(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 2015/1 53642 Al
`8 October 2015 (08.10.2015) WIPO! PCT
`
`
`\a
`
`(51) International Patent Classification:
`A61B 19/06 (2006.01)
`(21) International Application Number:
`
`PCT/US2015/023636
`31 March 2015 (31.03.2015
`arch 2015
`(31.03.2015)
`English
`
`.
`ous
`.
`(22) International Filing Date:
`(25) Filing Language:
`a
`(26) Publication Language:
`(30) PriorityData:
`61/973,257
`
`31 March 2014 (31.03.2014)
`
`English
`
`US
`
`INTUITIVE SURGICAL. OPERATIONS,
`(71) Applicant:
`INC.
`[US/US]; 1020 Kifer Road, Sunnyvale, California
`94086 (US).
`
`(72)
`
`Inventors: BATLEY, David W.; 230 Wyndham Drive,
`Portola Valley, California
`94028
`(US). ROGERS,
`Theodore W.; 3240 Sterling Avenue, Alameda, California
`94501 (US). DEYANOY, Rumen; 34289 Gadwall Com-
`mon, Fremont, California 94555 (US). LATHROP, Ray;
`2013 24th Ave S., Nashville, Tconnessce 37212 (US).
`BRISSON, Gabriel F.; 405 Red Oak Ave. Apt. 307, Al-
`bany, California 94706 (US).
`
`(74) Agents: ALLENBY, Christopher B. et al.; Intuitive Sur-
`gical Opcrations, Inc., 1020 Kifer Road, Sunnyvale, Cali-
`fornia
`94086
`.
`omia 9
`(US)
`(81) 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, FE, 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, Mb, 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.
`.
`oo
`(84) Designated States (unless otherwise indicated, for every
`kind of regional protection available): ARIPO (BW, GH,
`GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, ST, SZ,
`TZ, UG, ZM, ZW), Eurasian (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, SL SK,
`SM, TR), OAPI (BE, BJ, CE, CG, CL, CM, GA, GN, GQ,
`GW, KM,ML, MR, NF, SN, TD, TG).
`Declarations under Rule 4.17:
`
`of inventorship (Rule 4.17(iv))
`
`{Continued on next page]
`
`(34) Title: SURGICAL INSTRUMENT WITH SHIFTABLE TRANSMISSION
`
`192() .
`
`(57) Abstract: A surgical tool having an elongated shaft having a proximal
`end and distal end. A surgical end elector is located about the distal end.
`The surgical end effectorhas a plurality of effector mechanisms comprising a
`plurality of degree of freedoms. An effector bodyis 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
`
`
`
`j
`188(II)~ f
`
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`190(H1)ft
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`wean
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`
`
`
`
`186(II)
`1gztil)
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`:
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`Tap)“
`1ga(iy we
`U
`183(II)
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`no 172(1N)
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`“agai
`
`176iII)
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`FIG, 7B
`
`Ethicon Exhibit 2014.001
`Intuitive v. Ethicon
`IPR2018-01254
`
`
`
`
`
`wo2015/153642A1[IIMATEMIINTIMTACTMANN
`
`Ethicon Exhibit 2014.001
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642 Aq IIMTUIMITIAINIAM CATA CATATAU
`
`Published:
`
`— with international search report (Art. 21(3))
`
`Ethicon Exhibit 2014.002
`Intuitive v. Ethicon
`IPR2018-01254
`
`Ethicon Exhibit 2014.002
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
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`PCT/US2015/023636
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`SURGICAL INSTRUMENT WITH SHIFTABLE TRANSMISSION
`
`CROSS-REFERENCES TO RELATED APPLICATIONS
`
`[0001]
`
`This application claims the benefit of U.S. Provisional Application No. 61/973,257,
`
`filed March 31, 2014, which is incorporated by reference herein.
