Medical tool with length conservation mechanism for actuating a tension band

Abstract

An actuation assembly for a medical device connects four straps to three degrees of freedom of maneuverability. The actuation assembly includes a first actuator, a second actuator, and a third actuator. The first actuator is coupled to the first strap and the second strap, the first actuator being operable to pull in one of the first strap and the second strap and to deliver the other of the first strap and the second strap. The third actuator is coupled to the third strap and the fourth strap, the third actuator being operable to pull in one of the third strap and the fourth strap and to deliver the other of the third strap and the fourth strap. Each of the first strap, the second strap, the third strap, and the fourth strap passes through a second actuator, and the second actuator being operable to increase the travel path of both the first strap and the second strap or both the third strap and the fourth strap.

Description

[0001] Related applications

[0002] This patent application claims the benefit of priority and filing date of U.S. Provisional Patent Application No. 62 / 860,938, filed on June 13, 2019, entitled “MEDICAL TOOL WITH LENGTH CONSERVATION MECHANISM FOR ACTUATING TENSIONBANDS,” which is incorporated herein by reference in its entirety. Technical Field

[0003] Embodiments described herein relate to grasping tools, more particularly to medical devices, and even more particularly to endoscopic tools. More particularly, embodiments described herein relate to devices including a tensioning band and a mechanism for conserving the length of the band during a range of motion of a wrist joint. Background Art

[0004] Known techniques for minimally invasive surgery (MIS) employ instruments to manipulate tissue, which can be controlled manually or via computer-assisted teleoperation. Many known MIS instruments include a therapeutic or diagnostic end effector (e.g., forceps, cutting tools, or cautery tools) mounted on a wrist mechanism at the distal end of a shaft. During MIS surgery, the end effector, wrist mechanism, and distal end of the shaft can be inserted into a small incision or natural orifice in the patient to position the end effector at the work site within the patient's body. Optional wrist mechanisms can be used to change the orientation of the end effector relative to the shaft to perform the desired surgical procedure at the work site. Known wrist mechanisms typically provide desired degrees of freedom (DOF) for the end effector's motion. For example, for forceps or other grasping tools, known wrist mechanisms typically enable the end effector's pitch and yaw to be varied relative to the shaft. The wrist can optionally provide roll DOF for the end effector, or roll DOF can be achieved by rolling the shaft. The end effector can optionally have additional mechanical DOFs, such as gripping or blade motion. In some cases, the wrist and end effector mechanical DOFs can be combined. For example, US Patent No. 5,792,135 (filed May 16, 1997) discloses a mechanism in which wrist and end effector gripping DOFs are combined.

[0005] To achieve the desired movement of the wrist mechanism and end effector, known instruments include a tension member (e.g., a cable) extending through the instrument's shaft and connecting the wrist mechanism to an actuator (also referred to herein as a backend mechanism). The actuator moves the cable to operate the wrist mechanism. For robotic or teleoperated systems, the backend mechanism is driven by a motor and can be operably coupled to a processing system to provide a user interface for a clinical user (e.g., a surgeon) to control the instrument.

[0006] Patients benefit from ongoing efforts to improve the effectiveness of MIS methods and tools. For example, reducing the size and / or operational stowage space of the shaft and wrist mechanism can allow for smaller entry incisions and reduce the space required for the surgical site, thereby reducing the negative impacts of surgery, such as pain, scarring, and undesirable healing times. However, producing small medical devices that achieve clinically desired functions for minimally invasive surgery can be challenging. Specifically, simply reducing the size of known wrist mechanisms by "scaling down" components does not produce an effective solution because the required component and material properties do not scale down. For example, efficient implementation of wrist mechanisms can be complicated because cables must be carefully routed through the wrist mechanism to maintain cable tension throughout the wrist mechanism's range of motion and minimize the interaction (or coupling effect) of one axis of rotation with another. In addition, pulleys and / or contoured surfaces are often required to reduce cable friction, which extends instrument life and allows operation without applying excessive forces to the cable or other structures in the wrist mechanism. Increased localized forces that may be caused by smaller structures (including cables and other components of the wrist mechanism) can lead to undesirable lengthening of the cable during storage and use (e.g., "stretching" or "creep"), shortened cable life, and the like.

[0007] In addition, the wrist mechanism typically provides specific degrees of freedom for the motion of the end effector. For example, for a pliers or other gripping tool, the wrist may be able to change the pitch, yaw, and grip of the end effector. More degrees of freedom can be achieved with the wrist, but will require additional actuating members in the wrist and shaft, which will compete for the limited space that exists considering the size restrictions required for MIS applications. Other degrees of freedom (e.g., roll or insertion / extraction by moving the main tube) also compete for space at or in the shaft of the device.

[0008] Conventional architectures for wrist mechanisms in robotically controlled medical devices use cables to turn a capstan in the wrist mechanism, thereby rotating the portion of the wrist mechanism connected to the capstan. For example, a wrist mechanism may include three capstans for rotating about a pitch axis, a yaw axis, or a clamping axis. Each capstan can be controlled using two cables attached to the capstan, so that one side pulls out a cable while the other side pulls in an equal length of cable. In this architecture, a total of six cables are required for the three degrees of freedom, extending from the wrist mechanism along the length of the main tube to the rear end mechanism of the instrument. The efficient implementation of a wrist mechanism can be complex because the cables must be carefully routed through the wrist mechanism to maintain wrist stability throughout the wrist mechanism's range of motion and to minimize the interaction (or coupling effect) between one rotational axis and another. In addition, pulleys are often required to reduce cable friction, which extends the life of the instrument and allows operation without applying excessive forces to the cables or other structures in the wrist mechanism.

[0009] Therefore, there is a need for improved endoscopic tools, including improved backend mechanisms to enable the wrist to operate with a smaller number of tension elements to facilitate miniaturization and reduce the cost of the instrument, and to reduce manufacturing costs by reducing the number of required parts. Summary of the Invention

[0010] This summary introduces certain aspects of the embodiments described herein to provide a basic understanding. This summary is not an extensive overview of the subject matter of the present invention and is not intended to identify key or critical elements or to delineate the scope of the subject matter of the present invention. In some embodiments, a medical device includes a medical device shaft, an end effector, a housing, a first actuator, a second actuator, a first strap, and a second strap. The medical device shaft includes a proximal end and a distal end, and the end effector is coupled to the distal end of the shaft. The housing is coupled to the proximal end of the shaft. The first actuator and the second actuator are rotatably supported in the housing. The first strap has a first end and a second end, the first end of the first strap being coupled to the first actuator, and the second end of the first strap being coupled to the end effector. The second strap has a first end and a second end, the first end being coupled to the first actuator, and the second end being coupled to the end effector. The first actuator is configured to move the first strap in a first direction and the second strap in a second direction opposite the first direction, thereby actuating the end effector in a first degree of freedom. The second actuator includes a first guide structure having a first guide surface and a second guide surface. The first guide surface contacts the first end of the first strap, the second guide surface contacts the first end of the second strap, and movement of the second actuator actuates both the first and second straps in the first direction, thereby actuating the end effector in a second degree of freedom.

[0011] In some embodiments, the medical device further comprises a third actuator, a fourth actuator, a third strap, a fourth strap, and the end effector comprises a first jaw member and a second jaw member. The second ends of the first strap and the second strap are coupled to the first jaw member. The first ends of the third strap and the fourth strap are coupled to the third actuator, and the second ends of the third strap and the fourth strap are coupled to the second jaw member. Movement of the third actuator actuates the third strap in the first direction and the fourth strap in the second direction, thereby actuating the second jaw of the end effector. The fourth actuator comprises a second guide structure having a third guide surface and a fourth guide surface. The third guide surface contacts the first end of the third strap, and the fourth guide surface contacts the first end of the fourth strap. Movement of the fourth actuator actuates both the third strap and the fourth strap in the second direction, thereby actuating the end effector with a second degree of freedom.

[0012] In some embodiments, the first guide surface and the second guide surface each have a curved surface integrally constructed with the second actuator. The first guide surface and the second guide surface are curved about the first guide structure axis of the second actuator. The first guide surface has a first width extending along the first guide structure axis, and the second guide surface has a second width extending along the first guide structure axis, the second width being spaced apart from the first guide surface along the first guide structure axis. When the first actuator moves the first and second belts, the first end of the first belt slides along the first guide surface and the first end of the second belt slides along the second guide surface. The third and fourth guide surfaces are curved about the second guide structure axis of the second actuator. The third guide surface has a third width extending along the second guide structure axis, and the fourth guide surface has a fourth width extending along the second guide structure axis, the fourth width being spaced apart from the fourth guide surface along the second guide structure axis. When the third actuator moves the third and fourth belts, the first end of the third belt slides along the third guide surface and the first end of the fourth belt slides along the fourth guide surface.

[0013] In some embodiments, the second actuator includes a bridge portion. The bridge portion extends from a first position between the first guide surface and the second guide surface to a second position between the third guide surface and the fourth guide surface. In some embodiments, the second actuator includes a base portion having an axis of rotation. The first guide surface is a first width of the second actuator parallel to the axis of rotation, the second guide surface is a second width of the second actuator parallel to the axis of rotation, the third guide surface is a third width of the second actuator parallel to the axis of rotation, and the fourth guide surface is a fourth width of the second actuator parallel to the axis of rotation. In this way, the first width, the second width, the third width, and the fourth width are each spaced apart from each other relative to the axis of rotation. In some embodiments, the medical device includes a drive gear rotatably supported in the housing, and the second actuator includes a sector gear operable to transmit motion from the drive gear to the second actuator.

[0014] In some embodiments, a shaft of a medical device defines a lumen extending along a central axis of the shaft from a proximal end to a distal end of the shaft. The medical device includes a guide member coupled to a housing, the guide member including a first guide slot and a second guide slot. At least a portion of the guide member extends above the lumen at the proximal end of the shaft. A central portion of a first strap travels within the first guide slot and enters the lumen, and a central portion of a second strap travels within the second guide slot and enters the lumen. The first guide slot is located at a first distance from the central axis of the shaft, while the second guide slot is located at a second distance from the central axis. The first distance is different from the second distance. In some embodiments, the first actuator includes a hook, and the first end of the first strap is coupled to the first actuator via the hook. In some embodiments, simultaneous movement of the first and third actuators actuates the end effector with a third degree of motion. During this simultaneous movement, the first actuator moves the first strap in a first direction and the second strap in a second direction. The third actuator moves the third strap in the first direction and the second strap in the second direction.

[0015] In some embodiments, a medical device includes a shaft of the medical device, an end effector, a housing, a first actuator, a second actuator, a first belt, a second belt, and a guide member. The shaft of the medical device includes a proximal end and a distal end, and the shaft defines an inner cavity extending from the proximal end to the distal end along the central axis of the shaft. The end effector is coupled to the distal end of the shaft, and the housing is coupled to the proximal end of the shaft. The first actuator and the second actuator are rotatably supported in the housing. The first belt has a first end and a second end, the first end of the first belt being coupled to the first actuator, and the second end being coupled to the end effector. The second belt has a first end and a second end. The first end of the second belt is coupled to the first actuator, and the second end of the second belt is coupled to the end effector. The guide member is coupled to the housing, and at least a portion of the guide member extends over the inner cavity at the proximal end of the shaft. The guide member includes a first guide element and a second guide element. The central portion of the first belt travels over the first guide element and into the inner cavity, and the central portion of the second belt travels over the second guide element and into the inner cavity. The first guide element is at a first offset distance proximal to the shaft along the central axis, and the second guide element is at a second offset distance proximal to the shaft along the central axis, and the first offset distance is different from the second axial distance. The first actuator is configured to move the first belt in a first direction and the second belt in a second direction opposite the first direction to actuate the end effector in a first degree of freedom. The second actuator is configured to move the first belt and the second belt in the first direction to actuate the end effector in a second degree of freedom.

[0016] In some embodiments, the first guide element includes a first rod and a first bearing that can rotate about the first rod when the first belt moves. The second guide element includes a second rod and a second bearing that can rotate about the second rod when the second belt moves. When the first actuator moves the first belt in a first direction and the second belt in a second direction, the first bearing and the second bearing are operable to rotate in opposite directions. When the second actuator moves the first belt and the second belt in the first direction, the first bearing and the second bearing are operable to rotate in the same direction. In some embodiments, the central portions of the first belt and the second belt exit the guide member and enter the inner cavity of the shaft at approximately 90 degrees. In some embodiments, the first guide element is vertically offset from the central axis by a first offset distance. The second guide element is vertically offset from the central axis by a second offset distance, wherein the first distance is different from the second distance.

[0017] In some embodiments, the medical device further comprises a third actuator, a third strap, a fourth strap, and the end effector comprises a first jaw member and a second jaw member. The second ends of the first strap and the second strap are coupled to the first jaw member. The first ends of the third strap and the fourth strap are coupled to the third actuator, and the second ends of the third strap and the fourth strap are coupled to the second jaw member. Movement of the third actuator actuates the third strap in a first direction and the fourth strap in a second direction to actuate the second jaw of the end effector.

[0018] In some embodiments, the guide member includes a third guide element and a fourth guide element. A central portion of the third belt travels over the third guide element and into the lumen of the shaft. A central portion of the fourth belt travels over the fourth guide element and into the lumen. The third guide element is vertically offset from the central axis by a third offset distance, and the fourth guide element is vertically offset from the central axis by a fourth offset distance, the third offset distance being different from the fourth offset distance.

[0019] In some embodiments, a medical device includes a shaft of a medical instrument, an end effector, a housing, a first actuator, a second actuator, a first belt, and a guide member. The shaft includes a proximal end and a distal end, and defines an inner cavity extending from the proximal end to the distal end along the central axis of the shaft. The end effector is coupled to the distal end of the shaft, and the housing is coupled to the proximal end of the shaft. The first actuator and the second actuator are rotatably supported in the housing. The first belt has a first end and a second end, the first end is coupled to the first actuator, and the second end is coupled to the end effector. The second belt has a first end and a second end, the first end is coupled to the first actuator, and the second end is coupled to the end effector. The guide member is coupled to the housing, and at least a portion of the guide member extends over the inner cavity at the proximal end of the shaft. The central portion of the first belt passes through the guide member and enters the inner cavity of the shaft, and the first belt twists along the longitudinal centerline of the first belt between the first end of the first belt and the central portion of the first belt. The central portion of the second strap passes through the guide member and enters the lumen of the shaft, and the second strap is twisted along a longitudinal centerline of the second strap between the first end portion of the second strap and the central portion of the second strap. The first actuator is configured to move the first strap in a first direction and the second strap in a second direction opposite the first direction, thereby actuating the end effector with a first degree of freedom. The second actuator is configured to move the first strap and the second strap in the first direction, thereby actuating the end effector with a second degree of freedom.

