WO2022269633A1

WO2022269633A1 - A portable surgical device for minimally invasive surgeries

Info

Publication number: WO2022269633A1
Application number: PCT/IN2022/050565
Authority: WO
Inventors: Suarya Prakash MISHRA
Original assignee: Mishra Suarya Prakash
Priority date: 2021-06-21
Filing date: 2022-06-21
Publication date: 2022-12-29

Abstract

The present invention discloses a portable surgical device for minimally invasive surgeries comprising a surgical robot device (1), surgical tool (2), plurality of passive arms (6) characterized to be non-motorized with multiple degrees of freedom; and an endoscope (20). The present invention discloses a portable surgical device and the base rotation assembly (45), angulation assembly (46), tool rotation assembly (47) and tool translation assembly (48) are characterized to be connected in a way that it acts as a serial manipulator wherein the motion of a lower assembly is transferred to the upper assemblies and the axis of rotation passes through a concurrent point away from the said surgical robot device (1) and enables the surgical robot device (1) to be operated in polar coordinated way. The portable surgical device of the present invention has applications in Gastro-Intestinal, Urological, Cardiothoracic, Gynaecological and Obstetric surgical procedures.

Description

Title of invention

A portable surgical device for minimally invasive surgeries

Field of invention

The present invention relates to a portable robotic system for minimally invasive surgeries. More particularly the present invention relates to a robotic surgical system for Gastro-Intestinal, Urological, Cardiothoracic, Gynaecological and Obstetric surgical procedures. Even more particularly the present invention relates to a portable surgical robot system which achieves the end effect by moving the control of the slender surgical tools used in robotic surgeries, from distal end tools to a location much closer to the patient body.

Background of Invention

Robotic surgery was invented to address the problems often encountered with traditional laparoscopic surgery i.e., steep learning curve, non-intuitive motion (movements are inverted), low dexterity at surgical tool tips and high strain on the surgeons’ hands, neck and back. The state-of- the-art surgical robotics system is the DaVinci Surgical Robot.

The current systems occupy a complete operating room and often needs a dedicated room for itself. The following are the major parts of the system - the master system (surgeon console and 3d display), the robot (surgical robot and surgical tools), the optional side rack (display, tool rack with spare tools, and other accessories), and the digital endoscope.

The subsystems under consideration in this patent are the surgical robot and the surgical tools. The aim of the surgical robot is to provide motions to the long slender surgical tool so that it can reach the required spot within the patient body and move as a slave system to the surgeon’s console arms. The contemporary systems are having certain inherent incompetence that this patent intends to solve. These are: a. Size of the robot is large, since the tool tip is controlled at the distal end by robotic arms in the contemporary robotic systems, the range of motion required by the robot to achieve small motions inside the patient is high. In addition, since a smaller robotic arm will interfere with the movement of the Operating room staff, the robot needs to be big and partially overhung thereby making the robot even bigger. b. Degrees of freedom:

Although there are only 7 (seven) motions required for the tool including 4 (four) degrees of freedom for the macro motions of the tool and 3 (three) for the tool tip orientation and grasping, the robot needs to have redundant motions, because some approaches could be restricted due to the presence of humans in the workspace. c. Cost:

Due to the size and number of degree of freedoms of the contemporary robots, the cost is remarkably high. As the size of the robot increases, the power required for the motor increases, and hence cost skyrockets. d. Excessively powerful motors:

Laparoscopy is a delicate procedure, that does not require excessive forces. Currently used robots are too powerful for the purpose, and hence any failure of the motion can cause severe trauma to the patient.

To eliminate or mitigate the risks associated with such limiting parameters and to perform surgeries in a hassle-free manner, there is a need of system for surgical robot that can work in tandem with a surgeon’s console that takes the position and orientation of the surgical console’s master control arm(s) that the surgeon holds in his hand - either mechanically using encoders or using image recognition, processing, and tracking. In addition, the system needs to be small and portable enough to be transported, mounted, and used with ease.

