Robotic medical system with high-force instruments

Abstract

The present invention provides a robotic system, which may include a high-force instrument that amplifies an input force so that the output force is greater than the input force. The high-force instrument may include an end effector. The high-force instrument may also include a first pulley configured to rotate around a pulley axis and a first jaw member connected to the first pulley by a first drive pin. The high-force instrument may also include a second pulley configured to rotate around the pulley axis and a second jaw member connected to the second pulley by a second drive pin. The connector may provide a first pivot point and a second pivot point, the first jaw member being able to pivot around the first pivot point and the second jaw member being able to pivot around the second pivot point.

Description

[0001] Priority application

[0002] This application claims priority to U.S. Provisional Application No. 62 / 682,049, filed on June 7, 2018. Technical Field

[0003] The present application relates to robotic medical systems, and in particular, to robotic medical systems with high-force instruments. Background Art

[0004] Medical procedures such as laparoscopic surgery may involve accessing and visualizing the internal area of ​​a patient. During a laparoscopic procedure, a medical instrument may be inserted into the internal area through a laparoscopic portal.

[0005] In certain procedures, a robotic-enabled medical system may be used to control the insertion and / or manipulation of an instrument and its end effector. The robotic-enabled medical system may include a robotic arm or other instrument positioning device. The robotic-enabled medical system may also include a controller for controlling the instrument during the procedure. Summary of the invention

[0006] In a first aspect, a robotic system includes an instrument including an end effector. The instrument includes: a first pulley configured to rotate about a pulley axis; a first jaw member connected to the first pulley by a first drive pin; a second pulley configured to rotate about the pulley axis; a second jaw member connected to the second pulley by a second drive pin; and a connector providing a first pivot point and a second pivot point, the first jaw member being able to pivot about the first pivot point and the second jaw member being able to pivot about the second pivot point.

[0007] The robotic system may also include one or more of the following features in any combination: (a) a robotic arm coupled to the instrument; (b) wherein rotation of the first pulley causes rotation of the first drive pin about the pulley axis, thereby further causing the first jaw member to pivot about the first pivot point, and rotation of the second pulley causes rotation of the second drive pin about the pulley axis, thereby further causing the second jaw member to pivot about the second pivot point; and (c) a gear constraint configured to constrain movement of the first jaw member and the second jaw member so that movement of one of the first jaw member and the second jaw member causes substantially the same movement of the other of the first jaw member and the second jaw member. (d) wherein the gear constraint includes a cycloidal constraint including teeth formed on one of the first jaw member and the second jaw member and a notch formed on the other of the first jaw member and the second jaw member; (e) wherein the gear constraint includes a pin extending along an axis through the first jaw member and the second jaw member, wherein the pin is configured to ride within a slot formed in at least one of the first jaw member and the second jaw member; (f) a slot constraint configured to prevent or reduce the risk of the end effector rotating about the first drive pin and the second drive pin when the first drive pin and the second drive pin are aligned; (g) wherein the slot is approximately The beam portion includes: a first ear; a second ear, the second ear being spaced apart from the first ear to form a slot between the first ear and the second ear; and a pin extending along the pulley shaft and positioned in the slot; (h) wherein the first ear and the second ear are each coupled to a connector; (i) a gear constraint configured to constrain movement of the first jaw member and the second jaw member so that movement of one of the first jaw member and the second jaw member causes substantially corresponding movement of the other of the first jaw member and the second jaw member, and a slot constraint configured to prevent or reduce movement of the end actuator around the first drive pin and the second drive pin when the first drive pin and the second drive pin are aligned. risk of rotation of the second drive pin; (j) wherein the first pulley and the second pulley are capable of rotating to a position where the first drive pin and the second drive pin are aligned; (k) wherein, during rotation of the first pulley and the second pulley, the first drive pin is capable of rotating past the second drive pin; (l) wherein the connector includes a housing including a first bearing surface spaced apart from the second bearing surface, the first jaw member includes a first groove configured to pivot on the first bearing surface to form a first pivot point, and the second jaw member includes a second groove configured to pivot on the second bearing surface to form a second pivot point; (m) wherein the end effector is configured as a grasper, a cutter, or a clamp;(n) wherein the first link comprises a first distance between the pulley axis and the point at which an input force is applied by a cable wrapped around the first pulley, the second link comprises a second distance between the pulley axis and the axis of the first drive pin, the third link comprises a third distance between the axis of the first drive pin and the axis of the first pivot point, and the fourth link comprises a fourth distance between the axis of the first pivot point and the distal end of the first jaw member; (o) wherein the first distance of the first link is between 3 mm and 4 mm, the second distance of the second link is between 2 mm and 3 mm, the third distance of the third link is between 7 mm and 8 mm, and the fourth distance of the fourth link is between 17 mm and 23 mm; (p) wherein the first distance of the first link is approximately 3.35 mm, the second distance of the second link is approximately 2.5 mm, the third distance of the third link is approximately 1.8 mm, and the fourth distance of the fourth link is approximately 2.6 mm. The third distance of the third connector is about 7.3 mm, and the fourth distance of the fourth connector is about 20 mm; (q) wherein the first ratio between the second distance of the second connector and the first distance of the first connector is between 0.5 and 1.25, the second ratio between the third distance of the third connector and the first distance of the first connector is between 1.5 and 3.5, and the third ratio between the fourth distance of the fourth connector and the first distance of the first connector is between 1.5 and 20; and / or (r) wherein the first ratio between the second distance of the second connector and the first distance of the first connector is about 0.75, the second ratio between the third distance of the third connector and the first distance of the first connector is about 2.18, and the third ratio between the fourth distance of the fourth connector and the first distance of the first connector is about 6.;

[0008] In another aspect, a robotic system includes a medical device including an end effector configured to be inserted into a patient during a medical procedure. The medical device includes: a first pulley; a first jaw member connected to the first pulley; a second pulley; a second jaw member connected to the second pulley; a connector providing a first pivot point and a second pivot point, the first jaw member being pivotable about the first pivot point and the second jaw member being pivotable about the second pivot point; and at least one of a gear constraint and a slot constraint.

[0009] The robotic system may also include one or more of the following features in any combination: (a) wherein the end effector is connected to the robotic arm and is controlled by a processor of the system; (b) wherein the end effector and at least a portion of the medical device are configured to fit through a patient opening of less than 14 mm; (c) wherein the end effector and at least a portion of the medical device are configured to fit through a patient opening of less than 10 mm; (d) wherein the end effector and at least a portion of the medical device are configured to fit through a patient opening of less than 10 mm; (e) wherein the end effector is connected to the distal end of the medical device by a wrist having at least two degrees of freedom; (f) one or more cables connected to a first pulley, wherein pulling the one or more cables connected to the first pulley causes the first pulley to rotate; and one or more cables connected to a second pulley, wherein pulling the one or more cables connected to the second pulley causes the second pulley to rotate; (g) wherein the one or more cables connected to the first pulley and the one or more cables connected to the second pulley extend through the distal end of the medical device. (h) wherein the end actuator comprises a gear constraint, wherein the gear constraint comprises a cycloidal constraint, wherein the cycloidal constraint is configured to constrain the movement of the first jaw member and the second jaw member so that the movement of one of the first jaw member and the second jaw member causes substantially corresponding movement of the other of the first jaw member and the second jaw member; (i) wherein the gear constraint comprises teeth formed on one of the first jaw member and the second jaw member, and a notch formed on the other of the first jaw member and the second jaw member; (j) wherein the end actuator comprises a slot constraint, wherein the slot constraint is configured to prevent the end actuator from rotating around the first drive pin and the second drive pin when the first drive pin and the second drive pin are aligned; and / or (k) wherein the end actuator comprises a slot constraint and a gear constraint.

[0010] In another aspect, a method includes inserting a robotically controlled medical device into a patient. The device includes an end effector. The end effector includes: (i) a first jaw member coupled to a first pulley, (ii) a second jaw member coupled to a second pulley, (iii) a connector connecting the first jaw member and the second member, and (iv) at least one of a gear constraint and a slot constraint; and actuating the end effector based on pulling at least one cable connected to the first pulley or the second pulley to cause rotation of the first pulley or the second pulley, wherein the rotation of the first pulley or the second pulley opens or closes the first jaw member and the second jaw member of the end effector.

[0011] The method may also include one or more of the following features in any combination: (a) wherein actuating the end actuator includes causing rotation of a first pulley and a second pulley so that a first drive pin connecting the first pulley to the first jaw member overlaps with a second drive pin connecting the second pulley to the second drive member; (b) wherein the overlap of the first drive pin and the second drive pin increases force amplification at the end actuator; (c) wherein the end actuator includes a gear constraint, and wherein the gear constraint is configured to constrain movement of the first jaw member and the second jaw member so that movement of one of the first jaw member and the second jaw member is limited. (d) wherein the gear constraint comprises a cycloidal constraint comprising teeth formed on one of the first jaw member and the second jaw member, and a recess formed on the other of the first jaw member and the second jaw member; (e) wherein the end actuator comprises a slot constraint, wherein the slot constraint is configured to prevent the end actuator from rotating about the first drive pin and the second drive pin when the first drive pin and the second drive pin are aligned; and / or (f) wherein the end actuator comprises a slot constraint and a gear constraint. BRIEF DESCRIPTION OF THE DRAWINGS

[0012] The disclosed aspects will hereinafter be described in conjunction with the accompanying drawings, which are provided to illustrate and not to limit the disclosed aspects, wherein like reference numerals represent like elements.

[0013] Figure 1 An embodiment of a cart-based robotic system arranged for diagnostic and / or therapeutic bronchoscopy is shown.

[0014] Figure 2 Depicted Figure 1 Other aspects of the robotic system.

[0015] Figure 3 Shown is a ureteroscopy arrangement. Figure 1 Implementation scheme of a robotic system.

[0016] Figure 4 Shown is a vascular procedure arranged Figure 1 Implementation scheme of a robotic system.

[0017] Figure 5 An embodiment of a table-based robotic system arranged for use in a bronchoscopy procedure is shown.

[0018] Figure 6 Provided Figure 5 Alternative views of the robotic system.

[0019] Figure 7An exemplary system configured to stow a robotic arm is shown.

[0020] Figure 8 An embodiment of a table-based robotic system configured for use in a ureteroscopy procedure is shown.

[0021] Fig. 9 An embodiment of a table-based robotic system configured for laparoscopic procedures is shown.

[0022] Fig.10 Shows Figures 5 to 9 Embodiment of a stage-based robotic system with pitch and tilt adjustment.

[0023] Fig.11 Provided Figures 5 to 10 Detailed illustration of the interface between the stage and the column of the stage-based robotic system.

[0024] Fig.12 An exemplary instrument driver is shown.

[0025] Fig.13 An exemplary medical instrument having a pair of instrument drivers is shown.

[0026] Fig.14 An alternative design of an instrument drive and an instrument is shown, wherein the axis of the drive unit is parallel to the axis of the elongated shaft of the instrument.

[0027] Fig.15 A block diagram is shown according to an example embodiment, which shows an estimation Figures 1 to 10 The position of one or more elements of the robotic system (such as Fig.13 and Fig.14 A positioning system that determines the position of the device.

[0028] Fig.16A A side view of a high force instrument is shown.

[0029] Fig. 16B Shows Fig.16A Detailed view of the distal portion of a high-force instrument showing additional details of the wrist and end effector of the high-force instrument.

[0030] Fig.17A An embodiment of a high force instrument is shown in an open position.

[0031] Fig. 17B Shows Fig.17A High force instrument in closed position.

[0032] Fig.18A Another embodiment of a high force instrument is shown in an open position.

[0033] Fig.18B Shows Fig.18A High force instrument in closed position.

[0034] Fig.19A Another embodiment of a high force instrument is shown in an open position.

[0035] Fig.19B Shows Fig.19A High force instrument in closed position.

[0036] Fig. 20A , Fig. 20B , Fig. 20C and Fig.20D Views of components of various embodiments of a high force machine are shown, and also illustrate how the geometry may be varied to adjust the mechanical advantage of the high force machine.

[0037] Fig.21 A perspective view of an embodiment of a pulley with a pull wire wrapped around it is shown.

[0038] Fig.22A , Fig. 22B and Fig. 22C Views of embodiments of high-force instruments including a gear constraint configured as a pin-based cycloidal constraint are shown.

[0039] Fig.23 A view of another embodiment of a high force instrument including a gear constraint configured as a pin-based cycloidal constraint is shown.

[0040] FIG. 24A to FIG. 24H A view showing an embodiment of a high force instrument including two constraints is shown. Fig.24A is a front view of the device in the open position, Fig. 24B An exploded view of the device. Fig.24C A side view of the device. Fig.24D is a rear view of the device in the open position, and Fig.24E A cross-sectional view of the bottom of the device. Fig.24F , Figure 24G and Fig.24H The drive pins are shown crossing as the instrument moves from an open position to a closed position.

[0041] FIG. 25A to FIG. 25H Views of embodiments of high force instruments including two constraints and a one-piece connection are shown. Fig.25A and Fig.25B Views of the device are shown in an open configuration and a closed configuration, respectively. Fig.25C An embodiment of a housing used as a connector for an instrument is shown. Fig.25D A view of either the first jaw member or the second jaw member of the instrument is shown. Fig.25E , Fig.25F , Figure 25G and Fig.25H Stages during an exemplary assembly process of an instrument are shown.

[0042] Fig.26A and Fig.26B A schematic diagram showing how to determine the mechanical advantage of a high-force machine.

[0043] Fig. 27 is a graph depicting a force profile for one embodiment of a high force instrument. DETAILED DESCRIPTION

[0044] 1. Overview .

[0045] Aspects of the present disclosure may be integrated into a robotically enabled medical system that is capable of performing a variety of medical procedures, including both minimally invasive procedures such as laparoscopy, and non-invasive procedures such as endoscopy. Among endoscopy procedures, the system may be able to perform bronchoscopy, ureteroscopy, gastroscopy, etc.

[0046] In addition to performing a wide range of procedures, the system may provide additional benefits such as enhanced imaging and guidance to assist the physician. Additionally, the system may provide the physician with the ability to perform procedures from an ergonomic position without the need for awkward arm motions and positions. Additionally, the system may provide the physician with the ability to perform procedures with improved ease of use, such that one or more of the system's instruments may be controlled by a single user.

[0047] For illustrative purposes, various embodiments will be described below in conjunction with the accompanying drawings. It should be understood that many other embodiments of the disclosed concepts are possible, and various advantages can be achieved using the disclosed embodiments. Titles are included herein for reference and to help locate the various sections. These titles are not intended to limit the scope of the concepts described therein. Such concepts may have applicability throughout the specification.

