USOO8545515B2
`
`(12) United States Patent
`US 8,545,515 B2
`(10) Patent No.:
`Prisco et al.
`(45) Date of Patent:
`Oct. 1, 2013
`
`(54) CURVED CANNULA SURGICAL SYSTEM
`
`(75)
`
`Inventors: Giuseppe Maria Prisco, Mountain
`View, CA (US); Craig R. Gerbi, Half
`Moon Bay, CA (US); Theodore W.
`Rogers, Alameda, CA (US); John Ryan
`Steger, Sunnyvale, CA (US)
`
`(73) Assignee:
`
`Intuitive Surgical Operations, Inc.,
`Sunnyvale, CA (US)
`
`( * ) Notice:
`
`Subject to any disclaimer, the term of this
`patent is extended or adjusted under 35
`U.S.C. 154(b) by 745 days.
`
`(21) Appl.No.: 12/618,583
`
`(22)
`
`Filed:
`
`Nov. 13, 2009
`
`(65)
`
`Prior Publication Data
`
`US 2011/0071542 A1
`
`Mar. 24, 2011
`
`5,402,793 A
`5,507,758 A
`5,797,835 A
`6,331,181 B1
`6,508,759 B1
`6,551,270 B1
`6,770,081 B1 *
`
`4/1995 Gruner et a1.
`4/1996 Thomason et a1.
`8/1998 Green
`12/2001 Tierney et a1,
`1/2003 Taylor et a1.
`4/2003 Bimbo et al.
`8/2004 Cooper et a1.
`
`................ 606/130
`
`(Continued)
`FOREIGN PATENT DOCUMENTS
`1334700 Al
`8/2003
`1870043 A2
`12/2007
`
`EP
`EP
`
`(Continued)
`
`OTHER PUBLICATIONS
`
`PCT/US 10/56193 International Search Report and Written Opinion
`of the International Searching Authority, mailed Jun. 1, 2011, 19
`pages.
`
`(Continued)
`
`Related US. Application Data
`
`(63) Continuation-in-part of application No. 12/618,549,
`filed on Nov. 13, 2009, now abandoned.
`
`Primary Examiner 7 Gary Jackson
`
`Assistant Examiner 7 Katrina Stransky
`
`(60) Provisional application No. 61/245,171, filed on Sep.
`23, 2009.
`
`(57)
`
`ABSTRACT
`
`(51)
`
`(2006.01)
`
`Int. Cl.
`A613 19/00
`(52) US. Cl.
`USPC ................................ 606/130; 606/1; 600/184
`(58) Field of Classification Search
`USPC .......................... 606/130, 1; 414/1; 600/184
`See application file for complete search history.
`
`(56)
`
`References Cited
`
`U.S. PATENT DOCUMENTS
`
`4,616,631 A
`4,678,459 A
`4,863,430 A
`5,269,772 A
`
`10/1986 Takahashi
`7/1987 Onik et a1.
`9/1989 Klyce et a1.
`12/1993 Wilk
`
`A robotic surgical system is configured with rigid, curved
`cannulas that extend through the same opening into a
`patient’s body. Surgical instruments with passively flexible
`shafts extend through the curved cannulas. The cannulas are
`oriented to direct the instruments towards a surgical site.
`Various port features that support the curved cannulas within
`the single opening are disclosed. Cannula support fixtures
`that support the cannulas during insertion into the single
`opening and mounting to robotic manipulators are disclosed.
`A teleoperation control system that moves the curved cannu-
`las and their associated instruments in a manner that allows a
`
`surgeon to experience intuitive control is disclosed.
`
`26 Claims, 41 Drawing Sheets
`
`
`
`IS 1006
`
`1
`
`IS 1006
`
`

`

`US 8,545,515 132
`
`Page 2
`
`(56)
`
`References Cited
`
`2011/0071543 A1
`2011/0071544 A1
`2011/0125165 A1
`
`3/2011 Prisco et al.
`3/2011 Steger et al.
`5/2011 Simaan et al.
