Actuation of a Push-Pull Surgical Instrument End Effector Using a Flexible Tension Member

Abstract

The present invention relates to actuation of a push-pull surgical instrument end effector using a flexible tension member. A surgical tool and related method articulate an actuation rod assembly by actuating a tension member. The surgical tool includes an end effector, an instrument shaft assembly supporting the end effector, an actuation rod assembly drivingly coupled to the end effector, a guide surface, a flexible tension member connected to the actuation rod assembly, and an actuation portion. The actuation rod assembly is mounted to slide within the instrument shaft assembly. The flexible tension member is connected to the actuation rod assembly at a connection portion. The flexible tension member includes a first portion that extends distally from the connection portion to the guide surface, wraps around the guide surface, and extends proximally from the guide surface. The actuation portion is drivingly coupled to the flexible tension member and is operable to articulate the tension member to articulate the actuation rod assembly to actuate the end effector.

Description

[0001] This application is a divisional application of Chinese Patent Application No. 2017800545626 (PCT / US2017 / 050760), titled "Push-Pull Surgical Instrument End Effector Actuation Using a Flexible Tension Member", with an international filing date of September 8, 2017 and an entry into the national stage on March 6, 2019.

[0002] Cross-Reference to Related Applications

[0003] This application claims the benefit of U.S. Provisional Application No. 62 / 385,642, filed on September 9, 2016, the entire disclosure of which is incorporated herein by reference in its entirety for all purposes. Background Art

[0004] Minimally invasive surgical techniques are designed to reduce the amount of external tissue damaged during a diagnostic or surgical procedure, thereby reducing a patient's recovery time, discomfort, and harmful side effects. Thus, the use of minimally invasive surgical techniques can significantly shorten the average hospital stay for a standard surgical procedure. Additionally, patient recovery time, patient discomfort, surgical side effects, and time away from work can also be reduced through minimally invasive surgery.

[0005] A common form of minimally invasive surgery is endoscopy, and a common form of endoscopy is laparoscopy, which is a minimally invasive examination and surgery within the abdominal cavity. In standard laparoscopic surgery, a patient's abdominal cavity is insufflated with gas, and trocar sleeves are passed through small (about half an inch or less) incisions to provide entry ports for laparoscopic instruments.

[0006] Laparoscopic surgical instruments typically include an endoscope (e.g., a laparoscope) for viewing the surgical area and tools for working at the surgical site. The working tools are generally similar to those used in conventional (open) surgery, except that the working end or end effector of each tool is separated from its handle by an elongate tube (also referred to as, e.g., an instrument shaft or a main shaft). For example, the end effector can include a clamp, a gripper, scissors, a stapler, a cautery tool, a linear cutter, or a needle holder.

[0007] To perform a surgical procedure, a surgeon passes the working tools through the trocar sleeves into the internal surgical site and manipulates them from outside the abdomen. The surgeon views the procedure on a monitor that displays an image of the surgical site taken from the endoscope. For example, similar endoscopic techniques are used in arthroscopic surgery, retroperitoneal laparoscopy, pelvicoscopy, nephroscopy, cystoscopy, cystourethroscopy, sinusoscopy, hysteroscopy, urethroscopy, etc.

[0008] A minimally invasive remote surgical robotic system is being developed to increase the flexibility of a surgeon when working on an internal surgical site and to allow the surgeon to operate on a patient from a remote location (outside the sterile area). In a remote surgical system, a surgeon is typically provided with an image of the surgical site at a console. While viewing a three-dimensional image of the surgical site on a suitable viewer or display, the surgeon performs a surgical procedure on the patient by manipulating the primary input or control devices of the console. Each primary input device controls the movement of a servo-mechanically actuated / articulated surgical instrument. During the surgical procedure, the remote surgical system can provide mechanical actuation and control of various surgical instruments or tools having end effectors that enable the surgeon to perform various functions, such as holding or driving a needle, grasping a blood vessel, dissecting tissue, etc., in response to manipulation of the primary input devices.

[0009] Surgical clamping and cutting tools (e.g., non-robotic linear clamping, suturing, and cutting devices, also known as surgical staplers; and electrosurgical vessel sealing devices) have been used in many different surgical procedures. For example, surgical staplers can be used to excise cancerous or abnormal tissue from the gastrointestinal tract. Many known surgical clamping and cutting devices (including known surgical staplers) have opposing jaws for clamping tissue and an articulated knife for cutting the clamped tissue.

[0010] A surgical clamping and cutting tool can include an end effector supported by an instrument shaft, to which a replaceable stapler cartridge / anvil is mounted. The jaws of the end effector can be articulated to clamp tissue between the stapler cartridge and the jaws. The stapler cartridge can then be articulated to deploy staples from the stapler cartridge to staple the tissue clamped between the stapler cartridge and the jaws. The stapler cartridge can include a knife that can be articulated to cut the stapled tissue between the deployed staple rows.

[0011] The level of actuation force sufficient to clamp, suture, and / or cut tissue can be significant. Additionally, it is desirable to limit the diameter of the instrument shaft supporting the end effector and to actuate the end effector via a proximal actuation portion that is drivingly coupled to the end effector via a linkage extending through the instrument shaft. It is also desirable that the linkage extending through the small-diameter instrument shaft to drivingly couple the end effector to the proximal actuation portion be robust, economical, and reliable. The surgical tools and related methods presented herein are suitable for delivering sufficient actuation force to an end effector (such as a clamping, suturing, and cutting end effector) in a robust, economical, and reliable manner through a relatively small-diameter instrument shaft. SUMMARY OF THE INVENTION

[0012] Surgical tools and related methods are provided, wherein proximal retraction of a flexible tension member is used to transmit a distally directed actuating force through an instrument shaft assembly to an end effector supported by the instrument shaft assembly. The flexible tension member is wound around a guide surface disposed within the instrument shaft assembly and connected to an actuating rod assembly, and the actuating rod assembly moves toward the end effector in response to retraction of the flexible tension member. The actuating rod assembly, the guide surface, and the flexible tension member are configured to be enclosed within an elongated, relatively small-diameter instrument shaft assembly and to transmit a distally directed actuating force to actuate a surgical end effector, such as a clamping, suturing, and cutting surgical end effector.

