CN102143714A - 双极烧灼器械 - Google Patents

双极烧灼器械 Download PDF

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CN102143714A
CN102143714A CN2009801343862A CN200980134386A CN102143714A CN 102143714 A CN102143714 A CN 102143714A CN 2009801343862 A CN2009801343862 A CN 2009801343862A CN 200980134386 A CN200980134386 A CN 200980134386A CN 102143714 A CN102143714 A CN 102143714A
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W·A·伯班克
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Abstract

一种烧灼器械包括刷式接触件,该刷式接触件提供滑动电连接至器械的钳爪。为了提供隔离,钳爪可以具有在由绝缘材料制成的夹具中的空腔中的末端。非传导驱动线缆可以通过使用高摩擦路径被附接至钳爪,高摩擦路径阻止或阻碍线缆相对于钳爪的滑动。

Description

双极烧灼器械
相关申请的交叉引用
本专利文件涉及并且结合共同提交的题为“Four-Cable Wrist with Solid Surface Cable Channels”、代理卷号为ISRG01630US的美国专利申请和共同提交的题为“Backend Mechanism for Four-Cable Wrist”、代理卷号为ISRG01650US的美国专利申请作为参考。
背景技术
机器人控制的外科器械通常用在微创医疗程序中。这种器械的一个结构包括在延伸部分的远端处安装在腕机构上的(例如手术钳、剪切工具或烧灼工具)的执行器或工具,延伸部分有时在此称为器械的主管路。在医疗程序中,执行器和主管路的远端被***到病人的小切口或自然开口中,以将执行器放置在病人的体内的工作部位。然后,当在工作部位实施期望的程序时,腕机构可被用于移动或者操作执行器。延伸通过器械的主管路的线缆或相似结构可以将腕机构连接至传输装置,传输装置有时在此称为后端机构。为实现执行器和腕机构的机器人控制,后端机构是电机驱动的,并且处理***可以被用于为医生提供一个用户界面以便控制器械。
腕机构一般提供执行器运动的特定自由度。例如,对于手术钳或其他夹握工具,腕能够改变执行器的俯仰、偏转和夹握。虽然能够通过腕实现更多的自由度,但是实现腕的三个自由度并且通过主管路的运动实现例如侧滚或者***/抽出的其他自由度一般提供实施医疗程序所需的运动。
在机器人控制的医疗器械中腕机构的常规结构采用线缆来转动腕机构的绞盘(capstan)并且由此旋转被连接至绞盘的腕机构的部分。例如,腕机构可包括绕俯仰轴线、偏转轴线或夹握轴线旋转的三个绞盘。每个绞盘可以通过使用两根线缆来控制,这两根线缆均被附接至绞盘,从而使得一侧输出线缆而另一侧拉进相等长度的线缆。通过该结构,三个自由度需要从腕机构向后沿主管路的长度延伸至器械的后端机构的六根线缆。由于线缆必须被仔细地引导通过腕机构以在腕机构的整个运动范围内保持线缆的张力/张紧度并且最小化一个旋转轴线与另一个的相互作用(或联接作用),所以腕机构的有效实施是复杂的。此外,滑轮一般用于降低线缆的摩擦,这延长了器械的寿命并且允许在没有过大的力施加至腕机构的线缆或其他结构的情况下的操作。烧灼工具对于带有腕的器械存在更多的复杂性,因为烧灼器械需要输送电力至可移动执行器。例如,双极烧灼工具需要相反极性电压的输送,导体移动的空间和电压的有效隔离。
期望一种腕机构能够通过小数目的线缆操作,以便于器械的小型化并且降低器械的成本。期望腕机构的低部件数目,以降低制造成本。此外,腕机构应该允许适合于烧灼器械的电隔离并且具有高效的后端机构。
发明内容
根据本发明的一方面,适用于微创医疗程序的器械具有腕机构,该腕机构能够通过使用从腕延伸通过器械的主管路到达后端机构的四根线缆来控制执行器的俯仰、偏转和夹握。根据本发明的另一方面,后端机构将四根线缆连接至三个电机驱动机构,这三个电机驱动机构共同控制执行器的俯仰、偏转和夹握。在一个实施例中,执行器是双极烧灼工具,其采用刷式或者滑动接触用以电连接至执行器的可移动部件。
本发明的一个具体实施例是包括钳爪、导体和接触件的烧灼器械。钳爪被可旋转地安装,并且在电导体上的接触件使得与钳爪的表面电接触并且当钳爪旋转时在其表面上滑动。钳爪的旋转可以通过使用非传导线缆被控制,非传导线缆沿着高摩擦路径通过钳爪。
本发明的另一实施例是包括可被装配到机器人控制***的后端机构的医疗器械。主管路从后端机构延伸,并且由绝缘材料制成的夹具被可旋转地安装到主管路的远端处。钳爪被连接以绕夹具的销旋转。为了提供电力至钳爪,在延伸通过主管路的导体的末端的第一接触件与一个钳爪的表面电接触并且当钳爪旋转时在其表面上滑动。
本发明的另一实施例是电激励医疗器械中的执行器的方法。该方法包括抵靠所述执行器的导电部件的表面按压接触件,并且在医疗程序期间移动所述部件。移动所述部件导致所述第一接触件在所述第一表面上的滑动。然而,该方法仍然通过所述接触件施加电信号至所述部件。
附图说明
图1显示根据本发明的一个实施例的使用医疗器械的机器人控制***。
图2A、图2B和图2C显示根据本发明的实施例使用一对夹具(clevis)和在集成到夹具中的导向表面上滑动的四根驱动线缆的腕机构。
