Medical instrument for performing a minimally invasive procedure

Abstract

An apparatus for performing minimally invasive procedures, the apparatus comprising: a shaft having a distal end and a proximal end; a handle attached to the proximal end of the shaft; and an end actuation device attached to the distal end of the shaft; wherein the shaft includes a flexible portion, a first joint portion, and a second joint portion, wherein the flexible portion extends distally from the handle, the first joint portion extends distally from the flexible portion, and the second joint portion extends distally from the first joint portion; wherein at least one joint cable extends from the handle to the first joint portion such that the first joint portion deflects when tension is applied to the at least one joint cable; wherein a plurality of joint cables extend from the handle to the second joint portion such that the second joint portion deflects when tension is applied to at least one of the plurality of joint cables.

Description

[0001] Reference to pending prior patent applications

[0002] The patent application:

[0003] (1) is a partial continuation-of-part of a prior U.S. patent application filed on October 20, 2016, by Lumendi Ltd. and Jonathan O'Keefe et al., Serial No. 15 / 298,605, concerning Medical Instruments for Performing Minimally Invasive Procedures (Attorney File No. LUMENDI-051114), which claims the benefit of: (i) a prior U.S. provisional patent application filed on October 20, 2015, by Lumendi Ltd. and Jonathan O'Keefe et al., Serial No. 62 / 244,026, concerning Medical Instruments for Performing Minimally Invasive Procedures (Attorney File No. LUMENDI-5 PROV); and (ii) a prior U.S. provisional patent application filed on October 20, 2015, by Lumendi Ltd. and Jonathan O'Keefe et al., Serial No. 62 / 244,026; and (ii) a prior U.S. provisional patent application filed on October 20, 2015, by Lumendi Ltd. and Jonathan O'Keefe et al., Serial No. 62 / 244,026; and (ii) a prior U.S. provisional patent application filed on October 20, 2016, by Lumendi Ltd. and Jonathan O'Keefe et al. O'Keefe et al. filed a prior U.S. provisional patent application, serial number 62 / 400,759, on September 28, 2016, concerning medical devices for performing minimally invasive procedures (Attorney's file number LUMENDI-1114 PROV); and

[0004] (2) To claim the benefit of the prior pending U.S. provisional patent application filed on September 30, 2019, by Lumendi Ltd. and Amos Cruz et al., serial number 62 / 908,033, concerning MEDICAL INSTRUMENTS FOR PERFORMING MINIMALLY-INVASIVE PROCEDURES (Attorney File No. LUMENDI-25 PROV).

[0005] The four (4) patent applications mentioned above are thus incorporated herein by reference. Technical Field

[0006] The invention generally relates to medical devices, and more particularly to medical devices for performing minimally invasive procedures. Background Technology

[0007] Minimally invasive medical procedures have become commonplace. In a typical minimally invasive procedure, access to internal sites is achieved through one or more small incisions (e.g., natural body openings, small incisions in the skin, etc.). Observational devices (e.g., colonoscopes, arthroscopes, endoscopes, etc.) are inserted through these incisions to provide visualization of the internal sites, and then one or more medical instruments are inserted through the same incision (e.g., via an internal channel in the observation device) or through another incision, allowing the medical instruments to be used to perform operations at the internal sites under the visualization provided by the observation device.

[0008] In many cases, access to internal parts can be difficult due to anatomical limitations, equipment limitations, etc. As an example, and not a limitation, in many cases, a medical device may need to advance through the internal channels of an observation device to reach an internal part, or it may need to advance to an internal part adjacent to the observation device and then curve (e.g., along a short radius) to enter the field of view of the observation device so that the required procedure can be performed under the visualization provided by the observation device. Furthermore, in many cases, the path of advancement of the medical device may be tortuous (e.g., within the lumen of the colon). In this case, it is necessary for the medical device to be highly flexible, capable of articulating with a series of different movements, and configured for precise control, while operating only from the handle end (i.e., the proximal end) of the medical device (e.g., along a tortuous path). In practice, this is extremely difficult to achieve.

[0009] The present invention aims to provide a novel medical device with such functionality. Summary of the Invention

[0010] This invention includes a novel medical device for performing minimally invasive procedures. The novel medical device is highly flexible, capable of joint movement in a range of different motions, and configured for precise control while being operated only from the handle end of the medical device (e.g., along a zigzag path).

[0011] The novel medical device generally comprises a handle and a shaft extending distally from the handle. The shaft generally comprises an elongated, flexible proximal portion and a distal articulated portion attached to the distal end of the flexible proximal portion. An end effector is attached to the distal end of the distal articulated portion. The end effector can take many different forms (e.g., gripper, injection needle, scissors, heated snare, monopolar probe, hemostatic clip, bipolar forceps, suction tube, single or multiple closure devices (such as anastomosing devices and trackers), dissecting forceps, retrieval basket, monopolar scissors, light source, camera, etc.). For clarity, the end effector is shown as a gripper in the figure. The handle can take any of many different forms (e.g., pistol grip, shaft grip, etc.). For clarity, the handle is shown as a pistol grip in the figure.

[0012] According to the invention, the flexible proximal portion of the shaft is configured as a highly flexible element capable of extending a significant length (e.g., 95cm-140cm) along a tortuous path, the distal articulated portion of the shaft is configured to be omnidirectionally movable relative to the distal end of the flexible proximal portion of the shaft, and the end effector is configured to selectively rotate and selectively actuate relative to the distal end of the distal articulated portion, wherein all functions can be performed by a user with one hand via a handle. In a preferred embodiment of the invention, the substantially entire shaft of the medical device is flexible, wherein the portion of the shaft near the transition point (i.e., the flexible proximal portion) is passively flexible (e.g., capable of following a tortuous path), and the portion of the shaft away from the transition point (i.e., the distal articulated portion) is actively flexible (e.g., capable of omnidirectionally movable to a desired configuration).

[0013] As will be described in further detail below, the novel medical device is capable of performing at least the following movements:

[0014] Motion 1 - The end control device moves longitudinally by the longitudinal movement of the handle (sometimes referred to as "longitudinal movement function" below);

[0015] Motion 2 - The end control device rotates by rotating the handle (sometimes referred to below as "torsional motion function");

[0016] Movement 3 - The end effector is articulated relative to the handle by moving the distal articulated portion of the shaft relative to the distal articulated portion of the flexible proximal portion of the shaft (sometimes referred to as "universal joint function" below).

[0017] Movement 4 - Rotational movement of the distal end of the end-effector relative to the axis by rotating the end-effector relative to the axis (sometimes referred to below as "rotational function"); and

[0018] Movement 5 - Actuation of the end-effector, for example, selectively moving the elements of the end-effector relative to each other to perform a medical procedure, such as opening and closing the jaws of a gripper-type end-effector (sometimes referred to below as "jaw opening / closing function").

[0019] In a preferred embodiment of the invention, an apparatus for performing a minimally invasive procedure is provided, the apparatus comprising:

[0020] The tool includes:

[0021] A shaft having a distal end and a proximal end;

[0022] A shank, which is attached to the proximal end of the shaft; and

[0023] An end control device is attached to the distal end of the shaft;

[0024] The shaft includes a flexible portion extending distally from the proximal end of the shaft, and an articulated portion extending proximally from the distal end of the shaft, wherein the articulated portion includes a flexible spine.

[0025] Multiple articulated cables extend from the handle through an axis to the flexible spine, each of the multiple articulated cables having an articulated cable housing disposed around the articulated cable, such that when tension is applied to at least one of the multiple articulated cables, the flexible spine bends, wherein the articulated cable housing provides a reaction force to the flexible spine.

[0026] The rotatable element extends from the handle through a shaft to the end actuating device, such that when the rotatable element rotates, the end actuating device rotates; and

[0027] The actuating element extends from the handle through a shaft to the end control device, such that when the actuating element moves, it actuates the end control device.

[0028] In another preferred embodiment of the invention, a method for performing a minimally invasive procedure is provided, the method comprising:

[0029] Obtain a device for performing minimally invasive procedures, the device comprising:

[0030] The tool includes:

[0031] A shaft having a distal end and a proximal end;

[0032] A shank, which is attached to the proximal end of the shaft; and

[0033] An end control device is attached to the distal end of the shaft;

[0034] The shaft includes a flexible portion extending distally from the proximal end of the shaft, and an articulated portion extending proximally from the distal end of the shaft, wherein the articulated portion includes a flexible spine.

[0035] Multiple articulated cables extend from the handle through an axis to the flexible spine, each of the multiple articulated cables having an articulated cable housing disposed around the articulated cable, such that when tension is applied to at least one of the multiple articulated cables, the flexible spine bends, wherein the articulated cable housing provides a reaction force to the flexible spine.

[0036] The rotatable element extends from the handle through a shaft to the end actuating device, such that when the rotatable element rotates, the end actuating device rotates; and

[0037] The actuating element extends from the handle through a shaft to the end actuating device, such that when the actuating element moves, it actuates the end actuating device; and

[0038] Use this device to perform minimally invasive procedures.

[0039] In another preferred embodiment of the invention, an apparatus for performing a minimally invasive procedure is provided, the apparatus comprising:

[0040] The tool includes:

[0041] A shaft having a distal end and a proximal end;

[0042] A shank, which is attached to the proximal end of the shaft; and

[0043] An end control device is attached to the distal end of the shaft;

[0044] The shaft includes a flexible portion extending distally from the proximal end of the shaft, and an articulated portion extending proximally from the distal end of the shaft, wherein the articulated portion includes a flexible spine.

[0045] Multiple articulated cables extend from the stem through the shaft to the flexible spine, such that when tension is applied to at least one of the multiple articulated cables, the flexible spine bends.

[0046] The rotatable element extends from the handle through a shaft to the end actuation device, such that when the rotatable element rotates, the end actuation device rotates. The rotatable element includes a hollow tubular structure extending distally from the handle, formed of multiple filaments wound and forged together. Furthermore, the rotatable element also includes a laser-cut hypotube fixed to the hollow tubular structure, such that when the hollow tubular structure is rotated, the laser-cut hypotube also rotates.

[0047] The actuating element extends from the handle through a shaft to the end control device, such that when the actuating element moves, it actuates the end control device.

[0048] In another preferred embodiment of the invention, a method for performing a minimally invasive procedure is provided, the method comprising:

[0049] Obtain a device for performing minimally invasive procedures, the device comprising:

[0050] The tool includes:

[0051] A shaft having a distal end and a proximal end;

[0052] A shank, which is attached to the proximal end of the shaft; and

[0053] An end control device is attached to the distal end of the shaft;

[0054] The shaft includes a flexible portion extending distally from the proximal end of the shaft, and an articulated portion extending proximally from the distal end of the shaft, wherein the articulated portion includes a flexible spine.

[0055] Multiple articulated cables extend from the stem through the shaft to the flexible spine, such that when tension is applied to at least one of the multiple articulated cables, the flexible spine bends.

[0056] The rotatable element extends from the handle through a shaft to the end actuation device, such that when the rotatable element rotates, the end actuation device rotates. The rotatable element includes a hollow tubular structure extending distally from the handle, formed of multiple filaments wound and forged together. Furthermore, the rotatable element also includes a laser-cut sodium hypochlorite tube fixed to the hollow tubular structure, such that when the hollow tubular structure is rotated, the laser-cut sodium hypochlorite tube also rotates.

[0057] The actuating element extends from the handle through a shaft to the end actuating device, such that when the actuating element moves, it actuates the end actuating device; and

[0058] Use this device to perform minimally invasive procedures.

[0059] In another preferred embodiment of the invention, an apparatus for performing a minimally invasive procedure is provided, the apparatus comprising:

[0060] The tool includes:

[0061] A shaft having a distal end and a proximal end;

[0062] A shank, which is attached to the proximal end of the shaft; and

[0063] An end control device is attached to the distal end of the shaft;

[0064] The shaft includes a flexible portion extending distally from the proximal end of the shaft, and an articulated portion extending proximally from the distal end of the shaft, wherein the articulated portion includes a flexible spine.

[0065] Multiple articulated cables extend from the stem through the shaft to the flexible spine, such that when tension is applied to at least one of the multiple articulated cables, the flexible spine bends.

[0066] The rotatable element extends from the handle through a shaft to the end actuation device, such that when the rotatable element rotates, the end actuation device rotates.

[0067] The actuating element extends from the handle through a shaft to the end actuating device, such that when the actuating element moves, it actuates the end actuating device; and

[0068] The flexible portion of the shaft includes an outer coil fixed to the flexible spine, a rigid tube configured to rotate relative to the handle, and an outer cover fixed to the rigid tube and the flexible spine, such that rotation of the rigid tube causes rotation of the outer cover, which in turn causes rotation of the flexible spine.

[0069] In another preferred embodiment of the invention, a method for performing a minimally invasive procedure is provided, the method comprising:

[0070] Obtain a device for performing minimally invasive procedures, the device comprising:

[0071] The tool includes:

[0072] A shaft having a distal end and a proximal end;

[0073] A shank, which is attached to the proximal end of the shaft; and

[0074] An end control device is attached to the distal end of the shaft;

[0075] The shaft includes a flexible portion extending distally from the proximal end of the shaft, and an articulated portion extending proximally from the distal end of the shaft, wherein the articulated portion includes a flexible spine.

[0076] Multiple articulated cables extend from the stem through the shaft to the flexible spine, such that when tension is applied to at least one of the multiple articulated cables, the flexible spine bends.

