CN101351236B - 一种用于生物感应和外科手术的活性套管 - Google Patents
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Abstract
本发明公开了手术探针,或活动套管,它们可以沿着复杂路径通过病人体内的腔和组织。所述探针具有多个重叠柔韧性管,每个柔韧性管具有预形成曲率和预确定的弹性。所述的多个柔韧性管中的每一个的选择是基于它们各自的预形成曲率和弹性,因此给定重叠构型使重叠柔韧性管结合形成预定的形状,且所述形状大致匹配通过体内的目标路径。通过单独地控制每个柔韧性管地平移和角方向,手术探针可以根据目标路径被引导通过体内。
Description
本申请要求受益于2005年11月15日提交的题为一种用于生物感应和外科手术的活性套管,申请号为60/736,789的美国临时专利申请,和2006年10月6号提交的题为用于外科的蛇形机器人控制的方法,申请号为60/849,788的美国临时专利申请,其以参考方式合并入本申请,用于各种目的,就像被完全记载在此一样。
技术领域
本发明基本上涉及用于微创手术的外科套管和生物传感器。更特别地,涉及可通过复杂轨迹引导手术器械、注射物质、诊断装置和/或生物传感器的装置和技术,
背景技术
近年来,通过启动没有传统开放手术一样的大量创伤的外科疗法,微创手术(MIS)技术已具有革命性的药物。MIS已使得医师能够进入到先前开放外科技术不能到达的组织区域,并执行干预。此外,MIS技术已经能极大的减少与手术有关的创伤,因此可以减少手术有关的并发症,并加快手术后的恢复。没有可行的MIS供选方案,为了使工具能够到达手术部位,在体内有限空间的手术会产生大的切口,并会简单的破坏性地拆除健康的骨、皮肤和肌肉结构。
MIS工具涉及的技术包括坚硬的腹腔镜装置,为了在手术中能展示灵活的动作,所述腹腔镜装置在体内或体外都要求有大量的开发空间。该开发空间的要求限制了腹腔镜在很多类型的手术中的应用。其它MIS工具涉及的技术包括可变的形状记忆合金装置,当该装置在病人体内时其形状可以通过加热形状记忆合金来改变。所述装置的一个问题是非故意的加热周围组织。另外一个问题是,为了得到适当的热量和随后的散热,形状记忆合金的热时间常数要求使用一定的时间(长约数秒)。热时间常数引起的时间延迟限制了该MIS装置的应用。
MIS装置涉及的其他技术包括通常具有5-10mm直径的直的且坚硬工具的可电视操作的外科机器人,所述机器人具有一驱动电缆控制的导线或推动驱动电缆控制的杆的机械腕。该相关外科机器人技术的一个问题是,其不得不在身体入口点装枢轴,当通过弯曲的轨迹和环绕一旦在体内碰到的障碍物时不能进行灵活操作,该外科机器人一般不适合复杂的手术程序,比如在子宫中进行的胎儿手术。在胎儿手术需要至少两个支点:一个位于母亲皮肤,和另一个位于子宫壁。涉及头部和颈部的外科手术是种很大的挑战,甚至MIS技术出现后也是如此。比如,颅底损伤的治疗一般会将MIS通过鼻***进去作为内窥镜。因为MIS装置涉及的技术在窦腔中的弯头周围和小孔处不灵活,因此为了使MIS装置能进入包括颅底在内的各种手术部位,必须移除许多健康组织和骨结构,比如鼻的鼻甲骨。至于鼻的鼻甲骨,它们的正常功能是净化空气和帮助olefaction。一旦为了能够进入手术部位的目的而被移除后,它们不能通过重建以恢复功能。两个典型的不能通过直的MIS相关的技术到达的手术部位包括颈动脉后面的区域(眼底部附近)和额窦腔,其包括到达完全位于鼻梁后的骨的周围。
MIS装置涉及的技术缺乏灵活性的手术程序的其他例子是肺部手术和咽喉手术。至于肺部手术,相关支气管镜技术一般只能到达肺内部的1/3.目前,还没有用于移除活组织检查样品或直接治疗深入到肺内癌症的低风险方法。此外,其他用于肺活检和治疗的相关技术方法包括***针,其会引起并发症的实质危险,所述危险包括肺放气。至于咽喉手术,在没有大切口的情况下,很难进入深入到咽喉的损伤。通常使大切口能缝合。像大道一样的用于缝合的咽喉本身对大切口的需求将减轻。然而,相关的MIS装置技术缺少长距离的通过喉镜的灵活性,所述喉镜一般具有11mm的直径。
因此,需要一种为了能到达其他方式不能到达的手术部位而能根据解剖特点灵活操控的手术工具。此外,还需要一种能被引导通过腔内自由空间的手术装置,比如通过窦,咽喉,和肺,也包括组织介质。
发明内容
本发明提供了一种用于生物传感和外科手术的活动套管,其解决了前述由于相关技术限制引起的一个或多个问题。
因此,本发明的一个优点是,给医师提供了更好的体内区域的入口,所述体内区域通常不能到达。
本发明的另外一个优点是,其减少了获得目标组织区域入口时施加于组织的间接创伤。
本发明的另外一个优点是,其提供了新的治疗方法。
本发明的另外一个优点是,其增加了解剖特征对于治疗或诊断目的探针的可到达性。
