WO2016168226A1

WO2016168226A1 - Methods for exchanging instruments using a surgical port assembly

Info

Publication number: WO2016168226A1
Application number: PCT/US2016/027181
Authority: WO
Inventors: Jaimeen KAPADIA
Original assignee: Covidien Lp
Priority date: 2015-04-15
Filing date: 2016-04-13
Publication date: 2016-10-20
Also published as: AU2016247965A1; EP3282996A1; CA2978771A1

Abstract

The present disclosure relates to methods of performing a surgical procedure including detecting a coupling of an instrument drive unit to a port assembly during a surgical procedure, detecting an insertion of a first surgical instrument into the port assembly when the instrument drive unit is coupled to the port assembly, and electromechanically decoupling the instrument drive unit from the port assembly after detecting the insertion of the first surgical instrument.

Description

METHODS FOR EXCHANGING INSTRUMENTS USING A SURGICAL PORT

ASSEMBLY

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit of and priority to U.S. Provisional Patent

Application No. 62/147,626, filed April 15, 2015, the entire disclosure of which is incorporated by reference herein.

BACKGROUND

[0002] Surgical robotic systems made it easier and less tiresome for surgeons to perform minimally invasive surgery. During traditional laparoscopic surgery surgeons manually oriented, moved, and actuated surgical instruments in the patient during surgery. Surgeons had to maneuver, hold, and activate the surgical instruments in awkward positions for prolonged periods causing discomfort and fatigue. Surgical robotic systems had a separate console and input device that the surgeon could manipulate to direct the motorized movement and actuation of surgical instruments to reduce discomfort and fatigue. Unfortunately, these robotic surgical systems were large and bulky, they occupied a large amount of space around the patient making patient access more difficult, they were expensive, and they had complex, time-consuming setups leading to delays. The complexity, size, and cost of these robotic systems made it less desirable for hospitals and health-care centers to invest in such systems.

[0003] There is a need for a simple, cost-effective robotic system that occupies less physical space in the operating room.

SUMMARY [0004] The present disclosure relates to methods of performing a surgical procedure including detecting a coupling of an instrument drive unit to a port assembly during a surgical procedure, detecting an insertion of a first surgical instrument into the port assembly when the instrument drive unit is coupled to the port assembly, and electromechanically decoupling the instrument drive unit from the port assembly after detecting the insertion of the first surgical instrument.

[0005] It is further disclosed that, responsive to receiving an instrument exchange request, the method includes electromechanically coupling the instrument drive unit to the port assembly, enabling a removal of the first surgical instrument from the instrument drive unit, detecting an insertion of a second surgical instrument into the port assembly through the instrument drive unit while the instrument drive unit is coupled to the port assembly, and electromechanically decoupling the instrument drive unit from the port assembly after detecting the insertion of the second surgical instrument. It is also disclosed that the method includes detecting a coupling of the instrument drive unit to the port assembly during a calibration phase, sensing a position of the instrument drive unit after detecting the coupling during the calibration phase, and storing the sensed position of the instrument drive unit as a position that the instrument drive unit is moved to during the coupling of the instrument drive unit to the port assembly.

[0006] The disclosed method also includes detecting an orientation of the first surgical instrument inserted into the port assembly when the instrument drive unit is coupled to the port assembly, and maintaining the orientation of the first surgical instrument as the instrument drive unit is moved away from the port assembly during the decoupling. It is further disclosed that the electromechanically decoupling includes preventing a user from moving the instrument drive unit in at least one direction as the user moves the instrument drive unit away from the port assembly. In disclosed embodiments, the electromechanically decoupling includes robotically moving the instalment drive unit away from the port assembly, and/or releasing an electrical, magnetic, or mechanical device fastening the instrument drive unit to the port assembly.

[0007] The present disclosure also relates to methods of performing a surgical procedure, including coupling a first surgical instrument to an instrument drive unit, the instrument drive unit being capable of remote operation, the instrument drive unit being in a first position, moving the instrument drive unit distally into contact with a port assembly, inserting a second surgical instrument at least partially through the instrument drive unit, and moving the instrument drive unit proximally out of contact with the port assembly.

[0008] Disclosed embodiments of the method also include inserting a portion of the first surgical instrument through the port assembly and into contact with body tissue. It is further disclosed to perform a surgical task with the first surgical instrument.

[0009] It is further disclosed to couple the second surgical instrument with the instrument drive unit, and to perform a surgical task with the second surgical instrument.

[0010] It is additionally disclosed that embodiments of the method include removing the first surgical instrument from engagement with the instrument drive unit. Here, it is disclosed that removing the first surgical instrument from engagement with the instrument drive unit is performed when the instrument drive unit is in contact with the port assembly. It is further disclosed to perform a surgical task with the first surgical instrument while the instrument drive unit is free from contact from the port assembly. Additionally, embodiments of the method include removing the first surgical instrument along an axis defined by a shaft of the first surgical instrument. [0011] In disclosed embodiments of the method, coupling the second surgical instrument with the instrument drive unit is performed when the instrument drive unit is free from contact with the port assembly. Embodiments of the disclosed methods also include uncoupling the first surgical instrument from the instrument drive unit while the instrument drive unit is in contact with the port assembly, and performing a surgical procedure with the first stapling instrument prior to moving the instrument drive unit distally into contact with the port assembly.

[0012] Embodiments of the method further disclose moving the instrument drive unit into substantially the first position after moving the instrument drive unit proximally out of contact with the port assembly.

[0013] The present disclosure also relates to methods of exchanging instruments, comprising coupling a first surgical instrument to an instrument drive unit, the instrument drive unit being capable of remote operation, the instrument drive unit being in a first position, moving the instrument drive unit distally into contact with a port assembly, maintaining contact between the instrument drive unit and the port assembly while removing the first surgical instrument from the instrument drive unit, and inserting a second surgical instrument at least partially through the instrument drive unit while the instrument drive unit is in contact with the port assembly.

[0014] Embodiments of this method further include moving the instrument drive unit proximally out of contact with the port assembly after inserting a second surgical instrument at least partially through the instrument drive unit. Additionally, embodiments include moving the instrument drive unit into substantially the first position after moving the instrument drive unit proximally out of contact with the port assembly.