Summary of the Invention

Accordingly, the present invention provides a portable surgical robotic system for minimally invasive surgeries. The surgical robot has three major operation modes- Insertion and removal of device (hereby referred to as docking and undocking), Use during an operation (also known as standard operation) and Tool change.

The parts of the complete surgical system are the Surgical Robot(s); passive support arm(s); The surgical tool(s); the surgical console with the master control arms and display.

The surgical robot can work in tandem with a surgeon’s console that takes the position and orientation of the finger hold at the end of the master arms, that the surgeon holds in his hand. This is done either mechanically using encoders / angle / position sensors or using image recognition, processing, and tracking. The position and orientation of this finger hold is transferred to the surgical robot, that actuates the multiple motors to achieve the same (or similar) motion at the surgical tool tip. The motion of each motor is determined by the inverse kinematic function of the robot. The plurality of joints is explained in a better manner in the description below.

The arrangement of the motors, geometry and parts of the system are such that the axis of motion of all joints that enable macro motions - base rotation joint, angulation joint, tool rotation and tool translation, pass through a single point known as the fulcrum point.

During standard operation, the surgical tool is held inside the surgical robot with the surgical tool shaft passing through the surgical robot. The aim of the robot is to enable the surgical tool tip to reach all points inside a workspace within the abdomen of the patient. This includes four types of motions such as pitch, yaw, tool roll, and in-out translation. These motions are called macro motions. In addition, the surgical robot also enables 3 degrees of freedom to the surgical tool tip, known as tool tip motions.

The first two joints in the robot i.e the base rotation joint and the angulation joint enables the pitch and yaw of the surgical tool completely. The size and geometry of the components are adjusted so as to provide the maximum pitch and yaw to the tool and sure the point of no rotation is approximately at the centre of the patient’s abdominal wall. In the prefer ed embodiment this is achieved by moving the carriage with the last 2 joints along a curved rail where the axis of this curved rail is located some distance below the base of the robot.

In an alternate embodiment, a universal joint section is used between the first 2 and the last 2 joints to ensure that center of angulation is at the desired fulcrum point within the abdomen of the patient. This mechanism maintains the fulcrum of the surgical tool within the surgical canula / at the skin at the point of incision, and not within the surgical robot. In absence of this free joint, the motion due to the angulation joint will result in the fulcrum being inside the robot and will cause strain at the abdominal wall.

In another embodiment the same function can be achieved with a single free revolute joint with its axis parallel to the angulation joint, instead of the universal joint as mentioned above. The tool rotation joint enables the surgical tool to rotate about its axis. In addition, the rotation also negates the effect of the base rotation joint on the orientation of the tool tip inside the patient. This ensures that the orientation of the tool tip remains constant inside the patient even when the base rotation joint moves.

The final joint is the tool translation joint. In the preferred embodiment this achieved by a translation joint (e.g., a screw nut joint or belt drive or tendon actuated joint).

In an alternate embodiment the translation motion of the surgical tool is achieved using rollers. The rollers are characterized to be in contact with the surgical tool tube with friction as they are spring loaded. When the motorized roller moves, it results in translation motion of the surgical tool.

The final three degrees of freedom, i.e., motions of the surgical tool tip are achieved by a tool tip control unit at the top of the surgical robot. This control unit is the last link that is moved by the tool translation joint. The control unit houses multiple motors. The surgical tool is inserted into the robot and joins with the robot at the tool tip control unit. Once joined the motion of motors are transferred to mechanical means inside the control box of the tool tip. These in turn actuate the tool tip either through tendons, rods, or other mechanical connections.

The tool change operation of the surgical robot is to replace the used tool and replace it with a sterile new tool. This is achieved by unclamping the roller’s holder which releases the spring load on the surgical tool. The tool can now be pulled out, and a new one inserted and separately, the entire roller holders and rollers can be unscrewed from the rest of the assembly for sterilization. In the alternate embodiment the tool is slid out from the robot after unclamping the control box of the surgical tool from the tool control unit.

