US20020128662A1 - Surgical instrument - Google Patents

Abstract

A portable remotely controllable surgical instrument comprising: a manually portable elongated shaft having a proximal end and a distal end manually positionable at an operative site within a subject upon insertion of the shaft through an incision in the subject; a manually portable mounting mechanism being readily manually mountable in a fixed position outside the patient near the incision, the proximal end of the portable shaft being mounted thereon. The instrument may include a portable drive unit drivably intercoupled through the mounting mechanism to a tool mounted at the distal end of the portable shaft; wherein the drive unit is readily positionable at a selected position outside the patient. The instrument may include a manually portable support for fixedly positioning the manually portable mounting mechanism in a selected location relative to the subject, the manually portable support being readily fixedly attachable to and detachable from a stationary structure on or relative to which the subject is mounted

Description

CROSS REFERENCE TO RELATED APPLICATIONS
• This application is a continuation-in-part of and claims the benefit of priority from U.S. application Ser. No. 09/827,503, filed Apr. 6, 2001, which is a continuation of U.S. application Ser. No. 09/746,853, filed Dec. 21, 2000, which is a divisional of U.S. application Ser. No. 09/375,666, now U.S. Pat. No. 6,197,017, filed Aug. 17, 1999, which is a continuation of U.S. application Ser. No. 09/028,550 filed Feb. 24, 1998, now abandoned. This application is also a continuation-in-part of and claims the benefit of priority from U.S. application Ser. No. 09/783,637, filed Feb. 14, 2001, which is a continuation of PCT/US00/12553 filed May 9, 2000, which claims the benefit of priority of U.S. provisional patent application Serial No. 60/133,407, filed May 10, 1999, now abandoned. This application is also a continuation-in-part of and claims the benefit of priority from PCT/US01/1 1376 filed Apr. 6, 2001 which claims priority to U.S. application Ser. Nos. 09/746,853 filed Dec. 21, 2000 and 09/827,503 filed Apr. 6, 2001. This application is also a continuation-in-part of and claims the benefit of priority from U.S. application Ser. Nos. 09/746,853 filed Dec. 21, 2000 and 09/827,503 filed Apr. 6, 2001. This application is also a continuation-in-part of and claims the benefit of priority from U.S. application Ser. No. 09/827, 643 filed Apr. 6, 2001 which claims priority to, inter alia, U.S. provisional application serial No. 60/257,869 filed Dec. 21, 2000 and U.S. provisional application serial no. 60/195,264 filed Apr. 7, 2000 and is also a continuation-in-part of PCT/US00/12553 filed May 9, 2000 from which U.S. application Ser. No. 09/783,637 filed Feb. 14, 2001 claims priority.[0001]
• This application also claims the benefit of priority under 35 U.S.C. §§119 and 120 to U.S. Provisional Application Serial No. 60/293,346 filed May 24, 2001, U.S. Provisional Application Serial No. 60/279,087, filed Mar. 27, 2001, U.S. Provisional Application Serial No. 60/313,496 filed Aug. 21, 2001, U.S. Provisional Application Serial No. 60/313,497 filed Aug. 21, 2001, U.S. Provisional Application Serial No. 60/313, 495 filed Aug. 21, 2001, U.S. Provisional Application Serial No. 60/269,203 filed Feb. 15, 2001, U.S. Provisional Application Serial No. 60/269,200 filed Feb. 15, 2001, U.S. Provisional Application Serial No. 60/276,151 filed Mar. 15, 2001, U.S. Provisional Application Serial No. 60/276,217 filed Mar. 15, 2001, U.S. Provisional Application Serial No. 60/276,086 filed Mar. 15, 2001, U.S. Provisional Application Serial No. 60/276,152 filed Mar. 15, 2001, U.S. Provisional Application Serial No. 60/257,816 filed Dec. 21, 2000, U.S. Provisional Application Serial No. 60/257,868 filed Dec. 21, 2000, U.S. Provisional Application Serial No. 60/257,867 filed Dec. 21, 2000, U.S. Provisional Application Serial No. 60/257,869 filed Dec. 21, 2000.[0002]
• The disclosures of all of the foregoing applications and U.S. Pat. No. 6,197,017 are all incorporated herein by reference in their entirety.[0003]
• This application further incorporates by reference in its entirety the disclosures of the following U.S. Patent applications which are being filed concurrently on the same date herewith, having the following titles and docket numbers: 08491.7013—Surgical Instrument; 08491.7014—Surgical Instrument; 08491.7015—Surgical Instrument; 08491.7016—Surgical Instrument 08491.7017—Surgical Instrument; 08491.7018—Surgical Instrument; 08491.7019—Surgical Instrument; 08491.0006—Flexible Instrument; 08491.0006—Flexible Instrument; 08491.0007—Flexible Instrument; 08491.0008—Flexible Instrument; 08491.0009—Flexible Instrument; 08491.0010—Flexible Instrument; and 08491.0011—Flexible Instrument.[0004]
BACKGROUND OF THE INVENTION
• The present invention relates to surgical instruments and more particularly to surgical instruments which are remotely controlled by electronic control signals generated by a user which are sent to a drive unit which drives mechanically drivable components of a mechanical apparatus which support a surgical instrument.[0005]
SUMMARY OF THE INVENTION
• Instrument Support and Mounting[0006]
• One aspect of the present invention relates to a support member for holding a medical procedure instrument holder in a fixed position relative to a patient.[0007]
• In one embodiment, a medical procedure instrument is provided, including an instrument holder, an instrument insert, and a support. The instrument holder includes an elongated guide member for receiving the instrument insert. The insert carries on its distal end a medical tool for executing the medical procedure. The instrument holder is manually insertable into a patient so as to dispose a distal end of the guide member into a target site in which the procedure is to be executed. The support holds the instrument holder fixed in position relative to the patient. The instrument holder is held in fixed position in an incision in the patient between changes of instrument inserts during the course of a procedure such that trauma or damage which can result from withdrawal and re-insertion of another or the same instrument is minimized or eliminated. The distal end of the elongated guide member is preferably curved and at least the distal end of the instrument insert is flexible to enable the insert to slide through the curved distal end of the guide member.[0008]
• The instrument insert typically includes an elongated shaft having a proximal end, a distal end and a selected length between the two ends. One or more portions of the elongated shaft along its length, and most typically a distal end portion, may comprise a mechanically and controllably deformable material such that the portion of the selected lengths of the shaft which are deformable are controllably bendable or flexible in any one or more of an X, Y and Z axis direction relative to the axis of the shaft thus providing an additional three degrees of freedom of movement control. Flexible cables, rods or the like which are connected at one end to a deformable or flexible portion of a shaft and are drivably intercoupled to a controllably drivable drive unit are typically included for effecting control of the bending or flexing.[0009]
• In one embodiment, the support includes a bracket that holds an instrument holder to the support at a fixed reference point. The instrument holder is then pivotally supported at this reference point from the bracket.[0010]
• In various embodiments, the instrument insert is manually engageable and disengageable with the instrument holder. Generally, the instrument holder is inserted into the patient first, and then the insert is engaged to the holder, such that the medical tool at the distal end of the insert extends beyond the distal end of the guide member at the target site. One advantage is to maintain the guide member with its distal end at the target site upon withdrawal of the instrument insert. This enables exchange of instrument inserts during the procedure and facilitates ease of placement of the next instrument insert.[0011]
• The instrument insert preferably includes a mechanically drivable mechanism for operating the medical tool. The instrument holder also includes a mechanical drive mechanism such that the drive and drivable mechanisms are engageable and disengageable with one another, in order to enable engagement and disengagement between the insert and holder. Preferably, a drive unit for controlling the instrument insert and holder is disposed remote from the insert and holder, outside of a sterile field which may be defined by the area above the operating table.[0012]
• In another embodiment, a medical procedure instrument is provided which includes an instrument holder, an instrument insert, and a support. The instrument holder includes an elongated guide member for receiving the insert, the insert carrying at its distal end a medical tool for executing a medical procedure. The support holds the instrument holder with a distal end of the guide member at a target site internal of the patient. The insert is adapted for ready insertion and withdrawal by way of the guide member, while the guide member is held at the target site. Again, this facilitates ready exchange of instrument inserts during a medical procedure. The instrument inserts are preferably disposable, so they can be discarded after a single insertion and withdrawal from the patient.[0013]
• In a further embodiment, a remote controlled instrument system is provided which includes a user interface, an instrument, a support, and a controller. The user interface allows an operator to manually control an input device. The instrument has at its distal end a tool for carrying out a procedure, the instrument being manually inserted into a patient so as to dispose the tool at a target site at which the procedure is to be executed. The support holds a part of the instrument fixed in position relative to the patient. A controller coupled between the user interface and the instrument is responsive to a remote control by the operator for controlling the instrument at the target site.[0014]
• Another embodiment is a method for remotely controlling an instrument having multiple degrees-of-freedom. The instrument is manually inserted into a patient so as to dispose its distal end at a target site at which a procedure is to be executed. An instrument holder, that receives the instrument, is supported stationary relative to the patient during the procedure so as to maintain the instrument distal end at the target site. A user input device is used to remotely control the motion of the instrument distal end in executing the procedure at the target site.[0015]
• In a further method embodiment for remotely controlling an instrument, an instrument holder is provided for removably receiving and supporting a disposable instrument insert. The instrument holder is inserted into a patient so as to dispose its distal end at an operative site at which the procedure is to be executed. The instrument insert is received in the holder so as to dispose a tool at the distal end of the insert so that it extends from the holder and is positioned at the operative site. A user input device remotely controls motion of the insert in executing the procedure at the operative site. Preferably, the instrument holder is maintained at the operative site as the insert is withdrawn, enabling ready exchange of one instrument insert for another.[0016]
• The invention also provides a medical apparatus for exchanging surgical instruments having a selected tool to be positioned at an operative site of a subject, the apparatus comprising: a guide tube having an open distal end inserted through an incision of the subject, the guide tube being fixedly positioned relative to the subject such that the distal end of the guide tube is fixedly positioned at the operative site, the guide tube being readily manually insertable through the incision; one or more surgical instruments each having a selected tool mounted at a distal end of the instrument; wherein the one or more surgical instruments are readily insertable through the fixedly positioned guide tube such that the selected tool of an instrument is disposed through the open distal end of the guide tube at the operative site upon full insertion of the surgical instrument, the guide tube having a first mounting interface and the surgical instruments having a second mounting interface, the first and second mounting interfaces being readily engageable with each other to fixedly mount the surgical instruments within the guide tube upon full insertion of the surgical instrument. Such a medical apparatus may further comprise a readily manually portable support for fixedly positioning the guide tube in a selected location and orientation relative to the subject, the manually portable support being readily fixedly attachable to and detachable from a stationary structure on or relative to which the subject is mounted.[0017]
• These and other embodiments of the instrument, system and method are more particularly described in the later detailed description section.[0018]
• Ready Attachability, Couplability and Mountability[0019]
• Another aspect of the invention is to provide a drive unit or motor assembly which is attachable and detachable from a medical instrument assembly in order to provide one or more of the features of, positioning the motor assembly outside a sterile field in which a medical procedure takes place, increasing portability of the instrument assembly for ease of positioning with respect to the patient and ease of access to the patient during the procedure, e.g., avoiding bulky and unnecessary electromechanical equipment in the sterile field of the procedure so as to increase ease of access to the patient, enabling detachment, sterilization and reusability of certain components of the instrument assembly and/or detachment and disposability of certain other portions of the instrument assembly.[0020]
• In the first embodiment, a medical procedure instrument is provided. including a medical implement and a drive unit. The medical implement includes a mechanically drivable mechanism intercoupled with the tool used in executing a medical procedure. A drive unit, disposed remote from the medical implement, is used for mechanically driving the implement. The implement is initially decoupled from the drive unit and manually insertable into a patient so as to dispose the tool at an operative site within the patient. The medical implement is attachable and detachable with the drive unit for coupling and decoupling the mechanically drivable mechanism with the drive unit.[0021]
• In various preferred embodiments, the medical implement includes a holder and an instrument insert, the holder receiving the insert and the insert carries the mechanically drivable mechanism. Preferably, the insert is an integral disposable unit, including a stem section with the tool at its distal end and the mechanically drivable mechanism at its proximal end.[0022]
• The drive unit may be an electromechanical unit, and mechanical cabling may intercouple the drive unit with the mechanically drivable mechanism. Mechanical cabling may be provided to control motion for both the instrument holder, and the instrument insert. The medical implement may be remotely controllable by a user, manipulating a manually controllable device, which device is connected to the drive unit through an electrical drive control element.[0023]
• In another embodiment, a slave station of a robotic surgery system is provided in which manipulations by a surgeon control motion of a surgical instrument at a slave station. The slave station includes a support, mechanical cabling, and a plurality of motors. The support is manually portable and is provided to hold the surgical instrument at a position over an operating table so that the instrument may be readily disposed at an operative site. Mechanical cabling is coupled to the instrument for controlling movement of the instrument. The plurality of motors are controlled, by way of a computer interface, and by surgeon manipulations for driving the mechanical cabling. The mechanical cabling is driven by the plurality of motors in a manner so as to be attachable and detachable from the plurality of motors.[0024]
• In a preferred embodiment, a two section housing is provided, one housing section accommodating the ends of the mechanical cabling and the other housing section accommodating the plurality of motors. The two housing sections are respectively attachable and detachable. A plurality of coupler spindles supported by the one housing section receive cables of the mechanical cabling. The plurality of coupler spindles and plurality motors are disposed in aligned arrays. A plurality of coupler disks of the other housing section are provided, one associated with and supported by each motor by the plurality of motors. The housing sections support the coupler spindles and the coupler disks in aligned engagement. An engagement element may lock the coupler spindles and disks against relative rotation.[0025]
• In a further embodiment, a robotic surgery system is provided, including an instrument, a support, mechanical cabling, an array of actuators, and an engagement member. The support is manually portable and holds the instrument over an operating table so that the instrument may be disposed at an operative site in a patient for remote control thereof via a computer interface. The mechanical cabling is coupled to the instrument for controlling movement of the instrument. An array of electrically driven actuators is controlled by the computer interface for driving the mechanical cabling. An engagement member intercouples between the mechanical cabling and the array of actuators so that the mechanical cabling is readily attachable to and detachable from the array of actuators.[0026]
• In another aspect of the invention, there is provided a robotic surgery apparatus comprising: a mechanically drivable surgical instrument for use at an internal operative site of a subject; an electrically driven drive unit for driving the surgical instrument; mechanical cabling drivably intercoupled to the surgical instrument at one end of the cabling; the mechanical cabling having another end which is readily drivably couplable to and decouplable from the drive unit.[0027]
• In another aspect of the invention, there is provided a robotic surgery apparatus comprising: a surgical instrument for use at an internal operative site of a subject; a mechanically drivable mounting unit on which the surgical instrument is mounted, the mounting unit being drivably movable outside the operative site of the subject; an electrically driven drive unit for driving movement of the mounting unit; mechanical cabling drivably intercoupled to the mounting unit at one end of the cabling; the mechanical cabling having another end which is readily drivably couplable to and decouplable from the drive unit.[0028]
• In another aspect of the invention there is provided a robotic surgery apparatus comprising: a mechanically drivable surgical instrument for use at an internal operative site of a subject; an electrically driven drive unit for driving the surgical instrument; mechanical cabling drivably intercoupled to the surgical instrument at one end of the cabling; the drive unit being readily manually portable and readily attachable to and detachable from a fixed support on or relative to which the subject is mounted.[0029]
• These and other embodiments are described in the following detailed description section.[0030]
• Disposability[0031]
• Another aspect of the invention is to provide a disposable medical procedure instrument which includes a mechanically drivable mechanism for driving a tool.[0032]
• Disposable or disposability generally means that a device or mechanism is used or intended for a single use without a re-use of the device/mechanism and/or without the necessity or intention of a use of the device followed by sterilization of the device for an intended re-use. In practice, a device which is intended for one time or single use may be re-used by the user/physician but such re-use more than once, twice or a very limited number of times is not intended for a disposable device or mechanism.[0033]
• In one embodiment, a medical procedure instrument is provided including a disposable implement and a mounting mechanism interconnected to a drive mechanism. The disposable implement includes a shaft having a tool at its distal end and a mechanically drivable mechanism drivably interconnected to the tool. A mounting mechanism, interconnected to the drive mechanism, enables the mechanically drivable mechanism of the implement to be removably mounted on the mounting mechanism for drivable interconnection to the drive mechanism. The shaft is insertable into a patient along a select length of the shaft to position the tool at a target site in the patient. The shaft together with the mechanically drivable mechanism is disposable.[0034]
• At various embodiments, the drive mechanism is drivably interconnected to the mounting mechanism at a first interface which is remote from a second interface at which the mechanically drivable mechanism is mounted to the mounting mechanism. The drive mechanism may include a plurality of motors, and the mounting mechanism is preferably attachable and detachable from the drive mechanism. The mounting mechanism may include a guide tube, through which the shaft is inserted into the patient, and wherein the mounting mechanism includes a drivable mechanism for mechanically driving the guide tube.[0035]
• Preferably, the disposable instrument can be removed from the mounting mechanism and discarded after use, while the mounting mechanism can be removed from the drive mechanism and sterilized for reuse.[0036]
• The disposable implement is preferably remote controllably drivable by a user via a manually controllable mechanism which is electrically connected to the drive mechanism through an electrical drive control mechanism.[0037]
• Preferably, the mounting mechanism and the disposable implement are manually portable in a sterile field, while the drive mechanism is outside the sterile field.[0038]
• In another embodiment, a medical procedure instrument is provided which is a disposable instrument, drivably interconnectable to and disconnectable from a drive mechanism, the disposable instrument including a mechanically drivable interface, drivably interconnected through a shaft to a tool, the mechanically drivably interface being drivably engageable with and disengageable from a second drive interface which is drivably interconnected to the drive mechanism. Preferably, the mechanically drivable interface and the shaft are an integral disposable unit. The disposable implement may be remote controllably drivable by a user via a manually controllable mechanism which is electrically interconnected to the drive mechanism through an electrical drive control mechanism. The second drive interface may be manually portable in a sterile field. After use, the second drive interface is sterilized for reuse. The drive mechanism is outside the sterile field.[0039]
• In yet another embodiment, a surgical instrument system is provided positionable within an anatomic body structure and controllable by an operator. The system contains a guide member, a support, and an integral instrument member. The guide member has a proximal end and a distal end. The support positions the guide member with the proximal end outside the anatomic body structure and the distal end within the anatomic body structure adjacent to the operative site. An integral instrument member, disposable as a unit, includes a mechanical drivable element, a stem section and a distal tool. The instrument member is removably engageable with the guide member.[0040]
• In various embodiments, each of the instrument member and guide member has a coupler, the couplers being removably engageable in order to drive the mechanical drivable element of the instrument member. At least one motor is provided remote from the guide member and instrument member, and mechanical cabling is provided from the motor to the instrument member coupler via the guide member coupler to provide at least 1 degree-of-freedom of motion of the instrument member. The couplers may include interengageable wheels. The guide member coupler is pivotal to facilitate the removable engagement of the guide member and instrument member.[0041]
• In one embodiment, the guide member includes a base piece, and a guide tube extending from the base piece, wherein the coupler is pivotally supported from the base piece. The instrument member stem section has a mechanical cabling extending therethrough from the instrument member coupler to the distal tool. The instrument member stem section may include sections with different amounts of flexibility. The guide tube includes a straight section, and a more distal curved section. When the instrument member engages with the guide member, the more flexible stem section is disposed in the guide tube curved section. An electromechanical drive member may be provided remote from the guide tube and instrument member, having only mechanical coupling to the guide tube and instrument member. The mechanical coupling may control rotation of the guide tube as well as rotation of the instrument stem within the guide tube.[0042]
• In another embodiment, a disposable integral medical instrument is provided including a mechanical coupler, an elongated stem, and a tool. The mechanical coupler is at the proximal end of instrument for receiving mechanical drive from a drive unit. The elongated stem extends from the mechanical coupler. The tool is disposed at the distal end of the elongated stem and is interconnected, via the elongated stem, to the mechanical coupler. The elongated stem enables removable insertion in an instrument holder to position a tool at a target site inside a patient for performing a medical procedure.[0043]
• Preferably, the disposable integral medical instrument is attachable to and detachable from an instrument holder in order to couple mechanical drive from a remote drive unit. The mechanical coupler includes at least one interlocking wheel for coupling with the instrument holder. The mechanical coupler includes mechanical cabling extending to the tool. The stem is mounted to enable rotation of the stem relative to the mechanical coupler. A wrist joint may be provided at the distal end of the stem, coupling to the tool. The elongated stem may have a more distal flexible section. The instrument may have a means for registering the mechanical coupler with an instrument holder.[0044]
• In another aspect of the invention, there is provided a disposable surgical instrument comprising: a disposable elongated tube having a tool mounted at a distal end of the tube; one or more disposable cables drivably interconnected between the tool and a drive unit, the one or more disposable cables extending through the disposable tube between the tool and a proximal end of the disposable tube. The apparatus preferably includes a guide tube having an open distal end, the guide tube being readily manually insertable through an incision in a subject to position the distal end at an operative site within the subject, the disposable elongated tube being readily insertable through the guide tube to position the tool through the open distal end of the guide tube. The apparatus preferably also includes a manually portable support readily fixedly attachable to and detachable from a stationary structure on or relative to which the subject is mounted, the guide tube being readily fixedly interconnectable to and disconnectable from the support for fixedly positioning the distal end of the guide tube at the operative site. The drive unit is preferably mounted remotely from the operative site and is drivably interconnected to the one or more cables extending through the disposable tube by one or more cables extending between the drive unit and the proximal end of the disposable elongated tube.[0045]
• In another embodiment of the invention there is provided a disposable surgical instrument comprising: a disposable elongated tube having a tool mounted at a distal end of the tube; a disposable mechanically drivable interface mounted at a proximal end of the disposable tube, the tool being drivably intercoupled to a drive unit via the disposable mechanically drivable interface.[0046]
• These and other features of the invention are set forth more fully in the following detailed description.[0047]
• Translation and Other Movement Capability[0048]
• Another aspect of the invention relates to controlled movement of a surgical instrument system having a distal end positionable within a patient. More specifically, the controlled movement may be limited to translation in a predetermined plane. This controlled movement specifies certain degrees-of-freedom of the surgical instrument, including a guide tube that receives an instrument member having a tool at its distal end. Such movement may be remotely controlled via computer control in response to movements by a surgeon at an input interface.[0049]
• In one embodiment, a surgical instrument system is provided that is adapted to be inserted through an incision of a patient for operation by a surgeon from outside the patient. The system includes an arm member, a support for the arm member and an instrument member. The arm member has a proximal end disposed outside the patient and a distal end internal of the patient. A support for the arm member provides controlled translation of the arm member with a proximal end thereof moving substantially only in a predetermined plane. The instrument member is carried by the arm member and includes a tool disposed at the distal end of the arm member.[0050]
• In a preferred embodiment, a controller responsive to a surgeon manipulation controls movement of the arm member and of the tool. The surgeon may be positioned at a master station having an input interface, at which the surgeon manipulates an input device. The controller may allow a number of degrees-of-freedom of the tool and of the arm member. In one embodiment, the tool has 4 degrees-of-freedom, while the arm member has 3 degrees-of-freedom. More specifically, the arm member may have one degree-of-freedom in the predetermined plane. The arm member may have another degree-of-freedom that is rotation of the arm member about a longitudinal axis of the arm member. The arm member may have a further degree-of-freedom that is linear movement of the arm member along the longitudinal axis of the arm member. The tool may have one degree-of-freedom that is rotation of the instrument member about a longitudinal axis of the instrument member. The tool may have another degree-of-freedom that is pivotal in a second plane orthogonal to the first plane. The tool may have jaws and a further degree-of-freedom may be provided enabling opening and closing of the jaws.[0051]
• The support for the arm member may include a support post for positioning the arm member over an operating table upon which a patient is placed. Preferably, the support post positions the arm member at an acute angle to the operating table. The arm member may include a guide tube that receives the instrument member.[0052]
• In another embodiment, a surgical instrument system is provided adapted to be inserted through an incision in a patient for operation by a surgeon from outside the patient. The system may include an instrument member having a tool at its distal end. The guide member has a guide tube with a proximal end disposed outside the patient and a distal end internal of the patient. The guide tube has an elongated portion with a central access of rotation and a distal portion having an end which is positioned a radial distance away from the central access. The support for the guide member provides controlled translation of the guide member with the proximal end thereof moving substantially only in a predetermined plane.[0053]
• In various embodiments, a drive unit is coupled to the guide tube for rotating the guide tube and thereby displacing the tool with respect to the central access. Preferably, the distal portion of the guide tube is curved so as to displace the end thereof the radial distance away from the central access. When combined with translation in the plane, the rotation of the guide tube enables three-dimensional placement of the instrument tool.[0054]
• The instrument member may include a coupler for engaging the instrument member to the guide member, and an elongated section that is, at least, partially flexible for insertion into the guide tube. The instrument member may include in its distal end at least two adjacent link members intercoupled by way of at least one joint, and at least one cable extending along at least one of the link members for operating the adjacent link member. Separate cable sections may be coupled to opposite sides of the adjacent link members for enabling pivoting in either direction of the adjacent link member relative to the at least one link member.[0055]
• The instrument member can be readily engageable and disengageable with the guide member and constructed to enable exchange with other instrument members. The instrument member may be disposable.[0056]
• The instrument member may be couplable to and decouplable from a drive unit, the drive unit being controlled by a controller for operating the instrument member. The drive unit may be disposed remote from a sterile field in which the patient and instrument member are disposed.[0057]
• In another embodiment, an instrument system is provided, including a user interface, an instrument, a support, a controller, and a drive unit. A surgeon may manipulate an input device at the user interface. The instrument has a distal end internal of the patient and carrying at its distal end a tool used in executing a procedure at an operative site of the patient. The support for the instrument includes a pivot at the proximal end of the instrument that limits motion of the proximal end of the instrument substantially only in one plane. The controller receives commands from the user interface for controlling movement of the instrument. A drive unit intercouples with the controller and the instrument.[0058]
• In a preferred embodiment, the instrument includes an adapter and an instrument insert. The adapter may have a guide tube with an elongated portion having a longitudinal access of rotation and a distal end that is positioned a radial distance away from the longitudinal access. When the distal end of the guide tube is curved, the distal end will orbit about the longitudinal access as the guide tube is rotated under control from the user interface. The insert may be removably couplable with the adapter and include an elongated stem having a tool at its distal end. The adapter and insert may each include a coupler for lateral relative coupling and decoupling of the adapter and insert. The instrument coupler may include a series of wheels that engage with a series of wheels on the adapter coupler.[0059]
• The instrument insert may have an elongated stem which includes a more flexible stem section disposed distally of a less flexible stem section. Alternatively, the full length of the elongated stem may be flexible. A wrist link, intercoupling a more flexible stem section with the tool, provides one degree-of-freedom of the tool.[0060]
• In another embodiment of the invention there is provided a remotely controlled surgical instrument system that is adapted to be inserted through an incision of a patient for operation by a surgeon from outside the patient in a remote location, the system comprising: an elongate tube having a proximal end disposed outside the patient and a distal end internal of the patient; a support for the elongate tube that provides controlled translation of said elongate tube with the proximal end thereof moving substantially only in a predetermined plane; and the elongate tube having an axis and a tool mounted on a distal end of the tube, the elongate tube being curved along a distal length of the elongate tube and controllably rotatable around the axis such that the tool is movable in a circle or an additional two degrees of freedom internal of the patient by rotation of the arm member.[0061]
• These and other features of the invention are described in the following detailed description.[0062]
• Portability[0063]
• Another aspect of the invention is to provide readily manually portable components positionable in close proximity to a patient within the sterile field, without unduly reducing access to the patient or otherwise interfering with the procedure.[0064]
• In one embodiment, a portable remotely controllable surgical instrument is provided including a shaft, a mounting mechanism and a drive unit. A manually portable elongated shaft is provided having a proximal end and a distal end manually positionable at an operative site within a subject upon insertion of the shaft through an incision in the subject. A manually portable mounting mechanism is readily manually mountable in a fixed position outside the patient through the incision, the proximal end of the portable shaft being mounted thereon. A manually portable drive unit is drivably interconnected through the mounting mechanism to a tool mounted at the distal end of the portable shaft. The drive unit is readily manually positionable at a selected position outside the patient.[0065]
• In various embodiments, the drive unit is controllably drivable by a computer. The proximal end of the portable shaft is readily manually mountable on the portable mounting mechanism for enabling readily drivable intercoupling of the tool to the drive unit. The portable shaft may be disposable. The drive unit may be readily manually mountable at a position remote from the incision.[0066]
• In another embodiment, there is provided a portable remotely controllable surgical apparatus comprising: a manually portable elongated shaft having a proximal end and a distal end manually positionable at an operative site within a subject upon insertion of the shaft through an incision in the subject; a manually portable mounting mechanism being readily manually mountable in a fixed position outside the patient near the incision, the proximal end of the portable elongated shaft being mounted thereon; a manually portable support for fixedly positioning the manually portable mounting mechanism in a selected location relative to the subject, the manually portable support being readily fixedly attachable to and detachable from a stationary structure on or relative to which the subject is mounted. A portable drive unit is preferably drivably intercoupled through the mounting mechanism to a tool mounted at the distal end of the portable shaft; wherein the drive unit is readily positionable at a selected position outside and remote from the incision. The surgical instrument may include one or more mechanically drivable components drivably intercoupled to a drive unit, the apparatus further comprising mechanical cabling drivably coupled to the one or more components at one end of the cabling, the mechanical cabling being readily drivably couplable to and decouplable from the drive unit at another end of the mechanical cabling.[0067]
• In another embodiment there is provided a portable remotely controllable surgical apparatus comprising: a manually portable elongated shaft having a proximal end and a distal end manually positionable at an operative site within a subject upon insertion of the shaft through an incision in the subject; a manually portable mounting mechanism being readily manually mountable in a fixed position outside the patient near the incision, the proximal end of the portable elongated shaft being mounted thereon; a portable drive unit drivably interconnected to the portable elongated shaft through the mounting mechanism; mechanical cabling drivably coupled to the mounting mechanism at one end of the cabling and readily drivably couplable to and decouplable from the portable drive unit at another end of the cabling. The mounting mechanism typically includes one or more mechanically drivable components for moving the mounting mechanism outside the subject, the one or more mechanically drivable components being drivably interconnected to the drive unit through the mechanical cabling.[0068]
• These and other features of the invention are set forth in greater detail in the following detailed description section.[0069]
• User Control Apparatus[0070]
• Another aspect of the invention is to provide, in a master/slave surgery system, a master station which includes upper and lower positioner assemblies, movably connected, including an arm assembly with a distal hand assembly for engagement by the surgeon's hand.[0071]
• In one embodiment, a master station is adapted to be manually manipulated by a surgeon to, in turn, control motion to a slave station at which is disposed a surgical instrument. The master station includes a lower positioner assembly, an upper positioner assembly and an arm assembly. The upper positioner assembly is supported over and in rotational engagement with the lower positioner assembly to enable a lateral side-to-side surgical manipulation. An arm assembly has at its distal end a hand assembly for engagement by a surgeon's hand, and a proximal end pivotally supported from the upper positioner assembly to enable an orthogonal forward and back surgeon manipulation in a direction substantially orthogonal to the lateral surgeon manipulation.[0072]
• In various preferred embodiments, the arm assembly includes a proximal arm member and a distal arm member joined by a rotational joint. A position encoder is disposed at a rotational joint detects rotation of the distal arm member. A pivotal joint connects the hand assembly to the distal end of the distal arm member, this movement being responsive to a pivotal movement of a surgeon's wrist.[0073]
• The hand assembly may include a base piece with a pair of holders coupled with a base piece. One of these holder is adapted to receive a thumb and the other adapted to hold a forefinger. Each holder may comprise a metal bar positioned along the thumb or forefinger and a Velcro loop for attaching the thumb or finger to the bar. The hand assembly may further include a pair of rotating element pivotally supported from opposite ends of the base piece. One of these holders is secured to one of the rotating elements so that the surgeon can move one holder toward and away from the other holder. The pivotal joint that connects the hand assembly to the distal end of the distal arm is connected to the other rotating element, to account for rotational motion at the surgeon's wrist.[0074]
• In another embodiment, a master station of a master/slave surgery system includes a base, an arm assembly pivotally supported from the base, and a hand assembly pivotally supported from the arm assembly, wherein the hand assembly includes a finger holder and a thumb holder and wherein the holders are supported for relative movement therebetween. The hand assembly may include a base piece for the holders, wherein the thumb holder is fixed in position relative to a base piece and the finger holder rotates from the base piece.[0075]
• In another embodiment, a master station of a master/slave surgery system includes a base, an arm assembly pivotally supported from the base, and a hand assembly pivotally supported from the arm assembly, the hand assembly including a guide shaft adapted to be grasped by the surgeon, an actuator on the guide shaft, and a multiple rotation joint attaching the guide shaft to the arm assembly.[0076]
• In yet another embodiment, a template is provided secured to the support which holds the surgical instrument, for locating the position of the support and subsequently the position of the surgical instrument, relative to the incision point of the patient. This enables an accurate placement of the instrument at an operative site internal to the patient.[0077]
• These and other features of the present invention are described in greater detail in the following detailed description section.[0078]
• Electronic Controls and Methodology[0079]
• The invention also provides a method of controlling a surgical instrument that is inserted in a patient for facilitating a surgical procedure and controlled remotely from an input device manipulated by a surgeon at a user interface, the method comprising the steps of: initializing the position of the surgical instrument without calculating its original position, and the position of the input device under electronic control; the initializing including establishing an initial reference position for the input device and an initial reference position for the surgical instrument; calculating the current absolute position of the input device as it is manipulated by the surgeon; determining the desired position of the surgical instrument based upon: the current position of the input device, the reference position of the input device, and the reference position of the surgical instrument, and moving the surgical instrument to the desired position so that the position of the surgical instrument corresponds to that of the input device. The input device typically has position sensors, and the step of initializing includes initializing these position sensors. The initializing is preferably to zero. The method may include computing an initial reference orientation for the input device, computing a desired orientation for the surgical instrument and/or computing a desired position for the surgical instrument. The initializing step may include performing a forward kinematic computation from the input device. The method may include reading position sensor values and current time. The calculating step may include calculating both the position and orientation of the input device. The method may further include calculating the current orientation of the input device. The step of determining may include performing an inverse kinematic computation and/or a transformation into an earth coordinate system From the transformation determined joint angles and drive motor angles for the surgical instrument orientation may be determined.[0080]
• In another embodiment, there is provided a method of controlling a tool of a surgical instrument that is inserted in a patient for carrying out a surgical procedure and is controlled remotely by way of a controller from an input device at a user interface, the method comprising the steps of the input device at an initial reference configuration and under controller control; setting the surgical instrument in the patient at an initial predefined reference configuration without controller control; calculating the current absolute position of the input device; determining the desired location of the tool by a kinematic computation that accounts for at least the initial reference configuration of the input device and the current absolute position of the input device; and moving the surgical instrument to the desired position so that the location of the tool corresponds to that of the input device. The step of determining may also be based upon the initial reference configuration of the tool.[0081]
• In another embodiment, there is provided a system for controlling an instrument that is inserted in a patient to enable a surgical procedure and controlled remotely from an input device controlled by a surgeon at a user interface, the system comprising: a base; a first link rotatably connected to the base; an elbow joint for rotatably connecting the second link to the first link; a handle; a wrist member connecting the handle to the distal end of the second link; and a controller coupled to at least the base and links and for receiving signals representative of: a rotational position of the base, a rotational position of the first link relative to the base, and a rotational position of the second link relative to the first link.[0082]
• In another embodiment, there is provided a control system for an instrument that is controlled remotely from an input device, the system comprising: a forward kinematics block for computing the position of the input device; an initialization block for storing an initial reference position of the input device; an inverse kinematics block coupled from the forward kinematics block and the initialization block for receiving information from the forward kinetics block of the current input device position; and a controller block coupled from the inverse kinematics block for controlling the position of the instrument in response to manipulations at the input device. Such a control system may include a scaling block coupled between the forward kinematics block and the inverse kinematics block for scaling motions imparted at the input device. The system may also include an output from the forward kinematics block directly to the inverse kinematics block representative of current input device orientation. The system may also include a combining device coupled from the forward kinematics block and the initialization block to the scaling block for providing a signal to the inverse kinematics block representative of desired instrument position. The input device typically includes a wrist and a handle and the position of the wrist is expressed in x, y and z coordinates. The orientation of the handle is typically determined by a series of coordinate transformations. Such system may include a transformation matrix for the handle coordinate frame with respect to a reference coordinate frame, a transformation matrix R[0083]_whfor the wrist joint coordinate with respect to a reference coordinate, and a transformation matrix R_hwhfor the handle coordinate with respect to the wrist coordinate. The transformation matrix R_hfor the handle coordinate with respect to the reference coordinate may be R_h=R_whR_hwh.
