(19) United States
`(12) Patent Application Publication (10) Pub. No.: US 2012/0209314 A1
`(43) Pub. Date:
`Aug. 16, 2012
`Weir et al.
`
`US 20120209314A1
`
`(54) METHODS AND SYSTEMS FOR INDICATING
`A CLAMPING PREDICTION
`
`(75) Inventors:
`
`David Weir, Emerald Hills, CA
`(US); Grant Duque, San Jose, CA
`(US); Kevin Durant, Alameda, CA
`(US); Patrick Flanagan, Santa
`Clara, CA (US); Maggie Nixon,
`San Jose, CA (US); David
`Robinson, Mountain View, CA
`(US); John Zabinski, Fremont, CA
`(US)
`
`(73) Assignee:
`
`Intuitive Surgical Operations,
`Inc., Sunnyvale, CA (US)
`
`(21) Appl. No.:
`
`13/350,502
`
`(22) Filed:
`
`Jan. 13, 2012
`
`Related U.S. Application Data
`(60) Provisional application No. 61/443,159, filed on Feb.
`15, 2011.
`
`
`
`Publication Classification
`
`(51) Int. Cl.
`(2006.01)
`A6B 7/28
`(52) U.S. Cl. ........................................................ 606/205
`(57)
`ABSTRACT
`End effectors with closing mechanisms, and related tools and
`methods are disclosed. The disclosed end effectors may be
`particularly beneficial when used for minimally invasive sur
`gery. An example Surgical tool comprises a first and second
`jaw movable between a closed grasped or clamped configu
`ration and an open configuration. The tool further comprises
`a soft grip mode for grasping the tissue at a first force during
`which a separation parameter between the jaws is measured,
`and a therapeutic clamping mode in which the jaws clamp on
`the body tissue at a force greater than the grasping force. The
`methods comprise grasping the body tissue between jaw
`members, measuring the separation parameter between jaws,
`indicating on a user interface the separation parameter for
`comparison to a desired separation parameter, and then
`releasing the body tissue for repositioning or therapeutically
`clamping the body tissue in response to the separation param
`eter indication.
`
`Ethicon Exhibit 2019.001
`Intuitive v. Ethicon
`IPR2018-01247
`
`

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`Patent Application Publication
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`Aug. 16, 2012 Sheet 1 of 24
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`US 2012/0209314 A1
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`
`
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`
`
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`Ethicon Exhibit 2019.002
`Intuitive v. Ethicon
`IPR2018-01247
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`

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`Patent Application Publication
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`Aug. 16, 2012 Sheet 2 of 24
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`US 2012/0209314 A1
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`
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`Ethicon Exhibit 2019.003
`Intuitive v. Ethicon
`IPR2018-01247
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`Patent Application Publication
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`Aug. 16, 2012 Sheet 3 of 24
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`US 2012/0209314 A1
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`
`
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`Ethicon Exhibit 2019.004
`Intuitive v. Ethicon
`IPR2018-01247
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`Patent Application Publication
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`Aug. 16, 2012 Sheet 4 of 24
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`US 2012/0209314 A1
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`
`Ethicon Exhibit 2019.005
`Intuitive v. Ethicon
`IPR2018-01247
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`

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`Patent Application Publication
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`Aug. 16, 2012 Sheet 5 of 24
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`US 2012/0209314 A1
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`
`
`
`
`&
`
`Ethicon Exhibit 2019.006
`Intuitive v. Ethicon
`IPR2018-01247
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`

`

`Patent Application Publication
`
`Aug. 16, 2012 Sheet 6 of 24
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`US 2012/0209314 A1
`
`FIG. 6A
`
`
`
`FIG. 6B
`
`Ethicon Exhibit 2019.007
`Intuitive v. Ethicon
`IPR2018-01247
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`

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`Patent Application Publication
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`Aug. 16, 2012 Sheet 7 of 24
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`US 2012/0209314 A1
`
`FIG. 7A
`
`
`
`Ethicon Exhibit 2019.008
`Intuitive v. Ethicon
`IPR2018-01247
`
`

