(12) United States Patent
`(10) Patent No.:
`US 6,783,524 B2
`
`Anderson et al.
`(45) Date of Patent:
`Aug. 31, 2004
`
`USOO6783524B2
`
`(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:
`
`( * ) Notice:
`
`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.
`
`(21) Appl. No.: 10/126,499
`
`(22)
`
`(65)
`
`(60)
`
`Filed:
`
`Apr. 13, 2002
`_
`.
`_
`Pr10r Publlcatlon Data
`Us 2002/0177843 A1 NOV. 28 2002
`7
`Related US. Application Data
`Provisional application No. 60/285,485, filed on Apr. 19,
`2001.
`
`
`(51)
`Int. Cl.7 ............ A61B 18/04
`
`(52) US. Cl. ....................... 606/28; 606/1
`
`(58) Field of Search
`.. 606/1—19, 49_52
`
`(56)
`
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`Primary Examiner—Roy D. Gibson
`Assistant Examiner—Pete Vrettakos
`(74) Attorney,
`Agent,
`Flrm—TOWIISCIld&TOWIlSeIld&CreWLLP,
`Cassell, Esq.
`
`Nathan
`
`0,,
`S.
`
`ABSTRACT
`(57)
`.
`.
`.
`.
`A surgical instrument for enhancmg 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 eifector 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.
`
`(List continued on next page.)
`
`19 Claims, 28 Drawing Sheets
`
`
`
`IS 1013
`
`IS 1013
`
`1
`
`

`

`US 6,783,524 132
`
`Page 2
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`
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`
`* cited by examiner
`
`2
`
`

`

`US. Patent
`
`Aug. 31, 2004
`
`Sheet 1 0f 28
`
`US 6,783,524 B2
`
`
`
`3
`
`

`

`US. Patent
`
`Aug. 31, 2004
`
`Sheet 2 0f 28
`
`US 6,783,524 132
`
`N.O_n_
`
`4
`
`

`

`US. Patent
`
`Aug. 31, 2004
`
`Sheet 3 0f 28
`
`US 6,783,524 132
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`m.OE
`
`5
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`

`

`US. Patent
`
`Aug. 31, 2004
`
`Sheet 4 0f 28
`
`US 6,783,524 B2
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`246
`
`(PRIORART) FIG4
`
`274
`
`6
`
`

`

`US. Patent
`
`Aug. 31, 2004
`
`Sheet 5 0f 28
`
`US 6,783,524 B2
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`
`
`(PRIORART) FIG5
`
`7
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`US 6,783,524 B2
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`1
`ROBOTIC 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
`CFR §1.78(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 1/2 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
`
`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
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`US 6,783,524 B2
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`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 US. Pat. No. 6,056,735 issued May 2, 2000, entitled
`Ultrasound Treatment System; US. Pat. No. 6,066,151
`issued May 23, 2000, entitled Ultrasonic Surgical Appara-
`tus; US. Pat. No. 6,139,561 issued Oct. 31, 2000, entitled
`Ultrasonic Medical Instrument; US. Pat. No. 6,165,191
`issued Dec. 26, 2000, entitled Ultrasonic Treating Tool; and
`US. 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 SonoSurg® instrument model
`T3070 made by Olympus Optical Co., Ltd., of Tokyo, Japan.
`Other examples of manually operated ultrasound treatment
`instruments are the Harmonic Scalpel® LaparoSonic®
`Coagulating Shears, made by Ethicon Endo-Surgery, Inc, of
`Cincinnati, Ohio.; and the AutoSonix® Ultra Shears® 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
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`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.
`invention
`In accordance with one aspect,
`the present
`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 eifector 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
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`US 6,783,524 B2
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`5
`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.
`
`interface assembly is engagable with
`The instrument
`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-
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`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.
`
`instru-
`In certain exemplary embodiments of surgical
`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.
`instru-
`In certain exemplary embodiments of surgical
`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 assem-
`bly may include at least one distal joint to controllably orient
`the distal probe end relative to the probe axis, such as a
`wrist-like rotational or pivotal joint supporting a distal end
`effector. In another example, the probe medial portion may
`have a flexible section which is controllably variable in
`shape by one or more degrees of freedom, being driveable
`by longitudinal tendon members extending within the instru-
`ment probe assembly.
`In these alternative embodiments, the instrument interface
`assembly is coupled to drive members of the instrument
`probe assembly to activate such degrees of freedom and is
`engagable with the robotic surgical system to receive acti-
`vation inputs to activate such drive members. Further
`examples of alternative instrument embodiments include
`instrument probe assemblies having controllable shape-
`memory components, movable piezo-electric drive
`elements, hydraulic drive elements, and the like, or combi-
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`US 6,783,524 B2
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`7
`nations of these. As describe above, the robotic activation
`input may include a corresponding activation modality suit-
`able for any of these instrument probe assembly movement
`modalities, without departing from the spirit of the inven-
`tion.
`
`To reduce costs and for manufacturing convenience, the
`instrument may include OEM parts. For example, the instru-
`ment probe assembly may include parts or components
`generally similar or identical to parts or components (OEM
`components) of current or future commercially-available
`endoscopic instruments for surgical or diagnostic uses
`(OEM medical systems),
`including manually operated
`instruments. The surgical instruments of the invention may
`perform some or all of the functions of such OEM medical
`systems. For example, the instrument probe assembly of the
`surgical
`instruments of the invention may include OEM
`components of ultrasound treatm