WORLD INTELLECTUAL PROPERTY ORGANIZATION
`International Bureau
`
`
`
`PCT
`INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT)
`wo 98/2566?!
`
`(51) International Patent Classification 6 :
`A61M 37/00
`
`(11) International Publication Number:
`
`(43) International Publication Date:
`
`18 June 1998 (18.06.98)
`
`
`
`
`
`
`
`
`
`
`(21) International Application Number:
`PCT/U897/22035
`(81) Designated States: CA, JP, European patent (AT, BE, CH, DE,
`DK, ES, FI, FR, GB, GR, IE, IT, LU, MC, NL, PT, SE).
`
`Published
`With international search report.
`Before the expiration of the time limit for amending the
`claims and to be republished in the event of the receipt of
`amendments.
`
`(22) International Filing Date:
`
`12 December 1997 (12.12.97)
`
`(30) Priority Data:
`60/033,321
`
`12 December 1996 (12.12.96)
`
`US
`
`[US/US]; 1340
`INC.
`INTUITIVE SURGICAL,
`(71) Applicant:
`West Middlefield Road, Mountain View, CA 94303 (US).
`
`(72) Inventors: COOPER, Thomas, G.; 304 Concord Drive, Menlo
`Park, CA 94025 (US). PARSONS, Rodney, Lawrence, Jr.;
`1804 Thomas Road, Wilmington, DE 19803 (US). PATEL,
`Mona;
`111 Scotts Way, Wilmington, DE 19810 (US).
`SEITZ, Steven, Paul; 333 IIaverford Place, Swarthmore, PA
`19081 (US).
`
`(74) Agents: BARRISH, Mark, D. et a1.; Townsend and Townsend
`and Crew LLP, 8th floor, Two Embarcadero Center, San
`Francisco, CA 94111—3834 (US).
`
`
`
`(54) Title: MULTI—COMPONENT TELEPRESENCE SYSTEM AND METHOD
`
`(57) Abstract
`
`The present invention provides systems and methods for performing robotics assisted surgical procedures on a patient. In particular,
`a three component surgical system (2) is provided that includes a non—sterile drive and control component (40), a sterilized end effector or
`surgical tool (20), and an intermediate connector component (24) that includes mechanical elements for coupling the surgical tool (20) with
`the drive and control component (40), and for transferring motion and electrical signals therebetween. The drive and control component (40)
`is shielded from the sterile surgical site, the surgical tool (20) is sterilized and disposable and the intermediate connector (24) is sterilized
`and reusable. In this manner, the intermediate connector (24) can be sterilized after a surgical procedure without damaging the motors (170)
`or electrical connections within the drive and control component (40) of the robotics system.
`
`1
`
`Exhibit 1025
`Intuitive v. Ethicon
`|PR2018—01254
`
`1
`
`Exhibit 1025
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`
`
`FOR THE PURPOSES OF INFORMATION ONLY
`
`
`
`Codes used to identify States party to the PCT on the front pages of pamphlets publishing intemational applications under the PCT.