[0048] A. Robotic System-Cart .

[0049] Robot-enabled medical systems can be configured in a variety of ways, depending on the specific procedure. Figure 1An embodiment of a cart-based, robotically enabled system 10 arranged for diagnostic and / or therapeutic bronchoscopy is shown. During bronchoscopy, the system 10 may include a cart 11 having one or more robotic arms 12 to deliver medical instruments such as a steerable endoscope 13 (which may be a procedure-specific bronchoscope for bronchoscopy) to a natural orifice entry point (i.e., the mouth of a patient positioned on a table in this example) to deliver the diagnostic and / or therapeutic tool. As shown, the cart 11 may be positioned near the patient's upper torso to provide access to the entry point. Similarly, the robotic arms 12 may be actuated to position the bronchoscope relative to the entry point. The robotic arms 12 may also be utilized when performing gastrointestinal (GI) procedures with a gastroscope (a specialized endoscope used for GI procedures). Figure 1 The arrangement in . Figure 2 An exemplary embodiment of a cart is depicted in greater detail.

[0050] Continue to refer Figure 1 , once the cart 11 is properly positioned, the robotic arm 12 can insert the steerable endoscope 13 into the patient's body robotically, manually, or in combination. As shown, the steerable endoscope 13 may include at least two telescopic parts, such as an inner guide portion and an outer sheath portion, each of which is coupled to a separate instrument driver from a set of instrument drivers 28, each of which is coupled to the distal end of a separate robotic arm. This linear arrangement of the instrument drivers 28 that facilitates coaxial alignment of the guide portion with the sheath portion produces a "virtual track" 29, which can be repositioned in space by manipulating one or more robotic arms 12 to different angles and / or orientations. The virtual tracks described herein are depicted using dashed lines in the accompanying drawings, and therefore the dashed lines do not depict any physical structure of the system. The translation of the instrument driver 28 along the virtual track 29 causes the inner guide portion to telescope relative to the outer sheath portion, or to advance or retract the endoscope 13 from the patient. The angle of the virtual track 29 can be adjusted, translated, and pivoted based on clinical applications or physician preferences. For example, in bronchoscopy, the angle and orientation of the virtual track 29 as shown represents a compromise between providing the physician with access to the endoscope 13 while minimizing the friction caused by bending the endoscope 13 into the patient's mouth.

[0051] After insertion, the endoscope 13 can be guided down the patient's trachea and lungs using precise commands from the robotic system until the target destination or surgical site is reached. To enhance navigation through the patient's pulmonary network and / or to reach the desired target, the endoscope 13 can be manipulated to telescopically extend the inner guide portion from the outer sheath portion to obtain enhanced articulation and a larger bending radius. The use of a separate instrument driver 28 also allows the guide portion and the sheath portion to be driven independently of each other.

[0052] For example, the endoscope 13 can be guided to deliver a biopsy needle to a target, such as a lesion or nodule in a patient's lung. The needle can be deployed downward along a working channel that extends the length of the endoscope to obtain a tissue sample to be analyzed by a pathologist. Depending on the pathological results, additional tools can be deployed downward along the working channel of the endoscope for additional biopsies. After identifying that the nodule is malignant, the endoscope 13 can deliver tools through the endoscope to remove potential cancerous tissue. In some cases, diagnostic and therapeutic treatments may need to be delivered in separate procedures. In these cases, the endoscope 13 can also be used to deliver a benchmark to "mark" the location of the target nodule. In other cases, diagnostic and therapeutic treatments can be delivered during the same procedure.

[0053] The system 10 may also include a movable tower 30 that may be connected to the cart 11 via a support cable to provide control, electronic, fluid, optical, sensor and / or power support to the cart 11. Placing such functionality in the tower 30 allows for a smaller form factor cart 11 that can be more easily adjusted and / or repositioned by the operating physician and his / her staff. Additionally, dividing functionality between the cart / table and the support tower 30 reduces operating room clutter and facilitates improved clinical workflow. While the cart 11 may be positioned close to the patient, the tower 30 may be stowed in a remote location to be out of the way during the procedure.

[0054] To support the robotic system described above, the tower 30 may include components of a computer-based control system that stores computer program instructions, for example, in a non-transitory computer-readable storage medium such as a permanent magnetic storage drive, a solid-state drive, or the like. Whether the execution occurs in the tower 30 or in the cart 11, the execution of these instructions can control the entire system or its subsystems. For example, when executed by a processor of a computer system, the instructions can cause the components of the robotic system to actuate the associated brackets and arm mounts, actuate the robotic arm, and control the medical device. For example, in response to receiving a control signal, a motor in a joint of the robotic arm can position the arm into a specific posture.

[0055] The tower 30 may also include pumps, flow meters, valve controllers, and / or fluid pathways to provide controlled irrigation and aspiration capabilities to systems that may be deployed through the endoscope 13. These components may also be controlled using the computer system of the tower 30. In some embodiments, irrigation and aspiration capabilities may be delivered directly to the endoscope 13 via separate cables.

[0056] The tower 30 may include voltage and surge protectors designed to provide filtered and protected power to the cart 11, thereby avoiding the need to place power transformers and other auxiliary power components in the cart 11, resulting in a smaller, more mobile cart 11.

[0057] The tower 30 may also include support equipment for sensors deployed throughout the robotic system 10. For example, the tower 30 may include optoelectronic equipment for detecting, receiving, and processing data received from optical sensors or cameras throughout the robotic system 10. In conjunction with the control system, such optoelectronic equipment may be used to generate real-time images for display in any number of consoles deployed throughout the system (including display in the tower 30). Similarly, the tower 30 may also include electronic subsystems for receiving and processing signals received from deployed electromagnetic (EM) sensors. The tower 30 may also be used to house and position EM field generators for detection by EM sensors in or on medical devices.

[0058] The tower 30 may also include a console 31 in addition to other consoles available in the rest of the system (e.g., a console mounted on top of a cart). The console 31 may include a user interface and display screen, such as a touch screen, for a physician operator. The console in the system 10 is typically designed to provide both preoperative information and real-time information for robotic control and procedures, such as navigation and positioning information for the endoscope 13. When the console 31 is not the only console available to the physician, it may be used by a second operator (such as a nurse) to monitor the patient's health or vital signs and the operation of the system 10, as well as to provide procedure-specific data, such as navigation and positioning information. In other embodiments, the console 30 is housed in a body separate from the tower 30.

[0059] The tower 30 may be coupled to the cart 11 and the endoscope 13 via one or more cables or connections (not shown). In some embodiments, support functions from the tower 30 may be provided to the cart 11 via a single cable, thereby simplifying and eliminating clutter in the operating room. In other embodiments, specific functions may be coupled in separate wiring and connections. For example, while power may be provided to the cart via a single cable, support for control, optics, fluidics, and / or navigation may also be provided via separate cables.

[0060] Figure 2 Provided by Figure 1 Detailed illustration of an embodiment of a cart for a cart-based robotic-enabled system is shown. The cart 11 generally includes an elongated support structure 14 (commonly referred to as a "column"), a cart base 15, and a console 16 at the top of the column 14. The column 14 may include one or more brackets, such as for supporting one or more robotic arms 12 ( Figure 2The bracket 17 (alternatively "arm support") may include a separately configurable arm mount that rotates along a vertical axis to adjust the base of the robotic arm 12 to better position it relative to the patient. The bracket 17 also includes a bracket interface 19 that allows the bracket 17 to translate vertically along the column 14.

[0061] The bracket interface 19 is connected to the column 14 through slots, such as slot 20, which are positioned on opposite sides of the column 14 to guide the vertical translation of the bracket 17. The slot 20 contains a vertical translation interface to position and maintain the bracket 17 at various vertical heights relative to the cart base 15. The vertical translation of the bracket 17 allows the cart 11 to adjust the reach of the robotic arm 12 to meet various table heights, patient sizes, and physician preferences. Similarly, the separately configurable arm mounts on the bracket 17 allow the robotic arm base 21 of the robotic arm 12 to be angled in a variety of configurations.

[0062] In some embodiments, the slot 20 may be supplemented with a slot cover that is flush and parallel to the slot surface to prevent dust and fluid from entering the internal cavity of the column 14 and the vertical translation interface when the carriage 17 is vertically translated. The slot cover can be deployed by a pair of spring reels positioned near the vertical top and bottom of the slot 20. The cover is coiled within the reel until it is deployed to extend and retract from the coiled state of the cover when the carriage 17 is vertically translated up and down. When the carriage 17 is translated toward the reel, the spring loading of the reel provides a force to retract the cover into the reel while also maintaining a tight seal when the carriage 17 is translated away from the reel. The cover can be connected to the carriage 17 using, for example, a bracket in the carriage interface 19 to ensure proper extension and retraction of the cover when the carriage 17 is translated.

[0063] Column 14 may internally include mechanisms such as gears and motors designed to mechanized translate carriage 17 using a vertically aligned lead screw in response to control signals generated in response to user input (eg, input from console 16 ).

[0064] The robotic arm 12 may generally include a robotic arm base 21 and an end effector 22 separated by a series of links 23, the series of links being connected by a series of joints 24, each joint including an independent actuator, each actuator including an independently controllable motor. Each independently controllable joint represents an independent degree of freedom available to the robotic arm 12. Each of the robotic arms 12 may have seven joints and therefore provide seven degrees of freedom. Multiple joints result in multiple degrees of freedom, thereby allowing "redundant" degrees of freedom. Having redundant degrees of freedom allows the robotic arm 12 to position its corresponding end effector 22 at a specific position, orientation, and trajectory in space using different connector positions and joint angles. This allows the system to position and guide the medical device from a desired point in space, while allowing the physician to move the arm joint to a clinically advantageous position away from the patient to create greater access while avoiding arm collisions.

[0065] The cart base 15 balances the weight of the column 14, bracket 17, and robotic arm 12 on the floor. Thus, the cart base 15 houses heavier components such as electronics, motors, power supplies, and components that enable the cart 11 to be moved and / or secured. For example, the cart base 15 includes rollable wheel-shaped casters 25 that allow the cart 11 to be easily moved around the room prior to a procedure. After reaching the proper orientation, the casters 25 can be secured using wheel locks to maintain the cart 11 in the proper orientation during the procedure.

[0066] The console 16 positioned at the vertical end of the column 14 allows both a user interface and a display screen (or a dual-purpose device, such as a touch screen 26) for receiving user input to provide both preoperative and intraoperative data to the physician user. Potential preoperative data on the touch screen 26 may include preoperative planning, navigation and mapping data derived from a preoperative computerized tomography (CT) scan and / or a record from a preoperative patient interview. The intraoperative data on the display may include optical information provided from tools, sensors and coordinate information from sensors and important patient statistics, such as respiration, heart rate and / or pulse. The console 16 may be positioned and tilted to allow the physician to approach the console from the side of the column 14 opposite to the bracket 17. From this position, the physician can observe the console 16, the robot arm 12 and the patient while operating the console 16 from behind the cart 11. As shown, the console 16 also includes a handle 27 to help manipulate and stabilize the cart 11.

[0067] Figure 3An embodiment of a robotically enabled system 10 arranged for ureteroscopy is shown. In a ureteroscopy procedure, a cart 11 can be positioned to deliver a ureteroscope 32 (a procedure-specific endoscope designed to traverse a patient's urethra and ureters) to the patient's lower abdominal region. In a ureteroscopy, it may be desirable to align the ureteroscope 32 directly with the patient's urethra to reduce friction and forces on sensitive anatomical structures in this area. As shown, the cart 11 can be aligned at the foot of the table to allow the robotic arm 12 to position the ureteroscope 32 for direct linear access to the patient's urethra. The robotic arm 12 can insert the ureteroscope 32 directly into the patient's lower abdomen through the urethra along a virtual track 33 from the foot of the table.

[0068] After insertion into the urethra, the ureteroscope 32 can be navigated into the bladder, ureters, and / or kidneys for diagnostic and / or therapeutic applications using similar control techniques as in bronchoscopy. For example, the ureteroscope 32 can be guided into the ureters and kidneys to break up accumulated kidney stones using a laser or ultrasonic lithotripsy device deployed down the working channel of the ureteroscope 32. After lithotripsy is complete, the resulting stone fragments can be removed using a basket deployed down the ureteroscope 32.

[0069] Figure 4 An embodiment of a robotically enabled system similarly arranged for vascular procedures is shown. In a vascular procedure, the system 10 can be configured so that the cart 11 can deliver a medical device 34 (such as a steerable catheter) to an access point in the femoral artery of the patient's leg. The femoral artery presents both a larger diameter for navigation and a relatively less circuitous and tortuous path to the patient's heart, which simplifies navigation. As in a ureteroscopy procedure, the cart 11 can be positioned toward the patient's legs and lower abdomen to allow the robotic arm 12 to provide a virtual track 35 for direct linear access to the femoral artery access point in the patient's thigh / hip region. After insertion into the artery, the medical device 34 can be guided and inserted by translating the instrument drive 28. Alternatively, the cart can be positioned around the patient's upper abdomen to reach alternative vascular access points, such as the carotid and brachial arteries near the shoulder and wrist.

[0070] B. Robotic system - unit .

[0071] Embodiments of the robotic-enabled medical system may also incorporate a patient table. Incorporating a table reduces the amount of capital equipment in the operating room by removing a cart, which allows for greater access to the patient. Figure 5An embodiment of such a robotically enabled system is shown arranged for use in a bronchoscopy procedure. System 36 includes a support structure or column 37 for supporting a platform 38 (shown as a "table" or "bed") on a floor. Much like a cart-based system, the end effector of a robotic arm 39 of system 36 includes an instrument drive 42 designed to manipulate an elongated medical instrument, such as a slender medical instrument, through or along a virtual track 41 formed by the linear alignment of the instrument drive 42. Figure 5 In practice, a C-arm for providing fluoroscopic imaging can be positioned over the upper abdominal region of the patient by placing the emitter and detector around the table 38.

[0072] Figure 6 An alternative view of the system 36 without the patient and medical device for discussion purposes is provided. As shown, the column 37 may include one or more brackets 43 shown as annular in the system 36, on which one or more robotic arms 39 may be based. The bracket 43 may translate along a vertical column interface 44 extending along the length of the column 37 to provide different vantage points from which the robotic arm 39 may be positioned to reach the patient. The bracket 43 may rotate around the column 37 using a mechanical motor positioned within the column 37 to allow the robotic arm 39 to access multiple sides of the table 38, such as both sides of the patient. In an embodiment with multiple brackets, the brackets may be individually positioned on the column and may translate and / or rotate independently of the other brackets. Although the bracket 43 does not need to be around the column 37 or even circular, the annular shape as shown facilitates the rotation of the bracket 43 around the column 37 while maintaining structural balance. The rotation and translation of the bracket 43 allows the system 36 to align medical devices such as endoscopes and laparoscopes to different entry points on the patient. In other embodiments (not shown), the system 36 may include a patient table or bed with an adjustable arm support in the form of a rod or rail extending alongside the patient table or bed. One or more robotic arms 39 may be attached to the adjustable arm support (e.g., via a shoulder with an elbow joint) that may be vertically adjusted. By providing vertical adjustment, the robotic arms 39 advantageously can be compactly stored beneath the patient table or bed and subsequently raised during a procedure.

