(12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT)
`(19) World Intellectual Property
`Organization
`International Bureau
`
`(10) International Publication Number
`
`(43) International Publication Date
`WO 2015/153642 A1
` 8 October 2015 (08.10.2015) WI P O i P C T
`
`\a”
`
`(51) International Patent Classification:
`A6112 19/00 (2006.01)
`
`(21) International Application Number:
`
`PCT/US2015/023636
`
`(81)
`
`(22) International Filing Date:
`
`(25) Filing Language:
`
`(26) Publication Language:
`
`31 March 2015 (31.03.2015)
`
`English
`
`English
`
`(30) Priority Data:
`61/973,257
`
`31 March 2014 (31.03.2014)
`
`US
`
`(72)
`
`INTUITIVE SURGICAL OPERATIONS,
`(71) Applicant:
`INC.
`[US/US]; 1020 Kifer Road, Sminyvale, California
`94086 (US).
`Inventors: BAILEY, David W.; 230 Wyndham Drive,
`Portola Valley, California
`94028
`(US). ROGERS,
`Theodore W.; 3240 Sterling Avenue, Alameda, California
`94501 (US). DEYANOV, Rumen, 34289 Gadwall Com-
`mon, Fremont, California 94555 (US). LATHROP, Ray,
`2013 24th Ave 8,, Nashville, Tennessee 37212 (US).
`BRISSON, Gabriel F.; 405 Red Oak Ave. Apt. 307, Al—
`bany, California 94706 (U S).
`
`(74)
`
`Agents: ALLENBY, Christopher B. et a1.; Intuitive Sur-
`gical Operations, Inc., 1020 Kifcr Road, Sunnyvale, Cali-
`fornia 94086 (US).
`
`Designated States (unless otherwise indicated, for every
`kind of national protection available): AE, AG, AL, AM,
`AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY,
`BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM,
`DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT,
`HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR,
`KZ, LA, LC, LK, LR, LS, LU, LY, MA, MD, ME, MG,
`MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, OM,
`PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, SC,
`SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN,
`TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, ZW.
`
`(84)
`
`Designated States (unless otherwise indicated, for every
`kind of regional protection available): ARIPO (BW, GH,
`GM, RE, LR, LS, MW, MZ, NA, RW, SD, SL, ST, SZ,
`TZ, UG, ZM, ZW), Em‘asian (AM, AZ, BY, KG, KZ, RU,
`TJ, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE,
`DK, EE, ES, FI, FR, GB, GR, HR, HU, IE, IS, IT, LT, LU,
`LV, MC, MK, MT, NL, NO, PL, PT, RO, RS, SE, SI, SK,
`SM, TR), OAPI (BF, BJ, CF, CG, CI, CM, GA, GN, GQ,
`GW, KM, ML, MR, NE, SN, TD, TG),
`Declarations under Rule 4.17 :
`
`of inventorship (Rule 4.17(iv))
`
`[Continued on nextpage]
`
`(54) Title: SURGICAL INSTRUMENT WITH SI-IIFTABLE TRANSMISSION
`
`192m)
`
`,
`
`,7 156
`
`
`
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`_
`
`_
`
`_
`
`188(10-
`1901M)
`37(qu
`
`,
`
`’
`
`~'
`
`(57) Abstract: A surgical tool having an elongated shaft having a proximal
`end and distal end. A surgical end effector is located about the distal end.
`The sm‘gical end effector has a plurality of effector mechanisms comprising a
`plurality of degree of freedoms. An effector body is located at the proximal
`end. The effector body includes a plurality of motor interfaces for driving the
`plurality of effector mechanisms. A transmission is coupled to the effector
`body
`
`72w)
`
`
`
`
`,
`
`'
`
`7
`
`1361"]
`132m;
`
`mm?
