`Anderson et al.
`
`USOO6783524B2
`US 6,783,524 B2
`Aug. 31, 2004
`
`(10) Patent No.:
`(45) Date of Patent:
`
`(54) ROBOTIC SURGICAL TOOL WITH
`ULTRASOUND CAUTERIZING AND
`CUTTING INSTRUMENT
`
`(75) Inventors: Stephen C. Anderson, Northampton,
`MA (US); Christopher A. Julian, Los
`Gatos, CA (US)
`(73) Assignee: Intuitive Surgical, Inc., Sunnyvale, CA
`(US)
`Subject to any disclaimer, the term of this
`patent is extended or adjusted under 35
`U.S.C. 154(b) by 0 days.
`
`(*) Notice:
`
`(21) Appl. No.: 10/126,499
`(22) Filed:
`Apr. 18, 2002
`(65)
`Prior Publication Data
`
`... A61B 18/04
`... 606/28; 606/1
`... 606/1-19, 49–52
`
`US 2002/0177843 A1 Nov. 28, 2002
`Related U.S. Application Data
`(60) Provisional application No. 60/285.485, filed on Apr. 19,
`2001.
`(51) Int. CI.7.
`(52) U.S. Cl. ...............
`(58) Field of Search.
`(56)
`References Cited
`U.S. PATENT DOCUMENTS
`4,038,987 A 8/1977 Komiya
`4,149.278 A 4f1979 Frosch et al.
`4,281,447 A 8/1981 Miller et al.
`4,332,066 A 6/1982 Hailey et al.
`4,367.998 A
`1/1983 Causer
`4,486.928 A 12/1984 Tucker et al.
`4,500,065. A 2/1985 Hennekes et al.
`4,511,305 A 4/1985 Kawai et al.
`4,512,709 A 4f1985 Hennekes et al.
`4,706,372 A 11/1987 Ferrero et al.
`4,710,093 A 12/1987 Zimmer et al.
`4,744,363 A 5/1988 Hasson
`4,751,925 A 6/1988 Tontarra
`(List continued on next page.)
`
`
`
`WO
`WO
`WO
`WO
`WO
`WO
`
`FOREIGN PATENT DOCUMENTS
`WO 93/13916
`7/1993
`WO 94/26167
`11/1994
`WO95/16396
`6/1995
`WO95/30964
`11/1995
`WO 96/39944
`12/1996
`WO 99/50721
`10/1999
`
`OTHER PUBLICATIONS
`
`Madhani et al., “The black falcon: A teleoperated Surgical
`instrument for minimally invasive Surgery” (Submitted to
`IROS 1998) 9 pages total.
`
`(List continued on next page.)
`
`Of
`S.
`
`Nathan
`
`Primary Examiner Roy D. Gibson
`ASSistant Examiner-Pete Vrettakos
`(74) Attorney,
`Agent,
`Firm Townsend&Townsend&CrewLLP;
`Cassell, Esq.
`ABSTRACT
`(57)
`A Surgical instrument for enhancing robotic Surgery gener
`ally includes an elongate shaft with an ultrasound probe, an
`end effector at the distal end of the shaft, and a base at the
`proximal end of the shaft. The end effector includes an
`ultrasound probe tip and the Surgical instrument is generally
`configured for convenient positioning of the probe tip within
`a Surgical Site by a robotic Surgical System. Ultrasound
`energy delivered by the probe tip may be used to cut,
`cauterize, or achieve various other desired effects on tissue
`at a Surgical Site. In various embodiments, the end effector
`also includes a gripper, for gripping tissue in cooperation
`with the ultrasound probe tip. The base is generally config
`ured to removably couple the Surgical instrument to a robotic
`Surgical System and to transmit forces from the Surgical
`System to the end effector, through the elongate Shaft. A
`method for enhancing robotic Surgery generally includes
`coupling the Surgical instrument to a robotic Surgical System,
`positioning the probe tip in contact with tissue at a Surgical
`Site, and delivering ultrasound energy to the tissue.