`SI
`Slovenia
`LS
`Lesotho
`ES
`Slovakia
`LT
`SK
`Lithuania
`FI
`SN
`LU
`FR
`Luxembourg
`Senegal
`SZ
`Swaziland
`LV
`Latvia
`GA
`MC
`Monaco
`TD
`Chad
`GB
`TG
`MD
`GE
`Togo
`Republic of Moldova
`MG
`GH
`TJ
`Tajikistan
`Madagascar
`MK
`TM
`Turkmenistan
`GN
`The former Yugoslav
`TR
`GR
`Turkey
`Republic of Macedonia
`TT
`Mali
`HU
`Trinidad and Tobago
`Ukraine
`UA
`IE
`Mongolia
`Mauritania
`UG
`IL
`Uganda
`Malawi
`US
`United States of America
`IS
`Uzbekistan
`Mexico
`UZ
`IT
`VN
`Viet Nam
`JP
`Niger
`YU
`KE
`Netherlands
`Yugoslavia
`Zimbabwe
`ZW
`KG
`Norway
`New Zealand
`KP
`Poland
`Portugal
`Romania
`Russian Federation
`Sudan
`Sweden
`Singapore
`
`
`
`ML
`MN
`MR
`MW
`MX
`NE
`NL
`NO
`NZ
`PL
`PT
`RO
`RU
`SD
`SE
`SG
`
`Albania
`Armenia
`Austria
`Australia
`Azerbaijan
`Bosnia and Herzegovina
`Barbados
`Belgium
`Burkina Faso
`Bulgaria
`Benin
`Brazil
`Belarus
`Canada
`Central African Republic
`Congo
`Switzerland
`C6te d’lvoire
`Cameroon
`China
`Cuba
`Czech Republic
`Germany
`Denmark
`Estonia
`
`Spain
`Finland
`France
`Gabon
`United Kingdom
`Georgia
`Ghana
`Guinea
`Greece
`Hungary
`Ireland
`Israel
`Iceland
`Italy
`Japan
`Kenya
`Kyrgyzstan
`Democratic People’s
`Republic of Korea
`Republic of Korea
`Kazakstan
`Saint Lucia
`Liechtenstein
`Sri Lanka
`Liberia
`
`KR
`KZ
`LC
`LI
`LK
`LR
`
`
`
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`WO 98/25666
`
`PCT/US97/22035
`
`MULTI-COMPONENT TELEPRESENCE
`
`SYSTEM AND NIETHOD
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`CROSS-REFERENCE TO RELATED APPLICATIONS
`
`This application is a continuation of, and claims
`
`the benefit of priority from, U.S. Provisional Patent
`
`Application Serial No. 60/033,321, filed December 12, 1996,
`
`the full disclosure of which is hereby incorporated by
`reference.
`
`BACKGROUND OF THE INVENTION
`
`This invention relates to robotically—assisted
`
`surgical manipulators and more particularly to systems and
`
`methods for performing telerobotic surgical procedures on a
`
`patient while providing the surgeon with the sensation of
`
`physical presence at the surgical site.
`
`In robotically-assisted or telerobotic surgery,
`
`the
`
`surgeon typically operates a master controller to remotely
`
`control the motion of surgical instruments at the surgical
`
`site from a location that may be remote from the patient
`
`(e.g., across the operating room,
`
`in a different room or a
`
`completely different building from the patient).
`
`The master
`
`controller usually includes one or more hand input devices,
`
`such as joysticks, exoskeletal gloves or the like, which are
`
`coupled to the surgical instruments with servo motors for
`
`articulating the instruments at the surgical site.
`
`The servo
`
`motors are typically part of an electromechanical device or
`
`surgical manipulator ("the slave")
`
`that supports and controls
`
`the surgical instruments that have been introduced directly
`
`into an open surgical site or through trocar sleeves into a
`
`body cavity, such as the patient's abdomen. During the
`
`operation,
`
`the surgical manipulator provides mechanical
`
`articulation and control of a variety of surgical instruments,
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`such as tissue graspers, needle drivers, electrosurgical
`
`cautery probes, etc.,
`
`that each perform various functions for
`
`the surgeon, e.g., holding or driving a needle, grasping a
`
`blood vessel, or dissecting, cauterizing or coagulating
`tissue.
`
`This new method of performing telerobotic surgery
`
`through remote manipulation has, of course, created many new
`
`challenges.
`
`One such challenge results from the fact that a
`
`portion of the electromechanical surgical manipulator will be
`
`in direct contact with the surgical instruments, and will also
`
`be positioned adjacent the operation site. Accordingly,
`
`the
`
`surgical manipulator may become contaminated during surgery
`
`and is typically disposed of or sterilized between operations.
`
`Of course,
`
`from a cost perspective, it would be preferable to
`
`sterilize the device. However,
`
`the servo motors, sensors,
`
`encoders and electrical connections that are necessary to
`
`robotically control the motors typically cannot be sterilized
`
`using conventional methods, e.g., steam, heat and pressure or
`
`chemicals, because they would be damaged or destroyed in the
`
`sterilization process.
`
`Yet another challenge with telerobotic surgery
`
`systems is that a surgeon will typically employ a large number
`
`of different surgical instruments during a procedure.
`
`Since
`
`the number of instrument holders are limited due to space
`
`constraints and cost, many of these surgical instruments will
`
`be attached and detached from the same instrument holder a
`
`number of times during an operation.