图3A和图3B说明根据本发明的可替代实施例的使用高摩擦路径附接线缆的钳爪。
图4A说明根据本发明的实施例的腕机构在俯仰、偏转和夹握中产生变化的四根驱动线缆的运动。
图4B显示说明当使用图4A的线缆运动操作时图2A、图2B和图2C的腕机构的枢转轴线的透视图。
图5A和图5B分别显示根据本发明实施例使用齿轮和杆移动驱动线缆的后端机构的分解图和截面图。
图6显示根据本发明实施例使用滑轮、绞盘和齿轮移动驱动电缆的后端机构。
图7A是根据本发明的实施例在具有使用刷式接触的电连接的双极烧灼器械中腕机构的截面图。
图7B说明根据本发明的实施例在双极烧灼器械中导向驱动线缆和电导体的一种设置。
在不同的附图中使用相同的参考符号指示相似或同一部件。
具体实施方式
根据本发明的一个方面,医疗器械的腕机构为执行器或工具提供三个自由度(俯仰、偏转和夹握)并且仅使用四根驱动线缆。腕结构包括限定俯仰控制的枢转轴线的近端夹具和限定偏转和夹握控制的枢转轴线的远端夹具。驱动线缆在与所述夹具一体的导向通道的表面上滑动,从而不需要滑轮或者较大的线缆缠绕角。具体地,这些夹具可以包括支撑线缆的相对侧的一体线缆导向表面,并且线缆导向表面可以在多个方向上弯曲以消除对于在一些现有腕结构中需要的较大线缆缠绕角。线缆导向表面被额外地构造或者弯曲,以避免线缆的出轨并且将线缆保持在套管的直径限制内,藉此腕机构可以在微创医疗程序期间被***或移除。腕机构可以提供需要很少线缆和消除滑轮空间需求的优点,由此允许对腕机构在临床上的有益的更小工作容积;消除额外的部件例如滑轮的成本;并且当与带有更大线缆缠绕角的腕结构相比较时降低了摩擦。
根据本发明的另一方面,线缆将器械的钳爪拉在一起用于夹握的部分可以比器械中的其他线缆更坚硬,例如具有更大的直径。例如,在四根线缆的腕结构中,其中的两根线缆可以具有比其他线缆的对应部分更大的部分。选择的线缆的较大直径允许使用较大的夹握力,而没有扩大整个器械尺寸。
根据本发明的另一方面,腕型烧灼器械可以使用刷子或相似滑动接触,以使器械的钳爪电连接。为了在双极器械中提供电压的电隔离,远端夹具可以由电绝缘材料制成并且在共享同一枢转轴线的相对的极性钳爪之间提供间隔件。额外地,带有非传导部分的线缆可以通过使用较高摩擦路径被附接至钳爪。使用较高摩擦路径能够简化器械组件并且避免使用褶皱(crimp)或相似结构的需要,该褶皱和相似结构难以可靠附接至非传导线缆材料。
根据本发明的另一方面,腕机构的四根驱动线缆连接至后端机构中的三个电机驱动轴。后端机构与腕机构协作地工作,以实现执行器的俯仰、偏转和夹握的机器人控制。后端机构的一个实施例使用了两个绞盘,两根线缆缠绕绞盘使得绞盘的旋转拉进一根线缆的长度并且绕出相同长度的另一线缆,并且机器人的电机驱动两个自由度驱动绞盘。第三自由度以线缆经由一组滑轮而实现,其中该组滑轮被配置为与机器人电机驱动的第三自由度成比例的整组移动。滑轮组的移动主要是朝向一个绞盘而远离另一绞盘,这具有拉伸或输出一对绞盘线缆而缩短或拉进另一对线缆的效果。
后端机构的另一实施例具有附接至对应杆的末端的两个或两个以上驱动线缆。齿轮机构可以通过反向于线缆的附接移动杆的末端或者移动相应的杆的枢转轴线而移动线缆。通过杆的枢转轴线的适当设置,任一线缆的运动可以通过一个或一个以上的其他线缆的相等和反向运动被匹配,并且线缆的连接可以保证在所有腕移动期间保持线缆的张紧度,包括当器械与机器人的控制分离时可能的运动。杆一般沿器械的长度拉动线缆。这种近似线性的运动还允许线缆由固体杆或管替换,固体杆或管比绞合线缆成本更低。
图1显示能够使用根据本发明的一个实施例的医疗器械的机器人控制***100的示例。***100可以是来自Intuitive Surgical,Inc.(直观外科手术公司)的da Vinci
Figure BPA00001327906400051
外科手术***,***100包括多个医疗器械150,每个医疗器械被安装在机器人手臂130上的对接端口(docking port)中。器械150可以被制作为可互换的,从而被安装到手臂130上的器械150可以被选择用于具体医疗程序或者在医疗程序期间被改变以提供需要的临床功能。如在本领域已知的,器械150可以实现很多功能,包括但不限于不同形状和大小的手术钳或抓持器、针驱动器和剪刀。根据本发明的一方面,器械150可以是双极烧灼器械。
对接端口一般包括为器械150的操作提供机械动力的驱动电机。对接端口可以另外包括与器械150相连的电接口,以便例如识别在对接端口中的器械类型并且获得器械的参数。电接口还可以传送测量值,例如组织的阻抗的测量值,以用于确定密封操作的参数。高电压电气***(未示出)例如用于烧灼或密封器械的发电机一般通过分离的连接器连接至器械150,但可替代地通过控制***100的内置电路提供。
每个器械150通常包括传输装置或后端机构120、从后端机构120延伸的主管路110和在主管路110的远端处的腕机构200。被连接至器械150中的腕机构200的驱动线缆和电导体可以延伸通过主管路110并且连接至后端机构120。后端机构120一般提供驱动线缆至由驱动电机在控制***100中提供的电机驱动轴的机械联接。因此,控制***100可以如需要的位置、方向来控制驱动线缆中的运动和张力并且操作腕机构200。***100的处理***140能够为医生或其他操作空间的工作人员提供使得臂130的操纵可用的用户界面。例如,臂130可以被用于通过正经历医疗程序的病人的小切口中的套管***医疗器械150的端部,并且被用于在病人内部的工作部位处操作腕机构200。相应地,腕机构200和主管路110的直径可以根据使该器械可用的套管的大小来选择。在示例性实施例中,腕机构200和主管路110的直径约5mm或约8mm,以配合一些现有套管***的大小。