`
`19 Claims, 28 Drawing Sheets
`
`Ethicon Exhibit 2004.001
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`US 6,783,524 B2
`Page 2
`
`U.S. PATENT DOCUMENTS
`Hodge
`Zuccaro et al.
`Choly et al.
`Jannborg
`Alikhan
`Kakazu et al.
`Walters
`Hoover
`Matsen, III et al.
`Nakamura
`Hutchinson et al.
`Kwoh
`Weynant
`Matsen, III et al.
`Bales et al.
`Wilk
`Chang
`Matsen, III et al.
`Nishi et al.
`Ota et al.
`McEwen et al.
`Naka et al.
`Raab
`Naumec
`Kortenbach et al.
`Davison et al.
`Joskowicz et al.
`Hardy et al.
`Tesar
`Slater et al.
`Lathrop, Jr. et al.
`Taylor
`Lavallee et al.
`Denen et al.
`Taylor
`Matsen, III et al.
`Funda et al.
`Depp
`Jacob
`Heckele et al.
`Smith et al. ............. 604/95.01
`Green
`Jensen et al. ............... 606/205
`Taylor et al.
`
`8/1988
`12/1988
`3/1989
`5/1989
`5/1989
`6/1989
`5/1990
`7/1990
`12/1990
`3/1991
`5/1991
`1/1992
`9/1992
`10/1992
`12/1992
`6/1993
`6/1993
`8/1993
`10/1993
`11/1993
`12/1993
`3/1994
`4/1994
`5/1994
`5/1994
`6/1994
`8/1994
`10/1994
`10/1994
`11/1994
`12/1994
`3/1995
`3/1995
`3/1995
`4/1995
`4/1995
`5/1995
`6/1995
`9/1995
`5/1996
`* 4/1997
`5/1997
`* 7/1997
`12/1997
`
`4,766,775
`4.793,053
`4,809.747
`4,830,569
`4,832,198
`4,837,703
`4,928,546
`4,943,939
`4,979,949
`4,996.975
`5,018.266
`5,078,140
`5,143,453
`5,154,717
`5,174,300
`5,217,003
`5,221.283
`5,236.432
`5.255.429
`5,257,998
`5,271,384
`5,294,209
`5,305,203
`5,312.212
`5,313,935
`5,322,055
`5,343,385
`5,354,314
`5,355,743
`5,359.993
`5,372,147
`5,397.323
`5,399.951
`5,400.267
`5,402,801
`5,403,319
`5,417,210
`5,427,097
`5,451,368
`5,520,678
`5,624,398
`5,631,973
`5,649.956
`5,695,500
`
`
`
`5,697,939 A 12/1997 Kubota et al.
`5,762,458 A 6/1998 Wang et al.
`5,792,135 A 8/1998 Madhani et al.
`5,797.900 A
`8/1998 Madhani et al.
`5,800.423 A 9/1998 Jensen
`5,808,665 A 9/1998 Green
`5,845,646 A 12/1998 Lemelson ................... 128/899
`5,876,325 A 3/1999 Mizuno et al.
`6,056,735 A
`5/2000 Okada et al. .................. 606/1
`6,058,323 A
`5/2000 Lemelson ................... 600/408
`6,066,151 A 5/2000 Miyawaki et al.
`6,096,033 A
`8/2000 Tu et al. ....................... 606/31
`6,129,735 A * 10/2000 Okada et al. ............... 606/169
`6,132,368 A 10/2000 Cooper
`6,139,561. A 10/2000 Shibata et al.
`6,165,191. A 12/2000 Shibata et al.
`6,193,709 B1
`2/2001 Miyawaki et al.
`6,280.407 B1
`8/2001 Manna et al.
`Mansouri–Ruiz ......... 604/95.01
`6,319.227 B1 *
`11/2001
`Tierney et al.
