US20050228365A1 - Method and apparatus for performing minimally invasive surgical procedures - Google Patents

Abstract

The system includes a pair of surgical instruments that are coupled to a pair of robotic arms. The instruments have end effectors that can be manipulated to hold and suture tissue. The robotic arms are coupled to a pair of master handles by a controller. The handles can be moved by the surgeon to produce a corresponding movement of the end effectors. The movement of the handles is scaled so that the end effectors have a corresponding movement that is different, typically smaller, than the movement performed by the hands of the surgeon. The scale factor is adjustable so that the surgeon can control the resolution of the end effector movement. The movement of the end effector can be controlled by an input button, so that the end effector only moves when the button is depressed by the surgeon. The input button allows the surgeon to adjust the position of the handles without moving the end effector, so that the handles can be moved to a more comfortable position. The system may also have a robotically controlled endoscope which allows the surgeon to remotely view the surgical site. A cardiac procedure can be performed by making small incisions in the patient's skin and inserting the instruments and endoscope into the patient. The surgeon manipulates the handles and moves the end effectors to perform a cardiac procedure such as a coronary artery bypass graft.

Description

CROSS-REFERENCES TO RELATED APPLICATIONS
• The present application is a continuation of U.S. application Ser. No. 10/339,077 filed on Jan. 7, 2003; which is a continuation of U.S. application Ser. No. 09/557,950 filed on Apr. 24, 2000, now U.S. Pat. No. 6,699,177; which is a continuation of U.S. application Ser. No. 08/873,190 filed on Jun. 11, 1997, now U.S. Pat. No. 6,102,850; which is a continuation-in-part Application of U.S. patent application Ser. No. 08/755,063 filed on Nov. 22, 1996, now U.S. Pat. No. 5,855,583; and which is a continuation-in-part Application of U.S. patent application Ser. No. 08/603,543 was filed on Feb. 20, 1996, now U.S. Pat. No. 5,762,458 (of which all are incorporated herein by reference).
BACKGROUND OF THE INVENTION
• 1. Field of the Invention
• The present invention relates to a system and method for performing minimally invasive cardiac procedures. More particularly, the present invention relates to a robotic system and surgical instruments that may be removably attached thereto, wherein said system aids in performing minimally invasive surgical procedures.
• 2. Description of Related Art
• Blockage of a coronary artery may deprive the heart of the blood and oxygen required to sustain life. The blockage may be removed with medication or by an angioplasty. For severe blockage a coronary artery bypass graft (CABG) is performed to bypass the blocked area of the artery. CABG procedures are typically performed by splitting the sternum and pulling open the chest cavity to provide access to the heart. An incision is made in the artery adjacent to the blocked area. The internal mammary artery (IMA) is then severed and attached to the artery at the point of incision. The IMA bypasses the blocked area of the artery to again provide a full flow of blood to the heart. Splitting the sternum and opening the chest cavity, commonly referred to as ‘open surgery’, can create a tremendous trauma on the patient. Additionally, the cracked sternum prolongs the recovery period of the patient.
• There have been attempts to perform CABG procedures without opening the chest cavity. Minimally invasive procedures are conducted by inserting surgical instruments and, an endoscope through small incision in the skin of the patient. Manipulating such instruments can be awkward, particularly when suturing a graft to an artery. It has been found that a high level of dexterity is required to accurately control the instruments. Additionally, human hands typically have at least a minimal amount of tremor. The tremor further increases the difficulty of performing minimally invasive cardiac procedures.
• To perform MIS, the surgeon uses special instruments. These instruments allow the surgeon to maneuver inside the patient. One type of instrument that is used in minimally invasive surgery is forceps, an instrument having a tip specifically configured to grasp objects, such as needles. Because forceps and other instruments designed for minimally invasive surgery are generally long and rigid, they fail to provide a surgeon the dexterity and precision necessary to effectively carry out many procedures in a minimally invasive fashion. For example, conventional MIS forceps are not well suited for manipulating a needle during a minimally invasive procedure, such as during endoscopy. Therefore, many MIS procedures that might be performed, have, as of yet, not been accomplished.
• In essence, during open surgeries, the tips of the various instruments may be positioned with six degrees of freedom. However, by inserting an instrument through a small aperture, such as one made in a patient to effectuate a minimally invasive procedure, two degrees of freedom are lost. It is this loss of freedom of movement within the surgical site that has substantially limited the types of MIS procedures that are performed.
• Dexterity is lacking in MIS because the instruments that are used fail to provide the additional degrees of freedom that are lost when the instrument is inserted into a patient. One problem associated with this lack of dexterity is the inability to suture when the instruments are in certain positions. As a result, surgeries that require a great deal of suturing within the surgical site are almost impossible to perform because the surgical instruments to enable much of this work are not available.
• Another problem associated with MIS is the lack of precision within the surgical site. For procedures such as the MICABG (Minimally Invasive Coronary Artery Bypass Graft), extremely small sutures must be emplaced in various locations proximate the heart. As such, precise motion of the tool at the tip of a surgical instrument is necessary. Currently, with hand positioned instruments, the precision necessary for such suturing is lacking.
• As such, what is needed in the art is a tool and class of surgical instruments that may be articulated within the patient such that a surgeon has additional degrees of freedom available to more dexterously and precisely position the tool at the tip of the instrument, as is needed.
• Additionally, what is needed in the art is a method and mechanism that provides simple handle, instrument and tool changing capabilities so that various tools may be easily and readily replaced to enable faster procedures to thus minimize operating room costs to the patient and to lessen the amount of time a patient is under anesthesia.
• It is to the solution of the aforementioned problems to which the present invention is directed.
BRIEF SUMMARY OF THE INVENTION
• The present invention is a system for performing minimally invasive surgical procedures, and more particularly, minimally invasive cardiac procedures. The system includes a pair or more of surgical instruments that are coupled to a pair or more of robotic arms. The system may include only a single surgical instrument and a single robotic arm as well and as is hereinbelow disclosed. The instruments have end effectors that can be manipulated to sever, grasp, cauterize, irradiate and suture tissue. Each robotic arm is coupled to a master handle by a controller. The robotic arms may be selectively connected to a specific master handle such that a surgeon may selectively control one or more of a plurality of robotic arms. The handles can be moved by the surgeon to produce a corresponding movement of the end effectors and the surgical tools attached thereto. The movement of the handles is scaled so that the end effectors have a corresponding movement that is different, typically smaller, than the movement performed by the hands of the surgeon. This helps in removing any tremor the surgeon might have in their hands. The scale factor is adjustable so that the surgeon can control the resolution of the end effector movement. The scale factor may be effectuated via a voice recognition system, control buttons or the like. The movement of the end effector can be controlled by an input button, so that the end effector only moves when the button is depressed or toggled by the surgeon. Alternatively, the movement can be activated via voice control in a manner similar to the scaling factor adjustment set out hereinbelow. The input button allows the surgeon to adjust the position of the handles without moving the end effector, so that the handles can be moved to a more comfortable position. The system may also have a robotically controlled endoscope which allows the surgeon to remotely view the surgical site. A cardiac procedure can be performed by making small incisions in the patient's skin and inserting the instruments and endoscope into the patient. The surgeon manipulates the handles and moves the end effectors to perform a cardiac procedure such as a coronary artery bypass graft or heart valve surgery.
• The present invention is additionally directed to a surgical instrument and method of control thereof which permits the surgeon to articulate the tip of the instrument, while retaining the function of the tool at the tip of the instrument. As such, the instrument tip may be articulated with two degrees of freedom, all the while the tool disposed at the tip may be used.
• The robotic system generally comprises: a robotic arm; a coupler attached to the arm; a surgical instrument that is held by the coupler; a controller; and wherein movement at the controller produces a proportional movement of the robotic arm and surgical instrument.
• The present invention may include a surgical instrument that has an elongated rod. The elongated rod has a longitudinal axis and generally serves as the arm of the endoscopic instrument. An articulate portion is mounted to and extends beyond the elongated rod. Alternatively, the articulate portion may be integrally formed with the elongated rod. The articulate portion has a proximal portion, a pivot linkage and a distal portion. The proximal portion may include a pair of fingers. The fingers may be orthogonal to each other and oriented radially to the longitudinal axis of the elongated rod. For use in surgical procedures, it is generally preferable that the instrument and the majority of the components therein are formed of stainless steel, plastic, or some other easily steralizable material. Each of the fingers may have at least one aperture formed therein to allow the passage of a pin which aids in the attachment of the pivot linkage to the proximal portion of the articulate portion and which allows the pivot linkage to be pivotally mounted to the proximal portion. The articulate portion provides articulation at the tip of an instrument that includes the articulate portion. More particularly, this provides additional degrees of freedom for the tool at the tip of an instrument that includes an articulate portion.
