Articulating ultrasonic surgical instrument and system

Abstract

A surgical instrument includes a housing having an elongate body extending distally therefrom. The elongate body defines a first articulation section and a second articulation section. The elongate body defines an internal cavity therein. An end effector is supported at a distal end portion of the elongate body. A flexible waveguide extends through the internal cavity of the elongate body. A proximal end portion of the flexible waveguide is connected to an ultrasonic transducer. A distal end portion of the flexible waveguide is connected with the end effector. The flexible waveguide defines a first articulation section and a second articulation section, the first articulation section having a thickness that is narrower than a thickness of other portions of the flexible waveguide, the second articulation section having a thickness that is narrower than a thickness of other portions of the flexible waveguide.

Description

[0001] Cross-references to related applications

[0002] This application claims the benefit and priority of U.S. Provisional Patent Applications Nos. 63 / 026,323 and 63 / 026,377, each of which was filed on May 18, 2020. The entire contents of each of the foregoing applications are incorporated herein by reference. Technical Field

[0003] This disclosure relates to surgical instruments and systems, and more specifically, to articulated ultrasonic surgical instruments and systems. Background Technology

[0004] Ultrasonic surgical instruments and systems utilize ultrasonic energy, or ultrasonic vibrations, to treat tissue. More specifically, a typical ultrasonic surgical instrument or system includes a transducer configured to generate mechanical vibrational energy along a waveguide and transmit it at an ultrasonic frequency along the waveguide to an ultrasonic end effector, which is configured to treat tissue, for example, by coagulation, cauterization, fusion, sealing, cutting, drying, electrocautery, or other methods. Traditionally, the transducer is held externally to the surgical site, while the waveguide extends from the transducer into the surgical site to deliver ultrasonic energy to the ultrasonic end effector. The ultrasonic end effector is then manipulated into place to treat one or more desired tissues.

[0005] Some ultrasound surgical instruments and systems incorporate rotational features, enabling ultrasound end effectors to rotate to the desired orientation within the surgical site. However, even in such instruments and systems, the ability to navigate within the surgical site solely through rotation and manipulation is limited. Summary of the Invention

[0006] In one aspect of this disclosure, a surgical instrument includes a housing having an elongated body extending distally therefrom. The elongated body defines a first hinge portion and a second hinge portion. The elongated body defines an inner cavity therein. An end effector is supported at the distal portion of the elongated body. A flexible waveguide extends through the inner cavity of the elongated body. A proximal portion of the flexible waveguide is connected to an ultrasonic transducer. The distal portion of the flexible waveguide is connected to the end effector. The flexible waveguide defines a first hinge portion and a second hinge portion, the first hinge portion being narrower than the thickness of other portions of the flexible waveguide, and the second hinge portion being narrower than the thickness of other portions of the flexible waveguide.

[0007] In some aspects of this disclosure, the first hinge portion of the flexible waveguide is configured to be hinged in a first orientation, and the second hinge portion of the flexible waveguide is configured to be hinged in a second orientation. The first hinge portion and the second hinge portion of the flexible waveguide may each be hinged in the same orientation or in different orientations. The first or second hinge portion of the flexible waveguide is configured to be hinged from about 1 degree to about 45 degrees.

[0008] In some aspects of this disclosure, the end effector includes an ultrasonic blade and a clamp configured to rotate about the ultrasonic blade. The ultrasonic blade and the clamp are configured to capture and treat tissue therebetween in multiple rotational orientations of the clamp relative to the ultrasonic blade.

[0009] In some aspects of this disclosure, the elongated body is configured to rotate to achieve different directional orientations of the end effector. Independent controls are configured to rotate the elongated body, rotate the clamp about the ultrasonic blade, and hinge the first and second hinge portions of the elongated body. Thus, the first and second hinge portions of the flexible waveguide are rotated accordingly via independent controls.

[0010] In some aspects of this disclosure, the first and second transducers are located on opposite sides of the first hinged portion of the flexible waveguide. At least one of the first or second transducers is configured to amplify ultrasonic waves transmitted through the first hinged portion of the flexible waveguide.

[0011] In some aspects of this disclosure, the flexible waveguide may define a single hinged portion, the width of which is narrower than the width of other portions of the flexible waveguide, and the elongated body may be configured to rotate to achieve different directional orientations of the end effector.

