Articulatable wrist with flexible members and pivot guides

Abstract

An articulatable wrist for an end effector includes a first link, a second link rotatably coupled to the first link at a first articulation joint, and a flexible member extending at least partially through a central passage cooperatively defined by the first link and the second link. A first pivot guide is rotatably coupled to the second link at the first articulation joint and is rotatable about a first pivot axis extending through the first articulation joint, the first pivot guide defining a central aperture alignable with the central passage and sized to accommodate the flexible member therethrough. The first pivot guide supports an outer diameter of the flexible member at the first articulation joint and prevents the flexible member from flexing beyond the first pivot axis during articulation.

Description

BACKGROUND

[0001] Minimally invasive surgical (MIS) instruments are often preferred over traditional open surgical devices since a smaller incision is made with reduced tissue trauma, less pain, and a shorter recovery time. Laparoscopic surgery is one type of MIS procedure in which one or more small incisions are formed in the abdomen and a trocar is inserted through the incision to form a pathway into the abdominal cavity. Through the trocar, a variety of instruments and surgical tools can be inserted and manipulated by the surgeon to achieve a diagnostic or therapeutic effect. Such tools can include a surgical end effector configured for engagement with tissue in the abdominal cavity.

[0002] Various robotic systems have recently been developed to assist in MIS procedures. Robotic systems can enable more intuitive hand motions by maintaining a natural hand-eye axis. Robotic systems can also enable a greater degree of freedom of motion by including an articulatable "wrist" joint that can form more natural hand-like articulation motions. In such systems, an end effector positioned at a distal end of an instrument can be articulated using a cable-driven motion system having one or more drive cables (or other elongate members) that extend through the wrist joint. A user (e.g., a surgeon) can remotely operate the end effector by grasping and manipulating one or more controllers in space, which are in communication with tool drivers coupled to the surgical instrument. User inputs are processed by a computer system incorporated into the robotic surgical system, and the tool drivers respond by actuating the cable-driven motion system and thereby actively controlling the tension balance in the drive cables. Moving the drive cables articulates the end effector into a desired angular position and configuration.

[0003] In articulating robotic tools, cables that actuate jaw opening, closing, and clamping are routed through the wrist and articulation joints to reach the end effector. To help route the cables through the positions of the pitch and yaw articulation joints of the wrist, the cables can be further routed through a flexible member that also extends through the wrist. This flexible member is often referred to as a "multi-lumen" because it defines multiple axially-extending cable pathways or conduits that house the various cables.

[0004] Cables running through the flexible members and articulation joints of the wrist are generally not constrained on the centerline axis at the articulation pivot. Thus, as the articulation joint angle moves away from the straight position during actuation, the cable path through the flexible member can sink above or below the pivot axis, depending on the stiffness of the flexible member and its ability to flex in response to clamping loads. As the cables tighten under tensile loads, such as when high closure forces are applied to the closure cables to "clamp" the jaws onto tissue, they will tend to find the shortest path through the articulation pivot, which can result in the cables sinking below the pivot axis. If the cables sink below the pivot axis, this can create an unbalanced moment that causes the jaws to move suddenly (i.e., plunge) in an unbalanced direction. This unexpected tip deflection or "tip plunge" is undesirable in surgical uses where the jaws are clamping critical structures. BRIEF DESCRIPTION OF DRAWINGS

[0005] The following drawings are included to illustrate certain aspects of the present disclosure, and should not be viewed as exclusive embodiments. The disclosed subject matter is capable of a multitude of modifications in form, function, composition of matter, and order of operation.

[0006] FIG. 1 is a block diagram of an exemplary robotic surgical system that can incorporate some or all of the principles of the present disclosure.

[0007] FIG. 2 is an isometric view of an exemplary surgical tool that can incorporate some or all of the principles of the present disclosure.

[0008] FIG. 3 shows the potential degrees of freedom in which the wrist of the surgical tool can articulate (pivot) or translate. FIG. 2

[0009] FIG. 4 is a close-up isometric view of the distal end of the surgical tool of FIG. 2

[0010] FIG. 5 is an isometric view of the end effector of FIG. 4 in an open position, according to one or more embodiments.

[0011] FIG. 6A and FIG. 6B are close-up isometric front and rear views of the wrist of FIG. 4 and FIG. 5 , respectively, according to one or more embodiments.

[0012] FIG. 7A and FIG. 7B are close-up isometric front and rear views of the wrist of FIG. 6A-6B ​​Isometric views and exploded views of the flexible components, as well as the distal and proximal adapters.

[0013] FIG. 8A It can be combined with one or more principles of this disclosure. FIG. 4 , FIG. 5 and FIG. 6A-6B A side view of an exemplary embodiment of the wrist.

[0014] FIG. 8B yes FIG. 8A An enlarged isometric view of one embodiment of the intermediate connecting rod.

[0015] FIG. 8C yes FIG. 8A An enlarged isometric view of the second pivoting guide.

[0016] FIG. 8D It is based on one or more implementation schemes. FIG. 8A A cross-sectional view of the wrist in an exemplary operation.

[0017] FIG. 9A It can be combined with one or more principles of this disclosure. FIG. 4 , FIG. 5 and FIG. 6A-6B An isometric side view of another exemplary embodiment of the wrist.

[0018] FIG. 9B yes FIG. 9A An enlarged isometric view of one embodiment of the intermediate connecting rod.

[0019] FIG. 9C yes FIG. 9A An enlarged isometric view of the second pivoting guide.

[0020] FIG. 10A It can be combined with one or more principles of this disclosure. FIG. 4 , FIG. 5 and FIG. 6A-6B An isometric side view of another exemplary embodiment of a portion of the wrist.

[0021] FIG. 10B yes FIG. 10A An enlarged isometric view of another embodiment of the intermediate link.

[0022] FIG. 10C and FIG. 10D They are FIG. 10A Enlarged isometric view and exploded view of the first pivoting guide.

[0023] FIG. 11A-11F Depicting according to one or more implementation schemes FIG. 10C-10D The first pivot guide and FIG. 10BAn exemplary assembly of the intermediate connecting rod.

[0024] FIG. 12A and FIG. 12B It is an alternative implementation of two exemplary pivot guides according to one or more additional implementations.

[0025] FIG. 13A It can be combined with one or more principles of this disclosure. FIG. 4 , FIG. 5 and FIG. 6A-6B An exploded view of another exemplary embodiment of the wrist.

[0026] FIG. 13B yes FIG. 13A An isometric view of the assembly of the intermediate connecting rod.

[0027] FIG. 13C and FIG. 13D This is a cross-sectional end view of the first pivoting guide.

[0028] FIG. 14 It can be combined with one or more principles of this disclosure. FIG. 4 , FIG. 5 and FIG. 6A-6B An isometric side view of another exemplary embodiment of a portion of the wrist. Detailed Implementation

[0029] This disclosure relates to robotic surgical systems, and more specifically to end effectors having a wrist capable of joint movement, the wrist including a flexible member and sub-joint movement pivot guides extending through the joint-moving wrist, the flexible member being arranged at each joint movement joint to help support the flexible member and prevent the closed and open cables from migrating across the corresponding pivot axis.

[0030] In cable-jointed robotic tools, undesirable jaw tip movement can occur when high closing forces are applied during surgery to "clamp" the jaws onto tissue. This jaw tip movement results from a slight off-center displacement of the closure cable within the joint joint in certain postures. This generates an unbalanced torque that causes the jaws to suddenly move (depress) in an unbalanced direction. This "tip depressing" is accidental and undesirable in surgical applications where the jaws are clamping critical structures. Simulation studies have shown that if the centerline of the closure cable is lowered below the joint pivot axis due to deflection of the unsupported flexible member at the joint joint, the end effector will move in the direction of joint movement.

[0031] The embodiments described herein disclose an articulatable wrist for an end effector of a surgical tool. The articulatable wrist includes a first link, a second link rotatably coupled to the first link at a first articulation joint, and a flexible member extending at least partially through a central passage cooperatively defined by the first link and the second link. A first pivot guide is rotatably coupled to the second link at the first articulation joint and is rotatable about a first pivot axis extending through the first articulation joint, the first pivot guide defining a central aperture that is alignable with the central passage and sized to accommodate the flexible member therethrough. The first pivot guide supports an outer diameter of the flexible member at the first articulation joint and prevents the flexible member from flexing beyond the first pivot axis during articulation. In some embodiments, an axial extension conduit is defined in the flexible member to receive a closure cable for actuating jaws of the end effector. The pivot guide supports an outer diameter of the flexible member at the first articulation joint and prevents a centerline of the closure cable from deflecting below the first pivot axis during clamping.

[0032] Accordingly, embodiments of the present disclosure employ sub-articulation pivot guides that are operable to accommodate the outer diameter of the flexible member and constrain its ability to flex beyond the pivot axis. As a result, the closure cable will not be able to deflect below the pivot axis during closure as it is captured by these pivot guides. This will reduce the deflection moment that is generated when the tension on the closure cable increases during jaw clamping. This constraint can also reduce the effects of undesirable end effector motion ("tip down"). The pivot guides can bisect the angular pivot of the overall articulation angle and this will guide the smooth angular transition of the cables and wires housed within the flexible member. The pivot guides can be present in both the pitch articulation joint and the yaw articulation joint.

[0033] FIG. 1 is a block diagram of an exemplary robotic surgical system 100 that can incorporate some or all of the principles of the present disclosure. As shown, the system 100 can include at least one set of user input controls 102a and at least one control computer 104. The control computer 104 can be mechanically and / or electrically coupled to a robotic manipulator, and more particularly to one or more robotic arms 106 (alternatively referred to as "tool drivers"). In some embodiments, the robotic manipulator can be included in or otherwise mounted to an arm cart that enables the system to be portable. Each robotic arm 106 can include and otherwise provide a location for mounting one or more surgical instruments or tools 108 to perform various surgical tasks on a patient 110. Operation of the robotic arms 106 and associated tools 108 can be directed from the user input controls 102a by a clinician 112a (e.g., a surgeon).

[0034] In some embodiments, a second set of user input controllers 102b (shown in dashed lines) can be operated by a second clinician 112b to direct the operation of the robotic arms 106 and tools 108 in conjunction with the first clinician 112a. In such embodiments, for example, each clinician 112a, 112b can control a different robotic arm 106, or in some cases, full control of a robotic arm 106 can be passed between the clinicians 112a, 112b. In some embodiments, additional robotic manipulators (not shown) with additional robotic arms (not shown) can be used on the patient 110 during a surgical procedure, and these additional robotic arms can be controlled by one or more of the user input controllers 102a, 102b.

[0035] The control computer 104 and the user input controllers 102a, 102b can communicate with each other via a communication link 114, which can be any type of wired or wireless communication means structured to carry a variety of communication signals (e.g., electrical, optical, infrared, etc.) according to any communication protocol.