BRIEF DESCRIPTION OF THE DRAWINGS [0015] Embodiments of the present disclosure are described herein with reference to the accompanying drawings, wherein:

[0016] FIG. 1 is a schematic diagram of a system including a port assembly positioned partially within a patient, a surgical instrument positioned within the port assembly, and an endoscopic camera positioned within the patient, where the port assembly is in communication with the endoscopic camera, in accordance with embodiments of the present disclosure;

[0017] FIG. 2 is a cut-away view of the port assembly of FIG. 1 in accordance with embodiments of the present disclosure;

[0018] FIG. 3 is a top view of the port assembly of FIGS. 1 and 2 in accordance with embodiments of the present disclosure;

[0019] FIG. 4 is a cross-sectional view of the port assembly of the present disclosure, taken along line 4-4 of FIG. 3, shown with a surgical instrument extending longitudinally through an interior space therein;

[0020] FIG. 5 is a cross-sectional view of the port assembly of FIGS. 1-4 shown with a surgical instrument extending through the interior space of the port assembly at an angle;

[0021] FIG. 6 is a schematic illustration of a surgical system in accordance with the present disclosure;

[0022] FIG. 7 is a perspective view of a surgical assembly, in accordance with an embodiment of the present disclosure, and illustrated attached to a robot arm of a robotic surgical system; [0023] FIG. 8 is an enlarged view of the surgical assembly of FIG. 7, shown extended through a guide ring;

[0024] FIG. 9 is a schematic diagram of a system including a port assembly positioned partially within tissue, an instrument drive unit disposed proximally of the port assembly, and a surgical instrument mechanically engaged with the instrument drive unit and positioned through the port assembly and in contact with tissue, in accordance with embodiments of the present disclosure;

[0025] FIG. 10 is a schematic diagram of the system of FIG. 9 illustrating the port assembly positioned partially within tissue, the instrument drive unit in contact with the port assembly, and the surgical instrument disengaged from the instrument drive unit, positioned through the port assembly and in contact with tissue;

[0026] FIG. 11 is a schematic diagram of the system of FIGS. 9 and 10 illustrating the port assembly positioned partially within tissue, the instrument drive unit in contact with the port assembly, and the surgical instrument removed from engagement with the instrument drive unit and the port assembly;

[0027] FIG. 12 is a schematic diagram of the system of FIGS. 9-11 illustrating the port assembly positioned partially within tissue, the instrument drive unit in contact with the port assembly, and a second surgical instrument being inserted through a proximal portion of the instrument drive unit;

[0028] FIG. 13 is a schematic diagram of the system of FIGS. 9-12 illustrating the port assembly positioned partially within tissue, the instrument drive unit in contact with the port assembly, the second surgical instrument in contact with and uncoupled from the instrument drive unit, and an end effector of the second surgical instrument disposed within a cavity of the port assembly;

[0029] FIG. 14 is a schematic diagram of the system of FIGS. 9-13 illustrating the port assembly positioned partially within tissue, the instrument drive unit disposed proximally of the port assembly, the second surgical instrument in contact with and uncoupled from the instrument drive unit, and the end effector of the second surgical instrument disposed within the cavity of the port assembly;

[0030] FIG. 15 is a schematic diagram of the system of FIGS. 9-14 illustrating the port assembly positioned partially within tissue, the instrument drive unit disposed proximally of the port assembly, the second surgical instrument coupled to the instrument drive unit, and the end effector of the second surgical instrument disposed within the cavity of the port assembly; and

[0031] FIG. 16 is a schematic diagram of the system of FIGS. 9-15 illustrating the port assembly positioned partially within tissue, the instrument drive unit disposed proximally of the port assembly, the second surgical instrument coupled to the instrument drive unit, and the end effector of the second surgical instrument disposed distally of the port assembly.

DETAILED DESCRIPTION

[0032] An elongated shaft of a minimally invasive surgical instrument may be inserted directly into a port assembly providing access to patient tissue. The shaft may also be inserted into an instrument drive unit before being inserted into the port assembly. The instrument drive unit may dock to the port assembly during an instrument exchange and may decouple from the port assembly when the surgical instrument is being used. The port assembly and instrument drive unit may include electromechanical actuators that move the instrument and/or the instrument shaft. The port assembly and instrument drive unit may also include sensors that detect the presence and/or position of the instrument shaft therein.

[0033] The actuators in the port assembly and instrument drive unit may be configured to pivot the elongated instrument shaft about a predetermined point, rotate the instrument shaft to rotate the instrument, and/or move the instrument shaft longitudinally about a port assembly instrument insertion axis to move the instrument further into or out of the patient. The actuators in the instrument drive unit may be configured to move the instrument further into and/or out of the port assembly and/or couple and decouple the instrument drive unit to the port assembly. Sensors in the port assembly and instrument drive unit may detect the position of the instrument shaft, the position of the instrument drive unit relative to the port assembly, and/or whether the instrument drive unit is coupled to the port assembly.

[0034] The actuators may be coupled to a processing device and an input device having multiple degrees of freedom. The processing device may be configured to translate movements and/or other actuations of the input device by a clinician into mechanized movements and/or actuations of the surgical instrument inserted into the port assembly and/or instrument drive unit.

[0035] Including electromechanical actuators in the port assembly and/or instrument drive unit as described above may enable the mechanized movement of handheld laparoscopic instruments that would otherwise be moved manually by surgeons in potentially awkward positions for extended periods. This may reduce surgeon fatigue and discomfort. Additionally, actuators in the instrument drive unit may facilitate an exchange of surgical instrument by facilitating the docking of the instrument drive unit to the port assembly. The docking may maintain the position of the port assembly once the surgical instrument is removed. The docking may also facilitate instrument removal by minimizing the distance between the instrument drive unit and the port assembly so that the instrument shaft has to travel less distance to be removed from and/or inserted into the patient through the instrument drive unit and port assembly.

