US20030109877A1 - Minimally invasive surgical hook apparatus and method for using same - Google Patents

Abstract

A cautery hook includes a proximal portion, a shank portion, and a distal hook portion. The shank portion is connected to the proximal portion at a bent knee protruding generally on a front side of the cautery hook. The distal hook portion is connected to the shank portion at an ankle protruding generally on a rear side of the cautery hook opposite from the front side of the cautery hook. The distal hook portion includes a distal hook tip generally on the front side of the cautery hook. The bent knee, ankle, and distal hook tip are the three most likely locations of contact between the cautery hook and a cannula sleeve when the cautery hook is passed through the cannular sleeve between an internal surgical site and the outside. Each contact tends to self-align the cautery hook to allow the hook to pass through the cannula sleeve without getting stuck or damaged.

Description

CROSS-REFERENCES TO RELATED APPLICATIONS
• This application is related to the following patents and patent applications, the full disclosures of which are incorporated herein by reference: PCT International Application No. PCT/US98/19508, entitled “Robotic Apparatus”, filed on Sep. 18, 1998, U.S. Application Serial No. 60/111,713, entitled “Surgical Robotic Tools, Data Architecture, and Use”, filed on Dec. 8, 1998; U.S. Application Serial No. 60/111,711, entitled “Image Shifting for a Telerobotic System”, filed on Dec. 8, 1998; U.S. application Ser. No. ______ (Attorney Docket No. 17516-001510), entitled “Stereo Viewer System for Use in Telerobotic System”, filed on Aug. 20, 1999; U.S. application Ser. No. 09/398,507, entitled “Master Having Redundant Degrees of Freedom”, filed on Sep. 17, 1999, U.S. application Ser. No. 09/399,457, entitled “Cooperative Minimally Invasive Telesurgery System”, filed on Sep. 17, 1999; U.S. Provisional application Ser. No. 09/373,678, entitled “Camera Referenced Control in a Minimally Invasive Surgical Apparatus”, filed on Aug. 13, 1999; U.S. Provisional application Ser. No. ______ (Attorney Docket No. 17516-004410), entitled “Surgical Tools for Use in Minimally Invasive Telesurgical Applications”, filed on Sep. 17, 1999; and U.S. Pat. No. 5,808,665, entitled “Endoscopic Surgical Instrument and Method for Use”, issued on Sep. 15, 1998.[0001]
BACKGROUND OF THE INVENTION
• Advances in minimally invasive surgical technology could dramatically increase the number of surgeries performed in a minimally invasive manner. Minimally invasive medical techniques are aimed at reducing the amount of extraneous tissue that is damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and deleterious side effects. The average length of a hospital stay for a standard surgery may also be shortened significantly using minimally invasive surgical techniques. Thus, an increased adoption of minimally invasive techniques could save millions of hospital days, and millions of dollars annually in hospital residency costs alone. Patient recovery times, patient discomfort, surgical side effects, and time away from work may also be reduced with minimally invasive surgery.[0002]
• The most common form of minimally invasive surgery may be endoscopy. Probably the most common form of endoscopy is laparoscopy, which is minimally invasive inspection and surgery inside the abdominal cavity. In standard laparoscopic surgery, a patient's abdomen is insufflated with gas, and cannula sleeves are passed through small (approximately ½ inch) incisions to provide entry ports for laparoscopic surgical instruments. The laparoscopic surgical instruments generally include a laparoscope (for viewing the surgical field) and working tools. The working tools are similar to those used in conventional (open) surgery, except that the working end or end effector of each tool is separated from its handle by an extension tube. As used herein, the term “end effector” means the actual working part of the surgical instrument and can include clamps, graspers, scissors, staplers, and needle holders, for example. To perform surgical procedures, the surgeon passes these working tools or instruments through the cannula sleeves to an internal surgical site and manipulates them from outside the abdomen. The surgeon monitors the procedure by means of a monitor that displays an image of the surgical site taken from the laparoscope. Similar endoscopic techniques are employed in, e.g., arthroscopy, retroperitoneoscopy, pelviscopy, nephroscopy, cystoscopy, cisternoscopy, sinoscopy, hysteroscopy, urethroscopy and the like.[0003]
• Minimally invasive telesurgical robotic systems are being developed to increase a surgeon's dexterity when working within an internal surgical site, as well as to allow a surgeon to operate on a patient from a remote location. In a telesurgery system, the surgeon is often provided with an image of the surgical site at a computer workstation. While viewing a three-dimensional image of the surgical site on a suitable viewer or display, the surgeon performs the surgical procedures on the patient by manipulating master input or control devices of the workstation. The master controls the motion of a servomechanically operated surgical instrument. During the surgical procedure, the telesurgical system can provide mechanical actuation and control of a variety of surgical instruments or tools having end effectors such as, e.g., tissue graspers, needle drivers, or the like, that perform various functions for the surgeon, e.g., holding or driving a needle, grasping a blood vessel, or dissecting tissue, or the like, in response to manipulation of the master control devices.[0004]
