CN1216454A - 施行最小侵入性心脏手术的方法和装置 - Google Patents
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Abstract
本发明是一个进行最小侵入性手术的***(10)。该***包括与一对机械臂(16,18)连接的一对手术器械。这些器械(22,24)具有能够***作来抓取和缝合组织的末端操作装置。该机械臂通过一个控制器与一对主操作手柄(50,52)联结。手柄可以由外科医生移动来产生末端操作装置的一个相应移动。手柄的移动是成比例的,所以末端操作装置的相应的移动是不同的,通常小于医生手的移动。比例因子是可调的,这样外科医生可以控制末端操作装置的移动结果。末端操作装置的移动可以通过一个输入键控制,这样只有外科医生压下输入键时末端操作装置才动作。输入键允许医生不移动末端操作装置来调节手柄的位置,所以手柄可以移动到一个舒适的位置。
Description
发明背景与在先申请的关系
本申请是1996年2月20日提交的题为《施行最小侵入性心脏手术的方法和装置》的序列号为08/603,534的美国专利申请的继续申请,该专利申请现待审查,并将在下文中用作参考。
1.发明领域
本发明涉及施行最小侵入性心脏手术的***和方法。更进一步讲,本发明涉及一个机械手***和可拆卸安装的手术器械,其中所述***有助于施行最小侵入性的心脏手术过程。
2.相关技术的描述
冠状动脉阻塞将使心脏丧失维持生命所需的血液和氧。阻塞可以借助于药物或通过血管成型术去除。对严重冠状动脉阻塞则进行冠状动脉分流移植术(CABG)来绕过动脉的阻塞区域。CABG过程典型地通过切断胸骨并拉开胸腔从而获得通向心脏的通道来进行的。在动脉靠近阻塞的区域切开一个切口。接着断开***内动脉(IMA)并连接到冠状动脉切口点上。IMA绕过动脉的阻塞区域再次提供给心脏满流的血液。切断胸骨并打开胸腔,通常被称为“开胸手术”,会对病人产生严重的创伤。此外,胸骨断裂延长了病人的恢复期。
有人试图不打开胸腔完成CABG过程。通过从病人皮肤上的小切口***手术器械和一个内窥镜来进行最小侵入性手术。手动操作这些器械是很困难的,特别是当把一个接枝接到动脉上时。已经发现精确控制该器械需要很高的技巧。此外,人手通常至少有一个微小的抖动,这种抖动进一步增加了完成最小侵入性心脏手术的难度。
为了完成MIS,外科医生使用特殊的器械。这些器械允许外科医生在病人体内机动操作。用于最小侵入性手术中的器械之一为镊子,它是一个具有用来夹取如缝合针待等物体的特殊构造头部的器械。由于为最小侵入性手术设计的镊子和其它器械通常又长又硬,所以不能赋予外科医生在一个最小侵入性手术中有效完成许多操作需要的技巧和精度。例如,传统的MIS镊子不是非常适合在最小侵入性手术,如在内窥镜手术中操作缝合针。所以许多本来可能完成的MIS手术却没能实现。
大体上,在开胸手术中,各种器械的头部可以设置成具有六个自由度。但是,器械由于穿过一个为实行最小侵入性手术而在病人身上切开的小孔***,就失掉了两个方向的自由度。这种在手术场合的动作自由度的丧失实质上限定了能完成的MIS手术的类型。
由于使用的器械不能提供器械***病人体内时损失的附加的自由度,所以MIS手术缺乏灵巧性。与这种灵巧性的缺乏相关的一个问题是器械在某一位置时不能缝合。结果是,在手术中需要大量缝合的手术几乎不可能完成,因为手术器械使许多操作不能进行。
与MIS相关的另一个问题是在手术过程中缺乏精度。为了进行如MICABG(最小侵入性冠状动脉分流移植手术),必须在心脏附近的不同位置进行极细微的缝合。因此,手术器械头部的工具的动作需精确。当前,采用手***械达不到这种手术所需的精度。
因此,在本领域中需要的是在病人体内有关节连接类型的一个工具和手术器械,这样外科医生可以利用附加自由度来更灵巧、更精确地按照需要放置器械头部的工具。
此外,在该领域中需要的是一种具备简单的器械和工具更换能力的方法和设备,这样各种工具能够方便、迅速地更换,以便能加快手术过程,从而减少病人的手术室花费和减少病人处于麻醉状态的时间。
本发明就是为了解决上述问题。
发明概述
本发明是一个施行最小侵入性心脏手术的***。该***包括一对或多个连接在一对机械臂上的手术器械。该***也可以如下文中公开的那样仅包括一个手术器械和一只机械臂。器械具有末端操纵部分,能够***纵来切断、抓取、灼烧和缝合组织。机械臂通过一个控制器与一对主操作手柄联结。主操作手柄可以由外科医生操作来产生末端操纵部分的相应动作。主操作手柄的动作幅度是成比例的,所以末端操纵部分的相应动作不同于,通常小于外科医生的手完成的动作幅度,这有助于消除外科医生的手可能产生的抖动。比例因子(scalefactor)是可调节的,所以外科医生能够控制末端操纵部分动作的精确度。末端操纵部分的动作可以通过一个输入键控制,这样只有当外科医生压下或锁定输入键时,末端操纵部分才动作。输入键允许外科医生不移动末端操纵部分来调整主操作手柄的位置,所以主操作手柄可以移动到一个很舒适的位置。该***还可以具有一个机器人控制的内窥镜,允许外科医生从外面观察手术情况。心脏手术可以通过在病人皮肤上切一个小口,把器械和内窥镜***病人体内来进行。外科医生操纵主操作手柄移动来完成如冠状动脉分流移植术或心脏瓣膜手术等心脏手术。
本发明还致力于手术器械和控制该器械的方法,允许外科医生用活动关节连接器械的头部,同时保留器械头部的工具的功能。同样,器械的头部可以两个自由度进行活动关节连接,在两种条件下,都可使用安装在头部的工具。
机器人***通常包括:
一个机械臂;
一个安装在机械臂上的连接器;
一个通过连接器安装的手术器械;
一个控制器;和
其中控制器的动作产生机械臂和手术器械的一个成比例的动作。
本发明可以包括一个带细长杆的手术器械。该细长杆有一个纵向轴,通常作为内窥镜的臂。一个关节部分安装在细长杆上并延伸出来。作为选择,关节部分可以与细长杆制成一个整体。关节部分具有一个基部部分、一个铰接轴和一个末梢部分。基部部分可以包括一对指状物。该指状物可以彼此垂直并径向指向细长杆的纵轴。为了在手术中使用,通常器械和主要元件最好是由不锈钢、塑料或一些其他容易消毒的材料制成。每个指状物具有至少一个在其上形成的孔,该孔为将辅助铰接轴联结到关节部分的基部部分上的销子提供一个通道,并把铰接轴可转动地安装到基部部分上。关节部分在包括关节部分和器械和头部提供关节连接。更进一步讲,这为位于包括一个关节部分的器械头部的工具提供了附加自由度。
下文中将要公开的这种器械,当它与当前的手术***联合使用时,能提供给外科医生在最小侵入性手术过程中还没有获得的附加的灵巧性、精确度和柔韧性。同样,手术时间可以缩短,对病人的伤害大大减轻。
为了给在下文中公开的关节连接的头部提供更高的精确度,主操纵手柄设置了两个附加的自由度。每个附加的自由度都对应映射每个器械头部的自由度。这通过在主操纵手柄上增加两个连接处和使器械头部根据主操纵手柄的动作来作关节活动的自动装置而实现。
在了解了下面的详细描述和附图之后,本领域的普通技术人员对本发明的目的和优点将更加清楚。
附图简述
图1为本发明的最小侵入性手术***的透视图;
图2为该***的主操纵手柄的示意图;
图3为该***的从属操纵器的示意图;
图4为该***的控制***的示意图;
图5为在坐标系中的器械的示意图;
图6为围绕一个转动点动作的器械的示意图;
图7为根据本发明的***的末端操纵部分的分解图;
图8为根据本发明的***的主操纵手柄图;
图8a为根据本发明的***的主操纵手柄的侧视图;
图9-10A-J图示了***内动脉移植到冠状动脉上的过程;
图11为根据本发明的***的后部安装的工具驱动器的侧视图;
图12为图11所示后部安装的工具驱动器上的马达组件的平面图;
图13为根据本发明的关节连接的器械的侧面图;
图14为关节连接的器械的侧面图,其中器械头部是关节连接的;
图15为根据本发明的关节连接器械的关节部分的分解图;
图16为本发明的关节连接的手术器械的关节部分铰接轴的平面图;
图17为根据本发明的关节工具驱动组件的透视图;
图18为与本发明的可关节连接的器械相应的可拆卸的工具端部图;
图19为根据本发明的工具端部的接受器;