`

`Patent Application Publication
`
`Aug. 16, 2012 Sheet 8 of 24
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`US 2012/0209314 A1
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`
`
`FIG. 8B
`
`Ethicon Exhibit 2019.009
`Intuitive v. Ethicon
`IPR2018-01247
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`

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`Patent Application Publication
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`Aug. 16, 2012 Sheet 9 of 24
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`US 2012/0209314 A1
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`136
`
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`
`f : 8
`
`FIG. 8C
`
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`
`Ethicon Exhibit 2019.010
`Intuitive v. Ethicon
`IPR2018-01247
`
`

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`Patent Application Publication
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`Aug. 16, 2012 Sheet 10 of 24
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`US 2012/0209314 A1
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`
`
`114
`
`- 136
`f f
`
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`
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`
`
`
`FIG. 8F
`
`Ethicon Exhibit 2019.011
`Intuitive v. Ethicon
`IPR2018-01247
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`

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`Patent Application Publication
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`Aug. 16, 2012 Sheet 11 of 24
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`US 2012/0209314 A1
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`FIG. 9A
`
`
`
`Ethicon Exhibit 2019.012
`Intuitive v. Ethicon
`IPR2018-01247
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`

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`Patent Application Publication
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`Aug. 16, 2012 Sheet 12 of 24
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`US 2012/0209314 A1
`
`
`
`FIG. 1 O
`
`Ethicon Exhibit 2019.013
`Intuitive v. Ethicon
`IPR2018-01247
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`

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`Patent Application Publication
`
`Aug. 16, 2012 Sheet 13 of 24
`
`US 2012/0209314 A1
`
`r
`
`
`
`Ethicon Exhibit 2019.014
`Intuitive v. Ethicon
`IPR2018-01247
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`

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`Patent Application Publication
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`Aug. 16, 2012 Sheet 14 of 24
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`US 2012/0209314 A1
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`Robotic root
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`
`Ethicon Exhibit 2019.015
`Intuitive v. Ethicon
`IPR2018-01247
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`

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`Patent Application Publication
`
`Aug. 16, 2012 Sheet 15 of 24
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`US 2012/0209314 A1
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`
`
`Ethicon Exhibit 2019.016
`Intuitive v. Ethicon
`IPR2018-01247
`
`

`

`Patent Application Publication
`
`Aug. 16, 2012 Sheet 16 of 24
`
`US 2012/0209314 A1
`
`FIG. 14A
`
`
`
`FIG. 14B
`
`Ethicon Exhibit 2019.017
`Intuitive v. Ethicon
`IPR2018-01247
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`

`

`Patent Application Publication
`
`Aug. 16, 2012 Sheet 17 of 24
`
`US 2012/0209314 A1
`
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`Ethicon Exhibit 2019.018
`Intuitive v. Ethicon
`IPR2018-01247
`
`

`

`Patent Application Publication
`
`Aug. 16, 2012 Sheet 18 of 24
`
`US 2012/0209314 A1
`
`FIG. 16A
`
`
`
`iDiCAIOR -
`
`
`
`Ethicon Exhibit 2019.019
`Intuitive v. Ethicon
`IPR2018-01247
`
`

`

`Patent Application Publication
`
`Aug. 16, 2012 Sheet 19 of 24
`
`US 2012/0209314 A1
`
`
`
`300
`
`INDICATING ONUSER INTERFACE APREDICTION OF
`8:33 x * xiii-xx
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`
`Ethicon Exhibit 2019.020
`Intuitive v. Ethicon
`IPR2018-01247
`
`

`

`Patent Application Publication
`
`Aug. 16, 2012 Sheet 20 of 24
`
`US 2012/0209314 A1
`
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`C.A.R.PNG FORCE - 318
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`
`Ethicon Exhibit 2019.021
`Intuitive v. Ethicon
`IPR2018-01247
`
`