• An instrument such as that disclosed hereinbelow, when used in conjunction with the present surgical system, provides the surgeon additional dexterity, precision, and flexibility not yet achieved in minimally invasive surgical procedures. As such, operation times may be shortened and patient trauma greatly reduced.
• To provide increased precision in positioning the articulated tip as disclosed hereinbelow, there is provided two additional degrees of freedom to the master controller. Each of the two additional degrees of freedom are mapped to each of the degrees of freedom at the instrument tip. This is accomplished through the addition of two joints on the master and automatic means for articulating the instrument tip in response to movements made at the master.
• The objects and advantages of the present invention will become more readily apparent to those ordinarily skilled in the art after reviewing the following detailed description and drawings wherein:
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a perspective view of a minimally invasive surgical system in accordance with the present invention;
• FIG. 2 is a schematic of a master of the system;
• FIG. 3 is a schematic of a slave of the system;
• FIG. 4 is a schematic of a control system of the system;
• FIG. 5 is a schematic showing the instrument in a coordinate frame;
• FIG. 6 is a schematic of the instrument moving about a pivot point;
• FIG. 7 is an exploded view of an end effector in accordance with the system of the present invention;
• FIG. 8 is a view of a master handle of the system in accordance with the present invention;
• FIG. 8ais a side view of the master handle of the system in accordance with the present invention;
• FIGS.9-10A-I are illustrations showing an internal mammary artery being grafted to a coronary artery;
• FIG. 11 is a side view of a rear-loading tool driver in accordance with the system of the present invention;
• FIG. 12 is a plan view of the motor assembly of the back loading tool driver ofFIG. 11;
• FIG. 13 is a side plan view of an articulable instrument in accordance with the present invention;
• FIG. 14 is a side plan view of an articulable instrument, where the instrument tip is articulated;
• FIG. 15 is an exploded view of the articulable portion of the articulable instrument in accordance with the present invention;
• FIG. 16 is a plan view of a pivot linkage in accordance with the articulate portion of the articulable surgical instrument of the present invention;
• FIG. 17 is a perspective view of an articulating tool driving assembly in accordance with the present invention;
• FIG. 18 is a view of a removable tool-tip in accordance with an articulable instrument of the present invention;
• FIG. 19 is a tool-tip receptacle in accordance with the present invention;
• FIG. 20 is a cross-sectional view of an articulable instrument attached to the articulate-translator of the present invention;
• FIG. 21 is a close-up cross section view of the articulate-translator in accordance with the present invention;
• FIG. 22 is an end view of the articulate translator in accordance with the present invention;
• FIG. 23 is a cross-sectional view of the sterile section of the articulating tool driving assembly in accordance with the system of the present invention;
• FIG. 24 is a cross sectional view of the tool driver of the articulating tool driving assembly in accordance with the system of the present invention;
• FIG. 25 is an schematic of a master of a system in accordance with the present invention that includes the articulating tool driving assembly;
• FIG. 26 is a plan view of a drape for use with the robotic arm in accordance with the present invention;
• FIG. 27 is a plan view of a surgical instrument having a stapling tool disposed at the end thereof and wherein the surgical instrument is attached to the robotic arm in accordance with the present invention;
• FIG. 28 is a plan view of a surgical instrument having a cutting blade disposed at the end thereof wherein the instrument is attached to the robotic arm in accordance with the present invention;
• FIG. 29 is a plan view of a surgical instrument having a coagulating/cutting device disposed at the end thereof, the instrument attached to a robotic arm in accordance with the present invention;
• FIG. 30 is a plan view of a surgical instrument having a suturing tool disposed at the end thereof and wherein the surgical instrument is attached to the robotic arm in accordance with the present invention;
• FIG. 31 is a plan view of an alternative master-handle console in accordance the present invention;
• FIG. 32 is a plan view of an alternative master-handle console in accordance with the present invention;
• FIG. 33 is a partial cut away cross-section of the master handle console in accordance with the present invention;
• FIG. 34 is a partial cut-away plan view of a handle in accordance with the present invention;
• FIG. 35 is a perspective view of an alternative embodiment of a handle in accordance with the present invention;
• FIG. 36 is a top plan cross-sectional view of the handle depicted inFIG. 35;
• FIG. 37 is an alternative embodiment of a handle in accordance with the present invention;
• FIG. 38 is an alternative embodiment of a handle in accordance with the present invention; and
• FIG. 39 is an alternative embodiment of a handle in accordance with the present invention.
DETAILED DESCRIPTION OF THE INVENTION
• Referring to the drawings more particularly by reference numbers,FIG. 1 shows a system10 that can be used to perform minimally invasive surgery. In a preferred embodiment, the system10 may be used to perform a minimally invasive coronary artery, bypass graft, or Endoscopic coronary artery bypass graft (E-CABG) and other anastomostic procedures. Although a MI-CABG procedure is shown and described, it is to be understood that the system may be used for other surgical procedures. For example, the system can be used to suture any pair of vessels as well as cauterizing, cutting, and radiating structures within a patient.
• The system10 is used to perform a procedure on a patient12 that is typically lying on an operating table14. Mounted to the operating table14 is a first articulate arm16, a secondarticulate arm18 and a thirdarticulate arm20. The articulate arms16-20 are preferably mounted to the table so that the arms are in a plane proximate the patient. It is to be appreciated that the arms may be mounted to a cart or some other device that places the arms proximate the plane of the patient as well. Although three articulate arms are shown and described, it is to be understood that the system may have any number of arms, such as one or more arms.
• The first and secondarticulate arms16 and18 each have abase housing25 and arobotic arm assembly26 extending from thebase housing25.Surgical instruments22 and24 are preferably removably coupled at the end of eachrobotic arm assembly26 of the first and secondarticulate arms16,18. Each of theinstruments22,24 may be coupled to a correspondingrobotic arm assembly26 in a variety of fashions which will be discussed in further detail hereinbelow.
• The thirdarticulate arm20 additionally comprises abase housing25 and arobotic arm assembly26, and preferably has anendoscope28 that is attached to therobotic arm assembly26. Thebase housing25 androbotic arm assemblies26 of each of thearticulate arms16,18, and20 are substantially similar. However, it is to be appreciated that the configuration of the thirdarticulate arm20, may be different as the purpose of the third articulate arm is to hold and position theendoscope28 as opposed to hold and position a surgical instrument. Additionally, afourth arm29 may be included in the system10. Thefourth arm29 may hold anadditional instrument31 for purposes set out hereinbelow.
• Theinstruments22,24 and29 andendoscope28 are inserted through incisions cut into the skin of thepatient12. Theendoscope28 has acamera30 that is coupled to amonitor32 which displays images of the internal organs of thepatient12.
• Eachrobotic arm assembly26 has abase motor34 which moves thearm assembly26 in a linear fashion, relative to thebase housing25, as indicated by arrows Q. Eachrobotic arm assembly26 also includes a firstrotary motor36 and a secondrotary motor38. Each of therobotic arm assemblies26 also have a pair ofpassive joints40 and42. Thepassive joints40,42 are preferably disposed orthogonal to each other to provide pivotal movement of theinstrument22,24 orendoscope28 that is attached to a correspondingrobotic arm assembly26. The passive joints may be spring biased in any specific direction, however, they are not actively motor driven. The joint angle is controlled to a particular value using a feedback control loop. Therobotic arm assemblies26 also have acoupling mechanism45 to couple theinstruments22 and24, orendoscope28 thereto. Additionally, each of therobotic arm assemblies26 has a motor drivenworm gear44 to rotate theinstrument22,24 orendoscope28 attached thereto about its longitudinal axis. More particularly, the motor driven worm gear spins the instruments or endoscope.
• The first, second, and thirdarticulate arms16,18,20 as well as thefourth arm29 are coupled to acontroller46′ which can control the movement of the arms. The arms are coupled to thecontroller46 via wiring, cabling, or via a transmitter/receiver system such that control signals may be passed form thecontroller46 to each of thearticulate arms16,18, and20. It is preferable, to ensure error free communication between each of thearticulate arms16,18,20 and29 and thecontroller46 that eacharm16,18,20 and29 be electrically connected to the controller, and for the purposes of example, eacharm16,18,20 and29 is electrically connected to thecontroller46 via electrical cabling47. However, it is possible to control each of thearms16,18,20 and29 remotely utilizing well-known remote control systems as opposed to direct electrical connections. As such remote control systems are well-known in the art, they will not be further discussed herein.
• Thecontroller46 is connected to aninput device48 such as a foot pedal, hand controller, or voice recognition unit. For purposes of example, a foot controller and voice recognition unit are disclosed herein. Theinput device48 can be operated by a surgeon to move the location of theendoscope28 and view a different portion of the patient by depressing a corresponding button(s) disposed on theinput device48. Alternatively, theendoscope28 may be positioned via voice control. Essentially, a vocabulary of instructions to move the endoscope, such as up, down, back, and in may be recognized via a speech recognition system and the appropriate instructions are sent to the controller. The speech recognition system may be any well-known speech recognition software. Additionally, thecontroller46 includes a vocabulary of appropriate words that may be used with the system10. Including such a vocabulary in thecontroller46 may be accomplished through the inclusion of the aforementioned speech recognition software. To effectuate the voice recognition amicrophone37 is included in the system10. Themicrophone37 may be part of a digital system such that integrity of the signal is ensure.