The docking operation is the process of setting up the system prior to standard operation. During docking the passive arm is set up first aligned with the points on incision on the patient’s body. The robots are removed from the storage / transport cases and mounted on the passive arms. Surgical tools are then inserted through the robot into the patient’s abdomen.

During undocking the reverse of the above process is performed. In yet another embodiment, some of the motions described above could be achieved using a Stewart platform like parallel manipulator mechanism, made with linear actuators or rotational actuations.

Object of the Invention

The primary object of the present invention is to provide portable surgical device and a system for minimally invasive surgeries and some open surgeries.

Yet another object of the present invention is to provide a portable surgical device comprising of a plurality of components including the surgical tool with long tube, surgical tool control unit, clamps for surgical device, the base, bottom rotor, angler, rocker, universal joint section, roller holder, rollers, and support rod.

Yet another object of the present invention is portable surgical device comprising of a plurality of components including a surgical robot device, surgical tool, plurality of passive arms characterized to be non-motorized with multiple degrees of freedom; and an endoscope.

Still another object of the present invention is to provide portable surgical device comprising plurality of joints such as the joint between the Base and Bottom rotor, joint between the bottom rotor and the angler, between the angler and the universal joint section, between the universal joint section and rocker, the rocker and the roller holder, the roller holder and the rollers, and the rollers and the surgical tool; with the joints being motorized, free or rigid.

Another object of the present invention is to provide a system for the said portable surgical device comprising of one or more of the portable surgical robotic systems with a surgical tool (31) or with an endoscopic camera (32), the surgical tool and its control unit, the surgeon, the surgeon console and the master control unit, the display and the display control unit, auxiliary user interface, optional display, slave control unit, endoscopic camera, surgical cannula, and clamps. In addition, it also includes the patient, and the operating table.

Yet another object of the present invention is to provide a system for the said portable surgical device to enable surgery with safety to the patient and the operating room staff. Still another object of the present invention is to provide a system for the said portable surgical device to maintain its position when there are no input signals.

Another object of the present invention is to provide a system for the said portable surgical device that enables fast replacement of the surgical tool used during the procedure, while maintaining and enabling sterilization of the parts in contact with the patient.

Still another object of the present invention is to provide a system for the said portable surgical device that enables reduction of stress on the abdominal wall of the patient 15 during surgery.

Yet another object of the present invention is to provide a system for the said portable surgical device to reduce the size of the current generation of surgical robots by about 90% thereby enabling easy portability of the equipment.

Detailed description of the invention

The word "exemplary" is used herein to mean "serving as an example, instance, or illustration." Any embodiment described herein as "exemplary" is not necessarily to be construed as preferred or advantageous over other embodiments. Likewise, the term “embodiments" do not require that all embodiments include the discussed feature, advantage, or mode of operation.

The terminology used herein is provided to describe particular embodiments only and is not intended to limit any embodiments disclosed herein. As used herein, the singular forms "a," "an," and "the" are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms "comprises, “comprising," "includes," and/or "including," when used herein, specify the presence of stated features, steps, elements, and/or components, but do not preclude the presence or addition of one or more other features, steps, elements, components, and/or groups thereof.

Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs.

The portable robotic surgical system described in this invention is used for minimally invasive surgeries, where a keyhole size hole is made in the abdomen or thorax of the patient and long thin surgical tools are inserted. The surgical robot is responsible for the motion of these tools inside the patient. The surgical robot in turn is controlled by the surgeon remotely. The Surgical robotic system consists of multiple sub-systems namely the surgical robotic device (1), the surgical tools (2), the passive arms (6), the endoscope (20), the surgeon’s console (29), and the side stand (30). These work together with the existing infrastructure of the operating room e.g., insufflator, cautery, suction pump, endo-staplers, and other laparoscopic tools, these are not covered as a part of this invention.