`

`Patent Application Publication
`
`Aug. 16, 2012 Sheet 21 of 24
`
`US 2012/0209314 A1
`
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`Ethicon Exhibit 2019.022
`
`Intuitive v. Ethicon
`
`lPR2018-01247
`
`Ethicon Exhibit 2019.022
`Intuitive v. Ethicon
`IPR2018-01247
`
`

`

`Patent Application Publication
`
`Aug. 16, 2012 Sheet 22 of 24
`
`US 2012/0209314 A1
`
`
`
`Ethicon Exhibit 2019.023
`Intuitive v. Ethicon
`IPR2018-01247
`
`

`

`Patent Application Publication
`
`Aug. 16, 2012 Sheet 23 of 24
`
`US 2012/0209314 A1
`
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`Ethicon Exhibit 2019.024
`Intuitive v. Ethicon
`IPR2018-01247
`
`

`

`Patent Application Publication
`
`Aug. 16, 2012 Sheet 24 of 24
`
`US 2012/0209314 A1
`
`: 8
`
`
`
`Ethicon Exhibit 2019.025
`Intuitive v. Ethicon
`IPR2018-01247
`
`

`

`US 2012/0209314 A1
`
`Aug. 16, 2012
`
`METHODS AND SYSTEMIS FOR INDICATING
`A CLAMPING PREDICTION
`
`CROSS-REFERENCES TO RELATED
`APPLICATIONS
`
`0001. The present application is a non-provisional of, and
`claims the benefit of U.S. Provisional Patent Application No.
`61/443,159, filed Feb. 15, 2011, the entire contents of which
`are incorporated herein by reference.
`0002 The present application is related to U.S. application
`Ser. No. 12/705,418 entitled “Cut and Seal Instrument filed
`on Feb. 12, 2010, (Attorney Docket No. ISRG 02180/US);
`U.S. Provisional Application No. 61/260,907, entitled “END
`EFFECTOR WITH REDUNDANT CLOSING MECHA
`NISMS filed on Nov. 13, 2009, (Attorney Docket No.
`ISRG02330PROV): U.S. Provisional Application No.
`61/260,903, entitled “WRIST ARTICULATION BY
`LINKED TENSION MEMBERS filed on Nov. 13, 2009,
`(Attorney Docket No. ISRG02320PROV), (Attorney Docket
`No. ISRG 02320/US); U.S. Provisional Application No.
`61/260,903, entitled “WRIST ARTICULATION BY
`LINKED TENSION MEMBERS filed on Nov. 13, 2009,
`(Attorney Docket No. ISRG02320PROV); U.S. Provisional
`Application No. 61/260,915, entitled “SURGICAL TOOL
`WITHATWO DEGREE OF FREEDOM WRIST filed on
`Nov. 13, 2009, (Attorney Docket No. ISRG02350PROV):
`and U.S. Provisional Application No. 61/260.919, entitled
`MOTORINTERFACE FOR PARALLELDRIVE SHAFTS
`WITHIN AN INDEPENDENTLY ROTATING MEMBER,
`filed on Nov. 13, 2009, (Attorney Docket No.
`ISRG02360PROV); each of which is incorporated herein by
`reference in its entirety.
`
`BACKGROUND OF THE INVENTION
`
`0003 Minimally invasive surgical techniques are aimed at
`reducing the amount of extraneous tissue that is damaged
`during diagnostic or Surgical procedures, thereby reducing
`patient recovery time, discomfort, and deleterious side
`effects. As a consequence, the average length of a hospital
`stay for standard Surgery may be shortened significantly
`using minimally invasive Surgical techniques. Also, patient
`recovery times, patient discomfort, Surgical side effects, and
`time away from work may also be reduced with minimally
`invasive Surgery.
`0004. A common form of minimally invasive surgery is
`endoscopy, and a common form of endoscopy is laparoscopy,
`which includes minimally invasive inspection and Surgery
`inside the abdominal cavity. In standard laparoscopic Surgery,
`a patient's abdomen is insufflated with gas, and cannula
`sleeves are passed through small (approximately one-half
`inch or less) incisions to provide entry ports for laparoscopic
`instruments.
`0005 Laparoscopic surgical instruments generally
`include an endoscope (e.g., laparoscope) for viewing the Sur
`gical field and tools for working at the Surgical site. The
`working tools are typically similar to those used in conven
`tional (open) Surgery, except that the working end or end
`effector of each tool is separated from its handle by an exten
`sion tube (also known as, e.g., an instrument shaft or a main
`shaft). The end effector can include, for example, a clamp,