`
`BACKGROUND OF THE INVENTION
`
`[0002] Minimally invasive medical techniques are intended to reduce the amount of
`
`extraneoustissue that is damaged during diagnostic or surgical procedures, thereby reducing
`
`patient recoverytime, 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
`
`15
`
`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] Minimallyinvasive telesurgical systems have been developedto increase a
`
`surgeon's dexterily and avoid someofthe limitations on traditional minimally invasive
`
`techniques. In telesurgery, the surgeon uses some form of remote control(¢.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 imageofthe surgicalsite al a surgical workstation. While viewing a
`
`(wo 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
`IPR2018-01254
`
`Ethicon Exhibit 2014.003
`Intuitive v. Ethicon
`IPR2018-01254
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`

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`master controllers and associated robotic arm and instrument assembliesis typically achieved
`
`through a control system. ‘he control system typically includesat least one processor that
`
`rclays 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 VINCI® system available from Intuitive Surgical, Inc. of
`
`Sunnyvale, California, USA.
`
`[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.S. 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 arrangementto hold an
`
`instrument having a shaft. Such a manipulator structure can constrain movementof the
`
`instrumentso 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.S. 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.
`
`10
`
`15
`
`[0006] A variety of structural arrangements can also be used to support and position the
`
`robotic surgical manipulator and the surgical instrumentat the surgical site during robotic
`
`surgery. Supporting linkage mechanisms, sometimesreferred 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 mechanismfacilitates the alignment of a
`
`surgical manipulator with a desired surgical incision point and targeted anatomy. Exemplary
`
`30
`
`supporting linkage mechanismsare described in U.S. Pat. Nos. 6,246,200 and 6,788,018,
`
`which are incorporated herein by reference.
`
`i)
`
`Ethicon Exhibit 2014.004
`Intuitive v. Ethicon
`IPR2018-01254
`
`Ethicon Exhibit 2014.004
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

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`[0007] While the newtelesurgical 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, newsurgical instruments are
`
`developed for use on existing telesurgical system platforms.
`
`‘Vhus, the instrumentis required
`
`to adaptto the telesurgical system, since developmentof a new telesurgical systemfor a
`
`particular surgical application is cost prohibitive. However, issues arise when existing
`
`telesurgical platforms do not have the required amount of motor outputsforall of the
`
`mechanismsof a particular surgical instrument.
`
`‘Thus, there is a need to adapt newsurgical
`
`devices to existing telesurgical systems without limiting the surgical capabilities and without
`
`10
`
`requiring modification to the existing telesurgical systems.
`
`BRIEF SUMMARYOF THE INVENTION
`
`[0008] Many embodimentsare directed to a surgical tool comprising an elongated shaft
`
`having a proximal end and distal end. A surgical end effector is located aboutthe distal end.
`
`The surgical end effector may includea plurality of effector mechanisms, each effector
`
`15
`
`mechanism having oneora plurality of degree of freedoms (DOI's). 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
`
`motorinterfaces may includea first motorinterface. 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 comprising an elongated shaft
`
`having a proximal end anddistal 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
`
`componentshasafirst end effector component and a second end effector component. A
`
`drive mechanismis located at the proximal end of the shaft. The drive mechanismhasa first
`motor interface and a transmission. The transmission includes a shift mechanism movable
`
`between afirst state and a secondstate. In the first state the first motor interface is coupled
`
`30
`
`via the transmissionto drive the first end effector component without driving the second end
`
`effector component. In the secondstate 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
`IPR2018-01254
`
`Ethicon Exhibit 2014.005
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
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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 betweenthefirst state and the secondstate.
`
`[0011]
`
`In many embodiments,the plurality of end effector components includesa third end
`
`effector component. The shift mechanism may be movableto a third state. In the first state
`
`and in the secondstate 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 maybe associated with a
`
`first end effector mechanical degree of freedom, and the second end effector componentis
`
`associated with a second end effector mechanical degree of freedom. The drive mechanism
`
`may include a second motorinterface 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 motorinterface coupled to drive a fifth end effector mechanical
`
`degree of freedom. Thefirst, 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 includesa 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 freedomof 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 betweenthe first state and the secondstate.
`
`[0016]
`
`In many embodiments, the shift mechanismmay include a rotatable camshaft,
`
`wherea first position of the camshaft correspondingto the first state, and a second position of
`
`the camshaft corresponding to the secondstate.
