in an outward direction 33B. In an exemplary embodiment, the overmolded resilient portion 32a may be disposed over a portion of the elongate trigger hook 36. The proximal surface of the elongate trigger hook 32 remains uncoated or coated with a non-resilient substrate to allow the wearer to slide. easily their fingers in and out of aperture 38. In another embodiment, the trigger geometry forms a fully closed loop which defines an aperture suitably sized to receive, therethrough, one or more of the user's fingers. The fully closed loop trigger may also comprise a resilient portion molded onto the trigger substrate.
[00085] In an exemplary embodiment, the fixed wrist 34 comprises a proximal contact surface 40 and a gripping anchor or concave surface 42. The concave surface 42 rests on the membrane of the hand where the thumb and index finger join. The proximal contact surface 40 has a pistol grip contour that receives the palm of the hand in a normal pistol grip, without rings or openings. The profile curve of the proximal contact surface 40 can be contoured to accommodate or receive the palm. A stabilizing tail 44 is located toward a more proximal portion of the wrist assembly 12. The stabilizing tail 44 may be in contact with the uppermost portion of the webbing portion of the hand, located between the thumb and index finger, to stabilize the handle assembly 12 and make it more controllable.
[00086] In an exemplary embodiment, the key assembly 28 may comprise a toggle key 30. The toggle key 30 may be implemented as a single component with a central pivot 304 located within the handle assembly 12 to eliminate the possibility of simultaneous activation. In an exemplary embodiment, the flip switch 30 comprises a first raised knob 30a and a second raised knob 30b for selecting the power setting of the ultrasonic transducer 16 between a minimum power level (e.g. MIN) and a maximum power level ( for example MAX). In another embodiment, the flip-flop can pivot between a conventional setting and a special setting. Special tuning may allow one or more special programs to be implemented by the device. The flip switch 30 rotates about the center pivot as the first raised knob 30a and second raised knob 30b are actuated. The one or more raised buttons, 30a and 30b, are coupled to one or more arms that move through a small arc and cause the electrical contacts to close or open an electrical circuit to electrically energize or de-energize the ultrasonic transducer 16, so according to the activation of the first or second raised buttons, 30a and 30b. Flip-flop 30 is coupled to generator 20 to control activation of ultrasonic transducer 16. Flip-flop 30 comprises one or more electrical power setting switches for activating ultrasonic transducer 16 in order to set one or more power settings for the ultrasonic transducer 16. The forces required to activate flip-flop 30 are directed substantially towards the concave point 42, thus preventing any tendency of the instrument to rotate in the hand when flip-flop 30 is activated.
[00087] In an exemplary embodiment, the first and second raised buttons, 30a and 30b, are located on the distal end of the handle assembly 12, so that they can be easily accessed by the user to activate the power with a repositioning minimal, or substantially zero, grip, which is adequate to maintain control and maintain focused attention on the surgical site (eg, a monitor in a laparoscopic procedure) during activation of the flip-flop 30. The raised buttons, 30a and 30b, may be configured to go around the side of the wrist assembly 12 to a certain extent, to be more easily accessible to varying finger lengths, and to allow greater freedom of access for activation in uncomfortable positions or for fingers. shorter.
[00088] In the illustrated embodiment, the first raised button 30a comprises a plurality of tactile elements 30c, for example textured protrusions or "protrusions" in the illustrated embodiment, to allow the user to differentiate the first raised button 30a from the second raised button 30b. It will be understood by those skilled in the art that various ergonomic features may be incorporated into the wrist assembly 12. These ergonomic features are described in US patent application publication No. 2009/0105750 entitled "Ergonomic Surgical Instruments", which is incorporated herein in its entirety, for reference.
[00089] In an exemplary embodiment, the flip switch 30 can be operated by the user's hand. The user can easily access the first and second raised buttons, 30a and 30b, at any point, while also preventing inadvertent or unintentional activation at any time. The flip switch 30 can be readily operated with a finger to control the power supply to the ultrasonic assembly 16 and/or the ultrasonic assembly 16. For example, the index finger can be used to activate the first contact portion 30a to turn on the 16 ultrasonic assembly at a maximum power level (MAX). The index finger can be used to activate the second contact portion 30b, to turn on the ultrasonic assembly 16 at a minimum power level (MIN). In another embodiment, the flip switch can toggle the instrument 10 between a conventional setting and a special setting. The special setting can allow one or more special programs to be implemented by the instrument 10. The flip-flop 30 can be operated without the user having to look at the first or second raised button, 30a or 30b. For example, the first raised button 30a or the second raised button 30b may comprise a texture or projections for tactilely differentiating between the first and second raised buttons, 30a and 30b, without looking.
[00090] In an exemplary embodiment, the distal rotation assembly 13 is capable of rotating without limitation in any direction about a longitudinal axis "T". The distal rotation assembly 13 is mechanically engaged with the elongated rod assembly 14. The distal rotation assembly 13 is located on a distal end of the handle assembly 12. The distal rotation assembly 13 comprises a cylindrical hub 46 and a rotary knob 48 formed over hub 46. Hub 46 mechanically engages elongate stem assembly 14. Rotary knob 48 may comprise ridged polymeric features, and may be manipulated by a finger (e.g., an index finger) to rotate the stem assembly. 14. Hub 46 may comprise a material molded onto the main frame to form rotary knob 48. Rotary knob 48 may be overmolded to hub 46. Hub 46 comprises a plug portion 46a which is exposed at the distal end. The plug portion 46a of the hub 46 may contact the surface of a trocar during laparoscopic procedures. Hub 46 may be formed of a durable rigid plastic, such as polycarbonate, to alleviate any friction that may occur between the plug portion 46a and the trocar. Rotary knob 48 may comprise "ribs" or ribs formed by raised ribs 48a and concave portions 48b located between ribs 48a to provide a more precise rotational grip. In an exemplary embodiment, rotary knob 48 may comprise a plurality of splines (e.g., three or more splines). In other embodiments, any suitable number of striations may be used. The rotary knob 48 may be formed from a softer polymeric material overmolded to the rigid plastic material. For example, rotary knob 48 can be formed from malleable, resilient and flexible polymeric materials, including Versaflex® TPE alloys, available from GLS Corporation, for example. This softer overmolded material can provide a better grip and more precise control of the movement of the rotary knob 48. It should be understood that any materials that offer adequate strength for sterilization, are biocompatible, and provide adequate frictional resistance to surgical gloves can be used to form the rotary knob 48.
[00091] In an exemplary embodiment, the handle assembly 12 is formed from two (2) casing portions, or shells, comprising a first portion 12a and a second portion 12b. From the perspective of a user viewing the wrist assembly 12 from the distal end and toward the proximal end, the first portion 12a is considered the right portion, and the second portion 12b is considered the left portion. Each of the first and second portions, 12a and 12b, includes a plurality of interfaces 69 (Figure 5) sized to align and mechanically engage each other to form the handle assembly 12 and contain the internal functional components of the handle. same. Fixed handle 34, which is integrally associated with handle assembly 12, takes shape by assembling the first and second portions 12a and 12b of handle assembly 12. A plurality of additional interfaces (not shown) may be arranged at various points. around the periphery of the first and second portions, 12a and 12b, of the handle assembly 12, for ultrasonic welding purposes, e.g., power steering/deflection points. The first and second portions, 12a and 12b (as well as the other components described below) can be assembled together in any manner known in the art. For example, alignment pins, snap-fit interfaces, tongue and groove interfaces, locking tabs and adhesive doors can all be used, alone or in combination, for mounting purposes.
[00092] In an exemplary embodiment, the elongate rod assembly 14 comprises a proximal end 50 adapted to mechanically engage the handle assembly 12 and distal rotation assembly 13, and a distal end 52 adapted to engage mechanically to the end actuator assembly 26. The elongated stem assembly 14 comprises an outer tubular sheath 56 and a reciprocating tubular actuator member 58 located within the outer tubular sheath 56. The proximal end of the reciprocating tubular actuator member 58 is mechanically engaged with the trigger 32 of handle assembly 12 to move in direction 60A or 60B in response to actuation and/or release of trigger 32. Pivoting movable trigger 32 can generate reciprocating motion along longitudinal axis "T". This movement can be used, for example, to drive the jaws or the clamping mechanism of the end actuator assembly 26. A series of articulations convert the pivotal rotation of the trigger 32 into axial movement of a rocker arm coupled to an actuation mechanism, which controls the opening and closing of the jaws of the clamping mechanism of the end actuator assembly 26. The distal end of the reciprocating tubular actuator element 58 is mechanically engaged with the end actuator assembly 26. In the illustrated embodiment, a distal end of the actuator element The reciprocating tube 58 is mechanically engaged with a gripper arm assembly 64, which is pivotable about a pivot point 70, to open and close the gripper arm assembly 64 in response to actuation and/or release of trigger 32. For example, in the illustrated embodiment, the gripper arm assembly 64 is capable of moving in the direction 62A from an open position to a closed position. a, around a pivot point 70, when the trigger 32 is pulled in the direction 33A. Gripper arm assembly 64 is capable of moving in direction 62B from a closed position to an open position around pivot point 70 when trigger 32 is released or pushed out in direction 33B.
[00093] In an exemplary embodiment, the end actuator assembly 26 is connected to the distal end 52 of the elongate rod assembly 14 and includes a gripper arm assembly 64 and a blade 66. End actuator 26 are formed by gripper arm assembly 64 and blade 66. Blade 66 is ultrasonic actuated, and is acoustically coupled to ultrasonic transducer 16. Trigger 32 on handle assembly 12 is ultimately connected to a drive assembly, with which it mechanically cooperates to obtain movement of the gripper arm assembly 64. Squeezing the trigger 32 in the direction 33A moves the gripper arm assembly 64 in the direction 62A from an open position, in which the gripper assembly tweezers arm 64 and blade 66 are arranged in spaced relationship to each other for a pinched or closed position in which the tweezer arm assembly 64 and blade 66 cooperate to grip tissue between the themselves. The gripper arm assembly 64 may comprise a gripper block 69 for gripping the tissue between the blade 66 and the gripper arm 64. Releasing the trigger 32 in the 33B direction moves the gripper arm assembly 64 in the 62B direction. a closed relationship to an open position, in which the gripper arm assembly 64 and blade 66 are arranged in spaced relationship with respect to each other.
[00094] The proximal portion of the wrist assembly 12 comprises a proximal opening 68 for receiving a distal end of the ultrasonic assembly 16. The ultrasonic assembly 16 is inserted into the proximal opening 68, and is mechanically engaged with the elongated rod assembly 14.
[00095] In an exemplary embodiment, the elongated trigger hook portion 36 of the trigger 32 provides a longer trigger lever with a shorter extension and rotation stroke. The longer lever of the elongated trigger hook 36 allows the user to employ multiple fingers within the opening 38 to operate the elongated trigger hook 36 and cause the trigger 32 to revolve in the direction 33B to open the jaws of the trigger assembly. end 26. For example, user can insert three fingers (e.g., middle, ring and little fingers) into opening 38. Use of multiple fingers allows the surgeon to exert greater entry forces on trigger 32 and trigger hook 326 to activate the end actuator assembly 26. The shorter extension and rotation stroke creates a more comfortable grip when closing or squeezing trigger 32 in direction 33A, or when opening trigger 32 in the opening motion. outward in the 33B direction, lessening the need to extend the fingers further out. This substantially decreases hand fatigue and strain associated with the outward opening movement of trigger 32 in direction 33B. The outward movement of the trigger may be spring-assisted by spring element 98 (Figure 5) to help alleviate fatigue. The force of the opening spring is sufficient to aid in ease of opening, but not strong enough to adversely affect the tactile feedback of tissue tension during dissection propagation.
[00096] For example, during a surgical procedure, the index finger may be used to control the rotation of the elongated stem assembly 14 so as to position the jaws of the end actuator assembly 26 in a proper orientation. The middle finger and/or the other smaller fingers can be used to squeeze the trigger 32 and clamp the tissue between the jaws. Once the jaws are situated in the desired position and the tissue has been pinched, the index finger can be used to activate the flip switch 30 in order to adjust the energy level of the ultrasonic transducer 16 to treat the tissue. Once the tissue has been treated, the user can release the trigger 32 by pushing outward in the distal direction against the elongated trigger hook 36 with the middle finger and/or smaller fingers to open the jaws of the actuator assembly. 26. This basic procedure can be performed without the user having to adjust their grip on the wrist assembly 12.
[00097] Figures 3 to 4 illustrate the connection of the elongated rod assembly 14 to the end actuator assembly 26. As previously described, in the illustrated embodiment the end actuator assembly 26 comprises a gripper arm assembly 64 and a blade 66 for forming the jaws of the clamping mechanism. Blade 66 may be an ultrasonic actuatable blade, acoustically coupled to ultrasonic transducer 16. Trigger 32 is mechanically connected to a drive assembly. Together, the trigger 32 and actuation assembly mechanically cooperate to move the gripper arm assembly 64 to an open position in the direction 62A, wherein the gripper arm assembly 64 and blade 66 are arranged in spaced apart relationship with respect to each other. to the other, and into a pinched or closed position in direction 62B, wherein the pinch arm assembly 64 and blade 66 cooperate to secure tissue therebetween. The gripper arm assembly 64 may comprise a gripper block 69 for gripping tissue between the blade 66 and the gripper arm 64. The distal end of the reciprocating tubular actuator member 58 is mechanically engaged with the end actuator assembly 26. In the illustrated embodiment, a distal end of the reciprocating tubular actuator member 58 is mechanically engaged with the gripper arm assembly 64, which is pivotable about the pivot point 70, to open and close the gripper arm assembly 64 in response to actuation and /or release of trigger 32. For example, in the illustrated embodiment, the gripper arm assembly 64 is capable of moving from an open position to a closed position in the direction 62B, around a pivot point 70, when the trigger 32 is pulled in direction 33A. The gripper arm assembly 64 is capable of moving from a closed position to an open position in direction 62A, around pivot point 70, when trigger 32 is released or pushed out in direction 33B.
[00098] As previously discussed, the clamp arm assembly 64 may comprise electrodes electrically coupled to the electrosurgical/RF generator module 23 to receive therapeutic and/or subtherapeutic energy, wherein electrosurgical/RF energy can be applied to the electrodes, either simultaneously or non-simultaneously, with the ultrasonic energy being applied to the blade 66. These energy activations can be applied in any suitable combinations to obtain a desired effect on the tissue, in cooperation with an algorithm or other control logic. .
[00099] Figure 5 is an exploded view of the ultrasonic surgical instrument 10 shown in Figure 2. In the illustrated embodiment, the exploded view shows the internal elements of the wrist assembly 12, the wrist assembly 12, the distal rotation assembly 13, the key assembly 28, and the elongate shank assembly 14. In the illustrated embodiment, the first and second portions, 12a and 12b, mate to form the handle assembly 12. Each of the first and second portions, 12a and 12b, comprises a plurality of interfaces 69 sized to align and mechanically engage each other to form the handle assembly 12 and contain the internal functional components of the ultrasonic surgical instrument 10. The rotary knob 48 is mechanically engaged with the outer tubular sheath. 56, so that it can be rotated in the circular direction 54 up to 360°. Outer tubular sheath 56 is located over reciprocating tubular actuator member 58 which is mechanically engaged with and retained within handle assembly 12 by a plurality of coupler elements 72. Coupler elements 72 may comprise a ring seal 72a, a tube collar cap 72b, a distal washer 72c, a proximal washer 72d and a threaded tube collar 72e. The reciprocating tubular actuator member 58 is located within a reciprocating rocker arm 84 which is retained between the first and second portions 12a and 12b of the handle assembly 12. Rocker arm 84 forms part of a reciprocating rocker arm assembly 88 A series of articulations convert the pivotal rotation of the elongated trigger hook 32 into the axial movement of the reciprocating rocker 84, which controls the opening and closing of the jaws of the end actuator assembly clamping mechanism 26 at the distal end of the ultrasonic surgical instrument. 10. In an exemplary embodiment, a four-link design offers mechanical advantage over a relatively short span of rotation, for example.
[000100] In an exemplary embodiment, an ultrasonic transmission waveguide 78 is disposed within the reciprocating tubular actuator element 58. The distal end 52 of the ultrasonic transmission waveguide 78 is acoustically coupled (e.g., directly or indirectly mechanically coupled ) to the blade 66, and the proximal end 50 of the ultrasonic transmitting waveguide 78 is received within the handle assembly 12. The proximal end 50 of the ultrasonic transmitting waveguide 78 is adapted to acoustically mate with the distal end. of the ultrasonic transducer 16, as discussed in more detail below. The ultrasonic transmission waveguide 78 is isolated from the other elements of the elongate rod assembly 14 by means of a protective sheath 80 and a plurality of insulating elements 82, such as silicone rings. The outer tubular sheath 56, the reciprocating tubular actuator element 58 and the ultrasonic transmission waveguide 78 are mechanically engaged by a pin 74. The key assembly 28 comprises the flip switch 30 and electrical elements 86a,b for electrically energizing the transducer ultrasonic 16, according to the activation of the first or second raised buttons, 30a or 30b.