[0077] The rotatable element extends from the handle through a shaft to the end actuation device, such that when the rotatable element rotates, the end actuation device rotates.

[0078] The actuating element extends from the handle through a shaft to the end actuating device, such that when the actuating element moves, it actuates the end actuating device; and

[0079] The flexible portion of the shaft includes an outer coil fixed to the flexible spine, a rigid tube configured to rotate relative to the handle, and an outer cover fixed to the rigid tube and the flexible spine, such that rotation of the rigid tube causes rotation of the outer cover, which in turn causes rotation of the flexible spine; and

[0080] Use this device to perform minimally invasive procedures.

[0081] In another preferred embodiment of the invention, an apparatus for performing a minimally invasive procedure is provided, the apparatus comprising:

[0082] The tool includes:

[0083] A shaft having a distal end and a proximal end;

[0084] A shank, which is attached to the proximal end of the shaft; and

[0085] An end control device is attached to the distal end of the shaft;

[0086] The shaft includes a flexible portion extending distally from the proximal end of the shaft, and an articulated portion extending proximally from the distal end of the shaft, wherein the articulated portion includes a flexible spine.

[0087] Multiple articulated cables extend from the stem through the shaft to the flexible spine, such that when tension is applied to at least one of the multiple articulated cables, the flexible spine bends.

[0088] The rotatable element extends from the handle through a shaft to the end actuation device, such that when the rotatable element rotates, the end actuation device rotates.

[0089] The actuating element extends from the handle through a shaft to the end actuating device, such that when the actuating element moves, it actuates the end actuating device; and

[0090] The proximal end of the shaft also includes a rigid portion, and the device further includes a tool support that is mounted to the patient support, the tool support including an opening for receiving the rigid portion.

[0091] In another preferred embodiment of the invention, a method for performing a minimally invasive procedure is provided, the method comprising:

[0092] Obtain a device for performing minimally invasive procedures, the device comprising:

[0093] The tool includes:

[0094] A shaft having a distal end and a proximal end;

[0095] A shank, which is attached to the proximal end of the shaft; and

[0096] An end control device is attached to the distal end of the shaft;

[0097] The shaft includes a flexible portion extending distally from the proximal end of the shaft, and an articulated portion extending proximally from the distal end of the shaft, wherein the articulated portion includes a flexible spine.

[0098] Multiple articulated cables extend from the stem through the shaft to the flexible spine, such that when tension is applied to at least one of the multiple articulated cables, the flexible spine bends.

[0099] The rotatable element extends from the handle through a shaft to the end actuation device, such that when the rotatable element rotates, the end actuation device rotates.

[0100] The actuating element extends from the handle through a shaft to the end actuating device, such that when the actuating element moves, it actuates the end actuating device; and

[0101] The proximal end of the shaft also includes a rigid portion, and the device further includes a tool support for mounting to the patient support, the tool support including an opening for receiving the rigid portion; and

[0102] Use this device to perform minimally invasive procedures.

[0103] In another preferred embodiment of the invention, an apparatus for performing a minimally invasive procedure is provided, the apparatus comprising:

[0104] The tool includes:

[0105] A shaft having a distal end and a proximal end;

[0106] A shank, which is attached to the proximal end of the shaft; and

[0107] An end control device is attached to the distal end of the shaft;

[0108] The shaft includes a flexible portion extending distally from the proximal end of the shaft, and an articulated portion extending proximally from the distal end of the shaft, wherein the articulated portion includes a flexible spine.

[0109] Multiple articulated cables extend from the stem through the shaft to the flexible spine, such that when tension is applied to at least one of the multiple articulated cables, the flexible spine bends.

[0110] The rotatable element extends from the handle through a shaft to the end actuating device, such that when the rotatable element rotates, the end actuating device rotates; and

[0111] The actuating element extends from the handle through a shaft to the end control device, such that when the actuating element moves, it actuates the end control device;

[0112] The shaft is configured such that when the joint portion has moved, the rotatable element rotates without the accumulation of spring energy within the shaft.

[0113] In another preferred embodiment of the invention, a method for performing a minimally invasive procedure is provided, the method comprising:

[0114] Obtain a device for performing minimally invasive procedures, the device comprising:

[0115] The tool includes:

[0116] A shaft having a distal end and a proximal end;

[0117] A shank, which is attached to the proximal end of the shaft; and

[0118] An end control device is attached to the distal end of the shaft;

[0119] The shaft includes a flexible portion extending distally from the proximal end of the shaft, and an articulated portion extending proximally from the distal end of the shaft, wherein the articulated portion includes a flexible spine.

[0120] Multiple articulated cables extend from the stem through the shaft to the flexible spine, such that when tension is applied to at least one of the multiple articulated cables, the flexible spine bends.

[0121] The rotatable element extends from the handle through a shaft to the end actuating device, such that when the rotatable element rotates, the end actuating device rotates; and

[0122] The actuating element extends from the handle through a shaft to the end control device, such that when the actuating element moves, it actuates the end control device;

[0123] The shaft is configured such that when the joint portion has undergone articulation, the rotatable element rotates without any accumulation of spring energy within the shaft; and

[0124] Use this device to perform minimally invasive procedures.

[0125] In another preferred embodiment of the invention, an apparatus for performing a minimally invasive procedure is provided, the apparatus comprising:

[0126] The tool includes:

[0127] A shaft having a distal end and a proximal end;

[0128] A shank, which is attached to the proximal end of the shaft; and

[0129] An end control device is attached to the distal end of the shaft;

[0130] The shaft includes a flexible portion extending distally from the proximal end of the shaft, and an articulated portion extending proximally from the distal end of the shaft, wherein the articulated portion includes a flexible spine.

[0131] Multiple articulated cables extend from the stem through the shaft to the flexible spine, such that when tension is applied to at least one of the multiple articulated cables, the flexible spine bends.

[0132] The rotatable element extends from the handle through a shaft to the end actuating device, such that when the rotatable element rotates, the end actuating device rotates; and

[0133] The actuating element extends from the handle through a shaft to the end control device, such that when the actuating element moves, it actuates the end control device.

[0134] In another preferred embodiment of the invention, a method for performing a minimally invasive procedure is provided, the method comprising:

[0135] Obtain a device for performing minimally invasive procedures, the device comprising:

[0136] The tool includes:

[0137] A shaft having a distal end and a proximal end;

[0138] A shank, which is attached to the proximal end of the shaft; and

[0139] An end control device is attached to the distal end of the shaft;

[0140] The shaft includes a flexible portion extending distally from the proximal end of the shaft, and an articulated portion extending proximally from the distal end of the shaft, wherein the articulated portion includes a flexible spine.

[0141] Multiple articulated cables extend from the stem through the shaft to the flexible spine, such that when tension is applied to at least one of the multiple articulated cables, the flexible spine bends.

[0142] The rotatable element extends from the handle through a shaft to the end actuating device, such that when the rotatable element rotates, the end actuating device rotates; and

[0143] The actuating element extends from the handle through a shaft to the end actuating device, such that when the actuating element moves, it actuates the end actuating device; and

[0144] Use this device to perform minimally invasive procedures.

[0145] In a preferred embodiment of the invention, an apparatus for performing a minimally invasive procedure is provided, the apparatus comprising:

[0146] A shaft having a distal end and a proximal end;

[0147] A shank, which is attached to the proximal end of the shaft; and

[0148] An end control device is attached to the distal end of the shaft;

[0149] The shaft includes a flexible portion, a first joint portion and a second joint portion, wherein the flexible portion extends distally from the handle, the first joint portion extends distally from the flexible portion, and the second joint portion extends distally from the first joint portion.

[0150] At least one of the joint cables extends from the handle to the first joint portion, such that when tension is applied to the at least one joint cable, the first joint portion deflects;

[0151] Multiple articulated cables extend from the shank to the second articulated portion, such that when tension is applied to at least one of the multiple articulated cables, the second articulated portion deflects.

[0152] In another preferred embodiment of the invention, a method for performing a minimally invasive procedure is provided, the method comprising:

[0153] Provides a device for performing minimally invasive procedures, the device comprising:

[0154] A shaft having a distal end and a proximal end;

[0155] A shank, which is attached to the proximal end of the shaft; and

[0156] An end control device is attached to the distal end of the shaft;

[0157] The shaft includes a flexible portion, a first joint portion and a second joint portion, wherein the flexible portion extends distally from the handle, the first joint portion extends distally from the flexible portion, and the second joint portion extends distally from the first joint portion.

[0158] At least one of the joint cables extends from the handle to the first joint portion, such that when tension is applied to the at least one joint cable, the first joint portion deflects;

[0159] Multiple articulated cables extend from the shank to the second articulated portion, such that when tension is applied to at least one of the multiple articulated cables, the second articulated portion deflects; and

[0160] Use this device to perform minimally invasive procedures. Attached Figure Description

[0161] These and other objectives and features of the present invention will be explained by way of the appendix. Figure 1 The following detailed description of preferred embodiments of the invention, which are considered for the purposes of this study, is intended to disclose or make clearer the information more fully, wherein similar reference numerals denote similar parts, and further wherein:

[0162] Figure 1 This is a schematic diagram illustrating a novel medical device formed according to the present invention;

[0163] Figure 1A It is shown Figure 1 The diagram shows the proximal end of the shaft and the handle of the novel medical device.

[0164] Figure 1B It is shown Figure 1 The diagram shows the end control device and the distal end of the shaft of the novel medical device.

[0165] Figures 2-23 It is shown Figure 1 A schematic diagram showing further details of the end effector and shaft of the novel medical device;

[0166] Figures 24-46B It is shown Figure 1A schematic diagram showing further details of the proximal end of the shaft and the handle of the novel medical device is shown in the image.

[0167] Figures 47-55 It shows that it can be connected with Figure 1 A schematic diagram of a novel tool support used in conjunction with a novel medical device is shown in the figure;

[0168] Figures 56-58F This is a schematic diagram illustrating another novel medical device formed according to the present invention;

[0169] Figures 59-62 This is a schematic diagram illustrating another form of end-effector for the novel medical device used in this invention;

[0170] Figures 63-66 This is a schematic diagram illustrating another novel medical device formed according to the present invention;

[0171] Figures 67-72 This is a schematic diagram illustrating another novel medical device formed according to the present invention;

[0172] Figure 73 and Figure 74 This is a schematic diagram illustrating another novel medical device formed according to the present invention;

[0173] Figure 75 and Figure 76 This is a schematic diagram illustrating another novel medical device formed according to the present invention;

[0174] Figures 77-80 This is a schematic diagram illustrating another novel medical device formed according to the present invention; and

[0175] Figures 81-83 , Figure 83A and Figures 84-87 This is a schematic diagram illustrating another novel medical device formed according to the present invention. Detailed Implementation

[0176] 1. Generally speaking, new medical devices

[0177] This invention includes a novel medical device for performing minimally invasive procedures. The novel medical device is highly flexible, capable of joint movement in a range of different motions, and configured for precise control while being operated only from the handle end of the medical device (e.g., along a zigzag path).

[0178] First look Figure 1 , Figure 1A , Figure 1B and Figure 2The illustration shows a novel medical device 5 formed according to the present invention. The novel medical device 5 generally includes a handle 10 and a shaft 15 extending distally from the handle 10. The shaft 15 generally includes an elongated flexible proximal portion 20 and a distal articulated portion 25 attached to the distal end of the flexible proximal portion 20. An end effector 30 is attached to the distal end of the distal articulated portion 25. The end effector 30 can take many different forms (e.g., a gripper, injection needle, scissors, a thermal snare, a monopolar probe, a hemostatic clip, bipolar forceps, a suction tube, a single or multiple closure device (such as an anastomosis device and a tracker), dissecting forceps, a retrieval basket, monopolar scissors, a light source, a camera, etc.). For clarity, the end effector 30 is shown as a gripper in the figure. The handle 10 can take any of many different forms (e.g., a pistol grip, a shaft grip, etc.). For clarity, the handle 10 is shown as a pistol grip in the figure.

[0179] According to the invention, the flexible proximal portion 20 of the shaft 15 is configured as a highly flexible element capable of extending a significant length (e.g., 95cm-140cm) along a tortuous path, the distal articulated portion 25 of the shaft 15 is configured to be omnidirectionally movable relative to the distal end of the flexible proximal portion 20 of the shaft 15, and the end effector 30 is configured to be selectively rotated and selectively actuated relative to the distal end of the distal articulated portion 25, wherein all functions can be performed by a user with one hand via the handle 10. In a preferred embodiment of the invention, the substantially entire shaft 15 of the medical device 5 is flexible, wherein the portion of the shaft 15 near the transition point 32 (i.e., the flexible proximal portion 20) is passively flexible (e.g., capable of following a tortuous path), and the portion of the shaft 15 away from the transition point 32 (i.e., the distal articulated portion 25) is actively flexible (e.g., capable of omnidirectionally movable to the desired configuration).

[0180] As will be described in further detail below, the novel medical device 5 is capable of performing at least the following movements:

[0181] The end control device 30 moves longitudinally via the longitudinal movement of the handle 10 (sometimes referred to herein as "longitudinal movement function");

[0182] The motion 2 - end control device 30 rotates by the rotational motion of the handle 10 (sometimes referred to herein as "torsional motion function");

[0183] Movement 3 - The end effector 30 is articulated relative to the handle 10 by articulating the distal articulated portion 25 of the shaft 15 relative to the distal end of the flexible proximal portion 20 of the shaft 15 (sometimes referred to herein as "universal joint function").