[0036] The user input controllers 102a, 102b typically include one or more physical controllers that can be grasped and manipulated in space by the clinician 112a, 112b while viewing the procedure via a stereoscopic display. The physical controllers typically include a hand input device that is movable in multiple degrees of freedom, and often include an actuable handle or pedal for actuating a surgical tool 108. The control computer 104 can also include optional feedback gauges that can be seen by the clinician 112a, 112b via the display to provide visual indications of various surgical instrument metrics, such as the magnitude of force applied to a surgical instrument (i.e., a cutting instrument or a dynamic clamping member).

[0037] FIG. 2 is an isometric side view of an exemplary surgical tool 200 that can incorporate some or all of the principles of the present disclosure. The surgical tool 200 can be the same as or similar to the surgical tool 108 of FIG. 1 and thus can be used in conjunction with a robotic surgical system such as the robotic surgical system 100 of FIG. 1 However, in other embodiments, aspects of the surgical tool 200 can be adapted for use in a manual or hand-operated manner without departing from the scope of the present disclosure.

[0038] As shown, the surgical tool 200 includes an elongate shaft 202, an end effector 204, a wrist 206 (alternatively referred to as a“wrist joint” or an“articulatable wrist joint”) coupling the end effector 204 to a distal end of the shaft 202, and a drive housing 208 coupled to a proximal end of the shaft 202. In a robotic surgical system, the drive housing 208 can include coupling features that releasably couple the surgical tool 200 to a robotic surgical system (e.g., the robotic arm 106 of the FIG. 1

[0039] The terms“proximal” and“distal” are defined herein relative to a robotic surgical system having an interface configured to mechanically and electrically couple the surgical tool 200 (e.g., the drive housing 208) to a robotic manipulator. The term“proximal” refers to a location of an element closer to the robotic manipulator, and the term“distal” refers to a location of an element closer to the end effector 204 and thus further from the robotic manipulator. Alternatively, in a manual or hand-operated application, the terms“proximal” and“distal” are defined herein relative to a user such as a surgeon or clinician. The term“proximal” refers to a location of an element closer to the user, and the term“distal” refers to a location of an element closer to the end effector 204 and thus further from the user. Moreover, directional terms such as above, below, upper, lower, upward, downward, left, right, and the like are used with reference to the exemplary embodiments as they are shown in the drawings, with upward or upper being toward the top of the corresponding drawing and downward or lower being toward the bottom of the corresponding drawing.

[0040] During use of the surgical tool 200, the end effector 204 is configured to move (pivot) at the wrist 206 relative to the shaft 202 to position the end effector 204 at a desired orientation and location relative to a surgical site. To accomplish this, the drive housing 208 includes (contains) various drive inputs and mechanisms (e.g., gears, actuators, etc.) designed to control operation of various features associated with the end effector 204 (e.g., clamping, firing, rotating, articulating, cutting, etc.). In at least some applications, the shaft 202, and thus the end effector 204 coupled thereto, is configured to rotate about a longitudinal axis Al of the shaft 202. In such embodiments, at least one of the drive inputs controls the rotational movement of the shaft 202 about the longitudinal axis Al.

[0041] ​The surgical tool 200 can include, but is not limited to, forceps, graspers, needle drivers, scissors, electrocautery tools, vessel sealers, staplers, clip appliers, hooks, spatulas, suction tools, irrigation tools, imaging devices (e.g., endoscopes or ultrasound probes), or any combination thereof. In some embodiments, the surgical tool 200 can be configured to apply energy to tissue, such as radiofrequency (RF) energy. In the illustrated embodiment, the end effector 204 includes a tissue grasper and a vessel sealer including opposing jaws 210, 212 configured to move (articulate) between open and closed positions. However, as will be appreciated, the opposing jaws 210, 212 can alternatively form part of other types of end effectors, such as but not limited to surgical scissors, clip appliers, needle drivers, babcock forceps including a pair of opposing grasp jaws, bipolar jaws (e.g., bipolar Maryland graspers, forceps, fenestrated graspers, etc.), or the like. One or both of the jaws 210, 212 can be configured to pivot relative to the other to open and close the jaws 210, 212. However, the principles of the present disclosure are equally applicable to end effectors without opposing jaws.

[0042] FIG. 3 The potential degrees of freedom of articulation (pivoting) of the wrist 206 are shown. The wrist 206 includes joints configured to allow pivotal movement of the end effector 204 relative to the shaft 202. The degrees of freedom of the wrist 206 are represented by three translational variables (i.e., surge, heave, and sway) and three rotational variables (i.e., Euler angles or roll, pitch, and yaw). The translational and rotational variables describe the position and orientation of the end effector 204 relative to a given reference Cartesian coordinate frame. “Surge” refers to forward and rearward translational motion, “heave” refers to up and down translational motion, and “sway” refers to left and right translational motion. “Roll” refers to tilting left and right, “pitch” refers to tilting forward and rearward, and “yaw” refers to turning left and right.

[0043] The pivotal movement can include pitch movement about a first axis (e.g., X-axis) of the wrist 206, yaw movement about a second axis (e.g., Y-axis) of the wrist 206, and combinations thereof, such that the end effector 204 moves 360° about the wrist 206. In other applications, the pivotal movement can be limited to movement in a single plane, e.g., only pitch movement about the first axis of the wrist 206 or only yaw movement about the second axis of the wrist 206, such that the end effector 204 moves in only a single plane.

[0044] Referring again to FIG. 2 , the surgical tool 200 can further include a plurality of drive cables (in FIG. 2The cable-driven motion system facilitates movement and articulation of the end effector 204 relative to the shaft 202. Movement of the drive cables (articulation) moves the end effector 204 between unarticulated and articulated positions. The end effector 204 is shown in FIG. 1 in an unarticulated position, in which the longitudinal axis A2 of the end effector 204 is substantially aligned with the longitudinal axis Al of the shaft 202, such that the end effector 204 is at a substantially zero angle relative to the shaft 202. In an articulated position, the longitudinal axes Al, A2 will be angularly offset from one another, such that the end effector 204 is at a non-zero angle relative to the shaft 202. FIG. 2 The end effector 204 is shown in FIG. 1 in an unarticulated position, in which the longitudinal axis A2 of the end effector 204 is substantially aligned with the longitudinal axis Al of the shaft 202, such that the end effector 204 is at a substantially zero angle relative to the shaft 202. In an articulated position, the longitudinal axes Al, A2 will be angularly offset from one another, such that the end effector 204 is at a non-zero angle relative to the shaft 202.

[0045] In some embodiments, the surgical tool 200 can be supplied with electrical power (current) via a power cable 214 coupled to the drive device housing 208. In other embodiments, the power cable 214 can be omitted, and the surgical tool 200 can be supplied with electrical power via an internal power source, such as one or more batteries or fuel cells. In such embodiments, the surgical tool 200 can alternatively be characterized and otherwise referred to as an "electrosurgical instrument" capable of providing electrical energy to the end effector 204. The power cable 214 can place the surgical tool 200 in communication with a generator 216 that supplies energy, such as electrical energy (e.g., radiofrequency energy), ultrasonic energy, microwave energy, thermal energy, or any combination thereof, to the surgical tool 200 and more particularly to the end effector 204.

[0046] FIG. 4 is FIG. 2 a magnified isometric view of a distal end of the surgical tool 200. More particularly, FIG. 4 depicts a magnified view of the end effector 204 and the wrist 206, with the jaws 210, 212 of the end effector 204 in an open position. The wrist 206 operatively couples the end effector 204 to the shaft 202. However, in some embodiments, a shaft adapter can be directly coupled to the wrist 206 and otherwise interposed between the shaft 202 and the wrist 206. Thus, the wrist 206 can be operatively coupled to the shaft 202 by a direct coupling engagement, in which the wrist 206 is directly coupled to a distal end of the shaft 202, or an indirect coupling engagement, in which a shaft adapter is interposed between the wrist 206 and the distal end of the shaft 202. As used herein, the term "operatively coupled" refers to either a direct or indirect coupling engagement between two components.

[0047] To operatively couple the end effector 204 to the shaft 202, the wrist 206 includes a first link or "distal" link 402a, a second link or "intermediate" link 402b, and a third link or "proximal" link 402c. The links 402a-402c facilitate articulation of the end effector 204 relative to the elongate shaft 202. Articulation via the links 402a-402c can be limited to just pitch, just yaw, or a combination of pitch and yaw. As shown, a distal end of the distal link 402a can be coupled to the end effector 204, and more specifically to the lower jaw 212 (or an extension of the lower jaw 212). A proximal end of the distal link 402a can be rotatably coupled to the intermediate link 402b at a first shaft 404a, and the intermediate link 402b can also be rotatably coupled to the proximal link 402c at a second shaft 404b. A proximal end of the proximal link 402c can be coupled to the distal end 406 of the shaft 202 (or alternatively to a shaft adapter).

[0048] A first pivot axis P1 extends through the first shaft 404a and a second pivot axis P2 extends through the second shaft 404b. The first pivot axis P1 is substantially perpendicular (normal) to a longitudinal axis A2 of the end effector 204, and the second pivot axis P2 is substantially perpendicular (normal) to both the longitudinal axis A2 and the first pivot axis P1. Movement about the first pivot axis P1 provides "yaw" articulation of the end effector 204, and movement about the second pivot axis P2 provides "pitch" articulation of the end effector 204. Alternatively, the first pivot axis P1 can be configured to provide "pitch" articulation, and the second pivot axis P2 can be configured to provide "yaw" articulation.

[0049] A plurality of drive cables, shown as drive cables 408a, 408b, 408c, and 408d, extend longitudinally within a lumen 410 defined by the shaft 202 (or a shaft adapter) and through the wrist 206 to operatively couple to the end effector 204. The drive cables 408a-408d form part of the cable-driven motion system briefly described above, and can be referred to and otherwise characterized as cables, bands, wires, cords, wires, woven wires, ropes, threads, twisted threads, elongate members, and the like. The drive cables 408a-408d can be made from a variety of materials, including but not limited to metals (e.g., tungsten, stainless steel, etc.), polymers (e.g., ultra-high-molecular-weight polyethylene), synthetic fibers (e.g., Dyneema®, Kevlar®, etc.), or any combination thereof. While Although four drive cables 408a-408d are shown in the intermediate portion 206, more or less than four drive cables 408a-408d can be included without departing from the scope of the present disclosure. FIG. 4 Although four drive cables 408a-408d are shown in the intermediate portion 206, more or less than four drive cables 408a-408d can be included without departing from the scope of the present disclosure.