[0013] Accordingly, in one aspect, a surgical tool is provided. The surgical tool includes: an actuating portion, an end effector, an instrument shaft assembly coupling the actuating portion to the end effector, an actuating rod assembly drivingly coupled to the end effector, and a flexible tension member. The instrument shaft assembly extends along an instrument shaft axis and defines a lumen. The instrument shaft assembly includes a guide surface disposed distally toward the lumen. The actuating rod assembly is slidably mounted within the lumen for translation relative to the instrument shaft assembly along the instrument shaft axis. The flexible tension member drivingly couples the actuating portion to the actuating rod assembly. The flexible tension member is connected to the actuating rod assembly at a connection portion longitudinally disposed between the actuating portion and the guide surface. The flexible tension member includes a first portion that extends distally from the connection portion toward the guide surface, winds around the guide surface, and extends proximally toward the actuating portion. The actuating portion is operable to increase the tension in the first portion of the flexible tension member to translate the actuating rod assembly in a distal direction.

[0014] In many embodiments, the actuation portion is operable to rotate the instrument shaft assembly relative to a proximal chassis supporting the instrument shaft assembly about the instrument shaft axis. In many embodiments, the actuation rod assembly is constrained to rotate with the instrument shaft assembly about the instrument shaft axis. The surgical tool may include an isolation tube extending along the instrument shaft axis. The isolation tube may be disposed between the connection portion and the actuation portion. The first and second portions of the flexible tension member may pass through the isolation tube. The isolation tube may enclose an inter-twistable length of the first and second portions and isolate the inter-twistable length from the region surrounding the lumen of the isolation tube. Accordingly, one or more additional actuation members for actuating and / or articulating the end effector may pass through the region surrounding the lumen of the isolation tube and thus be protected from adverse effects caused by the inter-twisting of the first and second portions, which is caused by rotation of the instrument shaft assembly.

[0015] The flexible tension member may include any suitable flexible tension member. For example, the flexible tension member may include an actuation cable. The first portion of the flexible tension member may include a first length of cable, and the second portion of the flexible tension member may include a second length of cable. The surgical tool may include a pulley that includes the guiding surface. The actuation portion is operable to move the actuation rod assembly through a range of movement relative to the pulley. The actuation rod assembly may include a slot configured to accommodate the pulley throughout the range of movement. The actuation rod assembly may include a cable guide hole through which the second length of cable extends.

[0016] In many embodiments, the instrument shaft assembly includes separate components (e.g., separate upper and lower half-sections) that accommodate insertion of the actuation rod assembly, the guiding surface, and the flexible tension member into the lumen of the instrument shaft assembly and may be joined to form the lumen enclosing the actuation rod assembly, the guiding surface, and the flexible tension member. For example, the instrument shaft assembly may include a first component and a second component. The first and second components may be configured to be adapted to insert the actuation rod assembly, the guiding surface, and the flexible tension member into the lumen when the first and second components are not joined. The first and second components may be configured to be joined to form the lumen.

[0017] In many embodiments, the actuation portion is operable to move the actuator rod assembly through a range of movement relative to the guide surface. The actuator rod assembly can include a first guide feature projecting in a first direction and a second guide feature projecting in a second direction different from the first direction. The first member and the second member can form a first slot sized to receive the first guide feature and a second slot sized to receive the second guide feature throughout the range of movement.

[0018] The flexible tension member can include a suitable flexible tension member other than a cable. For example, the flexible tension member can include a drive belt. The drive belt can include a slot through which a portion of the actuator rod assembly between the connection portion and the end effector extends. The surgical tool can include a support frame, a first bearing, and a second bearing. The support frame can have a hole through which a portion of the actuator rod assembly between the connection portion and the end effector extends. The first bearing can be mounted to the support frame to rotate about a guide surface axis perpendicular to the instrument axis and engage the drive belt on a first side of the slot. The second bearing can be mounted to the support frame to rotate about the guide surface axis and engage the drive belt on a second side of the slot, the second side of the slot being opposite the first side of the slot. The actuator rod assembly can include a drive belt guide hole through which the drive belt extends.

[0019] In another aspect, a method for actuating an end effector of a surgical tool is provided. The method includes: supporting an end effector via an instrument shaft assembly extending along an instrument axis; enclosing an actuator rod assembly within a lumen of the instrument shaft assembly; guiding the actuator rod assembly during movement of the actuator rod assembly along the instrument axis; and operating an actuation portion to increase tension in a first portion of a flexible tension member drivingly coupled to the actuator rod assembly to move the actuator rod assembly toward the end effector to actuate the end effector. The first portion of the flexible tension member extends distally from the actuation portion to a guide surface, wraps around the guide surface, and extends from the guide surface to a connection portion between the first portion of the flexible tension member and the actuator rod assembly. In many embodiments, the method further includes operating the actuation portion to increase tension in a second portion of the flexible tension member drivingly coupled to the actuator rod assembly to move the actuator rod assembly away from the end effector.

[0020] In many embodiments, the method includes operating the actuation portion to rotate the instrument shaft assembly about the instrument shaft axis relative to a proximal chassis that supports the instrument shaft assembly. The method may include constraining the actuation rod assembly to rotate about the instrument shaft axis with the instrument shaft assembly. The method may include enclosing, within an isolation tube, the mutually twistable lengths of the first and second portions of the flexible tension member disposed between the actuation rod assembly and the actuation portion to isolate the mutually twistable lengths from the region surrounding the lumen of the isolation tube.