本发明的另外一个优点是,其为手术器械同时通过自由空间和组织介质提供了更好的操控性。
本发明的另外一个优点是,其提高了手术套管的小型化。
本发明的另外一个优点是,使手术器械在敏感组织存在时的引导更安全。
本发明另外的优点将被记载在随后的说明书中,其一部分可以表现在说明书中,或者可能通过本发明的实施来表现。通过说明书、权利要求书和附加的附图中指示的部分可以认识和达到本发明的优点。
为了达到这些和其他的优点,本发明包含手术套管。手术套管包含具有第一预形成曲率的第一柔韧性管;具有第二预形成曲率的第二柔韧性管,其中第二柔韧性管被置于第一柔韧性管中;与第一柔韧性管连在一起的第一驱动器,其中第一驱动器控制第一柔韧性管的平移和旋转;和与第二柔韧性管连在一起的第二驱动器,其中第二驱动器控制第二柔韧性管的旋转和平移,第二柔韧性管的旋转和平移独立于第一柔韧性管的平移和旋转。
在本发明的另外一个方面,通过用引导手术套管的软件编码的计算机可读介质来达到上述的及其他的优点,所述计算机可读介质包含一用于接收需要的套管路径的程序;一计算多个重叠柔韧性管构型的程序,所述重叠柔韧性管匹配于目标套管路径;一计算多个与目标套管路径相应的中间构型的程序;和一依照多个中间构型来指令大量驱动器的程序。
本发明的另外一个方面,通过引导一具有多个重叠柔韧性管的外科套管的方法来达到上述的及其他的优点。所述方法包含确定的需要的探针路径;选择多元性柔韧性管,其中众多柔韧性管中的每一个都具有预形成曲率和弹性;确定多元性柔韧性管的最终重叠构型,这样便可以使重叠构型的曲率结果与目标探针路径充分对应;和确定多元性柔韧性管的多个中间重叠构型,其中的每隔中间构型与目标探针路径相对应。
可以这样来理解,前述一般的说明和随后详细的说明都是典型和解释性的,是为本发明提供符合要求的进一步的说明。
附图简述
附图用于进一步理解本发明,其被引入并作为说明书的一部分,本发明的实施例和说明书一起用于解释发明原理。
图1说明活动套管,和本发明中用于控制套管的***;
图2A说明活动套管的典型外管;
图2B说明活动套管的典型中间管子;
图2C说明活动套管的典型内管;
图2D说明包含图2A-C中显示的3个管子的典型活动套管;
图3进一步说明图2B的活动套管,其中每个管都有自由度;
图4A说明本发明的一套两轴驱动器;
图4B说明用于两轴驱动器的典型装置;
图5说明一套手控驱动器;
图6说明用于活动套管控制的典型程序;
图7说明控制柔韧性管的运动帧;和
图8说明管的边长和曲率是如何相互应变的。
插图实施例的详细说明
本发明包含活动套管(也称为手术套管),其可用来展开手术探针,活动套管也被称为蛇形手术机器人。活动套管具有多个同心的中空柔韧性管,其中每个管具有预定的柔韧性和预形成的曲率。活动套管的端部前进是通过选择性地平移和旋转每个柔韧性管来实现地的。基于柔韧性,预形成曲率,角定向,每个柔韧性管的平移位置,可以操控活动套管去完成计划中的复杂形式,以使其能灵活地通过自由空间(比如,操控通过窦通道或者在支气管中)和/或通过具有各种阻力的组织。组织介质的阻力可以影响活动套管的形态,其是通过利用组织介质阻力引导活动套管的方式来完成的。当平移和转动期间每个柔韧性管在彼此内滑动时,每个柔韧性管中存储的弹性能可以使活动柔韧性管连续活动。
此外,通过由同心柔韧性管的相互作用力“返推自身”的方式,活动柔韧性管在被引导时可以采取复合形态来通过自由空间或者组织介质。其与利用推挤组织介质的方式来引导探针的相关技术方法形成对照,其中的组织介质可以是软组织,或像动脉壁一样的解剖特征。
图1是说明本发明用于控制活动套管的典型***100。***100包含一活动套管102,所述活动套管102包含外柔韧性管110,中间柔韧性管115,和内柔韧性管120。内柔韧性管120的端部可以有末端执行器125。***100进一步包含连接至内柔韧性管120的内部驱动模块140;连接至中间柔韧性管115的中间驱动模块135;连接至外柔韧性管110的外部驱动模块130。内部驱动模块140,中间驱动模块135,和外部驱动模块130被连到控制计算机145上。
控制计算机145通过控制网络连接146a与主机150连接。如果主机150和控制计算机145在同一个地点,控制网络连接146a可以是局域网(LAN)。选择性地,主机150和控制计算机145可能相隔很远,该情况下控制网络连接146a可以包含因特网。
主机150包含存储器152,其用执行与本发明有关的程序的软件(下文中的“软件”)编码。主机150与用户界面155连接。主机150可能是单个计算机,或者可能是通过网络连接的多台计算机,包括通过因特网。存储器152可能包含单个存储设备,比如硬盘驱动器,或者是包含分布在多台计算机中的多个存储设备和数据库。本领域技术人员将容易地理解,许多这样的用于主机150,存储器152,和用户界面155的体系结构是可行的并且在本发明的范围内。