[0050] Drive cables 408a-d extend proximally from end effector 204 to drive housing 208 FIG. 2 ), where they are operatively coupled to respective actuation mechanisms (e.g., capstans) or devices housed therein to facilitate longitudinal movement (translation) of drive cables 408a-d within lumens 410. Selective actuation of a given drive cable 408a-d causes the corresponding drive cable 408a-d to longitudinally translate within lumens 410 and thereby cause pivotal movement (articulation) of end effector 204. Moving a given drive cable 408a-d exerts tension (i.e., pulling force) on the given drive cable 408a-d in the proximal direction, which causes the given drive cable 408a-d to translate and thereby cause end effector 204 to move (articulate).

[0051] Drive cables 408a-d each longitudinally extend through first link 402a, second link 402b, and third link 402c. In some embodiments, each link 402a-c can define four equally spaced apart apertures 412 (only two are labeled) that are configured to guide drive cables 408a-d through wrist 206. When end effector 204 is in an unarticulated position, the apertures 412 of each link 402a-c are coaxially aligned.

[0052] The distal end of each drive cable 408a-d can terminate at distal link 402a, thereby operatively coupling each drive cable 408a-d to end effector 204, and more particularly to lower jaw 212. The distal end of each drive cable 408a-d can be enlarged to facilitate its secure attachment to end effector 204. In some embodiments, as shown, the distal end of each drive cable 408a-d can include a ball crimp 413 (only one is shown).

[0053] Jaws 210, 212 are movable between a closed position and an open position by pivoting upper jaw 210 relative to lower jaw 212. In the illustrated embodiment, upper jaw 210 is rotatably coupled (mounted) to lower jaw 212 at jaw shaft 414. Third pivot axis P3 extends through jaw shaft 414 and is generally perpendicular (orthogonal) to first pivot axis PI and parallel to second pivot axis P2. In this embodiment, lower jaw 212 remains stationary as upper jaw 210 is pivoted about third pivot axis P3. In other embodiments, without departing from the scope of the present disclosure, end effector 204 can be designed such that upper jaw 210 remains stationary as lower jaw 212 is pivoted about third pivot axis P3.

[0054] A center pulley 416 (partially visible) can be mounted to the jaw shaft 414 and receive a jaw cable 418 that can be actuated to selectively open and close the jaws 210, 212. Similar to the drive cables 408a-d, the jaw cable 418 extends longitudinally within the lumen 410 of the shaft 202 and through the wrist 206. The jaw cable 418 can form part of the cable-driven motion system described herein and thus can extend proximally from the end effector 204 to the drive housing 208 FIG. 2 ). The jaw cable 418 can comprise a single wire or wire-form that loops around the center pulley 416, and opposite first and second ends 420a, 420b of the jaw cable 418 extend proximally to the drive housing 208. Actuation of corresponding drive inputs will cooperatively cause tensioning or slackening in the jaw cable 418 and thereby cause the upper jaw 210 to rotate about the third pivot axis P3 between open and closed positions. More specifically, tensile loads borne on the first end 420a of the jaw cable 418 can be used to close the jaws 210, 212, and tensile loads borne on the second end 420b of the jaw cable 418 can be used to open the jaws 210, 212. Thus, the first end 420a of the jaw cable 418 can alternatively be referred to as a “closing cable” and the second end 420b of the jaw cable 418 can alternatively be referred to as an “opening cable”.

[0055] In some embodiments, an electrical conductor 422 can supply electrical energy to the end effector 204, and more specifically to an electrode 424 included in the end effector 204. The electrical conductor 422 extends longitudinally within the lumen 410, through the wrist 206, and terminates at the electrode 424. In some embodiments, the electrical conductor 422 can comprise a wire, but can alternatively comprise a rigid or semi-rigid shaft, rod, or strip (ribbon) made of an electrically conductive material. The electrical conductor 422 can be partially covered with an insulating covering (overmolded) made of a non-conductive material. Using the electrical conductor 422 and the electrode 424, the end effector 204 can be configured for monopolar or bipolar operation.

[0056] In the illustrated implementation, the end effector 204 comprises a combined tissue grasper and vessel sealer that includes a cutting element 426 (mostly obscured), which is alternatively referred to as a “knife” or “blade.” The cutting element 426 is aligned with and configured to traverse a rail 428 that is longitudinally defined in one or both of the upper and lower jaws 210, 212. The cutting element 426 is operably coupled to a distal end of a drive rod 430 that extends longitudinally within the lumen 410 and through the wrist 206. Longitudinal movement (translation) of the drive rod 430 correspondingly moves the cutting element 426 within the rail 428. Similar to the drive and jaw cables 408a-d, 418, the drive rod 430 can form part of a cable-driven kinematic system, and thus can extend proximally from the cutting element 426 to the drive housing 208 FIG. 2 Selective actuation of the corresponding drive input will cause the drive rod 430 to move distally or proximally within the lumen 410, and correspondingly move the cutting element 426 in the same direction.

[0057] FIG. 5 is an isometric side view of the end effector 204 in an open position in accordance with one or more implementations. More specifically, FIG. 5 depicts the upper jaw 210 pivoted to an open position, and the lower jaw 212 FIG. 4 ) is omitted to enable viewing of the internal components of the end effector 204. As shown, the end effector 204 includes a pivot link 502 that is operatively coupled to the upper jaw 210. More specifically, the upper jaw 210 provides or otherwise defines one or more legs 504 (one shown, one obscured) that are pivotally coupled at a pivot axle 508 to a corresponding one or more legs 506 (one shown, one obscured) of the pivot link 502. A fourth pivot axis P4 extends through the pivot axle 508 and can be generally perpendicular (orthogonal) to the first pivot axis PI and parallel to the second and third pivot axes P2, P3.

[0058] A center pulley 416 (mostly obscured) is rotatably supported on the jaw axle 414, and the jaw cable 418 loops around the center pulley 416 and opposite ends 420a, 420b of the jaw cable 418 extend proximally through the wrist 206. The jaw cable 418 can be operatively coupled to the pivot link 502 such that movement (i.e., longitudinal translation) of the jaw cable 418 correspondingly moves the pivot link 502. For example, a cable anchor 510 can be fixed to or otherwise form part of one proximally extending end 420a, 420b of the jaw cable 418 and can facilitate operatively coupling the jaw cable 418 to the pivot link 502.

[0059] To move the jaws 210, 212 to the open position, the jaw cable 418 can be actuated to move the pivot link 502 distally, which can be accomplished, for example, by pulling the second end 420b of the jaw cable 418 proximally (i.e., the “open cable”). As the pivot link 502 moves distally, the leg 506 of the pivot link 502 acts on the leg 504 of the upper jaw 210 at the pivot shaft 508 and forces the leg 504 to rotate downward about the fourth pivot axis P4. The downward movement of the leg 504 correspondingly causes the upper jaw 210 to pivot about the third pivot axis P3. As it pivots about the third pivot axis P3, the upper jaw 210 moves to the open position.

[0060] To move the upper jaw 210 back to the closed position, the jaw cable 418 can be actuated to move the pivot link 502 proximally, which can be accomplished by pulling the first end 420a of the jaw cable 418 proximally (i.e., the “close cable”). This causes the pivot link 502 to pull the leg 504 of the upper jaw 210 upward to rotate about the fourth pivot axis P4, and the upward movement of the leg 504 correspondingly causes the upper jaw 210 to pivot about the third pivot axis P3 and move the upper jaw 210 to the closed position.

[0061] FIG. 6A and FIG. 6B are enlarged isometric front and rear views, respectively, of the wrist 206 according to one or more embodiments. The wrist 206 has a first or “distal” end 602a and a second or “proximal” end 602b opposite the distal end 602a. The distal link 402a is positioned at the distal end 602a, the proximal link 402c is positioned at the proximal end 602b, and the intermediate link 402b is interposed between and operatively couples the distal link 402a and the proximal link 402c. However, embodiments are contemplated herein in which the intermediate link 402b is omitted and the distal link 402a and the proximal link 402c are alternatively coupled directly at a common shaft.

[0062] For simplicity, the drive cables 408a-d, the electrical conductor 422, the first and second ends 420a-b of the jaw cable 418 FIG. 4 and FIG. 5 ) and the drive rod 430 are each routed through the handle 202 in FIG. 6A-6BThe portions of the drive cables 408a-d that pass through the wrist 206 (e.g., the apertures 412) and terminate at the distal link 402a. The proximal link 402c can provide or otherwise define longitudinal grooves 604 that house each of the drive cables 408a-d, and each groove 604 can receive a corresponding one of the drive cables 408a-d. The grooves 604 can be aligned with corresponding apertures 412 defined by the proximal link 402c.

[0063] The wrist 206 provides or defines a central passage 606 that extends between the distal end 602a and the proximal end 602b. In embodiments in which the wrist 206 includes the distal link 402a, the intermediate link 402b, and the proximal link 402c, corresponding portions of the central passage 606 can be cooperatively and continuously defined by each link 402a-c. However, in embodiments in which the wrist 206 includes only the distal link 402a and the proximal link 402c, the central passage 606 can be cooperatively and continuously defined only by the distal link 402a and the proximal link 402c. Portions of the central passage 606 defined by each link 402a-c can be coaxially aligned when the wrist 206 is undergoing non-articulation motion, but out of axial alignment when the wrist 206 is moved in articulation.

[0064] The wrist 206 can also include a flexible member 608 that is positionable within the central passage 606 and extends at least partially between the first end 602a and the second end 602b of the wrist 206. As FIG. 6B As best shown, the flexible member 608 can provide or otherwise define one or more conduits 610 (four shown) that extend through the entire length of the flexible member 608. Thus, the flexible member 608 can be referred to as a "multi-lumen" or "multi-lumen element." The conduits 610 can be configured to receive the electrical conductor 422, the first and second end portions 420a-b of the jaw cable 418, FIG. 4 and FIG. 5 the drive rod 430, which are collectively referred to herein as "central actuation members." Thus, the central actuation members can penetrate the wrist 206 by extending through the conduits 610 of the flexible member 608.

[0065] In some embodiments, as shown, the conduits 610 can exhibit a circular cross-sectional shape, but can alternatively exhibit other cross-sectional shapes, such as polygons, ellipses, or ovals, without departing from the scope of the present disclosure. Moreover, one or more of the conduits 610 can be lined with a material that helps to mitigate wear and friction, such as nylon, silicone, Nitinol, or the like. Additionally, the size (diameter) of the conduits 610 can vary depending on the application. Those skilled in the art will readily appreciate that the shape, material, and size of the conduits 610 can be varied or otherwise customized to conform with known industry practices without departing from the scope of the present disclosure.

[0066] The flexible member 608 can be operatively coupled at its distal end to the distal link 402a, but can also be axially free to move relative to the proximal link 402c at its proximal end. In some embodiments, for example, the wrist 206 can include a distal adapter 612 FIG. 6A ) and a proximal adapter 614 FIG. 6B ). The distal adapter 612 can operatively couple the flexible member 608 to the distal link 402a, and the proximal adapter 612 can be configured to support the flexible member 608 in sliding axial engagement with the proximal link 402c. However, in at least one embodiment, the proximal adapter 612 can be omitted, and the flexible member 608 can directly contact the proximal link 402c in sliding engagement.