`grasper, Scissor, stapler, cautery tool, linear cutter, or needle
`holder.
`
`0006 To perform surgical procedures, the surgeon passes
`working tools through cannula sleeves to an internal Surgical
`site and manipulates them from outside the abdomen. The
`Surgeon views the procedure by means of a monitor that
`displays an image of the Surgical site taken from the endo
`Scope. Similar endoscopic techniques are employed in, for
`example, arthroscopy, retroperitoneoscopy, pelviscopy,
`nephroscopy, cystoscopy, cisternoscopy, sinoscopy, hysteros
`copy, urethroscopy, and the like.
`0007 Minimally invasive telesurgical robotic systems
`have been recently been developed to increase a Surgeon's
`dexterity when working on an internal Surgical site, as well as
`to allow a Surgeon to operate on a patient from a remote
`location (outside the sterile field). In a telesurgery system, the
`Surgeon is often provided with an image of the Surgical site at
`a control console. While viewing an image of the Surgical site
`on a suitable viewer or display, the Surgeon performs the
`Surgical procedures on the patient by manipulating master
`input or control devices of the control console. Each of the
`master input devices controls the motion of a servo-mechani
`cally actuated/articulated Surgical instrument. During the Sur
`gical procedure, the telesurgical system can provide mechani
`cal actuation and control of a variety of Surgical instruments
`or tools having end effectors that perform various functions
`for the Surgeon, for example, holding or driving a needle,
`grasping a blood vessel, dissecting tissue, or the like, in
`response to manipulation of the master input devices.
`0008. A huge variety of tools have been developed for
`open Surgery, many (though not necessarily all) of which have
`been Successfully modified for minimally invasive Surgical
`procedures. For example, manual clamps, linear cutters, and
`Stapling devices can apply significant therapeutic clamping
`forces on tissues, which can enhance a variety of Surgical
`procedures. Unfortunately, work in connection with the
`present invention indicates that adapting open Surgical
`clamping devices (and developing methods for safely and
`effectively using them) within minimally invasive settings
`may be more challenging than expected. In particular, devel
`oping and using Surgical clampingjaws capable of generating
`desired clamping force while also providing the desired
`maneuverability for use within size-restricted minimally
`invasive Surgical access and treatment sites has proven to be
`quite difficult. Transferring the advantages available from
`Surgical staplers, linear cutters, and Surgical clamping tools to
`robotic Surgical settings may involve even more challenges,
`particularly given the different paradigms in Surgeon-directed
`tool movement, tool activation, and physician feedback pre
`sented by the new telesurgical treatment systems.
`0009. Thus, there is believed to be a need for improved
`methods and systems for Surgical staplers, linear cutters, and/
`or other clamping Surgical tools. Such tools may be beneficial
`in a wide range of Surgical applications, particularly in mini
`mally invasive and/or robotic Surgical applications.
`
`BRIEF SUMMARY OF THE INVENTION
`0010 Improved systems and methods to facilitate clamp
`ing are provided. The claimed methods and system can be
`used to help predict whether clamping a body tissue grasped
`between jaws at a desired clamping force is likely to be
`Successful before attempting to clamp. The claimed systems
`and methods are particularly useful in Surgical applications
`involving clamping of a body tissue between two jaws of an
`end effector. Many Surgical applications involve clamping of
`a body tissue at a clamping force Sufficient for cutting, sealing
`
`Ethicon Exhibit 2019.026
`Intuitive v. Ethicon
`IPR2018-01247
`
`