[000101] In an exemplary embodiment, the outer tubular sheath 56 isolates the user or patient from the ultrasonic vibrations of the ultrasonic transmission waveguide 78. The outer tubular sheath 56 generally includes a hub 76. The outer tubular sheath 56 is threaded onto the distal end of the wrist assembly 12. The ultrasonic transmission waveguide 78 extends through the opening of the outer tubular sheath 56, and the insulating elements 82 insulate the ultrasonic transmitting waveguide 24 from the outer tubular sheath 56. The sheath outer tube 56 may be attached to waveguide 78 with pin 74. The hole for receiving pin 74 in waveguide 78 may nominally occur at a displacement node. The waveguide 78 can be threaded or fitted into the handle assembly 12 of the handle by means of a captive screw. Flat portions on hub 76 may allow the assembly to be torqued to a required level. In an exemplary embodiment, the hub portion 76 of the outer tubular sheath 56 is preferably constructed of plastic, and the tubular elongate portion of the outer tubular sheath 56 is made of stainless steel. Alternatively, the ultrasonic transmitting waveguide 78 may comprise polymeric material surrounding it for isolation against external contact.
[000102] In an exemplary embodiment, the distal end of the ultrasonic transmission waveguide 78 may be coupled to the proximal end of the blade 66 by an internal threaded connection, preferably at or near an antinode. It is contemplated that the blade 66 may be attached to the ultrasonic transmission waveguide 78 by any suitable means, such as a welded joint or the like. While blade 66 may be removable from ultrasonic transmission waveguide 78, it is also contemplated that the single element end actuator (e.g. blade 66) and ultrasonic transmission waveguide 78 may be formed as one. single unitary part.
[000103] In an exemplary embodiment, the trigger 32 is coupled to a hinge mechanism to convert the pivotal movement of the trigger 32, in directions 33A and 33B, into the linear movement of the reciprocating tubular actuator element 58, in the corresponding directions 60A and 60B. Trigger 32 comprises a first set of flanges 98 with openings formed therein to receive a first rocker pin 92a. The first rocker pin 92a is also positioned through a set of openings formed in the distal end of the rocker arm 84. The trigger 32 also comprises a second set of flanges 96 for receiving a first end 92a of a link 92. Trigger pin 90 is received in openings formed in link 92 and second set of flanges 96. Trigger pin 90 is received in openings formed in link 92 and second set of flanges 96, and is adapted to be coupled to first and second portions 12a and 12b of handle assembly 12 to form a pivot point for trigger 32. A second end 92b of link 92 is received in a slot 384 formed at a proximal end of rocker arm 84, and is retained in inside by a second rocker pin 94b. As trigger 32 is pivotally pivoted about pivot point 190 formed by trigger pin 90, rocker arm translates horizontally along longitudinal axis "T" in a direction indicated by arrows 60A,B.
[000104] Figure 8 illustrates an exemplary embodiment of an ultrasonic surgical instrument 10. In the illustrated embodiment, a cross-sectional view of the ultrasonic transducer 16 is shown within a partial cutaway view of the wrist assembly 12. An exemplary embodiment of the ultrasonic surgical instrument 10 comprises the ultrasonic signal generator 20 coupled to the ultrasonic transducer 16, comprising a handle housing 99 and an end actuator assembly 26 with one or more ultrasonic actuatable elements. As previously discussed, the end actuator assembly 26 comprises the ultrasound actuatable blade 66 and the gripper arm 64. The ultrasonic transducer 16, which is known as a "stack of Langevin", generally includes a transduction portion 100 , a first resonator or hind bell portion 102, and a second resonator or fore bell portion 104, as well as auxiliary components. The total construction of these components consists of a resonator. The ultrasonic transducer 16 is preferably the length of an integral number of half the wavelengths of the system (nA/2, where "n" is any positive integer, e.g. n = 1, 2, 3.. .), as will be described in more detail later in this document. An acoustic assembly 106 includes the ultrasonic transducer 16, a nose cone 108, a speed transformer 118 and a surface 110.
[000105] In an exemplary embodiment, the distal end of the hind bell 102 is connected to the proximal end of the transducing portion 100, and the proximal end of the fore bell 104 is connected to the distal end of the transducing portion 100. The fore bell 104 and The hind bell 102 has a length determined by a number of variables, including a thickness of the transducing portion 100, the density and modulus of elasticity of the material used to manufacture the hind bell 102 and the fore bell 22, and the frequency of resonance of the ultrasonic transducer 16. The anterior bell 104 may be tapered inwardly from its proximal end to its distal end to amplify the amplitude of the ultrasonic vibration like the speed transformer 118 or alternatively may have no amplification at all. A suitable vibrational frequency range may be around 20 Hz to 32 kHz, and a well-suited vibrational frequency range may be around 30 to 10 kHz. A suitable operating vibrational frequency might be approximately 55.5 kHz, for example.
[000106] In an exemplary embodiment, the piezoelectric elements 112 may be manufactured from any suitable material such as, for example, lead zirconate-titanate, lead methaniobate, lead titanate, barium titanate or other piezoelectric ceramic material. . Each of the positive electrodes 114, negative electrodes 116 and piezoelectric elements 112 have a hole extending through the center. Positive and negative electrodes 114 and 116 are electrically coupled to wires 120 and 122, respectively. Wires 120 and 122 are enclosed within cable 22 and are electrically connectable to ultrasonic signal generator 20.
[000107] The ultrasonic transducer 16 of the acoustic assembly 106 converts the electrical signal from the ultrasonic signal generator 20 into mechanical energy that primarily results in a standing acoustic wave of longitudinal vibratory motion from the ultrasonic transducer 16 and the blade portion 66 of the assembly of 26 end actuator at ultrasonic frequencies. In another embodiment, the vibrating motion of the ultrasonic transducer may act in a different direction. For example, the vibratory motion may comprise a local longitudinal component with a more complex motion of the tip of the elongated rod assembly 14. A suitable generator is available under model number GEN11 from Ethicon Endo-Surgery, Inc., of Cincinnati, Ohio, USA. When the acoustic assembly 106 is energized, a standing wave of vibratory motion is generated therethrough. The ultrasonic surgical instrument 10 is designed to operate at a resonance such that an acoustic standing wave pattern of predetermined amplitude is produced. The amplitude of the vibratory motion at any point along the acoustic array 106 depends on the location along the acoustic array 106 at which the vibratory motion is measured. A passage through a minimum or zero value in the standing wave of vibrating motion is usually called a node (i.e. where motion is minimal), and a maximum or peak of local absolute value in the standing wave is usually called an antinode (e.g. , where the local movement is maximum). The distance between an anti-node and its nearest node is one-quarter of the wavelength (A/4).
[000108] The wires 120 and 122 transmit an electrical signal from the ultrasonic signal generator 20 to the positive electrodes 114 and negative electrodes 116. The piezoelectric elements 112 are energized by the electrical signal provided from the ultrasonic signal generator 20 in response to a actuator 224, such as a foot switch, for example, to produce an acoustic standing wave in the acoustic assembly 106. The electrical signal causes disturbances in the piezoelectric elements 112 in the form of small repeated displacements, resulting in large alternating compression and tension forces. inside the material. The repeated small displacements cause the piezoelectric elements 112 to continuously expand and contract along the geometric axis of the voltage gradient, producing longitudinal waves of ultrasonic energy. The ultrasonic energy is transmitted through the acoustic assembly 106 to the blade portion 66 of the end actuator assembly 26 via a transmission component or an ultrasonic transmitting waveguide portion 78 of the elongate stem assembly 14.
[000109] In an exemplary embodiment, in order for the acoustic assembly 106 to supply power to the blade portion 66 of the end actuator assembly 26, all components of the acoustic assembly 106 must be acoustically coupled to the blade 66. The distal end of the ultrasonic transducer 16 may be acoustically coupled, on surface 110, to the proximal end of ultrasonic transmission waveguide 78 via a threaded connection, such as a stud 124.
[000110] In an exemplary embodiment, the components of the acoustic array 106 are preferably acoustically tuned so that the length of any array is an integer of half the wavelengths (nΔ/2), where the length of wave A is the wavelength of a preselected or functional longitudinal vibration drive frequency fd of the acoustic assembly 106. It is also contemplated that the acoustic assembly 106 may incorporate any suitable arrangement of acoustic elements.
[000111] In an exemplary embodiment, the blade 66 may have a length substantially equal to an integral multiple of half the wavelengths of the system (nΔ/2). A distal end of blade 66 may be disposed adjacent an antinode to provide maximum longitudinal excursion of the distal end. When the transducer assembly is energized, the distal end of blade 66 can be configured to move in the range of, for example, approximately 10 to 500 microns from peak to peak, and preferably in the range of about 30 to 64 microns. at a predetermined vibrational frequency of 55 kHz, for example.
[000112] In an exemplary embodiment, the blade 66 may be coupled to the ultrasonic transmission waveguide 78. The blade 66 and the ultrasonic transmission waveguide 78, as illustrated, are formed as a single unit construction from a material suitable for transmitting ultrasonic energy. Examples of such materials include Ti6Al4V (a titanium alloy that includes aluminum and vanadium), aluminum, stainless steel or other suitable materials. Alternatively, the blade 66 may be separable (and of different composition) from the ultrasonic transmission waveguide 78, and be coupled, for example, by a stud, solder, glue, quick connect, or other suitable known methods. The length of the ultrasonic transmitting waveguide 78 may be substantially equal to an integral number of half the wavelengths (nδ/2), for example. The ultrasonic transmission waveguide 78 may preferably be manufactured from a solid core rod constructed of material suitable for efficient propagation of ultrasonic energy, such as the titanium alloy discussed above (i.e., Ti6Al4V) or any alloy suitable aluminum, or other alloys, for example.
[000113] In an exemplary embodiment, the ultrasonic transmission waveguide 78 comprises an attachment column projecting longitudinally at a proximal end, to be coupled to the surface 110 of the ultrasonic transmission waveguide 78 by means of a threaded connection. , such as stud 124. Ultrasonic transmission waveguide 78 may include a plurality of stabilizing silicone rings or compatible supports 82 (Figure 5) positioned at a plurality of nodes. Silicone rings 82 dampen unwanted vibration and isolate ultrasonic energy from an outer protective sheath 80 (Figure 5), ensuring ultrasonic energy flow in a longitudinal direction to the distal end of blade 66 at maximum efficiency.
[000114] Figure 9 illustrates an exemplary embodiment of the proximal rotation assembly 128. In the illustrated embodiment, the proximal rotation assembly 128 comprises the proximal rotary knob 134 inserted over the cylindrical hub 135. The proximal rotary knob 134 comprises a plurality of projections radial lugs 138 which are received in corresponding slots 130 formed on a proximal end of cylindrical hub 135. Proximal rotary knob 134 defines an opening 142 for receiving the distal end of ultrasonic transducer 16. Radial projections 138 are formed of a flexible polymeric material and define a diameter that is undersized with respect to the outer diameter of the ultrasonic transducer 16 to create a frictional interference fit with the distal end of the ultrasonic transducer 16. The polymeric radial projections 138 project radially into the opening 142 to form "snap-in" ribs that securely hold the outer casing of the ultrasonic transducer 16. Therefore, the proximal rotary knob 134 securely holds the ultrasonic transducer 16.
[000115] The distal end of the cylindrical hub 135 comprises a circumferential shoulder 132 and a circumferential bearing surface 140. The circumferential flange engages a groove formed in the housing 12, and the circumferential bearing surface 140 engages the housing 12. Therefrom In this way, the cylindrical hub 135 is mechanically retained within the two shell portions (not shown) of the shell 12. The circumferential rim 132 of the cylindrical hub 135 is located or "trapped" between the first and second shell portions, 12a and 12b, and is free to rotate in place within the groove. The circumferential bearing surface 140 rests against internal portions of the housing to aid in proper rotation. In this way, the cylindrical hub 135 is free to rotate in place within the housing. The user interacts with the splines 136 formed on the proximal rotary knob 134 with a finger or thumb to rotate the cylindrical hub 135 within the housing 12.
[000116] In an exemplary embodiment, the cylindrical hub 135 may be formed of a durable plastic, such as polycarbonate. In an exemplary embodiment, the cylindrical hub 135 may be formed from a siliconized polycarbonate material. In an exemplary embodiment, the proximal rotary knob 134 may be formed from malleable, resilient, and flexible polymeric materials, including Versaflex® TPE alloys, available from GLS Corporation. Proximal rotary knob 134 may be formed from elastomeric materials, thermoplastic rubber known as Santoprene®, other thermoplastic vulcanizates (TPVs) or elastomers, for example. The modalities, however, are not limited in this context.
[000117] Figure 10 illustrates an exemplary embodiment of a surgical system 200 that includes a surgical instrument 210 with single element end actuator 278. System 200 may include a transducer assembly 216 coupled to end actuator 278 and a sheath 256 positioned around the proximal portions of the end actuator 278 as shown. Transducer assembly 216 and end actuator 278 may function in a manner similar to that of transducer assembly 16 and end actuator 18 described above to produce ultrasonic energy which can be transmitted to tissue via blade 226'.
[000118] Over the years, a variety of minimally invasive (or "tele-surgical") robotic systems have been developed to increase surgical dexterity, as well as to allow a surgeon to operate on a patient intuitively. Robotic surgical systems can be used with many different types of surgical instruments including, for example, ultrasonic instruments as described herein. Exemplary robotic systems include those produced by Intuitive Surgical, Inc., of Sunnyvale, California, USA. These systems, as well as robotic systems available from other manufacturers, are disclosed in the following US patents, each of which is incorporated herein by reference in their entirety: US Patent No. 5,792,135 entitled "Articulated Surgical Instrument For Performing Minimally Invasive Surgery With Enhanced Dexterity and Sensitivity", US Patent No. 6,231,565, entitled "Robotic Arm DLUs For Performing Surgical Tasks", US Patent No. 6,783,524, entitled "Robotic Surgical Tool With Ultrasound Cauterizing and Cutting Instrument", US Patent No. 6,364,888, entitled "Alignment of Master and Slave In a Minimally Invasive Surgical Apparatus", US Patent No. 7,524,320, entitled "Mechanical Actuator Interface System For Robotic Surgical Tools", US Patent No. 7,691,098 entitled "Platform Link Wrist Mechanism", US Patent No. 7,806,891, entitled "Repositioning and Reorientation of Master/Slave Relationship in Minimally Invasive Telesurgery", and patent US No. 7,824,401 entitled "Surgical Tool With Wristed Monopolar Electrosurgical End Effectors". Many of these systems, however, have in the past failed to generate the magnitude of forces needed to effectively cut and join tissue.
[000119] Figures 11 to 26 illustrate the exemplary modalities of robotic surgical systems. In some embodiments, the robotic surgical systems shown may use the ultrasonic or electrosurgical instruments described herein. Those skilled in the art will understand that the robotic surgical systems illustrated are not limited to only those instruments described herein, and may use any compatible surgical instruments. Those skilled in the art will further understand that while various modalities described herein can be used with the robotic surgical systems described, the description is not limited thereto, and can be used with any compatible robotic surgical system.
[000120] Figures 11 to 16 illustrate the structure and operation of various exemplary robotic surgical systems, and their components. Figure 11 shows a block diagram of an exemplary robotic surgical system 1000. The system 1000 comprises at least one controller 508 and at least one arm carriage 510. The arm carriage 510 may be mechanically coupled to one or more manipulators or arms. robotic arms, indicated by box 512. Each of the robotic arms 512 may comprise one or more surgical instruments 514 for performing various surgical tasks on a patient 504. Operation of the arm carriage 510, including arms 512 and instruments 514, may be controlled by a physician 502 from a controller 508. In some embodiments, a second controller 508', operated by a second physician 502', may also command the operation of the arm carriage 510, in conjunction with the first physician 502'. For example, each of the doctors, 502 and 502', can control different arms 512 of the car, or in some cases, full car control of the arm 510 can be passed between the doctors, 502 and 502'. In some embodiments, additional arm cars (not shown) can be used on patient 504. These additional arm cars can be controlled by one or more of the controllers, 508 and 508'. The one or more arm carriages 510 and controllers, 508 and 508', may be in communication with each other via a communication link 516, which may be any suitable type of wired or wireless communication link, carrying any suitable signal type (eg electrical, optical, infrared, etc.) in accordance with any suitable communication protocol. Exemplary implementations of robotic surgical systems, such as the 1000 system, are disclosed in US Patent No. 7,524,320, which is incorporated herein by reference. Accordingly, various details of these devices will not be described in detail in this document beyond what may be necessary to understand various embodiments of the claimed device.
