US20030153902A1 - Hand-actuated articulating surgical tool - Google Patents

Abstract

A double cylinder system is disclosed, comprising at least one controller being adapted to transmit hydraulic control signals; at least one slave being in fluid communication with the controller and being configured to respond to the hydraulic control signals transmitted by the controller; and at least one control line providing hydraulic communication between the controller and the slave. Also disclosed is a surgical device, comprising at least one controller located at a proximal end of the device, the controller being adapted to transmit hydraulic control signals; at least one manipulator, the manipulator being configured to be controlled by a human hand and to actuate the controller; at least one slave located at a distal end of the device, the slave being in fluid communication with the controller and being configured to respond to the hydraulic control signals transmitted by the controller; and at least one control line providing hydraulic communication between the controller and the slave.

Description

RELATED APPLICATIONS
• This application claims priority to the U.S. Provisional Application Serial No. 60/219,593, filed Jul. 20, 2000, by Doyle et al., and entitled “HAND-ACTUATED ARTICULATING SURGICAL TOOL,” which is incorporated by reference herein in its entirety, including any drawings.[0001]
FIELD OF THE INVENTION
• The invention relates generally to surgical instruments. More particularly, the invention relates to a hand-actuated articulating surgical tool for use in minimally invasive surgical procedures.[0002]
BACKGROUND OF THE INVENTION
• Current laparoscopic surgical tools are limited in accessibility of certain regions of the human body. Existing tools can perform invasive surgery without making a substantial incision, but these tools are incapable of bending within the body to reach, for example, the backside of the human heart.[0003]
• Additionally, existing tools rely on use of cables to manipulate the surgical tip of the tool. These tools have the disadvantage of requiring extensive sterilization of the internal components. The cleaning of internal metal cables can be a lengthy and expensive process. This process must be repeated prior to each procedure. Alternatively, disposable components may be used with a substantial increase in recurring costs.[0004]
• In order for a surgeon to perform a surgical procedure on an active organ, such as the heart, current tools require the organ to be arrested. For example, in order to operate on a small portion of the heart, the patient must be placed on an artificial support system while the heart is temporarily stopped for the surgery. This requires additional equipment such as the artificial support system, substantially increasing the cost of the procedure. Also, the recovery period for the patient is substantially increased.[0005]
SUMMARY OF THE INVENTION
• The present invention provides an apparatus for performing minimally invasive surgery while allowing articulation of the tool within the patient's body. Further, the present invention provides a surgical tool that is simple and inexpensive to sterilize and reuse. Another embodiment of the invention allows a surgeon to operate on a portion of an organ, for example, the heart, without the need for arresting the entire organ.[0006]
• One embodiment of the present invention is a surgical device, comprising at least one controller located at the proximal end of the device adapted to transmit hydraulic control signals. At least one manipulator, configured to be controlled by a human finger actuates the controller. At least one slave, located at the distal end of the device, is in fluid communication with the controller and is configured to respond to the hydraulic control signals transmitted by the controller. A control line provides hydraulic communication between the controller and the slave.[0007]
• In a preferred embodiment, the controller comprises a control cavity and a piston within the control cavity. The piston divides the control cavity into a first control cavity portion and a second control cavity portion and prevents communication between the two portions. The slave comprises a slave cavity and a piston within the slave cavity that divides the slave cavity into first and second portions and prevents communication between the two portions. The control line provides hydraulic communication between the first control cavity portion and the first slave cavity portion. A second control line provides hydraulic communication between the second control cavity portion and the second slave cavity portion.[0008]
• In another embodiment, the surgical device comprises a control portion located at the proximal end having a plurality of controllers, each controller being adapted to transmit hydraulic control signals. A plurality of manipulators, configured to be controlled by a human finger, actuate a corresponding controller. A slave portion located at the distal end of the device comprises a plurality of slaves. Each slave is in communication with a corresponding controller, and responds to the hydraulic control signals transmitted by the controller. A surgical tip is manipulated by the slaves in response to the hydraulic control signals. Control lines provide communication between the controllers and the slaves. In a preferred embodiment, an outer sleeve envelops the control lines.[0009]
• The device can also include an articulating portion. The articulating portion comprises a spring bar on one side and a plurality of pockets on an opposing side. The pockets are configured to receive a hydraulic fluid and expand, causing the device to bend as desired. In a preferred embodiment, the device includes a stabilizer having a rigid shaft and a stabilizing plate. The stabilizing plate has an access cutout, and is configured to pivot about the end of the shaft. The shaft can include an articulating portion, if desired.[0010]
BRIEF DESCRIPTION OF THE DRAWINGS
• The features, objects and advantages of the present invention will become more apparent from the detailed description set forth below when taken in conjunction with the drawings in which like references identify correspondingly throughout, and wherein:[0011]
• FIG. 1 is an overview of one embodiment of the invention.[0012]
• FIG. 2 is a detailed drawing of one embodiment of the control portion of the invention. FIG. 2A is top view, FIG. 2B is side view, and FIG. 2C is front view. FIG. 2D shows a top view of a grasp cam. FIG. 2E shows a top view of a bend cam.[0013]
• FIG. 3 is a detailed drawing of an embodiment of a control cylinder. FIG. 3A shows the cylinder's retracted position, while FIG. 3B shows the cylinder's extended position. FIG. 3D shows the components of the control cylinder individually.[0014]
• FIG. 4 is a detailed drawing of an embodiment of a hydraulic extend module. FIG. 4A shows the module's retracted position, while FIG. 4B shows the module's extended position. FIG. 4C shows the front view of the module. FIGS.[0015]4D-E show two embodiments of an electrical extend module.
• FIG. 5A is a detailed drawing of an embodiment of a hydraulic rotate module. FIG. 5B is a detailed drawing of an embodiment of an electrical rotate module.[0016]
• FIG. 6A is a detailed drawing of an embodiment of a hydraulic bend module. FIG. 6B is a drawing of a gear component in the module. FIG. 6C is a drawing of a rack component in the module. FIG. 6D is a detailed drawing of an embodiment of an electrical bend module.[0017]