[0012] Other features of this disclosure will be understood from the following description. Attached Figure Description

[0013] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate aspects and features of this disclosure and, together with the detailed description below, are used to further explain this disclosure, wherein:

[0014] Figure 1 It is a side perspective view of a surgical instrument having a hinged portion configured for use according to aspects and features of this disclosure;

[0015] Figure 2 It is a side perspective view of a surgical instrument having first and second hinged portions configured for use according to aspects and features of this disclosure;

[0016] Figure 3 This is a side view of a single conceptual hinged section, which includes a flexible waveguide shown constrained within a test fixture representing supports, pivots, and other features. The flexible waveguide is configured to... Figure 1 Used together with surgical instruments;

[0017] Figure 4A This is a side view of a conceptual first hinge portion, which includes a first section shown constrained within a test fixture representing supports, pivots, and other features. The flexible waveguide is configured to... Figure 2 The surgical instruments are used together with the hinge in the first plane;

[0018] Figure 4B This is a conceptual side view of a second hinge portion, which includes a second section shown constrained within a test fixture representing supports, pivots, and other features. The flexible waveguide is configured to... Figure 2 The surgical instruments are used together with the hinge in the second plane;

[0019] Figure 5A yes Figure 4A Side view of the flexible waveguide;

[0020] Figure 5B yes Figure 4A Top view of the flexible waveguide;

[0021] Figure 6A This is a side view of the distal end of an elongated body and an end effector including a rotatable clamping member, the end effector being configured to... Figure 1 Or, use surgical instruments in the first rotating position;

[0022] Figure 6B It is the distal end of the slender body and Figure 6A A side view of the end effector in the second rotational position;

[0023] Figures 7A to 7D It is a slender body and includes Figure 6A A side perspective view of the end effector of a rotatable clamping component in various rotational and articulated orientations;

[0024] Figure 8 This is a side view of a conceptual hinged section comprising a cable system for hinged connection between the hinged section and a flexible waveguide, shown as constrained within a test fixture representing supports, pivots, and other features, and configured to... Figure 1 Or use two surgical instruments together;

[0025] Figure 9 This is a side view of another hinge portion, which is configured to... Figure 1 Or, use together with the slender body of a surgical instrument having multiple curved sections;

[0026] Figure 10 This is a side view of a conceptual hinged portion, which includes a flexible waveguide shown constrained within a test fixture representing supports, pivots, and other features. The flexible waveguide is configured to... Figure 1 Or 2 surgical instruments used together and including transducers positioned on opposite sides of the hinged portion of the flexible waveguide;

[0027] Figure 11 This is a schematic illustration of a robotic surgical system configured for use according to this disclosure;

[0028] Figure 12A This is a longitudinal cross-sectional view of a flexible waveguide fixed in the cavity of a slender body by a pillar and hole attachment structure.

[0029] Figure 12B yes Figure 12A A perspective view of a flexible waveguide;

[0030] Figure 12C It was formed in Figure 12A A longitudinal cross-sectional view of a hole in the inner surface of a slender body;

[0031] Figure 12D yes Figure 12A A longitudinal cross-sectional view of the slender body and flexible waveguide in a hinged configuration;

[0032] Figure 13A This is a longitudinal cross-sectional view of a flexible waveguide that is fixed in the cavity of a slender body by an annular collar protruding outward from the flexible waveguide.

[0033] Figure 13B yes Figure 13A A perspective view of a flexible waveguide;

[0034] Figure 13C It is formed in the inner surface of the slender body and configured to receive Figure 13A A longitudinal cross-sectional view of the notch of the annular collar;

[0035] Figure 14A This is a longitudinal cross-sectional view of a flexible waveguide fixed in the cavity of an elongated body by an annular collar protruding inward from the inner surface of the elongated body.

[0036] Figure 14B This is a perspective view of a flexible waveguide including a notch configured to receive signals. Figure 14A A ring-shaped collar;

[0037] Figure 14C From Figure 14A A longitudinal cross-sectional view of the annular collar protruding from the inner surface of the slender body;

[0038] Figure 15A This is a longitudinal cross-sectional view of a flexible waveguide that is fixed in the inner cavity of a slender body by a movable annular collar.

[0039] Figure 15B yes Figure 15A The perspective view of the flexible waveguide with the movable annular collar omitted;

[0040] Figure 15C This is a longitudinal cross-sectional view of a movable annular collar, which is positioned around a flexible waveguide and formed on... Figure 15A The notch in the inner surface of the slender body is fixed in the inner cavity; and

[0041] Figure 15D yes Figure 15C A longitudinal cross-sectional view of the notch. Detailed Implementation

[0042] As used herein, the term "far side" refers to the portion described as being farther from the user, while the term "proximal side" refers to the portion described as being closer to the user. Furthermore, to a degree of consistency, any of the aspects and features detailed herein may be used in conjunction with any or all of the other aspects and features detailed herein.

[0043] As used herein, the terms parallel and perpendicular are understood to include relative configurations that are substantially parallel and substantially perpendicular, differing from true parallel and true perpendicular by approximately +10 degrees or -10 degrees.