[000121] Figure 12 shows an exemplary embodiment of a robotic arm carriage 520. The robotic arm carriage 520 is configured to drive a plurality of surgical instruments, or instruments, generically designated as 522 within a working envelope 519. Various robotic surgery systems and methods employing master controller and robotic arm carriage arrangements are disclosed in US Patent No. 6,132,368, entitled "Multi-Component Telepresence System and Method", the disclosure of which is incorporated in its entirety by reference. In various forms, the robotic arm carriage 520 includes a base 524 from which, in the illustrated embodiment, three surgical instruments 522 are supported. In various forms, each of the surgical instruments 522 is supported by a series of manually pivotable joints, generically referred to as configuration joints 526, and a robotic manipulator 528. These structures are illustrated in the present invention with protective covers that extend over much of the robotic joint. These protective covers may be optional, and may be limited in size or entirely eliminated in some embodiments to minimize the inertia that is encountered by the servomechanisms used to manipulate such devices, to limit the volume of moving components for the purpose of collision avoidance, and to limit the total weight of the carriage 520. The carriage 520 is generally of adequate dimensions for its transport between operating rooms. Cart 520 can be configured to typically fit operating room doors and conventional hospital elevators. In various forms, carriage 520 would preferably have a weight and would include a wheel system (or other transport) that allows carriage 520 to be positioned adjacent to an operating table by a single attendant.
[000122] Figure 13 shows an exemplary embodiment of the robotic manipulator 528 of the robotic arm carriage 520. In the example shown in Figure 13, the robotic manipulators 528 may include a hinge 530 that restricts the movement of the surgical instrument 522. In various embodiments, hinge 530 includes rigid links coupled together by rotational joints in a parallelogram arrangement so that surgical instrument 522 pivots about a point in space 532, as more fully described in granted US patent no. 5,817,084, the full description of which is incorporated herein by way of reference. The parallelogram arrangement restricts rotation to turning about an axis 534a, sometimes called the pitch axis. The links supporting the parallelogram linkage are pivotally mounted on configuration joints 526 (Figure 12), so that the surgical instrument 522 additionally rotates about an axis 534b, sometimes called the yaw axis. Pitch and yaw axes 534a and 534b intersect at remote center 536, which is aligned along a shank 538 of surgical instrument 522. Surgical instrument 522 may have additional guided degrees of freedom as supported by manipulator 540, which includes sliding movement of the surgical instrument 522 along the longitudinal axis "LT-LT" of the instrument. As surgical instrument 522 slides along the instrument axis LT-LT relative to manipulator 540 (arrow 534c), remote center 536 remains fixed with respect to base 542 of manipulator 540. Consequently, the entirety of manipulator 540 is generally moved to reposition remote center 536. Linkage 530 of manipulator 540 is driven by a series of motors 544. These motors 544 actively move linkage 530 in response to commands from a processor of a control system. As will be discussed in more detail below, motors 544 are also used to manipulate surgical instrument 522.
[000123] Figure 14 shows an exemplary embodiment of a robotic arm car 520' that has an alternative configuration joint structure. In this exemplary embodiment, a surgical instrument 522 is supported by an alternate handle structure 528' between two tissue handling instruments. Those skilled in the art will understand that various embodiments of the claimed device may incorporate a wide variety of alternative robotic structures, including those described in US Patent No. 5,878,193, the full disclosure of which is incorporated herein by reference. Additionally, while data communication between a robotic component and the robotic surgical system processor is primarily described herein with reference to communication between the surgical instrument 522 and the controller, it should be understood that similar communications can occur between the control circuitry. a manipulator, a setup joint, an endoscope or other image capture device or the like, and the robotic surgical system processor for checking component compatibility, identifying component type, communicating for component calibration (such as displacement or the like ), confirmation of component coupling to the robotic surgical system, or similar.
[000124] Figure 15 shows an exemplary embodiment of a controller 518 that can be used in conjunction with a robotic arm carriage, such as the robotic arm carriages 520 and 520' shown in Figures 12 to 14. Controller 518 includes , in general, master controllers (generally represented as 519 in Figure 15), which are held by the physician and manipulated in space while the physician observes the procedure through a stereoscopic screen 521. A surgeon feedback meter 515 can be seen through screen 521, and provide the surgeon with a visual indication of the amount of force being applied to the cutting instrument or dynamic clamping element. 519 master controllers generally comprise manual input devices which preferably move with multiple degrees of freedom, and which often additionally have a handle or trigger for instrument actuation (e.g. to close clamp saws, apply a electrical potential to an electrode, or the like).
[000125] Figure 16 shows an exemplary embodiment of an ultrasonic surgical instrument 522 adapted for use with a robotic surgical system. For example, surgical instrument 522 can be coupled to one of the surgical manipulators, 528 and 528', described earlier in this document. As can be seen in Figure 16, surgical instrument 522 comprises a surgical end actuator 548 comprising an ultrasonic blade 550 and a forceps arm 552, which may be coupled to an elongate rod assembly 554 which, in some embodiments, may The instrument 546 may also be operatively coupled to controller 518 to receive inputs from the clinician to control instrument 522. For example, actuation (e.g., opening and closing) of gripper arm 552, actuation (e.g., opening and closing) of the jaws, 551A and 551B, the activation of the ultrasonic blade 550, the extension of the scalpel 555 and the activation of the ene application surfaces 553A, 553B, among others, may be controlled via instrument drive assembly 546, based on inputs from the clinician provided via controller 518. Surgical instrument 522 is operatively coupled to the manipulator by a mounting portion of instrument, generically designated as 558. Surgical instruments 522 further include an interface 560 that mechanically and electrically couples instrument mounting portion 558 to the manipulator.
[000126] Figure 18 shows another view of the instrument drive assembly of Figure 17, which includes the ultrasonic surgical instrument 522. The instrument mounting portion 558 includes an instrument mounting plate 562 that operatively supports a plurality of ( four are shown in Figure 17) rotating body portions, disks or driven elements 564, each of which includes a pair of pins 566, which extend from a surface of driven element 564. A pin 566 is closest to a axis of rotation of each of the driven elements 564 than the other pin 566 on the same driven element 564, which helps ensure positive angular alignment of the driven element 564. The driven elements 564 and pins 566 may be positioned on one side of the 567 instrument mounting plate adapter 562.
[000127] Interface 560 also includes an adapter portion 568 that is configured to engage with mounting plate 562, as will be discussed further below. Adapter portion 568 may include an array of electrical connection pins 570, which may be coupled to a memory structure by a circuit board within instrument mounting portion 558. Although interface 560 is described herein with reference to mechanical, electrical, and magnetic coupling elements, it should be understood that a wide variety of telemetry modalities, including infrared, inductive coupling, or the like, may be used.
[000128] Figures 19 to 21 show additional views of the adapter portion 568 of the instrument drive assembly 546 of Figure 17. The adapter portion 568 generally includes an instrument side 572 and a bracket side 574 (Figure 19) . In various embodiments, a plurality of swivel bodies 576 are mounted to a float plate 578 which has a limited range of movement with respect to the surrounding adapter structure normal to the main surfaces of the adapter 568. The axial movement of the float plate 578 aids in disengage the rotating bodies 576 from the instrument mounting portion 558, when actuating the levers 580 along the sides of the housing of the instrument mounting portion 582 (see Figure 16). Other mechanisms/arrangements may be used to releasably couple the instrument mounting portion 558 to the adapter 568. In at least one form, swivel bodies 576 are resiliently mounted to the floating plate 578 by means of resilient radial elements that extend in a circumferential indentation around swivel bodies 576. Swivel bodies 576 can move axially with respect to plate 578 upon deflection of these resilient structures. When arranged in a first axial position (toward the instrument side 572), the rotating bodies 576 are free to rotate without angular limitation. However, as the swivel bodies 576 move axially toward the instrument side 572, the tabs 584 (extending radially from the swivel bodies 576) laterally engage detents on the floating plates so as to limit angular rotation. of the rotating bodies 576 around their axes. This limited rotation can be used to help drive the rotating bodies 576 into the drive pins 586 of a corresponding instrument support portion 588 of the robotic system, as the drive pins 586 will push the rotating bodies 576 into position. limited rotation until pins 586 are aligned with openings 590 (and slide into openings).
[000129] The openings 590 on the instrument side 572 and the openings 590 on the support side 574 of the rotating bodies 576 are configured to precisely align the driven elements 564 (Figures 18 and 28) of the instrument mounting portion 558 to the driving elements 592 of instrument holder 588. As described above in relation to inner and outer pins 566 of driven elements 564, openings 590 are at different distances from the axis of rotation on their respective swivel bodies 576 so as to ensure that alignment is not misaligned. at 33 degrees from your intended position. Additionally, each of the openings 590 may be slightly elongated radially so as to correctly receive the pins 566 in the circumferential orientation. This allows the pins 566 to slide radially within the openings 590 and accommodate any axial misalignment between the instrument 522 and the instrument holder 588, while minimizing any angular misalignment or jolt between the driving and driven elements. The openings 590 on the side of the instrument 572 may be offset by about 90 degrees from the openings 590 (shown in dashed lines) on the side of the holder 574, as can be seen more clearly in Figure 21.
[000130] Various embodiments may also include an array of electrical connection pins 570 located on the bracket side 574 of the adapter 568, and on the instrument side 572 of the adapter 568 may include slots 594 (Figure 21) to receive an array of pins (not shown) of instrument mounting portion 558. In addition to transmitting electrical signals between the surgical instrument, 522 and 523, and instrument holder 588, at least some of these electrical connections may be coupled to a memory device of the instrument. 596 adapter (Figure 20) via a 568 adapter circuit board.
[000131] A removable latch arrangement 598 may be used to releasably secure the adapter 568 to the instrument holder 588. For use in the present invention, the term "instrument drive assembly", when used in the context of the robotic system, encompasses at least various embodiments of adapter 568 and instrument holder 588, which has been generically designated as 546 in Figure 17. As can be seen in Figure 17, for example, instrument holder 588 may include a first latch pin arrangement 600 which is sized to be received in corresponding clevis slots 602 disposed in adapter 568. Furthermore, instrument holder 588 may additionally have second latch pins 604 which are sized to be retained in corresponding latch shackles 606, on adapter 568. See Figure 20. In at least one way, a latch assembly 608 is movably supported on adapter 568 and can be forced between a prim one locked position, in which the locking pins 604 are retained within respective locking shackles 606, and an unlatched position, in which the second locking pins 600 may be inside or outside of the locking shackles 606. One or more springs (not shown) are employed to force the lock assembly into the locked position. A lip on the instrument side 572 of the adapter 568 can slidably receive the laterally extending tabs of the instrument mounting housing 582.
[000132] As described, the driven elements 564 may be aligned with the driving elements 592 of the instrument holder 588 so that the rotational movement of the driving elements 592 causes the corresponding rotational movement of the driven elements 564. The rotation of the driving elements 592 and elements Drives 564 may be electronically controlled, for example, via robotic arm 612, in response to instructions received from clinician 502 via controller 508. Instrument mounting portion 558 may convert rotation of driven elements 564 into motion of the surgical instrument, 522 and 523.
[000133] Figures 22 to 24 show an exemplary embodiment of the instrument mounting portion 558, which shows components for converting the motion of driven elements 564 into motion of the surgical instrument 522. Figures 22 to 24 show the mounting portion instrument with a stem 538 having a surgical end actuator 610 at a distal end thereof. End actuator 610 can be any type of end actuator suitable for performing a surgical task on a patient. For example, the end actuator can be configured to apply ultrasonic energy to tissue at a surgical site. Stem 538 may be rotationally coupled to instrument mounting portion 558, and secured by an upper stem bracket 646 and a lower stem bracket 648 on a coupler 650 of stem 538.
[000134] In an exemplary embodiment, the instrument mounting portion 558 comprises a mechanism for converting the rotation of the various driven elements 564 into rotation of the rod 538, differential translation of elements along the axis of the rod (e.g., for articulation) , and reciprocally translating one or more elements along the axis of the shank 538 (e.g., to extend and retract fabric cutting elements such as 555, overtubes and/or other components). In an exemplary embodiment, rotating bodies 612 (e.g., rotating spools) are coupled to driven elements 564. Rotating bodies 612 may be formed integrally with driven elements 564. In some embodiments, rotating bodies 612 may be formed separately from driven elements 564, provided that the rotating bodies 612 and the driven elements 564 are fixedly coupled so that the driving of the driven elements 564 causes the rotating bodies 612 to rotate. Each of the rotating bodies 612 is coupled to a drive train. gears, or gear mechanism, to provide articulation and rotation of the shaft, opening and closing of the forceps jaw, and actuation of the scalpel.
[000135] In an exemplary embodiment, the instrument mounting portion 558 comprises a mechanism for causing the differential translation of two or more elements along the axis of the rod 538. In the example shown in Figures 22 to 24, this movement is used for manipulating the swivel joint 556. In the illustrated embodiment, for example, the instrument mounting portion 558 comprises a rack-and-pinion gear mechanism to achieve differential translation and, therefore, rod pivot functionality. In an exemplary embodiment, the rack gear mechanism comprises a first pinion gear 614 coupled to a rotating body 612 such that rotation of the corresponding driven element 564 rotates the first pinion gear 614. A bearing 616 is coupled to the rotating body 612 and disposed between the driven element 564 and the first pinion gear 614. The first pinion gear 614 meshes with a first rack gear 618 to convert the rotary motion of the first pinion gear 614 into linear motion of the first rack gear 618, so as to control pivoting of pivot section 556 of rod assembly 538 in a leftward direction 620L. The first rack gear 618 is connected to a first pivot band 622 (Figure 22), such that linear movement of the first rack gear 618 in a distal direction causes the pivot section 556 of the rod assembly 538 to pivot left 620L. A second pinion gear 626 is coupled to another swivel body 612 so that rotation of the corresponding driven element 564 rotates the second pinion gear 626. A bearing 616 is coupled to the swivel body 612 and is disposed between the driven element. 564 and second pinion gear 626. Second pinion gear 626 meshes with second rack gear 628 to convert rotary motion of second pinion gear 626 into linear motion of second rack gear 628 so as to control the pivot of pivot section 556 in a right direction 620R. The second rack gear 628 is connected to a second hinge band 624 (Figure 23) so that linear movement of the second rack gear 628 in a distal direction causes the hinge section 556 of the rod assembly 538 to pivot to the right 620R. Additional bearings can be arranged between the rotating bodies and corresponding gears. Any suitable bearings can be used to support and stabilize the assembly, and to reduce rotating friction from the rod and gears, for example.
[000136] In an exemplary embodiment, the instrument mounting portion 558 further comprises a mechanism for converting the rotation of the driven elements 564 into rotary motion about the axis of the rod 538. For example, the rotary motion may be rotation of the shaft. rod 538 itself. In the illustrated embodiment, a first spiral worm gear 630 is coupled to a rotating body 612, and the second spiral worm gear 632 is coupled to the rod assembly 538. A bearing 616 (Figure 17) is coupled to a rotating body 612 and is disposed between a driven element 564 and the first spiral worm gear 630. The first spiral worm gear 630 meshes with the second spiral worm gear 630. spiral worm thread 632, which may be coupled to the stem assembly 538 and/or another instrument component, 522 and 523, for which longitudinal rotation is desired. Rotation can be caused in either a clockwise (CW) or a counterclockwise (CCW) direction, based on the rotational direction of the first and second spiral worm gears, 630 and 632. Consequently, the rotation rotation of the first spiral worm gear 630 about the first axis is converted to rotation of the second spiral worm gear 632 about the second axis, which is orthogonal to the first axis. As shown in Figures 22 through 23, for example, a clockwise rotation of the second spiral worm gear 632 results in a clockwise rotation of the rod assembly 538 in the direction indicated by 634CW. A counterclockwise rotation of the second spiral worm gear 632 results in a counterclockwise rotation of the rod assembly 538 in the direction indicated by 634CCW. Additional bearings can be arranged between the rotating bodies and corresponding gears. Any suitable bearings can be used to support and stabilize the assembly, and to reduce rotating friction from the rod and gears, for example.