[0020] In some embodiments, the medical device further includes a third actuator, a third strap, and a fourth strap, and the end effector includes a first jaw member and a second jaw member. The second ends of the first and second straps are coupled to the first jaw member. The first ends of the third and fourth straps are coupled to the third actuator, and the second ends of the third and fourth straps are coupled to the second jaw member. Movement of the third actuator actuates the third strap in a first direction and the fourth strap in a second direction to actuate the second jaw of the end effector. The central portions of the third and fourth straps pass through the guide member and enter the lumen of the shaft. The third strap is twisted along its longitudinal centerline between its first end and central portion. The fourth strap is twisted along its longitudinal centerline between its first end and central portion. In some embodiments, the first strap is twisted at an angle of approximately 90 degrees. In some embodiments, the first strap is twisted in a first rotational direction, and the second strap is also twisted in the first direction. In some embodiments, the first strap is twisted in the first rotational direction, and the second strap is twisted in a second rotational direction different from the first direction. In some embodiments, the first strap is twisted in the first rotational direction, and the third strap is also twisted in the first direction. In some embodiments, the first belt is twisted in a first rotational direction, and the third belt is twisted in a second rotational direction that is different from the first direction. In some embodiments, the first belt is twisted in a first rotational direction, the second belt is twisted in the first rotational direction, the third belt is twisted in the second rotational direction, and the fourth belt is twisted in the second direction, and the first rotational direction is different from the second rotational direction. In some embodiments, the first belt is twisted in the first rotational direction, the second belt is twisted in the first rotational direction, the third belt is twisted in the first rotational direction, and the fourth belt is twisted in the first direction.

[0021] Other medical devices, related components, medical device systems and / or methods according to embodiments will be apparent to those skilled in the art upon review of the following drawings and detailed description. All such additional medical devices, related components, medical device systems and / or methods included in this specification are intended to be within the scope of this disclosure. BRIEF DESCRIPTION OF THE DRAWINGS

[0022] Figure 1 is a plan view of a minimally invasive teleoperated medical system according to an embodiment for performing a medical procedure such as a surgical procedure.

[0023] Figure 2 yes Figure 1 A perspective view of an optional auxiliary unit of a minimally invasive teleoperated surgical system is shown.

[0024] Figure 3 yes Figure 1 A perspective view of a user console for a minimally invasive teleoperated surgical system is shown.

[0025] Figure 4 yes Figure 1 A front view of a manipulator unit including multiple instruments of a minimally invasive teleoperated surgical system is shown.

[0026] Figure 5 is a schematic diagram of a portion of an apparatus including a first set of straps and two actuators, according to an embodiment.

[0027] Figure 6 yes Figure 5 An enlarged schematic diagram of the actuator assembly of the above-mentioned portion of the instrument, which depicts the operating state of the first actuator.

[0028] Figure 7 yes Figure 5 An enlarged schematic diagram of the actuator assembly of the above-mentioned portion of the instrument, which depicts the operating state of the second actuator.

[0029] Figure 8 is a schematic diagram of a portion of an apparatus including two sets of bands and four actuators, according to an embodiment.

[0030] Figure 9 yes Figure 8 An enlarged schematic diagram of the actuator assembly of the above-mentioned portion of the instrument, which depicts the operating states of the first actuator and the third actuator.

[0031] Figure 10 yes Figure 8 An enlarged schematic diagram of the actuator assembly of the above-mentioned portion of the instrument, which depicts the operating state of the second actuator.

[0032] Figure 11 yes Figure 8 An enlarged schematic diagram of the actuator assembly of the above-mentioned portion of the instrument, which depicts the operating state of the fourth actuator.

[0033] Figure 12 is a schematic diagram of a portion including two sets of belts and three actuators according to an embodiment.

[0034] Figure 13 yes Figure 12 An enlarged schematic diagram of the actuator assembly of the above-mentioned portion of the instrument, which depicts the operating state of the first actuator.

[0035] Figure 14 yes Figure 12 An enlarged schematic diagram of the actuator assembly of the above-mentioned portion of the instrument, which depicts the operating state of the third actuator.

[0036] Figure 15 yes Figure 12 An enlarged schematic diagram of the actuator assembly of the above-mentioned portion of the instrument, which depicts the operating state of the second actuator.

[0037] Figure 16 is a perspective view of an instrument of a surgical system according to an embodiment.

[0038] Figure 17 is Figure 16 An enlarged perspective view of the end effector and wrist assembly at the distal portion of the instrument, indicated by region Z1, is shown.

[0039] Figure 18 is Figure 16 An enlarged perspective view of the actuator assembly at the proximal portion of the instrument is shown, indicated by area Z2.

[0040] Figure 19 yes Figure 18 An enlarged perspective view of the actuator assembly in FIG, showing the housing and guide member assembly in transparent form to detail the internal arrangement of the components.

[0041] Figure 20 yes Figure 18 FIG. 1 is a perspective exploded view of the actuator assembly in FIG. 1 showing the housing and guide assembly removed from the base of the actuator assembly.

[0042] Figure 21 and Figure 22 yes Figure 20 A front perspective view of the second actuator of the actuator assembly ( Figure 21 ) and rear perspective ( Figure 22 ).

[0043] Figure 23 and Figure 24 yes Figure 20 Front perspective view of the actuator and belt of the actuator assembly ( Figure 23 ) and rear perspective ( Figure 24 ).

[0044] Figure 25a is a first belt according to an embodiment attached to Figure 23 A perspective exploded view of the first actuator of the actuator assembly.

[0045] Figure 25b According to another embodiment, the first belt is attached to Figure 23 A perspective exploded view of the first actuator of the actuator assembly.

[0046] Figure 26 When the second actuator is in the first position Figure 18 A cross-sectional view of a portion of the actuator assembly in FIG. Figure 18 The line X1-X1 in is intercepted.

[0047] Figure 27 When the second actuator is in the second position Figure 18A cross-sectional view of a portion of the actuator assembly in FIG. Figure 18 The line X1-X1 in is intercepted.

[0048] Figure 28 yes Figure 20 An enlarged perspective view of the housing is shown.

[0049] Figure 29 Is connected to Figure 18 An enlarged perspective view of the housing of the device is shown.

[0050] Figure 30 is a cross-sectional view of a portion of the actuator assembly, the cross section being taken along Figure 18 The line X2-X2 in is intercepted.

[0051] Figure 31 is Figure 23 An enlarged cross-sectional view of the guide member assembly, belt and shaft is shown in FIG. 1 , indicated by area Z3 .

[0052] Figure 32 is a perspective view of an actuator assembly according to an embodiment, showing the housing and guide member assembly in transparent form to detail the internal arrangement of the components.

[0053] Figure 33 yes Figure 32 An enlarged perspective view of the actuator assembly showing the housing and guide assembly removed from the base.

[0054] Figure 34 、 Figure 35 and Figure 36 yes Figure 32 A front perspective view of the second actuator of the actuator assembly ( Figure 34 )、Side view( Figure 35 ) and top view ( Figure 36 ). DETAILED DESCRIPTION

[0055] The embodiments described herein may be advantageously employed in a variety of grasping, cutting, and manipulation operations associated with minimally invasive surgical procedures.

[0056] The length conservation mechanism of the present application enables motion in three degrees of freedom (e.g., about the pitch axis, the yaw axis, and the clamp axis) using only four tension elements, thereby reducing the total number of tension elements required, reducing the space required within the shaft and wrist, reducing overall cost, and enabling further miniaturization of the wrist and shaft assembly, thereby facilitating MIS surgery. In addition, the apparatus described herein includes one or more tension bands that can be moved to actuate the end effector with several degrees of freedom. The band can include regions having a larger cross-sectional area to promote increased strength, or can be twisted to allow efficient travel within the transmission of the apparatus.

[0057] As used herein, the term "about" when used in conjunction with a numerical indication refers to the numerical indication plus or minus 10% of the numerical indication. For example, the language "about 50" encompasses a range of 45 to 55. Similarly, the language "about 5" encompasses a range of 4.5 to 5.5.

[0058] The term "flexible" in connection with a part such as a mechanical structure, component, or assembly of components should be interpreted broadly. Essentially, the term means that the part can be repeatedly bent and returned to its original shape without damage to the part. Certain flexible components may also be elastic. For example, if a component (e.g., a flexure) has the ability to absorb energy when elastically deformed and then release the stored energy when unloaded (i.e., returned to its original state), the component is said to be elastic. Many "rigid" objects have a slight inherent elastic "bend" due to the properties of their materials, but such objects are not considered to be "flexible" as the term is used in this article.

[0059] As used in this specification and the appended claims, the term "distal" refers to a direction toward a working site, and the term "proximal" refers to a direction away from a working site. Thus, for example, the end of a tool closest to the target tissue would be the distal end of the tool, and the end opposite the distal end (i.e., the end manipulated by the user or coupled to the actuation shaft) would be the proximal end of the tool.

[0060] In addition, the specific words selected to describe one or more embodiments and optional elements or features are not intended to limit the present invention. For example, spatial relative terms - such as "below", "below", "below", "above", "on", "near side", "far side" etc. - can be used to describe the relationship between an element or feature as shown in the figure and another element or feature. In addition to the position and orientation shown in the figure, these spatial relative terms are intended to include different positions (i.e., translation placement) and orientations (i.e., rotation placement) of the device in use or in operation. For example, if the device in the figure is flipped, the element described as "below" or "below" other elements or features will be "above" or "on" the other elements or features. Therefore, the term "below" can include both the position and orientation above and below. The device can be oriented in other ways (e.g., rotated 90 degrees or in other orientations) and the spatial relative descriptors used in this article are interpreted accordingly. Similarly, the description of the motion along (translation) and around (rotation) each axis includes various spatial device positions and orientations. The combination of the position and orientation of the subject defines the posture of the subject.

[0061] Similarly, geometric terms (e.g., "parallel," "perpendicular," "circular," or "square") are not intended to require absolute mathematical precision unless the context indicates otherwise. Instead, such geometric terms allow for variations due to manufacturing or functional equivalence. For example, if an element is described as "circular" or "substantially circular," this description still encompasses components that are not precisely circular (e.g., a component that is slightly oblong or multi-sided).

[0062] In addition, unless the context indicates otherwise, the singular forms "a", "an", and "the" also include the plural forms. The terms "comprising", "including", "having", etc. specify the presence of stated features, steps, operations, elements, components, etc., but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, or groups.

[0063] Unless otherwise indicated, the terms device, medical equipment, apparatus and variations thereof are used interchangeably.

[0064] Aspects of the present invention are primarily based on the use of da The present invention will be described with reference to an embodiment of a surgical system commercialized by Intuitive Surgical of Sunnyvale, California. An example of such a surgical system is the da Vinci Surgical System (IS4000) and da Vinci Surgical System (Model IS3000). However, those skilled in the art will appreciate that the inventive aspects disclosed herein may be embodied and implemented in a variety of ways, including computer-assisted, non-computer-assisted, and hybrid combinations of manual and computer-assisted embodiments and implementations. The embodiments of surgical systems (e.g., IS4000, IS3000, IS2000, IS1200) are presented only as examples, and they should not be considered to limit the scope of the inventive aspects disclosed herein. Where applicable, aspects of the present invention can be embodied and implemented both in relatively small, handheld, manually operated devices and in relatively larger systems with additional mechanical support.

[0065] Figure 11 is a plan view of a computer-assisted teleoperation system. Shown is a medical device, which is a minimally invasive robotic surgery (MIRS) system 1000 (also referred to herein as a minimally invasive teleoperated surgical system), which is used to perform minimally invasive diagnostic or surgical procedures on a patient P lying on a surgical table 1010. The system can have any number of components, such as a user control unit 1100 for use by a surgeon or other skilled clinician S during surgery. The MIRS system 1000 can also include a manipulator unit 1200 (commonly referred to as a surgical robot) and an optional auxiliary equipment unit 1150. The manipulator unit 1200 can include an arm assembly 1300 and a tool assembly removably coupled to the arm assembly. The manipulator unit 1200 can manipulate at least one removably coupled instrument 1400 (also referred to herein as a "tool") through a minimally invasive incision or natural orifice in the body of the patient P while the surgeon S views the surgical site and controls the movement of the instrument 1400 via the control unit 1100. An image of the surgical site is obtained by an endoscope (not shown), such as a stereo endoscope, which can be manipulated by the manipulator unit 1200 to orient the endoscope. An auxiliary equipment unit 1150 can be used to process the image of the surgical site for subsequent display to the surgeon S via the user control unit 1100. The number of instruments 1400 used at one time will typically depend on factors such as the diagnostic or surgical procedure and the space constraints within the surgical operating room. If it is necessary to replace one or more instruments 1400 in use during the operation, the assistant removes the instrument 1400 from the manipulator unit 1200 and replaces it with another instrument 1400 from the tray 1020 in the surgical operating room. Although shown as being used with instrument 1400, any instrument described herein can be used with the MIRS 1000.

[0066] Figure 2 1 is a perspective view of the control unit 1100. The user control unit 1100 includes a left-eye display 1112 and a right-eye display 1114 for presenting a coordinated stereoscopic view of the surgical site to the surgeon S that enables depth perception. The user control unit 1100 also includes one or more input control devices 1116, which in turn enable the manipulator unit 1200 ( Figure 1The input control devices 1116 provide at least the same degrees of freedom as their associated instruments 1400, providing the surgeon S with a sense of telepresence or integration of the input control devices 1116 with (or direct connection to) the instruments 1400. In this manner, the user control unit 1100 provides the surgeon S with a strong sense of direct control over the instruments 1400. To this end, position sensors, force sensors, and tactile feedback sensors (not shown) can be employed to transmit position, force, and tactile sensations from the instruments 1400 back to the surgeon's hand via the input control devices 1116.

