US008545515B2
`
`United States Patent
`US 8,545,515 B2
`(10) Patent No.:
`(12)
`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
`:
`°
`:
`.
`eon Bay. neda,CA(US)JobR
`ogers,
`Alameda,
`>
`youn
`Steger, Sunnyvale, CA (US)
`
`ixyan
`
`(73) Assignee:
`
`(*) Notice:
`
`Intuitive Surgical Operations, Inc.,
`Sunnyvale, CA (US)
`Subject to any disclaimer, the term ofthis
`patent is extended or adjusted under 35
`US.C. 154(b) by 745 days.
`
`EP
`EP
`
`5,402,793 A
`§,507,758 A
`5,797,835 A
`6,331,181 Bl
`6,508,759 Bl
`6,551,270 BL
`6,770,081 B1*
`
`4/1995 Gruneretal.
`4/1996 Thomasonet al.
`8/1998 Green
`12/2001 Tierney etal.
`1/2003 Tayloretal.
`4/2003 Bimboet al.
`8/2004 Cooper et al. cesses 606/130
`(Continued)
`FOREIGN PATENT DOCUMENTS
`1334700 Al
`8/2003
`1870043 A2
`12/2007
`(Continued)
`
`OTHER PUBLICATIONS
`
`(21) Appl. No.: 12/618,583
`
`(22)
`
`Filed:
`
`Nov. 13, 2009
`
`(65)
`
`Prior Publication Data
`
`US 2011/0071542 Al
`
`Mar. 24, 2011
`
`PCT/US 10/56193 International Search Report and Written Opinion
`of the International Searching Authority, mailed Jun. 1, 2011, 19
`pages.
`
`.
`(Continued)
`
`Related U.S. Application Data
`(63) Continuation-in-part of application No. 12/618,549,
`filed on Nov. 13, 2009, now abandoned.
`
`Primary Examiner — Gary Jackson
`Assistant Examiner — Katrina Stransky
`
`(60) Provisional application No. 61/245,171, filed on Sep.
`23, 2009.
`
`(57)
`
`ABSTRACT
`
`(S51)
`
`(56)
`
`Int. Cl.
`A61B 19/00
`(52) U.S. Cl.
`USPC cteeeeeeeesaesteeeeeeeees 606/130; 606/1; 600/184
`(58) Field of Classification Search
`USPC sisstetateeneasteneerenees 606/130, 1; 414/1; 600/184
`See applicationfile for complete search history.
`References Cited
`U.S. PATENT DOCUMENTS
`
`(2006.01)
`
`4,616,631 A
`4,678,459 A
`4,863,430 A
`5,269,772 A
`
`10/1986 Takahashi
`7/1987 Oniketal.
`9/1989 Klyceetal.
`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.
`Variousport 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 mannerthat allows a
`
`surgeon to experience intuitive controlis disclosed.
`
`26 Claims, 41 Drawing Sheets
`
`IS 1006
`
` 4
`
`1
`
`IS 1006
`
`

`

`US 8,545,515 B2
`Page 2
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`(56)
`
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`
`* cited by examiner
`
`2
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`U.S. Patent
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`Oct. 1, 2013
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`US 8,545,515 B2
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`3
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`US 8,545,515 B2
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`1004
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`202
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`6
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`US 8,545,515 B2
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`ee 08
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`FIG. 3
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`7
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`420a
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`T™ 408
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`424
`
`FIG. 4A
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`8
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`Oct. 1, 2013
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`Sheet 7 of 41
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`US 8,545,515 B2
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`420b—~/ BA 4208
`408b
`408a
`424
`
`FIG. 4B
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`9
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`604
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`606
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`11
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`12
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`U.S. Patent
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`FIG.7B
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`13
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`Sheet 12 of 41
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`US 8,545,515 B2
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`780774
`778766
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`768
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`772
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`FIG.7C
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`14
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`14
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`US 8,545,515 B2
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`908
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`19
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`FIG. 9D
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`20
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`20
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`1002
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`22
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`CONTROLLER
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` ENERGY
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`FIG. 10B
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`24
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`US 8,545,515 B2
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`1102a
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`FIG. 11A
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`25
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`FIG. 110
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`26
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`27
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`US 8,545,515 B2
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`FIG. 14A
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`FIG. 14B
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`29
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`33
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`FIG. 17A
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`FIG. 19B
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`35
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`35
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`s040a- >
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`FIG. 19C
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`36
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`36
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`FIG. 20A
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`37
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`37
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`38
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`40
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`U.S. Patent
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`Oct. 1, 2013
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`Sheet 41 of 41
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`US 8,545,515 B2
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`US 8,545,515 B2
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`1
`CURVED CANNULA SURGICAL SYSTEM
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`CROSS REFERENCE TO RELATED
`APPLICATIONS
`
`This application is a continuation in part of U.S. patent
`application Ser. No. 12/618,549 (filed Nov. 13, 2009) (dis-
`closing “Curved Cannula”’), which claimsthe benefit of pro-
`visional U.S. 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: U.S. patent application Ser. No. 12/618,598 (filed Nov.