[0044] Exemplary axes or directions, such as the X-axis, Y-axis, and Z-axis, may be shown in the accompanying drawings and / or described herein. As an example, the X-axis may be perpendicular to the Y-axis, and the Z-axis may be orthogonal to both the X-axis and Y-axis.

[0045] As used herein, “about,” “approximately,” or “basically” may include the stated value and mean within an acceptable range of difference for a particular value, as determined by a person generally skilled in the art, taking into account the relevant measurements and errors associated with the particular number of measurements (e.g., limitations of the measurement system). For example, “about” may mean within one or more standard deviations, or within ±30%, 20%, 10%, or 5% of the stated value.

[0046] The description of technical features or aspects of exemplary embodiments of this disclosure should generally be considered applicable and can be adapted to other similar features or aspects in other exemplary embodiments of this disclosure. Therefore, the technical features described herein according to one exemplary embodiment of this disclosure can be applied to other exemplary embodiments of this disclosure, and thus, repeated descriptions may be omitted herein.

[0047] Exemplary embodiments of this disclosure will be described more fully below (see, for example, the accompanying drawings). Throughout the specification and drawings, the same reference numerals may refer to the same elements.

[0048] Typically, in the flexible waveguides described herein (e.g., flexible waveguides 301, 401, 801, 1001, 1201, 1301, 1401, and 1501), the ultrasonic waveguide becomes thinner downwards at its hinged portions (e.g., hinged portions 310, 410, 430, 810, 1010, 1210, 1310, 1410, and 1510) to be flexible, but still has enough material to carry ultrasonic waves to the tip of the instrument (e.g., to end effectors 100, 200, and 600 and 700). Although the flexible waveguide has a generally cylindrical shape, the downwardly thinning sections and the flexible sections can be at least partially flattened to produce a at least partially flattened cylindrical shape, for example, comprising opposing planar surfaces. The term "flattened" refers to the end configuration, not the method of achieving the flexible sections. The above configuration enables an articulated ultrasonic surgical instrument, in which the ultrasonic transducer is located "outside" the body and the ultrasonic waves are carried to the end effector through a bend in the waveguide.

[0049] Unless otherwise indicated, the end effectors 100, 200, 600, and 700 described herein are substantially identical to each other. Unless otherwise indicated, the flexible waveguides 301, 401, 801, 1001, 1201, 1301, 1401, and 1501 described herein are substantially identical to each other. Unless otherwise indicated, the hinge portions 310, 410, 430, 810, 1010, 1210, 1310, 1410, and 1510 described herein are substantially identical to each other. Unless otherwise indicated, the clamping members 101, 201, 601, and 701 described herein are substantially identical to each other. Unless otherwise indicated, the blade members 102, 202, 602, and 702 described herein are substantially identical to each other. Unless otherwise indicated, the housings 12 and 212 described herein are substantially identical to each other. Unless otherwise indicated, the handle assemblies 132 and 232 described herein are substantially identical to each other. Unless otherwise indicated, stabilizers 351 and 851 described herein are substantially the same as each other. Unless otherwise indicated, stabilizers 352 and 852 described herein are substantially the same as each other.

[0050] General reference Figure 1 The accompanying drawings illustrate embodiments of surgical instruments (e.g., endoscopic surgical instruments) that exemplify aspects and features of the present disclosure, generally identified by reference numeral 10. For purposes herein, surgical instrument 10 has been described generally. Aspects and features of surgical instrument 10 that are not closely related to the understanding of the present disclosure are omitted to avoid obscuring the aspects and features of the present disclosure with unnecessary detail.

[0051] Surgical instrument 10 typically includes a housing 12 (defining a handle assembly 132), an elongated body 14, and an end effector 100. The handle assembly 132 supports a battery assembly 18 and a transducer and generator assembly (“TAG”) 120, and includes a first knob 22, a second knob 23, an activation button 24, and a clamping trigger 26.

[0052] An elongated body 14 defines a proximal portion 16 connected to a first knob 22 and a distal portion 18 supporting an end effector 100. The end effector 100 includes an ultrasonic blade 102 and a pivoting clamp 101. In embodiments, the ultrasonic blade 102 is cylindrical or additionally comprises one or more radially symmetrical (or fully radially symmetrical) blades, and the clamp 101 is configured to rotate about the ultrasonic blade 102 to clamp tissue therebetween in multiple (or an infinite number) orientations. An inner lumen 15 is defined within the elongated body 14.

[0053] The clamping trigger 26 of the surgical instrument 10 can be selectively actuated to actuate a motor, other power-driven mechanism, or manual drive mechanism (e.g., gears, pulleys, tension cables, etc.) to pivot the clamp 101 relative to the ultrasonic blade 102, thereby switching the end effector 100 between an open state and a clamping state.