`6,331,181 B1
`12/2001
`5/2002
`6,394,998 B1
`Wallace et al.
`9/2002 Pantages et al. ............ 600/466
`6,454,717 B1 *
`12/2002 Tierney et al. .............. 606/130
`6,491,701 B2 *
`OTHER PUBLICATIONS
`Moyer, T.H., Thesis entitled “The design of an integrated
`hand and wrist mechanism' for Master of Science in
`Mechanical Engineering at the Massachusetts Institute of
`Technology (1992) pp. 1-106.
`Neisius et al., “Robotic manipulator for endoscopic handling
`of Surgical effectors and cameras” Proceedings of the First
`International Symposium on Medical Robotics and Com
`puter Assisted Surgery, vol. 2, Workshop (Part I & II)-Ses
`sion VI, pp. 169-175.
`Salisbury, J.K., "Kinematic and force analysis of articulated
`hands' Department of Computer Science, Stanford Univer
`sity, Report No. STAN-CS-89–921 (1982) Chapter 9, pp.
`67 77.
`Thring, “Robots and telechirs: Manipulators with memory;
`remote manipulators, machine limbs for the handicapped'
`(1993) M.W. Thring/Ellis Horwood Ltd. pp. 9-11, 122-131,
`194-195, 235-257, 274–279.
`* cited by examiner
`
`Ethicon Exhibit 2004.002
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 1 of 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.003
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 2 of 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.004
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 3 of 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.005
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 4 of 28
`
`US 6,783,524 B2
`
`5.
`
`
`
`
`
`s
`
`S.
`
`Ethicon Exhibit 2004.006
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 5 of 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.007
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`US 6,783,524 B2
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 6 of 28
`
`
`
`39/Z
`
`p=----------?
`
`
`
`
`
`
`
`
`
`9 (9)|–|
`
`
`
`LHV (JOIHd)
`
`Ethicon Exhibit 2004.008
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 7 of 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.009
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`US. Patent
`
`B
`
`6SU
`
`3
`
`2B
`
`NVN
`
`
`
`
`
`
`M.8“IIIN‘.w‘VAin:%...[WV/Liv.
`
`3.,Q§§fififl
`
`$4M“:‘A.§IflrmvuI23...»\navazarumm,........
`
`
`onellflwurMn/I.1???
`-M”mmmmmnmmmmmmmmm—mmmmmmmmmfl““ImmunuwJHII1HHHNW¢IIIMWIIJAII4¢ILH0\lmm\»-MnuflxmtlllliiJ.
`
`
`AllNNNNNRfifiF!—c,f'1r.uluflhdfluvfi
`.
`
`wvwmFN
`
`
`
`
`
`4Ia,mDE
`
`070,ER«5?:
`
`NON
`
`momn2mNew
`
`Ethicon Exhibit 2004.010
`
`Intuitive v. Ethicon
`
`lPR2018-01254
`
`Ethicon Exhibit 2004.010
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 9 of 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.011
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 10 0f 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.012
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 11 of 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.013
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 12 of 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.014
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 13 of 28
`
`US 6,783,524 B2
`
`
`
`
`
`
`
`Ethicon Exhibit 2004.015
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 14 of 28
`
`US 6,783,524 B2
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`| _ |
`
`Ethicon Exhibit 2004.016
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 15 0f 28
`
`
`
`Ethicon Exhibit 2004.017
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 16 of 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.018
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 17 0f 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.019
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 18 of 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.020
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 19 of 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.021
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 20 0f 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.022
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 21 of 28
`
`US 6,783,524 B2
`
`
`
`v
`CN
`CD
`
`Ethicon Exhibit 2004.023
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 22 of 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.024
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 23 of 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.025
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 24 of 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.026
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 25 0f 28
`
`US 6,783,524 B2
`
`
`
`Ethicon Exhibit 2004.027
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 26 of 28
`
`US 6,783,524 B2
`
`
`
`
`
`434a
`
`Ethicon Exhibit 2004.028
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 27 of 28
`
`US 6,783,524 B2
`
`586
`
`59
`
`6
`
`
`
`Ethicon Exhibit 2004.029
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`U.S. Patent
`
`Aug. 31, 2004
`
`Sheet 28 of 28
`
`US 6,783,524 B2
`
`
`
`
`
`
`
`-era f O N
`YZZZZZZZZZZZZZZZ
`Us Ag:
`as LSU 2
`466
`N
`
`Ethicon Exhibit 2004.030
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`1
`ROBOTC SURGICAL TOOL WITH
`ULTRASOUND CAUTERIZING AND
`CUTTING INSTRUMENT
`
`CROSS-REFERENCES TO RELATED
`APPLICATIONS
`This application claims the benefit of prior provisional
`application No. 60/285,485, filed on Apr. 19, 2001, under 37
`CFRS1.78(a)(4), the full disclosure of which is incorporated
`herein by reference.