[0036] Additionally, many surgical robotic systems have proprietary interfaces compatible with a limited set of surgical instruments that are often substantially more expensive than handheld instruments offering similar functionality. The instrument drive units and port assemblies described herein may be compatible with a much broader range of standard handheld laparoscopic instruments having an elongated shaft, as the elongated shaft of such as standard instrument may be inserted into a corresponding opening of the instrument drive unit and/or port assembly to be controlled by the instrument drive unit and port assembly. These handheld laparoscopic instruments may be used in both traditional laparoscopic surgeries where the surgeon manually moves the instrument and in robotic assisted surgeries with the port assemblies and/or instrument drive units described herein. Since the same instrument may be used in both types of procedures, there is no need for the hospital to maintain a separate inventory of more expensive surgical instruments designed to interface solely with a robotic system. The mechanized port assemblies and/or instrument drive units described herein may be designed to be smaller, lighter, and easier to transport and setup than previously existing robotic systems.

[0037] Various embodiments of the present disclosure provide a port assembly adapted to hold and/or control the movement and/or positioning of a surgical instrument inserted therethrough in conjunction with an endoscopic camera. Embodiments of the presently- disclosed port assembly may be suitable for use in laparoscopic procedures as well as other minimally-invasive surgical procedures, for example.

[0038] Various embodiments of the present disclosure provide a port assembly wherein control of the movement and/or positioning of a surgical instrument inserted therethrough may be performed manually or automatically depending on the preference of the surgeon. In some embodiments, the surgical instrument or an endoscopic camera may be provided with a user interface including one or more user-actuable controls and a wireless transmitter to provide a communicative link between the user interface and the port assembly, e.g., to allow the surgeon to change the position and/or orientation of the surgical instrument inserted through the port assembly.

[0039] During minimally-invasive surgical procedures, the working end of an instrument is frequently located near the anatomical structure of interest and/or the surgical site within the working envelope. In some embodiments, wherein automatic control is employed for controlling the movement and/or positioning of an endoscopic camera or instrument, a sensor and/or transmitter may be disposed in association with the working end of an instrument, e.g., located on the tip of the instrument, and the endoscopic camera may be automatically controlled to "track" the movement of the instrument tip (e.g., align the field of view of the camera with the working end of the instrument) based on one or more signals outputted by the sensor and/or transmitter. In some embodiments, the sensor and/or transmitter may include an attachment mechanism, e.g., an adhesive backing, to allow the surgeon to selectively position the sensor and/or transmitter on a particular instrument and/or at a particular location on a select instrument, e.g., depending on surgeon preference, the type of surgery, etc. [0040] Some examples of instruments used in minimally-invasive procedures include staplers, graspers, cutters, forceps, dissectors, sealers, dividers, and other tools suitable for use in the area of the anatomical structure of interest. The instrument may be a standalone tool suitable for use within a body cavity or external to the patient's body cavity.

[0041] In some embodiments, the controls may include an attachment mechanism, e.g., an adhesive backing, to allow the physician to selectively position the controls on a particular instrument and/or at a preferred location on a select instrument. In some embodiments, the capability may be provided to interface with an existing operating-room management system, e.g., using speech recognition technology, to control one or more settings of operating-room equipment. In some embodiments, the port assembly may be a standalone tool that interfaces with any suitable endoscopic camera.

[0042] The present disclosure includes a surgical system 5, which includes a surgical instrument 10, a port assembly 100, an endoscopic camera 200, and/or a control mechanism 300.

[0043] FIG. 1 illustrates surgical instrument 10 inserted through an embodiment of port assembly 100 according to the present disclosure. A distal portion of surgical instrument 10 is shown within tissue "T" (e.g., adjacent a surgical site). A distal portion of an endoscopic camera 200 is also shown positioned within the tissue "T." Endoscopic camera 200 is positioned such that endoscopic camera 200 can view a distal portion of surgical instrument 10 within the tissue

[0044] In FIG. 1, an embodiment of surgical instrument 10 is shown for use with various surgical procedures and generally includes a housing assembly 20, a handle assembly 30, and an end-effector assembly 22. Surgical instrument 10 includes a shaft 12 that has a distal end 16 configured to mechanically engage the end-effector assembly 22 and a proximal end 14 configured to mechanically engage the housing assembly 20. End-effector assembly 22 generally includes a pair of opposing jaw assemblies 23 and 24 pivotably mounted with respect to one another. In various embodiments, actuation of a movable handle 40 toward a fixed handle 50 pulls a drive sleeve (not shown) proximally to impart movement to the jaw assemblies 23 and 24 from an open position, wherein the jaw assemblies 23 and 24 are disposed in spaced relation relative to one another, to a clamping or approximated position, wherein the jaw assemblies 23 and 24 cooperate to grasp tissue therebetween. Although FIG. 1 depicts a particular type of surgical instrument 10 (e.g., an electrosurgical forceps) for use in connection with endoscopic surgical procedures, port assembly 100, endoscopic camera 200, and control mechanism 300 may be used with a variety of instruments, e.g., depending on the type of surgery.

[0045] In some embodiments, as shown in FIG. 1, the port assembly 100 is coupled to a holding member 150. Holding member 150 may be adapted to be attachable to a table to provide support for the port assembly 100, e.g., to provide additional stability and/or reduce the weight of the tool on the patient's body.

[0046] When a powered surgical instrument is being used the surgical instrument 10 may be electrically and/or operably connected to an electrosurgical power generating source 28. Surgical instrument 10 may be configured to communicate with a processing device, input device, or other component of a surgical robotic system through wires or wirelessly. Surgical instrument 10 may also be battery-powered in some instances. Surgical instrument 10 may include a switch 65 configured to permit the user to selectively activate the surgical instrument 10. Alternatively, switch 65 may be located on another component of the surgical robotic system such as the control device 1004 used by the surgeon to move the surgical instrument 10. When the switch 65 is depressed, electrosurgical energy is transferred through one or more electrical leads (not shown) to the jaw assemblies 23 and 24, for instance.

[0047] In some embodiments, as shown in FIG. 1, the surgical instrument 10 includes a user interface 140, which may be adapted to provide a wireless (or wired) communication interface with the control mechanism 300 of the surgical system 5. Additionally, or alternatively, the surgical instrument 10 may include a sensor and/or transmitter 141, e.g., disposed in association with the end effector assembly 22, or component thereof, e.g., jaw assembly 23. Further, the user interface 140 may be associated with the endoscopic camera 200, for example.