[0054] The first knob 22 can be selectively operated to rotate the elongated body 14 and thus the end effector 100 relative to the housing 12. The second knob 23 can be selectively operated to actuate a motor, other power-driven mechanism, or manual-driven mechanism (e.g., gears, pulleys, tension cables, etc.) to rotate the clamping member 101 relative to the ultrasonic blade 102. As alternatives to the first and second knobs 22, 23, other suitable actuation mechanisms can be provided, such as toggle switches, levers, buttons, etc. The third knob 127 can be selectively operated to hinge the hinge portion 110.

[0055] The generators of battery assembly 18 and TAG 120 cooperate when activation button 24 is activated to power the transducer of TAG 120, enabling the generation of ultrasonic energy. This ultrasonic energy is transmitted to the blade 102 of end effector 100 for use in treating tissue, for example, by coagulation, cauterization, fusion, sealing, cutting, drying, electrocautery, or other methods as described below. Battery assembly 18 and TAG 120 are each releasably attached to and detachable from handle assembly 132 to facilitate disposal of handle assembly 132, except for battery assembly 18 and TAG 120. However, it is contemplated that any or all components of surgical instrument 10 are configured as disposable single-use components or sterilizable reusable components, and / or surgical instrument 10 may be connected to a remote power source or generator, rather than having such onboard components.

[0056] Special Reference Figure 1 , 3 Surgical instruments 10, as described above (6A, 6B, and 7A to 7D), include a housing 12 and an elongated body 14 extending therefrom. The elongated body 14 defines a lumen 15, a proximal portion 16, and a distal portion 18 supporting an end effector 100 therein. The elongated body 14 includes at least one hinge portion 110 between the proximal portion 16 and the distal portion 18. Flexible waveguides (e.g., Figure 3 The flexible waveguide 301 extends through the cavity 15 and includes a hinge portion 310. The hinge portion 110 of the elongated body 14 and the hinge portion 310 of the flexible waveguide are positioned substantially at the same location along the elongated body 14, such that the hinge portions 110 and 310 can be hinged to each other in a similar manner. The elongated body 14 is configured to rotate in conjunction with the flexible waveguide 310 extending through the cavity 15, and the clamping member 101 is configured to rotate about the blade 102 (see also, for example...). Figure 6A and 6B (The clamping member 601 and the blade 602). Therefore, the surgical instrument 10 can achieve any desired directional orientation of the end effector 100 by a combination of rotating the elongated body 14, the hinge of the hinge portions 110 and 310, and rotating the clamping member 101 about the blade 102 (see also, for example, Figures 7A to 7D The elongated body 714, the hinge portion 730, the clamping member 701, and the blade 702. This can be achieved either along a single hinge region of the elongated body 14 or through multiple hinge regions.

[0057] refer to Figure 1 and 3A flexible waveguide 301 extends through the cavity 15 of an elongated body 14. The proximal portion 302 of the flexible waveguide 301 is connected to an ultrasonic generator 120. The distal portion 303 of the flexible waveguide 301 is connected to the blade 102 of an end effector 100, for example, by attachment to the blade, integral formation, etc. The flexible waveguide 301 defines a hinge portion 310 having a dimension, such as width, narrower than the rest of the flexible waveguide 301. In this way, the hinge portion 310 is flexible, while the rest of the waveguide 301 is substantially non-flexible (e.g., not configured to bend significantly during use). The proximal portion 302 may define a threaded end 380 for connection to the ultrasonic generator 120, and the distal portion 303 may define the blade 102.

[0058] The hinge portion 110 of the elongated body 14 and the hinge portion 310 of the waveguide 301 can be hinged relative to a single plane defined by the thinned portion (hinge portion 310) of the flexible waveguide 301. As described above, the blade 102 is cylindrical or otherwise defines one or more radially symmetrical shapes, and the rotatable clamp 101 can rotate about the blade 102. The blade 102 may have a bent or partially bent configuration (e.g., see...). Figure 3 ) or a basically straight configuration (for example, see Figure 6B By making the blade 102 cylindrical or otherwise defining one or more radially symmetrical features, this allows the clamp 101 to be held on the blade 102 at multiple points or at any point on the outer surface of the blade, while achieving the same tissue-like effect. The flexible waveguide 301 is substantially cylindrical along most of its length and further includes a hinge portion 310 having a flattened cylindrical shape. Due to the cylindrical waveguide, the clamp 101 can rotate about the blade 102, while the blade 102 is fixed.