`184m)
`153(10/
`
`‘
`
`4
`
`T1
`
`Cine)
`
`new]
`
`FIG. 7B
`
`Ethicon Exhibit 2014.001
`
`Intuitive v. Ethicon
`
`lPR2018-01254
`
`
`
`wo2015/153642A1|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
`
`Ethicon Exhibit 2014.001
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642 A1 |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
`
`Published:
`
`— with international search report (Art. 21(3))
`
`Ethicon Exhibit 2014.002
`
`Intuitive v. Ethicon
`
`lPR2018-01254
`
`Ethicon Exhibit 2014.002
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
`
`PCT/US2015/023636
`
`SURGICAL INSTRUMENT WITH SHIFTABLE TRANSMISSION
`
`CROSS-REFERENCES TO RELATED APPLICATIONS
`
`[0001]
`
`This application claims the benefit of US. Provisional Application No. 61/973,257,
`
`filed March 31, 2014, which is incorporated by reference herein.
`
`BACKGROUND OF THE INVENTION
`
`10
`
`15
`
`[0002] Minimally invasive medical techniques are intended to reduce the amount of
`
`extraneous tissue that is damaged during diagnostic or surgical procedures, thereby reducing
`
`patient recovery time, discomfort, and deleterious side effects. One effect of minimally
`
`invasive surgery, for example, is reduced post—operative hospital recovery times. Because the
`
`average hospital stay for a standard surgery is typically significantly longer than the average
`
`stay for an analogous minimally invasive surgery, increased use of minimally invasive
`
`techniques could save millions of dollars in hospital costs each year. While many of the
`
`surgeries performed each year in the United States could potentially be performed in a
`
`minimally invasive manner, only a portion of the current surgeries use these advantageous
`
`techniques due to limitations in minimally invasive surgical instruments and the additional
`
`surgical training involved in mastering them.
`
`[0003] Minimally invasive telesurgical systems have been developed to increase a
`
`surgeon's dexterity and avoid some of the limitations on traditional minimally invasive
`
`techniques. In telesurgery, the surgeon uses some form of remote control (e.g., a
`
`servomechanism or the like) to manipulate surgical instrument movements, rather than
`
`directly holding and moving the instruments by hand. In telesurgery systems, the surgeon
`
`can be provided with an image of the surgical site at a surgical workstation. While viewing a
`
`two or three dimensional image of the surgical site on a display, the surgeon performs the
`
`surgical procedures on the patient by manipulating master control devices, which in turn
`
`control motion of the servo—mechanically operated instruments.
`
`30
`
`[0004] The servomechanism used for telesurgery will often accept input from two master
`
`controllers (one for each of the surgeon‘s hands) and may include two or more robotic arms
`
`on each of which a surgical instrument is mounted. Operative communication between
`
`Ethicon Exhibit 2014.003
`
`Intuitive v. Ethicon
`
`lPR2018-01254
`
`Ethicon Exhibit 2014.003
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
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`PCT/U52015/023636
`
`master controllers and associated robotic arm and instlument assemblies is typically achieved
`
`through a control system. The control system typically includes at least one processor that
`
`relays input commands from the master controllers to the associated robotic arm and
`instrument assemblies and back from the instrument and arm assemblies to the associated
`
`master controllers in the case of, for example, force feedback or the like. One example of a
`
`robotic surgical system is the DA VlNCl® system available from Intuitive Surgical, Inc. of
`
`Sunnyvale, California, USA.
`
`10
`
`15
`
`[0005] A variety of structural arrangements can be used to support the surgical instrument
`
`at the surgical site during robotic surgery. The driven linkage or "slave" is often called a
`
`robotic surgical manipulator, and exemplary linkage arrangements for use as a robotic
`
`surgical manipulator during minimally invasive robotic surgery are described in U.8. Pat.