[0067] The user control unit 1100 is Figure 1 1100 and the surgeon S can directly monitor the operation, be present in person if necessary, and speak directly with the assistant rather than via a telephone or other communication medium. However, in other embodiments, the user control unit 1100 and the surgeon S can be in different rooms, completely different buildings, or other remote locations away from the patient that allow for telesurgery.

[0068] Figure 3 is a perspective view of the auxiliary equipment unit 1150. The auxiliary equipment unit 1150 can be coupled to an endoscope (not shown) and can include one or more processors to process captured images for subsequent display, such as display via the user control unit 1100, or display on another suitable display located locally and / or remotely. For example, in the case of a stereoscopic endoscope, the auxiliary equipment unit 1150 can process the captured images to present a coordinated stereoscopic image of the surgical site to the surgeon S via the left eye display 1112 and the right eye display 1114. Such coordination can include alignment between the relative images and can include adjusting the stereo working distance of the stereoscopic endoscope. As another example, the image processing can include compensating for imaging errors of the image capture device, such as optical aberrations, using previously determined camera calibration parameters.

[0069] Figure 4 A front perspective view of a manipulator unit 1200 is shown. Manipulator unit 1200 includes components (e.g., arms, linkages, motors, sensors, etc.) that allow manipulation of an instrument 1400 and an imaging device (not shown), such as a stereo endoscope, for capturing images of the surgical site. Specifically, instrument 1400 and imaging device can be manipulated by a teleoperation mechanism having a plurality of joints. Furthermore, instrument 1400 and imaging device are positioned and manipulated through an incision or natural orifice in patient P in such a manner that the software and / or kinematic telemotion center remains at the incision or orifice. In this way, the incision size can be minimized.

[0070] Figure 5-72 is a schematic diagram of a portion of an apparatus 2400 according to an embodiment. The apparatus 2400 includes a wrist assembly 2500, a first belt 2420 (which serves as a first tension member), a second belt 2430 (which serves as a second tension member), an end effector 2460, and an actuator assembly 2700. The apparatus 2400 is configured such that movement of the first belt 2420 and the second belt 2430 produces movement of the wrist assembly 2500 about a first rotational axis A1 (which serves as a pitch axis, the term pitch being arbitrary), movement of the end effector 2460 about a second rotational axis A2 (which serves as a yaw axis, the term yaw being arbitrary), or both movement of the wrist assembly 2500 and movement of the end effector 2460. Although illustrated as belts, any of the belts discussed herein may be replaced with other forms of tension members, including but not limited to cables, wires, beams, rods, or a combination of one or more of these.

[0071] The wrist assembly 2500 (also referred to as a joint assembly) includes a first link 2510 and a second link 2610. The first link 2510 has a proximal portion 2511 coupled to the shaft 2410. The shaft 2410 can be any suitable elongated shaft that couples the wrist assembly 2500 to the actuator assembly 2700. For example, in some embodiments, the shaft 2410 can be a cylindrical shaft within which the first strap 2420, the second strap 2430, and other components (e.g., electrical wiring, a ground wire, or the like) that travel from the actuator assembly 2700 to the wrist assembly 2500 are disposed. The proximal portion 2511 can be coupled to the shaft 2410 via any suitable mechanism. For example, in some embodiments, the proximal portion 2511 can be matingly disposed within a portion of the shaft 2410 (e.g., via an interference fit). In some embodiments, the proximal portion 2511 can include one or more protrusions, recesses, openings, or connectors that couple the proximal portion 2511 to the shaft 2410. In some embodiments, the proximal portion 2511 can be welded, glued, or fused to the shaft 2410 .

[0072] The second link 2610 has a proximal portion 2611 and a distal portion 2612. The proximal portion 2611 is rotatably coupled to the first link 2510 to form a wrist assembly 2500 having a first axis of rotation A1, about which the second link 2610 rotates relative to the first link 2510. The wrist assembly 2500 can include any suitable coupling mechanism. For example, in some embodiments, the second link 2610 can be coupled to the first link 2510 via a pinned joint of the type shown and described herein.

[0073] The distal end portion 2612 of the second link 2610 includes a connector 2680 that is coupled to the pulley portion 2467 of the end effector 2460, allowing the end effector 2460 to rotate relative to the wrist assembly 2500 about a second axis of rotation A2. The second axis of rotation A2 is not parallel to the first axis of rotation A1. In embodiments having multiple tool members, axis A2 serves not only as a yaw axis (the term yaw is arbitrary) when the tool members rotate together, but also as a clamping axis when the tool members rotate in opposition to each other. Thus, the instrument 2400 provides at least three degrees of freedom (i.e., pitch motion about the first axis of rotation A1, yaw motion about the second axis of rotation A2, and clamping motion about the second axis of rotation A2). The connector 2680 can be any suitable connector to rotatably couple the end effector 2460 to the wrist assembly 2500. For example, in some embodiments, the first link 2510 and / or the second link 2610 can include a clevis and a pin, such as the pinned joint shown and described in U.S. Patent No. US 9,204,923 B2, entitled “Medical Instrument Electronically Energized Using Drive Cables” (filed on July 16, 2008), which is incorporated herein by reference in its entirety. In other embodiments, the first link 2510 and / or the second link 2610 can include a compliant mechanism, such as the compliant mechanism shown and described in International Patent Publication No. WO 2016 / 123139 A2, entitled “Rolling-Contact Joint Mechanisms and Methods” (filed on January 26, 2016), which is incorporated herein by reference in its entirety. In yet other embodiments, the wrist assembly 2500 can include any connector or feature shown and described in International Patent Application No. PCT / US18 / 64721, entitled “Medical Tools Having Tension Bands” (filed on December 10, 2018), which is incorporated herein by reference in its entirety.

[0074] End effector 2460 is coupled to wrist assembly 2500 and includes at least one tool member 2462. Tool member 2462 may include a contact portion 2464 and a pulley portion 2467. Contact portion 2464 is configured to engage or manipulate target tissue during a surgical procedure. For example, in some embodiments, contact portion 2464 may include an engagement surface that functions as a gripper, cutter, tissue manipulator, or the like. In other embodiments, contact portion 2464 may be an energized tool member for cauterization or electrosurgery. As described above, pulley portion 2467 is rotatably coupled to second link 2610, allowing tool member 2462 to rotate relative to wrist assembly 2500 about second rotation axis A2 in the direction of arrow KK. In this manner, contact portion 2464 of tool member 2462 can be actuated about second rotation axis A2 to engage or manipulate target tissue during a surgical procedure. Tool member 2462 (or any tool member described herein) may be any suitable medical tool member. Furthermore, while only one tool member 2462 is shown, in other embodiments, the instrument 2400 may include two movable tool members that cooperate to perform a clamping or shearing function.

[0075] First belt 2420 includes a proximal portion 2421 and a distal portion 2422, and extends from actuator assembly 2700, through shaft 2410, and into wrist assembly 2500. Proximal portion 2421 of first belt 2420 is attached to first actuator 2800 of actuator assembly 2700, and distal portion 2422 is attached to pulley portion 2467. Second belt 2430 includes a proximal portion 2431 and a distal portion 2432, and extends from actuator assembly 2700, through shaft 2410, and into wrist assembly 2500. Proximal portion 2431 of second belt 2430 is attached to first actuator 2800 of actuator assembly 2700, and distal portion 2432 is attached to pulley portion 2467.

[0076] First band 2420, second band 2430, and any other bands described herein can have any suitable shape. For example, in some embodiments, any band described herein can have a rectangular cross-sectional shape (taken in a cross-sectional plane perpendicular to the longitudinal centerline of the band). In other embodiments, any band described herein can have a trapezoidal shape. In still other embodiments, any band described herein can include a slightly curved surface. Furthermore, any band described herein can be constructed from any suitable material. For example, in some embodiments, first band 2420, second band 2430, and any other band described herein can be constructed from a series of laminates bonded together (e.g., via an adhesive). In other embodiments, the laminates can be joined by any other suitable method. The laminates can be constructed from any suitable material, including tungsten, steel, or any suitable polymer. These bands can be similar to any of the bands shown and described in International Patent Application No. PCT / US18 / 64721, entitled "Medical Tools Having Tension Bands" (filed December 10, 2018), which is incorporated herein by reference in its entirety.

[0077] like Figure 6 and Figure 7 As shown, actuator assembly 2700 (which may serve as a transmission or backend assembly) generates motion of first and second straps 2420, 2430, which operate to produce the desired articulation motion (pitch, yaw, or grip) at wrist assembly 2500. Thus, as described herein, actuator assembly 2700 includes components and controls for moving one strap proximally (i.e., pulling in a strap) while allowing the other strap to move distally (i.e., releasing or "unclamping") the other strap. Actuator assembly 2700 can also move both first and second straps 2420, 2430 in the same direction. In this way, actuator assembly 2700 can maintain a desired tension within the straps, thereby producing the desired motion at wrist assembly 2500. Furthermore, in some embodiments, actuator assembly 2700 can ensure that the strap lengths are conserved (i.e., move equally) throughout the range of motion of wrist assembly 2500.

[0078] Specifically, the actuator assembly 2700 includes a housing 2760, a first actuator 2800, and a second actuator 2820. The housing 2760 (which serves as a chassis) provides structural support for mounting and aligning the components of the actuator assembly 2700. For example, the housing 2760 may define openings, protrusions, and / or brackets for mounting shafts or other components. The first actuator 2800 is mounted to the actuator assembly 2700 (e.g., within the housing 2760) via a first actuator support member 2801. For example, the first actuator support member 2801 may be a mount, a shaft, or any other suitable support structure to secure the first actuator 2800 to the actuator assembly 2700. In some embodiments, the proximal portion 2421 of the first strap 2420 is attached to the first actuator 2800 at a first location, and the proximal portion 2431 of the second strap 2430 is attached to the first actuator 2800 at a second location different from the first location. The proximal portion 2421 and the proximal portion 2431 can both be attached to the first actuator 2800 via one or more fasteners. For example, the proximal portion 2421 of the first strap 2420 and the proximal portion 2431 of the second strap 2430 can be secured to the first actuator 2800 by bolts or screws.

[0079] like Figure 5-7 As shown, second actuator 2820 is mounted to actuator assembly 2700 (e.g., within housing 2760) via second actuator support member 2821. For example, second actuator support member 2821 can be a mounting member, a shaft, or any other suitable support structure to secure second actuator 2820 to actuator assembly 2700. In some embodiments, second actuator 2820 is a linear actuator operable to produce linear motion in the direction indicated by arrow DD. With respect to first belt 2420 and second belt 2430, the direction of travel of second actuator 2820 is non-parallel to the direction of travel indicated by arrows BB and CC (i.e., includes a component of travel perpendicular to arrows BB and CC). In other embodiments, second actuator 2820 includes a lever or cam operable to produce linear motion in the direction of arrow DD.

[0080] Second actuator 2820 includes a guide structure 2822 having a first guide surface 2823 and a second guide surface 2824. First guide surface 2823 contacts proximal portion 2421 of first strap 2420. Second guide surface 2824 contacts proximal portion 2431 of second strap 2430. In this manner, as described herein, movement of second actuator 2820 will produce movement of first strap 2420 and second strap 2430. Furthermore, this movement can be independent of the movement of first strap 2420 and second strap 2430 produced by first actuator 2800. First guide surface 2823 and second guide surface 2824 can be any suitable surfaces and can include any suitable features to contact and impart movement to first strap 2420 and second strap 2430. In some embodiments, when the second actuator 2820 is in an intermediate position before being actuated and moved in the direction of arrow DD as described below, the proximal portion 2421 of the first band 2420 can be spaced apart from the first guide surface 2823, and the proximal portion 2431 of the second band 2430 can be spaced apart from the second guide surface 2824.

[0081] The motion generated by the first actuator 2800 is translated to the proximal portion 2421 of the first strap 2420 and the proximal portion 2431 of the second strap 2430. In some embodiments, the first actuator 2800 is operable to generate rotational motion about the first actuator axis A3 in the direction of arrow AA. The proximal portion 2421 can be attached to the first actuator 2800 in a first orientation, and the proximal portion 2431 can be attached to the first actuator 2800 in a second orientation opposite the first orientation, such that when the first actuator 2800 is rotated in the direction of arrow AA, the first strap 2420 moves distally in the direction of arrow BB (i.e., releases), while the second strap 2430 moves proximally in the direction of arrow CC (i.e., pulls). The length of the released first strap 2420 can be the same as the length of the pulled or retracted second strap 2430 to ensure that the strap lengths are conserved (i.e., move equally) throughout the range of motion of the wrist assembly 2500. In other embodiments, the first actuator 2800 may be configured as a linear actuator to move the first belt 2420 and the second belt 2430 in the directions indicated by arrows BB and CC, respectively.

[0082] When the first belt 2420 moves in the direction of arrow BB and the second belt 2430 moves in the direction of arrow CC, the distal portion 2422 of the first belt 2420 is fed into the pulley portion 2467 while the distal portion 2432 of the second belt 2430 is retracted from the pulley portion 2467, causing the pulley portion 2467 and the tool member 2462 to move along the pulley portion 2467. Figure 5In contrast, when the first actuator 2800 is rotated in the direction indicated by the arrow KK, the second actuator 2800 rotates about the second rotation axis A2. Figure 6 When the belt 2420 rotates in the direction opposite to the arrow AA, the distal portion 2422 of the first belt 2420 is retracted from the pulley portion 2467, and the distal portion 2432 of the second belt 2430 is fed into the pulley portion 2467, thereby pushing the pulley portion 2467 and the tool member 2462 along the same direction as the pulley portion 2467. Figure 5 The second rotation axis A2 rotates in the direction opposite to the middle arrow KK.