• In another embodiment there is provided a method of controlling a medical implement remotely from an input device that is controlled by an operator, the method comprising the steps of positioning the medical implement at an initial start position at an operative site for the purpose of facilitating a medical procedure; establishing a fixed position reference coordinate representative of the initial start position of the medical implement based upon a base point of the implement and an active point of the implement being in a known relative dimensional configuration, positioning the input device at an initial start position; establishing a fixed position reference coordinate representative of the initial start position of the input device; calculating the current position of the input device as it is controlled; determining the desired position of the medical implement based upon; the current position of the input device, the fixed position reference coordinate of the input device, and the fixed position reference coordinate of the medical implement, and moving the medical implement to the desired position so that the position of the medical implement corresponds to that of the input device.[0084]
• In another embodiment there is provided a method of controlling a surgical instrument remotely from an input device and by way of an electronic controller, the method comprising the steps of: inserting the surgical instrument through an incision in the patient so as to dispose the distal end of the instrument at an initial start position; establishing a fixed position reference coordinate system corresponding to a fixed known position on the surgical instrument at the initial start position of the surgical instrument; positioning the input device at an initial start position; establishing a fixed position reference coordinate system representative of the initial start position of the input device; calculating the current absolute position of the input device as it is controlled; determining the desired position of the surgical instrument based upon the current absolute position of the input device, and the fixed position reference coordinate system for the respective surgical instrument and input device; and moving the surgical instrument to the desired position so that the position of the surgical instrument corresponds to that of the input device.[0085]
• The invention also provides a program of instructions for the processor which include: receiving an insertion length of a medical instrument inserted in a patient; and determining a distal end location of the instrument at a target site in the patient from the insertion length. The instrument typically has a straight proximal portion and curved distal portion, lies in a single plane and is a rigid guide member. The instrument is typically inserted and then fixed at a pivot axis outside the patient. The pivot axis is generally aligned with an insertion point at which the instrument is inserted into the patient. The program of instructions may include determining a subsequent location of the distal end associated with pivoting about the pivot axis. The program of instructions may include determining a subsequent location of the distal end associated with axial rotation of the instrument, determining a subsequent location of the distal end associated with linear translation along a length axis of the instrument and/or determining a subsequent movement of the distal end in a single plane about the pivot axis. The pivotal axis is typically a reference point used by the program of instructions in determining subsequent movement of the distal end.[0086]
• The invention also provides a processor and a memory device containing a program of instructions for the processor which include: receiving a coordinate representative of the desired location of the distal end of a medical instrument at a target site in a patient; and determining from the coordinate an insertion length for the medical instrument so as to locate the distal end at the target site.[0087]
• These and other features of the present invention are described in greater detail in the following detailed description section.[0088]
DESCRIPTION OF DRAWINGS
• FIG. 1 is a perspective view illustrating one embodiment of the robotic system of the present invention;[0089]
• FIGS.[0090]1A-1C are three views of a flexible cannula for use with the embodiment of FIG. 1;
• FIG. 2A is a schematic diagram illustrating the degrees-of-freedom associated with the master station;[0091]
• FIG. 2B is a schematic diagram illustrating the degrees-of-freedom associated with the slave station;[0092]
• FIG. 2C shows a functional schematic diagram of the surgical adapter component of the system of FIG. 1;[0093]
• FIG. 2D shows a functional schematic diagram of the instrument insert component of the system of FIG. 1;[0094]
• FIG. 3 is a perspective view of the positioner assembly at the master station;[0095]
• FIG. 4 is an exploded perspective view also of the positioner assembly at the master station;[0096]
• FIG. 5 is a partially exploded view of the hand assembly portion associated with the positioner assembly;[0097]
• FIG. 6 is a cross-sectional view of the hand assembly as taken along line[0098]6-6 of FIG. 3;
• FIG. 7 is a cross-sectional view at the master station as taken along lines[0099]7-7 of FIG. 3;
• FIG. 7A is a schematic perspective view of the yoke assembly portion of the positioner assembly;[0100]
• FIG. 8 is a perspective view of the slave station;[0101]
• FIG. 8A is a perspective view of an alternative adjustable clamp member at the slave station;[0102]
• FIG. 8B is a top plan view of the clamp of FIG. 8A;[0103]
• FIG. 8C is a side view of the clamp of FIGS. 8A and 8B as taken along[0104]line8C-8C of FIG. 8B;
• FIG. 8D is a perspective view of a template used with this embodiment;[0105]
• FIG. 8E is a schematic cabling diagram illustrating one cable arrangement used to operate a tool;[0106]
• FIG. 8F is an exploded perspective view of another version of the cable drive mechanism and tool in accordance with the present invention;[0107]
• FIG. 8G is a schematic perspective view similar to that illustrated in FIG. 8F but specifically showing the cabling construction,[0108]
• FIG. 8H is a partially broken away front elevational view as taken along[0109]line8H-8H of FIG. 8F;
• FIG. 8I is a top plan cross-sectional view taken along line[0110]8I-8I of FIG. 8H;
• FIG. 8J is a further cross-sectional top plan view as taken along[0111]line8J-8J of FIG. 8H,
• FIG. 8K is a cross-sectional side view as taken along[0112]line8K-8K of FIG. 8H;
• FIG. 8L is a cross-sectional rear view of the coupler spindle and disk as taken along[0113]line8L-8L of FIG. 8K.
• FIG. 9 is a view at the slave station taken along line[0114]9-9 of FIG. 8;
• FIG. 10 is a side elevation view at the slave station taken along line[0115]10-10 of FIG. 9;
• FIG. 11 is a perspective view at the slave station;[0116]
• FIG. 11A is a cross-sectional view as taken along[0117]line11A-11A of FIG. 11;
• FIG. 11B is a cross-sectional view as taken along[0118]line11B-11B of FIG. 11A;
• FIG. 11C is a cross-sectional view as taken along[0119]line11C-11C of FIG. 11A;
• FIG. 12 is a cross-sectional view as taken along line[0120]12-12 of FIG. 11;
• FIG. 13 is a cross-sectional view as taken along line[0121]13-13 of FIG. 12;
• FIG. 14 is a cross-sectional view as taken along line[0122]14-14 of FIG. 12;
• FIG. 15 is a perspective view at the slave station showing the instrument insert being removed from the adapter;[0123]
• FIG. 15A is a top plan view of the instrument insert itself;[0124]
• FIG. 16A is a perspective view at the tool as viewed along[0125]line16A-16A of FIG. 11;
• FIG. 16B is an exploded perspective view of the tool of FIG. 16A;[0126]
• FIG. 16C is a fragmentary perspective view of an alternative tool referred to as a needle driver;[0127]
• FIG. 16D is a side elevation view of the needle driver of FIG. 16C;[0128]
• FIG. 16E is a perspective view of an alternate embodiment of the tool and wrist construction;[0129]
• FIG. 16F is an exploded perspective view of the construction illustrated in FIG. 16E;[0130]
• FIG. 16G is a fragmentary perspective view showing a portion of the bending section;[0131]
• FIG. 16H is a plan view of the flexible wrist member associated with the construction of FIGS.[0132]16E-16G.
• FIG. 16I is a perspective view of still another embodiment of a flexible end tool;[0133]
• FIG. 16J is an exploded perspective view of the construction illustrated in FIG. 16I;[0134]
• FIG. 16K is a fragmentary perspective view showing further details of the bending section;[0135]
• FIG. 17 is a perspective view of the drive unit at the slave station;[0136]
• FIG. 17A is a schematic front view of the drive unit at the slave station;[0137]
• FIG. 18 is a schematic perspective view of an alternative hand piece for use at the master station;[0138]
• FIGS.[0139]19A-19D are schematic diagrams showing alternate positions of the guide tube of the adapter;
• FIG. 20 is a block diagram of the controller used with the robotic system of this embodiment;[0140]
• FIG. 21 is a block diagram of further details of the controller, including the module board;[0141]
• FIG. 22 is a block diagram of a control algorithm in accordance with the present embodiment; and[0142]
• FIGS.[0143]23-28 are a series of schematic diagrams of the input device position and resulting instrument position relating to the algorithm control of the present embodiment.
DETAILED DESCRIPTION
• A. Overview of Surgical Robotic System (FIGS.[0144]1-2)
• An embodiment of a surgical robotic system of the present invention is illustrated in the accompanying drawings. The described embodiment is preferably used to perform minimally invasive surgery, but may also be used for other procedures such as endoscopic or open surgical procedures.[0145]
• FIG. 1 illustrates a[0146]surgical instrument system10 that includes a master station M at which asurgeon2 manipulates a pair ofinput devices3, and a slave station S at which is disposed a pair ofsurgical instruments14. The surgeon is seated in acomfortable chair4 with his forearms resting uponarmrests5. His hands manipulate theinput devices3 which cause a responsive movement of thesurgical instruments14.
• A[0147]master assembly7 is associated with the master station M and aslave assembly8 is associated with the slavestation S. Assemblies7 and8 are interconnected by cabling6 to acontroller9.Controller9 has one or more display screens enabling the surgeon to view a target operative site, at which is disposed a pair oftools18. The controller further includes a keyboard for inputting commands or data.
• As shown in FIG. 1, the[0148]slave assembly8, also referred to as a drive unit, is remote from the operative site and is positioned outside of the sterile field. In this embodiment, the sterile field is defined above the plane of the top surface of the operating table T, on which is placed the patient P. Thedrive unit8 is controlled by a computer system, part of thecontroller9. The master station M may also be referred to as a user interface, whereby commands issued at the user interface are translated by the computer into an electrical signal received bydrive unit8. Eachsurgical instrument14, which is tethered to thedrive unit8 through mechanical cabling, produces a desired responsive motion.
• Thus, the[0149]controller9 couples the master station M and the slave station S and is operated in accordance with a computer program or algorithm, described in further detail later. The controller receives a command from theinput device3 and controls the movement of the surgical instrument in a manner responsive to the input manipulation.
• With further reference to FIG. 1, associated with the patient P are two separate[0150]surgical instruments14, one on either side of anendoscope13. The endoscope includes a camera mounted on its distal end to remotely view the operative site. The dashed line circle in FIG. 2B, labeled OS, is an example of the operative site). A second camera may be positioned away from the site to provide an additional perspective on the medical procedure or surgical operation. It may be desirable to provide the endoscope through an orifice or incision other than the one used by the surgical instrument. Here three separate incisions are shown, two for thesurgical instruments14,14 and a centrally disposed incision for theviewing endoscope13. A drape over the patient has a single opening for the three incisions.
• Each of the two[0151]surgical instruments14 is generally comprised of two basic components, an adaptor or guidemember15 and an instrument insert ormember16. Theadaptor15 is a mechanical device, driven by an attached cable array fromdrive unit8. Theinsert16 extends through theadaptor15 and carries at its distal end thesurgical tool18. Detailed descriptions of the adapter and insert are found in later drawings.
• Although reference is made to “surgical instrument” it is contemplated that this invention also applies to other medical instruments, not necessarily for surgery. These would include, but are not limited to catheters and other diagnostic and therapeutic instruments and implements.[0152]
• In FIG. 1 there is illustrated[0153]cabling12 coupling theinstrument14 to thedrive unit8. Thecabling12 is readily attachable and detachable from thedrive unit8. Thesurgical adaptor15, which supports the instrument at a fixed reference point is of relatively simple construction and may be designed for a particular surgical application such as abdominal, cardiac, spinal, arthroscopic, sinus, neural, etc. As indicated previously, theinstrument insert16 is couplable and decouplable to theadaptor15, and provides a means for exchanging instrument inserts, with then attached tools. The tools may include, for example, forceps, scissors, needle drivers, electrocautery, etc.
• Referring again to FIG. 1, the[0154]overall system10 includes a surgeon'sinterface11, computer system orcontroller9, driveunit8 andsurgical instruments14. Eachsurgical instrument14 is comprised of aninstrument insert16 extending throughadapter15. During use, a surgeon manipulates theinput device3 at the surgeon'sinterface11, which manipulation is interpreted bycontroller9 to effect a desired motion of thetool18 within the patient.
• Each[0155]surgical instrument14 is mounted on a separaterigid support post19 which is illustrated in FIG. 1 as removably affixed to the side of the surgical table T. This mounting arrangement permits the instrument to remain fixed relative to the patient even if the table is repositioned. Although twoinstruments14 are shown here, the invention can be practiced with more or with only a single surgical instrument.
• Each[0156]surgical instrument14 is connected to thedrive unit8 by two mechanical cabling (cable-in-conduit) bundles21 and22. Thesebundles21 and22 terminate at connection modules, illustrated in FIG. 8F, which are removably attachable to thedrive unit8. Although two cable bundles are used here, more or fewer cable bundles may be used. Also, thedrive unit8 is preferably located outside the sterile field as shown here, although in other embodiments the drive unit may be draped with a sterile barrier so that it may be located within the sterile field.
• In a preferred technique for setting up the system, a distal end of the[0157]surgical instrument14 is manually inserted into the patient through an incision or opening. Theinstrument14 is then mounted to therigid post19 using a mountingbracket25. The cable bundles21 and22 are then passed away from the operative area to thedrive unit8. The connection modules of the cable bundles are then engaged to thedrive unit8. One or more instrument inserts16 may then be passed through thesurgical adaptor15, while the adapter remains fixed in position at the operative site. Thesurgical instrument14 provides a number of independent motions, or degrees-of-freedom, to thetool18. These degrees-of-freedom are provided by both thesurgical adaptor15 and theinstrument insert16.
• The surgeon's[0158]interface11 is in electrical communication with thecontroller9. This electrical control is primarily by way of thecabling6 illustrated in FIG. 1 coupling from themaster assembly7.Cabling6 also couples from thecontroller9 to thedrive unit8. Thecabling6 is electrical cabling. Thedrive unit8 however, is in mechanical communication with theinstruments14 inmechanical cabling21,22. The mechanical communication with the instrument allows the electromechanical components to be removed from the operative region, and preferably from the sterile field.
• FIG. 2A illustrates the various movements (J[0159]1-J7) that occur at the master station M while FIG. 2B illustrates various movements (J1-J7) that occur at the slave station S. More specific details regarding FIGS. 2A and 2B are contained in a later discussion of FIGS.3-4 (with regard to the master station of FIG. 2A) and FIGS.8-9 (with regard to the slave station of FIG. 2B).
• FIG. 2C is a simplified representation of[0160]adaptor15 of the slave station, useful in illustrating the three degrees-of-freedom enabled by the adapter. The adapter as shown in FIG. 2C comprises a generally rigid outer guide tube200 (corresponding to guidetube17 in FIG. 2B) through which an inner flexible shaft, carrying atool18 at its distal end, is inserted into the patient. The adapter provides three degrees-of-freedom by way of a pivotal joint J1, a linear joint J2, and a rotary joint J3. From a fixed mountingpoint23 shown schematically at the top of FIG. 2C, the pivotal joint J1 allows theguide tube200 to pivot about a fixedvertical axis204, while maintaining the tube (both the proximalstraight portion208 and distal curved portion202) in a single plane, transverse to pivot axis204., in which lies centralhorizontal tube axis201. The linear joint J2, moves therigid guide tube200 along thissame axis201. The rotary joint J3 rotates theguide tube200 about thetube axis201. Theguide tube200 has a fixed curve or bend202 at itsdistal end203; as a result thedistal end203 will orbit in a circle about theaxis201 when thestraight portion208 of theguide tube200 is rotated about itsaxis201. Alternatively, the three degrees-of-freedom can be achieved by a structure other than acurve202, such as by means of a joint or angular end section. The point is to have thedistal end203 of thetube200 at a location spaced away from thetube axis201.
• FIG. 2C thus shows a schematic view of the three degrees of freedom of the rigid[0161]curved guide tube200. In summary, via thepivot205 theguide tube200 may rotate in a direction J1 about anaxis204. Theguide tube200 may also slide in an axial direction J2 along proximal tube axis201 (via the linear slider) and rotate in a direction J3 about the proximal tube axis201 (via a rotatable mounting at the guide tube housing). It is intended that thepoint205 at which the axes of linear movement androtation201 and204 intersect, be in linear alignment (along axis204) with the incision point illustrated in dotted outline at207, at which the guide tube enters the patient. Positioning theincision207 in substantially vertical linear alignment withpoint205 results in less trauma to the patient in the area around the incision, because movement of theguide tube17 near thepoint205 is limited.
• In addition to the three degrees-of-freedom provided by the[0162]guide tube17, thetool18 may have three additional degrees-of-freedom. This is illustrated schematically in FIG. 2D which shows an innerflexible shaft309, fixed at itsproximal end300, having a straightproximal portion301 and having a curveddistal portion302 with atool18 mounted at the distal end. Theshaft309 has a wrist joint that rotates aboutaxis306. A pair ofpinchers304,305 independently rotate as shown (J6 and J7) abouthorizontal axis308 to open and close (e.g., to grasp objects). Still further, the inner shaft can be rotated (J4) about the central axis ofproximal portion301.
• In practice, an instrument insert[0163]16 (carrying the inner shaft309) is positioned within the adaptor15 (including guide tube17), so that the movements of the insert are added to those of the adaptor. Thetool18 at the distal end ofinsert16 has twoend grips304 and305, which are rotatably coupled towrist link303, by two rotary joints J6 and J7. Theaxis308 of the joints J6 and J7 are essentially collinear. Thewrist link303 is coupled to a flexibleinner shaft302 through a rotary joint J5, whoseaxis306 is essentially orthogonal to theaxis308 of joints J6 and J7. Theinner shaft309 may have portions of differing flexibility, withdistal shaft portion302 being more flexible thanproximal shaft portion301. The morerigid shaft portion301 is rotatably coupled by joint J4 to theinstrument insert base300. The axis of joint J4 is essentially co-axial with therigid shaft301. Alternatively, theportions301 and302 may both be flexible.
• Through the combination of movements J[0164]1-J3 shown in FIG. 2C, theadaptor15 can position the curveddistal end203 ofguide tube200 to any desired position in three-dimensional space. By using only a single pivotal motion (J1), the motion of theadaptor15 is limited to a single plane. Furthermore, the fixedpivot axis204 and thelongitudinal axis201 intersect at afixed point205. At thisfixed point205, the lateral motion of theguide tube200 is minimal, thus minimizing trauma to the patient at the alignedincision point207.
• The combination of joints J[0165]4-J7 shown in FIG. 2D allow theinstrument insert16 to be actuated with four degrees-of-freedom. When coupled to theadaptor15, the insert and adaptor provide theinstrument14 with seven degrees-of-freedom. Although four degrees-of-freedom are described here for theinsert16, it is understood that greater and fewer numbers of degrees-of-freedom are possible with different instrument inserts. For example an energized insert with only one gripper may be useful for electro-surgery applications, while an insert with an additional linear motion may provide stapling capability.
• FIG. 2B shows in dotted outline a[0166]cannula487, through which theguide tube17 is inserted at the incision point. Further details of the cannula are illustrated in FIGS.1A-1C. FIG.1A is a longitudinal cross-sectional view showing acannula180 in position relative to, for example, anabdominal wall190 of the patient. FIG. 1B is a schematic view of theguide tube17 being inserted through theflexible cannula180. FIG. 1C is a schematic view of the guide tube inserted so that the proximal straight section of the tube is positioned at the incision point within the cannula, with the curved distal end of the guide tube andtool18 disposed at a target or operative site.
• The[0167]cannula180 includes arigid base182 and a flexible end orstem184. The base may be constructed of a rigid plastic or metal material, while the stem may be constructed of a flexible plastic material having a fluted effect as illustrated in FIGS.1A-1C. The length of the base is short enough that the curve in the guide tube can easily pass through a center passage or bore186 in thebase182. Thebore186 has a larger diameter than the outer diameter of theguide tube17 to facilitate passage of the guide tube through thecannula180. A diaphragm orvalve188 seals theguide tube17 within thecannula180.
• FIG. 1A shows a[0168]cap192 secured to the proximal end of the base182 by one or more o-rings194. Before theguide tube17 is inserted incannula180, aplug196 may be inserted to seal the proximal end of thebase182. Theplug196 is secured by atether198 tobase182.
• In the context of an insertable instrument system, there may generally be distinguished two types of systems, flexible and rigid. A flexible system would use a flexible shaft, which may be defined as a shaft atraumatically insertable in a body orifice or vessel which is sufficiently pliable that it can follow the contours of the body orifice or vessel without causing significant damage to the orifice or vessel. The shaft may have transitions of stiffness along its length, either due to the inherent characteristics of the material comprising the shaft, or by providing controllable bending points along the shaft. For example, it may be desirable to induce a bend at some point along the length of the shaft to make it easier to negotiate a turn in the body orifice. A mechanical bending of the tube may be caused by providing one or more mechanically activatable elements along the shaft at the desired bending point, which a user remotely operates to induce the bending upon demand. The flexible tube may also be caused to bend by engagement with a body portion of greater stiffness, which may, for example, cause the tube to bend or loop around when it contacts the more stiffer body portion. Another way to introduce a bend in the flexible shaft is to provide a mechanical joint, such as the wrist joint provided adjacent to[0169]tool18 as previously described, which, as discussed further, is mechanically actuated by mechanical cabling extending from a drive unit to the wrist joint.
• One potential difficulty with flexible shafts or tubes as just described is that it can be difficult to determine the location of any specific portion or the distal end of such shaft or tube within the patient. In contrast, what is referred to as a rigid system may utilize a[0170]rigid guide tube17 as previously described, for which the position of the distal end is more easily determined, simply based upon knowing the relevant dimensions of the tube. Thus, in the system previously described, a fixed pivot point (205 in FIG. 2C) is aligned with anincision point207. One can determine the position of therigid guide tube17, knowing the length from the fixed point to the distal end of the guide tube, which is fixed and predetermined based upon the rigid nature of the guide tube, and the known curvature of the distal end of the guide tube. The point of entry or incision point serves as a pivot point, for which rotation J1 of the guide tube about the fixedaxes204 is limited to maintaining the proximal end of the guide tube in a single plane.
• Furthermore, by inserting the more flexible shaft, carrying a[0171]tool18 at its distal end, within the rigid guide tube, the rigid guide tube in effect defines a location of the flexible shaft and its distalend location tool18.
• Also relevant to the present invention is the use of the term “telerobotic” instrument system, in which a physician or medical operator is manually manipulating some type of hand tool, such as a joy stick, and at the same time is looking at the effect of such manual manipulation on a tool which is shown on a display screen, such as a television or a video display screen, accessible to the operator. The operator then can adjust his manual movements in response to visual feedback he receives by viewing the resulting effect on the tool, shaft guide tube, or the like, shown on the display screen. It is understood that the translation of the doctor's manual movement, via a computer processor which feeds a drive unit for the inserted instrument, is not limited to a proportional movement, rather, the movement may be scaled by various amounts, either in a linear fashion or a nonlinear fashion. The scaling factor may depend on where the instrument is located or where a specific portion of the instrument is located, or upon the relative rate of movement by the operator. The computer controlled movement of the guide tube or insert shaft in accordance with the present invention, enables a higher precision or finer control over the movement of the instrument components within the patient.[0172]
• In practice, the physician, surgeon or medical operator would make an incision point, inserting the flexible cannula previously shown. He would then manually insert the rigid curved guide tube until the distal point of the guide tube was positioned at the operative site. With the guide tube aligned in a single plane, the operator would clamp the guide tube at the[0173]support bracket25 onpost19, to establish the fixed reference pivot point, (205 in FIG. 2C), with the incision point axially aligned under the fixed pivot point. The operator would then manually insert the instrument insert through the guide tube until thetool18 is extended out from the distal end of the guide tube. The wrist joint on the inner insert shaft is then positioned at a known point, based upon the known length and curvature of the rigid guide tube and distance along that length at which the incision point is disposed. Then, a physician, surgeon or medical operator located at the master station can manually adjust the hand assembly to cause a responsive movement of the inserted instrument. The computer control decides what the responsive movement at the instrument is, including one or more of movement of the guide tube, thewhole instrument14, or the flexible inner shaft or the tool at its distal end. A pivotal movement J1 will rotate the proximal end of the guide tube, causing pivoting of thewhole instrument14. An axial movement J2 of thewhole instrument14 will reposition the instrument in the single plane. A rotational movement J3 of just the guide tube results in the end of the guide tube and end of the inner shaft being taken out of the plane, following a circular path or orbit in accordance with rotation of the guide tube shaft. These three movements J1, J2 and J3 are defined as setting the position of thewrist joint303 of the tool.
• The other three movements J[0174]4-J7, are defined as setting the orientation of the instrument insert, and more specifically, a direction at which the tool is disposed with respect to the wrist joint. Central mechanical cables in the inner shaft cause motions J5-J7, J5 being the wrist movement and J6-J7 being the jaw movement of the tool. The J4 movement is for rotation of the inner shaft by its proximal axis, within the guide tube. These relative movements, and the position and orientation of the instrument insert, will be further described in a later discussion of an example of the computer algorithm for translating the movement at the master station to a movement at the slave station.
• B. The Master Station M (FIGS.[0175]3-7)
• At the master station M illustrated in FIG. 1 and shown in further detail in FIG. 3, there are two sets of identical hand controls, one associated with each hand of the surgeon. The outputs of both controls are fed to[0176]assembly7, which is secured to the surgeon'schair4 by across-brace40. In FIG. 3, thebrace40 is shown secured to thechair frame42 by means ofadaptor plate44 andbolts45.Additional bolts46, with associated nuts and washers secure the cross-brace40 in a desired lateral alignment (see double headed arrow) along theadaptor plate44. Additional bolts49 (see FIG. 4) are used for securing the cross-brace40 with abase piece48. Thebase piece48 supports lower and upper positioner assemblies, as will now be described.
• A[0177]lower positioner assembly50 is supported from thebase piece48. Anupper positioner assembly60 is supported above and in rotational engagement (see arrow J1 in FIGS. 2A and 4), in a substantially horizontal plane with the lower positioner assembly. This rotational movement J1 enables a lateral or side-to-side manipulation by the surgeon. Anarm assembly90, having a lowerproximal end90A, is pivotally supported (J2) from theupper positioner assembly60 about a substantiallyhorizontal axis60A (see FIGS. 2A and 3) to enable substantially vertical surgeon manipulation. Thearm assembly90 has an upper distal end90B (FIG. 3), carrying ahand assembly110.
• As shown in FIG. 4, the[0178]lower positioner assembly50 includes abase member51 that is secured to thebase piece48 bybolts52. It also includes abracket53 that is secured to thebase member51 by means ofbolts54. Thebracket53 supports a motor/encoder55. Avertical shaft56 that extends from theupper positioner assembly60 to thebase member51, extends through a passage in thebase member51 and is secured to apulley57 disposed under thebase member51. Abelt58 engages withpulley57 and with afurther pulley62 supported from thebracket53. Thisfurther pulley62 is on a shaft that engages apulley59. Afurther belt61intercouples pulley59 to the shaft of the motor/encoder55.
• In FIGS. 3 and 4, the[0179]base member51 andbracket53 are stationary; however, upon rotation about J1, drive is applied to thepulleys57 and59 thus applying drive to the motor/encoder55. This detects the position and movement from one position to another of theupper positioner assembly60 relative to thelower positioner assembly50.
• The[0180]upper positioner assembly60 has amain support bracket63, supporting on either side thereofside support brackets64 and66.Side bracket64 supports apulley65, whileside bracket66 supports apulley67. Abovepulley65 is anotherpulley70, while abovepulley67 is anotherpulley72.Pulley70 is supported onshaft71, whilepulley72 is supported onshaft73.
• Also supported from[0181]side support bracket64 is another motor/encoder74, disposed on one side of themain support bracket63. On the other side ofbracket63 is another motor/encoder76, supported fromside support bracket66. Motor/encoder74 is coupled to theshaft71 bypulleys65 and70 and associated belts, such as thebelt75 disposed aboutpulley65. Similarly, motor/encoder76 detects rotation of theshaft73 throughpulleys67 and72 by way of two other belts. Thepulley65 is also supported on a shaft coupling topulley70 supported byside support bracket64. A further belt goes aboutpulley70 so there is continuity of rotation from theshaft71 to the motor/encoder74. These various belts and pulleys provide a movement reduction ratio of, for example, 15 to 1. This is desirable so that any substantial movements at the master station are translated as only slight movements at the slave station, thereby providing a fine and controlled action by the surgeon.
• Extending upwardly from[0182]main support bracket63, isarm assembly90 which includes a pair of substantially parallel and spaced apart uprightproximal arms91 and92, forming two sides of a parallelogram.Arm91 is the main vertical arm, whilearm92 is a tandem or secondary arm. The bottoms ofarms91 and92 are captured betweenside plates78 and79. Thesecondary arm92 is pivotally supported by pin81 (see FIG. 4) from the forward end of theside plates78 and79. Themain arm91 is also pivotally supported between theside plates78 and79, but is adapted to rotate with theshaft71. Thus, any forward and back pivoting J2 of thearm91 is sensed through theshaft71 down to the motor/encoder74. This movement J2 in FIGS. 2A and 4 translates the forward and rearward motion at the surgeon's shoulder.
• The[0183]side plates78 and79 pivot on an axis defined byshafts71 and73. However, the rotation of theplates78 and79 are coupled only to theshaft73 so that pivotal rotation, in unison, of theside plates78 and79 is detected by motor/encoder76. This action is schematically illustrated in FIGS. 2A and 4 by J3. Movement J3 represents an up and down motion of the surgeon's elbow. Acounterweight80 is secured to the more rear end of theside plates78 and79, to counter-balance the weight and force of thearm assembly90.
• As depicted in FIGS. 3 and 4, the tops of the[0184]arms91 and92 are pivotally supported in abracket94 by two pivot pins89. Thebracket94 also supports adistal arm96 of thearm assembly90. The rotation ofdistal arm96 is sensed by anencoder88. Thus, thedistal arm96 is free to rotate J4 about its longitudinal axis, relative to thearms91 and92. This rotation J4 translates the rotation of the surgeon's forearm.
• The distal end of[0185]distal arm96 is forked, as indicated at95 in FIG. 4. The forkedend95supports disc97 in a fixed position onshaft98. Thedisc97 is fixed in position while theshaft98 rotates therein;bearings93 support this rotation. Theshaft98 also supports one end ofpivot member100, which is part ofhand assembly110. Thepivot member100 has at its proximal end adisc101 that is supported co-axially with thedisc97, but that rotates relative to the fixed disc97 (see FIGS. 5 and 6). This rotation is sensed by anencoder99 associated withshaft98. Thedisc end101 of thepivot member100 defines the rotation J5 in FIG. 4, which translates the wrist action of the surgeon, particularly the up and down wrist action.
• The[0186]pivot member100 has at its other end adisc103 that rotates co-axially with adisc end104 ofhand piece105. There is relative rotation betweendisc103 anddisc104 about a pivot pin106 (see FIGS. 4 and 6). This relative rotation between thepivot member100 and thehand piece105 is detected by afurther encoder109 associated withdiscs103 and104. This action translates lateral or side to side (left and right) action of the surgeon's hand.
• At the very distal end of the master station is a[0187]forefinger member112 that rotates relative to end114 of thehand piece105. As indicated in FIG. 3, theforefinger piece112 has aVelcro loop116 for holding the surgeon's forefinger to thepiece112. Also extending from thehand piece105 is a fixedposition thumb piece118, with an associatedVelcro loop120. In FIG. 3, motion J7 represents the opening and closing between the surgeon's forefinger and thumb.
• Reference is now made to FIG. 5, which shows expanded details of the distal end of the arm assembly. One end of the[0188]distal arm96 couples to thefork95;fork95 supports one end of thepivot member100. Theencoder99 detects the position of thepivot member100 relative to thedistal arm96. Theencoder109 couples to ashaft adapter119 and detects relative displacement between thepivot member100 and thehand piece105. Thethumb piece118 is secured to theside piece125 which, in turn, is secured as part of thehand piece105.Bolts126 secure thefinger piece112 to therotating disc130. Thedistal end encoder132, withencoding disc134, detects the relative movement between the surgeon's thumb and forefinger pieces.
• FIG. 6 shows further details of the distal end of the arm assembly.[0189]Pivot member100 is attached to thedistal arm96 and thehand piece105. Further details are shown relating to theencoder132 and theencoder disc134. Ashaft140,intercoupling hand piece105 anddisc130, is supported by abearing142. Theshaft106 is also supported by abearing144.
• The detailed cross-sectional view of FIG. 7 is taken along lines[0190]7-7 of FIG. 3. This illustrates thebase member51 with thepulley57 supported thereunder by means of theshaft56. Also illustrated arebearings147 aboutshaft56 which permit themain support bracket63 to pivot (J1).Pulley57 rotates therewith and its rotation is coupled to theencoder55 for detecting the J1 rotation. FIG. 7 also illustrates the motor/encoder76, where the separate dashed portions identifymotor76A and encoder76B.
• FIG. 7 also shows further details of the belt and pulley arrangement. For simplicity, only the[0191]pulley67 and its associated support is disclosed. Substantially the same construction is used on the other side of themain support bracket63 for the mounting of theopposite pulley65. Abelt149 aboutpulley72 also engages withpulley153 fixedly supported on theshaft155. Theshaft155 rotates relative to the fixedside support bracket66, by way ofbearings154. Theshaft155 supports thepulley67. Atoothed belt150 is disposed aboutpulley67 to thesmaller pulley152. Thepulley152 is supported on the shaft of the motor/encoder76. For the most part all pulleys and belts disclosed herein are toothed so that there is positive engagement and no slippage therebetween.
• In order to provide adjustment of the[0192]belts149 and150, adjusting screws are provided. One set of adjusting screws is shown at157 for adjusting the position of theside support bracket66 and thus thebelt149. Also, there arebelt adjusting screws158 associated withsupport plate159 for adjusting the position of the encoder and thus adjusting thebelt150.
• FIG. 7 also illustrates the[0193]pulleys70 and72 with theirrespective support shafts71 and73. FIG. 7A shows details of thepulleys70 and72 and their support structure. Thepulley70 is associated with motion J2. Thepulley72 is associated with motion J3. Thepulley70 and its associatedshaft71 rotate with the vertical main shaft orarm91. Thepulley72 and its associatedshaft73 rotate independent of thearm91 and instead rotate with the rotation of theside plates78 and79. One end ofshaft71 is secured with thepulley70. The other end of theshaft71 engages aclamp161, which clamps the other end of the shaft to thesupport piece162 of the mainvertical arm91. Theshaft71 is supported for rotation relative to themain support bracket63 and theside plates78,79 by means ofbearings164.
• The[0194]opposite pulley72 and itsshaft73 are supported so that thepulley72 rotates with rotation of the yoke formed byside plates78 and79. Aclamp166 clamps theshaft73 to the side plate and thus to the rotating yoke. This yoke actually rotates with the pin ofshaft73. For further support of theshaft73, there are also providedbearings168, one associated with thesupport bracket63 and another associated withsupport piece162.
• Regarding the yoke formed by[0195]side plates78 and79, at one end thereof is acounterweight80, as illustrated in FIGS. 4 and 7A. The other end supports a rotating block170 (see FIG. 4) that supports the lower end ofarm92 and has oppositely disposed ends ofpin81 rotatably engaged with that end of the yoke (side plates78 and79). Bushings or bearings may be provided to allow free rotation of the bottom end of thearm92 in the yoke that captures this arm.
• In practice, the following sequence of operations occur at master station M. After the[0196]instrument14 has been placed at the proper operative site, the surgeon is seated at the console and presses an activation button, such as the “enter” button on thekeyboard31 onconsole9. This causes the arms at the master station to move to a predetermined position where the surgeon can engage thumb and forefinger grips. FIG. 1 shows such an initial location where thearm assemblies3 are essentially pointed forward. This automatic initialization movement is activated by the motors inunit7 at the master station. This corresponds, in FIG. 2A, toupper arm96 being essentially horizontal andlower arm92 being essentially vertical.
• While observing the position of the tools on the[0197]video display screen30, the surgeon now positions his hand or hands where they appear to match the position of therespective tool18 at the operative site (OS in FIG. 2B). Then, the surgeon may again hit the “enter” key. This establishes a reference location for both the slave instrument and the master controls. This reference location is discussed later with details ofcontroller9 and an algorithm for controlling the operations between the master and slave stations. This reference location is also essentially identified as a fixed position relative to the wrist joint at the distal end ofdistal arm96 atpin98 in FIG. 4 (axis98A in FIG. 2A). This is the initial predefined configuration at the master station, definable with three dimensional coordinates.
• Now when the surgeon is ready to carry out the procedure, a third keystroke occurs, which may also be a selection of the “enter” key. When that occurs the motors are activated in the[0198]drive unit8 so that any further movement by the surgeon will initiate a corresponding movement at the slave end of the system.
• Reference is now made to FIG. 18 which is a schematic perspective view of an alternate embodiment of an input device or[0199]hand assembly860A. Rather than providing separate thumb and forefinger members, as illustrated previously, the surgeon's hand is holding aguide shaft861A. On the shaft861 there is provided a push-button866A that activates anencoder868A. Theguide shaft861A may be considered more similar to an actual surgical instrument intended to be handled directly by the surgeon in performing unassisted nonrobotic surgery. Thus, thehand piece860A illustrated in FIG. 18 may be more advantageous to use for some types of operative procedures.
• FIG. 18 illustrates, in addition to the[0200]encoder868A, three other encoder blocks,862A,863A and864A. These are schematically illustrated as being intercoupled byjoints870A and871A. All four of these encoders would provide the same joint movements depicted previously in connection with joints J4-J7. For example, thebutton866A may be activated by the surgeon to open and close the jaws.
• C. The Slave Station S[0201]
• C[0202]1—Slave Overview (FIGS.8-8D)
• Reference is now made to FIG. 8 which is a perspective view illustrating the present embodiment of the slave station S. A section of the surgical tabletop T is shown, from which extends the rigid[0203]angled post19 that supports thesurgical instrument14 at mountingbracket25. Thedrive unit8 is also supported from the side of the tabletop by an L-shapedbrace210 that carries an attachingmember212. The brace is suitably secured to the table T and thedrive unit8 is secured to the attachingmember212 by means of aclamp214. A lowervertical arm19A of therigid support rod19 is secured to the attachingmember212 by anotherclamping mechanism216, whichmechanism216 permits vertical adjustment of therigid support19 and attachedinstrument14. Horizontal adjustment of the surgical instrument is possible by sliding the mountingbracket25 along an upper horizontal arm19B of thesupport rod19. One embodiment of thedrive unit8 is described in further detail in FIG. 17. A preferred embodiment is illustrated in FIGS.8F-8L.
• The[0204]clamping bracket216 has aknob213 that can be loosened to reposition thesupport rod19 and tightened to hold thesupport rod19 in the desired position. Thesupport rod19, at itsvertical arm19A, essentially moves up and down through theclamp216. Similarly, the mountingbracket25 can move along the horizontal arm19B of thesupport rod19, and be secured at different positions therealong. Theclamp214, which supports thedrive unit8 on the operating table, also has aknob215 which can be loosened to enable the drive unit to be moved to different positions along the attachingmember212.
• FIG. 8 also shows the cable-in-conduit bundles[0205]21 and22. The cables in thebundle21 primarily control the action of the adapter or guidemember15. The cables inbundle22 primarily control thetool18, all described in further detail below.
• FIG. 8 also illustrates a[0206]support yoke220 to which is secured the mountingbracket25, apivot piece222, andsupport rails224 for acarriage226.Piece222 pivots relative to thesupport yoke220 aboutpivot pin225.
• FIG. 2B is a schematic representation of the joint movements associated with the slave station S. The first joint movement J[0207]1 represents a pivoting of theinstrument14 aboutpivot pin225 ataxis225A. The second joint movement J2 is a transition of thecarriage226 on therails224, which essentially moves the carriage andinstrument14 supported therefrom, in the direction indicated by thearrow227. This is a movement toward and away from the operative site OS. Both of these movements J1 and J2 are controlled by cabling inbundle21 in order to place the distal end of theguide tube17 at the operative site. The operative site is defined as the general area in proximity to where movement of thetool18 occurs, usually in the viewing area of the endoscope and away from the incision.
• FIG. 8 also shows a[0208]coupler230 pivotally coupled from abase piece234 by means of apivot pin232. Thecoupler230 is for engaging with and supporting the proximal end of theinstrument insert16.
• Reference is now made to FIGS. 8A, 8B and[0209]8C which are perspective views of a preferred clamping arrangement which allows a limited amount of pivoting of the mounting bracket25 (which supports instrument14). The mountingbracket25 includes a securingknob450 that clamps the mountingbracket25 to abase452. The mounting bracket is basically twopieces455 and457. Abottom piece457 is adapted to receive the upper arm of rigid supporting rod19 (see FIG. 8B) and is secured thereto by abolt458. Atop piece455 is pivotably adjustable relative to thebottom piece457 by means ofslots460 that engage withbolts462. Whenbolts462 are loosened, thetop piece455 may be rotated relative to thebottom piece457 so that theinstrument14 may be held in different positions. Thebolts462 may then be tightened when theinstrument14 is in a desired angular position.
• An[0210]adjustable bracket25 and support post19 may be provided at each side of the table for mounting asurgical instrument14 on both the left and the right sides of the table. Depending upon the particular surgical procedure, it may be desirable to orient a pair of guide tubes on the left and right sides in different arrangements. In the arrangement of FIG. 1, theguide tubes17,17 are arranged so that therespective tools18,18 face each other. However, for other procedures it may be desirable to dispose the guides in different positions, allowed by the adjustability ofbrackets25,25 on their respective support posts19,19.
• FIG. 8D shows a[0211]template470 useful in a preferred procedure for positioning the guide tube. In this procedure, when thesupport post19 is initially positioned, the mountingbracket25 holds the template470 (rather than the instrument14). Thetemplate470 has aright angle arm472 with a locatingball474 at the end thereof Thearm472 extends a distance that is substantially the same as the lateral displacement of theguide tube200 frompivot point205 above theincision point207 in FIG. 2C (see also thetrocar487 at the incision point485 in FIG. 2B). The mountingbracket25 is adjusted on thesupport post19 so that theball474 coincides with the intended incision point of the patient. Thereafter, the template is removed and when theinstrument14 is then clamped to the mounting bracket, theguide tube17 will be in the proper position vis-à-vis the patient's incision. Thus, thetemplate470 is used to essentially position thebracket25 where it is desired to be located with theball474 coinciding with the incision point. Once the template is removed and the instrument is secured, theguide tube17 will be in the proper position relative to the incision.
• In connection with the operation of the present system, once the patient is on the table, the[0212]drive unit8 is clamped to the table. It's position can be adjusted along the table by means of the attachingmember212. Thelower arm19A of therigid support rod19 is secured to the table by thebracket216. The surgeon determines where the incision is to be made. The mounting bracket on therigid rod19 is adjusted and thetemplate470 is secured to theclamp25. Theball474 on the template is lined up with the incision so as to position the securingrod19 and clamp25 in the proper position. At that time therigid rod19 and the securingclamp25 are fixed in position. Then the template is removed and theinstrument14 is positioned on theclamp25. The incision has been made and theguide tube17 is inserted through the incision into the patient and theinstrument14 is secured at the fixed position of mountingbracket25.