• Thecontroller46 receives the input signals from the input device;48 and moves theendoscope28 androbotic arm assembly26 of the thirdarticulate arm20 in accordance with the input commands of the surgeon. Each of therobotic arm assemblies26 may be devices that are sold by the assignee of the present invention, Computer Motion, Inc. of Goleta, Calif., under the trademark AESOP. The system is also described in U.S. Pat. No. 5,515,478, which is hereby incorporated by reference. Although afoot pedal49 is shown and described, it is to be understood that the system may have other input means such as a hand controller, or a speech recognition interface.
• The movement and positioning ofinstruments22,24 attached to the first and secondarticulate arms16 and18 is controlled by a surgeon at a pair of master handles50 and52. Each of the master handles50,52 which can be manipulated by the surgeon, has a master-slave relationship with a corresponding one of thearticulate arms16,18 so that movement of ahandle50 or52 produces a corresponding movement of thesurgical instrument22,24 attached to thearticulate arm16,18. Additionally, aswitch51 may be included in the system10. Theswitch51 may be used by the surgeon to allow positioning of thefourth arm29. This is accomplished because the position of theswitch51 allows the surgeon to select which of the arms aspecific handle50 or52 controls. In this way, a pair ofhandles50 and52 may be used to control a plurality of robotic arms. Theswitch51 may be connected to a multiplexer to act as a selector so that output from the multiplexer is transmitted to the appropriate robotic arm. Alternatively, the switch may have several positions and may, therefore, direct its output to the appropriate input on thecontroller46.
• Thehandles50 and52 may be mounted to aportable cabinet54. A second television monitor56 may be placed onto thecabinet54 and coupled to theendoscope28 via well-known means so that the surgeon can readily view the internal organs of thepatient12. Thehandles50 and52 are also coupled to thecontroller46. Thecontroller46 receives input signals from thehandles50 and52, computes a corresponding movement of the surgical instruments, and provides output signals to move therobotic arm assemblies26 andinstruments22,24. Because the surgeon may control the movement and orientation of theinstruments22,24 without actually holding the ends of the instruments, the surgeon may use the system10 of the present invention both seated or standing. One advantage of the present system is that a surgeon may perform endoscopic surgeries in a sitting position. This helps reduce surgeon fatigue and may improve performance and outcomes in the operating room, especially during those procedures that are many hours in length. To accommodate a seated position, achair57 may be provided with the system.
• Alternatively, and as depicted inFIGS. 31-33, thehandles50 and52 may be mounted to ahandle stand900. Thehandle stand900 essentially provides for adjustment of the height and tilt of thehandles50 and52. Thehandle stand900 includes abase902, aneck904 and ahandle portion906. The base902 may be adjusted so that thehandle stand900 is tilted. Alever908 connected to anelongated rod910 may provide a means for tilting thehandle stand900. As such, thestand900 may be tilted such that a surgeon using the system10 can remain comfortable standing or sitting while manipulating thehandles50 and52.
• Additionally, thehandle stand900 may be heightened or shortened depending upon the position of the surgeon (i.e. standing or sitting). This is accomplished via a telescoping section912. The telescoping section912 includes an upper portion914 telescopingly housed within a lower portion916. A spring biaseddetent918 is attached to the upper portion914 and a plurality of apertures920 are provided in the lower portion916 such that thedetent918 seats in an associated aperture920. The upper portion914 may be extended by depressing thedetent918 and pulling up on thestand900. Alternatively, thestand900 may be lowered by depressing the detent and pushing down on thestand900. The telescoping section912 and associated mechanisms serve as a means to raise and lower thestand900.
• Additionally, and as depicted inFIGS. 31-33, thehandles50 and52 may be attached to thestand900 via a plurality ofrollers930 and anelongated rod932. Motion of therod932 is transmitted to a plurality ofgears934 disposed on thestand900. Thegears934 may be housed within ahousing936 to protect them from the environment and to preclude access thereto. Additionally,potentiometers938 are utilized to measure the position of thehandles50 and52 relative to a starting position. This will be discussed in more detail hereinbelow. It is to be appreciated that the present invention may be accomplished either utilizing acabinet54 or astand900. As thehandles50 and52 are connected to thecontroller46 in either case.
• Each handle has multiple degrees of freedom provided by the various joints Jm1-Jm5 depicted inFIG. 2. Joints Jm1 and Jm2 allow the handle to rotate about a pivot point in thecabinet54 or on thestand900. Joint Jm3 allows the surgeon to move the handle into and out of thecabinet54 in a linear manner or in a similar manner on thestand900. Joint Jm4 allows the surgeon to rotate the master handle about a longitudinal axis of the handle. The joint Jm5 allows a surgeon to open and close a gripper.
• Each joint Jm1-Jm5 has one or more position sensors which provides feedback signals that correspond to the relative position of the handle. The position sensors may be potentiometers, or any other feedback device such as rotary optical encoders that provides an electrical signal which corresponds to a change of position. Additionally, a plurality of position sensors may be emplaced at each joint to provide redundancy in the system which can be used to alert a surgeon of malfunctions or improper positioning of a correspondingrobotic arm assembly26.
• In addition to position sensors, each joint may include tachometers, accelerometers, and force sensing load cells, each of which may provide electrical signals relating to velocity, acceleration and force being applied at a respective joint. Additionally, actuators may be included at each joint to reflect force feed back received at arobotic arm assembly26. This may be especially helpful at joint jm5 to indicate the force encountered inside a patient by the gripper disposed-at the end of one of thetools22, or24. As such, a force reflective element must be included at the gripper of theinstrument22,24 to effectuate such a force reflective feedback loop. Force reflective elements, such as a piezoelectric element in combination with a whetstone bridge are well-known in the art. However, it is not heretofore know to utilize such force reflection with such a system10.
• FIG. 3 shows the various degrees of freedom of eacharticulate arm16 and18. The joints Js1, Js2 and Js3 correspond to the; axes of movement of thebase motor34 androtary motors36,38 of therobotic arm assemblies26, respectively. The joints Js4 and Js5 correspond to thepassive joints40 and42 of thearms26. The joint Js6 may be a motor which rotates the surgical instruments about the longitudinal axis of the instrument. The joint Js7 may be a pair of fingers that can open and close. Theinstruments22 and24 move about a pivot point P located at the incision of the patient.
• FIG. 4 shows a schematic of a control system that translates a movement of a master handle into a corresponding movement of a surgical instrument. In accordance with the control system shown inFIG. 4, thecontroller46 computes output signals for the articulate arms so that the surgical instrument moves in conjunction with the movement of the handle. Each handle may have aninput button58 which enables the instrument to move with the handle. When theinput button58 is depressed the surgical instrument follows the movement of the handle. When thebutton58 is released the instrument does not track the movement of the handle. In this manner the surgeon can adjust or “ratchet” the position of the handle without creating a corresponding undesirable movement of the instrument. The “ratchet” feature allows the surgeon to continuously move the handles to more desirable positions without altering the positions of the arms. Additionally, because the handles are constrained by a pivot point the ratchet feature allows the surgeon to move the instruments beyond the dimensional limitations of the handles. Although aninput button58 is shown and described, it is to be understood that the surgical instrument may be activated by other means such as voice recognition. Using the voice recognition would require a specifically vocabulary such as “AWAKE” and “SLEEP” or some other two words having opposing meanings. Voice recognition is well known in general, and it is the specific use of voice recognition in this system10 that has substantial novelty and utility.
• The input button may alternatively be latched so that movement of the corresponding instrument toggles between active and inactive each time the button is depressed by the surgeon.
• When the surgeon moves a handle, the position sensors provide feedback signals M1-M5 that correspond to the-movement of the joints Jm1-Jm5, respectively. Thecontroller46 computes the difference between the new handle position and the original handle position incomputation block60 to generate incremental position values s_M1-_M5.
• The incremental position values M1-_M5 are multiplied by scale factors S1-S5, respectively inblock62. The scale factors are typically set at less than one so that the movement of the instrument is less than the movement of the handle. In this manner the surgeon can produce very fine movements of the instruments with relatively coarse movements of the handles. The scale factors S1-S5 are variable so that the surgeon can vary the resolution of instrument movement. Each scale factor is preferably individually variable so that the surgeon can more finely control the instrument in certain directions. By way of example, by setting one of the scale factors at zero the surgeon can prevent the instrument from moving in one direction. This may be advantageous if the surgeon does not want the surgical instrument to contact an organ or certain tissue located in a certain direction relative to the patient. Although scale factors smaller than a unit one are described, it is to be understood that a scale factor may be greater than one. For example, it may be desirable to spin the instrument at a greater rate than a corresponding spin of the handle.
• Thecontroller46 adds the incremental values_M1-_M5 to the initial joint angles Mj1-Mj5 inadder element64 to provide values Mr1-Mrs. The controller46 then computes desired slave vector calculations incomputation block66 in accordance with the following equations.
  Rdx=Mr3·sin(Mr2)·cos(Mr1)+Px
  Rdy=Mr3·sin(Mr2)·sin(Mr1)+Py
  Rdz=Mr3·cos(Mr2.)+Pz
  Sdr=Mr4
  Sdg=Mr5
  where;
• • Rdx, y, z=the new desired position of the end effector of the instrument.
  • Sdr=the angular rotation of the instrument about the instrument longitudinal axis.
  • Sdg=the amount of movement of the instrument fingers.
  • Px,y,z=the position of the pivot point P.
