US20090105639A1 - Catheter driver system - Google Patents

Abstract

An apparatus for performing medical procedures on an anatomical body includes an extension with an element near its distal end to be extended into the body, and a driver that moves the extension axially into the body, and that causes flexure of the distal end of the extension. The movement and flexure of the extension is driven by the driver from the proximal end of the extension, and an electronic controller directs the operation of the driver.

Description

RELATED APPLICATION DATA
• This application is a continuation of U.S. application Ser. No. 10/270,743, which claims the benefit of U.S. Provisional Application No. 60/332,287, filed Nov. 21, 2001, and is a continuation in part of U.S. application Ser. No. 10/216,067, filed Aug. 8, 2002, which claims the benefit of U.S. Provisional Application No. 60/313,497, filed Aug. 21, 2001, and is a continuation in part of U.S. application Ser. Nos. 10/023,024 (now abandoned), 10/011,371 (now U.S. Pat. No. 7,090,683), 10/011,449 (now abandoned), 10/010,150 (now U.S. Pat. No. 7,214,230), 10/022,038 (now abandoned), and 10/012,586, all filed Nov. 16, 2001, and all of which claim the benefit of U.S. Provisional Application Nos. 60/269,200, filed Feb. 15, 2001, 60/276,217, filed Mar. 15, 2001, 60/276,086, filed Mar. 15, 2001, 60/276,152, filed Mar. 15, 2001, and 60/293,346, filed May 24, 2001.
BACKGROUND
• Catheters are used extensively in the medical field in various types of medical procedures, as well as other invasive procedures. In general, minimally invasive medical procedures involve operating through a natural body opening or orifice of a body lumen, or through small incisions, typically 5 mm to 10 mm in length, through which instruments are inserted. In general, minimally invasive surgery is less traumatic than conventional surgery, due, in part, because no incision is required in certain minimally invasive procedures, or the significant reduction in the incision size in other procedures. Furthermore, hospitalization is reduced and recovery periods are shortened as compared with conventional surgical techniques.
• Catheters may be provided in a variety of different shapes and sizes depending upon the particular application. It is typical for a clinician to manipulate the proximal end of the catheter to guide the distal end of the catheter inside the body, for example, through a vein or artery. Because of the small size of the incision or opening and the remote location of the distal end of the catheter, much of the procedure is not directly visible to the clinician. Although clinicians can have visual feedback from the procedure site through the use of a video camera or endoscope inserted into the patient, or through radiological imaging or ultrasonic imaging, the ability to control even relatively simple instruments remains difficult.
• In some procedures, such as electrophysiology, the surgeon manually places the distal end of an extension, such as a catheter, at a site of interest in the patient's body. The distal end of the catheter can be coupled to an energy generator to treat the site of interest. Alternatively, or additionally, the catheter can be connected to a detector which receives signals from the distal end of the catheter for diagnostic purposes. The catheter is typically connected to a handle that includes control devices such as dials that enable the surgeon to articulate the catheter, and thus, to maneuver the catheter through the patient.
• In view of the above, some have proposed using robotic tele-surgery to perform minimally invasive procedures. Typically, these robotic systems use arms that reach over the surgical table and manipulate the surgical instruments inserted into the patient, while the surgeon sits at a master station located a distance from the table and issues commands to the arms.
SUMMARY
• An apparatus for performing medical procedures on an anatomical body includes an extension with an element near its distal end to be extended into the body, and a driver that moves the extension axially into the body, and that causes flexure of the distal end of the extension. The movement and flexure of the extension is driven by the driver from the proximal end of the extension, and an electronic controller directs the operation of the driver.
• In some embodiments, the driver includes control devices which may include conventional handle dials. A first control device is coupled to a first control wire, and a second control device is coupled to a second control wire. The first and second control wires extend along the length of the extension, and the terminal ends of the first and second control wires are coupled to the distal end of the extension. The first and second control devices are operated to control the flexure movements of the distal end of the extension with at least two degrees-of-freedom. The first and second control devices can be part of a handle which is a plug-in module that is removable from the driver.
• In certain embodiments, the driver moves the extension with a rotational movement. The driver may include a first drive mechanism and a second drive mechanism that are coupled to a motor array. The motor array in turn may be coupled to the controller, which directs the operation of the motor array and consequent operation of the drive mechanisms to move the extension with the axial and rotational movements.