`
`Nos. 7,594,912; 6,758,843; 6,246,200; and 5,800,423; which are incorporated herein by
`
`reference. These linkages often make use of a parallelogram an‘angement to hold an
`
`instrument having a shaft. Such a manipulator structure can constrain movement of the
`
`instrument so that the instrument pivots about a remote center of manipulation positioned in
`
`space along the length of the rigid shaft. By aligning the remote center of manipulation with
`
`the incision point to the internal surgical site (for example, with a trocar or cannula at an
`
`abdominal wall during laparoscopic surgery), an end effector of the surgical instrument can
`
`be positioned safely by moving the proximal end of the shaft using the manipulator linkage
`
`without imposing potentially dangerous forces against the abdominal wall. Alternative
`
`manipulator structures are described, for example, in U.8. Pat. Nos. 7,763,015; 6,702,805;
`
`6,676,669; 5,855,583; 5,808,665; 5,445,166; and 5,184,601; which are incorporated herein by
`
`reference.
`
`[0006] A veu‘iety of structural arrangements can also be used to support and position the
`
`robotic surgical manipulator and the surgical instlument at the surgical site during robotic
`
`surgery. Supporting linkage mechanisms, sometimes referred to as set-up joints, or set-up
`
`joint arms, are often used to position and align each manipulator with the respective incision
`
`point in a patient's body. The supporting linkage mechanism facilitates the alignment of a
`
`surgical manipulator with a desired surgical incision point and targeted anatomy. Exemplary
`
`30
`
`supporting linkage mechanisms are desclibed in US. Pat. Nos. 6,246,200 and 6,788,018,
`
`which are incorporated herein by reference.
`
`[\3
`
`Ethicon Exhibit 2014.004
`
`Intuitive v. Ethicon
`
`lPR2018-01254
`
`Ethicon Exhibit 2014.004
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
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`PCT/U52015/023636
`
`10
`
`15
`
`[0007] While the new telesurgical systems and devices have proven highly effective and
`
`advantageous, still further improvements are desirable In general, improved minimally
`
`invasive robotic surgery systems are desirable. Often, new surgical instruments are
`
`developed for use on existing telesurgical system platforms. Thus, the instrument is required
`
`to adapt to the telesurgical system, since development of a new telesurgical system for a
`
`particular surgical application is cost prohibitive. However, issues arise when existing
`
`telesurgical platforms do not have the required amount of motor outputs for all of the
`
`mechanisms of a particular surgical instrument. Thus, there is a need to adapt new surgical
`
`devices to existing telesurgical systems without limiting the surgical capabilities and without
`
`requiring modification to the existing telesurgical systems.
`
`BRIEF SUMMARY OF THE INVENTION
`
`[0008] Many embodiments are directed to a surgical tool comprising an elongated shaft
`
`having a proximal end and distal end. A surgical end effector is located about the distal end.
`
`The surgical end effector may include a plurality of effector mechanisms, each effector
`
`mechanism having one or a plurality of degree of freedoms (DOFs). An effector body may
`
`also be located at the proximal end. The effector body may include a plurality of motor
`
`interfaces for driving the plurality of effector mechanisms. For example, the plurality of
`
`motor interfaces may include a first motor interface. A transmission may be coupled between
`
`the effector body and the surgical end effector. The transmission may be configured to shift
`
`coupling of the first motor interface between only a portion of the plurality of effector
`
`mechanisms and associated DOFs.
`
`[0009] Many embodiments are directed to a surgical tool compn'sing an elongated shaft
`
`having a proximal end and distal end. A surgical end effector is located at the distal end of
`
`the shaft. The surgical end effector has a plurality of end effector components each
`
`associated with a unique mechanical degree of freedom. The plurality of end effector
`
`components has a first end effector component and a second end effector component. A
`
`drive mechanism is located at the proximal end of the shaft. The drive mechanism has a first
`motor interface and a transmission. The transmission includes a shift mechanism movable
`
`between a first state and a second state. In the first state the first motor interface is coupled
`
`30
`
`via the transmission to drive the first end effector component without driving the second end
`
`effector component. In the second state the first motor interface being coupled via the
`
`transmission to drive the second end effector component without driving the first end effector
`
`component.