`
`In laparoscopic
`
`procedures, for example,
`
`the number of entry ports into the
`
`patient's abdomen is generally limited during the operation
`
`because of space constraints as well as a desire to avoid
`
`unnecessary incisions in the patient.
`
`Thus, a number of
`
`different surgical instruments will typically be introduced
`
`through the same trocar sleeve during the operation.
`
`Likewise,
`
`in open surgery,
`
`there is typically not enough room
`
`around the surgical site to position more than one or two
`
`surgical manipulators, and so the surgeon's assistant will be
`
`compelled to frequently remove instruments from the holder and
`
`exchange them with other surgical tools.
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`What is needed,
`
`therefore, are improved telerobotic
`
`systems and methods for remotely controlling surgical
`
`instruments at a surgical site on a patient. These systems
`
`and methods should be configured for easy sterilization so
`
`that they can be reused after the components have been
`
`contaminated during an operation.
`
`In addition,
`
`these systems
`
`and methods should be designed to minimize instrument exchange
`
`time during the surgical procedure.
`
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`SUMMARY OF THE INVENTION
`
`The present invention provides systems and methods
`
`for performing remote, robotically—assisted surgical
`
`procedures on a patient while providing the surgeon with the
`
`sensation of physical presence at the surgical site (i.e.,
`
`telepresence).
`
`In particular, a three—component surgical
`
`system is provided that includes a non—sterile drive and
`
`control component, a sterilizable end effector or surgical
`
`tool and an intermediate connector component that includes
`
`mechanical elements for coupling the surgical tool with the
`
`drive and control component, and for transferring motion from
`
`the drive component to the surgical tool.
`
`The drive and
`
`control component is shielded from the sterile surgical site,
`
`the surgical tool is sterilizable and disposable and the
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`
`intermediate connector is sterilizable and reusable.
`
`In this
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`manner,
`
`the intermediate connector can be sterilized after a
`
`surgical procedure without damaging the motors or electrical
`
`connections within the drive and control component of the
`
`robotic system.
`
`The drive and control component of the present
`
`invention generally includes the drive actuators, e.g.,
`
`motors, gears or pulleys, etc., and positioning devices that
`
`are necessary to articulate the surgical tool at the surgical
`
`site.
`
`In addition,
`
`the drive and control component will
`
`usually include the encoders and electrical connectors
`
`required to couple the component to a servomechanism to form a
`
`master/slave telerobotic surgical system.
`
`In a specific
`
`configuration of the invention,
`
`this component comprises a
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`manipulator assembly having a drive assembly and a multiple
`
`degree of freedom manipulator arm.
`
`The arm and drive assembly
`
`are covered by a sterile drape to effectively shield these
`
`components from the sterile surgical field during the
`
`operation.
`
`In this way,
`
`the portion of the system including
`
`motors, encoders and fragile electronics does not have to be
`
`sterilized because it is separated from the sterile field
`
`surrounding the surgical site.
`
`The intermediate connector includes a sterile
`
`adaptor that extends through an opening in the sterile drape
`
`to couple the sterile surgical tool with the manipulator arm.
`
`The adaptor includes a plurality of motion and electrical
`
`feed—throughs for articulating the surgical tool, and for
`
`sending electrical signals to and from the tool, e.g.,
`
`force
`
`and torque feedback signals, etc.
`
`In one configuration,
`
`the
`
`intermediate component
`
`includes a scope adaptor for coupling a
`
`viewing scope, such as an endoscope coupled to a camera mount
`
`and a camera,
`
`to the manipulator arm.
`
`In another
`
`configuration,
`
`the intermediate connector includes a surgical
`
`instrument assembly coupled to the sterile adaptor.
`
`The
`
`surgical instrument assembly will usually include a surgical
`
`tool, which may comprise a variety of articulated tools with
`
`end effectors, such as jaws, scissors, graspers, needle
`
`holders, micro dissectors, staple appliers,
`
`tackers, suction
`
`irrigation tools, clip appliers, or non—articulated tools,
`
`such as cutting blades, cautery probes,
`
`irrigators, catheters
`
`or suction orifices.
`
`In a preferred configuration,
`
`the surgical
`
`instrument assembly will further include a wrist unit for
`
`removably coupling the surgical tool to the adaptor on the
`
`manipulator assembly.
