Endoscopic surgical robot

Abstract

The present invention discloses a surgical robot, particularly an irrigation and aspiration circulation system for a medical device operating within a patient's body organ, and also provides methods of using the same.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application claims priority to and the benefit of U.S. Provisional Application No. 62 / 967,176, filed on January 29, 2020, which is incorporated herein by reference in its entirety. Technical Field

[0003] The present disclosure relates generally to surgical robotics and, more particularly, to irrigation and aspiration pump systems for medical devices within a patient's body organs. Background Art

[0004] Kidney stones are a common disease that affects men and women of all ages. The incidence of kidney stones increases by about 10% per year worldwide. The probability of stone formation is 20.1% in Saudi Arabia and 13% in the United States. The recurrence rate of kidney stones within 10 years can reach 80% to 90%. Percutaneous nephrolithotomy (PCNL) is the preferred technique for surgical treatment of large kidney stones or stones that are resistant to other treatment methods. PCNL can also replace retrograde intrarenal surgery (RIRS) for stones between 10mm and 20mm, as a single operation can achieve better stone clearance rates. PCNL is also the main choice for the treatment of proximal ureteral impacted stones and symptomatic calyceal diverticulum stones.

[0005] Percutaneous nephrolithotomy (PCNL) is a medical procedure that allows doctors to remove patients' kidney or ureteral stones that are too large (over 20mm) or too complex for other forms of stone treatment, such as shock wave lithotripsy or ureteroscopy. Kidney stones form in the urinary tract due to crystallization of chemicals in the urine, and PCNL is the standard procedure for large, complex kidney stones. During the medical procedure, a small 1cm incision is made in the patient's flank area, and a sheath is placed through the incision into the kidney under X-ray or ultrasound guidance. A small telescope called a percutaneous nephroscope is then passed through the sheath, and the doctor holds the telescope throughout the operation in order to view the stone, break it up, and remove it from the body. If necessary, a laser or other device called a lithotripter may be used to break up the stone, which can then be removed. During the medical procedure, the patient is usually anesthetized in a prone or supine position.

[0006] Conventional PCNL procedures typically include a high-pressure irrigation method that allows an irrigation fluid to flush stones or stone fragments out of the patient's body and maintain adequate visual clarity for the physician performing the medical procedure. The pressure level of the irrigation fluid is pre-set by the physician using a pressure pump device. The irrigation fluid is pumped by the pressure pump device through the percutaneous nephroscope into the patient's kidney and then flows out of the patient's body through the space between the percutaneous nephroscope and the sheath to an open waste collector. Typically, 5% saline is used as the irrigation fluid.

[0007] In addition to the above methods, such as high-pressure irrigation methods, various mechanical devices can be used to assist in surgical procedures. For example, the development of various lithotripsy devices and the introduction of holmium lasers have improved the efficiency of lithotripsy and stone removal. During a PCNL medical procedure, a lithotripter or laser can be used to break up kidney stones and then remove them.

[0008] However, even when using existing methods (e.g., high-pressure irrigation methods) and using existing medical equipment (e.g., lithotripsy devices and holmium lasers), previous kidney stone removal techniques still have challenges. As an example, the high-pressure irrigation method cannot effectively manage the internal pressure of the patient's organs because it only pre-sets a constant pressure level outside the patient's body during the medical procedure without internal pressure measurement or control. PCNL is usually performed at high pressure to maintain the doctor's visual clarity, and the increase in renal pelvic pressure caused by the high-pressure irrigation method may spread infection through the renal pelvic venous reflux. In addition, stone fragments may get stuck between the percutaneous nephroscope and the sheath during the process of leaving the patient's body and hinder the outflow of the irrigation fluid during the medical procedure. As a result, the pressure level inside the patient's kidney increases dramatically. Due to the inability to measure or control the pressure inside the patient's kidney, complications such as postoperative bleeding, tissue damage, damage to nearby organs or structures, and urinary tract sepsis may occur, with a mortality rate of 20% to 42%. However, a decrease in pressure will hinder observation and increase bleeding. The doctor may have to stop the medical procedure, considering the patient's tolerance to high-pressure irrigation. As a result, the stone clearance rate is low, leading to the formation of kidney stones in patients after surgery.

[0009] Furthermore, the physician must hold the percutaneous nephroscope without resting throughout the PCNL procedure. Typically, the length of a PCNL procedure is three to four hours, and in extreme cases, when the patient has large or complex kidney stones, it may exceed five hours. As a result, the surgical risks (e.g., complications, bleeding, and organ damage) are high due to the long operation, the high pressure on the patient's organs, and the potential fatigue of the physician holding the percutaneous nephroscope.