`
`BACKGROUND OF THE INVENTION
`The present invention generally relates to Surgical appa
`ratus and methods. More specifically, the invention relates to
`a Surgical instrument and method for use with a robotic
`Surgical System, the instrument including an ultraSonic
`probe.
`Minimally invasive Surgical techniques generally reduce
`the amount of extraneous tissue damage during Surgical
`procedures, thereby reducing patient recovery time,
`discomfort, and deleterious side effects. One effect of mini
`mally 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 tech
`niques could save millions of dollars in hospital costs each
`year. Patient recovery times, patient discomfort, Surgical
`Side effects, and time away from work can also be reduced
`by increasing the use of minimally invasive Surgery.
`In theory, a significant number of Surgical procedures
`could potentially be performed by minimally invasive tech
`niques to achieve the advantages just described. Only a
`Small percentage of procedures currently use minimally
`invasive techniques, however, because certain instruments,
`Systems and methods are not currently available in a form
`for providing minimally invasive Surgery.
`Traditional forms of minimally invasive Surgery typically
`include endoscopy, which is visual examination of a hollow
`Space with a viewing instrument called an endoscope. One
`of the more common forms of endoscopy is laparoscopy,
`which is visual examination and/or treatment of the abdomi
`nal cavity. In traditional laparoscopic Surgery a patient's
`abdominal cavity is insufflated with gas and cannula Sleeves
`are passed through Small incisions in the musculature of the
`patient's abdomen to provide entry ports through which
`laparoscopic Surgical instruments can be passed in a Sealed
`fashion. Such incisions are typically about/3 inch (about 12
`mm) in length.
`The laparoscopic Surgical instruments generally include a
`laparoscope for viewing the Surgical field and working tools
`defining end effectors. Typical Surgical end effectors include
`clamps, graspers, Scissors, Staplers, and needle holders, for
`example. The working tools are Similar to those used in
`conventional (open) Surgery, except that the working end or
`end effector of each tool is separated from its handle by a
`long extension tube, typically of about 12 inches (about 300
`mm) in length, for example, So as to permit the Surgeon to
`introduce the end effector to the Surgical site and to control
`movement of the end effector relative to the Surgical Site
`from outside a patient's body.
`To perform a Surgical procedure, a Surgeon typically
`passes the working tools or instruments through the cannula
`sleeves to the internal Surgical Site and manipulates the
`instruments from outside the abdomen by Sliding them in
`
`15
`
`25
`
`35
`
`40
`
`45
`
`50
`
`55
`
`60
`
`65
`
`US 6,783,524 B2
`
`2
`and out through the cannula sleeves, rotating them in the
`cannula sleeves, levering (i.e., pivoting) the instruments
`against the abdominal wall and actuating the end effectors on
`distal ends of the instruments from outside the abdominal
`cavity. The instruments normally pivot around centers
`defined by the incisions which extend through the muscles
`of the abdominal wall. The Surgeon typically monitors the
`procedure by means of a television monitor which displayS
`an image of the Surgical site captured by the laparoscopic
`camera. Typically, the laparoscopic camera is also intro
`duced through the abdominal wall So as to capture the image
`of the Surgical Site. Similar endoscopic techniques are
`employed in, for example, arthroscopy, retroperitoneoScopy,
`pelviscopy, nephroscopy, cystoscopy, cisternoscopy,
`SinoScopy, hysteroscopy, urethroScopy, and the like.