[0073] The robotic arm 39 may be mounted on the carriage via a set of arm mounts 45 including a series of joints that may be individually rotated and / or telescopically extended to provide additional configurability to the robotic arm 39. Additionally, the arm mounts 45 may be positioned on the carriage 43 such that when the carriage 43 is appropriately rotated, the arm mounts 45 may be positioned on the same side of the table 38 (e.g., Figure 6 As shown), on the opposite side of the platform 38 (as shown Fig. 9 shown) or on an adjacent side of stage 38 (not shown).

[0074] The column 37 provides structural support for the stage 38 and provides a path for the vertical translation of the carriage 43. Internally, the column 37 may be equipped with a lead screw for guiding the vertical translation of the carriage, and a motor for mechanizing the translation of the carriage based on the lead screw. The column 37 may also transmit power and control signals to the carriage 43 and the robotic arm 39 mounted thereon.

[0075] The base 46 has Figure 2 The cart base 15 in the illustrated cart 11 functions similarly, accommodating heavier components to balance the table / bed 38, column 37, bracket 43, and robotic arm 39. The table base 46 may also incorporate rigid casters to provide stability during the procedure. Casters deployed from the bottom of the table base 46 may extend in opposite directions on both sides of the base 46 and retract when the system 36 needs to be moved.

[0076] continue Figure 6 , the system 36 may also include a tower (not shown) that divides the functions of the system 36 between the table and the tower to reduce the form factor and volume of the table. As in the previously disclosed embodiments, the tower can provide various support functions to the table, such as processing, computing and control capabilities, power, fluid and / or optical and sensor processing. The tower can also be movable to be positioned away from the patient, thereby improving the physician's access and eliminating clutter in the operating room. In addition, placing the components in the tower allows more storage space in the table base 46 for potential stowage of the robotic arm 39. The tower may also include a main controller or console that provides both a user interface (such as a keyboard and / or pendant) for user input and a display screen (or touch screen) for preoperative and intraoperative information (such as real-time imaging, navigation and tracking information). In some embodiments, the tower may also include a holder for a gas cylinder to be used for insufflation.

[0077] In some embodiments, the table base can fold up and store the robotic arm when not in use. Figure 7 A system 47 for stowing the robotic arm in an embodiment of a table-based system is shown. In the system 47, a carriage 48 can be translated vertically into a base 49 to stow a robotic arm 50, an arm mount 51, and the carriage 48 within the base 49. A base cover 52 can be translated and retracted open to deploy the carriage 48, the arm mount 51, and the robotic arm 50 around a column 53, and closed to stow the carriage, the arm mount, and the robotic arm to protect them when not in use. The base cover 52 can be sealed with a membrane 54 along the edges of its opening to prevent dust and fluids from entering when closed.

[0078] Figure 8An embodiment of a robotically enabled table-based system configured for a ureteroscopy procedure is shown. During ureteroscopy, the table 38 may include a rotating portion 55 for positioning the patient at an angle to the column 37 and the table base 46. The rotating portion 55 may rotate or pivot about a pivot point (e.g., located below the patient's head) so as to position the bottom portion of the rotating portion 55 away from the column 37. For example, the pivoting of the rotating portion 55 allows a C-arm (not shown) to be positioned above the patient's lower abdomen without competing for space with the column (not shown) below the table 38. By rotating the bracket 35 (not shown) about the column 37, the robotic arm 39 can insert the ureteroscope 56 directly into the patient's groin area along the virtual track 57 to reach the urethra. During ureteroscopy, stirrups 58 may also be fixed to the rotating portion 55 of the table 38 to support the orientation of the patient's legs during the procedure and allow full access to the patient's groin area.

[0079] In a laparoscopic procedure, minimally invasive instruments may be inserted into the patient's anatomical structure through a small incision in the patient's abdominal wall. In some embodiments, the minimally invasive instrument includes an elongated rigid member, such as a shaft, for accessing the patient's anatomical structure. After the patient's abdominal cavity is inflated, the instrument may be guided to perform a surgical or medical task, such as grasping, cutting, ablating, suturing, etc. In some embodiments, the instrument may include a scope, such as a laparoscope. Fig. 9 An embodiment of a robotically enabled table-based system configured for laparoscopic procedures is shown. Fig. 9 As shown, the carriage 43 of the system 36 can be rotated and vertically adjusted to position the pair of robotic arms 39 on opposite sides of the table 38 so that the arm mounts 45 can be used to position instruments 59 through minimal incisions on both sides of the patient to reach his / her abdominal cavity.

[0080] To accommodate laparoscopic procedures, the robotic-enabled table system can also tilt the platform to a desired angle. Fig.10 An embodiment of a robotic-enabled medical system with pitch or tilt adjustment is shown. Fig.10 As shown, the system 36 can accommodate the tilt of the table 38 to position one portion of the table at a greater distance from the floor than another portion. Additionally, the arm mount 45 can be rotated to match the tilt so that the robotic arm 39 maintains the same planar relationship with the table 38. To accommodate steeper angles, the column 37 can also include a telescoping portion 60 that allows vertical extension of the column 37 to prevent the table 38 from contacting the floor or colliding with the table base 46.

[0081] Fig.11A detailed illustration of the interface between the table 38 and the column 37 is provided. The pitch rotation mechanism 61 can be configured to change the pitch angle of the table 38 relative to the column 37 in multiple degrees of freedom. The pitch rotation mechanism 61 can be implemented by positioning orthogonal axes 1, 2 at the column-to-table interface, each axis being actuated by a separate motor 3, 4 in response to an electrical pitch angle command. Rotation along one screw 5 will enable tilt adjustment in one axis 1, while rotation along another screw 6 will enable tilt adjustment along another axis 2. In some embodiments, a spherical joint can be used to change the pitch angle of the table 38 relative to the column 37 in multiple degrees of freedom.

[0082] For example, pitch adjustment is particularly useful when attempting to position the table in a Trendelenburg position (i.e., positioning the patient's lower abdomen at a higher orientation from the floor than the patient's upper abdomen) for lower abdominal surgery. The Trendelenburg position causes the patient's internal organs to glide toward his / her upper abdomen by gravity, thereby clearing the abdominal cavity to allow minimally invasive tools to enter and perform a lower abdominal surgical or medical procedure, such as a laparoscopic prostatectomy.

[0083] C. Device Drivers and Interfaces .

[0084] The end effector of the system's robotic arm includes: (i) an instrument driver (alternatively referred to as an "instrument drive mechanism" or "instrument device manipulator"), which incorporates an electromechanical device for actuating a medical device; and (ii) a removable or detachable medical device, which may be free of any electromechanical components such as a motor. This dichotomy may be driven by the need to sterilize medical instruments used in medical procedures; and the inability to adequately sterilize expensive capital equipment due to its complex mechanical components and sensitive electronics. Therefore, the medical device may be designed to be disassembled, removed, and interchanged from the instrument driver (and therefore from the system) for separate sterilization or disposal by a physician or physician's staff. In contrast, the instrument driver does not need to be changed or sterilized, and can be covered for protection.

[0085] Fig.12 An exemplary instrument driver is shown. The instrument driver 62, positioned at the distal end of the robotic arm, includes one or more drive units 63 arranged in parallel axes to provide controlled torque to a medical device via a drive shaft 64. Each drive unit 63 includes a separate drive shaft 64 for interacting with the instrument, a gear head 65 for converting motor shaft rotation into a desired torque, a motor 66 for generating the drive torque, an encoder 67 for measuring the speed of the motor shaft and providing feedback to the control circuit, and a control circuit 68 for receiving control signals and actuating the drive unit. Each drive unit 63 is independently controlled and motorized, and the instrument driver 62 can provide multiple (e.g., Fig.12In operation, the control circuit 68 will receive the control signal, transmit the motor signal to the motor 66, compare the resulting motor speed measured by the encoder 67 with the desired speed, and modulate the motor signal to generate the desired torque.

[0086] For the procedures requiring a sterile environment, the robotic system can be combined with a drive interface, such as a sterile adapter connected to a sterile cover, which is located between the instrument driver and the medical device. The main purpose of the sterile adapter is to transfer angular motion from the drive shaft of the instrument driver to the drive input of the instrument, while maintaining the physical separation between the drive shaft and the drive input and thus maintaining sterility. Therefore, an exemplary sterile adapter may include a series of rotational inputs and rotational outputs intended to cooperate with the drive shaft of the instrument driver and the drive input on the instrument. The sterile cover composed of a thin flexible material (such as transparent or translucent plastic) connected to the sterile adapter is designed to cover capital equipment, such as instrument drivers, robot arms and carts (in cart-based systems) or tables (in tables-based systems). The use of the cover will allow capital equipment to be positioned near the patient while still being located in an area that does not require sterilization (i.e., non-sterile area). On the other side of the sterile cover, medical devices can dock with patients in areas that require sterilization (i.e., sterile areas).

[0087] D. Medical devices .

[0088] Fig.13 An exemplary medical device with a paired instrument driver is shown. Similar to other instruments designed for use with a robotic system, the medical device 70 includes an elongated shaft 71 (or elongated body) and an instrument base 72. The instrument base 72, also referred to as an "instrument handle" due to its intended design for manual interaction by a physician, can typically include a rotatable drive input 73 (e.g., a socket, pulley, or reel) that is designed to mate with a drive output 74 of a drive interface on an instrument driver 75 extending through a distal end of a robotic arm 76. When physically connected, latched, and / or coupled, the mating drive input 73 of the instrument base 72 can share an axis of rotation with the drive output 74 in the instrument driver 75 to allow torque to be transferred from the drive output 74 to the drive input 73. In some embodiments, the drive output 74 can include a spline that is designed to mate with a socket on the drive input 73.

[0089] The elongated shaft 71 is designed to be delivered through an anatomical opening or lumen (e.g., as in endoscopy) or through a minimally invasive incision (e.g., as in laparoscopy). The elongated shaft 71 can be flexible (e.g., having properties similar to an endoscope) or rigid (e.g., having properties similar to a laparoscope), or a customized combination of both flexible and rigid portions. When designed for laparoscopy, the distal end of the rigid elongated shaft can be connected to an end effector extending from an articulated wrist formed by a connecting fork having at least one degree of freedom and a surgical tool or medical instrument (e.g., a grasper or scissors) that can be actuated based on the force from the tendon when the drive input rotates in response to a torque received from the drive output 74 of the instrument driver 75. When designed for endoscopy, the distal end of the flexible elongated shaft can include a manipulable or controllable curved segment that articulates and bends based on the torque received from the drive output 74 of the instrument driver 75.

[0090] Tendons along the elongated shaft 71 are used to transmit torque from the instrument driver 75 along the elongated shaft 71. These individual tendons (e.g., pull wires) can be individually anchored to individual drive inputs 73 within the instrument handle 72. From the handle 72, the tendons are guided downward along one or more traction cavities of the elongated shaft 71 and anchored at the distal portion of the elongated shaft 71, or in the wrist at the distal portion of the elongated shaft. During surgical procedures such as laparoscopic, endoscopic, or hybrid surgery, these tendons can be coupled to a distally mounted end effector, such as a wrist, a grasper, or scissors. In such an arrangement, the torque applied to the drive input 73 transmits tension to the tendons, causing the end effector to actuate in some manner. In some embodiments, during surgical procedures, the tendons can cause the joint to rotate around an axis, causing the end effector to move in one direction or another. Alternatively, the tendons can be connected to one or more jaws of a grasper at the distal end of the elongated shaft 71, wherein the tension from the tendons causes the grasper to close.

[0091] In endoscopy, the tendon can be coupled to a bending or articulation segment located along the elongated shaft 71 (e.g., at the distal end) via an adhesive, a control ring, or other mechanical fastener. When fixedly attached to the distal end of the bending segment, the torque applied to the drive input 73 will be transmitted downward along the tendon, causing the softer bending segment (sometimes referred to as the articulation segment or region) to bend or articulate. Along the unbending segment, it may be advantageous to spiral or coil a separate traction cavity that guides a separate tendon along the wall (or inside) of the endoscope shaft to balance the radial forces caused by the tension in the traction wire. For specific purposes, the angle of the spiral and / or the spacing therebetween can be changed or designed, wherein a tighter spiral exhibits less axial compression under load force, while a lower amount of spiraling causes greater axial compression under load force, but limits bending. In another case, the traction cavity can be guided parallel to the longitudinal axis of the elongated shaft 71 to allow controlled articulation in the desired bending or articulation segment.

[0092] In endoscopy, the elongated shaft 71 houses a plurality of components to assist in robotic procedures. The shaft 71 may include a working channel at the distal end of the shaft 71 for deploying surgical tools (or medical devices), flushing and / or aspiration of the surgical area. The shaft 71 may also house wires and / or optical fibers to transmit signals to / from an optical assembly at the distal end, which may include an optical camera. The shaft 71 may also house an optical fiber to carry light from a proximally located light source (e.g., a light emitting diode) to the distal end of the shaft 71.

[0093] At the distal end of the instrument 70, the distal tip may also include an opening for a working channel for delivering tools for diagnosis and / or treatment, flushing and suctioning the surgical site. The distal tip may also include a port for a camera (such as a fiberscope or a digital camera) to capture images of the internal anatomical space. Relatedly, the distal tip may also include a port for a light source, which is used to illuminate the anatomical space when the camera is used.

[0094] exist Fig.13 In the example of , the drive shaft axis, and therefore the drive input axis, is orthogonal to the axis of the elongated shaft 71. However, this arrangement complicates the ability of the elongated shaft 71 to roll. Rolling the elongated shaft 71 along its axis while keeping the drive input 73 stationary can cause undesirable tangling of the tendon as it extends out of the drive input 73 and into the retraction cavity within the elongated shaft 71. Such resulting tangling of the tendon can disrupt any control algorithm designed to predict the movement of the flexible elongated shaft 71 during an endoscopic procedure.