`
`The wrist unit comprises an elongate
`
`shaft with a distal wrist coupled to the surgical tool for
`
`providing articulation of the tool about the distal wrist.
`
`During a surgical procedure,
`
`the telerobotic system will
`
`usually include a variety of surgical instrument assemblies,
`
`each having a wrist unit with a different surgical tool
`
`attached.
`
`The wrist units can be quickly and easily coupled
`
`and decoupled from the manipulator assemblies to facilitate
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`instrument exchange during the procedure.
`
`In an exemplary.
`
`embodiment,
`
`the wrist unit is reposable, and it includes a
`
`mechanism for counting the number of times the wrist unit is
`
`used to inhibit further use of the unit.
`
`The manipulator assembly provides a plurality of
`
`degrees of freedom to the wrist unit and surgical tool
`
`including pitch and yaw movement of the tool about the wrist,
`
`rotation about
`
`the wrist shaft axis, axial movement and
`
`articulation of the end effector on the surgical tool.
`
`In
`
`addition,
`
`the manipulator assembly preferably provides pitch
`
`and yaw motion of the wrist unit and the surgical tool about
`
`axes perpendicular to the wrist shaft.
`
`The motors of the
`
`drive assembly are located proximally from the arm and the
`
`intermediate component, which facilitates cleaning, decreases
`
`the cost of manufacturing the assembly and decreases the
`
`inertia of the surgical tool and wrist unit.
`
`In a preferred
`
`configuration,
`
`the manipulator assembly will include a remote
`
`center positioning device, such as a parallelogram linkage,
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`for constraining motion of the wrist unit and/or surgical tool
`about a desired fixed center of rotation. This fixed center
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`of rotation may be located on the wrist unit shaft, at the
`
`distal wrist, or in endoscopic procedures, coincident with the
`
`entry incision within the patient's body.
`
`In an exemplary embodiment,
`
`the three—component
`
`surgical manipulator of the present invention is part of a
`
`telerobotic system in which the surgeon manipulates input
`
`control devices and views the operation via a displayed image
`
`from a location remote from the patient.
`
`The system includes
`
`a servomechanism coupled to one or more manipulator assemblies
`
`to control the wrist units and surgical tools in response to
`
`the surgeon's manipulation of the input control devices.
`
`Position, force, and tactile feedback sensors (not shown) may
`
`also be employed to transmit position,
`
`force, and tactile
`
`sensations from the surgical tools back to the surgeon's hands
`
`as he/she operates the telerobotic system.
`
`A monitor is
`
`coupled to the viewing scope such that the displayed image of
`
`the surgical site is provided adjacent the surgeon's hands.
`
`The image is preferably oriented so that the surgeon feels
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`that he or she is actually looking directly at the operating
`
`site. This configuration provides the surgeon with
`
`telepresence, or the perception that the input control devices
`
`are integral with the surgical tools.
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`BRIEF DESCRIPTION OF THE DRAWINGS
`
`Fig.
`
`1 is a schematic View of an operating room,
`
`illustrating a telerobotic surgical system and method
`
`according to the present invention.
`
`Fig.
`
`2 is an enlarged view of the operating room of
`
`Fig.
`
`1 illustrating a pair of mounting joints coupled to an
`
`operating table according to the present
`
`invention.
`
`Fig.
`
`3A is a perspective view of a robotic surgical
`
`manipulator according to the present invention that is
`
`partially covered by a sterile drape.
`
`Fig. 3B is a perspective view of the robotic
`
`surgical manipulator without the sterile drape to illustrate a
`
`multiple degree of freedom arm coupling a driving assembly
`
`with a wrist unit and a surgical tool.
`
`Fig. 4 illustrates the robotic surgical manipulator
`
`of Figs.
`
`3A—3B incorporating a camera and endoscope for
`
`viewing the surgical site.
`
`Fig.
`
`5 is a partial View of the robotic manipulator
`
`of Figs. 3A—3B,
`
`illustrating mechanical and electrical
`
`couplings between the arm and the wrist unit.
`
`Fig.
`
`6 is a partially cut-away sectional view of a
`
`forearm and a carriage of the manipulator of Figs 3a and 3B.
`
`Fig.
`
`7 is a perspective view of the wrist unit
`
`according to the present invention.
`
`Fig.