• An electrosurgical instrument is an end effector for coagulating ruptured blood vessels or the like. The instrument typically includes an electrode that applies current to living tissue at a surgical site. As the tissue current is conducted through the tissue, the tissue temperature rises, ultimately causing desiccation, cutting, and/or coagulation of the target tissue or vessel. Some cautery instruments include a J-shaped or L-shaped distal hook conveniently configured to snag or capture anatomical tissue such as a blood vessel for cauterization. The J-shaped or L-shaped hook often includes a distal hook portion connected to a substantially straight shank portion. The lateral dimension of the hook portion typically is substantially larger than that of the shank portion. When the cautery hook is passed through a cannula sleeve between the internal surgical site and the outside, the hook portion may get caught at an edge of the cannula sleeve or become stuck in the sleeve, particularly if the hook portion includes a sharp tip. In some cases, the hook portion may even break off when passing through the cannula sleeve.[0005]
SUMMARY OF THE INVENTION
• The present invention is generally directed to robotic surgery methods, devices, and systems. The invention provides a cautery hook that is configured to substantially avoid being caught inside a cannula sleeve and being damaged or broken when the cautery hook is passed through the cannula sleeve.[0006]
• In accordance with an aspect of the present invention, a cautery hook includes a proximal portion having a proximal end. A shank portion is connected to the proximal portion at a bent knee protruding generally on a front side of the cautery hook. A distal hook portion includes a distal hook tip generally on the front side of the cautery hook. The distal hook portion is connected to the shank portion at an ankle protruding generally on a rear side of the cautery hook opposite from the front side of the cautery hook.[0007]
• In use, the bent knee, ankle, and distal hook tip are the three most likely locations of contact between the cautery hook and a cannula sleeve when the cautery hook is passed through the cannular sleeve between an internal surgical site and the outside. Each location of contact tends to self-align the cautery hook to allow the hook to pass through the cannula sleeve without getting stuck or damaged.[0008]
• In some preferred embodiments, a proximal portion line extending generally between the proximal end and the bent knee is angularly spaced from a shank portion line extending generally between the bent knee and the ankle by a bent knee angle generally on the front side of the cautery hook. The bent knee angle is greater than 180° and no greater than about 270°. In a specific embodiment, the bent knee angle is between about 200° and about 250°.[0009]
• In some preferred embodiments, the distal hook tip coincides with, or is disposed rearward of, a proximal portion plane which extends from the proximal end toward the bent knee and which is generally transverse to a distal hook plane on which the distal hook portion lies.[0010]
• In some preferred embodiments, a distal hook tip tangent which is generally tangential to the distal hook portion at the distal hook tip is angularly spaced by a master angle from a proximal portion line extending between the proximal end and the bent knee. The master angle is disposed generally on the front side of the cautery hook, and is greater than 90°, preferably between about 110° and about 180°, and more preferably between about 120° and about 150°.[0011]
• In a preferred embodiment, a rear support is disposed rearward of the bent knee and extends generally between the proximal end and the ankle.[0012]
• In another preferred embodiment, the bent knee is spaced from the ankle by a shank portion length and the ankle is spaced from the distal hook tip by a distal hook portion length. The shank portion length is approximately equal to or greater than the distal hook portion length.[0013]
• In specific embodiments, the distal hook portion is generally linear. The proximal portion, the shank portion, and the distal hook portion are generally planar and generally coplanar with each other. The proximal portion includes an engagement base at the proximal end for coupling the cautery hook to a support shaft.[0014]
• In accordance with another aspect of the invention, a cautery hook includes a generally linear proximal portion. A generally linear shank portion is connected to the proximal portion at a bent knee. The shank portion is generally coplanar with the proximal portion. A generally linear distal hook portion includes a distal hook tip and is connected to the shank portion at an ankle. The distal hook portion is generally coplanar with the shank portion. The distal hook tip and the bent knee are disposed generally on a front side of the cautery hook and the ankle is disposed generally on a rear side of the cautery hook which is opposite from the front side.[0015]