• Thecontroller46 then computes the movement of therobotic arm26 incomputational block68 in accordance with the following equations.$\mathrm{Jsd1}=\mathrm{Rdz}$$\mathrm{Jsd3}=\pi -{\cos }^{-1}\left[\frac{{\mathrm{Rdx}}^2+{\mathrm{Rdy}}^2-{\mathrm{L1}}^2}{2\mathrm{L1}·\mathrm{L2}}\right]$$\mathrm{Jsd2}={\tan }^{-1}\left(Rdy/Rdx\right)+\Delta \mathrm{for}\mathrm{Jsd3}\le 0$$\mathrm{Jsd2}={\tan }^{-1}\left(Rdy/Rdx\right)-\Delta \mathrm{for}\mathrm{Jsd3}\le 0$$\Delta ={\cos }^{-1}\left[\frac{{\mathrm{Rdx}}^2+{\mathrm{Rdy}}^2+{\mathrm{L1}}^2-{\mathrm{L2}}^2}{2·\mathrm{L1}\sqrt{{\mathrm{Rdx}}^2+{\mathrm{Rdy}}^2}}\right]$$\mathrm{Jds6}=\mathrm{Mr4}$$\mathrm{Jsd7}=\mathrm{Mr5}$
  where;
• • Jsd1=the movement of the linear motor.
  • Jsd2=the movement of the first rotary motor.
  • Jsd3=the movement of the second rotary motor.
  • Jsd6=the movement of the rotational motor.
  • Jsd7=the movement of the gripper.
  • L1=the length of the linkage arm between the first rotary motor and the second rotary motor.
  • L2=the length of the linkage arm between the second rotary motor and the passive joints.
• The controller provides output signals to the motors to move the arm and instrument in the desired location inblock70. This process is repeated for each movement of the handle.
• The master handle will have a different spatial position relative to the surgical instrument if the surgeon releases, or toggles, the input button and moves the handle. When theinput button58 is initially depressed, thecontroller46 computes initial joint angles Mj1-Mj5 incomputational block72 with the following equations.$\mathrm{Mj1}={\tan }^{-1}\left(\mathrm{ty}/\mathrm{tx}\right)$$\mathrm{Mj2}=\tan -1\left(d/\mathrm{tz}\right)$$\mathrm{Mj3}=D$$\mathrm{Mj4}=\mathrm{Js6}$$\mathrm{Mj5}=\mathrm{Js7}$$d=\sqrt{{\mathrm{tx}}^2+{\mathrm{ty}}^2}$$\mathrm{tx}=\frac{\mathrm{Rsx}-\mathrm{Px}}{D}\mathrm{ty}=\frac{\mathrm{Rsy}-\mathrm{Py}}{D}\mathrm{tz}=\frac{\mathrm{Rsz}-\mathrm{Pz}}{D}$$D=\sqrt{{\left(\mathrm{Rsx}-\mathrm{Px}\right)}^2+{\left(\mathrm{Rsy}-\mathrm{Py}\right)}^2+{\left(\mathrm{Psz}-\mathrm{Pz}\right)}^2}$
  The forward kinematic values are computed inblock74 with the following equations.
  Rsx=L1−cos(Js2)+L2−cos(Js2+Js3)
  Rsy=L1−sin(Js2)+L2−sin(Js2+Js3)
  Rsz=J1
• The joint angles Mj are provided to adder64. The pivot points Px, Py and Pz are computed incomputational block76 as follows. The pivot point is calculated by initially determining the original position of the intersection of the end effector and the instrument PO, and the unit vector Uo which has the same orientation as the instrument. The position P(x, y, z) values can be derived from various position sensors of the robotic arm. Referring toFIG. 5 the instrument is within a first coordinate frame (x, y, z) which has the angles θ4 and θ5. The unit vector Uo is computed by the transformation matrix:$\mathrm{Uo}=\begin{array}{ccc}\cos {\Theta }_5& 0& -\sin {\Theta }_5\\ -\sin {\mathrm{<figure-callout\; label="\Theta "\; filenames="US20050228365A1-20051013-D00014.png"\; state="\{\{state\}\}">\Theta </figure-callout>}}_4\sin {\Theta }_5& \cos {\Theta }_4& -\sin {\mathrm{<figure-callout\; label="\Theta "\; filenames="US20050228365A1-20051013-D00014.png"\; state="\{\{state\}\}">\Theta </figure-callout>}}_4\cos {\Theta }_5\\ \cos {\mathrm{<figure-callout\; label="\Theta "\; filenames="US20050228365A1-20051013-D00014.png"\; state="\{\{state\}\}">\Theta </figure-callout>}}_4\sin {\Theta }_5& \sin {\Theta }_4& \cos {\mathrm{<figure-callout\; label="\Theta "\; filenames="US20050228365A1-20051013-D00014.png"\; state="\{\{state\}\}">\Theta </figure-callout>}}_4\end{array}\left[\begin{array}{c}0\\ 0\\ -1\end{array}\right]$
• After each movement of the end effector an angular movement of the instrument Δθ is computed by taking the arcsin of the cross-product of the first and second unit vectors Uo and U1 of the instrument in accordance with the following line equations Lo and L1.
  Δθ=arc sin([T])
  T=UoxU1
  where;
• • T=a vector which is a cross-product of unit vectors Uo and U1.
• The unit vector of the new instrument position U1 is again determined using the position sensors and the transformation matrix described above. If the angle Δθ is greater than a threshold value, then a new pivot point is calculated and Uo is set to U1. As shown inFIG. 6, the first and second instrument orientations can be defined by the line equations Lo and L1:
• • Lo:
    xo=M_xo·Zo+Cxo
    yo=M_yo·Zo+Cyo
  • L1:
    x1=Mx1*Z1+Cx1
    y1=My1*Z1+Cy1
    where;
  • Zo=a Z coordinate along the line Lo relative to the z axis of the first coordinate system.
  • Z1=a Z coordinate along the line L1 relative to the z axis of the first coordinate system.
  • Mxo=a slope of the line Lo as a function of Zo.
  • Myo=a slope of the line Lo as a function of Zo.
  • Mx1=a slope of the line L1 as a function of Z1.
  • My1=a slope of the line L1 as a function of Z1.
  • Cxo=a constant which represents the intersection of the line Lo and the x axis of the first coordinate system.
  • Cyo=a constant which represents the intersection of the line Lo and the y axis of the first coordinate system.
  • Cx1=a constant which represents the intersection of the L1 and the x axis of the first coordinate system.
  • Cy1=a constant which represents the intersection of the line L1 and the y axis of the first coordinate system.
• The slopes are computed using the following algorithms:
  Mxo=Uxo/Uzo
  Myo=Uyo/Uzo
  Mx1=Ux1/Uz1
  My1=Uy1/Uz1
  Cx0=Pox−MX1·POZ
  Cy0=Poy−My1·Poz
  Cx1=P1x−Mx1·P1z
  Cy1=P1y−My1·P1z
  where;
• • Uo(x, y and z)=the unit vectors of the instrument in the first position within the first coordinate system.
  • U1(x, yandz)=the unit vectors of the instrument in the second position within the first coordinate system.
  • Po(x, y and z)=the coordinates of the intersection of the end effector and the instrument in the first position within the first coordinate system.
  • P1(x, yandz)=the coordinates of the intersection of the end effector and the instrument in the second position within the first coordinate system.
• To find an approximate pivot point location, the pivot points of the instrument in the first orientation Lo (pivot point Ro) and in the second orientation L1 (pivot point RI) are determined, and the distance half way between the two points Ro and R1 is computed and stored as the pivot point Rave of the instrument. The pivot point Rave is determined by using the cross-product vector T.
• To find the points Ro and R1 the following equalities are set to define a line with the same orientation as the vector T that passes through both Lo and L1.
  tx=Tx/Tz
  ty=Ty/Tz
  where;
• • tx=the slope of a line defined by vector T relative to the Z-x plane of the first coordinate system.
  • ty=the slope of a line defined by vector T relative to the Z-y plane of the first coordinate system.
  • Tx=the x component of the vector T.
  • Ty=the y component of the vector T.
  • Tz=the z component of the vector T.
• Picking two points to determine the slopes Tx, Ty and Tz (eg. Tx=x1−xo, Ty=y1−yo and Tz=z1−z0) and substituting the line equations Lo and L1, provides a solution for the point coordinates for Ro (xo, yo, zo) and R1(x1, y1, z1) as follows.
  zo=((Mx1−tx)z1+Cx1−Cxo)/(Mxo−tx)
  z1=((Cy1−Cyo)(Mxo−tx)−(Cx1−Cxo)(Myo−ty))/(Myo−ty)(Mx1−tx)−(My1−ty)(Mxo−tx))
  yo=Myo·zo+Cyo
  y1=My1·z1+Cy1
  xo=Mxo·zo+Cxo
  x1=Mx1·z1+Cx1
• The average distance between the pivot points Rc and R1 is computed with the following equation and stored as the pivot point of the instrument.
  R_ave=((x1+xo)/2,(y1+yo)/2,(z1+zo)/2
• The pivot point can be continually updated with the above described algorithm routine. Any movement of the pivot point can be compared to a threshold value and a warning signal can be issued or the robotic system can become disengaged if the pivot point moves beyond a set limit. The comparison with a set limit may be useful in determining whether the patient is being moved, or the instrument is being manipulated outside of the patient, situations which may result in injury to the patient or the occupants of the operating room.
• While substantial real time movement of the robotic arms is provided, it may be appreciated that pre-planned movements may be incorporated into the present system10. This is, most advantageous with regard to movement of the endoscope. Any type of movement may be stored in am associated memory of the controller so that a surgeon may define his own favorite movements and then actuate such movement by pressing a button or via voice control. Because the movement is taught in the present application as well as those patents incorporated herein by reference, no further disclosure of this concept is required.
• To provide feedback to the surgeon, the system10 may include a voice feedback unit. As such, it the robotic arms suffer any malfunction, the voice feedback may supply a message that such error has occurred. Additionally, messages regarding instrument location, time-in-use, as well as a host of other data may be supplied to the surgeon through the voice feedback unit. If such a condition occurs that requires a message, the system has a set of messages stored in an associated memory, such message may be encoded and saved in the memory. Aspeech synthesis unit89, as depicted inFIG. 1 can then vocalize the message to the surgeon. In this fashion, a surgeon can maintain sight of the operative environment as opposed to looking for messages displayed on a video screen or the like. Speech synthesis is well known, although its inclusion in a master-slave robotic system for minimally invasive surgery is heretofore unknown and present novel and unobvious advantages.
• To provide feedback to the surgeon the fingers of the instruments may have pressure sensors that sense the reacting force provided by the object being grasped by the end effector. Referring toFIG. 4, thecontroller46 receives the pressure sensor signals Fs and generates corresponding signals Cm inblock78 that are provided to an actuator located within the handle. The actuator provides a corresponding pressure on the handle which is transmitted to the surgeon's hand. The pressure feedback allows the surgeon to sense the pressure being applied by the instrument. As an alternate embodiment, the handle may be coupled to the end effector fingers by a mechanical cable that directly transfers the grasping force of the fingers to the hands of the surgeon.
• FIG. 7 shows a preferred embodiment of anend effector80 that may be used in the present invention. Theend effector80 includes asurgical instrument82, such as those disclosed hereinabove22,24, that is coupled to a frontloading tool driver84. Theend effector80 is mounted to one of therobotic arm assemblies26 bycoupling mechanism45. Thecoupling mechanism45 includes acollar85 that removably attaches to aholder86. Theholder86 includes aworm gear87 that is driven by a motor in therobotic arm assembly26 to rotate thecollar85 and in turn rotate theinstrument82 about its longitudinal axis. Theholder86 includes ashaft88 that seats into a slot-in therobotic arm assembly26. Theshaft88 may be turned by the motor in the arm assembly, which then rotates theworm gear87 thus rotating thecollar86 and theinstrument82. A tighteningtool89 may be employed to tighten and loosen the collar about theinstrument82. Such a tool operates like a chuck key, to tighten and loosen thecollar86.