[0048] User interface 140 may be disposed on another part of the surgical instrument 10 (e.g., the fixed handle 50, etc.) or another location on the housing assembly 20. User interface 140 may include one or more controls (e.g., two controls 142 and 143 shown in FIG. 1), which may include a switch (e.g., push button switch, toggle switch, slide switch) and/or a continuous actuator (e.g., rotary or linear potentiometer, rotary or linear encoder). In some embodiments, the user interface 140 includes a first control (e.g., control 142) adapted to transmit signals indicative of user intent to effect movement of the end effector assembly 22 within the body cavity. User interface 140 may additionally, or alternatively, include a second control (e.g., control 143) adapted to transmit signals indicative of user intent to adjust the tilt angle of the shaft 12.

[0049] Further details of a control mechanism, various sensors, and control interfaces are disclosed in U.S. Patent No. 8,641,610, which issued on February 4, 2014.

[0050] In disclosed embodiments, a multi-functional sensor 210 is disposed in association with a distal portion of endoscopic camera 200. In some embodiments, multi-functional sensor 210 provides illumination and houses a camera chip. It is to be understood that other sensor embodiments may be utilized. Sensor 210 is operably coupled to a power source (e.g., power supply 312 shown in FIG. 1) via a transmission line 310 coupled to the endoscopic camera 200. Transmission line 310 may include any transmission medium used for the propagation of signals from one point to another. Data from sensor 210 may also be wirelessly transmitted.

[0051] With particular reference to FIGS. 2-5, port assembly 100 generally includes a body 110 and a control interface 160. Body 110 includes an exterior surface 112, an interior surface 114, and an interior space 116 defined by the interior surface 114. In FIGS. 1, 2, 4 and 5, the exterior surface 112 of the body 110 is shown disposed in sealable contact with tissue "T" at an entry site into the patient's body cavity. Body 110 of port assembly 100 is adapted to allow access into the body cavity, e.g., to allow access of at least one surgical instrument 10 through interior space 116, and may include at least one sealing element or mechanism (not explicitly shown in the interest of clarity) to seal the opening into the body cavity in the presence and/or absence of a surgical instrument 10, e.g., to help prevent the escape of insufflation gas. Body 110 may be formed of any suitable material such as a metal, plastic, alloy, composite material or any combination of such materials, for example.

[0052] Control interface 160 includes a plurality of inflatable members 180 (e.g., inflatable members 180a-180i shown in FIG. 2) coupled to, or otherwise disposed in association with, the body 110 of port assembly 100.

[0053] Each inflatable member 180 is inflatable and deflatable to apply a force (e.g., perpendicular to a longitudinal axis "A" defined by body 110) to a portion of the elongated shaft 12 of the surgical instrument 10 (i.e., when the elongated shaft 12, or portion thereof, is disposed within the interior space 116 as shown in FIGS. 1 and 3-5) to move the elongated shaft 12 and/or end effector assembly 22 of the surgical instrument 10 to a desired position within the body cavity, for example. As shown in FIG. 1, a portion of the elongated shaft 12 may be disposed within the interior space 116 of the body 110 of the port assembly 100, while the end effector assembly 22 is disposed within the body cavity.

[0054] Control interface 160 is adapted to controllably move and/or position the elongated shaft 12 of the surgical instrument 10 to effect movement of the end effector assembly 22 within the body cavity. In disclosed embodiments, the control interface 160 is adapted to receive signals from control mechanism 300 (which is schematically illustrated in FIG. 1). Based on the signals received from the control mechanism 300, the control interface 160 may adjust the spatial aspects of the surgical instrument 10 (e.g., by causing inflation/deflation of at least one inflatable member 180) and/or perform other control functions, alarming functions, or other functions in association therewith. Some examples of spatial aspects associated with the surgical instrument 10 that may be adjusted include tilt angle of the elongated shaft 12 relative to longitudinal axis "A," and rotation of the elongated shaft 12 about a longitudinal axis "B" defined by the elongated shaft 12.

[0055] Inflatable members 180 are disposed in mechanical cooperation with the interior surface 114 of the body 110 of the port assembly 100. In disclosed embodiments, each inflatable member 180 is independently controllable with respect to the other inflatable members 180. Here, each inflatable member 180 is in fluid communication with an inflation medium 190 via a conduit 182. (For clarity, FIG. 1 illustrates three conduits 182, but any number of conduits 182 may be included, such as the same number of inflatable members 180). Inflation medium 190 includes any suitable gas (e.g., oxygen, etc.) or fluid (e.g., water or saline) that can be transferred to and from inflatable members 180 of the port assembly 100.

[0056] The amount, shape, size, arrangement, and orientation of inflatable members 180 are not limited by the examples shown in the accompanying figures. Rather, any amount, shape, size, arrangement, and orientation of inflatable members 180 are contemplated by the present disclosure.

[0057] In the embodiment illustrated in FIG. 2, port assembly 100 includes nine inflatable members 180a-180i associated therewith. The inflatable members 180a-180i of the illustrated embodiment include a first, proximal row of three inflatable members 180a- 180c radially disposed about interior surface 114 of the body 110, a second, middle row of three inflatable members 180d-180f radially disposed about interior surface 114 of the body 110, and a third, distal row of three inflatable members 180g-180i radially disposed about interior surface 114 of the body 110. As noted above, the amount, shape, size, arrangement, and orientation of inflatable members 180 are not limited by the accompanying figures. For example, more or fewer inflatable members are contemplated by the present disclosure.

[0058] Each inflatable member 180a-180i includes a respective conduit 182a-182i (FIG. 2) fluidly linking the inflatable member 180a-180i to the inflation medium 190. It is envisioned that inflation medium 190 is stored in individual storage containers (e.g., one storage container for each conduit 182a-182i), or that the inflation medium 190 is stored in a single storage container, and that each conduit 182a-182i includes a valve for controlling the amount of inflation medium 190 that can travel between the conduit 182a-182i and the respective inflatable member 180a-180i. [0059] In use, endoscopic camera 200 is configured to view at least a portion of the end effector assembly 22 of the surgical instrument 10 within the body cavity. The sensor 210 is configured to store and/or relay information regarding the precise orientation and positioning of the end effector assembly 22 (e.g., the degree tilt of the shaft 12 with respect to the longitudinal axis "A," and the amount of rotation of the end effector assembly 22 about the longitudinal axis "B") within the body cavity with respect to the endoscopic camera 200. The sensor 210 is also configured to compare the current orientation and positioning information of the end effector assembly 22 with stored (e.g., initial, optimal, user-defined, etc.) orientation and positioning information.