• FIG. 7A-B is a detailed drawing of an embodiment of a hydraulic grasp module. FIG. 7A is top view and FIG. 7B is side view. FIG. 7C is a detailed drawing of an embodiment of an electrical grasp module.[0018]
• FIG. 8 depicts a tool adapted to fit over the tynes of a grasp module.[0019]
• FIG. 9 depicts various arrangements of the modules. FIG. 9A shows the modules in bend-extend-rotate-grasp configuration, with the bend module in the straight conformation. FIG. 9B shows the same arrangement with the bend module in the bent conformation. FIG. 9C shows the modules in extend-rotate-bend-grasp configuration, with the bend module in the straight conformation. FIG. 9D shows the same arrangement with the bend module in the bent conformation.[0020]
• FIG. 10 shows an embodiment of the tubing management. FIG. 10A shows the guide tubes as they are attached to the cannula using an elastic strap. FIG. 10B shows the position of the guide tubes with respect to the bend module, while FIG. 10C shows the position of the guide tubes with respect to the extend module.[0021]
• FIGS.[0022]11A-B show an embodiment of the patient restraint.
• FIG. 12 shows an embodiment of the tissue restraint module. FIG. 12A is top view while FIG. 12B is side view. FIGS.[0023]12C-E show various embodiments of the separable tynes of the tissue restraint modules.
• FIG. 13 shows the different cylinder diameters for changing the ratio of movement between the control cylinder and slave cylinder.[0024]
• FIG. 14 shows an embodiment of the multiple stroke cylinder.[0025]
• FIGS.[0026]15A-B are side views showing the articulation mechanism of the present invention.
• FIGS.[0027]16A-C are side views showing the articulation mechanism of FIGS.15A-B in greater detail.
DETAILED DESCRIPTION OF THE INVENTION
• Certain embodiments of the invention will now be described in detail with reference to the figures.[0028]
• FIG. 1 shows a surgical tool according to the present invention. The tool has a[0029]control portion110,112 at the proximal end of the device and aslave portion120 at the distal end of the device. As used herein, “proximal” refers to the part of the device that remains outside the patient's body, closest to the user. “Distal” refers to the end inserted into the patient, farthest away from the user. As with a specific component of the device, “proximal” refers to the part of the component closest to the proximal end of the device, whereas “distal” refers to the part of the component closest to the distal end of the device. Anintermediate portion190 lies between thecontrol portion110 and theslave portion120. The “slave portion,” or the “distal end of the device,”120 is the portion of the device comprising the slave modules, i.e., the extend module, the bend module, the rotate module, and the grasp module, as each is described in greater detail below. Each portion will now be described in greater detail. The term “cannula” is used to refer to the portion of the device comprising both theintermediate portion190 and theslave portion120.
• The[0030]control portion110,112 may be any device that can translate the movements of the user's hand and fingers into hydraulic, mechanical, or electrical signals to actuate the corresponding parts of theslave portion120 of the device. For example, two such devices are shown in FIG. 1.
• In certain embodiments, the[0031]control portion110,112 uses hydraulic fluid to transfer pressure from a control cylinder to a slave cylinder. The fluid is preferably sterilized distilled water, however a saline solution, a perfluorinated hydrocarbon liquid, or any other physiologically compatible fluid could also be used. A “physiologically compatible fluid” is a fluid that once exposed to tissues and organs, does not create any intolerable reaction, such as a rash or immune response, in the patient, and does not adversely interfere with the normal physiological function of the tissues or organs to which it is exposed. In addition, a physiologically compatible fluid can remain in a patient's body or in contact with a tissue or an organ without the need to remove the fluid.
• In one embodiment, the[0032]control portion112 clamps onto the arm of the user by way of aclamp115. Thecontrol portion112 featuresfinger loops117, into which the user inserts the user's fingers. By squeezing eachfinger loop117, the user creates hydraulic pressure or an electrical signal that results in a corresponding motion at thedistal end120 of the device. The user may then “open” the squeezed finger to create the opposite motion.
• Each[0033]finger loop117 is connected with a control cylinder310 (shown in FIG. 3). Thefinger loop117 should be large enough to allow comfortable insertion of a human finger. Thefinger loop117 is connected to a longitudinal shaft. The shaft may be made of, for example, metal, ground glass, or ceramic. The shaft may be of any cross-sectional shape, but a circular cross-section is preferred. The cross-sectional size of the shaft, along with the material, are designed to provide sufficient stiffness for predictable control when thefinger loop117 is moved. The shaft slides through an opening in the end of the cylinder body. The interface between the shaft and the opening in the end of the cylinder body is formed to allow for smooth forward and backward movement of the shaft and preferably, at the same time, to provide a waterproof seal.
• Another embodiment of the invention includes a[0034]control portion110 that is clamped to the side of a surgicalbed using clamps130. In this embodiment, the user grasps thecontrol portion110 much in the same way that a motorcycle driver grasps the handles of a motorcycle. The user may turn the handles, push them in, pull them out, pivot them about their axes, or, with the aid of a thumb loop, squeeze them. As detailed below, each of these motions creates a corresponding motion at thedistal end120 of the device.
• In another embodiment, the[0035]control portion110 is clamped to an object other than the surgical bed, such as a table or a cart. In yet another embodiment, thecontrol portion110 is clamped to the user's arms or hand. In still another embodiment, thecontrol portion110 is held by the user, without it being clamped to anything.
• FIG. 2A shows the top view of the[0036]control portion110. Ahandle210 is provided for the user's fingers to pass through, while the user's thumb is inserted through athumb loop212. Thehandle210 may exhibit ridges on the inside of the open loop in order to more comfortably accommodate a user's fingers.
• The movements of the[0037]control portion110 are translated into hydraulic motion through the use ofcontrol cylinders214,216,218,220. When the user squeezes thethumb loop212 towards thehandle210, abend cam222 is turned about a vertical axis. Thebend cam222 is shown in FIG. 2D. As thebend cam222 turns, aroller224 is pushed towards the back of the handle. Theroller224 is connected to anouter cylinder312 of acontrol cylinder214 via ashaft318. The backward movement of theshaft318 extends apiston320 backwards, thereby creating the hydraulic pressure needed to actuate a slave cylinder in thedistal end120 of the device. The function of a control cylinder and its connection to a slave cylinder are discussed in greater detail below. In one embodiment of the invention, the squeezing of the thumb loop actuates a grasp function at thedistal end120.