[0067] FIG. 7A and FIG. 7B are isometric and exploded views, respectively, of the flexible member 608 and the distal adapter 612 and the proximal adapter 614, according to one or more embodiments. As shown, the flexible member 608 can include a generally cylindrical body 702 having a first or “distal” end 704a and a second or “proximal” end 704b opposite the distal end 704a. In some embodiments, as shown, the body 702 can exhibit a substantially circular cross-section, but can alternatively exhibit other cross-sectional shapes, such as polygons (e.g., triangles, rectangles, etc.), polygons with rounded corners, ellipses, ovals, or any combination thereof, without departing from the scope of the present disclosure.

[0068] The flexible member 608 can be made of any flexible or semi-flexible material that allows the flexible member 608 to flex or bend when the wrist 206 FIG. 6A-6B ) is articulated. The material used for the flexible member 608 can also exhibit low friction properties or can otherwise be lubricious, which can prove beneficial in minimizing wear and friction by the central actuation member (e.g., the pull wire 610) extending through the conduit 610. FIG. 6A-6BThe friction caused by the electrical conductor 422, the first end 420a and the second end 420b of the jaw cable 418, and the drive rod 430 is advantageous. Alternatively, the outer diameter of one or more central actuating members (such as the first end 420a and the second end 420b of the jaw cable 418) or the inner diameter of the conduit 610 may be coated with medical-grade grease (e.g., KRYTOX). TM This reduces contact friction. Furthermore, the material used for the flexible member 608 also exhibits good wear resistance, ensuring that the central actuating member does not accidentally cut through the corresponding conduit 610 after repeated use. The diameter or size of each conduit 610 can be large enough to allow the central actuating member to move within it without substantial obstruction (friction), but can also be small enough to support longitudinal movement of the central actuating member.

[0069] Suitable materials for the flexible component 608 include, but are not limited to, polytetrafluoroethylene (PTFE or... ), silicone resin, nylon, thermoplastic polyurethane (TPU, such as CARBOTHANE) TM , TECOBAX TM ), thermoplastic elastomers (TPE, for example) (or any combination thereof). In at least one embodiment, the flexible member 608 may comprise an extrusion or may be manufactured by other means via an extrusion process. In other embodiments, the flexible member 608 may be printed by an additive manufacturing process (e.g., 3D printing). In some embodiments, the flexible member 608 may be made of a plastic resin blended with a lubricant, such as with a liquid lubricant additive. Blended PTFE solid particles.

[0070] The distal adapter 612 may be made of rigid or semi-rigid materials, including but not limited to plastics, metals, composites, and any combination thereof. Exemplary materials for the distal adapter 612 include, but are not limited to, polyetherimide, polycarbonate, polystyrene, and nylon. In some embodiments, as shown, the distal adapter 612 may be provided with or otherwise define a radial shoulder 706 and a flange 708 extending from the radial shoulder 706. The flange 708 may be sized to receive the distal end 704a of the flexible member 608. However, in other embodiments, the flange 708 may be omitted and the distal adapter 612 may still be coupled to the flexible member 608.

[0071] The distal adapter 612 can be coupled (secured) to the distal end 704a of the flexible member 608 via various attachment means. Suitable attachment means include, but are not limited to, bonding (e.g., adhesive), welding (e.g., sonic or ultrasonic welding), overmolding the distal adapter 612 onto the distal end 704a, an interference or shrink fit, or any combination thereof.

[0072] The distal adapter 612 can define one or more orifices 710 (four shown) configured to be coaxially aligned with the conduit 610 of the flexible member 608. Thus, the electrical conductor 422 of the end effector 400, FIG. 6A-6B The electrical conductor 422, the first and second ends 420a, 420b of the jaw cable 418, and the drive rod 430 can each exit the flexible member 608 and extend through the distal adapter 612 at the orifices 710.

[0073] In some embodiments, the distal adapter 612 can provide one or more features 712 configured to mate with one or more corresponding features of the distal link 402a( FIG. 6A-6B ) of the wrist 206. In the illustrated embodiment, the features 712 are defined on the flange 708, but can alternatively be defined on any other portion of the distal adapter 612 without departing from the scope of the present disclosure. Mating the features 712 of the distal adapter 612 with corresponding features of the distal link 402a can help rotationally secure the distal end 704a of the flexible member 608 at the distal end 602a( FIG. 6A-6B ) of the wrist 206( FIG. 6A-6B ) of the wrist 206.

[0074] The proximal adapter 614 can be made of a rigid or semi-rigid material, including but not limited to a plastic, a metal, a composite material, or any combination thereof. Exemplary materials for the proximal adapter 614 include, but are not limited to, polyetherimide, polycarbonate, polystyrene, and nylon. The proximal adapter 614 can provide a generally annular body 714 sized to receive the proximal end 704b of the flexible member 608. In some embodiments, the proximal end 704b can extend completely through the annular body 714, but can alternatively extend only partially through the annular body.

[0075] The proximal adapter 614 can be coupled (secured) to the proximal end 704b of the flexible member 608 via various attachment means. Suitable attachment means include, but are not limited to, bonding (e.g., adhesive), welding (e.g., sonic or ultrasonic welding), overmolding the proximal adapter 614 onto the proximal end 704b, an interference or shrink fit, or any combination thereof.

[0076] In some embodiments, the flange 716 can extend proximally from the body 714 of the proximal adapter 614 and can provide or define a groove 718 that can be coaxially aligned with one of the conduits 610. The groove 718 can be sized to receive one of the central actuation members, such as the drive rod 430 FIG. 5 and FIG. 6A-6B ), which can prove advantageous in helping to prevent the drive rod 430 from buckling during operation.

[0077] The proximal adapter 614 can provide one or more features 720 that can cooperate with one or more corresponding features provided by the proximal link 402c FIG. 6A-6B . As discussed in greater detail below, the features 720 can include longitudinal ribs that can be configured to cooperate with longitudinal channels of the proximal link 402c.

[0078] Referring again to FIG. 6A-6B , in some embodiments, the distal adapter 612 can be partially received within the central channel 606 defined in the distal link 402a. More specifically, the flange 708 (see FIG. 6B ) of the distal adapter 612 can extend into the central channel 606 until the radial shoulder 706 (see FIG. 6A ) of the distal adapter 612 engages the distal end 602a of the wrist 206, and more specifically the distal link 402a. In some embodiments, one or more features (not shown) can be defined on an inner radial surface of the central channel 606 at the distal link 402a and configured to cooperate with the features 712 FIG. 7A-7B of the distal adapter 612. Cooperating these features can help rotationally fix the distal adapter 612 relative to the distal end 602a FIG. 6A-6B of the wrist 206 FIG. 6A-6B .

[0079] The distal adapter 612 can be arranged to insert the lower jaw 212 FIG. 4 and the distal link 402a within the assembly of the end effector 204 FIG. 4-5 , thereby constraining (catching) the distal adapter 612 between the lower jaw 212 and the distal link 402a. Since the distal adapter 612 can be fixed to the distal end 704a FIG. 7A-7B of the flexible member 608, the distal adapter 612 that is constrained (caught) between the lower jaw 212 and the distal link 402a can correspondingly fix the flexible member 608 in place at the distal end 602a of the wrist 206.

[0080] Referring specifically to FIG. 6BIn the example operation of the wrist 206, the drive cables 408a-d are selectively actuated to articulate the wrist 206. As the wrist 206 is articulated, the flexible member 608 correspondingly bends or flexes, and the central actuation members (e.g., the electrical conductors 422, the first and second end portions 420a, 420b of the jaw cables 418, and the drive rod 430) will correspondingly move in the direction of articulation and thereby lengthen or shorten depending on the direction of bending. The conduits 610 that extend through the flexible member 608 for the central actuation members form a defined and predictable pathway for each of the central actuation members.

[0081] In the example operation of the wrist 206, the drive cables 408a-d are selectively actuated to articulate the wrist 206. As the wrist 206 is articulated, the flexible member 608 correspondingly bends or flexes, and the central actuation members (e.g., the electrical conductors 422, the first and second end portions 420a, 420b of the jaw cables 418, and the drive rod 430) will correspondingly move in the direction of articulation and thereby lengthen or shorten depending on the direction of bending. The conduits 610 that extend through the flexible member 608 for the central actuation members form a defined and predictable pathway for each of the central actuation members.

[0082] When a high closure force is applied to the closure cable (e.g., the first end portion 420a of the jaw cable 418) to clamp the jaws 210, 212 onto tissue, undesirable movement can occur at the tip of the end effector 204 FIG. 2 . This jaw tip motion is created by the slight off-center location of the closure cable during movement at one or both of the articulation joints (i.e., the first and second pivot axes P1, P2 of the wrist 206). This creates an unbalanced moment that can cause the jaws 210, 212 to suddenly move or "dive" in an unbalanced direction. This "tip diving" is unexpected and undesirable when clamping critical structures. FIG. 4-5

[0083] ​According to embodiments of the present disclosure, one or more sub-articulation pivot guides can be included (mounted) in the wrist 206 at the articulation joints to help accommodate and support the outer diameter of the flexible member 608 and thereby limit its ability to flex beyond the pivot axis P1, P2. Thus, it will also be prevented that the closure cable (or either of the central actuation members) will deflect during actuation below the pivot axis P1, P2, and tip-down will be mitigated. Similarly, the opening cable can extend through a conduit 610 that is angularly offset 90° from the closure cable. The opening cable interacts with the sub-articulation pivot guides at the second articulation joint (i.e., the yaw axis) in the same manner as the closure cable. As the jaws 210, 212 open against the tissue, the tension in the opening cable increases, and the likelihood of tip-down in the yaw axis increases. The sub-articulation pivot guides disposed at the second articulation joint will resist the deflection moment and any resulting movement of the flexible member 608 in that direction.

[0084] FIG. 8A is a side view of one exemplary embodiment of a wrist 206 that can incorporate one or more principles of the present disclosure. For simplicity, the drive cables 408a-d FIG. 4-5 , the electrical conductors 422 FIG. 4-5 , the first and second end portions 420a, 420b of the jaw cables 418 FIG. 4-5 , and the drive rod 430 FIG. 4-5 are all omitted in FIG. 8A . Also omitted is the flexible member 608 FIG. 6A-6B and FIG. 7A-7B that otherwise extends through the central passage 606 of the wrist 206 and accommodates the central actuation members (e.g., the electrical conductors 422, the first and second end portions 420a, 420b of the jaw cables 418, and the drive rod 430).