[0095] Fig.14An alternative design of an instrument driver and an instrument is shown, wherein the axis of the drive unit is parallel to the axis of the elongated shaft of the instrument. As shown, a circular instrument driver 80 includes four drive units, and its drive output 81 is aligned in parallel at the end of a robot arm 82. The drive units and their respective drive outputs 81 are contained in a rotating assembly 83 of an instrument driver 80 driven by a drive unit in the drive unit in the assembly 83. In response to the torque provided by the rotating drive unit, the rotating assembly 83 rotates along a circular bearing, which connects the rotating assembly 83 to the non-rotating portion 84 of the instrument driver. Electric power and control signals can be transmitted to the rotating assembly 83 from the non-rotating portion 84 of the instrument driver 80 by electrical contact, and the electrical contact can be maintained by the rotation of the brush slip ring connection (not shown). In other embodiments, the rotating assembly 83 can be responsive to a separate drive unit integrated into the non-rotating portion 84, and is therefore not parallel to other drive units. The rotating mechanism 83 allows the instrument driver 80 to allow the drive unit and its corresponding drive output 81 to rotate around the instrument driver axis 85 as a single unit.

[0096] Similar to previously disclosed embodiments, the instrument 86 may include an elongated shaft portion 88 and an instrument base 87 (shown with a transparent outer skin for discussion purposes) that includes a plurality of drive inputs 89 (such as sockets, pulleys, and spools) configured to receive drive outputs 81 in the instrument driver 80. Unlike previously disclosed embodiments, the instrument shaft 88 extends from the center of the instrument base 87, with the axis of the instrument base being substantially parallel to the axis of the drive inputs 89, rather than being substantially parallel to the axis of the drive inputs 89. Fig.13 as orthogonal in the design.

[0097] When coupled to the rotation assembly 83 of the instrument driver 80, the medical device 86 including the instrument base 87 and the instrument shaft 88 rotates in combination with the rotation assembly 83 about the instrument driver axis 85. Since the instrument shaft 88 is located at the center of the instrument base 87, the instrument shaft 88 is coaxial with the instrument driver axis 85 when attached. Therefore, the rotation of the rotation assembly 83 causes the instrument shaft 88 to rotate about its own longitudinal axis. In addition, when the instrument base 87 rotates with the instrument shaft 88, any tendons connected to the drive input 89 in the instrument base 87 do not tangle during rotation. Therefore, the parallelism of the axes of the drive output 81, the drive input 89, and the instrument shaft 88 allows the shaft to rotate without tangling any control tendons.

[0098] E. Navigation and Control .

[0099] Conventional endoscopy may involve the use of fluoroscopy (e.g., as may be delivered by a C-arm) and other forms of radiation-based imaging modalities to provide intracavitary guidance to the operating physician. In contrast, the robotic system contemplated by the present disclosure may provide non-radiation-based navigation and positioning devices to reduce physician exposure to radiation and reduce the amount of equipment in the operating room. As used herein, the term "positioning" may refer to determining and / or monitoring the orientation of an object in a reference coordinate system. Technologies such as preoperative mapping, computer vision, real-time EM tracking, and robotic command data may be used alone or in combination to achieve a radiation-free operating environment. In other cases where radiation-based imaging modalities are still used, preoperative mapping, computer vision, real-time EM tracking, and robotic command data may be used alone or in combination to improve information obtained only by radiation-based imaging modalities.

[0100] Fig.15 is a block diagram illustrating a positioning system 90 for estimating the position of one or more elements of a robotic system, such as the position of an instrument, according to an example embodiment. The positioning system 90 may be a set of one or more computer devices configured to execute one or more instructions. The computer device may be embodied by a processor (or multiple processors) and a computer readable memory in one or more of the components discussed above. By way of example and not limitation, the computer device may be located at Figure 1 The tower 30 shown, Figures 1 to 4 The cart shown, Figures 5 to 10 The bed shown, etc.

[0101] like Fig.15 As shown, the positioning system 90 may include a positioning module 95 that processes the input data 91-94 to generate position data 96 for the distal tip of the medical device. The position data 96 may be data or logic that represents the position and / or orientation of the distal end of the device relative to a reference frame. The reference frame may be a reference frame relative to the patient's anatomy or a known object such as an EM field generator (see below for a discussion of EM field generators).

[0102] The various input data 91-94 are now described in more detail. Preoperative mapping can be accomplished using a collection of low-dose CT scans. The preoperative CT scans are reconstructed into three-dimensional images that are visualized, for example, as "slices" of cross-sectional views of the patient's internal anatomical structures. When analyzed as a whole, image-based models of anatomical cavities, spaces, and structures for the patient's anatomical structures (such as the patient's lung network) can be generated. Techniques such as centerline geometry can be determined and approximated from CT images to form a three-dimensional volume of the patient's anatomical structure, which is referred to as model data 91 (also referred to as "preoperative model data" when generated using only preoperative CT scans). The use of centerline geometry is discussed in U.S. Patent Application No. 14 / 523,760, the contents of which are incorporated herein in their entirety. Network topology models can also be derived from CT images and are particularly suitable for bronchoscopy.

[0103] In some embodiments, the instrument can be equipped with a camera to provide visual data (or images) 92. The positioning module 95 can process the visual data to implement one or more vision-based (or image-based) position tracking modules or features. For example, preoperative model data can be used in conjunction with the visual data 92 to implement computer vision-based tracking of a medical instrument (e.g., an endoscope or an instrument advanced through a working channel of an endoscope). For example, using the preoperative model data 91, the robotic system can generate a library of expected endoscopic images from the model based on the expected path of travel of the endoscope, each image being connected to a location within the model. During a surgical procedure, the robotic system can reference the library to compare real-time images captured at a camera (e.g., a camera at the distal end of an endoscope) with those in the image library to assist in positioning.

[0104] Other computer vision based tracking techniques use feature tracking to determine the motion of the camera, and therefore the motion of the endoscope. Some features of the localization module 95 may identify circular geometric structures in the preoperative model data 91 that correspond to anatomical cavities and track changes in those geometric structures to determine which anatomical cavity is selected, as well as track relative rotational and / or translational motion of the camera. The use of topological maps may further enhance vision based algorithms or techniques.

[0105] Optical flow (another computer vision-based technique) can analyze the displacement and translation of image pixels in a video sequence in the visual data 92 to infer camera movement. Examples of optical flow techniques can include motion detection, object segmentation calculations, brightness, motion compensated encoding, stereo disparity measurements, etc. Through multiple iterations of multi-frame comparisons, the movement and position of the camera (and therefore the endoscope) can be determined.

[0106] The positioning module 95 can use real-time EM tracking to generate the real-time position of the endoscope in a global coordinate system that can be aligned to the patient's anatomical structure represented by the preoperative model. In EM tracking, an EM sensor (or tracker) comprising one or more sensor coils in one or more positions and orientations embedded in a medical device (e.g., an endoscopic tool) measures changes in the EM field generated by one or more static EM field generators positioned at known locations. The position information detected by the EM sensor is stored as EM data 93. The EM field generator (or transmitter) can be placed close to the patient to generate a low-intensity magnetic field that can be detected by the embedded sensor. The magnetic field induces a small current in the sensor coil of the EM sensor, which can be analyzed to determine the distance and angle between the EM sensor and the EM field generator. These distances and orientations can be "aligned" to the patient's anatomical structure (e.g., a preoperative model) during surgery to determine a geometric transformation that aligns a single position in the coordinate system with an orientation in the preoperative model of the patient's anatomical structure. Once registered, an embedded EM tracker in one or more locations of a medical device (eg, the distal tip of an endoscope) can provide a real-time indication of the progress of the medical device through the patient's anatomy.

[0107] The robotic commands and kinematic data 94 may also be used by a positioning module 95 to provide orientation data 96 for the robotic system. The pitch and yaw of the device derived from the joint motion commands may be determined during preoperative calibration. In surgery, these calibration measurements may be used in conjunction with known insertion depth information to estimate the orientation of the instrument. Alternatively, these calculations may be analyzed in conjunction with EM, vision, and / or topological modeling to estimate the orientation of the medical device within the network.

[0108] like Fig.15 As shown, the positioning module 95 can use a variety of other input data. For example, although Fig.15 Not shown, but an instrument utilizing shape sensing fibers may provide shape data that positioning module 95 may use to determine the position and shape of the instrument.

[0109] The localization module 95 may use the input data 91-94 in combination. In some cases, such a combination may use a probabilistic approach, where the localization module 95 assigns a confidence weight to a position determined from each of the input data 91-94. Thus, in situations where the EM data may be unreliable (such as where EM interference may be present), the confidence in the position determined by the EM data 93 may be reduced, and the localization module 95 may rely more heavily on the visual data 92 and / or the robot command and kinematics data 94.

[0110] As discussed above, the robotic systems discussed herein may be designed to incorporate a combination of one or more of the above techniques. A computer-based control system for a robotic system located in a tower, bed, and / or cart may store computer program instructions, for example, in a non-transitory computer-readable storage medium (such as a permanent magnetic storage drive, a solid-state drive, etc.) that, when executed, causes the system to receive and analyze sensor data and user commands, generate control signals for the entire system, and display navigation and positioning data, such as the position of an instrument in a global coordinate system, an anatomical map, etc.

[0111] 2. Robot-enabled medical systems with high-force instruments

[0112] A robotically enabled medical system (such as the above-described system) may include a high-force instrument as described in this section. As used herein, a high-force instrument may refer to an instrument including an end effector (such as a gripper, a gripper, a cutter, etc.) that is configured to produce a mechanical advantage, whereby the input is amplified by the structure of the instrument to produce an amplified output. In some embodiments, the force input is amplified to produce a force output greater than the force input. For example, in some embodiments, the high-force instrument includes an end effector configured as a gripper, and the high-force instrument is configured so that the input force (e.g., the force applied to the pull line of the instrument) is amplified so that the output force at the jaws of the gripper is greater than the input force. In some embodiments, the high-force instrument includes a novel structure that provides a mechanical advantage that can achieve an even greater output than when there is no mechanical advantage. In some embodiments, the high-force instrument is a robotically controlled instrument as described above.

[0113] In many examples described herein, the end effector of the high-force instrument is actuated with a pull wire. The pull wire can be wrapped around a pulley within the instrument. In some embodiments, the high-force instrument can output higher forces than a simple pulley drive in a wrist configuration. For example, the high-force instrument can provide a mechanical advantage of two to one, three to one, four to one, five to one, or ten to one. Other mechanical advantages are also possible.

[0114] In many of the embodiments described below and shown in the accompanying drawings, the high-force instrument is a high-force gripper. However, the mechanisms described herein that are configured to achieve high forces can also be applied to other types of instruments, including clamping instruments and cutting instruments, among others.

[0115] A. Exemplary Instruments with High-Force End Effectors

[0116] Fig.16AA side view of an embodiment of a high-force instrument 100 is shown. As will be discussed below, the instrument 100 can be configured to provide a mechanical advantage that can, for example, amplify an input force to produce an increased output force. In the illustrated embodiment, the instrument 100 includes an elongated shaft 102 and a handle 104. The elongated shaft 102 extends between a distal end and a proximal end. An end effector 108 that can be configured as a gripper in the illustrated embodiment can be positioned at the distal end of the elongated shaft 102. In some embodiments, for example, as shown, the end effector 108 is connected to the distal end of the elongated shaft 102 by a wrist 106. The wrist 106 can be configured to allow one or more degrees of freedom of the instrument 100. For example, the wrist 106 can be a dual-degree-of-freedom wrist. For example, the dual-degree-of-freedom wrist can allow the end effector 108 to pivot or rotate around a pitch axis and a yaw axis. In some embodiments, the wrist 106 can be fixed so as to provide zero degrees of freedom. In some embodiments, the wrist 106 may allow one, two, three, or more degrees of freedom. Exemplary embodiments of the wrist 106 and end effector 108 are further described below. Fig. 16B is shown in more detail in .

[0117] like Fig.16A As shown, in some embodiments, the instrument 100 includes a handle 104. The handle 104 can be configured to be connected to an instrument drive mechanism, such as Fig.13 and Fig.14 As previously described, the instrument 100 may include one or more tendons, cables, or pull wires extending along (e.g., through or on) the elongated shaft 102 between the end effector 108 and the handle 104. The handle 104 may include one or more drive inputs configured to engage the instrument drive mechanism (see Fig.14 ) on the instrument drive mechanism to actuate (e.g., tension or pull) one or more drive outputs of the pull wire. Actuating the pull wire can cause movement of the end effector 108 to allow remote manipulation and control of the end effector 108. For example, in some embodiments, actuation of the pull wire can be configured to cause the jaws of the end effector 108 to open and close and / or allow the end effector 108 to rotate about a pitch axis or a yaw axis. As described above, the instrument drive mechanism can be positioned on a robotic arm. In some embodiments, the robotic arm can be controlled to position, roll, advance, and / or retract the instrument 100.

[0118] like Fig.16AAs shown, in some embodiments, the elongated shaft 102 extends through the handle 104. In such embodiments, the elongated shaft 102 can be configured to be advanced or retracted relative to the handle 104. In some embodiments, the instrument drive mechanism is configured to cause the elongated shaft 102 to be advanced or retracted relative to the handle 104. This can allow, for example, the handle 104 to remain stationary while the elongated shaft 102 and the end effector 108 are advanced into the patient during a procedure. In some embodiments, the proximal end of the elongated shaft 102 is attached to the handle 104 so that the elongated shaft 102 extends only between the end effector 108 and the handle 104.

[0119] Fig. 16B A detailed view of the distal end of the instrument 100 is shown, and an embodiment of the wrist 106 and the end effector 108 is shown. In the illustrated embodiment, the end effector 108 is configured as a grasper or gripper, but other types of end effectors (e.g., cutters or scissors) are also possible. The end effector 108 includes a first grasping member or jaw member 118 and a second grasping member or jaw member 120. The angle between the jaw members 118, 120 can be controlled to operate the end effector 108. For example, the jaw members 118, 120 can be opened and closed.

[0120] In the illustrated embodiment, the wrist 106 is a dual degree of freedom wrist, but as described above, the wrist 106 can provide other numbers of degrees of freedom in other embodiments. The dual degree of freedom wrist 106 shown is configured to allow the end effector 108 to pivot about a first axis 110 and a second axis 112. In the illustrated configuration, the second axis 112 extends into and out of the page. The first axis 110 and the second axis 112 can be orthogonal. In some embodiments, the first axis 110 can be the pitch axis of the instrument 100, and the second axis 112 can be the yaw axis.

[0121] In some embodiments, the instrument 100 includes a pulley 114 and a pulley 116. In some embodiments, the pulley 114 and / or the pulley 116 can be considered as part of the instrument 100, part of the wrist 106, and / or part of the end effector 108. As shown, the pulley 114 is configured to rotate about the first axis 110, and the pulley 116 is configured to rotate about the second axis 112. Although not shown, a pull wire extending along the elongated shaft 102 can be positioned to engage with the pulley 114 and the pulley 116. The end effector 108 can be controlled (e.g., opened, closed, rotated about the first axis 110, and / or rotated about the second axis 112) depending on which of the pull wires is actuated.

