Mechanical joints and related systems and methods

Abstract

The present application relates to mechanical joints and related systems and methods, wherein a surgical instrument may include a shaft including a wrist at a first end; an end effector coupled to the wrist; and an actuating element extending along the shaft and the wrist. The actuating element may follow a twisted path along at least a portion of the wrist. The twisted path may have an angular range of less than 360 degrees along the entire length of the wrist. A method of configuring a surgical instrument wrist and a support structure for an actuating element of a surgical instrument are also contemplated. The support structure may include at least one channel defining a twisted path around a longitudinal axis of the support structure. The channel may have an angular range of less than 360 degrees from a first end of the channel to a second end of the channel.

Description

[0001] This application is a divisional application of Chinese patent application No. 2015800093992, filed on February 20, 2015, and entitled “Mechanical Joints and Related Systems and Methods”.

[0002] CROSS-REFERENCE TO RELATED APPLICATIONS

[0003] This application claims the benefit of U.S. Provisional Patent Application No. 61 / 943,084, filed February 21, 2014, which is incorporated herein by reference in its entirety. Technical Field

[0004] The present disclosure relates to mechanical joint structures and instruments and methods that utilize actuation elements to articulate multiple mechanical joints. Specifically, aspects of the present disclosure relate to surgical instruments and methods that utilize remotely actuatable mechanical joints. Technical Background

[0005] Remotely controlled surgical instruments (including teleoperated surgical instruments) are often used in minimally invasive medical procedures. During the medical procedure, the surgical instrument can be articulated in one or more directions. For example, the surgical instrument can be actuated by a transmission mechanism located at the proximal end of the surgical instrument shaft to orient and position an end effector located at the distal end of the surgical instrument at a desired position. The surgical instrument may further include a wrist to which the end effector is connected, such as an articulated, articulated structure, so that the end effector can be positioned relative to the shaft. The surgical instrument may further include one or more end effector actuating elements (including the wrist) passing through the surgical instrument to actuate the end effector. Actuating (bending) the wrist can cause bending of (multiple) end effector actuating elements, which may cause a change in the length of (multiple) end effector actuating elements. Such a change in length may cause unexpected movement of the end effector. In view of this, it is desirable to provide a surgical instrument including one or more end effector actuating elements, which are configured to substantially conserve the lengths of these actuating elements when the wrist of the instrument is articulated. Summary of the invention

[0006] Exemplary embodiments of the present disclosure may solve one or more of the above problems and / or may demonstrate one or more of the above desirable features.Other features and / or advantages will become apparent from the following description.

[0007] According to at least one exemplary embodiment, a surgical instrument may include a shaft including a wrist at a first end; an end effector coupled to the wrist; and an actuating element extending along the shaft and the wrist. The actuating element may follow a twisted path along at least a portion of the wrist. The twisted path may have an angular range of less than 360 degrees along the entire length of the wrist.

[0008] According to another exemplary embodiment, the support structure of the actuating element of the surgical instrument may include at least one channel defining a tortuous path around the longitudinal axis of the support structure. The channel may have an angular range of less than 360 degrees from a first end of the channel to a second end of the channel.

[0009] According to another exemplary embodiment, a method of configuring a surgical instrument wrist may include extending an actuation element along the wrist such that the actuation element follows a twisted path along at least a portion of the wrist. The twisted path may have an angular range of less than 360 degrees.

[0010] Additional objects, features and / or advantages of the present invention will be described in part in the following description, and in part will become apparent from the description, or may be understood through the practice and / or claims of the present disclosure. At least some of these objects and advantages may be realized and obtained through the elements and combinations particularly pointed out in the appended claims.

[0011] It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the claims; which are to be entitled to the full breadth of their scope, including equivalents. BRIEF DESCRIPTION OF THE DRAWINGS

[0012] The present disclosure can be read from the following detailed description, either alone or in conjunction with the attached Figure 1 These drawings are included to further understand the present disclosure and are incorporated in and constitute a part of this specification. These drawings show one or more exemplary embodiments of the present teachings and are used together with this specification to explain certain principles and operations.

[0013] Figure 1 A teleoperated surgical system is shown according to an exemplary embodiment.

[0014] Figure 2 A schematic perspective view of a unitary flexible and bendable member in a straight configuration is shown according to an exemplary embodiment.

[0015] Figure 3 Shows Figure 2 A member in a bent configuration.

[0016] Figure 4 Shows Figure 2 A member in a bent configuration.

[0017] Figure 5 is a partially schematic perspective cross-sectional illustration of an exemplary embodiment of a surgical instrument shaft and components extending therethrough.

[0018] Figure 6 is a top view schematic diagram of an exemplary embodiment of a wrist of a surgical instrument.

[0019] Figure 7 is a top view schematic diagram of an exemplary embodiment of a wrist of a surgical instrument.

[0020] Figure 8 is a side view of a distal portion of a surgical instrument according to an illustrative embodiment.

[0021] Fig. 9 is a side view of an exemplary embodiment of a wrist of a surgical instrument.

[0022] Fig. 10A A schematic cross-sectional view of a wrist is shown according to an exemplary embodiment.

[0023] Fig. 10B A schematic cross-sectional view of a wrist is shown according to an exemplary embodiment.

[0024] Fig.11 A top view schematically illustrating the shape of the actuation element along the wrist is shown.

[0025] Fig. 12A A schematic cross-sectional view of a wrist of a surgical instrument is shown according to an exemplary embodiment.

[0026] Fig. 12B A schematic cross-sectional view of a wrist of a surgical instrument is shown according to an exemplary embodiment.

[0027] Fig.13 A top view schematically illustrating the shape of the actuation element along the wrist is shown.

[0028] Fig.14A A schematic cross-sectional view of a wrist of a surgical instrument is shown according to an exemplary embodiment.

[0029] Fig. 14B A schematic cross-sectional view of a wrist of a surgical instrument is shown according to an exemplary embodiment.

[0030] Fig. 14C A schematic cross-sectional view of a wrist of a surgical instrument is shown according to an exemplary embodiment.

[0031] Fig.14D A schematic cross-sectional view of a wrist of a surgical instrument is shown according to an exemplary embodiment.

[0032] Fig.15 A top view schematically illustrating the shape of the actuation element along the wrist is shown.

[0033] Fig.16A A schematic cross-sectional view of a wrist of a surgical instrument is shown according to an exemplary embodiment.

[0034] Fig. 16B A schematic cross-sectional view of a wrist of a surgical instrument is shown according to an exemplary embodiment.

[0035] Fig. 16C A schematic cross-sectional view of a wrist of a surgical instrument is shown according to an exemplary embodiment.

[0036] Fig.16D A schematic cross-sectional view of a wrist of a surgical instrument is shown according to an exemplary embodiment.

[0037] Fig.17 A top view schematically illustrating the shape of the actuation element along the wrist is shown.

[0038] Fig.18 A perspective view of a distal end portion of a surgical instrument shaft is shown according to an exemplary embodiment.

[0039] Fig.19 A schematic perspective view of an actuating element support and a push / pull actuating element according to an exemplary embodiment is shown.

[0040] Fig. 20 A side view of an end effector in a closed configuration is shown according to an exemplary embodiment.

[0041] Fig.21 Shows Fig. 20 The end effector in an open configuration.

[0042] Fig. 22 An end view of an end face of an actuating element support is shown according to an exemplary embodiment.

[0043] Fig.23 An end view of an end face of an actuating element support is shown according to an exemplary embodiment.

[0044] Fig.24 is a perspective view of components of a distal portion of a surgical instrument according to an exemplary embodiment.

[0045] Fig.25 is along Fig.24Cross-sectional view taken along midline 25-25.

[0046] Fig.26 is an exploded view of an actuating element support according to an exemplary embodiment.

[0047] Fig. 27 is a schematic perspective view of an actuating element support according to an exemplary embodiment.

[0048] Fig.28 is a side view of an exemplary embodiment of an actuation element including a rigid section.

[0049] Fig.29 yes Fig.28 A magnified view of a portion of the.

[0050] Fig.30 A cross-sectional side view of an actuating element support and an actuating element according to an exemplary embodiment is shown.

[0051] Fig.31 is a partial perspective view of an exemplary embodiment of a flexible shaft.

[0052] Fig.32 is a perspective end view of an actuation support member including a plurality of coaxial flexible tubes and an actuation member according to an illustrative embodiment.

[0053] Fig.33 is a perspective view of a projection of a distorted shape and an angular range of the distorted shape according to an exemplary embodiment. DETAILED DESCRIPTION

[0054] This specification and the accompanying drawings showing exemplary embodiments should not be considered as restrictive. Various mechanical changes, combination changes, structural changes, electrical changes, and operational changes can be realized without departing from the scope of this specification and claims, including equivalents. In some cases, well-known structures and technologies are not shown or described in detail, so as not to make the disclosure vague. The same numerals represent the same or similar elements in two or more figures. In addition, the elements and related features thereof (whenever they are practical) described in detail with reference to an embodiment can be included in other embodiments, in which they are not clearly shown or described. For example, if an element is described in detail with reference to an embodiment and is not described in detail with reference to a second embodiment, the element can still be claimed to be included in the second embodiment.

[0055] For purposes of this specification and the appended claims, unless otherwise indicated, all numbers expressing quantities, percentages or ratios, and other numerical values ​​used in the specification and claims should be understood as being modified in all cases by the term "about", to the extent that they have not been so modified. Therefore, unless otherwise indicated, the numerical parameters set forth in the following specification and the appended claims are approximate values ​​that may vary depending on the desired properties to be obtained. Without limiting the application of the doctrine of equivalents to the scope of protection of the present claims, each numerical parameter should be interpreted at least in accordance with the reported significant figures and by ordinary practice of the surrounding technology.

[0056] It should be noted that, as used in this specification and the appended claims, the singular forms "a", "an", and "the", as well as any singular use of any term, include plural referents unless expressly and unambiguously limited to one referent. As used herein, the term "include" and its grammatical variations are intended to be non-limiting, such that recitation of items in a list does not exclude other like items that can be substituted or added to the listed items.

[0057] In addition, the terms of this specification are not intended to limit the present disclosure or claims. For example, spatially relative terms-such as "below", "below", "lower", "above", "upper", "proximal end", "distal end", etc. can be used to illustrate the relationship between an element or feature and another element or feature, as shown in the figure. In addition to the positions and orientations shown in the figures, these spatial relationship terms are also intended to include different positions (i.e., locations) and orientations (i.e., rotational arrangements) of the device in use or in operation. For example, if the device in the figure is flipped, the elements described as "below" or "below" other elements or features will be "above" or "on" other elements or features. Therefore, the exemplary term "below" can include two positions and orientations, above and below. The device can be oriented in other ways (rotated 90 degrees or in other orientations), and the spatially related descriptors used here have been explained accordingly.