`
`[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
`IPR2018-01254
`
`Ethicon Exhibit 2014.006
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
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`[0018]
`
`In many embodiments, the transmission may include a rotatable camshaft. ‘The
`
`camshaft can includeafirst camshaft position for shifting coupling of the first motor interface
`
`to a first DOFofthe plurality of DOPs; a second camshaft position for shifting coupling of
`
`the first motor interface to a second DOHofthe plurality of DOFs; and a third camshaft
`
`position for shifting coupling of the first motor interface to a third DOFofthe 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
`
`[0020]
`
`In many embodiments, the plurality of DOFs further includes a fourth DOF coupled
`
`exclusively with the third motorinterface; a fifth DOF coupled exclusively with the fourth
`
`motor interface; and a sixth DOFcoupled exclusively with the fifth motorinterface.
`
`[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
`
`15
`
`pitch, yaw, and roll the gripping device with respect to the remotely controlled arm.
`
`[0022]
`
`In many embodiments, the first DOFis a mechanism for rolling the wrist; the
`
`second DOFis a mechanismfor actuating the surgical tool; the third DOFis a mechanism[or
`
`actuating the gripping device with high force relative to the sixth DOF; the fourth DOFis a
`
`mechanismfor causing the wrist to yaw; the fifth DOF is a mechanismfor causing the wrist
`
`to pitch; and the sixth DOFis 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 ofthe first, second, and third DOFs.
`
`[0025]
`
`In many embodiments, the transmission includesa first gear train for driving the
`
`first DOF, a second geartrain for driving the second DOF,and a third gear train for driving
`
`the third DOF.
`
`[0026]
`
`In many embodiments, the first gear rain includesa first input gear; a first oulput
`
`gear ullimately 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
`IPR2018-01254
`
`Ethicon Exhibit 2014.007
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
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`first locker arm moveably engaged with the camshaft for locking and unlocking thefirst
`
`output gear.
`
`[0027]
`
`In many embodiments, the second geartrain 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 outputgear.
`
`[0028]
`
`In many embodiments, the third gear train includesathird 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 andthird 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 wansmission 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 includea pluralily of non-shiftable outputs. The
`
`surgical device may be connected to a remote controlled arm.
`
`‘The remote controlled arm
`
`may havea 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 motorto drive a corresponding
`
`effector mechanism of the surgical end effector.
`
`30
`
`[0033] Many embodimentsare directed to a method in a surgical device comprising at least
`
`one ofa first motorinterface, a transmission, and an end effector comprising a first and a
`
`Ethicon Exhibit 2014.008
`Intuitive v. Ethicon
`IPR2018-01254
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`Ethicon Exhibit 2014.008
`Intuitive v. Ethicon
`IPR2018-01254
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`second component.
`
`‘The method includes operating the transmissionin afirst state, shifting
`
`the transmission from thefirst state to a second state, operating the transmission in the second
`
`state. and shifting the transmission from the secondstate 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 componentof the end effector. In the
`
`second state, the transmission couples the first motor interface with the second componentof
`
`the end effector and decouples the first motor interface fromthe first component of the end
`effector.
`
`[0034]
`
`In many embodiments, at least one of the plurality of non-shiftable effector outputs
`
`10
`
`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 oneofa plurality of geartrains.
`
`1
`
`5
`
`[0037]
`
`In many embodiments, the camshaft is rotated to movea 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 includesa 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
`
`woNn
`
`yaw DOF,pitch DOF, and a lowforce grip DOF.
`
`[0042] FIG.1is a plan viewof a minimally invasive telesurgically controlled surgery
`
`system being used to perform a surgery, in accordance with many embodiments.
`
`BRIEF DESCRIPTION OF THE DRAWINGS
`
`Ethicon Exhibit 2014.009
`Intuitive v. Ethicon
`IPR2018-01254
`
`Ethicon Exhibit 2014.009
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
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`[0043]
`
`FIG. 2 is a perspective viewof a surgeon’s control console for a telesurgically
`
`controlled surgery system, in accordance with many embodiments.
`
`[0044] FIG. 3 is a perspective viewof 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. 5Ais a partial view of a patient side cart of a telesurgically controlled surgery
`
`system, in accordance with many embodiments.
`
`[0047] FIG. 5B is afront 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-7Hare longitudinal and axial cross-sections of a transmission assembly
`
`ofa telesurgically operated surgery tool, in accordance with many embodiments.