[000137] In an exemplary embodiment, the instrument mounting portion 558 comprises a mechanism for generating reciprocating translation of one or more elements along the geometric axis of the rod 538. This type of translation may be used, for example, to drive a fabric cutting element such as 555, drive an overtube for closing and/or articulating end actuator 610, etc. In the illustrated embodiment, for example, a rack-and-pinion mechanism can provide reciprocating translation. A first gear 636 is coupled to a rotating body 612 so that rotation of the corresponding driven element 564 causes the first gear 636 to rotate in a first direction. A second gear 638 is free to rotate about a column 640 formed in the instrument mounting plate 562. The first gear 636 meshes with the second gear 638, so that the second gear 638 rotates in a direction that is opposite to the second gear 638. of the first gear 636. In an exemplary embodiment, the second gear 638 is a pinion gear meshing with a rack gear 642 which moves in a linear direction. Rack gear 642 is coupled to a translation block 644 which can translate distally and proximally with rack gear 642. Translation block 644 can be coupled to any suitable component of the stem assembly 538 and/or end actuator 610 to provide reciprocating longitudinal movement. For example, translation block 644 may be mechanically coupled to tissue cutting element 555 of radiofrequency surgical device 523. In some embodiments, translation block 644 may be coupled to an overtube, or other component of the end actuator. 610 or stem 538.
[000138] Figures 25 to 27 illustrate an alternative embodiment of the instrument mounting portion 558, showing an alternative example mechanism for converting the rotation of driven elements 564 into rotary motion about the geometric axis of the rod 538 and an alternative example mechanism to generate reciprocating translation of one or more elements along the geometric axis of the rod 538. Now with reference to the reciprocating rotational mechanism, a first spiral worm gear 652 is coupled to a second spiral worm gear 654, which is coupled to a third spiral worm gear 656. This type of arrangement can be used for a variety of reasons, including maintaining compatibility with existing 1000 robotic systems, and/or where space may be limited. . The first spiral worm gear 652 is coupled to a rotating body 612. The third spiral worm gear 656 meshes with a fourth spiral worm gear 658 coupled to the rod assembly 538 A bearing 760 is coupled to a rotating body 612 and is disposed between a driven element 564 and the first spiral worm gear 738. Another bearing 760 is coupled to a rotating body 612 and is disposed between a driven element 564 and third spiral worm gear 652. Third spiral worm gear 652 meshes with fourth spiral worm gear 658, which can be coupled to rod assembly 538 and /or to another component of the instrument 522 for which longitudinal rotation is desired. The rotation can be caused in either a clockwise or a counterclockwise direction, based on the rotational direction of the spiral worm gears, 656 and 658. Consequently, the rotation of the third spiral worm gear 656 about the first axis is converted into rotation of the fourth spiral worm gear 658 about the second axis, which is orthogonal to the first axis. As shown in Figures 26 and 27, for example, the fourth spiral worm gear 658 is coupled to the rod 538, and a clockwise rotation of the fourth spiral worm gear 658 results in a clockwise rotation. clockwise from rod assembly 538 in the direction indicated by 634CW. A counterclockwise rotation of the fourth spiral worm gear 658 results in a counterclockwise rotation of the rod assembly 538 in the direction indicated by 634CCW. Additional bearings can be arranged between the rotating bodies and corresponding gears. Any suitable bearings can be used to support and stabilize the assembly, and to reduce rotating friction from the rod and gears, for example.
[000139] Now with reference to the alternative example mechanism for generating reciprocating translation of one or more elements along the shaft axis 538, the instrument mounting portion 558 comprises a rack-and-pinion gear mechanism to provide reciprocating translation along the axis of stem 538 (e.g., translation of a tissue cutting element 555 of radiofrequency surgical device 523). In an exemplary embodiment, a third pinion gear 660 is coupled to a rotating body 612 such that rotation of the corresponding driven element 564 causes the third pinion gear 660 to rotate in a first direction. Third pinion gear 660 meshes with rack gear 662 which moves in a linear direction. Rack gear 662 is coupled to a translation block 664. The translation block 664 may be coupled to a device component, 522 and 523, for example the tissue cutting element 555 of the radiofrequency surgical device, and/or an overtube or other component that is desired to be longitudinally translated.
[000140] Figures 28 to 32 illustrate an alternative embodiment of instrument mounting portion 558, showing another alternative exemplary mechanism for converting rotation of driven elements 564 into rotary motion about the axis of rod 538. In Figures 28 at 32, the rod 538 is coupled to the remainder of the mounting portion 558 by means of a coupler 676 and a bushing 678. A first gear 666 coupled to a swivel body 612, a fixed column 668 comprising first and second openings 672 , a first and a second swivel pins 674 coupled to the rod assembly, and a cable 670 (or rope). The cable is wound around the swivel body 612. One end of the cable 670 is located through an upper opening 672 of the fixed column 668, and is fixedly coupled to an upper swivel pin 674. Another end of the cable 670 is located through a lower opening 672 of the fixed column 668, and is fixedly coupled to a lower swivel pin 674. This type of arrangement is used for a variety of reasons, including maintaining compatibility with existing robotic systems 1000, and/or where space may be limited. . Consequently, rotation of rotating body 612 causes rotation around rod assembly 538 in either a clockwise or counterclockwise direction, based on the rotational direction of rotating body 612 (e.g., rotation of rod 538 itself) . Consequently, rotation of the rotating body 612 about the first axis is converted to rotation of the rod assembly 538 about the second axis, which is orthogonal to the first axis. As shown in Figures 28 through 29, for example, a clockwise rotation of the rotating body 612 results in a clockwise rotation of the rod assembly 538 in the direction indicated by 634CW. A counterclockwise rotation of the swivel body 612 results in a counterclockwise rotation of the rod assembly 538 in the direction indicated by 634CCW. Additional bearings can be arranged between the rotating bodies and corresponding gears. Any suitable bearings can be used to support and stabilize the assembly, and to reduce rotating friction from the rod and gears, for example.
[000141] Figures 33 to 36A illustrate an alternative embodiment of instrument mounting portion 558, showing an alternative exemplary mechanism for differential translation of elements along the axis of shaft 538 (e.g., for articulation). For example, as illustrated in Figures 33 to 36A, instrument mounting portion 558 comprises a dual cam mechanism 680 to provide rod pivot functionality. In an exemplary embodiment, dual cam mechanism 680 comprises first and second cam portions 680A and 680B. The first and second follower arms 682 and 684 are pivotally coupled to corresponding pivot spools 686. As rotating body 612 coupled with dual cam mechanism 680 rotates, first cam portion 680A acts on first follower arm 682, and second cam portion 680B acts on second follower arm 684. As cam mechanism 680 rotates , follower arms 682 and 684 pivot around pivot spools 686. First follower arm 682 may be attached to a first element that is to be differentially translated (e.g., first hinge band 622). The second follower arm 684 is attached to a second element that is to be differentially translated (e.g., the second hinge band 624). As the upper cam portion 680A acts on the first follower arm 682, the first and second members are differentially translated. In the exemplary embodiment where the first and second elements are respective hinge bands 622 and 624, the rod assembly 538 pivots in a leftward direction 620L. As lower cam portion 680B acts on second follower arm 684, rod assembly 538 pivots in a rightward direction 620R. In some exemplary embodiments, two separate bushings, 688 and 690, are mounted under the respective first and second follower arms, 682 and 684, to allow rotation of the rod without affecting the pivotal positions of the first and second follower arms, 682 and 684 To achieve articulation movement, these bushings reciprocate with the first and second follower arms, 682 and 684, without affecting the pivotal position of jaw 902. Figure 36A shows bushings 688 and 690 and double cam assembly 680 , including the first and second cam portions, 680B and 680B, with the first and second follower arms, 682 and 684, removed to provide a more detailed and clear view.
[000142] In various embodiments, the instrument mounting portion 558 may additionally comprise internal power sources to drive the electronics and deliver the desired ultrasonic and/or radio frequency signals to the surgical tools. Figures 36B to 36C illustrate one embodiment of a tool mounting portion 558' comprising internal power and energy sources. For example, surgical instruments (eg instrument 522) assembled using the tool mounting portion 558' need not be hardwired to an external generator or other power source. Instead, the functionality of the generator 20 described herein may be implemented integrally with the mounting portion 558.
[000143] As illustrated in Figures 36B to 36C, the instrument mounting portion 558' may comprise a distal portion 702. The distal portion 702 may comprise various mechanisms for coupling the rotation of the actuator elements 612 to the end actuators of the various instruments. 522, for example, as described earlier in this document. Near the distal portion 702, the instrument mounting portion 558' comprises an internal direct current (DC) power source, and an internal drive and control circuit 704. In the illustrated embodiment, the power source comprises first and second batteries, 706 and 708. In other respects, the tool mounting portion 558' is similar to the various embodiments of the tool mounting portion 558 previously described herein. Control circuit 704 may function similarly to that described above with respect to generator 20. For example control circuit 704 may provide an ultrasonic and/or electrosurgical drive signal in a manner similar to that described above with respect to generator 20.
[000144] Figure 37 illustrates an embodiment of a pivotable surgical instrument 1000 comprising an ultrasonic transducer assembly situated in distal position 1012. An end actuator 1014 of the instrument 1000 comprises an ultrasonic blade 1018 and a clamp arm 1016. End actuator 1014 is coupled to a distal end of a stem 1004. The stem 1004 extends along a longitudinal axis 1002 and comprises a distal stem element 1007 and a proximal stem element 1009. For example, the end actuator 1014 may be coupled to a distal portion of the distal stem element 1007. The distal and proximal stem elements, 1007 and 1009, are pivotally coupled to one another in a hinge joint 1010. For example, the distal and proximal stem elements, 1007 and 1009, can be coupled so as to revolve about an axis 1006 that is perpendicular to the longitudinal axis 1002. Potential articulation directions are indicated. by arrow 1008.
[000145] In Figure 37, a proximal end of the stem 1009 is coupled to a handle 1001. The handle 1001 may comprise various controls for controlling the operation of the stem 1009 and the end actuator 1014 including, for example, trigger 1022 and buttons 1024 These features may function similarly to that of trigger 24 and buttons 28, previously described in this document. In some embodiments, the handle 1001 may comprise one or more electric or other motors to assist the clinician in operating the stem, 1007 and 1009, and the end actuator 1014. Examples of such handles are shown in US Patent No. 7,845,537, which is incorporated herein in its entirety by reference. Figure 38 illustrates an embodiment of stem 1004 and end actuator 1014 used in conjunction with an instrument mounting portion 1020 of a robotic surgical system. For example, stem 1004, end actuator 1014, and instrument mounting portion 1020 may be used in conjunction with robotic surgical system 500, described earlier in this document.
[000146] Figure 39 illustrates a cutaway view of an embodiment of the stem 1004 and the end actuator 1014. As illustrated, the distal and proximal stem portions, 1007 and 1009, may comprise respective shackles, 1026 and 1028, joined together by a pin 1030 to form the hinge joint 1010. In various embodiments, the pin 1030 is substantially parallel to the axis 1006 (Figures 37 to 38). Furthermore, although the hinge joint 1010 is illustrated in Figure 39 as being implemented with shackles, 1026 and 1028, and a pin 1030, it should be understood that any suitable type of pivot joint mechanism may be used. Figure 39 also illustrates a gripper arm control element 1044 that can be coupled to one or more components of the end actuator 1014, as described herein, to cause the gripper arm 1016 to open and close. A wire power supply 1038 may be coupled to the ultrasonic transducer assembly 1012, and specifically to an ultrasonic transducer 1040 thereof, so as to connect the ultrasonic transducer assembly 1012 to a generator, such as the generator 20 described herein.
[000147] In various embodiments, the articulation of the distal stem element 1007 and the end actuator 1014 can be achieved using the translational articulation control elements, 1032 and 1034. The control elements, 1032 and 1034, can be be substantially opposite the longitudinal axis 1002 and each other. Distal portions of control elements 1032 and 1034 may be coupled to end actuator 1014 or distal stem element 1007. For example, control elements 1032 and 1034 are illustrated in Figure 39 as being coupled to distal stem element 1007. through pegs 1046 and 1048. Control elements 1032 and 1034 extend proximally beyond hinge joint 1010 and through proximal rod portion 1009.
[000148] Control elements 1032 and 1034 may be differentially translated to cause articulation of end actuator 1014 and distal stem portion 1007. For example, proximal translation of control element 1034 may cause the stem element 1007 and end actuator 1014 revolve toward control element 1034, as shown in Figure 39 and indicated by arrow 1041. Similarly, proximal translation of control element 1032 can cause distal stem element 1007 and end actuator 1014 revolve toward control element 1032 in the opposite manner to that shown in Figure 39. In various embodiments, proximal translation of a control element, 1032 and 1034, may occur in conjunction with distal translation of the element. control element, for example, to obtain clearance in the opposing control element, 1032 and 1034, in order to facilitate articulation.
[000149] The differential translation of the control elements, 1032 and 1034, can be obtained in any suitable way. For example, when used in conjunction with a robotic surgical system, differential translation of control elements 1032 and 1034 can be initiated using any of the devices and methods described above with reference to Figures 22 to 36C. Figures 40 to 40A illustrate an embodiment for conducting differential translation of control elements 1032 and 1034 in conjunction with a hand instrument such as 1000. Figure 40 shows instrument 1000 which includes a linkage assembly 1050 including a lever 1052. Referring now to Figure 40A, the articulation lever 1052 is coupled to a spindle gear 1058. Each of the control elements, 1032 and 1034, can define the respective proximal rack gears, 1054 and 1056, in interface with spindle gear 1058. Rotation of pivot lever 1052 and spindle gear 1058 in a first direction, indicated by arrow 1060, can cause control element 1032 to translate distally and control element 1034 proximally translate Rotation of pivot lever 1052 in the opposite direction, indicated by arrow 1062, may cause control element 1034 to translate distally and control element 1034 proximally to translate. the control 1032.
[000150] Figure 41 illustrates a cutaway view of an embodiment of the ultrasonic transducer assembly 1012. As illustrated, the assembly 1012 comprises an outer housing 1064 surrounding the ultrasonic transducer 1040. The transducer may be in electrical communication with a generator via power cord 1038 as described herein. At a distal portion, the ultrasonic transducer 1040 is acoustically coupled to the ultrasonic blade 1018. The transducer 1040 may be secured within the housing 1064 by washers 1070, which may be produced from silicone or another suitable material. In certain embodiments, housing 1064 defines proximal (1066) and distal (1068) hinge portions, which can be used, as described herein, to couple assembly 1012 to a gripper arm member, for example, as described herein. .
[000151] Figure 42 illustrates an embodiment of the ultrasonic transducer assembly 1012 and the gripper arm 1016, arranged as part of a four-bar linkage. The gripper arm 1016 may comprise a gripper block 1076 positioned to contact the ultrasonic blade 1018 when the gripper arm 1016 is in the closed position. The gripper arm 1016 may further contain a proximal element 1078 pivotally coupled to the transducer assembly 1012 at pivot point 1072. Pivot point 1072 may be any suitable type of mechanical pivot and may, for example, comprise a pin, as shown. Proximal member 1078 may extend even more proximally from pivot point 1072 and, at or near a proximal end, may be pivotally coupled to connecting member 1074 at pivot point 1075. Similarly, a proximal portion of the ultrasonic transducer assembly 1012 may be pivotally coupled to a linkage 1076 at pivot point 1077. Linkages 1074 and 1076 may be pivotally coupled to each other, and to the gripper arm control member 1044, at a pivot point 1080. Proximal and distal translation of the gripper arm control element 1044 can transition the gripper arm 1016 and ultrasonic blade 1018 between open and closed positions, as described herein.
[000152] In the exemplary embodiment shown in Figure 42, the gripper arm 1016 comprises a second proximal element 1078', such that the proximal elements 1078 and 1078' flank the ultrasonic transducer assembly 1012 and are pivotally coupled to a second clamping element. link 1074'. Similarly, a second connector 1076' may be pivotally coupled to the ultrasonic transducer assembly 1012 in a manner similar to that of connector 1078. All connectors 1074, 1074', 1078 and 1078' may be pivotally coupled together at pivot point 1080. In various embodiments, pivot point 1075 may comprise a bar 1082 extending between proximal element/connector 1078/1074, and proximal element/connector 1078' /1074'. A similar bar 1084 may be positioned at pivot point 1080.
[000153] Figure 43 illustrates a side view of an embodiment of the ultrasonic transducer assembly 1012 and the clamp arm 1016, arranged as illustrated in Figure 42, coupled to the distal stem portion 1007 and in an open position. As illustrated in Figure 43, the distal rod portion 1007 comprises a clevis arm 1086 that is pivotally coupled to the ultrasonic transducer assembly 1012 and the gripper arm 1016 at pivot point 1072, such that the ultrasonic transducer assembly 1012, the gripper arm 1016 and the shackle arm 1086 are all pivotable relative to each other. In some embodiments, a second clevis arm (not shown) is present on an opposite side of the ultrasonic transducer assembly 1012 and the gripper arm 1016. As illustrated, the gripper arm control element 1044 is distally translated in the indicated direction. by the arrow 1088. This pushes the connecting elements 1074 and 1076 apart and, in turn, causes the gripper arm 1016 and blade 1018 (e.g., coupled to assembly 1012) to revolve so as to away from each other around pivot point 1072, to the position shown.