[0058] According to different exemplary embodiments, the present disclosure contemplates a surgical instrument for a teleoperated surgical system, the surgical instrument using an actuating element, wherein at least a portion of the actuating element is arranged along a twisted path. The actuating element can be used to actuate an end effector, to articulate a wrist, or to actuate another component of an instrument. In addition, exemplary embodiments can be applied to any actuating element offset from a central longitudinal axis (neutral axis) of a surgical instrument. According to exemplary embodiments, the twisted path can have an angular range of less than 360 degrees along the entire length of the wrist relative to the centerline of the wrist. According to exemplary embodiments, at least a portion of the actuating element can be arranged along a twisted path so that the length of the actuating element is conserved at each joint of the wrist when the wrist is actuated or bent. By conserving the length of the actuating element, changes in the length of the actuating element can be minimized or eliminated, and changes in the length of the actuating element may interfere with the actuating function of the actuating element, which may occur during the bending process of the wrist. According to an exemplary embodiment, the actuation element may be arranged along a twisted path such that the length of the actuation element is conserved at a separate joint of the wrist and not conserved at another separate joint of the wrist, wherein the entire twisted path of the actuation element is a length conserving structure.

[0059] The present disclosure further contemplates an actuator support. The actuator support can be used to shape at least a portion of the actuator into a desired shape, such as conserving the length of the actuator along a twisted path, and / or increasing the buckling strength of the actuator. According to an exemplary embodiment, the actuator support can be a single-piece component comprising at least one lumen, wherein at least a portion of the lumen has a twisted shape. According to an exemplary embodiment, the actuator support can include at least one rigid portion. According to an exemplary embodiment, the actuator support can include, for example, a plurality of coaxial tubes. According to an exemplary embodiment, the actuator support can include a tube with one or more material weakness areas (such as cut grooves) to provide flexibility to the support. According to an exemplary embodiment, the actuator support can include a hollow structure, such as a flexible shaft, which is beneficial for push-pull motion. The flexible shaft can be, for example, a coil spring connected to a filament. According to another exemplary embodiment, the flexible shaft can include multiple layers of wound filaments connected together.

[0060] Go to Figure 1 , shows an example of a teleoperated surgical system 100 that can employ surgical instruments according to embodiments described herein. The system 100 includes a patient side cart 102 having a plurality of surgical instruments 140, each mounted in a docking port of an arm 110, and can be obtained, for example, from Intuitive Surgical, Inc. Surgical system. The instruments 140 may be interchangeable so that the instruments 140 mounted on the arm 110 may be selected for a specific medical procedure or replaced during a medical procedure to provide a desired clinical function. As is well known in the art, the surgical instruments 140 may perform many functions including, but not limited to, for example, forceps or graspers, needle drivers, scalpels, scissors, cautery tools, and staplers.

[0061] Each instrument 140 generally includes a transmission mechanism or backend mechanism 150, a main shaft 160 extending from the transmission mechanism 150, an optional wrist (not shown) at the distal end of the main shaft 160, and a wrist portion 160 extending from the main shaft 160. Figure 1 ), and an end effector 180 extending from the wrist or directly from the shaft 160. For example, Figure 8 An exemplary embodiment of a distal end of a surgical instrument is shown that includes, among other things, a shaft 251, a wrist 250 at the distal end of the shaft 251, and an end effector 252 extending from the wrist 250. An actuating element 254 (e.g., such as a tendon or rod) can extend through the shaft 251 to the wrist 250 and / or to the end effector 252. As is familiar to those of ordinary skill in the art, the actuating element can be configured as a pull / pull or a push / pull actuating element. Exemplary embodiments of pull / pull and push / pull actuating devices are described in U.S. Patent No. 8,545,515, issued on October 1, 2013, which is incorporated herein by reference in its entirety. Thus, the actuating element 254 can be used to actuate the wrist 250 and / or the end effector 252. Therefore, with reference to Figure 1 , the actuating elements can extend from a transmission mechanism 150, which can be connected to the patient-side manipulator 112. The transmission mechanism 150 generally provides a mechanical coupling of these actuating elements to a drive motor in the patient-side cart 102. For example, the transmission mechanism 150 can be configured to be connected to the patient-side manipulator 112 of the arm 110 of the patient-side cart 102. As a result, the patient-side manipulator 112 and the transmission mechanism 150 can be used to apply force to the actuating elements 254 to actuate the wrist 250 and / or the end effector 252. In addition, reference is made herein to Figure 8 , electrical conductors (not in Figure 8 ) may also extend through shaft 251 and wrist 250 to end effector 252.

[0062] The system 100 can thus control motion and force along these actuation elements as needed to move or position the wrist and operate the end effector 180. The arm 110 of the patient side cart 102 can be used to insert the end of a surgical instrument 140 through a cannula in a small incision in a patient undergoing a medical procedure and to manipulate the wrist of the instrument 140 and / or the end effector 180 at a working site within the patient's body.

[0063] The camera instrument 104 may similarly be mounted on an arm of the cart 102 and optionally also have a wrist that the system 100 operates to position the distal end of the camera system 104 to view the working site within the patient and the operation of the surgical instrument 140. The views from the camera system 104 may be viewed at a console (not shown) and the images may be displayed on a display 106, which views may be stereoscopic or three-dimensional. The processing system of the system 100 may thus provide a user interface that enables a physician or other medical personnel to see and operate the camera system 104 and the instrument 140. For example, as with the surgical instrument 140, the arm 110 may be used to insert the distal end of the camera instrument 104 through a cannula in a small incision in a patient undergoing a medical procedure and to operate the wrist and / or end effector 180 at the working site within the patient.

[0064] The diameter or diameters of the spindle 160, wrist and end effector 180 of the surgical instrument 140 and the diameter of the imaging device 104 are generally selected based on the size of the cannula used with the instrument. In an exemplary embodiment, the diameter of the imaging device 104 and the diameter of the wrist and spindle 160 can range from about 3 mm to about 13 mm. For example, the diameter can be about 4 mm, about 5 mm, about 8 mm, about 10 mm, or about 13 mm to match the size of some existing cannula systems.

[0065] As in Figure 1As shown in the schematic view of FIG. 1 , the teleoperated surgical system 100 may further include a physician console 120 and an auxiliary control / vision cart 130. Generally speaking, the physician console 120 receives input from a user (e.g., a physician) through various different input devices, including but not limited to a gripping mechanism 122 and a foot pedal 124, and serves as a master controller to which the instruments 140 mounted on the patient side cart 102 respond to implement the desired movement of the (multiple) surgical instruments 102 and thereby perform the desired surgical procedure. For example, but not limited to, the gripping mechanisms 122 may serve as a "master" device that may control the surgical instruments 140 and / or the camera instruments 104, which may serve as corresponding "secondary" devices at the arm 110. For example, the gripping mechanism 122 may control the end effector 180 and / or wrist of the surgical instrument 140, as is familiar to those of ordinary skill in the art. In addition, but not limited to, the foot pedals 124 may be depressed to provide, for example, monopolar or bipolar electrosurgical energy, or to activate various other functions of the instruments 140 (e.g., suction, irrigation, and / or various other flow delivery modes). In other words, based on commands provided to an input device at, for example, the physician console 120, the patient side cart 102 may position and actuate the instruments 140, 104 to perform a desired medical procedure via the patient side operators 112 located at the arms 110. Thus, the instruments 140, 104 of the patient side cart 102 may be remotely controlled based on commands input by a user at the physician console 120. The physician console 120 may further include a display to allow the surgeon to observe a three-dimensional image of the surgical site during a surgical procedure, for example, via a camera device 104 at the patient side cart 102, for example.

[0066] In multiple non-limiting exemplary embodiments of a teleoperated surgical system, the control / vision cart 130 includes a “core” processing device (e.g., a core processor 134) and / or other auxiliary processing devices that may be incorporated into or physically supported on the control / vision cart 130. The control / vision cart 130 may also include other control devices for operating the surgical system. In an exemplary embodiment, the (multiple) signals or inputs transmitted from the physician console 120 may be transmitted to one or more processors at the control / vision cart 130, which interpret the (multiple) inputs and generate (multiple) instructions or outputs to be transmitted to the patient side cart 102 to cause manipulation of one or more of the surgical instruments 140, 104 and / or arms 110, which are coupled to these arms at the patient side cart 102. It should be noted that Figure 1The system components in are not shown in any particular orientation and may be arranged as desired, with the patient side cart 102 being positioned relative to the patient so as to effect a surgical procedure on the patient.

[0067] The surgical instrument may have one or more degrees of freedom, thereby allowing the instrument to bend in one or more directions. For example, the wrist may provide articulation to allow bending in one or more directions, such as in any pitch direction and yaw direction, which are substantially orthogonal to each other. The instrument may include other joints that allow bending, such as the mortise and tenon joints described in U.S. Patent No. 7,942,868 published on May 17, 2011 and U.S. Application Publication No. US2008 / 0065105 published on March 13, 2008, both of which are incorporated herein by reference in their entirety. Elements passing through the bending portion of the instrument, including actuating elements (e.g., reinforcing bars or rods) and cables (such as used to actuate the wrist or end effector), may also bend.

[0068] When these actuating elements pass through a curved portion of a surgical instrument, the curve can affect the actuating elements. Figure 2 , shows a schematic perspective view of a single flexible member 200 that can bend like a joint. A first actuating element 202 and a second actuating element 204 extend through the member 200, such as along a longitudinal axis 208 of the member 200. Figure 2 In an exemplary embodiment of the present invention, wherein the member 200 is in a straight (neutral) configuration, the bending axis 206 passes through each of the first actuation element 202 and the second actuation element 204. Figure 3 As shown in FIG. 2 , when the member 200 bends about the bending axis 206, the first and second actuation elements 202, 204 also bend. Since the axis 206 passes through both actuation elements 202, 204, there is no relative change in length between the first actuation element 202 and the second actuation element 204. In other words, one of the actuation elements 202, 204 does not become much longer or shorter than the other.

[0069] Go to again Figure 2 , the second bending axis 207 of the component 200 passes between the first actuating element 202 and the second actuating element 204. As a result, when the component 200 is Figure 4When the bending member 200 is bent about the bending axis 207 in the manner shown in , the first actuating element 202 is stretched relative to its neutral position, thereby causing a positive length change thereof, while the second actuating element 204 is compressed relative to its neutral position, thereby causing a negative length change thereof. Therefore, the bending member 200 can cause a relative length change of the actuating elements 202, 204 relative to the bending axis 207, wherein one of the actuating elements becomes longer than the other. Such relative length changes may interfere with the function of the actuating elements, such as actuating an end effector. For example, when the actuating elements 202, 204 are used to open or close an end effector by applying tension or compression to the actuating elements 202, 204, the relative length change between the actuating elements 202, 204 may produce slack in one of the actuating elements 202, 204, thereby weakening the ability of the actuating element to transmit the desired tension or compression and cause the desired actuation of the end effector.