`
`Ethicon Exhibit 2014.005
`
`Intuitive v. Ethicon
`
`lPR2018-01254
`
`Ethicon Exhibit 2014.005
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
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`PCT/U52015/023636
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`10
`
`15
`
`[0010]
`
`In many embodiments, the plurality of motor interfaces includes a second motor
`
`interface coupled to shift the shift mechanism between the first state and the second state
`
`[0011]
`
`In many embodiments, the plurality of end effector components includes a third end
`
`effector component. The shift mechanism may be movable to a third state. In the first state
`
`and in the second state the first motor interface is not driving the third end effector
`
`component. In the third state the first motor interface is coupled via the transmission to drive
`
`the third end effector component without driving the first and second end effector
`
`components.
`
`[0012]
`
`In many embodiments, the plurality of motor interfaces includes a second motor
`
`interface coupled to shift the shift mechanism between the first state, the second state, and the
`third state.
`
`[0013]
`
`In many embodiments, the first end effector component may be associated with a
`
`first end effector mechanical degree of freedom, and the second end effector component is
`
`associated with a second end effector mechanical degree of freedom. The drive mechanism
`
`may include a second motor interface coupled to drive a third end effector mechanical degree
`
`of freedom, a third motor interface coupled to drive a fourth end effector mechanical degree
`
`of freedom, and a fourth motor interface coupled to drive a fifth end effector mechanical
`
`degree of freedom. The first, second, third, fourth, and fifth mechanical degrees of freedom
`
`of the end effector are each unique.
`
`[0014]
`
`In many embodiments, the plurality of end effector components includes a third end
`
`effector component associated with a sixth end effector mechanical degree of freedom. The
`
`first, second, third, fourth, fifth, and sixth mechanical degrees of freedom of the end effector
`
`are each unique.
`
`[0015]
`
`In many embodiments, the plurality of motor interfaces includes a fifth motor
`
`interface coupled to shift the shift mechanism between the first state and the second state.
`
`[0016]
`
`In many embodiments, the shift mechanism may include a rotatable camshaft,
`
`where a first position of the camshaft corresponding to the first state, and a second position of
`
`the camshaft corresponding to the second state.
`
`[0017]
`
`In many embodiments, the plurality of motor interfaces further includes a second
`
`30
`
`motor interface coupled to drive the camshaft.
`
`Ethicon Exhibit 2014.006
`
`Intuitive v. Ethicon
`
`lPR2018-01254
`
`Ethicon Exhibit 2014.006
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
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`PCT/U52015/023636
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`[0018]
`
`In many embodiments, the transmission may include a rotatable camshaft. 'lhe
`
`camshaft can include a first camshaft position for shifting coupling of the first motor interface
`
`to a first DOF of the plurality of DOFs; a second camshaft position for shifting coupling of
`
`the first motor interface to a second DOF of the plurality of DOFs; and a third camshaft
`
`position for shifting coupling of the first motor interface to a third DOF of the plurality of
`
`DOFs.
`
`[0019]
`
`In many embodiments, the plurality of motor interfaces further includes a second,
`
`third, fourth, and fifth motor interface, wherein the camshaft is driven by the second motor
`
`interface.
`
`10
`
`15
`
`[0020]
`
`In many embodiments, the plurality of DOFs further includes a fourth DOF coupled
`
`exclusively with the third motor interface; a fifth DOF coupled exclusively with the fourth
`
`motor interface; and a sixth DOF coupled exclusively with the fifth motor interface.
`
`[0021]
`
`In many embodiment, the surgical end effector can include a gripping device having
`
`a surgical tool, wherein the surgical end effector includes a wrist, the wrist being able to
`
`pitch, yaw, and roll the gripping device with respect to the remotely controlled arm.
`
`[0022]
`
`In many embodiments, the first DOF is a mechanism for rolling the wrist; the
`
`second DOF is a mechanism for actuating the surgical tool; the third DOF is a mechanism for
`
`actuating the gripping device with high force relative to the sixth DOF; the fourth DOF is a
`
`mechanism for causing the wrist to yaw; the fifth DOF is a mechanism for causing the wrist
`
`to pitch; and the sixth DOF is a mechanism for actuating the gripping device with low force
`
`relative to the third DOF.