[000154] Figure 44 illustrates a side view of an embodiment of the ultrasonic transducer assembly 1012 and the clamp arm 1016, arranged as illustrated in Figure 42, coupled to the distal stem portion 1007 and in a closed position. In Figure 44, the gripper arm control element 1044 has been pulled proximally in the direction of arrow 1090. This pulls on connecting elements 1074 and 1076, moving pivot points 1075 and 1077 toward each other in the directions indicated by the arrows 1092 and 1094. Similarly, blade 1018 and gripper arm 1016 are pivoted about pivot point 1072 towards each other in the direction of arrows 1096 and 1098 to the illustrated closed position. Distal and proximal translation of the gripper arm control element 1044 may be achieved in any suitable manner. For example, in a handheld instrument, the gripper arm control element 1044 may be distally and proximally translated in a manner similar to that described above, with respect to the tubular actuator element 58. Further, for example, in a robotic instrument, the gripper arm control element 1044 can be distally and proximally translated in a manner similar to that previously described herein with respect to Figures 22 to 36C.
[000155] Figures 45 and 46 illustrate side views of an embodiment of the ultrasonic transducer assembly and clamp arm of Figures 37 to 38, arranged as illustrated in Figure 42, including proximal portions of the stem 1004. In Figure 45, the blade 1018 and forceps arm 1016 are shown in the closed position, similar to Figure 44. Proximal stem portion 1009 is shown extending from a trocar 1100. Distal stem portion 1007 and end actuator 1014 are shown hinged around hinge joint 1010 in the direction indicated by arrows 1102. The gripper arm control member 1044 is pulled proximally, as indicated by arrow 1090, and is shown curved around hinge joint 1010. In Figure 46, the blade 1018 and the gripper arm 1016 are shown in the open position, similar to Figure 43. The gripper arm control member 1044 is pushed distally, as indicated by 1088, and again is curved around the joint. hinged arm 1010. In the embodiments shown in Figures 37 to 46, and in various embodiments described herein, the ultrasonic blade and the gripper arm may assume any of one or more suitable shapes. For example, Figures 47 to 48 illustrate an embodiment of an end actuator 1014' having an alternatively shaped ultrasonic blade 1018' and gripper arm 1016'.
[000156] Figure 49 illustrates an embodiment of another end actuator 1014'', which comprises a flexible ultrasonic transducer assembly 1012'. The ultrasonic transducer assembly 1012' comprises a distal transducer portion 1103 and a proximal transducer portion 1104, coupled by a flexible intermediate portion 1106. The proximal transducer portion 1104 may be coupled to a proximal transducer holder 1108. For example, transducer portion 1104 may be coupled to bracket 1108 using multiple disks 1070, which may be positioned at nodes of the transducer. The bracket 1108 may be pivotally coupled to the connecting element 1074 at the pivot point 1080. The distal transducer portion 1103 may be coupled to a distal bracket 1110, again, for example, by using disks 1070 at nodes of the transducer. Distal bracket 1110 may be pivotally coupled to gripper arm 1016 and shackle arm 1086 at pivot point 1072. In various embodiments, flexible intermediate portion 1106 may have a cross-sectional area that is less than that of distal transducer portion 1103 and the proximal transducer portion 1104. Also, in some embodiments, the intermediate portion 1106 may be produced from a material different from that of the distal and proximal portions of the transducer, 1103 and 1104. For example, the distal and proximal portions of the transducer , 1103 and 1104, can be produced from piezoelectric elements (such as elements 112 described earlier in this document). Flexible intermediate portion 1106 may be produced from any suitable flexible material that conducts ultrasonic energy including, for example, titanium, a titanium alloy, nitinol, etc. It should be understood that the ultrasonic transducer assembly 1012' is illustrated in Figure 49 without any external housing in order to more clearly illustrate the embodiment. During use, the 1012 ultrasonic transducer assembly can be used with a housing, such as the 1064 housing, described earlier in this document with respect to Figure 41.
[000157] During use, the flexible intermediate transducer portion 1106 can perform a function similar to that of the pivot point 1077. For example, when the gripper arm control element 1044 is pushed distally, the flexible intermediate transducer portion 1106 can flex, pushing the blade 1018 and the gripper arm 1016 to an open position, shown in Figure 49. When the gripper arm control member 1044 is pulled proximally, the flexible intermediate transducer portion 1106 can become more straightened. , pulling blade 1018 and gripper arm 1016 to a closed position.
[000158] In some exemplary embodiments, the ultrasonic transducer assembly may be positioned on the stem so that a proximal end of the transducer assembly extends proximally from the hinge joint. This can serve to minimize a distance between the joint and a distal tip of the ultrasonic blade. Figure 50 shows an embodiment of a handheld surgical instrument 1200 having a transducer assembly 1012 extending proximally from the hinge joint 1010. It can be noted that a distance 1204 between a most distal point of the ultrasonic blade 1018 and the hinge joint 1010 is smaller than it would be if the entire 1012 ultrasonic transducer assembly were distal to the swivel joint. Although the instrument 1200 shown in Figure 50 is a handheld instrument, it should be understood that the stem 1004 and end actuator 1014 in the configuration illustrated in Figure 50 may also be used with a robotic surgical system, such as the system 500 here. described.
[000159] Figure 51 illustrates an approximation of the transducer assembly 1012, the distal rod portion 1007, the articulated joint 1010 and the end actuator 1014, arranged as shown in Figure 50. Figure 52 illustrates an embodiment of the articulated joint 1010 with the distal rod portion 1007 and the proximal rod portion 1009 removed to show an exemplary embodiment for articulating the rod 1004 and actuation of the yaw member 1016. In Figure 52, the articulation control elements, 1210 and 1212, are coupled to a pulley 1206. The pulley, in turn, may be coupled to the distal stem portion 1007, for example at the hinge joint 1010, such that rotation of the pulley 1206 causes corresponding articulation of the distal stem portion 1007 and the actuator for end 1014. Proximal translation of control element 1212 may rotate pulley 1206 clockwise (in the configuration shown in Figure 52), thereby pivoting end actuator 1014 toward the control element 1212, as shown in Figure 52. Similarly, proximal translation of the control element 1210 may rotate the pulley 1206 counterclockwise (in the configuration shown in Figure 52), thereby pivoting the end actuator 1014 towards the control element 1210, opposite to what is shown in Figure 52.
[000160] The gripper arm control element 1044 may extend through a groove 1208 in the pulley 1206. As illustrated, the gripper arm 1016 is configured to be pivotally coupled to a distal plate 1215 at a pivot point 1214. The gripper arm control member 1044 is coupled to the gripper arm 1016 at a point 1216, offset from the pivot point 1214, such that distal and proximal translation of the gripper arm control member 1044 opens and close the gripper arm 1016. Plate 1215, for example, may be coupled to distal stem portion 1007 (not shown in Figure 52), transducer assembly 1012, or any other suitable component. In some embodiments, the gripper arm 1016 is pivotally coupled directly to the distal stem portion 1007 and/or the transducer assembly 1012.
[000161] The articulation control elements 1210 and 1212 can be differentially translated to articulate the distal rod portion 1007 and the end actuator 1014. The differential articulation of the control elements, 1210 and 1212, can be actuated in any suitable manner. . For example, in a hand-held surgical instrument, control elements 1210 and 1212 can be differentially translated using a toggle lever 1052 and a spindle gear 1058, as illustrated in Figure 40A. Furthermore, in robotic surgical instruments, the control elements 1210 and 1212 may be differentially translated, for example, using any of the mechanisms described above with respect to Figures 22 to 36C. The gripper arm control element 1044 can be actuated in a variety of ways including, for example, all of the additional ways described herein.
[000162] In some embodiments, a surgical instrument has an end actuator that is capable of rotating independently of the stem. For example, the rod itself can rotate and pivot into a swivel joint. Additionally, the end actuator can rotate independently of the rod even, for example, while the rod is pivoted. This can effectively increase the spatial range of the end actuator. Figure 53 illustrates an embodiment of a handheld surgical instrument 1300 comprising a stem 1303 with a pivotable rotary end actuator 1312. While the shaft 1303 is illustrated for use with a handheld surgical instrument comprising a handle 1302, it should be understood that a similar rod can be used with a robotic surgical system such as those described herein.
[000163] The rod 1303 comprises an articulated joint 1010 which can be articulated using the toggle lever 1052, for example, as indicated by the arrow 1306. A rotary knob 1314 can rotate the rod 1303, for example, in accordance with the rotary knob. 48 rotates the rod assembly 14 previously described in this document. End actuator rotation selector 1304 can rotate the end actuator, for example, as indicated by arrow 1310. Figure 54 illustrates a cutaway view of one embodiment of instrument 1300 and stem 1303. Figure 54 illustrates one embodiment of toggle lever 1052, coupled to control elements 1032 and 1034, for example, as described above in connection with Figures 39, 40 and 40A. A central rod element 1316 may extend through the rod 1303 and be coupled at a distal end to the end actuator 1312 (e.g., the ultrasonic blade 1018 and the gripper arm 1016). A proximal end of the center rod element 1316 may be coupled to the rotation selector of the end actuator 1304, such that rotation of the selector causes rotation of the center rod element 1316 and corresponding rotation of the end actuator 1312.
[000164] The central rod element 1316 may be produced from any suitable material according to any suitable construction. In some embodiments, for example, the central rod element 1316 may be solid (or hollow to enclose wires and other components). The central stem element 1316 can be produced from a flexible material such as a surgical grade rubber, or a flexible metal such as titanium, nitinol, etc. In this way, the center rod element 1316 can flex when the rod 1303 is pivoted at the pivot joint 1010. The rotation of the center rod member 1316 can further be translated to the end actuator 1312 through the pivot joint 1010.
[000165] In some embodiments, the center rod element 1316, in addition to rotating the end actuator 1312, can also drive the gripper arm 1016. For example, the center rod element 1316 can drive the gripper arm. 1016 upon distal and proximal translation, for example, in response to triggering 1022. Figure 52, described above, illustrates one embodiment of a gripper arm 1016 that can be opened and closed with distal and proximal movement. An additional embodiment is described below in relation to Figure 59.
[000166] In embodiments where the central stem element 1316 drives the gripper arm 1016, it may be desirable to avoid distal and/or proximal translational movement of the central stem element 1316 to the selector 1304. Figure 55 illustrates an embodiment of instrument 1300 showing a specially shaped connection between end actuator rotation selector 1304 and center stem member 1316. A proximal portion of center stem member 1316 may be coupled to a collar 1324 which defines a slot 1326. Dial 1304 may be coupled to rod 1320 positioned within collar 1324. Rod 1320 defines a key or groove 1322 positioned to fit within slot 1326. In this way, rotation of dial 1304 can cause corresponding rotation of the dial. central stem element 1316, but distal and proximal translation of central stem element 1316 may not be communicated to selector 1304. Figure 55 also illustrates an exemplified method. r for passing an electrical drive signal to the transducer assembly 1012. For example, a drive cable 1318 may be coupled to a slip ring 1324. The slip ring 1324, in turn, may be coupled to a distal drive cable 1330 (Figure 56) which may extend through rod 1303, for example through central rod element 1316. Figure 56 illustrates one embodiment of rod 1303, with focus on hinge joint 1010. In the embodiment shown in Figure 56, it may not it will be necessary for the entirety of the central rod element 1316 to be flexible. Instead, as illustrated in Figure 56, the central rod element 1316 comprises a flexible section 1332 aligned with the pivot joint 1010 of the rod 1303.
[000167] Flexible section 1332 can be implemented in any suitable way. For example, flexible section 1332 can be constructed from a flexible material, such as surgical grade rubber, or a flexible metal, such as titanium, nitinol, etc. Furthermore, in some embodiments, the flexible section 1332 may be produced from articulated mechanical components. For example, Figure 57 illustrates an embodiment of the central rod element 1316 produced from articulated mechanical components. As illustrated in Figure 57, the central rod element 1316 comprises a distal element 1340 pivotally coupled to a central element 1342. The distal (1340) and central (1342) elements may pivot relative to each other in the direction indicated by arrow 1346. The central element 1342 may also be pivotally coupled to a proximal element 1344. The central (1342) and proximal (1344) elements may pivot relative to each other in the direction indicated by arrow 1348. For example, the direction of rotation of elements 1344 and 1342 may be substantially perpendicular to the articulation direction of elements 1342 and 1340. In this way, center rod element 1316 may provide turning torque to end actuator 1312 while revolving with the joint. hinge 1010 in flexible section 1332.
[000168] Referring again to Figure 56, the hinge joint 1010 is illustrated as a continuous flexible portion 1350 of the rod 1303. Various other configurations may be used. For example, Figure 58 illustrates an embodiment of stem 1303 comprising a distal stem portion 1356 and a proximal stem portion 1358. Respective stem portions 1356 and 1358 may be pivotally coupled to, for example, a of intermediate rod 1360, at pivot points 1352 and 1354, respectively. Hinged joint 1010, in the configuration shown in Figure 58, may be hinged as previously described in this document, for example with respect to Figures 39, 40 and 40A.
[000169] Figure 59 illustrates an embodiment of the stem 1303 and the end actuator 1312, illustrating a coupling between the central stem element 1316 and the gripper arm 1016. In Figure 59, the central stem element 1316 is illustrated under the in the form of a solid (or hollow) element that is flexible and/or has a flexible portion at the hinge joint 1010. In Figure 59, portions of the distal (1356) and proximal (1358) rod portions are omitted to show the function of the element. 1316. For example, the central shank member 1316 may extend around the ultrasonic transducer assembly 1012 and the transducer 1040, and be pivotally coupled to the gripper arm 1016 at pivot point 1366. The gripper arm 1016 can also be pivotally coupled to distal rod portion 1356 at pivot point 1364. Pivot points 1364 and 1366 can be offset from each other with respect to longitudinal axis 1002. When central rod portion 1316 is pushed distally However, it can push the gripper arm 1016 distally at the pivot point 1366. As the pivot point 1364 can remain stationary, the gripper arm 1364 can pivot to an open position. Pulling the center rod portion 1316 proximally can pull the gripper arm 1016 back into the closed position shown in Figure 59. As illustrated, when the center rod portion 1316 is translated distally and proximally, the transducer assembly 1012 and blade 1018 can , also, be translated distally and proximally.
[000170] While instrument 1300 is described herein as a handheld instrument, it should be understood that rod 1303 in the various embodiments described may also be used in a robotic surgical instrument. For example, differential translation of control elements 1032 and 1034, rotation of stem 1303, and rotation of central stem element 1316 can be achieved as previously described herein with reference to Figures 22 to 36C. Similarly, stem 1303 may be used in a hand instrument in which the articulation and rotation of end actuator 1312 is motorized. Figures 60 to 61 illustrate a control mechanism for a surgical instrument 1300', in which the articulation and rotation of the end actuator 1312 are motorized. The instrument 1300' comprises a handle 1302' which may comprise electric motors and mechanisms, for example, similar to the motors and mechanisms described herein in relation to Figures 22 to 36C. A pivot knob 1370 can be moved in the directions of arrow 1375 to pivot end actuator 1312 about pivot joint 1010, and/or can be rotated in directions indicated by arrow 1372 to rotate end actuator 1312 (eg. example, by rotating the central rod element 1316).
[000171] Figures 62 to 63 illustrate an embodiment of a stem 1400 that can be used with various surgical instruments described herein. Stem 1400 may comprise a bi-directional pivot joint 1402 which can be pivoted in multiple directions as indicated by arrows 1410 and 1412. Stem 1400 may comprise a proximal stem member 1404 pivotally coupled to a pivot member 1408 such that the proximal stem member 1404 is pivotable with respect to the pivot member 1408 in the direction of arrow 1412. The pivot member 1408 may also be pivotally coupled to a distal stem member 1406 such that the distal stem member 1406 is pivotal with respect to pivot element 1408 in the direction of arrow 1410. Pivoting couplings between respective elements 1404, 1406 and 1408 may be of any suitable type including, for example, pin and shackle couplings.
[000172] Now referring to Figure 63, the ball joint 1402 can be actuated by a series of control elements. Control elements 1414 and 1412 may be coupled to pivot element 1408, and may extend proximally through proximal stem element 1404. Differential translation of control elements 1414 and 1412 may cause end actuator 1411 to rotate from side to side. away from longitudinal axis 1002, in the directions of arrow 1412. For example, proximal translation of control element 1412 (e.g., accompanied by distal translation of control element 1414) can pull end actuator 1411, element rod 1406 and pivot element 1408 away from longitudinal axis 1002, and toward control element 1412. Similarly, proximal translation of control element 1414 (e.g., accompanied by distal translation of control element 1412) can pull end actuator 1411, distal rod element 1406 and pivot element 1408 away from the long axis. udinal 1002, and towards the control element 1414.
[000173] Additional control elements 1416 and 1418 may be coupled to distal stem element 1406. Differential translation of control elements 1416 may cause distal stem element 1406 and end actuator 1411 to revolve in the directions of the arrow 1410. For example, proximal translation of control element 1416 (e.g., accompanied by distal translation of control element 1418) may pull end actuator 1411 and distal stem element 1406 away from longitudinal axis 1002 , and toward control element 1416. Similarly, proximal translation of control element 1418 (e.g., accompanied by distal translation of control element 1416) can pull end actuator 1411 and distal stem element 1406 away from the longitudinal axis 1002, and toward the control element 1418. The drive signal wires for driving the ultrasonic transducer assembly 10 12 can pass through the proximal rod element 1404, the pivot element 1408 and the distal rod element 1406.