图20为安装在本发明的铰接转换器上的铰接器械的断面图;
图21为根据本发明的铰接转换器的断面放大图;
图22为根据本发明的铰接转换器的端视图;
图23为根据本发明***的铰接工具驱动组件的无菌部分的断面图;
图24为根据本发明***的铰接工具驱动组件的工具驱动器的断面图;
图25为根据本发明的包括铰接工具驱动组件的***的主操纵手柄的示意图;
图26为用于根据本发明的机械臂的罩袋的平面图;
图27为具有布置在末端的夹取工具(stapling tool)的手术器械的平面图,其中该手术器械安装在根据本发明的机械臂上;
图28为具有布置在末端的切割片的手术器械的平面图,其中该手术器械安装在根据本发明的机械臂上;
图29为具有布置在末端的凝固(coagulating)/切割的手术器械的平面图,其中该手术器械安装在根据本发明的机械臂上;
图30为具有布置在末端的夹取工具的手术器械的平面图,其中该手术器械是安装在根据本发明的机械臂上。
对本发明的详细描述
参照附图特别是附图标记,图1表示了一个能够用来施行最小侵入性手术的***10。在一个优选实施例中,***10可以用来施行最小侵入性的冠状动脉分流移植术,或内窥镜冠状动脉分流移植术(DCABG)和其它接合手术。虽然图示和描述了一个MICABG手术,但应该明白该***也可以用在其他手术过程中。例如,该***能够用于缝合血管。
***10用来为通常躺在手术台14上的病人12进行手术。一个第一关节臂16、一个第二关节臂18和一个第三关节臂20安装在手术台14上。关节臂16-20最好是安装在手术台上,从而使关节臂均以病人为同一参照平面。关节臂安装在一台车上或放置在靠近病人的平面的其他装置上也是合适的。虽然这里图示和描述了三个关节臂,但应当明白该***可以具有任何数量的关节臂,如一个或多个。
第一和第二关节臂16和18都有一个基础室25和一个从基础室25延伸出来的机械臂组件26。手术器械22和24最好是可拆卸地联结在每个第一和第二关节臂16、18的机械臂组件26的末端。每个器械22、24可以用下文中将要详细描述的各种方式联结到相应的机械臂组件26上。
第三关节臂20还包括一个基础室25和一个机械臂组件26,并最好包括一个安装在机械臂组件26上的内窥镜28。每个关节臂16、18、20的基础室25和机械臂组件26大致上相同。但是,最好是第三关节臂20的结构有所不同,因为第三关节臂的目的是抓取和放置内窥镜28而不是抓取和放置一个手术器械。
器械22和24及内窥镜28通过在病人12皮肤上的切口***。内窥镜28具有一个摄象机30,它与显示病人12内部器官的图象的显示器32相连接。
每个机械臂组件26具有一个机座马达34,它相对于基础室25以线性方式移动机械臂组件26,如箭头Q所示。每个机械臂组件26还包括一个第一回转马达36和一个第二回转马达38。每个机械臂组件26还包括一对钝态连接40和42。钝态连接40和42最好是彼此垂直布置,从而使安装在相应的机械臂组件26上的器械22、24或内窥镜28具有转动动作。钝态连接可以是在任何特定方向上的弹簧偏压,但是它们不是马达驱动。机械臂组件26还有一个连接器械22、24或内窥镜28的连接机构45。此外,机械臂组件26具有一个马达驱动的蜗轮齿轮44来使器械22、24和内窥镜28围绕它们的纵向轴转动。更进一步讲,马达驱动蜗轮齿轮转动器械或内窥镜。
第一、第二和第三关节臂16、18、20与一个能够控制关节臂的移动的控制器46联结。这些关节臂通过配线、电缆或通过传送/接收***与控制器46联结,从而控制信号可以从控制器46传到每个关节臂16、18、20上。为了保证每个关节臂16、18、20与控制器46的无误差联络,每个关节臂16、18、20最好是与控制器46电气连接,为了举例的目的,每个关节臂16、18、20通过电缆47与控制器46连接。但是,也可能采用公知的遥控***遥控每个关节臂16、18、20,而不是采用直接电气连接。由于这样的遥控***在本领域是公知的,在此不再进一步讨论。
控制器46与一个如脚踏板、手动控制器或声音识别***的输入装置连接。为了举例的目的,在此公开了一个脚踏板控制器。外科医生可以操作输入装置48来移动内窥镜28的位置并通过按下设置在输入装置48上的相应的按扭来观察病人的不同部位。控制器46接收从输入装置48来的输入信号,根据外科医生的输入指令移动内窥镜28和第三关节臂20上的机械臂组件26。每个机械臂组件26都可以是本发明的受让人加里佛尼亚Goletad的Computer Motion公司以商标AESOP出售的装置。该***也已在本文参考的美国专利US5,515,478中描述。虽然图示和描述了一个脚踏板49,但应当明白该***可以具有其他的输入装置如手动控制器或声音识别接口。
外科医生通过一对主操纵手柄50和52控制安装在第一和第二关节臂16和18上的器械22和24。能够被外科医生操纵的每个主操纵手柄50和52与相应的一个关节臂16或18具有一种主-从关系,这样手柄50和52的移动产生安装在第一和第二关节臂16和18上的手术器械22和24的一个相应的移动。
手柄50和52可以安装到一个轻便的柜子54上。一个第二电视显示器56可以放置在柜子54上并通过公知的装置与内窥镜28连接,这样外科医生就能够很容易地观察病人12的内部器官。手柄50和52也与控制器46连接。控制器46接收从手柄50和52来的输入信号,计算手术器械的相应移动值,并提供一个输出信号来移动机械臂组件26和器械22和24。由于外科医生不用实际拿着器械的手柄就可以控制器械22和24的移动和方向,所以外科医生可以坐着或站着使用本发明的***10。本发明的一个优点是外科医生可以坐着完成内窥镜手术。这有助于减轻外科医生的疲劳并可以提高手术室中的效率和效果,特别是在那些长达几个小时的手术中。为了提供一个坐的位置,在该***中可以提供一把椅子57。
每个手柄都有由图2中表示的各种连接处Jm1-Jm5提供的多个自由度。连接处Jm1和Jm2允许手柄围绕柜子54上的一个转动点转动。连接处Jm3允许外科医生以线性方式把手柄移进移出柜子54。连接处Jm4允许外科医生围绕手柄的一个纵向轴转动主操作手柄。连接处Jm5允许外科医生开合夹具。
每个连接处Jm1-Jm5具有一个或多个提供相应于手柄位置的反馈信号的位置传感器。该位置传感器可以是电位差器,或任何其他如旋转光学译码器等提供相应的位置变化信号的反馈装置。此外,多个位置传感器可以放置在每个连接处来提供***中的冗余度,它可以用来使外科医生警觉相应的机械臂组件26的故障或错误位置。
除了位置传感器之外,每个连接处可以包括转速器、加速器和负荷单元力传感器,它们都可以提供相对于速度、加速度和分别施加在各个连接处的力的电信号。此外,每个连接处可以包括用来反映在机械臂组件26处接收到的反馈力的执行机构。这可能在连接处Jm5处特别有帮助,它可以指示位于器械22或24的末端的夹具在病人体内施加的力。同样,在器械22、24的夹具处必须包括一个力反馈元件来构成一个力反馈回路。力反馈元件,如一个与磨石桥组合的压电元件在本领域是公知的。但是,直到现在还没有在这样的一个***10中使用这种力反馈单元。
图3表示了每个关节臂16和18的各种自由度。连接处Js1,Js2和Js3分别相应于机座马达34和机械臂组件26的回转马达36,38的转动轴线。连接处Js4和Js5分别相应于臂26的钝态连接40和42。连接处Js6可以是一个围绕器械的纵向轴转动手术器械的马达。连接处Js7可以是一对可以开合的指状物。器械22和24围绕位于病人的切口处的转动点P动作。
图4所示为把主操作手柄的移动转换成手术器械的相应移动的一个控制***的示意图。根据图4所示的控制***,控制器46计算供给关节臂的输出信号,从而手术器械根据手柄的动作而动作。每个手柄具有一个使器械能够随手柄动作的输入键58。当输入键58按下时,手术器械随手柄动作。当输入键58松开时,手术器械不随手柄动作。以这种方式,外科医生能够调节或“棘轮调整”手柄的位置而不产生器械不希望的相应的动作。该“棘轮调整”特性允许外科医生连续移动手柄到更期望的位置而不引起关节臂的位置变化。此外,由于手柄是被转动点限制的,棘轮调整特性允许外科医生超过手柄的尺寸限度移动器械。虽然这里图示和描述了一个输入键58,但应当明白手术器械可以通过如声音识别等其他方式动作。输入键可以选择被锁定,以便每次外科医生按下该键时,器械相应的移动锁定在动作和不动作之间。