[0083] When the second actuator 2820 moves in the direction of arrow DD, as shown in FIG. Figure 7 As shown, the lengths of both first and second belts 2420, 2430 outside of actuator assembly 2700 are retracted. As the lengths are retracted, distal portions 2422, 2432 of first and second belts 2420, 2430 move in the direction of arrow CC. The movement of distal portions 2422, 2432, in turn, exerts a force on pulley 2467 and pushes second link 2610 to rotate about first rotation axis A1 in the direction of arrow LL. Thus, the combination of first actuator 2800, second actuator 2820, and a set of belts (first and second belts 2420, 2430) is operable to control end effector 2460 and wrist assembly 2500 of instrument 2400 with at least two degrees of freedom (e.g., pitch and yaw).

[0084] As mentioned above, although Figure 5 The end effector 2460 in FIG. 2 is shown as having only one tool member 2462, but two (or more) tool members may be provided and the second tool member may be fixedly or rotatably mounted relative to the second link 2610. For example, Figure 8-11 3400 according to an embodiment. The instrument 3400 includes a wrist assembly 3500, a first belt 3420 (which serves as a first tension member), a second belt 3430 (which serves as a second tension member), a third belt 3440 (which serves as a third tension member), a fourth belt 3450 (which serves as a fourth tension member), an end effector 3460, and an actuator assembly 3700. The end effector 3460 may include a first tool member 3462 coupled to a first pulley portion 3467 and a second tool member 3472 coupled to a second pulley portion 3477. Although shown as including the first belt 3420, the second belt 3430, the third belt 3440, and the fourth belt 3450, in other embodiments, other forms of tension members, as described herein, may be employed.

[0085] Wrist assembly 3500 (also referred to as a joint assembly) includes a first link 3510 and a second link 3610. First link 3510 has a proximal portion 3511 coupled to shaft 3410. Shaft 3410 can be any suitable elongated shaft, such as those described above with reference to shaft 2410. Second link 3610 has a proximal portion 3611 and a distal portion 3612. Proximal portion 3611 is rotatably coupled to first link 3510 to form wrist assembly 3500 having a first rotational axis A1 (which serves as a pitch axis; the term pitch is arbitrary), about which second link 3610 rotates relative to first link 3510. Wrist assembly 3500 can include any suitable coupling mechanism shown and described herein. The distal end portion 3612 of the second link 3610 includes a connector 3680 that is coupled to the first pulley portion 3467 of the first tool member 3462 and the second pulley portion 3477 of the second tool member 3472. The first pulley portion 3467 and the second pulley portion 3477 are coupled to rotate independently or in unison about a second rotation axis A2 relative to the wrist assembly 3500. The second rotation axis A2 is non-parallel to the first rotation axis A1. Axis A2 serves not only as a yaw axis (the term yaw is arbitrary) when the first tool member 3462 and the second tool member 3472 rotate together, but also as a clamping axis when the first tool member 3462 and the second tool member 3472 rotate oppositely to each other. The connector 3680 can be any suitable connector for rotatably coupling the end effector 3460 to the wrist assembly 3500 as described herein.

[0086] The first tool member 3462 may include a contact portion 3464 and the second tool member 3472 may include a contact portion 3474. The contact portions 3464, 3474 are configured to engage or manipulate target tissue during a surgical procedure. For example, the contact portions 3464, 3474 may include an engagement surface that functions as a gripper, cutter, tissue manipulator, or the like. In other embodiments, the contact portions 3464, 3474 may be energized tool members for cauterization or electrosurgery. As described above, the first tool member 3462 and the second tool member 3472 are rotatably coupled to the second link 3610 such that the first tool member 3462 and the second tool member 3472 can rotate relative to the wrist assembly 3500 about the second rotational axis A2. In this manner, the contact portion 3464 of the first tool member 3462 can be actuated in the direction of arrow KK, and the contact portion 3474 of the second tool member 3472 can be actuated in the direction opposite to arrow KK to bring the contact portions 3464 and 3474 closer together, thereby grasping, cutting, engaging, or manipulating target tissue during surgery. Conversely, the contact portion 3464 of the first tool member 3462 can be actuated in the direction opposite to arrow KK, and the contact portion 3474 of the second tool member 3472 can be actuated in the direction of arrow KK to separate the contact portions 3464 and 3474 from each other and release the target tissue.

[0087] like Figure 8 As shown, first pulley portion 3467 is coupled to distal portion 3422 of first belt 3420 and distal portion 3432 of second belt 3430. Second pulley portion 3477 is coupled to distal portion 3442 of third belt 3440 and distal portion 3452 of fourth belt 3450. Each of first belt 3420, second belt 3430, third belt 3440, and fourth belt 3450 extends from its respective distal portion out of wrist assembly 3500, through shaft 3410, and into actuator assembly 3700.

[0088] like Figure 9-11As shown, actuator assembly 3700 (which can serve as a transmission assembly) generates movement of first and second bands 3420, 3430 (collectively, the first set of bands) and / or generates movement of third and fourth bands 3440, 3450 (collectively, the second set of bands). In this way, the different combinations of movement of the bands operate to produce the desired articulation motion (pitch, yaw, or clamp) at wrist assembly 3500. Thus, as described herein, actuator assembly 3700 includes components and controls in each set of bands for moving one band proximally (i.e., pulling in a particular band) while allowing the other bands to move distally (i.e., releasing or "unclamping") the other bands. Actuator assembly 3700 can also move two bands in the first or second set of bands in the same direction. In this way, actuator assembly 3700 can generate the desired torque via the bands to produce the desired motion at wrist assembly 3500. Furthermore, in some embodiments, actuator assembly 3700 can ensure that the length of the strap is conserved (ie, moves an equal amount) throughout the range of motion of wrist assembly 3500 .

[0089] Specifically, the actuator assembly 3700 includes a housing 3760, a first actuator 3800, a second actuator 3820, a third actuator 3840, and a fourth actuator 3860. The housing 3760 (which serves as a chassis) provides structural support for mounting and aligning the components of the actuator assembly 3700. For example, the housing 3760 may define openings, protrusions, and / or brackets for mounting shafts or other components. The first actuator 3800 is mounted to the actuator assembly 3700 via a first actuator support member 3801, the second actuator 3820 is mounted to the actuator assembly 3700 via a second actuator support member 3821, the third actuator 3840 is mounted to the actuator assembly 3700 via a third actuator support member 3841, and the fourth actuator 3860 is mounted to the actuator assembly 3700 via a fourth actuator support member 3861. As described herein, support members 3801 , 3821 , 3841 , 3861 can be any suitable support structure that secures the support member to the actuator assembly 3700 while enabling the corresponding actuator to transfer rotational and / or linear motion to one or more attached straps.

[0090] like Figure 9As shown, a proximal portion 3421 of a first strap 3420 is attached to a first actuator 3800 at a first location, and a proximal portion 3431 of a second strap 3430 is attached to the first actuator 3800 at a second location different from the first location. Both the proximal portion 3421 and the proximal portion 3431 can be attached to the first actuator 3800 via one or more fasteners as described herein. A proximal portion 3441 of a third strap 3440 is attached to a third actuator 3840 at a first location, and a proximal portion 3451 of a fourth strap 3450 is attached to the third actuator 3840 at a second location different from the first location. Both the proximal portion 3421 and the proximal portion 3431 can be attached to the third actuator 3840 via one or more fasteners as described herein.

[0091] The operation of the first actuator 3800 coupled to the first and second straps 3420 and 3430 is similar to the operation of the first actuator 2800 coupled to the first and second straps 2420 and 2430, as described above with reference to FIG. Figure 5 and Figure 6 For example, the movement of the first actuator 3800 about the first actuator axis A3 in the direction of arrow AA pushes the first belt 3420 to move in the direction of arrow BB and pushes the second belt 3430 to move in the direction of arrow CC, as shown in FIG. Figure 9 As shown. The movement of the first belt 3420 and the second belt 3430 in turn pushes the first pulley portion 3467 and the first tool member 3462 to rotate relative to the wrist assembly 3500 in the direction of arrow KK about the second rotation axis A2. Conversely, the rotation of the first actuator 3800 in the direction opposite to the arrow AA pushes the first pulley portion 3467 and the first tool member 3462 in the direction opposite to the arrow AA. Figure 9 Rotate in the opposite direction of the arrow KK.

[0092] The operation of the third actuator 3840 coupled to the third belt 3440 and the fourth belt 3450 is similar to the operation of the first actuator 3800 on the first belt 3420 and the second belt 3430. For example, the movement of the third actuator 3840 about the third actuator axis A4 in the direction of arrow EE pushes the second pulley portion 3477 and the second tool member 3472 to rotate about the second rotation axis A2 relative to the wrist assembly 3500 in the direction of arrow KK. Conversely, the rotation of the third actuator 3840 in the direction opposite to arrow EE pushes the second pulley portion 3477 and the second tool member 3472 in the direction opposite to arrow EE. Figure 9 Rotate in the opposite direction of arrow KK.

[0093] In one operating state, both the first actuator 3800 and the third actuator 3840 can be operated to actuate together (i.e., for the first actuator 3800 and the third actuator 3840, actuate together in the directions of arrows AA and arrows EE, respectively, or actuate together in the directions opposite to the arrows), thereby pushing the first pulley portion 3467 and the second pulley portion 3477 to rotate together in the direction of arrow KK, or rotate together in the direction opposite to arrow KK, thereby achieving control of the first tool member 3462 and the second tool member 3472 around the second rotation axis A2 (e.g., yaw). In another operating state, both the first actuator 3800 and the third actuator 3840 can be operated to be actuated in opposite directions (i.e., in the direction of arrow AA for the first actuator 3800 and in the direction opposite to arrow EE for the third actuator 3840), thereby forcing the first pulley portion 3467 and the second pulley portion 3477 to rotate in opposite directions about the second rotation axis A2 so as to move the first tool member 3462 and the second tool member 3472 closer together or apart, thereby achieving a second DOF about the second rotation axis A2 (e.g., clamping). In yet another operating state, one of the first actuator 3800 or the third actuator 3840 is actuated (i.e., in the direction of arrow AA for the first actuator 3800 or in the direction opposite to arrow EE for the third actuator 3840) while the other of the first tool member 3462 or the second tool member 3472 remains stationary. In this state, the tool member associated with the stationary actuator can remain in a fixed position while the other tool member associated with the movable actuator moves toward the fixed tool member, which may be beneficial for certain procedures requiring continuous contact or support of the target tissue prior to grasping, shearing, or cauterizing with both tool members. In view of this disclosure, other combinations of simultaneous yaw and clamp actuation via control of one or both of the first actuator 3800 or the third actuator 3840 will be apparent to those skilled in the art.

[0094] Reference Figure 9 and Figure 10 , the second actuator 3820 includes a guide structure 3822 having a first guide surface 3823 and a second guide surface 3824. The first guide surface 3823 and the second guide surface 3824 can be spaced apart from each other in the longitudinal direction relative to the central axis of the second actuator 3820. The first guide surface 3823 contacts the proximal portion 3421 of the first belt 3420. The second guide surface 3824 contacts the proximal portion 3431 of the second belt 3430. In some embodiments, when the second actuator 3820 is moved along the Figure 10When the first belt 3420 is actuated and moved in the direction of the arrow DD shown, the proximal portion 3421 of the first belt 3420 can be spaced apart from the first guide surface 3823, and the proximal portion 3431 of the second belt 3430 can be spaced apart from the second guide surface 3824. The operation of the second actuator 3820 on the first belt 3420 and the second belt 3430 is similar to the operation of the second actuator 2820 on the first belt 2420 and the second belt 2430. For example, the second actuator 3820 is a linear actuator that can be operated to generate linear motion in the direction shown by the arrow DD. For the first belt 3420 and the second belt 3430, the travel direction of the second actuator 3820 is the same as that of the second actuator 2820. Figure 9 The directions of travel indicated by arrows BB and CC are non-parallel (ie, include components of travel perpendicular to arrows BB and CC). In other embodiments, the second actuator 3820 includes a lever or cam operable to produce linear motion in the direction of arrow DD.

[0095] When the second actuator 3820 moves in the direction of arrow DD, as shown in FIG. Figure 10 As shown, the lengths of both the first and second belts 3420, 3430 outside of the actuator assembly 3700 are retracted. As the lengths are retracted, the distal portions 3422, 3432 of the first and second belts 3420, 3430 move in the direction of arrow CC. The movement of the distal portions 3422, 3432, in turn, exerts a force on the first pulley 3467 and urges the second link 3610 to rotate in the direction of arrow LL about the first rotation axis A1.

[0096] Reference Figure 9 and Figure 11 , the fourth actuator 3860 includes a guide structure 3862 having a first guide surface 3863 and a second guide surface 3864. The first guide surface 3863 and the second guide surface 3864 can be spaced apart from each other in the longitudinal direction relative to the central axis of the fourth actuator 3860. The first guide surface 3863 contacts the proximal portion 3441 of the third band 3440. The second guide surface 3864 contacts the proximal portion 3451 of the fourth band 3450. In some embodiments, when the fourth actuator 3860 is moved along the Figure 11When the third belt 3440 is actuated and moved in the direction of the arrow FF shown in the middle position before, the proximal portion 3441 of the third belt 3440 can be spaced apart from the first guide surface 3863, and the proximal portion 3451 of the fourth belt 3450 can be spaced apart from the second guide surface 3864. The operation of the fourth actuator 3860 on the third belt 3440 and the fourth belt 3450 is similar to the operation of the second actuator 3820 on the first belt 3420 and the second belt 3430. For example, the fourth actuator 3860 is a linear actuator that can be operated to generate linear motion in the direction shown by the arrow FF. For the third belt 3440 and the fourth belt 3450, the travel direction of the fourth actuator 3860 is the same as that of the second actuator 3820. Figure 9 The directions of travel indicated by arrows BB and CC are non-parallel (ie, include components of travel perpendicular to arrows BB and CC). In other embodiments, the fourth actuator 3860 includes a lever or cam operable to produce linear motion in the direction of arrow FF.