`13, 2009) disclosing “Curved Cannula Surgical System Con-
`trol”), U.S. patent application Ser. No. 12/618,608(filed Nov.
`13, 2009) (disclosing “Curved Cannula Instrument”), U.S.
`patent application Ser. No. 12/618,621 (filed Nov. 13, 2009)
`(disclosing “Surgical Port Feature”), and U.S. 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,
`moreparticularly to minimally invasive robotic surgical sys-
`tems, andstill 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 comparedto 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 andto retain the benefits
`of robotic surgical systems, surgeons have begunto carry out
`a surgical procedureto 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 providesa triangulation anglefor the surgical
`instrument at the surgical site. In one implementation, an
`endoscope and two such curved cannulas with distal ends
`oriented towardsa surgical site from different angles are used
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`so that effective instrument triangulation is achieved, which
`allowsthe surgeonto 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 coupledto the straight section. A second
`straight section may be coupled to the opposite end of the
`curved section to facilitate alignmentof a passively flexible
`surgical instrument that extends out of the cannula’s distal
`end towards a surgicalsite.
`In another aspect, a surgical instrument includes a pas-
`sively flexible shaft and a surgical end effector coupledto 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 sufficiently stiff
`to provide effective surgical actionat the surgicalsite, yetit is
`sufficiently flexible to allow it to be inserted and withdrawn
`through the curved cannula. In someaspects, the stiffness of
`the distal section of the instrument shaft is larger than the
`stiffness of the section of the shaft that remainsin the curved
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`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 cannulasat 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 someaspectsthe port feature
`also includes a channel for an endoscope cannula and/or one
`or more auxiliary channels. The channels may include vari-
`ousseals.
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`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 asthe curved cannulas, are
`defined in a waist sectionthat 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 mountingfixtures are disclosed.
`These fixtures support the cannulas for insertion and for
`docking to their associated robotic manipulators. In one
`aspect, a fixture includes armsthat 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 pointedto 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 commandsa robotic manipulator to move the
`curved cannula andits instrument in responseto 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 curvedsection.
`
`BRIEF DESCRIPTION OF THE DRAWINGS
`
`FIG. 1A is a front elevation view of a patient side cart ina
`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
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`3
`FIG. 1C is a front elevation view ofa visioncart in a robotic
`surgical system.
`FIG. 2A is a side elevation view of an instrument arm.
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`4
`FIG. 14A is a diagrammatic plan view ofa 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. 15Ais a diagrammatic cross-sectional view taken at a
`cut line in FIG. 14A.
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`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 surgicalsite.
`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 anda passively flexible surgical instru-
`ment.
`
`FIG. 4B is a schematic view that shows a secondpatient
`side robotic manipulator that supports and moves a second
`curved cannula and passively flexible surgical instrument
`combination, addedto the FIG. 4A view.
`FIG. 4C is a schematic view that shows an endoscopic
`camera manipulator that supports an endoscope, addedto the
`FIG. 4B view.
`
`FIG.5 is a diagrammatic view ofa 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 instrumentdesign.
`FIG. 7C is a plan view of a force transmission mechanism
`used in a push/pull instrumentdesign.
`FIG. 7D is a perspective view ofanother force transmission
`mechanism usedin a push/pull instrumentdesign.
`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 instrumentshaft 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
`instrumentshaft design.
`FIG.9A is an exploded perspective 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.
`FIG. 9D is an exploded perspective view ofthe distal end of
`anotherflexible shaft instrument.
`
`FIG. 9EF is a diagrammatic view of a push/pull type end
`effector.
`
`FIG.9F is a diagrammatic perspective view of an instru-
`mentshaft end cap.
`FIG. 10 is a diagrammatic view of a curved cannula.
`FIG. 10A is a diagrammatic view of an aligning keyfea-
`ture.
`FIG. 10B is a schematic view of a cannula end clearance
`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 poseto position curved cannulas.
`FIGS. 12A, 12B, and 12C are diagrammatic views that
`show an instrumentshaft running through and extending from
`various cannula configurations.