[0010] Therefore, there is a need for improved techniques for pressure management within a patient's body during medical procedures, and there is a need for improved techniques for safer and more effective stone removal. Summary of the invention

[0011] In one aspect, the present invention provides an endoscopic surgical robot system, the system comprising:

[0012] an endoscope preselected based on a lesion requiring endoscopic surgery (e.g., location and size within an organ), wherein the endoscope includes a fluid inlet channel for flowing an irrigation fluid to the organ;

[0013] a sheath for guiding and containing an endoscope during endoscopic surgery;

[0014] an aspiration channel within the sheath for removing irrigation fluid from the organ;

[0015] a pressure measurement channel positioned along the sheath, configured to measure pressure within an organ at a proximal end thereof and connected to a pressure detector at a distal end thereof;

[0016] a pressure relief valve in fluid communication with the sheath, wherein once pressure reaches a threshold, the pressure relief valve opens to allow removal of irrigation fluid in the aspiration channel, thereby reducing pressure within the organ;

[0017] a first retaining member for retaining the sheath;

[0018] a second retaining member for retaining the endoscope, wherein the first retaining member and the second retaining member are designed to move coaxially to move the endoscope into and out of the sheath; and

[0019] A robotic arm is used to control movement of the sheath, wherein the robotic arm is connected to the first holder.

[0020] In certain embodiments, the endoscope is selected from a percutaneous nephroscope, a ureteroscope, a cystoscope, a urethroscope, a hysteroscope, an arthroscopy, a spinal endoscope, a laparoscope, a lacrimal endoscope, a nasopharyngeal endoscope, and / or an otoscope.

[0021] In certain embodiments, the endoscope may further include a pierceable cap, optionally a rubber cap, located at the distal end of the sheath, the endoscope being inserted into the sheath through the distal end.

[0022] In certain embodiments, the endoscope may further include an irrigation-aspiration pump for continuously pumping irrigation fluid to the organ and continuously removing the irrigation fluid.

[0023] In certain embodiments, the endoscope may further include an aspiration pump in fluid communication with the aspiration channel for pumping and removing irrigation fluid from the organ.

[0024] In certain embodiments, the pressure measurement channel is located inside the sheath.

[0025] In some embodiments, the pressure detector monitors pressure in real time and is optionally connected to an electrocardiograph.

[0026] In certain embodiments, the threshold is predetermined based on the flow rate of the lesion, organ, sheath and / or irrigation fluid, wherein optionally, the threshold is approximately 40 cmH2O.

[0027] In certain embodiments, the first retainer is configured to removably retain the sheath via a first latch, and / or the second retainer is configured to removably retain the endoscope via a second latch.

[0028] In certain embodiments, the endoscopic surgical robotic system may further include a holder rod for suspending the first holder and the second holder so that they can move back and forth along the holder rod, wherein optionally, the holder rod is connected to the robotic arm via a connector.

[0029] In certain embodiments, the robotic arm includes a multi-degree-of-freedom actuator and a multi-degree-of-freedom control system, wherein the endoscope is fixed to an output end of the multi-degree-of-freedom actuator, and wherein the tool center point is defined on the endoscope by the multi-degree-of-freedom control system.

[0030] In certain embodiments, the endoscopic surgical robotic system may further include a command console for controlling the robotic arm.

[0031] In some embodiments, the command console includes a 3D controller and a control host, wherein the size of the 3D controller matches the degrees of freedom of the tool center point, and wherein the control host associates size information from a multi-dimensional sensor of the 3D controller with degree of freedom information from the tool center point.

[0032] In certain embodiments, a 3D controller remotely controls the multi-degree-of-freedom actuator and the endoscope.

[0033] In certain embodiments, the tool center point is the entry point of the incision.

[0034] In some embodiments, when the endoscope reaches the patient, the control host begins to limit the endoscope to move only along its axial direction and rotate around the tool center point in pitch, roll and yaw movements within a preset range of the safety zone.

[0035] In certain embodiments, the command console includes a monitor module for displaying patient monitoring information such as electrocardiogram and blood pressure, intrarenal pressure values ​​and curves, endoscopic images, perfusion and aspiration parameters, laser parameters, X-ray images, etc.

[0036] In certain embodiments, the endoscopic surgical robotic system may further include a lithotripter for crushing stones within an organ.