主管路110是中空的并且可以包含从后端机构120延伸至腕机构200的驱动线缆和电导体。主管路110可以是刚性的或者挠性的。挠性主管路100可被用于例如通过内窥镜或其他导向或套管沿着自体腔或者其他的弯曲的路径的***。然而,许多常用类型的微创医疗程序例如腹腔镜外科手术使用直套管来***和移除器械,从而允许使用刚性主管路110。刚性主管路110可以在医疗程序期间为使用腕机构200提供更坚硬的基础/基座(solid base)。刚性并且直的主管路110还允许延伸通过主管路110的驱动线缆的部分是例如杆或管(例如,海波管)的结构,该结构可以提供更好的抗拉伸性或者不那么昂贵。
图2A、2B和2C显示根据本发明实施例的腕机构200的三个示图。如在图2A中示意的,腕机构200包括近端夹具220、远端夹具230和执行器240。执行器240包括钳爪242和244,每个均具有附接至圆形轮毂上的夹握部分。线缆251、252、253和254均被附接至执行器240上,它们沿执行器240、远端夹具230和近端夹具220中的导向通道的坚硬表面延伸,并且从那里通过主管路110延伸返回至后端机构(例如,图1的后端机构120)。所使用的较少部件数的腕机构200和较小数目的驱动线缆251、252、253和254便于腕机构200和主管路110的较小直径的实现。此外,较少部件数允许在一次性器械(即在一次医疗程序之后器械被丢弃)中而不是在随后使用必须被消毒的器械中的腕机构的使用是有成本效益的。
图2B中的腕机构200的局部剖视图显示近端夹具220如何能够延伸进入并且附接至主管路110。近端夹具220中的销225将远端夹具230附接至近端夹具220但是允许远端夹具230围绕由销225限定的枢转轴线(有时在此被称为俯仰轴线)旋转。近端夹具220包括线缆251、252、 253和254的导向通道222,并且导向通道222的开口224提供线缆251、252、253和254的运动范围,其引导线缆251、252、253和254进入近端夹具230的导向通道232中。在示例性实施例中,导向通道222的开口224在平行于销225的方向上是狭窄的以便将线缆251、252、253和254引导到远端夹具230中相应的导向通道232中,但在垂直于销225的方向上展开从而在俯仰角的范围内保持较低的线缆摩擦,所述俯仰角由腕机构200提供给远端夹具230。相似地,最靠近近端夹具220的导向通道232的开口234在平行于俯仰轴线的方向上是狭窄的,但在垂直于销225的方向上展开从而适于俯仰旋转并且避免夹拧线缆251、252、253和254。
当围绕销225(即围绕俯仰轴线)旋转远端夹具230时,远端夹具230中的导向通道232限定了围绕销225的半径,在销225处线缆251、252、253和254作用在远端夹具230上。为了使得由线缆施加的扭矩的力臂在腕机构200的整个俯仰运动范围内是恒定的,导向通道232具有近似圆弧形状的表面。当远端夹具230处于在图2C中示意的位置时,线缆253具有抵靠下部导向表面的部分,下部导向表面围绕销225的俯仰轴线对包(substend)圆弧,并且在俯仰轴线和线缆253在导向通道232的下部表面上的接触点之间的距离是通过线缆253施加的扭矩的力臂。在图2C的示图中,当后端机构拉动线缆253时,远端夹具230顺时针旋转。如果从所示的位置继续顺时针旋转,则线缆253将保持在表面上并且作用恒定的力臂直到远端夹具230达到其运动范围的限制。此外,贯穿整个运动,圆弧的导向通道232的表面随着远端夹具230的旋转拉进并且逐渐放出相等长度的线缆,由此避免线缆的松弛。
在图2C中的远端夹具230的截面进一步示出了导向通道232如何延伸通过远端夹具230并且将线缆251、252、253和254引导到圆形导向通道246中,圆形导向通道246被集成到执行器240的钳爪242和244中。具体地,四个导向通道232为四根线缆251、252、253和254打开通道以贯通远端夹具230。最靠近执行器240的导向通道232的开口236引导线缆251、252、253和254到钳爪242和244中的相应导向通道246。
远端夹具230中的销235垂直于销225并且限定了作为整体的执行器240或单独地钳爪242和244的枢转轴线,有时被指称为偏转轴线或夹握轴线。(偏转轴线和夹握轴线在腕机构200中重合)。钳爪242和244的导向通道246是圆形的并且在销235的中央,从而当旋转钳爪242和244或者保持钳爪242和244的夹握力时,通道246的半径是线缆251、252、253和254施加至钳爪242和244的扭矩的力臂。术语夹握在此以一般意义被使用,因为钳爪242和244的动作取决于钳爪242和244的工作尖端。在图2A、2B和2C示出的实施例中,钳爪242和244的工作尖端具有用于夹握的表面并且可被使用在例如钳子或烧灼应用中。可替代地,当钳爪242和244的尖端是作为剪刀协作地剪切的叶片时,闭合钳爪242和244的“夹握”可以是剪切动作。因此,夹握能够根据执行器240的特征实施不同的功能。
线缆251、252、253和254通过腕机构200的路径没有使用滑轮。取代滑轮,腕机构200通过使用与夹具220和230一体的坚硬表面(即,导向通道222和232的表面)来引导如上说明的线缆251、252、253和254。有时,导向表面支撑(cradle)线缆的对置侧。例如,在图2C中显示的线缆253的顶部和底部表面与导向表面232在拐点237处接触,在拐点237处线缆253的曲率改变。坚硬导向表面还被弯曲以消除对于较大线缆缠绕角的需要并且保持固定的线缆半径或力臂。在一些现有腕机构中大缠绕角是必须的,以保持在整个运动范围内围绕枢转轴线的恒定线缆半径。导向通道222和232的表面可以另外被成形为保持(或避免出轨)线缆251、252、253和254并且保持线缆251、252、253和254处于套管的直径限制内,腕机构200在微创医疗程序期间通过该套管。