[0021] In many embodiments of the method, the flexible tension member includes a cable. For example, the first portion of the flexible tension member may include a first length of cable. The second portion of the flexible tension member may include a second length of cable. The surgical tool may include a pulley that includes the guiding surface. The method may include operating the actuation portion to move the actuation rod assembly through a range of movement relative to the pulley, and accommodating the pulley within a slot of the actuation rod assembly throughout the range of movement. The method may include guiding the second length of cable through a cable guiding aperture in the actuation rod assembly, the second length of cable extending through the cable guiding aperture.

[0022] In many embodiments of the method, the instrument shaft assembly includes separate components (e.g., a separate upper half section and lower half section) that are adapted to receive the actuation rod assembly, the guiding surface, and the flexible tension member within the lumen of the instrument shaft assembly and may be joined to form the lumen enclosing the actuation rod assembly, the guiding surface, and the flexible tension member. For example, the method may include inserting the actuation rod assembly, the guiding surface, and the flexible tension member into a first component of the instrument shaft assembly, and coupling a second component of the instrument shaft assembly to the first component to enclose a portion of the actuation rod assembly, the guiding surface, and the flexible tension member within the lumen of the instrument shaft assembly.

[0023] In many embodiments, the method includes operating the actuation portion to move the actuation rod assembly through a range of movement relative to the guiding surface. The method may include engaging a projecting guiding feature of the actuation rod assembly with the instrument shaft assembly to guide the actuation rod assembly relative to the instrument shaft assembly through the entire range of movement.

[0024] In many embodiments of the method, the flexible tension member may include a suitable flexible tension member other than a cable. For example, the flexible tension member may include a drive belt. The method may include receiving, through a slot in the drive belt, a portion of the actuator rod assembly between the connection portion and the end effector. The method may include: receiving, in a hole of a support frame, a portion of the actuator rod extending between the connection portion and the end effector; supporting a first bearing that is mounted to the support frame to rotate about a guide surface axis perpendicular to the instrument axis and that interfaces with the drive belt on a first side of the slot; and supporting a second bearing that is mounted to the support frame to rotate about the guide surface axis and that interfaces with the drive belt on a second side of the slot, the second side of the slot being opposite the first side of the slot. In many embodiments, the first bearing and the second bearing include the guide surface. The method may include guiding the drive belt through a drive belt guide hole of the actuator rod assembly, the drive belt extending through the drive belt guide hole.

[0025] To more fully understand the nature and advantages of the present invention, reference should be made to the following detailed description and the accompanying drawings. Other aspects, objects, and advantages of the present invention will become apparent from the accompanying drawings and the following detailed description. BRIEF DESCRIPTION OF THE DRAWINGS

[0026] Figure 1 is a plan view of a minimally invasive robotic surgical system for performing a surgical procedure according to many embodiments.

[0027] Figure 2 is a perspective view of a surgeon console for a robotic surgical system according to many embodiments.

[0028] Figure 3 is a perspective view of an electronic equipment cart of a robotic surgical system according to many embodiments.

[0029] Figure 4 schematically shows a robotic surgical system according to many embodiments.

[0030] Figure 5 is a front view of a patient-side cart (surgical robot) of a robotic surgical system according to many embodiments.

[0031] Figure 6 shows a robotic surgical tool according to many embodiments.

[0032] Figure 7A and Figure 7Bis a simplified schematic view showing a surgical tool according to many embodiments, the surgical tool including an end effector and a cable drive mechanism for transmitting a push / pull actuating force to the end effector.

[0033] Figure 8 is Figure 7A and Figure 7B a plan view of an embodiment of the surgical tool.

[0034] Figure 9 is a plan view showing components of a cable drive mechanism for transmitting a push / pull actuating force to the end effector of a surgical tool Figure 8 thereof.

[0035] Figure 10 is a close-up view showing components of a cable drive mechanism for transmitting a push / pull actuating force to the end effector of a surgical tool Figure 8 thereof.

[0036] Figure 11 and Figure 12 is a view of a proximal actuation mechanism operable to actuate a cable of a cable drive mechanism for transmitting a push / pull actuating force to the end effector of a surgical tool Figure 8 thereof.

[0037] Figure 13A and Figure 13B is a simplified schematic view showing a surgical tool according to many embodiments, the surgical tool including an end effector and a belt drive mechanism for transmitting a push / pull actuating force to the end effector.

[0038] Figure 14 is Figure 13A and Figure 13B a plan view of an embodiment of the surgical tool.

[0039] Figure 15 and Figure 16 is a close-up view showing a belt drive shuttle of a belt drive mechanism for transmitting a push / pull actuating force to the end effector of a surgical tool Figure 14 thereof.

[0040] Figure 17 is a close-up view showing a drive belt end support of a belt drive mechanism for transmitting a push / pull actuating force to the end effector of a surgical tool Figure 14 thereof. DETAILED DESCRIPTION

[0041] In the following description, various embodiments of the present invention will be described. For purposes of explanation, specific configurations and details are set forth in order to provide a thorough understanding of the embodiments. However, it will be apparent to those skilled in the art that the present invention may be practiced without specific details. In addition, well-known features may be omitted or simplified to avoid obscuring the described embodiments.