[0060] The sensor 210 is further configured to communicate the orientation and positioning information of the end effector assembly 22 with control mechanism 300 including a controller. Moreover, the sensor 210 is configured to communicate the difference between the current orientation and positioning of the end effector assembly 22 with the stored (e.g., initial) orientation and positioning information. The control mechanism 300 is configured to distribute the inflatable medium 190 to the appropriate inflatable member(s) 180 in order to move the shaft 12 of the surgical device 10 to re-orient the end effector assembly 22, such that the end effector assembly 22 moves to its stored (e.g., initial) orientation and position. For example, and with particular reference to FIG. 5, to tilt the end effector 22 with respect to the longitudinal axis "A" in the general direction of arrow "C," inflatable members 180a and 180i could be inflated and/or inflatable members 180c and 180g could be deflated. (Inflatable members 180b, 180e and 180h are not shown in FIG. 5 due to the particular cross-sectional view illustrated.)

[0061] Additionally, it is envisioned that rotation of the elongated shaft 12 about the longitudinal axis "B" could be accomplished by sequential inflation and/or deflation of adjacent inflatable members 180 (e.g., inflatable members 180 that are axially-aligned and radially- adjacent). For instance, rotation of the elongated shaft 12 may be accomplished by first inflating inflatable member 180a a certain amount (e.g., by a particular volume and/or a particular duration) while deflating inflatable member 180b, then inflating inflatable member 180c while deflating inflatable member 180a, then inflating inflatable member 180b while deflating inflatable member 180c. Additionally, it is envisioned that radially-aligned and axially-offset inflatable members (e.g., 180a, 180d and 180g; 180b, 180e and 180h; and 180c, 180f and 180i) can be inflated and/or deflated concurrently to facilitate rotation of the elongated shaft 12 about longitudinal axis "B."

[0062] It is envisioned that a user is able to set various parameters using the control mechanism 300. For example, it is envisioned that a user is able to set an initial orientation and position of end effector assembly 22 (e.g., after end effector assembly 22 is desirably positioned within the body cavity) via touch screen or pressing a button on the surgical device 10 and/or the control mechanism 300, for example. It is further envisioned that a user can select whether the control mechanism 300 changes the orientation and position of the end effector assembly 22 continuously (i.e., continuously ensuring the current orientation and position of the end effector assembly 22 matches the initial orientation and position), intermittently (i.e., changing the orientation and position of the end effector assembly 22 after a given amount of time, if necessary, such that the current orientation and position of the end effector assembly 22 matches the initial orientation and position), based on amount of movement of the end effector assembly 22 from its initial position (i.e., changing the orientation and position of the end effector assembly 22 after the end effector assembly 22 has moved a predetermined amount from its initial position), and/or at user-defined times (e.g., after removal and re-insertion of the surgical instrument 10 or a different surgical instrument), for example.

[0063] It is further envisioned that control mechanism 300, or another portion of the surgical system 5, is configured to give feedback to a user corresponding to a particular amount of change in position and/or orientation of the end effector assembly 22 of the surgical instrument 10. For example, it is envisioned that surgical system 5 gives visual (e.g., illuminating a light), audible (e.g., producing a beeping sound), and/or tactile (e.g., causing a handle of the surgical instrument 10 to vibrate) feedback in response to the change of position and/or orientation of the end effector assembly 22 which exceeds a predetermined value. Upon receiving this feedback, the user may manually instruct (e.g., by pushing a button) the control mechanism 300 to reposition the surgical instrument 10 back to its initial position and orientation, for example.

[0064] The present disclosure also comprises the inclusion of a friction-enhancing surface or coating on an instrument-engaging surface 181 (see FIG. 3) of at least one (e.g., all) inflatable member 180. It is envisioned that the friction-enhancing surface 181 is made from a material that is different from another portion of the inflatable member 180. For example, a majority of each inflatable member 180 may be made from polyurethane, HDPE, LDPE, polypropylene, polyester and the friction-enhancing surface or coating may include rubber or silicone.

[0065] In use, it may be desirable to insert and/or position the surgical instrument 10 when inflatable members 180 are at least partially deflated, and then to inflate necessary inflatable members 180 to help secure the location, position and orientation (e.g., initial position) of the surgical instrument 10. [0066] System 5 of the present disclosure may include a storage device. The storage device may include a set of executable instructions for performing a method of controlling surgical instruments using a port assembly 100 as described herein. In some embodiments, the system 5 also includes a processing unit and/or a database. Further details of exemplary processing units and databases are described in U.S. Patent No. 8,641,610, which has been incorporated by reference hereinabove.

[0067] The present disclosure also includes methods of controlling surgical instruments using system 5, or portions thereof, as described above. It is to be understood that the features of the method provided herein may be performed in combination and in a different order than presented herein without departing from the scope of the disclosure.

[0068] The various embodiments disclosed herein may also be configured to work with robotic surgical systems and what is commonly referred to as "Telesurgery." Such systems employ various robotic elements to assist the surgeon in the operating theater and allow remote operation (or partial remote operation) of surgical instrumentation. Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the surgeon during the course of an operation or treatment. Such robotic systems may include, remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc.

[0069] The robotic surgical systems may be employed with one or more consoles that are next to the operating theater or located in a remote location. In this instance, one team of surgeons or nurses may prepare the patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein while another surgeon (or group of surgeons) remotely control the instruments via the robotic surgical system. As can be appreciated, a highly skilled surgeon may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients.

[0070] The robotic arms of the surgical system are typically coupled to a pair of master handles by a controller. The handles can be moved by the surgeon to produce a corresponding movement of the working ends of any type of surgical instrument (e.g., end effectors, graspers, knifes, scissors, etc.) which may complement the use of one or more of the embodiments described herein. The movement of the master handles may be scaled so that the working ends have a corresponding movement that is different, smaller or larger, than the movement performed by the operating hands of the surgeon. The scale factor or gearing ratio may be adjustable so that the operator can control the resolution of the working ends of the surgical instrument(s).