`
`[0023]
`
`In many embodiments, the camshaft includes a plurality of camshaft lobes.
`
`[0024]
`
`In many embodiments, the plurality of camshaft lobes includes a pair of lobes for
`
`powering and locking each of the first, second, and third DOFs.
`
`[0025]
`
`In many embodiments, the transmission includes a first gear train for driving the
`
`first DOF, a second gear train for driving the second DOF, and a third gear train for driving
`
`the third DOF.
`
`[0026]
`
`In many embodiments, the first gear train includes a first input gear; a first output
`
`gear ultimately coupled with the first. input. gear; a first. rocker arm moveably engaged with
`
`the camshaft for engaging and disengaging the first input gear with the first output gear; a
`
`Ethicon Exhibit 2014.007
`
`Intuitive v. Ethicon
`
`lPR2018-01254
`
`Ethicon Exhibit 2014.007
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
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`PCT/U52015/023636
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`first locker arm moveably engaged with the camshaft for locking and unlocking the first
`
`output gear.
`
`[0027]
`
`In many embodiments, the second gear train includes a second input gear; a second
`
`output gear ultimately coupled with the second input gear; a second rocker arm moveably
`
`engaged with the camshaft for engaging and disengaging the second input gear with the
`
`second output gear; and a second locker arm moveably engaged with the camshaft for locking
`
`and unlocking the second output gear.
`
`[0028]
`
`In many embodiments, the third gear train includes a third input gear; a third output
`
`gear ultimately coupled with the third input gear; a third rocker arm moveably engaged with
`
`10
`
`the camshaft for engaging and disengaging the third input gear with the third output gear; a
`
`third locker arm moveably engaged with the camshaft for locking and unlocking the third
`
`output gear.
`
`[0029]
`
`In many embodiments, the first output gear may be coupled to a main shaft
`
`extending along and rotatable about an axis, and wherein the second and third output gears
`
`15
`
`are held within the main shaft and rotate with the main shaft about the axis.
`
`[0030]
`
`In many embodiments, the second output gear may be coupled to an first output
`
`shaft that extends within the main shaft, and the third output gear may be coupled to an
`
`second output shaft that extends within the main shaft.
`
`[0031]
`
`In many embodiments, the first, second, and third gear trains may be arranged along
`
`a common axis that is parallel with the camshaft.
`
`[0032] Many embodiments are directed to a method for shifting a transmission of a
`
`remotely controlled surgical apparatus. In the method, a transmission of a surgical device is
`
`shifted to engage one of a plurality of shiftable effector outputs to a surgical end effector of
`
`the surgical device. The surgical device may include a plurality of non—shiftable outputs. The
`
`surgical device may be connected to a remote controlled aim. The remote controlled arm
`
`may have a plurality of motors including a first motor for driving the transmission and a
`
`plurality of dedicated motors for driving the plurality of non—shiftable outputs. The one
`
`engaged shiftable effector output can be driven with the first motor to drive a corresponding
`
`effector mechanism of the surgical end effector.
`
`30
`
`[0033] Many embodiments are directed to a method in a surgical device comprising at least
`
`one of a first motor interface, a transmission, and an end effector comprising a first and a
`
`Ethicon Exhibit 2014.008
`
`Intuitive v. Ethicon
`
`lPR2018-01254
`
`Ethicon Exhibit 2014.008
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
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`PCT/U52015/023636
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`second component. The method includes operating the transmission in a first state, shifting
`
`the transmission from the first state to a second state, operating the transmission in the second
`
`state. and shifting the transmission from the second state to the first state. In the first state,
`
`the transmission couples the first motor interface to the first component of the end effector
`
`and decouples the first motor interface from the second component of the end effector. In the
`
`second state, the transmission couples the first motor interface with the second component of
`
`the end effector and decouples the first motor interface from the first component of the end
`effector.
`
`[0034]
`
`In many embodiments, at least one of the plurality of non-shiftable effector outputs
`
`of the surgical end effector may be driven using a dedicated motor.