• The[0038]control portion110 may be attached to the side of a surgical bed using aclamp130. However, the control portion is free to rotate about avertical axis226, shown in FIG. 2B. The rotation of thecontrol portion110 about theaxis226 causes aroller230 to move within abend cam228. Thebend cam228 is shown in FIG. 2E. Theroller230 is connected to anouter cylinder312 of acontrol cylinder220 via ashaft318. The forward movement of theshaft318 extends thepiston320 forward, thereby creating the hydraulic pressure needed to actuate a slave cylinder in thedistal end120 of the device. In one embodiment of the invention, the turning of the handle results in a rotation of thedistal end120 of the device through a rotate module, described in detail below.
• A user may also push the[0039]handle210 forward, in which case, the top portion of thecontrol portion110 moves forward over aslide232. Theslide232 is connected to anouter cylinder312 of acontrol cylinder218 via anattachment point330. Theouter cylinder312 is in turn attached to thepiston320 via ashaft318. The forward movement of theshaft318 extends thepiston320 forward, thereby creating the hydraulic pressure needed to actuate a slave cylinder in thedistal end120 of the device. In one embodiment of the invention, the forward movement of the handle results in an extension of thedistal end120 of the device through an extension module, described in detail below.
• The handle part of the[0040]control portion110 may also rotate along a longitudinal axis coinciding with theshaft234, as shown in FIG. 2B. In certain embodiments of the invention, the turning of the handle part causes ascrew236 to rotate within anut238. In some embodiments of the invention, thescrew236 is stationary and thenut238 is mobile, whereas in other embodiments of the invention, thescrew236 is mobile and thenut238 is stationary. The movement of thescrew236 within thenut238 causes the mobile unit to move linearly with respect to the stationary unit. The mobile unit, whether the screw or the nut, is connected to anouter cylinder312 of acontrol cylinder216 via anattachment point330. Theouter cylinder312 is in turn attached to thepiston320 via ashaft318. The forward movement of theshaft318 extends thepiston320 forward, while the backward movement of theshaft318 pulls thepiston320 backward. The forward and backward motion of thepiston320 creates the hydraulic pressure needed to actuate a slave cylinder in thedistal end120 of the device. In some embodiments of the invention, rotation of the handle part results in the rotation of thedistal end120 of the device through a rotation module, described in detail below.
• In certain embodiments of the invention, the movements of the different parts of the[0041]control portion110 creates electrical signals that are sent through wires in theintermediate portion190 to the slave cylinders in thedistal end120 of the device, The electrical signal is sufficient to actuate a motor in the corresponding slave cylinder, which in turn results in the slave module being actuated. Thus, for example, a forward movement of thehandle210 creates an electrical signal that actuates a motor in an extend module, which results in the extension of that module. Similarly, the rotation of thehandle210, the bending of thehandle210, and the squeezing of thethumb loop212, result in the rotate module, the bend module, and the grasp module, respectively, being actuated. The slave modules having a motor are described in greater detail below.
• [0042]Cylinders214,216,218, and220 are control cylinders. Atypical control cylinder310 is shown in its retracted position in FIG. 3A and in its extended position in FIG. 3B. Thecontrol cylinder310 comprises anouter cylinder312 and aninner cylinder314. Theinner cylinder314 has a diameter that allows it to move within theouter cylinder312. Theouter cylinder312 is connected to ashaft318, which in turn is connected to thecontrol portion110 through theattachment point330. The movements of thecontrol portion110, described above, causes theouter cylinder312 to move longitudinally with respect to the stationaryinner cylinder314.
• A[0043]piston320, attached to ashaft318, moves within theinner cylinder314, within a distance defined by the twoinlet points322,324 for the hydraulic fluid. The distal end of theshaft318 is configured to be capable of attachment to thepiston320, while the proximal end of theshaft318 is configured to be capable of attachment to the outer cylinder at a site close to theattachment point330. The outer cylinder or the handle assembly may be provided with ratchet teeth. The ratchet teeth are adapted to engage with a locking mechanism to secure thepiston320 at a desired position relative to the cylinder body. Alternatively, a locking mechanism may employ a friction lock to secure thepiston320 at a desired position.
• The[0044]piston320 has a solid front face and is movable along the longitudinal axis of theinner cylinder314. The front face of thepiston320 is identical in shape to the cross section of the cylindrical cavity. The outer surface of thepiston320 forms an airtight seal with the inner surface of theinner cylinder314. Thus, the portion of the cavity on one side of thepiston320 does not communicate with the portion of the cavity on the other side of thepiston320. At the same time, thepiston320 must be allowed to move smoothly back and forth along the longitudinal axis of theinner cylinder314.
• The proximal end of the[0045]inner cylinder314 is sealed with aseal316, comprising an opening therethrough, through which theshaft318 can slide. The distalend of theinner cylinder314 is sealed with anotherseal328, optionally comprising an0-ring326.
• Thus, in the extended position of the[0046]control cylinder310, FIG. 3B, thepiston320 is at rest against theproximal seal316. The hydraulic fluid is located in theinner cylinder314 in front of thepiston320. When thecontrol portion110 is moved in a way described above, i.e., when thehandle210 is moved forward, theouter cylinder312 moves forward, thereby moving theshaft318 and thepiston320. Hydraulic fluid exits theinner cylinder314 through aninlet324, creating a hydraulic pressure at a point in thedistal end120 of the device. Additional hydraulic fluid, displaced from a slave cylinder, enters to the back of thepiston320 through anotherinlet322, thereby keeping the volume of the hydraulic fluid in the system constant. When thecontrol portion110 is moved completely, thecontrol cylinder310 is in its retracted position, FIG. 3A. In this position, thepiston320 is at the distal end of theinner cylinder314, resting against thedistal seal328. The hydraulic fluid is in the back of thepiston320. Those of skill in the art understand that although in the above discussion thepiston320 is described to move from the fully retracted position to the fully extended position, thepiston320 may move from any point along the two extremes to any other point along the two extremes, and thereby cause a corresponding movement in a slave cylinder.
• The[0047]cannula190 comprises hydraulic tubings, connecting the control cylinders of thecontrol portion110 with the slave cylinders at thedistal end120, and housings for the hydraulic tubings.