`
`EP
`WO
`WO
`WO
`WO
`WO
`WO
`WO
`WO
`WO
`WO
`
`FOREIGN PATENT DOCUMENTS
`2047805 A1
`4/2009
`WO9712557 A1
`4/1997
`WO9712558 A1
`4/1997
`WO2008045350 A2
`4/2008
`WO2008103151 A2
`8/2008
`WO2006100658 A2
`12/2008
`WO2008157225 A1
`12/2008
`WO2009080399 A2
`7/2009
`WO2009102102 A1
`8/2009
`WO2009120944 A2
`10/2009
`WO2010041900 A2
`4/2010
`
`OTHER PUBLICATIONS
`
`
`
`PCT/L S10/56193 Invitation to Pay Additional Fees with Results of
`the Partial International Search, mailed Apr. 8, 2011, 7 pages.
`PCT/L S10/56203 Invitation to Pay Additional Fees with Results of
`the Partial International Search, mailed Apr. 8, 2011, 4 pages.
`PCT/L S20 1 0/056203 International Search Report and Written Opin-
`ion of the International Searching Authority, mailed Jul. 13, 2011, 15
`pages.
`PCT/L S 10/46948 International Search Report and Written Opinion
`of the International Searching Authority, mailed Nov. 26, 2010, 11
`pages.
`PCT/L S 10/56173 International Search Report and Written Opinion
`of the International Searching Authority, mailed Apr. 5, 2011, 13
`pages.
`PCT/L S 10/56188 International Search Report and Written Opinion
`of the International Searching Authority, mailed Apr. 5, 2011, 14
`pages.
`U.S. Appl. No. 12/618,621 Office Action mailed Nov. 23, 2011, 13
`pages.
`Final Office Action mailed Dec. 5, 2012 for US. Appl. No.
`12/618,598, filed Nov. 13, 2009.
`Final Office Action mailed Nov. 13, 2012 for US. Appl. No.
`12/618,631, filed Nov. 13,2009.
`Non-Final Office Action mailed Dec. 6, 2012 for US. Appl. No.
`12/618,608, filed Nov. 13,2009.
`Non-Final Office Action mailed Nov. 23, 2011 for US. Appl. No.
`12/618,621, filed Nov. 13,2009.
`Interview Summary mailed Oct. 10, 2012 for US. Appl. No.
`12/618,631, filed Nov. 13,2009.
`Interview Summary mailed Sep. 11, 2012 for US. Appl. No.
`12/618,598, filed Nov. 13,2009.
`Office Action mailed Jun. 1, 2012 for US. Appl. No. 12/618,621,
`filed Nov. 13, 2009.
`Office Action mailed Jul. 10, 2012 for US. Appl. No. 12/618,631,
`filed Nov. 13, 2009.
`Office Action mailed Jun. 22, 2012 for US. Appl. No. 12/618,598,
`filed Nov. 13, 2009.
`Decision on Petition mailed Mar. 12, 2013 for US. Appl. No.
`12/618,608, filed Nov. 13,2009.
`Final office action mailedApr. 5,2013 for US. Appl. No. 12/618,608,
`filed Nov. 13, 2009.
`Requirement for Restriction and Election mailed Sep. 19, 2012 for
`US. Appl. No. 12/618,608, filed Nov. 13,2009.
`Requirement for Restriction and Election mailed Feb. 21, 2012 for
`US. Appl. No. 12/618,631, filed Nov. 13,2009.
`Requirement for Restriction and Election mailed Sep. 28, 2011 for
`US. Appl. No. 12/618,621, filed Nov. 13,2009.