当外科医生移动手柄时,位置传感器提供分别相应于连接处Jm1-Jm5的移动的反馈信号M1-M5。控制器46在计算单元60中计算新的手柄位置与最初的手柄位置之间的差值来产生一个增加的位置值-M1-M5。
增加的位置值-M1-M5分别在单元62中与比例因子S1-S5相乘。比例因子通常设定至少小于1,以便使器械的移动小于手柄的移动。以这种方式,外科医生可以用手柄的相对粗糙动作作出器械的很精细的动作。比例因子S1-S5是不同的,从而外科医生能够改变器械移动的精度。每个比例因子最好是分别变化的,这样外科医生能够在某个方向上更精细地控制器械。例如,通过把一个比例因子设为0,外科医生可以防止器械在一个方向上的移动。如果外科医生不想让手术器械接触位于相对于病人的某个方向上的一个器官或某个组织时,这是很有用的。虽然这里说明的比例因子小于1,但应当明白比例因子可以大于1。例如,可以希望以大于相应于手柄的转动速率转动器械。
控制器46把增加值M1-M5加到初始连接角Mj1-Mj5上,在加法元件64中提供数值Mr1-Mr5。然后控制器46在计算单元66中根据下面的公式计算期望的从属矢量计算值。
Rdx=Mr3·sin(Mr1)·cos(Mr2)+Px
Rdy=Mr3·sin(Mr1)·sin(Mr2)+Py
Rdz=Mr3·cos(Mr1)+Pz
Sdr=Mr4
Sdg=Mr5其中:
Rdx,y,z=器械末端操作装置期望的新位置。
Sdr=围绕器械纵轴转动器械的角度。
Sdg=器械指状物的移动量。
Px,y,z=转动点P的位置。
接着控制器46在计算单元68中根据下面的公式计算机械臂组件26的移动量。
Jsd1=Rdz
Jsd2=tan-1(Rdy/Rdx)+Δfor Jsd3≤0
Jsd2=tan-1(Rdy/Rdx)-Δfor Jsd3>0
Jsd6=Mr4
Jsd7=Mr5其中:
Jsd1=线性马达的移动。
Jsd2=第一回转马达的移动。
Jsd3=第二回转马达的移动。
Jsd6=转动马达的移动。
Jsd7=夹具的移动。
L1=第一回转马达和第二回转马达之间的连接臂的长度。
L2=第二回转马达和钝态连接之间的连接臂的长度。
在单元70中控制器给马达提供输出信号,把机械臂和器械移动到期望的位置。手柄的每个移动重复该过程。
如果外科医生放开或锁定输入键并移动手柄,主操作手柄将具有一个相对于手术器械不同的空间位置。当输入键58最初按下时,控制器46在计算单元72中根据下面的公式计算初始的连接角Mj1-Mj5。
Mj1=tan-1(ty/tx)
Mj2=tan-1(d/tz)
Mj3=D
Mj4=Js6
向前的运动值在单元74中用下面的公式计算。
Rsx=L1·cos(Js2)+L2·cos(Js2+Js3)
Rsy=L1·cos(Js2)+L2·sin(Js2+Js3)
Rsz=J1
连接角Mj提供给加法器64。接着在计算单元76中计算转动点Px,Py和Pz。转动点是通过末端操作装置和器械的交叉点初始确定的起始位置PO和与器械具有同样方向的单位矢量Uo计算的。位置P(x,y,z)取自机械臂的各个传感器。参见图5,器械处于具有角度θ5和θ6的第一坐标系(x,y,z)中。单位矢量Uo以下面的转换矩阵计算:
在每个末端操作装置移动之后,器械的一个角位移ΔΘ通过根据下面的公式Lo和L1的器械的第一和第二单位矢量Uo和U1的交叉乘积取反正弦计算。
其中:
T=单位矢量Uo和U1的交叉乘积矢量。
新器械位置的单位矢量U1再次通过位置传感器和上述的转换矩阵确定。如果角度比阈值大,那么计算一个新的转动点,并把Uo设为U1。如图6所示,第一和第二器械的取向可以通过公式Lo和L1确定:Lo:
xo=Mxo·Zo+Cxo
yo=Myo·Zo+CyoL1:
x1=Mx1·Z1+Cx1
y1=My1·Z1+Cy1其中:
Zo=相对于第一坐标系的z轴沿线Lo的一个Z坐标。
Z1=相对于第一坐标系的z轴沿线L1的一个Z坐标。
Mxo=随Zo而变的直线Lo的斜率。
Myo=随Zo而变的直线Lo的斜率。
Mx1=随Z1而变的直线L1的斜率。
My1=随Z1而变的直线L1的斜率。
Cxo=一个表示直线Lo与第一坐标系的x轴相交的常数。
Cyo=一个表示直线Lo与第一坐标系的y轴相交的常数。
Cx1=一个表示直线L1与第一坐标系的x轴相交的常数。
Cy1=一个表示直线L1与第一坐标系的y轴相交的常数。
斜率采用下列算法计算:
Mxo=Uxo/Uzo
Myo=Uyo/Uzo
Mx1=Ux1/Uz1
My1=Uy1/Uz1
Cx0=Pox-Mx1·Poz
Cy0=Poy-My1·Poz
Cx1=P1x-Mx1·Plz
Cy1=Ply-My1·Plz其中:
Uo(x,y和z)=在第一坐标系中的第一位置的器械的单位矢量。
U1(x,y和z)=在第一坐标系中的第二位置的器械的单位矢量。
Po(x,y和z)=末端操作装置与在第一坐标系中的第一位置的器械的交点的坐标。
P1(x,y和z)=末端操作装置与在第一坐标系中的第二位置的器械的交点的坐标。
为找到一个近似的转动点的位置,确定在第一取向Lo(转动点Ro)和第二取向L1(转动点R1)上的器械的转动点,两个点Ro和R1之间的距离的一半被计算并作为器械的转动点Rave储存。转动点Rave通过交叉乘积矢量T确定。
为找到点Ro和R1,设定下列的公式来确定一条与通过线Lo和L1的矢量T取向相同的直线。
tx=Tx/Ty
ty=Ty/Tz其中:
tx=相对于第一坐标系的z-x平面通过矢量T确定的直线的斜率。
ty=相对于第一坐标系的z-y平面通过矢量T确定的直线的斜率。
Tx=矢量T的x分量值。
Ty=矢量T的y分量值。
Tz=矢量T的z分量值。
取两个点来确定斜率Tx,Ty和Tz(即Tx=x1-xo,Ty=y1-yo和Tz=z1-zo)代替公式Lo和L1,带来如下的点坐标Ro(xo,yo,zo)和R1(x1,y1,z1):
zo=((Mx1-tx)z1+Cx1-Cxo)/(Mxo-tx)
z1=((Cy1-Cyo)(Mxo-tx)-(Cx1-Cxo)(Myo-ty))/((Myo-ty)(Mx1-tx)-(My1-ty)(Mxo-tx))
yo=Myo·zo+Cyo
y1=My1·z1+Cy1
xo=Mxo·zo+Cxo
x1=Mx1·zo+Cx1
转动点Ro和R1之间距离的平均值通过下面的公式计算得到并作为器械的转动点储存。
Rave=((x1+xo)/2,(y1+yo)/2,(z1+zo)/2)
转动点可以根据上述的运算法则和常式继续升级。转动点的任何一个移动都可以与阈值比较,可以发出警告信号,或当转动点移动超出设定的限度时机器人***脱开。与设定限度的比较在确定病人是否移动或器械是否在病人体外操作(这个位置可能导致伤及病人或占用手术室)时都很有用。
为给医生提供反馈,器械的指状物可以具有感知末端操作装置抓取物体的反作用力的压力传感器。参见图4,控制器46接收压力传感器的信号Fs并在单元78中发出相应的信号Cm给手柄上的执行机构。执行机构提供一个传送到医生手上的手柄的相应的压力。压力反馈使医生能够感知加在器械上的压力。作为一个替代的实施例,手柄可以通过一个直接传送给医生手部指状物夹持力的机械绳索与末端操作装置联结。
图7表示了可以用在本发明中的末端操作装置80的一个优选实施例。该末端操作装置80包括一个与前端装配工具驱动器84联结的如那些上文中提到的22,24那样的手术器械82。末端操作装置80通过连接机构45安装在其中一个机械臂组件26上。连接机构45包括一个可拆卸地安装在夹持器86上的一个接头85。夹持器86包括一个机械臂组件26上的马达驱动的涡轮87来转动接头85,进而围绕器械82的纵向轴转动器械82。夹持器86包括一个插在机械臂组件26上的一个槽中的轴88。轴88可以被机械臂组件26上的马达转动,接着转动涡轮87,由此转动接头85和器械82。一个紧固工具89可以用来紧固和松开围绕器械82的接头。这样的工具象一个夹盘匙一样工作,从而紧固和松开接头86。