`Although traditional minimally invasive Surgical instru
`ments and techniques like those just described have proven
`highly effective, newer Systems may provide even further
`advantages. For example, traditional minimally invasive
`Surgical instruments often deny the Surgeon the flexibility of
`tool placement found in open Surgery. Difficulty is experi
`enced in approaching the Surgical Site with the instruments
`through the Small incisions. Additionally, the added length
`of typical endoscopic instruments often reduces the Sur
`geon's ability to feel forces exerted by tissues and organs on
`the end effector. Furthermore, coordination of the movement
`of the end effector of the instrument as viewed in the image
`on the television monitor with actual end effector movement
`is particularly difficult, Since the movement as perceived in
`the image normally does not correspond intuitively with the
`actual end effector movement. Accordingly, lack of intuitive
`response to Surgical instrument movement input is often
`experienced. Such a lack of intuitiveness, dexterity and
`Sensitivity of endoscopic tools has been found to be an
`impediment in the increased the use of minimally invasive
`Surgery.
`Minimally invasive robotic (or “telesurgical”) surgical
`Systems have been developed to increase Surgical dexterity
`as well as to permit a Surgeon to operate on a patient in an
`intuitive manner. TeleSurgery is a general term for Surgical
`operations using Systems where 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 tools by hand. In Such a
`teleSurgery System, the Surgeon is typically provided with an
`image of the Surgical Site on a visual display at a location
`remote from the patient. The Surgeon can typically perform
`the Surgical procedure at the location remote from the patient
`whilst viewing the end effector movement on the visual
`display during the Surgical procedure. While viewing typi
`cally a three-dimensional image of the Surgical Site on the
`Visual display, the Surgeon performs the Surgical procedures
`on the patient by manipulating master control devices at the
`remote location, which master control devices control
`motion of the remotely controlled instruments.
`Typically, Such a teleSurgery System can be provided with
`at least two master control devices (one for each of the
`Surgeon's hands), which are normally operatively associated
`with two robotic arms on each of which a Surgical instru
`ment is mounted. Operative communication between master
`control devices and associated robotic arm and instrument
`assemblies is typically achieved through a control System.
`The control System typically includes at least one processor
`which relays input commands from the master control
`devices to the associated robotic arm and instrument assem
`blies and from the arm and instrument assemblies to the
`asSociated master control devices in the case of, e.g., force
`
`Ethicon Exhibit 2004.031
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`3
`feedback, or the like. One example of a robotic Surgical
`system is the DAVINCITM system available from Intuitive
`Surgical, Inc. of Mountain View, Calif.
`Just as robotic Surgical Systems have been found
`advantageous, So too has use of ultrasound energy in Surgery
`been found beneficial. A number of patents disclose ultra
`Sonic treatment instruments for both open Surgery and
`manually-performed endoscopic Surgery. These patents
`include U.S. Pat. No. 6,056,735 issued May 2, 2000, entitled
`Ultrasound Treatment System; U.S. Pat. No. 6,066,151
`issued May 23, 2000, entitled Ultrasonic Surgical Appara
`tus; U.S. Pat. No. 6,139,561 issued Oct. 31, 2000, entitled
`Ultrasonic Medical Instrument; U.S. Pat. No. 6,165,191
`issued Dec. 26, 2000, entitled Ultrasonic Treating Tool; and
`U.S. Pat. No. 6,193,709 issued Feb. 27, 2001, entitled
`Ultrasonic Treatment Apparatus. The full disclosure of each
`of these patents is incorporated herein by reference.