• The[0048]distal end120 comprises modular components. The components can be selected from, for example, an extend module, a rotate module, a bend module, and a grasp module. Other functions can be included as well and activated in the manner described in detail below. Each module is individually describe in greater detail below. The invention is adapted such that the user can pick the combination of modules and the quantity of each individual module that is best suitable for the user's needs and assemble them conveniently.
• The extend[0049]module410 is depicted in both its retracted position, FIG. 4A, and extended position, FIG. 4B. The extendmodule410 is identical in its construction to thecontrol module310; however, the function of the two are reversed. By applying hydraulic pressure using thecontrol portion110, hydraulic fluid enters the inner cylinder414 pushing the piston420 towards the distal end of the module and the distal seal416. The shaft418 moves through the distal seal416, but it is attached to the outer cylinder412 at the distal end of the outer cylinder430. The movement of the piston420 moves the outer cylinder412 towards the distal end of the module, thereby extending the cannula. The hydraulic fluid present inside the inner cylinder414 exits the inner cylinder414 through the distal outlet422. The proximal seal428 prevents the leakage of hydraulic fluid from proximal end of the inner cylinder414.
• Additional modules can be attached to the extend module either at its distal end, through the distal attachment point[0050]430, or at its proximal end, through the proximal attachment point431.
• In another embodiment, the extend module may be extended using electrical power instead of hydraulic power. In this embodiment, by pushing forward on the[0051]handle210 of thecontrol portion110, the user causes an electrical connection to be formed, whereby electrical signal is sent from thecontrol portion110 through wires in theintermediate portion190 to the extendmodule432, FIGS. 4D, 4E. The electrical signal causes anelectrical motor434 to turn. In one embodiment, FIG. 4D, ascrew436 is mounted within themotor434. The turning of themotor434 causes the screw to move outward, thereby causing theouter cylinder440 to move away from theinner cylinder442. In this embodiment, the motor is stationary, i.e., it is attached to theinner cylinder442, whereas the screw is mobile, i.e., it moves with respect to the motor and theinner cylinder442. Thescrew436 is attached at its distal end to theouter cylinder440.
• In another embodiment, FIG. 4E, the[0052]motor434 causes thescrew436 to turn within anut438. Thenut438 is attached to theouter cylinder440. The turning of thescrew436 causes thenut438 to move with respect to thescrew436, thereby moving theouter cylinder440 longitudinally with respect to theinner cylinder442, causing the module to extend. In this embodiment, themotor434 and thescrew436 are stationary with respect to theinner cylinder442, whereas thenut438 and theouter cylinder440 are mobile.
• The rotate[0053]module510, FIG. 5A, comprises similar hydraulic components as those of the extendmodule410. As in the extendmodule410, hydraulic pressure, applied by rotating thecontrol portion110 along a longitudinal axis, causespiston520 to move toward the distal end of the module, causing theshaft518 to move in that direction as well. Theshaft518 is attached to alead screw522 at anattachment point524. Extension of theshaft518 causes thelead screw522 to move towards the distal end of the module. The lead screw is incapable of rotating, since astabilizer526 prevents its rotation. Thelead screw522 instead is extended through anut assembly528 which is immovably attached to anouter cylinder530. The movement of thelead screw522 through thenut assembly528 causes thenut assembly528 to rotate, thereby rotating theouter cylinder530.
• Additional modules can be attached to the rotate module either at its distal end, through the[0054]distal attachment point532, or at its proximal end, through theproximal attachment point534.
• In another embodiment, the rotate module may be rotated using electrical power instead of hydraulic power. In this embodiment, by turning the[0055]handle210 of thecontrol portion110, the user causes an electrical connection to be formed, whereby an electrical signal is sent from thecontrol portion110 through wires in theintermediate portion190 to the rotatemodule540, FIGS. 5B. The electrical signal causes anelectrical motor542 to turn. Theelectrical motor542 is attached to ashaft544 which in turn is attached to theouter cylinder546. The turning of the shaft rotates the outer cylinder. In some embodiments, agear reducer assembly548 may also be present to reduce the rotation speed. In certain embodiments, the connection between theouter cylinder546 and the cylinder housing themotor assembly542 may feature a bearingassembly550.
• The[0056]bend module610 is depicted in FIG. 6A. This module also features the same hydraulic assembly present in the extend and the rotate modules, above. Applying hydraulic pressure by rotating thecontrol portion110 along thevertical axis226 in a clockwise direction causes thepiston620 and theshaft618 to move towards the distal end of the module. Theshaft618 is attached to arack624 either directly or through anattachment assembly622. The movement of theshaft618 moves therack624. Therack624 has teeth that correspond to the teeth on agear626. The movement of therack624 causes thegear626 to rotate clockwise. Thegear626 is connected to thedistal end628 of the module. The rotation of thegear626 causes thedistal end628 of the module to bend clockwise. By rotating thecontrol portion110 in a counter-clockwise direction, thepiston620 is moved towards the proximal end of the module, causing therack624 to move backwards as well, which in turn causes thegear626 to turn counter-clockwise, which in turn causes thedistal end628 of the module to bend counter-clockwise.
• In some embodiments, the bending of the[0057]distal end628 of the module is through an angle of at least 110°, i.e., when thepiston620 moves from the proximal end of the hydraulic portion completely to the distal end of the hydraulic portion, thedistal end628 of the module bends at least 110°. In other embodiments, the rotation is an angle of at least 110°, at least 150°, at least 200°; at least 250°, at least 300°, or an angle of at least 350°.
• Additional modules can be attached to the bend module either at its distal end, through the[0058]distal attachment point630, or at its proximal end, through theproximal attachment point632.
• In another embodiment, the bend module may be bent using electrical power instead of hydraulic power. In this embodiment, by turning the[0059]handle210 of thecontrol portion110, the user causes an electrical connection to be formed, whereby electrical signal is sent from thecontrol portion110 through wires in theintermediate portion190 to the bend module. The electrical signal causes an electrical motor to turn. The electrical motor is attached to a shaft which in turn is attached to therack624. The movement of theshaft618 moves therack624, which in turn causes thegear626 to rotate, which in turn causes thedistal end628 of the module to bend.