[0097] When the fourth actuator 3860 moves in the direction of arrow FF, as shown in FIG. Figure 11 As shown, the lengths of both the third and fourth belts 3440 and 3450 outside of the actuator assembly 3700 are retracted. As their lengths are retracted, the distal portions 3442 and 3452 of the third and fourth belts 3440 and 3450 move in the direction of arrow CC. The movement of the distal portions 3442 and 3452, in turn, exerts a force on the second pulley 3477 and pushes the second link 3610 to rotate about the first rotation axis A1 in a direction opposite to arrow LL. By alternating actuation between the second actuator 3820 and the fourth actuator 3860, the second link 3610 is operable to pivot back and forth (e.g., pitch, the term pitch being arbitrary) about the first rotation axis A1. Thus, the combination of at least four actuators (a first actuator 3800, a second actuator 3820, a third actuator 3840, and a fourth actuator 3860), a first set of straps (a first strap 3420 and a second strap 3430), and a second set of straps (a third strap 3440 and a fourth strap 3450) can be operated to provide at least 3 DOF (e.g., pitch, yaw, and grip) to the end effector 3460 and the wrist assembly 3500 of the instrument 3400.

[0098] Although the actuator assembly 3700 is shown as having the second actuator 3820 separate from the fourth actuator 3860, in other embodiments, the actuator assembly can include any suitable arrangement of actuators. For example, Figure 12-154 is a schematic diagram of various components of an instrument 4400 according to an embodiment. Instrument 4400 includes a wrist assembly 4500, a first belt 4420 (which serves as a first tension member), a second belt 4430 (which serves as a second tension member), a third belt 4440 (which serves as a third tension member), a fourth belt 4450 (which serves as a fourth tension member), an end effector 4460, and an actuator assembly 4700. End effector 4460 may include a first tool member 4462 coupled to a first pulley portion 4467 and a second tool member 4472 coupled to a second pulley portion 4477. Although illustrated as including first belt 4420, second belt 4430, third belt 4440, and fourth belt 4450, in other embodiments, other forms of tension members, as described herein, may be employed.

[0099] Wrist assembly 4500 (also referred to as a joint assembly) includes a first link 4510 and a second link 4610. First link 4510 has a proximal portion 4511 coupled to shaft 4410. Shaft 4410 can be any suitable elongated shaft, such as those described above with reference to shaft 2410. Second link 4610 has a proximal portion 4611 and a distal portion 4612. Proximal portion 4611 is rotatably coupled to first link 4510 to form wrist assembly 4500 having a first axis of rotation A1 (which serves as the pitch axis; the term pitch is arbitrary), about which second link 4610 rotates relative to first link 4510. Wrist assembly 4500 can include any suitable coupling mechanism shown and described herein. The distal end portion 4612 of the second link 4610 includes a connector 4680 that is coupled to the first pulley portion 4467 of the first tool member 4462 and the second pulley portion 4477 of the second tool member 4472. The first pulley portion 4467 and the second pulley portion 4477 are coupled to rotate independently or in unison about a second rotation axis A2 relative to the wrist assembly 4500. The second rotation axis A2 is non-parallel to the first rotation axis A1. Axis A2 serves not only as a yaw axis (the term yaw is arbitrary) when the first tool member 4462 and the second tool member 4472 rotate together, but also as a clamping axis when the first tool member 4462 and the second tool member 4472 rotate oppositely to each other. The connector 4680 can be any suitable connector for rotatably coupling the end effector 4460 to the wrist assembly 4500 as described herein.

[0100] The first tool member 4462 may include a contact portion 4464 and the second tool member 4472 may include a contact portion 4474. The contact portions 4464, 4474 are configured to engage or manipulate target tissue during a surgical procedure. For example, the contact portions 4464, 4474 may include an engagement surface that functions as a gripper, cutter, tissue manipulator, or the like. In other embodiments, the contact portions 4464, 4474 may be energized tool members for cauterization or electrosurgery. As described above, the first tool member 4462 and the second tool member 4472 are rotatably coupled to the second link 4610 such that the first tool member 4462 and the second tool member 4472 can rotate relative to the wrist assembly 4500 about the second rotation axis A2. In this manner, the contact portion 4464 of the first tool member 4462 can be actuated in the direction of arrow KK, and the contact portion 4474 of the second tool member 4472 can be actuated in the direction opposite to arrow KK to bring the contact portions 4464, 4474 closer together, thereby grasping, cutting, engaging, or manipulating target tissue during surgery. Conversely, the contact portion 4464 of the first tool member 4462 can be actuated in the direction opposite to arrow KK, and the contact portion 4474 of the second tool member 4472 can be actuated in the direction of arrow KK to separate the contact portions 4464, 4474 and release the target tissue.

[0101] like Figure 12 As shown, first pulley portion 4467 is coupled to distal portion 4422 of first belt 4420 and distal portion 4432 of second belt 4430. Second pulley portion 4477 is coupled to distal portion 4442 of third belt 4440 and distal portion 4452 of fourth belt 4450. Each of first belt 4420, second belt 4430, third belt 4440, and fourth belt 4450 extends from its respective distal portion out of wrist assembly 4300, through shaft 4410, and into actuator assembly 4700.

[0102] like Figure 13-15As shown, actuator assembly 4700 (which can function as a transmission assembly) generates motion of first and second bands 4420, 4430 (collectively, the first set of bands) and / or generates motion of third and fourth bands 4440, 4450 (collectively, the second set of bands). In this manner, the various combinations of band movements operate to produce the desired joint motion (pitch, yaw, or grip) at wrist assembly 4500. Thus, as described herein, actuator assembly 4700 includes components and controls within each set of bands for moving one band proximally (i.e., pulling in a particular band) while allowing the other bands to move distally (i.e., releasing or "unclamping"), in each set of bands. Actuator assembly 4700 can also move two bands in the first or second set of bands in the same direction. In this manner, actuator assembly 4700 can maintain a desired tension within the bands to produce the desired motion at wrist assembly 4500. Furthermore, in some embodiments, actuator assembly 4700 can ensure that the length of the strap is conserved (ie, moves an equal amount) throughout the range of motion of wrist assembly 4500.

[0103] Specifically, actuator assembly 4700 includes a housing 4760, a first actuator 4800, a second actuator 4820, and a third actuator 4840. Housing 4760 (serving as a chassis) provides structural support for mounting and aligning the components of actuator assembly 4700. First actuator 4800 is mounted to actuator assembly 4700 via a first actuator support member 4801, second actuator 4820 is mounted to actuator assembly 4700 via a second actuator support member 4821, and third actuator 4840 is mounted to actuator assembly 4700 via a third actuator support member 4841. As described herein, support members 4801, 4821, and 4841 can be any suitable support structure that secures the support members to actuator assembly 4700 and enables the respective actuators to transmit rotational and / or linear motion to one or more attached belts.

[0104] like Figure 13 As shown, a proximal portion 4421 of a first strap 4420 is attached to a first actuator 4800 at a first location, and a proximal portion 4431 of a second strap 4430 is attached to the first actuator 4800 at a second location different from the first location. Both proximal portions 4421, 4431 can be attached to the first actuator 4800 via one or more fasteners as described herein. A proximal portion 4441 of a third strap 4440 is attached to a third actuator 4840 at a first location, and a proximal portion 4451 of a fourth strap 4450 is attached to the third actuator 4840 at a second location different from the first location. Both proximal portions 4441, 4451 can be attached to the third actuator 4840 via one or more fasteners as described herein.

[0105] The operation of the first actuator 4800 coupled to the first and second straps 4420 and 4430 is similar to the operation of the first actuator 3800 coupled to the first and second straps 3420 and 3430 (as described above with reference to FIG. Figure 8 and Figure 9 similar to the description above Figure 5 and Figure 6 For example, the movement of the first actuator 4800 about the first actuator axis A3 in the direction of arrow AA pushes the first belt 4420 to move in the direction of arrow BB and pushes the second belt 4430 to move in the direction of arrow CC, as shown in FIG. Figure 13 As shown. The movement of the first belt 4420 and the second belt 4430 in turn pushes the first pulley portion 4467 and the first tool member 4462 to rotate relative to the wrist assembly 4500 in the direction of arrow KK about the second rotation axis A2. Conversely, the rotation of the first actuator 4800 in the direction opposite to the arrow AA pushes the first pulley portion 4467 and the first tool member 4462 in the direction opposite to the arrow AA. Figure 12 Rotate in the opposite direction of the arrow KK.

[0106] The operation of the third actuator 4840 coupled to the third and fourth straps 4440, 4450 is similar to the operation of the third actuator 3840 on the third and fourth straps 3440, 3450 (as described above with reference to FIG. Figure 8 and Figure 9 For example, the movement of the third actuator 4840 about the third actuator axis A4 in the direction of arrow EE pushes the second pulley portion 4477 and the second tool member 4472 to rotate about the second pulley portion 4477 and the second tool member 4472 relative to the wrist assembly 4500 in the direction of arrow KK about the second rotation axis A2. Conversely, the rotation of the third actuator 4840 in the direction opposite to arrow EE pushes the second pulley portion 4477 and the second tool member 4472 in the direction opposite to arrow EE. Figure 12 Rotate in the opposite direction of arrow KK.

[0107] Reference Figure 13-15 , the second actuator 4820 includes a guide structure 4822 having a first guide surface 4823, a second guide surface 4824, a third guide surface 4825, and a fourth guide surface 4826. The first guide surface 4823 contacts the proximal portion 4421 of the first band 4420. The second guide surface 4824 contacts the proximal portion 4431 of the second band 4430. The third guide surface 4825 contacts the proximal portion 4441 of the third band 4440. The fourth guide surface 4826 contacts the proximal portion 4451 of the fourth band 4450. In some embodiments, the second actuator 4820 is moved along the Figure 14 and Figure 15 When in the neutral position before being actuated in the direction of arrow FF or arrow GG, each of the first guide surface 4823, the second guide surface 4824, the third guide surface 4825, and the fourth guide surface 4826 can be spaced apart from its respective band. In some embodiments, the first guide surface 4823 and the second guide surface 4824 can be located on a first side of the guide structure 4822. The third guide surface 4825 and the fourth guide surface 4826 can be located on a second side of the guide structure 4822, opposite the first side. The first guide surface 4823 and the second guide surface 4824 can be spaced apart from each other in the longitudinal direction along the second actuator axis A5. The third guide surface 4825 and the fourth guide surface 4826 can be spaced apart from each other in the longitudinal direction along the second actuator axis A5.

[0108] In some embodiments, the second actuator 4820 can be a linearly actuated, second actuator support member 4821 mounted to move along the axis of the actuator. Figure 14 and Figure 15 The directions of arrows FF and GG are shown as translations. For the first belt 4420, the second belt 4430, the third belt 4440 and the fourth belt 4450, the directions of arrows FF and GG are not parallel to the direction of travel indicated by arrows BB and CC.

[0109] The second actuator support member 4821 can be mounted to the base of the actuator assembly 4700, or can be fixed to a track or guide of the actuator assembly 4700 so that the first guide surface 4823 and the second guide surface 4824 can move along the Figure 13 In some embodiments, the second actuator 4820 may have an intermediate position, such as Figure 13 As shown, the first guide surface 4823 and the second guide surface 4824 do not act on or contact any of the first strap 4420, the second strap 4430, the third strap 4440 or the fourth strap 4450.

[0110] In such Figure 14In the illustrated first active position of the second actuator 4820, the first guide surface 4823 and the second guide surface 4824 of the second actuator 4820 are urged in the direction of arrow FF, thereby pressing against the proximal portion 4421 of the first belt 4420 and the proximal portion 4431 of the second belt 4430, respectively. When the first guide surface 4823 presses against the proximal portion 4421 and the second guide surface 4824 presses against the proximal portion 4431, the lengths of the first and second belts 4420, 4430 outside the actuator assembly 4700 are retracted. As the lengths are retracted, the distal portions 4422 and 4432 of the first and second belts 4420, 4430 move in the direction of arrow CC. This movement of the distal portions 4422 and 4432, in turn, exerts a force on the first pulley portion 4467 and forces the second link 4610 to rotate in the direction of arrow LL about the first rotation axis A1.

[0111] In such Figure 15 In the second active position of the second actuator 4820, the third and fourth guide surfaces 4825, 4826 of the second actuator 4820 are urged in the direction of arrow GG, pressing against the proximal portion 4441 of the third and fourth straps 4440, 4451 of the fourth strap 4450. When the third guide surface 4825 presses against the proximal portion 4441 and the fourth guide surface 4826 presses against the proximal portion 4451, the length of the third and fourth straps 4440, 4450 outside the actuator assembly 4700 is retracted. As the length is retracted, the distal portions 4442, 4452 of the third and fourth straps 4440, 4450 move in the direction of arrow CC. This movement of the distal portions 4442, 4452, in turn, exerts a force on the second first pulley portion 4477 and forces the second link 4610 to rotate in the direction of arrow LL about the first rotation axis A1.

[0112] By alternating actuation between the first active position and the second active position of the second actuator 4820, the second link 4610 is operable to pivot back and forth (e.g., pitch, the term pitch being arbitrary) about the first rotation axis A1. Thus, the combination of the three actuators (the first actuator 4800, the second actuator 4820, and the third actuator 4840), the first set of straps (the first strap 4420 and the second strap 4430), and the second set of straps (the third strap 4440 and the fourth strap 4450) is operable to provide at least three DOFs (e.g., pitch, yaw, and grip) to the end effector 4460 and the wrist assembly 4500 of the instrument 4400.

[0113] Figure 16-315400 are various views of an instrument 5400 according to an embodiment. In some embodiments, the instrument 5400 or any component thereof is optionally part of a surgical assembly for performing minimally invasive surgery and may include a patient-side teleoperated manipulator unit, one or more kinematic linkages, one or more cannulas, or the like. For example, the instrument 5400 may be coupled to a MIRS system (e.g., see the aforementioned Figure 1-4 MIRS system 1000 described herein) and operable therewith. Instrument 5400 includes an actuator assembly 5700 (serving as a transmission or backend mechanism), a shaft 5410, a wrist assembly 5500, and an end effector 5460. Instrument 5400 also includes a first belt 5420, a second belt 5430, a third belt 5440, and a fourth belt 5450 coupling actuator assembly 5700 to wrist assembly 5500. Wrist assembly 5500 can be similar to any wrist assembly shown and described herein. End effector 5460 can include any suitable tool member and can be similar to any end effector described herein. For example, the end effector can include a first tool member 5462 and a second tool member 5472 forming a pair of grippers. First tool member 5462 can include a contact portion 5464 and a pulley portion 5467. Similarly, second tool member 5472 can include a contact portion 5474 and a pulley portion 5477.