***100可能进一步包含医学成像***160,所述医学成像***包含图像处理机165。图像处理机165可能通过成像网络连接146b与主机150连接,所述网络连接的类型可以是与控制网络连接146a相同的类型。
图1例示了活动套管102被置于病人的组织170中,两者都在医学成像***160的视野范围内。病人组织170包含进入点175,活动套管102在其处进入病人;和手术部位180,其是病人体内所关心的进行外科手术或诊断的目标部位。
医学成像***160可以包含一个或多个医学成像方式,比如荧光透视,核磁共振成像,超声波,和类似方式。医学成像***160的特定成像形式可能取决于用于活动套管102的材料和活动套管102所处的病人组织170的性质。医学成像***160可以是这样一种类型,其提供具有充分时效性和充分帧率的3维图像,所述充分时效性和充分帧率能通过在主机152上运行软件的方式使其得以对活动套管102进行基于图像的反馈控制。
图2A-2D例示了活动套管102及其组件柔韧性管。图2A例示了典型的外柔韧性管110。外柔韧性管110可以具有外管直部210,外管弯部212,和外管过渡点211,所述过渡点定义外管直部210和外管弯部212之间的边界。外柔韧性管110可以具有宽度足以让中间柔韧性管115和内部柔韧性管120在外柔韧性管110内表面中独立滑动的内径。外柔韧性管110的厚度可以随管的目标弹性而函变,后面将进一步描述。相应地,外柔韧性管110的厚度可以适用于提供指定的弹性。图示的外柔韧性管110的圆形曲率是示范性的,给定管的材料,厚度,和活动套管102目标用途的情况下,很多不同的弯曲形状是可能的。
外柔韧性管110可能由形状记忆合金构成,例如镍钛合金(nitinol),尽管可以使用只要适合于手术用途且具有通过比如材料性质或指定管壁的厚度被预定型的弹性的其他材料。
图2B说明典型的中间柔韧性管115。中间柔韧性管115可以具有中间管直部215,中间管弯部217,和中间管过渡点216,所述过渡点是定义中间管直部215和中间管弯部217之间的边界。中间柔韧性管115可以具有宽度足以让内部柔韧性管120在中间柔韧性管115内表面中滑动的内径。中间柔韧性管115的厚度可以随管的目标弹性而函变,后面将进一步描述。因此,中间柔韧性管115的厚度可以适用于提供指定的弹性。图示的中间 柔韧性管115的圆形曲率是典型的,给定管的材料,厚度,和活动套管102目标用途的情况下,很多不同的曲率是可能的。
像外部柔韧性管的情况一样,中间柔韧性管115可能由形状记忆合金构成,例如镍钛合金(nitinol),尽管可以使用其他材料,只要适合于手术用途且具有通过比如指定特定的管厚度被预定型的弹性。此外,构成中间柔韧性管115的材料与外柔韧性管110的材料可以是相同的也可以是不同的,其取决于预计形状,厚度,和整个活动套管102的弹性。
图2C说明典型的内柔韧性管120。内柔韧性管120可以具有内管直部220,内管弯部222,和内管过渡点221,所述过渡点是定义内管直部220和内管弯部222之间的边界。内柔韧性管120可以具有宽度足以使套管顺利通过的内径等。此外,该内径的宽度可足以使线缆,比如导线、针、弹性推杆、或光学纤维线缆与末端执行器125连接。内柔韧性管120的厚度可以随管的目标弹性而函变,后面将进一步描述。因此,内柔韧性管120的厚度可能适用于提供指定的弹性。图示的内柔韧性管120的曲率是典型的,给定管的材料,厚度,和活动套管102目标用途的情况下,很多不同的曲率是可能的。
像外部柔韧性管的情况一样,内柔韧性管120可能由形状记忆合金构成,比如镍钛合金(nitinol),尽管其他材料也可以使用,只要其适合于手术用途且具有通过比如指定特定的管厚度被预定的弹性。此外,构成内柔韧性管120的材料与外柔韧性管110和中间柔韧性管115的材料可以是相同的也可以是不同的
末端执行器125可能是许多适合于目标外科手术装置中的一种。比如,末端执行器125可以是热烧蚀探头,光导纤维摄像机,用于注射放射源的尖端,用于执行活组织检查的探针,及类似装置。此外,末端执行器125可用于获取组织或流体样品,用于体外分析。另外,末端执行器125可以是被置入关心部位的生物传感器。该生物传感器可能包含立体定向***(比如,磁性***),分子传感器,电阻抗传感器,遥控的机械阻抗传感器,光学发光传感器,及类似的传感器。本领域技术人员将易于理解,末端执行器125可以采取很多形式并执行许多不同的功能,其都在本发明的范围内。
图2D例示了包含图2A-D中展示的每个管的活动套管102。内柔韧性管120***到中间柔韧性管115,内柔韧性管120和中间柔韧性管115的组合***到外柔韧性管110。