[0037] The present invention also provides a method for performing a PCNL procedure, the method comprising using the endoscopic surgical robot system disclosed herein.

[0038] Another aspect relates to a method for performing a PCNL procedure, the method comprising:

[0039] The sheath is inserted through a pre-cut incision in the patient into the organ requiring endoscopic surgery, optionally under X-ray or ultrasound guidance;

[0040] placing an endoscope into the sheath, wherein the endoscope includes a fluid inlet channel for flowing an irrigation fluid to the organ, and wherein the sheath includes an aspiration channel therein for removing the irrigation fluid from the organ;

[0041] continuously pumping a flushing fluid into the fluid inlet channel via an irrigation pump;

[0042] continuously removing irrigation fluid from the organ through the aspiration channel via the aspiration pump; and

[0043] The real-time pressure within the organ is monitored via a pressure measurement channel positioned along the sheath, wherein the pressure measurement channel is configured to measure the pressure within the organ at its proximal end and is connected to a pressure detector at its distal end, wherein once the pressure reaches a threshold, a pressure relief valve in fluid communication with the sheath opens to allow removal of irrigation fluid in the suction channel, thereby reducing the pressure within the organ. BRIEF DESCRIPTION OF THE DRAWINGS

[0044] Figure 1A An exemplary surgical robotic system is shown according to one embodiment.

[0045] Figure 1B-1C shows a connection to Figure 1A Various perspective views of the robotic platform of the surgical robotic system shown in .

[0046] Figure 1D An endoscope is shown connected to the Figure 1A An example of a connector for a surgical robotic arm is shown.

[0047] Figure 2 An exemplary command console for a surgical robotic system is shown according to one embodiment.

[0048] Figure 3A A side view of an exemplary endoscope is shown according to one embodiment.

[0049] Figure 3B According to an embodiment Figure 3A Surgical operation view of the endoscope shown.

[0050] Figure 4A An exemplary PCNL system is shown according to one embodiment.

[0051] Figure 4B Shown with Figure 4A Top view of an exemplary endoscope for use in conjunction with the system.

[0052] Figure 4C Shown with Figure 4A Side view of an exemplary endoscope and sheath design associated with the system.

[0053] Reference will now be made in detail to several embodiments, examples of which are shown in the accompanying drawings. It should be noted that similar or identical reference numerals may be used in the accompanying drawings, where applicable, and may indicate similar or identical functions. The accompanying drawings depict embodiments of the described systems (or methods) for illustration only. Those skilled in the art will readily recognize from the following description that alternative embodiments of the structures and methods shown herein may be used without departing from the principles described herein. DETAILED DESCRIPTION

[0054] The methods and apparatus disclosed herein provide improved stone removal techniques by providing a robotic endoscopic system to help physicians control the movement of elongated medical instruments such as flexible or rigid medical instruments (e.g., percutaneous nephroscopes) within the patient's body organs. It should be noted that while the present disclosure uses PCNL, particularly kidney stone removal, as an example, as will be appreciated by one of ordinary skill in the art, the methods and systems disclosed herein can be readily applied to other medical procedures. Such other medical procedures include, but are not limited to, percutaneous nephroscopic examinations, ureteroscopy, cystoscopy, urethroscopy, hysteroscopy, arthroscopy, spinal endoscopy, laparoscopy, lacrimal endoscopy, nasopharyngeal endoscopy, and otoscopy.

[0055] As an example, the device is a robotic percutaneous nephroscopic tool for accurately and safely stabilizing a percutaneous nephroscopic device at a desired anatomical site during a PCNL procedure. The robotic percutaneous nephroscopic tool includes a robotic arm system, an endoscope connector connected to the robotic arm, a percutaneous nephroscopic device, a pressure management system, a command console, an energy source (e.g., a laser device), and necessary layout accessories. The robotic percutaneous nephroscopic tool is controlled by a doctor with a real-time 3D controller, and the robotic arm is accurately and intuitively operated to move the percutaneous nephroscopic device during the PCNL procedure. The robotic arm system includes a multi-degree-of-freedom robotic arm actuator and a robotic arm controller. The percutaneous nephroscopic device is fixed to the output end of the robotic arm actuator via an endoscope connector. The tool center point is defined on the percutaneous nephroscopic device by the robotic arm controller, and the size of the 3D controller matches the degree of freedom of the tool center point. The command console is used to associate the size information of the multidimensional sensor from the 3D controller with the degree of freedom information from the tool center point.