当与具有更大线缆缠绕角的腕机构相比较时,导向线缆251、252、253和254受到更小的摩擦。线缆251、252、253和254抵靠远端夹具230和其他地方的摩擦还可以通过选择使用的材料而被减小。具体地,远端夹具230可以由塑料制成,其提供抵靠线缆251、252、253和254的材料的较低摩擦。此外,在一些实施例中,线缆251、252、253和254包括可被锻造以提供具有更低摩擦的更光滑线缆表面的多股绞合金属线缆(stranded metal cable)的部分。降低的线缆摩擦允许取消滑轮同时保持腕机构200在临床上运动的可接受的力、扭矩和精确度和逼真度(fidelity)。避免使用滑轮减低了腕机构200的空间需求,从而允许腕机构200具有临床上有益的更小工作体积。消除滑轮还降低了成本。
线缆251和252附接至执行器240的钳爪242,并且线缆253和254附接至执行器240的钳爪244。线缆251和252至钳爪242的附接使得拉进线缆251或252中一条线缆的长度同时释放线缆252或251中另一条相同的长度,导致钳爪242绕销235旋转。同理,线缆253和254至钳爪244的附接使得拉进线缆253或254中一条线缆的长度同时释放线缆254或253中另一条相同的长度,导致钳爪244绕销235旋转。许多附接线缆251、252、253和254的技术可以被使用。例如,在典型的附接中,线缆251和252(或者线缆253和254)是线缆环的相对末端部分,线缆环绕销235沿圆弧延伸,导向通道246限定在钳爪242(或244)内,并且附接可以通过绑在其中的结节扣(knot)或者固定在环上的褶皱而被产生并且在导向通道246中被安装到配合凹口(matching notch)(未显示)中。然而,将褶皱附接至一些线缆材料(例如非导电性的线缆材料)的可靠附接会存在挑战。为避免褶皱,线缆环可以通过钳爪242或244中的高摩擦路径终止,从而摩擦防止线缆251、252、253和254相对于钳爪242或244的滑动。
图3A显示了附接至线线缆环250的钳爪242A,关于线缆251和252,线缆环250具有延伸返回至主管路110的部分。环250沿钳爪242A的导向通道246的圆弧延伸到高摩擦路径248A中,并且沿导向通道246的另一圆弧返回。路径248A与导向通道246基本共面并且包括多个锐弯曲(sharp bend)。线缆环250和钳爪242A的表面在路径248A中的弯曲处的接触产生了防止或阻碍线缆250滑动的摩擦,每个弯曲增加防止线缆环250拉出的摩擦力。线缆环250没有附接的褶皱。
图3B显示使用可替代的高摩擦路径248B的钳爪242B,其中线缆环250穿过钳爪242B中的多个孔。线缆环250与钳爪242B在线缆环248B中的弯曲处(包括线缆环250通过242B的位置)的接触产生了阻碍或防止线缆环250的滑动。因此,不需要褶皱以将线缆环250附接到钳爪242B。使用高摩擦路径248B的腕机构的组件要求线缆穿过钳爪242B中的孔,但是一旦穿过,线缆环250被牢固地保持在钳爪242B中,这可使得使用图3B的高摩擦路径的腕组件比使用图3A的高摩擦路径248A的腕组件更简单。
没有褶皱的钳爪附接消除了褶皱的空间要求和与褶皱相关的成本。没有褶皱的附接还对于一些形成褶皱是困难的线缆材料(例如,非金属线缆)也是有利的。如在以下进一步说明的,非金属线缆作为在烧灼器械中的电绝缘体是有益的。即使是不需要电绝缘的器械,非金属线缆也可以提供腕机构中抵靠配合表面的降低的摩擦、磨损和颗粒的产生。
以上说明的改变腕机构200的俯仰、偏转或夹握一般要求分别施加至四根线缆251、252、253和254的运动或动作。图4A显示腕机构200的简化示图并且说明了改变钳爪242和244的俯仰、偏转和夹握的过程。所说明的过程一般一次执行一个或者同时以任意期望的组合执行,以改变机构200的俯仰、偏转和夹握。图4B以更多细节显示腕机构200以说明腕机构200的旋转轴线并且在此同时与图4A一起被说明。
俯仰轴线的旋转(即,图4B中的旋转425)围绕由销225限定的俯仰轴线旋转远端夹具230。为了围绕俯仰轴线顺时针旋转,后端机构(未显示)拉进线缆253和254相等的长度同时释放线缆251和252相同的长度。线缆253和254在由通过远端夹具230的线缆253和254的导向通道限定的力臂处施加力至远端夹具230。同理,为了围绕俯仰轴线逆时针旋转夹具230,后端机构拉进线缆251和252相等的长度同时释放线缆253和254相等的长度。
偏转旋转(即图4B中的旋转435)对应于在相同方向上旋转钳爪242和244并且通过相同的角度。具体地,后端机构拉进线缆252一定长度并且释放线缆251相同的长度将导致钳爪242以顺时针方向绕销235的轴线旋转。对于旋转,钳爪242中的导向通道限定了线缆252在钳爪242施加一个力的力臂,并且产生的扭矩导致钳爪242顺时针旋转以及线缆251和252在远端夹具230中的导向通道的坚硬表面上滑动。如果同时后端机构拉进线缆254一定长度并且释放线缆253相同的长度,则钳爪244将顺时针旋转一个角度,该角度与钳爪242旋转的角度相同。因此,钳爪242和244相对彼此保持它们的位置,并且作为一个整体旋转通过一个偏转角。当后端机构拉进线缆251和线缆253相等长度同时释放相同长度的线缆252和254时,包括钳爪242和244的执行器的逆时针旋转被相似地完成。