[0070] In view of these considerations, it may be desirable to design a joint for a surgical instrument such that the bending axis of the joint extends through the actuating element. For example, a single actuating element may be provided to actuate an end effector, wherein the single actuating element extends along the center of the surgical instrument. In such a configuration, substantially mutually orthogonal bending axes, such as to provide two bending degrees of freedom for the surgical instrument, may pass through the center of the instrument and the actuating element. As a result, the length of the actuating element does not substantially change when the surgical instrument is bent about either bending axis. However, while this approach is useful when a single actuating element is sufficient to control the end effector, the surgical instrument may include multiple actuating elements to actuate multiple different components of the instrument or to actuate an end effector or wrist that requires more than one actuating element.

[0071] Figure 5 An example of a surgical instrument 220 is shown, which includes a plurality of actuating elements. In different exemplary embodiments, the surgical instrument 220 can be according to the exemplary embodiments described in U.S. Application Publication No. US2012 / 0215220, published on August 23, 2012, U.S. Application Publication No. US2012 / 0310254, published on December 6, 2012, and U.S. Application Publication No. US2012 / 0310221, published on December 6, 2012, which are incorporated herein by reference in their entirety. As shown, the surgical instrument 220 includes a first component actuating element 222 extending along a centerline 221 of the surgical instrument 220. The first actuating element 222 can be configured to actuate a cutting blade 227 or other component, for example, by pushing or pulling the cutting blade along the centerline 221.

[0072] Because the first actuating element 222 is positioned along the centerline 221, the pitch and yaw bending axes 228, 229 of the instrument 220 both pass through the first actuating element 222. As a result, the first actuating element 222 does not substantially experience a change in length when the surgical instrument 220 is bent relative to the axis 228 or the axis 229. The surgical instrument 220 also includes other actuating elements, such as second and third end effector actuating elements 224, 226 to actuate, for example, an end effector (not shown) of the instrument 220. The end effector can be, for example, a forceps or grasper, a needle driver, a scalpel, scissors, a cauterizing tool, a stapler, or other types of end effectors used in the art, such as a claw-shaped end effector. According to an exemplary embodiment, the actuating elements 224, 226 can be pull / pull actuating elements that open and close the end effector by releasing one of the actuating elements 224, 226 and pulling the other of the actuating elements 224, 226, as is familiar to those of ordinary skill in the art. The surgical instrument 220 may include additional lumens 223, 225 for other components, such as, for example, additional actuation elements or flow conduits, such as conduits that provide electrosurgical energy or other flow supplies to the end effector.

[0073] Because of the presence of the first actuation element 222, the actuation elements 224, 226 cannot be positioned along the centerline 221 and the axis 228 does not pass through the actuation elements 224, 226. Therefore, when the surgical instrument 220 is bent relative to the axis 228, length changes may occur between the actuation elements 224, 226. Due to these changes in the length of the actuation elements 224, 226 during bending, the instrument 220 requires greater mechanical complexity to separate the actuation elements 224, 226 from each other in order to actuate the end effector.

[0074] In view of these considerations, the present disclosure contemplates surgical instruments having one or more actuating elements that exhibit substantially no overall change in length during bending, even when the position of the actuating element is offset from the bending axis. When the overall change in the length of the actuating element is minimized during bending, the mechanical complexity of the instrument including the actuating element can be reduced. In addition, by manufacturing an actuating element whose overall length does not change significantly due to bending (in other words, conserving the length of the actuating element), the actuating element can be decoupled from the movement of the joint through which the actuating element extends. In other words, despite the articulation of such joint(s), bending of the actuating element does not result in undesired or accidental actuation of the end effector.

[0075] One method to minimize or prevent an overall change in length of an actuating element due to bending is to arrange the actuating element along a tortuous path as the actuating element passes through a bend in a surgical instrument. For example, the actuating element can be arranged along a tortuous path having an angular range of 360° for each axis of bending through which the actuating element passes, to substantially minimize or prevent a change in the overall length of the actuating element (i.e., to conserve the length of the actuating element).

[0076] Go to Figure 6 , which shows a schematic diagram of an exemplary embodiment of a wrist 230 of a surgical instrument, the wrist including a first actuation element 232 and a second actuation element 234. The wrist 230 may include a joint (not shown). Figure 6 ) to cause the wrist 230 to bend about a bending axis 236 (which extends into and out of Figure 6 The wrist 230 bends about the bending axis 236, thereby causing the actuating elements 232, 234 to move in a Figure 6 238 experiences a positive change in length and a negative change in length below the longitudinal axis 238. Because the actuating elements 232, 234 are arranged along a twisted path having an angular range of 360° about the axis 238 extending through the wrist 230, the actuating elements 232, 234 do not experience substantially any change in length due to bending the wrist 230 about the axis 238. For example, while the portion of the actuating element 232 in zone 231 experiences a positive change in length, the portion of the actuating element 232 in zone 233 experiences a negative change in length that effectively cancels out the positive change in length from zone 231. Similarly, the negative change in length of the actuating element 232 in zone 235 is canceled out by the positive change in length of the actuating element 232 in zone 237. A similar cancellation of length changes occurs between zones 231 , 233 , 235 , 237 for actuating element 234 , but in an opposite manner, since actuating element 234 is positioned opposite actuating element 232 about axis 238 .

[0077] Go to Figure 7 , shows a schematic diagram of another exemplary embodiment of a wrist 240, which includes a first actuation element 242 and a second actuation element 244, wherein the wrist 240 is bent about a bending axis 246. Figure 6 Similar to the exemplary embodiment in FIG. 1 , wrist 240 may include a joint (not shown in FIG. 1 ). Figure 7 ) to cause the wrist 240 to bend about the bending axis 246. Figure 7 In an exemplary embodiment of the present invention, at the end of the regions 245, 547 of the wrist 240, the actuating elements 242, 244 are positioned along the neutral axis 248, rather than being offset from the neutral axis, as in Figure 6240 . However, the actuating elements 242, 244 are arranged along a twisted path and are offset from the longitudinal axis 248 in zones 241 and 243. Because the actuating elements 242, 244 are arranged along a twisted path having an angular range of 360° as they pass through the wrist 240, the overall length of the actuating elements 242, 244 does not substantially change. For example, while the portion of the actuating element 242 in zone 241 experiences a positive change in length, the portion of the actuating element 242 in zone 243 experiences a negative change in length that offsets the positive change in length. The actuating element 244 experiences a similar offset of length change, but in the opposite manner. The portions of the actuating elements 242, 244 in zones 245, 247 do not experience any significant length change relative to each other along the longitudinal axis 248.

[0078] As above relative to Figure 6 and Figure 7 As described in the exemplary embodiment of the present invention, the actuating elements offset from the central longitudinal axis (neutral axis) of the surgical instrument can be arranged along a twisting path having an angular range of 360° with respect to the bending axis of the surgical instrument. However, the surgical instrument may include several bending axes. For example, the wrist of the surgical instrument may include one or more multi-DOF (degrees of freedom) joints and thus include multiple bending axes. For example, if Figure 6 If the wrist 230 of the exemplary embodiment includes multiple bending axes 236 extending in substantially the same direction, the actuating elements 232, 234 can be arranged along a twisted path having an angular range of 360° while passing through two bending axes rather than just one bending axis.

[0079] According to another exemplary embodiment, including in one direction (such as in Figure 6 The plurality of first bending axes extending in the bending axis direction 236 of the embodiment of the present invention and the plurality of first bending axes extending in another direction (such as Figure 6 In one embodiment, the plurality of actuating elements may be arranged along a twisted path having an angular range of 360° on the first plurality of bending axes and along a twisted path having an angular range of 360° on the second plurality of bending axes, with the plurality of actuating elements extending substantially perpendicular to the bending axis 236. However, twisting the actuating elements along the twisted path to cause minimal or no change in length for each bending axis (e.g., when the bending axes extend in different or alternative directions) may cause increased friction between the twisted actuating elements and the surface supporting and / or guiding the actuating elements into the twisted shape. The friction between the actuating elements and their supporting surface may be given by the capstan equation T 负载 =T 保持 e μΦ To represent, where T 保持is the tension applied to the actuating element, μ is the coefficient of friction between the actuating element and the supporting surface, Φ is the total angle swept by the twist of the actuating element, and T 负载 is the force between the actuating element and the supporting surface. Twisting the actuating element by a large angle Φ thus creates a large T between the actuating element and the supporting surface(s) 负载 Thus, when the joints have multiple bending axes extending in different or alternative directions, twisting the actuating element 360 degrees for each joint may create manufacturing difficulties, particularly with respect to the relatively short length and small diameter of the wrist of the surgical instrument. In view of these considerations, the present disclosure contemplates surgical instruments that include one or more joints that conserve the length of one or more actuating elements when bent (i.e., the overall length of the actuating elements does not change significantly when bent) while also minimizing the amount of twisting to achieve length conservation.

[0080] Different exemplary embodiments for providing conservation of lengths of multiple actuating elements are contemplated by the present disclosure and are discussed in further detail below with respect to articulated structures of surgical instruments. Different articulated structures may use multiple actuating element configurations that follow a twisted path. For example, these articulated structures may be used in a wrist, for example, a wrist configured with exemplary embodiments like those of U.S. Provisional Application No. 61 / 943,068, entitled “Mechanical Wrist Joints with Enhanced Range of Motion, and Related Devices and Methods,” published on February 21, 2014, under attorney docket number ISRG04480PROV / US, and International PTC Application No. PCT / US15 / xxxxxx (ISRG04480 / PCT), filed concurrently with and claiming priority to U.S. Provisional Application No. 61 / 943,068, each of which is hereby incorporated by reference in its entirety. In other examples, these articulated structures may be used in mortise and tenon joints, such as those described in U.S. Patent No. 7,942,868, published on May 17, 2011, and U.S. Publication No. US2008 / 0065105, published on March 13, 2008.

[0081] Another type of connector that can be utilized by exemplary embodiments of the present disclosure is in Figure 8 As noted above, Figure 8A wrist 250 is shown connected to an end effector 252. According to an exemplary embodiment, the end effector 252 may include, for example, a U-shaped hook 253 and a claw member 255. According to an exemplary embodiment, the wrist 250 includes a first link 256 and a second link 258 connected to the end effector 252, wherein a joint 270 connects the first link 256 to the end effector 252 and a joint 269 connects the second link 258 to the first link 256. The links in the various exemplary embodiments described herein may be configured as disks, as is familiar to those of ordinary skill in the art. However, other shapes may be used without departing from the scope of the present disclosure and claims. In an exemplary embodiment, the end effector 252 is directly connected to the first link 256 via a joint 270, and at least a portion of the end effector 252 is part of the wrist 250.