• In some embodiments, the element may receive RF energy from an RF generator for delivery to a target site in the body. In particular embodiments, the element provides signals from the target site to a detector. The signals are typically related to properties of the target site.
• Since the movements of the driver are under the direction of the controller, these movements may be gentler than those produced by the surgeon when the instrument is manually driven through the patient. Furthermore, with the assistance of the driver, the surgeon is less likely to become fatigued during the procedure.
BRIEF DESCRIPTION OF THE DRAWINGS
• The foregoing and other objects, features and advantages of the invention will be apparent from the following more particular description of preferred embodiments of the invention, as illustrated in the accompanying drawings in which like reference characters refer to the same parts throughout the different views. The drawings are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention.
• FIG. 1 illustrates a manual catheter system;
• FIG. 1A a close-up view of the terminal end of the catheter shown inFIG. 2;
• FIG. 2 is a block and schematic diagram of a catheter drive system in accordance with the present invention;
• FIG. 2A is a variation of the configuration shown inFIG. 3;
• FIG. 3 is a block and schematic diagram of another version of a catheter drive system in accordance with the present invention;
• FIG. 4 is a perspective view of an illustrative embodiment of the catheter drive system ofFIG. 3;
• FIG. 4A is a top view of the catheter drive system ofFIG. 4; and
• FIG. 4B is a front view of the catheter drive system ofFIG. 4.
DETAILED DESCRIPTION OF THE INVENTION
• A description of preferred embodiments of the invention follows.
• The present invention provides a drive system that can be used to manipulate a surgical implement from its proximal end. For example, a manually operable instrument can be coupled to the drive system without requiring any modification to the instrument. The drive system can be operated by a surgeon at a master station of a master-slave telerobotic system. In some embodiments, the drive apparatus is in the form of a housing in which the instrument is inserted, which is then driven as the surgeon manipulates the housing.
• In electrophysiology procedures, as shown inFIG. 1, a extension such as acatheter30 is used for diagnostic purposes or sensing conditions at apredetermined target site31 as thecatheter30 extends through an artery orvein34. Thedistal end36 of thecatheter30 can be considered as an operative segment of the catheter and thus is capable of flexing or bending to assist guiding the catheter through the anatomic body, and curving to a desired location, for example, to lean against an inner surface of the heart. In this regard, there is schematically illustratedwiring40 that may extend along the length of thecatheter30 that transmits mechanical inputs of amanual handle60. As shown inFIG. 1A, there can beadditional wiring61a,61b, and61cthat are connected torespective electrophysiology elements62a,62b, and62cand extend from thedistal end36 to anRF generator45, as well as adetector50, associated with the handle60 (FIG. 1).
• In some embodiments, theRF generator45 couples energy through thehandle60 by way of thecatheter30 to theelements62a,62b, and62cat thedistal end36 for the application of RF energy at thetarget site31 for therapeutic purposes. In association with theRF generator45, thedetector50 may receives signals from a probe, such as theelements62a,62b, and62c, positioned at the target site. Typically, these signals are related to physiological properties at the target site.
• As can be seen inFIG. 1, thehandle60 has wheels or dials62 and64 that can be manually operated by the surgeon during a procedure. Manipulation of thedials62 and64 are transmitted through thecontrol wiring40 to thedistal end36 to control the flexing or bending of the distal end in respective orthogonal directions. In a particular embodiment, as shown in FIG.2, the operation of the drive system ofFIG. 1 is automated. That is, the system shown inFIG. 2 modifies the construction of that shown inFIG. 1 by providing for automatic control of acatheter130, which at its distal end is substantially the same as thecatheter30 shown inFIGS. 1 and 1A.
• Like thecatheter30, thecatheter130 is able to move at its end with at least two degrees-of-freedom under control ofwires128aand128b. In addition, thecatheter130 is coupled at its distal end to asupport block132 that includeswheels134 that provide linear translation of thecatheter130 in thedirection136. Afurther mechanism137 provides rotational motion of thecatheter130, such as depicted by thearrow138. Moreover, there are also wires extending through thecatheter130 associated with theRF generator145 and thedetector150.
• In the embodiment illustrated inFIG. 2, a guide wire is not used, nor is a guide wire used in the device shown inFIGS. 1 and 1A. Accordingly, only asingle support block132 is used with this catheter construction. However, theparticular catheter130 is provided with the flex control, and hence is provided with control wires that extend through thecatheter130 like those described previously in reference withFIG. 1.