`
`* cited by examiner
`
`6,821,285
`6,913,609
`7,066,926
`7,070,602
`7,248,944
`7,833,156
`7,854,738
`7,942,885
`7,988,679
`8,037,591
`8,114,097
`8,187,229
`8,287,554
`20
`1/0021859
`20
`2/0040226
`20
`2/0138082
`20
`2/0198537
`20
`4/0010245
`20
`5/0043718
`20
`5/0182386
`20
`6/0074406
`20
`6/0111615
`20
`6/0124134
`20
`6/0247500
`20
`6/0247673
`20
`6/0270911
`20
`6/0293643
`20
`7/0027458
`20
`7/0049966
`20
`7/0208312
`20
`7/0239106
`20
`7/0282266
`20
`8/0027476
`20
`8/0065105
`20
`8/0065107
`20
`8/0065111
`20
`8/0071288
`20
`8/0177283
`20
`8/0188986
`20
`8/0255519
`20
`8/0255585
`20
`8/0269562
`20
`9/0012477
`20
`9/0062602
`20
`9/0093752
`20
`9/0149936
`20
`9/0157076
`20
`9/0187079
`20
`9/0192444
`20
`9/0216234
`20
`9/0227843
`20
`9/0270676
`2010/0063452
`2010/0081871
`2010/0081881
`2010/0081883
`2010/0100043
`2010/0113886
`2010/0204713
`2010/0228091
`2010/0249523
`2010/0249524
`2010/0312063
`2011/0028793
`2011/0071347
`2011/0071473
`2011/0071541
`
`
`
`*
`
`................ 700/245
`
`U.S. PATENT DOCUMENTS
`B2
`11/2004
`Laufer et al.
`B2
`7/2005
`Yencho et al.
`B2
`6/2006
`Wallace et al.
`B2
`7/2006
`Smith et al.
`B2
`Green ...........
`7/2007
`B2
`11/2010
`Williams et al.
`B2
`12/2010
`Lcc ct a1.
`B2
`5/2011
`Sixto, Jr. et al.
`B2
`8/2011
`Daly et al.
`B2
`10/2011
`Spivey et al.
`B2
`2/2012
`Brock et al.
`B2
`5/2012
`Weitzner et al.
`B2
`10/2012
`Cerier et al.
`A1
`9/2001
`Kawai et al.
`A1
`4/2002
`Laufer et al.
`A1
`9/2002
`Brock et al.
`A1
`12/2002
`Smith et al.
`A1
`1/2004
`Cerier et al.
`A1
`2/2005
`Madhani et al.
`A1
`8/2005
`Aggerholm
`A1
`4/2006
`Cooper et al.
`A1
`5/2006
`Danitz et al.
`A1
`6/2006
`Wood et al.
`A1
`11/2006
`Voegele et al.
`A1
`11/2006
`Voegele et al.
`A1
`11/2006
`Voegele et al.
`A1
`12/2006
`Wallace et al.
`A1
`2/2007
`Sixto, Jr. et al.
`A1
`3/2007
`Bonadio et al.
`A1
`9/2007
`Norton et al.
`A1
`10/2007
`Weitzner et al.
`A1
`12/2007
`Davidson
`A1
`1/2008
`Piskun
`A1
`3/2008
`Larkin et al.
`A1
`3/2008
`Larkin et al.
`A1
`3/2008
`Blumenkranz et al.
`A1
`3/2008
`Larkin et a1.
`..
`................ 606/130
`A1
`7/2008
`Lee et al.
`A1
`8/2008
`Hoppe
`A1
`10/2008
`Piskun et al.
`A1
`10/2008
`Gerbi et a1.
`A1
`10/2008
`Marescaux et al.
`A1
`1/2009
`Norton et al.
`A1
`3/2009
`Rosenberg et al.
`A1
`4/2009
`Richard et al.
`A1
`Lentz
`6/2009
`A1
`6/2009
`Athas et al.
`A1
`7/2009
`Albrecht et al.
`A1
`7/2009
`Albrecht et al.
`A1
`8/2009
`Farr et al.
`......
`A1
`9/2009
`Smith et al.
`A1
`10/2009
`Sicvol
`...........
`A1
`3/2010
`Edelman et al.
`A1
`4/2010
`Widenhouse et al.
`A1
`4/2010
`Murray et al.
`A1
`4/2010
`Murray et al.
`A1
`Racenet
`4/2010
`A1
`5/2010
`Piskun et al.
`A1
`8/2010
`Ruiz
`A1
`9/2010
`Widenhouse et al.