`

`US 2012/0209314 A1
`
`Aug. 16, 2012
`
`and/or stapling of the clamped tissue. Since high force clamp
`ing may potentially damage tissues if clamping fails, the
`present methods and systems are particularly advantageous
`as they indicate a prediction as to the likelihood of clamping
`success before clamping is attempted. While the various
`embodiments disclosed herein are primarily described with
`regard to Surgical applications, these Surgical applications are
`merely example applications, and the disclosed end effectors,
`tools, and methods can be used in other Suitable applications,
`both inside and outside a human body, as well as in non
`Surgical applications.
`0011. In a first aspect, the invention provides a method of
`indicating whether clamping of a tissue grasped between a
`first and second jaw is likely to be successful. The method
`includes determining and/or measuring a separation between
`two jaws grasping a tissue at a grasping force and, in response
`to the determination of the separation, outputting on a user
`interface an indication of a prediction of whether clamping of
`the grasped tissue at a desired clamping force is likely to be
`Successful. In Such methods, the clamping force is greater
`than the grasping force and, in some embodiments, the
`clamping force may comprise a first predetermined range of
`forces, each larger than the grasping force. The indicator of
`whether clamping Success is likely may also comprise an
`indicator whether clamping Success at a desired clamping
`force and at a desired clamping separation is likely. The
`desired clamping separation may comprise a predetermined
`range of separations. Furthermore, the separation may be
`expressed in terms of a separation angle between the first and
`second jaw or a separation distance between jaw members. In
`many embodiments, the desired clamping separation is Suit
`able for firing a staple of a given size through the tissue
`clamped between the jaws, cutting the grasped tissues, and/or
`sealing the grasped tissue. The first and second jaws will
`typically be part of an end effector. The first and second jaw
`may comprise a first jaw articulable against a portion of the
`end effector, in which case the portion of the end effector
`comprises the second jaw. In certain embodiments, the pre
`diction may be based also on the stiffness of the tissue. The
`stiffness of the tissue may be input, if known, or may be
`estimated based on the grasping force and separation or on the
`rate of change of separation as the grasping force is applied.
`For example, the estimation of stiffness may be based on an
`empirically derived relationship between these factors and
`tissue stiffness.
`0012. The claimed methods provide an indication of
`clamping Success and/or clamping failure in response to a
`separation parameter between a first and second jaw, the first
`and second jaw having a body tissuegrasped therebetween. In
`Some embodiments, the indication is provided in response to
`the separation parameter and the grasping force. One embodi
`ment of the method includes grasping the tissue with the first
`and second jaw, typically in response to a command from a
`user. The method further includes clamping the tissue
`between the first and second jaw at the clamping force, after
`the system provides an indicator that clamping Success is
`likely. The system clamps the tissue typically in response to a
`command from a user to clamp the tissue, after the system has
`provided an indication of whether clamping Success or failure
`is likely. One embodiment of the claimed method includes
`releasing the grasped tissue after the system has provided an
`indication of a prediction of clamping failure. The system
`releases the grasped tissue typically in response to a com
`mand from a user to release the tissue from between the jaws.
`