图3例示了包含内柔韧性管120,中间柔韧性管115,和外柔韧性管110的活动套管102。如图所示,每个柔韧性管具有两个自由度:一个围绕轴向的旋转轴,和另一个沿着线性的平移轴。比如,外柔韧性管110具有一外部的旋转自由度305和一外部的平移自由度310。外部的旋转自由度305和一外部的平移自由度310以与其它管无关的方式适用于外柔韧性管110。中间柔韧性管115具有以中间旋转自由度315和以中间平移自由度320,两者只以与其它管不相关的方式适用于中间柔韧性管115。内柔韧性管120具有一内部旋转自由度325和一内部平移自由度330,两者以与其他管不相关的方式适用于内柔韧性管120。
再次参照图3,活动套管102具有大量的重叠过渡点T1-T5。每个重叠过渡点T1-T5定义一个区域的边界,在该边界,每个外柔韧性管110,中间柔韧性管115,和内柔韧性管120(或这三个的一些子集)具有充分的曲率度数常量,或没有曲率。比如,重叠过渡点T1和T2之间的区域包含外管弯部212,中间管直部215,和内管直部220。重叠过渡点T2与中间管过渡点216重叠。因此,T2和T3之间的区域包含外管弯部212,中间管弯部217,和内管直部220。
每个通过重叠过渡点T1-T5中的至少一个限定的区域具有曲率,所述曲率随着每个外柔韧性管110,中间柔韧性管115,和外柔韧性管120的曲率和弹性而变,也随组织介质周围阻力而变。需要注意的一点是有些区域只具有中间柔韧性管115和内柔韧性管120。在这种情况下,该区域的曲率随着该区域中的两个管的曲率而变。在简单的情况下,T5到末端执行器125间的区域的曲率随着内柔韧性管120的曲率和组织介质周围阻力而变化。
图4A说明根据本发明的一套两轴驱动器。该两轴驱动器包含连接到外柔韧性管110上的外部驱动模块130;连接到中间柔韧性管115上的中间驱动模块135;和连接到内柔韧性管120上的内部驱动模块140。每个驱动模块独立地驱动它们各自的柔韧性管。比如,外部驱动模块130在外 旋转自由度305附近,并沿着外平移自由度310驱动外部柔韧性管110。中间驱动模块135在中间旋转自由度315附近,并沿着中间平移自由度320驱动中间柔韧性管115。和内驱动模块140在内旋转自由度325附近,并沿着平移自由度330驱动内柔韧性管120。
图4B说明根据本发明的典型两轴驱动器405。两轴驱动器405可以被用于任何外驱动模块130,中间驱动模块135,和内驱动模块140。两轴驱动器405包含被坚硬地固定在柔韧性管(图中以柔韧性管110为例)上的导向螺杆410;螺母415通过螺纹与导向螺杆410结合;通过平移齿轮425与螺母415连接的线性平移电动机435。两轴驱动器405进一步包含通过链轮437连接到导向螺杆410上的皮带驱动440。皮带驱动440通过旋转齿轮445也连接到旋转电动机450上。两轴驱动器405也包含平移和旋转编码机(未显示),其分别向控制计算机145提供线性平移位置和角定向信号。
两轴驱动器405可以如下操作。在线性平移时,线性平移电动机430从控制计算机145接收指令并根据特定的平移距离去平移它的弹性管。在反应时,线性平移电动机430旋转跟螺母415咬合的平移齿轮425。螺母425随后的旋转咬合用于平移柔韧性管的导向螺杆410。
在旋转时,旋转电动机450从控制计算机145接收指令并根据特定的旋转角度来旋转。在反应时,旋转电动机450旋转与皮带驱动440咬合的旋转齿轮445。皮带驱动440咬合链轮437,依次旋转导向螺杆410。注意,导向螺杆410的旋转引起导向螺杆410的平移是因为存在螺母415。因此,为了预防附加的平移,通过在反方向旋转螺母415的方式来均衡线性平移电动机430。同样的,纯理论的柔韧性管旋转可能要求通过旋转电动机450和线性平移电动机430方式的同位电动机。
如图4B所示,导向螺杆410可以是空心的。在这种情况下,如果两轴驱动器405作为外驱动模块130,那么外柔韧性管110与导向螺杆410连接,中间柔韧性管115和内柔韧性管120可以在导向螺杆410的空心部分独立地平移和旋转。这样,外柔韧性管110,中间柔韧性管115,和内柔韧性管120可以被独立地平移和旋转。
图5说明一套手控两轴驱动器505a-c。在此,手控两轴驱动器505a 可以代替外驱动模块130来驱动外柔韧性管110;手控两轴驱动器505b可以代替中间驱动模块135来驱动中间柔韧性管115;手控两轴驱动器505c可以代替内驱动模块140来驱动内柔韧性管120。每个手控两轴驱动器505a-c可以包含平移的和旋转的编码器,所述编码器用来向控制计算机145提供线性位置和角定向信号。
两轴驱动模块的变化是可能的。比如,两轴驱动器405可能包含手动控制,比如分别代表线性平移电动机430和旋转电动机450的按钮。此外,***100可以包含电动驱动器和手控驱动器的结合。此外,两轴驱动器405是典型的。比如,可能有其他与这里显示不同的完成每个柔韧性管线性平移和旋转的方式。本领域技术人员可以容易地理解,许多这样的变化是可能的并都在本发明的范围内。