The passive arm may be a non-motorized arm with 4 to 6 degrees of freedom. Each of the degrees of freedom are actuated manually or using a controller, to position the top end of the passive arm at the right position near the patient’s body to mount the surgical robot. The bottom end of the passive arm has a mounting rail clamp (37) that is used to mount the passive arm rigidly to the mounting rail (36). The passive arm may contain a plurality of springs, links, gas springs, and other counter balancing mechanisms to enable the passive arm to be stable and rigid. The top end of the passive arm may contain a mechanism to connect to the bottom rail of the surgical robot and mount the surgical robot.

The passive arm may also contain a laser-based tool to ensure the surgical robot is mounted at the right distance, position, and orientation with respect to the patient’s body. In an alternate embodiment, the spacer ring (38) may be part of the top end of the passive arm. The spacer ring is a ring with diameter larger than the head of the cannula and located on a free pivot either on the base rail of the surgical robot or the passive arm to ensure that the surgical robot is at the right distance from the patient’s body.

The surgical robotic device (1) when used with the surgical tool (31) enables a total of 7 degrees of freedom (DOFs). This includes 4 DOFs known as macro motions - base rotation, angulation, tool rotation and tool translation; and 3 degrees of motion for the surgical tool tip (7). When the surgical robotic device is used with an endoscope (32) it only enables the 4 macro motions as there are no tool tip motions.

The surgical robotic device (1) consists of a base rotation assembly (45), angulation assembly (46), tool rotation assembly (47) and tool translation assembly (48). In addition, the surgical robotic device also has Surgical tool control unit (3) that has actuators and encoders to control the dofs of the surgical tool (2). The surgical tool (2) which consists of a pulley unit (39) containing pulleys, springs to control the motion of the surgical tool tip (7). The surgical tool tip is controlled from the pulley unit using tendons, cable, rods, or similar mechanisms. The surgical tool tip is at the end of a long shaft - the tool shaft (49).

The assemblies of the surgical robotic device in its preferred embodiment are arranged in a sequential manner like a serial manipulator. However, unlike other serial manipulators and surgical robots, this device operates in the polar coordinate system.

All motions of the above-mentioned assemblies are transferred to the surgical tool control unit (3) which in turn interfaces with the surgical tool via the pulley unit (39).

The arrangement of these assemblies, geometries and degrees of freedom is such that all the axes of motion of the macro motions pass through a single point. This point known as the fulcrum point (50) is located such that it lies a fixed distance below the spacer ring (38). This distance is such that during a surgery the fulcrum point is located at the approximate midpoint of the abdominal wall (52). The position of the spacer ring can be adjusted to account of different thickness of the abdominal wall in different patients.

In an alternate embodiment (Fig 7), a universal joint (Fig 7d) (16,17,18), single degree of freedom free joint, or similar mechanism is used to ensure that the fulcrum point lies in the middle of the abdominal wall. In this case the motor drives the angulation at the angulation joint motor axis (58) which controls the angulation joint angle (57). This results in a possible non-zero universal joint angle (60). The free joint ensures that the only naturally available fulcrum point is at the center of the abdominal wall resulting in a single possible position for the surgical tool from the Universal joint axis (59) to the center of the abdominal wall resulting in a perfectly placed fulcrum point (50). Alternately the universal joint may also be a powered joint to enable more control on the position of the fulcrum point. Alternatively, an artificial pivot point consisting of a joint that allows only in-out translation and rotation but no pan-tilt degree of freedom may be used on the patient’s abdomen, clamped on the operating table side rails, if required. The surgical robot has three major operation modes- Insertion and removal of device (hereby referred to as docking and undocking), Use during an operation (also known as standard operation) and Tool change.

At the beginning of the surgery, the patient (5) is positioned on the operating table (4). The surgeon (28) plans the approach for the surgery and makes small incisions on the abdomen or thorax of the patient using a surgical trocar and inserts the surgical cannulas (19) into the patient. A hollow cavity may be created in the region of operation to separate the internal organs from the abdominal wall known as insufflation. The surgical robotic devices (1) are then positioned on or close to the patient’s body and secured to the Operating table using passive arms (6). While positioning the robot, the spacer rings (38) are used to ensure that the robots are mounted at the correct distance from the abdominal wall of the patient. In an alternate embodiment laser-based distance aligners may be used for the same purpose. More than one surgical robot can be used in a surgery. The surgeon or the surgical staff use the Auxiliary user interface (27) on the Side Stand (30) to select the appropriate settings for the surgery. The surgical tool (2) is then inserted through the through the cavity of the surgical robot, through the cannula (6) into the patient. The surgical tool is then interfaced with the surgical robot by mechanically connecting the pulley unit (39) of the surgical tool to the surgical tool control unit (3) of the surgical robot.