[0184] Movement 4 - The distal end of the end actuation device 30 is rotated relative to the distal joint portion 25 of the shaft 15 by rotating the end actuation device 30 relative to the shaft 15 (sometimes referred to herein as the "rotation function"); and

[0185] Movement 5 - Actuation of the end manipulator 30, for example, causing the elements of the end manipulator 30 to move selectively relative to each other in order to perform a medical procedure, such as opening and closing the jaws of a gripper-type end manipulator (sometimes referred to herein as "jaw opening / closing function").

[0186] Construction of Shaft 15

[0187] 2.1 Flexible proximal portion 20

[0188] Looking at it now Figure 1 , Figure 1A , Figure 1B and Figures 2-4 The flexible proximal portion 20 of shaft 15 generally includes an elongated flexible outer coil 35. Figure 2 and Figure 3 The shaft 15 has a distal end 40, a proximal end 45, and an inner cavity 50 extending therebetween. The distal articulated portion 25 of the shaft 15 is mounted to the distal end 40 of the outer coil 35 via an intervention element (see below). The proximal end 45 of the outer coil 35 is secured to a shaft adapter 55, which in turn is secured to a shank 10 (see below).

[0189] Devices for selectively articulating the distal joint portion 25 relative to the distal end of the flexible proximal portion 20 (i.e., relative to the distal end 40 of the outer coil 35), devices for selectively rotating the end actuation device 30 relative to the distal joint portion 25, and devices for selectively actuating the end actuation device 30 extend through the cavity 50 of the outer coil 35, as will be discussed in further detail below.

[0190] In a preferred embodiment of the invention, the rigid tube 60 ( Figure 1A and Figure 4 A flexible proximal portion 20 is provided at its proximal end (i.e., disposed around the proximal end 45 of the outer coil 35 and fixed to the shaft adapter 55), thereby providing an area of ​​increased stiffness for mounting the novel medical device 5 to a tool support (e.g., a benchtop tool support), as will be discussed in further detail below. If desired, the rigid tube 60 may include a fillet 65 at its distal end. Figure 4 The fillet 65 provides a smooth transition between the outer surface of the rigid tube 60 and the outer surface of the portion of the flexible proximal portion 20 located on the far side of the rigid tube 60.

[0191] 2.2 Generally, the distal joint portion 25

[0192] As discussed above, the distal articular portion 25 is configured to selectively articulate distally relative to the flexible proximal portion 20. Therefore, and now let's look at... Figure 2 and Figure 5 The distal joint portion 25 generally includes a distal joint connection assembly 70, a proximal joint connection assembly 75, and a flexible spine 80 extending between the distal joint connection assembly 70 and the proximal joint connection assembly 75. The proximal joint connection assembly 75 is configured to be mounted to the distal end of the flexible proximal portion 20 of the shaft 15 and provides a reaction surface to allow selective articulation of the distal joint connection assembly 70 and the flexible spine 80, as will be discussed in further detail below.

[0193] 2.2.1 Proximal joint connector 75

[0194] Looking at it now Figure 2 and Figure 6 The proximal joint assembly 75 is disposed at the distal end 40 of the outer coil 35 of the flexible proximal portion 20. The distal end of the proximal joint assembly 75 provides a reaction surface to allow the distal joint assembly 70 and the flexible spine 80 to selectively bend relative to the distal end of the flexible proximal portion 20 of the axis 15 (i.e., to enable universal joint movement of the distal joint portion 25).

[0195] More specifically, the proximal joint connector 75 ( Figure 6 It includes a body 85 having a pair of distally extending fingers 90 configured to engage a flexible spine 80. Figure 5 As will be discussed in further detail below. Around the central opening 100 ( Figure 18 Multiple openings 95 () set Figure 6 A central opening 95 is formed in the body 85 and is sized to receive multiple articulated cables (see below). If desired, the opening 95 may include countersunk holes (not shown) located near their proximal ends for receiving articulated cable housings, as will be discussed below. Center opening 100 ( Figure 18 It may include a countersunk hole 102 located at its distal end. Figure 6 and Figure 18 ), to facilitate the mounting of the distal joint connection assembly 70 to the body 85, as will be discussed below.

[0196] The body 85 of the proximal articulation assembly 75 abuts against a plurality of articulated cable housings 235 (see below), which in turn abut against the shank 10, so that the proximal articulation assembly 75 provides a reaction surface for the distal articulated portion 25 of the selectively bending shaft 15, as will be discussed below. Note that the outer coil 35 is attached to the body 85 of the proximal articulation assembly 75 but essentially does not provide a reaction force on the body 85—the reaction force on the body 85 is provided by the articulated cable housings.

[0197] 2.2.2 Distal joint connection assembly 70

[0198] Looking at it now Figure 2 , Figure 5 and Figure 7 The distal joint connection assembly 70 generally includes a body 105 ( Figure 7 The body 105 has a central opening 110 therethrough and a short laser-cut hypotube 115 extending proximally therefrom. The short laser-cut hypotube 115 includes a distal end 120, a proximal end 125, and an inner cavity 130 extending therebetween. The short laser-cut hypotube 115 is configured to be highly flexible but with sufficient column strength so that when the proximal end 125 of the short laser-cut hypotube 115 supports the body 85 of the proximal joint assembly 75 (…), Figure 6 Furthermore, when an eccentric proximal force is applied to the body 105, it allows selective articulation of the body 105 relative to the proximal articulation assembly 75, as will be discussed below. The proximal end 125 of the short laser-cut hypotube 115 is mounted to the body 85 of the proximal articulation assembly 75 (e.g., via welding). The distal end 120 of the short laser-cut hypotube 115 is mounted to the body 105 (e.g., via welding), wherein when the distal articulation assembly 70 is in its relaxed (i.e., unbiased) state, the cavity 130 of the short laser-cut hypotube 115 is aligned with the central opening 110 of the body 105. Due to this configuration, rotation of the body 85 of the proximal articulation assembly 75 causes rotation of the laser-cut hypotube 115, thereby causing rotation of the body 105 of the distal articulation assembly 70. The body 105 also includes a pair of distal seats 135 ( Figure 7 (Only one is shown in the image), the distal seat 135 is used to mount one or more articular cables to the body 105, as will be discussed in further detail below. The body 105 also includes two proximal extending fingers 137 for connecting with the flexible spine 80 (…). Figure 5 (This will be discussed in more detail below.)

[0199] 2.2.3 Flexible Spine 80

[0200] Looking at it now Figure 5The flexible spine 80 generally comprises a flexible body 140 having a distal end 141 and a proximal end 142. A plurality of axially aligned openings 145 and a central opening 150 extend between the distal end 141 and the proximal end 142. The openings 145 are sized to each receive articular cables therein, as will be discussed below. The central opening 150 is sized to receive a short laser-cut hypotube 115 of the distal articular connection assembly 70. Figure 7 The proximal end 142 of the flexible spine 80 includes a proximal seat 155 for accommodating the aforementioned distally extending finger 90 of the proximal joint connection assembly 75. Figure 6 The distal end 141 of the flexible spine 80 includes a distal seat 160 for receiving the aforementioned proximal extension of the distal joint connection assembly 70 finger 137. Figure 7 It will be recognized that when the flexible spine 80 is installed in this manner, the flexible spine 80 is fixed, overcoming rotation relative to the distal joint assembly 70 or the proximal joint assembly 75.

[0201] 2.2.4 Rotatable housing assembly 165

[0202] Continue reading Figure 5 and Figures 8-12 The distal end of the distal joint portion 25 includes a rotatable housing assembly 165. Figure 9 The rotatable housing assembly 165 is used to rotatably mount the end actuation device 30 to the distal joint connection assembly 70, as will be discussed below.

[0203] More specifically, the rotatable housing assembly 165 generally includes a collar 170, a long laser-cut sodium hypotube 180 having a distal end 185, a proximal end 190, and an inner cavity 195 extending therebetween. The rotatable housing assembly 165 also includes a rotary connector 200. Figure 9 and Figure 10 The rotary connector 200 has an opening 205 formed therein, and is securely mounted to the distal end 185 of the long laser-cut subwoofer 180 such that when the rotatable housing assembly 165 is in its relaxed (i.e., unbiased) state, the inner cavity 195 of the long laser-cut subwoofer 180 is aligned with the opening 205 of the rotary connector 200, and the long laser-cut subwoofer 180 and the rotary connector 200 can rotate as a unit. End control device bracket 210 ( Figure 8 , Figure 9 , Figure 11 and Figure 12The end control device 30 is mounted to the rotary connector 200 such that the end control device bracket 210 rotates as the rotary connector 200 rotates (i.e., as the long laser-cut sodium tube 180 rotates). The end control device 30 is mounted to the end control device bracket 210 (see below). The rotary connector 200 and the end control device bracket 210 are connected via a collar 170 ( Figure 5 Rotatably mounted to the distal joint connection assembly 70 Figure 5 and Figure 7 The body 105. More specifically, the rotary connector 200 ( Figure 9 The end actuation device bracket 210 is rotatably mounted to the collar 170 and is rotatable relative to the collar 170. The end actuation device bracket 210 is mounted to the rotary connector 200 and engages the distal shoulder 215 of the rotary connector 200. Figure 10 The collar 170 is securely mounted to the body 105 of the distal joint connection assembly 75. Figure 7 Therefore, the end control device bracket 210 ( Figure 9 The aforementioned sub-assemblies (end control device bracket 170, rotary connector 200, and long laser-cut hyaluronic acid tube 180) are securely mounted to the rotary connector 200, which in turn is securely connected to the long laser-cut hyaluronic acid tube 180. The aforementioned sub-assemblies are rotatably mounted to the collar 170, wherein the collar 170 is securely mounted to the distal joint connection assembly 70. Figure 5 ), and wherein the long laser-cutting hysteresis tube 180 extends through the central opening 150 of the flexible spine 80 and the opening 100 of the body 85 of the proximal joint connection component 75 ( Figure 18 ).

[0204] 2.3 End control device 30

[0205] The end effector 30 can take many different forms (e.g., gripper, injection needle, scissors, thermal snare, monopolar probe, hemostatic clip, bipolar forceps, pipette, single or multiple closure devices (such as anastomosing devices and trackers), dissecting forceps, retrieval basket, monopolar scissors, light source, camera, etc.). For clarity, the end effector 30 is shown as a gripper in the figure.

[0206] In a preferred embodiment of the invention, and now it is understood that... Figure 8The end effector 30 is mounted to the end effector bracket 210. More particularly, in a preferred embodiment of the invention, the end effector 30 includes a gripper having two opposing jaws 216, 217, the jaws being pivotally mounted to the end effector bracket 210 via a pin 217A passing through a hole 217B in the jaws 216, 217 and through a hole 217C in the end effector bracket 210. A clevis 218 is mounted to the jaws 216, 217 via a pin 218A disposed in a slot 218B (the slot 218B is formed in the proximal portion of the jaws 216, 217), such that the reciprocating motion of a pull cord mounted to the clevis 218 (see below) causes the opposing jaws 216, 217 of the gripper to open and close relative to each other, as will be discussed below.

[0207] 2.4 General Joint Motion Devices

[0208] As discussed above, shaft 15 also includes (i) for making the distal joint portion 25 ( Figure 2 (ii) A device that selectively articulates relative to the flexible proximal portion 20, and (iii) a device for causing the rotatable housing assembly 165 ( Figure 9 (iii) A device for selectively rotating relative to axis 15 and thus for selectively rotating end-operation device 30 relative to axis 15, and (iii) a device for selectively actuating end-operation device 30. Figure 8 The device. As will be discussed below, all of the aforementioned devices are actuated via the handle 10.

[0209] More specifically, and now it seems Figure 13 and Figure 14 The shaft 15 generally includes (i) four articulated cables 220 for selectively articulating the distal articulated portion 25 relative to the distal end of the flexible proximal portion 20, and (ii) an HHS coil 225 (e.g., a hollow spiral type sold by Fort Wayne Metals of Fort Wayne, IN) for causing the rotatable housing assembly 165 ( Figure 9 (iii) a pull wire 230 for selectively actuating the end control device 30 relative to the shaft 15.

[0210] 2.4.1 Joint cable 220

[0211] Continue reading Figures 13-16 In a preferred embodiment of the invention, four joint cables 220 extend from the handle 10 to the distal seat 135 of the distal joint connection assembly 70. Figure 15 andFigure 16 The joint cable 220 passes through the opening 95 of the body 85. Figure 6 ), through the opening 145 of the flexible spine 80 ( Figure 5 ) extends to the distal seat 135 of the main body 105 ( Figure 16 The joint cables 220 are preferably slidably disposed in the joint cable housing 235. Figure 13 The distal end 240 of the joint cable housing 235 is mounted to the body 85 of the proximal joint connection assembly 75. Figure 15 (i.e., via the threaded adjuster 330, as will be discussed below). The joint cable housing 235 supports the body 85 of the proximal joint coupling assembly 75 and provides a reaction force to the body 85 for articulating the distal joint portion 25 of the shaft 15 relative to the flexible proximal portion 25 of the shaft 15. The joint cable housing 235 also separates the joint cables 220 from each other and from the HHS coil 225, and helps ensure smooth sliding of the joint cables 220 within the flexible proximal portion 20 of the shaft 15 (i.e., it can be quite long (e.g., 95cm-140cm) in the distance between the handle 10 and the proximal joint coupling assembly 75, and follows a tortuous path when the medical device 5 is placed in a patient). If desired, to facilitate mounting the distal end of the joint cable housing 235 to the body 85 ( Figure 15 Each opening 95 may include a countersunk hole (not shown) at its proximal end, the countersunk hole being sized to receive the distal end 240 of a given joint cable housing 235.