[0082] According to another exemplary embodiment, the wrist may include three links instead of two links. For example, instead of connecting the links 256 to the U-shaped hook 253 to provide a joint 270 between the links 256 and the U-shaped hook 253, as in Figure 8 As shown in the exemplary embodiment of , a third link may be provided between the link 256 and the U-shaped hook 253, wherein a joint 270 is formed between the link 256 and the third link and the link is attached to the U-shaped hook.

[0083] The first connecting rod 256 and the U-shaped hook 253 can be rotated in a direction 261 around an axis 260 (the axis extends in and out Figure 8 260 , 262 can be substantially orthogonal to each other so as to provide two degrees of freedom for the wrist 250, such as movement in arbitrarily selected pitch and yaw directions. Since the wrist 250 has two degrees of freedom to move in different directions, the wrist 250 can be described as an "AB" wrist, which refers to the two different motions provided by the joints 269 , 270 of the wrist 250.

[0084] The exemplary embodiments described herein can be used with wrists other than "AB" type wrists. For example, a wrist can include multiple joints of the same bending axis type, which can provide a greater range of motion for the wrist. Fig. 9, shows an exemplary embodiment of a wrist 280 that includes links 281-285. Links 281 and 282 are connected so that they can articulate relative to each other about axis 290 in direction 291. Links 284 and 285 are connected to each other in substantially the same manner as links 281 and 282, wherein links 284 and 285 articulate relative to each other about axis 296 in direction 297. Thus, joint 300 between links 281 and 282 and joint 306 between links 284 and 285 are of the same type and can be referred to as "A" joints. Links 282 and 283 are connected so that they can articulate relative to each other about axis 292 (which extends into and out of the direction 293). Fig. 9 Axes 290, 292 may be substantially orthogonal to each other to provide wrist 280 with two degrees of freedom, such as movement in either pitch and yaw directions (or A and B). Additionally, links 283 and 284 are connected to each other in substantially the same manner as links 282 and 283, wherein links 283 and 284 are articulated relative to each other in direction 295 about axis 294 (which extends into and out of the wrist). Fig. 9 The joint 302 between the links 282 and 283 and the joint 304 between the links 283 and 284 are of the same type and may be referred to as "B" joints. Thus, the wrist 280 may be referred to as an "ABBA" wrist, which refers to the order of the bending axis types of the joints along the wrist 280.

[0085] In another example, the wrist can have an "ABAB" configuration. Such a configuration, for example, can include two "AB" joints, such as Figure 8 The tandem links 256, 258 of the exemplary embodiment enable two "AB" joints to be directly connected to each other in an "ABAB" configuration.

[0086] Due to the small size of the wrist of the surgical instrument and the various complex components of the wrist, which can have different movements in different directions, different problems arise when passing the actuating element through the wrist, including determining how to pass the actuating element through the wrist to minimize the amount of extension of the actuating element when it passes through the wrist in a twisted shape, while maintaining the length of the actuating element substantially conserved when the wrist is bent. Various exemplary embodiments herein consider a wrist of a surgical instrument in which one or more actuating elements extend along a twisted path that has an angular range of less than 360° along the entire length of the wrist. Among other things, these designs consider, for example, the angular range traversed by the twisted path of the actuating element along the entire length of the wrist, the angular range traversed by the twisted path of the actuating element along a separate bending axis, the angular range traversed by the actuating element and the friction generated between the actuating element and the support surface(s) (i.e., minimizing the angular range minimizes the amount of friction to be overcome, as per Capstan's equation, when a force is applied to actuate the actuating element), and the initial angle of the actuating element relative to the bending axis.

[0087] Go to Fig. 10A and Fig. 10B , showing a schematic cross-sectional view of two joints 1000A and 1000B of the wrist. According to an exemplary embodiment, the structure of the wrist can be Figure 8 The wrist 250 of the exemplary embodiment of is similar. For example, in Fig. 10A and Fig. 10B The cross-section of the joints 1000A and 1000B may be along Figure 8 1000A and 1000B, but modified to illustrate the amount of distortion of the actuating elements 316A, 316B as they extend at each joint 1000A and 1000B. The actuating elements 316A, 316B may be used, for example, to actuate an end effector (e.g., Figure 8 The end effector 252 of the exemplary embodiment of the present invention may be used to actuate another component of the instrument, such as a wrist, for example. According to an exemplary embodiment, the actuation elements 316A, 316B may follow a twisted path so that actuation of the actuation elements 316A, 316B does not cause reverse motion, such as when the actuation elements 316A, 316B are used to actuate the wrist.

[0088] exist Fig. 10A and Fig. 10B The cross sections in FIG. 1 and FIG. 2 respectively represent two different joints 1000A and 1000B of the wrist, wherein the cross section of the joint 1000A represents a joint having a bending axis 312 (eg, Figure 8 269 ​​in the exemplary embodiment of the present invention) and the cross-section of the joint 1000B shows a joint having a bending axis 322 (such as Figure 8270 in an exemplary embodiment of the present invention).

[0089] The actuating elements of the various exemplary embodiments described herein can be substantially length-conserving. Thus, while in some cases the actuating element may have zero length change when the joint(s) through which the actuating element extends (e.g., one or more joints of a wrist) is actuated, in some cases the actuating element may experience a small amount of length change. According to exemplary embodiments, a substantially length-conserving actuating element may experience, for example, a length change of less than about 0.010 inches, including no length change, such as when a tension of 10 pounds or less is applied to the actuating element.

[0090] The angular range of the wrist of the actuating element 316A, 316B can be selected to conserve the length of the actuating element 316A, 316B on the wrist. For example, the actuating element 316A, 316B can have a 90° twist for each joint 1000A, 1000B of the wrist, such as in Fig. 10A and Fig. 10B . In other words, the actuating elements 316A, 316B can have an angular range of 90° relative to the centerline 318 of each joint 1000A, 1000B. For example, the actuating element 316A can be arranged along a twisted path on the joint 1000A, which has an angular range of about 90° from the initial position 311 to the subsequent position 313. In addition, the actuating element 316A can be twisted 90° from the initial position 315 (corresponding to the subsequent position 313 in the cross section of the joint 1000A) to the subsequent position 317 when passing through the joint 1000B.

[0091] In order to observe the distortion of the actuator, Fig.11 A schematic top view of a wrist 310 is shown, which includes Fig. 10A and Fig. 10B , wherein only the actuating elements 316A along the length of the joints 1000A, 1000B of the wrist 310 are shown in order to illustrate the shape of the actuating elements 316A of the different joints along the wrist 310. Fig.11 , wrist 310 is schematically segmented into joint 1000A and joint 1000B to illustrate the amount of twisting of actuating element 316A along each joint 1000A and 1000B. According to an exemplary embodiment, joint 1000A may have a length 326 and joint 1000B may have a length 328, which are Figure 8 The exemplary embodiment is schematically shown for the purpose of illustrating the amount of distortion of the joints 1000A and 1000B. Figure 8In an exemplary embodiment, joint 1000A may correspond to, for example, joint 269 , wherein the twist of joint 1000A is substantially centered at joint 269 and extends substantially equal amounts on either side of joint 269 .

[0092] Similarly, refer to Figure 8 In an exemplary embodiment of the present invention, joint 1000B may correspond to, for example, joint 260, wherein the twist of joint 1000B is substantially centered at joint 270 and extends substantially equal amounts on either side of joint 270. Fig.11 As shown in FIG. 1 , actuation element 316A may be twisted from initial position 311 to subsequent position 313 along joint 1000A and from initial position 315 to subsequent position 317 along joint 1000B. According to an exemplary embodiment, when actuation element 316A is twisted along joints 1000A and 1000B, the twisting of the actuation element may be substantially continuous, such as in FIG. Fig.11 The use of a substantially continuous twist can advantageously minimize the amount of friction between the actuation element and the support structure because the twist can occur over a longer longitudinal length of the wrist.

[0093] However, the distortion of the actuating element is not limited to Fig.11 316A, 316B. For example, the actuating element may be twisted into segments having different amounts of twist along the length of the actuating element. In other cases, the actuating element may instead follow a discontinuous twisting path including twisted portions separated by one or more regions in which the actuating element extends straight and substantially parallel to the neutral axis of the wrist. In such discontinuous twisting embodiments, the twisting of the actuating elements 316A, 316B may still follow a continuous twisting path due to the inclusion of one or more straight, non-twisted portions of the actuating elements 316A, 316B. Fig. 10A and Fig. 10B (i.e., 90°), but in Fig.11 The shorter span of the lengths 326, 328 of the joints 1000A and 1000B.

[0094] As in Fig. 10A and Fig. 10BAs best shown in FIG. 1 , the actuating element 316A is twisted 90° about a neutral axis 318 for each of the joints 1000A and 1000B (i.e., a twisted shape having an angular range of 90° relative to the centerline 318 of each joint 1000A and 1000B). According to an exemplary embodiment, the neutral axis 318 can be the longitudinal centerline of the wrist 310. Further, according to an exemplary embodiment, the axis 318 can be the longitudinal centerline of the wrist 310 and the centerline of the twisted path that the actuating elements 316A, 316B follow. The actuating element 316A can be radially separated from the neutral axis 318 by a distance 329, such as in FIG. Fig. 10B The actuating element 316B is also separated from the neutral axis by a radial distance 329, as shown in FIG. Fig. 10B 1000B. The radial distance 329 can vary depending on the diameter of the wrist 310. When the actuating element does not extend along the neutral axis 318 (e.g., is spaced apart from the neutral axis 318 by a non-zero radial distance), the radial distance 329 can be, for example, greater than about 0 mm to about 10 mm. According to another exemplary embodiment, the radial distance 329 can be, for example, greater than about 0 mm to about 6 mm. According to an exemplary embodiment, the radial distance 329 can be maximized so that the actuating elements 316A, 316B are spaced apart at or near the periphery of the joints 1000A and 1000B, so as to maximize the internal space within the wrist 310. According to another exemplary embodiment, the radial distance 329 can be minimized so that the actuating elements 316A, 316B are spaced apart near the neutral axis 318, such as when the actuating elements 316A, 316B and / or the guide lumens of the actuating elements 316A, 316B are difficult to bend.

[0095] Similar to actuating element 316A, actuating element 316B may also be twisted 90° (i.e., having an angular range of 90° along a twisted path about centerline 318) from an initial position 321 to a subsequent position 323 in the joint represented by cross section 1000A, as shown in FIG. Fig. 10A and Fig.11 In addition, the actuating element 316B can be twisted 90° from an initial position 325 in the joint represented by the cross-section 1000B (coinciding with a subsequent position 323 in the cross-section 1000B) to a subsequent position 327, as shown in FIG. Fig. 10B and Fig.11Thus, each of the actuation elements 316A, 316B may have a total of 180° of twist over the entire length of the wrist 310 (i.e., an angular range of 180° about the centerline 318 along the twist path) so that the length of the actuation elements 316A, 316B is conserved over the wrist 310. This results in an overall twist of each actuation element 316A, 316B that is substantially less than a 360° twist.