图6说明本发明用于控制活动套管的典型程序600。通过存储在存储器152上并在主计算机150和/或控制计算机145和/或图像处理机165上执行的软件来执行所有或部分程序600。程序600可以被分为两个子进程:路径计划(步骤605-25)和路径计划执行(步骤630-55)。
在步骤605中,医学成像***160获取病人组织170的图像。医学成像***160可以被设置成具有在入口点175周围和手术部位180处有视野。取决于它的成像形式(比如,核磁共振,超声等),医学成像***160可以获取病人组织的3-D图像,借此,每个图像的像素和体素被登记为相片坐标帧。图像处理机165可以通过成像网络连接146b向主计算机150提供图像及图像寄存信息。
在步骤610中,医师决定一个从入口点175到手术部位180的目标路径。在这样做时,医师可以确定一条路径,通过该路径活动套管102将在存在路径附近误差边界的情况下行进。取决于手术部位180的定位,和***组织或器官的存在,路径可以包含具有可变误差边界的复杂路径。
医师可以使用用户界面155去定义路径和它的误差边界。在这样做时,医师可以使用光标去标记通过步骤605获取的寄存后图像中的点。软件识别这些寄存图像中选择的点的位置并将这些位置存在存储器152中。
在步骤615中,软件计算出活动套管102的最终构型,所述构型将完成步骤610中选择的路径。在这样做时,软件可以确定每个外柔韧性管110, 中间柔韧性管115,和内柔韧性管120的平移位置和旋转取向,其将使活动套管102与路径符合。
在计算符合路径的最终构型时,该软件将活动套管102分为一组被重叠过渡点T1-T5定义的区域。在这样做时,该软件将为每个外柔韧性管110,中间柔韧性管115选择平移位置和旋转取向的初始组。重叠过渡点T1-T5 的位置取决于三根柔韧性管的重叠。然后对于每个被重叠过渡点T1-T5划界的区域,该软件根据以下关系计算在该区域的瞬间平衡曲率(在X和Y部分):
and
其中n是柔韧性管的数量(在该例子中n=3);Ki是该区域中ith柔韧性管的瞬间曲率;Ei是ith柔韧性管中材料的弹性模数(杨氏模数);Ii 是ith柔韧性管的截面转动惯量;θi是在朝向驱动器方向最靠近重叠过渡点T的ith柔韧性管的角取向;Φ是结合柔韧性管在给定各柔韧性管的角取向时的平衡角,其中的Φ是以该区域为基础决定的。换句话说,比如,对于通过重叠过渡点T3和T4划界的区域,Φ在T3上属于平衡角。
这些术语中的Ki,Ei和Ii是已知的。剩余的术语通过以下方式计算(1)计算驱动器和第一过渡点间直线部分中的扭转能量,和储存在活动套管中的弯曲能量(随柔韧性管定向而变),和(2)计算提供最小能量的形状。在这样做时,该软件分别计算存储在外柔韧性管110直线部分210,215,和220中的扭转能量,中间柔韧性管115,和内柔韧性管120中的扭转能量;该软件分别计算储存在外柔韧性管110弯部212,217,和222中的弯曲能量,中间柔韧性管115,和内柔韧性管120中的弯曲能量。该软件通过以下关系计算结合的储存能量来完成:
其中ai是内驱动模块140,中间驱动模块135,和外驱动模块130中的角输入;θi,j是在jth过渡点Tj中ith柔韧性管的角度; 是重叠过渡点T之间的每个m重叠区域的平衡平面;和 求出E(q)的最小值并得到θ1,1,θ1,2,...θ1,n在T1的旋转方向,和过渡点T之间的每个重叠区域的平衡面 这些值也可以为了上述KX和KY而用在方程式中,去计算活动套管102的过渡点T之间的每个重叠区域的曲率。
步骤615的进一步情况,软件可以为外柔韧性管110,中间柔韧性管115,和内柔韧性管120从管存量中选择不同的管。在这种情况下,许多各自的柔韧性管类型可能是可利用的,及它们的性能(直部分的长度,弯部的长度,弯部的曲率半径,弹性等)可以被储存在存储器152中。同样地,该软件可以重复上述步骤610所记载的计算,其中每次重复使用不同的有效管。如此,该软件可以确定两件事:第一,医师所确定的路径是否能被活动套管102重复;和第二,管的何种结合能完成该路径。此外,上 述关系没有被限制为3柔韧性管。因此,为了完成医师所确定的路径,该软件可以选择多种柔韧性管结合,包括被利用的柔韧性管数量。本领域技术人员将知道如何执行上述公式使柔韧性管大于三根。
步骤620中,软件为活动套管102计算大量构型,以使活动套管能逐步地完成步骤615中计算的最终构型,当活动套管没有偏离医师所确定的路径和误差边界时。在这样做时,软件可以计算一系列中间构型,和计算一组完成每个中间构型的线性平移和旋转。软件可以像上述步骤615一样的进行迭代计算,其对于每个计算后的中间构型的结果构型可以作为下一个计算后的中间构型的初始构型。