[0042] Minimally Invasive Robotic Surgery

[0043] Referring now to the drawings, wherein like reference numerals represent like parts in several views, Figure 1 is a plan view of a minimally invasive robotic surgery (MIRS) system 10 that is generally used to perform minimally invasive diagnostic or surgical procedures on a patient 12 lying on an operating table 14. The system may include a surgeon console 16 for use by a surgeon 18 during the procedure. One or more assistants 20 may also participate in the procedure. The MIRS system 10 may further include a patient-side cart 22 (surgical robot) and an electronics cart 24. The patient-side cart 22 may manipulate at least one removably coupled tool assembly 26 (hereinafter simply referred to as "tool") through a minimally invasive incision in the body of the patient 12, while the surgeon 18 observes the surgical site through the console 16. Images of the surgical site may be obtained by an endoscope 28 (such as a stereoscopic endoscope), and the endoscope 28 may be manipulated by the patient-side cart 22 to orient the endoscope 28. The electronics cart 24 may be used to process the images of the surgical site for subsequent display to the surgeon 18 through the surgeon console 16. The number of single-use surgical tools 26 generally depends on the diagnostic or surgical procedure and space limitations in the operating room and other factors. If it is necessary to change one or more of the tools 26 used during the procedure, the assistant 20 may remove the tool 26 from the patient-side cart 22 and replace it with another tool 26 from a tray 30 in the operating room.

[0044] Figure 2 is a perspective view of the surgeon console 16. The surgeon console 16 includes a left-eye display 32 and a right-eye display 34 for presenting a coordinated stereoscopic view of the surgical site to the surgeon 18, the coordinated stereoscopic view enabling depth perception. The console 16 further includes one or more input control devices 36, which in turn cause the patient-side cart 22 ( Figure 1 shown) to manipulate one or more tools. The input control devices 36 may provide the associated tool 26 ( Figure 1The same degrees of freedom as shown) so as to provide the surgeon with a sense of telepresence or that the input control device 36 is integral with the tool 26, such that the surgeon strongly feels that he directly controls the tool 26. To this end, position, force, and tactile feedback sensors (not shown) can be employed to transmit the position, force, and tactile sensations from the tool 26 back to the surgeon's hand via the input control device 36.

[0045] The surgeon console 16 is typically located in the same room as the patient so that the surgeon can directly monitor the procedure, be physically present if necessary, and communicate directly with the assistant, rather than via telephone or other communication media. However, the surgeon can be located in a different room, a completely different building, or other remote location of the patient, thus allowing a remote surgical procedure.

[0046] Figure 3 is a perspective view of the electronic equipment cart 24. The electronic equipment cart 24 can be coupled to the endoscope 28 and can include a processor for processing the captured images for subsequent display, such as displaying to the surgeon on the surgeon console or on another suitable display located locally and / or remotely. For example, in the case of using a stereoscopic endoscope, the electronic equipment cart 24 can process the captured images to present a coordinated stereoscopic image of the surgical site to the surgeon. Such coordination can include alignment between the relative images and can include adjusting the stereoscopic working distance of the stereoscopic endoscope. As another example, image processing can include compensating for imaging errors of the image capture device, such as optical aberrations, using previously determined camera calibration parameters.

[0047] Figure 4 Schematically shows a robotic surgical system 50 (such as Figure 1 the MIRS system 10). As described above, the surgeon can use the surgeon console 52 (such as Figure 1 the surgeon console 16 in Figure 1 to control the patient-side cart (surgical robot) 54 (such as Figure 1in the electronic device cart 24). As discussed above, the electronic device cart 56 can process the captured images in various ways before any subsequent display. For example, the electronic device cart 56 can overlay the captured images with a virtual control interface and then display the combined images to the surgeon via the surgeon console 52. The patient-side cart 54 can output the captured images for processing outside the electronic device cart 56. For example, the patient-side cart 54 can output the captured images to the processor 58, which can be used to process the captured images. The images can also be processed by a combination of the electronic device cart 56 and the processor 58, which can be coupled together to process the captured images jointly, sequentially, and / or in combination. One or more separate displays 60 can also be coupled to the processor 58 and / or the electronic device cart 56 for locally and / or remotely displaying images, such as images of the surgical site or other relevant images.

[0048] Figure 5 The patient-side cart 22 is shown. The illustrated patient-side cart 22 provides manipulation of three surgical tools 26 and an imaging device 28 (such as a stereoscopic endoscope for capturing images of the surgical site). The manipulation is provided by a robotic mechanism having a plurality of robotic joints. The imaging device 28 and the surgical tools 26 can be positioned and manipulated through an incision in the patient such that a remote center of motion is maintained at the incision to minimize the size of the incision. The images of the surgical site can include images of the distal ends of the surgical tools 26 when they are positioned within the field of view of the imaging device 28.

[0049] Figure 6 A robotic surgical tool 100 according to many embodiments is shown. The robotic surgical tool 100 is an example of the surgical tool 26. The surgical tool 100 includes an end effector 102, an elongate instrument shaft assembly 104, and a proximal assembly 106. The instrument shaft assembly 104 supports the end effector 102 at the distal end of the instrument shaft assembly 104. The proximal assembly 106 includes a proximal chassis 108 and an actuation portion 110 supported by the proximal chassis 108. The actuation portion 110 is configured to articulate an actuation cable that is used to articulate an actuation rod assembly that is mounted to translate along the lumen of the instrument shaft assembly 104. The actuation rod assembly includes an actuation rod that is drivingly coupled to the end effector 102 to transmit a push / pull actuation force to the end effector 102. The push / pull actuation force transmitted to the end effector 102 can be used to actuate any suitable mechanism of the end effector 102, for example, a jaw articulation mechanism for clamping tissue, a stapler deployment mechanism for deploying a stapler into the clamped tissue, and / or a cutting mechanism for cutting the tissue clamped and stapled by the end effector 102.