[0059] refer to Figure 2 , 4ASurgical instruments 20, 4B, 5A, and 5B, are substantially identical to surgical instrument 10 except for having a first hinge portion 210 and a second hinge portion 230. Each hinge portion 210 and 230 can achieve some degree of gentle curvature (e.g., from about 1 degree to about 45 degrees) about a single but distinct plane. Surgical instrument 20 generally includes a housing 212 (defining a handle assembly 232), an elongated body 214 defining a proximal portion 216 and a distal portion 218 and defining an inner cavity 215 therein, and an end effector 200. The end effector 200 includes an ultrasonic blade 202 and a clamp 201 pivotable relative to the ultrasonic blade 202, and can be configured to rotate about the ultrasonic blade 202. The handle assembly 232 supports the battery assembly 218 and the transducer and generator assembly (“TAG”) 220, and includes a first knob 222, a second knob 223, an activation button 224, a clamp trigger 226, a third knob 227 and a fourth knob 228.

[0060] The flexible waveguide 401 includes a first hinge portion 410 and a second hinge portion 430 extending through an inner cavity 215 of an elongated body 214. The first hinge portion 210 of the elongated body 214 and the first hinge portion 410 of the flexible waveguide 401 are positioned substantially at the same location along the elongated body 214, such that the first hinge portions 210 and 410 can be hinged in a similar manner to each other. The second hinge portion 230 of the elongated body 214 and the second hinge portion 430 of the flexible waveguide 401 are positioned substantially at the same location along the elongated body 214, such that the second hinge portions 230 and 430 can be hinged in a similar manner to each other, for example, in a second plane different from the hinge plane of the first portions 210, 410. Alternatively, the second plane may be substantially the same as the first plane (e.g., the first and second planes may each be along...). Figure 4A , 4B (The Y-axis direction of 5A and 5B). For example, the first plane can be along... Figure 4A , 4B The Y-axis directions of 5A and 5B, and the second plane can be along... Figure 4A , 4B The Z-axis directions of 5A and 5B. Therefore, the elongated member 214 and the flexible waveguide 401 extending through it can be hinged around two different directions to achieve the desired orientation of the end effector 200 and / or to achieve the desired placement of the various segments of the elongated member 214.

[0061] Special Reference Figure 5A and 5B Because the hinge portions 410 and 430 of the flexible waveguide 401 are formed with a flat shape, the thinning of the hinge portion 430 of the flexible waveguide 401 may only surround a single plane (e.g., as shown in the image). Figure 5A As can be seen in the side view (in the image), the thinning of the hinge portion 410 of the flexible waveguide 401 may only surround different single planes (e.g., as shown in the side view). Figure 5B (See the plan view in the image).

[0062] Special Reference Figure 8 The hinge portion 810 of the flexible waveguide 801 can be hinged using a cable system comprising a first cable 871 and a second cable 872. While two cables can be used, a single cable on a spool can also be used, or more than two cables can be used. Cables 871 and 872 can be in cavities (e.g., cavities 15 or 215 described herein, respectively) Figure 1 and 2 Wiring is provided alongside the flexible waveguide 801 within the inner cavity. The hinge portion 810 is caused to hinge in the direction of the taut cable by tightening one cable 871, 872 and loosening the other cable 871, 872. Alternatively, the hinge portion 810 of the flexible waveguide 801 can be hinged using a thin wire made of nitinol or other materials to push and tighten the inner tube of the elongated portion used for bending actuation. The thin wire can be secured in a sleeve or channel to allow pushing without buckling. The described cavity is used to house the flexible waveguide 801, while cable systems described herein employ cables or similar devices housed in separate cavities or channels to maintain separation from the flexible waveguide 801.

[0063] Special Reference Figure 3 and 8 Stabilizers 351, 851 and 352, 852 can be used to assist the controlled hinge of flexible waveguides 301, 801. Stabilizers 351, 851 are fixed to the flexible waveguides 301, 801 at proximal and distal positions of the hinge portions 310, 810. Stabilizers 351, 851 and 352, 852 can be fixed to the inner surface of the elongated member described herein. Therefore, proximal / distal movement of the flexible waveguides 301, 801 is suppressed. Holding / stabilizing the flexible waveguides 301, 801 at these positions allows for gradual bending of the hinge without causing heating / friction points or unwanted noise in the flexible waveguides 301, 801. Although Figure 3 and 8 Conceptually, an elongated body containing stabilizers 351 and 851 that hold / stabilize flexible waveguides 301 and 801 is shown; however, those skilled in the art will readily understand how such stabilizers would be incorporated into the elongated body 14 in practice. Figure 1 This is used to hold / stabilize flexible waveguides 301 and 801 within them. See below for reference. Figures 12A to 15D Describe additional stabilization structures used for flexible waveguides 301 and 801.

[0064] Special Reference Figure 6A , 6B The hinge portions 630 and 910 of the elongated bodies 614 and 914 may include multiple curved segments 681 and 981 to control the degree of hinge of the hinge portions 630 and 910. The curved segments 681 and 981 allow for gentle bending by permitting only a certain amount of bending in each segment. For example, each curved segment 681 and 981 may allow for approximately 5 degrees of bending, thus using nine curved segments 681 and 981 allows for a total bending of approximately 45 degrees. The curved segments 681 and 981 may allow bending only in one plane by means of pin joints, hinges, or partial cutouts, or may be configured to bend in multiple planes.