• As shown inFIG. 2, the support or driveblock132 is coupled to an electromechanical drive member ormotor array120. Also included in the system is aninput device124 at which a surgeon provides control actuations. Theinput device124 is coupled to acontroller122 which in turn is coupled to themotor array120. Thus, instructions from theinput device124 are received by thecontroller122 which then directs the operation of themotor array120.
• As mentioned previously, movement of the motors of thearray120 is transmitted to thecatheter130 through mechanically cabling extending through the catheter. In particular, amechanical cabling126 coupled directly to theblock132 controls the rotational and linear degrees-of-freedom of thecatheter130 through themechanism137 andwheels134, respectively. In addition, there is a cabling128 from themotor array120 to theblock132 which controls the bending and flexing movement of thecatheter130. As such, onecable128amay be used to control the bending movements of the catheter with one degree-of-freedom, and anothercable128bmay control the bending movements with a second degree-of-freedom.
• Theinput device124 may include separate manipulators for the different movements of thecatheter130. As described in connection withFIG. 1, the input device can take on one of many different forms including joysticks, wheels, dials, and other types of manual interfaces. For the control desired inFIG. 2, one input member controls themechanical cabling126 for providing the two degrees-of-freedom of action of thecatheter130, in particular, the linear and rotational movement. Another input member ininput device124 controls the flexing and bending of thecatheter130 by way of themechanical cabling128. The input instructions from theinput device124 are transmitted to themotor array120 by way of thecontroller122 which may be a microprocessor.
• In an alternative arrangement, as shown inFIG. 2A, anintermediate drive device59 may be interposed between themotor array120 and thecatheter130. In such an arrangement, themotor array120 communicates with thedrive device59 over thelines128, which may be electrical. In turn, thedrive device59 is coupled to the cabling extending through the length of the catheter, and actuates the cabling to cause the distal end of thecatheter130 to bend and flex with one or more degrees-of-freedom.
• Details of an automated catheter drive system are describe in the U.S. Application entitled “Coaxial Catheter System,” by Weitzer, Rogers, and Solbjor, U.S. application Ser. No. 10/270,740, filed Oct. 11, 2002, now abandoned, the entire contents of which are incorporated herein by reference. Details of an imaging system that aids the movement of the catheter through an anatomic body are described in the U.S. application entitled “Catheter Tracking System,” by Weitzner and Lee, U.S. application Ser. No. 10/270,741, filed Oct. 11, 2002, the entire contents of which are incorporated herein by reference.
• Referring now toFIG. 3, there is shown a further embodiment of a catheter drive system. InFIG. 3, like reference characters are used to identify like features shown inFIG. 2. Thus, in the embodiment ofFIG. 3, there is aninput device124, acontroller122, and amotor array120.FIG. 3 also depicts thesupport block132 which provides both linear and rotational movement of thecatheter130. As before, these movements are provide bywheels134 for the linear translation as noted by thearrow136, and the member ormechanism137 for the rotational translation as noted by thearrow138.
• In the embodiment ofFIG. 3, thehandle60 is depicted with its pair of actuating wheels or dials62 and64 shown earlier inFIG. 1. Rather than replacing thehandle60, as in the embodiment ofFIG. 2, thehandle60 here remains intact so that thewheels62 and64 are used to control the flexing and bending of thecatheter130. For this purpose, there are includeddrive pieces63 and65 associated, respectively, with thewheels62 and64. Each of the drive pieces engages its corresponding wheel to drive the wheels in either direction to provide the appropriate flex control of thecatheter130. Note inFIG. 3, theseparate lines127 and129, which may be mechanical or electrical, coupling thedrive pieces65 and63 to themotor array120. Hence, actuation of respective drive units in themotor array120 results in a consequent actuation of thewheels62 and64 via thecontrol line129 and drivepiece63, and thecontrol line127 and drivepiece65, respectively. Note that with this embodiment the proper support and housings are provided such that thedrive pieces63 and65 maintain proper engagement with thewheels62 and64.
• With the particular arrangement shown inFIG. 3, the existing catheter construction need not be modified. Rather, the drive system shown inFIG. 3 is simply coupled to an existing catheter system, such as thehandle60 andcatheter130 combination.