[0085] As shown, the wrist 206 includes a distal link 402a rotatably coupled to an intermediate link 402b at a first articulation joint 801a and a proximal link 402c rotatably coupled to the intermediate link 402b at a second articulation joint 801b. A first pivot axis P1 extends through the first articulation joint 801a and facilitates the end effector 204 FIG. 2The wrist 206 facilitates the "yaw" movement (articular movement) of the end effector 204, and the second pivot axis P2 extends through the second articular joint 801b and facilitates the "pitch" movement (articular movement) of the end effector 204. In some embodiments, the wrist 206 may alternatively include only the intermediate link and either the distal link 402a or the proximal link 402c. In such embodiments, the wrist 206 will have only one articular joint that facilitates either "yaw" or "pitch" movement, depending on the orientation of the relevant pivot axis.

[0086] The wrist 206 also includes a first pivot guide 802a disposed at the first articular joint 801a and a second pivot guide 802b disposed at the second articular joint 801b. Although this embodiment includes pivot guides 802a and 802b at each articular joint 801a, 801b, it is also contemplated herein that only one of the pivot guides 802a and 802b may be used at a corresponding articular joint 801a, 801b.

[0087] In the illustrated embodiment, each pivot guide 802a, 802b is rotatably mounted to the intermediate link 402b by extending at least partially through opposing openings 804 defined near each end of the intermediate link 402b. Furthermore, the pivot guides 802a, 802b are rotatable about a first pivot axis P1 and a second pivot axis P2, respectively, and in the illustrated embodiment, the pivot guides 802a, 802b provide or otherwise define a first shaft 404a and a second shaft 404b, respectively. Thus, the distal link 402a can be rotatably coupled to the intermediate link 402b via the first shaft 404a provided by the first pivot guide 802a, and the proximal link 402c can be rotatably coupled to the intermediate link 402b via the second shaft 404b provided by the second pivot guide 802b.

[0088] In some embodiments, one or both of the pivoting guides 802a, 802b may be made of a conductive material to help act as conductor 422. FIG. 4-5 The conductor can be grounded to the remote link 402a. FIG. 8A In other embodiments, one or both of the pivoting guides 802a and 802b may be made of any rigid or semi-rigid material, including but not limited to plastics (polymers), metals, composite materials, elastomers, or any combination thereof. Exemplary non-metallic materials include, but are not limited to, polyetherimide (e.g., The materials used include polycarbonate, polystyrene, polyetheretherketone (PEEK), carbon-filled polyaniline (PPA), and nylon. In at least one embodiment, one or both of the pivot guides 802a and 802b may be made of two or more materials, such as overmolding.

[0089] FIG. 8B This is an enlarged isometric view of one embodiment of the intermediate link 402b. In the illustrated embodiment, the intermediate link 402b includes a body 806 that defines a portion of a central channel 606 configured to receive a flexible member 608. FIG. 6A-6B and FIG. 7A-7B A pair of distally extending convex angles 808a and 808b extend distally from the body 806 and are laterally offset from each other, and a pair of proximal extending convex angles 810a and 810b extend proximally from the body 806 and are laterally offset from each other. The proximal extending convex angles 810a and 810b are angularly offset by 90° from the distal extending convex angles 808a and 808b, which makes the intermediate link 402b advantageous to the end actuator 204. FIG. 2 The yaw and pitch joint movements are both. Each convex angle 808a, 808b and 810a, 810b defines an opening 804, which is sized to rotatably receive a portion of the corresponding pivot guide 802a, 802b, as described above.

[0090] FIG. 8C This is an enlarged isometric view of the second pivot guide 802b. Since the first pivot guide 802a and the second pivot guide 802b are substantially similar in structure and operation, the discussion of the second pivot guide 802b will be equally applicable to the first pivot guide 802a. As shown, the second pivot guide 802b includes a generally cylindrical body 812 having a first end 814a and a second end 814b opposite to the first end 814a. The first end 814a and the second end 814b are rotatably received in an opening 804 defined in the intermediate link 402b. FIG. 8B The convex angles 810a and 810b extending proximally ( ) FIG. 8B As described above, protrusions extending outward from each end 814a, 814b of the body 812 help form or otherwise provide a second shaft 404b for the wrist 206. FIG. 8A Furthermore, the cylindrical body 812 may define a central opening 816, which can connect with the central channel 606 of the wrist 206. FIG. 8A-8B ) Aligned and sized or otherwise configured to accommodate a flexible member 608 passing through the central opening. FIG. 6A-6B and FIG. 7A-7B ).

[0091] FIG. 8D FIG. 6 is a cross-sectional side view of the wrist 206 demonstrating exemplary operations in accordance with one or more embodiments. FIG. 8A FIG. 7 is a cross-sectional side view of the wrist 206 of FIG. 6. As shown, the flexible member 608 extends through the central passage 606 of the wrist 206 and also through the central aperture 816 of each pivot guide 802a, 802b. The first end 420a and the second end 420b of the jaw cable 418 are shown in dashed lines extending through corresponding conduits 610 defined by the flexible member 608.

[0092] As depicted, the wrist 206 is articulating at the second articulation joint 801b in pitch motion and otherwise moving about the second pivot axis P2. Moving the second articulation joint 801b correspondingly causes the second pivot guide 802b to rotate about the pivot axis P2 to accommodate the bending (flexing) of the flexible member 608 as it flexes away from a straight position. As the angle at the second articulation joint 801b deviates from straight, the flexible member 608 will be forced to sink above or below the second pivot axis P2 (depending on the direction of articulation). Moreover, as the closure cable (i.e., the first end 420a of the jaw cable 418) tightens under clamping loads, it will tend to find the shortest path through the second articulation joint 801b, which can further force the flexible member 608 to sink below the second pivot axis P2.

[0093] However, the second pivot guide 802b helps accommodate and support the outer diameter of the flexible member 608 at the second articulation joint 801b and thereby prevents the flexible member 608 from flexing beyond the second pivot axis P2. As a result, the centerline of the closure cable (i.e., the first end 420a of the jaw cable 418) will also be unable to deviate below the second pivot axis P2 during clamping, which will mitigate tip drop at the end effector 204( FIG. 2 ) at the second articulation joint 801b.

[0094] While the foregoing description focuses on the operation of the second pivot guide 802b during articulation at the second articulation joint 801b, the first pivot guide 802a can also operate similarly in yaw motion during articulation at the first articulation joint 801a. Moreover, it is contemplated herein that the material properties (e.g., hardness, lubricity, etc.) of the pivot guides 802a, 802b (and any other pivot guides described herein) can be optimized to improve wear on the flexible member 608 extending through the central aperture 816 of each pivot guide 802a, 802b. The inner surface of the central aperture 816 may, for example, be smooth, curved, and / or contain a lubricant, which can help improve articulation joint friction and reduce surgical tool 200( FIG. 2abrasions in the joint, thereby extending the working life of the device.

[0095] FIG. 9A is an isometric side view of another exemplary embodiment of a wrist 206 that can incorporate one or more principles of the present disclosure. In the illustrated view, the intermediate link 402b is shown in phantom to enable viewing of the internal componentry of the wrist 206. For simplicity, the distal link 402a and the proximal link 402c FIG. 4-5 ), the drive cables 408a-d FIG. 4-5 ), the electrical conductors 422 FIG. 4-5 ), the first and second end portions 420a-b of the jaw cable 418 FIG. 4-5 ), and the drive rod 430 FIG. 4-5 ) are omitted, but they are otherwise included in the complete assembly of the wrist 206.

[0096] As shown, the flexible member 608 extends through the central passage 606 that is partially defined by the intermediate link 402b. A first pivot axis PI extends through the first articulation joint 902a and facilitates “yaw” movement (articulation) of the end effector 204 FIG. 2 ), and a second pivot axis P2 extends through the second articulation joint 902b and facilitates “pitch” movement (articulation) of the end effector 204.

[0097] The wrist 206 further includes a first pivot guide 904a disposed at the first articulation joint 902a and a second pivot guide 904b disposed at the second articulation joint 902b. Each pivot guide 904a, 904b is rotatably mounted to the intermediate link 402b at the corresponding articulation joint 902a, 902b and is rotatable about the first and second pivot axes PI, P2, respectively. The pivot guides 904a, 904b can be fabricated from any semi-rigid or flexible material, including but not limited to plastic, metal, composite, elastomer, or any combination thereof. Exemplary non-metallic materials include, but are not limited to, polyetherimide, polycarbonate, polystyrene, carbon-filled polyphenylene (PPA), and nylon.

[0098] FIG. 9B is an enlarged isometric view of another embodiment of the intermediate link 402b. In the illustrated embodiment, the intermediate link 402b includes a body 906 that defines a portion of the central passage 606 that is configured to accommodate the flexible member 608 FIG. 9A). A pair of distally extending lobes 908a and 908b extend distally from the body 906 and are laterally offset from one another, and a pair of proximally extending lobes 910a and 910b extend proximally from the body 906 and are laterally offset from one another. The proximally extending lobes 910a, 910b are angularly offset 90° from the distally extending lobes 908a, 908b, which advantageously facilitate both “yaw” and “pitch” articulation of the end effector 204( FIG. 2 ) by the intermediate link 402b. Each lobe 908a, 908b and 910a, 910b defines an aperture 912 sized to rotatably receive a portion of the corresponding pivot guide 904a, 904b. Further, the lobes 908a, 908b and 910a, 910b provide portions of the first and second shaft members 404a, 404b, respectively, to enable rotatable coupling to the distal link 402a and the proximal link 402c( FIG. 4-5 ).

[0099] FIG. 9C is a magnified isometric view of the second pivot guide 904b. As the first and second pivot guides 904a, 904b are substantially similar in structure and operation, the discussion of the second pivot guide 904b will equally apply to the first pivot guide 904a. As shown, the second pivot guide 904b includes a generally annular body 914 that defines a central aperture 916 that is alignable with the central passage 606( FIG. 9A ) of the wrist 206( FIG. 9A-9B ) and sized or otherwise configured to accommodate the flexible member 608( FIG. 9A ) therethrough. Opposed pins 918 can extend radially outward from the annular body 914 at angularly opposed sides of the body 914. To secure the second pivot guide 904b to the intermediate link 402b, the pins 918 are rotatably received in the apertures 912 defined on the proximally extending lobes 910a, 910b( FIG. 9B ) of the intermediate link 402b( FIG. 9B ).

[0100] Referring again to FIG. 9AAn exemplary operation of the wrist 206 will now be provided in accordance with one or more embodiments. As shown, the flexible member 608 extends through the central passage 606 of the wrist 206 and also through the central opening 916 of each pivot guide 904a, 904b. The first and second end portions 420a, 420b of the jaw cable 418 are shown in dashed lines extending through corresponding conduits 610 defined by the flexible member 608. As depicted, the wrist 206 is being articulated at the second articulation joint 902b in pitch motion and is otherwise moving about the second pivot axis P2. Moving the second articulation joint 902b correspondingly causes the second pivot guide 904b to rotate about the second pivot axis P2 to accommodate the bending of the flexible member 608 away from a straight position. As the angle at the second articulation joint 902b deviates from straight, the flexible member 608 and the closure cable (i.e., the first end portion 420a of the jaw cable 418) will tend to find the shortest path through the second articulation joint 902b, which can force the flexible member 608 and the closure cable to sink below the second pivot axis P2, which can result in tip down if the closure cable is actuated.