手术器械82具有一个与第二指状物91可转动连接的第一指状物90。指状物90,91能够操作来夹持如组织或缝合针等物体。指状物的内表面上可以有网纹以增加摩擦和器械82的抓取能力。第一指状物90与延伸穿过器械82的中心通道94的杆92连接。器械82可以有一个与一个弹簧偏压的球状快速拆开紧固件98配合的外套筒96。快速拆卸件98允许不同于指状夹持器的器械连接到前端装配工具驱动器84上。例如,器械82可以从快速拆卸件98上拆下并换成一个切割工具,一个缝合工具,一个可以用于该***中的常用工具(如Karlsruhe的美国专利US5,499,990或5,389,103公开的常用装置),一个切削片,或其他用在最小侵入性手术中的手术工具。快速拆卸件98允许手术器械换接而每次器械插到工具驱动器84中时不必对前端装配工具重新消毒。前端装配工具驱动器84的操作将在下文中进一步讨论。
快速拆卸件98具有一个接收前端装配工具驱动器84的销102的槽100。该销102把快速拆卸件98锁定到前端装配工具驱动器100上。销102可以通过压下弹簧偏压杆104松开。快速拆卸件98具有一个安装在工具杆92上的柱塞106,并与一个位于前端装配工具驱动器84上的装配腔的输出柱塞108连接。
装配腔110安装在一个丝杆螺母112上。该丝杆螺母112与从涡轮箱116中延伸出来的一个丝杆114拧接。涡轮箱116被一个与编码器120联结的可反转的马达118驱动。整个末端操纵部分80被马达驱动涡轮87转动。
操作时,前端装配工具驱动器84的马达118接收一个通过电气导线或一个传送/接收***从控制器来的输入指令并因此被开动。马达118转动以线性方式移动丝杆螺母112和装配腔110的丝杆114。装配腔110的移动驱动连接器柱塞106和转动第一指状物88的工具杆92。装配腔110感知施加给指状物的反作用力并提供给控制器46一个相应的反馈信号。
前端装配工具驱动器84可以盖一个无菌覆盖物124,这样工具驱动器84就不必在每个手术过程之后都进行消毒。另外,机械臂组件26最好是盖一个无菌覆盖物125,这样也不必消毒。覆盖物124,125主要作为封闭前端装配工具驱动器84和机械臂组件26的装置。用来封闭机械臂组件26的覆盖物125在图26中进一步说明。覆盖物125具有一个明显的开口端300,机械臂组件26可以由此被放置在覆盖物125中。覆盖物125还包括一个大致倾斜的封闭端302,它有效地把机械臂组件26与手术室环境分隔开。一个带有贯穿的小孔306的垫圈304使器械通过连接机构45与机械臂组件26连接。垫圈304增强了覆盖物125的强度,保证机械臂组件26移动时覆盖物125不会裂开。从本质上说,器械不能被封闭在覆盖物125中,因为它将被***病人12体内。覆盖物125还包括许多涂有胶310的带子308。至少一条带子308与其他的带子308相对布置来围绕机械臂组件26进行覆盖物125的封闭。
图8和8a表示了主操作手柄组件130的一个优选实施例。主操作手柄130组件包括一个与臂134连接的主操作手柄132。主操作手柄132可以通过一个***到该手柄132上的相应的槽138中的销136与臂134连接。手柄132具有一个可以由外科医生按下的控制键140。控制键140通过一个轴144与开关142连接。控制键140与图4中的输入键58相对应,并使末端操作装置移动。
主操作手柄132具有一个与静止的第二夹持器148可转动连接的第一夹持器146。第一夹持器146的转动产生手柄轴150的相应的线性移动。手柄轴150移动通过支座156连接着装配腔154的夹持器轴152。装配腔154感知施加的压力的大小并给控制器46提供一个输入信号。控制器46然后提供一个输出信号来移动末端操作装置的指状物。
装配腔154安装在一个与丝杆160拧接的丝杆螺母158上。丝杆160从一个连接到具有编码器166的马达164上的减压箱162中延伸出来。***的控制器46在末端操作装置中接收装配腔110的反馈信号并提供给马达一个相应的命令信号来移动丝杆160,从而在夹持器上施加一个压力,这样外科医生接收到与末端操作装置施加的力相关的反馈。以这种方式,外科医生具有操作末端操作装置的“感觉”。
手柄安装在围绕支座170转动的旋转轴承室168上。旋转轴承室168通过齿轮174与一个位置传感器172连接。位置传感器172可以是一个提供给控制器46相应于手柄相对位置的反馈信号的电位计。另外,为此目的可以采用一个光学编码器。作为选择,电位计和光学编码器都可以使用来在***中提供冗余度。旋转轴承的移动通过控制器和机械臂组件传送给末端操作装置作相应旋转。
臂134可以与一个线形支座176和允许并感知手柄线性移动的相应的位置传感器178连接。手柄的线性移动通过控制器和机械臂组件转换成末端操作装置的相应的线性移动。臂能够围绕支座180转动,并被位于支架184上的位置传感器182感知。支架184能够围绕带有相应的位置传感器188的支座186转动。臂的转动通过控制器和机械臂组件转换为末端操作装置的相应的转动。
人的手通常会有频率界于6-12赫兹的抖动。为了消除因手抖动引起的手术器械的移动,***可以有一个滤掉抖动频率波段范围内发生的任何手的移动的滤波器。参见图4,滤波器184可以滤去电位计提供的频率范围在6-12之间的模拟信号。作为选择,为此目的,通常的编码器和数字滤波器都可以采用。
如图9和10A-J所示,***最好是用来完成象冠状动脉分流移植术(CABG)那样的心脏手术。该手术通过一开始就在病人身上切开三个切口并从切口***手术器械22和24及内窥镜26来完成。当***病人的胸腔时,手术器械22夹持有缝合针和附带的线。如果动脉是与一个第二血管如隐静脉接合时,手术器械24可以夹持静脉,同时器械的末端操作装置***病人体内。
***内动脉(IMA)可以被切断并通过一个器械移动到冠状动脉的移植位置。在冠状动脉的动脉壁上切开一个相应于IMA的直径尺寸的切口。切口可以通过连接到末端操作装置之一上并通过主操作手柄遥控操作的切取工具来完成。动脉被夹紧以防止血液从切断的***和冠状动脉中流出。外科医生操纵手柄将IMA移到靠近冠状动脉开口。虽然这里图示和描述了IMA的移植,但应明白其他的血管如被切断的隐静脉可以移植来分流冠状动脉的阻塞。
参见图10A-J,外科医生移动手柄来操作器械,使针穿过IMA和冠状动脉。然后,如图10B所示,外科医生移动手术器械来夹紧并牵引针穿过冠状动脉和移植的动脉。接着如图10C所示,操作手术器械,在移植动脉的跟部打结缝合。之后可以把针从胸腔中取出。如图10D-F所示,可以将一个新针和线***胸腔,把移植动脉的尖部缝合到冠状动脉上。如图10H-J所示,***新针,外科医生操作手柄从跟部到尖部并从头部到跟部进行行走缝合。手术器械按比例的动作允许外科医生精确地围绕胸腔缝合。虽然在此图示和描述了特定的移植情形,但应该明白动脉可以采用其他技术移植。一般地讲本发明的***可以用来进行任何最小侵入性结合手术。
如上所述,***可以包括一个接收从控制器46来的相应于主操作手柄50或52的移动的控制信号并驱动位于手术器械末端的工具的前端装配工具驱动器84。作为选择,如图11和11a所示,一个后部装配工具驱动器200可以配合用于本发明的***10中。后部装配工具驱动器200与后部可装配的手术器械202配合。这种后部装配工具驱动器200与器械202的配合促进了手术中工具的更换,因为工具可以从工具驱动器200上拔下并以非常简单的方式更换成别的工具。
后部装配工具驱动器200通过上文中描述的接头和夹持器安装在一个机械臂组件26上。后部装配工具驱动器包括一个带有近端206和末端208的鞘204。鞘204可以由塑料或用于手术器械结构的其他公知的材料制成。鞘204大致上是一个与接头85吻合的中空管,并通过上文中已详细描述的紧固工具紧固在那里。
可后部装配的手术器械202具有一个工具端210和一个连接端212。手术工具214,如夹持器或其他可以由一个推/拉杆或绳索***驱动的工具,或不需要这种杆或绳索的工具,如凝结器或谐波手术刀安装在器械202的工具端210。