[0122] In some embodiments, the elongated shaft 102, wrist 106, and end effector 108 can be configured to be inserted into a patient during a minimally invasive procedure, such as a laparoscopic procedure or an endoscopic procedure. For example, in some embodiments, the elongated shaft 102, wrist 106, and end effector 108 are configured to be inserted through a small incision or other surgical port with a diameter or length of about 14 mm or less, about 12 mm or less, or about 10 mm or less. Therefore, in some embodiments, the maximum diameter or thickness of the elongated shaft 102, wrist 106, and end effector 108 may be about or less than 14 mm, 12 mm, or 10 mm. Other sizes are also possible. The high-force instruments described herein can also be used for non-minimally invasive procedures, such as open surgery.

[0123] Due to the narrowness of the elongated shaft 102, wrist 106, and end effector 108 (e.g., so as to be useful for minimally invasive procedures), it may be difficult to provide a structure that configures the instrument 100 to provide a mechanical advantage. For example, a small diameter or thickness may limit the moment arms through which forces may be transmitted to the distal grasping, clamping, and cutting devices. With limited moment arms, it may be difficult to obtain amplified output and mechanical advantage. However, as will be described below (e.g., with reference to 17A to 20D ) As described in more detail, the instrument 100 described herein can be configured to advantageously provide mechanical advantage while remaining suitable for minimally invasive procedures. For example, the instrument 100 can include a distal force amplification mechanism that can allow for higher gripping and cutting forces at lower actuation forces while maintaining a small overall diameter of the instrument 100. Reference will now be made to 17A to 20D Various features of instrument 100 are described that configure instrument 100 to provide a mechanical advantage.

[0124] Fig.17A and Fig. 17B Components of an embodiment of a high force instrument 100 configured to provide a mechanical advantage are shown. Fig.17A The device 100 is shown in an open position, and Fig. 17B The instrument 100 is shown in a closed position. In this embodiment, the instrument 100 includes a first jaw member 118, a second jaw member 120, a first pulley 122, a second pulley 124 (behind the first pulley 122), and a connector 126 arranged to provide a mechanical advantage. The first pulley 122 and the second pulley 124 may be the pulley 116 described above.

[0125] As shown, the proximal end of first jaw member 118 is connected to first pulley 122. The proximal end of first jaw member 118 may be connected to first pulley 122 via a first drive pin 128. First drive pin 128 may be integrally formed with first jaw member 118 or first pulley 122, or may be a separate component (e.g., a rod extending through openings in both first jaw member 118 and first pulley 122). Although Fig.17A and Fig. 17B The proximal end of the second jaw member 120 is connected to the second pulley 124. The proximal end of the second jaw member 120 can be driven by the second drive pin 130 (at Fig.17A and Fig. 17B Not visible in , but in e.g. FIG. 24F to FIG. 24H 122 and 124). Similar to first drive pin 128, second drive pin 130 may be integrally formed with second jaw member 120 or second pulley 124, or may be a separate component (e.g., a rod extending through openings in both second jaw member 120 and second pulley 124). First drive pin 128 and second drive pin 130 may allow first jaw member 118 and second jaw member 120 to rotate relative to first pulley 122 and second pulley 124, respectively.

[0126] Opposite to the proximal end, the distal ends of the first jaw member 118 and the second jaw member 120 can each be configured as a component of the end effector 108. For example, the distal ends of the first jaw member 118 and the second jaw member 120 can each be configured as a grasping jaw member, a gripping jaw member, a cutting jaw member, a clamping jaw member, etc. In some embodiments, the end effector 108 may include a combination end effector that performs multiple functions (e.g., grasping and cutting). In some embodiments, when the end effector 108 of the instrument 100 is actuated, the distal ends of the first jaw member 118 and the second jaw member 120 can interact with each other (e.g., contact) when the end effector 108 is closed to provide an end effector function (e.g., grasping or cutting).

[0127] The instrument 100 may include a connector 126. In some embodiments, the connector 126 may be considered a constraint (e.g., a connector constraint or a rod constraint). The connector 126 may be configured to provide a first pivot point (e.g., at the first connector pin 132) and a second pivot point (e.g., at the second connector pin 134) about which the first jaw member 118 can pivot and about which the second jaw member 120 can pivot to allow the end effector 108 to open and close. In some cases, the first pivot point and the second pivot point may be referred to as a dual pivot or dual pivot points. In the illustrated embodiment, the connector 126 includes a rod extending between the first jaw member 118 and the second jaw member 120, but in other embodiments, the connector 126 may have a different configuration (e.g., at the second connector pin 134). FIG. 25A to FIG. 25H In the illustrated embodiment, the connector 126 includes a housing 190 that includes bearing surfaces 192, 194 that provide a pivot point.

[0128] In the illustrated embodiment, connector 126 is connected to first jaw member 118 at a first end by first connector pin 132. First connector pin 132 may be integrally formed with first jaw member 118 or connector 126, or may be a separate component (e.g., a rod extending through openings in both first jaw member 118 and connector 126). First connector pin 132 may be configured to allow first jaw member 126 to rotate relative to connector 126. Similarly, connector 126 is connected to second jaw member 120 at a second end by second connector pin 134. Second connector pin 134 may be integrally formed with second jaw member 120 or connector 126, or may be a separate component (e.g., a rod extending through openings in both second jaw member 120 and connector 126). Second connector pin 134 may be configured to allow second jaw member 126 to rotate relative to connector 126. Thus, in the illustrated embodiment, the connector 126 provides a first pivot point at the first connector pin 132 and a second pivot point at the second connector pin 134 .

[0129] Connector 126 may be connected to first jaw member 118 and second jaw member 120 between proximal and distal ends of first jaw member 118 and second jaw member 120 (e.g., via first connector pin 132 and second connector pin 134). As will be discussed below, the position of connector 126 and the distance between the first pivot point and the second pivot point may be adjusted to vary the mechanical advantage provided by instrument 100 (see, e.g., FIG. 1 ). FIG. 20A to FIG. 20D , as described below).

[0130] like Fig.17A and Fig. 17BAs shown, for some embodiments, the first pulley 122 is configured to surround the pulley shaft 112 (which may be Fig. 16B In some embodiments, the pulley shaft 112 is a central axis. In the illustrated embodiment, the pulley shaft 112 extends into and out of the page. Similarly, the second pulley 124 is configured to rotate around the pulley shaft 112. In some embodiments, the axes of the first pulley 122 and the second pulley 124 may be substantially aligned. The first pulley 122 and the second pulley 124 may be configured so that each pulley can rotate freely. That is, the rotation of the first pulley 122 may be independent of the rotation of the second pulley 124. For example, the first pulley 122 may rotate (e.g., clockwise or counterclockwise) while the second pulley 124 remains stationary (or vice versa), or the first pulley 122 may rotate in a first direction (e.g., clockwise or counterclockwise) while the second pulley 124 rotates in a second direction (e.g., the other of clockwise or counterclockwise).

[0131] The first drive pin 128 may be located at a radius or distance 136 (in Fig.17A 122 is connected to or positioned on the first pulley 122. Fig.17A and Fig. 17B 1, the second drive pin 130 can be connected to or positioned on the second pulley 124 at a radius or distance 136 from the pulley shaft 112. In some embodiments, the distance 136 of the first pulley 122 can be equal to the distance 136 of the second pulley 124, although this need not be the case in all embodiments. As will be discussed below, the distance 136 can be adjusted to change the mechanical advantage provided by the instrument 100 (see, e.g., FIG. 20A to FIG. 20D , as described below).

[0132] One or more pull wires may be engaged with the first pulley 122, which can be actuated (e.g., pulled) to cause the first pulley 122 to rotate in a clockwise or counterclockwise direction around the pulley shaft 112. Similarly, one or more pull wires may be engaged with the second pulley 124, which can be actuated (e.g., pulled) to cause the second pulley 124 to rotate in a clockwise or counterclockwise direction around the pulley shaft 112. In some embodiments, the first pulley 122 and the second pulley 124 are wound with the pull wires in an α-wrap configuration, such as, for example Fig.21 as shown (described below).

[0133] As described above, the pull wire can be pulled or tensioned to actuate the end effector 108 of the instrument 100. For example, first considering the first pulley 122 and the first jaw member 118, the pull wire engaged with the first pulley 122 can be actuated to rotate the first pulley 122 about the pulley shaft 112. The rotation of the first pulley 122 is transmitted to the first jaw member 118 through the first drive pin 128. For example, considering Fig.17A When the first pulley 122 rotates in the clockwise direction, the first drive pin 128 causes the proximal end of the first jaw member 118 to move leftward (eg, toward Fig. 17B As the proximal end of first jaw member 118 is moved by rotation of first pulley 122, first jaw member 118 pivots about a first pivot point provided by connector 126, which in the illustrated embodiment is first connector pin 132. Continuing with the example of rotation of first pulley 122 in a clockwise direction, such movement of first jaw member 118 causes the distal end of first jaw member 118 to move toward the distal end of the second jaw member (e.g., end effector 108 of closure instrument 100 to, for example, Fig. 17B Conversely, rotation of first pulley 122 in a counterclockwise direction causes the proximal end of first jaw member 118 to move to the right, which causes first jaw member 118 to rotate in the opposite direction about the first pivot point, thereby causing the distal end of first jaw member 118 to move away from the distal end of second jaw member 120 (opening the end actuator 108 of instrument 100).

[0134] The second pulley 124 and the second jaw member 120 can provide similar movement when the second pulley 124 rotates. In many cases, the second pulley 124 rotates in the opposite direction to the first pulley 122, but not always. For example, the pull line engaged with the second pulley 124 can be actuated to cause the second pulley 124 to rotate around the pulley shaft 112. The rotation of the second pulley 124 is transmitted to the second jaw member 120 through the second drive pin 130. For example, when the second pulley 124 rotates in the counterclockwise direction, the second drive pin 130 causes the proximal end of the second jaw member 120 to move to the right. When the proximal end of the second jaw member 120 moves by the rotation of the second pulley 124, the second jaw member 120 pivots around the second pivot point provided by the connector 126, which is the second connector pin 134 in the illustrated embodiment. Continuing with the example of the second pulley 124 rotating in the counterclockwise direction, this movement of the second jaw member 120 causes the distal end of the second jaw member 120 to move toward the distal end of the first jaw member 118 (e.g., the end effector 108 of the closing instrument 100 to, for example, Fig. 17B Conversely, rotation of second pulley 124 in a clockwise direction causes the proximal end of second jaw member 120 to move to the right, which causes second jaw member 120 to rotate in the opposite direction about the second pivot point, thereby causing the distal end of second jaw member 120 to move away from the distal end of first jaw member 118 (opening the end actuator 108 of instrument 100).

[0135] The arrangement of first jaw member 118, second jaw member 120, first pulley 122, second pulley 124, and connector 126 can provide a mechanical advantage to instrument 100. For example, considering first jaw member 118 and first pulley 122, the arrangement of first jaw member 118, second pulley 124, and connector 126 can provide a mechanical advantage to instrument 100. Fig.17A The input force F is applied by pulling the pull wire engaged with the first pulley 122. 输入 The arrangement of the first pulley 122 and the first jaw member 118 can amplify this force to produce an output force F 输出 , as shown in the figure. Output force F 输出 can be amplified so that the output force F 输出 Greater than input force F 输入 Advantageously, the systems herein provide greater mechanical advantage than can be achieved with a simple pulley driven gripper.

[0136] The moment arms L1, L2, L3 and L4 are Fig.17A The moment arm L1 may be equal to the pulley shaft 112 and the force F applied from the cable tension. 输入 . In some embodiments, moment arm L1 is equal to or slightly less than the radius of first pulley 122. Moment arm L2 may be equal to distance 136, which is the distance between pulley shaft 112 and first drive pin 128, as described above. Generally, moment arm L2 is less than moment arm L1. Moment arm L3 is equal to the distance between first drive pin 128 and first connector pin 132. Generally, L3 is longer than L2. Moment arm L4 is equal to the distance between first connector pin 132 and the distal end of first jaw member 118. A mechanical advantage may be achieved because when input force F 输入 When a pull line is applied to the first pulley 122 at the moment arm L1 to rotate the first pulley 122 about the pulley shaft 112, this moves the shorter moment arm L2, which drives the longer moment arm L3 about the first pivot (e.g., the first connector pin 132). Changing the moment arm lengths (specifically, increasing the moment arm L1 relative to the moment arm L2 and / or increasing the moment arm L3 relative to the moment arm L4) can increase the mechanical advantage.

[0137] In some embodiments, to increase the grip strength (eg, output force F 输出 ), the following variables may be varied in the following directions: increasing moment arm L1, decreasing moment arm L2, increasing moment arm L3, decreasing moment arm L4, and / or increasing the distance between the pivot points (e.g., the length of connector 126). In some embodiments, the grip strength may be increased by varying the aforementioned variables in combination with secondary geometry changes. Those skilled in the art will appreciate that a variety of arrangements of moment arms L1, L2, L3, and L4 are possible. FIG. 26A to FIG. 27Further details regarding determining mechanical advantage are described. Advantageously, such an arrangement (eg, as described herein) can provide mechanical advantage while maintaining a form factor suitable for minimally invasive surgery as described above.

[0138] like Fig.17A and Fig. 17B In the embodiment illustrated in FIG. 1 , first pulley 122 and second pulley 124 may be positioned between the proximal ends of first jaw member 118 and second jaw member 120 . However, this is not required in all embodiments. For example, FIG. 18A to FIG. 18B An embodiment is shown in which first jaw member 118 and second jaw member 120 are both positioned between first pulley 122 and second pulley 124 . Fig.18A This embodiment of the device 100 is shown in an open position, and Fig.18B This embodiment of the instrument 100 is shown in a closed position.

[0139] In some embodiments, by placing first pulley 122 and second pulley 124 between first jaw member 118 and second jaw member 120 (e.g., Fig.17A and Fig. 17B ), the first pulley 122 and the second pulley 124 can be made with a larger diameter, which can produce a larger mechanical advantage in some cases. This can be at least partially because the pulley diameter can be defined by the chord length of a circle along the pulley plane. As you move the pulley closer to the center of the circle, the chord length increases up to the diameter of the circle.