• In some preferred embodiment, the distal hook portion is angularly spaced by a master angle from the proximal portion. The master angle is disposed generally on the front side of the cautery hook, and is greater than 90°.[0016]
• In accordance with another aspect of the invention, a cautery hook configured to self-align when passed through a cannula sleeve includes a distal hook portion having a distal hook tip disposed generally on a front side of the cautery hook. The cautery hook further includes a proximal end. A protruding portion is formed between the proximal end and the distal hook portion. The protruding portion includes a protruding surface generally on the front side of the cautery hook.[0017]
• In some preferred embodiments, the bent knee generally coincides with, or protrudes generally forward of, a plane extending between the proximal end and the distal hook tip. The cautery hook further includes an ankle formed between the bent knee and the distal hook tip. The ankle protrudes generally on the rear side of the cautery hook. The protruding portion is formed between a proximal portion extending from the protruding portion to the proximal end and a shank portion extending from the protruding portion to the ankle.[0018]
• Another aspect of the invention is directed to a system for cauterizing a target tissue in an internal surgical site of a patient body. The system includes a cannula sleeve having a proximal end, a distal end, and a lumen therebetween. The distal end is insertable into the patient body for accessing the internal surgical site through the lumen. A tool extends into the lumen of the cannula sleeve. The tool includes a cautery hook coupled with a shaft by a joint. The cautery hook has a tip supported by a bend so that the tip extends in a forward direction. A surface of the cautery hook is disposed proximally of the bend and extends forward sufficiently that sliding engagement between the proximal hook surface and the lumen of the cannula sleeve aligns the cautery hook with the shaft so as to inhibit interference between the tip and the distal end of the cannula sleeve when the cautery hook moves proximally into the cannula sleeve. The tool may be a robotic tool.[0019]
• In some preferred embodiments, the bend of the cautery hook is generally planar. The cautery hook is rotatable generally on a plane of rotation relative to the shaft at a pivotal connection with the bend lying generally on the plane of rotation. The proximal cautery surface generally coincides with, or extends generally forward of, a plane which is perpendicular to the plane of rotation and extends between the pivotal connection and the tip.[0020]
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a side view of a robotic arm and surgical instrument assembly according to a preferred embodiment of the invention;[0021]
• FIG. 2 is a perspective view of the robotic arm and surgical instrument assembly of FIG. 1;[0022]
• FIG. 3 is a perspective view of a surgical instrument according to a preferred embodiment of the invention;[0023]
• FIG. 4 is a schematic kinematic diagram corresponding to the side view of the robotic arm shown in FIG. 1, and indicates the arm having been displaced from one position into another position;[0024]
• FIG. 5 is a front view of a wrist mechanism for a cautery hook in accordance with a preferred embodiment of the invention;[0025]
• FIG. 6 is a side view of the wrist mechanism of FIG. 5 in the direction of arrow VI;[0026]
• FIG. 7 is a sectional view of the wrist mechanism of FIG. 5 along arrows VII-VII;[0027]
• FIG. 8 is a side view of a cautery hook in accordance with a preferred embodiment of the invention;[0028]
• FIG. 8A is a simplified schematic view illustrating alternate embodiments of the cautery hook of FIG. 8;[0029]
• FIG. 9 is a front view of the cautery hook of FIG. 8;[0030]
• FIG. 10 is a side view of a cautery hook in accordance with another embodiment of the invention;[0031]
• FIG. 10A is a simplified schematic view illustrating alternate embodiments of the cautery hook of FIG. 10;[0032]
• FIG. 10B is a simplified schematic view illustrating additional alternate embodiments of the cautery hook of FIG. 10;[0033]
• FIG. 11 is a front view of the cautery hook of FIG. 10;[0034]
• FIG. 11A shows a hook having an insulating sheath according to another embodiment of the invention;[0035]
• FIGS.[0036]12A-12C illustrate the self-aligning feature of the cautery hook of FIG. 10; and
• FIGS. 13 and 14 are front and side views of a cautery hook illustrating a sandwiched structure according to another embodiment of the present invention.[0037]
DESCRIPTION OF THE PREFERRED EMBODIMENTS
• As used herein, the terms “cautery” and “cauterize” are used to describe delivery of electricity to tissue to heat the tissue as well as heating to burn/seal tissue. Therefore, cautery instruments as used herein include electrosurgical instruments.[0038]
• FIGS. 1 and 2 illustrate a robotic arm and[0039]surgical instrument assembly10. Theassembly10 includes arobotic arm12 and asurgical instrument14. FIG. 3 indicates the general appearance of thesurgical instrument14.
• The[0040]surgical instrument14 includes an elongate shaft14.1. A wrist-like mechanism94 is located at a working end of the shaft14.1. Ahousing53 arranged releasably to couple theinstrument14 to therobotic arm12 is located at an opposed end of the shaft14.1. In FIG. 1, and when theinstrument14 is coupled or mounted on therobotic arm12, the shaft14.1 extends along an axis indicated at14.2. Theinstrument14 is typically releasably mounted on acarriage11 which is preferably driven to translate along alinear guide formation24 in the direction of arrows P. Thesurgical instrument14 is described in greater detail herein below.