夹握旋转(即在图4B中的旋转445)通过以相对方向旋转钳爪242和244相同的量而实现。为了打开钳爪242和244的夹握,后端机构拉进线缆251和254相等的长度同时释放线缆252和253相同的长度,这导致钳爪242和244以远离彼此的相对的方向旋转。为了闭合钳爪242和244的夹握,后端机构拉进线缆252和253相等的长度同时释放线缆251和254相同的长度,这导致钳爪242和244以朝向彼此的相对的方向旋转。当钳爪242和244的表面开始接触时,线缆252和253的张力可以保持在大于线缆251和254的张力,以便保持夹握力。
图4A说明线缆252和253的部分452和453能够被分别制作得比线缆251和254的对应部分更坚硬或更厚以容纳更高,或者保持用于夹握的张力。这能够通过熔合对应于具有更重材料的线缆252或253的线缆环的末端来实现。在本发明的典型实施例中,在线缆的运动期间具有更大挠性的线缆251、252、253和254的部分可以由挠性材料(例如多股绞合金属线缆)制成。在一些实施例中,每根线缆的相对直的部分(例如,延伸返回通过主管路的部分)可以是不太挠性的材料例如海波管或者在成本和抗拉伸方面有优势的相似结构,并且在这种实施例中,较大海波管可以被用于线缆252和253的部分452和453。因此,四根驱动线缆251、252、253和254的每一根的有效硬度可以被有利地控制,以改进临床性能。具体地,引起钳爪242和244关闭的驱动线缆252和253的有效硬度大于引起钳爪242和244打开的驱动线缆251和252的硬度。这种设置使线缆的松弛最小化,从而改进了腕机构200运动的逼真度。材料、直径和长度(例如部分452和453)被控制以影响期望的硬度。没有在线缆251和254中使用更大的结构节省了成本和空间。
图5A显示根据主要使用齿轮和杆来控制腕机构运动的本发明的实施例,后端机构500的部分的分解示图。后端机构500的所示部分包括底盘510、三个驱动轴512、513和514、三个齿形部件520、530和540以及两个杆550和560,并且联接至四根驱动线缆571、572、573和574。部件510、520、530、540、550和560可以根据各部件要求的负载和公差由任何适当的耐用材料(诸如,模塑或者机加工的塑料或者金属)制成。如以下进一步说明的,线缆571、572、573、574可以对应于线缆251、252、253和254并且连接至以上参考图2A、2B和2C说明类型的腕机构。然而,后端机构500更一般地用于期望四根线缆连接至三个电机驱动轴的任何器械中。
底盘(chassis)510可以具有用于选择连接至机器人控制***的轨迹,所述机器人控制***包括运行驱动轴512、513和514的电机。具体地,底盘510可以被成形以使得驱动轴512、513和514在安装进入底盘510时是被定位为由例如da Vinci
Figure BPA00001327906400121
Surgical System的机器人控制***接合并且旋转。
驱动轴512充当啮合齿形部件520的齿条部分的小齿轮。齿形部件520被附接至线缆572并且随着驱动轴512的转动以直线移动从而拉进或释放线缆572的长度。齿形部件520还包括臂,该臂包含接触杆550的调整螺钉522。具体地,调整螺钉522在与线缆571被附接至杆550位置相对的相对端接触杆550。杆550的枢转点或支点(fulcrum)在齿形部件540上,齿形部件540充当摇臂,如以下进一步说明的。在操作中,随着齿形部件520的移动,调整螺钉522导致或允许杆550围绕枢转点的旋转,从而杆550能够拉进或释放线缆571。线缆571至杆550的连接和调整螺钉522在杆550上的接触点可以被形成距离杆550的枢转点相等距离,从而当齿形部件520拉进(或释放)线缆572的一定长度时,杆550释放(或拉进)线缆571相同的长度。通过控制杆550相对于齿形部件520位置的取向,调整螺钉522允许线缆571和572上张力的调整。
驱动轴513相似地充当接合齿形部件530的齿条部分的小齿轮。齿形部件530被附接至线缆573并且随着驱动轴513的转动以直线移动从而拉进或释放线缆573的长度。齿形部件520还包括臂,该臂包含调整螺钉532,调整螺钉532在与线缆574被附接至杆560位置相对的相对端处接触杆560。杆560的枢转点或支点在齿形部件540上,并且从杆560的枢转点到线缆574的连接的距离可以被形成为与从杆560的枢转点到杆560上的调整螺钉532的接触点的距离相等。结果,当齿形部件550拉进(或释放)线缆573的一定长度时,杆560释放(或拉进)线缆574相同的长度。通过控制杆560相对于齿形部件530位置的取向,调整螺钉523允许线缆573和574上张力的调整。
驱动轴512和513可以***作,以便通过使用上述过程来改变腕机构的偏转角或者夹握。例如,当线缆571、572、573和574分别对应于图4A的线缆251、252、253和254时,以相同速度在相同方向或相反方向上转动驱动轴512和513将改变腕机构200的夹握或偏转。