`A1
`9/2010
`Spiegal et al.
`A1
`9/2010
`Ransden et al.
`A1
`12/2010
`Hess et al.
`A1
`2/2011
`Martin et al.
`A1
`3/2011
`Rogers et al.
`A1
`3/2011
`Rogers et al.
`A1
`3/2011
`Prisco et al.
`
`..
`
`................ 606/130
`
`............... 606/206
`
`.................. 606/79
`
`................ 600/106
`
`2
`
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`

`US. Patent
`
`Oct. 1, 2013
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`US 8,545,515 B2
`
`1
`CURVED CANNULA SURGICAL SYSTEM
`
`CROSS REFERENCE TO RELATED
`APPLICATIONS
`
`This application is a continuation in part of US. patent
`application Ser. No. 12/618,549 (filed Nov. 13, 2009) (dis-
`closing “Curved Cannula”), which claims the benefit of pro-
`visional US. Patent Application No. 61/245,171 (filed Sep.
`23, 2009) (disclosing “Curved Cannula”), both of which are
`incorporated herein by reference.
`This application may be related to the following applica-
`tions: US. patent application Ser. No. 12/618,598 (filed Nov.
`13, 2009) disclosing “Curved Cannula Surgical System Con-
`trol”), US. patent application Ser. No. 12/618,608 (filed Nov.
`13, 2009) (disclosing “Curved Cannula Instrument”), US.
`patent application Ser. No. 12/618,621 (filed Nov. 13, 2009)
`(disclosing “Surgical Port Feature”), and US. patent appli-
`cation Ser. No. 12/618,631 (filed Nov. 13, 2009) (disclosing
`“Cannula Mounting Fixture”), all of which are incorporated
`herein by reference.
`
`BACKGROUND
`
`1. Field of Invention
`
`Inventive aspects pertain to minimally invasive surgery,
`more particularly to minimally invasive robotic surgical sys-
`tems, and still more particularly to minimally invasive robotic
`surgical systems that work through a single entry point into
`the patient’s body.
`2. Art
`
`Benefits ofminimally invasive surgery are well known, and
`they include less patient trauma, less blood loss, and faster
`recovery times when compared to traditional, open incision
`surgery. In addition, the use of robotic surgical systems (e.g.,
`teleoperated robotic systems that provide telepresence), such
`as the da Vinci® Surgical System manufactured by Intuitive
`Surgical, Inc. of Sunnyvale, Calif. is known. Such robotic
`surgical systems may allow a surgeon to operate with intuitive
`control and increased precision when compared to manual
`minimally invasive surgeries.
`To further reduce patient trauma and to retain the benefits
`of robotic surgical systems, surgeons have begun to carry out
`a surgical procedure to investigate or treat a patient’s condi-
`tion through a single incision through the skin. In some
`instances, such “single port access” surgeries have been per-
`formed with manual instruments or with existing surgical
`robotic systems. What is desired, therefore, are improved
`equipment and methods that enable surgeons to more effec-
`tively perform single port access surgeries, as compared with
`the use of existing equipment and methods. It is also desired
`to be able to easily modify existing robotic surgical systems
`that are typically used for multiple incision (multi-port) sur-
`geries to perform such single port access surgeries.
`
`SUMMARY
`
`In one aspect, a surgical system includes a robotic manipu-
`lator, a curved cannula, and an instrument with a passively
`flexible shaft that extends through the curved cannula. The
`robotic manipulator moves the curved cannula around a
`remote center of motion that is placed at an opening into a
`patient’s body (e.g., an incision, a natural orifice) so that the
`curved cannula provides a triangulation angle for the surgical
`instrument at the surgical site. In one implementation, an
`endoscope and two such curved cannulas with distal ends
`oriented towards a surgical site from different angles are used
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`so that effective instrument triangulation is achieved, which
`allows the surgeon to effectively work at and view the surgical
`site.
`
`In another aspect, the curved cannula includes a straight
`section and an adjacent curved section. A robotic manipulator
`mounting bracket is coupled to the straight section. A second
`straight section may be coupled to the opposite end of the
`curved section to facilitate alignment of a passively flexible
`surgical instrument that extends out of the cannula’s distal
`end towards a surgical site.