[0212] Looking at it now Figure 15 and Figure 16 The joint cable 220 extends distally through the opening 145 in the flexible spine 80. Figure 5 Subsequently, the joint cable 220 is attached (e.g., via welding, crimping, etc.) to the distal seat 135 of the body 105 of the distal joint connection assembly 70. By way of example and not limitation, two of the joint cables 220 may be provided by a single-length cable, wherein the single-length cable has a tube 245 crimped thereto. Figure 16 Furthermore, the tube 245 is welded (or otherwise fixed) to the distal seat 135.

[0213] Due to this construction, by selectively pulling proximally on the proximal end of the joint cable 220, the body 105 of the distal joint connection assembly 70 ( Figure 7 The distal joint portion 25 of the shaft 15 can be moved laterally, thereby enabling joint movement. In addition, by providing at least three joint cables 220, wherein the three or more joint cables are positioned around the periphery of the body 105, the basic universal joint movement of the distal joint connection assembly 70 can be realized, thereby providing basic universal joint movement for the distal joint portion 25 of the shaft 15.

[0214] 2.4.2 HHS Coil 225

[0215] Continue reading Figure 13 , Figure 14 and Figure 17 HHS coil 225 includes a distal end 250 ( Figure 17 ), proximal 255 ( Figure 26 ) and the cavity 260 extending between them ( Figure 13 To facilitate rotation of the HHS coil 225 within the shaft 15, the HHS coil 225 is preferably disposed in a flexible, friction-reducing sleeve 267. Figure 13 More specifically, the HHS coil 225 preferably comprises a plurality of wires wound and forged together to form a hollow tubular structure. By way of example and not limitation, the HHS coil 225 may comprise a hollow helix of the type sold by Fort Wayne Metals of Fort Wayne, IN. In a preferred form of the invention, the HHS coil 225 comprises 10 wires wound and forged together into a single flexible structure. The distal end 250 of the HHS coil 225 ( Figure 17 ) via sleeve (or crimping part) 265 ( Figure 17 ) Installed into the rotatable housing assembly 165 ( Figure 9 ) long laser-cut 180 ( Figure 17 This configuration allows the long laser-cut hypotube 180 (and thus the end-operation device bracket 210 carrying the end-operation device 30) to rotate when the HHS coil 225 rotates. It will be appreciated that, due to this configuration, the rotational configuration of the end-operation device 30 can be adjusted by selectively rotating the HHS coil 225, thereby rotating the long laser-cut hypotube 180 and, therefore, the end-operation device bracket 210, to which the end-operation device 30 is fixed. Significantly, by using the HHS coil 225 and the long laser-cut hypotube 180 to transmit torque along the shaft 15, any accumulation of torsional spring energy within the shaft is minimized, even when the shaft 15 follows a tortuous path and the distal joint portion 25 articulates relative to the longitudinal axis of the shaft 15.

[0216] 2.4.3 Pull wire 230

[0217] Continue reading Figure 13 , Figure 14 , Figure 18 and Figure 19 The pull cable 230 provides for selectively actuating the end actuation device 30. The pull cable 230 ( Figure 19The distal end of the cable 230 is fixed to the U-shaped clip 218 of the end control device 30, wherein the U-shaped clip 218 is slidably mounted to the jaws 216, 217 of the end control device 30, and wherein the jaws 216, 217 are pinned to the end control device bracket 210, such that the reciprocating motion of the cable 230 causes the opposite jaws 216, 217 of the end control device 30 to open and close relative to each other.

[0218] 2.5 Further details regarding the construction of shaft 15

[0219] When shaft 15 is fully assembled, and now it looks like... Figures 18-23 Proximal joint connector 75 ( Figure 6 ) body 85 ( Figure 18 Installed to the far end 40 of the flexible outer coil 35. Figure 2 ), wherein the distal end 240 of the joint cable housing 235 ( Figure 15 The joint cable 220 is installed onto the body 85 of the proximal joint connector 75, wherein the joint cable 220 passes through an opening 95 formed in the body 85. Figure 6 By mounting the proximal end 125 of the short laser-cut sodium hydroxide tube 115 into the countersunk hole 102 of the body 85 ( Figure 6 In ), the distal joint connection component 70 ( Figure 7 ) Installed to the proximal joint connector 75. Flexible body 140 of flexible spine 80 ( Figure 5 The body 105 of the distal joint connection assembly 70 is "clamped" in place. Figure 7 ) and the body 85 of the proximal connecting component 75 ( Figure 6 Between, wherein the distally extending finger 90 of the body 85 is disposed on the proximal seat 155 of the flexible spine 80. Figure 5 In the flexible spine 80, the proximal extension of the finger 137 of the body 105 is disposed in the distal seat 160. The short laser-cut hypotube 115 of the distal joint connection assembly 70 ( Figure 7 ) through the central opening 150 of the flexible body 140 of the flexible spine 80 ( Figure 5 When the articulated cable 220 is pulled proximally, the distal end of the short laser-cut hysteresis tube 115 rests on the body 85 of the proximally articulated assembly 75 (which in turn rests on the articulated cable housing 235), thereby selectively articulating the distal articulated portion 25 of the shaft 15.

[0220] Long laser-cut sodium hypotube 180 with rotatable housing assembly 165 Figure 9 , Figure 10 and Figure 17 Extending proximally through a short laser-cut 115-inch hyaluronic acid tube. Figure 18 ), so that the long laser cuts the proximal end 190 of the sodium hypotube 180 ( Figure 17The body 85 of the proximal joint connection assembly 75 (e.g., by a central opening 100 and a countersunk hole 102 through the body 85) is fixed to the HHS coil 225. Figure 17 For example, via sleeve 265. Rotatable housing assembly 165 ( Figure 9 ) collar 170 ( Figure 18 The body 105 is mounted to the distal joint connector 70 and covers the distal seat 135 (and a portion of the joint cable 220 to which it is mounted). Rotary connector 200 Figure 9 and Figure 10 The end control device 30 is mounted to the distal end of the long laser-cut hypotube 180. The rotary connector 200 is also mounted to the end control device bracket 210. Due to this configuration, when the HHS coil 225 rotates, the long laser-cut hypotube 180 rotates, and the rotary connector 200 rotates, and the end control device bracket 210 rotates, thereby causing the end control device 30 to rotate.

[0221] Wire 230 ( Figure 18 Extending distally through the inner cavity 260 of the HHS coil 225 ( Figure 13 and Figure 14 ), and extends distally through the inner cavity 195 of the long laser-cut hypotube 180. Figure 9 ), away from the rotary connector 200. The distal end of the pull cable 230 is connected to the end actuation device 30. Due to this configuration, the reciprocating motion of the pull cable 230 causes the opposing jaws 216, 217 of the gripper to move away from the rotary connector 200. Figure 8 () relative to each other, they are open and closed.

[0222] The flexible proximal portion 20 of shaft 15 is preferably covered with a protective sleeve or outer cover (e.g., Pebax). ® )270( Figure 18 , Figure 20 and Figure 21 The protective sleeve or outer cover 270 is secured (e.g., bonded) to the rigid tube 60 at its proximal end, and the protective sleeve or outer cover 270 is secured (e.g., bonded) to the body 85 of the proximal joint connection assembly 75 at its distal end, and the distal joint portion 25 of the rod 15 is preferably covered by the protective sleeve or outer cover 275. Figure 18 and Figure 22 The protective sleeve or outer cover 275 is secured at its proximal end to the body 85 of the proximal joint connection assembly 75, and the distal end of the protective sleeve or outer cover 275 extends to and beyond the proximal portion of the end manipulator 30, thereby protecting the shaft 15 and allowing the shaft 15 to be easily inserted into the patient's body through a natural body opening, a cannula, the lumen of another surgical instrument, etc.

[0223] The proximal end of shaft 15 is mounted to shank 10. Figure 1 This allows the handle 10 to selectively actuate the joint cable 220, HHS coil 225, and pull wire 230, as will be discussed in further detail below.

[0224] 3 generally handle 10

[0225] Looking at it now Figures 24-26 The handle 10 generally includes an inner cavity 280, a joint control assembly 285 for selectively moving the joint cable 220 (and thus selectively jointing the distal joint portion 25 of the shaft 15), a push rod locking assembly 290 for selectively locking the joint control assembly 285 in a desired position (and thus locking the distal joint portion 25 of the shaft 15 in a selected position), a rotation control assembly 295 for selectively rotating the HHS coil 225 (and thus selectively rotating the end actuation device 30), and a trigger assembly 300 for selectively actuating the pull cable 230 (and thus selectively actuating the end actuation device 30).

[0226] 3.1 Joint control component 285

[0227] Looking at it now Figures 27-36 The joint control assembly 285 generally includes a ball plate 305 securely mounted within a cavity 280 of the stem portion 10. Figure 28 The thumb stick ball assembly 310 is configured to selectively pivot relative to the ball plate 305, and the thumb stick 315 is configured to be engaged by the user's thumb.

[0228] As will be discussed in further detail below, the ball plate 305 includes a central opening 325 for receiving the push rod locking assembly 290 and a plurality of threaded openings 320. Figure 28 The threaded opening 320 is configured to receive multiple thread adjusters 330. Figure 29 and Figure 30 The threaded adjuster 330 is then installed near the end of each joint cable housing 235. Figure 21 and Figure 30 It should be recognized that, due to this construction, the proximal end of the articulated cable housing 235 abuts against the ball plate 305 (which is then securely mounted to the handle 10), such that when the articulated cable 220 is pulled proximally, the articulated cable housing 235 can provide a reaction force on the body 85 of the proximal articulated coupling assembly 75. Each threaded adjuster 330 includes a central cavity therethrough, such that the articulated cable 220 ( Figure 30 It can be mounted to the thumb stick ball assembly 310 via a threaded adjuster (and therefore via the threaded opening 320 of the ball plate 305), as will be discussed below. Enlargement 335 ( Figure 30A joint cable 220 is formed (or attached) on the proximal end of each joint cable 220, thereby facilitating the mounting of the joint cable 220 to the thumb ball assembly 310. The ball plate 305 also includes a proximal-facing recess 340 for providing clearance to the thumb ball assembly 310. Figure 29 The thumb ball assembly 310 is pivotally mounted in a seat 342 (located within the cavity 280 of the handle 10), as will be discussed in further detail below.

[0229] Thumb stick ball assembly 310 includes a hemispherical distal ball 345 ( Figure 32 ) and a hemispherical proximal sphere 350. The hemispherical distal sphere 345 preferably has a maximum diameter (i.e., the diameter at its proximal end), which is larger than the maximum diameter of the hemispherical distal sphere 345 (i.e., the diameter at its distal end), thereby providing a proximal circumferential seat 355 around the proximal end of the hemispherical distal sphere 345. Figure 31 Multiple openings (or grooves) 360 ( Figure 31 A 335 is formed in the proximal circumferential seat 355 to receive the articulated cable 220 when the enlarged portion 335 is placed on the proximal circumferential seat 355, as will be discussed below. Due to this configuration, when the circular distal end of the hemispherical distal ball 345 is pivotally mounted on the handle 10 (… Figure 27 The seat 342 in the inner cavity 280 of the ball plate 305 is located within the cavity 280 of the ball plate 305. Figure 33 When the joint cable 220 is positioned on the proximal circumferential seat 355, it can pass through the opening (or groove) 360 in the proximal circumferential seat 355. Therefore, the joint cable 220 can be selectively moved by selectively pivoting the distal hemispherical ball 345 within its seat 342 inside the cavity 280 of the handle 10 (i.e., by selectively pivoting the thumb bar 315, as will be discussed in further detail below).

[0230] Thumb bar 315 includes threaded bar 362 ( Figure 33 The distal end of the threaded rod 362 secures the proximal hemispherical ball 350 to the distal hemispherical ball 345. The thumb seat 363 is secured to the proximal end of the threaded rod 362. Due to this configuration, the thumb rod 315 can be used to selectively move the distal hemispherical ball 345, thereby selectively moving the articulation cable 220, thereby selectively articulating the distal articulated portion 25 of the shaft 15 relative to the flexible proximal portion 20 of the shaft 15.