In the alternate embodiment, the surgical tool is inserted through the rocker (12) and roller holder (13) assembly and then through the cavity of the surgical robot, through the cannula (6) into the patient. The rocker (12) is screwed into position. Care is taken to align the support rod (15) with the control unit for surgical tool tip (3). Similar to the previous embodiment the pulley unit is mechanically interfaced with the surgical tool control unit. Prior to use on the patient, the surgical tool, along with the rocker and roller holder assembly are to be sterilized.

In addition to one or more tools, one of the surgical robotic devices may be inserted with an endoscope (20) in a manner similar to the surgical tool. The camera communicates with the Display control unit (23) that renders the view on the display (24) for the surgeon to see during the surgery. The endoscope may be used without a surgical robot to control it’s motion in which case the endoscope is directly mounted on the passive arm or any other support arm. The surgeon (28) then positions himself on the Surgeon’s Console (29). He/ She uses the master control arms (25) which are joystick-like master control devices. The motion of the arms are captured by the Master control unit (22). In addition, the surgeon can also visualize the operation on the display (24) which in turn is controlled by the Display control unit (23). During the surgery the surgeon can have additional control on the modes of the system using Surgeon switches and controls (34).

The surgeon controls the motion of the surgical tool tip inside the patient using the surgeon’s console. The motions of the hands of the surgeon are captured by the master control unit (22) which also interprets the position and orientation using forward kinematics. The master control unit then sends this information to the main processor control unit (35) which in turn send motion commands to the respective slave control units (21). The slave control unit computes the required inverse kinematics i.e., the motion of each actuator on the surgical robotic device and the surgical tool tip.

During the surgery when a change of tools is required, the surgery is paused using the auxiliary user interface and tool change mode is activated. The pulley unit is unclamped from surgical tool control unit and the tool is pulled out from the robot. The new tool is inserted and interfaced in a similar manner.

In an alternate embodiment, the rocker and roller holder assembly is unscrewed from the surgical robotic device. The surgical tool along with the above-mentioned assembly is then pulled out from the patient, through the cannula. A new surgical tool is then inserted in the same way after appropriate setting are done on the auxiliary user interface.

Once the new tool is inserted the surgery is resumed using the auxiliary user interface.

Detailed description of drawings

Fig. 1 shows the exemplary use of the Surgical robotics system on a patient (6) during surgery. The image shows the surgical robot (1) mounted on the passive arms (6) which in turn are clamped to the mounting rail (36) of the surgical table (4). The figure also shows the endoscope (20) inserted into the patient’s abdomen through a surgical cannula (19). The surgical tools (2) are also inserted into the abdomen of the patient through surgical cannulas. Fig. 2 shows the surgical robot (1) with the passive arm (6), a surgical tool (2) and the surgical cannula (19). The mounting rail clamp (37) is a part of the passive arm. The surgical tool tip (7) and the pulley unit (39) are part of the surgical tool. The surgical tool control unit (39) and Spacer ring (38) are parts of the surgical robot.

Fig 3 Assembly view of the surgical robot with different subsystems and the surgical tool.

Fig 4 Cross section view of the robot in the preferred embodiment showing the fulcrum point of the device

Fig 5 Shows an alternate embodiment of the surgical robotic device. For the sake of simplification and understanding, details of the design have not been shown.

Fig 6 Shows the individual assemblies that constitute the alternate embodiment of the surgical robot. These include the Base rotation (Fig 7a), Angulation assembly (Fig 7b), tool rotation assembly (Fig 7c), tool translation assembly with rollers (Fig 7e) and the Universal joint assembly (Fig 7d).