驱动轴514接合齿形部件540的内部扇形齿轮/齿弧(sector gear)部分。齿形部件540具有附接至底盘510的枢转轴,这样随着驱动轴514的转动,齿形部件540绕枢转轴542旋转。齿形部件540还包括充当杆550和560的枢转点的凸起(在图5A中未示出)。这些凸起可以位于距枢转轴542相等距离处,这样随着齿形部件540的旋转,一个枢转轴靠近腕机构移动并且另一枢转轴远离腕机构移动相等的量。如果齿形部件520和530以适当的速度和方向运动,以保持杆550和560的取向,则齿形部件540的旋转将拉进(或释放)线缆571和572相等的长度并且释放(或拉进)线缆573和574相同的长度。因此,当线缆571、572、573和574分别对应于线缆251、252、253和254时,后端机构500可以被用于执行如以上参考图4A说明的俯仰改变,但是俯仰改变过程需要所有三个齿轮512、513和514的协作旋转。这种协作的旋转能够通过机器人控制***的软件来实现。
图5B显示当采用未显示在图5A中的额外部件组装时,后端机构500的截面示图。如所说明的,后端机构500包括分别接合齿形部件520、530和540的驱动轴512、513和514,并且联接至后端机构500的机器人控制***能够旋转驱动轴512、513和514以控制腕机构(未示出)的俯仰、偏转和夹握。线缆571、572、573和574从腕机构(未示出)主管路110的远端处延伸通过主管路110并且进入后端机构500。
主管路110在后端机构500中被附接至斜齿轮580,斜齿轮通过中间斜齿轮582被联接至驱动轴511。当控制***旋转驱动轴511时,斜齿轮582和580旋转主管路110并且由此改变在主管路110的远端处的执行器的侧滚角度。
图5B还显示电路板590,其可以被包括在后端机构500内用于电连接至机器人控制***。电路板590可以包括存储器和其他电路,所述电路发送识别信号到控制***以指示哪个器械被连接至控制***和/或提供控制***为器械的适当运行所需的关键参数。可以在电路板590中包括连接至执行器的电部件的连接,例如以对烧灼器械通电或者中继传感器测量值。然而,期望独立的电连接,以对执行器通电,特别是当需要高电压时。
如在图5B中所示的后端机构500还包括封闭后端机构500的机械和电部件的盖516。可以使用两个杆518来使后端机构500与机器人控制***断开。
滑轮和绞盘可以用在后端机构中以代替图5A和图5B的一些齿形部件。图6显示根据本发明实施例使用线缆、滑轮和绞盘的后端机构600。后端机构600包括:底盘610;四根驱动轴611、612、613和614;一对绞盘620和630;安装在第一对滑轮642和第二对滑轮643上的摇臂640;斜齿轮580和582;和电路板590。被连接至腕机构(未显示)的四根驱动线缆671、672、673和674延伸通过主管路110进入后端机构600。线缆671、672、673和674可分别对应于连接到图2A、图2B和图2C中的腕机构200的线缆251、252、253和254。然而,后端机构600能够更一般地用于期望连接四根线缆至三个电机驱动轴的任何器械中。
底盘610的形状一般被选择具有对应于机器人控制***上的机架(mounting)的轨迹。因此,后端机构可以被装配至控制***,从而驱动轴611、612、613和614被机械地联接至控制***中的电机。然后,控制***能够旋转驱动轴611、612、613和614通过由软件选择的精确角度,以实现器械期望的操作或运动。
线缆671和672开始从主管路110穿过,围绕一个或一个以上滑轮642卷绕,并且围绕绞盘620绕紧。线缆671和672围绕绞盘620的缠绕使得当绞盘620转动时,线缆671或672中一根的长度被拉进并且线缆672或671中的另一根输出相等长度。相似地,线缆673和674开始从主管路110穿过,围绕一个或一个以上滑轮643卷绕,并且围绕绞盘630绕紧,从而当绞盘630转动时,线缆673或674中的一根的长度被拉进并且线缆674或673中的另一根的相等长度被输出。驱动轴612和613分别被联接以转动绞盘620和630。因此,控制***能够通过使用上述过程转动驱动轴612和613,以改变腕机构的偏转角度或夹握。例如,当线缆671、672、673和674分别对应于图4A的线缆251、252、253和254时,以相同速度在相同方向或相反方向上转动驱动轴612和613将改变腕机构200的夹握或偏转。
滑轮642和643被安装在摇臂640上。摇臂640具有接合驱动轴614的扇形齿轮部分,并且被联接至底盘610以便当驱动轴614转动时围绕枢转轴线旋转或来回摆动。摇臂640的齿弧部分和枢转轴被设计从而使得摇臂640的旋转主要导致一组滑轮642或643朝向与其相连的绞盘620或630运动并且另一组滑轮643或642远离与其相连的绞盘630或620运动。这有效拉进线缆671和672或者673和674中一对的长度并且释放线缆673和674或者671和672中另一对相等的长度。因此,当线缆671、672、673和674分别对应于线缆251、252、253和254时,后端机构600仅通过驱动轴614的旋转能够改变腕机构中的俯仰,如以上参考图4A说明的。
后端机构600能够通过使用驱动轴611转动斜齿轮582和580来控制在主管路110远端处的腕机构的侧滚角度。斜齿轮580和581被联接至主管路110并且以如上所述的相同方式操作。
后端机构600中的线缆671、672、673和674围绕滑轮642和643和绞盘620和630缠绕或绕紧,并且当绞盘620和630旋转时,必须能够弯曲。相应地,后端机构600中的线缆671、672、673和674部分要求挠性并且可以是例如能够绕相对急剧的拐角被重复弯曲而不受损害的多股绞合金属线缆。相应地,每根线缆671、672、673和674可以包括三个部分:在腕机构中的多股绞合线缆部分、延伸通过主管路110的直部分的更加刚性的部分(例如,海波管)和后端机构600中的第二多股绞合线缆部分。为了比较,图5B的后端机构500以近似线性的动作移动线缆571、572、573和574并且不需要线缆571、572、573和574围绕滑轮或者其他锐弯的弯曲。相应地,线缆571、572、573和574在后端机构500中的部分可以是相对刚性的结构,例如海波管。