`
`[0035]
`
`In many embodiments, shifting the transmission is caused by driving a camshaft of
`
`the transmission using a second motor.
`
`[0036]
`
`In many embodiments, driving the camshaft is caused by rotating the camshaft to
`
`sequentially engage one of a plurality of gear trains.
`
`[0037]
`
`In many embodiments, the camshaft is rotated to move a plurality of rocker arms
`
`that engage a plurality of gear trains of the transmission.
`
`[0038]
`
`In many embodiments, rotating the camshaft causes at least one of the non-engaged
`
`gear trains to become locked.
`
`[0039]
`
`In many embodiments, shifting can only occur sequentially along the plurality of
`
`gear trains.
`
`[0040]
`
`In many embodiments, the plurality of effector shiftable outputs includes a first
`
`shiftable output for actuating the roll DOF, and high force grip DOF, and a tool actuation
`
`DOF.
`
`[0041]
`
`In many embodiments, the wherein the plurality of dedicated DOFs comprises a
`
`[\3
`
`yaw DOF, pitch DOE, and a low force grip DOF.
`
`BRIEF DESCRIPTION OF TI IE DRAWINGS
`
`[0042] FIG. 1 is a plan view of a minimally invasive telesurgically controlled surgery
`
`system being used to perform a surgery, in accordance with many embodiments.
`
`Ethicon Exhibit 2014.009
`
`Intuitive v. Ethicon
`
`lPR2018-01254
`
`Ethicon Exhibit 2014.009
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
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`PCT/U52015/023636
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`[0043] FIG. 2 is a perspective view of a surgeon’s control console for a telesurgically
`
`controlled surgery system, in accordance with many embodiments
`
`[0044] FIG. 3 is a perspective View of a telesurgically controlled surgery system
`
`electronics cart, in accordance with many embodiments.
`
`[0045] FIG. 4 diagrammatically illustrates a telesurgically controlled surgery system, in
`
`accordance with many embodiments.
`
`[0046] FIG. 5A is a partial View of a patient side cart of a telesurgically controlled surgery
`
`system, in accordance with many embodiments.
`
`[0047] FIG. SB is a front view of a telesurgically operated surgery tool, in accordance with
`
`10
`
`many embodiments.
`
`[0048] FIG. 6 is a simplified schematic diagram of a telesurgically controlled surgery
`
`system surgical system, in accordance with many embodiments.
`
`[0049]
`
`FIGS. 7A—7H are longitudinal and axial cross—sections of a transmission assembly
`
`of a telesurgically operated surgery tool, in accordance with many embodiments.
`
`15
`
`[0050] FIG. 8 shows a cam state chart for operation of the of a transmission assembly of a
`
`telesurgically operated surgery tool, in accordance with many embodiments.
`
`DETAILED DESCRIPTION OF THE INVENTION
`
`[0051]
`
`In the following description, various embodiments of the present invention will be
`
`described. For purposes of explanation, specific configurations and details are set forth in
`
`order to provide a thorough understanding of the embodiments. However, it will also be
`
`apparent to one skilled in the art that the present invention may be practiced without the
`
`specific details. Furthermore, well—known features may be omitted or simplified in order not
`
`to obscure the embodiment being described.
`
`[0052]
`
`I. Minimally Invasive Teleassisted Surgery System
`
`[0053] Referring now to the drawings, in which like reference numerals represent like parts
`
`throughout the several views, FIG. 1 is a plan View illustration of a Minimally Invasive
`
`Robotic Surgical (MIRS) system 10, typically used for performing a minimally invasive
`
`diagnostic or surgical procedure on a Patient 12 who is lying down on an Operating table 14.