`A typical ultrasound treatment instrument for manual
`endoscopic Surgery is the SonoSurge instrument model
`T3070 made by Olympus Optical Co., Ltd., of Tokyo, Japan.
`Other examples of manually operated ultrasound treatment
`instruments are the Harmonic Scalpel(R) LaparoSonic(R)
`Coagulating Shears, made by Ethicon Endo-Surgery, Inc, of
`Cincinnati, Ohio.; and the AutoSonix E Ultra Shears(E) made
`by United States Surgical Corporation of Norwalk, Conn.
`Such an ultrasound treatment instrument may comprise
`ultraSonic transducers for generating ultraSonic vibrations, a
`handpiece including the ultrasonic transducers and Serving
`as an operation unit; a generally elongate probe connected to
`the ultraSonic transducers and Serving as a vibration con
`Veyer for conveying ultraSonic vibrations to a distal end
`effector member or tip used to treat a living tissue; a sheath
`Serving as a protective member for Shielding the probe. The
`instrument typically includes a movable holding, grasping or
`gripping end effector member pivotally opposed to the distal
`tip and constituting a movable Section which clamps a living
`tissue in cooperation with the distal tip; an operating mecha
`nism for moving the grasping member between a closed
`position in which the grasping member engages the distal tip
`of the vibration transmitting member and an open position in
`which the grasping member is separated from distal tip
`portion. The operating mechanism includes handle portions
`for manipulation and actuation by a Surgeon's hands.
`Surgical ultrasound instruments are generally capable of
`treating tissue with use of frictional heat produced by
`ultraSonic vibrations. For example, the heat may be use to
`cut and/or cauterize tissue. With many currently available
`instruments, tissue may first be grasped by an ultrasound
`Surgical device and then ultrasound energy may be delivered
`to the tissue to cut, cauterize or the like. Ultrasound instru
`ments provide advantages over other cutting and cauterizing
`Systems, Such as reduced collateral tissue damage, reduced
`risk of unwanted burns, and the like. Currently, however,
`ultrasound instruments for use with a robotic Surgical System
`are not available.
`Therefore, a need exists for a Surgical instrument, for use
`with a robotic Surgical System, that provides ultrasound
`energy at a Surgical site. Such an instrument would allow the
`advantages of ultrasound and minimally invasive robotic
`Surgery to be combined.
`BRIEF SUMMARY OF THE INVENTION
`Surgical apparatus and methods for enhancing robotic
`Surgery generally include a Surgical instrument with an
`elongate shaft having an ultrasound probe, an end effector at
`the distal end of the Shaft, and a base at the proximal end of
`
`15
`
`25
`
`35
`
`40
`
`45
`
`50
`
`55
`
`60
`
`65
`
`US 6,783,524 B2
`
`4
`the shaft. The end effector includes an ultrasound probe tip
`and the Surgical instrument is generally configured for
`convenient positioning of the probe tip within a Surgical Site
`by a robotic Surgical System. Ultrasound energy delivered by
`the probe tip may be used to cut, cauterize, or achieve
`various other desired effects on tissue at a Surgical Site. By
`providing ultrasound energy via a robotic Surgical instru
`ment for use with a robotic Surgical System, the apparatus
`and methods of the present invention enable the advantages
`associated with ultrasound to be combined with the advan
`tages of minimally invasive robotic Surgery.
`In accordance with one aspect, the present invention
`provides a method of performing a robotic Surgical proce
`dure on a patient. Generally, the method includes coupling
`a Surgical instrument with a robotic Surgical System, the
`Surgical instrument having a distal end with an ultrasound
`probe tip, positioning with the robotic Surgical System the
`ultrasound probe tip in contact with tissue at a Surgical Site
`in the patient, and delivering ultrasound energy to the tissue
`with the ultrasound probe tip. Optionally, the distal end of
`the Surgical instrument further includes a gripping member.