• With regard to the incision point, reference is made to FIG. 2B which shows the incision point along the dashed line[0213]485. Also shown at that point is thecannula487. In some surgical procedures it is common to use a cannula in combination with a trocar that may be used to pierce the skin at the incision. Theguide tube17 may then be inserted through the flexible cannula so that the tool is at the operative site. The cannula typically has a port at which a gas such as carbon dioxide enters for insufflating the patient, and a switch that can be actuated to desufflate. The cannula may typically include a valve mechanism for preventing the escape of the gas.
• C[0214]2—Slave Cabling and Decoupling (FIGS.8E-8L)
• FIG. 8E illustrates a mechanical cabling sequence at the slave station from the[0215]drive unit8, throughadaptor15 andinsert16, to thetool18. Reference will again be made to FIG. 8E after a description of further details of the slave station.
• In the present embodiment the[0216]cable conduits21 and22 are detachable from thedrive unit8. This is illustrated in FIG. 8F wherein the drive unit includesseparable housing sections855 and856. Theinstrument14 along with the attachedcable conduits21 and22 andhousing section856 are, as a unit, of relatively light weight and easily maneuverable (portable) to enable insertion of theinstrument14 into the patient prior to attachment to thebracket25 onsupport post19.
• FIG. 8F is an exploded perspective view of the cable drive mechanism and instrument illustrating the de-coupling concepts of the present embodiment at the slave station S. A section of the surgical tabletop T which supports the[0217]rigid post19 is shown. Thedrive unit8 is supported from the side of the tabletop by an L-shapedbrace210 that carries an attachingmember212. Thebrace210 is suitably secured to the table T. Thedrive unit8 is secured to the attachingmember212 by means of aclamp214. Similarly, therigid support rod19 is secured to the attachingmember212 by means of anotherclamping mechanism216.
• Also in FIG. 8F the[0218]instrument14 is shown detached from (or not yet attached to) supportpost19 atbracket25. Theinstrument14 along withcables21 and22 andlightweight housing section856 provide a relatively small and lightweight decoupleable slave unit that is readily manually engageable (insertable) into the patient at theguide tube17.
• After insertion, the instrument assembly, with attached[0219]cables21,22 andhousing856, is attached to thesupport post19 by means of theknob26 engaging a threaded hole inbase452 ofadapter15. At the other end of thesupport post19,bracket216 has aknob213 that is tightened when thesupport rod19 is in the desired position. Thesupport rod19, at itsvertical arm19A, essentially moves up and down through theclamp216. Similarly, the mountingbracket25 can move along the horizontal arm19B of the support rod to be secured at different positions therealong. Afurther clamp214 enables thedrive unit8 to be moved to different positions along the attachingmember212.
• FIG. 8F also shows the[0220]coupler230 which is pivotally coupled frombase piece234 by means of thepivot pin232. Thecoupler230 is for engaging with and supporting the proximal end of theinstrument insert16.
• Reference is now made to FIG. 8G which illustrates the mechanical cabling sequence at the slave station. The cabling extends from a motor[0221]800 (of the drive unit8), viaadaptor15, and via theinstrument insert16 to thetool18. Theadapter15 and insert16 are intercoupled by their associated interlockingwheels324 and334.Cables606 and607, which in reality, are a single-looped cable, extend between the interlockingwheel334 and thetool18. Thesecables606,607 are used for pivoting the wrist-joint mechanism (at the tool18), in the direction of arrow J5 illustrated in FIG. 8G.
• FIG. 8G also illustrates an[0222]idler pulley344 on theinsert16, as well as a pair ofpulleys317 associated with thewheel324 on theadapter15. Cabling315 extends from interlockingwheel324 about thepulleys317, about anidler pulley318 and throughsheathing319 to conduit turn buckles892. Thecables323 extending from the turn buckles892 are wrapped about acoupler spindle860. Associated with thecoupler spindle860 is acoupler disk862 secured to an output shaft of one of themotors800 ofdrive unit8.
• Reference is now made to further cross-sectional views illustrated in FIGS.[0223]8H-8L. FIG. 8H is a partially broken away front-elevational view as taken alongline8H-8H of FIG. 8F. FIGS. 8I and 8J are cross-sectional views taken respectively along lines8I-8I and8J-8J of FIG. 8H. FIG. 8K is a cross-sectional side view taken alongline8K-8K of FIG. 8H. Lastly, FIG. 8L is a cross-sectional view as taken alongline8L-8L of FIG. 8K.
• These cross-sectional views illustrate a series of seven[0224]motors800, one for each of an associated mechanical cabling assembly. In, FIG. 8K, there is illustrated one of themotors800 with itsoutput shaft865 extending therefrom. Themotor800 is secured to a housing wall866 (also shown in FIG. 8F). FIG. 8K also shows theangle iron868 that is used to support thehousing section855 from the bracket214 (see FIG. 8F).
• A[0225]coupler disk862 is illustrated in FIGS. 8J and 8K, secured to theshaft865 by aset screw869. Thecoupler disk862 also supports aregistration pin871 that is adapted to be received inslots873 of thecoupler spindle860. FIGS. 8K and 8L illustrate thepin871 in one of theslots873. Theregistration pin871 is biased outwardly from the coupler disk by means of acoil spring874.
• The[0226]first housing section855 also carries oppositely disposed thumb screws875 (see FIG. 8H). These may be threaded throughflanges876 as illustrated in FIG. 8J. When loosened, these set screws enable thesecond housing section856 to engage with thefirst housing section855. For this purpose, there is provided aslot878 illustrated in FIG. 8F. Once thesecond housing section856 is engaged with thefirst housing section855, then the thumb screws875 may be tightened to hold the two housing sections together, at the same time facilitating engagement between thecoupler disks862 and thecoupler spindles860.
• The cross-sectional view of FIG. 8K shows that at the end of[0227]coupler disk862 where it is adapted to engage with the coupler spindle8(50, the coupler disk is tapered as illustrated at879. This facilitates engagement between the coupler disk and the coupler spindle.
• As illustrated in FIG. 8F, the two[0228]housing sections855 and856 are separable from each other so that the relatively compact slave unit can be engaged and disengaged from the motor array, particularly from the first housing section85:5 that contains themotors800. Thefirst housing section855, as described previously, contains themotors800 and theircorresponding coupler disks862. In FIG. 8F, thesecond housing section856 primarily accommodates and supports thecoupler spindles860 and the cabling extending from each of the spindles to the cable bundles21 and22 depicted in FIG. 8F.
• FIGS. 8J and 8K illustrate one of the[0229]coupler spindles860 supported within a pair ofbearings881. The cable associated with the coupler spindle is secured to the coupler spindle by means of acable clamp screw883. FIGS. 8J and 8K illustrate the cable extending about the coupler spindle, and secured by thecable clamp screw883. The particular cable illustrated in FIGS. 8J aboutspindle860 is identified as cable D.
• In FIGS.[0230]8H-8K, the cabling is identified by cables A-G. This represents seven separate cables that are illustrated, for example, in FIG. 8H as extending into thesecond housing section856 with a flexible boot885 (see the top of FIGS. 8H and 8K) extending thereabout.
• At the top of the[0231]second housing section856 there is provided a conduit stop orretainer888 that is secured in place at the top of the housing section in an appropriate manner. Theconduit retainer888 has throughslots890, one for accommodating each of the cables A-G (see FIG. 8I). Refer in particular to FIGS. 8H and 8K illustrating the cables A-G extending through theretainer888 in the slots thereof. Each of the cables may also be provided with a turnbuckle892 that is useful in tensioning the cables. Each turnbuckle892 screws into an accommodating threaded passage in theretainer888, as illustrated in FIG. 8K.
• In FIG. 8H the coupler spindles are all disposed in a linear array. To properly accommodate the cabling, the spindles are of varying diameter, commencing at the top of the[0232]second housing section856 with the smallest diameter spindle and progressing in slightly larger diameter spindles down to the bottom of thesecond housing section856 where there is disposed the largest diameter coupler spindle.
• The detachability of the two[0233]housing sections855 and856 enables the cleaning of certain components which are disposed above the plane of the operating table, here referred to as the sterile field. More specifically, thedetachable housing856 with attachedcables21 and22 andinstrument14, needs to be sterilized after use, except for theinstrument insert16 which is an integral disposal unit. The sterilization of the designated components may include a mechanical cleaning with brushes or the like in a sink, followed by placement in a tray and autoclave in which the components are subjected to superheated steam to sterilize the same. In this manner, theadapter15 is reusable. Also, the engagement between theadapter15 and insert16 is such that the disposable insert element may have holes, which are relatively hard to clean, whereas the recleanable adapter element has a minimum number of corresponding projections, which are relatively easier to clean than the holes. By disposable, it is meant that the unit, here theinsert16, is intended for a single use as sold in the marketplace. The disposable insert interfaces with anadapter15 which is intended to be recleaned (sterilized) between repeated uses. Preferably, the disposable unit, here theinsert16, can be made of relatively lower cost polymers and materials which, for example, can be molded by low-cost injection molding. In addition, thedisposable instrument insert16 is designed to require a relatively minimal effort by the operator or other assistant who is required to attach the insert to theadapter15. More specifically, the operator is not required to rethread any of the multiple mechanical cabling assemblies.
• C[0234]3—Slave Instrument Assembly (FIGS.9-16)
• Further details of the detachable and portable slave unit are shown in FIGS.[0235]9-16. For example, FIG. 11 shows thecarriage226 which extends from the mountingbracket25 onsupport post19. Belowcarriage226, abase piece234 is supported from thecarriage226 by arectangular post228. Thepost228 supports the entire instrument assembly, including theadaptor15 and theinstrument insert16 once engaged.
• As indicated previously, a[0236]support yoke220 is supported in a fixed position from the mountingbracket25 viabase452.Cabling21 extends into thesupport yoke220. Thesupport yoke220 may be considered as having anupper leg236 and a lower leg238 (see FIG. 12). In the opening239 between theselegs236,238 there is arranged thepivot piece222 with its attachedbase240. Below thebase240 and supported by thepivot pin225 is acircular disc242 that is stationary relative to theyoke legs236,238. A bearing235 inleg236, abearing237 inleg238, and abearing233 indisc242, allow rotation of these members relative to thepivot pin225.
• Disposed within a recess in the[0237]support yoke220, as illustrated in FIG. 13, is acapstan244 about whichcables245 and246 extend and are coupled to opposite sides of thearcuate segment248 ofpivot piece222. The ends ofcables245 and246 are secured in holes at opposite sides ofarcuate segment248. Thecables245 and246 operate in conjunction with each other. At their other ends, these cables connect to a motor. Depending upon the direction of rotation of the motor, eithercable245 orcable246 will be pulled, causing thepivot price232 to rotate in a direction indicated by J1.
• The[0238]base240 ofpivot piece222 also has at one end thereof anend piece241 into which are partially supported the ends of rails224 (see FIG. 13). The other ends of the rails are supported by anend piece251, which also has cabling257,258 for thecarriage226 extending therethrough, such as illustrated in FIG. 14. Acapstan253 is supported from a lower surface of thebase240. Anothercapstan256 is supported within thesupport yoke220. Thecables257 and258 extend about thecapstan256, about disc242 (which may be grooved to receive the cables), to thecarriage226, and from there about anothercapstan260 disposed within end member262 (see FIG. 11).End member262 supports the other ends of therails224, upon which thecarriage226 transitions. The ends of thecables257 and258 are secured appropriately within the carriage. FIG. 11 illustrates by thearrow227 the forward and backward motion of thecarriage226, and thus of the attachedactuator15 toward and away from the operative site.
• Now, reference is made to FIG. 15 illustrating a portion of the slave unit with the[0239]instrument insert16 partially removed and rotated from thebase piece234. FIG. 15 shows a portion of the carriage mechanism, including thecarriage226 supported onrails224. As indicated previously, below thecarriage226 there is asupport post228 that supports thebase piece234. It is at thebase piece234, that cabling22 from thedrive unit8 is received.
• Also extending from the[0240]base piece234 is theguide tube17 ofadapter15. Theguide tube17 accommodates, through its center axial passage, theinstrument insert16. Also, supported from thebase piece234, atpivot pin232, is theadaptor coupler230. Theadaptor coupler230 pivots out of the way so that theinstrument insert16 can be inserted into theadaptor15. FIG. 15 shows theinstrument insert16 partially withdrawn from theadaptor15. Thepivot pin232 may be longer than the distance between the twoparallel bars270 and272 carried bybase piece234, so that the pin not only allows rotation, but can also slide relative tobars270 and272. This permits thecoupler230 to not only pivot, but also to move laterally to enable better access of theinstrument insert16 into thebase piece234. Theinstrument insert16 has a base (coupler)300 that in essence is a companion coupler to theadapter coupler230.
• With further reference to FIG. 15, the[0241]instrument insert16 is comprised of acoupler300 at the proximal end, and at the distal end an elongated shaft or stem, which in this embodiment has a more rigidproximal stem section301 and a flexible distal stem section302 (see FIG. 15A). Thedistal stem section302 carries thetool18 at its distal end. Theinstrument coupler300 includes one ormore wheels339 which laterally engagecomplimentary wheels329 of thecoupler230 onadaptor15. Theinstrument coupler300 also includes anaxial wheel306 at its distal end through which thestem301 extends, and which also engages a wheel on the adaptor, as to be described below in further detail. Theaxial engagement wheel306 is fixed to the morerigid stem section301, and is used to rotate thetool18 axially at the distal end of the flexible stem section302 (as shown by arrow J4 in FIG. 2B).
• The[0242]base piece234 has secured thereto two parallel spaced-apartbars270 and272. It is between thesebars270 and272 that is disposed thepivot pin232. Thepivot pin232 may be supported at either end in bearings in thebars270 and272, and as previously mentioned, has limited sliding capability so as to move theadapter coupler230 away frombase piece234 to enable insertion of theinstrument insert16. Aleg275 is secured to thepivot pin232. Theleg275 extends from thecoupler230 and provides for pivoting ofcoupler230 with respect tobase piece234. Thus, the combination ofpivot pin232 and theleg275 permits a free rotation of thecoupler230 from a position where it is clear to insert theinstrument insert16 to a position where thecoupler230 intercouples with thebase300 of theinstrument insert16. As depicted in FIG. 15, thebars270 and272 also accommodate therethrough cabling from cable bundles271.
• The[0243]base piece234 also rotatably supports the rigid tube17 (illustrated by arrow J3 in FIG. 2B). As indicated previously, it is the connection to thecarriage226 viapost228 that enables theactuator15 to move toward and away from the operative site. The rotation of thetube17 is carried out by rotation of pulley277 (see FIG. 15). A pair of cables from thebundle271 extend about thepulley277 and can rotate the pulley in either direction depending upon which cable is activated. To carry out this action, thetube17 is actually supported on bearings within thebase piece234. Also, the proximal end of thetube17 is fixed to thepulley277 so that theguide tube17 rotates with thepulley277.
• Also supported from the very proximal end of the[0244]tube17, is asecond pulley279 that is supported for rotation about theactuator tube17. For this purpose a bearing is disposed between thepulley279 and the actuator tube. Thepulley279 is operated from another pair of cables in thebundle271 that operate in the same manner. The cabling is such that two cables couple to thepulley279 for operation of the pulley in opposite directions. Also, as depicted in FIG. 15, thepulley279 has a detent at280 that is adapted to mate with atab281 on theaxial wheel306 ofinstrument coupler300. Thus, as thepulley279 is rotated, this causes a rotation of theaxial wheel306 and a corresponding rotation of flexible andrigid sections301,302 of theinstrument insert16, including thetool18.
• Again referring to FIG. 15, a[0245]block310 is secured to one side of thecoupler230. Theblock310 is next to theleg275 and contains a series of small, preferably plastic, pulleys that accommodatecabling315. These cables extend toother pulleys317 disposed along the length of thecoupler230. Refer also to the cabling diagram of FIG. 8E.
• In this embodiment, the[0246]coupler230 includeswheels320,322 and324. Each of these wheels is provided with acenter pivot325 to enable rotation of the wheels in thecoupler230. Theknob327 is used to secure together theadapter coupler230 and thebase coupler300 of theinstrument insert16.
• For the three wheels,[0247]320,322 and324, there are six correspondingpulleys317, two pulleys being associated with each wheel (see FIGS. 8E and 11B). Similarly, there are six pulleys in theblock310. Thus, for cablingbundle315 there are six separate cable conduits for the six separate cables that couple to thewheels320,322 and324. Two cables connect to each wheel for controlling respective opposite directions of rotation thereof.
• Each of the[0248]wheels320,322 and324 have a half-moon portion with aflat side329. Similarly, theinstrument base300 hascompanion wheels330,332 and334 with complimentary half-moon construction for engagement with thewheels320,322 and324. Thewheel320 controls one of the jaws of the tool18 (motion J6 in FIG. 2B). Thewheel324 controls the other jaw of the tool18 (motion J7 in FIG. 2B). Themiddle wheel322 controls the wrist pivoting of the tool18 (motion J5 in FIG. 2B). Also refer to FIG. 8E showing cabling for controlling tool movement.
• The[0249]coupler300 ofinsert16 has threewheels330,332 and334, each with apivot pin331, and which mate with the correspondingwheels320,322 and324, respectively of the adaptor coupler. In FIG. 15 theinstrument base piece300 is shown rotated from its normal position for proper viewing of the wheels. Normally, it is rotated through 180° so that the half-moon wheels330,332 and334 engage with the correspondingcoupler wheels320,322 and324. Also illustrated in FIG. 15 are capstans oridler pulleys340,342 and344 associated, respectively, withwheels330,332 and334.
• As shown in FIG. 15A, each wheel of the[0250]instrument coupler300 has twocables376 that are affixed to the wheel (e.g.,wheel334 in FIG. 8E) and wrapped about opposite sides at its base. The lower cable rides over one of the idler pulleys or capstans (e.g., capstan34 in FIG. 8E), which routes the cables toward the center of theinstrument stem301. It is desirable to maintain the cables near the center of the instrument stem. The closer the cables are to the central axis of the stem, the less disturbance motion on the cables when the insert stem is rotated. The cables may then be routed through fixed-length plastic tubes that are affixed to the proximal end of thestem section301 and the distal end of thestem section302. The tubes maintain constant length pathways for the cables as they move within the instrument stem.
• The[0251]instrument coupler300 is also provided with aregistration slot350 at its distal end. Theslot350 engages with aregistration pin352 supported between thebars270 and272 ofbase piece234. Thecoupler300 is also provided with aclamping slot355 on its proximal end for accommodating the threaded portion of the clamping knob327 (on adapter coupler230). Theknob327 affirmatively engages and interconnects thecouplers230 and300.
• In operation, once the surgeon has selected a[0252]particular instrument insert16, it is inserted into theadapter15. Theproximal stem301, having thedistal stem302 and thetool18 at the distal end, extend through theadapter guide tube17. FIG. 8 shows thetool18 extending out of theguide tube17 when thesurgical instrument16 is fully inserted into theadaptor15. When it is fully inserted, thetab281 on theaxial wheel306 engages with themating detent280 inpulley279. Also, theregistration slot350 engages with theregistration pin352. Then thecoupler230 is pivoted over thebase300 of theinstrument insert16. As this pivoting occurs, the respective wheels of thecoupler230 and thecoupler300 interengage so that drive can occur from thecoupler230 to theinsert16. Theknob327 is secured down so that the twocouplers230 and300 remain in fixed relative positions.
• Reference is also now made to detailed cross-sectional views of FIGS. 11A, 11B and[0253]11C. FIG. 11A is a cross sectional view taken alongline11A-11A of FIG. 11. FIG. 11B is a cross-sectional view taken alongline11B-11B of FIG. 11A. FIG. 11C is a further cross-sectional view taken through FIG. 11A alongline11C-11C.
• The[0254]base piece234 ofadapter15 rotatably supports theguide tube17, allowing rotation J3 shown in FIG. 2B. As noted in FIG. 11A, there are a pair ofbearings360 disposed at each end within theaxial passage362 in thebase piece234. The rotation of theguide tube17 is carried out by rotation of thefirst pulley277. In FIG. 11A there is aset screw364 that secures thepulley277 to theguide tube17.Nylon spacers366 separate various components, such as thebase piece234 and thepulley277, the twopulleys277 and279, andbase300 andwheel306.
• A nylon bearing[0255]368 is also provided between thesecond pulley279 and theguide tube17. FIG. 11A also shows theproximal stem section301 of theinsert16 inside of theguide tube17. Anylon bearing370 is supported within thefront block372 of theinsert16.
• In FIG. 11A, the[0256]second pulley279 is supported from the proximal end of thetube17. The bearing368 is disposed between thepulley279 and thetube17. Thepulley279 has adetent280 that is adapted to mate with atab281 on theaxial wheel306. Thus, when thepulley279 is rotated by cabling271 (see FIG. 11C), this, causes a rotation of theaxial wheel306, and a corresponding rotation (motion J4 in FIG. 2B) of thesections301,302 of theinstrument insert16, including thetool18. The very proximal end of thesection301 is illustrated in FIG. 11A as being rotatable relative to thebearing370.
• FIG. 11A also shows the intercoupling of the instrument and[0257]adapter couplers230 and300. Herewheel324 is shown interlocked withwheel334. FIGS. 11A and 11C also show cabling at376. This cabling includes six separate cables that extend through the length of thestem301,302 of the instrument. The cabling is illustrated connecting about anidler pulley344. The cabling associated withwheel334 is secured by thecable clamping screw378. For further details of the cabling, refer to FIG. 8E.
• FIG. 11B is a cross-sectional view taken along[0258]11B-11B of FIG. 11A which again shows the cooperatingwheels324 and334. Also illustrated is a cable clamping setscrew380 that is used to secure thecabling376 towheel324. Acable guide rail382 is attached and forms part of the base of theadapter coupler230. Thecable guide rail382 contains sixidler pulleys317, one of which is illustrated in FIG. 11B. It is noted that cabling376 extends about this pulley to thecable idler block310 whereconduits315 are coupled. The cableguide idler block310 includes a series of six idler pulleys shown in dotted outline in FIG. 11B at386.
• FIG. 11C is a cross-sectional view taken along[0259]line11C-11C of FIG. 11A, which shows further details at thepulley279. Also illustrated ispost228 supporting thebase piece234 of the instrument insert, and cabling376 extending through the instrument.
• FIGS. 16A and 16B illustrate the construction of one form of a tool. FIG. 16A is a perspective view and FIG. 16B is an exploded view. The[0260]tool18 is comprised of four members including abase600, link601, upper grip orjaw602 and lower grip orjaw603. Thebase600 is affixed to the flexible stem section302 (see FIG. 15A). The flexible stem may be constructed of a ribbed plastic. This flexible section is used so that the instrument will readily bend through the curved part of theguide tube17.
• The[0261]link601 is rotatably connected to the base600 aboutaxis604. FIG. 16B illustrates apivot pin620 ataxis604. The upper andlower jaws602 and603 are rotatably connected bypivot pin624 to thelink601 aboutaxis605, whereaxis605 is essentially perpendicular toaxis604.
• Six cables[0262]606-611 actuate the four members600-603 of the tool.Cable606 travels through the insert stem (section302) and through a hole in thebase600, wraps aroundcurved surface626 onlink601, and then attaches onlink601 at630. Tension oncable606 rotates thelink601, and attached upper andlower grips602 and603, about axis604 (motion J5 in FIG. 2B).Cable607 provides the opposing action tocable606, and goes through the same routing pathway, but on the opposite sides of the insert.Cable607 may also attach to link601 generally at630.
• [0263]Cables608 and610 also travel through thestem301,302 and though holes in thebase600. Thecables608 and610 then pass between twofixed posts612. These posts constrain the cables to pass substantially through theaxis604, which defines rotation of thelink601. This construction essentially allows free rotation of thelink601 with minimal length changes in cables608-611. In other words, the cables608-611, which actuate thejaws602 and603, are essentially decoupled from the motion oflink601.Cables608 and610 pass over rounded sections and terminate onjaws602 and603, respectively. Tension oncables608 and610 rotatejaws602 and603 counter-clockwise aboutaxis605. Finally, as shown in FIG. 16B, thecables609 and611 pass through the same routing pathway ascables608 and610, but on the opposite side of the instrument. Thesecables609 and611 provide the clockwise motion tojaws602 and603, respectively. At thejaws602 and603, as depicted in FIG. 16B, the ends of cables608-611 may be secured at635, for example by the use of an adhesive such as epoxy glue, or the cables could be crimped to the jaws.
• To review the allowed movements of the various components of the slave unit, the[0264]instrument insert16 slides through theguide tube17 ofadaptor15, and laterally engages theadaptor coupler230. Theadaptor coupler230 is pivotally mounted to thebase piece234. Thebase piece234 rotationally mounts the guide tube17 (motion J3). Thebase piece234 is affixed to the linear slider or carriage assembly (motion J2). The carriage assembly in turn is pivotally mounted at the pivot225 (motion J1).
• Reference is now made to FIGS. 16C and 16D. FIG. 16C is a fragmentary perspective view of an alternate set of jaws, referred to as needle drivers. FIG. 16D is a side elevation view of the needle drivers. This embodiment employs an over-center camming arrangement so that the jaw is not only closed, but also at a forced closure.[0265]
• In FIGS. 16C and 16D, similar reference characters are employed with respect to the embodiment of FIGS. 16A and 16B. Thus, there is provided a[0266]base600, alink601, anupper jaw650 and alower jaw652. Thebase600 is affixed to theflexible stem section302. Cabling608-611 operate the end jaws.Linkages654 and656 provide the over-center camming operation.
• The two embodiments of FIGS.[0267]16A-16D employ a fixed wrist pivot. An alternate construction is illustrated in FIGS.16E-16H in which there is provided, in place of a wrist pivot, a flexible or bending section. In FIGS.16E-16H, similar reference characters are used for many of the parts, as they correspond to elements found in FIGS.16A-16D.
• In the embodiment of FIGS.[0268]16E-16H, thetool18 is comprised of an upper grip orjaw602 and a lower grip orjaw603, supported from alink601. Each of thejaws602,603, as well as thelink601, may be constructed of metal, or alternatively, thelink601 may be constructed of a hard plastic. Thelink601 is engaged with the distal end of theflexible stem section302. In this regard reference may also be made to FIG. 15A that shows the ribbed, plastic construction of theflexible stem section302. FIG. 16E shows only the very distal end of thestem section302, terminating in a bending or flexingsection660. Theflexible stem section302 is constructed so as to be flexible and thus has a substantial length of a ribbed surface as illustrated in FIG. 15A. Also, at theflexible section660, flexibility and bending is enhanced by means of diametrically-disposedslots662 that definetherebetween ribs664. Theflexible section660 also has alongitudinally extending wall665, through which cabling extends, particularly for operation of the tool jaws. The very distal end of thebending section660 terminates with anopening666 for receiving theend668 of thelink601. The cabling608-611 is preferably at the center of the flex section atwall665 so as to effectively decouple flex or bending motions from tool motions.
• Regarding the operation of the tool, reference is made to the[0269]cables608,609,610, and611. All of these extend through the flexible stem section and also through thewall665 such as illustrated in FIG. 16G. The cables extend to therespective jaws602,603 for controlling operation thereof in a manner similar to that described previously in connection with FIGS.16A-16D. FIGS.16E-16H also illustrate thecables606 and607 which couple through thebending section660 and terminate at ball ends606A and607A, respectively. Again, refer to FIG. 16G that shows these cables. FIGS. 16F and 16H also show thecables606,607 with the ball ends606A,607A, respectively. These ball ends are adapted to urge against the very end of the bendable section inopening666. When these cables are pulled individually, they can cause a bending of the wrist at the bending or flexingsection660. FIG. 16H illustrates thecable607 having been pulled in the direction ofarrow670 so as to flex thesection660 in the manner illustrated in FIG. 16H. Pulling on theother cable606 causes a bending in the opposite direction.
• By virtue of the[0270]slots662 forming theribs664, there is provided a structure that bends quite readily, essentially bending thewall665 by compressing at the slots such as in the manner illustrated in FIG. 16H. This construction eliminates the need for a wrist pin or hinge.
• The embodiment illustrated in FIG. 16F has a[0271]separate link601. However, in an alternate embodiment, thislink601 may be fabricated integrally with, and as part of, thebending section660. For this purpose thelink601 would then be constructed of a relatively hard plastic rather than the metal link as illustrated in FIG. 16F and would be integral withsection660.
• In another embodiment, the bending or flexing[0272]section660 can be constructed so as to have orthogonal bending by using four cables separated at 90° intervals and by providing a center support with ribs and slots about the entire periphery. This embodiment is shown in FIGS.16I-16K. Thebending section613 is at the end offlexible stem section302. Thecables608,609,610 and611 are for actuation of thejaws602 and603 in the same manner as for earlier embodiments. Thelink601 couples thebending section613 to thejaws602 and603.
• The bending section has a[0273]center support wall614 supportingribs618 separated byslots619. This version enables bending in orthogonal directions by means of fourcables606,607,616 and617, instead of the single degree-of-freedom of FIG. 16E. The operation ofcables606 and607 provides flexing in one degree-of-freedom, while an added degree-of-freedom is provided by operation ofcables616 and617.
• Mention has also been made of various forms of tools that can be used. The tool may comprise a variety of articulated tools such as: jaws, scissors, graspers, needle holders, micro dissectors, staple appliers, tackers, suction irrigation tools and clip appliers. In addition, the tool may comprise a non-articulated instrument such as: a cutting blade, probe, irrigator, catheter or suction orifice.[0274]
• C[0275]4—Slave Drive Unit (FIGS.17-17A)
• Reference is now made to the perspective view of the[0276]drive unit8, previously illustrated in FIG. 8. FIG. 17 illustrates thedrive unit8 with the cover removed. The drive unit is adjustably positionable alongrail212 by anangle brace210 that is attached to the operating table. Within thedrive unit8 are sevenseparate motors800, corresponding to the seven separate controls at the slave station, and more particularly, to motions J1-J7 previously described in reference to FIG. 2B.
• The drive unit includes a[0277]support plate805 to which there is secured aholder808 for receiving and clamping thecabling conduits835. Themotors800 are each supported from thesupport plate805. FIG. 17 also illustrates the electrical interface at810, with one or moreelectrical connectors812.
• Regarding support for the[0278]motors800 there is provided, associated with each motor, a pair of opposed adjustingslots814 and adjusting screws815. This permits a certain degree of positional adjustment of the motors, relative to their associated idler pulleys820. The seven idler pulleys are supported for rotation by means of asupport bar825. FIG. 17 also shows the cabling coming830 from each of the idler pulleys. With seven motors, and two cables coming off of each motor for opposite direction control, there are a total of fourteen separate cables conduits at thebundle835. The cables move within the conduits in a known manner. The conduits themselves are fixedly supported and extend from theholder808 to theadapter15. Again, reference may be made to FIG. 8 showing the conduit bundles at21 and22.
• The seven motors in this embodiment control (1) one jaw of the tool J[0279]6, (2) the pivoting of the wrist at the tool J5, (3) the other jaw of the tool J7, (4) rotation of the insert J4, (5) rotation of the adaptor J3, (6) linear carriage motion J2 and (7) pivoting of the adaptor J1. Of course, fewer or lesser numbers of motors may be provided in other embodiments and the sequence of the controls may be different.
• FIG. 17A illustrates another aspect of the invention—a feedback system that feeds force information from the slave station back to the master station where the surgeon is manipulating the input device. For example, if the surgeon is moving his arm to the left and this causes some resistance at the slave station, the resistance is detected at the slave station and coupled back to one of the motors at the master station to drive the input device, such as the hand assembly illustrated herein, back in the opposite direction. This provides an increased resistance to the surgeon's movements which occurs substantially instantaneously.[0280]
• FIG. 17A illustrates schematically a[0281]load cell840 that is adapted to sense cable tension. FIG. 17A shows one of thepulleys842 associated with one of themotors800, andcables845 and847 disposed about a sensingpulley850. The sensingpulley850 is coupled to thepiezoelectric load cell840. Theload cell840 may be disposed in a Wheatstone bridge arrangement.
• Thus, if one of the motors is operating under tension, this is sensed by the[0282]load cell840 and an electrical signal is coupled from the slave station, by way of thecontroller9, to the master station to control one of the master station motors. When tension is sensed, this drives the master station motor in the opposite direction (to the direction of movement of the surgeon) to indicate to the surgeon that a barrier or some other obstacle has been encountered by the element of the slave unit being driven by the surgeon's movements.
• The cabling scheme is important as it permits the motors to be located in a position remote from the adaptor and insert. Furthermore, it does not require the motor to be supported on any moving arms or the like. Several prior systems employing motor control have motors supported on moveable arms. Here the motors are separated from the active instrument area (and sterile field) and furthermore are maintained fixed in position. This is illustrated in FIG. 8E by the[0283]motor800. FIG. 8E also illustrates a typical cabling sequence from themotor800 through to thetool18. Both ends ofcabling315 are secured to the motor at842 and the motor is adapted to rotate either clockwise or counterclockwise, in order to pull the cabling in either one direction or the other. The pair of cabling operates in unison so that as one cable is pulled inwardly toward the motor, the other cable pulls outwardly. As illustrated in FIG. 8E, the cables extend overpulley820 to other pulleys, such as the pair ofpulleys317 andcontrol wheel324 associated withcoupler230. From there, the mechanical drive is transferred to thecontrol wheel334 of theinstrument insert300, which is coupled towheel334 and to theoutput cables606 and607 which drive wrist rotation of thetool18, identified in FIG. 8E by the motion J5.
• Another important aspect is the use of inter-mating wheels, such as the[0284]wheels324 and334 illustrated in FIG. 8E. This permits essentially a physical interruption of the mechanical cables, but at the same time a mechanical drive coupling between the cables. This permits the use of aninstrument insert16 that is readily engageable with the adaptor, as well as disengagable from theadaptor15. This makes theinstrument insert16 easily replacable and also, due to the simplicity of theinstrument insert16, it can be made disposable. Refer again to FIG. 15A which shows the complete instrument insert and its relatively simple construction, but which still provides an effective coupling between the drive motor and the tool.
• C[0285]5—Slave Guide Tube (FIGS.19-19D)
• Reference is now made to FIG. 19, a schematic diagram illustrating different placements of the[0286]guide tube17. FIG. 19A illustrates left and right guide tubes substantially in the same position as illustrated in FIG. 1. For some surgical procedures, it may be advantageous to orient the tubes so that the curvatures are in the same direction. FIG. 19B shows the ends of the tubes pointing to the right, while FIG. 19C shows the ends of the tubes pointing to the left. Lastly, in FIG. 19D the ends of the tubes are shown converging but in a downwardly directed position. Regarding the different placements shown in FIG. 19, theadjustable clamp25, illustrated in FIGS.8A-8C may be useful, as this provides some added level of flexibility in supporting the positioning of the guide tubes on both the left and right side.
• C[0287]6—Slave Motor Control (FIGS.20-28)
• FIGS. 20 and 21 are block diagrams of the motor control system of the present embodiment. In the system of FIG. 1, there are two instruments supported on either side of the operating table. Thus, there are in actuality two[0288]separate drive units8. One of these is considered a left hand (LH) station and the other is considered a right hand (RH) station. Similarly, at the master station, on either side of the chair, as depicted in FIG. 1, there are left hand and right hand master station assemblies. Accordingly, there are a total of 28 (7×4) separate actions that are either sensed or controlled. This relates to seven separate degrees-of-motion at both the master and slave, as well as at left hand and right stations. In other embodiments there may be only a single station, such as either a left hand station or a right hand station. Also, other embodiments may employ fewer or greater numbers of degrees-of-motion as identified herein.
• Regarding the master station side, there is at least one position encoder associated with each of degree-of-motion or degree-of-freedom. Also, as previously described, some of the described motions of the active joints have a combination of motor and encoder on a common shaft. With regard to the master station, all of the rotations represented by J[0289]1, J2 and J3 (see FIG. 2A) have associated therewith, not only encoders but also individual motors. At the hand assembly previously described, there are only encoders. However, the block diagram system of FIGS. 20 and 21 illustrates a combination with motor and encoder. If a motor is not used at a master station, then only the encoder signal is coupled to the system.
• FIGS. 20 and 21 illustrate a multi-axis, high performance motor control system which may support anywhere from 8 to 64 axes, simultaneously, using either eight-bit parallel or pulse width modulated (PWM) signals. The motors themselves may be direct current, direct current brushless or stepper motors with a programmable digital filter/commutater. Each motor accommodates a standard incremental optical encoder.[0290]
• The block diagram of FIG. 20 represents the basic components of the system. This includes a[0291]host computer700, connected by adigital bus702 to aninterface board704. Theinterface board704 may be a conventional interface board for coupling signals between the digital bus and the eightindividual module boards706. The set of module boards is referred to as the motor control sub unit.Communication cables708 intercouple theinterface board704 to eightseparate module boards706. Thehost computer700 may be an Intel microprocessor based personal computer (PC) at a control station preferably running a Windows NT program communicating with theinterface board704 by way of a high-speed PCI bus702 (5.0 KHz for eight channels to 700 Hz for 64 channels).
• FIG. 21 shows one of the[0292]module boards706. Eachboard706 includes fourmotion control circuits710. Each of theblocks710 may be a Hewlett-Packard motion control integrated circuit. For example, each of these may be an IC identified as HCTL1100. Also depicted in FIG. 21 is a poweramplifier sub unit712. The power amplifier sub unit is based on National Semiconductor's H-bridge power amplifier integrated circuits for providing PWM motor command signals. Thepower amplifier712 associated with each of theblocks710 couples to a motor X. Associated with motor X is encoder Y. Also note the connection back from each encoder to theblock710. In FIG. 21, although the connections are not specifically set forth, it is understood that signals intercouple between theblock710 and theinterface board704, as well as viabus702 to thehost computer700.
• The motor control system may be implemented for example, in two ways. In a first method the user utilizes the[0293]motor control subunit706 to effect four control modes: positional control, proportional velocity control, trapezoidal profile control and integral velocity control. Using any one of these modes means specifying desired positions or velocities for each motor, and the necessary control actions are computed by themotion control IC710 of the motor control subunit, thereby greatly reducing the complexity of the control system software. However, in the case where none of the on-board control modes are appropriate for the application, the user may choose a second method in which a servo motor control software is implemented at the PC control station. Appropriate voltage signal outputs for each motor are computed by the PC control station and sent to the motor control/power amplifier unit (706,712). Although the computation load is mostly placed on the control station's CPU in this case, there are available high performance computers and high speed PCI buses for data transfer which can accommodate this load.
• D. Master—Slave Positioning and Orientation (FIGS.[0294]22-28)
• FIG. 22 provides an overview of control algorithm for the present embodiment. Its primary function is to move the[0295]instrument tool18 in such a way that the motions of the instrument tool are precisely mapped to that of thesurgeon interface device3 in three dimensional space, thereby creating the feel of the tool being an extension of the surgeon's own hands. The control algorithm assumes that both the surgeon's input interface as well as the instrument system always start at predefined positions and orientations, and once the system is started, it repeats a series of steps at every sampling period. The predefined positions and orientations, relate to the initial positioning of the master and slave stations.
• First, the joint sensors (box[0296]435), which are optical encoders in the present embodiment, of the surgeon's interface system are read, and via forward kinematics (box410) analysis, the current position (see line429) and orientation (see line427) of the input interface handle are determined. The translational motion of the surgeon's; hand motion is scaled (box425), whereas the orientation is not scaled, resulting in a desired position (see line432) and orientation (see line434) for the instrument tool. The results are then inputted into the inverse kinematics algorithms (box415) for the instrument tool, and finally the necessary joint angles and insertion length of the instrument system are determined. The motor command positions are sent to the instrument motor controller (box420) for commending the corresponding motors to positions such that the desired joint angles and insertion length are achieved.
• With further reference to FIG. 22, it is noted that there is also provided an initial start position for the input device, indicated at[0297]box440. The output ofbox440 couples to a summation device430. The output of device430 couples toscale box425. The initial handle (or hand assembly) position as indicated previously is established by first positioning of the handle at the master station so as to establish an initial master station handle orientation in three dimensional space. This is compared to the current handle position at device430. This is then scaled bybox425 to provide the desired tool position online432 to the instrumentinverse kinematics box415.
• The following is an analysis of the kinematic computations for both[0298]box410 andbox415 in FIG. 22.
Kinematic Computations
• The present embodiment provides a surgeon with the feel of an instrument as being an extension of his own hand. The position and orientation of the instrument tool is mapped to that of the surgeon input interface device, and this mapping process is referred to as kinematic computations. The kinematic calculations can be divided into two sub-processes: forward kinematic computation of the surgeon user interface device, and inverse kinematic computation of the instrument tool.[0299]
Forward Kinematic Computation
• Based on the information provided by the joint angle sensors, which are optical encoders of the surgeon interface system, the forward kinematic computation determines the position and orientation of the handle in three dimensional space.[0300]
• 1. Position[0301]
• The position of the surgeon's wrist in three dimensional space is determined by simple geometric calculations. Referring to FIG. 23, the x, y, z directional positions of the wrist with respect to the reference coordinate are[0302]
• X_p=(L₃sin θ₃+L₂cos θ_2a) cos θ_bp−L₂
• Y_p=−(L₃cos θ₃+L₂sin θ_2a)−L₃
• Z_p=(L₃sin θ₃+L₂cos θ_2a) sin θ_bp
• where X[0303]_p, Y_p, Z_pare wrist positions in the x, y, z directions, respectively.
• These equations for X[0304]_p, Y_p, and Z_prepresent respective magnitudes as measured from the initial reference coordination location, which is the location in FIG. 23 when θ₃and θ_2aare both zero degrees. This corresponds to the position wherein arm L2 is at right angles to arm L3, i.e., arm L2 is essentially horizontal and arm L3 is essentially vertical. That location is identified in FIG. 23 as coordinate location P′ where X_p=Y_p=Z_p=0. Deviations from this reference are calculated to determine the current position P.
• The reference coordinates for both the master and the slave are established with respect to a base location for each. In FIG. 23 it is location BM that corresponds structurally to the[0305]axis60A in FIG. 2A. In FIG. 25 it is the location BS that corresponds structurally to theaxis225A in FIG. 2B. Because both the master and slave structures have predefined configurations when they are initialized, the locations of themaster wrist60A and theslave pivot225A are known by the known dimensions of the respective structures. The predefined configuration of the master in the illustrated embodiment, per FIG. 23, relates to known lengths of arms L2 and L3, corresponding toarm91 orarm92, andarm96 respectively. The predefined configuration of the slave is similarly defined, per FIG. 25, by dimensions of arms L_sand L_band by initializing the slave unit with theguide tube17 flat in one plane (dimension Y=O) and the arm L_sin line with the Z axis.
• 2. Orientation[0306]
• The orientation of the surgeon interface handle in three dimensional space is determined by a series of coordinate transformations for each joint angle. As shown in FIG. 24, the coordinate frame at the wrist joint is rotated with respect to the reference coordinate frame by joint movements θ[0307]_bp, θ₂, θ₃and θ_ax. Specifically, the wrist joint coordinate frame is rotated (−θ_bp) about the y axis, (−θ_2a) about the z axis and θ_axabout the x axis where θ_2ais θ₂-θ₃. The resulting transformation matrix R_whfor the wrist joint coordinate frame with respect to the reference coordinate is then$R_{w\lambda }=\left[\begin{array}{ccc}{R}_{w\lambda 11}& R_{w\lambda 12}& R_{w\lambda 13}\\ R_{w\lambda 21}& R_{w\mathrm{\lambda 22}}& R_{w\mathrm{\lambda 23}}\\ R_{w\mathrm{\lambda 31}}& R_{w\lambda 32}& R_{w\mathrm{\lambda 33}}\end{array}\right]$