[0231] 3.1.1 Push rod locking assembly 290

[0232] Continue reading Figure 27 , Figure 28 and Figures 33-36 The push rod locking assembly 290 generally includes an actuator 365 ( Figure 33A cam 370 is mounted to an actuator rod 365, and a push rod locking assembly plate 375 has a push rod 380 mounted to and extending proximally therefrom. The push rod 380 is preferably disposed within a sleeve 385. In a preferred embodiment of the invention, a spring 390 ( Figure 35 ) is set on sleeve 385 so that push rod locking assembly plate 375 is offset distally away from ball plate 305. Figure 36 The push rod 380 is slidably positioned at the center opening 325 of the ball plate 305. Figure 28 ) and from it toward the thumb stick ball assembly 310 ( Figure 33 The actuator 365 and cam 370 are rotatably mounted within the cavity 280 of the handle 10, wherein the cam 370 contacts the push rod locking assembly plate 375, such that movement of the actuator 365 causes the push rod locking assembly plate 375 (and therefore the push rod 380) to cam-move against the force of the proximal spring 390, thereby causing the free end of the push rod 380 to engage the distal hemispherical ball 345, thus locking the thumb lever ball assembly 310 against movement. When the actuator 365 moves in the second, opposite direction, the cam 370 moves to allow the push rod locking assembly plate 375 (and therefore the push rod 380) to move distally under the force of the spring 390, away from the distal hemispherical ball 345, thereby allowing the thumb lever ball assembly 310 to move freely. As a result, it will be recognized that the pusher locking assembly 290 can be used to selectively lock the thumb ball assembly 310 in the desired position, thereby selectively locking the distal joint portion 25 of the shaft 15 in the desired (e.g., joint movement) configuration.

[0233] 3.2 Rotation control assembly 295

[0234] Continue reading Figures 37-41 The rotary control assembly 295 generally includes a rotary knob 395 ( Figure 37 and Figure 38 The rotary knob 395 has a keyway 400 therethrough. Figure 38The rotary key 405 includes a distal end 406, a proximal end 407, and an inner cavity 408 extending therebetween. An HHS coil 225 is received within the inner cavity 408 of the rotary key 405 and fixed to the rotary key 405, such that rotation of the rotary key 405 causes rotation of the HHS coil 225. As mentioned above, the HHS coil 225 is fixed to the long laser-cut hypotube 180, and the long laser-cut hypotube 180 is fixed to the end control device bracket 210, such that rotation of the HHS coil 225 causes rotation of the long laser-cut hypotube 180, which in turn causes rotation of the end control device bracket 210 (and therefore rotation of the end control device 30). The distal end 406 of the rotary key 405 is received in the keyway 400 of the rotary knob 395, such that the rotary key 405 is engaged by the rotary knob 395 and rotates when the rotary knob 395 is rotated. Due to this configuration, rotation of the rotary knob 395 causes rotation of the rotary key 405, which in turn causes rotation of the HHS coil 225 and thus rotation of the end actuation device 30. In a preferred embodiment of the invention, the keyway 400 of the rotary knob 395 includes a non-circular cross-sectional profile that matches the non-circular cross-sectional profile of the distal end 406 of the rotary key 405.

[0235] The rotary knob 395 is rotatably mounted within the cavity 280 of the handle 10, such that a portion of the rotary knob 395 protrudes into the handle 10. Figure 37 In addition, this allows the rotary knob 395 to be selectively rotated by the user. As will be discussed below, the pull wire 230 (located within the HHS coil 225) Figure 40 ) Extends through the rotary key 405 and uses the trigger component 300 ( Figure 25 Selective activation.

[0236] The proximal end 407 of the rotary key 405 extends to the rotary knob 395. Figure 39 In a preferred embodiment of the invention, the proximal end 407 of the rotary key 405 ( Figure 38 It includes multiple teeth 409 for releasably engaging the bulb nose spring plunger 410. Figure 41A bulbous spring plunger 410 is mounted within the cavity 280 of the handle 10 such that the bulbous spring plunger 410 releasably engages a tooth 409 disposed on the proximal end 407 of the rotary key 405. Due to the engagement between the bulbous spring plunger 410 and the rotary key 405, the rotary key 405 (and therefore the HHS coil 225 mounted to the rotary key 405) is prevented from rotating "spontaneously" without intentionally rotating the rotary knob 395. Therefore, the bulbous spring plunger 410 prevents accumulated spring tension (e.g., spring tension that can accumulate when the rotary knob 395 is used to rotate the HHS coil 225) from "dissipating" from the HHS coil 225, thereby causing unintended rotation of the HHS coil 225 (and therefore unintended rotation of the end actuation device 30).

[0237] 3.3 Trigger Component 300

[0238] Continue reading Figures 42-46 , Figure 46A , Figure 46B and Figure 47 The trigger assembly 300 generally includes a trigger 415 pivotally mounted to the handle 10 and a slide plate 420 movably disposed within a cavity 280 of the handle 10. Figure 43 ), and connecting the trigger 415 to one or more lever arms 425 of the slide plate 420, such that when the trigger 415 is actuated (i.e. pulled), the slide plate 420 moves proximally within the cavity 280 of the handle 10, thereby moving the pull cable 230 proximally, thereby actuating the end control device 30, as will be discussed in further detail below.

[0239] More specifically, the skateboard 420 includes cavity 430 ( Figure 45 ), and the distal bushing 435 located within the cavity 430 ( Figure 46 The inner support tube 450 is provided with a proximal bushing 440 disposed within the cavity 430, and a spring 445 disposed between the distal bushing 435 and the proximal bushing 440. The inner support tube 450 is fixed to the pull wire 230 (e.g., via a crimp sleeve 451 disposed at the proximal end of the inner support tube 450). The outer support tube 452 is disposed on the distal portion of the inner support tube 450, wherein the inner support tube 450 is slidable freely within the outer support tube 452. The outer support tube 452 also includes an outer support tube collar 453, the outer support tube collar 453 being sized to fit into a seat 454 formed in the cavity 280 of the handle 10. Figure 46B Inside. Spring 455 ( Figure 42 It is provided in the proximal end of the handle 10 so as to offset the slide plate 420 to the distal side.

[0240] Due to this construction, when the slide plate 420 overcomes the spring 455 ( Figure 42 When the force moves the distal bushing 435 (i.e., by pulling trigger 415) towards the proximal side, the distal bushing 435 (Figure 46 The slide plate 420 moves proximally, bearing against spring 445, which in turn bears against near bushing 440. Near bushing 440 bears against crimp sleeve 451 and pulls pull cable 230 proximally. Therefore, as slide plate 420 moves proximally, near bushing 440 and crimp sleeve 451 also move proximally, thereby moving pull cable 230 proximally and actuating end actuation device 30. However, it should be understood that because slide plate 420 is not directly mounted to pull cable 230, near bushing 440 and spring 445 act as force limiters, where spring 445 yields when the force on pull cable 230 exceeds a given level, thereby stopping the application of proximal force to pull cable 230. In other words, if the force applied to move the slide plate 420 proximally exceeds the force that biases the proximally bushing 440 away from the distal bushing 435 (i.e., the biasing force provided by the spring 445), the spring 445 will compress, thereby allowing the proximally bushing 440 and the crimp sleeve 451 (and thus the inner support tube 450 and the pull cable 230) to remain stationary as the slide plate 420 moves proximally. Thus, the trigger 415 can be pulled through its “full stroke” without the risk of breaking the pull cable 230.

[0241] It should also be recognized that, due to the spring 455 causing the slide plate 420 to be biased to the distal side, and due to the engagement of the crimp sleeve 451 by the shoulder 456 when the slide plate 420 moves to the proximal side, the slide plate 420 will return to its distal position within the handle 10, and the pull cable 230 will move to the distal side.

[0242] 4. Exemplary usage methods

[0243] In an exemplary use of the novel medical device 5 during minimally invasive procedures, the profile of the end effector 30 is reduced (e.g., in the case where the end effector 30 includes a gripper, the jaws of the gripper are closed); the shaft 15 is straightened; the handle 10 is advanced longitudinally so that the distal end of the medical device 5 is advanced longitudinally through the inlet and into the body (e.g., along a tortuous path); the handle 10 is advanced longitudinally and / or rotated, and / or the distal joint portion 25 of the shaft 15 is bent, and / or the end effector 30 is rotated such that the end effector 30 is internally... The end effector 30 is used to properly target the target tissue at the site; to perform the required process at the internal site (e.g., in the case where the end effector 30 includes a surgical gripper, to open and close the jaws of the gripper to grip the tissue); and to withdraw the distal end of the medical device 5 from the body, for example, by longitudinally withdrawing the handle 10 through the inlet (during which the handle may also be rotated, and / or the distal joint portion 25 of the shaft 15 may be kept straight, and / or the end effector may be rotated (if necessary)), thereby withdrawing the end effector from the body.

[0244] It will be recognized that the novel medical device 5 is capable of performing at least the following movements:

[0245] The end control device 30 moves longitudinally via the longitudinal movement of the handle 10 (sometimes referred to herein as "longitudinal movement function");

[0246] The motion 2 - end control device 30 rotates by the rotational motion of the handle 10 (sometimes referred to herein as "torsional motion function");

[0247] Movement 3 - The end effector 30 is articulated relative to the handle 10 by articulating the distal articulated portion 25 of the shaft 15 relative to the distal end of the flexible proximal portion 20 of the shaft 15 (sometimes referred to herein as "universal joint function").

[0248] Movement 4 - The distal end of the end actuation device 30 is rotated relative to the distal joint portion 25 of the shaft 15 by rotating the end actuation device 30 relative to the shaft 15 (sometimes referred to herein as the "rotation function"); and

[0249] Movement 5 - Actuation of the end manipulator 30, for example, causing the elements of the end manipulator 30 to move selectively relative to each other in order to perform a medical procedure, such as opening and closing the jaws of a gripper-type end manipulator (sometimes referred to herein as "jaw opening / closing function").

[0250] As will be recognized by those skilled in the art, the medical device may be modified, if necessary, to provide fewer (or more) of the above-described movements, for example, by eliminating the rotational function or adding additional rotational functions (such as selective rotation of axis 15), etc.

[0251] 5. New tool support components

[0252] Continue reading Figures 47-49 This illustration shows a novel tool support 460 that can be used to support a medical device 5. The tool support 460 generally includes a clamp 465 for mounting the tool support 460 to an operating table 466, an adjustable base 470 for mounting one or more medical devices 5 to the tool support 460, and an adjustable arm 475 for adjusting the base 470 to the clamp 465. Figure 48 One or more instrument adapters 480 ( Figure 49 The device 5 is mounted to the base 470, thereby allowing one or more medical devices 5 to be mounted to the tool support 460 (i.e., by providing support for the handle 10 and / or rigid tube 60 at the proximal end of the shaft 15), as will be discussed in further detail below.

[0253] One or more tool channels 485 configured to transmit axis 15 to a patient (or to the working cavity of another medical device) are mounted to one or more instrument adapters 480, as will be discussed in further detail below.

[0254] More specifically, and still looking Figures 47-50 The clamp 465 is configured to be mounted to a stable object (e.g., to an operating table 466) so as to allow the surgeon to manipulate the tool support 460 (and thus one or more medical devices 5 mounted thereto) relative to the patient and / or relative to other surgical instruments, as will be discussed below.

[0255] The adjustable arm 475 preferably includes one or more segments 490. Figure 49 The segments 490 are adjustablely mounted to each other and to the clamps 465 and the base 470, thereby allowing the surgeon to precisely adjust the configuration of the base 470 relative to the patient (and / or relative to another surgical instrument).

[0256] Looking at it now Figure 49 and Figure 50 Each instrument adapter 480 includes a bracket 495 and a tube 500. The bracket 495 is pivotally mounted to the base 470. Figure 49 The tube 500 has an inner lumen 505, the dimensions of which are defined to receive the proximal end of the shaft 15 of the medical device 5 (i.e., the rigid tube 60 located at the proximal end of the shaft 15). If desired, the inner lumen 505 may include a diaphragm 515 for fluidly sealing the tube 500 (and thus the tool chamber 485), and / or the tube 500 may include an end cap 520 for fluidly sealing the tube 500 (and thus the tool chamber 485).

[0257] Looking at it now Figures 51-55 The diagram illustrates some exemplary configurations for the tool support 460. It should be appreciated that the base 470 of the tool support 460 may include multiple pivots and / or arms, may be shaped in the form of arcs, and / or may include other geometries, etc., to suit the needs and / or preferences of the surgeon.

[0258] 6. Medical devices with a rotatable shaft 15

[0259] As discussed above, the novel medical device 5 includes a shaft 15 having a flexible proximal portion 20, a distal articulated portion 25 selectively articulated relative to the distal end of the flexible proximal portion 20, and an end effector 30 selectively rotatable relative to the distal end of the distal articulated portion 25. Regarding this configuration, longitudinal movement of the handle 10 can be used to move the shaft 15 distally and proximally, thereby moving the end effector 30 distally and proximally; rotational movement of the handle 10 can be used to rotate the shaft 15, thereby rotating the end effector 30; joint control assembly 285 ( Figure 25 ) can be used to move the distal joint portion 25 of shaft 15, thereby changing the direction of end actuation device 30; rotation control assembly 295 ( Figure 25) can be used to rotate the end control device 30; and the trigger assembly 300 ( Figure 25 This can be used to actuate the end control device 30. Regarding the aforementioned configuration, the flexible proximal portion 20 and the handle 10 rotate as a unit.

[0260] However, it has been recognized that a flexible proximal portion 20 capable of rotating independently of the handle 10 and the axis 15 may be required. Therefore, and now let's look at... Figures 56-58 A novel rotatable shaft adapter mechanism 525 may be disposed between the shaft 15 and the handle 10, thereby allowing the shaft 15 (i.e., both the flexible proximal portion 20 and the distal articulated portion 25) to rotate selectively relative to the handle 10.