`In embodiments including a gripping member, the method
`further includes transmitting at least one force from the
`robotic Surgical System to the gripping member and moving
`the gripping member with the at least one force to hold a
`portion of the tissue between the gripping member and the
`ultrasound probe tip.
`In Some embodiments, the method further includes trans
`mitting the at least one force from an interface member on
`the robotic Surgical System to a first rotatable shaft on the
`Surgical instrument, the first rotatable shaft being coupled to
`a Second rotatable shaft by a cable, the cable being coupled
`to an actuator rod, and the actuator rod being coupled to the
`gripping member, wherein the at least one force causes the
`first shaft, the Second shaft and the cable to rotate, causing
`the actuator rod to move the gripping member. In other
`embodiments, the method further includes releasing the
`portion of tissue after delivering a desired amount of ultra
`Sound energy to the portion of tissue. In various
`embodiments, the method also includes using the ultrasound
`probe tip to cut the tissue, cauterize the tissue, or both.
`In another aspect, the present invention provides a Surgi
`cal instrument for use with a robotic Surgical System.
`Generally, the Surgical instrument includes an elongate shaft
`having a proximal end and a distal end, the elongate Shaft
`including an ultrasound probe, an end effector disposed at
`the distal end, the end effector including an ultrasound probe
`tip of the ultrasound probe, and a base disposed at the distal
`end for connecting the Surgical instrument to the robotic
`Surgical System. Optionally, the elongate Shaft may be
`configured to rotate in relation to the base about an axis
`drawn from the proximal end to the distal end.
`Also optionally, the base of the Surgical instrument may
`include: at least two shafts rotatably mounted within the
`base, each of the Shafts having two ends, at least one of the
`ends of one of the Shafts protruding from the base to engage
`a corresponding interface member on the robotic Surgical
`System; at least two spools, each spool being mounted on
`one of the Shafts, at least one cable for connecting two of the
`Spools, and a rotating member coupled to the cable and to
`the elongate shaft, the rotating member being configured to
`rotate the elongate shaft in response to movements of the
`interface member, the at least two shafts, the at least two
`Spools and the at least one cable.
`In Some embodiments, the end effector of the Surgical
`instrument includes a gripping member hingedly attached to
`
`Ethicon Exhibit 2004.032
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`S
`the end effector for gripping tissue in cooperation with the
`ultrasound probe tip. In those embodiments, the Surgical
`instrument may optionally include at least one force trans
`mitting member for transmitting one or more forces between
`the robotic Surgical System and the gripping member to
`move the gripping member. In various embodiments, the
`transmitting member may include: at least two shafts rotat
`ably mounted within the base, each of the shafts having two
`ends, at least one of the ends of one of the Shafts protruding
`from the base to engage a corresponding interface member
`on the robotic Surgical System; at least two spools, each
`Spool being mounted on one of the Shafts, at least one cable
`for connecting two of the Spools, and an actuator rod
`coupled to the cable and to the gripping member and
`extending through the elongate shaft, the actuator rod being
`configured to move the gripping member in response to
`movements of the interface member, the at least two shafts,
`the at least two spools and the at least one cable.
`In Some embodiments, the base of the Surgical instrument
`includes an ultrasound Source connector for connecting the
`ultrasound probe to an external ultrasound Source. In other
`embodiments, the base includes an internal ultrasound
`Source for providing ultrasound energy to the ultrasound
`probe.
`Generally, the ultrasound probe of the Surgical instrument
`may include various components. For example, in one
`embodiment the probe includes an ultrasound transducer for
`generating ultraSonic vibrations and one or more amplifying
`horns for amplifying the ultrasonic vibrations.
`In Some embodiments, the ultraSonic probe assembly may
`be arranged to be axially movable within the elongate shaft,
`and the proximal portion of the probe may be mechanically
`coupled to one or more movable interface members So that
`the probe is movable in a reciprocating manner in response
`to movement of the interface member. The distal portion of
`the probe assembly may be coupled to the grip member, So
`that the grip opens or closes as the probe moves axially. In
`this manner the movable probe assembly may serve the
`function of a grip actuator rod in addition to transmitting
`ultrasound energy to the Surgical Site.