[0065] Generally refer to again Figure 2 and 4A Surgical instrument 20, 4B, 5A, and 5B, includes a housing 212 having an elongated body 214 extending distally therefrom. The elongated body 214 defines a first hinge portion 210 and a second hinge portion 230 distal to the first hinge portion 210. The elongated body 214 defines an inner cavity 215 therein. An end effector 200 is supported at a distal portion 218 of the elongated body 214. An ultrasonic transducer and generator assembly 220 is supported on the housing 212. A flexible waveguide 401 extends within the inner cavity 215 of the elongated body 214. A proximal portion 480 of the flexible waveguide 401 is connected to the ultrasonic generator 220. A distal portion 490 of the flexible waveguide 401 is connected (attached, integrally formed, etc.) to the blade 202 of the end effector 200. Flexible waveguide 401 defines a first hinge portion 410, which has a narrower dimension, such as width, than the width of other portions of flexible waveguide 401. Flexible waveguide 401 also defines a second hinge portion 430, which is configured in a hinge direction relative to the first hinge portion 410 (e.g., around). Figure 4A (Y-axis direction) different directions (around) Figure 4B The second hinge portion 430 is hinged in the Z-axis direction. The second hinge portion 430 has a narrower dimension (compared to the first hinge portion 410) that is different in height from the other portions of the flexible waveguide 401, for example, a narrower height.

[0066] The end effector 200 includes an ultrasonic blade 202 and a clamp 201, the ultrasonic blade being cylindrical or otherwise defining one or more radially symmetrical shapes, and the clamp being configured to rotate about the ultrasonic blade 202. The ultrasonic blade 202 and clamp 201 are configured to capture and treat tissue therebetween in the clamping position of the clamp 201. Alternatively or additionally, the ultrasonic blade 202 can be used to treat unclamped tissue closely adjacent to it. An elongated body 214 is configured to rotate (e.g., see...). Figure 6A and 6BThe slender body 614) is used to achieve different orientations of the end effector 200.

[0067] The first knob 222 is configured to rotate the elongated body 214 (e.g., to rotate the portion of the elongated body 214 near the first hinge portion 210). In embodiments providing this rotation, the second knob 223 is configured to rotate the clamp 201 about the ultrasonic blade 202. The third knob 227 is configured to hinge the first hinge portion 210 of the elongated body 214 and thus the first hinge portion of the waveguide 410. The fourth knob 228 is configured to hinge the second hinge portion 230 of the elongated body 214 and thus the second hinge portion 430 of the flexible waveguide.

[0068] refer to Figure 10 A first transducer 1050 and a second transducer 1060 are positioned on opposite sides of the hinged portion 1010 of the flexible waveguide 1001, for example, on the proximal and distal sides. The first transducer 1050 and the second transducer 1060 amplify ultrasonic waves transmitted through the hinged portion 1010 of the flexible waveguide 1001 (e.g., a portion with a width narrower than the other portions of the flexible waveguide 1001). For example, the second transducer 1060 on the distal side of the hinged portion 1010 amplifies the ultrasonic energy as the wave continues down the waveguide (i.e., to compensate for any energy loss caused by the hinged portion 1010). In this embodiment, only the transducer on the distal side of the hinged portion 1010, such as the second transducer 1060, is provided. Similar transducers may be located on opposite sides (or only on the distal side) of each hinged portion of the flexible waveguide, which has multiple hinged portions along its length.

[0069] The various embodiments disclosed herein can also be configured to work with robotic surgical systems and technologies commonly referred to as "remote surgery." Such systems employ various robotic components to assist surgeons and allow for remote (or partially remote) operation of surgical instruments. For this purpose, various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc., can be employed and designed to have robotic surgical systems to assist surgeons during surgical or treatment procedures. Such robotic systems can include remotely operable systems, automated flexible surgical systems, remote flexible surgical systems, remote articulated surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc.

[0070] Robotic surgical systems can be employed in conjunction with one or more consoles located immediately adjacent to the operating room or at a remote location. In this example, a team of surgeons or nurses can prepare the patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein, while another surgeon (or a group of surgeons) remotely controls the instruments via the robotic surgical system. It is understood that a highly skilled surgeon can perform multiple procedures in multiple locations without leaving his / her remote console, which is economically advantageous and beneficial to the patient or a group of patients.