`0013. In another aspect, the system and methods include a
`Soft grip mode, in which the first and second jaw grasp a body
`tissue at a grasping force, and a clamping mode, wherein the
`first and second jaw clamp the grasped body tissue at a clamp
`ing force, the clamping force being greater than the grasping
`force. A mechanism coupled with the jaws causes the jaws to
`close so as to grasp and/or clamp the body tissue between the
`first and second jaw. The mechanism may be one mechanism
`coupled with an actuator, Such as a motor, or, alternatively, the
`mechanism may comprise multiple mechanisms for exerting
`forces of differing magnitudes. The actuator may comprise an
`actuator system including one or more actuators. An actuator
`maybe any or all of an electric motor, a hydraulic actuator, a
`pneumatic actuator, and a variable torque output actuator. In
`embodiments having a soft grip mode and a clamping mode,
`the system typically Switches between modes in response to a
`user command after the system has provided an indication
`that clamping of the grasped tissue would likely be success
`ful.
`0014. In most embodiments, the separation parameter is
`measured and/or determined by the system during application
`of a grasping force or torque. The system may determine?
`measure the separation between jaw members from posi
`tional data obtained by the robotic system controlling the jaw
`members, such as a robotic patient-side manipulator (PSM)
`system, for example, described in U.S. Patent Application
`Publication No 2007/0005045, the entire contents of which
`are incorporated herein by reference. Typically, the clamping
`force is at least twice that of the grasping force, preferably
`about 5 to 10 times greater than the grasping force.
`0015. In another aspect of the invention, the indication of
`the clamping prediction is provided on a user interface. Pref
`erably, the indication is a visual indicator Superimposed over
`a display providing images of the Surgical tools during a
`Surgical procedure. In other embodiments, the indication of
`the clamping prediction may be any of an audio, visual or
`sensory indicator so as to communicate to the user a predic
`tion of whether clamping is likely to be successful. In another
`aspect of the invention, the indication of clamping prediction
`may further include an indication of whether it is safe to
`initiate a stapling action. For example, after a prediction that
`clamping is likely and clamping has been completed, a timer
`may be initiated Such that once a pre-determined amount of
`time has elapsed after Successful clamping, an indicator is
`displayed over the display that it is safe to proceed Stapling
`into the clamped tissue. A clamping timing indicator may be
`advantageous as it may reduce the amount of clamped tissue
`over time or reduce the amount of fluid within the tissue so as
`to reduce bleeding during Stapling and help achieve hemosta
`sis. The timing indicator may also track elapsed time of
`clamping after stapling of the clamped tissue so as to reduce
`bleeding or to aid in achieving hemostasis of the stapled
`tissue.
`0016. In another aspect, the prediction of clamping is pro
`vided in response to the separation parameter between
`grasped jaws as determined and/or measured by the system.
`In many embodiments, if the measured separation is greater
`than a threshold or a desired grasping separation parameter,
`then the prediction is indicative of likely clamping failure,
`while if the grasping separation is equal to or less than the
`desired grasping separation parameter, the prediction is
`indicative of likely clamping Success. In some embodiments,
`the threshold or desired grasping separation parameter may
`be based in part on an apparent or estimated tissue stiffness.
`
`Ethicon Exhibit 2019.027
`Intuitive v. Ethicon
`IPR2018-01247
`
`