• Although themotor array120 is illustrated as having two separate lines for two separate drive pieces, in other embodiments, thehandle60 may have only a single control dial. In such implementations, there may be only a single line and associated drive piece that couples themotor array120 to thehandle60. Thus, unlike thehandle60 withwheels62 and64 which provide flex control in orthogonal planes, if only a single wheel is used, the catheter typically flexes only in a single plane. However, in arrangements in which thecatheter support block132 provides for rotational movement of thecatheter130, the movement of the catheter is not limited to this single plane, since as the catheter is being rotated it moves out of this plane.
• A particular embodiment of the system ofFIG. 3 is illustrated inFIGS. 4,4A, and4B, where like reference characters are used to identify like features shown inFIG. 3. In this embodiment, thehandle60 is clamped in a clamp orvise200 with ascrew202. Theclamp200 is connected to ashaft201 supported in acarriage202 that moves back and forth on aguide bar204 mounted in thedrive block132. Associated with theshaft201 is a set ofgears206 that engage with another set ofgears208 of therotary drive mechanism137. Thedrive mechanism137 includes amotor210 driven by thearray120 located in thedrive block132 and under the direction of thecontroller122 as it receives instructions from the user through theinput device124. Thus, as themotor210 rotates thegears208, a consequent rotary motion is induced in thegears206 to rotate theclamp200, and hence thehandle60 andcatheter130, in therotational direction138.
• Thelinear drive mechanism134 of this embodiment includes amotor212 connected to ascrew drive214. Themotor212 andscrew drive214 are mounted to thedrive block132 in a manner to allow thescrew drive214 to rotate. Thescrew drive214 hasthreads215 about its periphery that engage with thecarriage202. Accordingly, under the direction of thecontroller122 via thearray120, themotor212 rotates thescrew drive214 to induce thecarriage202, and hence thehandle60 andcatheter130, to move back and forth in thelinear direction136.
• As previously mentioned, thedrive pieces63 and65 engage with the dials orwheels62 and64 of thehandle60 so that upon instructions from the user through theinput device124, thedrive pieces63 and65 manipulate thedials62 and64 to control the desired bending and flexing movements of thecatheter130.
• This invention can be implemented and combined with other applications, systems, and apparatuses, for example, those discussed in greater detail in U.S. Provisional Application No. 60/332,287, filed Nov. 21, 2001, the entire contents of which are incorporated herein by reference, as well as those discussed in greater detail in each of the following documents, all of which are incorporated herein by reference in their entirety:
• U.S. application Ser. No. 09/783,637 filed Feb. 14, 2001, which is a continuation of PCT application Serial No. PCT/US00/12553 filed May 9, 2000, which claims the benefit of U.S. Provisional Application No. 60/133,407 filed May 10, 1999; U.S. application entitled “Articulated Apparatus for Telemanipulator System,” by Brock and Lee, U.S. application Ser. No. 10/208,087, filed Jul. 29, 2002, now abandoned, which is a continuation of U.S. application Ser. No. 09/827,503 filed Apr. 6, 2001, which is a continuation of U.S. application Ser. No. 09/746,853 filed Dec. 21, 2000, which is a divisional of U.S. application Ser. No. 09/375,666 filed Aug. 17, 1999, now U.S. Pat. No. 6,197,017 which issued on Mar. 6, 2001, which is a continuation of U.S. application Ser. No. 09/028,550 filed Feb. 24, 1998, which is now abandoned; PCT application Serial No. PCT/US01/11376 filed Apr. 6, 2001, which claims priority to U.S. application Ser. No. 09/746,853 filed Dec. 21, 2000, and U.S. application Ser. No. 09/827,503 filed Apr. 6, 2001; U.S. application Ser. Nos. 10/014,143, 10/012,845, 10/008,964, 10/013,046, 10/011,450, 10/008,457, and 10/008,871, all filed Nov. 16, 2001 and all of which claim benefit to U.S. Provisional Application No. 60/279,087 filed Mar. 27, 2001; U.S. application Ser. No. 10/077,233 filed Feb. 15, 2002, which claims the benefit of U.S. Provisional Application No. 60/269,203 filed Feb. 15, 2001; U.S. application Ser. No. 10/097,923 filed Mar. 15, 2002, which claims the benefit of U.S. Provisional Application No. 60/276,151 filed Mar. 15, 2001; U.S. application Ser. No. 10/034,871 filed Dec. 21, 2001, which claims the benefit of U.S. Provisional Application No. 60/257,816 filed Dec. 21, 2000; U.S. application Ser. No. 09/827,643 filed Apr. 6, 2001, which claims the benefit of U.S. Provisional Application No. 60/257,869 filed Dec. 21, 2000, and U.S. Provisional Application No. 60/195,264 filed Apr. 7, 2000.
• While this invention has been particularly shown and described with references to preferred embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the invention encompassed by the appended claims. For example, the catheter need not be limited for use in electrophysiology procedures. That is, there may be other types of probes or end effectors located at the distal end of the catheter. The end effector may be, for example, an articulated tool such a grasper, scissor, needle holder, micro dissector, staple applier, tacker, suction irrigation tool, and clip applier. The end effector can also be a non-articulated tool, such as a cutting blade, probe, irrigator, catheter or suction orifice, and dilation balloon.