[000174] Differential translation of the respective control elements 1412, 1414, 1416 and 1418 can be implemented in any suitable way. For example, in a handheld instrument, differential translation of control elements 1412, 1414, 1416 and 1418 can be implemented in the manner described above with respect to Figures 39, 40 and 40A. In a robotic instrument, any method or mechanism may be used including, for example, those described above in relation to Figures 22 to 36C.
[000175] Figure 64 illustrates an embodiment of a rod 1600 that can be pivoted using a cable and pulley mechanism. Stem 1600 can be used with any of the various surgical instruments described herein. Stem 1600 comprises a proximal stem element 1602 and a distal stem element 1614 coupled to a swivel joint 1615. An end actuator 1617 may be coupled to a distal portion of the distal stem element 1614. The end actuator 1615, as illustrated in Figure 64, may comprise an ultrasonic blade 1018, an ultrasonic transducer assembly 1012, a gripper arm 1016, and linkages 1608 and 1610, arranged in a four-bar linkage configuration similar to that described herein with respect to the throttle actuator. end 1014, shown in Figures 42 through 46. For example, end actuator 1617 can be pivotally coupled to distal rod element 1614 on clevis arms 1615. Gripper arm control element 1624 can be coupled to clamping elements. connection 1608 and 1610, to open and close the gripper arm element 1016, as described above. Stem 1600 can be rotated, as indicated by arrow 1604. In contrast to end actuator 1014, end actuator 1617 may comprise only a single connecting element 1608 and a single connecting element 1610, as illustrated. It should be understood that the ultrasonic transducer assembly 1012 is illustrated in Figure 64 without any external housing in order to more clearly illustrate the embodiment. During use, the 1012 ultrasonic transducer assembly can be used with a housing, such as the 1064 housing, described earlier in this document with respect to Figure 41.
[000176] Figure 65 illustrates an embodiment of stem 1600, showing additional details of how distal stem portion 1614 (and end actuator 1617 not shown in Figure 65) can be pivoted. For example, control elements 1620 and 1622 may extend through proximal rod element 1602 and around a pulley 1618 coupled to distal rod element 1614. For example, rotation of pulley 1618 about axis 1615 ( Figure 64) can cause the distal rod portion 1614 to pivot. The pulley 1618 can be rotated by differential translation of the control elements 1620 and 1622, thereby causing the distal rod portion 1614 and the end actuator 1617 to pivot toward the end. arrow 1606. Figure 64 shows an alternative position 1601 of end actuator 1617, and distal rod member 1615 pivoted in a first direction with respect to longitudinal axis 1002. It should be noted, however, that end actuator 1617 and the distal rod member 1615 can be pivoted in multiple directions about pivot axis 1619 (Figure 64).
[000177] Control elements 1620 and 1622, and gripper arm control element 1624, can be actuated in any suitable manner. For example, control elements 1620 and 1622 may be differentially translated to pivot end actuator 1617 and distal stem element 1615. During use with a hand instrument, control elements 1620 and 1622 may be differentially translated, e.g. example, as previously described in this document with respect to Figures 39, 40 and 40A. During use with a robotic instrument, control elements 1620 and 1622 may be differentially translated, for example, using any of the mechanisms described above with respect to Figures 22 to 36C. In a hand instrument, the gripper arm control element 1624 may be mechanically coupled to an instrument trigger, as a tubular actuator element 58 is coupled to the trigger 22 described above. In a robotic instrument, the gripper arm control element 1624 can be actuated, for example, using any of the mechanisms described above in connection with Figures 22 to 36C.
[000178] Figure 66 illustrates an embodiment of an end actuator 1700 that can be used with any of the various instruments and/or rods described herein. The end actuator 1700 can facilitate separate actuation of the gripper arm 1016 and the ultrasonic blade 1018. The end actuator 1700 can function similarly to the four-bar linkage end actuator 1014, previously described in this document. Instead of connecting elements 1705 and 1707 being coupled to a single gripper arm control element 1044 (Figure 42), each of connecting elements 1705 and 1707 can be coupled to separate control elements 1702 and 1704 For example, connecting element 1705 can be coupled to a gripper arm control element 1702, while connecting element 1707 can be coupled to a blade controlling element 1704. The proximal ends of the connecting element, 1705 and 1707, may pass within slots 1706 and 1708 defined by shank 1710 (or a distal portion thereof). For example, connectors 1705 and 1076 may comprise respective pegs 1712 and 1714, which pass within slots 1706 and 1708. In some embodiments, connectors 1705 and 1707 may be singular (similar to connectors 1608 and 1610), or they may be dual connectors (similar to connectors 1074 and 1074', and 1076 and 1076').
[000179] Distal and proximal translation of the gripper arm control member 1702 may cause the gripper arm 1016 to revolve around the pivot point 1072. For example, proximal translation of the gripper arm control member 1702 may pull the connecting element 1705 and the proximal portion 1078 of the gripper arm 1016 proximally, tending to revolve the gripper arm 1016 around the pivot point 1072 in the direction indicated by arrow 1716. Distal translation of the arm control member forceps 1702 can push the connecting element 1705 and the proximal portion 1078 of the forceps arm element 1078 distally (shown at 1724), tending to revolve the forceps arm 1016 around the pivot point 1072 in the direction indicated by the arrow 1718 Similarly, distal and proximal translation of blade control member 1704 may cause blade 1018 to revolve around pivot point 1072. Proximal translation of blade control member 1704 may cause clamp the connector 1076 and transducer assembly 1012 proximally, causing the blade 1018 to revolve around pivot point 1072 in the direction indicated by arrow 1720. Distal translation of blade control member 1704 can push the connector 1076 and transducer assembly 1012 distally (shown at 1726), tending to revolve blade 1018 around pivot point 1072 in the direction indicated by arrow 1722.
[000180] By manipulating the various control elements, 1702 and 1704, the blade 1018 and the gripper arm 1016 of the end actuator 1700 can be opened and closed, and also pivoted together around the pivot point 1072, for example , to provide an additional degree of articulation to end actuator 1700. For example, while blade 1018 and gripper arm 1016 are shown in Figure 66 as being closed along longitudinal axis 1002, it should be understood that components 1018 and 1016 could be placed in a closed position pivoted away from the longitudinal axis 1002, as well.
[000181] Figure 67 illustrates an embodiment of the stem 1600, coupled to an alternate end actuator driven by pulley 1800. Figure 68 illustrates an embodiment of the end actuator 1800. The end actuator 1800 may comprise connecting elements, 1810 and 1812, each of which can be pivotally coupled to respective pulleys 1814 and 1816. Connecting elements 1810 and 1812 can be coupled to pulleys 1814 and 1816 in a position offset from a center 1817 of pulleys 1814 and 1816 so that rotation of pulleys 1814 and 1816 translates connecting elements 1810 and 1812 distally and proximally. Pulleys 1814 and 1816 may be individually driven. For example, pulley 1816 can be rotated by differential translation of control elements 1802 and 1804. Similarly, pulley 1814 can be rotated by differential translation of control elements 1806 and 1808. As pulley 1814 is rotated, the connecting element 1810 can be translated distally and proximally, causing the gripper arm 1016 to pivot about the pivot point 1072, in the directions indicated by arrows 1814 and 1816. Similarly, as the pulley 1816 is rotated, the element linkage 1812 can be translated distally and proximally, causing the ultrasonic transducer assembly 1012 and blade 1018 to pivot around pivot point 1072 in the direction of arrows 1818 and 1820. Differential translation of control element pairs 1802/ 1804 and 1806/1808 can be obtained in any suitable way. In handheld instruments, for example, pairs of control elements may be differentially translated, as described above in relation to Figures 39, 40 and 40A. In robotic instruments, pairs of control elements can be differentially translated, as described above in relation to Figures 22 to 36C. It should be understood that the ultrasonic transducer assembly 1012 is illustrated in Figures 67 to 68 without any external housing in order to more clearly illustrate the embodiment. During use, the 1012 ultrasonic transducer assembly can be used with a housing, such as the 1064 housing, previously described in this document with respect to Figure 41. Non-limiting modalities
[000182] Various embodiments refer to a surgical instrument comprising an end actuator, a pivotable rod and an ultrasonic transducer assembly. The end actuator may comprise an ultrasonic blade. The pivotable stem may extend proximally from the end actuator along a longitudinal axis, and may comprise a proximal stem member and a distal stem member pivotally coupled at an articulated joint. The ultrasonic transducer assembly may comprise an ultrasonic transducer acoustically coupled to the ultrasonic blade. The ultrasonic transducer assembly can be positioned distally to the swivel joint. In some embodiments, the ultrasonic transducer assembly may be positioned so that a portion of the ultrasonic transducer assembly is proximal to the swivel joint, and another portion of the ultrasonic transducer assembly is distal to the swivel joint.
[000183] In some embodiments, the instrument comprises first and second control elements extending through the stem such that proximal translation of the first control element causes the distal stem element and end actuator to revolve in towards the first control element. Furthermore, in some embodiments the distal rod portion may define a pulley around the hinge joint such that rotation of the pulley causes the distal rod portion to pivot. The first and second control elements may be positioned around the pulley such that differential translation of the first and second control elements causes rotation of the pulley and articulation of the distal rod element.
[000184] In addition, some embodiments comprise a gripper arm pivoting about a pivot point of the gripper arm from an open position to a closed position substantially parallel to the ultrasonic blade. The pivot point of the gripper arm can be offset with respect to the longitudinal axis. A gripper arm control element can be coupled to the gripper arm in a position offset with respect to the longitudinal axis, so that distal translation of the gripper arm control element causes the gripper arm to pivot to the open position. , and proximal translation of the gripper arm control element pivots the gripper arm to the closed position.
[000185] In some embodiments, the gripper arm defines a gripper portion extending distally from the pivot point of the gripper arm, and a proximal portion extending proximally from the pivot point of the gripper arm. A first connector may define a proximal end pivotally coupled to the gripper arm control member and a distal end pivotally coupled to a proximal portion of the ultrasonic transducer assembly. A second connecting element may define a proximal end pivotally coupled to the gripper arm control member and a distal end pivotally coupled to the proximal portion of the gripper arm. In some embodiments, the first connection element may be coupled to a blade control element, and the second connection element may be coupled to a gripper arm control element. Furthermore, in some embodiments the first and second connecting elements are coupled to respective pulleys, capable of rotating separately, by means of the respective control elements. Furthermore, in some embodiments the first and second connecting elements may be coupled to respective first and second pulleys, where each pulley is capable of rotating separately to revolve the gripper arm and blade.
[000186] In some embodiments, a proximal portion of the ultrasonic transducer assembly and a distal portion of the ultrasonic transducer assembly are separated by an acoustically transmissive flexible section, which has a cross-sectional area less than a longitudinal diameter of the distal and proximal portions of the assembly. of ultrasonic transducer. The first binding element may be connected as described above. The proximal portion of the ultrasonic transducer assembly may also be coupled to the gripper arm control element.
[000187] The Applicant is also the owner of the following patent applications, each of which is incorporated herein, by way of reference, in its entirety:
[000188] US Patent Application Serial No. 13/536,271, filed on June 28, 2012 and entitled "Flexible Drive Member" (Attorney Document No. END7131USNP/120135),
[000189] US Patent Application Serial No. 13/536,288, filed on June 28, 2012 and entitled "Multi-Functional Powered Surgical Device with External Dissection Features" (Attorney Document No. END7132USNP/120136),
[000190] US Patent Application Serial No. 13/536,295, filed on June 28, 2012 and entitled "Rotary Actuatable Closure Arrangement for Surgical End Effector" (Attorney Document No. END7134USNP/120138),
[000191] US Patent Application Serial No. 13/536,326, filed on June 28, 2012 and entitled "Surgical End Effectors Having Angled Tissue-Contacting Surfaces" (Attorney Document No. END7135USNP/120139),
[000192] US Patent Application Serial No. 13/536,303, filed on June 28, 2012 and entitled "Interchangeable End Effector Coupling Arrangement" (Attorney Document No. END7136USNP/120140),
[000193] US Patent Application Serial No. 13/536,393, filed June 28, 2012 and titled "Surgical End Effector Jaw and Electrode Configurations" (Attorney Document No. END7137USNP/120141),
[000194] US Patent Application Serial No. 13/536,362, filed June 28, 2012 and titled "Multi-Axis Articulating and Rotating Surgical Tools" (Attorney Document No. END7138USNP/120142), and
[000195] US Patent Application Serial No. 13/536,417, filed June 28, 2012 and titled "Electrode Connections for Rotary Driven Surgical Tools" (Attorney Document No. END7149USNP/120153).
[000196] In some embodiments, the rod additionally comprises a hinge element positioned around the hinge. The hinge element may be pivotally coupled to the distal stem element such that the distal stem element is pivotable with respect to the hinge element about a first pivot axis substantially perpendicular to the longitudinal axis and pivotally coupled to the stem element proximal, and such that the hinge element is pivotable with respect to the proximal rod element about a second pivot axis substantially perpendicular to the longitudinal axis and substantially perpendicular to the first pivot axis.
[000197] It should be understood that the terms "proximal" and "distal" are used throughout the specification with reference to a clinician manipulating an end of an instrument used to treat a patient. The term "proximal" refers to the portion of the instrument closest to the physician and the term "distal" refers to the portion located furthest from the physician. It is further understood that for the sake of brevity and clarity, spatial terms such as "vertical", "horizontal", "upwards" or "downwards" may be used in the present invention in relation to the illustrated embodiments. However, surgical instruments can be used in many orientations and positions, and these terms are not intended to be limiting or absolute.
[000198] Various modalities of surgical instruments and robotic surgical systems are described herein. Those skilled in the art will understand that the various modalities described herein can be used with the surgical instruments and robotic surgical systems described. The descriptions are provided for example purposes only, and those skilled in the art will understand that the modalities presented are not limited to the devices described herein, but may be used with any compatible surgical instrument or robotic surgical system.
[000199] References made throughout the specification to "several modalities", "some modalities", "an exemplary modality" or "one modality" mean that a particular element, structure or characteristic described in connection with the modality is included in at least one exemplary embodiment. Therefore, the appearance of the phrases "in various modalities", "in some modalities", "in an exemplary modality", or "in a modality" in places from the beginning to the end of the specification are not necessarily all referring to the same modality. . Furthermore, the specific features, structures, or features illustrated or described in connection with an exemplary embodiment may be combined, in whole or in part, with elements, structures, or features of one or more other embodiments, without limitation.
[000200] While various embodiments of the present invention have been illustrated by describing the various embodiments, and while the illustrative embodiments have been described in considerable detail, it is not the Applicant's intention to restrict or in any way limit the scope of the claims in attached to these details. Additional advantages and modifications may be readily available to those skilled in the art. For example, each of the modalities presented can be used in endoscopic procedures, laparoscopic procedures, as well as open procedures, without limitations on their intended use.
[000201] It should be understood that at least some of the figures and descriptions presented here have been simplified to illustrate elements that are relevant to a clear understanding of the description, while eliminating, for purposes of clarity, other elements. Those skilled in the art will recognize, however, that these and other elements may be desirable. However, due to the fact that such elements are well known in the art and due to the fact that they do not facilitate a better understanding of the description, a discussion of such elements is not provided here.
[000202] While various modalities have been described, it will be evident, however, that various modifications, alterations and adaptations to these modalities may occur to those skilled in the art, with some or all of the advantages of the description being obtained. For example, according to various embodiments, a single component may be replaced by multiple components, and multiple components may be replaced by a single component, to perform one or more specified functions. This order is therefore intended to cover all such modifications, alterations and adaptations, without departing from the scope and spirit of the description as defined by the appended claims.
[000203] Any patent, publication or other descriptive material, in whole or in part, which is said to be incorporated by reference into the present invention is incorporated into the present invention only to the extent that the materials incorporated do not come into conflict with existing definitions, statements or other descriptive material presented in this description. Accordingly, and to the extent necessary, the description as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, which is incorporated by reference into the present invention, but which conflicts with existing definitions, statements, or other descriptive materials set forth herein, will be incorporated herein only to the extent that no conflict will appear between the embedded material and the existing description material.