[0114] The shaft 5410 can be any suitable elongated shaft that couples the wrist assembly 5500 to the actuator assembly 5700. Specifically, the shaft 5410 includes a proximal end 5411 coupled to the actuator assembly 5700 and a distal end 5412 coupled to the wrist assembly 5500 (e.g., a proximal link of the wrist assembly 5500, which is similar to the proximal or first links 2510, 3510, 4510 described above). The shaft 5410 defines an inner lumen 5413 (see FIG. Figure 30 ) or several channels through which the belt and other components (e.g., electrical wires, ground wires, etc.) can pass from the actuator assembly 5700 to the wrist assembly 5500. The instrument 5400 is configured so that movement of the belt can produce movement of the wrist assembly 5500 about the joint axis A. 11 rotation of the end effector 5460 about the rotation axis A1 (eg, similar to the rotation about the pitch axis A1 described above), 12 rotation of the tool member of the end effector 5460 about the axis A2 (also referred to as the yaw axis) (e.g., similar to the rotation about the axis A2 described above), 12 The pitch, yaw or grip of the instrument 5400 can be changed by manipulating the belts within the actuator assembly 5700.

[0115] The actuator assembly 5700 includes a base 5710 and a housing 5760, and the housing 5760 can be attached to the base 5710 via one or more fastening members. For example, as shown in FIG. 20 , the fastening member can be a combination of a pin 5761 and a mounting hole 5711, however, any suitable fastener can be used to secure the housing 5760 to the base 5710. In some embodiments, the base 5710 and the housing 5760 can partially or completely enclose the components disposed within the actuator assembly 5700. The base 5710 and the housing 5760 provide structural support for mounting and aligning the components of the actuator assembly 5700. For example, referring to Figure 30 , the base 5710 defines a shaft opening 5712, and the proximal end 5411 of the shaft 5410 is mounted in the shaft opening 5712. The base 5710 further defines one or more bearing surfaces or openings 5713, and the actuator is mounted in the bearing surface or opening 5713 and is rotatably supported in the bearing surface or opening 5713. In some embodiments, the housing 5760 includes one or more bearing surfaces or openings 5763 in which the actuator is mounted. The opening 5763 of the housing 5760 can be axially aligned with the opening 5713 of the base. Figure 26 and Figure 27 , the actuator assembly 5700 defines an assembly centerline CL that bisects the actuator assembly 5700 A Component centerline CL A Extending from the centerline of the shaft opening 5712 and the centerline of the opening 5713, the first mounting portion of the second actuator 5820 is mounted within the opening 5713 (as described below). Similarly stated, the assembly centerline CL A The center line of the shaft opening 5412 and the central rotation axis A of the second actuator 5820 14 As described in more detail herein, under certain operating conditions, the centerline of the belt and the assembly centerline CL A coincide with the centerline of the assembly, while in other operating conditions the centerline of the belt is slightly offset from (or not parallel to) the centerline CL of the assembly. A .

[0116] In addition to providing mounting support for the internal components of the actuator assembly 5700, the base 5710 may include external features (e.g., notches, clips, etc.) that interface with a docking port of a drive device (not shown). The drive device may be, for example, a handheld system or a computer-assisted teleoperated system that can receive and manipulate the instrument 5400 to perform various surgical procedures. The drive device may include one or more motors to drive the actuators of the actuator assembly 5700. In other embodiments, the drive device may be an assembly capable of receiving and manipulating the instrument 5400 to perform various surgical procedures.

[0117] Specifically, refer to Figure 18-24 The actuator assembly 5700 includes a first actuator 5800, a second actuator 5820, and a third actuator 5840. Each of the first actuator 5800, the second actuator 5820, and the third actuator 5840 is rotatably supported in a corresponding opening (e.g., the opening 5713 ( Figure 30 )) and within the corresponding opening 5763 of the housing 5760. Each of the first actuator 5800, the second actuator 5820, and the third actuator 5840 can be driven by a corresponding motor in the driving device. For example, the first actuator 5800 can be driven to rotate about the first actuator axis A 13 Rotationally, the second actuator 5820 can be driven to rotate about the second actuator axis A 14 (also referred to as the central rotation axis), and the third actuator 5840 can be driven to rotate about the third actuator axis A 15 Rotate.

[0118] like Figure 23-25b and Figure 30 As shown, the first actuator 5800 includes a shaft around which the first end 5421 of the first belt 5420 and the first end 5431 of the second belt 5430 are wound. In this manner, for example, the first belt 5420 extends tangentially from one side of the first actuator 5800 and the second belt 5430 extends tangentially from the other side of the first actuator 5800, as shown in FIG. Figure 24 The first ends of the first strap 5420 and the second strap 5430 are fixed to the first actuator 5800 via a fastener mechanism. Specifically, as shown in more detail in FIG. Figure 25a As shown, the first end portion 5421 of the first band 5420 includes a through hole 5424 for receiving the fastener 5900. The shaft of the first actuator 5800 may include a threaded mounting hole 5801. The fastener 5900 is inserted through the through hole 5424 and screwed into the threaded mounting hole 5801 to secure the first band 5420 to the first actuator 5800. A washer 5910 may optionally be inserted between the fastener 5900 and the first end portion 5421 to improve contact between the fastener 5900 and the first band 5420. In some embodiments, as Figure 25bAs shown, the shaft of the first actuator 5800 may include a hook portion 5801', and the first end portion 5421 may include a corresponding pocket or opening 5424' for receiving the hook portion 5801'. Although the first and second straps 5420, 5430 are shown as being coupled to the first actuator 5800 using mechanical fasteners, in other embodiments, any suitable mechanism for fastening the first and second straps 5420, 5430 to the first actuator 5800 (or fastening the third and fourth straps 5440, 5450 to the third actuator 5840) may be used. For example, in some embodiments, the straps may be coupled to their respective actuators via adhesive, via welding, or by having protrusions that form an interference fit with mating openings defined by the actuators.

[0119] The first belt 5420 and the second belt 5430 are coupled to the pulley portion 5467 to control the first tool member 5462. Specifically, the first belt 5420 and the second belt 5430 pass from the first actuator 5800 through the second actuator 5820 and travel over the guide member 5770 of the housing 5760. As described in more detail herein, the guide member 5770 changes the direction of the longitudinal centerline of the first belt 5420 and the second belt 5430 so that the central portion 5423 of the first belt 5420 and the central portion 5433 of the second belt 5430 are guided into the opening at the proximal end 5411 of the shaft 5410. Specifically, referring to Figure 30 , the longitudinal center line CL1 of the first belt 5420 and the longitudinal center line of the second belt 5430 (at Figure 30 The first and second straps 5420 and 5430 are each redirected by guide member 5770 by an angle of approximately 90 degrees, similar to that shown for first strap 5420. Although the amount of change in direction (or "bend") of the straps is shown as ninety degrees, in other embodiments, the guide members can redirect the longitudinal centerlines of first and second straps 5420, 5430 by any suitable bend angle, such as, for example, a bend angle between 45 and 135 degrees, a bend angle between 60 and 120 degrees, or a bend angle between 75 and 105 degrees.

[0120] The first and second straps 5420, 5430 extend substantially parallel to the longitudinal axis of the shaft 5410 from the proximal end 5411 through the lumen 5413 of the shaft 5410 to the distal end 5412. For example, the second end 5422 of the first strap 5420 and the second end 5432 of the second strap 5430 travel from the distal end 5412 of the shaft 5410 through the wrist assembly 5500 and attach to the pulley portion 5467 of the first tool member 5462, as shown. Figure 17 In this manner, the first actuator 5800 is operable to move about the first actuator axis A. 13 Rotate, thereby pushing the first belt 5420 and the second belt 5430 around the axis A 12Actuating the first tool member 5462 (similar to the motion transfer from the first belt 4420 and the second belt 4430 on the first tool member 4462 discussed above). For example, the first actuator 5800 is moved about the axis A. 13 Rotation in the direction of arrow AA pushes the first tool member 5462 about the axis A in the direction of arrow KK. 12 Rotate.

[0121] The third actuator 5840 includes a shaft around which a first end 5441 of the third belt 5440 and a first end 5451 of the fourth belt 5450 are wound. In this manner, for example, the third belt 5440 extends tangentially from one side of the third actuator 5840 and the fourth belt 5450 extends tangentially from the other side of the third actuator 5840, as shown in FIG. Figure 24 . The first ends of the third belt 5440 and the fourth belt 5450 are secured to the third actuator 5840 via a fastener mechanism, as shown and described above with respect to the connection of the first belt 5420 and the second belt 5430 to the first actuator 5800. The third belt 5440 and the fourth belt 5450 are coupled to the pulley portion 5477 to control the second tool member 5472. Specifically, the third belt 5440 and the fourth belt 5450 pass from the third actuator 5840 through the second actuator 5820 and travel over the guide member 5770 of the housing 5760. The guide member 5770 changes the direction of the longitudinal centerline of the third belt 5440 and the fourth belt 5450 so that the central portion 5443 of the third belt 5440 and the central portion 5453 of the fourth belt 5450 are guided into the opening at the proximal end 5411 of the shaft 5410. Specifically, referring to Figure 30 , the longitudinal center line CL3 of the third belt 5440 and the longitudinal center line of the fourth belt 5450 (at Figure 30 540) is redirected by guide member 5770 by an angle of approximately 90 degrees. Although the amount of change in direction (or "bend") of the straps is shown as ninety degrees, in other embodiments, the guide members can redirect the longitudinal centerlines of the third strap 5440 and the fourth strap 5450 by any suitable bend angle, such as, for example, a bend angle between 45 degrees and 135 degrees, a bend angle between 60 degrees and 120 degrees, or a bend angle between 75 degrees and 105 degrees.

[0122] The third belt 5440 and the fourth belt 5450 extend substantially parallel to the longitudinal axis of the shaft 5410 from the proximal end 5411 through the inner cavity 5413 to the distal end 5412. The second end 5442 of the third belt 5440 and the second end 5452 of the fourth belt 5450 pass through the wrist assembly 5500 from the distal end 5412 and are attached to the pulley portion 5477 of the second tool member 5472. In this manner, the third actuator 5840 is operable about the third actuator axis A. 15 Rotate, thereby pushing the third belt 5440 and the fourth belt 5450 around the axis A 12 Actuate the second tool member 5472 (similar to the motion transfer from the third belt 4440 and the fourth belt 4450 on the second tool member 4472). For example, the third actuator 5840 is moved about the axis A. 15 Rotation in the direction of arrow EE pushes the second tool member 5472 in the direction of arrow KK about the axis A 12 The first actuator 5800 and the third actuator 5840 can be actuated together so that the first tool member 5462 and the second tool member 5472 can rotate around the axis A. 12 The first and second tool members 5462, 5472 can be rotated together to control yaw, or rotated opposite each other to control clamping of the first and second tool members 5462, 5472. Thus, the first and third actuators 5800, 5840 and the two pairs of belts 5420, 5430, 5440, 5450 can be operated to control two degrees of freedom (i.e., clamping and yaw).

[0123] Reference Figure 19-24 and Figures 26-27 The second actuator 5820 (which serves as a length conservation member) includes a first mounting portion 5822, a second mounting portion 5823, a guide structure 5821, and a sector gear 5824. The first mounting portion 5822 is configured to be rotatably supported by one of the openings 5713 of the base 5710. The second mounting portion 5823 is configured to be rotatably supported by one of the openings 5763 of the housing. Both the first mounting portion 5822 and the second mounting portion 5823 are along the rotation center axis A of the second actuator 5820. 14 The second actuator 5820 can be driven via a driving device (not shown) to rotate about the central axis A relative to the base 5710 and the housing 5760. 14 Specifically, the sector gear 5824 of the second actuator 5820 meshes with the drive gear 5714, which in turn can be coupled to a motor of the drive device. In this way, the rotation of the drive gear 5714 drives the second actuator 5820 around the central rotation axis A. 14 Rotate.

[0124] The guide structure 5821 of the second actuator 5820 includes a first guide structure axis A 15 and the second guide structure axis A 16 , the second guide structure axis A 16 Parallel to the first guide structure axis A 15 The first guide structure axis A is spaced apart from the first guide structure axis A. 15 and the second guide structure axis A 16 Both are parallel to the central rotation axis A 14 However, in other embodiments, the first guide structure axis A 15 May not be parallel to the second guide structure axis A 16 , and the first guide structure axis A 15 and the second guide structure axis A 16 Can be rotated with the central axis A 14 The guide structure 5821 includes at least a first guide surface 5825, a second guide surface 5826, a third guide surface 5827 and a fourth guide surface 5828. The first guide surface 5825 and the second guide surface 5826 are along the first guide structure axis A. 15 The third guide surface 5827 and the fourth guide surface 5828 extend along the second guide structure axis A. 16 The first guide surface 5825 defines a first width and the second guide surface 5826 defines a second width, the first width and the second width being along the first guide structure axis A 15 The third guide surface 5827 defines a third width and the fourth guide surface 5828 defines a fourth width, the third width and the fourth width are along the second guide structure axis A. 16 spaced apart from each other.

[0125] The first guide surface 5825 and the third guide surface 5827 define a first belt opening 5831 therebetween. Similarly, the first belt opening 5831 is defined between the first guide surface 5825 and the third guide surface 5827. In use, the first end 5421 of the first belt 5420 can contact and slide along the first guide surface 5825 when passing through the first belt opening 5831 of the second actuator 5820, and the first end 5441 of the third belt 5440 can contact and slide along the third guide surface 5827 when passing through the first belt opening 5831 of the second actuator 5820. The second guide surface 5826 and the fourth guide surface 5828 define a second belt opening 5832 therebetween. Similarly, the second belt opening 5832 is defined between the second guide surface 5826 and the fourth guide surface 5828. In use, the first end 5431 of the second band 5430 can contact the second guide surface 5826 and slide along the second guide surface 5826 when it passes through the band opening 5832 of the second actuator 5820, and the first end 5451 of the fourth band 5450 can contact the fourth guide surface 5828 and slide along the fourth guide surface 5828 when it passes through the second band opening 5832 of the second actuator 5820.