`
`8 is a side cross-sectional View of a portion
`
`of the robotic manipulator,
`
`illustrating the arm and the drive
`
`assembly.
`
`ESCRIPTION OF THE PREFERRED EMBODIMENT
`
`The present invention provides a multi—component
`
`system and method for performing robotically-assisted surgical
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`procedures on a patient, particularly including open surgical
`
`procedures, neurosurgical procedures, such as stereotaxy, and
`
`endoscopic procedures, such as laparoscopy, arthroscopy,
`
`thoracoscopy and the like.
`
`The system and method of the
`
`present invention is particularly useful as part of a
`
`telerobotic surgical system that allows the surgeon to
`
`manipulate the surgical instruments through a servomechanism
`
`from a remote location from the patient.
`
`To that end,
`
`the
`
`manipulator apparatus or slave of the present invention will
`
`usually be driven by a kinematically—equivalent master to form
`
`a telepresence system with force reflection.
`
`A description of
`
`a suitable slave-master system can be found in co—pending
`
`patent application Serial No. 08/517,053, filed August 21,
`
`1995 (Attorney Docket No. 287-004810),
`
`the complete disclosure
`
`of which is incorporated herein by reference.
`
`Referring to the drawings in detail, wherein like
`
`numerals indicate like elements, a telerobotic surgical
`
`system 2 is illustrated according to the present invention.
`
`As shown in Fig. 1,
`
`telerobotic system 2 generally includes
`
`one or more surgical manipulator assemblies 4 mounted to or
`
`near an operating table 0, and a control assembly 6 for
`
`allowing the surgeon S to View the surgical site and to
`
`control the manipulator assemblies 4.
`
`The system 2 will also
`
`include one or more viewing scope assemblies 19 and a
`
`plurality of surgical instrument assemblies 20 adapted for
`
`being removably coupled to manipulator assemblies 4
`
`(discussed
`
`in detail below). Telerobotic system 2 usually includes at
`
`least two manipulator assemblies 4 and preferably three
`
`manipulator assemblies 4. Of course,
`
`the exact number of
`
`manipulator assemblies 4 will depend on the surgical procedure
`
`and the space constraints within the operating room among
`
`other factors. As discussed in detail below, one of the
`
`assemblies 4 will typically operate a viewing scope assembly
`
`19 (in endoscopic procedures)
`
`for viewing the surgical site,
`
`while the other manipulator assemblies 4 operate surgical
`
`instruments 20 for performing various procedures on the
`
`patient P.
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`Control assembly 6 may be located at a surgeon's
`
`console C which is usually located in the same room as
`
`operating table 0 So that the surgeon may speak to his/her
`
`assistant(s) A and directly monitor the operating procedure.
`
`However, it will be understood that the surgeon S can be
`located in a different room or a completely different building
`
`from the patient P. Control assembly 6 generally includes a
`
`support 8, a monitor 10 for displaying an image of the
`
`surgical site to the surgeon S, and one or more
`
`controller(s) 12 for controlling manipulator assemblies 4.
`
`Controller(s) 12 may include a variety of input devices, such
`
`as joysticks, gloves,
`
`trigger—guns, hand—operated controllers,
`
`voice recognition devices or the like. Preferably,
`
`controller(s) 12 will be provided with the same degrees of
`
`freedom as the associated surgical
`
`instrument assemblies 20 to
`
`provide the surgeon with telepresence, or the perception that
`
`the controller(s) 12 are integral with the instruments 20 so
`
`that the surgeon has a strong sense of directly controlling
`
`instruments 20. Position, force, and tactile feedback sensors
`
`(not shown) may also be employed on instrument assemblies 20
`
`to transmit position,
`
`force, and tactile sensations from the
`
`surgical instrument back to the surgeon's hands as he/she
`
`operates the telerobotic system.
`
`One suitable system and
`
`method for providing telepresence to the operator is described
`
`in co-pending patent application Serial No. 08/517,053, filed
`
`August 21, 1995,
`
`(Attorney Docket No. 02878—004810), which has
`
`previously been incorporated herein by reference.
`
`Monitor 10 will be suitably coupled to the viewing
`
`scope assembly 19 such that an image of the surgical site is
`
`provided adjacent the surgeon's hands on surgeon console 6.