[0050] Figure 7AAnd Figure 7B is a simplified schematic view showing a surgical instrument 100. The surgical instrument 100 includes a cable drive mechanism 112 for transmitting push / pull actuation force to an end effector 102. The cable drive mechanism 112 includes an actuation rod assembly 114, a pulley assembly 116, an actuation cable 118, and an isolation tube 140. The actuation rod assembly 114 includes a shuttle 120 and an actuation rod 122 fixedly attached to the shuttle 120. The instrument shaft assembly 104 has a lumen 124 that extends from a proximal end 126 of the instrument shaft assembly 104 to a distal end 128 of the instrument shaft assembly 104. The instrument shaft assembly 104 extends along an instrument shaft axis 130. The shuttle 120 is disposed within the lumen 124 and is mounted within the instrument shaft assembly 104 for translation along the lumen 124 parallel to the instrument shaft axis 130. The pulley assembly 116 includes a pulley 132 and a pulley support 134 that supports the pulley 132 and is coupled to the instrument shaft assembly 104. The actuation cable 118 is attached to the shuttle 120 at a connection 136. A first section of the actuation cable 118 extends distally from the connection 136 to the pulley 132, passes around the pulley 132, extends proximally from the pulley 132 to a guide hole 138 through a proximal portion of the shuttle 120, extends through the guide hole 138, extends proximally from the guide hole 138 to the isolation tube 140, extends through the isolation tube 140, extends proximally from the isolation tube 140 to a winch 142 of the actuation portion 110, and winds around the winch 142 in a first direction. A second section of the actuation cable 118 extends proximally from the connection 136 to the isolation tube 140, extends through the isolation tube 140, extends proximally from the isolation tube 140 to the winch 142, and winds around the winch 142 in a second direction opposite to the first direction.

[0051] Controlled rotation of the winch 142 is used to control translation of the shuttle 120 along the lumen 124. In the illustrated embodiment, counterclockwise rotation of the winch 142 pulls the first section of the actuation cable 118 toward the winch 142 (and accommodates distal advancement of the second section of the actuation cable 118), thereby pulling the shuttle 120 distally toward the end effector 102. Pulling the shuttle 120 distally pushes the actuation rod 122 toward the end effector 102. For example, the winch 142 can be rotated to advance the shuttle 120 from Figure 7A the proximal position shown to Figure 7B the distal position shown, thereby advancing the actuation rod 122 distally through the actuation stroke. In a similar manner, the winch 142 can be rotated to retract the shuttle 120 from Figure 7B the distal position shown to Figure 7A the proximal position shown, thereby retracting the actuation rod 122 proximally through the actuation stroke. In the illustrated embodiment, the shuttle 120 has a central slot that is configured for the shuttle 120 to move from Figure 7A the proximal position shown to Figure 7BAll positions of the distal position shown accommodate the pulley assembly 116.

[0052] The articulation of the actuation lever 122 can be used to transmit a significant actuating force to the end effector 102 for any suitable mechanism for actuating the end effector 102. For example, the actuation lever 122 from Figure 7A the proximal position shown to Figure 7B the distal position shown and / or from Figure 7B the distal position shown to Figure 7A the proximal position shown can be used to articulate the jaws of the end effector to clamp tissue between the jaws and a replaceable stapler cartridge mounted to the end effector 102, articulate the stapler cartridge to deploy staples from the stapler cartridge into the tissue clamped between the stapler cartridge and the jaws, and / or articulate the cutting element to cut the tissue clamped between the stapler cartridge and the jaws and sutured via staples deployed from the stapler cartridge into the clamped tissue.

[0053] In many embodiments, the instrument shaft assembly 104 is mounted to the proximal assembly 106 for controlled rotation of the instrument shaft assembly 104 about the instrument shaft axis 130 relative to the proximal chassis 108. In many embodiments, the shuttle 120 is mounted within the lumen 124 to rotate with the instrument shaft assembly 104. Since the shuttle 120 rotates as the instrument shaft assembly 104 rotates, a portion of the second section of the actuation cable 118 (extending proximally from the connection 136 to the winch 142) and a portion of the first section of the actuation cable 118 (extending proximally from the guide hole 138 to the winch 142) will twist relative to each other according to the amount of rotation of the instrument shaft assembly 104 relative to the proximal chassis 108. In many embodiments, the isolation tube 140 is configured to enclose and / or constrain the position of at least a portion of the mutually twisting portion of the actuation cable 118. The isolation tube 140 can be used to isolate one or more other actuation members for the end effector disposed within the lumen 124 surrounding the isolation tube 140 from the mutually twisting portion of the actuation cable 118 to prevent the mutual twisting of the actuation cable 118 from interfering with the one or more other surrounding actuation members.

[0054] Figures 8 to 12 An embodiment of Figure 7A and Figure 7B the surgical tool 100 is shown. Figure 8 An embodiment showing a partial view of the end effector 102, the instrument shaft assembly 104, the proximal assembly 106, the pulley assembly 116, the shuttle 120, the actuation lever 122, and the isolation tube 140 is shown. Figure 9 is Figure 8 a plan view of an embodiment of the surgical tool 100, which shows a partial view of the instrument shaft assembly 104, the pulley assembly 116, the shuttle 120, the actuation lever 122, and the isolation tube 140.