• In another embodiment, FIG. 6D, the turning of the[0060]motor640 causes alead screw642 to rotate within anut644. Thelead screw642 is stationary with respect to themotor640 and the outer body of the module, whereas thenut644 is mobile. Thenut644 is connected to alink646 at the proximal end of thelink646. The distal end of thelink646 is connected to the distal end of the module. When thenut644 is moved backwards, it causes thelink646 to move backwards, thereby causing the distal end of the module to rotate. Reversing the electrical current, by rotating thecontrol portion110 in the opposite direction, will cause the motor to turn in the opposite direction, thereby causing the nut to move forward and the distal end of the module to bend in a clockwise direction.
• FIG. 7A depicts the top view of the[0061]grasp module710, whereas FIG. 7B depicts its side view. Thegrasp module710 also features a hydraulic portion similar to those of other modules. When thethumb loop212 is squeezed towards thehandle210, hydraulic pressure is applied and theshaft718 moves towards the distal end of the module. This movement causes thepin720 to move towards the distal end of the module as well, thereby causing the twopins722 to move away from the center. As the twopins722 move away from the center, the angle defined by pin722-pin720-pin722 tends away from 90° and towards 180°. The movement of thepins722 causes the twotynes724 to move towards each other and, eventually, touch. Moving thethumb loop212 away from thehandle210 will have the opposite effect of causing thetynes724 to move away from each other and open up.
• In another embodiment, the squeezing of the[0062]thumb loop212 causes an electrical current to turn amotor740, FIG. 7C, in thegrasp module730. Themotor740 turns astationary lead screw742, which in turn causes anut744 to move longitudinally. The movement of thenut744 causes the tynes to move closer to each other and, eventually, touch. Moving thethumb loop212 away from thehandle210 will have the opposite effect of causing thetynes724 to move away from each other and open up.
• The[0063]tynes724 of thegrasp module710 are configured to accommodate a number of different tools. For example, in FIG. 8, agrasp tool810 is shown that can fit over thetynes724. When thetynes724 move towards each other, the end portion of thegrasp tool810 also move toward each other and, eventually, touch. If an object or tissue is located between the end portions of thegrasp tool810, the object is then grasped by the tool. There may be a number of tools that can be attached over thetynes724. In addition to the grasp tool, these include a scissors, a knife for cutting the tissue, drill bits for drilling into bones, heating elements for cauterizing tissue, or any other tool necessary during a surgical procedure.
• All the above tools and other tools can fit individually and interchangeably on the[0064]grasp module710. Therefore, during a surgical procedure, the user may attach one tool to thegrasp module710, use it, remove it, and then attach another tool to thesame grasp module710. This process can be repeated any number of times with any number of tools.
• As mentioned above, the modules of the present invention are designed to be placed in order that the user deems most useful. For example, FIG. 9 depicts four of the modules attached in the order of (from proximal end to distal end) bend, extend, rotate, and grasp. FIG. 9A shows the bend module in its retracted position, where the cannula is straight. FIG. 9B shows the bend module in its extended position where the module is bent. Alternatively, the four modules could be arranged in the extend-rotate-bend-grasp configuration, as shown in FIGS. 9C, 9D. Other combinations are also possible. In addition, the user may attach more than a single module of a particular type, for example, two or three or more extend modules or two or three or more bend modules, could be put together, along with other modules to form the[0065]distal end120 of the device. Preferably, thegrasp module710 is always the most distally located module.
• As shown in FIG. 4C, the front view of the extend module, the hydraulic tubing connecting the various modules to the control cylinders are located at one side of the slave cylinders. The hydraulic tubing runs alongside the cannula and connects to the inlet openings of the hydraulic portion of each module. In some embodiments of the invention, to keep the hydraulic tubing in place, a series of low[0066]friction guide tubes1010 are attached to the cannula by an elastic strap1012 (FIG. 10A). Eachhydraulic tubing1014 fits through one guide tubing and is free to move longitudinally, i.e., in the direction of thearrow1016, within theguide tubing1010. Thus, when the bend module bends, FIG. 10B, or when the extend module extends, FIG. 10C, the hydraulic tubing can move along the cannula and maintain theconnection1018 with the hydraulic inlets of each of the modules.
• In certain embodiments, the present invention features a[0067]restraint1110 that can be attached to thecannula190 using a thumb screw1112 (FIG. 11). Therestraint1110 sits adjacent to the patient's skin on the outside of the patient's body at the point of entry of thecannula190. Therestraint1110 keeps the depth of thecannula190 with respect to the body of the patient's body. If the patient makes any moves during the surgery, for example if the anesthesia begins to wear off and the patient jolts, the cannula moves with the patient. More importantly, the depth of the cannula inside the patient's body remains unchanged. Therefore, if the patient moves, the patient will not be damaged by the cannula.
• As part of their normal physiological function, certain organs in the body have continuous motion. For example, the heart beats, the lungs expand and contract as the patient breathes, and the gastrointestinal tract also undergoes contractile motion. When performing surgery, it is often necessary stabilize the part of the organ undergoing surgery so that additional injury to the organ does not occur and the organ can be worked on. Aspects of the invention also feature a tissue restraint module[0068]1210 (FIG. 12) that can be inserted into the patient's body at or near the site where any other cannula has been inserted. Thetissue restraint module1210 features a bend module, as described above. Once inserted into the patient's body, the separable tynes1214 can be brought close to the tissue that is to be restrained. The bend module allows the tyne assembly to be bent with respect to the cannula, so that thetynes1214 may be placed over the tissue. Thetynes1214 are separable so that they can provide a relatively stable tissue area for the performance of the surgery.
• A number of different mechanisms for separating the[0069]tynes1214 are shown in FIGS.12C-E. In the embodiments shown, the tissue restraint module comprises two tynes1214. Thetynes1214 are adapted to be separable. When inserting the module into the patient's body, thetynes1214 are held together to reduce the width of the device. Inside the patient's body, thetynes1214 can be separated. In the embodiment shown in FIG. 12C, onetyne1214 is stationary, while thesecond tyne1214 slides away from thefirst tyne1214. In the embodiment shown in FIG. 12D, bothtynes1214 move away from the center. Since the twotynes1214 are bent inward, in their fully extended position the distal end of the twotynes1214 would be parallel to each other. The embodiment shown in FIG. 12E functions similarly, except that the two tynes are not bent. In the fully extended position the twotynes1214 form a “V” shaped opening. Other embodiments are also contemplated. For example, the tissue restraint module may comprise only one tyne. In certain embodiments, the single-tyne module may have a shape such as “∩”, “┌”, or “