[0101] However, the second pivot guide 904b helps accommodate and support the outer diameter of the flexible member 608 at the second articulation joint 902b and thereby prevents the flexible member 608 from flexing beyond the second pivot axis P2. As a result, the centerline of the closure cable (i.e., the first end portion 420a of the jaw cable 418) will also be unable to deviate below the second pivot axis P2 during clamping, which will mitigate tip down at the end effector 204 FIG. 2 ).

[0102] While the foregoing description focuses on the operation of the second pivot guide 904b during articulation at the second articulation joint 902b, the first pivot guide 904a can also operate similarly during articulation at the first articulation joint 902a in yaw movement.

[0103] FIG. 10A is an isometric side view of another exemplary embodiment of a portion of the wrist 206 that can incorporate one or more principles of the present disclosure. In the illustrated view, the distal link 402a and the proximal link 402c FIG. 4-5 ) are omitted and the flexible member 608 is depicted in dashed lines and extends through the central passage 606 partially defined by the intermediate link 402b. The first pivot axis PI extends through the first articulation joint 1002a and facilitates "yaw" movement (articulation) of the end effector 204 FIG. 2 ), and the second pivot axis P2 extends through the second articulation joint 1002b and facilitates "pitch" movement (articulation) of the end effector 204.

[0104] The wrist 206 further includes a first pivot guide 1004a arranged at the first articulation joint 1002a and a second pivot guide 1004b arranged at the second articulation joint 1002b. Each pivot guide 1004a, 1004b is rotatably mounted to the intermediate link 402b at the corresponding articulation joint 902a, 902b and is rotatable about a first pivot axis PI and a second pivot axis P2, respectively. The pivot guides 1004a, 1004b can be made of any of the materials mentioned herein for any of the pivot guides described herein.

[0105] FIG. 10B is a magnified isometric view of another embodiment of the intermediate link 402b. In the illustrated embodiment, the intermediate link 402b includes a body 1006 that defines a portion of the central passage 606 configured to accommodate the flexible member 608 ( FIG. 10A ). A pair of distally extending lobes 1008a and 1008b extend distally from the body 1006 and are laterally offset from one another, and a pair of proximally extending lobes 1010a and 1010b extend proximally from the body 1006 and are laterally offset from one another. The proximally extending lobes 1010a, 1010b are angularly offset 90° from the distally extending lobes 1008a, 1008b, which advantageously facilitates both "yaw" and "pitch" articulation of the end effector 204 ( FIG. 2 ) by the intermediate link 402b. Each lobe 1008a, 1008b and 1010a, 1010b defines an aperture 1012 sized to rotatably receive a portion of the corresponding pivot guide 1004a, 1004b.

[0106] A cutout 1014 can be defined on opposite sides of the body 1006. As shown, the cutouts 1014 extend orthogonally to one another and in succession with the apertures 1012 defined in the corresponding lobes 1008a, 1008b and 1010a, 1010b. As described below, the cutouts 1014 can be used to rotatably mount the pivot guides 1004a, 1004b ( FIG. 10A ) to the corresponding lobes 1008a, 1008b and 1010a, 1010b.

[0107] FIG. 10C and FIG. 10Dare enlarged assembly and exploded views, respectively, of the first pivot guide 1004a. As the first pivot guide 1004a and the second pivot guide 1004b are substantially similar in structure and operation, the discussion of the first pivot guide 1004a will equally apply to the second pivot guide 1004b. As shown, the first pivot guide 1004a includes an interlocking ring pivot guide segment, which is referred to herein as a first mateable member 1016a and a second mateable member 1016b, which are mirror images of one another. When the mateable members 1016a, 1016b are mated, the first pivot guide 1004a defines a central aperture 1018 that is alignable with the central passage 606( FIG. 10A-10B ) of the wrist 206( FIG. 10A ) and sized or otherwise configured to accommodate the flexible member 608( FIG. 10A ). Further, when the mateable members 1016a, 1016b are mated, a protrusion extending from an end of each mateable member 1016a, 1016b is axially aligned and helps form or otherwise provide for the first shaft 404a( FIG. 9A ) of the wrist 206. Further, each mateable member 1016a, 1016b defines a radial protrusion 1020 that is alignable with a corresponding cutout in the cutouts 1014( FIG. 10B ) defined on the intermediate link 402b to help mount the first pivot guide 1004a to the distally extending lugs 1008a, 1008b.

[0108] FIG. 11A-11F depicts an exemplary assembly of the first pivot guide 1004a with the intermediate link 402b of the wrist 206 FIG. 10B , in accordance with one or more embodiments. In FIG. 11A , the first mateable member 1016a is receivable within the aperture 1012 defined by the distally extending lugs 1008a, 1008b. To accomplish this, the radial protrusion 1020 defined on the second mateable member 1016b can be aligned with the cutout 1014 defined on the body 1006, and the second mateable member 1016b can then be advanced into the aperture 1012 in the direction of arrow A. FIG. 11B shows the first mateable member 1016a received in the aperture 1012 and the radial protrusion 1020 aligned with and received within the cutout 1014. In FIG. 11C , the first mateable member 1016a is rotated 180° as shown by arrow B, moving the radial protrusion 1020 out of the cutout 1014 in preparation for receiving the second mateable member 1016b.

[0109] inFIG. 11D In particular, the second mateable member 1016b can be received within the opening 1012 defined by the distally extending lobes 1008a, 1008b by aligning the radial protrusion 1020 defined on the second mateable member 1016b with the cutout 1014 and advancing the second mateable member 1016b into the opening 1012 in the direction of arrow C. Advancing the second mateable member 1016a into the opening 1012 will also mate the second mateable member 1016b with the first mateable member 1016a. FIG. 11E The first mateable member 1016a and the second mateable member 1016b are shown mated and received within the opening 1012 to form the assembled first pivot guide 1004a. The radial protrusion 1020 of the second mateable member 1016b is also aligned with and received within the cutout 1014. In FIG. 11F In particular, the first pivot guide 1004a is rotated 90° to secure the first mateable member 1016a and the second mateable member 1016b in the opening 1012 and to align the central opening 1018 with the central passage 606 of the wrist 206 FIG. 10A ) to prepare for receiving the flexible member 608 FIG. 10A

[0110] Referring again to FIG. 10A Exemplary operation of the wrist 206 will now be provided in accordance with one or more embodiments. As shown, the flexible member 608 extends through the central passage 606 of the wrist 206 and also through the central opening 1018 of each pivot guide 1004a, 1004b. The first end 420a and the second end 420b of the jaw cable 418 are shown in dashed lines extending through corresponding conduits 610 defined by the flexible member 608. The wrist 206 can be articulated in yaw motion about the first pivot axis PI at the first articulation joint 1002a and further articulated in pitch motion about the second pivot axis P2 at the second articulation joint 1002b. Articulation at the first articulation joint 1002a and the second articulation joint 1002b correspondingly causes the first pivot guide 1004a and the second pivot guide 1004b to rotate about the corresponding pivot axes PI, P2 to accommodate the bending of the flexible member 608 away from the straight position. The first pivot guide 1004a and the second pivot guide 1004b help accommodate and support the outer diameter of the flexible member 608 at the first articulation joint 1002a and the second articulation joint 1002b and thereby prevent the flexible member 608 from bending beyond the first pivot axis PI and the second pivot axis P2, which would mitigate tip drop-off FIG. 2

[0111] FIG. 12A and​​FIG. 12B is an alternative embodiment of two exemplary pivot guides according to one or more additional embodiments. FIG. 12A depicts a first pivot guide 1202a, and FIG. 12B depicts a second pivot guide 1202b. Each pivot guide 1202a, 1202b includes a generally annular body 1204 that defines a central aperture 1206 that is alignable with the central passage 606 of the wrist 206 and sized or otherwise configured to accommodate the flexible member 608. Each pivot guide 1202a, 1202b can also include opposing cylindrical heads 1208 positioned at angled opposite sides of the annular body 1204. The cylindrical heads 1208 can be configured to be received within an aperture defined on the convex corner of the intermediate link 402b. In addition, opposing tabs or pins 1210 can extend radially outwardly from each cylindrical head 1208 to help form or otherwise provide the first or second shaft 404a, 404b for the wrist 206. FIG. 6A-6B ) of the wrist 206. FIG. 6A-6B ) of the wrist 206. FIG. 12B ) of the wrist 206.

[0112] With particular reference to FIG. 12B , the second pivot guide 1202b also includes one or more dimples 1212 (four shown) that project radially inwardly from the annular body 1204 and into the central aperture 1206. The dimples 1212 can help secure and center the flexible member 608 within the central aperture 1206 and can create a gap or clearance between the outer diameter of the flexible member 608 and the inner diameter of the central aperture 1206. The dimples 1212 can also help transfer stress concentrations to corners of the flexible member 608 where more material is present and otherwise away from the location of the conduit 610 defined therethrough. Such corners of the flexible member can be characterized as “sacrificial zones.” In some embodiments, as shown, the dimples 1212 can be angularly offset from the location of the conduit 610, which can prove advantageous in reducing stress concentrations at the conduit 610, which can extend the life of the device tool.

[0113] FIG. 13A is an exploded view of another exemplary embodiment of the wrist 206 according to one or more additional embodiments. For simplicity, the drive cables 408a-d, the electrical conductor 422, the first and second end portions 420a, 420b of the jaw cable 418, and the drive rod 430 are not shown in FIG. 4-5 FIG. 4-5 FIG. 4-5 FIG. 4-5 FIG. 8A ​​​​The intermediate link 402b can be made from two or more pieces or component portions, which in the illustrated embodiment are shown as a first intermediate portion 1302a and a second intermediate portion 1302b. The first and second intermediate portions 1302a, 1302b can be identical elements or mirror images of one another and are capable of mating to form the intermediate link 402b and thereby help define a portion of the central passage 606 through which the flexible member 608 can extend. Although FIG. 13A While only two intermediate portions 1302a, 1302b are depicted, the intermediate link 402b can alternatively include three or more intermediate portions without departing from the scope of the present disclosure.

[0114] Each intermediate portion 1302a, 1302b can provide a distally extending convex angle 1303 and a proximally extending convex angle 1306 extending orthogonal to the distally extending convex angle 1303. When the intermediate portions 1302a, 1302b are mated to form the intermediate link 402b, the distally extending convex angles 1303 will be laterally offset from one another, and the proximally extending convex angles 1306 will be laterally offset from one another and angularly offset 90° from the distally extending convex angles 1306, which allows the intermediate link 402b to facilitate both “yaw” and “pitch” articulation of the end effector 204( FIG. 2 ).