`In another aspect, a surgical instrument includes a pas-
`sively flexible shaft and a surgical end effector coupled to the
`distal end of the shaft. The flexible shaft extends through a
`curved cannula, and a distal section of the flexible shaft
`extends cantilevered beyond a distal end of the curved can-
`nula. The distal section ofthe flexible shaft is sufliciently stiff
`to provide effective surgical action at the surgical site, yet it is
`sufficiently flexible to allow it to be inserted and withdrawn
`through the curved cannula. In some aspects, the stiffness of
`the distal section of the instrument shaft is larger than the
`stiffness of the section of the shaft that remains in the curved
`
`section of the cannula during a surgical procedure.
`In another aspect, a surgical port feature is a single body
`that includes channels between its top and bottom surfaces.
`The channels are angled in opposite directions to hold the
`straight sections ofthe curved cannulas at a desired angle. The
`body is sufficiently flexible to allow the curved cannulas to
`move around remote centers of motion that are generally
`located within the channels. In some aspects the port feature
`also includes a channel for an endoscope cannula and/or one
`or more auxiliary channels. The channels may include vari-
`ous seals.
`
`In another aspect, a second port feature that includes an
`upper funnel portion and a lower tongue is disclosed. Chan-
`nels for surgical instruments, such as the curved cannulas, are
`defined in a waist section that joins the funnel portion and the
`tongue. In one aspect, this second port feature is used for
`surgeries that require instruments to enter the patient’s body
`at a relatively small (acute) angle, because the port feature
`helps prevent unnecessary stress between the instruments and
`the patient’s body and vice versa.
`In another aspect, cannula mounting fixtures are disclosed.
`These fixtures support the cannulas for insertion and for
`docking to their associated robotic manipulators. In one
`aspect, a fixture includes arms that hold an endoscope cannula
`and a curved instrument cannula. In another aspect, a fixture
`is configured as a cap that holds distal ends of an endoscope
`and a curved cannula. The cap is pointed to facilitate insertion
`into the opening into the patient.
`In another aspect, a control system for a robotic surgical
`system with a curved cannula is disclosed. The control system
`uses kinematic data associated with the curved cannula. To
`provide an intuitive control experience for the surgeon, the
`control system commands a robotic manipulator to move the
`curved cannula and its instrument in response to the surgeon’s
`inputs at a master manipulator as if the instrument were
`positioned along a straight axis that extends from the distal
`end of the curved cannula, generally tangent to the distal end
`of the cannula’s curved section.
`
`BRIEF DESCRIPTION OF THE DRAWINGS
`
`FIG. 1A is a front elevation view of a patient side cart in a
`robotic surgical system.
`FIG. 1B is a front elevation view of a surgeon’s console in
`a robotic surgical system.
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`US 8,545,515 B2
`
`3
`FIG. 1C is a front elevation view of a Vision cart in a robotic
`
`surgical system.
`FIG. 2A is a side elevation view of an instrument arm.
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`FIG. 14A is a diagrammatic plan view of a port feature.
`FIG. 14B is a diagrammatic perspective view of a port
`feature.
`
`FIG. 2B is a perspective view of a manipulator with an
`instrument mounted.
`
`FIG. 15A is a diagrammatic cross—sectional view taken at a
`cut line in FIG. 14A.
`
`FIG. 15B shows a detail of a seal depicted in FIG. 15A.
`FIG. 15C is a diagrammatic cross-sectional view taken at
`another cut line in FIG. 14A.
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`FIG. 15D is a diagrammatic cross-sectional view that illus-
`trates an electrically conductive layer in a port feature.
`FIG. 15E shows a detail of another seal.
`
`FIG. 2C is a side elevation view of a portion of a camera
`arm with a camera mounted.
`
`FIG. 3 is a diagrammatic view of multiple cannulas and
`associated instruments inserted through a body wall so as to
`reach a surgical site.