`

`US 2012/0209314 A1
`
`Aug. 16, 2012
`
`The desired separation may comprise eitheran angle between
`jaws or a distance between jaws, and the separation parameter
`may be a discrete parameter or a predetermined range of
`values. For many applications, the threshold or desired grasp
`ing separation is an angle of about 8 degrees or a distance of
`about 6 mm between tips of the jaw members. In one embodi
`ment, a 4 degree angle results in a gap of approximately 3 mm
`between the tips of the jaws. In general, when the tissue is
`Successfully clamped, the gap between jaws is between 1.3
`mm to 2 mm, although one of skill in the art would appreciate
`that this value may vary depending on the application. In
`embodiments where the desired separation parameter is a
`predetermined range, clamping Success may be indicated
`when the measured separation is within the predetermined
`range. For example, a predetermined range of desired grasp
`ing separation parameters may be from 1 to 10 degrees, pref
`erably 1 to 8 degrees, or, in terms of distance, the range of
`desired grasping separation parameters from 0.7 mm to 8
`mm, preferably 2 to 5 mm. Ideally, the desired target separa
`tion is approximately 4 mm. The desired separation values or
`ranges may vary according to any number of variables,
`including but not limited to: a dimension of the first or second
`jaw, a staple length, a staple size, a stapler angle of articula
`tion, a thickness of the body tissue, a type of body tissue, a
`characteristic of the body tissue the desired clamping force or
`the desired clamping separation. In many embodiments, the
`grasping force between the tips of the jaws will be within a
`range from about 3 lb-fto 10 lb-f, preferably about 5 lb-f, and
`the clamping force between the tips of the jaws will be within
`a range from about 30 to 70 lb-f, preferably about 50 lb-f. The
`grasping force and desired clamping force may vary accord
`ing to any of the above variables or by the type of Surgical
`application (e.g. tissue cutting, sealing of tissue, and/or sta
`pling of tissue).
`0017. In another aspect, the present invention includes a
`system for performing the claimed methods. Ideally, the sys
`tem comprises a first and second jaw, a drive system coupled
`to the jaws, a user interface, and an electronic data processor
`coupled to the drive system. In many embodiments, the drive
`system closes the jaws on tissue at a predetermined grasping
`force, the electronic data processor measures a distance
`between the jaws, and based on the measured distance
`between the jaws, the electronic data processor outputs to the
`user interface a prediction of Success of clamping the tissue
`between the two jaws at a desired clamping force, wherein the
`clamping force is within a first predetermined range that is
`larger than the grasping force, and wherein the clamped jaw
`separation distance is within a second predetermined range.
`Ideally, the second predetermined range comprises a distance
`between the jaws that is suitable for applying a staple to the
`tissue between the jaws.
`0018. The system may also comprise one or more modes
`of operation. In some embodiments, the system comprises a
`Soft grip mode and a clamping mode. In the soft grip mode,
`the jaws close or close so as to grasp the body tissue at the
`predetermined grasping force. In the clamping mode, the
`jaws close so as to clamp the body tissue at the clamping
`force. Typically, the system only provides a prediction of
`clamping Success when in the grasping mode. Such that a
`Surgeon may grasp tissue in the grasping mode in preparation
`for clamping the grasped tissue. In embodiments having mul
`tiple modes, the system may further include a controller for
`Switching between modes.
`
`0019. The system may include an actuator system coupled
`with the jaws through a mechanism for effecting movement of
`the jaws so as to grasp and/or clamp the body tissue. In some
`embodiments, the mechanism may include cables and a link
`age. In many embodiments, the mechanism comprises a lead
`screw and cam. In some embodiments, particularly in
`embodiments having multiple modes, a first mechanism
`effects grasping of the jaw and a second mechanism effects
`clamping with the jaws. For example, the first mechanism
`may comprise cables and the second mechanism may com
`prise a lead screw. Effecting grasping with cables would be
`ideal for providing a fast response with a relatively low force,
`while a leadscrew would be more suited for provided a higher
`force despite having a longer response time. The first actua
`tion mechanism can provide a low force for grasping the body
`tissue between jaw members, and the second actuation
`mechanism can provide a high clamping force mode. For
`example, in many embodiments, the maximum clamping
`force of the movable jaw provided by the second actuation
`mechanism is larger thana maximum grasping force provided
`by the first actuation mechanism.
`0020. The first and second actuation mechanisms can
`employ different force transmission mechanisms correspond
`ing with the force requirements for the low force grasping
`mode and the high force clamping mode. For example, a force
`used by the first jaw actuation mechanism to move the jaw
`from the open to the close position can include a linear force,
`and a force used by the second jaw actuation mechanism to
`move the jaw from the open to the closed position can include
`a torque. In many embodiments, the first jaw actuation
`mechanism for use in the low force grasping mode includes a
`cable-driven mechanism, with the second jaw actuation
`mechanism for use in the high force clamping mode includes
`a leadscrew-driven mechanism.
`0021 Any of the above described methods may be used in
`the clamping of any material and may be used in application
`that are non-Surgical in nature. For example, the above
`described methods may be used to indicate to a user a clamp
`ing prediction regarding the clamping of a flexible compliant
`material in an industrial process.
`0022. For a fuller understanding of the nature and advan
`tages of the present invention, reference should be made to the
`ensuing detailed description and accompanying drawings.
`Other aspects, objects and advantages of the invention will be
`apparent from the drawings and detailed description that fol
`lows.
`
`BRIEF DESCRIPTION OF THE DRAWINGS
`
`0023 FIG. 1 is a plan view of a minimally invasive robotic
`Surgery system being used to perform a Surgery, in accor
`dance with many embodiments.
`0024 FIG. 2 is a perspective view of a surgeon's control
`console for a robotic Surgery system, in accordance with
`many embodiments.
`0025 FIG. 3 is a perspective view of a robotic surgery
`system electronics cart, in accordance with many embodi
`mentS.
`0026 FIG. 4 diagrammatically illustrates a robotic sur
`gery system, in accordance with many embodiments.
`0027 FIG. 5A is a front view of a patient side cart (surgical
`robot) of a robotic Surgery system, in accordance with many
`embodiments.
`(0028 FIG. 5B is a front view of a robotic surgery tool.
`
`Ethicon Exhibit 2019.028
`Intuitive v. Ethicon
`IPR2018-01247
`
`