  
• where R[0308]_wh11=cos θ_bplcos θ_2a
• R_wh12=cos θ_bplsin θ_2acos θ_ax−sin θ_bplsin θ_ax
• R_wh13=−cos θ_bplsin θ_2asin θ_ax−sin θ_bplcos θ_ax
• R_wh21=−sin θ^2a
• R_wh22=cos θ^2acos θ_ax
• R_wh23=−cos θ_2asin θ_ax
• R_wh31=sin θ_bplcos θ_2a
• R_wh32=sin θ_bplsin θ^2acos θ_ax+cos θ_bplsin θ_ax
• R_wh33=−sin θ_bplsin θ_2asin θ_ax+cos θ_bplcos θ_ax
• Similarly, the handle coordinate frame rotates joint angles φ and (−θ[0309]_h) about the z and y axes with respect to the wrist coordinate frame. The transformation matrix R_hwhfor handle coordinate frame with respect to the wrist coordinate is then$R_{\lambda w\lambda }=\left[\begin{array}{ccc}{R}_{\lambda w\lambda 11}& R_{\lambda w\lambda 12}& R_{\lambda w\lambda 13}\\ R_{\lambda w\lambda 21}& R_{\lambda w\mathrm{\lambda 22}}& R_{\lambda w\mathrm{\lambda 23}}\\ R_{\lambda w\mathrm{\lambda 31}}& R_{\lambda w\lambda 32}& R_{\lambda w\mathrm{\lambda 33}}\end{array}\right]$