`FIG. 13 is a schematic view thatillustrates another curved
`cannula andflexible instrument combination.
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`FIG. 15B showsa detail of a seal depicted in FIG. 15A.
`FIG. 15C is a diagrammatic cross-sectional view taken at
`another cut line in FIG. 14A.
`
`FIG. 15D is a diagrammatic cross-sectional view that illus-
`trates an electrically conductive layer in a port feature.
`FIG. 15E showsa detail of anotherseal.
`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 17Bare diagrammatic viewsofyet another
`port feature.
`FIGS. 18A and 18Bare 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 instrumentwith associated optical fiber
`strain sensors.
`FIG.23 is a diagrammatic view of a control system archi-
`tecture.
`
`DETAILED DESCRIPTION
`
`This description and the accompanying drawingsthatillus-
`trate inventive aspects and embodiments should not be taken
`as limiting—the claimsdefine the protected invention. Vari-
`ous mechanical, compositional, structural, electrical, and
`operational changes maybe 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 like—maybe usedto 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 (1.e.,
`locations) and orientations(i.e., rotational placements) of a
`device in use or operation in addition to the position and
`orientation shownin 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 elementsor features. Thus, the exemplary
`term “below”can encompassboth 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
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`US 8,545,515 B2
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`5
`intendedto include the plural formsas 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
`moreother 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 andtheir associated aspects that are described in
`detail with reference to one embodiment may, wheneverprac-
`tical, be included in other embodiments in whichthey are not
`specifically shown or described. For example, if an elementis
`described in detail with reference to one embodimentandis
`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 mechanicalstruc-
`ture or component should be broadly construed. In essence,
`the term meansthe structure or componentcan 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 componentsthat are similar to
`“vertebrae” in a snake-like arrangement. In such a vertebral
`arrangement, each componentis a short link in a kinematic
`chain, and movable mechanical constraints (e.g., pin hinge,
`cup andball, 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 modeledas, a single mechanical
`constraint (joint) that provides one or more DOF’s between
`twolinks in a kinematic chain, even thoughtheflexible 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 termsofits 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 maybe 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 thelike. A passively flexible piece
`is bent by using a force external to the piece. An example ofa
`passively flexible piece with inherentstiffness is a plastic rod
`or a resilient rubber tube. An actively flexible piece, when not
`actuated byits 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 IS3000, marketed as the da Vinci® Si™
`HD™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 IS2000, marketed as the da Vinci®
`S™ HD™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 asto allow a surgeon, with the assistance of
`a surgical team, perform diagnostic and corrective surgical
`procedures on a patient.
`FIG. 1A is a front elevation view of the patient side cart
`component100 ofthe da Vinci® 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@,1066 are instru-
`ment arms that support and movethe 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 106c that is supported on the
`back side of support tower 104 and that can be positioned to
`eitherthe left or right side ofthe patient side cart as necessary
`to conduct a surgical procedure. FIG. 1A further showsinter-
`changeable surgical instruments 110a,1106,110c mounted
`on the instrument arms 106a,1065,106c, and it shows endo-
`scope 112 mounted on the camera arm 108. The armsare
`discussed in more detail below. Knowledgeable persons will
`appreciate that the armsthat support the instruments and the
`camera may also be supported by a base platform (fixed or
`moveable) mountedto a ceiling or wall, or in some instances
`to another piece of equipmentin 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 isa front elevation view ofasurgeon’s console 120
`componentof the da Vinci® Surgical System. The surgeon’s
`console is equipped withleft 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,1246 on each MTM 122,
`typically with the thumb and forefinger, and can move the
`pincher assembly to variouspositions and orientations. When
`a taol control modeis selected, each MTM 122is 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 1066 and instrument 110a, and right
`MTM 1226 maybe coupledto control instrument arm 1065
`and instrument 1105. If the third instrument arm 106cis used
`
`during a surgical procedure andis positioned ontheleft side,
`then left MTM 122a can be switched between controlling arm
`1064 and instrument 1104 to controlling arm 106c and instru-
`ment 110c. Likewise,if the third instrument arm 106c is used
`during a surgical procedure andis positioned on therightside,
`then right MTM 122a can be switched between controlling
`arm 106and instrument 110to controlling arm 106c and
`instrument 110c. In some instances, control assignments
`between MTM’s 122a,1226 and arm 106a/instrument 110a
`combination and arm 106d/instrument 1105 combination
`mayalso be exchanged. This may be done,for example, ifthe
`endoscopeis rolled 180 degrees, so that the instrument mov-
`ing in the endoscope’s field ofview appears to be on the same
`side as the MTMthe surgeo