• The[0041]robotic arm12 is typically mounted on a base (not shown) by means of a bracket or mountingplate16. The base is typically in the form of a mobile cart or trolley (not shown) which is retained in a stationary position during a surgical procedure.
• The[0042]robotic arm12 includes acradle18, anupper arm portion20, aforearm portion22, and theguide formation24. Thecradle18 is pivotally mounted on theplate16 in a gimbaled fashion to permit rocking movement of the cradle in the direction ofarrows26 about apivot axis28, as shown in FIG. 2. Theupper arm portion20 includeslink members30,32 and theforearm portion22 includeslink members34,36. Thelink members30,32 are pivotally mounted on thecradle18 and are pivotally connected to thelink members34,36. Thelink members34,36 are pivotally connected to theguide formation24. The pivotal connections between thelink members30,32,34,36, thecradle18, and theguide formation24 are arranged to enable the robotic arm to move in a specific manner.
• The movements of the preferred[0043]robotic arm12 is illustrated schematically in FIG. 4. The solid lines schematically indicate one position of the robotic arm and the dashed lines indicate another possible position into which the arm can be displaced from the position indicated in solid lines.
• It will be understood that the axis[0044]14.2 along which the shaft14.1 of theinstrument14 extends when mounted on therobotic arm12 pivots about a pivot center orfulcrum49. Thus, irrespective of the movement of therobotic arm12, thepivot center49 normally remains in the same position relative to a stationary cart on which thearm12 may preferably be mounted. In use, thepivot center49 is positioned at a port of entry into a patient's body when an internal surgical procedure is to be performed. It will be appreciated that the shaft14.1 extends through such a port of entry, the wrist-like mechanism94 then being positioned inside the patient's body. Thus, the general position of themechanism94 relative to the surgical site in a patient's body can be changed by movement of thearm12. Since thepivot center49 is coincident with the port of entry, such movement of the arm does not excessively effect the surrounding tissue at the port of entry. It is to be appreciated that the invention is not limited to this particular arrangement and the field of application of the invention is not limited to surgical procedures at internal surgical sites only, but can be used on open surgical sites as well.
• As can best be seen in FIG. 4, the preferred[0045]robotic arm12 provides three degrees of freedom of movement to thesurgical instrument14 when mounted thereon. These degrees of freedom of movement are firstly the gimbaled motion indicated byarrows26, pivoting or pitching movement as indicated byarrows27, and the linear displacement in the direction of arrows P. Movement of the arm as indicated byarrows26,27 and P is controlled by appropriately positioned actuators, e.g., electrical motors or the like, which respond to inputs from its associated master control to drive thearm12 to a desired position as dictated by movement of the master control.
• Referring now to FIGS.[0046]5-7, in which like reference numerals are used to designate similar parts unless otherwise stated, an end effector in the form of acautery hook90 is indicated. Thehook90 preferably is removably mountable on asingle pulley arrangement92. Thepulley arrangement92 forms part of thewrist mechanism94. Thewrist mechanism94 hassingle pulleys96,98,100,102.
• The wrist-[0047]like mechanism94 includes arigid wrist member91. One end portion of thewrist member91 is pivotally mounted in aclevis17 on the end14.3 of the shaft14.1 by means of apivotal connection54. As best seen in FIG. 6, thewrist member91 can pivot in the direction ofarrows56 about thepivotal connection54.
• The[0048]hook90 is detachably coupled to thesingle pulley arrangement92, which is pivotally mounted in aclevis19 on an opposed end of thewrist member91, by means of apivotal connection60. As a result, thehook90 is angularly displaceable about thepivotal connection60 as indicated byarrows62 in FIG. 5.
• In the specific embodiment shown, the[0049]hook90 has an engagement portion90.1. The engagement portion90.1 is removably insertable into a slot92.1 defined in thepulley arrangement92. It will be appreciated that when the engagement portion90.1 of thehook90 is inserted into the slot92.1, a free end90.2 of the engagement portion90.1 is marginally and resiliently bent in the direction of arrow Z as shown in FIG. 7. Once inserted, and when thehook90 is urged to be removed from the slot92.1, frictional engagement of the end90.2 against an inner wall of the slot92.1 tends to urge the free end90.2 in an outward direction as indicated by arrow X, thus locking the engagement portion90.1 in the slot92.1. Locking thehook90 in a mounted condition on thepulley arrangement92 is important so as to inhibit thehook90 from becoming dismounted from thepulley arrangement92 during a surgical procedure. However, when removed from the surgical site, thehook90 can be removed when a sufficient pulling force is applied so as to overcome the frictional locking action in the slot92.1.