  
• where R[0310]_hwh11=cos φ cos θ_h
• R_hwh12=−sin φ
• R_hwh13=−cos φ sin θ_h
• R_hwh21=sin φ cos θ_h
• R_hwh22=cos φ
• R_hwh23=−sin φ sin θ_h
• R_hwh31=sin θ_h
• R_hwh32=0
• R_hwh33=cos θ_h
• Therefore, the transformation matrix R[0311]_hfor handle coordinate frame with respect to the reference coordinate is
• R_h=R_whR_hwh
• Inverse Kinematic Computation[0312]
• Once the position and orientation of the surgeon interface handle are computed, the instrument tool is to be moved in such a way that the position of the tool's wrist joint in three dimensional space X[0313]_w, Y_w, Z_wwith respect to the insertion point are proportional to the interface handle's positions by a scaling factor α
• (X_w−X_w—ref)=αX_p
• (Y_w−Y_w—ref)=αY_p
• (Z_w−Z_w—ref)=αZ_p
• where X[0314]_w—ref, Y_w—ref, Z_w—refare the initial reference positions of the wrist joint. The orientations could be scaled as well, but in the current embodiment, are kept identical to that of the interface handle.
• When X[0315]_w—ref,=Y_w—ref,=Z_w—ref=0 the foregoing equations simplify to:
• X[0316]_w=αX_p
• Y[0317]_w=αY_p
• Z[0318]_w=αZ_p
• where (X[0319]_w, Y_w, Z_w), (X_p, Y_p, X_p,) and α are the desired absolute position of the instrument, current position of the interface handle and scaling factor, respectively.
• 1. Position[0320]
• The next task is to determine the joint angles ω, ψ and the insertion length L[0321]_sof the instrument, as shown in FIG. 25, necessary to achieve the desired positions of the tool's wrist joint. Given Y_w, the angle ω is$\omega =\arcsin \left(\frac{Y_w}{L_{\delta s}}\right)\omega ={\sin }^{-1}\left(Y_w/L_{\mathrm{bs}}\right)\mathrm{or},$