• Thesurgical instrument82 has afirst finger90 that is pivotally connected to asecond finger91. Thefingers90,91 can be manipulated to hold objects such as tissue or a suturing needle. The inner surface of the fingers may have a texture to increase the friction and grasping ability of theinstrument82. Thefirst finger90 is coupled to arod92 that extends through acenter channel94 of theinstrument82. Theinstrument82 may have anouter sleeve96 which cooperates with a spring biased ballquick disconnect fastener98. Thequick disconnect98 allows instruments other than the finger grasper to be coupled to frontloading tool driver84. For example, theinstrument82 may be decoupled from thequick disconnect98 and replaced by a cutting tool, a suturing tool, a stapling tool adapted for use in this system, such as the stapling apparatus disclosed in U.S. Pat. No. 5,499,990 or 5,389,103 assigned to Karlsruhe, a cutting blade, or other surgical tools used in minimally invasive surgery. Thequick disconnect98 allows the surgical instruments to be interchanged without having to re-sterilize the frontloading tool driver84 each time an instrument is plugged into thetool driver84. The operation of the frontloading tool driver84 shall be discussed in further detail hereinbelow.
• Thequick disconnect98 has a slot100 that receives apin102 of the frontloading tool driver84. Thepin102 locks thequick disconnect98 to the front loading tool driver100. Thepin102 can be released by depressing a springbiased lever104. Thequick disconnect98 has apiston106 that is attached to thetool rod92 and in abutment with anoutput piston108 of aload cell110 located within the frontloading tool driver84.
• Theload cell110 is mounted to alead screw nut112. Thelead screw nut112 is coupled to alead screw114 that extends from agear box116. Thegear box116 is driven by areversible motor118 that is coupled to anencoder120. Theentire end effector80 is rotated by the motor drivenworm gear87.
• In operation, themotor118 of the frontloading tool driver84 receives input commands from thecontroller46 via electrical wiring, or a transmitter/receiver system and activates, accordingly. Themotor118 rotates thelead screw114 which moves thelead screw nut112 andload cell110 in a linear manner. Movement of theload cell110 drives thecoupler piston106 andtool rod92, which rotate thefirst finger88. Theload cell110 senses the counteractive force being applied to the fingers and provides a corresponding feedback signal to thecontroller46.
• The frontloading tool driver84 may be covered with asterile drape124 so that thetool driver84 does not have to be sterilized after each surgical procedure. Additionally, therobotic arm assembly26 is preferably covered with asterile drape125 so that it does not have to be sterilized either. Thedrapes124,125 serve substantially as a means for enclosing the frontloading tool driver84 androbotic arm assembly26. Thedrape125 used to enclose therobotic arm assembly26 is depicted in further detail inFIG. 26. Thedrape125 has a substantiallyopen end300 wherein therobotic arm assembly26 may be emplaced into thedrape125. Thedrape125 additionally includes a substantially taperedenclosed end302 that effectively separates thearm assembly26 from the operating room environment. Awasher304 having asmall aperture306 formed therethrough allows an instrument to be coupled to thearm assembly26 via thecoupling mechanism45. Thewasher304 reinforces thedrape125 to ensure that thedrape125 does not tear as thearm assembly26 moves about. Essentially, the instrument cannot be enclosed in thedrape125 because it is to be inserted into thepatient12. Thedrape125 also includes a plurality oftape308 having adhesive310 disposed thereon. At least one piece oftape308 is opposedly arranged the other pieces oftape308 to effectuate the closing of thedrape125 about thearm assembly26.
• FIGS. 8 and 8ashow a preferred embodiment of amaster handle assembly130. Themaster handle assembly130 includes amaster handle132 that is coupled to anarm134. The master handle132 may be coupled to thearm134 by apin136 that is inserted into acorresponding slot138 in thehandle132. Thehandle132 has acontrol button140 that can be depressed by the surgeon. Thecontrol button140 is coupled to aswitch142 by ashaft144. Thecontrol button140 corresponds to theinput button58 shown inFIG. 4, and activates the movement of the end effector.
• The master handle132 has afirst gripper146 that is pivotally connected to a secondstationary gripper148. Rotation of thefirst gripper146 creates a corresponding linear movement of ahandle shaft150. Thehandle shaft150 moves agripper shaft152 that is coupled aload cell154 by abearing156. Theload cell154 senses the amount of pressure being applied thereto and provides an input signal to thecontroller46. Thecontroller46 then provides an output signal to move the fingers of the end effector.
• Theload cell154 is mounted to alead screw nut158 that is coupled to alead screw160. Thelead screw160 extends from areduction box162 that is coupled to amotor164 which has anencoder166. Thecontroller46 of the system receives the feedback signal of theload cell110 in the end effector and provides a corresponding command signal to the motor to move thelead screw160 and apply a pressure on the gripper so that the surgeon receives feedback relating to the force being applied by the end effector. In this manner the surgeon has a “feel” for operating the end effector.
• The handle is attached to aswivel housing168 that rotates about bearing170. Theswivel housing168 is coupled to aposition sensor172 by agear assembly174. Theposition sensor172 may be a potentiometer which provides feedback signals to thecontroller46 that correspond to the relative position of the handle. Additionally, an optical encoder may be employed for this purpose. Alternatively, both a potentiometer and an optical encoder may be used to provide redundancy in the system. The swivel movement is translated to a corresponding spin of the end effector by the controller and robotic arm assembly. This same type of assembly is employed in thestand900.
• Thearm134 may be coupled to alinear bearing176 andcorresponding position sensor178 which allow and sense linear movement of the handle. The linear movement of the handle is translated into a corresponding linear movement of the end effector by the controller and robotic arm assembly. The arm can pivot aboutbearings180, and be sensed byposition sensor182 located in astand184. Thestand184 can rotate about bearing186 which has acorresponding position sensor188. The arm rotation is translated into corresponding pivot movement of the end effector by the controller and robotic arm assembly.
• A human hand will have a natural tremor typically resonating between 6-12 hertz. To eliminate tracking movement of the surgical instruments with the hand tremor, the system may have a filter that filters out any movement of the handles that occurs within the tremor frequency bandwidth. Referring toFIG. 4, thefilter184 may filter analog signals provided by the potentiometers in a frequency range between 6-12 hertz. Alternatively, an optical encoder and digital filter may be used for this purpose.
• As shown inFIGS. 9 and 10A-J, the system is preferably used to perform a cardiac procedure such as a coronary artery bypass graft (CABG). The procedure is performed by initially cutting three incisions in the patient and inserting thesurgical instruments22 and24, and theendoscope26 through the incisions. One of thesurgical instruments22 holds a suturing needle and accompanying thread when inserted into the chest cavity of the patient. If the artery is to be grafted with a secondary vessel, such as a saphenous vein, the othersurgical instrument24 may hold the vein while the end effector of the instrument is inserted into the patient.
• The internal mammary artery (IMA) may be severed and moved by one of the instruments to a graft location of the coronary artery. The coronary artery is severed to create an opening in the artery wall of a size that corresponds to the diameter of the IMA. The incision(s) may be performed by a cutting tool that is coupled to one of the end effectors and remotely manipulated through a master handle. The arteries are clamped to prevent a blood flow from the severed mammary and coronary arteries. The surgeon manipulates the handle to move the IMA adjacent to the opening of the coronary artery. Although grafting of the IMA is shown and described, it is to be understood that another vessel such as a severed saphaneous vein may be grafted to bypass a blockage in the coronary artery.
• Referring to FIGS.10A-J, the surgeon moves the handle to manipulate the instrument into driving the needle through the IMA and the coronary artery. The surgeon then moves the surgical instrument to grab and pull the needle through the coronary and graft artery as shown inFIG. 10B. As shown inFIG. 10C, the surgical instruments are then manipulated to tie a suture at the heel of the graft artery. The needle can then be removed from the chest cavity. As shown in FIGS.10D-F, a new needle and thread can be inserted into the chest cavity to suture the toe of the graft artery to the coronary artery. As shown inFIG. 10H-J, new needles can be inserted and the surgeon manipulates the handles to create running sutures from the heel to the toe, and from the toe to the heel. The scaled motion of the surgical instrument allows the surgeon to accurately move the sutures about the chest cavity. Although a specific graft sequence has been shown and described, it is to be understood that the arteries can be grafted with other techniques. In general the system of the present invention may be used to perform any minimally invasive anastomostic procedure.
• Additionally, it may be advantageous to utilize a fourth robotic arm to hold astabilizer75. The stabilizer may be a tube or wire or some other medical device that may be emplaced within an artery, vein or similar structure to stabilize such structure. Using theswitch51 to interengage the fourth robotic arm, with ahandle50 or52 a surgeon may position thestabilizer75 into the vessel. This eases the task of placing a stitch through the vessel as thestabilizer75 maintains the position of the vessel. Once thestabilizer75 has been placed, the surgeon then flips the switch or like mechanism to activate the robotic arm that had been disconnected to allow for movement of the fourth robotic arm. Thestabilizer75 should be substantially rigid and hold its shape. Additionally, the stabilizer should be formed form a material that is steralizable. Such material are well known in the medical arts. However, this application and configuration is heretofore unknown.
• As disclosed hereinabove, the system may include a frontloading tool driver84 which receives control signals from thecontroller46 in response to movement of amaster handle50 or52 and drives the tool disposed at the end of a surgical instrument. Alternatively, a backloading tool driver200 may be incorporated into the system10 of the present invention, as depicted inFIGS. 11 and 11a. The backloading tool driver200 cooperates with a back loadablesurgical instrument202. The incorporation of such a backloading tool driver200 andinstrument202 expedites tool changing during procedures, as tools may be withdrawn from thetool driver200 and replaced with other tools in a very simple fashion.