Claims (31)

1. A system for remotely controlling the positioning within the body of a patient of an elongated medical device having a control handle, the system comprising: a robotic device configured to position the medical device within the body of the patient; and a remote control mechanism configured to control the robotic device, wherein the robotic device comprises a handle controller to receive the control handle.

2. The system ofclaim 1, wherein the remote control mechanism comprises a remote control station and a robotic device controller, an operator using the remote control station to control the robotic device.

3. The system ofclaim 2, wherein the remote control mechanism includes one or more transmitters, receivers, and/or transceivers to communicate information between the remote control station and the robotic device controller.

4. The system ofclaim 1, wherein the robotic device is controlled from a remote control station at a location that is remote from the location of the patient.

5. The system ofclaim 2, wherein the remote control station comprises a joystick that can be an operated by an operator to control the robotic device.

6. The system ofclaim 1, wherein the robotic device is further configured to insert the medical device within the body of the patient.

7. The system ofclaim 1, wherein the medical device is a catheter and the robotic device comprises a catheter control device.

8. The system ofclaim 7, wherein the handle controller of the robotic device engages the control handle of the catheter.

9. The system ofclaim 8, wherein the handle controller uses the standard features of the catheter control handle to, within the body of the patient, insert the catheter, steer the catheter, rotate the catheter, place the catheter, shape the catheter, or deflect the catheter, or a combination of two or more thereof.

10. The system ofclaim 7, wherein the catheter is an electrophysiology catheter.

11. The system ofclaim 7, wherein the catheter control device is further configured to feed the catheter within the patient's circulatory system.

12. The system ofclaim 7, wherein the catheter is used for a cardiac procedure.

13. The system ofclaim 12, wherein the catheter is an interventional catheter used to deliver therapy for the cardiac procedure.

14. The system ofclaim 10, wherein the catheter is used for mapping and catheter ablation.

15. The system ofclaim 7, wherein the catheter is used for a dilation procedure.

16. The system ofclaim 8, wherein the handle controller further comprises: means for holding said catheter firmly; means for rotating said catheter; and means for shaping, deflecting, steering, placing, or positioning the catheter, or a combination of two or more thereof, within the patient.

17. The system ofclaim 10, wherein the electrophysiology catheter is a mapping and/or ablation catheter.

18. The system ofclaim 17, which can be used to perform atrial fibrillation ablation.

19. The system ofclaim 17, which can be used to perform ventricular tachycardia ablation.

20. The system ofclaim 17, which can be used to perform atrial flutter ablation.

21. The system ofclaim 17, which can be used to perform atrial tachycardia ablation.

22. The system ofclaim 17, which can be used to perform pulmonary vein isolation.

23. The system ofclaim 17, which can be used to perform simple ablations.

24. The system ofclaim 17, which can be used to perform complex ablations.

25. The system ofclaim 24, which can be used to perform complex ablations for accessory pathway mediated tachycardias.

26. The system ofclaim 1, wherein the robotic device comprises: a handle controller effective to receive a control handle of a catheter, the catheter having at least three ranges of motion and a distal end; a first motor connected to the handle controller and effective to at least move the catheter forward and/or backward; a second motor connected to the handle controller and effective to at least rotate the catheter; a third motor connected to the handle controller and effective to at least deflect the distal end in at least a first direction; and a controller unit connected to the first, second and third motors.

27. The system ofclaim 26, wherein: the first motor is connected to an externally threaded drive screw; the handle controller is connected to an internally threaded drive support; and the drive screw is mated with the drive support.

28. The system ofclaim 26, wherein the catheter includes at least one control member effective to control deflection of the distal end and the third motor is connected to the at least one control member.

29. In an improved method for mapping and catheter ablation by inserting a mapping and ablation catheter into a patient, the improvement wherein a remote positioning control system ofclaim 1 is used to position the catheter.

30. A system for remotely controlling the positioning of a medical device within the body of a patient, the system comprising: a robotic device configured to position the medical device within a body of a patient, the robotic device comprising a handle controller effective to manipulate controls on the medical device; a driver effective to move the medical device forward and backward inside the body; and a remote control mechanism effective to control the robotic device.

31. A system for remotely controlling the positioning within the body of a patient of an elongated medical device having a proximal end, the system comprising: a robotic device configured to position the medical device within the body of the patient; and a remote control mechanism configured to control the robotic device, wherein the robotic device comprises a handle controller to receive the proximal end of the medical device.

Images