[0115] As shown, the wrist 206 can also include a first pivot guide 1304a and a second pivot guide 1304b, which can be fixed when the first and second intermediate portions 1302a, 1302b are mated. Each pivot guide 1304a, 1304b includes a generally annular body 1308 defining a central aperture 1310 that can be aligned with the central passage 606 of the wrist 206 and sized or otherwise configured to accommodate the flexible member 608. The inner surface of the central aperture 1310 can be smooth, curved, and / or contain a lubricant, which can help improve articulation joint friction and reduce galling in the surgical tool 200( FIG. 2 ). The opposing disc-shaped heads 1312 can be positioned at angularly opposite sides of the annular body 1308 of each pivot guide 1304a, 1304b, and each head 1312 can be configured to be received in a corresponding bearing recess 1316 defined on an opposite convex angle 1303, 1306 of the intermediate link 402b. The heads 1312 can be configured to rotate within the bearing recesses 1316 as the flexible member 608 bends and flexes during operation. Each head 1312 can define or otherwise provide a bearing face 1314 that can slidably engage a bottom of the adjacent bearing recess 1316.

[0116] FIG. 13B is FIG. 13A an assembled isometric view of the intermediate link 402b. As shown, the first shaft member 404a can be defined on a distally extending lobe 1303 and provide a first articulation joint 1318a, and the second shaft member 404b can be defined on a proximally extending lobe 1306 and provide a second articulation joint 1318b. Further, a first pivot axis PI extends through the first articulation joint 1318a and facilitates a “yaw” movement (articulation) of the end effector 204 FIG. 2 ), and a second pivot axis P2 extends through the second articulation joint 1318b and facilitates a “pitch” movement (articulation) of the end effector 204.

[0117] The first intermediate portion 1302a and the second intermediate portion 1302b can be made from any rigid or semi-rigid material, including but not limited to plastic, metal, composite, elastomer, or any combination thereof. In at least one embodiment, the first intermediate portion 1302a and the second intermediate portion 1302b can be made from metal and manufactured by metal injection molding, with some post-machining on critical surfaces and / or pivot locations. The first intermediate portion 1302a and the second intermediate portion 1302b can be permanently or removably secured together to form the intermediate link 402b. Suitable securing methods include, but are not limited to, welding, adhesive attachment, one or more mechanical fasteners, or any combination thereof. In other embodiments, it can not be necessary to secure the first intermediate portion 1302a and the second intermediate portion 1302b together, as once the distal link 402a and the proximal link 402c FIG. 13A ) are rotatably coupled to the intermediate link 402b, the first intermediate portion 1302a and the second intermediate portion 1302b will be held in place by the distal link 402a and the proximal link 402c.

[0118] The first pivot guide 1304a and the second pivot guide 1304b will be secured to the intermediate link 402b when the first intermediate portion 1302a and the second intermediate portion 1302b are mated. The first pivot guide 1304a can be rotatably secured at the first articulation joint 1318a, and the second pivot guide 1304b can be rotatably secured at the second articulation joint 1318b. Further, the pivot guides 1304a, 1304b are capable of rotation about the first pivot axis PI and the second pivot axis P2. The pivot guides 1304a, 1304b can be made from any of the materials mentioned herein for any of the pivot guides described herein.

[0119] FIG. 13C and FIG. 13Dis a cross-sectional end view of the first pivot guide 1304a secured between the first intermediate portion 1302a and the second intermediate portion 1302b proximally extending lobe 1303. As shown, the bearing surface 1314 is received within the corresponding bearing recess 1316 and helps the first pivot guide 1304a rotate about the first pivot axis PI as the flexible member 608( FIG. 13A ) bends and flexes during operation. In at least one embodiment, one or both of the bearing surface 1314 or the bottom of the recess 1316 can be polished and / or include a lubricant, which can help reduce friction and wear as the pivot guide 1304a rotates during operation.

[0120] In FIG. 13D , the annular body 1308 of the first pivot guide 1304a is radially enlarged and thicker compared to the embodiment of FIG. 13C . Because the first intermediate portion 1302a and the second intermediate portion 1302b are capable of mating to secure the first pivot guide 1304, the wider and larger design of the first pivot guide 1304a can be accommodated and the first intermediate portion 1302a and the second intermediate portion 1302b will mate around the larger design. This can prove advantageous in providing additional strength to the system. Furthermore, enlarging the size of the pivot guide 1304a causes the contact radius of the central passage 1310 to also be enlarged. This will increase the radius of the arcuate surface that the elongate member 608 (and central actuation member) contacts and bends around during articulation. As a result, this will reduce the flex fatigue loads on the elongate member 608 and increase the useful life.

[0121] FIG. 14 is an isometric side view of another exemplary embodiment of a portion of the wrist 206 that can incorporate one or more principles of the present disclosure. In the illustrated view, the distal link 402a and the proximal link 402c( FIG. 4-5 ) as well as the flexible member 608( FIG. 6A-6B and FIG. 7A-7B ) are omitted for simplicity, and the flexible member 608 would otherwise extend through the central passage 606 partially defined by the intermediate link 402b. The first pivot axis PI extends through the first articulation joint 1402a and facilitates the "yaw" movement (articulation) of the end effector 204( FIG. 2 ), and the second pivot axis P2 extends through the second articulation joint 1402b and facilitates the "pitch" movement (articulation) of the end effector 204.

[0122] As shown, the intermediate link 402b includes a body 1404 that defines a portion of the central passage 606 and is made of two portions or pieces, similar to FIG. 13A-13Bfirst intermediate portion 1302a and a second intermediate portion 1302b. A pair of distally extending lobes 1406a and 1406b extend distally from the body 1404 and are laterally offset from one another, and a pair of proximally extending lobes 1408a and 1408b extend proximally from the body 1404 and are laterally offset from one another. The proximally extending lobes 1408a, 1408b are angularly offset 90° from the distally extending lobes 1406a, 1406b, which facilitates both “yaw” and “pitch” articulation of the intermediate link 402b with the end effector 204 FIG. 2 ) of the surgical instrument 200.

[0123] In the illustrated embodiment, each pair of opposing lobes 1406a, 1406b and 1408a, 1408b can be configured to secure a pivot guide 1410 therebetween to help support the flexible member 608 FIG. 6A-6B and FIG. 7A-7B ) during articulation. While only the pivot guide 1410 positioned at the distally extending lobes 1406a, 1406b is shown in FIG. 14 , the structure and operation of each pivot guide 1410 can be substantially similar. As shown, the pivot guide 1410 can include one or more pins 1412 that are received within and extend between corresponding arcuate recesses or slots 1414 defined in the opposing lobes 1406a, 1406b. In the illustrated embodiment, while two arcuate slots 1414 are defined in the opposing lobes 1406a, 1406b, a single arcuate or annular slot can also be defined in the opposing lobes 1406a, 1406b without departing from the scope of the present disclosure. Further, in the illustrated embodiment, a single pin 1412 is received in the corresponding arcuate slots 1414, but more than one pin 1412 can alternatively be received in the corresponding arcuate slots 1414 without departing from the scope of the present disclosure.

[0124] The pins 1412 can be angularly offset from one another to define a gap or central aperture 1416 that can be aligned with the central passage 606 and sized or otherwise configured to accommodate the flexible member 608 FIG. 6A-6B and FIG. 7A-7B ) therethrough. The pins 1412 can translate within the corresponding slots 1414 as the flexible member 608 bends and flexes during operation and thereby help prevent the flexible member 608 from sinking below the pivot axes PI, P2, which helps mitigate or prevent tip drop.

[0125] The embodiments disclosed herein include:

[0126] A. An articulatable wrist for an end effector, the articulatable wrist comprising: a first link; a second link rotatably coupled to the first link at a first articulation joint; a flexible member extending at least partially through a central passage cooperatively defined by the first link and the second link; and a first pivot guide rotatably coupled to the second link at the first articulation joint and rotatable about a first pivot axis extending through the first articulation joint, the first pivot guide defining a central aperture alignable with the central passage and sized to accommodate the flexible member therethrough, wherein the first pivot guide supports an outer diameter of the flexible member at the first articulation joint and thereby prevents the flexible member from flexing beyond the first pivot axis during articulation.

[0127] B. A surgical tool, comprising: a drive housing; an elongate shaft extending from the drive housing; an end effector arranged at an end of the elongate shaft; an articulatable wrist interposed between the end effector and the elongate shaft, the articulatable wrist comprising: a first link; a second link rotatably coupled to the first link at a first articulation joint; a flexible member extending at least partially through a central passage cooperatively defined by the first link and the second link; and a first pivot guide rotatably coupled to the second link at the first articulation joint and rotatable about a first pivot axis extending through the first articulation joint, the first pivot guide defining a central aperture alignable with the central passage and sized to accommodate the flexible member therethrough, wherein the first pivot guide supports an outer diameter of the flexible member at the first articulation joint and thereby prevents the flexible member from flexing beyond the first pivot axis during articulation.

[0128] C. A method of operating a surgical tool, the method comprising positioning the surgical tool adjacent a patient for operation, the surgical tool comprising a drive housing, an elongate shaft extending from the drive housing, an end effector arranged at an end of the elongate shaft, and a wrist interposed between the end effector and the elongate shaft and comprising a first link, a second link rotatably coupled to the first link at a first articulation joint, a flexible member extending at least partially through a central passage cooperatively defined by the first link and the second link, and a first pivot guide rotatably coupled to the second link at the first articulation joint and rotatable about a first pivot axis extending through the first articulation joint, the first pivot guide defining a central aperture alignable with the central passage and sized to accommodate the flexible member therethrough. The method further comprises articulating the wrist and simultaneously bending the flexible member within the central passage, and using the first pivot guide to support an outer diameter of the flexible member at the first articulation joint and thereby prevent the flexible member from flexing beyond the first pivot axis during articulation.