`

`US 2012/0209314 A1
`
`Aug. 16, 2012
`
`0029 FIG. 6A is a perspective view of an end effector
`having an articulated jaw, in accordance with many embodi
`mentS.
`0030 FIG. 6B is a perspective view of the end effector of
`FIG. 6A (with the articulated jaw removed to better illustrate
`leadscrew actuation mechanism components), in accordance
`with many embodiments.
`0031 FIGS. 7A and 7B illustrate components of a lead
`screw actuation mechanism, in accordance with many
`embodiments.
`0032 FIG. 8A illustrates components of a cable-driven
`actuation mechanism, in accordance with many embodi
`mentS.
`0033 FIG. 8B is a perspective view of the end effector of
`FIG. 8A with a portion of the articulated jaw removed to show
`cable-driven actuation mechanism components disposed
`behind the articulated jaw used to articulate the jaw towards a
`closed configuration, in accordance with many embodiments.
`0034 FIGS. 8C through 8F illustrate opposite side com
`ponents of the cable-driven actuation mechanism of FIG. 8A
`used to articulate the jaw towards an open configuration.
`0035 FIG. 9A is a perspective view illustrating a cable
`actuation mechanism, showing a cable used to articulate the
`jaw towards a closed configuration, in accordance with many
`embodiments.
`0036 FIG.9B is a perspective view illustrating the cable
`actuation mechanism of FIG. 9A, showing a cable used to
`articulate the jaw towards an open configuration.
`0037 FIG. 10 is a cross-sectional view illustrating com
`ponents of a leadscrew actuation mechanism, in accordance
`with many embodiments.
`0038 FIG. 11 is a simplified diagrammatic illustration of
`a tool assembly, in accordance with many embodiments.
`0039 FIG. 12 is a simplified diagrammatic illustration of
`a robotic tool mounted to a robotic tool manipulator, in accor
`dance with many embodiments.
`0040 FIGS. 13A through 13C depict an end effector hav
`ing a first and second jaw and illustrate the grasping separa
`tion between jaws in a grasping and clamping configuration,
`in accordance with many embodiments.
`0041
`FIGS. 14A-14B illustrate an end effector in a grasp
`ing configuration, in accordance with many embodiments.
`0042 FIGS. 15A-15B illustrate the user interface assem
`bly having an indicator of a prediction of tissue clamping, in
`accordance with many embodiments.
`0043 FIGS. 16A-16B illustrate examples of indicators of
`tissue clamping predictions, in accordance with many
`embodiments.
`0044 FIGS. 17-19 illustrate methods, in accordance with
`many embodiments.
`004.5 FIGS. 20-21 illustrate flow charts utilizing methods
`in accordance with many embodiments.
`0046 FIGS. 22A-22B illustrate additional examples of
`indicators in accordance with many embodiments.
`
`DETAILED DESCRIPTION OF THE INVENTION
`0047 Improved systems and methods related to clamping
`of body tissues are provided. The present invention relates to
`providing an indicator of whether clamping of grasped tissue
`is likely before attempting to clamp the tissue. The invention
`may be used in Systems having jaw members for clamping a
`body tissue, particularly in Surgical systems used in mini
`mally invasive Surgical applications. Typically, systems uti
`lizing the claimed methods have jaws that grasp a body tissue
`
`at a low force and Subsequently clamp the body tissue at a
`higher force. Grasping the body tissue at a low force allows a
`physician to manipulate and posit