[0140] exist Fig.17A , Fig. 17B , Fig.18A and Fig.18B In the illustrated embodiment of the apparatus 100, the connector 126 is positioned above the first pulley 122 and the second pulley 124 (relative to the illustrated orientation). This need not be the case in all embodiments. For example, Fig.19A and Fig.19B An embodiment of the instrument 100 is shown that includes a connector 126 positioned below the first pulley 122 and the second pulley 124 . Fig.19A This embodiment of the device 100 is shown in an open position, and Fig.19B This embodiment of the instrument 100 is shown in a nearly closed position. This arrangement may be advantageous in situations where there is more room for the mechanism below the first and second pulleys 122, 124 rather than above the first and second pulleys 122, 124. In some embodiments, the instrument 100 includes a shaft and a wrist having a sufficiently large diameter to provide space to fit components, such as the connector 126. Note that Fig.19A and Fig.19BAn advantage of the embodiment in is that the gripping or jaw members 118, 120 can open the same opening distance at a smaller angle at the distal end, thereby producing a more parallel closure, which may be advantageous for some devices such as a vessel sealer.

[0141] exist Fig.19A and Fig.19B In the embodiment of the instrument 100 shown, the instrument 100 may include a first jaw member 118, a second jaw member 120, a first pulley 122, a second pulley 124 (behind the first pulley 122), and a connector 126 arranged as shown. In this embodiment, the first jaw member 118 is connected to the first pulley 122 by a first drive pin 128 at a position located between the proximal end of the first jaw member 118 and the distal end of the first jaw member 118. The proximal end of the first jaw member 118 is connected to the connector 126 by a first connector pin 132, so that the connector 126 is positioned below the first pulley 122 (e.g., on the side of the first pulley 122 opposite the distal end of the first jaw member 118). Similarly, the second jaw member 120 is connected to the second pulley 124 by a second drive pin 130 (not visible) at a position located between the proximal end of the second jaw member 120 and the distal end of the second jaw member 120. The proximal end of second jaw member 120 is connected to connector 126 via second connector pin 134 such that connector 126 is positioned below second pulley 124 (e.g., on a side of second pulley 124 opposite the distal end of second jaw member 120). FIG. 17A to FIG. 18B The device 100 shown, Fig.19A and Fig.19B The device 100 may also provide mechanical advantage.

[0142] As described above, the dimensions of the various components of the high force device 100 may be varied to provide different mechanical advantages. Additionally, the starting point for pivoting L2 / L3 may be adjusted to increase or decrease the linear motion of the gripper as it opens and closes, such as FIG. 20A to FIG. 20D shown. Fig. 20A and Fig. 20B An embodiment of the apparatus 100 configured for high linear motion and low backdrive is shown. Fig. 20C and Fig.20D An embodiment of the instrument 100 is shown that is configured for low linear motion. When the L2 / L3 pivot points are added at the ends, you can get mechanical leverage due to driving in a circular motion. Fig. 20A and Fig. 20BThis is shown in the extreme case where the two L2 / L3 pivot points are directly across the diameter. In this case, any force attempting to backdrive the grip is resolved by the radius of the pulley, and no tension from the cable is required to maintain this point. Similarly, as you approach this point during closure, the mechanical leverage increases to infinity. Therefore, the dimensions of the components of the instrument 100 can be designed to provide the best compromise of low linear motion and high mechanical advantage.

[0143] In some embodiments, the first distance of the first connector L1 may be between 3 mm and 4 mm, the second distance of the second connector L2 may be between 2 mm and 3 mm, the third distance of the third connector L3 may be between 7 mm and 8 mm, and the fourth distance of the fourth connector L4 may be between 17 mm and 23 mm. For example, in one embodiment, the first distance of the first connector L1 is about 3.35 mm, the second distance of the second connector L2 is about 2.5 mm, the third distance of the third connector L3 is about 7.3 mm, and the fourth distance of the fourth connector L4 is about 20 mm. In some embodiments, the first ratio between the second distance of the second connector L2 and the first distance of the first connector L1 is between 0.5 and 1.25, the second ratio between the third distance of the third connector L3 and the first distance of the first connector L1 is between 1.5 and 3.5, and the third ratio between the fourth distance of the fourth connector L4 and the first distance of the first connector L1 is between 1.5 and 20. For example, in one embodiment, a first ratio between the second distance of the second connector L2 and the first distance of the first connector L1 is about 0.75, a second ratio between the third distance of the third connector L3 and the first distance of the first connector L1 is about 2.18, and a third ratio between the fourth distance of the fourth connector L4 and the first distance of the first connector L1 is about 6. Other sizes of the connectors L1, L2, L3, and L4 and other ratios between the connectors are also possible.

[0144] Fig.21An example of a pulley (e.g., a first pulley 122 or a second pulley 124) engaged with two cables or pull lines 138, 140 is shown, which are engaged with the pulley in an α-wrap configuration. In some embodiments, the pull lines 138, 140 are actually cable or pull line segments 138, 140, which are parts of a single cable or line separated by an intermediate crimp. As shown, in the α-wrap configuration, the first pull line 138 extends above the first side of the pulley (e.g., the right side in the figure), above the top of the pulley, and below the second side of the pulley (e.g., the left side in the figure), and then terminates in a crimping recess 146. Within the crimping recess 146, the end of the first pull line 138 is connected or otherwise fixed to the pulley via an intermediate crimp. Since the first pull line 138 is almost always around the pulley before terminating in the crimping recess 146, a large amount of rotation can be achieved by pulling the pull line 138. For example, the puller wire 138 can cause the pulley to rotate in a clockwise direction from the position shown until the crimping recess 146 is positioned at the first side of the pulley. In some embodiments, this can allow, for example, about or greater than 270 degrees of rotation.

[0145] The second puller wire 140 is similarly wound around the pulley, but in the opposite direction. As shown, the second puller wire 140 extends over the second side of the pulley (e.g., the left side in the figure), over the top of the pulley, and under the first side of the pulley (e.g., the riding side in the figure), and then terminates at the crimping dimple 146. Therefore, the second puller wire 140 can similarly allow the pulley to rotate in a large counterclockwise direction (e.g., about or greater than 270 degrees).

[0146] In some embodiments, the first puller wire 138 and the second puller wire 140 are a single puller wire that is continuously wrapped around a pulley and secured to the pulley in a crimping pocket 146 .

[0147] like Fig.21 The α-wrap configuration shown can be advantageous in the high-force instruments 100 described herein because the mechanical advantage of these instruments 100 converts greater pulley rotations into higher forces. Thus, the pulleys can be configured to allow greater rotations, which in some cases can accommodate a greater range of motion of the instrument.

[0148] Fig.21 It is also shown that the pulleys 122 , 124 may include a bore 142 configured to receive a pin about which the pulleys rotate, and a drive pin bore 144 configured to receive the drive pins 128 , 130 .

[0149] In some embodiments, the high-force instrument 100 may include one or more constraints. As described below, the constraints may help ensure that the movement of the high-force instrument 100 (e.g., opening and closing the first jaw member 118 and the second jaw member 120) is consistent and accurate and / or stabilize the instrument 100. In some cases, some embodiments of the high-force instrument 100 may exhibit undesirable parallelogram motion unless additional constraints are incorporated into the design. For example, in some embodiments, if there is no constraint, the first jaw member 118 and the second jaw member 120 may shift relative to each other (e.g., the first jaw member 118 may shift in an upward direction and the second jaw member 120 may shift in a downward direction) instead of opening and closing as required. In some embodiments, this undesirable motion is caused by a multi-connector system (e.g., four connectors) with two pivot points. Including one or more constraints can eliminate, help prevent or reduce this undesirable motion, thereby stabilizing the high-force instrument 100. For example, additional constraints that prevent the first jaw member 118 and the second jaw member 120 from sliding relative to each other can be incorporated. Various types of constraints are possible and are described in further detail below.

[0150] FIG. 22A to FIG. 22C A view of an embodiment of a high force instrument 100 including a constraint formed by a constraint pin 148 and a constraint slot 150 is shown. Fig.22A A front view of this embodiment of the high force apparatus 100 is shown, Fig. 22B A rear view of this embodiment of the high force apparatus 100 is shown, and Fig. 22C A side perspective view of this embodiment of the high force apparatus 100 is shown. Fig.22A In FIG. 1 , the pulley 124 and a portion of the restraining rod or connector 126 are not visible. FIG. 22A to FIG. 22C The instrument 100 includes a first jaw member 118, a second jaw member 120, a first pulley 122, a second pulley 124, and a connector 126 arranged as shown. In the illustrated embodiment, the connector 126 is positioned below the first pulley 122 and the second pulley 124. The first jaw member 118 is connected to the first pulley 122 by a first drive pin 128. The second jaw member 120 is connected to the second pulley 124 by a second drive pin 130. The first pulley 122 and the second pulley 124 rotate around the pulley shaft 112.

[0151] As shown, the instrument 100 also includes a constraint pin 148 and a constraint slot 150. The constraint pin 148 is formed on (or connected to) one of the gripping member or jaw member (e.g., 120) and extends through the constraint slot 150 formed in the other gripping member or jaw member (e.g., 118), thereby providing a gear motion between the jaw members 118, 120. As shown, the first jaw member 118 is connected to the connector 126 by the first connector pin 132. The constraint slot 150 can be formed as a curve or a cycloid (e.g., formed with a constant radius). In some embodiments, when the jaw members 118, 120 are opened or closed within a certain range of motion, the path traced by the constraint pin 148 in the gripping member or jaw member 118 forms a cycloid curve, thereby maintaining a symmetrical angle between the jaw members and the midplane. When such a cycloid curve is formed, the motion of the jaw members 118, 120 is advantageously constrained. In other words, the cycloidal curve can match the path of the restraining pin 148 when the first jaw member 118 and the second jaw member 120 move symmetrically to open and close. The restraining pin 148 and the restraining slot 150 can prevent the first jaw member 118 and the second jaw member 120 from shifting in parallel motion, thereby maintaining a symmetrical angle about the midplane. For example, when the first jaw member 118 pivots about the first connector pin 132, this can allow the restraining pin 148 to move through the restraining slot 150. That is, the restraining slot 150 can provide an additional connection between the first jaw member 118 and the second jaw member 120 while still allowing the first jaw member 118 to pivot about the first connector pin 132 relative to the connector 126. In some embodiments, this can help prevent the above-mentioned undesirable displacement and can stabilize the movement of the instrument 100.

[0152] While in the present embodiment, restraint pin 148 extends from jaw member 120 and into a restraint slot 150 formed in jaw member 118 , in other embodiments, restraint pin 148 extends from jaw member 118 and into a restraint slot 150 formed in jaw member 120 .

[0153] Additionally, for some embodiments, constraint pin 148 and constraint slot 150 may constrain the movement of first jaw member 118 to the movement of second jaw member 120. That is, the constraints may cause movement of first jaw member 118 to cause corresponding movement of second jaw member 120 (or vice versa). For example, if first jaw member 118 is opened five degrees, the constraints may cause second jaw member 120 to open five degrees. In some embodiments, the corresponding movement of second jaw member 120 is not perfect, such that it will not exactly correspond to the movement of first jaw member 118 (e.g., if first jaw member 118 is opened five degrees, the constraints may cause second jaw member 120 to open 5.5 degrees).

[0154] In some embodiments, these constraints (e.g., constraint pin 148 and constraint slot 150) can be considered as pin-based cycloidal constraints. In some embodiments, these constraints can be considered as gear constraints because they gear the movement of the first jaw member 118 into the movement of the second jaw member 120.

[0155] Fig.22A Also shown, in some embodiments, the instrument 100 can include a pulley shaft clearance slot 152. The pulley shaft clearance slot 152 can help provide clearance for the movement of the first jaw member 118 over the pulley drive pin so that the first jaw member 118 will open and not be restricted in its range of motion. Although not visible, the second jaw member 120 can also include a similar pulley shaft clearance slot.

[0156] Fig.23 A front view of another embodiment of a high-force instrument 100 is shown that includes a restraining pin 148 and a restraining slot 150 (similar to those described above) and is further configured such that the drive pins 128, 130 are positioned so that they never move to a position where they overlap. In some embodiments, it has been observed that if the drive pins 128, 130 move to a position where they overlap, the first jaw member 118 and the second jaw member 120 may rotate or pivot together about the aligned drive pins 128, 130. Keeping the drive pins 128, 130 separated in radial distance, angular distance, or both may help prevent such movement.

[0157] Fig.23 The instrument 100 includes a first jaw member 118, a second jaw member 120, a first pulley 122, a second pulley 124, and a connector 126 arranged as shown. In the illustrated embodiment, the connector 126 is positioned above the first pulley 122 and the second pulley 124. The first jaw member 118 is connected to the first pulley 122 by a first drive pin 128, and the second jaw member 120 is connected to the second pulley 124 by a second drive pin 130. The first pulley 122 and the second pulley 124 rotate around the pulley shaft 112 as described above. In addition, the instrument 100 includes a restraining pin 148 and a restraining slot 150 as described above. Although in this embodiment, the connector 126 is positioned above the pulleys 122, 124.

[0158] In addition, in this embodiment, each of the drive pins 128, 130 is positioned so that they never move to an overlapping position. For example, the instrument 100 is shown in a closed position (wherein the first jaw member 118 contacts the second jaw member 120), and in this position, the drive pins 128, 130 are positioned as shown. Because the first jaw member 118 contacts the second jaw member 120, the first drive pin 128 is prevented from rotating further in the clockwise direction, and the second drive pin 130 is prevented from rotating further in the counterclockwise direction. From this position, the first drive pin 128 and the second drive pin 130 can only rotate in the direction indicated by the arrow in the figure. That is, when the instrument 100 is opened, the first drive pin 128 can only rotate in the counterclockwise direction, and the second drive pin 130 can only rotate in the clockwise direction. Therefore, the first drive pin 128 and the second drive pin 130 are positioned so as not to overlap during any part of the movement, which can improve the stability of the instrument 100.

[0159] In some embodiments, by keeping the drive pins 128, 130 apart (e.g., preventing overlap), the range of motion of the first jaw member 118 and the second jaw member 120 can be limited. This is because preventing the drive pins 128, 130 from overlapping reduces the total amount of rotation available for each of the first pulley 122 and the second pulley 124. This can reduce the total amount of work (and therefore force) that can be transferred from the input to the output. Therefore, including non-overlapping drive pins 128, 130 (e.g., Fig.23 Some embodiments of the apparatus 100 of the present invention compromise jaw motion or force amplification for stability. When considering the present disclosure, those skilled in the art will know that this compromise can be selected in order to maximize the performance of the apparatus 100 for a given situation.