[0126] In some embodiments, the first guide surface 5825 and the second guide surface 5826 may include a first guide structure axis A extending from the first guide structure axis A to the second guide structure axis A. 15 The third guide surface 5827 and the fourth guide surface 5828 may include a circular or curved surface defined by a radius extending from the second guide structure axis A. 16 By providing a rounded or curved surface, when the belts 5420, 5430, 5440, 5450 pass through the belt opening or are acted upon by the guide structure 5821 and the corresponding guide surface, the wear and friction surface of the belts 5420, 5430, 5440, 5450 can be reduced, thereby increasing the service life of the components. Although the first guide surface 5825 and the second guide surface 5826 are shown as being relative to the first guide structure axis A 15 The fixing surface of the third guide surface 5827 and the fourth guide surface 5828 are shown relative to the second guide structure axis A. 16 However, in some embodiments, one or more of the first guide surface 5825, the second guide surface 5826, the third guide surface 5827, and the fourth guide surface 5828 may be fixed relative to the first guide structure axis A. 15 Or the second guide structure axis A 16 For example, one or more of the first, second, third or fourth guide surfaces may be formed to be rotatable about the first guide structure axis A.15 Or the second guide structure axis A 16 A rotating pulley member is provided to further reduce friction of the belt passing through the second actuator 5820.

[0127] As shown in the figure, the guide structure 5821 includes a bridge portion 5829, and the bridge portion 5829 is connected to the first guide structure axis A. 15 and the second guide structure axis A 16 The bridge portion 5829 extends from a position between the first guide surface 5825 and the second guide surface 5826 to a position between the third guide surface 5827 and the fourth guide surface 5828. Thus, the bridge portion 5829 separates the first belt opening 5831 and the second belt opening 5832. In this manner, the bridge portion 5829 can maintain the spacing between the first guide surface 5825, the second guide surface 5826, the third guide surface 5827, and the fourth guide surface 5828 during operation of the second actuator 5820 and the belts 5420, 5430, 5440, 5450, and improve their rigidity and stability. In some embodiments, the first guide surface 5825, the second guide surface 5826, the third guide surface 5827, and the fourth guide surface 5828 can be integrally formed with the second actuator 5820. In some embodiments, the bridge portion 5829 can also be integrally formed with the second actuator 5820. In other embodiments, the second actuator 5820 need not include a bridge, and the first strap opening 5831 can be continuous with the second strap opening 5832. Similarly stated, in some embodiments, the second actuator 5820 defines a single opening through which all straps can move.

[0128] Reference Figure 19 、 Figures 21-24 and Figures 26-27 , the sector gear 5824 of the second actuator 5820 can be driven by the driving gear 5714 to rotate about the central rotation axis A in the direction of arrow HH 14 Rotation. Because the second guide structure axis A 16 Offset center rotation axis A 14 , so the third guide surface 5827 and the fourth guide surface 5828 are actuated generally in the direction of arrow JJ, for example Figure 27 In this way, the third guide surface 5827 and the fourth guide surface 5828 are aligned with the center line CL of the assembly. A The first guide surface 5825 and the second guide surface 5826 are moved laterally from one side to the other, thereby increasing the travel path of the third belt 5440 and the fourth belt 5450 to exit the actuator assembly 5700. At the same time, the first guide surface 5825 and the second guide surface 5826 are actuated generally in the direction of arrow JJ to move away from the assembly centerline CL. A5400 and the second strap 5430 are moved, thereby reducing the travel path of the first strap 5420 and the second strap 5430 as they exit the actuator assembly 5700. By increasing the travel path of the third strap 5440 and the fourth strap 5450 within the actuator assembly 5700 and reducing the travel path of the first strap 5420 and the second strap 5430, the length of the third strap 5440 and the fourth strap 5450 is effectively retracted from outside the actuator assembly 5700, while the length of the first strap 5420 and the second strap 5430 is released outside the actuator assembly 5700. In this way, the movement of the first strap 5420, the second strap 5430, the third strap 5440, and the fourth strap 5450 push the wrist assembly 5500 in the direction of arrow LL about the axis A. 11 Rotation to achieve a third degree of freedom (i.e., pitch, the term pitch being arbitrary). As will be understood by those skilled in the art, rotation of the second actuator 5820 in a direction opposite to arrow HH will have the effect of increasing the path of travel of the first and second straps 5420, 5430 while decreasing the path of travel of the third and fourth straps 5440, 5450, thereby urging the wrist assembly 5500 about axis A in a direction opposite to arrow LL. 11 Rotate.

[0129] Reference Figure 18-20 、 Figure 23-2428-31, the housing 5760 includes a guide member 5770 for redirecting and aligning the ribbons 5420, 5430, 5440, 5450 entering and exiting the actuator assembly 5700. In some embodiments, to achieve actuation in three degrees of freedom using only two pairs of ribbons 5420, 5430, 5440, 5450 as described above, the ribbons 5420, 5430, 5440, 5450 can be arranged to travel in a direction generally perpendicular to the longitudinal axis of the shaft 5410. Furthermore, to enable the ribbons' travel paths to be altered by the guide structure 5821 of the second actuator 5820, the ribbons 5420, 5430, 5440, 5450 can initially be spaced apart as they travel through the second actuator 5820. However, due to the space constraints of minimally invasive surgery and the required reduced instrument shaft diameter, it is advantageous to redirect the ribbons and guide them in a compact manner through the lumen 5413 of the shaft 5410. As described herein, the actuator assembly 5700 and the guide member 5770 facilitate redirecting the belts through the bend angle so that the longitudinal centerline of each belt (e.g., the longitudinal centerline CL1 of the first belt 5420) can travel into the lumen 5413 of the shaft. The actuator assembly 5700 and the guide member 5770 are also configured to position the belts to enter the shaft 5410 at a desired location. Specifically, the guide member 5770 is configured such that the curved portion of the first belt 5420 is positioned at a first height h1 above the opening into the lumen 5413 of the shaft 5410, and the curved portion of the second belt 5430 is positioned at a second height h2 above the opening into the lumen 5413 of the shaft 5410, wherein the second height h2 is different from the first height h1 (see, e.g., FIG. Figure 31 ). In addition, the guide member 5770 is configured so that the belts can be spaced apart around the longitudinal centerline of the shaft 5410. In this way, the first belt 5420, the second belt 5430, the third belt 5440, and the fourth belt 5450 can be advanced into desired positions within the shaft lumen 5413. Specifically, the belts can be positioned within a shaft channel that is spaced apart from the shaft centerline and at different radial or circumferential positions within the shaft channel. This arrangement can prevent frictional contact of adjacent belts and reduce the likelihood that the belts will become entangled with each other within the shaft 5410. Although the guide member 5770 is shown as performing each of these advancement (or redirection) functions, in other embodiments, the guide member may include structures and / or may perform only a subset of these functions.

[0130] Reference Figure 28The guide member 5770 includes a first guide element 5771, a second guide element 5772, a third guide element 5773, and a fourth guide element 5774. Each of the first guide element 5771, the second guide element 5772, the third guide element 5773, and the fourth guide element 5774 can be sized to accommodate at least the width of the corresponding belt passing through the guide member 5770. The first guide element 5771 can include a first support pin 5781 and one or more first bearings 5791 for guiding and redirecting the first belt 5420 between the actuator assembly 5700 and the shaft 5410. The second guide element 5772 can include a second support pin 5782 and one or more second bearings 5792 for guiding and redirecting the second belt 5430. The third guide element 5773 can include a third support pin 5783 and one or more third bearings 5793 for guiding and redirecting the third belt 5440. The fourth guide element 5774 may include a third support pin 5784 and one or more fourth bearings 5794 for guiding and redirecting the fourth belt 5450. Each of the pins may be fixedly or rotatably mounted to the housing 5760. For example, the pins 5781, 5782, 5783, 5784 may be secured to the housing via a friction fit, a removable cover member, and / or one or more fastening members. Each of the bearings 5791, 5792, 5793, 5794 is operable to rotate independently. For example, when the first actuator 5800 advances a length of the first belt 5420 while retracting a length of the second belt 5430, the bearing 5791 may be operable to rotate in the first direction while the bearing 5792 rotates in a second direction opposite the first direction.

[0131] The bearings can be any type of suitable bearing for the belts 5420, 5430, 5440, 5450 to partially wrap around so as to slide on or roll with the bearings. For example, the bearings can be one or more of a bushing, a ball bearing, a needle bearing, and the like. In some embodiments, the pin and bearing arrangement can be replaced with a fixed circular member having a smooth or friction-reducing surface for the belts 5420, 5430, 5440, 5450 to pass through the guide member 5770. For example, the fixed circular member can include a surface treated with polytetrafluoroethylene (PTFE) or other friction-reducing coating. In some embodiments, each of the guide members 5771, 5772, 5773, 5774 can include two or more bearings 5791, 5792, 5793, 5794 to provide an even distribution of support and facilitate rotational motion, particularly given the small size involved. For example, the first guide member 5771 may have four bearings 5791 and the second guide member 5772 may have two bearings 5792 , wherein the width of the first band 5420 is greater than the width of the second band 5430 .

[0132] like Figure 19 、 Figure 20 、 Figure 23 、 Figure 24 and Figure 30 As shown, each of the straps 5420, 5430, 5440, 5450 is generally disposed along the length of the housing 5760 (i.e., along the Figure 26 and Figure 27 The component centerline CL is shown A ) direction from the first actuator 5800 or the third actuator 5840 to the guide member 5770. When the belts 5420, 5430, 5440, 5450 pass through the guide structure 5821 of the second actuator 5820, the width of each of the belts 5420, 5430, 5440, 5450 is parallel to the central rotation axis A. 14 In some embodiments, the width of each of the belts 5420, 5430, 5440, 5450 is respectively oriented in the vertical direction relative to the central rotation axis A. 14 Spaced apart from each other. Similar statements, such as Figure 30 As shown, the longitudinal centerline of each belt is along the central rotation axis A 14 Similarly, each of the guide elements 5771, 5772, 5773, 5774 is offset from the longitudinal centerline of the other belts. 14 For example, the first guide element 5771 is a first axial distance from the proximal portion 5411 of the shaft 5410 (ie, along the centerline of the shaft 5410 ), and the second guide element 5772 is a second, different axial distance from the proximal portion 5411 of the shaft 5410 .

[0133] To reduce the amount of space that the belts 5420, 5430, 5440, 5450 occupy as they travel through the shaft 5410, the first, second, third, and fourth guide elements 5771, 5772, 5773, and 5774 are radially offset from one another relative to the central axis of the shaft. In this manner, the first, second, third, and fourth guide elements 5771, 5772, 5773, and 5774 perform a funneling function, bringing the belts 5420, 5430, 5440, 5450 closer together as they enter the shaft 5410 while maintaining sufficient spacing to avoid interference. Figure 19 、 Figure 30 and Figure 31As shown, the central rotational axes of each of the bearings 5791, 5792, 5793, and 5794 can be offset from one another in the direction of arrow SS, which is perpendicular to the central axis of the shaft 5410. For example, the bearing 5792 of the second guide element 5772 can be positioned radially farthest from the central axis of the shaft 5410. The bearing 5794 of the fourth guide element 5774 can be positioned second farthest and horizontally spaced a first offset distance d1 in the SS direction from the bearing 5793. The bearing 5791 of the first guide element 5771 can be positioned third farthest and horizontally spaced a second offset distance d2 in the SS direction from the bearing 5794. The bearing 5792 of the third guide element 5773 can be positioned radially closest to the central axis of the shaft 5410 and horizontally spaced a third offset distance d3 in the SS direction from the bearing 5791. In this manner, the belts 5430, 5450, 5420, and 5440 can be spaced apart by respective spacing distances s1, s2, and s3 in the SS direction. In some embodiments, the offset distances d1, d2, d3 can be selected so that the resulting spacing distances s1, s2, s3 are 0.5 to 3 times the thickness of each corresponding belt (or belt laminate forming the belt), as measured in the SS direction. In some embodiments, the central rotational axis of each of the bearings 5791, 5792, 5793, 5794 can be horizontally aligned in the SS direction, and the diameters of the bearings 5791, 5792, 5793, 5794 can vary to achieve the resulting spacing distances s1, s2, s3. For example, the diameter of the bearing 5792 can be larger than the diameter of the bearing 5791.

[0134] Refer again Figure 29 and Figure 30 , the first guide element 5771, the second guide element 5772, the third guide element 5773, and the fourth guide element 5774 are horizontally oriented along a plane parallel to the base 5710, and each of the strips 5420, 5430, 5440, 5450 is twisted approximately 90 degrees along its respective longitudinal centerline so that the width of the strip is redirected to be parallel to the base 5710 as they enter the guide member 5770. In this manner, the cross-sectional shape of each strip is in a first orientation to produce a rotation about a first axis (i.e., the central rotation axis A). 14 , first actuator axis A 13 and the second actuator axis A 15 ) and is in a second orientation to produce a low area moment of inertia about a second axis (i.e., the bending axis of the guiding element). This arrangement can allow a single belt to deform to maintain a desired flexibility about two or more different axes (e.g., about the central rotational axis A). 14 and bending axis are easily deformed).

[0135] like Figure 23 As shown, the first and second straps 5420, 5430 are twisted +90 degrees relative to their respective longitudinal centerlines, while the third and fourth straps 5440, 5450 are twisted -90 degrees relative to their respective longitudinal centerlines. In this manner, the straps 5420, 5430, 5440, 5450 are stacked relative to each other along the central axis of the shaft 5410, for example, as shown in FIG. Figure 30 and Figure 31 As shown. In some embodiments, the first and second straps 5420, 5430 are twisted -90 degrees relative to their respective longitudinal centerlines, while the third and fourth straps 5440, 5450 are twisted +90 degrees relative to their respective longitudinal centerlines. In some embodiments, the twist angle and twist rotation direction can be selected for each of the first, second, third, and fourth straps 5420, 5430, 5440, and 5450 to adjust the respective paths of the straps for further length conservation. Each of the straps 5420, 5430, 5440, and 5450 is guided over and around a respective bearing 5791, 5792, 5793, and 5794 to rotate approximately 90 degrees over and above the opening at the distal end 5412 of the shaft 5410. In other words, each of the bands 5420 , 5430 , 5440 , 5450 exits their respective bearings 5791 , 5792 , 5793 , 5794 , aligned with the lumen 5413 of the shaft 5410 and within the inner diameter of the shaft 5410 .