  
• where L[0322]_bs=L_bsin θ_b.
• Referring to FIG. 26, the sine rule is used to determine the insertion length L[0323]_sof the instrument. Given the desired position of the tool's wrist joint, the distance from the insertion point to the wrist joint, L_wsis simply$L_w=\sqrt{{\mathrm{<figure-callout\; label="X\; w"\; filenames="US20020128662A1-20020912-D00000.png"\; state="\{\{state\}\}">X</figure-callout>}}_w^{}+{\mathrm{<figure-callout\; label="Y\; w"\; filenames="US20020128662A1-20020912-D00000.png"\; state="\{\{state\}\}">Y</figure-callout>}}_w^{}+{\mathrm{<figure-callout\; label="Z\; w"\; filenames="US20020128662A1-20020912-D00000.png"\; state="\{\{state\}\}">Z</figure-callout>}}_w^{}}$

  
• Then by the sine rule, the angle θ[0324]_ais${\theta }_a=\arcsin \left(\frac{L_{\delta }}{L_w}\sin {\theta }_b\right),\mathrm{and}L_s=L_w\left(\frac{\sin {\theta }_c}{\sin {\theta }_b}\right)\mathrm{where}{\theta }_c={\theta }_b-{\theta }_a$

  
• Having determined ω and L[0325]_s, the last joint angle ψ can be found from the projection of the instrument on the x-z plane as shown in FIG. 27.
• ψ=θ_L′w−θ_Δ
• where[0326]${\theta }_{\Delta }=\arccos \left(\frac{L_s+L_{\delta }\cos {\theta }_{\delta }}{L_w^{\prime }}\right),{\theta }_{L_w^{\prime }}=\arcsin \left(\frac{X_{\mathrm{wo}}}{L_w^{\prime }}\right),$

  

  $L_w^{\prime }=\sqrt{{\mathrm{<figure-callout\; label="X\; w"\; filenames="US20020128662A1-20020912-D00000.png"\; state="\{\{state\}\}">X</figure-callout>}}_w^{}+{\mathrm{<figure-callout\; label="Z\; w"\; filenames="US20020128662A1-20020912-D00000.png"\; state="\{\{state\}\}">Z</figure-callout>}}_w^{}}$

  
• and X[0327]_wois the x-axis wrist position in reference coordinate frame.
• 2. Orientation[0328]
• The last step in kinematic computation for controlling the instrument is determining the appropriate joint angles of the tool such that its orientation is identical to that of the surgeon's interface handle. In other words, the transformation matrix of the tool must be identical to the transformation matrix of the interface handle, R[0329]_h.
• The orientation of the tool is determined by pitch (θ[0330]_f), yaw (θ_wf) and roll (θ_af) joint angles as well as the joint angles ω and ψ, as shown in FIG. 28. First, the starting coordinate is rotated (θ_b−π/2) about the y-axis to be aligned with the reference coordinate, represented by the transformation matrix R₀$R_o=\left[\begin{array}{ccc}\sin {\theta }_b& 0& \left(-\cos {\theta }_b\right)\\ 0& 1& 0\\ \cos {\theta }_{\mathrm{<figure-callout\; label="b"\; filenames="US20020128662A1-20020912-D00022.png"\; state="\{\{state\}\}">b</figure-callout>}}& 0& \sin {\theta }_b\end{array}\right]$