[0160] In some embodiments, even with a pin-based cycloidal constraint (such as Fig.22A and Fig.23 Although the apparatus 100 may be constructed with a plurality of teeth, the apparatus 100 may still exhibit undesirable instability due to manufacturing tolerance stack-ups, even when the apparatus 100 is constructed with a plurality of teeth, the apparatus 100 may be constructed with a plurality of teeth, the plurality of teeth being disposed in a plurality of positions, and the plurality of teeth being disposed in a plurality of positions. In some embodiments, the apparatus 100 may be constructed with a plurality of teeth, the plurality of teeth being disposed in a plurality of positions, and the plurality of teeth being disposed in a plurality of positions. In some embodiments, the apparatus 100 may be constructed with a plurality of teeth, the plurality of teeth being disposed in a plurality of positions, and the plurality of teeth being disposed in a plurality of positions. FIG. 24A to FIG. 24H and FIG. 25A to FIG. 25H The illustrated embodiment of the instrument 100 includes an example of a tooth-based cycloidal constraint.

[0161] In some embodiments, in order to address the disadvantages associated with preventing the drive pins 128, 130 from overlapping rather than limiting the ability of the drive pins 128, 130 to overlap and cross, the instrument 100 may include a slot constraint. Even when the drive pins 128, 130 overlap, the slot constraint can prevent or reduce instability in the instrument 100. As will be described in more detail below, the slot constraint can be formed as a groove or slot between two ears. When the drive pins 128, 130 overlap to align and cross, the ears of the slot constraint can abut and contact the center pins of the pulleys 122, 124, thereby preventing undesired rotation of the first jaw member 118 and the second jaw member 120. Because the drive pins can cross, these designs can include unique features because they can obtain greater force advantages than designs that limit or prevent the drive pins 128, 130 from crossing. In addition, these designs can provide unique force distribution curves, in which the gripping force is highest when the grip is closed (see below Fig. 27 and corresponding description). FIG. 24A to FIG. 24H An embodiment including a slot constraint is shown.

[0162] FIG. 24A to FIG. 24H A view of an embodiment of a high force instrument 100 including a gear constraint (configured as a tooth-based cycloidal constraint) and a slot constraint is shown. Fig.24A is a front view of the device 100 in the open position, Fig. 24B is an exploded view of the device 100, Fig.24C is a side view of the device 100, Fig.24D is a rear view of the device 100 in the open position, and Fig.24E is a bottom cross-sectional view of the instrument 100 through the center pin. FIG. 24F to FIG. 24H The drive pins 128, 130 are shown intersecting as the instrument 100 moves from the open position to the closed position.

[0163] like Fig. 24BAs best shown in the exploded view of , the instrument 100 includes a first jaw member 118, which can be constructed as shown. For example, the first jaw member 118 can include a first drive pin 128 positioned at the proximal end of the first jaw member 118. Alternatively, the first drive pin 128 can be formed as a part of the first pulley 122 or as a separate piece as described above. The first jaw member 118 can also include a hole or opening 166 that provides a site line leading to the junction of the first connector pin 132 and the opening 162 (discussed below) so that the components can be laser welded together if necessary. Additional holes, openings, grooves or pits (not shown) can be formed on the inner surface of the first jaw member 118 to engage the pin 132. The first jaw member 118 can also include a recess 171 formed by an upper surface 172 and a lower surface 170. As will be described below, upper surface 172 and lower surface 170 forming the first recess will engage with corresponding features on second jaw member 120 to form a gear constraint or a tooth-based cycloidal constraint (see, e.g., Fig.24A ). First jaw member 118 may further include a slot 186. Slot 186 may be configured to receive an end of first piece 153 of connector 126.

[0164] The second jaw member 120 may include a second drive pin 130 positioned at the proximal end of the second jaw member 120. Alternatively, the second drive pin 130 may be formed as part of the second pulley 124 or as a separate piece as described above. The second jaw member 120 may also include an opening 168 configured to receive the second connector pin 134. The second jaw member 120 may also include teeth 175 having an upper surface 174 and a lower surface 176. As will be described below, the upper surface 174 and the lower surface 176 of the teeth 174 will engage with corresponding feature structures on the first jaw member 118 to form a gear constraint or a tooth-based cycloidal constraint (see, e.g., Fig.24A ). The second jaw member 120 may also include a slot 188. The slot 188 may be configured to receive an end of the second piece 154 of the connector 126. In some embodiments, the tooth 175 includes an extension or protrusion that may appear as a triangular fin. In other embodiments, the tooth 175 includes an extension or protrusion in another shape, such as a spike shape. The groove or notch 171 that receives the tooth 175 is large enough to provide clearance for the tooth 175 when the jaw members 118, 120 are opened and closed. In some embodiments, a cycloidal constraint is formed so that during the opening and closing of the jaw members, the lower surface 170 of the notch 171 remains in contact with the lower surface 174 of the tooth 175, and the upper surface of the notch 172 remains in contact with the upper surface 176 of the tooth 175.

[0165] The first pulley 122 may include a pulley shaft opening 178. The pulley shaft opening is configured to fit over the pulley pin 160. The pulley pin 160 may be aligned with the pulley shaft 112 (as described above). The first pulley 122 rotates around the pulley pin 160. The first pulley 122 may also include a hole 180 for receiving the first drive pin 128. Similarly, the second pulley 124 may include a pulley shaft opening 182 that is configured to fit over the pulley pin 160 to allow the second pulley 124 to rotate around the pulley pin 160. The second pulley 124 may also include a hole 184 for receiving the second drive pin 130.

[0166] exist FIG. 24A to FIG. 24H In the embodiment of the present invention, connector 126 is formed by first piece 153 and second piece 154. First piece 153 includes opening 162 for receiving first connector pin 132 therethrough. The portion of first piece 153 including opening 162 can be configured to be received in slot 186 of first jaw member 118 so that first connector pin 132 can extend through opening 162 in the first piece and into or through opening 166 in first jaw member 118. Fig. 24B As shown, the first piece 153 of the connector 126 may also include a second connector pin 134. In some embodiments, the second connector pin 134 is integrally formed with the first piece 153. In other embodiments, the second connector pin 134 may be a separate piece or integrally formed with the second jaw member 120. The first piece 153 of the connector 126 also includes an ear 156 as shown. The ear 156 may be formed as a downward protrusion or projection. As will be discussed below, when assembled, the inner surface of the ear 156 may contact the pulley pin 160 to prevent or reduce instability in the instrument 100 when the drive pins 128, 130 are aligned.

[0167] As described above, connector 126 may be formed from first piece 153 and second piece 154. Second piece 154 may include opening 164 for receiving second connector pin 134 therethrough. The portion of second piece 154 including opening 164 may be configured to be received in slot 188 of second jaw member 120 such that second connector pin 134 may extend through opening 164 in second piece 154 and into or through opening 168 in second jaw member 120. Fig. 24B14. As shown, the second piece 154 of the connector 126 may also include the first connector pin 132. In some embodiments, the first connector pin 132 is integrally formed with the second piece 154. In other embodiments, the first connector pin 132 may be a separate piece or integrally formed with the first jaw member 118. The second piece 154 of the connector 126 also includes an ear 158 as shown. The ear 158 may be formed as a downward protrusion or projection. As will be discussed below, when assembled, the inner surface of the ear 158 may contact the pulley pin 160 to prevent or reduce instability in the instrument 100 when the drive pins 128, 130 are aligned.

[0168] For example Fig.24A As shown, when assembled, the teeth 175 of the second jaw member 120 are received in the grooves or recesses 171 of the first jaw member 118. This interaction between the first jaw member 118 and the second jaw member 120 provides a gear constraint or a tooth-based cycloidal constraint for the instrument 100. The constraint can constrain the movement of the first jaw member 118 to the second jaw 120, similar to the above reference to Fig.22A and Fig.23 The pin-based cycloidal constraint described above. The constraint may also improve the stability of the instrument 100 by, for example, preventing or reducing parallel motion between the first jaw member 118 and the second jaw member 120. In some embodiments, an advantage of this constraint is that it may be less susceptible to manufacturing tolerance errors than other types of constraints (such as pin-based cycloidal constraints). In other embodiments, more than one tooth (e.g., a first tooth and a second tooth) may be provided between the first jaw member and the second jaw member to provide a tooth-based gear constraint.

[0169] Additionally, when assembled, the instrument 100 may include a slot constraint configured to prevent instability when the drive pins 128, 130 are aligned. This may mean FIG. 24A to FIG. 24H Embodiments of can be advantageously used in designs that allow the drive pins 128, 130 to overlap or cross. By having the drive pins 128, 130 overlap or cross, the pulley can perform more work, thereby producing the desired greater force output. Fig.24A , Fig.24D and Fig.24EAs shown, pulley pin 160 is received between first jaw member 118 and ear 156 of first piece 153 of connector 126. Similarly, pulley pin 160 is also received between second jaw member 120 and ear 158 of second piece 154 of connector 126. In some embodiments, ears 156, 158 of first piece 153 and second piece 154 of connector 126 form a slot or channel. Pulley pin 160 rides within and contacts the channel during movement of instrument 100. This contact provides an added point of stability, which can stabilize instrument 100 when drive pins 128, 130 overlap.

[0170] FIG. 24F to FIG. 24H The function of the slot constraints (formed by the ears 156 , 158 and the pulley pin 160 ) to stabilize the instrument 100 is shown as the drive pins 128 , 130 overlap and intersect during movement of the instrument 100 . FIG. 24F to FIG. 24H Various stages during the closing movement of the instrument 100 are shown. Fig.24F 1, first jaw member 118 and second jaw member 120 are shown in an open position, and first drive pin 128 is located to the right of second drive pin 130 (relative to the orientation shown in the figure). Instrument 100 is in a relatively stable position because drive pins 128, 130 are spaced apart. The position is further stabilized by the additional contact of pulley pin 160 with the slot formed between ears 156, 158.

[0171] As the device 100 is further closed to Figure 24G In the position shown, the drive pins 128 and 130 begin to overlap and cross. Specifically, the first drive pin 128 has been Fig.24F Rotate clockwise to Figure 24G and the second drive pin 130 has moved from Fig.24F Rotate counterclockwise to Figure 24G At this location ( Figure 24G ), with the drive pins 128, 130 overlapping as shown, the instrument 100 would be in a relatively unstable position without the slot constraint formed by the pulley pin 160 and the ears 158, 156. That is, in the absence of the slot constraint, the instrument 100 may tend to rotate about the axis of the aligned drive pins 128, 130. However, the slot constraint advantageously stabilizes the instrument 100 from such movement. For example, contact between the pulley pin 160 and the ears 156 prevents the instrument from rotating in a clockwise direction, and contact between the pulley pin 160 and the ears 158 prevents the instrument from rotating in a counterclockwise direction.

[0172] like Fig.24HAs shown, as the instrument 100 is further closed, the drive pins 128, 130 rotate past each other. For example, the first drive pin 128 is now positioned to the left of the second drive pin 130. Again, this position is relatively stable because the drive pins 128, 130 are separated and the slot constraint provides additional stability.

[0173] Consider the position of the pulley pin 160, where the slot is formed in FIG. 24F to FIG. 24H Between the ears 156 , 158 , it can be seen that in some embodiments, the pulley pin 160 moves along the narrow slot during movement of the instrument 100 .

[0174] FIG. 24A to FIG. 24H The embodiment of the device 100 shown expands upon the force amplification and constraint concepts described above with reference to previous embodiments by including both a gear constraint (e.g., a tooth-based cycloidal constraint) and a slot constraint. In some cases, these two constraints may impose limitations on the range of motion of the pulley, but advantageously, such limitations may occur at different angles. These two constraints may be implemented together, so that one may have a configuration that includes two constraints (e.g., a tooth-based cycloidal constraint). FIG. 24A to FIG. 24H By using two constraints, the range of motion of the pulleys 122, 124 can be extended to almost twice the range of motion of the embodiment that limits the drive pin crossing. This in turn increases the amount of force that can be delivered for a given range of motion. Having these two constraints reduces the instability to about the minimum of either constraint at any angle.

[0175] FIG. 25A to FIG. 25H An embodiment of the instrument 100 is shown that includes two constraints as described above, but reduces the overall number of components in the instrument 100. Such an embodiment may advantageously simplify the manufacture and assembly of the instrument 100. Fig.25A and Fig.25B Views of the device 100 are shown in an open configuration and a closed configuration, respectively. Fig.25C An embodiment of a housing 190 that serves as the connector 126 of the device 100 is shown. Fig.25D A view of either the first jaw member 118 or the second jaw member 120 is shown. FIG. 25E to FIG. 25H Stages during an exemplary assembly process of device 100 are shown.

[0176] like Fig.25A and Fig.25B shown, and in Fig.25C 1, the device 100 includes a connector 126 formed as a single housing 190. Fig.25CAs best seen in FIG. 1 , housing 190 may include first and second bearing surfaces 192, 194. Each of first and second bearing surfaces 192, 194 may be formed as a rod or cylinder extending across housing 190. As will be described below, bearing surfaces 192, 194 provide a pivot point on which first and second jaw members 118, 120 may pivot. In some aspects, the first and second bearing surfaces replace first and second connector pins 132, 134 in the aforementioned embodiments.

[0177] The housing 190 may also include a slot 195 as shown. The slot 195 may be configured to engage the pulley pin 160 to form the slot constraint described above. The slot constraint may provide stability to the instrument 100 when the drive pins 128, 130 are aligned.

[0178] In some embodiments, the housing 190 advantageously provides FIG. 24A to FIG. 24H The first piece 153 and the second piece 154 of the connecting member 126 of the embodiment have the same function. This can advantageously reduce the complexity of the design.

[0179] Fig.25D An embodiment of a jaw member (first jaw member 118 or second jaw member 120) is shown. Fig.25D , the features are numbered twice to describe both first jaw member 118 and second jaw member 120. As shown, jaw members 118, 120 include teeth 175 that are configured to engage corresponding grooves 171 on opposing jaw members. The interaction between teeth 175 and grooves 171 provides a gear constraint (or a tooth-based cycloidal constraint) as described above.

[0180] Jaw members 118, 120 also include grooves 196, 198. Grooves 196, 198 are configured to receive bearing surfaces 192, 194 of housing 190. For example, when assembled ( Fig.25A and Fig.25B ), groove 196 of first jaw member 118 receives first bearing surface 192 to allow first jaw member 118 to pivot about first bearing surface 192. Similarly, groove 198 of second jaw member 120 receives second bearing surface 194 to allow second jaw member 120 to pivot about second bearing surface 194.

[0181] like Fig.25A and Fig.25B As shown, the teeth 175 and grooves 171 provide a gear constraint (or a tooth-based cycloidal constraint), and the slots 195 and pulley pins 160 provide a slot constraint. FIG. 25A to FIG. 25H Embodiments of the apparatus 100 may provide the same FIG. 24A to FIG. 24HThe same advantages as the embodiment of the apparatus 100. In addition, FIG. 25A to FIG. 25H The total number of components of an embodiment of the apparatus 100 is reduced.