• The backloading tool driver200 is attached to arobotic arm assembly26 via a collar and holder as disclosed hereinabove. The back loading tool driver includes asheath204 having aproximal end206 and adistal end208. Thesheath204 may be formed of plastic or some other well-known material that is used in the construction of surgical instruments. Thesheath204 is essentially a hollow tube that fits through thecollar85 and is tightened in place by the tightening tool that is described in more detail hereinabove.
• The back loadablesurgical instrument202 has atool end210 and a connectingend212. Asurgical tool214, such as a grasper or some other tool that may be driven by a push/pull rod or, cable system, or a surgical tool that does not require such a rod or cable, such as a coagulator, or harmonic scalpel is disposed at thetool end210 of theinstrument202.
• A housing216 is disposed at the connectingend212 of theinstrument202. The housing has alever218 disposed interiorly the housing216. Thelever218 has apivot point220 that is established by utilizing a pin passing through an associatedaperture222 in the lever. The pin may be attached to theinterior wall224 of the housing. A push/pull cable orrod226, that extends the length of theinstrument202 is attached to thelever218, such that movement of thelever218 about the pivot point;220 results in a linear movement of the cable orrod226. Essentially the cable orrod226 servers as a means227 for actuating thetool214 at thetool end210 of theinstrument202. The cable orrod226 may be attached to the lever via a connection pin as well. Thelever218 has a C-shape, wherein the ends of thelever218 protrude through twoapertures228,230 in the housing216. Theapertures228,230 are preferably surrounded by O-rings232 the purpose of which shall be described in more detail hereinbelow.
• Thetool end210 of the back loadablesurgical instrument202 is emplaced in the hollow tube of the backloading tool driver200. Thetool202 may be pushed through the tool driver until thetool end210 extends beyond thesheath204. The O-rings232 seat in associatedapertures234,236 in ahousing238 of thetool driver200. The housing additionally has-anaperture240 centrally formed therethrough, the aperture being coaxial with the interior of the hollow tube. In this fashion, thesurgical instrument202 may be inserted into and through thetool driver200. Each of the O-rings232 snugly seats in its associated aperture in thehousing238 of thetool driver200.
• Thehousing238 additionally includes a motor assembly242 which is depicted inFIG. 11a. The motor assembly242 is attached to thehousing238 and is held firmly in place therein. The motor assembly generally includes amotor244 attached to areducer246. The motor drives aleaf248 attached at the end thereof. Theleaf248 engages the ends of thelever218 such that rotational movement of the motor results in the movement of thelever218 about thepivot point220. This in turn results in the lateral movement of the means227 for actuating thetool214 at thetool end210 of theinstrument202. The motor moves in response to movements at a control handle. Additionally,force sensors248,250 may be attached at the ends of theleaf248. As such, a force feedback system may be incorporated to sense the amount of force necessary to actuate thetool214 at thetool end210 of theinstrument202. Alternatively, themotor244 may have aforce feedback device252 attached thereto, which can be used in a similar fashion.
• One advantage of utilizing the backloading tool driver200 is that thesheath204 always remains in thepatient12. As such, the tools do not have to be realigned, nor does therobotic arm assembly26 when replacing or exchanging tools. Thesheath204 retains its position relative to the patient12 whether or not a toll is placed therethrough.
• The system10 of the present invention may additionally be supplied with one or two additional degrees of freedom at the tip of an instrument. For the purposes of example, two additional degrees of freedom will be disclosed; however it is to be appreciated that only one degree of freedom may be included as well. To provide the additional degrees of freedom, and as depicted inFIGS. 13-16, an articulablesurgical instrument300 may be incorporated into the present. Theinstrument300 may be coupled to thearm assembly26 via a collar and holder as disclosed hereinabove. In order to articulate the tip of thearticulable instrument300 an articulatingtool driver500 must be employed. The articulatingtool driver500 shall be described in more detail hereinbelow. The master must have an additional two degrees of freedom added thereto to proved the controls for the articulation at the tip of theinstrument300.FIG. 25 depicts an alternative master schematic that includes the two additional degrees of freedom. As disclosed hereinbelow, the two additional degrees of freedom are mapped to the articulable portion of theinstrument300. The two additional axes at the master are referred to as Jm6 and Jm7.
• By incorporating thearticulable instrument300 and the articulatingtool driver500 and the additional degrees of freedom at the master, difficult maneuvers may be carried out in an easier fashion.
• With reference toFIGS. 13-16, thearticulable instrument300 generally includes anelongated rod302, a sheath309, and atool306. The tool can be a grasper, a cutting blade, a retractor, a stitching device, or some other well-known tool used in minimally invasive surgical procedures.FIGS. 27-30 show various tools that may be emplaced at the distal end of the articulablesurgical instrument300.
• Theinstrument300 includes anarticulable portion301 having aproximal portion308, apivot linkage310 and adistal portion212 each of which will be discussed in more detail hereinbelow. Additionally, theinstrument300 includes means311 for articulating thearticulable portion301 of theinstrument300 with respect to theelongated rod302. The inclusion of thearticulable portion301 provides two additional degrees of freedom at the instrument tip. It must also be appreciated that although thearticulable portion301 is described as including a proximal portion, a pivot linkage and a distal portion, there may be provided a plurality of intermediate portions each mounted to each other via a corresponding pivot linkage.
• Disposed between and mounted to each of the respective proximal portion and distal portion and any intervening intermediate portions arepivot linkages310. Thepivot linkage310 interrogates with the proximal and distal portions of the articulable portion to provide articulation at the instrument tip. Essentially, the cooperation of the proximal portion, pivot linkage and distal portion serves as a universal joint.
• Theelongated rod302 is preferably hollow and formed of stainless steel or plastic or some other well-know material that is steralizable. Because therod302 is hollow, it encompasses and defines an interior314. Theelongated rod302 additionally has aproximal end316 and adistal end318. Thedistal end318 of theelongated rod302 should not be confused with thedistal portion312 of thearticulable portion301 of theinstrument300.
• Theproximal portion308 of thearticulable portion301 may be integrally formed with theelongated rod302 or it may be attached thereto vie welding, glue or some other means well-known to the skilled artisan. It is preferable that theproximal portion308 be integrally formed with theelongated rod302 to ensure sufficient stability and durability of theinstrument300. Theproximal portion308 of thearticulable portion301 comprises twofingers320,322 each of which have anaperture324,326 formed therethrough.
• Apivot linkage310 is mounted to theproximal portion308 via a plurality ofpins328 that each pass through an associated aperture in an adjoining finger. Thepivot linkage310 is a generally flat disk330 having acentral aperture332 passing therethrough and fourapertures334,336,338,340 evenly spaced at the periphery of the disk330. Additionally pins328 are attached to and extend from theedge342. Thepins328 seat in the apertures of the associated fingers to provide the articulability of theinstrument300. Five leads350,352,354,356,358 extend interiorly the hollow shaft. Onlead350 extends down the center and passes through thecenter aperture332 in thepivot linkage310. Two352,354 of the five leads extend down the hollow interior of the instrument and are attached to the pivot linkage such that linear tension on one of the leads results in rotational movement of thepivot portion301. These two leads352,354 attach to the pivot linkage at two of the apertures formed therethrough. Additionally, they attach at those apertures that are adjacent to the pins that pass through the fingers of theproximal portion308 of thearticulable portion301 of theinstrument300. The other twoleads356,358 pass through the two other apertures in the pivot linkage and attach at the distal end of thearticulable portion301.
• Movement of these two leads results in movement of thearticulable portion301 that is orthogonal to the movement when the twoother leads352,354 are moved.
• To articulate the instrument as a part of the present system, and as depicted inFIGS. 17-24, there is provided an articulatingmechanism400. The articulatingmechanism400 generally comprises the articulatingtool driver500, asterile coupler600, a translator700 and thearticulable tool300.
• The translator is attached to theproximal end316 of theinstrument300. Theinstrument300 may additionally have aremovable tool420 as shown inFIGS. 18-19. Theremovable tool420 may be any tool, such as acutter422 that is attached to an elongated rod orcable424. At the end of therod246 there is disposed aflat section428 with anaperture430 formed therethrough. Theflat section428 seats into achannel432 disposed at the end of a second cable orrod434 that travels down the elongated shaft of theinstrument300. Thesecond cable434 has achannel432 formed in the end thereof such that theflat section428 seats in thechannel432. At least one springbiased detent436 seats in theaperture430 disposed through theflat section428. This connects thetool420 to the rest of theinstrument300. As such, tools may be exchanged at the tip of the instrument without having to remove the instrument from the system10 every time a new tool is required.
• Thetool300 is attached to the translator700 and essentially is integrally formed therewith. The articulatingmechanism400 is attached to therobotic arm assembly26 via thecollar85 as is disclosed hereinabove. Thecollar85 fits about theshaft302 of theinstrument300.
• The translator700 has aproximal end702 and adistal end704. Thedistal end704 of the translator700 has a cross sectional shape that is substantially similar to the cross sectional shape of theelongated rod302 of theinstrument300. Additionally, the translator700 has ahollow interior706. Thecenter rod350 extends through thehollow interior706 of the translator700 and emerges at theproximal end702 thereof. Two of theleads352,354 terminate interiorly the translator at twoshoulders708,710 that are attached to a firsthollow tube712 through which thecenter lead350 extends. The firsthollow tube712 may be formed of some strong durable material such as stainless steel, steel, hard plastic or the like.
• The firsthollow tube712 is mounted to abearing714 such that it may be rotated. Rotation of the firsthollow tube712 results in the linear motion of theleads352,254 and the articulation of thearticulable portion301 of theinstrument300 in one plane of motion.