[0056] In some embodiments, the 3D controller remotely controls the multi-degree-of-freedom robotic arm and the percutaneous nephroscope. The robotic arm controller defines the entry point (i.e., the incision) as the tool center point. When the endoscopic device reaches the patient, the command console begins to limit the movement of the endoscopic device. During surgery, the command console only allows the endoscopic device to move in its axial direction and to pitch, roll, and yaw around the tool center point within a preset range called a safety zone. The host computer also includes a monitoring module for displaying images sent by an imaging sensor attached to the endoscopic device. The robotic endoscope system has great advantages in accurately and safely assisting the motion control of the endoscope during medical procedures. It allows doctors to operate more conveniently, more efficiently, and more safely. It is also easy to use because it is compatible with standard medical procedures. Exemplary robotic arm systems suitable for the present disclosure include Kuka LBR iiwa, Kuka LBR Med, Universal Robots UR5e, FrankaEmika Panda, Kinova Jaco, etc.

[0057] In addition, the methods and devices disclosed herein provide improved pressure management techniques by providing an improved pressure management system (e.g., irrigation and aspiration pump system) for medical devices such as flexible or rigid elongated medical devices (e.g., percutaneous nephroscopes) within an organ of a patient's body.

[0058] For example, the device is an irrigation fluid perfusion and suction pump system to flush stone fragments out of the patient's body and maintain sufficient visual clarity for surgical operations, while measuring and controlling the internal pressure of the patient's kidney during the PCNL procedure. The perfusion and suction pump system includes a pressure pump device, a pressure detector on the proximal end of the pressure measurement channel, a pressure reducing valve, and a waste collector. The pressure pump device perfuses the irrigation fluid into the patient's body, the pressure sensor and the pressure gauge measure and display the pressure inside the kidney, and the pressure reducing valve allows the irrigation fluid to be sucked out from the kidney to reduce the pressure inside the kidney when the threshold is reached. The threshold pressure can be changed and can be selected according to the patient, the state of the kidney (e.g., size, swelling, bleeding, number of stones), the size of the sheath, and the flow rate of the irrigation fluid. In some embodiments, the upper threshold can be about 40cmH2O, about 35cmH2O, about 30cmH2O, about 25cmH2O, or about 20cmH2O, or any number between the two, or higher or lower. In some embodiments, for the F24 sheath, the threshold can be about 17.2±5cmH2O. In some embodiments, the pressure inside the kidney is monitored in real time. In some embodiments, the monitoring can be achieved using an electrocardiogram (e.g., the pressure sensor can be connected to an electrocardiograph). The irrigation and aspiration pump system allows the physician to safely operate the procedure during the PCNL procedure by monitoring and managing the internal pressure of the patient's kidney in real time.

[0059] In certain embodiments, a small (e.g., 1 cm) incision is made in the lateral region of the patient, and the sheath is placed into the kidney through the incision. The percutaneous nephroscope is then passed through the sheath to observe the stone, break it down, and remove it from the body. Through the percutaneous nephroscope, the flushing fluid is pumped into the patient's kidney by a pressure pump device, and the stone fragments are pumped out of the patient's kidney together by an infusion and suction pump system. The flushing fluid can be an isotonic solution, optionally 5% saline. All waste fluids enter a waste collector.

[0060] In some embodiments, a pressure measurement channel is placed between the sheath and the percutaneous nephroscope. A pressure detector is connected by a pressure measurement catheter passing through the pressure measurement channel. The pressure detector includes a pressure sensor for collecting real-time internal pressure information, which is fixed to one end of the catheter inside the patient's kidney. The pressure detector that allows the doctor to read the internal pressure in real time is located outside the patient's body at the other end of the catheter. When the pressure reaches a threshold level pre-set by the doctor, a pressure relief valve can be used to reduce the internal pressure and aspirate the flushing fluid to the outside of the patient's body, which allows the doctor's vision to be clear and the operation to be safe. The system is easy to use and compatible with existing medical equipment and is suitable for PCNL procedures.

[0061] definition

[0062] For convenience, certain terms used in the specification, examples, and appended claims are collected here. Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs.

[0063] When used in conjunction with the term "comprising" in the claims and / or the specification, the word "a" or "an" may mean "one", but it is also consistent with the meaning of "one or more", "atleast one", "one or more than one".

[0064] In this application, the term "about" is used to indicate that a value includes the inherent error variation of the method / device used to determine the value, or the variation that exists between the subjects of study. Generally, the term refers to a variability of about or less than 1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%, 11%, 12%, 13%, 14%, 15%, 16%, 17%, 18%, 19% or 20%, depending on the situation.