[0096] For example, when considering the twisting of the actuating element 316A about the centerline 318, such as when the neutral axis 318 is the origin of the polar coordinate axis system, the actuating element 316A twists 180° over the entire length of the wrist 310 from the initial position 311 in the joint 1000A to the subsequent position 317 in the joint 1000B. Fig.33 This is further illustrated in the exemplary embodiment of FIG. , which depicts a twisted path 900. As shown in FIG. Fig.33 As shown in the exemplary embodiment of FIG. 9 , the twisted path 900 extends from a first end 902 to a second end 906 in a twisted shape about a longitudinal axis 908 (i.e., a centerline 908). To illustrate the angular range of the twisted path 900, the twisted path 900 can be projected into an arc 910 having a radius of curvature 913 on a plane 901, wherein points on the arc 910 correspond to locations on the twisted path 900. For example, a point 912 on the arc 910 can correspond to the first end 902 on the twisted path 900, and a point 914 on the arc 910 can correspond to the point 904 approximately halfway along the length of the twisted path 900.

[0097] Although the twist path 900 Fig.21 9, but the twisted path 900 (and therefore the arc 910) may include segments with different curvatures and / or may also include one or more straight segments. Therefore, when a twisted path is discussed herein in this exemplary embodiment, the twisted path may twist a substantially continuous radius of curvature or may include segments with different radii of curvature, including curved segments and / or straight segments with different radii of curvature.

[0098] As in Fig.33 As shown in , the angular range 920 between point 912 and point 914 on arc 910 relative to centerline 908 (which centerline can also be mapped onto plane 901) is approximately 180°. Therefore, when the angular range of the twisted path is discussed herein in this exemplary embodiment, the angular range can be determined based on the angular range 920 relative to centerline 908, as shown in Fig.33In addition, since the twisted path 900 completes a full 360° twist from the first end 902 to the second end 906, the point 912 on the arc 910 corresponds to both the first end 902 and the second end 906, wherein the angular range 922 between the first end 902 and the second end 906 is 360°. Fig.33 In the exemplary illustration of , arc 910 forms a complete circle. However, in other embodiments where the twisted path does not complete a 360° twist, arc 910 will not complete a circle because the angular range of the twisted path is less than 360°.

[0099] In Fig. 10A , 10B and Fig.11 Twisting the actuating elements 316A, 316B in the manner shown in FIG. 310 may allow the actuating elements 316A, 316B to be conserved in length with respect to the wrist 310. Additionally, according to an exemplary embodiment, the range of angles of twist of the actuating elements 316A, 316B may be selected to conserve the length of the actuating elements 316A, 316B for each joint 1000A and 1000B. For example, for the joint 1000A, approximately half of each of the actuating elements 316A, 316B is on the left side of the bending axis 312, and approximately half of each of the actuating elements 316A, 316B is on the right side of the bending axis 312, as in FIG. Fig. 10A As shown in the schematic depiction of an exemplary embodiment of . As a result, any positive or negative change in length of the portion of the actuating elements 316A, 316B to the left of the bending axis 312 is offset by any positive or negative change in length of the actuating elements 316A, 316B to the right of the bending axis 312. Therefore, there is essentially no net change in the actuating elements 316A, 316B, such that the length of each of the actuating elements 316A, 316B is conserved as it passes through the joint 1000A. Similarly, for the joint 1000B, approximately half of each of these actuating elements 316A, 316B is on the upper and lower sides of the bending axis 322, as shown in Fig. 10B As shown in the schematic depiction of the exemplary embodiment in , any change in length of the upper side of the actuating elements 316A, 316B relative to the bending axis 322 is substantially offset by any change in length of the lower side of the actuating elements 316A, 316B relative to the bending axis 322. Therefore, there is substantially no net change in the actuating elements 316A, 316B, so that the length of the actuating elements 316A, 316B is conserved when passing through the joint 1000B.

[0100] The amount of twisting of the actuating member through the joint can also be schematically represented by the average angular position of the actuating member over the length of the joint. For example, the average angular position 314 of the actuating element 316A relative to the neutral axis along the length 326 of the joint 1000A is Fig. 10A In other words, when the actuator element 316A is twisted 90° while passing through the length 326 of the joint 1000A, such as when the neutral axis 318 is taken as the origin in the polar coordinate system, the average angular position 314 of the actuator element 316A can be determined. When the average angular position 314 of the actuator element 316A passing through the length 326 of the joint 1000A is aligned with the bending axis 312 of the joint 1000A, such as when the neutral axis 318 is taken as the origin in the polar coordinate system, the average angular position 314 of the actuator element 316A can be determined. Fig. 10A This indicates that for joint 1000A, the length of actuating element 316A is conserved. Actuating element 316A has an average angular position 324 when passing through length 328 of joint 1000B, which is also aligned with bending axis 322, as shown in Fig. 10B Additionally, because actuation element 316B is positioned opposite actuation element 316A and substantially mirrors the twist of actuation element 316A, the average angular position of actuation element 316B as it passes through joints 1000A and 1000B can be considered to be the same as the average angular positions 314 and 324 of actuation element 316A.

[0101] As noted above, various exemplary embodiments take into account the initial angle of the actuating element to the bending axis. When the actuating element enters the joint, the initial angle can be considered to be the initial angle of the actuating element to the bending axis. Fig. 10A As shown in the exemplary embodiment of FIG. 1 , the actuating element 316A at its initial position 311 can have an initial angle 319 with the bending axis 312 in the joint 1000A. According to an exemplary embodiment, the initial angle 319 can be approximately 45°, particularly when the actuating element is twisted 90° along the length 326 of the joint 1000A, so that substantially equal amounts of the actuating element can be located on either side of the bending axis 312, such as in FIG. Fig. 10A . As the actuation element 316B may be positioned opposite the actuation element 316A on the neutral axis 318, the initial position 323 of the actuation element 316B in the joint 1000A may be at approximately the same angle 319, e.g., approximately 45°, relative to the bending axis 312. In the joint 1000B, the initial positions 315, 325 of the actuation elements 316A, 316B may be at an angle with respect to the bending axis 322 that is approximately the same as the angle 319 in the joint 1000A.

[0102] However, other initial angles may also be utilized, such as when a smaller or larger amount of angular range (twist) is used on a known joint. For example, the initial position 311 of the actuating element 316A may be at an angle of approximately 50° relative to the bending axis 312. In such an example, the amount of twist of the actuating element 316A along the joint 1000A may be approximately 100°, such that substantially equal amounts of the actuating element 316A may be positioned on either side of the bending axis 312 and the length of the actuating element 316A is conserved as it passes through the joint 1000A. According to an exemplary embodiment, other values ​​of the initial angle 319 are contemplated herein, such as, for example, approximately 40° to approximately 60°.

[0103] In addition to reference Fig. 10A , Fig. 10B and Fig.11 In addition to those shown and discussed in the exemplary embodiment of FIG. , other initial positions in the twisted configuration of the actuating element are contemplated according to various exemplary embodiments of the present disclosure. Fig. 12A , a schematic cross-sectional view of a joint of an exemplary embodiment of a wrist is shown. Fig. 12A The connector 1200A depicted in the exemplary embodiment of the present invention may be a connector having a plurality of Fig. 10A 1200A, except that the initial position of the actuating elements 330A, 330B in the joint 1200A is aligned with the bending axis 322A. The actuating elements 330A, 330B can be used, for example, to actuate an end effector (such as Figure 8 The end effector 252 of the exemplary embodiment of the present invention may be used to actuate another component of the instrument, such as a wrist, for example. According to an exemplary embodiment, the actuating elements 330A, 330B may follow a twisted path so that actuation of the actuating elements 330A, 330B does not result in reverse motion, such as when the actuating elements 330A, 330B are used to actuate the wrist.

[0104] As in Fig. 12A and in Fig.13 , which is a schematic top view of a wrist 320, which includes Fig. 12A and Fig. 12B 1200A, but only the wrist of the actuating element 330A is shown, and the actuating element 330A has no twisting along the length 336 of the joint 1200A relative to the longitudinal neutral axis 337. Fig.11 As discussed, axis 337 may be the centerline of wrist 320 and may further be the centerline of the tortuous path of actuating elements 330A, 330B. Fig.131200B) is aligned with the bending axis 332A (i.e., the bending axis 332A passes through the actuating elements 330A, 330B). As a result, the actuating elements 330A, 330B are already length-conserving in the joint 1200A and no twisting is required in that joint. However, in the joint 1200B, the corresponding initial positions 331A, 335A of the actuating elements 330A, 330B are offset from the bending axis 332B. For example, the initial positions 331A, 335A of the actuating elements 330A, 330B can be offset by approximately 90° from the bending axis 332B in the joint 1200B.

[0105] In order to achieve conservation of length of the actuating elements 330A, 330B as they pass through the joint 1200B, the actuating elements 330A, 330B may be twisted over an angular range of 180° to respective subsequent positions 331B, 335B (i.e., following a twisted path along an angular range of 180° about the centerline 337). As a result, substantially equal amounts of each of the actuating elements 330A, 330B are on either side of the bending axis 332B of the joint 1200B (i.e., Fig. 12B This is also achieved by the actuating elements 330A, 330B at the joint 1200B (at the top and bottom sides of the cross section of the joint 1200B). Fig.13 330B) is demonstrated by an average angular position 339 over a length 338 of the wrist 320 (schematically shown in FIG. 1 ), which average angular position is aligned with the bending axis 332B (i.e., the bending axis 332B passes through the average angular position 339 of the actuating elements 330A, 330B). Thus, the actuating elements 330A, 330B can follow a twisting path that has an angular range of 180° over the length of the wrist 320, similar to Fig. 10A , Fig. 10B and Fig.11 1200A) and all the twisting occurs over the length of the other joint (e.g., joint 1200B). In addition, the actuation elements 330A, 330B can be twisted in such a manner that each of the actuation elements 330A, 330B is conserved in length as it passes through each joint 1200A and 1200B.