`
`15
`
`[0050] FIG. 8 shows a camstate 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 representlike parts
`
`throughout the several views, FIG. 1 is a plan view illustration of a Minimally Invasive
`
`Robotic Surgical (MIRS) system10, 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
`IPR2018-01254
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`Ethicon Exhibit 2014.010
`Intuitive v. Ethicon
`IPR2018-01254
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`procedure. One or more Assistants 20 may also participate in the procedure.
`
`‘The MIRS
`
`system 10 can further include a Patient Side Cart 22 (surgical robot) and an Electronics
`
`Cart 24. The Patient Side Cart 22 can manipulate at least one removablycoupled tool
`
`assembly 26 (hereinafter simply referred to as a “tool”) through a minimally invasive incision
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`in the bodyof the Patient 12 while the Surgeon 18 viewsthe surgical site through the
`
`Console 16. An image ofthe surgical site can be obtained by an endoscope 28, such as a
`
`stereoscopic endoscope, which can be manipulated by the Patient Side Cart 22 to orient the
`
`endoscope 28. The Electronics Cart 24 can be used to process the images ofthe surgical site
`
`for subsequent display to the Surgeon 18 through the Surgeon’s Console 16. ‘lhe numberof
`
`10
`
`surgical tools 26 used at one time will generally depend on the diagnostic or surgical
`
`procedure and the space constraints within the operating room amongother factors. [f it is
`
`necessary to change one or moreof the tools 26 being used during a procedure, an
`
`Assistant 20 may removethe tool 26 fromthe Patient Side Cart 22, and replace it with
`
`another tool 26 from atray 30 in the operating room.
`
`15
`
`[0054] FIG. 2 is a perspective viewof the Surgeon’s Console 16. The Surgeon’s
`
`Console 16 includesa left eye display 32 and a right eye display 34 for presenting the
`
`Surgeon 18 with a coordinated stereo viewof the surgical site that enables depth perception.
`
`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 employedto transmit position, force, andtactile sensations from the
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`tools 26 back to the Surgeon’s hands through the input control devices 36.
`
`[0055]
`
`‘The Surgeon’s Console 16 is usually located in the same room asthe 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.
`
`However, the Surgeon can be located in a different room, a completely different building, or
`
`30
`
`other remote location from the Patient allowing for remote surgical procedures.
`
`[0056] FIG, 3 is a perspective viewof the Electronics Cart 24. The Electronics Cart 24 can
`
`be coupled with the endoscope 28 and can include a processorto process captured images for
`
`Ethicon Exhibit 2014.011
`Intuitive v. Ethicon
`IPR2018-01254
`
`Ethicon Exhibit 2014.011
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
`
`PCT/US2015/023636
`
`subsequent display, such as to a Surgeon on the Surgeon’s Console, or on another suitable
`
`display located locally and/or remotely. For example, where a stereoscopic endoscopeis
`
`used, the Electronics Cart 24 can process the captured imagesto present the Surgeon with
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`coordinated stereo images of the surgical site. Such coordination can include alignment
`
`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 cameracalibration parameters to compensate for imaging errors of the
`
`image capture device, such as optical aberrations.
`
`[0057] FIG. 4 diagrammatically illustrates a robotic surgery system 50 (such as MIRS
`
`10
`
`system 10 of FIG. 1). As discussed above, a Surgeon’s Console 52 (such as Surgeon’s
`
`Console 16 in FIG. 1) can be used by a Surgeon to control a Patient Side Cart (Surgical
`
`Robot) 54 (such as Patent Side Cart 22 in FIG. 1) during a minimally invasive procedure.
`
`The Patient Side Cart 54 can use an imaging device, such as a stereoscopic endoscope, to
`
`capture imagesof the procedure site and output the captured imagesto an Electronics Cart 56
`
`15
`
`(such as the Electronics Cart 24 in FIG, 1). As discussed above, the Electronics Cart 56 can
`
`process the captured images in a variety of ways prior to any subsequent display. For
`
`example, the Electronics Cart 56 can overlay the captured images with a virtual control
`
`interface prior to displaying the combined imagesto the Surgeon via the Surgeon’s
`
`Console 52. The Patient Side Cart 54 can output the captured images for processing outside
`
`the Electronics Cart 56. For example, the Patient Side Cart 54 can output the captured
`
`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 imagesjointly, sequentially, and/or combinations
`
`thereof. One or more separate displays 60 can also be coupled with the processor 58 and/or
`
`the Electronics Cart 56 for local and/or remote display of images, such as images of the
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`proceduresite, or other related images.