`
`The system can include a Surgeon’s Console 16 for use by a Surgeon 18 during the
`
`Ethicon Exhibit 2014.010
`
`Intuitive v. Ethicon
`
`lPR2018-01254
`
`Ethicon Exhibit 2014.010
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
`
`PCT/U52015/023636
`
`10
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`15
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`procedure One or more Assistants 20 may also participate in the procedure. The MlRS
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`system 10 can further include a Patient Side Cart 22 (surgical robot) and an Electronics
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`Cart 24. The Patient Side Cart 22 can manipulate at least one removably coupled tool
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`assembly 26 (hereinafter simply referred to as a “tool”) through a minimally invasive incision
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`in the body of the Patient 12 while the Surgeon 18 views the surgical site through the
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`Console 16. An image of the surgical site can be obtained by an endoscope 28, such as a
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`stereoscopic endoscope, which can be manipulated by the Patient Side Cart 22 to orient the
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`endoscope 28. The Electronics Cart 24 can be used to process the images of the surgical site
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`for subsequent display to the Surgeon 18 through the Surgeon’s Console 16.
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`'lhe number of
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`surgical tools 26 used at one time will generally depend on the diagnostic or surgical
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`procedure and the space constraints within the operating room among other factors. If it is
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`necessary to change one or more of the tools 26 being used during a procedure, an
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`Assistant 20 may remove the tool 26 from the Patient Side Cart 22, and replace it with
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`another tool 26 from a tray 30 in the operating room.
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`[0054] FIG. 2 is a perspective View of the Surgeon’s Console 16. The Surgeon’s
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`Console 16 includes a left eye display 32 and a right eye display 34 for presenting the
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`Surgeon 18 with a coordinated stereo View of the surgical site that enables depth perception.
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`The Console 16 further includes one or more input control devices 36, which in turn cause
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`the Patient Side Cart 22 (shown in FIG. 1) to manipulate one or more tools. The input
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`control devices 36 can provide the same degrees of freedom as their associated tools 26
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`(shown in FIG. 1) to provide the Surgeon with telepresence, or the perception that the input
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`control devices 36 are integral with the tools 26 so that the Surgeon has a strong sense of
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`directly controlling the tools 26. To this end, position, force, and tactile feedback sensors
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`(not shown) may be employed to transmit position, force, and tactile sensations from the
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`tools 26 back to the Surgeon’s hands through the input control devices 36.
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`[0055] The Surgeon’s Console 16 is usually located in the same room as the patient so that
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`the Surgeon may directly monitor the procedure, be physically present if necessary, and
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`speak to an Assistant directly rather than over the telephone or other communication medium.
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`However, the Surgeon can be located in a different room, a completely different building, or
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`30
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`other remote location from the Patient allowing for remote surgical procedures.
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`[0056] FIG. 3 is a perspective View of the Electronics Cart 24. The Electronics Cart 24 can
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`be coupled with the endoscope 28 and can include a processor to process captured images for
`
`Ethicon Exhibit 2014.011
`
`Intuitive v. Ethicon
`
`lPR2018-01254
`
`Ethicon Exhibit 2014.011
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
`
`PCT/U52015/023636
`
`10
`
`15
`
`subsequent display, such as to a Surgeon on the Surgeon’s Console, or on another suitable
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`display located locally and/or remotely. For example, where a stereoscopic endoscope is
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`used, the Electronics Cart 24 can process the captured images to present the Surgeon with
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`coordinated stereo images of the surgical site. Such coordination can include alignment
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`between the opposing images and can include adjusting the stereo working distance of the
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`stereoscopic endoscope. As another example, image processing can include the use of
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`previously determined camera calibration parameters to compensate for imaging errors of the
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`image capture device, such as optical aberrations
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`[0057] FIG. 4 diagrammatically illustrates a robotic surgery system 50 (such as MIRS
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`system 10 of FIG. 1). As discussed above, a Surgeon’s Console 52 (such as Surgeon’s
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`Console 16 in FIG. 1) can be used by a Surgeon to control a Patient Side Cart (Surgical
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`Robot) 54 (such as Patent Side Cart 22 in FIG. 1) during a minimally invasive procedure.