[0261] More specifically, a rotatable shaft adapter mechanism 525 is mounted to the proximal end of the shaft 15 (i.e., to the proximal end of the flexible proximal portion 20) and connects the shaft 15 to the handle 10. It should be understood that in this form of the invention, the rotatable shaft adapter mechanism 525 replaces the aforementioned shaft adapter 55 (where the aforementioned shaft adapter 55 is securely fixed to the handle 10 and securely fixed to the proximal end of the outer coil 35, and where the rigid tube 60 is securely fixed to the shaft adapter 55). More specifically, in this form of the invention, the shaft 15 is rotatably mounted to the distal end of the handle 10, and rotation is selectively locked / unlocked via the rotatable shaft adapter mechanism 525, as will be discussed in further detail below.

[0262] Still watching Figures 56-58 In this embodiment of the invention, the rigid tube 60 of the shaft 15 includes a flange 530 disposed around the proximal end of the rigid tube 60. The flange 530 is received in a corresponding groove 535 formed in the distal end of the handle 10 (i.e., in the cavity 280 of the handle 10 near the distal end of the handle 10), thereby rotatably mounting the rigid tube 60 of the shaft 15 to the handle 10. In this embodiment of the invention, the proximal end of the outer coil 35 is securely fixed to the rigid tube 60 (and the distal end of the outer coil 35 is fixed to the body 85 of the proximal joint connection assembly 75). The outer circumference of the distal end of the handle 10 includes a plurality of keyways 540 ( Figure 57 The dimensions of the keyway 540 are determined to receive a plurality of protrusions 542 formed on the rotatable shaft adapter mechanism 525, as will be discussed in further detail below. Note that, if desired, the positions of the keyway 540 and the protrusions 542 may be reversed as described above, i.e., the keyway 540 may be formed on the rotatable shaft adapter mechanism 525, and the protrusions 542 may be formed on the farthest end of the shank 10.

[0263] The rotatable shaft adapter mechanism 525 generally includes a shaft rotation knob 545 having an inner cavity 550 extending therethrough. The inner cavity 550 includes a distal end 555, a proximal end 560, and an annular shoulder 565 disposed therebetween. A spring 570 is disposed within the distal end 555 of the inner cavity 550, within a retaining cap 580. Figure 58 , Figure 58A , Figure 58B , Figure 58C and Figure 58D Extending between the proximal end 575 and the annular shoulder 565, the retaining cap 580 is circumferentially mounted around the outer periphery of the shaft 15, thereby biasing the shaft rotation knob 545 proximally such that the protrusion 542 of the shaft adapter mechanism 525 is received within the keyway 540 of the handle 10, thereby locking the shaft rotation knob 545 to prevent rotation. More specifically, the retaining cap 580 includes a pair of flat portions 585 keyed to corresponding flat portions 590 formed on the outer surface of the rigid tube 60 of the shaft 15. One or more spring fingers 591 engage grooves 592 on the outer surface of the rigid tube 60, thereby locking the retaining cap 580 to the rigid tube 60. The retaining cap 580 also includes a plurality of key features 593, the key features 593 being sized to be received in corresponding keyways 594 of the shaft rotation knob 545. Due to this construction, the rotary knob 545 can slide longitudinally relative to the rigid tube 60 of the shaft 15 (towards or to the proximal side); however, the rotary knob 545 is locked to prevent rotation relative to the rigid tube 60 (and therefore relative to the shaft 15). Thus, the knob 545 can move longitudinally without causing longitudinal movement of the rigid tube 60 and the shaft 15, but rotation of the knob 545 will be transmitted to the rigid tube 60 (and the shaft 15, as discussed below).

[0264] The shaft rotation knob 545 is connected to the rigid tube 60 of the shaft 15 (e.g., by protrusion, friction fit, etc.) so that the shaft rotation knob 545 can move longitudinally relative to the rigid tube 60, but is rotatably fixed to the rigid tube 60.

[0265] In this form of the invention, a protective sleeve or outer cover (e.g., Pebax) ® The proximal end of the protective sleeve or outer cover 270 is fixed (e.g., bonded) to the rigid tube 60, and the distal end of the protective sleeve or outer cover 270 is fixed (e.g., bonded) to the body 85 of the proximal articular connection assembly 75. Importantly, the protective sleeve or outer cover 270 is capable of transmitting torque between the rigid tube 60 and the body 85 of the proximal articular connection assembly 75.

[0266] Due to this construction, the spring 570 typically biases the shaft rotation knob 545 proximally, causing the protrusion 542 to engage the keyway 540 and lock the shaft 15 to prevent rotation relative to the handle 10. However, when the shaft rotation knob 545 moves distally against the force of the spring 570, the protrusion 542 disengages from the keyway 540, thereby allowing the shaft rotation knob 545 to selectively rotate relative to the handle 10, thereby selectively rotating the rigid tube 60 relative to the handle 10, thereby selectively rotating the protective sleeve or outer cover 270 relative to the handle 10, thereby selectively rotating the body 85 of the proximal joint coupling assembly 75, thereby selectively rotating the distal joint portion 25 of the shaft 15 relative to the handle 10. When the shaft 15 has been rotated to the desired position relative to the shank 10, the shaft rotation knob 545 is released, and the shaft rotation knob 545 moves proximally under the force of the spring 570, causing the protrusion 542 to re-engage the keyway 540, thereby locking the shaft 15 to prevent further rotation relative to the shank 10.

[0267] Therefore, it can be seen that in this form of the invention, the rigid tube 60 is rotatable relative to the handle 10, but is longitudinally fixed relative to the handle 10; the shaft rotation knob 545 is connected to the rigid tube 60 such that the shaft rotation knob 545 can move longitudinally relative to the rigid tube 60, but cannot rotate relative to the rigid tube 60, such that the shaft rotation knob 545 can be selectively locked to or unlocked from the handle 10, so as to allow the shaft rotation knob 545 to selectively rotate the rigid tube 60; and the protective sleeve or outer cover 270 transmits torque between the rigid tube 60 and the body 85 of the proximal joint connection assembly 75, such that the rotation of the rigid tube 60 causes the rotation of the body 85 of the proximal joint connection assembly 75, thereby causing the distal joint portion 25 of the shaft 15 to rotate relative to the handle 10.

[0268] It will be recognized that the infinite rotation of the rigid tube 60 and the shaft 15 will cause the articulated cable 220 and the articulated cable housing 235 to coil around themselves; therefore, in a preferred embodiment of the invention, a means for limiting the rotation of the rigid tube 60 and the shaft 15 is provided. More particularly, in a preferred embodiment of the invention, and now looking at... Figure 58E and 58F The rigid tube 60 of the shaft 15 preferably includes a groove 595 that extends circumferentially around the outer surface of the shaft 15. The groove 595 is located just distal to the proximal end of the shaft 15 and extends partially, but not entirely, around the circumference of the shaft 15. A corresponding boss 596 is formed on the distal end of the shank 10 and received within the groove 595. Due to this configuration, the shaft 15 can only rotate until the boss 596 reaches one end of the groove 595. In a preferred embodiment of the invention, the groove 580 is sized such that the shaft 15 can rotate up to 350 degrees.

[0269] 7 Additional Configurations

[0270] In the foregoing disclosure, a novel medical device 5 is described, comprising a handle, an elongated flexible shaft, and an end effector disposed at the distal end of the shaft, the end effector being configured to perform a medical procedure. It should be recognized that the medical device 5 can be modified in various ways to support different types of end effectors, to facilitate one-handed use of the medical device 5, to enhance the functionality of the medical device 5, etc.

[0271] 7.1 Alternative end control devices

[0272] As discussed above, in a preferred embodiment of the invention, the end-effector 30 includes two opposing jaws 216, 217. Figure 8 ) surgical gripper.

[0273] In another preferred embodiment of the invention, and now it is seen that... Figures 59-62 The end-operated device 30 includes scissors 600 having opposing blades 605 and 610. Blades 605 and 610 have sharp cutting edges that contact each other to facilitate cutting (e.g., tissue, sutures, etc.) when the blades 605 and 610 are placed together (i.e., closed). To ensure clean cutting with the blades 605 and 610, they need to remain in close contact when placed together (i.e., closed). For this purpose, a beveled washer 615 is provided between one of the blades 605 and 610 and the inner wall of the end-operated device support 210. Figure 61 and 62 The beveled washer 615 is preferably disposed on pin 217A, which pivotally mounts the blades 605, 610 to the end-operation device bracket 210. By mounting the beveled washer 615 in this manner, the blades 605, 610 remain tightly engaged when placed together (i.e., closed), thereby facilitating clean cutting (e.g., tissue, sutures, etc.).

[0274] 7.2 Finger slider for single-handed spindle rotation

[0275] As discussed above, in one form of the invention, the shaft 15 is rotatably mounted to the distal end of the handle 10, and a rotatable shaft adapter mechanism 525 can be used. Figures 56-58 (and 58A-58F) can be selectively rotated. In this form of the invention, the proximal end of the shaft 15 is rotatably mounted to the distal end of the shank 10 (e.g., by means of the aforementioned flange 530 on the rigid tube 60). Figure 58The shaft adapter mechanism 525 is rotatably received within the corresponding groove 535 formed in the distal end of the handle 10, and the rotatable shaft adapter mechanism 525 moves distally (i.e., pushed distally by the user against the force of the spring 570) to "unlock" the shaft 15 (i.e., allow the shaft rotation knob 545 to rotate, and thus the shaft 15 to rotate). The user can then rotate the shaft 15 as needed (i.e., by rotating the rotatable shaft adapter mechanism 525, and thus rotating the shaft 15). After the user rotates the shaft 15 as needed, the shaft adapter mechanism 525 releases and automatically moves proximally (i.e., under the force of the spring 570) to "lock" the shaft 15 to prevent further rotation. This movement typically requires the user to push the rotatable shaft adapter mechanism 525 distally with one hand (and then rotate the shaft 15), while the user keeps the handle 10 stationary with their other hand.

[0276] However, it should be recognized that the user may also need to rotate the shaft 15 with one hand. Therefore, in another form of the invention, the shaft 15 remains stationary (e.g., by means of the outer surface of the shaft 15 and the tool channel (e.g., tool channel 485)). Figure 48 The friction between the tool channel cavity located inside another medical instrument (such as an endoscope) causes the handle 10 to selectively rotate and separate from the shaft 15, and the user can selectively rotate the handle 10 to the desired rotation position with one hand. The handle 10 is then rotatably reattached to the shaft 15, and then rotated by the user (thus also rotating the shaft 15).

[0277] More particularly, regarding this form of the invention, and now looking at... Figures 63-66 A shaft-rotating finger slide assembly 625 is provided to enable the shaft 15 to be rotated with one hand, as will be discussed in further detail below. The shaft-rotating finger slide assembly 625 generally includes: a finger slide mechanism 630 slidably disposed within the handle 10; and a shaft collar 635 securely mounted to the proximal end of the shaft 15 (e.g., securely mounted to a rigid tube 60).

[0278] The finger sliding mechanism 630 includes a saddle 640 having a pair of protrusions 645 extending through corresponding grooves (not shown) formed in the sidewall of the handle 10. A pair of finger slides 647 are secured to the protrusions 645. A post 650 extends distally from the saddle 640 and is configured to selectively lock the bushing 635 to prevent rotation, as will be discussed in further detail below. A spring 655 distally biases the saddle 640 (and thus the post 650) such that when the finger sliding mechanism 630 is in its stationary state, the post 650 engages the bushing 635, as will be discussed in further detail below.

[0279] A bushing 635 is securely mounted to the proximal end of the shaft 15 (e.g., a rigid tube 60). The bushing 635 includes a distal end 660, a proximal end 665, and an inner cavity 670 extending therebetween. A plurality of teeth 675 are arranged around the inner circumference of the inner cavity 670 at the proximal end 665 of the bushing 635, wherein the teeth 675 are spaced such that the strut 650 of the finger sliding mechanism 630 can be received within the gap between pairs of adjacent teeth 675, thereby locking the bushing 635 (and thus the shaft 15) from rotation, as will be discussed in further detail below.

[0280] When the user needs to rotate shaft 15, the user moves the finger slider 647 proximally, thereby moving the protrusion 645 proximally, which in turn moves the saddle 640 proximally against the force of spring 655. When this occurs, the post 650 also moves proximally, disengaging the post 650 from the teeth 675 of the bushing 635 (and thus causing the handle 10 to rotate away from shaft 15). While holding the protrusion 645 proximally, the user can then rotate the handle 10 relative to shaft 15 as needed. When the handle 10 rotates, the shaft 15 does not rotate (i.e., the shaft 15 remains stationary due to friction between its outer surface and the interior of the cavity in which it is disposed (e.g., in the tool channel 485). After the user rotates the handle 10 to the desired extent, the user releases the finger slide 647, which allows the protrusion 645 and the saddle 640 (and thus the post 650) to move distally under the force of the spring 655, and the post 650 moves distally into the space between the paired teeth 675 of the bushing 635, thereby rotatably reconnecting the handle 10 to the bushing 635 (and thus... This shaft 15). At this point, the user can rotate the handle 10 to rotate the shaft 15 as needed. As an example and not a limitation, if the user needs to rotate the shaft 15 90 degrees clockwise, the user can rotatably separate the shaft 15 from the handle 10 in the manner described above, rotate the handle 10 90 degrees counterclockwise (e.g., the grip of the handle moves the handle 10 from the "6 o'clock" position to the "3 o'clock" position), reattach the shaft 15 to the handle 10 in the manner described above, and then rotate the handle 10 (and therefore the shaft 15) 90 degrees clockwise (e.g., rotate the grip of the handle 10 from the "3 o'clock" position to the "6 o'clock" position).