[0182] FIG. 25E to FIG. 25F 100. As shown, the first jaw member 118 and the second jaw member 120 can be positioned above the housing 190 ( Fig.24E ). First jaw member 118 and second jaw member 120 can be dropped into housing 190 and rotated, such as Fig.25F As shown. Figure 25G As shown, the first jaw member 118 and the second jaw member 120 can then be further lowered so that the grooves 196, 198 formed in the rear of the first jaw member 118 and the second jaw member 120 are concentric with the support surfaces 192, 194 of the housing. The first jaw member 118 and the second jaw member 120 are further rotated from this position to Fig.25H 106 and 107. The positions of the wrist 106 and the wrist 106 are such that they are held in place by the housing 190. Although not shown, the assembly may also include additional steps, such as attaching the pulleys 122, 124 and attaching to the wrist 106.

[0183] return Fig.25A and Fig.25B In some embodiments, the first jaw member 118 is constrained throughout the range of motion by the second jaw member 120 and the bearing surfaces 192, 194 of the housing 190. Once the assembly is installed in the distal fork of the wrist 106, the range of motion can be limited to a working range of motion that can be less than the angle required for disassembly.

[0184] FIG. 25A to FIG. 25B The instrument 100 shown has the advantage of fewer parts and can be made smaller than other embodiments. In some cases, another advantage of this embodiment is that when the slot 195 engages with either side of the pin 160 at each side of the jaws, the slot 195 can provide greater stability through tolerance issues, which prevents the wrist from having a torsional slope. Generally speaking, other assembly methods require additional parts or additional machining operations to ensure that the gripping member remains in its correct pivot, and then a swaging or laser welding process is performed to join them together. The instrument 100 constrains the jaw member to the correct position within the range of motion used by the mechanism, but allows the assembly of parts when the jaw member is excessively rotated. This has benefits in the surgical instrument top because when the connector 126 is a one-piece housing 190, it can be made smaller than other embodiments. Therefore, in some embodiments, the connector 126 can be stronger and have higher tolerances because it is a single structure. Reduced component count and shortened assembly time can reduce costs. Even if the connector 126 is made of multiple pieces, some of these benefits can still be achieved.

[0185] The teeth in any of the above embodiments need not be cycloid.In some embodiments, the teeth may include some other profile, including involute.

[0186] B. Determine the Mechanical Advantage / Magnification of High-Force Devices

[0187] This section discusses how the mechanical advantage of the high force instrument 100 described above can be determined. At a high level, the magnification is the ratio between the input range of motion and the output range of motion. For the instrument 100 described above, the input range of motion can be related to the geometry and size of the pulleys, and the output range of motion can be related to the geometry and size of the jaw members.

[0188] When determining the mechanical advantage and amplification of these robotically controlled high-force instruments 100, one metric to consider is the effective pulley diameter. The high-force instrument 100 can be abstracted as a mechanism that generates an output torque on a pair of jaw members by tension applied via a pull line or cable. The simplest way to generate an output torque on the pair of jaw members is to attach the jaw members directly and rigidly to a pulley. However, this architecture is limited in the amount of torque it can provide by the diameter of the pulley, which can be adapted to the diameter of the shaft / tube through which it passes. Therefore, it is desirable to have a mechanism that can provide a mechanical advantage that is superior to a simple pulley.

[0189] The mechanical advantage can be determined by calculating the pulley diameter that would be required to produce an equivalent holding (output) torque. This is called the effective diameter d 有效 , and can be determined by Formula 1:

[0190]

[0191] where d 有效 is the effective diameter, τ 抓持 is the holding (output) torque, and F is the input torque. Fig.26A , the gripping torque is related to the geometry of the jaw members by Equation 2:

[0192] τ 抓持 =F 抓持 *h2 (Formula 2)

[0193] Therefore, the effective diameter can be determined by Equation 3:

[0194]

[0195] where F 缆线 is the tension in the cable acting on the pulley, such as Fig.26B shown.

[0196] Fig. 27A representative force profile for one embodiment of a high force instrument 100 that can have drive pins that cross is shown (e.g., similar to FIG. 24A to FIG. 24H and FIG. 25A to FIG. 25H The force profiles shown are for an instrument 100 having an 8 mm wrist and a 6.7 mm drive pulley.

[0197] The force distribution curve shows the change of the effective pulley diameter of the instrument 100 with the grip opening angle. As shown in the figure, when the grip (jaw member) is almost closed (0 degree opening angle), the effective pulley diameter is about 26mm. Since the diameter of the drive pulley is 6.7mm, we can achieve a mechanical advantage of 3.88 times (26mm / 6.7mm) of the force that can be achieved using a simple lever and pulley system. As the grip angle increases (for example, increases to 40 degrees), the effective pulley diameter decreases, so that at 40 degrees, the mechanical advantage is about 3.28 times (22mm / 6.7mm) of the force that can be achieved using a simple lever and pulley system. Therefore, the mechanical advantage that we can achieve is at least 3 times or more of the force that can be achieved using a simple pulley and lever system. In addition, the force distribution curve shows that our dual drive pin design is unique because it allows the drive pin to cross so that the grip can be the most difficult to grip at the closed angle (zero degree grip opening angle).

[0198] 3. Implement systems and terminology .

[0199] Embodiments disclosed herein provide systems, methods, and apparatus for robotically enabled medical systems.Various embodiments described herein include robotically enabled medical systems with high-force instruments.

[0200] It should be noted that as used herein, the terms "couple", "coupling", "coupled" or other variations of the word coupled may indicate an indirect connection or a direct connection. For example, if a first component is "coupled" to a second component, the first component may be indirectly connected to the second component via another component or directly connected to the second component.

[0201] The position estimation and robot motion actuation functions described herein may be stored as one or more instructions on a processor-readable or computer-readable medium. The term "computer-readable medium" refers to any available medium that can be accessed by a computer or processor. By way of example and not limitation, such a medium may include a random access memory (RAM), a read-only memory (ROM), an electrically erasable programmable read-only memory (EEPROM), a flash memory, a compact disk read-only memory (CD-ROM) or other optical disk storage devices, a magnetic disk storage device or other magnetic storage device, or any other medium that can be used to store the desired program code in the form of an instruction or data structure and can be accessed by a computer. It should be noted that a computer-readable medium may be tangible and non-transient. As used herein, the term "code" may refer to software, instructions, code or data that can be executed by a computing device or processor.

[0202] The method disclosed herein includes one or more steps or actions for implementing the method. The method steps and / or actions may be interchangeable with each other without departing from the scope of the claims. In other words, unless the correct operation of the method being described requires a specific order of steps or actions, the order and / or use of specific steps and / or actions may be modified without departing from the scope of the claims.

[0203] As used herein, the term "plurality" means two or more. For example, a plurality of components indicates two or more components. The term "determine" encompasses a variety of actions, and thus, "determine" may include calculating, computing, processing, deriving, investigating, searching (e.g., searching in a table, a database, or another data structure), ascertaining, etc. Additionally, "determine" may include receiving (e.g., receiving information), accessing (e.g., accessing data in a memory), etc. Additionally, "determine" may include parsing, selecting, choosing, establishing, etc.

[0204] Unless explicitly stated otherwise, the phrase “based on” does not mean “based only on.” In other words, the phrase “based on” describes both “based only on” and “based at least on.”

[0205] As used herein, the term "about" or "approximately" refers to a measurement range of a length, thickness, amount, time period, or other measurable value. Such measurement ranges encompass variations of + / -10% or less, preferably + / -5% or less, more preferably + / -1% or less, and still more preferably + / -0.1% or less relative to the specified value, as long as such variations are appropriate in order to function in the disclosed devices, systems, and techniques.

[0206] The foregoing specific embodiments of the disclosed specific implementations are provided to enable any person skilled in the art to make or use the present invention. Various modifications to these specific implementations will be apparent to those skilled in the art, and the general principles defined herein may be applied to other specific implementations without departing from the scope of the present invention. For example, it should be understood that one of ordinary skill in the art will be able to adopt a plurality of corresponding alternatives and equivalent structural details, such as equivalent ways of fastening, mounting, coupling or engaging tool parts, equivalent mechanisms for producing specific actuating motions, and equivalent mechanisms for delivering electrical energy. Therefore, the present invention is not intended to be limited to the specific implementations shown herein, but is given the widest scope consistent with the principles and novel features disclosed herein.

Claims

1. A robot system, comprising: An instrument having an end effector, the instrument comprising: a first pulley configured to rotate about a pulley axis; a first jaw member connected to the first pulley via a first drive pin; a second pulley configured to rotate about the pulley axis; a second jaw member connected to the second pulley by a second drive pin; and a connecting member providing a first pivot point about which the first jaw member is pivotable and a second pivot point about which the second jaw member is pivotable, wherein during rotation of the first pulley and the second pulley, the first drive pin is capable of rotating past the second drive pin, wherein the robotic system further comprises a gear constraint configured to constrain movement of the first jaw member and the second jaw member so that movement of one of the first jaw member and the second jaw member causes substantially corresponding movement of the other of the first jaw member and the second jaw member, wherein the robotic system further comprises a slot constraint configured to prevent or reduce a risk of the end effector rotating about the first drive pin and the second drive pin when the first drive pin and the second drive pin are aligned, The slot constraint includes: a first ear; a second ear spaced apart from the first ear to form a slot therebetween; and a pin extending along the pulley shaft and positioned within the slot.

2. The robotic system of claim 1, further comprising a robotic arm coupled to the instrument.

3. The robotic system according to claim 1, wherein: Rotation of the first pulley causes rotation of the first drive pin about the pulley axis, thereby further causing the first jaw member to pivot about the first pivot point; and Rotation of the second pulley causes rotation of the second drive pin about the pulley axis, thereby further causing the second jaw member to pivot about the second pivot point.

4. The robot system according to claim 1, wherein the gear constraint comprises a cycloid constraint, the cycloid constraint comprising: teeth formed on one of the first jaw member and the second jaw member; and A notch is formed on the other of the first jaw member and the second jaw member.

5. The robotic system of claim 1 , wherein the gear constraint comprises a pin extending along an axis through the first jaw member and the second jaw member, wherein the pin is configured to straddle a slot formed in at least one of the first jaw member and the second jaw member.

6. The robotic system of claim 1, wherein the first ear and the second ear are each coupled to the connector. 7 . The robotic system of claim 1 , wherein the first pulley and the second pulley are rotatable to a position where the first drive pin and the second drive pin are aligned.

8. The robotic system of claim 1, wherein: The connector includes a housing including a first support surface spaced apart from a second support surface; the first jaw member comprising a first groove configured to pivot on the first bearing surface to form the first pivot point; and The second jaw member includes a second groove configured to pivot on the second bearing surface to form the second pivot point.

9. The robotic system of claim 1, wherein the end effector is configured as a grasper, a cutter, or a clamp.

10. The robotic system of claim 1, wherein: a first connection comprising a first distance between the pulley axis and a point at which an input force is applied by a cable wrapped around the first pulley; a second connection comprising a second distance between the pulley shaft and the axis of the first drive pin; a third connection comprising a third distance between the axis of the first drive pin and the axis of the first pivot point; The fourth connection comprises a fourth distance between the axis of the first pivot point and the distal end of the first jaw member.

11. The robotic system of claim 10, wherein: The first distance of the first connecting member is between 3 mm and 4 mm; The second distance of the second connecting member is between 2 mm and 3 mm; The third distance of the third connecting member is between 7 mm and 8 mm; and The fourth distance of the fourth connecting member is between 17 mm and 23 mm.

12. The robotic system of claim 10, wherein: The first distance of the first connector is about 3.35 mm; The second distance of the second connector is about 2.5 mm; The third distance of the third connecting member is about 7.3 mm; and The fourth distance of the fourth connecting member is about 20 mm.

13. The robotic system of claim 10, wherein: a first ratio between the second distance of the second connector and the first distance of the first connector being between 0.5 and 1.25; A second ratio between the third distance of the third connector and the first distance of the first connector is between 1.5 and 3.5; and A third ratio between the fourth distance of the fourth connector and the first distance of the first connector is between 1.5 and 20.

14. The robotic system of claim 10, wherein: a first ratio between the second distance of the second connector and the first distance of the first connector of about 0.75; A second ratio between the third distance of the third connector and the first distance of the first connector is about 2.18; and A third ratio between the fourth distance of the fourth connector and the first distance of the first connector is approximately 6.

15. A robot system comprising: A medical device comprising an end effector configured to be inserted into a patient during a medical procedure, the medical device comprising: First pulley; a first jaw member connected to the first pulley via a first drive pin; Second pulley; a second jaw member connected to the second pulley via a second drive pin; a connector providing a first pivot point about which the first jaw member is pivotable and a second pivot point about which the second jaw member is pivotable; and Gear constraint and slot constraint, wherein the gear constraint comprises a cycloidal constraint configured to constrain movement of the first jaw member and the second jaw member such that movement of one of the first jaw member and the second jaw member causes substantially corresponding movement of the other of the first jaw member and the second jaw member, wherein the gear constraint includes teeth formed on one of the first jaw member and the second jaw member, and a notch formed on the other of the first jaw member and the second jaw member, wherein the end effector comprises the slot constraint, wherein the slot constraint is configured to prevent the end effector from rotating about the first drive pin and the second drive pin when the first drive pin and the second drive pin are aligned, and The slot constraint includes: a first ear; a second ear spaced apart from the first ear to form a slot therebetween; and a pin extending along the pulley shaft and positioned within the slot.

16. The system of claim 15, wherein the end effector is connected to a robotic arm and controlled by a processor of the system.

17. The system of claim 15, wherein the end effector and at least a portion of the medical device are configured to fit through a patient opening that is less than 14 mm.

18. The system of claim 15, wherein the end effector and at least a portion of the medical device are configured to fit through a patient opening that is less than 10 mm.

19. The system of claim 15, wherein the end effector is connected to the distal end of the medical device by a wrist having at least two degrees of freedom.

20. The system of claim 15, further comprising: one or more cables connected to the first pulley, wherein pulling the one or more cables connected to the first pulley causes the first pulley to rotate; as well as One or more cables connected to the second pulley, wherein pulling the one or more cables connected to the second pulley causes the second pulley to rotate.

21. The system of claim 20, wherein: (i) the one or more cables connected to the first pulley and (ii) the one or more cables connected to the second pulley extend through the medical device; The medical device is attached to a device drive mechanism; and The instrument drive mechanism is configured to pull (i) the one or more cables connected to the first pulley and (ii) the one or more cables connected to the second pulley to actuate the end effector.

Images