`FIG. 4A is a schematic view of a portion of a patient side
`robotic manipulator that supports and moves a combination
`of a curved cannula and a passively flexible surgical instru-
`ment.
`
`FIG. 4B is a schematic view that shows a second patient
`side robotic manipulator that supports and moves a second
`curved cannula and passively flexible surgical instrument
`combination, added to the FIG. 4A view.
`FIG. 4C is a schematic view that shows an endoscopic
`camera manipulator that supports an endoscope, added to the
`FIG. 4B view.
`
`FIG. 5 is a diagrammatic view of a flexible instrument.
`FIG. 6A is a diagrammatic view of a pull/pull instrument
`design.
`FIG. 6B is a diagrammatic view of a push/pull instrument
`design.
`FIG. 7A is a bottom view of a force transmission mecha-
`nism.
`
`FIG. 7B is a plan view of a force transmission mechanism
`used in a pull/pull instrument design.
`FIG. 7C is a plan view of a force transmission mechanism
`used in a push/pull instrument design.
`FIG. 7D is a perspective view ofanother force transmission
`mechanism used in a push/pull instrument design.
`FIG. 8A is a cutaway perspective view of a portion of an
`instrument shaft.
`
`FIG. 8B is a cross-sectional diagrammatic perspective
`view of another instrument shaft design.
`FIG. 8C is a cutaway perspective view of a portion of
`another instrument shaft.
`
`FIG. 8D is a diagrammatic perspective view of yet another
`instrument shaft design.
`FIG. 9A is an explodedperspective view ofthe distal end of
`a flexible shaft instrument.
`
`FIG. 9B is a cross-sectional view of the implementation
`depicted in FIG. 9A.
`FIG. 9C is a diagrammatic view of a pull/pull type end
`effector.
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`FIG. 16A is a diagrammatic view ofvarious skin and fascia
`incisions.
`
`FIG. 16B is a diagrammatic perspective cross-sectional
`view of another port feature.
`FIGS. 17A and 17B are diagrammatic views ofyet another
`port feature.
`FIGS. 18A and 18B are diagrammatic views ofyet another
`port feature.
`FIG. 19A is a perspective view of a cannula insertion/
`stabilizing fixture.
`FIG. 19B is another perspective view of a cannula inser-
`tion/stabilizing fixture.
`FIG. 19C is a diagrammatic perspective view of a cannula
`stabilizing fixture.
`FIGS. 20A-20D are diagrammatic views that illustrate
`another way of inserting cannulas.
`FIG. 21 is a diagrammatic view of a curved cannula and
`various reference axes.
`
`FIG. 22 is a diagrammatic view of a curved cannula and the
`distal end ofa flexible instrument with associated optical fiber
`strain sensors.
`
`FIG. 23 is a diagrammatic view of a control system archi-
`tecture.
`
`DETAILED DESCRIPTION
`
`This description and the accompanying drawings that illus-
`trate inventive aspects and embodiments should not be taken
`as limitingithe claims define the protected invention. Vari-
`ous mechanical, compositional, structural, electrical, and
`operational changes may be made without departing from the
`spirit and scope of this description and the claims. In some
`instances, well-known circuits, structures, and techniques
`have not been shown or described in detail in order not to
`
`obscure the invention. Like numbers in two or more figures
`represent the same or similar elements.
`
`Further, this description’s terminology is not intended to
`limit the invention. For example, spatially relative terms
`such as “beneath”, “below”, “lower”, “above”, “upper”,
`“proximal”, “distal”, and the likeimay be used to describe
`one element’s or feature’s relationship to another element or
`feature as illustrated in the figures. These spatially relative
`terms are intended to encompass different positions (i.e.,
`locations) and orientations (i.e., rotational placements) of a
`device in use or operation in addition to the position and
`orientation shown in the figures. For example, if a device in
`the figures is turned over, elements described as “below” or
`“beneath” other elements or features would then be “above”
`
`or “over” the other elements or features. Thus, the exemplary
`term “below” can encompass both positions and orientations
`of above and below. A device may be otherwise oriented
`(rotated 90 degrees or at other orientations) and the spatially
`relative descriptors used herein interpreted accordingly. Like-
`wise, descriptions of movement along and around various
`axes includes various special device positions and orienta-
`tions. In addition, the singular forms “a”, “an”, and “the” are
`
`FIG. 9D is an explodedperspective view ofthe distal end of
`another flexible shaft instrument.