Fig 7 Is the alternate embodiment of the surgical robotic device being used on the patient during surgery. This shows the universal joint axis (59) and the abdominal wall (51) locating the position and orientation of the surgical tool.

Fig 08 is the complete system with mechanical linkages shown as solid arrows and data transfer shown in dashed arrows.

Claims

Claims: I Claim,

1. A portable surgical device for minimally invasive surgeries comprising: a. Surgical robot device (1); b. Surgical tool (2); c. Plurality of passive arms (6) characterized to be non-motorized with multiple degrees of freedom; and, d. An endoscope (20).

2. A portable surgical device for minimally invasive surgeries as claimed in claim 1 ; wherein, said surgical robot device (1) is characterized to comprise a base rotation assembly (45), angulation assembly (46), tool rotation assembly (47) and tool translation assembly (48), surgical tool control unit (3); characterized to contain motors and encoders to control the degree of freedoms of the surgical tool (2).

3. A portable surgical device for minimally invasive surgeries as claimed in claim 1 ; wherein, said base rotation assembly (45), angulation assembly (46), tool rotation assembly (47) and tool translation assembly (48) are characterized to be connected in a way that it acts as a serial manipulator wherein the motion of a lower assembly is transferred to the upper assemblies and the axis of rotation passes through a concurrent point away from the said surgical robot device (1) and enables the surgical robot device (1) to be operated in polar coordinated way.

4. A portable surgical device for minimally invasive surgeries as claimed in claim 1 ; wherein, in an embodiment, said surgical robot device (1) characterized in that a universal joint section (11) above the said angulation assembly (46) which enables the fulcrum point (50) of the said surgical tool (2) away from the surgical robotic device (1) and within the abdominal wall (51).

5. A portable surgical device for minimally invasive surgeries as claimed in claim 1 ; wherein, in an embodiment, said angulation assembly (46), characterized in that, an angulation rail (62) which enables the fulcrum point (50) of the said surgical tool (2) away from the surgical robotic device (1) and within the abdominal wall (51).

1

6. A portable surgical device for minimally invasive surgeries as claimed in claim 1 ; wherein, said surgical tool (2) comprises a pulley unit (39) characterized to contain pulleys, springs to control the motion of the surgical tool tip (7), said surgical tool tip (7) characterized to be controlled from the pulley unit (39) with means selected but not limited to tendons, cables, rods, or similar mechanisms.

7. A portable surgical device for minimally invasive surgeries as claimed in claim 1 ; wherein, said plurality of passive arms (6) characterized to be non-motorized or non-automated with multiple degrees of freedom are characterized to have a top end and a bottom end and maintaining the position of said top end of the passive arm (6) at the right position near the patient’s body to mount the surgical robot, is characterized to be actuated manually or using controller; and said bottom end of said passive arm (6) is characterized to comprise mounting rail clamp (37) for mounting the passive arm rigidly to the mounting rail (36) and a balancing mechanism to enable the passive arm (6) to be stable and rigid selected from plurality of springs, links, gas springs, and other counter balancing mechanisms wherein said top end of passive arm (6) is characterized to be connected with bottom rail of said surgical robot (1) and mount the surgical robot (1).

8. A portable surgical device for minimally invasive surgeries as claimed in claim 1 ; wherein, in an embodiment, said passive arm (6) comprises a laser tool for ensuring the distance, position, and orientation of the said surgical robot (1) with respect to the patient’s body or a spacer ring (38) is characterized to be connected with top end of said passive arm located on a free joint, wherein, the free joint is either connected to the base rail (61) of the surgical robot (1) or said top end of the passive arm (6).

9. A portable surgical device for minimally invasive surgeries as claimed in claim 1 ; wherein, in an embodiment, said endoscope (20) is characterized to be connected with surgical robotic device (1) in a manner similar to surgical tool (2) wherein, the endoscope (20) communicates with Display control unit (23) to render the view on the display (24).

2