[0106] The wrist can be configured to include any number of joints, each with a bending axis in a different direction. Some non-limiting examples contemplated within the scope of the present disclosure include a wrist having FIG. 10A to FIG. 13 One or more of the wrists 310 and / or 320 of the exemplary embodiment of the present invention, wherein the length of the actuating element is substantially conserved over the total length of the wrist. For example, the wrist may include two consecutive wrist devices, each of which is based on FIG. 10A to FIG. 13Such a wrist may include, for example, a first A joint, a first B joint, a second A joint, and a second B joint in order (i.e., the wrist may be an ABAB-type wrist). In order to achieve conservation of length of the actuating elements as they extend through the length of the wrist, the actuating elements may extend along a twisted path having an angular range of 360° over the length of the wrist, the angular range being FIG. 10A to FIG. 13 Conversely, a wrist comprising two consecutive wrist devices (e.g., an ABAB-type wrist) can be simplified to a wrist comprising a single wrist, such as FIG. 10A to FIG. 13 The wrist 310 and / or 320 of the exemplary embodiment (eg, AB type wrist) of FIG. 1 is a wrist having a plurality of AABB-type wrists. Similarly, the AABB-type wrist can be simplified to the AB wrist.

[0107] Different bending axis models of the wrist and twisting configurations of the actuating element are contemplated according to different exemplary embodiments of the present disclosure. Although the wrist configuration may include only a joint with two axes, such as in Figure 8 and FIG. 10A to FIG. 13 , but other wrist configurations may be used, such as Fig. 9 An exemplary embodiment of an ABBA wrist.

[0108] According to an exemplary embodiment, go to FIG. 14A to FIG. 14D , shows a cross-sectional view of the joints of a wrist, which includes four joints 1400A1, 1400B1, 1400B2, 1400A2. For example, the wrist can be configured according to Fig. 9 An exemplary embodiment of the ABBA wrist is constructed, and FIG. 14A to FIG. 14D The corresponding cross-sectional views A1, B1, B2, and A2 in FIG. Fig. 9 The views are taken along the lines A1-A1, B1-B1, B2-B2, and A1-A2. Therefore, FIG. 14A to FIG. 14D The cross sections of the joints 1400A1, 1400B1, 1400B2, 1400A2 are shown in Fig.15 340, wherein the joint 1400A1 has a bending axis 344 and a length 364 (in Fig.15 ), the joint 1400B1 has a bending axis 346 and a length 365 (in Fig.15 ), the joint 1400B2 has a bending axis 352 and a length 366 (in Fig.15 ), and the joint 1400A2 has a bending axis 354 and a length 367 (in Fig.15 In addition, the wrist 340 has a longitudinal neutral axis 348, as shown in FIG. 14A to FIG. 14D and Fig.15 . Axis 348 can be the centerline of wrist 340 and can further be the centerline of the twisted path of actuating elements 342, 350. Actuating elements 342, 350 can be used, for example, to actuate an end effector or to actuate another component of the instrument, such as a wrist, for example. According to an exemplary embodiment, actuating elements 342, 350 can follow a twisted path so that actuation of actuating elements 342, 350 does not result in reverse motion (e.g., Fig. 9 In one embodiment, the joints 300 and 306 in the joints 1400A1, 1400B1, 1400B2, 1400A2 do not bend in different directions about the axes 290 and 296 and the joints 302 and 304 do not bend in different directions about the axes 292 and 294), such as when the actuation elements 342, 350 are used to actuate the wrist. According to an exemplary embodiment, the twisting of the actuation elements 342, 350 of each of the joints 1400A1, 1400B1, 1400B2, 1400A2 can be centered about the respective bending axis 344, 346, 352, 354, wherein the twisting path extends by substantially the same amount on either side of the respective bending axis 344, 346, 352, 354.

[0109] The angular range of distortion of the actuating elements 342, 350 extending through the wrist 340 is such that the length of the actuating elements 342, 350 is conserved over the length of the wrist 340. In the joint 1400A1, both the actuating elements 342, 350 are aligned with the bending axis 344 (i.e., the bending axis 344 passes through the actuating elements 342, 350) and therefore have an average angular position 356 over the length 364 of the joint 1400A1 that is aligned with the bending axis 344. Therefore, both the actuating elements 342, 350 do not substantially vary over the length of the joint 1400A1 and do not twist in the joint. In the joint 1400B1, the actuating element 342 has an initial position 341 when it enters from the joint 1400A1 that is at an angle 349 of approximately 90° to the bending axis 346. The actuating element 350 also has an initial position 351 when it enters from the joint A1 , which is at an angle of approximately 90° to the bending axis 346 .

[0110] exist Fig. 14B In an exemplary embodiment of the present invention, the actuating elements 342, 350 can be twisted 90° in the joint 1400B1 (i.e., follow a twisting path having an angular range of 90° about the centerline 348) to reach the corresponding subsequent positions 343, 353, thereby providing the actuating elements 342, 350 with an average angular position 358 over the length 365 of the joint 1400B1. Fig. 14BIn the exemplary embodiment shown in FIG. 1400B2, the average angular position 358 is not aligned with the bending axis 346, thereby causing a positive or negative length change of the actuating elements 342, 350 in the joint 14000B1. In the joint 1400B2, the actuating element 342 has an initial position 345 at an angle 359 of 90° relative to the bending axis 352 after it enters from the joint 1400B1, and the actuating element 350 has an initial position 355 at 90° to the bending axis 352, as shown in FIG. Fig. 14C The actuating elements 342, 350 are twisted 90° in the joint 1400B2 (i.e., follow a twisted path having an angular range of 90° about the centerline 348) to provide an average angular position 360 over the length 366 of the joint 1400B2, thereby causing a positive or negative length change of each of the actuating elements 342, 350 in the joint 1400B2.

[0111] However, the distortion of the actuating elements 342, 350 in the joints 1400B1, 1400B2 is on opposite sides of the bending axes 346, 352, as indicated by the average angular positions 358, 360 over the respective lengths 365, 366 of the joints 1400B1, 1400B2, and the length changes of the actuating elements 342, 350 substantially cancel each other. In addition, the actuating elements 342, 350 are aligned with the bending axis 354 in the joint 1400A2 (i.e., the bending axis 354 passes through the actuating elements 342, 350), as indicated by the average angular position 362 of the actuating elements 342, 350 over the length 367 of the joint 1400A2. As a result, the entire length of the actuating elements 342, 350 through the wrist 340 (i.e., through each 90° twist in the joints 1400B1, 1400B2) is twisted 180° (i.e., the twist path has an angular range of 180° about the centerline 348). In addition, because the twisting of the actuating elements 342, 350 relative to the bending axes 346, 352 of the joints 1400B1, 1400B2 is on opposite sides of the bending axes 346, 352, the actuating elements 342, 350 do not experience a substantial length change in the joints 1400A1, 1400A2, and any positive or negative length change of the actuating elements 342, 350 in the joint B1 is offset by a corresponding negative or positive length change of the actuating elements 342, 350 in the joint 1400B2, and vice versa. Thus, each actuating element 342 , 350 is conserved in length over the entire length of the wrist 340 .

[0112] Other configurations of wrists having more than two joints are contemplated by this disclosure. FIG. 16A to FIG. 16D , shows a schematic cross-sectional view of the joints 1600A1, 1600B1, 1600B2, 1600A2 of the wrist. The wrist 370 can be, for example, based on Fig. 9 The exemplary embodiment is constructed and FIG. 16A to FIG. 16D The cross-sectional view of the joints 1600A1, 1600B1, 1600B2, 1600A2 in FIG. 1 may be along Fig. 9 Views of an exemplary embodiment of an ABBA wrist taken along lines A1-A1, B1-B1, B2-B2, and A2-A2.

[0113] According to an exemplary embodiment, the joint 1600A1 has a bending axis 391 and a length 400 (in Fig.17 Schematically shown in an exemplary embodiment of FIG, which shows the entire wrist 370 and includes FIG. 16A to FIG. 16D ), the joint 1600B1 has a bending axis 392 and a length 402 (in Fig.17 ), the joint 1600B2 has a bending axis 393 and a length 404 (in Fig.17 Schematically shown), the joint 1600A2 has a bending axis 394 and a length 406 (in Fig.17 In addition, the wrist 370 may include a longitudinal neutral axis 390 extending through the joints 1600A1, 1600B1, 1600B2, 1600A2, as shown in Figures 16A to 16D and Fig.17 . Axis 390 can be the centerline of wrist 370 and can also be the centerline of the twisted path of actuating elements 372, 380. Actuating elements 372, 380 can be used, for example, to actuate an end effector or to actuate another component of the instrument, such as a wrist, for example. According to an exemplary embodiment, actuating elements 372, 380 can follow a twisted path so that actuation of actuating elements 372, 380 does not result in reverse motion (e.g., Fig. 9 The joints 300 and 306 do not bend in different directions about the axes 290 and 296 and the joints 302 and 304 do not bend in different directions about the axes 292 and 294), such as when the actuation elements 372, 380 are used to actuate the wrist.

[0114] exist FIG. 16A to FIG. 16D and Fig.17In an exemplary embodiment of the present invention, the actuating elements 372, 380 may initially be offset and not aligned with the bending axis 391 in the joint 1600A1. For example, the actuating elements 372, 380 may initially be at an angle 395 of approximately 30° to the bending axis 391. To address this issue, the actuating elements 372, 380 may be twisted (i.e., follow a twisting path having an angular range of 60° about the centerline 390) 60° along the length 400 of the joint 1600A1 from the respective initial positions 371, 381 to the subsequent positions 373, 383 such that the length of the actuating elements 372, 380 in the joint 1600A1 is conserved. As a result, the average angular position 396 of the actuating elements 372, 380 over the length 400 of the joint 1600A1 is aligned with the bending axis 391 (the bending axis 391 passes through the average angular position 396 of the actuating elements 372, 380).

[0115] Similarly, the actuating elements 372, 380 can be twisted 60° from the corresponding initial positions 374, 384 in the joint 1600B1 (i.e., following a twisting path having an angular range of 60° around the centerline 390) to subsequent positions 375, 385; twisted 60° from the corresponding initial positions 376, 386 in the joint 1600B2 (i.e., following a twisting path having an angular range of 60° around the centerline 390) to subsequent positions 377, 387; and twisted 60° from the corresponding initial positions 378, 388 in the joint 1600A2 (i.e., following a twisting path having an angular range of 60° around the centerline 390) to subsequent positions 379, 389. Similar to joint A1, the average angular position 399 of the actuating elements 372, 380 over the length 406 of the joint 1600A2 is aligned with the bending axis 394, so that the actuating elements 372, 380 are substantially conserved in length over the joint 1600A2. The actuating elements 372, 380 are not conserved in length over the lengths 402, 404 of each joint 1600B1, 1600B2. However, when the sum of the combined lengths 402 and 404 of the joints 1600B1 and 1600B2 is considered, the actuating elements 372, 380 are substantially conserved in length over the combination of the joints 1600B1 and 1600B2. This is indicated by the average angular position 397 of the actuating elements 372, 380 over the length 402 of the joint 1600B1 and the average angular position 398 of the actuating elements 372, 380 over the length 404 of the joint 1600B2, which are on opposite sides of their respective bending axes 393 and 393. Thus, the actuating elements 372, 380 can be twisted a total amount of 240° (i.e., have a twisting path having an angular range of 240° about the centerline 390) over the entire length of the wrist 370 (i.e., 60° over each length of the joints 1600A1, 1600B1, 1600B2, 1600A2).