在器械202的连接端212布置有一个机架216。机架具有一个布置在机架216内部的杠杆218。杠杆218具有一个通过采用一个穿过杆的联结孔222的销确立的转动点220。该销可以安装在机架的内壁224上。一个延伸穿过整个器械202长度的推/拉绳索或杆226安装在杆218上,这样杆218围绕转动点220的转动引起绳索或杆226的一个线性移动。绳索或杆226主要作为操作器械202的工具端210的工具214的一个装置227。绳索或杆226也可以通过一个连接销安装在杆上。杠杆218为C形,其中杠杆218的末端通过两个孔228和230从机架216中凸伸出来。孔228和230最好是分别被一个0形圈232围绕,其目的将在下文中详细说明。
可后部装配的手术器械202的工具端210安装在后部装配驱动器200的中空管中。工具202可以通过工具驱动器推动,直到工具末端从鞘204中延伸出来为止。O形圈232处于在工具驱动器200的机架238中的联结孔234,236中。机架还具有一个在中心形成的孔240,该孔与内部的中空管同轴。以这种方式,手术器械202可以***穿到工具驱动器200中。每个O形圈232隐蔽地处于工具驱动器200的机架238的联结孔中。
机架238还包括一个图11a所示的马达组242。马达组件242安装在机架238上并牢固地保持在那里。马达组件通常包括一个安装在减压器246上的马达244。马达驱动一个安装在末端的叶片248。叶片248与杠杆218的末端啮合,这样马达的转动引起杠杆218围绕转动点220的移动。这接着引起装置227的横向移动,该装置用来驱动操作器械202的工具端210上的工具214。马达根据控制手柄的移动而动作。另外,力传感器248、250可以安装在叶片246的末端。这样,可以设有一个力反馈***来感知驱动操作器械202的工具端210上的工具214所需的力的大小。作为选择,马达244可以具有一个安装在其上的以同样方式使用的力反馈装置252。
使用后部装配工具驱动器200的一个优点是鞘204一直保持在病人12体内。这样,当重装或更换工具时,工具和机械臂组件26不必重新对位。无论是否放置工具,鞘204相对于病人12保持其位置。
本发明的***10可以在器械端部提供一个或两个附加的自由度。为了举例的目的,这里说明两个附加的自由度,但应当明白也可以包括仅有一个自由度。如图13-16所示,为了提供附加的自由度,一个有关节的器械300可以用在本发明中。器械300可以通过上文中描述的一个接头或夹持器与机械臂组件26连接。为了用关节连接有关节的器械300的端部,必须采用一个有关节的工具驱动器500。有关节的工具驱动器500将在下文中详细描述。总控制器必须增加有附加的两个自由度来控制器械300的端部的关节连接。图25表示了一个可供选择的包括两个附加自由度的控制器的示意图。如下文所述,两个附加的自由度对应映射器械300的关节连接部分。两个附加的控制器轴表示为Jm6和Jm7。
通过有关节的器械300和有关节工具驱动器500及控制器的附加自由度的配合使用,困难的操作可以以一个简单的方式实现。
参见图13-16,有关节器械300通常包括一个细长的杆302、一个鞘304和一个工具306。该工具可以是个夹持器、切割片、牵引器、缝合设备或其他用在最小侵入性手术中的公知的工具。图27-30表示了可以安在有关节的手术器械300的末端的各种工具。
器械300包括一个带有近端部分308的关节部分301,一个转动关节310和一个末端部分212,所述每一个部分都将在下文中详细描述。此外,器械300包括相对于细长的杆302活动器械300的关节部分301的装置311。关节部分301的结构在器械端部提供两个附加的自由度。也必须明白虽然这里描述了包括一个近端、一个转动关节和一个末端的关节部分301,但是它也可以提供各种中间部分,它们相互之间通过一个相应的转动关节连接。
界于并安装在每个相应的近端和末端之间的任何***的中间部分都是转动关节310。转动关节连接310连接近端部分和末端部分的关节部分,从而提供器械端部的关节连接。本质上,近端部分、转动关节和末端部分配合作为一个通用的连接。
细长的杆302最好是中空的,由不锈钢或塑料或其他可以进行无菌处理的公知的材料制成。由于杆302是中空的,它围成一个内部314。细长的杆302还具有一个近端316和一个末端318。不可把细长杆302的末端318与器械300的关节部分301的末端部分312混淆。
关节部分301的近端308可以与细长杆302制成一个整体或通过焊接、黏结或其他本领域公知的方法安装在杆302上。最好是近端308与伸长杆302制成一个整体,以保证器械300具有足够的稳定性和耐久性。关节部分301的近端部分包括两个指状物320、322,每个指状物上分别形成一个孔324、326。
转动关节连接310通过一组穿过连接的指状物上的联结孔的销328安装到近端部分308上。转动关节连接310通常是一个平盘330,它带有一个贯穿的中心孔332和均匀布置在盘330周边上的四个孔334、336、338、340。另外,销328安装在边缘342上并向外延伸。销328插在连接的指状物的孔中以提供器械300的关节活动性。5条连线350、352、354、356、358在中空轴的内部延伸。一条连线350从中心向下延伸穿过转动关节310的中心孔332。5条连线中的两条352、354沿器械的中空轴内部延伸安装在转动关节连接上,这样一条连线的线性拉伸就导致转动关节连接301的转动的动作。这两条连线352、354连接在转动关节连接的两个孔处。此外,它们连接在那些邻近穿过器械300关节部分301的近端部分308的指状物的销子的孔中。另两条连线356、358穿过转动关节的另两个孔连接到关节部分301的末端。这两条连线的动作引起关节部分301的动作,其动作方向垂直于另外两条连线352、354动作时的动作方向。
用关节连接器械作为本发明的一部分,如图17-24所示,提供有一个关节机构400。关节机构400通常包括关节工具驱动器500,一个无菌连接器600,一个传送器700和一个可关节活动的工具300。
传送器安装在器械300的近端316上。如图18-19所示,器械300还可以具有一个可拆卸的工具420。可拆卸的工具420可以是任何工具,如安装在细长的杆或绳索424上的剪切器422。在杆246的末端布置有一个平板部分428,其上带有一个孔430。平板部分428***到位于穿过器械300的延长轴的第二绳绳索或杆434末端的通道432中。第二绳索434具有一个形成在其末端的通道432,这样平板部分428安装在通道432中。至少一个弹簧偏移扳手436安装在穿过平板428布置的孔430中,这连接了工具420与器械300的支架。同样,工具可以在器械的端部更换,而不用每次需要一个新工具时把器械从***10中拆除。
工具300连接在传送器700上,必要时与其制成一体。关节机构400通过上文中描述的接头85连接到机械臂组件26上。接头85恰好套在器械300的轴302上。
传送器700具有一个近端702和一个末端704。传送器700的末端704具有一个与器械300的细长的杆302的横断面相同的横断面。此外,传送器700具有一个中空的内部706。中心杆350延伸穿过传送器700的中空内部706并从近端702处露出。两条连线352,354在传送器内部终止在两个肩部708,710处,这两个肩部安装在中心杆350穿过的第一中空管712上。第一中空管712可以由结实耐用的材料如不锈钢、钢、硬塑料等制成。
第一中空管712安装在支架714上,这样它就可以转动。第一中空管712的转动引起连线352、354的线性移动和器械300的可关节活动的关节部分301在一个平面内关节活动。
第二中空管716具有一对在其上延伸的肩部718、719。两条连线356、358分别连接在两个肩部718、719上。中空管716连接在支架组件720中,这样它就可以转动。和前面一样,第二中空管716的转动引起连线356、358的线性移动,它们使器械300的活动关节301在垂直于第一中空管的转动平面的平面中关节活动。可以想到第二中空管714径向围绕着第一中空管712。传送器700还包括一个快速拆卸装置722,它包括一个位于弹簧偏移扳手726的末端的销724,从而提供传送器700与无菌连接器600之间的可拆卸连接。中空管712和716都可以在其末端带有凹口750。凹口作为中空管与无菌连接器600之间连接的装置752,这将在下文中详细描述。