权利要求:
Claims (5)
[0001]
1. Surgical instrument, characterized in that it comprises: an end actuator (1014) for treating tissue, wherein the end actuator (1014) comprises an ultrasonic blade (1018); a pivotable rod (1004) extending proximally from the end actuator (1014) along a longitudinal axis, wherein the pivotable rod (1004) comprises: a proximal rod member (1009, 1602); and a distal stem member (1007, 1614) pivotally coupled to the proximal stem member (1009, 1602) at a pivot joint (1010); and an ultrasonic transducer assembly (1012) comprising an ultrasonic transducer (1040) acoustically coupled to the ultrasonic blade (1018), wherein the ultrasonic transducer assembly (1012) is positioned distally with respect to the hinge joint (1010); a pincer arm (1016) pivotable about a pincer arm pivot point (1072) from an open position to a closed position parallel to the ultrasonic blade (1018), wherein the pincer arm pivot point (1072) is offset from the longitudinal axis; and a gripper arm control element (1044, 1702) coupled to the gripper arm (1016) in a position offset from the longitudinal axis such that translation of the gripper arm control element (1044, 1702) in a first direction rotates the gripper arm (1016) to the open position and translating the gripper arm control element (1044, 1702) in a second direction opposite to the first direction rotates the gripper arm (1016) to the closed position; wherein the ultrasonic blade (1018) extends distally from the ultrasonic transducer (1040), wherein the gripper arm (1016) defines a gripper portion (1076) extending distally from the pivoting point of the gripper arm (1016). pincer arm (1072) and a proximal portion (1078) extending proximally from the pincer arm pivot point (1072), wherein the pincer arm control member (1044, 1702) extends through the pivot rod (1004); and wherein the surgical instrument further comprises: a first connecting element (1076') defining a proximal end pivotally coupled to the forceps arm control member (1044, 1702) and a distal end pivotally coupled to a proximal portion of the set of instruments. ultrasonic transducer (1076, 1707); and a second connecting element (1074, 1705) defining a proximal end pivotally coupled to the gripper arm control member (1044, 1702) and a distal end pivotally coupled to the proximal portion of the gripper arm (1016).
[0002]
2. Surgical instrument according to claim 1, characterized in that proximal translation of the forceps arm control element (1044, 1702) revolves the ultrasonic blade (1018) and the forceps portion (1076) of the forceps arm. forceps (1016) to the closed position, and wherein distal translation of the forceps arm control element (1044, 1702) rotates the ultrasonic blade (1018) and forceps portion (1076) of the forceps arm (1016) to the open position.
[0003]
3. Surgical instrument, according to claim 1, characterized in that the articulated rod (1004) further comprises: an articulation element (1615) positioned around the articulated joint (1010), wherein the articulation element ( 1615) is: pivotally coupled to the distal rod element (1007, 1614) so that the distal rod element (1007, 1614) is pivotable with respect to the pivot element (1615) about a first pivot axis perpendicular to the longitudinal axis; pivotally coupled to the proximal rod element (1009, 1602) such that the pivot element (1615) is pivotable with respect to the proximal rod element (1009, 1602) about a second pivot axis perpendicular to the longitudinal axis and perpendicular to the first pivot axis.
[0004]
4. Surgical instrument according to claim 3, characterized in that it further comprises: a first control element (1032) extending through the proximal stem element (1009, 1602); and a second control element (1034) extending through the proximal rod element (1009, 1602) in a position opposite the longitudinal axis from the first control element (1032), wherein proximal translation of the first control element ( 1032) causes the distal rod element (1007, 1614) to revolve toward the first control element (1032) about the first pivot axis.
[0005]
5. Surgical instrument according to claim 3, characterized in that it further comprises: a third control element coupled to the articulation element (1615) and extending proximally through the proximal rod element (1009, 1602); and a fourth control element coupled to the pivot element (1615) in a position opposite the longitudinal axis from the third control element and extending proximally through the proximal rod element (1009, 1602), wherein proximal translation of the third control element causes the pivot element (1615) and distal rod element (1007, 1614) to revolve toward the third control element about the second pivot axis.

