US 20080243141 A1
Surgical instruments are disclosed in which an elongated shaft is used in conjunction with a separate, remotely actuable tool head for performing a procedure on a target tissue. The shaft has a tool engagement member carried at its distal end that is remotely actuable through the shaft to engage and release the tool head.
1. A surgical instrument comprising:
an elongated shaft having a proximal end and a distal end;
a separate tool head for performing a procedure on a target tissue, the tool head being remotely actuable, and
a tool head engagement member carried at the distal end of the shaft, the engagement member being remotely actuable to engage and release the tool head.
2. The surgical instrument of
3. The surgical instrument of
4. The surgical instrument of
5. The surgical instrument of
6. The surgical instrument of
7. The surgical instrument of
8. The surgical instrument of
9. The surgical instrument of
10. A tool head for performing a medical procedure for use in combination with a surgical device having a shaft and a pair of jaws on the distal end of the shaft, the tool head comprising a clamping surface for engagement by the jaws of the forceps and a tether extending from the head and separate from the surgical device for actuating the tool head.
11. The tool head of
12. The tool head of
13. The tool head of
14. The tool head of
15. The tool head of
16. The tool head of
17. A method for performing a medical procedure in a surgical field comprising:
creating access to the surgical field;
introducing into the surgical field at least first and second remotely actuable toot heads for performing various aspects of the medical procedure;
introducing into the surgical field a first control arm having a distal end with a tool head engagement member associated therewith;
engaging the first tool head with the tool head engagement member of the first control arm;
positioning the first tool head and remotely actuating the tool head to perform a step of medical procedure;
releasing the first tool head from the tool head engagement member of the first control arm;
engaging the second tool head with the tool head engagement member of the first control arm without removing the engagement member from the surgical field; and
positioning the second tool head and remotely actuating the second tool head to perform a step of the medical procedure.
18. The method of
introducing into the surgical field a second control arm comprising a distal end with a tool head engagement member associated therewith;
simultaneously engaging a selected one of the first and second tool heads with the tool head engagement members of both control arms; and
releasing the selected tool head from the first control arm.
19. The method of
20. The method of
21. The method of
22. The method of
23. A surgical instrument comprising
a tool head;
a tether attached to the tool head for actuating the tool head, and
at least one engagement surface adapted to interface with a separate control arm.
24. The surgical instrument of
This application claims the benefit of U.S. Provisional Patent Application Ser. No. 60/909,666, filed Apr. 2, 2007, which is incorporated herein by reference.
The present application is related to surgical instruments and, more specifically but not exclusively, to robotic surgery instruments and methods for their use. Specifically, the present application relates to the provision of a plurality of specially configured tool heads for use with a control arm, which may be a robotic arm of a robotic surgical instrument, having an elongated shaft and preferably an articulatable “wrist” or articulation joint located at its distal or working end.
The tool heads disclosed and described herein are particularly, but not exclusively, suited for use in cardiac ablation procedures for the treatment of atrial fibrillation using electro-surgical RF energy, or some other energy, as shown and described for example in U.S. Pat. No. 6,546,935, which is incorporated herein by reference.
During the performance of cardiac ablation procedures, various instruments may be used to create transmural lines of ablation in tissue, such as an ablation clamp having opposed jaw members having opposed electrodes thereon, an ablation “pen” and a surgical dissector. Such instruments are shown generally in U.S. Pat. No. 7,113,831 and U.S. Published Application 2006/0084974 (showing an ablation clamp with opposed jaw members), U.S. Published Applications 2006/0161147 and 2006/0161149 (both showing an ablation pen), and U.S. Published Application 2005/0203561 (showing a lighted dissector), all of which are incorporated herein by reference. In another procedure, a clip may be applied externally to the left atrial appendage (LAA) to reduce the risks of clot generation associated with the LAA. Such a clip and clip applicator are shown in U.S. application Ser. No. 12/033,935, filed Feb. 20, 2008, which is also incorporated herein by reference. Each of the aforementioned devices or tools is typically carried on its own dedicated hand piece and a shaft, with the operating head at the distal end thereof.
By way of the present application, tools for performing cardiac ablation and other procedures are provided as discrete interchangeable independent devices or tool heads that are intended to be used with a control arm, such as a robotic arm or a durable, e.gs, reusable, arm. The tool heads are provided with a tether connected directly thereto to provide for actuation of the tool head. (As used herein, “actuation” or “actuable” are broadly understood to mean energizing or controlling the tool head mechanically, hydraulically, pneumatically, thermally, or activating a light/laser/light pipe/fiber optic, or providing a vacuum/suctionor fluid delivery and the like, as well as combinations thereof,) Specifically, each of the tool heads may include at least one gripping or clamping surface designed to be carried by the jaws of a forceps or grasper mounted to the distal end of the shaft of the control arm. The tool head may be removably mounted to the control arm in any of a variety of ways described below, or by other mounting arrangements.