`
`Preferably, monitor 10 will display an inverted image on a
`
`display 18 that is oriented so that the surgeon feels that he
`
`or she is actually looking directly down onto the operating
`
`site.
`
`To that end, an image of the surgical instruments 20
`
`appears to be located substantially where the operator's hands
`
`are located even though the observation points (i.e.,
`
`the
`
`endoscope or viewing camera) may not be from the point of view
`
`of the image.
`
`In addition,
`
`the real-time image is preferably
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`transformed into a perspective image such that the operator
`
`can manipulate the end effector and the hand control as if
`
`viewing the workspace in substantially true presence.
`
`By true
`
`presence, it is meant that the presentation of an image is a
`
`true perspective image simulating the Viewpoint of an operator
`
`that is physically manipulating the surgical instruments 20.
`
`Thus, a controller (not shown)
`
`transforms the coordinates of
`
`the surgical instruments 20 to a perceived position so that
`
`the perspective image is the image that one would see if the
`
`camera or endoscope was located directly behind the surgical
`
`instruments 20.
`
`A suitable coordinate transformation system
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`for providing this virtual image is described in patent
`
`application Serial No. 08/239,086, filed May 5, 1994,
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`(Attorney Docket No. 02878—003300),
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`the complete disclosure of
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`which is incorporated herein by reference.
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`As shown in Fig. 1, a servomechanism 16 is provided
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`for transferring the mechanical motion of controllers 12 to
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`manipulator assemblies 4.
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`Servomechanism 16 may be separate
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`from, or integral with manipulator assemblies 4.
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`Servomechanism 16 will usually provide force and torque
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`feedback from the surgical instruments 20 to the hand—operated
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`controllers 12.
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`In addition, servomechanism 16 will include a
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`safety monitoring controller (not shown)
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`that may freeze or at
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`least inhibit all robot motion in response to recognized
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`conditions (e.g., exertion of excessive force on the patient,
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`"running away" of the manipulator assemblies 4, etc.).
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`The
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`servomechanism preferably has a servo bandwidth with a 3 dB
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`cut off frequency of at least 10 hz so that the system can
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`quickly and accurately respond to the rapid hand motions used
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`by the surgeon.
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`To operate effectively with this system,
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`manipulator assemblies 4 have a relatively low inertia and the
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`drive motors 170 (see Fig. 8) have relatively low ratio gear
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`or pulley couplings. Any suitable conventional or specialized
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`servomechanism may be used in the practice of the present
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`invention, with those incorporating force and torque feedback
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`being particularly preferred for telepresence operation of the
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`system.
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`Referring to Fig. 7, surgical instrument assemblies
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`20 each include a wrist unit 22 and a surgical tool 24
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`removably attached to wrist unit 22.
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`As discussed in detail
`
`below, each wrist unit 22 generally includes an elongate
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`shaft 56 having a proximal cap 58 and a distal wrist 60
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`pivotally coupled to surgical tool 24.
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`Each wrist unit 22 is
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`substantially the same, and will have different or the same
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`surgical tools 24 attached thereto, depending on the
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`requirements of the surgical procedure. Alternatively, wrist
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`units 22 may have specialized wrists 60 designed for
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`individual surgical tools 24 so that the wrist units 22 may be
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`used with conventional tools 24. As shown in Fig.
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`l,
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`the
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`instrument assemblies 20 are usually assembled onto a table T
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`or other suitable support adjacent
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`the operating table 0.
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`According to a method of the present
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`invention (described
`
`below), wrist units 22 and their associated surgical tools 24
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`can be quickly exchanged during the surgical procedure by
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`coupling and decoupling wrist unit shafts 56 from manipulator
`assemblies 4.
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`Referring to Fig. 2, each manipulator assembly 4 is
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`preferably mounted to operating table 0 by a mounting
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`joint 30. Mounting joints 30 provide a number of degrees of
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`freedom (preferably at least 5)
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`to assemblies 4, and they
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`include a brake (not shown)
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`so that assemblies 4 can be fixed
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`at a suitable position and orientation relative to the
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`patient.
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`Joints 30 are mounted to a receptacle 32 for
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`mounting joints 30 to operating table 0, and for connecting
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`each manipulator assembly 4 to servomechanism 16.