[0055] Figure 10 is Figure 8 A close-up view of an embodiment of the surgical tool 100, which shows the first part 104(1) of the instrument shaft assembly 104, the pulley assembly 116, the shuttle 120, the actuating lever 122, the actuating cable 118, and the isolation tube 140. In Figure 10 the mating second part of the instrument shaft assembly 104 is not shown. In the illustrated embodiment, the instrument shaft assembly 104 includes the shown first part 104(1) of the instrument shaft assembly 104 and the mating second part ( Figure 10 not shown) such that the actuating lever assembly 114 (which includes the shuttle 120 and the actuating lever 122), the pulley assembly 116, the isolation tube 140, and the actuating cable 118 can be installed into the inner cavity 124 of the instrument shaft assembly 104. In the illustrated embodiment, the shuttle 120 includes a first guiding feature 144 protruding in a first direction and a second guiding feature 146 protruding in a second direction different from the first direction. In the illustrated embodiment, the second direction is in a direction opposite to the first direction. The first part 104(1) of the instrument shaft assembly 104 and the mating second part form a first groove 148 sized to receive the first guiding feature 144 and a second groove 150 sized to receive the second guiding feature 146 so as to restrict the shuttle 120 to translate along the instrument shaft axis 130 throughout the entire movement range of the shuttle 120 relative to the instrument shaft assembly 104. The first part 104(1) of the instrument shaft assembly 104 and the mating second part are also configured such that the pulley assembly 116 can be installed into the inner cavity 124 of the instrument shaft assembly 104. For example, the first part 104(1) of the instrument shaft assembly 104 and the mating second part may include recesses configured to receive and interface with the interface portion of the pulley support 134, thereby capturing the pulley support 134 and restricting the pulley support 134 within the inner cavity 124 of the instrument shaft assembly 104. In a similar manner, the first part 104(1) of the instrument shaft assembly 104 and the mating second part are also configured such that the isolation tube 140 can be installed into the inner cavity 124 of the instrument shaft assembly 104. For example, the first part 104(1) of the instrument shaft assembly 104 and the mating second part may include recesses configured to receive and interface with the interface portion of the isolation tube 140, thereby capturing the isolation tube 140 and restricting the isolation tube 140 within the inner cavity 124 of the instrument shaft assembly 104.

[0056] Figure 11 and Figure 12View of the proximal assembly 106 of the surgical instrument 100. The actuation cable 118 passes around the winch 142. The winch 142 is mounted for rotation about a winch axis 152 perpendicular to the instrument axis 130. Controlled rotation of the winch 142 via the actuation input 154 controls the extension and retraction of the first and second sections of the actuation cable 118 so as to control the transfer of the actuation force via the actuation rod 122 to the end effector 102. In the illustrated embodiment, the winch 142 includes adjustment features operable to adjust the tension and / or remove slack from the actuation cable 118.

[0057] Figure 13A and Figure 13B is a simplified schematic view showing the surgical instrument 200. The surgical instrument 200 is similar to the surgical instrument 100 but does not include the cable drive mechanism 112 and instead includes a belt drive mechanism 212 for transferring a push / pull actuation force to the end effector 102. The belt drive mechanism 212 includes an actuation rod assembly 214, a drive belt end support 216, a drive belt 218, and an isolation tube 240. The actuation rod assembly 214 includes a shuttle 220 and an actuation rod 222 fixedly attached to the shuttle 220. The instrument shaft 204 has a lumen 224 that extends from the proximal end 226 of the instrument shaft 204 to the distal end 228 of the instrument shaft 204. The instrument shaft 204 extends along the instrument axis 230. The shuttle 220 is disposed within the lumen 224 and is coupled to the instrument shaft 204 for translation along the lumen 224 along the instrument axis 230. The drive belt end support 216 includes a drive belt end support frame 234 that supports a first bearing 232a and a second bearing 232b. The drive belt end support frame 234 is disposed within the lumen 224 and is mounted to the instrument shaft 204. The drive belt 218 is attached to the shuttle 220 at a connection 236. A first section of the drive belt 218 extends distally from the connection 236 to the first bearing 132a and the second bearing 132b, passes around the first bearing 132a and the second bearing 132b, extends proximally from the first bearing 132a and the second bearing 132b on the side of the shuttle 220 opposite the connection 236 to a guide hole through the shuttle 220, extends through the guide hole, extends proximally from the guide hole to the isolation tube 240, extends through the isolation tube 240, extends proximally from the isolation tube 240 to a winch 242 of the actuation portion 210, and winds around the winch 242 in a first direction. A second section of the cable 218 extends proximally from the connection 236 to the isolation tube 240, extends through the isolation tube 240, extends proximally from the isolation tube 240 to the winch 242, and winds around the winch 242 in a second direction opposite to the first direction.

[0058] The controlled rotation of the winch 242 is used to control the translation of the shuttle 220 along the inner cavity 224. In the illustrated embodiment, rotation of the winch 242 in a first direction will pull the first section of the drive belt 218 toward the winch 242 (and accommodate the distal advancement of the second section of the drive belt 218), thereby pulling the shuttle 220 distally toward the end effector 102. Pulling the shuttle 220 distally will push the actuator rod 222 toward the end effector 102. For example, the winch 242 can be rotated to advance the shuttle 220 from Figure 13A the proximal position shown to Figure 13B the distal position shown, thereby advancing the actuator rod 222 distally through the actuation stroke. In a similar manner, the winch 242 can be rotated to retract the shuttle 220 from Figure 13B the distal position shown to Figure 13A the proximal position shown, thereby retracting the actuator rod 222 proximally through the actuation stroke.

[0059] The articulation of the actuator rod 222 can be used to transfer a significant actuating force to the end effector 102 to actuate any suitable mechanism of the end effector 102. For example, the articulation of the actuator rod 222 from Figure 13A the proximal position shown to Figure 13B the distal position shown and / or from Figure 13B the distal position shown to Figure 13A the proximal position shown can be used to articulate the jaws of the end effector to clamp tissue between the jaws and a replaceable stapler cartridge mounted to the end effector 102, articulate the stapler cartridge to deploy staples from the stapler cartridge into the tissue clamped between the stapler cartridge and the jaws, and / or articulate a cutting element to cut the tissue clamped between the stapler cartridge and the jaws and sutured via staples deployed from the stapler cartridge into the clamped tissue.