步骤620的进一步情况,为了完成序列中的中间构型,软件可以为每个外驱动模块130,中间驱动模块135,和内驱动模块140中的旋转发动机450计算一序列旋转指令,为线性平移发动机430计算一序列线性平移指令。
在步骤625中,软件为医学成像***160坐标系中的每个活动套管寄存最终的和中间的构型,就像步骤615和620中的分别计算。在这样做时,软件可以检索步骤605中获取的已寄存图像,在该图像中医师在步骤610中已经指定了一路径,并寄存活动套管102的最终和中间构型。其结果可能时一组曲线,一中间构型和一最终构型,其中每组曲线对应于活动套管102和一个重叠过渡点T1-T5之间的区域。软件可以通过在活动套管(寄存在图像空间中)的原点起始,通过入口点175,和在手术部位180(或在中间构型的活动套管102的末端执行器)结束的方式来完成。软件将这些曲线组储存在存储器152中。
这完成程序600的典型路径计划子程序,该路径计划子程序可以直接于手术前在手术室中进行。做为选择,该路径计划子程序可以在外科手术前在不同于手术室的场景中进行。在后一种情况下,步骤605获取的图像可能会过时,因为病人已经在路径计划子程序和执行子程序之间移动。在这种情况下,必须通过医学成像***160获取新的寄存图像来作为执行子程序的前体,和新获取的图像必须被寄存为初期寄存图像,所述初期寄存图像具有步骤625中计算的活动套管102的寄存构型(曲线)。关于机器人路径计划的进一步信息可以从Planning Algorithms,Steven M.LaVaIIe, Cambridge University Press(2006),(ISBN-10:0521862051 1 ISBN-13:9780521862059)中找到,其内容就像全部公开在本申请中一样,可以并入用来参考。
在最初的执行子程序,如图1所示,为手术准备好病人,且病人组织170被放在医学成像***160的视野内。活动套管102被放在入口点175的附近,外驱动模块130,中间驱动模块135,和内驱动模块140和活动套管102连接。控制计算机145与驱动模块130,135,和140三个连接,且通过控制网络连接器146a在控制计算机145和主计算机150之间建立通信。
在步骤630中,执行子程序的第一步骤,医师(通过用户界面)向软件发出一个指令将活动套管102移动到步骤630中(在路径计划子程序中)计算的第一中间构型。在这样做时,该软件,所述软件可能正在主计算机150和/或控制计算145上运行,向每个外驱动模块130,中间驱动模块135,和内驱动模块140的平移发动机430和旋转发动机145发出适当的指令,去完成步骤620中计算的第一中间构型。
在步骤635中,医学成像***160获取一张活动套管102在病人组织170中的图像。在这样做时,图像处理器165可能在图像坐标系中分割和寄存活动套管102。图像处理器165可能使用本领域公知的一种或多种分段算法。图像处理器165可以通过图像网络连接器136b向主计算机150传送寄存信息和图像。该软件可以接收活动套管102在病人组织107内的寄存信息和图像,并通过用户界面155向医师呈现信息和图像。
在步骤640中,该软件比较活动套管102的寄存图像和步骤620中计算的中间构型。在这样做时,该软件可以使用许多图像处理算法中的一种或多种去比较这两张图像。此外所述软件可以比较分割、寄存的活动套管坐标和给定中间构型计算出的坐标,基于该对比,计算路径误差,或差动位移。
在步骤645中,所述软件确定在分割、寄存的活动套管102和给定中间构型之间是否存在差异。如果没有差异,程序600通过“不”支路从步骤645进行到步骤655。
在步骤655中,所述软件确定给定的中间构型是否就是步骤615中计 算的最终构型。如果是,程序600可以通过步骤655的“是”支路进行到结束。如果它不是最终构型,于是程序600可以通过步骤655的“不”支路进行到具有下一中间构型(或最终构型)的重复步骤630-645。
回到步骤645,如果在分割、寄存的活动套管102跟给定的中间构型之间没有差异,那么程序600可以通过步骤645的“是”支路进行到步骤650。
在步骤650中,所述软件计算步骤630中活动套管102穿过病人组织170时,施加在活动套管102上的力和扭矩。该软件可以根据以下关系计算力和扭矩。
其中fx,y,z是通过组织介质作用在活动套管102上力的成分,所述力作用在两个重叠过渡点Ti和Ti+1之间的给定区域上;τx,y,z是作用在活动套管102上的扭矩,所述扭矩通过组织介质作用到活动套管102的相同区域上;dispx,y,z是步骤640中计算的活动套管102的差动位移的平移成分。rotx,y,z 是步骤640中计算的活动套管102的差动位移的旋转成分;K是柔度矩阵,其是6x6矩阵,并对应于两重叠过渡点Ti和Ti+1之间给定区域的活动套管102的力和扭矩柔度。