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`FIG. 9E is a diagrammatic view of a push/pull type end
`effector.
`
`FIG. 9F is a diagrammatic perspective view of an instru-
`ment shaft end cap.
`FIG. 10 is a diagrammatic view of a curved cannula.
`FIG. 10A is a diagrammatic view of an aligning key fea-
`ture.
`FIG. 10B is a schematic view of a cannula end clearance
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`detection system.
`FIGS. 11A and 11B illustrate cannula orientations.
`
`FIG. 11C is a plan view of a robotic surgical system with
`manipulators in an example pose to position curved cannulas.
`FIGS. 12A, 12B, and 12C are diagrammatic views that
`show an instrument shaft running through and extending from
`various cannula configurations.
`FIG. 13 is a schematic view that illustrates another curved
`cannula and flexible instrument combination.
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`US 8,545,515 B2
`
`5
`intended to include the plural forms as well, unless the con-
`text indicates otherwise. And, the terms “comprises”, “com-
`prising”, “includes”, and the like specify the presence of
`stated features, steps, operations, elements, and/or compo-
`nents but do not preclude the presence or addition of one or
`more other features, steps, operations, elements, components,
`and/or groups. Components described as coupled may be
`electrically or mechanically directly coupled, or they may be
`indirectly coupled Via one or more intermediate components.
`Elements and their associated aspects that are described in
`detail with reference to one embodiment may, whenever prac-
`tical, be included in other embodiments in which they are not
`specifically shown or described. For example, if an element is
`described in detail with reference to one embodiment and is
`not described with reference to a second embodiment, the
`element may nevertheless be claimed as included in the sec-
`ond embodiment.
`The term “flexible” in association with a mechanical struc-
`
`ture or component should be broadly construed. In essence,
`the term means the structure or component can be repeatedly
`bent and restored to an original shape without harm. Many
`“rigid” objects have a slight inherent resilient “bendiness”
`due to material properties, although such objects are not
`considered “flexible” as the term is used herein. A flexible
`
`mechanical structure may have infinite degrees of freedom
`(DOF’s). Examples of such structures include closed, bend-
`able tubes (made from, e.g., NITINOL, polymer, soft rubber,
`and the like), helical coil springs, etc. that can be bent into
`various simple and compound curves, often without signifi-
`cant cross-sectional deformation. Other flexible mechanical
`
`structures may approximate such an infinite-DOF piece by
`using a series ofclosely spaced components that are similar to
`“vertebrae” in a snake-like arrangement. In such a vertebral
`arrangement, each component is a short link in a kinematic
`chain, and movable mechanical constraints (e.g., pin hinge,
`cup and ball, live hinge, and the like) between each link may
`allow one (e.g., pitch) or two (e.g., pitch and yaw) DOF’s of
`relative movement between the links. A short, flexible struc-
`ture may serve as, and be modeled as, a single mechanical
`constraint (joint) that provides one or more DOF’s between
`two links in a kinematic chain, even though the flexible struc—
`ture itself may be a kinematic chain made of several coupled
`links. Knowledgeable persons will understand that a compo-
`nent’s flexibility may be expressed in terms of its stiffness.
`In this description, a flexible mechanical structure or com-
`ponent may be either actively or passively flexible. An
`actively flexible piece may be bent by using forces inherently
`associated with the piece itself. For example, one or more
`tendons may be routed lengthwise along the piece and offset
`from the piece’s longitudinal axis, so that tension on the one
`or more tendons causes the piece to bend. Other ways of
`actively bending an actively flexible piece include, without
`limitation, the use of pneumatic or hydraulic power, gears,
`electroactive polymer, and the like. A passively flexible piece
`is bent by using a force external to the piece. An example of a
`passively flexible piece with inherent stiffness is a plastic rod
`or a resilient rubber tube. An actively flexible piece, when not
`actuated by its inherently associated forces, may be passively
`flexible. A single component may be made of one or more
`actively and passively flexible portions in series.