  
• The wrist joint coordinate is then rotated about the reference coordinate by angles (−ψ) about the y-axis and ω about the z-axis, resulting in the transformation matrix R[0331]_w′f,$R_{w^{\prime }f}=\left[\begin{array}{ccc}\cos \Psi \cos \omega & \left(-\cos \Psi \sin \omega \right)& \left(-\sin \Psi \right)\\ \sin \omega & \cos \omega & 0\\ \sin \Psi \cos \omega & \left(-\sin \Psi \sin \omega \right)& \cos \Psi \end{array}\right]$

  
• followed by rotation of (π/2−θ[0332]_b) about they-axis, represented by R_wfw′f.$R_{{\mathrm{wfw}}^{\prime }f}=\left[\begin{array}{ccc}\sin {\theta }_{\mathrm{<figure-callout\; label="b"\; filenames="US20020128662A1-20020912-D00022.png"\; state="\{\{state\}\}">b</figure-callout>}}& 0& \cos {\theta }_{\mathrm{<figure-callout\; label="b"\; filenames="US20020128662A1-20020912-D00022.png"\; state="\{\{state\}\}">b</figure-callout>}}\\ 0& 1& 0\\ -\cos {\theta }_{\mathrm{<figure-callout\; label="b"\; filenames="US20020128662A1-20020912-D00022.png"\; state="\{\{state\}\}">b</figure-callout>}}& 0& \sin {\theta }_b\end{array}\right]\mathrm{which}\mathrm{is}\mathrm{equal}\mathrm{to}R_o^T.$

  
• Finally, the tool rolls (−θ[0333]_af) about the x-axis, yaws θ_wfabout the z-axis and pitches (−θ_f) about the y-axis with respect to the wrist coordinate, are calculated resulting in transformation matrix R_fwf$R_{\mathrm{fwf}}=\left[\begin{array}{ccc}{R}_{\mathrm{fwf11}}& R_{\mathrm{fwf12}}& R_{\mathrm{fwf13}}\\ R_{\mathrm{fwf21}}& R_{\mathrm{fwf22}}& R_{\mathrm{fwf23}}\\ R_{\mathrm{fwf31}}& R_{\mathrm{fwf32}}& R_{\mathrm{fwf33}}\end{array}\right]$

  
• where R[0334]_fwf11=cos θ_wfcos θ_f
• R_fwf12=−sin θ_wf
• R_fwf13=−cos θ_wfsin θ_f
• R_fwf21=cos θ_afsin θ_wfcos θ_f+sin θ_afsin θ_f
• R_fwf22=cos θ_afcos θ_wf
• R_fwf23=−cos θ_afsin θ_wfsin θ_f+sin θ_afcos θ_f
• R_fwf31=−sin θ_afsin θ_wfcos θ_f+cos θ_afsin θ_f
• R_fwf32=−sin θ_afcos θwf
• R_fwf33=sin θ_afsin θ_wfsin θ_f+cos θ_afcos_f
• Therefore the transformation matrix of the tool R[0335]_fwith respect to the original coordinate is
• R_f=R₀R_wfR₀^TR_fwf.
• Since R[0336]_fis identical to R_hof the interface handle, R_fwfcan be defined by
• R_fwf=R_oR_wf^TR_h=R_c
• [0337]$R_{\mathrm{fwf}}=R_oR_{\mathrm{wf}}^TR_o^TR_h=R_c=\left[\begin{array}{ccc}{R}_{\mathrm{c11}}& R_{\mathrm{c12}}& R_{\mathrm{c13}}\\ R_{\mathrm{c21}}& R_{\mathrm{c22}}& R_{\mathrm{c23}}\\ R_{\mathrm{c31}}& R_{\mathrm{c32}}& R_{\mathrm{c33}}\end{array}\right]$

  
• Where the matrix R[0338]_ccan be fully computed with known values. Using the computed values of R_cand comparing to the elements of R_fwf, we can finally determine the necessary joint angles of the tool.${\theta }_{\mathrm{wf}}=\arcsin \left(-R_{\mathrm{c12}}\right),{\theta }_f=\arccos \left(\frac{R_{\mathrm{c11}}}{\cos {\theta }_{\mathrm{wf}}}\right)=\arcsin \left(\frac{-R_{\mathrm{c13}}}{\cos {\theta }_{\mathrm{wf}}}\right)$${\theta }_{\mathrm{cf}}=\arccos \left(\frac{R_{\mathrm{c22}}}{\cos {\theta }_{\mathrm{wf}}}\right)=\arcsin \left(\frac{-R_{\mathrm{c32}}}{\cos {\theta }_{\mathrm{wf}}}\right)$

  
• The actuators, which are motors in the current embodiment, are then instructed to move to positions such that the determined joint angles and insertion length are achieved.[0339]
• Now reference is made to the following algorithm that is used in association with the system of the present invention. First are presented certain definitions.[0340]

  Variable Definitions: (RH - Right hand, LH - Left Hand)

  s_Ls_RH	Linear slider joint for RH slave
  s_Xi_RH	Lateral motion joint for RH slave (big disk in front of slider)
  s_Omega_RH	Up/down motion joint for RH slave (rotates curved tube)
  s_Axl_RH	Axial rotation joint for RH slave (rotates instrument insert along its axis)
  s_f1_RH	Finger 1 for RHslave
  s_f2_RH	Finger
  2 for RH slave
  s_wrist_RH	Wrist joint for RH slave
  m_base_RH	Base rotation joint for RH master
  m_shoulder_RH	Shoulder joint for RH master
  m_elbow_RH	Elbow joint for RH master
  m_Axl_RH	Axial rotation joint for RH master
  m_f1_RH	Finger 1 for RHmaster
  m_f2_RH	Finger
  2 for RH master
  m_wrist_RH	Wrist joint for RH master
  Radian[i]	Motor axle angle for joint no. i with i being one of above joints
  Des_Rad[i]	Desired motor axle angle for joint no. i
  Des_Vel[i]	Desired motor axle angular velocity for joint no. i
  Mout_f[i]	Motor command output for joint no. i
  Thetabp1_m_RH	Angle of base rotation joint for RH master
  Theta2_m_RH	Angle of elbow joint for RH master
  Theta3_m_RH	Angle of shoulder joint for RH master
  Xw_m_RH	Position of RH master handle in X-axis
  Yw_m_RH	Position of RH master handle in Y-axis
  Zw_m_RH	Position of RH master handle in Z-axis
  Xwref_m_RH	Reference position of RH master handle in X-axis
  Ywref_m_RH	Reference position of RH master handle in Y-axis
  Zwref_m_RH	Reference position of RH master handle in Z-axis
  Phi_f_m_RH	Angle of wrist joint for RH master
  Theta_f1_m_RH	Angle of finger 1 for RH master
  Theta_f2_m_RH	Angle offinger 2 for RH master
  ThetaAxl_m_RH	Angle of axial rotation joint for RH in aster
  Theta_h_m_RH	Angle of mid line of fingers for RH master
  Theta_f_m_RH	Angle of fingers from the mid line for RH master
  Xw_s_RH	Position of RH slave in X-axis
  Yw_s_RH	Position of RH slave in Y-axis
  Zw_s_RH	Position of RH slave in Z-axis
  Xwref_s_RH	Reference position of RH slave in X-axis
  Ywref_s_RH	Reference position of RH slave in Y-axis
  Zwref_s_RH	Reference position of RH slave in Z-axis
  alpha	Master-to-slave motion scaling factor
  Xw_s_b1_RH	Motion boundary 1 of RH slave in X-axis
  Xw_s_b2_RH	Motion boundary	2 of RH slave in X-axis
  Yw_s_b1_RH	Motion boundary 1 of RH slave in Y-axis
  Yw_s_b2_RH	Motion boundary	2 of RH slave in Y-axis

• Note the motion boundaries of the slave are used to define the virtual boundaries for the master system, and do not directly impose boundaries on the slave system. The following represents the steps through which the algorithm proceeds.[0341]
• 1. The system is started, and the position encoders are initialized to zero. This ASSUMES that the system started in predefined configuration.[0342]

  	/* Preset Encoder Position for all axis */
  	for(i=0; i<32; ++i)
  	{

  SetEncoder[i]=0;

  	}
  	/* Convert encoder count to radian */
  	for(i=0;i<32;i++)
  	{

  Radian[i] = Enc_to_Rad(Encoder[i]);

  	}

• 2. Bring the system to operating positions, Des_Rad[i], and hold the positions until the operator hits the keyboard, in which case the program proceeds to next step.[0343]

  While(!kbhit())
  {

  for(i=0;i<14;i++)

  /* compute motorout for slave robots*/

  {

  	Des_Vel[i] = 0.0;
  	Err_Rad[i] = Des_Rad[i] − Radian[i];
  	Err_Vel[i] = Des_Vel[i] − Velocity[i];
  	kpcmd = Kp[i]*Err_Rad[i];
  	kdcmd = (Kp[i]*Td[i])* Err_Vel[i];
  	Mout_f[i] = kpcmd + kdcmd; /* Command output to motor */

  }

  for(i=14;i<28;i++)

  /* compute motorout for master robot */

  {

  	Des_Vel[i] = 0.0;
  	Err_Rad[i] = Des_Rad[i] − Radian[i];
  	Err_Vel[i] = Des_Vel[i] − Velocity[i];
  	kpcmd = Kp[i]*Err_Rad[i];
  	kdcmd = (Kp[i]*Td[i])*Err_Vel[i];
  	Mout_f[i] = kpcmd + kdcmd; /* Command output to motor */

  }

  }

• 3. Based on the assumption that the system started at the predefined configuration, the forward kinematic computations are performed respectively for the master and the slave systems to find the initial positions/orientations of handles/tools.[0344]
• /* Compute Initial Positions of Wrist for Right Hand Master */[0345]
• Thetabp1o_m_RH=−Radian[m_base_RH]/PR_bp1;[0346]
• Theta3o_m_RH=−Radian[m_shoulder_RH]/[0347]PR_—3;
• Thetabp1_m_RH=Thetabp1o_m_RH;[0348]
• Theta3_m_RH=Theta3o_m_RH;[0349]
• Theta2o_m_RH=Theta3o_m_RH−Radian[m_elbow_RH]/[0350]PR_—2;
• Theta2_m_RH=Theta2o_m_RH;[0351]
• Theta2A_m_RH=(Theta2_m_RH−Theta3_m_RH);[0352]
• Theta2A_eff_m_RH=Theta2A_m_RH+Theta_OS_m;[0353]
• L_m_RH=(L3_m* sin (Theta3o_m_RH)+L2_eff_m* cos (Theta2A_eff_m_RH));[0354]
• Xwo_m_RH=L_m_RH* cos (Thetabp1o_m_RH);[0355]
• Ywo_m_RH=−(L3_m+L2_eff_m*sin (Theta2A_eff_m_RH));[0356]
• Zwo_m_RH=L_m_RH* sin (Thetabp1o_m_RH);[0357]
• /* Set these initial positions as the reference positions. */[0358]
• Xwref_m_RH=Xwo_m_RH=L2 (FIG. 23)[0359]
• Ywref_m_RH=Ywo_m_RH=L3[0360]
• Zwref_m_RH=Zwo_m_RH=0[0361]
• /* Initial Position of the Wrist for Right Hand Slave based on predefined configurations */[0362]
• Ls_RH=Ls;[0363]
• Xwo_s_RH=Lbs=X ref_s_RH[0364]
• Ywo_s_RH=0.0=Yref_s_RH[0365]
• Zwo_s_RH=−(Ls_RH+Lbc)=Zref_s_RH[0366]
• /* Compute Initial Orientations for Right Hand Handle */[0367]
• Phi_f_m_RH=Radian[m_wrist_RH];[0368]
• Theta_f1_m_RH=Radian[m_f1_RH];[0369]
• Theta_f2_m_RH=−Radian[m_f2_RH]−Theta_f1_m_RH;[0370]
• ThetaAx1_m_RH=Radian[m_Ax1_RH];[0371]
• Theta_h_m_RH=(Theta_f1_m_RH−Theta_f2_m_RH)/2.0; /* angle of midline[0372]
• Theta_f_m_RH=(Theta_f1_m_RH+Theta f2_m_RH )/2.0; /* angle of fingers from mid line */[0373]
• /* Repeat for Left Hand Handle and Slave Instrument */[0374]
• 4. Repeat the procedure of computing initial positions/orientations of handle and tool of left hand based on predefined configurations.[0375]
• 5. Read starting time[0376]
• /* Read starting time: init_time */[0377]
• QueryPerformanceCounter(&hirescount);[0378]
• dCounter=(double)hirescount.LowPart+(double)hirescount.HighPart * (double)(4294967296);[0379]
• QueryPerformanceFrequency(&freq);[0380]
• init_time=(double)(dCounter/freq.LowPart);[0381]
• prev_time=0.0;[0382]
• 6. Read encoder values of master/slave system, and current time[0383]

  /* Read encoder counters */
  for(i=1; i<9; ++i)
  {

  Read_Encoder(i);

  }

  /* Convert encoder counts to radian */

  for(i=0;i<32;i++)

  {

  Radian[i] = Enc_to_Rad(Encoder[i]);

  }

  /* Get current time */

  QueryPerformanceCounter(&hirescount);

  dCounter = (double)hirescount.LowPart +(double)hirescount.HighPart *

• (double)(4294967296);[0384]
• time_now=(double)(dCounter/freq.LowPart)−init_time;[0385]
• delta_time3=delta_time2;[0386]
• delta_time2=delta_time1;[0387]
• delta_time[0388]1 time_now−prev_time;
• prev_time=time_now;[0389]
• 7. Compute current positions/orientations of master handle for Right Hand[0390]
• /* Compute master handle's position for right hand */[0391]
• Thetabp1_m_RH=−Radian[m_base_RH]/PR_bp1;[0392]
• Theta3_m_RH=−Radian[m_shoulder_RH]/[0393]PR_—3;
• Theta2_m_RH=Theta3_m_RH−Radian[m_elbow_RH]/[0394]PR_—2;
• Theta2A_m_RH=(Theta2_m_RH−Theta3_m_RH);[0395]
• Theta2A_eff_m_RH=Theta2A_m_RH+Theta_OS_m;[0396]
• L_m_RH=(L3_m*sin_Theta3_m +L2_eff_m*cos_Theta2A_eff_m);[0397]
• Xw_m_RH=L_m_RH* cos_Thetabp1_m;[0398]
• Yw_m_RH=−(L3m*cos_Theta3_m+L2_eff_m*sin_Theta2A_eff_m);[0399]
• Zw_m_RH=L_m_RH * sin_Thetabp1_m;[0400]
• /* Compute master handle's orientation for right hand */[0401]
• Phi_f_m_RH=Radian[m_wrist_RH];[0402]
• Theta_f1_m_RH=Radian[m_f1_RH];[0403]
• Theta_f2_m_RH=−Radian[m_f2_RH]−Theta_f1_m_RH;[0404]
• ThetaAx1_m_RH=Radian[m_Ax1_RH];[0405]
• Theta_h_m_RH=(Theta_f1_m_RH−Theta[0406]_—f2_m_RH)/2.0; /* angle of midline*/
• Theta_f_m_RH=(Theta_f1_m_RH+Theta_f2_m_RH)/2.0; /* angle of fingers from mid line */[0407]
• /* Perform coordinate transformation to handle's coordinate */[0408]
• Rwh11=cos_Thetabp1_m*cos_Theta2A_m;[0409]
• Rwh12=−sin_Thetabp1_m*sin_ThetaAx1_m+cos_Thetabp1_m*sin_Theta2A_m*cos_ThetaAx1_m;[0410]
• Rwh13=−sin_Thetabp1_m*cos_ThetaAx1_m−cos_Thetabp1_m*sin_Theta2A_m*sin__ThetaAx1_m;[0411]
• Rwh21=−sin_Theta2A_m;[0412]
• Rwh22=cos_Theta2A_m*cos_ThetaAx1_m;[0413]
• Rwh23=−cos_Theta2A_m*sin_ThetaAx1_m;[0414]
• Rwh31=sin_Thetabp1_m*cos_Theta2A_m;[0415]
• Rwh32=cos_Thetabp1_m*sin_ThetaAx1_m+sin_Thetabp1_m*sin_Theta2A_m*cos_ThetaAx1_m;[0416]
• Rwh33=cos_Thetabp1_m*cos_ThetaAx1_m−sin_Thetabp1_m*sin_Theta2A_m*sin_ThetaAx1_m;[0417]
• Rhr11=cos_Phi_f_m*cos_Theta_h_m;[0418]
• Rhr12=−sin_Phi_f_m;[0419]
• Rhr13=−cos_Phi_f_m*sin_Theta_h_m;[0420]
• Rhr21=sin_Phi_f_m*cos_Theta_h_m;[0421]
• Rhr22=cos_Phi_f_m;[0422]
• Rhr23=−sin_Phi_f_m*sin_Theta_h_m;[0423]
• Rhr31=sin_Theta_h_m;[0424]
• Rhr32=0.0;[0425]
• Rhr33=cos_Theta_h_m;[0426]
• Rh11=Rwh11*Rhr11+Rwh12*Rhr21+Rwh13*Rhr31;[0427]
• Rh12=Rwh11*Rhr12+Rwh12*Rhr22+Rwh13*Rhr32;[0428]
• Rh13=Rwh11*Rhr13+Rwh12*Rhr23+Rwh13*Rhr33;[0429]
• Rh21=Rwh21*Rhr11+Rwh22*Rhr21+Rwh23*Rhr31;[0430]
• Rh22=Rwh21*Rhr12+Rwh22*Rhr22+Rwh23*Rhr32;[0431]
• Rh23=Rwh21*Rhr13+Rwh22*Rhr23+Rwh23*Rhr33;[0432]
• Rh31=Rwh31*Rhr11+Rwh32*Rhr21+Rwh33*Rhr31;[0433]
• Rh32=Rwh31*Rhr12+Rwh32*Rhr22+Rwh33*Rhr32;[0434]
• Rh33=Rwh31*Rhr13+Rwh32*Rhr23+Rwh33*Rhr33;[0435]
• 8. Desired tool position is computed for right hand[0436]
• /* Movement of master handle is scaled by alpha for tool position */[0437]
• Xw_s_RH=alpha*(Xw_m_RH−Xwref_m_RH)+Xwref_s_RH;[0438]
• Yw_s_RH=alpha*(Yw_m_RH−Ywref_m_RH)+Ywref_s_RH;[0439]
• Zw_s_RH=alpha*(Zw_m_RH−Zwref_m_RH)+Zwref_s_RH;[0440]
• /* The next step is to perform a coordinate transformation from the wrist coordinate (refer to FIG. 25 and coordinate Xwf, Ywf and Zwf) to a coordinate aligned with the tube arm Ls. This is basically a fixed 45° transformation (refer in FIG. 25 to θ[0441]_b) involving the sin and cos of θ_bas expressed below.*/
• Xwo_s_RH=Xw_s_RH*sin_Theta_b+Zw_s_RH*cos_Theta_b;[0442]
• Ywo_s_RH=Yw_s_RH;[0443]
• Zwo_s_RH=−Xw_s_RH*cos_Theta_b+Zw_s_RH*sin_Theta_b;[0444]
• 9. Perform inverse kinematic computation for the right hand to obtain necessary joint angles of the slave system such that tool position/orientation matches that of master handle.[0445]
• Omega_RH=asin (Ywo_s_RH/Lbs);[0446]
• Lw=sqrt(pow(Xwo_s_RH,2)+pow(Ywo_s_RH,2)+pow(Zwo_s_RH,2));[0447]
• Theta_a=asin (Lb/Lw*sin_Theta_b);[0448]
• Theta_c=Theta_b−Theta_a;[0449]
• Ls_RH=Lw*( sin (Theta_c)/ sin_Theta_b);[0450]
• Lwp=sqrt(pow(Lw,2)−pow(Ywo_s_RH,2));[0451]
• Theta_Lwp=asin (Xwo_s_RH/Lwp);[0452]
• Xi_RH=Theta_Lwp−Theta_delta;[0453]
• sin_Omega=sin (Omega_RH);[0454]
• cos_Omega=cos (Omega_RH);[0455]
• sin_Xi=sin (Xi_RH);[0456]
• cos_Xi=cos (Xi_RH);[0457]
• Ra11=cos_Xi * cos_Omega * sin_Theta_b+sin_Xi * cos_Theta_b;[0458]
• Ra12=sin_Omega * sin_Theta_b;[0459]
• Ra13=sin_Xi * cos_Omega * sin[0460]_—Theta_b−cos_Xi * cos_Theta_b;
• Ra21=−cos Xi * sin_Omega;[0461]
• Ra22=cos_Omega;[0462]
• Ra23=−sin_Xi * sin_Omega;[0463]
• Ra31=cos_Xi * cos_Omega * cos_Theta_b−sin_Xi * sin_Theta_b;[0464]
• Ra32=sin_Omega * cos_Theta_b;[0465]
• Ra33=sin_Xi * cos_Omega * cos_Theta_b+cos_Xi * sin_Theta_b;[0466]
• Rb11=Ra11 * sin_Theta_b−Ra13 * cos_Theta_b;[0467]
• Rb12=Ra12;[0468]
• Rb13=Ra11 * cos_Theta_b+Ra13 * sin_Theta_b;[0469]
• Rb21=Ra21 * sin_Theta_b−Ra23 * cos_Theta_b;[0470]
• Rb22=Ra22;[0471]
• Rb23=Ra21 * cos_Theta_b+Ra23 * sin_Theta_b;[0472]
• Rb31=Ra31 * sin_Theta_b−Ra33 * cos_Theta_b;[0473]
• Rb32=Ra32;[0474]
• Rb33=Ra31 * cos_Theta_b+Ra33 * sin_Theta_b;[0475]
• Rc11=Rb11*Rh11+Rb12*Rh21+Rb13*Rh31;[0476]
• Rc12=Rb11*Rh12+Rb12*Rh22+Rb13*Rh32;[0477]
• Rc13=Rb11*Rh13+Rb12*Rh23+Rb13*Rh33;[0478]
• Rc21=Rb21*Rh11+Rb22*Rh21+Rb23*Rh31;[0479]
• Rc22=Rb21*Rh12+Rb22*Rh22+Rb23*Rh32;[0480]
• Rc23=Rb21*Rh13+Rb22*Rh23+Rb23*Rh33;[0481]
• Rc31=Rb31*Rh11+Rb32*Rh21+Rb33*Rh31;[0482]
• Rc32=Rb31*Rh12+Rb32*Rh22+Rb33*Rh32;[0483]
• Rc33=Rb31*Rh13+Rb32*Rh23+Rb33*Rh33;[0484]
• sin_Theta_wf_s=−Rc12;[0485]
• Theta_wf_s_RH=asin ( sin_Theta_wf_s);[0486]
• cos_Theta_wf_s=cos (Theta_wf_s_RH);[0487]
• /* Compute Theta_f_s_RH */[0488]
• var1=Rc11/ cos_Theta_wf_s;[0489]
• var2=−Rc13/ cos_Theta_wf_s;[0490]
• Theta_f_s_RH=asin (var2) or acos (var1) depending or region;[0491]
• /* Compute ThetaAx1_s_RH */[0492]
• var1=Rc22/cos_Theta_wf_s;[0493]
• var2=−Rc32/cos_Theta_wf_s;[0494]
• ThetaAx1_s_RH=asin (var2) or acos (var1) depending or region;[0495]
• 10. Repeat steps[0496]7-9 for left hand system
• 11. Determine motor axle angles necessary to achieve desired positions/orientations of the slave systems, and command the motors to the determined positions.[0497]
• Des_Rad[s_Ls_RH]=63.04*(Ls_RH−Ls_init_RH−0.75*(Xi_RH−Xi_init_RH));[0498]
• Des_Rad[s_Xi_RH]=−126.08*(Xi_RH−Xi_init_RH);[0499]
• Des_Rad[s_Omega_RH]=−23.64*(Omega_RH−Omega_init_RH);[0500]
• Des_Rad[s_Ax1_RH]=−23.64*1.3333*(ThetaAx1_s_RH+Omega_RH−Omega[0501]_—init_RH);
• Des_Rad[s_wrist_RH]=18.9*Theta_wf_s_RH;[0502]
• Des_Rad[s_f1_RH]=18.9*(Theta_f_s_RH+Theta_f_m_RH);[0503]
• Des_Rad[s_f2_RH]=18.9*(−Theta_f_s_RH+Theta_f_m_RH);[0504]
• Des_Rad[s_Ls_LH]=−63.04*(Ls_LH−Ls_init_LH−0.75*(Xi_LH−Xi_init_LH));[0505]
• Des_Rad[s_Xi_LH]=126.08*(Xi_LH−Xi_init_LH);[0506]
• Des_Rad[s_Omega_LH]=−23.64*(Omega_LH−Omega_init_LH);[0507]
• Des_Rad[s_Ax1_LH]=−23.64*1.3333*(ThetaAx1_s_LH+Omega LH−Omega_init_LH);[0508]
• Des_Rad[s_wrist_LH]=18.9*Theta_wf_s_LH;[0509]
• Des_Rad[s_f1_LH]=−18.9*(−Theta_f s_LH−Theta_f_m_LH);[0510]
• Des_Rad[s_f2_LH]=−18.9*(Theta_f_s_LH−Theta_f_m_LH);[0511]
• /* Compute motor output for slave systems */[0512]
• for(i=0;i<14;i++)[0513]