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`In
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`addition, receptacle 32 may connect joints 30 to other
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`systems, such as an RF electrical power source, a suction-
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`irrigation system, etc. Receptacle 32 includes a mounting arm
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`34 that is slidably disposed along an outer rail 36 of
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`operating table 0. Of course, manipulator assemblies 4 may be
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`positioned over the operating table 0 with other mechanisms.
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`For example,
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`the system may incorporate a support system
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`(coupled to the ceiling or a wall of the operating room)
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`that
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`moves and holds one or more manipulator assemblies 4 over the
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`patient.
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`Referring now to Figs. 3—8, manipulator assembly 4
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`will be described in further detail. Manipulator assembly 4
`
`is a three—component apparatus that includes a non—sterile
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`drive and control component, a sterilizable end effector or
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`surgical tool (i.e., surgical instrument assembly 20) and an
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`intermediate connector component.
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`The intermediate connector
`
`includes mechanical elements for coupling the surgical tool 24
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`with the drive and control component, and for transferring
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`motion from the drive component
`
`to the surgical tool 24. As
`
`shown in Fig. 3B,
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`the drive and control component generally
`
`includes a drive assembly 40 and a multiple degree of freedom
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`robotic arm 42 coupled to a mounting bracket 44, which is
`
`adapted for mounting onto mounting joints 30 (Fig. 2).
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`Preferably, drive assembly 40 and robotic arm 42 are pivotally
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`coupled to bracket 44 about an X—axis, which extends through a
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`remote center of spherical rotation 45 (see Fig. 8, discussed
`
`in further detail below). Manipulator assembly 4 further
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`includes a forearm assembly 46 fixed to a distal end 48 of
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`arm 42, and a wrist unit adaptor 52 coupled to forearm
`
`assembly 46 for mounting wrist unit 22 and surgical tool 24 to
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`manipulator assembly 4.
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`For endoscopic procedures, manipulator assembly 4
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`additionally includes a cannula adaptor 64 attached to a lower
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`portion of forearm 46 for mounting a cannula 66 to manipulator
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`assembly 4. Alternatively, cannula 66 may be an integral
`
`cannula (not shown)
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`that is built into forearm assembly 46
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`(i.e., non—removable). Cannula 66 may include a force sensing
`
`element
`
`(not shown), such as a strain gauge or force—sensing
`
`resistor, mounted to an annular bearing within cannula 66.
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`The force sensing bearing supports surgical tool 24 during
`
`surgery, allowing the tool to rotate and move axially through
`
`the central bore of the bearing.
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`In addition,
`
`the bearing
`
`transmits lateral forces exerted by the surgical tool 24 to
`
`the force sensing element, which is connected to
`
`servomechanism 16 for transmitting these forces to
`
`forces acting on surgical
`In this manner,
`controller(s) 12.
`tools 24 can be detected without disturbances from forces
`
`acting on cannula 66, such as the tissue surrounding the
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`surgical incision, or by gravity and inertial forces acting on
`
`manipulator assembly 4. This facilitates the use of
`
`manipulator assembly in a robotic system because the surgeon
`
`will directly sense the forces acting against the surgical
`tool 24.
`
`As shown in Fig. 3A, manipulator assembly 4 further
`
`includes a sterile drape 7O sized to cover substantially the
`
`entire manipulator assembly 4. Drape 70 has a pair of
`
`holes 72, 74 sized and arranged so that wrist unit adaptor 52
`
`and cannula adaptor 64 may extend through holes 72, 74 to
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`mount wrist unit 22 and cannula 66 to manipulator assembly 4.
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`Sterile drape 70 comprises a material configured to
`
`effectively shield manipulator assembly 4 from the surgical
`
`site so that most of the components of assembly 4 (i.e , arm
`
`42, drive assembly 40 and forearm assembly 46) do not have to
`
`be sterilized prior to, or following the surgical procedure.
`
`As shown in Fig. 3A, wrist unit adaptor 52 and
`
`cannula adaptor 64 extend through holes 72, 74 of drape 70 so
`
`that forearm assembly 46 and the remainder of manipulator
`
`assembly 4 remain shielded from the patient during the
`
`procedure. Wrist unit adaptor 52 and cannula adaptor 64 are
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`preferably manufactured as reusable components that will be
`
`sterilized because these components extend into the sterile
`
`field of the surgical site. Wrist unit and cannula adapters
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`52, 64 may be sterilized by normal methods, i.e., steam, heat
`
`and pressure, chemicals and the like. Referring again to Fig.