[0071] The master handles may include various sensors to provide feedback to the surgeon relating to various tissue parameters or conditions, e.g., tissue resistance due to manipulation, cutting or otherwise treating, pressure by the instrument onto the tissue, tissue temperature, tissue impedance, etc. As can be appreciated, such sensors provide the surgeon with enhanced tactile feedback simulating actual operating conditions. The master handles may also include a variety of different actuators for delicate tissue manipulation or treatment further enhancing the surgeon's ability to mimic actual operating conditions. [0072] With reference to FIGS. 6-8, a surgical system, such as, for example, a robotic surgical system is shown generally as surgical system 1000 and is usable with surgical system 5, or portions thereof, of the present disclosure. Surgical system 1000 generally includes a plurality of robotic arms 1002, 1003, a control device 1004, and an operating console 1005 coupled with control device 1004. Operating console 1005 includes a display device 1006, which is set up in particular to display three-dimensional images; and manual input devices 1007, 1008, by means of which a person (not shown), for example a surgeon, is able to telemanipulate robotic arms

1002, 1003 in a first operating mode, as known in principle to a person skilled in the art.

[0073] Each of the robotic arms 1002, 1003 is composed of a plurality of members, which are connected through joints. System 1000 also includes an instrument drive unit 1200 connected to distal ends of each of robotic arms 1002, 1003. Surgical instrument 10 supporting end-effector assembly 22 may be attached to instrument drive unit 1200, in accordance with any one of several embodiments disclosed herein, as will be described in greater detail below.

[0074] Robotic arms 1002, 1003 may be driven by electric drives (not shown) that are connected to control device 1004. Control device 1004 (e.g., a computer) is set up to activate the drives, in particular by means of a computer program, in such a way that robotic arms 1002,

1003, their instrument drive units 1200 and thus the surgical instrument 10 (including end- effector assembly 22) execute a desired movement according to a movement defined by means of manual input devices 1007, 1008. Control device 1004 may also be set up in such a way that it regulates the movement of robotic arms 1002, 1003 and/or of the drives.

[0075] Surgical system 1000 is configured for use on a patient 1013 lying on a patient table 1012 to be treated in a minimally invasive manner by means of end-effector assembly 22. Surgical system 1000 may also include more than two robotic arms 1002, 1003, the additional robotic arms likewise being connected to control device 1004 and being telemanipulatable by means of operating console 1005. A surgical instrument 10 (including end-effector assembly 22; see FIGS. 7 and 8) may also be attached to the additional robotic arm.

[0076] Reference may be made to U.S. Patent Publication No. 2012/0116416, filed on November 3, 2011, entitled "Medical Workstation" for a detailed discussion of the construction and operation of surgical system 1000.

[0077] Turning to FIGS. 7 and 8, surgical system 1000 includes a surgical assembly 1300, which includes robotic arm 1002, an instrument drive unit 1200 connected to robotic arm 1002, and surgical instrument 10 coupled with or to instrument drive unit 1200. Instrument drive unit 1200 is configured for driving an actuation of end-effector assembly 22 of surgical instrument 10 and to operatively support surgical instrument 10 therein. Instrument drive unit 1200 transfers power and actuation forces from motors "M" to surgical instrument 10 to ultimately drive movement of cables that are attached to end-effector assembly 22, for example. A proximal portion of surgical instrument 10 is indicated by reference character 1400.

[0078] In use, a trocar shaft 1232 is moved between a pre-operative position, as shown in FIG. 7, and an operative position, as shown in FIG. 8. In the pre-operative position, a guide ring 1240 and end-effector assembly 22 are coplanar. In the operative position, guide ring 1240 is located proximal to end-effector assembly 22.

[0079] With reference to FIGS. 9-16, another system of the present disclosure is illustrated and in generally indicated by reference character 2000. A method of performing a surgical procedure utilizing system 2000 is also disclosed. [0080] Generally, system 2000 includes a port assembly 2100 (e.g., the same as or similar to port assembly 100 discussed herein), an instrument drive unit 2200 of a robotic surgical system (e.g., the same as or similar to surgical system 1000 discussed herein), at least one robotic arm 2300 (e.g., the same as or similar to robotic arm 1002 or 1003 discussed herein), and at least one surgical instrument 2400.

[0081] Method steps of utilizing system 2000 will now be discussed with reference to FIGS. 9-16. With initial regard to FIG. 9, system 2000 illustrates port assembly 2100 positioned partially within a patient or tissue "T," instrument drive unit 2200 disposed proximally of port assembly 2100, and surgical instrument 2400 mechanically engaged with instrument drive unit 2200 (e.g., via at least one latch 2420) and extending through port assembly 2100 such that an end effector 2402 of surgical instrument 2400 is within tissue "T." Here, it is envisioned that a surgeon is performing a surgical procedure with surgical instrument 2400 or has completed use of surgical instrument 2400.

[0082] With regard to FIG. 10, system 2000 illustrates port assembly 2100 positioned partially within tissue "T," instrument drive unit 2200 coupled to port assembly 2100, and surgical instrument 2400 disengaged from and adjacent (e.g., within two inches) instrument drive unit 2200 and extending through port assembly 2100 such that end effector 2402 of surgical instrument 2400 is within tissue "T." Here, robotic arm 2300 has moved instrument drive unit 2200 distally into engagement with port assembly 2100 (e.g., with the assistance of a nurse), such that instrument drive unit 2200 is docked onto port assembly 2100. The engagement between port assembly 2100 and drive unit 2200 can be accomplished in any suitable manner, such as with the use of magnets, latches, etc. It is disclosed that the movement of instrument drive unit 2200 is along a longitudinal axis "C" defined by a shaft 2404 of surgical instrument 2400. It is further disclosed that a portion of the robotic surgical system communicates with at least one sensor on instrument drive unit 2200, robotic arm 2300, and/or port assembly 2100 to help determine the optimal positioning of instrument drive unit 2200 with respect to port assembly 2100 and/or tissue "T," for example. The use of appropriate sensor(s) and/or sensing techniques is discussed above, for example.

[0083] Additionally, FIG. 10 illustrates that surgical instrument 2400 has been disengaged from drive unit 2200, e.g., by mechanical means such as the depression of a button or the moving of latch 2420, for example. Further examples of engaging a surgical instrument and drive unit are discussed above.