与图5B的后端机构500相似的图6的后端机构600包括带有电路的电路板590,所述电路提供至机器人控制***的接口,如以上说明的。高电压连接一般通过独立的电连接以及延伸通过后端机构500或600并且通过主管路110延伸至执行器的电线制成。例如,在本发明的一个实施例中,器械是双极烧灼器械并且电线或其他电导体(未示出)通过后端机构上的接头/连接器(未示出)连接至发电机,并且从那里驱动线缆延伸通过主管路110延伸至主管路110远端处的腕机构。在腕机构处,用于烧灼的电能量可以通过接触件被输送,其以与电机中的电刷相同的方式接合执行器的钳爪。
图7A显示用于烧灼器械的腕机构700的截面示图。腕机构700包括近端夹具220、通过近端夹具220可旋转地附接至销225的远端夹具230和通过远端夹具230可旋转地附接至销235的钳爪242和244。腕机构700的驱动线缆(在图7A中未显示)能够沿着夹具220和230中的导向通道并且附接至如以上参考图2A、图2B和图2C说明的钳爪242和244,并且能够以参考图4A和图4B说明的相同方式改变腕机构700的俯仰、偏转和夹握。接触钳爪242或244的驱动线缆或驱动线缆的至少一部分优选地由绝缘材料制成。如以上参考图3A和图3B提到的,驱动线缆至钳爪242和244的附接能够使用高摩擦路径被制成,以避免由非导向线缆的卷曲产生的困难。绝缘电线或其他导体772和774同样供给通过近端夹具220和远端夹具230,从而线772和774的末端分别邻接钳爪242和244。图7B显示近端夹具220的末端示图,其说明驱动线缆的导向通道222如何被定位在近端夹具220的外部边缘附近,以在近端夹具220的中心轴线附近为管道722提供空间。因此,线772和774可以在不影响驱动线缆的情况下延伸通过夹具220和230。
如在图7A中显示的接触件782和784位于线772和774的末端处并且与相应的钳爪242和244电接触。接触件782和784可以由回火金属(tempered metal)或弹性金属制成,当钳爪242和244被组装到远端夹具230中时,该金属被压缩以形成与钳爪242和244的良好电接触。在说明的实施例中,接触件782和784在各钳爪242和244的近端处接合恒定半径的圆周,从而随着钳爪242或244在偏转角度或夹握的改变期间旋转时,接触件782和784与圆形表面保持接触。可替代地,两个或任一个接触件782和784可以被定位,以接合垂直于夹握轴线和销235的钳爪242或244的平面侧。接触件782和784的优点是传递到线772和774的运动的减少。具体地,线772和774仅在俯仰改变期间移动,而当偏转或夹握被改变时不移动。通过直接(例如,焊接或皱缩)的电接触,不管俯仰、偏转或夹握的改变,附接的线都会移动。线772和774运动的减少降低了对于线772和774被老化、与异物接触、缠线或磨损的损害的可能性。
接触件782和784能够被用于以相反极性电压电激励钳爪242和244,以激活腕机构700的烧灼功能。例如,为了在医疗程序期间密封脉管,腕机构700可以***纵从而使得钳爪282和284夹紧脉管,由此封闭被密封的脉管。然后导体772和774和接触件782和784以具有相反极性的高频交流(AC)信号激励钳爪282和284。当电能被施加至钳爪242和244时,电流流过夹在钳爪242和244中的组织,并且电信号的持续时间可以被选择以使电流烧灼组织并且密封夹住的脉管。还可以通过本领域已知的其他方式使用烧灼来在医疗程序期间剪切或毁坏组织。
如在本领域已知的,用于电烧灼的能量一般来源于具有大于约100kHz频率的高电压(例如大于250伏特)交流(AC)信号。为了避免非故意的组织毁坏,每个电信号需要隔离与病人的任何非期望的接触并且相应地隔离与器械而不是钳爪242和244的任何暴露部分的接触。线772和774上的涂层使信号与主管路和近端夹具220隔离,从而使得他们都不会被电激励。线772和774优选地为挠性绞合并且具有例如FEP材料的绝缘涂层,这在当线772或774移动时提供了相对高电介质常数和低摩擦。接触件782和784位于其中的远端夹具230可由绝缘材料制成,例如塑料(例如,Ultem全能阻燃纤维)或者绝缘陶瓷。相似地,与钳爪242和244接触的销235由绝缘材料(例如陶瓷)制成,以避免电压泄漏并且阻止钳爪242和244之间的短路。
在如图7A中说明的双极烧灼器械的示例,钳爪242和244位于绝缘远端夹具230中的空腔中。具体地,隔离器/分离器732被集成于远端夹具中,以提供相反极性钳爪242和244之间的电隔离。该空腔能够提供钳爪242和244之间足够的隔离距离,从而每个钳爪242或244的密封条或单独的封装(如在一些现有烧灼***中存在的)是不需要的。接触件例如782和784还可被用于单极烧灼中,其中钳爪242和244是相同的电压,但钳爪242和244之间的分离/隔离对于单极烧灼是不需要的。
很多以上说明的实施例可以降低微创外科手术器械的成本,其通过降低:器械中的部件数目;器械的复杂性;所使用材料的成本;部件的制造难度;和器械组装难度。降低成本不仅具有明显的益处,还使得产生与现有可再使用的器械相比较更具成本竞争性(每件)的一次性使用的器械。一次性使用的器械具有在医院中消除再处理/消毒的益处并且允许在器械的制造过程中的进一步成本的节省,因为部件不需要为再处理而被设计和检验。