[0116] In order to extend the actuating element along the twisted path, as described in the exemplary embodiments above, various exemplary embodiments contemplate one or more structures that guide the one or more actuating elements along the twisted path. The one or more structures can provide support to the actuating element along its length to minimize or reduce buckling of the actuating element as the actuating element extends along the twisted path according to the exemplary embodiments described herein, such as FIG. 10A to FIG. 17 An exemplary embodiment of .

[0117] Go to Fig.18 , showing the distal end portion of a surgical instrument, including a distal end portion located at an instrument shaft (such as Figure 8 The actuating element support 410 of the exemplary embodiment of the shaft 251) is disposed distally of the actuating element support 410. According to an exemplary embodiment, the first portion 411 of the actuating element support 410 may include tortuous passages 415, 416 that provide a tortuous path for the actuating elements 426, 428 extending through the passages 415, 416 of the first portion 411. The actuating elements 426, 428 may extend out of the proximal end 423 of the support 410 and extend to the second portion 413 of the actuating element support 410, which may include substantially straight passages 438, 439 through which the actuating elements 426, 428 may extend, as in Fig.18 Although for simplicity in the exemplary embodiment of Fig.18 Although only two channels 438, 439 are depicted in the exemplary embodiment of the present invention, the second portion 413 of the actuator support 410 may include the same number of channels as the first portion 411. According to an exemplary embodiment, the channels of the second portion 413 may be connected to the channels of the first portion 411 such that any actuator extending through the channels of the second portion 413 extends through a corresponding channel in the first portion 411.

[0118] According to an exemplary embodiment, the support 410 may further include a central channel 419 through which the actuating element 414 may extend. The central channel 419 may extend along the longitudinal centerline 421 of the instrument so that any member extending through the central channel 419 (such as the actuating element 414 or the flow conduit) does not experience a substantial length change when the support 410 is bent. According to an exemplary embodiment, the centerline 421 may also be the centerline of the support 410. The actuating element 414 may be used, for example, to actuate an end effector, such as, for example, a cutting blade. The actuating elements radially offset from the neutral axis or centerline of the various exemplary embodiments described herein are not limited to actuating the end effector or wrist, but may be used to actuate other instrument components. For example, the actuating elements radially offset from the neutral axis or centerline of the various exemplary embodiments described herein may actuate a second wrist at the distal end of the actuating element support 410, or other instrument components. In another example, the actuating element 414 may be used to actuate the end effector, while the actuating elements 426, 428 are used to actuate the wrist connected to the end effector. According to another example, the flow conduit may extend through the central passage 419 instead of the actuating element 414 .

[0119] One or more actuation elements may extend from the actuation element support 410 and be connected to a device for actuating a component of the instrument. Fig.19 As shown in the exemplary embodiment of , the actuator support 440 can include: a central lumen 442, such as for a flow conduit or actuator element 414 (which can further extend through the lumen 424 of the connector 420); multiple lumens 446 for actuator elements 426, 428; and two additional lumens 444, which can be used for other actuator elements or flow conduits. According to an exemplary embodiment, the actuator elements 426, 428 and the connector 420 can form a push / pull actuator element of the actuating end effector, such as when the actuator elements 426, 428 and the connector are pushed or pulled along direction 435. Go to Fig. 20 , shows a side view of the end effector 434 in a closed configuration, wherein the protrusion 422 of the connector 420 extends through the slot 437 of the end effector 404. When the actuating elements 426, 428, the connector 420 and the protrusion 422 are pushed in the direction 425, the protrusion 422 moves through the slot 437 and forces the end effector 434 into an open configuration, as shown in FIG. Fig. 20 and 21 As shown in .

[0120] Although the actuation elements 426, 428 can be used as push / pull actuation elements, the actuation elements 426, 428 can alternatively be used as pull / pull actuation elements. For example, the actuation elements 426, 428 can be attached to the proximal end 409 of the end effector 404 without using the connector 420, so that the end effector 404 can be opened by pulling one of the actuation elements 426, 428 and closed by pulling the other of the actuation elements 426, 428.

[0121] According to an exemplary embodiment, an actuator element support can be positioned in a surgical instrument such that the position of the support corresponds to the position of a wrist, as the wrist can bend, which may cause an actuator element extending through the wrist to change in length. Because the central channel 419 is positioned along the longitudinal centerline 421 of the instrument, the actuator elements 426, 428 and their corresponding channels 415, 416 are radially offset from the centerline 421. Therefore, when the wrist 430 is actuated to bend the instrument in order to position the end effector 434 in a desired position, the actuator elements 426, 428 may experience a change in length. However, the support 440 provides a tortuous path for the actuator elements 426, 428, as shown in accordance with FIG. 10A to FIG. 17 In the exemplary embodiment, the actuating elements 426, 428 do not experience a substantial length change over the length of the wrist 430.

[0122] Channels 415 and 416 are Fig.18 In the exemplary embodiment of the invention, the invention is twisted 180°, however other twist configurations may be used, such as in Figures 10A to 17 The actuator support 410 may include different numbers of channels to provide a tortuous path for one or more actuator elements. For example, the actuator support 410 may include one channel, two channels, three channels, or four or more channels. For example, the actuator support 410 may include a third channel 417 and a fourth channel 418, which may be used for additional actuator elements or for flow conduits 427, 429, such as wires for providing electrical energy to an end effector (not shown).

[0123] As in Fig.18As shown in the exemplary embodiment of , the actuator support 410 can have a solid one-piece structure, wherein the channels 415-418 are formed to pass through the length of the support 410. According to an exemplary embodiment, the actuator support 410 can be manufactured, for example, by extruding a polymer material into a substantially cylindrical shape, wherein the twisted channels 415-418 are formed to pass through the length of the polymer material. However, other manufacturing methods can be used to provide a support 410 having one or more twisted channels that are radially offset from the centerline 421 of the support 410 and twisted around the centerline. Therefore, the support 410 can guide one or more actuators along a twisted path and provide support for these actuators so as to minimize or eliminate the buckling of these actuators. For example, when the actuator is used as a push / pull actuator and the actuator is pushed, the support 410 can reduce or eliminate the buckling of the actuator.

[0124] In various exemplary embodiments, the support 410 can be flexible to cause the support 410 to bend when the wrist through which the support 410 extends is actuated. The support 410 can be made of, for example, a polymer material to provide a relatively low coefficient of friction. According to exemplary embodiments, the support 410 can be made of, for example, polyether block amide (PEBAX), fluorinated ethylene propylene (FEP), and other polymer materials with a relatively low coefficient of friction familiar to those skilled in the art. In addition, the actuating elements extending through the support 410 can be coated with a material to minimize the friction between the actuating elements and the support 410. For example, the actuating elements can be coated with polyester copolyamide (PTFE) or other lubricating materials familiar to those skilled in the art.

[0125] As in Fig.19 As shown in the exemplary embodiment of FIG. 4 , the actuator support 440 may include five lumens 442, 444, 446. However, the surgical instrument including the actuator support is not limited to only five components, but a greater or lesser number of lumens may be used in the instrument. For example, the actuator support 450 may include seven lumens 452, as shown in FIG. Fig. 22 In addition, the lumen of the actuator support need not be arranged as a single ring lumen around the central lumen, as in Fig. 22 Alternatively, the lumen 462 of the support member 460 may be arranged in the form of a plurality of concentric rings around a central lumen, as in Fig.23 As shown in the exemplary embodiment of FIG.

[0126] As above based Fig.18As discussed in the exemplary embodiments of the present invention, the actuator support can have a one-piece structure. For example, the support can be a single piece that is extruded. Such an extrusion can have a solid, substantially continuous, non-grooved outer surface. However, other configurations and structures can be used for the actuator support. For example, the actuator support can include one or more material weak areas to enhance the flexibility of the support. Fig.24 , shows an exemplary embodiment of an actuator support 710, wherein actuator elements 724, 726 extend through the support 710. To enhance the flexibility of the support 710, such as when the support 710 is bent by the wrist, the support 710 may include one or more material weak areas, such as grooves 712, such as in Fig.24 According to an exemplary embodiment, the support member 710 can be formed as an extrusion with lumens formed through the support member 710, similar to Fig.19 and then having grooves 712 cut into the extrusion to provide vertebrae 714 separated by these grooves 712. Fig.25 As shown in the figure, the figure is along Fig.24 In the cross-sectional view taken along line 25-25 in FIG. 1 , the support member 710 may include five lumens 711, 713, 715, 717, 719, similar to Fig.19 However, the support member 710 may include other numbers of lumens and may include Fig. 22 and Fig.23 According to an exemplary embodiment, the support member 710 may include other fragile areas in addition to the grooves. For example, the support member 710 may include a plurality of holes 730 that may be formed in the vertebral body 714 to provide additional fragile areas and enhance the flexibility of the support member 710.

[0127] According to an exemplary embodiment, the actuating element can be moved by Fig.18 , 24 and 25 are supported by components other than the one-piece structure and formed into a twisted path. Fig.26 , according to an exemplary embodiment, an exploded view of an actuation support 800 formed of a plurality of separate links 802-805 is shown. The links 802-805 may include one or more channels 810, 812 for an actuation element (not shown). Fig.26As shown in the exemplary embodiment of FIG. 8 , the links 802-805 can be rotated about the longitudinal axis 816 (i.e., the centerline) of the support 800 in a direction 818 to twist the actuating elements passing through the passages 810, 812. Thus, the passages 810, 812 of the links 802-805 can have different angular positions relative to the centerline 816 from one link to another. The links 802-805 can provide other twist amounts, such as in FIG. FIG. 10A to FIG. 17 However, the links 802-805 may include other numbers of lumens and may include Fig. 22 and Fig.23 The tubular cavity configuration in the exemplary embodiment of .

[0128] As in Fig.18 As shown in the exemplary embodiment of FIG. 4 , the lumens 415-418 of the actuator support 410 may be twisted in one direction from one end of the support 410 to the other end. However, the actuator support is not limited to such a twisted configuration and may alternatively include lumens that twist in more than one direction. Fig. 27 , shows an exemplary embodiment of an actuator element support 470 that includes a plurality of lumens 472, 474 that twist along the support 470 in direction 471 toward a first direction 476 and then reversely twist in direction 478. Additionally, the amount of twist may be constant along the length of the support or may vary, increasing or decreasing along the length of the support.