[0065] Use of the term "or" in the claims is intended to mean "and / or" unless explicitly indicated referring to only alternatives or the alternatives are mutually exclusive, although the present disclosure supports a definition referring to only alternatives and "and / or."

[0066] As used in this specification and claims, the following terms: "comprising" (and any forms of "comprising" such as "including (general voice)" and "including (third person singular)"), "having" (and any forms of "having" such as "having (general voice)" and "having (third person singular)"), "including" (and any forms of "comprising" such as "including (third person singular)" and "including (general voice)"), or "comprising" (and any forms of "comprising" such as "including (third person singular)" and "comprising (general voice)") are inclusive or open-ended, and do not exclude additional unrecited elements or method steps. It is contemplated that any embodiment discussed in this specification can be implemented with respect to any method, system, host cell, expression vector and / or composition of the invention. In addition, the compositions, systems, host cells and / or vectors of the invention can be used to implement the methods and proteins of the invention.

[0067] As used herein, the term "consisting essentially of" refers to those elements required for a given embodiment. The term permits the presence of additional elements that do not materially affect the basic and novel or functional characteristics of the embodiment of the invention.

[0068] The term "consisting of" means that the compositions, methods, and corresponding components described herein do not include any elements not recited in the description of the embodiments.

[0069] The use of the term "for example" and its corresponding abbreviation "eg", whether italicized or not, means that the particular term is representative of examples and embodiments of the invention, and unless otherwise expressly stated, these examples and embodiments are not limited to the specific examples cited or referenced.

[0070] Surgical Robotic System

[0071] Figure 1A An exemplary surgical robotic system 100 is shown according to one embodiment. The surgical robotic system 100 includes a base 101 that is coupled to a robotic arm, such as a robotic arm 102. The base 101 is communicatively coupled to a command console, referred to below. Figure 2The base 101 is positioned so that the robotic arm 102 can perform a surgical procedure on a patient, while a user such as a physician can comfortably control the surgical robotic system 100 from a command console. Figure 1A 1, but the base 101 may include subsystems such as a power supply, etc. The robot arm 102 includes a plurality of arm links 110 coupled at joints 111, which provide the robot arm 102 with a plurality of degrees of freedom, for example, seven degrees of freedom corresponding to seven arm links. The robot arm controller 112 in the base 101 may also process and transmit control signals transmitted from the command console.

[0072] In some embodiments, the base 101 includes wheels 113 for transporting the surgical robotic system 100. During a procedure, a user can use a control device such as a command console to control the robotic arm 102. The mobility of the surgical robotic system 100 allows for efficient use of space in an operating room and allows the robotic arm 102 to not interfere with people or other equipment during a procedure.

[0073] The robotic arm 102 can be coupled to an endoscope 115 using a connector 114. The endoscope 115 can be removed and replaced with a different type of endoscope, such as a nephroscope or a hysteroscope. The connector 114 can be interchangeable based on the type of endoscope and can be customized for a particular type of surgical procedure. The robotic arm 102 can include joint level torque sensing.

[0074] Figure 1B-1C Various perspective views of a surgical robotic system 100 coupled to an operating bed 116 are shown according to various embodiments. Specifically, Figure 1B A side view of the surgical robotic system 100 is shown, with the robotic arm 102 manipulating an endoscope 115 to insert the endoscope into the body of a patient, with the patient lying on an operating table 116 . Figure 1C A top view of the surgical robotic system 100 and an operating table 116 is held in hand, and an endoscope 115 manipulated by a robotic arm is inserted into the patient's body.

[0075] Figure 1D An example of a connector 114 is handheld that couples to the robotic arm 102 to secure and move an endoscope (e.g., a percutaneous nephroscope) 115. The connector 114 includes a front screw 117 and a rear screw 118 for stabilizing the position of the percutaneous nephroscope 115. Figure 3A-3B The percutaneous nephroscope 115 is further described.

[0076] Command Console

[0077] Figure 2An exemplary command console 200 for a surgical robot system 100 according to one embodiment is shown. The command console 200 includes a console base 201, a display module 202 (e.g., a monitor), and a control module (e.g., a keyboard 203 and a 3D controller 204). A user 205, such as a doctor, uses the command console 200 to remotely control the surgical robot system 100 from an ergonomic position.