`
`[0058]
`
`FIGS. 5A and 5B show a Patient Side Cart 22 and a surgical tool 62, respectively.
`
`The surgical tool 62 is an example of the surgical tools 26. The Patient Side Cart 22 shown
`
`provides for the manipulation of three surgical tools 26 and an imaging device 28, such as a
`
`30
`
`stereoscopic endoscope used for the capture of imagesof the site of the procedure.
`
`Manipulation is provided by robotic mechanisms having a numberof robotic joints.
`
`‘The
`
`imaging device 28 and the surgical tools 26 can be positioned and manipulated through
`
`incisions in the patient so that a kinematic remote center is maintained at the incision to
`
`10
`
`Ethicon Exhibit 2014.012
`Intuitive v. Ethicon
`IPR2018-01254
`
`Ethicon Exhibit 2014.012
`Intuitive v. Ethicon
`IPR2018-01254
`
`

`

`WO 2015/153642
`
`PCT/US2015/023636
`
`minimize the size of the incision.
`
`Images of the surgical site can include imagesofthe distal
`
`ends ofthe surgical tools 26 when they are positioned within the field-of-view of the imaging
`
`device 28. Each tool 26 is detachable from and carricd by a respective surgical manipulator
`
`31, which is located at the distal end of one or more of the robotic joints. The surgical
`
`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 movementof the robotic joints.
`
`‘The surgical
`
`manipulator 31 also provides powerto operate the tool] 26 using one or more mechanical
`
`and/orelectrical interfaces. An example of such a carriage assembly is found at U.S. Patent
`
`Publication No. US 2013/0325034, (Atty. Docket No. ISRG04330/US), which is
`
`10
`
`incorporated by reference.
`
`[0059]
`
`FIG.6 is a simplified schematic diagram ofa telesurgically controlled surgery
`
`system surgical system 100. The surgical system 100 includes a surgeon console 102, which
`
`for example can be the Surgeon’s Console 52. The surgeon console 102 drives a patientside
`
`cart 104, which for example can be the Patient Side Cart 22. The patient side cart 104
`
`15
`
`includes a surgical manipulator 106, which for example can be the surgical manipulator 31.
`
`[0060]
`
`‘The surgical manipulator 106 includes a motor unit 108 and a surgical tool 110.
`
`‘The motor unit 108 is a carriage assembly that holds 5 motors. In some embodiments only 5
`
`motors are used, while in other embodiments more or less than 5 motors can be used. Here,
`
`the motor unit 108 includes a plurality of motors, which can be assigned to different
`
`mechanisms. Here, the motor unit 108 includes a power motor 112, camshaft motor114,
`
`pitch motor 116, yaw motor 118, and low-force grip motor 120, although these motors can be
`
`used for different purposes depending on the attached instrument. Generally, each motoris
`
`an electric motor that mechanically and electrically couples with corresponding inputs of the
`
`surgical tool 110. In some embodiments, the motor unit 108 may be located at a proximal
`
`end of the surgical tool 110 in a shared chassis with the surgical tool, as generally depicted by
`
`the proximal housing shown at FIG. 5B.
`
`[0061]
`
`‘The tool 110 for example, can be the tool 26 described above. An exampleofa tool
`
`usable as tool 110 is at Int’]. Pub. No. WO 2011/060318 (Attorney Docket No.:
`
`ISRG02360/PCT), which is incorporated by reference. Here, the tool 110 is an elongated
`
`30
`
`effector unit 122 that includes three discrete inputs that each mechanically couple with the
`
`pitch motor 116, yaw motor 118, and a low-force grip motor 120 by wayofthe surgical
`
`11
`
`Ethicon Exhibit 2014.013
`Intuitive v. Ethicon
`IPR2018-0