The actuation and/or energizing means for generating movement is preferably connected to the tool head separate from the control arm in a manner that permits remote actuation/energization of the tool head, (i.e. external to the body) independent of the control arm after the tool heads have been introduced, for example, by minimally invasive means, to a surgical site interior of the body.
Because the tool head is completely independent from the control arms, the tool head may be passed from one control arm to another control arm, or exchanged between control arms, and the various tools may be selectively grasped by the control arm to permit instrument exchanges during procedures. The tool heads may be introduced either through the same access port as the control arm or through a separate access port, into the surgical site. Thus, in a procedure, all of the tool heads needed for the procedure may be separately introduced into proximity of the surgical site, such as into a cavity at the start of the procedure and be readily available for use in connection with one or more control arms.
In one embodiment, the tool heads are provided with an extending or fin-like surface for gripping by jaws of a control arm. Preferably, the fins are made of a material having some compressibility, which allows the jaws of control arm forceps to better grip and hold the tool head.
Additionally, or alternatively, the fin and the forceps may be formed with complementarily-shaped interfitting surfaces that mate when the tool is gripped by the forceps. Such surfaces may be shaped to provide selected alignment of the tool with respect to the forceps. In one embodiment, for example, the jaws of the forceps of the control arm have an open or relieved interior or apertures or fenestrations and the gripping surfaces of the tool heads may be formed with one or more complementarily-shaped protrusion that is received within the fenestration interior of the jaws.
In a further alternative, these surfaces may be reversed, and the gripping or clamping surface may comprise a pocket or aperture that receives the closed jaws or projecting surfaces thereof and may be grasped by moving the jaws toward their open position.
As another option, the tool heads may be formed with two or more gripping surfaces, which permits a tool head to be simultaneously held by two or more control arms so that the tool head can be passed from a first control arm to a second control arm, and allows for both control arms to work in unison.
With reference to
The illustrated robotic arm 10 includes an elongated shaft 12 and a wrist-like articulation mechanism 14 at its distal end, A housing 16 at the proximal end of the assembly 10 couples the assembly to the telesurgical system. The housing 16 contains the mechanism for controlling (e.g., rotating) the shaft 12, articulating the wrist 14, and actuating a forceps 18 mounted to the wrist mechanism 14 carried on the distal end of the shaft 12. The illustrated forceps 18 is known as a cardiere forceps in which the jaws 20 are fenestrated, or otherwise have an opening or relief in their gripping surface. Preferably, and as shown, the gripping surfaces of the jaws are serrated.
With reference to
Because the activation sources for the tool head are separate from the control arm, the tool head may be exchanged between different control arms, the tool head may be released from the control arm and a different tool head attached, and multiple tool heads may be preselected and placed in or near the surgical site for user convenience. This feature has particular benefit in a minimally invasive surgery in that, for example, the tool heads expected to be needed for a selected surgery may be inserted in to the body cavity, creating what may be referred to as a tool kit or tool chest within the body cavity, and the surgeon or robotic instrument may use a single control arm for grasping and using each tool head, as needed, without the need for repeatedly removing the control to exchange or replace tools as needed. Further, the tool heads may be for one-time use only and disposable, with the control arm, and any associated articulation control mechanism, being reusable, if so desired.
To facilitate the grasping of the individual tool head 22 by the grasper 18, the tool head 22 may be provided, in one embodiment, with a clamping surface 30. Specifically, the illustrated clamp carries a generally flat or fin-like protrusion on the side of the tool opposite the jaw members 24, 26, although other configurations for the clamping surface or other arrangements other than a clamping surface are also contemplated. In order to enhance the grip of the jaws on the clamping surface, the fin 30 has opposed protrusions 32 sized and shaped to fit into the fenestrations 20a on the jaws 20 of the forceps 18. As shown, the protrusions 32 are formed on both surfaces of the clamping surface, although a protrusion could be formed on only one of the clamping surfaces. Also, if the fenestration 20a and protrusion 32 are complementarily shaped, such as one concave and the other convex, and non-circular, gripping of the tool head 22 in a particular orientation to the jaws 20 is facilitated.
As noted above, it is contemplated that other tools or tool heads useful in performing cardiac ablation or other intended procedures could similarly be provided with a clamping or gripping surface or other grasping arrangement. Turning to
Similar to the examples described above, the pen 72 is provided with a clamping surface 78 adapted to be held between the jaws 20 of the forceps 18. As seen in
While each of the tool heads described thus far has had a clamping surface adapted to be held between the closed jaws of a forceps, other configurations for securing the tool head are contemplated. For example, and with reference to
While the surgical instruments have been described in terms of those particularly appropriate for cardiac applications, this is not by way of limitation, but for illustration. Indeed, any surgical instruments adapted for use with robotic devices may advantageously include the clamping surface described above.