[0078] The console base 201 can interpret and process, for example, Figure 1A The console base 201 can also process commands and instructions provided by the user 205 through the control modules 203 and 204. Figure 2 In addition to the keyboard 203 and 3D controller 204 shown in FIG. 2 , the control module may also include other devices, such as a computer mouse and a control pad.

[0079] The user 205 can control surgical instruments such as the endoscope 115 using the command console 200 in speed mode. The tool center point is defined on the endoscope 115 by the robot arm controller, and the size of the 3D controller matches the degrees of freedom of the tool center point. In speed mode, the user 205 remotely controls the 6 degrees of freedom movement of the endoscope 115 based on direct manual control using the 3D controller 204. The 3D controller 204 can provide tactile feedback to the user. For example, the 3D controller 204 vibrates to indicate that the endoscope is contacting the boundary of the organ and must stop moving or rotating in the current direction. The command console can also use the patient's 3D image map to determine the safety zone. Once the operation exceeds the organ boundary or safety zone, the alarm system and automatic protection program will be triggered to warn or stop or correct the surgeon's operation, which will greatly optimize the accuracy of the surgeon's operation and improve the safety of the patient during surgery.

[0080] Specifically, the robot arm controller defines the entry point (i.e., the incision) as the tool center point. As the endoscope 115 approaches the patient, the command console begins to restrict the movement of the endoscope 115. During the procedure, the command console only allows the endoscope 115 to move along its axial orientation and to perform pitch, roll, and yaw movements around the tool center point within a pre-set range called a safety zone.

[0081] In certain embodiments, the user 205 can manually manipulate the robotic arm 102 of the surgical robotic system 100 without using the command console 200. During setup in the surgical operating room, the robotic arm 102 can be configured in a teach display mode. The user 205 can then move the robotic arm 102, endoscope 115, and other surgical equipment to access the patient. The surgical robotic system 100 can rely on force feedback and inertial control from the user 205 to determine the appropriate configuration of the robotic arm 102 and equipment. In particular, the user 205 can use the surgical robotic system 100 with this manual operation mode even during a procedure, which allows for greater flexibility and better safety control.

[0082] The display module 202 can display patient monitoring information, such as electrocardiogram and blood pressure, intrarenal pressure values ​​and curves, endoscopic images, perfusion and aspiration parameters, laser parameters, X-ray images, etc.

[0083] Endoscope

[0084] Depending on the medical procedure to be performed, various endoscopes can be adapted to the system described herein. A matching endoscope can be selected according to the location and size of the lesion inside the organ. For example, a percutaneous nephroscope, a ureteroscope, a cystoscope, a urethroscope, a hysteroscope, an arthroscope, a spinal endoscope, a laparoscope, a lacrimal endoscope, a nasopharyngeal endoscope, an otoscope, etc. can be used according to the organ, the lesion, etc. In various embodiments, the endoscope may include a fluid inlet channel, a light source, a light conductor (e.g., an optical fiber), and a prism.

[0085] Figure 3A A side view of an exemplary endoscope 115 according to one embodiment is shown. Endoscope 115 is an optical instrument that allows one to inspect the renal cavity system and perform various treatment procedures under direct visual control. Endoscope 115 can be used to remove stones, stone fragments, and small tumors up to about 1 cm. Endoscope 115 includes a sheath 308, an optical system, and a working channel 304.

[0086] The optical system includes a light port 301, a fiber optic inlet 302, and an eyepiece 303. The fiber optic light port 301 is combined with a working channel 304. During a medical procedure, a light source passes through the light port 301 and allows an optical fiber 305, which passes through the fiber optic inlet 302 and is located in the central axis 307 of the working channel 304, to collect real-time images within the patient's kidney. The real-time image can be visualized by a physician from the eyepiece 303. The optical system of the endoscope 115 ensures clear visibility to assist the physician in performing the medical procedure.

[0087] Working channel 304 allows the insertion of a wide range of rigid accessories necessary for the medical procedure, such as lithotripters or different working elements (stone forceps, extraction probes, etc.). The nephroscope tip 306 of working channel 304 will be inserted into the patient's kidney and allow the doctor to perform the medical procedure. Flushing fluid is used to maintain a clear field of vision and flush out stone fragments. The same axial channel also ensures the flow of flushing fluid from the inflow connection 307. The outflow of flushing fluid passes through the space between working channel 304 and sheath 308. Sheath 308 is further described below with reference to the pump system.