[0281] 7.3 Single-plane joint mechanism

[0282] As discussed above, in a preferred embodiment of the invention, the joint control assembly 285 includes a thumb ball assembly 310 configured to selectively pull one or more of the four joint cables 220 proximally, thereby allowing selective universal joint movement of the distal joint portion 25 of the shaft 15 relative to the flexible proximal portion 20 of the shaft 15 via the movement of the thumb ball assembly 310.

[0283] However, it has been recognized that there is sometimes a need to provide a simplified joint control assembly that can be used with only two joint cables, for example, to provide uniplane joint movement of the distal joint portion 25 of the shaft 15 relative to the flexible proximal portion 20 of the shaft 15. Therefore, in one form of the invention, and now seen... Figures 67-69 The diagram shows a joint control assembly 680, which is similar to the joint control assembly 285 described above, but configured to provide uniplane joint motion, as will be discussed in further detail below.

[0284] More specifically, the joint control assembly 680 includes a rocker arm 685 pivotally mounted within a cavity 280 of the handle 10. The rocker arm 685 may be pivotally mounted within the cavity 280 via a suitably formed seat disposed within the cavity 280 of the handle 10 or by other means (e.g., a pivot pin). A thumb lever 690 is mounted to the rocker arm 685 and extends proximally through a groove 695 formed in the housing of the handle 10. Figure 69 The wedge-shaped thumb support 700 is preferably mounted to the free end of the thumb bar 690, and two articulated cables 220 (not shown) are mounted to the rocker arm 685 (e.g., by mounting the proximal ends of the articulated cables 220 into grooves 705 formed on the rocker arm 685 with opposite diameters).

[0285] Because of this construction, the user can selectively move the distal joint portion 25 of the shaft 15 in a single plane by selectively moving the thumb lever 690, thereby selectively pivoting the rocker arm 685 in a single plane, and thus selectively pulling one of the two joint cables 220 mounted proximally to the rocker arm 685.

[0286] 7.4 HHS coil including compressed outer winding layer

[0287] As discussed above, the pull cord 230 is disposed within the cavity 260 of the HHS coil 225 and is able to slide freely relative to the HHS coil 225 in order to selectively actuate the end control device 30 (i.e., when the user pulls the trigger 415 of the handle 10, the pull cord 230 is moved proximally).

[0288] It has been found that because shaft 15 (and therefore HHS coil 225) can extend a considerable distance along a tortuous path (e.g., through the patient's colon), HHS coil 225 can sometimes be longitudinally compressed (i.e., longitudinally shortened), while pull cord 230 is not longitudinally compressed (i.e., longitudinally shortened). When this occurs, pull cord 230 needs to be moved proximally a certain distance to actuate end-operated device 30 because HHS coil 225 provides a reaction force to pull cord 230. However, further proximal movement of pull cord 230 may be impossible if trigger 415 has reached the end of its "stroke" (i.e., if trigger 415 cannot be pulled further).

[0289] To minimize the longitudinal compression of the HHS coil 225, now look at Figures 70-72 In one embodiment of the invention, a flat-wound coil 710 is provided, which is wound around the HHS coil 225. The flat-wound coil 710 is soldered to both the distal end 250 and the proximal end 255 of the HHS coil 225. The coil 710 rotates together with the HHS coil 225 and provides support for the HHS coil 225, thereby minimizing longitudinal compression of the HHS coil 225. Due to this configuration, the HHS coil 225 does not compress longitudinally (i.e., the HHS coil 225 does not shorten) when the shaft 15 is arranged along a tortuous path.

[0290] 7.5 Cover for end control device bracket 210

[0291] As discussed above, the end effector 30 can be pivotally mounted into the end effector bracket 210 via pin 217A of the jaws 216, 217 of the end effector and gripper.

[0292] However, for some end effectors, it is necessary to provide an opening in the side of the end effector bracket 210 so that the proximal end of the end effector element has room to move when the end effector is in certain configurations. This is by way of example, not limitation, and is now considered... Figure 73 and Figure 74 In one form of the invention, the end effector 30 includes scissors. More specifically, in this form of the invention, the end effector 30 includes a first blade 715 having a distal end 720 and a proximal end 725, and a second blade 730 having a distal end 735 and a proximal end 740. The first blade 715 and the second blade 730 are pivotally mounted to each other and pivotally mounted to the end effector support 210 via a pin 745. When the first blade 715 and the second blade 730 are opened (i.e., to receive tissue, sutures, etc. to be cut), the proximal end 725 of the first blade 715 and the proximal end 740 of the second blade 730 are dislodged from the end effector support 210. Figure 73Lateral protrusion. It has been found that when the end-effector 30 is used during surgery, particularly when the end-effector 30 is rotated at the surgical site and the blades 715, 730 are in the open position, the proximal ends 725, 740 can present a sharp surface that can damage surrounding equipment and / or anatomical structures. To eliminate this problem, a cover 750 can be provided to cover the proximal portion of the end-effector support 210. As a result, even when the blades 715, 730 are in their open position, the proximal ends 725, 740 of the blades 715, 730 remain covered, thereby preventing damage to anatomical structures or other surgical equipment. In a preferred embodiment of the invention, the cover 750 is formed of an electrically insulating material, so that the cover 750 also provides electrical insulation. This may be advantageous in cases where the end-effector 30 includes monopole scissors, etc.

[0293] 7.6 Enhanced Handle and Trigger Ergonomics

[0294] As discussed above, in a preferred embodiment of the invention, trigger 415 ( Figure 25 It can be pivotally mounted to the handle 10 and can be selectively pulled by the user to selectively actuate the end control device 30. For illustrative purposes, the trigger 415 is in Figure 25 The center is shown as a conventional "pistol-style" trigger, and the handle 10 is shown as including a conventional "pistol-style" grip.

[0295] However, it has been found that sometimes it is necessary to provide additional stabilizing elements on the handle 10 (e.g., to facilitate one-handed use of the medical device 5) and / or to provide triggers with longer strokes (i.e., increased radian of movement) to provide better leverage.

[0296] Therefore, and now let's look at it. Figure 75 and Figure 76 In one embodiment of the invention, the handle 10 includes a "little finger" stabilizer ring 755 for receiving the user's "little finger" and a "shepard's hook" type trigger 760 that provides the user with greater leverage and superior ergonomics. This configuration allows the user to better grip the handle 10 with one hand and also allows the user to easily move the trigger 415 proximally or distally (e.g., pull or push the pull line 230 to selectively close / open the jaws of the gripper, etc.).

[0297] 7.7 Unipolar Current Transfer

[0298] In some cases, it is necessary to be able to transmit unipolar electrical power to the end-operated device 30. By way of example and not limitation, in cases where the end-operated device 30 includes unipolar (“hot”) shears, it is necessary to transmit electrical power from the handle 10 along (or through) the shaft 15 to the end-operated device 30.

[0299] Therefore, and now let's look at it. Figures 77-80 In a preferred embodiment of the invention, an electrical connection port (e.g., a "banana socket") 765 is provided on the proximal end of the handle 10 for connection to an external power supply unit (not shown), and an electrical connection port 765 is provided within the inner cavity 280 of the handle 10 for transmitting electrical power from the electrical connection port 765 to the external power supply unit (not shown) provided on the handle 10. Figure 80 The flat conduction spring 775 inside the wire 770 ( Figure 79 The flat conductive spring 775 contacts a plurality of teeth 409 disposed on the rotary key 405, thereby making electrical contact with the rotary key 405, and thus making electrical contact with the HHS coil 225 and / or the pull wire 230 via the rotary key 405. It should be appreciated that, with respect to this form of the invention, the bulbous spring plunger 410 is preferably omitted (i.e., it is replaced by the flat conductive spring 775). Additionally, with respect to this form of the invention, the rotary key 405 (and the teeth 409 of the rotary key 405) is formed of an electrically conductive material (e.g., metal), as are the long laser-cut hysteresis tube 180, the rotary connector 200, and the end-operated device bracket 210. As a result, electrical power can be transmitted from an external power supply unit (not shown) to the electrical connection port 765, along line 770 to the flat conduction spring 775, from the conduction spring 775 to the rotary key 405, and then to the HHS coil 225 (and also to the pull wire 230), along the HHS coil 225 (and the pull wire 230) through the flexible proximal portion 20 of the shaft 15, through the sleeve (or crimping portion) 265 to the long laser-cut hyaluronic acid tube 180, along the long laser-cut hyaluronic acid tube 180 (and the pull wire 230) through the distal joint portion 25 of the shaft 15, to the rotary connector 200 and the end control device bracket 210, and from the end control device bracket 210 to the end control device 30. In this way, unipolar power can be supplied to the end control device 30.

[0300] 8. Medical devices with additional joint mobility 5

[0301] As discussed above, in a preferred embodiment of the invention, the novel medical device 5 generally includes a shaft 15 having a flexible proximal portion 20, a distal joint portion 25 configured for selective articulation with respect to the distal end of the flexible proximal portion 20, and an end effector 30 configured for selective rotation with respect to the distal end of the distal joint portion 25. With respect to this embodiment of the invention, longitudinal movement of the handle 10 can be used to selectively move the shaft 15 distally or proximally, thereby moving the end effector 30 distally or proximally; rotational movement of the handle 10 can be used to rotate the shaft 15 (and thus also rotate the end effector 30); joint control assembly 285 ( Figure 25This can be used to selectively articulate the distal articulated portion 25 of shaft 15 relative to the flexible proximal portion 20 of shaft 15, thereby allowing control over the positioning of the end effector 30; rotation control assembly 295 ( Figure 25 This can be used to selectively rotate the end actuation device 30 relative to the distal joint portion 25 of the shaft 15; and the trigger assembly 300 ( Figure 25 This can be used to selectively actuate the end actuation device 30. It should be understood that in this form of the invention, the flexible proximal portion 20 of the shaft 15, together with the handle 10, rotates as a single unit.

[0302] As also discussed above, in another preferred embodiment of the invention, the novel medical device 5 may further include a rotatable shaft adapter mechanism 525, which rotates the knob 545 ( Figures 56-58 Actuated by rotating knob 545, the shaft 15 (i.e., both the flexible proximal portion 20 and the distal articulated portion 25) can be selectively rotated relative to handle 10.

[0303] However, it should also be recognized that in some cases, additional articulation may be required to the axis 15 of the novel medical device. As an example, and not a limitation, when the medical device 5 passes along a sharp bend in the colon (or other anatomical structure), the axis 15 of the medical device 5 is anatomically constrained and forced to deflect along the outer curve of the bend in the colon (or other anatomical structure), making it difficult for the end-effector 30 to align with the corresponding inner curve of the bend in the colon (or other anatomical structure) and grip the tissue along it. Therefore, a medical device is needed that allows for greater articulation and thus allows for more options for addressing anatomy with the end-effector 30.

[0304] Therefore, and now let's look at it. Figure 81 In another preferred embodiment of the invention, the novel medical device 5 further includes an intermediate joint portion 800 disposed between the distal end of the flexible proximal portion 20 and the proximal end of the distal joint portion 25. The intermediate joint portion 800 is joint-movable in a single plane (e.g., in a manner similar to a human "elbow" joint) to provide an additional degree of joint movement to the distal joint-movable end portion of the medical device 5, as will be discussed in further detail below. This additional degree of joint movement is sometimes referred to hereinafter as "total joint function".

[0305] Utilizing the additional range of motion provided by the total joint function (provided by the intermediate joint portion 800), the novel medical device 5 is capable of performing at least the following movements:

[0306] The end control device 30 moves longitudinally via the longitudinal movement of the handle 10 (sometimes referred to herein as "longitudinal movement function");

[0307] The motion 2 - end control device 30 rotates by the rotational motion of the handle 10 (sometimes referred to herein as "torsional motion function");

[0308] Movement 3 - The end actuation device 30 is articulated relative to the handle 10 by articulating the distal articulated portion 25 of the shaft 15 relative to the distal end of the intermediate articulated portion 800 of the shaft 15 (sometimes referred to herein as "universal joint function").

[0309] Movement 4 - The distal end of the end actuation device 30 is rotated relative to the distal joint portion 25 of the shaft 15 by rotating the end actuation device 30 relative to the shaft 15 (sometimes referred to herein as the "rotation function").

[0310] Movement 5 - Actuation of the end manipulator 30, for example, causing the elements of the end manipulator 30 to move selectively relative to each other in order to perform a medical procedure, such as opening and closing the jaws of a gripper-type end manipulator (sometimes referred to herein as "jaw opening / closing function").

[0311] Movement 6 - Axis 15 rotates independently of handle 10, for example, by selectively rotating the rotary knob 545 of the rotatable shaft adapter mechanism 525 to allow shaft 15 (and thus the flexible proximal portion 20, intermediate joint portion 800, and distal joint portion 25) to rotate selectively relative to handle 10; and

[0312] Movement 7 - The distal joint portion 25 and the end actuation device 30 are jointed relative to the flexible proximal portion 20 of the shaft 15 by making the intermediate joint portion 800 of the shaft 15 joint relative to the distal end of the flexible proximal portion 20 of the shaft 15 joint (sometimes referred to herein as "total joint function").