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同族专利:

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公开号 | 公开日

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US20140005702A1|2014-01-02|

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CN104540461B|2018-03-27|

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JP2018020171A|2018-02-08|

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AU2013280943A1|2015-01-22|

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CN104540461A|2015-04-22|

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IN2015DN00378A|2015-06-12|

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JP6672236B2|2020-03-25|

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WO2014004112A1|2014-01-03|

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EP2866696A1|2015-05-06|

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CA2877686A1|2014-01-03|

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US20170245875A1|2017-08-31|

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US10779845B2|2020-09-22|

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JP2015528717A|2015-10-01|

---

BR112014032928A2|2017-06-27|

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

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2020-01-07| B06U| Preliminary requirement: requests with searches performed by other patent offices: procedure suspended [chapter 6.21 patent gazette]|

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2021-08-03| B06A| Patent application procedure suspended [chapter 6.1 patent gazette]|

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2021-11-23| B09A| Decision: intention to grant [chapter 9.1 patent gazette]|

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2022-02-01| B16A| Patent or certificate of addition of invention granted [chapter 16.1 patent gazette]|Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 14/06/2013, 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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US13/538,601|US20140005702A1|2012-06-29|2012-06-29|Ultrasonic surgical instruments with distally positioned transducers|

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US13/538,601|2012-06-29|

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PCT/US2013/045802|WO2014004112A1|2012-06-29|2013-06-14|Ultrasonic surgical instruments with distally positioned transducers|

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