[0129] Each of embodiments A, B, and C can have one or more of the following additional elements in any combination: Element 1 : further comprising an axially extending conduit defined in the flexible member to receive a closure cable for actuating the jaws of the end effector, wherein the pivot guide supports an outer diameter of the flexible member at the first articulation joint and prevents a centerline of the closure cable from shifting below the first pivot axis during clamping. Element 2: wherein the second link comprises: a body defining a portion of the central passage; a pair of lobes extending from the body and laterally offset from one another; and a bore defined in each lobe and sized to rotatably receive a portion of the first pivot guide. Element 3: wherein the first pivot guide comprises: a cylindrical body defining a central bore and having a first end rotatably received in the bore defined on each lobe and a second end; and a protrusion extending outwardly from each of the first and second ends and providing a first axle extending along the first pivot axis, wherein the first link is rotatably coupled to the second link at the first axle. Element 4: wherein the first pivot guide comprises: an annular body defining a central bore; and opposing pins extending radially outwardly from the annular body at angularly opposite sides of the annular body, wherein the opposing pins are rotatably received in the bore defined on each lobe. Element 5: wherein the first pivot guide comprises: first and second mateable members that cooperatively define the central bore when mated; a protrusion extending from an end of each mateable member and providing a first axle extending along the first pivot axis, wherein the first link is rotatably coupled to the second link at the first axle. Element 6: wherein the first pivot guide comprises: an annular body defining a central bore; opposing cylindrical heads positioned at angularly opposite sides of the annular body and rotatably received in the bore defined on each lobe; and opposing pins extending radially outwardly from each cylindrical head and providing a first axle extending along the first pivot axis, wherein the first link is rotatably coupled to the second link at the first axle. Element 7: further comprising one or more dimples protruding radially inwardly from the annular body and into the central bore. Element 8: wherein the second link comprises a first intermediate portion providing the first lobe and a second intermediate portion providing the second lobe, the second lobe being laterally offset from the first lobe when the first and second intermediate portions mate to form the second link and define the central passage.Element 9: wherein the first pivot guide comprises: an annular body defining a central aperture; and opposing disc-shaped heads positioned at angularly opposed sides of the annular body and rotatably receivable within bearing recesses defined on corresponding ones of the first or second lobes, wherein mating the first and second intermediate portions secures the first pivot guide to the articulatable wrist. Element 10: wherein the second link comprises: a body defining a portion of a central passage; a pair of lobes extending from the body and laterally offset from one another; and one or more arcuate slots defined in each lobe, and wherein the first pivot guide comprises two or more pins received within and extending between the one or more arcuate slots defined in each lobe, wherein the two or more pins are angularly offset from one another to define the central aperture. Element 11 : further comprising: a third link rotatably coupled to the second link at the second articulation joint and cooperatively defining the central passage with the first and second links; and a second pivot guide rotatably coupled to the second link at the second articulation joint and rotatable about a second pivot axis extending through the second articulation joint, the second pivot guide defining a central aperture alignable with the central passage and sized to accommodate the flexible member therethrough, wherein the second pivot guide supports an outer diameter of the flexible member at the second articulation joint and prevents the flexible member from flexing beyond the second pivot axis during articulation. Element 12: wherein the second link comprises: a body defining a portion of a central passage; a pair of distally extending lobes extending distally from the body and laterally offset from one another; a pair of proximally extending lobes extending proximally from the body and laterally offset from one another, wherein the pair of proximally extending lobes are angularly offset 90° from the pair of distally extending lobes; an aperture defined in each distally extending lobe and sized to rotatably receive a portion of the first pivot guide; and an aperture defined in each proximally extending lobe and sized to rotatably receive a portion of the second pivot guide. Element 13: wherein the first pivot guide is made of a material selected from the group consisting of: an electrically conductive material, a non-conductive material, a plastic, a metal, a composite material, an elastomer, and any combination thereof.

[0130] Element 14: wherein the end effector comprises jaws that are actuatable to open and close, the surgical tool further comprising a closure cable extending from the drive housing to the end effector and actuatable to close the jaws, wherein the closure cable extends through an axially extending conduit defined in the flexible member, and wherein the pivot guide supports an outer diameter of the flexible member at the first articulation joint and prevents a centerline of the closure cable from shifting below the first pivot axis during closure. Element 15: wherein the second link comprises: a body defining a portion of the central passage; a pair of lobes extending from the body and laterally offset from one another; and a bore defined in each lobe and sized to rotatably receive a portion of the first pivot guide. Element 16: wherein the first pivot guide comprises: first and second mateable members that cooperatively define a central bore when mated; a protrusion extending from an end of each mateable member and providing a first shaft extending along the first pivot axis, wherein the first link is rotatably coupled to the second link at the first shaft. Element 17: wherein the first pivot guide comprises: an annular body defining a central bore; and one or more dimples protruding radially inward from the annular body and into the central bore. Element 18: wherein the second link comprises a first intermediate portion providing a first lobe and a second intermediate portion providing a second lobe that is laterally offset from the first lobe when the first and second intermediate portions are mated to form the second link and define the central passage, and wherein the first pivot guide comprises: an annular body defining a central bore; and opposing disc-shaped heads positioned at angularly opposing sides of the annular body and rotatably received within bearing recesses defined on corresponding lobes in the first or second lobes.

[0131] Element 19: wherein the wrist further comprises: a third link rotatably coupled to the second link at the second articulation joint and cooperatively defining a central passage with the first link and the second link; and a second pivot guide rotatably coupled to the second link at the second articulation joint and rotatable about a second pivot axis extending through the second articulation joint, the second pivot guide defining a central aperture alignable with the central passage and sized to accommodate the flexible member therethrough, the method further comprising actuating a closure cable extending from the drive housing to the end effector to close the jaw of the end effector, wherein the closure cable extends through a first axially extending conduit defined in the flexible member; using the pivot guide to support an outer diameter of the flexible member at the first articulation joint and thereby prevent a centerline of the closure cable from shifting below the first pivot axis during closure; actuating an opening cable extending from the drive housing to the end effector to open the jaw, wherein the opening cable extends through a second axially extending conduit defined in the flexible member angularly offset 90° from the first axially extending conduit, and using the second pivot guide to support an outer diameter of the flexible member at the second articulation joint and thereby prevent the centerline of the opening cable from shifting past the second pivot axis during opening.

[0132] By way of non-limiting example, exemplary combinations applicable to A, B, and C include: element 2 with element 3; element 3 with element 4; element 3 with element 5; element 3 with element 6; element 6 with element 7; element 8 with element 9; element 11 with element 12; element 15 with element 16; and element 16 with element 17.

[0133] Thus, it is seen that the disclosed systems and methods are well adapted to attain the ends and advantages mentioned as well as those inherent therein. The particular embodiments disclosed above are illustrative only of the teachings of this disclosure and are not meant to limit or restrict the scope of the disclosure to these particular embodiments. Those skilled in the art will readily appreciate that other embodiments can be substituted for those described without departing from the scope of the disclosure. Accordingly, the disclosure is not intended to be limited to the particular embodiments described herein. Those skilled in the art will readily appreciate that the systems and methods taught herein can be substituted for any aspect, or aspects, of the systems and methods taught without departing from the scope of the disclosure. Although the compositions and methods have been described in terms of "comprising," "containing," or "including" various components or steps, the compositions and methods can also "consist essentially of or "consist of the various components and steps. All numbers and ranges disclosed above can vary by some amount. Whenever a numerical range is disclosed, any conclusion that a range implies any integer within the scope of the disclosed range is explicitly denied. In particular, every value within a range it disclosed herein (in the form of "about a to about b," or the equivalent form "from about a-b," or the equivalent form "from approximately a-b") should be understood to be specifically disclosed. Also, the terms in the claims have their plain, ordinary meaning unless otherwise explicitly provided. Moreover, the indefinite articles "a" or "an," as used in the claims, are defined herein to mean one or more than one of the elements. If there is any conflict between what is disclosed herein and any document incorporated by reference, the present document controls.

[0134] As used herein, the phrase "at least one of" following with a series of items (with the items separated by commas) is intended to mean any one of the items in the list, but not necessarily including more than one of each item. In other words, the phrase "at least one of" followed by a series of items means that at least one of the items in the list is present, but not necessarily more than one, and further that a selection of any one or more of the items can be present. As an example, the phrase "at least one of A, B, and C" or "at least one of A, B, or C" each mean A alone; B alone; C alone; A and B together; A and C together; B and C together; or A, B, and C together.

Claims

1. A wrist for an end effector capable of joint movement, comprising: First link; The second link is rotatably connected to the first link at the first joint kinematic joint; A flexible member that extends at least partially through a central channel defined cooperatively by the first link and the second link; as well as A first pivoting guide, rotatably coupled to the second link at the first articulated joint and rotatable about a first pivot axis extending through the first articulated joint, defines a central opening alignable with the central channel and sized to accommodate the flexible member passing through the central opening. The first pivot guide supports the outer diameter of the flexible member at the first joint joint and thereby prevents the flexible member from deflecting beyond the first pivot axis during joint movement. The second link includes: The main body defines a portion of the central channel; A pair of convex angles, the pair of convex angles extending from the body and laterally offset from each other; and An opening is defined in each convex corner and sized to rotatably receive a portion of the first pivot guide. The first pivoting guide includes: A first mating member and a second mating member, wherein the first mating member and the second mating member cooperate to define the central opening when mated; and A protrusion extending from the end of each mating member and providing a first shaft extending along the first pivot axis, wherein the first link is rotatably connected to the second link at the first shaft.

2. The wrist capable of joint movement according to claim 1, further comprising an axially extending conduit defined in the flexible member to receive a closed cable for actuating the jaws of the end effector, wherein the pivoting guide supports the outer diameter of the flexible member at the first joint movement joint and prevents the centerline of the closed cable from deviating below the first pivot axis during clamping.

3. The wrist capable of joint movement according to claim 1, further comprising: A third link, which is rotatably connected to the second link at a second joint kinematic joint and cooperates with the first link and the second link to define the central channel; as well as A second pivot guide, rotatably coupled to the second link at the second articulated joint and rotatable about a second pivot axis extending through the second articulated joint, defines a central opening alignable with the central channel and sized to accommodate the flexible member passing through the central opening. The second pivot guide supports the outer diameter of the flexible member at the second joint joint and prevents the flexible member from deflecting beyond the second pivot axis during joint movement.

4. The wrist capable of joint movement according to claim 3, wherein, The pair of convex angles includes: a pair of distally extending convex angles, the pair of distally extending convex angles extending distally from the body and laterally offset from each other; and The second link also includes: A pair of proximal convex angles extending from the body and laterally offset from each other, wherein the pair of proximal convex angles are angularly offset by 90° from the pair of distal convex angles; and An opening is defined in each proximal convex angle and sized to rotatably receive a portion of the second pivot guide.

5. The wrist capable of joint movement according to claim 1, wherein, The first pivot guide is made of a material selected from the group consisting of: conductive materials, non-conductive materials, plastics, metals, composite materials, elastomers, and any combination thereof.

6. A surgical instrument comprising: Drive housing; An elongated shaft extending from the drive housing; An end effector, the end effector being disposed at the end of the elongated shaft; The joint-moving wrist according to claim 1, wherein the joint-moving wrist is inserted between the end effector and the elongated shaft.

7. The surgical tool according to claim 6, wherein, The end effector includes jaws actuated to open and close, and the surgical tool further includes: A closing cable extends from the drive housing to the end effector and is actuable to close the jaws, wherein the closing cable extends through an axially extending conduit defined in the flexible member, and The pivoting guide supports the outer diameter of the flexible member at the first joint joint and prevents the centerline of the closed cable from deviating below the first pivot axis during closure.

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