`Certain exemplary Surgical instrument embodiments hav
`ing aspects of the invention may be described or character
`ized in general terms as comprising an instrument probe
`assembly having a distal end configured to be insertable into
`a patient's body through a Small aperture, Such as a mini
`mally invasive Surgical incision or the like, typically defined
`by a cannula or trocar. The instrument probe assembly
`comprises a proximal end coupled to an instrument base.
`The instrument probe assembly typically is elongate, having
`an axis extending between the distal and proximal probe
`ends, and may have a generally Straight or shaft-like medial
`portion. In alternative embodiments, the medial probe por
`tion may be curved and/or may be flexible in shape relative
`to the axis. The instrument base includes an instrument
`interface assembly which is engagable to a robotic Surgical
`system. Preferably, the instrument interface assembly is
`removably engageable to the robotic Surgical System, and
`may include a latch mechanism permitting quick connection
`and disconnection.
`The instrument interface assembly is engagable with
`provides for one or more instrument actuation inputs from
`the robotic Surgical System in response to an input by an
`operator (i.e., an activation input to the instrument, being an
`activation output from the robotic Surgical System, which in
`turn is a response by the robotic control System to an
`operator control input). Preferably the one or more instru
`
`15
`
`25
`
`35
`
`40
`
`45
`
`50
`
`55
`
`60
`
`65
`
`US 6,783,524 B2
`
`6
`ment activation inputs include an input to activate at least
`one degree of freedom of motion of the all or a portion of the
`instrument probe assembly relative to the instrument base.
`The activation input may be a mechanical input, an electrical
`input, a magnetic input, a Signal input, an optical input, a
`fluidic input, a pneumatic input, and the like, or a combi
`nation of these, without departing from the Spirit of the
`invention.
`In certain exemplary embodiments of Surgical instru
`ments having aspects of the invention, at least one activation
`input includes an operative engagement of a rotatable inter
`face body (activation interface body) of the robotic Surgical
`System with a corresponding rotatable shaft (instrument
`interface body or instrument interface shaft) of the instru
`ment interface assembly in the instrument base. The rotat
`able Shaft is in turn mechanically coupled by one or more
`drive elements to all or a portion of the to the instrument
`probe assembly, So as to impart a corresponding degree of
`freedom to all or a portion of the instrument probe assembly
`relative to the base.
`AS described above, in alternative embodiments another
`type of activation modality may be substituted for the
`rotatable interface body of the robotic Surgical system. For
`example, an electrical power/control interface (e.g., includ
`ing a multi-pin connector) may be included in the interface
`assembly to transmit electrical power and/or control Signals
`from the robotic Surgical System to actuate a motor pack
`mounted in the instrument base, the motor pack output may
`in turn may be coupled to the instrument probe assembly So
`as to impart one or more corresponding degrees of freedom
`to all or portions of the instrument probe assembly relative
`to the base. The motor pack may include one or more
`electrical motors, transmission gearing, position encoders,
`torque Sensors, feedback Sensors, and the like, and may
`transmit feedback or Sensor Signals to the robotic Surgical
`System via the interface.
`In certain exemplary embodiments of Surgical instru
`ments having aspects of the invention, the at least one degree
`of freedom of motion in response to an activation input from
`the robotic Surgical System includes the pivotal activation of
`a clamp or grip member of an end effector coupled to the
`distal probe end. In certain exemplary embodiments, the at
`least one degree of freedom of motion includes the axial
`rotation of at least the major portion of the instrument probe
`assembly about its axis relative to the instrument base.
`In alternative embodiments other types of degrees of
`freedom of motion of all or a portion of the instrument probe
`assembly may be activated by engagement of the robotic
`Surgical System. For example, the instrument probe asse