柔度矩阵K可以被预定在校准程序中,在所述校准程序中活动套管102在一个或多个具有已知阻力性质的人体模型中平移和旋转。此外,如果柔度矩阵K是已知的,然后活动套管102可以被用作力传感器。在这样情况下,医师可以为活动套管102设置路径(使用全部或部分典型程序600)以使末端执行器125可以与感兴趣的组织区域接触。一旦末端执行器125与感兴趣的组织区域接触,步骤650中计算的fx,y,z和τx,y,z数值可以分别对 应于通过感兴趣的组织区域作用在末端执行器125上的力和力矩。因此,活动套管102可以被用作力传感器。
图8说明张力如何应变于柔韧性管边长,所述柔韧性管可以是外柔韧性管110,中间柔韧性管115,和内柔韧性管120中的任一种。所述软件,在计算步骤615和620的最终和中间构型时,可以确定最大曲率度,或最小曲率半径,超过时给定柔韧性管将遭受塑性形变。塑性形变指形状记忆材料的弯曲程度,材料将不再恢复到它的原始形状。这可能符合柔韧性管容许曲率的极限。所述软件可以根据以下关系计算最大曲率度:
其中d是柔韧性管直径,和ε是柔韧性管材料的最大可恢复应变。对于镍钛合金(nitinol),ε范围可以从0.08到0.1。像从上面关系推断出的一样,内柔韧性管越大曲率度越大(或内柔韧性管越小曲率半径越小)。因此,根据步骤610中医师确定的路径,希望得到薄柔韧性管。所述软件可以帮助医师根据步骤610中确定的路径来选择优选的柔韧性管厚度。
活动套管102,***100,和程序600的变化是可能的,且落入本发明的范围。比如,活动套管102中的一些或全部柔韧性管可以有相同的弹性度
,或它们每个具有不同的弹性度。如果所有的柔韧性管具有相似弹性,其将使活动套管102更灵活,且更容易地引导通过复杂路径。作为选择,外柔韧性管110可以比中间柔韧性管115更硬,所述中间柔韧性管115可以比内柔韧性管120更硬。在后一种情况下,活动套管102可能比前一种情况不灵活(在前一种情况,所有柔韧性管具有相同弹性)。然而,在后一种情况下,活动套管102的路径可能更容易计算,可能更适合手控操作,比如,通过使用如图5所示的手控两轴驱动器505。
在另一个变化形式中,任何一种柔韧性管可以具有非圆形的内型材和/或外型材。柔韧性管截面的该变化形式可以随着弯曲角度提供不同弹性。此外,柔韧性管可以沿着它的长度具有不同成形区域,借此,每个区域可 以具有不同截面形状。
在活动套管102中的任何一种柔韧性管可以只具有一弯部或一直线部分。此外,任何一种柔韧性管可以具有多段,每段具有不同弯曲度(包含不弯曲的)。
这可以让活动套管102得到更多复杂形状。比如,任何一个柔韧性管可以具有三维曲线和直线区域的序列。同样,任何一种柔韧性管可以具有复杂形状的片断,比如螺旋形状,椭圆形状,抛物线形状,在三维中的可变曲率,及类似的。在这些情况的任何一种下,多数过渡点(像内管过渡点221,中间过渡点216,和外管过渡点211)可以被定义为特定柔韧性管曲率半径变化的标记。因此,曲率的离散分层可以被分开用来限定重叠区域,作为步骤615和620中计算套管最终和中间构型的一部分。
在另一个可变形式中,一个或多个柔韧性管被设计成具有可变的硬度,所述可变的硬度是根据柔韧性管弯曲的方向来变化的。比如,一个或多个柔韧性管在其内表面或外表面有刻痕或槽。
在另一个可变形式中,一个或多个柔韧性管可以包含标记,所述标记被置入到柔韧性管材料中,所述柔韧性管材料被设计成医学成像***160可视。比如,如果医学成像***160是光学摄像机,被置入的标记的形式可以是有色条带或浅色和深色波带。此外,如果医学成像***是C-arm荧光镜,置入的标记可以包含植入管材料中的导线结构。本领域技术人员将容易地理解,许多这样地变化形式是可能的,并落入本发明的范围。
如果镍钛合金(nitinol)被用在任何上述记载的柔韧性管中,那么***100可以包含一个或多个加热原件,所述加热原件沿着一个或多个柔韧性管110,115,和120运行。根据该变化形式,热量可以被用来改变给定柔韧性管的形状。本领域技术人员将懂得如何将加热原件结合到活动套管102和***100中,且该变化形式落入本发明的范围。
除了肺和咽喉手术外,像上面提到的,本发明可以用在其他手术程序中,在所述手术程序中活动套管102和***100提供的灵活性可能是有利的。所述手术程序包含射频烧蚀。在射频烧蚀中,在手术部位放置电极,和然后传输无痛射频能量来加热电极周围的组织。该程序可以作为肝、肾、和肺肿瘤治疗的一部分,用来杀死细胞。活动套管102和***100可能被 用来配置电极。
另一个可能的手术应用涉及在视网膜后面的外科手术。一个这样的外科手术可以包含视网膜套管***去治疗凝固,所述凝固是失明的主要原因之一。