[0084] Next, and with particular reference to FIG. 11, system 2000 illustrates port assembly 2100 positioned partially within tissue "T," instrument drive unit 2200 coupled to port assembly 2100, and surgical instrument 2400 removed from engagement with instrument drive unit 2200 and port assembly 2100. Here, surgical instrument 2400 has been withdrawn proximally from instrument drive unit 2200, e.g., along longitudinal axis "C." As can be appreciated, in this configuration, the total length "L" required to extract surgical instrument 2400 from tissue "T" and to remove surgical instrument 2400 from engagement with instrument drive unit 2200 (e.g., in a proximal direction), is less than the distance that would be required for such extraction and removal in embodiments where instrument drive unit 2200 is spaced proximally from port assembly 2100 (e.g., where instrument drive unit 2200 is not in contact with port assembly 2100).

[0085] Referring now to FIG. 12, system 2000 illustrates port assembly 2100 positioned partially within tissue "T," instrument drive unit 2200 coupled to port assembly 2100, and a second surgical instrument 2410 being inserted through a proximal end 2210 of instrument drive unit 2200.

[0086] With reference to FIG. 13, system 2000 illustrates port assembly 2100 positioned partially within tissue "T," instrument drive unit 2200 coupled to port assembly 2100, second surgical instrument 2410 uncoupled from instrument drive unit 2200, and an end effector 2412 of the second surgical instrument 2410 disposed within a cavity 2110 of port assembly 2100. Here, since instrument drive unit 220 is coupled to (e.g., in contact with) port assembly 2100, there is no need to re-align port assembly 2100 upon entry of the second surgical instrument 2410 therethrough, as is typically required when instrument drive unit 2200 is spaced from port assembly 2100 due to slight movements of port assembly 2100 upon exit and/or entry of a surgical instrument therethrough.

[0087] Referring to FIG. 14, system 2000 illustrates port assembly 2100 positioned partially within tissue "T," instrument drive unit 2200 disposed proximally of port assembly 2100, the second surgical instrument 2410 disengaged from and adjacent (e.g., within two inches) instrument drive unit 2200, and end effector 2412 of the second surgical instrument 2410 disposed within cavity 2110 of port assembly 2110. Here, robotic arm 2300 has moved instrument drive unit 2200 proximally out of engagement (e.g., contact) with port assembly 2100. It is disclosed that the movement of instrument drive unit 2200 is along longitudinal axis "C." Further, it is envisioned that instrument drive unit 2200 automatically begins to move proximally out of engagement with port assembly 2110 when a depth threshold (e.g., predetermined) of end effector 2412 is reached (e.g., after an end effector of a surgical instrument - here, second surgical instrument 2410 - reaches a certain location with respect to port assembly 2110). In the illustrated embodiment, the threshold is reached when end effector 2412 of second surgical instrument 2410 is at a certain position within cavity 2110 of port assembly 2100. It is envisioned that the reaching of a threshold is sensed by optical markers, magnetic contact(s), electrical contact(s), and/or a non-contact mode of sensing disposed on any combination of a surgical instrument (e.g., second surgical instrument 2410), and/or port assembly 2100, and a corresponding reader on robotic arm 2300, for example. It is further disclosed that robotic arm 2300 moves instrument drive unit 2200 proximally to the same or substantially same position as instrument drive unit 2200 was in when surgical instrument 2400 was used therewith in connection with a surgical procedure.

[0088] In FIG. 15, system 2000 is shown illustrating port assembly 2100 positioned partially within tissue "T," instrument drive unit 2200 disposed proximally of port assembly 2100, the second surgical instrument 2410 coupled to instrument drive unit 2200, and end effector 2412 of the second surgical instrument 2410 disposed within cavity 2110 of port assembly 2100. Here, second surgical instrument 2410 has been coupled to instrument drive unit 2200, e.g., via latch(es) 2440.

[0089] FIG. 16 illustrates system 2000 including port assembly 2100 positioned partially within tissue "T," instrument drive unit 2200 disposed proximally of port assembly 2100, the second surgical instrument 2410 coupled to instrument drive unit 2200, and end effector 2412 of the second surgical instrument 2410 disposed distally of port assembly 2100 and within tissue "T" or a tissue cavity. Here, robotic arm 2300 has moved instrument drive unit 2200, and thus second surgical instrument 2410 distally with respect to port assembly 2100 such that end effector 2412 is adjacent the surgical site. [0090] The present disclosure envisions the use of visual (e.g., lights), audio (e.g., beeps), and/or haptic feedback to alert a user when various components of system 2000 have be moved to an appropriate location (e.g., when robotic arm 2300 has moved instrument drive unit 2200 to a location that is sufficient for a surgical procedure) and/or have been properly engaged/disengaged with other components (e.g., when instrument drive unit 2200 is engaged with or disengaged from port assembly 2100).

[0091] The present disclosure also contemplates methods of performing a surgical procedure including detecting a coupling of instrument drive unit 2200 to port assembly 2100 during a surgical procedure, detecting an insertion of first surgical instrument 2400 into port assembly 2100 when instrument drive unit 2200 is coupled to port assembly 2100, and electromechanically decoupling instrument drive unit 2200 from port assembly 2100 after detecting the insertion of first surgical instrument 2400.

[0092] It is further disclosed that, responsive to receiving an instrument exchange request (e.g., from a physician, nurse, remote operator, etc.), the method of performing a surgical procedure includes electromechanically coupling instrument drive unit 2200 to port assembly 2100, enabling a removal of first surgical instrument 2400 from instrument drive unit 2200, detecting an insertion of second surgical instrument 2410 into port assembly 2100 through instrument drive unit 2200 while instrument drive unit 2200 is coupled to port assembly 2100, and electromechanically decoupling instrument drive unit 2200 from port assembly 2100 after detecting the insertion of second surgical instrument 2410. This disclosed method may also include detecting a coupling of instrument drive unit 2200 to port assembly 2100 during a calibration phase, sensing a position of instrument drive unit 200 after detecting the coupling during the calibration phase, and storing the sensed position of instrument drive unit 2200 as a position that instrument drive unit 2200 is moved to during the coupling of instrument drive unit 2200 to port assembly 2100.