传送器700通过快速拆卸装置722与无菌连接器600连接。由于关节连接工具驱动器500不易消毒,因此包括一个无菌连接器600的好处是不用对关节连接工具驱动器500消毒就可以更换器械。此外,连接器600提供了一个装置,通过它传送器700可以安装到工具驱动器500上,同时工具驱动器封闭在一个如图26所示的壳体125中。传送器700带有一个小室610。小室与连接器600的元件最好是由一些容易消毒的材料如不锈钢、塑料或其他公知的可消毒的材料制成。小室610具有一个大致中空的内部612和开口端614、616。两个中空管618、620可转动地布置在小室610中。为完成每个中空管618、620的转动,支架622、624布置在每个中空管的周围。每个中空管带有形成于其末端的凹口626,以此来实现传送器700与连接器600一端的连接,并在另一端实现连接器600与活动关节工具驱动器500的连接。
传送器上的销724可以安装在凹口628中,从而把传送器700安装到连接器600上。此外,连接器600可以包括一个安装在弹簧偏移关节632上的销630,从而实现连接器与工具驱动器500的连接。连接器600还包括一个可滑动地接收中心绳索或杆350的末端351的中心段634。末端351可以包括一个带有圆周沟槽353的端部。该端部安装在中心段634上的一个凹口636中并通过至少一个弹簧偏移扳手638可拆卸地锁定在那里。一个与带有圆周沟槽353的端部大致相同的端部640布置在邻近凹口636的地方来使中心绳索连接到活动关节工具驱动器500上,这将在下文中详细描述。
中心段634趋向于在最里面的管618中横向滑动。为了实现这样一种横向滑动,可以在最里面的管的内部的中心段布置一个线形的支架。作为选择,中心段634可以由能在最里面的管618中流畅滑动的支架材料构成。
连接器600可拆卸地安装在活动关节工具驱动器500上。活动关节工具驱动器通过一个壳体125封闭。活动关节工具驱动器500包括一个带有基本封闭的第一端部504和一个基本开启的第二端部506的大致中空的小室502。固定安装在小室内的是一个夹持器马达506和一对腕式马达508和510。每个马达都与控制器46电气连接。作为选择,马达可以通过一个公知的传送/接收***接收从控制器来的信号。这样一个传送/接收***应用到本发明中是新颖的。夹持器马达506连接在一个拧在装配丝杠512上的装配螺母510上。马达506接收控制信号并随之转动。装配螺母510横向移动装配丝杠512。装配丝杠512连接在一个可以用来测量横向移动绳索350(连接器600通过它连接到控制马达506上)所需的力的负荷单元514上。这可以用在一个与本发明的***10配合的力反馈***中。一个形成在末端的带有通道518的杆516安装在负荷单元514上。这样,杆516以一个线性方式移动。连接器600的端部640安装在通道518中,并通过至少一个弹簧偏移扳手或其他类似的安装机构520可拆卸地固定在那里。因此,如果外科医生在主操作手柄上操作夹持器,夹持器马达506转动,由此横向移动杆516,接着是在工具处开启和关闭夹持器的中心绳索350移动。当然,工具的动作取决于安装在那里的工具的类型。例如,如果一个常用的工具布置在手术器械300的端部,那么将发生一个常用的动作。
如果一个主操作手柄50或52围绕轴J6或J7转动,那么两个腕式马达510、508中的一个相应于要求的动作转动。每个马达508、510安装在一个相应的齿轮522、524上。每个齿轮522、524与相关中空管526、528上的开槽部分530、532啮合来围绕其纵向轴径向转动相应的中空管。每个中空管526、528包括凹口端534、536来与连接器600的相应的中空管的凹口端啮合。应该明白每个中空管526、528、618和620都是同轴的。此外,支架可以放置在每个中空管526、528中来提供各个中空管的简单、独立的可转动性。
当中空管526、528转动时,它们转动连接器中的中空管,从而转动传送器中的中空管。这引起手术器械300的端部的关节活动。更具体地讲,这引起手术器械300的活动关节的关节性活动。因此,无论是采用前部装配工具驱动器、后部装配工具驱动器还是关节活动工具驱动器,手术器械都可以很容易地更换。
因此,一个切割片800可以更换为一个夹持器,一个夹持器可以更换为一个切断器810。从本质上讲,这样一个***简化了包括从一个工具变为另一个工具步骤的最小侵入性手术的操作过程。由于该***允许在某个器械端部的关节活动,从而活动关节结构可以用来活动如上所述的与活动关节部分连接的切断或切割器械。
另外,器械可以不是关节连接的器械如切断器,但可采用关节连接的机械来控制它的其它功能。图27示出了一个通过法兰盘85和支持物86与机械臂组件连接的切断器器械810。一般用于抓取工具中的连线在此可用来实现切断这种机械操作。内窥镜切断器为一般的公知器械,但在此之前未闻切断器用于与此处公开的机械臂连接。
此外,如图28所示的切割片可以用在本发明的***中。切割片800通过一个接头85和一个夹持器86安装在机械臂组件26上。切割片不象夹持器或切断机那样要求一个连线,但是切割工具可以通过上文描述的关节机构关节活动。
一个烧灼器或凝结器可以通过接头85和夹持器安装在机械臂组件26上。烧灼器或凝结器是公知的,烧灼器械可以如上文所述安装在活动关节器械的末端。通过以一个预定顺序使用各种工具,各种过程都可以实现。由于许多手术的要求,通常最好是能够更换器械。
虽然在附图中表示并描述了某些示意性的实施例,但应该明白这些实施例主要是为了解释发明而不是为了限制发明,本发明并不限于图示和说明的特定结构和布置,因为本领域的普通技术人员可以进行各种其他变化。
Claims (67)
1.一种用缝合针将病人的第二血管缝合到冠状动脉上的最小侵入性手术方法,其中冠状动脉上有一个切口,该方法包括以下步骤:
a)提供一个第一关节臂和一个第二关节臂,所述第一和第二关节臂与一个控制器和一个输入装置联结,该输入装置接收输入指令并根据输入指令活动第一和第二关节臂;
b)在病人身上至少切开一个切口;
c)把第一和第二关节臂从该切口***病人体内;
d)发出一个输入指令来操作所述第一关节臂抓住第二血管;
e)发出一个输入指令来操作所述第二关节臂抓住缝合针;
f)发出一个输入指令操作所述第二关节臂来牵引缝合针穿过冠状动脉和第二血管;和
g)重复步骤(g)来把第二血管缝合到冠状动脉上。
2.如权利要求1所述的方法,其中第二血管是***内动脉,该方法还包括步骤:在把***内动脉移动到靠近冠状动脉切口处之前,在***内动脉上切一个开口。
3.如权利要求1所述的方法,还包括步骤:发出一个输入指令操作所述第一关节臂来移动缝合针,把第二血管缝合到冠状动脉上。
4.如权利要求1所述的方法,其中所述发出输入指令的步骤包括外科医生移动第一主操作手柄和第二主操作手柄,这样所述第一和第二关节臂的移动相应于所述第一和第二主操作手柄的移动。
5.如权利要求4所述的方法,其中所述第一和第二关节臂均带有一个与所述第一和第二主操作手柄的移动成比例的增量的末端操作装置。
6.如权利要求4所述的方法,还包括步骤:激活所述第一和第二关节臂,从而使第一和第二关节臂与所述第一和第二主操作手柄的移动相配合,和使所述第一和第二关节臂不动作,这样当所述第一和第二主操作手柄由外科医生移动时,所述第一和第二关节臂保持静止。
7.如权利要求1所述的方法,还包括步骤:提供一个与第三关节臂联结并从一个切口***到病人体内的内窥镜,其中所述第三关节臂与所述控制器和一个接收输入指令的内窥镜的输入装置联结。
8.如权利要求7所述的方法,还包括步骤:发出一个在病人体内移动所述第三关节臂和内窥镜的输入指令。
9.如权利要求5所述的方法,还包括步骤:施加给外科医生一个相应于由所述末端装置施加力的力。
10.如权利要求9所述的方法,其中施加给外科医生的力是与所述末端装置施加的力的成比例的增量。
11.如权利要求4所述的方法,还包括步骤:滤去相应于外科医生的手抖动的输入指令。
12.一种允许外科医生在病人身上完成手术的***,包括:
一个带有第一末端操作装置的第一关节臂;
一个第一输入装置,外科医生能够移动第一输入装置一个第一输入装置空间增量来产生第一输入指令;和
一个与所述第一输入装置和所述第一关节臂联结的控制器,所述控制器接收从所述第一输入装置来的所述第一输入指令,并输出一个第一输出指令给所述第一关节臂,从而移动所述第一末端操作装置一个第一末端操作装置空间增量,其中所述控制器与所述第一输入指令成比例,这样第一输入装置空间增量与第一末端操作装置空间增量不同。
13.如权利要求12所述的***,还包括一个具有第二末端操作装置的第二关节臂,和一个第二输入装置,外科医生能够移动第二输入装置一个第二输入装置空间增量来产生一个第二输入指令,所述控制器接收从所述第二输入装置来的所述第二输入指令,并输出一个第二输出指令给所述第二关节臂,从而移动所述第二末端操作装置一个第二末端操作装置空间增量,其中所述控制器与所述第二输入指令成比例,这样第二输入装置空间增量与第二末端操作装置空间增量不同。
14.如权利要求13所述的***,还包括一个装有内窥镜的第三关节臂,和一个接收外科医生命令并发出相应于该命令的第三输入指令的第三输入装置,所述控制器接收所述第三输入指令并提供给所述第三关节臂一个第三输出指令以移动内窥镜。
15.如权利要求12所述的***,其中所述第一输入装置是由外科医生移动的一个主操作手柄,所述输入装置还具有一个与所述控制器联结的输入键,该输入键用来激活所述第一关节臂,使所述第一末端操作装置与所述主操作手柄的移动相配合动作,和使所述第一关节臂不动作,这样当外科医生移动所述主操作手柄时,所述第一末端操作装置保持静止。
16.如权利要求15所述的***,其中所述主操作手柄围绕一个手柄转动点转动。
17.如权利要求12所述的***,其中所述第一末端操作装置具有一个力传感器,所述第一输入装置具有一个与所述力传感器联结的执行机构,从而施加给外科医生一个相应于所述力传感器感知到的力的力。
18.如权利要求17所述的***,其中施加给外科医生的力是与所述力传感器感知的力成比例的增量。
19.如权利要求12所述的***,其中所述输入装置是一个提供第一输入位置信号的第一位置传感器和一个提供第二输入位置信号的第二位置传感器,其中所述控制器提供一个供给所述第一输入位置信号的第一比例因子和一个供给所述第二输入位置信号的第二比例因子。
20.如权利要求12所述的***,其中所述第一关节臂包括一个通过无菌连接器与一个机械臂连接的手术器械。
21.如权利要求20所述的***,其中所述机械臂被一个无菌袋封闭。
22.如权利要求12所述的***,其中所述第一关节臂围绕一个位于病人的切口处的转动点转动。
23.如权利要求22所述的***,其中所述机械臂具有一对钝态的连接点。
24.如权利要求12所述的***,其中所述控制器具有一个滤去相应于外科医生的手抖动的第一输入指令的滤波器。
25.一种能够通过病人身上的第一切口***并由外科医生控制的医用机器人***,包括:
一个具有与***切口的第一末端操作装置联结的钝态连接点的关节臂,其中该切口为所述第一末端操作装置确定了一个第一转动点;
一个产生相应于外科医生命令的第一输入指令的第一输入装置;和
一个与所述第一输入装置和所述第一关节臂联结的控制器,所述控制器从所述第一输入装置接收所述第一输入指令并提供给所述第一关节臂一个第一输出指令来相对于第一转动点移动所述第一末端操作装置。
26.如权利要求25所述的***,还包括一个带有第二末端操作装置的第二关节臂,和一个相应于外科医生的命令产生第二输入指令的第二输入装置,所述控制器从所述第二输入装置接收所述第二输入指令并提供给所述第二关节臂一个第二输出指令来相对于位于病人的第二切口处的第二转动点移动所述第二末端操作装置。
27.如权利要求26所述的***,还包括一个装有内窥镜的第三关节臂,和一个接收外科医生命令并发出相应于该命令的第三输入指令的第三输入装置,所述控制器接收所述第三输入指令并提供给所述第三关节臂一个第三输出指令以围绕位于病人的第三切口处的第三转动点移动内窥镜。
28.如权利要求27所述的***,其中所述第一输入装置为一个由外科医生操作的主操作手柄。
29.如权利要求25所述的***,其中所述第一输入装置是由外科医生移动的一个主操作手柄,所述输入装置还具有一个与所述控制器联结的输入键,该输入键用来激活所述第一关节臂使所述第一末端操作装置与所述主操作手柄的移动相配合动作,和使所述第一关节臂不动作,这样当外科医生移动所述主操作手柄时,所述第一末端操作装置保持静止。
30.如权利要求28所述的***,其中所述第一末端操作装置移动一个与所述主操作手柄的移动成比例的增量。
31.如权利要求25所述的***,其中所述第一末端操作装置具有一个力传感器,所述第一输入装置具有一个与所述力传感器联结的执行机构,从而施加给外科医生一个相应于所述力传感器感知到的力的力。
32.如权利要求31所述的***,其中施加给外科医生的力是与所述力传感器感知的力成比例的增量。
33.如权利要求25所述的***,其中所述第一关节臂包括一个通过无菌连接器与一个机械臂连接的手术器械。
34.如权利要求33所述的***,其中所述机械臂被一个无菌袋封闭。
35.如权利要求25所述的***,其中所述机械臂具有一对钝态的连接点。
36.如权利要求25所述的***,其中所述控制器具有一个滤去相应于外科医生的手抖动的第一输入指令的滤波器。
37.一种允许外科医生在病人身上完成手术的***,包括:
一个带有第一末端操作装置的第一关节臂;
一个第一输入装置,外科医生能够移动第一输入装置一个第一输入装置空间增量来产生第一输入指令;
一个与所述第一输入装置和所述第一关节臂联结的控制器,所述控制器接收从所述第一输入装置来的所述第一输入指令,并输出一个第一输出指令给所述第一关节臂,从而移动所述第一末端操作装置;和
一个激活所述第一关节臂的第二输入装置,从而使所述第一末端操作装置与所述第一输入装置的移动相配合动作,和使所述第一关节臂不动作,这样当外科医生移动所述第一输入装置时,所述第一末端操作装置保持静止。
38.如权利要求37所述的***,还包括一个具有第二末端操作装置的第二关节臂,和一个第二输入装置,外科医生能够移动第二输入装置一个第二输入装置空间增量来产生一个第二输入指令,所述第二输入装置具有一个能够由外科医生压下的第二输入键,所述控制器接收从所述第二输入装置发出的所述第二输入指令并提供给所述第二关节臂一个第二输出指令,使得在压下第二输出键时移动所述第二末端操作装置。
39.如权利要求38所述的***,还包括一个装有内窥镜的第三关节臂,和一个接收外科医生命令并发出相应于该命令的第三输入指令的第三输入装置,所述控制器接收所述第三输入指令并提供给所述第三关节臂一个第三输出指令以移动内窥镜。
40.如权利要求37所述的***,其中所述第一输入装置包括一个围绕主操作手柄转动点转动的主操作手柄。
41.如权利要求40的***,其中所述第一输入装置是由外科医生移动的一个主操作手柄,所述输入装置还具有一个与所述控制器联结的输入键,该输入键用来激活所述第一关节臂使所述第一末端操作装置与所述主操作手柄的移动相配合动作,和使所述第一关节臂不动作,这样当外科医生移动所述主操作手柄时,所述第一末端操作装置保持静止。
42.如权利要求37的***,其中所述第一末端操作装置具有一个力传感器,所述第一输入装置具有一个与所述力传感器联结的执行机构,从而施加给外科医生一个相应于所述力传感器感知到的力的力。
43.如权利要求42的***,其中施加给外科医生的力是与所述力传感器感知的力成比例的增量。
44.如权利要求40的***,其中所述第一末端操作装置移动一个与所述主操作手柄的移动成比例的增量。
45.如权利要求37的***,其中所述第一关节臂包括一个通过无菌连接器与一个机械臂连接的手术器械。
46.如权利要求45所述的***,其中所述机械臂被一个无菌袋封闭。
47.如权利要求37所述的***,其中所述第一关节臂围绕位于病人身上的切口转动。
48.如权利要求47所述的***,其中所述机械臂具有一对钝态的连接点。
49.如权利要求37所述的***,其中所述控制器具有一个滤去相应于外科医生的手抖动的第一输入指令的滤波器。