• A secondhollow tube716 has a pair of shoulders718,719 extending therefrom. Two leads356,358 attach to one each of the shoulders718,719. Thehollow tube716 is disposed within a bearingassembly720 such that it may be rotated. Again, rotation of the secondhollow tube716 results in linear movement of theleads356,358 which articulates thearticulable portion301 of theinstrument300 in a plane orthogonal the plane of motion established through the rotation of the first hollow tube. It is to be appreciated that the secondhollow tube714 radially surrounds the firsthollow tube712. The translator700 additionally includes aquick disconnect722 comprising apin724 disposed at the end of a springbiased lever726 which provides removable attachment of the translator700 to thesterile coupler600. Both of thehollow tubes712 and716 may havenotches750 formed therein at their ends. The notches serve as a means752 for interconnecting each of the tubes to thesterile coupler600 which will be discussed in further detail hereinbelow.
• The translator700 is removably attached to thesterile coupler600 via thequick disconnect722. Because thearticulable tool driver500 is not easily sterilized, it is advantageous to include asterile coupler600 so that instruments may be exchanged without having to sterilize thearticulable tool driver500. Additionally, thecoupler600 provides a means by which the translator700 may be attached to thetool driver500 while the tool driver is enclosed in adrape125 such as that depicted inFIG. 26. Thetranslator600 has ahousing610. Preferably the housing and the components of thecoupler600 are formed of some easily sterilizable mater such as stain-less steel, plastics or other well-known sterilizable materials. Thehousing610 has a substantially hollow interior612 and open ends614 and616. Twohollow tubes618 and620 are rotatively disposed within thehousing610. To effectuate the rotation of each of thetubes618 and620,bearings622 and624 are disposed about each of the tubes. Each of the tubes hasnotches626 formed in the ends thereof so effectuate the attachment of the translator700 to thecoupler600 at one end. And to effectuate the attachment of thecoupler600 to thearticulable tool driver500 at the other end thereof.
• Thepin724 on the translator may seat in anotch628 to attach the translator700 to thecoupler600. Additionally, thecoupler600 may include apin630 attached to a springbiased pivot632 to effectuate attachment of the coupler to thedriver500. Thecoupler600 additionally includes acenter section634 that slidably receives theend351 of the center cable orrod350. Theend351 may include a tip with acircumferential groove353 disposed thereabout. The tip seats in arecess636 formed in thecenter section634 and is removably locked in place by at least one spring biased detent638. Atip640, which is substantially similar to the tip containing thecircumferential groove353 is disposed adjacent therecess636 and serves to attach thecable center cable350 to thearticulable tool driver500, which will be discussed in further detail hereinbelow.
• Thecenter section634 is intended to laterally slide within the innermost tube618. To effectuate such a sliding motion, a linear bearing may be disposed about the center section interiorly of the innermost tube. Alternatively, thecenter section634 may be formed of a bearing material that provides smooth sliding within the innermost tube618.
• Thecoupler600 is removably attached to thearticulable tool driver500. It is intended that the articulable tool driver be enclosed by adrape125. Thearticulable tool driver500 includes a substantiallyhollow housing502 having a closedfirst end504 and a substantially opensecond end504. Securely disposed interiorly thehousing502 is agripper motor506, and a pair ofwrist motors508 and510. Each of the motors are in electrical connection with thecontroller46. Alternatively, the motors may receive signals from the controller via a transmitter/receiver system where such systems are well known. It is the application of such a transmitter/receiver system to the present invention that is new. Thegripper motor506 is attached to aload nut510 that surrounds aload screw512. Themotor506 receives the control signals and turns in response thereto. Theload nut510 turns which laterally moves theload screw512. Theload screw512 is attached to a load cell which may be employed to measure the force required to laterally move thecable350 which is attached vie thecoupler600 to thegripper motor506. This may be used in a force feedback system that may be incorporated in the system10 of the present invention. A rod516 having achannel518 formed at the end thereof is attached to the load cell514. As such, the rod516 moves in a linear fashion. Thetip640 of thecoupler600 seats in thechannel518 and is removably held in place by at least one spring biased detent or some othersimilar attachment mechanism520. Therefore, if a surgeon at a master handle actuates the grippers, thegripper motor506 turns, thus laterally moving the rod516, and in turn thecenter cable350 which opens and closes the grippers at the tool accordingly. Of course, the action at the tool will depend upon the type of tool disposed thereat. For example, if a stapling tool is disposed at the end of thesurgical instrument300 then a stapling action would take place.
• If amaster handle50 or52 is turned about axes J6 or J7 then one of the twowrist motors510,508 corresponding to the required motion turns. Each of themotors508,510 are attached to acorresponding gear522,524. Each of thegears522,524 engage a corresponding slottedsection530,532 of an associatedhollow tube526,528 to turn the associated tube radially about its longitudinal axis. Each of thetubes526,528 include notched ends534,536 to engage the notched ends of corresponding hollow tubes of thecoupler600. It is to be appreciated that each of thehollow tubes526,528,618 and620 are all coaxial. Additionally, bearings may be emplaced intermediate each of thetubes526 and528 to provide easy independent rotatability of the individual tubes.
• When thetubes526,528 are rotated, they rotate the tubes in the coupler which rotates the tubes in the translator. This results in the articulation at the tip of thesurgical instrument300. More particularly, this results in the articulation of the articulable portion of thesurgical instrument300. Additionally, whether the front loading tool driver, the back loading tool driver, or the articulable tool driver are employed, surgical instruments may be easily exchanged.
• As such, acutting blade800 may be exchanged for a grasper, and a grasper may be exchanged for astapler810. Essentially, such a system simplifies the performance of minimally invasive surgical procedures where the procedures include the step of changing one tool for another. And because the system allows articulation at the tip of certain instruments, the articulation mechanism may be used to articulate such stapling, or cutting instruments that incorporate the articulable portion as disclosed hereinabove.
• Additionally, the instrument may not be an articulable instrument, but the articulating mechanism can be used to control other functions, such as stapling.FIG. 27 depicts astapling instrument810 attached to the robotic arm assembly via thecollar85 andholder86. The lead that is generally use for the grasping tool, may be used to effectuate the stapling mechanism. Endoscopic staplers are generally well known in the art, however, it is heretofore to known to use a stapler that is attached to a robotic arm as is disclosed herein.
• Additionally, a cutting blade, such as that depicted inFIG. 28 may be employed in the system of the present invention. Thecutting blade800 is attached to therobotic arm assembly26 via thecollar85 andholder86. The cutting blade does not require a lead such as that required by the grasper or the stapler; however, the cutting tool, may be articulated via the articulating mechanism that has been disclosed hereinabove.
• A cauterizer or coagulator may additionally be attached to therobotic arm assembly26 via thecollar85 and holder. Cauterizers and coagulators are well known and the cauterizing tool may be attached at the end of an articulable instrument as disclosed hereinabove. By using a variety of tools in predetermined sequences, various procedures may be carried out. It is generally preferable to be able to change instruments because many procedures require such.
• As disclosed hereinabove, thehandles50 and52 allow a surgeon to control the movement of the tools attached to the robotic arms. As such, the configuration of thehandles50 and52 should provide great ease of use for a surgeon.FIGS. 34-39 depict various handle configurations. Additionally, thehandles50 and52 may be selected by a surgeon from a plurality of handles960 that are available for use by the surgeon.
• A proximallyopen handle962 has aproximal end963 and adistal end965. Thehandle962 hasfirst finger portion964 and asecond finger portion966 pivotally attached at thedistal end965 of thehandle962. A joint968 disposed intermediate thefinger portion964 and966 provides linear motion of an elongated rod970 which is used to actuate the tool tip of an instrument attached to the robotic arm. This handle may serve as one or both of the twohandles50 and52 of the system.
• A distallyopen handle972 has aproximal end973 and adistal end975. Thehandle972 hasfirst finger portion974 and asecond finger portion976 pivotally attached at theproximal end973 of thehandle972. A joint978 disposed intermediate thefinger portion964 and966 provides linear motion of anelongated rod980 which is used to actuate the tool tip of an instrument attached to the robotic arm. This handle may serve as one or both of the twohandles50 and52 of the system.
• Such handles962 and972 may be interchanged through the inclusion of aninterchange mechanism984. Theinterchange mechanism984 includes abiased detent latch986 that engages an aperture in theelongated rod932 such that the handle may be attached or removed from therod932.
• Other handle configurations are depicted inFIGS. 37-39. And more particularly, each of thehandles1000,1100, and1200 have a pair offingerseats1020. The major difference between each of thehandles1000,1100, and1200 is the orientation of the fingerseats to a pivot point on the handle. The fingerseats may be parallel, or perpendicular to the axis S of the pivot point of the handle. Each of these configurations may be included as an attachable handle. As such, a surgeon may exchange handles throughout a procedure depending upon the task to be accomplished. A surgeon may prefer one handle for a set of tasks and another handle for a different set of tasks. As such, the surgeon may exchange handles during the performance of a surgical procedure to enable such tasks.
• While certain exemplary embodiments have been described and shown in the accompanying drawings, it is to be understood that such embodiments are merely illustrative of and not restrictive on the broad invention, and that this invention not be limited to the specific constructions and arrangements shown and described, since various other modifications may occur to those ordinarily skilled in the art.