另一个可能的手术应用涉及经胃手术,在该手术中,工具通过嘴巴进入胃,然后退出胃进入腹腔。活动套管102的灵活性,和其被引导通过自由空间和组织的能力,可以使得进行经胃手术。
在另一个可变形式中,***100可以包含第二活动套管102,所述第二活动套管102包含第二组连接到控制计算145上的内部、中间、和外部驱动模块。在该变化形式中,所述两个活动套管可以被用作并行机器人(″Stuart Platform″是个典型的并行机器人,但还有许多本领域公知的变体),借此,两个活动套管的尖端被连到单个末端执行器125上。这样做可以是***能控制末端执行器的位置和方向,就像控制位置和方向的刚性,在另一个具有两个活动套管***100的可变形式的应用中,两个活动套管可以被置入病人组织170中,并被用作抓取软组织和暴露手术部位的牵开器。
尽管上述描述涉及本发明的手术应用,本领域技术人员将易于理解,本发明可以被用于其它需要将装置引导通过包含自由空间的复杂路径的应用。其它应用可以包括制造和微型装配,远程结构检查,去除法令(defusing ordinance),在破损结构中搜寻和救助,及类似应用。
在没有脱离本发明精神或范围的前提下,本领域的技术人员可以理解,本发明可以做出各种改进和变化。因此,其意图是本发明覆盖了其改进和变化形式,所述改进和变化形式都落在所附的权利要求和其等同体的范围内。
Claims (14)
1.一种手术套管,包含:
具有第一预形成曲率的第一柔韧性管;
具有第二预形成曲率的第二柔韧性管,其中第二柔韧性管被置于第一柔韧性管内;
连到第一柔韧性管的第一驱动器,其中第一驱动器控制第一柔韧性管的平移和旋转;和
连到第二柔韧性管的第二驱动器,其中第二驱动器控制第二柔韧性管的平移和旋转,其独立于第一柔韧性管的平移和旋转,
其中所述第一和第二柔韧性管以一种组态存储弹性能,以使所述弹性能能够通过所述第二柔韧性管相对于所述第一柔韧性管的平移来释放,并且所述第一和第二柔韧性管中的至少一个的至少一部分被配置成当所述第二柔韧性管相对于所述第一柔韧性管平移时改变形状。
2.根据权利要求1的手术套管,其中第一柔韧性管比第二柔韧性管硬。
3.根据权利要求1的手术套管,其中第一柔韧性管具有第一硬度,第二柔韧性管具有第二硬度,且其中的第一硬度和第二硬度基本上相等。
4.根据权利要求1的手术套管,其中第一柔韧性管包含镍钛合金。
5.根据权利要求1的手术套管,其中第一柔韧性管具有直部。
6.根据权利要求1的手术套管,其中第一柔韧性管包含具有复合形状的区域。
7.根据权利要求1的手术套管,其中第一柔韧性管包含多个区域,其中对于所述多个区域中的每个区域,第一柔韧性管具有不同的厚度。
8.根据权利要求1的手术套管,其中第二柔韧性管包含镍钛合金。
9.根据权利要求1的手术套管,其中第二柔韧性管具有直部。
10.根据权利要求1的手术套管,其中第二柔韧性管包含具有复合形状的区域。
11.根据权利要求1的手术套管,其中第二柔韧性管包含多个区域,其中对于所述多个区域中的每个区域,第二柔韧性管具有不同的厚度。
12.根据权利要求1的手术套管,进一步包含连接到第一驱动器和第二驱动器的计算机,其中所述计算机被构造为根据第一柔韧性管的线性位置、第一柔韧性管角取向、第一预形成曲率、第二柔韧性管线性位置、第二柔韧性管角取向、第二预形成曲率、和第一柔韧性管和第二柔韧性管之间的重叠来确定手术套管的形状。
13.根据权利要求1的手术套管,进一步包含:具有第三预形成曲率的第三柔韧性管,其中第三柔韧性管被置于第二柔韧性管内;和
连接至第三柔韧性管的第三驱动器。
14.根据权利要求13的手术套管,进一步包含连接到第一驱动器、第二驱动器、和第三驱动器的计算机,所述计算机被构造为通过第一柔韧性管线性位置、第一柔韧性管角取向、第一预形成曲率、第二柔韧性管线性位置、第二柔韧性管角取向、第二预形成曲率、第三柔韧性管线性位置、第三柔韧性管角取向、第三预形成曲率、和第一柔韧性管、第二柔韧性管、和第三柔韧性管之间的重叠来确定手术套管的形状。
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CN2006800500468A Active CN101351236B (zh) | 2005-11-15 | 2006-11-15 | 一种用于生物感应和外科手术的活性套管 |
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US (2) | US8152756B2 (zh) |
EP (1) | EP1973595B1 (zh) |
JP (4) | JP5276987B2 (zh) |
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