[0136] Figures 32-36 are various views of an apparatus 5400' according to an embodiment. Figure 18-20 The device 5400 shown, the device 5400 'can be connected to a MIRS system (e.g., see above Figure 1-4 1000) and operates with the MIRS system 1000 described above. The instrument 5400' includes an actuator assembly 5700' (which serves as a transmission or backend mechanism), the actuator assembly 5700' having a housing 5760' coupled to a base 5710'. The actuator assembly 5700' is operable to actuate the first belt 5420, the second belt 5430, the third belt 5440, the fourth belt 5450, and the wrist assembly 5500 in a manner similar to that described above. The actuator assembly 5700' includes a first actuator 5800', a second actuator 5820', and a third actuator 5840'. The first actuator 5800' is connected to the first belt 5420 and the second belt 5430 in the same manner as the above-mentioned first actuator 5800 and is operable to actuate the first belt 5420 and the second belt 5430, and the third actuator 5840' is connected to the third belt 5440 and the fourth belt 5450 in the same manner as the above-mentioned third actuator 5840 and is operable to actuate the third belt 5440 and the fourth belt 5450.

[0137] In some embodiments, the second actuator 5820' may include a guide structure 5821' having one or more curved surfaces to increase or decrease the travel paths of the first belt 5420, the second belt 5430, the third belt 5440, and the fourth belt 5450. Figure 32 and Figure 33 As shown, the belts 5420, 5430, 5440, 5450 can travel around the guide structure 5821'. Figures 34-36 , the guide structure 5821' of the second actuator 5820' can be aligned with the central rotation axis A 14 The cam guide surfaces 5825', 5826', 5827', 5828' are aligned and include a first cam guide surface 5825', a second cam guide surface 5826', a third cam guide surface 5827', and a fourth cam guide surface 5828'. Each of the cam guide surfaces 5825', 5826', 5827', 5828' is operable to press against the belts 5420, 5430, 5440, 5450, respectively, in a direction that is not parallel to the centerline of the belts 5420, 5430, 5440, 5450. The amount by which each of the cam guide surfaces 5825', 5826', 5827', 5828' presses against each respective belt 5420, 5430, 5440, 5450 can be determined by measuring the amount of the cam guide surface 5825', 5826', 5827', 5828' pressing against each respective belt 5420, 5430, 5440, 5450 about the centerline A 14 Rotating the second actuator 5820' changes the amount of deflection in the belts 5420, 5430, 5440, 5450 due to compression of the respective cam surfaces 5825', 5826', 5827', 5828', in turn increases or decreases the path of travel of the belts 5420, 5430, 5440, 5450 within the actuator assembly 5700'.

[0138] like Figure 34 and Figure 36 As shown, each of the cam guide surfaces 5825', 5826', 5827', 5828' may have a central rotation axis A perpendicular to and relative to the second actuator 5820'. 14 For example, the third cam guide surface 5827' may have an eccentric profile with respect to the central rotation axis A. 14 Outer contours spaced at variable distances. Figure 35 and Figure 36 As shown, the first portion 5827a' of the third cam guide surface 5827' can be aligned with the central rotation axis A 14Separated by the first radial distance r1, the second portion 5827b' of the third cam guide surface 5827' may be separated by a second radial distance r2, and the third portion 5827c' of the third cam guide surface 5827' may be separated by a third radial distance r3. The third radial distance r3 is greater than the second radial distance r2, and the second radial distance r2 is greater than the first radial distance r1. For example, if the third band 5440 first contacts the third cam guide surface 5827' at the second portion 5827b', it can be rotated clockwise in the direction opposite to the arrow HH. Figure 36 The second actuator 5820' causes the third portion 5827c' to approach the contact point between the second actuator 5820' and the third belt 5440, thereby further displacing the third belt 5440 (thereby increasing the travel path). Conversely, the third belt 5440 can be further displaced by rotating counterclockwise in the direction of arrow HH. Figure 36 The second actuator 5820' causes the first portion 5827a' to approach the contact point between the second actuator 5820' and the third belt 5440, thereby reducing the displacement of the third belt 5440 (thereby reducing the travel path). In some embodiments, the entirety of one or more of the cam guide surfaces 5825', 5826', 5827', 5828' can be offset from the axis A. 14 , so that axis A 14 Does not intersect any area defined by one or more of the guide surfaces 5825', 5826', 5827', 5828'.

[0139] Once the belts 5420, 5430, 5440, 5450 have passed around the second actuator 5820', the belts 5420, 5430, 5440, 5450 can be moved in the same manner as described above with reference to Figure 18-20 、 Figure 23-24 and Figure 28-31 The guide member 5770 described above travels through the guide member 5770' of the housing 5760' and through the shaft 5410. Each of the belts 5420, 5430, 5440, 5450 may also be positioned as described above with reference to FIG. Figure 23 、 Figure 29 and Figure 30 The various configurations described are twisted between the second actuator 5820' and the guide member 5770' along their respective longitudinal centerlines.

[0140] While various embodiments have been described above, it should be understood that they are presented by way of example only and not limitation. Where the above methods and / or schematics indicate certain events and / or process patterns occurring in a certain order, the ordering of certain events and / or operations may be modified. While embodiments have been specifically shown and described, it should be understood that various changes in form and detail may be made.

[0141] For example, any instrument described herein (and components thereof) is optionally part of a surgical assembly for performing minimally invasive surgery, and may include a manipulator unit, a series of kinematic linkages, a series of cannulas, or the like. Thus, any instrument described herein may be used in any suitable surgical system, such as the MIRS system 1000 shown and described above. In addition, any instrument shown and described herein may be used to manipulate target tissue during a surgical procedure. Such target tissue may be a cancer cell, a tumor cell, a lesion, a vascular occlusion, a thrombosis, a stone, a uterine fibroid, a bone metastasis, adenomyosis, or any other body tissue. The examples of target tissues presented are not an exhaustive list. In addition, the target structure may also include an artificial substance (or non-tissue) within or associated with the body, such as, for example, a stent, a portion of an artificial tube, a fastener within the body, or the like.

[0142] For example, any tool member can be constructed from any material, such as medical-grade stainless steel, nickel alloys, titanium alloys, or the like. Furthermore, any connecting rod, tool member, tension member, or component described herein can be constructed from multiple pieces that are later joined together. For example, in some embodiments, a connecting rod can be constructed by joining together separately constructed components. However, in other embodiments, any connecting rod, tool member, tension member, or component described herein can be constructed as a single piece.

[0143] Although the instruments are generally shown as having a second axis of rotation A2 orthogonal to the first axis of rotation A1, in other embodiments, any instrument described herein can include a second axis of rotation A2 offset from the first axis of rotation A1 by any suitable angle.

[0144] Although the first belt 5420 is described as being separate from the second belt 5430, in some embodiments, the first belt 5420 and the second belt 5430 can be constructed integrally such that their respective distal ends are a single body wrapped around the pulley portion 5467 of the first tool member 5462.

[0145] Any belt described herein may have any suitable shape. For example, in some embodiments, the belt described herein may have a rectangular cross-sectional shape (taken in a cross-sectional plane orthogonal to the longitudinal centerline of the belt). In other embodiments, any belt described herein may have a trapezoidal shape or any other suitable cross-sectional shape. In addition, any belt described herein may be made of any suitable material. For example, in some embodiments, any belt described herein may be made of a series of laminates bonded together (e.g., via an adhesive). In other embodiments, the laminates may be joined by any other suitable method. The laminates may be made of any suitable material, including tungsten, steel, or any suitable polymer. Because the width of the belt provides a larger contact area than similar cables or wires, and therefore provides better load distribution, the surface that the belt contacts may be a fixed surface, a fixed surface with a surface coating that reduces friction, a rotatable surface (e.g., a pulley or bearing), or a rotatable surface with a surface coating that reduces friction. Additionally, any strap may be replaced with or used with other types of tension members, including but not limited to cables, wires, beams, rods, or a combination of one or more of straps, cables, wires, beams, or rods.

[0146] Although various embodiments have been described as having specific features and / or combinations of components, other embodiments are possible having any combination of features and / or components from any of the embodiments described above. Aspects have been described in the general context of medical devices, and more specifically surgical instruments, but inventive aspects are not necessarily limited to use in medical devices.

Claims

1. A device comprising: a shaft of the medical device, the shaft comprising a proximal end and a distal end; an end effector coupled to the distal end of the shaft; a housing coupled to the proximal end of the shaft; a first actuator rotatably supported in the housing; a second actuator rotatably supported in the housing; a first tension member comprising a first end and a second end, the first end of the first tension member being coupled to the first actuator, the second end of the first tension member being coupled to the end effector; a second tension member comprising a first end and a second end, the first end of the second tension member being coupled to the first actuator, the second end of the second tension member being coupled to the end effector, the first actuator being configured to move the first tension member in a first direction and the second tension member in a second direction opposite the first direction, thereby actuating the end effector in a first degree of freedom; The second actuator includes a first guide structure, the first guide structure including a first guide surface and a second guide surface, the first guide surface contacts the first end of the first tension member, the second guide surface contacts the first end of the second tension member; as well as Movement of the second actuator actuates both the first and second tension members in the first direction, thereby actuating the end effector in a second degree of freedom.

2. The device according to claim 1, wherein The first guide surface is a curved surface integrally constructed with the second actuator, and when the first actuator moves the first tension member, the first end portion of the first tension member slides along the first guide surface.

3. The device according to claim 2, wherein The second guide surface is a curved surface integrally configured with the second actuator, and when the first actuator moves the second tension member, the first end portion of the second tension member slides along the second guide surface.

4. The device according to claim 3, wherein: The first guide surface is curved about a guide structure axis of the second actuator, and the first guide surface is a first width of the second actuator extending along the guide structure axis; and The second guide surface is curved around the guide structure axis of the second actuator, and the second guide surface is a second width of the second actuator extending along the guide structure axis.

5. The device according to claim 4, wherein The first guide surface and the second guide surface are spaced apart from each other along the guide structure axis.

6. The apparatus according to claim 1, further comprising: a third actuator rotatably supported in the housing; a third tension member comprising a first end and a second end; a fourth tension member comprising a first end and a second end; The end effector includes a first jaw member and a second jaw member; the second end portion of the first tension member and the second end portion of the second tension member being coupled to the first jaw member of the end effector; The first end of the third tension member is coupled to the third actuator, and the second end of the third tension member is coupled to the second jaw member of the end effector; The first end of the fourth tension member is coupled to the third actuator, and the second end of the fourth tension member is coupled to the second jaw member of the end effector; Movement of the third actuator actuates the third tension member in the first direction and the fourth tension member in the second direction, thereby actuating the second jaw member of the end effector; the second actuator including a second guide structure including a third guide surface and a fourth guide surface, the third guide surface being in contact with the first end of the third tension member, the fourth guide surface being in contact with the first end of the fourth tension member; as well as Movement of the second actuator actuates the third and fourth tension members in the second direction, thereby actuating the end effector in the second degree of freedom.

7. The device according to claim 6, wherein: the second actuator defining a central rotational axis, a first guide structure axis parallel to the central rotational axis, and a second guide structure axis parallel to the central rotational axis; The first guide surface is curved about the first guide structure axis of the second actuator, and the first guide surface is a first width of the second actuator extending along the first guide structure axis; The second guide surface is curved about the first guide structure axis of the second actuator, and the second guide surface is a second width of the second actuator extending along the first guide structure axis; The third guide surface is curved about the second guide structure axis of the second actuator, and the third guide surface is a third width of the second actuator extending along the second guide structure axis; and The fourth guide surface is curved around the second guide structure axis of the second actuator, and the fourth guide surface is a fourth width of the second actuator extending along the second guide structure axis.

8. The apparatus according to claim 7, wherein: The first guide surface and the second guide surface are spaced apart from each other along the first guide structure axis; and The third guide surface and the fourth guide surface are spaced apart from each other along the second guide structure axis.

9. The device according to claim 6, wherein The second actuator includes a bridge portion extending from a first position between the first guide surface and the second guide surface to a second position between the third guide surface and the fourth guide surface.

10. The apparatus according to claim 6, wherein: The second actuator includes a base portion having an axis of rotation; The first guide surface is a first width of the second actuator parallel to the rotation axis; The second guide surface is a second width of the second actuator parallel to the rotation axis; The third guide surface is a third width of the second actuator parallel to the rotation axis; The fourth guide surface is a fourth width of the second actuator parallel to the rotation axis; and The first width, the second width, the third width, and the fourth width are spaced apart from each other.

11. The apparatus according to claim 1 , further comprising: a drive gear rotatably supported in the housing; and The second actuator includes a sector gear for transmitting motion from the drive gear to the second actuator.

12. The apparatus according to claim 1, wherein: The apparatus further includes a guide member coupled to the housing, the guide member including a first guide slot and a second guide slot; the shaft of the medical device defining a lumen extending along a central axis of the shaft from the proximal end of the shaft to the distal end of the shaft; at least a portion of the guide member extending over the lumen at the proximal end of the shaft; a central portion of the first tension member traveling within the first guide slot and into the inner cavity of the shaft; a central portion of the second tension member traveling within the second guide groove and into the inner cavity of the shaft; and The first guide slot is a first distance from the proximal end of the shaft along the central axis, the second guide slot is a second distance from the proximal end of the shaft along the central axis, and the first distance is different from the second distance.

13. The device according to claim 1, wherein A surface of the first actuator includes a hook portion, and the first end portion of the first tension member is coupled to the first actuator via the hook portion.

14. The device according to claim 6, wherein Simultaneous movement of both the first actuator and the third actuator actuates the end effector with a third degree of motion, the first actuator moving the first tension member in the first direction and the second tension member in the second direction, and the third actuator moving the third tension member in the first direction and the second tension member in the second direction.

15. The device according to any one of claims 1 to 14, wherein: The first tension member comprises a first strap; and The second tension member includes a second strap.

16. The device according to any one of claims 6 to 10 or 14, wherein The third tension member comprises a third strap; and The fourth tension member includes a fourth strap.

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