[0060] In the illustrated embodiment, the instrument shaft 204 is mounted to the proximal assembly 206 for controlled rotation of the instrument shaft 204 about the instrument shaft axis 230 relative to the proximal chassis 208. In many embodiments, the shuttle 220 is mounted within the lumen 224 to rotate with the instrument shaft 204. Since the shuttle 220 rotates as the instrument shaft 204 rotates, a portion of the second section of the drive belt 218 (extending proximally from the connection 236 to the winch 242) and a portion of the first section of the drive belt 218 (extending proximally from the guide hole in the shuttle 220 to the winch 242) will twist relative to each other according to the amount of rotation of the instrument shaft 204 relative to the proximal chassis 208. In many embodiments, the isolation tube 240 is configured to enclose and / or constrain the position of at least a portion of the mutually twisting portion of the drive belt 218. The isolation tube 240 can be used to isolate one or more other actuation members for the end effector 102 disposed within the lumen 224 surrounding the isolation tube 240 from the mutually twisting portion of the drive belt 218 to prevent the mutual twisting of the drive belt 218 from interfering with one or more other surrounding actuation members.

[0061] Figures 14 to 17 An embodiment of the surgical instrument 200 is shown Figure 13A and Figure 13B is shown. Figure 14 Embodiments of the end effector 102, the instrument shaft 204, the proximal assembly 206, the drive belt end support 216, the shuttle 220, the actuation rod 222, and the isolation tube 240 are shown. Figure 15 is a close-up view showing the shuttle 220, the drive belt 218, the actuation rod 222, the first component 204(1) of the instrument shaft 204 (the second component 204(2) of the instrument shaft 204 is not shown in Figure 15 and is shown in

[0062] In the illustrated embodiment, the instrument shaft 204 includes the shown first component 204(1) and mating second component 204(2) of the instrument shaft 204 ( Figure 15 not shown in Figure 16 and shown in Figure 15(hidden in the figure). In the illustrated embodiment, the second direction is in a direction opposite to the first direction. The first component 204(1) of the instrument shaft 204 has a first slot 248 sized to receive the second guide feature 246, and the second component 204(2) has a second slot 250 sized to receive the first guide feature 244 so as to restrict the shuttle 220 to translate along the instrument shaft axis 230 throughout the entire movement range of the shuttle 220 relative to the instrument shaft 204. The first component 204(1) and the mating second component 204(2) of the instrument shaft assembly 104 are also configured to enable the installation of the drive belt end support 216 into the inner cavity 224 of the instrument shaft 204. For example, the first component 204(1) and the mating second component 204(2) of the instrument shaft 204 may include recesses configured to receive and interface with the interface portion of the drive belt end support frame 234, thereby capturing the drive belt end support 216 and restricting the drive belt end support 216 within the inner cavity 224 of the instrument shaft 204. In a similar manner, the first component 204(1) and the mating second component 204(2) of the instrument shaft 204 are also configured to enable the installation of the isolation tube 240 into the inner cavity 224 of the instrument shaft 204. For example, the first component 204(1) and the mating second component 204(2) of the instrument shaft 204 may include recesses configured to receive and interface with the interface portion of the isolation tube 240, thereby capturing the isolation tube 240 and restricting the isolation tube 240 within the inner cavity 224 of the instrument shaft 204.

[0063] Figure 16 is a close-up view showing the shuttle 220 and the guide pins 238a, 238b forming the guide slots through which the drive belt 218 extends. During actuation of the shuttle 220 via actuation of the drive belt 218, the drive belt 218 slides through the guide slots between the guide pins 238a, 238b and the shuttle 220. Figure 16 Also shown is the second guide feature 246 and the second component 204(2) of the instrument shaft 204.

[0064] Figure 17is a close-up view showing the drive belt end support 216. The drive belt end support 216 includes a drive belt end support frame 234 and a first bearing 232a and a second bearing 232b mounted on the drive belt end support frame 234 for rotation about a drive belt end support axis 252 that is perpendicular to the instrument axis 230 and parallel to the side of the drive belt 218. The drive belt end support frame 234 has a hole 254 sized to receive an actuator rod 222 that extends through the hole 254. The drive belt end support frame 234 includes a first end journal 256 and a second end journal 258 that mate with complementary-shaped recesses in the instrument shaft 204 to support the drive belt end support frame 234 in a fixed position within the lumen 224 of the instrument shaft 204.

[0065] Other variations are within the spirit of the present invention. For example, although five different types of stapler cartridges are described herein, any suitable number of stapler cartridge types can be employed, including fewer and more than the five stapler cartridge types described. Thus, while the present invention is susceptible to various modifications and alternative configurations, certain illustrated embodiments thereof have been shown in the drawings and described in detail above. However, it should be understood that it is not intended to limit the present invention to the one or more specific forms disclosed, but rather, the present invention is intended to cover all modifications, alternative configurations, and equivalents falling within the spirit and scope of the present invention as defined by the appended claims.

[0066] In the context of describing the present invention (especially in the context of the appended claims), the use of the terms “a,” “an,” and “the” and similar references to objects should be construed to cover both the singular and the plural unless otherwise indicated herein or the context clearly dictates otherwise. The terms “comprising,” “having,” “including,” and “containing” should be construed as open-ended terms (i.e., meaning “including but not limited to”) unless otherwise specified. The term “connected” should be understood to mean partly or wholly incorporated therein, attached to, or joined together, even if there is something intervening. Unless otherwise indicated herein, the recitation of a range of values herein is merely intended to be a shorthand method of referring separately to each individual value falling within the range, and each individual value is incorporated into the specification as if it were individually recited herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or the context clearly dictates otherwise. The use of any and all examples, or exemplary language (e.g., “such as”) provided herein is merely intended to better illustrate the embodiments of the present disclosure and does not impose a limitation on the scope of the present disclosure unless otherwise claimed. The language in the specification should not be construed as indicating any non-claimed element as essential to the practice of the present invention.