[0088] Figure 3B According to an embodiment Figure 3A 309 is a surgical procedure of an endoscope. During the medical procedure, a small (e.g., 1 cm) incision 309 is made in the lateral area of ​​the patient, and a sheath 308 is placed through the incision into the kidney under X-ray or ultrasound guidance. Then, an endoscope (i.e., a percutaneous nephroscope) 115 is passed through the sheath 308 and inserted into the patient's kidney 310 for the doctor to view the kidney stone 311. A medical device (e.g., a laser device) can break the stone into pieces.

[0089] Pump system

[0090] The system may be used to continuously pump irrigation fluid through the system. In certain embodiments, an irrigation aspiration pump may be included in the system to achieve continuous aspiration.

[0091] Figure 4A An exemplary PCNL system according to one embodiment is shown. Shown is an irrigation-suction system that allows irrigation fluid to remove kidney stones and maintains sufficient visual clarity for doctors to perform medical procedures with real-time pressure management. The irrigation-suction pump system includes an irrigation-suction pump 403, a pressure detector 414 with a pressure sensor inside, a sheath 405 with a suction channel 406, and a rubber cap 410 at the rear end of the sheath 405. A pressure measurement channel 407 runs along the sheath 405. The irrigation channel 406 is connected to the irrigation pump 436 through a connecting tube 427. The water inlet channel 416 of the endoscope 415 is connected to the irrigation pump 437 through a connecting tube 428. During operation, the endoscope 415 is inserted into the sheath 405 from the center of the rubber cap 410 at the rear end of the sheath 405. A pressure relief valve 433 that allows real-time pressure release is located on the sheath 405.

[0092] At the beginning of the PCNL procedure, the doctor turns on the perfusion suction pump 403. A small incision of 1 cm is made in the lateral area of ​​the patient, and the sheath 405 is placed in the kidney through the incision under X-ray or ultrasound guidance. The endoscope 415 is inserted into the sheath 405 from the center of the rubber cap 410 at the rear end of the sheath 405 to enter the kidney. The perfusion pump 437 pumps the flushing fluid 432 into the endoscope 415, and then pumps into the kidney. Then, the suction pump 436 pumps the flushing fluid 432 (containing the fragmented kidney stones) out of the patient's body through the space between the endoscope 415 and the sheath 405. Then, the flushing fluid 432 will flow into the suction channel 406 and flow into the waste collector 430.

[0093] The sheath 405 has an intrarenal pressure measurement channel 407. A pressure measurement catheter 413 is placed inside the pressure measurement channel 407. The distal end of the pressure measurement catheter 413 is located inside the kidney, and the proximal end of the pressure measurement catheter 413 is connected to an external pressure detector 414. The pressure level of the perfusion-suction pump 403 can be automatically adjusted by the command console 404, or manually adjusted by the doctor based on real-time pressure measurement results. When the sheath 405 is blocked and the pressure in the kidney exceeds the safe pressure range (which can be 15-40 cmH2O), the pressure relief valve 433 will release the pressure inside the kidney.

[0094] Figure 4B According to one embodiment, Figure 4A A top view of an exemplary endoscope used in conjunction with a system of FIG. 404. A sheath 405 allows endoscope 415 to be advanced into a patient's kidney. A pressure measurement channel 407 is located on one side of sheath 405 in the space between sheath 405 and endoscope 415.

[0095] Figure 4C According to one embodiment, Figure 4A 4. A side view of an exemplary endoscope and sheath design associated with a system of FIG. 102. The robotic arm 102 is connected to a retaining rod 424 via a connector 114. A distal retainer 411 of the retaining rod 424 is connected to the sheath 405 by a sheath latch 408. A proximal retainer 412 of the retaining rod 424 is connected to an endoscope 415 by an endoscope latch 409. During the procedure, the distal retainer 411 and the proximal retainer 412 move in a coaxial motion. The distal retainer 411 controls the depth and angle of the sheath 405 in the kidney, while the proximal retainer 412 controls the movement of the endoscope 415 back and forth within the sheath 405.

[0096] Variants

[0097] Without departing from the scope and spirit of the present disclosure, those skilled in the art will clearly see variations and changes in the methods and compositions of the present disclosure. Although the present disclosure has been described in conjunction with specific embodiments, it should be understood that the present disclosure as described in the claims should not be unduly limited to such specific embodiments. In fact, it is intended and understood by those skilled in the relevant art to which the present disclosure belongs that various variations of the described modes for carrying out the present disclosure are within the scope of the present disclosure represented by the following claims.