50.一种医用机器人***,包括:
一个机械臂;
一个封闭所述机械臂的无菌袋;
一个插接到所述机械臂中的无菌连接器;
一个插接到所述无菌连接器中的手术器械。
51.如权利要求50所述的***,其中所述手术器械是一个带有一对指状物的末端操作装置。
52.如权利要求51所述的***,其中所述无菌连接器包括一个把所述末端操作装置指状物联结到所述机械臂的执行机构上的突起。
53.一种医用机器人***,包括:
一个机械臂;
一个可转动地连接到该机械臂上的连接器;
一个由所述连接器握持的内窥镜手术器械;和
其中控制器的移动产生一个与机械臂和手术器械的移动成比例的移动。
54.如权利要求53所述的***,其中所述连接器可拆卸地安装在所述机械臂上。
55.如权利要求53所述的***,其中所述内窥镜手术器械是一个可关节活动的内窥镜手术器械。
56.如权利要求53所述的***,其中所述可关节活动手术器械包括一个基部、一个转动关节和一个末端。
57.如权利要求56所述的***,其中控制器的移动引起可关节活动手术器械的末端相对于可关节活动手术器械的基部的相应的移动。
58.如权利要求53所述的***,其中所述连接器上形成有一个孔。
59.一种操作供在病人身上进行手术的机器人手术***的方法,该方法包括:
1)提供一个第一关节臂,一个控制器和一个接收输入指令的输入装置,第一关节臂与控制器电气连接,控制器和输入装置电气连接;
2)在病人身上至少切开一个切口;
3)把一个手术器械连接到第一关节臂上;
4)通过至少一个切口把所述手术器械***病人体内;
5)根据进行的手术发出一个输入指令来移动所述手术器械,其中所述机械臂根据输入指令移动所述手术器械;和
6)从病人身上移去手术器械。
60.如权利要求59所述的方法,其中在从病人身上移去手术器械之后还包括以下步骤:
1)用一个不同的手术器械替换该手术器械;
2)把所述不同的手术器械***到病人体内;
3)根据进行的手术发出一个输入指令来移动所述不同的手术器械,其中所述机械臂根据输入指令移动所述不同的手术器械;和
4)从病人身上移去不同的手术器械。
61.如权利要求59所述的方法,其中所述手术器械是一个夹持器。
62.如权利要求59所述的方法,其中所述手术器械是一个切断器。
63.如权利要求59所述的方法,其中所述手术器械是一个烧灼器。
64.如权利要求59所述的方法,其中所述手术器械是一个切割片。
65.如权利要求57所述的***,其中安装在可关节活动手术器械末端上的工具是一个切断器。
66.如权利要求57所述的***,其中安装在可关节活动手术器械末端上的工具是一个烧灼器。
67.如权利要求59所述的方法,其中把手术器械安装到接头上的步骤是通过让器械端部穿过接头实现的。
Applications Claiming Priority (4)
Application Number | Priority Date | Filing Date | Title |
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US08/603,543 US5762458A (en) | 1996-02-20 | 1996-02-20 | Method and apparatus for performing minimally invasive cardiac procedures |
US08/603,543 | 1996-10-22 | ||
US08/755,063 | 1996-10-22 | ||
US08/755,063 US5855583A (en) | 1996-02-20 | 1996-11-22 | Method and apparatus for performing minimally invasive cardiac procedures |
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CN1216454A true CN1216454A (zh) | 1999-05-12 |
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CN97193955A Pending CN1216454A (zh) | 1996-02-20 | 1997-02-19 | 施行最小侵入性心脏手术的方法和装置 |
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US (9) | US5855583A (zh) |
EP (1) | EP0883376B1 (zh) |
JP (1) | JP2000505328A (zh) |
KR (1) | KR19990087101A (zh) |
CN (1) | CN1216454A (zh) |
AT (1) | ATE323446T1 (zh) |
AU (1) | AU2131897A (zh) |
CA (2) | CA2246713C (zh) |
DE (1) | DE69735708T2 (zh) |
ES (1) | ES2264158T3 (zh) |
IL (1) | IL125822A (zh) |
RU (1) | RU2233626C2 (zh) |
WO (1) | WO1997029690A1 (zh) |
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Also Published As
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RU2233626C2 (ru) | 2004-08-10 |
US20050228365A1 (en) | 2005-10-13 |
US6007550A (en) | 1999-12-28 |
CA2547686A1 (en) | 1997-08-21 |
IL125822A0 (en) | 1999-04-11 |
CA2547686C (en) | 2011-11-15 |
CA2246713C (en) | 2006-08-15 |
DE69735708T2 (de) | 2006-09-28 |
IL125822A (en) | 2003-07-06 |
US20040186345A1 (en) | 2004-09-23 |
ATE323446T1 (de) | 2006-05-15 |
KR19990087101A (ko) | 1999-12-15 |
US5855583A (en) | 1999-01-05 |
AU2131897A (en) | 1997-09-02 |
CA2246713A1 (en) | 1997-08-21 |
EP0883376B1 (en) | 2006-04-19 |
US6905460B2 (en) | 2005-06-14 |
US7083571B2 (en) | 2006-08-01 |
DE69735708D1 (de) | 2006-05-24 |
US20080228196A1 (en) | 2008-09-18 |
US20030100817A1 (en) | 2003-05-29 |
EP0883376A1 (en) | 1998-12-16 |
US7695481B2 (en) | 2010-04-13 |
ES2264158T3 (es) | 2006-12-16 |
US6102850A (en) | 2000-08-15 |
US20030083648A1 (en) | 2003-05-01 |
WO1997029690A1 (en) | 1997-08-21 |
JP2000505328A (ja) | 2000-05-09 |
US20080215065A1 (en) | 2008-09-04 |
EP0883376A4 (en) | 2000-08-23 |
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