• As best seen in FIG. 6, the[0050]single pulley arrangement92 defines acircumferentially extending channel93 in which an elongate element in the form of, e.g., an activation cable C1, is carried. Acable seat95 defines a generally circumferentially directed hole generally in register with thecircumferentially extending channel93.
• In use, the activation cable C[0051]1 extends through thecable seat95, and has a thickened crimped portion along its length which seats against the larger side of the hole in thecable seat95. The rest of the activation cable C1 extends along thechannel93 in opposed directions. The thickened portion is seated into position in the hole of theseat95 so as to anchor the cable C1 in the hole.
• As best seen in FIG. 5, the[0052]wrist member91 is flanked by twopulleys96,100 which are coaxially positioned on thepivotal connection54 and in theclevis17 at the end14.3 of the shaft14.1. The other twopulleys98,102 are rotatably mounted on opposed sides of thewrist member91. Thepulley98 is generally co-planar with its associatedpulley96, and thepulley102 is generally co-planar with its associatedpulley100. Furthermore, each of thepulleys98,102 is positioned such that its circumference is in close proximity to the circumference of its associatedpulley96,100, respectively. Thus, the circumferentially extending channel formation of each of thepulley98,102 and that of each of their associatedpulleys96,100, respectively, define between them aspace72 through which the activation cable C1 can snugly pass. The cable C1 rides over thepulleys100,102, over part ofcircumferential channel93 of thepulley arrangement92, through the hole in thecable seat95, again along part of thecircumferential channel93 of thepulley arrangement92, and over thepulleys98,96.
• It will be appreciated that the[0053]electrocautery instrument14 is used to generate an electrical current at a surgical site so as to burn or seal, e.g., ruptured blood vessels. In use, the patient is earthed and a voltage is supplied to theelectrode90. An electricallyconductive cable124 extends from a plug on thehousing53 to theelectrode90. This conductive cable, or cautery wire, preferably includes a “service loop” around the distaljoint axis60, as shown in FIGS. 5 and 6. This service loop single, loose wrap around the joint permits rotation of theelectrode90 about the axis without placing undue stress or stretch on the wire during such rotation.
• Other elongate elements, e.g., cables, are used to effect additional movement of the[0054]wrist mechanism94. For example, an activation cable C2 as shown in FIG. 5 moves thewrist member91 to pivot relative to thepivotal connection54 in the direction of arrows56 (FIG. 6). The cables C1, C2 pass from thewrist mechanism94 through appropriately positioned holes in the base region of theclevis17, and internally along the shaft14.1, toward the housing53 (FIG. 3). The apparatus for operating thewrist mechanism94 are described in greater detail in U.S. application Ser. No. ______ (Attorney Docket No. 17516-004410), entitled “Surgical Tools for Use in Minimally Invasive Telesurgical Applications”, filed on Sep. 17, 1999.
• As shown in FIGS. 8 and 9, the[0055]cautery hook90 includes aproximal portion110, ashank portion112, and a distal hook portion orfoot portion114. Theproximal portion110 includes the engagement portion90.1. Theproximal portion110 is connected to theshank portion112 to define abent knee116 which is disposed generally on a front side of thecautery hook90. Theshank portion112 is connected to thehook portion114 to define anankle118 which is disposed generally on a rear side of thecautery hook90. Thehook portion114 has ahook tip120 disposed generally on the front side of thecautery hook90. In the embodiment shown, theproximal portion110,shank portion112, andhook portion114 are generally planar and generally uniform in thickness, and they are generally coplanar with each other. Thehook portion114 is generally linear. The cross-section of thehook90 is generally flat and uniform in a preferred embodiment.
• In this embodiment, the[0056]distal hook tip120 coincides with, or is generally rearward of, a proximal portion plane which extends from theproximal end115 toward theknee116 and which is generally transverse to a distal hook plane on which thedistal hook portion114 lies. That is, theknee116 coincides with, or extends generally forward of, a plane extending between theproximal end115 and thehook tip120. In this way, thedistal hook tip120 falls within the shadow of theknee116 which shields thetip120, and substantially prevents thetip120 from being caught in a cannula sleeve and reducing the risk of breakage. Furthermore, thebent knee116 is spaced from theankle118 by a shank portion length. Theankle118 is spaced from thedistal hook tip120 by a hook portion length. In some preferred embodiments, the shank portion length is approximately equal to or greater than the hook portion length.
• FIG. 8A illustrate schematically alternate embodiments of the[0057]hook90 by varying the angle of thehook portion114 with respect to theproximal portion110. As long as thedistal tip120 is shielded by the knee116 (by coinciding with or being disposed rearward of the proximal portion plane), thehook portion114 may be oriented in a wide range of angles while maintaining thedistal tip120 generally on the front side of thehook90. The maximum length of thehook portion114 between theankle118 and thetip120 is shortest when thehook portion114 is perpendicular to the proximal portion plane.