[0093] The disclosed method also includes detecting an orientation of first surgical instrument 2400 inserted into port assembly 2100 when instrument drive unit 2200 is coupled to port assembly 2100, and maintaining the orientation of first surgical instrument 2400 as instrument drive unit 2200 is moved away from port assembly 2100 during the decoupling. It is further disclosed that the electromechanically decoupling includes preventing a user from moving instrument drive unit 2200 in at least one direction as the user moves instrument drive unit 2200 away from port assembly 2100. The electromechanically decoupling may also include robotically moving instrument drive unit 2200 away from port assembly 2100, and/or releasing an electrical, magnetic, or mechanical device fastening instrument drive unit 200 to port assembly 2100.

[0094] It is envisioned that control device 1004 is configured to perform and/or help perform these detecting, decoupling, sensing, storing and/or maintaining tasks. It is further envisioned that at least one of port assembly 2100, instrument drive unit 220, first surgical instrument 2400, second surgical instrument 2410, and control device 1004 includes at least one sensor configured to communicate with at least one other sensor of a different component to help perform at least one of these tasks.

[0095] The present disclosure also relates to methods for using system 2000 and related methods of performing surgical procedures, as described above with reference to FIGS. 9-16. Additionally, the present disclosure relates to method of exchanging instruments, as described above. For example, disclosed methods of exchanging instruments include coupling first surgical instrument 2400 to instrument drive unit 2200, with instrument drive unit 2200 being in a first position, moving instrument drive unit 2200 distally into contact with port assembly 2100, maintaining contact between instrument drive unit 2200 and port assembly 2100 while removing first surgical instrument 2400 from instrument drive unit 2200, and inserting second surgical instrument 2410 at least partially through instrument drive unit 2200 while instrument drive unit 2200 is in contact with port assembly 2100.

[0096] Although embodiments have been described in detail with reference to the accompanying drawings for the purpose of illustration and description, it is to be understood that the inventive processes and apparatus are not to be construed as limited thereby. It will be apparent to those of ordinary skill in the art that various modifications to the foregoing embodiments may be made without departing from the scope of the disclosure.

Claims

IN THE CLAIMS What is claimed is:

1. A method of performing a surgical procedure, comprising:

detecting a coupling of an instrument drive unit to a port assembly during a surgical procedure;

detecting an insertion of a first surgical instrument into the port assembly when the instrument drive unit is coupled to the port assembly; and

electromechanically decoupling the instrument drive unit from the port assembly after detecting the insertion of the first surgical instrument.

2. The method according to claim 1, further comprising, responsive to receiving an instrument exchange request:

electromechanically coupling the instrument drive unit to the port assembly;

enabling a removal of the first surgical instrument from the instrument drive unit; detecting an insertion of a second surgical instrument into the port assembly through the instrument drive unit while the instrument drive unit is coupled to the port assembly; and

electromechanically decoupling the instrument drive unit from the port assembly after detecting the insertion of the second surgical instrument.

3. The method according to claim 1, further comprising:

detecting a coupling of the instrument drive unit to the port assembly during a calibration phase; sensing a position of the instrument drive unit after detecting the coupling during the calibration phase; and

storing the sensed position of the instrument drive unit as a position that the instrument drive unit is moved to during the coupling of the instrument drive unit to the port assembly.

4. The method according to claim 1, further comprising:

detecting an orientation of the first surgical instrument inserted into the port assembly when the instrument drive unit is coupled to the port assembly; and

maintaining the orientation of the first surgical instrument as the instrument drive unit is moved away from the port assembly during the decoupling.

5. The method according to claim 1, wherein the electromechanically decoupling includes preventing a user from moving the instrument drive unit in at least one direction as the user moves the instrument drive unit away from the port assembly.

6. The method according to claim 1, wherein the electromechanically decoupling includes robotically moving the instrument drive unit away from the port assembly.

7. The method according to claim 1, wherein the electromechanically decoupling includes releasing an electrical, magnetic, or mechanical device fastening the instrument drive unit to the port assembly.

8. A method of performing a surgical procedure, comprising:

coupling a first surgical instrument to an instrument drive unit, the instrument drive unit being capable of remote operation, the instrument drive unit being in a first position;

moving the instrument drive unit distally into contact with a port assembly;

inserting a second surgical instrument at least partially through the instrument drive unit; and

moving the instrument drive unit proximally out of contact with the port assembly.

9. The method according to claim 8, further comprising inserting a portion of the first surgical instrument through the port assembly and into contact with body tissue.

10. The method according to claim 8, further comprising performing a surgical task with the first surgical instrument.

11. The method according to claim 8, further comprising coupling the second surgical instrument with the instrument drive unit.

12. The method according to claim 8, further comprising performing a surgical task with the second surgical instrument.

13. The method according to claim 8, further comprising removing the first surgical instrument from engagement with the instrument drive unit.

14. The method according to claim 13, wherein removing the first surgical instrument from engagement with the instrument drive unit is performed when the instrument drive unit is in contact with the port assembly.

15. The method according to claim 14, further comprising performing a surgical task with the first surgical instrument while the instrument drive unit is free from contact from the port assembly.

16. The method according to claim 13, wherein the first surgical instrument is removed along an axis defined by a shaft of the first surgical instrument.

17. The method according to claim 11, wherein coupling the second surgical instrument with the instrument drive unit is performed when the instrument drive unit is free from contact with the port assembly.

18. The method according to claim 8, further comprising uncoupling the first surgical instrument from the instrument drive unit while the instrument drive unit is in contact with the port assembly.

19. The method according to claim 8, further comprising performing a surgical procedure with the first stapling instrument prior to moving the instrument drive unit distally into contact with the port assembly.

20. The method according to claim 8, further comprising moving the instrument drive unit into substantially the first position after moving the instrument drive unit proximally out of contact with the port assembly.

21. A method of exchanging instruments, comprising:

moving the instrument drive unit distally into contact with a port assembly;

maintaining contact between the instrument drive unit and the port assembly while removing the first surgical instrument from the instrument drive unit; and

inserting a second surgical instrument at least partially through the instrument drive unit while the instrument drive unit is in contact with the port assembly.

22. The method according to claim 21, further comprising moving the instrument drive unit proximally out of contact with the port assembly after inserting a second surgical instrument at least partially through the instrument drive unit.

23. The method according to claim 22, further comprising moving the instrument drive unit into substantially the first position after moving the instrument drive unit proximally out of contact with the port assembly.