  

  ”.
• In certain embodiments, the tissue restraint module is held against a tissue or an organ during the surgical procedure. By doing so, in the space between the two[0070]tynes1214, or a particular space created within a single tyne, a surface area of the tissue or organ becomes restrained, i.e., the local motion of the tissue or the organ is considerably reduced as compared with an unrestrained region of the tissue or the organ. The restraining of the tissue or the organ provides a relatively stable area on which the user can perform the surgical procedure.
• In certain embodiments, the[0071]immediate portion190 of the cannula can be adapted to hold a number of different tools to be used during the operation. The cannula may be the cannula leading to the tissue restraint module or the cannula leading to thegrasp module710 at thedistal end120 of the device. Preferably, the cannula is the one leading the tissue restraint module. During the operation, the user can retrieve a first tool from the cannula while within the patient's body and attach it to thegrasp module710. After using the first tool, the user can then return the first tool to the cannula, retrieve a second tool and attach it to thegrasp module710. Other tools may subsequently be used in a similar fashion.
• The[0072]cannula190 is held in place using a positioning arm140 (see FIG. 1). Thepositioning arm140 comprises at least one joint capable of being tightened or loosened using a release mechanism. The user can release the joint, move thepositioning arm140 to a desired location, and thereby re-position thecannula190. In one embodiment, the invention provides for a one-hand-release mechanism. In this embodiment, the user can grasp thepositioning arm140 with one hand, and while holding thepositioning arm140, loosen the joint using the same hand, move thepositioning arm140 to a new location using the same hand, and then tighten the joint, again using the same hand. The one-hand-release mechanism allows the user to reposition the cannula using one hand, while manipulating thedistal end120 of the device using thecontrol portion110 with the other hand.
• In using the devices of the present invention, it is often the case that the tools at the distal portion of the device are to move a short distance. This distance is small enough that it would become difficult for the user to move his hands or fingers for that short a distance. Therefore, a system is needed to convert a longer movement of the user's hands and fingers at the proximal end of the device to a short movement of the tools at the distal end of the device. This is accomplished by having the control cylinder and the slave cylinder be of different diameters. Of importance, is the relationship between the piston area and the shaft area when using cylinders of different diameters, as generally described below.[0073]
• At least a portion of the[0074]intermediate portion190 of the laparoscopic tool is preferably an articulation portion. FIGS.15A-B and16A-C illustrate one embodiment of an articulation mechanism implemented in the articulation portion of theintermediate portion190. Aspring bar1510 is embedded within the body of the outer sleeve. The spring bar may be made of any material, such as plastic or metal, that allows it to resiliently bend while exerting a reacting force against the bending. Thespring bar1510 acts to prevent the articulation portion from bending unless a force is exerted to cause it to bend. An opposite wall of the sleeve is lined withsmall pouches1520. FIG. 16C illustrates the arrangement of thepouches1520 and thespring bar1510 in a cross-sectional view of the articulation portion. Thepouches1520 are densely placed along the length of the articulation portion. Thepouches1520 are connected to a reservoir of hydraulic liquid (not shown) by a series of orifices or valves in each pouch. When hydraulic fluid is supplied to thepouches1520 through the orifices or valves, thepouches1520 are filled with the hydraulic liquid. The filledpouches1520 press against one another and force an expansion of the side of the articulation portion with thepouches1520. This expansion causes thespring bar1510 to bend, causing the articulation portion to bend, as shown in FIG. 16B.
• Double Acting/Double Cylinder System[0075]
• Another aspect of the present invention includes a double acting/double cylinder system. This system is depicted in FIG. 13. The system comprises a[0076]control cylinder1320 and aslave cylinder1310. The control cylinder comprises apiston1318 and ashaft1320 attached thereto. Thepiston1318 is capable of moving within thecontrol cylinder1320. The piston divides the control cylinder into two cavities: a distal cavity, a wall of which is A₁, and a proximal cavity, a wall of which is A₂. Theshaft1322 passes through the proximal cavity. Thepiston1318 prevents liquid communication between the distal cavity and the proximal cavity.
• The slave cylinder comprises a[0077]piston1314 and ashaft1316 attached thereto. Thepiston1314 is capable of moving within theslave cylinder1310. The piston divides the slave cylinder into two cavities: a distal cavity, a wall of which is A₃, and a proximal cavity, a wall of which is A₄. Theshaft1316 passes through the proximal cavity. Thepiston1314 prevents liquid communication between the distal cavity and the proximal cavity.
• A control line provides hydraulic communication between the proximal cavity of the control cylinder and the proximal cavity of the slave cylinder. Another control line provides hydraulic communication between the distal cavity of the control cylinder and the proximal cavity of the slave cylinder. Thus, in the system, the two distal cavities are in hydraulic communication with each other, the two proximal cavities are in hydraulic communication with each other, but no proximal cavity is in hydraulic communication with any distal cavity.[0078]
• If the[0079]control cylinder piston1318 moves towards the distal end of thecontrol cylinder1320, hydraulic fluid is moved from the distal cavity of the control cylinder, through a control line, and into the distal cavity of the slave cylinder, thereby pushing theslave cylinder piston1314 towards the proximal end of theslave cylinder1310. The reverse may also happen. If thecontrol cylinder piston1318 moves towards the proximal end of thecontrol cylinder1320, hydraulic fluid is moved from the proximal cavity of the control cylinder, through a control line, and into the proximal cavity of the slave cylinder, thereby pushing theslave cylinder piston1314 towards the distal end of theslave cylinder1310. Further, while thecontrol cylinder piston1318 remains stationary, thesalve cylinder piston1314 also remains stationary.
• In an embodiment, the double acting/double cylinder system of the invention comprises an overpressure reservoir. If the hydraulic pressure within the cylinders or the control lines exceeds a certain amount, some hydraulic fluid is transferred to the overpressure reservoir. The opening to the overpressure reservoir may comprise a pressure gauge device, which can become activated when the hydraulic pressure within a system surpasses a certain preset value. When the pressure gauge device is activated, the opening to the overpressure reservoir opens and hydraulic fluid can then enter the reservoir.[0080]
• In another embodiment, the overpressure reservoir comprises an opening, which is in constant fluid communication with the hydraulic fluid within the system. The reservoir further comprises a spring mechanism at the side opposite to the opening. When the hydraulic pressure within the system surpasses the pressure applied by the spring mechanism, hydraulic fluid enters the reservoir from the system. Conversely, when the pressure within the system falls below the pressure applied by the spring mechanism, for example due to a leak in the system, hydraulic fluid enters the system from the reservoir. Thus, the reservoir may also function as a fluid replacement reservoir.[0081]
• In certain embodiments, the flow of the hydraulic fluid inside the system will move very easily so that not enough resistance is afforded. In these situations, it is difficult for a user to control the movement of the cylinders with fine precision. Therefore, certain embodiments of the invention feature a narrowing at a point in the hydraulic tubing, the purpose of which is to create resistance. In some embodiments, the user can change the amount of narrowing, and therefore, the amount of resistance in the hydraulic tubing.[0082]
• FIG. 13 depicts the relationship between the[0083]control cylinder1310 and the slave cylinder1312. Thecontrol cylinder1310 has apiston1314 and ashaft1316. The front of thepiston1314, i.e., the opposite face from where theshaft1316 attaches to thepiston1314, has an area of A₃and the back of thepiston1314, i.e., the face where theshaft1316 attaches, has an area is A₄. Thus, A₃is equal to A₄plus the area of theshaft1316. When thepiston1314 moves backwards a distance of l₂, the amount of hydraulic fluid displaced in front of thepiston1314 will have a volume of A₃l₂. However, the volume of the hydraulic fluid displaced behind thepiston1314 will be A₄l₂.
• The slave cylinder[0084]1312 also has apiston1318 and ashaft1320. The volumes of displaced hydraulic fluid in front of and behind thepiston1318 must be equal to the volume of displaced hydraulic fluid in front of and behind thepiston1314. In other words,
• A₁l₁=A₃l₂
• and[0085]
• A₂l₁=A₄l₂
• where l[0086]₁is the distance traveled by the slave cylinder. Rearranging the equations results in$1_2=\frac{A_11_2}{A_3}=\frac{A_21_1}{A_4}$