• As shown in FIG. 8, the[0058]hook90 advantageously includes arear support113 extending between theproximal end115 and theankle118 to protect the backside of theknee116 and theankle118 from being caught in a cannula sleeve. Without thisrear support113, the ankle would have to be angled so as to avoid interfering with a cannula distal portion during withdrawal from the surgical site, as is addressed for the embodiment shown in FIGS.10-11.
• The[0059]proximal portion110 includes a forward branch orextension122 which makes anangle126 with thetrunk123, as shown in FIG. 8A. If theangle126 is greater than about 90°, theknee116 will aid in aligning the hook to prevent the front side of theproximal portion110 from being caught in a cannula sleeve. Theangle126 is typically between about 110° and about 180°, more preferably between about 120° and about 150°.
• FIGS. 10 and 11 show another[0060]cautery hook130 including aproximal portion140 with aproximal end141, ashank portion142, and adistal hook portion144. Theproximal portion140 is connected to theshank portion142 to define abent knee146 which is disposed generally on a front side of thecautery hook130. Theshank portion142 is connected to thehook portion144 to define anankle148 which is disposed generally on a rear side of thecautery hook130. Thehook portion144 has ahook tip150 disposed generally on the front side of thecautery hook130. Abent knee angle156 is formed between theproximal portion140 and theshank portion142, and is greater than 180°. In the embodiment shown, theproximal portion140,shank portion142, andhook portion144 are generally linear portions, and are generally coplanar with each other. An engagement portion similar to the portion90.1 shown in FIG. 8 may be attached to theproximal portion140.
• In this embodiment, the[0061]hook portion144 makes anangle158 with a proximal portion line extending between theproximal end141 and theknee146 which is greater than about 90°, as illustrated in FIG. 10A. If thismaster angle158 is equal to or less than about 90°, thedistal tip150 will tend to get caught in a cannula sleeve unless it is shielded by theknee146 as in FIG. 8A. When theangle158 increases beyond about 90°, the tendency of catching thetip150 in a cannula sleeve decreases, even without shielding from theknee146. The hook portion length between theankle148 and thetip150 may be greater than (as well as smaller than or equal to) the shank portion length between theknee146 and theankle148. Typically, themaster angle158 is between about 110° and 180°. In preferred embodiments, themaster angle158 is between about 120° and 150°. FIG. 10A likewise depicts aknee angle156 that results in theshank portion142 having an angle (equal to 360° minus angle156) of greater than 90°, preferably greater than about 110°. This angular positioning of theshank portion142 permits the ankle to self-align upon contacting a cannula distal tip, for example.
• FIG. 10B shows additional alternate embodiments in which the[0062]hook portion144 is not linear but curved. Further, theankle148 in FIG. 10B could be eliminated by providing for a curved surface between theknee146 andankle148. In any event, as long as theknee146 protects thedistal hook tip150 from the cannula, the lack of an ankle or curvature of certain of the hook portions is within the scope of the invention. However, if the distal hook tip is not protected, then the master angle should be of the magnitudes described previously. That is, for these embodiments, themaster angle158 is more appropriately defined based on a distalhook tip tangent159 which is generally tangential to thehook portion144 at thedistal hook tip150. Themaster angle158 is the angle measure from theproximal portion140 extending between theproximal end141 and thebent knee146 to the distalhook tip tangent159. Themaster angle158 is greater than 90°, typically between about 110° and 180°, more preferably between about 120° and 150°.
• The[0063]bent knee angle156 is greater than 180° and more typically is greater than about 200°. Thehook130 in FIG. 10 does not include a rear support (such as thesupport113 in FIG. 8) extending between theproximal end141 and theankle148 to protect the backside of theknee146 from being caught in a cannula sleeve. To avoid catching the cannula sleeve, thebent knee angle156 between theproximal portion140 and theshank portion142 should typically be no greater than about 270°, and more preferably no greater than about 250°.
• As shown in FIG. 11, the[0064]hook130 in a preferred embodiment has a round proximal cross-section extending from theproximal end141 to aregion151 in theshank portion142 between theknee146 and theankle148. A preferred diameter is about 0.06 inch. The distal cross-section extending from theregion151 to thedistal tip120 is generally slightly flattened (e.g., about 0.05 inch thickness) with corners that facilitate easier cutting over a round cross-sectional instrument.
• A round distal cross-section is preferred for an electrosurgical instrument using RF (radiofrequency) current because of the uniformly dense current across the skin or surface area of the instrument. For a flat, rectangular cross-section as in the embodiments shown in FIGS.[0065]8-11, the current is concentrated at the corners so that the hooks are better suited for cutting tissue than rounded hooks, although they do not coagulate as well because of the nonuniform concentration of current and the general sharpness of a generally flat hook of, e.g., 15 thousandths of an inch thick.