`
`3B, wrist unit adaptor 52 includes an opening 80 for receiving
`
`shaft 56 of wrist unit 22. As discussed in detail below,
`
`shaft 56 can be laterally urged through opening 80 and snap—
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`fit into adaptor 52 such that the non—exposed portion of wrist
`
`unit adaptor 52 remains sterile (i.e.,
`
`remains on the sterile
`
`side of drape 7O opposite the sterile field). Wrist unit
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`adaptor 52 may also include a latch (not shown)
`
`for securing
`
`wrist unit 22 therein. Similarly, cannula adaptor 64 includes
`
`an opening 82 for snap fitting cannula 66 thereto such that
`
`the non—exposed portion of adaptor 64 remains sterile during
`
`the surgical procedure.
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`As shown in Fig. 4, wrist unit adaptor 52 may also
`
`be configured to receive a viewing scope 100 for viewing the
`
`surgical site.
`
`For endoscopic procedures, viewing scope 100
`
`can be a conventional endoscope, which typically includes a
`
`rigid, elongated tube 102 containing a lens system (not shown)
`
`and a camera mount 104 at the proximal end of the tube 102.
`
`A small video camera 106 is preferably attached to the camera
`
`mount 104 and connected to video monitor 10 to provide a video
`
`image of the procedure. Preferably,
`
`the scope 100 has a
`
`distal end (not shown) configured to allow lateral or angled
`
`viewing relative to tube 102.
`
`The viewing scope may also have
`
`a guidable tip that can be deflected or rotated by
`
`manipulating an actuator on a proximal end of tube 102. This
`
`type of scope is commercially available from Baxter Healthcare
`
`Corp. of Deerfield, Illinois, or Origin Medsystems,
`
`Inc. of
`
`Menlo Park, California.
`
`As shown in Fig. 4, viewing scope 100 further
`
`includes a scope adaptor 110 for coupling viewing scope 100 to
`
`wrist unit adaptor 52.
`
`Scope adaptor 110 is sterilizable, ETO
`
`and autoclavable, and it includes a plurality of motion feed-
`
`throughs (not shown)
`
`for transferring motion from drive
`
`assembly 40 to scope 100.
`
`In the preferred configuration,
`
`the
`
`motion includes pitch and yaw motion, rotation about the Z—
`
`axis, and movement along the Z—axis.
`
`Referring now to Figs.
`
`5 and 6,
`
`forearm assembly 46
`
`will be described in further detail.
`
`As shown in Fig. 5,
`
`forearm assembly 46 includes a housing 120 fixed to arm 42 and
`
`a movable carriage 122 slidably coupled to housing 120.
`
`Carriage 122 slidably mounts wrist unit adaptor 52 to housing
`
`120 for moving wrist unit adaptor 52 and wrist unit 20 in the
`
`Z—direction.
`
`In addition, carriage 122 defines a number of
`
`openings 123 for transferring motion and electrical signals
`
`from forearm assembly 46 to wrist unit adaptor 52. As shown
`
`in Fig. 6, a plurality of rotatable shafts 124 are mounted
`
`within housing 120 for transferring motion from arm 42 through
`
`openings 123 to wrist unit adaptor 52 and wrist unit 22.
`
`Rotating shafts 124 preferably provide at least four degrees
`
`of freedom to wrist unit 22,
`
`including yaw and pitch motion of
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`surgical tool 62 about wrist 60 of wrist unit 22, rotation of
`
`wrist unit 22 about the Z—aXis and actuation of tool 62. Of
`
`course,
`
`the system may be configured to provide more or less
`
`degrees of freedom,
`
`if desired. Actuation of tool 62 may
`
`include a variety of motions, such as opening and closing
`
`jaws, graspers or scissors, applying clips or staples and the
`
`like. Motion of wrist unit 22 and tool 62 in the Z direction
`
`is provided by a pair of carriage cable drives 126 extending
`
`between rotatable pulleys 128, 129 on either end of
`
`forearm housing 120. Cable drives 126 function to mov