`Aspects ofthe invention are described primarily in terms of
`an implementation using a da Vinci® Surgical System (spe-
`cifically, a Model 183000, marketed as the da Vinci® SiTM
`HDTM Surgical System), manufactured by Intuitive Surgical,
`Inc. of Sunnyvale, Calif. Knowledgeable persons will under-
`stand, however, that inventive aspects disclosed herein may
`be embodied and implemented in various ways, including
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`robotic and non-robotic embodiments and implementations.
`Implementations on da Vinci® Surgical Systems (e.g., the
`Model IS3000; the Model 182000, marketed as the da Vinci®
`STM HDTM Surgical System) are merely exemplary and are
`not to be considered as limiting the scope of the inventive
`aspects disclosed herein.
`FIGS. 1A, 1B, and 1C are front elevation views of three
`main components of a teleoperated robotic surgical system
`for minimally invasive surgery. These three components are
`interconnected so as to allow a surgeon, with the assistance of
`a surgical team, perfomr diagnostic and corrective surgical
`procedures on a patient.
`FIG. 1A is a front elevation view of the patient side cart
`component 100 ofthe daVinci® Surgical System. The patient
`side cart includes a base 102 that rests on the floor, a support
`tower 104 that is mounted on the base 102, and several arms
`that support surgical tools (which include a stereoscopic
`endoscope). As shown in FIG. 1A, arms 106a,106b are instru-
`ment arms that support and move the surgical instruments
`used to manipulate tissue, and arm 108 is a camera arm that
`supports and moves the endoscope. FIG. 1A also shows an
`optional third instrument arm 1060 that is supported on the
`back side of support tower 104 and that can be positioned to
`either the left or right side of the patient side cart as necessary
`to conduct a surgical procedure. FIG. 1A further shows inter-
`changeable surgical instruments 110a,110b,1100 mounted
`on the instrument arms 106a,106b,106c, and it shows endo-
`scope 112 mounted on the camera arm 108. The arms are
`discussed in more detail below. Knowledgeable persons will
`appreciate that the arms that support the instruments and the
`camera may also be supported by a base platform (fixed or
`moveable) mounted to a ceiling or wall, or in some instances
`to another piece of equipment in the operating room (e. g., the
`operating table). Likewise, they will appreciate that two or
`more separate bases may be used (e.g., one base supporting
`each arm).
`FIG. 1B is a front elevation view ofa surgeon’ s console 120
`component of the da Vinci® Surgical System. The surgeon’s
`console is equipped with left and right multiple DOF master
`tool manipulators (MTM’s) 122a,122b, which are kinematic
`chains that are used to control the surgical tools (which
`include the endoscope and various cannulas). The surgeon
`grasps a pincher assembly 124a,124b on each MTM 122,
`typically with the thumb and forefinger, and can move the
`pincher assembly to various positions and orientations. When
`a tool control mode is selected, each MTM 122 is coupled to
`control a corresponding instrument arm 106 for the patient
`side cart 100. For example, left MTM 122a may be coupled to
`control instrument arm 106b and instrument 110a, and right
`MTM 122b may be coupled to control instrument arm 106b
`and instrument 11019. If the third instrument arm 1060 is used
`
`during a surgical procedure and is positioned on the left side,
`then left MTM 122a canbe switchedbetween controlling arm
`106a and instrument 11011 to controlling arm 106C and instru-
`ment 1100. Likewise, if the third instrument arm 1060 is used
`during a surgical procedure and is positioned on the right side,
`then right MTM 122a can be switched between controlling
`arm 106b and instrument 11019 to controlling arm 106C and
`instrument 1100. In some instances, control assignments
`between MTM’s 122a,122b and arm 106a/instrument 110a
`combination and arm 106b/instrument 110b combination
`
`may also be exchanged. This may be done, for exampl