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`The Patient Side Cart 54 can use an imaging device, such as a stereoscopic endoscope, to
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`capture images of the procedure site and output the captured images to an Electronics Cart 56
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`(such as the Electronics Cart 24 in FIG. 1). As discussed above, the Electronics Cart 56 can
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`process the captured images in a variety of ways prior to any subsequent display. For
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`example, the Electronics Cart 56 can overlay the captured images with a virtual control
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`interface prior to displaying the combined images to the Surgeon Via the Surgeon’s
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`Console 52. The Patient Side Cart 54 can output the captured images for processing outside
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`the Electronics Cart 56. For example, the Patient Side Cart 54 can output the captured
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`images to a processor 58, which can be used to process the captured images. The images can
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`also be processed by a combination the Electronics Cart 56 and the processor 58, which can
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`be coupled together to process the captured images jointly, sequentially, and/or combinations
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`thereof. One or more separate displays 60 can also be coupled with the processor 58 and/or
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`the Electronics Cart 56 for local and/or remote display of images, such as images of the
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`procedure site, or other related images.
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`[0058]
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`FIGS. 5A and 5B show a Patient Side Cart 22 and a surgical tool 62, respectively.
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`The surgical tool 62 is an example of the surgical tools 26. The Patient Side Cart 22 shown
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`provides for the manipulation of three surgical tools 26 and an imaging device 28, such as a
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`30
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`stereoscopic endoscope used for the capture of images of the site of the procedure.
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`Manipulation is provided by robotic mechanisms having a number of robotic joints. The
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`imaging device 28 and the surgical tools 26 can be positioned and manipulated through
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`incisions in the patient so that a kinematic remote center is maintained at the incision to
`
`10
`
`Ethicon Exhibit 2014.012
`
`Intuitive v. Ethicon
`
`lPR2018-01254
`
`Ethicon Exhibit 2014.012
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
`
`PCT/U52015/023636
`
`minimize the size of the incision. Images of the surgical site can include images of the distal
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`ends of the surgical tools 26 when they are positioned within the field-of-view of the imaging
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`device 28. Each tool 26 is detachable from and carried by a respective surgical manipulator
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`31, which is located at the distal end of one or more of the robotic joints. The surgical
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`manipulator 31 provides a moveable platform for moving the entirety of a tool 26 with
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`respect to the Patient Side Cart 22, via movement of the robotic joints. The surgical
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`manipulator 31 also provides power to operate the tool 26 using one or more mechanical
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`and/or electrical interfaces. An example of such a carriage assembly is found at US. Patent
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`Publication No. US 2013/0325034, (Atty. Docket No. ISRG04330/US), which is
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`10
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`incorporated by reference
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`[0059] FIG. 6 is a simplified schematic diagram of a telesurgically controlled surgery
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`system surgical system 100. The surgical system 100 includes a surgeon console 102, which
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`for example can be the Surgeon’s Console 52. The surgeon console 102 drives a patient side
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`cart 104, which for example can be the Patient Side Cart 22. The patient side cart 104
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`15
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`includes a surgical manipulator 106, which for example can be the surgical manipulator 31.
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`[0060] The surgical manipulator 106 includes a motor unit 108 and a surgical tool 110.
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`The motor unit 108 is a caniage assembly that holds 5 motors. In some embodiments only 5
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`motors are used, while in other embodiments more or less than 5 motors can be used. Here,
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`the motor unit 108 includes a plurality of motors, which can be assigned to different
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`mechanisms. Here, the motor unit 108 includes a power motor 112, camshaft motor 114,
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`pitch motor 116, yaw motor 118, and low-force grip motor 120, although these motors can be
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`used for different purposes depending on the attached instrument. Generally, each motor is
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`an electric motor that mechanically and electrically couples with corresponding inputs of the
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`surgical tool 110. In some embodiments, the motor unit 108 may be located at a proximal
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`end of the surgical tool 110 in a shared chassis with the surgical tool, as generally depicted by
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`the proximal housing shown at FIG. 5B.
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`[0061] The tool 110 for example, can be the tool 26 described above. An example of a tool
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`usable as tool 110 is at Int’l. Pub. No. WO 2011/060318 (Attorney Docket No.:
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`ISRG02360/PCT), whi