[0098] Join by reference

[0099] All publications, patents, and patent applications mentioned in this specification are herein incorporated by reference in their entirety to the same extent as if each independent patent and publication was specifically and individually indicated to be incorporated by reference.

Claims

1. An endoscopic surgical robot system, the system comprising: an endoscope preselected based on a lesion within the organ, wherein the endoscope includes a fluid inlet channel for flowing an irrigation fluid to the organ; a sheath for guiding the endoscope; an aspiration channel within the sheath for removing the irrigation fluid from the organ; a pressure measurement channel located along the sheath, configured to measure pressure within the organ, and connected to a pressure detector; a pressure relief valve in fluid communication with the sheath, wherein once the pressure reaches a threshold, the pressure relief valve opens to allow removal of the irrigation fluid in the aspiration channel, thereby reducing pressure within the organ; a first retaining member for retaining the sheath; a second retaining member for retaining the endoscope, wherein the first retaining member and the second retaining member are designed to move coaxially to move the endoscope into and out of the sheath; as well as A robotic arm is provided for controlling movement of the sheath, wherein the robotic arm is connected to the first holder.

2. The endoscopic surgical robot system according to claim 1, wherein: The endoscope is selected from a percutaneous nephroscope, a ureteroscope, a cystoscope, a urethroscope, a hysteroscope, an arthroscope, a spinal endoscope, a laparoscope, a lacrimal endoscope, a nasopharyngeal endoscope, and / or an otoscope.

3. The endoscopic surgical robot system according to claim 1 further includes a punctureable cap, optionally a rubber cap, located at the distal end of the sheath, and the endoscope is inserted into the sheath through the distal end. 4 . The endoscopic surgical robot system according to claim 1 , further comprising an irrigation-aspiration pump for continuously pumping the irrigation fluid into the organ and continuously removing the irrigation fluid.

5. The endoscopic surgical robot system according to claim 1 or 4, further comprising a suction pump connected to the suction channel fluid for pumping out and removing the irrigation fluid from the organ.

6. The endoscopic surgical robot system according to claim 1, wherein: The pressure measurement channel is located inside the sheath.

7. The endoscopic surgical robot system according to claim 1, wherein: The pressure detector monitors the pressure in real time and can optionally be connected to an electrocardiograph.

8. The endoscopic surgical robot system according to claim 1, wherein: The threshold value is predetermined based on the lesion, the organ, the sheath and / or the flow rate of the irrigation fluid.

9. The endoscopic surgical robot system according to claim 1, wherein: The first retainer is configured to removably retain the sheath via a first latch, and / or the second retainer is configured to removably retain the endoscope via a second latch.

10. The endoscopic surgical robot system according to claim 1 further includes a holder rod, which is used to suspend the first holder and the second holder so that they can move back and forth along the holder rod, wherein optionally, the holder rod is connected to the robot arm via a connector.

11. The endoscopic surgical robot system according to claim 1, wherein: The robotic arm comprises a multi-degree-of-freedom actuator and a multi-degree-of-freedom control system, wherein the endoscope is fixed to an output end of the multi-degree-of-freedom actuator, and wherein a tool center point is defined on the endoscope by the multi-degree-of-freedom control system.

12. The endoscopic surgical robot system according to claim 11, further comprising a command console for controlling the robot arm.

13. The endoscopic surgical robot system according to claim 12, wherein: The command console includes a 3D controller and a control host, wherein the size of the 3D controller matches the degree of freedom of the tool center point, wherein the control host associates size information from a multi-dimensional sensor of the 3D controller with degree of freedom information from the tool center point.

14. The endoscopic surgical robot system according to claim 13, wherein: The 3D controller remotely controls the multi-degree-of-freedom actuator and the endoscope.

15. The endoscopic surgical robot system according to claim 11, wherein: The tool center point is the entry point for the cut.

16. The endoscopic surgical robot system according to claim 13, wherein: When the endoscope reaches the patient, the control host begins to restrict the endoscope from moving along its axial direction and rotating around the tool center point in pitch, roll and yaw movements within a preset range of the safety zone.

17. The endoscopic surgical robot system according to claim 12, wherein: The command console includes a monitor module for displaying patient monitoring information.

18. The endoscopic surgical robot system according to claim 17, wherein: The patient monitoring information includes electrocardiogram and blood pressure, intrarenal pressure value and curve, endoscopic image, perfusion and aspiration parameters, laser parameters, and X-ray image.

19. The endoscopic surgical robot system according to claim 1, further comprising a lithotripter for crushing stones in the organ.

Images