[0067] Preferred embodiments of the invention are described herein, including the best mode known to the inventors for carrying out the invention. Variations of those preferred embodiments will be apparent to those of ordinary skill in the art upon reading the above description. The inventors expect those skilled in the art to appropriately utilize these variations, and the inventors expect the invention to be practiced otherwise than as specifically described herein. Accordingly, to the extent permitted by applicable law, the invention includes all modifications and equivalents of the subject matter recited in the claims appended hereto. In addition, unless otherwise indicated herein or the context clearly contradicts, the invention covers any combination of the above elements in all possible variations.

[0068] All reference documents cited herein, including publications, patent applications, and patents, are hereby incorporated by reference to the extent that each reference document is individually and specifically indicated to be incorporated by reference into this text and is stated in its entirety.

Claims

1. A surgical tool, comprising: Proximal actuation assembly; End effector; Instrument shaft assembly including an instrument shaft defining a lumen and an actuation rod assembly including an actuation rod extending within the lumen, wherein the instrument shaft supports the end effector and wherein the actuation rod is drivingly coupled to the end effector; and A flexible tension member including a first portion and a second portion and drivingly coupling the actuation rod to the proximal actuation assembly, wherein the proximal actuation assembly includes a winch coupled to the flexible tension member and configured to rotate to advance the first portion of the flexible tension member in a first direction and to advance the second portion of the flexible tension member in a second direction opposite the first direction to increase the tension in the flexible tension member and to move the actuation rod toward the end effector to actuate the end effector.

2. The surgical tool according to claim 1, wherein, The winch is configured to rotate in the opposite direction to advance the first portion of the flexible tension member in the second direction and to advance the second portion of the flexible tension member in the first direction to move the actuation rod away from the end effector.

3. The surgical tool according to claim 2, wherein: The proximal actuation assembly is operable to rotate the instrument shaft relative to a proximal chassis supporting the instrument shaft; The actuation rod is constrained to rotate with the instrument shaft; and The instrument shaft assembly includes an isolation tube through which the flexible tension member extends, wherein the isolation tube isolates the flexible tension member from the region of the lumen surrounding the isolation tube.

4. The surgical tool according to claim 2, wherein, The instrument shaft assembly includes a pulley in contact with the flexible tension member.

5. The surgical tool according to claim 4, wherein, The actuation rod assembly includes a hole through which the flexible tension member extends.

6. The surgical tool according to claim 1, wherein, The instrument shaft is configurable to insert the actuation rod assembly and the flexible tension member into the lumen.

7. The surgical tool according to claim 6, wherein the actuating rod assembly includes a first guiding feature protruding in a first direction and a second guiding feature protruding in a second direction different from the first direction.

8. The surgical tool according to claim 1, wherein: The flexible tension member includes a drive belt; and The drive belt includes a slot through which a portion of the actuation rod assembly extends.

9. The surgical tool according to claim 8, wherein the instrument shaft assembly includes: A support frame having a hole through which the portion of the actuation rod assembly extends; and A bearing mounted to the support frame and in contact with the drive belt.

10. The surgical tool according to claim 8, wherein, The actuation rod assembly includes a drive belt guide hole through which the drive belt extends.

11. A surgical tool, comprising: Proximal actuation assembly; End effector; Instrument shaft assembly including an instrument shaft, an actuation rod assembly, and a pulley mounted to the instrument shaft; wherein the instrument shaft defines a lumen, wherein the actuation rod assembly includes an actuation rod extending within the lumen, wherein the instrument shaft supports the end effector, and wherein the actuation rod is drivingly coupled to the end effector; and A flexible tension member actuated by the proximal actuation assembly, wherein the flexible tension member extends distally from the proximal actuation assembly, wraps around the pulley, and extends proximally from the pulley to the actuation rod assembly; and The proximal actuation assembly includes a winch that is coupled to the flexible tension member and configured to rotate to advance a first portion of the flexible tension member in a first direction and to advance a second portion of the flexible tension member in a second direction opposite the first direction to increase the tension in the flexible tension member and to move the actuator rod toward the end effector to actuate the end effector.

12. The surgical tool according to claim 11, wherein, The winch is configured to rotate in an opposite direction to advance the first portion of the flexible tension member in the second direction and to advance the second portion of the flexible tension member in the first direction to move the actuator rod away from the end effector.

13. The surgical tool according to claim 12, wherein: The proximal actuation assembly is operable to rotate the instrument shaft relative to a proximal chassis that supports the instrument shaft; The actuator rod is constrained to rotate with the instrument shaft; and The instrument shaft assembly includes an isolation tube through which the flexible tension member extends, wherein the isolation tube isolates the flexible tension member from the region surrounding the lumen of the isolation tube.

14. The surgical tool according to claim 11, wherein, The actuator rod assembly includes a hole through which the flexible tension member extends.

15. The surgical tool according to claim 11, wherein, The instrument shaft can be configured to be adapted to insert the actuator rod assembly and the flexible tension member into the lumen.

16. The surgical tool according to claim 15, wherein the actuating rod assembly includes a first guiding feature protruding in a first direction and a second guiding feature protruding in a second direction different from the first direction.

17. The surgical tool according to claim 11, wherein: The flexible tension member includes a drive belt; and The drive belt includes a slot through which a portion of the actuator rod assembly extends.

18. The surgical tool according to claim 17, wherein the instrument shaft assembly includes: A support frame having a hole through which the portion of the actuator rod assembly extends; and A bearing mounted to the support frame and engaging the drive belt.

19. The surgical tool according to claim 17, wherein, The actuator rod assembly includes a drive belt guide hole through which the drive belt extends.

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