Method and apparatus for performing minimally invasive surgical procedures

Abstract

The system includes a pair of surgical instruments that are coupled to a pair of robotic arms. The instruments have end effectors that can be manipulated to hold and suture tissue. The robotic arms are coupled to a pair of master handles by a controller. The handles can be moved by the surgeon to produce a corresponding movement of the end effectors. The movement of the handles is scaled so that the end effectors have a corresponding movement that is different, typically smaller, than the movement performed by the hands of the surgeon. The scale factor is adjustable so that the surgeon can control the resolution of the end effector movement. The movement of the end effector can be controlled by an input button, so that the end effector only moves when the button is depressed by the surgeon. The input button allows the surgeon to adjust the position of the handles without moving the end effector, so that the handles can be moved to a more comfortable position. The system may also have a robotically controlled endoscope which allows the surgeon to remotely view the surgical site. A cardiac procedure can be performed by making small incisions in the patient's skin and inserting the instruments and endoscope into the patient. The surgeon manipulates the handles and moves the end effectors to perform a cardiac procedure such as a coronary artery bypass graft.

Description

CROSS-REFERENCES TO RELATED APPLICATIONS [0001] The present application is a continuation of U.S. application Ser. No. 10 / 339,077 filed on Jan. 7, 2003; which is a continuation of U.S. application Ser. No. 09 / 557,950 filed on Apr. 24, 2000, now U.S. Pat. No. 6,699,177; which is a continuation of U.S. application Ser. No. 08 / 873,190 filed on Jun. 11, 1997, now U.S. Pat. No. 6,102,850; which is a continuation-in-part Application of U.S. patent application Ser. No. 08 / 755,063 filed on Nov. 22, 1996, now U.S. Pat. No. 5,855,583; and which is a continuation-in-part Application of U.S. patent application Ser. No. 08 / 603,543 was filed on Feb. 20, 1996, now U.S. Pat. No. 5,762,458 (of which all are incorporated herein by reference).BACKGROUND OF THE INVENTION [0002] 1. Field of the Invention [0003] The present invention relates to a system and method for performing minimally invasive cardiac procedures. More particularly, the present invention relates to a robotic system and surgical instru...

AI Technical Summary

Benefits of technology

[0015] The present invention is additionally directed to a surgical instrument and method of control thereof which permits the surgeon to articulate the tip of the instrument, while retaining the function of the tool at the tip of the instrument. As such, the instrument tip may be articulated with two degrees of freedom, all the while the tool disposed at the tip may be used.

[0017] The present invention may include a surgical instrument that has an elongated rod. The elongated rod has a longitudinal axis and generally serves as the arm of the endoscopic instrument. An articulate portion is mounted to and extends beyond the elongated rod. Alternatively, the articulate portion may be integrally formed with the elongated rod. The articulate portion has a proximal portion, a pivot linkage and a distal portion. The proximal portion may include a pair of fingers. The fingers may be orthogonal to each other and oriented radially to the longitudinal axis of the elongated rod. For use in surgical procedures, it is generally preferable that the instrument and the majority of the components therein are formed of stainless steel, plastic, or some other easily steralizable material. Each of the fingers may have at least one aperture formed therein to allow the passage of a pin which aids in the attachment of the pivot linkage to the proximal portion of the articulate portion and which allows the pivot linkage to be pivotally mounted to the proximal portion. The articulate portion provides articulation at the tip of an instrument that includes the articulate portion. More particularly, this provides additional degrees of freedom for the tool at the tip of an instrument that includes an articulate portion.

[0018] An instrument such as that disclosed hereinbelow, when used in conjunction with the present surgical system, provides the surgeon additional dexterity, precision, and flexibility not yet achieved in minimally invasive surgical procedures. As such, operation times may be shortened and patient trauma greatly reduced.

[0019] To provide increased precision in positioning the articulated tip as disclosed hereinbelow, there is provided two additional degrees of freedom to the master controller. Each of the two additional degrees of freedom are mapped to each of the degrees of freedom at the instrument tip. This is accomplished through the addition of two joints on the master and automatic means for articulating the instrument tip in response to movements made at the master.

Problems solved by technology

Blockage of a coronary artery may deprive the heart of the blood and oxygen required to sustain life.

Splitting the sternum and opening the chest cavity, commonly referred to as ‘open surgery’, can create a tremendous trauma on the patient.

Additionally, the cracked sternum prolongs the recovery period of the patient.

Manipulating such instruments can be awkward, particularly when suturing a graft to an artery.

It has been found that a high level of dexterity is required to accurately control the instruments.

The tremor further increases the difficulty of performing minimally invasive cardiac procedures.

Because forceps and other instruments designed for minimally invasive surgery are generally long and rigid, they fail to provide a surgeon the dexterity and precision necessary to effectively carry out many procedures in a minimally invasive fashion.

For example, conventional MIS forceps are not well suited for manipulating a needle during a minimally invasive procedure, such as during endoscopy.

Therefore, many MIS procedures that might be performed, have, as of yet, not been accomplished.

However, by inserting an instrument through a small aperture, such as one made in a patient to effectuate a minimally invasive procedure, two degrees of freedom are lost.

It is this loss of freedom of movement within the surgical site that has substantially limited the types of MIS procedures that are performed.

Dexterity is lacking in MIS because the instruments that are used fail to provide the additional degrees of freedom that are lost when the instrument is inserted into a patient.

One problem associated with this lack of dexterity is the inability to suture when the instruments are in certain positions.

As a result, surgeries that require a great deal of suturing within the surgical site are almost impossible to perform because the surgical instruments to enable much of this work are not available.

Another problem associated with MIS is the lack of precision within the surgical site.

Currently, with hand positioned instruments, the precision necessary for such suturing is lacking.

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