• Various portions of the[0066]hook90 or130 can be sheathed with insulating (e.g., PTFE/Teflon or silicon) tubing or injection molding, leaving exposed only the portion of the hook that is used to cauterize (typically the internal portion of the ankle). The insulating material is advantageous in limiting the electrically active surface area of the tool that is exposed to the surgical environment. If an insulating tubing or molding is provided to insulate, e.g., the proximal portion of the hook, a gasket153 (e.g., made of low durometer silicon) may be used to cover the exposed portion of the hook between the distalmost portion of the wrist joint (with joint axis60) of thewrist91 and the proximalmost portion of the insulatingmaterial155, as shown in FIG. 11A. Thegasket153 prevents a small portion of the metallic hook material (before the insulating material begins) from being undesirably exposed to the surgical environment.
• The cautery hooks[0067]90,130 of FIGS.8-11 advantageously can self-align as they are passed through a cannula sleeve to avoid getting stuck in the sleeve, to avoid any delay to a surgical procedure during tool exchange, and/or to protect thedistal hook portions114,144 from being bent or broken off. FIGS.12A-12C illustrate the self-aligning feature of thecautery hook130 which is being withdrawn through acannula sleeve160. Thecautery hook130 may be mounted on the shaft14.1 of the surgical instrument14 (FIG. 3) or connected to a cable or the like when it is passed through thesleeve160.
• In FIG. 12A, the[0068]bent knee146 of thecautery hook130 contacts the edge of thecannula sleeve160, causing thehook130 to rotate in thedirection162 to self-align thehook130. In FIG. 12B, theankle148 produces self-alignment of thecautery hook130 in thesleeve160 in thedirection164 when it contacts thesleeve160. In FIG. 12C, the contact between thedistal hook tip150 and thesleeve160 causes thecautery hook130 to self-align with respect to thesleeve160 in thedirection166. Thebent knee146 is preferably sufficiently forward that sliding engagement between the front surface of the bent knee46 and the lumen of thecannula sleeve160 aligns thecautery hook130 relative to the lumen so as to inhibit interference between thedistal hook tip150 and the cannula when thecautery hook130 moves proximally into thecannular sleeve160. Typically, thebent knee146 coincides with, or extends generally forward of, a plane extending between theproximal end141 and thedistal hook tip150. In the specific embodiment shown in FIGS. 10 and 11, theproximal portion140 is generally linear with a longitudinal axis, and thedistal hook tip150 generally coincides with the longitudinal axis extending from theproximal portion140.
• The[0069]bent knee146,ankle148, anddistal hook tip150 are the three most likely locations of contact between thecautery hook130 and thecannula sleeve160. Each contact tends to self-align thehook130 to allow thehook130 to pass through thesleeve160 without getting stuck or damaged. Thebent knee116,ankle118, anddistal hook tip120 of thecautery hook90 of FIGS. 8 and 9 provide self-alignment in a similar manner.
• FIGS. 13 and 14 show another[0070]hook200 which can be used as a bipolar cautery hook. Thehook200 includes a sandwiched structure having a core202 sandwiched between two shell layers orcoatings204. Thecore202 includes an insulative material such as ceramic or silicon. The shell layers204 include a metallic electrode material such as gold (Au). The metallic electrode material may be masked and sputter-deposited so that the deposited metal would not reach around theinsulative core202 to complete an undesired circuit.
• It is appreciated that the present invention is not limited to cautery or electrosurgical hooks, but applies, in general, to any hook-shaped instrument that is usable in minimally invasive surgery. Thus, the function required of the hooked structure should not be understood as limiting the invention. For example, hooks that are used to retract tissue that are delivered through a cannula or other tubular delivery device can benefit from the self aligning structure. Other hook structures might be used for dissection, e.g., to hook and then peel the IMA (internal mammary artery) away from the chest wall (instead of having to use scalpel and/or cautery instruments to achieve that function) or for retraction of certain tissues at the surgical site.[0071]
• It is further appreciated that the hooks having self-aligning features in accordance with the present invention can be of a variety of cross sections, and are not limited to the specific cross sections shown herein.[0072]
• The above-described arrangements of apparatus and methods are merely illustrative of applications of the principles of this invention and many other embodiments and modifications may be made without departing from the spirit and scope of the invention as defined in the claims. The scope of the invention should, therefore, be determined not with reference to the above description, but instead should be determined with reference to the appended claims along with their full scope of equivalents.[0073]