  
• which result in the basic relationship between the various surface areas as[0087]$\frac{A_1}{A_3}=\frac{A_2}{A_4}$

  
• It is readily understood by those of skill in the art that the above relationship will also hold true if the control cylinder and the slave cylinder are configured such that small movements by the user's hands and fingers results in longer movements at the distal end of the device, In other words, in FIG. 13, in one embodiment[0088]1312 represents the slave cylinder and1310 represents the control cylinder, whereas in another embodiment,1312 represents the control cylinder and1310 represents the slave cylinder.
• In certain embodiments, when it is desirable to have a long range of movement or very fine movement at the distal end of the device, it is preferable to affect a full range of movement at a slave cylinder at the distal end of the device using multiple strokes of a control cylinder. In these embodiments, the present invention features a multiple stroke cylinder system (FIG. 14). A stroke of the control cylinder[0089]1410 causescheck valve1414 to close andcheck valve1412 to open. Hydraulic fluid is then transferred from the control cylinder1410 to theslave cylinder1418. Returning the piston of the control cylinder1410 to the original position, i.e., at the proximal end of the control cylinder, causes thecheck valve1412 to close and thecheck valve1414 to open. Additional hydraulic fluid is then transferred from thereservoir1422 to the control cylinder1410. Another stroke of the control cylinder1410 will then cause additional movement in theslave cylinder1418.
• The system is also equipped with a “dump”[0090]valve1416. Thedump valve1416 may be activated by the user at anytime. When thedump valve1416 is activated, hydraulic fluid is transferred from theslave cylinder1418 back to thereservoir1422.
• In some embodiments, to aid the removal of the hydraulic fluid from the slave cylinder[0091]1418 aspring mechanism1420 is placed behind the piston of the slave cylinder. Those of skill in the art know of other mechanisms that can be used to return the piston of the slave cylinder to its original position.
• In other embodiments, the system is so configured that the user can reverse the flow of the hydraulic fluid. Therefore by additional strokes of the control cylinder the user can remove hydraulic fluid from the[0092]slave cylinder1418 and transfer it back to thereservoir1422.
Conclusion
• Thus, those of skill in the art will appreciate that the devices described herein provide a relatively easy and economical instrument to perform minimally invasive surgery.[0093]
• One skilled in the art will appreciate that these devices are and may be adapted to carry out the objects and obtain the ends and advantages mentioned, as well as those inherent therein. The methods, procedures, and devices described herein are presently representative of preferred embodiments and are exemplary and are not intended as limitations on the scope of the invention. Changes therein and other uses will occur to those skilled in the art which are encompassed within the spirit of the invention and are defined by the scope of the disclosure.[0094]
• It will be apparent to one skilled in the art that varying substitutions and modifications may be made to the invention disclosed herein without departing from the scope and spirit of the invention.[0095]
• Those skilled in the art recognize that the aspects and embodiments of the invention set forth herein may be practiced separate from each other or in conjunction with each other. Therefore, combinations of separate embodiments are within the scope of the invention as disclosed herein.[0096]
• All patents and publications mentioned in the specification are indicative of the levels of those skilled in the art to which the invention pertains. All patents and publications are herein incorporated by reference to the same extent as if each individual publication was specifically and individually indicated to be incorporated by reference.[0097]
• The invention illustratively described herein suitably may be practiced in the absence of any element or elements, limitation or limitations which is not specifically disclosed herein. Thus, for example, in each instance herein any of the terms “comprising”, “consisting essentially of” and “consisting of” may be replaced with either of the other two terms. The terms and expressions which have been employed are used as terms of description and not of limitation, and there is no intention that in the use of such terms and expressions indicates the exclusion of equivalents of the features shown and described or portions thereof. It is recognized that various modifications are possible within the scope of the invention disclosed. Thus, it should be understood that although the present invention has been specifically disclosed by preferred embodiments and optional features, modification and variation of the concepts herein disclosed may be resorted to by those skilled in the art, and that such modifications and variations are considered to be within the scope of this invention as defined by the disclosure.[0098]