[0071] The robotic arm of a surgical system is typically coupled to a pair of master handles via a controller. The surgeon can move the handles to produce a corresponding movement at the working end of any type of surgical instrument (e.g., end effector, gripper, scalpel, scissors, etc.), which can complement the use of one or more embodiments described herein. The movement of the master handles can be proportionally adjusted so that the working end has a corresponding movement that is different from, smaller than, or larger than, the movement performed by the surgeon's operating hand. The scaling factor or gear ratio can be adjustable, allowing the operator to control the resolution of the working end of one or more surgical instruments.

[0072] The main handle can incorporate various sensors to provide surgeons with feedback related to various tissue parameters or conditions, such as tissue resistance due to manipulation, cutting, or other treatments; pressure exerted by the instrument on the tissue; tissue temperature; and tissue impedance. As can be understood, these sensors provide surgeons with enhanced tactile feedback that simulates actual operating conditions. The main handle may also include a variety of actuators for manipulating or treating delicate tissues, further enhancing the surgeon's ability to simulate real-world scenarios.

[0073] Figure 11 A medical workbench is shown, generally represented as workbench 1000, and may generally include multiple robotic arms 1002, 1003; a control device 1004; and an operation console 1005 connected to the control device 1004. The operation console 1005 may include a display device 1006 that can be specifically configured to display three-dimensional images; and manual input devices 1007, 1008, by which a surgeon (not shown) may remotely control the robotic arms 1002, 1003 in a first operating mode.

[0074] According to any of the several embodiments disclosed herein, each of the robotic arms 1002, 1003 may include a plurality of components connected by couplings and attachment devices 1009, 1011 to which surgical tools “ST” supporting the end effector 1100 may be attached, as will be described in more detail below. In embodiments, the end effector 1100 may include, for example, an elongated body (or a portion thereof) and an end effector, as described in detail in any of the embodiments herein; thus, the robotic arm 1003 (together with the control device 1004, the operation console 1005 and / or the relevant portions of the manual input devices 1007, 1008) functions as the housing 12, 212 of the ultrasonic surgical instrument (respectively in…) Figure 1 and 2 ).

[0075] Robotic arms 1002 and 1003 can be driven by an electric actuator (not shown) connected to a control unit 1004. The control unit 1004 (e.g., a computer) can be positioned to activate the actuator, specifically by a computer program, such that the robotic arms 1002 and 1003, their attachments 1009 and 1011, and thus the surgical instruments (including the end effector 1100) perform desired movements according to movements defined by manual input devices 1007 and 1008. The control unit 1004 can also be positioned to regulate the movement of the robotic arms 1002 and 1003 and / or the actuator.

[0076] The medical workbench 1000 can be configured for a patient 1013 lying on a patient table 1012 to be treated minimally invasively by an end effector 1100. The medical workbench 1000 may also include more than two robotic arms 1002, 1003, with additional robotic arms similarly connected to a control unit 1004 and remotely controlled via an operation console 1005. Medical instruments or surgical tools (including the end effector 1100) may also be attached to additional robotic arms. The medical workbench 1000 may include a database 1014, specifically a database connected to the control unit 1004, storing preoperative data, for example, from patient / living body 1013 and / or body structure datasets.

[0077] Special Reference Figures 12A to 12DThis document describes a support system 1200 for a flexible waveguide 1201. The flexible waveguide 1201 includes a plurality of protruding posts 1251, 1252, 1253, and 1254 extending from the flexible waveguide 1201. The protruding posts 1251 and 1252 are shaped and sized to be received in corresponding recesses 1261 and 1262, respectively. Similarly, the protruding posts 1253 and 1254 are received in corresponding recesses 1263 and 1264, respectively. Recesses 1261 and 1262 are formed in the inner surface 1265 of an elongated member 1214 and are configured to receive the protruding posts 1253 and 1254 therein, respectively, to secure the flexible waveguide 1201 within the inner cavity 1215 of the elongated member 1214. Some of the plurality of protruding posts 1251, 1252, 1253, 1254 are positioned proximal to the hinge portion 1210, and the others of the plurality of protruding posts 1251, 1252, 1253, 1254 are positioned distal to the hinge portion 1210 to allow the hinge portion 1210 to hinge within the cavity 1215 and to prevent contact between the hinge portion 1210 and the inner surface 1265 of the elongated member 1214 (see, for example, see...). Figure 12D ).

[0078] Special Reference Figures 13A to 13C This paper describes a support system 1300 for a flexible waveguide 1301. The flexible waveguide 1301 includes a first annular collar 1351 and a second annular collar 1352 projecting circumferentially from the flexible waveguide 1301. The first annular collar 1351 and the second annular collar 1352 are shaped and sized to be received in corresponding notches 1361 and 1362, respectively. The notches 1361 and 1362 are formed circumferentially in the inner surface 1363 of the elongated member 1314 and are configured to receive the annular collars 1351 and 1352 therein, respectively, to secure the flexible waveguide 1301 within the inner cavity 1315 of the elongated member 1314. The annular collars 1351, 1352 and the notches 1361, 1362 are positioned on the proximal and distal sides of the hinge portion 1310, respectively, to allow the hinge portion 1310 to hinge within the inner cavity 1315 and to prevent contact between the hinge portion 1310 and the inner surface 1363 of the elongated member 1314.