  {

  	Des_Vel[i] = 0.0;
  	Err_Rad[i] = Des_Rad[i] − Radian[i];

  	Err_Vel[i] = Des_Vel[i] − Velocity[i];
  	kpcmd = Kp[i]*Err_Rad[i];
  	kdcmd = (Kp[i]*Td[i])*Err_Vel[i];
  	Mout_f[i] = kpcmd + kdcmd;

  	}
  	/* Virtual boundaries for master handles */
  	if (Xwo_s_RH>=Xw_s_b1_RH)
  	{

  	Fx_RH = 3.0*k_master*(Xwo_s_RH−Xw_s_b1_RH);
  	Mout_f[m_base_RH] = Fx_RH*cos(0.7854−(Radian[m_base_RH]/14.8));
  	Mout_f[m_shoulder_RH] = Fx_RH*sin(0.7854−

  (Radian[m_base_RH]/14.8))−

  1.0*Radian[m_shoulder_RH];

  	}
  	else if (Xwo_s_RH<=Xw_s_b2_RH)
  	{

  	Fx_RH = k_master*(Xwo_s_RH−Xw_s_b2_RH);
  	Mout_f[m_base_RH] = Fx_RH*cos(0.7854−(Radian[m_base_RH]/14.8));
  	Mout_f[m_shoulder_RH] = Fx_RH*sin(0.7854−

  (Radian[m_base_RH]/14.8))−

  1.0*Radian[m_shoulder_RH];

  	}
  	else
  	{

  	Mout_f[m_base_RH] =0.0;
  	Mout_f[m_shoulder_RH]=−1.0*Radian[m_shoulder_RH];

  	}
  	if (Ywo_s_RH>=Yw_s_b2_RH)
  	{

  Mout_f[m_elbow_RH] = −k_master*(Ywo_s_RH−Yw_s_b2_RH);

  	}
  	else if(Ywo_s_RH<=Yw_s_b1_RH)
  	{

  Mout_f[m_elbow_RH] = −k_master*(Ywo_s_RH−Yw_s_b1_RH);

  	}
  	else Mout_f[m_elbow_RH]=0.0;
  	/* Repeat for left master handle */

• 12. Go back to[0514]step6 and repeat
• Previously there has been described an algorithm for providing controlled operation between the master and slave units. The following description relates this operation to the system of FIGS.[0515]1-2.
• The[0516]controller9 receives input signals from theinput device3 that represent the relative positions of the different portions of the input device. These relative positions are then used to drive theinstrument14 to a corresponding set of relative positions. For example, the input device includes a base50 (FIG. 2A) to which afirst link90 is rotatably connected. Asecond link96 is rotatably connected to the first link at an elbow joint94. Connected to thesecond link96 opposite the elbow joint94 is a wrist joint98A and two fingers. A surgeon may attach a thumb and forefinger to the two fingers and move the input device to drive theinstrument14.
• As the surgeon operates the input device, rotational position of the base (Thetabp1_m_RH), the rotational position of the first link relative to the base (Theta3_m_RH), the rotational position of the second link relative to the first link (Theta2_m_RH), the angle of the wrist joint relative to the second link (PHI_f_m_RH, i.e., the angle the wrist joint is rotated about an axis perpendicular to the length of the second link), the rotary angle of the wrist joint relative to the second link (ThetaAx1_m_RH, i.e., the angle the wrist joint is rotate about an axis parallel to the length of the second link), and the angles of the fingers (Theta_f1_m_RH and Theta_f2_m_RH) are provided to the controller.[0517]
• When the surgical instrument is first started, the controller initializes all of the position encoders in the[0518]instrument14 and theinput device3, assuming that the system has been started in a desired initial configuration. See Sections1-3 of the algorithm. The initial position of the input device, e.g., Xwo_m_RH, Ywo_m_RH, and Zwo_m_RH, is then used to establish a reference position for the input device, Xwref_m_RH, Ywref_m_RH and Zwref_m_RH. SeeSection3 of the algorithm. Initial positions are also established for theinstrument14 based on the dimensions of theinstrument14. SeeSection3 of the algorithm.
• With reference to[0519]Section3 of the algorithm, it is noted that there is an assignment of the initial position of the wrist for the slave, and that this is not a forward kinematics calculation based upon joint angles, but rather is a number based upon the predefined configuration of the slave unit. The coordinate of the slave relates to fixed physical dimensions of the instrument and instrument holder.
• As the surgeon moves the[0520]input device3,the encoder values for the input device are read and used to compute the current absolute position of the input device, i.e., Xw_m_RH Yw_m_RH, and Zw_m_RH. SeeSections6 and7 of the algorithm. The controller then determines the desired position of the tool18 (Xw_s_RH, Yw_s_RH, and Zw_s_RH) based on the current position of the input device (Xw_m_RH Yw_m_RH, and Zw_m_RH), the reference position for the input device (Xwref_m_RH, Ywref_m_RH, and Zwref_m_RH) and the reference position for the instrument14 (Xwref_s_RH, Ywref_s_RH, and Zwref_s_RH). SeeSection8 of the algorithm. The desired position of the tool18 (Xw_s_RH, Yw_s_RH, and Zw_s_RH) is then transformed by a 45° coordinate transformation giving the desired position (Xwo_s_RH, Ywo_s_RH, Zwo_s_RH) which is used to determine joint angles and drive motor angles for theinstrument14 orientation to match that of the input device. See Sections8-11 of the algorithm. Thus, movement of thesurgical instrument14 is determined based on the current absolute position of the input device, as well as the initial positions of the input device and the instrument at the time of system start-up.
• E. Select Features of Described Embodiment[0521]
• The control in accordance with the present embodiment, as exemplified by the foregoing description and algorithm, provides an improvement in structure and operation while operating in a relatively simple manner. For example, the control employs a technique whereby the absolute position of the surgeon input device is translated into control signals to move the instrument to a corresponding absolute position. This technique is possible at least in part because of the particular construction of the instrument and controllable instrument holder, which essentially replace the cumbersome prior art multi-arm structures including one or more passive joints. Here there is initialized an all active joint construction, including primarily only a single instrument holder having a well-defined configuration with respect to the inserted instrument.[0522]
• Some prior-art systems rely upon passive joints to initially position the distal tip of the surgical instrument. Because the positions of the passive joints are initially unknown, the position of the distal tip of the surgical instrument with respect to the robot (instrument holder) is also unknown. Therefore, these systems require an initial calculation procedure. This involves the reading of joint angles and the computation of the forward kinematics of all elements constituting the slave. This step is necessary because the joint positions of the slave are essentially unknown at the beginning of the procedure.[0523]
• On the other hand, in accordance with the present invention it is not necessary to read an initial position of joint angles in order to determine an initial position of the distal tip of the surgical instrument. The system of the present invention, which preferably employs no passive joints, has the initial position of the distal tip of the surgical instrument known with respect to the base of the instrument. The instrument is constructed with known dimensions, such as between[0524]base pivot225 and the wrist (303 ataxis306 in FIG. 2D) of thetool18. Further, the instrument is initially inserted by the surgeon in a known configuration, such as illustrated in FIGS. 9 and 10, where the dimensions and orientations of the instrument insert and adaptor guide tube are known with respect to the base (pivot225). Therefore, an initial position of the surgical instrument distal tip need not be calculated before the system is used.
• The system of the present embodiment is fixed to the end of a static mount ([0525]bracket25 on post19) which is manually maneuvered over the patient, such as illustrated in FIG. 1. Since the initial position of the surgical instrument tip (tool18) with respect to the base (pivot225) of the articulate mechanism is invariant, the joint positions are neither read nor is the forward kinematics computed during the initial setup. Thus, the initial position of the surgical instrument tip is neither computed nor calculated. In addition, because the base of the system in accordance with the present embodiment is not necessarily fixed directly to the surgical table, but rather movable during a surgical procedure, the initial position of the surgical instrument in a world coordinate system is not knowable.
• Another advantage of the present system is that the instrument does not use the incision in the patient to define a pivot point of the instrument. Rather, the pivot point of the instrument is defined by the kinematics of the mechanism, independent of the patient incision, the patient himself, or the procedure. Actually, the pivot point in the present system is defined even before the instrument enters the patient, because it is a pivot point of the instrument itself. This arrangement limits trauma to the patient in an area around the incision.[0526]
• From an illustrative standpoint, the base of the instrument may be considered as pivot[0527]225 (Fig.8), and the wrist may be the pivot location604 (axis) depicted in FIG. 16B (oraxis306 in FIG. 2D). Theguide tube17 has known dimensions and because there are no other joints (active or passive) between thepivot225 and wrist joint, all of the intervening dimensions are known. Also, the instrument when placed in position has a predefined configuration such as that illustrated in FIGS. 1,9 and10 with the guide tube flat is one plane.
• The[0528]guide tube17 may also have an alignment mark therealong essentially in line with thepivot225, as shown in FIG. 9. This marks the location where theguide tube17 is at the patient incision point. The result is minimal trauma to the patient occasioned by any pivoting action aboutpivot225.
• Another advantage is the decoupling nature of the present system. This decoupling enables the slave unit to be readily portable. Here the instrument, drive unit and controller are decouplable. A sterilized[0529]adaptor15 is inserted into a patient, then coupled to a non-sterile drive unit8 (outside the sterile field). Instrument inserts16 are then removably attached to the surgical adaptor to perform the surgical procedure. The system of the present embodiment separates thedrive unit8 from theinstruments16. In this way, the instruments can be maintained as sterile, but the drive unit need not be sterilized. Furthermore, at the time of insertion, theadaptor15 is preferably decoupled from thedrive unit8 so it can be readily manually maneuvered to achieve the proper position of the instrument relative to the patient and the patient's incision.
• In accordance with the present embodiment, the instrument inserts[0530]16 are not connected to thecontroller9 by way of any input/output port configuration. Rather, the present system employs an exclusively mechanical arrangement that is effected remotely and includes mechanical cables and flexible conduits coupling to a remotemotor drive unit8. This provides the advantage that the instrument is purely mechanical and does not need to be contained within a sterile barrier. The instrument may be autoclaved, gas sterilized or disposed in total or in part.
• The present system also provides an instrument that is far less complex than prior art robotic system. The instrument is far smaller than that of a typical prior art robotic system, because the actuators (motors) are not housed in the articulate structure in the present system. Because the actuators are remote, they may be placed under the operating table or in another convenient location and out of the sterile field. Because the drive unit is fixed and stationary, the motors may be of arbitrary size and configuration, without effecting the articulated mechanics. Finally, the design allows multiple, specialized instruments to be coupled to the remote motors. This allows one to design an instrument for particular surgical disciplines including, but not limited to, such disciplines as cardiac, spinal, thoracic, abdominal, and arthroscopic.[0531]
• A further important aspect is the ability to make the instrument disposable. The disposable element is preferably the[0532]instrument insert16 such as illustrated in FIG. 15A. This disposable unit may be considered as comprising a disposable, mechanically drivable mechanism such as thecoupler300 interconnected to adisposable tool18 through a disposable elongated tube such as thestem section301,302 of the instrument insert. This disposable implement is mounted so that the mechanically drivable mechanism may be connectable to and drivable from a drive mechanism. In the illustrated embodiment the drive mechanism may include thecoupler230 and the associated drive motors. The disposableelongate tube301,302 is inserted into an incision or orifice of a patient along a selected length of the disposable elongated tube.
• The aforementioned disposable implement is purely mechanical and can be constructed relatively inexpensively, thus lending itself readily to being disposable. Another factor that lends itself to disposability is the simplicity of the instrument distal end tool (and wrist) construction. Prior tool constructions, whether graspers or other types, are relatively complex in that they usually have multiple pulleys at the wrist location for operation of different degrees-of-freedom there, making the structure quite intricate and relatively expensive to manufacture. On the other hand, in accordance with the present invention, no pulleys are required and the mechanism in the location of the wrist and tool is simple in construction and can be manufactured at far less expense, thus readily lending itself to disposability. One of the aspects of the invention that has enabled elimination of the pulleys, or the like, is the decoupling of tool action relative to wrist action by passing the tool actuation cables essentially through the center axis ([0533]604 in FIGS. 16A and 16B) of the wrist joint. This construction allows proper wrist action without any significant action being conveyed to the tool cables, and furthermore allows for a very simple and inexpensive construction at the distal end of the implement.
• Another aspect is the relative simplicity of the system, both in its construction and use. This provides an instrument system that is far less complex than prior robotic systems. Furthermore, by enabling a decoupling of the slave unit at the motor array, there is provided a readily portable and readily manually insertable slave unit that can be handled quite effectively by the surgeon or assistant when the slave unit is to be engaged through a patient incision or orifice. This enables the slave unit to be positioned through the incision or orifice so as to dispose the distal end at a target or operative site. A support is then preferably provided so as to hold a base of the slave unit fixed in position relative to the patient at least during a procedure that is to be carried out. This initial positioning of the slave unit with a predefined configuration immediately establishes an initial reference position for the instrument from which control occurs via a controller and user interface.[0534]
• This portable nature of the slave unit comes, about by virtue of providing a relatively simple surgical instrument insert in combination with an adaptor for the insert that is of relatively small configuration, particularly compared with prior large articulated robotic arm(s) structures. Because the slave unit is purely mechanical, and is decouplable from the drive unit, the slave unit can be readily positioned by the operator. Once in position, the unit is then secured to the support and the mechanical cables are coupled with the drive unit. This makes the slave unit both portable and easy to position in place for use.[0535]
• Another advantage of the system is the ability to position the holder or adaptor for the instrument with its distal end at the operative site and maintained at the operative site even during instrument exchange. By way of example, and with reference to FIG. 2B, the instrument holder is represented by the[0536]guide tube17 extending to the operative site OS. When instruments are to be exchanged, the distal end of theguide tube17 essentially remains in place and the appropriate instruments are simply inserted and/or withdrawn depending on the particular procedure that is being carried out.
• Accordingly, one of the advantages is the ease of exchanging instruments. In a particular operation procedure, there may be a multitude of instrument exchanges and the present system is readily adapted for quick and easy instrument exchange. Because the holder or adaptor is maintained in position, the surgeon does not have to be as careful each and every time that he reintroduces an instrument into the patient. In previous systems, the instrument is only supported through a cannula at the area of the incision and when an instrument exchange is to occur, these systems require removal of the entire assembly. This means that each time a new instrument is introduced, great care is required to reposition the distal end of the instrument so as to avoid internal tissue or organ damage. On the other hand., in accordance with the present invention, because the holder or adaptor is maintained in position at the operative site, even during instrument exchange, the surgeon does not have to be as careful as the insert simply slides through the rigid tube adaptor. This also essentially eliminates any chance of tissue or organ damage during this instrument exchange.[0537]
• Having now described a limited number of embodiments of the present invention, it should be apparent to those skilled in the art that numerous other embodiments and modifications thereof are contemplated as falling within the scope of the present invention.[0538]

Claims (13)

1. A portable remotely controllable surgical instrument comprising:

a manually portable elongated shaft having a proximal end and a distal end manually positionable at an operative site within a subject upon insertion of the shaft through an incision in the subject;

a manually portable mounting mechanism being readily manually mountable in a fixed position outside the patient near the incision, the proximal end of the portable shaft being mounted thereon;

a portable drive unit drivably intercoupled through the mounting mechanism to a tool mounted at the distal end of the portable shaft;

wherein the drive unit is readily positionable at a selected position outside the patient.

2. The portable surgical instrument ofclaim 1 wherein the drive unit is controllably drivable by a computer.

3. The portable surgical instrument ofclaim 1 wherein the proximal end of the portable shaft is readily manually mountable on the portable mounting mechanism for enabling ready drivable intercoupling of the tool to the drive unit.

4. The portable surgical instrument ofclaim 1 wherein the portable shaft is disposable.

5. The portable surgical instrument ofclaim 1 wherein the drive unit is readily mountable at a position remote from the incision.

6. A portable remotely controllable surgical apparatus comprising:

a manually portable elongated shaft having a proximal end and a distal end manually positionable at an operative site within a subject upon insertion of the shaft through an incision in the subject;

a manually portable mounting mechanism being readily manually mountable in a fixed position outside the patient near the incision, the proximal end of the portable elongated shaft being mounted thereon;

a manually portable support for fixedly positioning the manually portable mounting mechanism in a selected location relative to the subject, the manually portable support being readily fixedly attachable to and detachable from a stationary structure on or relative to which the subject is mounted.

7. The portable remotely controllable surgical apparatus ofclaim 6 further comprising a portable drive unit drivably intercoupled through the mounting mechanism to a tool mounted at the distal end of the portable shaft;

wherein the drive unit is readily positionable at a selected position outside and remote from the incision.

8. The portable remotely controllable surgical apparatus ofclaim 6 wherein the elongated shaft includes one or more mechanically drivable components drivably intercoupled to a drive unit, the apparatus further comprising mechanical cabling drivably coupled to the one or more components at one end of the cabling, the mechanical cabling being readily drivably couplable to and decouplable from the drive unit at another end of the mechanical cabling.

9. The portable remotely controllable surgical apparatus ofclaim 6 wherein the drive unit is readily attachable to and detachable from a fixed support on or relative to which the subject is mounted.

10. A portable remotely controllable surgical apparatus comprising:

a manually portable elongated shaft having a proximal end and a distal end manually positionable at an operative site within a subject upon insertion of the shaft through an incision in the subject;

a manually portable mounting mechanism being readily manually mountable in a fixed position outside the patient near the incision, the proximal end of the portable elongated shaft being mounted thereon;

a portable drive unit drivably interconnected to the portable elongated shaft through the mounting mechanism;

mechanical cabling drivably coupled to the mounting mechanism at one end of the cabling and readily drivably couplable to and decouplable from the portable drive unit at another end of the cabling.

11. The portable remotely controllable surgical apparatus ofclaim 10 wherein the elongated shaft includes one or more mechanically drivable components drivably intercoupled to the drive unit through the mechanical cabling.

12. The portable remotely controllable surgical apparatus ofclaim 10 wherein the drive unit is readily attachable to and detachable from a fixed support on or relative to which the subject is mounted.

13. The portable remotely controllable surgical apparatus ofclaim 10 wherein the mounting mechanism includes one or more mechanically drivable components for moving the mounting mechanism outside the subject, the one or more mechanically drivable components being drivably interconnected to the drive unit through the mechanical cabling.

Images