[0129] As discussed above, the actuator support can serve the dual purpose of guiding the actuator along a tortuous path and supporting the actuator to minimize or prevent the actuator from buckling. Other structures can be provided to enhance the support of the actuator and its buckling strength, which can be used in conjunction with the actuator support. Fig.28 , shows an exemplary embodiment of an actuation element 500 that includes a rigid section 510 distal to an unsupported section 502 of the actuation element 500. Fig.29 As shown in the figure, the Fig.28 504, the actuator element 500 may include a wire or cable 506 extending into the rigid section 510. The wire or cable 506 may be, for example, Fig.18 4. The rigid section 510 may include a rigid post 512 mounted on the wire or cable 506. The rigid post 512 may be made of, for example, steel (e.g., stainless steel). The rigid post 512 may be connected to the wire or cable 506 by, for example, crimping the post 512 onto the wire or cable 506.

[0130] According to an exemplary embodiment, the unsupported section 502 of the wire or cable 506 can include a coating 508. The coating 508 can be used, for example, to provide the wire or cable 506 with a smooth surface that has a lower coefficient of friction than the wire or cable 506. The coating 508 can be made of a polymer, such as a thermoplastic. According to an exemplary embodiment, the coating 508 can be made of, for example, PTFE, ethylene-tetrafluoroethylene (ETFE), silicone, or other coating materials familiar to those skilled in the art. According to an exemplary embodiment, the coating 508 can have a thickness that is substantially the same as the thickness of the post 512, such as in Fig.29 As shown in .

[0131] By providing the actuator 500 with the rigid section 510, the buckling strength of the actuator 500 can be enhanced. For example, when the actuator 500 is inserted through the actuator support 530 (e.g., Fig.18 The actuator support 410 of the exemplary embodiment of the present invention can push the actuator 500 in the direction 534, thereby causing the distal end of the actuator 500 to extend beyond the distal end 532 of the actuator support 530, as in Fig.30 Because the actuating element 500 includes the rigid section 510, the portion of the actuating element 500 that extends beyond the distal end 532 of the actuating element support 530 can have enhanced buckling strength. For example, the surgical instrument can be configured such that when the actuating element 500 is pushed in the direction 534, only the rigid section 510 of the actuating element 500 extends beyond the distal end 532 of the actuating element support 530, as in Fig.30 , in which the unsupported section 502 of the actuating element 500 remains within the actuating element 530 .

[0132] According to an exemplary embodiment, the proximal end of the actuation element 500 may also include a rigid section 520, such as at the proximal end of the actuation element, although other exemplary embodiments may lack a rigid section at the proximal end of the actuation element. Fig.28 The rigid section 520 at the proximal end can be configured according to Fig.29 According to an exemplary embodiment, the rigid section 520 can extend past the proximal end of the actuator support, such as when the actuator is pulled, similar to Fig.30 An exemplary embodiment of the invention is described in detail below.

[0133] Another structure that can be used to support the actuating element is a flexible shaft. Fig.31 , shows an exemplary embodiment of a flexible shaft 600, which includes a compression member 610 and a tension member 614. The flexible shaft 600 can be used to support an actuating element, wherein the flexible shaft 600 extends through at least a portion of the actuating element support, similar to Fig.30 610. The compression member 610 can have a central lumen 612 through which the actuating element passes. The compression member 610 can be, for example, a spring including a plurality of coils that compress against each other when a compressive force is applied along a longitudinal axis 616 of the flexible shaft 600. The tension member 614 can be a wire or cable attached to the compression member 610, such as on the exterior of the compression member 610, to resist tension applied along the axis 616 or bending forces applied to the flexible shaft 600. In other words, the flexible shaft 600 can be a combination of a compression member 610 that resists compression, which would otherwise compress the tension member 614 if the compression member 610 were not present, and a tension member 614 that resists extension and bending, which would otherwise pull the compression member 610 apart.

[0134] According to an exemplary embodiment, the actuator element support may include a plurality of flexible shaft layers. For example, the actuator element support may include a plurality of flexible shafts stacked on top of each other, such as by providing Fig.31 In the exemplary embodiment of the flexible shaft 600, multiple layers are arranged on top of each other. The different layers of these flexible shafts can be coaxial with each other. For example, as in Fig.32 As shown in the example embodiment of FIG. 1 , the actuator element support 1000 may include a first flexible tube 1002 and a second flexible tube 1004 that are coaxial with each other, wherein one or more actuator elements 1010 extend through the support 1000. Fig.32 Only two coaxial tubes 1002, 1004 are depicted in the exemplary embodiment of the support 1000, but the support 1000 may include other numbers of coaxial tubes, such as, for example, three, four or more flexible coaxial tubes. According to an exemplary embodiment, the flexible tubes 1002, 1004 may be flexible due to the removal of material from the tubes 1002, 1004, such as by cutting grooves or slits in the tubes 1002, 1004 to provide a weak area that allows the tubes 1002, 1004 to bend. According to an exemplary embodiment, the tubes 1002, 1004 may be solid coil springs (which are useful for compressive loads) with a coiled filament (which is useful for tensile loads).

[0135] According to another exemplary embodiment, the flexible shaft for supporting the actuation member may include multiple layers of coiled filaments connected together. Fig.31The compression member 610 of the exemplary embodiment of the present invention can include a plurality of tension members 614 connected together, such as by weaving the tension members 614 together. According to an exemplary embodiment, the actuator support can be a flexible shaft formed by a tube with multiple parts removed, wherein the multiple parts are removed, such as by cutting the tube at one or more locations, to enhance the flexibility of the tube. The tube can be made of, for example, stainless steel, thermoplastics, or other materials familiar to those skilled in the art.

[0136] The exemplary embodiments and methods described herein have been described for use with surgical instruments of a teleoperated surgical system. However, other surgical devices may use the exemplary embodiments described herein, such as laparoscopic instruments and other handheld instruments. In addition, these exemplary embodiments and methods may be employed in other applications using a remotely actuatable wrist or multi-joint structure to remotely position an object attached to the wrist or joint structure.

[0137] By providing a surgical instrument with an actuation element configured to substantially conserve its length when the surgical instrument is bent, the actuation element can be allowed to actuate components of the instrument without significantly interfering with its length change and the surgical instrument can have a simplified design that is relatively easy to manufacture.

[0138] In view of this disclosure, further modifications and alternative embodiments will become apparent to those of ordinary skill in the art. For example, these systems and methods may include additional components or steps that are omitted from these drawings and this specification for operational clarity. Therefore, this specification should be interpreted as being illustrative and for the purpose of teaching those skilled in the art the general method of implementing this tutorial. It should be understood that the different embodiments shown and described will be considered exemplary. Elements and materials and the arrangement of these elements and materials may replace those shown and described herein, parts and processes may be reversed, and certain features of this tutorial may be used independently, all of which will become apparent to those skilled in the art after having the benefit of the description herein. The elements described herein may be varied without departing from the spirit and scope of this tutorial and the following claims.

[0139] It is to be understood that the specific examples and embodiments set forth herein are non-limiting and that modifications in structure, dimensions, materials, and methods may be made without departing from the scope of the present teachings.

[0140] Other embodiments from the present disclosure will be apparent to those skilled in the art from consideration of the specification and practice of the disclosed invention.It is intended that the specification and examples be considered exemplary only, with the true scope and spirit being indicated by the following claims.

Claims

1. A surgical instrument, include: an articulatable wrist comprising a first joint and a second joint; an end effector coupled to the articulatable wrist; and an actuation element operably coupled to the end effector and disposed through the articulatable wrist, the actuating element follows a twisted path along at least a portion of the articulatable wrist, The length of the actuating element is conserved when passing through the combination of the first joint and the second joint, and The length of the actuating element is not conserved when the actuating element passes through the first joint or the second joint alone.

2. The surgical instrument according to claim 1, in: The surgical instrument also includes a shaft and a transmission mechanism; The shaft extends proximally from the articulatable wrist and includes a proximal portion; The transmission mechanism is located at the proximal portion of the shaft; and The transmission mechanism is configured to transmit a driving force along the actuating element.

3. The surgical instrument according to claim 2, in: The transmission mechanism is configured to transmit the driving force along the actuating element to actuate the end effector.

4. The surgical instrument according to claim 2, in: The transmission mechanism is configured to transmit the driving force along the actuating element to actuate the wrist.

5. The surgical instrument according to claim 1, in: defining a longitudinal centerline for said articulatable wrist; and The twist path twists about an axis that is radially offset from the longitudinal centerline of the articulatable wrist.

6. The surgical instrument according to claim 1, in: The first joint has a first bending axis, and the wrist is articulated about the first bending axis; The second joint has a second bending axis about which the wrist is articulatable; and The first bending axis and the second bending axis are orthogonal to each other.

7. The surgical instrument according to claim 1, in: The angular extent of the distorted path at the first joint is different from the angular extent of the distorted path at the second joint.

8. The surgical instrument according to claim 1, in: The wrist also includes a third joint; and The length of the actuating element is conserved when passing through the third joint.

9. The surgical instrument according to claim 1, in: The twisted path has a total angular extent of 180 degrees at the first joint and the second joint.

10. The surgical instrument according to claim 1, in: The twisted path has a total angular extent of 240 degrees at the first joint and the second joint.

11. The surgical instrument according to claim 1, in: defining a longitudinal centerline of said wrist; The twisted path extends along the first joint over a first angular range about a longitudinal centerline of the wrist; and The twist path extends along the second joint through a second angular range about the longitudinal centerline of the wrist.

12. The surgical instrument according to claim 11, in: The first angle range and the second angle range have sizes different from each other.

13. The surgical instrument according to claim 11, in: The first angle range and the second angle range are equal in size to each other.

14. The surgical instrument according to claim 11, in: The first angle range and the second angle range are equal in size to each other, and are twisted in opposite directions to each other.

15. The surgical instrument according to claim 14, in: The first angular range is twisted 90 degrees in a first direction; and The second angle range is twisted by 90 degrees in a second direction opposite to the first direction.

16. A surgical instrument, include: An articulatable wrist comprising a first joint and a second joint; an end effector coupled to the articulatable wrist; and an actuation element operably coupled to the end effector and disposed through the articulatable wrist; wherein the actuating element follows a twisted path along at least a portion of the articulatable wrist; wherein the entire length of the articulatable wrist is defined; and The twist path has an angular extent of 180 degrees along the entire length of the articulatable wrist.

17. The surgical instrument according to claim 16, in: The twisted path has an angular extent of 90 degrees along the first joint; and The twisted path has an angular extent of 90 degrees along the second joint.

18. The surgical instrument according to claim 17, in: The twisted path twists in a first direction along the first joint; and The twisted path twists at the second joint in a second direction opposite to the first direction.

19. The surgical instrument according to claim 16, in: The first joint has a first bending axis, and the wrist is articulated about the first bending axis; The second joint has a second bending axis about which the wrist is articulatable; and The tortuous path intersects the first bending axis and the second bending axis.

20. The surgical instrument according to claim 19, in: The first bending axis and the second bending axis are orthogonal to each other.

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