本发明降低部件数目的实施例还能够生产更小器械。这通过降低腕的直径和长度,具有临床上的益处。因此,医疗程序能够使用更小的切口,并且更精确的腕操纵控制是可能的。例如,双极内腕烧灼器械可以被制造为具有5mm直径,然而在以前,这种器械仅可制造为具有8mm或者更大的直径。
虽然已经参考具体的实施例说明了本发明,但是本说明书仅是本发明应用的一个示例并且不应作为限制。公开的实施例的特征的各种修改和组合落入由权利要求限定的本发明的范围内。

Claims (22)

1.一种烧灼器械,其包括:
可旋转安装到所述器械上的第一钳爪;
第一电导体;和
第一接触件,其位于所述第一电导体上并且与所述第一钳爪的表面电接触,其中当所述第一钳爪旋转时所述接触件在所述表面上滑动。
2.如权利要求1所述的器械,其进一步包括:
所述第一钳爪被安装到其上的第一夹具;和
第一线缆,其被附接至所述第一钳爪从而使得在所述第一线缆上的拉动导致所述第一钳爪绕所述第一夹具的第一销旋转,其中所述第一线缆由绝缘材料制成。
3.如权利要求2所述的器械,其中所述第一线缆沿着所述第一钳爪中的高摩擦路径并且被附接至所述第一钳爪,使得摩擦力阻碍所述第一线缆相对于所述第一钳爪的滑动。
4.如权利要求2所述的器械,其进一步包括附接至所述第一钳爪的第二线缆,使得拉动所述第二线缆导致所述第一钳爪绕所述第一销旋转,其旋转方向与由于拉动所述第一线缆产生的所述第一钳爪的旋转方向相反。
5.如权利要求4所述的器械,其中所述第一线缆和所述第二线缆是通过所述第一钳爪中的高摩擦路径的线缆环的相对末端。
6.如权利要求5所述的器械,其中所述高摩擦路径垂直于所述第一钳爪的旋转轴线并且包括多个弯曲。
7.如权利要求5所述的器械,其中所述线缆的高摩擦路径穿过所述第一钳爪的多个孔。
8.如权利要求2所述的器械,其进一步包括:
主管路,其中所述钳爪和所述夹具在所述主管路的远端处并且所述第一线缆延伸通过所述主管路;和
联接至所述主管路的近端的后端机构,其中所述后端机构可操作为移动所述第一线缆以用于所述第一钳爪的致动,所述后端机构装配到控制***的对接端口中并且所述后端机构提供所述第一线缆至所述控制***中的驱动电机的机械联接。
9.如权利要求1所述的器械,其进一步包括由电绝缘材料制成的夹具,其中所述第一钳爪被安装在所述夹具的销上。
10.如权利要求9所述的器械,其进一步包括:
安装到所述夹具的所述销上的第二钳爪;
通过所述夹具的第二电导体;和
第二接触件,其位于所述第二电导体的末端处并且与所述第二钳爪的表面电接触,其中当所述第二钳爪旋转时所述接触件在所述第二钳爪的所述表面上滑动。
11.如权利要求10所述的器械,其中所述第一电导体被连接以传导第一电信号,并且所述第二电导体被连接以传导具有与所述第一信号的极性相反的极性的第二信号。
12.如权利要求11所述的器械,其中所述夹具包括位于所述第一钳爪和所述第二钳爪之间的并且电隔离所述第一钳爪和所述第二钳爪的隔离器。
13.如权利要求11所述的器械,其中所述夹具包括所述第一钳爪的末端位于其中的第一空腔和所述第二钳爪的末端位于其中的第二空腔。
14.如权利要求1所述的器械,其中所述接触件随着所述第一钳爪的旋转沿所述第一钳爪的圆形表面滑动。
15.如权利要求1所述的器械,其中所述接触件沿垂直于所述第一钳爪的旋转轴线的平面表面滑动。
16.如权利要求1所述的器械,其中所述第一接触件包括被抵靠所述第一钳爪的所述表面压缩的弹性结构。
17.一种医疗器械,其包括:
后端机构;
从所述后端机构延伸的主管路;
由绝缘材料制成并且被可旋转地安装在所述主管路的远端的夹具;
被连接以便绕所述夹具的销旋转的第一钳爪和第二钳爪;
延伸通过所述主管路的第一导体;和
第一接触件,其位于所述第一导体的末端并且与所述第一钳爪的表面电接触,其中当所述第一钳爪旋转时所述第一接触件在所述表面上滑动。
18.如权利要求17所述的器械,其进一步包括:
延伸通过所述主管路的第二导体;和
第二接触件,其位于所述第二电导体的末端处并且与所述第二钳爪的表面电接触,其中当所述第二钳爪旋转时所述第二接触件在所述表面上滑动。
19.如权利要求17所述的器械,其中所述后端机构装配到控制所述器械操作的控制***的对接端口中。
20.一种电激励医疗器械中的执行器的方法,其包括:
抵靠所述执行器的第一部件的第一表面按压第一接触件;
在医疗程序期间移动所述第一部件,其中移动所述部件导致所述第一接触件在所述第一表面上的滑动;并且
通过所述第一接触件将第一电信号施加至所述第一部件。
21.如权利要求20所述的方法,其进一步包括:
抵靠所述执行器的第二部件的第二表面按压第二接触件;
在所述医疗程序期间移动所述第二部件,其中移动所述第二部件导致所述第二接触件在所述第一表面上的滑动;并且
通过所述第二接触件将所述第二电信号施加至所述第二部件。
22.如权利要求20所述的方法,其中移动所述第一部件和所述第二部件包括在脉管上闭合所述执行器的钳爪,并且施加所述第一信号和所述第二信号,并且加热和密封该脉管。
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US8771270B2 (en) 2014-07-08
EP2341847B1 (en) 2013-10-23
WO2010009223A3 (en) 2010-03-11
WO2010009223A2 (en) 2010-01-21
KR102006471B1 (ko) 2019-08-01
US20100016853A1 (en) 2010-01-21
KR101896053B1 (ko) 2018-09-06
KR20110052626A (ko) 2011-05-18

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