[0313] Even more specifically, let's continue. Figure 82 , Figure 83 and Figure 83A In this form of the invention, the novel medical device 5 includes (i) four of the aforementioned joint cables 220 for selectively jointing the distal joint portion 25 relative to the distal end of the flexible proximal portion 20; and (ii) the aforementioned hollow spiral (HHS) coil 225 for causing the rotatable housing assembly 165 ( Figure 9 (iii) the aforementioned pull cable 230, which is used to selectively actuate the end control device 30 relative to the shaft 15, and (iv) the total joint cable 805, which is used to selectively joint the intermediate joint portion 800 relative to the distal end of the flexible proximal portion 20, as will be discussed in further detail below.

[0314] Still looking Figure 82 , Figure 83 and Figure 83A The intermediate joint portion 800 generally includes a flexible spine 810 (e.g., a laser-cut hypotube), the flexible spine 810 having a proximal end 815, a distal end 820, and a central cavity 825 disposed therebetween. The proximal end 815 of the intermediate joint portion 800 is mounted (e.g., welded, crimped, etc.) to the distal end 40 of the flexible outer coil 35, and the distal end 820 of the intermediate joint portion 800 is mounted (e.g., welded, crimped, etc.) to the proximal joint connection assembly 75.

[0315] The master articulation cable 805 extends from the distal end 820 of the flexible spine 810 to the stem 10. The distal end of the master articulation cable 805 includes a crimp (not shown) that is welded to the distal end of the master articulation cable 805, which is then mounted (e.g., welded to) to the inner surface of the flexible spine 810 near the distal end 820. As will be discussed in further detail below, the proximal end of the master articulation cable 805 is attached to a control assembly within the stem 10.

[0316] A portion of the total joint cable 805, extending between the distal end 820 and the proximal end 815 of the flexible spine 810, is slidably disposed within a total joint cable conduit 830, which is disposed within a cavity 825 of the flexible spine 810. A portion of the total joint cable 805, extending from the distal end 40 of the flexible outer coil 35 through the flexible proximal portion 20 and through the shaft 15 to the handle 10, is slidably disposed within a joint cable housing 235. The total joint cable conduit 830 is welded to the proximal end 815 of the flexible spine 810, and the joint cable housing 235 is welded to the flexible outer coil 35 of the shaft 15, but the total joint cable conduit 830 is not connected to the joint cable housing 235.

[0317] The main joint cable conduit 830 and the joint cable housing 235 separate the main joint cable 805 from the joint cable 220 / joint cable housing 235 and from the HHS coil 225 / torque bushing 267, thereby ensuring smooth sliding movement of the main joint cable 805 within the intermediate joint portion 800, the flexible proximal portion 20 and the shaft 15 (i.e., it can be quite long (e.g., 95cm-140cm) in the distance between the handle 10 and the distal end 820 of the flexible spine 810, and typically follows a tortuous path when the medical device 5 is placed in the patient).

[0318] The main articulated cable conduit 830 is configured to be more compressible than the articulated cable housing 235 to ensure that the flexible spine 810 can be deflected to the desired angle. In a preferred embodiment of the invention, the main articulated cable conduit 830 includes a helical spring such that proximal movement of the main articulated cable 805 causes articulation of the flexible spine 810 relative to the distal end 40 of the flexible outer coil 35, while allowing the main articulated cable conduit 830 to compress along its longitudinal dimension.

[0319] Due to this configuration, by selectively moving the main joint cable 805 proximally, the flexible spine 810 of the intermediate joint portion 800 can be selectively moved laterally relative to the distal end 40 of the flexible outer coil 35, thereby selectively jointing the intermediate joint portion 800 of the shaft 15.

[0320] Significantly, because only a single total joint cable 805 is provided, the intermediate joint portion 800 can only move in a single plane. However, as will be apparent to those skilled in the art from the contents of this disclosure, additional total joint cables 805 may be provided if joint movement in additional planes is required.

[0321] Continue reading Figure 81 and Figures 84-87 A preferred mechanism for selectively moving the total joint cable 805 is shown.

[0322] More specifically, as discussed above, the handle 10 generally includes an inner cavity 280, a joint control assembly 285 for selectively moving the joint cable 220 (and thus selectively jointing the distal joint portion 25 of the shaft 15), a push rod locking assembly 290 for selectively locking the joint control assembly 285 in a desired position (and thus locking the distal joint portion 25 of the shaft 15 in a selected position), a rotation control assembly 295 for selectively rotating the HHS coil 225 (and thus selectively rotating the end actuation device 30), a trigger assembly 300 for selectively actuating the pull cable 230 (and thus selectively actuating the end actuation device 30), and a rotatable shaft adapter mechanism 525 for selectively rotating the shaft 15 (i.e., the flexible proximal portion 20, the intermediate joint portion 800, and the distal joint portion 25) relative to the handle 10.

[0323] In this form of the invention, the handle 10 is further provided with a total joint control assembly 835 for selectively moving the total joint cable 805 proximally or distally (and thus selectively jointing the flexible spine 810 of the intermediate joint portion 800 of the shaft 15 relative to the flexible proximal portion 20 of the shaft 15).

[0324] The overall joint control assembly 835 generally includes: a spindle housing 840, which is securely mounted within the cavity 280 of the handle 10; a spindle 845 configured to selectively rotate within the spindle housing 840; and a knob 850 configured to be engaged by a user.

[0325] The proximal end of the main joint cable 805 exits from the proximal end of the shaft 15, passes through a portion of the inner cavity 280 of the handle 10, and is mounted to the spindle 845 (e.g., via a crimped portion welded to the main joint cable 805 and the spindle 845, via direct welding to the spindle 845, etc.). The cable housing 235 for the main joint cable 805 preferably terminates at the proximal end of the shaft 15; however, if desired, the cable housing 235 for the main joint cable 805 may extend into the inner cavity 280 of the handle 10 and terminate at the outer wall of the spindle housing 840.

[0326] Due to this configuration, when the knob 850 is rotated in the first direction, the proximal end of the total joint cable 805 is pulled proximally, thereby selectively moving the flexible spine 810 of the intermediate joint portion 800 of the shaft 15 from a straight joint configuration to a joint configuration (relative to the flexible proximal portion 20 of the shaft 15). When the knob 850 is rotated in the second, opposite direction, the tension on the proximal end of the total joint cable 805 is relaxed and allowed to move distally, thereby allowing the flexible spine 810 of the intermediate joint portion 800 of the shaft 15 to return to its straight, non-jointed configuration.

[0327] It should also be recognized that, if desired, the flexible spine 810 of the intermediate joint portion 800 can be configured to automatically return to its straight (i.e., non-jointed) configuration when the knob 850 is released by the user. By way of example and not limitation, the flexible spine 810 may be formed of an elastic flexible material biased toward a straight configuration. Due to this configuration, releasing the knob 850 of the total joint control assembly 835 allows the total joint cable 805 to move distally (i.e., under the force of the biasing force provided by the elastic properties of the flexible spine 810), thereby allowing the flexible spine 810 to return to its straight (i.e., non-jointed) configuration. Alternatively and / or additionally, if desired, an additional total joint cable 805A (not shown) may be provided, wherein the distal end of the additional total joint cable 805A (e.g., diametrically opposite to the total joint cable 805) is mounted to the inner surface of the flexible spine 810 near the distal end 820 of the flexible spine 810, thereby facilitating the return of the flexible spine 810 (and thus the intermediate joint portion 800) to its straight (i.e., non-articular) configuration and / or the joint movement of the flexible spine 810 in a second, opposite direction.

[0328] Importantly, it should be noted that in order to enable joint movement of the flexible spine 810 of the intermediate joint portion 800, the rotary knob 850 of the total joint control assembly 835 typically requires the use of two hands (i.e., one hand grips the handle 10 and the other hand rotates the knob 850). However, it should be recognized that, if desired, the knob 850 can be replaced by a lever (not shown) or other actuating device to allow single-handed joint movement of the flexible spine 810 of the intermediate joint portion 800.

[0329] In an exemplary use of this novel medical device 5 in a minimally invasive procedure, the profile of the end effector 30 is first reduced (e.g., closing the jaws of a gripper if the end effector 30 includes a gripper); the shaft 15 is straightened; the handle 10 is advanced longitudinally so that the distal end of the medical device 5 is advanced longitudinally through the inlet and into the body (e.g., along a tortuous path); the handle 10 is advanced longitudinally and / or rotated, and / or the distal joint portion 25 of the shaft 15 is articulated, and / or the intermediate joint portion 800 is articulated, and / or the end effector 30 is articulated, such that the end effector 30 is properly aimed at the target tissue at the internal site; the end effector 30 is used to perform at the internal site The required processes (e.g., in the case where the end-effector 30 includes a surgical gripper, opening and / or closing the jaws of the gripper to grip tissue and / or perform a surgical procedure); and withdrawing the distal end of the medical device 5 from the body, for example, by longitudinally withdrawing the handle 10 through the inlet (during which the handle may also be rotated, and / or the distal articulated portion 25 of the shaft 15 straightened (i.e., moved to its non-articular configuration), and / or the flexible spine 810 of the intermediate articulated portion 800 straightened (i.e., moved to its non-articular configuration), and / or the end-effector 30 articulated and / or actuated (e.g., if necessary, reducing the profile of the end-effector 30)) such that the end-effector can be withdrawn from the body.

[0330] Those skilled in the art will recognize that, if necessary, the medical device can be modified to provide fewer (or more) of the seven movements described above, for example, the rotational function can be eliminated, additional rotational functions (such as selective rotation of axis 15) can be added, etc.

[0331] Modifications to the preferred embodiment

[0332] It should be understood that many additional changes in the details, materials, steps, and arrangement of parts described and illustrated herein for the purpose of explaining the nature of the invention can be made by those skilled in the art, while still remaining within the principles and scope of the invention.

Claims

1. Apparatus for performing a minimally invasive procedure, the apparatus comprising: a shaft having a distal end and a proximal end; a handle attached to the proximal end of the shaft; and an end effector attached to the distal end of the shaft; wherein the shaft comprises a flexible portion, a first articulation portion, and a second articulation portion, wherein the flexible portion extends distally from the handle, the first articulation portion extends distally from the flexible portion, and the second articulation portion extends distally from the first articulation portion; wherein at least one total articulation cable extends from the handle to the first articulation portion such that when tension is applied to the at least one total articulation cable, the first articulation portion deflects; wherein a plurality of articulation cables extend from the handle to the second articulation portion such that when tension is applied to at least one of the plurality of articulation cables, the second articulation portion deflects, wherein the first articulation portion and the second articulation portion articulate independently of one another, and wherein an actuation element extends from the handle to the end effector such that when the actuation element moves, the end effector is actuated, and wherein the at least one total articulation cable is at least partially slidably disposed within an articulation cable housing extending from the handle to a distal end of the flexible portion, and at least partially slidably disposed within a total articulation cable conduit extending from a proximal end of the first articulation portion to a distal end of the first articulation portion. the first articulation portion comprises a first flexible spine, and the second articulation portion comprises a second flexible spine.

2. The apparatus of claim 1, wherein, the plurality of articulation cables have an articulation cable housing disposed about the plurality of articulation cables such that when tension is applied to the plurality of articulation cables, the second articulation portion deflects, wherein the articulation cable housing provides a counter force to the second articulation portion.

3. The apparatus of claim 1, wherein, the at least one total articulation cable is at least partially slidably disposed within a total articulation cable conduit such that the at least one total articulation cable is separate from the plurality of articulation cables, wherein the total articulation cable conduit is configured to be more compressible than the articulation cable housing.

4. The apparatus of claim 3, wherein, the first articulation portion comprises a proximal end and a distal end, wherein the articulation cable housing extends from the handle to a distal end of the flexible portion, and the total articulation cable conduit extends from a proximal end of the first articulation portion to a distal end of the first articulation portion.

5. The apparatus of claim 4, wherein, the total articulation cable conduit comprises a helical spring.

6. The apparatus of claim 4, wherein, each of the plurality of articulation cables has an articulation cable housing disposed about each of the plurality of articulation cables such that when tension is applied to at least one of the plurality of articulation cables, the second articulation portion deflects, wherein the articulation cable housing provides a counter force to the second articulation portion.

7. The apparatus of claim 1, wherein, a rotatable element extends from the handle to the end effector such that when the rotatable element rotates, the end effector rotates.

8. The apparatus of claim 1, wherein, the flexible portion of the shaft comprises an outer coil fixed to the first flexible spine.

9. The apparatus of claim 2, wherein, ​ 10. The apparatus of claim 1, wherein, The device also includes a rigid tube configured to rotate relative to the handle such that rotation of the rigid tube causes rotation of the shaft relative to the handle.

11. The apparatus of claim 8, wherein, The rotatable element includes a hollow tubular structure that extends distally from the handle.

12. The apparatus of claim 11, wherein, The rotatable element also includes a laser-cut hypotube that is fixed to the hollow tubular structure such that when the hollow tubular structure rotates, the laser-cut hypotube also rotates.

13. The apparatus of claim 1, wherein, The actuation element includes a pull wire.

14. The apparatus of claim 1, wherein, The end effector includes one from the group consisting of: a grasper, an injection needle, scissors, a hot-loop, a monopolar probe, a hemostat, a bipolar forceps, a suction tube, a single-shot or multi-shot closure device such as a stapler and a tracker, a dissector forceps, a basket, a monopolar scissors, a light source, and a camera.

Images