Claims (25)

What is claimed is:

1. A cautery hook comprising:

a proximal portion having a proximal end;

a shank portion connected to the proximal portion at a bent knee protruding generally on a front side of the cautery hook; and

a distal hook portion including a distal hook tip generally on the front side of the cautery hook, the distal hook portion being connected to the shank portion at an ankle protruding generally on a rear side of the cautery hook opposite from the front side of the cautery hook.

2. The cautery hook ofclaim 1 wherein a proximal portion line extending generally between the proximal end and the bent knee is angularly spaced from a shank portion line extending generally between the bent knee and the ankle by a bent knee angle generally on the front side of the cautery hook, the bent knee angle being greater than 180°.

3. The cautery hook ofclaim 2 wherein the bent knee angle is no greater than about 270°.

4. The cautery hook ofclaim 3 wherein the bent knee angle is between about 200° and about 250°.

5. The cautery hook ofclaim 1 wherein the distal hook tip coincides with, or is disposed rearward of, a proximal portion plane which extends from the proximal end toward the bent knee and which is generally transverse to a distal hook plane on which the distal hook portion lies.

6. The cautery hook ofclaim 1 wherein a distal hook tip tangent which is generally tangential to the distal hook portion at the distal hook tip is angularly spaced by a master angle from a proximal portion line extending between the proximal end and the bent knee, the master angle being disposed generally on the front side of the cautery hook and being greater than 90°.

7. The cautery hook ofclaim 6 wherein the master angle is between about 110° and about 180°.

8. The cautery hook ofclaim 7 wherein the master angle is between about 120° and about 150°.

9. The cautery hook ofclaim 1 further comprising a rear support disposed rearward of the bent knee and extending generally between the proximal end and the ankle.

10. The cautery hook ofclaim 1 wherein the bent knee is spaced from the ankle by a shank portion length and the ankle is spaced from the distal hook tip by a distal hook portion length, the shank portion length being approximately equal to or greater than the distal hook portion length.

11. The cautery hook ofclaim 1 wherein the distal hook portion is generally linear.

12. The cautery hook ofclaim 1 wherein the proximal portion, the shank portion, and the distal hook portion are generally planar and generally coplanar with each other.

13. The cautery hook ofclaim 1 wherein the proximal portion includes an engagement base at the proximal end for coupling the cautery hook to a support shaft.

14. A cautery hook comprising:

a generally linear proximal portion;

a generally linear shank portion connected to the proximal portion at a bent knee, the shank portion being generally coplanar with the proximal portion; and

a generally linear distal hook portion including a distal hook tip and being connected to the shank portion at an ankle, the distal hook portion being generally coplanar with the shank portion, the distal hook tip and the bent knee being disposed generally on a front side of the cautery hook and the ankle being disposed generally on a rear side of the cautery hook which is opposite from the front side.

15. The cautery hook ofclaim 14 wherein the distal hook tip coincides with, or is disposed rearward of, a proximal portion plane which extends from the proximal end toward the bent knee and which is generally transverse to a distal hook plane on which the distal hook portion lies.

16. The cautery hook ofclaim 14 wherein the distal hook portion is angularly spaced by a master angle from the proximal portion, the master angle being disposed generally on the front side of the cautery hook and being greater than 90°.

17. The cautery hook ofclaim 14 wherein the proximal portion is angularly spaced from the shank portion by a bent knee angle generally on the front side of the cautery hook, the bent knee angle being greater than 180° and being no greater than about 270°.

18. A cautery hook configured to self-align when passed through a cannula sleeve, the cautery hook comprising:

a distal hook portion having a distal hook tip disposed generally on a front side of the cautery hook;

a proximal end;

a protruding portion formed between the proximal end and the distal hook portion, the protruding portion including a protruding surface generally on the front side of the cautery hook.

19. The cautery hook ofclaim 18 wherein the protruding surface generally coincides with, or protrudes generally forward of, a plane extending between the proximal end and the distal hook tip.

20. The cautery hook ofclaim 18 further comprising an ankle formed between the protruding portion and the distal hook tip, the ankle protruding generally on the rear side of the cautery hook.

21. The cautery hook ofclaim 20 wherein the protruding portion is formed between a proximal portion extending from the protruding portion to the proximal end and a shank portion extending from the protruding portion to the ankle.

22. The cautery hook ofclaim 21 wherein a distal hook tip tangent which is generally tangential to the distal hook portion at the distal hook tip is angularly spaced by a master angle from the a proximal portion line extending between the proximal end and the protruding portion, the master angle being disposed generally on a front side of the cautery hook and being greater than 90°.

23. A system for cauterizing a target tissue in an internal surgical site of a patient body, the system comprising:

a cannula sleeve having a proximal end, a distal end, and a lumen therebetween, the distal end insertable into the patient body for accessing the internal surgical site through the lumen; and

a tool extending into the lumen of the cannula sleeve, the tool including a cautery hook coupled with a shaft by a joint, the cautery hook having a tip supported by a bend so that the tip extends in a forward direction, a surface of the cautery hook disposed proximally of the bend and extending forward sufficiently that sliding engagement between the proximal hook surface and the lumen of the cannula sleeve aligns the cautery hook with the shaft so as to inhibit interference between the tip and the distal end of the cannula sleeve when the cautery hook moves proximally into the cannula sleeve.

24. The system ofclaim 23 wherein the tool is a robotic tool.

25. The system ofclaim 23 wherein the bend of the cautery hook is generally planar, and wherein the cautery hook is rotatable generally on a plane of rotation relative to the shaft at a pivotal connection with the bend lying generally on the plane of rotation, the proximal cautery surface generally coinciding with, or extending generally forward of, a plane which is perpendicular to the plane of rotation and extends between the pivotal connection and the tip.

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