Claims (18)

What is claimed is:

1. A double cylinder system, comprising:

at least one controller being adapted to transmit hydraulic control signals, said controller further comprises:

a control cavity; and

a first piston within said control cavity, said first piston dividing said control cavity into a first control cavity portion and a second control cavity portion and preventing communication between said first control cavity portion and said second control cavity portion;

at least one slave being in fluid communication with said controller and being configured to respond to said hydraulic control signals transmitted by said controller, said slave comprising

a slave cavity; and

a second piston within said slave cavity, said second piston dividing said slave cavity into a first slave cavity portion and a second slave cavity portion and preventing communication between said first slave cavity portion and said second slave cavity portion; and

at least one control line providing hydraulic communication between said first control cavity portion and said first slave cavity portion; and

at least one control line providing hydraulic communication between said second control cavity portion and said second slave cavity portion.

2. The system ofclaim 1, further comprising an overpressure reservoir.

3. The system ofclaim 1, further comprising a manipulator, wherein said manipulator is adapted to change the position of said first piston within said control cavity.

4. A surgical device, comprising:

at least one controller located at a proximal end of the device, said controller being adapted to transmit hydraulic control signals;

at least one manipulator, said manipulator being configured to be controlled by a human hand and to actuate said controller;

at least one slave located at a distal end of the device, said slave being in fluid communication with said controller and being configured to respond to said hydraulic control signals transmitted by said controller; and

at least one control line providing hydraulic communication between said controller and said slave.

5. The surgical device according toclaim 4, wherein said controller further comprises:

a control cavity; and

a piston within said control cavity, said piston dividing said control cavity into a first control cavity portion and a second control cavity portion and preventing communication between said first control cavity portion and said second control cavity portion;

wherein said slave further comprises:

a slave cavity; and

a piston within said slave cavity, said piston dividing said slave cavity into a first slave cavity portion and a second slave cavity portion and preventing communication between said first slave cavity portion and said second slave cavity portion; and

wherein said control line provides hydraulic communication between said first control cavity portion and said first slave cavity portion.

6. The surgical device according toclaim 5, further comprising a second control line providing hydraulic communication between said second control cavity portion and said second slave cavity portion.

7. A surgical device, comprising:

a control portion located at a proximal end of the device, comprising:

a plurality of controllers, each of said plurality of controllers being adapted to transmit hydraulic control signals; and

a plurality of manipulators, each of said plurality of manipulators being configured to actuate a corresponding one of said plurality of controllers;

a slave portion located at a distal end of the device, comprising:

a plurality of slaves, each of said plurality of slaves being in communication with a corresponding one of said plurality of controllers and being configured to respond to said hydraulic control signals transmitted by said corresponding one of said plurality of controllers; and

an intermediate portion, comprising a plurality of control lines, each of said plurality of control lines providing communication with one of said plurality of controllers and a corresponding one of said plurality of slaves.

8. The surgical device according toclaim 7, wherein said intermediate portion further comprises an outer sleeve enveloping said plurality of control lines.

9. The surgical device according toclaim 7, wherein said intermediate portion further comprises an articulating portion, said articulating portion further comprising:

a spring bar on a first side of said articulating portion; and

a plurality of pockets on a second side of said articulating portion, said second side opposing said first side,

wherein said pockets are configured to receive a hydraulic fluid, and

wherein, said pockets are configured to expand when said hydraulic fluid is received.

10. The surgical device ofclaim 7, further comprising a tip adapted to be manipulated by at least one of said plurality of slaves in response to said hydraulic control signals.

11. The surgical device ofclaim 7, wherein said hydraulic communication is through a hydraulic fluid.

12. The surgical device ofclaim 11, wherein said hydraulic fluid is physiologically acceptable.

13. The surgical device ofclaim 7, wherein each of said plurality of slaves has a predefined function.

14. The surgical device ofclaim 13, wherein said predefined function is selected from extension, rotation, bending, and grasping.

15. The surgical device ofclaim 13, wherein said predefined function of at least one of said plurality of slaves is different than said predefined function of at least another one of said plurality of slaves.

16. The surgical device ofclaim 7, further comprising a patient restraint.

17. A tissue restraint module comprising at least one remotely manipulatable tyne capable of restraining a tissue.

18. The tissue restraint module ofclaim 17, wherein said at least one remotely manipulatable tyne is configured to pivot about the distal end of said module.

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