[0079] Special Reference Figures 14A to 14CThis paper describes a support system 1400 for a flexible waveguide 1401. The flexible waveguide 1401 includes a first notch 1461 and a second notch 1462 circumferentially formed in an outer surface 1464 of the flexible waveguide 1401. The first notch 1461 and the second notch 1462 are shaped and sized to receive annular collars 1451 and 1452, respectively. The annular collars 1451 and 1452 protrude circumferentially from an inner surface 1463 of an elongated member 1414 and are configured to be received in the first notch 1461 and the second notch 1462, respectively, to secure the flexible waveguide 1401 within an inner cavity 1415 of the elongated member 1414. The annular collars 1451, 1452 and the notches 1461, 1462 are positioned on the proximal and distal sides of the hinge portion 1410, respectively, to allow the hinge portion 1410 to hinge within the inner cavity 1415 and to prevent contact between the hinge portion 1410 and the inner surface 1463 of the elongated member 1414.

[0080] Special Reference Figures 15A to 15D This describes a support system 1500 for a flexible waveguide 1501. Movable annular collars 1551 and 1552 are positioned around the flexible waveguide 1501. The movable annular collars 1551 and 1552 may each be formed of or contain plastic or silicone. The movable annular collars 1551 and 1552 allow a degree of longitudinal movement within the cavity 1515 of the elongated member 1514 to prevent stress on the flexible waveguide 1501. The movable annular collars 1551 and 1552 are positioned proximal and distal to the hinge portion 1510, respectively, to allow the hinge portion 1510 to hinge within the cavity 1515 and to prevent contact between the hinge portion 1510 and the inner surface 1563 of the elongated member 1514.

[0081] The inner cavity 1515 may include a first recess 1561 and a second recess 1562 circumferentially formed in the inner surface 1563 of the inner cavity 1515. The first recess 1561 and the second recess 1562 are designed to receive movable annular collars 1551 and 1552, respectively.

[0082] From the foregoing and with reference to the various drawings, those skilled in the art will understand that certain modifications can be made without departing from the scope of this disclosure. While several embodiments of this disclosure have been shown in the figures, it is not intended to limit this disclosure, as it is intended to be as broad as permitted by the art and this specification should be read in the same manner. Therefore, the foregoing description should not be construed as limiting, but merely as illustrative of specific embodiments. Those skilled in the art will contemplate other modifications within the scope and spirit of the appended claims.

Claims

1. A surgical instrument comprising: A housing having an elongated body extending distally therefrom, the elongated body defining a first hinge portion and a second hinge portion, and the elongated body defining an inner cavity therein; An end effector, which is supported at the distal portion of the elongated body; as well as A flexible waveguide extending through the cavity of the elongated body, the proximal portion of the flexible waveguide being configured to connect to an ultrasonic transducer, and the distal portion of the flexible waveguide being configured to connect to the end effector. The flexible waveguide defines a first hinge portion, the thickness of which is narrower than the thickness of other portions of the flexible waveguide, and the flexible waveguide also defines a second hinge portion, the thickness of which is narrower than the thickness of other portions of the flexible waveguide. The feature is that it further includes a first transducer and a second transducer located on opposite sides of the first hinge portion of the flexible waveguide, at least one of the first transducer or the second transducer being configured to amplify ultrasonic waves transmitted through the first hinge portion of the flexible waveguide.

2. The surgical instrument according to claim 1, wherein the first hinge portion of the flexible waveguide is configured to be hinged in a first orientation, and wherein the second hinge portion of the flexible waveguide is configured to be hinged in a second orientation.

3. The surgical instrument according to claim 1 or 2, wherein the first hinge portion of the flexible waveguide and the second hinge portion of the flexible waveguide are configured to be hinged to each other in the same orientation.

4. The surgical instrument of claim 1, wherein the end effector comprises an ultrasonic blade and a clamp configured to rotate about the ultrasonic blade, the ultrasonic blade and the clamp being configured to capture and treat tissue therebetween in a plurality of rotational orientations of the clamp relative to the ultrasonic blade.

5. The surgical instrument of claim 4, wherein the elongated body is configured to rotate to achieve different directional orientations of the end effector.

6. The surgical instrument of claim 5, wherein independent controls are configured to: rotate the elongated body; rotate the clamp about the ultrasonic blade; hinge the first hinge portion of the elongated body and thus hinge the first hinge portion of the flexible waveguide; and hinge the second hinge portion of the elongated body and thus hinge the second hinge portion of the flexible waveguide.

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