Claims (6)

1-4. (canceled)

5. A surgical robotic system comprise:

an input device having a first handle, the first handle movable in a first handle coordinate system;

a first surgical instrument having a tip;

a first robotic arm movably supporting the first surgical instrument, the first robotic arm having a plurality of actuators in a second coordinate system; and

a controller coupling the first robotic arm to the input device, the controller configured to apply a transformation so that a first input movement of the first handle in the first handle coordinate system results in a proportionally scaled movement of the tip of the first surgical instrument in the second coordinate system.

6. The surgical robotic system ofclaim 5, we the controller is configured to calculate a position of a pivot point of a shaft of the surgical instrument when the pivot point is disposed between a proximal end of the shaft and a distal end of the shaft, and wherein the controller uses the pivot point in determining the movement of the surgical instrument tip.

7. The surgical robotic system of clam5, wherein the controller comprises a tremor filter for filtering a hand-tremor of the first input movement so as to inhibit associated tremor of the surgical instrument tip.

8. The surgical robotic system ofclaim 5, wherein the controller determines a first desired tip vector of the surgical instrument tip using the first handle movement, and wherein the controller comprises inverse kinematic computing software for generating control signals to be sent to the first robotic arm in response to the first desired tip vector, the inverse kinematic software modeling a passive fling of the robotic arms.

9. The surgical robotic system ofclaim 5, further comprising:

a second handle of the input device;

a second surgical instrument having a tip;

a second robotic arm movably supporting the second surgical instrument, the second robotic arm having a plurality of actuators;

wherein the controller couples the second robotic arm to the input device so that a second input movement of the second handle results in a proportionally scaled movement of the tip of the second surgical instrument.

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